gynae infection - viral Flashcards
who is susceptible to CMV
immunocompromised eg HIV, organ transplant
histology CMV
owls eye
congenital CMV symptoms
IUGR, blueberry muffin skin, microcephaly, deaf, encephalitis (seizures), hepatosplenomegaly
which type of HSV more likely causes cold sores vs genital
HSV1 = mouth // HSV2 = genitals
symptoms genital herpes
painful genital ulcers (dysuria + itch) // primary infection more severe eg headache, fever, malaise // inguinal nodes
invx genital herpes
NAAT (+ HSV serology)
mx genital herpes
saline bath, topical lidocaine // oral aciclovir
when is C section adviced with genital herpes
if primary attack at 28 weeks or later
mx for HSV gingivostomatits
oral aciclovir + chlorehexidine mouthwash
what causes genital warts
HPV 6 + 11
1st line mx genital warts
topical podophyllum (multiple, non-keritanised) or cryotherapy (solitary, keritanised)
2nd line mx genital warts
imiquimod
what cells are infected in HIV
CD4 cells
what is HIV seroconversion (primary HIV)+ when does it happen
when body reacts to virus and antibodies begin to form (may not be detected yet) // 3-12 weeks after infection
features HIV seroconversion
flu like eg sore throat, lymph, malaise, myalgia, arthralgia, diarrhoea, rash, mouth ulcer
when do HIV antibodies become positive
usually 4-6 weeks can take 3 months
how do you test for HIV antibodies
ELISA test + blot assay
when does HIV antigen usually become positive
1 week to 4 weeks
how is HIV diagnosed
combined p24 antigen + HIV antibody // positive on 2 separate occasions
how is testing for HIV contacts done
test at 4 weeks and again at 12 weeks
ART for HIV
3 total // 2 nucleoside reverse transcriptase inhib drugs + 1 protease inhib OR a non-nuclease reverse transcriptase inhib
when should ART in HIV be started
as soon as diagnosis is confirmed
what effect does ritonavir (protease inhibitor) have on p450
inhibitor
who can get HIV prep and what drugs are given
high risk eg partner // Tenofovir and emtricitabine
what part of disease activity increases risk of HIV transmission
raised viral load
what does not require PePSE
human bites
mx HIV PEPSE
start taking within 72 hours // combination of ART // take for 4 weeks
symptoms from effects of virus in HIV (not related to low CD4
worsening psoriasis + dermatitis !! // diarrhoea // recurrent STI
what opportunistic infections can cause diarrhoea in HIV
cryptosporidium (most common) // CMV // giardia // myobacterium
incubation and diagnosis cryptosporidium
7 days // zeihl neelsen (acid fast stain)
when is mycobacterium seen in HIV + symptoms
CD4 <50 // sweats, fever, hepatomegaly, deranged LFTs
mx mycobacterium HIV
rifabutin, ethambutol and clarithromycin
what HIV infections occur at CD4 200-500
oral thrush // shingles // hairy leukoplakia // kaposi sarcoma
what HIV infections occur at CD4 100-200
Cryptosporidiosis // cerebral toxoplasmosis // leukoencephalopathy // jirovecii pneumonia // dementia
what HIV infections occur at CD4 50-100
aspergillosis // oesophageal candidas // CNS lymphoma
what HIV infections occur at CD4 <50
CMV retinitis // mycobacterium
what patients require Jiroveci prophylaxis
those with CD4 <200
mx Jiroveci pneumonia
co-trimoxazole (or IV pentamidine) // steroids if hypoxic
invx Jiroveci pneumonia
CXR // exercise induced desaturation
most common cause cerebral lesions HIV
toxoplasmosis
symptoms toxoplasmosis
headache, confusion, drowsy (mimics glandular fever)
invx toxoplasmosis
CT - ring enhancing lesions
mx toxoplasmosis
sulfadiazine or pyrimethamine
what is primary CNS lymphoma assoc with
EBV
invx CNS lympoma
CT - solid enhancing lesions // thallium SPECT +ive
mx CNS lymphoma
steroids + chemo (methotrexate) + brain irradiation
what causes encephalitis in HIV
HIV or CMV
most common fungal CNS infection in HIV
cryptococcus
invx cryptococcus meningitis HIV
LP - high opening pressure, raised protein, reduced glucose
what causes Progressive multifocal leukoencephalopathy
JC virus –> demylination
symptoms Progressive multifocal leukoencephalopathy
behavioural changes
invx Progressive multifocal leukoencephalopathy
CT // MRI better for demyelination
invx HIV dementia
CT - cortical atrophy
what causes kaposis sarcoma
herpes virus 8 (HHV8)
symptoms kaposis
purple plaques on skin or mucosa (GI or resp) // haemoptysis and pleural effusion
mx HIV oesophaegal candidas
(CD4<100) / fluclonazole and itraconazole
RF invasive aspergillosis
HIV, leukaemia, broad spec abx
