Bowles, N E, Bayston, T A, Zhang, H Y et al. · Journal of medicine · 1993
Researchers tested muscle samples from people with post-viral fatigue syndrome (a condition similar to ME/CFS that develops after a viral infection) and found evidence of enterovirus RNA in about 26% of samples. This was much higher than in healthy control samples. The study suggests that some cases of ME/CFS may develop after a viral infection causes inflammation in the muscles, similar to how viral heart infections can lead to long-term heart problems.
This study provides molecular evidence that some ME/CFS cases may have a viral origin, specifically persistence of enterovirus in muscle tissue. Understanding the pathophysiology of post-viral fatigue could help develop better diagnostic markers and targeted treatments, and validates the experience of patients whose illness began after a clear viral infection.
This study does not prove that all ME/CFS cases are caused by enterovirus persistence, as only about one-quarter of PFS samples tested positive. Detecting viral RNA does not establish that it is causing current symptoms or that it is replicating rather than simply persisting. The cross-sectional design cannot establish causation or the timeline of infection relative to symptom onset.
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
Bowles, N E, Bayston, T A, Zhang, H Y, Doyle, D, Lane, R J, Cunningham, L, et al. (1993). Persistence of enterovirus RNA in muscle biopsy samples suggests that some cases of chronic fatigue syndrome result from a previous, inflammatory viral myopathy.. Journal of medicine. https://pubmed.ncbi.nlm.nih.gov/8409778/
BibTeX
@article{mecfsatlas-bowles-1993-persistence-enterovirus,
author = {Bowles, N E and Bayston, T A and Zhang, H Y and Doyle, D and Lane, R J and Cunningham, L and Archard, L C},
title = {Persistence of enterovirus RNA in muscle biopsy samples suggests that some cases of chronic fatigue syndrome result from a previous, inflammatory viral myopathy.},
journal = {Journal of medicine},
year = {1993},
note = {PubMed: 8409778},
url = {https://www.mecfsatlas.com/evidence/bowles-1993-persistence-enterovirus},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-26. https://www.mecfsatlas.com/evidence/bowles-1993-persistence-enterovirus
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