***************************************************************************** *                  Lyme Disease Electronic Mail Network                     * *                          LymeNet Newsletter                               * *****************************************************************************                       Volume 1 - Number 09 - 4/26/93  I.    Introduction II.   Announcements III.  News from the wires IV.   Questions 'n' Answers V.    Op-Ed Section VI.   Jargon Index VII.  How to Subscribe, Contribute and Get Back Issues  I. ***** INTRODUCTION *****  In this issue of the Newsletter, we learn of the CDC's announced concern for the "resurgence of infectious diseases" in the United States.  Thanks to Jonathan Lord for sending me the UPI release.  The CDC announced they would feature a new series of articles in the Morbidity and Mortality Weekly Report on these infectious diseases (LD is one of them).  We will keep you up to date on this series.  In addition, we feature a The Wall Street Journal article on the legal issues surrounding LD.  We also look at Lyme's effects from the perspective of urologists in an abstract entitled "Urinary Dysfunction in Lyme Disease."  Finally, Terry Morse asks an intriguing question about a tick's habitat.  -Marc.   II. ***** ANNOUNCEMENTS *****  SOURCE: The Lyme Disease Update SUBJECT: Call for Articles  Attention Health Care Professionals:  The Lyme Disease Update would like to publish your articles on Lyme disease diagnosis, Lyme treatment, and the effects on Lyme on Lyme patients' physical and mental health.  The LDU has a monthly circulation of 6,000.  Our mailing list includes Lyme patients, physicians, researchers, county health departments, and over 100 Lyme support groups nationwide.  We strive to give our readers up-to-date information on Lyme disease prevention, diagnosis, and treatment, and a source for support and practical advice on living with Lyme disease.  Articles for the LDU should be approximately 900 to 1200 words and should address Lyme disease issues in non-scientific language.  To submit your article, mail to: Lyme Disease Update                   P.O. Box 15711-0711                   Evansville, IN 47716       or FAX to:  812-471-1990  One year subscriptions to the Lyme Disease Update are $19 ($24 outside the US).  Mail your subscription requests to the above address, or call 812-471-1990 for more information.   III. ***** NEWS FROM THE WIRES ******  Sender: Jonathan Lord <jml4s@uva.pcmail.virginia.edu> Subject: RESURGENCE OF INFECTIOUS DISEASE CONCERNS CDC Date: Thursday April 15, 1993  ATLANTA (UPI) --   A resurgence of infectious diseases blamed on newly emerging viruses and bacteria pose a major challenge for the nation's health care system, federal health officials said Thursday.  The Centers for Disease Control and Prevention, reporting its latest findings in an investigation of contaminated hamburger meat that sickened hundreds in 4 states and killed at least four, said it will put renewed emphasis on battling infectious diseases.  Part of that emphasis includes a new series titled "Emerging Infectious Diseases" to be featured in the CDC's Morbidity & Mortality Weekly Report, which has a wide circulation in the health community. The issue also will top the agenda of a two-day meeting of scientific counselors to update the CDC's draft plan for dealing with the growing threat of infectious ailments.  "This is an issue that has been coming and we do have a responsibility to deal with it," said Dr. Ruth Berkelman, deputy director of the CDC's National Center for Infectious Diseases.  There were more cases of malaria in the U.S. in 1992 than in any year since the 1960s, and Latin America is experiencing a cholera epidemic, the first in this century, she said.  Resistance of disease-causing agents to antibiotics is also a problem. "We are seeing much more antibiotic resistance than we have in the past" Berkleman said.  She said even common ear infections frequently seen in children are becoming resistant to antibiotic treatment.  "Despite predictions earlier this century that infectious  diseases would soon be eliminated as a public health problem, infectious diseases remain the major cause of death worldwide and a leading cause of illness and death in the United States," the CDC said.  It  cited  the  emergence since the 1970s of a "myriad" of newly identified pathogens and syndromes, such as Escherichia coli O157:H7, a deadly bacterial infection; the hepatitis C virus; HIV, the virus that causes AIDS; Legionnaires disease; Lyme disease; and toxic shock syndrome.  "The incidences of many diseases widely presumed to be under control, such as cholera, malaria and tuberculosis, have increased in many areas," the CDC said.  