Diagnosis Of Chronic Fatigue Syndrome Research Articles

Exploring levels of TSH and FT4 in patients with chronic fatigue syndrome (CFS), fibromyalgia (FM) and healthy controls did not reveal any associations between fatigue score and level of thyroid hormones

Aim The diagnoses of Chronic Fatigue Syndrome (CFS) and Fibromyalgia (FM) are highly associated with fatigue and pain, respectively. Physiologically and clinically an effect of thyroid status on fatigue and pain is expected. There may be clinically relevant differences in thyroid hormone axes though within values of reference in both patients with normal thyroid hormones, or in patients with well-regulated thyroid disease. These potential differences are explored in this study. Materials and methods In the present study, female patients with CFS (n = 49) and FM (n = 58) as well as female healthy controls (n = 53) were included. We explored plasma levels of TSH and FT4 between the groups using Kruskall-Wallis, and the relation between fatigue score and levels of TSH and FT4 by means of Spearman’s rho. Results There were no group differences between CFS patients, FM patients, and healthy controls in levels of TSH and FT4. Conclusion As one might clinically and physiologically expect an association between thyroid function and fatigue, which may be associated with clinical disorders such as CFS and FM, we suggest future studies to examine the field further by exploring the influence of thyroid receptors and responses of the thyroid hormone cascade.

The Significance of Chronic Fatigue in the Post-Covid Consultation and its Consequences for Outpatient Rehabilitation in the Context of Statutory Accident Insurance

The post-COVID consultation (PCC) is offered as part of a comprehensive range of treatment services provided by the statutory accident insurance for post-COVID patients to determine individual recommendations for further care. The aim of the study was to record the main symptoms and the associated restrictions on social and occupational participation in order to derive consequences for outpatient rehabilitation. In addition to a medical examination and a psychological consil, numerous assessments were carried out to evaluate the biopsychosocial state of health. 373 female (82.2%) and 81 male patients aged between 40 and 60 years from the professions of health and care services, education and pedagogy participated in the PCC since April 2021. Nearly all patients (98.2%) reported fatigue as a cardinal symptom of their post-COVID complaints, in combination with subjectively experienced limitations in brain functioning in over 73% of cases. The duration of the symptomatology persisted for an average of 14-15 months in both female and male insured persons. Thus, over 85% of the total sample can be classified as cases of chronic fatigue (Fatigue Scale). The severity of fatigue also proportionally affects quality of life (SF-36), feelings of anxiety and depression (HADS), psychological resilience (RS-13), and motor parameters such as maximum grip strength and endurance capacity. 54.3% of the patients also received a suspected mental diagnosis and 38.1% a recommendation for further neuropsychological diagnostics. For further treatment of the leading symptom of chronic fatigue, a multimodal and interdisciplinary outpatient rehabilitation is recommended, which should be oriented towards the treatment of the diagnosis of chronic fatigue syndrome (ME/CFS) and thus in particular towards a psychoeducational and rather than a curative therapeutic approach, and should consider aftercare strategies. Confirmed mental disorders and neuropsychological deficits are to be treated in addition.

Frequency and characteristics of chronic fatigue syndrome in multiple sclerosis patients at a university hospital in Eastern Saudi Arabia.

Multiple sclerosis (MS) is a chronic, inflammatory demyelinating disease that affects various parts of the central nervous system. Fatigue, a common symptom, transient, prolonged, or chronic experienced by individuals with MS, can significantly impact daily functioning. It can be associated with underlying pathological processes or can have an idiopathic cause, such as chronic fatigue syndrome (CFS). The study aimed to assess the presence and etiology of fatigue in MS patients and its relationship with CFS. This cross-sectional study was conducted in the Eastern Province of Saudi Arabia. Data were collected using a questionnaire from a sample of 225 MS patients receiving care at our university hospital. The questionnaire included the Centers for Disease Control and Prevention (CDC) criteria for diagnosing CFS and the Expanded Disability Status Scale to evaluate fatigue in MS patients. Of the total of 225 MS patients who participated in this study, 87.1% were diagnosed with relapsing-remitting MS, 6.7% with primary progressive MS, 3.6% with clinically isolated syndrome, and 2.7% with secondary progressive MS. About 53% had experienced fatigue that persisted for over 6 months. Analysis of CFS diagnosis revealed that 7.3% of patients met both CDC criteria and self-reported answers while 17.5% reported having CFS despite not meeting the CDC criteria. These findings highlight a significant lack of agreement between patient-reported diagnoses and established criteria, indicating poor agreement (P = 0.028). The study found an association between CFS and MS, and a significant impact on daily functioning. The study revealed lack of agreement between patient-reported diagnoses and established criteria for CFS. This emphasizes the need for a standardized approach to diagnosis and evaluation of fatigue in MS patients.

