LymeNet Newsletter Volume 4 Issue 03

Volume: 4
Issue: 03
Date: 04-Mar-96

Table of Contents:

I. LYMENET: CT Governor Proposes To Close Agricultural Experiment Station II. J INFECT DIS: Ixodes dammini as a potential vector of human granulocytic ehrlichiosis (HGE) III. AM J MED: Misdiagnosis of erythema migrans IV. N ENGL J MED: An epidemiologic study of Lyme disease in southern Sweden V. LYMENET: Patient Diagnosed with "Lyme-Like" disorder (Q) VI. About The LymeNet Newsletter

Newsletter:

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

IDX# Volume 4 - Number 03 - 3/04/96 IDX# INDEX IDX# IDX# I. LYMENET: CT Governor Proposes To Close Agricultural IDX# Experiment Station IDX# II. J INFECT DIS: Ixodes dammini as a potential vector of IDX# human granulocytic ehrlichiosis (HGE) IDX# III. AM J MED: Misdiagnosis of erythema migrans IDX# IV. N ENGL J MED: An epidemiologic study of Lyme disease in IDX# southern Sweden IDX# V. LYMENET: Patient Diagnosed with "Lyme-Like" disorder (Q) IDX# VI. About The LymeNet Newsletter IDX#

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I. LYMENET: CT Governor Proposes To Close Agricultural Experiment Station --------------------------------------------------------- Sender: Mark K. Stowe <[email protected]>

In a surprise move that leaves minimal time for public commentary, Connecticut Governor Rowland has proposed the elimination of the Connecticut Agricultural Experiment Station. This exceptionally productive institution is the nation's oldest state agricultural experiment station (established in 1875), with a long continuous history of ground-breaking work including the discovery of vitamin A, and recent advances in the biological control of various insect pests. More importantly for the members of this list, work by several station scientists is pivotal to our growing understanding of Lyme and other tick-borne diseases in the state. The station provides a wide variety of services to ordinary citizens including extensive Lyme disease public education efforts.

Every citizen in CT who values scientific research and monitoring in the areas of agriculture, insect-borne diseases and food-safety, needs to write their state legislators ASAP. Addresses of state legislators and the governor can be found at http://www.state.ct.us/LEG/GUIDE/legis1.htm and http://www.state.ct.us/ .

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II. J INFECT DIS: Ixodes dammini as a potential vector of human granulocytic ehrlichiosis (HGE) ----------------------------------------------------------- AUTHORS: Pancholi P, Kolbert CP, Mitchell PD, Reed KD Jr, Dumler JS, Bakken JS, Telford SR 3rd, Persing DH ORGANIZATION: Division of Clinical Microbiology, Mayo Clinic, Rochester, MN REFERENCE: J Infect Dis 1995 Oct;172(4):1007-12 ABSTRACT:

Little is known about the epidemiology and mode of transmission of the agent of human granulocytic ehrlichiosis (HGE). Analyses of an engorged female Ixodes dammini tick removed from an HGE patient and 101 field-collected I. dammini and Dermacentor variabilis from three Wisconsin counties for Borrelia burgdorferi and Ehrlichia phagocytophila/Ehrlichia equi DNA revealed that the patient tick and 7 of 68 I. dammini ticks from Washburn County collected in 1982 and 1991 were positive for ehrlichial DNA; 10 ticks from the same collections were positive for B. burgdorferi.

Two specimens (2.2%) were positive for both organisms. Serologic evidence for exposure to the agent of HGE or its relatives was detected in 3 of 25 Lyme disease patients from the upper Midwest. These data argue that I. dammini is a common vector for transmission of both Lyme disease and HGE.

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III. AM J MED: Misdiagnosis of erythema migrans ------------------------------------------------ AUTHORS: Feder HM Jr, Whitaker DL ORGANIZATION: Department of Pediatrics, University of Connecticut Health Center, Farmington CT REFERENCE: Am J Med 1995 Oct;99(4):412-9 ABSTRACT:

BACKGROUND: Erythema migrans is a clinical diagnosis that carries possible long-term repercussions. Despite widespread awareness of the clinical presentation of erythema migrans, incorrect diagnosis occurs.

