Pediatric Chronic Fatigue Syndrome Clinical Presentation

  • Author: Robert W Tolan Jr, MD; Chief Editor: Russell W Steele, MD   more...
 
Updated: Jan 10, 2012
 

Physical

The clinical profile of an individual with chronic fatigue syndrome (CFS) is of a high-achieving student or athlete who is usually female (80%), Caucasian, and in the middle-class or upper–middle-class socioeconomic level. This may reflect referral bias but appears consistent throughout most studies.

A familial predisposition (eg, for CFS or related fibromyalgia) has been reported; however, studies to accurately assess genetic factors are only now underway. Preliminary data suggest that the illness is different in boys and girls. An allergic history is common. Milk intolerance is often reported. Children have typically been referred to specialty clinics after extensive screening by their primary care physician has yielded negative or nonspecific test results. Therefore, common short-lived causes of fatigue are effectively excluded. The length of fatigue (ie, 6 mo, according to CDC) also effectively excludes many common illnesses and probably should be retained in any forthcoming pediatric case definition.

As suggested by the term chronic, the clinical course is punctuated by remissions and relapses often triggered by intercurrent infection or stress. The course in adolescents is similar to that in adults. Recently, the 15-year follow-up data from the Lyndonville outbreak were reported and indicated successful resolution in most cases, based on self-assessment measures. However, improvement was often a matter of interpretation on the part of the patients. When questioned further, many had persistence of symptoms but had tailored their lifestyles to the persistent disability.

Next

Causes

The etiology of chronic fatigue syndrome remains undefined. The role of xenotropic murine leukemia virus–related virus (XMRV) and other murine retroviruses has been posited.[10, 11] These findings must be replicated and assessed, but recently have been ascribed to cross-contamination[12, 13, 14, 15, 16, 17, 18, 19] and the prevailing opinion is that XMRV is not causative.[20]

Previous
Proceed to Workup
 
 
Contributor Information and Disclosures
Author

Robert W Tolan Jr, MD  Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine

Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility

Disclosure: Novartis Honoraria Speaking and teaching

Coauthor(s)

Julian M Stewart, MD, PhD  Associate Chairman of Pediatrics, Director, Center for Hypotension, Westchester Medical Center; Professor of Pediatrics and Physiology, New York Medical College

Julian M Stewart, MD, PhD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Bryan D Carter, PhD  Professor of Child Psychology in Psychiatry and Behavioral Sciences, Chief Psychologist in Division of Child and Adolescent Psychiatry, Director of Predoctoral Internship in Clinical Child/Pediatric Psychology, Director of Postdoctoral Fellowship Program in Pediatric Psychology, Director of Pediatric Consultation-Liaison Service to Kosair Children's Hospital, University of Louisville School of Medicine

Bryan D Carter, PhD is a member of the following medical societies: American Psychological Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Leonard R Krilov, MD  Chief of Pediatric Infectious Diseases and International Adoption, Vice Chair, Department of Pediatrics, Professor of Pediatrics, Winthrop University Hospital

Leonard R Krilov, MD is a member of the following medical societies: American Academy of Pediatrics, American Pediatric Society, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Society for Pediatric Research

Disclosure: Medimmune Grant/research funds Cliinical trials; Medimmune Honoraria Speaking and teaching; Medimmune Consulting fee Consulting

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Mark R Schleiss, MD  American Legion Chair of Pediatrics, Professor of Pediatrics, Division Director, Division of Infectious Diseases and Immunology, Department of Pediatrics, University of Minnesota Medical School

Mark R Schleiss, MD is a member of the following medical societies: American Pediatric Society, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Daniel Rauch, MD, FAAP  Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine

Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine

Disclosure: Baxter Honoraria Consulting

Chief Editor

Russell W Steele, MD  Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association

Disclosure: Nothing to disclose.

References

  1. Fukuda K, Straus SE, Hickie I, Sharpe MC, Dobbins JG, Komaroff A. The chronic fatigue syndrome: a comprehensive approach to its definition and study. International Chronic Fatigue Syndrome Study Group. Ann Intern Med. Dec 15 1994;121(12):953-9. [Medline].

  2. Stewart JM, Gewitz MH, Weldon A, Arlievsky N, Li K, Munoz J. Orthostatic intolerance in adolescent chronic fatigue syndrome. Pediatrics. Jan 1999;103(1):116-21. [Medline].

  3. Bell KM, Cookfair D, Bell DS, Reese P, Cooper L. Risk factors associated with chronic fatigue syndrome in a cluster of pediatric cases. Rev Infect Dis. Jan-Feb 1991;13 Suppl 1:S32-8. [Medline].

  4. Rowe PC, Bou-Holaigah I, Kan JS, Calkins H. Is neurally mediated hypotension an unrecognised cause of chronic fatigue?. Lancet. Mar 11 1995;345(8950):623-4. [Medline].

  5. Streeten DH. Pathogenesis of hyperadrenergic orthostatic hypotension. Evidence of disordered venous innervation exclusively in the lower limbs. J Clin Invest. Nov 1990;86(5):1582-8. [Medline].

  6. Fouad FM, Tadena-Thome L, Bravo EL, Tarazi RC. Idiopathic hypovolemia. Ann Intern Med. Mar 1986;104(3):298-303. [Medline].

  7. Medow MS. Postural tachycardia syndrome from a pediatrics perspective. J Pediatr. Jan 2011;158(1):4-6. [Medline].

  8. Burkhardt BE, Fischer PR, Brands CK, Porter CB, Weaver AL, Yim PJ. Exercise performance in adolescents with autonomic dysfunction. J Pediatr. Jan 2011;158(1):28-32, 32.e1. [Medline].

  9. Ojha A, Chelimsky TC, Chelimsky G. Comorbidities in pediatric patients with postural orthostatic tachycardia syndrome. J Pediatr. Jan 2011;158(1):119-22. [Medline].

