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Volume: 4
Issue: 06
Date: 29-Apr-96


Table of Contents:

I.    BOSTON GLOBE: Lyme May Have Lingering Effects
II.   LYMENET: Questions about LD and Pregnancy (A)
III.  About The LymeNet Newsletter


Newsletter:

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*                  The National Lyme Disease Network                  *
*                         LymeNet Newsletter                          *
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IDX#                Volume 4 - Number 06 - 4/29/96
IDX#                            INDEX
IDX#
IDX#  I.    BOSTON GLOBE: Lyme May Have Lingering Effects
IDX#  II.   LYMENET: Questions about LD and Pregnancy (A)
IDX#  III.  About The LymeNet Newsletter
IDX#



I.    BOSTON GLOBE: Lyme May Have Lingering Effects
---------------------------------------------------
Byline: By Peter J. Howe
Date: Saturday, April 20, 1996
Page: 1


Even after treatment, a significant number of people who get Lyme
disease develop lingering problems that include memory loss, poor
attention spans and depression, many specialists say.


But just how many people suffer from what is now being called "chronic
Lyme," and just what constitutes a medical definition of the syndrome,
are issues that remain in sharp dispute.


As New England enters its high season for the tick-borne illness, 300
of the nation's leading Lyme specialists yesterday began a two-day
conference in Boston.  It is aimed in part at reviewing extensive new
research into how chronic Lyme illness develops and fostering greater
recognition among doctors that for many people, it is not an imagined
illness or misdiagnosis of chronic fatigue, depression, or the effects
of aging.


"It's very real.  There is something going on with these people, and
we need to know what it is," said Dr. Patricia K. Coyle, a
neurologist at the State University of New York at Stony Brook who
today is presenting a paper detailing ongoing symptoms suffered by
many chronic Lyme victims.


Beyond arthritis-like joint pain, Coyle said, the symptoms can include
depression, impaired memory, diminished ability to summon words and
focus attention, lingering "pins and needles" nerve feelings, and --
in a small number of dire cases -- loss of movement similar to
multiple sclerosis or a major stroke.  Often people get the symptoms
even after what initially seems to be successful antibiotic treatment,
she said.


"The difficulty is that there is no formal definition," Coyle said.
"These patients often have a lot of symptoms with a paucity of signs,"
such as a persistent but hard-to-measure feeling that since contracting
Lyme disease they have been less mentally sharp.


Dr. Martina H. Ziska, medical chief at the Hartford-based Lyme Disease
Foundation, a nonprofit research and lobbying group that organized the
Copley Plaza Hotel conference, said she and many researchers believe
from observation that one-third of all people who get Lyme suffer
chronic effects afterward.  But she acknowledged that that figure
has not been proven in studies.


A number of Lyme specialists, including Allen Steere of the New
England Medical Center, who helped discover the disease in Connecticut
in the 1970s, have argued that Lyme disease is being overdiagnosed and
often confused with other illnesses such as chronic fatigue syndrome.


Dr. Sam T. Donta of Boston University Hospital, an internist who is
caring for 300 people with chronic Lyme, said: "These symptoms are
elusive, and they're frustrating for doctors as well as patients"
to identify, quantify and link to Lyme.  But, he said, "more and more
doctors are coming to the realization that these patients are for
real.  There are too many of them out there who couldn't have made
it all up."


...

Conference attendee Dr. Brian A. Fallon, A Columbia University
psychiatrist, said he encourages doctors to order brain-function tests
for people who seem to be suffering from chronic Lyme.  Frequently
those tests prove that people's mental function has slipped
measurably compared to earlier IQ tests, Fallon said.


Fallon also has found that two-thirds of the time, brain scans called
SPECT tests reveal that apparent chronic Lyme sufferers have visible
brain abnormalities such as cerebral inflammation.  Fallon said many
of the worst-stricken patients he sees at his anxiety clinic are
Lyme victims, a phenomenon he thinks merits more study.


