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Volume: 1
Issue: 24
Date: 25-Oct-93


Table of Contents:

                     Prehistoric Lyme
                (The History of Lyme Disease)


Newsletter:

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                     Volume 1 - Number 24 - 10/25/93


                        SPECIAL REFERENCE ISSUE
                           PREHISTORIC LYME


I.   Special Section
II.  Jargon Index
III. How to Subscribe, Contribute and Get Back Issues



I. ***** SPECIAL SECTION *****

From: Frank Demarest <76116.2065@CompuServe.COM>
Subject: Prehistoric Lyme


We recently found an interesting publication which included the early
history of Lyme Disease.


Acta Pediatrica Vol 82, Feb 1993, Supplement 386 (75 pages, 356 references).
"Epidemiology and Clinical Manifestations of Lyme Borreliosis in Childhood
- A Prospective Multicentre Study with Special Regard to Neuroborreliosis"


The following information is from Table 1 and the text. The reference numbers
correspond to the original, and are in the bibliography which follows.


[[ Editorial comments in brackets ]]
-----------------------------------------------------------------------------


Year  Ref
1883   42  Acrodermatitis chronica atrophicans (ACA)
1902  120  ACA
1910    7  Erythema Chronicum Migrans (ECM) after tick bite (Afzelius)
1913  178  ECM after tick bite
1922   88  Deltoid paralysis after tick bite and ECM
1930  119  Erythema Migrans and Lymphocytic Meningitis
1941   22  Lymphocytic meningoradiculitis (Bannwarth)
1942  230  Allergic meningitis
1943   19  Lymphadenosis benigna cutis (LABC)
1946  355  Chronic allergic meningitis
1949  266  Chronic aseptic meningitis
1946  316  ACA - Penicillin therapy
1949  319  ACA - Penicillin therapy
1951  127  Erythema migrans / meningitis - Penicillin therapy
1954   94  ACA - transmission in humans
1955   95  ACA - transmission in humans
1955   38  ECM - transmission in humans
1957  225  LABC - Transmission in humans
1955  116  ACA after tick bites
1966  129  ACA and peripheral neuropathy
1966  265  Lymphocytic meningitis after tick bite and ECM
1973  212  International symposium on arboviruses
          "Nearly the entire clinical spectrum of the disease

           known today as Lyme borreliosis was presented"
1973  130  International symposium on arboviruses
1976  304  Lyme arthritis after tick bite and ECM (Steere)


-----------------------------------------------------------------------------

The following information is from abstracts of Dr. Steere's papers:

Year  Ref
1977  305  EM rash, arthritis, suspected arthropod vector.
1977   S1  EM rash, arthritis, malaise, fatigue, chills and fever, headache,
          stiff neck, backache, myalgias, nausea, vomiting, and sore throat,
          neurologic abnormalities, myocardial conduction abnormalities.
1978   S2  Has since been found elsewhere and may be caused by a virus
          transmitted by ticks.  Symptomatic treatment only is advised,
          except in the rare instances of severe neurologic complications
          or myocardial conduction abnormality.
1978   S3  Findings support the hypothesis that erythema chronicum migrans
          and Lyme arthritis are tick-transmitted, specifically by
          I. scapularis.
1979   S4  Defined by erythema chronicum migrans and sometimes followed by
          neurologic, cardiac, or joint involvement.  Distribution
          correlates closely with that of Ixodes dammini and Ixodes
          pacificus.
1980   S5  Erythema chronicum migrans and its associated symptoms resolved

          faster in patients given penicillin or tetracycline.
1983   S6  Recovered spirochetes from the blood, skin lesions or
          cerebrospinal fluid of 3 of 56 patients with Lyme disease and
          from 21 of 110 ticks.
1983   S7  Reported studies done in 1980-81. For early Lyme disease,
          tetracycline appears to be the most effective drug, then
  penicillin, and finally erythromycin.  Nearly half had later
          symptoms.
1983   S8  High-dose intravenous penicillin for neurologic abnormalities of
          Lyme disease.
1984   S9  Confirmed spirchetal cause of LD with experiments on rabbits.
1984  S10  Lyme disease long recognized in Europe but only recently
          recognized in the United States.  Compared DNA of 10 strains.
1985  S11  A double-blind placebo-controlled trial carried out from 1980 to
          1982, patients with established Lyme arthritis, 20 treated with
          penicillin weekly for three weeks and 20 received saline.  Seven
          of the 20 penicillin-treated patients (35%) had complete

          resolution of arthritis soon after the injections and have
          remained well during a mean follow-up period of 33 months.  All 20
          patients given placebo continued to have attacks of arthritis.
          In 1983, of 20 patients treated with daily intravenous penicillin
          G for 10 days, 11 (55 per cent) had complete resolution of
          arthritis and have remained well since.
1987  S12  To determine the clinical evolution of Lyme arthritis, 55
          patients who did not receive antibiotic therapy for erythema
          chronicum migrans were followed longitudinally for a mean
          duration of 6 years.


