Boli infecto-contagioase Boli infecto-contagioase

Curs pediatrie
Prof. Dr. Ioana Alina Anca
Curs pediatrie
Prof. Dr. Ioana Alina Anca
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Aspecte generale Aspecte generale
l Boal infecto-contagioas
l Etiologie
l Modaliti de transmitere
l Incubaie
l Perioada prodromal
l Perioada de stare
l Convalescena
l Contagiozitate
l Tipuri de imunitate
l Boal infecto-contagioas
l Etiologie
l Modaliti de transmitere
l Incubaie
l Perioada prodromal
l Perioada de stare
l Convalescena
l Contagiozitate
l Tipuri de imunitate
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Boli infecto-contagioase
Romnia
Boli infecto-contagioase
Romnia
l Boli prevenite prin vaccinarea
obligatorie
l Polio
l Difterie
l Tetanos
l Pertussis
l Rujeol
l Rubeol
l Parotidit epidemica
l Hepatit B
l tbc
l Boli prevenite prin vaccinarea
obligatorie
l Polio
l Difterie
l Tetanos
l Pertussis
l Rujeol
l Rubeol
l Parotidit epidemica
l Hepatit B
l tbc
l Boli ce ar putea fi prevenite
prin vaccinare
l Gripa
l H. Influenzae
l Hepatita A
l Varicel
l Meningococ
l Pneumococ
l Rotavirus
l HPV
l Boli ce ar putea fi prevenite
prin vaccinare
l Gripa
l H. Influenzae
l Hepatita A
l Varicel
l Meningococ
l Pneumococ
l Rotavirus
l HPV
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Boli infecto-contagioase Boli infecto-contagioase
Vaccinare obligatorie n Romnia Vaccinare obligatorie n Romnia
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Poliomielita - istoric Poliomielita - istoric
l polios cenuiu
l myelos - mduv
l Cunoscut din antichitate
l infirmiti, atrofii musculare
l Pn n secolul XIX sporadic
l 1840 J akob Heine prima recunoatere ca entitate patologic
l Secolul XX epidemii frecvente cu un maxim n anii 50.
l Prevalena la nivel mondial a sczut prin campania agresiv de imunizri.
l Eradicarea bolii prioritate OMS 2007
l polios cenuiu
l myelos - mduv
l Cunoscut din antichitate
l infirmiti, atrofii musculare
l Pn n secolul XIX sporadic
l 1840 J akob Heine prima recunoatere ca entitate patologic
l Secolul XX epidemii frecvente cu un maxim n anii 50.
l Prevalena la nivel mondial a sczut prin campania agresiv de imunizri.
l Eradicarea bolii prioritate OMS 2007
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Poliomielita Poliomielita
l Infecie enteroviral determinat de virusurile polio picoRNA
l 3 tulpini I Brunhilde, II Lansing, III Leon,
l Nu confer imunitate incruciat
l Afecteaz persoane de orice vrst
l 50% copii ntre 3 5 ani
l Neurotropism
l 1% dintre cei neimunizai dezvolt
l paralizie flasc atrofii musculare
l Transmitere fecal oral
l ap, alimente contaminate
l contagiozitatea - sptmni
l Infecie enteroviral determinat de virusurile polio picoRNA
l 3 tulpini I Brunhilde, II Lansing, III Leon,
l Nu confer imunitate incruciat
l Afecteaz persoane de orice vrst
l 50% copii ntre 3 5 ani
l Neurotropism
l 1% dintre cei neimunizai dezvolt
l paralizie flasc atrofii musculare
l Transmitere fecal oral
l ap, alimente contaminate
l contagiozitatea - sptmni
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Poliomielita Poliomielita
l Incubaie medie 5-35 zile
l Boala minor - pseudogripal 2-4 zile
l Febr, vrsturi, cefalee, redoare ceaf
l Astenie, dureri la nivelul extremitilor
l Boala major 10-14 zile
l replicare n tract GI - limfatice - viremie - coarne anterioare
mduv/bulb
