Thread by @ravenscimaven

WE DID IT! This was HARD WORK. Leading this project was HARD. I am immensely grateful for the support of my team, their time and expertise, their patience. Y'all, every doctor in the world needs to read this manual. Let me tell you why in this thread 1/

https://twitter.com/CoRESinai/status/1955810573134012597

2/ Infection-Associated Chronic Illnesses (IACIs) like Long COVID, MECFS, and Post-Treatment Lyme Disease Syndrome aren’t “mystery illnesses."

They have biological drivers we can identify, study, and treat. That’s what this manual breaks down for clinicians.

3/ Driver 1: Persistence of pathogens in tissue Sometimes, a virus or bacteria or even parts of it, stick around in the body long after the initial infection, hiding in tissues where the immune system can’t easily clear them.

4/ Driver 2: Pathogen reactivation under immune dysregulation
Viruses like herpesviruses (which most of us have) or even bacteria can “wake up” when the immune system is off-balance. This reactivation can worsen symptoms or trigger new ones.

5/ Driver 3: Mitochondrial dysfunction
Mitochondria are your cells’ energy factories (dare I say, the powerhouse of the cell). In IACIs, they can get damaged or dysregulated, leaving people with crushing fatigue, post-exertional consequences, and muscle weakness.

6/ Driver 4: Coagulation & vascular dysfunction
IACIs can cause sticky blood clots called microclots and damage to blood vessels. This limits oxygen delivery to tissues and can impact every organ system.

7/ Driver 5: Dysautonomia & POTS
Your autonomic nervous system controls heart rate, blood pressure, digestion, all the “automatic” stuff. In IACIs, it can malfunction, leading to dizziness, heart palpitations, and exercise intolerance.

8/ Driver 6: Neuroinflammation & cognitive dysfunction
Inflammation in the brain and nervous system can cause brain fog, memory problems, headaches, sensory sensitivity, and mood changes.

9/ Driver 7: Immune activation, dysfunction, & autoimmunity
The immune system can get stuck in “on” mode or start attacking the body’s own tissues. This can perpetuate inflammation and damage.

10/ Driver 8: Microbiome imbalance & SIBO
The gut microbiome influences immunity and inflammation. Disruption after infection, plus small intestinal bacterial overgrowth, can drive symptoms across the body.

11/ Driver 9: Hormonal imbalance
IACIs can throw off endocrine systems, including thyroid, adrenal, and reproductive hormones, which can worsen fatigue, pain, and mood symptoms.

12/ Driver 10: Mast cell activation & immune cell priming
Mast cells can become overactive, releasing histamine and other chemicals that trigger inflammation, allergic-type symptoms, and flares.

13/ This manual walks clinicians through these drivers: the science, the evidence, and how to translate it into patient care.

It’s free, evidence-based, and updated every 6 months. Download now at .iacimanual.org

14/ To my team, collaborators, and patients whose lived experience guided this work: thank you. After living through severe Long COVID, it is an honor to lead this project. Every doctor in the world needs to read this manual, because the science is here, and patients can’t wait.