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Volume: 3
Issue: 01
Date: 27-Jan-95


Table of Contents:

I.    LYMENET: Patient Seeks Individuals Denied Treatment By
      Insurers
II.   AM J TROP MED HYG: Evidence Supporting The Presence Of
      Borrelia burgdorferi In Missouri
III.  AM J PSYCHIATRY: Lyme Disease: A Neuropsychiatric Illness
IV.   SCAND J INFECT DIS: Prevalence Of Borrelia burgdorferi In
      Selected Tick Populations In Finland
V.    Q&A: Question About Platelet Count (Q)
VI.   About The LymeNet Newsletter


Newsletter:

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*                  The National Lyme Disease Network                  *
*                         LymeNet Newsletter                          *
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IDX#                Volume 3 - Number 01 - 1/27/95
IDX#                            INDEX
IDX#
IDX#  I.    LYMENET: Patient Seeks Individuals Denied Treatment By
IDX#        Insurers
IDX#  II.   AM J TROP MED HYG: Evidence Supporting The Presence Of
IDX#        Borrelia burgdorferi In Missouri
IDX#  III.  AM J PSYCHIATRY: Lyme Disease: A Neuropsychiatric Illness
IDX#  IV.   SCAND J INFECT DIS: Prevalence Of Borrelia burgdorferi In
IDX#        Selected Tick Populations In Finland
IDX#  V.    Q&A: Question About Platelet Count (Q)
IDX#  VI.   About The LymeNet Newsletter
IDX#


QUOTE OF THE WEEK:

     "These results confirm that B. burgdorferi is present
      in questing D. variabilis and A. americanum ticks in
      areas of Missouri where Lyme disease occurs."


     -- Feir et al. [See Section II]


I.    LYMENET: Patient Seeks Individuals Denied Treatment By Insurers
---------------------------------------------------------------------
Sender: Pete McFadden


I am looking for people who are being denied treatment for Lyme
disease by their insurance company or HMO as the result of a
recommendation by Dr. Robert T. Schoen.  Dr. Schoen is associated
with Yale University and is also in private practice in New Haven,
CT.  


My insurer has denied me treatment for LD based on Dr. Schoen's
review of my medical files.  Despite a physician observed EM rash,
two positive PCR results from different labs, compatible symptoms
and treatment recommendations from three physicians, Dr. Schoen's
letter to my insurer has blocked any antibiotic regimen.


If you or anyone you know is being denied treatment under these
circumstances, please contact me.  We may be able to share
information to help each other.


Pete McFadden
4611 Governors Drive #1001
Huntsville, AL 35805
205-721-2665 (D)
205-722-0474 (E)



=====*=====


II.   AM J TROP MED HYG: Evidence Supporting The Presence Of
     Borrelia burgdorferi In Missouri
------------------------------------------------------------
AUTHORS: Feir D, Santanello CR, Li BW, Xie CS, Masters E, Marconi R,
        Weil G
REFERENCE: Am J Trop Med Hyg 1994 Oct;51(4):475-82
ORGANIZATION: Department of Biology, St. Louis University, Missouri
ABSTRACT:


Although Lyme disease is commonly seen in the southcentral United
States, the epidemiology of the disease is poorly defined there.
The purpose of this study was to document the presence of Borrelia
burgdorferi in ticks collected in southeastern Missouri and around
the city of St. Louis.  Spirochetes were detected and identified as
B. burgdorferi by immunofluorescent antibody (IFA) tests using the
monoclonal antibody H5332 in 1.9% of Amblyomma americanum and 2.0%
of Dermacentor variabilis ticks collected.  The identity of IFA-
positive organisms was verified by polymerase chain reactions (PCRs)
with two different sets of B. burgdorferi-specific primers followed
by Southern blotting.  The DNA sequences of amplified 371-basepair
PCR products from two positive Missouri ticks showed 97-98% identity
with that obtained by the same method for the B31 strain of B.
burgdorferi.  These results confirm that B. burgdorferi is present
in questing D. variabilis and A. americanum ticks in areas of
Missouri where Lyme disease occurs.  Additional studies are needed

to determine the role of these ticks in the epidemiology of Lyme
disease in Missouri and neighboring states.



