LymeNet Newsletter Volume 6 Issue 07

Volume: 6
Issue: 07
Date: 13-Jul-98

Table of Contents:

I. LYMENET: VII International Conference on Lyme Borreliosis and other Emerging Diseases: June 20-24, 1999 II. LYMENET: Lyme Disease Awareness for the New Jersey Dentist III. NIAID: Relapsing Fever Spirochete Switches Surface Proteins When It Changes Hosts IV. J CLIN MICROBIOL: Enzyme-linked immunosorbent assay using recombinant OspC and the internal 14-kDa flagellin fragment for serodiagnosis of early Lyme disease. V. SOC SCI MED: The public health risks of Lyme disease in Breckland, U.K.: an investigation of environmental and social factors. VI. ABOUT THE LYMENET NEWSLETTER

Newsletter:

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

Volume 6 / Number 07 / 13-JUL-98 INDEX

I. LYMENET: VII International Conference on Lyme Borreliosis and other Emerging Diseases: June 20-24, 1999 II. LYMENET: Lyme Disease Awareness for the New Jersey Dentist III. NIAID: Relapsing Fever Spirochete Switches Surface Proteins When It Changes Hosts IV. J CLIN MICROBIOL: Enzyme-linked immunosorbent assay using recombinant OspC and the internal 14-kDa flagellin fragment for serodiagnosis of early Lyme disease. V. SOC SCI MED: The public health risks of Lyme disease in Breckland, U.K.: an investigation of environmental and social factors. VI. ABOUT THE LYMENET NEWSLETTER

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I. LYMENET: VII International Conference on Lyme Borreliosis and other Emerging Diseases: June 20-24, 1999 --------------------------------------------------------------- Contact: AKM Congress Service -- Lyme '99 <[email protected]>

Dear Colleagues,

In the past two decades, scientific interest in Lyme borreliosis research as increased in a steady pace reflected by the growing number of papers published on this subject. A notable outgrowth of this research resulted in an increased awareness of other emerging tick-borne diseases. Therefore, as decided at the last meeting, other emerging tick-borne diseases such as tick-borne encephalitis, ehrlichiosis and babesiosis are included in the agenda of the next Conference. Following the first International Conference on Lyme Borreliosis 1993 in New Haven, subsequent meeting were held every two or three years in Europe and the United States, in Vienna, New York, Stockholm, Arlington, Bologna and San Francisco. The next Conference will be held in Munich, the capital of Bavaria. Munich, situated close to the Alps in beautiful surroundings, is one of the most desirable metropolitan areas in the world and hosts numerous cultural attractions. We cordially invite scientists from all over the world working in the fascinating field of tick-borne diseases,
to participate in and/or present their work at the meeting. Undoubtedly "Munich 1999" will present the opportunity to meet new friends and colleagues and initiate new friendships and collaborators.

The Local Organizers,

Bettina Wikske, Max von Pettenkofer Institute for Hygiene and Medical Microbiology, Ludwigs-Maximilians University, Munich.

Hans-Walter Pfister, Department of Neurology, Klinikum Grobhadern Ludwigs-Maximilians University, Munich.

CONFERENCE DATES: June 20-24, 1999

VENUE: Munich Park Hilton Hotel close to the English Garden, a famous and scenic park stretching from the down town area into the heart of Schwabing.

LANGUAGE: English, no simultaneous translation

CALL FOR ABSTRACTS: Deadline for submission of abstracts is February 1, 1999. The meeting will consist of plenary sessions with talks of invited speakers, sessions for free communications, symposia and workshops.

ACCOMODATION: Hotel rooms in the Congress Hotel and in various categories have been reserved.

SOCIAL PROGRAM: An attractive social program will be organized for the participants and accompanying persons.

EXIBITION: An exhibition will be held at the foyers of the Munich Park Hilton Hotel.

