YOU ARE NOW CONNECTED TO THE TOXLINE (1981 FORWARD, NON-ROYALTY) FILE. ==LYME DISEASE== 2 AUTHOR Wormser GP TITLE Controversies in the use of antimicrobials for the prevention and treatment of Lyme disease. SOURCE Infection; VOL 24, ISS 2, 1996, P178-81 (REF: 38) ABSTRACT Unanswered questions in the management of patients with Lyme disease or those who have had Ixodes tick bites include: Is antimicrobial therapy effective in preventing Lyme disease during the incubation period of the infection? Which oral agents are most effective in treatment of Lyme disease? Are macrolides efficacious? And, for how long a time period should antimicrobial therapy be given? Potentially useful insights into these questions can be gained by examining experience with other spirochetal infections. Using this information, in conjunction with existing data from recent studies on Lyme borreliosis, tentative answers to these questions can be formulated. Based on this analysis, it would be anticipated that a short course of antibiotic therapy, perhaps even a single dose, will be effective in preventing Lyme disease after a tick bite. Beta-lactam antibiotics such as amoxicillin, and tetracycline preparations, such as doxycycline, are the mainstays of oral therapy for treatment of active infection. Macrolides are less effective, but their utility is likely to be improved if they are given in maximal dosage. There is no convincing evidence for extending treatment of early Lyme disease beyond 14 days. There is also no evidence that longer therapy is more efficacious for other manifestations of Lyme disease, although this issue deserves further study. 4 AUTHOR Wegner Z AUTHOR Stanczak J TITLE [The role of ticks in the epidemiology of Lyme borreliosis] SOURCE Przegl Epidemiol; VOL 49, ISS 3, 1995, P245-50 (REF: 33) ABSTRACT In this paper the current knowledge of the natural circulation of Borrelia burgdorferi, the etiologic agent of Lyme borreliosis, and its relationships both to hard ticks (Ixodidae) serving as vectors, and to certain vertebrates which function as tick hosts and pathogen reservoirs is reviewed. The modes of transmission of borreliae (by salivation, regurgitation, defecation) by ticks to their animal hosts and men as well as prophylactic measures against tick-bites are also discussed. 7 AUTHOR Wallich R AUTHOR Kramer MD AUTHOR Simon MM TITLE A recombinant vaccine for Lyme disease. SOURCE Behring Inst Mitt, ISS 95, 1994, P106-8 (REF: 23) ABSTRACT We are studying processes leading to protective immunity in murine Lyme borreliosis in order to derive a suitable vaccine candidate for clinical use. Our work focuses on the role of the two main outer surface lipoproteins A and B (OspA and OspB) of the causative agent of Lyme disease, the spirochete Borrelia burgdorferi, as targets for its specific elimination. We could show that native and recombinant LipOspA induce monospecific immune sera able to passively transfer protection in SCID mice against experimental and tick-borne infection and disease. Recent results for phase I and II safety and efficacy trails are promising in demonstrating that the recombinant LipOspA vaccine candidate is safe and immunogenic and elicits borreliacidal antibodies. 8 AUTHOR Sigal LH TITLE Anxiety and persistence of Lyme disease. SOURCE Am J Med; VOL 98, ISS 4A, 1995, P74S-78S (REF: 22) ABSTRACT Lyme disease has become a major concern in endemic areas, in large measure because of fears that it does not respond to current antibiotic regimens. This anxiety has led to the use of untested drugs and longer courses of therapy than have been demonstrated to be necessary, with attendant increase in cost and toxicity. Concern about the lack of response to such therapy has convinced many patients that they have a permanent disease, with profound effects on their lives and those of their families. A better understanding of the natural history of Lyme disease and of possible causes for persisting symptoms other than active infection is needed to optimize management of such patients. Most symptoms persisting after adequate therapy can be explained by a small number of pathogenic mechanisms, only one of which is ongoing infection. Individualization of care and prudent analysis are crucial if overdiagnosis and overtreatment of Lyme disease are to be avoided. 