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By C A Bartzokas; G W Smith

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Med. 45: 158–163. G. (1997) What is ME/CFS? South Essex Health Trust, Brentwood. , Deale, A. and Wessely, S. (1996) A comparison of the characteristics of chronic fatigue syndrome in primary and tertiary care. Br. J. Psychiat. 168: 121–126. , Hickie, I. et al. (1994) The chronic fatigue syndrome: a comprehensive approach to its definition and study. Ann. Int. Med. 121: 953–959. Goldberg, D. and Williams, P. (1988) A User’s Guide to the General Health Questionnaire. NFER-Nelson, Windsor. , Gantz, N.

35. Further reading Franklin, A. (1995) Children with ME. Guidelines for School Doctors and General Practitioners. E. Association, Stanford le Hope. C. Swift The upper respiratory tract is constantly exposed to potential airborne pathogens, which include bacteria, viruses and fungi. However, infection is prevented in most instances by the natural defence provided by the nasal mucosa, saliva and the commensal population of resident bacterial flora. Infection will ensue however if the natural defence is breached or impaired and if the bacterial inoculum is large or virulent.

A diagnosis of CFS also requires at least four of the eight concurrent associated symptoms suggested by Fukuda et al. (1994), listed in Figure 1. In the UK, the Oxford criteria have been used extensively. Like the CDC criteria, they are intended for use as a research tool and are not currently recommended for clinical use. The Oxford criteria are as follows: (i) fatigue as the principle symptom; (ii) definite onset, not life long; (iii) substantial physical and mental functional impairment; (iv) a history of at least 6 months of fatigue, which has been present for over 50% of the time; (v) may be associated with myalgia, mood and sleep problems.

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