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Myalgic encephalomyelitis, chronic fatigue syndrome: An infectious disease

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By R. A. Underhill


The etiology of myalgic encephalomyelitis also known as chronic fatigue syndrome or ME/CFS has not been established. Controversies exist over whether it is an organic disease or a psychological disorder and even the existence of ME/CFS as a disease entity is sometimes denied. Suggested causal hypotheses have included psychosomatic disorders, infectious agents, immune dysfunctions, autoimmunity, metabolic disturbances, toxins and inherited genetic factors.

Clinical, immunological and epidemiological evidence supports the hypothesis that: ME/CFS is an infectious disease; the causal pathogen persists in patients; the pathogen can be transmitted by casual contact; host factors determine susceptibility to the illness; and there is a population of healthy carriers, who may be able to shed the pathogen.

ME/CFS is endemic globally as sporadic cases and occasional cluster outbreaks (epidemics). Cluster outbreaks imply an infectious agent. An abrupt flu-like onset resembling an infectious illness occurs in outbreak patients and many sporadic patients. Immune responses in sporadic patients resemble immune responses in other infectious diseases. Contagion is shown by finding secondary cases in outbreaks, and suggested by a higher prevalence of ME/CFS in sporadic patients’ genetically unrelated close contacts (spouses/partners) than the community. Abortive cases, sub-clinical cases, and carrier state individuals were found in outbreaks.

The chronic phase of ME/CFS does not appear to be particularly infective. Some healthy patient-contacts show immune responses similar to patients’ immune responses, suggesting exposure to the same antigen (a pathogen). The chronicity of symptoms and of immune system changes and the occurrence of secondary cases suggest persistence of a causal pathogen.

Risk factors which predispose to developing ME/CFS are: a close family member with ME/CFS; inherited genetic factors; female gender; age; rest/activity; previous exposure to stress or toxins; various infectious diseases preceding the onset of ME/CFS; and occupational exposure of health care professionals.

The hypothesis implies that ME/CFS patients should not donate blood or tissue and usual precautions should be taken when handling patients’ blood and tissue. No known pathogen has been shown to cause ME/CFS. Confirmation of the hypothesis requires identification of a causal pathogen. Research should focus on a search for unknown and known pathogens. Finding a causal pathogen could assist with diagnosis; help find a biomarker; enable the development of anti-microbial treatments; suggest preventive measures; explain pathophysiological findings; and reassure patients about the validity of their symptoms.

Source: R. A. Underhill. Myalgic encephalomyelitis, chronic fatigue syndrome: An infectious disease. Medical Hypotheses. Publication stage: In Press Corrected Proof. DOI:


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6 thoughts on “Myalgic encephalomyelitis, chronic fatigue syndrome: An infectious disease”

  1. shewolfdc says:

    I too believe its infectious but how it was transmitted was always the issue. Now I think I know- the pathogen is in the gut. Columbia’s Lipkin thought the gut was involved. After reading the book the Brain Maker. I put myself on high doses of high quality pro- and pre- biotic and after 20 years with the disease I am now CURED. I see it as nothing short of a miracle. Soon the world will see the importance of the gut environment. It is the biggest breakthrough in medicine in our lifetimes. Somehow we become exposed to another’s gut microbes. That must be how it’s transmitted.

    1. tiredforever says:

      shewolfdc can you tell use specifically which pro- and prebiotic supplements you used?

      I’ve tried numerous different products, but it is so hard to find a good product which does not aggravate the gut and also is effective.

      It would be really helpful to know what you used.

      Thank you!

    2. Elisa says:

      Hi Shewolfdc,

      Thanks for posting! I am also interested in what you used specifically…I would like to try it to see if I could improve too!

      Thanks So much, Elisabeth

    3. selvage says:

      shewolf-please respond with your protocol.

    4. selvage says:

      Zaher Nahle, PhD, MPA, V.P. for Research and Scientific Programs at Solve ME/CFS Initiative, in their recent 2014 Annual Report on page 4 stated that ME/CFS is a devastating NON-COMMUNICABLE disease. If it is non-communicable then it must be non-infectious! So there must be no pathogen. I didn’t realize that there was such conclusive research.

      So what is Ian Lipkin and others looking for?

      ME/CFS is definitely a research challenge but because no elusive pathogen has been identified as yet does not support abandoning the search.

      1. znahle says:

        Thank you for this important comment, selvage.

        I am sorry I not on this platform as often as I should or want to be, but nevertheless I wanted to reach out to you directly with this info: The area of immunity and inflammation in ME/CFS is a major focus at the organization. I stress that frequently in our publications and discussions with researchers and the community. It is important to emphasize that many non-communicable diseases that are chronic in nature are demonstrably pathogenic in their root causes. For instance, two well-known examples comes to mind right now: 1- HPV (a virus) and cervical cancers; and 2- H. Pylori (a bacteria) and ulcers/stomach cancers (also a Nobel Prize winning discovery on how some non-communicable diseases can in fact be caused by a pathogen, 2005). For an accurate description of our research philosophy, approach, programs and initiatives, kindly visit our site or this link when you can

        or email me directly at Available to talk anytime. Congratulations also to Dr. Rosemary Underhill for this important contribution. Finally and on a personal note, Pathogens and Host/gene interaction are core interests of mine (incidentally, my PhD work focused on how DNA tumor viruses trigger cell death and reprogram metabolic patterns) and I am glad to be part of this stimulating discussion. Thanks again!


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