Answers No. 41 - 60

41. Cutaneous leishmaniasis. Etiology, ways of transmission, clinical signs, diagnostic, treatment

Etiology-

Leishmaniasis is a parasitic infection caused by many species of the protozoa Leishmania.One of the most common forms of the disease is cutaneous leishmaniasis that occurs most commonly (over 90%) in Iran, Afghanistan, Syria, Saudi Arabia, Peru and Brazil.

Classification of cutaneous leishmaniasis.

l  Old world (middle east,north africa,asai)

L. tropica, L. major, L. infantum, L. Aethiopica

l  Americans (central and south america)

L. tropica mexicana, L. braziliensis, L. amazonensis

Ways of transmission -

Leishmaniasis is spread by the bite of infected sandflies.

Clinical signs-

Most common form causing one or more sores on the skin

Initially lesion is a small red papule up to 2cm in diameter.

Over several weeks, papules become darker and form ulcers with raised edges and central crater.

Ulcers can be moist and exude pus or dry with a crusted scab

Sores usually appear on exposed areas of the skin, especially the face and extremities

Lesions may occur immediately after the bite of an infected sandfly or may incubate for weeks or months before causing any sores

Sporotrichoid spread, i.e. lymphocutaneous nodules, may occur.

Diagnosis-

Diagnosis of cutaneous leishmaniasis is usually based on the appearance of the lesion. In over 70% of cases, skin biopsy can reveal the parasite.

Treatment-

No chemoprophylaxis for travelers exists. OWCL: Delay specific treatment until ulceration occurs, allowing protective immunity to develop, unless lesions are disfiguring, disabling, persist .6 months.

l  Lesional Therapy -Local injection of antimonials with or without steroids, cryosurgery, ultrasound-induced hyperthermia, excision, electrosurgery. Topical 15 % paramomycin sulfate, 12 % methylbenzethonium chloride in white paraffin twice daily for 10 days.

l  Systemic Therapy -Sodium antimony gluconate (Pentostam) IV or IM in single daily dose of 10 mg/kg for adults and 20 mg/kg for patients <18 years of age for 10 days. Meglumine antimoniate (Glucantime) 20 mg/kg daily for 10 days. ECG control. Amphotericin B or pentamidine or sodium antimony gluconate plus interferon gamma for resistant cases. Ketoconazole.

l  Combined Immunotherapy Leishmanial antigen in BCG.

42. Malignant melanoma: diagnostic, differentials, treatment, prognosis.

Melanoma is a potentially serious type of skin cancer, in which there is uncontrolled growth of melanocytes (pigment cells). Melanoma is thought to begin as uncontrolled proliferation of melanocytic stem cells that have undergone genetic transformation.Melanoma is sometimes called malignant melanoma.the highest reported rates of melanoma in the world are in Australia and New Zealand.

Diagnosis-

Melanoma may be suspected because of a lesion’s clinical features or because of a history of change. The dermatoscopic appearance is helpful in the diagnosis of featureless early melanoma. Some melanomas are extremely difficult to recognise clinically.

The suspicious lesion is surgically removed with a 2 to 3-mm clinical margin for pathological examination (diagnostic excision). Partial biopsy is best avoided, but may be considered in large lesions.

Differentail diagnosis-

Melanoma is differentiated from nevus-cell nevus, Spitz nevus, basal cell carcinoma, pyogenic granuloma, squamous cell carcinoma, verruca, angiosarcoma and subungual hematoma

Treatment-

Following confirmation of the diagnosis, wide local excision is carried out at the site of the primary melanoma. The extent of surgery depends on the thickness of the melanoma and its site.

Prognosis-

The prognosis is estimated by Breslow thickness (mm), which is the thickness of melanoma cells from the deepest area of the skin to the epidermal granular layer. Nearly all cases with lesions 1 mm or thinner have a 100% survival rate; the 5-year survival rate in cases with lesions thicker than 4 mm is 50%. TNM classification made by Union Internationale Contra le Cancer (UICC).

