Infection diseases: Syphilis, Gonorrhea, Tuberculosis, Leprosy. Clinic, diagnostic, treatment. Gonorrhea Gonorrhea is a sexually transmitted disease (STD). Gonorrhea is caused by Neisseria gonorrhoeae, a bacterium that can grow and multiply easily in the warm, moist areas of the reproductive tract, including the cervix (opening to the womb), uterus (womb), and fallopian tubes (egg canals) in women, and in the urethra (urine canal) in women and men. The bacterium can also grow in the mouth, throat, eyes, and anus. Gonorrhea Caused by: Neisseria gonorrhoeae It is typically genital lesions with rare oral manifestations; painful erythema or ulcers or both How do people get gonorrhea? The infection is transmitted from one person to another through vaginal, oral, or anal sex Men have a 20% risk of getting the infection from a single act of vaginal intercourse with an infected woman. The risk for men who have sex with men is higher. Women have a 60–80% risk of getting the infection from a single act of vaginal intercourse with an infected man. A mother may transmit gonorrhea to her newborn during childbirth; when affecting the infant's eyes, it is referred to as ophthalmia neonatorum. It cannot be spread by toilets or bathrooms Symptoms Some men with gonorrhea may have no symptoms at all. However, some men have signs or symptoms that appear one to fourteen days after infection. Symptoms and signs include a burning sensation when urinating, or a white, yellow, or green discharge from the penis. Sometimes men with gonorrhea get painful or swollen testicles. In women, the symptoms of gonorrhea are often mild, but most women who are infected have no symptoms. Even when a woman has symptoms, they can be so non-specific as to be mistaken for a bladder or vaginal infection. The initial symptoms and signs in women include a painful or burning sensation when urinating, increased vaginal discharge, or vaginal bleeding between periods. Women with gonorrhea are at risk of developing serious complications from the infection, regardless of the presence or severity of symptoms. Symptoms of rectal infection in both men and women may include discharge, anal itching, soreness, bleeding, or painful bowel movements. Rectal infection also may cause no symptoms.. Infections in the throat may cause a sore throat, but usually causes no symptoms Symptoms in men: Symptoms in men include: Burning and pain while urinating Increased urinary frequency or urgency Discharge from the penis (white, yellow, or green in color) Red or swollen opening of penis (urethra) Tender or swollen testicles Sore throat (gonococcal pharyngitis) Symptoms in women: can be very mild or nonspecific, and may be mistaken for another type of infection. They include: Vaginal discharge Burning and pain while urinating Increased urination Sore throat Painful sexual intercourse Severe pain in lower abdomen (if the infection spreads to the fallopian tubes and stomach area) Fever (if the infection spreads to the fallopian tubes and stomach area) If the infection spreads to the bloodstream, fever, rash, and arthritis-like symptoms may occur Signs and tests: Gonorrhea can be quickly identified by staining a sample of tissue or discharge and then looking at it under a microscope. This is called a gram stain. Although this method is fast, it is not the most certain. Gram stain tests used to diagnose gonorrhea include: Cervical gram stain in women Gram stain of urethral discharge in men Joint fluid gram stain Cultures (cells that grow in a lab dish) provide absolute proof of infection. Generally, samples for a culture are taken from the cervix, vagina, urethra, anus, or throat. Cultures can provide a preliminary diagnosis often within 24 hours and a confirmed diagnosis within 72 hours. Cultures used to diagnose gonorrhea include: Endocervical culture in women Urethral discharge culture in men Throat swab culture in both men and women Rectal culture in both men and women Culture of joint fluid Blood cultures DNA tests are especially useful as a screening test. They included the ligase chain reaction (LCR) test. DNA tests are quicker than cultures. Such tests can be performed on urine samples, which are a lot easier to collect than samples from the genital area. Treatment: 1. 2. There are two goals in treating a sexually transmitted disease, especially one as easily spread as gonorrhea. The first is to cure the infection in the patient. The second is to locate and test all of the other people the person had sexual contact with and treat them to prevent further spread of the disease. Tuberculosis Caused by: Mycobacterium tuberculosis Tuberculosis (TB) is an infectious disease caused by bacteria whose scientific name is Mycobacterium tuberculosis. It was first isolated in 1882 by a German physician named Robert Koch who received the Nobel Prize for this discovery. TB most commonly affects the lungs but also can involve almost any organ of the body. Tuberculosis Tuberculosis Injects about the one third of the world’s population and kills approximately 3 million people per year, making it the most important cause of death in the world. Oral manifestation of tuberculosis can be primary and secondary. Oral mucous memranes may become infected through implantation of organisms found in sputum or, less commonly, through hematogenous deposition. Clinical features: Unless the primary infection becomes progressive, an infected patient will probably exhibit no symptoms. In reactivated disease, lowgrade signs and symptoms of fever, night sweats, malaise and weight loss may appear. Than, cough, hemoptysis and chest pain develop. Oral manifestation - typical lesion is an indurated, chronic, nonhealing ulcer that is usually painful. The tongue and palate are favored locations. Clinical features: Bony involvement of the maxilla and mandible may produce tuberculous osteomyelitis. Pharyngeal involvement results in painful ulcers, and laryngeal lesions may cause dysphagia and voice changes. Treatment: 1. 