DOCSLIB.ORG

Cutaneous Manifestations of HIV Infection Carrie L

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Cutaneous Manifestations of HIV Infection Carrie L Chapter Title Cutaneous Manifestations of HIV Infection Carrie L. Kovarik, MD Addy Kekitiinwa, MB, ChB Heidi Schwarzwald, MD, MPH Objectives Table 1. Cutaneous manifestations of HIV 1. Review the most common cutaneous Cause Manifestations manifestations of human immunodeficiency Neoplasia Kaposi sarcoma virus (HIV) infection. Lymphoma 2. Describe the methods of diagnosis and treatment Squamous cell carcinoma for each cutaneous disease. Infectious Herpes zoster Herpes simplex virus infections Superficial fungal infections Key Points Angular cheilitis 1. Cutaneous lesions are often the first Chancroid manifestation of HIV noted by patients and Cryptococcus Histoplasmosis health professionals. Human papillomavirus (verruca vulgaris, 2. Cutaneous lesions occur frequently in both adults verruca plana, condyloma) and children infected with HIV. Impetigo 3. Diagnosis of several mucocutaneous diseases Lymphogranuloma venereum in the setting of HIV will allow appropriate Molluscum contagiosum treatment and prevention of complications. Syphilis Furunculosis 4. Prompt diagnosis and treatment of cutaneous Folliculitis manifestations can prevent complications and Pyomyositis improve quality of life for HIV-infected persons. Other Pruritic papular eruption Seborrheic dermatitis Overview Drug eruption Vasculitis Many people with human immunodeficiency virus Psoriasis (HIV) infection develop cutaneous lesions. The risk of Hyperpigmentation developing cutaneous manifestations increases with Photodermatitis disease progression. As immunosuppression increases, Atopic Dermatitis patients may develop multiple skin diseases at once, Hair changes atypical-appearing skin lesions, or diseases that are refractory to standard treatment. Skin conditions that have been associated with HIV infection are listed in Clinical staging is useful in the initial assessment of a Table 1. patient, at the time the patient enters into long-term HIV care, and for monitoring a patient’s disease progression. Once HIV infection has been confirmed, the diagnosis of The clinical stage of a patient has been shown to be certain mucocutaneous conditions in children (Table 2) related to survival, prognosis, and disease progression. and adults (Table 3) can be used to clinically stage the As shown in Tables 2 and 3, the skin examination plays a patient. The World Health Organization (WHO) clinically significant role in the clinical staging process of patients stages patients as having HIV that is asymptomatic (stage with HIV. Also, the diagnosis of these cutaneous diseases 1) or with mild symptoms (stage 2), advanced symptoms may lead to the early testing and diagnosis of HIV in (stage 3), or severe symptoms (stage 4). children and adults if recognized with other signs and symptoms of HIV infection. 173 173 HIV Curriculum for the Health Professional This module focuses on many of the most common and/or significant cutaneous manifestations of HIV; however, other sections cover several mucocutaneous manifestations in depth. To avoid duplication, we will mention them here only briefly. Viral Skin Disease Cutaneous Infection with Herpes Simplex Virus Herpes simplex virus (HSV) infection most commonly causes disease in the oral or anogenital region; however, widespread disease may be seen in immunocompromised patients (Figure 1). In adults, a relationship has been + Figure 1. Herpes Simplex Confirmed herpes simplex virus infection on the nose and observed between decreased CD4 cheek of an HIV-infected man. This patient also had similar ulcers on the genitals. lymphocyte counts and an increased incidence of cutaneous HSV. In children, herpes gingivostomatitis can be so severe that it leads to progressive, and painful orolabial, genital, or anorectal poor nutrition and dehydration (Figure 2). Chronic HSV lesions and is one of the criteria for severely symptomatic infection (present for >1 month) may manifest as severe, (WHO Clinical Stage 4) HIV infection (Figure 3). Table 2. Criteria for recognizing HIV-related mucocutaneous clinical events in children (younger than 15 years)* Clinical Event Clinical Diagnosis Definitive Diagnosis Clinical Stage 2 Pruritic papular Papular lesions with intense pruritus. Clinical diagnosis, exclude other causes, such eruptions as drug eruptions, atopic dermatitis, scabies. Fungal nail Fungal paronychia (painful, red, and swollen nail bed) or Clinical diagnosis, microscopic demonstration infections onycholysis (painless separation of the nail from the nail bed). of fungal hyphae, or culture of the nail. Proximal white subungual onycho mycosis is uncommon without immunodeficiency. Angular cheilitis Splits or cracks at the angles of the mouth, usually with