43.Squamous cell carcinoma(SCC): clinical signs, diagnostic, differentials, treatment.

 SCC induced by sunlight exposure is most common in geographic areas that have many days of sunshine annually and are inhabited by fair-skinned individuals.

Clinical signs-

Small papules and nodules appear on preexisting lesions, gradually extend, and form tumors or intractable ulcers.They proliferate, taking on a cabbage-like appearance.

The skin lesion is often accompanied by keratinous substance and crusts. When the surface of the lesion ulcerates, bacterial secondary infection accompanied by distinct odor occurs.

SCC tends to spread to the regional lymph node, which feel the firm when palpate.

Diagnosis- skin biopsy

Differential dignosis-

Keratoacanthoma, actinic keratosis and basal cell carcinoma are differentiated from SCC.

Treatment-

Surgical excision is the treatment of choice. Large lesions may require a skin graft.

In the elderly, squamous cell carcinomas of the face or scalp can be treated by radiotherapy (after an incisional biopsy for histological diagnosis).

Patients are examined for lymph node metastasis at the time of presentation: suspicious nodes are biopsied.

Radical lymph node dissection is conducted in cases with lymph node involvement.

44.Basal cell carcinoma: clinical signs, diagnostic, differential,treatment.

Clinical signs-

Basal cell carcinomas occur mainly on light-exposed sites, commonly around the nose, the inner canthus of the eyelids and the temple.  They grow slowly but relentlessly, are locally invasive, and may destroy cartilage, bone and soft tissue structures. A lesion has often been present for 2 or more years before the patient seeks advice. Often more than one tumour is evident. There are four main types of basal cell carcinoma, all of which occasionally may be pigmented.

l   Nodular-This is the commonest type of lesion and usually starts as a small, skin-coloured papule that shows fine telangiectasia and a glistening pearly edge . Central necrosis often occurs and leaves a small ulcer with an adherent crust. Usually 1cm in diameter.

l   Cystic- These become tense and translucent.

l   Multicentric- Superficial tumours, often multiple, plaque-like and several cm in diameter, are sometimes seen especially on the trunk they have a rim-like edge and are frequently lightly pigmented.

l   Morphoeic. This scarring (cicatricial) variant, most common on the face, often shows a white or yellow morphoea-like plaque that may be centrally depressed.

Diagnosis-Serious BCCs occurring in the danger sites are readily detectable by careful examination with good lighting, a hand lens, and careful palpation.

Differential Diagnosis-

The differential diagnosis depends on the type, pigmentation and location.

lentigo, blue nevus, Spitz nevus, seborrheic keratosis, chronic ulcer and chronic granuloma.The superficial type is further differentiated from psoriasis and Bowen’s disease. The sclerosing type is differentiated from localized scleroderma, discoid lupus erythematosus, granuloma annulare and keloid.

Treatment-

Surgical removal is the basic treatment. As the face is frequently affected, cosmetic surgery may be necessary. Cryotherapy and topical chemotherapy may be chosen.

If excision is difficult or not possible, incisional biopsy (to confirm the diagnosis) and radiotherapy are

suitable for those aged 60 years and over.

45. Premalignant disorders: actinic keratosis, actinic cheilitis, leukoplakia, Bowen's disease: clinical signs, diagnostic, treatment.

1)Actinic keratosis:

 Clinical signs-

diameter occurs on a sun-exposed area of the body, such as the face or dorsal hand. The plaque is covered with scales and crusts. The margin of the plaque is often vague. Keratinization is usually intense. Grayish-white keratotic nodules or horn-like protrusions (cutaneous horns) may form .The skin lesion occurs singly or multiply, most frequently in persons over age 60. Nearly all elderly Caucasians are affected. Actinic keratosis occurs in infancy in patients with xeroderma pigmentosum.