Increased risk of chronic fatigue syndrome following infection: a 17-year population-based cohort study

BackgroundPrevious serological studies have indicated an association between viruses and atypical pathogens and Chronic Fatigue Syndrome (CFS). This study aims to investigate the correlation between infections from common pathogens, including typical bacteria, and the subsequent risk of developing CFS. The analysis is based on data from Taiwan’s National Health Insurance Research Database.MethodsFrom 2000 to 2017, we included a total of 395,811 cases aged 20 years or older newly diagnosed with infection. The cases were matched 1:1 with controls using a propensity score and were followed up until diagnoses of CFS were made.ResultsThe Cox proportional hazards regression analysis was used to estimate the relationship between infection and the subsequent risk of CFS. The incidence density rates among non-infection and infection population were 3.67 and 5.40 per 1000 person‐years, respectively (adjusted hazard ratio [HR] = 1.5, with a 95% confidence interval [CI] 1.47–1.54). Patients infected with Varicella-zoster virus, Mycobacterium tuberculosis, Escherichia coli, Candida, Salmonella, Staphylococcus aureus and influenza virus had a significantly higher risk of CFS than those without these pathogens (p < 0.05). Patients taking doxycycline, azithromycin, moxifloxacin, levofloxacin, or ciprofloxacin had a significantly lower risk of CFS than patients in the corresponding control group (p < 0.05).ConclusionOur population-based retrospective cohort study found that infection with common pathogens, including bacteria, viruses, is associated with an increased risk of developing CFS.

A population-based investigation into the prevalence of chronic fatigue syndrome in United States military Veterans with chronic pain

ABSTRACT Objective Chronic fatigue syndrome (CFS) is a debilitating illness characterized by persistent fatigue among other symptoms. Pain symptoms are common and included in the diagnostic criteria for CFS but are not required for diagnosis. Despite the association between CFS and pain, few studies have examined CFS in the context of chronic pain (CP) conditions. The current study estimates the period prevalence of comorbid CFS among military Veterans with CP and compares sociodemographic characteristics and CP conditions of Veterans with CP + CFS to those with CP without CFS. Methods This study included Veterans Health Administration (VHA) data on 2,261,030 patients with chronic pain in 2018. Sociodemographic characteristics included age, sex, race, ethnicity, and rurality. Descriptive statistics were used to describe the sample and between-group comparisons included independent samples t-tests and chi-square tests of independence. Effect sizes were also examined. Results A total of 15,248 (0.67%) of Veterans with CP also had a diagnosis of CFS. Veterans diagnosed with CP + CFS were younger and were more likely to be female, White, non-Hispanic, and rural-dwelling. However, small and weak effect sizes were observed for these differences. The majority of Veterans with CP + CFS had limb/extremity (69.20%) back pain (53.44%), or abdominal/bowel pain (24.11%). Conclusion As CDC treatment recommendations for CFS include treating pain first, studying CFS in the context of CP is critically important. Veterans diagnosed with CP + CFS appear demographically similar, compared to Veterans with CP without CFS. Examining the utilization of pain-related healthcare services among this group would be a useful next step.

A phenomenological study on the lived experience of men with Chronic Fatigue Syndrome.

Whilst chronic fatigue syndrome (CFS) has been widely researched amongst women, studies investigating how men experience a CFS diagnosis is limited. This study utilised an interpretative phenomenological approach to interview five men who have a medical diagnosis of CFS. Six themes emerged to demonstrate the participants' experiences prior to, during and after obtaining their CFS diagnosis. Findings revealed that participants were initially reluctant to accept their condition, confounded by their perception that symptoms compromised their sense of masculinity. They also felt that healthcare professionals had limited recognition of CFS leading them to seek social support and legitimisation from other sources. The struggle to come to terms with a different lifestyle and sense of masculinity prevailed. Such knowledge could be effectively utilised by researchers, practitioners and employers to facilitate an increased understanding of male accounts of the condition and more bespoke interventions where required.

