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HICNet Medical News Digest      Sun, 27 Aug 1995        Volume 08 : 
Issue 28

Today's Topics:

  Workshop on Information Processing in Cells and Tissue
  [MMWR] Translocation of Coyote Rabies --- Florida, 1994
  [MMWR] Laboratory Practices for Diagnosis of Tuberculosis
  [MMWR] Recommendations for Test Performance and Interpretation
  [MMWR 18-aug-95] Human Granulocytic Ehrlichiosis -- New York, 1995

             +------------------------------------------------+
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To: hicnews

International Workshop on Information Processing in Cells and Tissues

The purpose of this workshop is to bring together a multidisciplinary 
group
of scientists working in the general area of modelling cells and 
tissues.
A central theme will be the nature of biological information and the 
ways
it is processed in cells and tissues. The workshop is intended to 
provide
a forum to report research, discuss emerging topics and gain new 
insights
into information processing systems, enzyme and gene networks, second
messenger
systems and signal transduction, automata models, PDP models, cellular
automata models, single neuron computation, information processing in
developmental systems, information processing in neural and non neural 
systems
and
new insights into non linear aspects of physiological behaviour.

Sponsored by:
GPT, Unilever, Zeneca, SmithKline Beecham,
Merseytravel, University of Liverpool

Please find below details of the International Workshop on
Information Processing in Cells and Tissues including details on:

 * Programme
 * Registration
 * Accomodation Booking

Ray Paton
IPCAT '95


+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
International Workshop on Information Processing in Cells and Tissues

IPCAT'95 PROGRAMME (PROVISIONAL and SUBJECT TO SOME CHANGES)

Liverpool Moat House, 6 - 8th September, 1995,

For further details email: tissues@csc.liv.ac.uk



Tuesday 5th September.
6.00 - 7.00 pm. Registration
7.00 - 8.00 pm. Welcome Reception.

Wednesday 6th September.
9.00 - 9.45 am. Registration
9.45 - 10.00 am. Welcome, announcements etc.

ORAL CONTRIBUTIONS

10.00 - 10.30 am. Session 1. Cellular Automata Models
10.00 P. Marchal, P. Nussbaum & C Piquet, Centre
Suisse d'Electronique, Neuchatel, Switzerland
"Genomic Cellular Automata Transposed in Silicon: Experiments in
Synthetic Life"

10.30 - 11.00 am Coffee, Posters and Book Displays

11.00 - 12.30 pm. Session 2. Morphogenesis
11.00 T. Hofer & P.K. Maini, Univ. Oxford,UK
"Interplay of Cell-Cell Signalling and Multicellular
Morphogenesis during Dictyostelium Aggregation"
11.30 N. Jakobi, Univ. Sussex, UK
"Harnessing Morphogenesis"
12.00 M. Lantin & F.D. Fracchia, Simon Fraser Univ., Canada
"Generalised Context Sensitive Cell Systems"

12.30 - 2.00 pm. Lunch, Posters and Book Displays

2.00 - 3.30 pm. Session 3  - Parallel Symposia:

Track 1 Neural Systems
2.00 M. Bogdan, A. Babanine, J. Kanieki & W. Rosenstiel,
Univ. Tubingen, Germany
"Nerve Signal Processing using Artificial Neural Nets"
2.30 K. Gurney, Brunel Univ., UK
"Toward a Theory of Neural-Processing Complexity"
3.00 Panel Session

Track 2 Non-linear Physiology
2.00 M.R. Boyett, A.V. Holden & H. Zhang, Univ.  Leeds UK
"Reconstruction of Excitable Tissue Physiology"
2.30 T.R.Chay, Univ. Pittsburg, USA.
"Elucidation of the roles of Ion Channels in Cardiac Arrhythmias by
a Bifurcation Analysis Approach"
3.00 Panel Session

Track 3 Cellular Information Processing
2.00 R. Cuthbertson, Univ. Liverpool, UK
"Oscillations, Positive Feedback and the Flow of Biological Information"
2.30 P. Hartmann, T.H. Darmstadt, Germany
"Models of Information Processing in Inhomogeneous Cellular Structures"
3.00 Panel Session

3.30 - 4.00 pm. Tea, Posters and Book Displays

4.00 - 6.00 pm. Session 4. Reaction Models and Metabolism
4.00     D.E. Cook & J.E. Hunt, Univ. Wales (Aberystwyth), UK
"Modelling Photosynthesis Using a Qualitative Reasoning System for
Plants"
4.30 P. Mendes, P. Marmillot, J-F Hevvagault, GR Welch
Univ. Wales, Aberystwyth, UK, etc
"Long Range Metabolic Signalling in Heterogeneous Catalytic Systems"
5.00 S. Schuster, C. Hilgetag, J. Woods & D.A. Fell,
Humboldt Univ., Berlin, Germany, Univ. Newcastle, Oxford Brookes
Univ., UK "Elementary Modes of Functioning in Biochemical Reaction
Networks.  Aspects of Interpretation and Application"
5.30 A.Bell & M.Holcombe, Univ. Sheffield, UK,
"Computational models of cellular processing"

6.00 - 8.00 pm. Social/Tourist Event
8.00 pm. Dinner.

Thursday 7th September.
8.30 - 10.30 am. Session 5. Cellular Signalling and Calmodulin
8.30 T. Igarashi, Y Nadaoka & T. Kaminum, Nat. Inst Heath
Services, Tokyo, Japan
"A Data and Knowledge Base for Cell Signalling Networks"
9.00 R Kotter, D. Schirok & K. Zilles, Heinricht Hesse
Univ., Dusseldorf, Germany
"Concerted Regulation of Cyclic AMP by Calmodulin/Calcium Complex
and Dopamine: A Kinetic Modelling Approach"
9.30 J. Nauroschat & U. an dar Heiden, Univ.
Witten/Herdecke, Germany
"A Mathematical Model of Transmembrane Signalling via G-Proteins"
10.00 H. Okamoto & K. Ichikawa, Fuji-Xerox
"A Role of Ca2+/Calmodulin - Dependent Protein Kinase II in the
Induction of Long-Term Potentiation"

