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1
Wootten, Andrea Elizabeth. Evaluation of immune activation in hospitalised elderly patients with asymptomatic and symptomatic infection using urinary neopterin measurements. [Guildford]: University of Surrey, 1996.
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2
Holland, Paul V. The Human immunodeficiency virus and the spectrum of its infection: From asymptomatic antibody positive state toAcquired Immunodeficiency Syndrome (AIDS). Saluggia (Vercelli): Sorin Biomedica, 1986.
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3
Bowker, Lesley K., James D. Price, Ku Shah, and Sarah C. Smith. Infection and immunity. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198738381.003.0024.
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This chapter provides information on the ageing immune system, an overview of infection in older people, antibiotic use in older patients, meticillin-resistant Staphylococcus aureus (MRSA), disease caused by MRSA, Clostridium difficile-associated diarrhoea, near-patient urine tests, asymptomatic bacteriuria, urinary tract infection, treatment of urinary tract infection, recurrent urinary tract infection, and varicella-zoster infection.
4
Temesgen, Zelalem, and Mary J. Kasten. HIV Infection. Oxford University Press, 2012. http://dx.doi.org/10.1093/med/9780199755691.003.0357.
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Testing for HIV became available in the United States in 1985. Amazing gains in the understanding and treatment of HIV have been made during the past 25 years. HIV and other retroviruses cause a frequently symptomatic primary infection followed by a relatively asymptomatic period lasting months to years and a final stage of overt disease in most people. There are 2 types of HIV: HIV-1 and HIV-2. Most reported cases of HIV disease around the world are caused by HIV-1. HIV-2 is found predominantly in western Africa. Although HIV-1 and HIV-2 are clinically indistinguishable and have identical modes of transmission, HIV-2 appears to be less easily transmitted than HIV-1 and slower to progress to AIDS. Epidemiology, diagnosis, and treatment of HIV are also reviewed.
5
Natarajan, Pavithra, and Nick Beeching. Protozoal infection: Gut organisms. Edited by Patrick Davey and David Sprigings. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199568741.003.0316.
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Protozoa are single-celled (unicellular) eukaryotic organisms. There are many protozoa causing parasitic infection in humans. This chapter will concentrate on the three that most commonly causes gastrointestinal disease worldwide and have the biggest impact in the UK: Giardia lamblia, Cryptosporidium spp., and Entamoeba histolytica. These three infections are of great significance worldwide, but are less common in Western settings. In the UK, they tend to be seen in more commonly in travellers returning from endemic countries, migrant populations, men who have sex with men, and the immunocompromised. The clinical features of all three infections vary from asymptomatic small- or large-bowel carriage with passage of cysts to infect others, to more serious manifestations.
6
Sheerin, Neil. Urinary tract infection in the adult. Edited by Neil Sheerin. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199592548.003.0175.
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Infection of the urinary tract is one of the commonest human infections. It can vary in severity from asymptomatic colonization, through self-limiting but distressing lower tract infection, to life-threatening sepsis. Any site in the urinary tract can be affected. The site of infection determines the pattern of symptoms, but this is also influenced by the age at presentation. The age at presentation and the nature of symptoms will not only suggest a clinical diagnosis, but also guide investigation and treatment. This chapter acts as an introduction to others in this section which address the different presentations of infections of the lower and upper urinary tracts in adults.
7
Thomas, David F. M. Urinary tract infection in children. Edited by David F. M. Thomas. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199659579.003.0114.
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Urinary tract infection (UTI) is one of the commonest conditions of childhood, affecting an estimated 10% of girls and 3% of boys in the first 16 years of life. Whereas asymptomatic bacteriuria and low-grade lower tract infection pose little or no risk of renal damage, pyelonephritis can cause severe systemic illness and poses a significant threat of long-term renal morbidity. The principal aim of investigation is to identify underlying abnormalities of the urinary tract, notably vesicoureteric reflux. Guidelines on investigation and management published by the National Institute of Clinical Excellence will be reviewed in this chapter. Treatment of dysfunctional voiding and other features of ‘elimination syndrome’ plays an important role in the prevention of urinary tract infection in this age group.
8
Ali, Ased. Pathogenesis of urinary tract infection. Edited by Rob Pickard. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199659579.003.0001.
