Postviral fatigue syndrome

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Postviral Fatigue Syndrome (PVFS) refers to a post-infectious fatiguing illness with many similarities to myalgic encephalomyelitis (ME) and chronic fatigue syndrome (CFS).[1][2] Since not all cases of ME or CFS are preceded by a viral infection, the term PVFS has become outdated and is nowadays seldom used in scientific literature. As ME-expert Peter Behan explained these developments: “It became abundantly, crystal clear that several patients had developed the syndrome, the identical syndrome but they had developed the syndrome not following a viral or other infection but due to their reaction to a particular form of stress.”[3]

Classifiation [edit | edit source]

ICD-10 title[edit | edit source]

Postviral fatigue syndrome is the official concept title of code G93.3 in the ICD-10,[4] the medical classification list of the World Health Organization (WHO). "Benign myalgic encephalomyelitis" is inscribed as an inclusion, while "chronic fatigue syndrome" is listed only in the index. Since postviral fatigue syndrome is seldom used in scientific research and clinical practice, some argue it should be removed as a concept title. Mary Dimmock and Suzy Chapman for example propose to list PVFS in the upcoming ICD-11 as a synonym term under a new concept title "Myalgic encephalomyelitis".[5] The proposal of the IACFS/ME, written by Lily Chu[6], however suggests to retain the term PVFS as a concept title and to simply elevate the terms "chronic fatigue syndrome" (CFS) and "myalgic encephalomyelitis" (ME) to concept titles at the same level, with each of the three terms given a unique code. Both proposals to the ICD-11 advocate to maintain the classification of these three terms in the neurological chapter.

Post-infectious Fatigue Syndrome[edit | edit source]

The Oxford criteria has a post-infectious fatigue syndrome (PIFS) as one of its definitions. The Argus Report article US NIH Report Calls for UK Definition of ME/CFS to be Scrapped states: "The NIH has issued a draft report that highlights the dire need for scientific research that will help find a cure for the millions of people suffering from myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) worldwide. The report also highlights the fact that the decades-old UK Royal Society of Medicine’s Oxford criteria for ME/CFS are severely “flawed,” and that continuing to use these criteria may “cause harm.” Further, the NIH report says that the Royal Society definition should “be retired” and replaced with a single case definition agreed to by the ME/CFS community."[7]

Post-EBV ME/CFS[edit | edit source]

Several studies have performed an extensive follow-up on adolescents with infectious mononucleosis. In general these studies have found that approximately 10% of the sample meets the diagnosis of ME/CFS after 6 months, though the percentage decreases as time moves on. Research has not been able to identify significant predictors of ME/CFS diagnosis except for the severity of the acute Epstein-Barr virus (EBV) infection.

More fatigue after EBV compared to other infections[edit | edit source]

White et al. showed the percentage of ME/CFS patients to be significantly higher after an infection with EBV (9%) than after an upper respiratory tract infection (0%).[8] Other research has shown that persistent fatigue is much more common after infectious mononucleosis than after other infectious diseases such as influenza or tonsillitis.[9]

Independent of psychological factors[edit | edit source]

The study by White et al. demonstrated that EBV does not cause an increase in psychiatric disorder[8] and that psychosocial factors were not predictors of persistent complaints.[10] This indicated that the postviral fatigue syndrome is a distinct disease category.[11] According to the authors, patients with the postviral fatigue syndrome reported more severe physical fatigue, especially after exertion, than patients with psychiatric disorders. A similiar conclusion was drawn by Buchwald et al., who followed up on 150 patients with infectious mononucleosis in the Seattle area. After six months, 12% of the patient sample said they still were not recovered. In agreement with White, the authors stated that they “do not believe that the postinfectious fatigue syndrome after infectious mononucleosis can be explained primarily by psychologic factors.”[12]

Only severity of  the acute illness predicts ME/CFS[edit | edit source]

The most comprehensive study of postviral fatigue syndrome was organized and funded by the CDC in the 2000s. The study focused on Dubbo a remote township in Australia where it is easier to follow up on medical records; 253 patients with either an acute infection with Epstein-Barr virus (EBV), coxiella burnetti (the bacteria that causes Q-fever) or Ross River virus were studied. After six months, 11% of the patient sample met diagnostic criteria for chronic fatigue syndrome, with no significant differences in prevalence between the different infections. ME/CFS was predicted mostly by the severity of the acute infection, rather than by demographic, psychological or microbiological factors. There was no significant difference in cytokine expression[13] or reactivation of herpesviruses (EBV, HHV-6, CMV)[14] between the group that did or did not recover.  

