Chronic Fatigue Syndrome Diagnosis

Aka: Chronic Fatigue Syndrome Diagnosis, Chronic Fatigue Diagnosis, Myalgic Encephalomyelitis Diagnosis

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II. Background

  1. As of 2015, Chronic Fatigue Syndrome is a clinical diagnosis (not a diagnosis of exclusion)

III. Diagnosis: National Academy of Medicine Criteria (2015)

  1. Major Criteria: Moderate to Severe symptoms >6 months and present >50% of the time (all required)
    1. Postexertional malaise (crash)
      1. Prolonged worsening of symptoms with even a small increase in previously tolerated activity
      2. Distinguishes from other conditions associated with Fatigue
    2. Profound Fatigue of new onset
      1. Substantially decreased ability to engage in pre-illness levels of activity and function
    3. Non-restorative or unrefreshing sleep
  2. Minor Criteria (at least one of the following)
    1. Cognitive Impairment (e.g. brain fog)
      1. May affect Driving, Reading, Conversation, Multitasking and Work oir school success
    2. Orthostatic symptoms with prolonged standing
      1. Symptoms with prolonged standing (e.g. Light Headedness, Nausea, Fatigue, Palpitations, Syncope)
  3. Associated Symptoms (not required)
    1. Gastrointestinal or genitourinary symptoms
    2. Hypersensitivity to external stimuli (e.g. light, noise, chemicals, foods)
    3. Increased susceptibility to infection or decreased immune function
    4. Influenza-like symptoms (e.g. Pharyngitis, Lymphadenopathy, chills, fever)
    5. Onset after infectious illness (e.g. COVID-19, Mononucleosis)
    6. Respiratory symptoms (e.g. sense of Air Hunger)
    7. Thermoregulatory dysfunction
    8. Visual disturbance
    9. Widespread pain
  4. References
    1. Bateman (2021) Mayo Clin Proc 96(11): 2861-78 [PubMed]

IV. Diagnosis: Old Criteria - modification history

  1. Earlier CDC 1994 guidelines
    1. Required severe Fatigue for 6 months (non-restorative sleep was a minor criteria)
    2. Also required 4 of 8 minor criteria (e.g. Headache, Arthralgias, myalgias, postexertional Fatigue, Pharyngitis, adenopathy)
  2. Earlier CDC 1988 guidelines required 6 minor criteria
    1. Included those listed above
    2. Other criteria present in prior guidelines
      1. Initial symptom onset acute or subacute
      2. Mild fever (37.5 - 38.6 Celsius) or chills
      3. Generalized Muscle Weakness
      4. Neuropsychiatric Symptoms
        1. Photophobia
        2. Transient visual scotomata
        3. Excessive irritability
        4. Confusion
        5. Difficult thinking
        6. Inability to concentrate
        7. Major Depression
  3. Earlier CDC 1988 guidelines required physical sign documentation
    1. Prior guidelines (not required by CDC)
      1. Two or more signs must be documented
      2. Physician must document each sign twice
      3. Signs must be present for longer than 1 month
    2. Criteria
      1. Low grade fever (37.6 - 38.6)
      2. Non-Exudative Pharyngitis
      3. Palpable or tender Lymph Nodes (size <2 cm)
        1. Anterior or Posterior Cervical Lymphadenopathy
        2. Axillary Lymphadenopathy
  4. References
    1. Holms (1988) Ann Intern Med 108:387-9 [PubMed]
    2. Levine (1997) Am J Med 105:35 [PubMed]
    3. Fukada (1994) Ann Intern Med 121(12): 953-9 [PubMed]

V. References

  1. Latimer (2023) Am Fam Physician 108(1): 58-69 [PubMed]
  2. Yancey (2012) Am Fam Physician 86(8): 741-6 [PubMed]

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