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Volume 7 / Number 07 / 23-JUL-1999

INDEX

I. N ENG J MED: Ehrlichia ewingii, a Newly Recognized Agent of

Human Ehrlichiosis

II. J CLIN MICROBIOL: Isolation of DNA after extraction of RNA To

detect the presence of Borrelia burgdorferi and expression of

host cellular genes from the same tissue sample.

III. J CLIN MICROBIOL: Infection of laboratory mice with the human

granulocytic ehrlichiosis agent does not induce antibodies to

diagnostically significant Borrelia burgdorferi antigens.

IV. PEDIATRICS: Characterization of Lyme meningitis and comparison

with viral meningitis in children.

V. J KOREAN MED SCI: Serologically diagnosed Lyme disease

manifesting erythema migrans in Korea.

VI. ABOUT THE LYMENET NEWSLETTER

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I. N ENG J MED: Ehrlichia ewingii, a Newly Recognized Agent of

Human Ehrlichiosis

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AUTHORS: Buller RS, Arens M, Hmiel SP, Paddock CD, Sumner JW,

Rikihisa Y, Unver A, Gaudreault-Keener M, Manian FA,

Liddell AM, Schmulewitz N, Storch GA

ORGANIZATION: Mallinckrodt Department of Pediatrics and the

Department of Medicine, Washington University

School of Medicine, St. Louis, MO.

REFERENCE: N Engl J Med 1999;341:148-55

ABSTRACT:

BACKGROUND: Human ehrlichiosis is a recently recognized tick-borne

infection. Four species infect humans: Ehrlichia chaffeensis, E.

sennetsu, E. canis, and the agent of human granulocytic ehrlichiosis.

METHODS: We tested peripheral-blood leukocytes from 413 patients with

possible ehrlichiosis by broad-range and species-specific polymerase-

chain-reaction (PCR) assays for ehrlichia. The species present were

identified by species-specific PCR assays and nucleotide sequencing

of the gene encoding ehrlichia 16S ribosomal RNA. Western blot

analysis was used to study serologic responses.

RESULTS: In four patients, ehrlichia DNA was detected in leukocytes

by a broad-range PCR assay, but not by assays specific for E.

chaffeensis or the agent of human granulocytic ehrlichiosis. The

nucleotide sequences of these PCR products matched that of E. ewingii,

an agent previously reported as a cause of granulocytic ehrlichiosis

in dogs. These four patients, all from Missouri, presented between

May and August 1996, 1997, or 1998 with fever, headache, and

thrombocytopenia, with or without leukopenia. All had been exposed

to ticks, and three were receiving immunosuppressive therapy. Serum

samples obtained from three of these patients during convalescence

contained antibodies that reacted with E. chaffeensis and E. canis

antigens in a pattern different from that of humans with E.

chaffeensis infection but similar to that of a dog experimentally

infected with E. ewingii. Morulae were identified in neutrophils

from two patients. All four patients were successfully treated with

doxycycline.

CONCLUSIONS: These findings provide evidence of E. ewingii infection

in humans. The associated disease may be clinically indistinguishable

from infection caused by E. chaffeensis or the agent of human

granulocytic ehrlichiosis.

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II. J CLIN MICROBIOL: Isolation of DNA after extraction of RNA To

detect the presence of Borrelia burgdorferi and expression of

host cellular genes from the same tissue sample.

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AUTHORS: Amemiya K, Schaefer H, Pachner AR

ORGANIZATION: National Institute of Neurological Diseases and Stroke,

National Institutes of Health, Bethesda, land

20892, USA.

REFERENCE: J Clin Microbiol 1999 Jun;37(6):2087-9

ABSTRACT:

We are investigating the neuropathogenesis of Lyme disease caused by

Borrelia burgdorferi in a nonhuman primate model. In the past, two

separate pieces of tissue had to be used when both analyzing for the

presence of the spirochete and examining the host response to

infection. We have modified a procedure to purify DNA from the same

sample after the extraction of RNA. The remaining material containing

the DNA was precipitated, and residual organic reagent was removed

prior to deproteinization and extraction of the DNA. This procedure

now allows us to both assay for the presence of the Lyme microorganism

and analyze the host response in the same tissue preparation.

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III. J CLIN MICROBIOL: Infection of laboratory mice with the human

granulocytic ehrlichiosis agent does not induce antibodies to

diagnostically significant Borrelia burgdorferi antigens.

