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Chronic Fatigue Syndrome

CFS

Chronic fatigue syndrome is characterized by persistent fatigue and other specific symptoms that last for a minimum duration of six months.


Presentation

This syndrome presents with a sudden onset of flu like symptoms with no prior history of severe exhaustion. With the onset of flu like symptoms patient complains of severe exhaustion even after minimal physical exertion [8].

Along with severe fatigue there maybe other general symptoms like anorexia, nausea and vomiting. There may be nightly drenching sweats.

Cognitive symptoms are very prominent and mainly include memory loss, poor concentration and lack of alertness. Intelligence, language and power of reasoning are not affected. Cognitive symptoms are very important for a diagnosis, without this the disorder cannot be concluded.

Mood fluctuations mainly anxiety, irritability and depression will be seen.

There can be severe joint and muscular pains associated with other conditions like fibromyalgia, irritable bowel syndrome, and any sensitivity to foods, medications and chemicals.

Though the symptom presentation will be more or less similar in most of the patients, the functional capacity varies. Some can lead fairly normal lives while others maybe bedridden. Due to severe physical and mental exhaustion, work and social activities are greatly reduced.

Fatigue
  • Assignment of Fatigue Groups We classified subjects into one of six fatigue categories, as outlined above (No Fatigue, Prolonged Fatigue, Chronic Fatigue, Explained Syndromic Fatigue, CFS-like, or CFS).[doi.org]
  • Chronic fatigue syndrome is an illness characterized by disabling fatigue of at least 6 months, accompanied by several other symptoms. This review summarizes the current state of knowledge about chronic fatigue syndrome.[ncbi.nlm.nih.gov]
  • Evidence for sensitized fatigue pathways in patients with chronic fatigue syndrome. Pain. 2015;156:750.[mayoclinic.org]
  • RESULTS: Patients were clinically classified into CFS (n   15), idiopathic chronic fatigue (n   5), fatigue from other causes (n   9) and recovered from fatigue (n   10).[ncbi.nlm.nih.gov]
  • Most individuals recovered with time; only 2 adolescents with chronic fatigue syndrome at 24 months seemed to have recovered or had an explanation for chronic fatigue at 12 months but then were reclassified as having chronic fatigue syndrome at 24 months[pediatrics.aappublications.org]
Chronic Fatigue Syndrome
  • Chronic fatigue syndrome is diagnosed on the basis of symptoms. Patients with chronic fatigue syndrome experience significant functional impairment.[ncbi.nlm.nih.gov]
  • Risk factors Factors that may increase your risk of chronic fatigue syndrome include: Age. Chronic fatigue syndrome can occur at any age, but it most commonly affects people in their 40s and 50s. Sex.[mayoclinic.org]
  • Stigma and chronic fatigue syndrome . Journal of Chronic Fatigue Syndrome, 5, 63 — 75 . Google Scholar Crossref Jason, L.A. , Eisele, H. , & Taylor, R.R. ( 2001 ). Assessing attitudes toward new names for chronic fatigue syndrome .[dps.sagepub.com]
  • Neuropsychological deficits in patients with chronic fatigue syndrome .[doi.org]
Pain
  • Furthermore depression seemed not related to pain in CFS and a staphylococcus toxoid vaccine caused no significant pain reduction.[ncbi.nlm.nih.gov]
  • METHODS: Pressure pain thresholds, temporal summation, conditioned pain modulation, and occlusion cuff pressure thresholds rated as painful (1st cuff pressure threshold) and as 3/10 on a verbal numerical scale (2nd cuff pressure threshold) were measured[ncbi.nlm.nih.gov]
  • Fransen , Association Between Fatigue and Pain in Rheumatoid Arthritis: Does Pain Precede Fatigue or Does Fatigue Precede Pain? , Arthritis Care & Research , 65 , 6 , (862) , (2013) .[doi.org]
  • Abstract Chronic fatigue syndrome (CFS) is a disorder that causes general fatigue and chronic widespread pain. A 28-year-old male visited an outpatient department due to general fatigue and pain involving the entire body.[ncbi.nlm.nih.gov]
  • In the ME/CFS group, positive correlations between the changes in pain severity and low frequency (r .552, P .014), and between the changes in bodily pain and diastolic blood pressure (r .472, P .036), were seen.[ncbi.nlm.nih.gov]
Malaise
  • Also, an association with symptoms of post-exertional malaise was demonstrated.[ncbi.nlm.nih.gov]