Diagnosis-

Skin biopsy.

Treatment-

The main treatments are surgical removal, cryotherapy and topical application of anticancer agents such as 5-FU and bleomycin.

2)Actinic cheilitis:

Clinical signs-

AC almost always affects the lower lip and only rarely the upper lip, probably because the lower lip is more exposed to the sun. Usually  Commissures are not involved.

Dry sensation and cracking of lips,this is usually painless.

Lesions appearance -White lesions (hyperkeratosis) ,red erosive ulcerative lesions (atrophy) ,loss of epithelium and inflammations. Red colour (erythematous), swollen (edematous).

Gray dry scaly in case of chronic.

Diagnosis-

Tissue biopsy.

Treatment-

Treatment options include 5-fluorouracil, imiquimod, scalpel vermillionectomy, chemical peel, electrosurgery, and carbon dioxide laser vaporization. These curative treatments attempt to destroy or remove the damaged epithelium.

3) Leukoplakia:

Clinical sign-

Mostly involve tongue nipple,genital membranes.

occurs as a precancerous lesion is slightly infiltrative, smooth-surfaced, keratinous, verrucous, papillary and/or erosive. The epidermis thickens from keratinous proliferation. There is high malignancy when an erythroplasia-like lesion is produced.

Diagnostic-

Skin biopsy is necessary to determine whether the lesion is malignant or benign. If there is malignancy, treatment should be done accordingly. If benign, investigation should be made for the underlying disease.

Treatment-

When there is the possibility of leukoplakia being precancerous, surgical removal, topical 5-FU application, laser therapy or cryotherapy is conducted. Smoking must be stopped.

46)Kaposi sarcoma: clinical signs, diagnostic, treatment.

Clinical signs-

Kaposi’s sarcoma occurs on the extremities, particularly on the feet, gradually spreading to the proximal areas. Multiple, purplish-brown patches or angioma-like papules appear in the skin, mucosa and internal organs  rapidly spreading and forming elevated plaques that become firm nodules. The progression begins with a patch stage, followed by a plaque stage and then a nodule stage. The eruptions themselves are largely painless; however, secondary lymphedema causes sharp pain. In progressive cases, infiltration occurs in the lymph nodes, gastrointestinal tract, liver, lungs and bones, causing various symptoms.

 Diagnosis-

Skin biopsy.Stool for occult blood.Incase of lesions in rectum.

Chest Xray,Bronchoscopy.gastrointestinal endoscopy tests.

Treatment-

Irradiation therapy and combination chemotherapy are the main treatments. Surgical removal may be conducted on localized lesions.

47.Syphilis, pathogen, its properties, ways of transmission, incubation period, classification.

Properties,pathogenesis and way of trasmission-

Syphilis is caused by the spirochete Treponema pallidum. Infection in all races and in mostly 20 -29 aged people are effected world wide but also less number above and below this age period.

The route is contact infection (acquired syphilis) or intrauterine infection (congenital syphilis). Acquired syphilis is caused by sexual activity in most cases; however, it may be transmitted in healthcare workers non-sexually through work.nearly half of all males with syphilis in the United States were homosexual, but this percentage has decreased due to safer sexual practices. The incidence of syphilis, however, has markedly increased in minorities and is associated with exchange of sex for drugs.

In rare cases, syphilis may be transmitted by transfusion or by mother-to-child transmission from birth canal infection or breast feeding.

Incubation period-average 29-20 days.

Classifications

Primary

Secondary

Latent )Early and late )

Tertiary

Late

Congenital

48.Primary syphilis: signs of chancre and lymphadenitis, differentials, treatment

Sign of chancre and lymphadenitis-

TYPE Chancre: button-like papule that develops into a painless erosion and then ulcer with raised border and scanty serous exudate. Surface may be crusted. Size: few millimeters to 1 or 2 cm in diameter.
 Border of lesion may be raised. 
COLOR Red, “meaty colored”

PALPATION Most commonly, firm with indurated border. Painless. Extragenital chancres particularly on the fingers may be painful. Atypically, genital chancres painful, especially if secondarily infected with Staphylococcus aureus.

