Epidemiologic advances in Chronic Fatigue Syndrome (CFS)

Epidemiologic studies of chronic fatigue syndrome (CFS) have been
hampered by the absence of a specific diagnostic test, but
with increasing interest in this disorder there has been a
greater understanding of the risk factors, illness patterns,
and other aspects of this multisystem disorder. Working case
definitions have been developed for research purposes but they
have continued to change over time and have not always been
utilized precisely by various investigators. This has been a
major factor in the widely varying estimates of prevalence
rates, but two different studies using the same working
definition and including a medical work-up have estimated the
prevalence to be approximately 200/100,000.

Clusters of CFS cases, which appear to be related to earlier reports
of "epidemic neuromyasthenia", have attracted considerable
attention and appear to be well documented, although
investigated with varying methodology and often with
dissimilar case definitions. Risk factors for cases occurring
in clusters and sporadically appear to be similar, the most
consistent ones being female gender and the co-existence of
some form of stress, either physical or psychological.

The prognosis of CFS is difficult to predict, although cases
occurring as part of clusters appear to have a better
prognosis as a group than sporadic cases, and those with an
acute onset have a better prognosis than those with gradual
onset. It is highly unlikely that there is a single agent,
infectious or noninfectious, that is responsible for more than
a small proportion of CFS cases and, at the present time, the
risk factors for developing CFS appear to lie more prominently
in the host rather than the environment.

MCM: From 1994 AACFS meeting in Ft. Lauderdale

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