SCIENTIFIC SECRETARIAT: PD Dr. Bettina Wilske Dr. Volker Fingerle Max von Pettenkofer Institut LMU Muenchen Pettenkoferstrasse 9a D-80336 Muenchen (Germany) Tel: ++49 89 51 60 52 42 Fax: ++46 89 51 60 47 57 [email protected]

ADMINISTRATIVE SECRETARIAT: All correspondence and inquiries should be addressed to the Adminitrative Secratariat: Lyme '99 c/o AKM Congress Service Clarastrasse 57 PO Box 6 CH-4005 Basel (Switzerland) Tel: ++41 61 691 51 11 Fax: ++41 61 691 81 89 [email protected]

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II. LYMENET: Lyme Disease Awareness for the New Jersey Dentist ---------------------------------------------------------------- Sender: Gary M. Heir, DMD <[email protected]>

A Survey of Orofacial and Headache Complaints Associated with Lyme Disease

Gary M. Heir, DMD Associate Clinical Professor Department of Oral Pathology, Biology and Diagnostic Services University of Medicine and Dentistry of New Jersey

Lesley A. Fein, MD, MPH Former member, New Jersey Congressional Task Force on Lyme Disease

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The healthcare provider involved with the diagnoses and management of orofacial pain disorders must rely on a knowledge of various primary and/or secondary disorders, which may manifest symptoms for which patients seek our aid. While a majority of facial pain complaints are due to primary dental or orofacial pathologies, many patients present with symptoms secondary to a primary systemic illness. Included in these primary conditions is a sprirochetal infection; Lyme disease.

Recent data suggest that the temporomandibular joints are commonly associated with atraumatic, non-dysfunctional Lyme arthritis. The data from 120 patients with laboratory confirmed Lyme disease responding to the survey found that 75% reported pain of the masticatory musculature and 72% reported symptoms of TMJ pain. Of those responding, only 4 of 90 patients reported a history of a traumatic jaw injury. The majority of these patients reported the spontaneous onset of their temporomandibular pain. Of those with Lyme disease reporting a temporomandibular disorder or myofascial pain, 75% indicated that their symptoms intensified on a cyclical basis with other symptoms related to Lyme disease. In such cases, only palliative treatment is indicated while the patient is medically evaluated.

Dental pain or toothache, often in the absence of clinical or radiographic evidence, is another characteristic of Lyme disease. Dental pain in the absence of detectable dental pathology was reported by 60% of those responding to this survey. These patients also reported that their dental pain had a tendency to move from tooth to tooth, change quadrants, or move from side to side. Of these, 36% had multiple dental treatments including endodontia and extraction with little benefit. Glossodynia, or burning mouth, was reported by 25% of patients, while 70% reported sore throat. Facial pain complaints other then those simulating toothache or a temporomandibular disorder are also seen with Lyme disease. A variety of dyesthesias, neuropathic or vascular complaints are more common then previously thought. Of Lyme patients reporting facial pain, 88% associated these complaints with other symptoms of Lyme disease.

Headache is another complaint common to the Lyme patient. It has been previously reported that 53% of Lyme patients hospitalized for neurological manifestations of Lyme disease describe some form of headache disorder. As with other symptoms, these headaches appear to cycle along with other pain complaints associated with Lyme disease. The results of this survey found that 49% of patients reported headache associated with other symptoms of their Lyme disease. Headache ranged from sinus-like pain through tension-type and migraine.

The dental practitioner may also be confronted with patients manifesting neurological symptoms. Unilateral facial nerve palsy was reported by 27% of those responding. Four of the 120 patients reported bilateral paralysis. Trigeminal neuralgia was reported by 25% of patients.

Summary

The dentist and allied health care provider can play a significant role in the early diagnosis and treatment of this often debilitating disease. You are encouraged to learn more about this illness and exercise diligence in evaluating suspect patients. A prompt and appropriate referral to a medial specialist is imperative.

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III. NIAID: Relapsing Fever Spirochete Switches Surface Proteins When It Changes Hosts ----------------------------------------------------------------- Contact: Laurie K. Doepel <[email protected]> Date: June 18, 1998

Scientists at the Rocky Mountain Laboratories (RML) report that the corkscrew-shaped bacterium that causes tick-borne relapsing fever switches surface proteins when it moves from a tick into a mammal or vice versa. Their finding, they say, could lead to an improved blood test for diagnosing the illness, one that might help clinicians distinguish relapsing fever from its better known relative, Lyme disease, in the Western United States where both diseases are endemic.

