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: © 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

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 ?