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The realization of the harms resulting from indiscriminate use of antibiotics for minor infection has added impetus to the need to understand better the interaction between urogenital tract epithelium and invading bacteria during the initial stages of urinary tract infection (UTI). It is thought that uropathogenic Escherichia coli clones develop in the gut and migrate across the perineum to the urethra and up into the bladder. The response of the epithelium to bacterial adherence and the evolution of the invading bacteria will then govern the clinical consequences. These can vary between rapid invasion and further migration to produce systemic sepsis to tolerance of the bacteria in a planktonic state in asymptomatic bacteriuria. The key to these differences is the activation of epithelial pathogen-associated molecular pattern receptors by expressed proteins on the bacterial cell wall. Increased understanding of these interactions will lead to non-antibiotic-based strategies for clinical management of urinary infection.
9
Bayston, Roger. Hospital-acquired urinary tract infection. Edited by Rob Pickard. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199659579.003.0003.
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Urinary tract infections (UTIs) account for the majority of hospital-acquired infections (HAI), and most of these occur in catheterized patients. However, for most the presence of bacteria in the urine (bacteriuria) is asymptomatic, yet in many institutional and national surveillance studies it is still attributed as ‘infection’. Although guidance is that only symptomatic UTI should be treated, except in pregnancy, bacteriuria in catheterized patients is frequently overinvestigated and antibiotics overused. Most infections are caused by enteric bacteria such as Escherichia coli, but other bacteria such as Proteus mirabilis and staphylococci are more prominent in HAI. Aseptic technique for catheter insertion and during subsequent catheter care together with minimizing catheter duration are very important to prevent catheter-associated UTI (CAUTI). Prophylactic antibiotics should be avoided. National and international action to adopt evidence-based consensus protocols for management of catheterized patients and judicial use of antimicrobial chemotherapy promise to be of greatest benefit.
10
Macintyre, Richard Charles. SEX, DRUGS AND T-CELLS: SYMBOLIC MEANINGS AMONG GAY MEN WITH ASYMPTOMATIC HIV INFECTION (IMMUNE DEFICIENCY). 1993.
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11
Anderson, Elizabeth H. STRESS, COGNITIVE APPRAISAL, COPING, AND ADAPTATIONAL OUTCOMES AMONG ASYMPTOMATIC PERSONS WITH HUMAN IMMUNODEFICIENCY VIRUS INFECTION (IMMUNE DEFICIENCY). 1992.
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12
Vigil, Karen J. Sexually Transmitted Diseases. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190493097.003.0044.
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Sexually transmitted diseases (STDs) are common in HIV-infected patients. Education and counseling on changes in sexual behaviors of patients with STDs and their sexual partners, identification of asymptomatic infection, and effective diagnosis and treatment are the cornerstone for prevention. HIV-infected patients with syphilis should have a detailed neurologic examination. Penicillin is the treatment of choice for syphilis. Gonococcal infection is an important cause of urethritis, cervicitis, pharyngitis, and proctitis in HIV-infected sexually active patients. Dual therapy for gonorrhea and chlamydia is recommended. Most Chlamydia trachomatis infections are asymptomatic and thus detected only by routine, periodic screening. Human papillomavirus is the most common STD in the United States.
13
Schleiss, Mark R. Cytomegalovirus. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190604813.003.0001.
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Congenital infection with human cytomegalovirus (CMV) is the most common infectious cause of developmental disability in newborns. Congenital CMV is also a leading cause of hearing loss in infants. The overall birth prevalence of congenital CMV is 0.5–1%, varying among different populations. CMV infection may be symptomatic at birth or, more commonly, asymptomatic. Both groups are at risk for sequelae. Antiviral therapy with ganciclovir (or valganciclovir) in infants with symptomatic congenital CMV infection can result in improved neurodevelopmental and hearing outcomes. CMV infections in very low birthweight premature infants, typically acquired via breast milk, can also produce substantial short-term and possibility long-term morbidity. This chapter reviews current concepts regarding the biology of CMV as well as the epidemiology, clinical presentation, diagnosis, management, and outcome of congenital and perinatal CMV infections. High-priority areas for future research, including in the arena of newborn screening for congenital CMV, are discussed.
14
Read, Jennifer S. Zika Virus. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190604813.003.0015.
