chronic fatigue syndrome

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Chronic Fatigue Syndrome

 

Definition

Chronic fatigue syndrome (CFS) is a condition that causes extreme tiredness. People with CFS have debilitating fatigue that lasts for six months or longer. They also have many other symptoms. Some of these are pain in the joints and muscles, headache, and sore throat. CFS does not have a known cause, but appears to result from a combination of factors.

Description

CFS is the most common name for this disorder, but it also has been called chronic fatigue and immune disorder (CFIDS), myalgic encephalomyelitis, low natural killer cell disease, post-viral syndrome, Epstein-Barr disease, and Yuppie flu. CFS has so many names because researchers have been unable to find out exactly what causes it and because there are many similar, overlapping conditions. Reports of a CFS-like syndrome called neurasthenia date back to 1869. Later, people with similar symptoms were said to have fibromyalgia because one of the main symptoms is myalgia, or muscle pain. Because of the similarity of symptoms, fibromyalgia and CFS are considered to be overlapping syndromes.
In the early to mid-1980s, there were outbreaks of CFS in some areas of the United States. Doctors found that many people with CFS had high levels of antibodies to the Epstein-Barr virus (EBV), which causes mononucleosis, in their blood. For a while they thought they had found the culprit, but it turned out that many healthy people also had high EBV antibodies. Scientists have also found high levels of other viral antibodies in the blood of people with CFS. These findings have led many scientists to believe that a virus or combination of viruses may trigger CFS.
CFS was sometimes referred to as Yuppie flu because it seemed to often affect young, middle-class professionals. In fact, CFS can affect people of any gender, age, race, or socioeconomic group. Although anyone can get CFS, most patients diagnosed with CFS are 25-45 years old, and about 80% of cases are in women. Estimates of how many people are afflicted with CFS vary due to the similarity of CFS symptoms to other diseases and the difficulty in identifying it. The Centers for Disease Control and Prevention (CDC) has estimated that four to 10 people per 100,000 in the United States have CFS. According to the CFIDS Foundation, about 500,000 adults in the United States (0.3% of the population) have CFS. This probably is a low estimate since these figures do not include children and are based on the CDC definition of CFS, which is very strict for research purposes.

Causes and symptoms

There is no single known cause for CFS. Studies have pointed to several different conditions that might be responsible. These include:
  • viral infections
  • chemical toxins
  • allergies
  • immune abnormalities
  • psychological disorders
Although the cause is still controversial, many doctors and researchers now think that CFS may not be a single illness. Instead, they think CFS may be a group of symptoms caused by several conditions. One theory is that a microorganism, such as a virus, or a chemical injures the body and damages the immune system, allowing dormant viruses to become active. About 90% of all people have a virus in the herpes family dormant (not actively growing or reproducing) in their bodies since childhood. When these viruses start growing again, the immune system may overreact and produce chemicals called cytokines that can cause flu-like symptoms. Immune abnormalities have been found in studies of people with CFS, although the same abnormalities are also found in people with allergies, autoimmune diseases, cancer, and other disorders.
The role of psychological problems in CFS is very controversial. Because many people with CFS are diagnosed with depression and other psychiatric disorders, some experts conclude that the symptoms of CFS are psychological. However, many people with CFS did not have psychological disorders before getting the illness. Many doctors think that patients become depressed or anxious because of the effects of the symptoms of their CFS. One recent study concluded that depression was the result of CFS and was not its cause.
Having CFS is not just a matter of being tired. People with CFS have severe fatigue that keeps them from performing their normal daily activities. They find it difficult or impossible to work, attend school, or even to take part in social activities. They may have sleep disturbances that keep them from getting enough rest or they may sleep too much. Many people with CFS feel just as tired after a full night's sleep as before they went to bed. When they exercise or try to be active in spite of their fatigue, people with CFS experience what some patients call "payback"—debilitating exhaustion that can confine them to bed for days.
Other symptoms of CFS include:
  • muscle pain (myalgia)
  • joint pain (arthralgia)
  • sore throat
  • headache
  • fever and chills
  • tender lymph nodes
  • trouble concentrating
  • memory loss
A recent study at Johns Hopkins University found an abnormality in blood pressure regulation in 22 of 23 patients with CFS. This abnormality, called neurally mediated hypotension, causes a sudden drop in blood pressure when a person has been standing, exercising or exposed to heat for a while. When this occurs, patients feel lightheaded and may faint. They often are exhausted for hours to days after one of these episodes. When treated with salt and medications to stabilize blood pressure, many patients in the study had marked improvements in their CFS symptoms.

