Volume: 2 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: *********************************************************************** * 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 <[email protected]> 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. =====*===== VI. HOW TO SUBSCRIBE, CONTRIBUTE AND GET BACK ISSUES ------------------------------------------------------ SUBSCRIPTIONS: Anyone with an Internet address may subscribe. Send a memo to: [email protected] in the body, type: subscribe LymeNet-L YourFirstName YourLastName DELETIONS: Send a memo to: [email protected] in the body, type: unsubscribe LymeNet-L CONTRIBUTIONS: Send all contributions to [email protected] or FAX them to 908-789-0028. 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