Recent Lyme-related articles in the news

Below, you will find a collection of news articles that have recently been published locally and nationallly, all pertaining to Lyme Disease, coinfections, and related stories. All headlines are links to the originating story. These links will remain active, to the best of our ability.
(should a link be broken, as to the archival of a story from the originating site, the link will subsequently be removed from these pages.)

Sissy Baglieri, from Gettysburg, PA, dead from a suicide.
By MARY P. FELTER and JOSHUA STEWART Staff Writers

An Annapolis woman killed herself by jumping off an observation tower at Gettysburg National Military Park in Pennsylvania on Tuesday.

Mary "Sissy" L. Pastirik, 47, was found dead at the bottom of an observation tower by Canadian high school students. Evidence indicated that the death was a suicide, Adams County Pennsylvania Coroner Patricia Felix said.

Mrs. Pastirik's family said the suicide was unusual and unexpected. They believe Lariam, an anti-malarial medication Mrs. Pastirik took a year ago, contributed to her death by causing suicidal thoughts.

"This wasn't normal - you don't know how much she loved her kids. She had so many more things she was going to do," said Cheri Cochran, Mrs. Pastirik's cousin from Annapolis.

She took the medicine for a trip to South Africa a year ago to train a young American tennis star. Three days after she began her prescription, she was hospitalized, said her brother Peter Baglieri from Dobbs Ferry, N.Y.

When she returned to her home in Sherwood Forest, she tried to take her life but her family stopped her. They monitored her around the clock and by August 2006 she seemed to be back to her normal, happy self, Mr. Baglieri said.

"What (happened) last year was devastating. What happened this year was worse," he said.

Lariam can stay in a person's system long after they stop taking it, the medicine's producer Roche said.

Now, a year after she first took the medication, Mrs. Pastirik went to Gettysburg, home of her high school alma mater, and climbed the stairs of the 76-foot tall Longstreet Tower and jumped to her death.

It was the last thing anyone ever thought Mrs. Pastirik would do. She was a dedicated wife and mother of four, a professional tennis player, an active member at St. Mary's Catholic Church and relished her career as a life coach at Athletic Performance Inc., a sports center in Millersville. She was partially responsible for the creation of Springhill Center for Family Development in Crownsville, an organization dedicated to strengthening communities through families.

"She was a ball of energy. Always very peppy and energetic," said Del. Ron George, R-Arnold, who volunteers at the center.

Lariam caused the woman they knew to change, Mrs. Pastirik's family said.

The medication's physical side-effects, like nausea and dizziness, are common among medications, but the psychological ones - though rare among the drug's users - are serious. Some people who take the medication have mild nightmares, trouble sleeping, hallucinations, depression and suicidal thoughts, the Food and Drug Administration said in a special guide it created for patients.

"Some patients taking Lariam think about killing themselves and there have been rare reports of suicides. We do not know if Lariam is responsible for these suicides," the FDA said in an online report.

After a series of murders and suicides among soldiers taking the anti- malarial drug both stateside and in the Middle East, the Army began its own research and determined that Lariam was not a causal factor in the incidents. However, the Army first developed the drug and then licensed it to Roche.

"This drug has gone to perfectly healthy people. People in the military, the Peace Corps, have killed themselves, have murdered their families," Ms. Cochran said.

Regardless of the circumstances surrounding Mrs. Pastirik's death, her life and legacy is what matters to those who knew her.

"You look at her and you look at her beautiful family, her wonderful family. They are really leaders in themselves. What a reflection on her," Mr. George said.

Born Dec. 8, 1959, in Sleepy Hollow N.Y., she graduated from Gettysburg Area High School in 1978 and from Slippery Rock University in 1982.

She worked as a life coach and events coordinator for Athletic Performance Inc. and was also a certified professional by the U.S. Professional Tennis Association as well as a trainer at Wake Forest University.

"She was all over the country training top people in the field," Mr. Baglieri said.

She was particularly dedicated to her church and a member of the Regnum Christi movement, an organization that promotes the Roman Catholic faith.

"She was a devout Catholic," Ms. Cochran said. "It is so sad; she was such a special person who touched so many lives. She was such a leader who brought people closer to God."

Her energy and devotion to her faith, which forbids suicide, makes her death especially troublesome, family said.

"She was a major person. She was a Catholic who didn't believe in (suicide). She was an amazing person who touched so many people in such a short time, from little children through adults. She was the ultimate connector, not in a business way but in a spiritual way," Mr. Baglieri said.

Surviving are Mrs. Pastirik's husband Thomas Pastirik. They married in 1998 and had three sons, Christian, Graceson and Gabriel, and one daughter, Mary Rose. Her father, Frank Baglieri, lives in Gettysburg. Her grandmother, Susan A. Melaville lives in Sleepy Hollow. Besides Peter Baglieri, she has two other brothers, Michael and Gerald Baglieri, of Berlin in Worcester County and Singapore, respectively. She was the daughter of the late Mary Lee Baglieri.

Visitation is from 2 to 4 and 6 to 8 p.m. tomorrow at Kalas Funeral Home, 2973 Solomons Island Road, Edgewater. A funeral Mass will be said at 9:30 a.m. Monday at St. John Neumann Catholic Church, 620 N. Bestgate Road. Burial will be at St. Mary's Cemetery.

Published April 14, 2007, The Capital, Annapolis, Md.
Copyright © 2007 The Capital, Annapolis, Md.

Lyme and Tick-Borne Disease Prevention, Education,
and Research Act of 2007 (Introduced in House)

HR 741 IH

110th CONGRESS

1st Session

H. R. 741

To provide for the expansion of Federal efforts concerning the prevention, education, treatment, and research activities related to Lyme and other tick-borne diseases, including the establishment of a Tick-Borne Diseases Advisory Committee.

