Chronic Fatigue Syndrome Cases Research Articles

Provision of health and education services in school children with chronic fatigue syndrome

ABSTRACTBackground Chronic fatigue syndrome (CFS) in childhood may have a profound effect on a child's life in terms of schooling, social activity and family interaction. Many reports have been based on specialist clinics with little information about CFS in children in the general population and the health and education services provided.Objectives To review cases of CFS in school age children (5–18 years) within the East Suffolk area and determine the health and education services provided.Methods Cases were identified by consultation with the three local health trusts and the education department. Provision of services was determined by review of hospital and school health records. School attendance was determined by postal questionnaire to the school in each case.Results A total of 32 cases were identified, with diagnosis at a peak age of 15 years and 5.8 months as the mean duration of symptoms prior to diagnosis. Some 28 cases were referred by their GP to an acute paediatrician. Only one case was referred to the school medical service. The majority (28/32) received a rehabilitation programme provided by either a child psychiatrist or physiotherapist. Only half the cases were attending school more than half‐time and 10 were not attending school at all and were receiving home tuition. Two of these had never received local paediatric review to confirm the diagnosis or plan management. Follow‐up was highly variable and rarely involved school medical services.Implications A significant number of children with CFS were identified in this semirural school‐age population. Poor involvement of community child services reduced the opportunity for liaison between health and education and made identification of cases difficult. Paediatric review should be mandatory before home tuition is instituted, appropriate referral to psychiatric services encouraged and regular school follow‐up organized to review progress. Close liaison between all health and education services is imperative in planning the provision of services and providing a coherent programme of rehabilitation.

The course of severe chronic fatigue syndrome in childhood

Little has been reported on prognostic indicators in children with chronic fatigue syndrome (CFS). We used interviews with children and parents, a mean of 45.5 months after illness onset, to follow up 25 cases of CFS referred to tertiary paediatric psychiatric clinics. At its worst, the illness had been markedly handicapping (prolonged bed-rest and school absence in two-thirds); mean time out of school was one academic year. Two-thirds, however, had recovered and resumed normal activities--mean duration of illness to recovery/assessment 38 months--and none had developed other medical conditions. Recovery was associated with specific physical triggers to the illness, with start of illness in the autumn school term and with higher socioeconomic status. Severe fatigue states in children can cause serious and longlasting handicap but most children recover.

Vegetative-Vascular Dystonia and Osteoalgetic Syndrome or Chronic Fatigue Syndrome as a Characteristic After-Effect of Radioecological Disaster

The aim of this study was to determine whether the Chronic Fatigue Syndrome (CFS) definition could be applicable to the assessment of the medical aftermath of radioecological disasters and to investigate a possible psychophysiological basis of fatigue in Chernobyl accident survivors. One hundred randomly selected clean-up workers of the Chernobyl accident who presented with complains of fatigue were examined neuropsychiatrically using MMPI profiles, Quantitative Electroencephalography (QEEG) and Somatosensory evoked potentials (SSEP). Twenty-six percent of them met the CFS diagnostic criteria. Their absorbed radiation doses were less than 0.3 Sv, an exposure level that is not expected to produce a clear deterministic radiation effect. Clinical symptomatology included persistent fatigue, odd skin sensations, bizarre feelings in bones, muscles and joints, irritability, headache, vertigo, pain in the chest area, emotional lability, irritability, lack of concentration and memory, cognitive deterioration, depression signs and sleep disorders. Liquidators with CFS had the characteristic MMPI profile with increased hypochondria, depression, clear hypochondria, schizophrenia, hysteria, psychasthenia, and bizarre sensory perception scales. Spectral analysis of QEEG showed lateralised (left-sided) increase of θ-power (P < 0.001) and lateralised (left-sided) decrease of a-power (P < 0.001) and lateralised (left-sided) increase of β-power (P < 0.01). SSEP were characterized by increased latencies and decreased amplitudes. SSEP significantly differed by topographic abnormalities in the left temporoparietal area in liquidators with CFS. Associations between schizophrenia-like, hypochondriac and psychasthenic psycho-pathology and an increase of latency of SSEP P300 and N400 in liquidators with CFS were revealed. Thus, “Vegetative-Vascular Dystonia” and “Osteoalgetic Syndrome” cases following exposure to ionizing radiation as a result of the Chernobyl accident can be classified as CFS cases. The psychophysiological basis of fatigue in liquidators consists of dysfunction of the cortico-limbical structures of the left, dominating, hemisphere. CFS is one of the most important consequences of radio-ecological disaster, which results from an interaction of different hazardous environmental factors.

