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Volume: 4
Issue: 12
Date: 02-Sep-96


Table of Contents:

I.    LYMENET: Compuserve now has two areas dedicated to LD
II.   ANN INTERN MED: Azithromycin compared with amoxicillin in
      the treatment of erythema migrans.  A double-blind,
      randomized, controlled trial
III.  AM J CLIN PATHOL: Polymerase chain reaction detection of
      Lyme disease: correlation with clinical manifestations and
      serologic responses
IV.   INFECT IMMUN: Dominant recognition of a Borrelia
      burgdorferi outer surface protein A peptide by T helper
      cells in patients with treatment-resistant Lyme arthritis
V.    AM J TROP MED HYG: The spread of tick-borne borreliosis in
      West Africa and its relationship to sub-Saharan drought
VI.   About The LymeNet Newsletter


Newsletter:

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


IDX#                Volume 4 - Number 12 - 9/02/96
IDX#                            INDEX
IDX#
IDX#  I.    LYMENET: Compuserve now has two areas dedicated to LD
IDX#  II.   ANN INTERN MED: Azithromycin compared with amoxicillin in
IDX#        the treatment of erythema migrans.  A double-blind,
IDX#        randomized, controlled trial
IDX#  III.  AM J CLIN PATHOL: Polymerase chain reaction detection of
IDX#        Lyme disease: correlation with clinical manifestations and
IDX#        serologic responses
IDX#  IV.   INFECT IMMUN: Dominant recognition of a Borrelia
IDX#        burgdorferi outer surface protein A peptide by T helper
IDX#        cells in patients with treatment-resistant Lyme arthritis
IDX#  V.    AM J TROP MED HYG: The spread of tick-borne borreliosis in
IDX#        West Africa and its relationship to sub-Saharan drought
IDX#  VI.   About The LymeNet Newsletter
IDX#



NEWS BRIEF: Author Polly Murray (the "Mother of Lyme Disease") will
sign her book THE WIDENING CIRCLE, which is about her struggle with
Lyme, at Waldenbooks in the Poughkeepsie Galleria, Poughkeepsie New
York, on Saturday, September 21, 1996.  For more information, contact
Gloria Wenk at 914-677-3286.



I.    LYMENET: Compuserve now has two areas dedicated to LD
-----------------------------------------------------------
Sender: Frank Demarest <76116.2065@compuserve.com>


The Public Health forum (GO PUBHLTH) contains information related to
public health.  Dave Cundiff, M.D. (102354.1707@compuserve.com) is the
Sysop, and Frank Demarest (76116.2065@compuserve.com) is the section
leader for the Lyme disease section.  The forum library contains Dr.
Burrascano's diagnosis and treatment recommendations, pictures of
ticks, pictures of the Lyme (EM) rash, and other information.


The PUBHLTH forum library also contains several years of back issues
of the CDC's publication, Morbidity and Mortality Weekly Reports, in
both plain text and Adobe Acrobat formats.  Other forum sections have
information on legislative issues, nutrition & exercise, mental
health, health administration, environment & health, sexual health,
overall drug policy, tobacco and alcohol, communicable diseases,
disasters, and injury prevention.


The Chronic Illness forum (GO CIFORUM) contains information and
support for those with chronic illness.  Ellen Atwood
(104125.2261@compuserve.com) is the Sysop, and Frank Demarest is the
section leader for the Lyme disease section.  The forum library also
has all back issues of the LymeNet Newsletter.  This forum also has
sections for CFS, Lupus, fibromyalgia, and other chronic illnesses.


For more information about becoming a CompuServe user, or for a new
member sign-up kit, point your web browser to:  
http://www.compuserve.com



=====*=====


II.   ANN INTERN MED: Azithromycin compared with amoxicillin in the
     treatment of erythema migrans.  A double-blind, randomized,
     controlled trial
-------------------------------------------------------------------
ABSTRACT: Luft BJ, Dattwyler RJ, Johnson RC, Luger SW, Bosler EM
         Rahn DW, Masters EJ, Grunwaldt E, Gadgil SD
ORGANIZATION: Department of Medicine, State University of New York
             at Stony Brook, NY USA
REFERENCE: Ann Intern Med 1996 May 1;124(9):785-91
ABSTRACT:


OBJECTIVE: To determine whether azithromycin or amoxicillin is more
efficacious for the treatment of erythema migrans skin lesions, which
are characteristic of Lyme disease.
DESIGN: Randomized, double-blind, double-dummy, multicenter study.
Acute manifestations and sequelae were assessed using a standardized
format.  Baseline clinical characteristics and response were
correlated with serologic results.  Patients were followed for 180
days.
SETTING: 12 outpatient centers in eight states.
PATIENTS: 246 adult patients with erythema migrans lesions at least
5 cm in diameter were enrolled and were stratified by the presence of
flu-like symptoms (such as fever, chills, headache, malaise, fatigue,
arthralgias, and myalgias) before randomization.
INTERVENTION: Oral treatment with either amoxicillin, 500 mg three
times daily for 20 days, or azithromycin, 500 mg once daily for 7
days.  Patients who received azithromycin also received a dummy
placebo so that the dosing schedules were identical.
RESULTS: Of 217 evaluable patients, those treated with amoxicillin

were significantly more likely than those treated with azithromycin
to achieve complete resolution of disease at day 20, the end of
therapy (88% compared with 76%; P=0.024).  More azithromycin
recipients (16%) than amoxicillin recipients (4%) had relapse
(P=0.005).  A partial response at day 20 was highly predictive of
relapse (27% of partial responders had relapse compared with 6% of
complete responders; P<0.001).  
For patients treated with azithromycin, development of an antibody
response increased the possibility of achieving a complete response
(81% of seropositive patients achieved a complete response compared
with 60% of seronegative patients; P=0.043).  Patients with multiple
erythema migrans lesions were more likely than patients with single
erythema migrans lesions (P<0.001) to have a positive antibody titer
at baseline (63% compared with 17% for IgM; 39% compared with 16% for
IgG).  Fifty-seven percent of patients who had relapse were
seronegative at the time of relapse.
CONCLUSIONS: A 20-day course of amoxicillin was found to be an

effective regimen for erythema migrans.  Most patients were
seronegative for Borrelia burgdorferi at the time of presentation
with erythema migrans (65%) and at the time of relapse (57%).



=====*=====


III.  AM J CLIN PATHOL: Polymerase chain reaction detection of Lyme
     disease: correlation with clinical manifestations and serologic
     responses
---------------------------------------------------------------------
AUTHORS: Mouritsen CL, Wittwer CT, Litwin CM, Yang L, Weis JJ
        Martins TB, Jaskowski TD, Hill HR
ORGANIZATION: Laboratory of Immunology and Infectious Diseases,
             Associated Regional and University Pathologists,
             Salt Lake City, UT, USA
REFERENCE: Am J Clin Pathol 1996 May;105(5):647-54
ABSTRACT:


The authors have developed a simple, nested polymerase chain reaction
(PCR) assay for amplification of an outer surface protein A (OspA)
gene fragment of Borrelia burgdorferi using rapid temperature cycling
and ethidium bromide detection on agarose gels, and applied it to the
diagnosis of Lyme disease in humans.  With denaturing and annealing
temperature spikes instead of holds, cycle times were less than 20
minutes for a 30-cycle amplification.  Using this rapid cycle PCR
technique, as few as 5 spirochetes per mL of phosphate buffered
saline were detected.  In addition, B burgdorferi DNA was detected
from spirochetes that had been spiked into one of several types of
human body fluids including serum, synovial fluid, and cerebrospinal
fluid (CSF).  A number of clinical samples, which had been tested for
Lyme immunoglobulin M (IgM) and immunoglobulin G (IgG) antibody were
also examined.  In 29 serologic positive samples (14 IgG and IgM
positive, 9 IgM alone and 6 IgG alone), B burgdorferi DNA was not

detected.  In contrast, nine serum samples and one synovial fluid
from patients with definite clinical features of Lyme disease were
found to be negative by EIA and Western blot analysis for IgG and IgM
antibody, but contained B burgdorferi DNA, as detected by PCR.
Polymerase chain reaction analysis of serum and synovial fluid may be
of significant diagnostic value in Lyme disease, especially in the
absence of a serologic response in early, partially treated and
seronegative chronic disease.  This is the first study to report an
association between PCR positivity and the absence of a serologic
response to Lyme  borreliosis.



