Complex Post-infection Fatigue Syndromes: The Case of ME/CFS

February 28, 2022


This Research Topic collects further pieces of evidence about how various viruses including SARS-CoV-2 can trigger ME/CFS. The neglect of research in ME/CFS during the last decades has left patients, carers, and clinicians alike adrift without a licensed drug to use in the disease.

On the one hand, the COVID-19 pandemic will result in an unprecedented explosion of ME/CFS cases. At the same time, this pandemic is the perfect storm that can motivate different stakeholders, including funders and clinicians, to take the necessary steps to accelerate research on ME/CFS and other post-infectious syndromes.

If taken, these steps will bring hope to all those outstanding patients who have been homebound or even bedridden for many years but neglected by national health authorities.

This is a joint editorial from Drs Francisco Westermeier, Eliana Lacerda, Carmen Scheibenbogen and Nuno Sepúlveda.

  • Dr Westermeier is a research scientist from Austria who has been working on various aspects of ME/CFS research using blood samples from the ME Biobank – a unique piece of research infrastructure that is funded by the ME Association Ramsay Research Fund. There has not been very much interest in ME/CFS from both clinicians and researchers in Austria – so this research interest is clearly an encouraging development.
  • Dr Eliana Lacerda is one of my colleagues at the ME/CFS Biobank in London.
  • Dr Carmen Scheibenbogen is from Berlin and has published a number of papers on immunological aspects of ME/CFS.
  • Dr Nuno Sepulveda is from Lisbon, Portugal, and has been working with the ME/CFS Biobank team at the London School of Hygiene and Tropical Medicine.

FULL ARTICLE: Current Insights Into Complex Post-infection Fatigue Syndromes With Unknown Aetiology: The Case of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and Beyond

Old and New Viral Triggers of ME/CFS

Early on, it was immediately recognized the impact of herpesviruses on the pathology of ME/CFS (911). Follow-up studies made clear that other viruses could also elicit the disease (12). However, the respective pathological mechanisms remain to be uncovered. In this regard, O'Neal and Hanson offered a critical review about past research on enteroviruses as causative agents of ME/CFS.

Another interesting review was conducted by Lidbury who discussed the immune evasion strategies of the Ross River virus, which is an arbovirus endemic to Australia, Papua New Guinea, and other islands in the South Pacific. We foresee this review to be useful for understanding post-infection fatigue syndromes due to other arboviruses, such as the Chikungunya, Dengue, and Zika. In this regard, it is a priority to study the burden of post-infection fatigue among Brazilian or Cape Verdean survivors who suffered from recent outbreaks of these arboviruses (1314).

Finally, Lee et al. and Domingues et al. provided new research on herpesviruses in patients from the United Kingdom ME/CFS biobank. The first study is a rare longitudinal analysis of multiple herpesviruses in patients with ME/CFS; such studies should become standard given the natural fluctuations in disease dynamics. The second study concerns a re-analysis of published serological data using a stratification based on infection and non-infection triggers. The findings of this study clearly show the necessity of stratifying patients adequately, as suggested by Jason et al. (15).

With the onset of the COVID-19 pandemic, a new viral trigger of ME/CFS is currently spreading across the world: SARS-CoV-2. Past experience with the “original” SARS-CoV pandemic suggested this coronavirus as another trigger of ME/CFS (16). Before any mainstream discussion about “long-COVID” or “post-acute sequelae SARS-CoV-2 infection”, Komaroff and Bateman on behalf of the US ME/CFS clinician coalition drafted a sort of memorandum alerting for the devastating long-term consequences in survivors of SARS-CoV-2 infections.

In turn, Petracek et al. reported probably the first three ME/CFS cases after 6 months of SARS-CoV-2 infections. Other studies published elsewhere provide further evidence that some long-COVID patients suffer from ME/CFS (1718) and, as such, there is a window of opportunity to improve the understanding of both conditions.

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