LymeNet Newsletter Volume 4 Issue 04

Volume: 4
Issue: 04
Date: 18-Mar-96

Table of Contents:

I. LYMENET: Early Detection of Borrelia burgdorferi infection: to treat or not? II. LYMENET: CT Governor Proposes To Close Agricultural Experiment Station (Response) III. LYMENET: Research investigating hearing disorders and LD IV. LYMENET: Michigan Natole Case Is Not Over V. INT J MED MICROBIOL: Small mammals as reservoir hosts for Borrelia in Russia VI. About The LymeNet Newsletter

Newsletter:

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

IDX# Volume 4 - Number 04 - 3/18/96 IDX# INDEX IDX# IDX# I. LYMENET: Early Detection of Borrelia burgdorferi infection: IDX# to treat or not? IDX# II. LYMENET: CT Governor Proposes To Close Agricultural IDX# Experiment Station (Response) IDX# III. LYMENET: Research investigating hearing disorders and LD IDX# IV. LYMENET: Michigan Natole Case Is Not Over IDX# V. INT J MED MICROBIOL: Small mammals as reservoir hosts IDX# for Borrelia in Russia IDX# VI. About The LymeNet Newsletter IDX#

I. LYMENET: Early Detection of Borrelia burgdorferi infection: to treat or not? ----------------------------------------------------------------- Sender: Dr. Edmond Godfroid <[email protected]> Organization: Service de Genetique Appliquee, Universite Libre de Bruxelles

You will find enclosed a letter that we have recently published in THE LANCET (Vol. 346 July 29, 1995, p. 321). This letter describes a very unique case of Borrelia burgdorferi infection. The bacteria was rapidly detected by PCR in the urine samples, three days after the bite. The patient was treated on day four without having any of the known clinical symptoms associated with Lyme disease. During the course of treatment, PCR data showed that the bacteria was eradicated by day fifteen. We believe that the decision to treat was justified in the light of possible chronic symptoms which may appear later. We think this is an open ethical question requiring further debate in view of existing sensitive technologies in the detection of early bacterial infection. ---

SIR - In response to Vartiovaara (April, p 842) and related letters (June 3, p 1436-37), we present the following data. At the beginning of May, one of our collaborators was bitten by a nymph of Ixodes ricinus. This 32 year-old man lives in an area endemic of Lyme borreliosis. The nymph was examined by PCR with Borrelia burgdorferi sensu lato and Borrelia species-specific primers, which target the OspA gene[1]. The results indicated that the nymph was infested with a Borrelia strain belonging to the B. garinii species. In view of these results, urine was obtained from our colleague daily (from day 2 to day 30 after the bite) and was analyzed by PCR with the OspA specific primers[1]. Before the bite, his urine samples had been regularly analyzed by PCR as a negative control of our routine testing procedure for Lyme disease patients, and were always negative. The results clearly indicated that his urine was infected from day 3 by a B. garinii strain. Although the patient showed none of the usual clinical symptoms
associated with Lyme disease, he received on day 4 an antibiotic treatment based on oral doxycyclin (200 mg per day) for 3 weeks. After the onset of the therapy, urine remained positive by PCR assay until day 15 and became negative on day 16. For thirty days after the bite, no erythema migrans, neurological deficits or arthritic inflammations were noted. In addition, the patient's immunological status (IgM and IgG), tested by ELISA at the start (day 3) of infection and after treatment (day 30), remained negative. This finding is not surprising since it is well known that detectable immunological response to B. burgdorferi infection takes 3 to 6 weeks to appear after the bite and that early antibiotic therapy can prevent the development of specific antibodies[2]. The decision to give an antibiotic treatment in the absence of clinical manifestations (erythema migrans or an immune response) of Lyme disease was taken solely on the basis of the PCR data. There is no known clinical evidence to indicate whether the patient was
likely to develop the disease or not. The treatment was applied on a purely ethical basis, carefully weighing risks and benefits of an immediate or delayed antibiotic therapy. In view of the dramatic cases previously reported[3,4], we believe that the decision to treat immediately had to be taken and thus we concur with Dr. Oksi's comments (June 3, p 1437) that "Theoretically, patients with positive PCR results are those who most probably will benefit from treatment or retreatment."

This work was supported by a grant from the walloon Region of Belgium (Convention ULB -Rigion Wallonne No 2267).

Edmond Godfroid (1), Patrice Driesschaert (2), and Alex Bollen (1).

(1) Laboratoire de Ginitique Appliquie, Universite Libre de Bruxelles, Rue de l'Industrie, 24, B-1400 Nivelles, Belgium. (2) Hospital Sainte Therese, Chaussie d'Houffalize, 1, B-6600 Bastogne, Belgium.

References : - 1. Demaerschalck I, Ben Messaoud A, De Kesel M, Hoyois B, Lobet Y, Hoet P et al. Simultaneous presence of different Borrelia burgdorferi genospecies in biological fluids of Lyme disease patients. J. Clin Microbiol. 1995; 33: 602-08.

2. Wilske B, Preac-Mursic V. Microbiological Diagnosis of Lyme Borreliosis. In: Weber K, Burgdorfer W, editors. Aspects of Lyme Borreliosis. Springer-Verlag, 1992:267-300.

