LymeNet Newsletter Volume 4 Issue 06

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:

*********************************************************************** * The National Lyme Disease Network * * LymeNet Newsletter * ***********************************************************************

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.

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II. LYMENET: Questions about LD and Pregnancy (A) --------------------------------------------------- Sender: Kathy McKenzie <[email protected]>

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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