Steere, A C, Taylor, E, McHugh, G L et al. · JAMA · 1993
This study looked at 788 people referred to a Lyme disease clinic who were thought to have Lyme disease. Researchers found that only 23% actually had active Lyme disease, while 57% did not have Lyme disease at all—many of these patients had chronic fatigue syndrome or fibromyalgia instead. The main problem was that patients were being incorrectly diagnosed with Lyme disease and given antibiotics that didn't help because they didn't actually have the infection.
This study is critical for ME/CFS patients because it demonstrates that Lyme disease is frequently misdiagnosed in patients who actually have ME/CFS or fibromyalgia, leading to inappropriate antibiotic treatment and delayed access to appropriate care. The findings highlight the importance of accurate serological testing and proper diagnostic criteria to distinguish Lyme disease from other conditions with overlapping symptoms. Understanding this distinction helps direct patients toward effective management strategies tailored to their actual condition.
This study does not prove that Lyme disease never causes ME/CFS-like symptoms or post-Lyme disease syndromes, only that misdiagnosis is common. It does not establish causality in the 49 cases where ME/CFS symptoms began after documented Lyme disease—temporal association does not prove causation. The cross-sectional design cannot determine whether serological false-positives reflect prior infection, cross-reactivity, or laboratory error.
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
Steere, A C, Taylor, E, McHugh, G L, & Logigian, E L (1993). The overdiagnosis of Lyme disease.. JAMA. https://pubmed.ncbi.nlm.nih.gov/8459513/
BibTeX
@article{mecfsatlas-steere-1993-overdiagnosis-lyme,
author = {Steere, A C and Taylor, E and McHugh, G L and Logigian, E L},
title = {The overdiagnosis of Lyme disease.},
journal = {JAMA},
year = {1993},
note = {PubMed: 8459513},
url = {https://www.mecfsatlas.com/evidence/steere-1993-overdiagnosis-lyme},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-28. https://www.mecfsatlas.com/evidence/steere-1993-overdiagnosis-lyme
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