LymeNet Newsletter Volume 6 Issue 10

Volume: 6
Issue: 10
Date: 16-Oct-98

Table of Contents:

I. LDANJ: Great Imitator Family Masquerade Party Fundraiser Oct 25 II. NIH: Chronic Lyme Borreliosis Clinical Trial RFP - NIH/ALI III. ARCH DEMATOL: Physician-diagnosed erythema migrans and erythema migrans-like rashes following Lone Star tick bites. IV. PEDIATR NEUROL: Pseudotumor cerebri in Lyme disease: a case report and literature review. V. AM J PHYS ANTHROPOL: Prehistoric juvenile rheumatoid arthritis in a precontact Louisiana native population reconsidered. VI. ABOUT THE LYMENET NEWSLETTER

Newsletter:

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

Volume 6 / Number 10 / 16-OCT-98 INDEX

I. LDANJ: Great Imitator Family Masquerade Party Fundraiser Oct 25 II. NIH: Chronic Lyme Borreliosis Clinical Trial RFP - NIH/ALI III. ARCH DEMATOL: Physician-diagnosed erythema migrans and erythema migrans-like rashes following Lone Star tick bites. IV. PEDIATR NEUROL: Pseudotumor cerebri in Lyme disease: a case report and literature review. V. AM J PHYS ANTHROPOL: Prehistoric juvenile rheumatoid arthritis in a precontact Louisiana native population reconsidered. VI. ABOUT THE LYMENET NEWSLETTER

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I. LDANJ: Great Imitator Family Masquerade Party Fundraiser Oct 25 --------------------------------------------------------------------- Sender: Patricia Smith <[email protected]>

The Lyme Disease Association of New Jersey, Inc., LDANJ, is sponsoring its 8th annual Great Imitator Family Masquerade Party on Sunday, October 25, 1998 from 2-7 PM at the Whiting Volunteer Fire Co #1, Lacey Road, Whiting, NJ. DJ Mr. Bill will lead the festivities with dancing and costume contests with great prizes. The Barnegat Bay Pipe band will also put in a guest appearance.

Tickets which include food, entertainment, and a chance for door prizes are adults $15, children $7, 3 & under, free. This is an event for all ages to enjoy. Come costumed or not. Proceeds will go to neuropsychiatric Lyme disease research being conducted by Dr. Brian Fallon, Columbia University. The all-volunteer LDANJ has raised over $400,000 for Lyme research, education, and prevention. For ticket and other information call Pam 732-886-5157, Deb 732-370-3027, and Edina 609-463-8411, Margaret Grayson Ph /609-296-7969/Fx. 609-296-9635.

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II. NIH: Chronic Lyme Borreliosis Clinical Trial RFP - NIH/ALI ---------------------------------------------------------------- Source: Carl Henn, Contracting Officer <[email protected]> Release Date: 7 October, 1998 URL: http://web.fie.com/htdoc/fed/nih/gen/any/proc/any/10099808.htm

CHRONIC LYME BORRELIOSIS CLINICAL TRIAL SOL N01-AI-65296 DUE 110498 POC Mr. Carl Henn, Contracting Officer, 301-496-0993.

The National Institute of Allergy and Infectious Diseases, Division of Microbiology and Infectious Diseases, is seeking sources capable of conducting randomized, placebo-controlled, double-blind clinical trials to demonstrate the efficacy of treatment with intravenous ceftriaxone (2 grams per day for 30 consecutive days) followed by oral doxycycline (200 mg per day for 60 consecutive days) for the treatment of chronic Lyme borreliosis. The trials will involve defined cohorts of patients, from regions of the United States in which Lyme disease is endemic, that are either seropositive or seronegative for Lyme disease (by the two-test CDC-Dearborn criteria) at the time of enrollment, and who meet the inclusion and exclusion criteria established and approved for this study. Primary analysis of the efficacy of the antibiotic therapy used will be determined by improvement in the patient's health-related quality of life, as measured by the SF-36 Health Survey; it includes eight multi-item scales that measure physical functioning,
role-physical, bodily pain, general health, vitality, social functioning, role-emotional, and mental health. Three additional multi-item scales from the medical outcomes study (MOS) will be used to measure cognitive functioning, pain, and role functioning; however, they will not be used for primary analysis of efficacy. The SF-36 Health Survey (and additional MOS measures) will be administered to study participants five times: at baseline (prior to therapy); at one month (the end of intravenous therapy); at three months (the end of intravenous and oral therapy); at six months; and at one year . Also, at baseline and at defined intervals (as stipulated in the protocol approved for use in these studies), specimens will be collected to test for: (a) an immune response to Borrelia burgdorferi antigens in serum and cerebrospinal fluid (CSF); (b) B. burgdorferi DNA in CSF; (c) viable B. burgdorferi in CSF; (d) B. burgdorferi antigens in urine; and (e) serum antibodies specific for possible co-infecting agents, e.g.,
Babesia microti and Ehrlichia species. Interested parties should submit, no later than November 4, 1998, four (4) copies of a capability statement addressing each of the areas outlined above. The statement also should include information on numbers of eligible volunteers likely to be enrolled per year (do not provide the names of prospective volunteers or personal identifiers). A copy of the specific inclusion and exclusion criteria approved for the study will be provided on request. This Sources Sought Announcement is a request for information to assist the NIAID in selecting additional sites for conducting the studies described. It may or may not result in a solicitation. Respondents are invited to discuss additional terms or conditions with the NIAID by contacting: Carl Henn Contracting Officer Contract Management Branch National Institute of Allergy & Infectious Diseases.

