I may have been wrong when I wrote back in November 2009 that the denizens of the online forum, LymeNut, were unable to detect craziness among themselves. Apparently, one or two of them can. Case in point: one deeply disturbed woman posted the following concern about the alleged communicability of B. burgdorferi.

I think I just gave a janitor Lyme--disposed of biohazards in bathroom trashcan

Onbam, Frequent Contributor (1K+ posts)

Member # 23758

posted 06-16-2010 01:16 AM

So for the past week I've been, when using the public bathroom at my school, covering the toilet with saran wrap (to reduc aerosol) before flushing and then disposing of it in the trash can. That was irresponsible of me (not sealing it in an additional bag first or something), and one of the janitors tonight may have simply reached in the trash bag and removed 3 flushes' worth of saran wrap, one of which would have still been wet, with his bare hands. I told the custodial supervisor about lyme, what had happened, etc, and he said he let the appropriate authorities know.

Yuke! Still later in the night when the rational are at rest….

[ 06-16-2010, 02:00 AM: Message edited by: onbam ]

….no, I've been using saran wrap to cover the toilet before flushing because i read that an aerosol can transmit lyme. I was then throwing the saran wrap (which would have gotten used toilet water on it from the flushing of the toilet) in the bathroom trash, assuming that it wouldn't be touched and would just be disposed of when the bag was changed. I'll be sealing it in a separate bag from now on.

The MSD sheet, an official document easily found with a google search, states that an aerosol can spread it. A chapter from the WWII-era book Japan's Secret Weapon, available on lymecryme.com, documents that this property was taken advantage of in biological warfare as far back as the 30's.

(So basically, I saran wrap toilets before I flush, let them stand for 10 minutes after, then spray them with bleach--NOT WITH URINE IN, THOUGH. that will make mustard gas--let that stand, then flush the out again. OCD? Who knows? Toilets do produce aerosols, though nobody to my knowledge has gotten sick from one.)

Double yuke! Mustard gas from urine?? This woman definitely spends way too much time in public bathrooms and not enough time on a locked ward. So what’s the reaction to this kind of looniness from the members of LymeNut? Mostly silence, but one poster did write the following:

“I am just going to be frank with you about this. I think you need to see a psychiatrist because based on your posts, you seem to be ruminating beyond what would be considered "normal...."

Yet a year or so later, she’s still worried about urine-soaked spirochetes flying through the air to infect the unsuspecting masses at a proposed Lyme rally in May. Here’s the topic she posted on February 27, 2011:

“How to eliminate the biohazard at a Lyme disease protest?”

But before too many people could read anymore about this urine aerosol nonsense, someone at LymeNut had it deleted, leaving only this message: “You have requested a topic that does not exist!”

Gone but not forgotten.

Public health officials, scientists, and academic experts spend a great deal of time countering the claims, arguments, anecdotes and outright lies of Lyme disease activists and their quack doctors. For reporters and politicians, the effort often seems like just a second opinion among two equally valid interpretations of medical care. Perhaps instead of presenting rational argument, scientific data and evidence-based medicine, scientists and physicians should rely more on the words of Lyme activists and patients. Reason, stats, data, and evidence sometimes may be lost on the media and the pols, but crazy is self evident.

And nothing says crazy like the personal beliefs and actions of the Lyme disease community. I can’t think of any better ammunition to use against these people than their own claims about Lyme disease being a government bioweapon; their fears of urine aerosols or leaving their houses, or having their phones and computers tapped and hacked; their use of detox footbaths and electromagnetic devices from the 1930’s; coffee enemas and herbal diets; fears of cellphones and their effects on Lyme infections; and their creepy fascination with flatulence, stool consistencies, mucus and other bodily functions that have nothing to do with a possible Lyme infection.

So never mind rational argument and debate; instead, mine the Internet for activists’ beliefs and present that to the public and the press. Science may be hard to see, but crazy is right there in your face, jumping up and down, screaming for attention.

-

Has ILADS—home of Lyme quacks and charlatans—bought itself a medical journal? Sounds like it. DovePress, an open-access, pay to publish business is starting up a journal on Lyme disease and trying to entice legitimate scientists and physicians to serve on the editorial board. No luck finding any such people yet, or an editor-in-chief. Here’s the background:

Journal of Lyme and Related Vector-Borne Diseases

Editor in Chief: To be appointed

An international, peer-reviewed, open-access journal that focuses on consistent, timely, effective diagnosis and treatment of Lyme disease, as well as its chronicity, epidemiology, causative spirochete (Borrelia burgdorferi), coinfections, and management of other vector-borne illnesses. The journal focuses on diseases and conditions involving multiple organ systems related to or comorbid with Lyme disease. These include neurologic and neuropsychiatric manifestations of Lyme and other vector-borne diseases (with particular emphasis on children), autoimmune entities often present in Lyme patients, and related diseases with evidence of vector-borne commonality. Microbiologic studies of B. burgdorferi, its coinfecting agents, and their relative antibiotic susceptibilities or resistance are key features of the journal's coverage, as are relevant advances in basic and laboratory science, with particular focus on testing methodologies.

The journal's overarching theme is to foster scholarly dialog to build an evidence-based paradigm for effective management of Lyme and related disorders, towards consistent favorable impact on patients, education, healthcare costs, and health outcomes. The journal provides rapid reporting of results of randomized clinical studies, other original research, case reports, reviews and guidelines in all areas of vector-borne disease.

Cost to publish your manuscript in the journal: $1695.00.

Will anyone find or read your manuscript? Not unless it gets indexed.

PubMed Central: Journal of Lyme and Related Vector-Borne Diseases will be submitted to PubMed Central as soon as it has met the criteria. …we expect [the] Journal of Lyme and Related Vector-Borne Diseases to be accepted once the application has been submitted.

Sounds like a 21^st century version of the old Journal of Spirochetal & Tick-borne Diseases: an Lyme activist-driven rag that published crap and didn’t last too long.

See Friday's MMWR for a report of two cases of Y. pestis in Oregon. (Not to be confused with the laboratory-acquired infection in Illinois.) It was also reported in Wired magazine.

Notes from:

Treatment of infection caused by Borrelia burgdorferi sensu lato.

Expert Rev. Anti Infect. Ther. 9(2), 245–260 (2011)

Gary P Wormser and Susan O’Connell

What is the most appropriate standard to judge successful treat ment of infectious diseases?

We would argue that resolution of the objective manifestation of a given infection is the most straightfor ward and logical standard and that progression or relapse of that manifestation or development of other objective manifestations is the most reasonable standard for failure of therapy. Of course, it must be kept in mind that some findings may not be fully reversible, such as facial nerve palsy.

In the treatment of most infections, it is probably unrealistic to expect that antimicrobial therapy per se will eliminate every single microorganism from an infected host; moreover, such an action is rarely if ever required for a successful outcome. More convention­ally, the role of antimicrobial therapy can be thought of in terms of ‘tipping the balance’ in favor of the host’s own defenses against a particular pathogen.

Indeed, for most infections, treatment with antibiotics that only inhibit rather than kill a microorganism is highly effective. The host’s immunologic response against spirochetal infections is considerable and should not be underesti mated despite the tendency for persistence of spirochetes in some untreated patients. Indeed, the objective clinical manifestations of Bbsl infection will eventually resolve in most patients even in the absence of antibiotic treatment.

Whether a few spirochetes or spirochetal DNA might per sist in either humans or animals is irrelevant to judging the outcome of treatment, unless these residual organisms can be shown to cause tissue inflammation or an objective clinical manifestation such as arthritis. Recent interest in a ‘test of cure’ beyond that of clinical resolution of erythema migrans, carditis, meningitis or other neurologic manifestations, or arthritis is arguably misdirected, and inconsistent with the standard of care for almost every other infectious disease.

