LymeNet Newsletter Volume 2 Issue 17

Volume: 2
Issue: 17
Date: 14-Oct-94

Table of Contents:

I. LYMENET: LymeNet Resource Guide Now Available II. LETTERS: Reader Responds to "What a Doctor Should Be" III. MD MED J: Maryland physicians' survey on Lyme disease IV. J CLIN MICROBIOL: Comparison of different strains of Borrelia burgdorferi sensu lato used as antigens in enzyme-linked immunosorbent assays V. FEMS MICROBIOL LETT: Nucleotide sequence and analysis of the gene in Borrelia burgdorferi encoding the immunogenic P39 antigen VI. J BACTERIOL: Analysis of the distribution and molecular heterogeneity of the ospD gene among the Lyme disease spirochetes: evidence for lateral gene exchange VII. About The LymeNet Newsletter

Newsletter:

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

IDX# Volume 2 - Number 17 - 10/14/94 IDX# INDEX IDX# IDX# I. LYMENET: LymeNet Resource Guide Now Available IDX# II. LETTERS: Reader Responds to "What a Doctor Should Be" IDX# III. MD MED J: Maryland physicians' survey on Lyme disease IDX# IV. J CLIN MICROBIOL: Comparison of different strains of IDX# Borrelia burgdorferi sensu lato used as antigens in IDX# enzyme-linked immunosorbent assays IDX# V. FEMS MICROBIOL LETT: Nucleotide sequence and analysis of IDX# the gene in Borrelia burgdorferi encoding the immunogenic IDX# P39 antigen IDX# VI. J BACTERIOL: Analysis of the distribution and molecular IDX# heterogeneity of the ospD gene among the Lyme disease IDX# spirochetes: evidence for lateral gene exchange IDX# VII. About The LymeNet Newsletter IDX#

QUOTE OF THE WEEK:

"The medical community and the school system seem to be burdened by the same unrealistic demands -- lift my emotional burden, provide comfort, make me feel safe, tell me everything I need to know, fix me. Much of that should be the responsibility of the patients' communities of friends, family, and fellow sufferers."

-- Author Michaela Mann (See Section II)

I. LYMENET: LymeNet Resource Guide Now Available --------------------------------------------------- Source: LymeNet News Byline: By Marc Gabriel <[email protected]> Date: October 9, 1994

A comprehensive document providing readers with general information on Lyme disease (LD) and pointers to other Lyme data sources is now available from the National Lyme Disease Network. For the uninitiated reader, the LymeNet Resource Guide provides a review of the LD basics, including transmission and diagnosis.

The Guide also list the different methods of obtaining the LymeNet Newsletter, including back issues. Since this information is dynamic and the Newsletters tend to lurk in the Net for long periods of time, these details will be removed from the Newsletter's signature file. Requesting the Guide will ensure readers will always have the most current subscription and back issue retrieval instructions.

To obtain the LymeNet Resource Guide, send a blank message to: [email protected] The system will immediately respond to your query by sending you the Guide via return e-mail. Since the document will be updated frequently, the LymeNet Newsletter will list the version number of the most current Guide in the signature file in place of the subscription information.

The current version of the Guide reflects our first attempt at providing readers with the information they request most frequently. The document will evolve to encompass as much information deemed relevant to the users. If you have any suggestions for the Guide, please send them to [email protected] .

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Since the announcement of the National LymeNet gopher service in the last issue of the Newsletter, several attempts have been made to FTP to the National LymeNet system. There are no plans to provide FTP service at this time. Please refrain from connecting to the system via FTP. Thank you.

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II. LETTERS: Reader Responds to "What a Doctor Should Be" ----------------------------------------------------------- Sender: Michaela Mann <[email protected]>

[ In response to Karen Angotti's commentary entitled "What a Doctor Should Be" (LymeNet Newsletter vol#2 #16, section IV) ]

To the Editor:

Please, let us debunk the myth of Doctor Superhero and build a saner medical world. Doctors need to be: decent, honorable, and clear thinking -- as we all do. Beyond that, they need to be excellent body mechanics, and to understand the body as a system and not as a series of vaguely connected parts. Above all, they need to know what they do not know, and be able discuss and refer within a wide network of health care professionals who have a variety of skills and specialties. They should also be able to communicate their health care beliefs and protocols rationale, or work with someone who can do it for them. Patients, or the advocates for the patients (should be required -- sick people think poorly) need to spend time learning about themselves, their bodies, and their illness, about doctors, and about how to get good health care.

It's no good wailing that doctors should be the be-all and end-all of health care. That can't and won't happen, nor should it happen. What can happen is patients shouldering a large measure of their health care burden, with expert guidance on where to look for remedies/care. This requires skills for recognizing effective healthcare providers, firing poor ones, finding information (no matter what the literacy level), and helping others to do the same. The medical community and the school system seem to be burdened by the same unrealistic demands -- lift my emotional burden, provide comfort, make me feel safe, tell me everything I need to know, fix me. Much of that should be the responsibility of the patients' communities of friends, family, and fellow sufferers. If we go with Doctor Superhero, we will have a permanent health care crisis of false promises, unfulfilled expectations, and patient-victims.

