O'Neal, Adam J, Hanson, Maureen R · Frontiers in medicine · 2021 · DOI
This review examined whether enteroviruses—common viruses that cause colds, stomach infections, and other illnesses—might be responsible for ME/CFS. While some studies found these viruses more often in ME/CFS patients than in healthy people, the evidence has been mixed and hard to interpret. The authors argue that past research methods weren't good enough to definitively answer the question, and they call for better studies using modern technology to investigate this possibility further.
Understanding whether enteroviruses cause or contribute to ME/CFS is crucial for developing targeted treatments and explaining disease mechanisms. If enteroviral persistence is confirmed with better methods, it could open pathways to antiviral interventions and provide patients with concrete biological explanations for their symptoms. This review highlights the urgent need for well-designed studies that could finally resolve a decades-long scientific debate.
This review does not prove that enteroviruses cause ME/CFS—it identifies that past evidence is suggestive but methodologically insufficient. The review cannot establish causation from correlation, nor does it demonstrate that antiviral treatments would be effective. It also does not rule out other potential etiologies or rule in enteroviral infection as the sole cause of disease.
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
O'Neal, Adam J & Hanson, Maureen R (2021). The Enterovirus Theory of Disease Etiology in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Critical Review.. Frontiers in medicine. https://doi.org/10.3389/fmed.2021.688486
BibTeX
@article{mecfsatlas-oneal-2021-enterovirus-theory,
author = {O'Neal, Adam J and Hanson, Maureen R},
title = {The Enterovirus Theory of Disease Etiology in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Critical Review.},
journal = {Frontiers in medicine},
year = {2021},
doi = {10.3389/fmed.2021.688486},
note = {PubMed: 34222292},
url = {https://www.mecfsatlas.com/evidence/oneal-2021-enterovirus-theory},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-28. https://www.mecfsatlas.com/evidence/oneal-2021-enterovirus-theory
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