Lecture 34: AIDS and headache Flashcards
Risk of transmission of HIV per unprotected episode?
man to man - 1%
man to woman - 0.1%
woman to man - 0.1%
Mother to infant - 25% at delivery + 12% with breastfeeding
(all of these are without treatment and a normal untreated viral load)
Two broad categories of fungi?
Yeasts (round or oval and reproduced by budding - look . little like gram pos cocci. = eg. candida albicans and crytococcus neoformans )
Moulds (coloured and fluffy in appearance - respoduce by generation of spores on conidia extending from tubular hyphae eg. dermatophytes infect the skin + aspergillus species is less common)
Candida albicans whas gud? causes
Commensal of mouth, gut and vagina
Overgrowth related to antibacterial therapy, immune suppression, hormonal effects, foreign bodies
Causes: (however, usually kept under control well)
- oral or vaginal “thrush” - not often on tongue rather on the soft palate
- cutaneous or nail candidiasis (in places that are regularly moist for some reason)
- urinary catheter-related bladder infection
- rare systemic infection
Treatment of candidiasis?
Because it is on a mucosal surface it can usually be treated topically (sometimes orally)
- Bystatin suspension or pastilles
- amphotericin B pastilles
- Azole pessaries or cream
Has been an area of “alternative medicine” fantasy overgrowth in gut etc. (do this test to see if it’s the cause of your tiredness, headaches blah blah blah)
Cryptococcus neoformans?
The “other” yeast that is very much rarer and some types are associated with pigeon faece or eucalyptus trees - environmental contamination is common
If immune system is not good then it uses the lungs as a way of getting in before establishing itself in the blood and colonising the surface of the brain (meninges) - only in eople with severe immunodeficiency
Meningitis in immunodeficient people
Chronic lymhocytic meningitis - slow deterioration in mental state with head ache and fever
Diagnosis of crytococcal meningitis? Treatment?
Usually 10-100 (not 1000s) of WBC in the CSF with lymphocytes not PMN predominance. Raised protein and lowered glucose.
Will have a fever and feel unwell
Encapsulated yeasts with india ink stain + C neoformans grown on agar.
ElISA test can also be done
Approx 6 weeks of IV antibiotics needed for full recovery
Dermatopytes cause ___?
Tinea: capitis, corporis, cruris etc.
“never” invasive and can have human or animal hosts
A range of moulds from a range of families
Treated with anti-fungal creames (azoles: eg. clotrimazole) and often don’t need to be tested (can use oral agents or nails to ensure enough gets to the infection site)
Diagnosed using microscopy or agar growth
Aspergillus fumigatus?
A spore bearing branching mould that is widespread in rotting vegetation.
A RARE cause of severe disease in neutropenic patients and can also cause allergic bronchopulmonary aspergillosis.
