LymeNet Newsletter Volume 6 Issue 03

Volume: 6
Issue: 03
Date: 16-Mar-98

Table of Contents:

I. LDF: LDF To Sponsor Satellite Conference on LD II. LDF: 11th Annual International Scientific Conference On LD III. LDRC: Yale Ignores True Consequences of Treatment Denial IV. J CLIN MICROBIOL: First isolation and cultivation of Borrelia burgdorferi sensu lato from Missouri. V. J CLIN MICROBIOL: Heterogeneity of BmpA (P39) among European isolates of Borrelia burgdorferi sensu lato and influence of interspecies variability on serodiagnosis. VI. ABOUT THE LYMENET NEWSLETTER

Newsletter:

*********************************************************************** * The National Lyme Disease Network * * http://www.lymenet.org/ * * LymeNet Newsletter * ***********************************************************************

Volume 6 / Number 03 / 16-MAR-98 INDEX

I. LDF: LDF To Sponsor Satellite Conference on LD II. LDF: 11th Annual International Scientific Conference On LD III. LDRC: Yale Ignores True Consequences of Treatment Denial IV. J CLIN MICROBIOL: First isolation and cultivation of Borrelia burgdorferi sensu lato from Missouri. V. J CLIN MICROBIOL: Heterogeneity of BmpA (P39) among European isolates of Borrelia burgdorferi sensu lato and influence of interspecies variability on serodiagnosis. VI. ABOUT THE LYMENET NEWSLETTER

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I. LDF: LDF To Sponsor Satellite Conference on LD ---------------------------------------------------- Sender: The Lyme Disease Foundation <[email protected]>

The Lyme Disease Foundation and the Illinois Academy of Family Practice Physicians and the Illinois Dept of Health will be broadcasting a FREE conference on Lyme disease on March 23rd from 9 am to noon. For more information on the conference and satellite coordinates, visit the LymeNet home page at:

http://www.lymenet.org/

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II. LDF: 11th Annual International Scientific Conference On LD ---------------------------------------------------------------- Sender: The Lyme Disease Foundation <[email protected]>

11th INTERNATIONAL SCIENTIFIC CONFERENCE ON LYME DISEASE AND OTHER TICK-BORNE & SPIROCHETAL DISORDERS with emphasis on Clinical Management April 25th (Sat) & 26th (Sun), 1998 Reception Sat night 6-8pm 7:30am sign-in 8am - 5 pm program each day

PROGRAM COMMITTEE

James N. Miller, PhD Professor-on-Recall, UCLA School of Medicine

Sam T. Donta, MD Infectious Diseases, Boston University

Edward Bosler, PhD Research Scientist, Stonybrook School of Medicine

Charles S. Pavia, PhD New York Medical College

KEYNOTE Willy Burgdorfer, PhD, MD(Hon) Scientist Emeritus, National Institutes of Health

The registration form is accessible from the LymeNet web site at:

http://www.lymenet.org/

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III. LDRC: Yale Ignores True Consequences of Treatment Denial -------------------------------------------------------------- Sender: Phyllis Mervine, President, Lyme Disease Resource Center and Editor, the Lyme Times, <[email protected]> Jean Hubbard, Associate Editor, the Lyme Times

The following review represents the opinions of the authors and not necessarily the perspectives of the editors.

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A recent AP press release reported on a study from Yale University Lyme Disease Clinic which alleged: "Fear of Lyme disease causes many people bitten by deer ticks to become depressed and pursue aggressive medical treatment they may not need."

It is always galling to those of us who are or work with Lyme disease patients when AP or Reuters picks up a story from Yale or one of the other big research centers and spreads their propaganda all over the country. Galling because their reports not only fly in the face of patients' experience, but also contradict other, less well publicized reports which point up the very serious consequences of untreated and undertreated Lyme disease.

Some doctors are definitely loath to diagnose or treat Lyme disease. This practice has serious consequences. We have no argument that some patients are treated unnecessarily, and that antibiotic resistance is of global concern. What we do contest is the assumption that the risk to the patient of unnecessary treatment is greater than the risk of failure to treat true Lyme disease. We contend that it would be preferable for physicians to stop treating viral illnesses with antibiotics - as they commonly do - than to deny treatment to a single person with possible Lyme disease. Treating viruses with antibiotics is no use at all. Treating a potential case of Lyme disease can save that person immeasurable life-long pain and suffering.

