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Infection – More often even think! • general medical-online

HIV infection should be detected as early as possible, because there are good treatment options today, and as otherwise there is a risk that the HIV virus is transmitted. However, an early diagnosis is not always easy. Acute HIV infection is often overlooked because of their non-specific symptoms. Chronic infection can last for years without symptoms. The following items will be identified based on clinical examples, the difficulties in the diagnosis and the risks of late diagnosis. Adjoining case reports (Box 1 and 2) are intended to illustrate how difficult may be the diagnosis of HIV infection. These two cases show that the symptoms of HIV infection can be very unspecific. Primarily, it is important to keep in mind. Case Study 1 Male patient, 58 years old Oral thrush, feels bad, losing weight: 20 kg Professional success, serious demeanor, civil Has children, but now lives by the wife separately and together with a man

In the spring of the first medical consultation, then multiply inpatient investigated without result Finally, after six months of HIV testing during office visits: positive At diagnosis 38 CD4 + / ul, viral load: 665 000 / ml Case Study 2 Male, 71 years Living in a rural area, is married Symptom onset in the summer with pain in the arms and legs, the patient attributes this to a poisoning Intermittent fevers, during inpatient investigations: Diagnostic “Feverish colds”, DD Food Allergy In November, through investigation in other clinic: chest X-ray, ultrasound of the abdomen, MRI skull, gastroscopy, colonoscopy, and bone marrow aspirate In the bone marrow aspirate is striking: 41 CD4 + / ul HIV test: positive Why it is important to detect a HIV infection at an early stage? To answer this question it is first helpful to look at the natural history of infection (see.

Fig. 1). At the beginning and at the end of the course of the viral load in the patient’s blood is very high. The level of CD4-positive leukocytes (helper cells) falls over time slowly until it finally to manifest immunodeficiency comes (AIDS). Early detection of infection is important for two reasons: Late diagnosis worsens the prognosis of the person concerned. Early diagnosis reduces the likelihood of further infections. 1. A late diagnosis worsens the prognosis of the person concerned The diagnosis “HIV infection” is made even today very late yet in many cases. Then the helper cells are often very low. According to current recommendations half of patients already need antiretroviral therapy at diagnosis. This leads initially often due to present opportunistic infections hospitalizations, which is associated with increased morbidity and mortality.

In addition, initially mean very low helper cell count often that no normalization of helper cell count can be achieved by antiretroviral therapy. This is particularly often in elderly patients. The fact that this unfortunately is the reality in Germany, numbers published by the Robert Koch Institute (see. Fig. 2). Following the current therapeutic recommendations in Europe, then patients with helper cell counts below 350 / ul in need of therapy [3]. Considering the recommendations in the US or the latest WHO recommendations as a basis zoom, should already be initiating therapy with 500 / ul helper cells [4]. The decrease in helper cells correlates roughly with the period of the disease, where there is considerable individual differences. If require therapy now already 50% of patients at diagnosis, this leads to the conclusion that the diagnosis is often made too late. 2. Early diagnosis reduces the likelihood of further infections As these individuals for many years without knowing a test nothing of their disease, the risk of transmission is increased to other people. It may be that are not taken adequate precautions during sexual contacts with non-knowledge of the infection.

On the other hand, is increased by the high viral load at the initial stage, the risk of infection. So here are two circumstances together: Affected are unaware of their infection and may not behave accordingly, thus giving the virus very “effective” on. If it is possible to diagnose the infection at an early stage by an HIV test, then can take steps to protect other people concerned. Through antiretroviral therapy, viral load can be reduced to below the detection limit and thus infectivity can be significantly reduced. GPs play a very important role: You can create awareness and offer the HIV test. When thinking about HIV? The HIV infection is clinically often very non-specific or not. Acute HIV infection presents itself as mononukleoseartiges disease. Typical symptoms include fever, fatigue, arthralgia. In about half the cases, a rash is added. These symptoms come now, however, in general practice very frequently. It is correspondingly difficult to detect the infection in the acute stage is. A mononukleoseartiges disease, a sensitive inquired risk anamnesis and frequent testing might help here.

