My best guess would be a variety of infections triggering long term immune dysfunction, resulting in those infections becoming chronic. This would make sense from the point of view of those infections ... they want to stay active. And this immune dysfunction then allows other infections to emerge from latency or to not be cleared properly when acquired after the dysfunction has set in.I do not doubt that treatment for Lyme helps in some cases. So does treatment for herpes viruses etc. So does Rituximab. Figuring out which goes with which is the trick, and also figuring out how to turn treatment into full cure is still proving elusive. Some make it to full cure, many get 90% of the way there, but we need all of us better.
So I think people can have multiple infections, but just one one causative/triggering infection with the rest being opportunistic. Treating the opportunistic infections may result in improvement and the resolution of certain symptoms, but is unlikely to have a permanent effect. But treating the underlying infection could have a much bigger and even permanent impact.
Outside of the context of ME, many people have reported complete recovery from Lyme with appropriate treatment. There's various sports stars, it's often in the media, and I know at least one person personally who had somewhat chronic Lyme without ME and has recovered from it and is now quite active and healthy.
But do ME patients with Lyme recover their functionality completely? The answer seems to be "no", though they do improve a lot, to the point that they can work and raise families, etc. Does that mean that Lyme isn't the underlying infection, even when it seems to have been the one which was acquired shortly before symptoms began? Was it merely a lurking latent infection which was allowed to emerge due to some other factors? Was it the underlying infection, but symptoms don't completely disappear after treatment in ME patients due to permanent damage caused while the infection was active?
So I'd say that it is possible that Lyme is the ultimate cause of ME/CFS for everyone who actually has ME. It's possible that we toddle along without major problems for however many years until hit by an additional infection (Q-fever, EBV, etc) which stirs up a shit-storm in combination with the underlying Lyme infection. But I think it's at least as likely that different infections are also completely and independently causative of ME, in the abscence of Lyme.
It'll be interesting to find out some day
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