Chronic fatigue syndrome ICD code 10. Causes, symptoms and treatment of chronic fatigue syndrome

CFS/ ME - Chronic fatigue syndrome/Myalgic encephalomyelitis in English.

Chronic Fatigue Syndrome - these three words, although they do not describe, but contain the transformation of my life into my daily suffering, my disability, pain and weakness of the body ...

For a while, CFS was again referred to by the name ME, which sounds like myalgic encephalomyelitis.

Some information about ME/CFS, translated by me from the Cfs-Aktuell.de pages, which always offer the latest news on the topic of ME/CFS and have many translations of English articles.

This information may differ significantly from what you already know or find in Russian.

DATA:

The disease Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a little-known disease in Germany.

In the US, it is also known as Chronic Fatigue Immune Dysfunction Syndrome - CFIDS

And in the UK it's called myalgic encephalomyelitis - ME.

The World Health Organization classifies it as a neurological disorder (ICD-10: G 93.3 below).

Doctors and patients alike are perplexed when faced with the massive, extremely debilitating symptoms of CFS.

Often, patients are so ill that they no longer work for many months and years, and sometimes they cannot even manage the simplest daily activities, while the usual methods of physical examinations are positive.

This contradiction and lack of knowledge about the disease is unbearable, both for the patients themselves, and for their environment and their doctors.

It is this contradiction and lack of knowledge about the disease that further exacerbate the already precarious situation of patients.

Often, they are misdiagnosed as mentally ill. And doctors, as well as family and friends, see them as malingerers, hypochondriacs, or just lazy people.

Scientists and patients are in favor of separating CFS as a concomitant syndrome from CFS/ME as a separate, distinct independent serious disease.

Recently, scientists have begun to separate Chronic Fatigue Syndrome and Myalgic Encephalomyelitis. For example, they studied pain and exhaustion in patients with depression, fibromyalgia, and myalgic encephalomyelitis.

The use of "fatigue" as the name of an illness gives it an exclusive emphasis and is the most confusing and misused criterion.
No other disease that has fatigue is attached to the name "chronic fatigue".

For example, Cancer/Chronic Fatigue, Multiple Sclerosis/Chronic Fatigue -- excluding ME/CFS (ME/CFS).
Fatigue in other cases is usually proportional to exertion or duration with rapid recovery and will recur to the same extent, with the same exertion and duration, as on the same or next day.
The pathologically low ME fatigue threshold described in the following criteria often occurs with minimal physical or mental exertion and with reduced ability to undertake the same activity for the same or several days.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3427890/

What is chronic fatigue?

Chronic fatigue is a serious condition that often leads to severe disability. According to the latest international studies, this is a violation in a characteristic way of neuroendocrine and immunological control schemes and, consequently, their functions.

CFS is characterized by flu-like symptoms and extreme physical and mental fatigue following minimal activity.

It is called chronic fatigue syndrome only when the condition persists for more than 6 months and no other cause has been found.

In the International Classification of Diseases (ICD 10) of the World Health Organization (WHO), CFS is coded as a neurological disorder under code G 93.3.

The US health authorities first identified CFS in 1988 and gave it that name.
Studies have used a revised version of this definition since 1994.

What are the main symptoms of CFS?

In addition to the symptom of continued and overwhelming emaciation, there are others, such as:
- headache,
- sore throat,
- sensitive lymph nodes,
- muscle and joint pain,
- impaired concentration and memory,
- non-recoverable sleep and
- continued deterioration after exercise.

There are also:
- allergy,
- dizziness and
- coordination disorders, visual impairment,
- violation of temperature control,
- depression,
- sleep disturbance,
- tingling and nervous twitching
- recurrent infections
- gastrointestinal disorders and
- chemical sensitivity.

It should be noted that not all patients experience the same symptoms. Some of them have only minor pain symptoms, while others have pain in the foreground.

New symptoms should always be investigated medically, as they may be signs of other illnesses.

What are the causes of chronic fatigue syndrome (CFS)? What causes this disease?

Despite intensive international research in recent years, the causes and mechanisms of the disease are not yet clear.

There are typical predisposing and precipitating factors, however, about 75 percent of those who get sick have CFS onset abruptly, usually after a "trivial" infection.

In addition, accidents, surgeries, vaccinations, or exposure to toxic chemicals are cited as a trigger.

The remaining 25 percent report an insidious beginning.

After a recent study, a genetic predisposition is most likely confirmed.

Recent studies such as Martin Pall suggest that the central, self-reinforcing mechanism of disease is described as the NO/ONOO cycle. He claims that these mechanisms explain many multisystem diseases such as fibromyalgia, Gulf War syndrome, and multiple chemical sensitivity.

Also, according to the theory of some experts and, in particular, Judy Mikovits, ME appeared as a result of vaccination against polio, when the first vaccines were cultured from mice in the very early days.
And already this, as a result, contributed to the emergence of a retrovirus in people who already had transmitted from vaccinated to unvaccinated.

How long does CFS last?

The duration of CFS varies greatly, depending on the severity of the disease.

Some patients recover after a few months, others are severely limited for many years. However, most of those who get sick get better over time, but make them more or less limited again, allowing them to still participate in life and lead a fulfilling life.

It is very important not to set unrealistic goals!

You can make many small changes every day that will eventually lead to improvement.

Don't lose hope, but imagine also that the disease can take a long time.

There are quite different treatment approaches that alleviate symptoms and may improve the chances of recovery. It is important that through lifestyle changes to avoid overwork, and therefore possible relapses (worsening).

Will I be healthy again?

Complete recovery is very rare. Reputable studies report 2-12 percent complete recovery.

It is not known how many people managed to restore the ability to work that they had before the onset of the disease.

The severity of CFS varies greatly.

Some patients have a relatively mild form that lasts less than a year, others stay home for years or are even bedridden.

It is believed that the chances of a full recovery are less, the longer the disease lasts.

However, most of those who get sick over time recover only to a certain extent, and few get worse and worse.

Fluctuations in symptoms and relapses are normal phenomena belonging to CFS, which must be learned to cope.

Recovery is not a straight line, but includes these fluctuations.

It is often difficult not to get frustrated by temporary relapses (worsening).

Is there a cure for CFS?

Treatment that acts on the causes of CFS still does not exist.

However, there are many ways to relieve symptoms.

Crucial is the management of the Pacing disease.

This load limit can be very variable and is determined by the patient using cardiac monitoring.

If there is an aggravation of symptoms, which often occurs only with a delay of 24 to 48 hours, then the limit has been exceeded and the load must be reduced.

Only then does the body have the ability to heal itself. Proper stimulation means finding the right balance between activity and rest, and this can be an important key to recovery.

After the first stage of the disease or during periods of relapse, it makes sense to limit activity, but it is also important not to lower the load limit for a long time. A certain load is applied, which can then be expanded over time.

Symptoms such as sleep disorders, allergies, pain and depression can be treated with medication. It should be noted, however, that many patients are extremely sensitive to drugs. Thus, one should start with small doses of each.

In some cases, dietary supplements such as vitamins and minerals may be appropriate. However, any medication should be discussed with your doctor.

Can you die from CFS?

CFS is not a progressive or fatal disease. However, in severe cases, it leads to complications, such as in other life-threatening chronic diseases.

Therefore, it is important to isolate new or more developing symptoms, not immediately classify them as a diagnosis of CFS, but to conduct examinations.

In general, people don't die from CFS. It happens, however, that those who, due to the consequences of this disease, find themselves in difficult psychosocial conditions, reach despair and suicide.

Thus, psychological treatment is urgently needed if suicidal thoughts occur.

How to find a doctor who is familiar with CFS?

