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Utigutimicro

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According to Ma'am Pacanan, hindi pa daw sure kung kasama 'to sa finals, pero inupload ko na din just in case :)

According to Ma'am Pacanan, hindi pa daw sure kung kasama 'to sa finals, pero inupload ko na din just in case :)

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    Utigutimicro Utigutimicro Presentation Transcript

    • 26
      Microbial Diseases of the Urinary and Reproductive Systems
    • Microbial Diseases of the Urinary and Reproductive Systems
      Microbes usually enter the urinary system through the urethra.
      Microbes usually enter the reproductive system through the vagina (in females) or urethra (in males).
    • Female Urinary Organs
      Figure 26.1
    • Female Reproductive Organs
      Figure 26.2a
    • Male Reproductive & Urinary Organs
      Figure 26.3
    • Normal Microbiota
      Urinary bladder and upper urinary tract sterile
      Lactobacilli predominant in the vagina
      >1,000 bacteria/ml or 100 coliforms/ml of urine indicates infection
    • Cystitis
      Usually caused by
      E. coli
      S. saprophyticus
      May also be caused by
      Proteus
      Klebsiella
      Enterococcus
      Pseudomonas
      E. coli usually causes pyelonephritis.
      Antibiotic-sensitivity tests may be required before treatment.
    • UTI
      Ureteritis = inflammation of ureter (maybe caused by stone in the ureter)
      Cystitis = inflammation of bladder (caused by ascending bacterial infection usually E. coli)
      Urethritis= inflammation of urethra (may lead to prostatitis and epididymitis)
    • “Bad Stroke”
    • FACTORS THAT CONTRIBUTE TO UTI
      FEMALE (PROXIMITY TO THE ANUS, SHORTER URETHRA)
      POOR HYGIENE
      UNSAFE SEXUAL PRACTICES
      BACK TO FRONT STROKE
      HIGH pH
      URINARY STASIS
      KIDNEY STONES
      OBSTRUCTION OF URINE OUTFLOW
    • S/Sx:
      PAIN assessment
      Pain during and after urination =
      cystitis
      Pain after urination = urethritis
      Inguinal pain = ureteritis
      Flank pain = pyelonephritis
      Inflammatory manifestations
      fever and chills
      Cx:
      Ascending infection
      Obstruction (stones/calculi)
    • Management
      E. coli (most common C.A.)
      Increase fluids
      Warm sitz bath
      EMPTY the bladder
      Good hygiene
      Observe safe sexual practice
      Front to back stroke
      Acidify urine (cranberry juice, prune, plums)
      C/S test before giving antibiotics
      For urosepsis give aminoglycosides
      Observe complications
    • Leptospirosis
      Leptospira interrogans
      Reservoir: Dogs and rats
      Transmitted by skin/mucosal contact from urine-contaminated water
      Diagnosis: Isolating bacteria or serological tests
      Figure 26.4
    • Silver Stain of Leptospira interrogans serotype icterohaemorrhagiae
      • Obligate aerobes
      • Characteristic hooked ends (like a question mark, thus the species epithet – interrogans)
    • Leptospirosis Clinical Syndromes
      • Mild virus-like syndrome
      • (Anicteric leptospirosis) Systemic with aseptic meningitis
      • (Icteric leptospirosis) Overwhelming disease (Weil’s disease)
      • Vascular collapse
      • Thrombocytopenia
      • Hemorrhage
      • Hepatic and renal dysfunction
      NOTE: Icteric refers to jaundice (yellowing of skin and mucus membranes by deposition of bile) and liver involvement
    • Pathogenesis of Icteric Leptospirosis
      • Leptospirosis, also called Weil’s disease in humans
      • Direct invasion and replication in tissues
      • Characterized by an acute febrile jaundice & immune complex glomerulonephritis
      • Incubation period usually 10-12 days with flu-like illness usually progressing through two clinical stages:
      Leptospiremia develops rapidly after infection (usually lasts about 7 days) without local lesion
      Infects the kidneys and organisms are shed in the urine (leptospiruria) with renal failure and death not uncommon
      • Hepatic injury & meningeal irritation is common
    • Clinical Progression of Icteric (Weil’s Disease) and Anicteric Leptospirosis
      (pigmented part of eye)
    • Epidemiology of Leptospirosis
      • Mainly a zoonotic disease
      • Transmitted to humans from a variety of wild and domesticated animal hosts
      • In USA most common reservoirs rodents (rats), dogs, farm animals and wild animals
      • Transmitted through breaks in the skin or intact mucus membranes
      • Indirect contact (soil, water, feed) with infected urine from an animal with leptospiruria
      • Occupational disease of animal handling
    • Comparison of Diagnostic Tests for Leptospirosis
    • Sexually Transmitted Diseases (STDs )
      Prevented by condoms
      Treated with antibiotics
    • Gonorrhea
      Figure 26.5a
    • Gonorrhea
      Neisseria gonorrhoeae
      Attaches to oral or urogenital mucosa by fimbriae.
