AIDs,Viral Hepatitis And STIs Flashcards
What is HIV,AIDS,? What are the types of HIV? What are STIs
How is HIV transmitted?
Which two diseases can HIV patient be coinfected with easily?
Why can’t individuals get HIV through kissing,hugging,food and water?
Acquire Immune Deficiency Syndrome (AIDS) is a late stage infection with Human Immuno Deficiency Virus
•HIV is an RNA virus which is an evolved Human
organism from the ancient simian origin and it belongs to the
Retroviridae family of viruses.
There are two types of HIV’s and they are:
HIV 1 and HIV 2
Sexually transmitted infections are diseases which are
mainly transmitted through body fluids during sexual
activities and HIV remains the largest.
Transmission of these viruses are through:
1.Exchange of a variety of body fluids from infected people such as blood (transfusions ), breast milk, semen and vaginal secretions.
2. From a mother to her child during pregnancy and delivery
NB: Individuals cannot become infected through ordinary day-to-day contact such as kissing, hugging, shaking hands, or sharing personal objects, food or water.
Co- infections with Tuberculosis and Hepatitis B are particularly
the most frequent and hence these diseases must be screened in all
HIV patients
Cuz HIV is gotten through the blood,breast milk,semen and vaginal secretions not through sweat or saliva
Name five risk factors for getting HIV
Behaviours and conditions that put individuals at greater risk
of contracting HIV include:
•having unprotected anal or vaginal sex;
•having another sexually transmitted infection (STI) such as syphilis, herpes, Chlamydia, gonorrhoea and bacterial vaginosis
•sharing contaminated needles, syringes and other injecting equipment and drug solutions when injecting drugs
•receiving unsafe injections, blood transfusions and tissue transplantation, and medical procedures that involve unsterile cutting or piercing
•experiencing accidental needle stick injuries among health workers
What is the pathophysiology of HIV
What leads to the majority of signs and symptoms observed in HIV patients
NB: blood infection and host with weak immune system lead to a quicker infection, progression and early symptoms than other routes.
True or false
What is budding?
The interrelationship between HIV and the host
immune system is the basis of the pathogenesis of HIV
disease
•After this section you must be able to
- understand the infection mechanism of Human Immune Viruses type 1 & 2 and the replication process of these viruses
- Correlate how the replication process leads to the late stage infection ‘AIDS’ and the observe clinical signs and symptoms with time
Pathophysiology cont…
After a successful entry of HIV 1 or 2 organisms through already stated routes , the following activities occurs :
A. Recognition of the virus
the virus surface antigen is detected by dendritic and Fc receptors and this leads to
Inflammatory response.
B. this first inflammatory response which starts after few minutes of infection is called the
ACUTE INFLAMMATION but this initial response involving Polymorphonuclear
leukocytes often fails to remove Viruses (foreign body) due to the presence of the capsules
and as a results this response is prolonged by chronic inflammation where Lymphocytes
and macrophages begin to get involve.
C. Unfortunately the virus antigens( gp 120 ) target molecules on the surface of T-
lymphocytes specifically sub-type CD4 (these receptors are CCXR4 and CCR5 ) and this
leads to binding and fusion of the virus into the cytoplasm of the CD4 molecules and this
leads to reverse transcription mechanism initiated by viral reverse transcriptase enzyme
and formation of the viruses DNA.
D. After replication viruses bud out of CD4 molecules in large numbers
leading to death of CD4 molecules. This again leads to viremia which is
followed by a latency period and a heavy reinfection if not well controlled
Depletion of CD4 cells leads to reduce immunity of the host
and susceptibility to co- infections such as infection by normal flora,
Tuberculosis, Hepatitis B and Candidiasis .
E. Lastly,CD8 molecules are released to control viremia as the population
of CD4 molecules decreases gradually.
•Co-infections leads to majority of the signs and symptoms observed after the immune defence is impacted by HIV
Budding:when the HIV virus is getting out
What are the complications of HIV and how many stages of HIV infection are there?
