Human immunodeficiency virus (HIV) infection/acquired immunodeficiency syndrome, a pandemic in the current population causes severe weakness of the body's immune system making the infected patient more vulnerable to life-threatening conditions. The disease predisposes the infected patient to several cardiovascular diseases and cerebrovascular diseases such as heart failure and stroke. The decline in CD4 cells following HIV infection, vulnerability to opportunistic infections and underlying HIV pathology plays a major role in the development of cardiovascular manifestations, and treatment targeting cardiomyopathy in this specific patient subset is not well recognized. Patients living with HIV (PLWH) also experience discrimination in receiving cardiovascular disease care and this needs to be addressed by strengthening frameworks for monitoring and providing nonjudgmental healthcare. This review aims to study the profile of the cardiovascular disease in HIV patients, treatment, and provide evidence of the disparity in the provision of healthcare with regard to PLWH.
Background
Primary bacterial peritonitis presenting as septic shock is infrequently seen in clinical practice. This is a case of gonococcal peritonitis presenting as septic shock in a pregnant lady needing emergency laparotomy, drainage of purulent fluid and abdominal lavage.
Case Presentation
A 35-year-old woman presented with severe generalised abdominal pain. No history of fever, vomiting, urinary or bowel complaints. She was in her 4th pregnancy, at 12-weeks gestation. She was afebrile but tachycardic and hypotensive. Abdomen was tender and there was no vaginal bleeding. Ultrasound scan showed minimal fluid in hepatorenal area and a viable intrauterine pregnancy. Differential diagnosis were ruptured appendix, ectopic pregnancy, acute abdomen and shock. Exploratory laparotomy was done. Moderate amount of purulent fluid was noted within the abdominal cavity and no bleeding was seen. General surgeon was called for assistance by the Obstetrician as no foci of infection was found. The uterus, fallopian tubes, ovaries, appendix, bowel and upper abdominal organs were found to be intact. Peritoneal fluid culture was taken. Drainage of purulent fluid and peritoneal wash was done. She was nursed in ICU because of peritonitis with septic shock and AKI. Peritoneal fluid culture showed Neisseria gonorrhoea and IV ceftriaxone was given for 7 days. Postoperatively she recovered well but needed evacuation of uterus for a missed miscarriage. She was screened for other STIs and were negative.
Discussion
Gonorrhoea is the second most common reported STI. It can present as acute peritonitis when the infection has spread beyond upper reproductive tract organs.
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