Chronic Fatigue Syndrome mcb 10. Chronic Fatigue Syndrome: A Phantom Epidemic

Chronic fatigue syndrome (CFS) is a post-infectious (ARVI) chronic disease, the main manifestation of which is unmotivated severe general weakness, which takes a person out of active everyday life for a long time. The main targets of the disease are the central nervous system and the immune system.

The incidence of CFS is 10-37 cases per 100,000 population.

Diagnostic criteria for CFS Center for Disease Control (USA, 1994), which include a set of large, small and objective criteria.

Great diagnostic criteria : 1) persistent fatigue and decreased performance (at least 50%) in previously healthy people during the last six months; 2) exclusion of other causes or diseases that can cause chronic fatigue.

Minor Symptomatic Criteria : 1) sudden onset with 2) temperature rise to 38°C; 3) sore throat, perspiration; 4) a slight increase (up to 0.3 - 0.5 cm) and soreness of the cervical, occipital and axillary lymph nodes; 5) unexplained generalized muscle weakness; 6) soreness of individual muscle groups (myalgia); 7) migrating pain in the joints (arthralgia); 8) periodic headaches; 9) rapid physical fatigue followed by prolonged (more than 24 hours) fatigue; 10) sleep disorders (hypo- or hypersomnia); 11) neuropsychological disorders (photophobia, memory loss, increased irritability, confusion, decreased intelligence, inability to concentrate, depression); 12) rapid development (within hours or days) of the entire symptom complex.

Objective (physical) criteria : 1) subfebrile temperature; 2) non-exudative pharyngitis; 3) palpable cervical or axillary lymph nodes (less than 2 cm in diameter).

The diagnosis of CFS is established by the presence of 1 and 2 major criteria, as well as minor symptomatic criteria: 6 (or more) of 11 symptomatic criteria and 2 (or more) of 3 physical criteria; or 8 (or more) of 11 symptomatic criteria.

People of any age are susceptible to the disease, however, it is noticed that women aged 25 - 49 years are sick more often than men. In some cases, the disease develops 2 years after the first attack. In most patients, chronic fatigue and other accompanying symptoms, which begin during the flu-like illness, decrease somewhat after one to two weeks, but recovery does not occur. In the most severe cases, severe depression can begin, loss of concentration and severe physical weakness. Cases of spontaneous recovery are described. However, most patients continue to suffer from cyclic diseases for many months or years.

Etiology and pathogenesis The most likely cause of CFS is a viral infection, the specific representative of which is currently not identified. It can be one of the herpes viruses (Epstein-Barr (EBV), cytomegalovirus (CMV), herpes virus types 1 and 2 (HSV-1, 2), herpes virus type 6 (HSV-6)), varisella zoster (HSV -4), Coxsackie A or B viruses, enteroviruses, etc. CFS, apparently, is a multi-causal disorder of neuroimmune mechanisms, which manifests itself in genetically predisposed individuals as a result of activation of the immune system by infectious agents and dysregulation of the central nervous system, mainly its temporo-limbic region. The limbic system not only takes part in the regulation of the activity of autonomic functions, but to a large extent determines the "profile" of the individual, his general emotional and behavioral background, performance and memory, providing a close functional relationship between the somatic and autonomic nervous systems. A latent infection can lead to illness (i.e. turn on) when exposed to a number of possible stimuli: severe emotional stress, adverse environmental factors, intoxication, trauma, surgery, pregnancy, childbirth, etc.

Another theory assigns the main role to neuropsychic factors with a predominance of immunodysregulation. Neuropsychological disorders (depression) are recognized as one of the diagnostic criteria for CFS.

immune dysfunction There are a large number of "triggers" that cause immunological reactions that involve various types of blood cells and molecules such as interferon and interleukins. It can be assumed that these mechanisms are impaired in patients with CFS, and both an increase and a decrease in the values of immunological parameters can be observed. For example, 20% of patients with CFS have leukocytosis and a similar number have leukopenia. Relative lymphocytosis is observed in 20% of cases, lymphopenia - in 30% of patients. In 30% of patients, a decrease in the level of serum immunoglobulins of classes A, D, G and M was noted, in 30% of patients with CFS, the level of immunoglobulins, on the contrary, was increased. 50% of patients have low levels of circulating immune complexes, 25% have reduced complement activity.

