Lyme disease is commonly referred to as the 'Great Imitator' since it can produce such a vast array of symptoms, and therefore imitate a large number of other illnesses. Lyme disease is the most common vector borne (carried by insects etc) illness in the western world with an estimated 200,000 new cases each year in the United States.
With environmental illnesses such as chronic fatigue syndrome, fibromyalgia, gulf war syndrome and autism still poorly understood, Lyme disease is one explanation that deserves investigation. There is the possibility that patients diagnosed with one of these illnesses is actually suffering from Lyme disease. Equally, the Borrelia burgdorferi spirochete (spiral bacteria), that causes Lyme disease, may also play a role in these illnesses. It is well known now that sufferers of chronic fatigue syndrome and other unexplained syndromes are subject to multiple infections from viruses, such as Epstein-Barr, to fungi and yeast, such as Candida species. Borrelia burgdorferi may take advantage of the poor immune function in sufferers of these syndromes and contribute to the disease process.
Let's examine the possible links between Lyme disease and these environmental illnesses.
Lyme Disease & Chronic Fatigue Syndrome
Both chronic Lyme disease and chronic fatigue syndrome have been described as "medically unexplained symptom" syndromes1 and are often grouped together due to the similarity in symptoms, and the current poor understanding of their etiology2. The overlap in symptoms between these two illnesses is great, with fatigue, musculoskeletal aches and pains, and cognitive symptoms, such as poor memory, concentration and "brain fog", being the most common in both.
With the substantial crossover in symptoms and the poor reliability of testing for Lyme disease, along with the lack of accepted diagnostic testing for chronic fatigue syndrome, misdiagnoses between the two is inevitable. There are widely varying estimates regarding how many people diagnosed with chronic fatigue syndrome are actually suffering from chronic Lyme disease (and vice versa), but it is generally accepted that this kind of misdiagnoses does occur. An informal study conducted by the American Lyme Disease Alliance (ALDA), found that most patients diagnosed with chronic fatigue syndrome were actually suffering from Lyme disease. From 31 volunteers diagnosed with chronic fatigue syndrome, the study found that 28 were actually suffering from Lyme disease. The accuracy of these results is open for debate however, as they were mostly based on response to antibiotic treatment. There are likely to be many other ways this could improve a chronic fatigue syndrome patients health, other than by killing the Borrelia burgdorferi spirochete that causes Lyme disease. One obvious mechanism would be that the antibiotics actually treated small intestinal bacterial overgrowth (SIBO) which has been shown to be associated with chronic fatigue syndrome3, 4. There is also evidence however, for a link between Lyme disease and chronic fatigue syndrome based on blood testing. A study published in 2000 of 1,156 healthy young men tested for Borrelia burgdorferi antibodies, those that tested positive had significantly higher levels of chronic fatigue and malaise. The researchers concluded that antibiotic therapy targeting Borrelia burgdorferi should be considered for chronic fatigue syndrome patients when blood testing is positive.
A number of influential doctors and researchers have noted the link between chronic fatigue syndrome and Lyme disease. Dr. Sam Donta, a bacteriologist and an infectious disease specialist who is the Director of the Lyme Disease Unit at Boston Medical Center, and has acted as a consultant to the National Institutes of Health (NIH), is one of these. In a lecture presented to Mass. CFIDS/FM Association members on November 3rd, 2002, Dr. Donta explained that chronic fatigue syndrome and Lyme disease are almost indistinguishable due to the similarity in symptoms. After successfully treating many patients diagnosed with both of these illnesses, he believes that Lyme disease is an important cause of CFS, along with other infectious agents such as mycoplasma species and viruses, such as Epstein-Barr Virus (EBV). Dr. Donta advocates long term antibiotic therapy of 12-18 months, and sometimes 24-36 months, for Lyme disease. He also believes that a 6 month trial of this antibiotic therapy in those diagnosed with chronic fatigue syndrome is warranted.
