Nunes, Jean M, Kell, Douglas B, Pretorius, Etheresia · Viruses · 2024 · DOI
This review examines the theory that a common virus family (herpesviruses) may infect the blood vessel lining in ME/CFS patients, potentially causing the disease's widespread symptoms. When these viruses damage blood vessels, they may disrupt blood flow, increase clotting problems, and affect brain function—all hallmarks of ME/CFS. The researchers suggest this endothelial (blood vessel) damage could explain why ME/CFS is chronic and affects multiple body systems.
This hypothesis-generating review offers a potentially unifying mechanistic explanation for ME/CFS's heterogeneous symptom profile and multisystem involvement, which could redirect clinical research toward targeted antiviral or endothelial-protective therapies. Understanding the role of persistent herpesvirus infection in endothelial dysfunction may also illuminate overlaps with Long COVID and inform prevention or treatment strategies.
This review does not establish that herpesviruses are actually present in or infecting endothelial cells in ME/CFS patients—it is a hypothesis-building synthesis rather than original research with patient data. Correlation between herpesvirus serology and endothelial markers in ME/CFS has not been formally demonstrated in this review. The mechanism remains theoretical and requires prospective studies with direct measurement of viral load and endothelial injury in patient populations.
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 →
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Primary citation
Nunes, Jean M, Kell, Douglas B, & Pretorius, Etheresia (2024). Herpesvirus Infection of Endothelial Cells as a Systemic Pathological Axis in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome.. Viruses. https://doi.org/10.3390/v16040572
BibTeX
@article{mecfsatlas-nunes-2024-herpesvirus-infection,
author = {Nunes, Jean M and Kell, Douglas B and Pretorius, Etheresia},
title = {Herpesvirus Infection of Endothelial Cells as a Systemic Pathological Axis in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome.},
journal = {Viruses},
year = {2024},
doi = {10.3390/v16040572},
note = {PubMed: 38675914},
url = {https://www.mecfsatlas.com/evidence/nunes-2024-herpesvirus-infection},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-25. https://www.mecfsatlas.com/evidence/nunes-2024-herpesvirus-infection
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