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Volume: 3
Issue: 14
Date: 07-Sep-95


Table of Contents:

I.    LYMENET: Protest March at NJ Board of Medical Examiners
II.   Q&A: Suspected CNS Relapsing fever in Israel (Q)
III.  MMWR: Recommendations on Lyme Serology
VI.   Q&A: WA resident seeks advice (Q)
V.    LYMENET: New Technique for Removal of Ticks
VI.   About The LymeNet Newsletter


Newsletter:

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*                  The National Lyme Disease Network                  *
*                         LymeNet Newsletter                          *
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IDX#                Volume 3 - Number 14 - 9/07/95
IDX#                            INDEX
IDX#
IDX#  I.    LYMENET: Protest March at NJ Board of Medical Examiners
IDX#  II.   Q&A: Suspected CNS Relapsing fever in Israel (Q)
IDX#  III.  MMWR: Recommendations on Lyme Serology
IDX#  VI.   Q&A: WA resident seeks advice (Q)
IDX#  V.    LYMENET: New Technique for Removal of Ticks
IDX#  VI.   About The LymeNet Newsletter
IDX#


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I.    LYMENET: Protest March at NJ Board of Medical Examiners Oct.11
--------------------------------------------------------------------
Sender: Gary M. Heir, DMD <heirgm@UMDNJ.EDU>


"TICK BITE FIGHT"

Join a rally in Trenton to promote awareness and express our concerns
to the New Jersey Board of Medical Examiners.  Meet in front of their
offices at 140 E. Front Street October 11, 3:30pm.  
[For directions only, call 609-826-7100 -- press #7]
Our voices and opinions must be heard...Your banners and posters are
welcome.  Please join us and together we will make a difference!


For further information call Barbara Brennan at 908-879-5331.


=====*=====


II.   Q&A: Suspected CNS Relapsing fever in Israel (Q)
------------------------------------------------------
Sender: David Raveh, MD <RAVEH@md2.huji.ac.il>


I would like to ask the assistance of the LYME Internet group about a
case of suspected long term CNS complications of relapsing fever.
The patient is now 23 years old.  Three years ago he entered a cave
in Israel and a week later developed four attacks of relapsing fever.
In the forth attack he was diagnosed and treated for borreliosis
(in Israel usually B. persica).  After recovery he started
complaining about a deterioration in the physical and the intellectual
abilities.  Routine blood, brain CT and neurological exams were OK.
Now he came to my clinic with the same story of gradual decrease in
those aspects.  Physical, neurological exams were OK.  MRI showed
multiple small lesions, perivnetricular, postrior-parietal.  The MRI
DD was a demyelination process etc.


I have searched the literature, and I would like to prove/exclude if
possible the exquisitely rare option of CNS borreliosis (we do not
have in Israel Lyme at all).  I plan to do LP and give him six weeks
of ceftriaxone, then repeat the MRI and possibly repeat LP (provided
that the first LP will be meaningful).  Could anyone comment on
this case?



=====*=====


III.  MMWR: Recommendations on Lyme Serology
--------------------------------------------


Recommendations for Test Performance and Interpretation from the
Second National Conference on Serologic Diagnosis of Lyme Disease
=================================================================
     SOURCE: MMWR 44(31);590-591   DATE: Aug 11, 1995


    The Association of State and Territorial Public Health
Laboratory Directors, CDC, the Food and Drug Administration, the
National Institutes of Health, the Council of State and Territorial
Epidemiologists, and the National Committee for Clinical Laboratory
Standards cosponsored the Second National Conference on Serologic
Diagnosis of Lyme Disease held October 27-29, 1994. Conference
recommendations were grouped into four categories: 1) serologic
test performance and interpretation, 2) quality-assurance
practices, 3) new test evaluation and clearance, and 4)
communication of developments in Lyme disease (LD) testing. This
report presents recommendations for serologic test performance and
interpretation, which included substantial changes in the
recommended tests and their interpretation for the serodiagnosis of
LD.
    A two-test approach for active disease and for previous
infection using a sensitive enzyme immunoassay (EIA) or
immunofluorescent assay (IFA) followed by a Western immunoblot was
the algorithm of choice. All specimens positive or equivocal by a