Clinical diagnosis or response to antifungal surrounding erythema, and not attributable to nutritional therapy. deficiency. Extensive wart Characteristic warty skin lesions. Variants include flat, Clinical or histologic diagnosis. virus infection plantar, papular, and genital. More than 5% or body surface area or disfiguring. Extensive molluscum Characteristic skin lesions: small flesh-colored, pearly or Clinical or histologic diagnosis. contagiosum pink, dome-shaped or umbilicated papules. May have surrounding redness. More than 5% or body surface area or disfiguring. Recurrent oral Current event plus at least one previous episode in the Clinical diagnosis. ulceration past 6 mo. Aphthous ulceration, typically with a halo of inflammation and yellow–gray pseudomembrane. Herpes zoster Painful rash with fluid-filled blisters, dermatomal distribution, Clinical diagnosis, microscopic diagnosis can be hemorrhagic on erythematous background, and can with Tzanck smear, or culture. become large and confluent. Should not cross the midline. Can become disseminated. Continued on next page 174 Cutaneous Manifestations of HIV Infection Table 2. Criteria for recognizing HIV-related mucocutaneous clinical events in children (younger than 15 years)* (concluded) Clinical Event Clinical Diagnosis Definitive Diagnosis Clinical Stage 3 Oral candidiasis Persistent or recurrent, creamy white to yellow, soft Clinical, microscopic, or culture diagnosis. plaques that can be scraped off, or red patches on the tongue, palate or lining on the mouth, usually painful or tender (erythematous form). Oral hairy leukoplakia Fine, small linear patches on lateral borders of the tongue, Clinical diagnosis. Acute necrotizing generally bilateral, that do not scrape off. ulcerative gingivitis Severe pain, ulcerated gingival papillae, loosening of teeth, Clinical diagnosis. or stomatitis, or spontaneous bleeding, bad odor, and rapid loss or bone acute necrotizing or soft tissue. ulcerative periodontitis Clinical Stage 4 Chronic herpes Severe and progressive painful orolabial, genital, or Clinical diagnosis, microscopic diagnosis simplex infection anorectal, lesions caused by HSV and present for >1 mo. with Tzanck smear, or culture. (HSV) Extrapulmonary Systemic illness, usually with prolonged fever, night sweats, Positive microscopy showing acid-fast bacilli tuberculosis and weight loss. Clinical features of organs involved, such or culture of Mycobacterium tuberculosis as sterile pyuria, pericarditis, ascites, pleural effusion, from blood or other relevant specimen/tissue meningitis, arthritis, orchitis, or skin lesions. except sputum or bronchoalveolar lavage. Biopsy and histology. Kaposi sarcoma Typical appearance in skin or oropharynx of persistent, Clinical diagnosis, may need histologic initially flat, patches with a pink or purple color. May confirmation. develop into plaques, nodules, or tumors. Disseminated fungal Wide range of clinical presentations in the skin, including Histology, antigen detection, and/or culture infection (cryptococ- papules, nodules, and ulcerations. is needed. cosis, histoplasmosis, coccidioidomycosis) Disseminated Wide range of clinical presentations in the skin, including Nonspecific clinical symptoms (weight loss, mycobacterial papules, nodules, and ulcerations. fever, anemia) plus culture of atypical infection, other than mycobacterial species from tissue other tuberculosis than lung. *Adapted from 2006 WHO case definitions of HIV for surveillance and revised clinical staging and immunological classification of HIV-related disease in adults and children. HSV cutaneous disease presents as small grouped vesicles (or blisters) with redness on the surrounding skin. The spread of HSV infection to other areas of the skin is common and occurs through autoinoculation or sexual contact. The typical clinical course of HSV infection includes the rupture of the blisters over the course of a week, with subsequent healing in 2 weeks; however, this course can be significantly prolonged in the immunocompromised host. The diagnosis of HSV infection can be reached through clinical examination, Figure 2. Herpes Simplex Figure 3. Large ulceration on the upper lip due microscopic identification of virally Herpes simplex virus inrection in an HIV- to herpes simplex virus infection. This patient’s infected girl. Chronic or progressive herpes ulcer had been present for more than 3 months. infected keratinocytes from the blister skin lesions are observed occasionally in cavity with a Tzanck stain, viral culture, HIV-infected children. 175 HIV Curriculum for the Health Professional Table 3. Criteria for recognizing HIV-related mucocutaneous clinical events in adults and adolescents (15 years and older)* Clinical Event Clinical Diagnosis Definitive Diagnosis Clinical Stage 2 Pruritic papular eruptions See Table 2. See Table 2.
