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Chronic fatigue syndrome is the current
name for a disease that has been described
for three centuries. It is characterized
by a debilitating fatigue and a variety
of other physical, constitutional,
and neuropsychological complaints.
Certain individuals, who were labeled
in the past with various diagnoses
ranging from neurasthenia to encephalomyelitis,(1)
are now thought to have chronic fatigue
syndrome. The diversity of names is
a reflection of the number and controversy
of theories of the disease. Whatever
the cause, there seems to be several
common themes that occur. It is often
postinfectious, it is associated with
immunological disturbances, and it
is frequently accompanied by depression.
Currently,
the lymphotropic herpes viruses, retroviruses,
and enteroviruses are being studied
as potential causes of chronic fatigue.
Multiple factors have led investigators
to believe one or more of these viruses
causes chronic fatigue syndrome. Chronic
fatigue can be precipitated by a variety
of acute infections, and some of these
organisms have the ability to persist
in humans, causing chronic illness.
Experience suggests that, while viruses
may precipitate the syndrome, it is
unlikely that they contribute to its
long-term features. There have been
several immunologic disturbances reported
in patients with chronic fatigue syndrome;
however, none of them appear in all
patients, nor have any been correlated
with the severity of the illness.
An
interesting finding that has been
observed in controlled studies in
recent years is that patients with
chronic fatigue syndrome have a reduced
production of a hormone called corticotropin-releasing
hormone which is found in the hypothalamus.(2)
Hypothetically, these endocrine abnormalities
could contribute to the mood and impaired
energy level of patients. It is unclear
what significance this finding may
have in determining the cause of this
syndrome. It does, however, further
indicate the complex nature of the
illness.
The
typical case of chronic fatigue syndrome
arises suddenly, in a previously active
individual. Usually the patient can
describe an otherwise unremarkable
flu-like illness or stressful occurrence
as the triggering event. Patients
usually seek medical treatment because
they believe that they have a persistent
infection. There may be a continued
feverishness, sore throat, swollen
lymph nodes, headache, joint aches,
and unbearable exhaustion. As the
syndrome continues, usually there
is disturbed sleep, difficulty in
concentrating, and depression.
Many
patients will make the rounds of allergists,
homeopaths, psychiatrists, rheumatologists,
and others seeking help, frequently
with unsatisfactory results. Patients
often complain that times of greatest
fatigue also equate with times of
greatest pain and difficulty in concentrating.
Most patients finally balance their
obligations of family, work, and other
factors. Some patients actually feel
they can no longer engage in gainful
employment. Quite often there is isolation,
a resignation to the illness, and
frustration. Many patients express
anger with members of the medical
community for not recognizing their
illness, or not resolving their plight.
Fortunately, chronic fatigue syndrome
does not seem to progress, and in
fact, over time, most patients gradually
improve.
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