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III. MD MED J: Maryland physicians' survey on Lyme disease ----------------------------------------------------------- AUTHORS: Jung PI, Nahas JN, Strickland GT, McCarter R, Israel E ORGANIZATION: University of Maryland School of Medicine, Baltimore REFERENCE: Md Med J 1994 May;43(5):447-50 ABSTRACT:

In a survey of 252 physicians practicing in Maryland, 170 responders diagnosed 142 cases of Lyme disease (LB) during 1990 and 1991. About 80% of the cases were diagnosed by primary care physicians. The most common clinical finding, erythema migrans (EM), was reported in half the cases and arthritis was reported in a quarter. Only 22.2% had a history of a tick bite; serological tests were ordered in a third of the cases. EM was treated with oral antibiotics for 10-21 days. Most physicians treated Lyme arthritis with the same therapy, although some used intravenous ceftriaxone. The most commonly used treatment for neurologic or cardiac complications was intravenous ceftriaxone. These preliminary data suggest that LB may be diagnosed by Maryland physicians more frequently than syphilis and tuberculosis. The data also indicate LB is a much larger problem in Maryland than suggested by official reports to the Centers for Disease Control. The clinical characteristics of the illness and the antibiotics prescribed for it
in Maryland are similar to those reported in northeastern states.

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IV. J CLIN MICROBIOL: Comparison of different strains of Borrelia burgdorferi sensu lato used as antigens in enzyme-linked immunosorbent assays ------------------------------------------------------------------- AUTHORS: Magnarelli LA, Anderson JF, Johnson RC, Nadelman RB, Wormser GP ORGANIZATION: Department of Entomology, Connecticut Agricultural Experiment Station, New Haven REFERENCE: J Clin Microbiol 1994 May;32(5):1154-8 ABSTRACT:

Eight strains of Borrelia burgdorferi sensu lato were tested with serum samples from persons who had Lyme borreliosis or syphilis in class-specific enzyme-linked immunosorbent assays (ELISAs). Antigens of B. burgdorferi sensu stricto, of Borrelia garinii, and of Borrelia spirochetes in group VS461 were prepared from cultured bacteria isolated from ticks, a white-footed mouse (Peromyscus leucopus), or human tissues in North America, the former Soviet Union, and Japan. Nearly all of the serum specimens that contained immunoglobulins to strain 2591, a Connecticut isolate, were also positive in antibody tests with the other seven strains. In general, all eight strains reacted similarly and were suitable as coating antigens in class-specific ELISAs. Assay sensitivities ranged from 82.6 to 100% in analyses for immunoglobulin M and G antibodies. Compared with reference antigen strain 2591, strains 231 (a tick isolate from Canada) and NCH-1 (a human skin isolate from Wisconsin) resulted in higher antibody titers in an ELISA. Syphilitic sera cross-reacted in all
tests regardless of the antigen used. Key immunodominant proteins are shared among the closely related strains of B. burgdorferi sensu lato tested, but it is suspected that variations in antigen compositions among these spirochetes may sometimes affect assay performance for detecting serum antibodies.

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V. FEMS MICROBIOL LETT: Nucleotide sequence and analysis of the gene in Borrelia burgdorferi encoding the immunogenic P39 antigen ----------------------------------------------------------------------- AUTHORS: Simpson WJ, Cieplak W, Schrumpf ME, Barbour AG, Schwan TG ORGANIZATION: Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health REFERENCE: FEMS Microbiol Lett 1994 Jun 15;119(3):381-7 ABSTRACT:

The P39 antigen is a specific, highly conserved, and immunogenic protein of Lyme disease spirochetes, Borrelia burgdorferi sensu lato. The nucleotide sequence of the gene encoding this protein was determined and found to be the first of two tandemly arranged open reading frames located on the spirochete's chromosome. These two open reading frames were designated bmpA for the gene encoding P39 and bmpB for the gene encoding the putative protein ORF2 encoded by the second open reading frame. The nucleic acid sequence identity for the two open reading frames was 62% while their deduced amino acid sequences were 52% identical. Comparison to sequence data bases demonstrated that the deduced amino acid sequences of both P39 and ORF2 were homologous to TmpC, a putative outer or cytoplasmic membrane lipoprotein of the syphilis spirochete, Treponema pallidum.

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VI. J BACTERIOL: Analysis of the distribution and molecular heterogeneity of the ospD gene among the Lyme disease spirochetes: evidence for lateral gene exchange ------------------------------------------------------------- AUTHORS: Marconi RT, Samuels DS, Landry RK, Garon CF ORGANIZATION: Laboratory of Vectors and Pathogens, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases REFERENCE: J Bacteriol 1994 Aug;176(15):4572-82 ABSTRACT:

Analysis of the ospD gene has revealed that this gene is not universal among Lyme disease spirochete isolates. The gene was found to be carried by 90, 50, and 24% of the Borrelia garinii, B. afzelii, and B. burgdorferi isolates tested. Size variability in the ospD-encoding plasmid was also observed. Sequence analysis has demonstrated the presence of various numbers of a 17-bp repeated sequence in the upstream control (promoter) region of the gene. In addition, a region within the coding sequence where various insertions, deletions, and direct repeats occur was identified. ospD gene sequences from 31 different isolates were determined and utilized in pairwise sequence comparisons and construction of a gene tree. These analyses suggest that the ospD gene was the target of several recombinational events and that the gene was recently acquired by Lyme disease spirochetes and laterally transferred between species.

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VII. 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 (10/09/94) ----------------------------------------------------------------------- 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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