  10. Lombardi VC, Ruscetti FW, Das Gupta J, et al. Detection of an infectious retrovirus, XMRV, in blood cells of patients with chronic fatigue syndrome. Science. Oct 23 2009;326(5952):585-9. [Medline].

  11. Lo SC, Pripuzova N, Li B, et al. Detection of MLV-related virus gene sequences in blood of patients with chronic fatigue syndrome and healthy blood donors. Proc Natl Acad Sci U S A. Sep 7 2010;107(36):15874-9. [Medline]. [Full Text].

  12. Kearney M, Maldarelli F. Current Status of Xenotropic Murine Leukemia Virus–Related Retrovirus in Chronic Fatigue Syndrome and Prostate Cancer: Reach for a Scorecard, Not a Prescription Pad. J Infect Dis. Oct 11 2010;[Medline].

  13. Courgnaud V, Battini JL, Sitbon M, Mason AL. Mouse retroviruses and chronic fatigue syndrome: Does X (or P) mark the spot?. Proc Natl Acad Sci U S A. Sep 7 2010;107(36):15666-7. [Medline]. [Full Text].

  14. Rusmevichientong A, Chow SA. Biology and pathophysiology of the new human retrovirus XMRV and its association with human disease. Immunol Res. Aug 18 2010;[Medline].

  15. McClure M, Kaye S. Can detection of xenotropic murine leukemia virus-related virus be linked to chronic fatigue syndrome?. Expert Rev Mol Diagn. Jul 2010;10(5):537-9. [Medline].

  16. Switzer WM, Jia H, Hohn O, et al. Absence of evidence of xenotropic murine leukemia virus-related virus infection in persons with chronic fatigue syndrome and healthy controls in the United States. Retrovirology. Jul 1 2010;7:57. [Medline]. [Full Text].

  17. Kearney M, Maldarelli F. Current status of xenotropic murine leukemia virus-related retrovirus in chronic fatigue syndrome and prostate cancer: reach for a scorecard, not a prescription pad. J Infect Dis. Nov 15 2010;202(10):1463-6. [Medline].

  18. Henrich TJ, Li JZ, Felsenstein D, Kotton CN, Plenge RM, Pereyra F. Xenotropic murine leukemia virus-related virus prevalence in patients with chronic fatigue syndrome or chronic immunomodulatory conditions. J Infect Dis. Nov 15 2010;202(10):1478-81. [Medline].

  19. Hue S, Gray ER, Gall A, et al. Disease-associated XMRV sequences are consistent with laboratory contamination. Retrovirology. Dec 20 2010;7(1):111. [Medline].

  20. Knox K, Carrigan D, Simmons G, Teque F, Zhou Y, Hackett J Jr, et al. No evidence of murine-like gammaretroviruses in CFS patients previously identified as XMRV-infected. Science. Jul 1 2011;333(6038):94-7. [Medline].

  21. Afari N, Buchwald D. Chronic fatigue syndrome: a review. Am J Psychiatry. Feb 2003;160(2):221-36. [Medline].

  22. Antiel RM, Caudill JS, Burkhardt BE, Brands CK, Fischer PR. Iron insufficiency and hypovitaminosis D in adolescents with chronic fatigue and orthostatic intolerance. South Med J. Aug 2011;104(8):609-11. [Medline].

  23. Avellaneda Fernandez A, Perez Martin A, et al. Chronic fatigue syndrome: aetiology, diagnosis and treatment. BMC Psychiatry. Oct 23 2009;9 Suppl 1:S1. [Medline]. [Full Text].

  24. Baker R, Shaw EJ. Diagnosis and management of chronic fatigue syndrome or myalgic encephalomyelitis (or encephalopathy): summary of NICE guidance. BMJ. Sep 1 2007;335(7617):446-8. [Medline].

  25. Bakheit AM, Behan PO, Watson WS, Morton JJ. Abnormal arginine-vasopressin secretion and water metabolism in patients with postviral fatigue syndrome. Acta Neurol Scand. Mar 1993;87(3):234-8. [Medline].

  26. Bakker RJ, van de Putte EM, Kuis W, Sinnema G. Risk factors for persistent fatigue with significant school absence in children and adolescents. Pediatrics. Jul 2009;124(1):e89-95. [Medline].

  27. Barnes PR, Taylor DJ, Kemp GJ, Radda GK. Skeletal muscle bioenergetics in the chronic fatigue syndrome. J Neurol Neurosurg Psychiatry. Jun 1993;56(6):679-83. [Medline].

  28. Bell DS. Chronic fatigue syndrome update. Findings now point to CNS involvement. Postgrad Med. Nov 1 1994;96(6):73-6, 79-81. [Medline].

  29. Bell DS, Bell KM, Cheney PR. Primary juvenile fibromyalgia syndrome and chronic fatigue syndrome in adolescents. Clin Infect Dis. Jan 1994;18 Suppl 1:S21-3. [Medline].

  30. Bell DS, Jordan K, Robinson M. Thirteen-year follow-up of children and adolescents with chronic fatigue syndrome. Pediatrics. May 2001;107(5):994-8. [Medline].

  31. Bhui KS, Dinos S, Ashby D, Nazroo J, Wessely S, White PD. Chronic fatigue syndrome in an ethnically diverse population: the influence of psychosocial adversity and physical inactivity. BMC Med. Mar 21 2011;9:26. [Medline]. [Full Text].

  32. Blakely AA, Howard RC, Sosich RM, Murdoch JC, Menkes DB, Spears GF. Psychiatric symptoms, personality and ways of coping in chronic fatigue syndrome. Psychol Med. May 1991;21(2):347-62. [Medline].

  33. Bou-Holaigah I, Rowe PC, Kan J, Calkins H. The relationship between neurally mediated hypotension and the chronic fatigue syndrome. JAMA. Sep 27 1995;274(12):961-7. [Medline].

