Kristiansen, Miriam Skjerven, Stabursvik, Julie, O'Leary, Elise Catriona et al. · Brain, behavior, and immunity · 2019 · DOI
This study looked at adolescents who had Epstein-Barr virus (EBV) infection and tracked whether they developed chronic fatigue 6 months later. Researchers found that those with ongoing fatigue had more symptoms overall, but blood tests and heart-monitoring showed only small differences compared to those who recovered—mainly slightly higher inflammation markers and changes in nervous system activity. The study suggests that post-EBV fatigue in teenagers involves subtle changes in the body's stress and immune systems, even though the virus itself had cleared.
This study is one of few to systematically characterize biological mechanisms in post-viral ME/CFS in an adolescent population, a group in whom post-EBV fatigue is common but understudied. It provides evidence that chronic fatigue following EBV involves real physiological alterations in immune and autonomic function, not solely psychogenic mechanisms, validating patient experiences while highlighting the need for more mechanistic research to guide treatment.
This study does not prove that subtle immune or autonomic changes cause chronic fatigue symptoms—the weak symptom-biomarker correlations suggest other mechanisms may be more important. The cross-sectional design cannot establish causality or temporal relationships. The findings also do not identify a single diagnostic biomarker for post-EBV fatigue, as individual markers have modest effect sizes and overlap significantly between fatigued and non-fatigued groups.
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
Kristiansen, Miriam Skjerven, Stabursvik, Julie, O'Leary, Elise Catriona, Pedersen, Maria, Asprusten, Tarjei Tørre, Leegaard, Truls, et al. (2019). Clinical symptoms and markers of disease mechanisms in adolescent chronic fatigue following Epstein-Barr virus infection: An exploratory cross-sectional study.. Brain, behavior, and immunity. https://doi.org/10.1016/j.bbi.2019.04.040
BibTeX
@article{mecfsatlas-kristiansen-2019-clinical-symptoms,
author = {Kristiansen, Miriam Skjerven and Stabursvik, Julie and O'Leary, Elise Catriona and Pedersen, Maria and Asprusten, Tarjei Tørre and Leegaard, Truls and Osnes, Liv Toril and Tjade, Trygve and Skovlund, Eva and Godang, Kristin and Wyller, Vegard Bruun Bratholm},
title = {Clinical symptoms and markers of disease mechanisms in adolescent chronic fatigue following Epstein-Barr virus infection: An exploratory cross-sectional study.},
journal = {Brain, behavior, and immunity},
year = {2019},
doi = {10.1016/j.bbi.2019.04.040},
note = {PubMed: 31039432},
url = {https://www.mecfsatlas.com/evidence/kristiansen-2019-clinical-symptoms},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-26. https://www.mecfsatlas.com/evidence/kristiansen-2019-clinical-symptoms
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