Patients suffering from any of the “invisible diseases”, namely myalgic encephalomyelitis/chronic fatigue
syndrome, long COVID, chronic Lyme disease, or Q-fever fatigue syndrome, present similar symptoms
and prognosis. So far they also bear the burden that they cannot heal. The most probable reason for this
is that these diseases occur in persons carrying a specific genetic composition, who have been victim of
a viral (Epstein-Barr virus or Cytomegalovirus) or bacterial (Borrelia burgdorferi or Coxiella burnetii)
infection, initiating a cascade of immune and inflammatory processes. Aside from causing oxidative
stress–associated cellular damage and membrane receptor dysfunction, these processes deregulate the
concentration and activity of several kinases, such as the pyruvate dehydrogenase kinase, phenylalanineand
tyrosine hydroxylases. Impaired glucose metabolism resulting from pyruvate dehydrogenase
deficiency causes poor energy production by the mitochondria, with fatigue and post-exertional malaise.
Deficient conversion of phenylalanine to tyrosine and dopamine results in neurological and cerebral
problems, such as brain fog, poor concentration and memory, and depressive mood. Local hypothalamic
inflammation may cause adrenal and gonadal endocrine dysfunctions. Whereas particular steps of the
pathogenesis of these diseases may be improved by treatment, it is currently impossible to restore the
entire process.
