Volume: 4 Table of Contents: I. NIH: HGE Bacterium Isolated II. LDF: IX Annual International Conference on Lyme Disease III. LYMENET: State of CT Investigating Phil Watsky, MD IV. About The LymeNet Newsletter Newsletter: *********************************************************************** * The National Lyme Disease Network * * LymeNet Newsletter * *********************************************************************** IDX# Volume 4 - Number 01 - 1/30/96 IDX# INDEX IDX# IDX# I. NIH: HGE Bacterium Isolated IDX# II. LDF: IX Annual International Conference on Lyme Disease IDX# III. LYMENET: State of CT Investigating Phil Watsky, MD IDX# IV. About The LymeNet Newsletter IDX# I. NIH: HGE Bacterium Isolated --------------------------------- Sender: Greg Folkers <[email protected]> For Release: Wednesday, Jan. 24, 1996 NIAID-Supported Researchers Isolate Bacterium That Causes Potentially Deadly Tick-Borne Disease Researchers supported by the National Institute of Allergy and Infectious Diseases (NIAID) have successfully isolated the organism that causes human granulocytic ehrlichiosis (HGE), a newly recognized and sometimes fatal infection transmitted to people by ticks. Jesse L. Goodman, M.D., of the University of Minnesota and his colleagues are the first researchers to grow the yet-unnamed bacterium in laboratory cell cultures, using blood from patients with HGE. They report their findings in the Jan. 25, 1996 issue of The New England Journal of Medicine. "Little is known about the agent that causes HGE, because until recently we have been unable to grow this intracellular pathogen in the laboratory," says Dr. Goodman. "Now that this bacterium has been isolated from patients, we can develop improved diagnostic tools and treatments, as well as better understand the biology and epidemiology of this emerging infection." "As has been the case with other emerging diseases such as Lyme disease, NIAID-supported investigators have worked quickly to understand HGE, building on our long-standing investment in fundamental biomedical research," says Anthony S. Fauci, M.D., NIAID director. HGE was first described in 1994 in patients in Minnesota and Wisconsin. Subsequently, cases have been reported in California, Florida, Maryland, Massachusetts and New York. Several dozen cases have been reported in the scientific literature, but the true prevalence of the disease is probably much higher, says Dr. Goodman. HGE appears to be transmitted by deer ticks, which also can transmit Lyme disease. It has been suggested that HGE may also be transmitted by dog ticks. Physicians have observed patients infected by two or more tick-borne infections at once, which can make diagnosis and treatment decisions difficult. "A diagnosis of HGE may be missed when there is simultaneous infection with the Lyme bacterium, which usually causes a rash that is not typically seen in people with HGE," says Dr. Goodman. "In such cases, patients may receive treatment for Lyme disease such as amoxicillin that is not effective against HGE. The emergence of HGE makes it critical that physicians consider this infection in the differential diagnosis of an acute illness with fever occurring after a possible tick exposure." The HGE bacterium is closely related to bacteria of the genus Ehrlichia, including E. chaffeensis, which causes a human disease (ehrlichiosis) that is similar to HGE. Ehrlichiosis was first observed in humans in 1986, and E. chaffeensis was isolated in 1991. Other Ehrlichia cause diseases in dogs, horses, sheep and cattle. Ehrlichia grow inside of cells; the HGE bacterium grows inside immune system cells called granulocytes, while E. chaffeensis favors different immune system cells called monocytes. Signs and symptoms of both HGE and ehrlichiosis due to E. chaffeensis are similar. They include fever, chills, headaches, muscle aches, nausea and vomiting. Laboratory findings often include elevated liver enzymes, and a decrease in a patient's blood platelets and white blood cells. Both diseases typically last one to two weeks, and most patients who receive treatment recover without long-lasting complications. However, a small proportion of patients with HGE or ehrlichiosis due to E. chaffeensis may suffer more severe symptoms, such as kidney failure, respiratory problems or meningitis. The case-fatality rate for both diseases may be as high as 5 percent. Severe infections and death are most likely in older people, and in those who are not promptly treated. HGE and disease caused by E. chaffeensis are generally treated with a minimum seven-day course of tetracycline or doxycycline. Because of the rise in tick-borne infections, including Lyme disease, Rocky Mountain Spotted Fever and diseases due to Ehrlichia such as HGE, avoiding exposure to ticks is important. In an editorial in the same issue of The New England Journal of Medicine, William Schaffner, M.D., of Vanderbilt University, and Steven M. Standaert, M.D., of the Association pour l'Aide a la Medecine Preventive (France), write, "The use of insect repellents reduces the risk of infection. Other precautions that discourage the attachment and feeding of ticks, such as the wearing of light-colored clothing, long pants and long-sleeved shirts, and thorough examination of the skin after walking in the woods or fields may also be helpful." Dr. Goodman's co-authors include Curtis Nelson, B.A., Timothy J. Kurtti, Ph.D., and Ulrike G. Munderloh, D.V.M., Ph.D., of the University of Minnesota; Blaise Vitale, M.D., of the Grantsburg Clinic, Grantsburg, Wis.; John E. Madigan, D.V.M., of the University of California, Davis; and J. Stephen Dumler, M.D., of the University of Maryland School of Medicine, Baltimore. The research by Dr. Goodman and colleagues is supported as part of NIAID's comprehensive research agenda to enhance the nation's ability to detect and control emerging microbes such as HGE. The goals of this agenda are to: 1) Develop a research and training infrastructure capable of responding expeditiously to infectious disease emergencies. 