Summary
Prolonged fatigue is a common complaint in the community and is usually transitory. If fatigue continues for more than six months, is disabling, and is accompanied by other constitutional and neuropsychiatric symptoms, then a diagnosis of chronic fatigue syndrome (CFS) should be considered.
CFS probably is an heterogeneous disease, maybe multifactorial, or it includes different pathologies which manifest with the same symptoms. In some cases, the mode of presentation of the illness implicate the exposure to chemical and/or food toxins as precipitating factors (e.g., ciguatera poisoning, Gulf War Syndrome, etc.). In other CFS cases, the etiology is still unknown: there are various hypotheses on pathogenetic events which, alone or in association with each other, may precipitate the illness. In fact, it is probable an involvement of multiple events in CFS onset where different precipitating factors can interact each other, even if not always all present in the single patient: latent and/or chronic viral infections, immunologic and neuroendocrine dysfunctions, psychological, environmental and mood factors.
In accordance to this theory, we consider various subgroups of CFS patients on the basis of the pathway and the mode of presentation of the disease. The Clinic of Infectious Diseases of “G. D'Annunzio” University of Chieti is one of the main National Reference Centers for the CFS Study in Italy. From January 1992 to January 1998, 238 patients came to our observation: 89 of them met CDC criteria for CFS (1994), 127 did not; the other 22 patients are still under evaluation. Our patients underwent physical examination (including tests for searching for the possible coexistence of a fibromyalgia syndrome), psychiatric interview with several neuropsychological tests, laboratory tests (including magnesium determination on serum), neuroendocrine evaluation (circadian rhythm of several hormones, buspirone challenge test), SPECT scans to evaluate cerebral perfusion, and other examinations where necessary in according to the symptomatology of each patient (e.g., orthopedic, ORL, EMG, muscle biopsy, etc.).
According to our preliminary results, we subdivided our patients in different subgroups and we studied them comparatively.
We report the more significant data collected from this evaluation that might lead to a better understanding of the syndrome and in particular of its pathways course, a knowledge that will help in choosing appropriate therapies for each subgroups.