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CDC Validation of Chronic Lyme: A Turning Point for Root-Cause Medicine
For decades, patients with chronic Lyme symptoms have been left in a painful limbo—experiencing debilitating fatigue, pain, cognitive dysfunction, and sleep disruption while being told that nothing persistent was happening, that their symptoms couldn’t possibly be connected to infection, or that the biology simply didn’t support their lived reality. Many of us in clinical practice have watched patients struggle through the same trajectory: significant symptoms after treatment, little acknowledgment, and even less guidance. This month, that changed.
In a special supplement of Emerging Infectious Diseases, the Centers for Disease Control and Prevention formally acknowledged that persistent symptoms following Lyme disease are real, medically significant, and part of a new category the agency is calling Infection-Associated Chronic Conditions and Illnesses (IACCIs). This is not a minor wording update—it is a recognition of biological reality. The CDC describes several mechanisms that may sustain long-term illness after infection, including ongoing immune stimulation, persistent infection in sequestered tissues, autoimmune responses, microbiome disruption, damaged or dysregulated nerve signaling, disordered coagulation, and lasting tissue injury. They also explicitly name the symptom patterns that patients have reported for years: debilitating fatigue, post-exertional malaise, cognitive impairment, musculoskeletal pain, and sleep disorders. For patients and clinicians who have lived and witnessed this, the CDC’s language simply reflects what has been evident at the bedside long before it appeared in federal print.
What stands out even more is how closely this new federal framework aligns with the IACIRS paradigm we use in our center. In my clinical experience, chronic symptoms after Lyme disease are almost never the result of either persistent infection or persistent immune imbalance. They emerge from both—an interplay between microbes that continue to drive inflammation and an immune system that remains dysregulated long after the acute infection should have resolved. We see evidence every day that Borrelia, Bartonella, Babesia, and other vector-borne pathogens can persist through immune evasion, tissue sequestration, altered morphologic forms, and biofilm formation. They may disappear from standard antibody tests but continue to disrupt mitochondrial function, neurological signaling, and inflammatory pathways beneath the surface. At the same time, the immune system—exhausted, irritated, and off balance—can remain hyper-reactive, confused, or misdirected. This creates the downstream landscape patients know all too well: chronic inflammation, cytokine abnormalities, coagulation problems, autonomic dysfunction, hormonal disruption, and microbiome shifts. This dual mechanism—persistent infection plus persistent immune dysregulation—is exactly what the CDC is now describing under the IACCI umbrella.
It’s important to acknowledge the people who pushed this shift forward. The CDC’s recognition is closely tied to the work of Col. Nicole Malachowski, who served as the lone patient representative on the National Academies committee that authored the influential Lyme IACCI report—work that directly informed the CDC’s new stance. Her advocacy brought patient experience and scientific urgency into a space that had long lacked both. The result is a true turning point. Chronic Lyme symptoms are now framed as real and biologically grounded. The federal scientific narrative now mirrors what many clinicians have already seen for years. Research, funding, and clinical care will now flow from a framework that matches lived reality rather than denying it.
For patients, this recognition doesn’t solve everything, but it does change the terrain. Persistent symptoms are no longer controversial. The legitimacy of their experience is no longer debated. And the country now has a scientific framework that finally reflects what so many have known intuitively: that persistent symptoms after Lyme disease are rooted in a combination of ongoing infectious drivers and a chronically dysregulated immune response. This is the exact pattern described in IACIRS, and the one we address daily in treatment plans that look upstream rather than chasing isolated symptoms.
The bottom line is simple. This moment is progress. It is validation. And it marks the beginning of a new chapter for chronic Lyme patients. The CDC now acknowledges that persistent symptoms are real, biologically explainable, and driven by the same infection–immune interaction the IACIRS model has emphasized for years. IACCI gives the nation a framework. IACIRS gives it a mechanism. And patients give it meaning. This shift has been a long time coming—and it is only the beginning.