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Expository essay: Lyme disease

Hong Anh Nguyen

AUHS, General Education

ENG101: English College Composition I

Dr. Brent M. Davis

November 26, 2022

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Abstract

After weeks or months being infected by Lyme disease, patients may develop certain

abnormalities in relation to the nervous system, the heart and especially arthritis, which attacks

for years. As a nurse, it is important to understand the disease in terms of its pathophysiology,

diagnosis, treatments, and interventions. Lyme disease will be discussed with the reference to

information from six interesting journal articles.

Keywords: Lyme disease, Borrelia burgdorferi, early diagnosis, post treatment Lyme

disease syndrome

Expository essay: Lyme disease

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Expository essay: Lyme disease

Lyme disease is reported to be the most common tick-borne condition in the United

States, which may subsequently cause serious health concerns. This essay will discuss the

definition and development of Lyme disease, how it can be diagnosed, what current treatments

are available, and public knowledge and perception towards the prevention of the disease.

Lyme disease can be defined as an infectious condition caused by a corkscrew-shaped

bacteria of the Spirochaetes class, which includes four species. They are Borrelia afzelii and

Borrelia garinii, causing the infection in Europe and Asia, and Borrelia burgdorferi and Borrelia

mayonii, which are in the United States (Radolf, Strle, Lemieux & Strle, 2021). These organisms

are more likely to live in overgrown areas with high humidity, leaving the rural communities

more vulnerable to health conditions caused by these ticks. Typically, humans get infected

through the bite of blacklegged ticks, which are generally known as deer ticks or sheep ticks. The

disease's name comes from where it was first started researching, a small town called Lyme in

Connecticut (Fallon & Sotsky, 2018). Lyme disease has existed for many years; however, its

cause was never recognized until 1975. It all started from a woman named Polly Murray. Polly

suffered from numerous symptoms such as sudden headaches, sore throats, followed by

laryngitis, and periodic shooting pain in lower limbs. Multiple letters describing these conditions

of Polly, her family and the individuals in her community were sent to the Connecticut State

Department of Health, which caught scientists' attention and brought them to Lyme. The medical

researchers went on and found out more details about this mysterious disease, including routes of

transmission and methods of treatment. Current knowledge of the disease was then established in

1981 when a new species of Borrelia was discovered from ticks on eastern Long Island by Willy

Burgdorfer and his colleagues (Fallon & Sotsky, 2018). Lyme disease can be acquired as being
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bitten by an infected tick. The size of ticks is tiny and their bites are usually painless, making it

difficult for hosts to even notice they have been bitten or mistake it with mosquito bite. Through

the bitten site, B. burgdorferi penetrates the human body and eventually enters the bloodstream.

In the duration of three to thirty-two days, bacteria either travel under the skin around the bitten

region, causing local lymph nodes, or follow the lymphatic vessels to migrate to neighbor areas

or other organs (Radolf, Strle, Lemieux & Strle, 2021). This at first will trigger an inflammatory

response, before a significant antibody reaction happens to fight the infection.

Without treatment, a patient will go through three stages of Lyme disease, namely, early

localized, early disseminated, and late disseminated infection. Various signs appear at each stage

and they can overlap. Erythema migrans is one of the key characteristics of the early localized

stage, which is also the earliest symptom of Lyme disease (Radolf, Strle, Lemieux & Strle,

2021). It is a slowly spreading rash that appears gradually on the skin around the bitten site. The

rash is often red, bull's-eye shaped, not painful or itchy and can be warm to the touch. Early

localized infection also includes enlarged lymph nodes known as lymphadenopathy, flu-like

signs such as tiredness, body aches, etc. (Radolf, Strle, Lemieux & Strle, 2021). No further

symptoms are developed if Lyme disease can be recognized and treated at this early stage.

Patients develop to the second stage, early disseminated infection, when the bacteria travels

throughout their body via the bloodstream (Radolf, Strle, Lemieux & Strle, 2021). On top of the

symptoms from the first stage, more rashes appear on other skin areas of the body. Some infected

hosts can experience neurologic issues. This means feeling numb, weak or painful in feet and

hands, facial paralysis on one or both sides, struggling to concentrate, having memory and other

thinking problems (Rayment & O’Flynn, 2018). A few may have cardiac problems, including an

irregular heartbeat and Lyme carditis, which makes patients feel a fluttering or pounding in the
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chest area. Unlike the second stage, which grows only a few weeks after being bitten by a tick,

the late disseminated infection can progress after months to years. It can be recognized by

frequent pain, stiffness and swelling of large joints, especially in the knee area. This condition is

common in the late stage and is called Lyme arthritis (Radolf, Strle, Lemieux & Strle, 2021). In

some situations, neurological problems are also involved. Besides that, a condition called post-

treatment Lyme disease syndrome sometimes happens to a small number of patients. It can

persist from months to years even after the patient receives antibiotics. Reports show that

patients complain of constant fatigue, body aches and headache with tests stating no bacteria in

the body.

