An examination of the working case definition of Chronic Fatigue Syndrome (CFS)
January 10, 1996
PURPOSE: Chronic fatigue syndrome (CFS) currently is defined
by a working case definition developed under the leadership of
the United States Centers for Disease Control and Prevention
(CDC) based on a consensus among experienced clinicians. We
analyzed the experience from one large center to examine the
adequacy of the case definition.
PATIENTS AND METHODS:
Predefined clinical and laboratory data were collected
prospectively from 369 patients with debilitating fatigue, of
whom 281 (76%) met the major criteria of the original CDC case
definition for CFS: (1) fatigue of at least 6 months'
duration, seriously interfering with the patient's life; and
(2) without evidence of various organic or psychiatric
illnesses that can produce chronic fatigue. The same clinical
data were obtained from 311 healthy control subjects and two
comparison groups with diseases that can present in a similar
fashion; relapsing-remitting multiple sclerosis (n = 25) and
major depression (n = 19).
RESULTS: All of the minor criteria
symptoms from the original CDC case definition distinguished
patients with debilitating chronic fatigue from healthy
control subjects, and many distinguished the patients with
chronic fatigue from the comparison groups with multiple
sclerosis and depression: myalgias, postexertional malaise,
headaches, and a group of infectious-type symptoms (ie,
chronic fever and chills, sore throat, swollen glands in the
neck or underarm areas). In addition, two other symptoms not
currently part of the case definition discriminated the
chronic fatigue patients from the control/comparison groups:
anorexia and nausea. Physical examination criteria only
infrequently contributed to the diagnosis. Patients meeting
the CDC major criteria for CFS also met the minor criteria in
91% of cases.
CONCLUSION: Patients meeting the major criteria
of the current CDC working case definition of CFS reported
symptoms that were clearly distinguishable from the experience
of healthy control subjects and from disease comparison groups
with multiple sclerosis and depression. Eliminating three
symptoms (ie, muscle weakness, arthralgias, and sleep
disturbance) and adding two others (ie, anorexia and nausea)
would appear to strengthen the CDC case definition of CFS.
MCM: Evaluates 281 Pts meeting original CDC *major* criteria
for CFS-- they are termed "chronic fatigue" patients and were
evaluated to see to what extent they met the minor criteria.
All of the minor criteria were found much more commonly in CF
compared to NL pts.
The following symptoms significantly differentiated the CF pts
vs muliple sclerosis MS and major depression MD: myalgias (89%
vs 68% vs 68%), postexertional malaise (79% vs 52% vs 19%),
headache (59 vs 28 vs 22), and infectious-type symptoms:
fever/chills (43 vs 4 vs 10), sore throat (64 vs 8 vs 11),
swollen neck glands (60 8 11) or swollen arm glands (32 8 0).
MD pts had similar incidence of difficulty concentrating (83
52 79) or thinking (31 48 68), photophobia (58 68 42),
irritability (70 44 74), and sleep disturbances (98 72 95).
Early morning awakening (19 24 58) appeared characteristic of
The definition could be strengthened by eliminating muscle
weakness (68% in CF vs 71% in MS and 28% in MD), arthralgia
(73% CF vs 68% MS vs 50% MD), and sleep disturbance (98% vs
72% in MS and 95% in MD) and by adding anorexia (35 4 5) and
nausea (58 8 16).
Komaroff AL, Fagioli LR, Geiger AM, Doolittle TH, Lee J, Kornish RJ,
Gleit MA, Guerriero RT
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