Volume: 7 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: *********************************************************************** * The National Lyme Disease Network * * http://www.LymeNet.org/ * * LymeNet Newsletter * *********************************************************************** 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. [email protected] 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 ----------------------------------------------------------------------- For the most current information on LymeNet subscriptions, contributions, and other sources of information on Lyme disease, please refer to: http://newsletter.lymenet.org ----------------------------------------------------------------------- To unsubscribe from the LymeNet newsletter, send a message to: [email protected] On the first line of the message, write: unsub lymenet-l ----------------------------------------------------------------------- LymeNet - The Internet Lyme Disease Information Source ----------------------------------------------------------------------- Editor-in-Chief: Marc C. Gabriel <[email protected]> FAX (for contributions ONLY): 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. Stolow, President <[email protected]> The Lyme Disease Network of New Jersey ----------------------------------------------------------------------- WHEN COMMENTS ARE PRESENTED WITH AN ATTRIBUTION, THEY DO NOT NECESSARILY REPRESENT THE OPINIONS/ANALYSES OF THE EDITORS. ----------------------------------------------------------------------- THIS NEWSLETTER MAY BE REPRODUCED AND/OR POSTED ON BULLETIN BOARDS FREELY AS LONG AS IT IS NOT MODIFIED OR ABRIDGED IN ANY WAY. ----------------------------------------------------------------------- SEND ALL BUG REPORTS TO [email protected] ----------------------------------------------------------------------- |
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