Rheumatology Book

http://www.fpnotebook.com/

Chronic Fatigue SyndromeAka: Chronic Fatigue Immune Deficiency Syndrome

Advertisement

  1. See Also
    1. Fatigue
  2. Epidemiology
    1. Incidence: 37 cases per 100,000 (difficult to assess)
      1. Fatigue is common complaint (20% of all patients)
      2. Higher Incidence may be in age 20-50 year old women
      3. Case reports include children as young as age 5 years
    2. Outbreaks have been known to occur for centuries
      1. Los Angeles County Hospital (1934)
      2. Akureyri, Iceland (1948)
      3. Royal Free Hospital, London (1955)
      4. Punta Gorda, Florida (1945)
      5. Incline Village, Nevada (1985)
  3. Etiology
    1. Unknown
    2. Thought to be chronic immune activation
      1. May be initiated by related conditions below
    3. Related conditions
      1. Epstein Barr Virus (Mononucleosis)
        1. EBV titers no higher than in healthy controls
        2. Linde (1992) J Infect Dis 165:994
      2. Mycoplasma pneumoniae
      3. Coxsackie virus
      4. Human Herpes Virus 6
      5. Cytomegalovirus
      6. Measles
      7. HTLV-II
  4. Pathophysiology
    1. T-Cell Activation
    2. Cytokine release
      1. Related to alpha-intrusion sleep disorder
  5. Symptoms
    1. See Fatigue
  6. Diagnosis
    1. See Chronic Fatigue Diagnosis
  7. Differential Diagnosis
    1. See Fatigue Causes
  8. Labs (base on other likely possible Fatigue Causes)
    1. See Fatigue Diagnostic Testing
  9. Course
    1. Most patients partially recover within 2 years
    2. All Chronic Fatigue patients are prone to relapse
  10. Management: Nonpharmacologic
    1. Understanding physician
      1. Listen
      2. Counsel
      3. Empathy
    2. Cognitive behavior therapy
      1. Identify unhealthy coping mechanisms
    3. Consider support group
    4. Avoid caffeine
    5. Avoid alcohol
    6. Graded Aerobic Exercise
      1. Duration: 30 minutes per session
      2. Repeat five Exercise sessions per week
    7. References
      1. Fulcher (1997) BMJ 314:1647
  11. Management: Pharmacologic
    1. Empiric therapies which may be beneficial
      1. Nicotinamide-adenine dinucleotide (NADH)
      2. Hydrocortisone 5-10 mg PO qd
    2. Pain Management
      1. NSAIDS
      2. Selective Serotonin Reuptake Inhibitors (SSRI)
      3. Tricyclic Antidepressants
        1. Elavil 10-25 mg PO qhs and increase as tolerated
  12. Resources
    1. Chronic Fatigue Syndrome and Immune Deficiency Syndrome
      1. (800) 442-3437
      2. http://www.ybi.com/cfids/tcaa.html
  13. References
    1. Gantz in Noble (2001) Primary Care Medicine, p. 1325
    2. Craig (2002) Am Fam Physician 65(6):1083
    3. Morrison (2001) Obstet Gynecol Clin North Am 28:225

Navigation Tree