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Lyme Disease and Chronic Fatigue Syndrome – New Study Reveals Differences

cfs lyme disease

Do these symptoms sound familiar? Is post-Lyme disease syndrome really Chronic Fatigue Syndrome?

Differentiating neurologic post-treatment Lyme disease and chronic fatigue syndrome is difficult as these conditions, both of unknown aetiology, share common characteristics. Neurologic post-treatment Lyme disease (nPTLS) and chronic fatigue syndrome (CFS) can both lead to fatigue and cognitive impairment making some physicians suspicious that nPTLS is actually a subset of CFS. However, a study published in PLoS ONE earlier this year detailed the development of a strategy for distinguishing patients with either condition from each other by assessing levels of specific proteins in cerebrospinal fluid samples (Schutzer, et al, 2011).

The hope is that by differentiating the two diseases researchers will be able to focus more on the study of each condition, leading to improved diagnosis and treatment strategies for Lyme disease and CFS.

Why Spinal Fluid Testing Is Not Standard

Until quite recently, the ability to use CSF to tell one disease from another has been hindered somewhat by having no comprehensive standard of a normal CSF proteome with which to compare them. Technical issues around sample preparation, analysis techniques, and mass spectrometry (MS) capacity have also proven obstructive to the efforts of research scientists in this area. Having overcome these issues, the medical world now has a reference point for healthy CSF to act as a basis for investigations into the progression of disease and the causes of such disease.

Abnormal Proteins in Spinal Fluid

The study by Schutzer, et al, is only the beginning of such research as this was designed simply to determine a way of telling CFS and post-Lyme disease apart, rather than identifying the role played by individual proteins in the development of either disease. The scientists here reported 2,783 non-redundant proteins in the samples of cerebrospinal fluid taken from CFS patients, with 2,768 proteins in nPTLS patients and 2,630 proteins in the samples of normal, healthy patients. The proteins that differ between these groups are now the targets of further research looking at uncovering the cause of post-Lyme disease syndrome and myalgic encephalomyelitis (CFS).

Such research also allows patients to partake in other studies into treatments and diagnosis with less speculation and concern that a patient labelled as having CFS is actually suffering from the after-effects of Lyme disease, or vice versa. Doctors looking at a differential diagnosis for Lyme disease may have better access to accurate diagnostic criteria in the future based on cerebrospinal fluid analysis, thus reducing the likelihood of misdiagnosis and delays in appropriate treatment. The similarities between chronic fatigue syndrome and Lyme disease do not begin and end at neurological symptoms; gastrointestinal issues, visual problems, weight gain, muscle pains, fever, sore throat, headaches, and inflamed lymph nodes can all be indicative of both CFS and Lyme disease. As many patients do not experience the initial erythema migrans Lyme disease rash and do not recall a tick bite it may be that their symptoms are overlooked at first and that Lyme disease is not even considered as a diagnosis.

Future Directions for Lyme Disease Research

The view, promulgated by the Centers for Disease Control (CDC) and the Infectious Diseases Society of America (IDSA) is that post-Lyme disease is exceptionally rare, if not non-existent in some parts, an assumption which makes it difficult for physicians and researchers to gain funding for studies or find patients meeting stringent criteria for trial participation. With the advent of a way of differentiating chronic fatigue syndrome and neurologic post-treatment Lyme disease it may be that such research can begin, providing hope for patients suffering either illness.


Schutzer, S.E., Angel, T.E., Liu, T., Schepmores, A.A., Clauss, T.R., Adkins, J.N., Camp, D.G., Holland, B.K., Bergquist, J., Coyle, P.K., Smith, R.D., Fallon, B.A., Natelson, B.H., (2011), Distinct Cerebrospinal Fluid Proteomes Differentiate Post-Treatment Lyme Disease from Chronic Fatigue Syndrome, PLoS ONE 6(2): e17287. doi:10.1371/journal.pone.0017287

{ 2 comments… add one }
  • Rico February 19, 2012, 2:40 am

    I’d like to see a study that compares the CSF of “post treatment Lyme syndrome” patients with currently infected Lyme patients. I’ll bet they’re the same. CFS/ME is widely believed to be caused by an as yet unidentified infectious agent. I strongly believe that if a “post Lyme treatment” patient has fatigue and migrating or new Lyme symptoms, then they are still infected (as compared to measurable and permanent nerve damage).

  • Rico February 19, 2012, 2:44 am

    I have read that this study found about 400 differences in the proteins between the “post Lyme” group and the CFS/ME group, providing clear evidence that these are two separate conditions despite their similarity.

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