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Sections Chronic Fatigue Syndrome (Myalgic Encephalomyelitis)
- Overview
- Presentation
- DDx
- Medication
- Questions & Answers
- References
Medication Summary
No drugs have been FDA-approved for CFS treatment. Clinical trials have found that antiviral agents are ineffective in relieving the symptoms of CFS. [28] Various medications have been shown to be ineffective, including antibiotics, glucocorticoids, liver extract, chelating agents, intravenous (IV) vitamins, vitamin B-12, and IV or oral vitamin or mineral supplements. Antidepressants have no major role in the treatment of CFS.
A randomized placebo-controlled double-blind trial to evaluate the effect of cytokine inhibition with anakinra, a recombinant human interleukin-1 (IL-1) receptor antagonist, was conducted and did not show any improvement in fatigue severity both in the short term (4 weeks) or the long term (6 months). [29] Future studies may evaluate inhibition of other cytokines such as IL-6, tumor necrosis factor, and/or interferons.
To date, no evidence-based interventions are available for the treatment of CFS.
Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. Centers for Disease Control and Prevention. Available at https://www.cdc.gov/me-cfs/index.html. June 29, 2018; Accessed: August 21, 2018.
Montoya JG, Holmes TH, Anderson JN, Maecker HT, Rosenberg-Hasson Y, Valencia IJ, et al. Cytokine signature associated with disease severity in chronic fatigue syndrome patients. Proc Natl Acad Sci U S A. 2017 Aug 22. 114 (34):E7150-E7158. [QxMD MEDLINE Link].
Cortes Rivera M, Mastronardi C, Silva-Aldana CT, et al. Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Comprehensive Review. Diagnostics (Basel). 2019 Aug 7. 9 (3):[QxMD MEDLINE Link].
Timbol CR, Baraniuk JN. Chronic fatigue syndrome in the emergency department. Open Access Emerg Med. 2019. 11:15-28. [QxMD MEDLINE Link].
Institute of Medicine. Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. Institute of Medicine of the National Academies. Available at http://www.iom.edu/MECFS. February 2015; Accessed: August 2018.
Capelli E, Zola R, Lorusso L, Venturini L, Sardi F, Ricevuti G. Chronic fatigue syndrome/myalgic encephalomyelitis: an update. Int J Immunopathol Pharmacol. 2010 Oct-Dec. 23(4):981-9. [QxMD MEDLINE Link].
Clayton EW. Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: An IOM Report on Redefining an Illness. JAMA. 2015 Feb 10. [QxMD MEDLINE Link].
Sapra A, Bhandari P. Chronic Fatigue Syndrome. 2020 Jan. [QxMD MEDLINE Link]. [Full Text].
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. 2009 Oct 23. 326(5952):585-9. [QxMD MEDLINE Link].
Lo SC, Pripuzova N, Li B, Komaroff AL, Hung GC, Wang R, 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. 2010 Sep 7. 107(36):15874-9. [QxMD MEDLINE Link]. [Full Text].
Shin CH, Bateman L, Schlaberg R, et al. Absence of XMRV retrovirus and other murine leukemia virus-related viruses in patients with chronic fatigue syndrome. J Virol. 2011 Jul. 85(14):7195-202. [QxMD MEDLINE Link]. [Full Text].
Schutzer SE, Rounds MA, Natelson BH, Ecker DJ, Eshoo MW. Analysis of cerebrospinal fluid from chronic fatigue syndrome patients for multiple human ubiquitous viruses and xenotropic murine leukemia-related virus. Ann Neurol. 2011 Apr. 69(4):735-8. [QxMD MEDLINE Link].
Maggi F, Focosi D, Lanini L, et al. Xenotropic murine leukaemia virus-related virus is not found in peripheral blood cells from treatment-naive human immunodeficiency virus-positive patients. Clin Microbiol Infect. 2012 Feb. 18(2):184-8. [QxMD MEDLINE Link].
Knox K, Carrigan D, Simmons G, et al. No evidence of murine-like gammaretroviruses in CFS patients previously identified as XMRV-infected. Science. 2011 Jul 1. 333(6038):94-7. [QxMD MEDLINE Link].
