The case addresses a 27-year-old white woman presented at her local physician’s walking clinic on August 15. She complained about a severe headache and backache, inability to concentrate, tender joints, fatigue, and a stiff neck. On physical exam, the patient’s fever was 38.5C, and the physician additionally noted an irregular heartbeat and a circular “rash” with a diameter of approximately 5 inches, bright red leading edge, and a dim centre in a “bull’s eye’s” form. According to the patient, she has spent three weeks in the field in Wisconsin during May and June tracking small mammals as a graduate student within a framework of the university’s wildlife program. As spring was wet and warm, a woman mentioned a large number of mosquitoes, ticks, and biting flies in the area. Initially, she felt well; however, after two weeks since her return, the first symptoms appeared. As many of them had progressed, the patients could not tolerate her worsening condition anymore.
On the basis of the patient’s complaints, history, and physical examination, it is possible to conclude that the most appropriate diagnosis is Lyme disease. It is a multistage and multisystem bacterial infection that may be caused by several species of tick-borne spirochetes, “flexible, spiral-shaped bacteria that have a unique, internal flagellar arrangement,” in the family of Borreliaceae (Willey et al., 2020, p. 41). First of all, the reservoirs of this infection in nature are birds and small mammals, and a human may acquire it from an infected tick’s bite. Thus, spending several weeks in the territory with small mammals and a large number of ticks increases the risk of the contraction of Lyme disease. In addition, according to the Wisconsin Department of Health Services (2020), “Lyme disease is the most commonly reported illness spread by ticks in Wisconsin” (para. 2). It is traditionally spread by infected immature ticks, called nymphs, presented in the state’s all counties. As nymphs are smaller in comparison with adult ticks, and their bites are painless, it is more difficult to see them and remove them promptly in order to prevent infection.
Subsequently, the patient’s symptoms almost fully correspond to the most common symptoms of Lyme disease that affects multiple organs and tissues, including joints, heart, skin, and nervous system. An early-stage infection that typically occurs several weeks after a bite is characterized by a specific skin rash called primary erythema migrans (Bergström & Normark, 2018). A high concentration of spirochetes in the blood causes fever and related fatigue, and, untreated, and the disease may lead to more serious skin disorders, neurological problems, a stiff neck associated with meningitis, myocarditis, permanent arthritis, and damaged joints (Bergström & Normark, 2018). In general, Lyme disease has multiple unique virulence factors, including outer surface molecules that aid in “attachment, transmission and immunological escape of the pathogen” and provide interaction with the mammalian host (Bergström & Normark, 2018, p. 486). Moreover, spirochete’s outer membrane proteins contribute to its survival in a host, virulence, and transmission (Willey et al., 2020).
The diagnostics of Lyme disease implies a two-step approach and aims to detect antibodies to spirochetes, which production is stimulated by bacteria’s proteins. Initially, the enzyme-linked immunosorbent assay (ELISA) test should be made, and if its results are positive, the Western blot test is essential in order to confirm infection. In laboratory settings, the Gram stain that implies bacteria’s division into gram-positive and gram-negative is the most efficient and frequently used technique for spirochetes’ direct detection (Willey et al., 2020). The treatment of Lyme disease traditionally includes antibiotics that guarantee a quick recovery in the majority of cases. Oral antibiotics, such as doxycycline, cefuroxime, and amoxicillin, may be regarded as a standard treatment, especially at early stages. However, if the infection has already affected a patient’s nervous system, intravenous antibiotics are required.
References
Bergström, S., & Normark, J. (2018). Microbiological features distinguishing Lyme disease and relapsing fever spirochetes.Wiener klinische Wochenschrift, 130, 484–490. Web.
Willey, J. M., Sandman, K. M., & Wood, D. (2020). Prescott’s microbiology (11th ed.). McGraw-Hill Education.
Wisconsin Department of Health Services. (2020). About Lyme Disease. Web.