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Volume: 5
Issue: 05
Date: 05-May-97


Table of Contents:

I.    LDRC: Emerging Tick-Borne Diseases in the Western United
      States Conference September 13
II.   INFECTION: Borrelia burgdorferi DNA in the urine of treated
      patients with chronic Lyme disease symptoms. A PCR study of
      97 cases
III.  J OROFAC PAIN: Lyme disease: considerations for dentistry
IV.   RETINA: Long-term follow-up of chronic Lyme neuroretinitis
V.    J CLIN MICROBIOL: Persistence of Borrelia burgdorferi in
      experimentally infected dogs after antibiotic treatment
VI.   LYMENET: Members of Congress Send Lyme Message to NIH
      Director
VII.  About The LymeNet Newsletter


Newsletter:

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IDX#                Volume 5 / Number 05 / 05-MAY-97
IDX#                            INDEX
IDX#
IDX#  I.    LDRC: Emerging Tick-Borne Diseases in the Western United
IDX#        States Conference September 13
IDX#  II.   INFECTION: Borrelia burgdorferi DNA in the urine of treated
IDX#        patients with chronic Lyme disease symptoms. A PCR study of
IDX#        97 cases
IDX#  III.  J OROFAC PAIN: Lyme disease: considerations for dentistry
IDX#  IV.   RETINA: Long-term follow-up of chronic Lyme neuroretinitis
IDX#  V.    J CLIN MICROBIOL: Persistence of Borrelia burgdorferi in
IDX#        experimentally infected dogs after antibiotic treatment
IDX#  VI.   LYMENET: Members of Congress Send Lyme Message to NIH
IDX#        Director
IDX#  VII.  About The LymeNet Newsletter
IDX#



I.    LDRC: Emerging Tick-Borne Diseases in the Western United States
     Conference September 13
---------------------------------------------------------------------
Sender: The Lyme Disease Resource Center


A day-long conference featuring the ecology, diagnosis and treatment of
the latest emerging tick-borne diseases, ehrlichiosis and babesiosis,
as well as Lyme disease.  The conference will be held at the Vector
Control Conference Center in Culver City, five miles from the Los
Angeles airport.  The fee for the conference is US $125.00.  CME credit
is being arranged.  For more information, please contact Dr. James
Katzel at 707-462-1097 or Rene Landis <Reeeneee@aol.com> at
702-256-9776.



=====*=====


II.   INFECTION: Borrelia burgdorferi DNA in the urine of treated
     patients with chronic Lyme disease symptoms. A PCR study of 97
     cases
--------------------------------------------------------------------
AUTHORS: Bayer ME, Zhang L, Bayer MH
ORGANIZATION: Fox Chase Cancer Center, Philadelphia, PA 19111
REFERENCE: Infection 1996 Sep-Oct;24(5):347-53
ABSTRACT:


The presence of Borrelia burgdorferi DNA was established by PCR from
urine samples of 97 patients clinically diagnosed as presenting with
symptoms of chronic Lyme disease. All patients had shown erythema
chronica migrans following a deer tick bite.  Most of the patients
had been antibiotic-treated for extended periods of time.  We used
three sets of primer pairs with DNA sequences for the gene coding of
outer surface protein A (OspA) and of a genomic sequence of B.
burgdorferi to study samples of physician-referred patients from the
mideastern USA.  Controls from 62 healthy volunteers of the same
geographic areas were routinely carried through the procedures in
parallel with patients' samples.  Of the 97 patients, 72 (74.2%) were
found with positive PCR and the rest with negative PCR.  The 62
healthy volunteers were PCR negative.  It is proposed that a sizeable
group of patients diagnosed on clinical grounds as having chronic Lyme
disease may still excrete Borrelia DNA, and may do so in spite of

intensive antibiotic treatment.


