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Fatigue and Lyme Disease

Probably all tick-borne infections can cause various degrees of fatigue. And perhaps the worst is the emerging Babesia infection with new human species well ahead of quality testing or any testing.

Chronic fatigue syndrome--a clinically empirical approach to its definition and study.

Reeves WC, Wagner D, Nisenbaum R, Jones JF, Gurbaxani B, Solomon L, Papanicolaou DA, Unger ER, Vernon SD, Heim C. BMC Med. 2005 Dec 15;3:19

Division of Viral and Rickettsial Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA. wcr1@cdc.gov

BACKGROUND: The lack of standardized criteria for defining chronic fatigue syndrome (CFS) has constrained research. The objective of this study was to apply the 1994 CFS criteria by standardized reproducible criteria. METHODS: This population-based case control study enrolled 227 adults identified from the population of Wichita with: (1) CFS (n = 58); (2) non-fatigued controls matched to CFS on sex, race, age and body mass index (n = 55); (3) persons with medically unexplained fatigue not CFS, which we term ISF [WHY IS THIS NOT APPRECIATED BY MORE PHYSICIANS? THAT FATIGUE HAS OVER A 1,000 MEDICAL CAUSES] (n = 59); (4) CFS accompanied by melancholic depression (n = 27); and (5) ISF plus melancholic depression (n = 28). [BECAUSE OF VAST IGNORANCE OF THE MANY CAUSES OF FATIGUE, WE SEE YET AGAIN, AN OVER PRESENTATION OF PSYCHIATRY SINCE WHEN DID EVERYONE BECOME A PSYCHIATRIST IN ALLOPATHIC MEDICINE? OF COURSE MANY MEDICAL ILLNESSES AND INFECTIONS CAUSE DEPRESSION, BUT IT IS A MERE SIGN OF THE MEDICAL ILLNESS, NOT THE CAUSE]. Participants were admitted to a hospital for two days and underwent medical history and physical examination, the Diagnostic Interview Schedule, and laboratory testing to identify medical and psychiatric conditions exclusionary for CFS. Illness classification at the time of the clinical study utilized two algorithms: (1) the same criteria as in the surveillance study; (2) a standardized clinically empirical algorithm based on quantitative assessment of the major domains of CFS (impairment, fatigue, and accompanying symptoms). RESULTS: One hundred and sixty-four participants had no exclusionary conditions at the time of this study. Clinically empirical classification identified 43 subjects as CFS, 57 as ISF, and 64 as not ill. There was minimal association between the empirical classification and classification by the surveillance criteria. Subjects empirically classified as CFS had significantly worse impairment (evaluated by the SF-36), more severe fatigue (documented by the multidimensional fatigue inventory), more frequent and severe accompanying symptoms than those with ISF, who in turn had significantly worse scores than the not ill; this was not true for classification by the surveillance algorithm. CONCLUSION: The empirical definition includes all aspects of CFS specified in the 1994 case definition and identifies persons with CFS in a precise manner that can be readily reproduced by both investigators and clinicians.

Int J Med Microbiol. 2006 May;296 Suppl 40:11-6. Epub 2006 Mar 9.

Clinical aspects of neuroborreliosis and post-Lyme disease syndrome in adult patients.

Pfister HW, Rupprecht TA.

Department of Neurology, Ludwig-Maximilians-University, Klinikum Grosshadern, Marchioninistrasse 15, D-81377 Munich, Germany. hans-walter.pfister@med.uni-muenchen.de

The diagnostic criteria of active neuroborreliosis include inflammatory changes of the cerebrospinal fluid (CSF) and an elevated specific Borrelia CSF-to-serum antibody index, indicating intrathecal Borrelia antibody production. Patients with neuroborreliosis are usually treated with intravenous ceftriaxone for 2-3 weeks. In case of allergy, doxycycline may be used. Treatment efficacy is detected by the improvement of the neurological symptoms and the normalization of the CSF pleocytosis. The measurement of serum and CSF antibodies is not suitable for follow-up, because they frequently persist. Post-Lyme disease (PLD) syndrome is characterized by persistent complaints and symptoms after previous treatment for Lyme borreliosis, e.g., musculoskeletal or radicular pain, dysaesthesia, and neurocognitive symptoms that are often associated with fatigue. There is no formal definition of the PLD syndrome, and its pathogenesis is unclear. Recent controlled studies do not support the use of additional antibiotics in these patients, but recommend primarily symptomatic strategies. [IF YOU REPEATEDLY MISS BABESIA, BARTONELLA, INDOOR MYCOTOXINS AND OTHER INFECTIONS, ONE IS NOT GOING TO BE BETTER ON ANTIBIOTICS, SINCE BABESIA IS NOT KILLED BY ANTIBIOTICS AND NEITHER IS BARTONELLA BASED ON OUR BLIND TESTING. THE STUDIES THAT SELL A ROUTINE ANTIBIOTIC FOR BARTONELLA, ARE NOT THE TREATMENTS WE SEE WORKING IN 2009. SEE MY 2 VOLUME COLOR TEXTBOOK ON BARTONELLA].

Appl Neuropsychol. 1999;6(1):3-11

Neuropsychological deficits in Lyme disease patients with and without other evidence of central nervous system pathology.

Kaplan RF, Jones-Woodward L, Workman K, Steere AC, Logigian EL, Meadows ME.

Department of Neurology, Tufts University School of Medicine, Boston, Massachusetts, USA.

A small percentage of Lyme patients develop mild to moderate encephalopathic symptoms months to years after diagnosis and treatment. Their symptoms typically include fatigue, memory loss, sleep disturbance, and depression. However, the etiology of this syndrome remains controversial. It is generally thought that Lyme patients with abnormal cerebral spinal fluid (CSF) have a neurological basis to their illness. To further examine this question, we compared Lyme patients with evidence of abnormal CSF, intrathecal antibody to Borrelia burgdorferi, elevated protein, or a positive polymerase chain reaction for B. burgdorferi DNA (n = 14); Lyme patients with normal CSF (n = 18); and healthy controls (n = 15) on a battery of neuropsychological and personality tests. Although both Lyme groups reported memory problems, only the Lyme group with abnormal CSF had measurable memory deficits. Both Lyme groups had higher depression scores than the normal control group, although depression was not correlated with memory scores. It appears that Lyme patients with abnormal CSF may have a neurological basis to their illness, whereas affective symptoms, common to many chronic disorders, may predispose other Lyme patients to the perception of cognitive dysfunction.


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