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.
Onset
Sudden onset cases
The majority of CFS cases start suddenly,[1] usually accompanied by a "flu-like illness"[2][3][4] which is more likely to occur in winter,[5][6] while a significant proportion of cases begin within several months of severe adverse stress.[7][8][1] 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.[9] One study reported CFS occurred in some patients following a vaccination or a blood transfusion.[10] 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.[10] Patients with Lyme disease may, despite a standard course of treatment, "evolve" clinically from the symptoms of acute Lyme to those similar to CFS.[11] This has become an area of great controversy.
Activity levels
Patients report critical reductions in levels of physical activity[12] and are as impaired as persons whose fatigue can be explained by another medical or a psychiatric condition.[13] 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.[14][15] The severity of symptoms and disability is the same in both genders,[16] and chronic pain is strongly disabling in CFS patients, but despite a common diagnosis the functional capacity of CFS patients varies greatly.[17] 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.[18]
References
- ↑ 1.0 1.1 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.
- ↑ 10.0 10.1 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.