Chronic fatigue syndromes: relationship to chronic viral infections.
Komaroff, A L · Journal of virological methods · 1988 · DOI
Quick Summary
This review examines whether ME/CFS (a condition causing severe, long-lasting tiredness) is connected to chronic viral infections, particularly herpes-type viruses. The authors found that ME/CFS often starts suddenly like the flu and is associated with symptoms like fever, sore throat, and muscle pain. While blood tests sometimes show signs of viral infection, particularly Epstein-Barr virus and human herpesvirus-6, the study could not prove that these viruses actually cause ME/CFS.
Why It Matters
This early synthesis of viral associations in ME/CFS helped establish the foundation for decades of research investigating infectious triggers in the disease. Understanding potential viral connections remains important because it may inform treatment strategies and help explain why some patients report flu-like illness preceding symptom onset.
Observed Findings
ME/CFS typically begins suddenly with acute flu-like illness
Common symptoms include chronic fever, pharyngitis, myalgias, adenopathy, and cognitive difficulties
Laboratory abnormalities sometimes observed include lymphocytosis, atypical lymphocytes, monocytosis, and elevated hepatocellular enzymes
Serologic evidence suggests associations with multiple human herpesviruses, particularly EBV and HBLV/HHV-6
Immune abnormalities include low-level antinuclear antibodies and low immune complexes in some patients
Inferred Conclusions
ME/CFS shows clinical and serologic associations with chronic viral infections, particularly human herpesviruses
The pattern of acute viral-like illness onset suggests a possible infectious trigger mechanism
Multiple herpesvirus associations suggest either reactivation of latent infection or inability to control persistent viral replication in CFS patients
No single herpesvirus has yet been identified as the definitive causal agent
Remaining Questions
Does herpesvirus infection cause ME/CFS, or do CFS patients simply have difficulty clearing or controlling chronic viral infection?
What This Study Does Not Prove
This review does not prove that any herpesvirus causes ME/CFS—it only documents that associations exist. The study cannot determine whether viral infection triggers the disease, perpetuates it, or is merely coincidental. No causality can be established from serologic association alone.
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 →