Research Published on Post-Infective Fatigue
The high-profile medical journal BMJ (formerly the British
Medical Journal) has published a study on post-infective fatigue from leading
CFS researchers including Andrew Lloyd of the University of New South Wales and
William Reeves and Suzanne Vernon of the CDC. The report details recent results
from the Dubbo Infection Outcome Study, in this case examining the occurrence of
post-infective fatigue at various intervals following infection of acute EBV
(Epstein-Barr virus; glandular fever), Q fever (Coxiella burnetii) or RRV (Ross
River virus; epidemic polyarthritis).
Investigators followed 253 individuals from the time of acute
infection through periodic evaluations at six weeks, three months, six months
and one year. At each phase a variety of symptoms were assessed and categorized
into six domains: acute sickness, irritability, fatigue, musculoskeletal pain,
mood disturbance and neurocognitive disturbance. At the six-month phase,
patients were assessed using the international case definition for CFS.
Results of the study shed light on numerous aspects of
post-infective fatigue syndrome (PIFS) and pointed to two significant findings.
First, that prolonged illness characterized by disabling fatigue,
musculo-skeletal pain, neurocognitive difficulties and mood disturbance was
evident in a definitive subset of patients infected with EBV, Q fever and RRV.
In fact, the PIFS phenotype occurred at a similar incidence regardless of the
precipitating infection. Twelve percent of subjects experienced PIFS at six
months, of whom all but one met the diagnostic criteria for CFS.
Second, the primary predictor of PIFS was the severity of the
acute illness during infection rather than any demographic, psychological or
Several things make this study different from previous
investigations into post-infective fatigue. First, the application of the CFS
case definition to designate incident cases in the post-infective setting
provides strong evidence for a role of these infections in triggering CFS in
certain instances. The findings confirm that CFS is a relatively common sequel
of several different infections, now documented to include EBV, RRV and Q fever.
Also, unlike other investigations, the cases identified in this study were
required to have serological confirmation of EBV infection, continuity of the
prolonged fatigue state and strict application of the CFS diagnostic criteria
with exclusion of alternative medical or psychiatric disorders.
Researchers concluded that a relatively uniform PIFS persists
in a significant minority of subjects for six months or more following clinical
infection with several different viral and non-viral micro-organisms. As such,
PIFS is a valid illness model for investigation of one pathophysiological
pathway to CFS.
To access a copy of the report from BMJ, visit