Progressive Multifocal Leukoencephalopathy
Progressive multifocal leukoencephalopathy is a demyelinating disease ( AIDS defining illness) which affect the brain. Patient may complain with vision and speech abnormalities and alteration of the mental function.Patient may fall into coma and death. Progressive multifocal leukoencephalopathy is commonly affecting HIV/ AIDS patient ( immunosuppressive disease). Progressive multifocal leukoencephalopathy is caused by JC virus which is a human polyomavirus. The present of JC virus infection is confirmed with polymerase chain reaction of the cerebrospinal fluid or from the biopsy of the brain tissue of the patient with progressive multifocal leukoencephalopathy. The common mode of transmission is via respiratory droplets. JC virus will be spread and establish a latent infection in lungs, kidney and lymphoid organs. The latent infection will be activated in immunocompromised patient. The activation of JC virus will lead to the spread of infection to the brain and lead to progressive multifocal leukoencephalopathy. JC virus will attach to the serotonin receptor on oligodendrocytes (myelin producing cells) which lead to lytic infection.
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Hepatitis B
Hepatitis B is caused by hepatitis B virus infection Hepatitis B virus infection is diagnosed by serological analysis / assay and liver function test. Hepatitis B may be divided into acute hepatitis and chronic hepatitis. Acute hepatitis may be indicated by the present of IgM antibody to hepatitis B core antigen ( HBcAg) as well as HBV DNA and HBe antigen.The common symptoms and signs of acute hepatitis B may include fatigue, fever, nausea, anorexia and hepatomegaly. Patient may also present with dark urine, pale stool, jaundice and elevation of liver enzyme. Patient who unable to clear the hepatitis B virus from the body may become carriers and develop chronic hepatitis. Chronic hepatitis may be detected by the present of HBsAG, HBeAg and HBV DNA. Chronic hepatitis is at risk for liver failure, liver cirrhosis and hepatocellular carcinoma. The present of antibody to the HBsAg is associated with immunity to the hepatitis B virus infection. The common mode of transmission of hepatitis B virus may include intravenous drug, sexual contact, perinatal and blood and bodily fluid. Hepatitis B virus will infect the hepatocytes. Cytotoxic T cells will be activated which lead to hepatocellular injury. The treatment may include interferon alpha, adefovir and lamivudine for chronic hepatitis. Recombinant HBsAg vaccine is considered as a form of active immunization against hepatitis B. Individual with needle stick exposures or neonates born to HBsAg positive mother may required passive immunization with HBV immune globulin. SARS
SARS is severe acute respiratory syndrome which is caused by coronavirus (COV). The incubation period of SARS is around 2- 7 days. The symptoms and signs of severe acute respiratory syndrome may include fever, body aches, headache and diarrhea. A few days later patient may suffer from dry non productive cough, pneumonia and hypoxia. SARS CoV is identified by serological testing with the aim to identify CoV - specific antibody and by using the reverse transcriptase polymerase chain reaction ( RT- PCR). The mode of transmission is via respiratory droplets from cough or sneezing and person to person contact. Infected person should be isolated and quarantine is considered in person who exposed to SARS. Pathologically SARS may present with diffuse damage of the alveolar and the present of thrombocytopenia and lymphopenia. The spread of SARS can be prevented by restriction to travel in the areas with SARS and frequent hand washing. Patient may required mechanical ventilation if hypoxic. Visceral Larva Migrans
Visceral larva migrans is a migratory of larvae of nematode roundworm such as toxocara canis and toxocara cati. Tocoxara infection can be confirmed by examination for the present of larvae in the tissue biopsies and serological testing. Toxocara canis is mostly affect the dogs as the host while toxocara cati is affecting the cats as the host. Dead end host is the humans. The infection can be prevented by proper pet hygiene and pet deworming. Patient may appear asymptomatic or suffer from symptoms and signs such as fever, rash, abdominal pain and hepatomegaly. Toxacara infection is transmitted via ingestion of eggs from the stools of the cats and dogs. Larvae will develop from the egg and invade the small intestine. The larvae will enter the bloodstream and spreading to lungs, kidney, hearts, muscle,eyes and liver as well as central nervous system. The larvae will die and eosinophilic granuloma may develop. The complication of the infection may include blindness due to involvement of the retinal , central nervous system abnormalities, respiratory disorders and cardiac abnormalities. The treatment may include medication such as diethylcarbamazine and corticosteroids. Listeriosis
