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Volume: 8
Issue: 01
Date: 30-Jan-00


Table of Contents:

I.    LYMENET: NYU Professor Responds to Burrascano Investigation
II.   LDF: 13th International Conference on Lyme Disease and Other
      Tick-Borne Disorders
III.  ARCH DERMATOL: Solitary erythema migrans in Georgia and South
      Carolina
IV.   EUR J CLIN MICROBIOL INFECT DIS: Incidence of Lyme borreliosis
      in the Wurzburg region of Germany.
V.    JAMA: Borrelia burgdorferi-specific immune complexes in acute
      Lyme disease.
VI.   ABOUT THE LYMENET NEWSLETTER


Newsletter:

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                  Volume 8 / Number 01 / 30-JAN-2000
                                INDEX


I.    LYMENET: NYU Professor Responds to Burrascano Investigation
II.   LDF: 13th International Conference on Lyme Disease and Other
     Tick-Borne Disorders
III.  ARCH DERMATOL: Solitary erythema migrans in Georgia and South
     Carolina
IV.   EUR J CLIN MICROBIOL INFECT DIS: Incidence of Lyme borreliosis
     in the Wurzburg region of Germany.
V.    JAMA: Borrelia burgdorferi-specific immune complexes in acute
     Lyme disease.
VI.   ABOUT THE LYMENET NEWSLETTER



=====*=====


I.    LYMENET: NYU Professor Responds to Burrascano Investigation
-----------------------------------------------------------------
Sender: Doris Aaronson, Ph.D. <doris@xp.psych.nyu.edu>


It has come to my attention that one of the most nationally
distinguished Lyme disease doctors and researchers, Dr. Joseph
Burrascano of Long Island, NY, needs the help of Lyme patients, their
family and friends.  I have some comments on his situation based on
my experiences as a chronic Lyme patient, as one who is knowledgeable
of the medical research on Lyme, and as an NYU professor who has
taught research methods and statistics to graduate and undergraduate
students for over 30 years, including those headed for careers in
medicine.


Dr. Burrascano is about to be prosecuted for medical misconduct by the
NY State Office of Professional Medical Conduct.  OPMC has already
investigated 17 other physicians who treat Lyme patients.  The
statistical odds are that doctors prosecuted by OPMC for providing
long-term antibiotic treatment for chronic Lyme patients will have
their medical licenses revoked, suspended or restricted (to not
treating Lyme patients); they will be fined, and defense costs will
run about $100,000.


The OPMC procedures are highly biased from the start.  In a letter to a
Lyme disease patient in explaining the procedures used by the NY OPMC,
Dr. Marks, Executive Secretary of the OPMC wrote "Rarely, if ever, have
the published guidelines indicated that anything more that (sic) tow
(sic) - three weeks of antibiotics are required to cure Lyme disease."  
However, Dr. Marks' statement is contradicted by numerous research
articles in peer-reviewed biomedical journals, indicating (a) that
many Lyme patients are not cured by 2-3 weeks of antibiotics, (b) that
some of those are cured after months or years of antibiotic treatment,
and (c) some are never cured.  The National Institutes of Health is
currently funding research on category (b) and (c) patients.  
Biomedical research has already documented some of the ways that Lyme
bacteria can resist the effects of antibiotics.


It appears from Dr. Marks' statement that OPMC has set up procedures
which DEFINE medical misconduct to target physicians who use long-term
antibiotic therapy. This would obviously deprive thousands of Lyme
patients of experienced physicians like Dr. Burrascano. There are two
important causal factors in this attack on such physicians.  (1) It
appears that many of these attacks are inspired by medical insurance
companies which do not want to pay for long-term antibiotic therapy,
especially costly I.V. therapy.  (2) Some of the Lyme researchers who
are involved in defining the standards for diagnosis and treatment
of Lyme used by the State and Federal Governments are ego-involved in
the "theory" stated by Dr. Marks, and further, they use flawed
research procedures to support their theory.