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Although generally asymptomatic or mildly symptomatic in the general population, infection with the Zika virus (ZIKV) during pregnancy may lead to severely adverse fetal and infant outcomes, including the congenital Zika syndrome (CZS). Characteristics of this syndrome that are unique to it or are not typically observed with other congenital infections comprise anomalies of the brain and cranial morphology, ocular anomalies, congenital contractures, and neurological sequelae. The full spectrum of outcomes of mother-to-child transmission (MTCT) of ZIKV appears to be large, ranging from asymptomatic infection at birth, with possible later manifestation of significant abnormalities, to obvious and severe abnormalities in the fetus and infant. Although our understanding of pathogenesis, rates, and manifestations of CZS has improved rapidly and dramatically, much remains unknown or poorly understood regarding this potentially devastating congenital infection. Because of this, a broad research agenda regarding ZIKV is being implemented.
15
Nolan, T. J. Trichostrongylidosis. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780198570028.003.0072.
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Trichostrongylidosis is an infection involving nematodes of the superfamily Trichostrongyloidea, mainly those of the genus Trichostrongylus. Infections are usually asymptomatic, but when heavy, a variety of gastrointestinal symptoms, including abdominal pain and diarrhea, can be present. Infections are initiated by the ingestion of third-stage larvae. There is no parenteral migration and the adults are usually found in the mucosa of the duodenum. Eggs pass out with the faeces, hatch in about one day and the larvae develop to the infective stage in 4 to 6 days. Human infections with Trichostrongylus spp. have been reported worldwide, and are particularly common in southern Asia. Infections respond well to anthelmintics and periodic dosing of livestock is the chief method of control.
16
Martagon-Villamil, Jose, and Daniel J. Skiest. Clinical Syndromes and Differential Diagnosis in the HIV-Infected Patient. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190493097.003.0011.
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Acute HIV infection is often missed but should be recognized. Most chronically infected individuals are asymptomatic. However, some patients with chronic HIV infection may present with certain clinical and laboratory abnormalities prior to the diagnosis of an opportunistic infection. HIV wasting syndrome is infrequently diagnosed in the era of antiretroviral therapy (ART). Recognition of HIV wasting is important because it carries adverse prognostic implications. Management includes a multifaceted approach, including ART, lifestyle and nutritional support, appetite stimulation, and possibly hormonal agents. The newer antigen–antibody test can detect new HIV infection as early as 15 days after exposure. Screening is important because most chronic HIV infection is asymptomatic.
17
Putman, Shannon B., and Arjun S. Chanmugam. Urethritis, Prostatitis, and Epididymitis. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199976805.003.0039.
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Urethritis, prostatitis, and epididymitis are a constellation of diseases often caused by infections; they can result in dysuria, pain, urethral discharge, and fever. Male dysuria can be the presenting complaint in patients with urethritis, prostatitis, epididymitis, or cystitis. Urethritis is most frequently caused by sexually transmitted infection, including Neisseria gonorrhea, Chlamydia trachomatis, Mycoplasma genitalium, and Trichomonas vaginalis. Prostatitis has four classifications: acute bacterial, chronic bacterial, chronic prostatitis/chronic pelvic pain, and asymptomatic inflammatory prostatitis. Epididymitis is an inflammation of the epididymis, with or without infection lasting less than 6 weeks. Acute epididymitis usually involves the testicles, resulting in an epididymo-orchitis. Although trauma is one example of a noninfectious cause, infectious causes must be considered, especially gonorrhea and chlamydia. Treatment for these diseases is targeted antibiotics based on lab and culture results.
18
Wood, Martyn, and Marilyn Bradley. Syphilis. Edited by Patrick Davey and David Sprigings. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199568741.003.0313.
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The term ‘syphilis’ describes the wide-ranging clinical manifestations of infection with the slowly dividing spirochete bacterium Treponema pallidum subsp. pallidum. T. pallidum infection is mainly sexually acquired; it is thought the bacterium enters through microabrasions in the skin or mucosa. Congenital infection via mother-to-child transmission is also recognized. The driving force of the clinical manifestations of all stages of syphilis is an underlying and often multisystem vasculitis. Acquired syphilis can be divided into early and late presentations. In early stage infection, the T. pallidum infection has been acquired within 2 years of the diagnosis. This early stage includes the symptomatic primary and secondary stages of infection, and the asymptomatic early latent stage. Late infection of over 2 years’ standing includes all the manifestations of tertiary syphilis and asymptomatic late latent infection. This chapter discusses syphilis, including its demographics, etiology, natural history, complications, diagnosis, prognosis, and treatment.