=====*=====


III.  J OROFAC PAIN: Lyme disease: considerations for dentistry
---------------------------------------------------------------
AUTHORS: Heir GM, Fein LA
ORGANIZATION: TMD and Orofacial Pain Center, University of Medicine
             and Dentistry, New Jersey Dental School, Newark, NJ.
REFERENCE: J Orofac Pain 1996 Winter;10(1):74-86
ABSTRACT:


Although Lyme disease has spread rapidly and it is difficult to
diagnose, a review of the dental literature does not reveal many
references to this illness.  Dental practitioners must be aware of the
systemic effects of this often multiorgan disorder.  Its clinical
manifestations may include facial and dental pain, facial nerve palsy,
headache, temporomandibular joint pain, and masticatory muscle pain.
The effects precipitated when performing dental procedures on a
patient with Lyme disease must also be considered.  This study
discusses the epidemiology and diagnosis of Lyme disease, its
prevention, and factors to consider when making a differential
diagnosis.  Dental care of the patient with Lyme disease and currently
available treatments also are considered.  Three case reports are
presented.



=====*=====


IV.   RETINA: Long-term follow-up of chronic Lyme neuroretinitis
----------------------------------------------------------------
AUTHORS: Karma A, Stenborg T, Summanen P, Immonen I, Mikkila H,
        Seppala I
ORGANIZATION: Department of Ophthalmology, University of Helsinki,
             Finland.
REFERENCE: Retina 1996;16(6):505-9
ABSTRACT:


PURPOSE: The authors report sequential fluorescein angiographic and
color photographic findings of the fundi and response to treatment in
a patient with chronic Lyme neuroretinitis.
METHODS: A Lyme enzyme-linked immunosorbent assay with purified 41-kd
flagellin as antigen was used to detect immunoglobulin G and
immunoglobulin M antibodies to Borrelia burgdorferi in serum,
cerebrospinal fluid, and vitreous.  The changes were documented by
fluorescein angiography and color photography tests performed during a
5 1/2 year follow-up.
RESULTS: The diagnosis of Lyme neuroretinitis was based on the history
of erythema migrans and positive Lyme enzyme-linked immunosorbent
assay tests from cerebrospinal fluid and vitreous and by the exclusion
of other infectious and systemic diseases and uveitis entities.
Fluorescein angiography results disclosed bilateral chronic neuroretinal
edema with areas of cystoid, patchy, and diffuse hyperfluorescence
peripapillary and in the macular areas. The hyperfluorescent lesions

enlarged despite a 9-month period of antibiotic therapy.
CONCLUSION: Lyme borreliosis may cause neuroretinitis with unusual
angiographic findings. Chronic Lyme neuroretinitis may be unresponsive
to antibiotic therapy.



=====*=====


V.    J CLIN MICROBIOL: Persistence of Borrelia burgdorferi in
     experimentally infected dogs after antibiotic treatment
--------------------------------------------------------------
AUTHORS: Straubinger RK, Summers BA, Chang YF, Appel MJ
ORGANIZATION: James A. Baker Institute for Animal Health, College of
             Veterinary Medicine, Cornell University, Ithaca, New York
             14853. <rks4@cornell.edu>
REFERENCE: J Clin Microbiol 1997 Jan;35(1):111-6
ABSTRACT:


In specific-pathogen-free dogs experimentally infected with Borrelia
burgdorferi by tick exposure, treatment with high doses of amoxicillin
or doxycycline for 30 days diminished but failed to eliminate
persistent infection.  Although joint disease was prevented or cured
in five of five amoxicillin- and five of six doxycycline-treated dogs,
skin punch biopsies and multiple tissues from necropsy samples
remained PCR positive and B. burgdorferi was isolated from one
amoxicillin- and two doxycycline-treated dogs following antibiotic
treatment.  In contrast, B. burgdorferi was isolated from six of six
untreated infected control dogs and joint lesions were found in four of
these six dogs.  Serum antibody levels to B. burgdorferi in all dogs
declined after antibiotic treatment.  Negative antibody levels were
reached in four of six doxycycline- and four of six amoxicillin-
treated dogs.  However, in dogs that were kept in isolation for 6
months after antibiotic treatment was discontinued, antibody levels

began to rise again, presumably in response to proliferation of the
surviving pool of spirochetes.  Antibody levels in untreated infected
control dogs remained high.



