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Definition

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Chronic fatigue syndrome (CFS) is a disorder characterized by persistent and unexplained fatigue resulting in severe impairment in daily functioning. Besides intense fatigue, most patients with CFS report concomitant symptoms such as pain, cognitive dysfunction, and unrefreshing sleep. Additional symptoms can include headache, sore throat, tender lymph nodes, muscle aches, joint aches, feverishness, difficulty sleeping, psychiatric problems, allergies, and abdominal cramps. Criteria for the diagnosis of CFS have been developed by the U.S. Centers for Disease Control and Prevention (Table 389-1).

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Table 389-1 Diagnostic Criteria for Chronic Fatigue Syndrome 
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Epidemiology

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CFS is seen worldwide, with adult prevalence rates varying between 0.2 and 0.4%. In the United States, the prevalence is higher in women, members of minority groups (African and Native Americans), and individuals with lower levels of education and occupational status. Approximately 75% of all CFS patients are women. The mean age of onset is between 29 and 35 years. It is probable that many patients go undiagnosed and/or do not seek help.

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Etiology

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There are numerous hypotheses about the etiology of CFS; there is no definitively indentified cause. Distinguishing between predisposing, precipitating, and perpetuating factors in CFS helps to provide a framework for understanding this complex condition (Table 389-2).

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Table 389-2 Predisposing, Precipitating, and Perpetuating Factors in Chronic Fatigue Syndrome 
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Predisposing Factors

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Physical inactivity and trauma in childhood tend to increase the risk of CFS in adults. Neuroendocrine ...

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