19
Feldman, Kristyn E., and Joshua Biddle. Babesiosis. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199937837.003.0164.
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Babesiosis is a zoonotic, tick-transmitted infection caused by intraerythrocytic protozoa of the genus Babesia. Although over 100 Babesia spp. may infect a broad range of both domesticated and wild animals worldwide, only a handful have been observed to infect man. Human illness can range from an asymptomatic, subclinical infection to severe, fulminant disease resulting in death. Definitive laboratory diagnosis can be made by blood smears or serological evaluation by immunologic or molecular methods. The longstanding treatment regimen of choice for most Babesia spp. infections is oral quinine plus intravenous clindamycin.
20
Bonthius, Daniel J. Lymphocytic Choriomeningitis Virus. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190604813.003.0011.
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Lymphocytic choriomeningitis virus (LCMV), an arenavirus, is a prevalent pathogen and an important and underrecognized cause of neurologic birth defects. LCMV utilizes rodents as its principal reservoir. Rodents that acquire the virus transplacentally often remain asymptomatic because congenital infection provides immunological tolerance for the virus. Humans typically acquire LCMV by direct contact with fomites contaminated with infectious virus, from rodents, or by inhalation of aerosolized virus. Congenital LCMV infection occurs when a woman acquires the virus during pregnancy. The virus is passed to the fetus transplacentally, presumably during maternal viremia. Published reports of LCMV infection during pregnancy make it clear that LCMV can be a severe neuroteratogen. Prospective epidemiological or clinical studies of congenital LCMV infection are needed to gain more knowledge about the incidence and spectrum of LCMV-induced teratogenicity. The clinical presentation of congenital LCMV is reviewed, along with recommendations for diagnostic studies and information about long-term prognosis.
21
Chanmugam, Arjun S., and Gino Scalabrini. Urinary Tract Infections in Women. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199976805.003.0037.
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Urinary tract infections (UTIs) refer to a urine culture yielding a minimum of 100 to 10,000 bacteria units/mm of urine usually from a clean catch midstream sample. This can result from infection of the lower urinary tract involving the bladder (cystitis) or an infection of the upper urinary tract involving the kidneys (pyelonephritis). Uncomplicated UTIs occur in healthy, pre-menopausal, non-pregnant women with a normal urinary tract who have a high likelihood to respond favorably to treatment, but consider local antibiotic resistance patterns. Complicated UTIs occur in women with coexisting pathology, anatomical abnormality, underlying comorbidity, or immunocompromise. Untreated UTIs can progress to pyelonephritis and urosepsis. Asymptomatic bacteriuria for pregnant women can progress very quickly; pyelonephritis carries increased risk of perinatal and neonatal mortality. Pregnant patients should be treated with cephalexin, amoxicillin, or amoxicillin-clavulanic acid (avoiding fluoroquinolones).
22
Ewald, Paul W. Evolutionary control of infectious disease in low-income countries. Oxford University Press, 2018. http://dx.doi.org/10.1093/oso/9780198789833.003.0009.
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An evolutionary suggests that health interventions can reduce not only the frequency of infectious disease but also the harmfulness of the causal organisms. Interventions that may accomplish this dual goal include hygienic investments such as vector proofing of housing, provisioning of safe water supplies, infrastructure that blocks transmission of durable propagules, the prevention of attendant-borne transmission in hospitals and reductions in the potential for sexual transmission. Vaccines can also reduce the frequency of infection and the harmfulness of the target organisms if they are designed to inhibit selectively the harmful variants in the target population. These approaches should help suppress the evolution of antimicrobial resistance because benign variants causing mild or asymptomatic infections will be less exposed to antimicrobial treatment, reducing the strength of selection for antimicrobial resistance. The interventions should improve health at low cost, which would be especially important for low-income populations.
23
Rours, G. Ingrid J. G., and Margaret R. Hammerschlag. Chlamydia trachomatis. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190604813.003.0018.