  • Chronic fatigue syndrome (CFS) is a condition characterized by impairment of neurocognitive functions and quality of sleep and of somatic symptoms such as recurrent sore throat, muscle aches, arthralgias, headache, and postexertional malaise.[ncbi.nlm.nih.gov]
  • CFS is characterized by debilitating fatigue with associated myalgias, tender lymph nodes, arthralgias, chills, feverish feelings, and postexertional malaise.[ncbi.nlm.nih.gov]
  • Contrary to their suggestion, the Institute of Medicine describes chronic fatigue syndrome not as psychological but as a serious, chronic, systemic disease, with post-exertional malaise as its main feature which inhibits exercise.[ncbi.nlm.nih.gov]
  • There are behavioral/symptomatic similarities (for example, fatigue, malaise, hyperalgesia) and dissimilarities (gastrointestinal symptoms, anorexia and weight loss) between sickness and ME/CFS.[ncbi.nlm.nih.gov]
Fever
  • The effect of antibiotic therapy on post-Q-fever fatigue syndrome has not been studied in south-east Europe thus far. CASE REPORTS: Three patients are presented with post-Q-fever fatigue syndrome.[ncbi.nlm.nih.gov]
  • The patient's fever resolved with the administration of intravenous immunoglobulin.[ncbi.nlm.nih.gov]
  • Syndrome thought to be caused by a viral organism resulting in chronic fatigue, fever, pain, sore throat, and, in some cases, depression ICD-9-CM Volume 2 Index entries containing back-references to 780.71 :[icd9data.com]
  • There exist two specific criteria that must be met for a diagnosis of CFS: (1) severe fatigue lasting six months or longer and (2) the coexistence of any four of a number of characteristic symptoms, defined as mild fever, sore throat, tender lymph nodes[britannica.com]
  • RESULTS: Symptoms such as fatigue, pain, sleep disturbance, and low-grade fever were dramatically improved after 15 to 25 sessions of thermal therapy.[ncbi.nlm.nih.gov]
Pneumonia
  • Abstract The year 1995 marked the onset of interstitial pneumonia spread in Nagoya, Japan.[ncbi.nlm.nih.gov]
  • Combination of pneumonia signs and dermatomyositis signs marked the onset of his CFS. b) Old infusion treatment together with the short term antibiotics treatment was found effective for the control of pneumonia in the first stage of the disease (from[ncbi.nlm.nih.gov]
  • Its acute form manifests as atypical pneumonia, flu-like syndrome, or hepatitis.[ncbi.nlm.nih.gov]
  • Hafnia Alvei; Pseudomonas Aeruginosa, Morganella Morganii, Pseudomonas Putida, Citrobacter Koseri, and Klebsielle Pneumoniae in CFS patients both before and after intake of natural anti-inflammatory and anti-oxidative substances (NAIOSs), such as glutamine[ncbi.nlm.nih.gov]
  • […] in human central nervous system disease; and the possible association of Chlamydia pneumoniae and human herpesvirus 6 with multiple sclerosis.[doi.org]
Abdominal Pain
  • Examples include irritable bowel syndrome (IBS), functional dyspepsia, and functional abdominal pain syndrome.[publichealth.va.gov]
  • "After that, we start looking for symptoms like abdominal pain, joint pain, problems sleeping, etc." Lots of people have it but don't know it. The Institute of Medicine (IOM) estimates up to 2.5 million Americans suffer from ME/CFS.[prevention.com]
  • Abdominal Pain: This can be quite severe in the acute onset cases. Whether it is due to affection of the external abdominal musculature or intra-abdominal pathology is unclear.[doi.org]
  • Case Presentation A 58-year-old patient presented to our outpatient clinic complaining of severe diffuse pain, insomnia, diarrhea, abdominal pain, bloating, photophobia, hyper- sensitivity to odor, noise, light touch, tinnitus and palpitations.[scirp.org]
  • Gastrointestinal symptoms - eg, abdominal pain, bloating, diarrhoea. Describing severity There is a wide spectrum of severity. About 25% of people are severely affected.[patient.info]
Abdominal Cramps
  • Digestive disturbances – These include; nausea, loss of appetite, indigestion, excessive wind, bloating, abdominal cramps, alternating diarrhea and constipation. These symptoms are often similar to IBS.[hacw.nhs.uk]
Chest Pain
  • Cardiological or respiratory causes should be considered for shortness of breath and chest pain, and many other illnesses, depending on the specific symptoms.[patient.info]
