LymeNet Home Page LymeNet Flash Discussion LymeNet Support Group Database LymeNet Literature Library LymeNet Legal Resources LymeNet Medical & Scientific Abstract Database LymeNet Newsletter Home Page LymeNet Recommended Books LymeNet Tick Pictures Search The LymeNet Site LymeNet Links LymeNet Frequently Asked Questions About The Lyme Disease Network LymeNet Newsletter Volume 7 Issue 11 LymeNet Home Page LymeNet Flash Discussion LymeNet Support Group Database LymeNet Literature Library LymeNet Legal Resources LymeNet Medical & Scientific Abstract Database LymeNet Newsletter Home Page LymeNet Recommended Books LymeNet Pictures Search The LymeNet Site LymeNet Links LymeNet Frequently Asked Questions About The Lyme Disease Network LymeNet Home LymeNet Newsletter Library

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



=====*=====


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



=====*=====
 


II.   LYME ALLIANCE: Honoring Of Allen Steere, M.D., As "Astute
     Clinician" Protested at NIH
---------------------------------------------------------------
Sender: Rita L. Stanley, Ph.D. <ritastan@worldnet.att.net>
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



=====*=====


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. jarmo.oksi@utu.fi
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.



=====*=====


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.



=====*=====


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.



=====*=====


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:
                   listserv@lehigh.edu
On the first line of the message, write:  unsub lymenet-l
-----------------------------------------------------------------------
LymeNet - The Internet Lyme Disease Information Source
-----------------------------------------------------------------------
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
-----------------------------------------------------------------------
WHEN COMMENTS ARE PRESENTED WITH AN ATTRIBUTION, THEY DO NOT
NECESSARILY REPRESENT THE OPINIONS/ANALYSES OF THE EDITORS.
-----------------------------------------------------------------------
THIS NEWSLETTER MAY BE REPRODUCED AND/OR POSTED ON BULLETIN BOARDS
FREELY AS LONG AS IT IS NOT MODIFIED OR ABRIDGED IN ANY WAY.
-----------------------------------------------------------------------
SEND ALL BUG REPORTS TO a229@Lehigh.EDU
-----------------------------------------------------------------------


Home | Flash Discussion | Support Groups | On-Line Library
Legal Resources | Medical Abstracts | Newsletter | Books
Pictures | Site Search | Links | Help/Questions
About LymeNet


© 1994-1999 The Lyme Disease Network of New Jersey, Inc.
All Rights Reserved.
Use of the LymeNet Site is subject to the Terms of Use.