Heterodox and Orthodox Discourses in the Case of Lyme Disease: A Synthesis of Arguments

In this article, we examine the arguments made by authors of published academic articles concerning the debates surrounding chronic Lyme disease (CLD). CLD is an example of a contested condition and shares problems of legitimacy with other medically unexplained conditions such as chronic fatigue syndrome. We use a critical discourse analysis (CDA) approach to understand the arguments of the authors to establish the legitimacy, or not, of a CLD diagnosis. This enabled us to make sense of the nature of the stalemate between patient groups and advocates of the medical establishment, as performed by authors of academic articles. In this article, we bring together the arguments to explain the polemical debate and to support accounts that avoid the impasse to give us greater insight into the experience of chronic illness.

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Characterising DSCATT: A case series of Australian patients with debilitating symptom complexes attributed to ticks

Australian & New Zealand Journal of Psychiatry ◽

10.1177/00048674211043788 ◽

2021 ◽

pp. 000486742110437

Author(s):

Jesse Schnall ◽

Georgina Oliver ◽

Sabine Braat ◽

Richard Macdonell ◽

Katherine B Gibney ◽

...

Keyword(s):

Chronic Fatigue Syndrome ◽

Lyme Disease ◽

Case Series ◽

Disease Process ◽

Chronic Fatigue ◽

Retrospective Case ◽

Medical Diagnoses ◽

Fatigue Syndrome ◽

First Case ◽

Medically Unexplained

Objectives(s): To characterise the clinical profile, aetiology and treatment responsiveness of ‘Australian Lyme’, or Debilitating Symptom Complexes Attributed to Ticks. Methods: Single-centre retrospective case analysis of patients referred to the Infectious Diseases Unit at Austin Health – a tertiary health service in Heidelberg, Australia – between 2014 and 2020 for investigation and treatment of suspected Debilitating Symptom Complexes Attributed to Ticks. Patients were included if they had debilitating symptoms suggested by either themselves or the referring clinician as being attributed to ticks. Results: Twenty-nine Debilitating Symptom Complexes Attributed to Ticks cases were included in the analysis. Other than Lyme disease (83%), the most common prior medical diagnoses were Epstein–Barr virus (38%), chronic fatigue syndrome (28%) and fibromyalgia (24%). Prior histories of anxiety (48%) and depression (41%) were common. The most frequently reported symptoms included fatigue (83%), headache (72%) and arthralgia (69%). National Association of Testing Authorities/Royal College of Pathologists of Australasia–accredited serology was not diagnostic of acute infective causes, including Lyme disease, in any patient. Of 25 cases with available data, 23 (92%) had previously been prescribed antimicrobials, with 53% reporting benefit from them. The most common diagnoses made by our hospital were chronic fatigue syndrome (31%), migraines (28%) and fibromyalgia (21%). Only one patient’s symptoms were not accounted for by other diagnoses. Conclusion: This is the first case series of patients with Debilitating Symptom Complexes Attributed to Ticks. They had high rates of other medically unexplained syndromes, and no evidence of acute Lyme disease, or any common organic disease process. Debilitating Symptom Complexes Attributed to Ticks remains medically unexplained, and may therefore be due to an as yet unidentified cause, or may be considered a medically unexplained syndrome similar to conditions such as chronic fatigue syndrome.

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Chronic Fatigue Syndrome Patients Subsequently Diagnosed with Lyme Disease Borrelia burgdorferi: Evidence for Mycoplasma Species Coinfections

Journal of Chronic Fatigue Syndrome ◽

10.1080/10573320802091809 ◽

2008 ◽

Vol 14 (4) ◽

pp. 5-17 ◽

Cited By ~ 2

Author(s):

Garth Nicolson ◽

Nancy Nicolson ◽

Joerg Haier

Keyword(s):

Chronic Fatigue Syndrome ◽

Lyme Disease ◽

Borrelia Burgdorferi ◽

Chronic Fatigue ◽

Mycoplasma Species ◽

Fatigue Syndrome

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A population-based study of chronic fatigue syndrome (CFS) experienced in differing patient groups: An effort to replicate Vercoulen et al.'s model of CFS

