title: The relationship between fatigue, psychological and immunological variables in acute infectious illness.
abstract: OBJECTIVE
  The aim of this paper is to explore the longitudinal relationships between physical and psychological symptoms and immunological factors following acute infective illnesses.
  
  
  METHODS
  Preliminary data from a prospective investigation of patients with serologically proven acute infectious illnesses due to Epstein-Barr virus (EBV), Ross River 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. Physical illness data were collected at interview. Psychological and somatic symptom profiles were assessed by standardised self-report questionnaires. Cell-mediated immune (CMI) function was assessed by measurement of delayed-type hypersensitivity (DTH) skin responses.
  
  
  RESULTS
  Thirty 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 fatigue and malaise were the most common symptoms. Classical depressive and anxiety symptoms were not prominent. Initially, 46% of cases had no DTH skin response (i.e. cutaneous anergy) indicative of impaired cellular immunity. Over the 4-week period, there was a marked improvement in both somatic and psychological symptoms, although fatigue remained a prominent feature in 63% of subjects. The reduction in reported fatigue 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 improvement in several symptoms occurs rapidly, fatigue commonly remains a prominent complaint at 4 weeks. Resolution of fatigue is associated with improvement in cell-mediated immunity.
authors.affiliation: School of Psychiatry, University of New South Wales, Sydney, Australia.
authors.forename: B K
authors.initials: BK
authors.lastname: Bennett
authors.forename: I B
authors.initials: IB
authors.lastname: Hickie
authors.forename: U S
authors.initials: US
authors.lastname: Vollmer-Conna
authors.forename: B
authors.initials: B
authors.lastname: Quigley
authors.forename: C M
authors.initials: CM
authors.lastname: Brennan
authors.forename: D
authors.initials: D
authors.lastname: Wakefield
authors.forename: M P
authors.initials: MP
authors.lastname: Douglas
authors.forename: G R
authors.initials: GR
authors.lastname: Hansen
authors.forename: A J
authors.initials: AJ
authors.lastname: Tahmindjis
authors.forename: A R
authors.initials: AR
authors.lastname: Lloyd
mesh_terms: D000223:Adaptation, Psychological / Q000502:physiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D018354:Alphavirus Infections / Q000276:immunology; D001007:Anxiety / Q000276:immunology / Q000523:psychology; D015331:Cohort Studies; D003863:Depression / Q000276:immunology / Q000523:psychology; D005221:Fatigue / Q000276:immunology / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D004854:Herpesvirus 4, Human / Q000276:immunology; D006801:Humans; D006968:Hypersensitivity, Delayed / Q000276:immunology; D007111:Immunity, Cellular / Q000276:immunology*; D007239:Infections / Q000276:immunology / Q000523:psychology*; D007244:Infectious Mononucleosis / Q000276:immunology / Q000523:psychology; D008297:Male; D008875:Middle Aged; D010555:Personality Inventory; D011446:Prospective Studies; D011598:Psychoneuroimmunology; D011778:Q Fever / Q000276:immunology / Q000523:psychology; D012398:Ross River virus / Q000276:immunology; D012803:Sick Role