  34. Bould H, Lewis G, Emond A, Crawley E. Depression and anxiety in children with CFS/ME: cause or effect?. Arch Dis Child. Mar 2011;96(3):211-4. [Medline].

  35. Buchwald D, Wener MH, Pearlman T, Kith P. Markers of inflammation and immune activation in chronic fatigue and chronic fatigue syndrome. J Rheumatol. Feb 1997;24(2):372-6. [Medline].

  36. Buskila D. Pediatric fibromyalgia. Rheum Dis Clin North Am. May 2009;35(2):253-61. [Medline].

  37. Butler S, Chalder T, Ron M, Wessely S. Cognitive behaviour therapy in chronic fatigue syndrome. J Neurol Neurosurg Psychiatry. Feb 1991;54(2):153-8. [Medline].

  38. Byrne E, Trounce I. Chronic fatigue and myalgia syndrome: mitochondrial and glycolytic studies in skeletal muscle. J Neurol Neurosurg Psychiatry. Jun 1987;50(6):743-6. [Medline].

  39. Cameron B, Flamand L, Juwana H, et al. Serological and virological investigation of the role of the herpesviruses EBV, CMV and HHV-6 in post-infective fatigue syndrome. J Med Virol. Oct 2010;82(10):1684-8. [Medline].

  40. Cannon JG, Angel JB, Abad LW, et al. Interleukin-1 beta, interleukin-1 receptor antagonist, and soluble interleukin-1 receptor type II secretion in chronic fatigue syndrome. J Clin Immunol. May 1997;17(3):253-61. [Medline].

  41. Carter BD, Edwards JF, Kronenberger WG, Michalczyk L, Marshall GS. Case control study of chronic fatigue in pediatric patients. Pediatrics. Feb 1995;95(2):179-86. [Medline].

  42. Carter BD, Kronenberger WG, Edwards JF, Marshall GS, Schikler KN, Causey DL. Psychological symptoms in chronic fatigue and juvenile rheumatoid arthritis. Pediatrics. May 1999;103(5 Pt 1):975-9. [Medline].

  43. Cavanaugh RM Jr. Evaluating adolescents with fatigue: ever get tired of it?. Pediatr Rev. Oct 2002;23(10):337-48. [Medline].

  44. Chalder T, Berelowitz G, Pawlikowska T, et al. Development of a fatigue scale. J Psychosom Res. 1993;37(2):147-53. [Medline].

  45. Chalder T, Deary V, Husain K, Walwyn R. Family-focused cognitive behaviour therapy versus psycho-education for chronic fatigue syndrome in 11- to 18-year-olds: a randomized controlled treatment trial. Psychol Med. Aug 2010;40(8):1269-79. [Medline].

  46. Chambers D, Bagnall AM, Hempel S, Forbes C. Interventions for the treatment, management and rehabilitation of patients with chronic fatigue syndrome/myalgic encephalomyelitis: an updated systematic review. J R Soc Med. Oct 2006;99(10):506-20. [Medline].

  47. Chatterjee T. Chronic fatigue syndrome or myalgic encephalomyelitis in children and adolescents. J Indian Med Assoc. Sep 2003;101(9):544, 547. [Medline].

  48. Chen R, Liang FX, Moriya J, et al. Chronic fatigue syndrome and the central nervous system. J Int Med Res. Sep-Oct 2008;36(5):867-74. [Medline].

  49. Cleare AJ, Bearn J, Allain T, et al. Contrasting neuroendocrine responses in depression and chronic fatigue syndrome. J Affect Disord. Aug 18 1995;34(4):283-9. [Medline].

  50. Clements GB, McGarry F, Nairn C, Galbraith DN. Detection of enterovirus-specific RNA in serum: the relationship to chronic fatigue. J Med Virol. Feb 1995;45(2):156-61. [Medline].

  51. Cockshell SJ, Mathias JL. Cognitive functioning in chronic fatigue syndrome: a meta-analysis. Psychol Med. Aug 2010;40(8):1253-67. [Medline].

  52. Cook DB, Nagelkirk PR, Poluri A, Mores J, Natelson BH. The influence of aerobic fitness and fibromyalgia on cardiorespiratory and perceptual responses to exercise in patients with chronic fatigue syndrome. Arthritis Rheum. Oct 2006;54(10):3351-62. [Medline].

  53. Cope H, David A, Pelosi A, Mann A. Predictors of chronic "postviral" fatigue. Lancet. Sep 24 1994;344(8926):864-8. [Medline].

  54. Costa DC, Tannock C, Brostoff J. Brainstem perfusion is impaired in chronic fatigue syndrome. QJM. Nov 1995;88(11):767-73. [Medline].

  55. Crawley E. Chronic fatigue syndrome in young people: the spectrum and the myths. Br J Hosp Med (Lond). Sep 2006;67(9):452-3. [Medline].

  56. Crawley E, Sterne JA. Association between school absence and physical function in paediatric chronic fatigue syndrome/myalgic encephalopathy. Arch Dis Child. Oct 2009;94(10):752-6. [Medline].

  57. De Lorenzo F, Hargreaves J, Kakkar VV. Possible relationship between chronic fatigue and postural tachycardia syndromes. Clin Auton Res. Oct 1996;6(5):263-4. [Medline].

  58. Demitrack MA, Engleberg NC. Chronic fatigue syndrome. Curr Ther Endocrinol Metab. 1997;6:152-60. [Medline].

  59. DiVasta AD, Alexander ME. Fainting freshmen and sinking sophomores: cardiovascular issues of the adolescent. Curr Opin Pediatr. Aug 2004;16(4):350-6. [Medline].

  60. Edwards RH, Gibson H, Clague JE, Helliwell T. Muscle histopathology and physiology in chronic fatigue syndrome. Ciba Found Symp. 1993;173:102-17; discussion 117-31. [Medline].