10.30 - 11.00 am Coffee, Posters and Book Displays

11.00 - 12.30 pm. Session 6. Dynamical Models and Networks I
11.00 K. Swann, A. James & M Reece, Univ. College, London, UK
"A Dynamic Model of the Distributed Interaction of Intercellular 
Signals"
11.30 F.A. Bignone, Univ. Firenze, Italy
"Models for Gene-Network Dynamics"
12.00 S Iyengar, Univ. Pittsburgh, USA
"Parameter Estimation for a Diffusion Approximation to Stein's Model"

12.30 - 2.00 pm. Lunch, Posters and Book Displays

2.00 - 3.30 pm. Session 7. Enzymes
2.00 M. Weininger & H.A. Smith, Florida Agric. & Mech. Univ., USA
"Pattern Formation in an Allosteric Enzymatic Reactions: Effects of
Enzyme Hetergeneity"
2.30 P. C. Marijua'n, Univ. Saragosa, Spain
"The cell as a problem-solving `engine'"
3.00 R.Paton, G. Staniford & G. Kendall, Univ. Liverpool, UK.
"Specifying Logical Agents in Cellular Hierarchies"

3.30 - 4.00 pm. Tea, Posters and Book Displays

4.00 - 6.00 pm. Session 8 - Parallel Symposia:
Track 1 Neuronal Models and Systems
4.00 M. Okamoto, K. Tanaka, Y. Maki & S. Yoshida, Kyushu
Inst. Tech., Japan
"Information Processing of a Neural Network System Composed of
`Biochemical Neurons'"
4.30  A.V. Rossokhin & L.E. Tsitolovsky, Brain Research
Inst., Moscow, Russia "Biophysical Model of a Neuron.
Numerical Investigations of the
Information Properties of the Model"
5. 00 Panel Sessions

Track 2 Non-linear Physiology and Bioenergetics
4.00 J.P.A. Foweraker & D Brown, Babraham Institute,
Cambridge, UK
"The Effects of Random Variation in Stimulation Timing and
Magnitude on Excitable and Oscillatory Forms of a Luteinizing
Hormone Pulse Generator Model"
4.30 E.A. Stephens, D. Brown, G. Leng & R.G. Smith,
Babraham Inst., Cambridge, UK
"A Model of Pituitary Release of Growth Hormone"
5.00 Panel Session

Track 3 Cellular Information Processing
4.00 U.D. Barseghyan, V.G. Vapradian & A.R. Sarhiryan,
"Some Aspects of Information Processing by Rubrospinal Neuron of
Red Nucleus"
4.30 K. Javorszky, Vienna, Austria
"The logic of self-sustaining sampling systems"
5.00 D.Alves, Univ. Saragosa, Spain.
"Information Processing in Cells: Revisiting the Molecular Automata
Hypothesis"

6.00 - 7.00 pm. Social/Tourist Event
7.30 pm. Gala Dinner

Friday 8th September.
8.30 - 10.30 am. Session 9. Dynamical Models and Networks II
8.30 L.E. Tsitolovsky, Bavr-Ilan Univ., Israel
"A Model of Motivation with Chaotic Neuronal Dynamics"
9.00 M.J. Hatcher, A.M. Dunn & C. Tofts, Univ. Leeds, Univ.
Manchester, UK
"The Effect of the Embryonic Bottleneck on Vertical Microparasite
Transmission"
9.30 H. Bersini, Univ. Libre de Bruxelles, Belgium
"Frustration in Biological Networks: A source of Diversity and
Instability"
10.00 E. Chiva & P. Tarroux, Ecole Normale Superieure,
Paris, France  "Modelling the Emergence of Coregulated
Proteins in Biological  Regulations Networks"

10.30 - 11.00 am. Coffee, Posters and Book Displays

11.00 - 12.30 pm. Session 10. Cellular Structure and Coherence
11.00 M.A.Aon, S.Cortessa & A.Caceres, Univ.
Tucuman and Inst. Inv. Medicas, Cordoba, Argentina
"Models of Cytoplasmic Structure and Function"
11.30 M-W Ho, Open Univ., UK
"Bioenergetics, the Coherence of Organisms and Biocommunications"
12.00 K. Matsuno, Nagaoka Univ. of Technology, Japan
"Cohesive Interaction in Biomolecules and their Organisations as
Energy Consumers"

12.30 - 2.00 pm. Lunch, Posters and Book Display

2.00 - 4.00 pm. Session 11. Cell Behaviour and Carcinogenesis
2.00 N.R. Smalheiser, Univ. Chicago, USA
"Detecting Hidden Stimuli that Regulate Behaviour of Cells and
Tissues: a Parametric Approach"
2.30 G. Zajicek, Hebrew Univ., Israel
"Tissue Automat: An A-Life Form with Feedback"
3.00 M. Guillard,R. MarcelPoil, et al, Cancer Imaging, BCCRC,
Vancouver, Canada "Multi-Scale Cellular Sociological Analysis"
3.30 LD Greller, FL Tobin & G Poste, SmithKline Beecham, USA
"Genetic Instability and Progression Interactions in Tumour Dynamics"

3.50 - 4.20 pm. Tea, Posters and Book Displays
4.20 - 5.30 pm. Plenary Session
5.30 pm. Depart




POSTER PRESENTATIONS (PROVISIONAL)


Goltsov Alexsey
"Selforganisation of surface channels of communication
within lipid membranes and mechanisms of protein and ion lateral
transport". Institute of Physics and Technology, Prechistenka
Str., 13/7, Moscow, 119034, Russia.


Alexander V. Spirov
"Zebra Stripped, Radial and Nested Patterns of Expression of
Gene Networks in Embryo Rudiments: Discrete Calculations
Modelling". I.M. Sechenov Institute of Evolutionary Physiology
and Biochemistry, 44 Thorez Pr, SanctPetersburg, 194223, Russia.


Geoff Kendall
"Towards some Fuzzy Models of Enzymes"
Department of Computer Science, The University of Liverpool


Gennady A. Savostyanov
"SYMMETRY OF SPATIAL ORGANIZATION OF EPITHELIA". Russian Academy of 
Science,
44 Thores av., St. Petersburg 194223. Russia.


C. Kesmir, I. Sondergaard, H. Frisner and H. Frokiaer.
"Pattern Completion in Immune Networks: Simulations by a
Computer Model Based on Cellular Automata".
Department of Biochemistry & Nutrition, Technical
University of Denmark, Bld. 224 DK2800 Lyngby, Denmark.


