DOCSLIB.ORG

Occurrence of Rectal Gonorrhoea and Chlamydia and Antibiotic Susceptibility Profile Among Men Who Have Sex with Men at the Kenyan Coast

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Occurrence of Rectal Gonorrhoea and Chlamydia and Antibiotic Susceptibility Profile Among Men Who Have Sex with Men at the Kenyan Coast i OCCURRENCE OF RECTAL GONORRHOEA AND CHLAMYDIA AND ANTIBIOTIC SUSCEPTIBILITY PROFILE AMONG MEN WHO HAVE SEX WITH MEN AT THE KENYAN COAST CAROLINE JUMWA NGETSA (BSC) P150/CE/25905/2014 A RESEARCH THESIS SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE AWARD OF THE DEGREE OF MASTER OF SCIENCE (INFECTIOUS DISEASES) IN THE SCHOOL OF MEDICINE OF KENYATTA UNIVERSITY OCTOBER, 2018 ii DECLARATION iii DEDICATION I dedicate this work to my family; loving husband Oscar, wonderful sons Lloyd and Hans and my lovely daughter Stacey. For your patience and love during this worthy course, God bless you! iv ACKNOWLEDGEMENT Firstly, I would like to thank God for his goodness and mercy in granting me the strength to finish this worthy course in my life. I am deeply indebted to my supervisors Dr. Margaret Muturi and Dr. Nelson Menza both of Department of Medical Laboratory Sciences, Kenyatta University, without their guidance, support, good nature and patience I would not have made it this far. The doors to their offices remained open all the times when I had trouble with this write up. My gratitude also goes to my mentor and project director, Prof. E. Sanders for his guidance, encouragement and recommendation to applying for the International Aids Vaccine Initiative (IAVI) Advance Degree Support scholarship. My special gratitude also goes to the IAVI for funding the project that culminated in to this thesis. To my colleagues; Peter Mugo, Amin Hassan and Simon Chengo, Eunice Nduati, Ian Oyaro and all IAVI project Kilifi staff big thank you for helping me in this write up and putting things into perspective in this world of science writing. My special gratitude goes to my laboratory colleagues John Mwambi, Clara Karani, Benedict Chengo and all Bacto staff in Microbiology department in helping with the hard and laborious laboratory work and tolerating my many times away from the laboratory. Finally, to my husband Oscar and kids your awesomeness in putting up with me during this very important time of my life. May Almighty God bless you all abundantly! v TABLE OF CONTENTS Title Page DECLARATION .......................................................................................................... ii DEDICATION ............................................................................................................. iii ACKNOWLEDGEMENT ........................................................................................... iv TABLE OF CONTENTS ...............................................................................................v LIST OF TABLES ..................................................................................................... viii LIST OF FIGURES ..................................................................................................... ix LIST OF APPENDICES ................................................................................................x ABBREVIATIONS AND ACRONYMS .................................................................... xi ABSTRACT ................................................................................................................ xii 1.0 INTRODUCTION..................................................................................................1 1.1 Background information .......................................................................................... 1 1.2 Problem Statement ................................................................................................... 2 1.3 Justification .............................................................................................................. 3 1.4 Research Questions .................................................................................................. 3 1.5 Objectives of Study .................................................................................................. 4 1.5.1 General Objective ................................................................................................. 4 1.5.2 Specific Objectives ............................................................................................... 4 1.6 Significance of the Study ......................................................................................... 5 2.0 LITERATURE REVIEW .....................................................................................6 2.1 Sexually Transmitted Infections .............................................................................. 6 2.2 Sexual Transmitted Infections among men who have sex with men ....................... 6 2.3 Asymptomatic gonorrhoea and chlamydia infections in men who have sex with men ........................................................................................................................ 7 2.3.1 Gonorrhoea Infection ............................................................................................ 7 2.3.2 Chlamydia Infection.............................................................................................. 8 2.4 Prevalence and occurrence of N. gonorrhoea and C. trachomatis ........................... 9 2.5 Rectal Cellular Changes during infection ................................................................ 9 2.6 Diagnosis of N. gonorrhoea and C. trachomatis .................................................... 10 2.6.1 Neisseria gonorrhoea.......................................................................................... 10 vi 2.6.2 Chlamydia trachomatis ....................................................................................... 