Lyme Disease & Fibromyalgia
As with CFS, the symptoms of fibromyalgia are almost indistinguishable from those of chronic Lyme disease, maybe even more so, as musculoskeletal symptoms are more pronounced in both of these than they are in CFS.
The similarities make diagnosis difficult, but researchers from the Division of Rheumatology, Scripps Clinic and Research Foundation, La Jolla, California, believe that the combination of widespread musculoskeletal pain, high tender point count, and nonrestorative sleep are sufficient criteria for the diagnosis of fibromyalgia, as opposed to Lyme disease or other associated conditions5.
A revealing piece of research was carried out at Pace University, New York, aimed at evaluating a modified Fibromyalgia Impact Questionnaire (FIQ) for use in evaluating patients with post-Lyme disease syndrome (PLDS)*. The researchers used the questionnaire to evaluate a total of 47 participants, of whom 13 were diagnosed with PLDS, 18 fibromyalgia (FM), and 16 were healthy controls. The study found that the PLDS patients demonstrated statistically significantly greater levels of impairment than controls in physical functioning, FIQ total score, global well-being, joint pain, fatigue, depression, ability to perform activities of daily living, and memory/concentration. FM patients demonstrated a statistically significantly greater level of impairment than the control group in all categories, and the scores were significantly higher than the PLDS group in the measurement of physical impairment, FIQ total score, muscle pain, and joint pain6.
These two research studies provide important information for differentiating fibromyalgia from Lyme disease, namely that fibromyalgia patients usually display higher overall levels of muscle and joint pain, particularly at tender-points.
As with CFS however, many medical professionals who deal with these illnesses on a day to day basis believe that Lyme disease may cause, or at least be involved with fibromyalgia. The International Lyme and Associated Diseases Society funded a working group consisting of a large panel of doctors and researchers from different disciplines, to formulate recommendations for the effective treatment of Lyme disease. The resulting report was titled 'Evidence-based guidelines for the management of Lyme disease'7. Specific mention of fibromyalgia is made in the report which states:
"The outcome of treating fibromyalgia secondary to Lyme disease with nonantibiotic regimens has been poor. The most encouraging clinical trial showed success in only one of 15 patients and only modest improvement in 6 of 15 individuals with fibromyalgia despite 2 years of treatment.
Antibiotic therapy has been much more effective than supportive therapy in symptomatic patients with fibromyalgia secondary to Lyme disease.
Fibromyalgia treatment alone without antibiotics raises the risk of conversion to refractory chronic Lyme disease and/or exacerbation of an undiagnosed persistent infection and is not recommended. Increasingly, clinicians do not feel comfortable treating fibromyalgia in Lyme disease without antibiotics."
Lyme disease specialist Dr. Sam Donta also believes that Lyme disease is an important causative agent in fibromyalgia, and as with CFS, he suggests a 6 month trial of appropriate Lyme fighting antibiotics for fibromyalgia of "unknown cause". Dr. Donta notes that antibiotic trials in both fibromyalgia AND chronic fatigue syndrome have been limited to 1 month, which he considers inadequate to determine if it would be effective in reducing symptoms from undiagnosed Lyme disease. He calls for further trials of such treatment over longer periods of time, as well as further research into microbial causes of fibromyalgia and related illnesses.
Lyme Disease & Gulf War Syndrome
Gulf war syndrome is a complex multisymptom illness reported by veterans of the Persian Gulf war in the early 1990's, and also by servicemen returning from the more recent conflict. The symptoms of Gulf war syndrome are very similar to those in chronic fatigue syndrome, and therefore chronic Lyme disease. Research studies have also discovered similar abnormalities such as immune, endocrine and nervous system dysfunction along with other markers such as increased oxidative stress and reduced glutathione levels (see CFS and Gulf war syndrome pages). Along with chemical exposures, stress, and other factors, infectious agents are suspected of being the cause of the illness. Military personnel were exposed to a range of pathogens including viruses and bacteria.
