资料教程精讲

SexualTransmittedSexualTransmittedDiseasesInfectiousDiseaseinNeurologicalInfectiousResummarizedbyHuZhichengSexualTransmittedVaginalinfections:bacterical,SexualTransmittedVaginalinfections:bacterical,trichomonas,candidasGonorrheaandchlamydiaSTDswithgenitallesions:syphilis,herpes,chancre,granulomainguinaleOthers:HIV,HBV,HCVHIV&opportunisticinfectiousLunginfection:pneumocystisjiroveci,CMV,mycobacteriumaviumcomplexCNSinfection:toxopiasmosisGIinfection:CMV,HSV,cryptosporidiumHIVmedicationsInfectiousDiseasesInfectiousDiseasesinneurologicalBacterial:neisseriameningtidis,hemophilusinfluenzae,streptococcuspneumoniae,GroupBstreptococcus,E.Coli,listeriaViral:HSV/CMV/intestinalFungal:cryptococcusTubercolousInfectiousinfection/vaginosis(白 Whiteinfection/vaginosis(白 Whiteshaginaldischarge, KOHwetpreparetolookforpseudo-TrichomonasGreenishvaginaldischarge,extremelyWetpreparetolookforBacterialvaginosis(臭Fishysmell(腥臭Wetpreparetolookfor“clueGardnerellaNeisseriaGcocciNoNeisseriaGcocciNomaltosefermentationUrethritis,bartholin’sglandswelling,pelvicinflammatorydisease,septicarthritisTreatment:ceftriaxone(过血脑屏障)Obligatedintracelluarorgansim,noATPproductionTreatment:macrolidesordoxycyclineReiter’ssyndrome:arthritis(反应性),Nopee,nosee,noclimbApainless,beefyrednoduleslowlyenlarges,becominganelevated,Apainless,beefyrednoduleslowlyenlarges,becominganelevated,velvety,malodorous,granulating,ulceratedplaqueGranuloma腹股沟肉芽肿肉芽肿荚膜杆菌CalymmatobacteriumPrimarylesionisaPrimarylesionisa5-to8-mm,soft,red,painlesserosionorulcer,healsspontaneouslyinafewdaysThesecondarystagebegins2to6laterandischaracterizedbytheoftender,inguinalThelatestageofLVischaracterizedanogenitalstricturesinuntreatedorunder-treatedcasesPainful,undermined,openPainful,undermined,openwithgray-yellow,necrotic,“dirty”base;usuallyaccompaniedbyinguinaladenopathy.CausedbyHemophilus疼的Hemophilusducreyi（docry，疼得直哭Single,rapid,painless,Single,rapid,painless,elevatedulcerationwitharedareolaandrollededgeswithaflatbaseDarkfieldtest:forT.Darkfieldtest:forT.ScreeningtestVDRL(敏感性↑，特异性ConfirmativetestFAT-ABS(特异性↑，确诊用Argyll-robertsonHemophilusChlamydiaHemophilusChlamydiaGranulomaHerpessimplexdsDNAvirus,HemophilusChlamydiaGranulomaHemophilusChlamydiaGranulomadsDNAvirus,HerpessimplexBeBePainfulgenitalPainlessgenitalHerpessimplexPainfulgenitalPainlessgenitalHerpessimplexIIpainlessinguinalHBV&HBV&HBVliveabscesslivecancer结节性动脉炎，HCV:commoninivdrugabuser,combinedwithHIV Screening:ELISA,confirmativeWesternSNoW:SouthernNorthernWesternDRoP:DNA HighriskHighriskIvdrugabuser（sharing直肠：柱状上皮（易出血Co- CCR5(early)CXCR4(late)andCo- CCR5(early)CXCR4(late)andonT CCR5andCD4HomozygousCCR5Heterozygousmutation:therapeuticFunctionofFunctionofCD4+TIL-1SecretedByMΦ“HotT-bonestEAK”:IL-1:fever(hot).IL-2:stimulatesTcells.IL-3:stimulatesboneIL-4:stimulatesIgEIL-5:stimulatesIgAIL-6:stimulatesaKute-phaseproteinIL-CD4TIL-CD4TTIL-CD8TTkIL-12,Th1,IL-2,IFN-gammaIL-4,Th2,IL-4,IL-5,IL-10Screeningtest:ConfirmativeScreeningtest:Confirmativetest:WesternMonitortheeffectofdrugtherapy:viralload CD4+<200(>200HIV+ HIV+withAIDSindicatorcondition(eg. CD4/CD8ratio<1.5(normalperson治疗目的：↓Viralload44y,M,44y,M,HIV+,fever&coughfor3d.rayshowsdiffuseintestinalchangeChestPneumocysticDrycough,PneumocysticDrycough,interstitialpneumonia,reactivationCD4+cellcount:200-50/mm3Sliverstain+SymptomsandsignsaresimilartoPCPThickAntibiotics:amphotericinToTobeSymptomsandsignsaresimilartoSymptomsandsignsaresimilartoPCPOwleyeAntibiotics:Fever,drycough,nightsweat,noduleonProphylaxis:44y,M,HIV+,44y,M,HIV+,headachefor1w.CerebralMRIshowsringenhancement,CD460ring周围水肿，也见于颅内淋巴Fromcatfeces&Fromcatfeces&pork,reactivationCD4<100,brainabscess,focaldefect.Ring-enhancementlesioninCTscan.Antibiotics:sulfadiazine+pyrimethamine+Ifpoorresponsein2w→CNSlymphomashouldbesuspected44yF44yFHIVdiarrheafor3w,间断腹痛，排便 