chronic fatigue syndrome
ABBR: CFS
A syndrome marked by incapacitating fatigue that rest does not relieve, and decreased physical, cognitive, and social function. It affects men and women of all ages and races. It is frequently associated with decreased concentration, irritability, sleep disturbances, recurrent sore throats, low-grade temperatures, swollen gland s, and bone or muscle aches. In the past, this condition was inaccurately called chronic Epstein-Barr virus infection, xenotropic murine leukemia-related virus infection, myalgic encephalomyelitis, “yuppie flu,” and chronic fatigue immunodeficiency syndrome (CFIDS).
Incidence: Approx. 17 million people worldwide have been diagnosed with CFS.
Causes: The cause of CFS is unknown. According to the Centers for Disease Control and Prevention (CDC), CFS may have many precipitating causes, all of which produce a common end point. These causes may include viral infection or disruptions in neurological, endocrine, or immune system function.
Symptoms and Signs:
SEE: table - Criteria for Diagnosing CFS.
Diagnosis: No definitive test exists for this disorder. Diagnostic studies should include tests to rule out other similar clinical illnesses.
Treatment: Because there is no known cause, treatment focuses on supportive care. Nonsteroidal anti-inflammatory drugs (NSAIDs) may be useful for myalgia or arthralgias. Low doses of tricyclic and some other antidepressants sometimes enhance control of pain and also may be useful for patients having trouble sleeping. Complex immunological or metabolic therapies have not proved consistently effective. Cognitive behavioral therapies have been helpful in some patients.
Prognosis: Studies suggest that approximately 50% of patients recover although not all symptoms disappear.
Patient Care: Activity level and degree of fatigue during activities of daily living are assessed. The patient's emotional response to the illness and coping abilities are evaluated. Emotional support is provided through the long period of diagnostic testing and the protracted, sometimes discouraging course of the illness. Patients are referred for mental health or career counseling as needed and to the CFS Association and /or or a local support group if available, to help them lead as normal a life as possible. Activities should be reduced when fatigue is greatest, but bedrest other than that required for sleep should be avoided because it does not relieve disability. The patient should participate in a graded exercise program, which may be difficult to initiate and maintain but may help him or her feel better. Exercise should be carried out for short periods and slowly increased, to avoid increasing fatigue.