Diagnosis

CFS is diagnosed by evaluating symptoms and eliminating other causes of fatigue. Doctors carefully question patients about their symptoms, any other illnesses they have had, and medications they are taking. They also conduct a physical examination, neurological examination, and laboratory tests to identify any underlying disorders or other diseases that cause fatigue. In the United States, many doctors use the CDC case definition to determine if a patient has CFS.
To be diagnosed with CFS, patients must meet both of the following criteria:
  • Unexplained continuing or recurring chronic fatigue for at least six months that is of new or definite onset, is not the result of ongoing exertion, and is not mainly relieved by rest, and causes occupational, educational, social, or personal activities to be greatly reduced.
  • Four or more of the following symptoms: loss of short-term memory or ability to concentrate; sore throat; tender lymph nodes; muscle pain; multi-joint pain without swelling or redness; headaches of a new type, pattern, or severity; unrefreshing sleep; and post-exertional malaise (a vague feeling of discomfort or tiredness following exercise or other physical or mental activity) lasting more than 24 hours. These symptoms must have continued or recurred during six or more consecutive months of illness and must not have started before the fatigue began.

Treatment

There is no cure for CFS, but many treatments are available to help relieve the symptoms. Treatments usually are individualized to each person's particular symptoms and needs. The first treatment most doctors recommend is a combination of rest, exercise, and a balanced diet. Prioritizing activities, avoiding overexertion, and resting when needed are key to maintaining existing energy reserves. A program of moderate exercise helps to keep patients from losing physical conditioning, but too much exercise can worsen fatigue and other CFS symptoms. Counseling and stress reduction techniques also may help some people with CFS.
Many medications, nutritional supplements, and herbal preparations have been used to treat CFS. While many of these are unproven, others seem to provide some people with relief. People with CFS should discuss their treatment plan with their doctors, and carefully weigh the benefits and risks of each therapy before making a decision.

Drugs

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, may be used to relieve pain and reduce fever. Another medication that is prescribed to relieve pain and muscle spasms is cyclobenzaprine (sold as Flexeril).
Many doctors prescribe low dosages of antidepressants for their sedative effects and to relieve symptoms of depression. Antianxiety drugs, such as benzodiazepines or buspirone may be prescribed for excessive anxiety that has lasted for at least six months.
Other medications that have been tested or are being tested for treatment of CFS are:
  • Fludrocortisone (Florinef), a synthetic steroid, which is currently being tested for treatment of people with CFS. It causes the body to retain salt, thereby increasing blood pressure. It has helped some people with CFS who have neurally mediated hypotension.
  • Beta-adrenergic blocking drugs, often prescribed for high blood pressure. Such drugs, including atenolol (Tenoretic, Tenormin) and propranolol (Inderal), are sometimes prescribed for neurally mediated hypotension.
  • Gamma globulin, which contains human antibodies to a variety of organisms that cause infection. It has been used experimentally to boost immune function in people with CFS.
  • Ampligen, a drug which stimulates the immune system and has antiviral activity. In one small study, ampligen improved mental function in people with CFS.

