Are you saying that is the 'only' thing that could be M.E (and M.E being what specifically ? ) and that comparable symptomology, not following a viral infection could not by definition, be M.E ? I also don't understand what you mean by "no host of secondary symptoms" - what symptoms are absent from a prolonged viral infection that are present in M.E/CFS which are not mediated by the effects of chronic incapacity ?
IVI
There are no primary symptoms mediated by the effects of chronic incapacity that we are aware of. Some secondary ones arise from reduced activity, but not much can be pinned on this as many sedentary people are less active than we are and do not have our symptom set.
Elsewhere on several occasions I have discussed problems with interpreting the Dubbo studies, I am not going to repeat them again at this point.
During a flu for example we get a host of symptoms. These nearly all resolve in post viral fatigue. That pathogen is gone (low or no viremia), but stamina is down. Immunological responses do not however just end. There are circulating activated immune cells, immune complexes, antibodies, cytokines etc.
In ME however the primary symptom is not chronic fatigue. Its hyperfatigueability including PENE/PEM. Secondary pain symptom arise, additional autonomic (which means neurological) and immunological issues arise. The biochemical basis of PENE/PEMis partly understood now.
Even post viral fatigue patients, so far as I am aware, do not have our secondary consequences. There is still some debate about whether or not diseases like MS have PEM/PENE but I don't think we are ready to answer that yet.
This question of post viral fatigue vs. ME is one that needs investigating. It could be a mirage, but its unlikely. We need science and not presumption to determine what the relationship is. It is possible, but highly improbable in my view, that post viral fatigue has the same symptom set. Most of us have experienced post viral fatigue, and its something like ten times more common than an ME diagnosis. Yet I never hear of OI, severe muscle pain, IBS, insulin resistance, thyroid issues and insomnia in post viral fatigue to name a few. Hypersomnia, yes.
A huge problem in ME research today is that most of the attention is on fatigue. Yet for many of us fatigue is not a very important symptom. Indeed, I wouldn't rate fatigue as higher than the third most important symptom in my case, and probably not even that high ... I have not thought about it much.
Fatigue is perhaps the most common symptom there is, along with pain. Conflating all unknown causes of prolonged fatigue with CFS, as is done in the oxford definition, is tantamount to saying that "I don't know what it is so I will pretend its all the same thing" and further complicated under psychogenic models by " and therefore will presume its a psychogenic illness, without evidence".
Another huge issue is this. In most of these pathogen induced diseases the blood load of pathogen declines. Recovery is delayed beyond that for some time, presumably (in the models I have read) due to persistent immune responses that take time to decline.
ME differs in one huge way. Recently it came to my attention that we have known for some years that enteroviruses at least have three lifecycles, not one. Secondary evidence shows that herpes family viruses might share this feature. In the case of ME patients (actually strictly defined CFS patients I think, this is Chia's work) we have high tissue viral loads of enteroviruses in gut. Yet viremia is not present. This fits with the two alternate viral lifecycles. It also fits with various findings Lerner has made with herpes viruses in strictly defined CFS subsets.
Now its possible these issues arise in post viral fatigue patients. They might. I would like that investigated.
The conflation of post viral fatigue with ME parallels the conflation of chronic fatigue with ME. Its a presumption. If there is some truth to it then the science could show it ... if anyone ever bothered to do adequate research, which means we need more funding, as usual.
I am not however saying that this is necessarily the only thing ME is. There is a range of evidence that strongly suggests ME is at least two different diseases, while we know from a number of lines of investigation now that Oxford defined CFS is typically a very mixed cohort.
Nor is ME necessarily induced by viral infection. The issue I am raising is that not all post viral fatigue is ME, not that all ME is necessarily a complication of post viral fatigue. However this latter interpretation might be correct ... something I don't want to discuss just yet, I am thinking about it. This is because of the existence of these two alternate viral lifecycles that have been largely ignored in modern research, though I am not up to date on my virology and want to investigate that more next year.
I think post viral fatigue, CFS and ME can be considered overlapping sets, but they cannot be considered as synonymous. We really need biomarkers to definitively separate these issues. I am hopeful that some of the many biomarkers currently under investigation will prove useful, and that combinations of biomarkers might be definitive.
Bye, Alex