Tags: Pelvic inflammatory disease

Chlamydia Trachomatis Infections

Essentials of Diagnosis Typical intracytoplasmic inclusions in Giemsa-stained cell scrapings from the conjunctiva. Ligase chain reaction (LCR) or polymerase chain reaction (PCR) in first-void urine. Positive culture in McCoy or HeLa cells of body fluids or secretions. Positive microimmunofluorescence serology for suspected cases of lymphogranuloma venereum and infants with pneumonia. Complement fixation titer of 1:64 or greater in patients with presumed lymphogranuloma venereum. Clinical Syndromes C trachomatis is associated with urethritis, proctitis, conjunctivitis, and arthritis in women and men; epididymitis in men; and mucopurulent cervicitis (MPC), acute salpingitis, bartholinitis, and the Fitz-Hugh and Curtis syndrome in women (Box 1). C trachomatis and Neisseria gonorrhoeae (see site) coinfections are common in women …

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Mycoplasma & Ureaplasma

Mycoplasma and Ureaplasma species (mycoplasmas) are ubiquitous in nature and are commonly found in plants, animals, and humans. These bacteria contain the smallest amount of double-stranded DNA that is capable of producing a free-living microorganism; they measure between 0.15 and 0.3 um in diameter and = 2 um in length. They are believed to have evolved from a putative common ancestor of the gram-positive bacteria by a process of genome reduction and adoption of a dependent, parasitic life style. Mycoplasma and Ureaplasma spp. lack a cell wall. Therefore, they cannot be visualized with the Gram stain and are not susceptible to antibiotics that act on cell wall synthesis (eg, penicillins and …

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Important Anaerobes

Essentials of Diagnosis • Foul odor of draining purulence. • Presence of gas in tissues. • No organism growth on aerobic culture media. • Infection localized in the proximity of mucosal surface. • Presence of septic thrombophlebitis. • Tissue necrosis and abscess formation. • Association with malignancies (especially intestinal). • Mixed organism morphologies on Gram stain. General Considerations A. Epidemiology and Ecology. Anaerobic bacteria are the predominant component of the normal microbial flora of the human body. The following sites harbor the vast majority of them: • Skin: Mostly gram-positive bacilli such as Propionibacterium acnes • Gastrointestinal tract: In the oral cavity Prevotella spp., Porphyromonas spp., Peptostreptococcus spp., microaerophillic streptococci, and …

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Important Anaerobes: Clinical Syndromes

Box 1 summarizes different clinical syndromes associated with anaerobic bacteria. The sections that follow describe the various syndromes, including clinical findings. For some syndromes, specific diagnosis and treatment information is included as well. For other syndromes, see summary diagnosis and treatment sections at the end of the chapter. HEAD & NECK 1. EAR & PARANASAL SINUSES The flora in as many as two-thirds of chronic sinusitis and otitis cases includes B fragilis, Prevotella spp., Peptostreptococcus spp., and Porphyromonas spp. It is not surprising that ~50% of patients with chronic otitis media are infected with anaerobic bacteria, B fragilis being the most common. Mastoiditis may arise as a complication in some of …

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Neisseria Gonorrhoeae & Neisseria Meningitidis

Neisseria gonorrhoeae was first described by Albert Neisser in 1879, in the ocular discharge and exudate from newborn infants with conjunctivitis. Descriptions of a condition resembling the disease gonorrhea can be found in the written record as early as 130 AD, when Galen created a descriptor for the malady by using the Greek words gonos (seed) and rhoea (flow) to characterize what was believed to be the morbid loss of semen. Neisseria meningitidis is thought to be responsible for epidemics in the Napoleonic and Persian armies in the early 1800s. The pathogen was first described in 1886 by Weichselbaum, who observed gram-negative diplococci in the cerebrospinal fluid (CSF) of a young …

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Streptococcal Toxic Shock Syndrome

In the late 1980s, invasive GAS infections occurred in North America and Europe in previously healthy individuals of all ages. This illness is associated with bacteremia, deep soft-tissue infection, shock, multi-organ failure, and death in 30% of cases. StrepTSS occurs sporadically, although minor epidemics have been reported. Most patients present with a viral-like prodrome, history of minor trauma, recent surgery, or varicella infection. The prodrome may be caused by a viral illness that predisposed to strepTSS, or these vague early symptoms may be related to the evolving infection. In cases associated with necrotizing fasciitis, the infection may begin deep in the soft tissue at a site of minor trauma that frequently …

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Cervicitis

Description of Medical Condition An inflammation of the uterine cervix. • Infectious cervicitis may be caused by Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, ureaplasmas, Herpes simplex or Trichomonas vaginalis. • Chronic cervicitis is characterized by inflammation of the cervix without an identified pathogen System(s) affected: Reproductive Genetics: N/A Incidence/Prevalence in USA: • Gonorrhea: 166/100,000; 2% of sexually active women < age 30 • Chlamydia: 290/100,000; 5-35% of women • Trichomonas: 1200/100,000; 5-25% of women Predominant age: Infectious cervicitis is most common in adolescents, but can be seen in women of any age Predominant sex: Female only Medical Symptoms and Signs of Disease • Mucopurulent (yellow) discharge from the cervix • Cervical …

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Specific Anti-Infective Agents

Antibiotics Before prescribing a specific antibiotic, clinicians should be able to answer these questions: •  How does the antibiotic kill or inhibit bacterial growth? •  What are the antibiotic’s toxicities and how should they be monitored? •  How is the drug metabolized, and what are the dosing recommendations? Does the dosing schedule need to be modified in patients with renal dysfunction? •  What are the indications for using each specific antibiotic? •  How broad is the antibiotic’s antimicrobial spectrum? •  How much does the antibiotic cost? Clinicians should be familiar with the general classes of antibiotics, their mechanisms of action, and their major toxicities. The differences between the specific antibiotics in …

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Sexually Transmitted Diseases

Definition The spectrum of sexually transmitted diseases includes the classic venereal diseases – gonorrhea, syphilis, chancroid, lymphogranuloma venereum, and granuloma inguinale – as well as a variety of other pathogens known to be spread by sexual contact (Table Sexually Transmitted Diseases). Common clinical syndromes associated with sexually transmitted diseases are listed in Table Selected Syndromes Associated with Common Sexually Transmitted Pathogens. The most current information on epidemiology, diagnosis, and treatment of sexually transmitted diseases provided by the Centers for Disease Control and Prevention  can be found at http://www.cdc.gov. TABLE. Sexually Transmitted Diseases Disease Associated Pathogens Bacterial Gonorrhea Neisseria gonorrhoeae Syphilis Treponema pallidum Chancroid Hemophilus ducreyi Granuloma inguinale Calymmatobacterium granulomatis Enteric disease …

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Gonorrhea

Neisseria gonorrhoeae is a gram-negative diplococcus estimated to cause up to 600,000 infections per year in the United States. Clinical presentation Infected individuals may be symptomatic or asymptomatic, have complicated or uncomplicated infections, and have infections involving several anatomic sites. Approximately 15% of women with gonorrhea develop pelvic inflammatory disease. Left untreated, pelvic inflammatory disease can be an indirect cause of infertility and ectopic pregnancies. In 0.5% to 3.0% of patients with gonorrhea, the gonococci invade the bloodstream and produce disseminated disease. The usual clinical manifestations of disseminated gonnococcal infection are tender necrotic skin lesions, tenosynovitis, and monoarticular arthritis. Diagnosis Diagnosis of gonococcal infections can be made by gram-stained smears, culture …

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