Research abstract:

BACKGROUND:

A subset of patients reporting a diagnosis of Lyme disease can be described as having alternatively diagnosed chronic Lyme syndrome (ADCLS), in which diagnosis is on the basis of laboratory results from a non-reference Lyme specialty laboratory using in-house criteria. ADCLS patients report similar symptoms to patients with chronic fatigue syndrome (CFS).

METHODS:

We performed a case-control study comparing patients with ADCLS and CFS to each other and to both healthy controls and controls with the chronic disease systemic lupus erythematosus (SLE). Subjects completed a history, physical exam, screening laboratory tests, seven functional scales, reference serology for Lyme disease using CDC criteria, reference serology for other tick-associated pathogens, and cytokine expression studies.

RESULTS:

The study enrolled 13 cases with ADCLS, 12 of whom were diagnosed by one alternative US laboratory, 25 CFS cases, 25 matched healthy controls, and 11 SLE controls. Baseline clinical data and functional scales indicate significant disability among ADCLS and CFS cases and many important differences between these groups and controls, but no significant differences between each other. No ADCLS patient was confirmed as having positive Lyme serology by reference laboratory testing and there was no difference in distribution of positive serology for other tick-transmitted pathogens or cytokine expression across the groups.

INTERPRETATION:

In British Columbia, a setting with low Lyme disease incidence, ADCLS patients have a similar phenotype to CFS patients. Disagreement between alternative and reference laboratory Lyme testing results in this setting is most likely explained by false positive results from the alternative laboratory.

Lyme Disease diagnosed by alternative methods: a common phenotype with Chronic Fatigue Syndrome, by DM Patrick et al, Complex Chronic Disease Study Group, University of British Columbia in Clin Infect Dis. 2015 Jun 16. pii: civ470. [Epub ahead of print]