  61. Elena Garralda M, Chalder T. Practitioner review: chronic fatigue syndrome in childhood. J Child Psychol Psychiatry. Nov 2005;46(11):1143-51. [Medline].

  62. Feder HM Jr, Dworkin PH, Orkin C. Outcome of 48 pediatric patients with chronic fatigue. A clinical experience. Arch Fam Med. Dec 1994;3(12):1049-55. [Medline].

  63. Fletcher MA, Zeng XR, Maher K, et al. Biomarkers in chronic fatigue syndrome: evaluation of natural killer cell function and dipeptidyl peptidase IV/CD26. PLoS One. May 25 2010;5(5):e10817. [Medline]. [Full Text].

  64. Freeman R, Komaroff AL. Does the chronic fatigue syndrome involve the autonomic nervous system?. Am J Med. Apr 1997;102(4):357-64. [Medline].

  65. Furlan R, Jacob G, Snell M, et al. Chronic orthostatic intolerance: a disorder with discordant cardiac and vascular sympathetic control. Circulation. Nov 17 1998;98(20):2154-9. [Medline].

  66. Galbraith S, Cameron B, Li H, Lau D, Vollmer-Conna U, Lloyd AR. Peripheral blood gene expression in postinfective fatigue syndrome following from three different triggering infections. J Infect Dis. Nov 2011;204(10):1632-40. [Medline].

  67. Galland BC, Jackson PM, Sayers RM, Taylor BJ. A matched case control study of orthostatic intolerance in children/adolescents with chronic fatigue syndrome. Pediatr Res. Feb 2008;63(2):196-202. [Medline].

  68. Garralda ME, Rangel L. Chronic fatigue syndrome of childhood. Comparative study with emotional disorders. Eur Child Adolesc Psychiatry. Dec 2005;14(8):424-30. [Medline].

  69. Gordon B, Lubitz L. Promising outcomes of an adolescent chronic fatigue syndrome inpatient programme. J Paediatr Child Health. May 2009;45(5):286-90. [Medline].

  70. Grubb BP, Kosinski DJ, Boehm K, Kip K. The postural orthostatic tachycardia syndrome: a neurocardiogenic variant identified during head-up tilt table testing. Pacing Clin Electrophysiol. Sep 1997;20(9 Pt 1):2205-12. [Medline].

  71. Gupta S, Aggarwal S, See D, Starr A. Cytokine production by adherent and non-adherent mononuclear cells in chronic fatigue syndrome. J Psychiatr Res. Jan-Feb 1997;31(1):149-56. [Medline].

  72. Gur A, Oktayoglu P. Central nervous system abnormalities in fibromyalgia and chronic fatigue syndrome: new concepts in treatment. Curr Pharm Des. 2008;14(13):1274-94. [Medline].

  73. Haig-Ferguson A, Tucker P, Eaton N, Hunt L, Crawley E. Memory and attention problems in children with chronic fatigue syndrome or myalgic encephalopathy. Arch Dis Child. Oct 2009;94(10):757-62. [Medline].

  74. Heim C, Wagner D, Maloney E, et al. Early adverse experience and risk for chronic fatigue syndrome: results from a population-based study. Arch Gen Psychiatry. Nov 2006;63(11):1258-66. [Medline].

  75. Hickie I, Davenport T, Wakefield D, Vollmer-Conna U, Cameron B, Vernon SD, et al. Post-infective and chronic fatigue syndromes precipitated by viral and non-viral pathogens: prospective cohort study. BMJ. Sep 16 2006;333(7568):575. [Medline]. [Full Text].

  76. Hickie I, Lloyd A, Wakefield D, Parker G. The psychiatric status of patients with the chronic fatigue syndrome. Br J Psychiatry. Apr 1990;156:534-40. [Medline].

  77. Huang Y, Katz BZ, Mears C, Kielhofner GW, Taylor R. Postinfectious fatigue in adolescents and physical activity. Arch Pediatr Adolesc Med. Sep 2010;164(9):803-9. [Medline].

  78. Hurum H, Sulheim D, Thaulow E, Wyller VB. Elevated nocturnal blood pressure and heart rate in adolescent chronic fatigue syndrome. Acta Paediatr. Feb 2011;100(2):289-92. [Medline].

  79. Jacob G, Shannon JR, Black B, et al. Effects of volume loading and pressor agents in idiopathic orthostatic tachycardia. Circulation. Jul 15 1997;96(2):575-80. [Medline].

  80. Jones JF, Maloney EM, Boneva RS, Jones AB, Reeves WC. Complementary and alternative medical therapy utilization by people with chronic fatiguing illnesses in the United States. BMC Complement Altern Med. Apr 25 2007;7:12. [Medline].

  81. Jones JF, Nicholson A, Nisenbaum R, et al. Orthostatic instability in a population-based study of chronic fatigue syndrome. Am J Med. Dec 2005;118(12):1415. [Medline].

  82. Katz BZ, Boas S, Shiraishi Y, Mears CJ, Taylor R. Exercise tolerance testing in a prospective cohort of adolescents with chronic fatigue syndrome and recovered controls following infectious mononucleosis. J Pediatr. Sep 2010;157(3):468-72, 472.e1. [Medline].

  83. Katz BZ, Shiraishi Y, Mears CJ, Binns HJ, Taylor R. Chronic fatigue syndrome after infectious mononucleosis in adolescents. Pediatrics. Jul 2009;124(1):189-93. [Medline].

  84. Katz BZ, Stewart JM, Shiraishi Y, Mears CJ, Taylor R. Autonomic symptoms at baseline and following infectious mononucleosis in a prospective cohort of adolescents. Arch Pediatr Adolesc Med. Aug 2011;165(8):765-6. [Medline].

  85. Keenan PA. Brain MRI abnormalities exist in chronic fatigue syndrome. J Neurol Sci. Dec 1 1999;171(1):1-2. [Medline].

