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Volume: 7
Issue: 08
Date: 23-Aug-99


Table of Contents:

I.    LYMENET: Burrascano Under Investigation
II.   LYMENET: LDANJ Makes New Funds Available for Researchers
III.  ARTHRITIS RHEUM:  Detection of Borrelia burgdorferi sensu stricto
      by reverse line blot in the joints of Dutch patients with Lyme
      arthritis.
IV.   J CLIN MICROBIOL: Validity of interpretation criteria for
      standardized Western blots (immunoblots) for serodiagnosis of
      Lyme borreliosis based on sera collected throughout Europe.
V.    APMIS: An in vitro study of the susceptibility of mobile and
      cystic forms of Borrelia burgdorferi to metronidazole.
IV.   J CLIN MICROBIOL: Validity of interpretation criteria for
      standardized Western blots (immunoblots) for serodiagnosis of
      Lyme borreliosis based on sera collected throughout Europe.
VI.   ABOUT THE LYMENET NEWSLETTER


Newsletter:

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                  Volume 7 / Number 08 / 23-AUG-1999
                                INDEX


I.    LYMENET: Burrascano Under Investigation
II.   LYMENET: LDANJ Makes New Funds Available for Researchers
III.  ARTHRITIS RHEUM:  Detection of Borrelia burgdorferi sensu stricto
     by reverse line blot in the joints of Dutch patients with Lyme
     arthritis.
IV.   J CLIN MICROBIOL: Validity of interpretation criteria for
     standardized Western blots (immunoblots) for serodiagnosis of
     Lyme borreliosis based on sera collected throughout Europe.
V.    APMIS: An in vitro study of the susceptibility of mobile and
     cystic forms of Borrelia burgdorferi to metronidazole.
IV.   J CLIN MICROBIOL: Validity of interpretation criteria for
     standardized Western blots (immunoblots) for serodiagnosis of
     Lyme borreliosis based on sera collected throughout Europe.
VI.   ABOUT THE LYMENET NEWSLETTER



=====*=====


I.    LYMENET: Burrascano Under Investigation
---------------------------------------------
Sender: LymeNet/LDANJ News Service
Date: 20-AUG-1999


Dr. Joseph Burrascano is under investigation by the New York State  
Office of Professional Medical Conduct (OPMC).  He is a pioneer and
leader in aggressive treatment methods for Lyme Disease patients
continuing to suffer symptoms from the disease.  Respected medical
journals such as Conn's Current Therapy have published his protocols
and his guidelines can be found on the LymeNet website.


As part of the investigation, he was interviewed on July 2. Patient
files were removed from his office and will be searched for evidence
of "unprofessional conduct."  By law, the charges brought against a
physician are not specified. In New York, the law authorizes the OPMC
to use the original complaint to gain access to the physician's
charts, but the final charges may not be the same as the original
complaint. In other words, they can use anything they find, even if
totally unrelated to the original complaint.


Burrascano's position on Lyme Disease conflicts with the view
of many members of the academic medical world. They believe Lyme
Disease is easily diagnosed and adequately treated with 3- 4 weeks of
antibiotics. This conservative protocol of treatment has left many
patients ill and looking for answers. Even with growing scientific
evidence of persistent infection in some patients, the medical world
has stayed divided into 2 camps concerning treatment.  There is a
sharp division between doctors treating aggressively for what they
believe to be an active infection and those who feel the infection is
eradicated after "adequate" treatment.


Burrascano's treatment methods and similar ideas are eagerly sought
by many Lyme Disease patients dissatisfied after being treated by
doctors using the conservative guidelines published  by the Centers for
Disease Control (CDC), American College of Physicians (ACP) and other
medical resources. These patients want a different approach to
regaining their health.


It is speculated that the charges were initiated by members of the
conservative camp. However, as OPMC rules give anonymity to the
accuses and the charges,  it cannot be denied or confirmed. This
gives the complainant protection against reprisals, but it also
prevents accountability. Without full disclosure, one can never
explore the motives of the accuser.


Regardless of innocence or guilt, investigations can be ruinous
to the practice, reputation, finances, and ultimately to the family
security of the physician accused.


Burrascano's treatment guidelines can be found at:

                     http://guidelines.LymeNet.org


=====*=====


II.   LYMENET: LDANJ Makes New Funds Available for Researchers
--------------------------------------------------------------


EDITORIAL NOTE: The following letter was sent from the LDANJ to
researcher looking into chronic Lyme disease.