l Neurotropismul - paralizie flasc
l Incubaie medie 5-35 zile
l Boala minor - pseudogripal 2-4 zile
l Febr, vrsturi, cefalee, redoare ceaf
l Astenie, dureri la nivelul extremitilor
l Boala major 10-14 zile
l replicare n tract GI - limfatice - viremie - coarne anterioare
mduv/bulb
l Neurotropismul - paralizie flasc
Forme de infecie
l infecie inaparent - 90 - 95 %
l forme non paralitice
l meningit aseptic
l forme paralitice 1 %
l spinal
l bulbar
l bulbo-spinal
Forme de infecie
l infecie inaparent - 90 - 95 %
l forme non paralitice
l meningit aseptic
l forme paralitice 1 %
l spinal
l bulbar
l bulbo-spinal
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Poliomielita tablou clinic Poliomielita tablou clinic
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febra
paralizii
Boala
minor
Stadiul paralitic
Laten
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Diagnosticul pozitiv Diagnosticul pozitiv
l Anamneza
l copil nevaccinat / vaccinare incomplet
l Examen fizic
l Forme simptomatice
l Investigaii
l culturi faringe, urin, scaun
l PL + culturi
l Anamneza
l copil nevaccinat / vaccinare incomplet
l Examen fizic
l Forme simptomatice
l Investigaii
l culturi faringe, urin, scaun
l PL + culturi
l Sindromul post-polio
l Slbiciune muscular, astenie
l la 20-40 de ani de la infecie polio inaparent
l Sindromul post-polio
l Slbiciune muscular, astenie
l la 20-40 de ani de la infecie polio inaparent
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Vaccinurile AP Vaccinurile AP
OPVvaccin viu atenuat - po (Sabin 1961)
l Imunizeaz i mpiedic rspndirea virusului
l crete imunitatea la nivelul tractului GI
l mpiedic rspndirea virusului slbatic
l n rare cazuri determin paralizii asociate vaccinrii
l Recomandat n zonele n care mai circul virus slbatic
l Contraindicat
l Imunodeficiene corticoterapie, neoplazii, SIDA
OPVvaccin viu atenuat - po (Sabin 1961)
l Imunizeaz i mpiedic rspndirea virusului
l crete imunitatea la nivelul tractului GI
l mpiedic rspndirea virusului slbatic
l n rare cazuri determin paralizii asociate vaccinrii
l Recomandat n zonele n care mai circul virus slbatic
l Contraindicat
l Imunodeficiene corticoterapie, neoplazii, SIDA
I PV vaccin inactivat - inj (Salk 1955)
l Recomandat n zonele unde infecia este eradicat
l Imunizeaz dar nu mpiedic rspndirea virusului
I PV vaccin inactivat - inj (Salk 1955)
l Recomandat n zonele unde infecia este eradicat
l Imunizeaz dar nu mpiedic rspndirea virusului
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Poliomielita plmn artificial
1953
Poliomielita plmn artificial
1953
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Pertussis Pertussis
l Infecie respiratorie foarte contagioas
l Bordetella pertussis bacil gram -
l Secolul XIV primele epidemii
l 1906 izolarea Bordetella pertussis
l imunitatea transplacentar absent
l Sindroame pertusisoide
l Bordetella parapertussis, Mycoplasma pn, Chlamydia pn.
l Pertussis la adult
l 7% dintre bolile nsoite de tuse / an
l forme mai uoare dect la sugar i copil
l adultul - surs de infecie pentru copil
l la nivel mondial 285.000 decesen 2001
l Infecie respiratorie foarte contagioas
l Bordetella pertussis bacil gram -
l Secolul XIV primele epidemii
l 1906 izolarea Bordetella pertussis
l imunitatea transplacentar absent
l Sindroame pertusisoide
l Bordetella parapertussis, Mycoplasma pn, Chlamydia pn.