  86. Kennedy G, Khan F, Hill A, Underwood C, Belch JJ. Biochemical and vascular aspects of pediatric chronic fatigue syndrome. Arch Pediatr Adolesc Med. Sep 2010;164(9):817-23. [Medline].

  87. Kennedy G, Underwood C, Belch JJ. Physical and Functional Impact of Chronic Fatigue Syndrome/Myalgic Encephalomyelitis in Childhood. Pediatrics. May 17 2010;[Medline].

  88. Kent-Braun JA, Sharma KR, Weiner MW, Massie B, Miller RG. Central basis of muscle fatigue in chronic fatigue syndrome. Neurology. Jan 1993;43(1):125-31. [Medline].

  89. Kerr JR, Petty R, Burke B, et al. Gene expression subtypes in patients with chronic fatigue syndrome/myalgic encephalomyelitis. J Infect Dis. April 2008 15;197:1171-84.

  90. Klimas NG, Koneru AO. Chronic fatigue syndrome: inflammation, immune function, and neuroendocrine interactions. Curr Rheumatol Rep. Dec 2007;9(6):482-7. [Medline].

  91. Knoop H, Stulemeijer M, de Jong LW, Fiselier TJ, Bleijenberg G. Efficacy of cognitive behavioral therapy for adolescents with chronic fatigue syndrome: long-term follow-up of a randomized, controlled trial. Pediatrics. Mar 2008;121(3):e619-25. [Medline].

  92. Krilov LR, Fisher M, Friedman SB, Reitman D, Mandel FS. Course and outcome of chronic fatigue in children and adolescents. Pediatrics. Aug 1998;102(2 Pt 1):360-6. [Medline].

  93. Kruesi MJ, Dale J, Straus SE. Psychiatric diagnoses in patients who have chronic fatigue syndrome. J Clin Psychiatry. Feb 1989;50(2):53-6. [Medline].

  94. Kuo DZ, Cheng TL, Rowe PC. Successful use of a primary care practice-specialty collaboration in the care of an adolescent with chronic fatigue syndrome. Pediatrics. Dec 2007;120(6):e1536-9. [Medline].

  95. Lane RJ, Barrett MC, Taylor DJ, Kemp GJ, Lodi R. Heterogeneity in chronic fatigue syndrome: evidence from magnetic resonance spectroscopy of muscle. Neuromuscul Disord. May 1998;8(3-4):204-9. [Medline].

  96. Lane TJ, Manu P, Matthews DA. Depression and somatization in the chronic fatigue syndrome. Am J Med. Oct 1991;91(4):335-44. [Medline].

  97. Lange G, DeLuca J, Maldjian JA, Lee H, Tiersky LA, Natelson BH. Brain MRI abnormalities exist in a subset of patients with chronic fatigue syndrome. J Neurol Sci. Dec 1 1999;171(1):3-7. [Medline].

  98. Lewis SF, Haller RG. Physiologic measurement of exercise and fatigue with special reference to chronic fatigue syndrome. Rev Infect Dis. Jan-Feb 1991;13 Suppl 1:S98-108. [Medline].

  99. Lorusso L, Mikhaylova SV, Capelli E, Ferrari D, Ngonga GK, Ricevuti G. Immunological aspects of chronic fatigue syndrome. Autoimmun Rev. Feb 2009;8(4):287-91. [Medline].

  100. MacLean AR, Allen EV. Orthostatic hypotension and orthostatic tachycardia: treatment with the "head-up bed". JAMA. 1940;115:2162-7.

  101. Manian FA. Simultaneous measurement of antibodies to Epstein-Barr virus, human herpesvirus 6, herpes simplex virus types 1 and 2, and 14 enteroviruses in chronic fatigue syndrome: is there evidence of activation of a nonspecific polyclonal immune response?. Clin Infect Dis. Sep 1994;19(3):448-53. [Medline].

  102. Manu P, Lane TJ, Matthews DA. Chronic fatigue and chronic fatigue syndrome: clinical epidemiology and aetiological classification. Ciba Found Symp. 1993;173:23-31; discussion 31-42. [Medline].

  103. Manu P, Lane TJ, Matthews DA. The frequency of the chronic fatigue syndrome in patients with symptoms of persistent fatigue. Ann Intern Med. Oct 1 1988;109(7):554-6. [Medline].

  104. Manu P, Matthews DA, Lane TJ. The mental health of patients with a chief complaint of chronic fatigue. A prospective evaluation and follow-up. Arch Intern Med. Oct 1988;148(10):2213-7. [Medline].

  105. Marshall GS. Report of a workshop on the epidemiology, natural history, and pathogenesis of chronic fatigue syndrome in adolescents. J Pediatr. Apr 1999;134(4):395-405. [Medline].

  106. Marshall GS, Gesser RM, Yamanishi K, Starr SE. Chronic fatigue in children: clinical features, Epstein-Barr virus and human herpesvirus 6 serology and long term follow-up. Pediatr Infect Dis J. Apr 1991;10(4):287-90. [Medline].

  107. May M, Emond A, Crawley E. Phenotypes of chronic fatigue syndrome in children and young people. Arch Dis Child. Apr 2010;95(4):245-9. [Medline].

  108. McComas AJ, Miller RG, Gandevia SC. Fatigue brought on by malfunction of the central and peripheral nervous systems. Adv Exp Med Biol. 1995;384:495-512. [Medline].

  109. McCully KK, Natelson BH. Impaired oxygen delivery to muscle in chronic fatigue syndrome. Clin Sci (Lond). Nov 1999;97(5):603-8; discussion 611-3. [Medline].

  110. McCully KK, Natelson BH, Iotti S, Sisto S, Leigh JS Jr. Reduced oxidative muscle metabolism in chronic fatigue syndrome. Muscle Nerve. May 1996;19(5):621-5. [Medline].

