A Validated Scale for Assessing the Severity of Acute Infectious Mononucleosis

Ben Z. Katz, MD1,3, Caroline Reuter, MD1, Yair Lupovitch3, Kristen Gleason, PhD2, Damani McClellan, BA2, Joseph Cotler, PhD2, and Leonard A. Jason, PhD2

Objective: create a severity scale to examine the risk factors for developing chronic fatigue syndrome. It is said that 6 months after having mono around 10% of adolescents and young adults meet the criteria for chronic fatigue syndrome

Methods:

126 students with mono at Northwestern University from December 2013- March 2017

• There were 56 male students, 70 female students, ages ranging from 18-23 years old
• Diagnosis were made by positive Monospot, positive viral capsid antigen IgM test, or positive viral capsid viral IgG test in the presence of a negative antibody to Epstein-bar antigen.
• Six months after mono diagnosis, all students were contacted by phone or email to assess recovery vs non-recovery. There was approximately a 1:1 ratio of those who were fully recovered vs those who were still symptomatic
  • At that point patients were evaluating for meeting the definition of CFS using the Fukuda definition and the Canadian consensus criteria
  • They characterized those who met >1 set of criteria for CFS as having severe CFS

Results

• The records were blindly review by 2 independent study physicians.
• Of the 8 symptoms of severe mono identified, the subjects only endorsed 3:
  • Not being able to leave home during worst symptoms
  • Trouble breathing
  • GI symptoms
• No one had bull neck or neurologic complications.
• There was a statistically significant association between severity of infectious mono score and prescription of corticosteroids. Of the 56 students endorsing severe mono, 31.4 were prescribed steroids.
• Of the 70 participants that didn’t endorse any risk factors for severe mono, 17.2 were prescribed steroids.
• The 25 participants that endorsed 2 or more risk factors for severe mono, had a 12% change of being hospitalized, while pt who met 1 or non, had no hospitalization.
• Of the 65 participants evaluated after 6 months, 52.3% did not meet any of the CFS criteria, 27.7% met a single criterion, 12.3%met criteria for 2 or more CFS case definitions. 7.7% were diagnosed with lingering symptoms or idiopathic chronic fatigue.
• A higher severity of mono score increased the risk of a CFS diagnosis

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