Chronic Fatigue Syndrome

Chronic Fatigue Syndrome

National Organization for Rare Disorders, Inc.

Important

It is possible that the main title of the report Chronic Fatigue Syndrome is not the name you expected. Please check the synonyms listing to find the alternate name(s) and disorder subdivision(s) covered by this report.

Synonyms

  • CFIDS
  • CFS
  • Chronic Fatigue and Immune Dysfunction Syndrome

Disorder Subdivisions

  • None

General Discussion

Chronic fatigue syndrome (CFS) is a complex disorder characterized by profound fatigue and other related symptoms. Standards for the diagnosis of CFS have been defined by researchers at the Centers for Disease Control and Prevention (CDC). These include excessive fatigue that does not respond to bed rest, combined with four or more of the following symptoms: substantial impairment in short-term memory or concentration; sore throat; tender lymph nodes; muscle pain; pain in multiple joints without redness or stiffness; headaches of a new type, pattern or severity; unrefreshing sleep; and a general feeling of ill health (malaise) for up to 24 hours after exertion.



Chronic fatigue syndrome has generated significant debate and controversy in the medical community. It remains a poorly understood and potentially debilitating illness. Scientists believe chronic fatigue syndrome is not contagious and that multiple factors including immunological, genetic, environmental ones working in combination cause the development of chronic fatigue syndrome. Laboratory tests (blood, urine, etc.) are of little value in diagnosing the syndrome.

Symptoms

After years of debate and controversy, chronic fatigue syndrome has been defined by an international group of physicians brought together by the Centers for Disease Control and Prevention (CDC). To receive a diagnosis of chronic fatigue syndrome, a patient must satisfy two criteria:



Have severe chronic fatigue of six months or longer duration with other known medical conditions excluded by clinical diagnosis, and



Concurrently, have four or more of the following symptoms: substantial impairment in short-term memory or concentration; 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 lasting more than 24 hours.



The symptoms must have persisted or recurred during six or more consecutive months of illness and must not have predated the fatigue.



The onset of these symptoms is usually sudden, sometimes following a flu-like illness. The syndrome may persist for months or years, and disappear without treatment. The many symptoms of chronic fatigue syndrome do not always occur with the same degree of severity or at the same time. There are usually instances when symptoms may disappear for periods of time.



Additional symptoms may develop in some individuals including visual disturbances such as light sensitivity or blurred vision; chills; night sweats, gastrointestinal abnormalities; cognitive impairment; a chronic cough; jaw pain; chest pain; difficulty breathing; and morning stiffness. Some individuals may also have psychological problems including depression, anxiety or panic attacks.

Causes

The exact cause of chronic fatigue syndrome is not known although researchers are continually investigating this disorder. Many clinical researchers believe that chronic fatigue syndrome is overdiagnosed. It is possible that many people diagnosed with CFS have another disease that has similar symptoms, and may be easily confused with CFS. Only those individuals who meet the strict diagnostic criteria set by the CDC actually have chronic fatigue syndrome.



Many researchers believe that chronic fatigue syndrome is a complex disorder in which several different factors contribute to the development of the disorder. Such factors include infectious, immunological, and genetic factors. Researchers have theorized that abnormalities of the immune system, the brain and the hypothalamic-pituitary-adrenal (HAP) axis may all play a role in the development of chronic fatigue syndrome. Some researchers believe that some affected individuals have a genetic predisposition to the disorder. A genetic predisposition means that a person carries a gene or genes for a disease, but that it may not be expressed unless other additional factors are present. The genetic factors associated with narcolepsy are insufficient to cause the disorder by themselves.



Researchers have investigated the role of viruses as a possible cause of chronic fatigue syndrome. During the 1980's physicians believed that the virus that causes mononucleosis, Epstein Barr virus, was the cause of this illness. However, that theory was disproven and tests for antibodies to this virus are no longer used to diagnose chronic fatigue syndrome. During 1990, a team of scientists at the Wistar Institute isolated a virus from the blood of adults and children with chronic fatigue syndrome. The virus, Human T- Cell Lymphotrophic, Type II (HTLV-2) is a slow virus or "retrovirus." Slow viruses may stay dormant in humans for extended periods of time, then for reasons yet unknown may unexplainably become reactivated. It is not clear how or if the virus may be transmitted, nor is there evidence yet to prove that this HTLV virus is actually associated with the cause or progression of chronic fatigue syndrome. More recent studies indicate that there is no evidence for the involvement of any slow virus as a cause for CFS.



Other studies suggest that HHV-6, a herpes virus, may be partially responsible for the development of chronic fatigue syndrome. However, this evidence remains inconclusive.



Researchers are also investigating abnormalities in the immune system of individuals with chronic fatigue syndrome. Some research suggests that an unknown immune defect, along with a viral disease which triggers the illness, may cause this disorder. Other information suggests that susceptibility to chronic fatigue syndrome may be associated with subtle immune system defects.



Another theory is that chronic fatigue syndrome may occur as the result of the immune system's over-reaction to infectious agents in highly allergic people. Some researchers suspect that chemicals called cytokines, which help regulate the immune system, may cause some symptoms of CFS in individuals with severe allergies. However, none of these theories have been scientifically proven, and the cause of CFS is still unknown.

