Hwang, Jae-Hyun, Lee, Jin-Seok, Oh, Hyeon-Muk et al. · Journal of translational medicine · 2023 · DOI
Researchers analyzed 64 studies involving nearly 5,000 ME/CFS patients to see if viral infections might cause or trigger the illness. They found that certain viruses—particularly Borna disease virus, human herpesvirus-7, parvovirus B19, enterovirus, and Coxsackie B virus—appeared more frequently in ME/CFS patients compared to healthy people and those with other diseases. While these associations are promising leads, finding a virus more often in patients doesn't prove it causes ME/CFS.
ME/CFS lacks a confirmed biological cause, leaving patients without clear diagnostic tests or targeted treatments. This comprehensive analysis suggests specific viruses warrant investigation as potential triggers, particularly relevant given post-COVID conditions resembling ME/CFS. Identifying viral associations could guide future diagnostic development and mechanistic research into ME/CFS pathogenesis.
This study demonstrates association, not causation—finding a virus more often in ME/CFS patients does not prove it causes the disease. The findings do not establish whether viral infections trigger ME/CFS, persist as a pathogenic agent, or represent a secondary consequence of immune dysfunction. Additionally, different studies used different viral detection methods, which may affect the reliability of comparisons across viruses.
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
Hwang, Jae-Hyun, Lee, Jin-Seok, Oh, Hyeon-Muk, Lee, Eun-Jung, Lim, Eun-Jin, & Son, Chang-Gue (2023). Evaluation of viral infection as an etiology of ME/CFS: a systematic review and meta-analysis.. Journal of translational medicine. https://doi.org/10.1186/s12967-023-04635-0
BibTeX
@article{mecfsatlas-hwang-2023-evaluation-viral,
author = {Hwang, Jae-Hyun and Lee, Jin-Seok and Oh, Hyeon-Muk and Lee, Eun-Jung and Lim, Eun-Jin and Son, Chang-Gue},
title = {Evaluation of viral infection as an etiology of ME/CFS: a systematic review and meta-analysis.},
journal = {Journal of translational medicine},
year = {2023},
doi = {10.1186/s12967-023-04635-0},
note = {PubMed: 37898798},
url = {https://www.mecfsatlas.com/evidence/hwang-2023-evaluation-viral},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-25. https://www.mecfsatlas.com/evidence/hwang-2023-evaluation-viral
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