Influence of Chronic Fatigue Syndrome Codiagnosis on the Relationship between Perceived and Objective Psychoneuro-Immunoendocrine Disorders in Women with Fibromyalgia.

Although the predominant symptom in fibromyalgia (FM) is muscle pain, and fatigue in chronic fatigue syndrome (CFS), differential diagnosis is very difficult. This research investigates the psychoneuroimmunoendocrine disorders of FM patients and ascertains whether a previous CFS diagnosis affected them. Through accelerometry objective parameters, physical activity/sedentarism levels in relation to fatigue are studied, as well as whether perceived levels of stress, anxiety, and pain correspond to objective biomarkers, all of these with respect to a reference group (RG) of women without FM. FM patients have a worse psychological state and perceived quality of life than those with RG. These perceived outcomes are consistent with impaired objective levels of a sedentary lifestyle, higher systemic levels of cortisol and noradrenaline, and lower levels of serotonin. However, FM patients with a previous CFS diagnosis had lower systemic levels of IL-8, cortisol, oxytocin, and higher levels of adrenaline and serotonin than FM patients without diagnosed CFS. In conclusion, while perceived health parameters do not detect differences, when objective neuroimmunoendocrine parameters related to stress, inflammation, pain, and fatigue are used, people with CFS could be overdiagnosed with FM. This reinforces the need for objective biomarker assessment of these patients for better diagnostic discrimination between both syndromes.

PD05-02 SMALL FIBER POLYNEUROPATHY AS A THERAPEUTIC TARGET FOR PATIENTS WITH INTERSTITIAL CYSTITIS/BLADDER PAIN SYNDROME

You have accessJournal of UrologyCME1 Apr 2023PD05-02 SMALL FIBER POLYNEUROPATHY AS A THERAPEUTIC TARGET FOR PATIENTS WITH INTERSTITIAL CYSTITIS/BLADDER PAIN SYNDROME Wyatt Whitman, Maxwell Sandberg, Dylan Wolff, Raymond Xu, Tyler Overholt, Robert Evans, Catherine Matthews, Gopal Badlani, and Stephen Walker Wyatt WhitmanWyatt Whitman More articles by this author , Maxwell SandbergMaxwell Sandberg More articles by this author , Dylan WolffDylan Wolff More articles by this author , Raymond XuRaymond Xu More articles by this author , Tyler OverholtTyler Overholt More articles by this author , Robert EvansRobert Evans More articles by this author , Catherine MatthewsCatherine Matthews More articles by this author , Gopal BadlaniGopal Badlani More articles by this author , and Stephen WalkerStephen Walker More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003229.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In addition to a variety of co-occurring urological and non-urological symptoms and syndromes, we have found that ∼30% of patients with a diagnosis of interstitial cystitis/bladder pain syndrome (IC/BPS) also have small fiber polyneuropathy (SFPN). The objective of this study was to determine the association between SFPN and co-occurring symptoms and syndromes in IC/BPS patients. METHODS: Skin biopsies were taken from the distal calf of IC/BPS patients who were undergoing therapeutic hydrodistension (HOD). SFPN status (+ or -) was determined by counting intraepidermal nerve fibers (IENF) in a stained section from the biopsy and comparing the IENF density to normative reference values. Patient characteristics such as anesthetic bladder capacity (BC), Hunner lesion (HL) status, and glomerulations were determined at the time of hydrodistension under direct cystoscopy. Patient demographics, co-occurring medical conditions, and symptomatology was obtained via patient reports and review of medical records. To test for an association of SFPN+ with demographic and clinical characteristics, an optimized logistic regression model was created using variables with p<0.1 on univariable analysis and/or those with an established clinical relevance. Standard logistic regression diagnostics were utilized to ensure the model fit to the data RESULTS: Between October 2019 and April 2022 153 participants were enrolled (134F;19M). Mean age was 50.32 (±15.32). Overall, one third (50/153) were SFPN+. There was a statistically significant difference in the adjusted odds ratios (OR, [95% CI]) between the SFPN+ and SFPN- groups for chronic fatigue syndrome (3.054, [1.22, 7.68]) and diabetes mellitus (4.185, [1.471, 11.90]). CONCLUSIONS: SFPN is common in patients with IC/BPS and is significantly associated with concomitant diagnoses of chronic fatigue syndrome and diabetes mellitus. These findings suggest that for a large subset of IC/BPS patients that have a systemic pain disorder, SFPN may provide an important new therapeutic target. Source of Funding: R01 DK124599 © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e148 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Wyatt Whitman More articles by this author Maxwell Sandberg More articles by this author Dylan Wolff More articles by this author Raymond Xu More articles by this author Tyler Overholt More articles by this author Robert Evans More articles by this author Catherine Matthews More articles by this author Gopal Badlani More articles by this author Stephen Walker More articles by this author Expand All Advertisement PDF downloadLoading ...

