LymeNet Newsletter Volume 3 Issue 14

Volume: 3
Issue: 14
Date: 07-Sep-95

Table of Contents:

I. LYMENET: Protest March at NJ Board of Medical Examiners II. Q&A: Suspected CNS Relapsing fever in Israel (Q) III. MMWR: Recommendations on Lyme Serology VI. Q&A: WA resident seeks advice (Q) V. LYMENET: New Technique for Removal of Ticks VI. About The LymeNet Newsletter

Newsletter:

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

IDX# Volume 3 - Number 14 - 9/07/95 IDX# INDEX IDX# IDX# I. LYMENET: Protest March at NJ Board of Medical Examiners IDX# II. Q&A: Suspected CNS Relapsing fever in Israel (Q) IDX# III. MMWR: Recommendations on Lyme Serology IDX# VI. Q&A: WA resident seeks advice (Q) IDX# V. LYMENET: New Technique for Removal of Ticks IDX# VI. About The LymeNet Newsletter IDX#

NOTICE:

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http://www.lehigh.edu/lists/lymenet-l

I. LYMENET: Protest March at NJ Board of Medical Examiners Oct.11 -------------------------------------------------------------------- Sender: Gary M. Heir, DMD <[email protected]>

"TICK BITE FIGHT"

Join a rally in Trenton to promote awareness and express our concerns to the New Jersey Board of Medical Examiners. Meet in front of their offices at 140 E. Front Street October 11, 3:30pm. [For directions only, call 609-826-7100 -- press #7] Our voices and opinions must be heard...Your banners and posters are welcome. Please join us and together we will make a difference!

For further information call Barbara Brennan at 908-879-5331.

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II. Q&A: Suspected CNS Relapsing fever in Israel (Q) ------------------------------------------------------ Sender: David Raveh, MD <[email protected]>

I would like to ask the assistance of the LYME Internet group about a case of suspected long term CNS complications of relapsing fever. The patient is now 23 years old. Three years ago he entered a cave in Israel and a week later developed four attacks of relapsing fever. In the forth attack he was diagnosed and treated for borreliosis (in Israel usually B. persica). After recovery he started complaining about a deterioration in the physical and the intellectual abilities. Routine blood, brain CT and neurological exams were OK. Now he came to my clinic with the same story of gradual decrease in those aspects. Physical, neurological exams were OK. MRI showed multiple small lesions, perivnetricular, postrior-parietal. The MRI DD was a demyelination process etc.

I have searched the literature, and I would like to prove/exclude if possible the exquisitely rare option of CNS borreliosis (we do not have in Israel Lyme at all). I plan to do LP and give him six weeks of ceftriaxone, then repeat the MRI and possibly repeat LP (provided that the first LP will be meaningful). Could anyone comment on this case?

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III. MMWR: Recommendations on Lyme Serology --------------------------------------------

Recommendations for Test Performance and Interpretation from the Second National Conference on Serologic Diagnosis of Lyme Disease ================================================================= SOURCE: MMWR 44(31);590-591 DATE: Aug 11, 1995

