HIV, STI, Atypical Mycobacterial And Fungal Diseases Flashcards
HIV (transmission)
Transmission: Sex, IDU, mother to child, breast feeding
Health care setting: dirty needle stick, organ transplant, Artificial insemination, contact with bloody bodily fluids
HIV (initial symptoms)
Occur 2-6 weeks post exposure, May last 2-4 weeks after onset
Flu-like:
Fever, rash, fatigue, pharyngitis, lymphadenopathy, myalgia, mucocutaneous ulceration, headache
(Should be highly suspicious if all are present)
HIV (testing)
Antibody screening 3-8 weeks after infection
-Testing too early could result in a false.
Negative
US primary is HIV 1 testing, some test HIV2
ELISA (highly sensitive, screening test) followed by Western Blot (specific, confirmatory)
HIV (background)
Lentivirus
possible origin from Africa
HIV 1 is prominent in the US
HIV 2 is prominent in Africa (less pathogenic)
HIV progresses into Acquired Immune Deficiency Syndrome (AIDS)
HIV (Progression)
Exposure
- (3-8 week) window of no immune response
Acute
-Flu-like symptoms, High infectivity
Asymptomatic
12 months to median 11 yrs before AIDS develops
HIV replication present during all stages of infection and progressively reduce CD4 lymphocytes
AIDS
-When CD4 counts fall below 200:
fever, weight loss, diarrhea, cough, shortness of breath, and oral candidiasis as the disease progresses-a cute
-Pneumonia, toxoplasmosis, TB, mycobacterium avium disease
HIV (Tests 1)
ELISA with confirmatory WB
Orasure HIV 1 Oral specimen
- oral fluid
- non clinician
- if positive, we need a confirmatory test
Oraquick Advance HIV 1/2 (Rapid) test
- can be outside clinic
- results from finger stick or VP in 20-40 mins
- Need to confirm with WB
HIV (tests 2)
NAAT
P 24 antigen
- can detect p24 protein (antigen) in 2 weeks
- lacks both sensitivity and specificity
- use in conjunction with antibody tests early
PCR for viral load
- can detect 11 days after infection
- newborn testing
- monitor therapeutic response to to
- most sensitive
HIV (who is tested)
The CDC recommends screening for pts 13-64 years in all health-care settings.
HIV (work-up)
hx
Sexual and substance abuse, vaccine, previous STD’s, travel
Through physical including Gynecological for women.
Tests
CD4 count, and viral load, other STI’s, CBC, blood Chem
HIV/AIDS (opportunistic infections)
Toxoplasma gondii encephalitis Cryptosporidiosis Disseminated Mycobacterium Avium Complex (MAC) disease Bacterial Enteric Infections Syphilis Mucocutaneous Candidiasis Cryptococcosis Histoplasmosis Coccidioidomycosis Cytomegalovirus Disease Herpes Simplex Virus Disease HHV-6 and HHV-7 Disease Varicella-Zoster Virus Diseases Human Papillomavirus Disease
Candidiasis (background)
Candida albicans
Yeast-like fungi
Risk factors: immunosuppressed, antibiotic use, diet, stress
Candidiasis (affected areas)
Superficial mucocutaneous: oral, vaginal, diaper area candidiasis, etc.
Can also be invasive, esophageal candidiasis in AIDS, systemic dissemination, etc
May involve virtually any organ
Candidiasis (transmission)
Human and animal reservoirs, but frequently found in environment
Candidiasis (Dx)
Diagnosis: depends on site
Superficial: wet mount looking for hyphae, pseudohyphae or budding yeast
May also do blood cultures, urine cultures, biopsies
Candidiasis (Tx)
Most healthy people do not show symptoms
topical antifungal agents for superficial infections
Systemic (invasive) infections – parenteral antifungals such as fluconazole
Histoplasmosis (background)
Histoplasma capsulatum is a fungus, that grows as a yeast at body temperatures in mammals
Endemic in OH, MO and MS River Valley, acidic soil in these areas provides growth media
Histoplasmosis (transmission)
Bats can be infected and spread infection
Contaminated soil may be a risk for years, as well as airborne spores
Associated with renovation, construction activities
Histoplasmosis (Symptoms)
Healthy people who are exposed are typically asymptomatic, Sometimes see chronic granulomas (calcified nodes and nodules on CXR
Flu-like symptoms with erythema nodosum (raised red dots on lower legs)
Immunocompromised: initially is pulmonary, may get systemic spread and manifestations such as CNS, liver, spleen, and rheumatologic, ocular, and hematologic systems
Histoplasmosis (progression)
If symptomatic, initial illness often flu-like & limited duration
Fever & chills, inspiratory chest pain and cough, joint pain, mouth sores & erythema nodosum on lower legs
If goes on to chronic phase, may develop or continue to have chest pain, cough, SOB, fever and sweating
In rare cases, may disseminate and cause inflammation in pericaridium, meninges, high fever
Histoplasmosis (Dx)
CXR, chest CT Bronchoscopy Biopsy Blood/urine for antigens or antibodies Spinal Tap if suspect infected CSF
Histoplasmosis (Tx)
Usually clears up without treatment
If symptoms last > 1 month, typically will need antifungal therapy: Amphotericin B, itraconazole, and ketoconazole
Cytomegalovirus (CMV) (background)
Common virus, nearly everyone infected with it but most people usually asymptomatic
Lifetime infection once infected, virus dormant in most cases
Cytomegalovirus(CMV) (transmission)
Transmission: Congenital (born with it) or perinatal (acquired via breast feeding)
Spread via body fluids: blood, saliva, urine, semen and breast milk
Lifetime infection once infected, virus dormant in most cases
Kids in daycare
Primary infection during first exposure
-can be go through periods of inactivity
Cytomegalovirus (Symptoms)
Congenital infection (serious illness)
Jaundice, rash, low birth weight, splenomegaly, hepatomegaly & hepatic dysfunction, seizures
Immunocompromised persons may develop infection in many organs
In HIV, often see CMV retinitis/uveitis or CMV diarrhea (GI track ulceration)
Also, pneumonia, encephalitis and behavioral changes, hepatitis, seizures & coma – and ultimately, death in some persons
Healthy people can also become ill with CMV, but rarer
Can develop a mono-like syndrome or other illnesses/symptoms as noted above
Cytomegalovirus (Tx)
No curative treatment for CMV, generally healthy adults and children not treated, but immunocompromised will get antivirals
Prevention is key!
Personal hygiene, avoid contact with body fluids/passing body fluids to others, appropriate disposal of infected items, don’t share glasses/kitchen utensils, safe sex
Gonorrhea (background)
Sexually transmitted infection (STI) caused by Neisseria
Highest rates among teens, young adults and African Americans
Gonorrhea (Transmission)
sexual contact or via childbirth
Gonorrhea (symptoms (males))
Symptoms vary
Men may be asymptomatic, experience dysuria or have a penile discharge (1-14 days after exposure)
Can develop epididymitis if untreated, and rarely, sterility
Gonorrhea (symptoms (females))
typically asymptomatic or low-grade symptoms like dysuria, increased vaginal discharge or bleeding between periods
Potentially serious complications if left untreated – PID/abscess and be at increased risk for ectopic pregnancy, infertility
Gonorrhea (additional symptoms)
Anal infections
May be asymptomatic, or have bleeding, burning, discharge
Throat infections
May be asymptomatic or have sore throat
Can occasionally get disseminated infection of bloodstream or joints (arthritis), potentially life-threatening
May disseminate infection to blood stream and joints (arthritis)
Gonorrhea (associated illnesses)
Increased risk of transmitting or being infected with HIV
Chlamydia