11 2.7 Treatment of gonorrhoea and chlamydia ............................................................... 12 2.7.1 History................................................................................................................. 12 2.7.2 Presumptive treatment of gonorrhoea and chlamydia infections ........................ 14 2.8 Antibiotic resistance profiles of N. gonorrhoea .................................................... 14 3.0 MATERIALS AND METHODS ........................................................................16 3.1 Study Site ............................................................................................................... 16 3.2 Study Design .......................................................................................................... 16 3.3 Ethical Consideration ............................................................................................. 16 3.4 Sampling Technique .............................................................................................. 17 3.5 Study Population .................................................................................................... 17 3.5.1 Inclusion criteria ................................................................................................. 18 3.5.2 Exclusion criteria ................................................................................................ 18 3.6 Enrolment of Participants ...................................................................................... 18 3.7 Sample Size Determination.................................................................................... 18 3.8 Sample Collection .................................................................................................. 20 3.8.1 Rectal Swab ........................................................................................................ 20 3.8.2 Blood Collection ................................................................................................. 21 3.9 Laboratory Methods ............................................................................................... 21 3.9.1 Direct Smear for the detection of N. gonorrhoea ............................................... 21 3.9.2 Gene Xpert Chlamydia trachomatis / Neisseria gonorrhoea assay.................... 22 3.9.2.1 Assay Quality Control...................................................................................... 22 3.9.2.2 Assay Procedure ............................................................................................... 23 3.9.3 Culture .............................................................................................................. 23 3.9.3.1 Gram stain ........................................................................................................ 24 3.9.3.2 Oxidase test ...................................................................................................... 25 3.9.3.3 Catalase Test .................................................................................................... 25 3.9.3.4 Analytical Profile Index for Neisseria and Haemophilus ................................ 26 3.9.3.5 Antibiotic susceptibility Test ........................................................................... 26 3.9.4 HIV Test.............................................................................................................. 27 3.10 Data Analysis ....................................................................................................... 28 vii 4.0 RESULTS .............................................................................................................30 4.1 Demographic Characteristics of the Study Population .......................................... 30 4.1.1 Sexual Transmitted Infection risk characteristics of participants ....................... 32 4.1.2 Risk for sexual exposure ....................................................................................
Load more

Recommended publications
  • Nonbacterial Pus-Forming Diseases of the Skin Robert Jackson,* M.D., F.R.C.P[C], Ottawa, Ont
    Nonbacterial pus-forming diseases of the skin Robert Jackson,* m.d., f.r.c.p[c], Ottawa, Ont. Summary: The formation of pus as a Things are not always what they seem Fungus result of an inflammatory response Phaedrus to a bacterial infection is well known. North American blastomycosis, so- Not so well appreciated, however, The purpose of this article is to clarify called deep mycosis, can present with a is the fact that many other nonbacterial the clinical significance of the forma¬ verrucous proliferating and papilloma- agents such as certain fungi, viruses tion of pus in various skin diseases. tous plaque in which can be seen, par- and parasites may provoke pus Usually the presence of pus in or on formation in the skin. Also heat, the skin indicates a bacterial infection. Table I.Causes of nonbacterial topical applications, systemically However, by no means is this always pus-forming skin diseases administered drugs and some injected true. From a diagnostic and therapeutic Fungus materials can do likewise. Numerous point of view it is important that physi¬ skin diseases of unknown etiology cians be aware of the nonbacterial such as pustular acne vulgaris, causes of pus-forming skin diseases. North American blastomycosis pustular psoriasis and pustular A few definitions are required. Pus dermatitis herpetiformis can have is a yellowish [green]-white, opaque, lymphangitic sporotrichosis bacteriologically sterile pustules. The somewhat viscid matter (S.O.E.D.). Pus- cervicofacial actinomycosis importance of considering nonbacterial forming diseases are those in which Intermediate causes of pus-forming conditions of pus can be seen macroscopicaily.
