Chronic Fatigue Syndrome

Description:

Ø      complex of symptoms characterized by chronic, debilitating fatigue and other nonspecific symptoms.

Ø      no known cause

Ø      may actually include several similar illnesses with different causes

Ø      symptoms of CFS may develop following an otherwise self-limited illness, (such as influenza, infectious mononucleosis, acute cytomegalovirus, or a nonspecific acute viral syndrome)

Ø      most CFS symptoms develop gradually over weeks to months, with no recognized precipitating event

Ø      symptoms vary widely in severity with many becoming severely disabled and unable to work

Ø      CFS is not a progressive disease (possible rare exceptions)

Ø      usually symptoms plateau early in the course of illness and persist or recur with varying degrees of severity for at least six months

Ø      Death resulting from CFS has not been reported.

Ø      CFS does not appear to be directly transmissible from person to person

Ø      there is no justification for isolation from other persons

Ø      CFS has been diagnosed in a wide variety of persons; young children to adults in their 60's

Ø      CFS appears to be more common in females than in males, although this may be the result of underdiagnosis in males

Ø      CAUSES:

Ø      Causes of CFS are unknown and may represent symptoms caused by several different disease

Ø      Several viruses have been investigated as possible causes of CFS (including the Epstein-Barr virus, cytomegalovirus , Coxsackie B virus, and adenovirus, Human Herpes Viirus type 6) None of these agents has been more than circumstantially associated with CFS.  Antibody tests, or serologic tests, are not recommended for use in diagnosing CFS.

Ø      Vaccines are not associated with CFS

Ø      CFS is not associated with the acquired immune deficiency syndrome (AIDS), although AIDS may cause symptoms resembling CFS

Ø      No single immunologic abnormality has been linked to CFS

Ø      Psychological factors and stressors are associated with CFS

Ø      Most CFS patients describe themselves as depressed or anxious, but many say that the depression and anxiety developed after the onset of CFS and is a natural consequence of a chronic physical illness.

Diagnostic criteria:

 It is very important for the patient with CFS symptoms to be fully evaluated for other chronic diseases. Chronic fatigue, as an isolated symptom, is common in the general population, and CFS appears to be present in only a small fraction of persons who have complaints of chronic fatigue.

ü      illness lasting at least 6 months

ü      characterized by chronic or recurrent, debilitating fatigue

ü      combined with at least 6 of the following chronic symptoms: headache, fever or feverishness, sore throat, muscle aches, joint pains, generalized muscle weakness, lymph node pain, prolonged fatigue following exercise, sleep alterations, and various nervous system complaints

ü      In the absence of any other disease or explanation after thorough medical and laboratory evaluation including depressive disorders

ü      There is no absolute means of confirming the diagnosis of CFS

ü      No known laboratory tests are of proven positive diagnostic value

ü      CFS should be considered by the physician only after a thorough evaluation for other potential causes of illness.

ü      Some possible causes of CFS-like symptoms include autoimmune diseases such as systemic lupus erythematosus, malignancies such as breast or ovarian cancer, lymphoma, thyroid disease, brain tumor, infectious diseases such as endocarditis, encephalitis, hepatitis, syphilis, or AIDS, and a variety of chronic diseases of the heart, lungs, liver, kidneys, gastrointestinal tract, endocrine system, or musculoskeletal systems

Diagnostic Checklist:

ü      rheumatologic disorders such as  lupus, RA, Still’s, Sjorgens, Scleroderma, etc.

ü      cancers (breast, prostate, brain ovarian, etc.)  and lymphomas, anemia, dyscrasias, vitamin deficiencies (B, D, folate, and iron)

ü      chronic heart problems (often the presenting sign is fatigue)

ü      chronic lung diseases; inherited, acquired, autoimmune, inflammatory and malignant.

ü      liver disease; inherited or acquired

ü      gastrointestinal disorders including inflammatory bowel disease, sprue, Whipple’s disease, parasites, GERD and PUD, etc.

ü      endocrine disorders, such as thyroid problems, diabetes, hyponatremia, calcium abnormalities, adrenal insufficiency, electrolyte abnormalities, metabolic syndrome, etc.

ü      obesity, especially in the face of recent weight gain

ü      debilitation including that due to inactivity

ü      neurological disorders; including demyelinating processes, migraine syndromes, and inflammatory disorders (multiple sclerosis, GBS, AIDP and CIDP)

ü      muscular disorders such as muscular dystrophy and polymyositis

ü      allergic manifestations; environmental and drug reactions

ü      adverse side effect of medications

ü      sleep disorders including sleep apnea and disorganized sleep disorders

ü      chronic pain

ü      primary psychiatric disorders, such as major depression or anxiety

ü      infectious diseases such as endocarditis, end stage hepatitis, syphilis, HIV disease with AIDS, encephalitis

ü      It is also advisable to periodically repeat such evaluations -- there have been several cases in which patients diagnosed with CFS have later been found to have a specific disease, such as a connective tissue disorder or other chronic illness, that was likely to have caused their CFS symptoms from the beginning.

Treatment:

Ø      no proven effective cure for CFS now exists

Ø      treatment should be initiated only after a thorough evaluation for other chronic diseases by a reputable physician

Ø      begin by recommending a regimen of balanced diet, adequate rest, and physical conditioning

Ø      moderate exercise, not to the point of exhaustion, is generally helpful.

Ø      CFS patients often report relapses of severe fatigue and other symptoms after over-exerting themselves.

Ø      Symptomatic treatment is often helpful in reducing symptoms to tolerable levels including anti-inflammatory agents for headaches, muscle and joint pains and low doses of anti-anxiety drugs

Ø      Many CFS patients suffer from depressive symptoms, such as sleep disturbance, loss of enjoyment of life, and decreased appetite. Low doses of antidepressant drugs, taken at bedtime, have been reported to improve many of these and other CFS symptoms

Ø      In persons who have depressive symptoms, formal psychological testing should be performed to confirm their severity. For such patients, full doses of antidepressants may be expected to produce significant improvement. Antidepressant drugs are very potent and have a number of possible side effects. They must be used under the careful guidance of a physician. A variety of antidepressant agents are available, each with its own range of side-effects. If one agent fails to be tolerated, another may be tried.

The CDC states that “all treatments have potential side effects, and in many instances the risk of side effects outweighs the potential beneficial effect of treatment. A number of currently used treatments are of no proven value, are often costly, and may actually be harmful. Only one agent, acyclovir, has undergone rigorous clinical testing, and it was recently reported to be no more effective than a placebo in treating CFS patients. Some successes have been reported in small numbers of patients, using a wide range of treatments, including antiviral and immunomodulating drugs, vitamins, holistic remedies, diet modifications, and activity reduction. However, such anecdotal reports are often based upon faulty study design and the results cannot be distinguished from a placebo effect or the natural course of the illness. Several formal treatment trials are in planning stages around the country and may shed new light on the treatment of CFS.”

Source:  http://www.cdc.gov.  Accessed March 2007

             http://guideline.gov.  Accessed March 2007