Alternative treatment

A variety of nutritional supplements are used for treatment of CFS. Among these are vitamin C, vitamin B12, vitamin A, vitamin E, and various dietary minerals. These supplements may help improve immune and mental functions. Several herbs have been shown to improve immune function and have other beneficial effects. Some that are used for CFS are astragalus (Astragalus membranaceus), echinacea (Echinacea spp.), garlic (Allium sativum), ginseng (Panax ginseng), gingko (Gingko biloba), evening primrose oil (Oenothera biennis), shiitake mushroom extract (Lentinus edodes), borage seed oil, and quercetin.

Key terms

Arthralgia — Joint pain.
Cytokines — Proteins produced by certain types of lymphocytes. They are important controllers of immune functions.
Depression — A psychological condition, with feelings of sadness, sleep disturbance, fatigue, and inability to concentrate.
Epstein-Barr virus (EBV) — A virus in the herpes family that causes mononucleosis.
Fibromyalgia — A disorder closely related to CFS. Symptoms include pain, tenderness, and muscle stiffness.
Lymph node — Small immune organs containing lymphocytes. They are found in the neck, armpits, groin, and other locations in the body.
Lymphocytes — White blood cells that are responsible for the actions of the immune system.
Mononucleosis — A flu-like illness caused by the Epstein-Barr virus.
Myalgia — Muscle pain.
Myalgic encephalomyelitis — An older name for chronic fatigue syndrome; encephalomyelitis refers to inflammation of the brain and spinal cord.
Natural killer (NK) cell — A lymphocyte that acts as a primary immune defense against infection.
Neurally mediated hypotension — A rapid fall in blood pressure that causes dizziness, blurred vision, and fainting, and is often followed by prolonged fatigue.
Neurasthenia — Nervous exhaustion—a disorder with symptoms of irritability and weakness, commonly diagnosed in the late 1800s.
Many people have enhanced their healing process for CFS with the use of a treatment program inclusive of one or more alternative therapies. Stress reduction techniques such as biofeedback, meditation, acupuncture, and yoga may help people with sleep disturbances relax and get more rest. They also help some people reduce depression and anxiety caused by CFS.

Prognosis

The course of CFS varies widely for different people. Some people get progressively worse over time, while others gradually improve. Some individuals have periods of illness that alternate with periods of good health. While many people with CFS never fully regain their health, they find relief from symptoms and adapt to the demands of the disorder by carefully following a treatment plan combining adequate rest, nutrition, exercise, and other therapies.

Prevention

Because the cause of CFS is not known, there currently are no recommendations for preventing the disorder.

Resources

Organizations

American Association for Chronic Fatigue Syndrome. 7 Van Buren St., Albany, NY 12206. (518) 435-1765. 〈http://weber.u.washington.edu/∼dedra/aacfs1.html〉.
The CFIDS Association. Community Health Services, P.O. Box 220398, Charlotte, NC 28222-0398. (704) 362-2343.
National CFIDS Foundation. 103 Aletha Road, Needham, MA 02192. (781) 449-3535. http://www.cfidsfoundation.org.
National CFS Association. 919 Scott Ave., Kansas City, KS 66105. (913) 321-2278.

Other

"Chronic Fatigue Syndrome." National Institutes of Health. http://www.nih.gov.
"The Facts about Chronic Fatigue Syndrome." Centers for Disease Control. 〈http://www.cdc.gov/ncidod/diseases/cfs/facts1.htm〉.

chronic

 [kron´ik]
persisting for a long time; applied to a morbid state, designating one showing little change or extremely slow progression over a long period.
chronic airflow limitation (CAL) any pulmonary disorder occurring as a result of increased airway resistance or of decreased elastic recoil; the diseases most often associated are asthma, chronic bronchitis, and chronic pulmonary emphysema. Called also chronic obstructive pulmonary disease.

Chronic airflow limitation has the highest morbidity rate of any significant chronic pulmonary disorder in the United States and is the second most common cause of hospital admissions. It is difficult to estimate its exact incidence because most diseases of the respiratory tract are not reportable and there is some confusion in definition of terms related to diseases of this type. However, the Social Security Administration reports that CAL ranked only second to heart disease as the cause of disability in men over the age of 40. The incidence of CAL is increasing and, although not all specific causes are known, factors contributing to its development and affecting its degree of severity have been identified. Heavy cigarette smoking is probably the most important factor, and others are industrial pollution, occupational exposure to irritating inhalants, allergy, autoimmunity, genetic predisposition, and chronic infections.