Affected Populations

Chronic fatigue syndrome was once considered a rare disorder and, although some physicians believe it to be overdiagnosed, studies conducted by the CDC place the incidence at between 1-4 million people in the United States. The CDC also states that fewer than 20 percent of individuals with chronic fatigue syndrome have been properly diagnosed.



Women are affected 2-4 times more often than men. Some researchers believe that this disparity results from women being more likely to report their symptoms to a doctor than men. Chronic fatigue syndrome is most likely to develop in individuals in their 40s or 50s. However, it can affect individuals of any age including children. Chronic fatigue syndrome affects individuals of every race and ethnicity.



In approximately 70 percent of cases, the onset of chronic fatigue syndrome is associated with an acute infectious illness. These illnesses include infectious mononucleosis, influenza, upper respiratory infections, acute inflammation of the liver (hepatitis), and flu-like diseases.

Standard Therapies

Evaluation, Screening and Diagnosis

Chronic fatigue symptom experts have developed a five-stage process for evaluating a patient for CFS. These steps are:



A detailed medical history followed by a complete physical examination



A mental status examination is administered by the physician by means of a short discussion and/or a brief oral test.



A standard set of laboratory tests of the patient's blood and urine is required in order to eliminate or identify other causes of fatigue.



If these lab tests indicate another source for the fatigue, additional tests will be administered in order to confirm the diagnosis.



If the results of the lab tests do not indicate an alternative cause of the fatigue, the physician will determine if the patient meets the CDC criteria for a diagnosis of CFS.



For a comprehensive description of the tests used to screen for CFS see:

http://www.cdc.gov/ncidod/diseases/cfs/about/definition/screening.htm



Treatment

There is no cure for chronic fatigue syndrome; treatment is aimed at alleviating symptoms. Treatment is highly individualized; treatment that is effective in one person may not be effective in others. A wide and diverse range of therapies have been used to treat individuals with chronic fatigue syndrome.



Counseling may help individuals adjust to the chronic nature of the illness. Anti-viral medications as well as many other drugs have not proven effective. Although rest, eating a balanced diet, and moderate exercise are recommended, there is no evidence that these measures cure chronic fatigue syndrome. For some people, physical and emotional stress may make the symptoms worse. The choice to begin any drug therapy that presumes to relieve symptoms depends on the patient's specific complaints, the potential for side effects, and the advice of a qualified caregiver.



Various therapies that may be used to treat chronic fatigue syndrome include behavioral modification, physical therapy, stretching exercise and nutritional supplementation. Certain over-the-counter medications can be used to treat specific symptoms such as gastrointestinal abnormalities, sleep problems, allergies and depression.

Investigational Therapies

A variety of drugs such as corticosteroids, immunoglobulins, stimulants such as methylphenidate (Ritalin) and others are being studied for the treatment of chronic fatigue syndrome. Acupuncture, yoga, massage therapy and other alternative therapies are also being studied. More research is necessary to determine the long-term safety and effectiveness of these potential therapies for individuals with chronic fatigue syndrome.



Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. Government funding, and some supported by private industry, are posted on this government web site.



For information about clinical trials being conducted at the NIH Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office:



Tollfree: (800) 411-1222

TTY: (866) 411-1010

Email: prpl@cc.nih.gov



For information about clinical trials sponsored by private sources, contact:

www.centerwatch.com

References

TEXTBOOKS

Beers MH, Berkow R., eds. The Merck Manual, 17th ed. Whitehouse Station, NJ: Merck Research Laboratories; 1999:2481-82.



Berkow R., ed. The Merck Manual-Home Edition.2nd ed. Whitehouse Station, NJ: Merck Research Laboratories; 2003:1717-18.



Larson DE. ed. Mayo Clinic Family Health Book. New York, NY: William Morrow and Company, Inc; 1996:1065.



Fauci AS, Braunwald E, Isselbacher KJ, et al. Eds. Harrison's Principles of Internal Medicine. 14th ed.McGraw-Hill Companies. New York, NY; 1998:2483.



REVIEW ARTICLES

Iwakami E, Arashima Y, Kato K, et al., Treatment of chronic fatigue syndrome with antibiotics: pilot study assessing the involvement of Coxiella burnetii infection. Intern Med. 2005;44:1258-63.



Bellanti JA, Sabra A, CastroHJ, et al. Are attention deficit hyperactivity disorder and chronic fatigue syndrome allergy related? What is fibromyalgia? Allergy Asthma Proc. 2005;26:19-28.



Rimes KA, Chalder T.Treatments for chronic fatigue syndrome. Occup Med (Lond). 2005;55:32-39.



Binder LM, Campbell KA. Medically unexplained symptoms and neurophysioligal assessment. J Clin Exp Neuropsychol. 2004;26:369-92.



Gerrity TR, Papanicolaou DA, Amsterdam JD, et al. Immunologic aspects of chronic fatigue syndrome. Report on a Research Symposium convened by the CFIDS Association of America and co-sponsored by the US Centers for Disease Control and Prevention and the National Institutes of Health. Neuroimmunomodulation. 2004;11:351-57.



