Escolar Documentos
Profissional Documentos
Cultura Documentos
February 8, 2008
CASE 3
R.R., 40 YEAR OLD MALE, WITH A
CHIEF COMPLAINT OF FEVER OF
1 DAY DURATION
HISTORY OF THE PRESENT
ILLNBESS(HPI) SHOWED THAT
THE FEVER WAS HIGH GRADE,
WITH BODY MALAISE AND CHILLS.
HE NOTED RASHES WHICH WERE
INITIALLY PINPOINT AND RED
THEN INCREASING IN SIZE, BUT
NON-PRURITIC. MOST OF THE
RASHES STARTED ON HIS BACK.
THERE IS A HISTORY OF TRAVEL
TO AN ARMY CAMP 3 DAYS AGO.
ON PHYSICAL EXAMINATION
BP 80/60mmHg
PR 90/MIN
T: 101 F
(+) NUCHAL RIGIDITY
MULTIPLE CONFLUENT
PURPURIC LESIONS ON HIS
BACK AND LEGS
CBC SHOWED LOW PLATELETS,
ELEVATED WBC
LUMBAR TAP SHOWED GRAM (-)
NEGATIVE DIPLOCOCCI IN THE
CSF
IMPRESSION:?
Neisseriaceae
Gram-negative coccus
0.6 to 1.0 µm in diameter
seen in pairs with adjacent flattened
sides(diplococci)
found intracellularly in
polymorphonuclear leukocytes
has fimbriae, which play a major role
in adherence, extend several
micrometers from the cell surface.
gonococci produces acid from
glucose only
N.gonorrhoea
susceptible to temperature changes,
drying, uv light
Media: hemoglobin, NAD, yeast
extract and other supplements are
needed for isolation and growth of the
organism
grown at 35-36 degrees in an
atmosphere of 3-10% added CO2.
Virulence factors
Pil E
major fimbrial protein
initial binding to epithelial cells
P.II (Opa)
outer membrane protein
contributes to invasion
Virulence factors
P.I (Por)outer membrane porin
may prevent phagolysosome
formation in neutrophils
reduce oxidative burst
LOS
outer membrane lipooligosaccharide
elicits inflammatory response
triggers release of TNF
Virulence factors
P.III (Rmp)
outer membrane protein
elicits formation of ineffective
antibodies that block that block
bactericidal antibodies against P.I
and LOS
PATHOGENESIS OF THE
INFECTION
Sexual contact
Microcolony;biofilm
Anterior urethritis
mucous membranes of the urethra
copious discharge of pus
more apparent in the male
generally limited to superficial
mucosal surfaces lined with columnar
epithelium
GONORRHEA
MALE
prostatitis
orchitis
FEMALES
salpingitis, with or without ovarian
involvement (ovaritis)
pelvic inflammatory disease (PID).
FALLOPIAN TUBE ABSCESS
INFERTILITY DUE TO PID
OTHER SITES OF INFECTION
Rectal infections (proctitis) in women
one-third of women with cervical
infection
autoinoculation with cervical discharge
rarely symptomatic
Rectal infections in homosexual men
anal intercourse
often symptomatic
treat partners
PROCTITIS
OTHER SITES OF INFECTION
Ocular infections
corneal scarring
perforation
ophthalmia neonatorum
silver nitrate or an antibiotic to the
newborns
OPHTHALMIA NEONATORUM
GONORRHEAL CONJUNCTIVITIS
TREATMENT
third-generation cephalosporin or a
fluoroquinolone
antibiotic for Chlamydia trachomatis:
doxycycline
Sex partners should be referred and
treated
resistant strains: ceftriaxone,
cefixime, ciprofloxacin, or oflaxacin
UNCOMPLICATED GONORRHEA
Endotoxin
Cytokines
free radicals
damage the vascular endothelium
producing platelet deposition
vasculitis.
SIGNS AND SYMPTOMS
INFANTS
onset: abrupt or insidious
rare signs of meningeal irritation
Irritability and refusal to take food
vomiting; dehydration
fever is typically absent in children less
than 2 months old
hypothermia is more common
s/s in infants
latter stages
apnea
seizures
disturbances in motor tone
coma
OLDER CHILDREN/ADULTS
Pulmonary insufficiency
death within 24 hours of being
hospitalized despite appropriate
antibiotic therapy and intensive care.
BILATERAL ADRENAL HEMORRHAGE:
WATERHOUSE-FREIDRICHSEN
SYNDROME
LAB EXAMS
Amputation
Pericardiocentesis may be required if
pericarditis is complicated by
tamponade.
TREATMENT OF CONTACTS