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Volume: 4
Issue: 03
Date: 04-Mar-96


Table of Contents:

I.    LYMENET: CT Governor Proposes To Close Agricultural
      Experiment Station
II.   J INFECT DIS: Ixodes dammini as a potential vector of
      human granulocytic ehrlichiosis (HGE)
III.  AM J MED: Misdiagnosis of erythema migrans
IV.   N ENGL J MED: An epidemiologic study of Lyme disease in
      southern Sweden
V.    LYMENET: Patient Diagnosed with "Lyme-Like" disorder (Q)
VI.   About The LymeNet Newsletter


Newsletter:

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*                  The National Lyme Disease Network                  *
*                         LymeNet Newsletter                          *
***********************************************************************


IDX#                Volume 4 - Number 03 - 3/04/96
IDX#                            INDEX
IDX#
IDX#  I.    LYMENET: CT Governor Proposes To Close Agricultural
IDX#        Experiment Station
IDX#  II.   J INFECT DIS: Ixodes dammini as a potential vector of
IDX#        human granulocytic ehrlichiosis (HGE)
IDX#  III.  AM J MED: Misdiagnosis of erythema migrans
IDX#  IV.   N ENGL J MED: An epidemiologic study of Lyme disease in
IDX#        southern Sweden
IDX#  V.    LYMENET: Patient Diagnosed with "Lyme-Like" disorder (Q)
IDX#  VI.   About The LymeNet Newsletter
IDX#


EDITORIAL NOTE:

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I.    LYMENET: CT Governor Proposes To Close Agricultural
     Experiment Station
---------------------------------------------------------
Sender: Mark K. Stowe <mks@zoo.ufl.edu>


In a surprise move that leaves minimal time for public commentary,
Connecticut Governor Rowland has proposed the elimination of the
Connecticut Agricultural Experiment Station.  This exceptionally
productive institution is the nation's oldest state agricultural
experiment station (established in 1875), with a long continuous
history of ground-breaking work including the discovery of
vitamin A, and recent advances in the biological control of various
insect pests.  More importantly for the members of this list,
work by several station scientists is pivotal to our growing
understanding of Lyme and other tick-borne diseases in the state.
The station provides a wide variety of services to ordinary citizens
including extensive Lyme disease public education efforts.


Every citizen in CT who values scientific research and monitoring in
the areas of agriculture, insect-borne diseases and food-safety,
needs to write their state legislators ASAP.  Addresses of state
legislators and the governor can be found at
http://www.state.ct.us/LEG/GUIDE/legis1.htm and
http://www.state.ct.us/ .



======*======


II.   J INFECT DIS: Ixodes dammini as a potential vector of
     human granulocytic ehrlichiosis (HGE)
-----------------------------------------------------------
AUTHORS: Pancholi P, Kolbert CP, Mitchell PD, Reed KD Jr, Dumler JS,
        Bakken JS, Telford SR 3rd, Persing DH
ORGANIZATION: Division of Clinical Microbiology, Mayo Clinic,
             Rochester, MN
REFERENCE: J Infect Dis 1995 Oct;172(4):1007-12
ABSTRACT:


Little is known about the epidemiology and mode of transmission
of the agent of human granulocytic ehrlichiosis (HGE).  Analyses
of an engorged female Ixodes dammini tick removed from an HGE patient
and 101 field-collected I. dammini and Dermacentor variabilis from
three Wisconsin counties for Borrelia burgdorferi and Ehrlichia
phagocytophila/Ehrlichia equi DNA revealed that the patient tick
and 7 of 68 I. dammini ticks from Washburn County collected in
1982 and 1991 were positive for ehrlichial DNA; 10 ticks from the
same collections were positive for B. burgdorferi.


Two specimens (2.2%) were positive for both organisms.  Serologic
evidence for exposure to the agent of HGE or its relatives was
detected in 3 of 25 Lyme disease patients from the upper Midwest.
These data argue that I. dammini is a common vector for transmission
of both Lyme disease and HGE.



=====*=====

III.  AM J MED: Misdiagnosis of erythema migrans
------------------------------------------------
AUTHORS: Feder HM Jr, Whitaker DL
ORGANIZATION: Department of Pediatrics, University of Connecticut
             Health Center, Farmington CT
REFERENCE: Am J Med 1995 Oct;99(4):412-9
ABSTRACT:


BACKGROUND: Erythema migrans is a clinical diagnosis that carries
possible long-term repercussions. Despite widespread awareness of the
clinical presentation of erythema migrans, incorrect diagnosis
occurs.