Prevention is best accomplished through education of the public about the hazards of cigarette smoking and air pollution and the need for early detection and prompt treatment of respiratory disorders that could become chronic in nature. The American Lung Association is particularly interested in education of lay persons in these matters and in the prevention of all types of respiratory disorders. This agency, which has local offices distributed throughout the country, is an excellent source of information about prevention and the latest developments in the treatment of respiratory diseases.
Symptoms. This is an insidious disease that can develop into advanced lung damage almost before its victim is aware that the condition is serious. The early symptoms are shortness of breath upon exertion, a mild cough (sometimes called “smoker's cough”), which occurs most often in the morning, and easy fatigability that follows even minimal physical effort. Prompt treatment of these symptoms can forestall the more serious effects of extensive lung damage; however, the destruction of lung tissue and bronchial mucosa damage that has already occurred by the time these symptoms appear is irreversible.

As the disease progresses, the symptoms of dyspnea, weakness, and cough become more severe. The patient has difficulty expelling air from the lungs and the cough becomes more productive of thick, tenacious sputum. The patient looks anxious and drawn and may speak in short, hesitant sentences. Symptoms related to disturbances of the respiratory and circulatory systems and acid-base balance may appear as these complications develop.
Complications. Destructive involvement of respiratory structures and the resultant impairment of circulatory function can produce serious life-threatening complications. Among these are acute respiratory failure, disturbance in the acid-base balance (which can occur either as uncompensated respiratory acidosis or metabolic alkalosis), bronchopulmonary infections, cor pulmonale (the result of increased resistance in pulmonary circulation), pulmonary embolism (especially if polycythemia is severe), and peptic ulcer. blood gas analysis is helpful in evaluating effectiveness of blood gas exchange across alveolar walls. In severe chronic airflow limitation, the PaCO2 level is high while the PaO2 and the SaO2 levels are low.
Treatment and Patient Care. In general, treatment is concerned with restoring and maintaining existing lung function, relieving symptoms, and planning a program of rehabilitation tailored to accommodate the individual patient's physiologic needs, physical stamina, vocational needs, lifestyle, and personality. Specific measures of patient care are concerned with (1) initial and periodic evaluation of patient status, (2) maintenance of general health as much as possible, (3) prevention and control of infection, (4) improvement of ventilation, and (5) patient education.

Chronic airflow limitation is a disease that has no cure; its chronic nature requires an ongoing program of assessment and long-term care that is planned and revised as the patient's needs dictate. Whatever the patient care setting—acute care facility, out-patient clinic, long-term care facility, or home—the elements of care presented below are essential to the effective management of the condition.
Evaluation. Patient assessment begins with the taking of the patient's history and performing physical examination and lung function tests at the time the diagnosis is established. These measures, along with blood gas analysis at rest and after exercise, provide a baseline for periodic evaluation of the patient's status to determine the progress of the disease and the effectiveness of treatment.

When patients are informed about the purpose of the tests and therapy they are more likely to participate in the planned regimen of care and to become motivated to continue carrying out their responsibilities in the management of their illness. Those who work with the patient should clarify the goals and offer encouragement when they make progress toward those goals, no matter how slight the improvement might be. This implies, of course, that all members of the health care team have an understanding of the disease, the meaning of various test values, and the purpose of each aspect of care.
Maintenance of Health Status. It is important to communicate to these patients the concept of health status, particularly in regard to their position on the health-illness continuum. They cannot be completely disease-free or restored to their former state of health. They can, however, manage the disease symptoms for periods of time and some may even make progress toward a better state of health. For those patients who continue to deteriorate despite appropriate care, encouragement should be provided to maintain as much function as possible.