Presence of depression and anxiety with distinct patterns of pharmacological treatments before the diagnosis of chronic fatigue syndrome: a population-based study in Taiwan

ObjectiveAn increased prevalence of psychiatric comorbidities (including depression and anxiety disorder) has been observed among patients with chronic fatigue syndrome (CFS). However, few studies have examined the presence of depression and anxiety disorder before the diagnosis of CFS. This study aimed to clarify the preexisting comorbidities and treatments associated with patients with subsequent CFS diagnosis in a population-based cohort in Taiwan.MethodsAn analysis utilizing the National Health Insurance Research Database of Taiwan was conducted. Participants included were 6303 patients with CFS newly diagnosed between 2000 and 2010 and 6303 age-/sex-matched controls.ResultsCompared with the control group, the CFS group had a higher prevalence of depression and anxiety disorder before the diagnosis of CFS. Sampled patients who took specific types of antidepressants, namely, selective serotonin reuptake inhibitors (adjusted odds ratio [aOR] = 1.21, 95% confidence interval [CI] 1.04–1.39), serotonin antagonists and reuptake inhibitors (SARI; aOR = 1.87, 95% CI 1.59–2.19), and tricyclic antidepressants (aOR = 1.46, 95% CI 1.09–1.95), had an increased risk of CFS. CFS risk was also higher among participants taking benzodiazepine, muscle relaxants, and analgesic drugs. A sub-group analysis revealed that SARI use was related to an increased risk of CFS in the depression, anxiety disorder, male, and female groups. In the depression and anxiety disorder groups, analgesic drug use was associated with an increased CFS risk. Nonpharmacological treatment administration differed between men and women.ConclusionThis population-based retrospective cohort study revealed an increased risk of CFS among populations with preexisting depression and anxiety disorder, especially those taking SARI and analgesic drugs.

Subjective and objective cognitive function in adolescent with chronic fatigue following Epstein-Barr virus infection

ObjectiveCognitive difficulties are among the most disruptive and disabling problems reported by chronic fatigue syndrome (CFS) sufferers. Acute Epstein-Barr virus (EBV) infection is a trigger of chronic fatigue (CF) and CFS. The aim of this study was to investigate subjectively reported and objectively measured cognitive functioning in fatigued and non-fatigued adolescents six months after EBV infection. MethodsA total of 195 adolescents (12–19 years) with acute EBV infection were followed prospectively for six months, after which they were grouped as chronically fatigued (CF+) and non-fatigued (CF−) cases based on questionnaire score; the CF+-group was further subgrouped according to CFS diagnosis. A group of 70 healthy controls was also included. Groups were cross-sectionally compared on objective measures of processing speed, executive functions and memory, and subjective cognitive functioning. ResultsThere were no group differences regarding objective cognitive measures, but the CF+-group reported significantly (p < 0.001) more cognitive problems (cognitive symptoms sum score = 9.5) compared to the CF−-group (cognitive symptoms sum score = 5.3) and the healthy control group (cognitive symptoms sum score = 6.4). The CFS subgroup rated symptoms scores even higher but did not differ on cognitive performance tests. ConclusionSubjective experiences of cognitive difficulties characterize adolescents with CF and CFS six months after acute EBV infection, whereas objective measures of cognitive impairment are inconspicuous.

