Quick Survey: Chronic Fatigue Syndrome
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Chronic Fatigue Syndrome

What is Chronic Fatigue Syndrome? Is it really illness or is it just a psychological problem?

Chronic Fatigue Syndrome (CFS) or Chronic Fatigue and Immune System Dysfunction Syndrome (CFIDS), is a very real and very disabling physical illness that causes profound fatigue and muscle weakness following a viral illness. This syndrome is also known as Myalgic Encephalitis (ME), post-infectious neuromyasthenia, post-viral syndrome, yuppie flu, or formerly chronic Epstein Barr virus. CFIDS can cause injury to the brain, the immune system and the muscles of the people who suffer from it.

CFIDS was formerly thought to be caused by the Epstein Barr virus, but this has not been proven. Other viruses may also be associated with this syndrome, including herpes-6 virus, enteroviruses (coxsackie-B virus, poliovirus, echovirus, etc) hepatitis virus, influenza virus, adenovirus, and cytomegalovirus. For the viral infection to take hold, the immune system is usually already weakened by a number of causes, including the overuse of antibiotics and cortisone, major stress, poor diet and chronic yeast infections.

Dr. Byron Hyde, a leading Canadian CFIDS researcher, notes that like poliomyelitis, the incidence of CFIDS goes up after immunization, and also in late summer and early autumn. He strongly recommends that "individuals do not go to work in third world countries or start work in hospitals or schools during the first four weeks after immunization."

The official diagnosis of CFIDS can be made only after a thorough medical history, physical exam, mental status exam and laboratory tests are done to exclude other underlying or contributing conditions that require treatment. Then the patient must fulfil both of the following criteria:

The first criteria is six months or greater duration of clinically evaluated, unexplained persistent or relapsing chronic fatigue that is of new or definite onset (ie not lifelong), is not the result of ongoing exertion, is not substantially alleviated by rest, and results in substantial reduction in previous levels of occupational, educational, social or personal activities.

The second criteria is the concurrent occurrence of four or more of the following symptoms: substantial impairment in short term memory or concentration; sore throat; tender lymph nodes; muscle pain; multi-joint pain without joint swelling or redness; headaches of a new type, pattern or severity; unrefreshing sleep; and post-exertional malaise lasting more than 24 hours. These symptoms must have persisted or recurred during 6 or more consecutive months of illness and must not have pre-dated the fatigue. Annals of Internal Medicine (Dec 15/94-121;953-959).

People with CFIDS can be so tired they do not have enough energy to get out of bed. Brushing their teeth can become a major effort.

Dr. Hyde emphasizes the muscular component of the chronic fatigue syndrome. He defines the condition as, "a chronic illness of at least six months in duration, that develops after an acute infectious disease, in a well and physically active person. In this disease, the patient develops an unusual form of muscle failure experiencing fatigue, pain, or exhaustion in the exercised muscle."

Other important features of this illness, according to Dr. Hyde, are sleep disturbances, variability and fluctuations of symptoms, serious difficulty processing information (memory loss, lack of concentration, slurred speech, disorientation, loss of coordination) and generalized malaise.

Fibromyalgia, the "sore all over" syndrome may be part of CFIDS, with pain being a more prominent symptom than fatigue. In this condition, which affects mainly women in their late 30's and forties, there is generalized pain and aching throughout the body, morning stiffness, fatigue, disturbed sleep, and multiple tender spots on the body.

Specialized types of brain scans have shown decreased blood flow to the brian of CFIDS patients. After exercise, brain scans show even more drastic decreases in blood flow and brain function. In addition, some researchers have noted white abnormalities in certain areas of the brain.

Most blood tests are normal in CFIDS, but there may be abnormalities of immunoglobulins and T-cell function. In particular, there may be a decrease in natural killer cells, or an increase in helper cells or an increase in the ratio of helper cells to suppressor cells.

Dr. Byron Hyde has published a comprehensive 750 word textbook on CFIDS for doctors entitled, The Clinical and Scientific Basis of ME/CFS which is available through The Nightingale Research Foundation at 613-729-9643.

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