9 AUTHOR Fish D TITLE Environmental risk and prevention of Lyme disease. SOURCE Am J Med; VOL 98, ISS 4A, 1995, P2S-8S; discussion 8S-9S (REF: 49) ABSTRACT An understanding of the environmental determinants of Lyme disease risk is essential to evaluate human disease potential and to recommend strategies for disease prevention. Tick vectors of Lyme disease require a vertebrate blood meal during each of three motile developmental stages (larva, nymph, and adult). Although the immature stages (larvae and nymphs) exhibit broad and overlapping host ranges, adult ticks are primarily dependent on deer for feeding and reproduction. Consequently, the distribution and abundance of these ticks often reflect those of deer. Several species of smaller mammals and some birds that host immature ticks are also competent reservoirs for Borrelia burgdorferi, which becomes established within the tick population during feeding. The relative abundance of these host species and their ability to infect ticks are key factors in determining the distribution of Lyme disease risk in the local environment. Available methods for reducing the risk of Lyme disease in the environment include the application of insecticides and use of deer fencing, which have been shown to be 83-97% effective in reducing risk. However, the adverse environmental impact of insecticides and high cost of deer fencing limit these methods to high-risk areas where human exposure is constant and unavoidable (i.e., residential or occupational). Personal protection in high-risk areas can lessen the likelihood of contact with ticks. Future prevention methods may include host-targeted insecticides, environmental alteration, and biologic control. Moreover, research is currently directed to identifying antigens for use in recombinant human vaccines. 22 AUTHOR Masson C TITLE [Neurologic aspects of Lyme disease] SOURCE Presse Med; VOL 16, ISS 2, 1987, P72-5 (REF: 30) ABSTRACT The neurological manifestations of Lyme disease--a condition caused by a spirochete (Borrelia burgdorferi) and transmitted by a tick Ixodes dammini)--consist of chronic lymphocytic meningitis, cranial neuritis and radiculoneuritis associated to varying degrees. The tick-borne meningoradiculitis well known in Europe (Garin-Bujadoux-Bannwarth syndrome) appears, with very slight differences, as equivalent to the neurological manifestations of Lyme disease. Lesions of the central nervous system, which occur long after the B. burgdorferi infection, are thought to represent a tertiary stage of Lyme disease. 26 AUTHOR Tortorice KL AUTHOR Heim-Duthoy KL TITLE Clinical features and treatment of Lyme disease. SOURCE Pharmacotherapy; VOL 9, ISS 6, 1989, P363-71 (REF: 64) ABSTRACT Lyme disease is caused by the spirochete Borrelia burgdorferi, which is carried by infected ticks. This disorder has a variable clinical course with multisystem manifestations, including dermatologic, neurologic, cardiac, and rheumatologic abnormalities. Although Lyme disease has been commonly associated with stages, the utility of staging may be limited due to the inconsistency of clinical manifestations among patients. Furthermore, stages may overlap as a result of the acute and chronic phases of the disease. The laboratory characteristics of Lyme disease are highly variable. The use of microbiologic cultures in establishing the diagnosis requires several weeks and has a low yield of positivity. Serologic assays using indirect immunofluorescence and enzyme-linked immunosorbence are preferred. Because of the highly variable features of Lyme disease, clinical and laboratory features must be correlated and interpreted in the context of the disease. Treatment should be initiated as early as possible after the onset of illness. Prompt therapeutic intervention may result in early resolution of the dermatologic hallmark, erythema chronicum migrans, as well as prevention and attenuation of subsequent complications. 31 AUTHOR Schwartz BS AUTHOR Goldstein MD TITLE Lyme disease: a review for the occupational physician. SOURCE J Occup Med; VOL 31, ISS 9, 1989, P735-42 (REF: 59) ABSTRACT Lyme disease, a multisystem illness caused by a spirochete (Borrelia burgdorferi) and transmitted to humans by ticks, is increasing in incidence. Outdoor workers in areas of endemic disease are at increased risk of infection. Increased recognition of this fact will be necessary to prevent the disease in working populations.