scholarly journals Chronic fatigue syndrome in the routine hematology practice

2020 ◽  
Vol 11 (4) ◽  
pp. 47-54
Author(s):  
Vsevolod G. V.G.Potapenko ◽  
Marina F. Ballyuzek
Keyword(s):  
Chronic Fatigue Syndrome ◽  
Clinical Signs ◽  
Chronic Fatigue ◽  
Deficiency Anemia ◽  
Fatigue Syndrome ◽  
Severe Fatigue ◽  
Iron Deficient ◽  
Initial Symptoms ◽  
Median Level ◽  
The Difference

Purpose. Presentation of clinical signs and laboratory profiles of the patients with chronic fatigue syndrome, and comparison of their symptoms with those of the patients with iron deficiency anemia. Materials and methods. Retrospective analysis of the patients symptoms referred to the hematologist outpatient clinic during the period between January 2016 and December 2018. Results. There were 560 patients(162 males and 398 females) referred for a primary consultation by a hematologist. Median age was 52.5 (1894) years. The unexplained fatigue was reported by 27 (4.8%) patients (1 male and 26 females), median age 41 (2466) years. Diagnosis chronic fatigue syndrome (CFS) was confirmed based on the criteria in 17 (63%) patients. 10 patients (47%) with symptoms partially meeting the criteria were diagnosed idiopathic fatigue syndrome (SIF). Half of the patients connected the onset of the diseases with emotional trauma (family issues etc.). The prevailing complaints (30%) were represented by: prolonged fatigue, mild memory impairment and distraction, arthralgia and insomnia. The most frequent reason to see a hematologist was fatigue and borderline changes in the blood tests. Five patients with CFS and 2 patients with SIF were known to have previously diagnosed iron deficient anemia (IDA). Median level of hemoglobin in the patients with severe fatigue and IDA was 10.7 (8.411.7) g/dl. Median follow up duration was 28 (640) months. In the observed group (n = 23) 17% of the patients (n = 4) showed spontaneous improvement. The rest of the patients had reported no changes. The comparison group (n = 64) included the patients with IDA. Most of them (n = 38) did not report fatigue as their initial symptoms (median level of hemoglobin was 9.35 (5.511.9) g/dl). Twenty six patients reported fatigue; median level of hemoglobin was 8.15 (5.911.7) g/dl. The difference between the hemoglobin levels in two groups was significant (р 0.05). However, there was no correlation between the level of hemoglobin and fatigue in the patients with CFS and SIF. The correlation was found in the patients with CFS and SIF between fatigue and patients perception. Conclusion. The main symptoms accompanying CFS are fatigue and other non-specific symptoms which are often related to patients emotional status. Considering CFS as a differential diagnosis when dealing with fatigue is essential.

Prevalence of ADHD in chronic fatigue syndrome

2011 ◽  
Vol 26 (S2) ◽  
pp. 1574-1574
Author(s):  
N. Sáez Francàs ◽  
J. Alegre ◽  
N. Calvo Piñero ◽  
J.A. Ramos Quiroga ◽  
E. Ruiz ◽  
...  
Keyword(s):  
Chronic Fatigue Syndrome ◽  
Rating Scale ◽  
Chronic Fatigue ◽  
Diagnostic Interview ◽  
Initial Sample ◽  
Hyperactivity Disorder ◽  
Fatigue Syndrome ◽  
Severe Fatigue ◽  
Severe Psychopathology ◽  
The Relationship

