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Volume: 7
Issue: 07
Date: 23-Jul-99


Table of Contents:

I.    N ENG J MED: Ehrlichia ewingii, a Newly Recognized Agent of
      Human Ehrlichiosis
II.   J CLIN MICROBIOL: Isolation of DNA after extraction of RNA To
      detect the presence of Borrelia burgdorferi and expression of
      host cellular genes from the same tissue sample.
III.  J CLIN MICROBIOL: Infection of laboratory mice with the human
      granulocytic ehrlichiosis agent does not induce antibodies to
      diagnostically significant Borrelia burgdorferi antigens.
IV.   PEDIATRICS: Characterization of Lyme meningitis and comparison
      with viral meningitis in children.
V.    J KOREAN MED SCI: Serologically diagnosed Lyme disease
      manifesting erythema migrans in Korea.
VI.   ABOUT THE LYMENET NEWSLETTER


Newsletter:

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                  Volume 7 / Number 07 / 23-JUL-1999
                                INDEX


I.    N ENG J MED: Ehrlichia ewingii, a Newly Recognized Agent of
     Human Ehrlichiosis
II.   J CLIN MICROBIOL: Isolation of DNA after extraction of RNA To
     detect the presence of Borrelia burgdorferi and expression of
     host cellular genes from the same tissue sample.
III.  J CLIN MICROBIOL: Infection of laboratory mice with the human
     granulocytic ehrlichiosis agent does not induce antibodies to
     diagnostically significant Borrelia burgdorferi antigens.
IV.   PEDIATRICS: Characterization of Lyme meningitis and comparison
     with viral meningitis in children.
V.    J KOREAN MED SCI: Serologically diagnosed Lyme disease
     manifesting erythema migrans in Korea.
VI.   ABOUT THE LYMENET NEWSLETTER



=====*=====


I.    N ENG J MED: Ehrlichia ewingii, a Newly Recognized Agent of
     Human Ehrlichiosis
-----------------------------------------------------------------
AUTHORS: Buller RS, Arens M, Hmiel SP, Paddock CD, Sumner JW,
        Rikihisa Y, Unver A, Gaudreault-Keener M, Manian FA,
Liddell AM, Schmulewitz N, Storch GA
ORGANIZATION: Edward Mallinckrodt Department of Pediatrics and the
             Department of Medicine, Washington University
     School of Medicine, St. Louis, MO.
REFERENCE: N Engl J Med 1999;341:148-55
ABSTRACT:


BACKGROUND: Human ehrlichiosis is a recently recognized tick-borne
infection. Four species infect humans: Ehrlichia chaffeensis, E.
sennetsu, E. canis, and the agent of human granulocytic ehrlichiosis.
METHODS: We tested peripheral-blood leukocytes from 413 patients with
possible ehrlichiosis by broad-range and species-specific polymerase-
chain-reaction (PCR) assays for ehrlichia. The species present were
identified by species-specific PCR assays and nucleotide sequencing
of the gene encoding ehrlichia 16S ribosomal RNA. Western blot
analysis was used to study serologic responses.
RESULTS: In four patients, ehrlichia DNA was detected in leukocytes
by a broad-range PCR assay, but not by assays specific for E.
chaffeensis or the agent of human granulocytic ehrlichiosis. The
nucleotide sequences of these PCR products matched that of E. ewingii,
an agent previously reported as a cause of granulocytic ehrlichiosis
in dogs. These four patients, all from Missouri, presented between
May and August 1996, 1997, or 1998 with fever, headache, and

thrombocytopenia, with or without leukopenia. All had been exposed
to ticks, and three were receiving immunosuppressive therapy. Serum
samples obtained from three of these patients during convalescence
contained antibodies that reacted with E. chaffeensis and E. canis
antigens in a pattern different from that of humans with E.
chaffeensis infection but similar to that of a dog experimentally
infected with E. ewingii. Morulae were identified in neutrophils
from two patients. All four patients were successfully treated with
doxycycline.


CONCLUSIONS: These findings provide evidence of E. ewingii infection
in humans. The associated disease may be clinically indistinguishable
from infection caused by E. chaffeensis or the agent of human
granulocytic ehrlichiosis.



=====*=====


II.   J CLIN MICROBIOL: Isolation of DNA after extraction of RNA To
     detect the presence of Borrelia burgdorferi and expression of
     host cellular genes from the same tissue sample.
-------------------------------------------------------------------
AUTHORS: Amemiya K, Schaefer H, Pachner AR
ORGANIZATION: National Institute of Neurological Diseases and Stroke,
             National Institutes of Health, Bethesda, Maryland
     20892, USA.
REFERENCE: J Clin Microbiol 1999 Jun;37(6):2087-9
ABSTRACT:


We are investigating the neuropathogenesis of Lyme disease caused by
Borrelia burgdorferi in a nonhuman primate model. In the past, two
separate pieces of tissue had to be used when both analyzing for the
presence of the spirochete and examining the host response to
infection. We have modified a procedure to purify DNA from the same
sample after the extraction of RNA. The remaining material containing
the DNA was precipitated, and residual organic reagent was removed
prior to deproteinization and extraction of the DNA. This procedure
now allows us to both assay for the presence of the Lyme microorganism
and analyze the host response in the same tissue preparation.