  • pain seizures paralysis Causes and risk factors Extreme stress might have links to the onset of CFS.[medicalnewstoday.com]
  • Red Flag Symptoms in Persons with Suspected Chronic Fatigue Syndrome Red flags Disease process indicated Chest pain Cardiac disease Focal neurologic deficits Central nervous system malignancy or abscess, multiple sclerosis Inflammatory signs or joint[aafp.org]
  • Pain Symptoms in Other Fatigue Conditions Chest pain and lymph node pain are more frequent in persons fulfilling the CCC than in those with chronic fatigue explained by psychiatric illness.[nap.edu]
Photophobia
  • […] weight change, nausea, bowel disturbance) 53 Muscle and multiple joint pain 62 Cognitive problems 16 Sleep disturbance 27 Impairment of short term memory &/or concentration 28 Fatigue 85 Other clinical features: Visual changes, including blurring and photophobia[doi.org]
  • Case Presentation A 58-year-old patient presented to our outpatient clinic complaining of severe diffuse pain, insomnia, diarrhea, abdominal pain, bloating, photophobia, hyper- sensitivity to odor, noise, light touch, tinnitus and palpitations.[scirp.org]
Myalgia
  • Individuals with fibromyalgia (FM) and/or chronic fatigue syndrome (CFS) report arthralgias and myalgias. However, only persons with FM alone exhibit abnormal pain responses to mild levels of stimulation, or allodynia.[ncbi.nlm.nih.gov]
  • CFS is characterized by debilitating fatigue with associated myalgias, tender lymph nodes, arthralgias, chills, feverish feelings, and postexertional malaise.[ncbi.nlm.nih.gov]
  • […] chronic Epstein-Barr virus syndrome is a poorly defined symptom complex characterized primarily by chronic or recurrent debilitating fatigue and various combinations of other symptoms, including sore throat, lymph node pain and tenderness, headache, myalgia[doi.org]
Arthralgia
  • Individuals with fibromyalgia (FM) and/or chronic fatigue syndrome (CFS) report arthralgias and myalgias. However, only persons with FM alone exhibit abnormal pain responses to mild levels of stimulation, or allodynia.[ncbi.nlm.nih.gov]
  • Chronic fatigue syndrome (CFS) is a condition characterized by impairment of neurocognitive functions and quality of sleep and of somatic symptoms such as recurrent sore throat, muscle aches, arthralgias, headache, and postexertional malaise.[ncbi.nlm.nih.gov]
  • CFS is characterized by debilitating fatigue with associated myalgias, tender lymph nodes, arthralgias, chills, feverish feelings, and postexertional malaise.[ncbi.nlm.nih.gov]
  • Epstein-Barr virus syndrome is a poorly defined symptom complex characterized primarily by chronic or recurrent debilitating fatigue and various combinations of other symptoms, including sore throat, lymph node pain and tenderness, headache, myalgia, and arthralgias[doi.org]
Back Pain
  • Roussel, Jo Nijs, Mira Meeus, Veit Mylius, Cécile Fayt and Rob Oostendorp , Central Sensitization and Altered Central Pain Processing in Chronic Low Back Pain , The Clinical Journal of Pain , 29 , 7 , (625) , (2013) . S. Kempke, P. Luyten, S.[doi.org]
  • A 2001 study on chronic, non-specific low back pain (Keitel) provides some evidence that capsaicin cream can help people with this type of low back pain who also have fibromyalgia.[verywellhealth.com]
  • A literature search was performed through PubMed and Ovid using the terms fibromyalgia, temporomandibular joint disorder, irritable bowel syndrome, irritable bladder/interstitial cystitis, headache, chronic low back pain, chronic neck pain, functional[ncbi.nlm.nih.gov]
  • Hodges , Targeting Chronic Recurrent Low Back Pain From the Top-down and the Bottom-up: A Combined Transcranial Direct Current Stimulation and Peripheral Electrical Stimulation Intervention , Brain Stimulation , 7 , 3 , (451) , (2014) . Peter C.[doi.org]
  • How is recovery from low back pain measured? A systematic review of the literature. European Spine Journal, 20 (1), 9–18. PubMed CrossRef PubMedCentral Google Scholar 7. Lindsay, R. M., Heidenheim, P. A., Nesrallah, G., Garg, A.[doi.org]
Muscle Weakness
  • In all three groups, a majority of patients exhibited muscle weakness in the lower limbs, and significant numbers of patients had absent or abnormal reflexes.[ncbi.nlm.nih.gov]
  • Other symptoms include sore throat, fever, muscle weakness, headache, and joint pain A syndrome characterized by persistent or recurrent fatigue, diffuse musculoskeletal pain, sleep disturbances, and subjective cognitive impairment of 6 months duration[icd9data.com]
