mage- tarminfeksjoner. hva står vi ovenfor ? virus – norovirus – rotavirus – adenovirus...
TRANSCRIPT
Mage- tarminfeksjoner
Hva står vi ovenfor ? • Virus
– Norovirus– Rotavirus– Adenovirus
• Bakterier– Campylobacter– Salmonella– Shigella– Toxinproduserende E coli– Yersinia– Listeria– Aeromonas– Plesiomonas– Vibrio spp
• Toxinmediert– Clostridium difficile– Bacillus spp– S aureus
• Parasitter– Giaridia lamblia– Cryptosporidium
– Entamoeba histolytica– Cyclospora
Rutineundersøkelser • Virus
– Norovirus– Rotavirus– Adenovirus
• Bakterier– Campylobacter– Salmonella– Shigella– Toxinproduserende E coli– Yersinia– Listeria– Aeromonas– Plesiomonas– Vibrio spp
• Toxinmediert– Clostridium difficile– Bacillus spp– S aureus
• Parasitter– Giaridia lamblia– Cryptosporidium
– Entamoeba histolytica– Cyclospora
Rutineundersøkelser ved kliniske opplysninger
• Virus– Norovirus– Rotavirus– Adenovirus
• Bakterier– Campylobacter– Salmonella– Shigella– Toxinproduserende E coli– Yersinia– Listeria– Aeromonas– Plesiomonas– Vibrio spp
• Toxinmediert– Clostridium difficile– Bacillus spp– S aureus
• Parasitter– Giaridia lamblia– Cryptosporidium
– Entamoeba histolytica– Cyclospora
Hvem gjør hva hvor ?
Flere i en familie syke ? Sesong ? ”noe som går”?
• Virus– Norovirus– Rotavirus– Adenovirus– Astrovirus
• Bakterier– Campylobacter– Salmonella– Shigella– Toxinproduserende E coli– Yersinia– Listeria– Aeromonas– Plesiomonas– Vibrio spp
• Toxinmediert– Clostridium difficile– Bacillus spp– S aureus
• Parasitter– Giaridia lamblia– Cryptosporidium
– Entamoeba histolytica– Cyclospora
Suspekte matvarer ?Hyperakutt start ?
• Virus– Norovirus– Rotavirus– Adenovirus
• Bakterier– Campylobacter– Salmonella– Shigella– Toxinproduserende E coli– Yersinia– Listeria– Aeromonas– Plesiomonas– Vibrio spp
• Toxinmediert– Clostridium difficile– Bacillus spp– S aureus
• Parasitter– Giaridia lamblia– Cryptosporidium
– Entamoeba histolytica– Cyclospora
Suspekte matvarer – i Norge ?
• Virus– Norovirus– Rotavirus– Adenovirus
• Bakterier– Campylobacter– Salmonella– Shigella– Toxinproduserende E coli– Yersinia– Listeria– Aeromonas– Plesiomonas– Vibrio spp
• Toxinmediert– Clostridium difficile– Bacillus spp– S aureus
• Parasitter– Giaridia lamblia– Cryptosporidium
– Entamoeba histolytica– Cyclospora
Suspekte matvarer ?Sjømat/Østers/muslinger ?
• Virus– Norovirus– Rotavirus– Adenovirus
• Bakterier– Campylobacter– Salmonella– Shigella– Toxinproduserende E coli– Yersinia– Listeria– Aeromonas– Plesiomonas– Vibrio spp
• Toxinmediert– Clostridium difficile– Bacillus spp– S aureus
• Parasitter– Giaridia lamblia– Cryptosporidium
– Entamoeba histolytica– Cyclospora
Gravid ? Muskelstivhet/verk ?
