Milovanović et al. (2026)
- Authors: Branislav Milovanović, Nikola Marković, Elizabeta Ristanović, Sonja Atanasievska Kujović, Nikoleta Đorđevski, Masa Petrovic, Milica Milošević, Sulin Bulatovic, Milovan Bojić
- Institutes: Institute for Cardiovascular Diseases ‘Dedinje’, Belgrade, Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Publisher: Pathogens (MDPI)
- Link: DOI
Summary
This research provides objective evidence linking acute Q fever infection to measurable dysfunction of the autonomic nervous system. By identifying specific impairments in heart rate and blood pressure control, the study validates a physiological basis for the post-infectious fatigue and fainting symptoms common in ME/CFS. The findings suggest that Coxiella burnetii may be a major infectious trigger for chronic dysautonomia, highlighting the need for early screening in post-viral and post-bacterial recovery.
What was researched?
This study investigated the prevalence and specific characteristics of autonomic nervous system dysfunction in patients who had recently been infected with the bacteria Coxiella burnetii.
Why was it researched?
While Coxiella burnetii is known to cause Q fever and subsequent post-infectious fatigue syndromes like ME/CFS, the exact role of the autonomic nervous system in producing these symptoms was not well-documented.
How was it researched?
Researchers compared 100 seropositive patients to 56 healthy controls using a variety of diagnostic tools, including cardiovascular reflex tests, 24-hour Holter monitoring for heart rate variability, and head-up tilt testing. The study focused on patients presenting with polymorphic symptoms such as extreme fatigue and orthostatic intolerance.
What has been found?
The infected group showed a significantly higher rate of autonomic dysfunction, particularly affecting parasympathetic regulation and the baroreflex mechanism which stabilizes blood pressure. Tilt testing revealed extreme blood pressure variability and a high rate of positive findings for syncope or orthostatic stress in the Coxiella group.
Discussion
A key finding was that short-term autonomic measurements were more sensitive at detecting impairment than long-term 24-hour measures. The study notes that while a clear association exists, the cross-sectional design cannot definitively prove the infection caused the long-term dysfunction.
Conclusion & Future Work
The study concludes that Coxiella burnetii infection can trigger persistent autonomic dysfunction, which likely contributes to the development of ME/CFS. Further long-term studies are recommended to understand how these autonomic changes progress over time.