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Copyright (c) 2024 Maged Ahmed Ali Abu Alghith, Ali Saleh m Saied, Aboud Jound Ageel Abuieisha, Bandar Mohsen Ahmed Alamri, Majed Mohammed Ali Dabbah, Saud DaifallAh Darraj, ABDU ALI YAHYA OQAYBI, TARIQ AHMED ALHARTHI, RAWIYAH MOHAMMED BUAYTI, SADAA MUTNI FRAIH ALSHAMMARI, SULAIMAN MOHAMMED ALI ALZAHRANI, DHAIFALLAH AHMED ALZAHRANI, ABDULLAH SAEED ABDULLAH ALQAHTANI
This work is licensed under a Creative Commons Attribution 4.0 International License.
Interdisciplinary Clinical Management of Lyme Disease: Implications for Nursing Practice, Pharmacotherapy, Diagnostic Laboratory Services, Radiological Assessment, and Public Health Surveillance
Corresponding Author(s) : Maged Ahmed Ali Abu Alghith
Saudi Journal of Medicine and Public Health,
Vol. 1 No. 2 (2024)
Abstract
Background: Lyme disease is the most common tick borne illness in the United States and a major global public health concern, progressing through early localized, early disseminated, and late stages, each with distinct clinical features. Its epidemiology is closely linked to Ixodes tick ecology, with high incidence in Northeastern and Midwestern U.S. regions.
Aim: This study aims to provide a comprehensive interdisciplinary review of Lyme disease, summarizing its etiology, epidemiology, clinical manifestations, diagnostic evaluation, and management to guide healthcare professionals in effective diagnosis and treatment.
Methods: A structured review of clinical, epidemiologic, diagnostic, and therapeutic evidence was conducted, synthesizing details on pathophysiology, histopathology, serologic testing, complications, and management approaches described in the source material.
Results: Lyme disease presents with dermatologic, neurologic, musculoskeletal, and cardiac manifestations across stages, with erythema migrans affecting ~70% of patients. Two tier serologic testing remains the diagnostic standard for non EM presentations. Stage specific antibiotic therapy is effective in most cases, though 10–20% of patients may develop post treatment Lyme disease syndrome (PTLDS).
Conclusion: Early recognition and timely treatment significantly reduce progression and complications, while interdisciplinary coordination enhances patient outcomes across diverse clinical presentations.
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- Cervantes J. [Lyme disease in Perú. A clinical and epidemiological review]. Rev Peru Med Exp Salud Publica. 2018 Apr-Jun;35(2):292-296.
- Bransfield RC. Neuropsychiatric Lyme Borreliosis: An Overview with a Focus on a Specialty Psychiatrist's Clinical Practice. Healthcare (Basel). 2018 Aug 25;6(3)
- Bernard Q, Thakur M, Smith AA, Kitsou C, Yang X, Pal U. Borrelia burgdorferi protein interactions critical for microbial persistence in mammals. Cell Microbiol. 2019 Feb;21(2):e12885.
- Muhammad S, Simonelli RJ. Lyme Carditis: A Case Report and Review of Management. Hosp Pharm. 2018 Jul;53(4):263-265.
- Berry K, Bayham J, Meyer SR, Fenichel EP. The allocation of time and risk of Lyme: A case of ecosystem service income and substitution effects. Environ Resour Econ (Dordr). 2018 Jul;70(3):631-650.
- Shapiro ED, Wormser GP. Lyme Disease in 2018: What Is New (and What Is Not). JAMA. 2018 Aug 21;320(7):635-636.
- Hatchette TF, Davis I, Johnston BL. Lyme disease: clinical diagnosis and treatment. Can Commun Dis Rep. 2014 May 29;40(11):194-208.
- Talbot NC, Spillers NJ, Luther P, Flanagan C, Soileau LG, Ahmadzadeh S, Viswanath O, Varrassi G, Shekoohi S, Cornett EM, Kaye AM, Kaye AD. Lyme Disease and Post-treatment Lyme Disease Syndrome: Current and Developing Treatment Options. Cureus. 2023 Aug;15(8):e43112. [
- Bobe JR, Jutras BL, Horn EJ, Embers ME, Bailey A, Moritz RL, Zhang Y, Soloski MJ, Ostfeld RS, Marconi RT, Aucott J, Ma'ayan A, Keesing F, Lewis K, Ben Mamoun C, Rebman AW, McClune ME, Breitschwerdt EB, Reddy PJ, Maggi R, Yang F, Nemser B, Ozcan A, Garner O, Di Carlo D, Ballard Z, Joung HA, Garcia-Romeu A, Griffiths RR, Baumgarth N, Fallon BA. Recent Progress in Lyme Disease and Remaining Challenges. Front Med (Lausanne). 2021;8:666554.
