title: Chronic fatigue syndrome and arthralgia following parvovirus B19 infection.
abstract: OBJECTIVE
  To determine the incidence of arthralgia and fatigue complicating B19 infection, along with associated B19 markers and autoantibodies.
  
  
  METHODS
  We studied patients with acute B19 infection (n = 51), patients followed from the time of acute B19 infection (mean 22.5 mo) (n = 39), and healthy controls (n = 50). Clinical details were collected using a questionnaire and blood was tested for B19 markers and autoantibodies.
  
  
  RESULTS
  Acute B19 arthralgia occurred in 31 patients and was associated with female sex (p = 0.007) and age > 20 years (p = 0.02). Acute B19 fatigue occurred in 8 patients and was not significantly associated with any marker. At followup, symptoms consisted of arthralgia (n = 5), arthralgia and fatigue (n = 6), fatigue (n = 7), lymphadenopathy (n = 1), and purpura due to thrombocytopenia (n = 2). Chronic B19 arthralgia was associated with persistent B19 viremia (p = 0.029). Comparison of the B19 followup group with the controls revealed a significantly increased prevalence of arthralgia (p = 0.0002), fatigue (p < 0.0001), and all other markers. Chronic B19 arthralgia was associated with both acute B19 arthralgia (p = 0.0168) and positive ANA at acute infection (p = 0.0043). Chronic B19 fatigue was associated with acute B19 fatigue (p = 0.011). Five patients fulfilled the Centers for Disease Control criteria for a diagnosis of chronic fatigue syndrome (CFS) and one of these was negative for serum anti-B19 IgG at followup by both Western blot and immunofluorescence. However, there was no characteristic pattern of B19 markers/autoantibodies in patients with B19 associated chronic fatigue.
  
  
  CONCLUSIONS
  CFS may follow acute parvovirus B19 infection; however, attribution of a case of CFS to B19 infection may be extremely difficult in the absence of serological confirmation of acute infection at fatigue onset.
authors.affiliation: Department of Microbiology, Royal Brompton Hospital, National Heart and Lung Institute, Imperial College School of Medicine, London, UK. j.kerr@ic.ac.uk
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Kerr
authors.forename: Janice
authors.initials: J
authors.lastname: Bracewell
authors.forename: Ian
authors.initials: I
authors.lastname: Laing
authors.forename: Derek L
authors.initials: DL
authors.lastname: Mattey
authors.forename: Robert M
authors.initials: RM
authors.lastname: Bernstein
authors.forename: Ian N
authors.initials: IN
authors.lastname: Bruce
authors.forename: David A J
authors.initials: DA
authors.lastname: Tyrrell
mesh_terms: D000328:Adult; D000974:Antibodies, Antinuclear / Q000097:blood; D000914:Antibodies, Viral / Q000097:blood; D018771:Arthralgia / Q000453:epidemiology* / Q000276:immunology / Q000821:virology*; D015415:Biomarkers; D003289:Convalescence; D015673:Fatigue Syndrome, Chronic / Q000453:epidemiology* / Q000276:immunology / Q000821:virology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010322:Parvoviridae Infections / Q000453:epidemiology* / Q000276:immunology; D016732:Parvovirus B19, Human; D011237:Predictive Value of Tests; D012217:Rheumatoid Factor / Q000097:blood; D017678:Sex Distribution; D014766:Viremia / Q000150:complications / Q000276:immunology
chemical_list: D000974:Antibodies, Antinuclear; D000914:Antibodies, Viral; D015415:Biomarkers; D012217:Rheumatoid Factor