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Volume: 1
Issue: 11
Date: 24-May-93


Table of Contents:

ANNOUNCEMENT: The Sixth Annual Rheumatology Symposium on Lyme Disease
UPI: Cases of Lyme disease increase 19-fold in decade
ABSTRACT: (Acta Paediatr) Epidemiology and Clinical Manifestations of
          Lyme Borreliosis in Childhood.  A Prospective Multicentre
          Study With Special Regard to Neuroborreliosis
ANSWER: Question on Lyme Vectors and Compost Piles
QUESTION: Does the Bull's Eye Rash Bode Ill or Well For The LD Victim?
QUESTION: Vaccination for Cats?
LETTER: Lyme Quilt


Newsletter:

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*                  Lyme Disease Electronic Mail Network                     *
*                          LymeNet Newsletter                               *
*****************************************************************************
                     Volume 1 - Number 11 - 5/24/93


I.    Introduction
II.   Announcements
III.  News from the wires
IV.   Questions 'n' Answers
V.    Op-Ed Section
VI.   Jargon Index
VII.  How to Subscribe, Contribute and Get Back Issues



I. ***** INTRODUCTION *****

I would like to apologize for the delay in getting this issue out.
Unfortunately, my health interfered with the newsletter's publication
schedule!  We're now back on track.


This issue contains lots of interesting information.  However, pay particular
attention to the UPI release that announces the new CDC patient count.
In the second to last paragraph, the CDC's David Dennis *finally* admits that
LD is under-reported!  I believe this is a first.  


The LymeNet now has an Internet Frequently Asked Questions (FAQ) list written
by Dr. Lloyd Miller of Troy, NY.  It may be obtained by sending the following
command to listserv@Lehigh.EDU:


get LymeNet-L faq

Mail delivery of this newsletter will now be available due to popular demand.
Obviously, I prefer the electronic media to disseminate the newsletter, but
I realize that many do not have access to the latest in electronic equipment.
While I will take care of the duplication costs, I ask that "snail-mail"
subscribers send me 2 books of 1st class stamps to cover the postage.  Send
requests (along with the stamps) to me at:
    1050 Lawrence Avenue
    Westfield, NJ 07090-3721


-Marc.


II. ***** ANNOUNCEMENTS *****

FROM: Yale University School of Medicine
SUBJECT: The Sixth Annual Rheumatology Symposium on Lyme Disease


The sixth annual Lyme disease symposium sponsored by the Section of
Rheumatology at Yale School of Medicine will provide a focused update on
all aspects of Lyme disease.  Both clinical topics and scientific advances
will be reviewed.  Specific attention will be directed to vector ecology,
epidemiology (both national and regional), clinical spectrum, laboratory
diagnosis, issues in treatment, vaccine development, and progress towards
better diagnostics.  Speakers will emphasize the current state of knowledge
and areas of active research.  Practical advice will be given about how
to approach commonly encountered questions in clinical practice.  The
symposium is directed toward primary care physicians, internists,
pediatricians, rheumatologists, and other health care professionals
interested in Lyme disease.


For more information:
        203-785-4578 VOICE
        203-785-3083 FAX  



III. ***** NEWS FROM THE WIRES ******

SOURCE: UPI
HEADLINE: Cases of Lyme disease increase 19-fold in decade
DATELINE: May 13, 1993, Thursday, BC cycle
BYLINE: BY CHARLES S. TAYLOR


Federal officials now cause Lyme disease an "emerging infectious disease"
because they have recorded a 19-fold increase in the number of cases
since 1982.


The Centers for Disease Control and Prevention recorded 40,195 cases of
the illness, spread by the bite of infected ticks, from 1982 to 1991.  There
were 9,677 cases reported in 1992 with all but two states listing incidences
of the illness.  Just 497 cases were reported by 11 states in 1982.


The emergence of Lyme disease as a major infectious illness results in part
from the fact that people are moving out to where the deer ticks are, said
the CDC's Dr. David Dennis.


He cited the transformation of farmland into suburban woodlots "that are
favorable for deer and deer ticks.


"This is a disease that has been spreading steadily since it was first
recognized in 1975 in the United States," Dennis said.  It is spreading both
geographically and in the areas where it already is endemic, he said.