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The estimated incidence of Chlamydia trachomatis infection is over 100 million cases globally and almost 1 million in the United States. Infection with C. trachomatis tends to be asymptomatic and of long duration. If a pregnant woman has active infection during delivery, the infant may acquire the infection, which can result in conjunctivitis or pneumonia. The most effective method of controlling perinatal C. trachomatis infection is the screening and treatment of pregnant women. Identification of infected mothers offers the opportunity to provide treatment for their sexual partners to help prevent reinfection and Chlamydia-associated morbidity in them, in addition to preventing morbidity during pregnancy and perinatal infection. Further research on prevention, especially in resource-limited settings, is most important. The implementation of prenatal screening and treatment is feasible now and will greatly reduce morbidity in pregnant women, their sexual partners, and their infants.
24
Chang, Jung-San, and Hung-Chun Chen. Dengue and other viral haemorrhagic fevers. Edited by Vivekanand Jha. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199592548.003.0189_update_001.
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Human infections of dengue viruses are mediated by mosquito bites. The disease spectrum ranges from asymptomatic infection to severe dengue haemorrhagic fever, and dengue shock syndrome. Dengue virus infects a wide range of immune cells that lead to plasma leakage and dengue haemorrhagic fever. Dengue haemorrhagic fever can be complicated with renal involvement, including haematuria, proteinuria, glomerulonephritis, acute kidney injury, and haemolytic uraemic syndrome. Diagnosis can be made by serology, detection of viral proteins by Western blot assay, or detection of the dengue viral genome by reverse transcription-polymerase chain reaction. Treatment is mainly supportive. Renal involvement associated with other viral haemorrhagic fevers has mostly been described as case reports and causality has not been established.
25
Honegger, Jonathan R. Hepatitis C Virus. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190604813.003.0005.
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An estimated 185 million individuals have been infected with hepatitis C virus (HCV) worldwide. Although often clinically silent for decades, chronic HCV infection predisposes to late-onset complications, including liver cirrhosis and hepatocellular carcinoma. Mother-to-child transmission (MTCT) of HCV affects approximately 5% of children born to viremic mothers and is the primary route of HCV infection in young children. While some vertically acquired HCV infections are resolved during the first years of life, many persist indefinitely. Chronically infected children tend to be asymptomatic and have mild liver disease, but they face a risk of progression to advanced liver disease in adulthood. Current diagnostic and management strategies leave most infected children undiagnosed and untreated. Widespread use of newly-available direct-acting antiviral therapies has the potential to substantially reduce the global burden of HCV, including vertically acquired HCV, but an effective vaccine likely will be required to achieve this ultimate goal.
26
Gaston, J. S. Hill. Reactive arthritis and enteropathic arthropathy. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199642489.003.0115.
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Reactive arthritis (ReA), and enteropathic arthritis secondary to inflammatory bowel disease, are forms of spondyloarthritis, all of which share an association with HLA B27 and can involve both axial and peripheral joints. Genetic studies strongly implicate the cytokines IL-17 and IL-23 in their pathogenesis, and evidence for autoimmunity is lacking. ReA is triggered by particular bacteria, mainly affecting the gut and genitourinary tract, though infections are sometimes asymptomatic. Classically an acute oligo- or monoarthritis with enthesitis occurs, often with inflammatory back pain, though mild polyarthritis can also occur. Septic and crystal-induced arthritis are the principal differential diagnoses. Extra-articular features may aid diagnosis, which otherwise requires laboratory evidence of preceding infection. Bacterial components traffic to the joint (which is nevertheless sterile), and elicit local proinflammatory immune responses. Most ReA is self-limiting, but persistent cases may require disease-modifying anti-rheumatic drugs or even biologics.
27
Gaston, J. S. Hill. Reactive arthritis and enteropathic arthropathy. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199642489.003.0115_update_002.
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Reactive arthritis (ReA), and enteropathic arthritis secondary to inflammatory bowel disease, are forms of spondyloarthritis, all of which share an association with HLA B27 and can involve both axial and peripheral joints. Genetic studies strongly implicate the cytokines IL-17 and IL-23 in their pathogenesis, and evidence for autoimmunity is lacking. ReA is triggered by particular bacteria, mainly affecting the gut and genitourinary tract, though infections are sometimes asymptomatic. Classically an acute oligo- or monoarthritis with enthesitis occurs, often with inflammatory back pain, though mild polyarthritis can also occur. Septic and crystal-induced arthritis are the principal differential diagnoses. Extra-articular features may aid diagnosis, which otherwise requires laboratory evidence of preceding infection. Bacterial components traffic to the joint (which is nevertheless sterile), and elicit local pro-inflammatory immune responses. Most ReA is self-limiting, but persistent cases may require disease-modifying anti-rheumatic drugs or even biologics.
