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Volume: 7
Issue: 01
Date: 25-Jan-99


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:

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                  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 <a229@Lehigh.edu>
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
spud@wadhurst.demon.co.uk
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.
             louis.magnarelli@po.state.ct.us
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.   ABOUT THE LYMENET NEWSLETTER
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Advisors: Carol-Jane Stolow, Director <carol_stolow@lymenet.org>
         William S. Stolow, President <bill_stolow@lymenet.org>
         The Lyme Disease Network of New Jersey
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