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Volume: 4
Issue: 17
Date: 03-Dec-96


Table of Contents:

I.    LETTERS: LDF NEJM Response Was Misguided
II.   LYMENET: LymeNet Flash Service Now Available
III.  LYMENET: Burrascano Guidelines Updates to Version 11
IV.   J INFECT DIS: Pentoxifylline fails to prevent the Jarisch-
      Herxheimer reaction or associated cytokine release.
V.    CLIN INFECT DIS: Treatment of erythema migrans in pregnancy.
VI.   About The LymeNet Newsletter


Newsletter:

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


IDX#                Volume 4 - Number 17 - 12/03/96
IDX#                            INDEX
IDX#
IDX#  I.    LETTERS: LDF NEJM Response Was Misguided
IDX#  II.   LYMENET: LymeNet Flash Service Now Available
IDX#  III.  LYMENET: Burrascano Guidelines Updates to Version 11
IDX#  IV.   J INFECT DIS: Pentoxifylline fails to prevent the Jarisch-
IDX#        Herxheimer reaction or associated cytokine release.
IDX#  V.    CLIN INFECT DIS: Treatment of erythema migrans in pregnancy.
IDX#  VI.   About The LymeNet Newsletter
IDX#



I.    LETTERS: LDF NEJM Response Was Misguided
----------------------------------------------
Sender: Douglas S. Dodge
Date: November 18, 1996


To The Editor:

It is unfortunate that in his zeal to correct accounts in the press,
Mr. Thomas Forschner [Executive Director, Lyme Disease Foundation]
unwittingly urges the authors of the October 24 New England Journal
of Medicine article, reviewed in the LymeNet Newsletter Vol#4 #15,
to repeat a falsehood.  He asked them for a press release to
"restate the actual conclusion of your paper."  This conclusion, in
the abstract which you published, reads as follows: "About 90
percent of children with Lyme disease present with erythema migrans,
which is an early stage of the disease.  The prognosis is excellent
for those with early Lyme disease who are treated promptly with
conventional courses of antimicrobial agents."


The figure of 90 percent has appeared previously in the preachings
of Eugene D. Shapiro, one of the authors of the present study, who had
already reached this "conclusion" last year (American Journal of
Medicine, April 24, 1995): "Careful prospective studies have found
that nearly 90% of children with Lyme disease have erythema migrans."


I have seen no studies that back Shapiro.  I have read that many
practicing physicians believe that only 30 percent of those who are
infected, children and adults, develop the rash; although Dr. J.J.
Burrascano says 38 percent.  I was not aware of any reports that
children are less prone to develop the erythema migrans rash until
I read the following at the beginning of the Discussion section of
the present NEJM study: "Limited data suggest that as compared with
adults, children with Lyme disease are more likely to present with
fever and arthritis and are less likely to present with erythema
migrans."


I am aware, however, that when the disinformation on Lyme disease
by "peers" in Academia trickles down from their scientific journals,
hundreds if thousands may be duped -- eventually to die in
ignorance of the Lyme disease that shattered the quality of their
lives.


May we pray that some of the irate mothers and fathers who read in
TIME magazine (November 4, 1996) that "Parents who fear Lyme disease
can rest easy; treatment with antibiotics cures infected children
within four weeks" will be moved to help in running Shapiro and his
ilk out of town before more young lives are ruined.



=====*=====


II.   LYMENET: LymeNet Flash Service Now Available
--------------------------------------------------
Sender: Bill Stolow, President, The Lyme Disease Network of
       New Jersey, Inc. <bill_stolow@lymenet.org>


The LymeNet Flash is a new service on the LymeNet Web server which
provides the members of the Lyme community with a bulletin board of
events and activities.


To submit your event or activity, send e-mail to: flash@lymenet.org .

