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UPPER RESPIRATORY SYSTEM INFECTIONS Streptococcus species Gram pos. cocci, chains Three groups: 1) Beta hemolytic - most virulent 2) Alpha hemolytic - opportunists 3) Gamma hemolytic - nonhemolytic, nonpathogenic Streptococcal Pharyngitis ( Strep throat ! " Streptococcus pyogenes Virulence: ncapsulate!, "-proteins in cell #alls, leu$oci!ins, %eta-hemolysins, strepto$inase, hyaluroni!ase Transmission: &'T secretions - !roplet nuclei (a!ult carriers) )* : +asopharyn, -isease: .ocali/es on m.m. tonsils, pharyn, secretes en/ymes in0lammation. ".m. %ecome re!, s#ollen, purulent e,u!ate (pus), hemorragic patches, high 0ever, pain, enlarge! lymph no!es. 1!enti0ication: 2emorragic patches, purulent e,u!ate, throat s#a%. 3omplications: 1) 'heumatic 0ever - anti%o!ies cross react #ith tissues o0 heart, 4oints - autoimmune !isease 2) Glomerulonephritis - Ag-A% comple,es 0iltere! out in $i!neys !amage $i!ney (glomerular capillaries) - autoimmune !isease 1mmunity: +one Scarlet #e$er " S% pyogenes Virulence: rythrogenic e,oto,in (!ue to lysogenic prophage lysogenic conversion)5 also see virulent characteristics a%ove Transmission: -roplet nuclei )* : +asopharyn,, oral cavity -isease: 6nset i!entical to 7strep throat8. ,oto,in pro!uce! %loo! stream s$in. 3auses re! rash on 0ace, nec$ chest, a%!omen e,tremities. Bright re! tongue (9:tra#%erry9 tongue) appears %e0ore rash. :$in peels, 0ever, chills, vomiting. 3omplications: 'heumatic 0ever, glomerulonephritis (autoimmune !iseases) 1mmunity: A% !evelop to e,oto,in %ut not to organism &iphtheria " Coryne'acteriu( )iphtheriae Gram pos. %acillus Virulence: potent !ermonecrotic e,oto,in (!ue to lysogenic prophage lysogenic conversion) Transmission: &'T secretions - !roplet nuclei. A!ult carriers. )* : +asal passage. .ocali/es in pharyn, -isease: 1nc. p!. 2 - ; !ays. :ecretes e,oto,in necrosis super0icial tissues ulceration mar$e! in0lammation thic$ (leather-li$e) e,u!ate 0orms pseu!omem%rane %loc$s trachea su00ocation !eath. 3omplications: ,oto,in enters %loo!stream !amages heart, $i!neys, 3+:. Vaccine: -)T - to,oi!

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*acterial (Contagious! Con+uncti$itis (Pin, Eye! " -ae(ophilus aegypticus. -% in#luen/ae Gram neg. %acillus Virulence: ncapsulate!, en!oto,ins (lipi!s in cell #alls) Transmission: ye, nasal secretions (e,tremely contagious). "ost common vector - han!s. )* : +asopharyn,, con4unctiva -isease: "ultiplies on con4unctiva mar$e! in0lammation re!, s#ollen eyes, purulent e,u!ate, photopho%ia. 1mmunity: none Co((on Col)s " Flu"li,e Illnesses "any viruses are causative agents: 1) 'hino viruses - most common, appro,. 1<< types, limite! to nasal passage. 2) 'eoviruses - part o0 normal 0lora in some in!ivi!uals. 1n0ections usually mil!, lo# gra!e. 3) 3orona viruses - can cause col!s, mil! pneumonia, acute respiratory !isor!ers, gastroenteritis =) )arain0luen/a - in a!ults limite! to &'T. 1n chil!ren > in0ants more severe pneumonia, croup. ;) 'espiratory :yncytial Virus (':V) - mil! in0ections in a!ults5 serious .'T in0ections in young chil!ren (?1 yr.) - pneumonia (mortality rate 2<@) A) A!enoviruses - common col!s, 0lu-li$e illnesses Virulence: inva!e m.m. respiratory tract cell lysis in0lammation Transmission: &'T secretions - han!s, 0omites )* : nasopharyn, 1mmunity: Buestiona%le. +o vaccine at present. 3omplications: :econ!ary %acterial in0ections (ear in0ections, pharyngitis, laryngitis, epiglottitis, %ronchitis, sinusitis, pneumonia) 0O1ER RESPIRATORY SYSTEM INFECTIONS Pneu(onia " Pri(ary. Secon)ary .o%ar pneumonia - involves lo%es Bronchial pneumonia - %egins in %ronchi Transmission: )rimary - !roplet nuclei, )* nasopharyn,. :econ!ary - !ue to normal 0lora, 0ollo#s resistance. -isease: .ocali/es in lungs in0lammation accumulation o0 0lui!s. Secon)ary Pneu(onia " Streptococcus pneu(oniae Gram pos. cocci. 3auses pneumonia 0ollo#ing severe illness o0 'T, !e%ilitate! patients, etc. Virulence: )art o0 &'T normal 0lora, encapsulate!, alpha hemolysins. Vaccine: 3apsular antigens Pri(ary Pneu(onias - 3ause! %y C pathogens. 1) :taphylococcus aureus - Gram pos. cocci 2) Dle%siella pneumonia - Gram neg. %acillus 3) "ycoplasma pneumoniae - lac$ cell #all, contagious =) 3hlamy!ia psittaci - Gram neg., intracellular ;) .egionella pneumophilia - Gram neg. %acillus, intracellular A) Viruses can also cause primary pneumonia

