Posttreatment Lyme disease syndrome and myalgic encephalomyelitis/chronic fatigue syndrome: A systematic review and comparison of pathogenesis. — ME/CFS Atlas
Posttreatment Lyme disease syndrome and myalgic encephalomyelitis/chronic fatigue syndrome: A systematic review and comparison of pathogenesis.
Bai, Natalie A, Richardson, Christie S · Chronic diseases and translational medicine · 2023 · DOI
Quick Summary
This review examined 18 studies comparing two similar chronic illnesses: posttreatment Lyme disease syndrome (PTLDS), which affects about 10% of Lyme disease patients even after antibiotic treatment, and ME/CFS. Both conditions cause severe fatigue, cognitive problems, pain, and sleep issues that last for months or years. The researchers found that patients with PTLDS experience many of the same symptoms as ME/CFS patients, suggesting these different illnesses may develop through similar biological pathways in the body.
Why It Matters
This research suggests that understanding what causes PTLDS after Lyme disease could provide insights into ME/CFS pathogenesis, potentially leading to better diagnostic tools and treatments. By identifying commonalities between post-infectious illnesses with different triggers, researchers may uncover shared biological mechanisms that apply broadly to chronic fatigue syndromes.
Observed Findings
In most PTLDS studies reviewed, at least four of six major ME/CFS symptoms were documented.
One PTLDS study identified 26 of 29 defined ME/CFS symptoms in its patient population.
Common symptoms in both PTLDS and ME/CFS include severe fatigue lasting >6 months, substantial activity impairment, post-exertional malaise, and unrefreshing sleep.
Approximately 10% of properly antibiotic-treated Lyme disease patients develop chronic PTLDS symptoms.
Inferred Conclusions
PTLDS and ME/CFS share strikingly similar symptom profiles despite different infectious origins, suggesting common pathogenic mechanisms in post-active infection syndromes.
Chronic illnesses following infectious triggers (whether Lyme disease or other pathogens) may develop through shared biological pathways resulting in comparable clinical presentations.
Post-infectious chronic illness syndromes represent a category of diseases with overlapping pathophysiology that warrants unified research approaches.
Remaining Questions
What are the specific biological mechanisms shared between PTLDS and ME/CFS that produce similar symptoms despite different initial infections?
Why do only ~10% of treated Lyme disease patients develop PTLDS while most recover—what host or pathogen factors determine progression to chronic illness?
What This Study Does Not Prove
This review does not prove that PTLDS and ME/CFS are the same disease or have identical causes—only that they share overlapping symptoms. It does not establish that the symptom overlap results from identical biological mechanisms; correlation in symptom presentation does not confirm identical pathogenesis. The qualitative nature of the analysis means findings represent patterns across studies rather than quantified statistical evidence.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
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