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Volume: 3
Issue: 07
Date: 10-May-95


Table of Contents:

I.    Q&A: Tick Testing (A)
II.   Q&A: Tick Testing (A)
III.  Q&A: Tick Testing (A)  
IV.   Q&A: Tick Testing (A)
V.    Q&A: Tick Testing (A)
IV.   LYMENET: Lyme Disease, Insurance Issues, Dentistry
VII.  Q&A: Combination Therapy (A)
VIII. LYMENET: The Public Health Risks of LD in Breckland, UK
IX.   About The LymeNet Newsletter


Newsletter:

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*                  The National Lyme Disease Network                  *
*                         LymeNet Newsletter                          *
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IDX#                Volume 3 - Number 07 - 5/10/95
IDX#                            INDEX
IDX#
IDX#  I.    Q&A: Tick Testing (A)
IDX#  II.   Q&A: Tick Testing (A)
IDX#  III.  Q&A: Tick Testing (A)  
IDX#  IV.   Q&A: Tick Testing (A)
IDX#  V.    Q&A: Tick Testing (A)
IDX#  IV.   LYMENET: Lyme Disease, Insurance Issues, Dentistry
IDX#  VII.  Q&A: Combination Therapy (A)
IDX#  VIII. LYMENET: The Public Health Risks of LD in Breckland, UK
IDX#  IX.   About The LymeNet Newsletter
IDX#



I.    Q&A: Tick Testing (A)
------------------------------------------------------------------
Sender: Tick Research Laboratory, U of RI <TICKLAB@URIACC.URI.EDU>


In response to the recent request on tick testing in your net we are
sending you the following message in hope to assist you to answer the
questions asked by your readers.  Tick Research Laboratory was
established in 1988 which affiliated with Department of Zoology,
University of Rhode Island.  Our current research include aspects of
epizootiology, epidemiology, and vector competency of tick-borne
diseases, particularly Lyme disease and human babesiosis.  If there is
anything we can do to help your readers, please feel free to contact
us.


Service for detecting the Lyme disease spirochete in ticks is
available at URI's Tick Research Laboratory.  The TICK RESEARCH
LABORATORY (TRL) is currently offering two services for interested
individuals and physicians.  Any tick received can be accurately
identified and can be tested for the presence of the causative agent
of Lyme disease, Borrelia burgdorferi.  Tick identification is made
by members of the TRL and takes only a few minutes.  Testing ticks
for the presence of Lyme disease spirochetes is accomplished using a
highly sensitive Polymerase Chain Reaction (PCR) test.  PCR analysis
is used to identify the Lyme disease organism at the molecular level
by amplifying specific DNA sequences of the spirochete.  The tick
specimens need not be alive; in fact, ticks from museum collections
have been successfully analyzed after several decades of storage.


Ticks, in any developmental stage (larva, nymph or adult) can be
screened for the presence of the spirochete.  Those specimens which
have been attached and show evidence of having fed on host blood are
the most likely to cause concern to both patients and physicians.  
It should be noted that this PCR technique is not a test for Lyme
disease in the patient but rather an assay for the presence of the
spirochete in the tick.  Interpretation by the physician, based on
the results, the degree of engorgement and stage of the tick will be
necessary in order to determine the appropriate treatment or
prophylactic strategies.


Cost for identification and evaluation of the tick as well as the PCR
test for the presence of the spirochete is a total of $45.00.  Tick
identification alone, without PCR, is only $15.00.  Prepayment is
necessary and checks should be made payable to the URI - TICK RESEARCH
LAB.  Turnaround time for the PCR test is approximately one week.  
Specimens can be hand-delivered or they can be mailed to the lab.  
Those that are being mailed should be individually placed in plastic
vials or securely sealed in plastic wrap and shipped in a small
protective mailer.  DO NOT fasten ticks to a letter with Scotch tape.  
Along with the specimen, you should include: the name, address and
telephone number of the sender; plus the name, age, and sex of the
host; where on the body the tick was attached; and where and when
the tick was encountered.  Send directly to:


    Professor Kerv Hyland
    Tick Research Laboratory
    Department of Zoology
    Biological Science Center, B-114
    University of Rhode Island
    Kingston, RI  02881-0816


For more information please call (401) 792-2650 or Fax (401) 792-4256
or e-mail: TICKLAB@URIACC.URI.EDU


Normally, we are open between 9:00 am and 4:30 pm.  If the laboratory
is closed, the specimen can be left in a container at room B-114 in
the Biological Sciences Center or dropped off in the Zoology
Department Main Office (B-101).  A check and the above information
must accompany the specimen.



=====*=====


II.   Q&A: Tick Testing (A)
-----------------------------------------------
Sender: Doris Aaronson <doris@xp.psych.nyu.edu>



A few years ago, a group from the Biology Dept. of William Paterson
College came to West Milford, NJ, and tested a lot of ticks.  They put
dry ice under the bushes in the woods and the ticks all came down,
in response to carbon dioxide gas -- and they collected from a sheet
of plastic covering the ground.


They found that 33% to 50% of West Milford ticks were infected with
the Lyme bacteria, and it was in the headlines of the Record
(newspaper).  I don't know that they test ticks for individual
people -- this was part of a research project.  But, they have the
facilities.  So, if they knew they could make some $$ by doing it
for a fee for private people, maybe they would be interested???  
I don't have the newspaper any more, and don't know which people
were involved.  



