Newly recognized Leptospira species ("Leptospira inadai" serovar lyme) isolated from human skin.

Leptospira strain 10, which represents a new Leptospira species, was isolated from a skin biopsy of a patient with Lyme disease. Although pathogenic for laboratory animals, the organism was not considered to have a significant role in the patient's illness.

Epidemiologic and laboratory investigation of an outbreak of Campylobacter enteritis associated with raw milk.

An outbreak of gastroenteritis occurred in March-April 1981, in Wichita, Kansas, and involved more than 250 persons who drank raw milk from a single local dairy. Campylobacter jejuni was recovered from 60 of 116 (52%) persons in households that had one or more ill family members. A cohort study of families that belonged to a food cooperative that purchased raw milk from the implicated dairy showed a significant association between illness and having drunk raw milk. Thirty-nine of 55 (71%) persons who drank raw milk became ill compared with four of 36 (11%) persons who did not drink raw milk (p less than 0.01, t test, accounting for clustering). Peak (convalescent) antibody titers to C. jejuni, determined by indirect immunofluorescence, in 20 raw-milk drinkers showed a geometric mean of 1:27 in contrast to geometric mean titer of 1:6 in 10 well persons from the cohort who did not drink raw milk (p less than 0.002, t test). C. jejuni was recovered from 21 of 34 (66%) raw-milk drinkers, versus none of 26 people who did not drink raw milk (p less than 0.001, Fisher's exact test, one tailed). C. jejuni of the same serotype was isolated from the case-patients and from rectal swabs of cows in the dairy. These findings indicate that raw milk contaminated by Campylobacter was the vehicle for this outbreak.

Arthritis caused by Borrelia burgdorferi in dogs.

From October 1982 to May 1984, we studied 34 dogs from the Lyme, Conn area that had a history of tick exposure and lameness associated with pain, warmth, and/or swelling in one or more joints. Large numbers of polymorphonuclear leukocytes were seen in Giemsa-stained smears of synovial fluid from 9 dogs, and spirochetes (Borrelia burgdorferi) were found in 1 sample by darkfield microscopy and immunoperoxidase techniques. The geometric mean antibody titer to B burgdorferi in the 34 dogs was 1:2,700, compared with 1:285 in 43 clinically normal dogs from the same area (P less than 0.0001) and 1:50 in 29 dogs from an area in New Jersey that is not endemic for human Lyme disease (P less than 0.00001). We concluded that B burgdorferi in dogs may cause arthritis similar to that in human Lyme disease.

Experimental Lyme disease in rabbits: spirochetes found in erythema migrans and blood.

In attempts to produce experimental Lyme disease, 33 rabbits were inoculated with Lyme spirochetes by tick feeding or from tick organ homogenates or cultures. Two rabbits developed erythema chronicum migrans at the site of inoculation, in one instance 2 days after injection of a tick organ homogenate and in the other instance, 17 days after feeding of infected Ixodes dammini ticks. Spirochetes were seen in skin biopsy specimens of the second lesion with Warthin-Starry and immunoperoxidase stains. Spirochetes were also recovered from blood cultures of two additional rabbits 2 weeks post-inoculation. These findings are characteristic of early Lyme disease in humans and give additional support for the spirochetal etiology of Lyme disease.

Recovery of Lyme disease spirochetes from patients.

Since the summer of 1982, we have cultured patient specimens for Lyme disease spirochetes. Of 118 patients cultured, four specimens yielded spirochetes: two from blood, one from a skin biopsy specimen of erythema chronicum migrans (ECM), and one from cerebrospinal fluid. All four isolates appeared identical when examined with a monoclonal antibody. However, attempts to recover the spirochete from synovium or synovial fluid were unsuccessful. In addition, the organism could not be visualized in skin or synovial biopsy specimens using the avidin-biotin peroxidase complex detection system. Thus, the current yield in culturing spirochetes from patients is quite low, and it is not yet known whether the organism is still alive later in the disease when arthritis is present.

Infection in rabbits with the Lyme disease spirochete.