- Brandt FC, Ertas B, Falk TM, Metze D, Böer-Auer A. Histopathology and immunophenotype of acrodermatitis chronica atrophicans correlated with ospA and ospC genotypes of Borrelia species. J Cutan Pathol. 2015 Oct;42(10):674-92.
- Donval L, Thibault L, Langer A, Oufkir N, Rouzier R, Bonneau C. Borrelial lymphocytoma of the breast: A rare differential diagnosis of breast cancer. J Gynecol Obstet Hum Reprod. 2023 Jan;52(1):102502.
- Norris SJ. Catching up with Lyme Disease Antigenic Variation Computationally. Trends Microbiol. 2018 Aug;26(8):644-645.
- Centers for Disease Control and Prevention (CDC). Recommendations for test performance and interpretation from the Second National Conference on Serologic Diagnosis of Lyme Disease. MMWR Morb Mortal Wkly Rep. 1995 Aug 11;44(31):590-1.
- Yeung C, Baranchuk A. Systematic Approach to the Diagnosis and Treatment of Lyme Carditis and High-Degree Atrioventricular Block. Healthcare (Basel). 2018 Sep 22;6(4)
- Paparone P, Paparone PW. Variable clinical presentations of babesiosis. Nurse Pract. 2018 Oct;43(10):48-54.
- Trayes KP, Savage K, Studdiford JS. Annular Lesions: Diagnosis and Treatment. Am Fam Physician. 2018 Sep 01;98(5):283-291.
- Lantos PM, Rumbaugh J, Bockenstedt LK, Falck-Ytter YT, Aguero-Rosenfeld ME, Auwaerter PG, Baldwin K, Bannuru RR, Belani KK, Bowie WR, Branda JA, Clifford DB, DiMario FJ, Halperin JJ, Krause PJ, Lavergne V, Liang MH, Meissner HC, Nigrovic LE, Nocton JJJ, Osani MC, Pruitt AA, Rips J, Rosenfeld LE, Savoy ML, Sood SK, Steere AC, Strle F, Sundel R, Tsao J, Vaysbrot EE, Wormser GP, Zemel LS. Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR): 2020 Guidelines for the Prevention, Diagnosis and Treatment of Lyme Disease. Clin Infect Dis. 2021 Jan 23;72(1):1-8.
- DeLong A, Hsu M, Kotsoris H. Estimation of cumulative number of post-treatment Lyme disease cases in the US, 2016 and 2020. BMC Public Health. 2019 Apr 24;19(1):352.
- Antony S. Mosquito and Tick-borne Illnesses in the United States. Guidelines for the Recognition and Empiric Treatment of Zoonotic Diseases in the Wilderness. Infect Disord Drug Targets. 2019;19(3):238-257.
- Centre for Food-borne, Environmental and Zoonotic Infectious Diseases. Synopsis: Lyme Disease in Canada - A Federal Framework. Can Commun Dis Rep. 2017 Oct 05;43(10):212-214.
- Patton SK, Phillips B. CE: Lyme Disease: Diagnosis, Treatment, and Prevention. Am J Nurs. 2018 Apr;118(4):38-45.
References
Cervantes J. [Lyme disease in Perú. A clinical and epidemiological review]. Rev Peru Med Exp Salud Publica. 2018 Apr-Jun;35(2):292-296.
Bransfield RC. Neuropsychiatric Lyme Borreliosis: An Overview with a Focus on a Specialty Psychiatrist's Clinical Practice. Healthcare (Basel). 2018 Aug 25;6(3)
Bernard Q, Thakur M, Smith AA, Kitsou C, Yang X, Pal U. Borrelia burgdorferi protein interactions critical for microbial persistence in mammals. Cell Microbiol. 2019 Feb;21(2):e12885.
Muhammad S, Simonelli RJ. Lyme Carditis: A Case Report and Review of Management. Hosp Pharm. 2018 Jul;53(4):263-265.
Berry K, Bayham J, Meyer SR, Fenichel EP. The allocation of time and risk of Lyme: A case of ecosystem service income and substitution effects. Environ Resour Econ (Dordr). 2018 Jul;70(3):631-650.
