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Volume: 5
Issue: 10
Date: 10-Oct-97


Table of Contents:

I.    LYMENET: LymeNet Introduces New Interactive Web Services
II.   N ENGL J MED: Ceftriaxone compared with doxycycline for the
      treatment of acute disseminated Lyme disease.
III.  J INFECT DIS: Genetic heterogeneity of Borrelia burgdorferi
      in the United States.
VI.   MUSCLE NERVE: Detection of Borrelia burgdorferi DNA and
      complement membrane attack complex deposits in the sural
      nerve of a patient with chronic polyneuropathy and tertiary
      Lyme disease.
V.    FOLIA PARASITOL: Role of grey squirrels and pheasants in
      the transmission of Borrelia burgdorferi sensu lato, the
      Lyme disease spirochaete, in the U.K.
VI.   About The LymeNet Newsletter


Newsletter:

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*                  The National Lyme Disease Network                  *
*                       http://www.lymenet.org/                       *
*                         LymeNet Newsletter                          *
***********************************************************************


IDX#                Volume 5 / Number 10 / 10-OCT-97
IDX#                            INDEX
IDX#
IDX#  I.    LYMENET: LymeNet Introduces New Interactive Web Services
IDX#  II.   N ENGL J MED: Ceftriaxone compared with doxycycline for the
IDX#        treatment of acute disseminated Lyme disease.
IDX#  III.  J INFECT DIS: Genetic heterogeneity of Borrelia burgdorferi
IDX#        in the United States.
IDX#  VI.   MUSCLE NERVE: Detection of Borrelia burgdorferi DNA and
IDX#        complement membrane attack complex deposits in the sural
IDX#        nerve of a patient with chronic polyneuropathy and tertiary
IDX#        Lyme disease.
IDX#  V.    FOLIA PARASITOL: Role of grey squirrels and pheasants in
IDX#        the transmission of Borrelia burgdorferi sensu lato, the
IDX#        Lyme disease spirochaete, in the U.K.
IDX#  VI.   About The LymeNet Newsletter
IDX#



I.    LYMENET: LymeNet Introduces New Interactive Web Services
--------------------------------------------------------------
Sender: Marc Gabriel <a229@lehigh.edu>
Date: October 10, 1997


The Lyme Disease Network of NJ, Inc. introduced today a new series
of Internet services designed to allow users to contribute content to
the LymeNet site.  The new applications will help break down the
traditional communication barriers between information providers and
consumers.


The most significant addition is the complete re-write of the Support
Group listings.  Under the new system, each individual support group
leader (or a designed representative) can add a listing for their
group and modify it at any time, as often as they want.  Using a user
name and password, each support group will have complete control over
their listing.  Support group representatives are encouraged to visit
the new system to add their group to the database.


The LymeNet Flash update page, designed to give the Lyme community a
bulletin board for Lyme related events and news, received a face lift
and will now accept contributions directly from users on the Web.
Again, a user name and password will control access to the system.


The new LymeNet Search server will support a new, frequently requested
feature.  Users will now be able to browse the newest abstracts in the
system.  The information is also displayed in a newer, more
user-friendly format.


The new services are now available via the LymeNet Home page at:

                      http://www.lymenet.org/

Over the next few weeks, the system will be refined and enhanced based
on user feedback.  Please send your feedback to:
marc_gabriel@lymenet.org .


The non-profit Lyme Disease Network, which operates entirely on
individual donations, is responsible for the LymeNet series of
services available on the Internet since 1994.  Information on
donations can be found on the Home page.



=====*=====


II.   N ENGL J MED: Ceftriaxone compared with doxycycline for the
     treatment of acute disseminated Lyme disease.
-----------------------------------------------------------------
AUTHORS: Dattwyler RJ, Luft BJ, Kunkel MJ, Finkel MF, Wormser GP
        Rush TJ, Grunwaldt E, Agger WA, Franklin M, Oswald D
        Cockey L, Maladorno D
ORGANIZATION: Department of Medicine, State University of New York,
             Stony Brook, NY.
REFERENECE: N Engl J Med 1997 Jul 31;337(5):289-94
ABSTRACT:


BACKGROUND: Localized Lyme disease, manifested by erythema migrans, is
usually treated with oral doxycycline or amoxicillin.  Whether acute
disseminated Borrelia burgdorferi infection should be treated
differently from localized infection is unknown.
METHODS: We conducted a prospective, open-label, randomized,
multicenter study comparing parenteral ceftriaxone (2 g once daily for
14 days) with oral doxycycline (100 mg twice daily for 21 days) in
patients with acute disseminated B. burgdorferi infection but without
meningitis.  The erythema migrans skin lesion was required for study
entry, and disseminated disease had to be indicated by either
multiple erythema migrans lesions or objective evidence of organ
involvement.
RESULTS: Of 140 patients enrolled, 133 had multiple erythema migrans
lesions.  Both treatments were highly effective.  Rates of clinical
cure at the last evaluation were similar among the patients treated
with ceftriaxone (85 percent) and those treated with doxycycline (88
percent); treatment was considered to have failed in only one patient

in each group.  Among patients whose infections were cured, 18 of 67
patients in the ceftriaxone group (27 percent) reported one or more
residual symptoms at the last follow-up visit, as did 10 of 71
patients in the doxycycline group (14 percent, P > or = 0.05). Mild
arthralgia was the most common persistent symptom.  Both regimens
were well tolerated; only four patients (6 percent) in each group
withdrew because of adverse events.
CONCLUSIONS: In patients with acute disseminated Lyme disease but
without meningitis, oral doxycycline and parenterally administered
ceftriaxone were equally effective in preventing the late
manifestations of disease.



