Integrated Clinics

Integrated Clinics INTEGRATED COURSE Clinics MEC-251M COURSE OF INFECTIOUS DISEASES PROFESSOR IN CHARGE Dr. Carlos Perez C. SCHEDULE P5 room Monday to Friday from 14:30 to 17:30 Hrs. S. Sem. 8, 7 and 6 on Monday, Tuesday, Thursday and Friday S.

Sem. 8, 7 Wednesday DATES (13 evenings for groups) Group 1: 6/3 to 22/3 Group 2: 19/4 to 8/5 Group 3: 4/6 to 21/6 OBJECTIVES Learn the basics of microbial taxonomy, identification techniques of infectious agents and methods of study of antimicrobial susceptibility. Recognize the clinical and laboratory features for the diagnosis of the most common infections in healthy and immunocompromised host. Knowing the pharmacokinetic and pharmacodynamic characteristics of the main antimicrobial agents and their indications in prevalent infections in ambulatory and hospital practice. Know the main bibliographical sources used in the field. FACULTY

Dr. Guillermo Acuña. Dr. Jaime Labarca Dr. Luis M. Noriega Dr. Carlos Perez Dr. Jorge Pérez Dr. Paul Vial

Dra. Enna Zunino Dr. Mario Salcedo Dra. Marisa Torres Other teachers Hospital Lucio Córdova (Seminars) BIBLIOGRAPHY It will be delivered at the beginning of the course. EVALUATION Seminar notes (20%) and written exam (80%) FIRST GROUP CALENDAR: March 6 to March 22 Tuesday

6 1 Febrile syndrome Dr. Guillermo Acuña 2 Laboratory diagnosis of infectious diseases. Antimicrobial susceptibility studies. Dr. Jaime Labarca Wednesday 7 1

Epidemiology, pathogenesis, evolution and treatment of HIV infection. Dr. Carlos Perez 2 Prevention and treatment of opportunistic infections in HIV infection Dr. Luis M. Noriega Thursday 8 1 Nosocomial infections. Universal Precautions.

Dr. Jaime Labarca 2 Concept of cyclic and noncyclic septicemias. Typhoid fever. Brucellosis. Salmonella enteritidis Dr. Jaime Labarca Friday 9 1 Herpes virus infections: Herpes simplex, Varicella zoster, Epstein Barr, Cytomegalovirus.

Dr. Paul Vial 2 Seminar: mononucleosis syndrome Dr. Jaime Labarca Dr. Carlos Perez Dr. Paul Vial Monday 12 1

Antibiotics Class: General highlights pharmacokinetic, pharmacodynamic and indications of major groups Dr. Carlos Perez 2 Upper respiratory infections: Tonsillopharyngitis, otitis, sinusitis. Dr. Paul Vial Tuesday 13 *1 Infections of the central nervous system (CNS) Dr. Luis M.

Noriega I: Meningitis clear liquid, purulent meningitis. *2 Seminar: lower respiratory infections: Dr. Luis M. Noriega Classical and atypical bacterial pneumonia. Dr. Carlos Perez Dra. Patricia González Wednesday

14 1 bone and joint infections Dr. Guillermo Acuña 2 Sexually transmitted infections. Dr. Guillermo Acuña Thursday fifteen 1 Streptococcus and staphylococcus infections.

Dr. Jorge Pérez 2 rash diseases and more frequent in the adult Vesicular: Measles, Rubella, Varicella. Dra. Marcela Ferres Friday 16 1 CNS infections II: encephalitis, brain abscess. Dr. Carlos Perez 2

Seminar: Clinical cases on use of antibiotics Dr. Carlos Perez Dr. Jaime Labarca Monday 19 *1 Infections of skin and soft tissue Dr. Carlos Perez *2 Seminar: Intra-abdominal infections

Dr. Carlos Perez Tuesday twenty 1 Infections in immunosuppressed Dr. Jaime Labarca 2 Seminar: Infections in immunosuppressed Dr. Jaime Labarca Dr.

