Earlier Considered Potential Causes
Depleted uranium
Depleted uranium was widely used in tank kinetic energy penetrator and autocannonrounds for the first time ever during the Gulf War and has been suggested as a possible cause of Gulf War syndrome. A 2008 review by the U.S. Department of Veterans Affairs found no association between DU exposure and multisymptom illness, concluding that “exposure to DU munitions is not likely a primary cause of Gulf War illness”. However, there are suggestions that long-term exposure to high doses of DU may cause other health problems unrelated to GWI.
More recent medical literature reviews disagree, stating for example that, “the number of Gulf War veterans who developed the Gulf War syndrome following exposure to high quantities of DU has risen to about one-third of the 800,000 U.S. forces deployed,” with 25,000 of those having had a premature death. Since 2011, US combat veterans may claim disability compensation for health problems related to exposure to depleted uranium. The Veterans Administration decides these claims on a case-by-case basis.
A team at the University of Portsmouth led by Professor Randall Parrish tested urine samples of 154 US veterans in 2021, reporting that no soldiers with the syndrome were exposed to significant amounts of depleted uranium and that it “is not and never was in the bodies of those who are ill at sufficient quantities to cause disease”.
Pyridostigmine bromide nerve gas antidote
Organophosphates
Organophosphate pesticides
Children Young People And Me/cfs
ME/CFS can affect people of all ages, including the very young. Young people with ME/CFS, especially children under the age of ten, might have trouble knowing or articulating that something is wrong. They may not realise that their loss of stamina, or other symptoms they are experiencing, are not normal. Alternatively, they may not have the words to describe what they are feeling.
For both younger children and teenagers, schooling can be affected but ME/CFS is not school refusal. While school refusal can often be accompanied by physical complaints , and these complaints may tend to disappear when the young person stays home, the pattern is different with ME/CFS. In a young person with ME/CFS, some symptoms never ease and symptom exacerbation is triggered by activity. In ME/CFS, symptoms are likely to be worse after school attendance, and can reduce with pacing and rest, which includes time away from school or during holidays.
Some young people with ME/CFS can continue to attend school, and others may be too unwell for regular classroom attendance. Parents, healthcare providers, schools and the child or teenager need to work together to come up with a plan for the young persons continued education. This plan needs to take into account the energy limits of ME/CFS. Being creative and flexible is key and might include things like fewer subjects or school from home.
Psychological Reactions Secondary To Me/cfs: Distinction From Depression And Anxiety Disorders
Studies focusing on psychological problems in pediatric ME/CFS patients are limited. In this section, available studies have been supplemented by the insights of our experienced clinicians. It is important to distinguish: normal emotional reactions to ME/CFS from clinically significant psychiatric symptoms such as depression or anxiety secondary to ME/CFS and from a primary psychiatric illness such as Major Depressive Disorder or an anxiety disorder without co-existing ME/CFS.
Emotional Responses to a Chronic Illness
Emotional responses to the difficulties of ME/CFS are common. These responses are similar to the responses of young patients with other chronic illnesses. Grief and anger can arise over illness-related losses, from negative responses to the illness from family members, friends and school staff, and from the pervasive stigmatization of this particular illness. Apprehension commonly follows the onset of an illness, which can be undiagnosed and about which there is generally ignorance. There can be frustration with the inability to do things that were easily done beforehand. Outbursts of weeping can stem from excessive tiredness and/or feeling overwhelmed. Emotional distress can also occur because of disbelief by others regarding the reality of the illness, or by the prescription of inappropriate remedies by health-care providers.
Identifying Clinically Significant Depression and Anxiety Co-Existing with ME/CFS
Factitious disorder by proxy .
School refusal .
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Diagnosis Of Chronic Fatigue Syndrome
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Clinical criteria
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Laboratory evaluation to exclude non-CFS disorders
The diagnosis of CFS is made by the characteristic history combined with a normal physical examination and normal laboratory test results. Any abnormal physical findings or laboratory tests must be evaluated and alternative diagnoses that cause those findings and/or the patient’s symptoms excluded before the diagnosis of CFS can be made. The case definition is often useful but should be considered an epidemiologic and research tool and in some circumstances should not be strictly applied to individual patients.
