LymeNet Newsletter Volume 2 Issue 13

Volume: 2
Issue: 13
Date: 08-Aug-94

Table of Contents:

I. LYMENET: Meeting with NIH Director Scheduled for Thursday II. LYMENET: CDC Grant Amounts for FY94 III. LYMENET: LDAOhio to Hold First Annual Meeting 9/24 IV. CLIN PEDIATR (PHILA): Physician beliefs, attitudes, and approaches toward Lyme disease in an endemic area V. CENT EUR J PUBLIC HEALTH: Electron microscopy and the polymerase chain reaction of spirochetes from the blood of patients with Lyme disease VI. J CLIN MICROBIOL: Isolation of Borrelia burgdorferi from biopsy specimens taken from healthy-looking skin of patients with Lyme borreliosis VII. How to Subscribe, Contribute, and Get Back Issues

Newsletter:

*********************************************************************** * The National Lyme Disease Network * * LymeNet Newsletter * ***********************************************************************

IDX# Volume 2 - Number 13 - 8/08/94 IDX# INDEX IDX# IDX# I. LYMENET: Meeting with NIH Director Scheduled for Thursday IDX# II. LYMENET: CDC Grant Amounts for FY94 IDX# III. LYMENET: LDAOhio to Hold First Annual Meeting 9/24 IDX# IV. CLIN PEDIATR (PHILA): Physician beliefs, attitudes, and IDX# approaches toward Lyme disease in an endemic area IDX# V. CENT EUR J PUBLIC HEALTH: Electron microscopy and the IDX# polymerase chain reaction of spirochetes from the blood IDX# of patients with Lyme disease IDX# VI. J CLIN MICROBIOL: Isolation of Borrelia burgdorferi from IDX# biopsy specimens taken from healthy-looking skin of IDX# patients with Lyme borreliosis IDX# VII. How to Subscribe, Contribute, and Get Back Issues IDX#

QUOTE OF THE WEEK:

"A wise man should consider that health is the greatest of human blessings, and learn how by his own thought to derive benefit from his illnesses"

-- Hippocrates, c. 460-377 B.C.

I. LYMENET: Meeting with NIH Director Scheduled for Thursday --------------------------------------------------------------- Source: LymeNet News Byline: By Marc Gabriel with reports from Carl Brenner Date: August 5, 1994

Representatives of the Lyme Disease Foundation, The American Lyme Disease Foundation, and the Lyme Disease Resource Center are scheduled to meet with Dr. Harold E. Varmus, Director of the NIH, next Thursday, August 11 at NIH headquarters in Bethesda, MD. Dr. Varmus called the meeting to discuss LD research issues with national LD organizations.

According to sources at the NIH, five individuals have been scheduled to attend the meeting as of last Friday. There is no indication at this time that a public forum will take place. LymeNet Newsletter Contributing Editor Carl Brenner is scheduled to represent the Lyme Disease Resource Center.

Lyme disease researchers, physicians, and patients are encouraged to communicate their thoughts on LD research to Dr. Varmus. Letters should contain only one or two clear points and should be as short as possible. Long letters containing many ideas are generally less effective.

Correspondence should be directed to:

Harold Varmus MD, Director National Institutes of Health Building 1 Room 126 1 Center Drive MSC 0148 Bethesda, MD 20892-0148 Voice: 301-496-2433 Fax: 301-402-2700

You may wish to copy your correspondence to:

Donna Shalala PhD Secretary of Health and Human Services Hubert H. Humphrey Building 200 Independence Av NW Washington, DC 20201

According to the NIH gopher server on the Internet, Dr. Varmus' email address is: harold_varmus%[email protected]

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II. LYMENET: CDC Grant Amounts for FY94 ----------------------------------------- Cooperative Agreements to Conduct Research, Treatment, and Education Programs on Lyme Disease in the United States Department of Health and Human Services Centers for Disease Control and Prevention