What happens in these stages ?(name at least theee)
Name four important signs you’ll see in early HIV in infected patients
According to WHO staging of HIV/AIDS we have 4 stages of HIV infection and they contribute to the complications that constitutes almost all the body systems
Stage1:Asymptomatic,persistent generalised lymphadenopathy,recurrent infections especially yeast infections
Stage2: Moderate unexplained weight loss (<10% of presumed or measured body weight)
•Recurrent respiratory tract infections (sinusitis, bronchitis, otitis media, pharyngitis)
•Herpes zoster
•Angular cheilitis/Recurrent oral ulcerations
•Papular pruritic eruptions
•Seborrhoeic dermatitis
•Fungal nail infections or fingers
Stage 3: Severe unexplained weight loss (<10% of presumed or measured body weight)
•Unexplained chronic diarrhoea for longer than 1 month
•Persistent oral candidiasis
•Oral hairy leukoplakia
•Severe bacterial infections (emphyema,pneumonia , pyomyositis, bone or joint infection, bacteremia , severe pelvic inflammation)
Stage4:
•HIV wasting syndrome
•Pneumocytis Jiroveci pneumonia
Recurrent severe bacterial pneumonia
•Oesophageal candidiasis ( 0r Candidiasis of the trachea or bronchi or lungs
•Extrapulmonary tuberclosis
•Kaposi sarcoma
•Cytomegalovirus infection( retinitis or infection of other organs)
•Central nervous system toxoplasmosis
•HIV encephalopathy
•Extrapulmonaary Cryptococcis including meningitis
•Progressive multifocal leukoencephalopathy
•Symptomatic HIV associated neuropathy
•Cocydiomycosis
•Isoporiasis
•lymphoma
•Cardiomyopathy
- Chronic diarrhea
- recurrent infections
- Hodgkins and non Hodgkin’s lymphoma
- Persistent generalised lymphadenopathy in an adult due to chronic infection
Name three non specific signs and symbols in HIV AIDS presentation
State five differentials for It
SYMPTOMS
These are non-specific during clinical presentation
•Fever
•Pharyngitis with cervical lymphadenopathy
•Myalgia/arthralgia
•Headache
SIGNS •rash •Mucosal ulceration • Chronic diarrhoea •Xeroderma •Oral hairy leucoplakia •Oropharyngeal candidiasis
Differential diagnosis •Tuberculosis •Syphilis •Gonorrhoea •Cytomegalovirus infection •Toxoplasmosis •Herpes infection
How is AIDS diagnosed
Where is viral load checked?
Which two diseases are dangerous for HIV patients
AIDS is defined by serologic evidence of HIV infection with the presence of a variety of indicator diseases associated with clinical immunodefi ciency
From the lymph nodes
Toxoplasmosis and Cytomegalovirus
What is the primary investigation for HIV and name four other investigations
Why is it that a person can have HIV but will test negative for the rapid diagnostic test
VCT (voluntary counseling and testing) or HIV rapid diagnostic test OraQuick for detecting antibodies against HIV •OTHER INVESTIGATIONS ●CD4 count ●Viral load ●Hepatitis B (HBV) status ●Hepatitis C (HCV) antibody ●Hepatitis A (HAV) IgG antibody ●Toxoplasma and cytomegalovirus (CMV) IgG antibody ●Lipid profile and urinalysis ● Cervical smear in women ● STI screen ● FBC
This is because the test shows positive if the person has been infected for 6-12 weeks
If the person tests before 6-12weeks and is infected,the person will test negative
What are the five objectives of treatment in an HIV patient?
What is the non pharmacological treatment and pharmacological treatment?
Objectives
To reduce viral proliferation
To increase CD4 count
To prevent spread of infection
To reduce co-morbidities
Prophylaxis against later infections
•Pharmacological
Anti –Retroviral/Highly active anti-retroviral medications(Haart)
Antibiotic prophylaxis
Treating co-morbidities
- Non- pharmacological
- Safe sexual practices
- Emotion and psychological counselling
State the classes of anti retroviral drugs and state examples,doses and significant side effects
1.Nucleotide Reverse Transcription Inhibitors: Zidovudine (AZT)-300mg 12hrly Lamivudine-150mg 12hrly Anemia Generally safe
- Nucleotide Reverse Transciptase Inhibitors:
Tenofovir-300mg 24hrly
Renal impairment - Non-Nucleoside Reverse Transcription Inhibitors
Nevirapine-200mg 12hrly
Efavirenz-600mg nocte
Skin rashes from mild to steven johnson syndrome and hepatoxicity - Protease Inhibitors
Lopinavir/Ritonavir-400/100 mg 12hrly
Dysglycemia
How is HIV prevented
Individuals can reduce the risk of HIV infection by limiting exposure to risk factors.
