Keijmel, Stephan P, Morroy, Gabriëlla, Delsing, Corine E et al. · Nederlands tijdschrift voor geneeskunde · 2012
After a bacterial infection called Q fever, about 1 in 5 patients develop long-lasting fatigue and other symptoms called Q fever fatigue syndrome (QFS). This guideline from the Netherlands helps doctors diagnose and treat QFS consistently. Many patients recover on their own within six months, but those who don't may benefit from cognitive behavioral therapy, a type of talk therapy that helps people manage chronic fatigue.
This guideline is relevant to ME/CFS research because QFS represents a well-characterized post-infectious fatigue syndrome with epidemiological data that can inform understanding of how acute infections trigger persistent fatigue. The emphasis on cognitive behavioral therapy aligns with existing ME/CFS treatment approaches and may help identify effective interventions for post-infectious conditions. Understanding QFS outcomes may provide insights into mechanisms and trajectories of post-viral fatigue syndromes.
This guideline does not prove that cognitive behavioral therapy cures QFS or that it is equally effective for all patients—the authors explicitly note that outcome data following treatment are not yet available. The study does not establish causal mechanisms of how Q fever leads to persistent fatigue, nor does it compare QFS to other post-infectious fatigue syndromes like ME/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
Keijmel, Stephan P, Morroy, Gabriëlla, Delsing, Corine E, Bleijenberg, Gijs, Bleeker-Rovers, Chantal P, & Timen, Aura (2012). [Persistent fatigue following Q fever].. Nederlands tijdschrift voor geneeskunde. https://pubmed.ncbi.nlm.nih.gov/23191971/
BibTeX
@article{mecfsatlas-keijmel-2012-persistent-fatigue,
author = {Keijmel, Stephan P and Morroy, Gabriëlla and Delsing, Corine E and Bleijenberg, Gijs and Bleeker-Rovers, Chantal P and Timen, Aura},
title = {[Persistent fatigue following Q fever].},
journal = {Nederlands tijdschrift voor geneeskunde},
year = {2012},
note = {PubMed: 23191971},
url = {https://www.mecfsatlas.com/evidence/keijmel-2012-persistent-fatigue},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-28. https://www.mecfsatlas.com/evidence/keijmel-2012-persistent-fatigue
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