IntroductionChronic Fatigue Syndrome (CFS) is characterized by severe fatigue associated with pain, sleep disturbance, attentional impairment and headaches. Evidence points towards a prominent role for Central Nervous System in its pathogenesis, and alterations in serotoninergic and dopaminergic neurotransmission have been described.Attention-deficit Hyperactivity Disorder (ADHD) courses with inattention, impulsivity, and hyperactivity. It affects children and persists into adulthood in 50% of patients. Dopamine transporter abnormalities lead to impaired neurotransmission of catecholaminergic frontal-subcortical-cerebellar circuits.ObjectivesTo describe the prevalence of ADHD in a sample of CFS patients, and the clinical implications of the association.AimsTo study the relationship between CFS and ADHD.MethodsThe initial sample consisted of 142 patients, of whom 9 were excluded because of severe psychopathology or incomplete evaluation. All the patients (age 49 ± 87; 94,7 women) received CFS diagnoses according to Fukuda criteria. ADHD was assessed with a diagnostic interview (CAADID), ADHD Rating Scale and the scale WURS, for childhood diagnose. The scales FIS-40, HAD, STAI and Pluthik Risk of Suicide (RS) were administrated.Results38 patients (28,8%) were diagnosed of childhood ADHD (4 combined, 22 hyperactive-impulsive, 12 inattentive) and persisted into adulthood in 28 (21,1%; 5 combined, 4 hyperactive-impulsive, 19 inattentive). There were no differences in Fukuda criteria profile and FIS-40 between groups. ADHD patients scored higher in HAD-Anxiety (9,88 ± 4,82 vs. 12,57 ± 3,49; p = 0,007), HAD-Depression (9,69 ± 4,84 vs. 12,04 ± 4,53; p = 0,023), STAI-E (30,55 ± 14,53 vs. 38,41 ± 11,35; p = 0,012), and RS (6,13 ± 3,48 vs. 8,49 ± 3,07; p = 0,002).ConclusionsADHD is frequent in CFS patients and it is associated with more severe clinical profile.

scholarly journals Understanding Muscle Dysfunction in Chronic Fatigue Syndrome

2016 ◽  
Vol 2016 ◽  
pp. 1-13 ◽  
Author(s):  
Gina Rutherford ◽  
Philip Manning ◽  
Julia L. Newton
Keyword(s):  
Skeletal Muscle ◽  
Chronic Fatigue Syndrome ◽  
Chronic Fatigue ◽  
Muscle Dysfunction ◽  
Biochemical Abnormality ◽  
Fatigue Syndrome ◽  
Acid Clearance ◽  
Severe Fatigue ◽  
Show Evidence ◽  
Accompanying Symptoms

Introduction. Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is a debilitating disorder of unknown aetiology, characterised by severe disabling fatigue in the absence of alternative diagnosis. Historically, there has been a tendency to draw psychological explanations for the origin of fatigue; however, this model is at odds with findings that fatigue and accompanying symptoms may be explained by central and peripheral pathophysiological mechanisms, including effects of the immune, oxidative, mitochondrial, and neuronal pathways. For example, patient descriptions of their fatigue regularly cite difficulty in maintaining muscle activity due to perceived lack of energy. This narrative review examined the literature for evidence of biochemical dysfunction in CFS/ME at the skeletal muscle level.Methods.Literature was examined following searches of PUB MED, MEDLINE, and Google Scholar, using key words such as CFS/ME, immune, autoimmune, mitochondria, muscle, and acidosis.Results. Studies show evidence for skeletal muscle biochemical abnormality in CFS/ME patients, particularly in relation to bioenergetic dysfunction.Discussion.Bioenergetic muscle dysfunction is evident in CFS/ME, with a tendency towards an overutilisation of the lactate dehydrogenase pathway following low-level exercise, in addition to slowed acid clearance after exercise. Potentially, these abnormalities may lead to the perception of severe fatigue in CFS/ME.

scholarly journals Fatigue Scales and Chronic Fatigue Syndrome: Issues of Sensitivity and Specificity

2011 ◽  
Vol 31 (1) ◽  
Author(s):  
Leonard Jason ◽  
Jason Meredyth Evans ◽  
Molly Brown ◽  
Nicole Porter ◽  
Abigail Brown ◽  
...  
Keyword(s):  
Chronic Fatigue Syndrome ◽  
Sensitivity And Specificity ◽  
Operating Characteristic ◽  
Chronic Fatigue ◽  
Roc Curve Analysis ◽  
Fatigue Syndrome ◽  
Specificity And Sensitivity ◽  
Severe Fatigue ◽  
Fatigue Severity ◽  
Extreme Care

