Date sent:      	Fri, 7 Dec 2001 

Predictions and associations of fatigue syndromes and mood disorders that
occur after infectious mononucleosis

Lancet 2001; 358: 1946-54

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)


Summary

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:
http://www.thelancet.com/journal/vol/iss/full/llan.358.9297.original_rese
arch.18720.1


Talking points

Feeling tired?

"There was no single predictor of a fatigue syndrome after infection"

Certain infections are known to trigger chronic fatigue syndromes (CFS)
in a small number of people. Peter White and colleagues investigated
which factors predict or are associated with prolonged fatigue after
infectious mononucleosis and contrasted these factors with those that
predicted mood disorders after the same infection. They found that there
were many predictors of CFS, such as lower physical fitness and a
positive Monospot test at onset, which differed with both definition and
time, depending particularly on the presence or absence of comorbid mood
disorders. According to investigators, the particular infection and its
consequent immune reaction may have an early role, as well as physical
deconditioning.

Source:
http://www.thelancet.com/journal/vol358/iss9297/full/llan.358.9297.talkin
g_points.18711.3