Comorbidities treated in primary care in children with chronic fatigue syndrome / myalgic encephalomyelitis: A nationwide registry linkage study from Norway

Abstract

BackgroundChronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is a complex condition. Causal factors are not established, although underlying psychological or immunological susceptibility has been proposed. We studied primary care diagnoses for children with CFS/ME, with children with another hospital diagnosis (type 1 diabetes mellitus [T1DM]) and the general child population as comparison groups.MethodsAll Norwegian children born 1992–2012 constituted the study sample. Children with CFS/ME (n = 1670) or T1DM (n = 4937) were identified in the Norwegian Patient Register (NPR) (2008-2014). Children without either diagnosis constituted the general child population comparison group (n = 1337508). We obtained information on primary care diagnoses from the Norwegian Directorate of Health. For each primary care diagnosis, the proportion and 99 % confidence interval (CI) within the three groups was calculated, adjusted for sex and age by direct standardization.ResultsChildren with CFS/ME were more often registered with a primary care diagnosis of weakness/general tiredness (89.9 % [99 % CI 88.0 to 91.8 %]) than children in either comparison group (T1DM: 14.5 % [99 % CI: 13.1 to 16.0 %], general child population: 11.1 % [99 % CI: 11.0 to 11.2 %]). Also, depressive disorder and anxiety disorder were more common in the CFS/ME group, as were migraine, muscle pain, and infections. In the 2 year period prior to the diagnoses, infectious mononucleosis was registered for 11.1 % (99 % CI 9.1 to 13.1 %) of children with CFS/ME and for 0.5 % (99 % CI (0.2 to 0.8 %) of children with T1DM. Of children with CFS/ME, 74.6 % (1292/1670) were registered with a prior primary care diagnosis of weakness / general tiredness. The time span from the first primary care diagnosis of weakness / general tiredness to the specialist health care diagnosis of CFS/ME was 1 year or longer for 47.8 %.ConclusionsThis large nationwide registry linkage study confirms that the clinical picture in CFS/ME is complex. Children with CFS/ME were frequently diagnosed with infections, supporting the hypothesis that infections may be involved in the causal pathway. The long time span often observed from the first diagnosis of weakness / general tiredness to the diagnosis of CFS/ME might indicate that the treatment of these patients is sometimes not optimal.

A Literature Review of GP Knowledge and Understanding of ME/CFS: A Report from the Socioeconomic Working Group of the European Network on ME/CFS (EUROMENE)

“…Other quantitative studies identified included two database studies [ 27 , 28 ] a review of medical records [ 29 ], and an evaluation of a training programme [ 30 ].…”

Antibodies to Human Herpesviruses in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Patients

“…An aberrant serological pattern of reactivity with individual EBV antigens has been found in some (11–21), but not in other (22–24) investigations. Besides EBV (9, 25) other herpesviruses that have been tentatively implicated in the pathogenesis, based on serology or nucleic acid detection, are human herpesvirus 6 [HHV-6A (26, 27), varicella-zoster virus (VZV) (28), cytomegalovirus (CMV), see e.g., (29), and HHV-7] (26). Although a direct causative effect of a herpesvirus may be unlikely (29), one or several of them may be involved in combinatorial pathogenic effects.…”

Psychological and demographic factors associated with fatigue and social adjustment in young people with severe chronic fatigue syndrome/myalgic encephalomyelitis: a preliminary mixed-methods study

“…Knight et al (2013) found that 51% of children and adolescents attending a specialist service reported having a comorbid disorder. Moreover, in a registry-linkage study of children and adolescents within the general population in Norway, Bakken et al (2016) found that a group with CFS were more likely to report a comorbid diagnosis than a group with type 1 diabetes, and a group from the general population. Comorbidities included anxiety, depression, diabetes, asthma and migraine.…”