Lyme disease was first recognized in 1975 when two mothers in Lyme,
Conn., convinced researchers at the Yale University School of Medicine to study
a rare outbreak of juvenile rheumatoid arthritis in their children.  Researchers
found that many people in Connecticut bitten by deer ticks had developed a
typical rash and similar symptoms.


However, a recent report from Tufts University researchers questioned the
accuracy of Lyme disease diagnoses and found many people who were told they
had the disease actually did not have it.


In the Connecticut area where the disease was first identified there has
been a nine-fold increase in reported cases.


The ailment causes skin lesions, muscle and joint pain, abnormalities of the
nervous system and cardiac symptoms.  It is readily treatable with
antibiotics and most people recover completely.  The major clinical marker
is an initial skin lesion that looks like a bullseye.


During 1992, Connecticut had 53.6 cases per 100,000 population -- the highest
incidence of Lyme disease in the northeast.  Wisconsin with 10.7 and
California with 0.8 cases reported the highest rates in the north central and
Pacific coastal regions, respectively.


The CDC said the 19-fold increase in  Lyme disease since 1982 may be due
not only to more cases actually occurring but also heightened awareness of
the disease by patients and physicians, increased laboratory testing, and
increased surveillance.


Dennis said there probably is considerable under-reporting of Lyme disease.  
"When we are able to provide resources for increased surveillance, the
numbers seem to go up," he said.


   Researchers still do not have a reliable lab test for Lyme disease but
Dennis said one should be ready by use in about two or three years.


=====*=====

TITL: Epidemiology and clinical manifestations of Lyme borreliosis in
     childhood.  A prospective multicentre study with special regard to
     neuroborreliosis.
AUTH: Christen HJ; Hanefeld F; Eiffert H; Thomssen R
ORGA: Department of Pediatrics, University Hospital, Gottingen, Germany.
CITE: Acta Paediatr 1993 Feb; 82 Suppl 386: 1-75


Lyme  borreliosis is a tick-borne infection caused by the spirochete
Borrelia burgdorferi, whose discovery in 1982 solved an aetiological mystery
involving a variety of dermatological and neurological disorders and
explained their association with Lyme disease.  Lyme borreliosis occurs
frequently and is readily treatable with antibiotics.  Along with its
discovery, however, came the realization that it is difficult to diagnose
accurately, especially antibody diagnosis.  False-positive antibody results
in particular led to gradual widening of the clinical spectrum, and
differential diagnosis became increasingly difficult.  This prospective,
multicentre study presents a systematic description of Lyme borreliosis in
childhood, emphasizing epidemiological and clinical issues.


Because, predominantly, inpatients were examined, Lyme neuroborreliosis was
the focus of the study, with the chief concern being to minimize false-
positive results. To this end, we chose to narrow the diagnostic criteria,
using the presence of specific antibodies in the cerebrospinal fluid as the
determining factor. The epidemiological investigation was focused on the
incidence of Lyme neuroborreliosis in childhood in southern Lower Saxony as
well as on the prevalence of Lyme neuroborreliosis among acute-inflammatory
neurological illnesses in children.  The clinical part of the study aimed at
establishing criteria for differential diagnosis in addition to the detection
of specific antibodies. The detection of specific IgM antibodies using an IgM
capture ELISA confirmed the presence of acute Lyme borreliosis.


The study examined 208 children with Lyme borreliosis, of whom 169 had Lyme
neuroborreliosis, from mid-1986 until the end of 1989.  The yearly incidence of
Lyme neuroborreliosis in Lower Saxony was 5.8 cases/100,000 children aged 1 to
13.  The manifestation index was 0.16, or one case of Lyme neuroborreliosis per
620 infected children, compared with the presence of specific antibodies against
B. burgdorferi for children in the same age group and region.  Both the seasonal
distribution of Lyme borreliosis, which peaked in summer and autumn, as well
as the information about when the tick bites took place point to an incubation
period of a few weeks.  The most frequent manifestation of  Lyme
neuroborreliosis in childhood was acute peripheral facial palsy, found in 55%
of all cases (n = 93).  Lyme borreliosis proved to be the most frequently
verifiable cause of acute peripheral facial palsy in children, causing every
second case of this disorder in summer and autumn. (ABSTRACT TRUNCATED AT 400
WORDS)



