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Samenvatting Infectieziekten
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Dit document bevat alle hoofdstukken van het deel 'infectieziekten' van Microbiologie en infectieziekten. Dit vak werd gegeven door prof. Peetermans
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INHOUDHoofdstuk 1: pathofysiologie van infectieziekten ................................................................................................... 6
Pathofysiologie .................................................................................................................................................... 6
Microbiële virulentie ........................................................................................................................................... 6
Pathogenese van infecties .................................................................................................................................. 7
Afweermechanismen van de gastheer................................................................................................................ 8
Huid- en mucosabarrière ................................................................................................................................ 8
Humorale afweermechanismen ...................................................................................................................... 9
Cellulaire afweermechanismen....................................................................................................................... 9
Fagocyten .................................................................................................................................................... 9
Lymfocyten .................................................................................................................................................. 9
Hoofdstuk 2: epidemiologie van infectieziekten................................................................................................... 10
Beschrijvende epidemiologie ............................................................................................................................ 10
Surveillance ....................................................................................................................................................... 10
Hoofdstuk 3: klinische aspecten van infectieziekten en aanvullende diagnostiek ............................................... 11
Klinische aspecten ............................................................................................................................................. 11
Koorts ................................................................................................................................................................ 11
Pathogenese.................................................................................................................................................. 11
Koortspatronen ............................................................................................................................................. 12
Behandeling .................................................................................................................................................. 12
Aanvullende diagnostiek ................................................................................................................................... 13
Hoofdstuk 4: sepsis ............................................................................................................................................... 14
Inleiding............................................................................................................................................................. 14
Etiologie ............................................................................................................................................................ 14
Pathogenese...................................................................................................................................................... 15
Prognose ........................................................................................................................................................... 15
Behandeling ...................................................................................................................................................... 16
Bijzondere gevallen van sepsis .......................................................................................................................... 17
Hoofdstuk 5: koorts bij terugkeer uit de (sub)tropen ........................................................................................... 19
Diagnostisch beleid ........................................................................................................................................... 19
Hoofdstuk 6: infectieuze diarree........................................................................................................................... 21
Etiologie en pathogenese.................................................................................................................................. 21
Symptomen en diagnose................................................................................................................................... 21
Behandeling ...................................................................................................................................................... 22
Antibiotica-geassocieerde diarree .................................................................................................................... 22
Hoofdstuk 7: HIV en AIDS ...................................................................................................................................... 24
1
, Epidemiologie ................................................................................................................................................... 24
Transmissie ....................................................................................................................................................... 24
Klinisch verloop ................................................................................................................................................. 24
Initiële evaluatie ................................................................................................................................................ 25
Klinische classificatie ......................................................................................................................................... 25
Behandeling en opvolging van de HIV-patiënt .................................................................................................. 26
Preventie bij zorgverleners ............................................................................................................................... 27
Preventie bij niet-professionele risico’s ............................................................................................................ 28
Hoofdstuk 8: seksueel overdraagbare aandoeningen (SOA) ................................................................................ 29
Syfilis ................................................................................................................................................................. 29
Etiologie ........................................................................................................................................................ 29
Kliniek ............................................................................................................................................................ 29
DIagnose........................................................................................................................................................ 29
Behandeling .................................................................................................................................................. 29
Gonorree ........................................................................................................................................................... 30
Etiologie ........................................................................................................................................................ 30
Kliniek ............................................................................................................................................................ 30