-----------------------------------------------------------------------------

[[ Note that Dr. Steere studied the problem for about 3 years before
reporting on trying antibiotics, then waited 3 more years, until Dr.
Burgdorfer discovered the spirochete, before agressively using antibiotic
treatment.  Then the next year he mentions that the disease has long been
recognized in Europe.  It would be interesting to know if the study reported
in 1987 continued after 1983, when the spirochete was discovered.  It is
apparent that Dr. Steere has done a lot of research, and his main talent is
as an academic researcher, not as a clinician. ]]


-----------------------------------------------------------------------------

7  Afzelius A.
    Verhandlungen der dermatologischen Gesellschaft zu Stockholm.
    Arch Dermatol Syph 1910;101:404
19  Bafverstedt B.
    Uber Lymphadenosis benigna cutis.
         Eine klinische und pathologisch-anatomische Studie.
    Acta Derm Venereol (Stockh) 1943;23 (Supl 11):1-202
22  Bannwarth A.
    Chronische lymphocytare Meningitis,
         enzundliche Polyneuritis und "Rheumatismus".
    Arch Psychiatr Neurvenkr 1941;113:284-376
38  Binder E, Doepfmer R, Hornstein O.
    Experimentelle Ubertragung des erythema chronicum migrans
         von Mensch zu Mensch.
    Hautarzt 1955;6:494-6
42  Buchwald A.
    Ein Fall von diffuser idiopathischer Haut-Atrophie.
    Arch Derm Syph 1883;15:553-6
88  Garin CH, Bujadoux CH.
    Paralysie par les tiques
    J Med Lyon 1922;71:765-7
94  Gotz H.
    Die Acrodermatitis chronica atrophicans Herxheimer
         als Infektionskrankheit.
    Hautarzt 1954;5:491-504
95  Gotz H.
    Die Acrodermatitis chronica atrophicans Herxheimer
         als Infektionskrankheit (Erganzung zur l. Mitteilung).

    Hautarzt 1955;6:249-52
116  Hauser W.
    Zur Kenntnis der Acrodermatitis chronica atrophicans.
    Arch Derm Syph 1955;199:350-93
119  Hellerstrom S.
    Erythema chronicum migrans Afzeli.
    Acta Derm Venereol (Stockh) 1930;11:315-21
120  Herxheimer K. Hartmann K.
    Uber Acrodermatitis chronica atrophicans.
    Arch Derm Syph 1902;61:57-76,255-300
127  Hollstrom E.
    Successful treatment of erythema migrans Afzelius.
    Acta Derm Venereol (Stockh) 1951;31:235-43
129  Hopf HC.
    Acrodermatitis chronica atrophicans (Herxheimer) und Nervensystem.
    Monographien aus dem Gesamtgebiet der Neurollogie und Psychiatrie.
    Heft 114. Berlin Heidelburg New York: Springer; 1966
130  Hopf HC.
    Epidemiologie der Radikulomyelomeningitis mit Erythem
          nach ZeckenbiB in der Umbebung von Gottingen.
    In: Muller WK, Schaltenbrand G eds
    Arboviruserkrankungen des Nervensystems in Europa.
    Stuttgart: Thieme; 1975;253-4
178  Lipschutz B.
    Uber eine seltene Erythemform (Erythema chronicum migrans).

    Arch Derm Syph 1913;118:349-56
212  Muller WK, Schaltenbrand G eds
    Arboviruserkrankungen des Nervensystems in Europa.
    Stuttgart: Thieme; 1975
225  Paschoud JM.
    Die Lymphadenosis benigna cutis als ubertragbare Infektionskrankheit.
    Hautarzt 1957;8:197-211
230  Pette H.
    Die akut entzundlichen Erkrankungen des Nervensystems.
    Leipzig: Thieme; 1942;302-5
265  Schaltenbrand G.
    Durch Arthropoden ubertragene Erkrankungen der Haut und des
    Nervensystems.  MMW 1966;108:1557-62
266  Schaltenbrand G.
    Chronische aseptische Meningitis.
    Nervenarzt 1949;20:433-42
304  Steere AC, Malawista SE, Snydman DR, Andiman WA.
    A cluster of arthritis in children and adults in Lyme, Connecticut.
    Arthritis Rheum 1976;19:824
305  Steere AC, Malawista SE, Snydman DR, Shope RE, Andiman WA,
          Ross MR, Steele FM.
    Lyme arthritis: an epidemic of oligoarticular arthritis in children
          and adults in three Connecticut communities.
    Arthritis Rheum 1977;20:7-17.

