Chronic fatigue & minor psychiatric morbidity after viral meningitis: a controlled study

OBJECTIVE–To test the hypotheses that patients exposed to viral

meningitis would be at an increased risk of developing chronic

fatigue syndrome and would have an excess of neurological

symptoms and physical impairment.

METHODS–Eighty three

patients were followed up 6-24 months after viral meningitis

and a postal questionnaire was used to compare outcome with 76

controls who had had non-enteroviral, non-CNS viral


RESULTS–For the 159 patients and controls the

prevalence of chronic fatigue syndrome was 12.6%, a rate

higher than previously reported from primary care attenders,

suggesting that moderate to severe viral infections may play a

part in the aetiology of some fatigue states. Those with a

history of meningitis showed a slight, non-significant

increase in prevalence of chronic fatigue syndrome (OR 1.4;

95% CI 0.5-3.6) which disappeared when logistic regression and

analysis was used to correct for age, sex, and duration of

follow up (OR 1.0; 95% CI 0.3-2.8). Controls showed marginally

higher psychiatric morbidity measured on the general health

questionnaire-12 (adjusted OR 0.6; 95% CI 0.3-1.3) Both groups

had similar rates of neurological symptoms and physical

impairment. The best predictor of chronic fatigue was a

prolonged duration time of off work after the illness (OR

4.93, 95% CI 1.3-18.8). The best predictor of severe chronic

fatigue syndrome diagnosed by Center for Disease Control

criteria was past psychiatric illness (OR 7.82, 95% CI

1.8-34.3). Duration of viral illness, as defined by days in

hospital, did not predict chronic fatigue syndrome.

CONCLUSIONS–(1) The prevalence of chronic fatigue syndrome is

higher than expected for the range of viral illnesses

examined; (2) enteroviral infection is unlikely to be a

specific risk factor for its development; (3) onset of chronic

fatigue syndrome after a viral infection is predicted by

psychiatric morbidity and prolonged convalescence, rather than

by the severity of the viral illness itself.

Hotopf M, Noah N, Wessely S

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