CHAPTER 3 Immune System^161
viruses: Epstein-Barr, cytomegalovirus, coxsackievirus B, adenovirus type I, and
human herpes virus 6. In an unknown way, the viruses disturb the immune system
which is then unable to adequately fight off the virus.
PROGNOSIS
The prognosis varies as the disease waxes and wanes. Remissions and exacerba-
tions may be frequent. By adulthood, most of the population in the United States
will test positive for EB virus.
SIGNS AND SYMPTOMS
Persistent fatigue unrelieved by rest, impairment of memory and concentration,
myalgias, arthralgias, headache, change in sleep, malaise, depression, and labile
mood. Insomnia is a common occurrence.
INTERPRETING TEST RESULTS
Since CFS is a diagnosis of exclusion, testing is done to rule out other etiologies
for the symptoms. These may include CBC, metabolic panel, thyroid studies, HIV,
ESR, rheumatoid factor, Lyme, EBV, and CMV titers.
TREATMENT
Treatment is empirical and based on symptoms. Treating and eliminating other
diagnoses is imperative. Allowing for frequent rest periods, and adequate nutrition
are necessary. Pharmacological treatment may include NSAIDs and analgesics. As
there is a higher prevalence of past and present psychiatric diagnoses in patients
with CFS, an evaluation may be indicated. Psychotherapy may help. Physical ther-
apy is often indicated and routine exercising has been found to be helpful.
NURSING DIAGNOSES
- Activity intolerance
- Fatigue
- Chronic pain