Chronic Fatigue Immune Dysfunction Syndrome
Also called chronic fatigue syndrome, chronic Epstein-Barr virus, myalgic encephalomyelitis,
and yuppie flu, this syndrome is characterized by incapacitating fatigue. The patient’s symptoms may wax and wane, but they are often severely debilitating and may last for months or years.
and yuppie flu, this syndrome is characterized by incapacitating fatigue. The patient’s symptoms may wax and wane, but they are often severely debilitating and may last for months or years.
Although most prevalent among professionals in their 20s and 30s, the syndrome affects people of all ages, occupations, and income levels. The diagnosis is more common in females than in males or children, especially females younger than age 45. Sporadic incidence as well as epidemic clusters have been observed.
Causes
The precise cause of chronic fatigue syndrome isn’t known. Although the syndrome originally was attributed to the Epstein-Barr virus, that hypothesis has since been rejected on the basis of serologic and epidemiologic observation.
Several other causative viruses have been proposed and investigated, including cytomegalovirus, herpes simplex virus types 1 and 2, human herpesvirus 6, Inoue-Melnick virus, human adenovirus 2, enteroviruses, measles virus, and a retrovirus that resembles human T-cell lymphotropic virus type II. The onset in some patients suggests a viral cause, but whether the syndrome results from a new or a reactivated infection isn’t known.
Another theory holds that some symptoms may result from an overactive immune system. In addition, genetic predisposition, age, hormonal balance, neuropsychiatric factors, sex, previous illness, environment, and stress appear to have a role in the syndrome.
Complications
Chronic fatigue syndrome causes few complications. Its debilitating nature, however, greatly influences the patient’s sense of well-being and can cause mild to moderate depression.
Assessment
The patient characteristically complains of prolonged, overwhelming fatigue, along with other signs and symptoms, including sore throat, myalgia, and cognitive dysfunction (especially in short-term memory or concentration), tender cervical or axillary lymph nodes, headache, and unrefreshing sleep. The Centers for Disease Control and Prevention uses a working case definition to group symptoms and severity. (See Diagnostic criteria in chronic fatigue syndrome, page 186.)When assessing the patient, keep in mind that this definition was developed for research purposes, not clinical use. Use the definition as a guide, not as the basis for determining the patient’s need for care.
Diagnostic tests
No definitive test exists for this disorder. Diagnostic testing should include studies to rule out other illnesses, such as Epstein Barr virus, leukemia, and lymphoma.
Some patients with chronic fatigue syndrome have reduced natural killer cell cytotoxicity, abnormal CD4+
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