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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.

Pneumonia
  • 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]
  • Some evidence indicates that the bacterium Chlamydia pneumoniae (which causes pneumonia and other illnesses) may be a cause of CFS in some cases.[emedicinehealth.com]
Fatigue
  • 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]
  • The severity of fatigue and the HRQoL were assessed using the Fatigue Impact Scale (FIS) and the Health Status Questionnaire Short Form-36 (SF-36), respectively.[ncbi.nlm.nih.gov]
  • Fatigue is commonly reported in the primary care setting; however, its cause is often unclear. This article presents 3 cases involving patients with chronic fatigue syndrome who responded poorly to treatment.[ncbi.nlm.nih.gov]
  • 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).[ncbi.nlm.nih.gov]
  • The effect of antibiotic therapy on post-Q-fever fatigue syndrome has not been studied in south-east Europe thus far. Three patients are presented with post-Q-fever fatigue syndrome. All fulfilled the CDC criteria for chronic fatigue syndrome.[ncbi.nlm.nih.gov]
Chronic Fatigue Syndrome
  • An association with a chronic fatigue syndrome was never described.[ncbi.nlm.nih.gov]
  • To review the evidence for the role of dietary modifications in alleviating chronic fatigue syndrome symptoms.[ncbi.nlm.nih.gov]
  • The EPA-rich essential fatty acid supplementation led to a marked clinical improvement in her symptoms of chronic fatigue syndrome, starting within 6-8 weeks.[ncbi.nlm.nih.gov]
  • fatigue syndrome and macrophagic myofasciitis.[ncbi.nlm.nih.gov]
Pain
  • 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 in patients[ncbi.nlm.nih.gov]
  • The relation between autonomous parameters and self-reported pain parameters was examined using correlation analysis. Some relationships of moderate strength between autonomic and pain measures were found.[ncbi.nlm.nih.gov]
  • 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]
  • The Pain Catastrophizing Scale (PCS); Pain Coping Inventory (PCI); and Tampa Scale of Kinesiophobia (TSK) were defined as outcome measures.[ncbi.nlm.nih.gov]
  • After treatment with psychostimulants, the 3 patients reported improved symptoms of fatigue and pain, and cognitive and core ADHD symptoms.[ncbi.nlm.nih.gov]
Malaise
  • Also, an association with symptoms of post-exertional malaise was demonstrated.[ncbi.nlm.nih.gov]
  • Post exertion malaise is one of the most debilitating aspects of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome, yet the neurobiological consequences are largely unexplored.[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]
  • Their symptoms, including muscular and joint pain, malaise and recurrent headaches, were not explained by the pattern of their MS. MS and CFS/ME are two common conditions with increased prevalence in middle aged females.[ncbi.nlm.nih.gov]
  • BACKGROUND Patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) present with profound fatigue, flu-like symptoms, pain, cognitive impairment, orthostatic intolerance, and post-exertional malaise (PEM), and exacerbation of some or[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. Three patients are presented with post-Q-fever fatigue syndrome. All fulfilled the CDC criteria for chronic fatigue syndrome.[ncbi.nlm.nih.gov]
  • The patient's fever resolved with the administration of intravenous immunoglobulin.[ncbi.nlm.nih.gov]
  • 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]
  • They initially developed a low grade fever and generalized fatigue, followed by sleep disturbance and psychosomatic symptoms, and their performance ability deteriorated. They were diagnosed as having CFS on the basis of criteria.[ncbi.nlm.nih.gov]
  • Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is characterized by unexplained persistent fatigue, commonly accompanied by cognitive dysfunction, sleeping disturbances, orthostatic intolerance, fever, lymphadenopathy, and irritable bowel[ncbi.nlm.nih.gov]
Abdominal Pain
  • This orthostatic (upright) intolerance may manifest as increased fatigue, weakness, naurea, abdominal pain, poor concentration, nervousness, shortness of breath, lightheadedness, headache, tremulousness, palpitations, and even faintness.[cfidsselfhelp.org]
  • "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]
  • These symptoms include chest pain , abdominal pain , shortness of breath , chronic cough , diarrhea , nausea , night sweats , jaw pan and muscle stiffness, double vision , and psychological problems such as panic attacks , anxiety , and depression .[medicinenet.com]
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
  • 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]
  • These symptoms include chest pain , abdominal pain , shortness of breath , chronic cough , diarrhea , nausea , night sweats , jaw pan and muscle stiffness, double vision , and psychological problems such as panic attacks , anxiety , and depression .[medicinenet.com]
Myalgia
  • Although enterovirus protein, RNA and non-cytopathic viruses have been demonstrated in the stomach biopsies of patients with myalgia encephalomyelitis/chronic fatigue syndrome (ME/CFS), causality for chronic diseases is difficult to establish without[ncbi.nlm.nih.gov]
  • He notes that many of the symptoms of sickness behavior (such as fatigue, sleep changes, myalgia, cognitive impairment, depression and zinc depletion) are also mediated by proinflammatory cytokines and observed in CFS.[hhv-6foundation.org]
  • Chronic fatigue syndrome (CFS) is characterised by a sudden or gradual onset of persistent disabling fatigue, post-exertional malaise (PEM, exertional exhaustion), unrefreshing sleep, cognitive and autonomic dysfunction, myalgia, arthralgia, headache,[bestpractice.bmj.com]
  • […] 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[symptoma.com]
  • Other common symptoms include: poor memory and concentration (‘brain fog’) muscle pain (myalgia) pains in key parts of the body and head (trigger points) sore throat and a feeling of swollen glands in the neck palpitations, lowered blood pressure and[yourhormones.info]
Arthralgia
  • Chronic fatigue syndrome (CFS) is characterised by a sudden or gradual onset of persistent disabling fatigue, post-exertional malaise (PEM, exertional exhaustion), unrefreshing sleep, cognitive and autonomic dysfunction, myalgia, arthralgia, headache,[bestpractice.bmj.com]
