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Chronic Fatigue Syndrome

Disease Details

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Description: Chronic Fatigue Syndrome (CFS) is a complex disorder characterized by extreme fatigue that cannot be explained by any underlying medical condition and is not significantly relieved by rest.
Type: Chronic Fatigue Syndrome (CFS) is a complex, long-term illness characterized primarily by extreme fatigue. Its exact cause is unknown, and it is not considered to be directly transmitted through genetic inheritance. However, some studies suggest a possible genetic predisposition, meaning that certain genetic factors may increase the likelihood of developing CFS, but it is not passed down in a straightforward Mendelian pattern.
Signs And Symptoms: The illness causes debilitating fatigue, sleep problems, and a pattern of getting worse after even mild activity. In addition, cognitive issues or orthostatic intolerance may be present; the exact symptoms required for diagnosis differ (see § Diagnostic criteria). Symptoms must have a significant impact on function and typically be present for three to six months before a diagnosis can be confirmed.: 13
Prognosis: Information on the prognosis of ME/CFS is limited, and the course of the illness is variable. Complete recovery, partial improvement, and worsening are all possible, but full recovery is rare.: 11 Symptoms generally fluctuate over days, weeks, or longer periods, and some people may experience periods of remission.: 20 Overall, "many will need to adapt to living with ME/CFS.": 10 An early diagnosis may improve care and prognosis. Factors that may make the disease worse over days, but also over longer time periods, are physical and mental exertion, a new infection, sleep deprivation, and emotional stress.: 11 Some people who improve need to manage their activities in order to prevent relapse. Children and teenagers are more likely to recover or improve than adults.: 20 For instance, a study in Australia among 6- to 18-year olds found two thirds reported recovery after ten years, and that the typical duration of illness was 5 years.: 11 The effect of ME/CFS on life expectancy is poorly studied, and evidence is mixed. One large retrospective study on the topic found no increase in all-cause mortality due to ME/CFS. Death from suicide was however significantly higher among those with ME/CFS.: 59
Onset: The onset of chronic fatigue syndrome (CFS), also known as myalgic encephalomyelitis (ME), can vary. It often begins suddenly, following a flu-like illness or severe physical or emotional stress. In some cases, the onset may be more gradual, with symptoms worsening over weeks or months. The exact cause of CFS is unknown and can involve a combination of genetic, environmental, and psychological factors.
Prevalence: The prevalence of chronic fatigue syndrome (CFS), also known as myalgic encephalomyelitis (ME/CFS), varies widely depending on the criteria used for diagnosis and the population studied. Estimates suggest it affects between 0.2% to 2.6% of the global population.
Epidemiology: Reported prevalence rates vary widely depending on how ME/CFS is defined and diagnosed. Overall, around one in 150 have ME/CFS. Based on the 1994 CDC diagnostic criteria, the global prevalence rate for CFS is 0.89%. In comparison, estimates using the 1988 CDC "Holmes" criteria and 2003 Canadian criteria for ME produced an incidence rate of only 0.17%.As of 2015, between 836,000 and 2.5 million Americans were estimated to have ME/CFS, with 84–91% of these being undiagnosed.: 1 In England and Wales, over 250,000 people are estimated to be affected.: 92 These estimates are based on data before the COVID-19 pandemic. It is likely that numbers have increased as a large share of people with Long COVID meet the diagnostic criteria of ME/CFS.: 29, 228 A 2021–2022 CDC survey found that 1.3% of adults in the United States, or 3.3 million, had ME/CFS.Females are diagnosed about 1.5 to 2.0 times more often with ME/CFS than males. An estimated 0.5% of children have ME/CFS, and more adolescents are affected with the illness than younger children.: 182 The incidence rate according to age has two peaks, one at 10–19 and another at 30–39 years, and the rate of prevalence is highest between ages 40 and 60.
Intractability: Chronic Fatigue Syndrome (CFS), also known as Myalgic Encephalomyelitis (ME), is often considered intractable because it lacks a specific, universally effective treatment or cure. The management of CFS typically focuses on alleviating symptoms and improving the quality of life through a combination of medical treatments, lifestyle changes, and supportive therapies. Patients often experience varying degrees of long-lasting fatigue and other symptoms despite these efforts.
Disease Severity: Chronic fatigue syndrome (CFS), also known as myalgic encephalomyelitis (ME), varies widely in severity. Some individuals may experience mild symptoms that allow them to maintain relatively normal daily activities, while others may be severely affected, leading to significant reductions in quality of life and requiring extensive care and support. The severity of the disease can fluctuate over time, with periods of relative improvement and relapse.
Healthcare Professionals: Disease Ontology ID - DOID:8544
Pathophysiology: ME/CFS is associated with changes in several areas, including the nervous and immune systems, as well as disturbances in energy production. Neurological differences include altered brain structure and metabolism and autonomic nervous system dysfunction. Observed immunological changes include decreased natural killer cell activity and, in some cases, autoimmunity. Endocrine differences, such as modestly low cortisol and HPA axis dysregulation, have been noted as well.
Carrier Status: Chronic fatigue syndrome (CFS), also known as myalgic encephalomyelitis (ME), does not involve a carrier status as it is not caused by a single identifiable pathogen or genetic mutation. The exact cause of CFS/ME is unknown, and it is believed to result from a combination of genetic, environmental, and psychological factors.
Mechanism: Chronic Fatigue Syndrome (CFS), also known as Myalgic Encephalomyelitis (ME), is a complex and poorly understood disorder characterized by extreme fatigue that is not alleviated by rest and is exacerbated by physical or mental activity. The precise mechanisms underlying CFS/ME are not fully understood, and its etiology is believed to be multifactorial.

