LymeNet Newsletter Volume 1 Issue 11

Volume: 1
Issue: 11
Date: 24-May-93

Table of Contents:

ANNOUNCEMENT: The Sixth Annual Rheumatology Symposium on Lyme Disease UPI: Cases of Lyme disease increase 19-fold in decade ABSTRACT: (Acta Paediatr) Epidemiology and Clinical Manifestations of Lyme Borreliosis in Childhood. A Prospective Multicentre Study With Special Regard to Neuroborreliosis ANSWER: Question on Lyme Vectors and Compost Piles QUESTION: Does the Bull's Eye Rash Bode Ill or Well For The LD Victim? QUESTION: Vaccination for Cats? LETTER: Lyme Quilt

Newsletter:

***************************************************************************** * Lyme Disease Electronic Mail Network * * LymeNet Newsletter * ***************************************************************************** Volume 1 - Number 11 - 5/24/93

I. Introduction II. Announcements III. News from the wires IV. Questions 'n' Answers V. Op-Ed Section VI. Jargon Index VII. How to Subscribe, Contribute and Get Back Issues

I. ***** INTRODUCTION *****

I would like to apologize for the delay in getting this issue out. Unfortunately, my health interfered with the newsletter's publication schedule! We're now back on track.

This issue contains lots of interesting information. However, pay particular attention to the UPI release that announces the new CDC patient count. In the second to last paragraph, the CDC's David Dennis *finally* admits that LD is under-reported! I believe this is a first.

The LymeNet now has an Internet Frequently Asked Questions (FAQ) list written by Dr. Lloyd Miller of Troy, NY. It may be obtained by sending the following command to [email protected]:

get LymeNet-L faq

Mail delivery of this newsletter will now be available due to popular demand. Obviously, I prefer the electronic media to disseminate the newsletter, but I realize that many do not have access to the latest in electronic equipment. While I will take care of the duplication costs, I ask that "snail-mail" subscribers send me 2 books of 1st class stamps to cover the postage. Send requests (along with the stamps) to me at: 1050 Lawrence Avenue Westfield, NJ 07090-3721

-Marc.

II. ***** ANNOUNCEMENTS *****

FROM: Yale University School of Medicine SUBJECT: The Sixth Annual Rheumatology Symposium on Lyme Disease

The sixth annual Lyme disease symposium sponsored by the Section of Rheumatology at Yale School of Medicine will provide a focused update on all aspects of Lyme disease. Both clinical topics and scientific advances will be reviewed. Specific attention will be directed to vector ecology, epidemiology (both national and regional), clinical spectrum, laboratory diagnosis, issues in treatment, vaccine development, and progress towards better diagnostics. Speakers will emphasize the current state of knowledge and areas of active research. Practical advice will be given about how to approach commonly encountered questions in clinical practice. The symposium is directed toward primary care physicians, internists, pediatricians, rheumatologists, and other health care professionals interested in Lyme disease.

For more information: 203-785-4578 VOICE 203-785-3083 FAX

III. ***** NEWS FROM THE WIRES ******

SOURCE: UPI HEADLINE: Cases of Lyme disease increase 19-fold in decade DATELINE: May 13, 1993, Thursday, BC cycle BYLINE: BY CHARLES S. TAYLOR

Federal officials now cause Lyme disease an "emerging infectious disease" because they have recorded a 19-fold increase in the number of cases since 1982.

The Centers for Disease Control and Prevention recorded 40,195 cases of the illness, spread by the bite of infected ticks, from 1982 to 1991. There were 9,677 cases reported in 1992 with all but two states listing incidences of the illness. Just 497 cases were reported by 11 states in 1982.

The emergence of Lyme disease as a major infectious illness results in part from the fact that people are moving out to where the deer ticks are, said the CDC's Dr. David Dennis.

He cited the transformation of farmland into suburban woodlots "that are favorable for deer and deer ticks.

"This is a disease that has been spreading steadily since it was first recognized in 1975 in the United States," Dennis said. It is spreading both geographically and in the areas where it already is endemic, he said.

Lyme disease was first recognized in 1975 when two mothers in Lyme, Conn., convinced researchers at the Yale University School of Medicine to study a rare outbreak of juvenile rheumatoid arthritis in their children. Researchers found that many people in Connecticut bitten by deer ticks had developed a typical rash and similar symptoms.