      Females may be asymptomatic; males have painful urination and pus discharge.
      Treatment is with antibiotics.
      If left untreated, may result in
      Endocarditis
      Meningitis
      Arthritis
      Ophthalmia neonatorum
    • Gonorrhea
      Figure 26.7
    • Gonorrhea
      UN 26.1
    • Nongonococcal Urethritis
      Chlamydia trachomatis
      May be transmitted to a newborn's eyes
      Painful urination and watery discharge
      Mycoplasma hominis
      Ureaplasma urealyticum
    • Pelvic Inflammatory Disease
      N. gonorrhoeae
      C. trachomatis
      Can block uterine tubes
      Chronic abdominal pain
    • GONORRHEA
      Neisseria gonorrhea, gram (+)
      IP: 3-7 days
      28
      Rex Karl S. Teoxon, R.N, M.D
    • SIGNS AND SYMPTOMS
      Females: usually asymptomatic or minimal urethral discharge w/ lower abdominal pain
      Male: Mucopurulent discharge, Painful urination
      29
      Rex Karl S. Teoxon, R.N, M.D
    • GONORRHEAMANIFESTATIONS IN MEN
      • Urethritis
      • Epididymitis
      • Proctitis
      • Pharyngitis
    • GONORRHEACLINICAL PRESENTATION
    • 32
    • GONORRHEAMANIFESTATIONS IN WOMEN
      • Urethritis
      • Endocervicitis
      • Proctitis
      • PID
      • Pharyngitis
    • GONORRHEADISSEMINATED INFECTION
      • Arthritis
      • Dermatitis
      • Pericarditis and endocarditis
      • Meningitis
      • Perihepatitis
    • DISSEMINATED GONORRHEACLINICAL PRESENTATION
    • 36
      Rex Karl S. Teoxon, R.N, M.D
    • 37
      Rex Karl S. Teoxon, R.N, M.D
    • 38
      Rex Karl S. Teoxon, R.N, M.D
    • DIAGNOSIS
      GSCS of cervical secretions on Thayer Martin medium
      39
      Rex Karl S. Teoxon, R.N, M.D
    • GONORRHEAGRAM STAIN
    • GONORRHEADIAGNOSIS
      • Clinical examination
      • Gram stain
      • Culture
      • Nucleic acid probes
    • MANAGEMENT
      Ceftriaxone (Rocephin) 250 mg IM
      Ofloxacin (Floxin) 400 mg orally
      treat concurrently with Doxycycline or Azithromycin for 50% infected w/ Chlamydia
      42
      Rex Karl S. Teoxon, R.N, M.D
    • GONORRHEASEQUELAE
      • Infertility
      • Ectopic pregnancy
      • Chronic pelvic pain
    • COMPLICATION
      PID
      ectopic pregnancy and infertility
      Peritonitis
      Perihepatitis
      Ophthalmia neonatorum
      Sepsis
      Arthritis
      44
      Rex Karl S. Teoxon, R.N, M.D
    • GONORRHEATREATMENT
      Patient and partner should be treated
      Drugs of choice
      Ceftriaxone
      Quinolone
    • CHLAMYDIA
      Chlamydia trachomatis, gram (-)
      IP: 2-10 days
      46
      Rex Karl S. Teoxon, R.N, M.D
    • SIGNS AND SYMPTOMS
      Maybe asymptomatic
      Gray white discharge, Burning and itchiness at the urethral opening
      DX:
      Gram stain
      Antigen detection test on cervical smear
      Urinalysis
      47
      Rex Karl S. Teoxon, R.N, M.D
    • Rex Karl S. Teoxon, R.N, M.D
      48
    • 49
      Rex Karl S. Teoxon, R.N, M.D
    • CHLAMYDIADIAGNOSIS
    • CHLAMYDIAMANIFESTATIONS IN MEN
      • Urethritis
      • Proctitis
      • Epididymitis
    • CHLAMYDIAMANIFESTATIONS IN WOMEN
      • Urethritis
      • Endocervicitis
      • Proctitis
      • PID
      • Perihepatitis
    • MANAGEMENT
      Doxycycline or Azithromycin
      Erythromycin and Ofloxacin
      CX:
      PID
      Ectopic pregnancy
      Fetus transmittal (vaginal birth)
      53
      Rex Karl S. Teoxon, R.N, M.D
    • Syphilis
      Figure 26.9a
    • Syphilis
      Treponema pallidum
      Invades mucosa or through skin breaks.