C. Kesmir, I. Sondergaard, and H. Frisner.
"The Role of Network Regulation and Anergy in Tolerance to
Self." Department of Biochemistry & Nutrition, Technical
University of Denmark, Bld. 224 DK2800 Lyngby, Denmark.

Steve Baigent
"Modelling the effect of gap junction
nonlinearities in cell-cell communication"
Centre for Nonlinear Dynamics, University College London
London, UK


Dean Jones
"Metaphors for Information Flow in Cells"
Department of Computer Science,
The University of Liverpool


Julian Haffegg, Zhou Yuming, Richard Newton, John
Bolton and MaeWan Ho.
"Mapping and Modelling the Morphogenetic Field".
Bioelectrodynamics Laboratory, Open University,
Walton Hall, Milton Keynes, MK7 6AA, U.K.


_
                                                           


R. H. Newton, J. P. Haffegee and M. W. Ho.
"Colour Contrast in Polarised Light Microscopy".
Department of Biology, Open University, Walton Hall,
Milton Keynes, MK7 6AA, U.K.


Yuming Zhou, John Bolton and MaeWan Ho.
"Nonlinear Optical Phenomena in Living Systems".
Bioelectrodynamics Laboratory, Open University,
Walton Hall, Milton Keynes, MK7 6AA, U.K.


Pedro Mendes
"Simulation of the Dynamics of Metabolic Pathways with a
UserFriendly Software Package".
Institute of Biological Sciences, University of Wales
Aberystwyth, Dyfed, SY23 3DA, U.K.


Sanjay S. Deshpande, Lev Goldfarb and Virenra C. Bhavsar.
"Cooperative Cellular Transformation Systems".
Faculty of Computer Science, University of New
Brunswick, Fredericton, N.B., Canada, E3B 5A3.


Craig Easton & Ray Paton
"Simulating an Artificial Tissue"
Department of Computer Science, The University of Liverpool


Vladimir Yu. Korda
"Gene Oriented Design and Computer Genetics"
Dept. of Physics Technology, Kharkov State
University, 310077 Kharkov, Ukraine.


Vladimir Ryazansky and Catherine E. Vulfius
"Modulation of Nicotinic Acetylcholine Receptor Response by
Changing Intracellular Calcium in Limnaea Stagnalis Neurones".
Dept. of Neurobiology, Pushchino State University,
Pushchino, Moscow region, 142292, Russia.




++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
+
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
+

REGISTRATION FORM [PLEASE SUBMIT HARDCOPY NOT ELECTRONIC VERSION]

INTERNATIONAL WORKSHOP ON INFORMATION PROCESSING IN CELLS AND TISSUES
                        (IPCAT 95)

THE LIVERPOOL MOAT HOUSE HOTEL
6-8 SEPTEMBER


Surname  ____________________________________________________


First Name(s)  ______________________________________________


Title _______________________

Department/Institute ________________________________________

_____________________________________________________________


Address  ____________________________________________________

_____________________________________________________________

_____________________________________________________________


Telephone  ______________________________________________

FAX  ____________________________________________________

Email ___________________________________________________



Wednesday 6th September - Friday 8th September

3 Day delegate package at Moat House Hotel      84 pounds (sterling)
(includes refereshments and lunches)

Registration fee for workshop                   60 pounds (sterling)


TOTAL COST FOR WORKSHOP                         144 pounds


-------------------------------------------------------------------------
-----
-
Cheques should be made payable to 'The University of Liverpool'
and sent with registration form to:
Miss K Houghton
Department of Computer Science
University of Liverpool
Liverpool L69 3BX  UK
Tel +44 151 794 3668;   FAX   +44 151 794  3715
Cancellation before August 1st 1995 70 percent refund;
after August 1st 1995 10 percent refund.

CLOSING DATE FOR REGISTRATION IS TUESDAY 22 AUGUST

-------------------------------------------------------------------------
-----
-



========================================================================
==

   ACCOMMODATION BOOKING FORM FOR THE LIVERPOOL MOAT HOUSE HOTEL
                [PLEASE NOTE BOOKING DEADLINE IS 17th JULY]


THE LIVERPOOL MOAT HOUSE
Paradise Street, Liverpool  L1 8JD

The Moat House is a modern 4 star hotel located close to the
main shopping area and the historic Albert Dock Complex.  The
hotel has two bars and restaurants and offers extensive leisure
facilities.

Rate
57 pounds Dinner, bed and breakfast per person per night in a single 
room.
47 pounds Dinner, bed and breakfast per person per night sharing a 
double
or twin room.

Please_Note  The above rate is an inclusive package.  If delegates
choose not to take dinner in the hotel the above rate will still
apply.
(If you wish to attend the Conference Dinner on Thursday 7th September
please see the attached form).


PLEASE COMPLETE THE FORM BELOW IF YOU REQUIRE ACCOMMODATION


NAME ___________________________________________________

ADDRESS ________________________________________________

________________________________________________________

POSTCODE _______________________________________________

TEL NO: ___________________ FAX NO: ____________________



TYPE_OF_ROOM_REQUIRED

SINGLE                        DOUBLE

TWIN                          FAMILY

Date Of Arrival_________________________________________

Date Of Departure_______________________________________


PAYMENT

Delegates will settle their own accounts with the hotel on departure.

Please return this form to:-   Caroline Griffiths
                               Merseyside Tourism & Conference Bureau
                               Atlantic Pavilion
                               Albert Dock
                               Liverpool
                               L3 4AE

                               Tel  0151 709 2444
                               Fax  0151 709 8129

BY MONDAY 17th JULY 1995

** PLEASE NOTE:
        We CANNOT guarantee accommodation will be available after
        this date.

When you have returned this form to Merseyside Tourism & Conference
Bureau you will receive a confirmation letter in due course.



________________________________________________________________________
_____

                CONFERENCE DINNER THURSDAY 7TH SEPTEMBER 1995

                                  BOOKING FORM


If you wish to attend the Conference Dinner to be held at the Liverpool
Moat House Hotel on 7th September please complete the form below.

NAME ___________________________________________________________

ADDRESS ________________________________________________________

________________________________________________________________

POSTCODE _______________________________________________________

TEL NO _____________________________ FAX NO ____________________


THE RATE FOR THE CONFERENCE DINNER IS:-

a)  #23 FOR DELEGATES NOT STAYING AT THE LIVERPOOL MOAT HOUSE HOTEL

b)  #5 FOR DELEGATES STAYING AT THE LIVERPOOL MOAT HOUSE (IE A #5
    SUPPLEMENT IS PAYABLE ON THE DINNER, BED AND BREAKFAST RATE).


