Volume: 6 Table of Contents: I. LYME TIMES: Antibodies may be Hidden in Immune Complexes II. EPIDEMIOL INFECT: Transmission risk of Borrelia burgdorferi sensu lato from Ixodes ricinus ticks to humans in southwest Germany III. J NEUROL NEUROSURG PSYCHIATRY: Differential diagnosis of multiple sclerosis: contribution of magnetic resonance techniques. IV. N ENG J MED: Persistent parasitemia after acute babesiosis. V. EPIDEMIOL MIKROBIOL IMUNOL: Educational status of the Czech population about Lyme borreliosis and experience with tick bites IV. ABOUT THE LYMENET NEWSLETTER Newsletter: *********************************************************************** * The National Lyme Disease Network * * http://www.LymeNet.org/ * * LymeNet Newsletter * *********************************************************************** Volume 6 / Number 08 / 21-AUG-98 INDEX I. LYME TIMES: Antibodies may be Hidden in Immune Complexes II. EPIDEMIOL INFECT: Transmission risk of Borrelia burgdorferi sensu lato from Ixodes ricinus ticks to humans in southwest Germany III. J NEUROL NEUROSURG PSYCHIATRY: Differential diagnosis of multiple sclerosis: contribution of magnetic resonance techniques. IV. N ENG J MED: Persistent parasitemia after acute babesiosis. V. EPIDEMIOL MIKROBIOL IMUNOL: Educational status of the Czech population about Lyme borreliosis and experience with tick bites IV. ABOUT THE LYMENET NEWSLETTER =====*===== I. LYME TIMES: Antibodies may be Hidden in Immune Complexes -------------------------------------------------------------- Source: the Lyme Times, April-June, 1998, p28 By: Jean Hubbard Editor's Note: This report was written based on a presentation at the 1998 Lyme Disease Foundation Scientific Conference. The remainder of this presentation describes studies using immune complex assays developed by Dr. Steve Shutzer and his colleagues. Full appreciation of those data require graphs and slides which the LymeNet Newsletter is unable to duplicate. ----- Classic serologies can be falsely negative -- or remain positive after infections have cleared -- due to the nature of the "immune complexes" that are formed when antibodies bind with antigen from the infecting agent. Steve Shutzer, MD, of the University of Medicine and Dentistry of New Jersey, described how these immune complexes develop and the "powerful effects" they have on what one can find when sampling sera for antibodies. Immediately after an infection begins, the infecting organism "begins proliferating and shedding antigen," a process which takes some time. For a while there is a growing load of antigen compared to the antibody response to it. Typically, it takes lymphocytes responding to an antigen four days to differentiate into plasma cells and produce antibodies directed to the stimulating antigen. The antibodies migrate to the antigen and lock onto it, typically making it vulnerable to destruction by the immune system. It then takes "a lot longer," Dr. Schutzer explained, until all available antigen is complexed and the surplus "free" antibodies are of sufficient number to be detectable by an antibody test, "whether the best test or the worst test." The same process occurs in all infections, including viruses and other bacteria. In Lyme disease, most studies indicate it takes from four to six weeks for the free antibodies to become detectable. Before this point the patient is in an apparent seronegative state. The only way to find antibodies during the preceding time would be by using techniques to capture the immune complexes, pull them apart and analyze the components. Because the ongoing interaction between an infectious antigen and the host's immune response involves several factors, it can result in a number of different outcomes: Conceivably a person could build up a lot of antibody and clear the infection, with the antibody response persisting for months to years; a positive serology in this situation would be a "false positive." The antibodies also could decrease and establish a level, or plateau, that still remains detectable. Or they might decrease even further, to a plateau below the threshold of antibody detection, and the patient would then be antibody negative on testing whether the infection had cleared or not. Therefore, according to Dr. Schutzer, once it had been established that a patient has Lyme disease, diagnostically it no longer matters what the antibody level is. Tests for antigen, he believes, are more likely to be of actual diagnostic significance because if antigen is found, either it is not being cleared or something is continuing to produce it. Antigen detection also allows for earlier diagnosis, during the period when antigen proliferation exceeds antibody production. Dr. Shutzer believes that a more promising strategy than counting antibodies via serology is to capture the immune complexes and analyze them for both antibodies and antigen. In every single infectious