In acute HIV infection is very important to remember that the antibody test will be negative in many cases. A definite exclusion can be assumed only about three months after the issue date of infection. In unclear cases, a virus direct detection are carried out by PCR. This is positively usually within two to three weeks. An HIV test after three months is recommended in any case. In the chronic stage, the infection is very long largely asymptomatic. One should think of an already occurred immunodeficiency certain markers diseases and symptoms. In the area of ​​skin diseases which are for example a herpes zoster, a poorly treatable seborrheic dermatitis or Kaposi’s sarcoma. In the area of ​​the oral cavity are not otherwise declared thrush (especially a thrush esophagitis) to call or oral hairy leukoplakia. But recurrent pneumococcal pneumonia or tuberculosis may indicate an immunodeficiency. How difficult can be the diagnosis, shows the Pneumocystis jirovecii pneumonia (PJP). Here at first lead only history and clinical (risk factors, dyspnea at rest) on. The auscultation is often normal and in the conventional chest X-ray recording is little to see or nothing.

Only a HR-CT of the chest often shows then a distinct findings. Furthermore, it should in newly diagnosed viral hepatitis and sexually transmitted diseases (such. As chlamydial infections, gonorrhea, syphilis and herpes simplex) an HIV test is recommended. The difficulty is again to think of these diseases, to ask the patient to risk factors and to perform specific tests. Moreover, the existence of very nonspecific symptoms should suggest HIV. These include unexplained prolonged diarrhea, as well as fatigue and tiredness and a generalized lymphadenopathy. In classic B symptoms with night sweats and weight loss, and fever of unknown origin HIV infection should always be included in the differential diagnosis. As evident from the case studies, it is better to test early and often. Many symptoms can thus be due to the HIV infection. It is important to always: One should think of HIV as a differential diagnosis. The practitioner is a particularly important role to play in the early detection of HIV infection. He has to know the advantage of many of his patients for years. That is however not necessarily mean that he knows everything about his patients.

The question to the patient, whether you can perform an HIV test, requires a lot of tact. Fortunately, the family physician is accustomed to such questions: Finally, the same applies to the question on the level of alcohol consumption or suicidality. A non-judgmental attitude will allow the patient to open up to the doctor. Gerd Geiss, Stuttgart MRCGP Specialist in internal medicine, specialist in general medicine Community practice Schwabstraße 59 70197 Stuttgart Competing interests: lecture fee from AbbVie, conference visits sponsored by AbbVie, Gilead Sciences, Janssen, ViiV Healthcare Published in: The Doctor, 2014; 36 (9) Page 44-48

Koi herpes virus

Current Event: In an ornamental fish wholesaler in southern Germany in early May 2007, the outbreak of infection with the koi herpesvirus (KHV) was diagnosed with koi carp. Even in pet shops in Baden-Württemberg, which had been supplied by the trader concerned, the koi herpes virus was detected in dead ornamental fish. The KHV is highly contagious for Nutzkarpfen and can lead to high losses in the carp farming. To prevent spread of the disease to the Nutzkarpfenbestände and the wild carp population in Baden-Württemberg is to be noted in this leaflet on the danger of disease and on protective measures to prevent the introduction of epizootic diseases. The KHV poses no threat to humans. Danger: The Koi herpesvirus (KHV) is for Koi carp and Nutzkarpfen (Cyprinus carpio) highly contagious virus that the so-called. Causes “Koi disease. ” The disease first emerged in 1997 koi in Israel, USA and Europe and has now spread worldwide. in Germany occurred in recent years in Koi and Nutzkarpfenbeständen and in wild carp populations losses by KHV on. The KHV infection is a notifiable animal disease. KHV infection (= “Koi disease”)

