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Incidence, risk & prognosis of acute & Chronic Fatigue Syndrome (CFS) & psychiatric disorders after glandular fever

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BACKGROUND: The role of viruses in the aetiology of both chronic

fatigue syndrome (CFS) and depressive illness is uncertain.

METHOD: A prospective cohort study of 250 primary care

patients, presenting with glandular fever or an ordinary upper

respiratory tract infection (URTI).

RESULTS: The incidence of

an acute fatigue syndrome was 47% at onset, after glandular

fever, compared with 20% with an ordinary URTI (relative risk

2.3, 95% CI 1.3-4.1). The acute fatigue syndrome lasted a

median (interquartile range) of eight weeks (4-16) after

glandular fever, but only three weeks (2-4) after an URTI. The

prevalence of CFS was 9-22% six months after glandular fever,

compared with 0-6% following an ordinary URTI, with relative

risks of 2.7-5.1. The most conservative measure of the

incidence of CFS was 9% after glandular fever, compared with

no cases after an URTI. A conservative estimate is that

glandular fever accounts for 3113 (95% CI 1698-4528) new cases

of CFS per annum in England and Wales. New episodes of major

depressive disorder were triggered by infection, especially

the Epstein-Barr virus, but lasted a median of only three

weeks. No psychiatric disorder was significantly more

prevalent six months after onset than before.

CONCLUSIONS:

Glandular fever is a significant risk factor for both acute

and chronic fatigue syndromes. Transient new major depressive

disorders occur close to onset, but are not related to any

particular infection if they last more than a month.

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