The Chronic Fatigue Syndrome

  • Gary P. Holmes
Part of the Clinical Topics in Infectious Disease book series (CLIN.TOP.INFECT)


In 1984 and 1985, three published reports described a symptom complex characterized primarily by chronic, relapsing fatigue or easy fatigability, recurrent low-grade fever, sore throat, lymph node pain, myalgias, arthralgias, headaches, sleep disturbances, decreased short-term memory and decreased ability to concentrate, and other nonspecific symptoms, and presented evidence suggesting a possible etiologic association with the Epstein-Barr virus (EBV) (DuBois et al. 1984; Jones et al. 1985; Straus et al. 1985). EBV serologic test results in these patients suggested that “elevated” immunoglobulin-G (IgG) titers against the diffuse and/or restricted components of early antigen (EA-D-IgG and EA-R-IgG, respectively, titers >40–80) and against the viral capsid antigen (VCA-IgG, titers >160–320) of EBV were significantly associated with the presence of these chronic illnesses.


Chronic Fatigue Syndrome Infectious Mononucleosis Chronic Fatigue Syndrome Patient Chronic Fatigue Syndrome Symptom Idiopathic Chronic Fatigue 
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  1. American Psychiatric Association. (1987). Diagnostic and Statistical Manual of Mental Disorders, 3rd ed., rev. Washington, American Psychiatric Association.Google Scholar
  2. Andersson, J., Britton, S., Emberg, I., et al. (1986). Effect of acyclovir on infectious mononucleosis: A double-blind, placebo-controlled study. J. Infect. Dis. 153:283–290.PubMedCrossRefGoogle Scholar
  3. Aoki, T., Usuda, Y., Miyakoshi, H., Tamura, K., and Herberman, R.B. (1987). Low natural killer syndrome: Clinical and immunologic features.Natl. Immun. Cell Growth Regul. 6:116–128.Google Scholar
  4. Armstrong, C.W., and Wetterhall, S.F. (1985). Ep- stein-Barr virus and unexplained illness (letter). Ann. Intern. Med. 102:722.Google Scholar
  5. Arnold, D.L., Bore, P.J., Radda, G.K., Styles, P., and Taylor, D.J. (1984). Excessive intracellular acidosis of skeletal muscle on exercise in a patient with a post-viral exhaustion/fatigue syndrome: A 31P nuclear magnetic resonance study. Lancet 1: 1367–1369.PubMedCrossRefGoogle Scholar
  6. Behan, RO., Behan, W.M.H., and Bell, E.J. (1985). The postviral fatigue syndrome—An analysis of the findings in 50 cases. J. Infect. 10:211–222.PubMedCrossRefGoogle Scholar
  7. Borysiewicz, L.K., Haworth, S.J., Cohen, J., Mundin, J., Rickinson, A., and Sissons, J.G.P. (1986). Ep- stein-Barr virus-specific immune defects in patients with persistent symptoms following infectious mononucleosis. Q. J. Med. 58:111–121.PubMedGoogle Scholar
  8. Buchwald, D., Goldenberg, D.L., Sullivan, J.L., and Komaroff, A.L. (1987). The “chronic, active Epstein-Barr virus infection” syndrome and primary fibromyalgia. Arthritis Rheum. 30:1132–1136.PubMedCrossRefGoogle Scholar
  9. Buchwald, D., Sullivan, J.L., and Komaroff, A.L. (1987). Frequency of “chronic active Epstein-Barr virus infection” in a general medical practice. JAMA 257:2303–2307.PubMedCrossRefGoogle Scholar
  10. Byrne, E., (1988). Idiopathic chronic fatigue and myalgia syndrome (myalgic encephalomyelitis): Some thoughts on nomenclature and etiology. Med J. Aust. 148:80–82.PubMedGoogle Scholar