IN THE HOUSE OF REPRESENTATIVES

January 31, 2007

Mr. SMITH of New Jersey (for himself, Mr. STUPAK, Mr. HOLDEN, Mr. GILCHREST, Mr. SHAYS, Mrs. LOWEY,
Ms. DELAURO, Ms. BEAN, Mr. LANGEVIN, Mr. BAIRD, Mr. KIRK, Mr. ACKERMAN, Mr. GRIJALVA, and Mr. MCHUGH)
introduced the following bill; which was referred to the Committee on Energy and Commerce

A BILL

To provide for the expansion of Federal efforts concerning the prevention, education, treatment, and research activities related to Lyme and other tick-borne diseases, including the establishment of a Tick-Borne Diseases Advisory Committee.

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

This Act may be cited as the `Lyme and Tick-Borne Disease Prevention, Education, and Research Act of 2007'.

SEC. 2. FINDINGS.

Congress makes the following findings:

(1) Lyme disease is a common but frequently misunderstood illness that, if not caught early and treated properly, can cause serious health problems.

(2) Lyme disease is a bacterial infection that is transmitted by a tick bite. Early signs of infection may include a rash and flu-like symptoms such as fever, muscle aches, headaches, and fatigue.

(3) Although Lyme disease can be treated with antibiotics if caught early, the disease often goes undetected because it mimics other illnesses or may be misdiagnosed. Untreated, Lyme disease can lead to severe heart, neurological, eye, and joint problems
because the bacteria can affect many different organs and organ systems.

(4) If an individual with Lyme disease does not receive treatment, such individual can develop severe heart, neurological, eye, and joint problems.

(5) Although Lyme disease accounts for 90 percent of all vector-borne infections in the United States, the ticks that spread Lyme disease also spread other diseases, such as ehrlichiosis, babesiosis, and other strains of Borrelia. All of these diseases in 1 patient makes diagnosis and treatment more difficult.

(6) Studies indicate that the actual number of tick-borne disease cases are approximately 10 times the amount reported.

(7) Persistence of symptomatology in many patients without reliable testing makes treatment of patients more difficult.

SEC. 3. ESTABLISHMENT OF A TICK-BORNE DISEASES ADVISORY COMMITTEE.

(a) Establishment- Not later than 180 days after the date of the enactment of this Act, the Secretary of Health and Human Services (referred to in this Act as the `Secretary') shall establish within the Office of the Secretary an advisory committee to be known as the Tick-Borne Diseases Advisory Committee (referred to in this section as the `Committee').

(b) Duties- The Committee shall advise the Secretary and the Assistant Secretary for Health regarding the manner in which such officials can--

(1) ensure interagency coordination and communication and minimize overlap regarding efforts to address tick-borne diseases;

(2) identify opportunities to coordinate efforts with other Federal agencies and private organizations addressing such diseases;

(3) ensure interagency coordination and communication with constituency groups;

(4) ensure that a broad spectrum of scientific viewpoints are represented in public health policy decisions and that information disseminated to the public and physicians is balanced; and

(5) advise relevant Federal agencies on priorities related to the Lyme and tick-borne diseases.

(c) Membership-

(1) APPOINTED MEMBERS-

(A) IN GENERAL- From among individuals who are not officers or employees of the Federal Government, the Secretary shall appoint to the Committee, as voting members, an equal number of individuals from each of the groups described in clauses (i) through (v) of
subparagraph (B).

(B) GROUPS- The groups described in this subparagraph include the following:

(i) Scientific community members representing the broad spectrum of viewpoints held within the scientific community related to Lyme and other tick-borne diseases.

(ii) Representatives of tick-borne disease voluntary organizations.

(iii) Health care providers, including at least 1 full-time practicing physician, with relevant experience providing care for individuals with a
broad range of acute and chronic tick-borne diseases.

(iv) Patient representatives who are individuals who have been diagnosed with a tick-borne disease or who have had an immediate family member diagnosed with such a disease.

(v) Representatives of State and local health departments and national organizations that represent State and local health professionals.

(C) DIVERSITY- In appointing members under this paragraph, the Secretary shall ensure that such members, as a group, represent a diversity of scientific perspectives relevant to the duties of the Committee.

(2) EX OFFICIO MEMBERS- The Secretary shall designate, as nonvoting, ex officio members of the Committee, representatives overseeing tick-borne disease activities from each of the following Federal agencies:

(A) The Centers for Disease Control and Prevention.

(B) The National Institutes of Health.

(C) The Agency for Healthcare Research and Quality.

(D) The Food and Drug Administration.

(E) The Office of the Assistant Secretary for Health.

(F) Such additional Federal agencies as the Secretary determines to be appropriate.

(3) CO-CHAIRPERSONS- The Secretary shall designate the Assistant Secretary of Health as the co-chairperson of the Committee. The appointed members of the Committee shall also elect a public co-chairperson. The public co-chairperson shall serve a 2-year term.

(4) TERM OF APPOINTMENT- The term of service for each member of the Committee appointed under paragraph (1) shall be 4 years.

(5) VACANCY- A vacancy in the membership of the Committee shall be filled in the same manner as the original appointment. Any member appointed to fill a vacancy for an unexpired term shall be appointed for the remainder of that term. Members may serve after
the expiration of their terms until their successors have taken office.

(d) Meetings- The Committee shall hold public meetings, except as otherwise determined by the Secretary, after providing notice to the public of such meetings, and shall meet at least twice a year with additional meetings subject to the call of the co-chairpersons. Agenda items with respect to such meetings may be added at the request of the members of the Committee, including the co-chairpersons.
Meetings shall be conducted, and records of the proceedings shall be maintained, as required by applicable law and by regulations of the Secretary.

(e) Authorization of Appropriations- For the purpose of carrying out this section, there is authorized to be appropriated $250,000 for each of the fiscal years 2008 through 2011. Amounts appropriated under the preceding sentence shall be used for the expenses and per diem costs incurred by the Committee under this section in accordance with the Federal Advisory Committee Act, except that no voting member of the Committee shall be a permanent salaried employee.

SEC. 4. FEDERAL ACTIVITIES RELATED TO THE DIAGNOSIS, SURVEILLANCE, PREVENTION, AND RESEARCH OF LYME AND OTHER TICK-BORNE DISEASES.

