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Volume: 7
Issue: 02
Date: 24-Feb-99


Table of Contents:

I.    LYMENET: LymeNet Vaccine Discussion Paper Now Available
II.   LDF: 12th International Conference on Lyme Disease and Other
      Spirochetal and Tick-Borne Disorders
III.  INFECT IMMUN: Killing of Borrelia burgdorferi by antibody
      elicited by OspA vaccine is inefficient in the absence of
      complement.
IV.   INFECT IMMUN: Influence of outer surface protein A antibody on
      Borrelia burgdorferi within feeding ticks.
V.    ANN INTERN MED: Comparison of culture-confirmed erythema migrans
      caused by Borrelia burgdorferi sensu stricto in New York State
      and by Borrelia afzelii in Slovenia.
VI.   PEDIATR EMERG CARE: Emergency department presentations of Lyme
      disease in children.
VII.  ABOUT THE LYMENET NEWSLETTER


Newsletter:

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


                  Volume 7 / Number 02 / 24-FEB-1999
                                INDEX


I.    LYMENET: LymeNet Vaccine Discussion Paper Now Available
II.   LDF: 12th International Conference on Lyme Disease and Other
     Spirochetal and Tick-Borne Disorders
III.  INFECT IMMUN: Killing of Borrelia burgdorferi by antibody
     elicited by OspA vaccine is inefficient in the absence of
     complement.
IV.   INFECT IMMUN: Influence of outer surface protein A antibody on
     Borrelia burgdorferi within feeding ticks.
V.    ANN INTERN MED: Comparison of culture-confirmed erythema migrans
     caused by Borrelia burgdorferi sensu stricto in New York State
     and by Borrelia afzelii in Slovenia.
VI.   PEDIATR EMERG CARE: Emergency department presentations of Lyme
     disease in children.
VII.  ABOUT THE LYMENET NEWSLETTER



=====*=====


I.    LYMENET: LymeNet Vaccine Discussion Paper Now Available
-------------------------------------------------------------
Sender: Marc C. Gabriel <a229@Lehigh.edu>


SmithKline Beecham has released their recombinant OspA Lyme disease
vaccine accompanied with an aggressive media campaign in selected
markets.  The Lyme Disease Network will not take a formal position,
for or against vaccination. However, LymeNet has developed a
discussion document reviewing the top vaccine issues.


Information for the paper was drawn primarily from the opinions
voiced at the May 1998 meeting of the FDA's Vaccine and Related
Biological Products Advisory Committee as well as the
peer-reviewed literature.  No anecdotal information was used.  
The document is available at:


http://www2.LymeNet.org/domino/file.nsf/UID/VaccinePosition


=====*=====


II.   LDF: 12th International Conference on Lyme Disease and Other
     Spirochetal and Tick-Borne Disorders
------------------------------------------------------------------
Sender: The Lyme Disease Foundation <ldftf@aol.com>


The Lyme Disease Foundation's 12th Annual Conference on Lyme Disease
and Other Spirochetal and Tick-Borne Disorders will take place on
April 9 and 10 at the Equitable Conference Center in New York City.
Details are as follows:


April 9 (Fri) & 10 (Sat), 1999
Equitable Conference Center,
New York City, USA


Jointly sponsored with The College of Physicians and Surgeons of
Columbia University and the Lyme Disease Foundation


Keynote Speaker:  
Willy Burgdorfer, PhD, MD (Hon)
Discoverer of the pathogen causing Lyme disease


The College of Physicians and Surgeons of Columbia University is
accredited by the Accreditation Council for Continuing Medical
Education (ACCME) to sponsor continuing medical education for
physicians.


The College of Physicians and Surgeons designates this educational
activity for  16 hours in Category 1 Credit towards the AMA
Physicians's Recognition Award.


Each physician should claim only those hours of credit that he/she
actually spent in the educational activity.