Shapiro ED, Wormser GP. Lyme Disease in 2018: What Is New (and What Is Not). JAMA. 2018 Aug 21;320(7):635-636.
Hatchette TF, Davis I, Johnston BL. Lyme disease: clinical diagnosis and treatment. Can Commun Dis Rep. 2014 May 29;40(11):194-208.
Talbot NC, Spillers NJ, Luther P, Flanagan C, Soileau LG, Ahmadzadeh S, Viswanath O, Varrassi G, Shekoohi S, Cornett EM, Kaye AM, Kaye AD. Lyme Disease and Post-treatment Lyme Disease Syndrome: Current and Developing Treatment Options. Cureus. 2023 Aug;15(8):e43112. [
Bobe JR, Jutras BL, Horn EJ, Embers ME, Bailey A, Moritz RL, Zhang Y, Soloski MJ, Ostfeld RS, Marconi RT, Aucott J, Ma'ayan A, Keesing F, Lewis K, Ben Mamoun C, Rebman AW, McClune ME, Breitschwerdt EB, Reddy PJ, Maggi R, Yang F, Nemser B, Ozcan A, Garner O, Di Carlo D, Ballard Z, Joung HA, Garcia-Romeu A, Griffiths RR, Baumgarth N, Fallon BA. Recent Progress in Lyme Disease and Remaining Challenges. Front Med (Lausanne). 2021;8:666554.
Brandt FC, Ertas B, Falk TM, Metze D, Böer-Auer A. Histopathology and immunophenotype of acrodermatitis chronica atrophicans correlated with ospA and ospC genotypes of Borrelia species. J Cutan Pathol. 2015 Oct;42(10):674-92.
Donval L, Thibault L, Langer A, Oufkir N, Rouzier R, Bonneau C. Borrelial lymphocytoma of the breast: A rare differential diagnosis of breast cancer. J Gynecol Obstet Hum Reprod. 2023 Jan;52(1):102502.
Norris SJ. Catching up with Lyme Disease Antigenic Variation Computationally. Trends Microbiol. 2018 Aug;26(8):644-645.
Centers for Disease Control and Prevention (CDC). Recommendations for test performance and interpretation from the Second National Conference on Serologic Diagnosis of Lyme Disease. MMWR Morb Mortal Wkly Rep. 1995 Aug 11;44(31):590-1.
Yeung C, Baranchuk A. Systematic Approach to the Diagnosis and Treatment of Lyme Carditis and High-Degree Atrioventricular Block. Healthcare (Basel). 2018 Sep 22;6(4)
Paparone P, Paparone PW. Variable clinical presentations of babesiosis. Nurse Pract. 2018 Oct;43(10):48-54.
Trayes KP, Savage K, Studdiford JS. Annular Lesions: Diagnosis and Treatment. Am Fam Physician. 2018 Sep 01;98(5):283-291.
Lantos PM, Rumbaugh J, Bockenstedt LK, Falck-Ytter YT, Aguero-Rosenfeld ME, Auwaerter PG, Baldwin K, Bannuru RR, Belani KK, Bowie WR, Branda JA, Clifford DB, DiMario FJ, Halperin JJ, Krause PJ, Lavergne V, Liang MH, Meissner HC, Nigrovic LE, Nocton JJJ, Osani MC, Pruitt AA, Rips J, Rosenfeld LE, Savoy ML, Sood SK, Steere AC, Strle F, Sundel R, Tsao J, Vaysbrot EE, Wormser GP, Zemel LS. Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR): 2020 Guidelines for the Prevention, Diagnosis and Treatment of Lyme Disease. Clin Infect Dis. 2021 Jan 23;72(1):1-8.
DeLong A, Hsu M, Kotsoris H. Estimation of cumulative number of post-treatment Lyme disease cases in the US, 2016 and 2020. BMC Public Health. 2019 Apr 24;19(1):352.
Antony S. Mosquito and Tick-borne Illnesses in the United States. Guidelines for the Recognition and Empiric Treatment of Zoonotic Diseases in the Wilderness. Infect Disord Drug Targets. 2019;19(3):238-257.
Centre for Food-borne, Environmental and Zoonotic Infectious Diseases. Synopsis: Lyme Disease in Canada - A Federal Framework. Can Commun Dis Rep. 2017 Oct 05;43(10):212-214.
Patton SK, Phillips B. CE: Lyme Disease: Diagnosis, Treatment, and Prevention. Am J Nurs. 2018 Apr;118(4):38-45.