  11. Byrne, E., and Trounce, I. (1987). Chronic fatigue and myalgia syndrome: Mitochondrial and glycolytic studies in skeletal muscle. J. Neurol. Neurosurg Psychiatr. 50:743–746.PubMedCrossRefGoogle Scholar
  12. Byrne, E., Trounce, I., and Dennett, X. (1985). Chronic relapsing myalgia (? postviral); clinical histological and biochemical studies. Aust. NZ J. Med. 15:305–308.CrossRefGoogle Scholar
  13. Calder, B.D., Wamock, P.J., McCartney, R.A., and Bell, E.J. (1987). Coxsackie B viruses and the post- viral syndrome: A prospective study in general practice. J. Roy. Coll. Gen. Pract. 37:11–14.Google Scholar
  14. Caligiuri, M., Murray, C., Buchwald, D., et al. (1987). Phenotypic and ftinctional deficiency of natural killer cells in patients with chronic fatigue syndrome.J. Immunol. 139:3306–3313.PubMedGoogle Scholar
  15. Campbell, S.M., Clark, S., Tindall, E.A., Forehand, M.E., and Bennett, R.M. (1983). Clinical characteristics of fibrositis: I. A “blinded,” controlled study of symptoms and tender points. Arthritis Rheum. 26:817–824.PubMedCrossRefGoogle Scholar
  16. Catalano, M.A., Carson, D.A., Slovin, S.F., Richman, D.D., and Vaughan, J.H. (1979). Antibodies to Epstein-Barr virus-determined antigens in normal subjects and in patients with seropositive rheumatoid arthritis. Proc. Natl. Acad. Sei. (USA) 76: 5825–5828.CrossRefGoogle Scholar
  17. Chen, M.K. (1986). The epidemiology of self-per- ceived fatigue among adults. Prevent. Med. 15:74–81.CrossRefGoogle Scholar
  18. Cheney PR, Dorman SE, and Bell DS (1989). Inter- leukin-Z and the chronic fatigue syndrome (letter). Ann. Intern. Med 110:321.PubMedGoogle Scholar
  19. Croft, W.A., Jarvis, B.B., and Yatawara, C.S. (1986). Airborne outbreak of trichothecene toxicosis. Atmosph. Environ. 20:549–552.CrossRefGoogle Scholar
  20. Dale, J.K., Straus, S.E., Ablashi, D.V., Salahuddin, Z.S., Gallo, R.C., Nishibe, Y., and Inoue, Y.K. (1988). The Inoue-Melnick virus, human herpesvirus type 6, and the chronic fatigue syndrome fetter). Ann. Intern. Med. 110:92–93.Google Scholar
  21. David, A.S., Wessely, S., and Pelosi, A.J. (1988). Postviral fatigue syndrome: Time for a new approach.Br. Med. J. 296:696–698.CrossRefGoogle Scholar
  22. Dickinson, A.C., Peacocke, N., Wray, B.B., Hutto, L., and Ades, E.W. (1988). Antibody-dependent cell- mediated cytotoxicity in patients with chronic mononucleosis syndrome: Evaluation of functional components and predictive value for gamma globulin therapy. Clin. Immunol Newslett 9:6–9.CrossRefGoogle Scholar
  23. Dorfman, L.J. (1987). Lake Tahoe mystery disease (letter). Science 235:623.CrossRefGoogle Scholar
  24. DuBois, R.E. (1986). Gamma globulin therapy for chronic mononucleosis syndrome. AIDS Res. 2 (Suppl. 1):S191-S195.PubMedGoogle Scholar
  25. DuBois, R.E., Seeley, J.K., Brus, I., et al. (1984). Chronic mononucleosis syndrome.South. Med. J. 77:1376–1382.PubMedCrossRefGoogle Scholar
  26. Eby, N., Grufferman, S., Whiteside, T., and Herberman, R. (1988). Natural killer cell activity as a marker of immune dysfunction in the chronic fatigue syndrome (abstract). Natl. Immunol. Cell Growth Regul. 7:48–49.Google Scholar
  27. Editorial. (1973). Statement on hypoglycemia.JAMA 223:682.Google Scholar
