Post-infection syndrome Flashcards
Post-infection syndrome also known as chronic fatigue syndrome/ myalgic encephalomyelitis
What is definition?
It is a complex, chronic medical condition affecting multiple body systems.
Pathophysiology is unclear
Extreme fatigue that is worsened by physical or mental exertion. Also included myalgia, impaired memory, insomnia, impaired concentration
Experienced in aftermath of infection
can have significant impact on quality of life
symptoms can fluctuate
How do CFS/ME NICE 2020 guidelines relate to post-viral fatigue in COVID19?
Guidelines drafted in 2020 based on evidence reviewed before COVID19. So recommendations do not apply to those who have fatigue due to COVID19
What is general approach to delivering care when speaking to patient with CFS?
ackowledge their symptoms
take time to build a supportive, trusting, empathetic relationship
person-centred approach
involve family members/ carers
early diagnose can help patients get appropriate help for their symptoms
When to suspect CFS/ME?
How long should patient have had symptoms before diagnosis can be made?
Must have had symptoms for 3 months to diagnose.
If had symptoms for 6 weeks, we can suspect it.
debilitating fatigability that is not caused by excessive cognitive, physical, emotional or social exertion, and is not relieved by rest
post-exertional symptom exacerbation after activity, that is disproportionate to the activity, and has prolonged recovery time
unrefreshed sleep
constant flu-like symptoms
cognitive difficulties
as soon as provisional diagnosis is made, do not delay. Refer patient for symptom management
Need 3x clinic appointments before can confirm diagnosis
What are other rarer symptoms of CFS/ME?
severe constant pain
GI upset - nausea, constipation, bloating
double vision/ dizziness
postural orthostatic tachycardia syndrome POTS
sensitive to stimulus - light/ noise
What is involved in initial CFS/ ME assessment?
comprehensive clinical history
physical examination
psychological wellbeing - impact on daily life
investigations to exclude other diagnoses
You diagnose patient with CFS/ME.
They ask what the condition is, and how it may change over time.
How do you explain this?
Fluctuating medical condition which affects everyone differently
symptoms can change, and severity can change over days or weeks
often involves remission/ relapse
small proportion never fully recover
can have triggers e.g physical injury, stress
CFS/ME treatment is about supporting the patient.
How can this be achieved?
Reduce stress/ stimuli - e.g light/ noise/ pain
refer to social care
mobility aids
home adaptations
work adjustments under Equality Act 2010 - offer to liaise with employer
energy management - flexible tailored approach to activities - could include physiotherapy. Graduated exercise therapy is not a treatment
symptom management - e.g analgesia for headaches/ neuropathic pain
CFS/ME patients with severely reduced mobility are at risk of certain diseases. What are examples?
DVT
pressure ulcer
contractures
cardiovascular disease
osteoporosis
vitamin deficiencies - no evidence to support routine vitamin supplementation as does not help with symptoms
CBT is not a treatment for CFS/ME, but can help with symptoms.
How do you explain what CBT is to patient?
involves collaborating with a therapist, to understand the main difficulties a person faces
exploring their personal meaning of symptoms and illness, and how this might relate to how the manage their symptoms
developing a self management plan
What is a CFS/MS flare?
Sustained exacerbation of symptoms to a greater level than person’s normal symptoms
patient should reduce their activity levels, and identify possible triggers e.g acute illness
What is a CFS/MS relapse?
Sustained period of exacerbation, lasting longer than a flare.
patient should reduce their activity levels, and identify possible triggers e.g acute illness
re-assess patient holistically, and agree plan of management
What is difference between mild/ moderate/ severe CFS/ ME?
Mild - mobile, can perform light activities, usually still in work/ school. But limited in activity
Moderate - reduced mobility, restricted in all activities of daily living. Usually stopped school/ work. Need rest periods.
Severe - severely affected ADLs, need wheelchair, spend most time in bed, sensitive to light/ noise
