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MSII Micro Unit 1 > Pediculosis and Syphils > Flashcards

Pediculosis and Syphils Flashcards

1
Q

pediculus humanus capitis

A
  • scalp, esp behind ears
  • egg sac and thinner adult body
  • classic presentation is schoolgirls sharing hair accessories
  • insecticidal shampoo TWICE- 10 days apart plus nit combing
  • hot wash all clothing and linens, check family and classmates
  • allergic reactions to louse saliva, secondary staph infection
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2
Q

pediculus humanus corporis

A
  • clothing, especially seams
  • life cycle
  • classic presentation- homeless
  • refer for services; improve hygiene
  • discard clothing, or wash plus insecticide treatment
  • can transmit typhus, trench fever, relapsing fever
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3
Q

pthirus pubis

A
  • pubic hair
  • looks like a crab
  • sexually promiscuous
  • shave pubic hair or coat with vaseline
  • hot wash all clothing and linens, check partners and children
  • marker for other STDs, condoms not protective
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4
Q

t. pallidum bacteriology

A
  • small- 0.25 microM diameter means invisible to light microscope
  • delicate- can’t survive outside host
  • motile- corkscrew motion
  • human restricted in nature
  • cannot be grown in culture
  • extremely infectious sexually
  • virulence based on immune evasion
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5
Q

t pallidum pathogenesis

A
  • transmitted by sexual contact (acquired), blood, transplacentally (congenital)
  • national plan to eliminate in US has hit bumps; working among whites, women, not among man MSM, slowing among minorities
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6
Q

acquired t pallidum

A
  • penetrates mucous membranes or small abrasions, grows in blood vessel endothelium, enters lymphatics and bloodstream
  • CNS invaded relatively early, though symptoms take years to develop: first CSF abnormalities, then meninges, then parenchyma of brain and spinal cord
  • host raises antibodies: specific anti-treponemal and non specific reagin
  • immunity is incomplete- surface of spirochete is non-immunogenic, and spirochete downregulates TH1 cells
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7
Q

primary syphilis

A
  • painless chancre at site of transmission 3-6 weeks later, highly infectious
  • inflammatory infiltrate at site fails to clear organism
  • chancre heals 3-12 weeks
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8
Q

secondary syphilis

A
  • 4-10 weeks, spirochete multiplication, systemic symptoms
  • fever, malaise, myalgias, arthralgias, lymphadenopathy
  • mucocutaneous lesions of variable types, condylomata lata, patchy alopecia (moth eaten)
  • high antibody titers
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9
Q

latent syphilis

A
  • end for 2/3
  • organism remains
  • secondary symptoms resolve, may return intermittently over the years
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10
Q

tertiary syphilis

A
  • 1/3 untreated, fatalities possible
  • gummatous syphilis- granulomatous lesions with rubbery necrotic center
  • primarily liver, bones, testes
  • cardiovascular syphilis- over 10 years- aneurysm of ascending aorta, inflammation of vasa vasorum
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11
Q

neurosyphilis

A
  • syphilitic meningitis early (6 mo)
  • meningovascular syphilis, damage to blood vessels of meninges, brain, spinal cord
  • parenchymal neurosyphilis:
  • tabes dorsalis- damage to spinal cord- top of foot loses sensation
  • disruption of dorsal roots- loss of pain
  • general paresis- damage to cortical brain
  • dementia
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12
Q

congenital syphilis

A
  • treponemes readily cross placenta and infect fetus
  • miscarriage/stillbirth/ neonatal death 40-50%
  • within first two years, surviving infants develop severe secondary syphilis
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13
Q

syphilis and HIV

A
  • ulcerations of syphilis facilitate HIV infection

- HIV immunosuppression accelerates syphilis course, reduces efficacy of treatment

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14
Q

syphilis diagnosis-exam

A
  • the great imitator
  • time course of sx- primary 3 weeks
  • chancres are raised, red, firm buttonlike structure up to several cm, heal in 4-8 weeks
  • not painful unless super infected
  • site may be genital or other intimate
  • local lymph node swells with invasion
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15
Q

exam secondary

A
  • beings 4-10 weeks after primary, peaks 3-4 mo after infection
  • may be subtle
  • first round rash is bilaterally symmetrical, with generalized non-tender lymphadenopathy, round pink spots, 5-10 mm
  • second batch of lesions appears days or weeks later, palms and something necrotic
  • patchy alopecia
  • condylomata lata
  • mild constitutional symptoms- malaise, headache, anorexia, nausea, aching pains in the bones, and fatigue, fever, and neck stiffness
  • syphilitic meningitis
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16
Q

condylomata lata

A
  • reddish brown papular lesions on the penis or anogenital area
  • can coalesce into large elevated plaques up to 2-3 cm diameter
  • lesions usually progress from red, painful, and vesicular to gun metal grey
  • sometimes confused with venereal warts
17
Q