Key approaches for HIV prevention, which are often used in combination, include:
•male and female condom use
•testing and counselling for HIV and STIs
•testing and counselling for linkages to tuberculosis (TB) care
•voluntary medical male circumcision (VMMC)
•use of antiretroviral drugs (ARVs) to reduce spread and also as prophylaxis for harm reduction for people who inject and use drugs
•Lastly preventing mother-to-child transmission (MTCT) of HIV through timely intervention with Antiretroviral drugs
What is the mechanism of action of each type of Anti retroviral drugs
Ask
What is hepatitis
• It can be acute, when the symptoms last for less than 6 months or chronic when the symptoms persist for more than 6 months. True or false
State five causes of it
Hepatitis is simply the inflammation of the hepatocytes or the liver cells (liver parenchyma)
True
Viruses (hepatitis A, B, C, D and E, yellow fever etc.)
• Drugs (allopathic alternative and herbal preparations) e.g. Methyldopa, isoniazid, ketoconazole.
• Alcohol
• Autoimmune response
• Hereditary e.g. Wilson’s disease
• Inflammatory bowel diseases
State five signs and five symptoms of a patient w hepatitis
SYMPTOMS • Right hypochondrial pain • Fever (occurring 1 – 4 weeks before the jaundice appears) • Malaise • Anorexia • Nausea • Vomiting • Yellow or dark coloured urine • Pale stools • Itching • Fatigue • Confusion
SIGNS
CLINICAL PRESENTATIONS
• Right hypochondrial tenders
• Hepatomegaly
• Asterixis
• Jaundice
• Mild splenomegaly (uncommon except in Epstein-Barr virus (EBV) infection)
• Mild hepatomegaly (but rapid shrinkage occurs in severe hepatitis)
• Cervical lymphadenopathy (uncommon)
• Skin manifestations include spider naevi, scratch marks in the pruritic phase, and rarely urticarial rash
State the common and less common causes of hepatitis
Which of the causes of Hepatitis can be acute? Which can be chronic?
CAUSES (COMMON) 1. Hepatitis A 2. Hepatitis B 3. Hepatitis C 4. Hepatitis D 5. Hepatitis E VIRAL HEPATITIS Less common 1. Cytomegalovirus 2. Epstein-Barr virus 3. Herpes virus 4. Yellow fever
They differ in their tendency to cause acute and chronic infections.
Hepatitis A, B, C, and E can all initiate and acute self-limited hepatitis. Only hepatitis b and c can cause chronic viral hepatitis
Hepatitis D co-infects patients infected with hepatitis B
How is Hep A and E transmitted?
How is B and C transmitted ?
Fecal-oral transmission
HAV is commonly acquired by travelers. HEV is commonly acquired from contaminated water or undercooked seafood.
Parenteral transmission (e.g., childbirth, unprotected intercourse, intravenous drug abuse [IVDA], and needle stick) (Note that B is transmitted through childbirth and not C making B ore dangerous)
C-Parenteral transmission (e.g., IVDA, unprotected intercourse); risk from transfusion is almost nonexistent due to screening of the blood supply
Anti-virus IgM marks active infection. Anti-virus IgG is protective, and its presence indicates prior infection or immunization (immunization is available for HAV).
True or false?
HEV infection in pregnant women is associated with?
Which test confirms the infection of hepC?
Decreased RNA levels indicate what?
Persistence indicates what?
Hep D is Dependent on HBV for infection; superinfection upon existing HBV is more severe than coinfection (infection with HBV and HDV at the same time)
True or false
True
fulminant hepatitis (liver failure with massive liver necrosis).