Chronic Fatigue Syndrome and Cancer

Several studies have indicated a link between chronic fatigue syndrome (CFS) and cancer, most of them based on anecdotal observations. We have attempted to use more population-based data to determine if the reported relationship is meaningful. Two outbreaks of a fatiguing illness which included well documented cases of CFS were evaluated ten years after the reported outbreak for long-term effects, particularly cancer. We found an unusual pattern of cancer which, in view of an increased incidence of brain tumors and non-Hodgkin's lym-phoma (NHL) reported in other studies involving CFS, indicates the need for further study. At the present time this link, which is often presumed to be due to immune dysfunction, has not yet been documented. Not all CFS patients have apparent dysregulation of the immune system and a single causative agent is highly unlikely, making the study of two heterogeneous illnesses, CFS and cancer, highly problematic. With the continuing focus on subgroups, however, this area of research may prove to be more productive.

Chronic Fatigue Syndrome – an occupational therapy programme

AbstractThe cause of Chronic Fatigue Syndrome (CFS) is as yet undetermined; therefore, precise definitions for diagnosis and research have been developed. The most accepted diagnostic criteria are detailed below. It has been suggested that there are 150 000 cases of CFS in the UK, with a 2:1 predominance of females to males, and that prognosis without treatment is poor. The patterns of illness seen in CFS are identified and the development of an occupational therapy programme for the management of CFS is described. Copyright © 1999 Whurr Publishers Ltd.

Clinical and Pathogenetical Characterization of 238 Patients of a Chronic Fatigue Syndrome Italian Center

SummaryProlonged fatigue is a common complaint in the community and is usually transitory. If fatigue continues for more than six months, is disabling, and is accompanied by other constitutional and neuropsychiatric symptoms, then a diagnosis of chronic fatigue syndrome (CFS) should be considered.CFS probably is an heterogeneous disease, maybe multifactorial, or it includes different pathologies which manifest with the same symptoms. In some cases, the mode of presentation of the illness implicate the exposure to chemical and/or food toxins as precipitating factors (e.g., ciguatera poisoning, Gulf War Syndrome, etc.). In other CFS cases, the etiology is still unknown: there are various hypotheses on pathogenetic events which, alone or in association with each other, may precipitate the illness. In fact, it is probable an involvement of multiple events in CFS onset where different precipitating factors can interact each other, even if not always all present in the single patient: latent and/or chronic vira...

In vitroStudy of Muscle Aerobic Metabolism in Chronic Fatigue Syndrome

AbstractThe purpose of this study was to establish if muscle aerobic metabolism is abnormal in chronic fatigue syndrome (CFS). Myoblast cultures from muscle biopsies of 16 patients with CFS and 10 healthy controls were established. Micromethods were used to determine the lactate/pyruvate (L/P) ratio, respiratory chain function and cytochrome oxidase and lactic dehydrogenase activities. Mitochondrial DNA (mtDNA) volume was measured and mtDNA rearrangements sought. The results showed that myoblasts from ten of 16 cases of CFS had defects in aerobic metabolism: two had increased L/P ratios, suggestive of a defect in oxidative phosphorylation while eight had decreased ratios, consistent with a deficiency in pyruvate dehydrogenase. There was a statistically significant broader range of L/P ratios in the patients' cultures, compared to controls (p = 0.011). No mtDNA rearrangements were present. This in vitro study confirms that there is convincing evidence of mild aerobic defects in skeletal muscle in some case...

