Komaroff, A L, Buchwald, D · Reviews of infectious diseases · 1991 · DOI
This review summarizes what doctors have learned about chronic fatigue syndrome (ME/CFS) by studying approximately 510 patients. The hallmark features include a sudden illness-like onset, long-lasting exhaustion that severely limits daily activities, and a unique symptom called postexertional malaise—where patients feel much worse after physical or mental activity. Many patients also experience fever, sore throat, swollen lymph nodes, muscle pain, sleep problems, and difficulty concentrating.
This early systematic clinical description helped establish consensus about ME/CFS's core symptom profile, particularly highlighting postexertional malaise as a distinguishing feature. For patients, having symptoms formally documented by experienced clinicians validates the disease's reality and complexity; for researchers, this foundational characterization has guided subsequent diagnostic criteria development and research priorities.
This review does not establish prevalence rates for specific symptoms in the broader ME/CFS population or prove the biological mechanisms causing the illness. It also does not demonstrate causation for any symptom or establish whether the observed symptoms are primary disease manifestations or secondary consequences of other pathophysiological processes.
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
Komaroff, A L & Buchwald, D (1991). Symptoms and signs of chronic fatigue syndrome.. Reviews of infectious diseases. https://doi.org/10.1093/clinids/13.supplement_1.s8
BibTeX
@article{mecfsatlas-komaroff-1991-symptoms-signs,
author = {Komaroff, A L and Buchwald, D},
title = {Symptoms and signs of chronic fatigue syndrome.},
journal = {Reviews of infectious diseases},
year = {1991},
doi = {10.1093/clinids/13.supplement_1.s8},
note = {PubMed: 2020806},
url = {https://www.mecfsatlas.com/evidence/komaroff-1991-symptoms-signs},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/komaroff-1991-symptoms-signs
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