l Pertussis la adult
l 7% dintre bolile nsoite de tuse / an
l forme mai uoare dect la sugar i copil
l adultul - surs de infecie pentru copil
l la nivel mondial 285.000 decesen 2001
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Pertussis Pertussis
l Transmitere - respiratorie picturi Pflugger
l Incubaie medie 5-10 zile, maximum21 zile
l Stadiul cataral 1-2 sptmni
l contagiozitate maxim
l debut insidios similar I ACRS uoare, tuse nespecific, febr absent / mic
l Tuse paroxistic - 1-6 sptmni
l spastic, zgomot caracteristic
l chinte uramte de episoade de apnee cianoz
l emetizant
l Convalescen - 2-3 sptmni luni
l reactivarea tusei cu ocazia IACRS
l Transmitere - respiratorie picturi Pflugger
l Incubaie medie 5-10 zile, maximum21 zile
l Stadiul cataral 1-2 sptmni
l contagiozitate maxim
l debut insidios similar I ACRS uoare, tuse nespecific, febr absent / mic
l Tuse paroxistic - 1-6 sptmni
l spastic, zgomot caracteristic
l chinte uramte de episoade de apnee cianoz
l emetizant
l Convalescen - 2-3 sptmni luni
l reactivarea tusei cu ocazia IACRS
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Pertussis Pertussis
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Criteriile OMS Criteriile OMS
l Definie caz clinic
l Caz diagnosticat cu tuse convulsiv de ctre medic sau
l tuse de 14 zile i 1 simptom
l Tuse paroxistic
l Zgomot inspirator
l Emetizant
l Criterii de confirmare paraclinic
l izolarea Bordetella pertussis sau
l PCR detecia secvenelor genomice sau
l Serologii pereche pozitive
l Clasificarea cazurilor
l Caz confirmat clinic
l ndeplinete criteriile clinice dar nu e confirmat paraclinic
l Caz confirmat paraclinic
l ndeplinete criteriile clinice i este confirmat paraclinic
l Definie caz clinic
l Caz diagnosticat cu tuse convulsiv de ctre medic sau
l tuse de 14 zile i 1 simptom
l Tuse paroxistic
l Zgomot inspirator
l Emetizant
l Criterii de confirmare paraclinic
l izolarea Bordetella pertussis sau
l PCR detecia secvenelor genomice sau
l Serologii pereche pozitive
l Clasificarea cazurilor
l Caz confirmat clinic
l ndeplinete criteriile clinice dar nu e confirmat paraclinic
l Caz confirmat paraclinic
l ndeplinete criteriile clinice i este confirmat paraclinic
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Pertussis - Complicaii Pertussis - Complicaii
o Pneumonie
o Crize de apnee i cianoz
o Convulsii hipoxice
o Encefalopatie
o Deces
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Difteria Difteria
l Extrem de rar n rile industrializate - datorit vaccinrii
l Corynebacterium diphtheriae - toxin difteric
l Sursa persoane bolnave
l Transmitere
l respiratorie
l contact direct cu produse infectate
l I ncubaia 2-4 zile
l Perioada de stare
l pseudomembrane - amigdale, faringe
l alb murdar, aderente
l coriz serosanguinolent
l subfebrilitate / febr
l adenopatii cervicale gt de taur
l Extrem de rar n rile industrializate - datorit vaccinrii
l Corynebacterium diphtheriae - toxin difteric
l Sursa persoane bolnave
l Transmitere
l respiratorie
l contact direct cu produse infectate
l I ncubaia 2-4 zile
l Perioada de stare
l pseudomembrane - amigdale, faringe
l alb murdar, aderente
l coriz serosanguinolent
l subfebrilitate / febr
l adenopatii cervicale gt de taur
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Difteria Difteria
l Mortalitate 5-10 %
l stare toxico-septic,
l miocardit,
l encefalopatie,
l insuficien renal acut - necroz tublar
l insuficien acut respiratorie, colaps
l Diagnostic bacteriologic
l culturi faringe
l Tratametul
l Antibiotic penicilin, macrolide, clindamicin