The manifestation of immune system dysfunction in patients with CFS is also expressed in a decrease in the cytotoxic activity of natural killers; increased levels of IL-1-alpha, 2 and 6; a decrease in mitogen-stimulated lymphocytes of an increased content of alpha-interferon and other cytokines; change in the number and function of T- and B-lymphocytes.

It has been observed that in most patients with CFS, the disease is accompanied by allergic manifestations, including an increased skin reaction to a variety of allergens and an increase in the level of circulating IgE.

Serological studies usually do not reveal significant abnormalities. There is evidence of the presence of antinuclear antibodies and rheumatoid factor in low concentrations, but without clinical manifestations of systemic lupus or rheumatoid arthritis. An increase in the content of cryoglobulins and cold agglutinins was found in a small number (8%) of patients.

There remains a controversial issue regarding the detection of specific antiviral antibodies (HSV-1,2,4,6, EBV, CMV, Coxsackie). Their reactivation is expected in patients with CFS. Enteroviruses can also serve as an etiological factor. Proponents of the viral etiology of the disease insist on a latent virus or viruses that are activated under certain conditions. One thing is clear that they have neuro- and immunotropic properties, since CFS affects the central nervous and immune systems. Thus, changes in laboratory parameters in CFS are rather contradictory. The main immunological parameters that have important diagnostic value in CFS are summarized in Table. 3.

Table 3. Immunological parameters for assessing CFS
Options			Raised
1. T-helpers
2. T-suppressors

4. HLADR/CD8 (activated TC)
5. CD38/CD8 (activated TC)
6. CD3/CD56 (NK cells)
7. CD56 (NK cells)
8. Interleukin-2 receptor
9. NK cell activity
10. Mitogenic response of lymphocytes
11. Humoral immunity
12. Secretory IgA in saliva
13. Immune complexes
14. Tissue and protein antibodies
15. Viral antibodies
16. Fungal antibodies

Taking into account the type of etiological factor, the following variants of CFS are distinguished:

1. Intoxication variant– the impact of biologically active environmental factors leads to a change in the functioning of the immune and central nervous systems. Characteristic changes in the immune system are a decrease in the phagocytic activity of leukocytes, an increase in the values of TZN (toxic granularity of neutrophils), a decrease in the NCT test, an increase in the level of IgG and the number of circulating immune complexes, then activation of the antitoxic function of immunity is observed.

2. Endocrine variant of CFS- the ratios of hormone levels both in the blood and in tissues are disturbed, which leads to a deterioration in the functioning of the central nervous system. The most significant are a decrease in the levels of thyroid hormones, an imbalance of sex hormones (with menopause), dysfunction of the adrenal cortex.

3. infectious variant- persistence of "slow" viral infections, such as herpes, CMV and Ebstein-Bar virus infection, lead to dysfunction of the immune system. Attention should be paid to the fact that a number of changes in immunological parameters, namely, a decrease in the functional activity of natural killer cells (NK cells) and macrophages, a decrease in the response of lymphocytes to mitogens, and activation of CD4+ lymphocytes, are common for CFS and various viral infections.

If we consider the neuroimmune system as a network (of interactions), then it becomes clear that its work can be disrupted by factors affecting various parts of the system (Fig. 1).

Figure 1. Pathogenesis of chronic fatigue syndrome

Basic principles of CFS treatment There is currently no specific treatment for CFS. There is a treatment tactic that allows you to prolong the remission of the disease and return patients to work. Tricyclic antidepressants, serotonin reuptake inhibitors (fluoxetine - Prozac) are used, which increase the patient's energy capabilities, correct sleep, reduce soreness and muscle tension. Complex therapy with immunotropic drugs is carried out, taking into account the results of an immunological examination. The main directions of CFS therapy can be formulated as follows:

1. A complete, balanced diet in terms of proteins, vitamins and microelements (Zn, Se, Cu, Co).

2. Antigenic sparing mode: hypoallergenic diet; sanitation of foci of chronic infection; refusal to vaccinate during the course of complex therapy; restoration of microbiocenosis of the skin, open and closed mucous membranes.

