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Lyme Disease Pondicherry Journal of Nursing Vol S, Issue1, December'11 -Marcl1'12 LYME DISEASE Ms. Snvithri K B INTRODUCTION Hard-bodied ticks of the genus lxodes arc the main vectors of Lyme Lyme disease, or Lyme disease. borreliosis is an emerging infectious disease caused by three species of Lyme spirochetes have been bacteria belonging to the genus found in insects as well as ticks. It has BoITelia The disease is named after the been found in semen and breast milk, town of Lyme, Connecticut, USA, but transmission has not been known to where a number of cases were take place through sexual contact. identified in 1975. Although Allen Transmission across the placenta Steere realized Lyme disease was a during pregnancy has not been tick-home disease in 1978, the cause of demonstrated. the disease remained a mystery until 1981, when B. burgdorferi was identified by Willy Burgdorfer. ETIOLOGY Borrelia bacteria, the causative agent of Lyme disease. It is caused by Gram-negative, spirochetal bacteria from the genus Borrelia. The Borrelia species that cause Lyme disease are collectively known as Borrelia burgdorferi sensu lato. It made up of three closely related species namely B. burgdorferi sensu stricto B. afzelii, and B. garinii TRANSMISSION Lyme disease is classified as a zoonosis, as it is transmitted to humans from a natural reservoir among rodents by ticks that feed on both sets of hosts. Ms. Savithri KB, Lecturer, Vel RS Deer Tick medical college - College of Nursing, life cycle Avadi, Chennai. 17 Pond/cherry Journal of Nursing Vol S, lssue1, December'll -1\,f Q,.c,_,, .1.< targeted by antibodies, an0 variation of the VlsE surface tg~i~ . k . Prote· inacttvatmg ey immune compon 111, ii such as complement, and hiding . ellts extracellular matnx,. which ll} th e interfere with the function of imllllllay factors une PATHOPHYSIOLOGY In the brain, B. burgdorferi n.. ••iay induce astroc~es . to undergo Borrelia burgdorferi can spread astrogliosis (prohferatton followed b throughout the body during the course apoptosis), which may contribute t~ of the disease , and has been found in neurodysfunction. The spirochetes rnay the skin, heart, joint, peripheral nervous also induce host cells to secrete system, and CNS. B. burgdorferi is products toxic to nerve cells and cause injected into the skin by the bite of an cognitive impairment. infected Ixodes tick. IMMUNOLOGICAL STUDIES Tick saliva, which accompanies the spirochete into the skin during the Exposure to the Borrelia feeding process, contains substances bacterium during Lyme disease that disrupt the immune response at the possibly causes a long-lived and site of the bite. The spirochetes damaging inflammatory response, a multiply and migrate outward within form of pathogen-induced autoimmune the dermis. Days to weeks following disease. The production of this reaction the tick bite, the spirochetes spread via might be due to a form of molecular the bloodstream to joints, heart, mimicry, where Borrelia avoid being nervous system, and distant skin sites, killed by the immune system by where their presence gives rise to the resembling normal parts of the body's variety of symptoms of disseminated tissues. disease. SIGNS AND SYMPTOMS The spread of B. burgdorferi is aided by the attachment of the host Lyme disease can affect protease plasmin to the surface of the multiple body systems. Not all patients spirochete. If untreated, the bacteria with Lyme disease will have all may persist in the body for months or symptoms. The incubation period from even years, despite the production of B. infection to the onset of symptoms is burgdorferi antibodies by the immune usually one to two weeks, but system. The spirochetes may avoid the can be much shorter (days) immune response by decreasing or much longer (months to years). expression of surface proteins that are A circular, expanding rash called erytbe.DIS 18 Pondicherry Journal of Nursing Vol S, /ssue1, December'11 - March'12 chronicum migrans (EM), which swelling), cramps, stiffness, muscle occurs at the site of the tick bite 3 to 30 twitches, numbness and tingling, days after the tick bite. The rash is red, shooting pains, and lower back or wann, painless & the innermost portion neck pain. remains dark red and becomes indurated; the outer edge remains red; • Circulatory system: too fast or and the portion in between clears, too slow heart rate, irregular giving the appearance of a bullseye. heartbeat (palpitations), EM occurs in about 80% of infected inflammation of the heart patients. muscle or arteries, and chest pam. • Respiratory system: sinusitis, difficulty breathing, and pneumonias, sore throat, hoarseness, • Skin: rashes, itching, crawling sensations, benign cysts and nodules, and skin discoloration. • Eyes: pain, inflammation, blurred or double vision, retinal damage, floaters, flashing lights, light sensitivity, dry eye, and blindness. • Ears: itching, earache, buzzing, ringing, and sound sensitivity. • Digestive tract: nausea, vomiting, diarrhea, constipation, loss of appetite, mild liver