Chester, A C, Levine, P H · Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 1994 · DOI
This study looked at three groups of people in different buildings who reported feeling sick, and found that some developed symptoms beyond what's typically expected from poor indoor air quality. While many had the usual complaints like respiratory irritation and headaches from their building environments, others developed more serious symptoms like extreme fatigue and neurological problems that match ME/CFS. The researchers concluded that ME/CFS may often occur alongside or be connected to sick building syndrome.
This study is significant because it highlights a potential environmental factor or trigger associated with ME/CFS symptom development, which could help explain why some ME/CFS cases appear to emerge suddenly in clustered outbreaks. For patients, understanding potential environmental contributors may help identify triggers or prevention strategies. For researchers, the observation of concurrent SBS and ME/CFS symptoms suggests investigating shared pathophysiological mechanisms or how environmental exposures might precipitate or exacerbate ME/CFS.
This study does not prove that sick building syndrome causes ME/CFS, nor does it establish that poor indoor air quality is the primary trigger for ME/CFS in general. The observational nature means the researchers could not control for other variables, so other shared exposures, infections, or factors could explain both conditions. Correlation between concurrent symptoms does not demonstrate a causal mechanism.
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
Chester, A C & Levine, P H (1994). Concurrent sick building syndrome and chronic fatigue syndrome: epidemic neuromyasthenia revisited.. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. https://doi.org/10.1093/clinids/18.supplement_1.s43
BibTeX
@article{mecfsatlas-chester-1994-concurrent-sick,
author = {Chester, A C and Levine, P H},
title = {Concurrent sick building syndrome and chronic fatigue syndrome: epidemic neuromyasthenia revisited.},
journal = {Clinical infectious diseases : an official publication of the Infectious Diseases Society of America},
year = {1994},
doi = {10.1093/clinids/18.supplement_1.s43},
note = {PubMed: 8148452},
url = {https://www.mecfsatlas.com/evidence/chester-1994-concurrent-sick},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/chester-1994-concurrent-sick
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