l dispriia contagioztii n 24 h
l Ser antidifteric + anatoxin
l Mortalitate 5-10 %
l stare toxico-septic,
l miocardit,
l encefalopatie,
l insuficien renal acut - necroz tublar
l insuficien acut respiratorie, colaps
l Diagnostic bacteriologic
l culturi faringe
l Tratametul
l Antibiotic penicilin, macrolide, clindamicin
l dispriia contagioztii n 24 h
l Ser antidifteric + anatoxin
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Tetanosul Tetanosul
l Clostridium tetani - Gram+ anaerob - neurotoxin
l Poarta de intrare cutanat plgi infectate
l Incubaie 3-21 zile
l Perioada de stare 3-4 sptmni
l trismus, contracturi musculare
l stare toxico-septic
l Forme
l localizate
l generalizate
l neonatal debut n ziua 7
l mortalitate ridicat n lipsa tratamentului
l Prevenirea prin imunizare i profilaxie postexpunere
l Clostridium tetani - Gram+ anaerob - neurotoxin
l Poarta de intrare cutanat plgi infectate
l Incubaie 3-21 zile
l Perioada de stare 3-4 sptmni
l trismus, contracturi musculare
l stare toxico-septic
l Forme
l localizate
l generalizate
l neonatal debut n ziua 7
l mortalitate ridicat n lipsa tratamentului
l Prevenirea prin imunizare i profilaxie postexpunere
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Rujeola Rujeola
l Virusul rujeolos paramixovirus ARN
l Contagiozitate crescut
l Transmitere respiratorie
l Incubaie fix
l 10-11 zile
l Perioada prodromal 3-4 zile
l catar oculo-nazo-bronic
l T
0
l Perioada eruptiv
l Examten maculo papulos
l debut n spatele urechii, pielea capului
l generailzare n 3-4 zile
l Enantem - semnul Koplik
l Convalescena
l pigmetri cutanate
l Virusul rujeolos paramixovirus ARN
l Contagiozitate crescut
l Transmitere respiratorie
l Incubaie fix
l 10-11 zile
l Perioada prodromal 3-4 zile
l catar oculo-nazo-bronic
l T
0
l Perioada eruptiv
l Examten maculo papulos
l debut n spatele urechii, pielea capului
l generailzare n 3-4 zile
l Enantem - semnul Koplik
l Convalescena
l pigmetri cutanate
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Rujeola Rujeola
l Complicaii
l Diaree, otit, pneumonie
l 60% decese
l Encefali acut 1/1000 cazuri
l mortalitate 15%
l sechele 25% - 35%
l PESS
l 1/100.000
l Sacina
l Avort spontan, prematuritate, retard de cretere
l Evoluie sever la imunocompromii
l Reactivri tbc
l Infecii baceriene
l Complicaii
l Diaree, otit, pneumonie
l 60% decese
l Encefali acut 1/1000 cazuri
l mortalitate 15%
l sechele 25% - 35%
l PESS
l 1/100.000
l Sacina
l Avort spontan, prematuritate, retard de cretere
l Evoluie sever la imunocompromii
l Reactivri tbc
l Infecii baceriene
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Rubeola Rubeola
l Virusul rubeolic - togavirus ARN
l Transmitere respiratorie (aerian)
l Contagiozitate sczut
l 7 zile nainte i dup erupie
l Incubaie 14-21 zile (16-18 zile)
l Perioada eruptiv 1-3 zile
l 30-50 % forme asimptomatice
l exantem maculopapuloas discret,
l fa-trunchi-membre
l enentem
l elemente purpurice luet, amigdale, faringe
l adenopatii cervicale dureroase
l artralgii, febr
l Diagnostic serologic n dinamic
l Virusul rubeolic - togavirus ARN
l Transmitere respiratorie (aerian)
l Contagiozitate sczut
l 7 zile nainte i dup erupie
l Incubaie 14-21 zile (16-18 zile)
l Perioada eruptiv 1-3 zile
l 30-50 % forme asimptomatice
l exantem maculopapuloas discret,
l fa-trunchi-membre
l enentem
l elemente purpurice luet, amigdale, faringe
l adenopatii cervicale dureroase
l artralgii, febr
l Diagnostic serologic n dinamic
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Rubeola Rubeola
l Rubeola congenital