<p>Few studies have explored issues of sensitivity and specificity for using the fatigue construct to identify patients meeting chronic fatigue syndrome (CFS) criteria. In this article, we examine the sensitivity and specificity of several fatigue scales that have attempted to define severe fatigue within CFS. Using Receiver Operating Characteristic (ROC) curve analysis, we found most scales and sub-scales had either significant specificity and/or sensitivity problems. However, the post-exertional subscale of the ME/CFS Fatigue Types Questionnaire (Jason, Jessen, et al., 2009) was the most promising in terms of specificity and sensitivity. Among the more traditional fatigue scales, Krupp, LaRocca, Muir-Nash, and Steinberg’s (1989) Fatigue Severity Scale had the best ability to differentiate CFS from healthy controls. Selecting questions, scales and cut off points to measure fatigue must be done with extreme care in order to successfully identify CFS cases.</p>

scholarly journals Internet-Based Cognitive Behavioral Therapy in Stepped Care for Chronic Fatigue Syndrome: Randomized Noninferiority Trial (Preprint)

2018 ◽  
Author(s):  
Margreet Worm-Smeitink ◽  
Anthonie Janse ◽  
Arno van Dam ◽  
Andrea Evers ◽  
Rosalie van der Vaart ◽  
...  
Keyword(s):  
Chronic Fatigue Syndrome ◽  
Cognitive Behavioral Therapy ◽  
Behavioral Therapy ◽  
Chronic Fatigue ◽  
Stepped Care ◽  
Cognitive Behavioral ◽  
Fatigue Syndrome ◽  
Fatigue Severity ◽  
Secondary Outcomes ◽  
The Difference

BACKGROUND Internet-based cognitive behavioral therapy (I-CBT) leads to a reduction of fatigue severity and disability in adults with chronic fatigue syndrome (CFS). However, not all patients profit and it remains unclear how I-CBT is best embedded in the care of CFS patients. OBJECTIVE This study aimed to compare the efficacy of stepped care, using therapist-assisted I-CBT, followed by face-to-face (f2f) cognitive behavioral therapy (CBT) when needed, with f2f CBT (treatment as usual [TAU]) on fatigue severity. The secondary aim was to investigate treatment efficiency. METHODS A total of 363 CFS patients were randomized to 1 of the 3 treatment arms (n=121). There were 2 stepped care conditions that differed in the therapists’ feedback during I-CBT: prescheduled or on-demand. When still severely fatigued or disabled after I-CBT, the patients were offered f2f CBT. Noninferiority of both stepped care conditions to TAU was tested using analysis of covariance. The primary outcome was fatigue severity (Checklist Individual Strength). Disabilities (Sickness Impact Profile -8), physical functioning (Medical Outcomes Survey Short Form-36), psychological distress (Symptom Checklist-90), and proportion of patients with clinically significant improvement in fatigue were the secondary outcomes. The amount of invested therapist time was compared between stepped care and TAU. Exploratory comparisons were made between the stepped care conditions of invested therapist time and proportion of patients who continued with f2f CBT. RESULTS Noninferiority was indicated, as the upper boundary of the one-sided 98.75% CI of the difference in the change in fatigue severity between both forms of stepped care and TAU were below the noninferiority margin of 5.2 (4.25 and 3.81, respectively). The between-group differences on the secondary outcomes were also not significant (P=.11 to P=.79). Both stepped care formats required less therapist time than TAU (median 8 hours, 9 minutes and 7 hours, 25 minutes in stepped care vs 12 hours in TAU; P<.001). The difference in therapist time between both stepped care formats was not significant. Approximately half of the patients meeting step-up criteria for f2f CBT after I-CBT did not continue. CONCLUSIONS Stepped care, including I-CBT followed by f2f CBT when indicated, is noninferior to TAU of f2f CBT and requires less therapist time. I-CBT for CFS can be used as a first step in stepped care. CLINICALTRIAL Nederlands Trial Register NTR4809; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4809 (Archived by WebCite at http://www.webcitation.org/74SWkw1V5)