3. Antioxidant therapy.

4. Immunomodulating therapy.

Principles of immunotropic (immunomodulatory) therapy for CFS (points of application):

1. Restoration of T-cell immunity using thymic factors (tactivin, thymalin, thymogen, imunofan, Gepon).

2. Restoration of interferon status (viferon, laferon).

3. Restoration of NK cell activity (immunomax, gepon, licopid, polyoxidonium).

4. Restoration of humoral immunity (myelopid).

If a patient with CFS is diagnosed with immunodeficiency of the lymphocytic type, the following is prescribed:

1) IL-2 synthesis stimulators (isoprinosine, groprinosine);

2) thymic peptides: old (thymalin, taktivin, timoptin) and new (zadaksin, immunofan);

3) galavit.

1. Decreased content of CD3, CD4, CD25.

2. Decreased immunoregulatory index CD4/CD8.

3. Decreased production of IL-2, gamma-INF.

When a patient with CFS is diagnosed with immunodeficiency of interferons wow type assign:

1) interferons (viferon, laferon);

2) inducers of endogenous interferon and NK cells: acridones (neovir, cycloferon); amiksin; antiplatelet agents (chimes); new (with a long-term effect) - Kagocel.

Immunological criteria for the effectiveness of therapy:

1. Decreased production of alpha and gamma IFN.

2. Decreased levels of CD4, CD16.

3. Decreased immunoregulatory index CD4/CD8.

4. Increased production of IL-4, 5, 6.

When a patient with CFS is diagnosed with immunodeficiency, humoral wow type designate specific immunoglobulins: antiherpetic (type 1 or 2), anticytomegalovirus, antichlamydia, and in the case of an unidentified type of viral infection, normal human.

Immunological criteria for the effectiveness of therapy:

1. Reducing the number of CD19.

2. Decreased levels of specific IgM, IgG and PCR normalization.

3. In the seronegative form of infection - normalization of IgA, IgM, IgG titers, a decrease in the level of B-lymphocytes and plasmacytes, a decrease in the level of CIC and complement.

If a patient with CFS is diagnosed with immunodeficiency phagocytic n wow type assign:

1) polyoxidonium - 6 mg of the drug before injection is dissolved in 1-1.5 ml of saline. r-ra, dist. water or 0.25% solution of novocaine, injected into / mice or s / c every other day, the course is 5 injections; then 2 times a week with a course of 10-15 injections.

2) methyluracil - used in tablets of 0.5 g 3 times a day for 3-4 weeks or longer courses.

Immunological criteria for the effectiveness of therapy:

1. Decreased phagocytic number and index.

2. Decrease in the NST-test.

Etiotropic therapy - prescribe drugs acyclovir (zovirax, acyclovir herd, geviran, atsik, herpevir), valaciclovir (valtrex), ganciclovir (cymeven), panciclovir (denavir), famciclovir (famvir). The drugs are indicated: 1) necessarily - during exacerbations (VHS-1,2,4,6, CMV, EBV IgM+, DNA+); 2) preferably - with the appearance of specific organ lesions, subject to an increase in the concentration of specific IgG (VHS-1,2,4,6, CMV, EBV) in dynamics; 3) as an option - virus-suppressive therapy (remission maintenance) at a lower dose and for a longer time. With recurrence in a patient of acute respiratory infections, frequent exacerbations of chronic bronchitis, other infections, antibiotic therapy with broad-spectrum drugs effective against intracellular infection is indicated: 1) macrolides (spiramycin, roxithromycin, clarithromycin, dirithromycin, azithromycin, josamycin, pristinamycin, minocycline; 2) fluoroquinolones ( 2nd, 4th generation - "non-respiratory": ciprofloxacin or gatifloxacin).

Criteria for the effectiveness of therapy: the presence of an infection is mandatory (for example, Chl -IgM +, Chl-DNA +, an increase in the concentration of Chl-IgG in dynamics).