DIagnose........................................................................................................................................................ 30
Behandeling .................................................................................................................................................. 30
Niet-gonokokken urethritis (NGU) .................................................................................................................... 30
Etiologie ........................................................................................................................................................ 30
Kliniek ............................................................................................................................................................ 30
DIagnose........................................................................................................................................................ 31
Behandeling .................................................................................................................................................. 31
Herpes genitalis ................................................................................................................................................. 31
Etiologie ........................................................................................................................................................ 31
Kliniek ............................................................................................................................................................ 31
DIagnose........................................................................................................................................................ 31
Behandeling .................................................................................................................................................. 31
Condylomata accuminata ................................................................................................................................. 31
Etiologie ........................................................................................................................................................ 31
Kliniek ............................................................................................................................................................ 31
Behandeling .................................................................................................................................................. 32
Algemene opmerkingen .................................................................................................................................... 32
Hoofdstuk 9: bacteriële infecties .......................................................................................................................... 33
Buiktyfus ........................................................................................................................................................... 33
Etiologie ........................................................................................................................................................ 33
2
, Kliniek ............................................................................................................................................................ 33
DIagnose........................................................................................................................................................ 33
Behandeling .................................................................................................................................................. 33
Non-typhi salmonellosen .................................................................................................................................. 33
Etiologie ........................................................................................................................................................ 33
Kliniek ............................................................................................................................................................ 34
Behandeling .................................................................................................................................................. 34
Brucellose .......................................................................................................................................................... 34
Etiologie ........................................................................................................................................................ 34
Kliniek ............................................................................................................................................................ 34
Diagnose........................................................................................................................................................ 34
Behandeling .................................................................................................................................................. 34
Leptospirose ...................................................................................................................................................... 34
Etiologie ........................................................................................................................................................ 34
Kliniek ............................................................................................................................................................ 35
Diagnose........................................................................................................................................................ 35
Behandeling .................................................................................................................................................. 35
Kattenkrabziekte (bartonella) ........................................................................................................................... 35
Etiologie ........................................................................................................................................................ 35
Kliniek ............................................................................................................................................................ 35
Diagnose........................................................................................................................................................ 35
Behandeling .................................................................................................................................................. 36
Ziekte van Lyme ................................................................................................................................................ 36
Etiologie ........................................................................................................................................................ 36
Kliniek ............................................................................................................................................................ 36
Diagnose........................................................................................................................................................ 37
Behandeling .................................................................................................................................................. 37
Tetanus (wondklem) ......................................................................................................................................... 37
Etiologie ........................................................................................................................................................ 37
Kliniek ............................................................................................................................................................ 37
Diagnose........................................................................................................................................................ 37
Behandeling .................................................................................................................................................. 38
Pertussis (kinkhoest) ......................................................................................................................................... 38
