LymeNet Newsletter Volume 4 Issue 17

Volume: 4
Issue: 17
Date: 03-Dec-96

Table of Contents:

I. LETTERS: LDF NEJM Response Was Misguided II. LYMENET: LymeNet Flash Service Now Available III. LYMENET: Burrascano Guidelines Updates to Version 11 IV. J INFECT DIS: Pentoxifylline fails to prevent the Jarisch- Herxheimer reaction or associated cytokine release. V. CLIN INFECT DIS: Treatment of erythema migrans in pregnancy. VI. About The LymeNet Newsletter

Newsletter:

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

IDX# Volume 4 - Number 17 - 12/03/96 IDX# INDEX IDX# IDX# I. LETTERS: LDF NEJM Response Was Misguided IDX# II. LYMENET: LymeNet Flash Service Now Available IDX# III. LYMENET: Burrascano Guidelines Updates to Version 11 IDX# IV. J INFECT DIS: Pentoxifylline fails to prevent the Jarisch- IDX# Herxheimer reaction or associated cytokine release. IDX# V. CLIN INFECT DIS: Treatment of erythema migrans in pregnancy. IDX# VI. About The LymeNet Newsletter IDX#

I. LETTERS: LDF NEJM Response Was Misguided ---------------------------------------------- Sender: Douglas S. Dodge Date: November 18, 1996

To The Editor:

It is unfortunate that in his zeal to correct accounts in the press, Mr. Thomas Forschner [Executive Director, Lyme Disease Foundation] unwittingly urges the authors of the October 24 New England Journal of Medicine article, reviewed in the LymeNet Newsletter Vol#4 #15, to repeat a falsehood. He asked them for a press release to "restate the actual conclusion of your paper." This conclusion, in the abstract which you published, reads as follows: "About 90 percent of children with Lyme disease present with erythema migrans, which is an early stage of the disease. The prognosis is excellent for those with early Lyme disease who are treated promptly with conventional courses of antimicrobial agents."

The figure of 90 percent has appeared previously in the preachings of Eugene D. Shapiro, one of the authors of the present study, who had already reached this "conclusion" last year (American Journal of Medicine, April 24, 1995): "Careful prospective studies have found that nearly 90% of children with Lyme disease have erythema migrans."

I have seen no studies that back Shapiro. I have read that many practicing physicians believe that only 30 percent of those who are infected, children and adults, develop the rash; although Dr. J.J. Burrascano says 38 percent. I was not aware of any reports that children are less prone to develop the erythema migrans rash until I read the following at the beginning of the Discussion section of the present NEJM study: "Limited data suggest that as compared with adults, children with Lyme disease are more likely to present with fever and arthritis and are less likely to present with erythema migrans."

I am aware, however, that when the disinformation on Lyme disease by "peers" in Academia trickles down from their scientific journals, hundreds if thousands may be duped -- eventually to die in ignorance of the Lyme disease that shattered the quality of their lives.

May we pray that some of the irate mothers and fathers who read in TIME magazine (November 4, 1996) that "Parents who fear Lyme disease can rest easy; treatment with antibiotics cures infected children within four weeks" will be moved to help in running Shapiro and his ilk out of town before more young lives are ruined.

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II. LYMENET: LymeNet Flash Service Now Available -------------------------------------------------- Sender: Bill Stolow, President, The Lyme Disease Network of New Jersey, Inc. <[email protected]>

The LymeNet Flash is a new service on the LymeNet Web server which provides the members of the Lyme community with a bulletin board of events and activities.

To submit your event or activity, send e-mail to: [email protected] .

For more information, visit the Flash page at:

http://www.lymenet.org/flash/

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III. LYMENET: Burrascano Guidelines Updates to Version 11 ---------------------------------------------------------- Sender: Marc Gabriel, Editor-in-Chief <[email protected]> Date: November 22, 1996

Dr. Joseph J. Burrascano's Diagnosis and Treatment guidelines for Lyme borroliosis were revised and updated in October. This eleventh edition is now available on the LymeNet Web server at:

http://www.lymenet.org/

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IV. J INFECT DIS: Pentoxifylline fails to prevent the Jarisch- Herxheimer reaction or associated cytokine release. ---------------------------------------------------------------- AUTHORS: Remick DG, Negussie Y, Fekade D. Griffin G ORGANIZATION: Department of Pathology, University of Michigan, Ann Arbor, USA. REFERENCE: J Infect Dis 1996 Sep;174(3):627-30 ABSTRACT:

The Jarisch-Herxheimer reaction (JHR) observed after antibiotic treatment of relapsing fever caused by Borrelia recurrentis is associated with the systemic appearance of cytokines. The decrease of cytokine production and block of JHR was attempted by administering pentoxifylline prior to antibiotic treatment. Fifteen patients with confirmed relapsing fever were infused intravenously with pentoxifylline 90 min before intramuscular injection of penicillin; 4 patients were not treated with pentoxifylline. All patients developed JHR to varying degrees. Treatment with pentoxifylline failed to prevent fever, increase in pulse, respiration, or blood pressure, or decrease in white blood cell count. No reduction of circulating levels of tumor necrosis factor, interleukin 6, or interleukin-8 was observed with pentoxifylline treatment. Pentoxifylline did not prevent clearance of the B. recurrentis spirochetes. Thus, pentoxifylline treatment of patients with relapsing fever fails to prevent or diminish JHR or the associated
cytokine release observed after appropriate antibiotic treatment.

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V. CLIN INFECT DIS: Treatment of erythema migrans in pregnancy. ------------------------------------------------------------------ AUTHORS: Maraspin V, Cimperman J, Lotric-Furlan S, Pleterski-Rigler D Strle F ORGANIZATION: Department of Infectious Diseases, University Medical Centre, Ljubljana, Slovenia. REFERENCE: Clin Infect Dis 1996 May;22(5):788-93 ABSTRACT:

The course of the illness and the outcome of pregnancy were investigated in a prospective study of 58 consecutively enrolled pregnant women with typical erythema migrans at the University Medical Centre of Ljubljana, Slovenia. Thirteen patients (22.4%) acquired borrelial infection in the first trimester of pregnancy, 27 (46.6%) in the second trimester, and 18 (31%) in the third trimester. All patients were treated for 14 days: 2 (3.4%) with phenoxymethylpenicillin (1 million IU thrice per day), 3 (5.2%) with benzylpenicillin (10 million units twice per day), and 53 (91.4%) with ceftriaxone (2 g daily). For 51 of the 58 women (87.9%), the pregnancies were normal and the infants were born at term, were clinically healthy, and had normal psychomotor development. Of the remaining 7 pregnancies, 1 ended with a missed abortion and 5 with preterm birth; 1 of the preterm babies had heart abnormalities. One child born at term was found to have urologic abnormalities at 7 months of age. A causal relationship between borrelial infection
and fetal adverse effects has not been proven, and for at least some such cases a reasonable explanation (not associated with Lyme borreliosis) was found.

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