sensitive EIA or IFA should be tested by a standardized Western
immunoblot. Specimens negative by a sensitive EIA or IFA need not
be tested further. When Western immunoblot is used during the first
4 weeks of disease onset (early LD), both immuno- globulin M (IgM)
and immunoglobulin G (IgG) procedures should be performed. A
positive IgM test result alone is not recommended for use in
determining active disease in persons with illness greater than 1
month's duration because the likelihood of a false-positive test
result for a current infection is high for these persons. If a
patient with suspected early LD has a negative serology, serologic
evidence of infection is best obtained by testing of paired acute-
and convalescent-phase serum samples. Serum samples from persons
with disseminated or late-stage LD almost always have a strong IgG
response to Borrelia burgdorferi antigens.
    It was recommended that an IgM immunoblot be considered
positive if two of the following three bands are present: 24 kDa
(OspC) * , 39 kDa (BmpA), and 41 kDa (Fla) (1). It was further

recommended that an that IgG immunoblot be considered positive if
five of the following 10 bands are present: 18 kDa, 21 kDa (OspC) *,
28 kDa, 30 kDa, 39 kDa (BmpA), 41 kDa (Fla), 45 kDa, 58 kDa (not
GroEL), 66 kDa, and 93 kDa (2).
    The details of both plenary sessions and the work group
deliberations are included in the publication of the proceedings,
which is available from the Association of State and Territorial
Public Health Laboratory Directors; telephone (202) 822-5227.


References
1. Engstrom SM, Shoop E, Johnson RC. Immunoblot interpretation
criteria for serodiagnosis of early Lyme disease. J Clin Microbiol
1995;33:419-22.
2. Dressler F, Whelan JA, Reinhart BN, Steere AC. Western blotting
in the serodiagnosis of Lyme disease. J Infect Dis 1993;167:392-400.


* The apparent molecular mass of OspC is dependent on the strain of
B. burgdorferi being tested. The 24 kDa and 21 kDa proteins
referred to are the same.



=====*=====


VI.   Q&A: WA resident seeks advice (Q)
------------------------------------------------------------
Sender: Christina Anagnost <anagnost@orcapaktcm.wr.usgs.gov>


I was bitten by a tick in southeastern Ohio (Lake Vesuivus) and
developed fever, chills, and swollen lymph glands 10 days after
infection.  I was treated for 10 days with Erthromycin.  The
antibiotic worked very slowly and I was taken off the medication
because the doctor assumed that I was "cured," even though I still
had symptoms (slightly swollen lymph glands) that the doctor could
not verify.  A couple weeks later, I developed severe symptoms again,
and was placed on Erthromycin again.  The doctor withdrew medication
after 10 more days of treatment, even though I was feeling
symptomatic.  The illness returned, and I went to another doctor.  
The doctor placed me on Tetracycline, which seemed to have a much
more immediate effect on my symptoms.  However, this medication was
withdrawn before my symptoms completely disappeared, and I have
been having recurrences ever since (swollen painful lymph glands on
the same side of my neck as the tick bite).  I have also developed
cardiac problems and shortness of breath.  Although I have been to

several doctors since, I cannot seem to find a physician who will take
my symptoms seriously.  "You had enough antibiotic therapy to cure the
illness" is what they usually say.


I am looking for a good infectious disease physician in the Tacoma-
Seattle, WA area who would be an expert on Lyme's Disease/human
granuloctic ehrlichiosis (HGE).  



=====*=====


V.    LYMENET: New Technique for Removal of Ticks
-------------------------------------------------
Sender: Marilyn Powers <Hutschool@aol.com>


The U.S. Patent Office has allowed for issuance as a patent a new,
innovative method for removing ticks utilizing low pressure carbon
dioxide.  This method easily removes embedded ticks by taking
advantage of their sensitivity to carbon dioxide.  It has
applications for both animal and human use.  This patent will soon
be available for licensing in both the U.S. and abroad.



=====*=====


VI.   ABOUT THE LYMENET NEWSLETTER
-----------------------------------
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