It said efforts at control and prevention have been undermined by drug resistance.  =====*=====  SOURCE:  WALL STREET JOURNAL REFERENCE: 04/15/93, pB1 HEADLINE: Lyme-Disease Ruling Raises Liability Issues  The tick that causes Lyme disease may have found a new way to cause damage: legal liability.  A federal judge's decision holding a property owner liable for not doing enough to protect workers from Lyme disease is getting as much attention as the latest medical study on the disease, a flu-like illness that can cause severe physical and mental disabilities and in rare instances death. The decision last week has put property owners on notice that they may have to do more than protect themselves from the ticks-they also may have to protect themselves from litigation if someone becomes infected while on the property.  The decision by U.S. District Judge Robert J. Ward in New York came after a week-long trial in a case involving four track workers for the Long Island Railroad. Judge Ward found that the workers contracted the disease after they were bitten by ticks while on the job. He ordered the New York state-owned commuter line to pay the workers more than $560,000 to compensate for pain and suffering, in addition to medical expenses and lost wages.  Summer camps, schools, companies with facilities in rural or semirural areas, and homeowners who rent to vacationers are among the groups that need to be worried about this ruling, says Stephen L. Kass, an attorney at New York law firm Berle, Kass & Case, who wrote a legal article three years ago warning property owners of the potential liability. Even a family that invites friends over for a backyard barbecue might be potentially liable.  Lawsuits for insect bites, while rare, aren't unheard-of. A summer vacationer in Southampton, N.Y., last year sued the owner of the home she rented, claiming that a tick on the property gave her Rocky Mountain spotted fever. In 1988, also on Long Island, a jury ordered an outdoor restaurant to pay more than $3 million to a patron who was stung by a bee, causing an allergic reaction and permanent quadriplegia. The judge later threw out the award, citing no evidence that a beehive was near the restaurant.  But lawyers say that the attention to Lyme disease throughout the country -- it's most prevalent in New England, the Middle Atlantic states, Wisconsin, Minnesota and the Northwest -- may make this particular insect bite a particularly litigious one.  The illness already has proved to be a source of controversy in the courtroom over such issues as the type of medical care insurers will cover and medical malpractice claims against doctors for not diagnosing the disease.  Lawyers say worker's-compensation claims related to Lyme disease have become common in some states in recent years. Payments in worker's-compensation cases, however, are limited to medical costs and lost earnings.  The case before Judge Ward dealt with a potentially much more lucrative avenue for damages, because it involved the question of negligence. Unlike the worker's compensation process, the law governing injuries to rail workers allows for a finding of negligence and, as a result, for additional payments for pain and suffering. Property owners and lawyers say that negligence claims can be made in many other situations where people are exposed to the ticks that carry the disease.  Ira M. Maurer, a partner at New York law firm Elkind, Flynn & Maurer, who represented the rail workers, says the decision will help to establish "the duty of all sorts of property owners to protect against Lyme disease."  Lawyers caution that despite Judge Ward's decision, winning a lawsuit for damages caused by Lyme disease may prove difficult. For one thing, victims have to demonstrate that they have pinned down when and where they got the tick bite. Judge Ward found that the plaintiffs in the railroad case got Lyme disease while working on property owned by the railroad, even though none of the men remembered being bitten. The workers, who weren't outdoorsmen likely to be exposed elsewhere to the insects, said they saw ticks in the high grass that surrounded some work sites.  A spokeswoman for the railroad says that there was no proof that the four men were bitten while on the job and that the railroad is considering an appeal. The railroad also disputes Judge Ward's finding that it didn't do enough to protect employees. The spokeswoman says the railroad provides track workers with insect repellent and special pants to protect against bug bites.  