Incidence, risk and prognosis of acute and chronic fatigue syndromes and psychiatric disorders after glandular fever.

The role of viruses in the aetiology of both chronic fatigue syndrome (CFS) and depressive illness is uncertain. A prospective cohort study of 250 primary care patients, presenting with glandular fever or an ordinary upper respiratory tract infection (URTI). The incidence of an acute fatigue syndrome was 47% at onset, after glandular fever, compared with 20% with an ordinary URTI (relative risk 2.3, 95% CI 1.3-4.1). The acute fatigue syndrome lasted a median (interquartile range) of eight weeks (4-16) after glandular fever, but only three weeks (2-4) after an URTI. The prevalence of CFS was 9-22% six months after glandular fever, compared with 0-6% following an ordinary URTI, with relative risks of 2.7-5.1. The most conservative measure of the incidence of CFS was 9% after glandular fever, compared with no cases after an URTI. A conservative estimate is that glandular fever accounts for 3113 (95% CI 1698-4528) new cases of CFS per annum in England and Wales. New episodes of major depressive disorder were triggered by infection, especially the Epstein-Barr virus, but lasted a median of only three weeks. No psychiatric disorder was significantly more prevalent six months after onset than before. Glandular fever is a significant risk factor for both acute and chronic fatigue syndromes. Transient new major depressive disorders occur close to onset, but are not related to any particular infection if they last more than a month.

Reproductive correlates of chronic fatigue syndrome

A case-control study was conducted to determine whether menstrual and gynecologic abnormalities precede the onset of chronic fatigue syndrome (CFS) in women with this disorder to a greater extent than that observed among healthy controls. We identified 150 women who met the 1988 Centers for Disease Control criteria for CFS from the Brigham and Women’s Hospital Cooperative CFS Research Center. A comparison group of 149 women being seen for nongynecologic conditions were selected from the waiting area of the Brigham and Women’s Hospital Internal Medicine outpatient department. Women with and without CFS completed self-administered questionnaires on menstrual, reproductive, and medical history. Women with CFS reported increased gynecologic complications and a lower incidence of premenstrual symptomatology. After adjustment for age, a somewhat greater number of cases compared with controls self-reported irregular cycles, periods of amenorrhea, and sporadic bleeding between menstrual periods. Factors suggestive of abnormal ovarian function—such as a history of polycystic ovarian syndrome, hirsutism, and ovarian cysts—were reported more often in CFS cases compared with controls. Frequent anovulatory cycles due to ovarian hyperandrogenism (PCOS) or hyperprolactinemia may increase risk for CFS through loss of the potential immunomodulatory effects of progesterone in the presence of continued estrogen production. We hypothesize that frequent anovulatory cycles due to PCOS and/or hyperprolactinemia may explain the increased reporting of gynecologic complications and the lower reported premenstrual symptomatology observed in women with CFS.

Factor analysis of unexplained severe fatigue and interrelated symptoms: overlap with criteria for chronic fatigue syndrome.

The objective of this study was to identify factors explaining the correlations among unexplained severe fatigue of different durations (1-5 months or > or =6 months) and symptoms reported as being significant health problems during a preceding 4-week period. Between June and December of 1994, a cross-sectional, random digit dialing telephone survey was conducted among residents of San Francisco, California. All subjects who reported having severe fatigue lasting for > or =1 month and a random sample of nonfatigued subjects were asked to participate in a detailed telephone interview. Data from 1,510 individuals aged 18-60 years who did not have medical or psychiatric conditions that could explain their severe fatigue were analyzed. Common factor analyses identified three correlated factors (defined as "fatigue-mood-cognition" symptoms, "flu-type" symptoms, and "visual impairment") that explained the correlations among fatigue lasting for > or =6 months and 14 interrelated symptoms. No factor explained the correlations among fatigue lasting for 1-5 months and other symptoms. The combination of fatigue of > or =6 months' duration and selected symptoms overlaps with published criteria used to define cases of chronic fatigue syndrome (CFS). Although symptoms described in this study were reported as appearing within the preceding month, and CFS symptoms must have been present for the previous 6 months, these results provide empirical support for the interrelations among unexplained fatigue of > or =6 months' duration and symptoms included in the CFS case definition.

