Chronic fatigue syndrome : Overview, Causes, & Risk Factors

Alternate Names : CFS, Fatigue – chronic, Immune dysfunction syndrome, Myalgic encephalomyelitis (ME)


Chronic fatigue syndrome is a condition of prolonged and severe tiredness or weariness (fatigue) that is not relieved by rest and is not directly caused by other conditions.

See also: Fatigue

Overview, Causes, & Risk Factors

The exact cause of chronic fatigue syndrome (CFS) is unknown. Some researchers suspect it may be caused by a virus, such as Epstein-Barr virus or human herpes virus-6 (HHV-6). However, no specific virus has been identified as the cause.

Studies suggest that CFS may be caused by inflammation along the nervous system, and that this inflammation may be some sort of immune response or process.

Other factors such as age, prior illness, stress, environment, or genetics may also play a role.

CFS most commonly occurs in women ages 30 to 50.

The Centers for Disease Control (CDC) describes CFS as a distinct disorder with specific symptoms and physical signs, based on ruling out other possible causes. The number of persons with CFS is unknown.

CFS is diagnosed after the health care provider rules out other possible causes of fatigue, including:

  • Drug dependence
  • Immune or autoimmune disorders
  • Infections
  • Muscle or nerve diseases (such as multiple sclerosis)
  • Endocrine diseases (such as hypothyroidism)
  • Other illnesses (such as heart, kidney, or liver diseases)
  • Psychiatric or psychological illnesses, particularly depression
  • Tumors
Symptoms & Signs

Symptoms of CFS are similar to those of most common viral infections (muscle aches, headache, and fatigue). They come on within a few hours or days and last for 6 months or more.

Main symptoms:

  • Fatigue or tiredness, never experienced to this extent before (new onset), lasting at least 6 months and not relieved by bed rest
  • Fatigue that is severe enough to restrict activity (serious fatigue develops with less than one-half of the exertion compared with before the illness)

Other symptoms:

  • Fatigue lasting more than 24 hours after an amount of exercise that would normally be easily tolerated
  • Feeling unrefreshed after sleeping an adequate amount of time
  • Forgetfulness or other similar symptoms including difficulty concentrating, confusion, or irritability
  • Headaches, different from previous headaches in quality, severity, or pattern
  • Joint pain, often moving from joint to joint (migratory arthralgias), without joint swelling or redness
  • Lymph node tenderness in the neck or armpit
  • Mild fever (101 degrees F or less)
  • Muscle aches (myalgias)
  • Muscle weakness, all over or multiple locations, not explained by any known disorder
  • Sore throat
Diagnosis & Tests

Physical examination may show:

  • Fever
  • Lymph node swelling
  • Lymph node tenderness
  • Redness in the throat without drainage or pus

A diagnosis of CFS must include:

  • Absence of other causes of chronic fatigue (excluding depression)
  • At least four of the other symptoms listed
  • Extreme, long-term fatigue

There are no specific tests to confirm the diagnosis of CFS, although a variety of tests are usually done to rule out other possible causes of the symptoms.

There have been reports of CFS patients being found positive on the following tests:

  • Brain MRI showing swelling in the brain or destruction of part of the nerve cells (demyelination)
  • Higher levels of specific white blood cells (CD4 T cells) compared with other types of white blood cells (CD8 T cells)
  • Specific white blood cells (lymphocytes) containing active forms of EBV or HHV-6

Review Date : 2/7/2010
Reviewed By : Mark James Borigini, Associate Clinical Professor of Medicine, University of California, Irvine, CA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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