Volume: 7 Table of Contents: I. LYMENET: British Lyme Disease Foundation Established to Inform Public and Advance Research II. PSYCHIATR CLIN NORTH AM: The underdiagnosis of neuropsychiatric Lyme disease in children and adults. III. SCAND J INFECT DIS: Immunoserologic evidence of Human Granulocytic Ehrlichiosis in Danish patients with Lyme neuroborreliosis. IV. RES MICROBIOL: Borrelia burgdorferi sensu lato in Russia and neighbouring countries: high incidence of mixed isolates V. J CLIN MICROBIOL: Human exposure to a granulocytic Ehrlichia and other tick-borne agents in Connecticut. VI. ABOUT THE LYMENET NEWSLETTER Newsletter: *********************************************************************** * The National Lyme Disease Network * * http://www.LymeNet.org/ * * LymeNet Newsletter * *********************************************************************** Volume 7 / Number 01 / 25-JAN-1999 INDEX I. LYMENET: British Lyme Disease Foundation Established to Inform Public and Advance Research II. PSYCHIATR CLIN NORTH AM: The underdiagnosis of neuropsychiatric Lyme disease in children and adults. III. SCAND J INFECT DIS: Immunoserologic evidence of Human Granulocytic Ehrlichiosis in Danish patients with Lyme neuroborreliosis. IV. RES MICROBIOL: Borrelia burgdorferi sensu lato in Russia and neighbouring countries: high incidence of mixed isolates V. J CLIN MICROBIOL: Human exposure to a granulocytic Ehrlichia and other tick-borne agents in Connecticut. VI. ABOUT THE LYMENET NEWSLETTER =====*===== I. LYMENET: British Lyme Disease Foundation Established to Inform Public and Advance Research -------------------------------------------------------------------- Sender: Marc C. Gabriel <[email protected]> Date: January 16, 1999 As Lyme disease and other tick borne illnesses are identified and described outside the United States, new charities and foundations are being established to support disease education and research. The British Lyme Disease Foundation is a new organization which is currently striving to provide the latest available information to patients and doctors alike. Their long term goal is to fund research into the disease, it's proper diagnosis and ultimately to finding a cure to chronic Lyme which will be of global benefit. Lyme disease is officially recognized and reportable to health authorities in the UK, but little information is available. "We know Lyme has been active for at least 100 years in the UK from results of tests on ticks in the natural history museum," notes Mark Greenfield, founder of the BLDF. However, I still hear reports of doctors saying there is no Lyme disease in Britain, or there is no Lyme outside the New Forest. " Greenfield believes the British Lyme situation is similar to where the US was 10 years ago. "Although we use the usual tests, there would seem to be a high probability that if blood tests come back negative there is little consideration of whether the clinical symptoms fit," he observed. "While it is of course very important to rule out all other possibilities I suspect we could learn much from studying the American situation over the last decade." "We do not have all the facts about the disease and as such it cannot be stressed enough that accurate clinical diagnosis is vital in cases of vague blood results," Greenfield adds. For more information on the British Lyme Disease Foundation, contact: Mark J Greenfield PO Box 331 East Grinstead, West Sussex England, RH19 1YT [email protected] http://www.wadhurst.demon.co.uk/lyme/index.htm "All contributions will go towards research and provision of information, we do not pay salaries or expenses to any staff." REFERENCES FOR FURTHER RESEARCH: "Distribution of Borrelia burgdorferi s.l. spirochaete DNA in British ticks (Argasidae and Ixodidae) since the 19th century, assessed by PCR." http://www2.LymeNet.org/domino/abstract.nsf/UID/98175131 "European interlaboratory comparison of Lyme borreliosis serology." http://www2.LymeNet.org/domino/abstract.nsf/UID/98224302 "Natural Lyme disease cycles maintained via sheep by co-feeding ticks." http://www2.LymeNet.org/domino/abstract.nsf/UID/98150128 "The value of serological testing for Lyme disease in the UK." http://www2.LymeNet.org/domino/abstract.nsf/UID/95219309 =====*===== II. PSYCHIATR CLIN NORTH AM: The underdiagnosis of neuropsychiatric Lyme disease in children and adults. --------------------------------------------------------------------- AUTHORS: Fallon BA, Kochevar JM, Gaito A, Nields JA ORGANIZATION: Department of Psychiatry, Columbia University Medical Center, New York, New York, USA. REFERENCE: Psychiatr Clin North Am 1998 Sep;21(3):693-703, viii ABSTRACT: Lyme Disease has been called "The New Great Imitator," a replacement for that old "great imitator" neurosyphilis. This article reviews the numerous psychiatric and neurologic presentations found in adults and children. It then reviews the features of Lyme Disease, which makes it almost uniquely hard to diagnose, including the complexity and unreliability of serologic tests. Clinical examples follow that illustrate those presentations of this disease that mimic attention deficit hyperactivity disorder (ADHD), depression, and multiple sclerosis. =====*===== III. SCAND J INFECT DIS: Immunoserologic evidence of Human Granulocytic Ehrlichiosis in Danish patients with Lyme neuroborreliosis. ------------------------------------------------------------ AUTHORS: Lebech AM, Hansen K, Pancholi