    [Show full text]
  • Sexually Transmitted Diseases
    Sexually Transmitted Diseases by John H. Dirckx, M.D. significant proportion of the modern practice of adult using condoms and avoiding high-risk behaviors such as anal gynecology and urology is devoted to the prevention, intercourse—and by limiting the number of sex partners. Adiagnosis, and treatment of sexually transmitted dis- The overall incidence of sexually transmitted infections eases (STDs), because of both the high prevalence of these has increased substantially during the past generation, and diseases and their almost exclusive involvement of the repro- some diseases have shown a marked increase. Several factors ductive systems in both sexes. have contributed to these changing statistics. The discovery in A sexually transmitted disease is any infectious disease the 1940s that penicillin could cure syphilis and gonorrhea and that is transmitted from one person to another through sexual the development during the 1950s of safe and effective oral contact, taking that phrase in its broadest sense. Venereal dis- contraceptives paved the way for the sexual revolution of the ease (VD), a synonymous term, has now largely fallen out of 1960s. Against a background of civil unrest, widespread drug use, as has the euphemism social disease. It is worth empha- abuse, and radical feminism, that revolution led to social sizing that the only thing all STDs have in common is their acceptance of sexual promiscuity, popularization of oral and mode of transmission. In other respects they vary widely anal sex, and definition of overt homosexuality as normal among themselves. The common tendency to lump them all behavior. together yields a biologically invalid concept that invites con- Other factors favoring sexual promiscuity have been the fusion and misunderstanding.
    [Show full text]
  • Herpes: a Patient's Guide
    Herpes: A Patient’s Guide Herpes: A Patient’s Guide Introduction Herpes is a very common infection that is passed through HSV-1 and HSV-2: what’s in a name? ....................................................................3 skin-to-skin contact. Canadian studies have estimated that up to 89% of Canadians have been exposed to herpes simplex Herpes symptoms .........................................................................................................4 type 1 (HSV-1), which usually shows up as cold sores on the Herpes transmission: how do you get herpes? ................................................6 mouth. In a British Columbia study, about 15% of people tested positive for herpes simplex type 2 (HSV-2), which Herpes testing: when is it useful? ..........................................................................8 is the type of herpes most commonly thought of as genital herpes. Recently, HSV-1 has been showing up more and Herpes treatment: managing your symptoms ...................................................10 more on the genitals. Some people can have both types of What does herpes mean to you: receiving a new diagnosis ......................12 herpes. Most people have such minor symptoms that they don’t even know they have herpes. What does herpes mean to you: accepting your diagnosis ........................14 While herpes is very common, it also carries a lot of stigma. What does herpes mean to you: dating with herpes ....................................16 This stigma can lead to anxiety, fear and misinformation
    [Show full text]
  • Skin Disease and Disorders
    Sports Dermatology Robert Kiningham, MD, FACSM Department of Family Medicine University of Michigan Health System Disclosures/Conflicts of Interest ◼ None Goals and Objectives ◼ Review skin infections common in athletes ◼ Establish a logical treatment approach to skin infections ◼ Discuss ways to decrease the risk of athlete’s acquiring and spreading skin infections ◼ Discuss disqualification and return-to-play criteria for athletes with skin infections ◼ Recognize and treat non-infectious skin conditions in athletes Skin Infections in Athletes ◼ Bacterial ◼ Herpetic ◼ Fungal Skin Infections in Athletes ◼ Very common – most common cause of practice-loss time in wrestlers ◼ Athletes are susceptible because: – Prone to skin breakdown (abrasions, cuts) – Warm, moist environment – Close contacts Cases 1 -3 ◼ 21 year old male football player with 4 day h/o left axillary pain and tenderness. Two days ago he noticed a tender “bump” that is getting bigger and more tender. ◼ 16 year old football player with 3 day h/o mildly tender lesions on chin. Started as a single lesion, but now has “spread”. Over the past day the lesions have developed a dark yellowish crust. ◼ 19 year old wrestler with a 3 day h/o lesions on right side of face. Noticed “tingling” 4 days ago, small fluid filled lesions then appeared that have now started to crust over. Skin Infections Bacterial Skin Infections ◼ Cellulitis ◼ Erysipelas ◼ Impetigo ◼ Furunculosis ◼ Folliculitis ◼ Paronychea Cellulitis Cellulitis ◼ Diffuse infection of connective tissue with severe inflammation of dermal and subcutaneous layers of the skin – Triad of erythema, edema, and warmth in the absence of underlying foci ◼ S. aureus or S. pyogenes Erysipelas Erysipelas ◼ Superficial infection of the dermis ◼ Distinguished from cellulitis by the intracutaneous edema that produces palpable margins of the skin.
