Tags: Syphilis

Leishmania

Leishmania & Trypanosoma The genera Leishmania and Trypanosoma are members of the family Trypanosomatidae. These protozoans cause diseases with widely varied clinical presentations as well as geographic distributions, including leishmaniasis, American trypanosomiasis (Chagas’ disease), and African trypanosomiasis (sleeping sickness). For example, the endemic zones for African and American trypanosomiasis do not overlap, the diseases are transmitted by different vectors, they involve distinct mechanisms of pathogenesis, and they follow different clinical courses. Nonetheless, the causative agents share important biological features. Each is a hemoflagellate with a kinetoplast containing its own chromosomal DNA with highly conserved and repeated elements, each forms a single flagellum at some point during its life cycle, and each …

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American Trypanosomiasis (Chagas’ Disease)

Essentials of Diagnosis • Epidemiologic factors: time spent in an endemic zone; poor housing conditions, eg, mud or thatched housing; exposure to reduviid insect vector • History and physical exam: Romana’s sign (swollen periorbital mucosal tissues after ocular inoculation); chagoma (skin nodule at the site of acute inoculation); in the chronic phase, congestive heart failure, dysphagia or regurgitation, and constipation • Laboratory exam: 1. Acute Chagas’: trypomastigotes revealed by Giemsa smear of blood or buffy coat; culture of affected tissues, ie, the inoculation site; serologic enzyme immunoassay and enzyme-linked immunosorbent assay (ELISA); xenodiagnosis if available 2. Chronic Chagas’: radiological studies show congestive heart failure, megacolon, or megaesophagus; ECG shows right bundle …

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Dermatophytes

Essentials of Diagnosis Characteristic pattern of inflammation on glabrous skin surfaces. The active border of infection is scaly, red, and slightly elevated. Wet mount preparation with potassium hydroxide (10-20%). Skin scraping of the active border shows branching, translucent, rod-shaped filaments (hyphae) in keratinized material under low-power microscopy (10-40×). Hyphae are uniformly wide and regularly septated. Wood’s light examination (UV light at 365 nm) shows blue-green fluorescence for Microsporum canis and Microsporum audouinii. Trichophyton schoenleinii is pale green, and tinea versicolor shows white-yellow fluorescence. Culture should be performed with hair, nail, and skin specimens from particularly inflammatory lesions, to make a definitive mycologic diagnosis. General Considerations Dermatophytes are molds that infect keratinized …

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Chromomycosis

Essentials of Diagnosis Patients are usually immunocompetent. Found worldwide but usually in tropical or subtropical areas. Mold in culture; forms sclerotic body or muriform cell in tissue. Infection results from direct inoculation from contaminated soil or vegetative substances. Chronic indolent cutaneous verrucous lesions, most often on the feet. General Considerations Chromomycosis, also known as chromoblastomycosis, is a chronic subcutaneous infection caused by several different fungi. Although rarely seen in the United States, it is common worldwide. A. Epidemiology. Chromomycosis occurs worldwide but is most frequently encountered in tropical and subtropical regions. The most common occurrence is in barefoot individuals, particularly among agricultural workers. The organisms causing chromomycosis are found commonly in …

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Treponema Pallidum

Essentials of Diagnosis Spiral, motile, coil-shaped, elongated (0.10 um × 5-20 um) spirochete. No reliable method for sustained in vitro cultivation. Direct detection with darkfield microscopy or immunofluorescent antibody in early syphilis. Nontreponemal antibody tests (rapid plasma reagin, Venereal Disease Research Laboratory [VDRL]) for screening, treatment follow-up. Treponema-specific antibody tests (fluorescent treponemal antibody test, microhemagglutination-T pallidum test) for confirmation. Cerebrospinal fluid (CSF) lymphocytosis, elevated CSF protein, or reactive CSF VDRL test suggests neurosyphilis. PCR, DNA probes, and immunoblotting techniques promising in congenital syphilis, early syphilis, or neurosyphilis. All patients with T pallidum infection should be tested for HIV coinfection and vice versa. General Considerations The term syphilis was first used in …

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Late (Tertiary) Syphilis

Clinical Findings Tertiary disease, usually seen 5-20 years after initial infection, traditionally includes cardiovascular syphilis, late benign (or gummatous) syphilis, and neurosyphilis (see Box 1). Fewer organisms are found in lesions during this stage. A. Cardiovascular Syphilis. The incidence of cardiovascular involvement is probably underestimated, although clinically significant disease eventually develops in ~ 10% of all untreated patients. Lesions include coronary ostial stenosis and coronary artery insufficiency, aortic valvular regurgitation with left ventricular hypertrophy and congestive heart failure, and saccular aortic aneurysms of the ascending and transverse portions of the thoracic aorta. These aneurysms usually do not dissect and rupture but can present as pulsating supraclavicular chest wall masses with associated …

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Secondary Syphilis

Clinical Findings A. Signs and Symptoms. The secondary stage of syphilis occasionally overlaps with the primary phase but usually begins ~ 6 weeks after resolution of the chancre; however, it can develop as late as 6 months after infection (see Box  1). Most patients have some degree of skin or mucocutaneous involvement. A faint and evanescent macular rash of the trunk and abdomen known as roseola syphilitica is sometimes seen initially. A generalized, symmetric, nonpruritic rash consists of some combination of erythematous or copper-colored macular, papular, papulosquamous, or pustular lesions. These lesions can be found on the palms, soles, genitalia, and oral mucous membranes. The rash of syphilis often provides a …

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Primary Syphilis

Clinical Findings A. Signs and Symptoms. The lesions of primary syphilis appear at the site of inoculation after an incubation period that is inversely proportional to the number of infecting organisms, usually 3 weeks (Box 1). The chancre is an ulcerative lesion that varies in size from several millimeters to 2 cm. Although classically described as a solitary lesion, multiple lesions may be present. They are generally located on the genitalia and anorectal areas, but any area on the body can be affected including the oropharynx and the extremities. This superficial ulcer is usually painless with well-defined, indurated borders surrounding a firm, clean base. Local and regional lymphadenopathy is bilateral, nonsuppurative, …

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Penicillins: Drug Administration

Drug formulations Embolictoxic reactions to penicillin depot formulations were first described in patients with syphilis. The symptoms include fear of death, confusion, acoustic and visual hallucinations, and possibly palpitation, tachycardia, and cyanosis. Generalized seizures or twitching of the limbs have been observed in children and adults. As a rule, the symptoms abate and disappear within several minutes to an hour. They rarely persist for up to 24 hours. If a cardiovascular reaction with a fall in blood pressure occurs simultaneously with typical symptoms, a combination with anaphylactic shock must be considered. Such reactions have been called “pseudo-anaphylactic reactions” or “acute non-allergic reactions”, “panic attack syndrome,” and “acute psychotic reactions”. In several …

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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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