Nicolson GL, Gan R, Haier J. Multiple co-infections (Mycoplasma, Chlamydia, human herpes virus-6) in blood of chronic fatigue syndrome patients: association with signs and symptoms. APMIS. 2003 May. 111(5):557-66. [QxMD MEDLINE Link].
Komaroff AL, Wang SP, Lee J, Grayston JT. No association of chronic Chlamydia pneumoniae infection with chronic fatigue syndrome. J Infect Dis. 1992 Jan. 165(1):184. [QxMD MEDLINE Link].
Sunnquist M, Jason LA, Nehrke P, Goudsmit EM. A Comparison of Case Definitions for Myalgic Encephalomyelitis and Chronic Fatigue Syndrome. J Chronic Dis Manag. 2017. 2 (2):[QxMD MEDLINE Link].
Shan ZY, Barnden LR, Kwiatek RA, et al. Neuroimaging characteristics of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS): a systematic review. J Transl Med. 2020 Sep 1. 18 (1):335. [QxMD MEDLINE Link].
Almutairi B, Langley C, Crawley E, Thai NJ. Using structural and functional MRI as a neuroimaging technique to investigate chronic fatigue syndrome/myalgic encephalopathy: a systematic review. BMJ Open. 2020 Aug 30. 10 (8):e031672. [QxMD MEDLINE Link].
Cleare AJ, Reid S, Chalder T, Hotopf M, Wessely S. Chronic fatigue syndrome. BMJ Clinical Evidence. 2015 Sep 28. [QxMD MEDLINE Link]. [Full Text].
White PD, Goldsmith KA, Johnson AL, Potts L, Walwyn R, DeCesare JC, et al. Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomised trial. Lancet. 2011 Mar 5. 377(9768):823–836. [QxMD MEDLINE Link]. [Full Text].
Surveillance report 2017 – Chronic fatigue syndrome/myalgic encephalomyelitis (or encephalopathy): diagnosis and management (2007) NICE guideline CG53. National Institute for Health and Care Excellence. Available at http://go.nature.com/2d4ckro. 20 September 2017; Accessed: 21 August 2018.
Vink M, Vink-Niese A. Multidisciplinary rehabilitation treatment is not effective for myalgic encephalomyelitis/chronic fatigue syndrome: A review of the FatiGo trial. Health Psychol Open. 2018 Jul-Dec. 5 (2):2055102918792648. [QxMD MEDLINE Link]. [Full Text].
Larun L, Brurberg KG, Odgaard-Jensen J, Price JR. Exercise therapy for chronic fatigue syndrome. Cochrane Database Syst Rev. 2017 Apr 25. 4:CD003200. [QxMD MEDLINE Link].
Nyland M, Naess H, Birkeland JS, Nyland H. Longitudinal follow-up of employment status in patients with chronic fatigue syndrome after mononucleosis. BMJ Open. 2014 Nov 26. 4(11):[QxMD MEDLINE Link]. [Full Text].
Joyce J, Hotopf M, Wessely S. The prognosis of chronic fatigue and chronic fatigue syndrome: a systematic review. QJM. 1997 Mar. 90(3):223-33. [QxMD MEDLINE Link].
Cairns R, Hotopf M. A systematic review describing the prognosis of chronic fatigue syndrome. Occup Med (Lond). 2005 Jan. 55(1):20-31. [QxMD MEDLINE Link]. [Full Text].
Montoya JG, Kogelnik AM, Bhangoo M, Lunn MR, Flamand L, Merrihew LE, et al. Randomized clinical trial to evaluate the efficacy and safety of valganciclovir in a subset of patients with chronic fatigue syndrome. Journal of Medical Virology. 19 August 2013. Volume 85, Issue 12:2101-2109. [QxMD MEDLINE Link]. [Full Text].
Roerink ME, Bredie SJH, Heijnen M, Dinarello CA, Knoop H, Van der Meer JWM. Cytokine Inhibition in Patients With Chronic Fatigue Syndrome: A Randomized Trial. Annals of Internal Medicine. 2017 Apr 18. 166(8):57-564. [QxMD MEDLINE Link]. [Full Text].