The Relation of Pain, Fatigue, Disease Impact, and Psychological Factors with Physical Function in post-COVID-19 Syndrome, Fibromyalgia, and Chronic Fatigue Syndrome

This research sought to identify the relation of pain, fatigue, disease impact, and psychological factors with physical function in individuals with post-COVID-19 syndrome (post-COVID), fibromyalgia, chronic fatigue syndrome (CFS), and those with combined diagnoses of post-COVID, FMS, and/or CFS (multi-Dx). Individuals with post-COVID, fibromyalgia, or CFS were invited to complete an anonymous survey. The following patient-reported outcome measures were collected: PROMIS-Physical Function (PROMIS-PF), PROMIS-Pain Interference (PROMIS-PI), Pain Severity (NRS; 0-10), 2016 Fibromyalgia Diagnostic Criteria Survey (FSS), Fatigue Severity (NRS; 0-10), PROMIS-Fatigue, Multisensory Amplification Scale (MSAS), PROMIS-Sleep Disturbance (PROMIS-SD), PROMIS-Dyspnea Severity (PROMIS-DS), Symptom Impact Questionnaire-Revised (SIQR), Coping Strategies Questionnaire-Catastrophizing Subscale (CSQ-CAT), Tampa Scale of Kinesiophobia-11 (TSK-11), and Hospital Anxiety and Depression Scale (HADS). Stepwise multiple linear regressions examined relationships between symptoms, disease impact, and psychological factors on physical function in each cohort. Results show 707 individuals (294-males, 413-females) completed surveys including 203 post-COVID, 99 FMS, 87 CFS, and 318 multi-Dx. Physical function was impaired in each cohort (post-COVID: 40.7±8.6; FMS: 39.5±5.5; CFS: 39.5±7.2; multi-Dx: 39.3±5.5). Regression analyses were significant for post-COVID (R2=.668, p<.001), fibromyalgia (R2=.502, p<.001), CFS (R2=.663, p<.001), and multi-Dx (R2=.611, p<.001). Unique factors significantly predicted physical function in each cohort as follows: 1) Post-COVID - dyspnea (β=-.453, p<.001), fatigue (β=-.182, p=.003), pain interference (β=-.196, p=.007), anxiety (β=.138, p=.007), symptom impact (β=-.185, p=.026); 2) fibromyalgia - fatigue (β=-.470, p<.001), symptom impact (β=-.351, p<.001); 3) CFS - symptom impact (β=-.427, p<.001), anxiety (β=.328, p<.001), dyspnea (β=-.210, p=.007), fatigue (β=-.334, p<.001), sleep disturbance (β=.249, p=.002), kinesiphobia (β=-.200, p=.014); 4) multi-Dx - fatigue (β=-.350, p<.001), symptom impact (β=-.201, p<.001), sleep disturbance (β=-.183, p<.001), pain interference (β=-.181, p<.001). Disease impact and fatigue related to physical function in all cohorts while pain interference, dyspnea, sleep disturbance, and psychological factors had varying relationships with physical function among individuals with post-COVID, FMS, CFS, and multi-Dx. Grant support from National Institutes of Neurological Disease and Stroke (NINDS) of the NIH under Award Number U24NS112873-03S2.

Reducing fatigue-related symptoms in Long COVID-19: a preliminary report of a lymphatic drainage intervention.

IntroductionIn the early days of the first global wave of the COVID-19 pandemic, the potential for a postviral syndrome to manifest following COVID-19 infection was first recognized. Here, we present an analysis of a case series of the first 20 patients’ data collected in clinical practice to evaluate the potential of a possible alternative treatment for Long COVID.MethodsFace-to-face treatment sessions with Perrin techniqueTM practitioners occurred weekly involving effleurage/other manual articulatory techniques. The individuals being treated also undertook daily self-massage along with gentle mobility exercises. Patients recorded symptom severity using the self-report 54-item profile of fatigue-related states (PFRS) before and after treatment.ResultsThe mean age of male patients was 41.8 years (range, 29–53 years), and for female patients, 39.3 years (range, 28–50 years). None of the participants had a prior diagnosis of chronic fatigue syndrome, and all were new attendees to the clinics at the time of initial assessment. The average number of treatment sessions was 9.7 in men and 9.4 in women. The reduction in PFRS scores was 41.8% in men and 60.5% in women. The highest subscale scores on average were for fatigue, with the lowest for somatic symptoms. All subscale scores showed, on average, a similar reduction of approximately 50% postintervention, with the reduction in score relating to a decrease in the severity of symptoms.ConclusionOur findings suggest that a specific manual lymphatic drainage intervention may help to reduce fatigue symptoms related to Long COVID, perhaps preventing acute symptoms through early intervention.