However, a recent report from Tufts University researchers questioned the accuracy of Lyme disease diagnoses and found many people who were told they had the disease actually did not have it.

In the Connecticut area where the disease was first identified there has been a nine-fold increase in reported cases.

The ailment causes skin lesions, muscle and joint pain, abnormalities of the nervous system and cardiac symptoms. It is readily treatable with antibiotics and most people recover completely. The major clinical marker is an initial skin lesion that looks like a bullseye.

During 1992, Connecticut had 53.6 cases per 100,000 population -- the highest incidence of Lyme disease in the northeast. Wisconsin with 10.7 and California with 0.8 cases reported the highest rates in the north central and Pacific coastal regions, respectively.

The CDC said the 19-fold increase in Lyme disease since 1982 may be due not only to more cases actually occurring but also heightened awareness of the disease by patients and physicians, increased laboratory testing, and increased surveillance.

Dennis said there probably is considerable under-reporting of Lyme disease. "When we are able to provide resources for increased surveillance, the numbers seem to go up," he said.

Researchers still do not have a reliable lab test for Lyme disease but Dennis said one should be ready by use in about two or three years.

=====*=====

TITL: Epidemiology and clinical manifestations of Lyme borreliosis in childhood. A prospective multicentre study with special regard to neuroborreliosis. AUTH: Christen HJ; Hanefeld F; Eiffert H; Thomssen R ORGA: Department of Pediatrics, University Hospital, Gottingen, Germany. CITE: Acta Paediatr 1993 Feb; 82 Suppl 386: 1-75

Lyme borreliosis is a tick-borne infection caused by the spirochete Borrelia burgdorferi, whose discovery in 1982 solved an aetiological mystery involving a variety of dermatological and neurological disorders and explained their association with Lyme disease. Lyme borreliosis occurs frequently and is readily treatable with antibiotics. Along with its discovery, however, came the realization that it is difficult to diagnose accurately, especially antibody diagnosis. False-positive antibody results in particular led to gradual widening of the clinical spectrum, and differential diagnosis became increasingly difficult. This prospective, multicentre study presents a systematic description of Lyme borreliosis in childhood, emphasizing epidemiological and clinical issues.

Because, predominantly, inpatients were examined, Lyme neuroborreliosis was the focus of the study, with the chief concern being to minimize false- positive results. To this end, we chose to narrow the diagnostic criteria, using the presence of specific antibodies in the cerebrospinal fluid as the determining factor. The epidemiological investigation was focused on the incidence of Lyme neuroborreliosis in childhood in southern Lower Saxony as well as on the prevalence of Lyme neuroborreliosis among acute-inflammatory neurological illnesses in children. The clinical part of the study aimed at establishing criteria for differential diagnosis in addition to the detection of specific antibodies. The detection of specific IgM antibodies using an IgM capture ELISA confirmed the presence of acute Lyme borreliosis.

The study examined 208 children with Lyme borreliosis, of whom 169 had Lyme neuroborreliosis, from mid-1986 until the end of 1989. The yearly incidence of Lyme neuroborreliosis in Lower Saxony was 5.8 cases/100,000 children aged 1 to 13. The manifestation index was 0.16, or one case of Lyme neuroborreliosis per 620 infected children, compared with the presence of specific antibodies against B. burgdorferi for children in the same age group and region. Both the seasonal distribution of Lyme borreliosis, which peaked in summer and autumn, as well as the information about when the tick bites took place point to an incubation period of a few weeks. The most frequent manifestation of Lyme neuroborreliosis in childhood was acute peripheral facial palsy, found in 55% of all cases (n = 93). Lyme borreliosis proved to be the most frequently verifiable cause of acute peripheral facial palsy in children, causing every second case of this disorder in summer and autumn. (ABSTRACT TRUNCATED AT 400 WORDS)

IV. ***** QUESTIONS 'N' ANSWERS *****

In LymeNet vol#1, issue#09, Terry Morse <[email protected]> asked:

> When I visited my sister on Long Island, NY, I was cautioned to avoid the >compost heap in her back yard, as she thinks this is where she became >infected. > > A friend of mine here in Oregon who has a compost heap would like me to >back that claim up with documentation. Do lyme-carrying ticks hang out in >compost heaps? >Thank you.