Listeriosis is a form of infection which is caused by listeria monocytogenes. Listeriosis may appear to be asymptomatic mostly in immuno competent adult. Fetal listeriosis may lead to stillborn birth and spontaneous abortion. Fetal listeriosis may lead to pneumonia, meningitis and granulomatosis infantiseptica ( septicemia). The common mode of transmission is via contamination of the food such as contaminated cheese, milk, meat, seafood and poultry. Person to person spread such as nosocomial transmission by hospital staff, infection of the uterus and colonization of the birth canal may also lead to transmission of listeria monocytogenes infection. Listeria monocytogenes may invade the endothelial cells of the placenta in a pregnant women which lead to transplacental spread of listeria monocytogenes infection. In immunocompromised individual ( organ transplant recipient or chemotherapy ) adult bacterial meningitis may occur due to infection by listeria monocytogenes. Listeria monocytogenes is a gram positive rod which able to survive ( intracellular growth) at low temperature. Contamination of the food still occur if the food is stored at the refrigerator. Listeria monocytogenes has two virulence factors which are listeriolysin O and internalin that facilitate the invasion of the host cell. Listeriolysin O will allow listeria monocytogenes to escape form the endosome. Listeriolysin O is a pore forming toxin. Listeria monocytogenes has a tumbling motility. Internalin will promote endocytosis by binding to the host cell. Rubella
Rubella is caused by rubella virus. Rubella virus infection is confirmed by the present of rubella specific IgM antibody and rubella specific IgG antibody. Rubella virus can be transmitted via respiratory droplets ( postnatal) and transplacental transmission from mother to fetus ( congenital rubella syndrome). Congenital rubella syndrome may occur during the first trimester of pregnancy or throughout pregnancy. Congenital rubella syndrome in children is presented with cataract, deafness, mental retardation and cardiac anomalies. Rubella virus may also affect adults and present with fever, maculopapular rash and lymphadenopathy. Postnatal rubella is presented with arthritis and arthralgia. Postnatal rubella is caused by the rubella virus which enter the respiratory tract and spread as well as disseminated to the lymph nodes, spleen, skin, joints, kidney and respiratory tract. Rubella virus will infect the placenta and finally organ in the fetus in congenital rubella syndrome. The treatment may include the live attenuated rubella virus vaccine which is given in a combination of measles,mumps and rubella vaccine ( MMR). Protozoan Vaginitis
Protozoan vaginitis is caused by urogenital flagellate protozoa which is trichomonas vaginalis. Trichomonas vaginalis can be detected by microscopic examination which may reveal the present of oval trophozoites which move in a jerky pattern with the help of four anterior flagella. Trichomonas vaginalis infection may lead to vaginitis. Vaginitis may present with itching and burning erythematous vagina with greenish, yellow watery foul smelling discharge. Trichomonas vaginalis may be transmitted via childbirth or sexual contact. Trophozoites will lead to destruction of the epithelial cells and activation of the inflammation of the host cell. Men may also be infected with trichomonas vaginalis which may lead to prostatitis and urethritis. Antibiotic such as metronidazole is useful in treating patient with protozoan vaginitis. Cryptosporidium Parvum Infection
Cryptosporidium parvum is a form of protozoa which can be diagnosed via direct microscopic examination of the fecal smears to detect for the acid fast oocysts. Other form of diagnosis may include fecal antigen test. Cryptosporidium parvum may lead to watery diarrhea. In worst case scenario ( immunocompromised patient ) patient may present with wasting, electrolytes imbalance and malnutrition due to massive loss of fluid. The mode of transmission may include oral anal route or fecal oral route and ingestion of oocyst contaminated water. The sporozoites will develop form the oocyst which attached to the jejunum epithelial cells. Trophozoites will form and divide to from merozoites. Merozoites develop into gametocytes. Oocysts from fertilized zygotes will be excretion in the stool. The treatment may include paromomycin and fluid replacement. Syphilis
There are four forms of syphilis. These include congenital syphilis,primary syphilis, secondary syphilis and tertiary syphilis. Congenital syphilis may lead to neurological and cardiovascular abnormalities. Transplacental spread may cause congenital syphilis. Primary syphilis is presented with painless ulcer or chancre which later resolve spontaneously. ( highly infectious) Secondary syphilis may present with papule lesions on genitals ( condyloma lata) and mucous membrane. Patient my also develop maculopapular rash entire body. Secondary syphilis may develop 3 months after primary syphilis. (highly infectious) Tertiary syphilis may develop few years later and present with formation of granulomas in the bone and skin, aortic aneurysm, dementia and meningitis. Syphilis is caused by treponema pallidum. Treponema pallidum can be detected via direct fluorescent assay and dark field microscopy. Serological testing for treponemal antigen and non treponemal antigen is useful in diagnosing syphilis. Treponema pallidum is a gram negative spirochetes which can be grown in a cell free culture. The mode of transmission is via sexual contact. Safe sex practice is vital. The treatment may include benzathine penicillin. Non trepenomal antibody will rise during infection and fall if the treatment is successful. Bloody diarrhea
Patient being infected with Balantidium coli may present with watery diarrhea containing blood and mucus. Balantidium coli may present in the cyst and trophozoite forms. Balantidium coli is a ciliated parasites. Balantidium coli can be detected via direct examination of the stool. Cyst may present on the stool or ciliated trophozoites are present in the diarrheal form of stool. The common mode of transmission is via fecal oral route or ingestion of water or food contaminated with cyst. Once ingested, the trophozoites will attach to the colon which lead to ulceration. The common treatment is via iodoquinol or tetracycline. |
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June 2023
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