Load more

Recommended publications
  • Expanding the Role of Dermatology at the World Health Organization and Beyond
    EDITORIAL A Seat at the Big Table: Expanding the Role of Dermatology at the World Health Organization and Beyond y patient can’t breathe. From across Kaposi’s sarcoma, seborrheic dermatitis, her- the busy, open ward, you can see the pes zoster, scabies, papular pruritic eruption, Mplaques of Kaposi’s sarcoma riddling eosinophilic folliculitis, tinea, molluscum, drug her skin. The impressive woody edema has reactions, and oral candidiasis (World Health enlarged her legs to the size of small tree trunks. Organization, in press). These conditions have We don’t have access to confirmatory pulmo- a high prevalence in developing countries, but nary testing in Kenya, but she probably wouldn’t many lack internationally agreed-on standards survive a bronchoscopy anyway. of care. This deficit led to inconsistent and some- When she dies six hours later, we can be pret- times dangerous treatment approaches or lack of ty sure that it is her pulmonary Kaposi’s sarcoma, essential drugs. Critically, dermatologists were along with her underlying HIV, that killed her. involved at all levels of the guideline-develop- Her family tells us that she had dark spots on ment process, including Cochrane reviews of the her skin and swelling in her legs for more than literature, guideline development and review, a year before she presented to the hospital. Like and additional funding for the project from many of our patients in East Africa, she sought the International Foundation for Dermatology help from a traditional healer for many months (http://www.ifd.org). before turning to the biomedical health system, Although diseases such as Kaposi’s sarcoma only hours before her death.
    [Show full text]
  • THROMBOCYTOPENIA: OUTCOMES of VARICELLA in ADULTS 1Amber Arshad, 2Dr
    IAJPS 2018, 05 (12), 14370-14373 Amber Arshad et al ISSN 2349-7750 CODEN [USA]: IAJPBB ISSN: 2349-7750 INDO AMERICAN JOURNAL OF PHARMACEUTICAL SCIENCES http://doi.org/10.5281/zenodo.1976759 Available online at: http://www.iajps.com Research Article THROMBOCYTOPENIA: OUTCOMES OF VARICELLA IN ADULTS 1Amber Arshad, 2Dr. Shafia Masood, 3Dr. Zarwa Shahid 1FMH Collage of Medicine and Dentistry, Lahore-Pakistan 2Holy Family Hospital Rawalpindi 3House Officer, Jinnah Hospital Lahore Abstract: Objectives: The purpose of this research work is to elaborate the seriousness and rate of the low quantity of the platelets in the blood having relation with adult patients suffering of chickenpox. Methodology: This was a descriptive research work carried out in Mayo hospital Lahore and the duration of this research work was from January 2015 to March 2018 in the department of infectious diseases. In this study, record of the demographics, medical data, and blood & biochemical alterations created for each and every patient. The entry of this data carried out on a special organized form. Patients with previous background of CLD (chronic liver disease), drug addicts, HIV patients, blood abnormalities, or consumers of the wine were not the part of this research work. The count of the full blood with count of the platelet conducted with the help of an automated BCM (Beckman Coulter machine). The verification of the haematological results, the patients having low quantity of the platelet underwent PSE (peripheral smear examination). Results: One hundred and ten patients were the participant of this research work. The average age of the patients was 32.9 ± 9.7 years.
