Sunday, June 30, 2013

GENITAL HERPES


GENITAL HERPES

Definition
Infections of the genital and surrounding areas
Herpes simplex virus (HSV)
Vesicles / erosion / ulceration in groups on the basis of  
  superficial erythematous
• Frequent relapses
Sexually transmitted diseases, need attention:
   - It is hard to recover
   - Frequent recurrences
   - Transmission of the virus can occur from asymptomatic patients
   - Effects on pregnancy and infant / fetus in the womb
   - The effect on immunocompromised patients
   - Impact of psychiatric

Etiology
HSV 1
HSV2

Herpes Simplex Virus
HSV 1:
   - Contact nonsexual
   - 50-100% adult population
   - 80% Orolabial infection, 20% genital
   - Early life
HSV 2:
   - Sexual Contact
   - 5-95% adult population
   - 80% genital, 20% Orolabial
   - Period of sexually active

Pathogenesis
Exposure to HSV infection can occur:
   - Episode I primary infection (initials)
   - Episode I non primary infection
   - Recurrent Infections
   - Asymptomatic
   - Not an infection


Primary Infection
Viru Hospes body
There was merging with the Hospes DNA
Conducting multiplication / replication -> abnormalities in skin
no specific antibodies
extensive lesions, severe constitutional symptoms
The virus propagates through sensory nerve fibers to the sacral  
  ganglion, silent and latent

Latent infection
Without symptoms
Basal ganglia

Factors Originator
Trauma
Excessive Coitus
Fever
Indigestion
Stress the emotions
Fatigue
Food that stimulates
Alcohol
Drugs (immunosuppressive, corticosteroid)

Recurrent Infections
Opinions occurrence:
   - Trigger factors -> reactivation of the virus in the ganglion. Virus  
      down through peripheral nerve axons to skin epithelial cells  
      disarafinya, experiencing replication, multiplication-> lesions
   - Virus continuously released into epithelial cells. Originator + ->
      local weakness -> recurrent lesions

Clinical Symptoms
The incubation period ranges from 3-7 days, much longer.
The clinical manifestations are affected:
   - Factor Hospes
   - Previous exposure to HSV
   - Episode History
   - Type of virus
Symptoms can be asymptomatic severe, retrospective study 70%  
   of asymptomatic HSV-2 infection
Burning, itching lesion area (a few hours before the lesion +)
After the lesions arise, constitutional symptoms (malaise, fever,  
   muscle aches)
Vesicles groups, easily broken -> multiple erosions,  
  erythematous base
Secondary infection -> recover 5-7 days, scarring -
Infection initials
   - Heavier, longer
   - Regional lymph nodes are enlarged, painful
   - Healing time -> 2-4 weeks, following attacks faster
   - Can occur dysuria (lesions in the urethra, periurethral), urinary 
      retention can
   - Infection in the cervix -> change diffuse, multiple ulcers, large  
     ulcers and necrotic. Can be asymptomatic.
• Recurrent infections
   - Can happen sooner or later
   - Symptoms lighter
   - Pain, itching +, + prodromal symptoms
   - Lesions are local
   - Healing faster 2 weeks
   - Specific antibodies +
• Place predilection:
 
- Men :
• prepuce, glans penis, shaft of the penis, urethra, anal area.
• The area of ​​the scrotum is rarely
  
- Women :
• The labia major / minor, clitoris, introitus vagina, cervix
• Perianal, buttocks, mons pubis rarely

Genital Herpes in Pregnancy
• Pregnant, arising genital herpes -> need attention
• Viruses -> placenta to the fetal circulation -> damage, fetal death
• Infection neonatal mortality rate 60%.
• Half of neurological disability living, or eye disorders
• encephalitis, microcephaly, hydrocephaly, koroidoretinitis,
   keratokonjunctivitis, hepatitis, skin lesions
• Transmission trimester I -> abortion,
trimester 2 -> preterm,
   intrapartum transmission

Genital herpes in immunodeficiency
• Abnormalities quite progressive → ulcers in anogenital region
• more extensive lesions
• Immunodeficiency not heavy → recurrence is more frequent, longer 
   healing

Complication
• Most Dreaded → newborn
   - Early pregnancy abortion → / Congenital malformations (microcephaly)
   - Babies born, mother → genital herpes hepatitis, severe infections, 
     encephalitis, keratokonjuntivitis, skin eruptions, stillbirth
• Meningitis herpetika → HSV 2
• Encephalitis → HSV1
• Expansion of local spread of the virus ektragenital

