From the Guidelines
The diagnostic approach for Myalgic Encephalomyelitis (ME)/Chronic Fatigue Syndrome (CFS) involves identifying a substantial reduction or impairment in the ability to engage in pre-illness levels of occupational, educational, social, or personal activities for at least 6 months, accompanied by profound fatigue that is not alleviated by rest, along with postexertional malaise, unrefreshing sleep, and cognitive impairment or orthostatic intolerance 1.
Key Diagnostic Criteria
- Substantial reduction or impairment in activity levels for at least 6 months
- Profound fatigue that is not alleviated by rest
- Postexertional malaise
- Unrefreshing sleep
- Cognitive impairment or orthostatic intolerance
Important Considerations
- ME/CFS is a multisystem neuroimmune illness with onset often following a viral or bacterial infection
- Biomedical findings in ME/CFS include diminished natural killer cell function, T cell exhaustion, mitochondrial dysfunction, and vascular and endothelial abnormalities
- Clinicians should be aware of the similarity between ME/CFS and long COVID, and consider using specific validated tools when conducting mental health testing to avoid misdiagnosis of mental health disorders 1
Diagnostic Challenges
- ME/CFS can be misdiagnosed as a mental health disorder, highlighting the need for careful evaluation and consideration of biomedical findings
- Clinicians should be familiar with validated tools for diagnosing ME/CFS and dysautonomia to ensure accurate diagnosis and treatment.
From the Research
Diagnostic Approach for Myalgic Encephalomyelitis (ME)/Chronic Fatigue Syndrome (CFS)
The diagnostic approach for ME/CFS involves a clinical evaluation based on the patient's symptoms and medical history, as there is no single diagnostic test for the condition 2, 3, 4. The diagnosis is typically made by excluding other potential medical conditions that may be causing the patient's symptoms.
Key Symptoms and Diagnostic Criteria
The key symptoms of ME/CFS include:
- Pathological fatigue and malaise that is worse after exertion
- Cognitive dysfunction
- Immune dysfunction
- Unrefreshing sleep
- Pain
- Autonomic dysfunction
- Neuroendocrine and immune symptoms 2, 3 The diagnostic criteria for ME/CFS have been established by various organizations, including the Institute of Medicine (IOM) and the Canadian Consensus Criteria 2, 4.
Diagnostic Process
The diagnostic process for ME/CFS typically involves:
- A thorough medical history and physical examination to rule out other potential medical conditions
- Laboratory tests to exclude other conditions that may be causing the patient's symptoms
- A clinical evaluation to assess the patient's symptoms and determine if they meet the diagnostic criteria for ME/CFS 3, 4 It is essential to note that the diagnosis of ME/CFS is often delayed or missed, and patients may experience significant distress and frustration as a result 2, 5.
Biomarkers and Research
Research is ongoing to identify potential biomarkers for ME/CFS, but currently, there is no single biomarker that can diagnose the condition 6. The use of lymphocytes as a model to investigate ME/CFS pathology has shown promise, and immune dysfunction has been identified as a key component of the condition 6.
Clinical Guidance and Recommendations
Clinical guidance and recommendations for the diagnosis and management of ME/CFS have been established by various organizations, including the US Centers for Disease Control and Prevention and the Mayo Clinic 5. These recommendations emphasize the importance of a patient-centered approach to care and the need for clinicians to be aware of the latest scientific research and clinical guidelines for ME/CFS.