Volume: 4 Table of Contents: I. LYMENET: Compuserve now has two areas dedicated to LD II. ANN INTERN MED: Azithromycin compared with amoxicillin in the treatment of erythema migrans. A double-blind, randomized, controlled trial III. AM J CLIN PATHOL: Polymerase chain reaction detection of Lyme disease: correlation with clinical manifestations and serologic responses IV. INFECT IMMUN: Dominant recognition of a Borrelia burgdorferi outer surface protein A peptide by T helper cells in patients with treatment-resistant Lyme arthritis V. AM J TROP MED HYG: The spread of tick-borne borreliosis in West Africa and its relationship to sub-Saharan drought VI. About The LymeNet Newsletter Newsletter: *********************************************************************** * The National Lyme Disease Network * * LymeNet Newsletter * *********************************************************************** IDX# Volume 4 - Number 12 - 9/02/96 IDX# INDEX IDX# IDX# I. LYMENET: Compuserve now has two areas dedicated to LD IDX# II. ANN INTERN MED: Azithromycin compared with amoxicillin in IDX# the treatment of erythema migrans. A double-blind, IDX# randomized, controlled trial IDX# III. AM J CLIN PATHOL: Polymerase chain reaction detection of IDX# Lyme disease: correlation with clinical manifestations and IDX# serologic responses IDX# IV. INFECT IMMUN: Dominant recognition of a Borrelia IDX# burgdorferi outer surface protein A peptide by T helper IDX# cells in patients with treatment-resistant Lyme arthritis IDX# V. AM J TROP MED HYG: The spread of tick-borne borreliosis in IDX# West Africa and its relationship to sub-Saharan drought IDX# VI. About The LymeNet Newsletter IDX# NEWS BRIEF: Author Polly Murray (the "Mother of Lyme Disease") will sign her book THE WIDENING CIRCLE, which is about her struggle with Lyme, at Waldenbooks in the Poughkeepsie Galleria, Poughkeepsie New York, on Saturday, September 21, 1996. For more information, contact Gloria Wenk at 914-677-3286. I. LYMENET: Compuserve now has two areas dedicated to LD ----------------------------------------------------------- Sender: Frank Demarest <[email protected]> The Public Health forum (GO PUBHLTH) contains information related to public health. Dave Cundiff, M.D. ([email protected]) is the Sysop, and Frank Demarest ([email protected]) is the section leader for the Lyme disease section. The forum library contains Dr. Burrascano's diagnosis and treatment recommendations, pictures of ticks, pictures of the Lyme (EM) rash, and other information. The PUBHLTH forum library also contains several years of back issues of the CDC's publication, Morbidity and Mortality Weekly Reports, in both plain text and Adobe Acrobat formats. Other forum sections have information on legislative issues, nutrition & exercise, mental health, health administration, environment & health, sexual health, overall drug policy, tobacco and alcohol, communicable diseases, disasters, and injury prevention. The Chronic Illness forum (GO CIFORUM) contains information and support for those with chronic illness. Ellen Atwood ([email protected]) is the Sysop, and Frank Demarest is the section leader for the Lyme disease section. The forum library also has all back issues of the LymeNet Newsletter. This forum also has sections for CFS, Lupus, fibromyalgia, and other chronic illnesses. For more information about becoming a CompuServe user, or for a new member sign-up kit, point your web browser to: http://www.compuserve.com =====*===== II. ANN INTERN MED: Azithromycin compared with amoxicillin in the treatment of erythema migrans. A double-blind, randomized, controlled trial ------------------------------------------------------------------- ABSTRACT: Luft BJ, Dattwyler RJ, Johnson RC, Luger SW, Bosler EM Rahn DW, Masters EJ, Grunwaldt E, Gadgil SD ORGANIZATION: Department of Medicine, State University of New York at Stony Brook, NY USA REFERENCE: Ann Intern Med 1996 May 1;124(9):785-91 ABSTRACT: OBJECTIVE: To determine whether azithromycin or amoxicillin is more efficacious for the treatment of erythema migrans skin lesions, which are characteristic of Lyme disease. DESIGN: Randomized, double-blind, double-dummy, multicenter