Carlos Perez Wednesday twenty-one 1 Fascioliasis, hydatidosis, trichinosis, cysticercosis, toxocariasis, toxoplasmosis: frequently in clinical practice Histoparasitosis. Dra. Marisa Torres Thursday 22 1 Evaluation Dr. Carlos Perez

* Module Teaching Hospital Sotero del Rio UDA SECOND GROUP CALENDAR: April 19 to May 8 Thursday 19 1 Febrile syndrome Dr. Guillermo Acuña 2 Laboratory diagnosis of infectious diseases. Antimicrobial susceptibility studies. Dr. Jaime Labarca

Friday twenty 1 Epidemiology, pathogenesis, evolution and treatment of HIV infection. Dr. Carlos Perez 2 Prevention and treatment of opportunistic infections in HIV infection Dr. Luis M. Noriega Monday 2.

3 1 Nosocomial infections. Universal Precautions. Dr. Jaime Labarca 2 Concept of cyclic and noncyclic septicemias. Typhoid fever. Brucellosis. Salmonella enteritidis Dr. Jaime Labarca


Tuesday 24 1 Herpes virus infections: Herpes simplex, Varicella zoster, Epstein Barr, Cytomegalovirus. Dr. Paul Vial 2 Seminar: mononucleosis syndrome Dr. Jaime Labarca Dr. Carlos Perez Dr.

Paul Vial Wednesday 25 1 Antibiotics Class: General highlights pharmacokinetic, pharmacodynamic and indications of major groups Dr. Carlos Perez 2 Upper respiratory infections: Tonsillopharyngitis, otitis, sinusitis. Dr. Paul Vial Thursday 26

*1 Infections of the central nervous system (CNS) Dr. Luis M. Noriega I: Meningitis clear liquid, purulent meningitis. *2 Seminar: lower respiratory infections: Dr. Luis M. Noriega Classical and atypical bacterial pneumonia. Dr.

Carlos Perez Dra. Patricia González Friday 27 1 bone and joint infections Dr. Guillermo Acuña 2 Sexually transmitted infections. Dr. Guillermo Acuña

Monday 30 1 Streptococcus and staphylococcus infections. Dr. Jorge Pérez 2 rash diseases and more frequent in the adult Vesicular: Measles, Rubella, Varicella. Dra. Marcela Ferres Wednesday 2 1

CNS infections II: encephalitis, brain abscess. Dr. Carlos Perez 2 Seminar: Clinical cases on use of antibiotics Dr. Carlos Perez Dr. Jaime Labarca Thursday 3 *1 Infections of skin and soft tissue

Dr. Carlos Perez *2 Seminar: Intra-abdominal infections Dr. Carlos Perez Friday 4 1 Infections in immunosuppressed Dr. Jaime Labarca 2

Seminar: Infections in immunosuppressed Dr. Jaime Labarca Dr. Carlos Perez Monday 7 1 Fascioliasis, hydatidosis, trichinosis, cysticercosis, toxocariasis, toxoplasmosis: frequently in clinical practice Histoparasitosis. Dra. Marisa Torres Tuesday 8

1 Evaluation Dr. Carlos Perez * Module Teaching Hospital Sotero del Rio UDA SCHEDULE THIRD GROUP: June 4 to June 21 Monday 4 1 Febrile syndrome Dr. Guillermo Acuña 2

Laboratory diagnosis of infectious diseases. Antimicrobial susceptibility studies. Dr. Jaime Labarca Tuesday 5 1 Epidemiology, pathogenesis, evolution and treatment of HIV infection. Dr. Carlos Perez 2 Prevention and treatment of opportunistic infections in HIV infection Dr.

Luis M. Noriega Wednesday 6 1 Nosocomial infections. Universal Precautions. Dr. Jaime Labarca 2 Concept of cyclic and noncyclic septicemias. Typhoid fever. Brucellosis.