disease that's ever been studied, he claimed, when immune complexes can no longer be found, that seems to correlate with elimination of infection. When evaluating new tests, he cautioned, it is imperative to use the noncontroversial cases; therefore, in evaluating tests for Lyme disease, one starts off with people with erythema migrans or microbiological confirmation of infection in some tissue by PCR or culture. Like the other presenters who talked about classic Lyme serologies, Dr. Shutzer believes that better serologic analyses would look at proteins unique to B. burgdorferi, including OspA, OspB, and the newly described p37 and p35, rather than the cross-reacting proteins such as 41kDa which are tested by classic serologies. The current serologies, he said, encourage people to "count the number of bands and vote on it." "If you find antibody reactive to p37 and p35, particularly in a complex where there are also antigens," he observed, "then you're likely to have active early infection with Lyme disease." He predicts that more new unique bands will be discovered, enabling research to "clear up a lot of the current misunderstanding in defining who had early Lyme disease and who has chronic Lyme disease." =====*===== II. EPIDEMIOL INFECT: Transmission risk of Borrelia burgdorferi sensu lato from Ixodes ricinus ticks to humans in southwest Germany ------------------------------------------------------------------ AUTHORS: Maiwald M, Oehme R, March O, Petney TN, Kimmig P, Naser K, Zappe HA, Hassler D, von Knebel Doeberitz M ORGANIZATION: Department of Microbiology and Immunology, Stanford University School of Medicine, Palo Alto, CA 94304, USA REFERENCE: Epidemiology and Infection, in press The risk of Borrelia burgdorferi infection and the value of antibiotic prophylaxis after tick bite are controversial. In this study, performed in two areas of southwestern Germany, ticks were collected from 730 patients and examined by the polymerase chain reaction (PCR) for B. burgdorferi. To assess whether transmission of B. burgdorferi occurred, the patients were clinically and serologically examined after tick removal and during follow-up examinations. Data from all tick bites gave a total transmission rate of 2.6% (19 patients). Eighty-four ticks (11.3%) were PCR positive. Transmission occurred to 16 (26.7%) of 60 patients who were initially seronegative and could be followed up after the bite of an infected tick. These results indicate that the transmission rate from infected ticks in Europe is higher than previously assumed. Examination of ticks and antibiotic prophylaxis in the case of positivity appear to be indicated. =====*===== III. J NEUROL NEUROSURG PSYCHIATRY: Differential diagnosis of multiple sclerosis: contribution of magnetic resonance techniques. ------------------------------------------------------------------------ AUTHORS: Triulzi F, Scotti G ORGANIZATION: Department of Neuroradiology, Scientific Institute H S Raffaele, Milan, Italy. [email protected] REFERENCE: J Neurol Neurosurg Psychiatry 1998 May;64 Suppl 1:S6-14 ABSTRACT: It is widely accepted that magnetic resonance imaging (MRI) findings are not totally specific for the diagnosis of multiple sclerosis. White matter lesions that mimic those of multiple sclerosis may be detected in both normal volunteers and patients harbouring different diseases. Virtually all the characteristic features of multiple sclerosis are sometimes encountered in other conditions affecting predominantly the white matter. Different conditions such as vasculitis, subcortical atherosclerotic leukoencephalopathy, Lyme disease, or acute disseminated encephalomyelitis can be virtually indistinguishable from multiple sclerosis on conventional MR images. Also the FLAIR technique adds little to the differential diagnosis. The calculation of magnetisation transfer ratio (MT ratio) may be useful to better characterise some entities, such as vasculitis, from multiple sclerosis. =====*===== IV. N ENG J MED: Persistent parasitemia after acute babesiosis. ----------------------------------------------------------------- AUTHORS: Krause PJ, Spielman A, Telford SR 3rd, Sikand VK, McKay K Christianson D, Pollack RJ, Brassard P, Magera J, Ryan R, Persing DH ORGANIZATION: Department of Pediatrics, Connecticut Children's Medical Center and University of Connecticut School of Medicine, Hartford CT 06106, USA. REFERENCE: N Engl J Med 1998 Jul 16;339(3):160-5 ABSTRACT: BACKGROUND: Babesiosis, a zoonosis caused by the protozoan Babesia microti, is usually not treated when the symptoms are mild, because the parasitemia appears to be transient. However, the microscopical methods used to diagnose this infection are insensitive, and few infected people have been followed longitudinally. We compared the duration of parasitemia in people who had received specific antibabesial therapy with that in silently infected people who had not been