Thursday, April 11, 2013

原因不明の発熱、脱力感が続く 働き盛りに多発 慢性疲労症候群 Unexplained fever, followed by weakness, multiple symptoms in the prime of life: Chronic Fatigue Syndrome


原因不明の発熱、脱力感が続く 働き盛りに多発 慢性疲労症候群

2013年4月9日
 ある日突然、全身の倦怠(けんたい)感に襲われ、疲労や微熱が続く「慢性疲労症候群」(CFS)。働き盛りの二十代~四十代で発症する例が多いが、詳しい原因

は不明で根本的な治療法もない。症状はうつ病と似ていて診断は難しく、病気を知らなかったり、認めなかったりする医師もいて、精神科や内科をたらい回しになる患者もいる。 (細川暁子)

 東京都内の女性(40)の体に異変が起きたのは二〇〇九年三月。三九度の熱が出て、解熱剤を飲んだが一週間以上も微熱が続いた。頭がボーッとして会話の内容が理解できなかったり、少し動くだけで息切れしたりするように。全身の筋力が低下して、次第に鍋がつかめないほどになった。治療を受けたが、症状は軽減せず、半年後にCFSと診断された。
 女性はシングルマザーで、中学一年の長女(12)と小学五年の長男(10)がいる。一〇年八月からは休職中だが、現在も微熱や頭痛が続く。ほとんど寝たきりで、移動には電動車いす。子どもたちが食事作りなど身の回りの世話をしている。漢方薬を服用し、血液循環をよくするマッサージを受けると、少し楽になるという。「思うように動けず、子どもにつらい思いをさせている」
 「CFSの患者は働き盛りの二十代~四十代に多く、女性の割合が高い」とCFS治療の第一人者で、関西福祉科学大教授の倉恒弘彦さんは指摘する。患者は全国に三十万人以上と推測する。
 CFSは激しいだるさや脱力感、微熱が続き、筋肉や関節が痛むのが特徴だ。それが半年以上続き、日常生活に支障が生じていることなどが診断基準で、リンパ節の腫れを根拠にする医師もいる。だが一般的な検査では異常は見つからず、詐病を疑われる場合もある。女性も、症状が急激に悪化して近隣の診療所に駆け込んだ際に、CFSについて伝えると「(CFSとは)診断できない。処置できない」と言われたという。
 多くの患者は身体的な症状だけでなく、不眠や思考力、集中力の低下などの症状も訴える。東京・池袋の「池袋内科」の井上幹紀親(みきちか)さんは「うつ病との区別が難しく、病院を渡り歩く患者も多い」と話す。症状としては、内科と精神科にまたがっているため、双方の協力が重要という。
 発症のメカニズムは解明されていないが、患者の血液を調べると、何らかのウイルスが見つかるケースがあり、倉恒さんは免疫との関連性を指摘している。
 患者は血液中の活性酸素が通常より高いことが特徴で、活性酸素を減らす薬を出すこともある。ただし、現状では、それぞれの症状を軽減する対症療法しかない。通常の日常生活に戻れる患者もいるが、十年以上も症状が軽減せず、苦しむ人もいる。
 倉恒さんらが参加する厚生労働省の研究班では、自律神経のバランスを指先の脈拍で調べるなど、新たな診断基準づくりを進めている。倉恒さんは「疲れを感じたら休息し、それでも改善しなければ、まずは専門医に相談を」と話している。

◆福祉サービスの対象外

 CFSの患者には、重症になると寝たきりで、食事や外出に介助が必要な人もいる。だが、症状が一定せず、身体障害者手帳の取得は難しい。
 四月施行の障害者総合支援法で、障害者手帳を持っていない難病患者も家事介助や補助具支給など、福祉サービスを受けられるようになったが、CFSは対象外だ。
 東京都練馬区の関町内科クリニックの申偉秀(しんいす)さんは「病名の『疲労』という言葉は実態を正しく表していない。誤解を与え、社会保障を受けられない一因になっているのでは」と指摘する。
 英国やカナダの一部の医師たちは、重症患者は脳などに炎症があることから「筋痛性脳脊髄炎」への病名変更を提唱しているという。申さんも病名変更には賛同し、「重症者には、優先的に福祉サービスを受けられるようにしてほしい」と話す。