  28. Epstein, M.A., Achong, B.G., and Barr, Y.M. (1964). Virus particles in cultured lymphoblasts from Burkitt’s lymphoma. Lancet 1:702–703.PubMedCrossRefGoogle Scholar
  29. Evans, A.S., Niederman, J.C., and McCollum, R.W. (1968). Seroepidemiologic studies of infectious mononucleosis with EB virus. N. Engl. J. Med. 279:1121–1127.PubMedCrossRefGoogle Scholar
  30. Ferrell, P.B., Aitcheson, C.T., Pearson, G.R., and Tan, E.M. (1981). Seroepidemiological study of relationships between Epstein-Barr virus and rheumatoid arthritis. J Clin. Invest. 67:681–687.PubMedCrossRefGoogle Scholar
  31. Franco, E., Kawa-Ha, K., Doi, S., et al. (1987). Remarkable depression of CD4-I-2H4+ T cells in severe chronic active Epstein-Barr virus infection. Scand. J. Immunol. 26:769–773.PubMedCrossRefGoogle Scholar
  32. Galpine, J.F., and Brady, C. (1957). Benign myalgic encephalomyelitis. Lancet 1:757–758.CrossRefGoogle Scholar
  33. Gantz, N.M., and Holmes, G.P. (1989). Treatment of patients with the chronic fatigue syndrome. Drugs (in press).Google Scholar
  34. Glaser, R., Strain, E.C., Tarr, K.L., Holliday, J.E., Donnerberg, R.L., and Kiecolt-Glaser, J.K. (1985). Changes in Epstein-Barr virus antibody titers associated with aging. Proc. Soc. Exp. BioC Med. 179:352–355.Google Scholar
  35. Goldenberg, D.L. (1987). Fibromyalgia syndrome: An emerging but controversial condition. JAMA 257:2782–2787.PubMedCrossRefGoogle Scholar
  36. Goldenberg, D.L., Felson, D.T., and Dinerman, H. (1986). A randomized, controlled trial of amitrypti- line and naproxen in the treatment of patients with fibromyalgia. Arthritis Rheum. 29:1371–1377.PubMedCrossRefGoogle Scholar
  37. Gotlieb-Stematsky, T., Zonis, J., Arlazoroff, A., Mozes, T.G, Sigal, M., and Szekely, A.G. (1981). Antibodies to Epstein-Barr virus, herpes simplex type 1, cytomegalovirus and measles virus in psychiatric patients. Arch. Virol. 67:333–339.PubMedCrossRefGoogle Scholar
  38. Gove, P.B., et al. (eds.). (1963). Webster’s Third International Dictionary of the English Language, Unabridged, Springfield, Mass., G. & C. Merriam Co.Google Scholar
  39. Gray, J.A. (1984). Some long-term sequelae of Coxsackie B virus infection (editorial). J. Roy. Coll. Gen. Pract. 34:3–6.Google Scholar
  40. Greenberg, D.B. (1986). Depression, anxiety, and Epstein-Barr virus infection (letter). Ann. Intern. Med. 104:449.PubMedGoogle Scholar
  41. Hallee, T.J., Evans, A.S., Niederman, J.C., Brooks, C.M., and Voegtly, J.H. (1974). Infectious mononucleosis at the United States Military Academy: A prospective study of a single class over four years. Yale J Biol. Med. 3:182–195.Google Scholar
  42. Hamblin, T.J., Hussain, J., Akbar, A.N., Tang, Y.C., Smith, J.L., and Jones, D.B. (1983). Immunological reason for chronic ill health after infectious mononucleosis. Br. Med. J. 287:85–88.CrossRefGoogle Scholar
  43. Hellinger, W.C., Smith, T.F., Van Scoy, R.E., Spitzer, P.G., Forgacs, P., and Edson, R.S. (1988). Chronic fatigue syndrome and the diagnostic utility of antibody to Epstein-Barr virus early antigen. JAMA 260:971–973.PubMedCrossRefGoogle Scholar
  44. Henle, G., Henle, W., and Diehl, V. (1968). Relation of Burkitt’s tumor-associated herpes-type virus to infectious mononucleosis. Proc. Natl. Acad. Sei. (USA) 59:94–101.CrossRefGoogle Scholar
