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Volume: 1
Issue: 17
Date: 01-Aug-93


Table of Contents:

GANNETT: Risk Of LD Low According to David Dennis
CLARIFICATION: Notes from LD Conference
HARTFORD COURANT: Lyme Disease Underreported, Study Says
UPI: Common Cat Fleas May Carry LD Bacterium
UPI: Breeding ticks linked with Lyme Disease found in Jasper County, IN
UPI: PA Ticks Wanted Dead or Alive
DISCUSSION: Transmission of Lyme Disease by intercourse?
QUESTION: Lyme and Heart Problems
QUESTION: Antibiotic Course


Newsletter:

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*                  Lyme Disease Electronic Mail Network                     *
*                          LymeNet Newsletter                               *
*****************************************************************************
                     Volume 1 - Number 17 - 8/01/93


I.    Introduction
II.   Announcements
III.  News from the wires
IV.   Questions 'n' Answers
V.    Jargon Index
VI.   How to Subscribe, Contribute and Get Back Issues



I. ***** INTRODUCTION *****

A few days ago, I send out issue #16a to e-mail and UseNet subscribers
only.  There was not enough time to pass the information on to everyone
else (at least, I didn't have the time).  The next issue, #18, will be
released shortly and will provide details on the Senate hearing on Lyme
Disease.  


This issue is a "regular" issue with all of the features you are accustomed
to.


-Marc.

And now, the OUTRAGE OF THE WEEK:

SOURCE:  GANNETT NEWS SERVICE
DATE: July 9, 1993, Friday
HEADLINE: FAMILY, PARENTING, EDUCATION BRIEFS
--- Precautions against Lyme disease
BYLINE: BECKY DILLNER; Gannett News Service


If you plan on going camping this summer, don't worry about the threat of
Lyme disease - even if you're bitten by an infected tick, the risk of getting
the disease is only 1 to 2 percent, says Dr. David Dennis, of the Centers
for Disease Control.



II. ***** ANNOUNCEMENTS *****

Sender: "Lloyd E. Miller,DVM" <71053.2727@compuserve.com>
Subject: CLARIFICATION OF NOTES - 6TH ANNUAL LYME DISEASE SCIENTIFIC
        CONFERENCE - 1993


Lyme disease, abdominal pain and the gastrointestinal tract
Martin D. Fried, MD


In the twelve children investigated for gastrointestinal involvement and
Lyme disease an AVERAGE of 8 organ systems were involved per patient.


The original notes stated that "Colonic biopsies were consistent with
Crohn's disease." This should read " Colonic biopsies in ONE patient were
consistent with a Crohn's-like disease".


Since the paper was presented the author has done several more colonic
biopsies. All have been consistent with what is found in colitis - none have
had Crohn's-like results.


By the time patients were biopsied most had been on antibiotics (and other
medications) for their illness. However the abdominal pain in most the
patients preceded the initiation of antibiotic therapy. Abdominal pain was an
early symptom often preceding the diagnosis of Lyme disease by 6 to 12
months.



III. ***** NEWS FROM THE WIRES ******

SOURCE: The Hartford Courant
DATE: May 21, 1993, A Edition
SECTION: CONNECTICUT; Pg. D10
HEADLINE:  Lyme disease  underreported, study says
BYLINE: FRANK SPENCER-MOLLOY; Courant Medical Writer


Are Connecticut's doctors scofflaws when it comes to reporting Lyme disease?

That's the suggestion in a report prepared by the state Department of Health
Services, which found that of the nearly 5,000 doctors in primary care
specialties in the state, 7 percent accounted for reporting the 1,760 known
Lyme disease cases last year.


Health officials suggest that means the actual number of cases in Connecticut,
which leads the nation in its Lyme disease rate, is much higher, said Matthew
Cartter, epidemiology program coordinator for the health department.


"You certainly can say there is underreporting," Cartter said. But, he added,
another study is needed before he can be more specific.


Cartter said the clustering of cases among a small number of doctors means
either that people are seeking known specialists to treat the  disease,
or that more doctors are diagnosing and treating the illness but not
reporting it.


Failure to notify state officials of a reportable disease is a violation of
state law and carries a $ 25 fine.  The law is not enforced because the
department believes persuasion is more productive, Cartter said.