In February 2015, the Institute of Medicine published an extensive review of this disease called Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness. In this review, they proposed a new name, systemic exertion intolerance disease , and new diagnostic criteria that simplified the diagnosis and emphasized the most consistent features. In addition, the review clearly emphasized the validity of this debilitating disease.
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Housebound Or Bedbound With Me/cfs
About 25% of people with ME/CFS are housebound or bedbound. Those who are housebound may be able to undertake minimal daily tasks for themselves, such as brushing teeth, cooking or using a computer for short periods of time, but they have to pace their activity and often use aids to help them . They are unable to leave the house, often because this requires more energy than they have available. When they do leave the house, they often need mobility aids such as a wheelchair or mobility scooter, or other assistance . Recovery from a trip out of the house can take days, or longer.
Some people are so severely unwell that they are bedbound some or all of the time. The most severely unwell may be unable to undertake even simple tasks, like eating or going to the toilet by themselves. They may require additional medical devices, such as feeding tubes, to help them get enough nutrition and fluids, and can be totally dependent on carers.
Myalgic Encephalomyelitis/chronic Fatigue Syndrome: Fact Sheet For Schools
Myalgic encephalomyelitis/chronic fatigue syndrome is characterized by the bodys inability to produce sufficient energy for the normal range of human activity and the patients energy reserves are substantially reduced. The main symptoms include:
Severe, overwhelming fatigue with loss of mental and/or physical stamina and a substantial reduction in ability to take part in personal, educational and/or social activities.
The cardinal symptom of worsening of symptoms and malaise following minimal physical or mental exertion which can persist for hours, days, or weeks and is not relieved by rest
Cognitive problems , unrefreshing or disturbed sleep and a variety of painful conditions . Cognitive problems may worsen with prolonged upright posture.
There is no medical test for the illness. The diagnosis is made from the characteristic pattern of symptoms some or all of the above symptoms must be present every day for at least 6 months, symptoms must be moderate or severe, and other fatiguing illnesses must be ruled out by history, physical exam, and medical testing
Additional symptoms are often present and include:
Orthostatic intolerance, which is the development of symptoms due to prolonged upright posture that result in lightheadedness , increased fatigue, cognitive worsening, headaches, and/or nausea.
Hypersensitivities to light, noise, touch, odors, and/or medications.
Gastrointestinal symptoms such as abdominal pain, nausea, and/or loss of appetite.
Curriculum
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Shortness Of Breath And Tiredness
You should be worried if you have been feeling tired, exhausted, or breathless, for longer durations of time. It could surely spell trouble for you if you have been experiencing these symptoms for over six months now, especially when there are no medical reasons for them to occur. A few medical tests could ascertain the underlying cause.
It may also come from ingesting toxins or after Hepatitis or Jaundice and can leave you hollowed out from within. Whatever be the underlying causes, we recommend going for the requisite pulmonary function tests to determine if your total lung capacity has reduced, and if so, what corrective measures can you take to set it right faster.
Note: Chronic Fatigue Syndrome as an ailment is easy to detect but takes time to go away, and may signify some serious health conditions related to the liver and heart. The sooner you get it diagnosed, the better it is.
Differential Diagnosis Exclusionary Medical Conditions
Myalgic encephalomyelitis/chronic fatigue syndrome should not be diagnosed if the patient has an identifiable medical or primary psychiatric condition that could plausibly account for the presenting symptoms. If ME/CFS symptoms persist after adequate treatment of other confounding illnesses, a diagnosis of ME/CFS can be considered.
Fatigue is an early symptom in many medical conditions and can be present before the appearance of the diagnostic features of the underlying illness. Careful follow-up over time is needed in order to identify illnesses that might mimic ME/CFS in their early stages. The presence of post-exertional malaise and exacerbation of symptoms after increased cognitive or physical effort increases the likelihood that ME/CFS is the correct diagnosis. The more common conditions in the differential diagnosis are shown in Table 3. For a more comprehensive list of the less common disorders in the differential diagnosis, see Appendix B. If there is diagnostic uncertainty and referral is necessary, it should be preferably to a specialist familiar with ME/CFS.
