Ewig, S, Dengler, H J · Klinische Wochenschrift · 1990 · DOI
This paper discusses chronic fatigue syndrome (CFS) as a condition that can develop after viral infections like Epstein-Barr virus or Coxsackie-B virus. Researchers noted that CFS may actually be several different diseases with different causes rather than one single condition. The authors emphasize that diagnosis requires ruling out other medical conditions first, and that at this time, we don't have enough knowledge to recommend specific treatments.
This work was foundational in establishing CFS as a recognized medical syndrome and proposing that it represents multiple disease entities with potentially different viral causes. Understanding that ME/CFS may encompass several distinct conditions has important implications for how patients are diagnosed and how researchers should approach treatment development.
This editorial does not establish definitive causation of CFS by any specific virus—it reviews evidence of association. It does not provide proof that viral infection always leads to CFS, nor does it establish specific treatments. The work acknowledges CFS as a hypothetical concept, meaning the disease definition was still preliminary and subject to revision.
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
Ewig, S & Dengler, H J (1990). [Chronic fatigue syndrome].. Klinische Wochenschrift. https://doi.org/10.1007/BF01796268
BibTeX
@article{mecfsatlas-ewig-1990-chronic-fatigue,
author = {Ewig, S and Dengler, H J},
title = {[Chronic fatigue syndrome].},
journal = {Klinische Wochenschrift},
year = {1990},
doi = {10.1007/BF01796268},
note = {PubMed: 2170741},
url = {https://www.mecfsatlas.com/evidence/ewig-1990-chronic-fatigue},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-28. https://www.mecfsatlas.com/evidence/ewig-1990-chronic-fatigue
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