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Tiredness/Fatigue:Persistent or recurrent debilitating fatigue that is not…
Tiredness/Fatigue:Persistent or recurrent debilitating fatigue that is not lifelong, or the result of ongoing exertion, or alleviated by rest, or explained by other conditions, and that results in a substantial reduction in activity
Causes
Physiological causes include pregnancy, breastfeeding, inadequate rest or sleep, and excessive exercise
Physical causes include anaemia, diabetes mellitus, glandular fever, or malignancy
Non specific
Psychological or psychosocial causes include depression, anxiety, loss, and stress
Risk Factors
low educational attainment
associated chronic condition
Higher BMI
associated psychosocial condition or comorbidity.
Women, Lower socioeconomic status, low physical activity, low self related health
Complications
Loss of employment
Increased risk of depression and anxiety
Negative impact on work, family life, social relationships, and quality of life
Excess mortality rate
Management
information and support
Manage stress/anxiety/depression
underlying causes addressed
Life style advice-sleep hygiene, healthy diet, exercise, relaxation exercises
Red Flags
Muscle or joint pain may suggest inflammatory joint disease or connective tissue disease
Localizing or focal neurological signs may suggest a neurodegenerative condition
Fever, night sweats, or lymphadenopathy
History of travel, insect or tick bites, and skin rash may suggest tropical infections or Lyme disease
unintentional weight loss
Investigations
Under 40yr old rule out glandular fever-monospot test
HIV test
Vitamin D levels
Hepatitis serology
Over 60 years- bone profile and myeloma screen
Chest X-ray and sputum for TB
3 months or longer Urine for protein & blood-renal tract infection, inflammation or tumours
creatine kinase- if muscle tenderness/weakness- rule our neuromuscular cause
Rule out Lyme disease, toxoplasmosis, Epstein-Barr virus, and cytomegalovirus,
Pathophysiology CFS
Typically accompanied by multiple other symptoms suggesting a combination of inflammatory, immune, viral, and endocrine dysfunction
Diagnosis
Hx- meaning of tiredness/fatigue. Onset, duration, severity of symptoms and identifiable causes (Sudden, gradual, persistent) Affect on life, sleep pattern.
Exclude sleep apnoea, depression, anxiety, CO poisoning. Chronic conditions e.g heart failure, kidney disease, respiratory disease
Medication- OTC, herbal remedies including sedatives/hypnotics, antidepressants, muscle relaxants, opioids, antihypertensives, and antihistamines.
symptoms of post-exertional fatigue or malaise, cognitive difficulties or memory problems, sleep disturbance, and chronic pain that may suggest a diagnosis of chronic fatigue syndrome (CFS) - IBS, fibromyalgia, migraine
Examination
Investigations- FBC, ESR or CRP, LFTs, U&Es, TFTs, HbA1c, IgA -to assess for infection, inflammation, thyroid disease, kidney and liver disease, diabetes, coeliac disease
All symptoms present- Persistent (for 4 months or longer) or recurrent, New or had a specific onset (that is, not lifelong), Unexplained by other conditions (including severe obesity with a body mass index [BMI] greater than 40 kg/m2, although this does not rule out CFS), Has resulted in a substantial reduction in activity level, Characterized by post-exertional malaise and/or fatigue (typically delayed, for example by at least 24 hours, with slow recovery over several days).
One or more- Difficulty with sleeping, Muscle or joint pain that is multisite and without evidence of inflammation, Headaches, Painful lymph nodes without pathological enlargement, Sore throat, Cognitive dysfunction, Worsening symptoms on physical or mental exertion, General malaise or flu-like symptoms, Dizziness and/or nausea, Palpitations in the absence of identified cardiac pathology.
Reconsider CFS no symptoms present
Post-exertional fatigue or malaise
Cognitive difficulties.
Sleep disturbance.
Chronic pain.
Referral
Specialist CFS- CBT, immediate if symptoms severe, 3-4 months if moderate, 6 months if symptoms are mild
Secondary care specialist- underlying cause, second opinion, doubt in diagnosis