说明精讲录音review46std cns

ualTransmittedInfectiousDiseaseinNeurologicalualTransmittedVaginalinfections:bacterical,trichomonas,GonorrheaandSTDswithgenitallesions:syphilis,herpes,chancre,Others:HIV,HBV,HIV&opportunisticinfectiousLunginfection: CMV,mycobacteriumaviumCNSinfection:GIinfection:CMV,HSV,HIVInfectiousDiseasesinneurologicalBacterial:neisseriameningtidis,hemophilusinfluenzae,streptococcusp oniae,GroupBstreptococcus,E.Coli,listeriaViral:TubercolousInfectiousCandidaalbicansinfection/vaginosis(白Whiteshaginaldischarge,KOHwetpreparetolookforpseudo-TrichomonasGreenishvaginaldischarge,extremelyWetpreparetolookforBacterialvaginosis(臭Fishysmell(腥臭Wetpreparetolookfor“clueGardnerellaNeisseria,G-cocci.NomaltoseUrethritis,bartholin’sglandswelling, torydisease,septicTreatmentceftriaxone(过血脑屏障Obligatedintracelluarorgansim,noATPTreatment:macrolidesorReiter’ssyndromearthritis(反应性NoNopee,nosee,noclimbGranuloma肉芽肿肉芽肿荚膜杆菌引CalymmatobacteriumApainless,beefyrednoduleslowlyenlarges,inganelevated,velvety,malodorous,granulating,ulcerated Primarylesionisa5-to8-mm,soft,red,painlesserosionorulcer,healsspontaneouslyinafewdaysThesecondarystagebegins2to6weekslaterandischaracterizedbytheappearanceoftender,inguinaladenoapthy.ThelatestageofLVischaracterizedbyanogenitalstricturesinuntreatedorunder-treatedcasesChancroidChancroid（softHemophilus（docry，疼得直哭疼的Painful,undermined,opensorewithgray-yellow,necrotic,“dirty”base;usuallypaniedbyinguinal疼的CausedbyHemophilusSingle,rapid,painless,elevatedulcerationwitharedareolaandrollededgeswithaflatbaseDarkfieldtest:forT.薄束：下肢深薄束：下肢深楔束：上肢深GranulomaHerpessimplex

HemophilusChlamydia ,withGranulomaHerpessimplex

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Painlessgenital

painlessinguinal

HerpessimplexII

HBV&HBVliveabscess,livecancer结节性动脉炎，HCV:commoninivdrugabuser,combinedwithHIV Screening:ELISA,confirmativeWesternSNSNoW:SouthernNorthernWesternDRoP:DNA HighriskIvdrugual Co-CCR5(early)orCXCR4(late)andCD4onTcellsCCR5andCD4HomozygousCCR5HeterozygousCCR5mutation:slowertherapeutictargets)FunctionofCD4+T

IL-1SecretedByMΦ“HotT-bonestEAK”:IL-1:fever(hot).IL-2:stimulatesTcells.IL-3:stimulatesboneIL-4:stimulatesIgEIL-5:stimulatesIgAIL-6:stimulatesaKute-phaseproteinCD4T

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IL-12,Th1,IL-2,IFN-IL-4,Th2,IL-4,IL-5,IL-Screeningtest:Confirmativetest:WesternMonitortheeffectofdrugtherapy:viralloadCD4+<200(>200HIV+HIV+withAIDSindicatorcondition(eg.CD4/CD8 治疗目的：治疗目的：↓Viralload,↑44y,M,HIV+,fever&coughfor3d.rayshowsdiffuseintestinalchange

