Moutschen, M, Triffaux, J M, Demonty, J et al. · Acta clinica Belgica · 1994 · DOI
This review examined research on ME/CFS and related fatigue conditions that develop after viral infections, looking at five main areas: infectious triggers, immune system problems, muscle function, hormonal imbalances, and psychiatric factors. The authors suggest that abnormalities in the body's stress-hormone system (HPA axis) may be a primary cause, leading to chronic immune activation and reactivation of dormant viruses like those in the herpes family, which then cause muscle weakness and fatigue symptoms.
This review was influential in proposing an integrated biological model for ME/CFS that moves beyond single-agent theories and identifies the HPA axis as a potential central mechanism linking immune dysregulation, viral reactivation, and symptom generation. Understanding these interconnected pathways is important for developing targeted treatments and validating biomarkers.
This review does not prove causation—elevated antibodies and viral reactivation may be consequences rather than causes of immune dysfunction. The model remains theoretical and based on literature synthesis; it does not constitute new experimental evidence. The review also does not establish which pathway abnormalities are primary versus secondary or whether all patients follow the same pathogenic mechanism.
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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