l Infecie n trimestrul I - 85 % fei afectai
l avort spontan
l natere ft mort
l sindromul rubeolei congenitale
l retardul creterii intrauterine
l surditate, BCC, cataract,
l microcefalie, retard mental
l Infecie peri / neonatal
l erupie fugace
l purur trombocitopenic
l anemie hemolitic
l HSM
l Rubeola congenital
l Infecie n trimestrul I - 85 % fei afectai
l avort spontan
l natere ft mort
l sindromul rubeolei congenitale
l retardul creterii intrauterine
l surditate, BCC, cataract,
l microcefalie, retard mental
l Infecie peri / neonatal
l erupie fugace
l purur trombocitopenic
l anemie hemolitic
l HSM
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Parotidita epidemic Parotidita epidemic
l Virusul urlian paramixovirus ARN
l Transmitere respiratorie
l Incubaie 14 (18) - 25 zile
l contagiozitate redus
l Perioada prodromal 3-4 zile
l semne nespecifice
l febr, cefalee, inapeten, artralgii, mialgii
l Perioda de stare 7-10 zile
l Tumefacia uni / bilateral
l a glandelor salivare
l parotide
l sublinguale, submaxilare
l Forme uoare la copil / severe la adult
l Virusul urlian paramixovirus ARN
l Transmitere respiratorie
l Incubaie 14 (18) - 25 zile
l contagiozitate redus
l Perioada prodromal 3-4 zile
l semne nespecifice
l febr, cefalee, inapeten, artralgii, mialgii
l Perioda de stare 7-10 zile
l Tumefacia uni / bilateral
l a glandelor salivare
l parotide
l sublinguale, submaxilare
l Forme uoare la copil / severe la adult
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Parotidita epidemic Parotidita epidemic
l Complicaii
l meningita aseptic - 15%
l orhita - 50%
l ooforita
l surditate sever neurosenzorial uni / bilateral
l pancreatit, nevrite, artrit, mastit, nefrit, tiroidit, pancreatit.
l avort spontan n trimestrul I
l nu exist dovezi ale unui efect teratogen al infeciei
l Complicaii
l meningita aseptic - 15%
l orhita - 50%
l ooforita
l surditate sever neurosenzorial uni / bilateral
l pancreatit, nevrite, artrit, mastit, nefrit, tiroidit, pancreatit.
l avort spontan n trimestrul I
l nu exist dovezi ale unui efect teratogen al infeciei
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Hepatita B Hepatita B
l VBHHepadnaviridae (ADN)
l Antigene principale
l Antigenul de suprafa (Hbs) produs n timpul infeciei.
l Antigenul Hbc n infecie i la purttori asimptomatici
l Antigenul Hbe probabilitatea crescut a infeciozitii
l Transmitere
l parenteral
l sexual
l vertical de la mama infectat / purttoare la natere
l VBHHepadnaviridae (ADN)
l Antigene principale
l Antigenul de suprafa (Hbs) produs n timpul infeciei.
l Antigenul Hbc n infecie i la purttori asimptomatici
l Antigenul Hbe probabilitatea crescut a infeciozitii
l Transmitere
l parenteral
l sexual
l vertical de la mama infectat / purttoare la natere
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Hepatita B Hepatita B
l Incubaie
l 50-180 zile
l Forme de boal acut
l Uoare - severe
l vrsruri, astenie, anorexie, T
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, prurit, artralgii, rash
l icter colestatic
l HSM
l Hepatita fulminant (2%)
l Purttor cronic
l frecvent la sugari i copii
l rspuns imun insuficient eliminrii virusului - se replic n continuare.
l istoricul de hepatit acut poate lipsi
l risc crescut de ciroz i carcinom hepatic
l mortalitate 15-25 %
l Incubaie
l 50-180 zile
l Forme de boal acut
l Uoare - severe
l vrsruri, astenie, anorexie, T
0
, prurit, artralgii, rash
l icter colestatic
l HSM
l Hepatita fulminant (2%)
l Purttor cronic
l frecvent la sugari i copii
l rspuns imun insuficient eliminrii virusului - se replic n continuare.