Debate in the scientific community over Lyme disease could open up some legal defenses for property owners, such as questioning whether a victim actually has the disease rather than some other illness. Earlier this week, the Journal of the American Medical Association reported that doctors overly diagnose patients as having Lyme disease. And damages awarded to a victim also might be influenced by medical disputes over the degree of harm that Lyme disease causes.  Because of health and safety concerns, some groups and companies already take special measures to protect against Lyme disease. Last year, at its headquarters in Franklin Lakes, N.J., Becton, Dickinson & Co. began using Damminix, a pesticide made by EcoHealth Inc. of Boston that is designed to kill ticks carrying the disease. The medical- supply company's headquarters include a 120-acre park, and the company was worried that employees who walk on its trails for recreation might get infected.  Ruth Lister, a spokeswoman for the American Camping Association in Indianapolis, says that many youth camps accredited by her organization also have begun to check children for ticks. And Carole Katz, a member of the board of the Fire Island Pines Property Owners Association, says her group spends $30,000 each year to treat their 100-acre site off the coast of New York with the tick-killing pesticide.  =====*=====  TITLE: Urinary dysfunction in Lyme disease. AUTHORS: Chancellor MB; McGinnis DE; Shenot PJ; Kiilholma P; Hirsch IH, Department of Urology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania. REFERENCE: J Urol 1993 Jan; 149 (1): 26-30  Lyme disease, which is caused by the spirochete Borrelia burgdorferi, is associated with a variety of neurological sequelae.  We describe 7 patients with neuro-borreliosis who also had lower urinary tract dysfunction. Urodynamic evaluation revealed detrusor hyperreflexia in 5 patients and detrusor areflexia in 2.  Detrusor external sphincter dyssynergia was not noted on electromyography in any patient.  We observed that the urinary tract may be involved in 2 respects in the course of Lyme  disease: 1) voiding dysfunction may be part of neuro-borreliosis and 2) the spirochete may directly invade the urinary tract.  In 1 patient bladder infection by the Lyme spirochete was documented on biopsy.  Neurological and urological symptoms in all patients were slow to resolve and convalescence was protracted.  Relapses of active Lyme disease and residual neurological deficits were common.  Urologists practicing in areas endemic for Lyme disease need to be aware of B. burgdorferi infection in the differential diagnosis of neurogenic bladder dysfunction.  Conservative bladder management including clean intermittent catheterization guided by urodynamic evaluation is recommended.   IV. ***** QUESTIONS 'N' ANSWERS *****  Note: If you have a response to this question, please forward it to the editor.  Sender: Terry Morse <morset@ccmail.orst.edu> Subject: Question on Lyme Vectors and Compost Piles    When I visited my sister on Long Island, NY, I was cautioned to avoid the compost heap in her back yard, as she thinks this is where she became infected.    A friend of mine here in Oregon who has a compost heap would like me to back that claim up with documentation.  Do lyme-carrying ticks hang out in compost heaps? Thank you.   V. ***** OP-ED SECTION *****  This section is open to all subscribers who would like to express an opinion.   VI. ***** JARGON INDEX *****  Bb - Borrelia burgdorferi - The scientific name for the LD bacterium. CDC - Centers for Disease Control - Federal agency in charge of tracking       diseases and programs to prevent them. CNS - Central Nervous System. ELISA - Enzyme-linked Immunosorbent Assays - Common antibody test EM - Erythema Migrans - The name of the "bull's eye" rash that appears in      ~60% of the patients early in the infection. IFA - Indirect Fluorescent Antibody - Common antibody test. LD - Common abbreviation for Lyme Disease. NIH - National Institutes of Health - Federal agency that conducts medical       research and issues grants to research interests. PCR - Polymerase Chain Reaction - A new test that detects the DNA sequence       of the microbe in question.  Currently being tested for use in       detecting LD, TB, and AIDS. Spirochete - The LD bacterium.  It's given this name due to it's spiral       shape. Western Blot - A more precise antibody test.   VII. ***** HOW TO SUBSCRIBE, CONTRIBUTE AND GET BACK ISSUES *****  SUBSCRIPTIONS: Anyone with an Internet address may subscribe. Send a memo to    listserv@Lehigh.EDU in the body, type: subscribe LymeNet-L <Your Real Name>  FAX subscriptions are also available.  Send a single page FAX to 215-974-6410 for further information.  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