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Kenneth J. Friedman PhD.

Letter to the Editor, The Rutland Herald, January, 2013

Readers of the Rutland Herald who read “Going ‘mano o mano’ with
mononucleosis” published in your Sunday Magazine section on January
6th, and written by Dr. Lewis First, Chief of Pediatrics at Vermont’s
Children’s Hospital at Fletcher Allen Healthcare, and Chairman of the
Department of Pediatrics at the University of Vermont College of
Medicine, may also wish to know of the relationship between
mononucleosis and Chronic Fatigue Syndrome (CFS). As indicated by Dr.
First, mononucleosis is caused by an infection with the Epstein-Barr
virus. Prolonged infection with the Epstein-Barr virus, or prolonged
symptoms of mononucleosis, lasting 6 months or longer in adults, was
termed chronic Epstein-Barr virus infection and now would be
classified as CFS.

The relationship between mononucleosis and CFS remains unclear.
However, clinical observation suggests that delayed treatment of
mononucleosis, whether because of misdiagnosis or the patient’s
refusal to succumb to the treatment regimen, increases the likelihood
of triggering CFS. In addition, the return to work, school, or to
full activity prior to complete recovery from mononucleosis may also
trigger CFS.

CFS is a debilitating illness of variable severity. In most cases,
however, individuals stricken with the illness are unable to work or
attend school full-time, and have a life-long disability. It is
estimated that CFS affects approximately 1 million Americans and costs
the U.S. economy 6 billion dollars per year. For these reasons, it is
far better to minimize the chances of precipitating CFS, by adequate
and timely treatment of mononucleosis.

Further information about CFS may be obtained from our own Vermont
CFIDS Association ( which hosts educational programs
about CFS, runs a support group for CFS patients, and provides a
medical scholarship to train healthcare professionals in its
treatment. The New Jersey Chronic Fatigue Syndrome Association
(NJCFSA) is perhaps this country’s leading advocate for children with
CFS and has issued a pediatric CFS fact sheet. The information
produced by NJCFSA may be accessed by visiting its website: In May of 2012, the International Association for
Chronic Fatigue Syndrome/ME released a primer for the diagnosis and
treatment of CFS. A copy of the primer may be downloaded as a PDF
file for free from the organization’s website: The
primer does include a brief discussion of the treatment of children
with CFS.

To minimize the potential of their children developing CFS, parents
would be well advised to watch for the symptoms of mononucleosis, and,
if they appear, to seek medical attention for a proper diagnosis and
treatment. The current pediatric case definition permits a diagnosis
of CFS if symptoms of mononucleosis persist in a child for more than 3
months. If CFS is diagnosed, symptomatic treatment of CFS – which is
the only available treatment – will reduce its severity and increase
the likelihood of a full recovery. Parental vigilance to, and
knowledge of, the relationship between mononucleosis and CFS may make
the difference between children living a normal adult life and living
a life in which the activities of daily living are a challenge and
cannot be accomplished without assistance.


Kenneth J. Friedman, Ph.D.
Pawlet, VT
Associate Professor of Pharmacology and Physiology, the New Jersey
Medical School, retired
Board Member, the Vermont CFIDS Association
Board Member, the New Jersey Chronic Fatigue Syndrome Association
Treasurer, the International Chronic Fatigue Syndrome Association