Milovanovic, Branislav, Markovic, Nikola, Petrovic, Masa et al. · Viruses · 2025 · DOI
This study examined 1036 patients with post-COVID syndrome, chronic fatigue syndrome, and Lyme disease to understand why they experience dizziness and fainting when standing up. Researchers performed tilt-table tests (where patients lie on a table that tilts upward) and checked for signs of past or ongoing infections through blood tests. They found that patients with evidence of multiple past infections were more likely to have abnormal responses during the tilt test, suggesting that lingering effects from infections may affect the nervous system's ability to control blood pressure and heart rate.
For ME/CFS patients, this study provides evidence that autonomic dysfunction—a hallmark symptom causing orthostatic intolerance and syncope—may be linked to lingering effects of multiple infections. Understanding this connection could lead to better diagnostic approaches and inform treatment strategies targeting both immune and autonomic components of the disease. The work supports the growing recognition that ME/CFS is a post-infectious condition with a biological basis.
This study demonstrates association, not causation—it shows that infection markers correlate with autonomic dysfunction but does not prove that infections directly cause it. Serological positivity (antibody presence) indicates past exposure, not necessarily active or persistent infection driving current symptoms. The cross-sectional design cannot establish whether antibody status precedes, accompanies, or follows the development of ANS dysfunction.
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
Milovanovic, Branislav, Markovic, Nikola, Petrovic, Masa, Stojanovic, Smiljana, Zugic, Vasko, Ostojic, Milijana, et al. (2025). The Relationship Between Hemodynamic Responses During Head-Up Tilt Testing and Parameters of Infection in Post-COVID Syndrome, Chronic Fatigue Syndrome, and Late-Stage Lyme Disease.. Viruses. https://doi.org/10.3390/v17111430
BibTeX
@article{mecfsatlas-milovanovic-2025-relationship-between,
author = {Milovanovic, Branislav and Markovic, Nikola and Petrovic, Masa and Stojanovic, Smiljana and Zugic, Vasko and Ostojic, Milijana and Bojic, Milovan},
title = {The Relationship Between Hemodynamic Responses During Head-Up Tilt Testing and Parameters of Infection in Post-COVID Syndrome, Chronic Fatigue Syndrome, and Late-Stage Lyme Disease.},
journal = {Viruses},
year = {2025},
doi = {10.3390/v17111430},
note = {PubMed: 41305452},
url = {https://www.mecfsatlas.com/evidence/milovanovic-2025-relationship-between},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-27. https://www.mecfsatlas.com/evidence/milovanovic-2025-relationship-between
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