LymeNet Newsletter Volume 7 Issue 02

Volume: 7
Issue: 02
Date: 24-Feb-99

Table of Contents:

I. LYMENET: LymeNet Vaccine Discussion Paper Now Available II. LDF: 12th International Conference on Lyme Disease and Other Spirochetal and Tick-Borne Disorders III. INFECT IMMUN: Killing of Borrelia burgdorferi by antibody elicited by OspA vaccine is inefficient in the absence of complement. IV. INFECT IMMUN: Influence of outer surface protein A antibody on Borrelia burgdorferi within feeding ticks. V. ANN INTERN MED: Comparison of culture-confirmed erythema migrans caused by Borrelia burgdorferi sensu stricto in New York State and by Borrelia afzelii in Slovenia. VI. PEDIATR EMERG CARE: Emergency department presentations of Lyme disease in children. VII. ABOUT THE LYMENET NEWSLETTER

Newsletter:

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

Volume 7 / Number 02 / 24-FEB-1999 INDEX

I. LYMENET: LymeNet Vaccine Discussion Paper Now Available II. LDF: 12th International Conference on Lyme Disease and Other Spirochetal and Tick-Borne Disorders III. INFECT IMMUN: Killing of Borrelia burgdorferi by antibody elicited by OspA vaccine is inefficient in the absence of complement. IV. INFECT IMMUN: Influence of outer surface protein A antibody on Borrelia burgdorferi within feeding ticks. V. ANN INTERN MED: Comparison of culture-confirmed erythema migrans caused by Borrelia burgdorferi sensu stricto in New York State and by Borrelia afzelii in Slovenia. VI. PEDIATR EMERG CARE: Emergency department presentations of Lyme disease in children. VII. ABOUT THE LYMENET NEWSLETTER

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I. LYMENET: LymeNet Vaccine Discussion Paper Now Available ------------------------------------------------------------- Sender: Marc C. Gabriel <[email protected]>

SmithKline Beecham has released their recombinant OspA Lyme disease vaccine accompanied with an aggressive media campaign in selected markets. The Lyme Disease Network will not take a formal position, for or against vaccination. However, LymeNet has developed a discussion document reviewing the top vaccine issues.

Information for the paper was drawn primarily from the opinions voiced at the May 1998 meeting of the FDA's Vaccine and Related Biological Products Advisory Committee as well as the peer-reviewed literature. No anecdotal information was used. The document is available at:

http://www2.LymeNet.org/domino/file.nsf/UID/VaccinePosition

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II. LDF: 12th International Conference on Lyme Disease and Other Spirochetal and Tick-Borne Disorders ------------------------------------------------------------------ Sender: The Lyme Disease Foundation <[email protected]>

The Lyme Disease Foundation's 12th Annual Conference on Lyme Disease and Other Spirochetal and Tick-Borne Disorders will take place on April 9 and 10 at the Equitable Conference Center in New York City. Details are as follows:

April 9 (Fri) & 10 (Sat), 1999 Equitable Conference Center, New York City, USA

Jointly sponsored with The College of Physicians and Surgeons of Columbia University and the Lyme Disease Foundation

Keynote Speaker: Willy Burgdorfer, PhD, MD (Hon) Discoverer of the pathogen causing Lyme disease

The College of Physicians and Surgeons of Columbia University is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing medical education for physicians.

The College of Physicians and Surgeons designates this educational activity for 16 hours in Category 1 Credit towards the AMA Physicians's Recognition Award.

Each physician should claim only those hours of credit that he/she actually spent in the educational activity.