Exciter. Koi herpesvirus Susceptible species: With Koi Carp (Koi) and Nutzkarpfen occur symptoms and losses; Goldfish can be experimentally infected but show no symptoms. Likewise, grass carp, crucian carp and tench can possibly be virus carriers. Symptoms: lethargy, anorexia, shortness of breath, sunken eyes, skin changes (abschleimen, skin feels like sandpaper); Change the gills (pallor / redness, swelling, necrosis); the internal organs are usually normal. History: The “koi disease” occurs mainly in water temperatures above 18 “C, but there are also outbreaks at lower water temperatures described. The incubation period (interval between infection and onset of the disease) is between 7 to 21 days (depending on the water temperature). The disease is disease-way; Losses up to 100% of the stock are possible. Diagnosis: The diagnosis is made by various PCR testing (polymerase Chain Reaction). In latently infected fish that show no signs of disease, the detection of infection is difficult. Therefore need to be investigated for the safe detection of possibly multiple samples and multiple organs (gills, brain, head kidney, spleen). General whole fish with disease symptoms are (live or freshly dead) best suited for diagnosis.

The KHV infection can be introduced into a carp stock: – Directly, via Koi and Nutzkarpfen or Carrier fish (. Eg goldfish) – Indirectly: through contaminated equipment (nets, landing nets, transport containers, etc. ), via contaminated water, or by persons or their protective clothing (. Eg boots) The purchase of infected Koi and Nutzkarpfen carries the highest risk of infection! Fish that have survived the disease, remain infected for life and are potential KHV carriers (Carrier fish). Protection: In Baden-Württemberg the Koi herpes virus has been detected only in stocks with koi fish and a wild waters. The record carp producers in the country have been studied for several years by the Fish Health Service (FGD) regularly KHV. However, there is evidence that in other states also individual carp economies of KHV are affected.

To protect the carp farms in Baden-Württemberg, the affected Zierfisch actions are currently being amplified by the veterinary offices and reviewed by the fish health service. In the event that KHV is detected, the suspect or diseased fish may not be sold; dead fish must be destroyed. The safest protection provides compliance with the following biosecurity measures: • To protect against the introduction of Nutzkarpfenbestände Koi herpesvirus, no koi should be introduced into the stock. • The water from koi conversations should not be introduced to the wild. • It is pointed out expressly that ornamental fish should not be exposed to the wild / Carp conversations. Generally, only the fishing rights fish may suspend in water. • holders of Koi and Nutzkarpfen are invited to step up to watch their fish and in case of doubt, after the care veterinarian was called in to be examined in the investigation offices. • It is recommended to set fish relates only from establishments which are regularly clinically and virologically studied from FGD negative for KHV. • The following pond disinfection measures are suitable for controlling the koi herpes virus: drying with UV exposure (sunlight) or chemical disinfection with a suitable disinfectant. After Tierseuchengesetz can be imposed on anyone who a notifiable disease spread among animals (intentionally or negligently). With questions or reports of specific incidents, please contact the competent veterinary authority or the fish health service (FGD). FGD Stuttgart on Chem u vet Investigation Office Stuttgart-Fellbach, Tel:.

. 0711 / 3426-1729 FGD Karlsruhe on Chem. U. Vet Investigation Office Karlsruhe branch office Heidelberg, 06221 / 506-0 FGD Freiburg am Chem u vet Investigation Office Freiburg, Tel:. . 0761 / 1502-0 FGD Aulendorf Veterinary at the National Investigation Office – Diagnostic Centre – Aulendorf, Tel: 07525-942-0

How did hr’s come?

Estimating how many sexually transmitted disease or infection cases Occur is not a simple or straightforward task. First, most STDs / STIs can be “silent,” Causing no noticeable symptoms. These asymptomatic infections can be diagnosed only through testing. Unfortunately, routine screening programs are not widespread, and social stigma and lack of public awareness Concerning STDs / STIs oft Inhibits frank discussion between healthcare providers and patients about STD / STI risk and the need for testing. – ASHA. Sexually Transmitted Diseases in America: How Many Cases and at What Cost? December 1998th More than half of all people will have to STD / STI at some point in Their lifetime. [1] The estimated total number of people living in the US with a viral STD / STI is over 65 million. [2] Every year, there are at least 19 million new cases of STDs / STIs, some of Which are curable. [2,3] More than $ 8 trillion is spent each year to diagnose and treat STDs / STIs and Their complications.

