special subjects
Chronic Fatigue Syndrome
Symptoms and Signs of Chronic Fatigue Syndrome
Before onset of CFS, most patients are highly functioning and successful. Onset is usually abrupt, often following a psychologically or medically stressful event. Many patients report an initial viral-like illness with swollen lymph nodes, extreme fatigue, fever, and upper respiratory symptoms. The initial syndrome resolves but seems to trigger protracted severe fatigue, which interferes with daily activities and typically worsens with exertion but is alleviated poorly or not at all by rest. Patients often also have disturbances of sleep and cognition, such as memory problems, "foggy thinking," hypersomnolence, and a feeling of having had unrefreshing sleep. Generalized pain is also a common complaint. The physical examination is normal, with no objective signs of muscle weakness, arthritis, neuropathy, or organomegaly. However, some patients have low-grade fever, nonexudative pharyngitis, and/or palpable or tender (but not enlarged) lymph nodes. Because patients typically appear healthy, friends, family, and even health care professionals sometimes express skepticism about their condition, which can worsen the frustration and/or depression patients often feel about their poorly understood disorder. 