Etiologie ........................................................................................................................................................ 38
Kliniek ............................................................................................................................................................ 38
Diagnose........................................................................................................................................................ 38
Behandeling .................................................................................................................................................. 38
3
,Hoofdstuk 10: virale infecties ............................................................................................................................... 39
Influenza (griep) ................................................................................................................................................ 39
Etiologie ........................................................................................................................................................ 39
Kliniek ............................................................................................................................................................ 39
Diagnose........................................................................................................................................................ 39
Behandeling .................................................................................................................................................. 39
Mononucleosis infectiosa (klierkoorts) ............................................................................................................. 39
Etiologie ........................................................................................................................................................ 39
Kliniek ............................................................................................................................................................ 40
Diagnose........................................................................................................................................................ 40
Behandeling .................................................................................................................................................. 40
Cytomegalovirus (CMV) .................................................................................................................................... 40
Etiologie ........................................................................................................................................................ 40
Kliniek ............................................................................................................................................................ 40
Diagnose........................................................................................................................................................ 41
Behandeling .................................................................................................................................................. 41
Herpes simplex virus (HSV) ............................................................................................................................... 41
Etiologie ........................................................................................................................................................ 41
Kliniek ............................................................................................................................................................ 41
Diagnose........................................................................................................................................................ 41
Behandeling .................................................................................................................................................. 41
Varicella zoster virus (VZV)................................................................................................................................ 42
Etiologie ........................................................................................................................................................ 42
Kliniek ............................................................................................................................................................ 42
Diagnose........................................................................................................................................................ 42
Behandeling .................................................................................................................................................. 42
Hanta-virus ........................................................................................................................................................ 43
Etiologie ........................................................................................................................................................ 43
Kliniek ............................................................................................................................................................ 43
Diagnose........................................................................................................................................................ 43
Behandeling .................................................................................................................................................. 43
SARS/MERS ....................................................................................................................................................... 43
Etiologie ........................................................................................................................................................ 43
Kliniek ............................................................................................................................................................ 44
Diagnose........................................................................................................................................................ 44
Behandeling .................................................................................................................................................. 44
Hoofdstuk 11: fungale infecties ............................................................................................................................ 45
4
, Candidiase ......................................................................................................................................................... 45
Etiologie ........................................................................................................................................................ 45
Kliniek ............................................................................................................................................................ 45
Behandeling .................................................................................................................................................. 45
Aspergillose ....................................................................................................................................................... 45
Etiologie ........................................................................................................................................................ 45
Kliniek ............................................................................................................................................................ 45
Diagnose........................................................................................................................................................ 46
Behandeling .................................................................................................................................................. 46
Hoofdstuk 12: parasitaire infecties ....................................................................................................................... 47
Toxoplasmose ................................................................................................................................................... 47
Etiologie ........................................................................................................................................................ 47
