Published online June 29, 2009
PEDIATRICS Vol. 124 No. 1 July 2009, pp. 189-193 (doi:10.1542/peds.2008-1879)
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ARTICLE

Chronic Fatigue Syndrome After Infectious Mononucleosis in Adolescents

Ben Z. Katz, MDa, Yukiko Shiraishi, PhDb, Cynthia J. Mears, DOa, Helen J. Binns, MD, MPHa,c and Renee Taylor, PhDb

a Department of Pediatrics, Northwestern University Feinberg School of Medicine and Children's Memorial Hospital, Chicago, Illinois
b Department of Occupational Health, College of Applied Sciences, University of Illinois at Chicago, Chicago, Illinois
c Mary and J. Milburn Smith Child Health Research Program, Children's Memorial Research Center, Chicago, Illinois

OBJECTIVE: The goal was to characterize prospectively the course and outcome of chronic fatigue syndrome in adolescents during a 2-year period after infectious mononucleosis.

METHODS: A total of 301 adolescents (12–18 years of age) with infectious mononucleosis were identified and screened for nonrecovery 6 months after infectious mononucleosis by using a telephone screening interview. Nonrecovered adolescents underwent a medical evaluation, with follow-up screening 12 and 24 months after infectious mononucleosis. After blind review, final diagnoses of chronic fatigue syndrome at 6, 12, and 24 months were made by using established pediatric criteria.

RESULTS: Six, 12, and 24 months after infectious mononucleosis, 13%, 7%, and 4% of adolescents, respectively, met the criteria for chronic fatigue syndrome. Most individuals recovered with time; only 2 adolescents with chronic fatigue syndrome at 24 months seemed to have recovered or had an explanation for chronic fatigue at 12 months but then were reclassified as having chronic fatigue syndrome at 24 months. All 13 adolescents with chronic fatigue syndrome 24 months after infectious mononucleosis were female and, on average, they reported greater fatigue severity at 12 months. Reported use of steroid therapy during the acute phase of infectious mononucleosis did not increase the risk of developing chronic fatigue syndrome.

CONCLUSIONS: Infectious mononucleosis may be a risk factor for chronic fatigue syndrome in adolescents. Female gender and greater fatigue severity, but not reported steroid use during the acute illness, were associated with the development of chronic fatigue syndrome in adolescents. Additional research is needed to determine other predictors of persistent fatigue after infectious mononucleosis.

Key Words: adolescent health • chronic fatigue • epidemiology • Epstein-Barr virus • mononucleosis

Abbreviations: CFS—chronic fatigue syndrome • IM—infectious mononucleosis

Accepted Nov 7, 2008.


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Figures quoted should be considered lower bounds given they have not been adjusted for refusals, etc
Tom Kindlon
Pediatrics Online, 6 Jul 2009 [Full text]