{"id":226017,"date":"2026-06-30T20:46:19","date_gmt":"2026-06-30T18:46:19","guid":{"rendered":"https:\/\/microbiome-center.nl\/aandoeningen\/post-acute-infectious-syndromes-pais\/"},"modified":"2026-06-30T20:48:43","modified_gmt":"2026-06-30T18:48:43","slug":"post-acute-infectious-syndromes-pais","status":"publish","type":"aandoeningen","link":"https:\/\/microbiome-center.nl\/en\/aandoeningen\/post-acute-infectious-syndromes-pais\/","title":{"rendered":"Post-acute infectious syndromes (PAIS)"},"content":{"rendered":"<style id=\"divi-off-canvas-hide-on-load\">\n[data-interaction-target=\"zwocqpy6qf\"] { display: none !important; }\n<\/style>\n<div class=\"et_pb_section_0 et_pb_section et_section_regular et_flex_section preset--module--divi-section--default\">\n<div class=\"et_pb_row_0 et_pb_row et_flex_row\">\n<div class=\"et_pb_column_0 et_pb_column et-last-child et_flex_column et_pb_css_mix_blend_mode_passthrough et_flex_column_24_24 et_flex_column_24_24_tablet et_flex_column_24_24_phone\">\n<div class=\"et_pb_heading_0 et_pb_heading et_pb_module et_flex_module\"><div class=\"et_pb_heading_container\"><h1 class=\"et_pb_module_header\">Post-acute infectious syndromes (PAIS)<\/h1><\/div><\/div>\n\n<div class=\"et_pb_text_0 et_pb_text et_pb_bg_layout_light et_pb_module et_flex_module\"><\/div>\n<\/div>\n<\/div>\n<\/div>\n\n<div class=\"et_pb_section_1 et_pb_section et_section_regular et_flex_section preset--module--divi-section--default\">\n<div class=\"et_pb_row_1 et_pb_row et_grid_row\">\n<div class=\"et_pb_column_1 et_pb_column et_flex_column et_pb_css_mix_blend_mode_passthrough\">\n<div class=\"et_pb_text_1 et_pb_text et_pb_bg_layout_light et_pb_module et_flex_module\"><div class=\"et_pb_text_inner\"><p>Since the 80s of the last century, a clinical picture has been on the rise in which chronic fatigue is in the foreground (1). Although the exact cause and disease mechanisms are unknown, research shows that this condition is preceded by infection in about 80% of cases (2). A common diagnosis is myalgic encephalomyelitis\/chronic fatigue syndrome (ME\/CFS). But since COVID-19, similar complaints have been seen under the heading of long-COVID, and the group of conditions has been given the name Post-acute infectious syndromes (PAIS) (1).   <\/p>\n<\/div><\/div>\n<\/div>\n\n<div class=\"et_pb_column_2 et_pb_column et_flex_column et_pb_css_mix_blend_mode_passthrough\">\n<div class=\"et_pb_heading_1 et_pb_heading et_pb_module et_flex_module\"><div class=\"et_pb_heading_container\"><h2 class=\"et_pb_module_header\">Myalgic Encephalomyelitis (ME) and Chronic Fatigue Syndrome (CFS)<\/h2><\/div><\/div>\n\n<div class=\"et_pb_text_2 et_pb_text et_pb_bg_layout_light et_pb_module et_flex_module\"><div class=\"et_pb_text_inner\"><p>ME\/CFS is related to fibromyalgia, but the focus of the symptom pattern is different. Patients with ME\/CFS are often severely fatigued, lack refreshing sleep, and experience fatigue and malaise after physical exertion (3). However, like fibromyalgia patients, they often suffer from pain, neurological complaints, and a 'brain fog' (3). ME\/CFS occurs in 80% of cases after an infection (2), and it is clear that the immune system is involved in ME\/CFS (4). It is striking that in ME\/CFS about 35-90% of patients have abdominal complaints (5), a clear indication of the role of the intestines. There has been a lot of research in recent years into the relationship between ME\/CFS and the microbiome. Differences appear to be found in the composition and diversity of the microbiome between patients and healthy individuals (6). In addition, there are indications in the blood of patients of the presence of substances of bacterial origin to which the immune system is known to react violently (6,7) and which are probably associated with increased permeability of the intestinal wall (8). Various studies show that there are often reduced butyric acid formers and increased pathogens (9).        <\/p>\n<p>In addition, a study in which 60 ME\/CFS patients underwent bacteriotherapy (rectal input of a bacterial culture) suggests that microbiome modification can have a major positive effect; 70% of patients got better (10).