CFS, Chronic Fatigue syndrome

Lach

Clinic

• Also called myalgic encephalomyelitis (ME) or ME/CFS
• It is a complex, debilitating, long-term medical condition.
• Causes and mechanisms are not fully understood.
• Lengthy exacerbations or flare-ups of the illness following ordinary minor physical or mental activity, known as post-exertional malaise (PEM); greatly diminished capacity to accomplish tasks that were routine before the illness; and sleep disturbances.
• Orthostatic intolerance (difficulty sitting and standing upright)
• Cognitive dysfunction

Signs and symptoms

• Main
  • Greatly lowered ability to do activities that were usual before the illness. This drop in activity level occurs along with fatigue and must last six months or longer.
  • Agg of symptoms after physical or mental activity
  • Sleep problems; people may still feel weary after full nights of sleep, or may struggle to stay awake, fall asleep or stay asleep.
  • Brain fog: Problems with thinking and memory
  • Orthostatic intolerance
• Others
  • Muscle pain, joint pain without swelling or redness, and headache
  • Tender cervical lymphadenopathy
  • Sore throat
  • Chills and night sweats
  • Allergies to foods, odors, chemicals, lights, or noise
  • Shortness of breath
  • Irregular heartbeat
  • Increased sensitivity to sensory stimuli and pain

Related disease

• Irritable bowel syndrome
• Fibromyalgia
• Interstitial cystitis

Cause

• Because it may begin as an influenza-like illness with a sudden onset, various infectious causes have been proposed, but evidence is insufficient to prove such causation.
• Infections proposed include mononucleosis, Chlamydophila pneumoniae, HHV-6, and Lyme disease
• Often, the illness will follow a viral illness such as mononucleosis or gastroenteritis.

Miasms

• EBV

• CMV
• HHV-6
• VZV

Pathophysiology

• Brainstem hypometabolism

• Autonomic nervous system dysfunction role in CFS
• Central sensitization have been observed in CFS.
• Evidence points to abnormalities in HPA axis.

Entities

CFS entities	EBV	HIV	HSV-1	CMV
Cognitive	+++	+++	+++	+++
Mononucleosis Tender cervical lymphadenopathy Sore throat	+++	+++		+++
Night sweet	+++	+++
Autonomic dysfunction Orthostatic intolerance Sleep problems Irregular heartbeat	+++	+++	+++	+++
Adrenal insufficiency	+++		++	+
Depression

Recent researches

• An association between CFS and abnormalities of the HPA axis has been described, and other adrenal steroid abnormalities have been suggested.
• DHEA and its sulphate (DHEA-S), apart from being a precursor of sex steroids, have other functions associated with memory, depression and sleep.
  • It has been suggested that CFS may be associated with a state of relative DHEA(-S) deficiency.
  • Therefore we investigated basal levels of DHEA(-S), the cortisol/DHEA molar ratio and the responsiveness of DHEA to stimulation by CRH.
• Recent studies have also suggested that low dose hydrocortisone may be effective at reducing fatigue in CFS. We therefore also assessed these parameters prior to and following treatment with low dose oral hydrocortisone.
• DHEA levels are raised in CFS and correlate with the degree of self-reported disability.
• Hydrocortisone therapy leads to a reduction in these levels towards normal, and an increased DHEA response to CRH, most marked in those who show a clinical response to this therapy.
• Note that in PCOS, we have also high level of DHEA.