Mørch, Kristine, Hanevik, Kurt, Rivenes, Ann C et al. · BMC gastroenterology · 2013 · DOI
After a water contamination outbreak in Norway, researchers followed people who developed severe tiredness following a Giardia intestinal infection. Five years after infection, they found that about 41% of patients still had chronic fatigue syndrome, while about 21% had recovered completely. The study also identified other conditions like sleep problems and depression that sometimes occur alongside post-infectious fatigue.
This study provides longitudinal evidence that ME/CFS can develop and persist years after specific infectious triggers, supporting the post-infectious etiology hypothesis in ME/CFS research. It also identifies sleep apnea and mood disorders as important comorbidities that may complicate or contribute to post-infectious fatigue, relevant for differential diagnosis and comprehensive patient management.
The study does not establish that Giardia causes ME/CFS in all exposed individuals or explain the biological mechanisms of post-infectious fatigue. The small sample size (n=53) limits generalizability, and the lack of a control group of non-fatigued giardiasis patients prevents determination of whether observed comorbidities are causally related or coincidental.
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
Mørch, Kristine, Hanevik, Kurt, Rivenes, Ann C, Bødtker, Jørn E, Næss, Halvor, Stubhaug, Bjarte, et al. (2013). Chronic fatigue syndrome 5 years after giardiasis: differential diagnoses, characteristics and natural course.. BMC gastroenterology. https://doi.org/10.1186/1471-230X-13-28
BibTeX
@article{mecfsatlas-mrch-2013-chronic-fatigue,
author = {Mørch, Kristine and Hanevik, Kurt and Rivenes, Ann C and Bødtker, Jørn E and Næss, Halvor and Stubhaug, Bjarte and Wensaas, Knut-Arne and Rortveit, Guri and Eide, Geir E and Hausken, Trygve and Langeland, Nina},
title = {Chronic fatigue syndrome 5 years after giardiasis: differential diagnoses, characteristics and natural course.},
journal = {BMC gastroenterology},
year = {2013},
doi = {10.1186/1471-230X-13-28},
note = {PubMed: 23399438},
url = {https://www.mecfsatlas.com/evidence/mrch-2013-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/mrch-2013-chronic-fatigue
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