Гипертиреоз – Hypertheriosis

Pubic pediculosis is due to infestation with the crab louse Phthirus pubis. The adult louse is blue-grey or reddish brown depending on how much blood it contains. It measures 1 to 2 mm diameter and is just visible to the naked eye. Eggs (nits) are in chitin sacs firmly attached to the base of single hairs. Although infestation may spread to other hairy parts of the body except the scalp, it usually involves only pubic and perianal hair. Although this is usually a sexually transmitted infestation, it may be acquired from contaminated toilet seats, towels, underclothing or bedding. Ordinary laundering is sufficient to disinfest clothing and bed linen.

Clinical manifestations

Symptoms may. develop after a period ranging from a few days to several weeks. The louse feeds by sucking blood; the bites may cause intense irritation followed by secondary infection or eczematous changes. The patient may present with black specks on underpants. Many patients are asymptomatic.

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Group III — Persistent generalised lymphadenopathy (PGL) Patients with PGL alone are classified as Group III. PGL is defined as palpable lymphadenopathy (>1 cm) at two or more extrainguinal sites, persisting for more than 3 months. The lymph node groups most commonly enlarged are the anterior and posterior cervical and axillary groups.

Group IV — Other HIV disease

This group includes patients with clinical features of HIV infection other than or in addition to PGL. This group includes cases of AIDS as originally defined for surveillance purposes and cases of AIDS related complex.

Group IV patients are assigned to subgroups A to E which are not mutually exclusive. The subgroups are:

Subgroup A — Constitutional disease

AIDS related complex (ARC) or slim disease — defined as an illness of greater than one month duration characterised by one or more of: fever, night sweats, weight loss greater than 10% of baseline body weight, or diarrhoea.

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The causes of biological false positive reagin (non-treponemal) tests are:

Acute (persisting less than 6 months): acute viral febrile illness (e.g. infectious mononucleosis, viral pneumonia, hepatitis); and pregnancy.

Chronic (persisting six months or more): intravenous drug abuse; autoimmune disease — positive serology may predate the disease (e.g. disseminated lupus erythematosis, rheumatoid arthritis, thyroiditis); malaria; and lepromatous leprosy.

The diagnosis of congenital syphilis is mainly dependent on serology.

Negative serology in the presence of Tpallidum infection may occur in: very early infection; and immunodeficiency following HIV infectioa CSF examination includes white cell count, total protein and VDRL or RPR. Raised lymphocyte count, raised total protein and positive reagin test in the CSF is indicative of neurosyphilis. CSF examination is indicated: where there are symptoms or signs of CNS disease in the presence of positive serological tests for syphilis;

before retreating a patient who has had relapse, treatment failure or reinfection after any form of treatment; in any patient who has been treated with non-penicillin regimens; where late or latent syphilis has been discovered and the period of latency cannot be determined or is in excess of 2 years; or before treatment with benzathine penicillin except in early disease.

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Antibiotics effective against gram negative or anaerobic bacilli are used when PID complicates delivery, abortion or gynaecological procedure or if these organisms complicate gonococcal or chlamydial PID. Various combinations of a penicillin, tetracycline, clindamycin, an imidazole (metronidazole, tinidazole or omidazole) or other agents will be used depending upon the circumstances of each particular case.

In an acute case, the failure to respond to antibiotic treatment in 24 to 48 hours may indicate a mistaken diagnosis (appendicitis, ectopic pregnancy), pus in the pouch of Douglas or tubo-ovarian abscess and surgical intervention may be necessary. Salpingectomy or salpingo-oophorectomy is indicated for tubal or tubo-ovarian abscess. Unless the life of the patient is endangered, trial of antibiotic therapy should be considered if the diagnosis is in doubt

Women with PID should be regularly reviewed to detect reinfections or relapses in an attempt to prevent long term sequelae such as tubal damage leading to ectopic pregnancy or infertility, recurrent pelvic pain, menstrual irregularities and depression.

Male partners of women with PID should be examined and treated if indicated as they often have gonococcal or chlamydial urethral infections.

In 1988, NHMRC approved the publication of a working party report on pelvic inflammatory disease.

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Where an STD exists or is suspected, it is likely that the patient will be embarrassed, fearful, or guilt-ridden. Patients may be less than frank about their sexual activities. Some patients concerned that their sexual behaviour or that of a partner has exposed them to risk may be unable to verbalise that concern. The patient may be belligerent and uncooperative. A patient presenting as the contact of a known case may be upset, angry or disbelieving and may direct these feelings at the practitioner.

The history of the patient’s present symptoms, sexual history and past medical history are important.

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