Burdge, D R, O'Hanlon, D P · Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 1993 · DOI
Doctors at a hospital created a special clinic to evaluate patients who thought they had Lyme disease, even though Lyme disease is not common in that region. Out of 65 patients referred to the clinic, only 2 actually had Lyme disease. However, the clinic successfully identified other real medical conditions in most patients, including rheumatologic diseases, infections, and chronic fatigue syndrome.
This study is relevant to ME/CFS patients because it demonstrates how disease anxiety and attribution bias can lead patients to seek Lyme disease diagnosis when they actually have other conditions, including ME/CFS and fibromyalgia. The findings highlight the importance of systematic clinical assessment in distinguishing between Lyme disease and other chronic illnesses that may present similarly, potentially reducing unnecessary testing and misdiagnosis in both conditions.
This study does not establish the true prevalence or incidence of Lyme disease in endemic areas, nor does it address whether ME/CFS and Lyme disease can co-occur. The non-endemic setting limits generalizability to regions where Lyme disease is actually present. It also does not evaluate the accuracy of individual diagnostic tests for Lyme disease or address whether psychiatric diagnoses truly represent primary conditions versus secondary responses to unexplained chronic illness.
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 →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Burdge, D R & O'Hanlon, D P (1993). Experience at a referral center for patients with suspected Lyme disease in an area of nonendemicity: first 65 patients.. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. https://doi.org/10.1093/clind/16.4.558
BibTeX
@article{mecfsatlas-burdge-1993-experience-referral,
author = {Burdge, D R and O'Hanlon, D P},
title = {Experience at a referral center for patients with suspected Lyme disease in an area of nonendemicity: first 65 patients.},
journal = {Clinical infectious diseases : an official publication of the Infectious Diseases Society of America},
year = {1993},
doi = {10.1093/clind/16.4.558},
note = {PubMed: 8513065},
url = {https://www.mecfsatlas.com/evidence/burdge-1993-experience-referral},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-29. https://www.mecfsatlas.com/evidence/burdge-1993-experience-referral
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