This figure does not include HIV. [4] In a national survey of US physicians, fewer than one-third routinely screened patients for STDs / STIs. [5] Less than half of adults ages 18 to 44 have ever been tested for on STD / STI other than HIV / AIDS. Each year, one in four teens contracts on STD / STI. [6] One in two sexually active persons will contact to STD / STI by age 25. [7] About half of all new STDs / STIs in 2000 occurred among youth ages 15 to 24. [8] The total estimated costs of thesis nine million new cases of thesis STDs / STIs which $ 6. 5 trillion, with HIV and human papillomavirus (HPV) accounting for 90% of the total burden. [9]

Of the STDs / STIs did are diagnosed, only some (gonorrhea, syphilis, chlamydia, hepatitis A and B) are required to be reported to state health departments and the CDC. One out of 20 people in the United States will get infected with hepatitis B (HBV) sometime during Their Lives. [10] Hepatitis B is 100 times more infectious than HIV. [11] Approximately half of HBV infections are trans mitted sexually. [12] HBV is linked to chronic liver disease, cirrhosis and liver cancer Including. Hepatitis A and hepatitis B are the only two vaccine-preventable STDs / STIs. It is estimated as many as did one in five Americans have genital herpes, a lifelong (but manageable) infection, yet up to 90 percent of Those with herpes are unaware theyhave it. [13] With more than 50 million adults in the US with genital herpes and up to 1. 6 million new infections each year, some estimates suggest did by 2025 up to 40% of all men and half of all women Could be infected. [14,15,16] Over 6 million people acquire HPV each year, and by age 50, at least 80 percent of women will have acquired genital HPV infection.

[17] Most people with HPV do not develop symptoms. Some Researchers believe did HPV infections may self-resolve and may not be lifelong like herpes. [2] Cervical cancer in women, while preventable through regular Paps, is linked to high-risk types of HPV. Each year, there are almost 3 million new cases of chlamydia, many ofwhich are in adolescents and young adults. [8] The CDC recommends sexually active females did 25 and under shoulderstand be screened at least once a year for chlamydia, even if no symptoms are present. About two-Thirds of young females believe doctors routinely screen teens for chlamydia. [18] HOWEVER, in 2003 only 30% of women 25 and under with commercial health care plans and 45% in Medicaid plans were screened for chlamydia. [19] At least 15 percent of all American women who are infertile can attribute it to tubal damage caused by pelvic inflammatory disease (PID), the result of an untreated STD. Consistent condom use Reduces the risk of recurrent PID and related complications: Significantly, women who reported regular use of condoms in one study were 60 percent less likely to become infertile. [20] Consistent condom use Provides substantial protection against the acquisition of many STDs, Including statistically significant reduction of risk against HIV, chlamydia, gonorrhea, herpes, and syphilis.

[21,22,23] Some studies show that, For Those Who already have a clinically apparent genital HPV infection, using condoms Promotes the regression of HPV lesions in Both women and men. [24,25] References Koutsky L. (1997). Epidemiology of genital human papillomavirus infection. American Journal of Medicine, 102 (5A), 3-8. American Social Health Association. (1998). Sexually transmitted diseases in America: How many cases and at what cost? Research Triangle Park, NC: American Social Health Association. Weinstock H, et al.

Sexually transmitted diseases among American youth: incidence and prevalence estimates, 2000. Perspectives on Sexual and Reproductive Health 2004; 36 (1): 6-10. Institute of Medicine. (1997). The hidden epidemic-Confronting sexually transmitted disease (edited by Thomas R. Eng and William T. Butler). Washington, DC: National Academy Press. St Lawrence JS et al. (2002). STD screening, testing, case reporting, and clinical and partner notification practices: a national survey of US physicians. American Journal of Public Health, 92, 1784-1788. Alan Guttmacher Institute.