In a study published last week by the U.S. Centers for Disease Control and
Prevention, Cartter and his health department colleagues described a computer
analysis they did of the 2,952 Lyme disease cases reported to their office in
1991 and 1992.


They began matching the cases with the four primary-care specialties where
patients would likely seek treatment: internal medicine, pediatrics, family
practice and dermatology.  Dermatology is included because of the distinctive
annular rash that appears early in most Lyme disease sufferers.


Of the 4,570 physicians practicing in those four fields, only 341 in 1991
and 313 in 1992, or 7 percent of the total, reported Lyme disease.


"What it tells us is that while there is a small group of physicians who
report from selected areas, there are other physicians in those same areas who
see but don't report cases," Cartter said. "We know there are doctors who feel
it is not a good use of their time."


Underreporting of illness is not isolated to Lyme disease,  but it presents
particular problems, Cartter said.  Unlike salmonella, where a commercial lab
test is enough to trigger a report to officials, Lyme disease requires a
doctor's diagnosis.  The lab test is not reliable enough alone to confirm the
disease.  Also, the illness rarely calls for admission to a hospital, which
would be more likely to notify officials.


Lyme disease occurs often in all eight Connecticut counties. In an
accompanying report last week in the Morbidity and Mortality Weekly Report, the
CDC said that Connecticut last year reported 53.6 cases per 100,000, the highest
in the nation.


=====*=====

DATE: July 19, 1993
  COLLEGE STATION, Texas (UPI) -- Laboratory experiments suggest that common
cat fleas carry the bacterium that causes Lyme disease, but researchers say
there's no evidence yet that humans are at risk of getting the disease from
fleas feeding on infected cats.


  Researchers at Texas A&M University's College of Veterinary Medicine said
cats themselves can develop the disease after being injected with the
organism.  Microbiologist Colin Young said the findings raise new questions
about how Lyme disease is transmitted from animal to animal and perhaps to
humans.


  Most researchers believe the ailment is spread by ticks that feed on the
blood of infected animals and later feed on other animals or humans.  Young
isn't sure ticks are the only culprit.


  He says, "It's something that needs to be looked at in some kind of
detail, because there are people who develop Lyme disease who say they've
never been bitten by a tick."


  He says the research shows that there's a lot about Lyme disease we
still don't understand.


=====*=====

DATE: July 21, 1993
HEADLINE: Breeding ticks linked with Lyme Disease found in Jasper County


  INDIANAPOLIS (UPI) -- Ticks that can carry Lyme Disease are increasing
in number in northern Indiana, health officials warned Wednesday.


  Insect specialists from the Indiana Department of Health and Ball State
University early this month discovered an active, breeding population of the
ticket in Jasper County.


  Michael Sinsko, the senior medical entomologist with the state health
department, said the finding, coupled with the increased numbers of
individual tickets found during the past three years or deer during the fall,
indicates that the species is gaining a foothold and expanding its population
within Indiana.


  The only tick species that can transmit Lyme disease in Indiana is the
deer tick.  The bacterial illness is transmitted in the tick's saliva when
it bites.


=====*=====

DATE: May 28, 1993, Friday, BC cycle
HEADLINE: Ticks sought for study


UNIVERSITY PARK, PA (UPI) -- Wanted dead or alive: Ticks.

If found, Penn State University entomologists want them.

It's part of a project to map the distribution of Lyme disease and the
disease -carrying deer tick in Pennsylvania. That's part of a larger project
being supported by the Centers for Disease Control to identify high-risk areas
and to educate the public about the disease.


Steven Jacobs of the College of Agricultural Science says Lyme disease is on
the increase in the state, but the chances of getting it are low, if you know
how to manage the risk.


Researchers have gotten ticks from 44 of the 67 counties in the state with
the largest number coming from southeastern Pennsylvania, the Moshannon Forest
area and the Pesque Isle peninsula in Erie.


But researchers need more ticks.  If found alive put the tick with a few
blades of grass in a clean container.  If dead put it in alcohol.  In both cases
note when and where found and turn it into your local county extension office.
They'll take it from there.



IV. ***** QUESTIONS 'N' ANSWERS *****

From LymeNet vol#1 #16:
>Ed: The conventional wisdom on this issue states that LD cannot be transmitted
>sexually by humans.  There appears to be little or no controversy on this
>issue.  If any reader is aware of evidence contradicting this wisdom, please
>send it in.