The flaw in much of their research is that they have very restrictive
criteria for the category of patients that can be used in their
research.  Then they inappropriately generalize their research results
to all Lyme patients including many who do not meet the restrictive
criteria.  Every text book in either introductory statistics or
research methods warns that false conclusions can be made based on
inappropriate generalization from a research sample population to
other populations with attributes that differ from the research sample.  
These researchers use as participants only patients with recent,
short-duration Lyme disease for which short-term therapy generally
works.  They do not use patients with long-term chronic Lyme, for
which long-term and aggressive antibiotic therapy is required. One can
observe the flawed logic by reading some of the publications of the
Lyme researchers who support Dr. Marks' theory, and by discussions
with knowledgeable physicians who are familiar with the Lyme research.


In my own case, I had a wide variety of clinical symptoms of Lyme for
well over 15 years, and had misdiagnoses on 22 occasions by doctors
who regularly under-diagnose Lyme.  After I diagnosed myself, had that
diagnosis verified by 6 consecutive positive blood tests taken by a
NJ doctor who regularly underdiagnoses and undertreats Lyme, and was
treated by inappropriate and ineffective oral antibiotics, I decided
to seek another doctor.  I was referred to a team of distinguished
NY doctors involved in the group represented by Dr. Marks' views.  
But they refused to take me as a patient BECAUSE I did not meet any
of their research criteria of (a) having a known tick bite, (b)
within 2 months or less of starting antibiotic treatment, and (c)
experiencing a "bull's-eye" rash.  Separate from their research,
those doctors would not provide clinical treatment in cases where
short-term therapy might not work.


Fortunately, I found a doctor who had read Dr. Burrascano's research
and followed his treatment philosophy.  After a few more tests to
eliminate alternative diagnoses, I was put on close to 2 months of
daily double-doses of I.V. antibiotics, followed by years of oral
antibiotics. The result is that I can continue to teach and do
research.  Without aggressive long-term antibiotic therapy, which would
likely be defined as medical misconduct by people with Dr. Marks'
views, I would have cost an insurance company, my employer and/or the
government a substantial amount of money for permanent medical
disability benefits, as opposed to only 9 months of disability.


If Dr. Burrascano is convicted and punished by NY OPMC, not only will
his patients suffer, but thousands of others, like myself, whose
doctors learn from Burrascano's publications, will suffer.  A
"political witch hunt" is going on in NY State, and it threatens many
ethical and experienced doctors who treat long-term Lyme patients.  
I encourage you to help present and future Lyme patients by helping to
defend Dr. Burrascano. As soon as possible (as his trial by OPMC is
approaching), send your comments in support of Dr. Burrascano, and his
views of giving long-term antibiotic therapy to patients who don't
respond to the 2-3 week version, to Gov. Pataki's email address:
gov.pataki@chamber.state.ny.us


Other NY email addresses to cc your same email are the following:
NYHealth@health.state.ny.us
NYSAG@org.state.ny.us
Bruno@senate.state.ny.us
speaker@assembly.state.ny.us
hannon@senate.state.ny.us
gottfrr@assembly.state.ny.us
senator@dpm.senate.gov
senator@schumer.senate.gov
jerroldnadler@mail.house.gov
dollinge@senate.state.ny.us


In addition to your emails to the relevant governmental people, you
might want to consider joining the Foundation for the Advancement of
Innovative Medicine (FAIM), which is supporting Dr. Burrascano's
defense.  FAIM's $35 dues provides a quarterly health-relevant
newsletter.  For information about FAIM phone 1-877-634-3246.


Prof. Doris Aaronson, Ph.D.
Departments of Psychology, Neural Science and Linguistics
New York University
doris@xp.psych.nyu.edu
Dr. Aaronson's research has focused on psychological and neural
factors in dyslexia, language acquisition, and verbal memory.



