A Validated Scale for Assessing the Severity of Acute Infectious Mononucleosis, 2019, Jason et al

Andy · Mar 16, 2019

Abstract
OBJECTIVES:
To develop a scale for the severity of mononucleosis.

STUDY DESIGN:
One to 5 percent of college students develop infectious mononucleosis annually, and about 10% meet criteria for chronic fatigue syndrome (CFS) 6 months following infectious mononucleosis. We developed a severity of mononucleosis scale based on a review of the literature. College students were enrolled, generally when they were healthy. When the students developed infectious mononucleosis, an assessment was made as to the severity of their infectious mononucleosis independently by 2 physicians using the severity of mononucleosis scale. This scale was correlated with corticosteroid use and hospitalization. Six months following infectious mononucleosis, an assessment is made for recovery from infectious mononucleosis or meeting 1 or more case definitions of CFS.

RESULTS:
In total, 126 severity of mononucleosis scales were analyzed. The concordance between the 2 physician reviewers was 95%. All 3 hospitalized subjects had severity of mononucleosis scores ≥2. Subjects with severity of mononucleosis scores of ≥1 were 1.83 times as likely to be given corticosteroids. Students with severity of mononucleosis scores of 0 or 1 were less likely to meet more than 1 case definition of CFS 6 months following infectious mononucleosis.

CONCLUSIONS:
The severity of mononucleosis scale has interobserver, concurrent and predictive validity for hospitalization, corticosteroid use, and meeting criteria for CFS 6 months following infectious mononucleosis.
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Paywalled at https://www.jpeds.com/article/S0022-3476(19)30123-4/fulltext

Kalliope · Mar 16, 2019

Well, that looks slightly more useful than Wyller's recent study on simply letting the GPs make a guess..
https://www.s4me.info/threads/ebv-r...-ebv-infection-vegard-bruun-wyller-team.8447/

Trish · Mar 16, 2019

Sci hub link for full paper
https://sci-hub.se/https://doi.org/10.1016/j.jpeds.2019.01.035

rvallee · Mar 16, 2019

Yikes

In total, 126 severity of mononucleosis scales were analyzed.
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Hutan · Mar 16, 2019

@rvallee, I puzzled over that '126 scales' for a while. It's actually the sample size; it was written poorly.

This is from the paper:

We rated 126 students who developed infectious mononu- cleosis (stage 2) at the Northwestern University Health Cen- ter (NUHS) from December 2013 through March 2017. There were 56 male students and 70 female students, ranging in age from 18 to 23 years.
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From the abstract, it looks like a useful study though.

rvallee · Mar 16, 2019

Hutan said: ↑

@rvallee, I puzzled over that '126 scales' for a while. It's actually the sample size; it was written poorly.

This is from the paper:

From the abstract, it looks like a useful study though.
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Ooof That really seemed extraordinarily high.

Webdog · Mar 20, 2019

Assessment tool predicts chronic fatigue syndrome six months after mono
https://medicalxpress.com/news/2019-03-tool-chronic-fatigue-syndrome-months.html

Medical Xpress said:

In a study with 126 college students, they found that participants with a higher mononucleosis severity score had over three times the risk of meeting two or more sets of diagnostic criteria for chronic fatigue syndrome after six months
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Medical Xpress said:

Our simple and objective assessment tool allows clinicians to identify patients at risk for more serious infectious mononucleosis, including those who might develop chronic fatigue syndrome following infectious mononucleosis
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Medical Xpress said:

Previous research by Dr. Katz and colleagues, published in Pediatrics, showed that adolescents who developed chronic fatigue syndrome after mononucleosis gradually got better, although 4 percent were still suffering from the condition two years later.
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Medical Xpress said:

"It appears that chronic fatigue syndrome might involve a combination of immunologic and psychologic factors, but we still don't know the exact cause or causes," says Dr. Katz.

Multiple studies have identified two treatments that may be effective for chronic fatigue syndrome—graded exercise therapy (physical activity that starts out slowly and is gradually increased over time) and cognitive behavioral therapy.
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Hutan · Mar 21, 2019

Medical Xpress said:

Multiple studies have identified two treatments that may be effective for chronic fatigue syndrome—graded exercise therapy (physical activity that starts out slowly and is gradually increased over time) and cognitive behavioral therapy.

"Potential follow-up research will evaluate if treatment for chronic fatigue syndrome begun at the time severe mononucleosis is diagnosed can reduce the chances of developing this challenging condition six months later," says Dr. Katz.
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I'm surprised at this. So the main author of this paper is suggesting potential follow-up research in which treatment of CFS will be begun at the time the severe mononucleosis is diagnosed. And the treatments that Medical Xpress mentions are GET and CBT. This would seem to suggest that the author(s) are signing up to the 'CFS is caused by deconditioning' idea.

And Leonard Jason is a co-author on this current study?

Michiel Tack · Mar 21, 2019

Hutan said: ↑

And Leonard Jason is a co-author on this current study?
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The most likely explanation is that Medical express put the GET/CBT thing in there.

Hutan · Mar 21, 2019

Michiel Tack said: ↑

The most likely explanation is that Medical express put the GET/CBT thing in there.
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Yeah, I wondered about that. But Dr Katz himself talks about treatment for CFS - if he's got something that isn't GET and CBT, I'd like to know what it is.

Andy · Mar 21, 2019

A quick skim/search through the article shows no reference to CBT and/or GET. Katz is corresponding author, perhaps a quick email from someone could clear it up, or clarify.

Andy · Mar 21, 2019

Happily, somebody else has beaten us to it.

ETA: Added "happily" and emoji to improve tone.

Sly Saint · Mar 21, 2019

John Mac · Apr 2, 2019

Covered on USA News website

TUESDAY, April 2, 2019 (HealthDay News) -- As if having the exhausting "kissing disease" -- also known as mononucleosis, or "mono" -- isn't bad enough, about 1 in 10 people with this infection will develop chronic fatigue syndrome in six months, researchers report.

To better predict which people with mono might end up with debilitating chronic fatigue syndrome, investigators at Lurie Children's Hospital of Chicago developed a new scale to rate how severe a mononucleosis infection is. They then tested it in 126 college students diagnosed with mono.
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https://www.usnews.com/news/health-...n-may-raise-risk-for-chronic-fatigue-syndrome

TigerLilea · Apr 2, 2019

John Mac said: ↑

Covered on USA News website

https://www.usnews.com/news/health-...n-may-raise-risk-for-chronic-fatigue-syndrome
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I'm the only person I know that had mono who later went on to develop ME/CFS. And that was 14 years later.

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