Category | ME/CFS | Sickness behavior |
---|---|---|
Physiosomatic symptoms | Disabling fatigue | Fatigue, lethargy, behavioral inhibition |
 | Mental fatigue | Reduction of exploration |
 | 'Pacing' as an energy-conservation strategy | Reduced locomotor activity |
 | Post-exertion malaise following mental/physical activities | Fatigability |
 | A flu-like malaise | Malaise, flu-like symptoms |
 | Hyperalgesia | Hyperalgesia |
 | Muscle tension and pain | Muscle pain |
 | Sleep disorders | Sleepiness |
 | High incidence of autonomic symptoms | Probably yes, but not well documented |
 | Failure to concentrate | Failure to concentrate |
 | Memory disturbances | Memory disturbances |
 | Gastrointestinal symptoms | - |
Depressive symptoms | May occur when comorbid depression is present | Disinterest in social interactions |
 | Anhedonia may occur when depression co-occurs | Anhedonia, or reduced intake of sweetened milk in rodent models |
 | Sadness | Sadness |
Anorexia/weight loss | May occur when comorbid depression is present | Anorexia and weight loss |
Pyrexia | Slightly increased body temperature in a few patients | Pyrexia |
Onset | Acute onset or insidious | Acute onset |
Course | Waxing and waning or progressive course | Acute adaptive response |
 | Chronic course (>6 months) | Maximal 19 to 43 days |
Energy metabolism | Mitochondrial dysfunction, lowered ATP, abnormally high lactate levels | Is an adaptive behavioral response aiming to conserve energy and to redirect energy to immune cells to combat the pathogens |
 |  | Is an adaptive response to counteract negative energy balance |
 | Impaired oxidative phosphorylation | Sickness behavior plays a key role in the resolution of acute inflammation |
 |  | When the energy stores are depleted and the acute inflammation is not resolved, chronic inflammation ensues |
 | Structural mitochondrial abnormalities |  |
 | Accelerated glycolysis; decreased phosphocreatine synthesis rates following exercise |  |
Pathways | (Sub)chronic inflammation with increased proinflammatory cytokines | Acute inflammation with increased proinflammatory cytokines |
 | Cell-mediated immune (CMI) activation | Probably activated |
 | Simultaneous T helper (Th)1 and Th2 responses | - |
 | Multiple immune dysfunctions | - |
 | Lowered antioxidant levels | - |
 | Reactive oxygen species (ROS)/reactive nitrogen species (RNS) | Probably yes |
 | Damage by oxidative and nitrosative stress (O&NS) to lipids, DNA, proteins | - |
 | Autoimmune responses to O&NS modified neoepitopes | - |
 | Autoimmunity | - |
 | Reduced hypothalamic-pituitary-adrenal (HPA) axis function in some patients | Enhanced HPA axis activity (part of compensatory (anti)-inflammatory reflex system (CIRS)) |
Triggers | Multiple, not well defined | Acute, highly defined |
 | Long-term effects of acute infection | Acute pathogens and tissue injury |
 | Disease exacerbated by infections | - |
 | Disease exacerbated by psychological stress | - |
 | Chronic medical inflammatory illness | - |
 | Chronic neuroinflammatory disorders | - |
 | Autoimmune disorders | - |
 | Sometimes no trigger factor is observed | Is always a response to a defined trigger |
Risk factors | IgG, IgG1 and IgG3 deficiencies | - |
 | Immune gene polymorphisms | - |
 | Reduced ω3/ω6 ratio | - |
General | Inflammation, O&NS and mitochondrial-related chronic progressive disorder | Inflammation-induced adaptive behavioral and CIRS response that is conserved through evolution |
Janus face | Bad 'chronic' side: a chronic disorder with positive feedback loops between inflammatory responses and autoimmune processes | Beneficial 'acute' side: supports inflammation, redirects energy to immune cells, conserves energy and prevents negative energy balance, helps eradicating the trigger, and has anti-inflammatory effects |