28
Jex, Aaron R., Rachel M. Chalmers, Huw V. Smith, Giovanni Widmer, Vincent McDonald, and Robin B. Gasser. Cryptosporidiosis. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780198570028.003.0053.
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Cryptosporidium species represent a genus of parasitic protozoa (Apicomplexa) that are transmitted via the faecal-oral route and commonly infect the epithelial tissues of the gastric or intestinal (or sometimes the respiratory) tract of many vertebrates, including humans. Infection occurs following the ingestion of viable and resistant oocysts, through direct host-to-host contact or in contaminated food, drinking or recreational water. Infection can be transmitted via anthroponotic (human-to-human, human-to-animal) or zoonotic (animal-to-human or animal-to-animal) pathways, depending upon the species of Cryptosporidium. Although infection can be asymptomatic, common symptoms of disease (cryptosporidiosis) include diarrhoea, colic (abdominal pain), nausea or vomiting, dehydration and/or fever. In humans, cryptosporidial infection in immunocompetent patients is usually short-lived (days to weeks) and eliminated following the stimulation of an effective immune response. However, infection in immunodeficient individuals (e.g., those with HIV/AIDS) can be chronic and fatal (in the absence of immunotherapy), as there are few effective anti-cryptosporidial drugs and no vaccines available. The present chapter provides an account of the history, taxonomy and biology, genomics and genetics of Cryptosporidium, the epidemiology, pathogenesis, treatment and control of cryptosporidiosis and the advances in tools for the identification and characterisation of Cryptosporidium species and the diagnosis of cryptosporidiosis.
29
Osman, Nadir I., and Christopher R. Chapple. Urethral diverticula. Edited by Christopher R. Chapple. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199659579.003.0042.
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Urethral diverticula (UD) are not uncommon, affecting up to 6% of the female population, but are in the majority of cases asymptomatic and of no clinical significance. They are thought to arise as a consequence of infection, obstruction, and subsequent rupture of a periurethral gland. UD often pose a significant diagnostic challenge, as symptoms are largely non-specific and easily confused with other conditions such as bladder pain syndrome and recurrent urinary tract infection. As such, both misdiagnosis and delayed diagnosis are common, to the frustration of both patients and surgeons. Traditional methods of diagnosis, such as voiding cystourethrogram, relied upon urethral catheterization and contrast instillation, and were associated with poor anatomical detail. Recent advances in imaging, particularly magnetic resonance imaging, have improved the diagnosis and staging of UD, and have allowed for more accurate preoperative planning.
30
Keshav, Satish, and Alexandra Kent. Dyspepsia. Edited by Patrick Davey and David Sprigings. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199568741.003.0025.
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Dyspepsia is a term encompassing several symptoms of the upper gastrointestinal (GI) tract, including acid reflux, heartburn, nausea, vomiting, and abdominal pain or discomfort. Up to 40% of the population suffer with dyspepsia; 5%–10% will consult their GP, and 1% will undergo endoscopic assessment. Over-the-counter medications cost patients £100 million annually, and prescribed drugs cost the NHS over £463 million annually. There is a steady rise in incidence with increasing age. Helicobacter pylori is present in 40% of the UK population, with many individuals acquiring the infection in childhood and remaining asymptomatic. It has been associated with peptic ulcer disease and distal gastric cancer. This chapter covers the approach to diagnosis, key diagnostic tests, therapies, and prognosis as well as dealing with uncertainty when it comes to the initial diagnosis.
31
Barsoum, Rashad S. Schistosomiasis. Edited by Vivekanand Jha. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199592548.003.0194_update_001.
