Principle Investigator: Samuel Shor, MD, FACP , Associate Clinical Professor :
George Washington University Health Care Sciences
Internal Medicine of Northern Virginia
1860 Town Center Drive #230
Reston, Virginia 20190
Phone 703 709-1119
Fax 703 709-7496
Cheryl Koopman, PhD
Nancy Klimas, MD
Christine Green, MD
Sarah Fletcher, MD
Michael Sheriden, ScD
G. Dawn Royall
Khalida Willoughby, MA
Chronic fatigue syndrome is a diagnosis of exclusion for which there are no markers. Lyme disease is the most common vector borne illness in the United States for which chronic fatigue is a frequent clinical manifestation. Intervention of patients with Lyme disease with appropriately directed antimicrobials has been associated with improved outcomes.
An arbitrary date was chosen such that all patients registered in the database of the practice of the PI, which is located in the Lyme endemic area of Northern Virginia area were reviewed. The diagnosis of clinically significant fatigue > 6 months was chosen. Inclusion criteria required fulfilling the International Case Definition for CFS.
Of the total 210 included in the analysis, 209 or 99% were felt to represent a high likelihood of “seronegative Lyme disease.” Initiating various antimicrobial regimen, involved at least a 50% improvement in clinical status in 130 or 62%. Although not achieving the 50% threshold according to the criteria discussed, another 55 patients subjectively identified a beneficial clinical response to antimicrobials, representing a total of 188 or 88% of the total identified as having a high potential for seronegative Lyme disease.
A potentially substantial proportion of patients with what would otherwise be consistent with internationally case defined CFS in a Lyme endemic environment actually have a perpetuation of their symptoms driven by a persistent infection by Borrelia burgdorferi. By treating this cohort with appropriately directed antimicrobials, we have the ability to improve outcomes.
The majority of those included in our analysis had moderate to severe disabilities and thus less likely to be impacted by placebo effects than those less ill. That being said, even if we were to discard inclusion of those with symptom scores improving by less than 50%, we would still be left with 62% respondents who improved by at least by 50% on antimicrobials.