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Old 04-08-2010, 11:58 PM   #1
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Distinguishing a Lengthly Mononucleosis Convalescence from a CFS diagnosis

How exactly does the medical community distinguish a lengthy recovery from Infectious Mononucleosis from a diagnosis of Chronic Fatigue Syndrome?
As reported in current research some people experience a pro-longed "post viral fatigue" after IM. Cases have been reported where patients experience a type of "post viral fatigue" that can last well past 6 months.
My question is how exactly do medical practitioners distinguish between the diagnosis of these 2 separate conditions considering the over-lapping symptoms?
What are the implications that Doctors make a CFS diagnosis, a completely separate condition from IM, when in fact IM has already been documented at the onset?

Last edited by sporque; 04-09-2010 at 12:02 AM.

 
Old 04-10-2010, 11:26 AM   #2
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Re: Distinguishing a Lengthly Mononucleosis Convalescence from a CFS diagnosis

Infectious mononucleosis is an objective condition which actually has diagnostic criteria. IM is actually not due to a virus' effect on the body; rather, the immune system's reaction to it. You are absolutely right, there are tons of symptoms of chronic fatigue syndrome (which I like calling post-infectious fatigue better) which overlap with IM, but part of the definition of IM is that it happens soon after primary exposure to a certain bunch of viruses and parasites. Additionally, with IM, you have to have a degree of atypical lymphocytosis in the form of, well, mononucleosis which is seen objectively on someone's blood film. Additionally with IM you have to document that it was caused by primary exposure (i.e. first time exposure) to a bunch of different viruses most commonly of which is EBV, but could also be CMV, HIV or a parasite called Toxoplasma.

There are many non-specific symptoms associated with IM which include fatigue, malaise, myalgias, but again these are non-specific. They are not essential to the diagnosis of mononucleosis. The prolonged fatigue which can occur after mononucleosis is different the mononucleosis in the blood film will have resolved and there will be evidence of seroconversion to one of the above pathogens. That means that there will be evidence of antibodies to one of those viruses or parasites. There is a time cutoff beyond which if there is fatigue, it is considered CFS, but I forget what it is. Somehow I remember it being around the 3 month point.

Mononucleosis obviously doesn't happen in everyone. There are many people who are exposed to EBV and CMV (and unfortunately HIV) who don't have any symptoms at all and will end up having evidence of seroconversion in the bloodwork.

Last edited by harka; 04-10-2010 at 11:27 AM.

 
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Old 04-10-2010, 11:44 AM   #3
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Re: Distinguishing a Lengthly Mononucleosis Convalescence from a CFS diagnosis

Sporque! Sorry, I didn't realize it was you. We were speaking on another thread.

The big thing with CFS to remember is that it happens a defined time AFTER a documented infection where the infection has been cleared by the body and there is no objective evidence of ACTIVE infection, and there is the persistence of symptoms, most notably fatigue.

We don't know why this happens, but it's probably because of ongoing immune activation with pro-inflammatory cytokine excretion (despite no infectious immunogenic stimulation) which makes the person feel unwell.

 
Old 04-10-2010, 11:53 PM   #4
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Re: Distinguishing a Lengthly Mononucleosis Convalescence from a CFS diagnosis

Interesting. So would you say that one Doctor would call a delayed recovery of IM, with no abnormal blood work,: post infectious fatigue and another Doctor might diagnosis CFS?
The similarities between CFS and prolonged mono are that the blood work shows their is no active infection but there are still unexplained symptoms?
It would seem more logical to me that the symptoms are less mysterious after IM then in CFS. With IM you at least had something happen at the onset that's been documented to cause a lengthy recovery in a percent of Mono sufferers. We know some people react badly to the virus, like myself.
It makes me wonder why a more complicated diagnosis like CFS would be used?
If Doctors had a documented case of IM at the onset advising patients of the potential for lingering symptoms after the acute infection, namely fatigue seems a more appropriate start.

Isn't it possible that a lengthy recovery from IM just resembles CFS but actually is a completely distinct condition in a percent of people with mono?
It seems like some Doctors do treat it as such, like mine who told me recovery takes 1 month to 1 year. But other Doctors are baffled when patients complain of symptoms 6 months after IM and look towards CFS.
Which basically means "we don't know whats wrong with you"

Since CFS has no known causes, cure or clear prognosis it would seem a safer and more logically route using the label "post infectious fatigue" as the initial diagnosis for delayed recovery mono patients.

I think the IM patient would be more encouraged knowing their condition isn't extremely mysterious hopefully discouraging them from self-diagnosis, and more hopeful they would recover rather than a CFS diagnosis with no clear outlook.

 
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Old 04-11-2010, 04:36 PM   #5
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Re: Distinguishing a Lengthly Mononucleosis Convalescence from a CFS diagnosis

As it is, CFS is a dubious diagnosis with poorly defined criteria with a lot of heterogeneity. People have tried to link it to EBV infection in the past, but there isn't a strong link. Whether they call it "post-infectious fatigue" or "chronic fatigue syndrome" or "post mono syndrome" is just semantics. The natural history of people who get mono is that they eventually get better. It's not easy because, while not life-threatening, fatigue can be a debilitating symptom. But in most people it gets better.

 
Old 07-22-2010, 04:40 AM   #6
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Re: Distinguishing a Lengthly Mononucleosis Convalescence from a CFS diagnosis

I disagree with the "post-viral" remark. Why can't it be viral and as yet undiscovered?

As it turns out XMRV has just been discovered to be closely associated with CFS. XMRV is a retrovirus and there is a new blood test available for it. You can even get it for free if you participate in the current research. Google up the Whittemore Peterson Institute for more info.

 
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Old 07-22-2010, 05:19 AM   #7
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Re: Distinguishing a Lengthly Mononucleosis Convalescence from a CFS diagnosis

You're completely right--it could be viral yet undiscovered, but at present there is no convincing evidence of this happening. The paper by Lombardi which was published in science about XMRV (xenotropic murine retrovirus) did definitely show an increased amount of XMRV in the blood of patients with CFIDS compared to those without the condition, but thus far that's all that's been found. There have been some followup studies that have failed to show this link, though admittedly, the assays in detecting the virus are not well established. This is an interesting question that has definitely prompted further research.

The problems with the XMRV hypothesis are numerous. First of all, in order for a micro-organism to be considered etiologic for a disease, it has to satisfy (modified) Koch's postulates. Thus far, XMRV has been shown to be present, in patients with CFIDS...that's it. Second, CFIDS itself is a dubious diagnosis. Many of the symptoms are non-specific, and while there is a diagnostic definition, it is all based on subjective clinical criteria--nothing objective. Without more stringent diagnostic criteria, the population of CFIDS patients remains heterogenous which also poses problems for the XMRV/CFIDS diagnosis. In any case, I do hope SOMETHING is found that is treatable so we can help all these thousands of people who have been debilitated by the condition.

 
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