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Volume: 2
Issue: 15
Date: 12-Sep-94


Table of Contents:

I.    LYMENET: Patient Responds to News of Lower CDC Figures
II.   REV NEUROL: Epilepsy disclosing Neuroborreliosis
III.  MED MICROBIOL IMMUNOL: Immunoblot using recombinant
      antigens derived from different genospecies of Borrelia
      burgdorferi sensu lato.
IV.   GENE: Homology between Borrelia burgdorferi OspC and
      members of the family of Borrelia hermsii variable major
      proteins.
V.    LDCNY: President Clinton Responds to the Plight of Lyme
      Disease Patients
VI.   How to Subscribe, Contribute, and Get Back Issues


Newsletter:

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


IDX#                Volume 2 - Number 15 - 9/12/94
IDX#                            INDEX
IDX#
IDX#  I.    LYMENET: Patient Responds to News of Lower CDC Figures
IDX#  II.   REV NEUROL: Epilepsy disclosing Neuroborreliosis
IDX#  III.  MED MICROBIOL IMMUNOL: Immunoblot using recombinant
IDX#        antigens derived from different genospecies of Borrelia
IDX#        burgdorferi sensu lato.
IDX#  IV.   GENE: Homology between Borrelia burgdorferi OspC and
IDX#        members of the family of Borrelia hermsii variable major
IDX#        proteins.
IDX#  V.    LDCNY: President Clinton Responds to the Plight of Lyme
IDX#        Disease Patients
IDX#  VI.   How to Subscribe, Contribute, and Get Back Issues
IDX#



QUOTE OF THE WEEK:

     "It is a little bit amazing that the [American] general
      physician did not give her antibiotics because it is well
      known that the diagnosis of Lyme disease should be based
      on compatible clinical findings in a patient with a
      reasonable probability of exposure to ticks, and available
      laboratory tests are unreliable."


    -- A Dutch physician, reacting to the misdiagnosis of an American
       patient (see Section I).



I.    LYMENET: Patient Responds to News of Lower CDC Figures
------------------------------------------------------------
Sender: Phyllis Tyzenhouse <PTYZEN@gems.vcu.edu>


I would like to respond to a feature article in the 8/22/94 issue of
the Newsletter, which mentioned that physicians are still failing to
diagnose and report Lyme disease.  In my case, I was bitten by a tick
(later reported to be a Lone Star Tick) two years ago.  Within a few
days, a typical bulls-eye rash appeared and symptoms developed that
I had never experienced before: irregular heart rhythm with bounding
pulsations in my neck, gastric reflux, and painful joints.  Later,
pain and swelling settled into one knee, and tingling and paresthesias
developed in my arms and legs.  Alarmed by the rash and early
symptoms, I took the tick and went to my family physician.


To my surprise, he refused to look at the rash, saying, "Oh, everyone
gets bitten by ticks.  I've had lots of bites myself."  He wasn't
interested in seeing the tick, but drew blood for a Lyme titer.


A postcard from the doctor said that my blood test was negative for
Lyme disease and therefore I did not have Lyme disease.  I returned a
few weeks later for advice on worsening symptoms and fatigue.  He said
that I had Lyme disease anxiety and that antibiotics were not
indicated, and referred me to a physical therapist for treatment of my
knee.


No antibiotics were prescribed until I saw a different physician eight
months after the tick bite, but when the symptoms did not respond after
about six weeks, he decided that I did not have Lyme disease.  He
attributed my cardiac symptoms to lack of fitness and my knee problem
to osteoarthritis, even though I reminded him that the symptoms
occurred abruptly about four days after the tick bite.


This summer when we were planning a vacation in the Netherlands, I
made an appointment with a Dutch neurologist who was recommended by
friends as an expert on Lyme disease.  He examined me, did tests, and
then wrote me a long letter reviewing my history and making
recommendations for treatment.  He declined to send a letter to my
current physician, saying that he preferred to send me a letter that I
could take to any physician I chose.


