Chronic fatigue syndrome
Signs and symptoms
Chronic fatigue syndrome is a flu-like condition that can drain your energy and, sometimes, last for years. People previously healthy and full of energy may experience a variety of signs and symptoms.
People with chronic fatigue syndrome exhibit signs and symptoms similar to those of most common viral infections. Unlike flu (influenza) symptoms, which usually subside in a few days or weeks, the signs and symptoms of CFS can last much longer. They may come and go frequently with no identifiable pattern.
Primary signs and symptoms
In addition to persistent fatigue, not caused by other known medical conditions, chronic fatigue syndrome has eight
possible primary signs and symptoms. Chronic fatigue syndrome symptoms include:
Painful and mildly enlarged lymph nodes in your neck or armpits
Pain that moves from one joint to another without swelling or redness
Headache of a new type, pattern or severity
Extreme exhaustion lasting more than 24 hours after physical or mental exercise
According to the International Chronic Fatigue Syndrome Study Group — a group of scientists, researchers and doctors
brought together by the Centers for Disease Control and Prevention (CDC) to determine a standard method for defining
and diagnosing chronic fatigue syndrome — a person meets the diagnostic criteria of chronic fatigue syndrome when
unexplained persistent fatigue occurs for six months or more
along with at least four of the eight
primary signs and
Additional signs and symptoms
In addition, people with chronic fatigue syndrome have reported other various signs and symptoms that aren't part of the
official definition. These include:
Allergies or sensitivities to foods, alcohol, odors, chemicals, medications or noise
Psychological problems, such as depression, irritability, anxiety disorders and panic attacks
Visual disturbances, such as blurring, sensitivity to light, eye pain and dry eyes
Of all chronic illnesses, chronic fatigue syndrome is one of the most mysterious. Unlike definite infections, it has no clear cause. Several possible causes have been proposed, including:
Virus infection, such as Epstein-Barr virus or human herpesvirus 6
Changes in the levels of hormones produced in the hypothalamus, pituitary glands or adrenal glands
Mild, chronic low blood pressure (hypotension)
The cause of chronic fatigue syndrome may be an inflammation of the pathways of the nervous system as a response to an autoimmune process, but with nothing measurable in the blood as in other autoimmune diseases, such as rheumatoid arthritis and lupus. Chronic fatigue syndrome may also occur when a viral illness is complicated by a dysfunctional immune system. Some people with CFS may have a low blood pressure disorder that triggers the fainting reflex.
In many cases, however, no serious underlying infection or disease is proved to specifically cause chronic fatigue syndrome. Lack of medical knowledge and understanding of CFS has made determining and describing the characteristics of the condition difficult.
Women are diagnosed with chronic fatigue syndrome two to four times as often as men, but sex isn't a proven risk factor for this condition. It may be that women are simply more likely than men are to report their symptoms to their doctor.
The condition is most common in people in their 40s and 50s, but it can affect people of all ages.
Because the cause of the condition is unknown, doctors have yet to determine and confirm definite risk factors for the disease.
Screening and diagnosis
A diagnosis of chronic fatigue syndrome is based on exclusion. This means that before arriving at a diagnosis, a doctor has ruled out any other disease or condition that may be causing your fatigue and related symptoms.
In general, doctors find it difficult to diagnose chronic fatigue syndrome because it has some of the same signs and symptoms as many other diseases. There's no diagnostic or laboratory procedure to confirm the presence of chronic fatigue syndrome.
Doctors exclude certain conditions before considering a diagnosis of chronic fatigue syndrome. These include:
Having an active, identifiable medical condition that often results in fatigue, such as low levels of thyroid
hormones (hypothyroidism) or sleep apnea
Having a relapse of a previously treated illness that can result in fatigue, such as cancer
Having had a past or current diagnosis of a major depressive disorder or other psychiatric illness, such as
Being severely obese, as defined by a body mass index (BMI) of 45 or greater
Over time, be alert to any new cues that might indicate that the problem is caused by something other than chronic fatigue syndrome. When other diseases or conditions are excluded, your doctor may then determine if your illness meets the CFS-specific criteria.
Possible complications of chronic fatigue syndrome include:
Depression, related both to symptoms and lack of diagnosis
Side effects and adverse reactions related to medication treatments
Side effects and adverse reactions associated with lack of activity (deconditioning)
Learning how to manage fatigue can help you improve your level of functioning and your quality of life despite your symptoms. You may work with a rehabilitation medicine specialist who can teach you how to plan activities to take advantage of times when you usually feel better.
These important self-care steps can help you to maintain good general health:
Develop a plan to avoid or limit overexertion and emotional stress. Allow yourself time each
day to relax. That may mean learning how to say no without guilt. If possible, don't change your routine totally. People who quit work or drop all activity tend to do worse than those who remain active.
Get enough sleep.
Getting sufficient sleep is essential. In addition to allotting enough time for sleep, practice
good sleep habits, such as going to bed and getting up at the same time each day and limiting daytime napping.
You may need to start slow and build up gradually. But exercising regularly often
improves symptoms. Many people find exercises such as walking, swimming, biking and water aerobics to be helpful. A physical therapist may help you develop a home-exercise program. Stretching, good posture and relaxation exercises also can be helpful.
Keep your activity on an even level. If you do too much on your good days, you may have
Maintain a healthy lifestyle.
Try to eat a balanced diet, drink plenty of fluids, limit your caffeine intake, stop
smoking, get adequate rest and exercise regularly. Find a hobby or career that's enjoyable and fulfilling for you.
Study collaboration Kenneth Berge, M.D. and Samorindo Peci M.D.
Many studies have evaluated a wide variety of natural products for effectiveness against chronic fatigue syndrome. Most results have been disappointing. A few remedies — intramuscular magnesium for people with low red blood cell magnesium, a combination of fish oil and evening primrose oil, melatonin, NADH, propionyl-L-carnitine, and ribose — have shown encouraging results in preliminary studies. However, many of these promising early results failed to be confirmed by subsequent studies or the original studies were too small to be conclusive. At this time, there is insufficient evidence of benefit to recommend any specific dietary or herbal supplements as a treatment for chronic fatigue.
BIOGRAPHICAL SKETCH Diane E. Taylor Professor Emeritus, Department of Medical Microbiology & Immunology, University of Alberta EDUCATION/TRAINING (Begin with baccalaureate or other initial professional education, such as nursing, and include postdoctoral training.) Positions and Employment 1977 - 1981 Senior Research Associate (MRC Scholar), Hospital for Sick Children, Toronto
T h e n e w e ng l a n d j o u r na l o f m e dic i n e Current Concepts Henry M. Feder, Jr., M.D., Barbara J.B. Johnson, Ph.D., Susan O’Connell, M.D., Eugene D. Shapiro, M.D., Allen C. Steere, M.D., Gary P. Wormser, M.D., and the Ad Hoc International Lyme Disease Group*From the Departments of Family Medi-cine and Pediatrics, Connecticut Chil-L B. bur yme disease, the most common ti