Of 33 rabbits inoculated with Lyme disease spirochetes, two developed erythema chronicum migrans at the site of inoculation. Spirochetes were seen in skin biopsies of one of the lesions with immunoperoxidase and Warthin-Starry stains. Spirochetes were also recovered from the blood of two additional rabbits two weeks post-inoculation. These findings are characteristic of early Lyme disease in humans.

Clinically mild tularemia associated with tick-borne Francisella tularensis.

Between May 9 and July 3, 1979, 12 cases of glandular or ulceroglandular tularemia occurred in residents of the Crow Indian Reservation in southcentral Montana; only 13 cases had been reported from this geographic area in the preceding 25 years. The illness was mild, characterized by fever and cervical or occipital adenopathy. Systemic symptoms were self-limited although residual lymphadenopathy was common. Francisella tularensis was isolated from ticks (Dermacentor variabilis), the suspected vector. The strains of F tularensis did not ferment glycerol and thus were identified as type B rather than the more virulent type A. None of 83 adults hospitalized in an urban area 50 miles from the reservation had agglutination titers of antibody to F tularensis of greater than or equal to 1:40 compared with eight of 77 patients at the reservation hospital (P less than 0.01). Mild tularemia in reservation residents may have gone unrecognized; similar illness due to type B F tularensis may occur elsewhere.

The spirochetal etiology of Lyme disease.

We recovered a newly recognized spirochete from the blood, skin lesions (erythema chronicum migrans [ECM]), or cerebrospinal fluid of 3 of 56 patients with Lyme disease and from 21 of 110 nymphal or adult lxodes dammini ticks in Connecticut. These isolates and the original one from l. dammini appeared to have the same morphologic and immunologic features. In patients, specific IgM antibody titers usually reached a peak between the third and sixth week after the onset of disease; specific IgG antibody titers rose slowly and were generally highest months later when arthritis was present. Among 40 patients who had early disease only (ECM alone), 90 per cent had an elevated IgM titer (greater than or equal to 1:128) between the ECM phase and convalescence. Among 95 patients with later manifestations (involvement of the nervous system, heart, or joints), 94 per cent had elevated titers of IgG (greater than or equal to 1:128). In contrast, none of 80 control subjects had elevated IgG titers, and only three control patients with infectious mononucleosis had elevated IgM titers. We conclude that the I. dammini spirochete is the causative agent of Lyme disease.

Tularemia: review of eight cases of tick-borne infection and the epidemiology of the disease in Georgia.

In the period 1960 to 1979, 177 cases of tularemia occurred in residents of Georgia. A tick bite was the implicated source of exposure in eight cases (4.5%), whereas 91 cases (51.4%) were associated with direct contact with infected rabbits. In Georgia and other southeastern states, the epidemiology of human tularemia infection primarily involves rabbits. However, a diagnosis of tularemia should still be considered in this region in a febrile patient with or without a primary lesion or reported exposure to rabbits. A history of having been bitten by a tick may be the major clue in determining the diagnosis. A primary ulcerative lesion on the legs or in concealed body areas such as the axillary or intergluteal regions, is commonly the presenting sign in the patient with tick-borne tularemia.

Veterinary and public health considerations in canine roundworm control: a survey of practicing veterinarians.

We conducted a survey to assess whether current veterinary practices concerning prophylaxis and treatment of canine roundworm (Toxocara canis) infection are adequate to prevent the potential public health risks of visceral larva migrans. We administered a standard questionnaire by telephone to 100 small animal practitioners. Fifty-four veterinarians included health education for the pet's owner as part of their routine care in a case of canine roundworm infection, and 39 recommended prophylactic treatment for this potential zoonosis. Seven veterinarians recommended that pups receive the 1st treatment for roundworm infection before 3 weeks of age, 32 recommended 1st treatment or deworming at 3-4 weeks of age, 39 recommended 5-6 weeks of age, and 22 suggested that it be done at or after 7 weeks of age. Fifteen veterinarians recommended that a nursing bitch be treated for roundworm infection. On the basis of the survey results, we concluded that current veterinary practices concerning the zoonotic aspect of T canis fections are inadequate. We recommend that veterinarians inform their clients that simple hygienic practices are important at avoid the risk of visceral larva migrans. We recommend that deworming programs be started at 2-3 weeks after whelping and include the nursing bitch as well as the pups.