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Volume: 8
Issue: 05
Date: 24-May-00


Table of Contents:

I.    LYMENET: LymeNet Headlines
II.   REV PRAT: Deafness of infectious origin
III.  EUR NEUROL: Chronic fatigue syndrome in patients with Lyme
      borreliosis
IV.   J INFECT DIS: Status of Borrelia burgdorferi infection after
      antibiotic treatment and the effects of corticosteroids:
      An experimental study
V.    TRANSFUSION: Fulminant babesiosis treated with clindamycin,
      quinine, and whole-blood exchange transfusion
VI.   ABOUT THE LYMENET NEWSLETTER


Newsletter:

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   Publishing Lyme disease information on the Internet since 1993


                  Volume 8 / Number 05 / 24-MAY-2000
                                INDEX


I.    LYMENET: LymeNet Headlines
II.   REV PRAT: Deafness of infectious origin
III.  EUR NEUROL: Chronic fatigue syndrome in patients with Lyme
     borreliosis
IV.   J INFECT DIS: Status of Borrelia burgdorferi infection after
     antibiotic treatment and the effects of corticosteroids:
     An experimental study
V.    TRANSFUSION: Fulminant babesiosis treated with clindamycin,
     quinine, and whole-blood exchange transfusion
VI.   ABOUT THE LYMENET NEWSLETTER



=====*=====


I.    LYMENET: LymeNet Headlines
--------------------------------


* The Newark Star Ledger has published an extensive report on Lyme
vaccine recipients suffering from debilitating side effects. Off the
record, one FDA official conceded that there are concerns about the
reactions. However, the manufacturer of the vaccine continues to
deny any problems with their product. [23-May-2000]


* The New York Times reported on the Lyme disease treatment
controversy in their May 23 edition. The article contains quotes
from the major players in the debate. [23-May-2000]


* The Lyme Disease Association of New Jersey, Inc., LDANJ, is making
new funds available for researchers seeking to unlock the mysteries
of Chronic Lyme disease. Click here for the details and the grant
application. [20-MAY-2000]


* The LymeNet Pictures pages have been updated with images of ticks
and Lyme rashes. [18-May-2000]


For more information on these headline stories, visit the LymeNet
web site at:  http://www.LymeNet.org



=====*=====


II.   REV PRAT: Deafness of infectious origin
---------------------------------------------
AUTHORS: Sauvaget, E.; Tran Ba Huy, P.
ORGANIZATION: Service ORL, Hopital Lariboisiere, Paris.
REFERENCE: Rev Prat 2000 Jan 15;50(2):150-5
ABSTRACT:


A large number of cases of deafness is due to infection. Both viral
and bacterial agents can induce lesions of the middle ear, the inner
ear and/or of the cochlear-vestibular nerve. The ear is reached
through the Eustachian tube, the outer ear or the subarachnoid
spaces. The characteristics of infection-induced hearing loss depend
on the infectious agent and on the site of infection. We discuss
successively the characteristics of deafness caused by infection of
the middle ear, represented by acute and chronic otitis of common or
mycobacterial origin, by infection of the inner ear with bacterial
labyrinthitis and otosyphilis, and lastly, neurolabyrinthitis of
viral origin or due to Lyme disease.



=====*=====


III.  EUR NEUROL: Chronic fatigue syndrome in patients with Lyme
     borreliosis
----------------------------------------------------------------
AUTHORS: Treib, J.; Grauer, M. T.; Haass, A.; Langenbach, J.;
        Holzer, G.; Woessner, R.
ORGANIZATION: Department of Neurology, University Hospital of the
             Saarland, Homburg, Germany.
REFERENCE: Eur Neurol 2000;43(2):107-9
ABSTRACT:


Several authors have reported a chronic fatigue-like syndrome in
patients that have suffered from Lyme borreliosis in the past. To
further investigate this suspicion of an association without sample
bias, we carried out a prospective, double-blind study and tested
1, 156 healthy young males for Borrelia antibodies. Seropositive
subjects who had never suffered from clinically manifest Lyme
borreliosis or neuroborreliosis showed significantly more often
chronic fatigue (p = 0.02) and malaise (p = 0.01) than seronegative
recruits. Therefore we believe it is worth examining whether an
antibiotic therapy should be considered in patients with chronic
fatigue syndrome and positive Borrelia serology.



