Connecticut natives have much to be proud of - we are the home of the Constitution and the hamburger.  We are also, unfortunately, the birthplace of the country's leading vector-borne illness: Lyme disease.  Since its identification in 1975, the disease has been reported in every US state.  Northeasterners are especially aware of the risks posed to exposed skin when walking in the woods where ticks infected by the bacteria Berrelia burgdorferi live.  And they know that this is the prime time of year for Lyme disease infections.  But with proper anticipatory information about prevention, identification, and treatment of Lyme disease, nurses can safely advise patients to enjoy their usual outdoor activities.

Although Lyme disease is transmitted via tick bites, less than half of those later diagnosed with the illness remember being bitten.  For this reason, proper preventative measures are recommended.  If your patients enjoy hiking in the woods, or walking in areas with tall grass, woodpiles, and dense vegetation, instruct them to wear hats, long-sleeved shirts, and long pants.  It is also a good idea to tuck pant legs into socks so that sneaky ticks can't access the skin at the gap.  Dressing in light colors is also recommended, as the tiny, brown, elongated tick will be tougher to spot on darker clothing.  Outdoorsmen and outdoorswomen should spray skin and clothing with tick repellent containing 20 to 30 percent DEET.  But remember to exercise caution with powerful repellents - do not recommend them for use on children under the age of two or on pregnant women. 

Tick checks should become a routine exercise for everyone who spends time outside.  Also advise patients to inspect pets for ticks since ticks are likely to migrate from animals to humans, spreading Lyme disease along the way.  Encourage individuals to clean their bodies and their clothing in hot water. 

Ticks are unlikely to infect hosts prior to the 24 hour mark; removal before this time is an effective method of preventing infection.  If the pinhead-sized bug is found attached to the skin, it should be removed with tweezers.  Grab the tick as close to the skin as possible and pull straight back to detach the whole tick.  Contrary to popular belief, the use of Vaseline, nail polish, alcohol, and matches is not advised.

The quintessential trademark of the Lyme-carrying tick, is a bulls-eye, or erythema migrans, rash, which develops one to four weeks after the initial bite (although a fifth of those who suffer from Lyme disease will not have a rash).  Flulike symptoms may be another sign of early infection.  Timely identification of Lyme disease is essential.  If left untreated, individuals can go on, in subsequent months and years, to develop joint pain and edema, meningitis, cardiac symptoms, neurological symptoms, and memory, sleep or mood complaints. 

Treatment is usually empiric; Lyme bacteria do not produce antibodies quickly enough during the first stage of infection to allow for accurate immunologic testing.  Two to three weeks of doxycycline (or amoxicillin for pregnant women and children less than 8 years old) is the antibiotic treatment regimen of choice.  Early disseminated disease or late-stage disease requires longer, more intense oral or intravenous antibiotic regimens.  It is important to bear in mind that patients with only anthralgias, headache, fatigue, or palpitations are unlikely to have Lyme disease.  Based on one of these symptoms alone, empiric treatment is not recommended.

Reference:

Brody, J. (2008, July 15). A Threat in a Grassy Knoll: Lyme Disease. The New York Times.

Uphold, C. & Graham, M. (2003).  Clinical Guidelines in Family Practice. 

Gainesville, FL:  Barmarrae Books, Inc.

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