Poor appetite and the potential for dehydration are problems commonly associated with pulmonary disease. Purulent sputum, coughing, and fatigue can contribute to loss of interest in eating. Mouth breathing, increased respiratory rate, and frequent expectorating contribute to the loss of fluid.

Frequent oral hygiene and mouth care can help diminish mouth odor and unpleasant taste. A short period of rest just prior to each meal can help overcome the problem of fatigue. Meals should be spaced so that the stomach is not overloaded at any one time; five small meals, rather than three a day, can help avoid overfilling of the stomach and interference with breathing. Postural drainage and similar procedures should not be done on a full stomach, nor should they be scheduled just before a meal. Adequate hydration can be accomplished by an intake of at least 3000 ml of liquid each day. Unless contraindicated, this should include bouillon, fruit juices, and other liquids the patient finds enjoyable and refreshing.

Physical activity may be severely limited by CAL because of inadequate ventilation and decreased circulation. As with all other aspects of patient care, plans to increase exercise tolerance and promote physical activity should be designed according to the patient's cardiopulmonary status. Techniques to promote muscular relaxation and breathing control are the first step, followed by gradual increase in activity as the patient's progress and general physical condition permit.

Adequate rest is essential, but the hazards of immobility must be avoided, especially in patients who are fearful that any physical activity may precipitate an exhausting episode of coughing and dyspnea. The goal is to provide sufficient rest so that the body's natural restorative processes can work, but to avoid long periods of sleeping and lying in bed during the day.

When the patient's cardiopulmonary condition is such that bed rest is prescribed, care is taken to avoid complete physical inactivity, which will only serve to increase problems of inadequate ventilation and muscle weakness. Proper positioning is essential and should be such that the neck is extended, with the chin well off the chest. Support under the thighs while the patient is supine will release tension on abdominal muscles, thereby facilitating movement of the diaphragm for deep breathing and effective coughing. The arms and hands should also be supported on pillows and positioned away from the sides to allow for maximum lung expansion without elevation of the upper chest. A foot board is placed so as to maintain good posture, promote comfort, and ensure good muscle tone in the legs and feet.
Prevention and Control of Infection. Acute respiratory infection can be fatal in patients with chronic airflow limitation. Chronic infections inflict further damage to the respiratory structures, lead to increased debilitation, and increase the likelihood of severe complications. Both acute and chronic infections produce increased secretions in the air passages, which further restrict the flow of air.

Contact with others who have an upper respiratory infection should be avoided, as should being in large crowds during the season when such infections are common. A high level of resistance should be maintained through good personal hygiene and adequate nutrition. Vaccines to guard against influenza are recommended. Patients should be taught to watch for changes in color and amount of sputum. If a change in sputum or any other symptoms of infection appear, this should be reported.
Improvement of Ventilation. It is obvious that measures to improve ventilation in the patient with CAL are of primary importance, and perhaps that is why so many ways have been devised to facilitate the flow of air to and from the lungs. Breathing is most difficult during the expiratory phase, making it difficult to remove trapped air and secretions. In addition, the bronchial walls are weakened in patients with emphysema and are subject to collapse. Health status and physical condition at the time the technique is used will affect the choice of method and its effectiveness.

Hydration is considered especially valuable in improvement of ventilation. Inhaled air should be moist so as to thin the secretions for removal and soothe the irritated mucous membranes. This can be accomplished through the use of vaporizers and humidifiers, either for environmental humidification in the patient's room or in conjunction with oxygen therapy and the administration of aerosols. Oral intake of fluids is also important. Bronchodilators, usually in the form of aerosols, sometimes as oral medications, are usually prescribed. The aerosol method of delivery depends on the ability of the patient to breathe deeply so that the medication reaches the lower segments of the respiratory tract.