=====*=====


II.   LDF: 13th International Conference on Lyme Disease and Other
     Tick-Borne Disorders
------------------------------------------------------------------
Sender: Lyme Disease Foundation <ldftf@aol.com>


March 25 & 26, 2000
Hartford Marriott, Farmington, CT  
800-228-9290
Travel: Huntington Hay Travel  800-783-9783


PROGRAM COMMITTEE:
Program Coordinator and Basic Sciences:  
James Miller, PhD  UCLA School of Medicine


Clinical:  
Sam Donta, MD  Boston University School of Medicine
Brian Fallon, MD  Columbia University College of Physicians & Surgeons


Entomology:  
Ed Bosler, PhD  Stonybrook School of Medicine


Epidemiology:  
Julie Rawlings, MPH  Texas Department of Health


Posters:  
Charles Pavia, PhD  New York Medical College
Ronald Schell, PhD  University of Wisconsin School of Medicine


PROGRAM  AGENDA:              
Saturday, March 25, 2000 (8am -5:15pm)
7:00 - 9:00 Registration
* Keynote   Richard Blumenthal, Attorney General of Connecticut
* West Nile virus: Epicenter to epidemic and expectations in 2000
* West Nile virus in Connecticut
* Overview of human ehrlichioses and Rocky Mountain spotted fever in
  the US
* Coinfections
* Lyme disease in the South
* Analysis of Southern Borrelia
* Babesiosis  Krause
* Preliminary in vitro and in vivo findings of hyperbaric oxygen
  treatment in experimental Borrelia burgdorferi infection
* Immunity against host-adapted Bb in the rabbit
* Immunologic aspects of Vlse, a Bb antigenic variation protein
* An Immunodominant peptide of Bb Vlse: Role in diagnosis and
  pathogenesis
* Antibiotic treatment of Lyme borreliosis: A review of results with
  dogs
* A Borrelia burgdorferi repetitive antigen that confers protection
  against eperimental Lyme disease
* Use of borreliacidal assay in the serodiagnosis of Lyme disease
* Lyme neuroborreliosis: Role of PCR and culture in the diagnosis and

  in the confirmation of relapse after antibiotic treatment
* Laboratory testing panel  Tilton, Shah, Schell, Golightly, Mordechai


Sunday, March 26, 2000   (8am - 5pm)
* Keynote Willy Burgdorfer, PhD, MD
* Characterization of an immune evasion system in Lyme disease
  spirochetes
* Environmental regulation of gene expression in Bb
* Matrix metalloproteinases in Lyme disease pathogenesis
* Interleukin-10 regulation during acute Lyme arthritis in dogs
* T-cell response  
* Protection against tick-transmitted LD in dogs vaccinated with a
  multiantigenic vaccine
* OspA vaccine update, including serologic results and range of EM
  rashes  
* Atypical EM and acute Lyme disease
* Neurologic Lyme disease in children and adolescents
* Cognitive deficits in children with chronic Lyme and the public
  health/educational implications
* Neurologic Lyme disease in adults
* Neuroimaging in neuropsychiatric Lyme disease: Uses, abuses, and the
  future
* Pharmacologic properties of antibiotics and their relevence to Lyme
  disease
* Treatment Roundtable  Fein, Leigner, Donta, Pietrucha, Burrascano


FACULTY:
John Anderson, PhD  Connecticut Agricultural Experiment Station
Edward M. Bosler, PhD SUNY at Stony Brook School of Medicine
Willy Burgdorfer, PhD, MD  National Institutes of Health
Joseph Burrascano, MD  Southhampton Hospital
Patricia Coyle, MD  SUNY at Stony Brook School of Medicine
Sam Donta, MD  Boston University School of Medicine
Brian Fallon, MD  Columbia University College of Physicians & Surgeons
Lesley Fein, MD  St. Barnabus & Mountainside Hospitals
Alan Frey, PhD  New York University School of Medicine
Mark Golightly, MD  Stonybrook School of Medicine
Angela James, PhD  Centers for Disease Control and Prevention
Peter Krause, MD  University of Connecticut School of Medicine
Kenneth Liegner, MD  Westchester Medical Center
Louis Magnorelli, PhD  Connecticut Agricultural Experiment Station
Richard Marconi, PhD  Medical College of Virginia
Edwin Masters, MD  Regional Primary Care Physicians
Adrianna Marques, MD  National Institutes of Health
Tracey McNamara, DVM  National Wildlife Conservation / Bronx Zoo