The first and main point of contact should always be with the family doctor.

Choose where there is a doctor who is ready to deal with this difficult disease and take care of you.

In Germany, unlike other countries, unfortunately, there is no such list of available "specialists".

Until now, only a few doctors are intensively involved in CFS. There are no specialized clinics.

Often patients are referred to psychosomatic clinics, but experience has shown that there are still no treatments that are suitable for CFS patients.

Many patients with ME/CFS who have left behind the psychosomatic clinic feel much worse after treatment than before, because they cannot cope with the stresses of everyday life in the clinic.

The treatments offered there do not help according to the experience of CFS/ME and rather cause worsening of symptoms or severe relapses.

Attention, also to "miracle healers" of any kind, who lure with promises of salvation and charge rather high fees.

The same is true for alternative forms of treatment, although they may well provide symptomatic relief.

How is CFS diagnosed?

There are no laboratory tests that can determine CFS positive, although some special laboratory values are often abnormal.

Since routine laboratory tests often fail, patients are easily pushed into the "psychosomatic corner" and referred to a psychiatrist.

However, specific tests directed at characteristic immunological and endocrine disorders lead to significant and characteristic findings. These tests are correspondingly costly and also not well known in Germany.

In any case, a careful history and careful physical examination is necessary to rule out other diseases that may have similar symptoms.

Only when a certain group of symptoms develops, which corresponds to the international definition of 1994 (Fukuda), can one speak of CFS (CFS).

In addition to the major severe wasting criterion, four of the so-called minor criteria must be met.

They include:
- non-restorative sleep,
- sensitive lymph nodes, sore throat,
- muscle and joint pain, new type of headaches,
- severe disorders of concentration and memory,
- general malaise after exercise that lasts longer than 24 hours.

When someone is exhausted for a long time, there can be many other reasons for this.

Only a small percentage of these people actually suffer from chronic fatigue syndrome.

Even after cancer treatment, for example, people often suffer from "fatigue." But this is another reason, therefore, as a rule, it is well treated.

Is CFS an appropriate name for this condition? Why are there different names for it?

Many sufferers dismiss the name CFS on the grounds that it doesn't describe the severity of the symptoms somehow more accurately than if you called tuberculosis like chronic cough syndrome or Parkinson's disease - chronic shaking.

The term "fatigue" is a harmless-sounding name for extreme weakness and performance limitation that is incomparable to the normal everyday fatigue of a healthy person.

In the first official description of the disease by the US health authorities, the CDC since 1988, however, the name CFS was chosen to emphasize the leading main symptom, emaciation.

This definition was taken mainly for pragmatic reasons, in order to have a working basis for further research in this disease, in which differences from other wasting conditions are possible.

In other countries, some other names exist, for example:
- in the UK - ME myalgic encephalopathy,
- in the USA - CFIDS - Chronic Fatigue and Immune Dysfunction Syndrome,
- in Australia - PVS - post viral syndrome.

At the request of the United States Department of Health, an international working group of CFS researchers, doctors, and patient advocates has been meeting for several years to establish a new name that would directly point to the causes and mechanisms of the disease and its main symptoms.

However, no agreement acceptable to all can yet be reached.

The name is discussed - Neuroendocrine immune disorder (NEID), reflecting the repeatedly proven disorders of the neuroendocrine and immunological control circuits.

Is CFS contagious or hereditary?

CFS is not known to be passed from person to person, but it is becoming more common in some families. This may be due to environmental or genetic factors, which indicate research on US twins and genome analysis at the University of Glasgow is currently under way.

Since CFS sometimes flares up, even as an epidemic, it is believed that although a virus caused CFS in these cases, it is not contagious.

Whether or not a patient develops CFS upon contact with a viral infection is a matter of individual predisposition.

Recent epidemiological studies from the US, Australia and Taiwan (Keyword: Dubbo studies and dengue fever) show that every certain percentage of people who have had an acute infection have developed CFS.

In Germany, the head of the Robert Koch Institute banned blood and organ donations from CFS patients until the causes of CFS were clarified.

Belgian researcher Kenny De Meer Leir reports cases that have occurred as a result of blood transfusions or organ transplants.

Who gets CFS?

CFS affects people of all ages, social classes and ethnic groups.

Children 12 years of age and young adults develop CFS. The most common manifestation is between 30 and 45 years of age.

About two-thirds of the affected people are women. The cause is unknown, but many immunological diseases are female-dominated.

How many sick people are there in Germany?

There are no frequency studies in Germany. However, in the UK and the US, so-called prevalence studies have been carried out, leading to an increase in the disease from 0.24 percent to 0.42 percent of the population.

In Germany, between 300,000 and 400,000 cases are expected. Since CFS is little known in Germany to both doctors, health authorities and the public it can still be assumed that more than 90 percent of affected people have received a correct diagnosis or not.

In addition, in Germany, in the usual classification of diseases, CFS, for some unknown reason, is considered as “somatoform disorders”. A simple equation from "not found" leads to "psychosomatic/somatoform" and means that patients with ME/CFS are often misdiagnosed with psychiatry, which leads to extreme difficulties.

In addition to stigmatization and the refusal of doctors to treat symptomatic patients, they are often denied pensions and so on.

Secondary, emerging psychiatric disorders such as (often) reactive depression account for the cause of the disease, with fatal consequences for those who become ill.

CFS - a new disease?

No.
CFS has been described in the medical literature for centuries. An epidemic like an outbreak in a London hospital in 1955 has received quite a bit of attention in the literature. Dr. Melvin Ramsay, who described the outbreak, then gave it the common name in the UK, myalgic encephalomyelitis (ME).

However, some researchers believe that CFS has increased significantly since the 1980s and is merely an expression of a range of multisystem environmental diseases.

In the 1980s, there were outbreaks of a group type everywhere in the United States that knocked down hundreds and thousands of people.

Their initiative and the pressure from physicians that took place in practice in such groups (such as Daniel Peterson, David Bell, Charles Lapp, Paul Cheney, Nancy Klimas and others) eventually led to the term "CFS" adopted by the health authorities. USA.

How do I explain CFS to my friends, my family, and my employer?

Undoubtedly, it is difficult to explain a disease that is associated with very strong functional impairment, but which is not “seen” and cannot be detected using standard laboratory tests.

Fluctuations in symptoms in patients are very difficult to understand by people from the outside. Patients are often confronted with doubt, distrust, and statements like, "I'm tired too" or "Pick it up once and then it'll work out," or "It's all just mental, of course."

Explain to those around you that your fatigue is by no means comparable to that of a healthy person. Not only is it a much more massive, in terms of severe illness, flu-like feeling, but it is not ameliorated by sleep or rest.

Explain that if you overexert yourself, you will feel worse afterwards and that it is not a matter of will.

Set clear boundaries.

Provide links to international research results that repeatedly show that CFS is a serious organic disease and psychological problems are usually only a consequence, not a cause of your condition.

In this case, find advice and support in a self-help organization.

Published in March 2008, Daphne Wurzbacher's book Living with CFS/ME gives a very good impression of the devastating effects of this disease and can make it clear to a doubting relative, friend and professional helper that the affected person is not just "always tired" but seriously ill.

Does stress play a role?

Often, patients report that they were exposed to long-term stress prior to the onset of CFS. Stress is the cause of many possible factors, but is not the cause of disease.

Martin Poll lists various stressors that are suitable triggers for multisystem disease.

In addition to infections, psychological stress is also included. Stress can be a disease-related factor and should be reduced as much as possible.

After the outbreak of the disease in general, all patients have very weak stress resistance.
Normal stresses for many people, such as light and noise, can very quickly lead to temperature fluctuations, sensorimotor and emotional problems, to the limits of the CFS patient and lead to worsening of his symptoms.