Controlled deep breathing patterns are especially helpful in emptying the lungs and providing adequate ventilation. The patient with CAL is taught to expand the lower chest and to use the accessory muscles and diaphragm to improve the breathing pattern. Performance of these breathing patterns is important because patients probably are not in the habit of breathing in the most effective manner, making optimum use of remaining pulmonary function. The patient is taught slow, controlled, and steady breathing. Respiratory effort should be concentrated on slow expiratory flow through parted or pursed lips. Pushing the air out of the lungs too forcefully can bring on collapse of the airway structures. During instruction, the caregiver watches for signs of exhaustion and warns against overdoing the deep breathing until the patient has adjusted to it. A correct breathing pattern should be coordinated with all of the patient's daily activities so that it becomes habitual and is done without too much thought.

Effective coughing does not come easily to patients with this condition. They may have experienced too many episodes in which a dry hacking cough has caused exhaustion, increased dyspnea, and prevented removal of tenacious sputum from the air passages. They must be convinced that, when done correctly, coughing can remove mucous plugs and relieve rather than produce dyspnea. Patients should be warned that explosive coughing is not very effective, can damage the airways, and can lead to exhaustion. The objective of coughing is to move secretions upward gradually so that they can be expectorated.

Postural drainage is also valuable in facilitating the removal of mucus from the air passages. The various maneuvers involved in this procedure are designed to take advantage of gravity flow as a means of clearing specified segments of the air passages when normal air flow is not sufficient to move secretions or stimulate the cough reflex. Chest percussion and vibration may be employed during postural drainage to loosen secretions. oxygen therapy is used as a supportive measure when there is decreased oxygenation of arterial blood. It can be administered to ambulatory patients being cared for at home. Blood gas analysis is an excellent guide in determining the need for initiating oxygen therapy and for monitoring dosage.
Patient Education. As with all chronic diseases that require long-term planning and management, patient education is of primary importance in successful execution of the plan. Each of the measures previously described involves instruction of the patient and family, particularly when care is carried out on an outpatient basis. The patient should be told why it is necessary to stop smoking, avoid other irritating inhalants, carry out good health practices, take medication only as prescribed, and faithfully perform techniques to improve ventilation. Those patients who follow the exercises prescribed for them often find they can lead more active lives than formerly. Exertional dyspnea becomes less severe and complications from infections caused by bacteria in secretions formerly trapped in the respiratory tract are less frequent. Active participation in a program of self-care gives these patients a sense of control and improves their self-esteem.
chronic fatigue syndrome (chronic fatigue and immunodeficiency syndrome) persistent debilitating fatigue of recent onset, with reduction of physical activity to less than half of usual, accompanied by some combination of muscle weakness, sore throat, mild fever, tender lymph nodes, headaches, and depression, with the symptoms not attributable to any other known causes. Its nature is controversial; viral infection (including Epstein-Barr virus and human herpesvirus-6) may be associated with it, but no causal relationship has been demonstrated. A number of names have been used for this syndrome, including Iceland disease and benign myalgic encephalomyelitis.
chronic granulomatous disease chronic suppurative lymphadenitis, eczematoid dermatitis, enlargement of the liver and spleen, and chronic pulmonary disease associated with a genetically determined defect in the intracellular bactericidal function of leukocytes.
chronic obstructive lung disease (COLD) (chronic obstructive pulmonary disease (COPD)) chronic airflow limitation.
chronic regional pain syndrome reflex sympathetic dystrophy.

chronic fatigue syndrome (CFS),

a syndrome of persistent incapacitating weakness or fatigue, accompanied by nonspecific somatic symptoms, lasting at least 6 months, and not attributable to any known cause.