      Figure 26.10
    • Syphilis
      Direct diagnosis
      Darkfield microscopic identification of bacteria
      Staining with fluorescent-labeled, monoclonal antibodies
      Indirect, serological diagnosis
      VDRL, RPR, ELISA test for reagin-type antibodies using cardiolipid (Ag)
      FTA-ABS tests for anti-treponemal antibodies
    • Syphilis
      Figure 3.6b
    • Syphilis
      Primary stage: Chancre at site of infection
      Secondary: Skin and mucosal rashes
      Latent period: No symptoms
      Tertiary: Gummas on many organs
      Congenital: Neurological damage
      Primary and secondary stages treated with penicillin
    • Virulence Factors of T. pallidum
      • Outer membrane proteins promote adherence
      • Hyaluronidase may facilitate perivascular infiltration
      • Antiphagocytic coating of fibronectin
      • Tissue destruction and lesions are primarily result of host’s immune response (immunopathology)
    • SYPHILIS
      Treponema pallidum, spirochete
      IP: 10-90 days
      60
      Rex Karl S. Teoxon, R.N, M.D
    • SYPHILISMECHANISMS OF TRANSMISSION
      • Sexual contact
      • Perinatal
    • SYPHILISFREQUENCY
      • Incidence has increased , especially in females aged 15-24 years
      • Highest prevalence - urban blacks and hispanics
    • SYPHILISCLASSIFICATION
      • Primary
      • Secondary
      • Latent
      • Early
      • Late
      • Tertiary
    • SIGNS AND SYMPTOMS
      Primary (3-6 wks after contact) – nontender lymphadenopathy and chancre; most infectious; resolves 4-6 wks
      Secondary – systemic; generalized macular papular rash including palms and soles and painless wartlike lesions in vulva or scrotum (condylomata lata) and lymphadenopathy
      Tertiary – (6-40 years) - neurosyphilis/ permanent damage (insanity); gumma (necrotic granulomatous lesions), aortic aneurysm
      64
      Rex Karl S. Teoxon, R.N, M.D
    • Pathogenesis of T. pallidum (cont.)
      Primary Syphilis
      • Primary disease process involves invasion of mucus membranes, rapid multiplication & wide dissemination through perivascular lymphatics and systemic circulation
      • Occurs prior to development of the primary lesion
      • 10-90 days (usually 3-4 weeks) after initial contact the host mounts an inflammatory response at the site of inoculation resulting in the hallmark syphilitic lesion, called the chancre (usually painless)
      • Chancre changes from hard to ulcerative with profuse shedding of spirochetes
      • Swelling of capillary walls & regional lymph nodes w/ draining
      • Primary lesion heals spontaneously by fibrotic walling-off within two months, leading to false sense of relief
    • PRIMARY SYPHILISPRINCIPAL CLINICAL FINDING
    • 67
      Rex Karl S. Teoxon, R.N, M.D
    • 68
      Rex Karl S. Teoxon, R.N, M.D
    • Pathogenesis of T. pallidum (cont.)
      Secondary Syphilis
      • Secondary disease 2-10 weeks after primary lesion
      • Widely disseminated mucocutaneous rash
      • Secondary lesions of the skin and mucus membranes are highly contagious
      • Generalized immunological response
    • SECONDARY SYPHILISPRINCIPAL CLINICAL FINDINGS
    • Generalized Mucocutaneous Rash of Secondary Syphilis
    • 72
      Rex Karl S. Teoxon, R.N, M.D
    • 73
      Rex Karl S. Teoxon, R.N, M.D
    • SECONDARY SYPHILISPRINCIPAL CLINICAL FINDINGS
    • LATE STAGE SYPHILISPRINCIPAL CLINICAL MANIFESTATIONS
      Destructive gummas
      Aortic valve injury
      CNS manifestations
      Dementia
      Tabes dorsalis
      Pupillary abnormalities
    • Pathogenesis of T. pallidum (cont.)
