Livieratos, Achilleas, Lockley, Steven W, Tsiodras, Sotirios · EClinicalMedicine · 2025 · DOI
This article discusses how infections like COVID-19 can disrupt the body's internal 24-hour clock, leading to persistent fatigue and sleep problems. The authors explain that viral infections may damage the genes and cellular machinery that control our daily rhythms, trigger inflammation in the brain, and harm energy-producing structures in our cells. Understanding these mechanisms could help doctors develop better treatments for Long COVID and chronic fatigue syndrome.
This article bridges understanding between Long COVID and ME/CFS by highlighting shared biological mechanisms of post-infectious fatigue and circadian disruption. For patients, identifying circadian dysregulation as a treatable target offers hope for interventions beyond symptom management. For researchers, the proposed multi-system model (genetic, mitochondrial, immune, epigenetic) suggests promising avenues for biomarker discovery and therapeutic development.
This editorial does not present new experimental data or patient cohort findings—it is a literature synthesis. It does not establish which mechanisms are most important or how they interact in individual patients. It does not prove causation between circadian disruption and fatigue, only that they are mechanistically linked and frequently co-occur after infection.
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
Livieratos, Achilleas, Lockley, Steven W, & Tsiodras, Sotirios (2025). Post infectious fatigue and circadian rhythm disruption in long-COVID and other infections: a need for further research.. EClinicalMedicine. https://doi.org/10.1016/j.eclinm.2025.103073
BibTeX
@article{mecfsatlas-livieratos-2025-post-infectious,
author = {Livieratos, Achilleas and Lockley, Steven W and Tsiodras, Sotirios},
title = {Post infectious fatigue and circadian rhythm disruption in long-COVID and other infections: a need for further research.},
journal = {EClinicalMedicine},
year = {2025},
doi = {10.1016/j.eclinm.2025.103073},
note = {PubMed: 39896874},
url = {https://www.mecfsatlas.com/evidence/livieratos-2025-post-infectious},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-28. https://www.mecfsatlas.com/evidence/livieratos-2025-post-infectious
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