Chronic fatigue syndrome

Chronic fatigue syndrome (CFS) or myalgic encephalomyelitis (ME) is a complex chronic disease. The main manifestations are exercise intolerance and decreased performance. In the literature, it is often mentioned under the common abbreviations of both names as ME / CFS.

In the International Classification of Diseases ICD-10, ME / CFS is classified by the World Health Organization as a disease of the nervous system under code G93.3 as postviral fatigue syndrome (myalgic encephalomyelitis).

Epidemiology
The prevalence of ME / CFS is reported to be in the range of 0.1 - 0.5%. However, a full-fledged study of the incidence of the disease in the population has not yet been carried out in the Czech Republic. It is estimated that this would represent 10,000 - 50,000 patients. Foreign sources report similar percentages in the population.

ME/CFS most often affects adults aged 30-50. However, the disease can develop at any age, and cases of pediatric patients are also described. The representation of both sexes differs significantly, with the ratio of sick women to sick men being about 3: 1. There are no known ethnic or socio-economic influences on disease prevalence.

Etiology and pathogenesis
The cause is not clear. Multifactorial etiology is probable, dysfunction of the immune system is presumed. The most commonly cited trigger is an infectious disease - such as an upper respiratory tract infection. Less often, a strong stressful experience, childbirth and others are also reported. Cases of the familial disease are also described. ME/CFS has some features in common with autoimmune diseases. Chronic fatigue syndrome is often mistaken for depressive states, but it is not a psychiatric illness. Encephalomyelitis in the name of the disease evokes the presence of inflammation of the nervous system, but this etiology has not been confirmed.

Clinical picture
ME/CFS is a multisystem disease, the manifestations vary according to the degree of involvement of individual organ systems. ME/CFS has a very different course in each patient, the condition can vary significantly within days and hours, in patients, the periods of improvement and re-exacerbation usually alternate.

All of these manifestations should be expressed to varying degrees when ME/CFS is suspected, of which PEM is completely pathognomonic.


 * a significant reduction in performance compared to the condition before the onset of the disease accompanied by severe fatigue, which is not the result of excessive stress and does not subside after rest
 * post-exertional malaise (PEM): general worsening or development of new symptoms after physical or mental stress, usually starts with a delay of 1-3 days after exertion and may persist for several days
 * sleep disorders, unresponsive sleep, hypersomnia or insomnia
 * cognitive disorders with preserved intellect, so-called brain fog - disorders of concentration, memory and attention, difficult expression, delayed reactions

The following manifestations may be present but are not exclusive to ME.


 * orthostatic intolerance and autonomic dysfunction including dizziness, palpitations, nausea when changing from horizontal to sitting or standing
 * thermoregulatory disorders: profuse sweating, hot flushes, chills
 * neuromuscular manifestations including twitching and tremor
 * flu-like symptoms: sore throat, sensitive lymph nodes, chills, muscle pain
 * hypersensitivity to light, noise, touch,
 * olfactory sensations and tastes

Diagnostics
There is no specific examination, test or uniform recommended diagnostic procedure for ME / CFS in the Czech Republic.

A major breakthrough in the history of the disease is the publication of the guidelines of the British National Institute for Health and Care Excellence from October 2021, from which this article is largely based.

Clinical symptoms that persist for at least 3 months and cannot be explained by other diseases are key to the diagnosis of ME/CFS.

The diagnostic procedure should include a detailed medical history, physical examinations, and examinations to assist in differential diagnosis, such as:


 * blood count with differential budget
 * erythrocyte sedimentation
 * C-reactive protein
 * urea, creatinine liver biochemistry: ALT, AST, GGT, ALP, bilirubin
 * ionogram
 * glycemia, glycated Hb
 * up. thyroid function
 * urine chemically + sediment
 * celiac disease screening
 * levels of ferritin, B12, folate, vitamin D
 * serology of infectious diseases
 * up. adrenal function

Therapy
The causal therapy of ME/CFS is unknown. Treatment is individually focused on alleviating symptoms (pain, sleep disorders). Patients need to learn to manage limited energy, the so-called pacing strategy - dosing activities, planning rest and not overcoming the symptoms of the disease.

The previously mentioned therapy by gradually increasing the load is not recommended for patients with ME/CFS.

Prognosis
The disease is associated with a very low quality of life, 75% of patients are forced to leave their jobs, about 25% of patients with a very difficult course are unable to leave their home or bed, with some exceptions, only about 5% of patients are completely cured. The severity of the disease can be demonstrated by HUA (hours of upright activity): healthy people can be active for 14-17 hours a day, patients with chronic diseases 10-12 hours and patients with ME/CFS 0-8 hours a day.

Links, Related articles
https://www.nice.org.uk/guidance/ng206

https://www.meaction.net/

https://neunavni.cz/

http://me-cfs.eu/

https://www.loono.cz/blog/chronicky-unavovy-syndrom-jak-se-projevuje

https://www.cdc.gov/me-cfs/index.html


 * DOSTÁL, V., et al. Infektologie. 1. vydání. Praha : Karolinum, 2004. 109-110 s.  ISBN 80-246-0749-2.