HCV-RNA test confirms infection; decreased RNA levels indicate recovery; persistence indicates chronic disease
True
In the acute ,window,resolved,chronic,and Immunization stage,HbsAg,(HbeAg, and HBV DNA) ,HbcAB,HbsAB are negative or positive?
Refer to
Microbiology textbook for more knfo
Positive and it’s the first serological marker to rise
Positive
IgM is present in HbcAB showing that it’s trying to clear the infection
If negative in HbsAB then it means it cleared the infection
In the window stage ,it’s negative ,negative,IgM is present ,negative
Resolved:negative,negative,IgG,IgG protective
Chronic:positive(presence > 6 months defines chronic state),can be positive or negative ( presence of HBeAg or HBV DNA indicates infectivity),IgG,negative
Immunization:negative,negative,negative,IgG protective
Name five lab investigations for hepatitis
FBC : The white cell count is usually normal with a relative lymphocytosis.
LIVER FUNCTION TESTS : AST, Aspartate aminotransferase and ALT Alanine aminotransferase are raised at the time of the onset of symptoms whilst the serum alkaline phosphatase(ALP) level is only slightly increased.
SEROLOGICAL TESTS Confirm the aetiology of the infection ( HBSAg, HCV ANTIBODY, HEPATITIS A IgM, HEPATITIS E IgM)
PROTHROMBIN TIME (PT) Or erythrocyte sedimentary rate (ESR) : prolonged PT indicates the severity of the hepatitis.
URINARY R/E : Shows excess urobilinogen in early and late phases. ABDOMINAL ULTRASOUND: To check splenomegaly, hepatomegaly etc. LIVER BIOPSY
How is hepatitis managed?
State five differentials and four complications
Most individuals do not need hospital care.
• No specific dietary modifications are needed.
• Alcohol should be avoided during the acute illness.
• Elective surgery should be avoided in cases of acute viral hepatitis, as there is a risk of post-operative liver failure.
• Liver transplantation is very rarely indicated for acute viral hepatitis complicated by liver failure, but is commonly performed for complications of cirrhosis resulting from chronic hepatitis b and c infection.
DIFFERENTIAL DIAGNOSIS OF HEPATITIS • Drug-induced jaundice • Alcoholic hepatitis • Acute Wilson's disease • Acute fatty liver disease • Ischaemia, generally after profound hypotension over many hours • Progressive malignant infiltration
COMPLICATIONS OF ACUTE HEPATITIS • Acute liver failure • Cholestatic hepatitis (hepatitis A infection mostly leads to) • Aplastic anaemia • Chronic liver disease • Cirrhosis (hepatitis B and C) • Relapsing hepatitis • Hepatocellular carcinoma
Name five ways STIs can be spread
Statesix symptoms someone w an STI can present with
STIs can spread in several ways including:
• Having sex with an infected partner (vaginal, oral or anal)
• Kissing or close body contact
• From mother to child before or during birth • Breastfeeding
Some STIs do not cause symptoms. If you do have symptoms of an STI, You may have:
• Sores on your genitals or mouth
• Discharge from the sores or your genitals • Pain or itching
• Pain when urinating
-lower abdominal pain
-scrotal swelling
-anorectal related syndrome
State three organisms each that cause the symptoms seen in STI patients
Which organism causes genital warts and inguinal bubo
Lower abdominal pain in women
• Neisseria gonorrhea -
• Chlamydia trachomatis -
• Anaerobic bacteria -
Urethral Discharge • Neisseria gonorrhea • Chlamydia trachomatis • Mycoplasma genitalum- • * Trichomonas vaginalis P
Vaginal Discharge • Neisseria gonorrhea • Chlamydia trachomatis • Trichomonas vaginalis • Herpes simplex virus
Scrotal swelling • Chlamydia trachomatis • Neisseria gonorrhea • Treponema pallidum (very rarely) -
