II. Epidemiology
- Incidence: 37 cases per 100,000 (difficult to assess)
- Outbreaks have been known to occur for centuries
- Los Angeles County Hospital (1934)
- Akureyri, Iceland (1948)
- Royal Free Hospital, London (1955)
- Punta Gorda, Florida (1945)
- Incline Village, Nevada (1985)
III. Etiology
- Idiopathic, likely multifactorial
- Genetic predisposition in some patients
- Childhood Trauma increases chronic Fatigue risk 6 fold
- Various viruses have been implicated (with possible chronic immune activation)
- Epstein Barr Virus (Mononucleosis)
- EBV titers no higher than in healthy controls
- Linde (1992) J Infect Dis 165:994-1000 [PubMed]
- Mycoplasma pneumoniae
- Coxsackie virus
- Human Herpes Virus 6
- Cytomegalovirus
- Measles
- HTLV-II
- Epstein Barr Virus (Mononucleosis)
IV. Pathophysiology
- T-Cell Activation
-
Cytokine release
- Related to alpha-intrusion sleep disorder
V. Symptoms
- See Fatigue
VI. Diagnosis
VII. Differential Diagnosis
- See Fatigue Causes
- See Fatigue Red Flags
VIII. Labs (base on other likely possible Fatigue Causes)
IX. Course
- Most patients partially recover within 2 years
- All Chronic Fatigue patients are prone to relapse
X. Management: Nonpharmacologic
XI. Management: Pharmacologic
- Symptomatic therapy
- Insomnia Management
- Major Depression Management
- Pain Management
- NSAIDS
- Selective Serotonin Reuptake Inhibitors (SSRI)
- Duloxetine (Cymbalta)
- Tricyclic Antidepressants
- Elavil 10-25 mg PO qhs and increase as tolerated
- Avoid empiric therapies which are not yet supported by good evidence
- Nicotinamide-adenine dinucleotide (NADH)
- Hydrocortisone 5-10 mg PO qd
XII. Resources
- CDC: Chronic Fatigue Syndrome
XIII. References
- Gantz in Noble (2001) Primary Care Medicine, p. 1325
- Craig (2002) Am Fam Physician 65(6):1083-95 [PubMed]
- Morrison (2001) Obstet Gynecol Clin North Am 28:225-40 [PubMed]
- Yancey (2012) Am Fam Physician 86(8): 741-6 [PubMed]