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1hooping Cough (Pertussis! " *or)etella pertussis Gram neg. cocco%acillus Virulence: ncapsulate!, pili, en!oto,ins (cell #all lipi!s), e,oto,ins Transmission: &'T secretions - !roplet nuclei. A!ult carriers. )* : nasopharyn, -isease: 1nc. p!. E-1< !ays. .ocali/es in trachea, %ronchi. To,ins release! loss o0 ciliate! epithelium in0lammation. Thic$, ropy, stic$y e,u!ate 0orms - clings to ciliate! m.m. prolonge! episo!es o0 cough. -isease occurs in three stages: 1) 3atarrhal - resem%les col! 2) :pasmo!ic ()aro,ysmal) - severe episo!es o0 cough accompanie! %y gagging, cho$ing, vomiting, cyanosis, convulsions, hemorrhage, 0racture! ri%s. 3) 3onvalescent - cough eventually su%si!es 3omplications: secon!ary %acterial in0ections (pneumonia) Vaccine: -)T - $ille! organisms Tu'erculosis (T*! " Myco'acteriu( tu'erculosis Aci! 0ast , small, slen!er %acillus. Virulence: #a,y ( lipi!s) cell #alls, intracellular. Transmission: &'T secretions - !roplet nuclei. -evelopment o0 !isease !epen!s on: 1) general health 2) age. A!ults in goo! general health more resistant. l!erly, young chil!ren, an! a!ults in poor health more suscepti%le. )* : nasopharyn, locali/es in lungs. 1nitial lesion !evelops - tu%ercle. 2istology o0 tu%ercle: 1) )"+Fs, macrophages - in0lammation 2) T-lymphocytes - cell immunity 3) Gi%ro%lasts connective tissue - non-speci0ic resistance. -isease : T#o 0orms !isease: 1) Benign TB - sel0-limiting (heals). 6ccurs in a!ults in goo! health. 2) )rogressive TB - sprea!s. 6ccurs in el!erly, young chil!ren, a!ults in poor health. .esion continues to !evelop - caseation. 3an sprea! to other parts %o!y 4oint, $i!ney, intestines, 3+:, etc. Arreste! TB: .esions heal %ut contain !ormant organisms5 can %e reactivate! at later !ate. :$in Test: 1n4ection Ag. rea! in 3 !ays - o%serve 0or re!, raise! har!ene! area (H). 1n!icates previous e,posure, +6T active illness. In#luen/a " In#luen/a 2irus types A. *. C A - most virulent5 responsi%le 0or most epi!emics, pan!emics B - less virulent5 causes some epi!emics 3 - least virulent5 causes mil! in0ections Virulence: inva!es m.m., ciliate! epithelium o0 nasal, oropharyn,, lungs Transmission: &'T secretions - !roplet nuclei )* : nasopharyn, -isease: 1nc. p!. 1- 3 !ays. -estroys epithelium in0lammation. :ymptoms vary #ith antigenic type. 3omplications: secon!ary %acterial in0ections (pneumococcal pneumonia) 1mmunity: Active in0ection pro!uces active immunity, %ut !oes not protect against 0uture in0ections !ue to 0reIuent antigenic changes in virus: 1) Antigenic !ri0t: !ue to spontaneous mutations, A > B. 2) Antigenic shi0t: !ue to recom%ination #ith animal viruses, A only. Vaccine: inactivate! viruses (current strains)

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Reyes Syn)ro(e :erious complication 0ollo#ing several !i00erent 0e%rile viral in0ections - in0luen/a, chic$enpo,, ru%eola, mumps, a!enoviruses, etc. )rimarily ages 2 - 1A. Assoc. #ith treatment 0ever #ith aspirin - prevents inter0eron pro!uction. Allo#s virus to sprea! causes severe encephalomyelitis, liver !amage. "ortality rate up to J<@. :urvivors usually su00er severe neurological !amage )revention: -o not use aspirin 0or 0evers o0 un$no#n origin. Mycoses " Fungal In#ections o# RT :ource: :pores in soil, animal 0eces )* : 1nhale spores (nasopharyn,) -isease: 1n0ections %egin in lungs - chronic. "ay %e %enign or progressive, some sprea! internal organs 3ausative agents: 1) 3occi!ioi!es immitis - Valley Gever5 !imorphic Begins in lungs can sprea! to %rain, %one. 2) 2istoplasma capsulatum - histoplasmosis5 !imorphic .ungs can sprea! to spleen, liver, lymph no!es. 3) 3ryptococcus neo0ormans - encapsulate! yeast .ungs %rain, meninges =) )neumocystis carinii - pneumocystic pneumonia 6pportunist - in0ects in!ivi!uals #ith severely !epresse! immune system (A1-:). S3IN INFECTIONS S,in In#ections " Staphylococcus aureus Gram pos. cocci, irregular clusters Virulence: 1) cell #all protein A 2) leu$oci!ins 3) coagulase =) %eta hemolysins ;) :taphylo$inase A) !ermonecrotic e,oto,in E) hyaluroni!ase :ource: &'T, s$in (human carriers) Transmission: &'T secretions, han!s (most common vector) )* : %rea$ in s$in, 0ollicles -isease: Basic lesion - a%scess. 3an ta$e 0orm o0 pimple, pustule, 0olliculitis, %oil, 0uruncle, car%uncle, #oun! in0ections, post-op a%scess, internal a%scesses, septicemia 2istology o0 a%scess: 1) 1ntro!uce! into su%cutaneous tissue. 2) "ultiply secrete en/ymes, to,ins tissue in4ury. 3) 1n0lammation accum. o0 0lui!s, )"+Fs, cell !e%ris, 0i%rin, organisms. =) :$in %ecomes !isten!e! pustule 0orms. ;) 3onnect. tissue sac 0orms aroun! lesion. A) )ustule ruptures !rains heals. 3omplications: septicemia, a%scesses in internal organs 1mmunity: none

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I(petigo " S% aureus Virulence: 3ause! %y strains that pro!uce large amounts o0 hyaluroni!ase. Transmission: !irect, in!irect contact. 2ighly contagious )* : %rea$ in s$in, insect %ites -isease: )ustule 0orms ruptures shallo# sprea!ing ulcer crusts 3omplication: septicemia, internal a%scesses 1mmunity: none Acne $ulgaris " Propioni'acteriu( acnes Gram pos. %acilli 6rganism in0ects 0ollicles plugge! #ith oily secretions in0lammation pustule, cysts *urn In#ections " Pseu)o(onas aeruginosa (P% #luorescence! Gram neg. %acilli. Anti%iotic resistant strains. GreIuently causes nosocomial in0ections in severely %urne! patients Roc,y Mountain Spotte) Fe$er " Ric,ettsia ric,ettsii Gram neg., small %acillus Virulence: o%ligate intracellular parasite. 1nva!es en!othelium %loo! vessels !amages vessel #alls lea$age petechiae (pinpoint hemorrhages in s$in) 'eservoir: small mammals in #il! - in0ects linings %loo! vessels tic$ in0ecte! #hen ta$es %loo! meal K gro#s cells lining gut small mammal in0ecte! %y tic$ %ite Vector: #oo! tic$ - man in0ecte! %y %ite-in0ecte! tic$. 6rganism inva!es en!othelium o0 %loo! vessels. -isease: 1nc. p!. 3 - = !ays. 6nset - 0ever, hea!ache, #ea$ness, rash (petechiae), enlarge! lymph no!es. Bloo! vessels in internal organs also !amage! (%rain, heart, lungs). 0y(e &isease " *orrelia 'urg)or#eri Gram neg. spirochete 'eservoir: Giel! mice (host 0or immature tic$). -eer are not in0ecte! - %ree!ing groun! 0or tic$s. Vector: -eer tic$ - in0ecte! #hen ta$es %loo! meal 0rom in0ecte! animal transmitte! to suscepti%le animal or human upon ta$ing su%seIuent %loo! meal. -isease: occurs in 3 stages: 1) 6nset characteri/e! %y 9%ulls eye9 re! rash at site tic$ %ite - clears in center as sprea!s. Accompanie! or 0ollo#e! %y 0lu-li$e illness, rash 0a!es 2) :econ! phase occurs #ee$s, months later. 2eart > neurological involvement irregular heart%eat, 0acial paralysis, meningitis, encephalitis 3) Thir! phase occurs months, years later. :evere arthritis !evelops pro%a%ly !ue to immune responses. 3an cause crippling. )revention: avoi! tic$ %ites Chic,enpo4. Shingles " -erpes $aricella (/oster! Chic,enpo4 (2aricella!5 2ighly contagious, common in young chil!ren. Virulence: inva!es epithelium, m.m. Transmission: &'T secretions - !roplet nuclei5 secretions 0rom lesions - !irect, in!irect contact )* : nasopharyn,, con4unctiva -isease: 1nc. p!. 2 - 3 #$s. Virus multiplies in nasal passage %loo!stream (viremia) s$in, mucus mem%ranes. "aculopapular rash - trun$ 0ace, nec$ e,tremities. .esion %egins as papule vesicle pustule ruptures, crusts (3-= !ays) - see 0ig. pg. =JJ. Gresh lesions (9crops8) appear 0irst 3 - = !ays. 1n a!ults can involve lungs, liver, spleen.

