History and Examination in Obstetrics and Gynaecology Obstetrics History - Detailed History and Examination For The Assessment of Mother and Fetus, Identify Risk Factors in Them and Plan Management
By Dr: Murtada Abubaker Physician Contents Virology and immunology Pathophysiology Epidemiology Transmission Clinical phases of HIV infection Diagnosis / Investigations Management (prevention &treatment ) Complications Virology and immunology
HIV virus is RNA virus belong to retrovirus
group . HIV virus divided into HIV1 and HIV2 HIV1 responsible for most HIV infections HIV2 cause similar illness,but longer latent period . Pathophysiology of HIV infection Once HIV infect a human it attaches to and enter immune cells that have CD4 protein on their surface ,mainly CD4 T-lymphocyte and macrophages . With in this cells the virus replicate using reverse transcriptase and protease enzymes ,producing billion of new virions .these are released and in turn infect new CD4 +ve cells depletion or impaired functions of CD4 +ve cells . Epidemiology The first AIDS case were recognized in USA in 1981 . Estimated that to date more than 25 million people have died as a result of HIV infection worldwide . Africa has 25% of world disease burden. Use of antiviral decrease the infectivity by 96%. Transmission Potentially infectious body fluids are (Blood ,Serous effusions ,Cerebrospinal Fluid, Semen , Vaginal fluids and Breast milk.) Non-infectious fluids unless they are contaminated with blood e.g Urine , Saliva and Vomitus . Transmission continue... The main routes of HIV transmission are : 1- unprotected sexual intercourse 2-Mother to child (during pregnancy , during delivery and breast feeding) 3- Receipt of infected blood products 4- injections or treatment with unsterile needles ,syringes or surgical apparatus. Needle stick injuries. Clinical phases of HIV infection
Primary infection (serocoversion)
occur 2-6 weeks after exposure to HIV infection . Patient may developed transient fever , malaise , myalgia , pharyngitis , maculopapular rash or meningoencephalitis . Asymptomatic infection but about 30% have persistent generalized lymphadenopathy (PGL). Defined as lymph node more than 1cm diameter at 2 extra inguinal sites Persistent for 3 months or longer. AIDS related complex : these a collection of symptoms and signs of fever , night sweat ,diarrhoea , weight loss ,minor opportunistic infections e.g oral candid , oral hairy leucoplakia ,herpes zoster, recurrent herpes simplex and Tinea infection . Diagnosis Serum HIV by ELISA test confirmed by western blot PCR for HIV RNA or core P24 antigen in plasma . Ora Quick ADVANCE test ; use oral fluid Prevention
Blood screening before donation
use of disposable syringes and equipment Use of antiviral in antenatal for HIV +ve lady . Post exposure prophylaxis. Raising the awareness of population towards the HIV risk . Treatment Supportive treatment( antipyretic if febrile , correct anaemia ,treat concomitant infection , iv fluid if dehydrated ) Specific treatment . Anti retroviral drugs if indicated . Complications CNS : cerebral toxoplasmosis , lymphoma , tuberculoma ,HIV leukoencephalopathy . Eye : CMV retinitis Respiratory system : Tuberculosis , Pneumocyst carrnii pneumonia (pneumocystitis jovercies) Complications continue
GIT : oral and oesophageal candidiasis ,
weight loss , hepatomegally , chronic diarrhoea . Kidney : HIV nephropathy Skin : Kaposi sarcoma
History and Examination in Obstetrics and Gynaecology Obstetrics History - Detailed History and Examination For The Assessment of Mother and Fetus, Identify Risk Factors in Them and Plan Management