----------
PROGRAM COMMITTEE


Program Coordinator and Basic Sciences:  
James Miller, PhD UCLA School of Medicine


Clinical:  Sam Donta, MD Boston University School of Medicine
Clinical:  Brian Fallon, MD Columbia University College of Physicians
          and Surgeons


Posters:  Charles Pavia, PhD New York Medical College
Posters:  Ronald Schell, PhD University of Wisconsin School of Medicine


Place: Equitable Conference Center
787 Seventh Ave (51st & 52nd), New York, NY


Host Hotel:
Sheraton NY  
212-581-1000  
800-223-6500


Travel:
Huntington Hay Travel  
800-783-9783


-----------
CONFERENCE GOALS


* Recognizing the complex nature of Borrelia burgdorferi in relation to
 host response to infection and to understand the rationale for different
 approaches to diagnosis and treatment.
* Determining criteria for diagnosis and treatment of the various
 presentations of LD and other tick-borne disorders.
* Identifying various approaches to, and role of, the laboratory
 testing of LD and coinfections.
* Diagnosing neurological LD and its many complex manifestations.
* Identifying the spectrum of problems associated with the etiology of
 chronic LD, (e.g. animal models and clinical data).
* Understanding coinfections and non-Lyme disease tick-borne infections.
* Differential diagnosis of Lyme disease and other disorders commonly
 compared to Lyme disease.
* Assessing the implications of genetic diversity of the LD spirochete
 on the development of new diagnostic tests and vaccines.


------------
REGISTRATION


Online registration is available at:

http://www.lyme.org/conferences/99_announce.html


=====*=====


III.  INFECT IMMUN: Killing of Borrelia burgdorferi by antibody
     elicited by OspA vaccine is inefficient in the absence of
     complement.
---------------------------------------------------------------
AUTHORS: Nowling JM, Philipp MT
ORGANIZATION:  Department of Parasitology, Tulane Regional Primate
              Research Center, Tulane University Medical Center,
      Covington, Louisiana 70433, USA.
REFERENCE: Infect Immun 1999 Jan;67(1):443-5
ABSTRACT:


A Lyme disease vaccine, based on the Borrelia burgdorferi lipoprotein
OspA, has recently undergone phase III trials in humans. The results
of one of these trials indicate that vaccine efficacy positively
correlates with anti-OspA antibody titer. Spirochete killing within
the tick vector midgut, upon which vaccine efficacy appears to depend,
may occur chiefly via a mechanism that involves antibody alone, as it
has been reported that complement is degraded by tick saliva
decomplementing factors. We compared the in vitro killing efficiencies
of anti-OspA antibody elicited in rhesus monkeys by the OspA vaccine,
in the presence and in the absence of monkey complement. Killing in
the absence of complement was between 14 and 3,800 times less
efficient than with complement present, depending on the spirochete
strain. The relative inefficiency of the complement-independent killing
mechanism by anti-OspA antibody may explain why OspA vaccine efficacy
is critically dependent on antibody titer.



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


IV.   INFECT IMMUN: Influence of outer surface protein A antibody on
     Borrelia burgdorferi within feeding ticks.
-------------------------------------------------------------------
AUTHORS: de Silva AM, Zeidner NS, Zhang Y, Dolan MC, Piesman J
        Fikrig E
ORGANIZATION: Section of Rheumatology, Department of Internal
             Medicine, Yale University School of Medicine, New Haven,
             Connecticut 06520, USA.
REFERENCE: Infect Immun 1999 Jan;67(1):30-5
ABSTRACT:


Borrelia burgdorferi, the spirochetal agent of Lyme disease, is
transmitted by Ixodes ticks. When an infected nymphal tick feeds on a
host, the bacteria increase in number within the tick, after which
they invade the tick's salivary glands and infect the host. Antibodies
directed against outer surface protein A (OspA) of B. burgdorferi
kill spirochetes within feeding ticks and block transmission to the
host. In the studies presented here, passive antibody transfer
experiments were carried out to determine the OspA antibody titer
required to block transmission to the rodent host. OspA antibody levels
were determined by using a competitive enzyme-linked immunosorbent
assay that measured antibody binding to a protective epitope defined
by monoclonal antibody C3.78. The C3.78 OspA antibody titer (>213
microgram/ml) required to eradicate spirochetes from feeding ticks was
considerably higher than the titer (>6 microgram/ml) required to block
transmission to the host. Although spirochetes were not eradicated

from ticks at lower antibody levels, the antibodies reduced the number
of spirochetes within the feeding ticks and interfered with the ability
of spirochetes to induce ospC and invade the salivary glands of the
vector. OspA antibodies may directly interfere with the ability of B.
burgdorferi to invade the salivary glands of the vector; alternately,
OspA antibodies may lower the density of spirochetes within feeding
ticks below a critical threshold required for initiating events linked
to transmission.