    [Show full text]
  • Pediatric Cutaneous Bacterial Infections Dr
    PEDIATRIC CUTANEOUS BACTERIAL INFECTIONS DR. PEARL C. KWONG MD PHD BOARD CERTIFIED PEDIATRIC DERMATOLOGIST JACKSONVILLE, FLORIDA DISCLOSURE • No relevant relationships PRETEST QUESTIONS • In Staph scalded skin syndrome: • A. The staph bacteria can be isolated from the nares , conjunctiva or the perianal area • B. The patients always have associated multiple system involvement including GI hepatic MSK renal and CNS • C. common in adults and adolescents • D. can also be caused by Pseudomonas aeruginosa • E. None of the above PRETEST QUESTIONS • Scarlet fever • A. should be treated with penicillins • B. should be treated with sulfa drugs • C. can lead to toxic shock syndrome • D. can be associated with pharyngitis or circumoral pallor • E. Both A and D are correct PRETEST QUESTIONS • Strep can be treated with the following antibiotics • A. Penicillin • B. First generation cephalosporin • C. clindamycin • D. Septra • E. A B or C • F. A and D only PRETEST QUESTIONS • MRSA • A. is only acquired via hospital • B. can be acquired in the community • C. is more aggressive than OSSA • D. needs treatment with first generation cephalosporin • E. A and C • F. B and C CUTANEOUS BACTERIAL PATHOGENS • Staphylococcus aureus: OSSA and MRSA • Gp A Streptococcus GABHS • Pseudomonas aeruginosa CUTANEOUS BACTERIAL INFECTIONS • Folliculitis • Non bullous Impetigo/Bullous Impetigo • Furuncle/Carbuncle/Abscess • Cellulitis • Acute Paronychia • Dactylitis • Erysipelas • Impetiginization of dermatoses BACTERIAL INFECTION • Important to diagnose early • Almost always
    [Show full text]
  • Impetigo Contagiosa the Association of Certain Types of Staphylococcus Aureus and of Streptococcus Pyogenes with Superficial Skin Infections by M
    [ 458 ] IMPETIGO CONTAGIOSA THE ASSOCIATION OF CERTAIN TYPES OF STAPHYLOCOCCUS AUREUS AND OF STREPTOCOCCUS PYOGENES WITH SUPERFICIAL SKIN INFECTIONS BY M. T. PARKER, Public Health Laboratory, Manchester A. J. H. TOMLINSON, Bacteriological Laboratory, County Hall, London AND R. E. 0. WILLIAMS, Streptococcus and Staphylococcus Reference Laboratory, Central Public Health Laboratory, Colindale Impetigo contagiosa may be defined as an acute, superficial infection of the skin characterized by exudation and crusting. In this country it is at present mainly seen in children, although it has been an important cause of minor illness among troops in wartime. It appears to have become much less common in the last 10 years, though a recent increase in incidence has been reported (Sneddon, 1953). In the 90 years since the original clinical description of Fox (1864) there appear to have been repeated fluctuations in the prevalence ofthe disease, and also differences in frequency, severity and predominant clinical type in different parts of the world. It is not surprising, therefore, that there have been great discrepancies between the bacteriological findings of various workers, and that the controversy between the supporters of the staphylococcal and the streptococcal theories of the aetiology ofthe diseasehas continued for almost 60 years. Most dermatologists nowrecognize the existence of at least two clinical types of impetigo, associated respectively with haemolytic streptococci and with Staphylococcus aureus, though it is not always possible to make such a clinical distinction in the individual case (Epstein, 1940). The investigation reported here falls into two parts, the first of which was carried out in association with Dr L.