=====*=====


III.  J INFECT DIS: Genetic heterogeneity of Borrelia burgdorferi
     in the United States.
-----------------------------------------------------------------
AUTHORS: Mathiesen DA, Oliver JH Jr, Kolbert CP, Tullson ED, Johnson BJ
        Campbell GL, Mitchell PD, Reed KD, Telford SR 3rd, Anderson JF
        Lane RS, Persing DH
ORGANIZATION: Department of Laboratory Medicine and Pathology, Mayo
             Clinic, Rochester, Minnesota.
REFERENCE: J Infect Dis 1997 Jan;175(1):98-107
ABSTRACT:


To examine in detail Borrelia burgdorferi strain diversity in the
United States, 186 isolates from human, tick, and rodent sources were
analyzed from multiple distinct geographic regions of the United
States and abroad.  Strains were characterized by genomic
macrorestriction analysis and ospA and 23S rDNA gene sequencing
followed by phylogenetic analysis.  Results indicate that spirochetal
isolates from the United States fall into two major divisions and nine
or more subdivisions; human isolates fell into five of these
subdivisions.  Greater genetic diversity was observed among B.
burgdorferi isolates from moderate climatic regions, consistent with
increased tick vector and reservoir diversity.  All of the Borrelia
isolates were reactive by ospA polymerase chain reaction except for
Borrelia hermsii controls and several tick isolates from the
Northeast, which were shown to lack the 49-kb plasmid encoding outer
surface protein A (OspA).  The data suggest that US B. burgdorferi
isolates demonstrate substantial genetic heterogeneity, with regional

differences in spirochete populations.


=====*=====


VI.   MUSCLE NERVE: Detection of Borrelia burgdorferi DNA and
     complement membrane attack complex deposits in the sural nerve
     of a patient with chronic polyneuropathy and tertiary Lyme
     disease.
--------------------------------------------------------------------
AUTHORS: Maimone D, Villanova M, Stanta G, Bonin S, Malandrini A
        Guazzi GC, Annunziata P
ORGANIZATION: Institute of Neurological Sciences, University of
             Siena, Italy.
REFERENCE: Muscle Nerve 1997 Aug;20(8):969-75
ABSTRACT:


We report a patient who developed a chronic sensory-motor
polyneuropathy and a progressive myelopathy 4 years after a tick bite.
An increased serum antibody titer to Borrelia burgdorferi suggested
a diagnosis of Lyme neuroborreliosis, although a concomitant
cervical spondylosis probably contributed to spinal cord damage.
Treatment with ceftriaxone resulted in a marked improvement of
neuropathic symptoms, providing indirect evidence of spirochetal
infection.  Search for B. burgdorferi DNA by polymerase chain reaction
amplification on sural nerve confirmed the diagnosis, demonstrating
that the spirochete localized in the peripheral nervous system.
The presence of complement membrane attack complex deposits and
macrophage infiltrates around epineurial vessels and within the
endoneurium suggests that the neuropathy in our patient was
immune-mediated.



=====*=====


V.    FOLIA PARASITOL: Role of grey squirrels and pheasants in the
     transmission of Borrelia burgdorferi sensu lato, the Lyme disease
     spirochaete, in the U.K.
-----------------------------------------------------------------------
AUTHORS: Craine NG, Nuttall PA, Marriott AC, Randolph SE
ORGANIZATION: Department of Zoology, University of Oxford, UK.
ABSTRACT:


In Britain, grey squirrels (Sciurus carolinensis Gmelin) and pheasants
(Phasianus colchicus Linnaeus) are important hosts of larvae and
nymphs of Ixodes ricinus L., the principal European vector of the Lyme
disease spirochaete, Borrelia burgdorferi sensu lato.  To test whether
squirrels are competent hosts of B. burgdorferi s.l., three females
were trapped in the wild and then held in captivity.  Following
treatment, each animal was exposed to uninfected xenodiagnostic
I. ricinus ticks. Squirrel A (an adult) which was inoculated
experimentally with B. burgdorferi s.l., transmitted the infection to
xenodiagnostic ticks.  In contrast, squirrel B (a juvenile that was
not inoculated)-showed no evidence of infection.  Xenodiagnostic ticks
that fed on control squirrel C (an adult) became infected and
subsequently transmitted the infection experimentally to an uninfected
hamster.  The results indicated that squirrel C had a disseminated
infection acquired in the wild and which persisted for at least 11
weeks.  These data clearly demonstrate that grey squirrels are

amplifying and reservoir hosts of B. burgdorferi s.l.  The strain
associated with squirrels was related to the B. afzelii genotype.
Two observations implicated pheasants in a similar role: (i) a high
prevalence of infection in engorged larvae collected from trapped
pheasants, and (ii) the detection of B. burgdorferi s.l. (B. garinii
genotype) in the wattle of 1/10 pheasants using PCR.  Xenodiagnostic
experiments similar to those undertaken with the squirrels are needed
to confirm the role of pheasants in the transmission cycle of Lyme
disease spirochaetes.



=====*=====


VI.   ABOUT THE LYMENET NEWSLETTER
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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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