Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (CFS)
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Basics
Description
- A chronic and complex physical illness characterized by a new or definitive onset of debilitating fatigue that persists for >6 months with moderate to severe intensity at least half of the time, which significantly reduces a person’s ability to perform preillness activities
- Key features include (1):
- Impaired memory or concentration
- Joint and muscle pain, unrefreshing sleep
- Postexertional malaise (PEM), orthostatic intolerance
- Synonyms: myalgic encephalomyelitis (ME)/chronic fatigue syndrome (CFS), chronic Epstein-Barr virus syndrome, postviral fatigue syndrome, chronic fatigue immune dysfunction, and systemic exertion intolerance disease
- Fatigue is not relieved by rest and results in >50% reduction in preillness activities (occupational, educational, social, and personal).
- Other commonly associated symptoms include heart rate variability; excessive sweating; muscle and joint pain; and light, sound; and chemical sensitivity (2).
- Other causes such as schizophrenia, manic-depressive illness, substance abuse, eating disorder, or proven organic brain disease must be ruled out (3).
Epidemiology
- Can affect all ages; incidence peaks at 10 to 19 years and 30 to 39 years (1).
- Females are twice as likely to be affected (3).
- Up to 70% of patients are unable to return to work, and one quarter remain bedridden or housebound (2).
Prevalence
- Affects all racial and ethnic groups; more prevalent in minority and low socioeconomic groups
- Estimated at 519 to 1,038 diagnosed per 100,000; 1.7 to 3.4 million patients may suffer from ME or CFS.
- Up to 90% of cases may remain undiagnosed (2).
Etiology and Pathophysiology
Cause is unknown and likely multifactorial
- Suspected initiating stressors:
- Viral, bacterial, or parasitic infection: Epstein-Barr virus (EBV), retroviruses, Lyme disease, Q fever, human herpesvirus type 6, enteroviruses, Ross river virus, Borna disease virus
- Significant physical or emotional trauma
- Recent vaccination
- Overexertion, chronic sleep deprivation
- Toxin exposure (e.g., organophosphate pesticides) or an atypical adverse reaction to a medication
- Suspected perpetuating factors:
- Delay in diagnosis
- Overexertion
- Stress, inadequate sleep
- Hypothesized contributing systems and factors (4):
- Cellular metabolism (e.g., reduced oxidative phosphorylation and mitochondrial function)
- Neuroendocrine system (e.g., diminished cortisol response to increased corticotropin)
- Immune system (e.g., increased proinflammatory cytokines, C-reactive protein, and β2-microglobulin)
- Muscular system (e.g., reduced oxygen uptake)
- Autonomic system (e.g., orthostatic hypotension)
- Serotonergic system (e.g., upregulation of serotonin receptors)
- Gastrointestinal system (e.g., increased wall permeability, altered gut microbiota, irritable bowel syndrome [IBS] comorbidity)
Genetics
- Higher concordance in monozygotic twins
- Genetic polymorphisms in several neuroimmunoendocrine-related genes may contribute to developing disease (4).
Risk Factors
- Family history of ME or CFS
- Personality characteristics (neuroticism and introversion)
- Comorbid depression or anxiety
- Long-standing medical and/or mental health conditions in childhood
- Childhood inactivity or overactivity
- Childhood trauma (emotional, physical, or sexual abuse)
- Prolonged idiopathic chronic fatigue
Commonly Associated Conditions
- Fibromyalgia (more common in women)
- IBS
- Gynecologic conditions (pelvic pain, endometriosis) and surgeries (hysterectomy, oophorectomy)
- Anxiety disorders and/or major depressive disorders
- Posttraumatic stress disorder (PTSD), including physical and/or past sexual abuse; domestic violence
- Attention deficit hyperactivity disorder (ADHD)
- Postural orthostatic tachycardia syndrome (POTS)
- Sleep disorders, including obstructive sleep apnea (OSA)
- Reduced left ventricular size and mass; prolapsed mitral valve
- Temporomandibular joint syndrome
- Multiple chemical sensitivities
- Migraines, myofascial pain syndrome
- Hashimoto thyroiditis, Raynaud phenomenon
- Interstitial cystitis, sicca syndrome, allergies
-- To view the remaining sections of this topic, please log in or purchase a subscription --
Basics
Description
- A chronic and complex physical illness characterized by a new or definitive onset of debilitating fatigue that persists for >6 months with moderate to severe intensity at least half of the time, which significantly reduces a person’s ability to perform preillness activities
- Key features include (1):
- Impaired memory or concentration
- Joint and muscle pain, unrefreshing sleep
- Postexertional malaise (PEM), orthostatic intolerance
- Synonyms: myalgic encephalomyelitis (ME)/chronic fatigue syndrome (CFS), chronic Epstein-Barr virus syndrome, postviral fatigue syndrome, chronic fatigue immune dysfunction, and systemic exertion intolerance disease
- Fatigue is not relieved by rest and results in >50% reduction in preillness activities (occupational, educational, social, and personal).
