Lyme disease: a growing threat to urban populations.
Steere, A C · Proceedings of the National Academy of Sciences of the United States of America · 1994 · DOI
Quick Summary
Lyme disease is an infection spread by tick bites that can affect multiple body systems and mimic other illnesses. This review explains that Lyme disease has been spreading across North America, Europe, and Asia, and notes an important problem: conditions like chronic fatigue syndrome and fibromyalgia are sometimes incorrectly diagnosed as 'chronic Lyme disease,' partly because diagnostic tests for Lyme disease are unreliable.
Why It Matters
This study is important for ME/CFS patients and researchers because it documents the frequent misdiagnosis of ME/CFS as 'chronic Lyme disease,' highlighting diagnostic confusion that can delay appropriate care and treatment. Understanding the distinction between actual Lyme disease and conditions like ME/CFS is critical for accurate diagnosis and ensuring patients receive targeted management.
Observed Findings
40,195 Lyme disease cases were reported to the CDC from 1982–1991 across 47 states, but confirmed enzootic cycles of B. burgdorferi existed in only 19 states.
Lyme disease exhibits multisystem involvement, stagewise progression, and clinical mimicry similar to syphilis.
Early manifestations of Lyme disease typically respond to oral antibiotics (doxycycline or amoxicillin).
Objective neurologic manifestations of Lyme disease appear to require intravenous antibiotic therapy.
Chronic fatigue syndrome and fibromyalgia are commonly misdiagnosed as 'chronic Lyme disease,' partly due to unreliable diagnostic testing.
Inferred Conclusions
Lyme disease has expanded geographically and now poses a growing public health threat in urban and periurban areas of North America, Europe, and Asia.
Diagnostic testing limitations and late neurologic manifestations of Lyme disease present significant clinical challenges.
Misdiagnosis of ME/CFS, fibromyalgia, and other poorly understood conditions as 'chronic Lyme disease' is a widespread clinical problem requiring improved diagnostic specificity.
Remaining Questions
What specific diagnostic tests most reliably differentiate Lyme disease from ME/CFS, fibromyalgia, and other conditions with overlapping symptoms?
What This Study Does Not Prove
This review does not prove a causal relationship between Lyme disease and ME/CFS, nor does it establish that ME/CFS and Lyme disease are the same condition. It also does not provide definitive guidance on which diagnostic tests reliably distinguish Lyme disease from ME/CFS, fibromyalgia, or other overlapping conditions. The article does not offer data on the actual prevalence of misdiagnosis or the clinical outcomes of patients incorrectly labeled with 'chronic Lyme disease.'
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 →