The Lyme Disease Association of New Jersey, Inc. (LDANJ) appreciates
your interest and willingness to conduct research that could
potentially lead to a cure for chronic Lyme disease.  Currently, the
LDANJ has funds available to award grants in varying amounts up to
$25,000.  Future grants could possibly be considered at a later date.  
Enclosed you will find a grant application for you to complete.  
Upon its receipt, the application and proposal information will be
reviewed by a committee composed of physicians and LDANJ members.  
Certain projects will then be selected for consideration by the
executive board of the LDANJ.


The LDANJ is an all-volunteer. non-profit, tax exempt corporation that
has raised over $500,000 for Lyme research, prevention, and education.  
The most important objective of the LDANJ is to find a cure for chronic
Lyme disease.  Accomplishments include:


* Funding the Lyme Disease Research Project Fox Chase Cancer Center
 (PCR)
* Funding for Dr. Fallon, New York State Psychiatric Institute
 (brain scans)
* Funding the Lyme Disease Project University of Pennsylvania/VAMC
 (PCR)
* Funding Dr. Manfred Bayer, effects of low frequency radiation on B.
 burgdorferi
* Funding for Dr. Steven Schutzer, UMDNJ, gold standard test for
 active infection
* Funding for Drs. Liegner, Pavia, Niasi for hyperbaric oxygen study
* Funding for Norwalk Hospital HBO study  
* Holding annual statewide seminars for educators
* Helping develop federal Lyme disease bill introduced in 1998 in House
 of Representatives
* Distributing information on Lyme disease to the general public
* Distributing "Patient Information Guide" to doctors
* Publishing "Tiny Tick Tales" informing readers of research updates
 and events
* Featuring TV Public Service Announcement on Lyme
* Producing low cost videos on Lyme disease
* Holding Lyme disease forum to educate federal officials


The LDANJ grant application may be downloaded from:

     http://www2.LymeNet.org/domino/news.nsf/UID/LDANJ-grant


=====*=====


III.  ARTHRITIS RHEUM:  Detection of Borrelia burgdorferi sensu stricto
     by reverse line blot in the joints of Dutch patients with Lyme
     arthritis.
-----------------------------------------------------------------------
AUTHORS: van der Heijden IM, Wilbrink B, Rijpkema SG, Schouls LM
        Heymans PH, van Embden JD, Breedveld FC, Tak PP
ORGANIZATION: Leiden University Medical Center, The Netherlands.
REFERENCE: Arthritis Rheum 1999 Jul;42(7):1473-80
ABSTRACT:


OBJECTIVE: To analyze the presence of Borrelia burgdorferi sensu lato
in synovial samples from the knee joint of patients with Lyme arthritis
by polymerase chain reaction, and to differentiate the species by
reverse line blot (RLB).
METHODS: Synovial fluid (SF) and synovial tissue (ST) samples were
obtained from patients with Lyme arthritis (n = 4) and from patients
with various other forms of arthritis (n = 9). DNA extracted from
synovial samples was amplified by using, as a target, the spacer
region between the 5S and 23S ribosomal RNA genes of B. burgdorferi
sensu lato. Subsequently, 4 species-specific DNA probes were used in
the RLB for specific hybridization.
RESULTS: DNA from B. burgdorferi sensu stricto DNA was detected in
the SF and ST from 3 patients with Lyme arthritis. B. burgdorferi
sensu lato DNA was not detected in the synovial samples from 9
control patients.
CONCLUSION: The relationship between different species of B.
burgdorferi sensu lato and arthritis can be studied using direct

analysis of extracted DNA from joint samples. This method can be used
to study the association between particular clinical manifestations of
Lyme disease and different species of B. burgdorferi sensu lato.



=====*=====


IV.   J CLIN MICROBIOL: Validity of interpretation criteria for
     standardized Western blots (immunoblots) for serodiagnosis of
     Lyme borreliosis based on sera collected throughout Europe.
-------------------------------------------------------------------
AUTHORS: Hauser U, Lehnert G, Wilske B
ORGANIZATION: Max von Pettenkofer-Institut fur Hygiene und Medizinische
             Mikrobiologie der Ludwig-Maximilians-Universitat Munchen,
             D-80336 Munich, Germany.
REFERENCE: J Clin Microbiol 1999 Jul;37(7):2241-7
ABSTRACT:


Western blotting (WB; immunoblotting) is a widely used tool for the
serodiagnosis of Lyme borreliosis (LB), but so far, no generally
accepted criteria for performance and interpretation have been
established in Europe. The current study was preceeded by a detailed
analysis of WB with whole-cell lysates of three species of Borrelia
burgdorferi sensu lato (U. Hauser, G. Lehnert, R. Lobentanzer, and B.
Wilske, J. Clin. Microbiol. 35:1433-1444, 1997). In that study,
interpretation criteria for a positive WB result were developed with
the data for 330 serum samples (from patients with LB in different
stages [n = 189] and from a control group [n = 141]) originating
mostly from southern Germany. In the present work, the interpretation
criteria for strains PKo (Borrelia afzelii) and PBi (Borrelia garinii)
developed in the previous study were reevaluated with 224 serum samples
(from patients with LB in different stages [n = 97] and from a control
group [n = 127]) originating from throughout Europe that were provided

by the European Union Concerted Action on Lyme Borreliosis (EUCALB).
De novo criteria were developed on the basis of the reactivities of
the EUCALB sera and were evaluated with the data for the samples from
southern Germany. Comparison of all results led to the following
recommendations: For WB for immunoglobulin G (IgG), at least two
bands among p83/100, p58, p43, p39, p30, OspC, p21, p17, and p14 for
PKo and at least one band among p83/100, p39, p30, OspC, p21, and p17b
for PBi; for WB for IgM, at least one band among p39, OspC, and p17 or
a strong p41 band for PKo and at least one band among p39 and OspC or
a strong p41 band for PBi. WB with PKo was the most sensitive, and
this strain is recommended for use in WB for the serodiagnosis of
LB throughout Europe.



=====*=====


V.    APMIS: An in vitro study of the susceptibility of mobile and
     cystic forms of Borrelia burgdorferi to metronidazole.
------------------------------------------------------------------
AUTHORS: Brorson O, Brorson SH
ORGANIZATION: Department of Microbiology, Vestfold Sentralsykehus,
             Tonsberg, Norway.
REFERENCE: APMIS 1999 Jun;107(6):566-76
ABSTRACT:


The aim of this study was to examine the susceptibility of mobile and
cystic forms of Borrelia burgdorferi to metronidazole. Because B.
burgdorferi is a microaerobic bacterium like Helicobacter pylori,
metronidazole (MZ) was chosen in the susceptibility test. For both
microaerobic and aerobic incubation the normal mobile spirochetes
were resistant to this antibiotic with an MBC > or = 512 microg/ml.
Conversion of mobile spirochetes to cystic forms was not observed when
they were incubated with MZ. When they were incubated under
microaerobic conditions, the biologically active cystic forms had an
MBC > or = 4 microg/ml, but the MBC was > or = 32 microg/ml with
aerobic incubation at 37 degrees C. Staining with acridine orange (AO),
dark field microscopy (DFM), and transmission electron microscopy
(TEM) revealed that the contents of the cysts were degraded when the
concentration of MZ was > or = MBC. Some cysts were also ruptured.
When incubated with a sufficient concentration of MZ, core structures

did not develop inside the cysts, and AO revealed less RNA in the
cysts. Our observations may help efforts to treat resistant
infections caused by B. burgdorferi with a combination of MZ and
other antibiotics in order to eradicate both cystic and mobile forms
of B. burgdorferi.



=====*=====


VI.  EUR J CLIN MICROBIOL INFECT DIS: Prevalence of antibodies against
    the human granulocytic ehrlichiosis agent in Lyme borreliosis
    patients from Germany.
----------------------------------------------------------------------
AUTHORS: Hunfeld KP, Brade V,
ORGANIZATION: Institute of Medical Microbiology, University Hospital of
             Frankfurt, Frankfurt/Main, Germany.
     K.Hunfeld@em.uni-frankfurt.de
REFERENCE: Eur J Clin Microbiol Infect Dis 1999 Mar;18(3):221-4
ABSTRACT:


To contribute to the discussion of whether or not human granulocytic
ehrlichiosis (HGE) occurs in midwestern Germany, sera from individuals
with different risk categories for tick exposure were retrospectively
examined by means of an immunofluorescence assay. The seroreprevalence
for the HGE agent accounted for 5.5% of the 270 patients tested.
Specific antibodies were detected more often in patients with early
Lyme infection than in patients with stage III disease or in
asymptomatic individuals seropositive for Lyme disease. Investigation
of 50 patients with an active or recent syphilis infection revealed
no cross-reactivity between Treponema pallidum antibodies and the HGE
agent. The prevalence of HGE antibodies (13.1%) among 76 Lyme
borreliosis patients from this urban area was significantly higher
(P < 0.05) than that in the control groups (2.6%). The findings
indicate that concomitant or serial infections with Borrelia
burgdorferi and the HGE agent or closely related organisms may be a
common occurrence in tick-exposed patients from Germany.



=====*=====


VI.   ABOUT THE LYMENET NEWSLETTER
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