{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T19:48:09Z","timestamp":1793303289146,"version":"4.5.0"},"reference-count":60,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T00:00:00Z","timestamp":1766102400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004564","name":"Ministry of Education, Science and Technological Development of the Republic of Serbia","doi-asserted-by":"publisher","award":["451-03-68\/2020-14\/200156"],"award-info":[{"award-number":["451-03-68\/2020-14\/200156"]}],"id":[{"id":"10.13039\/501100004564","id-type":"DOI","asserted-by":"publisher"}]},{"name":"the Science Fund of the Republic of Serbia","award":["COVANSA"],"award-info":[{"award-number":["COVANSA"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathogens"],"abstract":"<jats:p>Background:\u00a0Coxiella burnetii is a common zoonotic pathogen that can lead not only to acute or chronic Q fever but also to post-infectious syndromes, where autonomic nervous system (ANS) dysfunction has been suggested as a contributing mechanism. This study aimed to assess autonomic function in patients presenting with polymorphic symptoms, dysautonomia, or ME\/CFS who had serological evidence of acute infection with Coxiella burnetii. Methods: A total of 156 participants were evaluated, including 100 seropositive patients and 56 matched controls. All subjects underwent standardized cardiovascular reflex tests (CART), beat-to-beat analysis of heart rate and blood pressure with baroreflex indices, 24 h Holter ECG with HRV assessment, and, in the Coxiella group, head-up tilt testing (HUTT). Results: A significantly higher prevalence of autonomic dysfunction was observed in the Coxiella group, predominantly affecting parasympathetic regulation, with abnormal CART scores, reduced LF power and baroreflex effectiveness, and a high rate of positive HUTT findings characterized by extreme blood pressure variability. Although long-term HRV measures did not differ significantly between groups, short-term indices consistently indicated ANS impairment. Conclusions: These findings suggest that Coxiella burnetii infection may trigger persistent autonomic dysfunction, potentially contributing to the development of ME\/CFS and syncope in affected individuals. Further longitudinal studies are needed to clarify pathophysiological mechanisms and clinical implications.<\/jats:p>","DOI":"10.3390\/pathogens15010003","type":"journal-article","created":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T11:03:46Z","timestamp":1766142226000},"page":"3","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Autonomic Dysfunction in Patients with Acute Infection with Coxiella burnetii"],"prefix":"10.3390","volume":"15","author":[{"given":"Branislav","family":"Milovanovi\u0107","sequence":"first","affiliation":[{"name":"Institute for Cardiovascular Diseases \u201cDedinje\u201d, 11040 Belgrade, Serbia"},{"name":"School of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-5090-6029","authenticated-orcid":false,"given":"Nikola","family":"Markovi\u0107","sequence":"additional","affiliation":[{"name":"Institute for Cardiovascular Diseases \u201cDedinje\u201d, 11040 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeta","family":"Ristanovi\u0107","sequence":"additional","affiliation":[{"name":"Institute for Microbiology, Military Medical Academy, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonja","family":"Atanasievska Kujovi\u0107","sequence":"additional","affiliation":[{"name":"Institute for Microbiology, Military Medical Academy, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0314-2314","authenticated-orcid":false,"given":"Nikoleta","family":"\u0110or\u0111evski","sequence":"additional","affiliation":[{"name":"Institute for Microbiology, Military Medical Academy, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1709-8449","authenticated-orcid":false,"given":"Masa","family":"Petrovic","sequence":"additional","affiliation":[{"name":"Institute for Cardiovascular Diseases \u201cDedinje\u201d, 11040 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Milica","family":"Milo\u0161evi\u0107","sequence":"additional","affiliation":[{"name":"Institute for Cardiovascular Diseases \u201cDedinje\u201d, 11040 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-8674-8613","authenticated-orcid":false,"given":"Sulin","family":"Bulatovic","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Milovan","family":"Boji\u0107","sequence":"additional","affiliation":[{"name":"Institute for Cardiovascular Diseases \u201cDedinje\u201d, 11040 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,19]]},"reference":[{"key":"ref_1","unstructured":"Loscalzo, J., Fauci, A.S., Kasper, D.L., Hauser, S.L., Longo, D.L., and Jameson, J.L. (2022). Harrison\u2019s Principles of Internal Medicine, McGraw Hill. [21st ed.]