Chronic fatigue syndrome after Giardia enteritis: clinical characteristics, disability and long-term sickness absence

• Published in: BMC gastroenterology 2012-02, Vol.12 (1), p.13-13, Article 13
• Main Authors: Naess, Halvor, Nyland, Morten, Hausken, Trygve, Follestad, Inghild, Nyland, Harald I
• Format: Article
• Language: English
• Subjects: Abdomen; Absenteeism; Adult; Anxiety; Anxiety - epidemiology; Anxiety - psychology; Chronic fatigue syndrome; Complications and side effects; Depression - epidemiology; Depression - psychology; Disability Evaluation; Disease; Education; Employment; Enteritis; Enteritis - complications; Enteritis - parasitology; Fatigue Syndrome, Chronic - epidemiology; Fatigue Syndrome, Chronic - psychology; Female; Gastroenterology; Giardia - isolation & purification; Giardiasis - complications; Hospitals; Humans; Illnesses; Incidence; Likert scale; Male; Mental health; Neurology; Norway; Occupational therapy; Older people; Pain; Patient outcomes; Rehabilitation; Retrospective Studies; Severity of Illness Index; Studies; Time Factors
• ISSN: 1471-230X; 1471-230X
• DOI: 10.1186/1471-230X-12-13

A waterborne outbreak of Giardia lamblia gastroenteritis led to a high prevalance of long-lasting fatigue and abdominal symptoms. The aim was to describe the clinical characteristics, disability and employmentloss in a case series of patients with Chronic Fatigue Syndrome (CFS) after the infection. Patients who reported persistent fatigue, lowered functional capacity and sickness leave or delayed education after a large community outbreak of giardiasis enteritis in the city of Bergen, Norway were evaluated with the established Centers for Disease Control and Prevention criteria for CFS. Fatigue was self-rated by the Fatigue Severity Scale (FSS). Physical and mental health status and functional impairment was measured by the Medical Outcome Severity Scale-short Form-36 (SF-36). The Hospital Anxiety and Depression Scale (HADS) was used to measure co-morbid anxiety and depression. Inability to work or study because of fatigue was determined by sickness absence certified by a doctor. A total of 58 (60%) out of 96 patients with long-lasting post-infectious fatigue after laboratory confirmed giardiasis were diagnosed with CFS. In all, 1262 patients had laboratory confirmed giardiasis. At the time of referral (mean illness duration 2.7 years) 16% reported improvement, 28% reported no change, and 57% reported progressive course with gradual worsening. Mean FSS score was 6.6. A distinctive pattern of impairment was documented with the SF-36. The physical functioning, vitality (energy/fatigue) and social functioning were especially reduced. Long-term sickness absence from studies and work was noted in all patients. After giardiasis enteritis at least 5% developed clinical characteristics and functional impairment comparable to previously described post-infectious fatigue syndrome.