Transcript Mage-tarm infeksjoner. - Pko

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
• Absorberende
– banan, ris, fiberfattig
• Antiperistaltikk
medikament
– aktivt kull, vismut,
aluminiumforbindelser…
• Probiotika
– Laktobacillus,
Saccharomyces
– Loperamid
– Opiumsdråper
– Diphenoxylat….
• Anticholinergika
– atropin, skopolamin…
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 ?