."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1055\/s-0040-1710594","article-title":"Q Fever (Coxiella burnetii)","volume":"41","author":"Uranga","year":"2020","journal-title":"Semin. Respir. Crit. Care Med."},{"key":"ref_3","unstructured":"Brunette, G.W. (2025, September 17). Q Fever [Internet]. Medscape. Available online: https:\/\/emedicine.medscape.com\/article\/227156-overview."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1016\/j.jocn.2013.05.021","article-title":"Brainstem encephalitis caused by Coxiella burnetii","volume":"21","author":"Lim","year":"2014","journal-title":"J. Clin. Neurosci."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1001\/archinte.162.6.693","article-title":"Neurological involvement in acute Q fever: A report of 29 cases and review of the literature","volume":"162","author":"Bernit","year":"2002","journal-title":"Arch. Intern. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1051","DOI":"10.1007\/s10654-004-0108-2","article-title":"Neurological complications of acute Q fever infection","volume":"19","author":"Kofteridis","year":"2004","journal-title":"Eur. J. Epidemiol."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Townsend, L., Dyer, A.H., Jones, K., Dunne, J., Mooney, A., Gaffney, F., O\u2019Connor, L., Leavy, D., O\u2019Brien, K., and Dowds, J. (2020). Persistent fatigue following SARS-CoV-2 infection is common and independent of severity of initial infection. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0240784"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Chu, L., Valencia, I.J., Garvert, D.W., and Montoya, J.G. (2019). Onset Patterns and Course of Myalgic Encephalomyelitis\/Chronic Fatigue Syndrome. Front. Pediatr., 7.","DOI":"10.3389\/fped.2019.00012"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Cortes Rivera, M., Mastronardi, C., Silva-Aldana, C.T., Arcos-Burgos, M., and Lidbury, B.A. (2019). Myalgic Encephalomyelitis\/Chronic Fatigue Syndrome: A Comprehensive Review. Diagnostics, 9.","DOI":"10.3390\/diagnostics9030091"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"S\u0142omko, J., Est\u00e9vez-L\u00f3pez, F., Kujawski, S., Zawadka-Kunikowska, M., Tafil-Klawe, M., Klawe, J.J., Morten, K.J., Szrajda, J., Murovska, M., and Newton, J.L. (2020). Autonomic Phenotypes in Chronic Fatigue Syndrome (CFS) Are Associated with Illness Severity: A Cluster Analysis. J. Clin. Med., 9.","DOI":"10.3390\/jcm9082531"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Milovanovic, B., Markovic, N., Petrovic, M., Zugic, V., Ostojic, M., Rankovic-Nicic, L., and Bojic, M. (2025). Assessment of Autonomic Nervous System Function in Patients with Chronic Fatigue Syndrome and Post-COVID-19 Syndrome Presenting with Recurrent Syncope. J. Clin. Med., 14.","DOI":"10.3390\/jcm14030811"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1038\/s41569-023-00962-3","article-title":"Cardiovascular autonomic dysfunction in post-COVID-19 syndrome: A major health-care burden","volume":"21","author":"Fedorowski","year":"2024","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Adler, B.L., Chung, T., Rowe, P.C., and Aucott, J. (2024). Dysautonomia following Lyme disease: A key component of post-treatment Lyme disease syndrome?. Front. Neurol., 15.","DOI":"10.3389\/fneur.2024.1344862"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Novak, P., Felsenstein, D., Mao, C., Octavien, N.R., and Zubcevik, N. (2019). Association of small fiber neuropathy and post treatment Lyme disease syndrome. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0212222"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Milovanovic, B., Markovic, N., Petrovic, M., Zugic, V., Ostojic, M., and Bojic, M. (2025). Cross-Sectional Study Evaluating the Role of Autonomic Nervous System Functional Diagnostics in Differentiating Post-Infectious Syndromes: Post-COVID Syndrome, Chronic Fatigue Syndrome, and Lyme Disease. Biomedicines, 13.","DOI":"10.3390\/biomedicines13020356"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/0306-9877(77)90049-4","article-title":"Viral infections of the autonomic nervous system and its target organs: Pathogenetic mechanisms","volume":"3","author":"Price","year":"1977","journal-title":"Med. Hypotheses"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"686","DOI":"10.1038\/257686a0","article-title":"Latent infection of the peripheral ANS with herpes simplex virus","volume":"257","author":"Price","year":"1975","journal-title":"Nature"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1097\/IPC.0b013e318191781b","article-title":"Postural orthostatic tachycardia syndrome associated with Mycoplasma pneumoniae","volume":"17","author":"Kasmani","year":"2009","journal-title":"Infect. Dis. Clin. Pract."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e00227-19","DOI":"10.1128\/JVI.00227-19","article-title":"Herpes Simplex Virus 2 in Autonomic Ganglia: Evidence for Spontaneous Reactivation","volume":"93","author":"Pieknik","year":"2019","journal-title":"J. Virol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"403","DOI":"10.33678\/cor.2024.016","article-title":"Investigation of Heart Rate Variability and Ventricular Repolarization Indexes in Brucella Patients with Palpitations","volume":"66","author":"Tanriverdi","year":"2024","journal-title":"Cor Vasa"},{"key":"ref_21","unstructured":"National Institute for Health and Care Excellence (NICE) (2021). Myalgic Encephalomyelitis (or Encephalopathy)\/Chronic Fatigue Syndrome: Diagnosis and Management (NG206), NICE. Available online: https:\/\/www.nice.org.uk\/guidance\/ng206."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1883","DOI":"10.1093\/eurheartj\/ehy037","article-title":"2018 ESC Guidelines for the diagnosis and management of syncope","volume":"39","author":"Brignole","year":"2018","journal-title":"Eur. Heart J."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"E378","DOI":"10.1503\/cmaj.211373","article-title":"Diagnosis and management of postural orthostatic tachycardia syndrome","volume":"194","author":"Raj","year":"2022","journal-title":"Can. Med. Assoc. J."},{"key":"ref_24","first-page":"357","article-title":"Canadian Cardiovascular Society Position Statement on Postural Orthostatic Tachycardia Syndrome (POTS) and Related Disorders of Chronic Orthostatic Intolerance","volume":"36","author":"Raj","year":"2020","journal-title":"Can. J. Cardiol."},{"key":"ref_25","unstructured":"World Health Organization (2025, December 17). Post COVID-19 Condition (Long COVID). Available online: https:\/\/www.who.int\/europe\/news-room\/fact-sheets\/item\/post-covid-19-condition."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"916","DOI":"10.1136\/bmj.285.6346.916","article-title":"Diagnosis and management of diabetic autonomic neuropathy","volume":"285","author":"Ewing","year":"1982","journal-title":"Br. Med. J. (Clin. Res. Ed.)"},{"key":"ref_27","first-page":"61","article-title":"Diagnosis and management of diabetic autonomic neuropathy","volume":"287","author":"Bellavere","year":"1983","journal-title":"Br. Med. J. (Clin. Res. Ed.)"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1016\/S0010-4825(98)00005-5","article-title":"A software package for non-invasive, real-time beat-to-beat monitoring of stroke volume, blood pressure, total peripheral resistance and for assessment of autonomic function","volume":"28","author":"Gratze","year":"1998","journal-title":"Comput. Biol. Med."},{"key":"ref_29","first-page":"H1606","article-title":"Effects of aging on 24-h dynamic baroreceptor control of heart rate in ambulant subjects","volume":"268","author":"Parati","year":"1995","journal-title":"Am. J. Physiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1016\/0735-1097(91)90714-K","article-title":"Methodology of head-up tilt testing in patients with unexplained syncope","volume":"17","author":"Fitzpatrick","year":"1991","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1111\/j.1469-0691.2008.02163.x","article-title":"Q fever in northern Greece: Epidemiological and clinical data from 58 acute and chronic cases","volume":"15","author":"Pape","year":"2009","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"574","DOI":"10.1016\/S0025-6196(11)60733-7","article-title":"Q fever: Epidemiology, diagnosis, and treatment","volume":"83","author":"Hartzell","year":"2008","journal-title":"Mayo Clin. Proc."