Lyme Disease Case Study

Diagnosing Lyme disease

A 38-year-old male had a 3-week history of fatigue and lethargy with intermittent complaints of headache, fever, chills, myalgia, and arthralgia. According to the history, the patient’s symptoms began shortly after a camping vacation. He recalled a bug bite and rash on his thigh immediately after the trip. The following studies were ordered:

Studies Results Lyme disease test, Elevated IgM antibody titers against Borrelia burgdorferi (normal: low) Erythrocyte sedimentation rate (ESR), 30 mm/hour (normal: ≤15 mm/hour) Aspartate aminotransferase (AST), 32 units/L (normal: 8-20 units/L) Hemoglobin (Hgb), 12 g/dL (normal: 14-18 g/dL) Hematocrit (Hct), 36% (normal: 42%-52%) Rheumatoid factor (RF), Negative (normal: negative) Antinuclear antibodies (ANA), Negative (normal: negative)

Diagnostic Analysis Based on the patient’s history of camping in the woods and an insect bite and rash on the thigh, Lyme disease was suspected. Early in the course of this disease, testing for specific immunoglobulin (Ig) M antibodies against B. burgdorferi is the most helpful in diagnosing Lyme disease. An elevated ESR, increased AST levels, and mild anemia are frequently seen early in this disease. RF and ANA abnormalities are usually absent.

Critical Thinking Questions 1. What is the cardinal sign of Lyme disease? (always on the boards)

2. At what stages of Lyme disease are the IgG and IgM antibodies elevated?

3. Why was the ESR elevated?

4. What is the Therapeutic goal for Lyme Disease and what is the recommended treatment.



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Lyme Disease Case Study

Diagnosing Lyme Disease

“Imagine experiencing flu-like symptoms such as fever, fatigue, and muscle aches, only to be told months later that what you have is a debilitating disease transmitted by ticks – this is the reality for many individuals diagnosed with Lyme disease, including the subject of this case study.” Lyme disease is a tick-borne illness caused by the bacterium Borrelia burgdorferi (Lucy et al. 40). A case study of Lyme disease involves a patient who may have been exposed to infected ticks during outdoor activities. Lyme disease symptoms include a characteristic rash, fever, fatigue, headache, and muscle and joint pain. If left untreated, the infection can spread to other parts of the body, leading to more severe symptoms such as meningitis and heart palpitations. Diagnosis is often based on clinical symptoms and laboratory testing (John et al. 221). Treatment typically involves antibiotics, with earlier treatment leading to a better outcome. In addition to medical management, prevention measures such as avoiding tick-infested areas and using protective clothing and tick repellent can help reduce the risk of contracting Lyme disease.

Lyme disease is a bacterial infection caused by the bacterium Borrelia burgdorferi. It is transmitted to humans through the bite of infected black-legged ticks, also known as deer ticks. Lyme disease is most commonly found in the northeastern and upper Midwestern regions of the United States, as well as in some parts of Europe and Asia (Albina 1). Lyme disease symptoms include fever, headache, fatigue, and a characteristic “bulls-eye” rash. Lyme disease can lead to more severe complications such as joint pain, heart problems, and even neurological damage if left untreated. Early diagnosis and treatment with antibiotics can usually lead to a full recovery. This essay will explore the cardinal sign of Lyme disease, the stages of Lyme disease where the IgG and IgM antibodies are elevated, the elevation of the ESR, and finally, look at the therapeutic goal for Lyme disease and the recommended treatment.

The Cardinal Signs of Lyme Disease

Recognizing the cardinal signs of Lyme Disease, such as the characteristic erythema migrans rash and flu-like symptoms, is crucial for prompt diagnosis and treatment of the disease. The disease often presents various symptoms, including a characteristic rash, flu-like symptoms, and neurological problems. These symptoms may not appear immediately after a tick bite but may take several weeks or months to develop. The hallmark sign of Lyme disease is a rash that appears at the tick bite site (Donita 14). Known as erythema migrans, this rash is usually round or oval and expands over time. It typically appears within 3-30 days of the tick bite and may be accompanied by fever, headache, and muscle and joint pain. The rash can vary from a few inches to over a foot in diameter, and it usually has a clear center with a reddish border. In addition to the rash, flu-like symptoms are common in Lyme disease. These symptoms may include fever, chills, headache, fatigue, muscle and joint pain, and swollen lymph nodes (Jennifer 14). These symptoms can occur at any time during the disease and persist for weeks or months. Finally, Lyme disease can also cause neurological symptoms. These symptoms may include meningitis, which can cause severe headaches, neck stiffness, and sensitivity to light, or facial nerve palsy, which can cause drooping of one side of the face (Figoni et al. 321). Other neurological symptoms may include numbness, tingling, weakness in the limbs, memory problems, or difficulty concentrating. The cardinal signs of Lyme disease include erythema, migrans rash, flu-like symptoms, and neurological problems. If you suspect that you may have been bitten by an infected tick and are experiencing any of these symptoms, it is essential to seek medical attention promptly for diagnosis and treatment.

