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All you need to know about Syphilis

Created by - Dr. Prashant Raj

All you need to know about Syphilis

ETIOLOGY: Syphilis is caused by T. pallidum.INCIDENCE: Each year, there are 29,000 new cases of syphilis. This figure represents probably only 10% of actual cases.CLINICAL FEATURES1. Primary syphilis: After an average incubation period of approximately 3 weeks, a smooth, painless ulcer called a chancre appears at the site of primary inoculation. The chancre heals without treatment in approximately 3 to 6 weeks; at about the same time, a painless uni- or bilateral regional adenopathy develops.2. Secondary syphilis represents disseminated disease and occurs in all patients with untreated primary infection. The lesions of secondary syphilis are papulosquamous lesions that occur over the entire trunk, extremities, penis, and buttocks. Fever and weight loss occur in 70% of patients.3. Tertiary syphilis occurs at least 10 years after the primary infection in at least 30% to 35% of untreated patients. The two most important manifestations of tertiary syphilis are cardiovascular syphilis, causing thoracic aneurysms, and neurosyphilis, causing meningitis, stroke, seizures, dementia, general weakness, and posterior column dysfunction.DIFFERENTIAL DIAGNOSES— Chancroid— HSV type 1 infection— Lymphogranuloma venereum— Tinea, sarcoid— Lichen planus— Seborrhea dermatitis— Molluscum contagiosum— Traumatic ulcer— Furuncle— CarcinomaEVALUATION: The clinical diagnosis can be confirmed by darkfield microscopic examination or more commonly serologic testing.THERAPY1. The standard treatment for primary, secondary, and early tertiary syphilis is benzathine penicillin G (2.4 million U administered intramuscularly as a single dose).2. For late tertiary syphilis or neurosyphilis, benzathine penicillin G (2.4 million U, three doses administered intramuscularly 1 week apart) is used. Doxycycline (100 mg orally twice daily for 14 days) can be given to patients who are allergic to penicillin.DISPOSITION1. Primary and secondary syphilis can be treated on an outpatient basis.2. Patients with neurosyphilis or major cardiovascular manifestations require admission for intravenous therapy.

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Published - Tue, 15 Nov 2022

What is Pemphigus Vulgaris?

Created by - Dr. Prashant Raj

What is Pemphigus Vulgaris?

Pemphigus Vulgaris is a rare disease that affects elderly patients. The mortality rate is 10%; most deaths result from steroid complications, secondary infection, dehydration, or thromboembolism. Pemphigus Vulgaris is caused by the attachment of immunoglobulin G autoantibodies to the epidermis. It has been associated with D -penicillamine and captopril administration.CLINICAL FEATURES1. Mucosal lesions and erosions are very common. Examination of all mucosal sites is warranted.2. Non-pruritic, painful, flaccid bullae appear that rupture easily. Blisters can be extended or new bullae formed by applying firm tangential pressure on the intact epidermis.3. Weakness, weight loss, and dysphagia may be presenting complaints.DIFFERENTIAL DIAGNOSES— Erythema multiforme— Bullous impetigo— Herpes zosterEVALUATION: Biopsy of lesions shows eosinophils, intraepidermal bullae, and acantholysis. Indirect immunofluorescent staining shows immunoglobulin G antibodies. Serum titers can be followed to evaluate the effectiveness of therapy.THERAPY1. Prednisone (200 to 350 mg/day) for 5 to 10 weeks is used until the cessation of new blister formation occurs. The dosage is then reduced to 40 mg on alternative days and tapered over 1 year.2. Azathioprine (100 mg/day) is added to the regimen and the dosage is reduced over a 4- to 6-month period. Methotrexate and cyclophosphamide can be used instead of azathioprine.3. Topical analgesics (e.g., viscous lidocaine) can be used to alleviate the pain associated with oral lesions.DISPOSITION: Patients with severe cases and oral lesions may require hospital admission for intravenous hydration. Others can be treated as outpatients with close follow-up.