Salmonella enteritidis Dr. Jaime Labarca Thursday 7 1 Herpes virus infections: Herpes simplex, Varicella zoster, Epstein Barr, Cytomegalovirus. Dr. Paul Vial 2 Seminar: mononucleosis syndrome Dr. Jaime Labarca

Dr. Carlos Perez Dr. Paul Vial Friday 8 1 Antibiotics Class: General highlights pharmacokinetic, pharmacodynamic and indications of major groups Dr. Carlos Perez 2 Upper respiratory infections: Tonsillopharyngitis, otitis, sinusitis. Dr.

Paul Vial Tuesday 12 *1 Infections of the central nervous system (CNS) Dr. Luis M. Noriega I: Meningitis clear liquid, purulent meningitis. *2 Seminar: lower respiratory infections: Dr. Luis M.

Noriega Classical and atypical bacterial pneumonia. Dr. Carlos Perez Dra. Patricia González Wednesday 13 1 bone and joint infections Dr. Guillermo Acuña 2

Sexually transmitted infections. Dr. Guillermo Acuña Thursday 14 1 Streptococcus and staphylococcus infections. Dr. Jorge Pérez 2 rash diseases and more frequent in the adult Vesicular: Measles, Rubella, Varicella. Dra. Marcela Ferres

Friday fifteen 1 CNS infections II: encephalitis, brain abscess. Dr. Carlos Perez 2 Seminar: Clinical cases on use of antibiotics Dr. Carlos Perez Dr. Jaime Labarca Monday

18 *1 Infections of skin and soft tissue Dr. Carlos Perez *2 Seminar: Intra-abdominal infections Dr. Carlos Perez Tuesday 19 1 Infections in immunosuppressed

Dr. Jaime Labarca 2 Seminar: Infections in immunosuppressed Dr. Jaime Labarca Dr. Carlos Perez Wednesday twenty 1 Fascioliasis, hydatidosis, trichinosis, cysticercosis, toxocariasis, toxoplasmosis: frequently in clinical practice Histoparasitosis. Dra.

Marisa Torres Thursday twenty-one 1 Evaluation Dr. Carlos Perez * Module Teaching Hospital Sotero del Rio UDA

Visualizza argomento – herpes labial dopo 7 giorni dal rapporto a richio nn protetto

New User Messaggi inviati: 1 Buongiorno, è la prima volta che scrivo in un qualsiasi forum e quindi non so ‘come fare! Provo a riassumere le mie paure e domande in queste poche righe: Circa una settimana fà ho avuto un rapporto completo vaginal oral anal ed con una giovane ragazza di 19 anni della quale la tenera data età mi sono scoccamente FIDATO! Dopo sono venuto a sapere che era una ragazzina molto poco raccomandabile e sono cominciate a sorgere le più paure disparate. La mia paura è principale data dal fatto che dopo pochi giorni mi è una venuta herpes labial che in un paio di giorni è scomparsa ed oggi mi sono una nuova svegliata con. E ‘possibile che questa sia una causa del contagio, anche a pochi giorni di distanza? Premetto che ho avuto l’influenza e subito dopo mi sono fatto un solarium col quale mi sono quasi ustionato. Non sò come giudicherete il mio racconto, ma sono 2 giorni che mi giro nel letto nn trovando la pace. Dopo qanto posso fare un test di IV generazione via stre più tranquillo? che cosa gli devo chiedere al centro dove mi reco? Grazie per le millein anticipo risposte che spero mi darete.

