CD-ROM Today 1996 January/CD-ROM Today 1996 January.iso/dp/0360/03603.txt

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$Unique_ID{BRK03603}
$Pretitle{}
$Title{Chronic Fatigue Syndrome}
$Subject{Chronic Fatigue Syndrome Chronic Fatigue Immune Dysfunction Syndrome
(CFIDS) Mononeucleosis Fibromyalgia}
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Copyright (C) 1986, 1987, 1988, 1989, 1990, 1991, 1992 National
Organization for Rare Disorders, Inc.

125:
Chronic Fatigue Syndrome

** IMPORTANT **
It is possible that the main title of the article (Chronic Fatigue
Syndrome) is not the name you expected.  Please check the SYNONYM listing to
find the alternate names and disorder subdivisions covered by this article.

Synonyms

     Chronic Fatigue Immune Dysfunction Syndrome (CFIDS)

Information on the following diseases can be found in the Related
Disorders section of this report:

     Mononeucleosis
     Fibromyalgia

General Discussion

** REMINDER **
The information contained in the Rare Disease Database is provided for
educational purposes only.  It should not be used for diagnostic or treatment
purposes.  If you wish to obtain more information about this disorder, please
contact your personal physician and/or the agencies listed in the "Resources"
section of this report.


Chronic Fatigue Syndrome is a controversial disorder that is
characterized by extreme fatigue that occurs after the abrupt onset of a flu-
like illness.  Symptoms may include muscle aches, a low grade fever, sore
throat or swollen glands.  The fatigue must persist for at least six months
and must significantly limit daily activities by about fifty percent under
the diagnostic criteria set for CFS by the Centers for Disease Control (CDC).
Other disabling symptoms that usually occur are painful lymph nodes in the
neck or armpits, generalized muscle weakness with pain, severe headaches,
joint pains that come and go, vision problems, and various psychological
complaints such as confusion, irritability, inability to concentrate,
depression and sleep disturbances.  A person must experience at least six of
these debilitating symptoms before a diagnosis can be made.

Symptoms do not always occur with the same degree of severity or at the
same time, and there are usually periods when symptoms disappear for awhile.
Most scientists believe Chronic Fatigue Syndrome is not contagious and blood
tests have proven to be of little value in diagnosing the syndrome as have
other laboratory tests.

Symptoms

Symptoms of Chronic Fatigue Syndrome must include at least six of the
following before a diagnosis can be made with certainty, and must limit daily
activities by at least fifty percent according to the diagnostic criteria
developed by Centers for Disease Control in Atlanta, Georgia.  The symptoms
are:  low-grade fever, sore throat, painful lymph nodes in the neck or
armpits, generalized weakness and pain or discomfort of the muscles or
joints, disabling fatigue lasting more than twenty-four hours after exercise
that would previously have been tolerated, severe headaches, visual or other
central nervous system involvement and sleep disturbances.  The fatigue must
last for at least six months.

Causes

The exact cause of Chronic Fatigue Syndrome is not known at this time
although researchers are continually working on identifying the cause.  There
are three different theories about possible causes of CFS, none of which have
been proven.  Many scientists generally feel that CFS is overdiagnosed and
that many people who have been told they have CFS do not.  Only those who fit
the strict diagnostic criteria set by the Centers for Disease Control
actually have CFS.

The first theory of the cause of CFS is the Viral Theory.  During 1990, a
team of researchers at the Wistar Institute isolated a virus from the blood
of adults and children with CFS.  The virus is a member of the Human T-Cell
Leukemia virus (HTLV) family.  Usually, the HTLV virus can cause T-Cell
malignancies such as Leukemia or Lymphoma.  The HTLV virus found in the blood
of people with CFS is similar, but not identical to the cancer causing virus,
and there is no evidence that people with CFS are at greater risk of getting
cancer.  It is not clear how or if the virus may be transmitted, nor is there
enough evidence yet to prove that this HTLV virus is the actual cause of CFS.
However, additional research on this specific virus may lead to a better
understanding of CFS if it is proven to be related to the syndrome.  Other
studies suggest that HHV-6, a herpes virus, may be partially responsible for
the development of CFS.  Scientists have found organic abnormalities in the
immune system of CFS patients, that, in conjunction with viral disease, may
cause the development of the disorder.

The second theory is that CFS is the result of the immune system's over-
reaction to infectious agents in highly allergic people.  Some researchers
suspect that chemicals called Cytokines (which help regulate the immune
system) cause the painful symptoms of CFS in persons with severe allergies.

The third theory is the most controversial.  It states that almost all
unexplained CFS cases occur in patients with prior or current psychiatric
problems, the most notable being depression.  No conclusion has been drawn
from this information since it is unclear which came first; the CFS or the
depression.

Affected Population

CFS affects women two out of three times more often than men.   Fatigue is a
common complaint of many people, and it is one of the most frequent reasons
that people visit doctors.  However, Chronic Fatigue Syndrome is rare because
few people fit the criteria for CFS accepted by the Centers for Disease
Control.  Other common causes of fatigue include anxiety, depression, sleep
disorders such as narcolepsy or sleep apnea, hypothyroidism, endocrine and
metabolic disorders, etc.  (For more information choose "Fatigue" as your
search term in the Rare Disease Database).

