LymeNet Newsletter Volume 2 Issue 18

Volume: 2
Issue: 18
Date: 02-Nov-94

Table of Contents:

I. LYMENET: National LymeNet Begins Holiday Donation Drive II. LYMENET: Steere Admits Some Of His Former Patients May Still Be Chronically Infected III. IMMUNOL LETT: Killing of Borrelia burgdorferi by macrophages is dependent on oxygen radicals and nitric oxide and can be enhanced by antibodies to outer surface proteins of the spirochete IV. J AM OSTEOPATH ASSOC: Lyme disease with concurrent ehrlichiosis V. About The LymeNet Newsletter

Newsletter:

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

IDX# Volume 2 - Number 18 - 11/02/94 IDX# INDEX IDX# IDX# I. LYMENET: National LymeNet Begins Holiday Donation Drive IDX# II. LYMENET: Steere Admits Some Of His Former Patients May IDX# Still Be Chronically Infected IDX# III. IMMUNOL LETT: Killing of Borrelia burgdorferi by IDX# macrophages is dependent on oxygen radicals and nitric IDX# oxide and can be enhanced by antibodies to outer surface IDX# proteins of the spirochete IDX# IV. J AM OSTEOPATH ASSOC: Lyme disease with concurrent IDX# ehrlichiosis IDX# V. About The LymeNet Newsletter IDX#

QUOTES OF THE WEEK:

1993: "Standard antibiotic treatment probably fails less often that one might think. Most apparent treatment failures actually reflect misdiagnosis." [1] 1994: "It has become increasingly apparent that the Lyme disease spirochete, Borrelia burgdorferi, may persist in some patients for years."

-- Allen C. Steere, M.D. (See Section II)

I. LYMENET: National LymeNet Begins Holiday Donation Drive ------------------------------------------------------------- Source: LymeNet News Byline: By Marc Gabriel <[email protected]> Date: October 30, 1994

The Lyme Disease Network is seeking donations to enhance the services it provides to its members and the entire Internet community via the National LymeNet. Projects awaiting funding include an upgrade of the system's connection to the Internet, an increase in storage capacity, and the creation of database of all MedLine entries relating to LD.

"As we enter the season of giving, please remember that the Lyme Disease Network has been working to bring all the members of the LD community together," said Bill Stolow, President of the Lyme Disease Network. "The National LymeNet is up and running, but it does take additional funding to enable us to better serve the people who need it the most."

Many subscribers have attempted to send money for their subscriptions to the Newsletter. In the past, these offerings have been returned, as the Newsletter is provided to the Internet community free of charge. The LymeNet Holiday Donation Drive offers readers the opportunity to express their gratitude by making a donation to expand the range of LymeNet services.

For a $50 donation, contributors will receive a diskette containing the current contents of the LymeNet gopher server. This includes all the past issues of the LymeNet Newsletter, the current consensus treatment protocol, as well as the writings of physicians such as Joseph Burrascano and Dorothy Pietrucha.

One hundred percent of all proceeds from this drive will benefit the aforementioned projects. All donations are fully tax-deductible. This is your opportunity to help the Network spread the word about the increasingly important issues relating to Lyme disease and LD patients. The Network receives no government funding and is dependent on individual donations.

Please make your checks payable to the Lyme Disease Network. Address them to: The Lyme Disease Network LymeNet Holiday Donation Drive 43 Winton Road East Brunswick, NJ 08816

For donations of $50 or greater, please specify in which format (IBM or MAC) you would like to receive your gopher server diskette.

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II. LYMENET: Steere Admits Some Of His Former Patients May Still Be Chronically Infected ------------------------------------------------------------------ Source: LymeNet News Byline: By Marc Gabriel <[email protected]> Date: October 25, 1994

Dr. Allen C. Steere, Chief of Rheumatology & Immunology at Tufts - New England Medical Center, and the first to describe Lyme disease as a distinct clinical entity, has asked some of his patients to participate in a "follow-up" study designed to determine if they are still infected with Borrelia burgdorferi, the causative agent of Lyme disease, despite supposedly curative treatment.

In a letter to his former patients dated August 11, he expresses concern that some may still harbor the spirochete. "Is has become increasingly apparent that the Lyme disease spirochete, Borrelia burgdorferi, may persist in some patients for years," he writes. "Of particular concern, recent studies have shown that the spirochete may persist in the nervous system in a small percentage of patients and may cause chronic neurological involvement. The purpose of our long-term follow-up studies is to determine whether past patients may still have evidence of Lyme disease and, if so, to offer appropriate treatment. These studies are being funded by the National Institutes of Health and the Centers for Disease Control."