---------- PROGRAM COMMITTEE

Program Coordinator and Basic Sciences: James Miller, PhD UCLA School of Medicine

Clinical: Sam Donta, MD Boston University School of Medicine Clinical: Brian Fallon, MD Columbia University College of Physicians and Surgeons

Posters: Charles Pavia, PhD New York Medical College Posters: Ronald Schell, PhD University of Wisconsin School of Medicine

Place: Equitable Conference Center 787 Seventh Ave (51st & 52nd), New York, NY

Host Hotel: Sheraton NY 212-581-1000 800-223-6500

Travel: Huntington Hay Travel 800-783-9783

----------- CONFERENCE GOALS

* Recognizing the complex nature of Borrelia burgdorferi in relation to host response to infection and to understand the rationale for different approaches to diagnosis and treatment. * Determining criteria for diagnosis and treatment of the various presentations of LD and other tick-borne disorders. * Identifying various approaches to, and role of, the laboratory testing of LD and coinfections. * Diagnosing neurological LD and its many complex manifestations. * Identifying the spectrum of problems associated with the etiology of chronic LD, (e.g. animal models and clinical data). * Understanding coinfections and non-Lyme disease tick-borne infections. * Differential diagnosis of Lyme disease and other disorders commonly compared to Lyme disease. * Assessing the implications of genetic diversity of the LD spirochete on the development of new diagnostic tests and vaccines.

------------ REGISTRATION

Online registration is available at:

http://www.lyme.org/conferences/99_announce.html

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III. INFECT IMMUN: Killing of Borrelia burgdorferi by antibody elicited by OspA vaccine is inefficient in the absence of complement. --------------------------------------------------------------- AUTHORS: Nowling JM, Philipp MT ORGANIZATION: Department of Parasitology, Tulane Regional Primate Research Center, Tulane University Medical Center, Covington, Louisiana 70433, USA. REFERENCE: Infect Immun 1999 Jan;67(1):443-5 ABSTRACT:

A Lyme disease vaccine, based on the Borrelia burgdorferi lipoprotein OspA, has recently undergone phase III trials in humans. The results of one of these trials indicate that vaccine efficacy positively correlates with anti-OspA antibody titer. Spirochete killing within the tick vector midgut, upon which vaccine efficacy appears to depend, may occur chiefly via a mechanism that involves antibody alone, as it has been reported that complement is degraded by tick saliva decomplementing factors. We compared the in vitro killing efficiencies of anti-OspA antibody elicited in rhesus monkeys by the OspA vaccine, in the presence and in the absence of monkey complement. Killing in the absence of complement was between 14 and 3,800 times less efficient than with complement present, depending on the spirochete strain. The relative inefficiency of the complement-independent killing mechanism by anti-OspA antibody may explain why OspA vaccine efficacy is critically dependent on antibody titer.

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IV. INFECT IMMUN: Influence of outer surface protein A antibody on Borrelia burgdorferi within feeding ticks. ------------------------------------------------------------------- AUTHORS: de Silva AM, Zeidner NS, Zhang Y, Dolan MC, Piesman J Fikrig E ORGANIZATION: Section of Rheumatology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut 06520, USA. REFERENCE: Infect Immun 1999 Jan;67(1):30-5 ABSTRACT:

Borrelia burgdorferi, the spirochetal agent of Lyme disease, is transmitted by Ixodes ticks. When an infected nymphal tick feeds on a host, the bacteria increase in number within the tick, after which they invade the tick's salivary glands and infect the host. Antibodies directed against outer surface protein A (OspA) of B. burgdorferi kill spirochetes within feeding ticks and block transmission to the host. In the studies presented here, passive antibody transfer experiments were carried out to determine the OspA antibody titer required to block transmission to the rodent host. OspA antibody levels were determined by using a competitive enzyme-linked immunosorbent assay that measured antibody binding to a protective epitope defined by monoclonal antibody C3.78. The C3.78 OspA antibody titer (>213 microgram/ml) required to eradicate spirochetes from feeding ticks was considerably higher than the titer (>6 microgram/ml) required to block transmission to the host. Although spirochetes were not eradicated
from ticks at lower antibody levels, the antibodies reduced the number of spirochetes within the feeding ticks and interfered with the ability of spirochetes to induce ospC and invade the salivary glands of the vector. OspA antibodies may directly interfere with the ability of B. burgdorferi to invade the salivary glands of the vector; alternately, OspA antibodies may lower the density of spirochetes within feeding ticks below a critical threshold required for initiating events linked to transmission.