Could the phenomenon of PCR positivity for Bbsl DNA after antibiotic therapy, in the absence of culture positivity, if it occurs in humans, provide an explanation for PBIS [chronic Lyme]?

This seems highly unlikely. Clearly the Bbsl cells remaining in animals after antibiotic treatment are biologically different from those in untreated animals. Their presence does not elicit a local inflam matory response, even in immunocompromised animals. In addition, the decline in antibody response to Bbsl in animals after treatment suggests a reduction in the overall immunologic response to the spirochete. Since there is no convincing evi dence that Bbsl is capable of elaborating a systemic toxin, it is difficult to imagine how residual spirochetes in the absence of a detectable local or generalized immunologic or inflammatory response by the host could lead to chronic subjective symptoms. Certainly, experience with other microorganisms has taught us that latent infections are clinically silent.

A little diversion from the world of infectious diseases to the everyday world of modern travel in the age of unreasonable fear and the government’s use of that fear to control, coerce, and intimidate…and make a few bucks on the side.

A Transportation Security Officer at Newark Liberty International Airport in New Jerseyadmitted on Thursday he regularly stole cash from travelers--totaling an estimated $10,000 to $30,000 in less than a year--during security screenings.

Al Raimi, a 29-year old Woodbridge, N.J., resident, was a lead TSA officer at the B-3 security checkpoint for Terminal B at Newark, one of three major New York City-area airports, according to court documents and statements. He stole the cash at the checkpoint from October 2009 to September 2010, and would kick up a portion of the money he stole to his immediate supervisor, Michael Arato, who allowed him to continue stealing.

Court documents cite examples of the theft, such as security footage that showed Raimi stealing about $5,000 from a woman's handbag while he conducted a secondary screening of her belongings in August of last year.

Raimi faces a maximum penalty of 10 years in prison and a $250,000 fine. He and Arato are scheduled to be sentenced June 6 and May 24, respectively, according to U.S. Attorney Paul Fishman's office.

While they’re busy rifling through other people’s property they’restill missing guns. Guns carried by people through the striptease scanners. Theft and missed weapons are bad enough, but why are there pedophiles working for this organization? How hard could it be for an actual terrorist to get a job with these clowns?

MMWR

February 25, 2011 / 60(07);201-205

Fatal Laboratory-Acquired Infection with an Attenuated Yersinia pestis Strain --- Chicago, Illinois, 2009

On September 18, 2009, the Chicago Department of Public Health (CDPH) was notified by a local hospital of a suspected case of fatal laboratory-acquired infection with Yersinia pestis, the causative agent of plague.

The patient [aged 60 years with insulin-dependent diabetes mellitus], a researcher in a university laboratory, had been working along with other members of the laboratory group with a pigmentation-negative (pgm-) attenuated Y. pestis strain (KIM D27). The strain had not been known to have caused laboratory-acquired infections or human fatalities. Other researchers in a separate university laboratory facility in the same building had contact with a virulent Y. pestis strain (CO92) that is considered a select biologic agent; however, the pgm- attenuated KIM D27 is excluded from theNational Select Agent Registry.

The university, CDPH, the Illinois Department of Public Health (IDPH), and CDC conducted an investigation to ascertain the cause of death. This report summarizes the results of that investigation, which determined that the cause of death likely was an unrecognized occupational exposure (route unknown) to Y. pestis, leading to septic shock. Y. pestis was isolated from premortem blood cultures. Polymerase chain reaction (PCR) identified the clinical isolate as a pgm- strain of Y. pestis. Postmortem examination revealed no evidence of pneumonic plague. A postmortem diagnosis of hereditary hemochromatosis was made on the basis of histopathologic, laboratory, and genetic testing.

One possible explanation for the unexpected fatal outcome in this patient is that hemochromatosis-induced iron overload might have provided the infecting KIM D27 strain, which is attenuated as a result of defects in its ability to acquire iron, with sufficient iron to overcome its iron-acquisition defects and become virulent. Researchers should adhere to recommended biosafety practices when handling any live bacterial cultures, even attenuated strains, and institutional biosafety committees should implement and maintain effective surveillance systems to detect and monitor unexpected acute illness in laboratory workers.

Another rare infection acquired in the lab. First it was cowpox, now it’s plague. What’s next…the Andromeda Strain?

NYT February 22, 2011

A Climate Skeptic With a Bully Pulpit in Virginia Finds an Ear in Congress

RICHMOND, Va. — For nearly a year, Kenneth T. Cuccinelli II,Virginia’s crusading Republican attorney general, has waged a one-man war on the theory of man-made global warming.

Invoking his subpoena powers, he has sought to force theUniversity of Virginia to turn over the files of a prominent climatology professor, asserting that his research may be marred by fraud. The university is battling the move in the courts.

At the same time, Mr. Cuccinelli is suing the Environmental Protection Agency over its ruling that carbon dioxide and other global warming gases pose a threat to human health and welfare, describing the science behind the agency’s decision as “unreliable, unverifiable and doctored.”

Now his allegations of manipulated data and scientific fraud are resonating in Congress, where Republican leaders face an influx of new members, many of them Tea Party stalwarts like Mr. Cuccinelli, eager to inveigh against the body of research linking man-made emissions to warming.

“There’s a huge appetite among the rank-and-file to raise fundamental[ist] questions about the underlying science,” said Michael McKenna, a Republican strategist and energy lobbyist.

Responding to those concerns, the new Republican majority has introduced legislation that would strip federal regulators of their power to police the industrial emissions that contribute to climate change. But party leaders, treading warily, have cast their arguments against regulation largely in terms of economic consequences, playing down the prospect of major hearings to examine the scientific basis of human-caused warming.

Even dedicated opponents of climate action concede that hauling climate scientists before Congress and challenging their findings could easily backfire, as many representatives lack a sophisticated grasp of climatology and run the risk of making embarrassing errors.

“It’s a trap for a lot of members,” said Marc Morano, a former Republican staff member on the Senate Environment and Public Works committee and publisher of Climate Depot, a Web site that advances the arguments of climate skeptics. “They’re apt to make mistakes.”

Meanwhile, a planned investigation by Representative Darrell Issa of California into alleged instances of manipulation and fraud by climate scientists — broadly similar to those cited by Mr. Cuccinelli in his legal complaints — has been indefinitely postponed.

Yet as the Republican leadership puts the brakes on a climate science confrontation, Mr. Cuccinelli has forged ahead. [Maybe he and Blumenthal roomed together in law school.]

In the process, his critics say, he has not only made mistakes, but also twisted facts to bolster his case against the climatologist, Michael E. Mann, now a professor at Pennsylvania State University.

Sherwood L. Boehlert, a retired Republican congressman from New York and a former chairman of the House Science Committee, is among those who have sharply criticized Mr. Cuccinelli’s tactics.

“I find no logical explanation for spending taxpayer dollars on this politically designed, headline-grabbing pursuit of his,”said Mr. Boehlert, whose panel in 2006 investigated nearly identical charges by climate skeptics that Dr. Mann had falsified results but found no evidence of wrongdoing.

[snip]

The case has also been divisive in Virginia politics, with the Democrat-controlled State Senate voting on Feb. 3 to strip Mr. Cuccinelli of the power to investigate future instances of academic fraud at public universities. The following week, senators passed a budget amendment requiring the attorney general to keep detailed expense records on projects that exceed 100 work hours — a proposal aimed at forcing Mr. Cuccinelli to open the books on his investigation of Dr. Mann.