      Latent Stage Syphilis
      • Following secondary disease, host enters latent period
      • First 4 years = early latent
      • Subsequent period = late latent
      • About 40% of late latent patients progress to late tertiary syphilitic disease
    • Pathogenesis of T. pallidum (cont.)
      Tertiary Syphilis
      • Tertiary syphilis characterized by localized granulomatous dermal lesions (gummas) in which few organisms are present
      • Granulomas reflect containment by the immunologic reaction of the host to chronic infection
      • Late neurosyphilis develops in about 1/6 untreated cases, usually more than 5 years after initial infection
      • Central nervous system and spinal cord involvement
      • Dementia, seizures, wasting, etc.
      • Cardiovascular involvement appears 10-40 years after initial infection with resulting myocardial insufficiency and death
    • LATE STAGE SYPHYLISGUMMAS
    • 79
      Rex Karl S. Teoxon, R.N, M.D
    • 80
      Rex Karl S. Teoxon, R.N, M.D
    • CONGENITAL SYPHILISCLINICAL MANIFESTATIONS
      Fetal death
      Growth restriction
      Multiple anomalies
      Immediately apparent at birth
      Delayed appearance
    • Pathogenesis of T. pallidum (cont.)
      Congenital Syphilis
      • Congenital syphilis results from transplacental infection
      • T. pallidumsepticemia in the developing fetus and widespread dissemination
      • Abortion, neonatal mortality, and late mental or physical problems resulting from scars from the active disease and progression of the active disease state
    • CONGENITAL SYPHILISRISK OF PERINATAL TRANSMISSION
      %
    • SYPHILISDIAGNOSIS
      Clinical examination
      Darkfield microscopy
      Serology
      VDRL – screening test
      MHA or FTA – confirmatory test
    • DIAGNOSIS
      Dark-field examination of lesion- 1st and 2nd stage
      Non specific VDRL and RPR
      FTA-ABS
      Mgmt
      Primary and secondary - Pen G
      Tertiary - IV Pen G
      85
      Rex Karl S. Teoxon, R.N, M.D
    • Diagnostic Tests for Syphilis
      (Original Wasserman Test)
      NOTE: Treponemal antigen tests indicate experience with a treponemal infection, but cross-react with antigens other than T. pallidum ssp. pallidum. Since pinta and yaws are rare in USA, positive treponemal antigen tests are usually indicative of syphilitic infection.
    • SYPHILISTREATMENT
      Patient and sexual partner(s) should be treated
      Antibiotic therapy
      Penicillin – preferred in pregnancy
      Doxycycline
      Tetracycline
    • Prevention & Treatment of Syphilis
      • Penicillin remains drug of choice
      • WHO monitors treatment recommendations
      • 7-10 days continuously for early stage
      • At least 21 days continuously beyond the early stage
      • Prevention with barrier methods (e.g., condoms)
      • Prophylactic treatment of contacts identified through epidemiological tracing
    • Lymphogranuloma Venereum (LGV)
      Chlamydia trachomatis
      Initial lesion on genitals heals
      Bacteria spread through lymph causing enlargement of lymph nodes
      Treatment: Doxycycline
    • LGVCLINICAL MANIFESTATIONS
    • CHLAMYDIALGV
      STD caused by serovars L1, L2, L3
      Common in Asia, Africa, South America, and the Caribbean
      Incubation period 3 days to 3 weeks
      Painless vesicleregional lymphaticsinguinal and femoral adenitis and proctitis
    • Chancroid (Soft Chancre)
      Haemophilus ducreyi
      Ulcer on genitalia
      May break through surface
      Infection of lymph nodes
      Treatment: Erythromycin and ceftriaxone
    • Bacterial Vaginosis
      Gardnerella vaginalis
      Diagnosis by clue cells
      Treatment: Metronidazole
      Figure 26.12
    • DIAGNOSIS
      Viral culture
      Pap smear (shows cellular changes)
      Tzanck smear (scraping of ulcer for staining)
      94
      Rex Karl S. Teoxon, R.N, M.D
    • MANAGEMENT
      Anti viral – acyclovir (zovirax)
      CX:
      Meningitis – mild and self limiting
      Neonatal infection (vaginal birth)
      Disseminated with liver involvement
      Encephalitis
      Skin, eyes, mouth
      95
      Rex Karl S. Teoxon, R.N, M.D
    • Genital Herpes
      Herpes simplex virus 2 (Human herpesvirus 2 or HHV–2)
      Neonatal herpes transmitted to fetus or newborns
      Recurrences from viruses latent in nerves
      Suppression: Acyclovir or valacyclovir
    • HERPES GENITALIS
      HSV 2
      Envelop, icosahedral, dsDNA
      Latent – sacral nerve ganglia
      97
      Rex Karl S. Teoxon, R.N, M.D
    • 98
      Rex Karl S. Teoxon, R.N, M.D
    • 99
      Rex Karl S. Teoxon, R.N, M.D
    • SIGNS AND SYMPTOMS
      Painful sexual intercourse
      Painful vesicular lesions (cervix, vagina, perineum, glans penis)
      101
      Rex Karl S. Teoxon, R.N, M.D
    • Genital Warts
      Human papillomaviruses
      Treatment: Imiquimod to stimulate interferon
      HPV 16 causes cervical cancer and cancer of the penis.