The Association of State and Territorial Public Health Laboratory Directors, CDC, the Food and Drug Administration, the National Institutes of Health, the Council of State and Territorial Epidemiologists, and the National Committee for Clinical Laboratory Standards cosponsored the Second National Conference on Serologic Diagnosis of Lyme Disease held October 27-29, 1994. Conference recommendations were grouped into four categories: 1) serologic test performance and interpretation, 2) quality-assurance practices, 3) new test evaluation and clearance, and 4) communication of developments in Lyme disease (LD) testing. This report presents recommendations for serologic test performance and interpretation, which included substantial changes in the recommended tests and their interpretation for the serodiagnosis of LD. A two-test approach for active disease and for previous infection using a sensitive enzyme immunoassay (EIA) or immunofluorescent assay (IFA) followed by a Western immunoblot was the algorithm of choice. All specimens positive or equivocal by a
sensitive EIA or IFA should be tested by a standardized Western immunoblot. Specimens negative by a sensitive EIA or IFA need not be tested further. When Western immunoblot is used during the first 4 weeks of disease onset (early LD), both immuno- globulin M (IgM) and immunoglobulin G (IgG) procedures should be performed. A positive IgM test result alone is not recommended for use in determining active disease in persons with illness greater than 1 month's duration because the likelihood of a false-positive test result for a current infection is high for these persons. If a patient with suspected early LD has a negative serology, serologic evidence of infection is best obtained by testing of paired acute- and convalescent-phase serum samples. Serum samples from persons with disseminated or late-stage LD almost always have a strong IgG response to Borrelia burgdorferi antigens. It was recommended that an IgM immunoblot be considered positive if two of the following three bands are present: 24 kDa (OspC) * , 39 kDa (BmpA), and 41 kDa (Fla) (1). It was further
recommended that an that IgG immunoblot be considered positive if five of the following 10 bands are present: 18 kDa, 21 kDa (OspC) *, 28 kDa, 30 kDa, 39 kDa (BmpA), 41 kDa (Fla), 45 kDa, 58 kDa (not GroEL), 66 kDa, and 93 kDa (2). The details of both plenary sessions and the work group deliberations are included in the publication of the proceedings, which is available from the Association of State and Territorial Public Health Laboratory Directors; telephone (202) 822-5227.

References 1. Engstrom SM, Shoop E, Johnson RC. Immunoblot interpretation criteria for serodiagnosis of early Lyme disease. J Clin Microbiol 1995;33:419-22. 2. Dressler F, Whelan JA, Reinhart BN, Steere AC. Western blotting in the serodiagnosis of Lyme disease. J Infect Dis 1993;167:392-400.

* The apparent molecular mass of OspC is dependent on the strain of B. burgdorferi being tested. The 24 kDa and 21 kDa proteins referred to are the same.

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VI. Q&A: WA resident seeks advice (Q) ------------------------------------------------------------ Sender: Christina Anagnost <[email protected]>

I was bitten by a tick in southeastern Ohio (Lake Vesuivus) and developed fever, chills, and swollen lymph glands 10 days after infection. I was treated for 10 days with Erthromycin. The antibiotic worked very slowly and I was taken off the medication because the doctor assumed that I was "cured," even though I still had symptoms (slightly swollen lymph glands) that the doctor could not verify. A couple weeks later, I developed severe symptoms again, and was placed on Erthromycin again. The doctor withdrew medication after 10 more days of treatment, even though I was feeling symptomatic. The illness returned, and I went to another doctor. The doctor placed me on Tetracycline, which seemed to have a much more immediate effect on my symptoms. However, this medication was withdrawn before my symptoms completely disappeared, and I have been having recurrences ever since (swollen painful lymph glands on the same side of my neck as the tick bite). I have also developed cardiac problems and shortness of breath. Although I have been to
several doctors since, I cannot seem to find a physician who will take my symptoms seriously. "You had enough antibiotic therapy to cure the illness" is what they usually say.

I am looking for a good infectious disease physician in the Tacoma- Seattle, WA area who would be an expert on Lyme's Disease/human granuloctic ehrlichiosis (HGE).

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V. LYMENET: New Technique for Removal of Ticks ------------------------------------------------- Sender: Marilyn Powers <[email protected]>

The U.S. Patent Office has allowed for issuance as a patent a new, innovative method for removing ticks utilizing low pressure carbon dioxide. This method easily removes embedded ticks by taking advantage of their sensitivity to carbon dioxide. It has applications for both animal and human use. This patent will soon be available for licensing in both the U.S. and abroad.

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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.lehigh.edu/lists/lymenet-l ----------------------------------------------------------------------- LymeNet - The Internet Lyme Disease Information Source ----------------------------------------------------------------------- Editor-in-Chief: Marc C. Gabriel <[email protected]> FAX: 908-789-0028 Contributing Editors: Carl Brenner <[email protected]> John Setel O'Donnell <[email protected]> Frank Demarest <[email protected]> Advisors: Carol-Jane Stolow, Director William S. Stolow, President The Lyme Disease Network of New Jersey (908-390-5027) ----------------------------------------------------------------------- WHEN COMMENTS ARE PRESENTED WITH AN ATTRIBUTION, THEY DO NOT
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