[snip]

On climate change, Mr. Cuccinelli said he had begun to pay serious attention to the issue only recently, after momentum began to grow behind legislation to establish a national cap-and-trade system for greenhouse gases. He did “basic reading,” he said, and became convinced that scientific proof linking industrial emissions to warming was lacking. [If I do some “basic reading” of law books can I practice law in Virginia?]

Read the full article about this right-wing nut here.

Distinct Cerebrospinal Fluid Proteomes Differentiate Post-Treatment Lyme Disease from Chronic Fatigue Syndrome.

Steven E. Schutzer, et al.

PLoS ONE, 2011;6(2):e17287

“It’s evidence that there’s biological stuff involved…that it’s not imagined,” said Steven Schutzer, a UMDNJ-New Jersey MedicalSchool physician and scientist.

Indeed, but exactly what is going on is unclear, and the paper just published doesn’t add much clarity at this point. It’s going to take years to sort out. Here are the highlights:

Prime objectives in studying neurologic and psychiatric disorders are to develop discriminating markers and generate data that can provide insight into disease pathogenesis. This can lead to novel treatment strategies. Chronic Fatigue Syndrome (CFS) and Lyme disease, particularly Neurologic Post Treatment Lyme disease syndrome (nPTLS), represent two conditions that share common symptoms of fatigue and cognitive dysfunction. Despite extensive research CFS and nPTLS remain medically unexplained. [Right. It’s not an infection.] There are no biological markers to distinguish these syndromes, creating diagnostic dilemmas and impeding research into understanding each individual syndrome.

…we searched for distinguishing protein marker profiles by applying our advanced proteomics strategy to characterize the CSF [cerebral spinal fluid] proteomes from well described CFS and nPTLS patients.

…15 females and 10 males (n = 25) with nPTLS [were studied]. All were documented to have had prior Lyme disease which met CDC surveillance case definition criteria, persistent neurologic features, including cognitive impairment and fatigue, despite appropriate antibiotic treatment. Subjects were 17–64 years old (median = 48). All were seropositive for antibodies to B. burgdorferi (the etiologic agent of Lyme disease). Patients, enrolled in an NIH funded study, met the following criteria:

(1) current positive IgG Western blot using CDC surveillance criteria assessed using a single reference laboratory (University Hospital of Stony Brook);

(2) treatment for Lyme disease with at least 3 weeks of intravenous ceftriaxone or cefotaxime that was completed at least 4 months before study entry; and

(3) objective evidence of memory impairment as documented by the Wechsler Memory Scale-III compared to age-, sex-and education-adjusted population norms.

nPTLS subjects were excluded if history or testing revealed a medical condition that could cause cognitive impairment or confound neuropsychological assessment (e.g., neurological disease, autoimmune disease, unstable thyroid disease, learning disability, substance abuse, B12 deficiency). Patients with cephalosporin allergy or a history of significant psychiatric disorder prior to onset of Lyme disease were also excluded.

The numbers of proteins for each of these three categories separately is shown outside the circles (2,630 for true normal controls, 2,783 for CFS, and 2,768 for nPTLS). …692 proteins were identified in the nPTLS patients, but not in healthy normal controls or CFS. [That’s still a lot of proteins to sort through.]

Discussion

Our results support the concept that CFS and nPTLS are distinguishable disorders with distinct CSF proteomes, where one can be separated from the other. The results also demonstrate that each condition has a multitude of candidate diagnostic biomarkers for future validation and optimization studies. The discovery of many of the same proteins in each proteome is important because it allows comparative pathway analysis, so that useful hypotheses of pathogenesis can be formulated and tested.

Our findings alone do not describe why CFS or nPTLS occur, but are provided to illustrate that CSF proteome analysis may provide important and meaningful insights into the biological processes modulated as a function of disease and facilitate the identification of protein candidates for further investigation.

…these results are encouraging because there is an abundance of data now that can be analyzed with existing tools and future methods to develop hypotheses on pathogenesis.

The clinical significance of the proteins identified in each pooled sample is difficult to determine in the current discovery phase.

Caption: The numbers of proteins for each of these three categories separately is shown outside the circles (2,630 for true normal controls, 2,783 for CFS, and 2,768 for nPTLS). …692 proteins were identified in the nPTLS patients, but not in healthy normal controls or CFS. [That’s still a lot of proteins to sort through.]

Infectious Disease News

February 16, 2011

HHS unveils new national vaccine plan

The Department of Health and Human Services has unveiled a newNational Vaccine Plan, which aims to ensure increased access to the protective benefits of vaccines during the next 10 years.

The main goals of the plan, which was discussed today at theNational Vaccine Advisory Committee Meeting, are to establish priority areas for new vaccines and vaccine enhancement, develop evidence-based surveillance strategies for assessing safety as well as efficacy of vaccines, create awareness of vaccine-preventable diseases, and to enhance coordination of all aspects of federal vaccine and immunization activities, according to Bruce Gellin, MD, MPH. Gellin is Director of the National Vaccine Program Office and presented the plan to the committee.

[snip]

Next steps include a series of regional meetings with stakeholders in the spring and summer of 2011, which will focus on how to implement the strategies laid out in the National Vaccine Plan. The final implementation plan will be completed by the end of 2011, Gellin said.

-

InfectiousDiseaseNews.com

February 15, 2011

Blood donations go through five layers of safety

“Blood is highly regulated, not just by the FDA, but also by state regulations and CDC regulations, as well as regulations by the Occupational Safety and Health Administration and the American Association of Blood Banks,” Davey said.

About 40% to 45% of people in the United States are eligible to donate blood, but only 2.5% to 4.5% actually donate, he said. This leads to periodic shortages and appeals for blood donors and, sometimes, the postponement of surgery when blood will be needed.

There are five layers of safety that go into effect when a person donates blood, according to Davey. The first is the selection of suitable donors, which includes a donor history questionnaire and a limited physical evaluation. The second is donor deferral registries that identify people who are permanently deferred from donating blood. The third layer of safety is the testing of blood for infectious agents. The fourth is quarantining blood while verifying suitability. Lastly, the FDA takes corrective actions to address errors.

All blood donations are tested for HIV, hepatitis C and hepatitis B, and more recently, blood donations began being tested for Chagas disease.

“We are watching for other diseases that might come up, such as dengue and XMRV,” Davey said. “We are aware of these potential threats and will take action if necessary.”

PolitiFact Rhode Island is a partnership of the Providence Journal and PolitiFact.com.

Sen. Sosnowski says Rhode Island ranks second in U.S. for Lyme disease.

To help combat Lyme disease, state Sen. Susan Sosnowski of South Kingstown proposed legislation that would authorize the Rhode Island Lottery to sell "Scratch-A-Tick" scratch tickets, with the proceeds going toward prevention and research.

What caught our eye was the assertions in her news release that "Lyme disease is one of the fastest growing infectious diseases in the United States, and Rhode Island has the second-highest incidence of this disease in the country."

The Centers for Disease Control and Prevention in Atlanta, which tracks diseases in the United States, doesn't rank infectious diseases by growth rate.

But the CDC does release annual reports on the number of cases. We took their numbers and did some additional math. We picked 2008 -- the most recent online report -- and looked at growth rate of infectious diseases from 2004. While there were higher growth rates for much rarer diseases, such as measles, in terms of the actual number of additional cases, Lyme ranked third.

Because she couched her language, the first part of Sosnowski’s statement was true.

The second question is whether Rhode Island really ranks second in incidence of Lyme cases nationwide. We were intrigued by that figure because we had heard that the disease has become very common in other parts of the country. (Lyme was first identified in 1975 in Lyme, Conn., but scientists believe it has been around for at least a century -- and maybe since the last Ice Age.)