    [Show full text]
  • Syndrome Definitions for Diseases Associated with Critical Bioterrorism-Associated Agents (Continued from Previous Page)
    Syndrome Definitions for Diseases Associated with Critical Bioterrorism-associated Agents (continued from previous page) Lesion ICD-9-CM Code List ICD9CM ICD9DESCR Consensus 020.0 PLAGUE, BUBONIC 1 020.1 CELLULOCUTANEOUS PLAGUE 1 021.0 ULCEROGLANDUL TULAREMIA 1 022.0 CUTANEOUS ANTHRAX 1 680.0 CARBUNCLE FACE 1 680.1 CARBUNCLE NECK 1 680.2 CARBUNCLE TRUNK 1 680.3 CARBUNCLE ARM 1 680.4 CARBUNCLE HAND 1 680.5 CARBUNCLE BUTTOCK 1 680.6 CARBUNCLE LEG 1 680.7 FURUNCLE FOOT, HEEL, TOE 1 680.8 FURUNCLE HEAD/SCALP EXCEP 1 707.11 ULCER OF THIGH 1 707.12 ULCER OF CALF 1 707.13 ULCER OF ANKLE 1 707.14 ULCER OF HEEL AND MIDFOOT 1 707.19 ULCER OF LOWER LIMB,OTHER 1 680.9 BOIL NOS 2 681.00 CELLULITIS FINGER, NOS 2 681.01 FELON 2 681.02 ONYCHIA/PARONYCHIA OF FIN 2 681.11 ONYCHIA/PARONYCHIA OF TOE 2 681.9 CELLULITIS DIGIT, NOS 2 682.0 CELLULITIS FACE 2 682.1 CELLULITIS NECK 2 682.2 CELLUL/ABSCESS-TRUNK/ABDO 2 682.3 CELLULITIS/ABSCESS ARM 2 682.4 CELLULITIS/ABSCESS HAND/W 2 682.5 CELLULITIS BUTTOCK 2 682.6 CELLULITIS LEG 2 682.7 CELLULITIS FOOT 2 682.8 ABSCESS/CELLULITIS-HEAD/S 2 682.9 CELLULITIS NOS 2 707.10 ULCER OF LOWER LIMB, UNSP 2 707.15 ULCER OF FOOT, OTHER PART 2 027.1 ERYSIPELOTHRIX INFECTION 3 054.6 HERPETIC WHITLOW 3 081.2 SCRUB TYPHUS 3 082.1 BOUTONNEUSE FEVER 3 082.2 NORTH ASIAN TICK FEVER 3 082.3 QUEENSLAND TICK TYPHUS 3 085.1 LEISHMANIASIS, CUTANEOUS, URBAN 3 October 23, 2003 Page 10 of 29 Syndrome Definitions for Diseases Associated with Critical Bioterrorism-associated Agents (continued from previous page) Lesion ICD-9-CM Code List, Cont’d
    [Show full text]
  • Herpetic Whitlow in a 39-Year-Old Woman
    PRACTICE | CLINICAL IMAGES Herpetic whitlow in a 39-year-old woman Arif Ismail MD, Wayne L. Gold MD n Cite as: CMAJ 2020 August 31;192:E1010. doi: 10.1503/cmaj.191732 previously healthy 39-year-old woman presented to the emergency depart- ment with a 9-day history of pain, erythemaA and blistering of the right thumb (Figure 1A) with lymphangitic streaking up the forearm. She reported that years earlier, she had had an episode of oral herpes sim- plex virus (HSV) infection, but no previous genital HSV infection. On the day of onset, she had left on a planned vacation. She sought medical attention upon arrival and received 2 courses of outpatient antimicrobial therapy for a presumed bacterial infection, without benefit. This prompted admission to hospital, where she underwent 2 surgical irri- gation and débridement procedures (Fig- ure 1B). The surgeons noted an absence of purulence. Bacterial cultures were negative, Figure 1: Right thumb of a 39-year-old woman with herpetic whitlow, (A) before the first inci- according to patient report. sion and drainage procedure, showing a blistering paronychia. (B) The same digit after the On return home (day 9 of illness), she second surgery and before antiviral therapy was begun. sought medical attention at our emergency References department for persistent pain and discolouration of the distal 1. Wu IB, Schwartz RA. Herpetic whitlow. Cutis 2007;79:193-6. digit. We made a presumptive diagnosis of herpetic whitlow and 2. Rubright JH, Shafritz AB. The herpetic whitlow. J Hand Surg Am 2011;36:340-2. confirmed it by a swab positive for HSV type 1 via polymerase 3.
