Peter D White, Janice M Thomas, Hillar O Kangro, William D A Bruce-Jones, John Amess, Dorothy H Crawford, Shirlyn A Grover, Anthony W Clare
Departments of Psychological Medicine (P D White MD, W D A Bruce-Jones MPhil, Prof A W Clare MD), Computer Sciences (J M Thomas MSc), Virology (H O Kangro PhD), and Haematology (J Amess MB), St Bartholomew's and the Royal London School of Medicine and Dentistry, London; Department of Virology, St George's Hospital Medical School, London (S A Grover); and Department of Medical Microbiology, University of Edinburgh, Edinburgh, UK (Prof D H Crawford DSc)
Correspondence to: Dr Peter D White, Department of Psychological Medicine, St Bartholomew's and the Royal London School of Medicine and Dentistry, St Bartholomew's Hospital, London EC1A 7BE, UK (e-mail:P.D.White@qmul.ac.uk)
Background: Certain infections can trigger chronic fatigue syndromes (CFS) in a minority of people infected, but the reason is unknown. We describe some factors that predict or are associated with prolonged fatigue after infectious mononucleosis and contrast these factors with those that predicted mood disorders after the same infection.
Methods: We prospectively studied a cohort of 250 primary-care patients with infectious mononucleosis or ordinary upper-respiratory-tract infections until 6 months after clinical onset. We sought predictors of both acute and chronic fatigue syndromes and mood disorders from clinical, laboratory, and psychosocial measures.
Findings: An empirically defined fatigue syndrome 6 months after onset, which excluded comorbid psychiatric disorders, was most reliably predicted by a positive Monospot test at onset (odds ratio 2·1 [95% CI 1·4-3·3]) and lower physical fitness (0·35 [0·15-0·8]). Cervical lymphadenopathy and initial bed rest were associated with, or predicted, a fatigue syndrome up to 2 months after onset. By contrast, mood disorders were predicted by a premorbid psychiatric history (2·3 [1·4-3·9]), an emotional personality score (1·21 [1·11-1·35]), and social adversity (1·7 [1·0-2·9]). Definitions of CFS that included comorbid mood disorders were predicted by a mixture of those factors that predicted either the empirically defined fatigue syndrome or mood disorders.
Interpretation: The predictors of a prolonged fatigue syndrome after an infection differ with both definition and time, depending particularly on the presence or absence of comorbid mood disorders. The particular infection and its consequent immune reaction may have an early role, but physical deconditioning may also be important. By contrast, mood disorders are predicted by factors that predict mood disorders in general.
Source: Lancet 2001; 358: 1946-54