Chronic fatigue syndrome history and symptoms
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Signs and symptoms
As the name chronic fatigue syndrome suggests, this illness is accompanied by fatigue. However, it's not the kind of fatigue patients experience after a particularly busy day or week, after a sleepless night or after a stressful event. It's a severe, incapacitating fatigue that isn't improved by bed rest and that may be exacerbated by physical or mental activity. It's an all-encompassing fatigue that results in a dramatic decline in both activity level and stamina.
People with CFS function at a significantly lower level of activity than they were capable of prior to becoming ill. The illness results in a substantial reduction in occupational, personal, social or educational activities.
Chronic fatigue syndrome shares symptoms with many other disorders. Fatigue, for instance, is found in hundreds of illnesses, and 10% to 25% of all patients who visit general practitioners complain of prolonged fatigue. The nature of the symptoms, however, can help clinicians differentiate CFS from other illnesses.
A CFS diagnosis should be considered in patients who present with six months or more of unexplained fatigue accompanied by other characteristic symptoms. These symptoms include:
- cognitive dysfunction, including impaired memory or concentration
- postexertional malaise lasting more than 24 hours (exhaustion and increased symptoms) following physical or mental exercise
- unrefreshing sleep
- joint pain (without redness or swelling)
- persistent muscle pain
- headaches of a new type or severity
- tender cervical or axillary lymph nodes
- sore throat
Other Common Symptoms
In addition to the eight primary defining symptoms of CFS, a number of other symptoms have been reported by some CFS patients. The frequency of occurrence of these symptoms varies among patients. These symptoms include:
- irritable bowel, abdominal pain, nausea, diarrhea or bloating
- chills and night sweats
- brain fog
- chest pain
- shortness of breath
- chronic cough
- visual disturbances (blurring, sensitivity to light, eye pain or dry eyes)
- allergies or sensitivities to foods, alcohol, odors, chemicals, medications or noise
- difficulty maintaining upright position (orthostatic instability, irregular heartbeat, dizziness, balance problems or fainting)
- psychological problems (depression, irritability, mood swings, anxiety, panic attacks)
- jaw pain
- weight loss or gain
Clinicians will need to consider whether such symptoms relate to a comorbid or an exclusionary condition; they should not be considered as part of CFS other than they can contribute to impaired functioning.
Institute of Medicine criteria
The Institute of Medicine has recommended the new name, "Systemic Exertion Intolerance Disease", with criteria[1].: The following 3 symptoms:
- "A substantial reduction or impairment in the ability to engage in preillness levels of occupational, educational, social, or personal activities that persists for more than 6 months and is accompanied by fatigue, which is often profound, is of new or definite onset (not lifelong), is not the result of ongoing excessive exertion, and is not substantially alleviated by rest"
- Postexertional malaise (at least 50% of time)
- Unrefreshing sleep (at least 50% of time)
At least 1 of the 2 following:
- Cognitive impairment (at least 50% of time)
- Orthostatic intolerance
Onset
Sudden onset cases
The majority of CFS cases start suddenly,[2] usually accompanied by a "flu-like illness"[3][4][5] which is more likely to occur in winter,[6][7] while a significant proportion of cases begin within several months of severe adverse stress.[8][9][2] Many people report getting a case of a flu-like or other respiratory infection such as bronchitis, from which they seem never to fully recover and which evolves into CFS. The diagnosis of Post-viral fatigue syndrome is sometimes given in the early stage of the illness.[10] One study reported CFS occurred in some patients following a vaccination or a blood transfusion.[11] The accurate prevalence and exact roles of infection and stress in the development of CFS however are currently unknown.
Gradual onset cases
Other cases have a gradual onset, sometimes spread over years.[11] Patients with Lyme disease may, despite a standard course of treatment, "evolve" clinically from the symptoms of acute Lyme to those similar to CFS.[12] This has become an area of great controversy.
Activity levels
Patients report critical reductions in levels of physical activity[13] and are as impaired as persons whose fatigue can be explained by another medical or a psychiatric condition.[14] According to the CDC, studies show that the disability in CFS patients is comparable to some well-known, very severe medical conditions, such as; multiple sclerosis, AIDS, lupus, rheumatoid arthritis, heart disease, end-stage renal disease, chronic obstructive pulmonary disease (COPD) and similar chronic conditions.[15][16] The severity of symptoms and disability is the same in both genders,[17] and chronic pain is strongly disabling in CFS patients, but despite a common diagnosis the functional capacity of CFS patients varies greatly.[18] While some patients are able to lead a relatively normal life, others are totally bed-bound and unable to care for themselves. A systematic review found that in a synthesis of studies, 42% of patients were employed, 54% were unemployed, 64% reported CFS-related work limitations, 55% were on disability benefits or temporary sick leave, and 19% worked full-time.[19]
References
- ↑ Clayton EW (2015). "Beyond myalgic encephalomyelitis/chronic fatigue syndrome: an IOM report on redefining an illness". JAMA. 313 (11): 1101–2. doi:10.1001/jama.2015.1346. PMID 25668027.