For detection of Lyme disease, early diagnosis is the key to have proper treatment and

improve outcomes. Because the early localized stage takes place before serologic tests show

positive results, it can be detected clinically based on erythema migrans and other supported

elements such as medical history, past exposure to endemic location or recent tick bite (Lantos,

Auwaerter & Nelson, 2016). For any suspicion of Lyme disease, a screening test called enzyme-

linked immunosorbent assay is used, measuring the level of Lyme disease antibodies in a

patient’s blood sample. In the early disseminated and late disseminated manifestations,

antibodies are more likely to form after the long incubation period. If the result is positive,

further test, namely, Western blot test or second enzyme immunoassay (EIA), are recommended

for confirmation of Lyme disease. If the test result is negative, depending on the presence or

absence of symptoms, a second test may be required within four to six weeks after the first test to

avoid a false negative result. Cerebrospinal fluid (CSF) and synovial fluid are sometimes

obtained for polymerase chain reaction (PCR) tests to produce a more accurate diagnosis

(Lantos, Auwaerter & Nelson, 2016).

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In addition, Lyme disease can be treated with antibiotics, which vary with each stage of

the condition. Research shows the most successful treatment in the early stage. In the later

stages, antibiotics work to eliminate the bacteria and relieve arthritis. The sooner treatment is

started, the faster and better the patient will recover. Generally, the medications include three

main types: amoxicillin, doxycycline and ceftriaxone. It can be administered orally or

intravenously (IV). IV antibiotics are usually given for more severe cases with ongoing arthritis

or problems associated with the heart and nervous system. Different manifestations of Lyme

disease will be treated with corresponding medications. Children are paid more attention when

taking antibiotics. If the child is less than eight years old, it is important to avoid doxycycline

and adjust doses based on weight. Also, patients are sometimes prescribed nonsteroidal anti-

inflammatory drugs to relieve symptoms. For those that develop heart block, a temporary

pacemaker may be required.

More importantly, an ounce of prevention is better than a pound of cure. LYMErix was

previously developed in the United States for the prevention of Borrelia burgdorferi bacteria

(Wormser, 2022). However, this vaccine was stopped manufacturing in 2002 as its protection

against Lyme disease declined over time. Currently, there is no vaccine for this illness. This

leads to the importance of educating Lyme disease knowledge and health prevention in society.

To better understand the awareness of the disease in the public, one of the proposed methods is

to compare knowledge levels and knowledge needs among individuals, who stay outdoors for

occupational and leisure activities. According to Pierre, Gould and Lloyd (2020), a study was

conducted with a sample of 137 employees from a number of outdoor institutions, who reported

36% of their time was spent for work and 64% left was spent for recreational purposes.

Researchers have found no significant difference between the two compared patterns. A low
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level of knowledge about Lyme disease was shown throughout the entire group sample. Findings

are similar for educational needs. Preventative behaviors for Lyme disease include wearing long

sleeves, long pants and protective footwear to cover the exposed areas of skin for tick contact,

applying repellents, regularly checking for tick bite, or staying away from grassy and woody

locations if possible. In the list above, participants reported the most performed activity was

wearing defensive clothes to avoid contact with ticks. Other preventions were perceived

somewhat effective, but the behavioral performance was variable (Pierre, Gould & Lloyd, 2020).

It comes to a conclusion that in order to improve public health interventions for Lyme disease, it

is important to consider not only the effectiveness of the methods but also the potential

components that influence the application of preventative behaviors.

In conclusion, Lyme disease can pose a major threat to health if not diagnosed early and

treated properly. It is vital for nurses to be aware of Lyme disease symptoms, which can continue

for months or even years despite antibiotic treatment. Patients need to be educated about this

feature of the illness and the possibility for developing the post treatment Lyme disease

syndrome. This allows them to be prepared and able to notify their general practitioners if they

have any symptoms after discharge. Having comprehensive knowledge about Lyme disease also

helps nurses empathize with the tiredness and frustration that patients may experience as a result

of prolonged illness, improving satisfaction and better outcome.

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References

Fallon, B. A., & Sotsky, J. (2018). The early history and epidemiologic surveillance. In

Conquering Lyme Disease (pp. 17-29). Columbia University Press.

Lantos, P. M., Auwaerter, P. G., & Nelson, C. A. (2016). Lyme disease serology. JAMA,

315(16), 1780-1781.

Radolf, J. D., Strle, K., Lemieux, J. E., & Strle, F. (2021). Lyme disease in humans. Current

issues in molecular biology, 42, 333–384. doi:https://doi.org/10.21775/cimb.042.333

Rayment, C., & O’Flynn, N. (2018). Diagnosis and management of patients with Lyme disease:

NICE guideline. British journal of general practice, 68(676), 546-547.

St Pierre, S. E., Gould, O. N., & Lloyd, V. (2020). Knowledge and knowledge needs about Lyme

disease among occupational and recreational users of the outdoors. International journal

of environmental research and public health, 17(1), 355.

doi:https://doi.org/10.3390/ijerph17010355

Wormser, G. P. (2022). A brief history of OspA vaccines including their impact on diagnostic

testing for Lyme disease. Diagnostic microbiology and infectious disease, 102(1),

115572.