IV. ***** QUESTIONS 'N' ANSWERS *****

In LymeNet vol#1, issue#09, Terry Morse <morset@ccmail.orst.edu> asked:

>  When I visited my sister on Long Island, NY, I was cautioned to avoid the
>compost heap in her back yard, as she thinks this is where she became
>infected.
>
>  A friend of mine here in Oregon who has a compost heap would like me to
>back that claim up with documentation.  Do lyme-carrying ticks hang out in
>compost heaps?
>Thank you.


Our answer comes from the Rutgers University Department of Entomology and the
Prevent Lyme Foundation.


Compost heaps attract white footed mice, which are known hosts for ticks such
as I. dammini.  The heaps are great places for the mice to reproduce.  Where
you find the mice, you will most probably find the ticks, including
Lyme-carrying ticks.


The solution is to keep the mice from getting in the compost heaps in the
first place by enclosing them.  Thanks to Lynn Latchford for sending us this
response.


Feel free to send in additional questions to  LymeNet-L@Lehigh.EDU

=====*=====

Sender: Ralph E. Yozzo  <yozzo@watson.ibm.com>
Subject: Does the Bull's eye rash bode ill or well for the LD Victim?


Has there been any study on Lyme Disease patients which focused
on whether or not they had the characteristic bull's eye rash or not
and whether or not they got late Lyme symptoms?


In other words, if you get the bull's eye rash,  are you less or more
likely to suffer late Lyme complications?


I would hope that the bull's eye rash would be a good sign.
My reasoning is that if your body reacts to the intruder and
fights it, (I assume that the rash is a battle between the body
and the spirochete.) then (in concert with antibiotics) you
would be better off than a person whose body does not
fight or fights to a lesser degree.


As you can probably tell,  I do not have a medical degree.
My interest is a personal one.  In September of 1992, I had
Lyme Disease and the characteristic bull's eye rash.


=====*=====

Sender: Ralph E. Yozzo <yozzo@watson.ibm.com>
Subject: Vaccination for cats


I noticed that in the Lyme FAQ,  there was a reference to
a Lyme vaccine for dogs.  Is a Lyme vaccine for cats available now
or in the near future?


Take care of yourself.


V. ***** OP-ED SECTION *****

Letter to the Editor,

Some time ago I received a letter from Brin King asking me to design and sew
a square of material to represent my case of Lyme disease.  This square would
be joined with other squares to create a "blanket" that would be brought to
Washington.  I chose to ignore what I believed to be an appalling idea.
Since then, I have heard of people actually making squares for this blanket.
I cannot ignore this any longer.  My only hope is that people don't realize
what they are doing.


When I first saw the AIDS Memorial Quilt, I was profoundly moved.  Even
though I have lost no one close to be to AIDS, it touched me deeply.  In
November of 1991, there were 14,780 panels to this quilt.  That is seventeen
solid acres!  Every single square of that quilt that now stretches out over
more than ten football fields represents someone who is DEAD.  Lyme disease
is devastating.  I will be the first to acknowledge this.  But we cannot
compare what we have to a disease that kills virtually everyone it infects.
Going to Washington with this "blanket" (calling a large grouping of pieces
of material a blanket instead of a quilt is not enough to distance ourselves
from the AIDS quilt) will not bring us recognition.  It will bring us
ridicule and make a mockery of our struggle.


I am not against ideas to bring the Lyme community recognition.  On the
contrary, I have been fighting this battle for five years.  I simply think
we can come up with our own ideas, not steal them from the AIDS community.
Especially not one so incredibly meaningful.


I implore anyone who has sent a square to Mr. King: Please ask him to return
it to you.  Maybe someday, when the cure for AIDS is found and we are still
fighting this insidious disease, they can be of use.


Sincerely,
Sallie Timpone
Hasbrouck Heights, NJ



VI. ***** 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.



VII. ***** HOW TO SUBSCRIBE, CONTRIBUTE AND GET BACK ISSUES *****

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