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Volume: 2
Issue: 13
Date: 08-Aug-94


Table of Contents:

I.    LYMENET: Meeting with NIH Director Scheduled for Thursday
II.   LYMENET: CDC Grant Amounts for FY94
III.  LYMENET: LDAOhio to Hold First Annual Meeting 9/24
IV.   CLIN PEDIATR (PHILA): Physician beliefs, attitudes, and
      approaches toward Lyme disease in an endemic area
V.    CENT EUR J PUBLIC HEALTH:  Electron microscopy and the
      polymerase chain reaction of spirochetes from the blood
      of patients with Lyme disease
VI.   J CLIN MICROBIOL: Isolation of Borrelia burgdorferi from
      biopsy specimens taken from healthy-looking skin of
      patients with Lyme borreliosis
VII.  How to Subscribe, Contribute, and Get Back Issues


Newsletter:

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


IDX#                Volume 2 - Number 13 - 8/08/94
IDX#                            INDEX
IDX#
IDX#  I.    LYMENET: Meeting with NIH Director Scheduled for Thursday
IDX#  II.   LYMENET: CDC Grant Amounts for FY94
IDX#  III.  LYMENET: LDAOhio to Hold First Annual Meeting 9/24
IDX#  IV.   CLIN PEDIATR (PHILA): Physician beliefs, attitudes, and
IDX#        approaches toward Lyme disease in an endemic area
IDX#  V.    CENT EUR J PUBLIC HEALTH:  Electron microscopy and the
IDX#        polymerase chain reaction of spirochetes from the blood
IDX#        of patients with Lyme disease
IDX#  VI.   J CLIN MICROBIOL: Isolation of Borrelia burgdorferi from
IDX#        biopsy specimens taken from healthy-looking skin of
IDX#        patients with Lyme borreliosis
IDX#  VII.  How to Subscribe, Contribute, and Get Back Issues
IDX#


QUOTE OF THE WEEK:

     "A wise man should consider that health is the greatest
      of human blessings, and learn how by his own thought
      to derive benefit from his illnesses"


     -- Hippocrates, c. 460-377 B.C.


I.    LYMENET: Meeting with NIH Director Scheduled for Thursday
---------------------------------------------------------------
Source: LymeNet News
Byline: By Marc Gabriel with reports from Carl Brenner
Date: August 5, 1994


Representatives of the Lyme Disease Foundation, The American Lyme
Disease Foundation, and the Lyme Disease Resource Center are scheduled
to meet with Dr. Harold E. Varmus, Director of the NIH, next Thursday,
August 11 at NIH headquarters in Bethesda, MD.  Dr. Varmus called
the meeting to discuss LD research issues with national LD
organizations.


According to sources at the NIH, five individuals have been scheduled
to attend the meeting as of last Friday.  There is no indication at
this time that a public forum will take place.  LymeNet Newsletter
Contributing Editor Carl Brenner is scheduled to represent the Lyme
Disease Resource Center.


Lyme disease researchers, physicians, and patients are encouraged to
communicate their thoughts on LD research to Dr. Varmus.  Letters
should contain only one or two clear points and should be as short as
possible.  Long letters containing many ideas are generally less
effective.


Correspondence should be directed to:

Harold Varmus MD, Director
National Institutes of Health
Building 1 Room 126
1 Center Drive MSC 0148
Bethesda,  MD  20892-0148
Voice: 301-496-2433
Fax:   301-402-2700


You may wish to copy your correspondence to:

Donna Shalala PhD
Secretary of Health and Human Services
Hubert H. Humphrey Building
200 Independence Av NW
Washington, DC 20201


According to the NIH gopher server on the Internet, Dr. Varmus' email
address is:   harold_varmus%nihod1e.bitnet@cu.nih.gov



=====*=====


II.   LYMENET: CDC Grant Amounts for FY94
-----------------------------------------
Cooperative Agreements to Conduct Research, Treatment, and Education
          Programs on Lyme Disease in the United States
             Department of Health and Human Services
           Centers for Disease Control and Prevention


