Bertram, G, Dreiner, N, Krueger, G R et al. · In vivo (Athens, Greece) · 1991
This study looked at 215 patients with infectious mononucleosis to see which viruses were causing their illness. Researchers found that most patients had Epstein-Barr virus (EBV), but many also had human herpesvirus-6 (HHV-6) at the same time. About 40% of patients had active infection with both viruses, and some had a third virus (CMV) as well. Patients were followed for two years to track changes in their virus levels.
This study is relevant to ME/CFS research because it documents that HHV-6 reactivation commonly occurs during acute infectious mononucleosis and that persistent HHV-6 infection may accompany post-infectious chronic fatigue syndrome in over 60% of cases. Understanding herpesvirus coinfection patterns during acute illness may help explain why some people develop prolonged fatigue after infection.
This study does not establish that HHV-6 causes ME/CFS or post-infectious chronic fatigue syndrome—it only shows correlation between HHV-6 presence and these conditions. The cross-sectional design cannot determine causality or whether HHV-6 reactivation is a cause or consequence of immune dysregulation. The study also does not explain why some patients with dual infection recover while others develop chronic fatigue.
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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