Smith, J L · Neurologic clinics · 1991
This study suggests that some patients diagnosed with chronic fatigue syndrome (CFS) might actually have Lyme disease, a tick-borne infection that can affect the brain and eyes. The authors recommend doctors ask CFS patients detailed questions about tick exposure and check for specific eye and neurological problems, then use blood and urine tests to look for evidence of Lyme infection.
For ME/CFS patients, this work is significant because it highlights the possibility that some cases of chronic fatigue may be misattributed when undiagnosed Lyme borreliosis is the underlying cause. Understanding the overlap between CFS presentations and Lyme disease could improve diagnostic accuracy and guide appropriate treatment decisions.
This study does not prove that Lyme borreliosis causes or explains most CFS cases, nor does it establish the prevalence of Lyme infection among CFS patients. It is a clinical review proposing diagnostic criteria rather than a controlled study demonstrating the frequency of this misdiagnosis or comparing treatment outcomes between Lyme-positive and Lyme-negative CFS cohorts.
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
Smith, J L (1991). Neuro-ocular Lyme borreliosis.. Neurologic clinics. https://pubmed.ncbi.nlm.nih.gov/2011111/
BibTeX
@article{mecfsatlas-smith-1991-neuro-ocular,
author = {Smith, J L},
title = {Neuro-ocular Lyme borreliosis.},
journal = {Neurologic clinics},
year = {1991},
note = {PubMed: 2011111},
url = {https://www.mecfsatlas.com/evidence/smith-1991-neuro-ocular},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-28. https://www.mecfsatlas.com/evidence/smith-1991-neuro-ocular
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