Preprint Predictors of Postviral Symptoms Following Epstein-Barr Virus-Associated Infectious Mononucleosis in Young People - the IMMUC Study, 2024, Bodenhausen

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https://www.medrxiv.org/content/10.1101/2024.05.17.24307333v1

Predictors of Postviral Symptoms Following Epstein-Barr Virus-Associated Infectious Mononucleosis in Young People - Data from the IMMUC Study

Maren Bodenhausen, Jonas Geisperger, Julia Lange de Luna, Johannes Wendl, Alexander Hapfelmeier, Lina Schulte-Hillen, Rafael Pricoco, Nina Koerber, Tanja Bauer, Josef Mautner, Dieter Hoffmann, Peter Luppa, Silvia Egert-Schwender, Elfriede Noessner, Henri-Jacques Delecluse, Susanne Deleculse, Fabian Hauck, Christine S. Falk, Thomas Schulz, Marc-Matthias Steinborn, Andreas Bietenbeck, Alexandra Nieters, Lorenz Mihatsch, Katrin Gerrer, Uta Behrends, IMMUC Study Group

doi: https://doi.org/10.1101/2024.05.17.24307333



Abstract

Background:

Epstein-Barr virus-associated Infectious Mononucleosis (EBV-IM) is a common disease following primary EBV infection in children and adolescents. While EBV-IM is mostly self-limiting, symptoms like fatigue may persist over several months or even result in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). This large clinical observational study aimed at identifying risk factors for protracted courses of EBV-IM in young people.

Methods:

A cohort of N=200 children, adolescents, and young adults with acute primary EBV infection was recruited from hospitals and private practices. Data on the patients' medical history as well as clinical and laboratory parameters were collected at a baseline visit (V1) within four weeks after symptom onset (Tonset) and at two follow-up visits (V2 and V3) one and six months after Tonset. Risk factors for protracted symptoms at V3 were modeled using multivariable logistic regressions.

Results:

Protracted symptoms were observed in 55/183 (30.1%) and protracted fatigue in 34/181 (18.8%) patients at V3. A medical history indicating an increased susceptibility to infectious diseases as well as distinct severe IM symptoms, e.g. severe gastrointestinal symptoms, were significantly associated with protracted disease [OR: 2.31; P=0.011 and OR: 3.42; P=0.027] and with chronic fatigue [OR: 2.98; P=0.006 and OR: 3.54; P=0.034], respectively. Occurrence of twelve or more clinical and laboratory parameters until and including V1 discriminated between fatigue and no fatigue at V3 [OR 2.43, P=0.033].

Conclusion:

A clinical history of immune dysregulation as well as distinct severe IM symptoms might predict protracted post-viral disease and thus help in the identification of young patients at risk.

 

I really think this is important. I know this isn’t referring to ME but lingering symptoms but I still feel drawing with a personal experience is relevant.

In my experience, I suffered from many symptoms after a viral infection but not fatigue. It took about 1 year and me becoming very severe for the fatigue to become noticeable.

I fit the ICC months after the virus, but it took me much longer (and becoming bedridden) to fit the IOM and CCC. I really think the BPS folks and the name “chronic fatigue syndrome” have skewered views of the disease while self-selecting for patients with more fatigue.

 

I don't know if I got EBV when I became ill in 1991 during sudden viral onset. I did not have fatigue, PEM or cognitive issues for years. I had vertigo and other symptoms and felt 'flat' after exercise. I was still functional for months until I was vaccinated with Hep B and that's when my stamina changed.

There is a story in Nature that I posted a few yrs ago about a neighbourhood in my city where 15 people who lived there developed MS in 1991, the same year I got sick but developed M.E.

 

Bit frustrating that they don't provide a clear overview of the all the predictor variables that were tested.

 

I wouldn't judge this work yet, it seems to be just be one of the first publications of the IMMUC study and as such has a short term follow-up. I suspect the work will be interesting once there is a 12 month follow-up. However, for ME/CFS research the cohort of n=200 is exceedingly small and in fact far too small to reveal anything. If n=200 people become infected with EBV the estimated number of pwME from that cohort is 0.

 

As a note to that: Ascherios EBV-MS study had a sample size larger than 10 000 000. I suspect if you want to conduct a similar study for ME/CFS, that is supposed to include some level of control, then something similar would be required. Without controls a couple of thousand might suffice, but would this give much useful data especially with the high circulation rate of things such as Covid?