And they did...  Here is response # 1:

From: jod@equator.com (John Setel O'Donnell)
Subject: Sexual transmission


There is controversy on this issue.  It's all anecdotal.

#1) Viable bugs are present in urine.  Urinary transmission is believed
to be responsible for dairy herd and canine "wildfire" transmission.


#2) I've heard half a dozen people in support groups in CT speculating
on this topic.


#3) My wife contracted Lyme (yes she was seropositive) with no history
of known exposure, at a time when I was not on antibiotic treatment
(& was intermittently very sick) & at a time when we weren't using
condoms.


I don't believe in the epidemiology showing no sexual transmission;
the case-cluster studies that have been done have all had such
restrictive criteria for reporting positive cases that their results
will probably shown to be wrong by future work.


--

Jill Butler from the Lyme Disease Update (812-471-1990) sent in pages from
the January '92 issue of the Update (Headline: Is Lyme Contagious Through
Infected Body Fluids?).


Wendy P. Feaga, D.V.M., writes that there is evidence for direct transmission
of Bb between animals via urine.  She writes "...since people are cleaner,
Lyme is not likely to be transmitted in this manner.  However, when one
member of a family does have Lyme, there is an increased chance the disease
will occur in another family member because of the common environment, not
because of direct contact."


Dr. Joseph T. Joseph writes "There are some definites we know with the spread
of the disease through body fluids, and I think without a doubt we know that
blood transfusions can spread the disease.  Also we know that mother's breast
milk definitely spreads the spirochete.  Unknown at this time is whether it
is spread by any other body fluids, such as saliva.  I have had a suspicion
for a long time personally that there is possible sexual transmission.  We
have never been able to prove this, but we in our office have several female
patients who have a very difficult time getting better and who have had
relapse upon relapse.  Once we drag their husbands in and test them, we find
out that the husbands test positive also and likely are infecting them."


=====*=====

Sender: Robert Fuhrmann <fuhr@hpocbw1.sj.hp.com>
Subject: Question on Lyme and Heart Problems


I was wondering if there is any relationship between Lyme disease and
idiopathic cardiomyopathy?  Other heart problems/conditions?


=====*=====

Sender: rpj@armadillo.trilogy.com (Rich Johns)
Subject: question


Hello. I am new to this group. I recently contracted Lyme disease.
I have a question regarding my antibiotic course.


I have an Infectious Disease specialist as my doctor.  He started me on a
21 day course of Doxycycline 100mg 3 times a day. This promptly gave me
heartburn, which is the only way I can describe it.  It's worse though,
because it feels like something is stuck in my esophogus


Sometimes and I have a nearly constant discomfort in my stomach. When I
swallow is seems to hurt deep in my throat.


Now, none of this is too terrible and I would be willing to deal with it if
I thought that I wasn't doing damage to myself. To ease the discomfort I
starting taking it 2 times a day, ie., 100mg, instead of 3 times a day.
The reason I don't feel badly about going against my doctor's advice is
because I have heard that the course should last 4-6 weeks. Also, my
brother-in-law, who is a family doctor, one I trust, told me that 100mg
2 x a day is enough. However, I thought I'd get the wisdom of this newsgroup.



V. ***** JARGON INDEX *****

Bb - Borrelia burgdorferi - The scientific name for the LD bacterium.
CDC - Centers for Disease Control - Federal agency in charge of tracking
     diseases and programs to prevent them.
CNS - Central Nervous System.
ELISA - Enzyme-linked Immunosorbent Assays - Common antibody test
EM - Erythema Migrans - The name of the "bull's eye" rash that appears in
    ~60% of the patients early in the infection.
IFA - Indirect Fluorescent Antibody - Common antibody test.
LD - Common abbreviation for Lyme Disease.
NIH - National Institutes of Health - Federal agency that conducts medical
     research and issues grants to research interests.
PCR - Polymerase Chain Reaction - A new test that detects the DNA sequence
     of the microbe in question.  Currently being tested for use in
     detecting LD, TB, and AIDS.
Spirochete - The LD bacterium.  It's given this name due to it's spiral
     shape.
Western Blot - A more precise antibody test.



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