Download - lp3 neuroviroze
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Diagnostic de laborator in neuroviroze
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Definitie de caz – meningita virala
Febra ≥ 38.5 C asociata cu minim un simptom dintre: Cefalee severa şi persistenta; Redoare de ceafa Durere de ceafa asociata cu minim 2 din urmatoarele:
Fotofobie Greata Varsaturi Faringita exudativa Dureri abdominale
La sugari si copiii mici semnele principale sunt febra ≥ 38.5 C asociata cu iritabilitate si pulsarea fontanelei
1. SUSPICIUNEA CLINICA
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Algoritm de diagnostic virusologic
ETIOLOGIE
POSIBILA
Produs
PatologicIZOLARE Dg. DIRECT
=detectie directa
Dg. INDIRECT
=serologie
80%-90%
Enterovirusuri Polio Cocsackie A si B E.C.H.O.
10 – 20% alte virusuri:VZV; V. URLIAN; HSV; CMV; V. PARAGRIPALE
Materii Fecale*
SNF
LCR**
De electieCulturi celulareAnimal de laborator
NU DA
•Este important de notat ca enterovirusurile se excreta saptamani la rand, dar sansele de izolare scad. Se recomanda recoltarea a 2 - 3 probe de la pacient la interval de 24-48 ore•** Sansa de izolare din acest produs creste când participarea meningiana este evidenta. Acest lucru se traduce prin pleiocitoza (cresterea numarului de celule limfo-monocitare in LCR).
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IZOLAREA ENTEROVIRUSURILOR IN CULTURI DE CELULE ECP picnotic litic
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RSN: IDENTIFICAREA VIRUSURILOR=VIRUS NEUTRALIZARETITRAREA ANTICORPILOR= REACTIA DE SERONEUTRALIZARE
VIRUSNEUTRALIZARE VIRUS NECUNOSCUTANTICORPI CUNOSCUTI=SER IMUN DE
REFERINTA
SERONEUTRALIZARETITRU DE ANTICORPI NECUNOSCUTVIRUS CUNOSCUT = TULPINA DE REFERINTA
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ETAPE RSN
1. TITRAREA INFECTIVITATII VIRALE
2. BLOCAREA INFECTIVITATII VIRALE
3. DEMONSTRAREA NEUTRALIZARII INFECTIVITATII VIRALE
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1.1. TITRAREA INFECTIVITATII VIRALE TITRAREA INFECTIVITATII VIRALE – metoda plajelor– metoda plajelor
Dilutii seriale ale virusului
Insamantare pe celule susceptibiledupa adsorbtie, 1h la 37, se acopera cu agar
Restrictia raspandirii virusului determina liza focalizata a monostratului celular vizibila sub forma plajelor, PFU
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Metoda plajelor
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2. BLOCAREA INFECTIVITATII VIRALE
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3. DEMONSTRAREA NEUTRALIZARII INFECTIVITATII VIRALE
= Repetarea etapei 1 cu amestecurile antigen-anticorp
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Identificarea enterovirusurilor dupa metoda “Tabla de sah”
Lim - Benyesh – Melnick
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ENCEFALITE Algoritm de diagnostic virusologic
SINDROM ETIOLOGIE
POSIBILA
Prod.
Patologic
IZOLARE Dg. DIRECT
=detect. directa
Dg. INDIRECT
=serologie
ENCEFALITA ACUTA
MENINGO-ENCEFALITA
ENCEFALO-MIELITA
HERPES
VIRUSURI:HSV1
HSV2
VZV,EBV,CMV
Lichid vezicular
Biopsie cerebrala
LCR
Culturi celulare
Animal de laborator
PCR
IF
NU
V. RABIC
ARBOVIRUSURI TOGAVIRUSURI
FLAVIVIRUSURI
BUNYAVIRUSURI
SALIVA,
AMPRENTE DERMICE, CORNEENE,
BIOPSIE CEREBRALA
LCR
SANGE
Culturi celulare
Animal de laborator
PCR
IF
De electie pt. ARBO
VIRUSURI
POSTINFECTIOASE:
V. RUJEOLOS
V. URLIAN
V. GRIPALE
VVZ
SALIVA,
BIOPSIE CEREBRALA
LCR
Culturi celulare
PCR
IF
NU