SHAPE Round or oval

ARRANGEMENT Single lesion. May be few or multiple; kissing lesions. Multiple chancres may occur in HIV-infected patients.

DISTRIBUTION Sites of Predilection Male: inner prepuce, coronal sulcus of the glans, shaft, base. Female: cervix, vagina, vulva, clitoris, breast; chancres observed less frequently in women because of their location within vagina or on cervix.

Extragenital Chancres Anus or rectum, mouth, lips, tongue, tonsil, fingers (painful!), toes, breast, nipple.

 Differential diagnostic-

In the differential diagnosis of any genital lesion, primary syphilis should be considered as suspect until ruled out clinically and by specific testing. Chancroid, genital herpes, fixed drug eruption, lymphogranuloma venereum, donovanosis, traumatic ulcer, furuncle, aphthous ulcer.

Treatment-

Benzathine penicillin G, 2.4 million units IM, in one dose.

Alternative Regimen for Penicillin-Allergic Patients (Nonpregnant) Doxycycline 100mg, Tetracycline, 500 mg  Erythromycin, 500 mg Ceftriaxone.

 (An acute febrile reaction, often accompanied by chills, fever, malaise, nausea, headache, myalgia, arthralgia, that may occur after any therapy for syphilis. May occur within hours after treatment, subsiding within 24 hours. More common in patients with early syphilis; developing lesions of secondary syphilis may first appear at this time. Treatment: reassurance, bed rest, aspirin. Pregnant patients should be warned that early labor may occur.)

49.Secondary syphilis: types of skin lesions, differentials, treatment.

Types of skin lesions-

 Macules (pink)and papules (brownish red) 0.5 to 1.0 cm, round to oval. However, may be papulosquamous, pustular, or acneform. Vesiculobullous lesions occur only in neonatal congenital syphilis (palms and soles). Condylomata lata: soft, flat-topped, moist, red-to-pale papules, nodules, or plaques, which may become confluent. Uncommonly, lesions of secondary syphilis and chancre of primary syphilis occur concomitantly.

Differential diagnosis-

Drug eruption (e.g., captopril), pityriasis rosea, viral exanthem, infectious mononucleosis, tinea corporis, tinea versicolor, scabies, condylomata acuminata, acute guttate psoriasis, lichen planus.

Treatment-

Same like primary syphilis.

50.Latent syphilis: classification, diagnostics, treatment.

Latent syphilis is that stage in which there are no clinical signs or symptoms of the infection. The diagnosis is made only after a careful history and physical examination have ruled out symptoms and signs of active infection

Classification-

 Early latent syphilis (<2 years) late latent disease (>2 years)

Diagnosis-

Clinical findings, confirmed by STS and lesional skin biopsy; dark-field examination always negative, silver impregnation of histologic sections for demonstration of spirochetes only very rarely positive.

Treatment-

Treatment is same as primary syphilis In period of early latent stage (1 and less than 1 year )

If more than 1 year in late latent stage,treatment is:

 Benzathine penicillin G, 7.2 million units total, administered as three doses of 2.4 million units IM, given 1 week apart for 3 consecutive weeks.

Alternative Regimen for Penicillin-Allergic Patients (Nonpregnant) Doxycycline, 100 mg for 4 weeks,or Tetracycline 500 mg 4 weeks .

51.Tertiary syphilis: clinical signs, diagnostic, treatment.

