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Chronic Fatigue Syndrome
Aka: Chronic Fatigue Syndrome, Chronic Fatigue Immune Deficiency Syndrome
- See Also
- Fatigue (includes Fatigue Red Flags)
- Fatigue Diagnostic Testing
- Fatigue Causes
- Medication Causes of Fatigue
- Epidemiology
- Incidence: 37 cases per 100,000 (difficult to assess)
- Fatigue is common complaint (20% of all patients)
- Higher Incidence may be in age 20-50 year old women
- Case reports include children as young as age 5 years
- 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)
- Etiology
- Idiopathic, likely multifactorial
- Genetic predisposition in some patients
- Childhood Trauma increases chronic Fatigue risk 6 fold
- Heim (2009) Arch Gen Psychiatry 66(1):72-80 [PubMed]
- 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
- Pathophysiology
- T-Cell Activation
- Cytokine release
- Related to alpha-intrusion sleep disorder
- Symptoms
- See Fatigue
- Diagnosis
- See Chronic Fatigue Diagnosis
- Differential Diagnosis
- See Fatigue Causes
- See Fatigue Red Flags
- Labs (base on other likely possible Fatigue Causes)
- See Fatigue Diagnostic Testing
- Course
- Most patients partially recover within 2 years
- All Chronic Fatigue patients are prone to relapse
- Management: Nonpharmacologic
- Understanding physician
- Listen
- Counsel
- Empathy
- Cognitive behavior therapy
- Identify unhealthy coping mechanisms
- Consider support group
- Avoid Caffeine
- Avoid Alcohol
- Graded Aerobic Exercise
- Duration: 30 minutes per session
- Repeat five Exercise sessions per week
- References
- Fulcher (1997) BMJ, 314:1647-52 [PubMed]
- 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
- Resources
- CDC: Chronic Fatigue Syndrome
- http://www.cdc.gov/cfs/
- 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]