2) Expand basic and applied research on ecologic and environmental factors influencing emergence. 3) Expand basic and applied research on microbial changes and adaptations influencing emergence. 4) Expand basic and applied research on host interactions with emerging pathogens. 5) Support development and testing of control strategies for specific diseases with potential for emergence. References: Goodman JL, Nelson C, Vitale B, et al. Direct cultivation of the causative agent of human granulocytic ehrlichiosis. N Engl J Med 1996;334:209-15. Schaffner W, Standaert SM. Ehrlichiosis - in pursuit of an emerging infection. N Engl J Med 1996;334:262-3. =====*===== II. LDF: IX Annual International Conference on Lyme Disease ------------------------------------------------------------- Sender: The Lyme Disease Foundation <[email protected]> CHRONIC LYME DISEASE: Basic Science & Clinical Approaches April 19 & 20, 1996 -- Wyndam Copley Plaza Hotel, Boston, MA Conference Chair: Martina Ziska, MD, Lyme Disease Foundation Conference Co-Chairs: Elizabeth Aberer, MD, University of Graz (Austria) Sam T. Donta, MD, Boston University Hospital Poster Session Chair: Jonathan A. Edlow, MD, Mount Auburn Hospital AGENDA INCLUDES: Animal Models of Chronic Lyme Disease Prevention of Lyme Disease Pathogenesis of Chronic Lyme Disease Emerging Tick-borne Diseases Laboratory Diagnosis of Chronic Lyme Disease Clinical Diagnosis of Lyme Disease Treatment of Chronic Lyme Disease For more information, contact the Lyme Disease Foundation at: (860) 525-2000 =====*===== III. LYMENET: State of CT Investigating Phil Watsky, MD -------------------------------------------------------- Sender: Cindy Onorato <[email protected]> Dr. Phil Watsky of Bristol, CT. is currently being investigated by the State of Connecticut's Department of Public Health for allegations of over-diagnosis and treatment of Lyme Disease. This investigation was initiated in 1993 based on a letter sent by Dr. Lawrence Zemel of the Newington's Children Hospital in CT. Dr. Zemel's allegations are based, by his own admission, entirely on second hand reports. Initially 2 cases were being investigated, one case was dropped. The patient in the current case never saw or spoke with Dr. Zemel and did not file any complaints with the state of CT. The patient in question is currently a patient of Dr. Watsky. Where Dr. Zemel got this patient's name and information has not been disclosed to Dr. Watsky. Dr. Zemel's letter initially charged that Dr. Watsky is over diagnosing Lyme disease, over treating Lyme Disease and profiteering from unnecessary therapies. The charge of profiteering was immediately investigated and dropped because the charge was completely and totally unfounded. Recently a compliancy hearing was held, and Dr. Wastky is awaiting a decision by the state concerning this one case that Dr. Watsky is allegedly over-treating. The consequences of a decision against Dr. Watsky could result in limiting Dr. Watsky's ability to treat Lyme disease patients. The decision is expected to be made very soon. Letters must go out by the end of January, the sooner, the better, as a decision could be made any day. He asks for your help. If you are a patient of Dr. Watsky, or know of one, or want to show your support for Dr. Watsky you can write to the head of the Department of Public Health at the following address: Stephen A. Harriman CT Health Commissioner 150 Washington Street Hartford, CT 06106 The person directly responsible for the decision, who reports to Mr. Harriman, is Donna Brewer. Her address is: Donna Brewer Department of Public Health and Addiction Services Hearing Office 750 Washington Street Hartford, CT 06106 Send a copy of your letter to: Dr. P. Watsky 61 Bradley Street Bristol, CT 06010. This action by the State of CT threatens doctor/patient relationships everywhere. If you are so inclined, you can also write to the following addresses regarding your concerns about this case: State Ethics Commission 97 Elm Rear Hartford, CT 06106 The Honorable George Gunther Chair, Public Health Comm. Legislative Office Building Hartford, CT 06106 Scott Godspeed Hospital Director Newington Children's Hospital 181 E. Cedar St Newington, CT 06111 You should also share your concerns with your state Senators & Representatives. Now is also the time to file complaints about negative experiences with other doctors who misdiagnosed you, treated you rudely or ridiculed you. The State Health departments need to hear that you have problems with doctors who treat solely on the bases of unreliable test results, who ignored your complaints, who dismissed your illness. Now is the time to do something. Your continued treatment IS in jeopardy. We have to support and stand up for our treating doctors. Send copies of your letters to the Lyme Disease Foundation at One Financial Plaza, Hartford, CT 06103. They can use these letters now, and for future advocacy efforts. =====*===== IV. 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