• Mononucleosis and chronic fatigue
    January 13,2013


    and chronic fatigue

    Readers of the Rutland Herald who read “Going ‘mano a mano’ with mononucleosis” published in your Sunday Magazine section on Jan. 6, and written by Dr. Lewis First, chief of pediatrics at Vermont’s Children’s Hospital at Fletcher Allen Health Care, and chairman of the Department of Pediatrics at the University of Vermont College of Medicine, may also wish to know of the relationship between mononucleosis and chronic fatigue syndrome (CFS).

    As indicated by Dr. First, mononucleosis is caused by an infection with the Epstein-Barr virus. Prolonged infection with the Epstein-Barr virus, or prolonged symptoms of mononucleosis, lasting six months or longer in adults, was termed chronic Epstein-Barr virus infection and now would be classified as CFS.

    The relationship between mononucleosis and CFS remains unclear. However, clinical observation suggests that delayed treatment of mononucleosis, whether because of misdiagnosis or the patient’s refusal to succumb to the treatment regimen, increases the likelihood of triggering CFS.

    In addition, the return to work, school or to full activity prior to complete recovery from mononucleosis may also trigger CFS. This is a debilitating illness of variable severity. In most cases, however, individuals stricken with the illness are unable to work or attend school full-time, and have a life-long disability.

    It is estimated the CFS affects approximately 1 million Americans and costs the U.S. economy $6 billion per year. For these reasons, it is far better to minimize the chances of precipitating CFS, by adequate and timely treatment of mononucleosis.

    Further information about CFS may be obtained from our own Vermont CFIDS Association (www.vtcfids.org) which hosts educational programs about CFS, runs a support group for CFS patients, and provides a medical scholarship to train healthcare professionals in its treatment.

    The New Jersey Chronic Fatigue Syndrome Association (NJCFSA) is perhaps this country’s leading advocate for children with CFS and has issued a pediatric CFS fact sheet. The information produced by NJCFSA may be accessed by visiting its website: www.njcfsa.org.

    In May of 2012, the International Association for Chronic Fatigue Syndrome/ME released a primer for the diagnosis and treatment of CFS. A copy of the primer may be downloaded as a PDF file for free from the organization’s website: www.iacfsme.org. The primer does include a brief discussion of the treatment of children with CFS.

    To minimize the potential of their children developing CFS, parents would be well advised to watch for the symptoms of mononucleosis, and, if they appear, to seek medical attention for a proper diagnosis and treatment.

    The current pediatric case definition permits a diagnosis of CFS if symptoms of mononucleosis persist in a child for more than 3 months. If CFS is diagnosed, symptomatic treatment of CFS — which is the only available treatment — will reduce its severity and increase the likelihood of a full recovery.

    Parental vigilance to, and knowledge of, the relationship between mononucleosis and CFS may make the difference between children living a normal adult life and living a life in which the activities of daily living are a challenge and cannot be accomplished without assistance.

    Kenneth J. Friedman, Ph.D.


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