Clinical signs-

Skin lesions

NODULOULCERATIVE SYPHILIDES Simulate lupus vulgaris (cutaneous tuberculosis) Type Plaques and nodules with scars healed in the center with or without psoriasiform scales and with or without ulceration.(Typically, and in contrast to lupus vulgaris )syphilides do not recur in scars but rather on their periphery.
Brown 
Palpable
Firm 
Arrangement Grouped, serpiginous (snake-like), annular, polycyclic, scalloped borders 
Distribution Solitary isolated lesions: arms (extensor aspects), back, or face.

heart, blood vessels and central nervous system become involved (metasyphilis). The main symptoms are myocarditis, aortic aneurysm, myelophthisis and general paresis. Syphilis today rarely progresses to this stage.

Diagnosis-

Clinical findings, confirmed by STS and lesional skin biopsy; dark-field examination always negative, silver impregnation of histologic sections for demonstration of spirochetes only very rarely positive.

Treatment-

Benzathine penicillin or alternative regimen Doxycycline, 100 mg  or Tetracycline, 500 mg. Treatment repeated every 6 month.

52.Neurosyphilis: classification, clinical signs, diagnostic, treatment.

Neurosyphilis is a Treponema pallidum bacterial infection of the brain or spinal cord. It usually occurs in people who have had untreated syphilis for many years.

Classification-

There are four different forms of neurosyphilis:

Asymptomatic (most common form)

General paresis

Meningovascular

Tabes dorsalis

Clinical sign-

Symptoms usually affect the nervous system. Depending on the form of neurosyphilis, symptoms may include any of the following:

Abnormal walk (gait), or unable to walk,

Numbness in the toes, feet, or legs

Problems with thinking, such as confusion or poor concentration

Mental problems, such as depression or irritability

Headache, seizures, or stiff neck

Incontinence

Tremors, or weakness

Visual problems, even blindness

Some people have no symptoms.

Diagnosis-

Blood test, spinal fluid test

To look for the problems in nervous system, cerebral angiogram,head CT scan,lumbar puncture, for cerebral fluid analysis,MRI.

Treatment-

Antibiotic pencillin (intra venous) several time per day 10 -14 days.oraly 4 time per day for 10 -14 days.
 Blood test and CSF test should be followed for several months.

53.Inborn (congenital) syphilis: classification, clinical signs, diagnostic, treatment.

 Congenital syphilis is caused by the bacterium Treponema pallidum, which is passed from mother to child during fetal development or at birth. congenital syphilis begins with secondary syphilis and without primary syphilis.

Classification-

l  Early- early congenital syphilis occurs in children between 0 and 2 years old./.After, they can develop late congenital syphilis.

l  Late- it occurs in children at or greater than 2 years of age who acquired the infection trans-placentally.

Diagnosis-

Blood test is done (infected pregnancy mother)

An infant may have following tests:

·         Bone x-ray

·         Dark-field examination to detect syphilis bacteria under a microscope

·         Eye examination

·         Lumbar puncture.

Treatment-pencilline

54.Gonorrhea: Etiology, clinical features, diagnostic, treatment.

Gonorrhea is an acute sexually transmitted infection of the mucocutaneous surfaces of the lower genitourinary tract, anorectum, and oropharynx characterized clinically in males by a purulent urethral discharge, but in females infection is often asymptomatic; if untreated, infection can spread to deeper structures with abscess formation.

Age -Young, sexually active; infection of conjunctiva in newborns

Sex -Symptomatic infection more common in males. 
Pharyngeal and anorectal in homosexual males.

Incubation Period MALES 90 % of males develop urethritis within 5 days of exposure.
 FEMALES Usually >2 weeks when symptomatic; however, up to 75 % of women are asymptomatic.

Etiology- Neisseria gonorrhoeae, the gonococcus, a gram-negative diplococcus.

Clinical features-

Skin Symptoms Urethral discharge, dysuria. Vaginal discharge; deep pelvic or lumbar pain. Copious purulent anal discharge; burning or stinging pain on defecation; tenesmus; blood in/on stool. Mild sore throat.