2. 3. 4. 5. Such drugs as: Isoniazid Rifampin Pirazinamid Ethambutol Streptomycin (for multidrug-resistant cases) Combination of that drug are often used in 6-, 9-, 12- month to 2 year. Syphilis Syphilis: Syphilis is a sexually transmitted disease (STD) caused by the bacterium Treponema pallidum. It has often been called “the great imitator” because so many of the signs and symptoms are indistinguishable from those of other diseases. How do people get syphilis? Syphilis is passed from person to person through direct contact with a syphilis sore. Sores occur mainly on the external genitals, vagina, anus, or in the rectum. Sores also can occur on the lips and in the mouth. Transmission of the organism occurs during vaginal, anal, or oral sex. Pregnant women with the disease can pass it to the babies they are carrying. Syphilis cannot be spread through contact with toilet seats, doorknobs, swimming pools, hot tubs, bathtubs, shared clothing, or eating utensils. Primary stage: The primary stage of syphilis is usually marked by the appearance of a single sore (called a chancre), but there may be multiple sores. The time between infection with syphilis and the start of the first symptom can range from 10 to 90 days (average 21 days). The chancre is usually firm, round, small, and painless. It appears at the spot where syphilis entered the body. The chancre lasts 3 to 6 weeks, and it heals without treatment. However, if adequate treatment is not administered, the infection progresses to the secondary stage. Primary syphilis: Secondary stage: Skin rash and mucous membrane lesions characterize the secondary stage. This stage typically starts with the development of a rash on one or more areas of the body. The rash usually does not cause itching. Rashes associated with secondary syphilis can appear as the chancre is healing or several weeks after the chancre has healed. The characteristic rash of secondary syphilis may appear as rough, red, or reddish brown spots both on the palms of the hands and the bottoms of the feet. However, rashes with a different appearance may occur on other parts of the body, sometimes resembling rashes caused by other diseases. Sometimes rashes associated with secondary syphilis are so faint that they are not noticed. In addition to rashes, symptoms of secondary syphilis may include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and fatigue. The signs and symptoms of secondary syphilis will resolve with or without treatment, but without treatment, the infection will progress to the latent and possibly late stages of disease. Secondary syphilis Secondary syphilis: Late and Latent Stages: The latent (hidden) stage of syphilis begins when primary and secondary symptoms disappear. Without treatment, the infected person will continue to have syphilis even though there are no signs or symptoms; infection remains in the body. This latent stage can last for years. The late stages of syphilis can develop in about 15% of people who have not been treated for syphilis, and can appear 10–20 years after infection was first acquired. In the late stages of syphilis, the disease may subsequently damage the internal organs, including the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints. Signs and symptoms of the late stage of syphilis include difficulty coordinating muscle movements, paralysis, numbness, gradual blindness, and dementia. This damage may be serious enough to cause death. Syphilis tetriary stage: Early infections treatment: The first-choice treatment for uncomplicated syphilis remains a single dose of intramuscular penicillin G or a single dose of oral azithromycin. Doxycycline and tetracycline are alternative choices; however, they cannot be used in pregnant women. Antibiotic resistance has developed to a number of agents including macrolides, clindamycin, and rifampin. Ceftriaxone, a thirdgenerationcephalosporin antibiotic, may be as effective as penicillin based treatment. Late infections treatment: For neurosyphilis due to the poor penetration of penicillin G into the central nervous system it is recommended that those affected be given large doses of intravenous penicillin for a minimum of 10 days. If a person is allergic, ceftriaxone may be used or penicillin desensitization attempted. Other late presentations may be treated with once weekly intramuscular penicillin G for three weeks. If allergic as in the case of early disease doxycycline or tetracycline may be used but for a longer duration. Treatment at this point will limit further progression but has only slight effect on damage which has already occurred Leprosy: Leprosy: Leprosy is a disease caused by the bacteria Mycobacterium leprae, which causes damage to the skin and the peripheral nervous system. What is the history of leprosy (Hansen’s disease)? Unfortunately, the history of leprosy and its interaction with man is one of suffering and misunderstanding. The newest research suggests that at least as early as 4000 B.C. individuals had been infected with M. leprae, while the first known written reference to