Can I work with CFS?

This is highly dependent on individual symptoms and the specific requirements of your job.
Some people who have a relatively mild form of CFS can keep their jobs, albeit with difficulty, if they give up any further activities.

You can try to work part-time. But there are patients who are no longer able to work.

According to a study in the US about 53 percent of those who work in some form.

The decision to change careers or retire should always be carefully considered.

If necessary, consult with an employee of your company or other consultant about your disability.

Why has CFS been ignored by doctors for so long and misunderstood?

ME/CFS is not a fatal and/or contagious disease such as HIV.

Consequently, for health authorities, the need for action seems to be less relevant and is not a major topic for physician training. But in vain.

Conventional laboratory tests for CFS often show no abnormalities that would have "clinical significance" from the point of view of physicians.

Especially in Germany and German-speaking countries, it is customary to include diseases that are "not associated with any known disease" and should be classified as "somatoform disorders".

This means - for medical professionals, patients no longer meet their specialization, but are referred to a psychologist or psychiatrist.

Due to a lack of understanding of the problem, there are no funds to conduct biomedical research into the causes of ME/CFS in Germany.

In other countries, such as the US, UK and Belgium, there will be significant funding from governments as well.

In the UK, there should be public funding to ensure that people who get sick are supported through the National Health Service.

In Germany, however, there is not yet even a consultation center or special medical service centers.

Is ME/CFS a depression or mental disorder?

Primary psychiatric disorders such as depression or Majore eating disorders are exclusion criteria for CFS.

Numerous international studies show important biochemical and symptomatic differences between patients with depression and those with CFS.

However, depression occurs in many CFS patients, as in many other chronic diseases, as a secondary symptom and as such also needs to be treated.

In the history of medicine and until recently, illnesses whose causes are not yet understood have often been called hysteria, depression, somatoform disorders or "psychological factors".

Examples include multiple sclerosis, tuberculosis, and gastrointestinal diseases caused by Helicobacter pylori.

What can I do to feel better?

Pay attention to your body signals!

When exceeding - too long and too strong maximum load (determined subjectively!), Serious relapses can occur.

Patients' organizations in the UK and the USA recommend the "Pacing" concept, that is, their own assessment of the possibilities corresponding to the load, at which its limit should not be exceeded.

This lifestyle change promotes the healing process and allows for expansion of exercise limits over time.

Excessive overload is just as harmful as constant underload!

At the same time, some patients feel so bad that they can hardly get out of bed for a long time.

Manage your financial affairs and professional prospects so as to keep the stress as low as possible as a result.

Creating an environment where you can relax and find long-term support. Never give up, look for these conditions, even if they are hard to come by.

Since there is still no cure for CFS, it is important to learn how to live with the disease.

And this means living in such a way that the symptoms do not become stronger, but weaken.

The experiences of thousands of patients have been included in short messages which are compiled by the UK Patients' Organization in one of their DOE brochures Living with CFS:

1. “Learn to manage your energy and equally your physical, mental and emotional activity.

Become an expert in disease control and you will be in control of your life.

2. Treat the symptoms that hurt you the most so they don't define your life. These include pain, sleep disturbance and depression.

Symptoms that you can't control can be your path to recovery.
Your doctor can help you manage your side effects by prescribing appropriate medications.
There are other strategies that can help you.
Share your activity, take breaks, and reduce your activity level.
In addition, you may benefit from relaxation techniques or complementary therapies.

3. Build a good collaborative relationship with your family doctor.
This may take some time, and in some cases, can be difficult, but the overall approach of partnering with your doctor can be the deciding factor in order to stabilize your health and allow recovery.

4. Always remember that you can recover from ME/CFS!
Learn to accept your condition, only in this way the likelihood that you will recover increases.

5. You are not alone in your condition!
In the UK, an estimated 240,000 people are affected, in Germany (300,000 - 400,000).

chronic fatigue syndrome- This article or section needs to be revised. Please improve the article in accordance with the rules for writing articles ... Wikipedia

chronic fatigue syndrome- - a state of persistent neuropsychic exhaustion of a complex and completely unexplored etiology, includes somatogenic, procedural and psychogenically conditioned asthenic conditions. See Neurasthenia. * * * Constant fatigue with a decrease ... ... Encyclopedic Dictionary of Psychology and Pedagogy

Chronic Fatigue Syndrome- see Myalgic encephalomyelitis. Source: Medical Dictionary... medical terms

chronic fatigue syndrome- Chronic fatigue syndrome / Fatigue syndrome after a viral illness / Benign myalgic encephalomyelitis ICD 10 G93.3 ICD 9 780.71 DiseasesDB ... Wikipedia

irritable bowel syndrome- ICD 10 K58.58. ICD 9 564.1564.1 DiseasesDB ... Wikipedia

Honey. Myofascial syndrome is local pain and tension in certain areas of the skeletal muscles. The predominant age is over 20 years. The predominant gender is female. Risk factors Excessive exercise Prolonged static stress,… … Disease Handbook

Chinese Syndrome- This term has other meanings, see Chinese Syndrome (meanings). China syndrome (eng. China Syndrome) is an ironic expression that originally denoted a hypothetical severe accident at a nuclear power plant with a meltdown ... ... Wikipedia

CFS- chronic fatigue syndrome... Dictionary of abbreviations of the Russian language

Honey. Fibromyalgia is a rheumatic disease characterized by generalized muscle weakness (feeling tired) and tenderness on palpation of characteristic areas of the body, referred to as tender points. Frequency 3% of the adult population ... Disease Handbook

fibromyalgia- Rice. 1. Location of sensitive points in fibromyalgia ICD 10 M79.779.7 ... Wikipedia

Books

Pathophysiological mechanisms of chronic fatigue syndrome, A. A. Podkolzin. Chronic fatigue syndrome (CFS) is a new pathology of the modern age, a disease of civilized countries associated with the characteristics and type of life of the population of large cities, the general ecological…

Excluded:

fever of unknown origin (during) (at):
- childbirth (O75.2)
- newborn (P81.9)
puerperal fever NOS (O86.4)

Pain in the face

Excluded:

atypical facial pain (G50.1)
migraine and other headache syndromes (G43-G44)
trigeminal neuralgia (G50.0)

Includes: pain that cannot be attributed to any particular organ or part of the body

Excluded:

chronic pain personality syndrome (F62.8)
headache (R51)
pain in):
- abdomen (R10.-)
- back (M54.9)
- mammary gland (N64.4)
- chest (R07.1-R07.4)
- ear (H92.0)
- pelvis (H57.1)
- joint (M25.5)
- limbs (M79.6)
- lumbar region (M54.5)
- pelvis and perineum (R10.2)
- psychogenic (F45.4)
- shoulder (M25.5)
- spine (M54.-)
- throat (R07.0)
- language (K14.6)
- dental (K08.8)
renal colic (N23)

General physical exhaustion

Excluded:

weakness:
- congenital (P96.9)
- senile (R54)
exhaustion and fatigue (due to) (with):
- nervous demobilization (F43.0)
- overvoltage (T73.3)
- hazard (T73.2)
- heat exposure (T67.-)
- neurasthenia (F48.0)
- pregnancy (O26.8)
- frailty (R54)
fatigue syndrome (F48.0)
after a viral illness (G93.3)

Old age without mention of psychosis

Senile:

asthenia
weakness

Excludes: senile psychosis (F03)

