Increased risk of chronic fatigue syndrome following infection: a 17-year population-based cohort study

• Published in: Journal of translational medicine Vol. 21; no. 1; pp. 1 - 12
• Main Authors: Chang, Hsun, Kuo, Chien-Feng, Yu, Teng-Shun, Ke, Liang-Yin, Hung, Chung-Lieh, Tsai, Shin-Yi
• Format: Journal Article
• Language: English
• Published: London BioMed Central 11.11.2023; BioMed Central Ltd; BMC
• Subjects: Antibiotics; Azithromycin; B cells; Bacteria; Biomedical and Life Sciences; Biomedicine; Chlamydia; Chronic fatigue syndrome; Chronic infection; Chronic obstructive pulmonary disease; Ciprofloxacin; Cohort analysis; Cytokines; Cytomegalovirus; Data analysis; Dengue fever; Doxycycline; E coli; Epstein-Barr virus; Escherichia coli; Fatigue; Fibromyalgia; Hepatitis; Hypothalamic–pituitary–adrenal axis; Illnesses of Unknown Etiology; Infection; Infections; Influenza; Influenza viruses; Irritable bowel syndrome; Levofloxacin; Medical research; Medicine, Experimental; Medicine/Public Health; Moxifloxacin; Multiple sclerosis; Myalgic encephalomyelitis; National health insurance; Pathogen; Pathogens; Population; Population studies; Salmonella; Tetracycline; Tetracyclines; Tuberculosis; Ulcers; Varicella; Viruses; Taiwan; United States > US; Infection; Hypothalamic–pituitary–adrenal axis; Fatigue; Autoimmune; Pathogen; Myalgic encephalomyelitis; Chronic fatigue syndrome
• ISSN: 1479-5876; 1479-5876
• DOI: 10.1186/s12967-023-04636-z

Background Previous serological studies have indicated an association between viruses and atypical pathogens and Chronic Fatigue Syndrome (CFS). This study aims to investigate the correlation between infections from common pathogens, including typical bacteria, and the subsequent risk of developing CFS. The analysis is based on data from Taiwan’s National Health Insurance Research Database. Methods From 2000 to 2017, we included a total of 395,811 cases aged 20 years or older newly diagnosed with infection. The cases were matched 1:1 with controls using a propensity score and were followed up until diagnoses of CFS were made. Results The Cox proportional hazards regression analysis was used to estimate the relationship between infection and the subsequent risk of CFS. The incidence density rates among non-infection and infection population were 3.67 and 5.40 per 1000 person‐years, respectively (adjusted hazard ratio [HR] = 1.5, with a 95% confidence interval [CI] 1.47–1.54). Patients infected with Varicella-zoster virus, Mycobacterium tuberculosis , Escherichia coli , Candida , Salmonella , Staphylococcus aureus and influenza virus had a significantly higher risk of CFS than those without these pathogens ( p  < 0.05). Patients taking doxycycline, azithromycin, moxifloxacin, levofloxacin, or ciprofloxacin had a significantly lower risk of CFS than patients in the corresponding control group ( p  < 0.05). Conclusion Our population-based retrospective cohort study found that infection with common pathogens, including bacteria, viruses, is associated with an increased risk of developing CFS.