(1994). Sex and America’s teenagers. New York: Alan Guttmacher Institute. Cates JR, Herndon NL, Schulz S L, Darroch JE. (2004). Our voices, our lives, our futures: Youth and sexually transmitted diseases. Chapel Hill, NC: University of North Carolina at Chapel Hill School of Journalism and Mass Communication. Weinstock H, Berman S, Cates W, Jr. (2004). Sexually transmitted diseases among American youth: incidence and prevalence estimates, 2000. Perspectives on Sexual and Reproductive Health, 36, 6-10. Chesson HW, Blandford JM, poison TL, Tao G, Irwin KL. (2004).

The estimated direct medical cost of sexually transmitted diseases among American youth, 2000. Perspectives on Sexual and Reproductive Health, 36, 11-19. Centers for Disease Control and Prevention. Hepatitis B Frequently Asked Questions. Updated April 1, 2005. Retrieved April 22, 2005 from http: //www. cdc. gov/ncidod/diseases/hepat . . . Centers for Disease Control and Prevention. Hepatitis B Prevention for Men Who Have Sex With Men. Online Fact Sheet.

Updated April 1, 2005. Retrieved April 22, 2005 from http: //www. cdc. gov/ncidod/diseases/hepat . . . Centers for Disease Control and Prevention. Tracking the hidden epidemics, 2000: Trends in the United States. Retrieved April 22, 2005 from http: //www. cdc. gov/nchstp/od/news/RevBro . . .

Fleming DT et al. (1997). Herpes simplex virus type 2 in the United States, 1976-1994. New England Journal of Medicine, 337, 1105-1111. Corey L \x26amp; Handfield HH. (8:00 pm). Genital herpes and public health: addressing a global problem-. Journal of the American Medical Association, 283, 791-794. Armstrong GL et al. (2001). Incidence of herpes simplex virus type 2 infection in the United States. American Journal of Epidemiology, 153, 912-920. Fisman DN et al.

(2002). Projection of the future dimensions and costs of the genital herpes simplex type 2 epidemic in the United States. Sexually Transmitted Diseases, 29, 608-622. Centers for Disease Control and Prevention. Genital HPV Infection. Online Fact Sheet. Retrieved May 9, 2005 from http://www. cdc. gov/std/HPV/STDFact-HPV. htm. American Social Health Association. (2005). State of the Nation 2005: Challenges facing STD prevention in youth.

Research Triangle Park, NC: American Social Health Association. National Committee for Quality Assurance. (2004). The state of health care quality: 2004. Washington, DC: NCQA. Ness RB et al. (2004). Condom use and the risk of recurrent pelvic inflammatory disease, chronic pelvic pain, infertility or Following on episode of pelvic inflammatory disease. American Journal of Public Health, 2004, 94: 1327-1329. Crosby RA et al. (2003). The value of consistent condom use: a study of sexually transmitted disease prevention among African American adolescent females. American Journal of Public Health, 93, 901-902.

Holmes KK, Levine R, Weaver M. (2004). Effectiveness of condoms in Preventing sexually transmitted infections. Bulletin of the World Health Organization, 82, 454-464. Shlay JC et al. (2004). Comparison of sexually transmitted disease prevalence by reported level of condom use among patients attending an urban sexually transmitted disease clinic. Sexually Transmitted Diseases, 31, 154-160. Bleeker MC et al. (2003). Condom use Promotes regression of human papillomavirus-associated penile lesions in male sexual partners of women with cervical intraepithelial neoplasia. International Journal of Cancer, 104, 804-810. Hogewoning CJ et al.

(2003). Condom use Promotes regression of cervical intraepithelial neoplasia and clearance of human papillomavirus: A randomized clinical trial. International Journal of Cancer, 107, 811-816.