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Background: Chronic fatigue syndrome is a diagnosis of exclusion for which there are no markers. Lyme disease is the most common vector borne illness in the United States for which chronic fatigue is a frequent clinical manifestation. Intervention of patients with Lyme disease with appropriately directed antimicrobials has been associated with improved outcomes.
Methods: An arbitrary date was chosen such that all patients registered in the database of the practice of the PI, which is located in the Lyme endemic area of Northern Virginia area were reviewed. The diagnosis of clinically significant fatigue > 6 months was chosen. Inclusion criteria required fulfilling the International Case Definition for CFS.
Results: Of the total 210 included in the analysis, 209 or 99% were felt to represent a high likelihood of “seronegative Lyme disease.” [Serology tests used to detect infection with the various microbes known to be carried by the Lyme tick Lyme disease were negative.]
Initiating various antimicrobial regimens, involved at least a 50% improvement in clinical status in 130 or 62%. [Duration of treatments with various antimicrobials ranged from 2 to 12 months.]
Although not achieving the 50% threshold according to the criteria discussed, another 55 patients subjectively identified a beneficial clinical response to antimicrobials, representing a total of 188 or 88% of the total identified as having a high potential for seronegative Lyme disease.
Conclusions: A potentially substantial proportion of patients with what would otherwise be consistent with internationally case defined CFS in a Lyme endemic environment actually have a perpetuation of their symptoms driven by a persistent infection by Borrelia burgdorferi.
By treating this cohort with appropriately directed antimicrobials, we have the ability to improve outcomes.
Source: Bulletin of the IACFS/ME, Winter 2011. Principle Investigator Samuel Shor, MD, FACP, Associate Clinical Professor, George Washington University Health Care Sciences; Internal Medicine of Northern Virginia, Reston, Virginia, USA. [Email: firstname.lastname@example.org]