Stages of Lyme Disease where the IgG and IgM Antibodies Are Elevated

One crucial aspect of the Stages of Lyme Disease is the elevation of IgG and IgM antibodies, which plays a vital role in diagnosing and treating the disease. The disease can cause various symptoms, including fever, headache, fatigue, and a characteristic skin rash. Blood tests commonly diagnose Lyme disease by detecting antibodies to the bacterium. Two types of antibodies can be detected in blood tests for Lyme disease: IgG and IgM (Ram et al. 120). IgM antibodies are the first to appear after infection and indicate an early or active infection, while IgG antibodies usually appear later and indicate a past or resolved infection. In the early stages of Lyme disease, both IgG and IgM antibodies may be present, but they tend to be more elevated (Song et al. 3). They are produced first as the immune system responds to the initial infection. As the infection progresses, IgG antibodies increase and can remain elevated even after the infection has been successfully treated. In the later stages of Lyme disease, IgM antibodies may no longer be detectable, while IgG antibodies remain elevated (Jack et al. 3). However, it is important to note that antibody levels can vary widely between individuals. Some people may not produce detectable levels of antibodies even when they have an active infection. Overall, the presence and level of IgG and IgM antibodies in the blood can provide important information about the stage and progression of Lyme disease. However, a diagnosis should be made based on clinical symptoms, laboratory tests, and medical history.

The Elevation of the Erythrocyte Sedimentation Rate (ESR)

The erythrocyte sedimentation rate (ESR) is a laboratory test measuring the rate at which red blood cells settle in a test tube over time. It is a nonspecific indicator of inflammation and is often elevated in various inflammatory and infectious conditions, including Lyme disease. In Lyme disease, the immune system produces antibodies against Borrelia burgdorferi, the bacteria that causes the disease (Cassidy and Catherine 3). These antibodies can trigger an inflammatory response, releasing cytokines and other mediators of inflammation. These mediators, in turn, can increase the production of acute-phase reactants, such as C-reactive protein (CRP) and fibrinogen, which are known to elevate the ESR (Teddy et al. 63). In addition, the presence of the bacteria itself can also stimulate the inflammatory response, leading to an elevated ESR. The ESR tends to rise early in the course of the disease before other laboratory markers, such as CRP, become elevated. Therefore, in this patient, the elevated ESR is likely a result of the inflammatory response triggered by the Borrelia burgdorferi infection. The ESR, combined with other clinical and laboratory findings, can help support the Lyme disease diagnosis.

The Therapeutic Goal for Lyme Disease and the Recommended Treatment

Lyme disease is an infectious disease caused by the bacterium Borrelia burgdorferi, which is transmitted to humans through the bite of infected black-legged ticks. The disease is characterized by a range of symptoms that affect different organs and systems of the body, including the skin, nervous system, joints, and heart. The therapeutic goal for Lyme disease is to eliminate the bacterium from the body and alleviate the symptoms (Ally and Lloyd 11). The recommended treatment for Lyme disease depends on the stage of the disease and the severity of the symptoms. In the early stage of the disease, when the infection is localized and has not spread to other organs, oral antibiotics are typically prescribed for 2-4 weeks (Marie 3). The most common antibiotics used for this stage of the disease include doxycycline, amoxicillin, and cefuroxime. These antibiotics effectively kill the bacterium and reduce the disease’s symptoms.

