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Volledige samenvatting infectieziekten prof. De Munter
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Volledige samenvatting infectieziekten prof. De Munter. Geslaagd met glans in eerste zit.
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SV INFECTIEZIEKTENEXAMEN
• 1 open, grote vraag (ongeveer 1 hoofdstuk)
• 1 open vraag over de cursus heen vb bespreek klierkoorts
• 1 casus: DD en behandeling geven
Examen........................................................................................................................................................... 1
H1: Pathofysiologie van infectieziekten .......................................................................................................... 4
Definities ............................................................................................................................................................. 4
Pathofysiologie.................................................................................................................................................... 4
Microbiële virulentie ........................................................................................................................................... 5
Pathogenese van infecties .................................................................................................................................. 5
Afweermechanismen van de gastheer ................................................................................................................ 6
H2: Epidemiologie van infectieziekten ............................................................................................................ 8
Beschrijvende epidemiologie............................................................................................................................... 8
Surveillance ......................................................................................................................................................... 8
H3: Klinische aspecten en aanvullende diagnostiek van infectieziekten .......................................................... 9
Klinische aspecten ............................................................................................................................................... 9
Koorts .................................................................................................................................................................. 9
Aanvullende diagnostiek ................................................................................................................................... 11
H4: Sepsis ..................................................................................................................................................... 12
Definities ........................................................................................................................................................... 12
Etiologie ............................................................................................................................................................ 12
Pathogenese ..................................................................................................................................................... 13
Prognose ........................................................................................................................................................... 15
Behandeling ...................................................................................................................................................... 15
Bijzondere gevallen van sepsis .......................................................................................................................... 15
H5: Koorts bij terugkeer uit (sub)tropen........................................................................................................ 17
H6: Infectieuze diarree .................................................................................................................................. 19
Etiologie en pathogenese .................................................................................................................................. 19
Symptomen en diagnose ................................................................................................................................... 20
1
, Behandeling ...................................................................................................................................................... 20
Antibiotica-geassocieerde diarree .................................................................................................................... 20
H7: HIV en AIDS ............................................................................................................................................ 22
Epidemiologie.................................................................................................................................................... 22
Transmissie ....................................................................................................................................................... 22
Klinisch verloop ................................................................................................................................................. 22
Initiële evaluatie ................................................................................................................................................ 23
Klinische classificatie ......................................................................................................................................... 23
Behandeling en opvolging van de HIV patiënt .................................................................................................. 24
Preventie bij zorgverleners ................................................................................................................................ 26
Preventie bij niet-professionele risico’s ............................................................................................................. 26
H8: Seksueel overdraagbare aandoeningen (SOA) ......................................................................................... 27
Syphilis .............................................................................................................................................................. 27
Gonorree ........................................................................................................................................................... 27
Niet gonokokken urethritis................................................................................................................................ 28
Herpes genitalis................................................................................................................................................. 28
Condylomata accuminata ................................................................................................................................. 28
Algemene opmerkingen bij SOA ........................................................................................................................ 28
H9: Bacteriële infecties ................................................................................................................................. 29
Buiktyphus......................................................................................................................................................... 29
Non-typhi salmonellosen................................................................................................................................... 29
Bijtwonden ........................................................................................................................................................ 29
Leptospirose ...................................................................................................................................................... 30
