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Volume: 3
Issue: 05
Date: 03-Apr-95


Table of Contents:

I.    Q&A: Experience with Timentin or Cefpodoxime in LD? (A)
II.   Q&A: Antibiotics for Thrombocytopenia Patients (Q)
III.  Q&A: Swelling Associated with LD Treatment (Q)  
IV.   AM J OPHTHALMOL: Diagnosis and clinical characteristics
      of ocular Lyme borreliosis
V.    NEUROLOGY: Inoculation of nonhuman primates with the N40
      strain of Borrelia burgdorferi leads to a model of
      Lyme neuroborreliosis faithful to the human disease
VI.   About The LymeNet Newsletter


Newsletter:

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


IDX#                Volume 3 - Number 05 - 4/03/95
IDX#                            INDEX
IDX#
IDX#  I.    Q&A: Experience with Timentin or Cefpodoxime in LD? (A)
IDX#  II.   Q&A: Antibiotics for Thrombocytopenia Patients (Q)
IDX#  III.  Q&A: Swelling Associated with LD Treatment (Q)  
IDX#  IV.   AM J OPHTHALMOL: Diagnosis and clinical characteristics
IDX#        of ocular Lyme borreliosis
IDX#  V.    NEUROLOGY: Inoculation of nonhuman primates with the N40
IDX#        strain of Borrelia burgdorferi leads to a model of
IDX#        Lyme neuroborreliosis faithful to the human disease
IDX#  VI.   About The LymeNet Newsletter
IDX#



QUOTE OF THE WEEK:

     "Ocular Lyme borreliosis was diagnosed in ten patients
      on the basis of medical history, clinical findings,
      and serologic test results... Four of the five
      patients with borderline or negative results by ELISA
      had a positive result by western blot analysis. "


      -- Karma et al. (see Section IV)


I.    Q&A: Experience with Timentin or Cefpodoxime in LD? (A)
-------------------------------------------------------------
Sender: Doris Aaronson <doris@xp.psych.nyu.edu>


My understanding is that there was a recent US conference of physicians
at which cefpodoxime (vantin) was recommended.  Based on that a friend
in Conn. was switched onto it, and also I will be starting that in a
couple of weeks.  Both of us will be on the following schedule:


day 1:  zithromax 500 mg
day 2:  zithromax 250 mg
day 3:  zithromax 250 mg
day 4:  nothing
day 5:  250 mg vantin + 500 mg probenecid (which affects the kidneys
       in ways to keep the vantin in your body longer)
day 6:  250 mg vantin + 500 mg probenecid
day 7:  250 mg vantin + 500 mg probenecid


Then start all over again.

Be sure to read the information in the Physician's Desk Reference
(or the drug manufacturer's package insert -- which you can often
get from your local pharmacist) as all 3 of the above drugs have
lots of side effects, some of which can be bad (e.g., the probenecid
can cause kidney stones).  As with all other antibiotics, you should
take at least 3 acidophilus pills a day to restore your gut bacteria
that the antibiotics wipe out, causing nausea & diarrhea, and sometimes
very serious problems of fungus and yeast overgrowth in your intestines
because the normal gut bacteria aren't around to control other bad
micro-organisms.  


If you obtain some useful information on vantin, I'd be interested.
My doctor said that he had used it in the hospital for other types
of rare infections. He thinks that the primary reason that doctors
are now thinking about it for Lyme is that it is new, and so the
Lyme bacteria would be less likely to have developed drug resistance
to it.



=====*=====


II.   Q&A: Antibiotics for Thrombocytopenia Patients (Q)
--------------------------------------------------------
Sender: Jerry am Ende <jerry@amendegw.lvs.dupont.com>


Our son has just displayed a bullseye rash.  His pediatrician has
placed him on antibiotics because she thinks this could be Lyme
disease.                      
                                                                                     
Now, here's the complication... Chris has genetic thrombocytopenia
where he is not producing platelets in normal quantities (platelet
counts run in the 20,000-30,000/ul range).                                                              
                                                                                     
I've read that ticks can also carry diseases that cause a
thrombocytopenic condition - can't remember the name of the
disease(s).  In any case, Chris cannot afford to have any platelets
consumed.                                    
                                                                                     
I'd like to alert his pediatrician and hematologist to look for
(and treat??) for certain things, but I need some advice regarding

what to tell them.
                                                                                     


=====*=====                                                                          
                                                                                     


III.  Q&A: Swelling Associated with LD Treatment (Q)
----------------------------------------------------
Sender: Suzanne Colter <73073.2677@compuserve.com>


I am a support group founder/leader for north and central Missouri -
the Green Hills Lyme Disease Support Group.  This covers a 5 county
area.  We have seen several cases of Lyme Disease in this area.  
Among all of the cases - the symptoms have been fairly comparable,
especially neurological symptoms.


However, recently we seeing an unusual symptom afflicting two Lyme
patients - that I am unfamiliar with and have not seen anything
published on this particular condition.  It even has our doctors
puzzled.


This condition starts out with swelling around the face, neck, throat,
and chest areas... then "travels" down into the upper legs - above the
knees.  Over a period of a few days to a few weeks - the swelling
continues until it has effected the whole body with the exception of
the hands and feet.  This appears as a form of bloating.


