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Chronic Fatigue SyndromeAka: Chronic Fatigue Immune Deficiency Syndrome

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  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

Chronic Fatigue Syndrome (C0015674)

Definition (MSH)A syndrome characterized by persistent or recurrent fatigue, diffuse musculoskeletal pain, sleep disturbances, and subjective cognitive impairment of 6 months duration or longer. Symptoms are not caused by ongoing exertion; are not relieved by rest; and result in a substantial reduction of previous levels of occupational, educational, social, or personal activities. Minor alterations of immune, neuroendocrine, and autonomic function may be associated with this syndrome. There is also considerable overlap between this condition and FIBROMYALGIA. (From Semin Neurol 1998;18(2):237-42; Ann Intern Med 1994 Dec 15;121(12): 953-9)
Definition (CSP)distinctive syndrome characterized by chronic fatigue, mild fever, lymphadenopathy, headache, myalgia, arthralgia, depression, and memory loss; candidate etiologic agents include Epstein-Barr and other herpesviruses.
Definition (NCI)A syndrome of unknown etiology. Chronic fatigue syndrome (CFS) is a clinical diagnosis characterized by an unexplained persistent or relapsing chronic fatigue that is of at least six months' duration, is not the result of ongoing exertion, is not substantially alleviated by rest, and results in substantial reduction of previous levels of occupational, educational, social, or personal activities. Common concurrent symptoms of at least six months duration include impairment of memory or concentration, diffuse pain, sore throat, tender lymph nodes, headaches of a new type, pattern, or severity, and nonrestorative sleep. The etiology of CFS may be viral or immunologic. Neurasthenia and fibromyalgia may represent related disorders. Also known as myalgic encephalomyelitis.
ConceptsDisease or Syndrome (T047)
ICD9780.71
MSHD015673
EnglishAkureyri disease, Benign myalgic encephalomyelitis, CFIDS, CFS, CFS - Chronic fatigue syndrome, Chronic Fatigue and Immune Dysfunction Syndrome, CHRONIC FATIGUE DIS, Chronic Fatigue Disorder, Chronic Fatigue Disorders, Chronic Fatigue Fibromyalgia Syndrome, Chronic Fatigue Syndrome, Chronic Fatigue Syndromes, Chronic Fatigue-Fibromyalgia Syndrome, Chronic Fatigue-Fibromyalgia Syndromes, ENCEPH MYALGIC, Epidemic neuromyasthenia, Iceland disease, INFECT MONONUCLEOSIS LIKE SYNDROME CHRONIC, ME - Myalgic encephalomyelitis, MYALGIC ENCEPH, Myalgic encephalitis, Myalgic encephalomyelitis, Myalgic encephalomyelitis syndrome, Postviral Fatigue Syndrome, Postviral Fatigue Syndromes, PVFS - Postviral fatigue syndrome, ROYAL FREE DIS, Royal Free Disease, YUPPIE FLU
Spanishencefalomielitis mialgica benigna, enfermedad de Akureyri, enfermedad de Islandia, neuromiastenia epidemica, sindrome de agotamiento cronico, sindrome de fatiga cronica, sindrome de fatiga postviral, sindrome de fatiga posviral
Parent ConceptsVirus Diseases (C0042769), Syndrome (C0039082), [D]Malaise and fatigue NOS (C0024528), Encephalomyelitis (C0014070), Myopathy (C0026848), Neuromuscular Diseases (C0027868), Immunologic Deficiency Syndromes (C0021051), Mental disorders (C0004936), Chronic Fatigue Syndrome (C0015674), Multisystem disorder (C0559758), Post-viral disorder (C1264605), Duplicate concept (C1274013)
SourcesAOD, COSTAR, CSP, DXP, ICD9CM, MEDLINEPLUS, MSH, MTH, NCI, NDFRT, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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