  • Other common symptoms include: Joint pain without swelling or redness, muscle aches, muscle weakness all over, or headaches that differ from those you have had in the past Sore throat, sore lymph nodes in the neck or under the arms, chills and night sweats[medlineplus.gov]
Neck Pain
  • A literature search was performed through PubMed and Ovid using the terms fibromyalgia, temporomandibular joint disorder, irritable bowel syndrome, irritable bladder/interstitial cystitis, headache, chronic low back pain, chronic neck pain, functional[ncbi.nlm.nih.gov]
  • Soo Yun, You Lim Kim and Suk Min Lee , The effect of neurac training in patients with chronic neck pain , Journal of Physical Therapy Science , 27 , 5 , (1303) , (2015) . Lotte Bloot, Marianne J.[doi.org]
  • Patients also described chronic pain behind the eyes, neck pain, neuropathic or nerve pain, “full-body ice-cream-headache-like pains,” and feeling like “my brain was going to explode” (FDA, 2013, p. 14).[nap.edu]
Night Sweats
  • Many people with chronic fatigue syndrome may experience other symptoms, including irritable bowel; depression or other psychological problems; chills and night sweats; visual disturbances; inability to think clearly; difficulty maintaining upright position[arthritis.org]
  • Other common symptoms include: Joint pain without swelling or redness, muscle aches, muscle weakness all over, or headaches that differ from those you have had in the past Sore throat, sore lymph nodes in the neck or under the arms, chills and night sweats[medlineplus.gov]
  • sweats Along with the three above core symptoms that are present, one or both of the following must also be present for the diagnosis of CFS: Cognitive impairment Difficulties with thought processes can occur in many forms for people with CFS.[medicalnewstoday.com]
Flushing
  • "It appears that ME/CFS patients are flush with cytokines until around the three-year mark, at which point the immune system shows evidence of exhaustion and cytokine levels drop." This shows there are distinct stages to the disease, she said.[bbc.com]
  • “It appears that ME/CFS patients are flush with cytokines until around the three-year mark, at which point the immune system shows evidence of exhaustion and cytokine levels drop,” says Dr. Hornig.[mailman.columbia.edu]
  • […] memory &/or concentration 28 Fatigue 85 Other clinical features: Visual changes, including blurring and photophobia 1 Emotional lability 23 Impaired temperature control, with intolerance of extremes of temperature 4 Vasomotor instability, with e.g. flushing[doi.org]
  • When handling capsaicin, be sure to: Wear gloves Don't expose the skin to heat, such as from a heating pad or when your skin is heated up from a shower or bath Keep away from eyes and flush eyes with water if it gets in them Don't use it on broken or[verywellhealth.com]
  • For 14 years, he had been a highly successful psychology professor, flush with research grants, president of the community psychology division of the American Psychological Association, and director of clinical training at DePaul.[gizmodo.com]
Emotional Lability
  • lability 23 Impaired temperature control, with intolerance of extremes of temperature 4 Vasomotor instability, with e.g. flushing and/or postural hypotension 2 Severe headache 3 Sore throat, with enlarged lymph nodes 7 Alcohol intolerance 2 Clinical[doi.org]
Headache
  • Symptoms of cfs include fatigue for 6 months or more and experiencing other problems such as muscle pain, memory problems, headaches, pain in multiple joints, sleep problems, sore throat and tender lymph nodes.[icd9data.com]
  • Chronic fatigue syndrome (CFS) is a condition characterized by impairment of neurocognitive functions and quality of sleep and of somatic symptoms such as recurrent sore throat, muscle aches, arthralgias, headache, and postexertional malaise.[ncbi.nlm.nih.gov]
  • Abstract A Japanese woman developed prolonged fatigue, neck and shoulder pain, headache, pyrexia, insomnia, anorexia, lymphadenopathy, and diarrhea for two months. She had experienced various stressors before these symptoms developed.[ncbi.nlm.nih.gov]
  • […] be met for a diagnosis of CFS: (1) severe fatigue lasting six months or longer and (2) the coexistence of any four of a number of characteristic symptoms, defined as mild fever, sore throat, tender lymph nodes, muscle pain and weakness, joint pain, headache[britannica.com]