<\/p>\n<\/div><\/div>\n<\/div>\n\n<div class=\"et_pb_column_3 et_pb_column et_flex_column et_pb_css_mix_blend_mode_passthrough\">\n<div class=\"et_pb_heading_2 et_pb_heading et_pb_module et_flex_module\"><div class=\"et_pb_heading_container\"><h2 class=\"et_pb_module_header\">Long-COVID<\/h2><\/div><\/div>\n\n<div class=\"et_pb_text_3 et_pb_text et_pb_bg_layout_light et_pb_module et_flex_module\"><div class=\"et_pb_text_inner\"><p>Long-COVID, or post-COVID, is a clear example of a PAIS, as the symptoms develop after infection with SARs-CoV-2, the virus that causes COVID. There is a considerable overlap in the symptom picture between long COVID and ME\/CFS, although there are also differences (11). Research shows that post-COVID, the gut microbiome is disrupted and slowly recovers to its pre-infection state in most people, except for those who develop long-COVID (9). The more time passes, the greater the difference between recovered persons and long-COVID patients. An important deviation is that in long-COVID the richness and diversity is lower, and various butyric acid-forming bacterial species have decreased. A group of researchers from TNO also found this in a literature review, and also concluded that degree of dysbiosis correlates with the severity of the symptoms (12). One study they cite even shows that the gut microbiome is the best predictor of variation in symptoms in long COVID (13). Interestingly, research shows that the gut is a reservoir of viruses (14). In some people, SARS-CoV-2 virus material is still found in faeces even seven months after infection (15). There is also evidence that treatment targeting the microbiome can help. An RCT that investigated the effect of synbiotics showed positive effects on various outcome measures such as concentration, fatigue, muscle pain, and several others (16). Another RCT with a different blend of pre- and probiotics showed little difference on key outcome measures such as fatigue (17). This supports the fact that effects are strain-specific and that one probiotic is not the other. An RCT with 100 patients per group used three different strains of Bacillus plus enzymes and found that after two weeks in the intervention group, 91% were free of fatigue, compared to only 15% of participants in the placebo group (18). Although the number of intervention studies is small, quite good ones are found.                <\/p>\n<\/div><\/div>\n<\/div>\n\n<div class=\"et_pb_column_4 et_pb_column et_flex_column et_pb_css_mix_blend_mode_passthrough\">\n<div class=\"et_pb_heading_3 et_pb_heading et_pb_module et_flex_module\"><div class=\"et_pb_heading_container\"><h2 class=\"et_pb_module_header\">Q fever fatigue syndrome (QVS)<\/h2><\/div><\/div>\n\n<div class=\"et_pb_text_4 et_pb_text et_pb_bg_layout_light et_pb_module et_flex_module\"><div class=\"et_pb_text_inner\"><p>Q fever is an infectious disease caused by the bacterium <em>Coxiella burnetii<\/em>. This is a so-called zoonosis, and is common in small ruminants such as goats. Between 2007 and 2010, the Netherlands experienced the largest epidemic ever, infecting 50,000 to 100,000 people. About 20% of people who become ill develop Q fever fatigue syndrome (QVS). Dutch research among QVS patients shows that their microbiome differs in the same way from that of a healthy control group as that of ME\/CFS patients (19). Research by Q-support with the help of Erasmus MC shows that the percentage of patients with IBS in QVS is higher than in the general population and that this even increases as the years go by to 16.5% (20). This finding prompted Q-support to do a pilot project with Microbiome Center. In 2024, 85 QVS patients were treated with lifestyle advice combined with personalized microbiome treatment. During treatment, a lot of data is generated in all patients treated via our platform, including three-weekly self-reported complaints and general well-being. With the permission of the QVS patients, we then did a retrospective data analysis and there was enough data from 69 QVS patients to draw conclusions. Almost half of them experienced an improvement in their general well-being, with one in seven a strong improvement. We saw the same result in the different medical complaints per person, more than half of them also reported some to a lot of improvement in the total number of complaints. Such self-reporting obviously has limitations, but to put things in perspective, it is useful to know that these participants had had QVS for an average of sixteen years and had tried everything in vain in all those years. This reduces the chance that the reported improvements will result from a placebo effect. These results are reason for Microbiome Center to conduct further research into the effects of personalized microbiome therapy in PAIS.              <\/p>\n<\/div><\/div>\n<\/div>\n\n<div class=\"et_pb_column_5 et_pb_column et-last-child et_flex_column et_pb_css_mix_blend_mode_passthrough\">\n<div class=\"et_pb_heading_4 et_pb_heading et_pb_module et_flex_module\"><div class=\"et_pb_heading_container\"><h2 class=\"et_pb_module_header\">References<br><\/h2><\/div><\/div>\n\n<div class=\"et_pb_text_5 et_pb_text et_pb_bg_layout_light et_pb_module et_flex_module\"><div class=\"et_pb_text_inner\"><ol>\n<li>Komaroff AL. Growing recognition of post-acute infection syndromes. Proc natl acad sci u s a 2025; 122:e2513877122.<\/li>\n<li>Arron HE, Marsh BD, Kell DB, Khan MA, Jaeger BR, Pretorius E. Myalgic Encephalomyelitis\/Chronic Fatigue Syndrome: the biology of a neglected disease. Front Immunol 2024;15:1386607.<\/li>\n<li>Bested AC, Marshall LM. Review of Myalgic Encephalomyelitis\/Chronic Fatigue Syndrome: an evidence-based approach to diagnosis and management by clinicians. Rev Environ Health 2015; 30:223\u201349.  <\/li>\n<li>Mensah FKF, Bansal AS, Ford B, Cambridge G. Chronic fatigue syndrome and the immune system: Where are we now? Neurophysiol Clin Clin Neurophysiol 2017; 47:131\u20138. <\/li>\n<li>Stallmach A, Quickert S, Puta C, Reuken PA. The gastrointestinal microbiota in the development of ME\/CFS: a critical view and potential perspectives. Front Immunol 2024;15:1352744.<\/li>\n<li>Giloteaux L, Goodrich JK, Walters WA, Levine SM, Ley RE, Hanson MR. Reduced diversity and altered composition of the gut microbiome in individuals with myalgic encephalomyelitis\/chronic fatigue syndrome. Microbiome [Internet] 2016 [cited 2018 Feb 4];4. Available from: https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4918027\/   <\/li>\n<li>Maes M, Twisk FNM, Kubera M, Ringel K, Leunis J-C, Geffard M. Increased IgA responses to the LPS of commensal bacteria is associated with inflammation and activation of cell-mediated immunity in chronic fatigue syndrome. J Affect Disord 2012; 136:909\u201317. <\/li>\n<li>Morris G, Berk M, Carvalho AF, Caso JR, Sanz Y, Maes M. The Role of Microbiota and Intestinal Permeability in the Pathophysiology of Autoimmune and Neuroimmune Processes with an Emphasis on Inflammatory Bowel Disease Type 1 Diabetes and Chronic Fatigue Syndrome. Curr Pharm des 2016; 22:6058\u201375. <\/li>\n<li>Guo C, Yi B, Wu J, Lu J. The microbiome in post-acute infection syndrome (PAIS). Comput Struct Biotechnol J 2023; 21:3904\u201311. <\/li>\n<li>Borody TJ, Nowak A, Finlayson S. The GI microbiome and its role in Chronic Fatigue Syndrome: A summary of bacteriotherapy. J australas coll nutr environ med 2012;31:3. <\/li>\n<li>Komaroff AL, Lipkin WI. ME\/CFS and Long COVID share similar symptoms and biological abnormalities: road map to the literature. Front Med 2023;10:1187163.<\/li>\n<li>Scheithauer TPM, Montijn RC, Mieremet A. Gut microbe\u2013host interactions in post-COVID syndrome: a debilitating or restorative partnership? Gut Microbes Taylor & Francis; 2024;16:2402544.<\/li>\n<li>Su Q, Lau RI, Liu Q, Li MKT, Mak JWY, Lu W, Lau ISF, Lau LHS, Yeung GTY, Cheung CP, et al. The gut microbiome associates with phenotypic manifestations of post-acute COVID-19 syndrome. Cell Host Microbe Elsevier; 2024;32:651-660.e4.  <\/li>\n<li>Neurath MF, \u00dcberla K, Ng SC. Gut as viral reservoir: lessons from gut viromes, HIV and COVID-19. BMJ Publishing Group; 2021 [cited 2026 Mar 10]; Available from: https:\/\/gut.bmj.com\/content\/70\/9\/1605.full  <\/li>\n<li>Natarajan A, Zlitni S, Brooks EF, Vance SE, Dahlen A, Hedlin H, Park RM, Han A, Schmidtke DT, Verma R, et al. Gastrointestinal symptoms and fecal shedding of SARS-CoV-2 RNA suggest prolonged gastrointestinal infection. Med Elsevier; 2022;3:371-387.e9.  <\/li>\n<li>Lau RI, Su Q, Lau ISF, Ching JYL, Wong MCS, Lau LHS, Tun HM, Mok CKP, Chau SWH, Tse YK, et al. A synbiotic preparation (SIM01) for post-acute COVID-19 syndrome in Hong Kong (RECOVERY): a randomised, double-blind, placebo-controlled trial. Lancet Infect Dis 2024; 24:256\u201365.  <\/li>\n<li>Ranisavljev M, Stajer V, Todorovic N, Ostojic J, Cvejic JH, Steinert RE, Ostojic SM. The effects of 3-month supplementation with synbiotic on patient-reported outcomes, exercise tolerance, and brain and muscle metabolism in adult patients with post-COVID-19 chronic fatigue syndrome (STOP-FATIGUE): a randomized Placebo-controlled clinical trial. Eur J Nutr 2025;64:28.  <\/li>\n<li>Rathi A, Jadhav SB, Shah N. A Randomized Controlled Trial of the Efficacy of Systemic Enzymes and Probiotics in the Resolution of Post-COVID Fatigue. Medicines 2021;8:47. <\/li>\n<li>Raijmakers RPH, Roerink ME, Jansen AFM, Keijmel SP, Gacesa R, Li Y, Joosten LAB, van der Meer JWM, Netea MG, Bleeker-Rovers CP, et al. Multi-omics examination of Q fever fatigue syndrome identifies similarities with chronic fatigue syndrome. J Transl Med 2020;18:448.  <\/li>\n<li>Stemerdink NC, Haagsma JA, Hartman E, Tieleman P, Burdorf A, Heemskerk SC. Four years of QVS database research: Impact of Q fever fatigue syndrome on health, daily life and care use [Internet]. Q-support; 2025 Nov. Available from: https:\/\/www.q-support.nu   <\/li>\n<\/ol>\n<\/div><\/div>\n<\/div>\n<\/div>\n<\/div>\n\n<div class=\"et_pb_section_2 et_pb_section et_section_regular et_flex_section preset--module--divi-section--default\">\n<div class=\"et_pb_row_2 et_pb_row et_flex_row\">\n<div class=\"et_pb_column_6 et_pb_column et-last-child et_flex_column et_pb_css_mix_blend_mode_passthrough et_flex_column_24_24 et_flex_column_24_24_tablet et_flex_column_24_24_phone\">\n<div class=\"et_pb_heading_5 et_pb_heading et_pb_module et_flex_module\"><div class=\"et_pb_heading_container\"><h4 class=\"et_pb_module_header\">Agenda<\/h4><\/div><\/div>\n\n<div class=\"et_pb_heading_6 et_pb_heading et_pb_module et_flex_module\"><div class=\"et_pb_heading_container\"><h2 class=\"et_pb_module_header\">Knowledge & meetings<\/h2><\/div><\/div>\n\n<div class=\"et_pb_text_6 et_pb_text et_pb_bg_layout_light et_pb_module et_flex_module\"><div class=\"et_pb_text_inner\"><p style=\"text-align: center;\">Microbiome Center regularly organizes intervisions, webinars and knowledge meetings for doctors and professionals. The sessions are aimed at both healthcare providers who are orienting themselves on microbiome therapy and experienced practitioners who want to deepen their knowledge.<\/p>\n<\/div><\/div>\n\n<div class=\"et_pb_module et_pb_button_module_wrapper et_pb_button_0_wrapper preset--module--divi-button--default_wrapper\"><a class=\"et_pb_button_0 et_pb_button et_pb_bg_layout_dark et_pb_module et_flex_module button_outline preset--module--divi-button--default\" href=\"https:\/\/microbiome-center.nl\/en\/agenda\/\">View the agenda<\/a><\/div>\n<\/div>\n<\/div>\n<\/div><div class=\"et_pb_section_3 et_pb_section et_pb_section--fixed et_section_regular et_flex_section et-interaction-target-zwocqpy6qf preset--module--divi-section--default\" data-interaction-trigger=\"7hv7hq8l9z\" data-interaction-target=\"zwocqpy6qf\" id=\"video_canvas\"><div class=\"et_pb_row_3 et_pb_row et_flex_row\"><div class=\"et_pb_column_7 et_pb_column et-last-child et_flex_column et_pb_css_mix_blend_mode_passthrough et_flex_column_24_24 et_flex_column_24_24_tablet et_flex_column_24_24_phone\"><div class=\"et_pb_icon_0 et_pb_icon et_pb_module et_flex_module video_close\"><span class=\"et_pb_icon_wrap\"><span class=\"et-pb-icon\">\uf057<\/span><\/span><\/div><div class=\"et_pb_code_0 et_pb_code et_pb_module\" id=\"microbiome_center_video_iframe\"><\/div><\/div><\/div><\/div>","protected":false},"featured_media":0,"template":"","doelgroep":[106],"class_list":["post-226017","aandoeningen","type-aandoeningen","status-publish","hentry","doelgroep-practitioner"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.0 - 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