RETROSPECTIVE ANALYSIS OF A COHORT OF INTERNATIONALLY CASE DEFINED CHRONIC FATIGUE SYNDROME PATIENTS IN A LYME ENDEMIC AREA
(ANÁLISIS RETROSPECTIVO DE UN COHORTE DE PACIENTES CON SÍNDROME DE FATIGA CRÓNICA DEFINIDO POR EL CRITERIO INTERNACIONAL, EN UN ÁREA ENDÉMICA DE LYME)
Explicación de los resultados (abajo el estudio completo):
De un total de 210 pacientes aleatoriamente escogidos un día, los cuales cumplían los criterios internacioales para la EM/SFC, sufrían fatiga crónica por más de 6 meses, eran negativos por serología para Lyme, el 99% eran sospechosos de sufrir Lyme cónico (bajas CD57, presencia de coinfeccones, entre otros). De estos pacientes, el 62% había mejorado con tratamiento antimicrobiano en al menos un 50% (Los tratamientos difieren al ser un análisis restrospectivo, igual que el tiempo en que esta mejora se experimentó). Este procentaje se eleva al 88%, atendiendo al resto de los pacientes que explicaban haber experimentado una respuesta clínica beneficiosa con el tratamiento.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.
En resumen, una gran mayoría de pacientes que cumplían los criterios Internacionales para ME/SFC, eran sospechos de sufrir Lyme crónico no aparente en pruebas serológicas (de anticuerpos en sangre) y mejoraron significativamente tras tratamiento antimicrobiano.
ORIGINAL:
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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.
