Chronic fatigue and immune dysfunction syndrome

Chronic fatigue and immune dysfunction syndrome: Excerpt from Handbook of Diseases

Chronic fatigue and immune dysfunction syndrome (CFIDS) — also known as chronic fatigue syndrome, chronic Epstein-Barr virus [EBV], benign myalgic encephalomyelitis, and “Yuppie flu” — is typically marked by debilitating fatigue, neurologic abnormalities, and persistent symptoms that suggest chronic mononucleosis. It commonly occurs in adults younger than age 45, and its incidence is highest in women.

Causes

Although the cause of CFIDS is unknown, researchers suspect that it may be found in human herpesvirus 6 or in other herpesviruses, enteroviruses, or retroviruses. Rising levels of antibodies to EBV, once thought to implicate EBV infection as the cause of CFIDS, are now considered a result of this disease.

CFIDS may be associated with a reaction to viral illness that’s complicated by dysfunctional immune response and by other factors that may include sex, age, genetic disposition, prior illness, stress, and environment.

Signs and symptoms

The characteristic symptom of CFIDS is prolonged, often overwhelming fatigue that’s commonly associated with a varying complex of other symptoms. To aid identification of the disease, the Centers for Disease Control and Prevention (CDC) uses a “working case definition” to group symptoms and severity. (See CDC criteria for diagnosing CFIDS.)

Diagnosis

The cause and nature of CFIDS are still unknown, and no single test unequivocally confirms its presence. Therefore, the diagnosis is based on the patient’s history and the CDC criteria. Because the CDC criteria are admittedly a working concept that may not include all forms of this disease and are based on symptoms that can result from other diseases, diagnosis is difficult and uncertain. Considerable overlap exists between CFIDS and fibromyalgia syndrome, with many patients having features of both.

Treatment

Treatment is aimed at the cause, if one can be found. Supportive therapy includes an anti-inflammatory, an antihistamine, and rest.

Treatment of symptoms may include a tricyclic antidepressant (doxepin), a histamine₂-blocker (cimetidine), and an anxiolytic (alprazolam). In some patients, avoidance of environmental irritants and certain foods may help to relieve symptoms.

Experimental treatments include the antiviral acyclovir and selected immunomodulators, such as I.V. gamma globulin, ampligen, and transfer factor.

Special considerations

Clinical tip  Refer the patient to the CFIDS Association for information as well as to local support groups; supportive contact with others who share this disease may benefit the patient.

❑ If appropriate, suggest psychological counseling.

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Book Source Details

• Book Title: Handbook of Diseases
• Author(s): Springhouse
• Year of Publication: 2003
• Copyright Details: Handbook of Diseases, Copyright © 2003 Lippincott Williams & Wilkins.

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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: Handbook of Diseases Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 1-58255-266-5

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