Journal
BRITISH MEDICAL JOURNAL
Volume 333, Issue 7568, Pages 575-578Publisher
B M J PUBLISHING GROUP
DOI: 10.1136/bmj.38933.585764.AE
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- PHS HHS [U50/CCU019851-01] Funding Source: Medline
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Objective To delineate the risk factors, symptom patterns, and longitudinal course of prolonged illnesses after a variety of acute infections. Design Prospective cohort stud), following patients from the time of acute infection with Epstein-Barr virus (glandular fever), Coxiella burnetti (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 die diagnostic criteria for chronic fatigue syndrome. This post-infective fatigue syndrome phenotype was stereotyped and occurred at a similar 1 incidence after each infection. The syndrome was predicted largely by the severity of the acute illness rather dian 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.
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