Edmonds M, McGuire H, Price J. Exercise therapy for chronic fatigue syndrome. Cochrane Database Syst Rev. 2004;(3):CD003200



Luthra A, Wessely S. Unloading the trunk: neurasthenia, CFS and race. Soc Sci Med. 2004;58:2363-69.



Chaudhuri A, Behan PO. Fatigue in neurological disorders. Lancet. 2004;363:978-88.



Richardson RD, Engel CC Jr. Evaluation and management of medically unexplained physical symptoms. Neurologist. 2004;10:18-30.



Kerr JR, Tyrell DA. Cytokines in parvovirus B19 infection as an aid to understanding chronic fatigue syndrome. Current Pain Headache Rep. 2003;7:333-41.



Lyall M, Peakman M, Wessely S. A systematic review and critical evaluation of the immunology of chronic fatigue syndrome. J Psychosom Res. 2003;55:79-90.



Covelli V, Pellegrino NM, Jirillo E . A point-of-view: The need to identify an antigen in psaychoneuroimmunological disorders. Curr Pharm Des. 2003;9:1951-55.



FROM THE INTERNET

Chronic Fatigue Syndrome. National Center for Infectious Diseases. CDC. May 24, 2005. 1p.

www.cdc.gov/ncidod/diseases/cfs.htm



Chronic Fatigue Syndrome. Health Matters. National Institute of Allergy and Infectious Diseases. May 2004. 6pp.

www.niaid,nih.gov/factsheets/cfs.htm

Resources

National Chronic Fatigue Syndrome & Fibromyalgia Association

P.O. Box 18426

Kansas City, MO 64133

USA

Tel: (816)737-1343

Fax: (816)524-6782

Email: information@ncfsfa.org

Internet: http://www.ncfsfa.org



American Autoimmune Related Diseases Association, Inc.

22100 Gratiot Ave.

Eastpointe, MI 48021

Tel: (586)776-3900

Fax: (586)776-3903

Tel: (800)598-4668

Email: aarda@aarda.org

Internet: http://www.aarda.org/



Centers for Disease Control and Prevention

1600 Clifton Road NE

Atlanta, GA 30333

Tel: (404)639-3534

Tel: (800)232-4636

TDD: (888)232-6348

Email: cdcinfo@cdc.gov

Internet: http://www.cdc.gov/



NIH/National Institute of Allergy and Infectious Diseases

Office of Communications and Government Relations

6610 Rockledge Drive, MSC 6612

Bethesda, MD 20892-6612

Tel: (301)496-5717

Fax: (301)402-3573

Tel: (866)284-4107

TDD: (800)877-8339

Email: ocpostoffice@niaid.nih.gov

Internet: http://www.niaid.nih.gov/



American Academy of Allergy, Asthma and Immunology

611 East Wells Street

Milwaukee, WI 53202

Tel: (414)272-6071

Fax: (414)276-3349

Tel: (800)822-2762

Email: info@aaaai.org

Internet: http://www.aaaai.org



CFIDS Association of America

PO Box 220398

Charlotte, NC 28222-0398

USA

Tel: (704)365-2343

Fax: (704)365-9755

Tel: (800)442-3437

Email: cfids@cfids.org

Internet: http://www.cfids.org



National CFIDS Foundation, Inc.

103 Aletha Road

Needham, MA 02492-3931

Tel: (781)449-3535

Fax: (781)449-8606

Email: info@ncf-net.org

Internet: http://www.ncf-net.org



CF-Alliance

P.O. Box 9204

Bardonia, NY 10954

Tel: (914)648-9197

Fax: (845)215-0041

Email: cf_alliance@yahoo.com

Internet: http://www.cfalliance.org/



Wisconsin Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Association, Inc.

747 Lois Drive

Sun Prairie, WI 53590

USA

Tel: (608)834-1001

Email: newdawn2@compufort.com

Internet: http://www.wicfs-me.org/



New Horizons Un-Limited, Inc.

811 East Wisconsin Ave

P.O. Box 510034

Milwaukee, WI 53203

USA

Tel: (414)299-0124

Fax: (414)347-1977

Email: horizons@new-horizons.org

Internet: http://www.new-horizons.org



Genetic and Rare Diseases (GARD) Information Center

PO Box 8126

Gaithersburg, MD 20898-8126

Tel: (301)251-4925

Fax: (301)251-4911

Tel: (888)205-2311

TDD: (888)205-3223

Internet: http://rarediseases.info.nih.gov/GARD/



Autoimmune Information Network, Inc.

PO Box 4121

Brick, NJ 08723

Fax: (732)543-7285

Email: autoimmunehelp@aol.com



European Society for Immunodeficiencies

1-3 rue de Chantepoulet

Geneva, CH 1211

Switzerland

Tel: 410229080484

Fax: 41229069140

Email: esid@kenes.com

Internet: http://www.esid.org



AutoImmunity Community

Email: moderator@autoimmunitycommunity.org

Internet: http://www.autoimmunitycommunity.org



For a Complete Report

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