Kembara Xtra - Medicine - Chronic Fatigue Syndrome
An extended period of terrible exhaustion lasting more than six months, with intensity ranging from moderate to severe at least half the time, which considerably impairs one's capacity to carry out pre-illness activities. Important characteristics include: - Decreased memory or focus - Joint and muscular discomfort, restless sleep - Orthostatic intolerance and postexertional malaise (PEM) Synonyms include systemic exertion intolerance illness, chronic Epstein-Barr virus syndrome, postviral fatigue syndrome, chronic fatigue immune dysfunction, and myalgic encephalomyelitis (ME)/chronic fatigue syndrome (CFS). Resting does not make fatigue go away, and it causes a >50% drop in pre-illness activities (work, study, social, and personal). Other causes like schizophrenia, manic-depressive illness, substance abuse, eating disorders, or proven organic brain diseases must be ruled out. Other symptoms that are frequently associated with the condition include heart rate variability, excessive sweating, muscle and joint pain, and sensitivity to light, sound, and chemicals. Epidemiology Females are twice as likely to be afflicted; incidence peaks at 10 to 19 and 30 to 39 years of age. Approximately one-fourth of patients remain bedridden or housebound, and up to 70% of patients are unable to return to work. Prevalence Affects all racial and ethnic groups; it is more common in low socioeconomic and minority groups. 1.7 to 3.4 million people may have ME or CFS, with 519 to 1,038 instances being diagnosed per 100,000 cases; up to 90% of cases may go untreated. Pathophysiology and Etiology Unknown and probably multifaceted in its origin Potentially triggering stressors: - Infection caused by a virus, bacterium, or parasite: Epstein-Barr virus (EBV), retroviruses, Lyme disease, Q fever, human herpesvirus type 6, enteroviruses, Ross river virus, and Borna disease virus. - Serious mental or bodily trauma Recent immunization - Excessive physical activity, long-term sleep deprivation - Exposure to toxins (such organophosphate insecticides) or an unusual adverse drug reaction - Suspected perpetuating factors: - Delayed diagnosis - Overwork - Stress, little sleep - Systems and elements that are thought to contribute (4): - The functioning of mitochondria and decreased oxidative phosphorylation in cells - Neuroendocrine system (for instance, decreased cortisol response to elevated corticotropin) - Immune system (e.g., elevated C-reactive protein, 2-microglobulin, and proinflammatory cytokines) - Muscular system (e.g., decreased intake of oxygen) - The autonomic nervous system, such as orthostatic hypotension - Serotonergic system, such as increased serotonin receptor activity - Digestive system (e.g., increased wall permeability, changed gut flora, and comorbidity with irritable bowel syndrome [IBS]) Genetics Higher concordance in monozygotic twins Disease development may be influenced by genetic variations in a number of neuroimmunoendocrine-related genes. Risk factors include a family history of ME or CFS, neuroticism and introversion, and co-occurring depression or anxiety. Long-term idiopathic chronic fatigue; childhood trauma (emotional, physical, or sexual abuse); childhood inactivity or overactivity; long-standing medical and/or mental health issues; Accompanying Conditions IBS, pelvic pain, endometriosis, gynecologic diseases (hysterectomy, oophorectomy), fibromyalgia (more prevalent in women), anxiety disorders, and/or serious depressive disorders. PTSD, which includes physical and/or sexual abuse in the past, and domestic violence Sleep disorders, such as obstructive sleep apnea (OSA), attention deficit hyperactivity disorder (ADHD), postural orthostatic tachycardia syndrome (POTS), Multiple chemical sensitivities, tempromandibular joint condition, myofascial pain syndrome, decreased left ventricular size and mass, prolapsed mitral valve Raynaud phenomenon, allergies, sicca syndrome, interstitial cystitis, and Hashimoto thyroiditis Diagnosis A complete medical and psychological history is necessary for a precise diagnosis. According to the Institute of Medicine's (IOM) 2015 diagnostic criteria, there must be three symptoms and at least one of two additional signs. A significant decrease in or impairment of pre-illness levels of activity (in work, school, social, or personal life) that: - Lasts for six months - Is accompanied by fatigue that is: - Often profound - Of recent onset (not lifelong) - Is not brought on by ongoing or unusually excessive exertion - Is not significantly improved by rest PEM* is the exacerbation of symptoms following mental, emotional, or physical effort that would not have been problematic prior to the illness. PEM frequently