• Virus– Norovirus– Rotavirus– Adenovirus
• Bakterier– Campylobacter– Salmonella– Shigella– Toxinproduserende E coli– Yersinia– Listeria– Aeromonas– Plesiomonas– Vibrio spp
• Toxinmediert– Clostridium difficile– Bacillus spp– S aureus
• Parasitter– Giaridia lamblia– Cryptosporidium
– Entamoeba histolytica– Cyclospora
Nylig antibiotika eller institusjonsopphold ?
• Virus– Norovirus– Rotavirus– Adenovirus
• Bakterier– Campylobacter– Salmonella– Shigella– Toxinproduserende E coli– Yersinia– Listeria– Aeromonas– Plesiomonas– Vibrio spp
• Toxinmediert– Clostridium difficile– Bacillus spp– S aureus
• Parasitter– Giaridia lamblia– Cryptosporidium
– Entamoeba histolytica– Cyclospora
Reise ?
• Virus– Norovirus– Rotavirus– Adenovirus
• Bakterier– Campylobacter– Salmonella– Shigella– Toxinproduserende E coli– Yersinia– Listeria– Aeromonas– Plesiomonas– Vibrio spp
• Toxinmediert– Clostridium difficile– Bacillus spp– S aureus
• Parasitter– Giaridia lamblia– Cryptosporidium
– Entamoeba histolytica– Cyclospora
Halvkronisk/langvarig ?
• Virus– Norovirus– Rotavirus– Adenovirus
• Bakterier– Campylobacter– Salmonella– Shigella– Toxinproduserende E coli– Yersinia– Listeria– Aeromonas– Plesiomonas– Vibrio spp
• Toxinmediert– Clostridium difficile– Bacillus spp– S aureus
• Parasitter– Giaridia lamblia– Cryptosporidium
– Entamoeba histolytica– Cyclospora
Blodig ?
• Virus– Norovirus– Rotavirus– Adenovirus
• Bakterier– Campylobacter– Salmonella– Shigella– Toxinproduserende E coli– Yersinia– Listeria– Aeromonas– Plesiomonas– Vibrio spp
• Toxinmediert– Clostridium difficile– Bacillus spp– S aureus
• Parasitter– Giaridia lamblia– Cryptosporidium
– Entamoeba histolytica– Cyclospora
Clinical characteristics of patients from whose stool selected bacterial pathogens were recovered at 10 hospitals in the United States (n = 30,463 specimens).
Guerrant R L et al. Clin Infect Dis. 2001;32:331-351
© 2001 by the Infectious Diseases Society of America
Når lete ?
• Blodig diare• Feber• Dehydrerte tiltrengende iv væske• IBD• Immunsupprimerte• Institusjonaliserte
– Fæcal leukocytter– Fæcal lactoferrin
Behandling
Behandling
Tiltak
• Rehydrering– Peroralt (ORT)
• ”Det man klarer”• ½ ts salt – 6 ts sukker –
1 liter vann• Eplejuice og Farris 1:4
– Intravenøst• Ringeracetat evt med
ekstra elektrolytter (K)
• Kost – banan, ris, fiberfattig
• Antiperistaltikk medikament– Loperamid– Opiumsdråper– Diphenoxylat….
• Anticholinergika– atropin, skopolamin…
• Absorberende– aktivt kull, vismut,
aluminiumforbindelser…
• Probiotika– Laktobacillus,
Saccharomyces
Guideline for the management of acute diarrhea in adults
• Antisekretorisk– NSAIDs (aspirin, indometacin) chlorpromazin….
– Serotoninreopptakshemmere (5HT3)
– Enkephalinase-hemmer (”Racecadotril”)
– Octreotid
Guideline for the management of acute diarrhea in adults
Hvem skal vurderes for antibakteriell behandling ?
• Dehydrerte tiltrengende sykehusinnleggelse ?• Blodig diare ?• Feber • Puss og/eller mucus• IBD• Immunsvekkede• Eldre • Over en ukes varighet ?
Acute infectious diarrhea in immunocompetent adults - NEJM 2002
Hvordan behandle ?