Now, granted, I have read and am familiar with sporadic swelling and
swelling in isolated areas of the body.  This usually "comes and goes"
as with most other Lyme symptoms.  But for this to effect and
encompass the entire body except for the hands and feet is new to me
and our physicians.  These two patients were on different oral
antibiotics and different medications.  So, this can not be
attributed to a drug interaction, and a form of allergy has been
ruled out.  Also, this swelling or bloating does fluctuate in
intensity from hour to hour, day to day... but both patients have had
this for 2 months, now.


In both cases, the swelling of the throat - has caused incidents of
associated swelling around the wind pipe, causing difficulty with
breathing.  On one occasion it was necessary to have a breathing tube
inserted to assist with breathing.  Also, some swelling around the
heart is suspected and in both patients - their blood pressure has
notably increased since the onset of this swelling.


To treat this swelling and the associated problems, especially when
the swelling produced breathing difficulty - injections of steroids
have been administered, or by IV when they were hospitalized.  This
seemed to help when first introduced.  However, subsequent treatments
of these steroids did not provide relief from these symptoms.


My question is if anyone has experienced or is familiar with this type
of swelling described above?  Any contributions or comments are
welcome.  I would appreciate any feedback, comments, or
recommendations from any physicians.



--

Please send responses to these questions to: LymeNet-L@Lehigh.EDU


=====*=====


IV.   AM J OPHTHALMOL: Diagnosis and clinical characteristics of
     ocular Lyme borreliosis
----------------------------------------------------------------
AUTHORS: Karma A, Seppala I, Mikkila H, Kaakkola S, Viljanen M,
        Tarkkanen A
ORGANIZATION: Department of Ophthalmology, University of Helsinki
REFERENCE: Am J Ophthalmol 1995 Feb;119(2):127-35
ABSTRACT:


PURPOSE: To establish a diagnosis, in a group of patients we studied
the characteristics of ocular Lyme borreliosis.
METHODS: During a two-year period, 236 patients with prolonged
external ocular inflammation, uveitis, retinitis, optic neuritis, or
unexplained neuro-ophthalmic symptoms were examined for Lyme
borreliosis.  Antibodies to Borrelia burgdorferi were measured by
indirect ELISA and western blot. Cerebrospinal fluid was also
analyzed by polymerase chain reaction.
RESULTS: Ocular Lyme borreliosis was diagnosed in ten patients on the
basis of medical history, clinical findings, and serologic test
results.  Results of ELISA disclosed that five patients were
seropositive, two patients showed borderline reactivity, and three
patients were seronegative.  Four of the five patients with borderline
or negative results by ELISA had a positive result by western blot
analysis.  In one seropositive patient, polymerase chain reaction
verified a gene of B. burgdorferi endoflagellin from the vitreous and

cerebrospinal fluid specimen.  In five of the six patients with known
onset of the Borrelia infection, the ocular disorder appeared as a
late manifestation.  Abnormalities of the posterior segment of the
eye, such as vitreitis, retinal vasculitis, neuroretinitis,
choroiditis, and optic neuropathy were seen in six patients.
Bilateral paralytic mydriasis, interstitial keratitis, episcleritis,
and anterior uveitis were seen in one patient each.
CONCLUSIONS: Late-phase ocular Lyme borreliosis is probably
underdiagnosed because of weak seropositivity or seronegativity in
ELISA assays.  Ocular borrelial manifestations show characteristics
resembling those seen in syphilis.



=====*=====


V.    NEUROLOGY: Inoculation of nonhuman primates with the N40
     strain of Borrelia burgdorferi leads to a model of
     Lyme neuroborreliosis faithful to the human disease
--------------------------------------------------------------
AUTHORS: Pachner AR, Delaney E, O'Neill T, Major E
ORGANIZATION: Department of Neurology, Georgetown University Medical
             Center, Washington, DC
REFERENCE: Neurology 1995 Jan;45(1):165-72
ABSTRACT:


We injected rhesus macaques with a highly infective strain of
Borrelia burgdorferi to assess whether experimentally inoculated
nonhuman primates (NHPs) could serve as models of human Lyme
neuroborreliosis (LNB).  The animals developed biopsy-confirmed
erythema migrans in the area of the inoculations.  ELISA testing
of sera revealed strong antibody reactivity to B burgdorferi antigens,
and Western blotting showed that 16-, 22-, 31-, 34-, and 41-kd
proteins of the spirochete were major antigens recognized by
antibody.  Culture and polymerase chain reaction (PCR) testing of
serial CSF specimens revealed that chronic infection of the CNS
occurred in all NHPs injected.  CSF pleocytosis occurred
concurrently with CNS infection.  Brain MRI revealed intense
meningeal inflammation in one NHP as manifested by gadolinium
uptake by the dura at the base of the temporal lobes.  All animals
had measurable antibody in the CSF after invasion.  These studies are
the first to demonstrate that experimental LNB in NHPs is a reliable

model faithful to the human disease, with spirochetal invasion of the
subarachnoid space.  This also is the first report of CSF samples
positive by culture in experimental LNB.  Inflammation in the CNS as
manifested by CSF pleocytosis and MRI findings was also correlated
with the presence of spirochetal DNA detected by PCR.  These data
support the hypothesis that the pathogenesis of LNB is associated
with direct spirochetal invasion, and provide evidence that CNS
involvement is more common than heretofore thought.



=====*=====


VI.   ABOUT THE LYMENET NEWSLETTER
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