Chronic fatigue syndrome

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Chronic fatigue syndrome (CFS) is the name coined by the Centers for Disease Control (CDC) in response to an outbreak of "chronic flu-like illness" at Incline Village, Lake Tahoe in 1984-1985.[1]

As of February 2013, the CDC recognized that more than one million Americans have CFS.[2] The February 2015 Institute of Medicine report stated that there are 836,000 to 2.5 million ME/CFS patients.[3] The Prognosis for ME/CFS is generally poor.

Chronic Fatigue Syndrome should be distinguished from chronic fatigue (CF), which is a symptom of many different conditions, though not a condition in its own right. These terms are often confused by the media, healthcare practitioners, and the general public. CFS is a grossly misnamed disease whereas CF is a symptom of many diseases, illnesses and drug therapies.[4][5] Dr. Jarred Younger explains chronic fatigue and begins by stating "Fatigue is not a disease and it is not even a symptom. So fatigue is a alarm system and the most general alarm system the body has." Webinar with Jarred Younger, Ph.D. (@6:04-7:54)


Hallmark symptom[edit]

  • Post-exertional malaise (PEM) is the hallmark symptom of ME/CFS. After physical or mental exertion (which for some patients can be a shower or making out a to-do list, others grocery shopping, socializing or reading a news article, while some just walking to the mailbox, getting to the doctor or mentally following a T.V. program) there is a payback which can be delayed 24-48 hours and can last 24 hours or more. The patient will experience even greater fatigue as well as exasperate the flu-like symptoms and body pain. Every patient experiences different symptoms and symptom severity from different activities and exertion output according to how sick he or she is with the disease.[6][7][8]

Regarding PEM the CFIDS Association of America states: "This is a term which describes a symptom in which exercise or exertion can bring on malaise (illness). In the case of people with ME/CFS, malaise often occurs during a period some 24-72 hours after exertion. For example, in some cases, a short walk can worsen ME/CFS symptoms two days later. This lack of understanding about the delayed onset of symptoms has, in the past, made it harder to test for ME/CFS. Follow-up tests, taken less than 24 hours after an initial exercise test, may show that the patient can still perform activities at the same level (before post-exertional malaise has a chance to take hold)."[9]

Core and additional symptoms (see IOM Clinicians Guide below)[edit]

Other symptoms, comorbids[edit]

Expanded lists of symptoms[edit]

Clinicians guides[edit]

US Government guides on symptoms[edit]

Canada guides on symptoms[edit]

Disease onset and course of illness[edit]

The disease ME/CFS is diagnosed when a person does not recover from a flu-like illness, EBV, Mononucleosis, HHV, Q fever, Virus or other infections and meets one or more diagnostic criteria for either ME, CFS or ME/CFS.[12][13][14] "Occasionally, ME/CFS has been triggered by environmental toxins, the receipt of an immunizing injection, or surviving a major trauma."[15] Patient health is never the same and they experience numerous symptoms and disease severity which fluctuate day to day, week to week, month to month, year to year and decade to decade as well as varying symptoms and disease severity among patients.[16][17][18]

Female to male ratio[edit]

Like many auto-immune and neuro-immune diseases where mostly women are afflicted,[19] the ME/CFS female/male patient ratio is 6:1.[20] Fibromyalgia has a F/M 7:1 ratio and some ME/CFS patients have this additional diagnosis.[21][22]

Jennifer Brea gives a WMC Live radio interview addressing F/M auto-immune ratio and the disease at 5:00.

Clinical course[edit]

From the Centers for Disease Control (CDC): What's the Clinical Course of CFS?

The severity of CFS varies from patient to patient. Some people can maintain fairly active lives. For most patients, however, CFS significantly limits their work, school, and family activities for periods of time.
While symptoms vary from person to person in number, type, and severity, all CFS patients are limited in what they can do to some degree. CDC studies show that CFS can be as disabling as multiple sclerosis, lupus, rheumatoid arthritis, heart disease, end-stage renal disease, chronic obstructive pulmonary disease (COPD), and similar chronic conditions.
CFS often affects patients in cycles: Patients will have periods of illness followed by periods of relative well-being. For some patients, symptoms may diminish or even go into complete remission; however, they often recur at a later point in time. This pattern of remission and relapse makes CFS especially hard for patients to manage. Patients who are in remission may be tempted to overdo activities when they're feeling better, but this overexertion may actually contribute to a relapse.
The percentage of CFS patients who recover is unknown, but there is some evidence to indicate that patients benefit when accompanying conditions are identified and treated and when symptoms are managed. High-quality health care is important.[23]

Name controversy[edit]

The name Chronic Fatigue Syndrome is controversial, as many consider it stigmatizing. For decades, patient advocates have been lobbying the CDC to instead use the name Myalgic Encephalomyelitis (ME), though the CDC has refused.[24] Most patients and patient organizations prefer the name ME, or the hybrid ME/CFS.

