Lyme’s Disease with Quadriplegia

 

J. Kezia Angeline

B.Sc (N) IV Year, College of Nursing, Sri Ramakrishna Institute of Paramedical Sciences, Coimbatore – 44

 

 

Case history:

Mr. X, 30 years old, diagnosed as having “Lyme’s disease with quadriplegia” got admitted in Intensive Care Unit (I.C.U), at Sri. Ramakrishna Hospital, Coimbatore.

 

His case History revealed the following details:

He had earlier attack of Lyme’s disease in 2009, initially identified with rashes all over his body, -2009, but, it was left undiagnosed until January 2013.  In September 2009, while he undertook an official visit to Pondicherry, he was bitten by an insect, after which, he developed rashes all over the body.  His physician told that these rashes might have developed due to allergies and improper skin hygiene. So, he was left untreated.  From then on he gradually developed quadriplegia. In January 2012, he was taken to Vellore CMC and was diagnosed as having Lyme’s disease with gradually developing quadriplegia.  He got discharged after three months continuous hospitalization.In December 2012, his family got shifted to Coimbatore, to stay along with their relatives.

 

Though his condition did not get worse, he got admitted in Sri. Ramakrishna Hospital Coimbatore during December, with the following complaints:

(i)    Sudden bluish discoloration of body while taking food.--Single episode for about 10 minutes 

(ii)   Sudden unconsciousness--continuously.

(iii)  Eyeballs rolling upwards

Admission to I.C.U was done after his saturation levels dropped to 60%

 

He was kept under ventilation support (CPAP with PS: Continuous Positive Airway Pressure with Pressure Support).  Medications like: Potassium -  supplements, proton-pump inhibitors, anti-epileptic agents, anti-inflammatory steroids, cephalosporin antibiotics were given. 

1)    Syrup. Potklor, 15ml, NG feed, TDS

2)    Injection. Levipil, 500mg in 100 ml NS, IV, BD

3)    njection. Pentab, 40 mg, IV, BD

4)    Injection. Solumedrol, 250mg in 100 ml NS, IV,BD

5)    Injection. Hibact, 1 gm, IV, BD.

 

Investigations revealed the following:

(i) Echo – cardiography: Mitral Value Prolapse

(ii) Hematology:	Patient Value	Normal Value
a)Increased WBCS	24, 830 cells per cu.mm	4,000 to 11,000 cells / cu.mm
b) Leukocytosis	83.7% of leukocytes	45 to 75% of leukocytes
c) Lymphocytopenia	10.4% of Lymphocytes	16 to 45% of lymphocytes
d) Hypokalemia	3 meq / L of Potassium	3.5 to 5 meq / L of Potassium
e) Hypomagnesemia	1.35 mg/dl of magnesium	1.8 to 3 mg / dl of magnesium

 

f) Susceptible to DKA – Diabetic Keto-Acidosis:

He manifested with the following signs and symptoms of Borrelia burgdorferi infection (Lyme’s Disease):

(i)      Skin rashes

(ii)    Arthritis

(iii)   Mitral Valve Prolapse, respiratory failure

(iv)   Quadriplegia

 

Disease Condition:

Lyme disease (Lyme borreliosis) is an infectious disease caused by atlease three species of bacteria belonging to the

 

Genus Borrelia:

(i)      Borreliaburgdorferi

(ii)    Borreliaafzelii

(iii)   Borreliagarinii

 

Lyme disease is classified as “Zoonosis”, as it is transmitted to humans from a natural reservoir among rodents by ticks that feed on both sets of hosts.  Hard-bodied ticks of the genus Ixodes are the main vectors of Lyme disease.

 

Borrelia burgdorferi can spread throughout the body during the course of the disease, and has been found in the skin, heart, joint, peripheral nervous system and central nervous system. 

 

B. Burgdorferi is injected into the skin by the bite of an infected Ixodes tick.  The host inflammatory response to the bacteria in the skin causes characteristic circular EM lesion.  This allows the bacteria to survive and eventually spread throughout the body.

 

Days to weeks following the tick bite, the spirochetes spread via the bloodstream to joints, heart, nervous system and distant skin sites, where their presence gives rise to the variety of symptoms of disseminated disease.

 

If untreated, the bacteria may persist in the body for months or even years, despite the production of B.burgdorferi antibodies in the immune system.

(1)/ Its manifestations are as follows:

 

I. Early localized infection:

a) skin – rashes (erythema chronicummigrans)

b) Flu – like symptoms: head-ache, fever, malaise and muscle soreness

 

II. Early disseminated infection:

a)     Purplish lump on earlobe, nipple and scrotum

b)    Migrating pain in muscles, joints and tendons

c)     Heart palpitations and changes in heart beat

d)    Dizziness

e)     Facial palsy

f)     Neck  - Stiffness

g)    Sensitivity to light

h)    Cardiac problems

i)     Sleep disturbances

j)     Memory loss

 

III. Late disseminated infection:

a)     Depression

b)    Myalgia

c)     Paresis (permanent)

d)    Chronic skin disorders

e)     Lyme arthritis/(1)

 

Patient’s Progress:

·        Symptomatic management as well as prophylaxis with antibiotics, anti-epileptics and anti-inflammatory steroids was given. 

·        His prognosis was good initially.  He made the following progress:

 

(i)      At the time of admission in ICU, he was kept in ventilator, CPAP mode.  He had no spontaneous effort of respiration. Dietary supplements were ingested through the NG tube.

(ii)    Gradually, he initiated efforts of breathing; so, his ventilator mode was changed from CPAP to SIMV: Synchronized Intermittent Mandatory Ventilator.

(iii)   Once his respiratory patterns were stable, he was kept under observation under NIV: Non-invasive Ventilation mode.

(iv)  Oxygen support with venture mask (60%, 15 Litres of Oxygen) was provided; he started to take oral feeds slowly and so, NG tube was removed.  His saturation was maintained at 98% and so, oxygen mask was removed. 

(iv)   On the day of removal of oxygen mask, the following evening, he experienced gasping and shortness of breath. Oxygen saturation, it was 88% and so, again oxygen was administered using the venturi mask.

(v)    Tracheostomy was done for him to provide continuous oxygen.  He was unable to  sustain life without mechanical ventilation.

 

On 24.01.2014 he had a respiratory arrest and his life came to an end.

 

Lymes disease acted as a silent killer in his life – gradual changes lead to his death.

 

ACKNOWLEDGEMENT:

The author extends her sincere gratitude to her guide, Professor Mrs. Jean Tresa, Medical–Surgical  Nursing Department, who was a sole – supporter to bring – up the case – study as an article.

 

REFERENCES:

1        Davidson’s “Principles and Practice of Medicine”, 21^st Edition (2010), Elsevier Publications, New Delhi, Page Number: 329 to 331(1)

2        Net reference: “http:/google.co.in “Lyme’s Disease”.