Chronic fatigue syndrome (CFS) is characterized by debilitating fatigue and several associated physical, constitutional, and neuropsychological complaints. The majority of pts (~75%) are women, generally 30-45 years old. The CDC has developed diagnostic criteria for CFS based upon symptoms and the exclusion of other illnesses (Table 29-2). The cause is uncertain, although clinical manifestations often follow an infectious illness (Q fever, Lyme disease, mononucleosis, or another viral illness). Many studies have attempted, without success, to link CFS to specific infectious agents such as EBV, a retrovirus (including a murine leukemia virus-related retrovirus), or an enterovirus, and many others. CFS might be caused by more than one infectious agent or by postinfectious immune responses. Physical or psychological stress is also often identified as a precipitating factor. Depression is present in half to two-thirds of pts, and some experts believe that CFS is fundamentally a psychiatric disorder.

CFS remains a diagnosis of exclusion, and no laboratory test can establish the diagnosis or measure its severity. CFS does not appear to progress but typically has a protracted course. The median annual recovery rate is 5% (range, 0-31%) with an improvement rate of 39% (range, 8-63%).

The management of CFS commences with acknowledgement by the physician that the pt's daily functioning is impaired. The pt should be informed of the current understanding of CFS (or lack thereof) and be offered general advice about disease management. NSAIDs alleviate headache, diffuse pain, and feverishness. Regular and adequate sleep is important. Antihistamines or decongestants may be helpful for symptoms of rhinitis and sinusitis. Although the pt may be averse to psychiatric diagnoses, features of depression and anxiety may justify treatment. Nonsedating antidepressants may improve mood and disordered sleep and may attenuate the fatigue. Cognitive behavioral therapy (CBT) and graded exercise therapy (GET) have been found to be effective treatment strategies in some pts.