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:radiculopathy
headache, poor coordination, memory
loss & 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, neuropathy
• Chronic fatigue
• Memory/thinking problems
• Permanent damage to
joints/NS
• Cardiac: myocarditis
• Tx: AB
Diagnostics
• Two-step testing
• 1st step
• Sensitive Enzyme
immunoassay or
immunofluorescence[EIA]:
Positive
• 2nd step
• 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 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.
REMOVING A TICK