Thursday 14 July 2011

ANTIBIOTICS FOR PATIENTS WITH ME/CFS?

RETROSPECTIVE ANALYSIS OF A COHORT OF INTERNATIONALLY CASE DEFINED CHRONIC FATIGUE SYNDROME PATIENTS IN A LYME ENDEMIC AREA
Samuel Shor1, MD, FACP
ABSTRACT

Background
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.

Methods
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.
Results
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.
Conclusions
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.
Link to the study here
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Of course here in the UK a growing number of areas are being found to have ticks carrying Lyme Disease so depending on having been infected in just the known Lyme Endemic areas is just not the best way forward. What we need is much more research relevant to the situation in the UK.
Meanwhile anyone with ME/CFS symptoms should at least consider the possibility that it could be Lyme Disease, not everyone is aware of the sometimes poppy seed sized tick that can infect us and currently research shows that blood tests can miss up to 50% of cases, with about 50% of those infected not seeing a typical Bulls eye rash.

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