Unexplained fever, followed by weakness, multiple symptoms in the prime of life: Chronic Fatigue Syndrome

April 9, 2013

Suddenly one day, she was overcome by a sense of systemic malaise, fatigue followed by low-grade fever -- i.e. "chronic fatigue syndrome" (CFS). While there are many cases developing from one`s twenties to one`s forties, in the prime of life, the exact cause is unknown and there is no simple treatment. Diagnosis is difficult and the symptoms are similar to depression. There are also doctors who do not know or will not acknowledge the disease, and patients get passed around by general practitioners and psychiatrists. (Akiko Hosokawa)

Something happened inside the body of a woman (40) in Tokyo in March of 2009. She broke out in a fever of 39 degrees and hence took anti-fever medication, but a low-grade fever continued to last for more than a week. She fell into a brain fog and could not understand the content of conversations while the slightest of movements left her breathless. Gradually, general muscle strength became so weak, she was not even able to grasp the pots on the stove. She was treated, but there was no alleviation of symptoms, and she was diagnosed with CFS six months later.

She is a single mother, with a daughter (12) in junior high school and a son (10) in elementary school. Since August of 2010 she has been on leave from work but the low-grade fever and headache still continue. She is almost completely bedridden and gets around in an electric wheelchair. Her children prepare her meals and take care of her. She says she feels a little better when taking Chinese medicine and or when receiving a massage to increase blood circulation. "Since I am able to move around as I would like, I think I will be leaving my children with some bitter memories."

"Many CFS patients are in their twenties to forties with a good percentage of these being women," points out CFS leading authority Kansai University of Welfare Sciences Professor KURATSUNE Akihiko. He guesstimates there are over three hundred thousand patients in Japan.

CFS is distinguished by a sense of languor and weakness, followed by a low-grade fever, and muscle and joint pain.  While diagnostic criteria is based on such things as this continuing for more than six months and disrupting daily life, a number of doctors also base it on the patient having swollen lymph nodes. In some cases, when a general examination finds no abnormalities it is suspected the patient is feigning the illness. One women with a sudden worsening of symptoms ran to the local clinic and when she mentioned CFS she was told that "CFS can not be diagnosed or treated."

Many patients also complain of symptoms besides the physical symptoms, such as insomnia and a reduction in concentration and the ability to think. INOUE Michichika of the "Ikebukuro Clinic" in Ikebukuro, Tokyo states, "It is difficult to distinguish between depression, and often patients wander from hospital to hospital." Since the symptoms overlap between psychiatry and internal medicine, it is important to have the cooperation of both here.

While it is not clear what causes the onset of symptoms, when patients' blood is examined, there are cases where some sort of virus is found and KURATSUNE points out that there must be some connection with the immune system.


One distinguishing factor found in patients' blood is a higher than normal presence of reactive oxygen species and sometimes medicines are prescribed which lowers the amount of these.

However, at present, there are only specific treatments available to alleviate each symptom. And while some patients return to a normal everyday life, there are others who suffer for more than ten years without an alleviation of symptoms.


A  study group with the Ministry of Health, Labour and Welfare, in which KURATSUNE is participating, is making advances in diagnostic criteria like checking the pulse from the fingertip to determine autonomic system balance.  Kuratsune states "If you feel tired, take a rest, and if that does not help, then see a specialist."


◆ Outside the Scope of Welfare Services

Some CFS patients whose symptoms become severe end up bedridden and require assistance to eat and to go out. However, if their symptoms are not constant, then it is difficult for them to get disability benefits.


In the Comprehensive Welfare Act for Persons with Disabilities set to take effect in April, patients with intractable diseases who do not have a disability will also be able to receive welfare services such as aid payment and housework assistance. However, CFS is excluded.


Dr. SHIN Isu of the Sekimachi Medical Clinic in Nerima-ku, Tokyo, points out that "The word 'Fatigue' in the disease name does not reflect the actual conditions. It invites misunderstanding and this is one factor as to why these people cannot receive social security benefits."


It is said that some doctors in Canada and the United Kingdom advocate a name change to "Myalgic Encephalomyelitis" because there are such things as inflammation of the brain, etc. in critically ill patients. Dr. Shin also agrees with a name change. He states, "I would like for the critically ill to be able to receive welfare services on a priority basis."



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