Mantovani, Elisa, Mariotto, Sara, Gabbiani, Daniele et al. · Journal of neurovirology · 2021 · DOI
Some people who recover from COVID-19 continue to experience symptoms that look very similar to ME/CFS, including severe tiredness, pain, and difficulty thinking clearly. This study found that about 27% of COVID-19 survivors had these ME/CFS-like symptoms, and they reported worse sleep, more fatigue, and more difficulty with basic activities compared to those who recovered normally. The researchers measured markers of nerve damage and inflammation to understand what might be causing these symptoms.
This study highlights the potential for ME/CFS-like illness to emerge as a major long-term consequence of COVID-19, affecting millions of survivors globally. Understanding the overlap and potential shared mechanisms between post-COVID ME/CFS-like syndrome and primary ME/CFS is crucial for developing diagnostic criteria, identifying at-risk populations, and informing treatment strategies for both conditions.
This study does not establish that COVID-19 causes ME/CFS or definitively identify the mechanisms responsible for these symptoms—it demonstrates association only. The cross-sectional design cannot determine whether ME/CFS-like symptoms are causally related to SARS-CoV-2 infection, persistent viral effects, or represent pre-existing vulnerabilities unmasked by infection. The study does not prove that axonal damage, inflammation, or lung changes are the primary drivers of symptoms.
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
Mantovani, Elisa, Mariotto, Sara, Gabbiani, Daniele, Dorelli, Gianluigi, Bozzetti, Silvia, Federico, Angela, et al. (2021). Chronic fatigue syndrome: an emerging sequela in COVID-19 survivors?. Journal of neurovirology. https://doi.org/10.1007/s13365-021-01002-x
BibTeX
@article{mecfsatlas-mantovani-2021-chronic-fatigue,
author = {Mantovani, Elisa and Mariotto, Sara and Gabbiani, Daniele and Dorelli, Gianluigi and Bozzetti, Silvia and Federico, Angela and Zanzoni, Serena and Girelli, Domenico and Crisafulli, Ernesto and Ferrari, Sergio and Tamburin, Stefano},
title = {Chronic fatigue syndrome: an emerging sequela in COVID-19 survivors?},
journal = {Journal of neurovirology},
year = {2021},
doi = {10.1007/s13365-021-01002-x},
note = {PubMed: 34341960},
url = {https://www.mecfsatlas.com/evidence/mantovani-2021-chronic-fatigue},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-26. https://www.mecfsatlas.com/evidence/mantovani-2021-chronic-fatigue
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