    [Show full text]
  • Melioidosis: an Emerging Infectious Disease
    Review Article www.jpgmonline.com Melioidosis: An emerging infectious disease Raja NS, Ahmed MZ,* Singh NN** Department of Medical ABSTRACT Microbiology, University of Malaya Medical Center, Kuala Lumpur, Infectious diseases account for a third of all the deaths in the developing world. Achievements in understanding Malaysia, *St. the basic microbiology, pathogenesis, host defenses and expanded epidemiology of infectious diseases have Bartholomew’s Hospital, resulted in better management and reduced mortality. However, an emerging infectious disease, melioidosis, West Smithfield, London, is becoming endemic in the tropical regions of the world and is spreading to non-endemic areas. This article UK and **School of highlights the current understanding of melioidosis including advances in diagnosis, treatment and prevention. Biosciences, Cardiff Better understanding of melioidosis is essential, as it is life-threatening and if untreated, patients can succumb University, Cardiff, UK to it. Our sources include a literature review, information from international consensus meetings on melioidosis Correspondence: and ongoing discussions within the medical and scientific community. N. S. Raja, E-mail: [email protected] Received : 21-2-2005 Review completed : 20-3-2005 Accepted : 30-5-2005 PubMed ID : 16006713 KEY WORDS: Melioidosis, Burkholderia pseudomallei, Infection J Postgrad Med 2005;51:140-5 he name melioidosis [also known as Whitmore dis- in returning travellers to Europe from endemic areas.[14] The T ease] is taken from the Greek word ‘melis’ meaning geographic area of the prevalence of the organism is bound to distemper of asses and ‘eidos’ meaning resembles glanders. increase as the awareness increases. Melioidosis is a zoonotic disease caused by Pseudomonas pseudomallei [now known as Burkholderia pseudomallei], a B.
    [Show full text]
  • Chronic Paronychia Refers to a Skin Condition, Which Occurs Around the Nails
    Robert E. Kalb, M.D. Buffalo Medical Group, P.C. Phone: (716) 630-1102 Fax: (716) 633-6507 Department of Dermatology 325 Essjay Road Williamsville, New York 14221 PARONYCHIA (CHRONIC) Chronic paronychia refers to a skin condition, which occurs around the nails. The term chronic means that the condition can come and go over time. The word paronychia is a fancy medical term referring to the inflammation, redness and swelling that can occur around the nails. Chronic paronychia occurs most commonly in people whose hands are in a wet environment, for example nurses, bartenders, dishwashers and hairdressers. Repeated cuts and minor trauma of the skin can damage the area around the nail and in the cuticle. This minor damage allows further irritation. There can be overgrowth of various surface germs, which slow the healing process. Symptoms of chronic paronychia include loss of the cuticle, tenderness, redness and swelling. Often the nails can appear changed with rough surfaces or grooves. Sometimes the area around the nail can be colonized with a normal bacteria or yeast on the skin. Because of this, one of the treatments that is often used is a medication, which has antibiotic properties against these types of organisms. In many cases, it is not an actual infection, but simply colonization on the surface of the skin, which impedes the healing. Treatment of chronic paronychia starts by avoiding any chronic irritation or wet environments. Wearing cotton-lined gloves to wash dishes can be helpful if this is an exposure. In most cases, topical medications are used. These often involve two different creams or two different liquids.
    [Show full text]
  • A Review of Cutaneous Manifestations in Newborn Infants
    Available online at www.scholarsresearchlibrary.com Scholars Research Library Der Pharmacia Lettre, 2017, 9[3]:1-8 [http://scholarsresearchlibrary.com/archive.html] ISSN 0975-5071 USA CODEN: DPLEB4 A Review of Cutaneous Manifestations in Newborn Infants Mohammad Ali Shakeri Hosseinabad* Ahvaz Jundishapur University of Medical Sciences, Resident of Dermatology, Ahvaz, Iran. *Corresponding author: Mohammad Ali Shakeri Hosseinabad, Ahvaz Jundishapur University of Medical Sciences, Resident of Dermatology, Ahvaz, Iran, Email: [email protected] _______________________________________________________ ABSTRACT Introduction: manifestations are very common in infants, and it can be a serious concern for parents, although most of them are benign and transient but some of them need further evaluation, accordingly knowledge about manifestations associated with infants can be an effective aid in the early diagnosis and treatment. The range of skin disorders is very wide. Timely examination of the skin in infants and control them is a good indicator to maintain the health of babies. Material and method: The required information through searching key words like: cutaneous manifestations, rashes, cutaneous infections, neonatal acne, early diagnosis, by Google Scholar, PubMed, Scopus, Magiran, Sid and Irandoc [from 1990 to 2016] was done Which some relevant articles were found and examined. Among 82 articles only 19 papers were quite relevant to cutaneous rashes. Findings: The first review of articles associated with this disease and infection and cutaneous rashes among infants and early diagnosis make a great help in timely treatment. Conclusion: one of the common cutaneous diseases is rashes, which treatment of bacterial or viral rashes is depends on its cause. Since that time of the disease is limited, in many patients and people with mild symptoms, do not need treatment.
