What Nurses Need to Know About Lyme Disease

• The CDC reports 300,000 reports of Lyme disease in the United States each year.
• Symptoms of Lyme disease at different stages and how nurses can identify symptoms for early intervention.
• Challenges in the development of a vaccine for Lyme Disease from 1998 through 2017.

Lyme disease is a bacterial infection spread by ticks. In recent years, there has been a resurgence. According to the Centers for Disease Control and Prevention (CDC), approximately 300,000 cases of Lyme disease are diagnosed in the United States each year.

This is a significant increase from the 1990s, and the actual number of cases may be higher, as many cases go undiagnosed or unreported.

Several factors have contributed to Lyme’s resurgence. A primary cause is the expanding tick population. Ticks populate wooded areas, tall grass, and brush.

Climate change is another contributing variable to the spread of Lyme disease. Warmer temperatures and milder winters have led to longer tick seasons, allowing the insects to feed and breed. And, of course, Lyme disease lacks a safe and effective vaccine.

Symptoms and Stages of Lyme Disease

Borrelia burgdorferi is the primary bacterium causing Lyme disease. Less common is the organism Borrelia mayonii. Transmission to humans occurs through the bite of infected black-legged ticks (Ixodes scapularis) or the Western black-legged ticks (Ixodes pacificus).

When the bacterium enters the human body, it can cause a wide range of symptoms affecting various physiological systems in three stages: early localized, early disseminated, and late disseminated Lyme disease.

Early localized Lyme disease

The first stage occurs within days to weeks after a tick bite as the bacterium multiplies and spreads from the site of the bite. Common characteristics at this stage are erythema migrans, a circular red rash that often resembles a bull’s eye. The rash may expand over several days and can reach up to twelve inches in diameter. Flu-like symptoms, such as fever, fatigue, headache, muscle and joint aches, and swollen lymph nodes, can develop.

Early disseminated Lyme disease

The second stage occurs weeks to months after the tick bite if the infection remains untreated. The bacteria affect multiple body systems as it spreads through the bloodstream.

Symptoms at this stage may include the following:

• Erythema migrans may surface in other areas of the body
• Severe headaches and neck stiffness due to inflammation of the membranes surrounding the brain and spinal cord (meningitis)
• Facial palsy (loss of muscle tone or drooping on one or both sides of the face)
• Pain and swelling in the large joints, such as the knees
• Heart palpitations, chest pain, and inflammation of the heart tissue
• Episodes of dizziness or shortness of breath

Late Disseminated Lyme disease

The third stage can occur months to years after the tick bite. An untreated infection can cause long-term complications such as the following:

• Chronic joint inflammation, leading to arthritis with severe joint pain and swelling, often in the knees
• Neurological problems, such as impaired muscle movement, numbness or weakness in the limbs, and impaired speech
• Cognitive issues, including memory problems and lack of concentration

Challenges in Developing a Vaccine

As mentioned earlier, Lyme disease lacks an effective vaccine. In 1998, the FDA approved LYMErix for the United States as a potential vaccine.

In 2002, because of concerns over human safety (a potential trigger between the vaccine and autoimmune disorders after patients developed arthritis-like symptoms), the vaccine was withdrawn from the market. The lack of an effective vaccine against Lyme disease is concerning given the long-term serious health consequences of the disease.

A small percentage of patients will develop chronic symptoms that can last for months or even years. Borrelia burgdorferi is a highly adaptive organism, capable of evading the immune system and changing its surface proteins to avoid detection. Scientists have made considerable progress in understanding the biology of the Borrelia bacterium and the way it interacts with the human immune physiology has led to new potential targets for vaccines and therapies.

There is significant scrutiny on the safety of any new vaccine for Lyme disease. Despite these challenges, the need for a vaccine for Lyme disease remains urgent as the tick population expands.

In recent years, renewed efforts to develop a safe vaccine have surfaced. In 2017, a vaccine called VLA15 entered phase II clinical trials. Pfizer and Valneva, a company based in France, developed the vaccine which targets six distinct types of the complex Borrelia bacterium.

Borrelia burgdorferi is a highly adaptive organism, capable of evading the immune system and changing its surface proteins to avoid detection. The vaccine is based on a protein found in the outer surface of the Borrelia bacterium and has shown promising results in early-stage clinical trials, and phase III clinical trials are ongoing.

By design, the multivalent nature of the vaccine protects against multiple strains of Borrelia, increasing its potential effectiveness.

Another challenge in developing a vaccine is the lack of funding and research resources. Lyme disease is not like high-profile diseases, such as cancer or heart disease, which receive significant research funding. As a result, there has been little investment in developing a Lyme disease vaccine.

The Bottom Line

As one can see, the best prevention method for Lyme disease is avoiding tick bites. Antibiotics (doxycycline or amoxicillin) can treat most early cases of Lyme. Individuals can wear long sleeves and pants when in wooded or grassy areas, use insect repellent, and check for ticks after spending time outdoors. Since it is difficult to detect small ticks on the human body, continued vigilance is required.

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