Lyme Disease

Description

• Most common vector-borne disease

U.S. (Ixodes tick)
• Reservoir animal: white-foot mouse
& white-tailed deer
• Infection from the spirochete
(Borrelia burgdorferi) from a tick
bite: black-legged tick
• Peaks: summer
• Risk factors:
• Outdoor activities, pets, walking
in high grassy areas
Stage 1 [Early localized Stage]

• Early symptoms: FLU-like symptoms

• Small, red migratory rash [macular or popular]
that spreads into a large ring-shaped rash w/wo
central clearing
• ERYTHEMA MIGRANS-clinically, distinctive
dermatologic hallmark of Lyme
• Round,oval, flat or slightly raised rash,
pain & stiffness in muscles/joints
• Aka as “ Bull’s eye rash”
• Rx
• Doxycycline or amoxicillin 14-21
days
• E-mycin: PCN allergic clients
ECM: BULL’S EYE
Stage 2: Early Disseminated

• Arthritis: joint pain & swelling

• Neurological involvement
• Meningitis, facial paralysis,
peripheral neuritis headache, poor
coordination, memory & thinking
problems, tertiary neuro borrelosis:
confusion/forgetfulness
• Cardiac: CARDITIS w/Dysrhythmias, chest
pain, palpitations, dizziness, dyspnea
• Rx
• Severe: IV ceftriaxone or cefotaxime x30
days
Stage 3 [Chronic Persistent Stage]

• Chronic complications
• Arthritis
• Chronic fatigue
• Memory/thinking problems
• Permanent damage to
joints/NS
• Tx: may not respond to AB
Diagnostics

• Enzyme immunoassay [EIA]:

Positive
• If + or inconclusive:
Western Blot to confirm
infection
• CSF: if neuro involvement
Interventions
• Lyme prevention: reducing exposure
• Reinforcing compliance w/full course of
AB
• Instructing to avoid areas where ticks
can be prevalent: wooded, grassy areas
esp. summer-time
• Instruct to dress appropriately: long-
sleeves, long pants, closed shoes and
hats; tuck pants into boots
• Instruct to spray body with tick
repellent containing DEET [N,N-diethyl-m-
toluamide]before going outside
• Instruct to examine body when returning
inside for the presence of tics.
Interventions
• Encourage plenty of fluids
• ROM & strengthening exercises,
avoid overexertion
• Assess neurologic function, LOC
frequently
• Watch for signs of ICP, cranial
nerve involvement, strabismus and
diplopia
• Assess for cardiac abnormalities
• Inform pt to notify provider if
symptoms persist or recur
Patient Teaching
•Take a shower as soon as you can
after working outdoors.
•Look for ticks on your body.
• Ticks can hide under the
armpits, behind the knees, in
the hair, and in the groin.
• Put your clothes in the dryer
on high heat for 60 minutes to
kill any remaining ticks.
Patient Teaching
How to remove a tick
1. If a tick is attached to you, use fine-tipped
tweezers to grasp the tick at the surface of your
skin.
2. Pull the tick straight up and out. Don’t twist or
jerk the tick—this can cause the mouth parts to
break off and stay in the skin. If this happens,
remove the mouth parts with tweezers if you can. If
not, leave them alone and let your skin heal.
3. Clean the bite and your hands with rubbing
alcohol,or soap and water.
4. You may get a small bump or redness that goes
away in 1-2 days, like a mosquito bite. This is not
a sign that you have Lyme disease.
Note: Do not put hot matches, nail polish, or
petroleum jelly on the tick to try to make it pull
away from your skin.