Our answer comes from the Rutgers University Department of Entomology and the Prevent Lyme Foundation.

Compost heaps attract white footed mice, which are known hosts for ticks such as I. dammini. The heaps are great places for the mice to reproduce. Where you find the mice, you will most probably find the ticks, including Lyme-carrying ticks.

The solution is to keep the mice from getting in the compost heaps in the first place by enclosing them. Thanks to Lynn Latchford for sending us this response.

Feel free to send in additional questions to [email protected]

=====*=====

Sender: Ralph E. Yozzo <[email protected]> Subject: Does the Bull's eye rash bode ill or well for the LD Victim?

Has there been any study on Lyme Disease patients which focused on whether or not they had the characteristic bull's eye rash or not and whether or not they got late Lyme symptoms?

In other words, if you get the bull's eye rash, are you less or more likely to suffer late Lyme complications?

I would hope that the bull's eye rash would be a good sign. My reasoning is that if your body reacts to the intruder and fights it, (I assume that the rash is a battle between the body and the spirochete.) then (in concert with antibiotics) you would be better off than a person whose body does not fight or fights to a lesser degree.

As you can probably tell, I do not have a medical degree. My interest is a personal one. In September of 1992, I had Lyme Disease and the characteristic bull's eye rash.

=====*=====

Sender: Ralph E. Yozzo <[email protected]> Subject: Vaccination for cats

I noticed that in the Lyme FAQ, there was a reference to a Lyme vaccine for dogs. Is a Lyme vaccine for cats available now or in the near future?

Take care of yourself.

V. ***** OP-ED SECTION *****

Letter to the Editor,

Some time ago I received a letter from Brin King asking me to design and sew a square of material to represent my case of Lyme disease. This square would be joined with other squares to create a "blanket" that would be brought to Washington. I chose to ignore what I believed to be an appalling idea. Since then, I have heard of people actually making squares for this blanket. I cannot ignore this any longer. My only hope is that people don't realize what they are doing.

When I first saw the AIDS Memorial Quilt, I was profoundly moved. Even though I have lost no one close to be to AIDS, it touched me deeply. In November of 1991, there were 14,780 panels to this quilt. That is seventeen solid acres! Every single square of that quilt that now stretches out over more than ten football fields represents someone who is DEAD. Lyme disease is devastating. I will be the first to acknowledge this. But we cannot compare what we have to a disease that kills virtually everyone it infects. Going to Washington with this "blanket" (calling a large grouping of pieces of material a blanket instead of a quilt is not enough to distance ourselves from the AIDS quilt) will not bring us recognition. It will bring us ridicule and make a mockery of our struggle.

I am not against ideas to bring the Lyme community recognition. On the contrary, I have been fighting this battle for five years. I simply think we can come up with our own ideas, not steal them from the AIDS community. Especially not one so incredibly meaningful.

I implore anyone who has sent a square to Mr. King: Please ask him to return it to you. Maybe someday, when the cure for AIDS is found and we are still fighting this insidious disease, they can be of use.

Sincerely, Sallie Timpone Hasbrouck Heights, NJ

VI. ***** JARGON INDEX *****

Bb - Borrelia burgdorferi - The scientific name for the LD bacterium. CDC - Centers for Disease Control - Federal agency in charge of tracking diseases and programs to prevent them. CNS - Central Nervous System. ELISA - Enzyme-linked Immunosorbent Assays - Common antibody test EM - Erythema Migrans - The name of the "bull's eye" rash that appears in ~60% of the patients early in the infection. IFA - Indirect Fluorescent Antibody - Common antibody test. LD - Common abbreviation for Lyme Disease. NIH - National Institutes of Health - Federal agency that conducts medical research and issues grants to research interests. PCR - Polymerase Chain Reaction - A new test that detects the DNA sequence of the microbe in question. Currently being tested for use in detecting LD, TB, and AIDS. Spirochete - The LD bacterium. It's given this name due to it's spiral shape. Western Blot - A more precise antibody test.

VII. ***** HOW TO SUBSCRIBE, CONTRIBUTE AND GET BACK ISSUES *****

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