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Lyme disease and POTS

POTS is recognized by some clinicians as a contributor to persistent Lyme disease symptoms but more research is needed.

A man sits on the couch in his pajamas and gives himself a blood pressure check.

Lyme disease is under-diagnosed and often under-treated. A multidisciplinary team at Johns Hopkins University School of Medicine published a research review in Frontiers in Neurology that implicates dysregulation of the autonomic nervous system in post-treatment/persistent Lyme disease (PTLD). PTLD is a research term invented in 2006 to mask treatment failure. Infectious disease specialist, Dr. Jack Lambert, refers to PTLD as standing for ‘Partially Treated Lyme Disease’. Could under-treatment of Lyme disease contribute to autonomic nervous system dysregulation?1

Although not yet well-established in the medical literature, the Johns Hopkins team, by examining case reports, autopsy and primate studies, found compelling clinical and biologic bases for the association between dysautonomia and Lyme disease. Dysautonomia is widely accepted as an underlying contributor to long COVID and myalgic encephalomyelitis/chronic fatigue syndrome, or ME/CFS.

Infection-associated chronic illnesses such as Long COVID, ME/CFS and chronic Lyme disease share similar symptoms and may share important biologic mechanisms as well. Common symptoms of these infection-associated chronic conditions include severe fatigue, musculoskeletal pain, cognitive and sleep difficulties.

Postural Orthostatic Tachycardia Syndrome, or POTS, the most common manifestation of dysautonomia, is reported to occur after an acute Lyme infection. POTS has been recognized by some clinicians as a contributor to post-treatment/persistent Lyme disease but has not been studied in depth.

POTS symptoms can be debilitating and include brain fog, severe fatigue, profound weakness with standing, racing heart, exertional intolerance, light-headedness, and muscle aches. When properly evaluated with formal testing, POTS can be diagnosed and treated.

More research is needed.

There are gaps in knowledge needed to identify underlying abnormal biologic mechanisms causing Lyme disease associated dysautonomia, and to compare those with other infection-associated chronic illnesses. In some cases it might even lead to some Lyme patients to be retreated as better treatments are discovered, tested and approved for complex disseminated Lyme infection.


  1. Adler BL, Chung T, Rowe PC and Aucott J (2024) Dysautonomia following Lyme disease: a key component of post-treatment Lyme disease syndrome? Front. Neurol. 15:1344862. doi: 10.3389/fneur.2024.1344862

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