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


IV.   J INFECT DIS: Status of Borrelia burgdorferi infection after
     antibiotic treatment and the effects of corticosteroids:
     An experimental study
-------------------------------------------------------------------
AUTHORS: Straubinger, R. K.; Straubinger, A. F.; Summers, B. A.;
        Jacobson, R. H.
ORGANIZATION: James A. Baker Institute for Animal Health, College of
             Veterinary Medicine, Cornell University, Ithaca NY,
     14853, USA. rks4@cornell.edu
REFERENCE: J Infect Dis 2000 Mar;181(3):1069-81
ABSTRACT:


Sixteen specific-pathogen-free beagles were infected with Borrelia
burgdorferi. Three groups of 4 dogs were treated with antibiotics for
30 consecutive days starting 120 days after tick exposure; 4 dogs
were untreated controls. At day 420 after tick exposure and again
before euthanasia, 2 dogs of each group were treated with prednisone
for 14 days. All dogs contracted infection and 11 developed acute
arthritis 50- 120 days after exposure. After day 120, one of 12
antibiotic-treated dogs and 2 of 4 untreated dogs became lame.
Antibiotic therapy reduced the frequency of Borrelia-positivity in
subsequent skin biopsy samples. After prednisone treatment, both
control dogs developed severe polyarthritis. At euthanasia, single
tissues of the antibiotic-treated dogs and multiple tissues of all
control dogs were Borrelia-positive by polymerase chain reaction.
Viable spirochetes were not recovered from antibiotic-treated dogs.
Two antibiotic-treated dogs showed histologic evidence of minimal
lesions, whereas all control dogs had mild polyarthritis with

periarteritis.


=====*=====


V.    TRANSFUSION: Fulminant babesiosis treated with clindamycin,
     quinine, and whole-blood exchange transfusion
-----------------------------------------------------------------
AUTHORS: Dorman, S. E.; Cannon, M. E.; Telford, S. R.; Frank, K. M.;
        Churchill, W. H.
ORGANIZATION: Division of Hematology, Department of Medicine, and the
             Department of Pathology, Brigham and Women's Hospital,
     Boston, MA 02215, USA.
REFERENCE: Transfusion 2000 Mar;40(3):375-80
ABSTRACT:


BACKGROUND: Babesiosis is an increasingly recognized parasitic
infection with manifestations that range from a subclinical or mild
flu- like illness to life-threatening disease. Risk factors that may
be associated with a more severe clinical course include
immunosuppression, splenectomy, and advanced age. The most effective
chemotherapeutic regimen, clindamycin plus quinine, is sometimes
ineffective in cases of severe disease.
CASE REPORT: A previously healthy, 58-year-old man was infected by
Babesia microti, presumably through a tick bite. He developed
fulminant disease characterized by severe hemolytic anemia,
disseminated intravascular coagulation, acute renal failure, and
respiratory failure. There was no history of splenectomy or
immunodeficiency. He was given oral clindamycin (300 mg/4x/day) 2
days before admission. Oral quinine (650 mg/3x/day) was added upon
hospitalization. There was no clinical improvement despite antibiotic
therapy with clindamycin and quinine. On the second hospital day, a

whole-blood exchange transfusion was performed to simultaneously
lower the parasite load and replace the patient's plasma. With an
automated blood cell separator, 87 percent of the patient's total
blood volume was exchanged. As replacement fluid, 6.7 L of packed
RBCs reconstituted with FFP (average Hct, 33%) was used. The patient's
Hct increased from 26.9 percent before the exchange to 28.3 percent
after the exchange. The percentage of parasitized RBCs decreased from
13.8 percent just before exchange to 4.2 percent immediately after
exchange. There was rapid clinical improvement after the whole-blood
exchange transfusion. The patient's subsequent clinical course was
marked by a disappearance of the parasitemia and continued slow,
general improvement. Therapy with clindamycin was continued for 14
days after the exchange transfusion and quinine for 17 days.
CONCLUSION: In cases of severe babesiosis, prompt institution of
whole-blood exchange transfusion, in combination with appropriate
antimicrobial therapy, can be life-saving.



=====*=====


VI.   ABOUT THE LYMENET NEWSLETTER
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         The Lyme Disease Network of New Jersey
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