Bouquet, Jerome, Li, Tony, Gardy, Jennifer L et al. · PloS one · 2019 · DOI
Researchers gave ME/CFS patients and healthy controls exercise tests on two consecutive days, then tracked their blood samples for up to a week to look for signs of immune activation or virus reactivation during post-exertional malaise (PEM). Although ME/CFS patients felt significantly worse after exercise and some showed reduced oxygen use on day 2, blood tests revealed almost no differences in gene expression between patients and controls, and no evidence of viruses reactivating during PEM symptoms.
This study directly tests whether the physiological stress of exercise testing—which consistently triggers PEM in ME/CFS patients—produces detectable immune or viral changes in the blood. Understanding what actually happens during PEM at the molecular level is crucial for developing targeted therapies and validating biomarkers for this disabling condition.
This study does not prove that immune dysregulation or viral reactivation do not occur in ME/CFS or during PEM—it only suggests these mechanisms may not be detectable in circulating whole blood using these methods. Pathology could exist in specific tissues, particular immune cell subsets, or involve mechanisms not captured by transcriptional analysis (e.g., protein-level changes, metabolic abnormalities, or intracellular viral persistence).
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
Bouquet, Jerome, Li, Tony, Gardy, Jennifer L, Kang, Xiaoying, Stevens, Staci, Stevens, Jared, et al. (2019). Whole blood human transcriptome and virome analysis of ME/CFS patients experiencing post-exertional malaise following cardiopulmonary exercise testing.. PloS one. https://doi.org/10.1371/journal.pone.0212193
BibTeX
@article{mecfsatlas-bouquet-2019-whole-blood,
author = {Bouquet, Jerome and Li, Tony and Gardy, Jennifer L and Kang, Xiaoying and Stevens, Staci and Stevens, Jared and VanNess, Mark and Snell, Christopher and Potts, James and Miller, Ruth R and Morshed, Muhammad and McCabe, Mark and Parker, Shoshana and Uyaguari, Miguel and Tang, Patrick and Steiner, Theodore and Chan, Wee-Shian and De Souza, Astrid-Marie and Mattman, Andre and Patrick, David M and Chiu, Charles Y},
title = {Whole blood human transcriptome and virome analysis of ME/CFS patients experiencing post-exertional malaise following cardiopulmonary exercise testing.},
journal = {PloS one},
year = {2019},
doi = {10.1371/journal.pone.0212193},
note = {PubMed: 30897114},
url = {https://www.mecfsatlas.com/evidence/bouquet-2019-whole-blood},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-27. https://www.mecfsatlas.com/evidence/bouquet-2019-whole-blood
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