Category: Overlapping Illnesses

Low grade pyrexia: is it chronic fatigue syndrome?

Abstract:

Eighty seven consecutive patients presenting with prolonged low grade pyrexia (99 degrees-101 +/- F) during 1984-93 were followed up for a mean duration of 2.9 years. Mean age was 37.55 years (SD + 10.16) and 66 (75.8%) were females. Onset of pyrexia was acute in 57 patients and was associated with chilly sensation (42), Fatigue (69), Arthralgias (61), myalgias (55) and several other non specific symptoms. Clinical examination showed paucity of physical signs with 7 patients showing tender lymphadenopathy, 7 showing splenomegaly, 5 hepatomegaly, and 1 phylctenular conjunctivitis. Psychiatric examination was within normal limits. Extensive investigations for any viral or other infection, autoimmune disorder or malignancy were unrewarding. Patients were followed up for an average of 2.9 (2 to 5 years). Thirteen patients had become asymptomatic within one year of onset of symptoms, 38 by two years and 45 by the end of three years. This syndrome may be a variant of chronic fatigue syndrome.

Comment in: Low grade pyrexia: is chronic fatigue syndrome a safe and justified diagnosis? [J Assoc Physicians India. 1995]

 

Source: Anand AC, Kumar R, Rao MK, Dham SK. Low grade pyrexia: is it chronic fatigue syndrome? J Assoc Physicians India. 1994 Aug;42(8):606-8. http://www.ncbi.nlm.nih.gov/pubmed/7868552

 

Epstein-Barr virus infection in Desert Storm reservists

Abstract:

Approximately 150 U.S. Army reservists from Indiana reported symptoms consistent with chronic fatigue syndrome after returning stateside from the tour of duty in Saudi Arabia. A psychiatric team confirmed the diagnosis, evaluated possible etiology, and treated the service members when appropriate. Those available service members who met the study’s diagnostic criteria for chronic fatigue syndrome (n = 37) received an Epstein-Barr virus panel. Seventy-three percent of these selected service members were positive either for an acute or reactivated Epstein-Barr viral infection. These data suggest that service members who suffer from chronic fatigue syndrome may have their symptoms increased and prolonged by secondary viral infections.

 

Source: Carver LA, Connallon PF, Flanigan SJ, Crossley-Miller MK. Epstein-Barr virus infection in Desert Storm reservists. Mil Med. 1994 Aug;159(8):580-2. http://www.ncbi.nlm.nih.gov/pubmed/7824153

 

Effort syndrome: hyperventilation and reduction of anaerobic threshold

Abstract:

Effort syndrome is an entity in danger of being subsumed into “chronic fatigue syndrome” and lost to sight. Its distinctive feature is the reduction of the anaerobic threshold for work by depletion of the body’s alkaline buffering systems through hyperventilation. This article describes the history and clinical features of effort syndrome and reports a study in which capnography is used to identify the anaerobic threshold by registering the respiratory response to the onset of metabolic acidosis. The patients’ thresholds are low, and provide a goal for rehabilitation. In other forms of chronic fatigue syndrome, the pathogenesis and logic of therapy are unclear.

 

Source: Nixon PG. Effort syndrome: hyperventilation and reduction of anaerobic threshold. Biofeedback Self Regul. 1994 Jun;19(2):155-69. http://www.ncbi.nlm.nih.gov/pubmed/7918753

 

Chronic fatigue: a peculiar evolution of eosinophilia myalgia syndrome following treatment with L-tryptophan in four Italian adolescents

Abstract:

We describe four Italian adolescents in whom a persistent, debilitating fatigue appeared after therapeutic ingestion of products containing L-tryptophan and subsequent to the development of a transient rise in eosinophil count and severe myalgia (Eosinophilia Myalgia Syndrome-EMS). Their clinical picture was indistinguishable from that of the so-called Chronic Fatigue Syndrome. A chronic fatigue may occur after diverse triggering agents and its represents the peculiar clinical evolution of these four paediatric cases of EMS.