Brief loss of consciousness and vision

Excluded:

neurocirculatory asthenia (F45.3)
orthostatic hypotension (I95.1)
neurogenic (G23.8)
shock:
- NOS (R57.9)
- cardiogenic (R57.0)
- complicating or accompanying:
  - abortion, ectopic or molar pregnancy (O00-O07, O08.3)
  - labor and delivery (O75.1)
- postoperative (T81.1)
Stokes-Adams attack (I45.9)
fainting:
- sinocarotid (G90.0)
- thermal (T67.1)
- psychogenic (F48.8)
unconsciousness NOS (R40.2)

Excludes: convulsions and paroxysmal seizures (with):

dissociative (F44.5)
epilepsy (G40-G41)
newborn (P90)

Excluded:

shock (caused):
- anesthesia (T88.2)
- anaphylactic (due to):
  - NOS (T78.2)
  - adverse reaction to food (T78.0)
  - serum (T80.5)
- complicating or accompanying abortion, ectopic or molar pregnancy (O00-O07, O08.3)
- electric shock (T75.4)
- due to lightning strike (T75.0)
- obstetric (O75.1)
- postoperative (T81.1)
- mental (F43.0)
- traumatic (T79.4)
toxic shock syndrome (A48.3)

Includes: swollen glands

Excludes: lymphadenitis:

NOS (I88.9)
acute (L04.-)
chronic (I88.1)
mesenteric (acute) (chronic) (I88.0)

Excluded:

ascites (R18)
hydrops fetalis NOS (P83.2)
hydrothorax (J94.8)
edema:
- angioedema (T78.3)
- cerebral (G93.6)
- associated with birth trauma (P11.0)
- during pregnancy (O12.0)
- hereditary (Q82.0)
- larynx (J38.4)
- in case of malnutrition (E40-E46)
- nasopharynx (J39.2)
- newborn (P83.3)
- pharynx (J39.2)
- pulmonary (J81)

Excludes: delayed puberty (E30.0)

Excluded:

bulimia NOS (F50.2)
eating disorders of inorganic origin (F50.-)
malnutrition (E40-E46)

Excluded:

wasting syndrome as a result of HIV disease (B22.2)
malignant cachexia (C80.-)
alimentary insanity (E41)

This category should not be used in primary coding. The category is intended to be used in multiple coding to define a given syndrome from any cause. A code from another chapter should be assigned first to indicate the cause or underlying disease.

chronic fatigue syndrome

... in the International Classification of Diseases - ICD-10 - there is no such diagnosis in principle. There is a syndrome, there is no diagnosis. Paradox!

... this term is often used in general medical practice, despite the fact that the criteria for its allocation by 97% coincide with the characteristics of neurasthenia in ICD-10 (A.Farmer et al., 1995).

Introduction(relevance of the topic). It is believed that chronic fatigue syndrome can manifest itself at any age, including children. According to Australian scientists, chronic fatigue syndrome occurs with a frequency of 37 cases per 100,000 people (Vollmer-Conna V., Lloid A., Hickie I., Wakefield D., 1998). With chronic fatigue syndrome, there are no changes in the composition of blood and urine, no radiological changes, no organic or functional abnormalities of ultrasound are detected. Indicators of clinical biochemical studies are normal, no changes in the endocrine and immune status are detected. Such patients are usually diagnosed with "neuro-vegetative dystonia" and neuroses. At the same time, the courses of treatment prescribed for such cases usually do not give any effect at all. The disease typically progresses with deterioration, and in advanced cases, severe memory and mental disorders are detected, confirmed by changes in the EEG.

chronic fatigue syndrome is a disease of unknown etiology, the main manifestation of which is unmotivated severe general weakness, which for a long time deprives the patient of active participation in everyday life.

(! ) Due to the fact that the development of chronic fatigue syndrome is closely associated with significant disorders in the functioning of the immune system, this disease has received a new name - "chronic fatigue syndrome and immune dysfunction", although the old term is still widely used when characterizing it as a nosological form. - chronic fatigue syndrome.

Etiology and pathogenesis. Despite an active discussion, there is still no single point of view on the etiology and pathogenesis of chronic fatigue syndrome. Some authors attach importance to various viruses (Epstein-Barr, cytomegaloviruses, herpesvirus types I and II, enteroviruses, herpesvirus type 6, etc.), nonspecific activation of immune responses and mental factors. At the same time, the majority points to the connection of the disease with environmentally unfavorable conditions and to the fact that it is a “disease of the middle class”, thus giving an important role to social factors (however, without detailing the latter). Recent studies indicate increased brain serotonin activity in patients with chronic fatigue syndrome, which may play a role in the development of this pathological condition. However, there are also studies in which such a pattern could not be identified. The reason for this was probably the heterogeneity of the groups of subjects and the use of various stimulants of serotonin metabolism. Thus, increased serotonin metabolism may underlie the development of chronic fatigue syndrome. The increase in prolactin secretion stimulated by serotonin in chronic fatigue syndrome may be secondary to various behavioral features (eg, such as prolonged inactivity and disturbances in falling asleep and waking up).

Currently, in the pathogenesis of chronic fatigue syndrome, a large role is given to disorders in the cytokine system. The latter, being mediators of the immune system, not only have an immunotropic effect, but also affect many functions of the body, participating in the processes of hematopoiesis, repair, hemostasis, the activity of the endocrine and central nervous systems. It should be emphasized that the infectious or viral theory remains the most convincing (the debut of chronic fatigue syndrome is often associated with an acute flu-like illness).

Clinical manifestations. One of the leading symptoms in chronic fatigue syndrome is exhaustion, which is especially clearly detected in the study by special methods for studying performance (Schulte tables, correction test, etc.), which manifests itself as hyposthenic or hypersthenic syndromes. With the phenomena of exhaustion in chronic fatigue syndrome, the lack of active attention is directly related, which manifests itself as an increase in the number of errors.

Chronic fatigue syndrome differs from a transient state of weakness in healthy people and in patients with various diseases in the initial stage and in the convalescence stage in terms of the duration and severity of psychosomatic disorders. Clinical manifestations of chronic fatigue syndrome are commensurate with the classical ideas about the disease as an independent nosological unit.

Typical clinical manifestations for developing chronic fatigue syndrome in the early stages are: (1) weakness, fatigue, increasing attention disorders, (2) increased irritability and instability of the emotional and mental state; (3) recurring and increasing headaches not associated with any pathology; (4) disorders of sleep and wakefulness in the form of drowsiness during the day and insomnia at night; progressing against this background, a decrease in efficiency, which forces patients to use various psychostimulants on the one hand and sleeping pills on the other; (5) typical: frequent and intense smoking for the purpose of mental stimulation during the day, daily evening alcohol intake to relieve neuropsychic excitation in the evening, which leads to widespread domestic drunkenness; (6) weight loss (insignificant, but clearly noted by patients) or, for groups of financially secure individuals leading a physically inactive lifestyle, stage I-II obesity; (7) pain in the joints, usually large and in the spine; (8) apathy, gloomy mood, emotional depression. (!) It is very important that this symptomatology flows progressively and cannot be explained by any somatic diseases. Moreover, a thorough clinical examination fails to reveal any objective changes in the state of the body - laboratory studies show no deviations from the norm.

Clinical diagnostics. The criteria published in 1988, 1991, 1992 and 1994 are used to diagnose Chronic Fatigue Syndrome. Center for Disease Control (USA), which include a complex of large (1 - prolonged fatigue for an unknown reason, not passing after rest and a decrease of more than 50% of the motor regime observed for at least 6 months; 2 - the absence of diseases or other causes, that can cause such a condition.), and small objective criteria. The minor symptomatic criteria of the disease include the following: the disease begins suddenly, as with influenza, with (1) an increase in temperature to 38 ° C; (2) sore throat, perspiration; (3) slight enlargement (up to 0.3-0.5 cm) and tenderness of cervical, occipital and axillary lymph nodes; (4) unexplained generalized muscle weakness; (5) soreness of individual muscle groups (myalgia); (6) migratory joint pain (arthralgia); (7) recurrent headaches; (8) rapid physical fatigue followed by prolonged (more than 24 hours) fatigue; (9) sleep disorders (hypo- or hypersomnia); (10) neuropsychological disorders (photophobia, memory loss, increased irritability, confusion, decreased intelligence, inability to concentrate, depression); (11) rapid development (within hours or days) of the entire symptom complex.