PATIENTS AND METHODS: We describe 13 cases in which erythema migrans was misdiagnosed and discuss some pitfalls in diagnosis. These cases were seen at a tertiary referral center in Connecticut, a state where Lyme disease is endemic. The patients selected for inclusion were those who most clearly illustrate potential difficulties involved in making the diagnosis of erythema migrans.

RESULTS: The diagnosis of erythema migrans was missed in 5 patients due to atypical presentations. Eight patients with skin eruptions closely mimicking erythema migrans were incorrectly diagnosed with erythema migrans.

CONCLUSIONS: There are pitfalls associated with the diagnosis of erythema migrans that may result in overdiagnosis or underdiagnosis.

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IV. N ENGL J MED: An epidemiologic study of Lyme disease in southern Sweden -------------------------------------------------------------- AUTHORS: Berglund J, Eitrem R, Ornstein K, Lindberg A, Ringer A, Elmrud H, Carlsson M, Runehagen A, Svanborg C, Norrby R ORGANIZATION: Department of Community Health Sciences, University of Lund, Sweden REFERENCE: N Engl J Med 1995 Nov 16;333(20):1319-27 ABSTRACT:

BACKGROUND. Lyme disease is the most common vector-borne infection in some temperate regions of the Northern Hemisphere. However, for most areas of endemic disease reliable epidemiologic data are sparse.

METHODS. Over a one-year period, we conducted a prospective, population-based survey of cases of Lyme disease in southern Sweden. The diagnosis was made on the basis of the presence of erythema migrans at least 5 cm in diameter or characteristic clinical manifestations such as arthritis, neuroborreliosis, and carditis.

RESULTS. We identified 1471 patients with Lyme disease, for an overall annual incidence of 69 cases per 100,000 inhabitants. The incidence varied markedly according to geographic region, and there were several areas where disease was widely prevalent. The incidence varied according to age, with the highest rates among people 5 to 9 and 60 to 74 years of age, but not according to sex. The most frequent clinical manifestation was erythema migrans (seen in 77 percent of all cases), followed by neuroborreliosis (16 percent) and arthritis (7 percent). Carditis was rare. A preceding tick bite was reported by 79 percent of the patients. Bites in the head and neck region were more common among children than among adults and were associated with an increased risk of neuroborreliosis.

CONCLUSIONS. Lyme disease is very common in southern Sweden, with a relatively high frequency of neurologic complications and arthritis. With the exception of the low incidence of carditis, the pattern of disease we found in Sweden was similar to that reported in the United States.

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V. LYMENET: Patient Diagnosed with "Lyme-Like" disorder (Q) -------------------------------------------------------------- Sender: Sandy <[email protected]>

Editor's note: Please send responses to: [email protected]

This letter comes from a person whose family doctor (of almost nine years) tells her that she always waits too long when sick, to get to the doctor. On Labor Day of 1995, I was sitting on my lanai watching my husband mow the lawn, when a so-called very small spider fell off the ceiling fan and bit me on the top of the left foot. I have never had a bug bite hurt so bad. The top of my foot went numb almost immediately. I didn't think much more about it that week until that Sunday when I noticed my left foot wanted to drag a little. That night the entire left side of my body tingled, and it alerted me a little. The next morning it happened again and my left arm and leg felt heavy. I called my doctor.

By the time I got to her office my heart was beating hard and fast and my blood pressure of normally 100-110/70-80 was now 185+ / 95+. Other than a very fast heart and heavy heart beat, the EKG was normal. After reducing my BP, and my foot still being numb, along with my left side being "tingly", I was sent to have an MRI because I was having stroke symptoms. I was sent to a neurologist who did a Lyme test and a B-12 test. B-12 test done because of rapid weight loss. Both tests were negative.