  • Similarities with fibromyalgia exist and concomitant illnesses include irritable bowel syndrome, depression, and headaches. Therefore, treatment of CFS may be variable and should be tailored to each patient.[ncbi.nlm.nih.gov]
Sleep Disturbance
  • STUDY OBJECTIVES: Little is known about the type and severity of sleep disturbances in the pediatric chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) population, compared with healthy adolescents.[ncbi.nlm.nih.gov]
  • Moreover, HPA axis changes can be reversed by modifying behavioural features of the illness, such as inactivity, deconditioning and sleep disturbance.[ncbi.nlm.nih.gov]
  • RESULTS: Symptoms such as fatigue, pain, sleep disturbance, and low-grade fever were dramatically improved after 15 to 25 sessions of thermal therapy.[ncbi.nlm.nih.gov]
  • CFS/FM often seems to be triggered by infections and physical trauma, but depression, sleep disturbances, and personality may also be involved.[ncbi.nlm.nih.gov]
  • BACKGROUND AND OBJECTIVE: Chronic Fatigue Syndrome (CFS) is characterized by excessive fatigue after minimal physical or mental exertion, muscle and joint pain, poor concentration, dizziness, and sleep disturbances.[ncbi.nlm.nih.gov]
Irritability
  • This review demonstrates that sympathetic nervous system predominance is common in fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, and interstitial cystitis.[ncbi.nlm.nih.gov]
  • The main symptoms of CFS in these students included being afraid of going to school, despondency, and irritability in addition to those specified in the Centers for Disease Control and Prevention (CDC).[ncbi.nlm.nih.gov]
  • Similarities with fibromyalgia exist and concomitant illnesses include irritable bowel syndrome, depression, and headaches. Therefore, treatment of CFS may be variable and should be tailored to each patient.[ncbi.nlm.nih.gov]
  • Exposure to LP&P to vulnerable subjects may cause a symptom complex consisting of 1) irritation and hyperresponsiveness of the upper and lower respiratory tract; and 2) chronic fatigue (syndrome, CFS).[ncbi.nlm.nih.gov]
Confusion
  • CFS: (1) severe fatigue lasting six months or longer and (2) the coexistence of any four of a number of characteristic symptoms, defined as mild fever, sore throat, tender lymph nodes, muscle pain and weakness, joint pain, headache, sleep disorders, confusion[britannica.com]
  • For centuries its confusing array of features has been attributed to numerous environmental, metabolic, infectious, immunologic, and psychiatric disturbances.[ncbi.nlm.nih.gov]
  • […] that subtyping individuals with CFS on sociodemographic, functional disability, viral, immune, neuroendocrine, neurology, autonomic, and genetic biomarkers can provide clarification for researchers and clinicians who encounter CFS' characteristically confusing[ncbi.nlm.nih.gov]
  • In chronic fatigue syndrome (CFS), the lack of consensus on how recovery should be defined or interpreted has generated controversy and confusion.[ncbi.nlm.nih.gov]
  • At least 20 sets of diagnostic criteria exist, the committee noted, which has confused patients, clinicians, and their families, as well as researchers studying the disease.[sciencemag.org]
Insomnia
  • Abstract A Japanese woman developed prolonged fatigue, neck and shoulder pain, headache, pyrexia, insomnia, anorexia, lymphadenopathy, and diarrhea for two months. She had experienced various stressors before these symptoms developed.[ncbi.nlm.nih.gov]
  • At the initial visit, he complained of lack of concentration, memory decline, frequent urination, insomnia and occasional difficulty of emotional control, as well as general fatigue and pain involving the entire body.[ncbi.nlm.nih.gov]
  • A cognitive model of insomnia. Behav Res Ther. 2002;40:869–93. [ PubMed ] 99 Harvey AG, author. A cognitive theory and therapy for chronic insomnia. J Cogn Psychother. 2005;19:41–59 100 Lundh LG, author.[doi.org]
  • On the KSQ, the CFS patients reported significantly more insomnia symptoms, sleepiness, awakening problems and a longer sleep onset latency than healthy individuals.[ncbi.nlm.nih.gov]
  • CFS is a condition which causes persistent fatigue that can’t be fixed with normal sleep or rest and often means that sufferers can struggle with dizziness, heart palpitations, insomnia and muscle pain.[thesun.co.uk]

