20 de diciembre de 2011

Chronic Fatigue Syndrome: Evaluation and Treatment

Chronic Fatigue Syndrome: Evaluation and Treatment
Am Fam Physician.�2002�Mar�15;65(6):1083-1091.
Severe fatigue is a common complaint among patients. Often, the fatigue is transient or can be attributed to a definable organic illness. Some patients present with persistent and disabling fatigue, but show no abnormalities on physical examination or screening laboratory tests. In these cases, the diagnosis of chronic fatigue syndrome (CFS) should be considered. CFS is characterized by debilitating fatigue with associated myalgias, tender lymph nodes, arthralgias, chills, feverish feelings, and postex-ertional malaise. Diagnosis of CFS is primarily by exclusion with no definitive laboratory test or physical findings. Medical research continues to examine the many possible etiologic agents for CFS (infectious, immunologic, neurologic, and psychiatric), but the answer remains elusive. It is known that CFS is a heterogeneous disorder possibly involving an interaction of biologic systems. Similarities with fibromyalgia exist and concomitant illnesses include irritable bowel syndrome, depression, and headaches. Therefore, treatment of CFS may be variable and should be tailored to each patient. Therapy should include exercise, diet, good sleep hygiene, antidepressants, and other medications, depending on the patient's presentation.
Chronic fatigue syndrome (CFS), also referred to as chronic fatigue immune deficiency syndrome, is a disabling illness characterized by persistent fatigue accompanied by rheumatologic, cognitive, and infectious-appearing symptoms. Despite intense medical research, there is no known cause for CFS, but it appears to be a heterogeneous disorder which affects multiple systems, including hormonal, neurologic, and immunologic. Because there are no specific diagnostic tests or physical findings for CFS, diagnosis requires knowledge of possible symptoms and a method of exclusion. CFS is likely a spectrum of illnesses sharing a common pathogenesis with varying degrees of fatigue and associated symptoms. Other disorders, such as fibromyalgia, have overlapping symptoms with CFS, suggesting that both diseases may share common physiologic abnormalities.
Chronic fatigue syndrome affects both genders, all racial, ethnic, and socioeconomic populations, and can begin as early as five years of age. Although previous reports showed a predominance of CFS in well-educated, white females between 20 and 50 years of age, these findings may be skewed by study populations that were selected from patients who sought medical care for the disorder. Furthermore, the diagnostic ambiguity surrounding CFS invariably leads to imprecise and inconsistent epidemiologic statistics.