LymeNet Newsletter Volume 5 Issue 05

Volume: 5
Issue: 05
Date: 05-May-97

Table of Contents:

I. LDRC: Emerging Tick-Borne Diseases in the Western United States Conference September 13 II. INFECTION: Borrelia burgdorferi DNA in the urine of treated patients with chronic Lyme disease symptoms. A PCR study of 97 cases III. J OROFAC PAIN: Lyme disease: considerations for dentistry IV. RETINA: Long-term follow-up of chronic Lyme neuroretinitis V. J CLIN MICROBIOL: Persistence of Borrelia burgdorferi in experimentally infected dogs after antibiotic treatment VI. LYMENET: Members of Congress Send Lyme Message to NIH Director VII. About The LymeNet Newsletter

Newsletter:

*********************************************************************** * The National Lyme Disease Network * * http://www.lymenet.org/ * * LymeNet Newsletter * ***********************************************************************

IDX# Volume 5 / Number 05 / 05-MAY-97 IDX# INDEX IDX# IDX# I. LDRC: Emerging Tick-Borne Diseases in the Western United IDX# States Conference September 13 IDX# II. INFECTION: Borrelia burgdorferi DNA in the urine of treated IDX# patients with chronic Lyme disease symptoms. A PCR study of IDX# 97 cases IDX# III. J OROFAC PAIN: Lyme disease: considerations for dentistry IDX# IV. RETINA: Long-term follow-up of chronic Lyme neuroretinitis IDX# V. J CLIN MICROBIOL: Persistence of Borrelia burgdorferi in IDX# experimentally infected dogs after antibiotic treatment IDX# VI. LYMENET: Members of Congress Send Lyme Message to NIH IDX# Director IDX# VII. About The LymeNet Newsletter IDX#

I. LDRC: Emerging Tick-Borne Diseases in the Western United States Conference September 13 --------------------------------------------------------------------- Sender: The Lyme Disease Resource Center

A day-long conference featuring the ecology, diagnosis and treatment of the latest emerging tick-borne diseases, ehrlichiosis and babesiosis, as well as Lyme disease. The conference will be held at the Vector Control Conference Center in Culver City, five miles from the Los Angeles airport. The fee for the conference is US $125.00. CME credit is being arranged. For more information, please contact Dr. James Katzel at 707-462-1097 or Rene Landis <[email protected]> at 702-256-9776.

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II. INFECTION: Borrelia burgdorferi DNA in the urine of treated patients with chronic Lyme disease symptoms. A PCR study of 97 cases -------------------------------------------------------------------- AUTHORS: Bayer ME, Zhang L, Bayer MH ORGANIZATION: Fox Chase Cancer Center, Philadelphia, PA 19111 REFERENCE: Infection 1996 Sep-Oct;24(5):347-53 ABSTRACT:

The presence of Borrelia burgdorferi DNA was established by PCR from urine samples of 97 patients clinically diagnosed as presenting with symptoms of chronic Lyme disease. All patients had shown erythema chronica migrans following a deer tick bite. Most of the patients had been antibiotic-treated for extended periods of time. We used three sets of primer pairs with DNA sequences for the gene coding of outer surface protein A (OspA) and of a genomic sequence of B. burgdorferi to study samples of physician-referred patients from the mideastern USA. Controls from 62 healthy volunteers of the same geographic areas were routinely carried through the procedures in parallel with patients' samples. Of the 97 patients, 72 (74.2%) were found with positive PCR and the rest with negative PCR. The 62 healthy volunteers were PCR negative. It is proposed that a sizeable group of patients diagnosed on clinical grounds as having chronic Lyme disease may still excrete Borrelia DNA, and may do so in spite of
intensive antibiotic treatment.

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III. J OROFAC PAIN: Lyme disease: considerations for dentistry --------------------------------------------------------------- AUTHORS: Heir GM, Fein LA ORGANIZATION: TMD and Orofacial Pain Center, University of Medicine and Dentistry, New Jersey Dental School, Newark, NJ. REFERENCE: J Orofac Pain 1996 Winter;10(1):74-86 ABSTRACT:

Although Lyme disease has spread rapidly and it is difficult to diagnose, a review of the dental literature does not reveal many references to this illness. Dental practitioners must be aware of the systemic effects of this often multiorgan disorder. Its clinical manifestations may include facial and dental pain, facial nerve palsy, headache, temporomandibular joint pain, and masticatory muscle pain. The effects precipitated when performing dental procedures on a patient with Lyme disease must also be considered. This study discusses the epidemiology and diagnosis of Lyme disease, its prevention, and factors to consider when making a differential diagnosis. Dental care of the patient with Lyme disease and currently available treatments also are considered. Three case reports are presented.

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IV. RETINA: Long-term follow-up of chronic Lyme neuroretinitis ---------------------------------------------------------------- AUTHORS: Karma A, Stenborg T, Summanen P, Immonen I, Mikkila H, Seppala I ORGANIZATION: Department of Ophthalmology, University of Helsinki, Finland. REFERENCE: Retina 1996;16(6):505-9 ABSTRACT:

PURPOSE: The authors report sequential fluorescein angiographic and color photographic findings of the fundi and response to treatment in a patient with chronic Lyme neuroretinitis. METHODS: A Lyme enzyme-linked immunosorbent assay with purified 41-kd flagellin as antigen was used to detect immunoglobulin G and immunoglobulin M antibodies to Borrelia burgdorferi in serum, cerebrospinal fluid, and vitreous. The changes were documented by fluorescein angiography and color photography tests performed during a 5 1/2 year follow-up. RESULTS: The diagnosis of Lyme neuroretinitis was based on the history of erythema migrans and positive Lyme enzyme-linked immunosorbent assay tests from cerebrospinal fluid and vitreous and by the exclusion of other infectious and systemic diseases and uveitis entities. Fluorescein angiography results disclosed bilateral chronic neuroretinal edema with areas of cystoid, patchy, and diffuse hyperfluorescence peripapillary and in the macular areas. The hyperfluorescent lesions
enlarged despite a 9-month period of antibiotic therapy. CONCLUSION: Lyme borreliosis may cause neuroretinitis with unusual angiographic findings. Chronic Lyme neuroretinitis may be unresponsive to antibiotic therapy.

