Infectious Diseases 2 Flashcards
(22 cards)
What are the stages of Syphilis
1-3 months - Primary - painless ulcer (penis/cervix/anus/pharynx) +/- LN (painless rubbery) - May go unnoticed.
1-6 months - Secondary - Rash - generalised or to palms and soles of feet +/- fever/lethargy/headaches (may also get neuro signs)
Under 2 years and asympto - Early Latent (highly infectious during this time).
Over 2 years and asympto - Late latent (less infectious but can still pass to child vertically).
TERTIARY - occurs many decades later - with gummas (granulomatous lesion with central necrosis), neurosyphilis - progressive dementia, Tabes dorsalis, ischaemic stroke.
CONGENITAL - under 2 years - maculopapular rash and rhinitis - over two years - Gummas - affecting eyes (keratitis), ears (Deafness), bones, etc
How is syphilis treated ?
Primary, Secondary, early latent: 1.8g Benzathine penicillin stat
Late latent: 1.8 g Benzathine penicillin weekly for three weeks.
VDRL/RPR ratio over 16 - suggests active disease
Less than 16 - likely treated or late latent
Which tests in syphillis serology are positive for life?
EIA (Enzyme immuneassay) and TPPA (trepenoma pallidum particle)
They are positive for life
so usually just check VDRL/RPR
IF after a high risk encounter tests negative initially?
Recheck in 12 weeks (3 months)
Who should be checked for syphillis?
- MSM
- HIV positive patients with each CD4 count
- Pregnancy screening
- When patients need sexual health check
- Sex workers
- Symptoms: painless ulcer, rash on palms and soles, pyrexia of unknown origin, unexplained LFT disturbance, Lymphadenopathy, Allopecia
Other management for patient with syphilis
No sex for one week
No sex with previous partners for 3 months (primary) or 6 months (secondary)
Contact trace partners from last 3 months (primary) and 6 months (secondary)
Public health notification
Review in seven days for discussion re: treatment, symptoms, contact tracing and safe sex education
TOC in 3, 6 and 12 months
Presumptively treat all sexual contacts in primary or secondary syphilis with 1.8g benzathine penicillin STAT
Which groups are considered High risk in MSM and reccomend Prep
In last three months
- CLAI with HIV positive partner (not on treatment/detectable viral load)
- CLAI with unknown status partner
- Rectal gonorrhea, rectal chlamydia, infectious syphilis,
- Methamphetamine usage
AND in next three months
multiple episodes of CLAI with or without sharing IV drug equipment
medium risk (consider PreP) is condom slipped off
uncircumcised insertive sex with someone HIV pos or unknown status AND future three months multiple CLAI etc
Which tests should be ordered when someone asks for prep
HIV Ag/Ab
UEC +/- Urine protein-creatinine ratio
In high risk activities
Check Syphillis serology
Hep A, ,B, C serology and swabs pharyngeal and rectal for NAAT (chlamydia and gonorrhea) and Urine first pass for Chlamydia and gonorrhea PCR
IF patient is female - they need a pregnancy test too
How do you prescribe PreP
Tenofovir/Emitricitabine one tablet daily
1.Advise men that it will take seven days before PreP will give full protection to patient
In women this 20 days.
- If he wishes to stop PreP its important he take PreP for 28 days from last potential HIV exposure.
- Discuss the importance of still wearing condoms because of STI risk (non HIV)
- Explain nausea and hedache are normal in first seven days
- He needs 3 monthly monitoring with HIV Ab/Ag STI screen and Renal function checked each time.
What are the side effects of Tenofovir/Emitricitabine
Small reversible reductions in renal function (esp over 50)
Also theoretical reduction in BMD
How would you diagnose a patient with HIV (Tests)
remember western blot needs to be indeterminant or pos in order for a diagnosis
HIV Ag/Ab EIA is highly sensitive
Western Blot is highly specific
The p24 antigen is produced in early HIV infection, it takes 4-6 weeks for the antibodies to be made.
if neg - repeat in six weeks.
Whats important in giving information to a newly diagnosed patient with HIV
- Inform patient of diagnosis. Treatable and chronic.
- Educate patient about the illness
- Discuss immediate implications and treatment options if ready to hear it
- Arrange review the next day
- Start contact tracing today and more tomorrow.
- Check immediate plans and supports
- Organise CD4/Viral load and STI screen (also will need CMV/toxo/mantoux)
- Advise safe sexual practices
- Notify the department of health
- If has given blood since last negative test inform the Australian red cross blood service
If presribing PEP to someone whats the deal
Within 72 hours
2 or 3 drug regimen
STI screen and HIV Ag/Ab at baseline
After full 28 days then HIV testing at 2 weeks post cessation and then 8 weeks post cessation.
Patient who has been to Europe or North America presents with a bulls eye rash
lyme disease
(erythema migrans)
Treat with 3 weeks of bd doxy 100mg
(21 days)
Cx of lyme disease
stage 1 - Erythema migrans and fever/sweats chills/LN
Stage 2 - Cardiac -myocarditis/pericarditis
heart block
Arthralgia and arthritis
Stage 3 - polyneuropathy
encephalopathy
persistent arthritis
Only order serology for borellia burgdorferi in stage 2 or 3
How is listeria transmited
undercooked meat, eggs, fish,
Soft cheeses
unpasteurised milk
contaminated fruit and veg
Affects immunocompromised/elderly and pregnant women
Can be passed vertically to fetus and cause septicaemia and pnemonia
Woman may present with gastro/influenza like illness
MCS - to identify organism (Sputum or stool)
Tx - Hospital admission
Amoxycillin 1g 8hrly for 10 -14 days
FARMER with abrupt fever, headache and conjunctivitis?
Leptospirosis
Doxycycline 100mg BD for seven days
Or if severe
Ceftriaxone 1g IV daily for seven days
In the context of swimming in schisto waters and cerceriae getting in - whats the acute illness?
URTICARIA, Itch, fever, headache, arthralagia,
They can also get seizures/myocarditis
FBE shows eosinophils
Serology takes 1.5 to 3 months to be positive
KATAYAMA FEVER
Anyone swimming in the regions should have serology at 3 months if they are symptomatic
Treatment is Praziquantel
Haematobium in Urine at three months
Japonicum and Mansoni - in feces at three months
TB protocols?
When initiating syphilis treatment what advice must be given re ADR?
Repeat an RPR on day treatment begins to obtain genuine baseline.
Inform patient of the Jarish herxheimer reaction which occurs in patients with primary and secondary syphillis (not an allergy)- malaise, rigors, chills fevers which lasts several hours - if pregnant and notices fever, contractions or reduced fetal movements following Abx - get to hospital
No sex with previous partners till they’ve been tested and treated
Contact tracing for secondary is six months/3 for primary
GP should initiate contact tracing with help from local sexual health service.