One potential culprit for the production of the widespread symptoms in Gulf war syndrome is Lyme disease/Borrelia burgdorferi. Although infection with Lyme disease is unlikely in the Persian Gulf, since symptoms of Lyme disease may not develop until months or even years after infection, it has been theorized that latent Lyme disease, acquired whilst training in the field, could have been activated during or after service in the Gulf in some of those personnel who report ill health. This theory was proposed in an article published in Medical Hypotheses in 2005 titled 'Is Gulf War Syndrome actually chronic Lyme disease?'8. The author suggests "that sufferers of Gulf War Syndrome or similar illnesses should be examined by physicians who have experience diagnosing and treating large numbers of patients with Lyme disease."
Lyme Disease & Depression, Anxiety and other Mental/Emotional Problems
Borrelia burgdorferi is known to be particularly attracted to cells of the nervous system and as a result causes many neurological and psychological symptoms. Common symptoms of Lyme disease include depression, mood swings, irritability, poor attention and concentration, poor short-term memory and 'brain fog'.
There is a large amount of research illustrating the mental and emotional symptoms associated with Lyme disease. Lyme disease is often only discovered to be the cause of illness after a psychiatric diagnosis has been given.
Research published in December 2005 found that neurocognitive symptoms, such as those listed above, can persist for years in those who contracted Lyme disease, despite treatment with antibiotics9. The Journal of Psychiatric Practice published an article in 2000 describing three patients who suffered panic attacks, which later turned out to be the result of "previously unsuspected tick-borne disease" attributable to infections with the spirochete Borrelia burgdorferi, babesiosis, and ehrlichiosis. When treated with antibiotic therapy by a Lyme disease specialist, all three patients became free from panic attacks10. Finally, an article published in the Clinical Journal of Pain describes the more extreme mental and emotional disturbances that can be caused by Lyme disease, including schizophrenia-like psychosis and hallucinations, and how these can complicate achieving a correct diagnosis and treatment regimen11.
The mental and emotional symptoms that can result from Lyme disease are so diverse that Dr. Paul Fink, a former president of the American Psychiatric Association, was prompted to acknowledge that Lyme disease can contribute to every single psychiatric disorder in the Diagnostic Symptoms Manual IV (DSM-IV), the manual used to diagnose psychiatric disorders.
The symptoms may be a result of Borrelia burgdorferi and related organisms directly interfering with normal functioning of the brain and nervous system, or through the action of the toxins they produce. Dr. C. Shoemaker, MD and H Kenneth Hudnell, PhD state that "Borrelia burgdorferi produces a large suite of bio-toxins that have tissue affinity, mainly neurotoxins...". These bio-toxins are thought to alter various specific sites in the brain on molecular, structural and chemical levels, interfering with all the major neurotransmitters (dopamine, serotonin, norepinephrine, acetylcholine, GABA). In this way they can cause all manner of neurological and psychiatric symptoms.
Lyme Disease & Autism
Autism is a complex neurological disorder, and one which is growing at exponential rates. Estimates of its prevalence range from 1/150 to 1/80 across the US and similar figures can be applied to most western nations. As a result of the increasing incidence of autistic disorders, many medical professionals have been prompted to consider environmental factors as important triggers for the illness. The use of chemicals, drugs and vaccinations all increased dramatically during the 20th century, paralleling increases in cases of autism. Much research has focused on the genetics of autism, but it seems unlikely that this could explain the increasing incidence.
See our autism page for more details of these possible causes of the illness.
While the above factors may indeed be important, a less publicized explanation could lie with undiagnosed Lyme disease. In December 2004, Kathy Blanco published an article called "Autism - A Type Of Lyme Disease", in the journal Medical Hypotheses. This article describes in detail how Lyme disease may be amongst the triggers for development of autism and related developmental disorders.
A possible route of infection would be from the parents. Lyme disease is usually transmitted through a tick bite but it is now thought that the Borrelia burgdorferi bacterium that causes Lyme disease can also be passed through bodily fluids, including semen, breast milk, and gestational fluids in the womb. The mother may unknowingly have been infected by her partner or a tick bite (symptoms may not show for years), and then pass the infection on to her child whilst in the womb, or through breast feeding. This possibility needs studying carefully so that parents aren't left feeling guilty for their child's illness.