Small criteria can be combined into several groups. (1) The first group includes symptoms reflecting the presence of a chronic infectious process (subfebrile temperature, chronic pharyngitis, swollen lymph nodes, muscle and joint pain). (2) The second group includes mental and psychological problems (sleep disorders, memory impairment, depression, etc.). (3) The third group of minor criteria combines the symptoms of autonomic-endocrine dysfunction (rapid change in body weight, dysfunction of the gastrointestinal tract, loss of appetite, arrhythmias, dysuria, etc.). (4) The fourth group of minor criteria includes symptoms of allergy and hypersensitivity to drugs, sun exposure, alcohol, and some other factors. Objective (physical) criteria are: (1) subfebrile fever; (2) non-exudative pharyngitis; (3) palpable cervical or axillary lymph nodes (less than 2 cm in diameter).

To make a diagnosis of chronic fatigue syndrome, the presence of 1 and 2 major criteria, as well as minor symptomatic criteria: (1) 6 or more of 11 symptomatic criteria and 2 or more of 3 physical criteria; or (2) 8 or more of the 11 symptomatic criteria.

According to the chronic fatigue syndrome diagnostic scheme adopted by the International Chronic Fatigue Syndrome Study Group in 1994, all cases of unexplained fatigue can be clinically divided into (1) chronic fatigue syndrome and (2) idiopathic chronic fatigue.

The criteria for chronic fatigue syndrome are: (1) the presence of chronic fatigue, which is defined as clinically established, unexplained, persistent or intermittent chronic fatigue of a new type (not previously encountered in life), not associated with physical or mental exertion, not resolving with rest and leading to a significant fall earlier achieved levels of professional, educational or personal activity; (2) the simultaneous presence of four or more of the following symptoms (all symptoms can be observed constantly or recur for 6 months or more): 1 - headaches that differ in nature from previously observed, 2 - muscle pain, 3 - pain in several joints in the absence of itching and redness, 4 - unrefreshing sleep, 5 - discomfort after physical or neuropsychic stress lasting more than 24 hours, 6 - impaired short-term memory or concentration of attention, significantly reducing the level of professional, educational or other social and personal activity. 7 - signs of inflammation of the mucous membrane of the throat. 8 - soreness of the cervical or axillary lymph nodes.

Cases of idiopathic chronic fatigue are defined as clinically established chronic fatigue that does not meet the criteria for chronic fatigue syndrome. The reasons for this discrepancy need to be investigated. Chronic fatigue is defined as subjectively recorded persistent or increasing fatigue that lasts 6 months or more. Prolonged fatigue is fatigue that lasts more than 1 month. The presence of a history of long-term or chronic fatigue requires a clinical examination to identify the underlying and concomitant diseases and subsequent treatment.

Further diagnosis and verification of a clinical case of chronic fatigue cannot be carried out without an additional medical examination, including: (1) an assessment of the state of the psyche to identify deviations in mood, intelligence and memory characteristics; special attention should be paid to current symptoms of depression and anxiety, the presence of suicidal thoughts, as well as the data of an objective psychophysiological examination; (2) examination of somatic systems; (3) laboratory screening tests, including: a complete complete blood count, ESR, blood transaminase levels, blood levels of total protein, albumin, globulins, alkaline phosphatase, calcium, phosphorus, glucose, urea, electrolytes, and creatinine; determination of the level of thyroid-stimulating hormone and clinical analysis of urine. Additional laboratory tests are not needed for all patients. A more in-depth laboratory test is ordered on an individual basis to confirm or rule out other diseases, such as multiple sclerosis. In these cases, it is necessary to use the advanced panel of laboratory methods of analysis. When making a diagnosis, in order to prevent diagnostic errors, attention should be paid to a number of symptoms that are not characteristic of chronic fatigue syndrome, but are significant in other diseases.

Diseases with explainable chronic fatigue: (1) the most common causes of complaints of chronic fatigue are hypothyroidism, narcolepsy and iatrogenic diseases, including side effects of pharmacotherapy; (2) chronic fatigue may be accompanied by cancer; (3) mental illness with symptom complexes of a psychotic and melancholic nature (bipolar affective disorders, schizophrenia of any type, manic-depressive psychosis, bulimia nervosa, dementia of any origin) simultaneously cause a decrease in working capacity and rapid fatigue; (4) abuse of alcohol and drugs for more than two years with the formation of dependence, preceding the appearance of complaints of chronic fatigue, is actually its immediate cause; (5) being overweight, as measured by body mass index (weight (kg)/height (m2)), when the index value is equal to or greater than 45, may be the cause of complaints of increased fatigue. Chronic fatigue may be accompanied by an undiagnosed viral infection.

Diseases that may be associated with chronic fatigue syndrome. A special clinical situation is the combination of chronic fatigue syndrome with other diseases. In this case, the following options are possible: (1) diseases with symptoms that are not determined by diagnostic laboratory tests (fibromyalgia, anxiety, somatic disorders, non-psychotic or non-melancholic depression, neurasthenia, hypersensitivity to chemicals); (2) diseases resistant to treatment; this is primarily hypothyroidism, in the treatment of which the adequacy of replacement therapy was verified only by the achievement of a normal level of thyroid-stimulating hormone in the blood plasma, and other options for adjusting the prescribed dose were not used; constant fatigue is possible with bronchial asthma, infectious diseases, such as Lyme disease or syphilis; (3) isolated unexplained symptoms on physical examination or questionnaire testing, as well as persistent abnormalities in laboratory values that are clinically significant but not sufficient to make a diagnosis of a particular disease, such as clinical cases in which the titer of antinuclear antibodies in patients' blood serum increases, but the diagnosis of autoimmune connective tissue damage has no other laboratory or clinical confirmation.

Risk Factors for Chronic Fatigue Syndrome: (1) unfavorable environmental and hygienic living conditions, especially with increased radiation exposure to the body; (2) effects that weaken the general, immunological and neuropsychic resistance of the body (narcosis, surgical interventions, chronic diseases, chemotherapy, radiation therapy, and possibly other types of non-ionizing radiation (computers), etc.; (3) frequent and prolonged stresses as typical conditions of work and life in a modern technically highly developed society; (4) one-sided hard work; (5) constant insufficient physical activity and lack of physical culture and sports activities with sufficient well-being and excessive structural non-physiological nutrition; (6) lack of life prospects and wide interest in life.

Concomitant pathology and typical bad habits that become pathogenetically significant in the development of chronic fatigue syndrome: (1) irrational and high-calorie excess nutrition, leading to stage I-II obesity; (2) alcoholism, often in the form of domestic drinking, usually associated with an attempt to relieve nervous excitement in the evening; (3) heavy smoking, which is an attempt to stimulate declining performance during the day; (4) chronic diseases of the genital area, including currently chlamydia; (5) hypertension stage I-II, vegetative-vascular dystonia and others.

