The persistence of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) after SARS-CoV-2 infection: A systematic review and meta-analysis

J Infect. 2024 Dec;89(6):106297. doi: 10.1016/j.jinf.2024.106297. Epub 2024 Sep 29.

Abstract

Objectives: Long COVID-19 (LC) patients experience a number of chronic idiopathic symptoms that are highly similar to those of post-viral myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). We have therefore performed a systematic review and meta-analysis to determine the proportion of LC patients that satisfy ME/CFS diagnostic criteria.

Methods: Clinical studies published between January 2020 and May 2023 were identified using the PubMed, Web of Science, Embase and CINAHL databases. Publication inclusion/exclusion criteria were formulated using the global CoCoPop framework. Data were pooled using a random-effects model with a restricted maximum-likelihood estimator. Study quality was assessed using the Joanna Briggs Institute critical assessment tool.

Results: We identified 13 eligible studies that reported a total of 1973 LC patients. Our meta-analysis indicated that 51% (95% CI, 42%-60%) of LC patients satisfied ME/CFS diagnostic criteria, with fatigue, sleep disruption, and muscle/joint pain being the most common symptoms. Importantly, LC patients also experienced the ME/CFS hallmark symptom, post-exertional malaise.

Conclusions: Our study not only demonstrates that LC patients exhibit similar symptom clusters to ME/CFS, but that approximately half of LC patients satisfy a diagnosis of ME/CFS. Our findings suggest that current ME/CFS criteria could be adapted to the identification of a subset of LC patients that may facilitate the standardised diagnosis, management and the recruitment for clinical studies in the future.

Keywords: Chronic fatigue syndrome; Diagnosis; Long-COVID; Long-haul COVID-19; Meta-analysis; Myalgic encephalomyelitis/chronic fatigue syndrome; Post-acute sequelae of COVID-19; Post-exertional malaise; Post-viral syndrome; Prevalence.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • COVID-19* / complications
  • COVID-19* / physiopathology
  • COVID-19* / virology
  • Fatigue Syndrome, Chronic* / diagnosis
  • Fatigue Syndrome, Chronic* / physiopathology
  • Fatigue Syndrome, Chronic* / virology
  • Humans
  • Post-Acute COVID-19 Syndrome* / diagnosis
  • Post-Acute COVID-19 Syndrome* / physiopathology
  • Post-Acute COVID-19 Syndrome* / virology
  • SARS-CoV-2