The use of oxygen as a possible screening biomarker for the diagnosis of chronic fatigue

The aim of this study was to verify whether the mean percentage of oxygen use in the aerobic-anaerobic transition phase or isocapnic buffering (IB) was lower in women with chronic fatigue syndrome (CFS) compared to healthy women, and if this variable could be used as a screening biomarker for the diagnosis of CFS A cross-sectional study was conducted. Forty-four adult women (22 with CFS and 22 healthy) performed a cycle ergometer stress test with gas analyser (CPET). Maximum oxygen consumption (V˙O2 max), oxygen consumption at the anaerobic threshold (V˙O2 at Vt2), maximum ventilatory volume (V˙E max), time of maintenance of the isocapnic buffering phase (IB duration), and mean percentage of oxygen use in isocapnic buffering phase (% O2 use in IB) were analyzed. Data were explored from a principal component analysis. Groups were matched by propensity score to be mismatched in BMI and a comparison of means and medians was performed. A logistic regression model was built to predict the probability of CFS. The mean and median values of the variables obtained in the CPET was significantly higher in the healthy group compared to the CFS. In the logistic regression model, VO2 max, IB duration, and mean % of O2 use in IB were selected as predictors. The sensitivity and specificity were greater than 90%. The combination of the factors V˙O2 max, IB duration, and mean % of O2 use in IB can be used as a screening biomarker for the diagnosis of CFS.

How mycobacterium tuberculosis infection could lead to the increasing risks of chronic fatigue syndrome and the potential immunological effects: a population-based retrospective cohort study

BackgroundChronic fatigue syndrome (CFS) has been shown to be associated with infections. Tuberculosis (TB) is a highly prevalent infectious disease. Patients with chronic fatigue syndrome and post-tuberculosis experience similar symptoms. Furthermore, chronic fatigue syndrome and tuberculosis share similar plasma immunosignatures. This study aimed to clarify the risk of chronic fatigue syndrome following the diagnosis of Mycobacterium tuberculosis infection (MTI), by analyzing the National Health Insurance Research Database of Taiwan.Methods7666 patients aged 20 years or older with newly diagnosed Mycobacterium tuberculosis infection during 2000–2011 and 30,663 participants without Mycobacterium tuberculosis infection were identified. Both groups were followed up until the diagnoses of chronic fatigue syndrome were made at the end of 2011.ResultsThe relationship between Mycobacterium tuberculosis infection and the subsequent risk of chronic fatigue syndrome was estimated through Cox proportional hazards regression analysis, with the incidence density rates being 3.04 and 3.69 per 1000 person‐years among the non‐Mycobacterium tuberculosis infection and Mycobacterium tuberculosis infection populations, respectively (adjusted hazard ratio [HR] = 1.23, with 95% confidence interval [CI] 1.03–1.47). In the stratified analysis, the Mycobacterium tuberculosis infection group were consistently associated with a higher risk of chronic fatigue syndrome in the male sex (HR = 1.27, 95% CI 1.02–1.58) and age group of ≥ 65 years old (HR = 2.50, 95% CI 1.86–3.38).ConclusionsThe data from this population‐based retrospective cohort study revealed that Mycobacterium tuberculosis infection is associated with an elevated risk of subsequent chronic fatigue syndrome.

Синдром хронічної втоми, асоційований з герпесвірусними інфекціями

Синдром хронічної втоми (СХВ) є важливою медико-соціальною проблемою з огляду на великий вплив на якість життя й інвалідність у сучасній людській популяції. Слід розрізняти власне СХВ від аналогічного за клінічними проявами синдрому, зумовленого хронічною реактивованою лімфотропною герпесвірусною інфекцією, викликаною вірусом Епштейна — Барр, вірусом герпесу 6-го і 7-го типу і рідше — цитомегаловірусом. Вірусасоційована хвороба має двофазний перебіг із переважанням імунозапальних розладів протягом перших місяців/років і розвитком нейродегенерації за типом скроневого медіанного склерозу в подальшому. Оскільки загальновизнані нині критерії діагностики СХВ, запропоновані Centers for Disease Control and Prevention, не дозволяють відрізнити ці дві різнорідні хвороби, наріжним каменем діагностики є ідентифікація реактивованого герпесвірусу за результатами полімеразної ланцюгової реакції лейкоцитів крові (однак не сироватки крові) або виявлення специфічних антитіл до певних молекул вірусу, асоційованих з реактивацією. Другий важливий компонент діагностики — оцінка імунного статусу та ідентифікація на підставі отриманих даних імунодефіцитної хвороби, що є причиною підтримання хронічного реактивованого стану опортуністичного вірусу в організмі людини внаслідок послаблення імунного нагляду. Згідно з результатами контрольованих клінічних досліджень, при СХВ, асоційованому з герпесвірусною інфекцією, оптимальною є комбінована терапія, що включає ациклічний аналог гуанозину для пригнічення вірусної активності та агент адресної імунотерапії для компенсації причинної імунодефіцитної хвороби. Даний огляд присвячений всебічному висвітленню накопиченої доказової бази щодо етіології, патогенезу, діагностики і лікування СХВ, асоційованого з герпесвірусною інфекцією.