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. 1994 Dec 15. 121(12):953-9. [QxMD MEDLINE Link].
Brurberg KG, Fønhus MS, Larun L, Flottorp S, Malterud K. Case definitions for chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME): a systematic review. BMJ Open. 2014 Feb 7. 4(2):e003973. [QxMD MEDLINE Link]. [Full Text].
Katz BZ, Jason LA. Chronic fatigue syndrome following infections in adolescents. Curr Opin Pediatr. 2013 Feb. 25(1):95-102. [QxMD MEDLINE Link].
Morris G, Maes M. Case definitions and diagnostic criteria for Myalgic Encephalomyelitis and Chronic fatigue Syndrome: from clinical-consensus to evidence-based case definitions. Neuro Endocrinol Lett. 2013. 34(3):185-99. [QxMD MEDLINE Link].
Moss-Morris R, Deary V, Castell B. Chronic fatigue syndrome. Handb Clin Neurol. 2013. 110:303-14. [QxMD MEDLINE Link].
Hatziagelaki E, Adamaki M, Tsilioni I, Dimitriadis G, Theoharides TC. Myalgic Encephalomyelitis/Chronic Fatigue Syndrome-Metabolic Disease or Disturbed Homeostasis?. The Journal of Pharmacology and Experimental Therapeutics. 2018 Aug 3. Vol. 366, Issue 3:[QxMD MEDLINE Link]. [Full Text].
Nacul L, O'Boyle S, Palla L, et al. How Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) Progresses: The Natural History of ME/CFS. Front Neurol. 2020. 11:826. [QxMD MEDLINE Link].
Thapaliya K, Marshall-Gradisnik S, Staines D, Barnden L. Mapping of pathological change in chronic fatigue syndrome using the ratio of T1- and T2-weighted MRI scans. Neuroimage Clin. 2020 Jul 31. 28:102366. [QxMD MEDLINE Link].
Tables
Jefferson R Roberts, MD Chief of Rheumatology Service, Tripler Army Medical Center; Assistant Clinical Professor of Medicine, Uniformed Services University of the Health Sciences
Jefferson R Roberts, MD is a member of the following medical societies: American College of Physicians, American College of Rheumatology, Society for Simulation in Healthcare
Disclosure: Nothing to disclose.
Mary L Lan, MD, MPH Resident Physician, Department of Medicine, Tripler Army Medical Center
Disclosure: Nothing to disclose.
Michael W Price, MD Chief, Medical Specialty Clinic #1, Tripler Army Medical Center; Instructor in Medicine, Uniformed Services University of the Health Sciences, F Edward Herbert School of Medicine
Michael W Price, MD is a member of the following medical societies: American Society of Tropical Medicine and Hygiene, Armed Forces Infectious Diseases Society, Infectious Diseases Society of America
Disclosure: Nothing to disclose.
Michael A Kaliner, MD Clinical Professor of Medicine, George Washington University School of Medicine; Medical Director, Institute for Asthma and Allergy
Michael A Kaliner, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Association of Immunologists, American College of Allergy, Asthma and Immunology, American Society for Clinical Investigation, American Thoracic Society, Association of American Physicians
Disclosure: Nothing to disclose.
Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America; Fellow of the Royal College of Physicians, London
Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Medical Association, Association of Professors of Medicine, Infectious Diseases Society of America, Oklahoma State Medical Association, Southern Society for Clinical Investigation
Disclosure: Nothing to disclose.
Burke A Cunha, MD Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, Infectious Diseases Society of America
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.
Thomas M Kerkering, MD Chief of Infectious Diseases, Virginia Tech Carilion School of Medicine
Thomas M Kerkering, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Public Health Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Medical Society of Virginia, and Wilderness Medical Society
Disclosure: Nothing to disclose.
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
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.
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.
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.
Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference
Disclosure: Medscape Salary Employment
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
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.
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Sections Chronic Fatigue Syndrome (Myalgic Encephalomyelitis)
- Overview
- Presentation
- DDx
- Medication
- Questions & Answers
- References