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III. ARCH DEMATOL: Physician-diagnosed erythema migrans and erythema migrans-like rashes following Lone Star tick bites. --------------------------------------------------------------------- AUTHORS: Masters E, Granter S, Duray P, Cordes P ORGANIZATION: Regional Primary Care, Cape Girardeau, Mo, USA. REFERENCE: Arch Dermatol 1998 Aug;134(8):955-60 ABSTRACT:

OBJECTIVE: To differentiate cases of physician-diagnosed erythema migrans and erythema migrans-like rashes associated with Lone Star tick (Amblyomma americanum) bites. DESIGN: Retrospective case series. SETTING: Private primary care clinic in rural Missouri. PATIENTS: Seventeen patients with physician-diagnosed erythema migrans following a definite Lone Star tick bite at the rash site. INTERVENTIONS: A biopsy was performed on all rash sites. All patients were treated with oral antibiotics. MAIN OUTCOME MEASURES: Rash appearance, size, body location, multiple lesions, incubation times, associated symptoms, seasonal occurrence, histopathological features, tick stage and sex, patient age and sex, treatment response, growth in BSK II culture media, and serologic evaluation. RESULTS: Rashes associated with Lone Star ticks were similar to erythema migrans vectored by other Ixodes ticks. Differences were noted in Lyme disease serology results, especially flagellin-based enzyme immunoassays, and failure to yield spirochetes in BSK II
cultures. Lyme serology results were often negative, but were also frequently inconsistent with results of controls without Lyme disease. CONCLUSIONS: Lone Star ticks are associated with rashes that are similar, if not identical, to erythema migrans associated with borrelial infection. The recent isolation and cultivation of Borrelia burgdorferi from ticks (including 1 Lone Star tick) from the farm of a patient included in this report has raised the possibility that Lone Star ticks are "bridge vectors" for human borrelial infection. Although further investigation is needed, these rashes may be secondary to spirochetal infection.

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IV. PEDIATR NEUROL: Pseudotumor cerebri in Lyme disease: a case report and literature review. ------------------------------------------------------------------ AUTHORS: Kan L, Sood SK, Maytal J ORGANIZATION: Division of Pediatric Neurology, Schneider Children's Hospital, Long Island Jewish Medical Center, Long Island Campus for the Albert Einstein College of Medicine, New Hyde Park, New York 11040, USA. REFERENCE: Pediatr Neurol 1998 May;18(5):439-41 ABSTRACT:

Pseudotumor cerebri is an unusual presentation of Lyme disease. The case of an 8-year-old girl with pseudotumor cerebri secondary to acute neuroborreliosis is reported. She presented with acute onset of headache, papilledema, sixth nerve palsy, increased intracranial pressure, and cerebrospinal fluid pleocytosis. Serum and cerebrospinal fluid Lyme antibodies were positive. Twelve reported cases that mostly presented with systemic findings and signs of Lyme disease before development of pseudotumor cerebri were reviewed. We conclude that acute neuroborreliosis can present with pseudotumor cerebri as an initial manifestation. It is important to include Lyme disease in the differential diagnosis of pseudotumor cerebri in an area endemic for Lyme disease.

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V. AM J PHYS ANTHROPOL: Prehistoric juvenile rheumatoid arthritis in a precontact Louisiana native population reconsidered. -------------------------------------------------------------------- AUTHORS: Lewis BA ORGANIZATION: Department of Geography and Anthropology, Louisiana State University, Baton Rouge, USA. [email protected] REFERENCE: Am J Phys Anthropol 1998 Jun;106(2):229-48 ABSTRACT:

Descriptions of skeletal pathological conditions evident in the prehistoric Tchefuncte adolescent 16ST1-14883b are clarified. The basis is reaffirmed for assigning to the described pathological conditions a diagnostic perspective of juvenile rheumatoid arthritis or juvenile Lyme disease--a disease that mimics juvenile rheumatoid arthritis in its arthritic presentation--rather than of assigning them as representative of juvenile onset ankylosing spondylitis or other juvenile spondyloarthropathies. A hypothesis (Lewis [1994] Am. J. Phys. Anthropol. 93:455-475) is restated that 1) the spirochete Borrelia burgdorferi was the infectious agent responsible for prevalence of adult rheumatoid arthritis in prehistoric southeastern Native American populations, 2) that B. burgdorferi is a possible cause of the arthritis evident in individual 16ST1-14883b, and 3) that antibodies to B. burgdorferi provided partial immunity to the related spirochete Treponema pallidum for the 16ST1 precontact Tchefuncte population from Louisiana, protecting them from severe treponemal
response. Given the probable widespread existence of Ixodid tick vectors for B. burgdorferi in prehistoric North America, coupled with the existence of treponematosis, it follows that the transition of Native American hunting-gathering economies to more sedentary economies would predictably be linked to an increased incidence of treponematosis due to the loss of benefits of the above-stated partial immunity. In other words, as prehistoric Native American exposure to tick vectors for B. burgdorferi decreased, susceptibility to treponematosis increased. Inferences regarding biological controls interacting with and influencing prehistoric Native American migration patterns are suggested from the link of B. burgdorferi to an Ixodid tick common to northeast Asia.

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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] -----------------------------------------------------------------------