- Other commonly associated symptoms include heart rate variability; excessive sweating; muscle and joint pain; and light, sound; and chemical sensitivity (2).
- Other causes such as schizophrenia, manic-depressive illness, substance abuse, eating disorder, or proven organic brain disease must be ruled out (3).
Epidemiology
- Can affect all ages; incidence peaks at 10 to 19 years and 30 to 39 years (1).
- Females are twice as likely to be affected (3).
- Up to 70% of patients are unable to return to work, and one quarter remain bedridden or housebound (2).
Prevalence
- Affects all racial and ethnic groups; more prevalent in minority and low socioeconomic groups
- Estimated at 519 to 1,038 diagnosed per 100,000; 1.7 to 3.4 million patients may suffer from ME or CFS.
- Up to 90% of cases may remain undiagnosed (2).
Etiology and Pathophysiology
Cause is unknown and likely multifactorial
- Suspected initiating stressors:
- Viral, bacterial, or parasitic infection: Epstein-Barr virus (EBV), retroviruses, Lyme disease, Q fever, human herpesvirus type 6, enteroviruses, Ross river virus, Borna disease virus
- Significant physical or emotional trauma
- Recent vaccination
- Overexertion, chronic sleep deprivation
- Toxin exposure (e.g., organophosphate pesticides) or an atypical adverse reaction to a medication
- Suspected perpetuating factors:
- Delay in diagnosis
- Overexertion
- Stress, inadequate sleep
- Hypothesized contributing systems and factors (4):
- Cellular metabolism (e.g., reduced oxidative phosphorylation and mitochondrial function)
- Neuroendocrine system (e.g., diminished cortisol response to increased corticotropin)
- Immune system (e.g., increased proinflammatory cytokines, C-reactive protein, and β2-microglobulin)
- Muscular system (e.g., reduced oxygen uptake)
- Autonomic system (e.g., orthostatic hypotension)
- Serotonergic system (e.g., upregulation of serotonin receptors)
- Gastrointestinal system (e.g., increased wall permeability, altered gut microbiota, irritable bowel syndrome [IBS] comorbidity)
Genetics
- Higher concordance in monozygotic twins
- Genetic polymorphisms in several neuroimmunoendocrine-related genes may contribute to developing disease (4).
Risk Factors
- Family history of ME or CFS
- Personality characteristics (neuroticism and introversion)
- Comorbid depression or anxiety
- Long-standing medical and/or mental health conditions in childhood
- Childhood inactivity or overactivity
- Childhood trauma (emotional, physical, or sexual abuse)
- Prolonged idiopathic chronic fatigue
Commonly Associated Conditions
- Fibromyalgia (more common in women)
- IBS
- Gynecologic conditions (pelvic pain, endometriosis) and surgeries (hysterectomy, oophorectomy)
- Anxiety disorders and/or major depressive disorders
- Posttraumatic stress disorder (PTSD), including physical and/or past sexual abuse; domestic violence
- Attention deficit hyperactivity disorder (ADHD)
- Postural orthostatic tachycardia syndrome (POTS)
- Sleep disorders, including obstructive sleep apnea (OSA)
- Reduced left ventricular size and mass; prolapsed mitral valve
- Temporomandibular joint syndrome
- Multiple chemical sensitivities
- Migraines, myofascial pain syndrome
- Hashimoto thyroiditis, Raynaud phenomenon
- Interstitial cystitis, sicca syndrome, allergies
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