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1mmunity: active in0ection li0e-long immunity Vaccine: via%le virus Shingles (6oster!5 6ccurs in a!ults #ho have ha! chic$en po, as chil!ren. Virus remains latent in sensory ganglia. Lhen activate! lytic cycle causes vesicular rash along path nerve. 3an reoccur. Re) Measles " Ru'eola $irus 2ighly contagious, acute illness. Virulence: inva!es epithelium, m.m. o0 con4unctiva > 'T Transmission: &'T secretions - !roplet nuclei )* : nasopharyn,, mouth, con4unctiva -isease: 1nc. p!. 2 #$s. Virus multiples in &'T mucosa an! con4unctiva %loo! (viremia) inva!es s$in maculopapular rash on hea!, nec$, trun$, e,tremities. Accompanie! %y Dopli$ spots in mouth (0ig. pg. =M1), con4unctivitis (photosensitivity), 0ever, acute &'T secretions. 3omplications: secon!ary %acterial in0ections, encephalitis. 1!enti0ication: Dopli$ spots 1mmunity: active in0ection li0e-long immunity Vaccine: ""'-via%le attenuate! virus 7er(an Measles. (8")ay Measles! " Ru'ella 2irus "il!er in0ection, less contagious than 'u%eola Virulence: inva!es epithelium rash Transmission: &'T secretions - !roplet nuclei )* : nasopharyn, -isease: 1nc. p!. 3 #$s. )attern same as ru%eola, e,cept accompanie! %y mil!er symptoms, no Dopli$ spots, no con4unctivitis. .asts a%out 3 !ays. +o complications in chil!ren. 1mmunity: active in0ection li0e-long immunity 3omplication: 10 pregnant #oman #ith no immunity, in 0irst trimester o0 pregnancy e,pose! an! %ecomes in0ecte! #ith virus, virus #ill cross placenta an! in0ect em%ryo*0etus. 3auses cell !ivision, chromosomal a%normalities, cell lysis !eath, !e0ormities Vaccine: ""' - via%le attenuate! virus Roseola " Roseola $irus Viral illness o0ten mista$en 0or measles. 3ommon in in0ants. -isease: 0ever, convulsions, vomiting - appro,. 3 !ays. Temperature , rash appears lasts 2 - 3 !ays. S(allpo4 " 2ariola $irus 2ighly contagious, high mortality rate Virulence: 1nva!es epithelium Transmission: +asal-oral secretions, e,u!ate 0rom lesions, !rie! crusts (sca%s), e,pire! in!ivi!ual, 0etus in utero. )* : +asopharyn, -isease: 1nc. p!. 2 #$s. "aculopapular rash on 0ace arms, legs very 0e# lesions on trun$. )apule vesicle (3!) pustule (J-M!) crusts, heals #ith scarring (2 #$s.). +o 9crops.9 Accompanie! %y 0ever, chills, muscle aches, severe prostration. 1!enti0ication: Guarnieri %o!ies (inclusion %o!ies) in in0ecte! cells Vaccine: Via%le attenuate! virus. Vaccine no longer given %ecause L26 %elieves !isease era!icate! - %ase! on lac$ reporte! cases. Also vaccine can cause !eath !ue to: a) progressive vaccinia, %) generali/e! vaccinia, c) post vaccinial encephalitis

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!) allergic reactions to vaccine

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Fungal S,in In#ections -ermatophytes: 1n0ect $eratini/e! tissues. Three genus: 1) pi!ermatophyton 2) "icrosporum 3) Trichophyton :ource: Gertile soil Virulence: Brea$s !o#n $eratini/e! tissues )* : Brea$ in s$in -isease: 1n0ection !evelops slo#ly. .esion circular, scaly, itches. Tinea pe!is - athletes 0eet5 Tinea corporus - ring #orm o0 %o!y5 Tinea curis - groin5 Tinea unguium - nails5 Tinea capitis - ring #orm o0 scalp5 Tinea %ar%ae - %ear! Can)i)a al'icans Neast5 part o0 normal 0lora (mouth, G1 tract), opportunistic. -iseases: Thrush - m.m. mouth5 Vaginitis - m.m. vagina5 !iarrhea NER2OUS SYSTEM INFECTIONS Meningococcal (Epi)e(ic! Meningitis " Neisseria (eningiti)is Gram neg. !iplococci, %ean-shape!, pairs Virulence: 1ntracellular parasites, encapsulate!, catalase, en!oto,ins, Transmission: &'T secretions (0resh) - reIuires close contact, !irect contact )* : +asopharyn, -isease: +asopharyn, %loo! %acteria inva!e meninges mar$e! in0lammation e!ema, 0lui!s intercranial pressure 6nset: 2igh 0ever, chills, hea!ache, sti00 pain0ul nec$ !elirium convulsions shoc$. :$in rash !ue to hemorrhages (capillaries). 3oma !eath. 1!enti0ication: :pinal tap num%er )"+Fs, Gram negative intracellular !iplococci in )"+Fs Vaccine: 3apsular antigens -ae(ophilus Meningitis " -ae(ophilus in#luen/ae (type *! Gram neg. %acillus Virulence: ncapsulate!, en!oto,ins Transmission: &'T secretions - !roplet nuclei. 3hil!ren common carriers. -isease occurs primarily in chil!ren 2 mo. - 1 yr. o0 age. )* : +asopharyn, -isease: nters %loo!stream meninges in0lammation e!ema, 0lui!s intercranial pressure 6nset - high 0ever, hea!ache, pain0ul sti00 nec$, irrita%ility, %ulging 0ontanel convulsions coma !eath 1!enti0ication: :pinal tap - num%er )"+Fs, presence Gram neg. %acilli in 0lui! Vaccine: 2i% - capsular > mem%rane antigens Epiglottitis " -% in#luen/ae 3auses in0ection > mar$e! in0lammation epiglottis. 3an %loc$ trachea su00ocation.