The CDC gave us state statistics from 2005 to 2009, and we found earlier numbers, showing that Rhode Island isn't even near the top among states where Lyme is common.

The numbers showed that Rhode Island was number two in the country in 2002 (behind Connecticut) and number one in 2003.

But since then, our ranking has declined. Six states -- Delaware, Connecticut, Pennsylvania, New Jersey, New York and Massachusetts -- beat us out in 2004. We went back up to fourth in 2006, but in the other years after 2004, we ranked 13th or lower.

In 2009, the CDC numbers showed, a dozen states had a higher rate of confirmed cases of Lyme than Rhode Island. Nine states had rates that were double our rate of 142 cases per million people.

In other words, these days we're not even close to being second.

So we contacted Sosnowski. She said her statement was based on a July 2003 news release from the Lyme Disease Association of Rhode Island. "It might be out of date," she acknowledged. [This is what happens when you use unreliable sources.]

[snip]

Annemarie Beardsworth, a spokeswoman for the Rhode Island Department of Health, said the state’s Lyme disease numbers dropped from 2005 to 2007 because the Health Department didn’t have anyone to evaluate the data. That subsequently changed, she said, and the numbers have been reliable since 2008.

[snip]

We found that for 2009, even if you took all 85 "probable" cases of Lyme in Rhode Island and added them to the 150 "confirmed" cases (and only do it for Rhode Island), we would be ranked 11th in the nation, not second.

From a broader perspective, Dr. Paul Mead, a chief of epidemiology and surveillance activity at the CDC, discourages people from focusing on state rankings because such numbers aren't as precise as you might expect. He said the uncertainty varies from disease to disease, and there may be more uncertainty in the numbers from some states than others.

"Lyme disease advocates will often push the idea of counting every case and surveillance is terrible," said Mead. "I think much of that is borne from the notion that if you get your case count up, people will take it seriously and the disease will get more recognition."

In the end, CDC data confirm that, even though Sosnowski was citing outdated information, it's still fair to say that Lyme is "one of" the nation’s fastest growing infections.

But when she says that Rhode Island ranks second when it comes to the incidence of Lyme, she is giving a very precise statistic, citing it with authority, and using the present tense to make it sound current.

Yet there's no data to support her claim.

[snip]

Estimates of Funding for Various Research, Condition, and Disease Categories (RCDC)

Table Published: February 14, 2011

At the request of Congress, the NIH embarked on a process to provide better consistency and transparency in the reporting of its funded research. This new process, implemented in 2008 through the Research, Condition, and Disease Categorization (RCDC) system, uses sophisticated text data mining (categorizing and clustering using words and multiword phrases) in conjunction with NIH-wide definitions used to match projects to categories. The definitions are a list of terms and concepts selected by NIH scientific experts to define a research category. The research category levels represent the NIH’s best estimates based on the category definitions.

Consistent with the Administration’s emphasis on transparency, two separate columns are used to distinguish FY 2009 and FY 2010 actual support funded from American Recovery & Reinvestment Act (ARRA) accounts from projects funded by regular NIH appropriations.

The FY 2011-2012 estimates are based on RCDC actual data.

Total Number of Research/Disease Areas: 229

Check out how much money is being spent on your favorite disease here.

Some colleagues put me on to this 2009 announcement from World Health Organization about the dangers of homeopathy among Developing World patients.

WHO: ‘Homeopathy not a cure’

Congratulations to the Voice of Young Science Network, a part ofSense About Science, whose open letter to the World Health Organization has received a response.

The letter, which is available here, called for the body to issue a clear international statement regarding the use of homeopathy in the developing world.

The WHO has done exactly that, and made it explicitly clear that where homeopathy is used as a preventative or treatment for HIV, TB, influenza, malaria and infant diarrhoea, lives are at risk. The office of Dr. Margaret Chan, Director-General of the WHO, has stated that the following responses “clearly express the WHO’s position”:

Dr Mario Raviglione, Director, Stop TB Department, WHO: “Our evidence-based WHO TB treatment/management guidelines, as well as the International Standards of Tuberculosis Care (ISTC) do not recommend use of homeopathy.”

Dr Mukund Uplekar, TB Strategy and Health Systems, WHO: “WHO’s evidence-based guidelines on treatment of tuberculosis…have no place for homeopathic medicines.”

Dr Teguest Guerma, Director Ad Interim, HIV/AIDS Department, WHO:“The WHO Dept. of HIV/AIDS invests considerable human and financial resources [...] to ensure access to evidence-based medical information and to clinically proven, efficacious, and safe treatment for HIV… Let me end by congratulating the young clinicians and researchers of Sense About Science for their efforts to ensure evidence-based approaches to treating and caring for people living with HIV.”

Dr Sergio Spinaci, Associate Director, Global Malaria Programme, WHO: “Thanks for the amazing documentation and for whistle blowing on this issue… The Global Malaria programme recommends that malaria is treated following the WHO Guidelines for the Treatment of Malaria.”

Joe Martines, on behalf of Dr Elizabeth Mason, Director, Department of Child and Adolescent Health and Development, WHO: “We have found no evidence to date that homeopathy would bring any benefit to the treatment of diarrhoea in children…Homeopathy does not focus on the treatment and prevention of dehydration - in total contradiction with the scientific basis and our recommendations for the management of diarrhoea.”

NYT: February 17, 2011

Psychotherapy Eases Chronic Fatigue, Study Finds

By D. Tuller

A new study suggests that psychotherapy and a gradual increase in exercise can significantly benefit patients with chronic fatigue syndrome.

While this may sound like good news, the findings — published Thursday in The Lancet — are certain to displease many patients and to intensify a fierce, long-running debate about what causes the illness and how to treat it.

Many patients, citing two recent high-profile studies, believe the syndrome may be caused by viruses related to mouse leukemia viruses, and they are clamoring for access to antiretroviral drugs used to treat the virus that causes AIDS. That treatment is very expensive and would be expected to continue indefinitely, and health insurers are not generally willing to pay for untested drug regimens.

The new study, conducted at clinics in Britain and financed by that country’s government, is expected to lend ammunition to those who think the disease is primarily psychological or related to stress.

[snip]

By contrast, the idea that a viral infection is responsible for chronic fatigue syndrome, also called myalgic encephalomyelitis, has been proposed at least since early outbreaks were investigated in the mid-1980s in the United States. Although studies have shown that many patients with the disease have elevated antibody levels for several viruses, no causal role has been proved for any of them. Health officials in the United States are coordinating studies to determine why the mouse leukemia viruses were found in patients in two studies but not in several others.

A major difficulty with conducting studies on the syndrome is that there are several different ways of defining and identifying the illness. These variations have led to a wide range of estimates of its prevalence.

Patient groups and some researchers have challenged the criteria used by the British investigators as likely to include many people with depression, which often causes severe fatigue. They also note that the study excluded patients who could not get to treatment centers, most likely ruling out some of the sickest patients. And at least one survey has found that exercise therapy can significantly worsen many patients’ symptoms.

ScienceInsider: First U.S. Cowpox Infection: Acquired From Lab Contamination

by Sara Reardon

17 February 2011

A student laboratory worker at the University of Illinois, Urbana-Champaign, is the first person in the United States to come down with cowpox, a less dangerous relative of smallpox, and the culprit is lab contamination. Researchers from the U.S. Centers for Disease Control and Prevention (CDC) reported last week at the International Meeting on Emerging Diseases and Surveillance in Vienna that the unvaccinated patient was infected by a genetically modified cowpox virus strain in her research lab, one she had never even worked with, by inadvertently handling contaminated materials.