### Mechanism
The primary mechanisms suspected to contribute to CFS/ME involve dysfunctions in various systems of the body, including:

1. **Immune System:** Abnormal immune responses, including chronic immune activation and autoimmunity, have been observed in patients.
2. **Nervous System:** Dysregulation in the central and autonomic nervous systems, including abnormalities in neurotransmitter levels, has been implicated.
3. **Endocrine System:** Dysfunctions in the hypothalamic-pituitary-adrenal (HPA) axis, leading to abnormal cortisol levels, are common.
4. **Energy Metabolism:** Impaired mitochondrial function, leading to deficits in cellular energy production, is a suspected factor.

### Molecular Mechanisms
At the molecular level, several abnormalities have been identified in CFS/ME patients:

1. **Cytokine Profiles:** Elevated levels of pro-inflammatory cytokines (e.g., IL-1, IL-6, TNF-alpha) suggest an ongoing inflammatory process.
2. **Epigenetics:** Altered DNA methylation and histone modification patterns have been observed, which may affect gene expression related to immune and stress responses.
3. **Gene Expression:** Differential expression of genes involved in immune function, mitochondrial energy production, and nerve function has been reported.
4. **Oxidative Stress:** Increased markers of oxidative stress and reduced antioxidant defenses could contribute to cellular damage and dysfunction.
5. **Neuroinflammation:** Elevated levels of neuroinflammatory markers in cerebrospinal fluid and brain imaging studies suggest ongoing inflammation in the central nervous system.

Research into these mechanisms is ongoing, and a unified understanding of how these factors interact to cause CFS/ME is still developing. The complexity and variability of the condition among patients make it a challenging area of study.
Treatment: The primary treatments for Chronic Fatigue Syndrome (CFS), also known as Myalgic Encephalomyelitis (ME), focus on symptom management and improving daily functioning. These may include:

1. **Medications**: To address symptoms such as pain, sleep disturbances, and depression. Examples include pain relievers, sleep aids, and antidepressants.
2. **Cognitive Behavioral Therapy (CBT)**: Aimed at improving mental health and coping strategies.
3. **Graded Exercise Therapy (GET)**: A personalized exercise plan that starts at a very low level and gradually increases.
4. **Lifestyle Changes**: Pacing activities to avoid overexertion, establishing a regular sleep schedule, and maintaining a balanced diet.
5. **Supportive Therapies**: Such as physical therapy, occupational therapy, and counseling.

Each treatment plan should be tailored to the individual's specific symptoms and needs.
Compassionate Use Treatment: For chronic fatigue syndrome (CFS), also known as myalgic encephalomyelitis (ME/CFS), compassionate use and experimental treatments may include:

1. **Rituximab**: Originally used for treating certain types of cancers and autoimmune conditions, Rituximab has been tried experimentally in ME/CFS patients due to potential benefits observed in small studies. However, results have been mixed, and larger clinical trials are needed.

2. **Ampligen (Rintatolimod)**: An experimental antiviral and immune-modulating drug that has shown some promise in clinical trials for ME/CFS. It remains investigational and is available only through clinical trials or compassionate use programs.

3. **Low-dose Naltrexone (LDN)**: An off-label use of Naltrexone in low doses has shown some potential benefits in reducing symptoms of ME/CFS and other conditions like fibromyalgia by modulating the immune system.

4. **Intravenous Immunoglobulin (IVIG)**: Occasionally used off-label for ME/CFS, IVIG is an immunoglobulin therapy that can help modulate the immune response. Its efficacy for ME/CFS is still under investigation.

Always consult healthcare professionals for personalized medical advice and information on availability and suitability of such treatments.
Lifestyle Recommendations: ### Lifestyle Recommendations for Chronic Fatigue Syndrome (CFS)

1. **Pacing and Energy Management:**
- Implement a method called "pacing,” balancing periods of activity with rest to avoid overexertion.
- Maintain an activity diary to help identify patterns and manage energy levels better.

