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Chronic Fatigue Syndrome
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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
Gene
tic 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
NSAID
S
Selective Serotonin Reuptake Inhibitor
s (
SSRI
)
Duloxetine
(
Cymbalta
)
Tricyclic Antidepressant
s
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]
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