502 Idiopathic hypersomnia and co-occurring psychopathology among veterans

Abstract Introduction Idiopathic hypersomnia (IH) is relatively rare and characterized by excessive daytime sleepiness despite prolonged and undisturbed sleep as well as the absence of cataplexy and other causes of hypersomnolence. The etiology of IH is largely unknown. The present study capitalized on electronic medical record (EMR) data from the Veterans Health Administration (VHA) to create a cohort of veterans diagnosed with IH in order to: 1) estimate the prevalence of IH diagnosis in the VHA, and 2) identify co-occurring physical and behavioral health conditions to characterize IH in the sample. Methods Using 2009–19 VHA EMR data, we created two cohorts: those with an IH diagnosis (N = 3,674) or a hypersomnia diagnosis (e.g., primary hypersomnia) other than IH (N = 110,530). Diagnostic data (i.e., ICD 9 and 10 codes) were extracted for the 6-months prior to index diagnosis to examine group differences in the prevalence of physical and behavioral health conditions. Results Veterans diagnosed with IH, as compared to veterans with another hypersomnia disorder, were more likely to be female (30.1% vs 12.3%) and less likely to be obese (16% vs 28.3%; chi-squared = 79.27, p &amp;lt;.001), or carry diagnoses of diabetes (type 1 or 2; 9.7% vs 24.4%; chi-squared = 123.02, p &amp;lt;.001), or anxiety disorders (5.8% vs 9.5%; chi-squared = 16.83, p &amp;lt;.001). Individuals with IH were more likely to carry diagnoses of chronic fatigue syndrome (4.2% vs 1.6%; chi-squared = 45.91, p &amp;lt;.001), depression (31.3% vs 23.4%; chi-squared = 36.04, p &amp;lt;.001), and posttraumatic stress disorder (29.5% vs 26.5%; chi-squared = 5.79, p = .02). Conclusion Data suggest that veterans diagnosed with idiopathic hypersomnia may present with different diagnostic profiles than veterans with other hypersomnia disorders. Far more basic and clinical research is needed in IH. Support (if any) This work was supported by the Hypersomnia Foundation and in part by the VA Center of Excellence for Suicide Prevention in the Finger Lakes Healthcare System.

Chronic Fatigue Syndrome

Chronic fatigue syndrome is an enduring disease, characterized by a level of persistent fatigue for 6 months or a longer time period. At this time, the etiology is unknown. The other symptoms individuals effected by chronic fatigue syndrome, may experience are sore throat, headaches, impaired cognition, depression, sleep disturbances, and many others. While the diagnosis of chronic fatigue syndrome can be challenging, the Center for Disease Control (CDC) has a set of guidelines to help characterize the presence of this condition in patients. Chronic fatigue syndrome has far-reaching consequences impacting an individual’s physical and mental wellbeing. The best approach in helping these individuals to still engage in physical activity is through gentle, lowlevel exercise program with the use of patient feedback to individualize the treatment as well as providing guidance and support through support groups and therapy as prescribed by a medical professional.

Reliability and Validity of the Modified Korean Version of the Chalder Fatigue Scale (mKCFQ11).