      DNA test is needed to detect cancer-causing strains.
      Vaccination against HPV strains
    • GENITAL WARTS
      Condyloma Acuminatum
      HPV type 6 & 11, papilloma virus
      103
      Rex Karl S. Teoxon, R.N, M.D
    • SIGNS AND SYMPTOMS
      Single or multiple soft, fleshy painless growth of the vulva, vagina, cervix, urethra, or anal area, Vaginal bleeding, discharge, odor and dyspareunia
      DX:
      Pap smear-shows cellular changes (koilocytosis)
      Acetic acid swabbing (will whiten lesion)
      104
      Rex Karl S. Teoxon, R.N, M.D
    • 107
      Rex Karl S. Teoxon, R.N, M.D
    • 108
      Rex Karl S. Teoxon, R.N, M.D
    • MANAGEMENT
      Laser treatment is more effective
      CX:
      Neoplasia
      Neonatal laryngeal papillomatosis (vaginal birth)
      Rex Karl S. Teoxon, R.N, M.D
      109
    • Candidiasis
      Candida albicans
      Grows on mucosa of mouth, intestinal tract, and genitourinary tract.
      NGU in males
      Vulvovaginal candidiasis
      Diagnosis is by microscopic identification and culture of yeast.
      Treatment: Clotrimazole or miconazole.
    • CANDIDIASIS
      Moniliasis (oral candidiasis)
      Vulvovaginal candidiasis
      Candida albicans (Yeast or fungus)
      111
      Rex Karl S. Teoxon, R.N, M.D
    • SIGNS AND SYMPTOMS
      Cheesy white discharge
      Extreme itchiness
      DX:
      KOH (wet smear indicate positive result)
      112
      Rex Karl S. Teoxon, R.N, M.D
    • 113
      Rex Karl S. Teoxon, R.N, M.D
    • 115
      Rex Karl S. Teoxon, R.N, M.D
    • MANAGEMENT
      Imidazole, Monistat, Diflucan
      CX:
      Oral thrush to baby (vaginal birth)
      116
      Rex Karl S. Teoxon, R.N, M.D
    • Trichomoniasis
      Trichomonas vaginalis
      Found in semen or urine of male carriers
      Vaginal infection causes irritation and profuse discharge.
      Diagnosis is by microscopic identification of protozoan.
      Treatment: Metronidazole.
      Figure 26.15
    • TRICHOMONIASIS
      Trichomonas vaginalis
      parasite
      118
      Rex Karl S. Teoxon, R.N, M.D
    • SIGNS AND SYMPTOMS
      Females: itching, burning on urination, yellow gray frothy malodorous vaginal discharge, foul smelling
      Males: usually asymptomatic
      Dx: microscopic exam of vaginal discharge
      119
      Rex Karl S. Teoxon, R.N, M.D
    • MANAGEMENT
      Metronidazole (Flagyl)
      include partners
      CX: PROM
      120
      Rex Karl S. Teoxon, R.N, M.D
    • Vaginitis and Vaginosis
      Table UN 26.1
    • Know Normal!
      1. Epithelial Cells
      2. Lactobacilli
      - 5 to 15 µ
      3. WBCs
      - Few = NL
      - Never > Epi’s
      - Many = Inflammation
      (Parabasilar Cell) >
    • Vaginosis - Know 3
      Bacterial Vaginosis
      - FEW or NO LACTOBACILLI
      - MANY Coccobacillary Orgs.