(a) In General- The Secretary, acting as appropriate through the Director of the Centers for Disease Control and Prevention, the Director of the National Institutes of Health, the Commissioner of Food and Drugs, and the Director of the Agency for Healthcare Research and Quality, as well as additional Federal agencies as the Secretary determines to be appropriate, and in consultation with the Tick-Borne
Diseases Advisory Committee, shall provide for the coordination of all Federal programs and activities related to Lyme and other tick-borne diseases, including the activities described in paragraphs (1) through (4) of subsection (b).

(b) Activities- The activities described in this subsection are the following:

(1) DEVELOPMENT OF DIAGNOSTIC TESTS- Such activities include--

(A) the development of sensitive and more accurate diagnostic tools and tests, including a direct detection test for Lyme disease capable of
distinguishing active infection from past infection;

(B) improving the efficient utilization of diagnostic testing currently available to account for the multiple clinical manifestations of both
acute and chronic Lyme disease; and

(C) providing for the timely evaluation of promising emerging diagnostic methods.

(2) SURVEILLANCE AND REPORTING- Such activities include surveillance and reporting of Lyme and other tick-borne diseases--

(A) to accurately determine the prevalence of Lyme and other tick-borne disease;

(B) to evaluate the feasibility of developing a reporting system for the collection of data on physician-diagnosed cases of Lyme disease that do not meet the surveillance criteria of the Centers for Disease Control and Prevention in order to more accurately gauge disease incidence; and

(C) to evaluate the feasibility of creating a national uniform reporting system including required reporting by laboratories in each State.

(3) PREVENTION- Such activities include--

(A) the provision and promotion of access to a comprehensive, up-to-date clearinghouse of peer-reviewed information on Lyme and other
tick-borne disease;

(B) increased public education related to Lyme and other tick-borne diseases through the expansion of the Community Based Education Programs of the Centers for Disease Control and Prevention to include expansion of information access points to the public;

(C) the creation of a physician education program that includes the full spectrum of scientific research related to Lyme and other tick-borne
diseases; and

(D) the sponsoring of scientific conferences on Lyme and other tick-borne diseases, including reporting and consideration of the full spectrum of clinically-based knowledge, with the first of such conferences to be held not later than 24 months after the date of enactment of this Act.

(4) CLINICAL OUTCOMES RESEARCH- Such activities include--

(A) the establishment of epidemiological research objectives to determine the long term course of illness for Lyme disease; and

(B) determination of the effectiveness of different treatment modalities by establishing treatment outcome objectives.

(c) Authorization of Appropriations- For the purposes of carrying out this section, and for the purposes of providing for additional research, prevention, and educational activities for Lyme and other tick-borne diseases, there is authorized to be appropriated $20,000,000 for each of the fiscal years 2008 through 2012. Such authorization is in addition to any other authorization of appropriations available for such purpose.

SEC. 5. REPORTS ON LYME AND OTHER TICK-BORNE DISEASES.

(a) In General- Not later than 18 months after the date of enactment of this Act, and annually thereafter, the Secretary shall submit to Congress a report on the activities carried out under this Act.

(b) Content- Reports under subsection (a) shall contain--

(1) significant activities or developments related to the surveillance, diagnosis, treatment, education, or prevention of Lyme or other tick-borne diseases, including suggestions for further research and education;

(2) a scientifically qualified assessment of Lyme and other tick-borne diseases, including both acute and chronic instances, related to the broad spectrum of empirical evidence of treating physicians, as well as published peer reviewed data, that shall include recommendations for addressing research gaps in diagnosis and treatment of Lyme and other tick-borne diseases and an evaluation of treatment
guidelines and their utilization;

(3) progress in the development of accurate diagnostic tools that are more useful in the clinical setting for both acute and chronic disease;
and

(4) the promotion of public awareness and physician education initiatives to improve the knowledge of health care providers and the public regarding clinical and surveillance practices for Lyme disease and other tick-borne diseases.

Tickborne Relapsing Fever Diagnosis Obscured by Malaria, Togo

EID Journal Home > Volume 13, Number 1–January 2007
Volume 13, Number 1–January 2007
Research

Annika Nordstrand,* Ignas Bunikis,* Christer Larsson,* Kodjo Tsogbe,† Tom G. Schwan,‡ Mikael Nilsson,§ and Sven Bergström*
*Umeå University, Umeå, Sweden; †Association Protestante des Oeuvres Médico-Sociales et Humanitaires du Togo, Lomé, Togo;
‡National Institutes of Health, Hamilton, Montana, USA; and §The Swedish Institute for Infectious Disease Control, Solna, Sweden

Abstract: Given the prevalence of relapsing fever (RF) in Senegal, this disease may cause illness and death in other areas of West Africa. We performed a cross-sectional, clinic-based study to investigate the presence of RF in Togo during 2002–2004. Blood samples from
patients with fever were examined for RF spirochetes by microscopy, PCR, and DNA sequencing of amplicons and for antibodies to the
glycerophosphodiester phosphodiesterase antigen. Although no spirochetes were seen in blood smears, 10% of the patients were positive by PCR and ?13% were seropositive for spirochetes. DNA sequencing demonstrated that Borrelia crocidurae and B. duttonii were present. Most patients were treated for malaria whether or not plasmodia were observed. Thus, many RF patients originally had a misdiagnosis of malaria, which resulted in ineffective treatment. The inability of microscopic analysis to detect spirochetes compared with PCR demonstrates the need for tests with greater sensitivity.

Spirochetes of the genus Borrelia are known to cause 2 major types of human disease, Lyme disease, which occurs primarily in temperate
regions, and relapsing fever (RF), which occurs in both temperate and tropical regions. Many vertebrates serve as enzootic hosts for the bacteria, and borreliosis is related to climatic and other environmental parameters required for the vectors and reservoir hosts (1,2). Borrelia-related disease is endemic intropical and subtropical regions; B. hermsii and B. turicatae cause tickborne RF (TBRF) in North America. In Europe, TBRF is uncommon; B. hispanica is the causative agent in Spain, Portugal, Greece, and Cyprus (3,4).

TBRF in Africa is caused primarily by B. duttonii, which is transmitted by Ornithodoros moubata ticks in East and Central Africa, and by B. crocidurae, which is transmitted by O. sonrai in West Africa. Humans are the only known vertebrate host for B. duttonii. B. crocidurae is maintained in enzootic cycles in rodents and other small mammals. African TBRF is associated with proximity to tick-infested burrows and huts (4–6).

