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Volume: 7
Issue: 03
Date: 24-Mar-99


Table of Contents:

I.    MED MICROBIOL IMMUNOL: Heterogeneity of Borrelia burgdorferi
      sensu lato demonstrated by an ospA-type-specific PCR in synovial
      fluid from patients with Lyme arthritis.
II.   AM J TROP MED HYG: Human granulocytic ehrlichiosis in Bulgaria.
III.  MED MICROBIOL IMMUNOL: Expression of outer surface proteins A
      and C of Borrelia burgdorferi in Ixodes ricinus ticks removed
      from humans.
IV.   EUR J CLIN MICROBIOL INFECT DIS: Comparison of oral cefixime and
      intravenous ceftriaxone followed by oral amoxicillin in
      disseminated Lyme borreliosis.
V.    J MED MICROBIOL: Advantage of recombinant borrelial proteins for
      serodiagnosis of neuroborreliosis.
VI.   ABOUT THE LYMENET NEWSLETTER


Newsletter:

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                  Volume 7 / Number 03 / 24-MAR-1999
                                INDEX



I.    MED MICROBIOL IMMUNOL: Heterogeneity of Borrelia burgdorferi
     sensu lato demonstrated by an ospA-type-specific PCR in synovial
     fluid from patients with Lyme arthritis.
II.   AM J TROP MED HYG: Human granulocytic ehrlichiosis in Bulgaria.
III.  MED MICROBIOL IMMUNOL: Expression of outer surface proteins A
     and C of Borrelia burgdorferi in Ixodes ricinus ticks removed
     from humans.
IV.   EUR J CLIN MICROBIOL INFECT DIS: Comparison of oral cefixime and
     intravenous ceftriaxone followed by oral amoxicillin in
     disseminated Lyme borreliosis.
V.    J MED MICROBIOL: Advantage of recombinant borrelial proteins for
     serodiagnosis of neuroborreliosis.
VI.   ABOUT THE LYMENET NEWSLETTER



=====*=====


I.    MED MICROBIOL IMMUNOL: Heterogeneity of Borrelia burgdorferi
     sensu lato demonstrated by an ospA-type-specific PCR in synovial
     fluid from patients with Lyme arthritis.
----------------------------------------------------------------------
AUTHORS: Vasiliu V, Herzer P, Rossler D, Lehnert G, Wilske B
ORGANIZATION: Max von Pettenkofer-Institut fur Medizinische
             Mikrobiologie der Ludwig-Maximilians-Universitat
     Munchen, Munich, Germany.
REFERENCE: Med Microbiol Immunol (Berl) 1998 Oct;187(2):97-102
ABSTRACT:


Borrelia burgdorferi sensu lato, the etiological agent of Lyme
borreliosis, has been divided into three genospecies: B. burgdorferi
sensu stricto (OspA-type 1), B. afzelii (OspA-type 2) and B. garinii
(OspA-type 3-7). Whereas in Europe B. afzelii (OspA-type 2) is
predominant among human skin isolates and B. garinii (OspA-type 3-7)
among human CSF isolates, some previous serological studies suggested
that Lyme arthritis is also associated with B. burgdorferi sensu
stricto in Europe. In the present study we designed ospA type-specific
PCRs and identified four different ospA types associated with Lyme
arthritis. Our study group consisted of 20 patients with positive
serology (ELISA and immunoblotting) and clinical criteria for Lyme
arthritis. B. burgdorferi DNA was detected in 13 patients and in none
of 10 control patients from synovial fluid. We identified ospA-type 1
(26.6%), ospA-type 2 (33.3%), ospA-type 4 (6.6%) and ospA-type 5
(33.3%). Our conclusion is that in Europe B. burgdorferi sensu lato

strains causing Lyme arthritis are considerably heterogeneous and that
there is no prevalence of certain genospecies or OspA-types among this
strains.



=====*=====


II.   AM J TROP MED HYG: Human granulocytic ehrlichiosis in Bulgaria.
---------------------------------------------------------------------
AUTHORS: Christova IS, Dumler JS
ORGANIZATION: Department of Microbiology, National Center of
             Infectious and Parasitic Diseases, Sofia, Bulgaria.
REFERENCE: Am J Trop Med Hyg 1999 Jan;60(1):58-61
ABSTRACT:


Human granulocytic ehrlichiosis (HGE) is a recently described
rickettsiosis in the United States transmitted by Ixodes species ticks.
In Europe, only a few studies on HGE exist. Two hundred Bulgarian
patients with tick bites and 70 healthy blood donors were tested for
HGE using an immunofluorescence assay with the HGE agent as an
antigen. Elevated antibody titers (> or = 1:80) were found in 14
(9.7 %) of 145 patients with erythema migrans, two (8%) of 25
tick-exposed patients with lymphadenopathy only, one (20%) of five
patients with tick bite with fever, chills, and headache, one (4%)
of 25 healthy tick-exposed patients, and two (2.9%) of 70 blood
donors. These results show for the first time that HGE is probably
common in southeastern Europe. The study provides evidence of
coinfection or concurrent infection of patients with Lyme disease
and HGE, thus supporting the possible role of I. ricinus for
transmitting the HGE agent.



