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How is chronic fatigue syndrome (or systemic exertion intolerance disease) diagnosed?

Chronic fatigue syndrome (CFS) or SEID is a diagnosis made by excluding many diseases that have chronic fatigue as a major or frequent symptom. Unfortunately, there are no physical signs or diagnostic tests that identify CFS. The diagnosis is made by fitting the two major criteria set out by a group of CFS research experts.

The first criteria states the patient must have severe chronic fatigue of six months or longer duration with other known medical conditions excluded by clinical diagnosis (a diagnosis by exclusion).

The second criteria requires the patients have four or more of the following symptoms that either occurred at the same time or after the severe chronic fatigue. The symptoms are substantial impairment in short-term memory or concentration; sore throat; tender lymph nodes; muscle pain; multi-joint pain without swelling or redness; headaches of a new type, pattern or severity; unrefreshing sleep; and post-exertion malaise lasting more than 24 hours.

Although there are no lab studies that identify CFS, lab studies do provide some supportive evidence for a diagnosis. Lab studies that confirm either the presence or absence of cause of other diseases help define the diagnosis of exclusion. Additionally, many patients with CFS have certain lab findings listed below:

  • Very low erythrocyte sedimentation rate (ESR)
  • Elevated immunoglobulins against Coxsackie B virus, HHV-6 (human herpes virus strain 6), and/or Chlamydia pneumoniae
  • Decreased number of natural killer cells
  • Normal CBC, liver function tests, and normal urinalysis

When taken as a group, these tests support a diagnosis of CFS but are not definitive; only the patients who meet the two established criteria for CFS are definitively diagnosed with CFS.

Below is the new proposed criteria for SEID; the new report used an older designation (ME/CFS) but the criteria are for SEID; this fact shows the medical terminology problems when new names of diseases are proposed.

Return to Chronic Fatigue Syndrome (CFS or SEID)

See what others are saying

Comment from: kingofpain, 45-54 Male (Patient) Published: December 30

I had been suffering a lot of sport like injuries for 3 years along with severe pain in many areas, joints and muscle groups. The recovery times from these injuries were increasing or the injuries would never heal. After reporting to my doctor about the exhaustion I was feeling from my job, he ordered lab work once a month for about a period of three months. Each lab work up showed elevated cytokine levels, chronic vitamin D and vitamin B deficiency. Along with a pressure point exam of my joints and muscles the doctor, a colonel in the regular army said, �I'm sorry, you have fibromyalgia, myalgic encephalomyelitis/chronic fatigue syndrome.� I had only a vague understanding of the term but I may as well have been diagnosed with HIV/AIDS, I would have received better treatment.

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Comment from: mel, 65-74 Female (Patient) Published: February 02

I was feeling tired a lot all last year after a virus. Never me! I had shortness of breath with any exertion. I was generally not able to really exercise because of the CFS (chronic fatigue syndrome). If I did I'd get sick with headache and IBS (irritable bowel syndrome) the next day, flu symptoms, and cold symptoms as well. Then I went on a cruise in October. I picked up a horrible flu after the sixth day. I was in bed for 10 days of the trip. I came home and went to bed but never really got over the flu. Any exercise rendered me out of breath with major headaches, IBS and congestion. After four and 1/2 months I am barely better. Blood tests say I am normal. I am not! I am desperate to find answers as I am 66 and had enough stress in my life. I thought that now I might live the rest of my life with some joy, riding my horse, walking. Even going to the store renders me sick the next day. I am beyond being frustrated. I am useless when I used to be an athlete, tennis and show jumping, etc. I think I may be dying sometimes. I need help.

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