LymeNet Newsletter Volume 8 Issue 05

Volume: 8
Issue: 05
Date: 24-May-00

Table of Contents:

I. LYMENET: LymeNet Headlines II. REV PRAT: Deafness of infectious origin III. EUR NEUROL: Chronic fatigue syndrome in patients with Lyme borreliosis IV. J INFECT DIS: Status of Borrelia burgdorferi infection after antibiotic treatment and the effects of corticosteroids: An experimental study V. TRANSFUSION: Fulminant babesiosis treated with clindamycin, quinine, and whole-blood exchange transfusion VI. ABOUT THE LYMENET NEWSLETTER

Newsletter:

*********************************************************************** * The National Lyme Disease Network * * http://www.LymeNet.org/ * * LymeNet Newsletter * *********************************************************************** Publishing Lyme disease information on the Internet since 1993

Volume 8 / Number 05 / 24-MAY-2000 INDEX

I. LYMENET: LymeNet Headlines II. REV PRAT: Deafness of infectious origin III. EUR NEUROL: Chronic fatigue syndrome in patients with Lyme borreliosis IV. J INFECT DIS: Status of Borrelia burgdorferi infection after antibiotic treatment and the effects of corticosteroids: An experimental study V. TRANSFUSION: Fulminant babesiosis treated with clindamycin, quinine, and whole-blood exchange transfusion VI. ABOUT THE LYMENET NEWSLETTER

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I. LYMENET: LymeNet Headlines --------------------------------

* The Newark Star Ledger has published an extensive report on Lyme vaccine recipients suffering from debilitating side effects. Off the record, one FDA official conceded that there are concerns about the reactions. However, the manufacturer of the vaccine continues to deny any problems with their product. [23-May-2000]

* The New York Times reported on the Lyme disease treatment controversy in their May 23 edition. The article contains quotes from the major players in the debate. [23-May-2000]

* The Lyme Disease Association of New Jersey, Inc., LDANJ, is making new funds available for researchers seeking to unlock the mysteries of Chronic Lyme disease. Click here for the details and the grant application. [20-MAY-2000]

* The LymeNet Pictures pages have been updated with images of ticks and Lyme rashes. [18-May-2000]

For more information on these headline stories, visit the LymeNet web site at: http://www.LymeNet.org

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II. REV PRAT: Deafness of infectious origin --------------------------------------------- AUTHORS: Sauvaget, E.; Tran Ba Huy, P. ORGANIZATION: Service ORL, Hopital Lariboisiere, Paris. REFERENCE: Rev Prat 2000 Jan 15;50(2):150-5 ABSTRACT:

A large number of cases of deafness is due to infection. Both viral and bacterial agents can induce lesions of the middle ear, the inner ear and/or of the cochlear-vestibular nerve. The ear is reached through the Eustachian tube, the outer ear or the subarachnoid spaces. The characteristics of infection-induced hearing loss depend on the infectious agent and on the site of infection. We discuss successively the characteristics of deafness caused by infection of the middle ear, represented by acute and chronic otitis of common or mycobacterial origin, by infection of the inner ear with bacterial labyrinthitis and otosyphilis, and lastly, neurolabyrinthitis of viral origin or due to Lyme disease.

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III. EUR NEUROL: Chronic fatigue syndrome in patients with Lyme borreliosis ---------------------------------------------------------------- AUTHORS: Treib, J.; Grauer, M. T.; Haass, A.; Langenbach, J.; Holzer, G.; Woessner, R. ORGANIZATION: Department of Neurology, University Hospital of the Saarland, Homburg, Germany. REFERENCE: Eur Neurol 2000;43(2):107-9 ABSTRACT:

Several authors have reported a chronic fatigue-like syndrome in patients that have suffered from Lyme borreliosis in the past. To further investigate this suspicion of an association without sample bias, we carried out a prospective, double-blind study and tested 1, 156 healthy young males for Borrelia antibodies. Seropositive subjects who had never suffered from clinically manifest Lyme borreliosis or neuroborreliosis showed significantly more often chronic fatigue (p = 0.02) and malaise (p = 0.01) than seronegative recruits. Therefore we believe it is worth examining whether an antibiotic therapy should be considered in patients with chronic fatigue syndrome and positive Borrelia serology.

