LymeNet Newsletter Volume 3 Issue 05

Volume: 3
Issue: 05
Date: 03-Apr-95

Table of Contents:

I. Q&A: Experience with Timentin or Cefpodoxime in LD? (A) II. Q&A: Antibiotics for Thrombocytopenia Patients (Q) III. Q&A: Swelling Associated with LD Treatment (Q) IV. AM J OPHTHALMOL: Diagnosis and clinical characteristics of ocular Lyme borreliosis V. NEUROLOGY: Inoculation of nonhuman primates with the N40 strain of Borrelia burgdorferi leads to a model of Lyme neuroborreliosis faithful to the human disease VI. About The LymeNet Newsletter

Newsletter:

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

IDX# Volume 3 - Number 05 - 4/03/95 IDX# INDEX IDX# IDX# I. Q&A: Experience with Timentin or Cefpodoxime in LD? (A) IDX# II. Q&A: Antibiotics for Thrombocytopenia Patients (Q) IDX# III. Q&A: Swelling Associated with LD Treatment (Q) IDX# IV. AM J OPHTHALMOL: Diagnosis and clinical characteristics IDX# of ocular Lyme borreliosis IDX# V. NEUROLOGY: Inoculation of nonhuman primates with the N40 IDX# strain of Borrelia burgdorferi leads to a model of IDX# Lyme neuroborreliosis faithful to the human disease IDX# VI. About The LymeNet Newsletter IDX#

QUOTE OF THE WEEK:

"Ocular Lyme borreliosis was diagnosed in ten patients on the basis of medical history, clinical findings, and serologic test results... Four of the five patients with borderline or negative results by ELISA had a positive result by western blot analysis. "

-- Karma et al. (see Section IV)

I. Q&A: Experience with Timentin or Cefpodoxime in LD? (A) ------------------------------------------------------------- Sender: Doris Aaronson <[email protected]>

My understanding is that there was a recent US conference of physicians at which cefpodoxime (vantin) was recommended. Based on that a friend in Conn. was switched onto it, and also I will be starting that in a couple of weeks. Both of us will be on the following schedule:

day 1: zithromax 500 mg day 2: zithromax 250 mg day 3: zithromax 250 mg day 4: nothing day 5: 250 mg vantin + 500 mg probenecid (which affects the kidneys in ways to keep the vantin in your body longer) day 6: 250 mg vantin + 500 mg probenecid day 7: 250 mg vantin + 500 mg probenecid

Then start all over again.

Be sure to read the information in the Physician's Desk Reference (or the drug manufacturer's package insert -- which you can often get from your local pharmacist) as all 3 of the above drugs have lots of side effects, some of which can be bad (e.g., the probenecid can cause kidney stones). As with all other antibiotics, you should take at least 3 acidophilus pills a day to restore your gut bacteria that the antibiotics wipe out, causing nausea & diarrhea, and sometimes very serious problems of fungus and yeast overgrowth in your intestines because the normal gut bacteria aren't around to control other bad micro-organisms.

If you obtain some useful information on vantin, I'd be interested. My doctor said that he had used it in the hospital for other types of rare infections. He thinks that the primary reason that doctors are now thinking about it for Lyme is that it is new, and so the Lyme bacteria would be less likely to have developed drug resistance to it.

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II. Q&A: Antibiotics for Thrombocytopenia Patients (Q) -------------------------------------------------------- Sender: Jerry am Ende <[email protected]>

Our son has just displayed a bullseye rash. His pediatrician has placed him on antibiotics because she thinks this could be Lyme disease. Now, here's the complication... Chris has genetic thrombocytopenia where he is not producing platelets in normal quantities (platelet counts run in the 20,000-30,000/ul range). I've read that ticks can also carry diseases that cause a thrombocytopenic condition - can't remember the name of the disease(s). In any case, Chris cannot afford to have any platelets consumed. I'd like to alert his pediatrician and hematologist to look for (and treat??) for certain things, but I need some advice regarding
what to tell them.

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III. Q&A: Swelling Associated with LD Treatment (Q) ---------------------------------------------------- Sender: Suzanne Colter <[email protected]>

I am a support group founder/leader for north and central Missouri - the Green Hills Lyme Disease Support Group. This covers a 5 county area. We have seen several cases of Lyme Disease in this area. Among all of the cases - the symptoms have been fairly comparable, especially neurological symptoms.

However, recently we seeing an unusual symptom afflicting two Lyme patients - that I am unfamiliar with and have not seen anything published on this particular condition. It even has our doctors puzzled.

This condition starts out with swelling around the face, neck, throat, and chest areas... then "travels" down into the upper legs - above the knees. Over a period of a few days to a few weeks - the swelling continues until it has effected the whole body with the exception of the hands and feet. This appears as a form of bloating.