Diagnosis
• Clinical:
   - Group of multiple vesicles, previous history of similar lesions
  
- Pain
• Differential diagnosis:
   - Ulcers due to Treponema pallidum,
   - Ulcers because Haemophylus ducrey
   - The cause of non-infectious
• The simplest, test tzank, paint Giemsa -> giant cell nuclei lot
• Electron microscopy -> herpes virus group indistinguishable
• Tissue culture -> the best way. High viral titers, positive results 
   within 24-48 hours. Long and costly
• HSV antigen detection tests -> faster
   - In imunologik: immunofluorescent, imunoperoksidase, ELISA
• ELISA, determine the presence of HSV antigen. Sensitivity 
   of 95%, very specific. Time of 4.5 hours. Able for 
   the detection of antibodies to HSV in serum
• Imunoperoksidase indirect, direct immunofluorescence using 
   polyclonal antibodies -> positive and false negative results. 
   Monoclonal antibodies in immunofluorescence -> determine 
   the type of virus
• Imunoflouresensi indirect lesion scrapings, sensitivity 78-88%

Management
• Purpose:
   - Prevent infection (prophylactic therapy)
   - Shortening the period of illness and frequency of complications
     of primary infection
   - Prevent happen latency and clinical recurrence after first episode
   - Preventing recurrences in asymptomatic
   - Reduce disease transmission
   - Eradication of latent infection
• Currently only a few objectives that can be met

Prophylaxis Treatment
• Lighting the nature of the disease, can be transmitted when any 
   attack -> abstinensia
• individual protection, use a tool with a foam barrier spermisidal
  and condoms.
• Avoiding precipitating factors
• psychiatric consultation, stress -> attack

Treatment of Non-Specific
• Pain and other symptoms with analgesic, antipyretic and antipruritic
• The drying agent antiseptic, povidone iodine dry lesions, prevent
   infection, speed up healing
• Antibiotics to prevent secondary infection

Specific Treatment
• Infection initials / first episode:
   - Acyclovir 200 mg orally, 5 times daily for 7-10 days
   - Acyclovir 3 x 500 mg / day
   - Or Valacyclovir, 500 mg orally, 2 times a day for 7 days
   - Reduces the formation of new lesions, reducing the length of pain, 
     reduced wound penututupan time, the proliferation of viruses.
   - Does not affect the course of disease

Treatment
Recurrent infections
   - Acyclovir, 200 mg orally, 5 times a day, for 5 days
   - Or Valacyclovir, 500 mg orally, 2 times a day, for 5 days
   - Or mild conditions, acyclovir cream.
   - Treatment done since the prodromal period or within 1 day after 
      the onset of lesions.
   - Treatment of genital lesions shortening
Suppressive:
   - Acyclovir, 400 mg orally, 2 times a day, continuously.
   - Or valacyclovir, 500 mg orally, once daily
   - Treatment will reduce the frequency of relapse.
   - This treatment reduces but does not stop the proliferation of  
      the virus is asymptomatic
disease with severe symptoms:
   - Acyclovir, 5-10 mg / kg body weight, given intravenously every  
     8 hours, for 7-10 days or until clinical improvement is achieved
Co-infection with HIV:
   - It can include skin and mucosal ulceration or persistent and  
      severe -> wide area
   - The lesions are very painful, atipis
   - Response by acyclovir +, the dose was increased over a long period
   - Acyclovir 400 mg orally 3-5 times per day until the lesions are healed.


Thursday, June 27, 2013

TRICHOMONIASIS VAGINALIS


TRICHOMONIASIS VAGINALIS
 


Definition :
Infection caused by Trichomonas vaginalis.

Trichomonas Vaginalis
• Shaped ovoid
• Size 10-20 mmikron
• Has four flagella movement Dengah
• Perform attachment to the mucous membranes
• It anaerobic.

Pathogenesis
• Infection of the most genito urinary tract.
• Women most of the vagina.
• Can the urethra and Skene kel.
• Isolation of the bladder
• Men more in-urethra.
• Symptoms can be asymptomatic, mild symptoms, to acute and    severe inflammation.
• Secretion contains many pmnl
• The smell is like a fishy fish.
• Women> Men (asymptomatic)
• Sexual and Non-Sexual Transmission
• Non-venereal transmission in infants
• Survive for 45 minutes in the toilet, tub of water.

Occurred In Women
Incubation period: 5-28 days
Complaints and symptoms
• Symptoms (20% -50%).
• complaints and symptoms:
   - Vaginal secretions little to much diluted
   - Yellow / greenish foamy (10% - 30%) à classical
   - Smelling.
   - Vulvitis and vaginitis.
   - When the number of germs aplenty → strawberry cervix (2%)
   - Discomfort in the lower abdomen.

