mage- tarminfeksjoner. hva står vi ovenfor ? virus – norovirus – rotavirus – adenovirus...

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 ?