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The urinary system is the primary target of Schistosoma haematobium infection, which leads to granuloma formation in the lower urinary tract that heals with fibrosis and calcification. While the early lesions may be associated with distressing acute or subacute symptoms, it is the late lesions that constitute the main clinical impact of schistosomiasis. The latter include chronic cystitis, ureteric fibrosis, ureterovesical obstruction or reflux which may lead to chronic pyelonephritis. Secondary bacterial infection and bladder cancer are the main secondary sequelae of urinary schistosomiasis.The kidneys are also a secondary target of S. mansoni infection, attributed to the systemic immune response to the parasite. Specific immune complexes are responsible for early, often asymptomatic, possibly reversible, mesangioproliferative lesions which are categorized as ‘class I’. Subsequent classes (II–VI) display different histopathology, more serious clinical disease, and confounding pathogenic factors. Class II lesions are encountered in patients with concomitant salmonellosis; they are typically exudative and associated with acute-onset nephrotic syndrome. Classes III (mesangiocapillary glomerulonephritis) and IV (focal segmental sclerosis) are progressive forms of glomerular disease associated with significant hepatic pathology. They are usually associated with immunoglobulin A deposits which seem to have a significant pathogenic role. Class V (amyloidosis) occurs with long-standing active infection with either S. haematobium or S. mansoni. Class VI is seen in patients with concomitant HCV infection, where the pathology is a mix of schistosomal and cryoglobulinaemic lesions, as well as amyloidosis which seems to be accelerated by the confounded pathogenesis.Early schistosomal lesions, particularly those of the lower urinary tract, respond to antiparasitic treatment. Late urological lesions may need surgery or endoscopic interventions. As a rule, glomerular lesions do not respond to treatment with the exception of class II where dual antiparasitic and antibiotic therapy is usually curative. Patients with end-stage kidney disease may constitute specific, yet not insurmountable technical and logistic problems in dialysis or transplantation. Recurrence after transplantation is rare.
32
Academy of Medicine of New Jersey. and New Jersey. State Dept. of Health., eds. Identification and management of asymptomatic HIV-infected persons in New Jersey: A practical protocol for New Jersey clinicians. 2nd ed. Lawrenceville: Academy of Medicine of New Jersey, 1992.
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33
Academy of Medicine of New Jersey. and New Jersey. Dept. of Health and Senior Services., eds. Identification and management of asymptomatic HIV-infected persons in New Jersey: A practical protocol for New Jersey clinicians. 3rd ed. Princeton Junction, NJ: Academy of Medicine of New Jersey, 1996.
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34
Restrepo, Angela, Angel A. Gónzalez, and Beatriz L. Gómez. Endemic dimorphic fungi. Edited by Christopher C. Kibbler, Richard Barton, Neil A. R. Gow, Susan Howell, Donna M. MacCallum, and Rohini J. Manuel. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780198755388.003.0016.
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Endemic dimorphic infections are acquired by inhalation of fungal spores which undergo a thermal transition to a yeast-like phase in the host. The causative organisms are geographically restricted and are isolated from the environment; likewise, the infections are associated with people living in, or visiting, these endemic regions. The clinical presentations range from asymptomatic to chronic, and disseminated, depending on the host immune status and other risk factors. The infections and their causative agents are: histoplasmosis (Histoplasma capsulatum), paracoccidioidomycosis (Paracoccidioides brasiliensis/lutzii), blastomycosis (Blastomyces dermatitidis/gilchristii), coccidioidomycosis (Coccidioides immitis/posadasii), talaromycosis (previously penicilliosis; Talaromyces [Penicillium] marneffei), and emmonsiosis (Emmonsia species). Diagnosis relies on microscopy and culture, histology, and immunological detection. Owing to their infectious nature, all of these organisms must be handled using biosafety level-3 containment. Treatment is based around azole administration, usually itraconazole, with amphotericin B for the more severe forms or for the most at risk patients.
35
Clement, Jan. Acute kidney injury and hantavirus disease. Edited by Norbert Lameire. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199592548.003.0242_update_001.
Full textAbstract:
Hantavirus disease or at least its renal form, the so-called haemorrhagic fever with renal syndrome is the only globally emerging acute kidney injury (AKI) form, and currently without doubt the most underestimated form of community-acquired AKI. Hantavirus disease is a viral zoonosis, caused by inhalation of infectious aerosolized excreta from chronically infected rodents, which are both the reservoir and the vector of different hantavirus species. Clinical presentation consists of sudden flu-like symptoms (fever, headache, myalgia), followed by gastrointestinal discomfort and AKI, often with anuria or oliguria. More rarely, acute myopia and/or non-cardiogenic acute lung oedema or injury is the presenting or complicating symptom. Laboratory hallmarks are initial thrombocytopenia and proteinuria, raised C-reactive protein and lactate dehydrogenase, left-shift leucocytosis, and typical but transient serum lipid disturbances. Spontaneous remission occurs within 2–3 weeks without sequelae. Case fatality rate is between 0.1% and 15% according to the infecting hantavirus species, but most infections show in fact an asymptomatic or paucisymptomatic presentation. Treatment is only supportive, but may necessitate life-saving intensive care techniques. Together with leptospirosis, haemorrhagic fever with renal syndrome is the only form of AKI against which different vaccines are in use, but a World Health Organization-licensed hantavirus vaccine is still lacking.
