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Volume: 2
Issue: 17
Date: 14-Oct-94


Table of Contents:

I.    LYMENET: LymeNet Resource Guide Now Available
II.   LETTERS: Reader Responds to "What a Doctor Should Be"
III.  MD MED J: Maryland physicians' survey on Lyme disease
IV.   J CLIN MICROBIOL: Comparison of different strains of
      Borrelia burgdorferi sensu lato used as antigens in
      enzyme-linked immunosorbent assays
V.    FEMS MICROBIOL LETT: Nucleotide sequence and analysis of
      the gene in Borrelia burgdorferi encoding the immunogenic
      P39 antigen
VI.   J BACTERIOL: Analysis of the distribution and molecular
      heterogeneity of the ospD gene among the Lyme disease
      spirochetes: evidence for lateral gene exchange
VII.  About The LymeNet Newsletter


Newsletter:

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


IDX#                Volume 2 - Number 17 - 10/14/94
IDX#                            INDEX
IDX#
IDX#  I.    LYMENET: LymeNet Resource Guide Now Available
IDX#  II.   LETTERS: Reader Responds to "What a Doctor Should Be"
IDX#  III.  MD MED J: Maryland physicians' survey on Lyme disease
IDX#  IV.   J CLIN MICROBIOL: Comparison of different strains of
IDX#        Borrelia burgdorferi sensu lato used as antigens in
IDX#        enzyme-linked immunosorbent assays
IDX#  V.    FEMS MICROBIOL LETT: Nucleotide sequence and analysis of
IDX#        the gene in Borrelia burgdorferi encoding the immunogenic
IDX#        P39 antigen
IDX#  VI.   J BACTERIOL: Analysis of the distribution and molecular
IDX#        heterogeneity of the ospD gene among the Lyme disease
IDX#        spirochetes: evidence for lateral gene exchange
IDX#  VII.  About The LymeNet Newsletter
IDX#


QUOTE OF THE WEEK:

     "The medical community and the school system seem to
      be burdened by the same unrealistic demands -- lift
      my emotional burden, provide comfort, make me feel safe,
      tell me everything I need to know, fix me.  Much of that
      should be the responsibility of the patients'
      communities of friends, family, and fellow sufferers."


     -- Author Michaela Mann (See Section II)    


I.    LYMENET: LymeNet Resource Guide Now Available
---------------------------------------------------
Source: LymeNet News
Byline: By Marc Gabriel <marc@lymenet.org>
Date: October 9, 1994


A comprehensive document providing readers with general information on
Lyme disease (LD) and pointers to other Lyme data sources is now
available from the National Lyme Disease Network.  For the uninitiated
reader, the LymeNet Resource Guide provides a review of the LD basics,
including transmission and diagnosis.  


The Guide also list the different methods of obtaining the LymeNet
Newsletter, including back issues.  Since this information is dynamic
and the Newsletters tend to lurk in the Net for long periods of time,
these details will be removed from the Newsletter's signature file.  
Requesting the Guide will ensure readers will always have the most
current subscription and back issue retrieval instructions.


To obtain the LymeNet Resource Guide, send a blank message to:
                   resource-guide@lymenet.org
The system will immediately respond to your query by sending you the
Guide via return e-mail.  Since the document will be updated
frequently, the LymeNet Newsletter will list the version number of the
most current Guide in the signature file in place of the subscription
information.


The current version of the Guide reflects our first attempt at
providing readers with the information they request most frequently.  
The document will evolve to encompass as much information deemed
relevant to the users.  If you have any suggestions for the Guide,
please send them to marc@lymenet.org .  



---

Since the announcement of the National LymeNet gopher service in the
last issue of the Newsletter, several attempts have been made to FTP
to the National LymeNet system.  There are no plans to provide FTP
service at this time.  Please refrain from connecting to the system
via FTP.  Thank you.



