Volume: 5 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: *********************************************************************** * 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 <[email protected]> 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: [email protected] . 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 ---------------------------------- For the most current information on LymeNet subscriptions, contributions, and other sources of information on Lyme disease, please refer to the LymeNet Home Page at: http://www.lymenet.org ----------------------------------------------------------------------- To unsubscribe from the LymeNet newsletter, send a message to: [email protected] On the first line of the message, write: unsub lymenet-l ----------------------------------------------------------------------- LymeNet - The Internet Lyme Disease Information Source ----------------------------------------------------------------------- Editor-in-Chief: Marc C. Gabriel <[email protected]> FAX (for contributions ONLY): 908-789-0028 Contributing Editors: Carl Brenner <[email protected]> John Setel O'Donnell <[email protected]> Frank Demarest <[email protected]> Advisors: Carol-Jane Stolow, Director <[email protected]> William S. 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