=====*=====


VI.   LYMENET: Members of Congress Send Lyme Message to NIH Director
--------------------------------------------------------------------
[Editor's Note: The following letter was sent to NIH Director Harold
Varmus this month by two Members of Congress]


Dr. Harold E. Varmus, Director
National Institute of Health
9000 Rockville Pike
NIHB-1, Room 126
MSC 0148
Bethesda, MD 20892


Dear Dr. Varmus,

       We are writing to urge you to make research on Lyme Disease a
priority during fiscal years 1997 and 1998, including the development
of a new and innovative direct detection laboratory test for Lyme.
       
       We also want to thank you for responding to the needs of those
suffering from the long term consequences of acute and chronic Lyme
disease, as evidenced by the current NIH intramural study of suitable
markers of disease activity and the NIH-funded extramural study of
treatment issues in chronic Lyme Disease, as well as the ongoing
research conducted by the Rocky Mountain Laboratories of NIH into the
Characteristics of the causative organism. All of these must continue.


       As NIH advances a careful balance between both intramural and
extramural programs for Lyme Disease, we urge you to adopt the
following as research priorities;


                 1.  Direct detection tests
                 2.  Chronic Lyme Disease treatment
                 3.  Neuropsychiatric manifestations of Lyme Disease
                 4.  Pathology and pathogenesis


      Direct detection tests; While acknowledging the important work
NIH has funded in the area of direct testing, there is no universally
acknowledged direct detection laboratory test for Lyme. As a result,
it is clear to patients that the lack of reliable testing for diagnosis
and cure is the single largest hindrance to proper diagnosis, treatment,
and scientific inquiry. It also causes patients to endure years of
worsening symptoms before receiving proper treatment because many
existing tests -- such as Western blot analysis -- often yield false
positive and false negative results.


      Equally important, the lack of reliable testing leads to many
conflicts between patients and insurance companies over antibiotic
treatment coverage -- with patients on the losing side.  Despite the
lack of conclusive scientific evidence that 28 days of treatment is
curative, many (if not most) insurance carriers deny coverage for
Lyme treatment: in New Jersey alone, according to patient advocacy
groups, some 30 percent of all Lyme cases are denied coverage initially,
and nearly 80 percent are denied coverage after 28 days.


      We firmly believe that before legislators consider mandated
insurance coverage periods, we need to develop better laboratory tests
so that physicians can differentiate between Lyme Disease,
co-infections, and other conditions.


      Chronic Lyme Disease treatment; Building upon the research being
conducted intramurally and extramurally, NIH needs to aggressively
encourage the development of many different treatment modalities, both
antimicrobial and immunological.  Any Program Announcements or Requests
for Proposal should explicitly recognize the importance of enlisting
the cooperation of physicians and patient groups in the studies,
including the formation of advisory groups which include practicing
physicians and patients.  


      Neuropsychiatric manifestations of Lyme Disease:   As the
disease is increasingly defined by its neurological effects, it is
becoming clear that neuropsychiatric manifestations are some of the
most disabling and troubling symptoms faced by patients.  Again, the
lack of reliable testing for Lyme often results in neuropsychiatric
symptoms being misdiagnosed.  In the case of children, this impact is
most often noticed by their patents and teachers, and the toll of Lyme
in terms of lost potential has been substantial.


      Pathology and pathogenesis:   Every practicing physician
involved in treating chronic patients is stymied by the lack of
pathology resources to aid in their diagnosis and understanding of
Lyme Disease.  Tissue and fluid samples have been stored for years in
local practices.  In addition, the pathogenesis of Lyme Disease is
poorly understood.


      We thank you for your thoughtful consideration to our
constituents' requests and wish to reiterate that we are committed to
working with you to ensure that NIH's important work in the area of
Lyme Disease continues.
                                               Sincerely,


     CHRISTOPHER H. SMITH, M.C.        BENJAMIN A. GILMAN, M.C.

CC:  Dr. John R. LaMontagne, Director
    Div. of Microbiology and Infectious Diseases, NIAID



=====*=====


VII.  ABOUT THE LYMENET NEWSLETTER
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         The Lyme Disease Network of New Jersey
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