ME/CFS caseness decreases as time move on[edit | edit source]

A study in the Chicago area showed that the percentage of patients meeting ME/CFS criteria after infectious mononucleosis decreases as time moves on. While 13% met ME/CFS criteria at the six-month time interval, this decreased to 7% at 12 months and only 4% at 24 months.[15] The most important predictors of ME/CFS caseness were autonomic symptoms and days spent in bed since mono.[16] This confirmed the main conclusion of the Dubbo studies, namely that the severity of the acute infection is the main predictor of ME/CFS. In the Chicago study however, cytokine expression indicated differences in Th17 function in patients with post-infectious ME/CFS.[17]

Psychosocial factors determine persistent fatigue but not ME/CFS[edit | edit source]

Studies that looked at a broader definition of fatigue after an EBV infection have reached different conclusions. Candy et al. for example found that persistent fatigue six months after infectious mononucleosis was predicted by certain illness perceptions such as the belief that the illness would take more than one month to recover from and would have serious consequences.[18]Moss-Morris et al. followed-up on 246 patients with glandular fever from New Zealand. After six months, 7.8% still reported severe fatigue. Depression, anxiety and perfectionism were associated with persistent complaints though perceived stress and limiting activity were not.[19] A Norwegian study found that fatigue after acute EBV was predicted by variables related to symptoms and negative emotions instead of immune processes.[20] These studies however do not regard patients who meet official ME/CFS diagnostic criteria.

Learn more[edit | edit source]

See also[edit | edit source]

References[edit | edit source]