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Published - Tue, 15 Nov 2022

Know about Scorpion Stings

Created by - Dr. Prashant Raj

Know about Scorpion Stings

Introduction: A nocturnal arachnid that lives in the Southwest of the United States is the scorpion. It has two venom glands and a stinger in its tail. The majority of species are rather benign, and they often only create a limited reaction similar to that brought on by a bee sting. The bark scorpion (Centruroides sculpturatus) venom, on the other hand, has neurotoxic that can result in a serious reaction. This dangerous scorpion is found on trees in Arizona and New Mexico.CLINICAL FEATURES1. Local effects: The C. sculpturatus scorpion bite causes immediate, excruciating pain at the stung site, as well as swelling and ultimately, numbness. The area that was hurt is extremely sensitive, and the implicated extremity could become paralyzed.2. Systemic effects: The neurotoxin is strongly cholinergic and can cause excessive salivation, blurred vision, muscular spasms, hypertension, and respiratory difficulties.DIFFERENTIAL DIAGNOSES — Snakebite— A puncture wound or other trauma— Insect or spider bite— Drug intoxicationEVALUATION: Typically, the offending scorpion is seen or assumed by history; if safety allows the scorpion to be brought in, this is best. Due to the wide range of symptoms and quick progression, a thorough history and physical examination are necessary.THERAPY1. Pre-hospital management includes rapid transportation of the patient, application of an ice pack to the sting site, and safe transport of the scorpion for identification. When serious symptoms appear, life-saving procedures should be started.2. ED managementa) Antivenin should be administered in all cases of severe envenomation.b) Ventilatory support may be required, with intubation and oxygen for patients with severe systemic response or anaphylaxis.c) Atropine may be required to counteract the cholinergic effects; the dose is titrated to relieve the cholinergic signs.d) Benzodiazepines may be used for seizures and muscle spasms.DISPOSITION: All victims should be observed for 24 hours, especially children. Symptomatic patients should be transferred to the intensive care unit if symptoms are severe.

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Published - Sat, 12 Nov 2022

All you need to know about Stevens-Johnson Syndrome

Created by - Dr. Prashant Raj

All you need to know about Stevens-Johnson Syndrome

Stevens-Johnson syndrome is a severe form of erythema multiforme, associated with a mortality rate of 10%. Complications include blindness, renal failure, meningitis, necrotizing tracheobronchitis, dehydration, secondary bacterial infection, arrhythmias, and congestive heart failure.Who is commonly affected?Children and young adults are most frequently affected by the disease. CLINICAL FEATURES1. Upper respiratory tract infection, headache, fever, hematuria, diarrhea, and arthralgias can precede the rash.2. Rash: Skin lesions are burning but not itchya) Bullae appear in 1 to 14 days on the skin and the mucous membranes of the mouth, genitalia, and anus.b) Ulcers: Corneal ulcers can lead to blindness. Ulcerative stomatitis leads to hemorrhagic crusting. Patients are unable to eat or drink and continuously drool.c) Vesicles rupture and leave denuded bases and necrotic epithelium.3. Signs of toxic epidermal necrolysis (TEN) may develop. Urinary retention can result from urethral involvement.DIFFERENTIAL DIAGNOSES include TEN and pemphigus.EVALUATION: Skin biopsy findings include necrolysis with edema and erythrocytes in the dermis.THERAPY1. Definitive treatment entails treating the cause if it can be identified (e.g., with antibiotics or termination of drug therapy). Prednisone (80 to 120 mg/day in divided doses) can be administered orally with subsequent tapering. Intravenous immunoglobulin has also been used successfully to halt the progression of TEN. It is important to note that treatment with prednisone or intravenous immunoglobulin is controversial and varies from one institution to another.2. Supportive treatmenta) Cool, wet compresses— Aluminum acetate compresses are applied to blisters.— Compresses soaked in potassium permanganate solution are applied to bullous lesions.b) Anesthetic troches, 2% viscous lidocaine, or 10% sodium bicarbonate mouthwashes can be used to soothe mouth lesions. If the patient cannot tolerate a liquid diet, he or she will require intravenous rehydration.c) Antibiotic therapy is indicated for patients with secondary bacterial infections.d) Ophthalmology consult: An ophthalmologist should be consulted.d) Urology consult: Urology should be consulted if genitourinary involvement is suspected.DISPOSITION: Patients with severe mucous membrane involvement require admission to a burn unit for reverse isolation and treatment of fluid and electrolyte imbalances.

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Published - Sat, 12 Nov 2022

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A Feather in Our Cap!

Delhi's Chief Minister awards Dr. Prashant Raj Gupta for his efforts toward society. Dr. Prashant Raj Gupta's contribution to society through his education and treatment is honored by Delhi's Chief Minister, Mr. Arvind Kejriwal. Dr. Prashant Raj Gupta's educational courses empower the youth in the medical field through online medical courses. With his experience of more than a decade and with his skills and treatments, Dr. Prashant, working as an integrative treatment expert, helped enhance the patients' quality of life. They enabled them to live healthily and happily, which proved to be an effective contribution to the well-being of society and making positive changes toward society's betterment.

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