  111. Meeus M, Nijs J. Central sensitization: a biopsychosocial explanation for chronic widespread pain in patients with fibromyalgia and chronic fatigue syndrome. Clin Rheumatol. Apr 2007;26(4):465-73. [Medline].

  112. Montague TJ, Marrie TJ, Klassen GA, Bewick DJ, Horacek BM. Cardiac function at rest and with exercise in the chronic fatigue syndrome. Chest. Apr 1989;95(4):779-84. [Medline].

  113. Morillo CA, Klein GJ, Thakur RK, Li H, Zardini M, Yee R. Mechanism of 'inappropriate' sinus tachycardia. Role of sympathovagal balance. Circulation. Aug 1994;90(2):873-7. [Medline].

  114. Moss RB, Mercandetti A, Vojdani A. TNF-alpha and chronic fatigue syndrome. J Clin Immunol. Sep 1999;19(5):314-6. [Medline].

  115. Nacul LC, Lacerda EM, Campion P, Pheby D, Drachler Mde L, Leite JC, et al. The functional status and well being of people with myalgic encephalomyelitis/chronic fatigue syndrome and their carers. BMC Public Health. May 27 2011;11:402. [Medline]. [Full Text].

  116. Nacul LC, Lacerda EM, Pheby D, Campion P, Molokhia M, Fayyaz S, et al. Prevalence of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) in three regions of England: a repeated cross-sectional study in primary care. BMC Med. Jul 28 2011;9:91. [Medline]. [Full Text].

  117. Natelson BH, Johnson SK, DeLuca J, et al. Reducing heterogeneity in chronic fatigue syndrome: a comparison with depression and multiple sclerosis. Clin Infect Dis. Nov 1995;21(5):1204-10. [Medline].

  118. Nater UM, Jones JF, Lin JM, Maloney E, Reeves WC, Heim C. Personality features and personality disorders in chronic fatigue syndrome: a population-based study. Psychother Psychosom. 2010;79(5):312-8. [Medline]. [Full Text].

  119. Nijhof SL, Bleijenberg G, Uiterwaal CS, Kimpen JL, van de Putte EM. Fatigue In Teenagers on the interNET--the FITNET Trial. A randomized clinical trial of web-based cognitive behavioural therapy for adolescents with chronic fatigue syndrome: study protocol. [ISRCTN59878666]. BMC Neurol. Feb 19 2011;11:23. [Medline]. [Full Text].

  120. Nijhof SL, Maijer K, Bleijenberg G, Uiterwaal CS, Kimpen JL, van de Putte EM. Adolescent chronic fatigue syndrome: prevalence, incidence, and morbidity. Pediatrics. May 2011;127(5):e1169-75. [Medline].

  121. Nijs J, Frémont M. Intracellular immune dysfunction in myalgic encephalomyelitis/chronic fatigue syndrome: state of the art and therapeutic implications. Expert Opin Ther Targets. Mar 2008;12(3):281-9. [Medline].

  122. Novak V, Novak P. Postural tachycardia syndrome. In: Low PA, ed. Clinical Autonomic Disorders. 2nd ed. Lippincott-Raven: Philadelphia, Pa; 1997:681-99.

  123. Patarca R, Klimas NG, Lugtendorf S, Antoni M, Fletcher MA. Dysregulated expression of tumor necrosis factor in chronic fatigue syndrome: interrelations with cellular sources and patterns of soluble immune mediator expression. Clin Infect Dis. Jan 1994;18 Suppl 1:S147-53. [Medline].

  124. Paul L, Wood L, Behan WM, Maclaren WM. Demonstration of delayed recovery from fatiguing exercise in chronic fatigue syndrome. Eur J Neurol. Jan 1999;6(1):63-9. [Medline].

  125. Pelcovitz D, Septimus A, Friedman SB, Krilov LR, Mandel F, Kaplan S. Psychosocial correlates of chronic fatigue syndrome in adolescent girls. J Dev Behav Pediatr. Oct 1995;16(5):333-8. [Medline].

  126. Plioplys AV, Plioplys S. Electron-microscopic investigation of muscle mitochondria in chronic fatigue syndrome. Neuropsychobiology. 1995;32(4):175-81. [Medline].

  127. Prins JB, van der Meer JW, Bleijenberg G. Chronic fatigue syndrome. Lancet. Jan 28 2006;367(9507):346-55. [Medline].

  128. Reeves WC, Heim C, Maloney EM, et al. Sleep characteristics of persons with chronic fatigue syndrome and non-fatigued controls: results from a population-based study. BMC Neurol. Nov 16 2006;6:41. [Medline].

  129. Rimes KA, Goodman R, Hotopf M, Wessely S, Meltzer H, Chalder T. Incidence, prognosis, and risk factors for fatigue and chronic fatigue syndrome in adolescents: a prospective community study. Pediatrics. Mar 2007;119(3):e603-9. [Medline].

  130. Robertson D. The epidemic of orthostatic tachycardia and orthostatic intolerance. Am J Med Sci. Feb 1999;317(2):75-7. [Medline].

  131. Rosen SG, Cryer PE. Postural tachycardia syndrome. Reversal of sympathetic hyperresponsiveness and clinical improvement during sodium loading. Am J Med. May 1982;72(5):847-50. [Medline].

  132. Rosenblum H, Shoenfeld Y, Amital H. The Common Immunogenic Etiology of Chronic Fatigue Syndrome: From Infections to Vaccines via Adjuvants to the ASIA Syndrome. Infect Dis Clin North Am. Dec 2011;25(4):851-63. [Medline].

  133. Russell IJ, Vipraio GA, Michalek JE, Craig FE, Kang YK, Richards AB. Lymphocyte markers and natural killer cell activity in fibromyalgia syndrome: effects of low-dose, sublingual use of human interferon-alpha. J Interferon Cytokine Res. Aug 1999;19(8):969-78. [Medline].

