Chronic Fatigue Syndrome

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Chronic fatigue syndrome (CFS) is characterized by at least 6 months of exceptional fatigue, with several associated chronic symptoms. Chronic diseases that would exclude the diagnosis of CFS include untreated hypothyroidism, sleep apnea, chronic active hepatitis, any psychotic disorder, dementia, anorexia nervosa or bulimia nervosa, recent substance abuse, and severe obesity. Bipolar affective disorder excludes a diagnosis of CFS, but nonpsychotic unipolar major depression or anxiety disorders do not. As so defined, patients with CFS represent a small fraction (1 to 3%) of all patients seeking medical care for the complaint of chronic fatigue.

Patients with CFS may be of any age, of either sex, and from all walks of life; the typical patient is a 35-year-old white woman. The onset is often sudden, frequently after an acute “viral” syndrome. In unusual cases, CFS follows in the wake not of a nondescript “flulike” illness but of a well-defined acute infectious illness, including acute infectious mononucleosis and Lyme disease (despite adequate antibacterial therapy and the resolution of Lyme disease-specific symptoms).

CFS is associated with a wide range of dysfunction. Some patients appear to be completely disabled by the fatigue, cognitive impairment, muscle weakness, and pain. There is growing evidence of objective biologic abnormalities in patients with CFS. Various imaging and functional studies of the central nervous system and immune system have been reported, and these include low levels of circulating immune complexes, elevated total complement (CH50), elevated IgG, atypical lymphocytosis, elevated alkaline phosphatase, low lactate dehydrogenase, elevated total cholesterol, and low levels of antinuclear antibody. No infectious agent has been convincingly shown to be a cause of CFS. Nevertheless, there is evidence from controlled studies of the reactivation of several chronic viral infections in CFS. buy indocin online

A patient with chronic fatigue, as described, should have the following diagnostic tests: complete blood count, manual differential white blood cell count, erythrocyte sedimentation rate, chemistry panel, thyroid-stimulating hormone, antinuclear antibody, rheumatoid factor (if arthralgias), and urinalysis. These tests can help identify organic diseases and may also provide clues regarding the diagnosis of CFS, although none constitutes a diagnostic test. buy penisol online