Ano-rectal related syndromes • Chlamydia trachomatis • Herpes Simplex Virus-2 (HSV-2) • Neisseria gonorrhea • Treponema Pallidum
GENITAL ULCERS OTHER CAUSES • HERPES SIMPLEX VIRUS • Treponema pallidum (SYPHILIS) • Haemophilus ducreyi (CHANCROID) • Calymmatobacterium granulomatis or Klebsiella granulomatis (GRANULOMA INGUINALE)
INGUINAL BUBO
• Chlamydia trachomatis (LYMPHOGRANULOMA VENEREUM)
GENITAL WARTS
• Human papilloma virus Gram negative
State the symptoms and signs ,investigations,treatment for urethral and vaginal discharge
URETHRAL DISCHARGE Symptom • Urethral discharge • Dysuria or discomfort on urination Investigations • Urethral swab culture and sensitivity Treatment For Gonorrhoea • Ceftriaxone • Cefixime • Ciprofloxacin
For Chlamydia and Mycoplasma • Doxycycline -/+ B • Tetracycline -/+ W • Erythromycin +/s- • Azithromycin -/+ b
For trichomonas vaginalis
• Metronidazole (P, +/-) L
• Tinidazole P
• Secnidazole P
VAGINAL DISCHARGE Symptoms • Vaginal discharge – change in colour, odour, consistency of amount • Vulvar swelling • Pain on urination • Lower abdominal pain Sign • Vaginal discharge • Vulvar swelling • Vulvar erythema • Lower abdominal tenderness • Cervical mucopus or erosion
Investigations
• Urethral swab culture and sensitivity
Treatment For Gonorrhoea • Ceftriaxone -/+ B • Cefixime - B • Ciprofloxacin -/+ B
For Chlamydia and Mycoplasma • Doxycycline -/+ B • Tetracycline -/+ W • Erythromycin +/s- • Azithromycin -/+ b
For Trichomonas vaginalis
• Metronidazole (P, +/-) L
• Tinidazole P
• Secnidazole P
State the symptoms and signs ,investigations,treatment for lower abdominal pain and anorectal syndrome
LOWER ABDOMINAL PAIN Symptoms • Lower abdominal pain • Dyspareunia • Vaginal discharge • Dysuria or urethral discomfort • Fever Signs • Lower abdominal tenderness • Vaginal discharge • Cervical excitation • Adnexal tenderness or pelvic tenderness
Investigations
• High vaginal swab culture and sensitivity
• Pelvic ultrasound
TREATMENT • Cefixime - B • Ciprofloxacin -/+ B • Doxycycline -/+ B • Metronidazole (P, +/-) L
ANORECTAL RELATED SYNDROMES Symptoms • Anal discharge • Rectal bleeding • Pruritus • Rectal pain • Tenesmus • Constipation Signs • Anal ulcers or blisters • Anal growth • Tenderness on rectal examination • Anal discharge or bleeding Investigations • Anal and rectal cultures
TREATMENT
For Anorectal discharge
• Treat for gonorrhea and
chlamydia
For anorectal ulcers or vesicles
• Treat for herpes simplex virus
• Acyclovir
For Chancroid • Ceftriaxone -/+ B • Azithromycin -/+ b • Ciprofloxacin -/+ B • Erythromycin +/s-
For persons allergic to penicillin
• Doxycycline -/+ B
• Tetracycline -/+ W
• Erythromycin +/s-
State the symptoms and signs ,investigations,treatment for scrotal swelling
SCROTAL SWELLING S&S • Scrotal swelling • Scrotal pain • Urethral discharge • Dysuria • Frequency of micturition • Fever Examination • Scrotal swelling, oedema and/or erythema • Scrotal tenderness • Urethral discharge • Fever Investigations • Urethral swab for culture • Urine culture and sensitivity • Ultrasound scan for the scrotum Treatment For Gonorrhoea • Ceftriaxone -/+ B • Cefixime - B • Ciprofloxacin -/+ B For Chlamydia • Doxycycline -/+ B • Tetracycline -/+ W • Erythromycin +/s- • Azithromycin -/+ b
What are the signs and symptoms of genital ulcers
State the characteristics of the lesions and adenopathy in the types of genital ulcers
Why is lymphadenopathy a sign of genital ulcers?
SYMPTOMS SIGNS
• Genital ulcer (painful or painless) • Inguinal lymphadenopathy • Urethral discharge
• Lymphadenopathy
Genital Herpes ulcers
LESION: multiple, painful, erythematous vesicles. Incubation 2-7 days
ADENOPATHY: tender, soft; not prominent with recurrent lesions.