For more information, visit the Flash page at:  

                  http://www.lymenet.org/flash/


=====*=====


III.  LYMENET: Burrascano Guidelines Updates to Version 11
----------------------------------------------------------
Sender: Marc Gabriel, Editor-in-Chief <a229@Lehigh.edu>
Date: November 22, 1996


Dr. Joseph J. Burrascano's Diagnosis and Treatment guidelines for
Lyme borroliosis were revised and updated in October.  This eleventh
edition is now available on the LymeNet Web server at:


                     http://www.lymenet.org/


=====*=====


IV.   J INFECT DIS: Pentoxifylline fails to prevent the Jarisch-
     Herxheimer reaction or associated cytokine release.
----------------------------------------------------------------
AUTHORS: Remick DG, Negussie Y, Fekade D. Griffin G
ORGANIZATION: Department of Pathology, University of Michigan,
             Ann Arbor, USA.
REFERENCE: J Infect Dis 1996 Sep;174(3):627-30
ABSTRACT:


The Jarisch-Herxheimer reaction (JHR) observed after antibiotic
treatment of relapsing fever caused by Borrelia recurrentis is
associated with the systemic appearance of cytokines.  The decrease
of cytokine production and block of JHR was attempted by administering
pentoxifylline prior to antibiotic treatment.  Fifteen patients with
confirmed relapsing fever were infused intravenously with
pentoxifylline 90 min before intramuscular injection of penicillin;
4 patients were not treated with pentoxifylline.  All patients
developed JHR to varying degrees.  Treatment with pentoxifylline
failed to prevent fever, increase in pulse, respiration, or blood
pressure, or decrease in white blood cell count.  No reduction of
circulating levels of tumor necrosis factor, interleukin 6, or
interleukin-8 was observed with pentoxifylline treatment.
Pentoxifylline did not prevent clearance of the B. recurrentis
spirochetes.  Thus, pentoxifylline treatment of patients with
relapsing fever fails to prevent or diminish JHR or the associated

cytokine release observed after appropriate antibiotic treatment.


======*=====


V.    CLIN INFECT DIS: Treatment of erythema migrans in pregnancy.
------------------------------------------------------------------
AUTHORS: Maraspin V, Cimperman J, Lotric-Furlan S, Pleterski-Rigler D
        Strle F
ORGANIZATION: Department of Infectious Diseases, University Medical
             Centre, Ljubljana, Slovenia.
REFERENCE: Clin Infect Dis 1996 May;22(5):788-93
ABSTRACT:


The course of the illness and the outcome of pregnancy were
investigated in a prospective study of 58 consecutively enrolled
pregnant women with typical erythema migrans at the University Medical
Centre of Ljubljana, Slovenia.  Thirteen patients (22.4%) acquired
borrelial infection in the first trimester of pregnancy, 27 (46.6%) in
the second trimester, and 18 (31%) in the third trimester.  All
patients were treated for 14 days: 2 (3.4%) with
phenoxymethylpenicillin (1 million IU thrice per day), 3 (5.2%) with
benzylpenicillin (10 million units twice per day), and 53 (91.4%) with
ceftriaxone (2 g daily).  For 51 of the 58 women (87.9%), the
pregnancies were normal and the infants were born at term, were
clinically healthy, and had normal psychomotor development.  Of the
remaining 7 pregnancies, 1 ended with a missed abortion and 5 with
preterm birth; 1 of the preterm babies had heart abnormalities.
One child born at term was found to have urologic abnormalities at
7 months of age.  A causal relationship between borrelial infection

and fetal adverse effects has not been proven, and for at least some
such cases a reasonable explanation (not associated with Lyme
borreliosis) was found.



=====*=====


VI.   ABOUT THE LYMENET NEWSLETTER
----------------------------------
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LymeNet - The Internet Lyme Disease Information Source
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Editor-in-Chief: Marc C. Gabriel <a229@Lehigh.EDU>
           FAX (for contributions ONLY): 908-789-0028
Contributing Editors: Carl Brenner <cbrenner@postoffice.ptd.net>
                     John Setel O'Donnell <jod@Equator.com>
                     Frank Demarest <76116.2065@CompuServe.com>
Advisors: Carol-Jane Stolow, Director <carol_stolow@lymenet.org>

         William S. Stolow, President <bill_stolow@lymenet.org>
         The Lyme Disease Network of New Jersey
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