scholarly journals The course of severe chronic fatigue syndrome in childhood

2000 ◽  
Vol 93 (3) ◽  
pp. 129-134 ◽  
Author(s):  
L Rangel ◽  
M E Garralda ◽  
M Levin ◽  
H Roberts
Keyword(s):  
Chronic Fatigue Syndrome ◽  
Bed Rest ◽  
Chronic Fatigue ◽  
Prognostic Indicators ◽  
Illness Onset ◽  
Fatigue Syndrome ◽  
School Absence ◽  
Duration Of Illness ◽  
Severe Fatigue ◽  
Recovery Assessment

Summary Little has been reported on prognostic indicators in children with chronic fatigue syndrome (CFS). We used interviews with children and parents, a mean of 45.5 months after illness onset, to follow up 25 cases of CFS referred to tertiary paediatric psychiatric clinics. At its worst, the illness had been markedly handicapping (prolonged bed-rest and school absence in two-thirds); mean time out of school was one academic year. Two-thirds, however, had recovered and resumed normal activities—mean duration of illness to recovery/assessment 38 months—and none had developed other medical conditions. Recovery was associated with specific physical triggers to the illness, with start of illness in the autumn school term and with higher socioeconomic status. Severe fatigue states in children can cause serious and longlasting handicap but most children recover.

A Measure of Heart Rate Variability is Sensitive to Orthostatic Challenge in Women with Chronic Fatigue Syndrome

2003 ◽  
Vol 228 (2) ◽  
pp. 167-174 ◽  
Author(s):  
Yoshiharu Yamamoto ◽  
John J. Lamanca ◽  
Benjamin H. Natelson
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Chronic Fatigue Syndrome ◽  
Coarse Graining ◽  
Chronic Fatigue ◽  
Specific Response ◽  
Spectral Exponent ◽  
Fatigue Syndrome ◽  
Head Up Tilt ◽  
The Difference

The use of symptoms generated by head up tilt (HUT) is not a useful tool in identifying chronic fatigue syndrome (CFS). We investigated whether heart rate variability (HRV) assessed early during HUT might be useful. A sample of 46 female subjects (24 with CFS and 22 sedentary, age-matched healthy controls; CON) who had exhibited no difference in time to syncope during tilt was examined for HRV responses to 10 min of 70° HUT after 5 min of baseline in the supine position. HRV data were analyzed by the method of coarse graining spectral analysis. Variables compared between groups included mean and standard deviation (SDRRI) of RR intervals (RRI), amplitudes of low- (ALF; 0.04–0.15 Hz) and high-frequency (AHF; >0.15 Hz) harmonic as well as aperiodic, fractal (AFR; 1/fβ) spectral components, the spectral exponent β, and the difference in these values between baseline and HUT for each subject. In the supine baseline, only mean RRI was significantly (P< 0.01) lower in CFS than in CON. During HUT, however, mean RRI (P < 0.01), SDRRI, (P < 0.01), AHF (P < 0.05), and AFR (P < 0.01) were significantly lower in CFS than in CON. When the difference in values between baseline and HUT for each subject was examined, only the difference for AFR (ΔAFR) was significantly (P < 0.01) lower in CFS than in CON, suggesting that AFR is a disease-specific response of HRV to HUT. When a cut-off level was set to ΔAFR = –2.7 msec, the sensitivity and the specificity in differentiating CFS from controls were 90% and 72%, respectively. The data suggest that a decrease in aperiodic fractal component of HRV in response to HUT can be used to differentiate patients with CFS from CON.

scholarly journals Idiopathic combined adrenocorticotropin and growth hormone deficiency mimicking chronic fatigue syndrome

2021 ◽  
Vol 14 (10) ◽  
pp. e244861
Author(s):  
Kazuki Tokumasu ◽  
Kanako Ochi ◽  
Fumio Otsuka
Keyword(s):  
Growth Hormone ◽  
Chronic Fatigue Syndrome ◽  
Gh Deficiency ◽  
Chronic Fatigue ◽  
Hormone Deficiency ◽  
Fatigue Syndrome ◽  
General Fatigue ◽  
Severe Fatigue ◽  
Anterior Pituitary Function ◽  
Combined Deficiency

