NCLEX Review Guide: Lyme Disease

Disease Overview

• Lyme disease is caused by the spirochete Borrelia burgdorferi, transmitted through infected deer tick (Ixodes) bites that remain attached for 36-48 hours.
• The disease progresses through three distinct stages: early localized, early disseminated, and late disseminated, each with characteristic manifestations.
• Peak transmission occurs during spring and summer months when ticks are most active and people spend more time outdoors.

Stage 1: Early Localized (3-30 days)

• Erythema migrans (bull's-eye rash) appears in 70-80% of patients, typically expanding outward from the tick bite site with central clearing.
• Flu-like symptoms including fever, chills, headache, fatigue, and muscle aches accompany the characteristic rash.

Stage 2: Early Disseminated (days to weeks)

• Cardiac complications include AV blocks and myocarditis, requiring immediate cardiac monitoring and intervention.
• Neurological manifestations such as Bell's palsy, meningitis, and peripheral neuropathy indicate systemic spread.
• Multiple erythema migrans lesions may appear at sites distant from the original tick bite.

Stage 3: Late Disseminated (months to years)

• Lyme arthritis typically affects large joints, especially the knees, with intermittent swelling and pain.
• Chronic neurological symptoms include memory problems, concentration difficulties, and peripheral neuropathy.

Laboratory Studies

• Two-tier testing approach uses ELISA screening followed by Western blot confirmation for positive or equivocal results.
• Early disease may have negative serology due to insufficient time for antibody development, making clinical diagnosis crucial.
• PCR testing of synovial fluid is highly specific for Lyme arthritis diagnosis in late-stage disease.

Antibiotic Therapy

1. Early disease: Doxycycline 100mg BID for 10-21 days is first-line treatment for adults and children ≥8 years.
2. Alternative antibiotics include amoxicillin or cefuroxime for pregnant women and children <8 years.
3. Disseminated disease may require IV antibiotics (ceftriaxone) for 14-28 days, especially with cardiac or neurologic involvement.
4. Late-stage Lyme arthritis typically responds to oral doxycycline for 28 days.

Patient Education

• Teach proper tick removal using fine-tipped tweezers, grasping close to the skin and pulling straight up without twisting.
• Emphasize the importance of completing the full antibiotic course even if symptoms improve to prevent treatment failure.
• Educate about tick prevention strategies including protective clothing, DEET repellent, and daily tick checks after outdoor activities.

Monitoring & Follow-up

• Monitor for signs of treatment failure or disease progression, particularly cardiac conduction abnormalities in disseminated disease.
• Post-treatment Lyme disease syndrome may cause persistent fatigue and joint pain but doesn't require additional antibiotics.