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Chronic Fatigue Syndrome/ Myalgic Encephalomyelitis [ME/CFS]

CFS/ME is defined as a long-standing, severe, disabling fatigue without demonstrable muscle weakness. Leading health organizations recognize this as a serious, long-term illness possibly caused by a disruption in how the immune system responds to infection or stress. It shares many characteristics with autoimmune diseases like rheumatoid arthritis but without apparent signs of tissue damage.

Myalgic Encephalomyelitis literally means acute inflammation in the brain and the spinal cord along with muscle pain. Chronic fatigue must not be confused with ME/CFS because the “fatigue” of ME/CFS represents pathophysiological exhaustion and is only one of many symptoms.
Chronic Fatigue Syndrome also now known as Myalgic Encephalomyelitis is classified as a neurological disease in the World Health Organization’s International Classification of Diseases (ICD).

By now most of you must be guessing that you are one of those sufferers, trust me so did I! But we actually might not be, as the fatigue termed here is so life tasking that it usually only gets worse, as even the mildest activity, like brushing your teeth, can lead to a debilitating fatigue, the core symptom of the disease.

ETIOLOGY

The etiology is controversial and the precise cause remains unknown. A few probable causes are:

  1. Psychological factors
  2. Various immunologic abnormalities have been reported, they include low levels of IgG, decreased lymphocytic proliferation, low levels of interferon- γ in response to mitogens, and poor cytotoxicity of natural killer cells.
  3. Other prodromal events include immunization, anesthetics, physical trauma, exposure to environmental pollutants, chemicals and heavy metals, and rarely blood transfusions.
  4. Some have abnormal circulating autoantibodies and immune complexes.
  5. A chronic viral infection such as Lyme disease, mononucleosis, influenza, Q fever, Ross River virus, parvovirus.
  6. Epstein- Barr virus also, however the immunologic markers are not so sensitive or specific.
  7. Other possible but unknown viral causes include rubella, HIV, Enteroviruses, Human herpes virus 6 and human T-cell lymphotropic virus.
  8. Other proposed mechanism involves impaired activation of the Hypothalamic-Pituitary-Adrenal Axis in the CFS patients.
  9. Abnormal levels of neurotransmitters, inadequate cerebral circulation, prolonged bed rest, undernutrition, and elevated levels of ACE.
  10. In addition to infectious causes, a genetic predisposition may be considered when more than one separated family member is afflicted.

SYMPTOMS & SIGNS

Onset is usually abrupt and many patients report an initial viral-like illness.

With the possible mentioned symptoms below:

  • Minimal exertion, patients tend to “crash” or “collapse” and may require days, weeks or longer rebound.
  • Brain function is often described as “foggy,” causing problems with memory, quick thinking and attention to detail.
  • Muscle and joint pain unrelated to an injury is a common accompaniment.
  • Headaches those are new or worse than before.
  • Some have tender lymph nodes in the neck or armpits,
  • A frequent sore throat, chills and night sweats,
  • Allergic sensitivities
  • Or digestive problems.
  • Sleep dysfunction.

However no organomegaly is present.

 

 

Response to Exercise Healthy People ME/CFS Patients
Sense of well-being Invigorating, anti- depressant effect Feel malaise, fatigue and worsening of symptoms
Resting heart rate Normal Elevated
Heart rate at maximum workload Elevated Reduced heart rate
Maximum oxygen uptake Elevated Approximately 1⁄2 of sedentary controls
Age-predicted target heart rate Can achieve it Often cannot achieve it and should not be forced
Cardiac output Increased Sub-optimal level
Cerebral blood flow Increased Decreased
Cerebral oxygen Increased Decreased
Body temperature Increased Decreased
Respiration Breathing irregularities: shortness of breath, shallow breathing
Cognitive processing Normal, more alert Impaired
Recovery period Short Often 24 hours but can last days or weeks
Oxygen delivery to the muscles Increased Impaired
Gait kinematics Normal Gait abnormalities

 

DIAGNOSIS

There is no definitive diagnostic test, diagnosis is by clinical criteria only. However, because of all the more possible theories of this exist and one should confine to a single criteria for an individual unless it’s for an epidemic.

A reasonable assessment includes CBP and electrolytes measure, ESR, and thyroid stimulating hormone. In some cases X-Ray and tests for viral infections based on the individual.

Correctly diagnosing ME/CFS, hard enough in adults, is even more of a challenge in children and adolescents, whose problems both within and outside of school can be misattributed to a neurological, learning or psychosocial disorder or simply laziness.Youngsters may also get the syndrome and require a team approach with flexible educational resources and demands suited to each child’s ability to meet them.

MANAGEMENT

The patient must be thoroughly informed of the current understanding of CFS and the daily functions impairment, along with the general advice for the disease management.

Patients with CFS have benefitted from a comprehensive multidisciplinary intervention, including optimal medical management, and implementing comprehensive, cognitive-behavioral treatment program. At present, cognitive-behavioral therapy and graded exercise are the treatments of choice for the patients with chronic fatigue syndrome. Although a few patients are cured, the treatment basis is substantial.

  • Cognitive-behavioral therapy, the emphasis is on self-help and aiming to change perceptions and behaviors that may perpetuate symptoms and disability, is helpful.
  • Graded exercise emphasizes on improving functional work capacity and physical function. Studies show an altered immune response to exercise in patients with CFS.

In addition, the clinicians sympathetic listening and explanatory responses can help overcome the patient’s frustrations and debilitation by this still mysterious illness. All patients should be encouraged to engage in normal activities to the extent possible and should be reassured that full recovery is eventually possible in most cases.

SOURCES:

Current Medical Diagnosis & Treatment, Edition 2017, Common symptoms – Pg.No. 37-39
Harrisons Manual Of Medicine, 19th Edition, Section 3, Pg. No. 134
The Merck Manual, 19th Edition, Chapter 348, Syndromes of Uncertain Origin, Pg. No. 3442-3443
https://www.independent.co.uk/life-style/health-and-families/new-recognition-for-chronic-fatigue-a8081751.html
http://angliameaction.org.uk/docs/CanadianOverviewUK.pdf
https://academic.oup.com/jcem/article-abstract/73/6/1224/2653522

By: MAHEK SINGH
2nd Year, BHMS.

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