Fukuda criteria

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The Fukuda criteria (or CDC 1994 criteria) are criteria for the diagnosing chronic fatigue syndrome (CFS), published in 1994. It has been widely used in research.[1]


Keiji Fukuda; Stephen Straus; Ian Hickie; Michael Sharpe; James Dobbins; Anthony Komaroff, plus the International Chronic Fatigue Syndrome Study Group:

Ann Schluederberg, James F. Jones, Andrew R. Lloyd, Simon Wessely, Nelson M. Gantz, Gary P. Holmes, Dedra Buchwald, Susan Abbey, Jonathan Rest, Jay A. Levy (FDA), Heidi Jolson (Incline Village, Nevada), Daniel L. Petereson, Jan H.M.M. Vercoulen, Umberto Tirelli, Birgitta Evengard, Benjamin H. Natelson, (CDC); Lea Steele (CDC), Michele Reyes (CDC), and William C. Reeves (CDC).

CDC Fukuda definition of CFS

Primary symptoms

Clinically evaluated, unexplained, persistent or relapsing chronic fatigue that is:

  • of new or definite onset (has not been lifelong);
  • is not the result of ongoing exertion;
  • is not substantially alleviated by rest;
  • and results in substantial reduction in previous levels of occupational, educational, social, or personal activities.

Additional symptoms

The concurrent occurrence of four or more of the following symptoms:

These symptoms must have persisted or reoccurred during 6 or more consecutive months of illness and must not have stated before the fatigue.[1]

Final requirement

All other known causes of chronic fatigue must have been ruled out, specifically clinical depression, side effects of medication, eating disorders and substance abuse.


  • Post-exertional malaise (PEM) is not mandatory. (Most US researchers use PEM option.)
  • Doctors and researchers not using PEM option have misdiagnosed chronic fatigue (CF) patients with chronic fatigue syndrome (CFS)
  • In research, if PEM option is not used the study is not considered by patients and many researchers to be a true CFS study; it is considered to be a (CF) study. Or both CFS and CF patients are in a CFS study as some patients have PEM and other patients do not making the study severely flawed and useless to either CFS or CF research.
  • It is not easy to use on a clinical level as it was created for research. It can take several specialists and years to diagnose a patient.
  • Dual diagnosis is not always possible and this is not useful in a clinical setting. (i.e., AIDS + CFS or MS + CFS.)
  • Leads to confusion over chronic fatigue (a symptom of many illness, depression, diseases, medications) and chronic fatigue syndrome (a grossly misnamed disease.)[2]

Learn more

See also


Fukuda criteria - The most commonly used diagnostic criteria for chronic fatigue syndrome, created by the United States Centers for Disease Control (CDC).

chronic fatigue syndrome (CFS) - A fatigue-based illness. The term CFS was invented invented by the U.S. Centers for Disease Control as an replacement for myalgic encephalomyelitis (ME). Some view CFS as a neurological disease, others use the term for any unexplained long-term fatigue. Sometimes used as a the term as a synonym of myalgic encephalomyelitis, despite the different diagnostic criteria.

Centers for Disease Control and Prevention (CDC) - The Centers for Disease Control and Prevention is a U.S. government agency dedicated to epidemiology and public health. It operates under the auspices of the Department of Health and Human Services.

adverse reaction - Any unintended or unwanted response to the treatment under investigation in a clinical trial.

post-exertional malaise (PEM) - A notable exacerbation of symptoms brought on by small physical or cognitive exertions. PEM can last for days or weeks. Symptoms can include cognitive impairments, muscle pain (myalgia), trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, among others.

chronic fatigue (CF) - Persistent and abnormal fatigue is a symptom, not an illness. It may be caused by depression, multiple sclerosis, fibromyalgia, chronic fatigue syndrome or many other illnesses. The term "chronic fatigue" should never be confused with the disease chronic fatigue syndrome.

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.