=====*=====


III.  AM J PSYCHIATRY: Lyme Disease: A Neuropsychiatric Illness
---------------------------------------------------------------
AUTHORS: Fallon BA, Nields JA
REFERENCE: Am J Psychiatry 1994 Nov;151(11):1571-83
ORGANIZATION: Department of Psychiatry, College of Physicians and
             Surgeons, Columbia University, New York
ABSTRACT:


OBJECTIVE: Lyme disease is a multisystemic illness that can affect
the central nervous system (CNS), causing neurologic and psychiatric
symptoms.  The goal of this article is to familiarize psychiatrists
with this spirochetal illness.  
METHOD: Relevant books, articles, and abstracts from academic
conferences were perused, and additional articles were located
through computerized searches and reference sections from
published articles.  
RESULTS: Up to 40% of patients with Lyme disease develop neurologic
involvement of either the peripheral or central nervous system.  
Dissemination to the CNS can occur within the first few weeks after
skin infection.  Like syphilis, Lyme disease may have a latency
period of months to years before symptoms of late infection emerge.  
Early signs include meningitis, encephalitis, cranial neuritis, and
radiculoneuropathies.  Later, encephalomyelitis and encephalopathy
may occur.  A broad range of psychiatric reactions have been
associated with Lyme disease including paranoia, dementia,

schizophrenia, bipolar disorder, panic attacks, major depression,
anorexia nervosa, and obsessive-compulsive disorder.  Depressive
states among patients with late Lyme disease are fairly common,
ranging across studies from 26% to 66%.  The microbiology of
Borrelia burgdorferi sheds light on why Lyme disease can be
relapsing and remitting and why it can be refractory to normal
immune surveillance and standard antibiotic regimens.
CONCLUSIONS: Psychiatrists who work in endemic areas need to include
Lyme disease in the differential diagnosis of any atypical
psychiatric disorder.  Further research is needed to identify better
laboratory tests and to determine the appropriate manner
(intravenous or oral) and length (weeks or months) of treatment
among patients with neuropsychiatric involvement.



=====*=====


IV.   SCAND J INFECT DIS: Prevalence Of Borrelia burgdorferi In
     Selected Tick Populations In Finland
---------------------------------------------------------------
AUTHORS: Junttila J, Tanskanen R, Tuomi J,
REFERENCE: Scand J Infect Dis 1994;26(3):349-55
ORGANIZATION: Department of Microbiology and Epizootology, College
             of Veterinary Medicine, Helsinki, Finland
ABSTRACT:


The purpose of the studies was to determine the prevalence of
Borrelia burgdorferi sensu lato in selected populations of Ixodes
ricinus in Finland and to secure strains of the spirochete for
further characterization.  1,210 Ixodes ricinus ticks (399 females,
419 males and 392 nymphs) were collected during June to August 1992
by flagging from 8 sites in 3 regions.  The frequency of B.
burgdorferi infection was determined by isolation in BSK II medium.
The species identity of most of the isolates was confirmed with the
immunofluorescence method. 67 B. burgdorferi strains were isolated
from 8 sites; the prevalence ranged from 2.8% to 7.9%.  The overall
isolation percentage for adult male ticks was 6.4% (7.5% for
females, 5.3% for males); for nymphs, 3.8%.  No statistically
significant association of the prevalence was observed with either
pasture or off-pasture habitats nor with specific geographic
region/regions.  Prevalence figures were roughly of the same
magnitude in areas and parts of the country known to differ in their

incidence of human borreliosis.  An additional 294 ticks, mainly
engorged females, were collected from places outside the main study
sites.  Of the 7 positive ticks 3 were engorged females, originating
from a cow, a dog and a cat, respectively.  The results in general
demonstrate that tick populations in various parts of Finland quite
commonly harbour B.  burgdorferi.



=====*=====


V.    Q&A: Question About Platelet Count (Q)
--------------------------------------------
Sender: hunter@s07.es.llnl.gov (Steve Hunter 510-423-2219)


Is the blood platelet count likely to be low for a person with late
Lyme disease?  If so, what sort of value would be expected?


[Editor's Note: Please send your responses to: LymeNet-L@Lehigh.EDU]


=====*=====


VI.   ABOUT THE LYMENET NEWSLETTER
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