Volume: 3 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: *********************************************************************** * The National Lyme Disease Network * * LymeNet Newsletter * *********************************************************************** 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 <[email protected]> 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: [email protected] 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 <[email protected]> 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 <[email protected]> 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 <[email protected]> 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#[email protected]> 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 <[email protected]> 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 <[email protected]> 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 <[email protected]> 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 ----------------------------------- For the most current information on LymeNet subscriptions, contributions, and other sources of information on Lyme disease, please request the LymeNet Resource Guide. To obtain the Guide, send a blank message to: [email protected] ----------------------------------------------------------------------- The LymeNet Resource Guide is in Revision: 1.10 ----------------------------------------------------------------------- LymeNet - The Internet Lyme Disease Information Source ----------------------------------------------------------------------- Editor-in-Chief: Marc C. Gabriel <[email protected]> FAX: 908-789-0028 Contributing Editors: Carl Brenner <[email protected]> John Setel O'Donnell <[email protected]> Frank Demarest <[email protected]> Advisors: Carol-Jane Stolow, Director <[email protected]> William S. 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