http://en.wikipedia.org/wiki/Naples, picture of naples municipal coat of arms Treponema pallidum, picture from http://en.wikipedia.org/wiki/Treponema_pallidum T. pallidum pallidum is a motile spirochaete that is generally acquired by close sexual contact, entering the host via breaches in squamous or columnar epithelium. The organism can also be transmitted to a fetus by transplacental passage during the later stages of pregnancy, giving rise to congenital syphilis. The helical structure of T. pallidum pallidum allows it to move in a corkscrew motion through viscous mediums such as mucus. It gains access to host's blood and lymph systems through tissue and mucus membranes.
Syphilis remains a public health problem in metropolitan areas with large populations of MSM. For the third consecutive year, San Francisco had the highest P&S rate of any U.S. city in 2004 (45.9). Other leading cities include Atlanta, Georgia (34.6); Baltimore, Maryland (33.2); New Orleans, Louisiana (16.4); St Louis, Missouri (14.1); Detroit, Michigan (13.5); Washington, D.C. (12.2); Dallas, Texas (11.6); Jersey City, New Jersey (10.8); and Chicago, Illinois (9.7).
March 17, 2006 MMWR report; titled: Primary and Secondary syphilis United States 2003-2004 After declining for 13 years the rate of syphilis has increased. Since 1991 this is the first time that the rate in women has not decreased This represents the first increase in the disparity between black and white rates since 1993. The increasing M:F rate ratio suggests that increases are still occurring among MSM. CDC has estimated that in 2004, approximately 64% of all P&S syphilis cases were among MSM.¶ After 13 years of decline, rates of P&S syphilis in 2004 increased in the South and did not decrease among women.
From 2004 to 2005 there is an increase of 24%
scanning electron microscope (SEM) image of a T-lymphocyte (right), a platelet (center), and a red blood cell (left). Image Innate response is nonspecific, exposure leads to immediate maximum response, cell are leukocytes,no immunological memory Adaptive response is specific per pathogen and antigen response, cells are called lymphocytes, have memory T cells - Cell mediated immunity is mediated by the T lymphocytes and is responsible for defense against intracellular microbes B cells-Humoral immunity protects against extracellular immunity
Apoptosis chronic activation of unifected cells responding to HIV itself or to common infections, leads to cell death, thus the numbers of CD4 cells that die are far greater than Gp41 inserts through host cell membrane and passes on RNA material Stages of HIV page 253, Kumar Picture: Immature HIV particle These are characterized by a disorganized central core but otherwise a complete virus able to infect the lymphocytes. This particle is tightly attached to the membrane of this cell. We believe that membrane transformation caused by direct attachment is significant to the progression of AIDS.
Outcomes projects for availability: Increase receipt of test results Increase identification of HIV-infected pregnant women so they can receive effective prophylaxis Increase feasibility of testing in acute-settings with same-day results Increase number of venues where testing can be offered to high-risk persons
The standard screening test for antibodies to HIV is the enzyme immunoassay (EIA) or ELISA OraQuick Advance, Uni Gold Recombin Reveal G2, Multispot Sure Check and Stat Pak (May 2006)
Depressed CD4: Is it always HIV? Aaron J. Loeb, BSN, RN Celine Hanson, MD Texas Children’s Hospital 12-14-2006
Antas, P.R., Ding, L., Hackman, J., Reeves-Hammock, L., Shintani, A.K., Schiffer, J., Holland, S.M., et al. (2004). Decreased CD4+ lymphocytes and innate immune responses in adults with previous extrapulmonary tuberculosis. Journal of Allergy Clinical Immunology 117(4).
Fan, Y.M., Zeng, W.J. & Li, S.F. (2004). Immunophenotypes, apoptosis, and expression of Fas and Bcl-2 from peripheral blood lymphocytes in patients with secondary early syphilis. Sexually Transmitted Diseases. 31(4).
Gamadia, L.E., Rentenaar, R.J., Van Lier, R.A., & Berge, I.J. (2004). Properties of CD4 (+) T cells in human cytomegalovirus infection. Human Immunology. 65 (5).
Grossman, Z., & Paul, W.E. (2000). The impact of HIV on naïve T-cell homeostasis. Nature Medicine (6)
Hatton, A.E., Montamat-Sicotte, D., Gudgeon, N., Rickinson, A.B., McMichael, A.J. & Calian, M.F. (2003). Characteristics of the CD4 + T cell response to Epstein-Barr virus during primary and secondary infection. Journal of Expert Medicine 198(6).
Kofoed, K., Gerstoft, J. Mathiesen, L.R., & Benfield, T. ( 2006). Syphilis and human immunodeficiency virus (HIV)-1 coinfection: influence on CD4 T-cell count, HIV-1 viral load, and treatment response. Sexually Transmitted Diseases. 33(3).