Tom G. Schwan, Ph.D., acting chief of the RML Laboratory of Microbial Structure and Function, and B. Joseph Hinnebusch, Ph.D., staff fellow in the lab, co-authored the report published July 19 in the journal Science. RML, based in Hamilton, Mont., is part of the National Institute of Allergy and Infectious Diseases (NIAID).

"A large number of proteins on the surface of the relapsing fever spirochete vary during infection in mammals," explains Dr. Schwan. In fact, it's the spontaneous changes in these proteins during human infection that allow the microbe to periodically escape immune detection, leading to a relapse of symptoms. "In our mouse studies," says Dr. Schwan, "we found that these proteins all get turned off during infection in the tick and a different stable type of protein gets produced in their place. But when the spirochete's transmitted back to a mammal, that tick-specific protein gets turned off again and the microbe again produces that very same variable membrane protein that was being produced when the tick ingested it."

Decreasing the temperature, the RML scientists discovered, can trigger the change. "One likely cue that promotes this switch is the drop in temperature that occurs when the spirochete moves from a warm-blooded animal to a tick," Dr. Schwan notes.

Their observations of Borrelia hermsii, the spirochete that causes relapsing fever, can be extended to other Borrelia species, says Dr. Schwan, including B. burgdorferi, the causative agent of Lyme disease. "For us," he says, "it's a way to get a handle on the whole genus."

For example, they now know that when either Lyme disease or relapsing fever spirochetes are transmitted to a mammal via tick saliva, the spirochetes turn on similar surface proteins. "We think this family of proteins is an important part of the spirochete in all Borrelia, possibly in their transmission from arthropod to mammal," says Dr. Schwan. Knowing how these spirochetes behave during tick feeding will increase scientists' ability to design more effective strategies for both diagnoses and protection, he notes.

In addition, Dr. Schwan - who has spent his entire research career studying ticks and the diseases they cause - says relapsing fever can be easier to study than Lyme disease. "The ticks that transmit relapsing fever are easier to rear than those that transmit Lyme disease," he notes. "Transmission is easier to document and observe, and infection in the laboratory animals is easier to detect."

Currently, the RML scientists are exploring the protein's exact function to determine the role it plays in transmission. By manipulating the genome of the relapsing fever spirochete, they can inactivate the gene that makes the protein. "We want to know," explains Dr. Schwan, "if we knock out the gene making this protein associated with transmission, is transmission blocked?"

Relapsing fever is not a nationally reportable disease. However, Dr. Schwan and his colleagues at the Centers for Disease Control and Prevention and elsewhere conclude in a recent review of 182 case records that the disease is underrecognized and underreported, and often mistaken for Lyme disease.

People with tick-borne relapsing fever suffer cyclical high fevers and other symptoms such as headache and pain in the joints, muscles or abdomen that easily can be mistaken for a severe flu. These episodes usually last several days, alternating with periods when the symptoms cease. In most patients, the infection responds to treatment with antibiotics such as penicillin, tetracycline or erythromycin.

Background

While the hard-shelled ticks that transmit Lyme disease feed on their host for three to eight days, the soft-bodied ticks that transmit relapsing fever take a blood meal in 10 to 90 minutes. "They feed at night, they feed rapidly, and generally people don't even know they've been bitten by these ticks. People might wake up in the morning and think they've been bitten by a mosquito," says Dr. Schwan.

Tree squirrels, chipmunks and other wild rodents found in coniferous forests in the higher elevations of the Western United States serve as the primary reservoirs for the relapsing fever spirochete. The soft-bodied ticks that associate with these rodents can remain alive and infectious for years without feeding.

Human cases of illness tend to peak in the warmer months, since if it's too cold, the ticks can't move. But the disease can occur year-round. A common scenario for human infection is to have a tick population established with rodents who've made their home in rustic mountain cabins, explains Dr. Schwan, in attics, walls, basements or under the floor. "If the rodents die off, leave or hibernate, the ticks look for other hosts. In winter, people often will stay in these cabins and warm them up for a week. The rodents are not active, the ticks get warmed up, and they become hungry and start moving around looking for a food source. A person who's breathing is basically a carbon dioxide generator. The ticks actually orient to a carbon dioxide gradient, and this is one of the ways they find their hosts."

