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Volume: 4
Issue: 04
Date: 18-Mar-96


Table of Contents:

I.    LYMENET: Early Detection of Borrelia burgdorferi infection:
      to treat or not?
II.   LYMENET: CT Governor Proposes To Close Agricultural
      Experiment Station (Response)
III.  LYMENET: Research investigating hearing disorders and LD
IV.   LYMENET: Michigan Natole Case Is Not Over
V.    INT J MED MICROBIOL: Small mammals as reservoir hosts
      for Borrelia in Russia
VI.   About The LymeNet Newsletter


Newsletter:

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*                  The National Lyme Disease Network                  *
*                         LymeNet Newsletter                          *
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IDX#                Volume 4 - Number 04 - 3/18/96
IDX#                            INDEX
IDX#
IDX#  I.    LYMENET: Early Detection of Borrelia burgdorferi infection:
IDX#        to treat or not?
IDX#  II.   LYMENET: CT Governor Proposes To Close Agricultural
IDX#        Experiment Station (Response)
IDX#  III.  LYMENET: Research investigating hearing disorders and LD
IDX#  IV.   LYMENET: Michigan Natole Case Is Not Over
IDX#  V.    INT J MED MICROBIOL: Small mammals as reservoir hosts
IDX#        for Borrelia in Russia
IDX#  VI.   About The LymeNet Newsletter
IDX#



I.    LYMENET: Early Detection of Borrelia burgdorferi infection:
     to treat or not?
-----------------------------------------------------------------
Sender: Dr. Edmond Godfroid <godfroid@sga-met.ulb.ac.be>
Organization: Service de Genetique Appliquee, Universite Libre
             de Bruxelles


You will find enclosed a letter that we have recently published in
THE LANCET (Vol. 346 July 29, 1995, p. 321).  This letter describes
a very unique case of Borrelia burgdorferi infection.  The bacteria
was rapidly detected by PCR in the urine samples, three days after
the bite.  The patient was treated on day four without having any
of the known clinical symptoms associated with Lyme disease.  
During the course of treatment, PCR data showed that the bacteria
was eradicated by day fifteen.

We believe that the decision to treat was justified in the light of
possible chronic symptoms which may appear later.  We think this is
an open ethical question requiring further debate in view of existing
sensitive technologies in the detection of early bacterial infection.

---


SIR - In response to Vartiovaara (April, p 842) and related letters
(June 3, p 1436-37), we present the following data.

At the beginning of May, one of our collaborators was bitten by a
nymph of Ixodes ricinus.  This 32 year-old man lives in an area
endemic of Lyme borreliosis.  The nymph was examined by PCR with
Borrelia burgdorferi sensu lato and Borrelia species-specific
primers, which target the OspA gene[1].  The results indicated that
the nymph was infested with a Borrelia strain belonging to the B.
garinii species.  In view of these results, urine was obtained
from our colleague daily (from day 2 to day 30 after the bite) and
was analyzed by PCR with the OspA specific primers[1].  Before the
bite, his urine samples had been regularly analyzed by PCR as
a negative control of our routine testing procedure for Lyme disease
patients, and were always negative.  The results clearly indicated
that his urine was infected from day 3 by a B. garinii strain.  
Although the patient showed none of the usual clinical symptoms

associated with Lyme disease, he received on day 4 an antibiotic
treatment based on oral doxycyclin (200 mg per day) for 3 weeks.  
After the onset of the therapy, urine remained positive by PCR
assay until day 15 and became negative on day 16.

For thirty days after the bite, no erythema migrans, neurological
deficits or arthritic inflammations were noted.  In addition, the
patient's immunological status (IgM and IgG), tested by ELISA at
the start (day 3) of infection and after treatment (day 30),
remained negative.  This finding is not surprising since it is
well known that detectable immunological response to B.
burgdorferi infection takes 3 to 6 weeks to appear after the bite
and that early antibiotic therapy can prevent the development of
specific antibodies[2].

The decision to give an antibiotic treatment in the absence of
clinical manifestations (erythema migrans or an immune response) of
Lyme disease was taken solely on the basis of the PCR data.  There
is no known clinical evidence to indicate whether the patient was

likely to develop the disease or not.  The treatment was applied
on a purely ethical basis, carefully weighing risks and benefits
of an immediate or delayed antibiotic therapy.  In view of the
dramatic cases previously reported[3,4], we believe that the
decision to treat immediately had to be taken and thus we concur
with Dr. Oksi's comments (June 3, p 1437) that "Theoretically,
patients with positive PCR results are those who most probably
will benefit from treatment or retreatment."


This work was supported by a grant from the walloon Region of
Belgium (Convention ULB -Rigion Wallonne No 2267).


Edmond Godfroid (1), Patrice Driesschaert (2), and Alex Bollen (1).

(1) Laboratoire de Ginitique Appliquie, Universite Libre de Bruxelles,
Rue de l'Industrie, 24, B-1400 Nivelles, Belgium.
(2) Hospital Sainte Therese, Chaussie d'Houffalize, 1, B-6600
Bastogne, Belgium.


References :
-
1. Demaerschalck I, Ben Messaoud A, De Kesel M, Hoyois B, Lobet Y,
Hoet P et al. Simultaneous presence of different Borrelia burgdorferi
genospecies in biological fluids of Lyme disease patients. J. Clin
Microbiol. 1995; 33: 602-08.


2. Wilske B, Preac-Mursic V. Microbiological Diagnosis of Lyme
Borreliosis. In: Weber K, Burgdorfer W, editors. Aspects of Lyme
Borreliosis. Springer-Verlag, 1992:267-300.