treated. METHODS: Forty-six babesia-infected subjects were identified from 1991 through 1996 in a prospective, community-based study designed to detect episodes of illness and of seroconversion among the residents of southeastern Connecticut and Block Island, Rhode Island. Subjects with acute babesial illness were monitored every 3 months for up to 27 months by means of thin blood smears, Bab. microti polymerase-chain- reaction assays, serologic tests, and questionnaires. RESULTS: Babesial DNA persisted in the blood for a mean of 82 days in 24 infected subjects without specific symptoms who received no specific therapy. Babesial DNA persisted for 16 days in 22 acutely ill subjects who received clindamycin and quinine therapy (P=0.03), of whom 9 had side effects from the treatment. Among the subjects who did not receive specific therapy, symptoms of babesiosis persisted for a mean of 114 days in five subjects with babesial DNA present for 3 or more months and for only 15 days in seven others in whom the DNA was detectable for less than 3 months (P<0.05); one subject had recrudescent disease after two years. CONCLUSIONS: When left untreated, silent babesial infection may persist for months or even years. Although treatment with clindamycin and quinine reduces the duration of parasitemia, infection may still persist and recrudesce and side effects are common. Improved treatments are needed. =====*===== V. EPIDEMIOL MIKROBIOL IMUNOL: Educational status of the Czech population about Lyme borreliosis and experience with tick bites ---------------------------------------------------------------------- AUTHORS: Basta J, Janovska D, Daniel M ORGANIZATION: Statni zdravotni, ustav, Praha, Czech Republic REFERENCE: Epidemiol Mikrobiol Imunol 1998 Apr;47(2):52-5 ABSTRACT: The incidence of Lyme borreliosis (LB) has a rising trend since 1995. In 1995 6,302 cases were reported, in 1996 4,192 (EPIDAT, SZU). The objective of the present work was to assess in a selected population sample knowledge of ticks and their relationship to Lyme borreliosis. The investigation was based on a survey using questionnaires. 110 respondents were selected according to the following pattern: 19 secondary school students, 32 blood donors, 44 visitors of parks, 15 countryside people. 99.1% of the subjects knew about the existence of ticks in the Czech Republic, 10.9% of the respondents do not know about Lyme borreliosis. More than 80% of the people are in the countryside at least once a week. 87% of the people report they had a tick, 75% removed a tick from another person. Only 6.7% of the respondents never had any contact with ticks. When removing ticks 17% of the subjects use disinfection, 67% use oil. Almost 30% of the respondents remove ticks with bare hands and more than 14% destroy them by squashing them between their fingers. 41% are not aware of the risk of transmission of tick-borne encephalitis. From the investigation a frequent contact of the population with ticks is apparent. Theoretical knowledge of the problem is extensive, practical experience is different. Unfortunately unsuitable habits in removal of ticks persist and this increases the risk of transmission of Lyme borreliosis. =====*===== IV. ABOUT THE LYMENET NEWSLETTER ----------------------------------------------------------------------- For the most current information on LymeNet subscriptions, contributions, and other sources of information on Lyme disease, please refer to the LymeNet Home Page at: http://www.lymenet.org ----------------------------------------------------------------------- To unsubscribe from the LymeNet newsletter, send a message to: [email protected] On the first line of the message, write: unsub lymenet-l ----------------------------------------------------------------------- LymeNet - The Internet Lyme Disease Information Source ----------------------------------------------------------------------- Editor-in-Chief: Marc C. Gabriel <[email protected]> FAX (for contributions ONLY): 908-789-0028 Contributing Editors: Carl Brenner <[email protected]> John Setel O'Donnell <[email protected]> Frank Demarest <[email protected]> Advisors: Carol-Jane Stolow, Director <[email protected]> William S. Stolow, President <[email protected]> The Lyme Disease Network of New Jersey ----------------------------------------------------------------------- WHEN COMMENTS ARE PRESENTED WITH AN ATTRIBUTION, THEY DO NOT NECESSARILY REPRESENT THE OPINIONS/ANALYSES OF THE EDITORS. ----------------------------------------------------------------------- THIS NEWSLETTER MAY BE REPRODUCED AND/OR POSTED ON BULLETIN BOARDS FREELY AS LONG AS IT IS NOT MODIFIED OR ABRIDGED IN ANY WAY. ----------------------------------------------------------------------- SEND ALL BUG REPORTS TO [email protected] ----------------------------------------------------------------------- |
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