American College of Physicians (Scott) $220,000 Minnesota Department of Health (Moen) $200,000 New York Medical College (Fish) $ 90,000 New York Medical College (Wormser) $ 80,000 New York Medical College (Nadelman) $ 75,000 Mayo Clinic Foundation (Persing) $120,000 Marshfield Medical Research Education Foundation (Reed) $ 42,000 Harvard University School of Public Health (Pollack) $ 75,000 Oregon Department of Health (Hedberg) $ 60,126 West Virginia Department of Health (Haddy) $ 22,655 University of Illinois at Urbana - Champagne (Jones) $ 70,000 Georgia Southern University (Oliver) $100,000 New England Medical Center (Steere) $165,000 Connecticut Department of Public Health (Cartter) $220,000 American Lyme Disease Foundation, Inc. (Weld) $ 45,000
New Jersey Department of Health (Spitalny) $104,000 University of California - Berkeley (Lane) $100,000 Michigan Department of Public Health (Hall) $ 60,000 New York Department of Health (Bosler) $ 82,000 New York Department of Health (White) $225,000 Tulane Regional Primate Center (Philipp) $160,000 Yale University (Flavell) $140,000 State University of New York (Luft) $150,000 Lyme Disease Foundation, Inc. (Forschner) $ 75,000 Rhode Island Department of Health (Matyas) $ 70,000

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III. LYMENET: LDAOhio to Hold First Annual Meeting 9/24 -------------------------------------------------------- Sender: Jean Weisert <[email protected]> Subject: LDAOhio Conference

LDAOhio (Lyme Disease Association of Ohio) will be holding its first annual membership meeting on Saturday, 9/24/94, at St. Edward's Catholic Church in Granville Ohio from 8:30 a.m. to 3 p.m. The meeting is co-sponsored with Licking Memorial Hospital in Newark and Continuing Education Units (CEUs) will be awarded to nurses. The emphasis will be on chronic LD.

Presenters: Dr. James Katzel of Ukiah CA -- "LD 1944 State of the Art" Dr. Craig Cleveland -- "Chronic LD in Ohio" Dr. Richard Berry, Director of Ohio Dept of Health, Vector-Borne Disease Unit -- "What is Being Done, What Can Be Done, and What We Want To Do" Dr. Gawaine Banks, psychologist from Cincinnati -- "Coping With LD" Ann Graupman, parent and patient advocate from Cleveland -- "Recognizing LD in Children"

The $10 conference fee includes Continental breakfast, lunch, and refreshments. All those interested in LD are invited to attend. For more info, call 614-928-LYME or 513-748-0150 or write to LDAOhio, 27 Barton Place SE, Hebron, OH 43025. Fax inquiries to Tim Weisert, 614-349-4185. For CEU credit, contact Adele Sabol, Licking Memorial Hospital, 614-344-0331 or write to her at LMH; 1320 W. Main St; Newark, OH 43055.

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IV. CLIN PEDIATR (PHILA): Physician beliefs, attitudes, and approaches toward Lyme disease in an endemic area -------------------------------------------------------------- AUTHORS: Eppes SC, Klein JD, Caputo GM, Rose CD ORGANIZATION: Division of Pediatric Infectious Diseases, Alfred I. duPont Institute, Wilmington, Delaware 19899. REFERENCE: Clin Pediatr (Phila) 1994 Mar;33(3):130-4 ABSTRACT:

To assess the beliefs and practice habits regarding Lyme disease among practitioners, questionnaires were sent to physicians in a seven-county Lyme-endemic region. One hundred twenty-four evaluable responses were returned from 53 family physicians, 39 pediatricians, 27 internists, and five subspecialists who diagnosed three to four cases of Lyme disease per year, on average. The majority presented with erythema migrans (EM) or other early symptoms, although arthritis was the presenting sign in 16%. The enzyme-linked immunosorbent assay (ELISA) was the most frequently ordered diagnostic test, but 45% of respondents did not specify which test when ordering Lyme serology. The majority would use amoxicillin or doxycycline to treat EM in children or adults, respectively. Nearly all would use ceftriaxone for meningitis, and half would use it to treat Lyme arthritis or Bell's palsy. Physicians differed markedly in the duration of therapy they would prescribe. Eighty-three percent would treat a patient for possible Lyme disease with antibiotics
(many intravenously), even in the absence of EM or positive serology. Thirty-five percent of practitioners prescribed antibiotics for deer-tick bites. Our survey documents significant variation in approaches to Lyme disease among primary-care physicians and suggests the need for well-designed clinical trials, continuing basic research, and physician education.

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V. CENT EUR J PUBLIC HEALTH: Electron microscopy and the polymerase chain reaction of spirochetes from the blood of patients with Lyme disease ------------------------------------------------------------- AUTHORS: Hulinska D, Krausova M, Janovska D, Rohacova H Hancil J, Mailer H ORGANIZATION: Department of Electron Microscopy, National Institute of Public Health, Prague, Czech Republic REFERENCE: Cent Eur J Public Health 1993 Dec;1(2):81-5 ABSTRACT:

Results of studies using direct antigen detection suggest that seronegative Lyme borreliosis is not rare and support the hypothesis that Borrelia antigens can persist in humans. We report three successful cultures from blood out of 30 attempts from 96 Lyme disease patients. The proof of borreliaemia in early or late phases of Lyme disease by immuno-capture electron microscopy has practical importance for subsequent cultivation. The polymerase chain reaction with oligonucleotide sequences directed against 16S rRNA identified two of our blood isolates as Borrelia burgdorferi genospecies III., VS 461 group, and one as Borrelia garinii sp. nov. All of the three isolates were reactive with monoclonal antibody H9724 against flagellin and with antibody against main extracellular protein at 83 kDa. Borrelia garinii had a single predominant protein OspA at 33.5 kDa and reacted with monoclonal antibody H5332 in contrast to two isolates of the VS 461 group with two major proteins OspA and OspB at 32.5 and 35 kDa. We conclude that isolation of
spirochetes from the blood might prove successful in clinically selected cases of Lyme borreliosis. Immuno-capture electron microscopy has proved to be a sensitive assay for monitoring and studying Lyme borreliosis.

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VI. J CLIN MICROBIOL: Isolation of Borrelia burgdorferi from biopsy specimens taken from healthy-looking skin of patients with Lyme borreliosis ---------------------------------------------------------------------- AUTHORS: Kuiper H, van Dam AP, Spanjaard L, de Jongh BM, Widjojokusumo A, Ramselaar TC, Cairo I, Vos K, Dankert J ORGANIZATION: Department of Medical Microbiology, Academic Medical Centre, University Hospital, University of Amsterdam, The Netherlands REFERENCE: J Clin Microbiol 1994 Mar;32(3):715-20 ABSTRACT:

Erythematous skin lesions due to infection with Borrelia burgdorferi will often disappear without antibiotic treatment. The aim of the study was to assess whether after disappearance of the erythematous skin lesion B. burgdorferi is still present in the healthy-looking skin of untreated patients. In six patients, a skin biopsy specimen was taken at the site of a previous erythematous skin lesion 1 to 6 months after disappearance of the lesion. Four of them presented with early disseminated Lyme borreliosis. In one additional patient with early disseminated Lyme borreliosis, the site of a previous tick bite was biopsied. None of these patients had been treated with antibiotics before presentation. The cultures of the skin biopsy specimens of the seven patients showed growth of Borrelia species. By rRNA gene restriction analysis and genospecies-specific PCR, six isolates were classified as Borrelia garinii and one as Borrelia group VS461. These results show that B. burgdorferi can still be cultured from the skin after disappearance of the erythematous skin
lesion or at the site of a previous tick bite.

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