LymeNet Newsletter Volume 3 Issue 01

Volume: 3
Issue: 01
Date: 27-Jan-95

Table of Contents:

I. LYMENET: Patient Seeks Individuals Denied Treatment By Insurers II. AM J TROP MED HYG: Evidence Supporting The Presence Of Borrelia burgdorferi In Missouri III. AM J PSYCHIATRY: Lyme Disease: A Neuropsychiatric Illness IV. SCAND J INFECT DIS: Prevalence Of Borrelia burgdorferi In Selected Tick Populations In Finland V. Q&A: Question About Platelet Count (Q) VI. About The LymeNet Newsletter

Newsletter:

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

IDX# Volume 3 - Number 01 - 1/27/95 IDX# INDEX IDX# IDX# I. LYMENET: Patient Seeks Individuals Denied Treatment By IDX# Insurers IDX# II. AM J TROP MED HYG: Evidence Supporting The Presence Of IDX# Borrelia burgdorferi In Missouri IDX# III. AM J PSYCHIATRY: Lyme Disease: A Neuropsychiatric Illness IDX# IV. SCAND J INFECT DIS: Prevalence Of Borrelia burgdorferi In IDX# Selected Tick Populations In Finland IDX# V. Q&A: Question About Platelet Count (Q) IDX# VI. About The LymeNet Newsletter IDX#

QUOTE OF THE WEEK:

"These results confirm that B. burgdorferi is present in questing D. variabilis and A. americanum ticks in areas of Missouri where Lyme disease occurs."

-- Feir et al. [See Section II]

I. LYMENET: Patient Seeks Individuals Denied Treatment By Insurers --------------------------------------------------------------------- Sender: Pete McFadden

I am looking for people who are being denied treatment for Lyme disease by their insurance company or HMO as the result of a recommendation by Dr. Robert T. Schoen. Dr. Schoen is associated with Yale University and is also in private practice in New Haven, CT.

My insurer has denied me treatment for LD based on Dr. Schoen's review of my medical files. Despite a physician observed EM rash, two positive PCR results from different labs, compatible symptoms and treatment recommendations from three physicians, Dr. Schoen's letter to my insurer has blocked any antibiotic regimen.

If you or anyone you know is being denied treatment under these circumstances, please contact me. We may be able to share information to help each other.

Pete McFadden 4611 Governors Drive #1001 Huntsville, AL 35805 205-721-2665 (D) 205-722-0474 (E)

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II. AM J TROP MED HYG: Evidence Supporting The Presence Of Borrelia burgdorferi In Missouri ------------------------------------------------------------ AUTHORS: Feir D, Santanello CR, Li BW, Xie CS, Masters E, Marconi R, Weil G REFERENCE: Am J Trop Med Hyg 1994 Oct;51(4):475-82 ORGANIZATION: Department of Biology, St. Louis University, Missouri ABSTRACT:

Although Lyme disease is commonly seen in the southcentral United States, the epidemiology of the disease is poorly defined there. The purpose of this study was to document the presence of Borrelia burgdorferi in ticks collected in southeastern Missouri and around the city of St. Louis. Spirochetes were detected and identified as B. burgdorferi by immunofluorescent antibody (IFA) tests using the monoclonal antibody H5332 in 1.9% of Amblyomma americanum and 2.0% of Dermacentor variabilis ticks collected. The identity of IFA- positive organisms was verified by polymerase chain reactions (PCRs) with two different sets of B. burgdorferi-specific primers followed by Southern blotting. The DNA sequences of amplified 371-basepair PCR products from two positive Missouri ticks showed 97-98% identity with that obtained by the same method for the B31 strain of B. burgdorferi. These results confirm that B. burgdorferi is present in questing D. variabilis and A. americanum ticks in areas of Missouri where Lyme disease occurs. Additional studies are needed
to determine the role of these ticks in the epidemiology of Lyme disease in Missouri and neighboring states.

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III. AM J PSYCHIATRY: Lyme Disease: A Neuropsychiatric Illness --------------------------------------------------------------- AUTHORS: Fallon BA, Nields JA REFERENCE: Am J Psychiatry 1994 Nov;151(11):1571-83 ORGANIZATION: Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York ABSTRACT:

OBJECTIVE: Lyme disease is a multisystemic illness that can affect the central nervous system (CNS), causing neurologic and psychiatric symptoms. The goal of this article is to familiarize psychiatrists with this spirochetal illness. METHOD: Relevant books, articles, and abstracts from academic conferences were perused, and additional articles were located through computerized searches and reference sections from published articles. RESULTS: Up to 40% of patients with Lyme disease develop neurologic involvement of either the peripheral or central nervous system. Dissemination to the CNS can occur within the first few weeks after skin infection. Like syphilis, Lyme disease may have a latency period of months to years before symptoms of late infection emerge. Early signs include meningitis, encephalitis, cranial neuritis, and radiculoneuropathies. Later, encephalomyelitis and encephalopathy may occur. A broad range of psychiatric reactions have been associated with Lyme disease including paranoia, dementia,
schizophrenia, bipolar disorder, panic attacks, major depression, anorexia nervosa, and obsessive-compulsive disorder. Depressive states among patients with late Lyme disease are fairly common, ranging across studies from 26% to 66%. The microbiology of Borrelia burgdorferi sheds light on why Lyme disease can be relapsing and remitting and why it can be refractory to normal immune surveillance and standard antibiotic regimens. CONCLUSIONS: Psychiatrists who work in endemic areas need to include Lyme disease in the differential diagnosis of any atypical psychiatric disorder. Further research is needed to identify better laboratory tests and to determine the appropriate manner (intravenous or oral) and length (weeks or months) of treatment among patients with neuropsychiatric involvement.

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IV. SCAND J INFECT DIS: Prevalence Of Borrelia burgdorferi In Selected Tick Populations In Finland --------------------------------------------------------------- AUTHORS: Junttila J, Tanskanen R, Tuomi J, REFERENCE: Scand J Infect Dis 1994;26(3):349-55 ORGANIZATION: Department of Microbiology and Epizootology, College of Veterinary Medicine, Helsinki, Finland ABSTRACT:

The purpose of the studies was to determine the prevalence of Borrelia burgdorferi sensu lato in selected populations of Ixodes ricinus in Finland and to secure strains of the spirochete for further characterization. 1,210 Ixodes ricinus ticks (399 females, 419 males and 392 nymphs) were collected during June to August 1992 by flagging from 8 sites in 3 regions. The frequency of B. burgdorferi infection was determined by isolation in BSK II medium. The species identity of most of the isolates was confirmed with the immunofluorescence method. 67 B. burgdorferi strains were isolated from 8 sites; the prevalence ranged from 2.8% to 7.9%. The overall isolation percentage for adult male ticks was 6.4% (7.5% for females, 5.3% for males); for nymphs, 3.8%. No statistically significant association of the prevalence was observed with either pasture or off-pasture habitats nor with specific geographic region/regions. Prevalence figures were roughly of the same magnitude in areas and parts of the country known to differ in their
incidence of human borreliosis. An additional 294 ticks, mainly engorged females, were collected from places outside the main study sites. Of the 7 positive ticks 3 were engorged females, originating from a cow, a dog and a cat, respectively. The results in general demonstrate that tick populations in various parts of Finland quite commonly harbour B. burgdorferi.

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V. Q&A: Question About Platelet Count (Q) -------------------------------------------- Sender: [email protected] (Steve Hunter 510-423-2219)

Is the blood platelet count likely to be low for a person with late Lyme disease? If so, what sort of value would be expected?

[Editor's Note: Please send your responses to: [email protected]]

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