 

Source: Priori R, Conti F, Luan FL, Arpino C, Valesini G. Chronic fatigue: a peculiar evolution of eosinophilia myalgia syndrome following treatment with L-tryptophan in four Italian adolescents. Eur J Pediatr. 1994 May;153(5):344-6. http://www.ncbi.nlm.nih.gov/pubmed/8033924

 

Pain rehabilitation. 2. Chronic pain syndrome and myofascial pain

Abstract:

This article highlights chronic pain syndrome and myofascial pain. It is part of the chapter on pain rehabilitation in the Self-Directed Medical Knowledge Program for practitioners and trainees in physical medicine and rehabilitation. This article discusses behavioral maladaptations to chronic pain which lead to global physical, psychologic, social, and vocational impairments–the chronic pain syndrome. The spectrum of myofascial pain syndromes, contributing factors, and interventions are detailed. New advances that are covered in this section include controversies in long-term use of opioids and muscle relaxants; differentiating fibromyalgia, myofascial pain syndromes, and chronic fatigue syndrome; pathophysiology of myofascial pain; and beneficial treatments.

 

Source: King JC, Goddard MJ. Pain rehabilitation. 2. Chronic pain syndrome and myofascial pain. Arch Phys Med Rehabil. 1994 May;75(5 Spec No):S9-14. http://www.ncbi.nlm.nih.gov/pubmed/7910454

 

Fibromyalgia, chronic fatigue syndrome, and myofascial pain syndrome

Abstract:

No major pathophysiologic or therapeutic findings have appeared over the past year regarding fibromyalgia, chronic fatigue syndrome, and myofascial pain syndrome, three poorly understood, controversial, and overlapping syndromes. The frequent prevalence of these disorders in association with Lyme disease and other medical and psychiatric illness was emphasized. New studies demonstrated the potential role for central nervous system activation in fibromyalgia and chronic fatigue syndrome.

 

Source: Goldenberg DL. Fibromyalgia, chronic fatigue syndrome, and myofascial pain syndrome. Curr Opin Rheumatol. 1994 Mar;6(2):223-33. http://www.ncbi.nlm.nih.gov/pubmed/8024971

 

Concurrent sick building syndrome and chronic fatigue syndrome: epidemic neuromyasthenia revisited

Abstract:

Sick building syndrome (SBS) is usually characterized by upper respiratory complaints, headache, and mild fatigue. Chronic fatigue syndrome (CFS) is an illness with defined criteria including extreme fatigue, sore throat, headache, and neurological symptoms.

We investigated three apparent outbreaks of SBS and observed another more serious illness (or illnesses), characterized predominantly by severe fatigue, that was noted by 9 (90%) of the 10 teachers who frequently used a single conference room at a high school in Truckee, California; 5 (23%) of the 22 responding teachers in the J wing of a high school in Elk Grove, California; and 9 (10%) of the 93 responding workers from an office building in Washington, D.C.

In those individuals with severe fatigue, symptoms of mucous membrane irritation that are characteristic of SBS were noted but also noted were neurological complaints not typical of SBS but quite characteristic of CFS. We conclude that CFS is often associated with SBS.

 

Source: Chester AC, Levine PH. Concurrent sick building syndrome and chronic fatigue syndrome: epidemic neuromyasthenia revisited. Clin Infect Dis. 1994 Jan;18 Suppl 1:S43-8. http://www.ncbi.nlm.nih.gov/pubmed/8148452

 

Chronic fatigue syndrome and a disorder resembling Sjögren’s syndrome: preliminary report

Abstract:

Chronic fatigue syndrome (CFS), as currently described in the working criteria proposed by the Centers for Disease Control and Prevention (Atlanta), may be associated with multiple, distinct, and possibly unique clinical and/or etiopathogenic subsets.

Sjögren’s syndrome (SS) is a disease of unknown etiology that is characterized by dryness of the mucous membranes and a variety of autoimmune phenomena and conditions. Subjective manifestations of SS such as neurocognitive dysfunction and fatigue have been stressed by some observers. We have detected a large number of patients with unrecognized SS-like illness in a clinic specializing in CFS and believe the relationship to be more than casual.

