Does Frequency of a Myalgic Encephalomyelitis/Chronic Fatigue Syndrome-Like Illness Vary Between Those with Differing COVID Test Results?

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Chronic medical syndromes can take place following various acute infections, such as post–Epstein Barr virus syndrome and postpolio syndrome.^1,2 Known as postacute infection syndromes (PAISs), they present similar symptoms, such as cognitive issues, an intolerance to exertion, and functional impairment related to fatigue. One condition—Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)—is quite characteristic of PAIS, with it being a debilitating condition that is related a prior acute influenza-like illness.^3,4

As many may know, fatigue also happens to be a common symptom among patients experiencing post-COVID condition or long COVID (also known as postacute sequelae) so when compared alongside one another, the symptoms of COVID-19 and other PAISs overlap quite a bit with that of ME/CFS. Since this suggests that many patients could be affected, a study published in JAMA Network Open⁵ sought to analyze the occurrence of ME/CFS among Innovative Support for Patients with SARS-CoV-2 Infections Registry (INSPIRE) individuals after experiencing a symptomatic acute illness that caused them to conduct a COVID-19 test. The odds of ME/CFS in the COVID-19–positive cohort and the COVID-19–negative cohort were then compared.

This multisite, longitudinal cohort study enrolled INSPIRE patients from Dec.11, 2020, to Aug. 29, 2022, ages 18-64 years, who were not only experiencing acute symptoms similar to that of SARS-CoV-2 infection, but who were provided with an FDA-approved SARS-CoV-2 test at the time and did not pass away or remove themselves from the study by three months. Investigators conducted follow-up surveys through Feb. 28, 2023.

In total, the study consisted of 4,738 participants, with females representing 3,226, or [68.1% of the total; their mean (SD) age was 37.8 (11.8) years. The survey’s completion rates varied from 38.7% (1,835 of 4,738 participants) to 76.3% (3,613 of 4,738) and decreased as time went on.

The weighted proportion of individuals that identified with an ME/CFS-like illness did not drastically change at month 3 through month 12 of follow-up, which was comparable to the COVID-19–positive (range, 2.8%-3.7%) and COVID-19–negative (range, 3.1%-4.5%) groups. Also, adjusted analyses did not show any significant difference in the odds of ME/CFS-like illness at any time point between COVID-19–positive and COVID-19–negative individuals (marginal odds ratio range, 0.84 [95% confidence interval CI, 0.42-1.67] to 1.18 [95% CI, 0.55-2.51]).

As a result, the investigators concluded that, “In this prospective, multicenter cohort study of participants with acute infection–like symptoms prompting SARS-CoV-2 testing, the prevalence of ME/CFS symptoms was similar between COVID-19–positive and COVID-19–negative individuals. At 12 months, 2.8% of those in the COVID-19–positive group and 4.5% in the COVID-19–negative group met the definition of ME/CFS. Our findings suggest that ME/CFS may follow several precipitating events (acute COVID-19 illness, other acute infections, or life disruptions due to the COVID-19 pandemic) but that regardless of reason or exact percentages, there will be millions affected who will seek care.”

References

1. Choutka J, Jansari V, Hornig M, Iwasaki A. Unexplained post-acute infection syndromes. Nat Med. 2022;28(5):911-923. doi:10.1038/s41591-022-01810-6PubMed

2. Komaroff AL, Bateman L. Will COVID-19 lead to myalgic encephalomyelitis/chronic fatigue syndrome? Front Med (Lausanne). 2021;7:606824. doi:10.3389/fmed.2020.606824

3. Kujawski S, Zalewski P, Newton JL. Do some long COVID patients suffer from ME/CFS?Medical Research Journal. 2021;6(4):279-280. doi:10.5603/MRJ.a2021.0049

4. Naess H, Sundal E, Myhr KM, Nyland HI. Postinfectious and chronic fatigue syndromes: clinical experience from a tertiary-referral center in Norway.In Vivo. 2010;24(2):185-188.

5. Unger ER, Lin JS, Wisk LE, et al. Myalgic Encephalomyelitis/Chronic Fatigue Syndrome After SARS-CoV-2 Infection. JAMA Netw Open. 2024;7(7):e2423555. doi:10.1001/jamanetworkopen.2024.23555