James Miller, PhD  UCLA School of Medicine
Eli Mordechai, PhD  Medical Diagnostic Laboratories
Steve Norris, PhD  University of Texas Medical School
Jim  Oliver, PhD  Georgia Southern University
Jarmo Oksi, MD, PhD Turku University Central Hospital, Department of
Medicine, Finland
Christopher Padduck, MD  Centers for Disease Control and Prevention
Dennis Parenti, MD  SmithKline Beecham Biologicals
Charles Pavia, PhD  NYMedical College School of Medicine, NYCOM
Microbiology and Immunodiagnostic Laboratory of NYIT
George Perides, MD  Beth Israel Deaconess Medical Center
Mario Philipp, PhD  Tulane University School of Medicine
Dorothy Pietrucha, MD Cornell/NYHospital, Jersey Shore Medical Center
Marian Rissenberg, MD  Assistant Professor, Columbia University
Scott Samuels, PhD  University of Montana School of Medicine
Rheinhard Staubinger, DVM, PhD  Cornell University School of Veterinary
Medicine
Ronald Schell, PhD  University of Wisconsin School of Medicine
Jyotsna Shah, PhD  Igenex Laboratories
Richard Skare, PhD Texas A & M University Health Science Center

Richard Tilton, PhD  BBI Clinicial Laboratories

TARGET AUDIENCE:
This conference is designed for clinical professionals (including but
not limited to Primary Care Physicians, Nurse Practitioners, Physician
Assistants, Public Health Officers, Researchers and Veterinarians) and
for other health professionals (medical directors, risk managers) who
wish to enhance their knowledge of Lyme disease and other tick-borne
disorders.


REGISTRATION:
http://www.lyme.org/lyme/reg.html


=====*=====


III.  ARCH DERMATOL: Solitary erythema migrans in Georgia and South
     Carolina
-------------------------------------------------------------------
AUTHORS: Felz MW, Chandler FW Jr, Oliver JH Jr, Rahn DW, Schriefer ME
ORGANIZATION: Department of Family Medicine, Medical College of
             Georgia, Augusta 30912-3500, USA. mfelz@mail.mcg.edu
REFERENCE: Arch Dermatol 1999 Nov;135(11):1317-26
ABSTRACT:


OBJECTIVE: To evaluate the incidence of Borrelia burgdorferi infection
in humans with erythema migrans (EM) in 2 southeastern states.
DESIGN: Prospective case series. SETTING: Family medicine practice
at academic center.
PATIENTS: Twenty-three patients with solitary EM lesions meeting
Centers for Disease Control and Prevention (CDC) criteria for Lyme
disease.
INTERVENTIONS: Patients underwent clinical and serologic evaluation for
evidence of B burgdorferi infection. All lesions underwent photography,
biopsy, culture and histopathologic and polymerase chain reaction
analysis for B burgdorferi infection. Patients were treated with
doxycycline hyclate and followed up clinically and serologically.
MAIN OUTCOME MEASURES: Disappearance of EM lesions and associated
clinical symptoms in response to antibiotic therapy; short-term and
follow-up serologic assays for diagnostic antibody; growth of
spirochetes from tissue biopsy specimens in Barbour-Stoenner-Kelly
II media; special histopathologic stains of tissue for spirochetes;

and polymerase chain reaction assays of tissue biopsy specimens for
established DNA sequences of B burgdorferi.
RESULTS: The EM lesions ranged from 5 to 20 cm (average, 9.6 cm).
Five patients (22%) had mild systemic symptoms. All lesions and
associated symptoms resolved with antibiotic therapy. Overall, 7
patients (30%) had some evidence of B burgdorferi infection.
Cultures from 1 patient (4%) yielded spirochetes, characterized
as Borrelia garinii, a European strain not known to occur in the
United States; 3 patients (13%) demonstrated spirochetallike forms
on special histologic stains; 5 patients (22%) had positive
polymerase chain reaction findings with primers for flagellin
DNA sequences; and 2 patients (9%) were seropositive for B
burgdorferi infection using recommended 2-step CDC methods. No late
clinical sequelae were observed after treatment.
CONCLUSIONS: The EM lesions we observed are consistent with early
Lyme disease occurring elsewhere, but laboratory confirmation of
B burgdorferi infection is lacking in at least 16 cases (70%)

analyzed using available methods. Genetically variable strains of
B burgdorferi, alternative Borrelia species, or novel,
uncharacterized infectious agents may account for most of the
observed EM lesions.



