chronic fatigue syndrome

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chronic fatigue syndrome

(CFS), collection of persistent, debilitating symptoms, the most notable of which is severe, lasting fatigue. In other countries it is known variously as myalgic encephalomyelitis (ME), chronic fatigue and immune dysfunction syndrome, and postviral fatigue syndrome. It may have been first recognized as a syndrome in the 1860s by George Beard, who used the term neurasthenianeurasthenia
, condition characterized by general lassitude, irritability, lack of concentration, worry, and hypochondria. The term was introduced into psychiatry in 1869 by George M. Beard, an American neurologist; he believed it to be a neurosis with a fatigue component.
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 to described what he believed to be a neurosis with a fatigue component. Definitions and theories of its cause have changed over the years; many cases have been misdiagnosed as imaginary because doctors could find no cause. In the mid-1980s it came to the public's attention, as affluent women in their thirties began to seek treatment. (For unknown reasons, more women than men seek treatment for the disease.)

Symptoms and Identification

As currently defined, chronic fatigue syndrome is the presence of severe, disabling fatigue lasting for six or more consecutive months. The fatigue is persistent or relapsing, and is new (i.e., not lifelong), not relieved by rest, not the result of ongoing exertion, and interferes with normal work, social, educational, or personal activities. Diagnosis also requires at least four of the following symptoms, each persistent or recurring and not present before the fatigue: impairment of short-term memory or concentration, sore throat, tender lymph nodes in the neck or axillary region, muscle pain, joint pain, headaches peculiar to the syndrome, unrefreshing sleep, and malaise of more than one day's duration following exertion. Chronic fatigue that does not meet all these criteria is termed "idiopathic fatigue."

The course of the disease varies. Many people first experience symptoms after a cold or bout of the flu. Most people reach a plateau early on; the symptoms come and go with varying severity afterward. Some experience complete remission; others have their symptoms indefinitely.

There are no specific diagnostic tests. Diagnosis must first rule out known causes of fatigue such as hypothyroidism, cancer, multiple sclerosis, and major depression with psychotic or melancholic features (e.g., schizophrenia, bipolar disorder). Chronic fatigue syndrome and nonpsychotic, nonmelancholic depression, however, are not mutually exclusive. Substance abuse and side effects of prescribed medications must also be eliminated as possible causes.

Cause and Treatment

There is no known single cause of CFS. Some authorities believe it is a condition shared by many different underlying diseases rather than an entity unto itself; others believe it is caused by a defect of the immune system. Hormonal deficits, low blood pressure, and viral infections have been studied as possible causes or contributors. The postulated causal link with Epstein-Barr virusEpstein-Barr virus
(EBV), herpesvirus that is the major cause of infectious mononucleosis and is associated with a number of cancers, particularly lymphomas in immunosuppressed persons, including persons with AIDS.
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 hypothesized in the mid-1980s has been discounted. In 2009 researchers announced that they had found xenotropic murine-leukemia-virus-related virus (XMRV) in many patients with CFS, but the study did not show that XMRV was linked to CFS. Other studies failed to replicate its findings, and the paper was later retracted.

There is no definitive treatment for CFS, although success has been reported anecdotally with antidepressants, antianxiety medications, antivirals, and immune boosters. Symptomatic treatment for the muscle and joint pains is helpful in some cases, as are psychological and physical therapies. Counseling and peer support groups may help some patients cope with the frustrating nature of the disease. A British study reported in 2012 that cognitive behavioral therapy and graded exercise therapy were the most successful and cost-effective treatments, but other have asserted that that assessment significantly overstating the results of the study.

References in periodicals archive ?
It may lead to ulceration with discharge of chalky materials.3 We noticed calcinosis cutis in relatively higher proportion of cases compared to Ghosh et al.7 and Al-Adhadh et al.12 Sclerodactyly and digital pitted scars are included as minor criteria by subcommittee for scleroderma criteria.4 Sclerodactyly was also found in a higher proportion in our study compared to Sharma et al.6 (64.6%) and Teh et al.9 (65%).
* Probable ReA: when one of the following is fulfilled: two major criteria but no relevant minor criteria are met, or one major and one or more minor criteria are met/verovatni ReA: kada je ispunjeno jedno od ovoga: dva velika kriterijuma, ali bez relevantnih malih kriterijuma ili jedan veliki kriterijum i jedan ili vise malih kriterijuma
For multivariable logistic regression of factors associated with attending or not attending the preliminary clinic, we used a predetermined model with age (linear term), sex, and presence of major or minor criteria as explanatory variables.
Cases were included if the endoscopist reported at least three minor criteria for the pancreas.
CASE 1 CASE 2 MAJOR CRITERIA Petechial Rash Yes No Respiratory Insufficiency Yes Yes Cerebral Involvement Yes Yes MINOR CRITERIA Tachycardia Yes Yes Pyrexia Yes Yes Retinal changes: fat or petechiae Yes No Jaundice No No Renal: anuria/oliguria or lipiduria No No Sudden fall in hemoglobin concentration Yes Yes Sudden Thrombocytopenia No No High erythrocyte sedimentation Rate Yes Yes Fat macroglobulinemia No N/A
Gurd's criteria were used most widely, and the diagnosis of FES requires at least two major criteria or one major criterion plus two minor criteria. In Lindeque's criteria, FES can be diagnosed using respiratory parameters alone.
The clinical workup has been well summarised by Campeau and Lee considering major and minor criteria (Table 2) [3].
At least two of the following minor criteria are also required: recurrent fever, objective findings of abnormal bone remodeling with or without bone pain (assessed by bone scintigraphy, MRI, or elevation of bone alkaline phosphatase), neutrophilic dermal infiltrate on skin biopsy, and elevated CRP and/or leukocytosis (CRP > 30 mg/L and/or neutrophils > 10,000/[mm.sup.3]) [4].
Polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, and skin changes (POEMS) syndrome is a rare syndrome with the following diagnostic criteria: major criteria: polyneuropathy, monoclonal plasma disorder, Castleman's disease, sclerotic bone lesions, increased vascular endothelial growth factor; minor criteria: organomegaly, extravascular volume overload, skin changes, endocrinopathy, papilledema, thrombocytosis, and polycythemia [2, 9].
Hittner described 10 children who had choanal atresia as well as coloboma, congenital heart defect, and hearing loss.3 In 1998, an expert group described the major classical 4C's: Choanal atresia, Coloboma, characteristic ear and Cranial nerve anomalies and minor criteria of CHARGE syndrome.
For the diagnosis of iPPSD, major and minor criteria have been described and a minimum of one of the major criteria is mandatory for clinical diagnosis of iPPSD (see Table 2) (52).