Evaluation of chronic fatigue should exclude diseases associated with fatigue. The time of onset of symptoms and the nature of the fatigue should be determined. Chronic fatigue syndrome is characterized by fatigue that is typically present throughout the day (even upon awakening), worsens with exercise, and is not improved with rest.
Fever, chills, night sweats, weight loss or anorexia may be seen in chronic fatigue syndrome; however, infectious disease or malignancy should also be considered. Confusion and cognitive difficulties are reported by nearly all chronic fatigue syndrome patients.
Headaches, myalgias, arthralgias, and painful adenopathy are common complaints in chronic fatigue syndrome, although the presence of arthritis may also suggest connective tissue diseases. Anhedonia is suggestive of depression.
Recent travel, insect bites, tick exposure, skin rashes, and use of prescription and over-the-counter drugs should be sought.
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