From <@VMS.DC.LSOFT.COM:owner-mednews@ASUVM.INRE.ASU.EDU> Sun Aug 27 14:47:44 1995 (LSMTP for OpenVMS v0.1a) with SMTP id 74F8FB84 ; Sun, 27 Aug 1995 14:32:53 - 1300 release 1.8b) with NJE id 7017 for MEDNEWS@ASUVM.INRE.ASU.EDU; Sun, 27 Aug 1995 11:30:52 -0700 (LMail V1.2a/1.8a) with BSMTP id 2046; Sun, 27 Aug 1995 11:30:51 - 0700 V2R3) with TCP; Sun, 27 Aug 95 11:30:44 MST (8.6.12/8.6.9) with UUCP id LAA08622 for mednews@asuvm.inre.asu.edu; Sun, 27 Aug 1995 11:15:37 -0700 mednews@asuvm.inre.asu.edu Comments: To: asumednews@stat.com 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 +------------------------------------------------+ ! ! ! Health Info-Com Network ! ! Medical Newsletter ! +------------------------------------------------+ Editor: David Dodell, D.M.D. 10250 North 92nd Street, Suite 210, Scottsdale, Arizona 85258-4599 USA Telephone +1 (602) 860-1121 FAX +1 (602) 451-1165 Internet: mednews@stat.com Bitnet: ATW1H@ASUACAD Mosaic WWW *Asia/Pacific: http://biomed.nus.sg/MEDNEWS/welcome.html *Americas: http://outland.cardinal.com/hicn *Europe: http://www.dmu.ac.uk/ln/MEDNEWS/ Compilation Copyright 1995 by David Dodell, D.M.D. All rights Reserved. License is hereby granted to republish on electronic media for which no fees are charged, so long as the text of this copyright notice and license are attached intact to any and all republished portion or portions. The Health Info-Com Network Newsletter is distributed biweekly. Articles on a medical nature are welcomed. If you have an article, please contact the editor for information on how to submit it. If you are interested in joining the automated distribution system, please contact the editor. Associate Editors: E. Loren Buhle, Jr. Ph.D. Dept. of Radiation Oncology, Univ of Pennsylvania Tom Whalen, M.D., Robert Wood Johnson Medical School at Camden Douglas B. Hanson, Ph.D., Forsyth Dental Center, Boston, MA Lawrence Lee Miller, B.S. Biological Sciences, UCI Dr K C Lun, National University Hospital, Singapore W. Scott Erdley, MS, RN, SUNY@UB School of Nursing Jack E. Cross, B.S Health Care Admin, 882 Medical Trng Grp, USAF Albert Shar, Ph.D. CIO, Associate Prof, Univ of Penn School of Medicine Stephen Cristol, M.D. MPH, Dept of Ophthalmology, Emory Univ, Atlanta, GA Subscription Requests = mednews@stat.com anonymous ftp = vm1.nodak.edu; directory HICNEWS FAX Delivery = Contact Editor for information ---------------------------------------------------------------------- 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). ------------------------------ To: hicnews 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. ------------------------------ To: hicnews 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. ------------------------------ 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. ------------------------------ End of HICNet Medical News Digest V08 Issue #28 *********************************************** --- Editor, HICNet Medical Newsletter Internet: david@stat.com FAX: +1 (602) 451-6135