What is Chronic Fatigue Syndrome (CFS)?

 Chronic fatigue syndrome (CFS), also known as myalgic encephalomyelitis (ME), is a complex, chronic disease characterized by profound insurmountable fatigue with no known cause that does not decrease with rest and may worsen with physical and mental activity.

The impact of CFS in the patient’s life is devastating, both the disease itself and by the isolation and lack of understanding of the environment, in fact, validated measures of quality of life when compared with other diseases, evidence that CFS is one of the worst diseases that quality of life entails.

In addition to these basic features, some patients with chronic fatigue syndrome (CFS) suffer various nonspecific symptoms such as special weakness in the legs, muscle and joint pain, impaired memory or concentration, odors intolerance, insomnia and very slow recovery, so that the fatigue persists over twenty-four hours after exertion.

Most often the disease is chronic (less than 5-10% cures) and a major impact on the patient’s life.

 The cause of Chronic Fatigue Syndrome (CFS) is still unknown  and we have no specific diagnostic tests, but most groups of scholars believe that infections (particularly those caused by certain viruses), autoimmune response and agents or toxic chemicals , can trigger the disease even at doses considered “safe” for most people. Recent work describing gene expression in disease subgroups seem to affirm the relationship with toxicants.

The latest hypotheses point to a coexistence of predisposing factors and triggers (severe physical or psychological stress, viral infections, chemicals).

For some time it was thought that the Epstein Barr Virus (EBV) was the cause of CFS, but later it was found that there are many other possibilities.

We believe it is premature to rule out the virus as factors associated with ME / CFS or other diseases in humans. Rigorous studies are needed double-blind in well characterized patients and healthy controls. One such study is underway under the auspices of the National Institute of Health of the U.S. and its results were expected during 2011. 

In any case, research on CFS / ME has taken a giant step, and allowed to show very consistent immunological abnormalities in these patients when printing postverial subgroup is well defined.

Ultimately this is that in people with a predisposition in which genomics appears to have significant weight. In particular, the risk factor which appears to influence more relevant in the SFC / MS postvirales feature is the lack of certain factors in lymphocyte subpopulations activation of CD8 lymphocytes, which produces a reduced or absent activity against certain stimuli essentially viral or toxic, so just triggering an alteration of the immune, endocrine and neurological body that can be affected permanently, becoming more susceptible to other infections or reactivation of the same virus or other viruses, intracellular bacteria and fungi and producing symptoms very relevant. Elevated expression of CD5-/ – has been proposed ( external link to the quote ) as a marker of anergy situation.

Since numerous conditions have incapacitating fatigue before diagnose caution must be exercised not to rule out other known ailments which often have treatment (such as some infectious diseases such as Lyme disease or borreliosis). That is why, in Chronic Fatigue Syndrome (CFS), the differential diagnosis plays a crucial role not seem easy to be taken by primary care.

In these diseases, the search for a second opinion can be a wise decision. Unfortunately this “second opinion” can not be easily obtained in non-specific, which is why we recommend going to dedicated units notwithstanding that there may be other units of the same capacity or individual professionals who are fully aware of this disease.

Definition of Chronic Fatigue Syndrome (CFS)

There is much debate about the best description of Chronic Fatigue Syndrome (CFS). In order to adopt a solution, an expert committee (Fukuda and CDC) in 1994 outlined a definition (diagnostic criteria) serve both researchers and those who have to issue diagnostics. In essence, following must be true:

 

  • Having a chronic physical and mental fatigue no serious pre-existing (impact over 50% of the activity and usual activity including employment, education, social and personal) for six or more months, according to a clinical diagnosis, which can not be attributed to any known disease

  • Currently have four or more of the following symptoms: substantial impairment of memory or concentration in the short term, pharyngitis or tonsillitis, tender lymph nodes, muscle and joint pain without swelling or multiple erythema, headaches and intensity of a class not previously suffered , sleep disturbance and discomfort persists more than a day after exercise. These symptoms must have been submitted, persistent or recurring, for at least six consecutive months and not have predated the fatigue.

  • Exclusion criteria are: A medical condition that may justify fatigue, major depressive disorder or bipolar disorder, schizophrenia, dementia, anorexia nervosa, bulimia, active autoimmune diseases, AIDS, alcoholism or substance abuse, severe obesity (> 45% BMI) .

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