Journal of Mental Health ◽

10.1080/09638230500076165 ◽

2005 ◽

Vol 14 (3) ◽

pp. 277-289 ◽

Cited By ~ 14

Author(s):

Sharon Song ◽

Leonard A Jason

Keyword(s):

Chronic Fatigue Syndrome ◽

Chronic Fatigue ◽

Population Based ◽

Population Based Study ◽

Fatigue Syndrome ◽

Patient Groups ◽

S Model

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C-Reactive Protein Response in Patients With Post-Treatment Lyme Disease Symptoms Versus Those With Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

Clinical Infectious Diseases ◽

10.1093/cid/ciy299 ◽

2018 ◽

Vol 67 (8) ◽

pp. 1309-1310 ◽

Cited By ~ 4

Author(s):

Melanie Uhde ◽

Alyssa Indart ◽

Brian A Fallon ◽

Gary P Wormser ◽

Adriana R Marques ◽

...

Keyword(s):

Chronic Fatigue Syndrome ◽

Lyme Disease ◽

Chronic Fatigue ◽

Post Treatment ◽

Myalgic Encephalomyelitis ◽

C Reactive Protein ◽

Disease Symptoms ◽

Reactive Protein ◽

Fatigue Syndrome ◽

Protein Response

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Humoral and cellular immune response after influenza vaccination in patients with postcancer fatigue and patients with chronic fatigue syndrome.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.9070 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. 9070-9070

Author(s):

Hetty Prinsen ◽

Jolanda de Vries ◽

Foekje Stelma ◽

Sasja Mulder ◽

Carla Van Herpen ◽

...

Keyword(s):

Immune Response ◽

T Cell ◽

Chronic Fatigue Syndrome ◽

Cellular Immune Response ◽

Foxp3 Expression ◽

Chronic Fatigue ◽

Fatigue Syndrome ◽

Patient Groups ◽

Postcancer Fatigue ◽

Cellular Immune

9070 Background: Postcancer fatigue (PCF) is a frequently occurring problem, impairing quality of life. Patients with chronic fatigue syndrome (CFS) also suffer from severe fatigue symptoms. We hypothesized that in fatigued patients (PCF and CFS) alterations in immune response could explain fatigue symptoms. Therefore, we examined whether the humoral and/or cellular immune response after influenza vaccination differed between fatigued patients and non-fatigued individuals and between PCF and CFS patients. Methods: PCF (n=15) and CFS patients (n=22) were vaccinated against influenza. Age and gender matched non-fatigued cancer survivors (n=12) and healthy controls (n=23) were included for comparison. Antibody responses were measured at baseline and at day 21 by a hemagglutination inhibition test. T cell responses were measured at baseline and at day 7 by a lymphocyte proliferation and activation assay. Results: Both patient groups developed seroprotection rates comparable to the accompanying control groups. Functional T cell reactivity was observed in all groups. Proliferation at baseline was significantly lower in fatigued patients compared to non-fatigued individuals. A significant increase in proliferation from baseline to day 7 was observed in fatigued patients, but not in controls. At day 7, proliferation was not significantly different between fatigued patients and non-fatigued individuals. CD4+CD127-FoxP3+ expression was significantly higher in PCF patients compared to non-fatigued cancer survivors. Conclusions: We observed a lower T cell proliferation at baseline in fatigued patients compared to non-fatigued individuals, suggesting a difference in the baseline state of the immune system between fatigued patients and non-fatigued individuals. Furthermore, the difference in CD4+CD127-FoxP3+ expression between PCF and CFS patients suggests subtle differences in immune state between these two fatigued patient groups. However, since humoral and cellular immune responses after vaccination did not differ significantly between fatigued patients and non-fatigued individuals, vaccination of fatigued patients (PCF and CFS) can be effective.

