As future nurse practitioners (NPs) prepare for careers focused on treating patients, they need to know how to detect and prevent patients from being infected from various diseases. For example, by educating patients about the causes, symptoms, and treatment of Lyme disease, nursing practitioners can help reduce its spread.
Using commercial insurance claims data, the Centers for Disease Control and Prevention (CDC) estimates approximately 476,000 Americans were diagnosed with and treated for Lyme disease between 2010 and 2018. While the CDC notes the need for more accurate diagnosis, the numbers provide a glimpse into the frequency of Lyme disease and the importance of improving prevention.
What Is Lyme Disease?
A deeper look into Lyme disease reveals several key facts:
- The illness was first identified in Lyme, Conn., in 1975.
- Lyme disease is a bacterial infection that functions within an organism, both humans and animals.
- A direct correlation between ticks and Lyme disease exists: The bacterium Borrelia burgdorferi, which ticks most commonly spread, causes Lyme disease.
- Ticks, such as the deer tick in the U.S., spread Lyme disease to humans with their bite.
- The disease is prevalent from April through October, but precautions should be taken year-round.
For humans, the potential chronic and long-term effects of Lyme disease include fatigue, pain, insomnia, muscle aches, mental fog, and depression — these can persist for years. Lyme disease is also a fairly common canine disease. Dogs often experience fever, loss of appetite, reduced energy, lameness, stiffness, and swelling of joints. Lyme disease in dogs can sometimes cause kidney failure and cardiac and neurological effects, according to the American Kennel Club.
Lyme Disease in the U.S.
To understand the rapid increase of Lyme disease throughout the country, it’s important to know what causes Lyme disease and where it’s most prevalent. People with Lyme disease can get a rash in the pattern of a bull’s-eye, feel ill with flu-like symptoms, and experience joint pain. Long-term effects of Lyme disease can include neurological problems, chronic joint inflammation, and irregular heartbeat.
Based on the CDC’s Lyme disease map data for 2019, the condition has been most prevalent in Connecticut, Delaware, Maine, Maryland, and Massachusetts. Lyme disease is far outpacing other infectious diseases in the U.S, with 618% more cases than West Nile virus, hepatitis B, and hepatitis C combined, according to the Global Lyme Alliance.
Lyme disease goes beyond the borders of the U.S. For example, Lyme disease affects 69 cases per 100,000 people in southern Sweden and 206 cases per 100,000 people in Slovenia, according to Medscape. With the prevalence of Lyme disease extending to other parts of the world, including Canada, Europe, and Asia, it’s become a global concern.
Lyme Disease Informational Resources
The following resources can help individuals learn about the fundamentals of the condition, including what causes Lyme disease:
- MedlinePlus, Lyme Disease: Risk factors, symptoms, and treatment of Lyme disease.
- National Institute of Allergy and Infectious Diseases, Lyme Disease: Information about Lyme disease, antibiotics, vaccines, clinical trials, coinfection, and more.
- Centers for Disease Control and Prevention, Educational Materials: Brochures, posters to hang in outdoor areas, and fact sheets from the CDC.
- Global Lyme Alliance, Resources: Informative articles, a Lyme disease library, and information on tick repellants and testing labs.
- Global Lyme Alliance, About Lyme: Get to know about the history of Lyme disease; read about ticks; and learn about diagnosis, causes, and more.
- Centers for Disease Control and Prevention, How Many People Get Lyme Disease?: Data on the growing number of Lyme disease cases and answers to common questions.
The Causes and Risk Factors of Lyme Disease
Lyme disease is more common from mid-spring to mid-fall because it’s when people in some of the most affected regions often enjoy outdoor activities. In the U.S., the regions with the highest number of incidents include the Northeast and mid-Atlantic, as well as Midwest states like Minnesota and Wisconsin.
Ticks carrying Lyme disease thrive in wooded or grassy areas, so hikers and campers are among those at most risk, along with those whose jobs involve working outdoors. These include geographers, landscape architects, environmental engineers, wildlife biologists, farmers, and ranchers.
In colder weather, people expose less skin. However, when the weather allows, people are more likely to wear clothing that exposes more skin. While walking in tall grass, ticks can attach themselves to a person’s skin or to a section of clothing first, before traveling to an area where the skin is exposed.
Tick Removal
Not all tick bites lead to infection, but the odds of getting the disease increase the longer the tick remains attached to the skin. Identifying the presence of a tick is a critical step in avoiding Lyme disease, but removing a tick can be tricky. Folk remedies such as using nail polish, petroleum jelly, or a hot match can actually cause the tick to burrow deeper into the skin. These methods are ineffective and can cause more harm than good.
According to the CDC, effective tick removal requires a tool such as fine-tipped tweezers, which allow you to grasp the tick as close to the skin as possible. Here are recommended steps you should take when removing and disposing of a tick:
- With clean tweezers, pull straight upward without twisting. Otherwise remnants of the tick’s mouth, which transmits the infection, can remain.
