infection 2 Flashcards
trichomonas vaginalis
flagellate protozoan trichomonas vaginalis
highest incidence of all sti worldwide
S+S: men asymptomatic
females- some asymptomaitc, others offensive yellow green frothey vag discharge + strawberry cervix
Ix: microscopy of vag discharge–> motile protozoa
NAAT- posterior fornix swab.
urine test in men.
complications: HIV aquisition, pre-term delivery, low birth weight, pelvic inflammatory disease.
Rx: metronidazole.
discuss bacterial vaginosis
an overgrowth of anaerobic organisms + loss of lactobacili
PH rises to more than 4.5
NOT AN STI
RF: sexually active, douches, deoderants. excessive semen (alkali), copper IUD, smoking.
Anti-RF: circumsised partner, hormonal contraception, condom use.
most common cause of vaginal discharge in childbearing age women.
puts women at inc risk of getting STI.
S+S: fishy smelling vaginal discharge, coating walls of vag and vestibule.
Ix: test acidity of vagina. gram stain the discharge.
no IX needed if its barn door.
Rx:
may not need.
if symptomatic- metronidazole- oral or gel.
discuss candidiasis
mucosal- commensual that has taken over- selected for its growth by taking abx
invasive- identification of candida in a normally sterile site. (fungal infection)
RF for all types: abx use, HIV, DM, imunosupressive dugs (asthma inhailers for oral)
Oral- nystatin suspension or oral fluconazole
oesophageal- PO fluconazole.
vulvovaginal- intravaginal anatifungal cream, pessary (both clotrimazole) or oral fluconazole
discuss invasive candidiasis
isolation of candida from normally sterile site
if gets into blood stream diseminates easily. - biofulmm helps it stick to stuff- espesh implants.
Key things to ax in clinic:
eyes- retinitis
heart- endocarditis
in hospital mortality 40-60%.
Ix:
blood cultures
culture sterile site
1,3 B-D-glycan - fungal biomarker.
Rx: echinocandin
remove source of infection.
discuss lymphogranuloma venereum
an ulcerative disease of the genital area
by chlamydia trachomatis- serovars L1, L2, L3
rare- tropical and subtropical areas of world.
Men sex Men. - more apparent in men also
sig assoc with HIV
affects the lymph system- extend from infection site to regional lymph nodes– then forms a abcess
Ix: clinical suspicion
serology tests- culture
Rx: Doxy bd 21/7 100mg
complications result when untreated- necrosis and rupture of lymph nodes
what is resistance
factors affecting it
all of it is genetic
level of antimicrobial misuse in humans and animals (80% used in agriculture)
poor infection control
ttransmisability of resistance genes
fitness of resistant organisms
tracel and health tourism.
what is donovanosis and investigations and management
a genital ulcreative disease
caused by intracellular gram negative klebsiella granulomatis. presents very simalar to syphyliss
S+S- small painless nodules occur 10-40 days after exposure to bacteria
nodules then burst- creating open fleshy ulcers, continue bleeding and often get further infections
occur around the shaft of the penis, labia, erineum + oral region
continues to destroy tissue untill treated.
Ix: characteristic rolled edge ulcers, minimal lymph swelling
biopsy
wright-giemsa stain.- Donovan bodies (rod oval organisms in cytoplasm)
Rx:
azithromycin 1G per week or
doxy 100mg BD
should last 3 weeks.
chancroid clinical summary
H ductreyi gram -ve.
important cofactor in HIV transmission- need to R/O if they have this
STI in resourse poor areas
10/7 befor symptos able to transmit
RF: sex, lots of sex, male (25:1), substance abuse
S+S: painful papules – pustuation then ulceration.
soft painful ulcers, 1-2cm. sharp boarders, undermined edges.
lymphadenitis
Ix: swab ulcer + gram stain.
PCR,
R/o siphylis, hiv
Rx: azithromycin 1g oral single dose.
cipro 2nd line or 1st in HIV+ve.
complications:
phimosis, abcess, fistula,
clinical summmary of travelers diarrhea
most common travel related illness
first 1-2 weeks.parasites can take longer to incubate.
bacterial- e. coli
virus or parasitic also causes.
generally poor resourse countries, fecal oral route.
definition- 3 or more loose stools within 24 hours.
clinical diagnosis- can do stool samples if concerned.
Rx: rehydrate, symptomatic management
bismuth subsalicylaate (2xQDS) can be prophylactic.
principles of fungal infection
eukaryotes- membrane bound organelles and nucleus
only around 100 can cause human disease- usually in immunocompromised individulals.
yeasts- unicellular and ‘bud’ off
moulds- grow as filaments which form a mass
dimorphic- yeast in the body, moulds outside
aspergillosis clinical summary
naturally present mould.
inhailed spores–> if immunosuppressed spors develop and grow in the lungs.
destroy enironment and invade blood vessels–> disseminate.
if abnormal lung structure–> aspergilloma–> a dense ball of fungi in the lungs–> haemoptysis, SOB.
can also cause allergies.
Ix:
bronchoalveolar lavage
PCR, histology, galactomannan (spec fungi antigen)
Rx: voriconazole + pred.
pneumocystis jirovecii clinical summary
yeast style fungi
Occurs in those with HIV CD4<200
RF: immunosuppression
cancer- espesh haem. organ rejection.
S+S: cough + fever over a few weeks.
worsening of hypoxia on exertion
Ix:
CXR: diffuse bilateral interstitial infiltrates.
FBC: high ldh, high B-D-glucan
PCP CANT BE CULTURED IN A LAB.
Rx:
co-trimoxazole iv/po, 3/52 high dose.
steroids if hypoxic in HIV pts.
when is it chronic hep b
when someone has the surface antigen present for more than 6/12.
e antigen is the marker for iniectivity. (HBeAg).
antiHBs present if have been vaccinated.
which one is particularly bad in 3rd trimester pregnancy (hepatitis)
hep E.