  • […] 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[symptoma.com]
  • In ME/CFS patients, fatigue is just one of multiple incapacitating symptoms that include cognitive impairment, postexertional malaise, unrefreshing sleep, headaches, myalgias, arthralgias, sore throats, lymphadenopathy, hypersensitivity to noise, light[pnas.org]
  • The concurrent occurrence of 4 or more of the following symptoms: Substantial impairment in short-term memory or concentration Sore throat Tender lymph nodes Muscle pain Multiple arthralgias (joint pain) without swelling or redness Headaches of a new[physio-pedia.com]
Muscle Weakness
  • It is not due to muscle weakness. It is not loss of motivation or pleasure which occurs in people who are depressed. The tiredness is often made worse by activity. This is called post-exertional malaise.[patient.info]
  • Weakness (common at onset) Multiple Joint Pain [5] without swelling or redness [1] Neurally mediated hypotension (NMH) (May experience lightheadedness, lower blood pressure and pulse, visual dimming, slow response to verbal stimuli) [1] Tender lymph[physio-pedia.com]
Shoulder Pain
  • 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]
  • Finger pain pressure thresholds of patients with CFS, compared with patients with MS, were 25% lower (difference ratio 0.75 [95% CI 0.59, 0.95], P 0.02) and shoulder pain pressure thresholds were 26% lower (difference ratio 0.74 [0.52, 1.04], P 0.08).[ncbi.nlm.nih.gov]
Back Pain
  • 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]
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]
  • sweats Low grade fever or low body temperature Irritable bowel Allergies and sensitivities to foods, odors, chemicals, medications, and sound Numbness, tingling, or burning sensations in the face, hands, or feet Symptoms of ME/CFS vary widely from person[womenshealth.gov]
  • sweats, weight changes and intolerance of alcohol.[cfidsselfhelp.org]
  • In addition to the profound fatigue experienced, other serious symptoms often accompany CFS, such as: joint pain that moves from one spot to another muscle pain poor concentration loss of memory enlarged lymph nodes headaches chills night sweats digestive[draxe.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]
  • 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]
Headache
  • 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]
  • Their symptoms, including muscular and joint pain, malaise and recurrent headaches, were not explained by the pattern of their MS. MS and CFS/ME are two common conditions with increased prevalence in middle aged females.[ncbi.nlm.nih.gov]
  • Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is characterised by multiple symptoms including fatigue, headaches and cognitive impairment, which have a significantly adverse effect on the normal functioning and well-being of the individual[ncbi.nlm.nih.gov]
  • The cardinal symptoms of each - fatigue and headache - are common in the other and their multiple other symptoms are frequently seen in both.[ncbi.nlm.nih.gov]
  • In addition, in ME/CHFS the change in headache severity was inversely correlated (r -.480, P .038) with the change in high frequency heart rate variability.[ncbi.nlm.nih.gov]
Irritability
  • 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]
  • 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]
  • Mood fluctuations mainly anxiety, irritability and depression will be seen.[symptoma.com]
  • Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is characterized by unexplained persistent fatigue, commonly accompanied by cognitive dysfunction, sleeping disturbances, orthostatic intolerance, fever, lymphadenopathy, and irritable bowel[ncbi.nlm.nih.gov]
  • Patients with chronic fatigue syndrome are also more likely to experience irritable bowel syndrome and similar symptoms, Medscape reported.[newsmax.com]
Sleep Disturbance
  • This study provides objective and subjective evidence of sleep disturbance in adolescents with CFS/ME compared with healthy adolescent controls.[ncbi.nlm.nih.gov]
  • 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]
  • 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]
  • They initially developed a low grade fever and generalized fatigue, followed by sleep disturbance and psychosomatic symptoms, and their performance ability deteriorated. They were diagnosed as having CFS on the basis of criteria.[ncbi.nlm.nih.gov]
  • Chronic fatigue syndrome (CFS) is a heterogeneous disease which presents with pronounced disabling fatigue, sleep disturbances, and cognitive impairment that negatively affects patients' functional capability.[ncbi.nlm.nih.gov]
Insomnia
  • 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]
  • 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]
  • Light pollution may cause insomnia in older adults November 30, 2018 A new study is the first population-based investigation to report a significant association between artificial, outdoor light exposure at night and insomnia, as indicated by older adults[medicalxpress.com]
  • 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]
Confusion
  • Dr Mark Davis, professor of immunology and microbiology and director of Stanford’s Institute for Immunity, Transplantation and Infection, said: “There’s been a great deal of controversy and confusion surrounding ME/CFS — even whether it is an actual disease[express.co.uk]
  • “There’s been a great deal of controversy and confusion surrounding ME/CFS — even whether it is an actual disease,” the study's senior author, Mark Davis said in a statement, adding that the new research provides “a solid basis for a diagnostic blood[abcnews.go.com]
  • As yet, there is not enough research to confirm the causes of CFS and there remains to be a lot of confusion around the condition.[hacw.nhs.uk]
  • Recent efforts to address the problem have led to infighting, with patients and experts arguing that the effort may only lead to further confusion.[washingtonpost.com]
  • “There has been a great deal of controversy and confusion surrounding ME/CFS – even whether it is an actual disease,” he says. “Our findings show clearly that it's an inflammatory disease and provide a solid basis for a diagnostic blood test.”[cosmosmagazine.com]

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