Milovanović, Branislav, Marković, Nikola, Ristanović, Elizabeta et al. · Pathogens (Basel, Switzerland) · 2025 · DOI
This study looked at how the autonomic nervous system (the part that controls heart rate, blood pressure, and other automatic body functions) works in people who had acute infection with Coxiella burnetii, a bacterium that causes Q fever. Researchers tested 100 infected patients and 56 healthy controls using heart monitoring tests and found that infected patients had more problems with autonomic control, particularly in how their bodies regulate heart rate and blood pressure. These findings suggest that this infection might trigger lasting problems with the autonomic nervous system that could contribute to ME/CFS symptoms.
ME/CFS patients and researchers have long suspected autonomic dysfunction as a key mechanism in post-infectious ME/CFS. This study provides objective physiological evidence that acute Coxiella burnetii infection can trigger measurable autonomic nervous system dysfunction, strengthening the biological plausibility of infection-triggered autonomic abnormalities in ME/CFS development. Understanding these mechanisms may guide future diagnostic approaches and therapeutic targets.
This study does not prove that Coxiella burnetii infection directly causes ME/CFS, only that it is associated with autonomic dysfunction in some patients. The cross-sectional design cannot establish causation or determine whether autonomic dysfunction persists long-term or predicts ME/CFS development. The findings in acutely infected patients may not apply to all ME/CFS cases or other post-infectious conditions.
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
Milovanović, Branislav, Marković, Nikola, Ristanović, Elizabeta, Atanasievska Kujović, Sonja, Đorđevski, Nikoleta, Petrovic, Masa, et al. (2025). Autonomic Dysfunction in Patients with Acute Infection with <i>Coxiella burnetii</i>.. Pathogens (Basel, Switzerland). https://doi.org/10.3390/pathogens15010003
BibTeX
@article{mecfsatlas-milovanovi-2025-autonomic-dysfunction,
author = {Milovanović, Branislav and Marković, Nikola and Ristanović, Elizabeta and Atanasievska Kujović, Sonja and Đorđevski, Nikoleta and Petrovic, Masa and Milošević, Milica and Bulatovic, Sulin and Bojić, Milovan},
title = {Autonomic Dysfunction in Patients with Acute Infection with <i>Coxiella burnetii</i>.},
journal = {Pathogens (Basel, Switzerland)},
year = {2025},
doi = {10.3390/pathogens15010003},
note = {PubMed: 41598987},
url = {https://www.mecfsatlas.com/evidence/milovanovi-2025-autonomic-dysfunction},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-29. https://www.mecfsatlas.com/evidence/milovanovi-2025-autonomic-dysfunction
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