Laboratory diagnostics. Among the objective indicators of chronic fatigue syndrome, changes in the immune status are primarily described: (1) a decrease in IgG due primarily to G1 and G3 classes, (2) a decrease in the number of lymphocytes with the CD3 and CD4 phenotype, (3) a decrease in natural killers, (4) an increase in levels of circulating complexes, (5) increased levels of various types of antiviral antibodies, (6) increased beta-endorphin, (7) increased interleukin-1 (beta), interferon, and tumor necrosis factor. All this, together with a 5-8-fold increase in the frequency of allergic diseases in such patients, indicates non-specific activation, as well as an imbalance in the immune system, the causes of which are not clear. Special studies of the biochemistry of muscle tissue and energy exchange did not show any changes. KLA (the number of leukocytes, platelets and Hb content) is normal; (!) typical low ESR (0–3 mm/h). OAM without pathology. ALT, AST are normal. The level of thyroid hormones, steroid hormones is normal. Bacteriological cultures from the nasopharyngeal mucosa are not informative

(! ) Currently, there are no laboratory tests that would unambiguously indicate the presence or absence of chronic fatigue syndrome in a patient. Moreover, the data cited by various researchers indicate the possibility of changing many indicators, both upward and downward.

Differential Diagnosis. Since chronic fatigue syndrome is still considered a disease with unknown etiology, the most correct diagnosis is to verify the diagnosis by excluding other causes of chronic fatigue. When making the final diagnosis of "Chronic Fatigue Syndrome" based on the results of the study of the anamnesis, when assessing the patient's complaints, the data of objective and laboratory and instrumental studies, it is necessary to exclude diseases (1) of the endocrine system - hypothyroidism, hyperthyroidism, hypocorticism, impaired carbohydrate metabolism; (2) autoimmune diseases - fibromyalgia, polymyalgia rheumatica, polymyositis, scleroderma, systemic lupus erythematosus, reactive arthritis, rheumatoid arthritis; (3) neuropsychiatric diseases - chronic depression, multiple sclerosis, Alzheimer's disease; (4) infectious diseases - Lyme disease, mononucleosis, AIDS, tuberculosis, toxoplasmosis, viral and fungal infections; (5) diseases of the blood system - anemia, malignant lymphomas, leukemias; (6) chronic toxic poisoning - drugs, heavy metals, pesticides, industrial chemicals harmful to health; (7) chronic sleep deprivation and unbalanced nutrition with metabolic disorders; (8) drug and other related addictions (drug, alcohol, nicotine, cocaine, heroin or opioid). The differential diagnosis of chronic fatigue syndrome is based on the exclusion of symptoms of these diseases.

Principles of treatment. It is currently believed that there is no effective monotherapy for chronic fatigue syndrome; (!) therapy should be complex and strictly individualized. One of the important conditions of treatment is also the observance of the protective regimen and the constant contact of the patient with the attending physician. Of the medicines, small doses of psychotropic drugs have proven themselves well: tricyclic antidepressants, selective serotonin reuptake inhibitors (fluoxetine, sertraline), etc. Vitamins and microelements are also prescribed. A noticeable clinical effect is described when using essential fatty acids, the possibility of using acetylcarnitine is discussed. The effectiveness of immunotropic therapy (administration of immunoglobulins, immune stimulants, etc.), antimicrobial and antiviral treatment is being studied. In patients with chronic fatigue syndrome, there is a pronounced immune dysfunction in the cellular and humoral immunity and in the interferon system, which requires appropriate correction and long-term immunorehabilitation. A number of authors also recommend correcting the state of the immune system: small doses of glucocorticoids, short courses of L-DOPA, etc.). Symptomatic therapy is used: non-steroidal anti-inflammatory drugs (NSAIDs), painkillers, H2 blockers, etc. Significant assistance is provided by methods of psychological as well as functional rehabilitation, including methods: physiotherapy, acupuncture, physiotherapy, etc. Certain hopes are pinned on the use of polypeptide nootropic drugs, as they effectively restore disturbed metabolism and integrative functions of the brain. One of the most popular drugs in this group is Cortexin.

Fatigue syndrome after a viral illness

Definition and background[edit]

Chronic Fatigue Syndrome (CFS)

Chronic fatigue syndrome has been repeatedly described under various names; the search for a term that most fully reflects the essence of the disease continues at the present time. In the literature, the following terms were most often used: "benign myalgic encephalomyelitis" (1956), "myalgic encephalopathy", "chronic mononucleosis" (chronic Epstein-Barr virus infection) (1985), "chronic fatigue syndrome" (1988), "postviral syndrome fatigue." ICD-9 (1975) did not mention CFS, but included the term "benign myalgic encephalomyelitis" (323.9). ICD-10 (1992) introduced a new category - postviral fatigue syndrome (G93).

For the first time, the term and definition of chronic fatigue syndrome were presented by US scientists in 1988, who suggested a viral etiology of the syndrome. Epstein-Barr virus was considered as the main causative agent. In 1994, the definition of CFS was revised and, in an updated version, it acquired international status.

Etiology and pathogenesis[edit]

Initially, they were inclined to the infectious theory of the development of chronic fatigue syndrome (viral infection), but further research revealed a wide variety of changes in many areas, including brain structure and function, neuroendocrine response, sleep structure, immune system, and psychological profile. Currently, the most common stress-dependent model of the pathogenesis of chronic fatigue syndrome, although it cannot explain all the pathological changes characteristic of this syndrome. Based on this, most researchers postulate that chronic fatigue syndrome is a heterogeneous syndrome, which is based on various pathophysiological abnormalities. Some of them may predispose to the development of chronic fatigue syndrome, others directly cause the development of the disease, and still others cause its progression. Risk factors for CFS include female gender, genetic predisposition, certain personality traits or behaviors, and others.

Clinical manifestations[edit]

Subjectively, patients can formulate the main complaint in different ways (“I feel completely exhausted”, “I constantly lack energy”, “I am completely exhausted”, “I am exhausted”, “normal loads bring me to exhaustion”, etc. .). With active questioning, it is important to differentiate the actual increased fatigue from muscle weakness or a feeling of despondency.

Most patients rate their premorbid physical condition as excellent or good. Feeling extremely tired comes on suddenly and is usually associated with flu-like symptoms. The disease may be preceded by respiratory infections, such as bronchitis or vaccination. Less often, the disease has a gradual onset, and sometimes begins gradually over many months. After the onset of the disease, patients notice that physical or mental efforts lead to an aggravation of the feeling of fatigue. Many patients find that even minimal physical effort leads to significant fatigue and an increase in other symptoms. Prolonged rest or lack of physical activity can reduce the severity of many symptoms of the disease.

Often observed pain syndrome is characterized by diffuseness, uncertainty, a tendency to migration of pain sensations. In addition to muscle and joint pain, patients complain of headache, sore throat, soreness of the lymph nodes, abdominal pain (often associated with a comorbid condition - irritable bowel syndrome). Chest pain is also typical for this category of patients, some of them complain of "painful" tachycardia. Some patients complain of pain in unusual places [eyes, bones, skin (pain at the slightest touch to the skin), perineum and genitals].

Immune system changes include tenderness of the lymph nodes, repeated episodes of sore throat, recurrent flu-like symptoms, general malaise, and hypersensitivity to previously well tolerated foods and/or drugs.

Approximately 85% of patients complain of impaired concentration, memory impairment, however, routine neuropsychological examination usually does not reveal impaired mnestic function. However, an in-depth study often reveals minor, but undoubted violations of memory and digestibility of information. In general, patients with CFS have normal cognitive and intellectual abilities.

Sleep disturbances are represented by difficulty falling asleep, interrupted night sleep, daytime sleepiness, while the results of polysomnography are highly variable. The most commonly described are “alpha intrusion” (imposition) during non-REM sleep and a decrease in the duration of stage IV sleep. However, these findings are unstable and have no diagnostic value, in addition, sleep disturbances do not correlate with the severity of the disease. In general, fatigue should be clinically distinguished from drowsiness and it should be taken into account that drowsiness can both accompany chronic fatigue syndrome and be a symptom of other diseases that exclude the diagnosis of chronic fatigue (for example, sleep apnea syndrome).

