Kawai, K, Kawai, A · Internal medicine (Tokyo, Japan) · 1992 · DOI
This study examined whether Epstein-Barr virus (EBV), a common virus that causes infectious mononucleosis, might be connected to chronic fatigue syndrome (CFS). Researchers tested 22 patients with long-lasting fatigue and found that those with definite CFS had higher levels of certain EBV antibodies compared to patients with milder symptoms and healthy controls. The study suggests a possible link between EBV activation and the severity of fatigue experienced.
This early Japanese study provides evidence that EBV reactivation may play a role in at least some CFS cases, supporting the hypothesis that viral factors contribute to disease pathogenesis. Understanding potential triggers could inform future diagnostic approaches and targeted interventions for ME/CFS patients.
This study does not prove that EBV causes CFS—it shows correlation, not causation. The small sample size (10 definite cases) and observational design limit generalizability. The study does not determine whether elevated EBV antibodies are a cause, consequence, or coincidental finding in 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
Kawai, K & Kawai, A (1992). Studies on the relationship between chronic fatigue syndrome and Epstein-Barr virus in Japan.. Internal medicine (Tokyo, Japan). https://doi.org/10.2169/internalmedicine.31.313
BibTeX
@article{mecfsatlas-kawai-1992-studies-relationship,
author = {Kawai, K and Kawai, A},
title = {Studies on the relationship between chronic fatigue syndrome and Epstein-Barr virus in Japan.},
journal = {Internal medicine (Tokyo, Japan)},
year = {1992},
doi = {10.2169/internalmedicine.31.313},
note = {PubMed: 1319246},
url = {https://www.mecfsatlas.com/evidence/kawai-1992-studies-relationship},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/kawai-1992-studies-relationship
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