Clinical Infectious Diseases Discussion Essay Paper
Clinical Infectious Diseases Discussion Essay Paper
Pelvic inflammatory disease
Research has shown that Sexually transmitted diseases (STDs) do affect the fertility of an individual by, among other things, damaging the reproductive system. Yagur et al. (2021) cited that diseases such as chlamydia and gonorrhea cause pelvic inflammatory disease (PID) which scars and damages the fallopian tubes, uterus, and ovaries in women. More tellingly the damage on the fallopian tubes presents the risk of infertility, ectopic pregnancy, and chronic pelvic pain. Other STDs like as herpes and human papillomavirus (HPV) damage the reproductive system and equally impact fertility. On the one hand, herpes causes sores and blisters in the genital area, while HPV, on the other hand, heightens the risks of developing cervical cancer. In their article, Wiesenfeld et al. (2021) highlighted that inflammatory markers rise in PID. The researchers elaborated that the inflammatory markers such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) increase when they detect that the body is infected leading to inflammation. Where the individual is suffering from STD/PID, the inflammatory response is triggered by the bacteria in the reproductive system which trigger an immune response culminating in the release of cytokines and other inflammatory mediators. What’s more, these bacteria also activate the liver to produce acute phase reactants such as CRP. The CRP as explained by Wiringa et al. (2020) are measured in the blood. ESR reflects the rate at which red blood cells settle in blood and which an outcome of the presence of inflammatory mediators is. Clinical Infectious Diseases Discussion Essay Paper
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Research by Ravel, Moreno and Simón (2021) found that infection occur when bacteria from the vagina or cervix travel up through the uterus and into the fallopian tubes ultimately triggering the PID infection. The analysis by these researchers further highlight that this can happen during sexual intercourse and also due to other factors like childbirth, abortion, or the insertion of an intrauterine device (IUD). There are a number of factors that lead to systemic reaction from infection. Darville (2021) explained that infections in some circumstances cause a systemic reaction when they release inflammatory mediators for example cytokines and chemokines. The researchers highlighted that these mediators cause fever, chills, fatigue, and malaise. Considering the case of PID, the bacterial infection the patient has could potentially lead to the release of endotoxins. Notably, the duly released endotoxins have the capability of causing sepsis and shock. Moreno and Simón (2021) wrote that lab values like the case of elevated white blood cell count, elevated neutrophil count, and elevated inflammatory markers like CRP and ESR are a reflection of the body’s response to infection. In addition to this, the vital signs for example fever, tachycardia, and tachypnea are also indicative of a systemic reaction. Physical presentation of these symptoms include dehydration, confusion, and altered mental status. On exam, these patients depict abdominal tenderness, guarding, or rebound, and in the case of PID and they may also have adnexal tenderness and cervical discharge.
Guided by this and focusing on the provided scenario, the patient’s systemic reaction to the infection is evidenced by the identified high temperature of 103.2°F. In addition to this, there is also the outcome of the tachycardia which showed a high result of a pulse of 120 beats per minute. These two point towards the likelihood of this patient is experiencing a systemic reaction. Research has shown that when these two manifest themselves on an individual they indicate that the person has a fever and this is a common response to infection. Additionally, this particular patient showed a high amount of white blood cell with the specific value showing a count of 18. According to Curry, Williams and Penny (2019), a high number of white blood cells means that the body is responding to an infection or a foreign body. Moreover, the inflammatory markers of this particular patient and primarily the recorded sed rate and CRP are elevated and this further gives credence to the PID diagnosis. The physical presentation from the patient showed abdominal tenderness in the LLQ. According to Wiringa et al. (2020), this kind of inflammation gives the impression that the reproductive system is inflamed. Further to this, the pelvic exam on the patient also demonstrated copious foul-smelling green drainage. This type of discharge is as well consistent with PID. The assessment of this patient also showed that she had bilateral adnexal tenderness and a positive chandelier sign. These two indicate that the patient has inflamed fallopian tubes. Clinical Infectious Diseases Discussion Essay Paper
Following the realization that the patient is actually suffering from PID, treatment should be done immediately because if the condition is left untreated it could lead to a systemic inflammatory response causing the patient to experience sepsis and shock. Sepsis signs include altered mental status, confusion, and dehydration and in some severe cases the patient may require admission to the intensive care unit for aggressive treatment and supportive care. In view of this, expeditious diagnosis and treatment of PID are necessary in order to prevent these complications and preserve fertility.
