Risks for Developing Myalgic Encephalomyelitis/Chronic Fatigue Syndrome in College Students Following Infectious Mononucleosis: A Prospective Cohort Study

Abstract

Background Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) involves severe fatigue, unrefreshing sleep, and cognitive impairment, leading to functional difficulties; prior studies have not evaluated risk factors with behavioral and immune data collected prior to developing ME/CFS.. Up to 5% of university students develop infectious mononucleosis (IM) annually, and 9-12% meet criteria for ME/CFS six months later. We sought to determine predictors of ME/CFS. Methods We enrolled college students at the start of the school year (Time 1), identified those who developed IM (Time 2) and followed them for 6 months (Time 3), identifying three groups: those who developed ME/CFS, those who developed severe ME/CFS (meeting >1 set of criteria) and those who were asymptomatic. We conducted 8 behavioral and psychological surveys and analyzed cytokines at three time points. Results 238 of the 4501 students (5.3%) developed IM; 6 months later, 55 of the 238 (23%) met criteria for ME/CFS and 157 (66%) were asymptomatic. 67 of the 157 asymptomatic students served as controls. Students with severe-ME/CFS were compared to students who were asymptomatic at three time points. The former group was not different from the latter group at Time 1 (prior to developing IM) in stress, coping, anxiety or depression, but were different in several behavioral measures and had significantly lower levels of IL-6 and IL-13. At Time 2 (when they developed IM), the two ME/CFS groups tended to have more autonomic complaints and behavioral symptoms while the severe- ME/CFS group had higher levels of IL-12 and lower levels of IL-13 than the recovered group. Conclusion At baseline, those who developed ME/CFS had more physical symptoms and immune irregularities, but not more psychological symptoms, than those who recovered.

The Female-Predominant Persistent Immune Dysregulation of the Post-COVID Syndrome

“…The presence of a common pathway mediated by immune dysregulation provides a common cause of these conditions, and IL-6 is elevated in these syndromes. 52 , 53 , 54 , 55 , 56 Interleukin 6 is associated with fatigue and sleep disturbance in chronic stress and inflammation in CS syndromes. 57 Diagnosis of these conditions has traditionally been frustrating as patients will have multiple disabling symptoms yet will have few (if any) abnormalities on laboratory and procedural testing.…”

Epstein-Barr Virus and the Origin of Myalgic Encephalomyelitis or Chronic Fatigue Syndrome

“…The identification of successful treatment would potentially prevent the development of this or other diseases associated with this pathogen. Interestingly, a recent prospective study investigating risk factors for developing ME/CFS in college students following infectious mononucleosis, found that those who developed ME/CFS had more physical symptoms and immune irregularities at baseline ( 137 ). If the association between the expression of certain HLA-II alleles and higher susceptibility to develop ME/CFS exists, individuals with post infectious mononucleosis fatigue syndrome could be an interesting group to study and test the hypothesis discussed in this review.…”

The Female Predominant Persistent Immune Dysregulation of the Post COVID Syndrome: A Cohort Study

“…The presence of a common pathway mediated by immune dysregulation provides a common etiology of these conditions and IL-6 is elevated in these syndromes. [51][52][53][54][55] IL-6 is associated with fatigue and sleep-disturbance in chronic stress and inflammation in central sensitization syndromes. 56 Treatment of these conditions have traditionally been frustrating as patients will have multiple disabling symptoms yet will have very few (if any) abnormalities on laboratory and procedural testing.…”