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Volume: 2
Issue: 03
Date: 04-Mar-94

Table of Contents:

I.    ANNOUNCEMENT: Patients sought for LD neuroborreliosis study
II.   ANNOUNCEMENT: VI Int'l Conference on Lyme Borreliosis
III.  WASHINGTON POST: Infectious Disease Tracking Infrastructure
      "All but Collapsed"
IV.   AM J PUBLIC HEALTH: Antibodies to Borrelia burgdorferi and
      Tick Salivary Gland Proteins in New Jersey Outdoor Workers
V.    Q&A: Roxithromycin and Lyme
VIII. How to Subscribe, Contribute, and Get Back Issues


*                  The National Lyme Disease Network                  *
*                         LymeNet Newsletter                          *

IDX#                Volume 2 - Number 03 - 3/04/94
IDX#                            INDEX
IDX#  I.    ANNOUNCEMENT: Patients sought for LD neuroborreliosis study
IDX#  II.   ANNOUNCEMENT: VI Int'l Conference on Lyme Borreliosis
IDX#  III.  WASHINGTON POST: Infectious Disease Tracking Infrastructure
IDX#        "All but Collapsed"
IDX#  IV.   AM J PUBLIC HEALTH: Antibodies to Borrelia burgdorferi and
IDX#        Tick Salivary Gland Proteins in New Jersey Outdoor Workers
IDX#  V.    Q&A: Roxithromycin and Lyme
IDX#  VIII. How to Subscribe, Contribute, and Get Back Issues


   "Many colleagues in the clinic and laboratory persistently fail
    to acknowledge the problem of persistence, following the
    motto 'What I can't see, doesn't exist.'  Unfortunately,
    however, Borrelia are easy to overlook in patient samples, and
    not so easy to detect ... the colleagues in America, particularly,
    have failed to accept the problems of treatment and the possible
    persistence of B. burgdorferi."

 -- Dr. Vera Preac-Mursic of the Max Von Pettenkofer Institute in
    Munich, Germany, in a letter to Dr. Kenneth Leigner of Armonk,
    NY, dated November 22, 1993.


The last issue of the LymeNet Newsletter featured questions from
readers.  The purpose of this Q&A section is to solicit a response
from subscribers, as the editors unfortunately don't have all the
answers.  If you have any ideas on the issues raised by those
questions, please send them in (via e-mail or FAX).


I.    ANNOUNCEMENT: Patients sought for LD neuroborreliosis study

Dr. Brian Fallon, assistant professor of psychiatry at Columbia
University, is conducting a free research study on the
neuropsychological aspects of late Lyme disease.  The study hopes to
begin to provide answers to a major medical controversy: "Among
patients with persistent cognitive deficits, such as memory problems,
who have already been treated with one course of IV antibiotics, does
a second course of IV antibiotics help or not?"  If eligible, patients
will receive free neuropsychological testing and free functional brain
imaging (regional cerebral blood flow studies and/or SPECT scans)
*before* their second course of IV antibiotics and 12 weeks later.

For this study, Dr. Fallon is seeking patients age 18-65 with
persistent symptoms who have already received once course of IV
antibiotics.  He is interested in hearing from two groups of patients:
(1) patients with persistent memory problems who are about to start a
second course of IV antibiotics; and (2) patients with persistent
memory problems who plan to be off antibiotics for a while to see if
the symptoms resolve on their own with time.

Dr. Fallon is also seeking patients with Lyme arthritis but no central
neurological symptoms who are about to start a second course of IV
antibiotics.  Just like the neuroLyme patients, these patients will get
free neuropsych tests and brain imaging at baseline and at week 12.

The benefit of this study to the patients is the free
neuropsychological studies and the free brain imaging.  Results will be
sent to the patient's doctor at the end of the three month study.  The
benefit to society is that information may be obtained that will help
answer a major medical controversy.

If interested, please call Dr. Brian Fallon at 212-960-2487.