Clinical effects of CFS therapy:

1) regression of the manifestations of CFS, regression of chronic fatigue, restoration of working capacity, mental abilities, memory, improvement of mood;

2) regression of symptoms of chronic intoxication;

3) regression of signs of chronic pharyngitis and tonsillitis;

4) reduction in the number of SARS from 15-24/year to 1-3/year;

5) decrease in VHS-1,2 episodes from 15-24/year to 1-2/year.

6) elimination of EBV, CMV, HV-6, Chl (PCR - pre-diagnostic level).

The prognosis for CFS is favorable in most cases. Patients generally recover within 2 to 4 years, but full recovery of physical activity does not occur. Approximately 15 - 20% of patients have a progressive increase in symptoms.

As an example, let us cite the case history of patient O., 48 years old, who complained of severe fatigue over the past 6 months. The patient has a history of frequent stressful situations at work, chronic recurrent herpetic infection with rashes in the lips. The last exacerbation was observed after hypothermia 2 weeks ago, accompanied by an increase in general weakness, "brokenness", depression, which forced the patient to turn to a neuropsychiatrist who referred her to a clinical immunologist (Example 5.).

Immunogram(Example 5.): Relative CTL cytosis. Increased absorption activity of neutrophils (Phi, Fch), spontaneous bactericidal activity (NST-test sp.). The functional reserve of the redox potential of phagocytes was reduced (NST-test res.), the complement content was increased.

The relative and absolute content of T-lymphocytes (CD-3) with a decrease in the immunoregulatory index (IRI) in the direction of T-cytotoxic lymphocytes (helpers) CD8 is reduced. An increase in the level of all classes of immunoglobulins (IGG, IgM, IgA), the content of immune complexes is slightly increased ( CEC).

Conclusion: Signs of the formation of an immunodeficiency state in the T-cell link against the background of a high antigenic load (activation of phagocytosis, an increase in the content of immunoglobulins).

Elevated titers of IgG HSV-1 1:550, IgM HSV-1 1:600, IgG CMV 1:550 (norm up to 1:400) were determined by ELISA in the patient.

The patient was diagnosed with Chronic Fatigue Syndrome. Chronic recurrent herpesvirus infection with localization in the lips, HSV-1, exacerbation. Immunodeficiency (D84.9), lymphocytic type, chronic course, IN-1, stage II FN.

Example 5. Patient O., 48 years old. Diagnosis: Chronic fatigue syndrome. Chronic recurrent herpesvirus infection with localization in the lips, HSV-1, exacerbation. Immunodeficiency (D84.9), lymphocytic type, chronic course, IN-1, stage II FN.

Index

Result

Hemoglobin

W - 115 - 145, M - 132 - 164 g / l

red blood cells

W - 3.7 - 4.7, M - 4.0 - 5.1 10 12 / l

platelets

150 – 320 10 9 /l

2 – 15 mm/h

Leukocytes

Immunological indicators

Result

Immunological indicators

Result

T-lymph CD-3

T-help CD-4

T-cytotox CD-8

30 - 50 units opt. dense

absorbent

activity

Abs. number

NST-test

Abs. number

Complement

30 - 60 gems. U/ml

Based on the characteristics of the immunological status in patient O., the following scheme of immunotropic therapy was prescribed for the treatment of CFS:

1) specific antiviral therapy (replacement - antiherpetic immunoglobulin type 1, 1.5 ml IM, 5 injections in total 2 times a week and anticytomegalovirus immunoglobulin (cytotect) 1.5 ml IM, 5 injections in total 2 times a week

2) etiotropic antiviral therapy - acyclovir 2 tab. 3 times a day for 7 days.

3) non-specific antiviral therapy:

Laferon 1 million IU every other day in / m for 10 days.

Interferon inducer - cycloferon - 12.5% injection - 2 ml, single dose 0.25 g / m for 1, 2, 4, 6, 8, 11, 14, 17, 20, 23, 26, 29 days . Assign after interferon therapy.

4) galavit 200 mg per 5 ml of physical. solution in / m every other day, 3 injections.

QuestsIfor the final control of knowledge

11. Which of the following symptoms are, according to the WHO, serious?

D) Lymphadenopathy

12. Which of the following statements regarding chemotaxis and chemokinesis are correct?

A) Chemotaxis is the direct migration of granulocytes along the concentration gradient of mediators, and chemokinesis is the mobility of these cells.

