[Book] ME/CFS and Long Covid: Diagnosis and management of chronic fatigue syndromes, 2025, Spickett

[forestglip]

ME/CFS and Long Covid: Diagnosis and management of chronic fatigue syndromes

Gavin Spickett

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Abstract
This book covers the history and characteristic symptoms of ME/CFS and Long Covid in adults. Children are not discussed in detail.

It discusses the extensive differential diagnosis in patients presenting with chronic fatigue. Current theories of the aetiology and pathogenesis of the conditions are also discussed. The possibilities of chronic viral infection are discussed together with the role of chronic neuroinflammation.

Treatment and management of patients is discussed, including activity management, supporting psychological therapies and drug therapy for symptom management. Information is given on what to tell patients and how to deal with issues relating to education, employment, and benefits.

Web | Oxford Infectious Diseases Library | Paywall

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Requested to be posted by @Nightsong

 

[forestglip]

Contents:

1 The history of chronic fatigue syndromes including ME/CFS and Long Covid

2 When to suspect ME/CFS or Long Covid

3 The diagnosis of ME/CFS and Long Covid

4 Primary ME/CFS or Long Covid versus secondary chronic fatigue

5 Theories of causation

6 What do you tell a patient?

7 Children and young people with ME/CFS or Long Covid

8 What therapies are helpful?

9 What drug treatments are available?

10 Prognosis

11 Work, school, university, wheelchairs, and travel

12 Benefits and pensions

13 Conclusions

 

[Utsikt]

Lumping together LC and ME/CFS is not a useful approach. Based on the abstracts of the chapters, I’m not very impressed.

Chapter 5 covers the main theories for the development of fatigue, including, genetic, immunological, infective, autonomic, endocrine, mitochondrial, clotting, gut microbiome and virome, psychiatric, and psychological. It also provides a tentative synthesis of current thinking, focused on possible viral persistence in the brain and consequent chronic neuroinflammation. Many research studies into ME/CFS and Long Covid are hampered by insufficient numbers, lack of appropriate control groups, and inappropriate patient groups (longstanding and new patients combined). The exact pathways causing chronic fatigue and associated symptoms in ME/CFS and Long Covid have not yet been fully explored. Many different viruses and some bacteria may trigger chronic fatigue. In some cases of Long Covid, there is evidence for persistent viral presence in the brain, long after the acute infection has resolved. Further work is required to identify viral persistence in ME/CFS. A disordered immune response to infection is important. There are markers of chronic inflammation. Chronic viral persistence may lead to chronic inflammation, including neuroinflammation. This can lead to endocrine abnormalities due to interference with the HPA.

Lots of speculation and meme theories.

Chapter 8 deals with general non-drug approaches to the management of ME/CFS and Long Covid, based around published guidelines and current literature. It covers activity management, pacing, CBT, mindfulness (and related therapies), and diet. The management of relapses and the severely affected are covered. Current advice focuses on activity management and pacing. Graded exercise is no longer routinely recommended. Different therapies may work for individual patients: there is no ‘one size fits all’. Other therapies with weaker evidence bases are also discussed. The management of the severely affected is difficult in the United Kingdom, as appropriate facilities are very limited.

«No one size fits all» implies that something works for some. We don’t have the evidence to say that anything works for anyone.

Pacing is also listed under therapies, which is wrong. It’s a management strategy.

 

[Jonathan Edwards]

This looks like a standard BCAME approach based on a pretence at knowledge within a framework of not understanding how to asses the evidence.

 

[Trish]

Extract

Dr Gavin Spickett is a retired consultant in immunology, allergy, and general medicine. He trained in medicine at the University of Oxford and earned his DPhil at the MRC Cellular Immunology Unit, Oxford. He completed general medical training in Ipswich and trained in immunology, allergy, and immunopathology at the MRC Clinical Research Centre, Harrow, and the Department of Immunology at the John Radcliffe Hospital, Oxford. In 1991, he took up the position of consultant clinical immunologist, allergist, and general physician in Newcastle, where he worked until retirement in 2021. During his career, he developed the Regional Clinical Immunology and Allergy service and the associated laboratory service. He established and led the Regional Chronic Fatigue Network and was the lead clinician for ME/CFS at the Royal Victoria Infirmary. In 2017, he was awarded a Lifetime Achievement Award by the UK Primary Immunodeficiency Network for his work for patients with primary immunodeficiencies.

Chapter 6 covers what to tell patients about the diagnosis and management of ME/CFS and Long Covid. This should include discussions of current science, approaches to treatment, warnings about inappropriate or unhelpful alternative treatments. Common questions include prognosis, drug treatments, exercise including managing post-exertional malaise, pregnancy, and dealing with relapses. Patients should be signposted to appropriate information and patient support groups. A diagnosis should not be given without a careful history, examination, and at least the minimum set of investigations. It needs to be presented in a positive way, stressing what can be done to help. Females of reproductive years will be anxious about the impact on pregnancy. Discussion of boom and bust and how to deal with relapses is very important.

Chapter 10 covers the outcome and prognosis of ME/CFS and Long Covid in adults and children. Good long-term outcome data are lacking. Children and adolescents may have a better prognosis than adults. Female sex, severity of initial respiratory illness, and concomitant mental health issues seem to be risk factors for prolonged post-Covid symptoms. Similar findings have been identified in other studies of post-infectious chronic fatigue. Early diagnosis and intervention improved outcomes. The use of antivirals in Long Covid may lead to improvements in some patients. Some patients with ME/CFS and Long Covid will show a relapsing and remitting pattern of illness, while others remain long-term disabled, some seriously.