The prevalence of CFS in the U.S. is currently estimated at 800,000 (0.5% of women and 0.3% of men). Prevalence is apparently not affected by race or socioeconomic status. CFS was first defined by the U.S. Centers for Disease Control in 1988. According to the case definition as revised in 1994, CFS consists of both (1) persistent or relapsing fatigue not resulting from exertion or relieved by rest, having a clear-cut onset, lasting for at least 6 months, and causing substantial (for example, 50% or more) reduction in the level of physical activity, and (2) simultaneous occurrence of 4 or more of the following symptoms for at least 6 months: headache, muscle pain, joint pain, sore throat, tender cervical or axillary lymph nodes, prolonged malaise after physical exertion, failure to be refreshed by sleep, and cognitive deficits (for example, impairment of attention, concentration, and short-term memory). Physical findings are typically unremarkable. However, many patients experience postural tachycardia and delayed orthostatic hypotension. Although routine laboratory tests yield normal results in CFS, special studies have detected certain abnormalities (for example, elevation of inflammatory cytokines, increased numbers of CD8-activated cytotoxic T cells, depression of natural killer-cell function, inactivation of the 2,5 ribonuclease-L antiviral defense pathway, and downregulation of the hypothalamic-pituitary axis manifested by low levels of ACTH and cortisol) in some but not all patients. A complex deregulation of immune response triggered by viral infection has been suggested as the cause of CFS. An influenzalike onset is more common during winter than in other seasons. Psychiatric comorbidity is common, but the current consensus is that CFS is not induced by chronic anxiety or depression. Of numerous treatments that have been used in this disorder, graded exercise and cognitive-behavioral therapy have been most effective. Tricyclic antidepressants, selective serotonin reuptake inhibitors, and nonsteroidal antiinflammatory drugs have been helpful in relieving pain and sleep problems for some patients. On long-term (for example, 5+ years) followup, 20-50% of adult patients with CFS show some improvement but only 5-10% regain full function.

chronic fatigue syndrome

n. Abbr. CFS
A syndrome characterized by debilitating fatigue and a combination of flulike symptoms such as sore throat, swollen lymph glands, low-grade fever, headaches, and muscle pain or weakness. Also called chronic fatigue immune dysfunction syndrome.

chronic fatigue syndrome (CFS)

a condition characterized by disabling fatigue, accompanied by a constellation of symptoms, including muscle pain, multijoint pain without swelling, painful cervical or axillary adenopathy, sore throat, headache, impaired memory or concentration, unrefreshing sleep, and postexertional malaise. This diagnosis requires that a patient have four or more symptoms concurrently that persist for 6 or more months. The diagnosis is one of exclusion. Also called immune dysfunction syndrome.

chronic fatigue syndrome

A condition resembling poliomyelitis, which was first described in the mid-1980s in California, often following viral infections (e.g., herpes, hepatitis, CMV) or which may be induced by an unrecognised virus. CFS is defined by a new onset (not lifelong) of unexplained, persistent fatigue unrelated to exertion and not substantially relieved by rest, which causes a significant reduction in previous activity levels. While CFS had been associated with EBV infection, more than half of those with the CFS improve without a change in EBV titers.

Aetiology
Unknown, psychosocial dysfunction has been implicated.
 
Clinical findings
Unexplained persistent fatigue, inability to concentrate, weakness, lymphadenopathy and malaise, severe headache, myalgia, myasthenia, variable cranial and peripheral nerve dysfunction and depression.

Treatment
None; alleged reported cures are thought to be due to placebo response or spontaneous remission; recuperation requires up to a year.

Chronic Fatigue syndrome symptoms
Four or more of the following symptoms that last six months or longer:
• Impaired memory or concentration;
• Post-exertional malaise, where physical or mental exertion bring on extreme, prolonged exhaustion and sickness.
• Unrefreshing sleep.
• Myalgia.
• Arthalgias.
• Headaches of a new kind or greater severity.
• Sore throat, frequent or recurring.
• Tender lymph nodes (cervical or axillary).

chronic fatigue syndrome

Chronic fatigue & immune dysfunction syndrome
A chronic, idiopathic debilitating condition that may follow viral infections–eg herpes, hepatitis, CMV, EBV; CFS is probably a real entity; linked to a combination of CMV and EBV infection Clinical Unexplained fatigue, weakness, muscle pain pain, lymphadenopathy and malaise; CFS is a diagnosis of exclusion; there are no valid tests, treatment consists of relief of symptoms, life style changes; some cases may resolve with time Management None; the 'cures' reported may be mere placebo effect or spontaneous remission. See Fibromyalgia syndrome.
Chronic Fatigue syndrome–CDC case definition
Major criteria (required)
   