Cowpox exists in the wild in Europe and Asia, where it is carried by rats and other animals and is often reported in veterinarians and zoo workers, but isn't found in the United States except in research labs. It can severely affect immunocompromised patients, but is not normally lethal. CDC still recommends smallpox vaccination for all lab workers who come in contact with intact orthopoxviruses, a category that includes vaccinia, cowpox, and other animal viruses. The cowpox patient had declined vaccination since she had no intention of handling the virus, and the lab hadn't worked on cowpox for 5 years previous to the incident.

However, CDC investigators found cowpox DNA in many locations around the lab and in stocks of purportedly harmless virus, although no live poxvirus was found on surfaces. The student said she didn't recall an injury or needle stick prior to developing a painful lesion on her finger in July 2010, so it seemed the infection likely occurred from handling chemicals and contaminated samples. In October, a biopsy was sent to CDC, which worked with the Illinois Department of Public Health (IDPH) to identify the disease as cowpox caused by one of the modified virus strains stored in the lab's freezer.

[snip]

"We're becoming quite interested in the concept of people inadvertently being infected with recombinant organisms, not necessarily because of a high safety risk but because of the challenge it provides to state health departments in confirming diagnosis," says Reynolds [an epidemiologist in the CDC's Division of High-Consequence Pathogens and Pathology]. Genetic modification of viruses can confound the usual DNA sequencing methods used to identify the virus and make it even more difficult to track down the source. Reynolds says that CDC investigators are beginning to work with the National Institutes of Health Office of Biotechnology Activities and state public health agencies to discuss better ways to diagnose such infections.

Could have been worse. Could have been like the U.K. incident in 1978.

Well, it’s not the work of Childe Hassam or anyone from the Hudson River School, but it is apparently art. It just needs a detailed caption. And here it is:

A deer (left lower segment) deposits a tick containing a Borrelia spirochete

(central black squiggle) that penetrates human skin (upper right) causing a

bullseye and other rashes. Cardiac (upper left), neurologic, and arthritic

(lower right) systems are also depicted.

by Philip Eras, MD, gastroenterology, Fairfield, Connecticut.

From the National Academies

Date: Feb. 15, 2011

FOR IMMEDIATE RELEASE

WASHINGTON – A National Research Council committee asked to examine the scientific approaches used and conclusions reached by the Federal Bureau of Investigation during its investigation of the 2001 Bacillus anthracis mailings has determined that it is not possible to reach a definitive conclusion about the origins of the anthrax in letters mailed to New York City and Washington, D.C., based solely on the available scientific evidence.

Findings of the committee's study include:

• The FBI correctly identified the dominant organism found in the letters as the Ames strain of B. anthracis.
• Silicon was present in significant amounts in the anthrax used in the letters. But the committee and FBI agree that there is no evidence that the silicon had been added as a dispersant to "weaponize" the anthrax.
• Spores in the mailed letters and in RMR-1029, a flask found at the U.S. Army Medical Research Institute for Infectious Diseases (USAMRIID), share a number of genetic similarities consistent with the FBI finding that the spores in the letters were derived from RMR-1029. However, the committee found that other possible explanations for the similarities -- such as independent, parallel evolution -- were not definitively explored during the investigation.
• Flask RMR-1029, identified by the U.S. Department of Justice as the "parent material" for the anthrax in the attack letters, was not the immediate source of spores used in the letters. As noted by the FBI, one or more derivative growth steps would have been required to produce the anthrax in the attack letters. Furthermore, the contents of the New York and Washington letters had different physical properties.
• Although the FBI's scientific data provided leads as to the origin of anthrax spores in the letters, the committee found that the data did not rule out other possible sources. The committee recommended that realistic expectations and limitations regarding the use of forensic science need to be clearly communicated to the public.

Read the rest of the press release here.

New York Times

February 15, 2011

Review Faults F.B.I.’s Scientific Work in Anthrax Investigation

WASHINGTON — A review of the F.B.I.’s scientific work on the investigation into the anthrax letters of 2001 concludes that the bureau overstated the strength of genetic analysis linking the mailed anthrax to a supply kept by Dr. Bruce E. Ivins, the late Army microbiologist whom the investigators blamed for the attacks.

The review, by a panel of experts convened by the national Academy of Sciences, says the genetic analysis “did not definitively demonstrate” that the mailed anthrax spores were grown from a sample taken from Dr. Ivins’s laboratory at Fort Detrick in Frederick, Md. It does add, however, that the evidence is “consistent with and supports an association” between anthax found in Dr. Ivins’s laboratory flask and anthrax used in the attacks.

The academy’s report faults the F.B.I. for failing to take advantage of new scientific methods developed between the mailings in 2001 and its conclusion after Dr. Ivins’s suicide in 2008 that he was the sole perpetrator. “In subsequent years, the investigators did not fully exploit molecular methods to identify and characterize” anthrax samples, the report said.

[snip]

The F.B.I. and the Postal Inspection Service devoted 600,000 work hours in the investigation, which involved 10,000 witness interviews, 80 searches and 5,750 grand jury subpoenas, according to the F.B.I., which declined to estimate the total cost. The case also involved 29 government, university and commercial laboratories and helped develop a new branch of science, called microbialforensics, which uses genetics and other evidence to trace the source of biological pathogens.

Read the whole article at the NYT or the Washington Post.

Notes from: "Small risk of developing symptomatic tick-borne diseases following a tick bite in the Netherlands."

Parasites & Vectors 2011, 4:17

Ellen Tijsse-Klasen, et al.

The most prevalent and widespread vector-borne disease of humans and animals in the northern hemisphere is Lyme borreliosis. Early detection of Lyme borreliosis is crucial, as antibiotics are most effective at this stage, preventing the development severe sequelae. Over the last decade, the incidence of Lyme borreliosis has increased significantly in Europe, with up to 16 and 21 cases per 10,000 individuals reported in Scandinavia and Slovenia, respectively. A periodical retrospective study under general practitioners in The Netherlands has shown a continuing and strong increase in general practitioner (GP) consultations for erythema migrans and hospital admissions in the past 15 years with 22000 cases in 2009. The most straightforward explanation for this increase is the concomitant increase in the number of GP consultations for tick bites. Although direct evidence is lacking, the factors responsible for this increase are most probably a combination of higher tick numbers and intensified human recreational behaviour, leading to an increased exposure of the population to tick bites.

The risk of developing Lyme borreliosis or any other tick-borne disease after a tick bite depends on many unrelated factors, including the tick species, the number of pathogens per tick, the site and duration of the tick bite, the (genetic) constitution of the pathogen and the individual susceptibility to infection. Many, if not all, of these factors may vary geographically and in time. Several prospective studies have estimated the risk of developing Lyme borreliosis following a tick bite, but not in The Netherlands, and rarely for other tickborne diseases such as spotted fever rickettsiosis, babesiosis, and anaplasmosis.

Ticks were collected from 246 study participants. In total 297 ticks were removed ranging from 1 to 18 ticks per individual with an average of 1.2 ticks per individual. All ticks that were identified to species level were Ixodes ricinus. Life stages of 236 ticks could be determined microscopically. Of these ticks, 65 (28%) were adults, 133 (56%) were nymphs and 38 (16%) were larvae. At least 53 participants were bitten by adult ticks, 96 by nymphs and 16 by larvae. Two hundred-ninety-four ticks were tested for Borrelia burgdorferi s.l., Rickettsia spp. and Babesia spp., 286 ticks were also tested for Ehrlichia/Anaplasma spp. One-hundred ninety-three (78.5%) participants were reached for a second interview, 51 participants were lost to follow-up. For epidemiological analysis only data of the responding participants were used.