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-ansen9s )isease " Myco'acteriu( leprae Aci! 0ast , small %acillus Virulence: La,y ( lipi!s) cell #alls, intracellular Transmission: -irect, very close contact. Also !epen!s on suscepti%ility o0 host: 1) age 2) health )* : :$in - causes chronic lesion #ith same histology as tu%ercle, !ue to same immune responses. -isease: T#o 0orms can occur: 1) Tu%erculoi! - mil!er, sel0-limiting, involves s$in. "ore li$ely to occur in healthy a!ults 2) .epromatous - progressive 0orm - no!ular lesions occur in s$in, m.m., cartilage, nerves. 3auses !is0iguring, crippling, loss sensation. "ore li$ely to occur in very young, el!erly, in!ivi!uals #ith cell immunity. 1!enti0ication: -emonstration AG %acillus in lesions. +ot yet gro#n in vitro. E:uine Encephalitis " Ar'o$iruses (Toga $iruses! ncephalitis - in0lammation o0 the %rain. Iuine - in0ects horses also. Types viruses: 1) 2) L 3) :. =) .a3ross encephalitis 'eservoir: Go#l Vector: "osIuito (3ule,, Ae!es). )revalent in summer #hen in rain0all 0ollo#e! %y in mosIuito population. Virulence: 1nva!es cells o0 %rain Transmission: Bite o0 in0ecte! mosIuito -isease: 1nva!es lymphatics 3+: in0lammation. Accomp. %y 0ever, chills, !ro#siness. Gollo#e! %y coma !eath (2;@) 3omplication: Brain !amage in survivors )revention: 3ontrol mosIuito population Polio(yelitis " Polio $iruses. types ;. <. 8 Virulence: 1nva!es motor neurons Transmission: 0ecal-oral route, oro-pharyngeal secretions. Virus har!y in 0oo! an! #ater. )* : 6ropharyn, in contaminate! 0oo!, #ater -isease: 1n0ection %egins in throat, small intestine. 3an pro!uce 2 types !isease: 1) A%ortive: most common - occurs in in0ants, young chil!ren. 'emains locali/e!, resem%les 0lu-li$e illness. :el0-limiting. &sually inapparent, un!iagnose!. )ro!uces li0e-long immunity. 2) )aralytic: prevalent in ol!er chil!ren, teens. Begins in throat, small intestine virus enters %loo!stream (viremia) 3+: - inva!es motor neurons in anterior horn o0 upper spinal cor!. 3auses !estruction motor neurons paralysis. 10 me!ulla in %rain stem in0ecte! paralysis o0 respiratory muscles 'elationship %et#een e00ective sanitation measures > inci!ence paralytic polio: 1n countries #ith lo# socioeconomic con!itions, poor sanitation measures chil!ren are e,pose! at early age a%ortive 0orm permanent immunity. 1n countries #ith more a!vance! sanitation measures young chil!ren escape in0ection, !evelop +6 immunity, an! there0ore are more suscepti%le to paralytic 0orm i0 e,pose! at later age. Vaccine: :a%in oral vaccine - via%le attenuate! viruses - in0ect G1 tract.

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Ra'ies (-y)ropho'ia! " Ra'ies $irus Gatal viral encephalitis normally occurring in #il! animals. Bats carriers. Virulence: 1nva!es nervous tissue Transmission: :aliva in0ecte! animal - %y %ite, scratch5 inhalation !rie! %at 0eces - rare. )* : Brea$ in s$in, rarely nasal passage -isease: 1nc. p!. 1 - 3 mo., up to 1 - 2 yrs. Virus multiplies at site travels up nerve 0i%er spinal cor!, %rain inva!es nervous tissue in0lammation, hemorrhages 6nset: hea!ache, 0ever, vomiting, nervousness, con0usion, lac$ coor!ination, !epression, e,cita%ility, hallucinations spasms o0 muscles throat (pain0ul to s#allo#) convulsions coma !eath !ue to paralysis respiratory muscles. +o treatment once %egins. )revention: Vaccination ()asteur treatment) #ith inactivate! virus (active immunity). 10 animal ra%i! - also in4ect antira%ies antiserum (passive immunity). 3ontrol: 1mmuni/e pets. 10 %itten, hol! animal, have e,amine! ('a%ies 3ontrol). 1!enti0ication: +egri %o!ies in in0ecte! cells, serological tests. 1OUN& INFECTIONS Tetanus " Clostri)iu( tetani Gram pos. %acillus, anaero%ic, en!ospores, common in soil > G1 tract animals Virulence: )o#er0ul neuroto,in - %loc$s neurotransmitter inhi%itor cholinesterase )* : n!ospores intro!uce! !eep into tissue #oun! (puncture #oun!) -isease: 1nc. p!. = !. - 2 #$. n!ospores germinate %acteria multiply at site, remain locali/e! pro!ucing little or no in0lammation secretes neuroto,in enters %loo!stream 3+: #here inter0eres #ith cholinesterase causes tonic contractions, pain0ul spasms o0 muscles. 6nset: 2ea!ache, sti00 nec$, 0ever, chills. :pasms %egin in muscles o0 0ace (causes !i00iculty in opening mouth) nec$ %ac$ chest a%!omen e,tremities. :pasms can %rea$ %ones, cause %o!y contortions. 1nvolvement o0 respiratory, car!iac muscles convulsions coma !eath. Vaccine: -)T to,oi! Antitetanus antiserum also availa%le - only neutrali/es to,in in %loo!stream. *0OO& AN& 0YMP-ATIC INFECTIONS *acterial En)ocar)itis " Su'acute. Acute :u%acute - most common - :treptococcus veri!ans Acute - less common - :taphylococcus aureus Su'acute 'acterial en)ocar)itis " Streptococcus $eri)ans Gram pos. cocci5 part o0 nasal, oral normal 0lora5 opportunist. Virulence: :ecretes alpha hemolysins. &sually causes secon!ary in0ections &'T. 3an also cause secon!ary in0ection in in!ivi!uals #ith !amage! heart valves or scarring o0 en!ocar!ium (!ue to rheumatic 0ever, surgery, heart attac$, etc.), congenital !e0ects o0 valves.