With proper additional antibiotic treatment, such as tetracycline,
many people can recover "80 to 90 percent" of the mental function
they have lost, Fallon said.



=====*=====


II.   LYMENET: Questions about LD and Pregnancy (A)
---------------------------------------------------
Sender: Kathy McKenzie <lmcken@netten.net>


Here are some references on congenital Lyme I have collected over
the past few years.


*****AMERICAN JOURNAL OF MEDICINE*****

(REFERENCE 1 OF 10)
95243257


Shapiro ED
Lyme disease in children.


In: Am J Med (1995 Apr 24) 98(4A):69S-73S

Lyme disease is the most common vector-borne disease among children
 in the United States; the incidence of Lyme disease is higher among
 children than among adults. Extensive publicity in the lay press
 about the effects of Lyme disease has led to widespread anxiety about
 this illness that is out of proportion to the actual frequency of
 severe consequences, especially among children. The problem is
 exacerbated by the difficulty of documenting the diagnosis (or more
 often of ruling out the diagnosis in children with vague symptoms),
 especially when the diagnosis depends on serologic tests that are
 often inaccurate. This caveat applies particularly to commercial
 laboratories using prepackaged kits, which often give inaccurate
 results that should not be relied on by themselves to make a
 diagnosis. Careful prospective studies have found that nearly 90% of
 children with Lyme disease have erythema migrans. Although there has
 been great concern about congenital Lyme disease, no data suggest

 that it is a significant problem, nor has transmission of Lyme
 disease through breast milk been documented. Virtually all children
 will respond well to treatment for any stage of Lyme disease.
 Misdiagnosis is the most common reason for treatment failure. Long-
 term follow-up studies indicate that the prognosis for children with
 Lyme disease is excellent.


Institutional address:
    Department of Pediatrics
    Yale University School of Medicine
    New Haven
    Connecticut 06520-8064
    USA.



*****ANNALS OF INTERNAL MEDICINE*****

(REFERENCE 2 OF 10)
85223525


Schlesinger PA  Duray PH  Burke BA  Steere AC  Stillman MT
Maternal-fetal transmission of the Lyme disease spirochete, Borrelia
 burgdorferi.


In: Ann Intern Med (1985 Jul) 103(1):67-8

[No Abstract Available]


*****JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY*****

(REFERENCE 3 OF 10)
88257659


Berger BW  MacDonald AB  Benach JL
Use of an autologous antigen in the serologic testing of patients
 with erythema migrans of Lyme disease.


In: J Am Acad Dermatol (1988 Jun) 18(6):1243-6

We attempted to detect an early rise in antibody titers to Borrelia
 burgdorferi in the serum of patients with erythema migrans of Lyme
 disease by utilizing B. burgdorferi isolates obtained from patients'
 own skin lesions instead of the B31 reference strain. B. burgdorferi
 was isolated from nine of 23 skin biopsy specimens submitted for
 culture. Elevated antibody titers were not detected in any of the 23
 acute serum samples by immunofluorescence assay. The antigens derived
 from patient isolates were no more effective than the reference
 strain in detecting antibodies in patients with early Lyme disease.


Institutional address:
    Department of Dermatology
    New York University School of Medicine
    New York.



*****JOURNAL OF INFECTIOUS DISEASES*****

(REFERENCE 4 OF 10)
85291038


Benach JL  Coleman JL  Habicht GS  MacDonald A  Grunwaldt E  Giron JA
Serological evidence for simultaneous occurrences of Lyme disease and
 babesiosis.