The primary clinical manifestations of RF are recurrent high fever interrupted by afebrile periods, hepatomegaly, splenomegaly, and
anemia. These signs are similar to those of malaria. The fever peaks are associated with high spirochetemias, and antigenic variation
leads to new antigenic variants of a major surface protein and the recurrence of high numbers of borreliae in the blood (7–10). When
patients have high fever, spirochetes may achieve sufficiently high cell densities in the blood to be observed directly by microscopy
when wet mounts of blood or Giemsa-stained blood smears are examined. Between peaks, the bacteria are too scarce to be visualized in the blood. Treatment with various antimicrobial drugs is effective (5,6); however, borreliae may rapidly invade the brain, and infection of the central nervous system may persist if not treated or if treated with antimicrobial drugs that do not readily penetrate the blood-brain barrier (5).

Research on RF in Africa has been limited, and little is known regarding the presence and geographic distribution of the spirochetes and tick vectors. Studies in Senegal indicate that RF is widely distributed and prevalent in this country; investigators speculate that RF may cause illness in rural areas throughout much of West Africa (11). A 2-year prospective investigation in a rural community in the Senegalese savanna showed that 10% of the study population became infected during the study period, resulting in an incidence of 5.1% (12). A recent 14-year longitudinal study demonstrated an average TBRF incidence of 11/100 person-years in Delmo, Senegal, and suggested that TBRF is a common cause of fever in most rural areas of Senegal as well as in some regions of Mauritania and Mali (13). In other areas of West Africa, where RF has not been identified, the disease is generally not considered in the diagnosis when patients have a fever.

We hypothesized that RF caused by B. crocidurae may be present in other areas of West Africa where the climate and environment are similar to that of Senegal. However, because of the lack of knowledge, diagnostics, and the high prevalence of malaria in these areas, RF remains undetected (14). Therefore, we conducted a study in Togo to determine if patients with fever might have RF. The study included examination of blood by direct microscopy, molecular methods, and serologic analysis.

Methods

Setting

Figure
[Photos omitted on LymeInfo – go to URL at top of
page to view photo
captioned below.]
Figure. Locations of clinics in Togo involved in the
study: 1,
Dapaong; 2, Sodo; 3, Kpalimé; 4, Agou; 5, Bethesda;
6, sites of the
community study in the Sodo region...

Clinics participating in the study were located in the northern dry savannah and the southern tropical high plateau of Togo. The clinics
were at the children's hospital, Hopital d'Enfants, in Dapaong (urban/semiurban) in northern Togo and rural clinics in southern Togo, including the Centre Medico-Social de Sodo in Sodo, Hopital Bethesda, Agou Clinic in the Agou area, and the general hospital in
Kpalimé, a town with 50,000 inhabitants (Figure).

Participants

Interviews and sampling were conducted from March 2002 through September 2004; sampling was performed from August through October in 2003 and 2004 in northern and southern Togo, respectively. Trained laboratory personnel in various clinics obtained blood
samples, conducted interviews, and performed microscopic analyses. A total of 244 persons with fever were randomly selected; 14 persons
without fever were included as controls.

Procedures

A questionnaire that contained information on demography, living conditions such as building materials that may be favorable for nesting ticks and rodents, and occupation was used in interviews. Axillary temperature of each patient with fever was measured. Blood was collected from the arm by venipuncture or from a finger by lancet stick and applied to glass microscope slides. Thick and thin blood smears were stained with Giemsa and analyzed by microscopy at a magnification of 1,000× for plasmodia and at 400× for spirochetes.
Microscopic examination for spirochetes was used at the clinics to enable diagnosis on site by the method routinely used in Senegal
(14,15). Approximately 300 fields were examined to detect malaria parasites and borreliae. For malaria diagnosis, samples were
examined for trophozoites and gametocytes. Blood and serum samples were stored at -20°C and shipped frozen to Sweden for further
testing.

Plasmid Cloning and Protein Expression

Genomic DNA from B. crocidurae was used as a template for amplification of the glycerophosphodiester phosphodiesterase (glpQ)
gene and subsequent sequence analysis (Table 1). The PCR amplification product was digested with BamHI and XhoI and cloned
into the pET-15b vector (Novagen, Madison, WI, USA) as previously described (16). The resulting recombinant plasmid was transformed
into the Rosetta strain of Escherichia coli. The heterologously produced histidine (His)–tagged GlpQ fusion protein was purified by
using Ni-NTA spin columns (Qiagen, Valencia, CA, USA), and the protein concentration was determined with Bradford assay (Bio-Rad
Laboratories, Hercules, CA, USA).

ELISA with Recombinant GlpQ Protein

An ELISA was used to detect anti-GlpQ immunoglobulin G (IgG) antibodies in patient sera and was performed as described by Porcella et al. (16). Briefly, His-GlpQ protein was adsorbed onto microtiter well surfaces of Ni-NTA HisSorb plates (Qiagen). Wells were blocked with diluent to inhibit nonspecific binding and washed. Serum samples were tested at a 1:100 dilution by incubating 100 ?L/well for 1 h at room temperature. After 3 washes, 100 L of a 1:2,500 dilution of goat anti-human IgG (heavy and light chains) conjugated to horseradish peroxidase (Kirkegaard and Perry Laboratories, Gaithersburg, MD, USA) was added to each well and incubated for 1 h. After 3 washes, 50% 2,2´-azino-di-(3-ethyl-benzthiazoline sulfonate) substrate was added and incubated for 25 min before analysis at 405 nm with a Multiskan microtiter plate reader (Labsystems, Vantaa, Finland). Each serum sample was tested in triplicate, and the mean absorbance value was determined. Samples were considered positive if their mean absorbance was greater than the mean plus 3 standard deviations of the absorbance of control sera tested at the same dilution. Serum samples from Ethiopian patients with RF were included as positive controls (16).