2. **Healthy Diet:**
- Consume a balanced diet rich in vitamins and minerals. Focus on fruits, vegetables, lean proteins, and whole grains.
- Stay hydrated by drinking plenty of water throughout the day.

3. **Sleep Hygiene:**
- Establish a regular sleep schedule by going to bed and waking up at the same time every day.
- Create a comfortable sleeping environment and practice relaxation techniques before bedtime.

4. **Stress Management:**
- Practice stress-reducing activities such as mindfulness, meditation, or gentle yoga.
- Consider cognitive-behavioral therapy (CBT) to help manage stress and improve coping strategies.

5. **Light Physical Activity:**
- Engage in low-impact exercises like walking, swimming, or stretching, tailored to one’s energy levels.
- Avoid high-intensity workouts that may exacerbate symptoms.

6. **Social Support:**
- Maintain social connections and seek support from friends, family, or support groups.
- Consider joining a CFS support group for shared experiences and coping strategies.

7. **Task Prioritization:**
- Prioritize tasks and focus on completing essential activities.
- Break larger tasks into smaller, manageable steps to avoid overwhelm.

8. **Professional Help:**
- Work with healthcare providers to create a personalized management plan.
- Consult specialists in chronic fatigue syndrome for advanced care strategies.

By integrating these lifestyle modifications, individuals with chronic fatigue syndrome can better manage their symptoms and improve their quality of life.
Medication: There is no specific medication that cures Chronic Fatigue Syndrome (CFS), also known as Myalgic Encephalomyelitis (ME/CFS). Treatment typically focuses on symptom management. Some commonly used medications include:

1. **Pain relievers**: Over-the-counter options like ibuprofen or acetaminophen for muscle and joint pain.
2. **Antidepressants**: Low doses can help improve sleep and pain.
3. **Sleep aids**: Medications like melatonin or prescription sleep medicines might be used.

It's essential for individuals to work closely with healthcare professionals to develop a personalized treatment plan.
Repurposable Drugs: For chronic fatigue syndrome (CFS), also known as myalgic encephalomyelitis (ME), the search for repurposable drugs is ongoing. Some drugs currently being investigated for repurposing include:

1. **Rituximab**: Originally used for certain cancers and autoimmune diseases, it's being studied for its potential benefits in CFS/ME due to its effects on B-cells, although results have been mixed.

2. **Low-dose Naltrexone (LDN)**: Initially used for opioid addiction and autoimmune diseases, LDN is being explored for its immunomodulatory effects and potential to reduce symptoms in CFS/ME patients.

3. **Antiviral medications**: Drugs like Valganciclovir have been considered for patients with evidence of viral reactivation, though more research is needed.

4. **Metformin**: Commonly used for type 2 diabetes, Metformin is being studied for its potential to improve mitochondrial function and reduce fatigue in CFS/ME.

These investigations are still in various stages of research, and more clinical trials are needed to confirm their efficacy and safety for CFS/ME patients.
Metabolites: In chronic fatigue syndrome (CFS), also known as myalgic encephalomyelitis (ME), studies have indicated alterations in various metabolites. These may include changes in amino acids, lipids, and energy metabolism pathways. Recent research has suggested that people with ME/CFS may exhibit a unique metabolic signature involving several metabolites, which could potentially be used for diagnostic or therapeutic purposes. The metabolic anomalies point towards a state of hypo-metabolism or a hypometabolic state, which bears some resemblance to metabolic patterns seen in hibernating animals.
Nutraceuticals: Nutraceuticals, which are products derived from food sources with additional health benefits, have been explored for Chronic Fatigue Syndrome (CFS). Some commonly discussed nutraceuticals include Coenzyme Q10 (CoQ10), L-carnitine, magnesium, omega-3 fatty acids, and certain vitamins like B-complex and D. These are considered for their potential to support cellular energy production and reduce fatigue.

However, it's important to note that evidence on their effectiveness is still limited, and they should be used under the supervision of a healthcare provider. More research is needed to confirm their benefits in managing CFS.
Peptides: Research into Chronic Fatigue Syndrome (CFS), also known as Myalgic Encephalomyelitis (ME), has explored various treatments, including the use of peptides and nanotechnology. Peptides are short chains of amino acids that can potentially modulate immune responses and improve cellular function. Some studies have investigated the use of specific peptides to boost energy levels and reduce symptoms of CFS, though concrete evidence and standardized treatments are still lacking.

Nanotechnology in CFS research includes the development of diagnostic tools and targeted drug delivery systems. Nanoparticles can improve the precision and efficacy of treatments by targeting specific cells or tissues affected by CFS, potentially reducing side effects and enhancing patient outcomes.

Both peptides and nanotechnology hold promise but require further research to establish their safety, effectiveness, and practical application in CFS treatment.