Handout Medical Surgical Nursing Lyme Disease

>appear within several weeks after the tick bite, even in someone who has not developed the initial rash.

Lyme disease >is an infection caused by the bacteriumBorrelia burgdorferi, usually found in animals such as mice and deer. >Ixodes ticks can pick up the bacteria when they bite an infected animal, then transmit it to a person, which can lead to Lyme disease. Ticks >live in shady, moist ground cover >cling to tall grass, brush, shrubs, and low tree branches. >attach themselves to a suitable host as it passes by >small and can be hard to see Immature ticks, or nymphs, >are about the size of a poppy seed. *Lawns and gardens may harbor ticks, especially at the edges of woods and forests and around old stone walls (areas where deer and mice, the primary hosts of the deer tick, thrive).

*Lyme disease Stage II can affect: Heart >leading to an irregular heart rhythm or chest pain Nervous system >causing facial paralysis (Bell's palsy) >tingling and numbness in the arms and legs >headaches and neck stiffness, which may be a sign of meningitis Masculoskeletal >Swelling and pain in the large joints can also occur.

Stage III Late persistent infection Symptoms >appear any time from weeks to years after an infectious tick bite and include >Arthritis particularly in the knees (adults) >Cognitive deterioration

At Risk: Signs and Symptoms Lyme disease can affect: >skin >joints >nervous system >other organ systems *Symptoms, and their severity, can vary from person to person. Three Stages (though not everyone experiences all stages)

Stage I Early localized infection Erythema migrans>The first sign of infection >Circular rash > Appears within 1–2 weeks of infection but may develop up to 30 days after the tick bite. >"bull's-eye" appearance, with a central red spot surrounded by clear skin that is ringed by an expanding red rash >It may also appear as an expanding ring of solid redness. >It may be warm to the touch and is usually not painful or itchy. >difficult to see on people with darker skin tones, where it may take on a bruise-like appearance. The rash usually resolves in about a month. *Although this rash is considered typical of Lyme disease, many patients never develop it. flu-like symptoms: swollen lymph nodes fatigue headache muscle aches.

Stage II Early disseminated infection >Left untreated, the infection can spread to other parts of the body. Symptoms: >The person may feel very tired and unwell, or may have more areas of rash that aren't at the site of the bite.

>depends on an individual's exposure to ticks >Kids and adults who spend a lot of time outdoors — particularly in or near wooded areas >Lyme disease contracted during pregnancy may infect the fetus. >Domestic animals dogs, cats *Nsg Advice >Tell to the pet owner to talk with your veterinarian about what kinds of tick-control products and other protective measures you can take for your pet.

Diagnosis Circular bull's-eye rash (Pathognomonic Sign) >the most telling symptom of Lyme disease is the >consider taking a picture of any suspicious rash on your child if you are unable to see the doctor immediately Blood tests are not necessary >Because the rash can rapidly disappear Bull's-eye rash never formed >Blood tests can help diagnose Lyme disease by detecting the presence of antibodies to Borrelia burgdorferi in the patient's blood >can give inaccurate results if done within a month after initial infection, since it takes time for the antibodies to develop > The bacteria may persist in the body for months or even years, despite the production of anti-B. burgdorferi antibodies by the immune system.[32] *Lyme disease can be difficult to diagnose because it may resemble many other medical conditions

Treating Lyme disease Pharmacotherapy: If diagnosed quickly and treated with antibiotics >antibiotics administered for 3 to 4 weeks. *Lyme disease in children is almost always treatable. *The skin rash usually goes away within several days after starting treatment, *Other signs and symptoms may persist for several weeks.

Prevention >Vaccination -A recombinant

vaccine against Lyme disease, based on the outer surface protein A (OspA) of B. burgdorferi, was developed byGlaxoSmithKline -hundreds of vaccine recipients reported that they had developed autoimmuneside effects -These claims were investigated by the FDA and the U.S. Centers for Disease Control (CDC), who found no connection between the vaccine and the autoimmune complaints >avoid contact with soil, leaves, and vegetation as much as possible, especially during May, June, and July, when ticks have not yet matured and are harder to detect. >When you do venture into the great outdoors, follow these tips: >Wear enclosed shoes and boots >long-sleeved shirts >long pants >Tuck pants into boots or shoes to prevent ticks from crawling up legs. >Wear light-colored clothing to help you see ticks easily >Keep long hair pulled back or placed in a cap for added protection. >When outside, don't sit on the ground. >While outdoors, check yourself and your child frequently for ticks. >Wash all clothes after leaving tickinfested areas, and bathe and shampoo your child thoroughly to eliminate any unseen ticks >Insect repellents containing DEET (look for N,N-diethyl-meta-toluamide) can help to repel ticks. Choose one with a 10% to 30% concentration of DEET. Generally, DEET should not be applied more than once a day, and is not recommended for babies younger than 2 months. DEET can be used on exposed skin, as well as clothing, socks, and shoes, but should not be used on the face, under clothing, or on the hands of young children. You can help keep ticks away from your house by keeping lawns mowed and trimmed; clearing brush, leaf litter, and tall grass; and stacking woodpiles off the ground.

Management >Ticks can bite anywhere, but they prefer certain areas of the body, such as: >behind the ears >back of the neck >armpits >groin >behind the knees >If you find a tick on your child, call your doctor, who may want you to save the tick after removal (you can put it in a jar of alcohol to kill it). >Use tweezers to grasp the tick firmly at or mouth, next to your child's skin.

its head

>Pull firmly and steadily on the tick until it let goes, then swab the bite site with alcohol. *Myths abound about ways to kill ticks (such as using petroleum jelly or a lit match), but don't try them — these methods don't work.

When to Call the Doctor If your child has a bull's-eye rash or other symptoms that can occur in Lyme disease — such as swollen lymph glands near a tick bite, general achiness, headache, or fever — call your doctor right away.

Pathophysiology of Lyme disease B. burgdorferi is injected into the skin by the bite of an infected Ixodes tick.

The spirochetes multiply and migrate outward within the dermis.

appearance of the characteristic EM lesion

activation inflammatory response to the bacteria

The spirochetes may avoid the immune response by decreasing expression of surface proteins that are targeted by antibodies, antigenic variation of the VlsE surface protein, inactivating key immune components such as complement, and hiding in the extracellular matrix, which may interfere with the function of immune factors.

Neutrophils fail to appear in the developing EM lesion

permitting the bacteria to survive andbloodstream eventually spread The spirochetes spread via the to joints, heart, nervous system, throughout the body and distant skin sites The spread of B. burgdorferi is aided by the attachment of the host protease plasmin to the surface of the spirochete.

B. burgdorferi In the brain

induce astrocytes to undergo astrogliosis (proliferation followed by apoptosis),

The spirochetes may also induce host cells to secrete products toxic to nerve cells, including quinolinic acid and thecytokines IL6 and TNF-alpha, which can produce fatigue and malaise. Both microglia and astrocytes secrete IL-6 and TNF-alpha in the presence of the spirochete. IL-6 is also significantly indicated in cognitive impairment.

chronic secretion of stress hormones as a result of Borrelia infection may reduce the effect ofneurotransmitters, or other receptors in the brain by cell-mediated pro-inflammatory pathways, mediated via thehypothalamic-pituitary-adrenal axis

tryptophan, a precursor to serotonin appears to be reduced within the centralofnervous leading to the dysregulation neurohormones, system(CNS) in a number of infectious diseases specifically glucocorticoids and catecholamines, thatmajor affect stress the brain, including Lyme neurodysfunction the hormones