PAYMENT

PAYMENT FOR THE CONFERENCE DINNER MUST BE RETURNED WITH THIS FORM
PAYMENT CAN BE MADE BY:-

1)  Cheque in pounds sterling payable to Merseyside Tourism & Conference
    Bureau.

2)  By credit card.  Please tick   Mastercard       Visa

    NUMBER ______________________________________________________

    EXPIRY DATE _________________________________________________

    AMOUNT #____________

    NAME ________________________________________________________

    ADDRESS _____________________________________________________

    _____________________________________________________________

    SIGNATURE ___________________________________________________

Please note a fee of 4% will be taken for credit card bookings to
cover administration costs.


Please return to:-  Caroline Griffiths
                    Merseyside Tourism & Conference Bureau
                    Atlantic Pavilion
                    Albert Dock
                    Liverpool
                    L3 4AE

                    Tel  0151 709 2444
                    Fax  0151 709 8129

BY MONDAY 17th JULY 1995

When you have returned this form to Merseyside Tourism & Conference
Bureau you will receive a confirmation letter in due course.



________________________________________________________________________
_____

                               PARTNERS PROGRAMME

           LIVERPOOL CITY SIGHTSEEING TOUR 7th SEPTEMBER 2.00 PM

                                  BOOKING FORM


THE TOUR

This is a two hour guided coach tour of the City Of Liverpool.  The tour
takes in the history of the Port Of Liverpool, its magnificent 
architecture,
famous people, the Pier Head and Albert Dock.  It includes a visit to 
the
city's two cathedrals.  See where thousands of emmigrants embarked on 
their
journey to the New World, the home of the Beatles and the birthplace of
William Gladstone.

The Tour will depart from the Liverpool Moat House at 2.00 pm on 7th
September


RATE  THE COST OF THE TOUR IS #9.00 PER PERSON


IF YOU WOULD LIKE TO BOOK A PLACE ON THE TOUR PLEASE COMPLETE THE FORM
BELOW.

NAME ______________________________________________________________

ADDRESS ___________________________________________________________

___________________________________________________________________

TEL NO ___________________________ FAX NO __________________________


NUMBER OF PLACES REQUIRED   ..........

TOTAL COST                   ........


PAYMENT

PAYMENT FOR THE TOUR MUST BE RETURNED WITH THIS FORM.  PAYMENT CAN BE
MADE
BY:-

1)  CHEQUE IN POUNDS STERLING PAYABLE TO MERSEYSIDE TOURISM & CONFERENCE
    BUREAU

2)  BY CREDIT CARD.  PLEASE TICK     MASTERCARD     VISA

NUMBER _________________________________________________

EXPIRY DATE ____________________________________________

AMOUNT # ________________________

NAME ___________________________________________________

ADDRESS ________________________________________________

________________________________________________________

SIGNATURE ______________________________________________


PLEASE_NOTE  A FEE OF 4% WILL BE TAKEN FOR CREDIT CARD BOOKINGS TO COVER
ADMINISTRATION COSTS.


PLEASE RETURN TO          Caroline Griffiths
                          Merseyside Tourism & Conference Bureau
                          Atlantic Pavilion
                          Albert Dock
                          Liverpool
                          L3 4AE

                          Tel  0151 709 2444
                          Fax  0151 709 8129

BY MONDAY 17th JULY 1995


PLEASE NOTE  We reserve the right to cancel the tour if the minimum 
number
of bookings is not met.  In this event all monies will be refunded.







---
Editor, HICNet Medical Newsletter
Internet: david@stat.com                 FAX: +1 (602) 451-6135

------------------------------

To: hicnews

         Translocation of Coyote Rabies -- Florida, 1994

     Translocation of a rabies variant from one area to another has
been identified increasingly in the United States. During November
and December 1994, rabies was diagnosed in five dogs from two
associated kennels in Florida; in addition, two other dogs being
kept at one of the kennels died with suspected, but unconfirmed,
rabies. Rabies virus recovered from the five dogs was identified as
a variant not previously found in Florida but endemic in coyotes
(Canis latrans) in south Texas. The suspected source of infection
was translocation of infected coyotes from Texas to Florida. This
report summarizes the findings of an investigation of these cases
by the Alachua County Public Health Unit, the Florida Department of
Health and Rehabilitative Services, and CDC.
     On November 21, 1994, a Walker hound used for fox hunting
escaped from one of the fenced kennels; on recapture later that
day, the dog was unusually aggressive and bit one of the kennel
owners. The dog was euthanized and tested positive for rabies. On
November 21, the Alachua County Public Health Unit identified 102
dogs and 10 cats potentially exposed to this dog while it was loose
and established a 20-square-mile quarantine area. Measures
implemented by public health and animal-control authorities
included vaccinating against rabies all unvaccinated dogs and cats
within the quarantine area and administering booster vaccine to
previously vaccinated animals, prohibiting movement of animals in
and out of the quarantine area, systematically mailing rabies
update advisories to residents of the quarantine area, and--with
the assistance of the news media--increasing rabies surveillance by

