Chang, Hsun, Kuo, Chien-Feng, Yu, Teng-Shun et al. · Journal of translational medicine · 2023 · DOI
This large study from Taiwan tracked nearly 400,000 people over 17 years to see if getting an infection increased their chances of developing ME/CFS. Researchers found that people who had certain infections—including chickenpox, tuberculosis, flu, and common bacterial infections—were about 1.5 times more likely to develop ME/CFS compared to people without these infections. Interestingly, people who took certain antibiotics had lower rates of ME/CFS, suggesting that some infections may trigger ME/CFS in some people.
This study provides population-level evidence supporting the clinical observation that ME/CFS often emerges following acute infections, potentially validating infection as an important trigger or risk factor. The finding that specific pathogens and antibiotic treatments correlate with CFS risk may inform future research into mechanisms of post-infectious ME/CFS and guide clinical investigation strategies.
This study establishes correlation, not causation—infection does not necessarily cause ME/CFS, and other unmeasured factors may explain the association. The study cannot determine why certain infections increase CFS risk or whether infection directly triggers disease pathology versus simply marking a susceptible subpopulation. The protective effect of certain antibiotics requires further investigation and does not prove these drugs prevent ME/CFS.
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
Chang, Hsun, Kuo, Chien-Feng, Yu, Teng-Shun, Ke, Liang-Yin, Hung, Chung-Lieh, & Tsai, Shin-Yi (2023). Increased risk of chronic fatigue syndrome following infection: a 17-year population-based cohort study.. Journal of translational medicine. https://doi.org/10.1186/s12967-023-04636-z
BibTeX
@article{mecfsatlas-chang-2023-increased-risk,
author = {Chang, Hsun and Kuo, Chien-Feng and Yu, Teng-Shun and Ke, Liang-Yin and Hung, Chung-Lieh and Tsai, Shin-Yi},
title = {Increased risk of chronic fatigue syndrome following infection: a 17-year population-based cohort study.},
journal = {Journal of translational medicine},
year = {2023},
doi = {10.1186/s12967-023-04636-z},
note = {PubMed: 37951920},
url = {https://www.mecfsatlas.com/evidence/chang-2023-increased-risk},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-28. https://www.mecfsatlas.com/evidence/chang-2023-increased-risk
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