=====*=====


III.  Q&A: Tick Testing (A)
-------------------------------------------
Sender: Lloyd Miller, DVM <LloydEM@aol.com>



Contact North American Labs in Connecticut.  They do tick testing.
       1-203-8261140 or 1-800-866-6254


Caveat - a negative test does not necessarily mean that the tick was
not infected.  There may not enough bacteria in tick to find.



=====*=====


IV.   Q&A: Tick Testing (A)
-----------------------------------------------
Sender: Lora Mermin <smermin@facstaff.wisc.edu>



I read in Lyme Times about Ukiah Pub Health Lab, and Jo McCallum
got in touch with them and learned that they will accept ticks from
other states for testing.  They use the Fluorescent Antibody Test.  
"If a tick bites you and you wish to have it identified, place it
in a small container with a moist, but not real wet, piece of paper
towel or cotton ball.  Include your name, address, phone number and
age of the person who was bitten.  Send to the Public Health Dept.
Laboratory, 890 North Bush St., Ukiah, CA 95482.  If you wish to
determine whether the tick carried the bacteria that causes LD, the
cost is $17.00.  For information call 707-463-4461 or 707-463-4145.
Call your own Public Health Dept. for local resources."  


The North American Laboratory Group once did culture tick testing for
$25 (check this price before sending), and a PCR test is $115.00
(800-866-NALG).  IGenex does a PCR for $65 (800-832-3200--phone no.
for physicians only).



=====*=====


V.    Q&A: Tick Testing (A)
----------------------------------------------------------------------
Sender: Marvin Hirschberg <HIRSCHBERG#m#_MARVIN@lims-a1.lerc.nasa.gov>


Call the Vector Borne Disease Unit of the Ohio Dept. of Health for
tick ID (614) 752-1029.
         
North American Labs 1-800-866-6254 will ID and test ticks for $25.
         


=====*=====


IV.   LYMENET: Lyme Disease, Insurance Issues, Dentistry
--------------------------------------------------------
Sender: Gary M. Heir, DMD <heirgm@umdnj.edu>


I am a dentist both in private practice and as an Associate Clinical
Professor at UMDNJ-NJ Dental School.  I teach in the TMD and Orofacial
Pain Center of the University.  My interest in Lyme Disease came when
my daughter, who went undiagnosed for many years, was finally
diagnosed correctly.  I became acutely aware of this condition and
have diagnosed and referred more than a dozen patients for treatment.
Currently I am writing an article on Lyme Disease and Dentistry.
There is a paucity of articles in the dental literature concerning the
Lyme patient.


On another note, I am in the midst of a problem with my insurance.  My
daughter has neuroborreliosis.  Her neurologic manifestations were
disequilibrium and sudden hearing loss.  She was treated with infusion
therapy for several months last year, suffered a relapse and required
retreatment.  Initial treatment and the first part of the second
course of infusion therapy was covered by my insurance company, but
now they have "cut-off" her therapy stating that "a review of the
accepted medical literature does not support the need for long term
care."  My search of the MEDLINE finds many references supporting
the need for retreatment and prolonged treatment in cases of
neurologic manifestations of LD.  I wonder if the LYMENET would be
able to provide a forum for discussing this topic.  


If you are interested in some case reports of dental/LD patients, let
me know.



=====*=====


VII.  Q&A: Combination Therapy (A)
-------------------------------------------------------
Sender: Carl Brenner <brenner@lamont.ldgo.columbia.edu>


There are several references to combination treatment for LD in
the literature.  One that I know of is a letter to The Lancet in
which Gasser and Dusleag recommend a combination of roxithromycin
and co-trimoxazole.  The reference is: Lancet 1990;336:1189-90.
This was followed up with a concurring letter by Pederson and
Friis-Moller (Lancet 1991;337:241).  These are European physicians,
which may make your physician more comfortable. :-)


The use of combinations of antibiotics increases the chance of
adverse reactions (Clostridia or yeast overgrowth, etc.)  You should
probably monitor your blood chemistry every couple of weeks as well.



=====*=====


VIII. LYMENET: The Public Health Risks of LD in Breckland, UK
-------------------------------------------------------------
Sender: T.V.MAWBY <T.V.Mawby@uea.ac.uk>


The Breckland area of Norfolk and Suffolk (in East Anglia, UK), is
considered to be an endemic focus of Lyme disease, where
retrospective studies of medical records show human cases since at
least 1968.  As it is suggested that prevention of Lyme disease
may be improved by increasing public awareness about the risks of
encountering infected ticks, the first part of this project aims to
identify key 'risk' areas by an investigation of spatial and temporal
patterns of tick host seeking activity and the environmental factors
associated with high tick densities (vegetation type and climatic
variables).  Ten recreational sites were used for fieldwork in the
Summer and Autumn of 1994 and the results currently being analyzed.
This year, more detailed surveys on 3-4 of these sites are just
starting.


However, the public health risk is not only influenced by
biogeographical factors affecting tick distribution and activity.  
A major part lies in the social factors of land-use, recreational and
occupational behavior and in the individuals awareness/perception
of risk.  The second stage of the project will be to investigate the
tick/human interaction in the Breckland by questionnaire surveys of
targeted groups and also to consider how past and present land use
has created a landscape favorable to abundant tick populations.


TRACEY VICTORIA MAWBY , SCHOOL OF ENVIRONMENTAL SCIENCES,
UNIVERSITY OF EAST ANGLIA, NORWICH, UK. NR4 7TJ.



=====*=====


IX.   ABOUT THE LYMENET NEWSLETTER
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