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)* : 6ral cavity - %rea$ in m.m. !ue to !ental surgery, tooth e,tractions, tooth a%scesses, root canals, cleaning a%rasions on gums. 6rganisms enter %loo!stream (reIuires large C) locali/e in !amage! valves, scar tissue in heart multiply mil! in0lammation, inter0eres #ith 0unction valves, e!ema heart muscle. :ymptoms - very mil!, lo# gra!e - slight 0ever, tire!ness, heart murmurs. 10 un!iagnose! > untreate! congestive heart 0ailure. 1!enti0ication: 1solation - %loo! culture - !i00icult )revention: Anti%iotics %e0ore !ental proce!ures in patients #ith history o0 heart !amage Acute en)ocar)itis " Staphylococcus aureus )rogresses rapi!ly !estroys heart valves 0atal in 0e# !ays. Septice(ia -ue to multiplying %acteria in %loo!stream. 3ause! %y num%er organisms (see %oo$) - Gram neg. %acteria most common. Virulence: &sually en!oto,ins o0 Gram neg. %acilli -isease: Gever, lymphangitis, shoc$ ( %loo! pressure), %loo! vessel collapse. In#ectious Mononucleosis " Epstein"*arr $irus Virulence: 1nva!es human B lymphocytes Transmission: 6ropharyngeal secretions - !irect, in!irect contact (9$issing !isease9) )* : 6ropharyn, -isease: Virus multiples in respiratory mucosa, paroti! salivary glan!s lymphoi! tissue (lungs, liver, lymph no!es, spleen) inva!es B lymphs. Accom. %y 0ever, sore throat, s#ollen lymph glan!s, #ea$ness. :pleen an! liver also %ecome enlarge!. .ymphs increase in C an! appear a%normal. 1llness mil!er in in0ancy, more severe i0 e,pose! later in li0e. 1!enti0ication: :erology tests, %loo! smear *ur,itt=s 0y(pho(a5 E* $irus Tumor o0 4a#, occurs mainly in A0rican chil!ren #ith malaria. Malaria " Plas(o)iu( $i$a4 )roto/oan, nonmotile (:poro/oa) Virulence: 1ntracellular parasite - inva!es 'B3Fs, liver Transmission: Bite o0 in0ecte! Anopheles mosIuito 3omple, li0e cycle - part in mosIuito, part in human liver, r%cFs -isease: 'elease o0 parasites > to,ic su%stances 0rom rupture! r%cFs causes high 0ever, chills, vomiting, severe hea!aches. 6ccurs in appro,. 3-!ay cycles. 1!enti0ication: 6%servation parasite in r%cFs To4oplas(osis " To4oplas(a gon)ii )roto/oan (:poro/oa) intracellular parasite 'eservoir: Bir!s, cats, mice, cattle, etc. Transmitte!: &sually %y contact #ith 0eces o0 in0ecte! animal (cat), ingestion ina!eIuately coo$e! %ee0 -isease: 1n0ects lymph no!es mil! in0lammation 3omplication: 10 pregnant 0emale %ecomes in0ecte! crosses placenta, in0ects 0etus causes several congenital !e0ects (neurological), spontaneous a%ortions, still%irths.

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UPPER A0IMENTARY SYSTEM INFECTIONS &ental Caries. Pla:ue. Perio)ontal &isease Pla:ue: ' A- 0ormation on plaIue in te,t. &ental Caries5 Streptococcus (utans - Gram pos. cocci )art o0 normal 0lora o0 mouth. Germents sucrose aci! !issolves enamel, tooth structures. Vaccine: in !evelopment stages. Perio)ontal )isease: ' A- causes in te,t. Contagious parotitis (Mu(ps! " Mu(ps $irus Virulence: inva!es paroti! salivary glan!s, an! sometimes %rain, meninges, pancreas, testes, ovaries. 3ommon in chil!ren %e0ore vaccine - epi!emics in Gall. 2<-=<@ su%clinical. -evelop permanent immunity. Transmission: :aliva, nasal secretions - !irect, in!irect contact - not highly contagious. )* : 6ral cavity, nasopharyn, -isease: 1nc. p!. 2 - 3 #$s. virus multiples in nasopharyn, %loo!stream (viremia) inva!es paroti! salivary glan!s acute in0lammation. Accomp. %y mar$e! s#elling %ehin! ears, !i00iculty s#allo#ing, 0ever, hea!ache, pain #hen eating acetic 0oo!s. :#elling reaches ma,imum in 2 - 3 !ays (may %e unilateral or %ilateral - 0ig. pg. ;A1), su%si!es in a%out 1 #$. 1llness more acute in a!ults. 3omplication: 1n chil!ren - meningoencephalitis, pancreatitis. 1n a!ult males - orchitis (may cause sterility). Vaccine: ""' - via%le attenuate! virus Peptic Ulcers o# Sto(ach. &uo)enu( - -elico'acter pylori Gram neg. short spiral Virulence: &rea (pro!uct o0 protein meta%olism) ammonia #hich neutrali/es stomach aci!s. -isease: "igrates thru mucus coating o0 stomach lining attaches to cells re!uces pro!uction o0 mucus in0lammation. 3omplication: stomach cancer 0O1ER A0IMENTARY SYSTEM INFECTIONS Cholera " 2i'rio cholera Gram neg., comma shape! Virulence: pro!uces potent entero-e,oto,in - causes cells m.m. o0 G1 tract to lose large amts. 0lui!s (up to 22 .*!ay) severe electrolyte im%alance. Transmission: Gecal-oral route - contaminate! 226, 0oo! -isease: locali/es in small > large intestine. 6nset su!!en - vomiting, a%!ominal pain, severe !ysentery. :tools - clou!y 0lui!s #ith mucus, organisms (9rice #ater stools9) severe !ehy!ration, electrolyte im%alance. 2igh mortality rate (A<@) - !ue to shoc$. 3arrier state can occur a0ter in0ection. 1mmunity: Temporary Vaccine: To,oi! - not very e00ective