Related Disorders

Symptoms of the following disorders can be similar to those of Chronic
Fatigue Syndrome.  Comparisons may be useful for a differential diagnosis:

Mononucleosis, also known as "Glandular Fever" or the "Kissing Disease,"
is characterized by fever, fatigue, swollen glands and an abnormally large
number of lymphocytes (type of white blood cell) in the blood.  It is caused
by the Epstein-Barr virus.  It is a very common disorder which is most
prevalent in places where young people live together such as colleges and
military posts.  A simple blood test can diagnose mononucleosis.   In the
U.S., 80% of adults have antibodies to the Epstein-Barr virus in their blood
indicating that 80% of people have had mononucleosis during childhood or
young adulthood.  Therefore, Epstein-Barr antibody tests are not a tool for
diagnosing Chronic Fatigue Syndrome.

Fibromyalgia is a syndrome characterized by chronic muscle pain and
fatigue.  The onset of pain is sudden and aggravated by movement.  Fever is
not characteristic and only occurs when there is a provoking condition such
as an infection.  Like CFS, there is no clear-cut laboratory diagnostic
tests.  The two disorders, CFS and Fibromyalgia, share many of the same
symptoms and some scientists believe that they may be variations of the same
illness.  (For more information on this disorder, choose "Fibromyalgia" as
your search term in the Rare Disease Database).

There are many other disorders that can cause fatigue.  Patients with
excessive fatigue should have a complete physical examination to rule out
other causes before the diagnosis of CFS can be made.

Therapies:  Standard

There are no specific laboratory tests (blood or urine tests, etc.) that can
diagnose CFS.  There are no treatments proven to alleviate its symptoms.
Vitamins, anti-viral medications (acyclovir) and other drugs have not proven
effective.  Recommended treatment is rest, good balanced diet, exercise, and
waiting for symptoms to improve.  Most patients fully recover within six
months to two years with no treatment.  Unfortunately, CFS has been one of
the primary disorders that attracts quackery and patients should guard
against unproven treatments.

Therapies:  Investigational

Researchers are studying the involvement of the endocrine system in Chronic
Fatigue Syndrome, and the possibility of excessive levels of endorphins in
the brains of patients with this disorder.  Experimental studies with the
drug Naltrexone are underway.  Naltrexone is a drug that is ordinarily used
to control withdrawal from narcotics.  Some scientists believe that high
levels of endorphins in the brains of people with Chronic Fatigue Syndrome
may cause the symptoms of this disease.

Other studies on the use of gammaglobulin (immunoglobulin) are underway,
but in the absence of well controlled clinical trials it is difficult to
determine whether this or any other drug treatment is useful because CFS
symptoms wax and wane, and most patients recover without treatment in six
months to two years.

A Scandinavian drug company, Scotia, has developed a new drug for the
treatment of Chronic Fatigue Syndrome.  It is being manufactured under the
name Efamol Marine.  It is a combination of gamma-linolenic acid and
eicosapentaenoic acid.  This drug is not available in the United States.

The FDA has refused to allow HEM Pharmaceuticals to give the drug Ampligen to
a broader spectrum of patients until the problem of serious side effects is
cleared up.  The drug has been used in a very small clinical trial; however,
irregular heartbeat may be potentially life-threatening.

This disease entry is based upon medical information available through
February 1992.  Since NORD's resources are limited, it is not possible to
keep every entry in the Rare Disease Database completely current and
accurate.  Please check with the agencies listed in the Resources section for
the most current information about this disorder.

Resources

     National Organization for Rare Disorders (NORD)
     P.O. Box 8923
     New Fairfield, CT  06812-1783
     [phone]

     Chronic Fatigue & Immune Dysfunction Syndrome Association
     P.O. Box 220398
     Charlotte, NC  28222
     [phone]

     National Chronic Fatigue Syndrome Association
     3521 Broadway, Suite 222
     Kansas City, MO  64111
     [phone]

     American CFIDS Association
     4500 Summer Ave., Suite 149
     Memphis, TN  38122
     [phone] or [phone]

     NIH/National Institute of Allergy and Infectious Disease
     9000 Rockville Pike
     Bethesda, MD  20892
     [phone]

     Centers for Disease Control (CDC)
     Office of Public Inquiries
     1600 Clifton Rd. NE
     Atlanta, GA 30333
     404-639-3534

References

CHRONIC FATIGUE SYNDROME, Harvard Med Sch Health Lt. (July, 1988, Vol. 13
(9)).  Pp. 1-3.

CHRONIC FATIGUE; ALL IN THE MIND?, Consumer Reports, (October, 1990, Vol
55 (10)).  Pp. 671-675.

THE LOW YIELD OF PHYSICAL EXAMINATIONS AND LABORATORY INVESTIGATIONS OF
PATIENTS WITH CHRONIC FATIGUE.  T.J. Lane, et al.; Am J Med Sci (May, 1990,
issue 299 (5)).  Pp. 313-318.

HIGH FREQUENCY OF FIBROMYALGIA IN PATIENTS WITH CHRONIC FATIGUE SEEN IN A
PRIMARY CARE PRACTICE.  D.L. Goldenberg, et al.; Arthritis Rheum, (March,
1990. issue 33 (3)).  Pp. 381-387.

CHRONIC FATIGUE.  A PROSPECTIVE CLINICAL AND VIROLOGIC STUDY.  D. Gold,
et al.; JAMA (July 4, 1990, issue 246 (1)).  Pp. 48-53.