KatteNkrabziekte .............................................................................................................................................. 30
Ziekte van Lyme ................................................................................................................................................ 31
Tetanus ............................................................................................................................................................. 32
Pertussis ............................................................................................................................................................ 32
H10: Virale infecties ...................................................................................................................................... 34
Influenza............................................................................................................................................................ 34
Mononucleosis infectiosa .................................................................................................................................. 34
Cytomegalovirus ............................................................................................................................................... 35
Herpes Simplex virus ......................................................................................................................................... 35
Varicella Zoster Virus ........................................................................................................................................ 36
Hantavirus ......................................................................................................................................................... 37
SARS/MERS ....................................................................................................................................................... 37
COVID-19 (SARS-CoV-2)..................................................................................................................................... 38
2
,H11: Fungale infecties ................................................................................................................................... 39
Candidase.......................................................................................................................................................... 39
Aspergillose ....................................................................................................................................................... 40
H12: Parasitaire infecties .............................................................................................................................. 41
Toxoplasmose ................................................................................................................................................... 41
Malaria.............................................................................................................................................................. 41
H13: Vaccinaties bij volwassenen .................................................................................................................. 42
Wie vaccineren? ................................................................................................................................................ 42
Basisvaccinatieschema...................................................................................................................................... 42
Tetanus-difterie ................................................................................................................................................. 42
Influenza............................................................................................................................................................ 43
Pneumokokken .................................................................................................................................................. 44
Hoe patiënten overtuigen ................................................................................................................................. 45
EXTRA: Asplenie ................................................................................................................................................ 45
H14: Rationele antimicrobiële therapie......................................................................................................... 46
Inleiding ............................................................................................................................................................ 46
Microbiologische basis van antibiotica therapie ............................................................................................... 46
Farmacologische basis van antimicrobiële therapie ......................................................................................... 49
Klinische basis van antimicrobiele therapie ...................................................................................................... 50
3
, H1: PATHOFYSIOLOGIE VAN INFECTIEZIEKTEN
DEFINITIES
Infectieziekte = klinisch waarneembare toestand van schade of verandering in de normale fysiologie
van de gastheer die gepaard gaat met een ontstekingsreactie (inflammatie), veroorzaakt door de
besmetting met een ziekmakend micro-organisme
Besmetting gaat infectie vooraf, maar leidt niet noodzakelijk tot infectie, soms is er enkel kolonisatie
(vb darmflora) of dragerschap (micro-organismen vermenigvuldigen zich, maar leiden niet tot
inflammatie of schade)
PATHOFYSIOLOGIE
Infectie als pathogeen vermogen van micro-organisme (virulentie) > afweermechanismen gastheer
PIRAMIDE VAN DE INFECTIEZIEKTEN : geeft interactie tussen micro-organisme en gastheer weer
Klinisch beeld wordt bepaald door ziekmakend vermogen vh micro-organisme en de infectiefocus
enerzijds en inflammatoire reactie van de gastheer anderzijds
4
, MICROBIËLE VIRULENTIE
Onderscheid op basis van ziekmakend vermogen van micro-organismen (virulentie)
PRIMAIR/OBLIGAAT PATHOGENE MICRO-ORGANISMEN
• Besmetting -> ziekte (meestal)
• Exogene infectie, overdraagbaar, kunnen leiden tot epidemie
• Salmonella typhi, mycobacterium tuberculosis, HIV, influenza, SARS-COV2, mazelen, shigella,
plasmodium falciparum
• Preventie: vermijden blootstelling, eradiceren reservoir en vector, vaccinatie, chemoprofylaxe
POTENTIEEL PATHOGENEN MICRO-ORGANISMEN
• Besmetting -> kolonisatie = dragerschap
• Commensale flora
• Infectie als
o Lokale of algemene voorbeschiktheid
§ Vb iv kathederinfectie door coagulase negatieve stafylokokken
§ Postoperatieve wondinfectie
§ Candida in de mond of vulvovaginaal: bij diabetica of na AB
o Micro-organismen krijgen toegang tot steriele lichaamscompartimenten vb e.coli in
de urine
• Endogene infectie: worden dus veroorzaakt door eigen flora
• Preventie: vermijden of corrigeren van voorbeschikkende gastheerfactoren en
hygiëne/asepsie in de zorg
• Nosocomiale infecties = verworven in het ziekenhuis
o Koloniserende micro-organismen die de pt verwerft tijdens ziekenhuisopname
o Kan evolueren naar ernstige infectie
o Vaak AB-resistent
o Preventie: vermijden voorbeschikkende gastheerfactoren, hygiëne/asepsie in de zorg,
bronisolatie
OPPORTUNISTISCHE MICRO-ORGANISMEN
• Besmetting -> kolonisatie bij gezonde personen
• Infectie enkel bij gastheer met ernstige stoornis in humorale of cellulaire afweermechanismen
• Exogeen, maar niet overdraagbaar tussen gezonde personen -> geen epidemies
• Pneumocystis jiroveci pneumonie bij AIDS pt, aspergillus pneumonie bij de langdurige
neutropene pt na chemotherapie
PATHOGENESE VAN INFECTIES
Noodzakelijk voor infectie: virulentiefactoren en inflammatoire respons van gastheer
VIRULENTIEFACTOREN VAN MICRO-ORGANISME
• Adherentie: stabiele binding van micro-organisme aan lichaamsoppervlak
• Proliferatie
• Exotoxines -> inflammatie en ziektesymptomen vb tetanospasmine van Clostridium tetani
• Invasief worden
1. Overschrijden huid- en mucosabarrière
2. Weerstandig aan afweermechanismen van gastheer (innate immunity)
3. Verspreiden in lichaam naar doelwitorganen
5
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