study. Acute manifestations and sequelae were assessed using a standardized format. Baseline clinical characteristics and response were correlated with serologic results. Patients were followed for 180 days. SETTING: 12 outpatient centers in eight states. PATIENTS: 246 adult patients with erythema migrans lesions at least 5 cm in diameter were enrolled and were stratified by the presence of flu-like symptoms (such as fever, chills, headache, malaise, fatigue, arthralgias, and myalgias) before randomization. INTERVENTION: Oral treatment with either amoxicillin, 500 mg three times daily for 20 days, or azithromycin, 500 mg once daily for 7 days. Patients who received azithromycin also received a dummy placebo so that the dosing schedules were identical. RESULTS: Of 217 evaluable patients, those treated with amoxicillin were significantly more likely than those treated with azithromycin to achieve complete resolution of disease at day 20, the end of therapy (88% compared with 76%; P=0.024). More azithromycin recipients (16%) than amoxicillin recipients (4%) had relapse (P=0.005). A partial response at day 20 was highly predictive of relapse (27% of partial responders had relapse compared with 6% of complete responders; P<0.001). For patients treated with azithromycin, development of an antibody response increased the possibility of achieving a complete response (81% of seropositive patients achieved a complete response compared with 60% of seronegative patients; P=0.043). Patients with multiple erythema migrans lesions were more likely than patients with single erythema migrans lesions (P<0.001) to have a positive antibody titer at baseline (63% compared with 17% for IgM; 39% compared with 16% for IgG). Fifty-seven percent of patients who had relapse were seronegative at the time of relapse. CONCLUSIONS: A 20-day course of amoxicillin was found to be an effective regimen for erythema migrans. Most patients were seronegative for Borrelia burgdorferi at the time of presentation with erythema migrans (65%) and at the time of relapse (57%). =====*===== III. AM J CLIN PATHOL: Polymerase chain reaction detection of Lyme disease: correlation with clinical manifestations and serologic responses --------------------------------------------------------------------- AUTHORS: Mouritsen CL, Wittwer CT, Litwin CM, Yang L, Weis JJ Martins TB, Jaskowski TD, Hill HR ORGANIZATION: Laboratory of Immunology and Infectious Diseases, Associated Regional and University Pathologists, Salt Lake City, UT, USA REFERENCE: Am J Clin Pathol 1996 May;105(5):647-54 ABSTRACT: The authors have developed a simple, nested polymerase chain reaction (PCR) assay for amplification of an outer surface protein A (OspA) gene fragment of Borrelia burgdorferi using rapid temperature cycling and ethidium bromide detection on agarose gels, and applied it to the diagnosis of Lyme disease in humans. With denaturing and annealing temperature spikes instead of holds, cycle times were less than 20 minutes for a 30-cycle amplification. Using this rapid cycle PCR technique, as few as 5 spirochetes per mL of phosphate buffered saline were detected. In addition, B burgdorferi DNA was detected from spirochetes that had been spiked into one of several types of human body fluids including serum, synovial fluid, and cerebrospinal fluid (CSF). A number of clinical samples, which had been tested for Lyme immunoglobulin M (IgM) and immunoglobulin G (IgG) antibody were also examined. In 29 serologic positive samples (14 IgG and IgM positive, 9 IgM alone and 6 IgG alone), B burgdorferi DNA was not detected. In contrast, nine serum samples and one synovial fluid from patients with definite clinical features of Lyme disease were found to be negative by EIA and Western blot analysis for IgG and IgM antibody, but contained B burgdorferi DNA, as detected by PCR. Polymerase chain reaction analysis of serum and synovial fluid may be of significant diagnostic value in Lyme disease, especially in the absence of a serologic response in early, partially treated and seronegative chronic disease. This is the first study to report an association between PCR positivity and the absence of a serologic