Detecting Chronic Fatigue Syndrome: The Role of Counselors

Chronic fatigue syndrome (CFS) is a physical illness, the cause of which is unknown. Known also as chronic fatigue immune dysfunction syndrome and myalgic encepalomyelitis, the illness has a probable incidence of 2 to 3 per 1,000 among adults and adolescents and is seen also in children. Only a small minority of cases are diagnosed, and only 25% of those suffering from CFS suspect this as the diagnosis. For this reason, counselors often see persons with unsuspected cases and may play an important role in detecting and referring these clients appropriately. Case histories are used to illustrate how suspected cases of CFS can be distinguished from depression and other mental health conditions in counseling practice.

Chronic fatigue syndrome in psychiatric patients: lifetime and premorbid personal history of physical health.

This preliminary report compares a group of chronic fatigue syndrome (CFS) patients and controls on several variables of potential significance in the etiology of CFS. The lifetime prevalence of reported physical disorders was compared among 46 CFS psychiatric patients, 92 relatively physically healthy psychiatric patients (C-I), and 46 psychiatric patients selected without regard to physical health (C-II). All patients were matched on age, sex, and psychiatric diagnosis and were drawn from the same psychiatric practice. The same groups were compared on a 7-point scale of lifetime physical health by three raters independently evaluating physical health narratives of the CFS patients up to the time of onset of CFS and that of the controls up to the corresponding age. The CFS patients had a significantly higher reported lifetime prevalence of irritable bowel syndrome (IBS), infectious mononucleosis-like syndromes (IM), infectious mononucleosis-like syndromes two or more times (IM x 2), and herpes (other than genital or perioral herpes) than one or both control groups. The CFS group also had a higher incidence of allergic rhinitis or asthma, IBS, IM, and IM x 2 than the combined controls. On the independent ratings, the CFS patients had significantly more impaired physical health up to the time of onset of the CFS than C-I at a comparable age. The findings suggest that a general health factor may be involved in the pathogenesis of some cases of CFS.

A Doctor's Dilemma

INCREASING administrative and legal responsibilities have been added to the traditional roles of physicians. This became even clearer to me as a medical adviser to administrative law judges considering appeals of applicants who have been initially denied disability claims under the Social Security system. Guidelines are published listing specific medical requirements for disability under Social Security regulations. The physician's role is to interpret the medical guidelines and advise the judge if the objective medical data meet the requirements. However, what does one do when no objective medical data exist? I recently served as medical adviser in 3 cases of chronic fatigue syndrome (CFS) that created a dilemma. Chronic fatigue syndrome is characterized by a principal complaint of severe fatigue of at least 6 months' duration associated with appreciable disability and unexplained by recognized organic disease.^1,2A recent study³has concluded that adding cognitive behavior therapy to the medical

A doctor's dilemma. Is a diagnosis disabling or enabling?

INCREASING administrative and legal responsibilities have been added to the traditional roles of physicians. This became even clearer to me as a medical adviser to administrative law judges considering appeals of applicants who have been initially denied disability claims under the Social Security system. Guidelines are published listing specific medical requirements for disability under Social Security regulations. The physician's role is to interpret the medical guidelines and advise the judge if the objective medical data meet the requirements. However, what does one do when no objective medical data exist? I recently served as medical adviser in 3 cases of chronic fatigue syndrome (CFS) that created a dilemma. Chronic fatigue syndrome is characterized by a principal complaint of severe fatigue of at least 6 months' duration associated with appreciable disability and unexplained by recognized organic disease.1,2A recent study3has concluded that adding cognitive behavior therapy to the medical

A population-based incidence study of chronic fatigue.