_
                                 

requesting reports of persons or animals that had been bitten by an
animal. As a result of exposure to this dog or other animals in the
quarantine area, 26 persons received rabies postexposure treatment,
and three persons received preexposure prophylaxis.
     Concurrent investigations by the Alachua County Public Health
Unit revealed that two other dogs from the same kennel had died on
November 10 and November 18. Neither of these dogs were tested for
rabies; however, rabies was suspected and confirmed in four
additional dogs (three from the same kennel and one from an
associated kennel), who died November 28 (one), November 30 (one),
and December 1 (two). Rabies in the five dogs tested was confirmed
at CDC, and the isolates were identified as the variant associated
with coyotes in south Texas (1). None of the seven dogs with
presumed or confirmed rabies had a history of rabies vaccination.
All seven dogs had been kept in Florida for greater than or equal
to 7 months preceding their deaths.
     Several times each week during September and October, the
kennel owner, family members, and a business associate hunted
coyotes that were kept in a 320-acre fenced foxpen 18 miles from
the dog kennels. The foxpen had not been rented for use by other
hunters. The foxpen had housed 20-25 coyotes, which were reported
to have been captured in Florida during February 1994 and placed in
the pen during the same month with gray foxes and raccoons. The
coyotes were reported to have been fed regularly, and no ill or
dead wildlife had been noted in the enclosure within the previous
6 months. Six of the dogs with presumed or confirmed rabies had
accompanied the hunters in the foxpen. The one rabid dog that was
never taken to the foxpen had shared a kennel with two of the dogs
with rabies. Four of the seven rabid dogs also had been to a field
trial with approximately 400 other hunting dogs in late October;
none of these other dogs are known to have died from rabies.
     Depopulation of the free-ranging carnivores within the
enclosed foxpen was instituted with the assistance of the Florida
Game and Fresh Water Fish Commission because the affected dogs in
the foxpen may have been exposed to other rabid animals. The
potentially exposed or infected animals included 32 coyotes, five
raccoons, two gray foxes, two bobcats and one cat; diagnostic tests
of these animals at CDC were negative for rabies. Continuing
surveillance in the quarantine area subsequently identified rabies
in a puppy that had been bitten by the escaped rabid dog.
Reported by: T Belcuore, MS, Alachua County Public Health Unit; L
Conti, DVM, G Hlady, MD, L Crockett, MD, R Hopkins, MD, State
Epidemiologist, Florida Dept of Health and Rehabilitative Svcs. M
Dunbar, DVM, Florida Game and Fresh Water Fish Commission. Viral
and Rickettsial Zoonoses Br, Div of Viral and Rickettsial Diseases,
National Center for Infectious Diseases, CDC.
Editorial Note: The episode described in this report resulted in
six confirmed and two presumed cases of dog rabies and the need for
rabies postexposure treatment of 26 persons. It highlights the
increasing problem of animal rabies in the United States, which
reached record levels in 1993.
     The incubation period for rabies in the cases in this report
and the rabies variant with which they were infected suggest that
the source of infection was coyotes in the foxpen during October.
Although the incubation period for rabies in dogs usually is 3-8
weeks, it can vary from 10 days to 8 1/2 months (2). The rabies
variant identified is not present in animal populations of the
southeastern United States but is found exclusively in 17 counties
in southern Texas. Because the dogs had not traveled outside
Florida, translocation of infected animals from Texas is suspected.
A similar case of dog rabies in Alabama was attributed to coyotes
transported for hunting purposes from Texas to Alabama (3).
     Enzootic dog rabies has been nearly eliminated in the United
States as the result of effective mass vaccination programs and
programs initiated during the 1950s to control stray animal
populations. Dog-to-dog transmission of the magnitude described in
this report has not been documented since the early 1970s, except
in areas along the U.S.-Mexico border. However, 12 of the 25 human
rabies cases diagnosed in the United States since 1980 were
associated with exposure to dog rabies viruses outside the United
States or near the U.S.-Mexico border. In the cases in this report,
rabies transmission to the dogs probably could have been prevented
if the dogs had been appropriately vaccinated against rabies.
     Since 1988, rabies in coyotes in southern Texas has accounted
for most coyote-associated rabies in the United States, including
70 of 75 cases in 1992, and 71 of 74 cases in 1993 (3). The coyote
rabies epizootic has been a source for infection for unvaccinated
domesticated dogs and further expansion of rabies. Since 1991, at
least two human deaths have been associated directly with the
southern Texas rabies variant (4,5), probably associated with
interactions between coyotes and dogs. In addition to established
measures for preventing rabies, including mandatory vaccination of
domesticated dogs (6) and prompt postexposure treatment of humans
(7), the development of safe and effective oral rabies vaccines for
coyotes and other wild carnivores would be a potentially important
adjunct control strategy.
     The interstate transport of wildlife from geographic areas
with enzootic hazards to new areas has resulted in disease
outbreaks with substantial public health and economic impact. For
example, the current raccoon rabies epizootic in the mid-Atlantic
and northeastern United States is the direct consequence of
translocation and spread of infected raccoons from the southeastern
United States during the late 1970s; raccoons are now the primary
rabies reservoir in the United States (3). A recent surge in
popularity of coyote hunting in the southeastern United States has
resulted in an increase in sales of wild canids for foxpens;
although coyotes are indigenous to that region, some of these
animals may have been imported illegally. Intensified surveillance
for this rabies variant is warranted in those states where
residents participate in coyote hunting in enclosures.
     In addition to rabies, public health risks associated with
wildlife translocation include zoonotic infections such as plague,
hantavirus pulmonary syndrome, brucellosis, echinococcosis, Lyme
disease, Rocky Mountain spotted fever, ehrlichiosis, and tularemia.
However, federal and state regulations have not been applied
consistently to the interstate movement of native wildlife. Because
of the public health risks and lack of feasible methods to certify
animals as free of many of these zoonotic agents, restrictions on
the interstate movement of native wildlife may need to be
considered.
     The Florida Department of Health and Rehabilitative Services
and CDC are strain-typing all rabies variants found in wild and
domestic canids. No additional isolates of the coyote rabies
variant have been identified in Florida.
References
1. Clark K, Neill SU, Smith JS, et al. Epizootic canine rabies
transmitted by coyotes in south Texas. J Am Vet Med Assoc
1994;204:536-40.
2. Tierkel ES. Canine rabies. In: Baer GM, ed. The natural history
of rabies. New York: Academic Press, 1975:123-37.
3. Krebs JW, Strine TW, Smith JS, Rupprecht CE, Childs JE. Rabies
surveillance in the United States during 1993. J Am Vet Med Assoc
1994;205:1695-709.
4. CDC. Human rabies--Texas, Arkansas, and Georgia, 1991. MMWR
1991;40:765-9.
5. CDC. Human rabies--Alabama, Tennessee, and Texas, 1994. MMWR
1995;44:269-72.
6. CDC. Compendium of animal rabies control, 1995: National
Association of State Public Health Veterinarians, Inc. MMWR
1995;44(no. RR-2).
7. ACIP. Rabies prevention--United States, 1991: recommendations of
the Immunization Practices Advisory Committee (ACIP). MMWR
1991;40(no. RR-3).