Ciao ciao. Elite veteran Messaggi inviati: 1100 Ciao Giancarlo, l’età di una persona, la sua Reputazione, la fiducia che sono elementi Ispira non in a base cui il valutare rischio d’infezione. L’Hiv è un’infezione a trasmissione sessuale e riguarda chiunque abbia una vita sessuale attiva. Il sesso non protetto dal profilattico è a rischio, qualunque sia la circostanza il partner e la relazione. In ogni caso l’herpes o qualunque altro sintomo non avvalora né escludono l’infezione. L’unico modo per diagnosticare l’Hiv è il test. In linea generale un test effettuato a 3 mesi di distanza dal comportamento a rischio è considerato definitivo; se decidi di effettuare il test prima dello scadere del periodo finestra (i 3 mesi), parla con il medico per avere tutte le informazioni e necessarie chiarire ogni tuo dubbio sull’attendibilità del risultato. Ti suggerisco di leggere nella stanza “Comunicazioni Purple” sia le informazioni sui comportamenti a rischio e su quelli sicuri, sia le informazioni sul test. Hai avuto la tua dose di rischio, ma l ‘herpes non è un indicatore sufficiente per poter diagnosticare l’ infezione. Mi sciocca invece, la facilità con cui si attribuiscono Definizioni come “poco di buono oppure poco raccomandabile”.

Ma come, prima gli lo metti in ogni dove e poi was capace anche di sputtanarla? Sei un cretino! Regular Messaggi inviati: 55 Non Ti paranoiare coi sintomi, non esiste nessun sintomo specifico che possa avvalorare la tesi di un contagio, fai il primo test a un mese, ha già valore, poi a 2 e il terzo e ultimo definitivo a 3 mesi. Se Ti può consolare le possibilità di contagio con un solo rapporto sono piuttosto basse. Stai sereno. Ciao. Elite veteran Messaggi inviati 1136 Premetto che ho avuto l’influenza e subito dopo mi sono fatto un solarium col quale mi sono quasi ustionato. Coglione GIA TI SEI DATO LA RISPOSTA! giancarlo541 – 2009-11-17 14:50

Dopo sono venuto a sapere che era una ragazzina molto poco raccomandabile e sono cominciate a sorgere le più paure disparate. Che cosa che hai scritto brutta davvero brutta: impara a non sporcare gli altri. Composto da uncieloimmenso 2009-11-21 09:09 giancarlo541 – 2009-11-17 14:50 Circa una settimana fà ho avuto un rapporto completo vaginal oral anal ed con una giovane ragazza di 19 anni della quale la tenera data età mi sono scoccamente FIDATO! Dopo sono venuto a sapere che era una ragazzina molto poco raccomandabile e sono cominciate a sorgere le più paure disparate. povera ragazzina alla sua eta ha gia conosciuto il peggio . . . . .

Regular Messaggi inviati: 54 A me la cosa sembra sospetta, giancarlo parla di se al femminile, secondo me è una sola. E poi scusa perchè la ragazza sarebbe una poco di buono? perchè a 19 anni è venuta a letto con te ? ? ? Ripeto seconod me è una bufala

Shingles – Herpes Zoster

Shingles – Herpes Zoster Shingles – Herpes Zoster . . . Viral infection that causes pain, sensory disturbances and lesions in the coverage area of ​​a particular nerve. Synonym: Zoster Cause: The cause of shingles is a reactivation of the body of existing varicella zoster virus (Fig. Right). Shingles occurs only in people who were diagnosed in their childhood chickenpox. Incubation period (time between infection and outbreak): 7 to 21 days; seronegative may impair health in infection by a Zosterkranken chickenpox, but seropositive (ie previously undergone chickenpox) ill not obligate to shingles. Reinfection is the incubation period appears to be shorter (3 to 7 days? ).

