Cause of chronic fatigue remains a puzzle to medical authorities


January 08, 1991|By Dr. Simeon Margolis

Q: I have what they call chronic fatigue syndrome. I am ill and exhausted most of the time.

A: Chronic fatigue syndrome is a mysterious entity. For a long time most physicians thought its manifestations were due to depression or neurosis. Some physicians still do. More and more evidence now indicates that chronic fatigue syndrome is a real disease, but its cause remains a puzzle to researchers.

Initially, it was attributed to a chronic infection with Epstein-Barr virus (the most common cause of infectious mononucleosis). Further studies have cast doubt on this virus, at least as the only cause of the syndrome.

Alternate candidates include other viruses and either overactivity or deficiency of the immune system. Probably there are many causes for the syndrome.

In 1988, the U.S. Centers for Disease Control (CDC) published a working definition of chronic fatigue syndrome that included two absolute requirements for diagnosis: new onset of severe fatigue persisting for at least six months and the absence of any other medical or psychiatric illness that could produce the symptoms.

A positive diagnosis depends on the presence of at least eight of the following symptoms: mild fever, sore throat, painful lymph nodes in the neck or under the arms, generalized fatigue after exercise, headaches, joint pains without redness or swelling, neuropsychologic complaints (for example, sensitivity to light, confusion, irritability), sleep disturbances, and a history of developing this set of symptoms over a few hours or days.

Despite the progress made in defining chronic fatigue syndrome, your doctor is, unfortunately correct. At the moment there is no effective treatment for the condition.

Dr. Margolis is professor of medicine and biological chemistry at the Johns Hopkins School of Medicine and associate dean for academic affairs at the school.

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