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   Laboratory Practices for Diagnosis of Tuberculosis -- United States, 
1994

     The increase in cases of tuberculosis (TB) during 1985-1992
and the emergence of multidrug-resistant Mycobacterium tuberculosis
strains led to recommendations for rapid laboratory testing to
support control efforts and selection of proper therapy (1,2). Many
laboratories have adopted the recommendations to use rapid
acid-fast bacilli (AFB) smears, growth detection (i.e., primary
culture), identification, and drug-susceptibility testing for M.
tuberculosis (3). The regulations implementing the 1988 Clinical
Laboratory Improvement Amendments* (CLIA) require all laboratories
that perform any mycobacteriology testing to enroll in federally
approved proficiency testing (PT) programs. This report summarizes
information reported by the laboratories to PT programs in the
United States about their practices for M. tuberculosis.
     The PT programs submit samples of unknown content to
laboratories for testing in the same manner as actual patient
specimens; the laboratories subsequently report methods and test
results to the program. In 1994, the U.S. Department of Health and
Human Services approved six PT programs for mycobacteriology
testing: five programs (the College of American Pathologists [CAP];
the states of New Jersey, New York, and Wisconsin; and the
Commonwealth of Puerto Rico) provide PT testing for AFB smears,
growth detection, organism identification, and drug-susceptibility
testing; and one program (the American Association of Bioanalysts)
provides testing for AFB smears only.
     To determine the number of laboratories that performed various
levels of testing for M. tuberculosis, laboratories were classified
into four categories based on the practices specifically reported
for M. tuberculosis. These categories were laboratories that
perform 1) AFB smears and refer all specimens for primary culture
to another laboratory; 2) AFB smears and primary cultures for M.
tuberculosis but refer all AFB-positive culture isolates for
organism identification and drug-susceptibility tests; 3) AFB
smears and primary culture with identification of M. tuberculosis
isolates but refer isolates for drug-susceptibility testing; and 4)
AFB smears, primary culture, identification, and
drug-susceptibility testing for M. tuberculosis. Some laboratories
must enroll in more than one PT program to meet the requirements of
both state laboratory licensure programs and private laboratory
accreditation programs. Therefore, because most laboratories were
enrolled in the CAP PT program, the actual number of laboratories
in each of the four categories ranges from a minimum that
represents the enrollment of CAP only to a maximum that represents
the total reported enrollment for all PT programs.
     In 1994, a total of 2862 mycobacteriology laboratories were
enrolled in PT programs; 2459 (85%) were enrolled in CAP.
Category-specific enrollment ranged from 506 (CAP only) to 683 (all
PT programs) for laboratories that perform AFB smears only, 1126-1166 
for
those that perform primary culture without organism
identification, 568-699 for those that perform primary culture and
identification, and 259-314 for those that perform primary culture,
identification, and drug-susceptibility testing (Figure 1).
     Of the 2862 mycobacteriology laboratories, 2179 reported
performing primary culture for M. tuberculosis. Of these, 1166
(54%) referred any AFB-positive isolates to another laboratory for
organism identification and drug-susceptibility testing, 699 (32%)
performed primary culture with identification, and 314 (14%)
performed primary culture, identification, and drug-susceptibility
testing. Similarly, of the 1953 laboratories enrolled in CAP only
that reported performing primary culture for M. tuberculosis, 1126
(58%) referred any AFB-positive isolates to another laboratory for
organism identification and drug-susceptibility testing, 568 (29%)
performed primary culture with identification, and 259 (13%)
performed primary culture, identification, and drug-susceptibility
testing.
Reported by: N Serafy, American Association of Bioanalysts,
Brownsville, Texas. N Kubala, G Woods, MD, College of American
Pathologists, Northfield, Illinois. M Salfinger, MD, I Salkin, PhD,
New York State Dept of Health. R La Fisca, New Jersey Dept of
Health. C Robles Rivera, Puerto Rico Dept of Health. N Bourdeau,
Univ of Wisconsin Center for Health Sciences, Madison. Div of
Laboratory Systems, Public Health Practice Program Office, CDC.
Editorial Note: Rapid laboratory testing to identify and determine
the drug susceptibility of M. tuberculosis isolates is vital to
effective diagnosis, treatment, and control of TB in the community.
The findings in this report indicate that for a substantial
proportion of TB cases, organism identification and
drug-susceptibility determinations may be delayed because at least
54% of laboratories performing primary cultures for M. tuberculosis
must refer AFB culture isolates to another laboratory for complete
analysis.
     Although both solid and liquid media together are recommended
for culturing M. tuberculosis, the liquid-culture method is needed
to rapidly isolate and detect the organism in primary culture and
to test susceptibility to the primary anti-TB drugs (1). In
addition to decreasing the time required to detect and isolate
mycobacteria, liquid-culture methods also increase the sensitivity
of culture for M. tuberculosis (1,4). Although primary
culture-isolation methods are not routinely reported to PT
programs, a 1992 survey of 749 laboratories that performed primary
culture with referral of all isolates to another laboratory
indicated that 97 (13%) were using the recommended liquid-culture
method (CAP, unpublished data, 1994). In addition, a survey of
hospital laboratories in 1992 indicated that only 35 (14%) of 248
laboratories that referred isolates for identification of M.
tuberculosis used the recommended liquid-culture method compared
with 139 (50%) of 280 laboratories that routinely identified
isolates of M. tuberculosis (CDC, unpublished data, 1994). Reasons
for the continued use of solid-culture medium alone may reflect
minimum test-volume requirements and higher costs associated with
the liquid-culture system.
     The exclusive use of solid-medium culture methods delays
isolation of M. tuberculosis by an average of 7-10 days (4),
thereby delaying organism identification to confirm diagnosis. In
addition, the referral of AFB-positive culture growth to another
laboratory may result in delays associated with transport. These
delays also may prolong determination of whether isolates are
resistant to anti-TB drugs: in 1994, based on test results for 28
states, 8% of cases were resistant to isoniazid (INH) and 2% were
resistant to both INH and rifampin (5). At least one state (i.e.,
New York) has regulations that prohibit laboratories from
performing primary culture if the laboratory does not perform
identification of M. tuberculosis.
     The findings in this report are subject to at least two
limitations. First, data were unavailable about the proportion of
all M. tuberculosis specimens tested by each of the four categories
of laboratories enrolled in PT programs. Second, data were
unavailable to determine whether laboratories that refer culture
isolates for identification have adopted use of liquid-culture
methods.
     Laboratories should select culture tests that provide rapid
identification of M. tuberculosis and drug-susceptibility test
results to enable early confirmation of the diagnosis and
initiation of infection-control measures and case-finding.
Laboratories that perform only primary culture for M. tuberculosis
should determine whether referral of the patient specimen, rather
than culture isolates, may decrease the time required for
identification and drug-susceptibility testing.
References
1. Tenover FC, Crawford JT, Huebner RE, Geiter LJ, Horsburgh CR Jr,
Good RC. The resurgence of tuberculosis: is your laboratory ready?
J Clin Microbiol 1993;31:767-70.
2. CDC. National action plan to combat multidrug-resistant
tuberculosis. MMWR 1992;41(no. RR-11).
3. Woods G, Witebsky F. Mycobacterial testing in clinical
laboratories that participate in the College of American
Pathologists Mycobacteriology E survey: results of a 1993
questionnaire. J Clin Microbiol 1995;33:407-12.
4. Nolte FS, Metchock B. Mycobacterium. In: Murray PR, Baron EJ,
Pfaller MA, Tenover FC, Yolken RH, eds. Manual of clinical
microbiology. 6th ed. Washington, DC: American Society for
Microbiology, 1995:400-37.
5. CDC. Tuberculosis morbidity--United States, 1994. MMWR
1995;44:387-9,395.