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*acillary )ysentery (Shigellosis! " Shigella species Gram neg. %acillus - = species pathogenic 0or man. :. !ysenteriae - most virulent. :. sonnei - least virulent, most common in &.:. S% )ysenteriae - Virulence: n!oto,ins, e,oto,ins Transmission: Gecal-oral route 226, 0oo! -isease: 1nc. p!. 1-= !. 6rganism locali/es in large intestine multiplies inva!es m.m. causing ulceration, %lee!ing intestinal lining (no per0oration) severe in0lammation 0lui! loss !ysentery (stools mostly 0lui!s #ith %loo!, pus, mucus), vomiting. Accom. %y 0ever, severe a%!ominal pain, e,treme #ea$ness. )ersists appro,. 1 #$. - sel0-limiting. 3omplication: 3an cause severe !ehy!ration, electrolyte im%alance. "ortality rate high in in0ants, young chil!ren. +o soli! immunity. Vaccine: via%le, oral - limite! use Typhoi) #e$er (enteric #e$er! " Sal(onella typhi Gram neg. %acillus Virulence: n!oto,ins (cell #all lipi!s). 6rganisms inva!e m.m. > other organs enteric 0ever (%egins in G1 tract, enters %loo!, sprea!s throughout %o!y). Transmission: Gecal-oral route )* : 6ral cavity - contaminate! 0oo!, 226 -isease: 1nc. p!. 1 - 3 #$s. 6rganism locali/es in small intestine inva!es m.m., lymphatic tissues ()eyers patches. 1n 0irst #ee$ - 0ever, hea!ache, malaise, !iarrhea. 1n secon! #ee$ en!oto,ins cause ulceration intestinal #all (sometimes per0orates) %loo!stream septicemia sprea!s to other organs: (liver, $i!neys, spleen, %one marro#, s$in, gall %la!!er). :ymptoms more acute - severe a%!ominal pain, severe !iarrhea #ith %loo!, pus, #ea$ness, a%!ominal !istention. 6ther symptoms !epen! on organs in0ecte!. 'ose spots in s$in - !ue to multiplication organisms. 3arrier state: 3ommon 0ollo#ing illness. 6rganisms remain in gall %la!!er - must %e surgically remove! to eliminate. :pora!ic out%rea$s - trace! to carriers - 0oo! han!lers Vaccine: 1nactivate! ($ille!) %acteria 3ontrol: )roper hygiene, sanitation measures (proper se#age treatment) *acterial Foo) Poisoning > Foo) In#ections Goo! )oisoning - 1ngestion 0oo!s contaminate! #ith e,oto,ins pro!uce! %y %acteria (some 0ungi) multiplying in 0oo!. 3ause! %y several !i00erent organisms. Goo! 1n0ections - 1ngestion o0 0oo!s contaminate! #ith via%le organisms. 1n0ect an! cause in0lammation G1 tract (enteritis). Non#atal Foo) Poisoning " Staphylococcus aureus - Gram pos. cocci - most common Virulence: :train capa%le o0 pro!ucing entero-e,oto,in (e,oto,in) - causes in0lammation o0 G1 tract. ,oto,in heat sta%le (#ithstan!s %oiling 3< min.), an! aci! sta%le. :ource: &'T, s$in human carriers Transmission: 2an!s - most common vector. 1ntro!uce! into 0oo! !uring preparation. "ultiply in previously coo$e!, un!ercoo$e! or uncoo$e! 0oo!s (usually 326) that have %een ina!eIuately re0rigerate! - custar!, cream pies, pastries, !airy pro!ucts, cream sauces > gravies, sala!s (potato, meat), sala! !ressings, picnic or lunch%o, 0oo!s (san!#iches). 6rganisms multiply in 0oo! secrete entero-e,oto,in 0oo! #ith e,oto,in consume! e,oto,in comes in contact #ith m.m. G1 tract. -isease: 1nc. p!. 1-A hrs. :evere a%!ominal pain, vomiting, !iarrhea (no 0ever). :el0limiting - lasts J - 12 hrs. +o organisms isolate! 0rom stool5 sometimes 0oun! in 0oo!. : T OT - other causative agents

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*otulis( (#atal #oo) poisoning! " Clostri)iu( 'otulinu( Gram pos. %acillus, anaero%ic, en!ospores, common in soil > G1 trac$ animals Virulence: )otent neuroto,in. )revents release neurotransmitter acetylcholene )* : 1ntro!uce! in contaminate! 0oo!s (nonaci! canne! vegeta%les, smo$e! meats). )rocessing (!oes not !estroy en!ospores) anaero%ic con!itions pro!uce! en!ospores germinate organisms multiply secrete neuroto,in consume! #ith 0oo!. 3auses no change in color, o!or, taste o0 0oo! > can #ithstan! %oiling 1< min. -isease: 1nc. p!. 2-3 !ays. +euroto,in enters G1 tract %loo!stream 3+: #here inter0eres #ith release acetylcholene no impulses transmitte! to muscles 0lacci! paralysis 6nset: "ay or may not have G1 !istur%ances hea!ache, %lurre! or !ou%le vision !i00iculty spea$ing, s#allo#ing respiratory 0ailure convulsions !eath. "ortality rate A< - E<@. Vaccine: none Antiserum availa%le - only neutrali/es to,in in %loo!stream. In#ant 'otulis( 1n0ants consume en!ospore (e,: in honey) germinates in G1 tract !ue to lac$ normal 0lora pro!uces neuroto,in %loo! 3+: Foo) In#ection (*acterial Enteritis! - Sal(onella sp% (enteriti)is. typhi(uriu(! Gram neg. %acilli. Virulence: n!oto,ins (cell #all lipi!s) :ource: G1 tract animals: i.e., poultry, por$, pets, turtles, sometimes human carriers. "eats - in0ection !ue to ina!eIuate coo$ing. 6ther 0oo!s in0ecte! !uring preparation %y han!s, utensils, cutting %oar!s, etc. -isease: 1nc. p!. J-3A hrs. 6rganisms inva!e an! !amage intestinal mucosa in0lammation. Accomp. %y a%!ominal pain, vomiting, !iarrhea, 0ever. :el0-limiting - lasts several !ays (appro,. 3 !ays). 6rganism can %e isolate! 0rom stool, 0oo!. 3arriers common 0ollo#ing in0ection. 7astroenteritis (Tra$elers )iarrhea. In#antile )iarrhea! " Escherichia coli Gram neg. %acillus, lactose H, normal 0lora. Virulence: 3ertain strains capa%le pro!ucing in0ections !ue to: 1) A%ility to pro!uce enteroto,in (e,oto,in) 0lui! loss. 2) A%ility to attach to an! inva!e "". en!oto,ins cell !eath in0lammation. -iseases: TravelerFs !iarrhea - consumption 0oo!, 2 26. Varies in severity - !iarrhea, vomiting. :el0 limiting. 1n0antile !iarrhea - occurs in ne#%orns (!ue to lac$ normal 0lora), young in0ants. 2ighly contagious - sprea!s rapi!ly in ne#%orn nursery. Transmission usually han!s o0 employees. 3auses severe !iarrhea, Iuic$ly !ehy!rates ne#%orn. 3an inva!e %loo! meningitis resulting in %rain !amage, !eath. )ractical value: use! as in!icator o0 0ecal contamination #ater, mil$, or ina!eIuate se#age treatment. Test 0urther to i!enti0y any pathogens present. 2iral enteritis " Rota$iruses. EC-O. Co4ac,ie. Nor?al, $iruses .arge C viruses can in0ect m.m. G1 tract !iarrhea, vomiting, etc. - 9intestinal 0lu or stomach 0lu.9 &sually sel0 limiting. "ore severe in in0ants.