    [Show full text]
  • Wrestling Skin Condition Report Form
    IOWA HIGH SCHOOL ATHLETIC ASSOCIATION - WRESTLING SKIN CONDITION REPORT This is the only form a referee will accept as “current, written documentation” that a skin condition is NOT communicable. National Federation wrestling rules state, “If a participant is suspended by the referee or coach of having a communicable skin disease or any other condition that makes participation appear inadvisable, the coach shall provide current written documentation from an appropriate health-care professional, stating that the suspected disease or condition is not communicable and that the athlete’s participation would not be harmful to any opponent.” “COVERING A COMMUNICABLE CONDITION SHALL NOT BE CONSIDERED ACCEPTABLE AND DOES NOT MAKE THE WRESTLER ELIGIBLE TO PARTICIPATE.” This form must be presented to the referee, or opposing head coach, AT THE TIME OF WEIGH INS or the wrestler in question will not be allowed to compete. NFHS rule 4.2.5 states, “A contestant may have documentation from an appropriate health-care professional only, indicating a specific condi- tion such as a birthmark or other non-communicable skin conditions such as psoriasis and eczema, and that documentation is valid for the season. It is valid with the understanding that a chronic condition could become secondarily infected and may require re-evaluation. ________________________________________________ from ____________________________________ High School has Wrestler’s Name (Type or Print Legibly) High School Name (Type or Print Legibly) been examined by me for the following skin condition: ___________________________________________________________ Common name of skin condition here (Note: Wrestling coaches - the most common communicable wrestling skin conditions, and their medical names, are: boils - “furuncles” ; cold sores - “herpes simplex type-1”; impetigo - “pyoderma”; pink eye - “conjunctivitis”; ringworm - “tinea corporis”.) Mark the location(s) of the condition(s) on one of the sihlouettes below.
    [Show full text]
  • WO 2014/134709 Al 12 September 2014 (12.09.2014) P O P C T
    (12) INTERNATIONAL APPLICATION PUBLISHED UNDER THE PATENT COOPERATION TREATY (PCT) (19) World Intellectual Property Organization International Bureau (10) International Publication Number (43) International Publication Date WO 2014/134709 Al 12 September 2014 (12.09.2014) P O P C T (51) International Patent Classification: (81) Designated States (unless otherwise indicated, for every A61K 31/05 (2006.01) A61P 31/02 (2006.01) kind of national protection available): AE, AG, AL, AM, AO, AT, AU, AZ, BA, BB, BG, BH, BN, BR, BW, BY, (21) International Application Number: BZ, CA, CH, CL, CN, CO, CR, CU, CZ, DE, DK, DM, PCT/CA20 14/000 174 DO, DZ, EC, EE, EG, ES, FI, GB, GD, GE, GH, GM, GT, (22) International Filing Date: HN, HR, HU, ID, IL, IN, IR, IS, JP, KE, KG, KN, KP, KR, 4 March 2014 (04.03.2014) KZ, LA, LC, LK, LR, LS, LT, LU, LY, MA, MD, ME, MG, MK, MN, MW, MX, MY, MZ, NA, NG, NI, NO, NZ, (25) Filing Language: English OM, PA, PE, PG, PH, PL, PT, QA, RO, RS, RU, RW, SA, (26) Publication Language: English SC, SD, SE, SG, SK, SL, SM, ST, SV, SY, TH, TJ, TM, TN, TR, TT, TZ, UA, UG, US, UZ, VC, VN, ZA, ZM, (30) Priority Data: ZW. 13/790,91 1 8 March 2013 (08.03.2013) US (84) Designated States (unless otherwise indicated, for every (71) Applicant: LABORATOIRE M2 [CA/CA]; 4005-A, rue kind of regional protection available): ARIPO (BW, GH, de la Garlock, Sherbrooke, Quebec J1L 1W9 (CA). GM, KE, LR, LS, MW, MZ, NA, RW, SD, SL, SZ, TZ, UG, ZM, ZW), Eurasian (AM, AZ, BY, KG, KZ, RU, TJ, (72) Inventors: LEMIRE, Gaetan; 6505, rue de la fougere, TM), European (AL, AT, BE, BG, CH, CY, CZ, DE, DK, Sherbrooke, Quebec JIN 3W3 (CA).