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AUTHORS: Bunnell JE, Magnarelli LA, Dumler JS

ORGANIZATION: Department of Molecular Microbiology and Immunology,

The s Hopkins University School of Hygiene and

Public Health, Baltimore, land 21205, USA.

REFERENCE: J Clin Microbiol 1999 Jun;37(6):2077-9

ABSTRACT:

Laboratory diagnosis of Borrelia burgdorferi is routinely made by an

enzyme-linked immunosorbent assay, with positive results confirmed

by Western blot analysis. Concern has been raised that false-positive

diagnoses may be made on the basis of serologic cross-reactivity with

antibodies directed against other bacterial pathogens, in particular

the agent of human granulocytic ehrlichiosis (HGE). The present study

made use of a mouse model to ascertain the validity of these concerns.

Two different strains of mice were inoculated with the HGE agent and

assayed for production of polyclonal and monoclonal antibodies to

antigens of both of these bacteria. Infection of mice with the HGE

agent does not induce diagnostically significant B. burgdorferi

serologic cross-reactions.

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IV. PEDIATRICS: Characterization of Lyme meningitis and comparison

with viral meningitis in children.

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AUTHORS: Eppes SC, DK, LL, Klein JD

ORGANIZATION: Division of Infectious Diseases, Alfred I. duPont

Hospital for Children, Wilmington, Delaware, USA.

seppes@...

REFERENCE: Pediatrics 1999 May;103(5 Pt 1):957-60

ABSTRACT:

OBJECTIVES: The objectives of this study were to characterize Lyme

meningitis (LM) in the pediatric population; to compare LM with

viral meningitis (VM) with respect to epidemiology, history and

physical examination, and laboratory data; and to provide means of

early distinction of Lyme neuroborreliosis from other forms of

aseptic meningitis.

METHODS: This retrospective analysis involved children admitted to

Alfred I. duPont Hospital for Children between 1990 and 1996 whose

discharge diagnoses indicated viral or aseptic meningitis or Lyme

disease. LM was defined as the presence of cerebrospinal fluid

(CSF) pleocytosis with positive Lyme serology and/or erythema

migrans. Patients were considered to have VM if they exhibited CSF

pleocytosis and had a positive viral culture. Demographic, clinical,

and laboratory data were collected for each patient, and patients

with LM were compared with age-matched patients with VM.

RESULTS: Of 179 patient records, 12 patients with LM and 10 patients

with VM (all, >2 years old) were identified by using the above

criteria. In comparing LM patients with VM patients, we noted no

differences among demographic variables. Children with LM had

significantly lower temperatures at the time of presentation. The

presence of headache, neck pain, and malaise was similar for the

two groups, but the duration of these symptoms was significantly

longer among LM patients. Five children with LM had cranial

neuropathies. All but 1 LM patient exhibited either papilledema,

erythema migrans, or cranial neuropathy. These three findings

were absent in the VM group. On CSF analysis, LM patients had fewer

white blood cells (mean, 80/mm3 versus 301/mm3) and a significantly

greater percentage of mononuclear cells than the VM patients.

CONCLUSIONS: In this study, in a Lyme-endemic area, LM was about as

common as VM in older children who were hospitalized with aseptic

meningitis. Attention to pertinent epidemiologic and historical

data, along with physical and CSF findings, allows early

differentiation of LM from VM.

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V. J KOREAN MED SCI: Serologically diagnosed Lyme disease

manifesting erythema migrans in Korea.

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AUTHORS: Kim TH, Choi EH, Lee MG, Ahn SK

ORGANIZATION: Department of Dermatology, Yonsei University, Wonju

College of Medicine, Korea.

REFERENCE: J Korean Med Sci 1999 Feb;14(1):85-8

ABSTRACT:

Lyme disease is a vector-borne infection, primarily transmitted by

Ixodes ticks, and caused by Borrelia burgdorferi. It has a wide

distribution in the northern hemisphere. In Korea, however, only one

human case has been reported, although B. burgdorferi was isolated

from the vector tick I. persulcatus in the region. A 60-year-old male

and a 45-year-old female developed the clinical sign of erythema

migrans. Each patients were bitten by a tick four weeks and five

weeks, respectively, before entering the hospital. On serologic

examination, significantly increased IgM and IgG antibody titers to

B. burgdorferi were observed in consecutive tests performed at an

interval of two weeks. They responded well to treatment with

tetracycline.

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VI. ABOUT THE LYMENET NEWSLETTER

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