Post-infective and Chronic Fatigue Syndromes precipitated by viral and non-viral pathogens: Prospective cohort study

Authors and Affiliations: Ian Hickie 1, Tracey Davenport 1, Denis Wakefield 2, Ute Vollmer-Conna 3, Barbara Cameron 2, Suzanne D Vernon 4, William C Reeves 4, Andrew Lloyd 2*, for the Dubbo Infection Outcomes Study Group.

1. Brain and Mind Research Institute, Sydney University, Sydney, NSW 2050, Australia
2. School of Medical Sciences, University of New South Wales, Sydney, NSW 2052
3. School of Psychiatry, University of New South Wales
4. Division of Viral and Rickettsial Diseases, Centers for Disease Control and Prevention, Atlanta, GA 31033, USA

DOI: 10.1136/bmj.38933.585764.AE [Download a pdf of the entire article at: http://bmj.bmjjournals.com/cgi/rapidpdf/bmj.38933.585764.AEv1]

Objective: To delineate the risk factors, symptom patterns, and longitudinal course of prolonged illnesses after a variety of acute infections.

Design: Prospective cohort study following patients from the time of acute infection with Epstein-Barr virus (glandular fever), Coxiella burnetii (Q fever), or Ross River virus (epidemic polyarthritis).

Setting: The region surrounding the township of Dubbo in rural Australia, encompassing a 200 km geographical radius and 104,400 residents.

Participants: 253 patients enrolled and followed at regular intervals over 12 months by self report, structured interview, and clinical assessment.

Outcome measures: Detailed medical, psychiatric, and laboratory evaluations at six months to apply diagnostic criteria for Chronic Fatigue Syndrome. Premorbid and intercurrent illness characteristics recorded to define risk factors for chronic fatigue syndrome. Self reported illness phenotypes compared between infective groups.

Results: Prolonged illness characterised by disabling fatigue, musculoskeletal pain, neurocognitive difficulties, and mood disturbance was evident in 29 (12%) of 253 participants at six months, of whom 28 (11%) met the diagnostic criteria for chronic fatigue syndrome. This post-infective fatigue syndrome phenotype was stereotyped and occurred at a similar incidence after each infection. The syndrome was predicted largely by the severity of the acute illness rather than by demographic, psychological, or microbiological factors.

Conclusions: A relatively uniform post-infective fatigue syndrome persists in a significant minority of patients for six months or more after clinical infection with several different viral and non-viral micro-organisms. Post-infective fatigue syndrome is a valid illness model for investigating one pathophysiological pathway to chronic fatigue syndrome.