Occurred In Men
Complaints and symptoms :
• a female partner who is infected
• complaints and symptoms:
   - Urethritis light
   - Asymptomatic



LABORATORY
In women:
• vaginal pH > 5
• Test amin / whiff test can be positive
• Microscopic (wet preparation):
  - Looks Trichomonas vaginalis with the movement "flagella" typical

In men:
• Urine Sediment: Trichomonas vaginalis

MANAGEMENT
• Metronidazole 2 x 500 mg po (7 days)
                 
or
   2 g po single dose
• Sexual partners should be treated
• In pregnancy:
  - The entire period of pregnancy: Metronidazole 2g single dose po

COMPLICATIONS
Pregnant women:
• premature parturition
• Low Birth Weight Babies

Wednesday, June 26, 2013

GONORRHEA


GONORRHEA
Definition
All diseases caused by Neisseria gonorrhoeae, a gram negative 

  diplokokus
Generally about :
      -          Urethral
      -          Endocervical
      -          Rectum
      -          Pharyngeal
      -          Conjunctiva
hematogenous spread:
DIG (Disseminated Gonococcal Infection)


Gonorrhea Attack
Men
- Urethra
- Ex tyson
- Ex Cowper
- Ex parauretra
- Prostate
- The epididymis
- Testis
- Conyunctiva
- Larinks
- Pharinks
- rectum

Women
- cervix
- Bartholin
- Ex skein
- Salphinx
- Ovary
- Pid
- Joints
- Septicemia
- Pericard
- disseminated

Etiology
Gram negative
Intracellular
Diplokokus
 

Epidemiology
350 million people are infected each year
Gonorrhea 60%
Infection mixture
Developed countries Chlamydia> Gonorrhea
Cofaktor HIV / AIDS.
The received treatment and recovered about 10%

Pathogenesis
Adhesions (pili and surface proteins)
Epithelial cells penetrate the network.
Pmnl
Micro abscess
Deployment

Clinical
incubation 2-5 day

Clinical Symptoms :
Infection in men
anterior urethra
- Test thompson
Complaints disuri, urethral discharge
Mucus turbidity until pus


Examination
Mue: edema, erythema, ectropion, purulent discharge

Infection in women
60-80% asymptomatic.
Complaint :
vaginaldischarge
Disuri
intermenstrual bleeding
Menorrhagia
Back pain

Diagnosis
Anamnesis, clinical, laboratory
Laboratory
- Cat Gram duh body
- Culture: Thayer martin / modifications TM
- Definitive test (test oxidase, Fermentase)
- Test NGPP (Beta Lactamase, Yodometri, Penicillin disk Difusion, Thomson Tests
- Elisa
Men : materials from the body duh urethra / sed.urine / massage prostate secretions
Women : material from the urethra, srviks, estuaries kel.bartholin, rectum

Complication
Men

Tisonitis
Parauretritis
Cowperitis: pain in the perineum, disuri
Infection post urethra
vesica urinaria : polakisuri, hematuri
prostatitis : pain in the perineum, feels pain when defecating, febrile
Vesikulitis
Funikulitis
Epididymitis: febrile, edema, scrotal skin inflammatory signs (+)
Infertility

Women
Bartholinitis: labium Mayus edema (tu. third bottom),  

  signs of acute inflammation
PRP scarring, tubal infertility
salpingitis
Disseminated: Arthritis, myocarditis, endocarditis, pericarditis,

   meningitis and dermatitis

Therapy
Consider, effectiveness, single dose, side effects, site of infection, resistance, the possibility of infection of C. trachomatis simultaneously

Anogenital Infection, Complications (-)
First-Line

Cefixime 400 mg/single dose oral

Second-Line
Ciprofloxacin* 500mg/oral single dose
Ofloxacin* 400mg/oral single dose
Spektinomisin 2g single dose intra-muscular

*) Is not recommended in children / adolescents

 
 


CHLAMYDIA TRACHOMATIS



CHLAMYDIA TRACHOMATIS

Chlamydia trachomatis consists of 15 serovars :
A, B, Ba, C: causes trachoma
D, E, F, G, H, I, J, K: causes of genital tract infections, conjungtivitis, infantile pneumonia
L1, L2, L3, causes LGV (lymphogranuloma venereum)

Epidemiology :
Th. 1997:> 500,000 cases (200/100.000 population)
United States: 3-4 million cases / year
WHO: 90 million cases

Cause :
Chlamydia trachomatis serovar D, E, F, G, H, I, J
Have a cell wall and cell membrane
The cytoplasm containing DNA and RNA
Multiplication only on cells (obligate intracellular)
Establish inclusions in the cytoplasm
Antigen: MOMP (major outer membrane protein), lipopolysaccharide, HSP (heat shock protein)
Causing the immune response: the formation of antibodies and cellular immunity

Chlamydia Trachomatis
Process of entry into the cell :
1. Elementari inherent in the cell body
2. Entry into the cell
3. Berfubah be retikulate body (grow and reproduce)
4. Transformed into the body Elementari
5. Released to infect.