    [Show full text]
  • Environmental Assessment Mammal Damage Management in Pennsylvania
    ENVIRONMENTAL ASSESSMENT MAMMAL DAMAGE MANAGEMENT IN PENNSYLVANIA Prepared By: UNITED STATES DEPARTMENT OF AGRICULTURE ANIMAL AND PLANT HEALTH INSPECTION SERVICE WILDLIFE SERVICES In Consultation With: PENNSYLVANIA GAME COMMISSION PENNSYLVANIA DEPARTMENT OF CONSERVATION AND NATURAL RESOURCES PENNSYLVANIA FISH AND BOAT COMMISSION UNITED STATES FISH AND WILDLIFE SERVICE December 2014 SUMMARY Pennsylvania’s wildlife has many positive values and is an important part of life in the state. However, as human populations expand, and land is used for human needs, there is increasing potential for conflicting human/wildlife interactions. This Environmental Assessment (EA) analyzes the potential environmental impacts of alternatives for United States Department of Agriculture, Animal and Plant Health Inspection Service, Wildlife Services (WS) involvement in the reduction of conflicts by mammals in Pennsylvania, including damage to property, agricultural and natural resources and risks to human and livestock health and safety. The proposed wildlife damage management activities could be conducted on public and private property in Pennsylvania when the property owner or manager requests assistance and/or when assistance is requested by an appropriate state, federal, tribal or local government agency. The preferred alternative considered in the EA, would be to continue and expand the current Integrated Wildlife Damage Management (IWDM) program in Pennsylvania. The IWDM strategy encompasses the use of practical and effective methods of preventing or reducing damage while minimizing harmful effects of damage management measures on humans, target and non-target species, and the environment. Under this action, WS could provide technical assistance and direct operational assistance including non- lethal and lethal management methods, as described in the WS Decision Model (Slate et al.