Table 3. Common conditions in the differential diagnosis of ME/CFS.
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Alternative Or Complementary Medicine
Since there is no standard treatment for CFS/ME, people often consider alternatives to traditional medicine or use non-traditional treatments to complement their other medications. Commonly used alternative and complementary treatments include:
- Mind-body treatments, like qigong, tai chi, and meditation
- Trigger point therapy, called myofascial release
- Chiropractic treatments
Complementary therapies have received mixed results when scientifically studied. Before beginning an alternative or complementary treatment, talk with your doctor to ensure that you arent trying something potentially dangerous.
How Is Myalgic Encephalomyelitis/chronic Fatigue Syndrome Diagnosed
Your doctor diagnoses ME/CFS by performing a mental and physical examination. Doctors will ask about your medical history and order blood and urine tests to check for infection. In many cases, doctors refer people with suspected ME/CFS to other specialists to rule out other illnesses that could be causing symptoms.
For your doctor to diagnose ME/CFS, you must have these 3 symptoms:
- Severe fatigue lasting at least 6 months that does not improve with rest or sleep
- Difficulty sleeping
- Fatigue that gets worse after mental or physical exercise
Additionally, you must have at least 1 of the following symptoms:
- Orthostatic intolerance
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Myalgic Encephalomyelitis/chronic Fatigue Syndrome: Essentials Of Diagnosis And Management
- Alison C. BestedAffiliations
- Lily ChuCorrespondenceCorrespondence: Address to Lily Chu, MD, MSHS, Independent Consultant, 16 Lorton Ave, Unit 4, Burlingame, CA 94010.
- Nancy G. KlimasAffiliationsInstitute for Neuro Immune Medicine, Dr Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL
- Jose G. MontoyaAffiliationsDr Jack S. Remington Laboratory for Specialty Diagnostics, Palo Alto Medical Foundation Research Institute, Palo Alto, CA
- Irma R. ReyAffiliationsInstitute for Neuro Immune Medicine, Dr Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL
The Acute Stage Of Me/cfs
In the early, acute, febrile stage of ME/CFS, the diagnosis can be uncertain and other causes of fever need to be considered. Adequate rest and activity management are the mainstays of treatment. Premature resumption of activity or attempts to return to school can result in a relapse or increased severity of symptoms.
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Fukuda Research Case Definition For Chronic Fatigue Syndrome
Patients can be classified as having CFS if they meet the following criteria:
1. The individual has had severe, clinically evaluated, persisting or relapsing fatigue for six or more consecutive months. The fatigue is not due to ongoing exertion or other medical conditions associated with fatigue. The fatigue significantly interferes with daily activities and work.
2. The individual has four or more of the following symptoms, persisting, or relapsing and concurrent with the fatigue:
Post-exertional malaise lasting more than 24 h
Unrefreshing sleep
Significant impairment of short-term memory or concentration
Muscle pain
Pain in the joints without swelling or redness
Headaches of a new type, pattern, or severity
Tender lymph nodes in the neck or armpit
A sore throat that is frequent or recurring
3. A thorough medical history, physical examination, mental status examination, and laboratory tests are necessary to identify other conditions with similar symptoms that require treatment. The diagnosis of chronic fatigue syndrome cannot be made without such an evaluation.
Treatment Of Chronic Fatigue Syndrome
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Acknowledgment of patient’s symptoms
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Sometimes graded exercise, limited to avoid a setback
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Drugs for depression, sleep, or pain if indicated
To provide effective care to patients with CFS, physicians must acknowledge and accept the validity of patients’ symptoms. Whatever the underlying cause, these patients are not malingerers but are suffering and strongly desire a return to their previous state of health. For successful management patients need to accept and accommodate their disability, focusing on what they can still do instead of lamenting what they cannot do.
If these measures are ineffective, hypnotic drugs and/or referral to a sleep specialist may be necessary. Patients with pain widespread tenderness of muscles, areas around… read more ) can be treated using a number of drugs such as pregabalin, duloxetine, amitriptyline, or gabapentin. Physical therapy is also often helpful. Treatment for orthostatic hypotension Treatment Orthostatic hypotension is an excessive fall in blood pressure when an upright position is assumed. The consensus definition is a drop of > 20 mm Hg systolic, > 10 mm Hg diastolic… read more may also be helpful.
