The Infectious Disease Assignment Paper
Lyme disease is the most common vector-borne disease in the United States due to its increasing incidence and prevalence rates (Skar & Simonsen, 2024). The disease is caused by the bacteria Borrelia burgdorferi, named after Dr. Willy Burgdofer, who identified it in 1982 (Mead et al., 2024). The bacteria is spread through a tick bite from the species Ixodes scapularis, and it has an incubation period of one to two weeks (Mead et al., 2024; Skar & Simonsen, 2024). The disease begins with the development of an expanding rash with a central clearing, termed erythema migrans rash, which occurs at the site of tick bite in 70% to 80% of the cases and is often accompanied by fever and fatigue (Skar & Simonsen, 2024)The Infectious Disease Assignment Paper. These symptoms constitute early Lyme disease.
If early Lyme disease is not treated, it leads to disseminated disease with non-specific symptoms such as facial nerve palsy, radiculopathy, or lymphocytic meningitis in neurologic Lyme disease (Skar & Simonsen, 2024). It can cause myopericarditis resembling a heart block in Lyme cardiac disease or mono- or pauciarticular arthritis, affecting the large joints in Lyme arthritis (Skar & Simonsen, 2024). The disease is diagnosed based on clinical and laboratory findings with no specific pathognomic test for Lyme disease except the observation of spirochete bacteria under microscopy (Skar & Simonsen, 2024). The treatment for the disease is based on the patient’s age and stage of the disease. As a bacterial infection, it is typically treated adequately using antibiotics, specifically doxycycline, for ten days in children above eight years (Skar & Simonsen, 2024). In children below 8 years, treatment involves amoxicillin or cefuroxime for 14 days and ceftriaxone in pregnant women (Skar & Simonsen, 2024). The treatment of the disease in its early stages is curative. However, antimicrobial resistance, immunosuppression, and late diagnosis lead to complications such as post-treatment Lyme disease syndrome, which presents with persistent fatigue, pain, arthralgia, or myalgia for more than six months in 5% of the cases (Skar & Simonsen, 2024)The Infectious Disease Assignment Paper. Additionally, a persistent or chronic infection stage could occur with treatment failure.
Annually, the disease affects approximately half a million people. The incidence of the disease is higher among males, accounting for 55% of cases in all age groups (Mead et al., 2024). It is also more common among Caucasians but can affect all races, with the rationale for higher cases reported in Caucasians being as a result of an inability to easily identify the skin lesions caused by the disease in other races (Mead et al., 2024). The disease has a bimodal age distribution, showing peak incidence rates among children and adolescents aged 5 to 15 years and older adults above 50 (Mead et al., 2024)The Infectious Disease Assignment Paper.
The disease was first described in a 1977 publication by Dr. Allen Steere and colleagues following the eruption of two disease foci in the Northeastern and upper Midwestern parts of the United States (Mead et al., 2024). It is common during summer seasons when temperatures are high, thus demonstrating high incidence rates, 50% of the cases between June and early July (Mead et al., 2024). Therefore, the geographical distribution of the cases coincides with areas of higher temperatures.
The disease is common in Virginia, Pennsylvania, and Ohio in the Northeast, as well as Minnesota and Wisconsin in the Midwest, among other ten counties (Bloch et al., 2022). The incidence rate of the disease in these endemic areas is up to 40 cases per 100000 population (Bloch et al., 2022). Annually, Lyme disease accounts for 6.93 cases per 100000 population of hospitalizations, but has a relatively low mortality rate of less than 1% (Bloch et al., 2022)The Infectious Disease Assignment Paper. The disease has increased incidence rates and demonstrated a widening geographical distribution patterns that be explained by various factors under the epidemiological triad.
Determinants of Health
The determinants of health refer to the various that increase an individual’s risk of developing a disease. Typically, the determinants of health are described within a social context, highlighting the conditions in which an individual was born, lives, schools, works, and worships and their effects on the individual’s health (Logan et al., 2024). The social determinants of health specific for Lyme disease include working in wooden areas, having a house with a yard, knowing an individual previously affected by Lyme disease, living in disease endemic areas, origin from marginalized racial groups, and having a low knowledge index regarding the tick bite prevention measures (Logan et al., 2024). These social determinants of health place individuals living in the fifteen identified counties in the Northeastern and Midwestern areas of the United States at the highest risk of disease transmission. These social determinants of health contribute to developing Lyme disease by increasing the risk of exposure to tick bites, which results in Lyme disease. Specifically, working in wooden areas or living in a house with a yard coupled with little knowledge of the prevention of the disease results in a high risk of developing Lyme disease. Therefore, there is a need to adequately address population knowledge on disease prevention measures to ensure protection from tick bites and Lyme and other tick-borne diseases.