Physical Examination -
Site of Infection EXTERNAL GENITALIA

l  Males Urethral discharge ranging from scanty and clear to purulent and copious meatal edema; preputial or penile edema. Balanoposthitis with subpreputial discharge in uncircumcised men; balanitis in circumcised men. Folliculitis or cellulitis of thigh or abdomen. Rare complications of anterior urethritis include infection of: parafrenal sebaceous glands of Tyson, paraurethral ducts, Littrés glands, lacunae of Morgagni, subepithelial and periurethral tissue of the urethra, median raphe, Cowper’s ducts, and glands.

l Females Periurethral edema, urethritis. Purulent discharge from cervix but no vaginitis. In prepubescent females, vulvovaginitis. Bartholin’s abscess.

INTERNAL GENITALIA Males Prostatitis, epididymitis, vesiculitis, cystitis Females Pelvic inflammatory disease with signs of peritonitis, endocervicitis, endosalpingitis, endometritis.

ANORECTUM (In females and homosexual males, proctitis with pain and purulent discharge)

OROPHARYNX (In females and homosexual males, pharyngitis with erythema.)

EYE Conjunctivitis( In newborn, organism is transmitted as newborn passes through birth canal. In adults, rare in industrialized nations but in epidemics in third world countries such as Ethiopia. Usually occurs in the absence of genital infection or rarely in adult, copious purulent conjunctival discharge. Can be complicated by corneal ulceration and perforation.)

Diagnosis-

Clinical suspicion, confirmed by laboratory findings, i.e., presumptively by identifying gram-negative diplococci intracellularly in PMNs, confirmed by culture.

Treatment-

 Most patients with incubating syphilis may be cured by any of the regimens containing ceftriaxone or doxycycline.

Cefixime 400 mg PO in a single dose or Ciprofloxacin 500 mg PO in a single dose or Oxofloxacin 400 mg PO.

55.Trichomoniasis: Etiology, clinical features, diagnostic, treatment.

Trichomoniasis is a sexually transmitted disease caused by a parasite. You get it through sexual intercourse with an infected partner. Many people do not have any symptoms.

Etiiology-

Trichomonas vaginalis.

Clinical features-

Women may have these symptoms:

·         Itching of the inner thighs

·         Vaginal discharge (thin, greenish-yellow, frothy or foamy)

·         Vaginal itching

·         Vulvar itching or swelling of the labia

·         Vaginal odor (foul or strong smell)

Men who have symptoms may have:

·         Burning after urination or ejaculation

·         Itching of urethra

·         Slight discharge from urethra

Occasionally, some men with trichomoniasis may develop:

·         Swelling and irritation in the prostate gland (prostatitis)

·         Swelling in the epididymis (epididymitis), the tube that connects the testicle with the vas deferens. The vas deferens connects the testicles to the urethra.

Diagnosis-

In women, a pelvic examination shows red blotches on the vaginal wall or cervix. Examining the vaginal discharge under a microscope may show signs of inflammation or infection-causing germs in vaginal fluids. A Pap smear may also diagnose the condition.

The disease can be hard to diagnose in men. Men are treated if the infection is diagnosed in any of their sexual partners. They may also be treated if they keep having symptoms of urethral burning or itching, even after getting treatment for gonorrhea and chlamydia.

Treatment-

Antibiotics are commonly used to cure the infection.

DO NOT drink alcohol while taking the medicine and for 48 hours afterwards. Doing so can cause:

·         Severe nausea

·         Abdominal pain

·         Vomiting

Avoid sexual intercourse until finish treatment.

56.Chlamidiosis: ways of transmission, clinical signs, complications, diagnostic, treatment.

Chlamydia is an infection caused by the bacteria Chlamydia trachomatis. It is most often spread through sexual contact.

