Shikova, Evelina, Reshkova, Valentina, Kumanova, Аntoniya et al. · Journal of medical virology · 2020 · DOI
Researchers tested 58 ME/CFS patients and 50 healthy people for three common viruses (EBV, CMV, and HHV-6) that have been suspected of triggering ME/CFS. They found that ME/CFS patients had significantly higher rates of active EBV infection in their bloodstream compared to healthy people, though most people in both groups carried these viruses in a dormant state. This suggests that for some patients, active EBV infection may play a role in ME/CFS development.
This study provides evidence that active EBV reactivation may contribute to ME/CFS pathogenesis in at least some patients, moving beyond speculation to measured biological differences. Understanding which viral infections are actually active versus dormant could guide targeted treatment approaches and help identify disease subtypes within the ME/CFS population.
This study does not prove that EBV causes ME/CFS—only that active EBV infection is more common in ME/CFS patients. It does not explain whether the virus triggers the disease, results from it, or is coincidentally associated. The findings cannot be generalized beyond Bulgarian populations without further research.
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
Shikova, Evelina, Reshkova, Valentina, Kumanova, Аntoniya, Raleva, Sevdalina, Alexandrova, Dora, Capo, Natasa, et al. (2020). Cytomegalovirus, Epstein-Barr virus, and human herpesvirus-6 infections in patients with myalgic еncephalomyelitis/chronic fatigue syndrome.. Journal of medical virology. https://doi.org/10.1002/jmv.25744
BibTeX
@article{mecfsatlas-shikova-2020-cytomegalovirus-epstein,
author = {Shikova, Evelina and Reshkova, Valentina and Kumanova, Аntoniya and Raleva, Sevdalina and Alexandrova, Dora and Capo, Natasa and Murovska, Modra and On Behalf Of The European Network On Me/Cfs Euromene},
title = {Cytomegalovirus, Epstein-Barr virus, and human herpesvirus-6 infections in patients with myalgic еncephalomyelitis/chronic fatigue syndrome.},
journal = {Journal of medical virology},
year = {2020},
doi = {10.1002/jmv.25744},
note = {PubMed: 32129496},
url = {https://www.mecfsatlas.com/evidence/shikova-2020-cytomegalovirus-epstein},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-29. https://www.mecfsatlas.com/evidence/shikova-2020-cytomegalovirus-epstein
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