A unifying pathobiological question
Myalgic encephalomyelitis/chronic fatigue syndrome is a complex multisystem disease. Its defining features include a marked worsening after exertion — post-exertional malaise — alongside substantial impairment, unrefreshing sleep and other neurological, autonomic and immune-related symptoms.
The 2022 paper The Pathobiology of ME/CFS: The Case for Neuroglial Failure reviews whether dysfunction of glial cells in the central nervous system could connect two prominent findings: post-exertional malaise and reduced cerebral blood flow.
The authors present a hypothesis and synthesis of existing literature. The paper does not establish neuroglial failure as a proven single cause.
Renz-Polster H, Tremblay M-E, Bienzle D, Fischer JE. “The Pathobiology of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: The Case for Neuroglial Failure.” Frontiers in Cellular Neuroscience 16:888232.
Read the open-access paper →ME/CFS within post-COVID illness
Also in 2022, Herbert Renz-Polster and Carmen Scheibenbogen reviewed post-COVID courses characterized by fatigue and exercise intolerance. The article describes the overlap between a subset of post-COVID illness and ME/CFS and emphasizes post-exertional malaise as a key clinical feature.
Renz-Polster H, Scheibenbogen C. “Post-COVID syndrome with fatigue and exercise intolerance: myalgic encephalomyelitis/chronic fatigue syndrome.” Innere Medizin 63, 830–839.
Read the full article →Young people after infectious mononucleosis
A 2023 study followed young people who developed ME/CFS after Epstein–Barr virus infectious mononucleosis. It documented clinical phenotypes and one-year outcomes in a German pediatric cohort, contributing prospective evidence in an area with limited longitudinal data.
Pricoco R et al. “One-year follow-up of young people with ME/CFS following infectious mononucleosis by Epstein-Barr virus.” Frontiers in Pediatrics 11:1266738.
Read the open-access study →Clinical consensus
In 2024, an interdisciplinary group from Germany, Austria and Switzerland published a collaborative consensus statement on diagnosis and treatment. It highlights Canadian Consensus Criteria, the central role of post-exertional malaise, current management options and priorities for future care and research.
Hoffmann K et al. “Interdisciplinary, collaborative D-A-CH consensus statement concerning the diagnosis and treatment of ME/CFS.” Wiener klinische Wochenschrift 136, 103–123.
View the consensus statement on PubMed →Additional clinical publications and guidance
The following German-language resources complement the PubMed-indexed record. They are listed separately because they are not indexed in PubMed.
Renz-Polster H, Broxtermann W, Behrends U. “Chronische Erschöpfung bedeutet nicht, einfach nur müde zu sein” [Chronic fatigue does not mean simply being tired]. Pädiatrie 34, 26–33. DOI: 10.1007/s15014-022-4043-z.
This certified clinical education article introduces ME/CFS with particular attention to children and adolescents. It distinguishes pathological fatigue from ordinary tiredness, explains post-exertional malaise and outlines clinical assessment and management.
Read the open-access article →Scheibenbogen C, Renz-Polster H, Hohberger B, Behrends U, Schieffer E, Schieffer B. “Post COVID und Post-Vakzin-Syndrom: Die Pandemie nach der Pandemie” [Post-COVID and post-vaccination syndrome: the pandemic after the pandemic]. Deutsches Ärzteblatt 120(13), A-566–A-570.
The article reviews persistent illness following SARS-CoV-2 infection and discusses the much less well-defined reports of similar symptoms following vaccination. It summarizes proposed mechanisms, clinical patterns and major gaps in evidence and care.
Read the article →Renz-Polster H, Dräger M and the German Association for ME/CFS team. Praxisleitfaden Myalgische Enzephalomyelitis / Chronisches Fatigue Syndrom (ME/CFS). Scientific lead: Herbert Renz-Polster; developed in cooperation with the Charité Fatigue Centre.
This continuously updated guide is written for primary-care professionals. It covers clinical presentation, diagnostic criteria, post-exertional malaise, differential diagnosis and symptom-oriented management. Some professional content requires a DocCheck login.
Open the practice guide →Clinical context
ME/CFS is a serious illness and post-exertional malaise can be worsened by inappropriate exertion. This archive summarizes publications; it does not diagnose disease or recommend individual treatment.