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Nationwide Epidemiological Characteristics of Chronic Fatigue Syndrome in South Korea

10.21203/rs.3.rs-954071/v1 ◽

2021 ◽

Author(s):

Eun Jin Lim ◽

Jin-Seok Lee ◽

Eun-Jung Lee ◽

Seok-Ju Jeong ◽

Ho-Young Park ◽

...

Keyword(s):

Chronic Fatigue Syndrome ◽

South Korea ◽

Chronic Fatigue ◽

Fatigue Syndrome ◽

Female Predominance ◽

Increasing Trend ◽

Medically Unexplained ◽

Epidemiological Characteristics ◽

Entire Dataset

Abstract Background: Chronic fatigue syndrome (CFS) is a long-term disabling illness accompanied by medically unexplained fatigue. This study aimed to explore the epidemiological characteristics of CFS in South Korea.Methods: Using the nationwide medical records provided by the Korean Health Insurance Review & Assessment Service (HIRA), we analyzed the entire dataset for CFS patients diagnosed by physicians in Korea from January 2010 to December 2020. Results: The annual mean incidence of CFS was estimated to be 44.71 ± 6.10 cases per 100,000 individuals [95% CI: 40.57, 48.76], and the prevalence rate was 57.70 ± 12.20 cases per 100,000 individuals [95% CI: 49.40, 65.79]. These two rates increased by 1.53- and 1.94-fold from 2010 to 2020, respectively, and showed an increasing trend with aging and an approximately 1.5-fold female predominance. Conclusions: This study is the first to report the nationwide epidemiological features of CFS, which reflects the clinical reality of CFS diagnosis and care in South Korea. This study will be a valuable reference for studies of CFS in the future.

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Lyme Disease Presenting as Chronic Fatigue Syndrome

Journal of Chronic Fatigue Syndrome ◽

10.1300/j092v13n04_06 ◽

2006 ◽

Vol 13 (4) ◽

pp. 67-75 ◽

Cited By ~ 1

Author(s):

Samuel Shor

Keyword(s):

Chronic Fatigue Syndrome ◽

Lyme Disease ◽

Chronic Fatigue ◽

Fatigue Syndrome

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Cognitive deficits in patients suffering from chronic fatigue syndrome, acute infective illness or depression

The British Journal of Psychiatry ◽

10.1192/bjp.171.4.377 ◽

1997 ◽

Vol 171 (4) ◽

pp. 377-381 ◽

Cited By ~ 47

Author(s):

Ute Vollmer-Conna ◽

Denis Wakefield ◽

Andrew Lloyd ◽

Ian Hickie ◽

Jim Lemon ◽

...

Keyword(s):

Chronic Fatigue Syndrome ◽

Cognitive Performance ◽

Acute Infection ◽

Reaction Times ◽

Response Speed ◽

Chronic Fatigue ◽

Mood Disturbance ◽

Healthy Controls ◽

Fatigue Syndrome ◽

Patient Groups

BackgroundPatients with chronic fatigue syndrome (CFS) report neuropsychological symptoms as a characteristic feature. We sought to assess cognitive performance in patients with CFS, and compare cognitive performance and subjective workload experience of these patients with that of two disease comparison groups (non-melanchonic depression and acute infection) and healthy controls.MethodA computerised performance battery employed to assess cognitive functioning included tests of continuous attention, response speed, performance accuracy and memory. Severity of mood disturbance and subjective fatigue were assessed by questionnaire.ResultsAll patient groups demonstrated increased errors and slower reaction times, and gave higher workload ratings than healthy controls. Patients with CFS and non-melancholic depression had more severe deficits than patients with acute infection. All patient groups reported more severe mood disturbance and fatigue than healthy controls, but patients with CFS and those with acute infection reported less severe mood disturbance than patients with depression.ConclusionsAs all patients demonstrated similar deficits in attention and response speed, it is possible that common pathophysiological processes are involved. The differences in severity of mood disturbance, however, suggest that the pathophysiological processes in patients with CFS and acute infection are not simply secondary to depressed mood.

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