1. Recent onset of debilitating or recurring fatigue of > 6 months duration and
2. Exclusion of clinically similar conditions
Minor criteria (eight of ten required)
   1. Low-grade fever (< 38.6º C) or chills
   2. Sore throat (or pharyngitis)
3. Painful anterior and/or posterior cervical and axillary lymphadenopathy
4. Unexplained muscular weakness
5. Myalgia
6. Generalized fatigue of > 24 hours after previously tolerated exercise

chron·ic fa·tigue syn·drome

(kron'ik fă-tēg' sin'drōm)
Clinically evaluated new onset debilitating fatigue not substantially relieved by rest and concurrent four of eight symptoms persisting or occurring during 6 or more consecutive months and not predating the fatigue: substantial short-term memory impairment or concentration; sore throat; tender lymph nodes; muscle and multijoint pain; unusual headache; unrefreshing sleep; postexertional malaise lasting more than 24 hours; of unknown etiology.
Synonym(s): chronic fatigue and immune dysfunction syndrome, myalgic encephalomyelitis.

chronic fatigue syndrome

The currently-preferred name for the condition formerly known, with questionable accuracy, as myalgic encephalomyelitis (ME). This distressing condition predominantly affects women and features severe fatigue, muscle aching and emotional disturbance brought on by exercise, sometimes minimal. This complex is found in many conditions and the diagnosis is usually made by the subject after thorough investigation has proved negative. The medical profession is divided as to whether or not this is an organic entity. There is no evidence that the condition involves inflammation of the brain or spinal cord as the earlier name would imply. There is, however, no doubting the distress and disability of the unfortunate sufferers and their families. Also known as Royal Free disease, epidemic neuromyasthenia, Otago mystery disease, Icelandic disease, institutional mass hysteria, benign myalgic encephalomyelitis and the postviral fatigue syndrome. The most effective treatment to date has been cognitive behaviour therapy which is said to effect improvement in about 70 percent of cases.

Patient discussion about chronic fatigue syndrome

Q. I think i might have chronic fatigue syndrome or fibromyalgia. how can i tell the difference? So far, the doctors have not been able to diagnose anything and have basically been putting me on random medications just to relieve the symptoms. Symptoms I have: Fatigue (sleeping thirteen hours +) exhaustion pain in my knees, ankles, and weirdly my elbows. Headaches, congestion. I’ve been really nauseous occasionally and ended up having to go to the ER because of it.

A. Here is a site that might help you. You can type in the symptoms one at a time and it’ll give you optional illnesses that correlates with the symptoms:
http://www.healthline.com/directory/symptoms

Q. What can cause chronic fatigue? For the last few weeks I’ve been having this strange fatigue, I sleep 12-14 hours at night (I used to sleep 6-7 hours), and I’m tired all day long. It really bothers me. What can is be?

A. Wow, there are so many…to give you a taste- here is a list. I guess some of them you can rule out pretty easily through checking your habits and other symptoms (if you have any):
http://www.wrongdiagnosis.com/symptoms/fatigue/common.htm

Q. How do you know when your tiredness is a chronic health symptom? Sometimes I'm just overwhelmingly tired and need to lay down for awhile. Then I feel better but then I haven't accomplished a lot. At least after I rest I am able to do things again. What is Chronic Fatigue all about?

A. Wow! Good question!
I tell you what- here is a very good site I use all the time. You enter a symptom and it gives you all the illnesses that have the symptom. Then you enter another symptom you have and it narrows the list.
I already entered fatigue for you:
http://www.healthline.com/symptomsearch?addterm=Fatigue

and here is a site about chronic fatigue syndrome that you can look for differences:
http://www.idph.state.il.us/about/womenshealth/factsheets/cfsyndrome.htm

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