Most research on syndromes of chronic fatigue has been conducted in clinical settings and is therefore subject to selection biases. We report a population-based incidence study of chronic fatigue (CF) and chronic fatigue syndrome (CFS). Questionnaires assessing fatigue and emotional morbidity were sent to 695 adult men and women who had replied to a postal questionnaire survey 1 year earlier. Possible CFS cases, subjects with probable psychiatric disorder and normal controls were interviewed. Baseline fatigue score, the level of emotional morbidity and a physical attribution for fatigue were risk factors for developing CF. However, after adjusting for confounding, premorbid fatigue score was the only significant predictor. A minority of CF subjects, all female, had consulted their general practitioner; higher levels of both fatigue and emotional morbidity were associated with consultation. Possible CFS cases reported similar rates of current and past psychiatric disorder to psychiatric controls, but after controlling for fatigue or a diagnosis of neurasthenia the current rates were more similar to those of normal controls. Two new cases of CFS were confirmed. Both fatigue and emotional morbidity are integral components of chronic fatigue syndromes. The demographic and psychiatric associations of CFS in clinical studies are at least partly determined by selection biases. Given that triggering and perpetuating factors may differ in CFS, studies that examine the similarities and differences between chronic fatigue syndromes and psychiatric disorder should consider both the stage of the illness and the research setting.

The Prevalence of Chronic Fatiguing Illnesses Among Adolescents in the United States

Objective. To compare the prevalence of unexplained chronic fatigue (CF) and chronic fatigue syndrome (CFS) among adolescents in three studies conducted by the Centers for Disease Control and Prevention and to compare these estimates with those for adults in two of the studies.Design. The studies used the following three designs: (i) a physician-based CFS surveillance system, (ii) a random, cross-sectional community telephone survey and (iii) a cross-sectional survey of school nurses.Setting. Surveillance included all patients with unexplained fatigue seen by participating physicians in four communities over a 2-year period; the community survey was conducted in a defined, urban population; and the survey of nurses included all middle, junior, and high school nurses in two communities.Patients or other participants. Twenty-three adolescent cases of unexplained chronic fatiguing illness were reported to the surveillance system, 7 of whom were classified with CFS. The community survey screened 2,249 persons between the ages of 2 and 17 years and identified 5 with unexplained chronic fatiguing illness, only one of whom might have had CFS. The school nurses identified 22 students with unexplained fatiguing illness, 10 of whom had received a diagnosis of CFS.Main outcome measures. The prevalence of unexplained chronic fatiguing illness was estimated in all three studies. The prevalence of CFS was estimated in one study, the prevalence of CFS-like illness was estimated in another, and the prevalence of a reported diagnosis of CFS was estimated in the third.Results. In general, the prevalence estimates of CF, CFS-like illness, and CFS for adolescents were lower than those for adults. One study also included children ages 2 to 11 years and found very little CF and no CFS. Cases of CFS among adolescents were evenly distributed across individual years of age.Conclusions. CFS was clearly present among adolescents, although the prevalence for this group was lower than for most adult age groups. Differences in prevalence estimates among the three studies were consistent with differences in study designs. The validity of adolescent/adult comparisons within each study should not be affected by the study design. Further study of the applicability of the current CFS case definition to adolescents is warranted.

The natural history of concurrent sick building syndrome and chronic fatigue syndrome

An outbreak of chronic fatigue syndrome linked with sick building syndrome was recently described as a new association. Whether chronic fatigue syndrome acquired in this setting tends to remit or, as sporadic cases often do, persist, is unknown. To clarify the natural history of chronic fatigue syndrome in association with sick building syndrome the 23 individuals involved in the outbreak were interviewed four years after the onset. In the previous interview one year after the onset of symptoms, 15 (including 5 with chronic fatigue syndrome and 10 with idiopathic chronic fatigue) of the 23 noted fatigue. Three years later 10 of the 15 were “fatigue free” or “much improved”. Five were only “some better”, “the same”, or “worse”. Three of the five people previously diagnosed with chronic fatigue syndrome were “much improved” (two) or “fatigue free” (one). The remaining two were seriously impaired, homebound and unable to work. The 10 individuals with substantially improved fatigue (three of the five with chronic fatigue syndrome and seven of the 10 with idiopathic chronic fatigue) were more likely to have noted improvement in nasal and sinus symptoms, sore throats, headaches, and tender cervical lymph nodes when compared to those with a lingering significant fatigue ( p < 0.001). Upper respiratory symptoms and headaches improved in those with reduced fatigue but remained problematic in those with persisting significant fatigue. We conclude that the fatigue related to sick building syndrome, including chronic fatigue syndrome, is significantly more likely to improve than fatigue identified in sporadic cases of chronic fatigue syndrome.