From January 1991 through April 1992, 172 patients were evaluated for CFS; the SS cohort consisted of 27 females (mean age, 41.9 years). Sixteen of these patients had previously been found to have CFS by a physician, and 11 were self-referred. All patients complained of severe, dominating, chronic fatigue. Complaints of myalgia were prominent; 20 of 27 patients met the criteria for fibromyalgia. Neurocognitive complaints and/or a history of neuropsychiatric disease was frequent.

Results of Schirmer’s test were abnormal for 16 of 27, and results of minor salivary-gland biopsy were abnormal for 20 of 25. Antibodies to nuclear antigen were present in 16 of 27, but anti-Ro was present in only 1 of 21. In the SS group, 13 of 27 patients met eight or more CDC minor criteria for CFS, and 18 of 27 met six or more of the criteria.

We believe SS may represent a common and frequently overlooked clinical subset of CFS; however, further work is needed to define the similarities and/or differences between the SS observed in association with CFS and SS in the general population as well as the prevalence of SS among patients with CFS.

 

Source: Calabrese LH, Davis ME, Wilke WS. Chronic fatigue syndrome and a disorder resembling Sjögren’s syndrome: preliminary report. Clin Infect Dis. 1994 Jan;18 Suppl 1:S28-31. http://cid.oxfordjournals.org/content/18/Supplement_1/S28.abstract

 

Primary juvenile fibromyalgia syndrome and chronic fatigue syndrome in adolescents

Abstract:

Chronic fatigue syndrome (CFS) and primary juvenile fibromyalgia syndrome (PJFS) are illnesses with a similar pattern of symptoms of unknown etiology. Twenty-seven children for whom CFS was diagnosed were evaluated for fibromyalgia by the presence of widespread pain and multiple tender points.

Eight children (29.6%) fulfilled criteria for fibromyalgia. Those children who met fibromyalgia criteria had a statistically greater degree of subjective muscle pain, sleep disturbance, and neurological symptoms than did those who did not meet the fibromyalgia criteria. There was no statistical difference between groups in degree of fatigue, headache, sore throat, abdominal pain, depression, lymph node pain, concentration difficulty, eye pain, and joint pain.

CFS in children and PJFS appear to be overlapping clinical entities and may be indistinguishable by current diagnostic criteria.

 

Source: Bell DS, Bell KM, Cheney PR. Primary juvenile fibromyalgia syndrome and chronic fatigue syndrome in adolescents. Clin Infect Dis. 1994 Jan;18 Suppl 1:S21-3. http://www.ncbi.nlm.nih.gov/pubmed/8148447

 

The grey area of effort syndrome and hyperventilation: from Thomas Lewis to today

Abstract:

Lewis used the diagnosis ‘effort syndrome’ for subjects whose ability to make and sustain effort had been reduced by homeostatic failure. A major element was depletion of the body’s capacity for buffering the acids produced by exercise.

In his view this systems disorder was not to be regarded as a specific organ disease, and losing sight of the metabolic element would foster the invention of fanciful, unphysiological diagnoses. His views were dismissed because normal resting plasma bicarbonate levels were considered by others in that era to exclude serious depletion of the body’s total capacity for buffering the effects of exertion.

Today, effort syndrome is still a useful diagnosis for a condition of exhaustion and failure of performance associated with depletion of the body’s buffering systems. Other elements associated with homeostatic failure are now recognised, principally emotional hyperarousal and hyperventilation. Their physiological interrelationships are described. Effort syndrome is amenable to recovery through rehabilitation, and it may be a mistake to treat chronic fatigue syndrome and unspecific illness without including it in the differential diagnosis.

 

Source: Nixon PG. The grey area of effort syndrome and hyperventilation: from Thomas Lewis to today. J R Coll Physicians Lond. 1993 Oct;27(4):377-83. http://www.ncbi.nlm.nih.gov/pubmed/8289156