B) Chemotaxis and chemokinesis are carried out under the control of the chemokinetic factor of eosinophils.

C) Chemokinesis is the migration of granulocytes under the control of the chemokinetic factor of eosinophils.

D) Chemotaxis and chemokinesis is a process of spontaneous activation of mast cells.

13. A patient who completed a course of treatment for focal pulmonary tuberculosis 5 years ago applied to a tuberculosis dispensary for deregistration. During the control examination, it was found that the previously positive Mantoux reaction became negative. Count...

A) A patient cured of tuberculosis.

B) The active tuberculous process persists.

C) The patient is indicated for BCG vaccination.

D) There is an immunodeficiency state (possibly AIDS).

14. The effectiveness of treatment with interferon is higher with ...

A) Combined treatment.

B) Isolated use of the drug.

C) No significant difference.

15. Is there a synergistic effect of chemotherapy drugs and interferon?

16. Does interferon act synergistically with tumor necrosis factor?

C) There is no definite pattern.

17. Immunocompetent cells that have completed differentiation are normal ...

A) Capable of self-reproduction.

B) Lose the ability to reproduce themselves.

18. What pathological conditions and diseases associated with immunosuppression should be differentiated from AIDS?

A) With congenital immunodeficiency

B) With a malignant tumor of the lymphoreticular system

C) With severe protein-energy malnutrition

D) None of the listed pathological conditions

19. Which of the following symptoms are, according to the WHO, serious symptoms?

A) Weight loss of 10% or more

B) Chronic diarrhea lasting more than 1 month

C) Fever lasting more than 1 month (variable or constant)

D) Lymphadenopathy

20. What is the systemic response to infection in sepsis?

A) In uncontrolled releases of a whole complex of mediators

C) In a reduced number of lymphocytes

C) In the release of a whole complex of prosaic and anti-inflammatory cytokines

D) In the inactivation of the compliment system

E) In the activation of the system of macrophages, lymphocytes and endothelium

21. What route of infection transmission is most dangerous in the presence of an immunodeficiency state?

A) Povitryano-drip.

B) Alimentary.

C) Contact.

D) Sexual.

E) No significant difference.

22. What protective factors can most often be impaired in immunodeficiency?

A) Mechanical protection of the penetration of an infectious agent into the body.

B) Humoral factors that destroy the pathogen that has entered the body.

C) Factors of phagocytosis.

D) None of the above options.

23. When examining patients to assess the immune status, it is necessary:

A) cellular immunity research

B) study of humoral immunity

C) study of the complement system

D) study of all parameters.

24. Immunological examination of patients is carried out as:

A) a single examination of the patient upon admission to the clinic

B) double examination of the patient

C) immunological monitoring of the course of the disease

D) immunological examination in dynamics when using immunotropic therapy.

25. Tasks of immunological examination of patients in the clinic:

A) immunodiagnostics

B) predicting the course of the disease

C) quality control of treatment

D) appointment of immunoregulatory therapy according to indications.

26. What environmental factors contribute to the development of secondary immunodeficiency states:

A) prolonged stress

B) adverse climatic factors

C) bacteria

D) viruses.

27. Infections in secondary immunodeficiencies of the B-cell type:

A) viral

B) fungal

C) bacterial

28. Time of appearance of the first clinical signs of secondary immunodeficiencies:

A) from the first month of life

B) from 4-6 months of life

C) in adolescence.

D) At any age

29. Clinical markers of secondary T-cell immunodeficiency are:

A) recurrent pyogenic infections

B) recurrent viral infections

C) thymus hypoplasia

D) pathology of the parathyroid glands.

30. Common infections in phagocytosis defects in patients with secondary immunodeficiency:

A) bacterial

B) viral

D) fungal.

31 Causes of secondary immunodeficiency states:

A) chromosomal abnormalities

B) immunosuppressive therapy

C) oncological diseases

D) chronic infections.