Epidemiological Triad
The most susceptible hosts for the disease are populations living in endemic areas, especially those with yards or working in wooden areas. The lack of knowledge on disease prevention measures, more so the use of tick repellants, increases the host’s or an individual’s risk of contracting the disease. Secondly, the presence of immunosuppressed hosts, such as patients with malignancy or Human Immunodeficiency Virus/ Acquired Immunodeficiency Syndrome (HIV/AIDS), increases the morbidity and mortality rates from Lyme disease. The agent factors are associated with changes in weather, such as global warming, resulting in higher temperatures that allow for tick proliferation. The summer heat in June and early July coincides with the peak occurrence of the tick’s nymphal life stages, which are the stages that transmit Lyme disease (Mead et al., 2024)The Infectious Disease Assignment Paper. Therefore, the presence of these stages in summer results in higher disease transmission and the occurrence of Lyme disease peaking in June and early July. Lastly, environmental factors contributing to Lyme disease development and progression are summarized above, such as providing adequate breeding grounds and conditions in the summer and wooden areas.
Role of the Nurse Practitioner
Finally, the nurse practitioner, among other healthcare providers, assumes crucial roles in disease identification, management, and prevention. According to the American Association of Nurse Practitioners (AANP), a nurse practitioner must help their clinical setting and patients with infection prevention and control (AANP News, 2024). Specifically, the nurse practitioner should be active in educating her patients about disease prevention as part of primary disease prevention. An example is provided through a health talk by one of the nurse practitioners registered with the entity using practical, real-life examples on national television (AANP News, 2024)The Infectious Disease Assignment Paper. The nurse practitioner must help in disease surveillance and secondary interventions through active screening and reporting patient cases with Lyme disease to relevant authorities. The nurse forms a crucial part of the multi-disciplinary team managing patients with Lyme disease in outpatient settings and those admitted in medico-surgical units as part of tertiary interventions for the disease. Lastly, community health nurse practitioners could help with patient follow-up to ensure treatment adherence, adherence to prevention strategies for the disease, and prevention of chronic disease states. The patient-centered care paradigm of health should guide the nurse practitioner in every intervention stage to ensure that their nursing interventions are tailored to meet individual patient needs and respect patients’ preferences for high-quality care, enhanced patient safety, and outstanding patient clinical outcomes.
References
American Association of Nurse Practitioners (AANP) News (2024, August 9). How to avoid getting “ticked off” with nurse practitioner expert Vanessa Pomarico-Denino. AANP News. https://www.aanp.org/news-feed/how-to-avoid-getting-ticked-off-with-nurse-practitioner-expert-vanessa-pomarico-denino
Bloch, M. E., Zhu, X., Kruse, J. P., Patel, U. E., Grabowski, K. M., Goel, R., Auwaerter, G. P., & Tobian, A. R. A. (2022). Comparing the epidemiology and health burden of Lyme disease and babesiosis hospitalizations in the United States. Open Forum Infectious Diseases, 9(11), ofac597. https://doi.org/10.1093%2Fofid%2Fofac597
Logan, J. J., Sawada, M., Knudby, A., Ramsay, T., Blanford, I. J., Ogden, H. N., & Kulkarni, A. M. (2024). Knowledge, protective behaviors, and perception of Lyme disease in an area of emerging risk: results from a cross-sectional survey of adults in Ottawa, Ontario. BMC Public Health, 24(867). https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-024-18348-6 The Infectious Disease Assignment Paper
Mead, P., Hinckley, A., & Kugeler, K. (2024). Lyme disease surveillance and epidemiology in the United States: A historical perspective. The Journal of Infectious Diseases, 230(Suppl_1), S11-S17. https://doi.org/10.1093/infdis/jiae230
Skar, L. G., & Simonsen, A. K. (2024). Lyme Disease. Treasure Island (FL): StatPealrs Publishing. https://www.ncbi.nlm.nih.gov/books/NBK431066/ The Infectious Disease Assignment Paper