Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and COVID-19: is there a connection? 2023, Al Muhaissen et al

[Andy]

Objectives
Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a chronic systemic disease that leads to neurological, immunological, autonomic, and energy metabolism dysfunction. COVID-19 has been reported to cause similar symptoms to ME/CFS. The study aims to investigate the prevalence of myalgic encephalomyelitis in patients post-COVID-19 infection by assessing acute and long-term COVID-19 symptoms.

Methods
A cross-sectional questionnaire was developed based on the ME/CFS diagnostic criteria, as specified by the IOM clinical diagnostic criteria, and administered to participants with confirmed COVID-19 who are more than 18 years old and have BMI below 40 Kg/m2. Data from 437 participants were completed.

Results
The current study results revealed that 8.1% of the study participants met the ME/CFS diagnostic criteria. Interestingly, 2.8 of the study participants were classified to have COVID-19 related to ME/CFS. While 4.6% of participants were determined to have disease-related fatigue, 0.7% of participants showed ME/CFS that was not related to COVID-19, and 3.7% of participants were considered to have long COVID-19. Almost one-fourth of the study participants had a family history of ME/CFS. The current study demonstrated that the prevalence of ME/CFS is similar to slightly higher than reported in the literature.

Conclusion
The presence of a relationship between ME/CFS and COVID-19 has been supported by the results of our study. Follow-up of COVID-19 patients is strongly recommended to ensure proper management of ME/CFS symptoms.

Paywall, https://www.tandfonline.com/doi/full/10.1080/03007995.2023.2242244

 

[Hutan]

Research from Jordan.

I can't quite work out what the Results section is saying. I don't know about the selection approach, but there's a possibility that there are some useful findings there in the text of the paper. And it's always interesting to hear views from another country about ME/CFS.

 

[Trish]

I was just typing a very similar comment to yours, @Hutan. I agree, the data in the abstract don't make much sense without being able to see the full paper.

 

[SNT Gatchaman]

It's mostly OK, doesn't add much. On the plus side, used IOM criteria and referenced the 2021 NICE guidelines.

Out of the total number of 437 participants, 313 (71.6%) were females; ages ranged from 18-68 years with a mean value of 28.7 years. As for the body mass index (BMI), the mean was 24.9 kg/m2 . Regarding the monthly income, 263 (60.2%) had a monthly income of less than 700$; and 174 (39.8%) had an income of more than 700$. The majority of participants, 368 (84.2%), had a diploma or more, and more than two-thirds of study participants (298, 68.2%) described themselves as moderately active. Almost one-third of participants (147, 33.6%) worked in an occupation in the medical field.

Regarding the risk factors for ME/CFS, 109 (24.9%) of the study participants had a family history of ME/CFS, and 60 (13.7%) stated that they were exposed to either early abuse, trauma, or family problems.

They didn't break down the early abuse, trauma and family problems. 13.7% seems a bit low for even just "family problems" which I have to imagine is more the rule rather than the exception in any part of the world.

The wording of the discussion could be tightened up. They say —

To the best of our knowledge, this study is the first one that focuses on the relationship between ME/CFS and COVID-19 in Jordan. In line with the hypothesis that ME/CFS is triggered by an infection with COVID-19, our results demonstrated an incidence rate of 2.8%. More precisely, 12 out of the entirety of participants in our study (N=437) met the IOM’s diagnostic criteria of ME/CFS and happened to be infected with COVID-19 before the onset of fatigue symptoms and had symptoms for more t han 6 months. This suggests that patients who suffered from COVID-19 at one point can develop ME/CFS in the long run, not just post-acute sequelae of SARS-CoV-2 infection (PASC)/ long COVID. This supports the theory that ME/CFS may develop following a viral infection, which is COVID-19 in this scenario.

This bit is very odd —

A relatively high percentage of our ME/CFS cohort, 45% of our cases to be precise, were also found to have suffered from abuse or childhood trauma near the onset of symptoms, this risk factor has already been proven to be a key element in the pathogenesis of ME/CFS in multiple studies [7, 8], this could be explained by the occurrence of neuroendocrine dysfunction which is a hallmark found in both ME/CFS patients alongside childhood trauma survivors.

The inclusion criteria were 18+, so I'm not sure what they mean by "found to have suffered from abuse or childhood trauma near the onset of symptoms".

Refs 7 and 8 are Early Adverse Experience and Risk for Chronic Fatigue Syndrome (2006) and Childhood Trauma and Risk for Chronic Fatigue Syndrome: Association With Neuroendocrine Dysfunction (2009) - both JAMA Psychiatry.

This bit is fine —

A very small number of patients required hospitalization with O2 masks, and none of them required hospitalization in ICU with intubation. This may suggest that developing ME/CFS does not necessarily correlate with the initial severity of the COVID-19 infection.

It then starts to get a bit confusing —

Furthermore, the nature of the severity of ME/CFS symptoms was episodic rather than constant in almost 70% of cases, including the ones having COVID-19-related ME/CFS, and the duration of these episodic symptoms was for days or less rather than being extended for weeks or months. None of the cases suffered from symptoms that lasted for more than a month.

I think they're talking about PEM as episodic severe symptoms here.

Not only did our study include the symptoms required for ME/CFS diagnosis, but it also offers a novel perspective regarding the other symptoms suffered by these patients which are hallmarks of long COVID, the most common symptoms among the cases who met the criteria were muscle pain, pain in the joints without swelling or redness, the headache of a new type or severity, and sensitivity to light and sound. These symptoms were largely more prevalent in ME/CFS patients, which may suggest that many of these symptoms could be a result of the COVID infection itself, as they align well with the characteristics of PASC. One possible explanation is that the symptoms of both long COVID-19 and ME/CFS may originate from redox imbalance, which is mainly linked to inflammation and energy metabolic defects.

I think they're trying to square ME with LC, by looking at the non-IOM criteria symptoms?

 

[MeSci]

I think there's a percentage symbol missing in:

"2.8 of the study participants".