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"499","DOI":"10.3349\/ymj.2010.51.4.499","article-title":"Gender Difference in Patients with Recurrent Neurally Mediated Syncope","volume":"51","author":"Park","year":"2010","journal-title":"Yonsei Med. J."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1016\/j.reuma.2015.05.007","article-title":"Diferencias de g\u00e9nero en pacientes con s\u00edndrome de fatiga cr\u00f3nica","volume":"12","author":"Faro","year":"2016","journal-title":"Reumatol. Cl\u00ednica"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1016\/j.jinf.2019.01.006","article-title":"Cytokine profiles in patients with Q fever fatigue syndrome","volume":"78","author":"Raijmakers","year":"2019","journal-title":"J. Infect."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Bellocchi, C., Carandina, A., Montinaro, B., Targetti, E., Furlan, L., Rodrigues, G.D., Tobaldini, E., and Montano, N. (2022). The Interplay between Autonomic Nervous System and Inflammation across Systemic Autoimmune Diseases. Int. J. Mol. Sci., 23.","DOI":"10.3390\/ijms23052449"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Milovanovic, B., Markovic, N., Petrovic, M., Zugic, V., Ostojic, M., Dragicevic-Antonic, M., and Bojic, M. (2025). A New Approach to the Etiology of Syncope: Infection as a Cause. Viruses, 17.","DOI":"10.3390\/v17030427"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"510","DOI":"10.3343\/alm.2021.41.5.510","article-title":"Serological Evidence of Coxiella burnetii and SARS-CoV-2 Co-infection: A Case Report","volume":"41","author":"Park","year":"2021","journal-title":"Ann. Lab. Med."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Michalak, K.P., Michalak, A.Z., and Brenk-Krakowska, A. (2025). Acute COVID-19 and Long COVID syndrome\u2013molecular implications for therapeutic strategies\u2014Review. Front. Immunol., 16.","DOI":"10.3389\/fimmu.2025.1582783"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"11","DOI":"10.5114\/aoms.2010.13500","article-title":"Methods of evaluation of autonomic nervous system function","volume":"6","author":"Zygmunt","year":"2010","journal-title":"Arch. Med. Sci."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1002\/mus.20365","article-title":"Quantitative studies of autonomic function","volume":"33","author":"Hilz","year":"2006","journal-title":"Muscle Nerve"},{"key":"ref_42","first-page":"66","article-title":"Why not to use the handgrip test in the assessment of cardiovascular autonomic neuropathy among patients with diabetes mellitus?","volume":"15","author":"Kempler","year":"2017","journal-title":"Curr. Vasc. Pharmacol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1001\/jamaneurol.2020.1127","article-title":"Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China","volume":"77","author":"Mao","year":"2020","journal-title":"JAMA Neurol."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Marques, K.C., Silva, C.C., Trindade, S.D.S., Santos, M.C.S., Rocha, R.S.B., Vasconcelos, P.F.D.C., Quaresma, J.A.S., and Falc\u00e3o, L.F.M. (2022). Reduction of Cardiac Autonomic Modulation and Increased Sympathetic Activity by Heart Rate Variability in Patients with Long COVID. Front. Cardiovasc. Med., 9.","DOI":"10.3389\/fcvm.2022.862001"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"8131","DOI":"10.1007\/s11033-022-07486-y","article-title":"Potential autonomic nervous system dysfunction in COVID-19 patients detected by heart rate variability is a sign of SARS-CoV-2 neurotropic features","volume":"49","author":"Mohammadian","year":"2022","journal-title":"Mol. Biol. Rep."