Researchers are beginning to clarify doubts about chronic fatigue syndrome (ME/CFS). Read the article by Dr. Drauzio.
In the 1980s, cases of patients complaining of disabling physical and mental fatigue were described. However, clinical and laboratory exams and images were within the normal range.
The tendency of doctors, faced with chronic fatigue without palpable justification, was to refer patients to psychiatric care. Discouraged by that person who was always exhausted, unwilling to perform even minimal tasks, family and friends had no doubt: “It must be psychological” was the phrase most often used by ignorant people to explain what they didn’t know.
See also: Chronic fatigue
In 2015, the Institute of Medicine published a report in which it stated: “The healthcare community generally doubts the existence and severity of this disease.”
In the United States, the Center for Diseases Control (CDC) gave the name chronic fatigue syndrome to the set of symptoms involved in this condition. In the United Kingdom and other countries, the term chosen was myalgic encephalomyelitis (we will use EM/SFC).
According to the CDC, this syndrome is characterized by:
1) Decreased ability to perform daily activities, for more than six months, accompanied by severe fatigue that does not improve with rest;
2) Exaggerated and debilitating response to physical and mental activities;
3) Non-refreshing or altered sleep.
To receive the diagnosis, there must also be impairment of memory and articulation of thought, as well as intolerance to maintaining an orthostatic position. Headache, muscle pain and shortness of breath may also be present.
The pandemic Covid-19 increased interest in the syndrome. In patients diagnosed with long covidaround 50% develop symptoms compatible with ME/CFS.
In a demonstration that it is better late than never, the National Institutes of Health (NIH) has finally sponsored a study to standardize diagnosis and study the pathophysiology of syndrome.
A multidisciplinary team of five specialists was recruited to evaluate a group of patients with clinical conditions compatible with chronic fatigue, established after infectious processes.
17 patients with a history and symptoms highly suggestive of ME/CFS were selected to undergo a battery of clinical, laboratory and imaging tests. When compared with a group of healthy people (control), the results revealed the following differences:
1) Differences in subpopulations of immunologically competent cells involved in the response to infectious agents;
2) Less diversity in the composition of the intestinal microbiome;
3) Lower concentrations of the neurotransmitter serotonin in the CSF, associated with worsening motor performance and cognitive symptoms;
4) Elevated heart rate at rest and drop in rate during outpatient activities;
5) In a test with maneuvers to press buttons, in order to receive financial reward, patients chose those that required less mental effort:
6) Reduced strength in the hands when testing a spring compression.
The authors attributed fatigue to the integrative dysfunction of brain areas that control the motor cortex, responsible for coordinating movements. Therefore, according to them, “psychiatric disorders are neither the main component nor responsible for the intensity of symptoms”.
Based on these findings, the researchers concluded that an infection would cause lasting changes in the immune system and intestinal microbiome, caused by the persistence of the infectious agent in the body.
As a consequence, the brain would be affected in a cascade of events that would lead to a decrease in the concentration of neurotransmitters in the CSF, capable of explaining the changes in heart rate and cardiopulmonary capacity.
ME/CFS can be a highly disabling illness. Close to 25% of patients have such impaired muscle strength that they become bedridden. Doctors, patients and their families must understand that this is a complex disease, with poorly understood pathophysiology, which requires treatment to alleviate symptoms.
In a disease that affects so many organs and systems, the approach must be multidisciplinary with neurologists, cardiologists, psychiatrists and pain specialists. Now, doctors with experience in long Covid are better prepared to monitor these patients.
