LymeNet Newsletter Volume 7 Issue 11

Volume: 7
Issue: 11
Date: 22-Nov-99

Table of Contents:

I. REUTERS: New type of Lyme disease found in southeastern US II. LYME ALLIANCE: Honoring Of Allen Steere, M.D., As "Astute Clinician" Protested at NIH III. ANN MED: Borrelia burgdorferi detected by culture and PCR in clinical relapse of disseminated Lyme borreliosis. IV. ZENTRALBL BAKTERIOL: Persistence of Borrelia garinii and Borrelia afzelii in patients with Lyme arthritis. V. EUR J CLIN MICROBIOL INFECT DIS: Evidence-based diagnosis of Lyme disease. VI. ABOUT THE LYMENET NEWSLETTER

Newsletter:

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

Volume 7 / Number 11 / 22-NOV-1999 INDEX

I. REUTERS: New type of Lyme disease found in southeastern US II. LYME ALLIANCE: Honoring Of Allen Steere, M.D., As "Astute Clinician" Protested at NIH III. ANN MED: Borrelia burgdorferi detected by culture and PCR in clinical relapse of disseminated Lyme borreliosis. IV. ZENTRALBL BAKTERIOL: Persistence of Borrelia garinii and Borrelia afzelii in patients with Lyme arthritis. V. EUR J CLIN MICROBIOL INFECT DIS: Evidence-based diagnosis of Lyme disease. VI. ABOUT THE LYMENET NEWSLETTER

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I. REUTERS: New type of Lyme disease found in southeastern US ----------------------------------------------------------------

NEW YORK, Nov 19 (Reuters Health) -- New research suggests that Georgia, South Carolina, and possibly other states in the Southeast may be beset by their own type of Lyme disease.

"There is some type of tick-transmitted illness here that acts like Lyme disease but only fits the laboratory pattern 30% of the time," lead researcher Dr. Michael W. Felz said in a statement released by the Medical College of Georgia in Augusta.

"In other words," he explained, "we may need a whole new testing system for this illness in the Southeast."

Lyme disease is caused by a bite from a deer tick, which transmits bacteria known as Borrelia burgdorferi. The first sign of infection is an enlarging red, circular "bull's-eye" rash. In studying 23 adults who consulted a doctor about the telltale rash, Felz and his colleagues discovered that 70% of the patients tested negative for Borrelia burgdorferi infection.

Furthermore, even in the 30% of study participants who did test positive, the DNA of the bacteria was different from what the experts expected to see. The bacteria seem to be genetically variant strains of Borrelia burgdorferi, the researchers report in the November issue of Archives of Dermatology.

As Felz explained in the statement, "the tick species transmitting this illness seems to be different and may be transmitting an organism that is very different." Also, none of the patients in the study progressed to the second stage of Lyme disease, which can include symptoms such as muscle paralysis, joint inflammation, and heart rhythm disorders.

The newly identified strain of Borrelia burgdorferi may be less toxic than the strain that is common in Northeast and the Midwest, the authors conclude. They speculate that the infection it causes might be more responsive to treatment with antibiotics.

SOURCE: Archives of Dermatology 1999;135:1317-1326. http://archderm.ama-assn.org/issues/v135n11/full/dst9036.html

A related editorial in the same issue can be found at: http://archderm.ama-assn.org/issues/v135n11/full/ded9012.html

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II. LYME ALLIANCE: Honoring Of Allen Steere, M.D., As "Astute Clinician" Protested at NIH --------------------------------------------------------------- Sender: Rita L. Stanley, Ph.D. <[email protected]> Date: November 18, 1999

On November 3, 1999, 35 patients gathered on the outskirts of the NIH campus in Bethesda, MD, to peacefully demonstrate their outrage at the honoring of Allen Steere, M.D., being assigned "astute clinician" status. Picketing was undertaken to draw attention to this lead physician's controversial yet predominant guidelines to Lyme disease diagnosis and treatment. Protesters contended that his hypotheses are obsolete, biologically unfounded and ethically suspect, and that the results have been increasing patient tragedy and unfounded physician harassment.

Following the demonstration, patients calmly faced Steere at his honorary lecture and encompassed about 1/3 of the estimated 150 in attendance. Many went to a reception afterwards.

Patients had a series of questions prepared to ask Steere after his talk. None were addressed, and the question and answer session was abruptly terminated. Demonstrators indicated that many attending the lecture were naive to the controversies between the "overdiagnosis and overtreatment" and "underdiagnosis and undertreatment" camps and to the political influences leading to Steere's philosophical predominance.

Patients came from as far away as Michigan and Florida to draw attention to the solidarity in their community at this outrage. Organization and support was on a national scale.

Protesters used this demonstration to highlight the controversies in the Lyme arena to the public at large; and to stress that Steere's guidelines are based on historical and political directives rather than rational science, clinical experience and patient perspective.