References
Curry, A., Williams, T., & Penny, M. L. (2019). Pelvic inflammatory disease: diagnosis, management, and prevention. American family physician, 100(6), 357-364.
Darville, T. (2021). Pelvic inflammatory disease due to Neisseria gonorrhoeae and Chlamydia trachomatis: immune evasion mechanisms and pathogenic disease pathways. The Journal of Infectious Diseases, 224(Supplement_2), S39-S46. https://doi.org/10.1093/infdis/jiab031
Ravel, J., Moreno, I., & Simón, C. (2021). Bacterial vaginosis and its association with infertility, endometritis, and pelvic inflammatory disease. American journal of obstetrics and gynecology, 224(3), 251-257. https://doi.org/10.1016/j.ajog.2020.10.019
Wiesenfeld, H. C., Meyn, L. A., Darville, T., Macio, I. S., & Hillier, S. L. (2021). A randomized controlled trial of ceftriaxone and doxycycline, with or without metronidazole, for the treatment of acute pelvic inflammatory disease. Clinical Infectious Diseases, 72(7), 1181-1189. https://doi.org/10.1093/cid/ciaa101
Wiringa, A. E., Ness, R. B., Darville, T., Beigi, R. H., & Haggerty, C. L. (2020). Trichomonas vaginalis, endometritis and sequelae among women with clinically suspected pelvic inflammatory disease. Sexually transmitted infections, 96(6), 436-438. http://dx.doi.org/10.1136/sextrans-2019-054079
Yagur, Y., Weitzner, O., Tiosano, L. B., Paitan, Y., Katzir, M., Schonman, R., … & Miller, N. (2021). Characteristics of pelvic inflammatory disease caused by sexually transmitted disease–An epidemiologic study. Journal of Gynecology Obstetrics and Human Reproduction Clinical Infectious Diseases Discussion Essay Paper
Scenario 1: A 32-year-old female presents to the ED with a chief complaint of fever, chills, nausea, vomiting, and vaginal discharge. She states these symptoms started about 3 days ago, but she thought she had the flu. She has begun to have LLQ pain and notes bilateral lower back pain. She denies dysuria, foul-smelling urine, or frequency. States she is married and has sexual intercourse with her husband. PMH negative.
Labs: CBC-WBC 18, Hgb 16, Hct 44, Plat 325, ¬ Neuts & Lymphs, sed rate 46 mm/hr., C-reactive protein 67 mg/L CMP wnl
Vital signs T 103.2 F Pulse 120 Resp 22 and PaO2
99% on room air. Cardio-respiratory exam WNL with the exception of tachycardia but no murmurs, rubs, clicks, or gallops. Abdominal exam + for LLQ pain on deep palpation but no rebound or rigidity. The pelvic exam demonstrates copious foul-smelling green drainage with the reddened cervix and + bilateral adnexal tenderness. + chandelier sign. Wet prep in ER + clue cells and gram stain in ER + gram-negative diplococci.
The case reflects PID. One would suspect the patient is not forthcoming or the husband is not monogamous. Clinical Infectious Diseases Discussion Essay Paper
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Please do the assignment within the 2-page limit asked for
The Assignment (1- to 2-page case study analysis)
In your Case Study Analysis related to the scenario provided, explain the following:
1. The factors that affect fertility (STDs).
2. Why inflammatory markers rise in STD/PID.
3. Why infection happens.
4. Explain the causes of a systemic reaction from infection (Lab values, Vital Signs, physical presentation, and exam). Clinical Infectious Diseases Discussion Essay Paper