* 42 CFR 493.825.


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     Recommendations for Test Performance and Interpretation from the
     Second National Conference on Serologic Diagnosis of Lyme Disease

     The Association of State and Territorial Public Health
Laboratory Directors, CDC, the Food and Drug Administration, the
National Institutes of Health, the Council of State and Territorial
Epidemiologists, and the National Committee for Clinical Laboratory
Standards cosponsored the Second National Conference on Serologic
Diagnosis of Lyme Disease held October 27-29, 1994. Conference
recommendations were grouped into four categories: 1) serologic
test performance and interpretation, 2) quality-assurance
practices, 3) new test evaluation and clearance, and 4)
communication of developments in Lyme disease (LD) testing. This
report presents recommendations for serologic test performance and
interpretation, which included substantial changes in the
recommended tests and their interpretation for the serodiagnosis of
LD.
     A two-test approach for active disease and for previous
infection using a sensitive enzyme immunoassay (EIA) or
immunofluorescent assay (IFA) followed by a Western immunoblot was
the algorithm of choice. All specimens positive or equivocal by a
sensitive EIA or IFA should be tested by a standardized Western
immunoblot. Specimens negative by a sensitive EIA or IFA need not
be tested further. When Western immunoblot is used during the first
4 weeks of disease onset (early LD), both immuno- globulin M (IgM)
and immunoglobulin G (IgG) procedures should be performed. A
positive IgM test result alone is not recommended for use in
determining active disease in persons with illness greater than 1
month's duration because the likelihood of a false-positive test
result for a current infection is high for these persons. If a
patient with suspected early LD has a negative serology, serologic
evidence of infection is best obtained by testing of paired acute-
and convalescent-phase serum samples. Serum samples from persons
with disseminated or late-stage LD almost always have a strong IgG
response to Borrelia burgdorferi antigens.
     It was recommended that an IgM immunoblot be considered
positive if two of the following three bands are present: 24 kDa
(OspC)*, 39 kDa (BmpA), and 41 kDa (Fla) (1). It was further
recommended that an that IgG immunoblot be considered positive if
five of the following 10 bands are present: 18 kDa, 21 kDa (OspC)*,
28 kDa, 30 kDa, 39 kDa (BmpA), 41 kDa (Fla), 45 kDa, 58 kDa (not
GroEL), 66 kDa, and 93 kDa (2).
     The details of both plenary sessions and the work group
deliberations are included in the publication of the proceedings,
which is available from the Association of State and Territorial
Public Health Laboratory Directors; telephone (202) 822-5227.

_
                                                                            

References
1. Engstrom SM, Shoop E, Johnson RC. Immunoblot interpretation
criteria for serodiagnosis of early Lyme disease. J Clin Microbiol
1995;33:419-22.
2. Dressler F, Whelan JA, Reinhart BN, Steere AC. Western blotting
in the serodiagnosis of Lyme disease. J Infect Dis 1993;167:392-400.

* The apparent molecular mass of OspC is dependent on the strain of
B. burgdorferi being tested. The 24 kDa and 21 kDa proteins
referred to are the same.