II.   VI Int'l Conference on Lyme Borreliosis
DATE: June 19 - 22, 1994
LOCATION: Palazzo della Cultura e del Congressi, Bologna, Italy

The purpose of the VI International Conference of Lyme Borreliosis is
to provide an interdisciplinary forum at which investigators involved
in basic, applied and clinical worldwide research can meet in order to
review recent developments in all areas concerning Lyme disease.

The Conference will consist of oral and poster presentations.  An
Opening Lecture by invited speakers will introduce each scientific
session.   The following main topics will be addressed: biology,
genetics, pathogenicity, immunity, clinical manifestations, diagnostic
tests, therapy, ecology, epidemiology and control.

For more information and to register, contact:

        SOGEPACO Convention and Travel
        Piazza Constituzione 5/c
        I-40128 Bologna Italy
        Phone: +39-51-6375111
        FAX:   +39-51-6375149


III.  WASHINGTON POST: Infectious Disease Tracking Infrastructure
     "All but Collapsed"
HEADLINE: Gaps in Tracking Wide Range of Diseases; Public Health
         Officials Say Surveillance of Infections Is Inadequate
DATE: January 4, 1994, Tuesday
BYLINE:  Sally Squires,  Washington Post Staff Writer

Stretched thin by budget cuts, public health departments throughout the
country are struggling to track infectious disease outbreaks. Some
even have trouble keeping tabs on such reportable illnesses as
tuberculosis, measles and whooping cough.

"Being a reportable disease in this country really means almost
nothing," said Michael Osterholm, state epidemiologist in Minnesota
and president of the Council of State and Territorial Epidemiologists.
"The infrastructure for reportable diseases has all but collapsed."

Public health officials say the reporting system is eroded by funding
cutbacks and the continuing difficulty of tracking disease outbreaks
in inner cities and far-flung rural areas.  "We are making decisions
flying by the seat of our pants," Osterholm said.


Adding to the difficulties is the lack of a clear definition of what
constitutes a reportable illness.  The CDC is the federal agency in
charge of tracking infectious illnesses in the nation.  The CDC
monitors not only familiar maladies, such as measles, mumps, rubella
and polio, but also less well-known afflictions, such as murine typhus
fever and tularemia.

But the list is far from complete.  The CDC tracks only 49 reportable
diseases.  Scarlet fever, strep throat infections, infectious
mononucleosis and the common sexually transmitted disease chlamydia are
among those not monitored by CDC.

"CDC and the federal government have no direct ability or statute to
say to states, 'You have to report this disease,' " said Michael Gregg,
former director of the epidemiology office at the CDC and a past editor
of its Morbidity and Mortality Weekly Review.  Reporting is at the
discretion of each state.

With one exception -- cholera, whose national surveillance was mandated
by federal law in the 19th century -- the CDC does not even decide
which illnesses will be reportable each year.  That decision is largely
left up to the Council for State and Territorial Epidemiologists, a
private, nonprofit group that recommends annually which illnesses ought
to be reported to the CDC by state health departments.  But the final
choice is made by each state.


Among the other problems cited by Osterholm's study:

* Lack of funding to track measles, mumps, rubella, tetanus and polio --
illnesses that can be prevented by childhood immunizations. Less than 7
percent of the total budget for infectious disease surveillance --
$ 5.2 million -- goes annually to track these illnesses despite
outbreaks in recent years and low rates of immunization among
youngsters in some areas.

* Inadequate efforts to monitor drug-resistant infections, such as
certain types of tuberculosis and some day-care center illnesses.  Only
$ 55,000 was spent nationwide in 1992 by public health departments to
track drug-resistant bacterial and viral infections, despite rising
reports of outbreaks of these dangerous illnesses.

* Staff shortages, particularly at local and state levels.  In 1992,
the study found, 70 percent of all public health employees involved
in surveillance were busy tracking AIDS, tuberculosis and sexually
transmitted diseases. That left 30 percent -- equivalent to 486
full-time employees -- to monitor all other infections, including
outbreaks of Lyme disease, meningitis, Reye's syndrome, Legionnaire's
disease and hanta virus, as well as serious infections such as
giardiasis and hepatitis, found in day-care centers, hospitals and
nursing homes.

