Fukuda criteria

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.

Authors

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:

• substantial impairment in short-term memory or concentration;
• sore throat;
• tender lymph nodes;
• muscle pain;
• multi-joint pain without swelling or redness;
• headaches of a new type, pattern, or severity;
• unrefreshing sleep; and
• post-exertional malaise lasting more than 24 hours.

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

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.

Criticisms

• 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.)

Learn more

• Fukuda criteria summary
• CDC criteria
• 2001, A Comparison of the 1988 and 1994 Diagnostic Criteria for Chronic Fatigue Syndrome. Leonard Jason et al.
• 2003, Identification of ambiguities in the 1994 chronic fatigue syndrome research case definition and recommendations for resolution, by Reeves, et al.
• 2004, Comparing the Fukuda et al. Criteria and the Canadian Case Definition for Chronic Fatigue Syndrome. Leonard Jason et al.

See also

• Case Definition Comparison - Graph 1
• Definitions of ME and CFS
• Centers for Disease Control and Prevention
• International Consensus Criteria
• Canadian Consensus Criteria

See chronic fatigue syndrome.

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.

See Centers for Disease Control and Prevention.

adverse reaction Any unintended or unwanted response to a treatment, whether in a clinical trial or licensed treatment. May be minor or serious.

post-exertional malaise (PEM) - A notable exacerbation of symptoms brought on by small physical or cognitive exertions. PEM may be referred to as a "crash" or "collapse" and can last for days or weeks. Symptoms can include cognitive impairments, muscle pain, trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, and others.

See post-exertional malaise.

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.