Manchal, Naveen, Adegboye, Oyelola A, Eisen, Damon P · European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2020 · DOI
This study looked at chronic Q fever, a bacterial infection that can cause long-term complications beyond heart valve infections. Researchers found that when chronic Q fever affects bones, blood vessels, or causes abscesses (pockets of infection), patients experience significantly more pain than other forms of the disease. Importantly, the study reviewed existing research to understand how pain and fatigue appear in these less common forms of chronic Q fever.
This research highlights that chronic Q fever presents with diverse clinical manifestations that may mimic other conditions, including CFS-like presentations. Understanding these pain-associated complications is clinically important for avoiding diagnostic delays and inappropriate management in patients with chronic infection serology.
This systematic review does not prove that fatigue is unrelated to these chronic Q fever manifestations—the lack of significant association may reflect study limitations or heterogeneity in fatigue reporting. The study does not establish causation, only associations, and findings may not generalize globally given reported regional disease pattern variations. It also explicitly excludes chronic fatigue syndrome cases, limiting relevance to understanding CFS-Q fever 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 →
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
Manchal, Naveen, Adegboye, Oyelola A, & Eisen, Damon P (2020). A systematic review on the health outcomes associated with non-endocarditis manifestations of chronic Q fever.. European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology. https://doi.org/10.1007/s10096-020-03931-7
BibTeX
@article{mecfsatlas-manchal-2020-systematic-review,
author = {Manchal, Naveen and Adegboye, Oyelola A and Eisen, Damon P},
title = {A systematic review on the health outcomes associated with non-endocarditis manifestations of chronic Q fever.},
journal = {European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology},
year = {2020},
doi = {10.1007/s10096-020-03931-7},
note = {PubMed: 32661808},
url = {https://www.mecfsatlas.com/evidence/manchal-2020-systematic-review},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/manchal-2020-systematic-review
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