By Alice || Edited by Go Ask Alice Editorial Team || Last edited Mar 17, 2023
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Alice! Health Promotion. "Lyme disease vs. chronic fatigue syndrome." Go Ask Alice!, Columbia University, 17 Mar. 2023, Accessed 23, Jun. 2024.

Alice! Health Promotion. (2023, March 17). Lyme disease vs. chronic fatigue syndrome. Go Ask Alice!,

Dear Alice,

I'm wondering about Lyme disease and chronic fatigue syndrome — the differences and similarities?

— Tired

Dear Tired, 

It can be difficult to distinguish between two distinct conditions that have similar symptoms, as is the case with Lyme disease and chronic fatigue syndrome (CFS). In fact, there are some in the medical community who believe that individuals with CFS may actually have undiagnosed and untreated chronic Lyme disease. While more research may help clarify the possible links between CFS and Lyme disease, individuals suffering from CFS-like symptoms may want to consider talking with a health care professional who can distinguish between the two conditions through diagnostic tests and find a treatment plan that works best for you. 

Lyme disease is transmitted to humans by the bite of a tick that is infected with the Borrelia burgdorferi bacteria—these ticks most commonly live on deer and mice). The Centers for Disease Control and Prevention (CDC) report that in most cases, the first symptom of Lyme disease is a circular rash—erythema migrans—that develops at the site of the tick bite (typically three to 30 days after being bitten). This peculiarly named rash resembles a bullseye, expands up to twelve inches in diameter, and may be warm to the touch, but is rarely painful or itchy. Other early symptoms of Lyme disease may include fatigue, chills, achy muscles and joints, fever, headache, and swollen lymph nodes. 

Lyme disease may be cured with a course of antibiotics, especially if it is still in the early stages. For those with more advanced symptoms, a medical provider may prescribe an intravenous (IV) antibiotic. Individuals who have not been treated, or who have not been treated successfully, may experience complications from Lyme disease weeks, months, or potentially years after an infected tick bite. These complications include facial paralysis, heart rhythm abnormalities, and arthritis, because the disease affects the nervous, cardiovascular, and musculoskeletal systems. 

While the causes of Lyme disease are known, those of CFS are not as clear. Current areas of study for potential causes of CFS include infection, immune system changes, stress affecting the body's internal chemistry, and a probable genetic component. As for symptoms, the most obvious symptom of CFS is debilitating fatigue lasting for at least six months, but additional signs may include: 

  • Muscle and joint pains 
  • Waking up from sleep and not feeling refreshed 
  • Discomfort lasting more than 24 hours following exertion 
  • Sore throat 
  • Painful lymph nodes 
  • Headaches 
  • Impaired memory and concentration ("brain fog") 

List adapted from the Centers for Disease Control and Prevention 

Though CFS may impact individuals differently, it can significantly affect a person's ability to work and perform routine daily activities. There is no set treatment for CFS, though strategies exist to manage or alleviate its symptoms. Some may recover enough to work, while others may remain homebound. In a few cases, individuals fully recovered from CFS. 

There are, however, other conditions that may also cause fatigue, including hypothyroidism, narcolepsy, sleep apnea, alcohol or drug abuse, depression, cancer, autoimmune disease, obesity, infection, and chronic mononucleosis. In any case, if you are experiencing fatigue that affects your ability to function, consider having a discussion about this with your health care provider. For more information on Lyme disease and CFS, you may want to check out resources such as: 

Hope this helps! 

Additional Relevant Topics:

General Health
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