title: Acute infectious mononucleosis: characteristics of patients who report failure to recover.
abstract: OBJECTIVE
  We sought to determine how often acute mononucleosis precipitates chronic illness, and to describe the demographic, clinical, and psychosocial features that characterize patients who report failure to recover.
  
  
  METHODS
  We enrolled 150 patients with infectious mononucleosis during the acute illness and asked them to assess their recovery at 2 and 6 months. At baseline, we performed physical and laboratory examinations; obtained measures of psychological and somatic functioning, social support, and life events; and administered a structured psychiatric interview.
  
  
  RESULTS
  Self-assessed failure to recover was reported by 38% of patients (55 of 144) at 2 months and by 12% (17 of 142) at 6 months. Those who had not recovered reported a persistent illness characterized by fatigue and poor functional status. No objective measures of disease, including physical examination findings or serologic or laboratory markers, distinguished patients who failed to recover from those who reported recovery. Baseline predictors for failure to recover at 2 months were older age (odds ratio [OR] = 1.4, 95% confidence interval [CI]: 1.1 to 1.8, per 5-year increase), higher temperature (OR = 1.5, 95% CI: 1.1 to 2.2, per 0.5 degrees C increase), and greater role limitation due to physical functioning (OR = 1.5, 95% CI: 1.2 to 1.9, per 20-point decrease in Short Form-36 score). At 6 months, baseline predictors for failure to recover included female sex (OR = 3.3, 95% CI: 1.0 to 12), a greater number of life events more than 6 months before the disease began (OR = 1.7, 95% CI: 1.1 to 2.5, per each additional life event), and greater family support (OR = 1.9, 95% CI: 1.1 to 4.2, per 7-point increase in social support score).
  
  
  CONCLUSIONS
  We were not able to identify objective measures that characterized self-reported failure to recover from acute infectious mononucleosis. The baseline factors associated with self-reported failure to recover at 2 months differed from those associated with failure to recover at 6 months. Future studies should assess the generalizability of these findings and determine whether interventions can hasten recovery.
authors.affiliation: Department of Medicine, University of Washington, Seattle, Washington, USA.
authors.forename: D S
authors.initials: DS
authors.lastname: Buchwald
authors.forename: T D
authors.initials: TD
authors.lastname: Rea
authors.forename: W J
authors.initials: WJ
authors.lastname: Katon
authors.forename: J E
authors.initials: JE
authors.lastname: Russo
authors.forename: R L
authors.initials: RL
authors.lastname: Ashley
mesh_terms: D000203:Activities of Daily Living; D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001831:Body Temperature; D005221:Fatigue; D005260:Female; D006801:Humans; D007244:Infectious Mononucleosis / Q000453:epidemiology* / Q000503:physiopathology / Q000523:psychology*; D008297:Male; D016017:Odds Ratio; D020127:Recovery of Function; D012944:Social Support; D013315:Stress, Psychological / Q000209:etiology; D014861:Washington / Q000453:epidemiology