Workup

There is no single symptom or test to diagnose this condition. Diagnosis is mainly based on exclusion of other medical conditions which can produce fatigue mainly AIDS, malignancy, and thyroid or adrenal conditions [9].

When a patient presents with fatigue after any physical activity as the main complaint, a thorough physical examination and blood examination must be done to exclude any other systemic disease.

For a clinical diagnosis there are certain essential criteria which should be present for an accurate diagnosis mainly:

  • Short term memory loss / concentration difficulties
  • Physical or mental exertion brings about severe malaise
  • Altered and unrefreshing sleep
  • Myalgia
  • Arthralgia
  • Sore throat which is persistent or recurring
  • Tender lymph nodes mainly cervical and axillary

At least four of these criteria should be met along with dysfunctional cognitive symptoms.

Blood examination will show a low ESR, thus showing no signs of inflammation or infection. MRI and CT scans show no abnormality. Blood tests may be done to detect any antibodies, if there was any prior infection.

Since mood related symptoms are prominently seen, other mental health conditions like schizophrenia, depression, bipolar disorder need to be ruled out. A psychiatrist will be able to diagnose if any one of the above conditions are causing the undue fatigue.

Treatment

As there is no known etiology for this condition there is no well-established mode of treatment. The treatment is mainly for the symptoms rather than for cure. The objective is to improve the functional capacity of the patients so that they are able to carry out their daily activities with minimal fatigue.

The physician should plan the treatment according to the personal needs and status of the patient. This treatment should be modified from time to time depending on the medical condition and symptoms.

Nowadays, Cognitive behavioural therapy (CBT) and Graded Exercise therapy (GET) are being used for faster recovery [10].
CBT involves psychological counselling which helps the patient overcome any stressful situations, and helps the patient deal with the condition. This psychotherapy helps to improve the patient’s outlook to the disease. This helps patients develop strategies to overcome their individual restrictions.

