No retraction, correction or concern found when last checked on Oct 30, 2026.

Myalgic encephalomyelitis: International Consensus Criteria

B. M. Carruthers, M. I. van de Sande, K. L. De Meirleir and 23 more

Journal of Internal Medicine · 2011 · Review

doi:10.1111/j.1365-2796.2011.02428.x

Abstract

Carruthers BM, van de Sande MI, De Meirleir KL, Klimas NG, Broderick G, Mitchell T, Staines D, Powles ACP, Speight N, Vallings R, Bateman L, Baumgarten-Austrheim B, Bell DS, Carlo-Stella N, Chia J, Darragh A, Jo D, Lewis D, Light AR, Marshall-Gradisbik S, Mena I, Mikovits JA, Murovska M, Pall ML, Stevens S (Independent, Vancouver, BC, Canada; Independent, Calgary, AB, Canada; Department of Physiology and Medicine, Vrije University of Brussels, Himmunitas Foundation, Brussels, Belgium; Department of Medicine,University of Miami Miller School of Medicine and Miami Veterans Affairs Medical Center, Miami, FL, USA; Department of Medicine, University of Alberta, Edmonton, AB, Canada; Honorary Consultant for NHS at Peterborough/Cambridge, Lowestoft, Suffolk, UK; Gold Coast Public Health Unit, Southport, Queensland; Health Sciences and Medicine, Bond University, Robina, Queensland, Australia; Faculty of Health Sciences, McMaster University and St Joseph’s Healthcare Hamilton, Hamilton, ON, Canada; Independent, Durham, UK; Howick Health and Medical Centre, Howick, New Zealand; Fatigue Consultation Clinic, Salt Lake Regional Medical Center; Internal Medicine, Family Practice, University of Utah, Salt Lake City, UT, USA; ME/CFS Center, Oslo University Hospital HF, Norway; Department of Paediatrics, State University of New York, Buffalo, NY; Independent, Pavia, Italy; Harbor-UCLA Medical Center, University of California, Los Angeles, CA; EV Med Research, Lomita, CA, USA; University of Limerick, Limerick, Ireland; Pain Clinic, Konyang University Hospital, Daejeon, Korea; Donvale Specialist Medical Centre, Donvale, Victoria, Australia; Departments or Anesthesiology, Neurobiology and Anatomy, University of Utah, Salt Lake City, Utah, USA; Health Sciences and Medicine, Bond University, Robina, Queensland, Australia; Department of Medicina Nuclear, Clinica Las Condes, Santiago, Chile; Whittemore Peterson Institute, University of Nevada, Reno, NV, USA; Miwa Naika Clinic, Toyama, Japan; A. Kirchenstein Institute of Microbiology and Virology, Riga Stradins University, Riga, Latvia; Department of Biochemistry & Basic Medical Sciences, Washington State University, Portland, OR; Department of Sports Sciences, University of the Pacific, Stockton, CA USA). Myalgic encephalomyelitis: International Consensus Criteria (Review). J Intern Med 2011; 270: 327–338. The label ‘chronic fatigue syndrome’ (CFS) has persisted for many years because of the lack of knowledge of the aetiological agents and the disease process. In view of more recent research and clinical experience that strongly point to widespread inflammation and multisystemic neuropathology, it is more appropriate and correct to use the term ‘myalgic encephalomyelitis’ (ME) because it indicates an underlying pathophysiology. It is also consistent with the neurological classification of ME in the World Health Organization’s International Classification of Diseases (ICD G93.3). Consequently, an International Consensus Panel consisting of clinicians, researchers, teaching faculty and an independent patient advocate was formed with the purpose of developing criteria based on current knowledge. Thirteen countries and a wide range of specialties were represented. Collectively, members have approximately 400 years of both clinical and teaching experience, authored hundreds of peer-reviewed publications, diagnosed or treated approximately 50 000 patients with ME, and several members coauthored previous criteria. The expertise and experience of the panel members as well as PubMed and other medical sources were utilized in a progression of suggestions/drafts/reviews/revisions. The authors, free of any sponsoring organization, achieved 100% consensus through a Delphi-type process. The scope of this paper is limited to criteria of ME and their application. Accordingly, the criteria reflect the complex symptomatology. Operational notes enhance clarity and specificity by providing guidance in the expression and interpretation of symptoms. Clinical and research application guidelines promote optimal recognition of ME by primary physicians and other healthcare providers, improve the consistency of diagnoses in adult and paediatric patients internationally and facilitate clearer identification of patients for research studies.

Shown for reading. Its publisher allows quoting it, not republishing it.