response to Lyme borreliosis. =====*===== IV. INFECT IMMUN: Dominant recognition of a Borrelia burgdorferi outer surface protein A peptide by T helper cells in patients with treatment-resistant Lyme arthritis ------------------------------------------------------------------- AUTHORS: Kamradt T, Lengl-Janssen B, Strauss AF, Bansal G, Steere AC ORGANIZATION: Division of Rheumatology, Immunology, Department of Medicine, New England Medical Center Hospitals, Tufts University School of Medicine, Boston, Massachusetts USA REFERENCE: Infect Immun 1996 Apr;64(4):1284-9 ABSTRACT: In an earlier study, we found that T-cell lines (TCL) from five patients with treatment-resistant Lyme arthritis preferentially recognized Borrelia burgdorferi outer surface protein A (OspA), but TCL from four patients with treatment-responsive arthritis only rarely recognized this protein. Dominant T-cell recognition of an arthritogenic OspA epitope is one way in which the immune response against OspA might be involved in the pathogenesis of treatment- resistant Lyme arthritis. In an effort to test this hypothesis, we mapped the epitopes of 31 OspA-specific TCL and five T-cell clones derived from the synovial fluid or peripheral blood samples of three patients with treatment-resistant Lyme arthritis. Although each patient's TCL recognized a broad array of OspA peptides with different individual patterns, two regions of OspA were dominantly recognized. Each patient's TCL dominantly recognized a C-terminal epitope of OspA, ranging from amino acids (aa) 214 to 233 in one patient to 244 to 263 in another, and the TCL of all three patients dominantly recognized an epitope between aa 84 and 113. These dominant regions were confirmed by clonal analysis in one patient. Thus, the region of OspA between aa 84 and 113 was the dominant T-cell epitope shared by these three patients with treatment-resistant Lyme arthritis. If the T-cell response to OspA is involved in the pathogenesis of treatment- resistant Lyme arthritis, and epitope contained within aa 84 to 113 is a potentially arthritogenic epitope. =====*===== V. AM J TROP MED HYG: The spread of tick-borne borreliosis in West Africa and its relationship to sub-Saharan drought --------------------------------------------------------------------- AUTHORS: Trape JF, Godeluck B, Diatta G, Rogier C, Legros F, Albergel J, Pepin Y, Duplantier JM ORGANIZATION: Laboratoire de Paludologie, Service d'Hydrologie, Institut Francais de Recherche Scientifique pour le Developpement en Cooperation (ORSTOM), Dakar, Senegal REFERENCE: Am J Trop Med Hyg 1996 Mar;54(3):289-93 ABSTRACT: In West Africa, tick-borne relapsing fever is due to the spirochete Borrelia crocidurae and its geographic distribution is classically limited to the Sahel and Saharan regions where the vector tick Alectorobius sonrai is distributed. We report results of epidemiologic investigations carried out in the Sudan savanna of Senegal where the existence of the disease was unknown. A two-year prospective investigation of a rural community indicated that 10% of the study population developed an infection during the study period. Transmission patterns of B. crocidurae to humans and the small wild mammals who act as reservoirs for infection were similar to those previously described in the Sahel region. Examination of 1,197 burrows and blood samples from 2,531 small mammals indicated a considerable spread of the known area of distribution of A. sonrai and B. crocidurae. The actual spread of the vector and the disease has affected those regions where the average rainfall, before the start of the extended drought in West Africa, reached up to 1,000 mm and corresponds to the movement of the 750-mm isohyet toward the south from 1970 to 1992. Our findings suggest that the persistence of sub-Saharan drought, allowing the vector to colonize new areas in the Sudan savanna of West Africa, is probably responsible for a considerable spread of tick-borne borreliosis in this part of Africa. =====*===== 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] ----------------------------------------------------------------------- |
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