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In Reply. —
We appreciate the interest our article has generated. Drs Chang and Bittner's approach of prospectively following up a large cohort of adult patients with primary EBV infection and assessing the frequency of subsequent chronic fatigue is of interest. Their definition of persistent fatigue (>2 months of malaise) markedly differs from the prolonged and persistent fatigue reported in our patients (mean duration, 40 months).We appreciate Drs Fletcher and Klimas' and Drs Hudson, Pope, and Goldenberg's observations demonstrating a similar psychological testing profile in their patients as was seen in ours. For what it is worth, the four patients we studied who met the Centers for Disease Control definition of chronic fatigue syndrome did not differ in their immunologic indexes from the 17 patients who did not meet the definition. We did not study CD4 subsets or interferon-α generation to EBV or other antigens to determine whether EBV
Corey L, Sixbey J, Ashley R, Bowden R. Chronic Fatigue Syndrome-Reply. JAMA. 1991;265(3):358. doi:10.1001/jama.1991.03460030063028