HISTORY. Establish a history of the sudden onset of flulike symptoms accompanied by intense fatigue that does not resolve within 6 months. Determine if the patient has experienced any other symptoms of a neurological or psychological nature. Ask the patient if she or he has been exposed to a toxin or has recently experienced stress. Determine if the patient's occupation involves interaction with the public. It is important to remember that symptoms can vary widely with CFIDS.

PHYSICAL EXAMINATION. Assessment of the CFIDS patient may reveal flulike symptoms such as sore throat, low-grade fever, chills, muscular pain, and swollen, painful lymph nodes. Neurological assessment findings may include sensitivity to light, headache, inability to think clearly or concentrate, memory loss, sleep disorders, equilibrium problems, and depression.

PSYCHOSOCIAL. Patients with CFIDS are often depressed because of the stress of dealing with a chronic, debilitating illness that affects their total lifestyle. Anxiety and mood swings are common, and there are increased rates of divorce and suicide among these patients. Assess the effect of the disease on the patient's job and child-care responsibilities.

Diagnostic Highlights

There is no definitive method of diagnosing CFIDS. The Centers for Disease Control and Prevention (CDC) have set forth diagnostic criteria, however (Box 1).

The CDC recommends the following diagnostic tests: complete blood count, serum electrolytes, liver function tests, thyroid function tests, erythrocyte sedimentation rate, cortisol level, and antinuclear antibody test.

232 Chronic Fatigue Immune Dysfunction Syndrome

• BOX 1 CDC Criteria for CFIDS

CDC definition of CFIDS stipulates that a patient must fulfill two major criteria, eight symptoms, or six symptoms and two physical signs.

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