Illnesses characterized by chronic fatigue are often defined by symptoms and not by objective biomarkers that support both diagnosis and treatment. Without readily obta ined b io marke rs, c linica l ma na ge me nt ca n be compromised by lack of certainty. This uncertainty creates a wide spectrum of possible therapies that in many cases is reduced to trial and error medicine, resulting in patient frustration and resource exhaustion, with little improvement in health status. Modern medicine must leverage modern science to bring common research tools into the clinic for patient diagnostics. Using biomarkers previously confirmed as useful in diagnosis and treatment of chronic inflammatory response syndrome (CIRS), including transcriptomics, the authors present evidence of benefit in assessment of a “symptoms-only illness.” These immune biomarkers, such as transforming growth factor beta (TGFb), vasoactive intestinal peptide (VIP), melanocyte stimulating hormone (MSH), split produc ts o f co mp le me nt act ivat io n, and ma ny ot hers disc ussed he re, are now a va ilab le for use a s c linica l diagnostics, but rarely ordered in cases of chronic illness. In cases of cognitive decline, new technology for brain MRI analysis, NeuroQuant, can pick up small changes in brain structures that are frequently missed by radiologists, but consistently shown in CIRS. By focusing on persistent symptoms seen in antibiotic-treated Lyme disease (Post-Lyme Syndrome, PLS), CIRS-biomarkers have utility to define both an initial infectious process and a subsequent inflammatory illness. Genomic testing can determine predisposition to chronic stages of Lyme after acute illness and use of Next Generation Sequencing now brings transcriptomics to the Lyme community, to assess remaining abnormalities at any given treatment stage of PLS. Application of these new, object ive tes t ing o ffe r ings w ill re vea l t he mo le c ular pathophysiology of illness, avoiding over-reliance on symptoms and antibody testing alone. This will help providers direct highly targeted therapies on an individual basis, in this era of personalized medicine.
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