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-epatitis " -epatitis 2iruses Types: A, B, 3, Virulence: 1nva!es cells o0 liver necrosis, in0lammation Type A5 In#ectious hepatitis. Transmitte! %y 0ecal-oral route - contaminate! 0oo! (shell0ish), #ater. 3an occur in epi!emics )* : 6ral cavity. 1nc. p!. ave. 3< !. Type *5 Seru( hepatitis. Transmitte! %y - %o!y secretions (%loo! ,semen, vaginal secretions). )* : )arenteral (tissues) - contaminate! nee!les5 anal or oral se,. 1nc. p!. ave. M< !ays. 3an cause chronic in0ections. Type C5 Post"trans#usion hepatitis - 3ontaminate! %loo! trans0usion. 1nc. p!. up to A mo. -isease: :prea!s 0rom )* %loo! inva!es liver (A-spleen, $i!neys5 B- lymphoi!) causes necrosis, in0lammation enlarge!, ten!er liver mal0unctions. Accom. %y 0ever, nausea, a%!ominal ten!erness, 4aun!ice, #ea$ness. )ersists several #ee$s recovery prolonge!. "il!er in young chil!ren. 3arrier state - 0ollo#ing in0ection. 3omplication: 1n cases o0 chronic in0ections #ith B, inci!ence liver cancer. )revention: 10 e,pose! to A - gamma glo%ulin. +ot e00ective 0or B. Vaccine: B - antigenic !eterminants pro!uce! %y recom%inant -+A techniIues. 'eIuire! 0or health care #or$ers. 7iar)iasis " 7iar)ia intestinalis )roto/oan - 0lagellate! Transmission: Gecal-oral route - ingest cysts in 0oo!, #ater. -isease: 3ysts release tropho/oites small intestine attaches to #all (a!hesive !isc) in0lammation, !iarrhea, %loc$s a%sorption o0 nutrients. Becoming more common in &.:. la$es, etc. A(oe'ic &ysentery " Enta(oe'a histolytica )roto/oan - amoe%a Transmission: Gecal-oral - ingestion o0 cysts in 0oo!, #ater -isease: 3ysts tropho/oites intestinal tract inva!e mucosa ulceration severe !iarrhea, a%!ominal pain, etc. Tape?or( in#ections " Taenia saginata - %ee0 tape #orm, Taenia soliu( - por$ tape #orm. .i0e cycle: 1ngest cysts in ra#, poorly coo$e! meat release larvae intestine !evelop into a!ult #orms. m%e!s scole, in intestinal #all increases in length proglotti!s a%sor% nutrients lea!ing to malnutrition. )roglotti!s, eggs !eposite! in soil consume! %y animals hatch larvae encyst in muscles (meat). -oo,?or( in#ections " Necator a(ericanus .i0e 3ycle: ggs passe! in 0eces hatch in moist soil 0ree living larvae %urro# thru s$in 0eet, legs %loo! vessels lungs coughe! up, s#allo#e! intestine mature into a!ults %urro# hea! into intestinal #all - 0ee! on %loo!. 3auses a%!ominal pain, loss appetite, protein an! iron !e0iciencies (anemia). Pin?or(s " Entero'ius $er(icularis .i0e 3ycle: ggs ingeste!, inhale! hatch in small intestine mature an! repro!uce in large intestine - male > 0emale mate gravi! 0emales migrate to perianal region !uring night to !eposit eggs on s$in. 3auses itching, irritation in area. ggs easily sprea! to 0amily mem%ers - all are treate!. 'ein0ections common.

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7ENITOURINARY INFECTIONS Urinary Tract In#ections (UTI9s! &rethritis - in0lammation urethra 3ystitis - in0lammation %la!!er )yelonephritis - in0lammation $i!neys &sually cause! %y Gram neg. %acilli o0 G1 tract: ( . coli, )roteus, )seu!omonas, Dle%siella). 6ccur !ue to: 1) 6%struction that prevents complete emptying o0 %la!!er - scarring urethra, compression %la!!er %y uterus, enlarge! prostate, paralysis, !e0ormity sphincter muscle, in0reIuent urination. &pon stan!ing p2 urine neutrali/es, can serve as reservoir 0or micro%ial gro#th. 2) +osocomial in0ection !ue to poor asepsis #hile inserting catheter or other instrument into urethra, %la!!er. 1!enti0ication: urinalysis, urine culture To4ic Shoc, Syn)ro(e TSS " Staphylococcus aureus Gram pos. cocci Virulence: :train causing T:: pro!uces an e,0oliation e,oto,in (scal!e! s$in syn!rome) an! enteroe,oto,in (!iarrhea, shoc$). Transmission: Grom &'T, s$in o0 carriers. 2an!s most common vector tampon vagina. -isease: 6rganism in num%ers in %loo! > a%rasions in m.m. o0 vaginal #all secretes to,ins %loo!stream. 3auses sun%urn-li$e rash on s$in s$in an! m.m. separate an! slough o00 in0lammation. Also accomp. %y severe vomiting, !iarrhea. Bloo! pressure , shoc$ can %e 0atal. )revention: Lashing han!s %e0ore han!ling, insertion o0 tampon5 avoi!ing use o0 tampons. 2as also occurre! in males 0ollo#ing surgery, or #ith %oils or other :taph in0ections. SE@UA00Y TRANSMITTE& &ISEASES 7onorrhea " Neisseria gonorrhea Gram neg. !iplococci, %ean-shape! #ith in!ente! si!es 0acing Virulence: ncapsulate!, pili, en!oto,ins, catalase, intracellular parasite. Transmission: -irect contact - se,ual contact )* : ".m. o0 genitourinary tract: i.e., vagina, urethra in males. -isease: A!heres to an! inva!es m.m. causes !amage to m.m. lining in0lammation. 1n males usually more acute - pain0ul voi!ing, purulent !ischarge 0rom urethra. 3an sprea! to vas !e0erens, testes causing scarring, in0ertility. :carring in urethra lea!s to 0reIuent &T1Fs. 1n 0emales in0ection o0ten lo# gra!e, asymptomatic (chronic). :prea!s to uterus, cervi,, 0allopian tu%es, ovaries. :carring o0 0allopian tu%es sterility. 1!enti0ication: -irect smear e,u!ate - o%serve Gram neg. !iplococci in )"+Fs (0ig. pg. A<A), 0ollo# #ith culture.

