The Epstein-Barr Virus and Chronic Fatigue Syndrome

To the Editor.—  Based on eight years of clinical experience and having performed many thousands of Epstein-Barr virus (EBV) serological assays with emphasis on IgG anti-early antigen I cannot agree with the conclusion of Hellinger et al¹ that the antibody to EBV early antigen is not helpful in the clinical evaluation of patients with chronic fatigue syndrome. The initial suspicion of a direct etiologic link between EBV and chronic fatigue syndrome has yielded to the probability that EBV reactivation is a secondary phenomenon related to a primary, transient immune dysfunction, the cause of which is currently unknown.In contrast to all other EBV serological markers, which reflect only previous infection, anti-early antigen does rise and fall with clinical activity of the signs and symptoms used to define the chronic fatigue syndrome.² Although not diagnostic, it is a useful therapeutic marker when initially found in significant elevation (ie, ≥1:80).