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V. J CLIN MICROBIOL: Persistence of Borrelia burgdorferi in experimentally infected dogs after antibiotic treatment -------------------------------------------------------------- AUTHORS: Straubinger RK, Summers BA, Chang YF, Appel MJ ORGANIZATION: James A. Baker Institute for Animal Health, College of Veterinary Medicine, Cornell University, Ithaca, New York 14853. <[email protected]> REFERENCE: J Clin Microbiol 1997 Jan;35(1):111-6 ABSTRACT:

In specific-pathogen-free dogs experimentally infected with Borrelia burgdorferi by tick exposure, treatment with high doses of amoxicillin or doxycycline for 30 days diminished but failed to eliminate persistent infection. Although joint disease was prevented or cured in five of five amoxicillin- and five of six doxycycline-treated dogs, skin punch biopsies and multiple tissues from necropsy samples remained PCR positive and B. burgdorferi was isolated from one amoxicillin- and two doxycycline-treated dogs following antibiotic treatment. In contrast, B. burgdorferi was isolated from six of six untreated infected control dogs and joint lesions were found in four of these six dogs. Serum antibody levels to B. burgdorferi in all dogs declined after antibiotic treatment. Negative antibody levels were reached in four of six doxycycline- and four of six amoxicillin- treated dogs. However, in dogs that were kept in isolation for 6 months after antibiotic treatment was discontinued, antibody levels
began to rise again, presumably in response to proliferation of the surviving pool of spirochetes. Antibody levels in untreated infected control dogs remained high.

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VI. LYMENET: Members of Congress Send Lyme Message to NIH Director -------------------------------------------------------------------- [Editor's Note: The following letter was sent to NIH Director Harold Varmus this month by two Members of Congress]

Dr. Harold E. Varmus, Director National Institute of Health 9000 Rockville Pike NIHB-1, Room 126 MSC 0148 Bethesda, MD 20892

Dear Dr. Varmus,

We are writing to urge you to make research on Lyme Disease a priority during fiscal years 1997 and 1998, including the development of a new and innovative direct detection laboratory test for Lyme. We also want to thank you for responding to the needs of those suffering from the long term consequences of acute and chronic Lyme disease, as evidenced by the current NIH intramural study of suitable markers of disease activity and the NIH-funded extramural study of treatment issues in chronic Lyme Disease, as well as the ongoing research conducted by the Rocky Mountain Laboratories of NIH into the Characteristics of the causative organism. All of these must continue.

As NIH advances a careful balance between both intramural and extramural programs for Lyme Disease, we urge you to adopt the following as research priorities;

1. Direct detection tests 2. Chronic Lyme Disease treatment 3. Neuropsychiatric manifestations of Lyme Disease 4. Pathology and pathogenesis

Direct detection tests; While acknowledging the important work NIH has funded in the area of direct testing, there is no universally acknowledged direct detection laboratory test for Lyme. As a result, it is clear to patients that the lack of reliable testing for diagnosis and cure is the single largest hindrance to proper diagnosis, treatment, and scientific inquiry. It also causes patients to endure years of worsening symptoms before receiving proper treatment because many existing tests -- such as Western blot analysis -- often yield false positive and false negative results.

Equally important, the lack of reliable testing leads to many conflicts between patients and insurance companies over antibiotic treatment coverage -- with patients on the losing side. Despite the lack of conclusive scientific evidence that 28 days of treatment is curative, many (if not most) insurance carriers deny coverage for Lyme treatment: in New Jersey alone, according to patient advocacy groups, some 30 percent of all Lyme cases are denied coverage initially, and nearly 80 percent are denied coverage after 28 days.

We firmly believe that before legislators consider mandated insurance coverage periods, we need to develop better laboratory tests so that physicians can differentiate between Lyme Disease, co-infections, and other conditions.

Chronic Lyme Disease treatment; Building upon the research being conducted intramurally and extramurally, NIH needs to aggressively encourage the development of many different treatment modalities, both antimicrobial and immunological. Any Program Announcements or Requests for Proposal should explicitly recognize the importance of enlisting the cooperation of physicians and patient groups in the studies, including the formation of advisory groups which include practicing physicians and patients.

Neuropsychiatric manifestations of Lyme Disease: As the disease is increasingly defined by its neurological effects, it is becoming clear that neuropsychiatric manifestations are some of the most disabling and troubling symptoms faced by patients. Again, the lack of reliable testing for Lyme often results in neuropsychiatric symptoms being misdiagnosed. In the case of children, this impact is most often noticed by their patents and teachers, and the toll of Lyme in terms of lost potential has been substantial.

Pathology and pathogenesis: Every practicing physician involved in treating chronic patients is stymied by the lack of pathology resources to aid in their diagnosis and understanding of Lyme Disease. Tissue and fluid samples have been stored for years in local practices. In addition, the pathogenesis of Lyme Disease is poorly understood.

We thank you for your thoughtful consideration to our constituents' requests and wish to reiterate that we are committed to working with you to ensure that NIH's important work in the area of Lyme Disease continues. Sincerely,

CHRISTOPHER H. SMITH, M.C. BENJAMIN A. GILMAN, M.C.

CC: Dr. John R. LaMontagne, Director Div. of Microbiology and Infectious Diseases, NIAID

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