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3omplications: Gonococcal 6pthalmia +eonatorum 1n0ection o0 eyes o0 ne#%orn - e,pose! !uring %irth i0 organisms present in %irth canal. 3auses !estruction, scarring cornea %lin!ness. )revent: treat eyes #ith 1@ silver nitrate, anti%iotics 0ollo#ing %irth. 1n a!ults, %acteria can %e trans0erre! 0rom genitals to eyes %y han!s, also see 0ig. pg. A<A. Syphilis " Trepone(a palli)u( Gram neg. spiral, very small, tightly-coile! Transmission: -irect contact - se,ual intercourse, occasionally $issing. )* : ".m. genitourinary tract (occas. mouth). -isease: 1nc. p!. - 3 #$s. ave. -isease occurs in stages: 1) )rimary stage: &sually single lesion - chancre - ulcer-li$e, a%out 1*2 inch !ia., asymptomatic . :el0 limiting - heals a0ter several (=-A) #$s. "ay remain 0ree o0 symptoms 2 #$s. - several mo. %e0ore ne,t stage. 2) :econ!ary stage: "ultiple lesions occurring on s$in, m.m. on 0ace, in an! aroun! mouth, palms o0 han!s, soles o0 0eet, e,ternal genitalia. 2eals in 0e# #$s., %ut can recur over perio! o0 2 - ; yrs. Accom. %y 0ever, enlarge! lymph no!es, malaise. Then in!ivi!ual may remain 0ree o0 symptoms (latent) ; - =< yrs. 3) Tertiary stage: 1nternal lesions pro!uce! in %one, car!iovascular, 3+:. 3alle! gummas - a%scess-li$e lesions #ith central ru%%ery mass surroun!e! %y connect. tissue pro%a%ly !evelops !ue to !elaye! hypersensitivity. .ea!s to crippling, aneurysm, insanity, paralysis. 1n this stage not very in0ectious. This stage sel!om seen to!ay !ue to e00ective treatment. 3omplications: 3an cross placenta, in0ecting 0etus congenital syphilis. 3auses congenital !e0ormities or !eath. 1!enti0ication: -emonstration organism in e,u!ate 0rom lesions, serological tests. 6rganism cannot %e gro#n in la%. Nongonococcal Urethritis (N7U! " Chla(y)ia tracho(atis Virulence: 6%ligate intracellular parasite (cannot pro!uce AT), lea$y mem%rane) Transmission: :e,ual intercourse )* : m.m. genitourinary tract -isease: 'esem%les gonorrhea, %ut mil!er. 1n0ects m.m. o0 vagina, urethra. .o# gra!e, scanty, #atery !ischarge. "ay also %e asymtomatic, causing chronic in0ections. 3an eventually cause scarring an! in0ertility in males an! 0emales. 3omplication: 1n pregnant 0emales, can in0ect 0etus causing !eath, congenital !e0ormities. +G& is %ecoming more prevalent than any other se,ually-transmitte! !isease. -erpes$irus In#ections " -erpes si(ple4. type I. type II 1 - 'ecurrent 0ever %listers5 11 - Genital herpes. ither virus can cause either in0ection. Virulence: 1nva!es m.m. ulcer-li$e lesion Transmission: -irect contact, rarely in!irect Type I: Transmitte! %y oral nasal secretions )* : 6ral m.m., s$in -isease: )ain0ul vesicular lesions on m.m., s$in shallo# ulcer sel0 limiting, heals in 2-3 #$s. Virus remains in state o0 lysogeny in trigeminal nerve ganglia. 3an %e reactivate! %y trauma, &V, hormonal changes, etc.

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Type II: Transmitte! %y se,ual intercourse )* : genital m.m., s$in -isease: )ain0ul vesicular lesion occurring on m.m., s$in o0 genitalia, vagina small ulcer, sel0 limiting, heals in several #ee$s. Virus remains in latent state in spinal ganglia. 3an %e reactivate! %y hormonal changes, stress, 0e%rile illness, etc. 3omplication: 2erpes encephalitis (neonatal herpes) in ne#%orn. 3an %e transmitte! to ne#%orn in nursery %y #or$er #ith 0ever %lister, or 0rom in0ecte! mother (active lesion in vagina) !uring %irth5 3-section recommen!e!. 1n0ecte! ne#%orns have high mortality rate, survivors have severe neurological !amage. 1ncrease! inci!ence cervical cancer in 0emales #ith genital herpes. 7enital 1arts (Con)ylo(as! " Papillo(a $iruses Transmission: :e,ual intercourse5 increase! inci!ence in se,ually-active teens, young a!ults. -isease: Larts occur on penis, anus or perineum in males, in 0emales - vagina, cervi,, perineum, anus. 3auses irritation, itching, can %ecome in0ecte! #ith %acteria. 10 persist can %ecome malignant. 3omplications: 1n0ants can %ecome in0ecte! !uring !elivery. 1n 0emales cervical cancer. AI&S (ACAUIRE& IMMUNO&EFIENCY SYN&ROME! -I2 (-u(an I((uno)e#iciency 2irus 'etrovirus '+A virus -+A !uring replication Virulence: 1nva!es T2 lymphocytes, macrophages Transmission: :e,ual intercourse, %loo! trans0usions, share! nee!les (intravenous !rug a%users), mother 0etus (transplacentally) > nursing in0ants -isease: Virus in0ects T2 lymphocytes provirus permanently incorporate! into host cell -+A in0ectious virions synthesi/e! an! release! T2 lymphocyte !ies, or is !estroye! %y cells > anti%o!ies o0 immune system eventual 0ailure o0 immune system. Virus may also sprea! to macrophages virus carrie! to %rain, %one marro#, intestinal mucosa 6nset o0 -isease: 6ccurs in 3 stages: 1). 1nc. p!. A !ays - A #$s. 1nitial in0ection 0lu-li$e illness or asymptomatic. "ay %e 0ollo#e! %y long asymptomatic perio!. 2). GreIuent opportunistic in0ections: 0reIuent &'T in0ections, nausea, !iarrhea, 0ever, night s#eats, enlarge! lymph no!es, 0ungal s$in in0ections, yeast in0ections o0 gums, mouth, hepatitis, etc. 3). :evere opportunistic in0ections: pneumocystic pneumonia, TB, To,oplasmosis, 3"V, 2erpes virus, DaposiPs sarcoma, systemic 0ungal in0ections, %rain lesions > !ementia, chronic #eight loss, muscle #asting syn!rome. 1!enti0ication: .1:A most #i!ely use! test. 1n0ecte! in!ivi!uals seroconvert to positive in 1 to 3 months5 some in A mo. to a year. )revention: REA& te4t. (+6T : 0ailure rate o0 con!oms 1E to ;<@)

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