Almost all patients with CFS develop social maladaptation. Approximately one third of patients are unable to work and another third prefer part-time professional employment. The average duration of the disease is 5-7 years, but symptoms can persist for more than 20 years. Often the disease proceeds in waves, periods of exacerbation (deterioration) alternate with periods of relatively good health. Most patients experience partial or complete remissions, but the disease often recurs.

Fatigue syndrome after a viral illness: Diagnosis [edit]

According to the 1994 definition, a diagnosis of chronic fatigue syndrome requires persistence (or remittance) of unexplained fatigue that is not relieved by rest and significantly limits daily activities for at least 6 months. In addition, 4 or more of the 8 following symptoms must be present.

Impaired memory or concentration.
Pharyngitis.
Soreness on palpation of the cervical or axillary lymph nodes.
Muscle soreness or stiffness.
Joint tenderness (no redness or swelling).
A new headache or a change in its characteristics (type, severity).
Sleep that does not bring a sense of recovery (freshness, vivacity).
Exacerbation of fatigue to the point of exhaustion after physical or mental effort lasting more than 24 hours.

In 2003, the International Chronic Fatigue Syndrome Study Group recommended the use of standardized scales to assess the main symptoms of chronic fatigue syndrome (impaired daily activity, fatigue, and the accompanying symptom complex).

There are no specific paraclinical tests to confirm the clinical diagnosis of chronic fatigue syndrome. At the same time, a mandatory examination is carried out to exclude diseases, one of the manifestations of which may be chronic fatigue. Clinical evaluation of patients with a leading complaint of chronic fatigue includes the following activities.

A detailed medical history, including medications used by the patient that may be causing fatigue.

Exhaustive examination of the somatic and neurological status of the patient. Superficial palpation of the somatic muscles in 70% of patients with CFS with gentle pressure reveals painful points localized in various muscles, often their location corresponds to that of fibromyalgia.

Screening study of cognitive and mental status.

Carrying out a set of screening laboratory tests:

- complete blood count (including leukocyte formula and determination of ESR);

- biochemical blood test (calcium and other electrolytes, glucose, protein, albumin, globulin, creatinine, ALT and AST, alkaline phosphatase);

- evaluation of thyroid function (thyroid hormones);

- urine analysis (protein, glucose, cellular composition).

Additional studies usually include the determination of C-reactive protein (a marker of inflammation), rheumatoid factor, CK activity (muscle enzyme). Determination of ferritin is advisable in children and adolescents, as well as in adults if other tests confirm iron deficiency. Specific tests confirming infectious diseases (Lyme disease, viral hepatitis, HIV, mononucleosis, toxoplasmosis, cytomegalovirus infection), as well as a serological panel of tests for Epstein-Barr viruses, enteroviruses, retroviruses, herpes viruses type 6 and Candida albicans are carried out only with a history of indications of an infectious disease. On the contrary, MRI of the brain, the study of the cardiovascular system are classified as routine methods for suspected chronic fatigue syndrome. Polysomnography should be performed to rule out sleep apnea.

In addition, it is advisable to use special questionnaires that help assess the severity of the disease and monitor its course. The most commonly used are the following.

The Multidimensional Fatigue Inventory (MFI) assesses general fatigue, physical fatigue, mental fatigue, reduction in motivation and activity. Fatigue is defined as severe if the overall fatigue score is 13 or more (or the activity reduction scale is 10 or more).

SF-36 (Medical outcomes survey short form-36) questionnaire for assessing functional impairment in 8 categories (limitation of physical activity, limitation of usual role activity due to health problems, limitation of usual role activity due to emotional problems, bodily pain assessment, general health assessment, vitality assessment, social functioning and general mental health). The ideal score is 100 points. Patients with CFS are characterized by a decrease in functional activity (70 points or less), social functioning (75 points or less), and a decrease in the emotional scale (65 points or less).

List of CDC symptoms (CDC Symptom Inventory) for identifying and assessing the duration and severity of concomitant fatigue of the symptom complex (in a minimized form, it is a total assessment of the severity of 8 symptoms-criteria for CFS).

If necessary, the McGill Pain Score and the Sleep Answer Questionnaire are also used.

Differential diagnosis[edit]

Chronic fatigue syndrome is a diagnosis of exclusion, that is, its formulation requires careful differential diagnosis to exclude many severe and even life-threatening diseases (chronic heart disease, anemia, thyroid pathology, tumors, chronic infections, endocrine diseases, connective tissue diseases, inflammatory diseases). intestines, mental disorders, etc.).

In addition, it should be remembered that feeling tired can be a side effect of certain medications (muscle relaxants, analgesics, β-blockers, benzodiazepines, antihistamines and anti-inflammatory drugs, beta interferons).

Fatigue syndrome after a viral illness: treatment [edit]

Since the etiology and pathogenesis of chronic fatigue syndrome are still unknown, there are no reasonable therapeutic recommendations. Controlled studies have been conducted on the effectiveness of certain drugs, nutritional supplements, behavioral therapy, physical training, etc. In most cases, the results were negative or inconclusive. The most encouraging results were obtained in relation to complex non-drug treatment.

There are a few studies showing some positive effect of intravenous immunoglobulin (compared to placebo), but the effectiveness of this method of therapy cannot yet be considered proven. Most other drugs (glucocorticoids, interferons, antivirals, etc.) were ineffective in relation to both the actual feeling of fatigue and other symptoms of CFS.

In clinical practice, antidepressants are widely used to successfully relieve some symptoms of chronic fatigue syndrome (improve sleep and reduce pain, positively affect comorbid conditions, in particular fibromyalgia). Some open studies have established a positive effect of reversible MAO inhibitors, especially in patients with clinically significant autonomic symptoms. However, it should be borne in mind that most patients with CFS do not tolerate drugs that act on the central nervous system, so therapy should be started with low doses. Preference should be given to antidepressants with a favorable tolerability spectrum. In addition, officinal herbal preparations with significantly fewer side effects can be considered as an alternative therapy for people who have a negative experience with antidepressants. The basis of most official complex herbal remedies is valerian. Controlled randomized trials demonstrate that the effects of valerian on sleep include improved sleep quality, longer sleep time, and reduced time to fall asleep. The hypnotic effect of valerian on sleep is more evident in insomniacs than in healthy individuals. These properties allow the use of valerian in individuals with CFS, the core of the clinical picture of which is dyssomnic manifestations. More often, not a simple valerian extract is used, but complex herbal preparations (novo-passit), in which a harmonious combination of extracts of medicinal plants provides a complex psychotropic (sedative, tranquilizing, mild antidepressant) and "organotropic" (antispasmodic, analgesic, antiallergic, vegetostabilizing) effect.

There is evidence that some patients have a positive effect when prescribing amphetamine and its analogues, as well as modafinil.

In addition, paracetamol or other NSAIDs are used, which are especially indicated for patients with musculoskeletal disorders (muscle soreness or stiffness).

In case of sleep disorders, sleeping pills may sometimes be required. As a rule, one should start with antihistamines (doxylamine) and only if there is no effect, prescribe prescription sleeping pills in minimal doses.

Some patients use alternative treatment - vitamins in large doses, herbal medicine, special diets, etc. The effectiveness of these measures has not been proven.