=====*=====


III.  MED MICROBIOL IMMUNOL: Expression of outer surface proteins A
     and C of Borrelia burgdorferi in Ixodes ricinus ticks removed
     from humans.
-------------------------------------------------------------------
AUTHORS: Fingerle V, Liegl G, Munderloh U, Wilske B
ORGANIZATION: Max von Pettenkofer-Institut fur Hygiene und Medizinische
             Mikrobiologie der Ludwig-Maximilians-Universitat Munchen,
             Germany. u7b03ac@mvp.med.uni-muenchen.de
REFERENCE: Med Microbiol Immunol (Berl) 1998 Oct;187(2):121-6
ABSTRACT:


A total of 131 Ixodes ricinus (51 females, 1 male and 79 nymphs)
removed from persons living in Southern Germany were investigated by
immunofluorescence assay for the presence of Borrelia burgdorferi with
a polyvalent rabbit immune serum and monoclonal antibodies specific for
outer surface proteins (Osp) A or C. Borreliae were detectable in 48
(36.6%) of the ticks. Infection rates of these adults and nymphs were
significantly higher than infection rates of unfed ticks from Southern
Germany. Borreliae in 31.3% (n=15) of the infected ticks expressed
solely OspA, solely OspC in 12.5% (n=6), and both OspA and OspC in
39.6% (n=19) of ticks, while in 16.7% (n=8) of ticks neither were
expressed. Presentation of OspC by B. burgdorferi in I. ricinus was
correlated with tick weight: in females, OspC was detectable only in
ticks with a minimum weight of about 3.5 mg, and in nymphs weighing at
least 1 mg. These results indicate that in I. ricinus removed from
humans OspC is up-regulated during the blood meal of the tick, but in

most ticks OspA is still detectable and might even be present in the
absence of OspC expression in the midgut and salivary glands of nearly
fully engorged nymphal ticks. Furthermore, we found strong evidence
that borreliae expressing solely OspA while in the salivary glands can
cause Lyme borreliosis. Our findings indicate that during tick feeding,
humans are exposed to borreliae that may express either OspA or OspC
or both, or lack both OspA and C. These findings suggests that, at the
minimum, both OspA and C should be considered as vaccine candidates
for prophylaxis of Lyme borreliosis in Europe.



=====*=====


IV.   EUR J CLIN MICROBIOL INFECT DIS: Comparison of oral cefixime and
     intravenous ceftriaxone followed by oral amoxicillin in
     disseminated Lyme borreliosis.
----------------------------------------------------------------------
AUTHORS: Oksi J, Nikoskelainen J, Viljanen MK
ORGANIZATION: Department of Medicine, Turku University Central
             Hospital, Finland.
REFERENCE: Eur J Clin Microbiol Infect Dis 1998 Oct;17(10):715-9
ABSTRACT:


Two treatment regimens for disseminated Lyme borreliosis (mainly
neurologic and musculoskeletal manifestations) were compared in a
randomized trial. A group of 30 patients received oral cefixime 200 mg
combined with probenecid 500 mg three times daily for 100 days. Another
group of 30 patients received intravenous ceftriaxone 2 g daily for 14
days followed by oral amoxicillin 500 mg combined with probenecid 500
mg three times daily for 100 days. There was no statistically
significant difference in the outcome of infection between the two
groups. However, the total number of patients with relapses or no
response at all and the number of positive polymerase chain reaction
findings after therapy were greater in the cefixime group. The general
outcomes of infection in patients with disseminated Lyme borreliosis
after 3-4 months of therapy indicate that prolonged courses of
antibiotics may be beneficial in this setting, since 90% of the
patients showed excellent or good treatment responses.



=====*=====


V.    J MED MICROBIOL: Advantage of recombinant borrelial proteins for
     serodiagnosis of neuroborreliosis.
----------------------------------------------------------------------
AUTHORS: Kaiser R, Rauer S
ORGANIZATION: Neurologische Klinik und Poliklinik der
             Albert-Ludwigs-Universitat Freiburg, Germany.
REFERENCE: J Med Microbiol 1999 Jan;48(1):5-10
ABSTRACT:


Two enzyme immunoassay (EIA) systems were compared for their ability
to detect Borrelia burgdorferi sensu lato specific IgG and IgM
antibodies and to differentiate between symptomatic (83 patients with
neuroborreliosis) and asymptomatic seropositive subjects (80 healthy
controls). Antibody concentrations were determined by EIA; the
antigens used were either a sonicate of B. burgdorferi or three
recombinant borrelial proteins: the 14-kDa flagellin fragment, the
outer surface protein C (22 kDa) and the high molecular mass protein
p83 (83 kDa). In the sonicate, EIA, IgG or IgM antibodies to B.
burgdorferi, or both, were detected in all patients with
neuroborreliosis and in all controls. Pre-absorption of sera with
Treponema phagedenis sonicate diminished the sensitivity of detection
of borrelial specific IgG (IgG or IgM or both) antibodies in patients
with neuroborreliosis from 80 to 57% (100 to 82%) and in the controls
from 100 to 32% (100 to 37%). While being specific for B. burgdorferi,
the recombinant EIAs proved to be significantly more sensitive than

the sonicate EIA: IgG or IgM, or both antibodies against any of the
recombinant antigens were detected in 92% of patients with
neuroborreliosis and in 24% of controls. The increase in sensitivity
in patients with neuroborreliosis was mostly due to the higher
detection rate of IgM antibodies in the recombinant EIA (77% versus 48%
in the sonicate EIA), while IgG antibodies were demonstrated with
similar frequencies in both EIA systems (57% versus 60%). It was
concluded that the recombinant EIAs are superior to the sonicate
EIA with pre-absorption of cross-reactive antibodies in the
confirmation of an acute borrelial infection and in the
differentiation between symptomatic and asymptomatic infections.



=====*=====


VI.   ABOUT THE LYMENET NEWSLETTER
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