Adler, Brittany L, Chung, Tae, Rowe, Peter C et al. · Frontiers in neurology · 2024 · DOI
This review examines how Lyme disease can damage the autonomic nervous system—the part of your nervous system that controls automatic body functions like heart rate, blood pressure, and digestion. The authors argue that this autonomic dysfunction may explain why some people with Lyme disease develop persistent, widespread symptoms similar to those seen in ME/CFS and long COVID. They review existing evidence and propose possible mechanisms for how the Lyme disease bacteria might cause these ongoing problems.
This study is important because it proposes a unifying mechanism—autonomic nervous system dysfunction—that may explain overlapping symptoms across infection-associated chronic illnesses including ME/CFS, long COVID, and PTLDS. For ME/CFS patients, this framework suggests that dysautonomia-focused diagnostic and therapeutic approaches developed for other post-infectious conditions may be relevant and worth investigating. Recognition of dysautonomia as a Lyme disease complication could improve clinical understanding and management of a subset of patients with ME/CFS-like symptoms.
This is a narrative review rather than an original research study, so it does not provide new experimental data proving that Borrelia burgdorferi causes dysautonomia in humans. The review highlights that dysautonomia has not yet been formally established as a recognized complication of Lyme disease in the medical literature, and the proposed mechanisms remain largely theoretical. The overlapping features between PTLDS, PASC, and ME/CFS suggest common mechanisms but do not prove they share identical underlying causes.
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 →
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