316  Svartz N.
    Penicillinbehandling vid dermatitis atrophicans Herxheimer.
    Nord Med 1946;32:2783
319  Thyresson N.
    The penicillin treatment of acrodermatitis atrophicans
          chronica (Herxheimer).
    Acta Derm Venereol (Stockh) 1949;29:572-621
355  Zellweger H.
    Uber die chronische allergische Meningitis.
    Helv Paediatr Acta 1946;1:417-26


-----------------------------------------------------------------------------

S1   Steere AC  Malawista SE  Hardin JA  Ruddy S  Askenase W  
      Andiman WA  
    Erythema chronicum migrans and Lyme arthritis. The enlarging clinical
      spectrum.
    Ann Intern Med 1977 Jun;86(6):685-98
S2   Steere AC  Hardin JA  Malawista SE  
    Lyme arthritis: a new clinical entity.
    Hosp Pract 1978 Apr;13(4):143-58
S3   Steere AC  Broderick TF  Malawista SE  
    Erythema chronicum migrans and Lyme arthritis: epidemiologic evidence
      for a tick vector.
    Am J Epidemiol 1978 Oct;108(4):312-21
S4   Steere AC  Malawista SE  
    Cases of Lyme disease in the United States: locations correlated with
      distribution of Ixodes dammini.
    Ann Intern Med 1979 Nov;91(5):730-3
S5   Steere AC  Malawista SE  Newman JH  Spieler PN  Bartenhagen NH  
    Antibiotic therapy in Lyme disease.
    Ann Intern Med 1980 Jul;93(1):1-8
S6   Steere AC  Grodzicki RL  Kornblatt AN  Craft JE  Barbour AG  
      Burgdorfer W  Schmid GP  Johnson E  Malawista SE  
    The spirochetal etiology of Lyme disease.

    N Engl J Med 1983 Mar 31;308(13):733-40
S7   Steere AC  Hutchinson GJ  Rahn DW  Sigal LH  Craft JE  DeSanna ET  
      Malawista SE  
    Treatment of the early manifestations of Lyme disease.
    Ann Intern Med 1983 Jul;99(1):22-6
S8   Steere AC  Pachner AR  Malawista SE  
    Neurologic abnormalities of Lyme disease: successful treatment with
      high-dose intravenous penicillin.
    Ann Intern Med 1983 Dec;99(6):767-72
S9   Kornblatt AN  Steere AC  Brownstein DG  
    Experimental Lyme disease in rabbits: spirochetes found in erythema
      migrans and blood.
    Infect Immun 1984 Oct;46(1):220-3
S10  Schmid GP  Steigerwalt AG  Johnson SE  Barbour AG  Steere AC  
      Robinson IM  Brenner DJ  
    DNA characterization of the spirochete that causes Lyme disease.
    J Clin Microbiol 1984 Aug;20(2):155-8
S11  Steere AC  Green J  Schoen RT  Taylor E  Hutchinson GJ  Rahn DW  
      Malawista SE  
    Successful parenteral penicillin therapy of established Lyme
      arthritis.
    N Engl J Med 1985 Apr 4;312(14):869-74

S12  Steere AC  Schoen RT  Taylor E  
    The clinical evolution of Lyme arthritis.
    Ann Intern Med 1987 Nov;107(5):725-31
-----------------------------------------------------------------------------



II. ***** JARGON INDEX *****

Bb - Borrelia burgdorferi - The scientific name for the LD bacterium.
CDC - Centers for Disease Control - Federal agency in charge of tracking
     diseases and programs to prevent them.
CNS - Central Nervous System.
ELISA - Enzyme-linked Immunosorbent Assays - Common antibody test
EM - Erythema Migrans - The name of the "bull's eye" rash that appears in
    ~60% of the patients early in the infection.
IFA - Indirect Fluorescent Antibody - Common antibody test.
LD - Common abbreviation for Lyme Disease.
NIH - National Institutes of Health - Federal agency that conducts medical
     research and issues grants to research interests.
PCR - Polymerase Chain Reaction - A new test that detects the DNA sequence
     of the microbe in question.  Currently being tested for use in
     detecting LD, TB, and AIDS.
Spirochete - The LD bacterium.  It's given this name due to it's spiral
     shape.
Western Blot - A more precise antibody test.



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