Now, granted, I have read and am familiar with sporadic swelling and swelling in isolated areas of the body. This usually "comes and goes" as with most other Lyme symptoms. But for this to effect and encompass the entire body except for the hands and feet is new to me and our physicians. These two patients were on different oral antibiotics and different medications. So, this can not be attributed to a drug interaction, and a form of allergy has been ruled out. Also, this swelling or bloating does fluctuate in intensity from hour to hour, day to day... but both patients have had this for 2 months, now.

In both cases, the swelling of the throat - has caused incidents of associated swelling around the wind pipe, causing difficulty with breathing. On one occasion it was necessary to have a breathing tube inserted to assist with breathing. Also, some swelling around the heart is suspected and in both patients - their blood pressure has notably increased since the onset of this swelling.

To treat this swelling and the associated problems, especially when the swelling produced breathing difficulty - injections of steroids have been administered, or by IV when they were hospitalized. This seemed to help when first introduced. However, subsequent treatments of these steroids did not provide relief from these symptoms.

My question is if anyone has experienced or is familiar with this type of swelling described above? Any contributions or comments are welcome. I would appreciate any feedback, comments, or recommendations from any physicians.

--

Please send responses to these questions to: [email protected]

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IV. AM J OPHTHALMOL: Diagnosis and clinical characteristics of ocular Lyme borreliosis ---------------------------------------------------------------- AUTHORS: Karma A, Seppala I, Mikkila H, Kaakkola S, Viljanen M, Tarkkanen A ORGANIZATION: Department of Ophthalmology, University of Helsinki REFERENCE: Am J Ophthalmol 1995 Feb;119(2):127-35 ABSTRACT:

PURPOSE: To establish a diagnosis, in a group of patients we studied the characteristics of ocular Lyme borreliosis. METHODS: During a two-year period, 236 patients with prolonged external ocular inflammation, uveitis, retinitis, optic neuritis, or unexplained neuro-ophthalmic symptoms were examined for Lyme borreliosis. Antibodies to Borrelia burgdorferi were measured by indirect ELISA and western blot. Cerebrospinal fluid was also analyzed by polymerase chain reaction. RESULTS: Ocular Lyme borreliosis was diagnosed in ten patients on the basis of medical history, clinical findings, and serologic test results. Results of ELISA disclosed that five patients were seropositive, two patients showed borderline reactivity, and three patients were seronegative. Four of the five patients with borderline or negative results by ELISA had a positive result by western blot analysis. In one seropositive patient, polymerase chain reaction verified a gene of B. burgdorferi endoflagellin from the vitreous and
cerebrospinal fluid specimen. In five of the six patients with known onset of the Borrelia infection, the ocular disorder appeared as a late manifestation. Abnormalities of the posterior segment of the eye, such as vitreitis, retinal vasculitis, neuroretinitis, choroiditis, and optic neuropathy were seen in six patients. Bilateral paralytic mydriasis, interstitial keratitis, episcleritis, and anterior uveitis were seen in one patient each. CONCLUSIONS: Late-phase ocular Lyme borreliosis is probably underdiagnosed because of weak seropositivity or seronegativity in ELISA assays. Ocular borrelial manifestations show characteristics resembling those seen in syphilis.

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V. NEUROLOGY: Inoculation of nonhuman primates with the N40 strain of Borrelia burgdorferi leads to a model of Lyme neuroborreliosis faithful to the human disease -------------------------------------------------------------- AUTHORS: Pachner AR, Delaney E, O'Neill T, Major E ORGANIZATION: Department of Neurology, Georgetown University Medical Center, Washington, DC REFERENCE: Neurology 1995 Jan;45(1):165-72 ABSTRACT:

We injected rhesus macaques with a highly infective strain of Borrelia burgdorferi to assess whether experimentally inoculated nonhuman primates (NHPs) could serve as models of human Lyme neuroborreliosis (LNB). The animals developed biopsy-confirmed erythema migrans in the area of the inoculations. ELISA testing of sera revealed strong antibody reactivity to B burgdorferi antigens, and Western blotting showed that 16-, 22-, 31-, 34-, and 41-kd proteins of the spirochete were major antigens recognized by antibody. Culture and polymerase chain reaction (PCR) testing of serial CSF specimens revealed that chronic infection of the CNS occurred in all NHPs injected. CSF pleocytosis occurred concurrently with CNS infection. Brain MRI revealed intense meningeal inflammation in one NHP as manifested by gadolinium uptake by the dura at the base of the temporal lobes. All animals had measurable antibody in the CSF after invasion. These studies are the first to demonstrate that experimental LNB in NHPs is a reliable
model faithful to the human disease, with spirochetal invasion of the subarachnoid space. This also is the first report of CSF samples positive by culture in experimental LNB. Inflammation in the CNS as manifested by CSF pleocytosis and MRI findings was also correlated with the presence of spirochetal DNA detected by PCR. These data support the hypothesis that the pathogenesis of LNB is associated with direct spirochetal invasion, and provide evidence that CNS involvement is more common than heretofore thought.

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