Does Coxsackievirus (Coxsackie virus) cause Chronic Fatigue Syndrome (CFS)?

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Last updated: May 25, 2025View editorial policy

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From the Guidelines

Coxsackie virus is not definitively proven to cause Chronic Fatigue Syndrome (CFS), but it may be a potential trigger in some cases, as suggested by the complex interplay of viral infections, immune system dysregulation, and other factors in the development of ME/CFS. The relationship between Coxsackie virus and CFS is likely complex, involving multiple factors such as immune system dysregulation, genetic predisposition, and environmental factors 1. According to a recent study published in Nature Reviews Microbiology, ME/CFS is a multisystem neuroimmune illness with onset often following a viral or bacterial infection, and a wide range of pathogens, including EBV, Coxiella burnetii, Ross River virus, and West Nile virus, can cause ME/CFS onset 1.

While Coxsackie virus, an enterovirus, can cause acute infections with symptoms like fever, sore throat, and muscle pain, and in some patients, these infections appear to precede the development of CFS symptoms, no single pathogen, including Coxsackie, has been established as the definitive cause of CFS 1. The condition appears to involve complex interactions between infectious triggers, immune dysfunction, neurological abnormalities, and other physiological systems, making it difficult to attribute CFS to any single cause. Key findings in ME/CFS include diminished natural killer cell function, T cell exhaustion, mitochondrial dysfunction, and vascular and endothelial abnormalities, which are also observed in long COVID studies 1.

Some of the key points to consider in the relationship between Coxsackie virus and CFS include:

  • The potential for Coxsackie virus to trigger CFS symptoms in susceptible individuals
  • The complex interplay of viral infections, immune system dysregulation, and other factors in the development of ME/CFS
  • The lack of definitive evidence establishing Coxsackie virus as the sole cause of CFS
  • The presence of consistent abnormal findings in ME/CFS, including diminished natural killer cell function, T cell exhaustion, and mitochondrial dysfunction 1.

Overall, while Coxsackie virus may play a role in the development of CFS in some cases, the relationship is complex and multifactorial, and further research is needed to fully understand the causes of ME/CFS 1.

From the Research

Coxsackie Virus and Chronic Fatigue Syndrome (CFS)

  • There is no direct evidence in the provided studies that links Coxsackie virus to Chronic Fatigue Syndrome (CFS) 2, 3, 4, 5, 6.
  • The studies focus on the treatment and management of CFS, including cognitive behavioral therapy 4, valacyclovir treatment 3, 5, and graded exercise therapy 6.
  • Some studies suggest that CFS may be triggered by viral infections, but the evidence is not specific to Coxsackie virus 2, 3.
  • The exact cause of CFS remains unclear, and it is likely that the condition is the result of a complex interplay of factors, including viral infections, genetic predisposition, and environmental factors 2.

Treatment and Management of CFS

  • Cognitive behavioral therapy has been shown to be effective in reducing fatigue and improving physical functioning in patients with CFS 4.
  • Valacyclovir treatment has been used to treat CFS in patients with evidence of viral infection, such as Epstein-Barr virus 3, 5.
  • Graded exercise therapy has also been shown to be effective in improving fatigue, physical functioning, and work and social adjustment in patients with CFS 6.
  • These treatments may be used alone or in combination to manage the symptoms of CFS and improve patient outcomes 2, 3, 4, 5, 6.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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