The surveillance of diseases that does occur can fall short.
Staff-depleted health departments, for example, are not always able
to check whether a patient with hepatitis or E. coli works in a
restaurant or in a day-care center, where the disease might be spread.

Some diseases are also under-reported because physicians don't see the
need to report them, a problem cited in a 1989 CDC study, which found
variances of 6 to 90 percent for commonly reported illnesses.  "What
does he [the doctor] get out of it?" Gregg said.  "What does the
patient get out of it? There is often a lackluster view of local
health departments by private physicians."

Penalties for noncompliance vary and are rarely enforced.  "In theory,
we could report them to the board of medical examiners and ask to have
their wrists slapped," said Richard Hopkins of the Florida Department
of Health and Rehabilitative Services. "In practice, there are no

Some states enhance reporting of infectious diseases by requiring
laboratories, hospitals and clinics to notify health departments when
a patient tests positive for certain illnesses.

"We are still able to respond to crises," said Guthrie Birkhead,
director of the bureau of communicable disease control for New York
State.  But the routine, day-to-day efforts to report, track and stifle
a disease, he said, "are much more difficult and probably less
coordinated than [they] should be."


IV.   AM J PUBLIC HEALTH: Antibodies to Borrelia burgdorferi and Tick
     Salivary Gland Proteins in New Jersey Outdoor Workers
AUTHORS: Schwartz BS, Goldstein MD, Childs JE
REFERENCE: Am J Public Health 1993;83:1746-1748

In 1990, a second cross-sectional study of outdoor workers (n=758) at
high risk for Lyme disease was conducted.  A questionnaire was
administered, and antibodies to Borrelia burgdorferi and tick salivary
gland proteins (antitick saliva antibody, a biological marker of tick
exposure) were assayed by enzyme-linked immunosorbent assay.  The
statewide Lyme disease seroprevalence increased from 8.1% in 1988 to
18.7% in 1990.  Antitick saliva antibody varied by county and was
associated with measures of self-reported tick exposure.  The data
suggest that the prevalence of B. burgdorferi infection increased in
New Jersey outdoor workers from 1988 to 1990.


V.    Q&A: Roxithromycin and Lyme
Sender: [email protected] (Llyod Miller, DVM)

In response to Brian's comments in LymeNet Newsletter V2#2.

I have observed the same response to the various antibiotics that he
describes.  Initially the antibiotic seems to have a positive effect
(not placebo!) but then in time, and that time varies greatly, the
person's condition levels off and maintains for some time and then
begins to regress with increase in symptoms and severity of symptoms.
I have made this observation in my own family experience with the
disease and have heard of it from many other Lyme patients.

I have no idea why this happens.  If the reason for persistent disease
is persistent infection then one could speculate that it is possible
that initially the bacterium is suppressed or its population is
diminished by the antibiotic but then it develops a population
resistant to the effect of the antibiotic and begins to multiply again.
Often changing antibiotic at this point begins the process all over

If this is the case I wonder if an antibiotic resistant population is
being produced within the patient so that over time the bacterium may
develop resistant populations to most antibiotics.  However, if that's
the case why does going back to an antibiotic used in the past on the
same patient follow the same pattern?  I have also heard or read
someplace that bacteria lose their resistance quickly (within several
generations) if they are no longer exposed to the antibiotic.
Is there a bacteriologist out there who can comment on this?

Specifically about Roxy with or without Bactrim.  I have seen the same
experience of initial improvement with a long period of stability
(months) and then the same decline as with all other antibiotics.
It turned out to be no more effective than any other treatment
protocol.  There may be some difference in antibiotic sensitivity by
geographic region and he may be experiencing this.

Of course all this is anecdotal.  You know that if you measure and
observe results on a patient it is considered anecdotal but if you do
the same on a rat then it is SCIENCE!



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