Steere has been an outspoken advocate of short term treatment for Lyme disease for many years. When asked to explain why some patients improve with long term treatment, he has often cited the placebo effect. [1] Steere has rarely referenced any research demonstrating persistent infection after treatment in his writings.

Reaction to the letter has been mixed. One observer, who commented on the condition of anonymity, was outraged. "How can Dr. Steere participate in legal actions against Dr. Joseph Natole in Michigan for alleged over treatment of Lyme patients on one hand, and on the other write a letter to his former patients which seems to acknowledge that he many not have treated them intensively enough? It's hypocrisy."

Others were more optimistic. "Maybe this will be the turning point for LD patients," said Carol Stolow, Director of the Lyme Disease Network. "It is significant that the grandfather of Lyme disease has begun to admit the possibility of chronic persistent infection. Hopefully, this will trickle down and reach the local practitioner."

[1] Steere AC, "Current Understanding of Lyme Disease," Hospital Practice, April 15, 1993, 29-36.

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III. IMMUNOL LETT: Killing of Borrelia burgdorferi by macrophages is dependent on oxygen radicals and nitric oxide and can be enhanced by antibodies to outer surface proteins of the spirochete ------------------------------------------------------------------ AUTHORS: Modolell M, Schaible UE, Rittig M, Simon MM, ORGANIZATION: Max-Planck-Institut fur Immunbiologie, Freiburg, Germany REFERENCE: Immunol Lett 1994 May;40(2):139-46 ABSTRACT:

Interaction of B. burgdorferi organisms with mouse bone marrow-derived macrophages (BMM phi) leads to phagocytosis of microorganisms, induction of nitric oxide (NO) and superoxide radicals (O2-) by BMM phi and killing of spirochetes. Destruction of spirochetes by BMM phi was quantified by a new method based on the release of radioactivity from spirochetes pre-labelled with [3H]adenine. Uptake of B. burgdorferi by BMM phi, which mainly occurs by coiling phagocytosis, generation of NO and O2- radicals as well as killing of spirochetes were significantly enhanced by pre-opsonization of spirochetes with monoclonal antibodies (mAb) to the outer surface proteins A and B but not with those to the periplasmic flagellin. Addition of inhibitors specific for NO and O2- radical synthesis either separately or together to cultures of BMM phi and spirochetes resulted in only partial reduction of the killing potential of effector cells. The data indicate that NO and O2- radicals are necessary, but not sufficient, for complete elimination of B. burgdorferi by macrophages.
Together with previous findings that protection against B. burgdorferi infection is conveyed by humoral immune responses the present data indicate that one of the important functions of specific antibodies is their participation in macrophage-mediated control of spirochetes.

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IV. J AM OSTEOPATH ASSOC: Lyme disease with concurrent ehrlichiosis -------------------------------------------------------- AUTHORS: Paparone PW, Glenn WB ORGANIZATION: Lyme Disease Center for South Jersey, Abescon REFERENCE: J Am Osteopath Assoc 1994 Jul;94(7):568-70, 573, 577 ABSTRACT:

Lyme disease constitutes a major health hazard with an increased incidence throughout the United States, in particular the eastern states. Human ehrlichiosis, also a tick-borne illness, has recently been identified. It is characterized by fever, headache, malaise, leukopenia, thrombocytopenia, and elevated liver enzyme titers, and has been reported to occur mainly in the South Central and South Atlantic states. As with Lyme disease, most patients have a history of tick exposure. These two diseases may be difficult to differentiate clinically. Physicians must consider the possibility of both infections when patients become ill with a systemic illness after tick exposure. Although certain demographic and clinical features are characteristic of these diseases, they can be misleading. Only serologic evidence can confirm the diagnosis. Two cases of concurrent Borrelia and Ehrlichia infections have been previously reported. The authors herein describe a third case that further illustrates the potential diagnostic dilemma posed by the concurrence of these two
entities.

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V. ABOUT THE LYMENET NEWSLETTER ----------------------------------- For the most current information on LymeNet subscriptions, contributions, and other sources of information on Lyme disease, please request the LymeNet Resource Guide. To obain the Guide, send a blank message to: [email protected] ----------------------------------------------------------------------- The LymeNet Resource Guide is in Revision: 1.02 ----------------------------------------------------------------------- LymeNet - The Internet Lyme Disease Information Source ----------------------------------------------------------------------- Editor-in-Chief: Marc C. Gabriel <[email protected]> FAX: 908-789-0028 Contributing Editors: Carl Brenner <[email protected]> John Setel O'Donnell <[email protected]> Frank Demarest <[email protected]> Advisors: Carol-Jane Stolow, Director <[email protected]> William S. Stolow, President <[email protected]>
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