American College of Physicians (Scott)                       $220,000
Minnesota Department of Health (Moen)                        $200,000
New York Medical College (Fish)                              $ 90,000
New York Medical College (Wormser)                           $ 80,000
New York Medical College (Nadelman)                          $ 75,000
Mayo Clinic Foundation (Persing)                             $120,000
Marshfield Medical Research Education Foundation (Reed)      $ 42,000
Harvard University School of Public Health (Pollack)         $ 75,000
Oregon Department of Health (Hedberg)                        $ 60,126
West Virginia Department of Health (Haddy)                   $ 22,655
University of Illinois at Urbana - Champagne (Jones)         $ 70,000
Georgia Southern University (Oliver)                         $100,000
New England Medical Center (Steere)                          $165,000
Connecticut Department of Public Health (Cartter)            $220,000
American Lyme Disease Foundation, Inc. (Weld)                $ 45,000

New Jersey Department of Health (Spitalny)                   $104,000
University of California - Berkeley (Lane)                   $100,000
Michigan Department of Public Health (Hall)                  $ 60,000
New York Department of Health (Bosler)                       $ 82,000
New York Department of Health (White)                        $225,000
Tulane Regional Primate Center (Philipp)                     $160,000
Yale University (Flavell)                                    $140,000
State University of New York (Luft)                          $150,000
Lyme Disease Foundation, Inc. (Forschner)                    $ 75,000
Rhode Island Department of Health (Matyas)                   $ 70,000



=====*=====


III.  LYMENET: LDAOhio to Hold First Annual Meeting 9/24
--------------------------------------------------------
Sender: Jean Weisert <LymeWife@aol.com>
Subject: LDAOhio Conference


LDAOhio (Lyme Disease Association of Ohio) will be holding its first
annual membership meeting on Saturday, 9/24/94, at St. Edward's
Catholic Church in Granville Ohio from 8:30 a.m. to 3 p.m.  The
meeting is co-sponsored with Licking Memorial Hospital in Newark and
Continuing Education Units (CEUs) will be awarded to nurses.  The
emphasis will be on chronic LD.


Presenters:
Dr. James Katzel of Ukiah CA -- "LD 1944 State of the Art"
Dr. Craig Cleveland -- "Chronic LD in Ohio"
Dr. Richard Berry, Director of Ohio Dept of Health, Vector-Borne
   Disease Unit -- "What is Being Done, What Can Be Done, and What
   We Want To Do"
Dr. Gawaine Banks, psychologist from Cincinnati -- "Coping With LD"
Ann Graupman, parent and patient advocate from Cleveland --
   "Recognizing LD in Children"


The $10 conference fee includes Continental breakfast, lunch, and
refreshments. All those interested in LD are invited to attend.
For more info, call 614-928-LYME or 513-748-0150 or write to
LDAOhio, 27 Barton Place SE, Hebron, OH 43025.  Fax inquiries to
Tim Weisert, 614-349-4185. For CEU credit, contact Adele Sabol,
Licking Memorial Hospital, 614-344-0331 or write to her at LMH;
1320 W. Main St; Newark, OH 43055.



=====*=====


IV.   CLIN PEDIATR (PHILA): Physician beliefs, attitudes, and
     approaches toward Lyme disease in an endemic area
--------------------------------------------------------------
AUTHORS: Eppes SC, Klein JD, Caputo GM, Rose CD
ORGANIZATION: Division of Pediatric Infectious Diseases, Alfred I.
             duPont Institute, Wilmington, Delaware 19899.
REFERENCE: Clin Pediatr (Phila) 1994 Mar;33(3):130-4
ABSTRACT:


To assess the beliefs and practice habits regarding Lyme disease among
practitioners, questionnaires were sent to physicians in a
seven-county Lyme-endemic region.  One hundred twenty-four evaluable
responses were returned from 53 family physicians, 39 pediatricians,
27 internists, and five subspecialists who diagnosed three to four
cases of Lyme disease per year, on average.  The majority presented
with erythema migrans (EM) or other early symptoms, although arthritis
was the presenting sign in 16%.  The enzyme-linked immunosorbent
assay (ELISA) was the most frequently ordered diagnostic test, but
45% of respondents did not specify which test when ordering Lyme
serology.  The majority would use amoxicillin or doxycycline to treat
EM in children or adults, respectively.  Nearly all would use
ceftriaxone for meningitis, and half would use it to treat Lyme
arthritis or Bell's palsy.  Physicians differed markedly in the
duration of therapy they would prescribe.  Eighty-three percent
would treat a patient for possible Lyme disease with antibiotics