Cognitive behavioral therapy is widely used to address pathological perceptions and perverted interpretations of bodily sensations (i.e., factors that play a significant role in maintaining CFS symptoms). Cognitive behavioral therapy may also be useful in teaching the patient more effective coping strategies, which in turn may lead to increased adaptive capacity. In controlled studies, it has been found that 70% of patients note a positive effect. Combining a staggered exercise program with cognitive behavioral therapy may be helpful.

Deep breathing techniques, muscle relaxation techniques, massage, kinesiotherapy, yoga are considered as additional influences (mainly to eliminate comorbid anxiety).

Prevention[edit]

Other [edit]

With long-term follow-up of patients with CFS, it was found that improvement occurs in approximately 17-64% of cases, deterioration - in 10-20%. The probability of a complete cure does not exceed 10%. 8-30% of patients return to their previous professional activities in full. Old age, long duration of the disease, severe fatigue, comorbid mental illness are risk factors for poor prognosis. In contrast, children and adolescents are more likely to experience a complete recovery.

Sources (links)[edit]

1. Buchwald D., Herrell R., Ashton S. et al. A twin study of chronic fatigue // Psychosom. Med. - 2001. - Vol. 63. - P. 936-943.

2. Fukuda K., Straus S. E., Hickie I. et al. The chronic fatigue syndrome: a comprehensive approach to its definition and study // Ann. Intern. Med. - 1994. - Vol. 121. - P. 953-959.

3. Holmes G.P., Kaplan J.E., Gantz N.M. et al. Chronic fatigue syndrome: a working case definition // Ann. Intern. Med. - 1988. - Vol. 108. - P. 387-389.

4. Lloyd A., Hickie I., Wakefield D. et al. A double-blind, placebo-controlled trial of intravenous immunoglobulin therapy in patients with chronic fatigue syndrome // Am. J. Med. - 1990. - Vol. 89. - P. 561-568.

5. Rowe P.C., Bou-Holaigah I., Kan J.S., Calkins H. Is neurally mediated hypotension an unrecognized cause of chronic fatigue? // Lancet. - 1995. - Vol. 345. - P. 623-624.

6. Smets E.M., Garssen B.J., Bonke B., DeHaes J.C. The multidimensional fatigue inventory (MFI) psychometric qualities of an instrument to assess fatigue // J. Psychosom. Res. - 1995. - Vol. 39. - P. 315-325.

7. Wagner D., Nisenbaum R., Heim C. et al. Psychometric properties of a symptom-based questionnaire for the assessment of chronic fatigue syndrome // BMC Hlth Quality Life Outcomes. - 2005. - Vol. 3. - P. 8.

Chronic fatigue syndrome is also called postviral weakness syndrome, myalgic encephalomyelitis, chronic fatigue syndrome, or immune dysfunction syndrome. It is a disease that results in severe permanent weakness over an extended period of time and is accompanied by a wide range of other symptoms.

Causes

The cause of the disease remains unknown, although it is believed that several different factors are involved in its development. In some cases, chronic fatigue syndrome appears after a viral infection or severe emotional trauma, such as divorce. In others, there were no previous illnesses or significant events noted.

Risk factors

Most often, the disease occurs in women in the age group from 25 to 45 years.

Symptoms

severe weakness, which can last up to 6 months;
impaired short-term memory and concentration;
sore throat;
painful lymph nodes;
pain in the joints and muscles without swelling and redness;
sleep that does not bring rest;
headache;
extreme fatigue and malaise after minimal exertion.

Because of the wide variability in symptoms, the disease is often not even recognized or misdiagnosed.

Complications

Most people with chronic fatigue syndrome develop, which manifests itself in a lack of interest in work, hobbies, or constant anxiety. With chronic fatigue syndrome, allergic diseases such as and are exacerbated.

Diagnostics

A doctor may diagnose chronic fatigue syndrome if weakness persists for more than 6 months without apparent cause and is accompanied by at least 4 of the above symptoms. These are the diagnostic criteria for this condition. However, constant weakness is a common symptom of many diseases, including and, and the doctor must first exclude these disorders. If no causes of weakness are found during the examination, then the diagnosis of chronic fatigue syndrome is made only if the diagnostic criteria are met. At the doctor's appointment, a general examination will be performed, questions will be asked about whether the patient has psychological problems, such as depression. Blood tests may also be done. Since there are no specific diagnostic tests, the diagnosis takes a significant amount of time.

Self-help measures

Although there is no specific treatment for chronic fatigue syndrome, there are a number of self-help measures that can help manage this condition. It is recommended to take the following actions:

try to separate periods of rest and work;
gradually build up physical and mental stress, force yourself to be active every week;
set yourself realistic goals;
make changes in diet, drink less alcohol and completely abandon caffeine;
try to reduce the level of stress in your life;
join a support group if the patient feels lonely.

Your doctor may prescribe medication to relieve some of your symptoms. For example, to relieve headache, joint and muscle pain, such as aspirin and are prescribed. They can also improve the patient's condition (even in the absence of symptoms of depression). The doctor will arrange for the patient to consult a psychologist in order to cope with the disease and receive support, cognitive and behavioral therapy will also be useful.

Chronic fatigue syndrome is a very long-term illness. Some patients experience worsening of symptoms in the first 1–2 years, and sometimes symptoms appear and disappear for many years. In about half of the cases, the disease resolves completely within a few years.

... in the International Classification of Diseases - ICD-10 - there is no such diagnosis in principle. There is a syndrome, there is no diagnosis. Paradox!

chronic fatigue syndrome- this is a disease of unknown etiology, the main manifestation of which is unmotivated severe general weakness, for a long time depriving the patient of active participation in everyday life.

Clinical diagnostics. The criteria published in 1988, 1991, 1992 and 1994 are used to diagnose Chronic Fatigue Syndrome. Center for Disease Control (USA), which include a complex of large (1 - prolonged fatigue for an unknown reason, not passing after rest and a decrease of more than 50% of the motor regime observed for at least 6 months; 2 - absence of diseases or other causes, that can cause such a condition.), and small objective criteria. The minor symptomatic criteria of the disease include the following: the disease begins suddenly, as with influenza, with (1) an increase in temperature to 38 ° C; (2) sore throat, perspiration; (3) slight enlargement (up to 0.3-0.5 cm) and tenderness of cervical, occipital and axillary lymph nodes; (4) unexplained generalized muscle weakness; (5) soreness of individual muscle groups (myalgia); (6) migratory joint pain (arthralgia); (7) recurrent headaches; (8) rapid physical fatigue followed by prolonged (more than 24 hours) fatigue; (9) sleep disorders (hypo- or hypersomnia); (10) neuropsychological disorders (photophobia, memory loss, increased irritability, confusion, decreased intelligence, inability to concentrate, depression); (11) rapid development (within hours or days) of the entire symptom complex.

Laboratory diagnostics. Among the objective indicators of chronic fatigue syndrome, changes in the immune status are primarily described: (1) a decrease in IgG due primarily to G1 and G3 classes, (2) a decrease in the number of lymphocytes with the CD3 and CD4 phenotype, (3) a decrease in natural killers, (4) an increase in levels of circulating complexes, (5) increased levels of various types of antiviral antibodies, (6) increased beta-endorphin, (7) increased interleukin-1 (beta), interferon, and tumor necrosis factor. All this, together with a 5-8-fold increase in the frequency of allergic diseases in such patients, indicates non-specific activation, as well as an imbalance in the immune system, the causes of which are not clear. Special studies of the biochemistry of muscle tissue and energy exchange did not show any changes. KLA (the number of leukocytes, platelets and Hb content) - normal; (!) typical low ESR (0–3 mm/h). OAM without pathology. ALT, AST are normal. The level of thyroid hormones, steroid hormones is normal. Bacteriological cultures from the nasopharyngeal mucosa are not informative