Unproven or disproven treatments, such as antivirals, immunosuppressants, elimination diets, and amalgam extractions, should be avoided.
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Etiology Of Chronic Fatigue Syndrome
Etiology of CFS is unknown. No infectious, hormonal, immunologic, or psychiatric cause has been established. Among the many proposed infectious causes, Epstein-Barr virus, Lyme disease, candidiasis, and cytomegalovirus have been proven not to cause CFS. Similarly, there are no allergic markers and no immunosuppression.
Some people who have recovered from COVID-19 infection COVID-19 COVID-19 is an acute, sometimes severe, respiratory illness caused by the novel coronavirus SARS-CoV-2. Prevention is by vaccination, infection control precautions Posttraumatic Stress Disorder Posttraumatic stress disorder is recurring, intrusive recollections of an overwhelming traumatic event recollections last > 1 month and begin within 6 months of the event. The pathophysiology… read more . In addition, in some patients COVID-19 seems to trigger typical CFS, but further study is needed to confirm this association and determine causality.
Various minor immunologic abnormalities have been reported. These abnormalities include low levels of IgG, abnormal IgG, decreased lymphocytic proliferation, low interferon-gamma levels in response to mitogens, poor cytotoxicity of natural killer cells, circulating autoantibodies and immune complexes, and many other immunologic findings. However, none provide adequate sensitivity and specificity for defining CFS. They do, however, underscore the physiologic legitimacy of CFS.
What Complications Are Associated With Myalgic Encephalomyelitis/chronic Fatigue Syndrome
For some people, the fatigue associated with ME/CFS makes activities of daily living very difficult or even impossible. Research shows that only half of all people diagnosed with ME/CFS work full-time or part-time jobs.
ME/CFS causes significant depression in many people living with the condition. If you experience depression, talk with your doctor â effective treatments are available.
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What Else Could It Be
Many people who have ME/CFS have other conditions, too. If you get treated for those, it might also improve your chronic fatigue.
ME/CFS can look a lot like âmonoâ , Lyme disease, lupus, multiple sclerosis, fibromyalgia, sleep disorders, or depression. It affects about 2.5 million Americans, but experts believe only about 20% are diagnosed.
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What Is The Latest Research On Me/cfs
Today, we have a better understanding of ME/CFS, but researchers are still searching for the cause. ME/CFS is sometimes seen in members of the same family, perhaps because of a genetic link. Researchers are also testing a variety of treatments for ME/CFS, including anti-viral medications and medications that affect the immune system.
Researchers also are looking at ways to help health care providers identify and diagnose ME/CFS more quickly. HHS currently supports a study led by the Institute of Medicine to recommend improved and updated criteria to help physicians make a diagnosis of ME/CFS. The IOM’s recommendations may also guide future research.
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Can Complementary Or Alternative Medicine Help Manage The Symptoms Of Me/cfs
Some people say that complementary or alternative medicine has helped their ME/CFS symptoms. Keep in mind that many alternative treatments, dietary supplements, and herbal remedies claim to cure ME/CFS, but some might do more harm than good. Talk to your doctor before trying alternative therapies to be sure they’re safe.
Symptoms Of Chronic Fatigue Syndrome
The main feature of ME/CFS is a type of exhaustion known as post-exertional malaise, crash or payback. This means having flu-like symptoms after exercise and not having enough energy for daily activities.
Research shows that people with ME/CFS have a different physiological response to activity or exercise from other people. This includes abnormal exhaustion after any form of exertion, and a worsening of other symptoms. The response may be delayed, perhaps after 24 hours. Depending on the amount and type of exercise, it may result in post-exertional malaise for a few days, or serious relapses lasting weeks, months or even years.
- problems with thinking, concentrating, memory loss, vision, clumsiness, muscle twitching or tingling
- disrupted sleep
- sore throat, tender lymph nodes and a flu-like feeling
- inability to cope with temperature changes.
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