Fatigue can accompany various diseases; however, fatigue itself is a key symptom for patients with chronic fatigue syndrome (CFS). Due to the absence of biological parameters for the diagnosis and severity of CFS, the assessment tool for the degree of fatigue is very important. This study aims to verify the reliability and validity of the modified Korean version of the Chalder Fatigue Scale (mKCFQ11). This study was performed using data from 97 participants (Male: 37, Female: 60) enrolled in a clinical trial for an intervention of CFS. The analyses of the coefficient between the mKCFQ11 score and the Fatigue Severity Scale (FSS), the Visual Analogue Scale (VAS) or the 36-item Short-Form Health Survey (SF-36) at two time points (baseline and 12 weeks) as well as their changed values were conducted. The mKCFQ11 showed strong reliability, as evidenced by the Cronbach’s alpha coefficient of 0.967 for the whole item and two subclasses (0.963 for physical and 0.958 for mental fatigue) along with the suitable validity of the mKCFQ11 structure shown by the principal component analysis. The mKCFQ11 scores also strongly correlated (higher than 0.7) with the VAS, FSS and SF-36 on all data from baseline and 12 weeks and changed values. This study demonstrated the clinical usefulness of the mKCFQ11 instrument, particularly in assessing the severity of fatigue and the evaluation of treatments for patients suffering from CFS.

Development and Validation of Questionnaire for Chronic Fatigue Syndrome (CFS) Diagnosis Based on Systemic Exertion Intolerance Disease (SEID) Criteria

Purpose: This study aimed to develop a questionnaire for the diagnosis of chronic fatigue syndrome (CFS) designed based on the systematic exertion intolerance disorder (SEID) criteria, and to validate the reliability of the questionnaire. Methods: A literature search on questionnaires for CFS diagnosis was conducted to develop a SEID questionnaire (SEID-Q27), followed by a pilot survey to identify the reliability of the questionnaire. Adults (Daejeon university personnel) with a Chalder fatigue scale (CFQ) score ≥15 were invited for the survey. We commenced the survey in November 2019 with a two weeks of interval for the test and retest method. The reliability of the questionnaire was investigated in three angles: 1. Cronbach’s α, 2. correlations (r) of the questions, numerical rating scale (NRS), and visual analog scale (VAS), and 3. kappa (k) analysis. Results: Among the total 275 adults registered, 55 (20%) participants with a CFQ score ≥15 were invited, and 31 (11%) [15 male, 16 female] completed the questionnaire. The total Cronbach’s α was 0.944 for the test and 0.949 for the retest. The reliability (r) of questions by CFQ score (≥15, ≥18, ≥20) ranged from 0.533–0.928 (p <0.05), and the r score of the NRS and VAS were the highest in CFQ scores ≥20, at 0.933 (p<0.001). The agreement rate of the SEID-Q27 between the test and retest was 87% (kappa k=0.743). Conclusions: The SEID-Q27 seems to be reliable. Further studies are needed to measure the validity of the tool and the cutoff point. Keywords: chronic fatigue syndrome, systemic exertion intolerance disease, reliability, diagnostic tool, survey questionnaire

Systemic Hyperalgesia in Females with Gulf War Illness, Chronic Fatigue Syndrome and Fibromyalgia

Pain is a diagnostic criterion for Gulf War Illness (GWI), Chronic Fatigue Syndrome (CFS), and fibromyalgia (FM). The physical sign of systemic hyperalgesia (tenderness) was assessed in 920 women who were stratified by 2000 Kansas GWI, 1994 CFS, and 1990 FM criteria. Pressure was applied by dolorimetry at 18 traditional tender points and the average pressure causing pain determined. GWI women were the most tender (2.9 ± 1.6 kg, mean ± SD, n = 70), followed by CFS/FM (3.1 ± 1.4 kg, n = 196), FM (3.9 ± 1.4 kg, n = 56), and CFS (5.8 ± 2.1 kg, n = 170) compared to controls (7.2 ± 2.4 kg, significantly highest by Mann-Whitney tests p < 0.0001, n = 428). Receiver operating characteristics set pressure thresholds of 4.0 kg to define GWI and CFS/FM (specificity 0.85, sensitivities 0.80 and 0.83, respectively), 4.5 kg for FM, and 6.0 kg for CFS. Pain, fatigue, quality of life, and CFS symptoms were equivalent for GWI, CFS/FM and CFS. Dolorimetry correlated with symptoms in GWI but not CFS or FM. Therefore, women with GWI, CFS and FM have systemic hyperalgesia compared to sedentary controls. The physical sign of tenderness may complement the symptoms of the Kansas criteria as a diagnostic criterion for GWI females, and aid in the diagnosis of CFS. Molecular mechanisms of systemic hyperalgesia may provide new insights into the neuropathology and treatments of these nociceptive, interoceptive and fatiguing illnesses.