Chronic fatigue syndrome in the practice of a general practitioner: prevalence, diagnosis, and management of patients (literature review)

Background. In modern medicine, chronic fatigue syndrome is an urgent problem for internists. The high prevalence of chronic fatigue syndrome, which has a significant impact on public health, requires primary care professionals to have an in-depth understanding of the diagnosis and management of this condition. This literature review analyzes the prevalence, diagnostic criteria, and approaches to managing patients with chronic fatigue syndrome in the practice of a general practitioner in order to raise awareness and improve the quality of medical care.

Results. Chronic fatigue syndrome is defined as unexplained, prolonged fatigue lasting more than six months, which is not eliminated by rest and increases with physical or mental exertion. The prevalence of chronic fatigue syndrome varies in different regions of the world, reaching, according to some estimates, from 120 to 140 million cases. In North America, prevalence rates range from 0.2% to 0.7%, in Europe from 0.1% to 1%, and in Australia from 0.2% to 0.4%. Among patients seeking therapy, the prevalence of chronic fatigue syndrome ranges from 5% to 10%. Risk factors for developing chronic fatigue syndrome include being female, low income, and living outside major cities. Genetic studies have revealed a link between chronic fatigue syndrome and 14 different genes. Various factors such as toxins, chronic stress, viral or bacterial infections, as well as an imbalance of the intestinal microflora (dysbiosis) can act as triggers triggering the development of chronic fatigue syndrome. The diagnosis of chronic fatigue syndrome presents certain difficulties due to the lack of specific biomarkers. Various criteria are used to make a diagnosis, including the CDC/Fukuda criteria, the Canadian Consensus Criteria, and the IOM/NAM criteria. Comprehensive treatment of chronic fatigue syndrome includes normalization of the daily routine, physiotherapy, psychotherapy and pharmacotherapy (including vitamins, immunocorrectors and drugs aimed at improving mitochondrial metabolism). At the same time, an individual approach to each patient is important. The effectiveness of treatment can be high, but relapses of the disease are possible. Prompt detection of chronic fatigue syndrome and provision of qualified, personalized management of patients suffering from this condition is a crucial factor in ensuring a significant improvement in overall well-being, increased physical and psycho-emotional activity, as well as restoration of full-fledged social and professional adaptation, which together contributes to a significant improvement in the quality of life of these people.

1. Vorobyeva O. V. Chronic fatigue syndrome (from symptom to diagnosis). Trudny patsient. 2020; 8 (10): 16-21. (In Russ.) DOI: 10.17116/jnevro2021121402113.

2. Pigarov E. A., et al. Chronic fatigue syndrome: modern ideas about etiology. Ozhireniye i metabolism. 2020; 3: 8-13. (In Russ.) DOI: https://doi.org/10.14341/2071-8713-4977.

3. Board on the Health of Select Populations, Committee on the Diagnostic Criteria for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. Beyond myalgic encephalomyelitis/chronic fatigue syndrome: redefining an illness. – National Academies Press, 2021. PMID: 25695122.

4. Jason L. A., et al. A community-based study of chronic fatigue syndrome. Archives of internal medicine. 2022; 159 (18); 2129-2137. DOI: 10.1001/archinte.159.18.2129.

5. Orji N., et al. Prevalence of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) in Australian primary care patients: only part of the story? BMC public health. 2022; 22 (1); 1516. DOI: 10.1186/s12889-022-13929-9.

6. Pizova N. V. Chronic fatigue syndrome. Farmateka. 2023; 7: 22-26. (In Russ.)

7. Centers for Disease Control and Prevention prevalence of ME/CFS [сайт]. Centers for Disease Control and Prevention; [процитировано 23 марта 2025]. Доступно: https://www.cdc.gov/me-cfs/about/prevalence/index.html.

8. Das S.,et al. Genetic risk factors for ME/CFS identified using combinatorial analysis. Journal of translational medicine. 2022; 20 (1); 598. DOI: 10.1186/s12967-022-03815-8.

9. Heim C., et al. Childhood trauma and risk for chronic fatigue syndrome: association with neuroendocrine dysfunction. Archives of general psychiatry. 2021; 66 (1); 72-80. DOI: 10.1001/archgenpsychiatry.2008.508.

10. Wessely S. The neuropsychiatry of chronic fatigue syndrome. Ciba Foundation Symposium 173-Chronic Fatigue Syndrome: Chronic Fatigue Syndrome: Ciba Foundation Symposium 173. – Chichester, UK: John Wiley & Sons, Ltd., 2021; 212-237. DOI: 10.1002/9780470514382.ch13.

11. Hickie I., et al. Post-infective and chronic fatigue syndromes precipitated by viral and non-viral pathogens: prospective cohort study. Bmj. 2006; 333 (7568); 575. DOI: 10.1136/bmj.38933.585764.

12. Blagodurov A. S., Safaralieva S. A. Modern etiological hypotheses of chronic fatigue syndrome. BBK 28.0 S37. 2023; 218. (In Russ.)

13. Komarov S. G. Diagnosis of chronic fatigue syndrome and algorithm for organizing medical care for patients with this pathology. Vestnik Ivanovskoi meditsinskoi akademii. 2022; 12 (3-4): 37-38. (In Russ.) DOI: https://dx.doi.org/10.18565/therapy.2020.1.129-135.

14. Prikhoda I. V. Chronic fatigue syndrome: questions of diagnosis and treatment. Pedagogics, psychology, medical-biological problems of physical training and sports. 2021; 1: 120-122. (In Russ.)

15. Sapfirova V. A., Guseva E. V., Zus'man A. A. Chronic fatigue syndrome. Almanakh klinicheskoi meditsiny. 2022; 8-3: 202-204. (In Russ.)

16. Ryabkova V. A.., et al. Modern concepts of chronic fatigue syndrome: diagnosis and differential diagnosis with other variants of asthenic syndrome. Novye Sankt-Peterburgskie vrachebnye vedomosti. 2024; 2: 42-50. (In Russ.) https://doi.org/10.24884/1609-2201-2024-103-2-42-50.

17. Stryuk R. I., Berns S. A., Yun V. L. Chronic fatigue syndrome: aspects of diagnosis and treatment from modern positions. Terapiya. 2023; 6 (1): 129. (In Russ.) DOI: https://dx.doi.org/10.18565/therapy.2020.1.129-135.

18. Moroz I. N., Podkolzin A. A. New in the diagnosis and treatment of chronic fatigue syndrome. Profilaktika stareniya. 2022; 1: 45-47. (In Russ.) DOI: https://doi.org/10.14341/2071-8713-4977.