(many intravenously), even in the absence of EM or positive serology.
Thirty-five percent of practitioners prescribed antibiotics for
deer-tick bites.  Our survey documents significant variation in
approaches to Lyme disease among primary-care physicians and
suggests the need for well-designed clinical trials, continuing
basic research, and physician education.



=====*=====


V.    CENT EUR J PUBLIC HEALTH:  Electron microscopy and the
     polymerase chain reaction of spirochetes from the blood
     of patients with Lyme disease
-------------------------------------------------------------
AUTHORS: Hulinska D, Krausova M, Janovska D, Rohacova H
        Hancil J, Mailer H
ORGANIZATION: Department of Electron Microscopy, National Institute
             of Public Health, Prague, Czech Republic
REFERENCE: Cent Eur J Public Health 1993 Dec;1(2):81-5
ABSTRACT:


Results of studies using direct antigen detection suggest that
seronegative Lyme borreliosis is not rare and support the hypothesis
that Borrelia antigens can persist in humans.  We report three
successful cultures from blood out of 30 attempts from 96 Lyme
disease patients.  The proof of borreliaemia in early or late
phases of Lyme disease by immuno-capture electron microscopy has
practical importance for subsequent cultivation.  The polymerase
chain reaction with oligonucleotide sequences directed against 16S
rRNA identified two of our blood isolates as Borrelia burgdorferi
genospecies III., VS 461 group, and one as Borrelia garinii sp. nov.
All of the three isolates were reactive with monoclonal antibody
H9724 against flagellin and with antibody against main extracellular
protein at 83 kDa.  Borrelia garinii had a single predominant protein
OspA at 33.5 kDa and reacted with monoclonal antibody H5332 in
contrast to two isolates of the VS 461 group with two major proteins
OspA and OspB at 32.5 and 35 kDa. We conclude that isolation of

spirochetes from the blood might prove successful in clinically
selected cases of Lyme borreliosis.  Immuno-capture electron
microscopy has proved to be a sensitive assay for monitoring and
studying Lyme borreliosis.



=====*=====


VI.   J CLIN MICROBIOL: Isolation of Borrelia burgdorferi from biopsy
     specimens taken from healthy-looking skin of patients with Lyme
     borreliosis
----------------------------------------------------------------------
AUTHORS: Kuiper H, van Dam AP, Spanjaard L, de Jongh BM,
        Widjojokusumo A, Ramselaar TC, Cairo I, Vos K, Dankert J
ORGANIZATION: Department of Medical Microbiology, Academic Medical
             Centre, University Hospital, University of Amsterdam,
             The Netherlands
REFERENCE: J Clin Microbiol 1994 Mar;32(3):715-20
ABSTRACT:


Erythematous skin lesions due to infection with Borrelia burgdorferi
will often disappear without antibiotic treatment.  The aim of the
study was to assess whether after disappearance of the erythematous
skin lesion B. burgdorferi is still present in the healthy-looking
skin of untreated patients.  In six patients, a skin biopsy specimen
was taken at the site of a previous erythematous skin lesion 1 to 6
months after disappearance of the lesion.  Four of them presented with
early disseminated Lyme  borreliosis.  In one additional patient with
early disseminated Lyme borreliosis, the site of a previous tick bite
was biopsied.  None of these patients had been treated with
antibiotics before presentation.  The cultures of the skin biopsy
specimens of the seven patients showed growth of Borrelia species.
By rRNA gene restriction analysis and genospecies-specific PCR, six
isolates were classified as Borrelia garinii and one as Borrelia
group VS461.  These results show that B. burgdorferi can still be
cultured from the skin after disappearance of the erythematous skin

lesion or at the site of a previous tick bite.


=====*=====


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