Commoncuase: Commoncuase:E.HEC，E.IEC,Salmonella,Campylobacter(mostYersinia,Clodtridiumdifficile, Uncommoncause:CMV(multipleshallowowl`seyecell)EBV(multipledeepulcer,giantnuclearcell)Kaposisarcoma(HSV-8,紫色突起Watery CD4countTB;VZV;Cadida;nia;arthralgia;CD4:50-Herpssimplex;CervicalOralhairyCD4countTB;VZV;Cadida;nia;arthralgia;CD4:50-Herpssimplex;CervicalOralhairy-CD4<50:CD4<50:CMV,cryptococcus,MAC(鸟分支杆菌 CD4<100:histoplasmosis,Toxoplasmosis,candidalesophagitis CD4<200JCvirus,PCP, AdultTcellTax活化LliverLiverCervixCA.AngoenitalCA.OropharynixCA.KaposiAdultTcellTax活化LliverLiverCervixCA.AngoenitalCA.OropharynixCA.Kaposi灭活BurkittlymphomaCNSprimarylymohoma刺激BcellHighlyactiveantiretroviral↓totalburdenHighlyactiveantiretroviral↓totalburdenofMaintainsfunctionofimmunoPreventopportunisticinfectionswhichleadtoInitiatedwhenpresentingAIDS-defindingillness,CD4counts(<500),orhighvirusload3drugstopreventresistance2nucleosidereverseinhibitors(NRTIs)+1non-nucleosidetranscriptaseinhibitor(NNRTI)OR1proteaseOR1integeaseBindBindviralgp41HypersensitivityNucleosidereverseNucleosidereversetranscriptaseZidovudine,didanosine,zalcitazbine,stavudine,lamibudine,abacavirNucleosideanalogue.BlockSideeffectismainlyduetomitochondriatoxicity:peripheralneuropathy,cardiomyopathy,diabetes,lacticacidosis,BMsuppressionNon-NucleosidereversetranscriptaseNevirapine,Non-NucleosidereversetranscriptaseNevirapine,Efavirenz,AllostericreversetranscriptaseInhibitsInhibitsHIVgenomeintegrationintohostcellchromosomebyreversiblyinhibitingHIVintegrase.ProteaseAmprenavir,nelfinavir,IndiProteaseAmprenavir,nelfinavir,Indinavir,Ritonavir,Blockprotease,thuspreventproperproteinHyperglycemia(常考GIintolerance(nausea,diarrhea),lipodystrophy,thrombocytopeniazalcitazbine,stavudine,lamibudine,abacavirIndinavir,Lopinavir,Ritozalcitazbine,stavudine,lamibudine,abacavirIndinavir,Lopinavir,Ritonavir,SaquinavirBlockelongationBlockproteasepreventproperviralproteinsplicing胰腺炎Hyperglycemia,GIintolerance(nausea,pathy,hematuriaLumberpuncturefinding:Lumberpuncturefinding:neutrophildominant,↓glucose,PathogenofbacterialGroupBS.NeisseriaListeria李大李大GroupBstreptococcus（产道常见。如存在，NeisseriaMostcommonin2-18y,NeisseriaMostcommonin2-18y,communityoutbreakdisease,skinrash(渗血,不褪色G-,diplococciincapsuleListeriamonocytogenesisCommoninneonateor>70orcompromiseds.FormingsmallG+rods,intracellular,infectthoseTcellStreptococcusMostcommonStreptococcusMostcommonin18-70y,communityacquired,G+,diplococciincapsuleGroupBMostcommonneonatalCNSinfectionAcquiredfrombirthcannel2ndmostcommonneonatalCNSinfectionoracuqiredCNSinfectionHemophilusinfluenzaeUnvaccinatedchildren,communityacquiredG-rodsincapsuleCeftriaxone(forG-)+Vancomycin(forpenicillinresistantpneumococcus)IfCeftriaxone(forG-)+Vancomycin(forpenicillinresistantpneumococcus)IfListeriaissuspected,addSteroidis细菌性脑膜炎→渗出→交通性脑水LPfindings:↑WBC(100-500),lymphocytedominant,normalglucose,LPfindings:↑WBC(100-500),lymphocytedominant,normalglucose,↑protein.RBCmayHerpessimplevirus(esp.Others(intestinalHerpessimpleProfoundalteredmentalHerpessimpleProfoundalteredmentalstatus.TemporallobeRBCinCongenitalinfection,periventir