Lyme Disease and Fatigue
In the Journal of Chronic Fatigue Syndrome (v13_06), the case study of a 33 year old man was presented. For two years, the man was treated for CFS with limited success. Once doctors reconsidered the diagnosis of Lyme disease for the patient, realizing he had a history of prolonged exposure to tick-infested mountains, they were able to confirm Lyme disease and alter disease management. With the accurate diagnosis, the patient improved and achieved better function. Researchers concluded it is very important to be aware that chronic Lyme disease can present as CFS.
Dr. Donta pointed out that Chronic Fatigue Syndrome shares a number of symptoms with Lyme disease. Symptoms of Lyme disease include fatigue, arthalgias, myalgias, headaches, cognitive problems, mood swings, and paresthesias. Similarly, Chronic Fatigue Syndrome is characterized by a fatigue for 6 months, associated with at least 4 of 8 associated symptoms such as impaired memory, sore throat, tender or swollen lymph nodes, muscle pain, multi-joint pain, unrefreshing sleep, new onset headaches, and post-exertion malaise.
Chronic Lyme disease etiology may be multifactorial, Dr. Donta said. It may stem from a persistent relapsing infection, be an autoimmune-triggered disorder, or result from release of toxin during reactivation of infection. The persistent infection hypothesis has also been applied to some of the other CMSDs. In recent studies of chronic fatigue syndrome, tests showed evidence of mycoplasma DNA in the WBC buffy coat in 50% of subjects. In another study -- this one of patients with Gulf War Syndrome -- similar findings were seen: mycoplasma fermentens in the blood of half the subjects.
Post-Lyme Disease and Chronic Fatigue Syndrome
The other presentation that highlighted how other clinical syndromes share symptomology with Lyme disease was delivered by Dr. Lauren Krupp, of the State University of New York at Stony Brook and principal investigator of the Stop Lyme Disease NIH-funded research study. She described her work comparing Post-Lyme Syndrome with Chronic Fatigue Syndrome. She said her studies are based on observations that a small percentage of patients (5-16%) experience a constellation of symptoms following early disease treatment: headache, myalgia, fatigue, paresthesias, arthralgias, and mood disturbance.
Prior studies have demonstrated that risk factors for the development of sequelae from Lyme disease include lengthy duration of disease (>1 year) prior to treatment, high specific IgG antibody titers, and multiple bands on the Western blot (which have been correlated with poor verbal memory performance). The term "Post-Lyme Syndrome" encompasses chronic or intermittent problems that begin at the time of clinical Lyme disease and persist for months to years despite adequate antibiotic therapy. Synonymous terms include "post treatment Lyme disease" and "chronic Lyme disease". Similar in symptomology to other disorders, Post-Lyme Syndrome (PLS) may produce cognitive disturbances (encephalopathy), fatigue/malaise (Chronic Fatigue Syndrome), joint and muscle pain (fibromyalgia), headache, and other features such as hearing loss, vertigo, mood disturbances, paresthesias, sleep disturbances, and stiff neck.
Dr. Krupp said estimates of the frequency of PLS range from 13% (in a 1993 study of 788 patients), to 53% (in a 1993 study of 215 patients). In a population-based study by Shadick in 1994 comparing Lyme disease patients to community controls, the significantly more common and distinguishing clinical symptoms between the two groups respectively were severe fatigue (26% vs 9%), concentration problems (47% vs 16%), emotional lability (18% vs 5%), difficulty sleeping (47% vs 16%), and objective cognitive impairment (12% vs 5%). Dr. Krupp said that in addition to persistent infection, reinfection, or a post-infectious immune or inflammatory process, other causes of Post-Lyme Syndrome need to be considered. These include incorrect diagnosis, slow resolution of symptoms, residual damage, and unmasked prior pathology.
In one post-treatment Lyme disease study, Dr. Krupp compared patients with PLS to patients with Chronic Fatigue Syndrome (CFS). The PLS patients had a history of seropositivity, a compatible clinical syndrome, severe fatigue persisting for 6 months or more, and no other explanation for fatigue. The CFS patients had no history of Lyme disease. Although all of the CFS patients met the 1994 CFS criteria, as many as 84% of the PLS patients also met the same criteria. The clinical symptoms that significantly distinguished the two groups, comparing CFS and PLS respectively, were: fever (72% vs 28%), sore throat (76% vs 28%), unrefreshing sleep (96% vs 36%) and tender cervical or axillary lymph nodes (60% vs 26%). In the CSF analyses of these two patient groups, 21-40% of the PLS patients were Borrelia antigen positive vs 0% of the CFS patients. In regards to cognitive performance, both groups had more deficits than the controls, with the PLS patients having more deficits on verbal fluency, verbal memory, and digit span than the CFS patients.
Quotes above courtesy of Dr. B. Fallon, Columbia.
There are also a number of co-infections that are commonly transmitted along with the Lyme bacteria, which include Bartonella, Babesia, Ehrlichia and others. There are many different species which are not able to be tested for by large or specialty labs. All tick-borne infections have false-negative results (test negative despite infection being present). Treatment of Lyme disease which has been missed for a year or more complex since Bartonella and Babesia make Lyme cure impossible and Borrelia (Lyme) bacteria can transform from the standard cork screw bacteria to other complex forms and treatment resistant cysts. Standard antibiotic treatments are only effective against the cell wall form and are only two are effective against cystic forms.
Dr. Schaller has tried to specialize in the treatment of fatigue disorders and tick infections that fail the so-called "successful" treatment of sadistic experts who ignore their own treatment failures and insult patients who are not better with their simplistic treatments and approach.