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Volume: 2
Issue: 18
Date: 02-Nov-94


Table of Contents:

I.    LYMENET: National LymeNet Begins Holiday Donation Drive
II.   LYMENET: Steere Admits Some Of His Former Patients May
      Still Be Chronically Infected
III.  IMMUNOL LETT: Killing of Borrelia burgdorferi by
      macrophages is dependent on oxygen radicals and nitric
      oxide and can be enhanced by antibodies to outer surface
      proteins of the spirochete
IV.   J AM OSTEOPATH ASSOC: Lyme disease with concurrent
      ehrlichiosis
V.    About The LymeNet Newsletter


Newsletter:

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


IDX#                Volume 2 - Number 18 - 11/02/94
IDX#                            INDEX
IDX#
IDX#  I.    LYMENET: National LymeNet Begins Holiday Donation Drive
IDX#  II.   LYMENET: Steere Admits Some Of His Former Patients May
IDX#        Still Be Chronically Infected
IDX#  III.  IMMUNOL LETT: Killing of Borrelia burgdorferi by
IDX#        macrophages is dependent on oxygen radicals and nitric
IDX#        oxide and can be enhanced by antibodies to outer surface
IDX#        proteins of the spirochete
IDX#  IV.   J AM OSTEOPATH ASSOC: Lyme disease with concurrent
IDX#        ehrlichiosis
IDX#  V.    About The LymeNet Newsletter
IDX#


QUOTES OF THE WEEK:

1993:    "Standard antibiotic treatment probably fails less
         often that one might think.  Most apparent treatment
         failures actually reflect misdiagnosis." [1]
1994:    "It has become increasingly apparent that the Lyme
         disease spirochete, Borrelia burgdorferi, may
         persist in some patients for years."


      -- Allen C. Steere, M.D. (See Section II)


I.    LYMENET: National LymeNet Begins Holiday Donation Drive
-------------------------------------------------------------
Source: LymeNet News
Byline: By Marc Gabriel <marc@lymenet.org>
Date: October 30, 1994


The Lyme Disease Network is seeking donations to enhance the services
it provides to its members and the entire Internet community via the
National LymeNet.  Projects awaiting funding include an upgrade of
the system's connection to the Internet, an increase in storage
capacity, and the creation of database of all MedLine entries
relating to LD.


"As we enter the season of giving, please remember that the Lyme
Disease Network has been working to bring all the members of the LD
community together," said Bill Stolow, President of the Lyme Disease
Network.  "The National LymeNet is up and running, but it does take
additional funding to enable us to better serve the people who need
it the most."


Many subscribers have attempted to send money for their subscriptions
to the Newsletter.  In the past, these offerings have been returned,
as the Newsletter is provided to the Internet community free of
charge.  The LymeNet Holiday Donation Drive offers readers the
opportunity to express their gratitude by making a donation to
expand the range of LymeNet services.


For a $50 donation, contributors will receive a diskette containing
the current contents of the LymeNet gopher server.  This includes all
the past issues of the LymeNet Newsletter, the current consensus
treatment protocol, as well as the writings of physicians such as
Joseph Burrascano and Dorothy Pietrucha.


One hundred percent of all proceeds from this drive will benefit the
aforementioned projects.  All donations are fully tax-deductible.
This is your opportunity to help the Network spread the word about
the increasingly important issues relating to Lyme disease and LD
patients.  The Network receives no government funding and is
dependent on individual donations.


Please make your checks payable to the Lyme Disease Network.  Address
them to:     The Lyme Disease Network
            LymeNet Holiday Donation Drive
            43 Winton Road
            East Brunswick, NJ  08816


For donations of $50 or greater, please specify in which format (IBM
or MAC) you would like to receive your gopher server diskette.



=====*=====


II.   LYMENET: Steere Admits Some Of His Former Patients May Still
     Be Chronically Infected
------------------------------------------------------------------
Source: LymeNet News
Byline: By Marc Gabriel <marc@lymenet.org>
Date: October 25, 1994


Dr. Allen C. Steere, Chief of Rheumatology & Immunology at Tufts -
New England Medical Center, and the first to describe Lyme disease
as a distinct clinical entity, has asked some of his patients to
participate in a "follow-up" study designed to determine if they are
still infected with Borrelia burgdorferi, the causative agent of
Lyme disease, despite supposedly curative treatment.


In a letter to his former patients dated August 11, he expresses
concern that some may still harbor the spirochete.  "Is has become
increasingly apparent that the Lyme disease spirochete, Borrelia
burgdorferi, may persist in some patients for years," he writes.  
"Of particular concern, recent studies have shown that the spirochete
may persist in the nervous system in a small percentage of patients
and may cause chronic neurological involvement.  The purpose of our
long-term follow-up studies is to determine whether past patients may
still have evidence of Lyme disease and, if so, to offer appropriate
treatment.  These studies are being funded by the National Institutes
of Health and the Centers for Disease Control."