Clinical signs-

In men, chlamydia may cause symptoms similar to gonorrhea. Symptoms may include:

·         Burning feeling during urination

·         Discharge from the penis or rectum

·         Tenderness or pain in the testicles

·         Rectal discharge or pain

Symptoms that may occur in women include:

·         Burning feeling during urination

·         Painful sexual intercourse

·         Rectal pain or discharge

·         Symptoms of pelvic inflammatory disease (PID), salpingitis (inflammation of the fallopian tubes), or liver inflammation similar to hepatitis

·         Vaginal discharge or bleeding after intercourse.

Complications-

in men

l  Inflammation of the testicles

In men, chlamydia can spread to the testicles and epididymis (tubes that carry sperm from the testicles), causing them to become painful and swollen.

l  Reactive arthritis

joints, eyes or urethra (the tube urine passes out of the body through) become inflamed, usually within the first few weeks after having chlamydia.

Complications in women

l  Pelvic inflammatory disease (PID)

In women, chlamydia can spread to the womb, ovaries or fallopian tubes.this can lead following problems infertility,pelvic pain,ectopic pregnancy,

pain during sex, pain during urination, and bleeding between periods and after sex.

l  Pregnancy complications

If not treated while pregnant, chance to pass the infection to fetus.

Premature birth,stillbirth.

Diagnosis-

Nucleic acid amplification tests (NAAT), such as polymerase chain reaction (PCR), transcription mediated amplification (TMA), and the DNA strand displacement amplification (SDA).

Treatment-

Antibiotics- azithromycin, doxycycline, erythromycin, or ofloxacin. 
Agents recommended for pregnant women include erythromycin or amoxicillin.^[

(An option for treating partners of patients (index cases) diagnosed with chlamydia or gonorrhea is patient-delivered partner therapy (PDT or PDPT), which is the clinical practice of treating the sex partners of index cases by providing prescriptions or medications to the patient to take to his/her partner without the health care provider first examining the partner.)

57.Reiter's disease: clinical signs, diagnostic, treatment.

Men in their 20s are most commonly affected. The incidence is 20 males to 1 female. Inflammatory symptoms such as urethritis (or uterocervical inflammation; most cases are sexually transmitted) and bacterial diarrhea precede Reiter’s disease.

Men aged 10 to 30 are most frequently affected. After prodromes such as diarrhea, the three characteristic symptoms of polyarthritis, urethritis and conjunctivitis occur.

Diagnosis-

When the prodromes subside, arthritis, conjunctivitis and cutaneous symptoms appear. Erythema or papules are produced in the palms and soles, coalescing to form hyperkeratotic nodules. The lesions are accompanied by pustules. Balanitis circinata (painless shallow erosion) and keratosis in nails also occur.

Treatment-

NSAIDs are used primarily. Steroids and immunosuppressants may be administered in severe cases.

58.Venereal urethrites: pathogens, diagnostics, treatment.

Venereal urethritis is comparison of gonorrhea and nongonococcal urethritis.

 the commonest sexually transmitted diseases in men, are endemic at high levels in most regions of the world, despite effective methods of diagnosis and treatment.

Pathogen-

Pathogen of gonnorrhea is neisseria gonorrhea and  pathogen of

non gonococcal urethritis are

bacterias-Chlamydia trachomatis, but it can also be caused by Ureaplasma urealyticum, Haemophilus vaginalis, and Mycoplasma genitalium.

Viral-Herpes simplex virus (rare), Adenovirus

Parasites- richomonas vaginalis

Noninfectious causes- mechanical injuries,irritating by chemical antiseptics or some spermicides.

Diagnosis-

test for the presence of gonorrhea by viewing a Gram stain of the urethral discharge under a microscope.PCR test for gonorrhea.

Treatment-

Based on antibiotic anti viral and

According to a study, tinidazole used with doxycycline or azithromycin may cure NGU better than when doxycycline or azithromycin is used alone.

59.Condyloma acuminatum: ways of transmission, clinical signs, diagnostic, treatment.

