LymeNet Newsletter Volume 1 Issue 17

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:

***************************************************************************** * 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" <[email protected]> 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: [email protected] (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 <[email protected]> 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: [email protected] (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.

VI. ***** HOW TO SUBSCRIBE, CONTRIBUTE AND GET BACK ISSUES *****

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