l istoricul de hepatit acut poate lipsi
l risc crescut de ciroz i carcinom hepatic
l mortalitate 15-25 %
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Infecia tbc Infecia tbc
l Robert Koch
l Calmette-Guerin
l Victor Babe
l Robert Koch
l Calmette-Guerin
l Victor Babe
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Infecia tbc Infecia tbc
l Mycobacterium tuberculosis
l TBC primar primoinfecia
l asimptomatic
l viraj tuberculinic
l simptomatic
l TBC secundar adult
l IDR la PPD
l 48-72 h
l < 10 mm
l > 10 mm
l Mycobacterium tuberculosis
l TBC primar primoinfecia
l asimptomatic
l viraj tuberculinic
l simptomatic
l TBC secundar adult
l IDR la PPD
l 48-72 h
l < 10 mm
l > 10 mm
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Infecia tbc Infecia tbc
l Regiuni cu prevalen crescut a TBC
l Vaccinarea nou-nscuilor recomandat n Romnia
l Reduce riscul complicaiilor severe
l Meningita tbc
l Tbc miliar
l Riscul infeciilor cu bk multirezistent
l Coexistena cu infecia HIV
l Regiuni cu prevalen crescut a TBC
l Vaccinarea nou-nscuilor recomandat n Romnia
l Reduce riscul complicaiilor severe
l Meningita tbc
l Tbc miliar
l Riscul infeciilor cu bk multirezistent
l Coexistena cu infecia HIV
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Alte boli infecto-contagioase Alte boli infecto-contagioase
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Varicela Varicela
l Virus varicelozosterian - herpetic uman tip 3 (ADN)
l Contagiozitate foarte crescut vrsat de vnt
l Caracter sezonier
l toamna iarna - primvara
l Transmitere
l respiratorie: secreii nazofaringiene
l contact cu leziunile cutanate
l Incubaie 7-14-21 zile
l Perioada preeruptiv 1-2 zile
l modificarea strii generale,
l astenie,
l erupie scarlatiniform / morbiliform
l uneori absent
l Virus varicelozosterian - herpetic uman tip 3 (ADN)
l Contagiozitate foarte crescut vrsat de vnt
l Caracter sezonier
l toamna iarna - primvara
l Transmitere
l respiratorie: secreii nazofaringiene
l contact cu leziunile cutanate
l Incubaie 7-14-21 zile
l Perioada preeruptiv 1-2 zile
l modificarea strii generale,
l astenie,
l erupie scarlatiniform / morbiliform
l uneori absent
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Varicela Varicela
l Perioada eruptiv
l macule-papule-vezicule-cruste
l piele i mucoase
l 5-20 zile
l caracter centripet
l debut pe trunchi
l extindere - inclusiv pielea capului
l 1 /mai multe valuri eruptive T
0
l Complicaii
l pneumonie
l laringit
l encefalit
l sindrom Reye, nevrite, mielite
l hepatit
l Perioada eruptiv
l macule-papule-vezicule-cruste
l piele i mucoase
l 5-20 zile
l caracter centripet
l debut pe trunchi
l extindere - inclusiv pielea capului
l 1 /mai multe valuri eruptive T
0
l Complicaii
l pneumonie
l laringit
l encefalit
l sindrom Reye, nevrite, mielite
l hepatit
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Varicela Varicela
l Varicela congenital 0.7-2%
l infecia n sptmna 8-20 de sarcin
l cicatrici, cecitate parial / total
l malformaii craniene, ale membrelor,
l retard neuropsihic, retarul creterii
l avort spontan, ft mort
l Varicela perinatal
l infecia ntre ziua 5 prenatal - 14 postnatal
l risc de afectare sever 17-30%
l Herpes zoster prin reactivarea virusului varicelos latent
l la persoane adulte cu imunosupresie
l Expunerea in utero la varicel ntre sptmnile 25-36
l corelat riscul de herpes zoster n copilrie - 0.8-1.7%.
l Varicela congenital 0.7-2%
l infecia n sptmna 8-20 de sarcin
l cicatrici, cecitate parial / total
l malformaii craniene, ale membrelor,
l retard neuropsihic, retarul creterii
l avort spontan, ft mort
l Varicela perinatal
l infecia ntre ziua 5 prenatal - 14 postnatal
l risc de afectare sever 17-30%
l Herpes zoster prin reactivarea virusului varicelos latent
l la persoane adulte cu imunosupresie
l Expunerea in utero la varicel ntre sptmnile 25-36
l corelat riscul de herpes zoster n copilrie - 0.8-1.7%.
