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Mage- tarminfeksjoner. Hva står vi ovenfor ? Virus – Norovirus – Rotavirus – Adenovirus...
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Transcript of Mage- tarminfeksjoner. Hva står vi ovenfor ? Virus – Norovirus – Rotavirus – Adenovirus...
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Mage- tarminfeksjoner
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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
![Page 3: Mage- tarminfeksjoner. Hva står vi ovenfor ? Virus – Norovirus – Rotavirus – Adenovirus Bakterier – Campylobacter – Salmonella – Shigella – Toxinproduserende.](https://reader035.fdocument.pub/reader035/viewer/2022081513/56649c6e5503460f94920055/html5/thumbnails/3.jpg)
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
![Page 4: Mage- tarminfeksjoner. Hva står vi ovenfor ? Virus – Norovirus – Rotavirus – Adenovirus Bakterier – Campylobacter – Salmonella – Shigella – Toxinproduserende.](https://reader035.fdocument.pub/reader035/viewer/2022081513/56649c6e5503460f94920055/html5/thumbnails/4.jpg)
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
![Page 5: Mage- tarminfeksjoner. Hva står vi ovenfor ? Virus – Norovirus – Rotavirus – Adenovirus Bakterier – Campylobacter – Salmonella – Shigella – Toxinproduserende.](https://reader035.fdocument.pub/reader035/viewer/2022081513/56649c6e5503460f94920055/html5/thumbnails/5.jpg)
Hvem gjør hva hvor ?
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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
![Page 7: Mage- tarminfeksjoner. Hva står vi ovenfor ? Virus – Norovirus – Rotavirus – Adenovirus Bakterier – Campylobacter – Salmonella – Shigella – Toxinproduserende.](https://reader035.fdocument.pub/reader035/viewer/2022081513/56649c6e5503460f94920055/html5/thumbnails/7.jpg)
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
![Page 8: Mage- tarminfeksjoner. Hva står vi ovenfor ? Virus – Norovirus – Rotavirus – Adenovirus Bakterier – Campylobacter – Salmonella – Shigella – Toxinproduserende.](https://reader035.fdocument.pub/reader035/viewer/2022081513/56649c6e5503460f94920055/html5/thumbnails/8.jpg)
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
![Page 9: Mage- tarminfeksjoner. Hva står vi ovenfor ? Virus – Norovirus – Rotavirus – Adenovirus Bakterier – Campylobacter – Salmonella – Shigella – Toxinproduserende.](https://reader035.fdocument.pub/reader035/viewer/2022081513/56649c6e5503460f94920055/html5/thumbnails/9.jpg)
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
![Page 10: Mage- tarminfeksjoner. Hva står vi ovenfor ? Virus – Norovirus – Rotavirus – Adenovirus Bakterier – Campylobacter – Salmonella – Shigella – Toxinproduserende.](https://reader035.fdocument.pub/reader035/viewer/2022081513/56649c6e5503460f94920055/html5/thumbnails/10.jpg)
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
![Page 11: Mage- tarminfeksjoner. Hva står vi ovenfor ? Virus – Norovirus – Rotavirus – Adenovirus Bakterier – Campylobacter – Salmonella – Shigella – Toxinproduserende.](https://reader035.fdocument.pub/reader035/viewer/2022081513/56649c6e5503460f94920055/html5/thumbnails/11.jpg)
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
![Page 12: Mage- tarminfeksjoner. Hva står vi ovenfor ? Virus – Norovirus – Rotavirus – Adenovirus Bakterier – Campylobacter – Salmonella – Shigella – Toxinproduserende.](https://reader035.fdocument.pub/reader035/viewer/2022081513/56649c6e5503460f94920055/html5/thumbnails/12.jpg)
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
![Page 13: Mage- tarminfeksjoner. Hva står vi ovenfor ? Virus – Norovirus – Rotavirus – Adenovirus Bakterier – Campylobacter – Salmonella – Shigella – Toxinproduserende.](https://reader035.fdocument.pub/reader035/viewer/2022081513/56649c6e5503460f94920055/html5/thumbnails/13.jpg)
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
![Page 14: Mage- tarminfeksjoner. Hva står vi ovenfor ? Virus – Norovirus – Rotavirus – Adenovirus Bakterier – Campylobacter – Salmonella – Shigella – Toxinproduserende.](https://reader035.fdocument.pub/reader035/viewer/2022081513/56649c6e5503460f94920055/html5/thumbnails/14.jpg)
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
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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
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Når lete ?
• Blodig diare• Feber• Dehydrerte tiltrengende iv væske• IBD• Immunsupprimerte• Institusjonaliserte
– Fæcal leukocytter– Fæcal lactoferrin
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Behandling
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Behandling
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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)
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• 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
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• Antisekretorisk– NSAIDs (aspirin, indometacin) chlorpromazin….
– Serotoninreopptakshemmere (5HT3)
– Enkephalinase-hemmer (”Racecadotril”)
– Octreotid
Guideline for the management of acute diarrhea in adults
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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
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Hvordan behandle ?