QJM Advance Access originally published online on December 5, 2005
QJM 2006 99(1):49-55; doi:10.1093/qjmed/hci149
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Risk and predictors of fatigue after infectious mononucleosis in a large primary-care cohort
From the 1Centre for Psychiatry and 2Department of Information Services, Barts and The London, Queen Mary's School of Medicine and Dentistry, London, and 3Academic Unit of Primary Health Care, Department of Community-Based Medicine, University of Bristol, Bristol, UK
Address correspondence to Professor P.D. White, Department of Psychological Medicine, St Bartholomew's Hospital, London EC1A 7BE. email: p.d.white{at}qmul.ac.uk
Received 9 August 2005 and in revised form 4 November 2005
Background: Fatigue has been found to complicate infectious mononucleosis (IM) when patients are directly asked about it. We do not know whether such fatigue is clinically significant, nor whether IM is a specific risk for fatigue (or whether it can follow other common infections). Various risk markers for post-infectious fatigue have been identified, but findings are inconsistent.
Aim: To determine the risk of clinically reported fatigue (compared with depression) after IM (compared with both influenza and tonsillitis) in patients attending primary care, and to examine risk markers for post-IM fatigue.
Design: Comparison of matched primary-care cohorts.
Methods: We identified 1438 adult patients with a positive heterophil antibody test for IM from the UK General Practice Research Database. These patients were individually matched on age, sex and practice to two comparison groups; one with a clinical diagnosis of influenza and the other of tonsillitis.
Results: The odds ratios (ORs) (95%CI) for reported fatigue after IM vs. influenza and tonsillitis were 4.4 (2.9–6.9) and 6.6 (4.2–10.4), respectively. Risk markers for post-IM fatigue included female sex and premorbid mood disorder. By comparison, the ORs for depression after IM vs. influenza and tonsillitis were 1.6 (0.9–2.6) and 2.3 (1.4–3.9), respectively.
Discussion: IM is a specific and significant risk for clinically reported fatigue, which is both separate from, and more common than, depression. Female sex and premorbid mood disorder are risk markers for fatigue. These can be used both to target prevention strategies and to explore aetiological mechanisms.
*Current address: Primary Care and Population Sciences, University College London, London, UK.