Komaroff, Anthony L, Cho, Tracey A · Seminars in neurology · 2011 · DOI
This review examines the connection between infections and ME/CFS, looking at decades of cases where people developed long-lasting fatigue after infections. The authors found evidence that certain viruses and bacteria can cause persistent infections that trigger and maintain ME/CFS symptoms by affecting the nervous system and triggering ongoing immune responses. While no single infection has been proven to cause ME/CFS in all cases, the pattern suggests that chronic infections may be important triggers in some people with the illness.
This work is important because it provides a framework for understanding how infections might trigger and perpetuate ME/CFS in some patients, which could guide future diagnostic and therapeutic approaches. For patients, it validates the connection many report between infections and illness onset and suggests that ongoing immune activation may explain persistent symptoms. For researchers, it highlights neuropathogenic agents as priority candidates for mechanistic investigation.
This review does not prove that any specific infectious agent causes ME/CFS—only that associations exist. It does not establish whether infections are necessary or sufficient causes of ME/CFS, nor does it demonstrate that all ME/CFS cases involve chronic infection. The study is a synthesis of existing evidence rather than new experimental data, so correlation between infection and CFS does not confirm causal relationships.
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 →
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Primary citation
Komaroff, Anthony L & Cho, Tracey A (2011). Role of infection and neurologic dysfunction in chronic fatigue syndrome.. Seminars in neurology. https://doi.org/10.1055/s-0031-1287654
BibTeX
@article{mecfsatlas-komaroff-2011-role-infection,
author = {Komaroff, Anthony L and Cho, Tracey A},
title = {Role of infection and neurologic dysfunction in chronic fatigue syndrome.},
journal = {Seminars in neurology},
year = {2011},
doi = {10.1055/s-0031-1287654},
note = {PubMed: 21964849},
url = {https://www.mecfsatlas.com/evidence/komaroff-2011-role-infection},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/komaroff-2011-role-infection
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