My condition worsened with Bells Palsy on the left side, seizure symptoms and occasional vertigo. EEG and LP were normal as well as all blood work on LD coming back negative. Diagnosis from neurologist: Post toxic neuropathy due to a spider. Also stated, stocking-glove nerve damage on both sides with a partial left foot drop. I was then sent to an infectious disease doctor by my family doctor. He looked at the diagnosis, and took one look at my foot and said I have a Lyme-like disease. He put me on an oral form of penicillin for 28 days and said I did not need to see him again, that I needed to continue seeing the neurologist for the nueropathy. I did well during the time I was on the cillin. I got rid of the foot drop, the Bells Palsy went away, as did the "night sweats" and the internal smell. This part is hard to explain, but there is a smell, an internal one.

About three days after completing the oral antibiotics, I woke up crying. I just felt really bad and didn't know why. I called my neurologist a few days later because all of my symptoms had returned, and I was scared. He said if I was running a low grade fever that I should call the infectious disease physician. I was, so I called. I saw the doctor again and he referred me to another neurologist for a second opinion. The second neurologist opinion was the same as the first. The infectious disease doctor said if my symptoms did not improve that I would be put on IV Rocephin for a 30 day period. He also stated that if my symptoms did not clear up after IV therapy that he wanted me to see a psychiatrist. I said that I was very open to this idea. If these symptoms are in my head then maybe we could do something about them.

FYI: I have never liked going to doctors and I hate hospitals. I have always avoided them as much as possible. During the third week of IV therapy, I noticed the symptoms coming back. At this point, I need to tell you one more symptom: I had and have pressure in my temples. I was told these are migraine headaches. Sometimes the headaches are hard to handle. (I never have had a migraine before this bug bite.)

After the completion of the IV therapy, I returned to the infectious disease doctor. I told him that I am "very up mentally," but the symptoms have returned. I said I was, and am, very much open to seeing a psychiatrist. At this point he told me I do not need one, that it is "this" , referring to the Lyme-like disease. He also told me that if the symptoms get bad again that he will put me back on oral antibiotics. He states he believes me about the symptoms.

Almost four weeks after completing the IV therapy: I have good days and bad days. I pace myself. When I get tired, I notice the symptoms are worse. I still get the pressure in my temples several times a day, almost every day, and if I get stressed, the pressure is even more frequent. Stress is something I can't handle like before. I tire very easily. I still have tingliness in my feet and sometimes legs. My right shoulder hurts quite a bit and my right arm and hand goes numb and hurts several times during the day, like a pinched nerve. My left arm and left hand also gets tingly, occasionally.

I still very often get the flu-like symptoms in the afternoon along with a low grade fever. I am also on BP medicine, I never had BP problems before the bug bite. Mentally, I try to stay "up." I try to think positively, and I am back in college, trying to keep my mind active. I sold my wallpapering business to my partner and only help her with 1-4 very light hours of work each week, if that much. When I work, I tire very easily and feel bad the rest of the day. Although staying mentally "up", I have to tell you that I'm scared. My symptoms are back and I feel like a time-bomb, wondering if they will flare up as bad as they were. (There have been times that I prayed that I wouldn't wake up the next day because I didn't want to feel so bad.) I wish I could see a psychiatrist or find a support group in my area. I have also heard many horror stories of people never fully recovering from this disease. So little is known.

All I know is that something terrible has happened to me that I did not ask for: it's altered my way of life and that of my husband's, also financially. I sometimes have a hard time believing that I am having these terrible symptoms, especially on a day when I feel good. Lyme and like diseases are wicked diseases. And I wonder, how bad do I have to feel before I go back to the doctor, and when I finally do go, will he believe me? It is also a very emotional disease. It is almost unheard of here in central Florida, but I know that I have something and it doesn't seem to be going away. And I know I had NONE of these symptoms before that spider bit me six months ago.

If you can, my plea to you is this: Should I pursue this further?

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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]>
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