Sandler, Carolina X, Lloyd, Andrew R · The Medical journal of Australia · 2020 · DOI
ME/CFS affects about 1 in 100 people who visit their doctor, but there's currently no single test to diagnose it. The main symptom is extreme tiredness that affects both physical activities and thinking, and it gets worse after doing tasks that used to be manageable. Doctors can diagnose ME/CFS by recognizing the typical fatigue pattern, ruling out other conditions through examination and basic tests, though more research is needed to fully understand what causes it.
This synthesis clarifies what ME/CFS is not, reducing diagnostic confusion and directing future research toward functional neuroimaging and genetic studies. For patients, improved clinician education based on these diagnostic criteria can reduce delays in diagnosis and appropriate supportive care, while for researchers, the identified knowledge gaps highlight priorities for large-scale studies needed to advance the field.
This editorial does not prove the specific mechanisms of brain dysfunction in ME/CFS or identify the precise genetic variants involved, as it calls for larger studies to answer these questions. It also does not establish a causal relationship between infections and disease—only that infections are temporally associated with onset in some cases. The review cannot validate any single diagnostic biomarker, as it explicitly states none currently exists.
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
Sandler, Carolina X & Lloyd, Andrew R (2020). Chronic fatigue syndrome: progress and possibilities.. The Medical journal of Australia. https://doi.org/10.5694/mja2.50553
BibTeX
@article{mecfsatlas-sandler-2020-chronic-fatigue,
author = {Sandler, Carolina X and Lloyd, Andrew R},
title = {Chronic fatigue syndrome: progress and possibilities.},
journal = {The Medical journal of Australia},
year = {2020},
doi = {10.5694/mja2.50553},
note = {PubMed: 32248536},
url = {https://www.mecfsatlas.com/evidence/sandler-2020-chronic-fatigue},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/sandler-2020-chronic-fatigue
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