      = “GARBAGE”
      - CLUE CELLS
      = CELL EDGE
      - FEW WBCs!!!!!!!
      - MOBILUNCUS = MOTILE
      Cytolytic Vaginosis
      = “Lactobacillus
      Overgrowth Syndrome”
      - MANY LACTOBACILLI
      - 5 to 15 µ
    • Vaginosis - Know 3
      3. Lactobacillosis/Leptothrix
      - LONG LACTOBACILLI
      - 40 to 75 µ
    • Vaginitis - Know 2+
      1. Trichomonas
      2. Candidiasis/Yeast
      - Candida albicans 1) Blastospores
      “CANDIDIASIS” 2) Budding Yeast
      3) Pseudohyphae
      - Candida glabrata 1) Blastospores
      (Torulopsis g.) 2) Budding yeast
      “YEAST”
      Grow is clusters = CUMULI >
    • Additional Slides - Normals
      Normal Epithelial Cells with Sharp Borders
      Normal Lactobacilli - 5 to 15 µ (note size relative to cell nucleus)
      1. Epithelial Cells
      2. Lactobacilli
      - 5 to 15 µ
      3. WBCs
      - Few = NL
      - Never > Epi’s
      - Many = Inflammation
      (Parabasilar Cell) >
    • Additional Slides - Clue CellsAND Inflammation of ? Cause
      1. Epithelial Cells
      2. Lactobacilli
      - 5 to 15 µ
      3. WBCs
      - Few = NL
      - Never > Epi’s
      - Many = Inflammation
      (Parabasilar Cell) >
    • STD
      128
      Rex Karl S. Teoxon, R.N, M.D
    • HIV and AIDS
      Retrovirus (HIV1 & HIV2)
      Attacks and kills CD4+ lymphocytes (T-helper)
      Capable of replicating in the lymphocytes undetected by the immune system
      Immunity declines and opportunistic microbes set in
      No known cure
      Rex Karl S. Teoxon, R.N, M.D
      129
    • 130
      Rex Karl S. Teoxon, R.N, M.D
    • MOT
      Sexual intercourse (oral, vaginal and anal)
      Exposure to contaminated blood, semen, breast milk and other body fluids
      Blood Transfusion
      IV drug use
      Transplacental
      Needle stick injuries
      131
      Rex Karl S. Teoxon, R.N, M.D
    • HIGH RISK GROUP
      Homosexual or bisexual
      Intravenous drug users
      BT recipients before 1985
      Sexual contact with HIV+
      Babies of mothers who are HIV+
      Rex Karl S. Teoxon, R.N, M.D
      132
    • 133
      Rex Karl S. Teoxon, R.N, M.D
    • SIGNS AND SYMPTOMS
      Acute viral illness (1 mo after initial exposure) – fever, malaise, lymphadenopathy
      Clinical latency – 8 yrs w/ no sx; towards end, bacterial and skin infections and constitutonal sx – AIDS related complex; CD4 counts 400-200
      AIDS – 2 yrs; CD4 T lymphocyte < 200 w/ (+) ELISA or Western Blot and opportunistic infections
      134
      Rex Karl S. Teoxon, R.N, M.D
    • DIAGNOSIS
      HIV+
      2 consecutive positive ELISA and
      1 positive Western Blot Test
      AIDS+
      HIV+
      CD4+ count below 200/ml
      135
      Rex Karl S. Teoxon, R.N, M.D
    • SIGNS AND SYMPTOMS
      Extreme fatigue
      Intermittent fever
      Night sweats
      Chills
      Lymphadenopathy
      Enlarged spleen
      Rex Karl S. Teoxon, R.N, M.D
      136
    • SIGNS AND SYMPTOMS
      Anorexia
      Weight loss
      Severe diarrhea
      Apathy and depression
      PTB
      Kaposis sarcoma
      Pneumocystis carinii
      AIDS dementia
      137
      Rex Karl S. Teoxon, R.N, M.D
    • 138
      Rex Karl S. Teoxon, R.N, M.D
    • MANAGEMENT
      Nucleoside Reverse Transcriptase Inhibitors NRTI’s
      Zidovudine (AZT) – limit viral growth
      Non-nucleoside Reverse Transcriptase Inhibitors NNRTI’s Ritonavir (Norvir)
      Prevention of spread (safe sex)
      Universal precautions
      Symptomatic intervention and treatment of opportunistic infections
      Vaccines (influenza and hepa B)
      139
      Rex Karl S. Teoxon, R.N, M.D