Chlamydia Infection In Men
Symptomatic: 25% of cases
milder symptoms of gonorrhea
   - Urethral discharge
   - Dysuria
   - Epididymitis
   - Prostatitis.
Can cause infertility
Incubation :7-21 days


Other Forms Clinic
Epididymitis
Prostatitis
proctitis
Reiter syndrome

Sal Genital Chlamydia Infection In Women
Asymptomatic: 60-80%
Symptoms:
   - Purulent vaginal discharge
   - Servicitis mukopurulen
   - Lower abdominal pain
   - Post coital / intermenstrual bleeding
   - Dysuria
   - Pelvic inflammatory disease (PID)
Can lead to extra uterine pregnancy, infertility, cervical atypia Celluler

Cervicitis
Striking a cylindrical cervical epithelial
It is difficult to distinguish from other processes in the cervix inflammasi
Symptoms:
   - Discharge mukopurulent
   - Hypertrophic Ectopia
   - Postcoital bleeding
   - spotting
Criteria alleged cervicitis:
   - Cervical smear PMN> 15 PLP
   - Erythema, edema, bleeding easily
C. trachomatis serotype G could develop into SCC


Other Clinical Forms
Bartholinitis
Endometritis
salpingitis
perihepatitis

Laboratory Examination Of Chlamydia Infection
Detection of Chlamydia :
Cell culture
DFA (Direct Fluorescent Antibody Assays)
EIA (Enzyme Immunoassays)
hybridzation RNA-DNA (PCR and LCR)

Serology :
Microimmunofluorescence (MIF)
ELISA (Enzyme-lnked immunosorbent assay) IgM, IgA, IgG


Treatment :
Doxycycline 2 x100 mg for 7-10 days
Erytromisin 2 g / day for 7-10 days
Azithoromycin 1000 mg single dose


Tuesday, June 18, 2013

PEDIATRIC INFECTIOUS DISEASES

PEDIATRIC INFECTIOUS DISEASES
Infection is an attempt organism to survive
   - Virus without cytoplasm, must enter into another cell
   - Germs go into organ
   - Parasites / worms in the gut / blood
Victory is temporary: the change is lasting: adaptation and mutation, addition and deletion
supportive climate throughout the year
Eradication of mosquitoes is against nature

Pyramid of infection and illness prevention

 
ENVIRONMENT
Tropical belt full environmental battle of life,
deprived of food, both carbohydrate and protein.
Population density and environmental pressures
"Rapid population growth and very greedy for natural resources, causing changes in the chemical and biological balance of the world"


Violation of the rules of health and hygiene sanitation
Uncontrolled urbanization
   - Displacement (displaced) due to rapid population disaster
   - Causing density and density and trigger lack shelter, water, sewage
Cause the more rapid transmission of the disease

GERM
Germs that cause infections should have the ability to:
Perform invasion
Multiplication
Transmission to another individual

Germs are designed to survive in extreme conditions, is able to live
   - Up to 10,000 m in the soil
   - A few thousand feet in the air
   - In a volcano
   - In the dust spores of Cl. tetani
In the human body there are cells prokaryotik 10 more than the cell Eukaryotic Structural


CONDYLOMA ACUMINATA





  • Cause: Human Papilloma Virus
  • Epidemiology :
1. including sexually transmitted diseases
2. Men = women
3. Transmission of direct skin contact

  • Clinical
1. Predilection: perianal, vulvar, penile region
2. Papulae wet pink or flesh color that grows like very much.
3. Often clustered forming lesions
like cauliflower.
  • Condyloma acuminata are usually asymptomatic
  • Treatment:
1. caustic materials
2. for example: AgNO3
25%, As.trikloroasetat
3. Frozen Surgery - Surgery electricity
4. Surgical scalpel - Laser Surgery

  • Caustic Materials
1. Tingtura prodofilin 25%
2. 50% trichloroacetic acid