=====*=====


III.  J CLIN MICROBIOL: Infection of laboratory mice with the human
     granulocytic ehrlichiosis agent does not induce antibodies to
     diagnostically significant Borrelia burgdorferi antigens.
-------------------------------------------------------------------
AUTHORS: Bunnell JE, Magnarelli LA, Dumler JS
ORGANIZATION: Department of Molecular Microbiology and Immunology,
             The Johns Hopkins University School of Hygiene and
     Public Health, Baltimore, Maryland 21205, USA.
REFERENCE: J Clin Microbiol 1999 Jun;37(6):2077-9
ABSTRACT:


Laboratory diagnosis of Borrelia burgdorferi is routinely made by an
enzyme-linked immunosorbent assay, with positive results confirmed
by Western blot analysis. Concern has been raised that false-positive
diagnoses may be made on the basis of serologic cross-reactivity with
antibodies directed against other bacterial pathogens, in particular
the agent of human granulocytic ehrlichiosis (HGE). The present study
made use of a mouse model to ascertain the validity of these concerns.
Two different strains of mice were inoculated with the HGE agent and
assayed for production of polyclonal and monoclonal antibodies to
antigens of both of these bacteria. Infection of mice with the HGE
agent does not induce diagnostically significant B. burgdorferi
serologic cross-reactions.



=====*=====


IV.   PEDIATRICS: Characterization of Lyme meningitis and comparison
     with viral meningitis in children.
--------------------------------------------------------------------
AUTHORS: Eppes SC, Nelson DK, Lewis LL, Klein JD
ORGANIZATION: Division of Infectious Diseases, Alfred I. duPont
             Hospital for Children, Wilmington, Delaware, USA.
     seppes@nemours.org
REFERENCE: Pediatrics 1999 May;103(5 Pt 1):957-60
ABSTRACT:


OBJECTIVES: The objectives of this study were to characterize Lyme
meningitis (LM) in the pediatric population; to compare LM with
viral meningitis (VM) with respect to epidemiology, history and
physical examination, and laboratory data; and to provide means of
early distinction of Lyme neuroborreliosis from other forms of
aseptic meningitis.
METHODS: This retrospective analysis involved children admitted to
Alfred I. duPont Hospital for Children between 1990 and 1996 whose
discharge diagnoses indicated viral or aseptic meningitis or Lyme
disease. LM was defined as the presence of cerebrospinal fluid
(CSF) pleocytosis with positive Lyme serology and/or erythema
migrans. Patients were considered to have VM if they exhibited CSF
pleocytosis and had a positive viral culture. Demographic, clinical,
and laboratory data were collected for each patient, and patients
with LM were compared with age-matched patients with VM.
RESULTS: Of 179 patient records, 12 patients with LM and 10 patients
with VM (all, >2 years old) were identified by using the above

criteria. In comparing LM patients with VM patients, we noted no
differences among demographic variables. Children with LM had
significantly lower temperatures at the time of presentation. The
presence of headache, neck pain, and malaise was similar for the
two groups, but the duration of these symptoms was significantly
longer among LM patients. Five children with LM had cranial
neuropathies. All but 1 LM patient exhibited either papilledema,
erythema migrans, or cranial neuropathy. These three findings
were absent in the VM group. On CSF analysis, LM patients had fewer
white blood cells (mean, 80/mm3 versus 301/mm3) and a significantly
greater percentage of mononuclear cells than the VM patients.
CONCLUSIONS: In this study, in a Lyme-endemic area, LM was about as
common as VM in older children who were hospitalized with aseptic
meningitis. Attention to pertinent epidemiologic and historical
data, along with physical and CSF findings, allows early
differentiation of LM from VM.



=====*=====


V.    J KOREAN MED SCI: Serologically diagnosed Lyme disease
     manifesting erythema migrans in Korea.
------------------------------------------------------------
AUTHORS: Kim TH, Choi EH, Lee MG, Ahn SK
ORGANIZATION: Department of Dermatology, Yonsei University, Wonju
             College of Medicine, Korea.
REFERENCE: J Korean Med Sci 1999 Feb;14(1):85-8
ABSTRACT:


Lyme disease is a vector-borne infection, primarily transmitted by
Ixodes ticks, and caused by Borrelia burgdorferi. It has a wide
distribution in the northern hemisphere. In Korea, however, only one
human case has been reported, although B. burgdorferi was isolated
from the vector tick I. persulcatus in the region. A 60-year-old male
and a 45-year-old female developed the clinical sign of erythema
migrans. Each patients were bitten by a tick four weeks and five
weeks, respectively, before entering the hospital. On serologic
examination, significantly increased IgM and IgG antibody titers to
B. burgdorferi were observed in consecutive tests performed at an
interval of two weeks. They responded well to treatment with
tetracycline.



=====*=====


VI.   ABOUT THE LYMENET NEWSLETTER
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