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Milovanovic, B., Djajic, V., Bajic, D., Djokovic, A., Krajnovic, T., Jovanovic, S., Verhaz, A., Kovacevic, P., and Ostojic, M. (2021). Assessment of Autonomic Nervous System Dysfunction in the Early Phase of Infection with SARS-CoV-2 Virus. Front. Neurosci., 15.","DOI":"10.3389\/fnins.2021.640835"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"502","DOI":"10.4330\/wjc.v6.i6.502","article-title":"Respiratory modulation of cardiac vagal tone in Lyme disease","volume":"6","author":"Puri","year":"2014","journal-title":"World J. Cardiol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"H378","DOI":"10.1152\/ajpheart.00019.2013","article-title":"Distension of central great vein decreases sympathetic outflow in humans","volume":"305","author":"Cui","year":"2013","journal-title":"Am. J. Physiol-Heart Circ. Physiol."},{"key":"ref_49","unstructured":"Low, P.A., and Benarroch, E.E. (2008). Clinical Autonomic Disorders, Wolters Kluwer Health. [3rd ed.]."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1016\/j.bbi.2019.03.009","article-title":"Heart rate variability and inflammation: A meta-analysis of human studies","volume":"80","author":"Williams","year":"2019","journal-title":"Brain Behav. Immun."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1696","DOI":"10.1093\/europace\/eup338","article-title":"Blood pressure oscillations during tilt testing as a predictive marker of vasovagal syncope","volume":"11","author":"Hausenloy","year":"2009","journal-title":"Europace"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"303","DOI":"10.2147\/VHRM.S380270","article-title":"Postural Orthostatic Tachycardia Syndrome in COVID-19: A Contemporary Review of Mechanisms, Clinical Course and Management","volume":"19","author":"Narasimhan","year":"2023","journal-title":"Vasc. Health Risk Manag."},{"key":"ref_53","unstructured":"Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology (1996). Heart rate variability: Standards of measurement, physiological interpretation and clinical use. Circulation, 93, 1043\u20131065."},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Shaffer, F., and Ginsberg, J.P. (2017). An Overview of Heart Rate Variability Metrics and Norms. Front. Public Health, 5.","DOI":"10.3389\/fpubh.2017.00258"},{"key":"ref_55","unstructured":"Schwalm, T. (2006). Modern Tilt Table Testing and Non-Invasive Monitoring: Traditional and Innovative Applications in Theory and Practice, ABW Wissenschaftsverlag."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"15814","DOI":"10.1038\/s41598-023-42615-y","article-title":"Autonomic dysregulation in long-term patients suffering from Post-COVID-19 Syndrome assessed by heart rate variability","volume":"13","author":"Mooren","year":"2023","journal-title":"Sci. Rep."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1038\/nature01321","article-title":"The inflammatory reflex","volume":"420","author":"Tracey","year":"2002","journal-title":"Nature"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"5781","DOI":"10.1113\/JP271539","article-title":"Anti-inflammatory properties of the vagus nerve: Potential therapeutic implications of vagus nerve stimulation","volume":"594","author":"Bonaz","year":"2016","journal-title":"J. Physiol."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"895","DOI":"10.1016\/j.molmed.2021.06.002","article-title":"Insights from myalgic encephalomyelitis\/chronic fatigue syndrome may help unravel the pathogenesis of postacute COVID-19 syndrome","volume":"27","author":"Komaroff","year":"2021","journal-title":"Trends Mol. Med."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1038\/nn.4477","article-title":"Neural regulation of immunity: Molecular mechanisms and clinical translation","volume":"20","author":"Pavlov","year":"2017","journal-title":"Nat. Neurosci."}],"container-title":["Pathogens"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-0817\/15\/1\/3\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T11:20:01Z","timestamp":1766143201000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-0817\/15\/1\/3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,19]]},"references-count":60,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["pathogens15010003"],"URL":"https:\/\/doi.org\/10.3390\/pathogens15010003","relation":{},"ISSN":["2076-0817"],"issn-type":[{"value":"2076-0817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,19]]}}}