Syphilitic ulcers (Treponema pallidum) LESION [chancre]: ulcerated, painless, firm, indurated papule. Incubation 10-90 days. ADENOPATHY: firm, discrete movable, painless, occurring 1 weak after chancre.
CHANCROID (HAEMOPHILUS DUCREYI)
• LESION: soft, not indurated, very painful vesicle/papule to ulcer. incubation 3-5
days.
• ADENOPATHY: painful, unilateral, suppurative, occurring 1 week after primary.
Granuloma inguinale (Calymmatobacterium granulomatis) • LESION: painless, irregular, thickened papule/ulcer. incubation 9-50 days. • ADENOPATHY: none. may develop groin abscesses, however.
Lymphadenopathy can be caused by infection,malignancy, so an STI lymphadenopathy is caused in the inguinal region near the genitals
What are the investigations and treatment of genital ulcers caused by herpes,syphillis,treatment for persons allergic to penicillin,pregnant women allergic to penicillin,for chancroid
VDRL (IF AVAILABLE) [DIAGNOSTIC TEST]
VENEREAL DISEASE RESEARCH LABORATORY TEST.
• the VDRL test is a screening test for syphilis. it measures substances (proteins), called antibodies, which your body may produce if you have come in contact with the bacteria that causes syphilis. blood drawn from a vein (venipuncture), usually from the inside of the elbow or the back of the hand.
TPHA (IF AVAILABLE) [DIAGNOSTIC TEST]
TREPONEMA PALLIDUM HEMAGGLUTINATION ASSAY
• Treponema pallidum hemagglutination commonly known as TPHA is diagnostic test used to detect the dissolve amount of antibodies in the serum sample of a patient against the causative agents of syphilis. to be precise the TPHA test helps in the detection of palladium antibodies via the hemagglutination method.
For herpes simplex • Acyclovir For syphilis • Benzathine penicillin G For persons allergic to penicillin • Doxycycline • Tetracycline TREATMENT For pregnant women allergic to penicillin • Erythromycin • Azithromycin For chancroid • Ceftriaxone • Azithromycin • Ciprofloxacin • Erythromycin
State the signs and symptoms of inguinal bubo and investigations of both and genital warts
How is the vinegar test done
• Painful or painless inguinal swelling (s)
Signs
• Inguinal swelling • Genital ulcer
Investigations: recommended in managing STIs )if the swelling becomes associated with another STI symptom)
GENITAL WARTS
• Usually no symptoms
• Small painless swellings in the ano-genital region • Itching or discomfort in the genital area
• May cause increased vaginal discharge
• Anal or vaginal bleeding during or after sex
SIGN
• Small, flat, papular, pedunculated, flesh-coloured swelling on the skin and mucous membranes of the genitals (penis, vulva, vagina, cervix, urethra, perianal region)
INVESTIGATION
• ACETIC ACID SOLUTION (VINEGAR) TEST
After application of 3-5% acetic acid. If the lesion contains abnormal load of cellular proteins, the acetic acid coagulates the proteins conferring an opaque and white aspect of the concerned area.
How is LGV and Chancroid treated?
How is warts treated?
lymphogranuloma venereum (LGV) and chancroid • Doxycycline • Azithromycin • Erythromycin(narrow spectrum)
Warts:
.Podophyllin
• Trichloroacetic acid (TCA)
• Imiquimod
State five objectives of STI treatment
To prevent complications and sequelae by treating infections
• To reduce risk of HIV infection
• To treat both partners simultaneously as much as possible or prevent further transmission to sexual partners.
• To relieve pain and inflammation
• To treat small ulcers and vesicles, especially if recurrent for herpes simplex,
syphilis and chancroid concurrently
• To treat for gonorrhea and chlamydia simultaneously
• To relieve the swelling especially in HSV infections
• To treat the infection of lymphogranuloma venereum and chancroid concurrently
State five complications of STIs
Pelvic pain • Pregnancy complications • Pelvic inflammatory disease • Infertility • Certain cancers, such as HPV-associated cervical and rectal cancers