In February 2016, Dr Anthony Komaroff, who was part of the CDC group of clinicians who coined the name Chronic Fatigue Syndrome, said of it: "I think that was a big mistake because the name, in my opinion, and the opinion of a lot of people, it both trivializes and stigmatizes the illness. It makes it seem unimportant, maybe not even real".[25]

Dr. Nancy Klimas discusses the name controversy in the video ME/CFS Diagnosis and Name.

Notable studies[edit]


Learn more[edit]

See also[edit]


  1. Fatigue 'Virus' Has Experts More Baffled And Skeptical Than Ever - NY Times July 1987
  2. Chronic Fatigue Syndrome - CDC
  3. Institute of Medicine (USA); Committee on the Diagnostic Criteria for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (10 February 2015), Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness 
  4. Chronic Fatigue vs. Chronic Fatigue Syndrome - One's a Symptom, One's a Disease - Health FMS/ME/CFS By: Adrienne Dellwo
  5. Chronic Fatigue Versus Chronic Fatigue Syndrome What's the Difference? - Health FMS/ME/CFS - By Carol Eustice
  6. Unraveling Post-Exertional Malaise - Solve ME/CFS Initiative By: Jennifer M. Spotila, J.D. - Plus a link to all 4 parts
  7. Chronic Fatigue Syndrome - Symptoms - Web MD
  8. Post-Exertional Malaise - Health - FMS/ME/CFS
  9. - What Health - International CFS/ME Awareness Day 2017 - CFIDS Association of America
  10. Myalgic encephalomyelitis: International Consensus Criteria - Wiley - Journal of International Medicine
  11. What is ME/CFS? - Solve ME/CFS Initiative
  12. IOM Report - INFECTION
  13. The Lipkin Study, The Vagus Nerve Infection Hypothesis and HHV-6: Kristin Loomis of the HHV-6 Foundation Talks – Pt. I - Health Rising - By: Cort Johnson - June 2014
  14. Definitions of ME and CFS - MEpedia
  15. Chronic Fatigue Syndrome Myalgic Encephalomyelitis - Primer for Clinical Practitioners - 2014 Edition - Massachusettes CFIDS/FM Assoc
  16. Symptoms and diagnosis of ME/CFS - ME Association
  17. Chronic Fatigue Syndrome - Symptoms - Web MD
  18. Facts (ME/CFS) Severity
  19. Fact Sheet Autoimmune Disease in Women: NWHIC - Right Diagnosis - Aug 2015
  20. Chronic fatigue syndrome/myalgic encephalomyelitis: an update. - PUBMed Dec. 2010
  21. Fibromyalgia - CDC
  22. What Is ME/CFS (Fibromyalgia) Solve ME/CFS Initiative
  23. What's the Clinical Course of CFS? - CDC
  24. A Disease in Search of a Name: The History of CFS and the Efforts to Change Its Name - Chronic Fatigue Support
  25. Komaroff, Anthony; Iskander, John (17 Feb 2016), "Interview with Dr Anthony Komaroff", CDC Public Health Ground Rounds - Beyond the Data - Chronic Fatigue Syndrome: Advancing Research and Clinical Education 
  26. Shan, ZY; Kwiatek, R; Burnet, R; Del Fante, P; Staines, DR; Marshall-Gradisnik, SM; Barnden, LR (2016-04-28), "Progressive brain changes in patients with chronic fatigue syndrome: A longitudinal MRI study", Journal of magnetic resonance imaging: JMRI, PMID 27123773, doi:10.1002/jmri.25283 
  27. Jaime S (2016-05-05), "Progressive Brain Changes in Patients with Chronic Fatigue Syndrome: Are our Brains Starved of Oxygen?", #MEAction 
  28. Chronic Fatigue Patients Suffer 3 Major Brain Abnormalities; Findings May Lead To Clearer Diagnosis. - Patient Health Care

The information provided at this site is not intended to diagnose or treat any illness.

From MEpedia, a crowd-sourced encyclopedia of ME and CFS science and history