Download Chronic Fatigue Syndrome

Chronic Fatigue Syndrome
By Dr Hassan Raji Jallab
Introduction
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Severe fatigue is a common complaint
among patients. Often, the fatigue is
transient or can be attributed to a
definable organic illness. Some patients
present with persistent and disabling
fatigue, but show no abnormalities on
physical examination or screening
laboratory tests. In these cases, the
diagnosis of chronic fatigue syndrome
(CFS) should be considered.
Definition
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Also called CFS/ME(Myalgic
Encephalomyelitis) CFS is a disabling illness
characterized by persistent fatigue , which
exists without other explanation, for a long
time, and is accompanied by cognitive
difficulties.
CFS includes both an encephalitic component
( cognitive difficulties ) and a skeletal muscle
component( chronic fatigue )
Patient without cognitive dysfunction should
not be considered to have CFS.
Epidemiology
Chronic fatigue syndrome affects both genders,
all racial, ethnic, and socioeconomic
populations, and can begin as early as five
years of age.
 Up to 5%
 Female >> Male
 Caucasians > other groups
 Majority in their 30s
.
How does CFS begin?
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Can begin after a minor illness such as cold,
or an intestinal bug
During a period of high stress
Gradually, with no clear illness or other event
starting it
The main symptoms of CFS/ME are
persistent profound weakness, extreme
tiredness after any form of exertion, sleep
disturbance, pain disturbance and
neurological and cognitive problems
Symptoms
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Fatigue 100%
Difficulty concentration 90%
Headache 90%
Sore throat 90%
Tender lymph nodes 80%
Muscle ache 80%
Joint aches 75%
Feverishness 75%
Difficulties sleeping 70%
Psychiatric problems 65%
Allergies 55%
Abdominal cramps 40%
Weight loss 20%
Diagnosis

The Centers for Disease Control and
Prevention's criteria for diagnosis of
chronic fatigue syndrome require the
patient to present with severe fatigue
lasting at least six consecutive
months, have no definable organic
disease, and experience associated
physical symptoms.

1)
2)
Major criteria :
New onset of persistent or relapsing
fatigue not previously present,
sufficient to reduce daily activity by
50% or more.
Exclusion of other conditions which
may produce similar symptoms.
Diagnosis
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1)
2)
3)
4)
5)
6)
Minor criteria :
Mild fever (37.5-38.6)
Sore throat
Painful cervical or axillary lymph nodes
Unexplained generalized muscle weakness.
Muscle discomfort or myalgias
Prolonged (>24hr) generalized fatigue after
previously tolerated exercise
Diagnosis
7) Generalized headaches
8) Migratory arthralgia without jont swelling or
redness
9) Neuropsychiatric complaints e.g.,
photophobia , forgetfulness, irritability,
confusion, inability to concentrate, difficulty
in thinking, depression.
10) Sleep disturbances
11) Onset of main symptom complex in hours
of a few days
Physical criteria ;
1) Low grade fever
2) Non-exudative pharyngitis
3) Palpable or tender ant or post cervical
or axillary nodes
>> 2 major + 6 minor + 2 physical
>> 8/11 minor
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CDC criteria
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Four or more of the following symptoms are present for six months or more:
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Impaired memory or concentration
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Postexertional malaise
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(extreme, prolonged exhaustion and exacerbation of symptoms following
physical or mental exertion)
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Unrefreshing sleep
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Muscle pain
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Multijoint pain without swelling or redness adults
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Headaches of a new type or severity
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Sore throat that’s frequent or recurring
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Tender cervical or axillary lymph nodes
DDx
Infectious
Chronic Epstein-Barr virus ,Influenza,Tuberculosis,Lyme disease
 Neuroendocrine
Hypothyroidism / Hyperthyroidism
Addison's disease, Cushing's disease ,Diabetes
 Psychiatric
 Neuropsychologic
Obstructive sleep syndromes (sleep apnea, narcolepsy) ,Multiple
sclerosis, Parkinsonism
 Hematologic
Anemia, Lymphoma ,Occult malignancy
 Rheumatologic
Fibromyalgia,Sjögren's syndrome ,Polymyalgia rheumatica ,Giant
cell arteritis ,Polymyositis ,Dermatomyositis

Etiology
Unknown cause
 Some hypotheses:
 INFECTIOUS
Many patients with CFS attribute the onset of their illness to an
acute influenza-like infection, and It is now believed that CFS is
not specific to one pathogenic agent but could be a state of
chronic immune activation, possibly of polyclonal activity of Blymphocytes, initiated by a virus.
 IMMUNOLOGIC
Many of the symptoms seen in patients with CFS, such as
disabling lethargy, myalgias, and cognitive impairment, are
similar to the effects observed with high dosage treatments of
cytokines including interleukin-2 and alpha interferon.Given
that CFS may be an illness of immune dysregulation.
 AUTONOMIC NERVOUS SYSTEM
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Psychiatric : Although there is some overlap in
symptoms presented by patients with CFS and
those with depression, patients with CFS also
show symptoms that are not typical of clinical
depression, such as sore throat,
lymphadenopathy, and postexertional
malaise. Patients with CFS lack feelings of
anhedonia, guilt, and decreased motivation
classically seen in patients with depression
“Studies have shown that two thirds of patients with
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CFS have signs of major depressive illness and one
half of all patients with CFS have experienced at
least one episode of major depression. “
ALLERGEN
Treatment
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Given the ambiguity surrounding
CFS, the current suggested
management includes exercise,
optimal diet, appropriate sleep
hygiene, low-dose tricyclic
antidepressants and/or a selected
serotonin reuptake inhibitor,
combined with cognitive-behavior
therapy.
Treatment
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Counseling : about the illness and its prognosis.
Heavy meals, alcohol and caffeine at night can make
sleep even more difficult with increased fatigue.
NSAIDs alleviate headache, diffuse pain, and fever.
Allergic rhinitis and sinusitis are common;
antihistamines or decongestants ma be helpful.
Reports of subtle hypocortisolism in patients with
CFS has spurred interest in treatment with
mineralocorticoids and corticosteroids. In a
randomized control study , researchers successfully
demonstrated a response to low-dose
hydrocortisone (five to 10 mg daily). Fatigue was
improved and disability was reduced without
significant short-term adverse events.
Sleep hygiene
Sleep hygiene means habits that help
you to have a good night’s sleep.
 you can dramatically improve your
sleep quality by making a few minor
adjustments to lifestyle and attitude.
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Sleep hygiene
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4.
Obey your body clock :
Get up at the same time every day. Soon, this
strict routine will help to set your body clock, and
you’ll find yourself getting sleepy at about the
same time every night.
Don’t ignore tiredness. Go to bed when your body
tells you it’s ready.
Don’t go to bed if you don’t feel tired. You will only
reinforce bad habits such as lying awake.
Get enough sunshine. Exposure to light during
waking hours helps to set your body clock.
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Improve your sleeping environment:
Use a mattress that is neither too
hard nor too soft.
Make sure the room is at the right
temperature
Ensure the room is dark enough
Only use your bed for sleeping.
Avoid :
Cigarettes
Alcohol
Sleeping pills
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Coping with the mid-afternoon energy
slump!!
Most people feel drowsy after lunch
This mid afternoon drop in energy levels is linked to
the brain’s circadian rhythm
Prevention may be impossible, but there are ways to
reduce the severity of the slump, including:
1.
don’t over eat or skip a meal
2.
Be careful with caffeine
3.
Eat a combination of protein and carbohydrates for
lunch,carbohydrate provide glucose for energy.
4.
Walking for 10 minutes improves blood flow to
brain.
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