Chronic Fatigue Syndrome Disease

BASICS

DESCRIPTION

Chronic fatigue syndrome (CFS) is characterized primarily by profound fatigue, in association with multiple systemic and neuropsychiatric symptoms, lasting at least 6 months. The fatigue must have a new or definite onset (i.e., not lifelong), is not relieved by rest, and results in a substantial reduction in previous activities (occupation, education, social, and personal).

System(s) affected: Endocrine/Metabolic, Musculoskeletal
Genetics: N/A
Incidence/Prevalence in USA: 10/100,000
Predominant age: Young adult
Predominant sex: Female > Male (slightly)

SIGNS AND SYMPTOMS

Fatigue (100%)
Ability to date onset of illness (100%)
Unexplained general muscle weakness (90%)
Arthralgias (90%)
Forgetfulness (90%)
Inability to concentrate (90%)
Emotional lability (90%)
Myalgias (90%)
Confusion (90%)
Mood swings (90%)
Low-grade fever (37.5-38.6°C) (85%)
Irritability (85%)
Prolonged fatigue lasting 24 hours after exercise (80%)
Depression (80%)
Headaches (76%)
Photophobia (76%)
Difficulty sleeping (76%)
Allergies (70%)
Vertigo (40%)
Adenopathy (40%)
Shortness of breath (33%)
Chest pain (33%)
Nausea (33%)
Weight loss (30%)
Hot flushes (30%)
Palpitations (30%)
Painful lymph nodes (30%)
Gastrointestinal complaints (30%)
Night sweats (25%)
Weight gain (15%)
Rash (15%)

CAUSES

Unknown. Multiple immunologic abnormalities suggestive of viral reactivation syndrome have been reported. Attention has been to viruses (EBV, HHV-6, enteroviruses), possibly in concert, possibly with environmental factors. No infectious agent has been implicated in the syndrome.

RISK FACTORS

Unknown

DIAGNOSIS

LABORATORY

Initial lab studies
- Chemistry panel
- CBC
- Urinalysis
- Thyroid function
Additional studies
- ESR
- ANA
- VDRL
- Rheumatoid factor
- Purified protein derivative
- Serum cortisol
- HIV
- Immunoglobulin
- Epstein-Barr serology

Drugs that may alter lab results: N/A
Disorders that may alter lab results: N/A

PATHOLOGICAL FINDINGS

N/A

SPECIAL TESTS

None. Diagnosis of exclusion. History, physical exam normal.

IMAGING

Experimental at present

DIAGNOSTIC PROCEDURES

To establish the diagnosis - 2 major criteria and at least 6 symptoms plus at least 2 physical signs; or at least 8 symptoms

Major criteria:
- New onset fatigue lasting longer than 6 months with a 50% reduction in activity
- No other medical or psychiatric conditions that could cause symptoms
Symptoms:
- Low grade fever
- Sore throat
- Painful cervical or axillary adenopathy
- Generalized muscle weakness
- Myalgias
- Headaches
- Migratory arthralgias
- Sleep disturbances (hypersomnia or insomnia)
- Neuropsychological complaints (one or more of: photophobia, visual scotomas, forgetfulness, irritability, confusion, difficulty concentrating, depression)
Physical signs:
- Low grade fever (37.5-38.6°C)
- Pharyngitis (nonexudative)
- Cervical or axillary adenopathy

TREATMENT

APPROPRIATE HEALTH CARE

Outpatient

GENERAL MEASURES

Because the cause of CFS is unknown and no specific therapy has shown consistent results, mainstay of therapy is supportive care
A program of moderate exercise (with rest periods during exacerbations of the disease), a healthy diet, stress reduction, and support groups or counseling is likely to be beneficial and while not necessarily curative will help the patient cope with their disease
Alternative therapies (chiropractic, homeopathy, acupuncture, enforced rest, guided image hypnosis) helpful for some; may be worth trying
Psychiatric symptoms often prominent but generally felt secondary rather than causative, but symptom treatment beneficial

SURGICAL MEASURES

N/A

ACTIVITY

As tolerated, but strenuous exercise tends to exacerbate symptoms in most

DIET

Rich in vitamins and minerals

PATIENT EDUCATION

Support groups available. Contact CFS Association, 3521 Broadway, Suite 222, Kansas City, MO 64111, (816)931-4777
CFIDS Association. P.O. Box 220398, Charlotte, NC 28222-0398
International Chronic Fatigue Syndrome Society. P.O. Box 230108, Portland, OR 97223

FOLLOW UP

PREVENTION/AVOIDANCE

Unknown

POSSIBLE COMPLICATIONS

Depression
Socioeconomic problems

EXPECTED COURSE AND PROGNOSIS

Indolent; waxes and wanes
Generally very slow improvement over months or years

MISCELLANEOUS

ASSOCIATED CONDITIONS

Fibromyalgia (70% reported to meet criteria)
Depression
Hypochondriasis

AGE-RELATED FACTORS

Pediatric: Reported in children
Geriatric: Reported in elderly
Others: N/A

PREGNANCY

No information

OTHER NOTES

Controversial topic, data often conflicting

ABBREVIATIONS

CFS = chronic fatigue syndrome

Clinical Investigations

ROLE OF HOMOEOPATHY

Holistic healing that treats the person, not just the disease. Experience gentle, lasting wellness with expert constitutional care.