Kliniek ............................................................................................................................................................ 47
Diagnose........................................................................................................................................................ 47
Behandeling .................................................................................................................................................. 47
Malaria .............................................................................................................................................................. 47
Hoofdstuk 13: vaccinaties bij volwassenen........................................................................................................... 48
Tetanus-difterie................................................................................................................................................. 48
influenzavaccin .................................................................................................................................................. 48
pneumokokkenvaccin ....................................................................................................................................... 49
SARS-CoV2 vaccin .............................................................................................................................................. 49
Hoofdstuk 14: rationele antimicrobiële therapie ................................................................................................. 50
Inleiding............................................................................................................................................................. 50
Microbiële basis van antibiotica therapie ......................................................................................................... 50
Gevoeligheid ................................................................................................................................................. 50
Werkingsmechanisme ................................................................................................................................... 50
Antimicrobiële resistentiemechanismen ...................................................................................................... 51
Antibioticaresistentie uit klinische praktijk ................................................................................................... 51
Farmacologische basis van antimicrobiële therapie ......................................................................................... 52
Klinische basis van antimicrobiële therapie ...................................................................................................... 53
Principe van rationele antimicrobiële therapie ............................................................................................ 53
Formularium en antibioticabeleid..................................................................................................................... 53
Empirische therapie ...................................................................................................................................... 53
Gerichte therapie .......................................................................................................................................... 54
Profylaxe ....................................................................................................................................................... 54
Medische indicaties voor profylaxe .............................................................................................................. 54
5
,INFECTIEZIEKTEN
HOOFDSTUK 1: PATHOFYSIOLOGIE VAN INFECTIEZIEKTEN
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 vooraf, maar leidt niet altijd tot infectie, soms ook dragerschap (louter kolonisatie)
- Klinisch waarneembaar: anamnese, klinisch onderzoek, parameters, labo
PATHOFYSIOLOGIE
Infectie = wanneer het pathogeen vermogen van het micro-organisme (virulentie) de overhand haalt op de
afweermechanismen (immuunsysteem) van de gastheer
Pathogeen micro-organisme
- °virulentie <-> weerstand van de gastheer
- °kolonisatie <-> kolonisatieresistentie door commensale micro-organismen van gastheer
- °resistentie → ontsnappen aan verdedigingsmechanismen
Therapie
- Farmacokinetiek <-> metabolisatie en excretie
- Farmacodynamiek <-> resistentie aan medicatie, AB
- Opletten voor interacties tussen geneesmiddelen en toxiciteit
Klinisch beeld van een infectie wordt bepaald door:
- Ziekmakend vermogen van het micro-organisme (virulentiefactoren)
- Focus van infectie
- Inflammatoire reactie van de gastheer
MICROBIËLE VIRULENTIE
Primair (obligaat) pathogene micro-organismen = besmetting leidt in vele gevallen tot ziekte, bij een groot
deel van de gevoelige, overigens gezonde populatie, kort of lang na de besmetting
- Exogene infecties → overdraagbaar → °epidemie
- Bv Salmonella typhi, Mycobacterium tuberculosis, HIV, influenza, SARS-CoV2, mazelen, Plasmodium
falciparum
- Preventie:
o Vermijden blootstelling
o Eradiceren (uitroeien) reservoir of vector
o Vaccinatie
o Chemoprofylaxe (pillen)
6
,Potentieel pathogene micro-organismen = besmetting leidt meestal tot kolonisatie (dragerschap). Infectie
treedt enkel op bij een lokale of algemene voorbeschiktheid (intravasculaire katheter (bv coagulase-negatieve
stafylokokken) of diabetes (Candida)) of indien micro-organismen toegang hebben tot steriele
lichaamscompartimenten (bv E. coli in urine)
- Endogene infecties → weinig overdraagbaar
- Bv commensale flora
- Preventie:
o Vermijden of corrigeren van voorbeschikkende factoren
o Asepsie in zorg
Nosocomiale infecties = infectie door koloniserende micro-organismen die de patiënt verwerft tijdens de
ziekenhuisopname
- Speciale vorm van potentieel pathogeen
- Initiële kolonisatie kan evolueren naar ernstige infecties met micro-organismen die vaak multiresistent
zijn tegen AB
- Bv MRSA, Clostridium
- Preventie:
o Vermijden van voorbeschikkende factoren (bv sonde, intravasculaire katheter verwijderen)
o Asepsie in zorg
o Bronisolatie
o Strikte handhygiëne → vermijden verspreiding nosocomiale kiemen
Opportunistisch pathogene micro-organismen = besmetting leidt tot (voorbijgaande) kolonisatie bij gezonde
personen. Infectie treedt enkel op bij de gastheer met ernstige stoornis in de humorale of cellulaire
afweermechanismen
- Exogene infecties → niet overdraagbaar naar gezonde, wel naar zieke personen → niet °epidemie
- Bv Pneumocystis jiroveci pneumonie bij AIDS, Aspergillus pneumonie bij neutropene patiënt met
chemotherapie
- Preventie:
o Vermijden contact met besmettelijke bron
o Protectieve isolatie: voorbeschikte patiënten (bv luchtfilter)
PATHOGENESE VAN INFECTIES
Micro-organismen brengen virulentiefactoren tot expressie
- Adhesie: micro-organismen gaan een stabiele binding aan met het lichaamsoppervlak
o Proliferatie aan lichaamsoppervlak
o Secretie van exotoxines → inflammatie en ziektesymptomen
- Invasie (soms): overschrijden huid- en mucosabarrière
o Weerstandig aan spontane afweermechanismen van de gastheer (innate immuunsysteem)
o Verspreiden in lichaam (uitzaaiingen) naar doelwitorganen
o °inflammatie reactie door gastheer (adaptive immuunsysteem)
▪ Gemedieerd door celwandbestanddelen van het micro-organisme (endotoxines) (LPS
van gram neg bacteriën, teicchoïnezuur, lipoteichoïnezuur van gram pos bacteriën)
▪ WBC, macrofagen
▪ Mogelijkheden van micro-organismen om aan verdediging te ontsnappen
7
, AFWEERMECHANISMEN VAN DE GASTHEER
Niet antigeen-specifiek Antigeen-specifiek
Huid- en mucosabarrière Mechanisme barrière Secretoir IgA
Secreties
Motiliteit
Kolonisatie-resistentie
Humorale afweer Lactoferrine Immunoglobulines (Ig)
Lysosyme
Complementfactoren
Cellulaire afweer
- Fagocyten Granulocyten /
Monocyten – macrofagen
- Lymfocyten / T-lymfocyten
HUID- EN MUCOSABARRIÈRE
Stoornissen in huid- en mucosabarrière zijn frequent in de klinische praktijk
- Postoperatieve wondinfecties
- Intravasculaire kathetersepsis
- Urineweginfecties (UWI) op blaassonde
- Ventilatie-geassocieerde pneumonie
NIET ANTIGEEN-SPECIFIEK
- Mechanische barrière tegen invasie
- Versterkt door:
o Microbiële secreties van talg- en zweetklieren in de hudi
o Maagzuur
o Productie mucus in luchtwegen
o Afschilfering van huidcellen
o Motiliteit thv mucosae (darmperistaltiek, diurese, hoesten)
- Kolonisatieresistentie: commensale flora verhinderen adhesie en proliferatie van pathogene micro-
organismen
ANTIGEEN-SPECIFIEK
- Secretoir IgA
8
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