References 119

1.
Tirelli U, Chierichetti F, Tavio M, et al. Brain positron emission tomography (PET) in chronic fatigue syndrome: preliminary data. Am J Med. 1998;105:54S-8S.
Not in our library10.1016/s0002-9343(98)00179-x
2.
Cook DB, Lange G, DeLuca J, Natelson BH. Relationship of brain MRI abnormalities and physical functional status in chronic fatigue syndrome. Int J Neurosci. 2001;107:1-6.
Not in our library10.3109/00207450109149754
3.
Chen R, Liang FX, Moriya J, et al. Chronic fatigue syndrome and the central nervous system. J Int Med Res. 2008;36:867-74.
Not in our library10.1177/147323000803600501
4.
Broderick G, Fuite J, Kreitz A, Vernon SD, Klimas N, Fletcher MA. A formal analysis of cytokine networks in chronic fatigue syndrome. Brain Behav Immun. 2010;24:1209-17.
Not in our library10.1016/j.bbi.2010.04.012
5.
Lorusso L, Mikhaylova SW, Capelli E, Ferrari D, Ngonga GK, Ricevuti G. Immunological aspects of chronic fatigue syndrome. Autoimmun Rev. 2009;8:287-91.
Not in our library10.1016/j.autrev.2008.08.003
6.
Fletcher MA, Zeng XR, Maher K, et al. Biomarkers in chronic fatigue syndrome: evaluation of natural killer cell function and dipeptidyl peptidase IV. PLoS ONE. 2010;5:e10817.
Not in our library10.1371/journal.pone.0010817
7.
Mihaylova I, DeRuyter M, Rummens JL, Basmans E, Maes M. Decreased expression of CD69 in chronic fatigue syndrome in relation to inflammatory markers: evidence for a severe disorder in the early activation of T lymphocytes and natural killer cells. Neuro Endocrinol Lett. 2007;28:477-83.
Not in our library
8.
Klimas NG, Salvato FR, Morgan R, Fletcher MA. Immunologic abnormalities in chronic fatigue syndrome. J Clin Microbiol. 1990;28:1403-10.
Not in our library10.1128/jcm.28.6.1403-1410.1990
9.
Myhill S, Booth NE, McLaren-Howard J. Chronic fatigue syndrome and mitochondrial dysfunction. Int J Clin Exp Med. 2009;2:1-16.
Not in our library
10.
Pieczenik SR, Neustadt J. Mitochondrial dysfunction and molecular pathways of disease. Exp Mol Pathol. 2007;83:84-92.
Not in our library10.1016/j.yexmp.2006.09.008
11.
Behan WM, More IA, Behan PO. Mitochondrial abnormalities in the postviral fatigue syndrome. Acta Neuropathol. 1991;83:61-5.
Not in our library10.1007/bf00294431
12.
Streeten DH, Thomas D, Bell DS. The roles of orthostatic hypotension, orthostatic tachycardia and subnormal erythrocyte volume in the pathogenesis of the chronic fatigue syndrome. Am J Med. 2000;320:1-8.
Not in our library10.1097/00000441-200007000-00001
13.
Peckerman A, LaManca JJ, Dahl KA, Chemitiganti R, Qureishi B, Natelson BH. Abnormal impedance cardiography predicts symptom severity in Chronic Fatigue Syndrome. Am J Med Sci. 2003;326:55-60.
Not in our library10.1097/00000441-200308000-00001
14.
Hollingsworth KG, Jones DE, Taylor R, Blamire AM, Newton JL. Impaired cardiovascular response to standing in chronic fatigue syndrome. Eur J Clin Invest. 2010;40:608-15.
Not in our library10.1111/j.1365-2362.2010.02310.x
15.
Sharpe MC, Archard LC, Banatvala JE, et al. A report – chronic fatigue syndrome: guidelines for research. J R Soc Med. 1991;84:118-21.
Not in our library10.1177/014107689108400224
16.
Chronic Fatigue Syndrome – A clinically empirical approach to its definition and study · 2005
No notice
17.
Fukuda K, Straus SE, Hickie I, et al. Chronic Fatigue Syndrome: a comprehensive approach to its definition and study. Ann Intern Med. 1994;121:953-9.
Not in our library10.7326/0003-4819-121-12-199412150-00009
18.
Jason LA, Najar N, Porter N, Reh C. Evaluating the Centers for Disease Control’s empirical chronic fatigue syndrome case definition. J Disabil Pol Studies. 2009;20:91-100.
Not in our library
19.
Jason LA, Choi M, Watanabe Y, Evengard B, Natelson BH, Jason LA, Kuratsune H. Dimensions and assessment of fatigue. Fatigue Science Human Health. 2008;1-16.
Not in our library
20.
Carruthers BM, Jain AK, De Meirleir KL, et al. Myalgic encephalomyelitis/chronic fatigue syndrome: clinical working case definition, diagnostic and treatment protocols. J. Chronic Fatigue Syndr. 2003;11:7-116.
Not in our library
21.
Jason LA, Torres-Harding SR, Jurgens A, Helgerson J. Comparing the Fukuda et al Criteria and the Canadian case definition for chronic fatigue syndrome. J. Chronic Fatigue Syndr. 2004;12:37-52.
Not in our library
22.
De Becker P, McGregor N, De Meirleir K. A definition-based analysis of symptoms in a large cohort of patients with chronic fatigue syndrome. J Intern Med. 2001;250:234-40.