- Once the tick is removed, use water and soap or rubbing alcohol to clean the area.
- The CDC recommends putting the tick in rubbing alcohol and placing it in a sealed bag.
- Alternatively, it can be flushed down the toilet.
What Are the Symptoms of Lyme Disease?
The symptoms of Lyme disease vary and often resemble the symptoms of other conditions, such as rheumatoid arthritis (RA), chronic fatigue syndrome, fibromyalgia, multiple sclerosis, and depression, according to WebMD. For example, a common symptom for RA and Lyme disease is joint stiffness. A doctor or a nurse practitioner can determine whether a patient has RA or Lyme disease with a blood test to look for antibodies.
It’s important to recognize the symptoms of Lyme disease as early as possible, as it can pose a serious health threat. Early symptoms include rash, body aches, or swollen lymph nodes. Common symptoms of untreated Lyme disease in later stages include the following:
- Rash spread
- Joint pain
- Severe headaches
- Facial palsy
- Neck stiffness
- Dizziness
- Shortness of breath
- Numbness in the hands and feet
- Neurological problems
If left untreated, neurological effects can become chronic and long term. Other chronic or long-term effects include chronic joint inflammation (Lyme arthritis); cognitive defects, including impaired memory; and heart palpitations/irregular heartbeat, also known as Lyme carditis.
Treating Lyme Disease
Nurses can use these resources to educate patients about what causes Lyme disease and find information about risk factors and symptoms. Ultimately, though, they should consult the advice of medical and nursing professionals to overcome the challenges of the disease.
These are the steps medical professionals take for patients with Lyme disease:
- Diagnosis strategies to confirm the presence of Lyme disease include looking over joints for tenderness and determining if any swelling could be caused by the condition. The health care provider will likely order blood work if symptoms are present and potentially send the patient to see a specialist to rule out any other possible condition.
- A diagnosis of Lyme disease will mean that the patient will be prescribed oral antibiotics. If a patient is ill in a hospital or clinic, the use of intravenous antibiotics is likely. Treatment for the erythema migrans rash, the most common symptom of Lyme disease, includes medicines such as doxycycline, amoxicillin, and cefuroxime. Dosages vary between adults and children.
Standard therapies for Lyme disease involve a course of antibiotics over several weeks, most commonly, doxycycline. However, there are instances in which the infection appears resistant to antibiotics. For example, Borrelia burgdorferi is a bacterium in Lyme diseases responsible for stimulating an inflammatory response in patients, and it has been found to be tolerant to certain drugs. But according to Medical News Today, a new treatment shows a compound known as azlocillin could kill the drug-tolerant bacterium.
Another promising development in the treatment of Lyme disease is the development of a new vaccine, which is a preventive treatment that could potentially be available in about two years.
Resources: Lyme Disease Treatments
Before treating Lyme disease, it’s important to get a diagnosis. The following resources provide information about Lyme disease and how to treat it.
- Mayo Clinic, Lyme Disease — Diagnosis: Learn about the enzyme-linked immunosorbent assay (ELISA) test and Western blot test, tools used for diagnosis.
- American Lung Disease Foundation, Lyme Disease: Browse an extensive list of links to issues and insights regarding Lyme disease diagnosis.
- Global Lyme Alliance, Lyme Disease Treatment: Learn how Lyme disease is treated, and get information about identifying signs of recurrence, maintaining a healthy lifestyle, and finding a medical professional.
Preventing Lyme Disease
NPs can teach individuals and communities to protect themselves from Lyme disease by taking a proactive approach to prevention. When enjoying the outdoors, personal protection strategies include wearing shoes, socks, long pants, and shirts with long sleeves. Also, since ticks stand out against light backgrounds because they’re dark, wearing light-colored clothing is recommended.
Other recommendations include the following:
- Understanding ticks’ natural habitat to avoid it when possible
- Applying tick repellent to skin and clothing
- Protecting pets and property from ticks
- Performing daily tick checks when returning from outdoor activities
- Learning how to properly remove a tick
Resources: Lyme Disease Prevention
Individuals can gain additional insight on Lyme disease prevention strategies from the following resources:
- Centers for Disease Control and Prevention, Division of Vector-Borne Diseases (DVBD) — Prevent Lyme Disease: A wide range of tips and strategies to prevent tick bites and reduce the risk of Lyme disease.
- Lyme Disease Association, Cases, Stats, Maps & Graphs: Interactive case maps of Lyme disease prevalence.
- Lyme Disease Association, LDA Materials: Information about tick-borne diseases, including symptoms, testing, and tick removal.
- International Association for Medical Assistance to Travelers, Lyme Disease: Lyme disease information and prevention tips for international travelers.
Nurse Practitioners, Health Literacy, and Lyme Disease
Lyme disease is a potentially serious illness. Nurse practitioners play a pivotal role in helping inform patients about what causes Lyme disease and disseminating important prevention strategies. By communicating the fundamental concepts of health and well-being, nurse practitioners help patients develop health literacy skills, which help to improve health outcomes.