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Scarlatina Scarlatina
l Streptococ beta hemolitic grup A
l Incubaie 3-6 zile
l Perioada preeruptiv 24-48 h
l faringita eritemato-pultacee
l T
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, vrsturi
l Perioada eruptiv 5-7 zile
l Exantem micropapulos, eritematos
l aspru, plete la presiune
l linii Pastia Grozovici la plici
l pe trunchi i membre n 24-48 h
l respect faa, paloare perioral, masca Filatov
l Enantem ciclul lingual 4-5 zile
l Perioada de descuamare cazuri netratate
l Streptococ beta hemolitic grup A
l Incubaie 3-6 zile
l Perioada preeruptiv 24-48 h
l faringita eritemato-pultacee
l T
0
, vrsturi
l Perioada eruptiv 5-7 zile
l Exantem micropapulos, eritematos
l aspru, plete la presiune
l linii Pastia Grozovici la plici
l pe trunchi i membre n 24-48 h
l respect faa, paloare perioral, masca Filatov
l Enantem ciclul lingual 4-5 zile
l Perioada de descuamare cazuri netratate
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Scarlatina Scarlatina
l Diagnostic pozitiv
l Anamnez
l Vrsta copii 5-14 ani
l contact cu bolnavi / purttori de SHGA
l Date clinice
l Date paraclinice prezena SHGA
l test rapid
l exsudat nazal, faringian
l Tratament
l Penicilin G - profilaxia complicaiilor
l Complicaii
l Imediate - toxice i septice
l Tardive - RAA i GNPS
l Diagnostic pozitiv
l Anamnez
l Vrsta copii 5-14 ani
l contact cu bolnavi / purttori de SHGA
l Date clinice
l Date paraclinice prezena SHGA
l test rapid
l exsudat nazal, faringian
l Tratament
l Penicilin G - profilaxia complicaiilor
l Complicaii
l Imediate - toxice i septice
l Tardive - RAA i GNPS
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Mononucleoza infecioas Mononucleoza infecioas
l Virusul Epstein Barr
l Adolescent, adult tnr
l Transmitere respiratorie
l Incubaie 10-14 zile
l Perioada de stare
l Febr
l Faringe hiperemic cu exsudate
l Adenopatii cervicale / generalizate
l HSM
l Tratamentul cu ampiciline
l 90 % erupie maculopapuloas
l Complicaii
l Hepatit MNI
l Virusul Epstein Barr
l Adolescent, adult tnr
l Transmitere respiratorie
l Incubaie 10-14 zile
l Perioada de stare
l Febr
l Faringe hiperemic cu exsudate
l Adenopatii cervicale / generalizate
l HSM
l Tratamentul cu ampiciline
l 90 % erupie maculopapuloas
l Complicaii
l Hepatit MNI
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Mononucleoza infecioas Mononucleoza infecioas
l hematologic
l 10 % limfocite atipice
l testul monospot rapid
l atc heterofili
l hematologic
l 10 % limfocite atipice
l testul monospot rapid
l atc heterofili
C
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Boala a 5 a
Eritema infectiosum
Boala a 5 a
Eritema infectiosum
l Parvovirus
l Eritem n reea
l Facies plmuit
l Parvovirus
l Eritem n reea
l Facies plmuit
C
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Boala a 6 a, exantem subit
roseola infantum
Boala a 6 a, exantem subit
roseola infantum
l Virus herpetic tip6
l Virus herpetic tip7
l Virus herpetic tip6
l Virus herpetic tip7
C
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Boala mini-gur-picioare Boala mini-gur-picioare
l Virus coxsackie A-16 l Virus coxsackie A-16
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Vaccinarea Vaccinarea
