Recent reports indicate that in addition to viral infections,1 chronic bacterial infections may also lead to chronic fatigue syndrome. For example, chronic fatigue syndrome has been diagnosed in patients with Lyme disease, which is caused by intracellular Borrelia infections.2 In addition, patients with chronic fatigue may have intracellular Chlamydia spp. or mycoplasmal infections. Brucellosis and tuberculosis are also important causes of chronic fatigue.3
Patients with symptoms of fatigue should be screened for these bacterial infections.