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Volume: 8
Issue: 02
Date: 22-Feb-00


Table of Contents:

I.    LYMENET: LYME-PAC Requests NY Dept. of Heath Public Hearings
II.   ARCH DERMATOL: Infection with multiple strains of Borrelia
      burgdorferi sensu stricto in patients with Lyme disease.
III.  J NEUROSCI RES: Borrelia burgdorferi induces matrix
      metalloproteinases by neural cultures.
IV.   J MED ENTOMOL: Seasonal activity and host associations of Ixodes
      scapularis (Acari: Ixodidae) in southeastern Missouri.
V.    BR J OPHTHALMOL: Ocular manifestations in children and
      adolescents with Lyme arthritis.
VI.   ABOUT THE LYMENET NEWSLETTER


Newsletter:

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                  Volume 8 / Number 02 / 22-FEB-2000
                               INDEX


I.    LYMENET: LYME-PAC Requests NY Dept. of Heath Public Hearings
II.   ARCH DERMATOL: Infection with multiple strains of Borrelia
     burgdorferi sensu stricto in patients with Lyme disease.
III.  J NEUROSCI RES: Borrelia burgdorferi induces matrix
     metalloproteinases by neural cultures.
IV.   J MED ENTOMOL: Seasonal activity and host associations of Ixodes
     scapularis (Acari: Ixodidae) in southeastern Missouri.
V.    BR J OPHTHALMOL: Ocular manifestations in children and
     adolescents with Lyme arthritis.
VI.   ABOUT THE LYMENET NEWSLETTER



=====*=====


I.    LYMENET: LYME-PAC Requests NY Dept. of Heath Public Hearings
------------------------------------------------------------------
Sender: LYME-PAC <Lyme-pac@mail.com>


NEW YORK, Feb. 21 /PRNewswire/ -- LYME-PAC, a coalition of 12 regional
Lyme patient advocacy groups in New York State, is requesting public
hearings regarding the Department of Health's decision to take sides in
a heated scientific and medical controversy concerning the appropriate
standard for diagnosis and treatment of Lyme and other tick-borne
diseases.


In a letter dated December 21, 1999, Dr. Ansel Marks of the New York
State Department of Health (NYS DOH), stated that, "Rarely if ever have
the published guidelines indicated that anything more than two to three
weeks of antibiotics are required to cure Lyme disease."  The
experience of thousands of patients, together with extensive articles
in peer-reviewed medical literature, refutes this assertion.


There is no scientific proof that 3 weeks of antibiotics will eradicate
the Lyme bacteria in most patients.


Extensive articles in peer-reviewed medical journals establish that the
testing for Lyme disease is unreliable and that the bacteria is often
not destroyed by this 2 to 3-week treatment protocol.


Physicians who do not adhere to this arbitrarily dictated standard of
2 to 3 weeks of antibiotic treatment are being targeted by the DOH for
licensure revocation hearings.  LYME-PAC believes that the DOH is
violating its role as an honest arbiter and protector of medical
conduct.


"The DOH is taking sides in a scientific dispute, before all the
science is in, at the cost of New Yorkers' lives and well-being.  It's
inexcusable," says Monica Miller, a spokesperson for the Foundation
for the Advancement of Innovative Medicine.


LYME-PAC calls for public hearings into the conduct of the DOH in order
to preserve the ability of New York State's physicians to practice
clinical medicine in accordance with their experience, best judgment
and the complete body of scientific evidence available.  Physicians
must be allowed to tailor treatment on a case-by-case basis.  Lyme
disease is a multi-systemic disease.  Therefore, it is absurd to treat
all people with different clinical symptoms the same way.  The
"one size fits all" approach is inherently incorrect in the practical
application of medical science, and it is specifically failing to
effectively address the real life medical tragedy in a large number of
Lyme disease patients.



=====*=====


II.   ARCH DERMATOL: Infection with multiple strains of Borrelia
     burgdorferi sensu stricto in patients with Lyme disease.
----------------------------------------------------------------
AUTHORS: Seinost G, Golde WT, Berger BW, Dunn JJ, Qiu D, Dunkin DS
        Dykhuizen DE, Luft BJ, Dattwyler RJ
ORGANIZATION: Department of Medicine, State University of New York
             at Stony Brook, 11794-8161, USA.
REFERENCE: Arch Dermatol 1999 Nov;135(11):1329-33
ABSTRACT:


OBJECTIVE: To assess human skin biopsy specimens from erythema migrans
lesions for the presence of infection with multiple strains of the
Lyme disease spirochete, Borrelia burgdorferi.  
DESIGN: Skin biopsy specimens were obtained prospectively from patients
with erythema migrans. To determine allelic differences and strain
identification of B burgdorferi, the biopsy specimens were analyzed by
cold single-strand conformation polymorphism of an amplified fragment
of the outer surface protein C (ospC) gene.  Further single-strand
conformation polymorphism patterns of amplified ospC genes from
culture isolates were compared with polymerase chain reaction products
obtained directly from erythema migrans biopsy specimens.
SETTING: A private dermatology office and a university medical center
outpatient department.
PATIENTS: Sixteen patients presenting with erythema migrans.    
RESULTS: Two of the 16 patients in this cohort were infected with 2 B
burgdorferi sensu stricto strains, as evidenced by 2 ospC alleles in

their skin biopsy results.
CONCLUSION: This is the first documented description of the existence
of more than a single strain of B burgdorferi sensu stricto in a human
specimen.