- ↑ 2.0 2.1 Salit IE (1997). "Precipitating factors for the chronic fatigue syndrome". J Psychiatr Res. 31 (1): 59–65. doi:10.1016/S0022-3956(96)00050-7. PMID 9201648.
- ↑ Sairenji T, Nagata K (2007). "Viral infections in chronic fatigue syndrome". Nippon Rinsho. 65 (6): 991–6. PMID 17561687.
- ↑ Evengård B, Jonzon E, Sandberg A, Theorell T, Lindh G (2003). "Differences between patients with chronic fatigue syndrome and with chronic fatigue at an infectious disease clinic in Stockholm, Sweden". Psychiatry Clin Neurosci. 57 (4): 361–8. doi:10.1046/j.1440-1819.2003.01132.x. PMID 12839515.
- ↑ Evengård B, Schacterle RS, Komaroff AL (1999). "Chronic fatigue syndrome: new insights and old ignorance". J Intern Med. 246 (5): 455–69. doi:10.1046/j.1365-2796.1999.00513.x. PMID 10583715.
- ↑ Jason LA, Taylor RR, Carrico AW (2001). "A community-based study of seasonal variation in the onset of chronic fatigue syndrome and idiopathic chronic fatigue". Chronobiol Int. 18 (2): 315–9. doi:10.1081/CBI-100103194. PMID 11379670.
- ↑ Zhang QW, Natelson BH, Ottenweller JE, Servatius RJ, Nelson JJ, De Luca J, Tiersky L, Lange G (2000). "Chronic fatigue syndrome beginning suddenly occurs seasonally over the year". Chronobiol Int. 17 (1): 95–9. doi:10.1081/CBI-100101035. PMID 10672437.
- ↑ Hatcher S, House A (2003). "Life events, difficulties and dilemmas in the onset of chronic fatigue syndrome: a case-control study". Psychol Med. 33 (7): 1185–92. doi:10.1017/S0033291703008274. PMID 14580073. Text "url: http://eprints.whiterose.ac.uk/1226/1/house3.pdf" ignored (help)
- ↑ Theorell T, Blomkvist V, Lindh G, Evengard B. "Critical life events, infections, and symptoms during the year preceding chronic fatigue syndrome (CFS): an examination of CFS patients and subjects with a nonspecific life crisis". Psychosom Med. 61 (3): 304–10. PMID 10367610.
- ↑ Hickie I, Davenport T, Wakefield D; et al. (2006). "Post-infective and chronic fatigue syndromes precipitated by viral and non-viral pathogens: prospective cohort study". BMJ. 333 (7568): 575. doi:10.1136/bmj.38933.585764.AE. PMID 16950834.
- ↑ 11.0 11.1 De Becker P, McGregor N, De Meirleir K (2002). "Possible Triggers and Mode of Onset of Chronic Fatigue Syndrome". Journal of Chronic Fatigue Syndrome. 10 (2): 2–18. doi:10.1300/J092v10n02_02.
- ↑ Donta S (2002). "Late and chronic Lyme disease". Med Clin North Am. 86 (2): 341–9, vii. doi:10.1016/S0025-7125(03)00090-7. PMID 11982305.
- ↑ McCully KK, Sisto SA, Natelson BH (1996). "Use of exercise for treatment of chronic fatigue syndrome". Sports Med. 21 (1): 35–48. doi:10.2165/00007256-199621010-00004. PMID 8771284.
- ↑ Solomon L, Nisenbaum R, Reyes M, Papanicolaou DA, Reeves WC (2003). "Functional status of persons with chronic fatigue syndrome in the Wichita, Kansas, population". Health Qual Life Outcomes. 1 (1): 48. doi:10.1186/1477-7525-1-48. PMID 14577835. PMC 239865
- ↑ Press Conference: The Chronic Fatigue and Immune Dysfunction Syndrome Association of America and The Centers For Disease Control and Prevention Press Conference at The National Press Club to Launch a Chronic Fatigue Syndrome Awareness Campaign - November 3 2006
- ↑ The Centers For Disease Control and Prevention (website): Chronic Fatigue Syndrome > For Healthcare Professionals > Symptoms > Clinical Course
- ↑ Ho-Yen DO, McNamara I (1991). "General practitioners' experience of the chronic fatigue syndrome". Br J Gen Pract. 41 (349): 324–6. PMID 1777276.
- ↑ Vanness JM, Snell CR, Strayer DR, Dempsey L 4th, Stevens SR (2003). "Subclassifying chronic fatigue syndrome through exercise testing". Med Sci Sports Exerc. 35 (6): 908–13. doi:10.1249/01.MSS.0000069510.58763.E8. PMID 12783037.
- ↑ Ross SD, Estok RP, Frame D, Stone LR, Ludensky V, Levine CB (2004). "Disability and chronic fatigue syndrome: a focus on function". Arch Intern Med. 164 (10): 1098–107. doi:10.1001/archinte.164.10.1098. PMID 15159267.