  45. Henle, W., and Henle, G. (1973). Epstein-Barr virus- related serology in Hodgkin’s disease. Natl. Cancer Inst. Monogr. 36:79–84.PubMedGoogle Scholar
  46. Henle, W., Henle, G., Andersson, J., et al. (1987). Antibody responses to Epstein-Barr virus-deter- mined nuclear antigen (EBNA)-l and EBNA-2 in acute and chronic Epstein-Barr virus infection. Proc. Natl. Acad Sei. (USA) 84:570–574.CrossRefGoogle Scholar
  47. Hesse, J., Ibsen, K.K., Krabbe, S., and Uldall, P. (1983). Prevalence of antibodies to Epstein-Barr virus (EBV) in childhood and adolescence in Denmark. Scand. J. Infect. Dis. 15:335–338.PubMedGoogle Scholar
  48. Holmes, G.P., Kaplan, J.E., Gantz, N.M., et al. (1988). Chronic fatigue syndrome: A working case definition. Ann. Intern. Med. 108:387–389.PubMedGoogle Scholar
  49. Holmes, G.P., Kaplan, J.E., Stewart, J.A., Hunt, B., Pinsky, P.F., and Schönberger, L.B. (1987). A cluster of patients with a chronic mononucleosis-like syndrome: Is Epstein-Barr virus the cause? JAMA 257:2297–2302.PubMedCrossRefGoogle Scholar
  50. Horwitz, C.A., Henle, W., Henle, G., Rudnick, H., and Latts, E. (1985). Long-term serological follow- up of patients for Epstein-Barr virus after recovery from infectious mononucleosis.J. Infect. Dis. 151:1150–1153.PubMedCrossRefGoogle Scholar
  51. Hudson, J.I., Hudson, M.S., Pliner, L.F., Goldenberg, D.L., and Pope, H.G. (1985). Fibromyalgia and major affective disorder: A controlled phenomenology and family history study. Am. J. Psychiatry 142:441–446.PubMedGoogle Scholar
  52. Innes, S.G.B. (1970). Encephalomyelitis resembling benign myalgic encephalomyelitis. Lancet 1: 969–971.PubMedCrossRefGoogle Scholar
  53. Isaacs, R. (1948). Chronic infectious mononucleosis. Blood 3:858–861.PubMedGoogle Scholar
  54. Jacobson, E.J. (1988). Chronic mononucleosis—It almost never happens. Postgrad. Med. 83:56–65.PubMedGoogle Scholar
  55. Jamal, G.A., and Hansen, S. (1985). Electrophysiological studies in the post-viral fatigue syndrome. J. Neurol. Neurosurg. Psychiatr. 48:691–694.PubMedCrossRefGoogle Scholar
  56. Jones, J.F., Ray, C.G., Minnich, L.L., Hicks, M.J., Kibler, R., and Lucas, D.O. (1985). Evidence for active Epstein-Barr virus infection in patients with persistent, unexplained illnesses: Elevated anti- early antigen antibodies. Ann. Intern. Med. 102:1–7.PubMedGoogle Scholar
  57. Jones, J.F., and Straus, S.E. (1987). Chronic Epstein- Barr virus infection. Ann. Rev. Med. 38:195–209.PubMedCrossRefGoogle Scholar
  58. Jones, S.R. (1985). Letter. Ann. Intern. Med 102:723.Google Scholar
  59. Josephs, S.F., Salahuddin, S.Z., Ablashi, D.V., Schachter, F., Wong-Staal, F., and Gallo, R.C. (1986). Genomic analysis of the human B-lymphotropic virus (HBLV). Science 234:601–603.PubMedCrossRefGoogle Scholar
  60. Keighley, B.D., and Bell, E.J. (1983). Sporadic myalgic encephalomyelitis in a rural practice. J. R. Coll. Gen. Pract. 33:339–341.PubMedGoogle Scholar
  61. Kibler, R., Lucas, D.O., Hicks, M.J., Poulos, B.T., and Jones, J.F. (1985). Immune function in chronic active Epstein-Barr virus infection. J. Clin. Immunol. 5:46–54.PubMedCrossRefGoogle Scholar
  62. Komaroff, A.L. (1987). The “chronic mononucleosis” syndromes.Hosp. Pract. 22:71–75.Google Scholar
  63. Komaroflf, A.L., Geiger, A.M. and Wormsley, S. (1988). IgG Subclass deficiencies in chronic fatigue syndrome (letter). Lancet 1:1288–1289.CrossRefGoogle Scholar