32. Secondary immunodeficiency may result from:

A) malnutrition

B) radiation therapy

C) multiple transfusions

D) burn disease

33. According to the importance of participation in the destruction of virus-infected cells, immune factors are arranged in the following sequence:

A) NK non-specific killing, T cell cytotoxicity, complement dependent cytolysis

b) action interferons, NK non-specific destruction, T-cellcytotoxicity, action macrophages, antibody-andcomplement dependent cytotoxicity

C) antibody-dependent cytotoxicity, NK-nonspecific destruction, the action of interferons.

34. Circulating immune complexes are:

A) antigen+antibody complex

B) myeloma proteins

C) complex antigen + antibody + complement

D) allergen + IgE

E) aggregated IGGs.

35. An immunodeficiency state is characterized by an increased sensitivity of the patient to viral and fungal infections. The main defect of the immune system is determined by a dysfunction of:

A) macrophages

B) T-lymphocytes

C) B-lymphocytes

D) complement systems

E) neutrophils.

36. An immunodeficiency state developed against the background of a burn disease. The main defect of the immune system is characterized by a violation of:

A) T-lymphocytes

B) B-lymphocytes

C) complement systems

D) phagocytosis.

A) suspected primary immunodeficiency

B) suspected secondary immunodeficiency

C) to confirm the diagnosis of any infectious disease

D) if it is necessary to conduct a study of a specific immune response by ELISA and RIA.

38. Indications for intravenous administration of immunoglobulins:

A) congenital immunodeficiencies

B) secondary immunodeficiencies

C) bacterial infection

D) viral infection

E) allergy

F) endotoxic shock.

39. Which antimicrobial systems of neutrophils should include:

A) cationic proteins

B) proteinases

C) acid hydrolases

D) lactoferrin

E) reactive oxygen species

F) myeloperoxidase

G) hydrogen peroxide.

1) oxygen dependent (...)

2) oxygen independent (.../)

40. What immunomodulators are most effective in secondary immunodeficiencies caused by persistence of viruses

A) Timalin

B) Polyoxidonium

C) Myelopid

D) Galavit

E) Sodium nucleinate

Correct answers to questions: 11 ABC, 12 A, 13 D, 14 A, 15 A, 16 A, 17 B, 18 ABC, 19 ABC, 20 A, 21 E, 22 ABC, 23 D, 24 CD, 25 ABCD, 26ABCD, 27CD, 28D, 29B, 30AD, 31BCD, 32ABCD, 33V, 34AC, 35V, 36CD, 37AB, 38ABCD, 39AB/CD, 40ABD.

Fatigue is experienced by everyone without exception. For some, this feeling manifests itself in the form of slight fatigue, and for someone - in the form of a real breakdown. Under certain conditions, a person develops chronic fatigue.

From the point of view of medicine, fatigue is considered as a special condition, which is preceded by a period of intense physical or intellectual activity. Distinctive features of this condition are decreased efficiency, drowsiness, increased irritability, apathy.

If we talk about fatigue as a physical breakdown, then this term conveys the inability of the body to fully use the strength of the muscles of the body due to their weakness.

Mental fatigue can be characterized as the depletion of the ability to think constructively, make adequate decisions, and remember information.

It often happens that both of these conditions manifest themselves in a person at the same time. This makes it impossible to carry out productive activities.

A separate problem is a prolonged state of fatigue, which does not go away even after a long rest. This phenomenon is called "Chronic Fatigue Syndrome" (CFS).

Essence of CFS

A constant feeling of tiredness and exhaustion, which even a long rest is not able to overcome, is called chronic fatigue syndrome. According to the ICD-10 classification, CFS is a disease of the nervous system.

In different countries of the world, this disease occurs under the following names:

post-viral syndrome;
chronic fatigue syndrome;
chronic fatigue syndrome and immune dysfunction.

CFS is considered a common problem associated with the peculiarities of life. Due to excessive emotional and mental stress, there is a decrease in the physical and mental activity of a person.

In the presence of such a disorder, the patient often feels drowsiness. With CFS, one or the other often develops.

The patient cannot concentrate on doing any work, concentrate attention. He becomes irritable, the emotional state is unstable.

Constant chronic fatigue can provoke the appearance of various kinds of phobias.