Chest ocystic Drycough,interstitial onia,CD4+cellcount:200-SliverAntibiotics:SMZ-SymptomsandsignsaresimilartoPCPlungThickAntibiotics:amphotericinToSymptomsandsignsaresimilartoPCPOwleyeAntibiotics:MycobacteriumAviumFever,drycough,nightsweat,noduleonPPD(-Prophylaxis:44y,M,HIV+,headachefor1w.CerebralMRIshowsringenhancement,CD460ringring周围 Fromcatfeces&pork,reactivationwhenCD4<100,brainabscess,focalneurologicaldefect.Ring-enhancementlesioninCTscan.Antibiotics:sulfadiazine+pyrimethamine+Ifpoorresponsein2w→CNSlymphomashouldbe 44y,FHIVdiarrheafor3wBloodyCommoncuase:E.HEC，E.IEC,Shigella,Salmonella,Campylobacter(mostcommon),Yersinia,Clodtridiumdifficile,entamoeba moncause:CMV(multipleshallowulcer,owl`seyecellEBV(multipledeepulcergiantnuclearcell),Kaposia(HSV-8,紫色突起)WateryCD4countsCD4:50-

TB;VZV; Herpssimplex;

nia;arthralgia;Oralhairy wastingHIV-CD4<50CMVcryptococcusMAC(鸟分支杆菌 CD4<100:histo smosis,Toxo candidalesophagitisCD4<200 PCP,

AdultTcell

Tax活化

Lliver

Liver

Hbx灭活

CervixCA.AngoenitalOropharynix

E6灭活E7灭活

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灭活

BurkittlymphomaNasopharyngealcarcinomaCNSprimarylymohoma

刺激Highlyactiveantiretroviral↓totalburdenofMaintainsfunctionofimmunoPreventopportunisticinfectionswhichleadtoInitiatedwhenpresentingAIDS-defindingillness,CD4counts(<500),or 3drugsto2nucleosidereversetranscriptaseinhibitors(NRTIs)+1non-nucleosidereversetranscriptaseinhibitor(NNRTI)OR1proteaseinhibitOR1integeaseinhibitorBindviralgp41NucleosidereversetranscriptaseZidovudine,didanosine,zalcitazbine,stavudine,lamibudine,abacavir ogue.BlockSideeffectismainlyduetomitochondriatoxicity:peripheralneuropathy,cardiomyopathy,diabetes,lacticacidosis,BMsuppressionNon-Nucleosidereverse 滴蜡InhibitsHIVgenomeintegrationintohostcellchromosomebyreversiblyinhibitingHIVintegrase.Amprenavir,nelfinavir,Indinavir,Lopinavir,Ritonavir,SaquinavirBlockprotease,thuspreventproperviralproteinsplicingHyperglycemia(常考GIintolerancenausea,diarrhea),lipodystrophy,thrombocytopenia药Zidovudine,didanosine,名zalcitazbine,stavudine,lamibudine,abacavir药 理Block副总：线粒体毒性作周围N病(常考)用心肌病胰腺炎乳酸

Amprenavir,nelfinavir,Indinavir,Lopinavir,Ritonavir,SaquinavirBlockproteasepreventproperviralproteinsplicingHyperglycemia,GIintolerance(nausea,pathy,hematuria

Lumberpuncturefinding:↑WBC(>500),neutrophildominant,↓glucose,↑proteinPathogenofbacterialStreptococcus GroupBS. NeisseriaListeria李大GB（Listeriamonocytogenesis（胞内菌，难染色GroupBstreptococcus（产道常见。如存在，出NeisseriaMostcommonin2-18y,communityacquired,outbreakdisease,skinrash(渗血,不褪色),adrenalcrisis(persistenthypotensiondespiteadequatefluid HighlyG-,diplococciinListeriaCommoninneonateor>70 promiseds.FormingsmallG+rods,intracellular,infectthoseTcell Mostcommonin18-70y,communityG+,diplococciinGroupBMostcommonneonatalCNSAcquiredfrombirth2ndmostcommonneonatalCNSinfectionoracuqiredCNSG-rodsinCeftriaxone(forG-)ycin(forpenicillinresistantp IfListeria ed,addSteroidis细细菌性脑膜炎→渗出→交通LPfindings:↑WBC(100-500),lymphocytedominant,normalglucose,↑protein.RBCmayHerpes HerpesProfoundalteredmentalstatus.TemporallobeRBCinAntibiotics:ganciclovir.Ifresist