  134. Saidi G, Haines L. The management of children with chronic fatigue syndrome-like illness in primary care: a cross-sectional study. Br J Gen Pract. Jan 2006;56(522):43-7. [Medline].

  135. Sankey A, Hill CM, Brown J, Quinn L, Fletcher A. A follow-up study of chronic fatigue syndrome in children and adolescents: symptom persistence and school absenteeism. Clin Child Psychol Psychiatry. Jan 2006;11(1):126-38. [Medline].

  136. Schikler KN. Potential polygenic influences on chronic fatigue syndrome. Pediatrics. Oct 2006;118(4):1799-800; author reply 1800. [Medline].

  137. Schondorf R, Benoit J, Wein T, Phaneuf D. Orthostatic intolerance in the chronic fatigue syndrome. J Auton Nerv Syst. Feb 15 1999;75(2-3):192-201. [Medline].

  138. Schondorf R, Low PA. Idiopathic postural orthostatic tachycardia syndrome: an attenuated form of acute pandysautonomia?. Neurology. Jan 1993;43(1):132-7. [Medline].

  139. Schutzer SE, Angel TE, Liu T, Schepmoes AA, Clauss TR, Adkins JN, et al. Distinct cerebrospinal fluid proteomes differentiate post-treatment lyme disease from chronic fatigue syndrome. PLoS One. Feb 23 2011;6(2):e17287. [Medline]. [Full Text].

  140. Schwartz RB, Garada BM, Komaroff AL, et al. Detection of intracranial abnormalities in patients with chronic fatigue syndrome: comparison of MR imaging and SPECT. AJR Am J Roentgenol. Apr 1994;162(4):935-41. [Medline].

  141. Siegel MJ, Camras CB, Lustgarten JS, Podos SM. Effect of flurbiprofen on the reduction of intraocular pressure after administration of 1% apraclonidine in patients with glaucoma. Arch Ophthalmol. May 1992;110(5):598-9. [Medline].

  142. Sisto SA, Tapp W, Drastal S, et al. Vagal tone is reduced during paced breathing in patients with the chronic fatigue syndrome. Clin Auton Res. Jun 1995;5(3):139-43. [Medline].

  143. Smets EM, Garssen B, Bonke B, De Haes JC. The Multidimensional Fatigue Inventory (MFI) psychometric qualities of an instrument to assess fatigue. J Psychosom Res. Apr 1995;39(3):315-25. [Medline].

  144. Smith MS, Mitchell J, Corey L, et al. Chronic fatigue in adolescents. Pediatrics. Aug 1991;88(2):195-202. [Medline].

  145. Smits B, van den Heuvel L, Knoop H, Küsters B, Janssen A, Borm G, et al. Mitochondrial enzymes discriminate between mitochondrial disorders and chronic fatigue syndrome. Mitochondrion. Sep 2011;11(5):735-8. [Medline].

  146. Sommerfeldt L, Portilla H, Jacobsen L, Gjerstad J, Wyller VB. Polymorphisms of adrenergic cardiovascular control genes are associated with adolescent chronic fatigue syndrome. Acta Paediatr. Feb 2011;100(2):293-8. [Medline].

  147. Stewart J, Weldon A, Arlievsky N, Li K, Munoz J. Neurally mediated hypotension and autonomic dysfunction measured by heart rate variability during head-up tilt testing in children with chronic fatigue syndrome. Clin Auton Res. Aug 1998;8(4):221-30. [Medline].

  148. Stewart JM, Gewitz MH, Weldon A, Munoz J. Patterns of orthostatic intolerance: the orthostatic tachycardia syndrome and adolescent chronic fatigue. J Pediatr. Aug 1999;135(2 Pt 1):218-25. [Medline].

  149. Stokes MJ, Cooper RG, Edwards RH. Normal muscle strength and fatigability in patients with effort syndromes. BMJ. Oct 22 1988;297(6655):1014-7. [Medline].

  150. Straus SE. History of chronic fatigue syndrome. Rev Infect Dis. Jan-Feb 1991;13 Suppl 1:S2-7. [Medline].

  151. Streeten DH, Anderson GH Jr. Delayed orthostatic intolerance. Arch Intern Med. May 1992;152(5):1066-72. [Medline].

  152. Streeten DH, Anderson GH Jr. The role of delayed orthostatic hypotension in the pathogenesis of chronic fatigue. Clin Auton Res. Apr 1998;8(2):119-24. [Medline].

  153. Streeten DH, Anderson GH Jr, Richardson R, Thomas FD. Abnormal orthostatic changes in blood pressure and heart rate in subjects with intact sympathetic nervous function: evidence for excessive venous pooling. J Lab Clin Med. Mar 1988;111(3):326-35. [Medline].

  154. Swanink CM, van der Meer JW, Vercoulen JH, Bleijenberg G, Fennis JF, Galama JM. Epstein-Barr virus (EBV) and the chronic fatigue syndrome: normal virus load in blood and normal immunologic reactivity in the EBV regression assay. Clin Infect Dis. May 1995;20(5):1390-2. [Medline].

  155. Swanink CM, Vercoulen JH, Galama JM, et al. Lymphocyte subsets, apoptosis, and cytokines in patients with chronic fatigue syndrome. J Infect Dis. Feb 1996;173(2):460-3. [Medline].

  156. Taerk GS, Toner BB, Salit IE, Garfinkel PE, Ozersky S. Depression in patients with neuromyasthenia (benign myalgic encephalomyelitis). Int J Psychiatry Med. 1987;17(1):49-56. [Medline].

  157. Takken T, Henneken T, van de Putte E, Helders P, Engelbert R. Exercise testing in children and adolescents with chronic fatigue syndrome. Int J Sports Med. Jul 2007;28(7):580-4. [Medline].