One statement in his letter struck me as a significant commentary on
the medical care I had received.  It says, "It is a little bit amazing
that the general physician did not give her antibiotics because it is
well known that the diagnosis of Lyme disease should be based on
compatible clinical findings in a patient with a reasonable
probability of exposure to ticks, and available laboratory tests are
unreliable."


It would be wonderful to continue treatment under the Dutch physician,
but that is not feasible; so I am left feeling helpless and
disappointed because so many American doctors fail to diagnose and
treat Lyme disease.  Aren't we supposed to have the best medical
care in the world?



=====*=====


II.   REV NEUROL: Epilepsy disclosing Neuroborreliosis
------------------------------------------------------
AUTHORS: Mourin S, Bonnier C, Bigaignon G, Lyon G
REFERENCE: Rev Neurol (Paris) 1993;149(8-9):489-91
ORGANIZATION: Service de Neurologie Pediatrique, Cliniques
             Universitaires Saint-Luc, Bruxelles, Belgium.
ABSTRACT:


After two seizures, a 13 year-old boy experienced headache, fatigue
and loss of appetite over a period of 3 weeks.  There was a bilateral
papilledema with normal visual acuity.  CT and MRI disclosed two
ischemic foci, that were interpreted as evidence of vasculitis.
High serum levels of IgG and IgM antibodies specific to Borrelia
burgdorferi, were present.  The patient had attended an outdoor scout
camp in a area, in south-east Belgium, known to be endemic for
tick-borne borreliosis.  The clinical symptoms, the levels of the
specific antibodies and the radiologic abnormalities responded
dramatically to treatment.  We believe that seizures in this case
were related to cerebral vasculitis.  This case confirms the
extreme diversity of the neurological manifestations of Borreliosis.



=====*=====


III.  MED MICROBIOL IMMUNOL: Immunoblot using recombinant antigens
     derived from different genospecies of Borrelia burgdorferi
     sensu lato.
------------------------------------------------------------------
AUTHORS: Wilske B, Fingerle V, Preac-Mursic V, Jauris-Heipke S,
        Hofmann A, Loy H, Pfister HW, Rossler D, Soutschek E
REFERENCE: Med Microbiol Immunol (Berl) 1994 Feb;183(1):43-59
ORGANIZATION: Max von Pettenkofer-Institut fur Hygiene und Medizinische
             Mikrobiologie, Universitat Munchen, Germany.
ABSTRACT:


Immunodominant proteins are variable in molecular and antigenic
structure among different genospecies of Borrelia burgdorferi sensu
lato.  We have recently developed an immunoblot using five recombinant
antigens: the chromosomal-encoded B. burgdorferi proteins p100, the
flagellin and an internal flagellin fragment thereof, and the
plasmid-encoded outersurface proteins A (OspA) and C (OspC).  In the
present study the same antigens (derived from strain PKo, genospecies
B. afzelii) were compared with the homologous recombinant proteins
from strain B31 (genospecies B. burgdorferi sensu stricto) and with
OspA, OspC and the internal flagellin fragment from strain PBi
(genospecies B. garinii).  Patients with neuroborreliosis (n = 28) and
patients with acrodermatitis chronica atrophicans (n = 20) were
investigated in the IgG immunoblot; the IgM immunoblot was performed
only in patients with neuroborreliosis.  There was a small increase in
the detection rate of OspA-specific IgG or IgM antibodies using the

different variants of recombinant OspA; however, OspA remained an
insensitive antigen for antibody detection in Lyme borreliosis.  The
same was true to OspC-specific IgG antibodies.  The sensitivity of
OspC, which is the immunodominant antigen for IgM antibody detection,
could not be increased using recombinant antigens derived from
different strains.  However, some sera which were negative in the
recombinant immunoblot reacted with OspC in the conventional
immunoblot using B. burgdorferi whole cell lysate as antigen.  The
most unexpected finding was the high degree of immunological
heterogeneity of the internal flagellin fragments: IgG antibodies
were detected in 18 of 48 patients using B31 fragments, in 25 of 48
using PKo fragments, in 23 of 48 using PBi fragments versus 33 of 48
when the three recombinant proteins were combined.  PKo-derived
fragments were more sensitive for antibody detection in patients with
acrodermatitis chronica atrophicans, B31- and PBi-derived fragments
for antibody detection in patients with neuroborreliosis. This is in