Blood Screening by Nested PCR

Blood samples that were positive or borderline positive by ELISA were tested by a nested PCR for Borrelia DNA. DNA was purified from the blood samples and 4 primers (Table 1) were used for detection of the 16S rRNA gene of borreliae. The first PCR amplified a 584-bp region of the gene with the primers Nested_1_F – Nested_1_R. The second PCR amplified a 498-bp region with the primers Nested_2_F – Nested_2_R. The amplicons obtained from the nested PCRs were sequenced to identify the Borrelia species because
the primers were not able to amplify DNA from specific species of RF spirochetes.

PCR and Sequencing

For amplification of the complete coding sequence of glpQ gene from B. duttonii, 2 primers were designed by using B. hermsii noncoding
sequences flanking the glpQ gene and 4 primers were designed by using sequences within the gene (Table 1). Nested PCR primers (Table
1) were designed to target the 16S rRNA gene. The PCR product for the B. duttonii glpQ gene was sequenced, and data were deposited in
GenBank (accession no. DQ909058).

Ethics

The study was approved by the Ethics Committee at Umeå University (Dnr 04–050 M). Informed consent was obtained at clinics from all
patients or from the accompanying parent if the patient was a child.

Statistical Analysis

Proportions were compared with a 2-tailed 2-corrected (Yates) analysis and Fisher exact test. p values <0.05 were considered significant.

Results

No patients were positive for borreliae by microscopic examination of Giemsa-stained blood smears. Among patients with fever, 9 (10%)
of 90 children in northern Togo, and 5 (9.8%) of 51 children and 16 (16.3%) of 98 adults in southern Togo were seropositive by ELISA. A total of 12.6% of patients with fever were positive by ELISA (Table 2). For those patients without fever, 2 (14.3%) of 14 were
seropositive. Because the glpQ gene is present in RF spirochetes but not in Lyme disease spirochetes, the positive serologic results
strongly suggest that patients were infected with RF spirochetes (11). However, this serologic test is not species specific and cannot distinguish current from past infections.

Current Borrelia infections were detected by PCR and 16S rRNA gene sequence analysis in blood samples of patients from both northern
and southern Togo. DNA sequencing identified both B. crocidurae and B. duttonii, but B. duttonii was found only in patients from
northern Togo (Table 2). All 81 patients from northern Togo who were seronegative were also negative by PCR. In contrast, 8 (88.9%) of 9 patients who were positive by ELISA were also positive by PCR (p<0.05). All patients who were positive by PCR had a fever when
their blood samples were collected.

A total of 28 patients from southern Togo were tested for current spirochetemias and included all ELISA-positive and some ELISA-negative patients. The negative samples chosen were those with the highest values below the cut-off value as well as randomly chosen
samples with lower values. The 13 PCR-positive patients included 11 (55%) of 20 ELISA-positive patients and 2 (25%) of 8 ELISA-negative patients. Two samples from ELISA-positive patients could not be tested by PCR because the DNA was degraded. Both
patient samples that were PCR positive and ELISA negative had ELISA values just below cut-off value used in the study.

All patients from northern Togo were children (age range <1–14 years). For children <4 years of age, 6 (10%) of 60 were seropositive. Of these children, 5 had a fever and 4 had an active Borrelia infection detected by PCR. DNA sequence analysis showed that 3 children were infected with B. crocidurae and 1 with B. duttonii. In southern Togo, 1 (9.1%) of 11 children <1–4 years of age were seropositive. The overall male-to-female ratio among study patients was 1.3:1. Serologic and PCR results did not differ by sex, ethnic background, or profession, with the exception of cow herders. The prevalence of seropositive adults was 62.5% (5/8) among cow herders compared with 12.2% (11/90) among those in other professions (p<0.05); 11 (78.6%) of 14 adults in the Peuhl ethnic group were cow herders (95% confidence interval [CI] 49.2%–95.3%), and 4 of 5 ELISA-positive Peuhl were cow herders. A total of 10.8% (95% CI 5.9%– 17.8%) of all adults studied were cow herders. More Borrelia- infected patients lived in houses made of mud rather than cement than persons without RF infection (p = 0.008, data not shown).

The prevalence of malaria among patients with fever was 63.1%. Of 21 patients with PCR-confirmed Borrelia infections, malaria was
diagnosed for 7 on the basis of a positive blood smear. Therefore, 7 (4.5%) of 154 patients were coinfected with malaria parasites and
Borrelia (Table 3). In the youngest children (<4 years of age), 4 of 5 Borrelia-infected children also had malaria.

In northern Togo, patients infected with malaria and Borrelia were treated primarily with chloroquine, artemether, quinine, and amoxicillin. Borrelia-infected, malaria-negative patients were treated primarily with chloroquine, quinine, or amoxicillin. In southern Togo, patients with malaria and Borrelia infections were treated primarily with quinine and chloramphenicol for typhoid fever, metronidazole for amebiasis, and albendazole for digestive parasitosis. Borrelia-infected, malaria-negative patients were treated with chloroquine and antimicrobial drugs, such as amoxicillin, which are ineffective against RF Borrelia (Table 3) (14).

Discussion

Although microscopic analysis of Giemsa-stained blood smears for Borrelia showed negative results, current infections were demonstrated by PCR and gene sequencing in 8.8% of patients with fever. Therefore, no RF infections would have been detected if only microscopic examination of stained blood smears had been performed. Our results emphasize the low sensitivity of microscopy in the diagnosis of RF, as has demonstrated by others (11,14,17). Another problem in diagnosis is that the borreliae are detectable only during the short peaks of fever (18). Microscopy might have shown positive results if dark-field or fluorescent microscopy had been used, but this was not possible in the clinics in this study. However, 1 of the primary objectives of this study was to improve the diagnosis of RF borreliosis by using molecular and serologic techniques.

A study of rodents in Senegal showed that 57.7% of Borrelia infections were false negative by microscopy (11). Microscopy is the
method routinely used to diagnose B. crocidurae infections in Senegal, where the disease is common (14,15). Thus, methods that
provide greater sensitivity are needed to determine more accurately the presence of RF throughout West Africa. Since the GlpQ antigen is
present in RF Borrelia but absent in Lyme disease Borrelia, positive antibody test results strongly indicated that infections with RF
Borrelia were occurring or had occurred (16). However, the infecting species and the time of infection could not be determined by this
method. Positive serologic test results correlated with current infection, as demonstrated by PCR and sequence analysis. Thus,
serologic tests may be more adequate for diagnosis, although ELISA procedures would have to be modified for use in small rural clinics.