How is chronic fatigue different from normal fatigue?

The main difference between CFS and the usual fatigue inherent in every person is that the breakdown does not go away even with prolonged rest and a full sleep regimen.

Ordinary fatigue is also not accompanied by deep moral depression, which is typical for chronic fatigue.

In addition, symptoms of CFS include muscle pain, unreasonable weight loss, decreased libido, and fever.

CFS: Real Facts and Common Misconceptions

Below are the real facts about CFS:

There are also quite common misconceptions regarding this deviation:

fatigue syndrome cause only mental and physical stress. In fact, such a state can also arise from completely opposite reasons - lack of purpose and motivation, useless pastime.
CFS - self-hypnosis, not a real disease. In fact, chronic fatigue syndrome is deservedly categorized as a disease of the nervous system. Experts have proven that pathology inhibits all processes occurring in the body.

Factors provoking the development of the syndrome

The diagnosis of "chronic fatigue syndrome" appeared relatively recently: back in the 1980s, nothing was known about such a pathology.

To date, experts identify such main reasons why CFS can get an impetus for development, and in a person’s life there are only drowsiness, fatigue, weakness and apathy:

stress factor. Depression, emotional and mental stress provoke structural changes in the nervous system.
immune factor. Pathology can occur due to damage to the immune system.
genetic factor. The presence of deviations in individual genes is also a provocateur of CFS.
Viral factor. Herpes virus, cytomegaloviruses, enteroviruses, Epstein-Barr virus create a high risk of developing this pathology.

Individuals at particular risk are those who:

recently had serious illnesses, were injured, underwent radiation or chemotherapy;
suffer from allergic, infectious, endocrine diseases of a chronic progressive nature;
occupy positions of responsibility;
live in an area characterized by unfavorable environmental conditions;
malnutrition, little sleep and rest;
lead a sedentary lifestyle;
drink alcohol, smoke.

Clinical picture and symptoms

Chronic fatigue syndrome is defined by a number of specific symptoms.

The first sign of CFS is rapid fatigue, which appears even after minor exertion. The feeling of weakness and fatigue that accompanies CFS does not disappear during the day and even after sufficient sleep.

In addition to the above, chronic fatigue syndrome has the following symptoms:

emotional instability;
apathy;
a complete decrease in physical activity;
feeling of ache in the limbs and body;
unreasonable and sharp increase in temperature;
muscle pain;
swollen lymph nodes, sore throat, mild cough (with Epstein-Barr virus infection);
the development of skin diseases against the background of a nervous breakdown;
inflammatory processes;
anemia;
constipation or diarrhea.

Symptoms of CFS are characterized by a progressive course. Apathy with such a disorder indicates.

Diagnosis of CFS as a disorder of the nervous system

The diagnosis is made based on the analysis of the deviations observed in the patient. A certain number of criteria that a neurologist calculates indicate a disorder or refute it.

Since CFS may indicate the development of endocrine, oncological, somatic, infectious or psychiatric diseases, the patient is also examined by an infectious disease specialist, endocrinologist, internist and rheumatologist.

In addition, they conduct blood tests for the presence of infections, including HIV.

How to deal with constant fatigue on your own?

If a person suffers from CFS, then it is impossible to cure this condition on your own, since an integrated approach is required. But without actions that the patient is quite capable of performing on his own, chronic fatigue is unlikely to recede.

You can get rid of chronic fatigue and drowsiness on your own if:

Occupational Therapy

Treatment of chronic fatigue syndrome is impossible without professional help, the need to consult a specialist is due to the fact that the causes of CFS can have a different basis.

Thus, in the presence of mental disorders as a determining factor in CFS, attention is paid to auto-training and group therapy sessions.

In the presence of diseases of the internal organs and systems of the body as a risk factor, an effective method of treatment is physiotherapy.

To relieve chronic fatigue, the following methods are suitable:

The schedule for each procedure is prescribed by the doctor, depending on the individual characteristics of the patient and his current condition.

Medications for the treatment of CFS

Depending on the cause of chronic fatigue syndrome and its dominant symptoms, the following types of drugs can be prescribed:

Vitamin therapy is of great importance in the treatment of this pathology. The action of vitamins, of course, is not aimed at suppressing, but these beneficial elements will help support the immune system.

