Lyme Disease

Lyme disease is an infectious malady caused by bacteria of the genus borrelia. It got its name from Lyme, Connecticut, USA where the first cases were documented and identified. There are also incidence of such disease recorded in other parts of America and some of Europe. After several researches, it was found out that such disease is a tick-borne infection transmitted by the bite of ticks belonging to the genus Ixodes, specifically infected with a gram-negative, spirochete bacteria known as Borrelia burgdorferi.

Symptoms

After acquiring the infection, early symptoms will manifest, such as:

  • May be asymptomatic
  • Bull’s eye rash (erythema migrans) – classic symptom
  • Fever
  • Muscle fatigue
  • Headache
  • Dizziness
  • Malaise
  • Psychological symptom (depression, mood changes, sleep disorders)
  • Purplish lump (earlobes scrotal area)
  • Muscle pain
  • Joint pain
  • Palpitations
  • Neurological symptoms (photosensitivity, stiff neck, memory loss, headaches)

However, if left untreated, infection will carry on, manifesting the following symptoms:

  • Paraplegia
  • Facial palsy
  • Neuropathy (numbness, tingling, pain)
  • Neurological symptoms (short term memory loss, cognitive difficulties, attention deficits)
  • Psychological Symptom (psychosis, panic attacks, anxiety, delusions)
  • Arthritis

Pathophysiology

An infected tick injects the bacteria (B. burgdorferi) into the skin. The saliva coming from the tick bite disturbs the normal immunity responses. With such occurrence, the bacteria readily spread and travel through the dermis establishing an infection. The host responds to the bacterial entry by the appearance of a rash, erythema migrans (classic sign, described to appear like a bull’s-eye pattern). The immune response should now be fighting the condition, however, this response fails and such allows the bacteria to survive. Eventually, the bacteria spread to the bloodstream reaching the heart, the brain, the joints and the nervous system. This facilitates the manifestation of miscellany of symptoms.

Diagnosis

  • Lyme disease can be primarily diagnosed by the symptoms manifested by the patient, specifically; the presence of erythema migrans, in most cases, arthritis.
  • In some cases, a thorough patient history and assessment is done, noting any travel to places from which the prevalence of Lyme disease is endemic, any tick infection exposure, or tick bite recall.
  • Serological blood tests – measure the level of specific antibodies combating the disease
    • ELISA
    • Western blot

Management

  • Medical treatment would usually last up to three to four weeks depending on severity. Treatment would be antibiotics, doxycycline, amoxicillin, ceftriaxone, cefuroxime, erythromycin, cefotaxime are the common anti-infectives used.
  • Nursing management includes assertive assessment, diagnosis, care implementation and evaluation.
  • Compliance to medications should be emphasized, proper monitoring of response to medications should be accomplished.
  • Health education should be carried out. Preventive measures such as wearing protective clothing (long-sleeves top and trousers, closed shoes), strict handling and inspection of outdoor pets that may bring in ticks and having vaccination against B. burgdorferi.

 

Byron Webb Romero, RN, MSN

Finished BSN at Lyceum of the Philippines University, and Master of Science in Nursing Major in Adult Health Nursing at the University of the East Ramon Magsaysay Memorial Medical Center. Currently working at Manila Doctors College of Nursing as a Team Leader for Level I and II, Lecturer for Professional Nursing Subjects, and also a Clinical Instructor.

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