the disease was found on Egyptian papyrus in about 1550 B.C. The disease was well recognized in ancient China, Egypt, and India, and there are several references to the disease in the Bible. Because the disease was poorly understood, very disfiguring, slow to show symptoms, and had no known treatment, many cultures thought the disease was a curse or punishment from the gods. Consequently, leprosy was left to be “treated” by priests or holy men, not physicians. Risk factors: At highest risk are those living in endemic areas with poor conditions such as inadequate bedding, contaminated water, and insufficient diet, or other diseases that compromise immune function. Professional studies show little evidence that HIV is an important factor in increasing the risk of leprosy infection According to The Leprosy Mission Canada, most people-–about 95% of the population-–are naturally immune to the disease Risk factors: Several genes have been associated with a susceptibility to leprosy. Name Locus OMIM Gene LPRS1 10p13 609888 LPRS2 6q25 607572 PARK2, PACRG LPRS3 4q32 246300 TLR2 LPRS4 6p21.3 610988 LTA LPRS5 4p14 613223 TLR1 LPRS6 13q14.11 613407 Signs and Symptoms of Leprosy: Skin lesions are the primary external sign of Hansen’s disease, but these are quite subtle and appear in a slow pace that they may not be noticeable at first. Certain symptoms are similar with those with syphilis, leptospirosis and tetanus. Skin lesions are the primary external sign. Left untreated, leprosy can be progressive, causing permanent damage to the skin, nerves, limbs, and eyes. Contrary to folklore, leprosy does not cause body parts to fall off, but tissues can become numb and other microbes can invade them as secondary infections when the disease weakens the body's defences. Signs and Symptoms of Leprosy: Aside from skin lesions other early symptoms are: Numbness Inability to identify temperature Lost of sensations of touch As the disease progresses other sign may occur like: Painless ulcers Hypopigmented macules or having flat and pale areas of skin Eye damage like less blinking and dryness Facial disfigurement There are two main classification of leprosy lesions: The Ridley-Jopling system is composed of six forms or classifications, listed below according to increasing severity of symptoms: 1. Indeterminate leprosy: a few hypopigmented macules; can heal spontaneously, persists or advances to other forms 2. Tuberculoid leprosy: a few hypopigmented macules, some are large and some become anesthetic (lose pain sensation); some neural involvement in which nerves become enlarged; spontaneous resolution in a few years, persists or advances to other forms 3. Borderline tuberculoid leprosy: lesions like tuberculoid leprosy but smaller and more numerous with less nerve enlargement; this form may persist, revert to tuberculoid leprosy, or advance to other forms 4. Mid-borderline leprosy: many reddish plaques that are asymmetrically distributed, moderately anesthetic, with regional adenopathy (swollen lymph nodes); the form may persist, regress to another form, or progress 5. Borderline lepromatous leprosy: many skin lesions with macules (flat lesions) papules (raised bumps), plaques, and nodules, sometimes with or without anesthesia; the form may persist, regress or progress to lepromatous leprosy 6. Lepromatous leprosy: Early lesions are pale macules (flat areas) that are diffuse and symmetric; later many M. leprae organisms can be found in them. Alopecia (hair loss) occurs; often patients have no eyebrows or eyelashes. As the disease progresses, nerve involvement leads to anesthetic areas and limb weakness; progression leads to aseptic necrosis (tissue death from lack of blood to area), lepromas (skin nodules), and disfigurement of many areas including the face. The lepromatous form does not regress to the other less severe forms. Histoid leprosy is a clinical variant of lepromatous leprosy that presents with clusters of histiocytes (a type of cell involved in the inflammatory response) and a grenz zone (an area of collagen separating the lesion from normal tissue) seen in microscopic tissue sections. 1. 2. The 2009 WHO classifications are simply based on the number of skin lesions as follows: Paucibacillary leprosy: skin lesions with no bacilli (M. leprae) seen in a skin smear Multibacillary leprosy: skin lesions with bacilli (M. leprae) seen in a skin smear How is leprosy transmitted? 1. 2. 3. M. leprae are spread person to person by nasal secretions or droplets. Infected droplets can infect others by entering breaks in the skin.( but M. leprae apparently cannot infect intact skin). Rarely, humans get leprosy from the few animal species mentioned above (Nine-Banded Armadillo, some primates) Treatment: The majority of cases (mainly clinically diagnosed) are treated with antibiotics. Since 1982, the WHO has recommended a 6-12 month course of multidrug therapy (MDT), which it provides free throughout the world. Patients are given a cocktail of 3 strong antibiotics (dapsone, rifampicin and clofazimine) which can completely cure the tuberculoid form of the disease within six months and the more infectious lepromatous form within two years. Vaccines for leprosy are being tested but aren't yet in general use. Treatment: Surgery is individualized for each patient with the goal to attempt cosmetic improvements and, if possible, to restore limb function and some neural functions that were lost to the disease. Thank you for attention! Good bye.
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