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The Disease

Lyme disease is the most common tickborne disorder in the United States. It is

caused by spirochete Borrelia burgdorferi, which enters the skin and bloodstream

through the saliva and feces of ticks, especially the deer tick. (Butler, 2007).

The disease may initially appear in any of three stages:

 Stage 1: consists of the tick bite at the time of inoculation, followed in 3 to 31

days by the development of erythema migrans at the site of the bite.

 Stage 2: the most serious stage of the disease is characterized by systemic

involvement of neurologic cardiac, and musculoskeletal systems that appears

several weeks after the cutaneous phase is completed.

 Stage 3: or, the late stage, includes musculoskeletal pain that involves the

tendons, bursae, muscles, and synovia. Arthritis may occur, and late

neurologic problems include deafness, and chronic encephalopathy.

Sign and Symptoms

A small, red bump often appears at the site of a tick bite or tick removal and resolves

over a few days. This is normal after a tick bite and does not indicate Lyme disease.

However, these signs and symptoms may occur within a month after you've been

infected: (Moreno, 2011).

  Rash. From 3 to 30 days after an infected tick bite, an expanding red area

might appear that sometimes clears in the center, forming a bull’s-eye

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pattern. The rash (erythema migrans) expands slowly over days and can spread to

12 inches across. It is typically not itchy or painful. Erythema migrans is one of the

hallmarks of Lyme disease. Some people develop this rash at more than one place on

their bodies.

 Flu-like symptoms. Fever, chills, fatigue, body aches and a headache may

accompany the rash. (Moreno, 2011).

Later Signs and Symptoms

If untreated, new signs and symptoms of Lyme infection might appear in the

following weeks to months. These include:

 Erythema migrans appearing in other areas of your body.

 Joint pain. Bouts of severe joint pain and swelling are especially likely to

affect your knees, but the pain can shift from one joint to another.

 Neurological problems. Weeks, months or even years after infection, you

might develop inflammation of the membranes surrounding your brain

(meningitis), temporary paralysis of one side of your face (Bell's palsy),

numbness or weakness in your limbs, and impaired muscle movement.

(Moreno, 2011).
 Treatment

Early and appropriate treatment is essential to prevent complications. Children

older than 8 y/o are treated with oral doxycycline; amoxicillin is recommended for

children younger than 8 y/o. (CDC, 2009).

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For patients who are allergic to penicillin, alternative drugs include cefuroxime or

erythromycin. Most experts treat individuals with early Lyme disease for 14 to 21

days. Persons who have removed ticks should monitor for signs and symptoms of

tickborne disease for 30 days. Treatment of erythema migrans most often prevents

development of later stages of Lyme disease. (Butler, 2007).

Nursing Care

The major thrust of nursing care should be educating parents ti protect their

children from exposure to ticks. Children should avoid tick-infested areas or wear

light-colored clothing so that ticks can be spotted easily. Parents and children should

need to perform regular tick checks when they are in infested areas. Parents should

be on alert for signs of skin lesions. Insect repellants containing DEET and

permethrin can protect against ticks, but should be used with caution. (Butler,

2007).

Education

It's important to consult your doctor even if signs and symptoms disappear, the

absence of symptoms doesn't mean the disease is gone. Left untreated, Lyme disease

can spread to other parts of your body from several months to years after infection,
causing arthritis and nervous system problems. Ticks also can transmit other

illnesses, such as babesiosis and Colorado tick fever. (Network, 2010).

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References

Butler C: Pediatric skin care: guidelines for assessment, prevention, and treatment,
Dermatological Nurse 19(5): 471-485, 2007.

Moreno, MA: Lyme disease in children and adolescents, Arch Pediatric Adolescents
Medicine 165(1): 96, 2011.

Network to Reduce Lyme Disease in School-Aged Children: You can make a

difference to a child by reducing risk of Lyme Disease, NASN School Nurse25: 110-
113, 2010.