Of all tested ticks 58% were negative for all microorganisms tested for. 16% were positive for B. burgdorferi s.l., 19% for Rickettsia spp., 10% forBabesia spp. and 12% for Ehrlichia/ Anaplasma spp.. The overall infection rate with B. burgdorferi s.l. was 16% (n=294, CI 12.1-20.5%), which is significantly lower (p= 0.005) than in the early 90s (24% (n=521, CI 20.7-28.0%) [32]. Different sub-species of B. burdorferi s.l. were found during this study of which B. afzelii was the most common one. Rickettsiae that were identified to species level were Rickettsia helvetica and Rickettsia monacensis. All but one Babesia species were identified as Babesia microti. The Ehrlichia/Anaplasma species identified were mainly Ehrlichia sp. schotti variant (recently named “Candidatus Neoehrlichia mikurensis”), one tick contained Anaplasma phagocytophilum and a last one could not be determined to species level.

In our study, the overall risk of developing symptoms after a tick bite is 11.4% and most of these symptoms are restricted to local reactions. The risk of contracting symptoms of Lyme borreliosis after a single tick bite, even if the tick is infested with potential pathogens, is lower than 1%.Based upon the data collected in this study none of the participants developed symptomatic rickettsiosis, babesiosis or ehrlichiosis. This means that the risk of contracting overt symptoms one of these diseases was lower than 0.5% in this study population. The study shows that prompt removal of ticks reduces the risk of developing symptoms after a tick bite. Thorough checking for ticks together with appropriate clothing, tick avoiding behavior and use of insect repellents, is therefore the most powerful measure to prevent tick-borne diseases. Although the risk of developing symptoms after a tick bite is very low, timely removal of the tick is of an essence and this message should be promoted more clearly and with emphasis to the public.

Here’s a recent posting on LymeNut:

lymecryme.com replaced with a blog.

posted 02-13-2011 03:21 AM.

It went from being one of the best-organized, most incriminating sites out there to what seems like a less informative version of actionlyme.org.

Best organized? Incriminating? Informative? This is what passes for judgment on LymeNut. (Or what passes for judgment when you’re still up at three in the morning posting things about Lyme disease.) This clueless poster is talking about a conspiracy-filled website called lymecryme that claims Lyme borreliosis is not a natural infection but rather an engineered bioweapon intentionally released by the government. It’s a blog packed full of utter gibberish and techno-babble, and one can only marvel at the time and energy devoted to nicely formatting and assembling such a pile of psychological crap….

Until one realizes that one of the instigators of the site is a former mental patient and fugitive named Kathleen Dickson. Here’s a some background on her from the Connecticut newspapers:

Featured in Court & Police

The New London Day

Published on 5/8/2004

Kathleen Dickson, 46, of 23 Garden St., Pawcatuck, was charged Thursday with being a fugitive from justice.

Featured in Court & Police

The New London Day

Published on 5/9/2004

Kathleen Dickson, 45, of 23 Garden St., Pawcatuck, was charged Friday with second-degree harassment and threatening.

Lyme Disease Activist Told To Stop. Judge Offers To Let Charges Drop.

By Hilda Munoz

Courant Staff Writer, Page B3

October 5 2005

NEW BRITAIN -- A 47-year-old woman accused of threatening an assistant attorney general may have harassment charges against her dropped if she stops barraging state officials with information about Lyme disease.

[snip]

In 2003, the Department of Children and Families removed Dickson's children from her custody because the department contended that she was spending so much time campaigning for changes in Lyme disease care that she neglected their needs, Dickson said. Dickson and her children have Lyme disease. Dickson went to court to regain custody, but Assistant Attorney General Jessica Gauvin successfully argued that the children should be in the custody of Dickson's ex-husband.

Dickson was arrested in 2004 after allegedly deluging Gauvin with insulting and threatening e-mails. She was charged with two counts of second-degree harassment and one count of second-degree threatening and was granted accelerated rehabilitation, a special form of probation.

[snip]

Which brings us to another Connecticut resident, Seth Kalichman, a social psychologist at the University of Connecticut who studies conspiracy theorists and science denialism.

As mentioned in other posts about Dr. Kalichman:

He believes the instigators of denialist movements [such as LymeCryme] have more serious psychological problems than most of their followers. “They display all the features of paranoid personality disorder,” he says, including anger, intolerance of criticism, and what psychiatrists call a grandiose sense of their own importance. “Ultimately, their denialism is a mental health problem. That is why these movements all have the same features, especially the underlying conspiracy theory.”

Neither the ringleaders nor rank-and-file denialists are lying in the conventional sense, Kalichman says: they are trapped in what classic studies of neurosis call “suspicious thinking”. “The cognitive style of the denialist represents a warped sense of reality, which is why arguing with them gets you nowhere,” he says. “All people fit the world into their own sense of reality, but the suspicious person distorts reality with uncommon rigidity.”

So what does it say about the judgment of LymeNut posters and the quality of information traded on that forum when so much of that information seems to come from at least one long-term mental patient and ex-con? I think it says that as long as LymeNut readers and posters are not confronted with any opinions or facts that contradict their cherished beliefs they’ll happily take and endorse information from anyone.

Maybe they all watch Fox News too.

Notes from:

European neuroborreliosis: quality of life 30 months after treatment. Eikeland R, Mygland A , Herlofson K, Ljøstad U. Acta Neurol Scand: DOI: 10.1111/j.1600-0404.2010.01482.x.

Most patients with LNB experience marked improvement in neurological symptoms within weeks to a few months after antibiotic treatment, but years after treatment 10–50% report persisting or new symptoms including fatigue, paresthesias, concentration difficulties, myalgias, arthralgias, and headache. Remaining complaints after adequately treated Bb infections are often named post-Lyme disease syndrome (PLD).

The prevalence and impact of PLD is debated because similar symptoms are common in the general population, and there are few controlled studies on the issue. In two recent publications, one American study of long-term outcome after erythema migrans and one Swedish study of 6-month outcome after pediatric LNB, subjective symptoms were not more frequent among patients than among non-infected controls. Our aim was to investigate the long-term impact of LNB on health-related Quality of Life (QoL) in a controlled study of prospectively followed well-characterized adult European patients with LNB.

In the period 2004-2008, 102 consecutive adult patients with LNB from nine different hospitals in southern Norway were included in a treatment trial comparing 14-day courses of intravenous ceftriaxone (2 g daily) and oral doxycycline (200 mg daily). The study design, population, and inclusion criteria are described elsewhere. We invited the patients with LNB from two of the nine hospitals in the treatment trail to participate in our follow-up study 30 months (range 27–34) after treatment.

This first controlled study of QoL in European patients with LNB clearly demonstrates that mean physical and mental health QoL are reduced in a group of patients treated for LNB 30 months earlier when compared to a group of matched controls. Twenty-eight percent of the LNB-treated patients had minor neurological findings. Fatigue was the dominating symptom, while depression, apathy, and pain did not seem to be a clinical significant problem. Further studies should be carried out to elucidate the underlying pathogenesis and the total impact on long-term outcome of Lyme disease.

Interesting, but perhaps not surprising given the seriousness of neurological infections in general, and the prior work of Hickie, et al. noted below.

Post-infective and chronic fatigue syndromes precipitated by viral and non-viral pathogens: prospective cohort study. Ian Hickie, et al. BMJ 2006;333(7568):575.

