TESTING RECOMMENDATIONS FOR SUSPECTED ME/CFS - US ME/CFS Clinician Coalition Version 1

Additional syndrome workup to identify underlying cause or referral to a specialist NOTE: High levels can indicate ongoing infection, inflammation Testing Recommendations for Suspected ME/CFS Version 1 2 US ME/CFS Clinician Coalition February 2021 Vitamin B12 All suspected patients Malabsorption Additional workup or syndromes, referral to a specialist. [...] Additional workup or referral to a specialist Autonomic Dysfunction 10 minute All patients with Orthostatic Additional workup or NASA Lean symptoms or signs intolerance, referral to a specialist. [...] signs, neurologic syndromes Referral to a specialist for symptoms from upright additional workup posture Infectious Diseases Anti- Patients with recurrent Untreated chronic Consider appropriate streptolysin O strep infections / strep infections treatment regimens for (ASO) titer, pharyngitis or suspected and associated pharyngitis or to treat the Strep throat history of strep and lack of condition. [...] Consider the culture, Anti- prior screening or Exposure to group possibility of transmission DNaseB treatment A strep carrier (risk from a carrier of transmission to others) Immunological Disorders Histamine, Patients with severe Mast cell activation Referral to a specialist Testing Recommendations for Suspected ME/CFS Version 1 10 US ME/CFS Clinician Coalition February 2021 tryptase and allergies. [...] illness, or seizures justification for Consider PCR as an trial of antiviral alternate way of drugs evaluating for chronic infection or reactivation Herpes Simplex Clinical presentation of Indirect support Prolonged suppression of 1 & 2 IgG frequent outbreaks of for chronic viral HSV outbreaks can HSV, or in reactivation and improve quality of life and combination with other opportunity to may red.