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Malaise

Definition

Malaise is a indefinite feeling of debility, lack of health, physical discomfort or uneasiness, usually accompanied by lack of energy that is often indicative of or accompanying the onset of a physical or mental illness.

What is going on in the body?

Malaise is often the first sign of an infection or other disease. Many people can "feel" an infection or disease starting because they develop the feeling of malaise. The causes of malaise can range from working out or studying too hard to cancer.

Risks

What are the causes and risks of the condition?

Almost any sudden illness and many chronic illnesses can cause malaise.
The more common causes include:
  • stress
  • sleep disorders or lack of sleep
  • infections, such as acute bronchitis, a common cold, the flu, or infectious mononucleosis
  • a low blood count, called anemia
  • hormone imbalances, such as a low thyroid hormone level, called hypothyroidism, or a low adrenal hormone level, called hypoadrenalism.
  • depression or other psychological disorders
  • autoimmune disorders, which are conditions in which a person's immune system attacks his or her own body for no apparent reason. Examples of autoimmune diseases include systemic lupus erythematosus and rheumatoid arthritis.
  • toxin or chemical exposure, such as carbon monoxide or lead poisoning
  • allergies
  • medications, such as antihistamines, cancer chemotherapy, or certain medications used to treat depression and high blood pressure. Examples include atenolol, paroxetine, and diphenhydramine.
  • systemic disorders, such as heart, liver, lung, or kidney disorders
  • uncontrolled diabetes
  • tumors or cancer, such as lung cancer or a blood cancer called leukemia
  • salt imbalances, such as a low sodium level or a high potassium level
  • chronic fatigue syndrome and fibromyalgia, two poorly understood conditions with no known cause. These conditions commonly cause malaise and make people feel weak and tired.
  • a wide variety of mental disorders
Other causes of malaise are also possible. Sometimes, the cause cannot be identified even after a thorough history and physical examination.

Prevention

What can be done to prevent the condition?

Prevention is related to the cause. Avoiding stress and overexertion, getting enough sleep, avoiding unnecessary medications or other substances, and eating a healthy diet can prevent some cases of malaise. Taking medications as prescribed can prevent some cases due to diabetes and allergies.

Diagnosed

How is the condition diagnosed?

The role of the healthcare professional is to help the person think through the possible causes and pinpoint the reason(s) for the malaise. In some cases, the cause may be strongly suspected after a complete history and physical exam on the initial visit.
In other cases, further tests must be done. This often involves blood tests, such as a complete blood count (CBC), which can help detect anemia or an infection. Blood hormone levels, such as thyroid function tests, can help diagnose hormone imbalances. Blood salt (electrolyte) levels can also be measured. A blood glucose test can help detect diabetes.
Other tests may be advised based on the suspected condition. For instance, a chest x-ray may be done if lung or heart disease is thought to be the cause. An x-ray test called a chest CT scan may be used if lung cancer is suspected.
Sometimes the entire workup is unrevealing, and the cause comes to light only as the professional observes and interacts with the person over time. A trusting relationship with the professional is essential. Consults with mental health or pastoral professionals can often be helpful.

Long Term Effects

What are the long-term effects of the condition?

Malaise can limit a person's ability to work or go to school. Other long-term effects depend on the cause. For instance, cancer may result in death. An infection often goes away and results in no long-term effects.

Other Risks

What are the risks to others?

Malaise itself is not contagious in the true sense of the word, though symptoms of feeling ill have been shown to transmit by suggestion through classrooms and workplaces, especially if an environmental or infectious exposure is rumored. Malaise may be caused by an infection that is contagious.

Treatments

What are the treatments for the condition?

In general, recommendations for treatment of malaise include:
  • regular exercise without overdoing it
  • getting enough sleep
  • eating a healthy diet
  • decreasing stress
More specific treatment is directed at the cause. For instance, a person may need antibiotics for infection. Thyroid hormone medication may be needed for low thyroid levels. In other people, control of diabetes or another systemic disorder may be needed. Those with depression often need medication to treat their condition. Those with cancer may need surgery, chemotherapy, or radiation therapy.

Side Effects

What are the side effects of the treatments?

Side effects depend on the treatments used. Medication side effects can include allergic reactions, stomach upset, and headache. Surgery can be complicated by bleeding, infection, or an allergic reaction to the anesthetic.

After Treatment

What happens after treatment for the condition?

If the malaise goes away, a person may or may not need further treatment. For instance, an individual with diabetes needs lifelong treatment. Someone who was "overdoing it" may need no further treatment once he or she gets some rest. Someone with cancer may die if treatment is not successful.

Monitor

How is the condition monitored?

A person can often monitor his or her symptoms at home. Any new or worsening symptoms should be reported to the healthcare professional. Other monitoring is related to the cause. For instance, someone with diabetes needs to monitor his or her blood sugar regularly.

Sources

Harrison's Principles of Internal Medicine, 1998, Fauci et al.

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