=====*=====


II.   LETTERS: Reader Responds to "What a Doctor Should Be"
-----------------------------------------------------------
Sender: Michaela Mann <mb_mann@gate.pnl.gov>


[ In response to Karen Angotti's commentary entitled "What a Doctor
 Should Be" (LymeNet Newsletter vol#2 #16, section IV) ]


To the Editor:

Please, let us debunk the myth of Doctor Superhero and build a saner
medical world.  Doctors need to be: decent, honorable, and clear
thinking -- as we all do.  Beyond that, they need to be excellent
body mechanics, and to understand the body as a system and not as a
series of vaguely connected parts.  Above all, they need to know what
they do not know, and be able discuss and refer within a wide network
of health care professionals who have a variety of skills and
specialties.  They should also be able to communicate their health
care beliefs and protocols rationale, or work with someone who can do
it for them.  Patients, or the advocates for the patients (should be
required -- sick people think poorly) need to spend time learning
about themselves, their bodies, and their illness, about doctors, and
about how to get good health care.


It's no good wailing that doctors should be the be-all and end-all of
health care.  That can't and won't happen, nor should it happen.  What
can happen is patients shouldering a large measure of their health
care burden, with expert guidance on where to look for remedies/care.
This requires skills for recognizing effective healthcare providers,
firing poor ones, finding information (no matter what the literacy
level), and helping others to do the same.  The medical community and
the school system seem to be burdened by the same unrealistic
demands -- lift my emotional burden, provide comfort, make me feel
safe, tell me everything I need to know, fix me.  Much of that should
be the responsibility of the patients' communities of friends, family,
and fellow sufferers.  If we go with Doctor Superhero, we will have a
permanent health care crisis of false promises, unfulfilled
expectations, and patient-victims.



=====*=====


III.  MD MED J: Maryland physicians' survey on Lyme disease
-----------------------------------------------------------
AUTHORS: Jung PI, Nahas JN, Strickland GT, McCarter R, Israel E
ORGANIZATION: University of Maryland School of Medicine, Baltimore
REFERENCE: Md Med J 1994 May;43(5):447-50
ABSTRACT:


In a survey of 252 physicians practicing in Maryland, 170 responders
diagnosed 142 cases of Lyme disease (LB) during 1990 and 1991.  About
80% of the cases were diagnosed by primary care physicians.  The most
common clinical finding, erythema migrans (EM), was reported in half
the cases and arthritis was reported in a quarter.  Only 22.2% had a
history of a tick bite; serological tests were ordered in a third of
the cases.  EM was treated with oral antibiotics for 10-21 days.
Most physicians treated Lyme arthritis with the same therapy, although
some used intravenous ceftriaxone.  The most commonly used treatment
for neurologic or cardiac complications was intravenous ceftriaxone.
These preliminary data suggest that LB may be diagnosed by Maryland
physicians more frequently than syphilis and tuberculosis.  The data
also indicate LB is a much larger problem in Maryland than suggested
by official reports to the Centers for Disease Control.  The clinical
characteristics of the illness and the antibiotics prescribed for it

in Maryland are similar to those reported in northeastern states.


=====*=====


IV.   J CLIN MICROBIOL: Comparison of different strains of Borrelia
     burgdorferi sensu lato used as antigens in enzyme-linked
     immunosorbent assays
-------------------------------------------------------------------
AUTHORS: Magnarelli LA, Anderson JF, Johnson RC, Nadelman RB,
        Wormser GP
ORGANIZATION: Department of Entomology, Connecticut Agricultural
             Experiment Station, New Haven
REFERENCE: J Clin Microbiol 1994 May;32(5):1154-8
ABSTRACT:  


Eight strains of Borrelia burgdorferi sensu lato were tested with
serum samples from persons who had Lyme borreliosis or syphilis in
class-specific enzyme-linked immunosorbent assays (ELISAs).  Antigens
of B. burgdorferi sensu stricto, of Borrelia garinii, and of Borrelia
spirochetes in group VS461 were prepared from cultured bacteria
isolated from ticks, a white-footed mouse (Peromyscus leucopus), or
human tissues in North America, the former Soviet Union, and Japan.
Nearly all of the serum specimens that contained immunoglobulins to
strain 2591, a Connecticut isolate, were also positive in antibody
tests with the other seven strains.  In general, all eight strains
reacted similarly and were suitable as coating antigens in
class-specific ELISAs.  Assay sensitivities ranged from 82.6 to
100% in analyses for immunoglobulin M and G antibodies.  Compared with
reference antigen strain 2591, strains 231 (a tick isolate from Canada)
and NCH-1 (a human skin isolate from Wisconsin) resulted in higher
antibody titers in an ELISA.  Syphilitic sera cross-reacted in all

tests regardless of the antigen used.  Key immunodominant proteins are
shared among the closely related strains of B. burgdorferi sensu lato
tested, but it is suspected that variations in antigen compositions
among these spirochetes may sometimes affect assay performance for
detecting serum antibodies.



