Summary
Samenvatting Infectieziekten
- Course
- Institution
Dit document bevat alle hoofdstukken van het deel 'infectieziekten' van Microbiologie en infectieziekten. Dit vak werd gegeven door prof. Peetermans
[Show more]
1 review
By: kikipada • 5 months ago
Seller
Follow
zGNK
Reviews received
Content preview
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
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through EFT, credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying this summary from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller zGNK. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy this summary for R147,11. You're not tied to anything after your purchase.
Can Stuvia be trusted?
4.6 stars on Google & Trustpilot (+1000 reviews)
62555 documents were sold in the last 30 days
Founded in 2010, the go-to place to buy summaries for 14 years now