  64. Kroenke, K., Wood, D.R., Mangelsdorff, A.D., Meier, N.J., and Powell, J.B. (1988). Chronic fatigue in primary care: Prevalence, patient characteristics, and outcome. JAMA 260:929–934.PubMedCrossRefGoogle Scholar
  65. Krueger, G.R.F., Koch, B., and Ablashi, D.V. (1987). Persistent fatigue and depression in patient with antibody to human B-lymphotropic virus (letter). Lancet 2:36.PubMedCrossRefGoogle Scholar
  66. Kruesi, M.J.P., Dale, J.K., Straus, S.E., (1989). Psychiatric diagnoses in patients who have chronic fatigue syndrome. J. Clin. Psychiatry 50:53–56.PubMedGoogle Scholar
  67. Lamy, M.E., Favart, A.M., Comu, C., Mendez, M., Segas, M., and Burtonboy, G. (1982). Study of Ep- stein-Barr virus (EBV) antibodies: IgG and IgM anti-VCA, IgG anti-EA and Ig anti-EBNA obtained with an original microtiter technique. Acta. Clin. Belg. 37:281–298.PubMedGoogle Scholar
  68. Lehrer, J.F., and Hover, L.M. (1988). Fatigue syndrome (letter). JAMA 259:842–843.PubMedCrossRefGoogle Scholar
  69. Lloyd, A., Hanna, D.A. and Wakefield, D. (1988). Interferon and myalgic encephalomyelitis (letter) Lancet 1:471.PubMedCrossRefGoogle Scholar
  70. Lloyd, A.R., Wakefield, D., Boughton, C., and Dwyer, J. (1988). What is myalgic encephalomye- Utis? (letter). Lancet 1:1286–1287.PubMedCrossRefGoogle Scholar
  71. Lopez, C. (1987). Human herpesvirus VI. Presented at the 27th Interscience Conference on Antimicrobial Agents and Chemotherapy, New York, N.Y., October 6, 1987 (unpublished).Google Scholar
  72. Lopez, C., Pellett, P., Stewart, J., et al. (1988). Characteristics of human herpesvirus-6.J. Infect. Dis. 157:1271–1273.PubMedCrossRefGoogle Scholar
  73. Marinacci, A.A., and von Hägen, K.O. (1965). The value of the electromyogram in the diagnosis of Iceland disease.Electromyography 5:241–251.PubMedGoogle Scholar
  74. Masucci, G., Mellstedt, H., Masucci, M.G., et al. (1984). Immunological characterization of Hodg- kin’s and non-Hodgkin’s lymphoma patients with high antibody titers against Epstein-Barr virus-asso- ciated antigens. Cancer Res. 44:1288–1300.PubMedGoogle Scholar
  75. Matthews, D.A., Lane, T.J., and Manu, P. (1988). Letter. Ann. Intern. Med. 109:511–512.PubMedGoogle Scholar
  76. McDonald, E.M., Mann, A.H., and Thomas, H.C. (1987). Interferons as mediators of psychiatric morbidity: An investigation in a trial of recombinant alpha-interferon in hepatitis-B carriers. Lancet 2:1175–1178.PubMedCrossRefGoogle Scholar
  77. Miller, G., Grogan, E., Rowe, D., et al. (1987). Selective lack of antibody to a component of EB nuclear antigen in patients with chronic active Epstein-Barr virus infection. J. Infect. Dis. 156:26–35.PubMedCrossRefGoogle Scholar
  78. Morrison, J.D. (1980). Fatigue as a presenting complaint in family practice. J. Fam. Pract. 10: 795–801.PubMedGoogle Scholar
  79. Mueller, N. (1987). Epidemiologic studies assessing the role of the Epstein-Barr virus in Hodgkin’s disease. Yale J Biol. Med 60:321–327.PubMedGoogle Scholar
  80. Mueller, N., Evans, A., Harris, N.L., Comstock, G.W., Jellum, E., Magnus, K., Orentreich, N., Polk, B.F., and Vogelman, J. (1989). Hodgkins disease and Epstein-Barr virus: altered antibody pattern before diagnosis. N. Engl. J. Med. 320: 689–695.PubMedCrossRefGoogle Scholar