=====*=====


V.    FEMS MICROBIOL LETT: Nucleotide sequence and analysis of the
     gene in Borrelia burgdorferi encoding the immunogenic P39 antigen
-----------------------------------------------------------------------
AUTHORS: Simpson WJ, Cieplak W, Schrumpf ME, Barbour AG, Schwan TG
ORGANIZATION: Rocky Mountain Laboratories, National Institute of
             Allergy and Infectious Diseases, National Institutes
             of Health
REFERENCE: FEMS Microbiol Lett 1994 Jun 15;119(3):381-7
ABSTRACT:


The P39 antigen is a specific, highly conserved, and immunogenic
protein of Lyme disease spirochetes, Borrelia burgdorferi sensu lato.
The nucleotide sequence of the gene encoding this protein was
determined and found to be the first of two tandemly arranged open
reading frames located on the spirochete's chromosome.  These two open
reading frames were designated bmpA for the gene encoding P39 and bmpB
for the gene encoding the putative protein ORF2 encoded by the second
open reading frame.  The nucleic acid sequence identity for the two
open reading frames was 62% while their deduced amino acid sequences
were 52% identical.  Comparison to sequence data bases demonstrated
that the deduced amino acid sequences of both P39 and ORF2 were
homologous to TmpC, a putative outer or cytoplasmic membrane
lipoprotein of the syphilis spirochete, Treponema pallidum.  



=====*=====


VI.   J BACTERIOL: Analysis of the distribution and molecular
     heterogeneity of the ospD gene among the Lyme disease
     spirochetes: evidence for lateral gene exchange
-------------------------------------------------------------
AUTHORS: Marconi RT, Samuels DS, Landry RK, Garon CF
ORGANIZATION: Laboratory of Vectors and Pathogens, Rocky Mountain
             Laboratories, National Institute of Allergy and
             Infectious Diseases
REFERENCE: J Bacteriol 1994 Aug;176(15):4572-82
ABSTRACT:


Analysis of the ospD gene has revealed that this gene is not universal
among Lyme disease spirochete isolates.  The gene was found to be
carried by 90, 50, and 24% of the Borrelia garinii, B. afzelii, and
B. burgdorferi isolates tested.  Size variability in the ospD-encoding
plasmid was also observed.  Sequence analysis has demonstrated the
presence of various numbers of a 17-bp repeated sequence in the
upstream control (promoter) region of the gene.  In addition, a
region within the coding sequence where various insertions,
deletions, and direct repeats occur was identified. ospD gene
sequences from 31 different isolates were determined and utilized in
pairwise sequence comparisons and construction of a gene tree.
These analyses suggest that the ospD gene was the target of several
recombinational events and that the gene was recently acquired by Lyme
disease spirochetes and laterally transferred between species.



=====*=====


VII.  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 obain the Guide,
send a blank message to:      resource-guide@lymenet.org
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The LymeNet Resource Guide is in Revision:  1.02  (10/09/94)
-----------------------------------------------------------------------
LymeNet - The Internet Lyme Disease Information Source
-----------------------------------------------------------------------
Editor-in-Chief: Marc C. Gabriel <a229@Lehigh.EDU>
           FAX: 908-789-0028
Contributing Editors: Carl Brenner <brenner@ldeo.Columbia.EDU>
                     John Setel O'Donnell <jod@Equator.COM>
                     Frank Demarest <76116.2065@CompuServe.COM>
Advisors: Carol-Jane Stolow, Director <carol@lymenet.org>
         William S. Stolow, President <bill@lymenet.org>

         The Lyme Disease Network of New Jersey (908-390-5027)
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