  158. ter Wolbeek M, van Doornen LJ, Kavelaars A, Heijnen CJ. Predictors of persistent and new-onset fatigue in adolescent girls. Pediatrics. Mar 2008;121(3):e449-57. [Medline].

  159. ter Wolbeek M, van Doornen LJ, Kavelaars A, Heijnen CJ. Severe fatigue in adolescents: a common phenomenon?. Pediatrics. Jun 2006;117(6):e1078-86. [Medline].

  160. ter Wolbeek M, van Doornen LJ, Kavelaars A, Tersteeg-Kamperman MD, Heijnen CJ. Fatigue, depressive symptoms, and anxiety from adolescence up to young adulthood: a longitudinal study. Brain Behav Immun. Aug 2011;25(6):1249-55. [Medline].

  161. Tortorici Z. Masturbation, salvation, and desire: connecting sexuality and religiosity in colonial Mexico. J Hist Sex. 2007;16(3):355-72. [Medline].

  162. Tucker P, Haig-Ferguson A, Eaton N, Crawley E. What to do about attention and memory problems in children with CFS/ME: a neuropsychological approach. Clin Child Psychol Psychiatry. Apr 2011;16(2):215-23. [Medline].

  163. van de Putte EM, Bocker KB, Buitelaar J, et al. Deficits of interference control in adolescents with chronic fatigue syndrome. Arch Pediatr Adolesc Med. Dec 2008;162(12):1196-7. [Medline].

  164. van de Putte EM, Engelbert RH, Kuis W, Kimpen JL, Uiterwaal CS. How fatigue is related to other somatic symptoms. Arch Dis Child. Oct 2006;91(10):824-7. [Medline].

  165. van de Putte EM, van Doornen LJ, Engelbert RH, Kuis W, Kimpen JL, Uiterwaal CS. Mirrored symptoms in mother and child with chronic fatigue syndrome. Pediatrics. Jun 2006;117(6):2074-9. [Medline].

  166. van Geelen SM, Bakker RJ, Kuis W, van de Putte EM. Adolescent chronic fatigue syndrome: a follow-up study. Arch Pediatr Adolesc Med. Sep 2010;164(9):810-4. [Medline].

  167. Viner RM, Clark C, Taylor SJ, et al. Longitudinal risk factors for persistent fatigue in adolescents. Arch Pediatr Adolesc Med. May 2008;162(5):469-75. [Medline].

  168. Visser J, Blauw B, Hinloopen B, et al. CD4 T lymphocytes from patients with chronic fatigue syndrome have decreased interferon-gamma production and increased sensitivity to dexamethasone. J Infect Dis. Feb 1998;177(2):451-4. [Medline].

  169. Vojdani A, Choppa PC, Lapp CW. Downregulation of RNase L inhibitor correlates with upregulation of interferon-induced proteins (2-5A synthetase and RNase L) in patients with chronic fatigue immune dysfunction syndrome. J Clin Lab Immunol. 1998;50(1):1-16. [Medline].

  170. Vollmer-Conna U. Chronic fatigue syndrome in adolescence: where to from here?. Arch Pediatr Adolesc Med. Sep 2010;164(9):880-1. [Medline].

  171. Walford GA, Nelson WM, McCluskey DR. Fatigue, depression, and social adjustment in chronic fatigue syndrome. Arch Dis Child. Mar 1993;68(3):384-8. [Medline].

  172. Ware NC. Society, mind and body in chronic fatigue syndrome: an anthropological view. Ciba Found Symp. 1993;173:62-73; discussion 73-82. [Medline].

  173. Wessely S, Powell R. Fatigue syndromes: a comparison of chronic "postviral" fatigue with neuromuscular and affective disorders. J Neurol Neurosurg Psychiatry. Aug 1989;52(8):940-8. [Medline].

  174. Wong R, Lopaschuk G, Zhu G, et al. Skeletal muscle metabolism in the chronic fatigue syndrome. In vivo assessment by 31P nuclear magnetic resonance spectroscopy. Chest. Dec 1992;102(6):1716-22. [Medline].

  175. Woods TO, Goldberg DP. Psychiatric perspectives: an overview. Br Med Bull. Oct 1991;47(4):908-18. [Medline].

  176. Wyller VB. The chronic fatigue syndrome--an update. Acta Neurol Scand Suppl. 2007;187:7-14. [Medline].

  177. Wyller VB, Barbieri R, Saul JP. Blood pressure variability and closed-loop baroreflex assessment in adolescent chronic fatigue syndrome during supine rest and orthostatic stress. Eur J Appl Physiol. Mar 2011;111(3):497-507. [Medline]. [Full Text].

  178. Wyller VB, Barbieri R, Thaulow E, Saul JP. Enhanced vagal withdrawal during mild orthostatic stress in adolescents with chronic fatigue. Ann Noninvasive Electrocardiol. Jan 2008;13(1):67-73. [Medline].

  179. Wyller VB, Godang K, Morkrid L, Saul JP, Thaulow E, Walloe L. Abnormal thermoregulatory responses in adolescents with chronic fatigue syndrome: relation to clinical symptoms. Pediatrics. Jul 2007;120(1):e129-37. [Medline].

  180. Wyller VB, Saul JP, Amlie JP, Thaulow E. Sympathetic predominance of cardiovascular regulation during mild orthostatic stress in adolescents with chronic fatigue. Clin Physiol Funct Imaging. Jul 2007;27(4):231-8. [Medline].

  181. Wyller VB, Saul JP, Walloe L, Thaulow E. Sympathetic cardiovascular control during orthostatic stress and isometric exercise in adolescent chronic fatigue syndrome. Eur J Appl Physiol. Apr 2008;102(6):623-32. [Medline].

  182. Wyller VB, Thaulow E, Amlie JP. Treatment of chronic fatigue and orthostatic intolerance with propranolol. J Pediatr. Jun 2007;150(6):654-5. [Medline].

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.