=====*=====


IV.   INFECT IMMUN: Dominant recognition of a Borrelia burgdorferi
     outer surface protein A peptide by T helper cells in patients  
     with treatment-resistant Lyme arthritis
-------------------------------------------------------------------
AUTHORS: Kamradt T, Lengl-Janssen B, Strauss AF, Bansal G, Steere AC
ORGANIZATION: Division of Rheumatology, Immunology, Department of
             Medicine, New England Medical Center Hospitals, Tufts
             University School of Medicine, Boston, Massachusetts USA
REFERENCE: Infect Immun 1996 Apr;64(4):1284-9
ABSTRACT:


In an earlier study, we found that T-cell lines (TCL) from five
patients with treatment-resistant Lyme arthritis preferentially
recognized Borrelia burgdorferi outer surface protein A (OspA), but
TCL from four patients with treatment-responsive arthritis only
rarely recognized this protein. Dominant T-cell recognition of an
arthritogenic OspA epitope is one way in which the immune response
against OspA might be involved in the pathogenesis of treatment-
resistant Lyme arthritis.  In an effort to test this hypothesis, we
mapped the epitopes of 31 OspA-specific TCL and five T-cell clones
derived from the synovial fluid or peripheral blood samples of three
patients with treatment-resistant Lyme arthritis.  Although each
patient's TCL recognized a broad array of OspA peptides with different
individual patterns, two regions of OspA were dominantly recognized.
Each patient's TCL dominantly recognized a C-terminal epitope of OspA,
ranging from amino acids (aa) 214 to 233 in one patient to 244 to 263
in another, and the TCL of all three patients dominantly recognized an

epitope between aa 84 and 113.  These dominant regions were confirmed
by clonal analysis in one patient.  Thus, the region of OspA between
aa 84 and 113 was the dominant T-cell epitope shared by these three
patients with treatment-resistant Lyme arthritis.  If the T-cell
response to OspA is involved in the pathogenesis of treatment-
resistant Lyme arthritis, and epitope contained within aa 84 to 113 is
a potentially arthritogenic epitope.



=====*=====


V.    AM J TROP MED HYG: The spread of tick-borne borreliosis in West
     Africa and its relationship to sub-Saharan drought
---------------------------------------------------------------------
AUTHORS: Trape JF, Godeluck B, Diatta G, Rogier C, Legros F,
        Albergel J, Pepin Y, Duplantier JM
ORGANIZATION: Laboratoire de Paludologie, Service d'Hydrologie,
             Institut Francais de Recherche Scientifique pour le
             Developpement en Cooperation (ORSTOM), Dakar, Senegal
REFERENCE: Am J Trop Med Hyg 1996 Mar;54(3):289-93
ABSTRACT:


In West Africa, tick-borne relapsing fever is due to the spirochete
Borrelia crocidurae and its geographic distribution is classically
limited to the Sahel and Saharan regions where the vector tick
Alectorobius sonrai is distributed.  We report results of
epidemiologic investigations carried out in the Sudan savanna of
Senegal where the existence of the disease was unknown.  A two-year
prospective investigation of a rural community indicated that 10% of
the study population developed an infection during the study period.
Transmission patterns of B. crocidurae to humans and the small wild
mammals who act as reservoirs for infection were similar to those
previously described in the Sahel region.  Examination of 1,197
burrows and blood samples from 2,531 small mammals indicated a
considerable spread of the known area of distribution of A. sonrai
and B. crocidurae.  The actual spread of the vector and the disease
has affected those regions where the average rainfall, before the
start of the extended drought in West Africa, reached up to 1,000 mm

and corresponds to the movement of the 750-mm isohyet toward the south
from 1970 to 1992.  Our findings suggest that the persistence of
sub-Saharan drought, allowing the vector to colonize new areas in the
Sudan savanna of West Africa, is probably responsible for a
considerable spread of tick-borne borreliosis in this part of Africa.



=====*=====


VI.   ABOUT THE LYMENET NEWSLETTER
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         The Lyme Disease Network of New Jersey
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