    [Show full text]
  • RASH in INFECTIOUS DISEASES of CHILDREN Andrew Bonwit, M.D
    RASH IN INFECTIOUS DISEASES OF CHILDREN Andrew Bonwit, M.D. Infectious Diseases Department of Pediatrics OBJECTIVES • Develop skills in observing and describing rashes • Recognize associations between rashes and serious diseases • Recognize rashes associated with benign conditions • Learn associations between rashes and contagious disease Descriptions • Rash • Petechiae • Exanthem • Purpura • Vesicle • Erythroderma • Bulla • Erythema • Macule • Enanthem • Papule • Eruption Period of infectivity in relation to presence of rash • VZV incubates 10 – 21 days (to 28 d if VZIG is given • Contagious from 24 - 48° before rash to crusting of all lesions • Fifth disease (parvovirus B19 infection): clinical illness & contagiousness pre-rash • Rash follows appearance of IgG; no longer contagious when rash appears • Measles incubates 7 – 10 days • Contagious from 7 – 10 days post exposure, or 1 – 2 d pre-Sx, 3 – 5 d pre- rash; to 4th day after onset of rash Associated changes in integument • Enanthems • Measles, varicella, group A streptoccus • Mucosal hyperemia • Toxin-mediated bacterial infections • Conjunctivitis/conjunctival injection • Measles, adenovirus, Kawasaki disease, SJS, toxin-mediated bacterial disease Pathophysiology of rash: epidermal disruption • Vesicles: epidermal, clear fluid, < 5 mm • Varicella • HSV • Contact dermatitis • Bullae: epidermal, serous/seropurulent, > 5 mm • Bullous impetigo • Neonatal HSV • Bullous pemphigoid • Burns • Contact dermatitis • Stevens Johnson syndrome, Toxic Epidermal Necrolysis Bacterial causes of rash
    [Show full text]
  • The Blue Book: Guidelines for the Control of Infectious Diseases I
    The blue book: Guidelines for the control of infectious diseases i The blue book Guidelines for the control of infectious diseases ii The blue book: Guidelines for the control of infectious diseases Acknowledgements Disclaimer These guidelines have been developed These guidelines have been prepared by the Communicable Diseases Section, following consultation with experts in the Public Health Group. The Blue Book – field of infectious diseases and are based Guidelines for the control of infectious on information available at the time of diseases first edition (1996) was used as their preparation. the basis for this update. Practitioners should have regard to any We would like to acknowledge and thank information on these matters which may those who contributed to the become available subsequent to the development of the original guidelines preparation of these guidelines. including various past and present staff Neither the Department of Human of the Communicable Diseases Section. Services, Victoria, nor any person We would also like to acknowledge and associated with the preparation of these thank the following contributors for their guidelines accept any contractual, assistance: tortious or other liability whatsoever in A/Prof Heath Kelly, Victorian Infectious respect of their contents or any Diseases Reference Laboratory consequences arising from their use. Dr Noel Bennett, content editor While all advice and recommendations are made in good faith, neither the Dr Sally Murray, content editor Department of Human Services, Victoria, Ms Kerry Ann O’Grady, content editor nor any other person associated with the preparation of these guidelines accepts legal liability or responsibility for such advice or recommendations. Published by the Communicable Diseases Section Victorian Government Department of Human Services Melbourne Victoria May 2005 © Copyright State of Victoria, Department of Human Services 2005 This publication is copyright.
    [Show full text]
  • WHITLOW and ITS TREATMENT. [Talrjral 423 2
    FIB. 24, 19o6.] WHITLOW AND ITS TREATMENT. [TaLrJRAL 423 2. Oral Sepsis in Relation to the Oceurrence of, the subsequent occurrence !ofl- tonsillitis, of., adenitis, and Secondary An?yina.-In 60 per cenit. of. -tlle eases having especially has undo,ubtedly', ,itflueneed the, severity. qf this oral sepsis ill whichl complicationss occurird, the oral the complications afterwards.- sepsis was noted to be very severe. The last ease I 'have The.practical outcome,.irrespective of imere etatistical lescribed to you illustrates that very wel Here is imy. considerations as to, whetler oral. sepsis, .:d,oes or niote of it. Rashi, moderate; aniginia, moderate:; adenitis, does not influence scarlet fever, is. tbat it. is absolutely moderate. Yet the one fact noted in connexion with' that necessary -to remove ;even, the -chance of it doing so. is that there was the severest degree of oral sepsis, witlh Therefore it is .to me a; very impiortant duty, in all cases an ab§cess rounid onle of her teethl. Tle 'subsequeint' course of fever coming under mny care, to ,endeavour to,eliminate of thi§ case was the severest angina, thek sevlerest adentitis, this factor as far ;as possible. So,L;ddilnot wait to find out and the severest cellulitis. She also 'iad' vomiting, and wlhat it is goinig to do, but. I remo.ve it,., as I .should she had diarrhloea, denoting " septic gastritis " and " septic remove any other possible source of.. trouble, just as I enteritis," anld afterwards lhyperpyrexia occurred and should give the patient fresh air, good food, or see that he deatlh.
    [Show full text]