=====*=====


IV.   EUR J CLIN MICROBIOL INFECT DIS: Incidence of Lyme borreliosis
     in the Wurzburg region of Germany.
--------------------------------------------------------------------
AUTHORS: Huppertz HI, Bohme M, Standaert SM, Karch H, Plotkin SA
ORGANIZATION: Children's Hospital, University of Wurzburg, Germany.
REFERENCE: Eur J Clin Microbiol Infect Dis 1999 Oct;18(10):697-703
ABSTRACT:


To assess the incidence of Lyme borreliosis in Central Europe, a
12-month, prospective, population-based surveillance study of Lyme
borreliosis was conducted in the Wurzburg region of central Germany,
following an aggressive awareness campaign. The diagnosis of Lyme
borreliosis required the presence of (i) erythema migrans (diameter
> or =5 cm); (ii) lymphocytoma; or (iii) another specific
manifestation including Lyme arthritis, neuroborreliosis,
carditis or acrodermatitis chronica atrophicans in conjunction with
serological confirmation. A total of 313 cases of Lyme borreliosis
was diagnosed, giving an incidence of 111 cases/100000 inhabitants,
the highest rates occurring in children and elderly adults living in
wooded as opposed to agricultural areas. The incidence in city dwellers
and inhabitants of rural areas was not significantly different.
Erythema migrans was the only manifestation in 279 (89%) patients. Of
the 34 patients with manifestations other than erythema migrans alone,
15 had arthritis, nine neuroborreliosis, six lymphocytoma, four

acrodermatitis chronica atrophicans and one carditis. Children were
more likely than adults to have manifestations other than erythema
migrans alone. Lyme borreliosis was very common in central Germany,
and one of the most frequent bacterial infections. The observation of
more cases of arthritis than neuroborreliosis was similar to that in
the USA. These results may be representative for many parts of central
Europe and suggest the need for development of a vaccine against
borreliosis caused by European strains of Borrelia species.



=====*=====


V.    JAMA: Borrelia burgdorferi-specific immune complexes in acute
     Lyme disease.
-------------------------------------------------------------------
AUTHORS: Schutzer SE, Coyle PK, Reid P, Holland B
ORGANIZATION: Department of Medicine, University of Medicine and
             Dentistry of New Jersey-New Jersey Medical School,
     Newark 07103, USA. schutzer@umdnj.edu
REFERENCE: JAMA 1999 Nov 24;282(20):1942-6
ABSTRACT:


CONTEXT: Diagnosis of infection with Borrelia burgdorferi, the cause
of Lyme disease (LD), has been impeded by the lack of effective assays
to detect active infection.
OBJECTIVE: To determine whether B. burgdorferi-specific immune
complexes are detectable during active infection in LD.
DESIGN, SETTING, AND PATIENTS: Cross-sectional analysis of serum samples
from 168 patients fulfilling Centers for Disease Control and Prevention
surveillance criteria for LD and 145 healthy and other disease controls
conducted over 8 years. Tests were performed blinded.
MAIN OUTCOME MEASURE: Detection of B. burgdorferi immune complexes by
enzyme-linked immunosorbent assay and Western blot.
RESULTS: The B. burgdorferi immune complexes were found in 25 of 26
patients with early seronegative erythema migrans (EM) LD; 105 of 107
patients with seropositive EM LD; 6 of 10 patients who were
seronegative with culture-positive EM; 0 of 12 patients who were
treated and recovered from LD; and 13 of 13 patients with neurologic LD

without EM. Among 147 controls, B. burgdorferi immune complex was found
in 0 of 50 healthy individuals; 0 of 40 patients with persistent
fatigue; 0 of 7 individuals with frequent tick exposure; and 2 of 50
patients with other diseases.
CONCLUSION: These data suggest that B. burgdorferi immune complex
formation is a common process in active LD. Analysis of the B.
burgdorferi immune complexes by a simple technique has the potential to
support or exclude a diagnosis of early as well as active LD infection.



=====*=====


VI.   ABOUT THE LYMENET NEWSLETTER
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