Contagiousness (infectiousness): as with chickenpox ( “the wind fanned”) is very high Frequency: up to about 4 new cases per 1000 inhabitants per year Special hazards: the elderly, immunodeficiencies (z. B. AIDS or patients receiving immunosuppressive therapy, such as leukemia and tumors – also very dangerous complications possible – radiate therapierte patients among others, frequently even with systemic diseases such as diabetes mellitus or malignancy observed). One should therefore, if necessary, looking in all patients for a reason, which one comes after some expressed in the literature estimates at about 20% of people suffering from zoster to a significant underlying disease. Symptoms: small blisters on reddened skin that occur semi-bounded and are accompanied by pain and sensory disturbances, on the chest and abdomen often ring along certain of a nerve-supplied skin (segment), possibly even more segments, ie typically like a belt, whereupon the naming is based; but may also be the head or extremities (as often in the dispersion area of ​​a branch of the trigeminal nerve or on the leg in the dispersion area of ​​the sciatic nerve) spread more vertically. Initially, there are itching, however untreated course more and more turns into pain. The Allegemeinbefinden varies from hardly disturbed (possibly through pain) to fatigue and fever with severe malaise. Abortive courses with no or very small bubbles formation can occur occasionally. The infestation of mucous membranes and the swelling regional Lyphknoten is also possible. With the onset of crust formation, the pain subsides. Me After dropping the crusts like the chickenpox depigmented small skin scars.

Diagnosis: As with chickenpox the microbiological detection is difficult. The detection of elementary bodies by electron microscopy or the bacterial culture on human embryo cells is possible, but playing this method in practice no role. From the scrapings of fresh bubbles giant cells and Kerneinschlußkörper can lichtmekroskopisch indeed be detected, but again this is irrelevant, because the diagnosis can usually make reference to the situation described by the patient symptoms and by the typical lesions. Only in very extreme circumstances against other diseases you will fall back in some cases to the detection of antibodies in the serum. but Microbiological detection of pathogens in shingles could be necessary if the primary skin lesions by uncleanliness (esp. by scratching) are secondarily colonized with other bacteria (superinfection). Here, the microscopic or cultural detection of the pathogen should be sought. Clinic: The clinical course can best be dargestell to the typical skin symptoms: Fig. 1: 49-year-old patient, a few, z. T. scattered blisters, uncomplicated course Fig.

2: 65-year-old patient, distributed over several segments and a large area confluent vesicles groups, sometimes livid spots by lower circulation (warfarin therapy) Figure 3: The same patient as in figure 2 after 1 week of treatment with 5 x 800 mg acyclovir, residual crusts, yet distension, already visible depigmentation (scars) complications: Under bleeding (in very severe inflammation of the bubbles) = zoster haemorrhagicus ulcerative disintegration (in case of superinfection) = zoster gangraenosus Full infestation as chickenpox (esp. Immunosuppressed or elderly patients) = zoster generalized satus persistent nerve pain (often months) = post-zoster neuralgia The latter is but declined significantly since the introduction of antiviral therapy! Infestation of both halves of the body or more segments of a body half = zoster duplex or multiplex unilateralis Infestation of 1. Trigeminusastes involving the eye (Hornahaut u. Conjunctival) = ophthalmic zoster

Infestation of 2. Zervicalsegmentes with participation of the ear (hearing loss, facial nerve palsy, among others) = zoster oticus Involvement and inflammation of the brain (encephalitis), the meninges (meningitis) and spinal cord (myelitis) are possible and require fast and inpatient treatment. Prognosis: generally good, perilous is the zoster generalized satus, also forecast always determined by the simultaneous existence of a serious underlying disease. Therapy: treatment of choice is an antiviral drug acyclovir (Zovirax as ©) or brivudine (Zostex ©), possibly intravenously or as a short-term infusion in difficult cases (for example, immunosuppression); in case of non-response foscarnet (foscavir ©) as an infusion, dosage by age and weight Externally: zinc lotions, clioquinol soln. (Often no treatment required) Pain: all common painkillers bishin temporary therapy with opiates Superinfection: externally antibiotic on the pathogen or internally Zoster neuralgia: Pain Mitel and / or the anticonvulsant carbamazepine (Tegretal ©), alternatively amantadine (PK-Merz ©) In general, the treatment can be performed on an outpatient basis. Complicated courses should the clinic. In zoster opthalmicus or oticus can possibly be treated on an outpatient basis, but the competent specialist should be turned on.