You should take preparations containing selenium, zinc, iron and magnesium. From chronic fatigue and weakness, you need to take vitamins A, B, E.

Dangers - hidden and obvious

As a rule, the prognosis for fatigue syndrome is favorable, the disease is treatable - of course, if it is adequate and timely. But, if for a long time you do not attach importance to such a condition and do not fight it, then it is fraught with the development of secondary diseases later. It:

infectious and viral diseases;
pathology of the male and female reproductive system;
in old age;
schizophrenia and (especially for children).

Preventive measures

It is quite possible to prevent the development of CFS. For this purpose it is necessary:

try to lead an active, healthy lifestyle;
spend more time outdoors, if most of the time you have to spend indoors, you need to at least ventilate it more often and maintain an optimal level of humidity;
avoid if possible;
change the environment from time to time to get new sensations;
to refuse from bad habits;
learn to correctly plan the regime of work and rest and follow it.

CFS is not fatal. But, since the pathology affects the nervous system, it must be dealt with without postponing it for later, otherwise you may face even more serious consequences later.

An integrated approach is the main principle of the treatment of CFS. 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.
The chronic fatigue syndrome treatment program includes:
normalization of the regime of rest and physical activity;
unloading and dietary therapy;
vitamin therapy with preparations of vitamins B1, B6, B12 and C;
general or segmental massage together with hydroprocedures and physiotherapy exercises;
autogenic training or other active methods of normalizing the psycho-emotional background, psychotherapy;
general immunocorrectors with an adaptogenic effect;
other aids (daytime tranquilizers, enterosorbents, nootropics, antihistamines in the presence of allergies).
Many patients do not fully recover from CFS, even with treatment. Several management strategies have been proposed to reduce the consequences of having CFS. All kinds of drug treatment methods, various medical therapies, complementary and alternative medicine are taken into account. Systematic observation has shown that patients with CFS are less susceptible to the placebo effect, and placebo has less effect on them compared to patients with other diseases. CFS is associated with chemical sensitivity, and some patients often respond to a small fraction of the therapeutic dose that is normal in other conditions. A number of recent clinical trials have used several immunomodulatory agents: Staphylococcal vaccine Staphypan Berna, lactic acid bacteria, kuibitang, and intravenous immunoglobulin. For example, according to recent data, antidepressants appear to be beneficial in increasing natural killer (NK) cell activity in depressed patients.
Researchers who have identified deficiencies in antioxidants, L-carnitine, B vitamins, magnesium, believe that the addition of drugs containing these substances can significantly reduce the symptoms of CFS. Magnesium regulates all the processes of production and consumption of energy in the body, with its chronic deficiency, fatigue, lethargy and loss of strength occur. It is even known that 80-90% of intracellular magnesium is in complex with ATP, a nucleotide that is a universal carrier and the main energy accumulator in living cells.
From the point of view of physiology, fatigue occurs after the exhaustion of energy resources in the tissues and the accumulation of catabolism products. The formation of available energy for cells (ATP) occurs in mitochondria due to the oxidation of glucose and fatty acids. At the same time, energy deficiency occurs not due to a lack of substrate, but due to the limited throughput of mitochondria. The efficiency of mitochondria is largely determined by the amount of fatty acid transporter - L-carnitine. With a lack of L-carnitine, the oxidation of fatty acids in mitochondria slows down and, as a result, ATP production decreases.
A number of clinical studies have shown the effectiveness of L-carnitine preparations (and its esters) in CFS. The daily dose was usually 2 g. The strongest effect occurred after 2-4 weeks of treatment. Fatigue decreased by 37-52%. In addition, such an objective cognitive parameter as concentration of attention improved.
Profile studies conducted in the period from 2006 to 2008. showed high efficiency in the treatment of chronic fatigue syndrome using low-intensity laser therapy, performed according to the method of individually dosed laser therapy. The effectiveness of laser therapy for patients with CFS using this technique is 86.7%. The effectiveness of laser therapy is due to the ability to eliminate the dysfunction of the central regulatory centers of the autonomic nervous system.