causes relapse in the patient, which may linger for days, weeks, or even longer. Along with a 2-day cardiopulmonary test, getting the patient's response to activities that they could previously tolerate can be useful in determining PEM. Unrefreshing sleep*—Despite the absence of any obvious objective sleep abnormalities, ME/CFS patients may not feel any better or less exhausted even after a full night of sleep. If sleep apnea is present, sleep testing may assist identify it. At least one of the extra two manifestations listed below must exist: - Cognitive impairment* – Patients with this condition struggle with thinking, memory, executive function, and information processing, in addition to attention deficit and reduced psychomotor abilities. Each of these conditions may become worse with exertion, effort, prolonged upright posture, stress, or time constraints and may seriously impair a patient's ability to hold down a job or go to school full-time. - Orthostatic intolerance: Patients with this condition experience symptoms that worsen when they assume and maintain an upright position, as determined by head-up tilt testing, bedside orthostatic vital signs, and objective heart rate and blood pressure abnormalities while standing. Orthostatic symptoms, such as dizziness, fainting, increased fatigue, cognitive deterioration, migraines, or nausea, are made worse by quiet upright posture (either standing or sitting) throughout daily activities and are made better (though not always totally cured) by lying down.It is necessary to assess the frequency and severity of these symptoms. clinical assessment comprehensive physical examination to rule out further medical explanations for the symptoms. Also necessary is a thorough evaluation of the patient's mental state. Differential diagnosis: Psychiatric diseases such as depression, anxiety, somatization disorder, and substance misuse; Idiopathic chronic fatigue (i.e., fatigue of unknown cause for more than six months without meeting criteria for CFS). Causes of physiological fatigue: inadequate sleep habits, menopause, and pregnancy up until three months after delivery Sleep disorders such narcolepsy, sleep apnea, and insomnia, as well as endocrine conditions like hypothyroidism, Addison's disease, Cushing syndrome, and diabetes mellitus. Chronic illnesses, such as chronic hepatitis B/C and Lyme disease - Fungal illness (such as coccidioidomycosis and histoplasmosis) - Parasitic illness (such as helminth infection, giardiasis, and amebiasis) - Tuberculosis and illnesses connected to HIV - Bacterial illnesses that are chronic or subacute (such as endocarditis and occult abscess). Iatrogenic (such as negative effects from medications) Toxic agent exposure Obesity Malignancy Autoimmune Diseases Multiple sclerosis, myasthenia gravis, Parkinson disease, chronic inflammatory disorders (such as sarcoidosis, Wegener disease, celiac disease, and inflammatory bowel disease), neuromuscular diseases, and cardiovascular diseases (such as cardiomyopathy or various causes of heart failure). Laboratory Results There isn't a valid diagnostic test available. Remember that finding the source of weariness is not always the same as a result that is abnormal. If the suspected issue is resolved but the patient's fatigue persists, reopen the search. Initial examinations (lab, imaging) To rule out further explanations for symptoms, standard laboratory testing are advised: Complete metabolic panel; CBC; urine analysis; free thyroxine (free T4) and thyroid-stimulating hormone (TSH); serum folate; creatine kinase (CK); 25-hydroxy-cholecalciferol (vitamin D); serum iron; iron-binding capacity; ferritin; ESR or C-reactive protein; Check for domestic abuse: "Have you been struck, kicked, punched, or harmed in any other way by someone within the last 12 months? If so, who, exactly? "Do you feel safe in your current relationship?" - "Is there a partner from a previous relationship who is making you feel unsafe right now?" Tests in the Future & Special Considerations Additional laboratory tests based on clinical characteristics include: - Rheumatoid factor and antinuclear antibodies Skin test for tuberculin - Serum cortisol - HIV, RPR, VDRL, and Lyme serology - Tissue transglutaminase for IgA Take into account age- and gender-specific cancer screening. If central nervous system symptoms are present, consider getting an electroencephalogram and/or a magnetic resonance imaging. If symptoms of a sleep disturbance are present, consider polysomnography and/or multiple sleep latency testing (MSLT). Consider drug testing for urine in people with troubling past characteristics. Assess personality, psychological characteristics, and unhealthy coping mechanisms. Management: No