  1. Lask, B; Dillon, M J (Nov 1990). "Postviral fatigue syndrome" (PDF). bmj.com. 
  2. Archer, M.I. (1987). "The post-viral syndrome: a review". The Journal of the Royal College of General Practitioners. 37 (298): 212–214. ISSN 0035-8797. PMID 3320358. 
  3. "ME: The Toxic Tiredness (Part 2)". YouTube. forcedout99. Feb 1, 2012. 35:19. 
  4. "ICD-10 Version:2016". apps.who.int. Retrieved Aug 24, 2018. 
  5. Chapman, Suzy; Dimmock, Mary (2017). "Proposal for the ICD-10 G93.3 legacy terms for ICD-11" (PDF). dxrevisionwatch.files.wordpress.com. 
  6. Bested, Alison M. (Apr 18, 2017). "IACFS/ME Newsletter Volume 10, Issue 2 – April 2017". IACFS/ME. 
  7. Swift, Penny. "US NIH Report Calls for UK Definition of ME/CFS to be Scrapped". theargusreport.com. Retrieved Aug 24, 2018. 
  8. 8.08.1 White, P. D.; Thomas, J. M.; Amess, J.; Crawford, D. H.; Grover, S. A.; Kangro, H. O.; Clare, A. W. (Dec 1998). "Incidence, risk and prognosis of acute and chronic fatigue syndromes and psychiatric disorders after glandular fever". The British Journal of Psychiatry: The Journal of Mental Science. 173: 475–481. ISSN 0007-1250. PMID 9926075. 
  9. Petersen, I.; Thomas, J. M.; Hamilton, W. T.; White, P. D. (Jan 2006). "Risk and predictors of fatigue after infectious mononucleosis in a large primary-care cohort". QJM: monthly journal of the Association of Physicians. 99 (1): 49–55. doi:10.1093/qjmed/hci149. ISSN 1460-2725. PMID 16330509. 
  10. White, P. D.; Thomas, J. M.; Kangro, H. O.; Bruce-Jones, W. D.; Amess, J.; Crawford, D. H.; Grover, S. A.; Clare, A. W. (Dec 8, 2001). "Predictions and associations of fatigue syndromes and mood disorders that occur after infectious mononucleosis". Lancet (London, England). 358 (9297): 1946–1954. doi:10.1016/S0140-6736(01)06961-6. ISSN 0140-6736. PMID 11747919. 
  11. White, P. D.; Grover, S. A.; Kangro, H. O.; Thomas, J. M.; Amess, J.; Clare, A. W. (Sep 1995). "The validity and reliability of the fatigue syndrome that follows glandular fever". Psychological Medicine. 25 (5): 917–924. ISSN 0033-2917. PMID 8588010. 
  12. Buchwald, D. S.; Rea, T. D.; Katon, W. J.; Russo, J. E.; Ashley, R. L. (Nov 2000). "Acute infectious mononucleosis: characteristics of patients who report failure to recover". The American Journal of Medicine. 109 (7): 531–537. ISSN 0002-9343. PMID 11063953. 
  13. Vollmer-Conna, Uté; Cameron, Barbara; Hadzi-Pavlovic, Dusan; Singletary, Kristi; Davenport, Tracey; Vernon, Suzanne; Reeves, William C.; Hickie, Ian; Wakefield, Denis (Sep 15, 2007). "Postinfective fatigue syndrome is not associated with altered cytokine production". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 45 (6): 732–735. doi:10.1086/520990. ISSN 1537-6591. PMID 17712757. 
  14. Cameron, Barbara; Flamand, Louis; Juwana, Hedy; Middeldorp, Jaap; Naing, Zin; Rawlinson, William; Ablashi, Dharam; Lloyd, Andrew (Oct 2010). "Serological and virological investigation of the role of the herpesviruses EBV, CMV and HHV-6 in post-infective fatigue syndrome". Journal of Medical Virology. 82 (10): 1684–1688. doi:10.1002/jmv.21873. ISSN 1096-9071. PMID 20827765. 
  15. Katz, Ben Z.; Jason, Leonard A. (Feb 2013). "Chronic fatigue syndrome following infections in adolescents". Current Opinion in Pediatrics. 25 (1): 95–102. doi:10.1097/MOP.0b013e32835c1108. ISSN 1531-698X. PMID 23263024. 
  16. Jason, Leonard A.; Katz, Ben Z.; Shiraishi, Yukiko; Mears, Cynthia J.; Im, Young; Taylor, Renee R. (Jan 1, 2014). "Predictors of post-infectious chronic fatigue syndrome in adolescents". Health Psychology and Behavioral Medicine. 2 (1): 41–51. doi:10.1080/21642850.2013.869176. ISSN 2164-2850. PMC 3956649Freely accessible. PMID 24660116. 
  17. Broderick, Gordon; Katz, Ben Z.; Fernandes, Henrique; Fletcher, Mary Ann; Klimas, Nancy; Smith, Frederick A.; O'Gorman, Maurice R. G.; Vernon, Suzanne D.; Taylor, Renee (Sep 13, 2012). "Cytokine expression profiles of immune imbalance in post-mononucleosis chronic fatigue". Journal of Translational Medicine. 10: 191. doi:10.1186/1479-5876-10-191. ISSN 1479-5876. PMC 3480896Freely accessible. PMID 22973830. 
  18. Candy, B.; Chalder, T.; Cleare, A. J.; Peakman, A.; Skowera, A.; Wessely, S.; Weinman, J.; Zuckerman, M.; Hotopf, M. (Jul 2003). "Predictors of fatigue following the onset of infectious mononucleosis". Psychological Medicine. 33 (5): 847–855. ISSN 0033-2917. PMID 12877399. 
  19. Moss-Morris, R.; Spence, M. J.; Hou, R. (May 2011). "The pathway from glandular fever to chronic fatigue syndrome: can the cognitive behavioural model provide the map?". Psychological Medicine. 41 (5): 1099–1107. doi:10.1017/S003329171000139X. ISSN 1469-8978. PMID 20663256. 
  20. Pedersen, Maria; Asprusten, Tarjei Tørre; Godang, Kristin; Leegaard, Truls Michael; Osnes, Liv Toril; Skovlund, Eva; Tjade, Trygve; Øie, Merete Glenne; Wyller, Vegard Bruun Bratholm (Sep 25, 2018). "Predictors of chronic fatigue in adolescents six months after acute Epstein-Barr virus infection: A prospective cohort study". Brain, Behavior, and Immunity. doi:10.1016/j.bbi.2018.09.023. ISSN 1090-2139. PMID 30261303. 
  21. "[ELLE] Anecdotes used to promote O'Sullivan, complain she's being trolled". Phoenix Rising ME / CFS Forums. Retrieved Aug 24, 2018. 

Myalgic encephalomyelitis or M.E. has different diagnostic criteria to chronic fatigue syndrome; neurological symptoms are required but fatigue is an optional symptom.Cite error: Closing </ref> missing for <ref> tag

Myalgic encephalomyelitis or chronic fatigue syndrome, often used when both illnesses are considered the same.

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From MEpedia, a crowd-sourced encyclopedia of ME and CFS science and history.