    [Show full text]
  • Rheumatic Manifestations of Bartonella Infection in 2 Children MOHAMMAD J
    Case Report Rheumatic Manifestations of Bartonella Infection in 2 Children MOHAMMAD J. AL-MATAR, ROSS E. PETTY, DAVID A. CABRAL, LORI B. TUCKER, BANAFSHI PEYVANDI, JULIE PRENDIVILLE, JACK FORBES, ROBYN CAIRNS, and RALPH ROTHSTEIN ABSTRACT. We describe 2 patients with very unusual rheumatological presentations presumably caused by Bartonella infection: one had myositis of proximal thigh muscles bilaterally, and the other had arthritis and skin nodules. Both patients had very high levels of antibody to Bartonella that decreased in asso- ciation with clinical improvement. Bartonella infection should be considered in the differential diag- nosis of unusual myositis or arthritis in children. (J Rheumatol 2002;29:184–6) Key Indexing Terms: MYOSITIS ARTHRITIS BARTONELLA Infection with Bartonella species has a wide range of mani- was slightly increased at 9.86 IU/l (normal 4.51–9.16), and IgA was 2.1 IU/l festations in children including cat scratch disease (regional (normal 0.2–1.0). C3 was 0.11 g/l (normal 0.77–1.43) and C4 was 0.28 (nor- mal 0.07–0.40). Antinuclear antibodies were present at a titer of 1:40, the anti- granulomatous lymphadenitis), bacillary angiomatosis, streptolysin O titer was 35 (normal < 200), and the anti-DNAase B titer was encephalitis, Parinaud’s oculoglandular syndrome, Trench 1:85 (normal). Urinalysis showed 50–100 erythrocytes and 5–10 leukocytes fever (Vincent’s angina), osteomyelitis, granulomatous per high power field. Routine cultures of urine, blood, and throat were nega- hepatitis, splenitis, pneumonitis, endocarditis, and fever of tive. Liver enzymes, electrolytes, HIV serology, cerebrospinal fluid analysis, unknown origin1-3.
    [Show full text]
  • Metronidazole Induced Aphthous Ulcer with Angular Cheilitis
    Pharmacy & Pharmacology International Journal Case Report Open Access Metronidazole induced aphthous ulcer with angular cheilitis Abstract Volume 4 Issue 3 - 2016 Metronidazole is an antiprotozoal drug, which has broad spectrum cidal activity Aruna Bhushan,1 Ved Bhushan ST2 against anaerobic protozoa and microaerophillic bacteria. Aphthous ulcer is a very 1Associate Professor, Department of Pharmacology, India rare side effect with metronidazole. Here we report a case of 55 year old male suffered 2Professor of Surgery, KLE- Centrinary Charitable Hospital, from metronidazole induced aphthous ulcer with angular cheilitis. India metronidazole, adrs, cheilites Keywords: Correspondence: Aruna Bhushan, Associate Professor, Department of Pharmacology, BIMS, Karnataka, India, Tel 9480538661, Email [email protected] Received: April 04, 2016 | Published: April 19, 2016 Introduction complex and Anti histaminic CPM (chlorpheniramine maleate 10mg tablets) twice daily was started. Patient was also prescribed topical Metronidazole, chemically a nitroimidazole is an antiprotozoal anesthetics Zytee (choline salicylate and benzalkonium chloride drug, which has broad spectrum cidal activity against anaerobic solution 10ml gel) small quantity to be applied on affected area twice protozoa, anaerobic and microaerophillic bacteria. It was introduced daily. in 1959 for trichomoniasis, and later found to be highly active amoebicide. Metronidazole after entering the cell by diffusion, its The patient gradually and progressively improved within 5-7days nitro group is reduced by certain redox proteins to a highly reactive lesions resolved within 7-10days and completely recovered in 2weeks. nitro radical, which acts as an electron sink competes with the biological electron acceptors generated by cell mitochondria and Discussion hence interferes with energy metabolism. The drug is completely Metronidazole is a frequently prescribed drug for amoebiasis, absorbed orally, metabolized in liver followed by renal excretion.