therapy has been shown to be helpful in significant randomized studies; recommendations are based on professional judgment and accepted symptom management (e.g., pain, depression, and sleep problems). Patients frequently employ sunglasses, eyeglasses, earplugs, and earphones to reduce their sensitivity to light and sound (2). Put an emphasis on alterations in lifestyle and insight with the aim of avoiding therapies that are overly complex (such as addictive drugs, invasive testing, or measures that promote secondary gain). It is advised to take a multidisciplinary approach. Evidence suggests that graded exercise therapy (GET) and cognitive-behavioral therapy (CBT) may be helpful. General Actions Symptom management and guided self-management are part of the treatment. Reducing symptoms and raising quality of life are the goals. Decide which symptoms are the most bothersome (pain and sleeplessness are typical) and take care of those first. Individual CBT is not curative, but it can help with coping mechanisms and/or rehabilitation (social, occupational, etc.). GET: Monitor the amount of exercise the patient can perform without aggravating their symptoms, and then gradually increase the time and intensity. Maintain a healthy balance between work and rest. To avoid a disease worsening, GET should only be carried out in the presence of a qualified professional. There are no recognized pharmacologic therapies for this condition. The main purpose of the drugs is to treat particular symptoms. Use the lowest effective dose and gradually raise it. - Antivirals, antidepressants, immunoglobulins, hydrocortisone, modafinil, staphylococcus toxoid, methylphenidate, melatonin, and galantamine have all been the subject of studies. None exhibit a definite benefit. In preliminary investigations, agomelatine, an antidepressant with agonist activity at melatonin receptors, showed promise. - Use of nonaddictive sleep aids (hydroxyzine, trazodone, doxepin, etc.) may improve results if insomnia is present. Rehabilitative medicine, a sleep or pain management expert, a psychiatrist for co-occurring behavioral disorders Alternative Therapies It has been demonstrated that acupuncture, massage therapy, and chiropractic care can help certain individuals with pain. Physical therapy, stretches, hydrotherapy, yoga, tai chi, and meditations are some other non-pharmacologic treatments that can be beneficial. Warm baths, hot or cold packs, electric massagers, and transcutaneous electrical nerve stimulations can all be beneficial. Equivocal evidence for biofeedback and homeopathic Patient Follow-Up Monitoring Although there is no universal agreement, periodic reevaluation is necessary for support, symptom alleviation, and screening for additional potential causes of symptoms. Diet A nutritious diet that includes the appropriate amounts of vitamins and minerals each day. No specific diet plan has been proven to be successful in treating CFS. It is unknown if losing weight helps obese CFS sufferers with their symptoms. Patient Education - Explain PEM and the limitation of aerobic metabolism to patients so they are aware of their "energy envelope" and can gradually raise their exercise tolerance. "Paced" activity management can assist patients in staying within their energy ranges. Avoid taking long naps, but make sure you get enough rest in between activities. Techniques for relaxation may also be beneficial. Promote the advantages of pharmacological therapy, lifestyle modifications, and cognitive therapies. Inform the patient's relatives about their condition and help them with disability claims. A variable course with relapse is the typical prognosis. In general, progress is gradual and takes months or years. 15% of patients are thought to recover completely. Patients who are older than 50, have poor social adjustment, strongly believe in an organic origin, or who have financial secondary gain are less likely to improve. Complications Patients with CFS may cut back on exercise out of concern that it would make their symptoms worse. Depression and multi-drug use Unemployment: Despite studies showing improvements with treatment, only around one-third of patients in trials go back to work. According to the Social Security Administration, CFS qualifies as a disability. Receiving third-party disability benefits (secondary gain) has been linked to treatment failure; in elderly (>80 years) CFS patients, chronic immunological activation or an accompanying infection may raise the risk of non-Hodgkin lymphoma.
0 Comments
Leave a Reply. |
Kembara XtraFacts about medicine and its subtopic such as anatomy, physiology, biochemistry, pharmacology, medicine, pediatrics, psychiatry, obstetrics and gynecology and surgery. Categories
All
|