Condyloma acuminatum is caused by HPV-6 or HPV-11(human papiloma virus). Most cases occur in the sexually active years, transmitted through sexual activity. The virus invades through minor external injury of the genitalia, perianal region, or vaginal introitus, and infects epidermal basal cells, inducing abnormal cellular proliferation. Proliferation of the epidermis results in formation of papillary tumors (warts)

Trasmission way- sexual activity

Clinical signs-

The latency of condyloma acuminatum is 2 to 3 months. Multiple verrucous papules of papillary or cauliflower shape occur in the genitalia or perianal region . Keratinization is rarely present. The papules are infiltrative at the surface and may give off foul odor. Condyloma acuminatum may enlarge. Keratinization and ulceration may closely resemble squamous cell carcinoma (Buschke-Lowenstein tumor).

Diagnosis-

Condyloma acuminatum can be diagnosed by the clinical features; however, biopsy may be needed for differential diagnosis.

Treatments-

Treatment for condyloma acuminatum is the same as for verruca vulgaris. Liquid nitrogen cryotherapy and surgical removal using electrical scalpel or carbon gas laser are conducted. Local injection of bleomycin is used in intractable cases.

60.HIV epidemiology: ways of transmission, outcomes. Skin lesions in AIDS patients.  

EPIDEMIOLOGY-

Age -Commonly young, but any age

Sex -Initially in the United States and Europe, much more common in males due to male-male sexual intercourse; currently, incidence in females increasing due to heterosexual transmission. In Africa, nearly equal incidence in sexes due to pattern of male-female sexual transmission

Etiology

Nearly all cases in the United States and western Europe caused by HIV-1; some cases in western Africa caused by HIV-2. Both HIV-1 and HIV-2 can have a similar acute retroviral syndrome; clinical findings with HIV-2 infection are usually less severe.

Incidence

HIV/AIDS is a global pandemic. As of 2012, approximately 35.3 million people are living with HIV globally. Of these, approximately 17.2 million are men, 16.8 million are women and 3.4 million are less than 15 years old. There were about 1.8 million deaths from AIDS in 2010, down from 2.2 million in 2005.

Transmission of HIV-

l   SEXUAL EXPOSURE Unprotected receptive intercourse (anal and vaginal) is the most efficient mode of transmission of HIV.

l  INJECTING DRUG USER (IDU) Needle sharing transmits HIV.

l  BLOOD OR BLOOD PRODUCTS Recipients of blood or blood products after 1978 but before 1985 were inadvertently infected with HIV. Currently, newly HIV-infected donors may be HIV-seronegative but are HIV-viremic.

l  HEALTH CARE WORKERS HIV can be transmitted by needle sticks and cuts contaminated with HIV-infected blood during medical procedures.

l  ORGAN TRANSPLANT RECIPIENTS Prior to HIV testing, HIV was transmitted during transplantation of solid organs, bone marrow, and corneae.

l   PERINATAL TRANSMISSION Child born to mother with HIV infection, i.e., intrauterine, during birthing, or by breast feeding, may become infected.

Outcomes-

Early diagnosis is critical in the management of HIV disease for several reasons. Given the knowledge of their HIV infection and its contagiousness, most patients will reduce or eliminate behaviors associated with transmission of HIV. Early treatment with antiretroviral drugs retards progression of HIV-induced immunodeficiency. Many of the opportunistic infections such as Pneumocystis carinii pneumonia (PCP) that plague HIV-infected patients are better treated by primary prophylactic regimens prior to development of clinical disease.

Skin lesions-

Kaposi sarcoma

Eosinophilic folliculitis

Morbilliform exanthem rash, i.e., infectious exanthem with macules, papules up to 1 cm in diameter.

Ulcers occur on penis and/ or scrotum. Less commonly: urticaria. Also reported: vesicular and pustular exanthems, desquamation of palms/soles.

Pink to red Arrangements- Lesions remain discrete and do not become confluent.

 Most common site of exanthem is upper thorax and collar region (100 %) . face (60 %) . arms (40 %) . scalp, thighs (20 %). Palms.