Exploring the Overlap Between Dysautonomia and Lyme Disease

In this article we will focus on the relationship between Postural Orthostatic Tachycardia Syndrome (POTS) and Lyme disease can significantly affect quality of life. In clinical practice, symptoms overlap between the two, leading to diagnostic challenges and questions about their potential connection. This article explores the relationship between POTS and Lyme disease, highlighting shared features, underlying mechanisms, and the implications for diagnosis and treatment.

What is POTS?

POTS is a form of dysautonomia characterized by an abnormal increase in heart rate upon standing, often accompanied by symptoms such as fatigue, dizziness, brain fog, and gastrointestinal disturbances. It predominantly affects young women but can occur in individuals of all ages and genders. POTS arises from a dysfunction in the autonomic nervous system, though the exact cause varies and may include genetic predispositions, viral infections, or trauma.

What is Lyme Disease?

Lyme disease is a tick-borne illness caused by the bacterium Borrelia burgdorferi. Early symptoms include fever, fatigue, and headache. An expanding circular erythema rash may be present but is not always recognizable. A Lyme rash most commonly is solid red in color but less often can have a tell-tale bull’s-eye appearance. If untreated, Lyme disease can progress to involve the nervous system, heart, and joints. Chronic or persistent Lyme disease can lead to lingering debilitating symptoms, sometimes referred to as post-treatment Lyme disease syndrome (PTLDS).

Symptom Overlap

Both POTS and Lyme disease share a broad range of symptoms, particularly those involving the nervous system. Common overlapping symptoms include:

• Fatigue: A hallmark of both conditions, often debilitating in nature.
• Cognitive Dysfunction (“Brain Fog”): Difficulty with memory, concentration, and mental clarity.
• Dizziness and Lightheadedness: Often linked to autonomic dysfunction in POTS and nervous system involvement in Lyme disease.
• Heart Palpitations: Present in POTS due to tachycardia and potentially in Lyme disease as part of Lyme carditis.
• Gastrointestinal Issues: Common in both due to autonomic involvement or direct bacterial impact in Lyme disease.

The presence of these shared symptoms can complicate diagnosis and may lead to misattribution of symptoms to one condition over the other.

Potential Mechanisms of Overlap

The overlap in symptoms might arise from several factors:

• Autonomic Nervous System Dysfunction: Lyme disease, especially in its chronic stages, can affect the autonomic nervous system, potentially triggering POTS.
• Inflammatory Processes: Both conditions involve immune system dysregulation. Inflammation caused by Lyme disease could exacerbate POTS.
• Post-Infectious Syndrome: Like POTS, which can develop after viral infections, persistent symptoms of Lyme disease may reflect a post-infectious state where the autonomic system is compromised.

Diagnostic Challenges

Diagnosing POTS and Lyme disease can be challenging due to a lack of definitive diagnostic tests. For Lyme disease, laboratory tests like the enzyme-linked immunosorbent assay (ELISA) and Western blot are commonly used, but false negatives can occur. POTS diagnosis relies on clinical criteria, such as an increase in heart rate of 30 beats per minute (or more) within 10 minutes of standing, without significant drops in blood pressure.

A thorough patient history, including tick exposure, and an evaluation of symptom progression are crucial for treating these conditions.

Treatment Implications

The overlap between POTS and Lyme disease necessitates a nuanced approach to treatment:

• For Lyme Disease: Antibiotics remain the cornerstone of treatment. However, addressing lingering symptoms might require supportive therapies, including physical therapy and immune modulation.
• For POTS: Management focuses on symptom control, often involving increased fluid and salt intake, compression garments, medications, and lifestyle modifications.

When the two conditions coexist, treatment plans may need to be integrated, addressing both infectious and autonomic components. Collaboration between specialists, including infectious disease doctors, neurologists, and cardiologists, can optimize outcomes.

Conclusion

POTS and Lyme disease overlapping symptoms highlight the complexity of diagnosing and managing these conditions. Understanding the potential connections between them can help clinicians provide better care for patients experiencing persistent, debilitating symptoms. It is important for patients with Lyme disease to be evaluated for POTS.
As research evolves, unraveling the relationship between these conditions may pave the way for more effective and tailored treatments.

References

For comprehensive medical advice, consult a healthcare provider or specialist familiar with these conditions. This article is intended for informational purposes and should not replace professional medical guidance.

Project Lyme would like to thank Johns Hopkins University, specifically Nancy Dougherty, for their input for this article and for use of their existing video resources. To learn more from JHU, visit https://www.hopkinsmedicine.org/physical-medicine-rehabilitation/specialty-areas/pots

To learn more about the many forms of Dysautonomia, visit https://www.dysautonomiainternational.org/.