agreement with the fact that isolates from patients with
neuroborreliosis are predominantly belonging to the genospecies B.
burgdorferi sensu stricto and B. garinii. For detection of IgM
antibodies in sera from patients with neuroborreliosis, recombinant
internal fragments derived from strains B31 and PBi were more sensitive
than the PKo-derived fragment.  The best discrimination between
neuroborreliosis sera and control sera was achieved when the IgM blot
was performed using recombinant internal flagellin fragments derived
from strains PKo and PBi and OspC derived from B31 or PKo.



=====*=====


IV.   GENE: Homology between Borrelia burgdorferi OspC and members
     of the family of Borrelia hermsii variable major proteins.
------------------------------------------------------------------
AUTHORS: Margolis N, Hogan D, Cieplak W Jr, Schwan TG, Rosa PA
REFERENCE: Gene 1994 May 27;143(1):105-10
ORGANIZATION: Laboratory of Microbial Structure and Function, Rocky
             Mountain Laboratories, National Institutes of Health,
             National Institute of Allergy and Infectious Diseases,
             Hamilton, MT 59840.
ABSTRACT:


Synthesis of the Borrelia burgdorferi outer surface protein C (OspC)
is quite variable.  We have cloned and sequenced the ospC gene from
B. burgdorferi isolate CA-11.2A, a clone in which ospC expression
varies.  The 5' flanking region of the gene contains at least two
consensus promoter regions, as well as two large overlapping inverted
repeats.  Sequence comparison to other OspC proteins indicated that
the CA-11.2A OspC is as closely related to OspC from two different
genospecies of Lyme disease spirochetes as it is to OspC from the
prototype B. burgdorferi strain, B31.  Comparisons of the OspC amino
acid (aa) sequence with those in aa sequence databases revealed
partial identity with the variable major proteins Vmp3 and Vmp24 of
B. hermsii, a causative agent of tick-borne relapsing fever.  An
ospC probe hybridized to B. hermsii restriction fragments and linear
plasmids that also were recognized by the vmp3 and vmp24 probes.  
OspC and these Vmp appear to be related, but their synthesis is
regulated differently in the two species of spirochetes.  This

represents a fascinating example of the evolution of the number,
position, regulation and perhaps function of homologous genes in two
related pathogens.  These parameters may relate to characteristic
properties of the pathogens and their separate tick vectors.



=====*=====


V.    LDCNY: President Clinton Responds to the Plight of Lyme
     Disease Patients
-------------------------------------------------------------
Source: The Lyme Disease Coalition of New York
Date: August 31, 1994
Contact: Ginger Lucie 914-245-8562
For Immediate Release


On August 19, 1994 we received word from President William J. Clinton,
that he is concerned about the effect Lyme disease is having on the
lives of many Americans.  President Clinton assured us that the
detailed agenda we worked on regarding the many complex issues of this
disease will be forwarded to the appropriate staff at the National
Institutes of Health for further review.  This is an extremely timely
opportunity for the thousands of chronically ill Lyme disease patients
to make their voices heard to the NIH.  Dr. Harold Varmus, Director of
the NIH, chaired a meeting on August 11 regarding LD.


We applaud President Clinton for taking this first step, recognizing
the Lyme disease community!  Of the hundreds of contacts that have been
made to our government representatives, as well as the news media,
he is one of the few to respond and validate our plight.  It is our
hope that in-depth studies of *chronic* Lyme disease patients will
finally begin in earnest.  The medical community needs to work together
to diagnose and provide the long-term treatment that *chronic* Lyme
disease patients require, optimistically, encouraged and endorsed by
our President.



=====*=====


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