P, Sloan LM, Magera JM Persing DH ORGANIZATION: Department of Clinical Biochemistry, Statens Seruminstitut, University Hospital Hvidovre, Copenhagen, Denmark. REFERENCE: Scand J Infect Dis 1998;30(2):173-6 ABSTRACT: Human Granulocytic Ehrlichiosis (HGE) is a recently described human illness in the US which manifests as fever, myalgia and headache combined with pancytopenia and elevated concentrations of hepatic transaminases. Genetic analyses indicate that the agent of HGE appears to be an Ehrlichia species that is closely related to E. equi and E. phagocytophila. Ixodes dammini and I. scapularis were identified as potential vectors of HGE. Ixodes ticks are also the vector of Borrelia burgdorferi, the agent of Lyme borreliosis. The presence of antibodies against Ehrlichia in 132 sera from Danish patients with definite Lyme neuroborreliosis were examined in order to provide immunoserologic evidence of this infection in Denmark. Patients with Lyme neuroborreliosis were chosen as a test cohort, as these patients had been infested by a tick sufficient for transmission of B. burgdorferi. All had cerebrospinal fluid lymphocytic pleocytosis. As controls, serum samples from 50 healthy Danish blood donors were included. Of the 132 patients with Lyme neuroborreliosis, 5 (3.8%) reacted with the E. equi antigen substrate at titres 1:128. None of the blood donors were found seropositive for E. equi. At least 2 of the patients found seropositive for HGE constituted probable cases of HGE with E. equi antibody titres of at least 80 combined with fever, headache and myalgias. However, in no cases were we able to detect the presence of the HGE agent in the serum by PCR. We conclude that human exposure to granulocytic Ehrlichiae species may also occur in Europe, although further studies will be necessary to document active infection with these potential pathogens. =====*===== IV. RES MICROBIOL: Borrelia burgdorferi sensu lato in Russia and neighbouring countries: high incidence of mixed isolates ------------------------------------------------------------------ AUTHORS: Postic D, Korenberg E, Gorelova N, Kovalevski YV, Bellenger E, Baranton G ORGANIZATION: Unite de Bacteriologie moleculaire et medicale, Institut Pasteur, Paris. REFERENCE: Res Microbiol 1997 Nov;148(8):691-702 ABSTRACT: A total of 365 isolates of Borrelia burgdorferi sensu lato from 12 major administrative territories of Russia (from St. Petersburg in the west to South Sakhalin in the east) and from the Czech Republic, Estonia, Lithuania, Byelorussia, Moldavia, Ukraine and Kirghizia were identified by analysis of restriction polymorphism of ribosomal rrf-rrl spacer amplicons. The isolates were obtained mainly from ixodes persulcatus and I. ricinus ticks. Other sources included small mammals, human patients and I. trianguliceps ticks. The results showed that B. garinii (two variants) together with B. afzelii circulated throughout the territories studied. The distribution of the variant NT29 of the species B. garinii, the most frequently isolated, was associated with that of I. persulcatus ticks. B. burgdorferi sensu stricto, and the species B. valaisiana and B. lusitaniae (formerly the genomospecies VS116 and PotiB2, respectively) were isolated only from I. ricinus ticks in the western part of the studied territories. None of these three species were found in 327 isolates from Russia where I. persulcatus is the most frequently distributed vector. This work also provides evidence for a high incidence of mixed Borrelia infections within vectors and hosts (9.3% of isolates were mixtures of Borrelia species). A detailed analysis of Borrelia species distribution over the territories studied is presented. =====*===== V. J CLIN MICROBIOL: Human exposure to a granulocytic Ehrlichia and other tick-borne agents in Connecticut. ---------------------------------------------------------------------- ABSTRACT: Magnarelli LA, Ijdo JW, Anderson JF, Padula SJ, Flavell RA Fikrig E ORGANIZATION: Department of Entomology, The Connecticut Agricultural Experiment Station, New Haven, Connecticut 06504, USA. [email protected] REFERENCE: J Clin Microbiol 1998 Oct;36(10):2823-7 ABSTRACT: Indirect fluorescent-antibody (IFA) staining methods with Ehrlichia equi (MRK or BDS strains) and Western blot analyses containing a human granulocytic ehrlichiosis (HGE) agent (NCH-1 strain) were used to confirm probable human cases of infection in Connecticut during 1995 and 1996. Also included were other tests for Ehrlichia chaffeensis, the agent of human monocytic ehrlichiosis (HME), Babesia microti, and Borrelia burgdorferi. Thirty-three (8.8%) of 375 patients who had fever accompanied by marked leukopenia or thrombocytopenia were serologically confirmed as having HGE. Western blot analyses of a subset of positive sera confirmed the results of the IFA staining methods for 15 (78.9%) of 19 seropositive specimens obtained from different persons. There was frequent detection of antibodies to a 44-kDa protein of the HGE agent. Serologic testing also revealed possible cases of Lyme borreliosis (n = 142), babesiosis (n = 41), and HME (n = 21). Forty-seven (26.1%) of 180 patients had antibodies to two or more tick-borne agents. Therefore, when one of these diseases is clinically suspected or diagnosed, clinicians should consider the possibility of other current or past tick-borne infections. =====*===== VI. 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