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IV. J INFECT DIS: Status of Borrelia burgdorferi infection after antibiotic treatment and the effects of corticosteroids: An experimental study ------------------------------------------------------------------- AUTHORS: Straubinger, R. K.; Straubinger, A. F.; Summers, B. A.; Jacobson, R. H. ORGANIZATION: James A. Baker Institute for Animal Health, College of Veterinary Medicine, Cornell University, Ithaca NY, 14853, USA. [email protected] REFERENCE: J Infect Dis 2000 Mar;181(3):1069-81 ABSTRACT:

Sixteen specific-pathogen-free beagles were infected with Borrelia burgdorferi. Three groups of 4 dogs were treated with antibiotics for 30 consecutive days starting 120 days after tick exposure; 4 dogs were untreated controls. At day 420 after tick exposure and again before euthanasia, 2 dogs of each group were treated with prednisone for 14 days. All dogs contracted infection and 11 developed acute arthritis 50- 120 days after exposure. After day 120, one of 12 antibiotic-treated dogs and 2 of 4 untreated dogs became lame. Antibiotic therapy reduced the frequency of Borrelia-positivity in subsequent skin biopsy samples. After prednisone treatment, both control dogs developed severe polyarthritis. At euthanasia, single tissues of the antibiotic-treated dogs and multiple tissues of all control dogs were Borrelia-positive by polymerase chain reaction. Viable spirochetes were not recovered from antibiotic-treated dogs. Two antibiotic-treated dogs showed histologic evidence of minimal lesions, whereas all control dogs had mild polyarthritis with
periarteritis.

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V. TRANSFUSION: Fulminant babesiosis treated with clindamycin, quinine, and whole-blood exchange transfusion ----------------------------------------------------------------- AUTHORS: Dorman, S. E.; Cannon, M. E.; Telford, S. R.; Frank, K. M.; Churchill, W. H. ORGANIZATION: Division of Hematology, Department of Medicine, and the Department of Pathology, Brigham and Women's Hospital, Boston, MA 02215, USA. REFERENCE: Transfusion 2000 Mar;40(3):375-80 ABSTRACT:

BACKGROUND: Babesiosis is an increasingly recognized parasitic infection with manifestations that range from a subclinical or mild flu- like illness to life-threatening disease. Risk factors that may be associated with a more severe clinical course include immunosuppression, splenectomy, and advanced age. The most effective chemotherapeutic regimen, clindamycin plus quinine, is sometimes ineffective in cases of severe disease. CASE REPORT: A previously healthy, 58-year-old man was infected by Babesia microti, presumably through a tick bite. He developed fulminant disease characterized by severe hemolytic anemia, disseminated intravascular coagulation, acute renal failure, and respiratory failure. There was no history of splenectomy or immunodeficiency. He was given oral clindamycin (300 mg/4x/day) 2 days before admission. Oral quinine (650 mg/3x/day) was added upon hospitalization. There was no clinical improvement despite antibiotic therapy with clindamycin and quinine. On the second hospital day, a
whole-blood exchange transfusion was performed to simultaneously lower the parasite load and replace the patient's plasma. With an automated blood cell separator, 87 percent of the patient's total blood volume was exchanged. As replacement fluid, 6.7 L of packed RBCs reconstituted with FFP (average Hct, 33%) was used. The patient's Hct increased from 26.9 percent before the exchange to 28.3 percent after the exchange. The percentage of parasitized RBCs decreased from 13.8 percent just before exchange to 4.2 percent immediately after exchange. There was rapid clinical improvement after the whole-blood exchange transfusion. The patient's subsequent clinical course was marked by a disappearance of the parasitemia and continued slow, general improvement. Therapy with clindamycin was continued for 14 days after the exchange transfusion and quinine for 17 days. CONCLUSION: In cases of severe babesiosis, prompt institution of whole-blood exchange transfusion, in combination with appropriate antimicrobial therapy, can be life-saving.

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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: http://newsletter.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]> 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] -----------------------------------------------------------------------