Do the authors of the Yale paper really think that worrying about having Lyme disease is as bad or worse than actually having Lyme disease? The notion is ludicrous. There is well-documented evidence of serious, persistent problems in more than 50% of treated patients -- the vast majority being those patients whose treatment was delayed. Many people with chronic Lyme disease do suffer from depression, but not, as the authors imply, from worry. It is because of real, measurable effects on the brain by this bacterium, which is neurotropic - that is, it seeks out nervous system cells. These objective effects are often quite obvious if the patient undergoes a SPECT scan of the brain. SPECT scans in late Lyme patients with depression or other central nervous system symptoms often show a changed pattern in the cerebral white matter areas of the brain, a "hypoperfusion" that is due either to restriction of the blood supply to those areas or dysfunction at the cellular level. These changes are associated not only with depression, but also with a number of
other neurologic deficits, including attention problems (including ADD itself), mood disorders, marked phobias, measurably slower mental processing, and even dementia. In fact, although Lyme disease was originally described as a musculoskeletal disease, the list of neurologic symptoms now is considerably longer - and more frightening. Depression strikes from 20% to 70% of Lyme disease patients, more than any other chronic illness. Some of the most prominent Lyme neurologists and physicians consider encephalopathy -- a degenerative disease of the brain -- to be the most common late manifestation of Lyme disease. Suicide is the most common kind of fatality.

Does this sound like "worry"?

Of course the Yale authors were claiming that 60% of the study patients did not have Lyme disease after all. We have heard that story before and it is patently false. They use insensitive tests and case standards so restrictive that they have all but defined the disease out of existence. So much so that a patient who has once been treated with an arbitrary 2 or 3 weeks of antibiotics, who relapses after completing those antibiotics, and continues to have symptoms, is often reclassified with fibromyalgia (for which there is no cure), given aspirin, and sent home. It is not uncommon for such patients to be closely questioned about their sex lives and referred to a psychiatrist. This in spite of the fact that the Lyme disease bacterium is known to disguise itself and hide deep in tissues. This in spite of the fact that there are many published accounts, in the peer-reviewed medical journals doctors like to quote, of treatment failures and persistence of infection despite aggressive antibiotic treatment. In no other disease are patients
treated with such callous disregard, or such denial of facts which seem to stare one in the face.

Why is Lyme disease treated differently?

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The Lyme Disease Resource Center is an educational nonprofit corporation dedicated to sharing knowledge to fight Lyme and other tick-borne diseases. The authors may be contacted at LDRC, PO Box 1423, Ukiah CA 95482.

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IV. J CLIN MICROBIOL: First isolation and cultivation of Borrelia burgdorferi sensu lato from Missouri. ---------------------------------------------------------- AUTHORS: Oliver JH Jr, Kollars TM Jr, Chandler FW Jr, James AM Masters EJ, Lane RS, Huey LO ORGANIZATION: Institute of Arthropodology and Parasitology, Georgia Southern University, Statesboro 30460-8056, USA. [email protected] REFERENCE: J Clin Microbiol 1998 Jan;36(1):1-5 ABSTRACT:

Five Borrelia burgdorferi sensu lato isolates from Missouri are described. This represents the first report and characterization of such isolates from that state. The isolates were obtained from either Ixodes dentatus or Amblyomma americanum ticks that had been feeding on cottontail rabbits (Sylvilagus floridanus) from a farm in Bollinger County, Mo., where a human case of Lyme disease had been reported. All isolates were screened immunologically by indirect immunofluorescence by using monoclonal antibodies to B. burgdorferi- specific outer surface protein A (OspA) (antibodies H3TS and H5332), B. burgdorferi-specific OspB (antibody H6831), Borrelia (genus)- specific antiflagellin (antibody H9724), and Borrelia hermsii-specific antibody (antibody H9826). Analysis of the isolates also involved a comparison of their protein profiles by sodium dodecyl sulfate- polyacrylamide gel electrophoresis. Finally, the isolates were analyzed by PCR with six pairs of primers known to amplify selected DNA target sequences specifically found in the reference strain B.
burgdorferi B-31. Although some genetic variability was detected among the five isolates as well as between them and the B-31 strain, enough similarities were found to classify them as B. burgdorferi sensu lato.