  81. Niederman, J.C., Evans, A.S., Subrahmanyan, L., and McCollum, R.W. (1970). Prevalence, incidence and persistence of EB virus antibody in young adults. N. Engl. J. Med. 282:361–365.PubMedCrossRefGoogle Scholar
  82. Olson, G.B., Kanaan, M.N., Gersuk, G.M., Kelley, L.M., and Jones, J.F. (1986). Correlation between allergy and persistent Epstein-Barr virus infections in chronic-active Epstein-Barr virus-infected patients. J. Allerg. Clin. Immunol 78:308–314.CrossRefGoogle Scholar
  83. Olson, G.B., Kanaan, M.N., Kelley, L.M., and Jones, J.F. (1986). Specific allergen-induced Epstein-Barr nuclear antigen-positive B cells from patients with chronic-active Epstein-Barr virus infections. J. Allerg. Clin. Immunol. 78:315–320.CrossRefGoogle Scholar
  84. Pagano, J.S., Sixbey, J.W., and Lin, J-C. (1983). Acyclovir and Epstein-Barr virus infection.J. Antimicrob. Chemother. 12 (Suppl. B):113–121.PubMedGoogle Scholar
  85. Porter, D.D., Wimberly, I., and Benyesh-Melnick, M. (1969). Prevalence of antibodies to EB virus and other herpesviruses. JAMA 208:1675–1679.PubMedCrossRefGoogle Scholar
  86. Poskanzer, D.C., Henderson, D.A., and Kunkle, E.G. (1957). Epidemic neuromyasthenia: An outbreak in Punta Gorda, Florida. N. Engl. J. Med. 257: 336–364.CrossRefGoogle Scholar
  87. Ramsay, A.M., and Rundle, A. (1979). Clinical and biochemical findings in ten patients with benign myalgic encephalomyelitis. Postgrad. Med. J. 55 856–857.PubMedCrossRefGoogle Scholar
  88. Read, R., Spickett, G., Harvey, J., Edwards, A.J., and Larson, H.E. (1988). IgGl subclass deficiency in patients with chronic fatigue syndrome (letter). Lancet 1:241–242.PubMedCrossRefGoogle Scholar
  89. Rubin, S.J. (1983). Immunological techniques in the diagnosis of viral infections. In Immunodiagnostics, R. M. Aloisi and J. Hyun (eds.). Proceedings of a National Symposium, University of Hartford, West Hartford, Conn., July 6–9, 1982. New York, Alan R. Liss, pp. 173–182.Google Scholar
  90. Sacks, N., and van Rensburg, A.J. (1976). Clinical aspects of chronic brucellosis. S. Afr. Med. J. 50:725–728.PubMedGoogle Scholar
  91. Salahuddin, S.Z., Ablashi, D.V., Markham, P.D., et al. (1986). Isolation of a new virus, HBLV, in patients with lymphoproliferative disorders. Science 234:596–603.PubMedCrossRefGoogle Scholar
  92. Salit, I.E. (1985). Sporadic postinfectious neuromyasthenia. Can. Med. Assoc. J. 133:659–663.Google Scholar
  93. Schooley, R.T., Carey, R.W., Miller, G., et al (1986). Chronic Epstein-Barr virus infection associated with fever and interstitial pneumonitis: Clinical and serologic features and response to antiviral chemotherapy. Ann. Intern. Med. 104:636–643.PubMedGoogle Scholar
  94. Sculley, D.G., Sculley, T.B., and Pope, J.H. (1986). Reactions of sera from patients with rheumatoid arthritis, systemic lupus erythematosus and infectious mononucleosis to Epstein-Barr virus-induced polypeptides. J. Gen. Virol. 67:2253–2258.PubMedCrossRefGoogle Scholar
  95. Straus, S.E. (1988a). Chronic Epstein-Barr virus infection: A critical assessment. In Immunobiology and Pathogenesis of Persistent Virus Infections, C. Lopez (ed.). Washington, D.C., American Society for Microbiology, pp. 281–293.Google Scholar
