CDC Holmes Criteria for CFS (1988)


Holmes GP, Kaplan JE, Gantz NM, Komaroff AL, Schonberger LB, Straus SE, Jones JF, Dubois RE, Cunningham-Rundles C, Pahwa S, et al. Chronic fatigue syndrome: a working case definition. Ann Intern Med. 1988 Mar;108(3):387-9. PMID: 2829679


Read the Working Case Definition


Major Criterion:

Must have new onset of persistent or relapsing, debilitating fatigue or easy fatigability in a person who has no previous history of similar symptoms, that does not resolve with bedrest, and that is severe enough to reduce or impair average daily activity below 50% of the patient’s premorbid activity level for a period of at least 6 months.


Exclusionary Criterion:

Other clinical conditions that may produce similar symptoms must be excluded by thorough evaluation. (Excluded conditions mentioned are malignancy; autoimmune disease; localized infection such as occult abscess; bacterial disease such as endocarditis, Lyme disease, or tuberculosis; fungal disease such as histoplasmosis, blastomycosis, or coccidioidomycosis; parasitic disease such as toxoplasmosis, amebiasis, giardiasis, or helminthic infestation; disease related to  HIV infection; chronic psychiatric disease such as endogenous depression, hysterical personality disorder, anxiety neurosis, or schizophrenia; chronic use of major tranquilizers, lithium, or antidepressive medications; chronic inflammatory disease such as sarcoidosis, Wegener granulomatosis, or chronic hepatitis; neuromuscular disease such as multiple sclerosis or myasthenia gravis; endocrine disease such as hypothyroidism, Addison disease, Cushing syndrome, or diabetes mellitus; alcohol or drug dependency or abuse; side effects of a chronic medication or other toxic agent such as a chemical solvent, pesticide, or heavy metal; or other known or defined chronic pulmonary, cardiac, gastrointestinal, hepatic, renal, or hematologic disease.)


Minor Criterion:

For a diagnosis of CFS, the patient must fulfill 8 or more of the following criteria (including 6 or more of criteria 1-11).

1. Mild fever (oral temperature between 37.5° C and 38.6° C) or chills.

2. Sore throat.

3. Painful lymph nodes in the anterior or posterior cervical or axillary distribution.

4. Unexplained generalized muscle weakness.

5. Muscle discomfort or myalgia.

6. Prolonged (24 hours or greater) generalized fatigue after levels of exercise that would have been easily tolerated in the patient’s premorbid state.

7. Generalized headaches (of a type, severity or pattern that is different than the patient may have had in the premorbid state).

8. Migratory arthralgia without joint swelling or redness.

9. Neuropsychologic complaints (one or more of the following: photophobia, transient visual scotomata, forgetfulness, excessive irritability, confusion, difficulty thinking, inability to concentrate, depression)

10. Sleep disturbance (hypersomnia or insomnia)

11. Description of the main symptom complex as initially developing over a few hours to a few days

12. Low-grade fever (37.8 to 38.8 degrees C), documented by a physician on at least two occasions, at least one month apart

13. Nonexudative pharyngitis, documented by a physician on at least two occasions, at least one month apart

14. Palpable or tender anterior or posterior cervical or axillary lymph nodes, documented by a physician on at least two occasions, at least one month apart


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