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V. ANN INTERN MED: Comparison of culture-confirmed erythema migrans caused by Borrelia burgdorferi sensu stricto in New York State and by Borrelia afzelii in Slovenia. ---------------------------------------------------------------------- AUTHORS: Strle F, Nadelman RB, Cimperman J, Nowakowski J, Picken RN Schwartz I, Maraspin V, Aguero-Rosenfeld ME, Varde S, Lotric-Furlan S, Wormser GP ORGANIZATION: University of Ljubljana, Slovenia. REFERENCE: Ann Intern Med 1999 Jan 5;130(1):32-6 ABSTRACT:

BACKGROUND: The clinical manifestations of Lyme borreliosis in North America and Europe seem to differ, but a systematic comparison has never been done. OBJECTIVE: To compare European and U.S. patients with culture-confirmed erythema migrans. DESIGN: Prospective, clinical cohort study. SETTING: University medical centers in Westchester County, New York, and Ljubljana, Slovenia. PATIENTS: 119 U.S. patients with Borrelia burgdorferi sensu stricto infection and 85 Slovenian patients with B. afzelii infection. MEASUREMENTS: Interview, physical examination, and laboratory assays. RESULTS: Compared with Slovenian patients, U.S. patients had erythema migrans for a briefer duration (median duration, 4 days compared with 14 days; P < 0.001) but were more likely to have systemic symptoms (P = 0.01), abnormal findings on physical examination (P < 0.001), and seroreactivity (P < 0.001). Central clearing of erythema migrans lesions was more likely in Slovenian patients (P < 0.001). CONCLUSIONS: Erythema migrans caused by B. afzelii in Slovenia and
erythema migrans caused by B. burgdorferi in New York have distinct clinical presentations. Caution should be used when clinical and laboratory experience from one side of the Atlantic is applied to patients on the other.

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VI. PEDIATR EMERG CARE: Emergency department presentations of Lyme disease in children. ------------------------------------------------------------------- AUTHORS: Bachman DT, Srivastava G, ORGANIZATION: Pediatric Emergency Services, Maine Medical Center, Portland, USA. REFERENCE: Pediatr Emerg Care 1998 Oct;14(5):356-61 ABSTRACT:

OBJECTIVE: To review the clinical characteristics and diagnostic evaluation of children with Lyme disease evaluated in an emergency department (ED) in an endemic area. DESIGN: A retrospective review of the demographic, historical, clinical, and laboratory data of pediatric patients with a final diagnosis of Lyme disease. SETTING: The pediatric ED of an urban university hospital. PARTICIPANTS: Children with Lyme disease evaluated during the three- year period from 1992 to 1994. RESULTS: Twenty-nine children ranging in age from three to 19 years who were diagnosed with Lyme disease subsequent to a visit to a pediatric ED were identified. Four patients had early localized disease with erythema migrans and varying degrees of systemic symptoms. Ten had early disseminated Lyme disease, with multiple erythema migrans, neurologic involvement (including three patients with pseudotumor cerebri), or carditis. Fifteen cases of late Lyme disease with arthritis were identified. Recognition of Lyme arthritis proved
particularly difficult; seven children were initially diagnosed as having septic arthritis, six of whom underwent arthrotomy. Marked elevations of the erythrocyte sedimentation rate and synovial fluid white blood cell counts were observed in these patients, making it difficult to distinguish Lyme disease from septic arthritis on the basis of laboratory findings. CONCLUSION: Lyme disease is an infrequent, often difficult, diagnosis in children who present to an ED. Early disseminated and late disease predominate; classic erythema migrans is uncommon in the ED in comparison with other ambulatory venues. Diagnosis of Lyme arthritis may be difficult; exposure in an endemic area and clinical findings may help distinguish it from septic arthritis. Overall, underdiagnosis of Lyme disease may actually be more of a problem than overdiagnosis in the ED setting. Recognition of Lyme disease by emergency medicine practitioners requires familiarity with its epidemiology and its multiple manifestations.

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VII. 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]> 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]> 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] -----------------------------------------------------------------------