GET is an individualised exercise program conducted under the supervision of a physical therapist. This involves limited exercise and activity for the patient so as to improve their functionalcapacity. As the condition improves, the exercise programme would be modified with increased exercise intensity and duration.

Certain cases of the syndrome may require antidepressants or sleeping pills for altered sleep. Along with this patient should be advised to restrict any form of over activity or overexertion [11]. Sleeping habits should be formed wherein patient sleeps at a constant time. Avoidance of caffeine, tobacco and alcohol are a must.

Prognosis

Recovery rates are good with proper treatment. Individuals are able to resume their daily activities. Relapses and remissions occur [6].

With treatment patients can recover within two years. Severe persistent cases show poor prognosis. Children and adolescents show better recovery rates.

Regular monitoring is necessary as treatment requires modification according to status and symptoms of the condition [7].

Etiology

Chronic fatigue syndrome is supposed to have multiple factors responsible but the exact etiology still remains unknown. Several theories have been postulated but there is no documented evidence.

Viruses have been implicated in the causation of chronic fatigue syndrome; most common associated viruses are Epstein-Barr virus (EBV) and herpes simplex 6 virus.

Other immunosuppressive conditions like AIDS, malignancy and thyroid disorders also have certain role to play. These conditions also produce symptoms similar to chronic fatigue syndrome. Any abnormality in the immune system can trigger off this condition.

Genetic predisposition and familial tendency seem to play a role in this disorder. Depression, emotional instability and mental fatigue are seen in cases with the condition but there is an uncertainty whether it’s a result or causation.

Recent studies show any period of stress, trauma or emergency situations cause the hypothalamic–pituitary-adrenal axis (HPA) to fluctuate resulting in abnormal hormonal response causing a decreased production of cortisol [3].

There is no single causative agent, but interplay of all the above factors produces this syndrome.

Epidemiology

Since there are various definitions for the condition, the exact prevalence also varies. The condition affects all races and ethnic backgrounds. There is a female preponderance usually affecting women between 30-50 years of age. Children and young adults are rarely affected [4]. It is not a contagious disease but shows a familial tendency.

Sex distribution
Age distribution

Pathophysiology

The pathogenesis still remains unknown in spite of many years of research. Many theories have been postulated, but no single theory has been pointed out in the etiopathogenesis.

On the basis of the clinical presentation, etiopathogenesis has been documented. Other investigations demonstrated abnormalities in other aspects including human brain functioning, immune responses, neuroendocrine responses and psychological tendencies [5]. Genetic predisposition is also considered vital for the manifestation of chronic fatigue syndrome.

Several investigations reveal the role of central nervous system due to several symptoms including difficulty in concentration, memory loss and lack of alertness. Various imaging techniques like MRI show significant changes in the subcortical white matter of the affected individuals. Other tests show decreased cerebral blood flow.

Imbalance in hypothalamic-pituitary-adrenal axis is also implicated including serotonin pathways. Abnormal response to stress or trauma is considered as a reason. Many patients also show decreased cortisol.

Viral infections like EBV virus or Herpes 6 virus have been implicated as patient’s blood shows antibodies to these infections. So post viral infection, patients present with chronic fatigue. Immune system also seems to play a role in the etiology, mainly immunocompromised states.

However, the outcome and medical utility of these findings still remains elusive. Chronic fatigue syndrome is a complex syndrome with varied pathophysiological abnormalities manifesting similar signs.

Due to a wide spectrum of symptoms and a number of physiological, pathological and psychological pathways playing a role, it makes the pathogenesis multifactorial.

Prevention

There is no known prevention for chronic fatigue syndrome as the exact cause is not known.

Once diagnosed, prevention of aggravation of symptoms includes avoiding stimulants, stress and too much sleep. These factors are known to trigger the symptoms. Too much overexertion should be avoided.

Summary

Chronic fatigue syndrome is a state of of persistent fatigue that remains without any explanation for a minimum duration of 6 months. The cardinal symptoms are fatigue, memory loss, poor concentration, irritability, altered sleep patterns and muscle aches [1].

