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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:

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                   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



=====*=====


I.    LYMENET: VII International Conference on Lyme Borreliosis
     and other Emerging Diseases: June 20-24, 1999
---------------------------------------------------------------
Contact: AKM Congress Service -- Lyme '99 <akm@bluewin.ch>


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
                       Bettina.Wilske@mvp-bak.med.uni-muenchen.de


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
                           akm@bluewin.ch



=====*=====


II.   LYMENET: Lyme Disease Awareness for the New Jersey Dentist
----------------------------------------------------------------
Sender: Gary M. Heir, DMD <heirgm@umdnj.edu>


 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


--------

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.



=====*=====


III.  NIAID: Relapsing Fever Spirochete Switches Surface Proteins
     When It Changes Hosts
-----------------------------------------------------------------
Contact: Laurie K. Doepel <ldoepel@nih.gov>
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).



=====*=====


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.   rauer@nz11.ukl.uni-freiburg.de
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.



=====*=====


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.



=====*=====


VI.   ABOUT THE LYMENET NEWSLETTER
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