CFS

      CFS  is uniquely characterized by profound, debilitating fatigue that persists or relapses for at least 6 consecutive months. Symptoms are life-altering, and are described as taking the “vitality” of the patient away. Etiology is unknown.  (12,14, 19)

      Approximately 500,000 Americans are diagnosed with CFS. The peak age of onset is 20 - 40; it occurs more than 80% of the time in Caucasians, and it is 3 times more common in women. About 75% of patients cite an acute flu-like viral infection prior to the onset of CFS. Unlike other causes of persistent fatigue, onset is usually sudden, and the accompanying subjective symptoms have no physical or psychiatric cause. Researchers are investigating the possibility of a viral link to onset. Some researchers feel that a sleep disorder, which results in neurotransmitter shifts, is the primary cause of CFS. (1, 2, 12, 14, 17, 19)

CFS Presentation and Diagnosis

      In addition to the debilitating fatigue for at least 6 months, CFS is accompanied by at least 4 of the following symptoms: new headache, unrefreshed sleep, sore throat, muscle pain, joint pain, impaired memory or concentration, lymphadenopathy, and post-exertion malaise lasting at least 24 hours. Some patients report low-grade fever, anorexia, nausea, night sweats, dizziness, and intolerance to alcohol or drugs that affect the central nervous system (CNS). Forty to 75% of patients also are diagnosed with major depression. (1, 2, 12, 14, 19)

      Clinical features of CFS include going from healthy and fit to chronically ill, usually after an acute viral infection. The fatigue experienced fluctuates, whereas most other illnesses describe a steady decline or fatigue plateau until it is relieved by treatment. All blood, thyroid, and muscle enzyme analyses are normal in CFS patients. Vasomotor complaints often do not match objective tests. For example, the patient may feel feverish, but body temperature is normal. Finally, CFS patients have a constant and characteristic sleep disorder pattern that can be described as: difficulty getting to sleep, frequent nocturnal awakenings, no spontaneous awakening in the morning, feeling unrested after sleep, and a compelling desire to sleep during the day. (12)

      The National Institutes of Health recommends the following diagnostic tests be conducted before diagnosing CFS: general health blood testing panel, erythrocyte sedimentation rate, and urinalysis. Optional tests to consider include: antinuclear antibodies, free serum cortisol, quantitative rheumatoid factor, immunoglobulin levels, tuberculin skin test, Lyme serology, and HIV serology. These tests are valuable in diagnosing various fatigue causing illnesses, and do not need to be ordered routinely in CFS patients. Up to 20% of patients have a dysregulation of their autonomic nervous system (ANS), as demonstrated in tilt table testing. A complete discussion regarding the diagnosis criteria for CFS can be found in reference 16. (2, 14, 17, 19)

      In summary, CFS is primarily diagnosed after other fatigue producing conditions have been ruled out. CFS is distinguished from FMS because fatigue is the chief complaint, rather than pain. (12)

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