  96. Straus, S.E. (1988b). The chronic mononucleosis syndrome. J Infect. Dis. 157:405–411.PubMedCrossRefGoogle Scholar
  97. Straus, S.E., Dale, J.K., Armstrong, G., Preble, O., Lawley, T., and Henle, W. (1988c). Acyclovir treatment of the chronic fatigue syndrome: Lack of efficacy in a placebo-controlled trial. N. Engl. J. Med. 319:1692–1698.PubMedCrossRefGoogle Scholar
  98. Straus, S.E., Tosato, G., Armstrong, G., et al. (1985). Persisting illness and fatigue in adults with evidence of Epstein-Barr virus infection. Ann. Intern. Med. 102:7–16.PubMedGoogle Scholar
  99. Sumaya, C.V. (1985). Serological testing for Epstein- Barr virus—Developments in interpretation.J. Infect. Dis. 151:984–987.PubMedCrossRefGoogle Scholar
  100. Sumaya, C.V., Henle, W., Henle, G., Smith, M.H.D., and LeBlanc, D. (1975). Seroepidemiologic study of Epstein-Barr virus infections in a rural community. J. Infect. Dis. 131:403–408.PubMedCrossRefGoogle Scholar
  101. Sumaya, C.V., Myers, L.W., Ellison, G.W., and Ench, Y. (1985). Increased prevalence and titer of Epstein-Barr virus antibodies in patients with multiple sclerosis. Ann. Neurol. 17:371–377.PubMedCrossRefGoogle Scholar
  102. Tobi, M., Morag, A., Ravid, Z., et al. (1982). Prolonged atypical illness associated with serologic evidence of persistent Epstein-Barr virus infection. Lancet 1:61–64.PubMedCrossRefGoogle Scholar
  103. Tobi, M., and Straus, S.E. (1988). Chronic mononucleosis—A legitimate diagnosis. Postgrad. Med. 83:69–78.PubMedGoogle Scholar
  104. Tosato, G., Straus, S., Henle, W., Pike, S.E., and Blaese, R.M. (1985). Characteristic T cell dysfunction in patients with chronic active Epstein-Barr virus infection (chronic infectious mononucleosis). J. Immunol. 134:3082–3088.PubMedGoogle Scholar
  105. Vilmer, E., Lenoir, G.M., Virelizier, J.L., and Griscelli, C. (1984). Epstein-Barr serology in immunodeficiencies: An attempt to correlate with immune abnormalities in Wiskott-Aldrich and Che- diak-Higashi syndromes and ataxia telangiectasia. Clin. Exp. Immunol. 55:249–256.PubMedGoogle Scholar
  106. Waters-Peacocke, N., Wray, B.B., and Ades, E.W. (1988). A prospective study: Evaluation of the anti- body-dependent cell-mediated cytotoxicity assay in chronic active Epstein-Barr syndrome. J. Clin. Lab. Immunol.Google Scholar
  107. Wokke, J.H.J., de Koning, J., Stanek, G., and Jenne- kens, F.G.I. (1987). Chronic muscle weakness caused by Borrelia burgdorferi meningitis. Ann. Neurol. 22:389–392.PubMedCrossRefGoogle Scholar
  108. Wolfe, E., and Cathey, M.A. (1983). Prevalence of primary and secondary fibrositis. J. Rheumatol. 10:965–968.PubMedGoogle Scholar
  109. Yousef, G.E., Bell, E.J., Mann, G.F., et al. (1988). Chronic enterovirus infection in patients with post- viral fatigue syndrome. Lancet 1:146–150.PubMedCrossRefGoogle Scholar
  110. Yunus, M., Masi, A.T., Calabro, J.J., Miller, K.A., and Feigenbaum, S.L. (1981). Primary fibromyalgia (fibrositis): Clinical study of 50 patients with matched normal controls. Semin. Arthr. Rheum. 11:151–171.CrossRefGoogle Scholar
  111. Zimmerman, B., and Weber, E. (1983). Candida and “20th-century disease.” Can. Med. Assoc. J. 133: 965–966.Google Scholar

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  • Gary P. Holmes

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