Persisting Illness and Fatigue in Adults with Evidence of Epstein-Barr Virus Infection

  1. STEPHEN E. STRAUS, M.D.;
  2. GIOVANNA TOSATO, M.D.;
  3. GARY ARMSTRONG, B.S.M.T.;
  4. THOMAS LAWLEY, M.D.;
  5. OLIVIA T. PREBLE, Ph.D.;
  6. WERNER HENLE, M.D.;
  7. RICHARD DAVEY, M.D.;
  8. GARY PEARSON, Ph.D.;
  9. JAY EPSTEIN, M.D.;
  10. IRENA BRUS, M.D.; and
  11. R. MICHAEL BLAESE, M.D.
  1. Bethesda, Maryland; Rochester, Minnesota; New York, New York; and Philadelphia, Pennsylvania

    Abstract

    Clinical, serologic, virologic, and immunologic evaluations for 31 adults with chronic illness and fatigue suggested that 23 had persisting Epstein-Barr virus infection. Among these 23 patients, cellular immune mechanisms were generally normal, but 4 had mild immunoglobulin deficiencies. However, 20 patients had abnormal serologic profiles specific for Epstein-Barr virus shown by significantly elevated titers of antibodies to the viral capsid antigen or early antigen, or by a deficiency of late-appearing antibodies. In 11 of 15 patients tested, circulating immune complexes were found. Circulating interferon was not found in 18 patients tested, but the activity of 2-5 oligoadenylate synthetase, an interferon-induced enzyme, was increased in 5 patients studied. Of 19 patients, 18 had persisting suppressor T-cell activity typically found in patients recovering from acute infectious mononucleosis. We believe that the Epstein-Barr virus may be associated with chronic illness in adults.

    Article and Author Information

    • ▸From the Laboratory of Clinical Investigation, National Institute of Allergy and Infectious Diseases, Division of Virology, Office of Biologic Research and Review, Food and Drug Administration, Dermatology Branch and Metabolism Branch, National Cancer Institute, and the Clinical Center, National Institutes of Health, Bethesda, Maryland; Department of Pathology, Uniformed Services University of the Health Sciences, Bethesda, Maryland; Department of Microbiology, Mayo Clinic, Rochester, Minnesota; Beth Israel Medical Center and Joint Diseases North General Hospital, New York, New York; and the Division of Virology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.

    • Grant support: in part by grant R07439 from the Uniformed Services University of the Health Sciences. Dr. Preble is the recipient of grant CA34994, and Dr. Henle of grant CA33324, from the National Institutes of Health.

    • ▸Requests for reprints should be addressed to Stephen E. Straus, M.D.; Medical Virology Section, Building 10, Room 11N-113, National Institutes of Health; Bethesda, MD 20205.

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    1. Ann Intern Med January 1, 1985 vol. 102 no. 1 7-16
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