Characteristic bullseye rash caused by Lyme abnonnalities, and disease Borre/ ial lymphocytoma on the cheek function spleen tenderness and • Central Nervous System: enlargement. migraines, dizziness, brain fog, poor • Genitourinary tract: memory, poor sleep, lack of verbal inflammation of the urethra and fluency, confusion or disorientation, bladder, pelvic pain, testicular decreased ability to concentrate, pain, and loss of sexual desire. facial nerve tics or paralysis, sore • General: tiredness, lack of jaw, mood & all the psychiatric stamina, fever, vague discomfort, disorders. irritability, nervousness or • Muscles, joints, and bones: pains anxiety, and weight loss or gain. that come and go (with or without 19 Vol 5, /ssue1, December'JJ ~ .1 .. ~P:o~n~d1~·ch~e~ny ~ J~o:u~m:a!!l~of~N:r~,r.~'S1~·nio __iiiiiiiii ________iiiiiiiiiiiii.&iiiiiiiiiiiiiiii~iiiiiiiiiiiiii;;~ ~ ..,q,,.c~. 1 Late persistent infection Laboratory testing < After several months, The most widely usect . test serologies, which measure 8 a. untreated or inadequately treated 1 1 'b d' . eveis i patients may go on to develop specific anti o ies m a patient's b! 01 severe and chronic symptoms that These tests may be negative in °oQ_ affect many parts of the body, infection, as the body may not earl) . 'fi h~ including the brain, nerves, eyes, produced a s1gn1 1cant quantit i joints and heart. Chronic neurologic antibodies. The serological labo y Of rato symptoms occur in up to 5% of tests most widely available ~ untreated patients. employed are the Western blot anq . a~~ ELISA. · Hi~h titers of either A polyneuropathy that immunoglobulm G (IgG) involves shooting pains, numbness, immunoglobulin M (IgM) antibodies ~r 0 and tingling in the hands or feet Borrelia antigens indicate disease b • Ut may develop. A neurologic lower titers can be misleading, because syndrome called Lyme the IgM antibodies may remain after encephalopathy is associated with the initial infection, and IgG antibodies subtle cognitive problems, Lyme may remain for years. arthritis usually affects the knees PREVENTION DIAGNOSIS Attached ticks should be Lyme disease is diagnosed removed promptly, as removal within clinically based on symptoms, 36 hours can reduce transmission rates. objective physical findings (such as Protective clothing includes a hat, long­ erythema migrans, facial palsy or sleeved shirts and long trousers tucked arthritis) or a history of possible into socks or boots. Light-colored exposure to infected ticks, as weII clothing makes the tick more easily as serological blood tests. Because visible before it attaches itself. People of the difficulty in culturing should use special care in handling and Borrelia bacteria in the laboratory, allowing outdoor pets inside homes diagnosis of Lyme disease is because they can bring ticks into the typically based on the clinical exam house. findings and a history of exposure to endemic Lyme areas. Lyme A more effective, community disease may be misdiagnosed as wide method of preventing Lyme multiple sclerosis, rheumatoid disease is to reduce the numbers of arthritis, fibromyalgia, chronic primary hosts on which the deer tick fatigue syndrome, lupus, Crohn's depends, such as rodents, other small disease or other autoimmune and mammals, and deer. Reduction of the neurodegenerati ve diseases. deer population may, over time, helP break the reproductive cycle of the deer 20 Pond/cherry Journal ofNursing Vol 5, Issue 1, December'11 - March'12 ticks and their ability to flourish in Alternative choices are cefuroxime and suburban and rural areas. cefotaxime. Treatment of pregnant women is similar, but tetracycline TICK REMOVAL should not be used. Folk remedies for tick removal MANAGEMENT tend to be ineffective, offer no NURSING advantages in preventing the transfer of Health Education regarding · the disease, and may increase the risks of prevention of Lyme disease transmission or infection. The best People should use special care in method is simply to pull the tick out handling and allowing outdoor pets with tweezers as close to the skin as inside homes because they can bring possible, without tw1stmg, and ticks into the house. Protective avoiding crushing the body of the tick clothing includes a hat, long-sleeved or removing the head from the body. shirts and long trousers tucked into socksor boots. Light-colored clothing VACCINATION makes the tick more easily visible A recombinant vaccme against before it attaches itself. To remove Lyme disease, based on the outer the tick pull the tick out with tweezers surface protein A (OspA) of B. as close to the skin as possible, without burgdorferi, was developed by twisting, and avoiding crushing the GlaxoSmithKline. In clinical trials body of the tick or removing the head involving more than 10,000 people, the from the body. vaccine, called LYMErix, was found to REFERENCES confer protective immunity to Borrelia in 76% of adults and 100% of children • Rapini, Ronald P.; Bolognia, Jean L.; with only mild or moderate and Jorizzo, Joseph L. (2007). Dennatology: 2- Volume Set.
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