Perera, Krishani Dinali, Cameron, Paige, Sarwar, Tayyibah et al. · International journal of molecular sciences · 2025 · DOI
Many people with ME/CFS report that their illness started after a viral infection, but scientists haven't found clear evidence of viruses in their blood. This review suggests researchers have been looking in the wrong places—focusing on blood instead of mucosal tissues (like the throat and gut lining) where viruses naturally enter the body and may hide. The authors propose that viruses could be persisting in these mucosal sites and occasionally reactivating, potentially triggering the ongoing inflammation and symptoms that characterize ME/CFS.
This perspective highlights why many viral studies in ME/CFS have produced conflicting or negative results—they may have been sampling the wrong biological sites. Understanding whether viruses persist in mucosal tissues could eventually lead to better diagnostic tests, targeted treatments, and explanation of why some patients experience post-viral illness onset.
This editorial does not provide original experimental evidence that mucosal viruses cause ME/CFS or definitively prove viruses are present in mucosal tissues of ME/CFS patients. It is a hypothesis-generating review proposing future research directions, not a definitive demonstration of causation. The connection between mucosal viral persistence and the specific symptoms of ME/CFS remains to be rigorously established.
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
Perera, Krishani Dinali, Cameron, Paige, Sarwar, Tayyibah, & Carding, Simon R (2025). Mucosal Viruses in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Missing Piece of the Puzzle?. International journal of molecular sciences. https://doi.org/10.3390/ijms262211161
BibTeX
@article{mecfsatlas-perera-2025-mucosal-viruses,
author = {Perera, Krishani Dinali and Cameron, Paige and Sarwar, Tayyibah and Carding, Simon R},
title = {Mucosal Viruses in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Missing Piece of the Puzzle?},
journal = {International journal of molecular sciences},
year = {2025},
doi = {10.3390/ijms262211161},
note = {PubMed: 41303644},
url = {https://www.mecfsatlas.com/evidence/perera-2025-mucosal-viruses},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-26. https://www.mecfsatlas.com/evidence/perera-2025-mucosal-viruses
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