Prophylaxis: No known! With the introduction of the chickenpox vaccine in childhood since 2004 possibly the shingles will decline in the future. Image sources: Fig . : varicella zoster virus (top) of Medicine Worlwide (http://www. m-ww. de/krankheiten/infektionskrankheiten/zoster. html) Fig. 1-3 are the property of the author. Created: 03. 12. 2004 / update: no / author: F. Wiegleb (fwiegleb@gmx.

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Herpes in pregnancy – 8 questions ask your doctor

The herpes virus is particularly dangerous for the fetus, it is 50% of cases of intrauterine infection. What is the future mother of herpes infection knows? Let us try to answer the most important questions. 1. Why should I be tested for the herpes virus before pregnancy, is when you get rid of it still is not possible? 2. What is so dangerous herpes virus? 3. How to get the child? 4. What is herpes is the most dangerous for pregnant women, genital or plain? 5. What happens if a woman is already pregnant?


6. In pregnant women with herpes is almost no chance of a healthy baby? 7. Maybe help drugs that stimulate the immune system? 8. What about herpes on the lips? The fact that you need to prepare for pregnancy, know almost everything, but few do it correctly. According to statistics, 40% of women come to the gynecologist on the fact of pregnancy, considering that preventive intake of vitamins is enough to successfully create, perform and give birth to a healthy child. However, the planned examination of the spouses before conception to solve many problems, is caused in particular to intrauterine infection of the fetus by the herpes virus. 1. Why should I be tested for the herpes virus before pregnancy, if you are getting rid of it is still not possible? Indeed, it is impossible to cure the herpes infection, but no such problems and is not intended. The aim is to prepare the woman’s body, strengthen immunity, increases the body’s resistance and prevent the herpes virus activated in the decisive phase of childbearing.

2. What is so dangerous herpes virus? The disease herpes during pregnancy can lead to miscarriage, fetal malformations, especially microcephaly, microphthalmia, chorioretinitis. Child transmission can be full development spread of the infection, which flows from the liver, spleen, bleeding, pneumonia, encephalitis be, and in 90-95% of cases leads to death, when the baby is born too early especially. In mild cases of herpes infection leads to lesions of the skin and mucous membranes. 3. How to catch the baby? In 85% of cases of infection of the child occurs intrapartum, ie, during childbirth, when. Through the birth canal Interestingly, the virus from the mother is transmitted to the newborn, regardless of whether there is currently clinical manifestations of herpes in the genital area of ​​the woman or not, that is asymptomatic. The risk of infection increases in times of cervix and in the field of cervical and vulvar cancer has herpes if holiday is premature rupture of membranes, prolonged rupture of membranes preceded when doctors have to apply the tools of intervention at birth. Herpes can the newborn after birth in contact with the mother, cutaneous manifestations of infection are transmitted. 4. What is herpes is the most dangerous for pregnant women, genital or plain?

For a pregnant woman and the unborn child is the greatest risk of genital herpes, but not even the fact that his presence and his infection during pregnancy. Such cases lead to intrauterine infection of the fetus and have serious consequences. Therefore, for the herpes virus is not only a woman, but also their sexual partners should be checked, regardless of whether he signs of infection. As the statistics, only 20% of infected people have a confirmed diagnosis occurs 60% of the disease in an atypical form, 20% – in bessiptomnoy. In such cases, the virus can only be identified via assays. If a woman identified the partner herpes, but it is not a woman, it is important to prevent infection during pregnancy. 5. What to do if a woman is already pregnant? Tested for the herpes virus is necessary in any case. When it is detected, but no symptoms of the disease is not available, a treatment is needed. Later, carried out with the occurrence of herpes sores, the lo . . .