PATIENTS AND METHODS: We describe 13 cases in which erythema migrans
was misdiagnosed and discuss some pitfalls in diagnosis.  These cases
were seen at a tertiary referral center in Connecticut, a state where
Lyme disease is endemic.  The patients selected for inclusion were
those who most clearly illustrate potential difficulties involved in
making the diagnosis of erythema migrans.


RESULTS: The diagnosis of erythema migrans was missed in 5 patients
due to atypical presentations.  Eight patients with skin eruptions
closely mimicking erythema migrans were incorrectly diagnosed with
erythema migrans.


CONCLUSIONS: There are pitfalls associated with the diagnosis of
erythema migrans that may result in overdiagnosis or underdiagnosis.



=====*======


IV.   N ENGL J MED: An epidemiologic study of Lyme disease in
     southern Sweden
--------------------------------------------------------------
AUTHORS: Berglund J, Eitrem R, Ornstein K, Lindberg A, Ringer A,
        Elmrud H, Carlsson M, Runehagen A, Svanborg C, Norrby R
ORGANIZATION: Department of Community Health Sciences, University
             of Lund, Sweden
REFERENCE:  N Engl J Med 1995 Nov 16;333(20):1319-27
ABSTRACT:


BACKGROUND. Lyme disease is the most common vector-borne infection
in some temperate regions of the Northern Hemisphere.  However, for
most areas of endemic disease reliable epidemiologic data are sparse.


METHODS. Over a one-year period, we conducted a prospective,
population-based survey of cases of Lyme disease in southern Sweden.
The diagnosis was made on the basis of the presence of erythema
migrans at least 5 cm in diameter or characteristic clinical
manifestations such as arthritis, neuroborreliosis, and carditis.


RESULTS. We identified 1471 patients with Lyme disease, for an
overall annual incidence of 69 cases per 100,000 inhabitants. The
incidence varied markedly according to geographic region, and
there were several areas where disease was widely prevalent. The
incidence varied according to age, with the highest rates among
people 5 to 9 and 60 to 74 years of age, but not according to
sex.  The most frequent clinical manifestation was erythema migrans
(seen in 77 percent of all cases), followed by neuroborreliosis
(16 percent) and arthritis (7 percent).  Carditis was rare.  A
preceding tick bite was reported by 79 percent of the patients. Bites
in the head and neck region were more common among children than
among adults and were associated with an increased risk of  
neuroborreliosis.


CONCLUSIONS. Lyme disease is very common in southern Sweden, with a
relatively high frequency of neurologic complications and arthritis.
With the exception of the low incidence of carditis, the pattern of
disease we found in Sweden was similar to that reported in the
United States.



=====*=====


V.    LYMENET: Patient Diagnosed with "Lyme-Like" disorder (Q)
--------------------------------------------------------------
Sender: Sandy <worm@digital.net>


Editor's note: Please send responses to: LymeNet-L@Lehigh.edu

This letter comes from a person whose family doctor (of almost nine
years) tells her that she always waits too long when sick, to get to
the doctor.  On Labor Day of 1995, I was sitting on my lanai watching
my husband mow the lawn, when a so-called very small spider fell off
the ceiling fan and bit me on the top of the left foot.  I have
never had a bug bite hurt so bad.  The top of my foot went numb
almost immediately.  I didn't think much more about it that week
until that Sunday when I noticed my left foot wanted to drag a
little.  That night the entire left side of my body tingled, and it
alerted me a little.  The next morning it happened again and my left
arm and leg felt heavy.  I called my doctor.  


By the time I got to her office my heart was beating hard and fast
and my blood pressure of normally 100-110/70-80 was now 185+ / 95+.  
Other than a very fast heart and heavy heart beat, the EKG was
normal.  After reducing my BP, and my foot still being numb, along
with my left side being "tingly", I was sent to have an MRI because
I was having stroke symptoms.  I was sent to a neurologist who did
a Lyme test and a B-12 test.  B-12 test done because of rapid weight
loss.  Both tests were negative.  


