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Volume: 3
Issue: 06
Date: 24-Apr-95


Table of Contents:

I.    Q&A: Experience with Timentin or Cefpodoxime in LD? (A)
II.   Q&A: Antibiotics for Thrombocytopenia Patients (A)
III.  Q&A: Combination Therapy (Q)  
IV.   Q&A: Tick Testing (Q)
V.    POSTGRAD MED: Polymyalgia rheumatica or Lyme disease?  
      How to avoid misdiagnosis in older patients
VI.   J CLIN MICROBIOL: Distribution of Borrelia burgdorferi in
      host mice in Pennsylvania
VII.  About The LymeNet Newsletter


Newsletter:

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*                  The National Lyme Disease Network                  *
*                         LymeNet Newsletter                          *
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IDX#                Volume 3 - Number 06 - 4/24/95
IDX#                            INDEX
IDX#
IDX#  I.    Q&A: Experience with Timentin or Cefpodoxime in LD? (A)
IDX#  II.   Q&A: Antibiotics for Thrombocytopenia Patients (A)
IDX#  III.  Q&A: Combination Therapy (Q)  
IDX#  IV.   Q&A: Tick Testing (Q)
IDX#  V.    POSTGRAD MED: Polymyalgia rheumatica or Lyme disease?  
IDX#        How to avoid misdiagnosis in older patients
IDX#  VI.   J CLIN MICROBIOL: Distribution of Borrelia burgdorferi in
IDX#        host mice in Pennsylvania
IDX#  VII.  About The LymeNet Newsletter
IDX#


QUOTE OF THE WEEK:

     "Nevertheless, high isolation rates from counties
      of the southeastern corner of [Pennsylvania]
      illustrate well that hemlock habitat is not essential.  
      Evidence suggests that in some areas, transmission
      between mice is occurring in some way other than
      through ticks as vectors."


      -- Lord et al.  (see Section VI)


I.    Q&A: Experience with Timentin or Cefpodoxime in LD? (A)
-------------------------------------------------------------------
Sender: Phyllis Mervine, Editor, the Lyme Times <fredm@pacific.net>


Resistance in Borrelia burgdorferi is not generally considered a
problem.  The recognized problem is that the bacterium employs
various mechanisms to evade the immune system, enabling it also to
avoid contact with antibiotics.  Sequestration in various types of
body cells and long generation time are two of these mechanisms.
Throwing the arsenal of the pharmaceutical industry at this bacterium
is not the solution.  Understanding the microbiology of the organism
is the first line of attack.



=====*=====


II.   Q&A: Antibiotics for Thrombocytopenia Patients (A)
-------------------------------------------------------------------
Sender: Phyllis Mervine, Editor, the Lyme Times <fredm@pacific.net>


The two tick-borne diseases which may affect the platelets are
babesiosis and ehrlichiosis.  Dr David Persing, Dept of Laboratory
Medicine and Pathology, Mayo Clinic, is an authority on this subject.



=====*=====


III.  Q&A: Combination Therapy (Q)
---------------------------------------------
Sender: Peter Rohleder <Peter.Rohleder@gmd.de>
       http://zeus.gmd.de/i3/people/peter.rohleder.html


I was diagnosed having Lyme-disease last summer.  The Western-Blot
test was positive and showed the specific bands.


I had various symptoms like libido loss, muscle weakness, headaches,
stiff neck, irritable bladder for which I had no explanation for a
long time.  After being misdiagnosed about 4 years I was now happy
to know the reasons for these different symptoms of my illness.


I got Rocephin I.M. for 15 days, was soon feeling better and thought
being cured.  But 14 days after the end of the Rocephin therapy,
most of the symptoms appeared again.  In January '95 I spent four
weeks in a hospital again getting Rocephin, now I.V.


But to my surprise it didn't help any more.  After the end of the
Rocephin-therapy I got Amoxicillin plus Probenecid for about four
weeks, but this also didn't help.  With one exception: A very short
period of time (about 18 hours) when I ended the Rocephin-therapy
and started getting Amoxicillin I was feeling better.  To me it
seems that it was the overlapping time period when both antibiotics
were working.


And indeed: In the treatment guide of Dr. Burrascano one can read
that in some cases a combination therapy with two different working
antibiotics could be the right way.


Now I'm at the point that I need to convince my doctor that this kind
of therapy makes sense. He says that he had never heard of this kind
of therapy for Borreliose (that the mostly used name for Lyme-disease
in Germany).  Is there any kind of scientific literature available
(preferable electronically) which I can get and which I can show him?



=====*=====


IV.   Q&A: Tick Testing (Q)
---------------------------
Sender: <Jeanger@aol.com>


A child has been bitten by a tick (central Ohio), and the mother has
removed the tick and saved it in alcohol.  Can this tick be tested?
We have been given the name of the Yale Lyme Disease Clinic which
will test a tick for $75.  Are there any other places which will
test a tick for LD?


--

Please send responses to these questions to: LymeNet-L@Lehigh.EDU


=====*=====


V.    POSTGRAD MED: Polymyalgia rheumatica or Lyme disease?  
     How to avoid misdiagnosis in older patients
-----------------------------------------------------------
AUTHOR: Paparone PW
ORGANIZATION: Lyme Disease Center for South Jersey, Absecon
REFERENCE: Postgrad Med 1995 Jan;97(1):161-4, 167-70
ABSTRACT:


This case report demonstrates the need to consider Lyme disease in
older patients who present with nonspecific signs and symptoms often
seen in polymyalgia rheumatica, particularly a markedly elevated
erythrocyte sedimentation rate (ESR).  ESRs greater than 100 mm/hr
are common in polymyalgia rheumatica, but rates higher than 85 mm/hr
are also possible in Borrelia infection.  Because positive serologic
findings for Lyme disease have been noted in patients with
polymyalgia rheumatica who have been exposed to endemic areas,
differential diagnosis must be based on clinical manifestations.
Response to therapy should be monitored closely to confirm the
diagnosis and avoid the adverse consequences of inappropriate
treatment.  The potentially deleterious effect that corticosteroids
can have on Lyme disease must be considered in the decision to treat
polymyalgia rheumatica.



=====*=====


VI.   J CLIN MICROBIOL: Distribution of Borrelia burgdorferi in
     host mice in Pennsylvania
---------------------------------------------------------------
AUTHORS: Lord RD, Lord VR, Humphreys JG, McLean RG
ORGANIZATION: Biology Department, Indiana University of
             Pennsylvania
REFERENCE: J Clin Microbiol 1994 Oct;32(10):2501-4
ABSTRACT:


Host mice (Peromyscus leucopus and Peromyscus maniculatus) were
sampled throughout the state of Pennsylvania to determine the
geographical and ecological distribution of the Lyme disease
spirochete Borrelia burgdorferi.  All 67 counties of the state were
sampled.  A total of 1,619 mice were captured from a total of 157
sites during the period 1990 to 1993 for an overall capture rate of
29.69%.  A total of 112 (6.92%) isolations of B. burgdorferi were
made.  The distribution of isolations revealed the reason for the
correlated distribution of human cases of Lyme disease in the state.
Significantly more mice were captured and significantly more
isolations were made from hemlock (Tsuga canadensis) habitat than
from deciduous species forest.


Nevertheless, high isolation rates from counties of the southeastern
corner of the state illustrate well that hemlock habitat is not
essential.  Evidence suggests that in some areas, transmission
between mice is occurring in some way other than through ticks as
vectors.  Host mice proved useful for determining the geographical
and ecological distribution of B. burgdorferi.



=====*=====


VII.  ABOUT THE LYMENET NEWSLETTER
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