Our finding of TBRF in Togo demonstrates that the geographic distribution of this disease in West Africa is greater than previously thought. Trape et al. suggested that RF caused by B. crocidurae might be spreading to new areas because of the sub-Saharan drought, which might allow vector ticks to colonize new areas in the savannas of West Africa (2). Our results suggest that this might be true. We also found RF caused by B. crocidurae in the tropical region of southern Togo, where the climate may be less favorable for its tick vector. Thus, habitats believed to be preferred by O. sonrai may need to be reconsidered. Southern Togo has been subjected to deforestation, periods of drought, and slash-and-burn agriculture. During the rainy season, the average temperatures in Dapaong and Atakpame are 24°C and 25.8°C, respectively, compared with dry season mean temperatures of 28.9°C and 26.8°C, respectively (19). The dry wind or
harmattan from the Sahara Desert during winter can cause periodic droughts in northern Togo. We propose that areas with similar climate in West Africa are likely to have TBRF.

Of particular interest was our finding of B. duttonii in northern Togo, which extends the known distribution of this species in Africa. Additional work is needed to determine if its vector O. moubata is present in northern Togo or if B duttonii can be transmitted by O. sonrai. More studies are needed to determine the distribution of RF spirochetes and their vectors in Africa and what effect these infections have on human health.

Many of the primary symptoms of malaria and RF are similar, such as recurrent fever, chills, anemia, hepatomegaly, splenomegaly, and
possible neurologic symptoms. Thus, a considerable risk for misdiagnosis of TBRF as malaria exists in countries in which RF is not recognized but in which malaria is prevalent. Occasional reports of European tourists returning home from Senegal with B. crocidurae
infections have implied that the disease may be misdiagnosed as malaria, which leads to incorrect treatment (14,15,20). Because RF
has not been investigated in most West African countries including Togo, the disease is generally not considered in a differential
diagnosis for fever patients. Also, malaria is often diagnosed on the basis of only clinical symptoms, not examination for parasites
in the blood, which increases misdiagnosis. Increased knowledge of the geographic distribution and epidemiology of RF in West Africa
should improve the recognition and treatment of this disease. Prompt diagnosis of RF would also reduce the number of people in whom
chronic symptoms such as neuroborreliosis later develop when bacteria cross the blood-brain barrier and infect the central nervous system (5,21,22).

We used a questionnaire to determine possible risk factors associated with RF. Some children <4 years of age were infected with RF Borrelia. Since O. sonrai is nocturnal, feeding mostly at night, these children may have been infected at home. However, RF among
infants may also reflect infection from mothers before or during birth, as occurs with B. duttonii in East Africa (18). We also found
that persons with current Borrelia infections more often lived in houses made of mud rather than cement. This observation is similar
to ones in Senegal, where Ornithodoros ticks feed primarily at night inside mud or in adjacent areas where small mammals
are present (2,6,20).

Before our study, we trapped 66 rodents and insectivores in or near houses in Togo. Four species were identified: musk shrew (Crocidura
spp.), Nile rat (Arvicanthis niloticus), multimammate rat (Mastomys natalensis), and brown rat (Rattus norvegicus); 3 are known
reservoirs for B. crocidurae in Senegal. These findings showed the presence of these potential reservoirs in northern and southern Togo
(unpub. data). We found that mud huts were associated with entrances of rodent burrows, which might increase the risk for exposure to
ticks (data not shown). In the present study, cow herders were also at a greater risk of acquiring RF. However, more studies are
required to investigate potential risk groups. A higher proportion of cow herders who were ELISA positive were also Peuhl, who are
nomadic people. Their behavior and sleeping outside at night may put them at greater risk of being bitten by nocturnal soft ticks.

We report TBRF in Togo with a prevalence of 8.8% among the patients studied. For those with fever, 63.1% had malaria and 4.5% were
coinfected with RF Borrelia. Among those with RF, 33.3% were coinfected with malaria parasites. Given the retrospective finding
of spirochetes by PCR, only 1 of 18 patients with TBRF received treatment effective against this disease at the time she was seen in
the clinic. Thus, TBRF is obscured by the high incidence of malaria in Togo, and this problem likely occurs in other regions in West
Africa. In rural health centers without laboratory facilities, diagnosis of malaria is based only on clinical symptoms. The potential risk for misdiagnosis and ineffective treatment of patients with RF rather than malaria needs to be addressed. Our findings demonstrate the need for improved diagnostic procedures to detect TBRF in West Africa. We consider the high prevalence of RF among febrile children and the lack of correct treatment as important health concerns, particularly with regard to the severity of untreated neuroborreliosis and women infected during pregnancy.

For Article Figures, Acknowledgments, References, and Resources, please visit the Original Article.

Use the force, bacteria

The Scientist, Volume 20 | Issue 12 | Page 20
By Stephen Pincock

NOTEBOOK

A couple of years ago, Australian postdoc Nate Lo was working at the University of Milan, looking for human pathogens in the tick species Ixodes ricinus, the main vector for Lyme disease. It was all routine until the day his PCR screening protocol revealed a novel 16S rRNA sequence. When his team took a tick apart to look for the new bug, they found it in the ovaries. And, when they looked closely at electron micrographs of infected ovarian tissues, they could see that the microbes were intracellular - living not in the cytoplasm of tick ova, but within their mitochondria.

"We'd never seen anything like this before," Lo says, as he opens the image files on his laptop on a rainy afternoon in Sydney. "They seem to get in between the inner and outer mitochondrial membranes and eat the mitochondria up. In the end you've just got this empty sack."