In: J Infect Dis (1985 Sep) 152(3):473-7

Babesia microti and Borrelia burgdorferi, the spirochetal agent of
 Lyme disease, are both transmitted by the tick Ixodes dammini.
 Serological evidence has shown that 54% of the patients with
 babesiosis tested have IgG and IgM antibodies to the spirochete
 causing Lyme disease. Likewise, 66% of randomly selected patients
 with Lyme disease from geographic areas endemic for both diseases,
 but not from areas where babesiosis does not occur, also have IgM and
 IgG antibodies to B. microti. Antigenic cross-reactivity is not the
 reason for these findings, as laboratory animals experimentally
 infected with B. microti do not develop antibodies to B. burgdorferi,
 and laboratory animals immunized with organisms derived from pure
 cultures of spirochetes do not develop antibodies to B. microti. We
 suggest that these patients are concurrently exposed to both
 organisms by doubly infected tick vectors.



*** <NOT IN PaperChase Core Journals> ***


*****JOURNAL OF CLINICAL NEURO-OPHTHALMOLOGY*****

(REFERENCE 5 OF 10)
89198123


Pizzarello LD  MacDonald AB  Semlear R  DiLeo F  Berger B
Temporal arteritis associated with Borrelia infection. A case report.


In: J Clin Neuroophthalmol (1989 Mar) 9(1):3-6

A 71-year-old man had sudden vision loss associated with headache. A
 temporal artery biopsy revealed a typical picture of giant cell
 arteritis. Subsequent steroid therapy failed to restore sight. A
 later blood culture contained spirochetes compatible with Borrelia
 species, and a silver stain of the temporal artery biopsy specimen
 demonstrated a similar spirochete. Treatment with i.v. ceftriaxone
 sodium led to some limited return of sight. To our knowledge, this is
 the first case report of a spirochete compatible with Borrelia found
 in a temporal artery biopsy specimen.


Institutional address:
    Southampton Hospital
    New York 11968.


(REFERENCE 6 OF 10)
88116055


MacDonald AB
Lyme disease. A neuro-ophthalmologic view.


In: J Clin Neuroophthalmol (1987 Dec) 7(4):185-90

Lyme borreliosis is a spirochetal infection with a potential to
 produce a clinical disease in the human host with protean
 manifestations as diverse as the spectrum of disease caused by
 Treponema pallidum. Neuro-ophthalmologic manifestations of Lyme
 borreliosis are emphasized in this short review. A brief historical
 chronicle of Lyme disease is offered. Potential pitfalls in the
 diagnosis of Lyme disease with an emphasis on false negative serology
 and currently available diagnostic modalities are presented.
 Therapeutic options for Lyme borreliosis are briefly reviewed.


Institutional address:
    Department of Pathology
    Southampton Hospital
    NY 11968.



*****NEW YORK STATE JOURNAL OF MEDICINE*****

(REFERENCE 7 OF 10)
88095529


MacDonald AB  Benach JL  Burgdorfer W
Stillbirth following maternal Lyme disease.


In: N Y State J Med (1987 Nov) 87(11):615-6

[No Abstract Available]


*****PEDIATRIC NEUROLOGY*****

(REFERENCE 8 OF 10)
95077616


Gerber MA  Zalneraitis EL
Childhood neurologic disorders and Lyme disease during pregnancy.


In: Pediatr Neurol (1994 Jul) 11(1):41-3

To determine the prevalence of clinically significant nervous system
 disease attributable to transplacental transmission of Borrelia
 burgdorferi, we surveyed neurologists in areas of the United States
 in which Lyme disease is endemic (i.e., Massachusetts, Rhode Island,
 Connecticut, New York, New Jersey, Wisconsin, and Minnesota).
 Overall, 162 of the 176 (92%) pediatric neurologists contacted
 responded to the survey with a range of 90-100% in the different
 geographic areas. One pediatric neurologist was following 3 children
 who were labeled as having "congenital Lyme disease," but none of the
 3 met our case definition. None of the other pediatric neurologists
 surveyed had ever seen a child whose mother had been diagnosed as
 having Lyme disease during pregnancy. Similarly, none of the 37 adult
 neurologists in Connecticut surveyed had ever seen a child whose
 mother had been diagnosed as having had Lyme disease during
 pregnancy. We conclude that congenital neuroborreliosis is either not

 occurring or is occurring at an extremely low rate in areas endemic
 for Lyme disease.


