E2 ModeratePreliminaryPEM unclearCross-SectionalPeer-reviewedReviewed
Coxsackie B viruses and myalgic encephalomyelitis.
Bell, E J, McCartney, R A, Riding, M H · Journal of the Royal Society of Medicine · 1988 · DOI
Quick Summary
This study examined whether a common virus called Coxsackie B might be linked to ME/CFS. Researchers tested blood samples from ME/CFS patients and healthy people, and found that ME/CFS patients had higher rates of antibodies to this virus—suggesting they may have been infected with it. The findings suggest Coxsackie B viruses may play a role in this illness, though more research is needed to understand exactly how.
Why It Matters
This study provides early serological evidence that Coxsackie B viruses may be associated with ME/CFS in a subset of patients, which could help explain the post-viral nature many patients report. Understanding potential viral triggers is important for developing targeted diagnostic tests and future therapeutic approaches for this disabling condition.
Observed Findings
- 12.5% of psychiatric hospital patients had significantly raised CBV antibody titres compared with 4-5% of healthy controls
- 37% of adult ME patients tested CBV IgM-positive versus 9% of healthy adult controls
- 38% of children with ME tested CBV IgM-positive, suggesting recent or active infection
- The highest percentage of positive cases (21%) occurred in psychiatric patients aged 30-39 years
Inferred Conclusions
- Coxsackie B viruses appear to play an important role in ME/CFS pathogenesis based on elevated seroprevalence in affected populations
- The CBV IgM ELISA test may be a useful diagnostic tool for identifying recent or active CBV infection in ME/CFS patients
- Both children and adults with ME show elevated rates of CBV markers, suggesting this association spans age groups
Remaining Questions
- Does Coxsackie B virus infection directly cause ME/CFS, or is the association secondary to immune dysregulation in ME/CFS patients?
- What proportion of ME/CFS cases are attributable to CBV infection versus other potential triggers?
- Can longitudinal follow-up of CBV-positive individuals determine whether CBV infection precedes ME/CFS symptom onset?
What This Study Does Not Prove
This study does not prove that Coxsackie B viruses cause ME/CFS—it only shows an association in a cross-sectional design. The presence of antibodies indicates past or current infection but does not establish direct causality. Additionally, the study cannot determine whether CBV infection triggers ME in susceptible individuals or whether CBV reactivates as a consequence of ME-related immunological changes.
Tags
Symptom:Fatigue
Biomarker:AutoantibodiesBlood Biomarker
Phenotype:Infection-TriggeredPediatric
Method Flag:PEM Not DefinedWeak Case DefinitionSmall SampleExploratory OnlyMixed Cohort
Metadata
- DOI
- 10.1177/014107688808100609
- PMID
- 2841461
- Review status
- Editor reviewed
- Evidence level
- Single-study or moderate support from human research
- Last updated
- 12 April 2026
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 →
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