CHRONIC FATIGUE SYNDROME has many names, "Yuppie flu", "neurasthenia", "irritable heart", "effort syndrome", "myalgic encephalomyelitis", etc. It is not a disease, but rather a condition of exhaustion with many possible causes, presentations and treatments.
ETIOLOGY
--multifactorial
--immune dysfuction
--stress/adrenal fatigue
--virus, microbes (EBV, HTLV, Enterovirus, Brucella, Borrelia)
--allergy and atopy
--food intolerance
--oxidative stress (mitochondrial dysfunction)
--usu severe stress 3-12 months before onset
INCIDENCE
--age 40-59 most common
--4x more common in women than men
--more in adults than adolescents that children
--even distribution across incomes, socioeconomic status and race (this is unusual)
--runs in families
SIGNS AND SYMPTOMS
--fatigue, disabling
--fever, low grade
--chest pain
--dizziness
--mood problems
--sleep problems, unrefreshing sleep
--forgetfulness, loss of concentration
--weakness
--GI problems
--negative mental outlook
--continues for 6+ months, unexplained, persistent or relapsing
--sore throat
--tender lymph nodes
--headaches
--exertional fatigue (tired for more than 24 hours from exertion)
--changes in appetite
--night sweats
--joint pain
--never feel like you've recovered
DIFFERENTIAL
--fibromyalgia
--hypothyroid
--adrenal disease
--toxicity
--lupus
--chronic dehydration
--EBV (95% of CFS pts have Ab's, higher titer correlates with more fatigue, test costs $200-300)
--HTLV (50% either have virus or viral genes integrated into host genome)
--enterovirus (20% have it in stool)
--Brucella, Borrelia
IT'S NOT CFS IF WE CAN BLAME ONE OF THESE
--bipolar
--schizophrenia
--anorexia
--medication SE
--obesity
--hep B or C
--depression
IMMUNE SYSTEM EFFECTS
--looks like chronic viral infection, pesticide exposure, sick building or Gulf war syndrome
--increased cytokines, IL's, IFN
--decreased T cell count
--decreased CD8 T cell function (less perforin, granzymes)
--decreased antibodies even though there are increased B cells
--decreased natural killer cell function, less perforin, even though number of NK cells may be up, need L-arginine?, exposed to organochloropesticides?
--CFIDS = chronic fatigue immune deficiency syndrome
--genetic components??
ALLERGY/ATOPY COMPONENT
--50% of CFS sufferers have it
--hypersensitivity to metals is common, esp nickel
--eosinophilic cationic protein (ECP) is elevated
--77% have positive RAST test to 1+ allergens
--"common immunologic background
FOOD INTOLERANCE
--IgG (vs IgE)
--diet modification helps a great many sufferers
--esp elimination of wheat, dairy
OXIDATIVE STRESS
--disrupted cell membranes
--mitochondrial disfunction
--worse causes muscle pain
--higher markers correlate with CFS
--RBC's
--pts have IgM against waste products, immune activation
--peroxynitrite due to viral infx
--inhibits hormone synthesis and release
HORMONES
--ATCH is usually high but sometimes low
--CRH, synthetic sometimes used as Tx
--cortisol is usually low or abnormal pattern, low in am when it should be high
--DHEA is usually high
--common Tx is to normalize DHEA with hydrocortisone, dangerous
TREATMENTS (incomplete)
--modulate immune system via hydro, diet, etc
--diet modification incl elimination diet
--test for bugs
--test hormones
--herbs
--???