3. Olivier R, Godfroid E, Heintz R, Bigaignon G, Bollen A. Lyme Borreliosis in a Patient with Severe Multiple Cranial Neuropathy. Clin. Infect. Dis. 1995; 20:200.

4. Oksi J, Marjamdki M, Koksi K, Nikoskelainen J, Viljanen MK. Bilateral facial palsy and meningitis caused by borrelia double infection. Lancet 1995; 345:1583-84.

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II. LYMENET: CT Governor Proposes To Close Agricultural Experiment Station (Response) -------------------------------------------------------------------- Sender: Ellie <[email protected]>

There is a great deal of controversy about this issue and many CT residents are getting on the band-wagon to preserve the institution. It's a joy to access. The first deer tick I ever found on me I took to the Agricultural Station where entomologist Kenneth Welch identified it as Ixodes dammini adult female. The date was 5/22/89! At the time, few people had seen this critter and he asked if he might have it as a specimen. But, it was already promised to a vet friend who wanted it for the same reason. Today, deer ticks are all too plentiful!

Gardeners make great use of the resources available at the Aggie Station -- for testing soil, insect ID, planting and growing problems. And each year they hold a Plant Science Day. It's an open house with many exhibits and speakers covering a host of topics -- one of which usually deals with Lyme disease.

If we lose this facility we will really have lost a treasure!

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III. LYMENET: Research investigating hearing disorders and LD -------------------------------------------------------------- Sender: Marsha Johnson <[email protected]>

I am in the early stages of developing a project which will assess the hearing status of individuals with Lyme disease who meet federal standards. I am interested in this project as several friends of mine have the disease and have noted various subjective effects, including vestibular disorders and fluctuating hearing losses.

I will complete my Master's program in Audiology in June 1996. I am working with a Ph.D. at Portland State University and will submit a grant for funding for this project. I am seeking interested individuals who wish to participate, even in different areas of the USA, via exam by audiologists in different agencies, who will co-op to provide services and test results.

I am also interested in any anecdotal and subjective impressions of the effects of Lyme disease as my research so far into the literature has demonstrated a marked fluctuation in the symptomology. Therefore I would like to hear from people who have suffered hearing loss in the past as well.

If you would like to participate in this project, please contact me via e-mail or snail-mail at:

Marsha Johnson 4307 NE Brazee Portland, OR 97213

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IV. LYMENET: Michigan Natole Case Is Not Over ----------------------------------------------- Sender: Kim Weber <[email protected]> Organization: Michigan Lyme Disease Association

Dr. Natole, a Saginaw physician, has treated hundreds of cases of LD since 1989. He has been investigated for overdiagnosis and overtreatment of LD for over two years by the State Attorney General. He is being charged for overdiagnosing in a nonendemic area. However, 90% of surveillance has been devoted to the upper peninsula and not adequately studied in the remainder of Michigan. The Attorney General is maintaining that there is one (1) standard of care for treatment of LD (e.g., Dr. Allan Steere's philosophy of 2-4 weeks antibiotic treatment) and that Dr. Steere is the only recognized expert in Lyme disease treatment.

Although Lyme disease care in Michigan may soon be determined with Dr. Natole's case - this also has implications nationally - with other doctors being targeted. This could be YOUR doctor next.

Now, the Michigan Medical Review Board has voted to form a subcommittee to rewrite Judge Renee A. Osburn's decision vindicating Dr. Natole from 35 of 37 cases. Jane Huegel, President of the Michigan Lyme Disease Association, is hoping for a large show of support for Dr. Natole.

Please help with your letter to Governor Engler and President Clinton. Please emphasize that this investigation must stop and all charges against Dr. Natole are unfounded and should be dropped. Also mention if you have not been cured with short-term treatment.

The Governor's address is:

THE HONORABLE GOVERNOR ENGLER STATE CAPITOL BUILDING LANSING, MI 48909

We are also planning to join the LDF in the national Wake Up Washington Rally on May 14th to send a strong message to our Senators of the scope of our problems with denial of the true incidence of LD and physician harassment.

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V. INT J MED MICROBIOL: Small mammals as reservoir hosts for Borrelia in Russia ----------------------------------------------------------- AUTHORS: Gorelova NB, Korenberg EI, Kovalevskii YV, Shcherbakov SV ORGANIZATION: Vector Laboratory, Gameleya Institute for Epidemiology and Microbiology, Russian Academy of Medical Sciences, Moscow. REFERENCE: Int J Med Microbiol Virol Parasitol Infect Dis 1995 Apr;282(3):315-22 ABSTRACT:

In 1992-1993, a total of 29 isolates of Borrelia were obtained from small mammals captured in taiga forests of the Perm' region: 26 isolates were obtained from Clethrionomus glareolus and one each from C. rufocanus, Microtus oeconomus, and Apodemus sylvaticus. Isolation of Borrelia was performed by plating the animal material on BSK-II medium. Most isolates (86.2%) were obtained from the urinary bladder, the rest from the heart and spleen. According to the results of IFA with a set of monoclonal antibodies, isolates did not contain Borrelia burgdorferi sensu stricto. Preliminary data suggest that they can belong to B. garinii and B. afzelii. On the basis of the abundance of animals, it is suggested that C. glareolus, a background species among small mammals inhabiting the study region, is the main reservoir host for Borrelia.

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