    [Show full text]
  • WHO GUIDELINES for the Treatment of Treponema Pallidum (Syphilis)
    WHO GUIDELINES FOR THE Treatment of Treponema pallidum (syphilis) WHO GUIDELINES FOR THE Treatment of Treponema pallidum (syphilis) WHO Library Cataloguing-in-Publication Data WHO guidelines for the treatment of Treponema pallidum (syphilis). Contents: Web annex D: Evidence profiles and evidence-to-decision frameworks - Web annex E: Systematic reviews for syphilis guidelines - Web annex F: Summary of conflicts of interest 1.Syphilis – drug therapy. 2.Treponema pallidum. 3.Sexually Transmitted Diseases. 4.Guideline. I.World Health Organization. ISBN 978 92 4 154980 6 (NLM classification: WC 170) © World Health Organization 2016 All rights reserved. Publications of the World Health Organization are available on the WHO website (http://www.who.int) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; email: [email protected]). Requests for permission to reproduce or translate WHO publications – whether for sale or for non-commercial distribution– should be addressed to WHO Press through the WHO website (http://www.who.int/about/licensing/ copyright_form/index.html). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned.
    [Show full text]
  • Dermatologic Conditions Educational Format Faculty Expertise Required Expertise in the Field of Study
    2019 AAFP FMX Needs Assessment Body System: Integumentary Session Topic: Dermatologic Conditions Educational Format Faculty Expertise Required Expertise in the field of study. Experience teaching in the field of study is desired. Preferred experience with audience Interactive REQUIRED response systems (ARS). Utilizing polling questions and Lecture engaging the learners in Q&A during the final 15 minutes of the session are required. Expertise teaching highly interactive, small group learning environments. Case-based, with experience developing and Problem- teaching case scenarios for simulation labs preferred. Other Based workshop-oriented designs may be accommodated. A typical OPTIONAL Learning PBL room is set for 50-100 participants, with 7-8 each per (PBL) round table. Please describe your interest and plan for teaching a PBL on your proposal form. Learning Objective(s) that will close Outcome Being Professional Practice Gap the gap and meet the need Measured Physicians have knowledge 1. Evaluate the presented skin condition Learners will gaps with regard to and determine differential diagnosis submit written diagnosing and evaluating and the need for further testing or commitment to common skin diseases (e.g. referral. change statements acne, dermatitis, rosacea). 2. Counsel patients on lifestyle on the session Primary care physicians modifications and proper skin care to evaluation, often receive inadequate control flare-ups and avoid outbreaks. indicating how dermatology training in 3. Create a disease management strategy they plan to medical school and for patients with a diagnosed implement residency. dermatologic condition based on the presented practice Patients with skin disease type and severity of the condition. recommendations. often have misconceptions 4.
    [Show full text]
  • Cutaneous Manifestations of Newborns in Omdurman Maternity Hospital
    ﺑﺴﻢ اﷲ اﻟﺮﺣﻤﻦ اﻟﺮﺣﻴﻢ Cutaneous Manifestations of Newborns in Omdurman Maternity Hospital A thesis submitted in the partial fulfillment of the degree of clinical MD in pediatrics and child health University of Khartoum By DR. AMNA ABDEL KHALIG MOHAMED ATTAR MBBS University of Khartoum Supervisor PROF. SALAH AHMED IBRAHIM MD, FRCP, FRCPCH Department of Pediatrics and Child Health University of Khartoum University of Khartoum The Graduate College Medical and Health Studies Board 2008 Dedication I dedicate my study to the Department of Pediatrics University of Khartoum hoping to be a true addition to neonatal care practice in Sudan. i Acknowledgment I would like to express my gratitude to my supervisor Prof. Salah Ahmed Ibrahim, Professor of Peadiatric and Child Health, who encouraged me throughout the study and provided me with advice and support. I am also grateful to Dr. Osman Suleiman Al-Khalifa, the Dermatologist for his support at the start of the study. Special thanks to the staff at Omdurman Maternity Hospital for their support. I am also grateful to all mothers and newborns without their participation and cooperation this study could not be possible. Love and appreciation to my family for their support, drive and kindness. ii Table of contents Dedication i Acknowledgement ii Table of contents iii English Abstract vii Arabic abstract ix List of abbreviations xi List of tables xiii List of figures xiv Chapter One: Introduction & Literature Review 1.1 The skin of NB 1 1.2 Traumatic lesions 5 1.3 Desquamation 8 1.4 Lanugo hair 9 1.5
    [Show full text]