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Chronic fatigue syndrome comes of age

  • Paul H Levine
    Correspondence
    Requests for reprints should be addressed to Paul H. Levine, MD, GWSPHHS, Ross Hall 120, 2300 Eye Street, Washington, DC 20037
    Affiliations
    Viral Epidemiology Branch, National Cancer Institute, Bethesda, Maryland, USA

    George Washington University Medical Center, Washington, DC, USA
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      Chronic fatigue syndrome (CFS) is a disabling illness that has probably afflicted humankind for centuries, but it first became prominent as a recognizable disorder in 1988,
      • Holmes G.P
      • Kaplan J.E
      • Gantz N.M
      • et al.
      Chronic fatigue syndrome a working case definition.
      when a case definition was developed under the auspices of the US Centers for Disease Control and Prevention (CDC; Table 1). The precise prevalence of CFS is unknown since there is no diagnostic test or pathognomonic physical finding, but it is not rare, probably being more common than Parkinson’s disease or systemic lupus erythematosus. In the past 2 years, 2 events—a national televised satellite conference sponsored by the US Department of Health and Human Services and a meeting in San Francisco organized by the American Association of Chronic Fatigue Syndrome—brought together clinicians and scientists to review the latest information on the epidemiology, pathophysiology, and clinical management of CFS. From these events it became apparent that while CFS is a heterogeneous disorder, as discussed below, increasing information is being developed on the neurologic, hormonal, immunologic, and other biologic abnormalities that could provide clues to the pathogenesis and/or management of this puzzling illness.
      Table 1Criteria for Chronic Fatigue Syndrome
      Holmes et al., 1988 Fukuda et al., 1994
      Major criteria
      New onset + +
      No previous history + +
      Does not resolve with bed rest + +
      Activity reduction >50% +
      ≥6 months + +
      Exclude all other illnesses + +
      Exclude all psychiatric disorders + ±
      Minor criteria 8/14 4/8
      Low-grade fever +
      Sore throat + +
      Painful lymph nodes + +
      Generalized weakness +
      Muscle discomfort (pain) + +
      Prolonged fatigue after exercise + +
      Generalized (new) headaches + +
      Migratory arthralgias + +
      Neuropsychiatric complaints (impaired memory or concentration) + +
      Sleep disorders (unrefreshing sleep) + +
      Acute onset +
      Documented low-grade fever +
      Documented nonexudative pharyngitis +
      Documented palpable or tender lymph nodes +
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