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Wagenlehner, Florian M. E., Adrian Pilatz, Thomas Bschleipfer, Thorsten Diemer, and Wolfgang Weidner. Inflammation. Edited by Rob Pickard. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199659579.003.0007.
Full textAbstract:
There is a consensus on the diagnostic and therapeutic manage¬ment of bacterial prostatitis (acute and chronic). However, increas¬ing antimicrobial resistance rates for quinolones pose problems for the future, especially for therapy of chronic bac¬terial prostatitis. In chronic prostatitis/chronic pelvic pain syndrome, the diag¬nostic approach currently points more and more to an individu¬alized phenotypic assessment, in an effort to direct multimodal management towards improvement of specific symptom domains. Most therapy trials for single agents in CP/CPPS have been nega¬tive, therefore stratification by phenotype followed by individu¬alized multimodal treatment seems to be a promising strategy, although good evidence-based data are not available currently to substantiate this. Consensus regarding the need and option for treatment of asymptomatic prostatitis is far from being achieved. Therefore, taking the high prevalence of infections and inflammations in different asymptomatic conditions into consideration, further research is urgently needed to address this important field.
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Ralston, Stuart H. Paget’s disease of bone. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199642489.003.0144_update_001.
Full textAbstract:
Paget’s disease of bone (PDB) affects up to 1% of people of European origin aged 55 years and above. It is characterized by focal abnormalities of bone remodelling which disrupt normal bone architecture, leading to expansion and reduced mechanical strength of affected bones. This can lead to various complications including deformity, fracture, nerve compression syndromes, and osteoarthritis, although many patients are asymptomatic. Genetic factors play a key role in the pathogenesis of PDB. This seems to be mediated by a combination of rare genetic variants which cause familial forms of the disease and common variants which increase susceptibility to environmental triggers. Environmental factors which have been suggested to predispose to PDB include viral infections, calcium and vitamin D deficiency, and excessive mechanical loading of affected bones. The diagnosis can be made by the characteristic changes seen on radiographs, but isotope bone scans are helpful in defining disease extent. Serum alkaline phosphatase levels can be used as a measure of disease activity. Inhibitors of bone resorption are the mainstay of medical management for PDB and bisphosphonates are regarded as the treatment of choice. Bisphosphonates are highly effective at reducing bone turnover in PDB and have been found to heal osteolytic lesions, and normalize bone histology. Although bisphosphonates can improving bone pain caused by elevated bone turnover, most patients require additional therapy to deal with symptoms associated with disease complications. It is currently unclear whether bisphosphonate therapy is effective at preventing complications of PDB.
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Ralston, Stuart H. Paget’s disease of bone. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199642489.003.0144.
Full textAbstract:
Paget's disease of bone (PDB) affects up to 1% of people of European origin aged 55 years and above. It is characterized by focal abnormalities of bone remodelling which disrupt normal bone architecture, leading to expansion and reduced mechanical strength of affected bones. This can lead to various complications including deformity, fracture, nerve compression syndromes, and osteoarthritis, although many patients are asymptomatic. Genetic factors play a key role in the pathogenesis of PDB. This seems to be mediated by a combination of rare genetic variants which cause familial forms of the disease and common variants which increase susceptibility to environmental triggers. Environmental factors which have been suggested to predispose to PDB include viral infections, calcium and vitamin D deficiency, and excessive mechanical loading of affected bones. The diagnosis can be made by the characteristic changes seen on radiographs, but isotope bone scans are helpful in defining disease extent. Serum alkaline phosphatase levels can be used as a measure of disease activity. Inhibitors of bone resorption are the mainstay of medical management for PDB and bisphosphonates are regarded as the treatment of choice. Bisphosphonates are highly effective at reducing bone turnover in PDB and have been found to heal osteolytic lesions, and normalize bone histology. Although bisphosphonates can improving bone pain caused by elevated bone turnover, most patients require additional therapy to deal with symptoms associated with disease complications. It is currently unclear whether bisphosphonate therapy is effective at preventing complications of PDB.