3. Olivier R, Godfroid E, Heintz R, Bigaignon G, Bollen A. Lyme
Borreliosis in a Patient with Severe Multiple Cranial Neuropathy.
Clin. Infect. Dis. 1995; 20:200.


4. Oksi J, Marjamdki M, Koksi K, Nikoskelainen J, Viljanen MK.
Bilateral facial palsy and meningitis caused by borrelia double
infection. Lancet 1995; 345:1583-84.



=====*=====


II.   LYMENET: CT Governor Proposes To Close Agricultural Experiment
     Station (Response)
--------------------------------------------------------------------
Sender: Ellie <Audice@aol.com>


There is a great deal of controversy about this issue and many CT
residents are getting on the band-wagon to preserve the institution.
It's a joy to access.  The first deer tick I ever found on me I
took to the Agricultural Station where entomologist Kenneth Welch
identified it as Ixodes dammini adult female. The date was 5/22/89!
At the time, few people had seen this critter and he asked if he
might have it as a specimen.  But, it was already promised to a
vet friend who wanted it for the same reason.  Today, deer ticks
are all too plentiful!


Gardeners make great use of the resources available at the Aggie
Station -- for testing soil, insect ID, planting and growing problems.
And each year they hold a Plant Science Day.  It's an open
house with many exhibits and speakers covering a host of topics --
one of which usually deals with Lyme disease.


If we lose this facility we will really have lost a treasure!


=====*=====


III.  LYMENET: Research investigating hearing disorders and LD
--------------------------------------------------------------
Sender: Marsha Johnson <Oregon7@aol.com>


I am in the early stages of developing a project which will assess
the hearing status of individuals with Lyme disease who meet
federal standards.  I am interested in this project as several
friends of mine have the disease and have noted various subjective
effects, including vestibular disorders and fluctuating hearing
losses.  


I will complete my Master's program in Audiology in June
1996.  I am working with a Ph.D. at Portland State University and
will submit a grant for funding for this project.  I am seeking
interested individuals who wish to participate, even in different
areas of the USA, via exam by audiologists in different agencies,
who will co-op to provide services and test results.


I am also interested in any anecdotal and subjective impressions of
the effects of Lyme disease as my research so far into the literature
has demonstrated a marked fluctuation in the symptomology.  Therefore
I would like to hear from people who have suffered hearing loss in
the past as well.


If you would like to participate in this project, please contact me
via e-mail or snail-mail at:


Marsha Johnson
4307 NE Brazee
Portland, OR 97213



=====*=====


IV.   LYMENET: Michigan Natole Case Is Not Over
-----------------------------------------------
Sender: Kim Weber <Ticktalk2@aol.com>
Organization: Michigan Lyme Disease Association


Dr. Natole, a Saginaw physician, has treated hundreds of cases of
LD since 1989.  He has been investigated for overdiagnosis and
overtreatment of LD for over two years by the State Attorney General.  
He is being charged for overdiagnosing in a nonendemic area.  However,
90% of surveillance has been devoted to the upper peninsula and not
adequately studied in the remainder of Michigan.  The Attorney General
is maintaining that there is one (1) standard of care for treatment of
LD (e.g., Dr. Allan Steere's philosophy of 2-4 weeks antibiotic
treatment) and that Dr. Steere is the only recognized expert in Lyme
disease treatment.


Although Lyme disease care in Michigan may soon be determined with
Dr. Natole's case - this also has implications nationally - with
other doctors being targeted.  This could be YOUR doctor next.


Now, the Michigan Medical Review Board has voted to form a
subcommittee to rewrite Judge Renee A. Osburn's decision vindicating
Dr. Natole from 35 of 37 cases.  Jane Huegel, President of the
Michigan Lyme Disease Association, is hoping for a large show of
support for Dr. Natole.


Please help with your letter to Governor Engler and President Clinton.
Please emphasize that this investigation must stop and all charges
against Dr. Natole are unfounded and should be dropped.  Also mention
if you have not been cured with short-term treatment.


The Governor's address is:

THE HONORABLE GOVERNOR ENGLER
STATE CAPITOL BUILDING
LANSING, MI  48909


We are also planning to join the LDF in the national Wake Up
Washington Rally on May 14th  to send a strong message to our
Senators of the scope of our problems with denial of the true
incidence of LD and physician harassment.



=====*=====


V.    INT J MED MICROBIOL: Small mammals as reservoir hosts
     for Borrelia in Russia
-----------------------------------------------------------
AUTHORS: Gorelova NB, Korenberg EI, Kovalevskii YV, Shcherbakov SV
ORGANIZATION: Vector Laboratory, Gameleya Institute for Epidemiology
             and Microbiology, Russian Academy of Medical Sciences,
             Moscow.
REFERENCE: Int J Med Microbiol Virol Parasitol Infect Dis 1995
          Apr;282(3):315-22
ABSTRACT:


In 1992-1993, a total of 29 isolates of Borrelia were obtained from
small mammals captured in taiga forests of the Perm' region:
26 isolates were obtained from Clethrionomus glareolus and one each
from C. rufocanus, Microtus oeconomus, and Apodemus sylvaticus.
Isolation of Borrelia was performed by plating the animal material
on BSK-II medium.  Most isolates (86.2%) were obtained from the
urinary bladder, the rest from the heart and spleen.  According to
the results of IFA with a set of monoclonal antibodies, isolates did
not contain Borrelia burgdorferi sensu stricto.  Preliminary data
suggest that they can belong to B. garinii and B. afzelii.  On the
basis of the abundance of animals, it is suggested that C. glareolus,
a background species among small mammals inhabiting the study region,
is the main reservoir host for Borrelia.



=====*=====


VI.   ABOUT THE LYMENET NEWSLETTER
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