"It's a very novel observation," says Scott O'Neill, a specialist in invertebrate endosymbionts and head of the School of Integrative Science at the University of Queensland, who wasn't involved in the research. O'Neill, whose recent work has focused on the bacterium Wolbachia, says he wasn't aware of any other bacteria that live inside mitochondria. "It's pretty surprising to see a bacterial species living inside the mitochondrion, which itself was a bacterium," he says. "I think it is significant." Bill Ballard, a mitochondrial specialist from the University of New South Wales, agrees. "This is, as far as I know, the first [bacterium] that actually infects within the mitochondria," he says. "It's a pretty cool paper."

Lo's newly found organism doesn't seem to have any negative effects on the ticks. "About half the mitochondria don't get infected," he says, "so perhaps they are only destroying old ones. We don't really know what's going on."

Lo moved to his current post at the University of Sydney, and then wrote to scientists across Europe, Russia, North Africa, and the Middle East, asking them to send ticks for him to screen. Sure enough, he found his bugs, nestled into the ovaries of 100% of female ticks.

Soon, Lo and his colleagues began looking for a name for their new genus, which proved easier said than done. The morphology of the organism didn't present any immediate clues, and there weren't any eminent tick bacterium researchers in whose honor it could be named.

So Lo started surfing the Web, looking for ideas and finding nothing until one link took him to a page on the Wikipedia Web site describing midichlorians. He discovered that George Lucas had invented these creatures while dreaming up his Star Wars movies. The mysterious intracellular organisms apparently reside within the cells of almost all living things and communicate with the Force.

"I quite liked the earlier Star Wars movies, but I'd never heard of these midichlorians before," Lo explains. Although he's not what you'd call a Star Wars fanatic, Lo began thinking perhaps he should name his real-life organism after the imaginary ones. After all, he says, "Art is often imitating science, but it doesn't often go the other way."

In May of this year, Lo and his colleagues submitted a paper to the International Journal of Systematic and Evolutionary Microbiology suggesting that their new species be called Midichloria mitochondrii. They crossed their fingers and waited for the publishing process to take its course.

Meanwhile, one of Lo's coauthors started to get a little nervous. Weren't midichlorians the intellectual property of George Lucas? Might he sue? While the paper was out for review, Lo wrote to Lucas and sought his permission. "I was really praying he wouldn't say no," Lo says. Lucas' assistant wrote back graciously to say that George was fine with the whole thing, and on June 20, the journal accepted the paper. "One reviewer was very negative about the name, but fortunately the editor was fairly open-minded," Lo says.

The journal published the paper early last month. It turns out that Lo and his colleagues had submitted their suggestion just before the well-known French rickettsia expert, Didier Raoult, had proposed the name Nicolleia massiliensis. "As far as we know it's the first species to be formally named after anything in the entertainment industry," Lo says. "There's plenty of science in Star Wars but not enough Star Wars in science as far as I'm concerned."

SCHOOLS ON SICK WATCH
JOSEPH B. NADEAU, Staff Writer (The Woonsocket Call)
NORTH SMITHFIELD (RI)-- Area school nurses and health professionals are on the lookout for cases of a specific respiratory illness believed behind cases of bacterial meningitis and encephalitis that claimed the life of 7-year-old Dylan Gleavy of Warwick and left two other Kent County students seriously ill before the holidays. After speaking with school department physician Dr. Peter T. Yasigian about the Kent County concerns on Tuesday and also receiving information from the state departments of Health and Education, North Smithfield School Superintendent Stephen Lindberg sent out a letter to parents describing the illness and suggesting health precautions to limit its spread.

While state officials Tuesday said they are on the watch for new cases of the serious variation of mycoplasma bacteria-related pneumonia outside of Kent County, Lindberg said he hasn't been informed of any local cases.

"But we are going to monitor it day to day," he added.

The information forwarded from Commissoner of Education Peter McWalters and state Department of Health Director Dr. David R.
Gifford included a list of frequently asked questions about the more common form of the illness, which can also be obtained through the health department's Web site, www.health.ri.gov.

"Mycoplasma is an organism which frequently causes upper respiratory infections and pneumonia in both adults and children," Yasigian states in the school department's letter to parents.

"It is very rare for this bacterium to cause encephalitis or meningitis," he added.

Locally, the closing of school for the past 10 days due to the holiday season should have reduced the transmission of mycoplasma-related illness through the schools, but Yasigian noted, "It is still possible to pick up illness in the community in supermarkets, movies, churches, clubs" and day care centers.

"It is important to contact your doctor or your child's doctor for a cough progressing after five days especially if not accompanied by a runny nose and if accompanied by a fever," Yasigian said.

"Contact your child's doctor for any severe headache or lethargy," he added.

Precautions to minimize the spread of such illnesses included teaching children to cough into the sleeve on their arm and as well as instructing them in "good hand washing techniques," Yasigian said. The doctor also advised parents to keep their child home "if they
are coughing frequently."

During a briefing for media on Tuesday, Gifford said the cluster of three serious cases of the mycoplasma-related illness, including the death of Dylan Gleavey, prompted his agency to contact the federal Centers for Disease Control to explore options for heading off
any further spread of the more virulent form of the bacteria.

The federal agency recommended the issuance of a preventative round of antibiotics for those coming in contact with the strain, much as is
recommended for control of bacterial meningitis outbreaks.

That action was ordered for Gleavey's school, Greenwood Elementary in Warwick, which is expected to remain closed until Monday as an added precaution.

The case of encephalitis ending in the Warwick student's death had been initially viewed as viral meningitis when the child was hospitalized, but department officials now believe it was related to a variation of mycoplasma illness also believed to have affected
the two other children, Gifford said.

It was the "cluster" of such cases in one area that caused the state such alarm, he noted.

"This is an unusual event," he said. "Our concern is whether there are more cases cropping up or not."

The Department of Health is currently investigating a suspected higher-than-normal incidence of mycoplasma illness in Coventry and West
Warwick this fall, and is also continuing to study the incidence of the illness in Warwick schools, he said.

In many cases the illness resolves on its own without treatment, he noted, and in others, a round of antibiotics are required. In rare cases the
illness can continue on into forms of bacteria meningitis and encephalitis, an infection affecting the brain and spinal membranes.

As part of the state's efforts to learn more about the illness, Gifford said the Department of Health provided school nurses around the state with information on the symptoms of the illness and how to report any findings regarding their communities.