This syndrome was earlier known as myalgic encephalomyelitis (ME) and has been attributed to a viral infection. There is however no documented evidence of any infective cause of this condition at present. Laboratory investigations are normal.

The syndrome usually disables the individual to perform daily activities due to profuse exhaustion, lack of concentration and memory loss. This leads to depression in the patients. Genetic and psychological mechanisms also seem to play a role in this condition. The severity of symptoms varies from individual to individual.

The proportion of patients with organic disease remains uncertain [2]. Recent studies suggest that two thirds of patients with symptom duration of more than 6 months have an underlying psychiatric disorder.

Patient Information

Chronic fatigue syndrome is a condition which causes severe fatigue. This fatigue persists even after periods of rest. Any physical or mental exertion brings about the exhaustion, which restricts the individual from doing their daily activities. There is no known cause for this condition. Viral infections are thought to cause this condition.

This syndrome mainly shows fatigue which should be present for a minimum 6 months to confirm this medical condition. Along with this the patient will show memory loss, problems in sleeping, muscle and joint pains, and sore throat. These symptoms are important to confirm chronic fatigue syndrome.

This syndrome mainly affects women, and usually occurs between 30- 50 years of age. There are no specific tests for this condition and thus hard to detect by the physician. Exclusion of other medical conditions help in the diagnosis.

Since the cause remains unknown, there is no specific treatment. Treatment is mainly directed towards relieving the symptoms shown by the patient. The aim of the treatment is to enable the individual to carry out daily activities and prevent from being totally bedridden. Exercise and behavioural therapy are important to improve the outlook of the disease. There is no total cure for this condition; periods of relapse and remission are common.

Regular monitoring and follow-up are important as the treatment will also be modified according to the condition of the patient.
Total recovery is not possible, but lifestyle modifications and exercise therapy can help the patient lead a fairly normal life.

References

Article

  1. Fukuda K, Straus SE, Hickie I, et al. The chronic fatigue syndrome: a comprehensive approach to its definition and study. International Chronic Fatigue Syndrome Study Group. Ann Intern Med. 1994 Dec 15; 121(12): 953-59.
  2. Sharpe M, Archard LC, Banatvala JE et al. A report: chronic fatigue syndrome: guidelines for research. J R Soc Med. 1991 Feb; 84(2): 118-21.
  3. Afari N, Buchwald D. Chronic fatigue syndrome: a review. Am J Psychiatry. 2003 Feb; 160(2): 221-36.
  4. Wessely S. The epidemiology of chronic fatigue syndrome. Epidemiol Rev. 1995; 17(1): 139-51.
  5. Harvey SB, Wadsworth M, Wessely S, et al. The relationship between prior psychiatric disorder and chronic fatigue: evidence from a national birth cohort study. Psychol Med. 2008 Jul; 38(7): 933-940.
  6. Joyce J, Hotopf M, Wessely S. The prognosis of chronic fatigue and chronic fatigue syndrome: a systematic review. QJM. 1997 Mar; 90(3): 223-33.
  7. Cairns R, Hotopf M. A systematic review describing the prognosis of chronic fatigue syndrome. Occup Med (Lond). 2005 Jan; 55(1): 20-31.
  8. Swanink CM, Vercoulen JH, Bleijenberg G, et al. Chronic fatigue syndrome: a clinical and laboratory study with a well matched control group. J Intern Med. 1995 May; 237(5): 499-506.
  9. Knoop H, van der Meer JW, Bleijenberg G. Guided self-instructions for people with chronic fatigue syndrome: randomised controlled trial. Br J Psychiatry. 2008 Oct; 193(4): 340-41.
  10. Wallman KE, Morton AR, Goodman C, et al. Randomised controlled trial of graded exercise in chronic fatigue syndrome. Med J Aust. 2004 May 3; 180(9): 444-48.
  11. Moss-Morris R, Sharon C, Tobin R, et al. A randomized controlled graded exercise trial for chronic fatigue syndrome: outcomes and mechanisms of change. J Health Psychol. 2005 Mar; 10(2): 245-59.

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Last updated: 2018-06-21 22:16