Abstract
Twenty-one percent of 500 unselected patients, aged 17 to 50 years, seeking primary care for any reason were found to be suffering from a chronic fatigue syndrome consistent with "chronic active Epstein-Barr virus (EBV) infection," They had been experiencing "severe" fatigue, usually cyclic, for a median of 16 months (range, six to 458 months), associated with sore throat, myalgias, or headaches; 45% of the patients were periodically bedridden; and 25% to 73% reported recurrent cervical adenopathy, paresthesias, arthralgias, and difficulty in concentrating or sleeping. The patients had no recognized chronic "physical" illness and were not receiving psychiatric care. While antibody titers to several EBV-specific antigens were higher in patients than in age- and sex-matched controls subjects, the differences generally were not statistically significant. A chronic fatigue syndrome consistent with the chronic active EBV infection syndrome was prevalent in our primary care practice. However, our data offer no evidence that EBV is causally related to the syndrome. Indeed, we feel that among unselected patients seen in a general medical practice currently available EBV serologic test results must be interpreted with great caution.
Highlights
Twenty-one percent of 500 unselected patients, aged 17 to 50 years, seeking primary care for any reason were found to be suffering from a chronic fatigue syndrome consistent with "chronic active Epstein-Barr virus (EBV) infection." They had been experiencing "severe" fatigue, usually cyclic, for a median of 16 months, associated with sore throat, myalgias, or headaches; 45% of the patients were periodically bedridden; and 25% to 73% reported recurrent cervical adenopathy, paresthesias, arthralgias, and difficulty in concentrating or sleeping
A chronic fatigue syndrome consistent with the chronic active EBV infection syndrome was prevalent in our primary care practice
We feel that among unselected patients seen in a general medical practice currently available EBV serologic test results must be interpreted with great caution. (JAMA 1987;257:2303-2307)
Summary
History Chief complaint is the fatigue syndrome Severity of the fatigue at its worst Bedridden: can do virtually nothing Shut-in: cannot do even light housework or its equivalent Can do all the things I usually do at home or work, but feel much more fatigued from it: no energy left for anything else Description of the frequency of the fatigue Constant fatigue that does not change Always some fatigue that may get better but never goes away completely The fatigue alternates with periods of feeling normal Associated recurrent pharyngitis. The following rea¬ sons were given by 63 patients for de¬ clining to participate in the study: the patient was not interested in participat¬ ing in any kind of research studies (n = 43); the patient felt that viral infec¬ tion was unlikely and that there were "other reasons" (unspecified) to account for his or her fatigue (n = ll); and the patient did not want to have a phle¬ botomy (n = 9) Those patients partici¬ pating in the study were not signifi¬ cantly different (P>.05) from those eligible patients who declined to partici¬ pate: mean age (34 vs 33 years); sex (70% vs 75% female); and severity of illness—percentage with fatigue and sore throat and myalgias and headache (29% vs 45%)
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