Hickie, Ian, Davenport, Tracey, Wakefield, Denis et al. · BMJ (Clinical research ed.) · 2006 · DOI
This study followed 253 people in Australia who had three different infections (glandular fever, Q fever, and a virus causing joint pain) to see how many developed long-lasting fatigue and related symptoms. About 11% of people met the diagnostic criteria for chronic fatigue syndrome six months after infection, experiencing disabling fatigue, pain, thinking difficulties, and mood changes. The researchers found that the severity of the initial infection—not personality type, prior health, or the specific germ involved—was the main predictor of who would develop prolonged illness.
This study provides evidence that ME/CFS-like symptoms can develop after multiple different infections through a common pathway, suggesting a shared biological mechanism rather than pathogen-specific causation. Understanding that acute illness severity drives post-infective fatigue syndrome may help identify high-risk patients early and inform treatment strategies targeting illness severity rather than infection type.
This study does not identify the underlying biological mechanisms causing post-infective fatigue syndrome, nor does it establish causation at the molecular level. The study's 12-month timeframe does not determine whether these syndromes persist long-term or fully resolve, limiting conclusions about chronic progression. Correlation between acute severity and later symptoms does not prove direct causation, as unmeasured factors could confound this relationship.
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
Hickie, Ian, Davenport, Tracey, Wakefield, Denis, Vollmer-Conna, Ute, Cameron, Barbara, Vernon, Suzanne D, et al. (2006). Post-infective and chronic fatigue syndromes precipitated by viral and non-viral pathogens: prospective cohort study.. BMJ (Clinical research ed.). https://doi.org/10.1136/bmj.38933.585764.AE
BibTeX
@article{mecfsatlas-hickie-2006-post-infective,
author = {Hickie, Ian and Davenport, Tracey and Wakefield, Denis and Vollmer-Conna, Ute and Cameron, Barbara and Vernon, Suzanne D and Reeves, William C and Lloyd, Andrew and Dubbo Infection Outcomes Study Group},
title = {Post-infective and chronic fatigue syndromes precipitated by viral and non-viral pathogens: prospective cohort study.},
journal = {BMJ (Clinical research ed.)},
year = {2006},
doi = {10.1136/bmj.38933.585764.AE},
note = {PubMed: 16950834},
url = {https://www.mecfsatlas.com/evidence/hickie-2006-post-infective},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-27. https://www.mecfsatlas.com/evidence/hickie-2006-post-infective
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