Post-infective fatigue states have a long history and have been linked to a diverse spectrum of infections, including:

• brucellosis (which is caused by an intracellular bacterium),
• glandular fever (caused by the herpesvirus Epstein-Barr virus),
• Lyme disease (caused by infection with the tick-borne spirochaete Borrelia burgdorferi),
• Q fever (caused by the intracellular, rickettsia-like pathogen Coxiella burnetii),
• Ross River virus (a mosquito-borne arbovirus found in countries around the Pacific rim), and viral meningitis (most commonly caused by enteroviral infection).

By contrast, a comprehensive prospective study of clinical outcomes after other common, more minor, viral infections found no association with prolonged fatigue.

Population based prospective studies of the spectrum of post-infective fatigue states are therefore needed to delineate the key symptoms and longitudinal course of the post-infective fatigue syndrome; to identify demographic, microbial, immunological, and psychological risk factors; and to determine whether disparate pathogens can precipitate chronic fatigue syndrome.

Examination of outcomes after the three distinctive acute infections reported here [EB, RR, Q] strongly implicates aspects of the host response to infection (rather than the pathogen itself) as the likely determinants of post-infective fatigue syndrome, as the case rates after infection with Epstein-Barr virus (a DNA virus), Ross River virus (an RNA virus), and C burnetii (an intracellular bacterium) were comparable and the symptom characteristics progressively merged over time. In combination with the predominantly self limiting natural history of post-infective fatigue syndrome recorded here, these risk factors and demographic characteristics indicate that patients with post-infective fatigue syndrome constitute a distinguishable subset within the broad diagnostic category of chronic fatigue syndrome. This is consistent with the recognised heterogeneity in patient groups identified within the label of chronic fatigue syndrome.

NYT: Leprosy, Plague and Other Visitors to New York

By A. Hartocollis

When New York City’s health department revealed last weekend that three people had contracted cholera, it was a reminder that the city is not just a world capital of arts, business and the like — but also of exotic diseases.

If a disease has cropped up in the world, there is a good chance it will eventually find its way to New York City through the diverse travelers who cross the city’s borders.

For instance, several people every year are found to have a biblical disease, leprosy, though health officials say no one has to fear catching it in the subway. In 2002, bubonic plague, more commonly associated with the 14th century, found its way toNew York City through two travelers who came from a ranch in New Mexico, where the disease is endemic in flea-bitten wild animals like prairie dogs.

[snip]

For hypochondriacs, New York City offers EpiQuery, an interactive database of communicable diseases from amebiasis to yersiniosis on the health department’s Web site. (EpiQuery lists only diseases that are caught by New York City residents and are reportable by law.)

[snip]

More prosaically, Lyme disease is on the rise, with about 550 cases reported in 2008, the last year for which statistics were available, up from 215 in 2000. But here, Dr. Weiss hypothesizes, the higher numbers could reflect increased testing.

Read the whole article at the NYT.

KANSAS CITY, Kan. (AP) — A Kansas doctor has been sentenced to time served after pleading guilty to being part of a scheme to sell a phony system to diagnose and cure Lyme disease.

U.S. Attorney Barry Grissom said Wednesday that 61-year-old John Toth of Topeka was also sentenced to two years supervised released and fined $25,100.

Toth has already served 26 months in prison after pleading no contest to state manslaughter charges in 2007 after the death of a patient. He was released in 2010.

In the federal case, Toth admitted in October that he and three co-defendants began selling a microscope they said could diagnose Lyme disease. They also promoted a drug treatment plan they claimed could cure the disease.

-

From ScienceInsiderTomorrow, chimpanzees will take part in a vaccine experiment that, for the first time, aims to help chimpanzees. Researchers at the New Iberia Research Center, a branch of the University of Louisiana, Lafayette, plan to inoculate six chimpanzees with a vaccine against Ebola, which is decimating wild ape populations. The experiment will not test whether the vaccine works, which would require injecting the animals with a "challenge" dose of the deadly Ebola virus. Rather, it will simply assess the safety of the vaccine and its ability to trigger an immune response.

Read the entire article here.

Borrelia burgdorferi Has Minimal Impact on the Lyme Disease Reservoir Host Peromyscus leucopus

Lisa E. Schwanz, Maarten J. Voordouw, Dustin Brisson, and Richard S. Ostfeld

Vector-Borne and Zoonotic Diseases February 2011, Vol. 11, No. 2: 117-124.

The epidemiology of vector-borne zoonotic diseases is determined by encounter rates between vectors and hosts. Alterations to the behavior of reservoir hosts caused by the infectious agent have the potential to dramatically alter disease transmission and human risk. We examined the effect of Borrelia burgdorferi, the etiological agent of Lyme disease, on one of its most important reservoir hosts, the white-footed mouse, Peromyscus leucopus. We mimic natural infections in mice using the vector (Black-legged ticks, Ixodes scapularis) and examine the immunological and behavioral responses of mouse hosts. Despite producing antibodies against B. burgdorferi, infected mice did not have elevated white blood cells compared with uninfected mice. In addition, infected and uninfected mice did not differ in their wheel-running activity. Our results suggest that infection with the spirochete B. burgdorferi has little impact on the field activity of white-footed mice. Lyme disease transmission appears to be uncomplicated by pathogen-altered behavior of this reservoir host.

The finding that B. burgdorferi does not appear to affect healthy white-footed mouse hosts potentially explains why P. leucopus is such a competent host for this pathogen.

Infected P. leucopus persist in the habitat with a sustained infection of B. burgdorferi, which can be transmitted to uninfected ticks for the rest of the summer. When a pathogen is transmitted via a vector with asynchronous life stages, such as I. scapularis in the northeastern United States (larval densities peak 1–2 months after nymphal densities peak), persistence of infective reservoir hosts is necessary for pathogen persistence. Persistence in a host at low levels of parasitemia appears to also be an important component of transmission and population persistence for other vector-borne pathogens, such as Bartonella and Babesia.

For B. burgodorferi, the low level of pathogenicity in white-footed mice may be the result of the relatively benign nature of the specific immunological response of white-footed mice or evolution of reduced virulence of the spirochete.

Fidaxomicin versus Vancomycin for Clostridium difficile Infection

http://www.nejm.org/doi/full/10.1056/NEJMoa0910812

Thomas J. Louie, M.D., et al.

N Engl J Med 2011; 364:422-431February 3, 2011

Background

Clostridium difficile infection is a serious diarrheal illness associated with substantial morbidity and mortality. Patients generally have a response to oral vancomycin or metronidazole; however, the rate of recurrence is high. This phase 3 clinical trial compared the efficacy and safety of fidaxomicin with those of vancomycin in treating C. difficile infection.

Methods

Adults with acute symptoms of C. difficile infection and a positive result on a stool toxin test were eligible for study entry. We randomly assigned patients to receive fidaxomicin (200 mg twice daily) or vancomycin (125 mg four times daily) orally for 10 days. The primary end point was clinical cure (resolution of symptoms and no need for further therapy for C. difficile infection as of the second day after the end of the course of therapy). The secondary end points were recurrence of C. difficile infection (diarrhea and a positive result on a stool toxin test within 4 weeks after treatment) and global cure (i.e., cure with no recurrence).

Results

A total of 629 patients were enrolled, of whom 548 (87.1%) could be evaluated for the per-protocol analysis. The rates of clinical cure with fidaxomicin were noninferior to those with vancomycin in both the modified intention-to-treat analysis (88.2% with fidaxomicin and 85.8% with vancomycin) and the per-protocol analysis (92.1% and 89.8%, respectively). Significantly fewer patients in the fidaxomicin group than in the vancomycin group had a recurrence of the infection, in both the modified intention-to-treat analysis (15.4% vs. 25.3%, P=0.005) and the per-protocol analysis (13.3% vs. 24.0%, P=0.004). The lower rate of recurrence was seen in patients with non–North American Pulsed Field type 1 strains. The adverse-event profile was similar for the two therapies.

