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Case Definition.
The following is the case definition for Chronic Fatigue Syndrome as it was published in The Annals of Internal Medicine in December 1994.
Fatigue:
Patients must have otherwise unexplained, relapsing fatigue that is new (not life-long; not the result of ongoing exertion; not relieved by rest; and that results in substantial decreases in levels of occupational, social, educational, or personal activities.
Symptoms:
The patient must have four or more of the following eight symptoms. Symptoms must persist for six months and the patient must not have predated fatigue.
1. Self-reported impairment of memory or concentration that affects occupational, social, educational, or personal activities.
2. Sore throat.
3. Tender cervical (neck area) or axillary (underarm area) nodes.
4. Myalgias.(muscle pain)
5. Arthralgias (pain along the nerve of the joint). No redness or swelling.
6. Headache of a new tpye.
7. Unrefreshing sleep.
8. Post-exertional malaise, lasting at least 24 hours.
Clinical and Laboratory Evaluation:
1. Thorough medical history.
2. Mental status examination. Evidence of psychiatric or neurologic disorders requires consultation.
3. Thorough physical examination
4. Tests to rule out other illnesses. Tests should include the following;
...Complete blood count (CBC).
...Erythrocyte blood count.
...Chemistry panel.
...Urinalysis.
...Thyroid stimulating hormone.
...Further testing may be suggested on an individual basis; for example, an MRI to rule out MS.
Examples of conditions that can explain fatigue that may rule out the diagnosis of Chronic Fatigue Syndrome:
1. A medical condition, such as untrested hypothyroidism, sleep apnea, narcolepsy, or the effects of some medications.
2. Previously diagnosed and unresolved medical conditions such as malignancy or chronic hepatitis.
3. Major psychiatric disorders, past or present, including major depressive disorder, bipolar disease, schizophrenia, anorexia nervosa, or bulimia.
4. Substance abuse within two years before the onset of fatigue or at any time after the onset.
5. Severe obesity.
Conditions that re permitted in the case definition, yet do not explain fatigue:
1. Conditions that laboratory tests can't confirm such as Fibromyalgia, anxiety disorders, non-psychotic depression, or multiple chemical sensitivities.
2. Medical condition that might cause fatigue but have been treated adequately; examples might be, hypothyroidism with normal thyroid levels.
3. Lyme disease or Syphillis treated before the onset of CFS.
4. Any isolated or unexplained physical finding or laboratory test.
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