HIV background
- type 1 is most common, destroys CD4 t lymphocytes
- transmission: parenteral, sexual, vertical (1/3 in untreated moms)
- if viral load >1000 need c/s!
HIV stages
- primary infection
- asymptomatic HIV - longest!
- sx HIV
- AIDS - cd4 <200
hiv stage 1 pres
- acute, severe mono/viral illness lasting 3 days - 2 weeks 1-12 weeks after exposure
- maculopapular truncal rash
hiv stage 2…
asymptomatic - 4-7 years
-seropositive
hiv stage 3…
symptomatic: 1-3 years w/ signs of immune dysfunction
- constitutional symptoms, lymphadenopathy, fungal and yeast infections and oral hairy leukoplakia
hiv stage 4
AIDS with CD4 < 200 - pulm, neuro, gi, derm sx
- pulm: PCP #1 cause of death! LDL always elevated!!!!!
- Bactrim x 3 weeks, prophylaxis once <100
- cryptococcal meningitis: use INDIA INK for stain
- tx: ampho B 10-14 d then fluconazole 8-10 weeks then maintenance fluconazole
- gi: diarrhea, thrush, oral hairy leukoplakia
- derm: kaposis (raised purple brown-black lesions on face, chest, genitals, mouth)
- increased malignancies: CNS lymphoma, non-hodgkins, kaposis!
1 opportunistic bacterial infection in AIDS….
MAC! w/ cd4<50
- wasting + lymphadenopathy + anemia + diarrhea
tx: clarithromycin or azithromycin
HIV / AIDS dx…
- ELISA - detects antibody, present 1-12 weeks after infection
- western blot: w/ positive ELISA to confirm!
- RNA viral load and CD4 count for monitoring
* AIDS dx: cd4<200 + indicator condition
HIV /AIDS tx
HAART if sx or cd4 <500!
2 NRT + NNRT or protease inhibitor!
-no live vaccines! need pneumococcal q 5-6 yr, flu, hep b
syphilis background…
d/t treponema pallidum, SPIROCHETE, transmitted by direct sexual contact
4 stages
syphilis stage 1…
primary:
CHANCRE - painless ulcer w/ clean base that develops 3-4 weeks after exposure and lasts 14 weeks
**seronegative but HIGHLY CONTAGIOUS!
syphilis stage 2…
secondary - 4-8 weeks after chancre heals..
- maculopapular rash - on PALMS AND SOLES, condyloma lata (flat papules on genitals) and inguinal lymphadenopathy
- constitutional / flu symptoms
- *CONTAGIOUS!!!
syphilis stage 3…
latent: asx, seropositive
- early: 1 year, not contagious
syphilis stage 4
tertiary: 1/3 untreated develop
- cardiovascular (AR), neuro, and GUMMA!!
- neuro: early have meningovascular involvement w/ meningitis symptoms, CN palsies, unequal reflexes then later have tabesdoralis and general paresis
- tabes dorsalis: degeneration of posterior column and sensory nerve root - decreased vibration and propioception, hypotonia and decreased reflexes
- ARGYLL ROBINSON PUPILS, charcot joints, neurogenic bladder, pain crisis (anal, urethral, laryngeal, gastric)
- general paresis: invades cerebral cortex causing memory and concentration impairment and personality changes - messy, irritable, irresponsible, slovenly!
syphilis diagnosis…
- definitive: evidence of spirochetes on DARK FIELD microscopy
- labs:
1. VDRL and RPR - nontreponemal screening tests, with positive do:
2. FTA-ABS, MHA-TP - more specific treponemal tests for confirmation - always test for HIV
tx syphilis:
- early: 1 IM PCN g
- pcn allergy: doxy x 2 weeks
- late: 1 IM PCN g x 3 doses q 1 week
- monitor VDRL levels for reinfection / tx response
chancroid…
d/t h. ducreyi
chancroid presentation…
PAINFUL ULCER - indurated, purulent w/ foul d/c, ragged edges w/ tender inguinal lymphadenopathy (draining buboes)
***NO SYSTEMIC SYMPTOMS!!
chancroid dx…
- *always r/o syphilis and HIV
* CLINICAL DX! NO serologic tests to confirm!
chancroid tx…
1 g Azithro and 250 IM ceftriaxone or PO azithro, erythro, cipro
lymphogranuloma venereum…
SUPER CHLAMYDIA!! by c. trachomatis!
lymphogranuloma venereum pres…
- painless ulcer, then weeks later develop tender inguinal lymphadenopathy (unilateral) then constitutional symptoms!
- w/o tx: proctocolitis, perianal fissures, rectal strictures and elephantiasis gentialis w/ lymph obstruction
lymphogranuloma venereum dx…
serology: NAAT and chlamydia
tx LV…
doxy x 21 days