A pre-event article by the Boston Herald can be viewed at: http://www.bostonherald.com/bostonherald/health/lyme11031999.htm

Responses (over 300) to this article can be viewed at: http://www.bostonherald.com/guestbook/mlasalandra/guestbook.html

Photos of the event are on: http://www.angelfire.com/or2/lymeprotest/index.html

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III. ANN MED: Borrelia burgdorferi detected by culture and PCR in clinical relapse of disseminated Lyme borreliosis. ------------------------------------------------------------------ AUTHORS: Oksi J, Marjamaki M, Nikoskelainen J, Viljanen MK ORGANIZATION: Department of Medicine, Turku University Central Hospital, Finland. [email protected] REFERENCE: Ann Med 1999 Jun;31(3):225-32 ABSTRACT:

A total of 165 patients with disseminated Lyme borreliosis (diagnosed in 1990-94, all seropositive except one culture-positive patient) were followed after antibiotic treatment, and 32 of them were regarded as having a clinically defined treatment failure. Of the 165 patients, 136 were tested by polymerase chain reaction (PCR) during the follow-up. PCR was positive from the plasma of 14 patients 0-30 months after discontinuation of the treatment, and 12 of these patients had a clinical relapse. In addition, Borrelia burgdorferi was cultured from the blood of three patients during the follow-up. All three patients belonged to the group with relapse, and two of them were also PCR positive. This report focuses on the 13 patients with clinical relapse and culture or PCR positivity. Eight of the patients had culture or PCR-proven initial diagnosis, the diagnosis of the remaining five patients was based on positive serology only. All 13 patients were primarily treated for more than 3 months with intravenous and/or
oral antibiotics (11 of them received intravenous ceftriaxone, nine for 2 weeks, one for 3 weeks and one for 7 weeks, followed by oral antibiotics). The treatment caused only temporary relief in the symptoms of the patients. All but one of them had negative PCR results immediately after the first treatment. The patients were retreated usually with intravenous ceftriaxone for 4-6 weeks. None of them was PCR positive after the retreatment. The response to retreatment was considered good in nine patients. We conclude that the treatment of Lyme borreliosis with appropriate antibiotics for even more than 3 months may not always eradicate the spirochete. By using PCR, it is possible to avoid unnecessary retreatment of patients with 'post-Lyme syndrome' and those with 'serological scars' remaining detectable for months or years after infection.

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IV. ZENTRALBL BAKTERIOL: Persistence of Borrelia garinii and Borrelia afzelii in patients with Lyme arthritis. ----------------------------------------------------------------------- AUTHORS: Hulinska D, Votypka J, Valesova M ORGANIZATION: National Institute of Public Health, Prague, Czech Republic. REFERENCE: Zentralbl Bakteriol 1999 Jul;289(3):301-18 ABSTRACT:

We repeatedly detected DNA of Borrelia garinii or B. afzelii and Borrelia-like structures in the blood, joint fluid or in the synovium of 10 patients with Lyme arthritis by means of the polymerase chain reaction and immunoelectron microscopy at 2-4-month intervals in the course of two years. All samples were analyzed using primers which amplified the 16S rRNA gene sequence of Borrelia burgdorferi sensu lato and nucleotide sequences for the OspA gene. No cross hybridization occurred with DNA from human cells and with DNA from other bacteria. Capture and labelling with monoclonal antibodies of aggregated antigens, membranes and flagellae were evident in the blood of 7 patients, in 4 synovial membranes and 2 synovial fluids. Borreliae were found in blood capillaries, in collagen and in clusters surrounding inflammatory cells in the synovium of patients with recurrent infections who carried IgM and IgG antibodies to OspA and to 83 kDa core protein. After significant improvement for several weeks after treatment, arthritis
recurred in six patients. Synoviocyte hyperplasia, inflammatory infiltration and concentric adventitial fibroplasia were seen in the synovium of the patients with persisting borreliae. Only two patients were infected with B. afzelii, the others with B. garinii.

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V. EUR J CLIN MICROBIOL INFECT DIS: Evidence-based diagnosis of Lyme disease. ----------------------------------------------------------------------- AUTHORS: Davidson MM, Ling CL, Chisholm SM, Wiseman AD, Joss AW, Ho-Yen DO ORGANIZATION: Microbiology Department, Raigmore Hospital NHS Trust, Inverness, UK. REFERENCE: Eur J Clin Microbiol Infect Dis 1999 Jul;18(7):484-9 ABSTRACT:

The aim of this study was to make an evidence-based comparison of four commercial enzyme immunoassays (EIAs) (Serion Classics, Sigma Diagnostics, Cambridge Biotech and ICN Diagnostics) and an in-house enzyme immunoassay (EIA) in order to select the most appropriate screening assay for diagnosis of Lyme disease. Borrelia burgdorferi sensu stricto cultured in BSK-H medium was used to develop the in-house assay. Escherichia coli antigen (0.9 mg/ml) was included in the serum diluent to reduce non-specific background. Comparison of the number of tests needed to diagnose (i.e. to indicate a positive result) and the cost per positive diagnosis for the five assays was made using a panel of 176 Western blot-characterised sera. The Cambridge Biotech and Sigma assays had the highest sensitivity but poorer specificity, whereas the Serion and ICN assays had highest specificity but poorer sensitivity. The in-house assay had average sensitivity and specificity, the number of tests needed to diagnose being 2.32 compared to 1.92 for Serion,
2.17 for ICN, 2.5 for Sigma and 2.7 for Cambridge Biotech. In a diagnostic protocol that uses an EIA as screening test, with confirmation by Western blot, a good balance of sensitivity and specificity is essential. The in-house assay was the most cost- effective (lowest cost per positive diagnosis), and is probably the best option for specialist laboratories in Europe.

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VI. ABOUT THE LYMENET NEWSLETTER ----------------------------------------------------------------------- For the most current information on LymeNet subscriptions, contributions, and other sources of information on Lyme disease, please refer to: http://newsletter.lymenet.org ----------------------------------------------------------------------- To unsubscribe from the LymeNet newsletter, send a message to: [email protected] On the first line of the message, write: unsub lymenet-l ----------------------------------------------------------------------- LymeNet - The Internet Lyme Disease Information Source ----------------------------------------------------------------------- Editor-in-Chief: Marc C. Gabriel <[email protected]> FAX (for contributions ONLY): 908-789-0028 Contributing Editors: Carl Brenner <[email protected]> John Setel O'Donnell <[email protected]> Frank Demarest <[email protected]>
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