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To: hicnews
1995

Human Granulocytic Ehrlichiosis -- New York, 1995
     Since 1986, two human tickborne diseases caused by Ehrlichia
spp. have been recognized in the United States: human monocytic
ehrlichiosis (HME), caused by E. chaffeensis, and human
granulocytic ehrlichiosis (HGE), caused by an agent closely related
to E. equi (1,2). In June 1995, the Westchester County (New York)
Department of Health (WCDOH) received reports from physicians who
were treating patients for suspected HGE. In response, the WCDOH
sent information to all primary-care physicians in Westchester
County describing the clinical and laboratory features of
ehrlichiosis (fever, myalgia, headache, leukopenia, and
thrombocytopenia) and requested that they voluntarily report
suspected cases of ehrlichiosis. This report summarizes an
investigation by the New York State Department of Health (NYSDOH)
and the WCDOH of suspected ehrlichiosis cases and the clinical
characteristics of confirmed and probable cases.
     Hospitals and large group practices in Westchester County were
asked to report current and past suspected cases, and the NYSDOH
laboratory initiated free diagnostic testing for ehrlichiosis for
New York state residents. Potential cases of ehrlichiosis were
identified through reports submitted by health-care providers to
their county health departments and from a review of NYSDOH
laboratory records of serum specimens that were submitted for
diagnostic testing for ehrlichiosis since 1994. Serum specimens
from potential cases were tested for antibodies to E. equi and/or
E. chaffeensis, and/or the presence of DNA of the HGE agent by
polymerase chain reaction (PCR) assay. A confirmed case of HGE was
defined as either a fourfold change in antibody titer to E. equi or
identification of DNA sequences of the HGE agent by PCR assay. A
probable case of HGE was defined as a single antibody titer greater
than or equal to 64 by immunofluorescent assay to E. equi or the
identification of organisms (morulae) in granulocytes on a
peripheral blood smear from a patient with an acute illness
characterized by fever, headache, myalgia, and/or malaise.
     As of August 15, 1995, medical records and/or clinical
information had been reviewed for 68 patients with suspected
ehrlichiosis: 50 had onset in 1995; 17, in 1994; and one, in 1992.
Serum specimens from 30 patients had been tested for antibodies to
E. equi and/or E. chaffeensis; 20 patients had acute serum
specimens tested by PCR analysis.
     Illnesses in 29 patients met the case definition of either
confirmed (23 patients) or probable (six patients) HGE, 20 from
1995 and nine from 1994; other potential cases remain under
investigation. Eighteen (62%) case-patients had onset of symptoms
in June or July 1995. Twenty-five patients lived in Westchester
County, two lived north of Westchester in adjacent Putnam County,
and two lived on Long Island in Nassau and Suffolk counties. The
mean age of patients with confirmed or probable HGE was 49 years
(range: 21-90 years), and 15 (52%) were male. Fourteen (48%) of the
29 case-patients reported a tick bite less than or equal to 21 days
before onset of illness. Fever greater than 101.0 F ( greater than
38.3 C) was noted in 27 patients. Reported symptoms included
headache (22 patients), arthralgia (13), malaise (11), and myalgia
(11). The lowest reported platelet count for 21 patients averaged
106,000 mm3 (range: 28,000-275,000 mm3; normal: 150,000-350,000
mm3), and the lowest reported white blood cell count for 26
patients averaged 4200 mm3 (range: 700-7700 mm3; normal: 4300-10,800 
mm3).
Thirteen patients had mild serum elevations of liver
enzymes aspartase aminotransferase, alanine aminotransferase, and
lactate dehydrogenase. Thirteen patients were hospitalized, and
none died. Twenty-two patients received doxycycline during their
acute illness.
     Of the 23 confirmed cases, 11 had a fourfold rise in antibody
titer to E. equi using a polyvalent antihuman conjugate, and 15 had
HGE 16S ribosomal DNA detected from acute serum specimens (a
positive PCR test). One confirmed case also had characteristic
morulae observed in granulocytes on a peripheral blood smear. The
six probable cases had single titers greater than or equal to 64 to
E. equi. Five case-patients had serologic evidence of E.
chaffeensis infection (titer greater than or equal to 64) but all
had at least a 10-fold greater titer to E. equi.
Reported by: G Wormser, MD, D McKenna, M Aguero-Rosenfeld, MD, H
Horowitz, MD, J Munoz, MD, J Nowakowski, MD, G Gerina, MD,
Westchester County Medical Center, Valhalla; P Welch, MD, Mt.
Kisco; H Moorjani, MD, T Rush, MD, Tarrytown; G Jacquette, MD, A
Stankey, R Falco, PhD, M Rapoport, MD, Westchester County Dept of
Health, Hawthorne; D Ackman, MD, J Talarico, DO, D White, PhD, L
Friedlander, R Gallo, G Brady, M Mauer, DO, S Wong, PhD, R Duncan,
L Kingsley, R Taylor, G Birkhead, MD, D Morse, MD, State
Epidemiologist, New York State Dept of Health. JS Dumler, MD, Univ
of Maryland Medical Center, Baltimore, Maryland. Viral and
Rickettsial Zoonoses Br, Div of Viral and Rickettsial Diseases,
National Center for Infectious Diseases, CDC.
Editorial Note: HGE was first described in 1994 among patients in
Minnesota and Wisconsin. In addition to these cases, reports have
suggested that acquisition of HGE may have occurred in California,
Florida, Maryland, Massachusetts, and New York (4,5). Approximately
400 cases of HME have been confirmed in 30 states, primarily in the
southeastern and south central regions (3). E. chaffeensis has most
commonly been identified in the Lone Star tick (Amblyomma
americanum), while HGE has been identified in the deer (Ixodes
scapularis) and dog (Dermacentor variabilis) ticks (2).
     Physicians evaluating patients with an acute febrile illness
should consider ehrlichiosis in the differential diagnosis,
particularly if the patient is leukopenic or thrombocytopenic, and
should solicit a history of known or possible exposure to ticks.
Empiric therapy with doxycycline antibiotics should be considered
if the diagnosis of ehrlichiosis is suspected because delayed
treatment while awaiting laboratory confirmation may increase the
risk for adverse outcomes. The diagnosis can be confirmed through
antibody assays and/or PCR. The agent that causes HGE has not been
identified in cell culture, but tests for antibody to E. equi have
been used to confirm the diagnosis. The sensitivity, specificity,
and cross-reactivity of serologic assays for the two species are
not well established. Because the geographic distribution of HME
and HGE overlap, physicians should consider obtaining serologic
tests for both E. equi and E. chaffeensis. PCR is a useful research
tool but is not widely available for diagnostic purposes.
     The patients described in this report live in areas where I.
scapularis is common. I. scapularis collected in Westchester and
Suffolk counties have been found positive for the HGE agent by PCR
assay (CDC, unpublished data, 1995). The geographic extent of HGE
in New York is not known. Persons spending time outdoors in
tick-infested areas should take precautions against tickborne
diseases, including wearing light-colored clothing, using insect
repellent, and checking thoroughly for ticks after being outdoors.
The NYSDOH has asked physicians in New York to report suspected
cases to their local health departments. In addition, the NYSDOH is
working with local health departments to provide information to the
public and medical community and is offering serologic testing for
HME and HGE through the NYSDOH laboratory. CDC provides serologic
and PCR testing for HME and HGE of specimens sent through state
health departments.
References
1. Dawson JE, Anderson BE, Fishbein DB, et al. Isolation and
characterization of and Ehrlichia sp. from a patient diagnosed with
human ehrlichiosis. J Clin Microbiol 1991;29:2741-5.
2. Bakken JS, Dumler JS, Chen SM, Eckman MR, Van Etta LL, Walker
DH. Human granulocytic ehrlichiosis in the upper midwest United
States. JAMA 1994;272:212-8.
3. Fishbein DB, Dawson JE, Robinson LE. Human ehrlichiosis in the
United States, 1985-1990. Ann Intern Med 1994;120:736-43.
4. Dumler JS, Bakken JS. Ehrlichial diseases of humans: emerging
tick-borne infections. Clin Infect Dis 1995;20:1102-10.
5. Telford SR, Lepore TJ, Snow P, Warner CK, Dawson JE. Human
granulocytic ehrlichiosis in Massachusetts. Ann Intern Med
1995;123:277-9.



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End of HICNet Medical News Digest V08 Issue #28
***********************************************


---
Editor, HICNet Medical Newsletter
Internet: david@stat.com                 FAX: +1 (602) 451-6135

                                                                                                                       
