E3 PreliminaryPreliminaryPEM requiredReview-NarrativePeer-reviewedReviewed
COVID-19 and post-infectious myalgic encephalomyelitis/chronic fatigue syndrome: a narrative review.
Poenaru, Sonia, Abdallah, Sara J, Corrales-Medina, Vicente et al. · Therapeutic advances in infectious disease · 2021 · DOI
Quick Summary
Some people who recover from COVID-19 continue experiencing prolonged symptoms like fatigue, difficulty breathing, and brain fog for months afterward. These lingering symptoms are remarkably similar to ME/CFS, a chronic illness characterized by severe fatigue that worsens with activity. While COVID-19 could potentially trigger ME/CFS in some people, researchers currently don't have enough evidence to confirm this connection.
Why It Matters
This review highlights critical similarities between post-COVID symptoms and ME/CFS, raising awareness among clinicians and patients about a potential new disease mechanism and population at risk. Understanding COVID-19's potential role in triggering ME/CFS could improve early identification, prevention strategies, and clinical management for both conditions.
Observed Findings
- Post-acute COVID-19 symptoms include fatigue, dyspnea, myalgia, exercise intolerance, sleep disturbances, cognitive impairment, anxiety, fever, headache, malaise, and vertigo
- These post-COVID symptoms closely resemble the core clinical features of ME/CFS
- ME/CFS has previously been associated with several infectious agents including Epstein-Barr Virus, Q fever, influenza, and other coronaviruses
- ME/CFS is characterized by multi-system dysfunction with unclear pathophysiology thought to involve dysregulation of multiple biological systems
Inferred Conclusions
- Important clinical and symptomatic similarities exist between post-acute COVID-19 syndrome and ME/CFS that warrant further investigation
- COVID-19 may represent a potential infectious trigger for ME/CFS development in susceptible individuals, though current evidence is insufficient to confirm this relationship
- Future research must define the natural history, prevalence, and risk factors for post-COVID ME/CFS to improve patient outcomes
Remaining Questions
- What is the actual prevalence and incidence of ME/CFS following COVID-19 infection across different populations?
- What are the biological and genetic risk factors that determine whether COVID-19 triggers ME/CFS in certain patients?
What This Study Does Not Prove
This narrative review does not establish COVID-19 as a confirmed infectious trigger for ME/CFS—it identifies important clinical similarities but lacks definitive epidemiological or mechanistic proof. The review acknowledges that symptom overlap does not prove causation, and determining actual incidence and risk factors requires prospective longitudinal research beyond this scope.
Tags
Method Flag:PEM_DEFINEDEXPLORATORYPEM Not DefinedExploratory Only
Symptom:Post-Exertional MalaiseCognitive DysfunctionUnrefreshing SleepOrthostatic IntolerancePainFatigueTemperature Dysregulation
Phenotype:Infection-TriggeredLong COVID Overlap
Metadata
- DOI
- 10.1177/20499361211009385
- PMID
- 33959278
- Review status
- Editor reviewed
- Evidence level
- Early hypothesis, preprint, editorial, or weak support
- Last updated
- 7 April 2026
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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