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===<span id="2007">NICE Definition (2007-Oct 2021)</span>=== Healthcare professionals should consider the possibility of CFS/ME if a person has: *[[fatigue]] with all of the following features: **new or had a specific [[onset]] (that is, it is not lifelong) **persistent and/or recurrent **unexplained by other conditions **has resulted in a substantial reduction in activity level **characterised by [[post-exertional malaise]] and/or fatigue (typically delayed, for example by at least 24 hours, with slow recovery over several days) '''and''' *one or more of the following symptoms: **[[Sleep dysfunction|difficulty with sleeping]], such as [[insomnia]], [[hypersomnia]], [[unrefreshing sleep]], a disturbed sleep–wake cycle **[[myalgia|muscle]] and/or [[arthralgia|joint pain]] that is multi-site and without evidence of inflammation **[[headache]]s **[[painful lymph nodes]] without pathological enlargement **[[sore throat]] **[[cognitive dysfunction]], such as difficulty thinking, [[attention deficit|inability to concentrate]], [[memory problems|impairment of short-term memory]], and difficulties with word-finding, planning/organising thoughts and information processing **[[post-exertional malaise|physical or mental exertion makes symptoms worse]] **general malaise or [[flu-like symptoms|"flu-like" symptoms]] **[[dizziness]] and/or [[nausea]] **[[heart palpitation|palpitations]] in the absence of identified cardiac pathology Healthcare professionals should be aware that the symptoms of CFS/ME fluctuate in severity and may change in nature over time. Signs and symptoms that can be caused by other serious conditions (‘red flags’) should not be attributed to CFS/ME without consideration of alternative diagnoses or comorbidities. In particular, the following features should be investigated: *localising/focal neurological signs *signs and symptoms of inflammatory [[arthritis]] or connective tissue disease *signs and symptoms of cardiorespiratory disease *significant [[weight loss]] *[[sleep apnea]] *clinically significant lymphadenopathy A diagnosis should be made after other possible diagnoses have been excluded and the symptoms have persisted for: *4 months in an adult *3 months in a child or young person; the diagnosis should be made or confirmed by a paediatrician The diagnosis of CFS/ME should be reconsidered if none of the following key features are present: *[[post-exertional malaise|post-exertional fatigue or malaise]] *[[cognitive dysfunction|cognitive difficulties]] *[[sleep disturbance]] *[[chronic pain]]<ref name="CG53-evidence">{{Cite web|url=https://www.nice.org.uk/guidance/cg53/evidence/full-guideline-196524109 | title = NICE Guidelines for CFS/ME: diagnosis and [CG53]}}</ref>
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