Limonard, G J M, Peters, J B, Nabuurs-Franssen, M H et al. · QJM : monthly journal of the Association of Physicians · 2010 · DOI
This study looked at people who had Q fever (a bacterial infection) during an outbreak in the Netherlands and checked how they were doing about a year later. Compared to people who never had Q fever, the infected patients reported significantly more fatigue, symptoms, and problems with daily functioning. About half of the Q fever patients experienced severe fatigue, which is notably higher than in the comparison group.
This research is relevant to ME/CFS because Q fever can trigger chronic fatigue syndrome in 10-20% of infected individuals, providing a model for understanding post-infectious fatigue. The study demonstrates objective evidence that infection-triggered fatigue is a measurable, sustained phenomenon affecting multiple health domains—findings applicable to understanding ME/CFS pathophysiology and clinical presentation.
This study does not prove causation between Q fever and the observed health decline, as the cross-sectional design captures only a single time point without baseline data. It also does not establish the biological mechanisms underlying post-Q fever fatigue, nor does it prove that the fatigue observed meets ME/CFS diagnostic criteria specifically. The small sample size and lack of longitudinal data limit generalizability of findings to broader populations.
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
Limonard, G J M, Peters, J B, Nabuurs-Franssen, M H, Weers-Pothoff, G, Besselink, R, Groot, C A R, et al. (2010). Detailed analysis of health status of Q fever patients 1 year after the first Dutch outbreak: a case-control study.. QJM : monthly journal of the Association of Physicians. https://doi.org/10.1093/qjmed/hcq144
BibTeX
@article{mecfsatlas-limonard-2010-detailed-analysis,
author = {Limonard, G J M and Peters, J B and Nabuurs-Franssen, M H and Weers-Pothoff, G and Besselink, R and Groot, C A R and Dekhuijzen, P N R and Vercoulen, J H},
title = {Detailed analysis of health status of Q fever patients 1 year after the first Dutch outbreak: a case-control study.},
journal = {QJM : monthly journal of the Association of Physicians},
year = {2010},
doi = {10.1093/qjmed/hcq144},
note = {PubMed: 20802011},
url = {https://www.mecfsatlas.com/evidence/limonard-2010-detailed-analysis},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-28. https://www.mecfsatlas.com/evidence/limonard-2010-detailed-analysis
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