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Volume: 4
Issue: 01
Date: 30-Jan-96

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


*                  The National Lyme Disease Network                  *
*                         LymeNet Newsletter                          *

IDX#                Volume 4 - Number 01 - 1/30/96
IDX#                            INDEX
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

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.
Goodman JL, Nelson C, Vitale B, et al. Direct cultivation of the
causative agent of human granulocytic ehrlichiosis. N Engl J Med

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

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 &

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.


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