Apostolou, Eirini, Rizwan, Muhammad, Moustardas, Petros et al. · Frontiers in immunology · 2022 · DOI
This study found that people with ME/CFS have a different immune response to COVID-19 compared to healthy people, even when the COVID infection is mild. Specifically, the researchers discovered that after COVID-19, dormant viruses (like EBV and others) reactivate more strongly in people with ME/CFS, as shown by antibody patterns in saliva. This suggests that COVID-19 may trigger hidden virus reactivation that could contribute to fatigue symptoms in ME/CFS patients.
This research provides evidence that ME/CFS patients may have a fundamentally different way of responding to viral infections, particularly COVID-19, which could explain why some people develop post-viral fatigue syndromes. Understanding that latent virus reactivation occurs in saliva (local immunity) rather than just in the blood may help explain why standard blood tests sometimes miss these abnormalities, and opens new avenues for diagnosis and treatment research.
This study does not prove that latent virus reactivation causes ME/CFS symptoms or functional decline—it only shows that the antibody pattern differs between groups. The cross-sectional design cannot establish causation or temporal relationships between reactivation and symptom onset. The findings also cannot be generalized to vaccinated individuals, as the study enrolled only non-vaccinated participants.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Apostolou, Eirini, Rizwan, Muhammad, Moustardas, Petros, Sjögren, Per, Bertilson, Bo Christer, Bragée, Björn, et al. (2022). Saliva antibody-fingerprint of reactivated latent viruses after mild/asymptomatic COVID-19 is unique in patients with myalgic-encephalomyelitis/chronic fatigue syndrome.. Frontiers in immunology. https://doi.org/10.3389/fimmu.2022.949787
BibTeX
@article{mecfsatlas-apostolou-2022-saliva-antibody,
author = {Apostolou, Eirini and Rizwan, Muhammad and Moustardas, Petros and Sjögren, Per and Bertilson, Bo Christer and Bragée, Björn and Polo, Olli and Rosén, Anders},
title = {Saliva antibody-fingerprint of reactivated latent viruses after mild/asymptomatic COVID-19 is unique in patients with myalgic-encephalomyelitis/chronic fatigue syndrome.},
journal = {Frontiers in immunology},
year = {2022},
doi = {10.3389/fimmu.2022.949787},
note = {PubMed: 36341457},
url = {https://www.mecfsatlas.com/evidence/apostolou-2022-saliva-antibody},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/apostolou-2022-saliva-antibody
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