C
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Istoric Istoric
l 1796 Edward J enner (17491823)
l protecia fa de variol a celor aflai n contact cu vacile
l J ames Phipps 8 ani
l suspensie din pustulele vacii
l boal uoar - imunizare fa de variol
l Vaccinare - vaccinus de la vaci
l 1774 Benjamin J esty
l fermier din Dorset care s-a vaccinat pe el i familia sa
l 1979 - OMSdeclar eradicarea complet a variolei
l 1796 Edward J enner (17491823)
l protecia fa de variol a celor aflai n contact cu vacile
l J ames Phipps 8 ani
l suspensie din pustulele vacii
l boal uoar - imunizare fa de variol
l Vaccinare - vaccinus de la vaci
l 1774 Benjamin J esty
l fermier din Dorset care s-a vaccinat pe el i familia sa
l 1979 - OMSdeclar eradicarea complet a variolei
C
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Istoric Istoric
l 1885 Louis Pasteur (18221895)
l salveaz viaa lui J oseph Meister
l bieel de 9 ani mucat de un cine cu rabie
l primul vaccin creat n laborator
l virus viu atenuat (uscat pe carbonat de K)
l 1955 J onas Salk (19141995)
l IPV virus inactivat
l 1961 Albert Sabin (19061993)
l OPV virus viu atenuat
l 1885 Louis Pasteur (18221895)
l salveaz viaa lui J oseph Meister
l bieel de 9 ani mucat de un cine cu rabie
l primul vaccin creat n laborator
l virus viu atenuat (uscat pe carbonat de K)
l 1955 J onas Salk (19141995)
l IPV virus inactivat
l 1961 Albert Sabin (19061993)
l OPV virus viu atenuat
C
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Scheme de vaccinare Scheme de vaccinare
l PNI
l Polio
l Difterie
l Tetanos
l Pertussis celular
l Rujeol
l Rubeol
l Parotidit epidemica
l Hepatit B
l tbc
l PNI
l Polio
l Difterie
l Tetanos
l Pertussis celular
l Rujeol
l Rubeol
l Parotidit epidemica
l Hepatit B
l tbc
l Extra PNI
l Pertussis acelular
l H. Influenzae
l Hepatita A
l Varicel
l Meningococ
l Pneumococ
l Extra PNI
l Pertussis acelular
l H. Influenzae
l Hepatita A
l Varicel
l Meningococ
l Pneumococ
l n viitor
l Rotavirus
l HPV
l n viitor
l Rotavirus
l HPV
C
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Romania - 2009 calendarul
imunizrilor
Romania - 2009 calendarul
imunizrilor
Vrsta VACCIN Comentarii
primele 24 h
Ziua 4-7
Hep B
BCG
Maternitate
Maternitate
2 luni DTPa, Hep B, IPV, Simultan
4 luni DTPa, IPV Simultan
6 luni DTPa, Hep B, IPV, Simultan
13-15 luni DTPa, OPV, MMR Simultan
4 ani DTPa
7 ani (I cls) MMR coal
9 ani (III cls) OPV coal
14 ani (VIII cls) dT, Rub* coal
24 ani si ulterior din 10 in 10 ani dT coal
Fete Fete**
C
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Vaccinarea antipertussis Vaccinarea antipertussis
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Vaccinarea antipertussis Vaccinarea antipertussis
l1940 vaccin Pw
l1961Romania Pw
l1982 vaccin Pa
l1940 vaccin Pw
l1961Romania Pw
l1982 vaccin Pa
C
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Incidena tusei convulsive n
J aponia 1950-1990
N
r
.

c
a
z
u
r
i
r
a
p
o
r
t
a
t
e
nceperea
vaccinri i Pw
Oprirea tempor a
DTPw
Introducerea
DTPa
100000
10000
1000
100
1950 1960 1970 1980 1990
Anul
Statistics of Food Poisoning and Infectious Diseases, the Ministry of Health and Welfare
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