Steere has been an outspoken advocate of short term treatment for
Lyme disease for many years.  When asked to explain why some patients
improve with long term treatment, he has often cited the placebo
effect. [1]  Steere has rarely referenced any research demonstrating
persistent infection after treatment in his writings.


Reaction to the letter has been mixed.  One observer, who commented on
the condition of anonymity, was outraged.  "How can Dr. Steere
participate in legal actions against Dr. Joseph Natole in Michigan
for alleged over treatment of Lyme patients on one hand, and on the
other write a letter to his former patients which seems to acknowledge
that he many not have treated them intensively enough?  It's hypocrisy."


Others were more optimistic.  "Maybe this will be the turning point
for LD patients," said Carol Stolow, Director of the Lyme Disease
Network.  "It is significant that the grandfather of Lyme disease
has begun to admit the possibility of chronic persistent infection.
Hopefully, this will trickle down and reach the local practitioner."


[1] Steere AC, "Current Understanding of Lyme Disease," Hospital
Practice, April 15, 1993, 29-36.



=====*=====


III.  IMMUNOL LETT: Killing of Borrelia burgdorferi by macrophages
     is dependent on oxygen radicals and nitric oxide and can be
     enhanced by antibodies to outer surface proteins of the
     spirochete
------------------------------------------------------------------
AUTHORS: Modolell M, Schaible UE, Rittig M, Simon MM,
ORGANIZATION: Max-Planck-Institut fur Immunbiologie, Freiburg, Germany
REFERENCE: Immunol Lett 1994 May;40(2):139-46
ABSTRACT:


Interaction of B. burgdorferi organisms with mouse bone marrow-derived
macrophages (BMM phi) leads to phagocytosis of microorganisms,
induction of nitric oxide (NO) and superoxide radicals (O2-) by BMM
phi and killing of spirochetes.  Destruction of spirochetes by BMM phi
was quantified by a new method based on the release of radioactivity
from spirochetes pre-labelled with [3H]adenine.  Uptake of B.
burgdorferi by BMM phi, which mainly occurs by coiling phagocytosis,
generation of NO and O2- radicals as well as killing of spirochetes
were significantly enhanced by pre-opsonization of spirochetes with
monoclonal antibodies (mAb) to the outer surface proteins A and B but
not with those to the periplasmic flagellin. Addition of inhibitors
specific for NO and O2- radical synthesis either separately or
together to cultures of BMM phi and spirochetes resulted in only
partial reduction of the killing potential of effector cells.  The
data indicate that NO and O2- radicals are necessary, but not
sufficient, for complete elimination of B. burgdorferi by macrophages.

Together with previous findings that protection against B. burgdorferi
infection is conveyed by humoral immune responses the present data
indicate that one of the important functions of specific antibodies is
their participation in macrophage-mediated control of spirochetes.



=====*=====


IV.   J AM OSTEOPATH ASSOC: Lyme disease with concurrent
     ehrlichiosis
--------------------------------------------------------
AUTHORS: Paparone PW, Glenn WB
ORGANIZATION: Lyme Disease Center for South Jersey, Abescon
REFERENCE: J Am Osteopath Assoc 1994 Jul;94(7):568-70, 573, 577
ABSTRACT:


Lyme disease constitutes a major health hazard with an increased
incidence throughout the United States, in particular the eastern
states.  Human ehrlichiosis, also a tick-borne illness, has recently
been identified. It is characterized by fever, headache, malaise,
leukopenia, thrombocytopenia, and elevated liver enzyme titers, and
has been reported to occur mainly in the South Central and South
Atlantic states.  As with Lyme disease, most patients have a history
of tick exposure.  These two diseases may be difficult to
differentiate clinically. Physicians must consider the possibility of
both infections when patients become ill with a systemic illness after
tick exposure.  Although certain demographic and clinical features are
characteristic of these diseases, they can be misleading.  Only
serologic evidence can confirm the diagnosis.  Two cases of concurrent
Borrelia and Ehrlichia infections have been previously reported.
The authors herein describe a third case that further illustrates the
potential diagnostic dilemma posed by the concurrence of these two

entities.


=====*=====


V.   ABOUT THE LYMENET NEWSLETTER
-----------------------------------
For the most current information on LymeNet subscriptions,
contributions, and other sources of information on Lyme disease,
please request the LymeNet Resource Guide.  To obain the Guide,
send a blank message to:      resource-guide@lymenet.org
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LymeNet - The Internet Lyme Disease Information Source
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Editor-in-Chief: Marc C. Gabriel <a229@Lehigh.EDU>
           FAX: 908-789-0028
Contributing Editors: Carl Brenner <brenner@ldeo.Columbia.EDU>
                     John Setel O'Donnell <jod@Equator.COM>
                     Frank Demarest <76116.2065@CompuServe.COM>
Advisors: Carol-Jane Stolow, Director <carol@lymenet.org>
         William S. Stolow, President <bill@lymenet.org>

         The Lyme Disease Network of New Jersey (908-390-5027)
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