II. Background
- As of 2015, Chronic Fatigue Syndrome is a clinical diagnosis (not a diagnosis of exclusion)
III. Diagnosis: National Academy of Medicine Criteria (2015)
- Major Criteria: Moderate to Severe symptoms >6 months and present >50% of the time (all required)
- Postexertional malaise (crash)
- Prolonged worsening of symptoms with even a small increase in previously tolerated activity
- Distinguishes from other conditions associated with Fatigue
- Profound Fatigue of new onset
- Substantially decreased ability to engage in pre-illness levels of activity and function
- Non-restorative or unrefreshing sleep
- Postexertional malaise (crash)
- Minor Criteria (at least one of the following)
- Cognitive Impairment (e.g. brain fog)
- May affect Driving, Reading, Conversation, Multitasking and Work oir school success
- Orthostatic symptoms with prolonged standing
- Symptoms with prolonged standing (e.g. Light Headedness, Nausea, Fatigue, Palpitations, Syncope)
- Cognitive Impairment (e.g. brain fog)
- Associated Symptoms (not required)
- Gastrointestinal or genitourinary symptoms
- Hypersensitivity to external stimuli (e.g. light, noise, chemicals, foods)
- Increased susceptibility to infection or decreased immune function
- Influenza-like symptoms (e.g. Pharyngitis, Lymphadenopathy, chills, fever)
- Onset after infectious illness (e.g. COVID-19, Mononucleosis)
- Respiratory symptoms (e.g. sense of Air Hunger)
- Thermoregulatory dysfunction
- Visual disturbance
- Widespread pain
- References
IV. Diagnosis: Old Criteria - modification history
- Earlier CDC 1994 guidelines
- Required severe Fatigue for 6 months (non-restorative sleep was a minor criteria)
- Also required 4 of 8 minor criteria (e.g. Headache, Arthralgias, myalgias, postexertional Fatigue, Pharyngitis, adenopathy)
- Earlier CDC 1988 guidelines required 6 minor criteria
- Included those listed above
- Other criteria present in prior guidelines
- Initial symptom onset acute or subacute
- Mild fever (37.5 - 38.6 Celsius) or chills
- Generalized Muscle Weakness
- Neuropsychiatric Symptoms
- Photophobia
- Transient visual scotomata
- Excessive irritability
- Confusion
- Difficult thinking
- Inability to concentrate
- Major Depression
- Earlier CDC 1988 guidelines required physical sign documentation
- Prior guidelines (not required by CDC)
- Two or more signs must be documented
- Physician must document each sign twice
- Signs must be present for longer than 1 month
- Criteria
- Low grade fever (37.6 - 38.6)
- Non-Exudative Pharyngitis
- Palpable or tender Lymph Nodes (size <2 cm)
- Prior guidelines (not required by CDC)
- References