=====*=====


V.    ANN INTERN MED: Comparison of culture-confirmed erythema migrans
     caused by Borrelia burgdorferi sensu stricto in New York State
     and by Borrelia afzelii in Slovenia.
----------------------------------------------------------------------
AUTHORS: Strle F, Nadelman RB, Cimperman J, Nowakowski J, Picken RN
        Schwartz I, Maraspin V, Aguero-Rosenfeld ME, Varde S,
        Lotric-Furlan S, Wormser GP
ORGANIZATION: University of Ljubljana, Slovenia.
REFERENCE: Ann Intern Med 1999 Jan 5;130(1):32-6
ABSTRACT:


BACKGROUND: The clinical manifestations of Lyme borreliosis in North
America and Europe seem to differ, but a systematic comparison has
never been done.
OBJECTIVE: To compare European and U.S. patients with culture-confirmed
erythema migrans.
DESIGN: Prospective, clinical cohort study.
SETTING: University medical centers in Westchester County, New York,
and Ljubljana, Slovenia.
PATIENTS: 119 U.S. patients with Borrelia burgdorferi sensu stricto
infection and 85 Slovenian patients with B. afzelii infection.
MEASUREMENTS: Interview, physical examination, and laboratory assays.
RESULTS: Compared with Slovenian patients, U.S. patients had erythema
migrans for a briefer duration (median duration, 4 days compared with
14 days; P < 0.001) but were more likely to have systemic symptoms
(P = 0.01), abnormal findings on physical examination (P < 0.001), and
seroreactivity (P < 0.001). Central clearing of erythema migrans
lesions was more likely in Slovenian patients (P < 0.001).
CONCLUSIONS: Erythema migrans caused by B. afzelii in Slovenia and

erythema migrans caused by B. burgdorferi in New York have distinct
clinical presentations.  Caution should be used when clinical and
laboratory experience from one side of the Atlantic is applied to
patients on the other.



=====*=====


VI.   PEDIATR EMERG CARE: Emergency department presentations of Lyme
     disease in children.
-------------------------------------------------------------------
AUTHORS: Bachman DT, Srivastava G,
ORGANIZATION: Pediatric Emergency Services, Maine Medical Center,
             Portland, USA.
REFERENCE: Pediatr Emerg Care 1998 Oct;14(5):356-61
ABSTRACT:


OBJECTIVE: To review the clinical characteristics and diagnostic
evaluation of children with Lyme disease evaluated in an emergency
department (ED) in an endemic area.
DESIGN: A retrospective review of the demographic, historical,
clinical, and laboratory data of pediatric patients with a final
diagnosis of Lyme disease.
SETTING: The pediatric ED of an urban university hospital.
PARTICIPANTS: Children with Lyme disease evaluated during the three-
year period from 1992 to 1994.
RESULTS: Twenty-nine children ranging in age from three to 19 years who
were diagnosed with Lyme disease subsequent to a visit to a pediatric
ED were identified. Four patients had early localized disease with
erythema migrans and varying degrees of systemic symptoms. Ten had
early disseminated Lyme disease, with multiple erythema migrans,
neurologic involvement (including three patients with pseudotumor
cerebri), or carditis. Fifteen cases of late Lyme disease with
arthritis were identified. Recognition of Lyme arthritis proved

particularly difficult; seven children were initially diagnosed as
having septic arthritis, six of whom underwent arthrotomy. Marked
elevations of the erythrocyte sedimentation rate and synovial fluid
white blood cell counts were observed in these patients, making it
difficult to distinguish Lyme disease from septic arthritis on the
basis of laboratory findings.
CONCLUSION: Lyme disease is an infrequent, often difficult, diagnosis
in children who present to an ED.  Early disseminated and late disease
predominate; classic erythema migrans is uncommon in the ED in
comparison with other ambulatory venues. Diagnosis of Lyme arthritis
may be difficult; exposure in an endemic area and clinical findings
may help distinguish it from septic arthritis. Overall, underdiagnosis
of Lyme disease may actually be more of a problem than overdiagnosis
in the ED setting. Recognition of Lyme disease by emergency medicine
practitioners requires familiarity with its epidemiology and its
multiple manifestations.



=====*=====


VII.  ABOUT THE LYMENET NEWSLETTER
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Editor-in-Chief: Marc C. Gabriel <a229@Lehigh.EDU>
           FAX (for contributions ONLY): 908-789-0028
Contributing Editors: Carl Brenner <cbrenner@ldeo.columbia.edu>
                     John Setel O'Donnell <jod@Equator.com>
                     Frank Demarest <76116.2065@CompuServe.com>

Advisors: Carol-Jane Stolow, Director <carol_stolow@lymenet.org>
         William S. Stolow, President <bill_stolow@lymenet.org>
         The Lyme Disease Network of New Jersey
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