tertiary syphilis exam

A
  • 3-10 year after infection, years of inflammation
  • gumma= bone, deep boring pain worse at night, skin-hyperpigmented circle, often of lowe leg, asymmetric, few grouped close
  • liver jaundice
  • cardiovascular syphilis, aorta or other major arterial scarring, diastolic murmur with a tambour quality, aortic dilation with insufficiency
  • meningovascular syphilis- 5-10 years after infection, endarteritis affects small blood vessels of the meninges, brain, and spinal cord
  • CNS vascular insufficiency or stoke
  • parenchymal neurosyphilis- 15-20 years after primary infection
  • argyll-robertson pupil
18
Q

argyll robertson pupil

A
  • hallmark of neurosyphilis
  • one or both pupils fail to constrict in response to light
  • but they do constrict to focus on a near obkect
19
Q

imaging for exam

A
  • CT for gummas
  • chest radiograph, angiograph for cardiovascular syphilis
  • CT and MRI for neurosyphilis
  • lumbar puncture for neurosyhilis or syphilis + HIV
  • VDRL, cell count, protein
  • PCR for evidence of past infection
20
Q

lab diagnosis

A
  • wont culture, too small to gram stain
  • swab moist cutaneous lesions for darkfield microscopy or IF
  • for neuro, use CSF for tests, specific but not senstitive
  • serology- first, non treponemal serology screening using venereal disease research lab (VDRL), rapid plasma reagin (RPR), or ICE syphilis recombinant antigen test
21
Q

VDRL/RPR flocculation assay

A
  • reagin + ox heart extract= aggregates if you have it
  • cheap
  • easy
  • semiquantitative titer decreases with successful treatment
22
Q

lab diagnosis 2

A
  • confirm positive/equivocal results with treponeme specific tests
  • fluorescent treponemal antibody absorption
  • quantitative VDRL/RPR
  • microhemagglutination assay MHA-TP
  • t pallidium hemagglutination TPHA
  • t pallidum particle agglutination TPPA
23
Q

lab for primary

A
  • dark field

- RPR/VDRL +/-

24
Q

lab for secondary

A
  • RPR, VDRL
  • TPPA
  • AIA, FTA
25
Q

lab for tertiary

A
  • TPPA, AIA, FTA

- RPR and VDRL +/-

26
Q

histology

A
  • endarteritis caused by binding of spirochetes to endothelial cells mediated by host fibronectin
  • plasma cell rich infiltrate- delayed hypersensitivity to t pallidum leads eventually to gummatous ulcerations/ necrosis
27
Q

t pallidum treatment

A
  • penicillin- benzathing penecillin G
  • full panel of STD tests
  • kills bacterial over weeks of slow release, no known resistance
  • tertiary/ neuro damage may not heal
  • congenital, treat mother by month 5, if allergic desensitize her and still treat
28
Q

prevention

A
  • condoms
  • clean needles
  • routine serologic screening of pregnant, planning, and post partum women
  • notification of exposed sexual and drug partners
29
Q

yaws and pinta

A

-both will give RPR and VDRL pos results

30
Q

yaws

A
  • treponema pertenue
  • tropical areas of africa, asia, south america, ocean
  • few thousand cases per year, usually peds
  • overcrowding and poor sanitation
  • transmitted by direct contact with skin lesions
  • multiple stages similar to syphilis, but without neuro/cardio involvement
  • penicillin G
31
Q

pinta

A
  • treponema carateum
  • skin lesions, primarily young adults, probably passed by direct contact
  • very similar to yaws except for hyperpigmentation and restriction to skin- no constitutional symptoms
  • a few hundred cases/ year in central and south america
  • entirely human restricted
  • penicillin G
32
Q

summary 1

A
  • pediculosi is caused by three types of lice
  • head is schoolkids, itchy behind ears. body is homeless, itchy at night. pubic is promiscuous, itchy groin
  • diagnose by eye in office, mag glass, microscope
  • head and pubic nits on hair, body nits onclothes
  • head and body elongated, pubic wide
  • treat with 2 rounds of insecticide and nit combing and hot laundering
  • check close contacts, inform all contacts
  • pubic- STD panel
33
Q

summary 2

A
  • treponema:
  • too small to see by standard microscopy, need darkfield
  • cant be cultured
  • invade lymphatics and bloodstream right away, no build up
  • virulence based on immune evasion- low IF
  • t pallidum transmitted sexually or congenitally, yaws and pinta by direct contact
  • humans raise mostly useless antibodies, in quantity (reagin)
  • syphilis has four stage disease- 1 chancre, 2 body wide rashes, condylomata lata, and patchy alopecia, latent period, 3 gummas, neuro, cardiac
  • neurosyphilis may be meningitis, tabes dorsalis, general paresis, check for argyll robertson pupil
  • congential syphilis kills 50% fetus/newborn, survivors are infected, bone deformities, interstital keratisis, progress rapidly to symptoms of secondary and tertiary syphilis if untreated
  • diagnosis depends on assembling accurate timecourse of the many varied symptoms, patient may have ignored early ones that appeared to resolve
  • labs- VDRL, RPR, confirm exposure with tests for specific antibodies, histo of lesions shows infiltrate
  • treat with penicillin G

MSII Micro Unit 1 (5 decks)

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