Institutional address:
    Department of Pediatrics
    University of Connecticut Health Center
    Farmington 06030-1515.



*****RHEUMATIC DISEASES CLINICS OF NORTH AMERICA*****

(REFERENCE 9 OF 10)
90069113


MacDonald AB
Gestational Lyme borreliosis. Implications for the fetus.


In: Rheum Dis Clin North Am (1989 Nov) 15(4):657-77

Great diversity of clinical expression of signs and symptoms of
 gestational Lyme borreliosis parallels the diversity of prenatal
 syphilis. It is documented that transplacental transmission of the
 spirochete from mother to fetus is possible. Further research is
 necessary to investigate possible teratogenic effects that might
 occur if the spirochete reaches the fetus during the period of
 organogenesis. Autopsy and clinical studies have associated
 gestational Lyme borreliosis with various medical problems including
 fetal death, hydrocephalus, cardiovascular anomalies, neonatal
 respiratory distress, hyperbilirubinemia, intrauterine growth
 retardation, cortical blindness, sudden infant death syndrome, and
 maternal toxemia of pregnancy. Whether any or all of these
 associations are coincidentally or causally related remains to be
 clarified by further investigation. It is my expectation that the
 spectrum of gestational Lyme borreliosis will expand into many of the
 clinical domains of prenatal syphilis.


Institutional address:
    Southampton Hospital
    New York.



*****ZENTRALBLATT FUR BAKTERIOLOGIE, MIKROBIOLOGIE, UND HYGIENE.  
SERIES*****


(REFERENCE 10 OF 10)
87208538


MacDonald AB
Human fetal borreliosis, toxemia of pregnancy, and fetal death.


In: Zentralbl Bakteriol Mikrobiol Hyg [A] (1986 Dec) 263(1-2):189-200

[No Abstract Available]


*****PAEDIATRIC AND PERINATAL EPIDEMIOLOGY*****

(REFERENCE 1 OF 1)
96061203


Williams CL  Strobino B  Weinstein A  Spierling P  Medici F
Maternal Lyme disease and congenital malformations: a cord blood
 serosurvey in endemic and control areas.


In: Paediatr Perinat Epidemiol (1995 Jul) 9(3):320-30

This report describes a cohort study of over 5000 infants and their
 mothers who participated in a cord blood serosurvey designed to
 examine the relationship between maternal exposure to Lyme disease
 and adverse pregnancy outcome. Based on serology and reported
 clinical history, mothers of infants in an endemic hospital cohort
 are 5 to 20 times more likely to have been exposed to B. burgdorferi
 as compared with mothers of infants in a control hospital cohort. The
 incidence of total congenital malformations was not significantly
 different in the endemic cohort compared with the control cohort, but
 the rate of cardiac malformations was significantly higher in the
 endemic cohort [odds ratio (OR) 2.40; 95% confidence interval (CI)
 1.25, 4.59] and the frequencies of certain minor malformations
 (haemangiomas, polydactyly, and hydrocele), were significantly
 increased in the control group. Demographic variations could only
 account for differences in the frequency of polydactyly. Within the
 endemic cohort, there were no differences in the rate of major or

 minor malformations or mean birthweight by category of possible
 maternal exposure to Lyme disease or cord blood serology. The
 disparity between observations at the population and individual
 levels requires further investigation. The absence of association at
 the individual level in the endemic area could be because of the
 small number of women who were actually exposed either in terms of
 serology or clinical history. The reason for the findings at the
 population level is not known but could be because of artifact or
 population differences.


Institutional address:
    Child Health Center
    American Health Foundation
    Valhalla
    New York 10595
    USA.



=====*=====


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