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Aunque
actualmente el Síndrome de Fatiga Crónica Postviral y la
Encefalomielitis Miálgica Benigna comparte epígrafe en el Código
Internacional de Enfermedades, en el inicio de su desarrollo como
entidades patológicas existían claras diferencias, como por ejemplo
en el aspecto epidémico y en el importante impacto cognitivo.
Conocer un poco de
historia al respecto, puede ayudarnos a establecer algunos matices
diferenciales.
En 1956 aparece en
"The Lancet", el primer artículo proponiendo una denominación para
la enfermedad y posteriormente, en 1958 y 1959 se desarrolla el
conceto y la definición de Encefalolimielitis Miálgica Benigna en
sendos trabajos históricos, que puede reproducir pinchando en los
siguientes enlaces:
Algunas referencias
epidémicas
Acheson ED. The clinical syndrome variously called benign
myalgic encephalomyelitis, Iceland Disease, and epidemic
neuromyasthenia. American Journal of Medicine 1959; 26:
569-95.
Ball AP. Disease due to echovirus type 19 in Birmingham,
England, 1975. Postgraduate Medical Journal 1978; 54:
737-40.
Abstract: In the summer of 1975 an extensive
epidemic of disease due to echovirus type 19 occurred in the West
Midlands. The features of this outbreak, and their relationship to
the syndrome referred to as 'epidemic neuromyasthenia', are
discussed. The two diseases are considered to be separate
entities.
Behan PO. Epidemic myalgic encephalomyelitis.
Practitioner 1980; 224: 805-7.
Compston N. An outbreak of encephalomyelitis in the Royal
Free Hospital Group, London, in 1955. Postgraduate Medical
Journal 1978; 54: 722-24.
Corridan JP. 'Epidemic neuromyasthenia' in Southwest
Ireland. Postgraduate Medical Journal 1978; 54: 731-36.
Abstract: During the course of an obscure illness
in a teenage girl it was eventually realized that the diagnosis
was 'epidemic neuromyasthenia'. The illness which occurred between
February and September 1976 was characterized by fatigue, pallor,
headache, nuchal pain, alterations in mentation, dizziness, nausea
and vomiting, paraesthesiae, weakness and heaviness of limbs, and
a prolonged relapsing course. Investigation brought to light
fourteen patients with similar symptoms-twelve female and two
male. In view of the shortcomings of retrospective enquiries,
especially those involving the assessment of notes made by other
people, and the problem of trying to define a nonfatal illness
with protean symptoms, many of a nonspecific nature, with few
physical findings and negative laboratory studies, caution is
necessary. Under these circumstances it is claimed on clinical
epidemiological evidence that a diagnosis of 'epidemic
neuromyasthenia' could be sustained confidently in three patients
and probably in a fourth. Six patients were considered possible
cases and four were rejected.
Currie DM, Shelokov A. Repetitive stimulation abnormalities
in 'epidemic neuromyasthenia': identification and implications.
[Abstract] Postgraduate Medical Journal 1978; 54: 746.
Daikos GK, Garzonis S, Paleologue A, Bousvaros GA. Benign
myalgic encephalomyelitis: an outbreak in a nurses' school in
Athens. Lancet 1959; 1: 693-6.
Dillon MJ, et al. Epidemic neuromyasthenia: outbreak among
nurses at a children's hospital. British Medical Journal
1974; 1: 301-5.
Dillon MJ. 'Epidemic neuromyasthenia' at the Hospital for
Sick Children, Great Ormond Street, London. Postgraduate
Medical Journal 1978; 54: 725-30.
Abstract: An outbreak of an illness with features
in common with 'epidemic neuromyasthenia' affected the staff of
the Hospital for Sick Children in London between August 1970 and
January 1971. At least 145 cases were observed and the majority of
these were nurses. Symptomatology was protean, clinical findings
minimal and relapses frequent. Care was taken to minimize anxiety
and fear in a vulnerable population, and laboratory investigations
were purposefully limited in number for this reason. In general,
laboratory findings, including virological investigations were
negative. A high incidence of anti-complementary activity and the
presence of ill defined aggregates in some acute sera on electron
microscopy were interesting and possibly significant findings
suggesting the presence of immune complexes. These findings, plus
the ability of lymphocytes from some patients to proliferate in
vitro, were thought to represent possible evidence of an infective
process. Although no children were affected during the 1970
outbreak, it is interesting that seven children have recently been
referred to the hospital with features compatible with 'epidemic
neuromyasthenia'.
Editorial. A new clinical entity? Lancet 1956; 1:
789-90.
Editorial. Outbreak of the Royal Free. Lancet 1955;
2: 351.
Henderson DA, Shelokov A. Epidemic neuromyasthenia -
clinical syndrome. New England Journal of Medicine 1959;
260: 757-64.
Hill RCJ, Cheetham RWS, Wallace HL. Epidemic myalgic
encephalomyelopathy - the Durban outbreak. Lancet 1959; 1:
689-93.
