Chronic Fatigue Syndrome; Overview

Chronic Fatigue Syndrome; Overview

Chronic fatigue syndrome (CFS) is an illness characterized by prolonged, debilitating fatigue that is severe enough to affect one or more aspects of a person’s life (work, home, school or social) and multiple nonspecific symptoms such as headaches, recurrent sore throats, muscle and joint pains, memory and concentration difficulties. Profound fatigue, the hallmark of the disorder, can come on suddenly or gradually and persists or recurs throughout the period of illness. Unlike the short-term disability of say, the flu, CFS symptoms linger for at least six months and often for years. The cause of CFS remains unknown.

CFS affects women three to four times more often than men, and appears to be most prevalent in women between the ages of 40-49. CFS can affect any sex, race or socioeconomic class. It has also been reported in children and adolescents, although cases in children under 12 are atypical.

The U.S. Centers for Disease Control and Prevention (CDC) conducted a study from 1989 to 1993 to estimate the prevalence of CFS; they estimated that four to 8.7 of every 100,000 adults living in the U.S. suffered from CFS. However, more recent studies indicate that these projections are underestimated. The prevalence of CFS is difficult to measure because the illness can be difficult to diagnose, but in general, it is estimated that 900,000 persons in the U.S. have a CFS-like condition, according to the CDC Studies at DePaul University in Chicago, place the estimates even higher.

CFS does not appear to be a new illness, although it has only recently been assigned the name CFS. Relatively small outbreaks of similar disorders have been described in medical literature since the 1930s. Furthermore, case reports of comparable illnesses date back several centuries.

Interest in what now is called CFS was renewed in the mid-1980s after several studies found slightly higher levels of antibody to Epstein-Barr virus (EBV) in patients with CFS-like symptoms than in healthy individuals. Most of these patients had experienced an episode of infectious mononucleosis (sometimes called mono or the “kissing disease”) a few years before they began to experience the chronic, incapacitating symptoms of CFS. As a result, for a time the CFS-like illness became popularly termed “chronic EBV”.

Further investigation revealed that elevated EBV antibodies were not indicators of CFS. Some healthy people have high EBV antibodies and some people with CFS do not. Currently, it is not considered useful to test for antibodies to EBV in a patient with symptoms suggestive of CFS.

The illness was named chronic fatigue syndrome because it reflects the most common symptom-long-term, persistent fatigue. When the International CFS Study Group updated the definition of CFS in 1994, it decided to keep this name until a specific cause for the illness is discovered. Today, CFS also is known as myalgic encephalomyelitis (ME), postviral fatigue syndrome, and chronic fatigue and immune dysfunction syndrome (CFIDS). It is important to note, however, that the word “fatigue” is extremely misleading-it is but one symptom among many that make up this illness and does not reflect the significance of other disabling symptoms. The word also adds to generalized misunderstanding and trivialization of the illness.

There are no published data to indicate that CFS is contagious, that it can be transmitted through intimate or casual contact or by blood transfusion, or that people with CFS need to be isolated in any way.

CFS often begins abruptly, but sometimes the onset is gradual. In about one-third of cases, the sudden onset follows a respiratory, gastrointestinal or other acute infection with flu-like symptoms, including mononucleosis. Other cases develop after emotional or physical traumas such as serious accidents, bereavement or surgery.

The current diagnostic criteria for CFS specifies debilitating fatigue of at least six months, which is unalleviated by rest and is made worse by physical or mental exertion that was previously well-tolerated, and four of eight of the following symptoms:

* unrefreshing sleep

* reduced short-term memory or concentration

* post-exertional malaise

* joint pain without joint swelling or redness

* muscle discomfort or pain

* headaches of a new type or severity

* recurrent sore throat

* tender lymph nodes

Multiple subjective symptoms are also reported, and although these are not included in the current diagnostic criteria, they are reported with relative frequency and include, but are not limited to, irritable bowel syndrome and other gastrointestinal complaints, allergy-like symptoms, skin rashes, visual disturbances, dizziness, numbness and tingling in extremities, sensitivities to various chemicals, dry eyes, chills, night sweats, alcohol and medication intolerances.

The severity of CFS symptoms varies broadly among individuals.

Some CFS patients also report mild to moderate symptoms of anxiety or depression. However, it is important to note that studies have shown that 50 percent or more of carefully evaluated CFS patients do not have depression or another psychiatric illness. Depression may be a secondary effect of CFS, not necessarily a primary condition, as people attempt to cope with the changes in lifestyle that living with a chronic illness dictates. Whether anxiety or depression occur before or during the illness is not the significant factor; getting help for these distressing conditions is what is essential.

Some studies have found that allergies are significantly more common in CFS patients than in the general population. Many CFS patients have a history of allergies years before the onset of the syndrome. Sometimes patients report a worsening of allergic symptoms or the onset of new allergies after becoming ill with CFS. Because allergies are so common in people with CFS, it is important to identify symptoms caused by allergies so they can be treated independently.

Although CFS can persist for many years, long-term studies indicate that CFS generally is not a progressive illness. Symptoms are usually most severe in the first year or two. Thereafter, the symptoms typically stabilize and then can persist chronically, wax and wane, or improve. For a subset of people with CFS, symptoms worsen over time. It appears that the majority of people with CFS partially recover, only a few fully recover and others recover and relapse. Currently, an individual’s course of illness cannot be predicted. Although there has been very little study of the course of illness over time, the CDC states that if CFS has been present for a period of five years, it is statistically unlikely that the person will recover. No long-term health risks have been associated with having CFS and current evidence suggests that CFS is not a fatal illness.

“Chronic Fatigue Syndrome.” Fact Sheet. National Institute of Allergy and Infectious Diseases. National Institutes of Health. http://www.niaid.nih.gov. Accessed Oct. 2001.

“Chronic Fatigue Syndrome.” Centers for Disease Control and Prevention. National Center for Infectious Diseases. http://www.cdc.gov. Accessed Oct. 2001.

“Introduction to CFIDS and CFS” and “Medical Issues.” The CFIDS Association of America, Inc. http://www.cfids.org. Accessed Oct. 2001.

Natelson, Benjamin, H., Facing and Fighting Fatigue, (Yale University Press, 1998)

Editorial Staff of the National Women’s Health Resource Center 2002/07/31 2005/03/16 All of us have experienced fatigue at one time or another. If you have experienced lingering fatigue that is accompanied by various unexplained symptoms you may be suffering from chronic fatigue syndrome (CFS), an illness characterized by prolonged, debilitating fatigue and multiple nonspecific symptoms such as headaches, recurrent sore throats, muscle and joint pains, and cognitive complaints. Antidepressants,cfs,Chronic fatigue syndrome,EBV,Epstein-Barr virus,Fibromyalgia,Mononucleosis,Post-exertional malaise

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