The department has also asked families in affected Kent County schools to be tested for evidence of the bacteria in their saliva through throat swabs. Further blood tests could be requested of those found to have evidence of the bacteria, he noted.

The Department of Education was also working with the Department of Health to get out information on the illness concerns, according to Elliot Kreiger, a spokesman for that agency.

In addition to the Department of Health contacting the school nurses, Kreiger said the Department of Education sent out further information to school superintendents in the state Tuesday.

According to the information distributed by the state, the symptoms of a mycoplasma infection typically include fever, cough,
bronchitis, sore throat and headache. A common form of the illness is a so-called bout of "walking pneumonia" that is usually mild and rarely requires hospitalization, according to the state. Ear infections can also be experienced during a case of the illness and the
symptoms can persist from a few days to more than a month. Typically, symptoms begin two to three weeks after exposure and develop slowly over a period of two to four days, according to the state.

Testing for mycoplasma can be arranged through a family's health care provider, the Department of Health said. As of Tuesday the state was only providing testing services and preventative antibiotics to the Greenwood Elementary School community.

North Smithfield School Committee Chairman Robert E. Lafleur, joining Lindberg and other committee members at Tuesday's
council meeting, said local schools have not been experiencing a higher than normal rate of absences this fall but added that school officials will be watching for any problems as a result of the mycoplasma concerns in Kent County.

"We are finding out from the state what we can do to be proactive about this," Lafleur said.

The school officials met with the Town Council to seek funding assistance for improvements in school security at the town's
three school buildings.

The council voted unanimously in support of the school department going out to bid on improved security features such as new
doors and electronic monitoring equipment and will meet with the panel again for review of using past school bonding to fund the estimated $200,000 or more project.

SAN ANTONIO (AP) -- The $10.6 million Margaret Batts Tobin Laboratory Building will provide a 22,000-square- foot facility to study such diseases as anthrax, tularemia, cholera, lyme disease, desert valley fever and other parasitic and fungal diseases. The Centers for Disease Control and Prevention identified these diseases as potential bioterrorism agents.".

So, for the first time, a US government body admits that Lyme disease is a biological warfare agent.

This is the reason that hundreds of thousands of men, women and children around the world have been left to rot with wrong diagnoses, or have had their Lyme disease acknowledged but been told that it is an "easily-treated" disease, given 3 weeks' antibiotics, then told to shove off when their symptoms carried on after that.

In Britain the existence of the epidemic is denied completely, and virtually no effort made to warn or educate the public about the dangers of ticks, which carry the bacteria Borrelia burgdorferi.

The Borrelia genus has been a subject of biowar experimentation at least as far back as WW2, when the infamous Japanese Unit 731, which tortured and experimented on live prisoners, studied it.

The reality is, Lyme disease is for many a chronic, horrendous, incapacitating disease producing crippling fatigue, constant pain, loss of memory, possible paralysis, psychosis, blindness and even death.

It was an ideal biowar agent because it evades detection on routine tests, has an enormous range of different presentations, and can mimic everything from ADHD to multiple sclerosis to carpal tunnel syndrome to rheumatoid arthritis to chronic fatigue syndrome (M.E.) to lupus to schizophrenia.

Enemy medical staff would never know what had hit them, nor even that ONE illness had hit their population, rather than an unexplained rise in dozens of known conditions.

Honest doctors and scientists who tried to treat or research Lyme disease according to ethical principles have been viciously persecuted by government-backed organisations in the US, Europe and elsewhere.

Many specialists in the US were threatened with loss of their license or had anonymous, false allegations sent to the medical board, which tied them up in mountains of paperwork and legal fees...some were forced out of medicine or even driven to suicide.

Instead, medical disinfo agents, most of whom have a background in military/biowarfare units, such as Dr Allen Steere, Mark Klempner, Philip Baker, Edward McSweegan, David Dennis, Alan Barbour, etc., were enabled to assume top positions in Lyme research , CDC, NIH, etc., from where they issued false information, covering up the true seriousness and chronic nature of the disease, and comdemned untold numbers to a living hell.

VIRUS MAY AFFECT MEMORY DECADES LATER, STUDY FINDS
Mon Oct 23, 12:09 PM ET

WASHINGTON (Reuters) - Forget where you left your glasses? Did those keys go missing again? Now you do not have to blame your spouse -- a virus may be to blame.

A family of viruses that cause a range of ills from the common cold to polio may be able to infect the brain and cause steady damage, a team at the Mayo Clinic in Minnesota reported on Monday.

"Our study suggests that virus-induced memory loss could accumulate over the lifetime of an individual and eventually lead to clinical cognitive memory deficits," said Charles Howe, who reported the findings in the journal Neurobiology of Disease.

The viruses are called picornaviruses and infect more than 1 billion people worldwide each year. They include the virus that causes polio, as well as colds and diarrhea. People contract two or three such infections a year on average.

"We think picornavirus family members cross into the brain and cause a variety of brain injuries. For example, the polio virus can cause paralysis," Howe said.

"It can injure the spinal cord and different parts of the brain responsible for motor function. In the murine (mouse) virus we studied, it did the same thing and also injured parts of the brain responsible for memory."

The Mayo Clinic infected mice with a virus called Theiler's murine encephalomyelitis virus, which is similar to human poliovirus.

Infected mice later had difficulty learning to navigate a maze. Some were barely affected, while others were completely unable to manage, and when the mice were killed and their brains examined, a correlating amount of damage was seen in the hippocampus region, related to learning and memory.

One virus particularly likely to cause brain damage is enterovirus 71, which is common in Asia, the researchers said. It can cross over into the brain and cause encephalitis, a brain inflammation that can lead to coma and death.

"Our findings suggest that picornavirus infections throughout the lifetime of an individual may chip away at the cognitive reserve, increasing the likelihood of detectable cognitive impairment as the individual ages," the researchers wrote in their report.

"We hypothesize that mild memory and cognitive impairments of unknown etiology may, in fact, be due to accumulative loss of hippocampus function caused by repeated infection with common and widespread neurovirulent picornaviruses."

Other viruses are known to kill brain cells, including the herpes virus and human immunodeficiency virus or HIV.

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