Conclusions

The rates of clinical cure after treatment with fidaxomicin were noninferior to those after treatment with vancomycin. Fidaxomicin was associated with a significantly lower rate of recurrence of C. difficile infection associated with non–North American Pulsed Field type 1 strains.

(Funded by Optimer Pharmaceuticals; ClinicalTrials.gov number,NCT00314951.)

URI cancer researcher now aiming sights on Lyme disease

02/02/2011

KINGSTON, R.I. – As part of her research into breast cancer,University of Rhode Island scientist Roberta King has for years been studying the role of an enzyme in regulating estrogen activity.

King is specifically interested a type of enzyme, calledsulfotransferases, which contribute to balancing and regulating numerous biologically active compounds such as estrogen and dopamine.

Now the associate professor of biomedical sciences in the College of Pharmacy is targeting dopamine sulfotransferase and its potential role in the transmission of the bacteria that causes Lyme disease. In a partnership with Thomas Mather, professor of entomology and director of the URI Center for Vector-Borne Diseases, King and her research team are looking at how tick dopamine sulfotransferase affects tick salivation and ultimately the feeding process that leads to Lyme disease and other tick-borne diseases.

“In the lab, we have shown that the tick sulfotransferase controls dopamine activity. Because others have shown that dopamine controls tick salivation, we expect that manipulating the sulfotransferase may turn off salivation, which in turn would prevent ticks from feeding,” King said. “If we can prevent ticks from feeding, then we can stop them from transmitting diseases.”

[snip]

“Tom’s team, which has included Sivakamasundari Pichu, a former post-doctoral fellow, and Dr. Jose Ribeiro from the National Institutes of Health in Rockville, Md., identified tick genes that looked like sulfotransferase and that the gene expression level changed from before a tick fed to after a tick fed,” King said. “He keyed in on that action because it should be important biologically. Organisms don’t waste energy changing things unless they benefit from the change. We wanted to discover the purpose of the gene and to see if the protein it produced could be targeted for a vaccine or drug.”

[snip]

She said deer ticks need to blood feed for longer than 24 hours to transmit disease.

“We don’t have to stop the initial bite, as much as we need to shorten the feeding process,” King said. “With these long-feeding ticks (they typically feed for 3 or more days), if we shorten the attachment time by interrupting salivation, then we may have an effective way to stop transmission of Lyme disease. We found that tick sulfotransferase turns off dopamine, which should turn off salivation, and in turn prevent feeding. The tick then would drop off the person and/or die.”

Since King and her team have found that tick sulfotransferase is potentially a key to regulating salivation in lab tests with tick tissue, they are now proceeding with tests on live ticks in Mather’s lab.

King said they were initially looking at two options for attacking Lyme disease--a vaccine, which would target the sulfotransferase in the tick saliva, or a drug, which would be absorbed into the tick. Mather’s research focus is on anti-tick vaccine development, “but it also may be possible to target the tick sulfotransferase using a topical drug,” King said.

[snip]

Effective treatment of Lyme-disease-related arthritis depends on proper diagnosis

STUDY SHOWS WHEN IDENTIFIED EARLY, MOST CASES RESPOND WELL TO ANTIBIOTICS

– Early, correct diagnosis is the best way to prevent the development of Lyme arthritis in individuals with the tick-borne illness, according to a paper published in the Journal of the American Academy of Orthopaedic Surgeons (JAAOS). In patients who do develop the condition, most cases can be treated successfully with antibiotics, the review found.

"Lyme arthritis occurs commonly in patients with Lyme disease and should be considered when evaluating patients with joint complaints and who live in areas where the disease occurs," said study author Aristides Cruz, MD, chief orthopaedic resident, Yale-New Haven Hospital. "When diagnosed early, most patients do not develop Lyme arthritis. But when correct diagnosis is delayed, arthritis can occur and requires intervention before permanent joint damage develops."

Read the whole article at EurkeAlert.

ScienceInsider

Why the 'Prius Driving, Composting' Set Fears Vaccines

by Greg Miller

31 January 2011

Journalist Seth Mnookin's new book, The Panic Virus: A True Story of Medicine, Science, and Fear, explores the public health scare over vaccines and autism. The 1998 paper in The Lancet by British physician Andrew Wakefield that sparked the panic has long since been debunked and retracted, and Wakefield himself has been barred from practicing medicine and accused of fraud. But that hasn't stopped thousands of people from refusing to vaccinate their children out of fear that they could become autistic.

Mnookin warns of grave consequences. Recent outbreaks of measles, whooping cough, and other preventable infections have sickened thousands of children and killed more than a dozen in the United States. Vaccine rates are falling below the level needed to prevent an outbreak in a growing number of communities, including ones with wealthy, educated populations.

Read the interview here.

End-Of-Life Health Care Debated In Minnesota Case

Scripps News, January 31, 2011

Al Barnes lay motionless in his hospital bed -- head to the side, mouth agape -- as the court-appointed attorney searched for consciousness in his 85-year-old client.

[snip]

Whether Barnes is dying is in dispute, with his wife, Lana, and Methodist Hospital doctors due to resume arguments over his medical care Wednesday in Hennepin County Probate Court in Minneapolis.

[snip]

After Wednesday's hearing, a judge will decide whether Lana Barnes remains in charge. A Methodist Hospital doctor wants to take decision-making rights from her because he believes she is demanding hopeless and painful treatments. The 56-year-old wife accuses the doctor and others of misdiagnosis that has left Barnes substantially -- but not irreversibly -- incapacitated.

Barnes granted his wife authority over his care in a written health care declaration in 1993, but the court temporarily took that away in January. Alternate Decision Makers Inc., a Minneapolis firm, is Barnes' guardian until the hearing is resolved.

[snip]

Numerous doctors have assessed Barnes in the past year, and agree on his prognosis. According to court records,Barnes suffers from dementia so profound that doctors believe it is pointless to treat his kidney failure and respiratory failure.

[snip] [Here comes the really wacky part of the story.]

Lana Barnes believes her husband suffers from chronic Lyme disease, and that antibiotic treatment of the tick-borne bacterial infection would reverse his dementia -- and necessitate treatment for his other conditions as well.

[snip]

While doctors dispute that Lyme disease can be chronic, or that aggressive antibiotic treatment works, Judith Weeg of the Lyme Disease United Coalition has been scrambling to find doctors who will provide antibiotic treatment. "This is an issue of ageism," Weed said. "... Why not experiment? What would it hurt?"

Sounds like Lana Barnes has been spending too much time in LymeLand; a place where every illness, every symptom, every disorder and disease is actually the result of a B. burgdorferi infection: all of which can be cured with a massive infusion of expensive antibiotics. In LymeLand there are no diseases, no cancers, no complex neurologic or genetic disorders. There is only Lyme disease and its alleged ability to mimic every disease and every symptom. In LymeLand, almost everyone in the world is infected and if you are willing to turn over most of your money to one of their “Lyme literate” doctors you may be cured of this insidious infection…or at least be unburdened with having to watch your finances.

As for Judith Weeg’s suggestion that doctors “experiment” on the helpless Mr. Barnes, I can only remind her that Mr. Barnes, however hopelessly ill he may be, is not a guinea pig or a lab rat. He’s a human being entitled to whatever level of care and dignity his physicians can provide at this stage of his life. If there is any experimenting to be done Mrs. Barnes and Ms. Weeg can surely volunteer.