NIAID supports biomedical research to prevent, diagnose and treat illnesses such as AIDS and other infectious diseases, asthma and allergies. NIH is an agency of the U.S. Department of Health and Human Services.

References:

TG Schwan and BJ Hinnebusch. Bloodstream- versus tick-associated variants of a relapsing fever bacterium. Science 280:1938-40 (1998).

MS Dworkin, DE Anderson, TG Schwan, PC Shoemaker, SN Banerjee, BO Kassen and W Burgdorfer. Tick-borne relapsing fever in the Northwestern United States and Southwestern Canada. Clinical Infectious Diseases 26:122-31 (1998).

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IV. J CLIN MICROBIOL: Enzyme-linked immunosorbent assay using recombinant OspC and the internal 14-kDa flagellin fragment for serodiagnosis of early Lyme disease. --------------------------------------------------------------------- AUTHORS: Rauer S, Spohn N, Rasiah C, Neubert U, Vogt A ORGANIZATION: Abteilung Immunologie, Institut fur Medizinische Mikrobiologie und Hygiene der Albert-Ludwigs-Universitat, Freiburg, Germany. [email protected] REFERENCE: J Clin Microbiol 1998 Apr;36(4):857-61 ABSTRACT:

The outer surface protein C (OspC) and the internal 14-kDa flagellin fragment of strain GeHo of Borrelia burgdorferi sensu stricto were expressed as recombinant proteins in Escherichia coli and were purified for use in an immunoglobulin M (IgM) enzyme-linked immunosorbent assay (OspC-14-kDa antigen ELISA). No hint at disturbing protein-protein interferences, which might influence the availability of immunoreactive epitopes, was found when the recombinant antigens were combined in the ELISA. The recombinant OspC-14-kDa antigen ELISA was compared to a commercial IgM ELISA that used a detergent cell extract from Borrelia afzelii PKo as the antigen. According to the manufacturer's information, the cell extract contains, in addition to other antigens, the following diagnostically relevant antigens: the 100-kDa (synonyms, 93- and 83-kDa antigens), 41-kDa, OspA, OspC, and 17-kDa antigens. The specificity was adjusted to 95% on the basis of data for 154 healthy controls. On testing of 104 serum samples from patients with erythema
migrans (EM), the sensitivity of the recombinant ELISA (46%) for IgM antibodies was similar to that of the commercial ELISA (45%). However, when 42 serum samples from patients with polyclonal B-cell stimulation due to an Epstein-Barr virus infection were tested, false-positive reactions were significantly less frequent in the recombinant ELISA (10%) than in the whole-cell-extract ELISA (23%). OspC displays sequence heterogeneity of up to 40% according to the genomospecies. However, when the reactions of serum specimens from controls and EM patients with OspC from representative strains of B. burgdorferi sensu stricto (strain GeHo) and B. afzelii (strain PKo) were compared in an ELISA, almost no differences in specificity and sensitivity were seen. This demonstrates that the sera predominantly recognize the common epitopes of OspC tested in this study. In conclusion, we suggest that the OspC-14-kDa antigens ELISA is a suitable test for the detection of an IgM response in early Lyme disease.

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V. SOC SCI MED: The public health risks of Lyme disease in Breckland, U.K.: an investigation of environmental and social factors. ------------------------------------------------------------------- AUTHORS: Mawby TV, Lovett AA ORGANIZATION: School of Environmental Sciences, University of East Anglia, Norwich, U.K. REFERENCE: Soc Sci Med 1998 Mar;46(6):719-27 ABSTRACT:

This paper considers the public health risks of Lyme disease, a borrelial infection transmitted to humans chiefly by nymphal Ixodes ticks. A study undertaken in the Breckland area of East Anglia, U.K., combined analysis of the spatial and temporal factors affecting tick activity at recreational sites with a survey of current levels of disease awareness among visitors to these locations. Significant relationships were found between densities of questing ticks and vegetation type, relative humidity and temperature. More than two thirds of the general public visiting the sites were aware ticks could carry diseases, but only 13% recognized an unfed nymph, and under half knew that Lyme disease could be contracted from tick bites. Such results need to be taken into account when formulating public health and education measures.

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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]>
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