Persistent enteroviral infection in gastric tissue is found in a high percentage of cfs-patients by Chia & Chia (Sept. 13, 2007) while histological changes are not specifically addressed in this paper. A comparison between cfs - and non-cfs enterovirus positive patients with regard to local inflammatory reaction would be of interest, though, as the lack of a proper inflammatory response to infectious agents is a common finding in postinfectious fatigue syndrome, and the symptoms are easily dismissed as psychosomatic.

Among the comparatively few that later develop cfs or myalgic encephalomyelitis (me) that see a doctor during the initial stages of a triggering infection, a lack of adequate inflammatory response is frequently seen not only with respect to fever and enlarged lymph nodes, but also to SR, CRP and white cell count, even in the presence of ongoing infection verified otherwise. An exception to the rule are cases that present with low grade fever and enlarged lymph nodes, that may persist for months and years despite no other evidence of ongoing infection. Cfs/me is for instance rarely diagnosed following meningitis, whereas it may be triggered by what is perceived as a mild encephalitis - although these conditions almost invariably coexist.

During the Cumberland epidemic, white cell count was in the lower normal range (Wallis, 1957). During the Los Angeles epidemic in 1934 that ran parallel to a polio epidemic, patients failed to present changes in cerebrospinal fluid and the epidemic was known as atypical polio (Hyde, 1992). Only rarely do patients with polio develop cfs/me. The postpolio syndrome is postponed by several decades. Why?

Epidemics that presented with similar features as the Cumberland and Los Angeles epidemics were included in the proposed designation benign myalgic encephalomyelitis in 1956 although the –itis was difficult to establish as such. Variability with respect to findings in cerebrospinal fluid (Ramsay, 1986) strengthened the notion that viral infections were crucial in initiating this condition when agents were not identified. These findings do not, however, preclude the notion that cfs/me is an erratic expression or a forme fruste of the classical inflammatory reaction and, albeit harmful, may be perceived as a type of general reaction mode to various inflammatory agents, in keeping with vast clinical experience.

References
1. Chia JKS and Chia AY. Chronic fatigue syndrome is associated with chronic enterovirus infection of the stomach. J Clin Pathol 2007; 0:1-6 (online)
2. Wallis, AL. An investigation into an unusual disease seen in epidemic and sporadic form in a general practice in Cumberland in 1955 and subsequent years. University of Edinburgh 1957, M.D. Thesis.
3. Hyde, BM (ed). The clinical and scientific basis of myalgic encephalomyelitis chronic fatigue syndrome. Ottawa 1992, The Nightingale Research Foundation
4. Ramsay, AM. Postivral fatigue syndrome The saga of Royal Free disease. London 1986, Gower Medical Publishing