Última revisão: 27 Jun 2021
Última atualização: 12 Jan 2021

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

  • fadiga incapacitante persistente
  • mal-estar/fadiga pós-esforço (PEM), exaustão por esforço
  • perda da memória de curto prazo e comprometimento de concentração
  • faringite
  • artralgia generalizada sem inflamação
  • cefaleia/enxaqueca com início após a fadiga
  • sono não revigorante
  • intolerância ortostática
  • dor difusa nos músculos, tendões, fáscias ou outro tipo de dor
  • linfonodos sensíveis à palpação

Outros fatores diagnósticos

  • idade de início (adolescência e dos 30 aos 50 anos)
  • sintomas tipo gripe (mal-estar, mialgia, sensação de febre)
  • tontura
  • ansiedade, transtorno afetivo, depressão atípica
  • sensações de temperatura alterada
  • disfunção cognitiva induzida por esforço (afetando a memória de trabalho, não persistente)
  • sensibilidade a substâncias irritantes
  • sensação febril

Fatores de risco

  • sexo feminino
  • Infecção por Epstein-Barr em adolescentes
  • história familiar positiva de SFC/EM
  • fatores genéticos
  • doenças infecciosas específicas em adultos
  • autoimunidade
  • microbioma intestinal
  • fatores psicológicos
  • transtorno depressivo maior
  • ascendência
  • hipermobilidade/frouxidão articular

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • Questionário de sintomas DePaul
  • hemograma completo com diferencial de leucócitos
  • velocidade de hemossedimentação
  • proteína C-reativa
  • perfil metabólico completo
  • hormônio estimulante da tireoide
  • fator antinuclear (FAN), fator reumatoide
  • exame de anticorpo anti-HIV (vírus da imunodeficiência humana)

Investigações a serem consideradas

  • teste da mesa inclinável com a cabeça para cima em caso de intolerância ortostática sintomática
  • ferritina sérica
  • HbA1c
  • exame toxicológico da urina
  • testes de anticorpos para sensibilidade ao glúten/doença celíaca

Novos exames

  • teste ergométrico de 2 dias

Algoritmo de tratamento

Colaboradores

Autores

James N. Baraniuk, MD
James N. Baraniuk

Professor

Division of Rheumatology, Immunology, and Allergy

Georgetown University

Washington

DC

Declarações

JNB declares that he has no competing interests.

Agradecimentos

Dr James N. Baraniuk would like to gratefully acknowledge Dr Craig N. Sawchuk and Dr Dedra Buchwald, previous contributors to this topic.

Declarações

CNS declares that he has no competing interests. DB is an author of a number of references cited in this topic. This topic was reviewed in 2018 by a patient with CFS/ME, and their feedback was considered as part of the topic update. The patient peer reviewer does not wish to be named.

Revisores

Alastair Santhouse, MA (Cantab), MB, B.Chir, FRCP, FRCPsych

Consultant Psychiatrist in Psychological Medicine

South London and Maudsley NHS Foundation Trust

Denmark Hill

London

UK

Declarações

AS declares that he was a guideline development group member for NICE CFS/ME 2007 guidelines CG53.

Ben Z. Katz, MD

Professor of Pediatrics

Division of Infectious Diseases

Northwestern University Feinberg School of Medicine

Attending Physician

Ann & Robert H. Lurie Children’s Hospital of Chicago

Chicago

IL

Declarações

BZK declares that he has no competing interests.

Indre Bileviciute-Ljungar, MD, PhD

Associated Professor in Rehabilitation Medicine

Department of Clinical Sciences

Danderyd University Hospital

Karolinska Institutet

Stockholm

Sweden

Declarações

IB-L declares that he has no competing interests.

Tarek Gaber, MB, BCh, MSc, FRCP

Consultant Physician in Rehabilitation Medicine

Wrightington, Wigan and Leigh NHS Trust

Leigh Infirmary

Leigh

UK

Declarações

TG declares that he has no competing interests.

Malcolm Hooper, PhD, B Pharm, MRIC, C Chem

ME patient advocate

Emeritus Professor of Medicinal Chemistry

University of Sunderland

Sunderland

UK

Declarações

MH has lectured on ME and made national and international presentations to groups concerned with ME in Denmark, Sweden, Australia, US, and UK. He has acted as a witness for the GMC (UK) and received payment for this (travel and subsistence). He has also received payment from a family he supported in legal proceedings relating to vaccine damage, after the case was settled in their favour. He is a founder member of the Academy Of Nutritional Medicine, which has a special interest in Lyme disease. Their guidelines mention ME/CFS several times. He has given their keynote address for 3 years. He is the author of the paper Hooper M. Myalgic encephalomyelitis: a review with emphasis on key findings in biomedical research. J Clin Pathol. 2007;60:466-71. He is a member of the trustees for the John Richardson Research Group and the ME research group. He is also a trustee of European Services for People with Autism (ESPA) and a member of ESPA-Research, which is developing techniques to help with this condition. All of this work is voluntary.

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