Hyde B, Bergman S. Akureyri Disease (myalgic
encephalomyelitis), forty years later [Letter]. Lancet
1988; 1191-2.
Macrae AD, Galpine JF. An illness resembling poliomyelitis.
Lancet 1954; 2: 350-2.
Medical Staff of the Royal Free Hospital. An outbreak of
encephalomyelitis, Iceland Disease, and epidemic neuromyasthenia.
British Medical Journal 1957; 2: 895-904.
Parish JG. Early outbreaks of 'epidemic neuromyasthenia'
Postgraduate Medical Journal 1978; 54: 711-17.
Abstract: The literature of the outbreaks of
'epidemic neuromyasthenia' (ENM) from 1934 to 1955 has been
selected to show that the disease affects other people besides
young adult females in hospitals and nursing homes. There have
been district epidemics, in which the male: female ratio was
almost even and several male outbreaks affecting soldiers in
barracks. Some outbreaks appear to have been triggered off by an
epidemic of poliomyelitis, and the epidemiology of outbreaks in
Iceland in 1948 and 1955 suggests that the normal cytopathological
effects of poliomyelitis infection have been suppressed by the new
disease. In the Durban epidemic (1955) a toxic metabolite was
discovered in the urine of many patients and a markedly increased
urinary excretion of creatine was noted in two New York State
outbreaks. The results of the transmission of an agent from
patients with ENM to monkeys suggest that the neurological
disorder might be in the form of mild disseminated lesions
scattered throughout the nervous system from the brain to
peripheral nerves and associated with perivascular round cell
infiltration without significant cellular damage. ENM infection
was widespread in the North of England in 1955 and associated with
lymphocyte abnormalities, which have persisted in some cases for
several years. This suggests a continuous organic process.
Pellow RAA, Miles JAR. Further investigations on a disease
resembling poliomyelitis in Adelaide. Medical Journal of
Australia 1955; 2: 480-485.
Pellow RAA. A clinical description of a disease resembling
poliomylitis in Adelaide. Medical Journal of Australia
1951; 1: 944-946.
Poskanzer DC, Henderson DA, Kunkle EC, Kalter Ss, Clement WB, Bond
JO. Epidemic neuromyasthenia: an outbreak in Punta Gorda
Florida. New England Journal of Medicine 1957; 257: 356-64.
Ramsay AM. 'Epidemic neuromyasthenia' 1955-1978.
Postgraduate Medical Journal 1978; 54: 718-21.
Abstract: A record of fifty-three patients
admitted to the Infectious Diseases Department of the Royal Free
Hospital between April 1955 and September 1957 suffering from
'epidemic neuromyasthenia' establishes the fact that the condition
was endemic in the general population before, during and after the
outbreak among the staff of the hospital. A further outbreak
occurred in North Finchley between 1964 and 1967 and sporadic new
cases are still being encountered. The majority of these patients
show evidence of involvement of the central and sympathetic
nervous systems and the reticulo-endothelial system. Abnormal
muscular fatigability is the dominant clinical feature and it is
suggested that mitochondrial damage may provide an explanation for
this phenomenon. Enzyme tests carried out in seven cases show
pathologically high levels of lactic dehydrogenase, and glutamic
oxalo-acetic transaminase. A follow-up study suggests that there
is one group of patients that recovers completely or nearly
completely, a second that recovers but is subject to relapses and
a third that shows little or no recovery, these patients remaining
incapacitated.
Ramsay MA. Myalgic encephalomyelitis and postviral fatigue
states: the saga of Royal Free Disease. Second Edition.
Gower Publishing Co. 1988;
Richardson AT. Electromyographic studies of patients with
'epidemic neuromyasthenia' at the Royal Free Hospital.
[Abstract] Postgraduate Medical Journal 1978; 54: 745.
Shelokov A, Currie DM, Nelson M. 'Epidemic neuromyasthenia',
Texas 1977.[Abstract] Posgraduate Medical Journal 1978; 54:
741.
Shelokov A, Habel K, Verder E, Welsh W. Epidemic
neuromyasthenia: an outbreak of poliomyelitislike illness in student
nurses. New England Journal of Medicine 1957; 257: 345-55.
Sigurdsson B, Gudmundsson KR. Clinical findings six years
after outbreak of Akureyri disease. Lancet 1956; 1: 766-7.
Sumner DW. Further outbreak of a disease resembling
poliomyelitis. Lancet 1956; i: 764-6.
Wallis AL. An investigation into an unusual disease in
epidemic and sporadic form in a general practice in Cumberland in
1955 and subsequent years. University of Edinburgh Doctoral
Thesis 1957;
White DN, Burtch RB. Iceland disease: new infection
simulating anterior poliomyelitis. Neurology 1954; 4:
506-16.
aPuede
acceder a un documento de la organización MERGE sobre todas las
incidencias epidémicas en EnMI publicadas. (pdf en inglés 137 Kb.)
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