Lyme disease is the fastest growing vector-borne disease in the US with some experts estimating that the number of new cases every year is close to 200,000. As with other environmental factors being studied as possible causes of autism, the fact that Lyme infections seem to be increasing, lends credibility to the idea that they may be involved.
Lyme disease results in many neurological abnormalities including underconnectivity of brain areas, defects of the fusiform gyrus and loss of purkinje cells in the cerebellum. It has been reported that white matter disease is prevalent in children and adults with autism, which parallels patterns seen in lyme disease12. Additionally, symptoms of Lyme disease sometimes include those which are emotional in nature, such as obsessive-compulsive disorder, depression, aggression, panic disorder, and other phobic disorders. These same observations are also seen in autism, as parents often report these symptoms. Cognitive problems such as poor attention, difficulty concentrating, and memory problems, are amongst those commonly attributed to chronic Lyme disease and could account for learning deficits seen in autistic children.
Kathy Blanco notes that autoimmune conditions occur at an increased rate in those with autism, compared to otherwise healthy individuals, leading to the possibility that an infectious agent such as Borrelia burgdorferi is involved, with the result of immune system dysfunction. Interestingly, genetic studies have found that susceptibility genes for autism parallel the susceptibility genes for arthritis and other autoimmune disorders.
Finally, evidence supporting the theory that Lyme is being passed from parents to child includes, low levels of selenium in blood tests and metallothionein deficiency, a glutathione dependent oxidant. Parents show higher than normal sedimentation rates (ESR) and thrombaphilia and fibrin deposits indicating inflammation, as well as thyroid dysfunction and other hormonal balances13. Lyme disease is capable of causing all of these abnormalities.
Lyme Disease & Candida/Gut Dysbiosis
Due to the fact that antibiotics are necessary to treat Lyme disease and related infections, patients are at an increased risk for developing candida (yeast) intestinal overgrowth and local infections. Since chronic Lyme is an immune-deficiency disease, this also offers opportunity for parasites like yeasts/fungi to gain a foothold. Many doctors treating chronic Lyme disease therefore believe it is especially important to prevent, recognize and treat candida infections. Important aspects of treating candida are dietary factors, antifungal medication and/or supplements, immune enhancement, colon/liver cleansing, and the replenishment of friendly bacteria (ie. with probiotic supplements).
Dr. Mrs Laurence Meer-Scherre presented a lecture at the the Lyme Disease Action conference in York, England, in 2003. In the lecture entitled 'Tick Bite Co-Infections', Dr. Meer-Scherre described the importance of concurrently treating co-infections including candida, whilst treating Lyme disease with antibiotic therapy. Dr. Meer-Scherre provided a number of case histories and believes that anti-candida therapy and improving immune function through use of nutritional supplements and other interventions, are an important part of treatment for Lyme disease patients.
Dr. Steven J. Bock, MD, who specializes in integrative medicine, also routinely treats Lyme disease patients for candida overgrowth. Dr. Bock states:
"When a patient is placed on antibiotic therapy, it is imperative to give him or her probiotics (e.g., Lactobacillus, acidophilus or bifidum) and Saccharomyces boulardii. this prevents imbalance in the intestinal flora, which could lead to intestinal dysbiosis and/or C.dificile infection.
Chronic candidiasis and intestinal dysbiosis are frequently encountered in the treatment of Lyme patients. In some cases, natural anti-fungal therapy is utilized. Nystatin or fluconazole can also be used. Occasionally, intestinal cleansing is necessary. milk thistle extract can help prevent potential dysfunction of liver enzymes from antibiotic therapy."
Visit our Lyme disease page to learn more about the symptoms, diagnosis, testing, and treatment, of this disease.
* Post-Lyme disease syndrome (PLDS) is the name often given to the chronic illness that follows acute Lyme disease, when the Borrelia burgdorferi infection is presumed to have been successfully eradicated with antibiotic therapy.
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