Epidemiologic advances in chronic fatigue syndrome

Epidemiologic studies of chronic fatigue syndrome (CFS) have been hampered by the absence of a specific diagnostic test, but with increasing interest in this disorder there has been a greater understanding of the risk factors, illness patterns, and other aspects of this multisystem disorder. Working case definitions have been developed for research purposes but they have continued to change over time and have not always been utilized precisely by various investigators. This has been a major factor in the widely varying estimates of prevalence rates, but two different studies using the same working definition and including a medical work-up have estimated the prevalence to be approximately 200 100 000 . Clusters of CFS cases, which appear to be related to earlier reports of “epidemic neuromyasthenia”, have attracted considerable attention and appear to be well documented, although investigated with varying methodology and often with dissimilar case definitions. Risk factors for cases occurring in clusters and sporadically appear to be similar, the most consistent ones being female gender and the co-existence of some form of stress, either physical or psychological. The prognosis of CFS is difficult to predict, although cases occurring as part of clusters appear to have a better prognosis as a group than sporadic cases, and those with an acute onset have a better prognosis than those with gradual onset. It is highly unlikely that there is a single agent, infectious or noninfectious, that is responsible for more than a small proportion of CFS cases and, at the present time, the risk factors for developing CFS appear to lie more prominently in the host rather than the environment.

Immunoglobulin subclass levels in chronic fatigue syndrome.

The levels of immunoglobulin subclasses were determined for 46 patients meeting the original Centers for Disease Control case definition of chronic fatigue syndrome and were compared to values obtained for 50 age- and gender-matched healthy volunteer blood donor controls. The levels of immunoglobulin subclasses in these groups were further compared to a third group of additional chronic fatigue syndrome cases from whom samples had been obtained and frozen prospectively over a period of 7 years. These data do not demonstrate significant immunoglobulin subclass deficiencies in patients with chronic fatigue syndrome.

A case-control study to assess possible triggers and cofactors in chronic fatigue syndrome

To assess possible triggers and cofactors for chronic fatigue syndrome (CFS) and to compare levels of selected cytokines between cases and an appropriately matched control group. We conducted a case-control study of 47 cases of CFS obtained through a regional CFS research program maintained at a tertiary care medical center. One age-, gender-, and neighborhood-matched control was identified for each case through systematic community telephone sampling. Standardized questionnaires were administered to cases and controls. Sera were assayed for transforming growth factor-beta (TGF-beta), interleukin-1 beta, interleukin-6, tumor necrosis factor-alpha, and antibody to Borrelia burgdorferi and Babesia microti. Cases were more likely to have exercised regularly before illness onset than controls (67% versus 40%; matched odds ratio (MOR) = 3.4; 95% CI = 1.2 to 11.8; P = 0.02). Female cases were more likely to be nulliparous prior to onset of CFS than controls (51% versus 31%; MOR = 8.0; 95% CI = 1.03 to 170; P = 0.05). History of other major factors, including silicone-gel breast implants (one female case and one female control), pre-morbid history of depression (15% of cases, 11% of controls) and history of allergies (66% of cases, 51% of controls) were similar for cases and controls. However, cases were more likely to have a diagnosis of depression subsequent to their diagnosis of CFS compared to a similar time frame for controls (MOR = undefined; 95% CI lower bound = 2.5; P < 0.001). Positive antibody titers to B burgdorferi (one case and one control) and B microti (zero cases and two controls) were also similar. Further investigation into the role of prior routine exercise as a cofactor for CFS is warranted. This study supports the concurrence of CFS and depression, although pre-morbid history of depression was similar for both groups.