A 42-year-old man who had suffered from severe fatigue for 5 years was diagnosed as having chronic fatigue syndrome (CFS) and fibromyalgia. Endocrinological workup using combined anterior pituitary function tests showed that the patient had adrenocorticotropin hormone (ACTH) deficiency, with a normal pituitary MRI. Treatment with a physiologic dose of oral hydrocortisone replacement physically ameliorated his general fatigue. A secondary workup using a growth hormone-releasing peptide-2 test revealed that he also had growth hormone (GH) deficiency, and GH replacement therapy was started. His muscle pain and depression were improved by the therapy. Here, we present a rare case of combined deficiency of ACTH and GH in a middle-aged man with severe general fatigue. This case report aims to raise awareness of combined deficiency of ACTH and GH as a differential diagnosis of CFS and its mimics.

scholarly journals The Emerging Role of Gut Microbiota in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): Current Evidence and Potential Therapeutic Applications

2021 ◽  
Vol 10 (21) ◽  
pp. 5077
Author(s):  
Angelica Varesi ◽  
Undine-Sophie Deumer ◽  
Sanjana Ananth ◽  
Giovanni Ricevuti
Keyword(s):  
Chronic Fatigue Syndrome ◽  
Gut Microbiota ◽  
Therapeutic Potential ◽  
Chronic Fatigue ◽  
Myalgic Encephalomyelitis ◽  
Current Evidence ◽  
Fatigue Syndrome ◽  
Severe Fatigue ◽  
Irritable Bowel

The well-known symptoms of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) are chronic pain, cognitive dysfunction, post-exertional malaise and severe fatigue. Another class of symptoms commonly reported in the context of ME/CFS are gastrointestinal (GI) problems. These may occur due to comorbidities such as Crohn’s disease or irritable bowel syndrome (IBS), or as a symptom of ME/CFS itself due to an interruption of the complex interplay between the gut microbiota (GM) and the host GI tract. An altered composition and overall decrease in diversity of GM has been observed in ME/CFS cases compared to controls. In this review, we reflect on genetics, infections, and other influences that may factor into the alterations seen in the GM of ME/CFS individuals, we discuss consequences arising from these changes, and we contemplate the therapeutic potential of treating the gut to alleviate ME/CFS symptoms holistically.

scholarly journals Chronic COVID-19 / Chronic Fatigue Syndrome (ME/CFS) following the first pandemic wave in Germany and biomarkers associated with symptom severity

2021 ◽  
Author(s):  
Claudia Kedor ◽  
Helma Freitag ◽  
Lil Meyer-Arndt ◽  
Kirsten Wittke ◽  
Leif Hanitsch ◽  
...  
Keyword(s):  
Chronic Fatigue Syndrome ◽  
Symptom Severity ◽  
Chronic Fatigue ◽  
Observational Cohort Study ◽  
Prospective Observational Cohort Study ◽  
Fatigue Syndrome ◽  
Hand Grip ◽  
Severe Fatigue ◽  
Observational Cohort ◽  
Pandemic Wave

Abstract A subset of patients has long-lasting symptoms after mild to moderate COVID-19. In a prospective observational cohort study we analysed clinical and laboratory parameters in 42 patients (29 female/13 male, median age 36.5 years) with persistent moderate to severe fatigue and exertion intolerance six months following COVID-19 referred to as Chronic COVID-19 Syndrome (CCS). Most patients were moderately to severely impaired in daily live. 19 patients fulfilled the 2003 Canadian Consensus Criteria for myalgic encephalomyelitis/chronic fatigue syndrome referred to as CFS/CCS. Hand grip strength (HGS) was diminished in most patients. Association of several biomarker with key symptoms of physical and mental fatigue and post exertional malaise indicate low level inflammation and hypoperfusion as potential pathomechanisms.

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