In the later stages of the disease, intravenous antibiotics may be necessary when the infection has spread to other organs and the symptoms are more severe. Intravenous antibiotics are given through a vein and are usually administered for 2-4 weeks (Gerold and Franc 249). The most common intravenous antibiotics used for Lyme disease include ceftriaxone and penicillin G. These antibiotics are more potent than oral antibiotics and are better able to reach the bacteria in the bloodstream and tissues. In addition to antibiotics, supportive therapy may be recommended to help alleviate symptoms and promote healing. Supportive therapy may include pain relievers, anti-inflammatory drugs, and physical therapy. In some cases, alternative therapies such as acupuncture, herbal medicine, and nutritional supplements may complement conventional treatment (Abigail 450). Overall, the therapeutic goal for Lyme disease is to eliminate the bacterium from the body and alleviate the symptoms. Treatment typically involves a course of antibiotics and supportive therapy, and the specific treatment regimen will depend on the stage of the disease and the severity of the symptoms. With prompt diagnosis and appropriate treatment, most people with Lyme disease can fully recover and return to normal activities.


In conclusion, diagnosing Lyme disease requires a thorough patient history and laboratory testing. The cardinal sign of Lyme disease is a rash that often has a bullseye appearance. Testing for elevated IgM antibodies against B. burgdorferi is most helpful early in the disease. IgG antibodies are elevated in the later stages of the disease. An elevated ESR, increased AST levels, and mild anemia is frequently seen early in the disease. The therapeutic goal for Lyme disease is eliminating the infection with appropriate antibiotic therapy. The recommended treatment for early Lyme disease is oral doxycycline, whereas intravenous antibiotics are used for late Lyme disease with neurological involvement. Early recognition and treatment of Lyme disease can prevent long-term complications.

















Work Cited

Adams, Lucy, et al. “Living with Lyme disease: The nurse’s role in patient care.” Nursing made Incredibly Easy 19.4 (2021): 38-45.

Adias, Teddy Charles, Evelyn M. Eze, and Diweni Pere Dick. “Acute Phase Reactant Correlates and Erythrocyte Sedimentation Rate Among Type 2 Diabetes Mellitus Patients in Yenagoa, Nigeria.” IOSR Journal of Nursing and Health Science 7.1 (2018): 63-70.

Anderson, Cassidy, and Catherine A. Brissette. “The brilliance of Borrelia: mechanisms of host immune evasion by Lyme disease-causing spirochetes.” Pathogens 10.3 (2021): 281.

Blanken-Little, Donita. “Lyme Disease Essentials for Healthcare Workers.” (2021).

Dessau, Ram B., et al. “To test or not to test? Laboratory support for the diagnosis of Lyme borreliosis: a position paper of ESGBOR, the ESCMID study group for Lyme borreliosis.” Clinical Microbiology and Infection 24.2 (2018): 118-124.

Dumes, Abigail A. “Lyme Disease and the epistemic tensions of “medically unexplained illnesses”.” Medical Anthropology 39.6 (2020): 441-456.

Figoni, J., et al. “Lyme borreliosis and other tick-borne diseases. Guidelines from the French Scientific Societies (I): prevention, epidemiology, diagnosis.” Médecine et maladies infectieuses 49.5 (2019): 318-334.

Liu, Song, et al. “Pilot study of immunoblots with recombinant Borrelia burgdorferi antigens for laboratory diagnosis of Lyme disease.” Healthcare. Vol. 6. No. 3. MDPI, 2018.

Ponosheci-Biçaku, Albina. The risk of Lyme borreliosis infection following tick bite in Pristina region, Kosovo. Diss. University of Zagreb. School of Medicine, 2021.

Reifert, Jack, et al. “Serum epitope repertoire analysis enables early detection of Lyme disease with improved sensitivity in an expandable multiplex format.” Journal of Clinical Microbiology 59.2 (2021): e01836-20.

Rogerson, Ally G., and Vett K. Lloyd. “Lyme Disease Patient Outcomes and Experiences; A Retrospective Cohort Study.” Healthcare. Vol. 8. No. 3. MDPI, 2020.

Salerno, John, et al. “A Pilot Open-Label Study Assessing the Effects of AHCC Supplementation on Lyme Disease Patients.” Bioactive Compounds in Health and Disease 2.11 (2019): 221-229.

Shea, Jennifer. “Physical Therapist Recognition and Referral of Patients with Suspected Lyme Disease.” Physical Therapy (2021).

Stanek, Gerold, and Franc Strle. “Lyme borreliosis–from tick bite to diagnosis and treatment.” FEMS microbiology reviews 42.3 (2018): 233-258.

Van Hout, Marie Claire. “The controversies, challenges and complexities of Lyme disease: implications for medical education, clinical practice and research.” Journal of Pharmacy and Pharmaceutical Sciences 21.1 (2018): 429-436.

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