Not in our library10.1046/j.1365-2796.2001.00890.x
23.
Rowe KS, Rowe KJ, Singh NN, Ollendick TH, Singh AN. Symptom patterns of children and adolescents with chronic fatigue syndrome. Intern Perspective Child Adolescence Mental Health. 2002;2.
Not in our library
24.
Kaushik N, Fear D, Richards SC, et al. Gene expression in peripheral blood mononuclear cells from patients with chronic fatigue syndrome. J Clin Pathol. 2005;58:826-32.
Not in our library10.1136/jcp.2005.025718
25.
Kerr JR, Burke B, Petty R, et al. Seven genomic subtypes of chronic fatigue syndrome/myalgic encephalomyelitis; a detailed analysis of gene network and clinical phenotypes. J Clin Pathol. 2008;61:730-9.
Not in our library10.1136/jcp.2007.053553
26.
Kerr JR, Petty R, Burke B, et al. Gene expression subtypes in patients with chronic fatigue syndrome/myalgic encephalomyelitis. J Infect Dis. 2008;197:1171-84.
Not in our library10.1086/533453
27.
Evidence of inflammatory immune signaling in chronic fatigue syndrome: A pilot study of gene expression in peripheral blood · 2008
Not checked
28.
Broderick G, Craddock RC, Whistler T, Taylor R, Klimas N, Unger ER. Identifying illness parameters in fatiguing syndromes using classical projection methods. Pharmacogenomics. 2006;7:407-19.
Not in our library10.2217/14622416.7.3.407
29.
Light AR, White AT, Hughen RW, Light KC. Moderate exercise increases expression for sensory, adrenergic, and immune genes in chronic fatigue syndrome patients but not in normal subjects. J Pain. 2009;10:1099-112.
Not in our library10.1016/j.jpain.2009.06.003
30.
Light AR, Bateman L, Jo D, et al. Gene expression alterations at baseline and following moderate exercise in patients with Chronic Fatigue Syndrome, and Fibromyalgia Syndrome. J Intern Med. 2011.
Not in our library10.1111/j.1365-2796.2011.02405.x
31.
Gräns H, Nilsson M, Dahlman-Wright K, Evengård B. Reduced levels of oestrogen receptor beta mRNA in Swedish patients with chronic fatigue syndrome. J Clin Pathol. 2007;60:195-8.
Not in our library10.1136/jcp.2005.035956
32.
Narita M, Nishigami N, Narita N, et al. Association between serotonin transporter gene polymorphism and chronic fatigue syndrome. Biochem Biophys Res Commun. 2003;311:264-6.
Not in our library10.1016/j.bbrc.2003.09.207
33.
Falkenberg VR, Gurbaxani BM, Unger ER, Rajeevan MS. Functional genomics of serotonin receptor 2A (HTR2A): interaction of polymorphism, methylation, expression and disease association. Neuromolecular Med. 2011;13:66-76.
Not in our library10.1007/s12017-010-8138-2
34.
Rajeevan MS, Smith AK, Dimulescu I, et al. Glucocorticoid receptor polymorphisms and haplotypes associated with chronic fatigue syndrome. Genes Brain Behav. 2007;6:167-76.
Not in our library10.1111/j.1601-183x.2006.00244.x
35.
Carlo-Stella N, Bozzini S, De Silvestri A, et al. Molecular study of receptor for advanced glycation endproduct gene promoter and identification of specific HLA haplotypes possibly involved in chronic fatigue syndrome. Int J Immunopathol Pharmacol. 2009;22:745-54.
Not in our library10.1177/039463200902200320
36.
Goertzel BN, Pennachin C, de SouzaCoelho L, Gurbaxani B, Maloney EM, Jones JF. Combinations of single nucleotide polymorphisms in neuroendocrine effector and receptor genes predict chronic fatigue syndrome. Pharmacogenomics. 2006;7:475-83.
Not in our library10.2217/14622416.7.3.475
37.
Underhill JA, Mahalingam M, Peakman M, Wessely S. Lack of association between HLA genotype and chronic fatigue syndrome. Eur J Immunogenet. 2001;28:425-8.
Not in our library10.1046/j.1365-2370.2001.00235.x
38.
Sullivan PF, Evengård B, Jacks A, Pedersen NL. Twin analyses of chronic fatigue in a Swedish national sample. Psychol Med. 2005;35:1327-36.
Not in our library10.1017/s0033291705005222
39.
Landmark-Høyvik H, Reinertsen KV, Loge JH, et al. The genetics and epigenetics of fatigue. PM R. 2010;2:456-65.
Not in our library10.1016/j.pmrj.2010.04.003
40.
Maher K, Klimas NG, Fletcher MA, Jason LA, Fennell PA, Taylor RR. Immunology. Handbook of Chronic Fatigues. 2003;124-51.
Not in our library

All 119 references

Cited by papers we hold 17

Reads

Read by people on this page

None yet.

Checked or read by AI through naulon

None yet.

A person counts once a day per paper. We keep no cookie and no address: a reader is a hash that changes every day. Any month under five reads shows no number.

Are you an author?

Is this your paper?

Claim it to add your note and be paid when agents cite it. Free.