=====*=====


III.  J NEUROSCI RES: Borrelia burgdorferi induces matrix
     metalloproteinases by neural cultures.
---------------------------------------------------------
AUTHORS: Perides G, Tanner-Brown LM, Eskildsen MA, Klempner MS
ORGANIZATION: Tupper Research Institute, Department of Medicine, Tufts
             University School of Medicine, New England Medical
     Center, Boston, Massachusetts.
     gperides@caregroup.harvard.edu
REFERENCE: J Neurosci Res 1999 Dec 15;58(6):779-90
ABSTRACT:


Matrix metalloproteinases (MMPs) are associated with chronic neurologic
diseases such as multiple sclerosis and senile dementia. Lyme disease
is a multisystemic infection involving the nervous system, skin,
joints, and heart. Neurologic manifestations of chronic Lyme disease
include encephalopathy and cranial and peripheral neuropathy. Borrelia
burgdorferi, the spirochaete causing Lyme disease, has been cultured
from the cerebrospinal fluid (CSF), and B. burgdorferi DNA is
frequently detected in the CSF of patients with Lyme neuroborreliosis.
We used cerebral and cerebellar primary cultures to determine whether
B. burgdorferi induces the production of MMPs by primary neural
cultures. B. burgdorferi in a dose- and time-dependent manner induced
the expression of MMP-9 by primary neural cultures but had no effect
on the expression of MMP-2. Human and rat type I astrocytes expressed
MMP-9 when incubated with B. burgdorferi in the same manner as primary
neural cultures. This response may play a role in the symptomatology

and the pathogenesis of Lyme neuroborreliosis.


=====*=====


IV.   J MED ENTOMOL: Seasonal activity and host associations of Ixodes
     scapularis (Acari: Ixodidae) in southeastern Missouri.
----------------------------------------------------------------------
AUTHORS: Kollars TM Jr, Oliver JH Jr, Kollars PG, Durden LA
ORGANIZATION: Institute of Arthropodology and Parasitology, Georgia
             Southern University, Statesboro 30460, USA.
REFERENCE: J Med Entomol 1999 Nov;36(6):720-6
ABSTRACT:


Based on tick collections recovered from wild vertebrates and by
dragging, the seasonal occurrence of adult blacklegged ticks, Ixodes
scapularis Say, extended from October through May in southeastern
Missouri. Adult activity was bimodal with the higher peak occurring
in November followed by a lower peak in February. The activity of
immature I. scapularis had the general pattern of that found in the
Northeast where Lyme disease is hyperendemic, with larval activity
(July) peaking after that of nymphs (May and June). Vertebrates varied
in their importance as hosts of I. scapularis. White-tailed deer,
Odocoileus virginanus (Zimmerman), and coyotes, Canis latrans Say,
were the primary hosts of adult I. scapularis. Broad-headed skinks,
Eumeces laticeps (Schneider), and eastern fence lizards, Sceloporus
undulatus (Latreille), were the primary hosts of nymphal I.
scapularis. The broad-headed skink, 5-lined skink, Eumeces fasciatus
(L.), and Carolina wren, Thryothorus ludovicianus (Latham), were the
primary hosts of larval I. scapularis. Homeotherms were important

hosts of immature I. scapularis, accounting for 30% of nymphs and 39%
of larvae collected. The eastern cottontail rabbit, Sylvilagus
floridanus (Allen), may play an important role in the epidemiology
of Lyme disease in Missouri. Isolates of Borrelia burgdorferi
Johnson, Schmid, Hyde, Steigerwalt & Brenner were made from ticks
recovered from rabbits, making the cottontail rabbit a key species
for further study of the epidemiology of Lyme borreliosis in Missouri.



=====*=====


V.    BR J OPHTHALMOL: Ocular manifestations in children and
     adolescents with Lyme arthritis.
------------------------------------------------------------
AUTHORS: Huppertz HI, Munchmeier D, Lieb W
ORGANIZATION: Children's Hospital, University of Wurzburg, Wurzburg,
             Germany.
REFERENCE: Br J Ophthalmol 1999 Oct;83(10):1149-52
ABSTRACT:


BACKGROUND: Lyme arthritis is the most frequent late manifestation
of Lyme borreliosis and has been associated with ocular inflammation.
METHODS: A group of 153 children and adolescents with arthritis, 84 of
whom had Lyme arthritis and 69 other causes of arthritis, were followed
prospectively for 22-73 (median 44) months in the course of a national
study.
RESULTS: Three of 84 patients with Lyme arthritis had ocular
inflammation (4%), including keratitis, anterior uveitis, and uveitis
intermedia. All three had symptoms of decreased visual acuity. Whereas
anterior uveitis disappeared without sequelae, a corneal scar and a
permanent loss of visual acuity in the patients with keratitis and
intermediate uveitis remained. Systematic examination of all
patients revealed no further ocular involvement. Of 69 patients with
other causes of arthritis who were followed in parallel as a control
group, four of 15 patients with early onset pauciarticular juvenile
rheumatoid arthritis had chronic anterior uveitis and two of 12

patients with juvenile spondyloarthropathy had acute anterior uveitis.
CONCLUSIONS: Ocular involvement with keratitis, anterior uveitis, and
intermediate uveitis may occur in children and adolescents with Lyme
arthritis. Visual loss appears to be symptomatic, making regular
ocular screening of such patients unnecessary.



=====*=====


VI.   ABOUT THE LYMENET NEWSLETTER
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