My condition worsened with Bells Palsy on the left side, seizure
symptoms and occasional vertigo.  EEG and LP were normal as well as
all blood work on LD coming back negative.  Diagnosis from
neurologist: Post toxic neuropathy due to a spider.  Also stated,
stocking-glove nerve damage on both sides with a partial left foot
drop.  I was then sent to an infectious disease doctor by my
family doctor.  He looked at the diagnosis, and took one look at
my foot and said I have a Lyme-like disease.  He put me on an oral
form of penicillin for 28 days and said I did not need to see him
again, that I needed to continue seeing the neurologist for the
nueropathy.  I did well during the time I was on the cillin.  I got
rid of the foot drop, the Bells Palsy went away, as did the
"night sweats" and the internal smell.  This part is hard to
explain, but there is a smell, an internal one.  


About three days after completing the oral antibiotics, I woke up
crying.  I just felt really bad and didn't know why.  I called my
neurologist a few days later because all of my symptoms had
returned, and I was scared.  He said if I was running a low grade
fever that I should call the infectious disease physician.  
I was, so I called.  I saw the doctor again and he referred me to
another neurologist for a second opinion.  The second neurologist
opinion  was the same as the first.  The infectious disease doctor
said if my symptoms did not improve that I would be put on IV
Rocephin for a 30 day period.  He also stated that if my symptoms
did not clear up after IV therapy that he wanted me to see a
psychiatrist.  I said that I was very open to this idea.  If these
symptoms are in my head then maybe we could do something about them.  


FYI: I have never liked going to doctors and I hate hospitals.  I
have always avoided them as much as possible.  During the third week
of IV therapy, I noticed the symptoms coming back.  At this point, I
need to tell you one more symptom: I had and have pressure in my
temples.  I was told these are migraine headaches.  Sometimes the
headaches are hard to handle.  (I never have had a migraine before
this bug bite.)  


After the completion of the IV therapy, I returned to the infectious
disease doctor.  I told him that I am "very up mentally," but the
symptoms have returned.  I said I was, and am, very much open to
seeing a psychiatrist.  At this point he told me I do not need one,
that it is "this" , referring to the Lyme-like disease.  He also told
me that if the symptoms get bad again that he will put me back on
oral antibiotics.  He states he believes me about the symptoms.


Almost four weeks after completing the IV therapy: I have good days
and bad days.  I pace myself.  When I get tired, I notice the
symptoms are worse.  I still get the pressure in my temples several
times a day, almost every day, and if I get stressed, the pressure is
even more frequent.  Stress is something I can't handle like
before.  I tire very easily.  I still have tingliness in my feet
and sometimes legs.  My right shoulder hurts quite a bit and my
right arm and hand goes numb and hurts several times during the
day, like a pinched nerve.  My left arm and left hand also gets
tingly, occasionally.  


I still very often get the flu-like symptoms in the afternoon along
with a low grade fever.  I am also on BP medicine, I never had
BP problems before the bug bite.  Mentally, I try to stay "up."  
I try to think positively, and I am back in college, trying to keep
my mind active.  I sold my wallpapering business to my partner and
only help her with 1-4 very light hours of work each week, if that
much.  When I work, I tire very easily and feel bad the rest of the
day.  Although staying mentally "up", I have to tell you that I'm
scared.  My symptoms are back and I feel like a time-bomb,
wondering if they will flare up as bad as they were.  (There have
been times that I prayed that I wouldn't wake up the next day
because I didn't want to feel so bad.)  I wish I could see a
psychiatrist or find a support group in my area.  I have also
heard many horror stories of people never fully recovering from
this disease.  So little is known.  


All I know is that something terrible has happened to me that I
did not ask for: it's altered my way of life and that of my husband's,
also financially.  I sometimes have a hard time believing that I am
having these terrible symptoms, especially on a day when I feel
good.  Lyme and like diseases are wicked diseases.  And I wonder,
how bad do I have to feel before I go back to the doctor, and when I
finally do go, will he believe me?  It is also a very emotional
disease.  It is almost unheard of here in central Florida, but I
know that I have something and it doesn't seem to be going away.  And
I know I had NONE of these symptoms before that spider bit me six
months ago.


If you can, my plea to you is this: Should I pursue this further?  


=====*======


VI.   ABOUT THE LYMENET NEWSLETTER
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