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V. J CLIN MICROBIOL: Heterogeneity of BmpA (P39) among European isolates of Borrelia burgdorferi sensu lato and influence of interspecies variability on serodiagnosis. ------------------------------------------------------------------ AUTHORS: Roessler D, Hauser U, Wilske B, ORGANIZATION: Max von Pettenkofer-Institut fur Hygiene und Medizinische Mikrobiologie der Ludwig-Maximilians Universitat Munchen, Lehrstuhl fur Bakteriologie, Munich, Germany. [email protected] REFERENCE: J Clin Microbiol 1997 Nov;35(11):2752-8 ABSTRACT:

The molecular and antigenic variabilities of BmpA (P39) among European isolates of Borrelia burgdorferi were analyzed. The bmpA sequences of 12 isolates representing all three species of B. burgdorferi sensu lato pathogenic for humans were amplified by PCR, cloned, and sequenced. The BmpA protein of Borrelia garinii is heterogeneous, with an amino acid sequence identity ranging from 91 to 97%, whereas the BmpA proteins of Borrelia afzelii and B. burgdorferi sensu stricto strains appear to be highly conserved (>98.5% intraspecies identity). The interspecies identities ranged from 86 to 92%. Cluster analysis of BmpA reflected the subdivision of B. burgdorferi sensu lato isolates into the three species as well as a considerable heterogeneity among B. garinii strains. The BmpA protein of each species of B. burgdorferi sensu lato was recombinantly expressed in Escherichia coli, purified, and used to generate monoclonal antibodies. Seven BmpA-specific antibodies were identified; six of them recognized conserved epitopes of all three species, whereas one
was specific for BmpA of B. afzelii and B. garinii. A monoclonal antibody (H1141) recommended by the Centers for Disease Control and Prevention for use in the standardization of immunoblots showed strong reactivity with BmpA of B. burgdorferi sensu stricto but no or only weak reactivity with BmpA of B. garinii and B. afzelii, respectively. Sera from 86 European patients with Lyme borreliosis in different stages and 73 controls were tested in immunoglobulin G (IgG) and IgM immunoblots with the recombinant BmpA proteins of the three species, revealing specificities of 98.6 to 100%. IgM antibodies against recombinant BmpA were only rarely detected (1.1 to 8.1%). With the BmpA proteins of B. afzelii and B. garinii, sensitivities for the IgG test (sera from stages I to III) were 36.0 and 34.9%, respectively, in contrast to 13.9% with BmpA of B. burgdorferi sensu stricto. Therefore, we recommend that recombinant BmpA of B. afzelii or B. garinii should be used solely, or in addition to B. burgdorferi sensu
stricto BmpA, in serodiagnostic tests for Lyme borreliosis in Europe.

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VI. ABOUT THE LYMENET NEWSLETTER ----------------------------------------------------------------------- For the most current information on LymeNet subscriptions, contributions, and other sources of information on Lyme disease, please refer to the LymeNet Home Page at: http://www.lymenet.org ----------------------------------------------------------------------- To unsubscribe from the LymeNet newsletter, send a message to: [email protected] On the first line of the message, write: unsub lymenet-l ----------------------------------------------------------------------- LymeNet - The Internet Lyme Disease Information Source ----------------------------------------------------------------------- Editor-in-Chief: Marc C. Gabriel <[email protected]> FAX (for contributions ONLY): 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]> The Lyme Disease Network of New Jersey ----------------------------------------------------------------------- WHEN COMMENTS ARE PRESENTED WITH AN ATTRIBUTION, THEY DO NOT NECESSARILY REPRESENT THE OPINIONS/ANALYSES OF THE EDITORS. ----------------------------------------------------------------------- THIS NEWSLETTER MAY BE REPRODUCED AND/OR POSTED ON BULLETIN BOARDS FREELY AS LONG AS IT IS NOT MODIFIED OR ABRIDGED IN ANY WAY. ----------------------------------------------------------------------- SEND ALL BUG REPORTS TO [email protected] -----------------------------------------------------------------------