THE RELATIONSHIP BETWEEN FATIGUE, PSYCHOLOGICAL AND IMMUNOLOGICAL VARIABLES IN ACUTE INFECTIOUS ILLNESS

Objective: The aim of this paper is to explore the longitudinal relati onships between physical and psychological symptoms and immunological factors following acute infective illnesses. Method: Preliminary data from a prospective investigation of patients with serologically proven acute infectious illnesses due to Epstein-Barr virus (EBV), Ross Rive r virus (RRV) or Q fever are reported. Patients were assessed within 4 weeks of onset of symptoms and then reviewed 2 and 4 weeks later. Phy sical illness data were collected at interview. Psychological and soma tic symptom profiles were assessed by standardised self-report questio nnaires. Cell-mediated immune (CMI) function was assessed by measureme nt of delayed-type hypersensitivity (DTH) skin responses. Results: Thi rty patients who had been assessed and followed over the 4-week period (including 17 patients with EBV, five with RRV and eight with Q fever ) were included in this analysis. During the acute phase, profound fat igue and malaise were the most common symptoms. Classical depressive a nd anxiety symptoms were not prominent. Initially, 46% of cases had no DTH skin response (i.e. cutaneous anergy) indicative of impaired cell ular immunity Over the 4-week period, there was a marked improvement i n both somatic and psychological symptoms, although fatigue remained a prominent feature in 63% of subjects. The reduction in reported fatig ue was correlated with improvement in the DTH skin response (p = 0.001 ) and with improvement in General Health Questionnaire (GHQ) scores (p < 0.01). Conclusions: Acute infectious illnesses are accompanied by a range of nonspecific somatic and psychological symptoms, particularly fatigue and malaise rather than anxiety and depression. Although impr ovement in several symptoms occurs rapidly, fatigue commonly remains a prominent complaint at 4 weeks. Resolution of fatigue is associated w ith improvement in cell-mediated immunity.