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Infectii Flashcards

1
Q

Ce patologii poate determina OREION

A
  • meningita
  • pericardita
  • hemoglobinurie paroxistica la rece
  • DZ
  • pancreatita acuta
  • sd nefritic acut
  • orhita virala si infertilitate masculina
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2
Q

CAZUE de meningita NON-infectioase

A
  1. Meningita maligna
  2. Medicamentele intratecale
  3. Sg din urma hemoragiei subarahnoidiene
  4. LES - meningita aseptica
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2
Q

Bacterii care determina meningita

A

=70% sunt bacterii
1. neisseria meningitidis
2. strep pneumoniae
3. staf aureus
4. strep de gr B
5. listeria
6. tbc
7. treponema pallidum
8. bacilii gram - = e coli

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2
Q

Virusuri care determina meingita

A
  1. eneterovirusri ( echo, cocxsakie )
  2. HIV
  3. VEB
  4. OREION
  5. HSV
  6. POLIO
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3
Q

Fungi care determina meningita

A
  1. Cryptococcus neoformans
  2. Candida albicans
  3. Coccioides
  4. Histoplasma capsulatum
  5. Blastomycetes dermatidis
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3
Q

Meningita bacteriana acuta HP

A
  • apare inflitrarea piamater si arahnoidei cu PMN care duce la formarea unui strat de puroi care se poate organiza si poate forma aderente => leziuni de nv cranieni si hidrocefalie

EDEMUL CEREBRAL APARE IN ORICE MENINGITA BACTERIANA

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4
Q

Meningita bacteriana cronica - tbc HP

A
  • apare un exsudat vascos in jurul craniului de culoare GRI-VERDE cu numerosi tuberculi meningieni
  • aderente invariabile
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4
Q

Meningita acuta virala

A
  • infiltrat limfocitar
  • FARA PMN, ADERENTE, PUROI
    poate aparea edem cerebral minim/deloc cu exceptia aparitia encefalitei virale
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5
Q

Triada sd meningeal

A
  1. CEFALEE
  2. RIGIDITATEA CEFEI
  3. FEBRA

+/- poate fi asociat frecvent cu varsaturi/ fotofobie

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6
Q

Constienta si complicatiile

A

este pastrata in meningita necomplicata DAR aparitia
- somnolentei
- paraliziei de nv cranieni
- semne de lateralizare
======> ori CA EXISTA COMPLICATII ( tromboza de sinus venos, hidrocefalie, edem cerebral acut )
======> ori ca avem un DD : ABCES CEREBRAL/ ENCEFALITA

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7
Q

Simptome ce sugereaza Pneumococul

A
  • fracturile de craniu
  • spina bifida oculta/ fracturile=> meningite recurente
  • leziuni congenitale de SNC
  • afectiuni ale urechii
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8
Q

Specific pentru M meningitica

A

petesiile ( purpura )

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9
Q

Specific pentru LEPTOSPIRA

A
  • lucratorii in ape murdare
  • innotatori recreationali
  • canale
    MIALGII
    ICTER
    CONJUNCTIVITA
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10
Q

Specific pentru enterovirusuri

A

RASH
DURERE PLEURITICA

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11
Q

Tratament suspect meningita meningococica

A
  1. cefalosporina de gen 3 ( CEFOTAXIM ) ca tratament empiric si apoi inlocuiesti cu BENZILPENICILINA daca e sb
  2. Dexametazona 0,6mg/kgc iv cu/inainte de AB
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12
Q

Meningita virala

A

= benigna, autolimitata
dureaza frecvent 4-10 zile
- poti avea dureri de cap cateva luni dupa
- nu lasa sechele cu exc - ENCEFALITA

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13
Q

DD al durerii brusc instalata

A
  1. Meningita
  2. Malaria cu afectare cerebrala
  3. MIGRENELE
  4. HSA = hemoragia subarahnoidiana
14
Q

DD AL M CRONICE

A
  1. EPILEPSII
  2. TUMORI INTRACRANIENE
  3. LEZIUNI FOCALE
  4. CEFALEE
15
Q

Punctia lombara

A
  • meningita cu meningococ => inutila
  • CI daca ai HTIC
  • CT pentru a exclude prezenta unei mase inlocuitoare de spatiu ca sa nu faci herniere de amigdale cerebrale
16
Q

punctia lombara - LCR NORMAL

A

Normal LCR
- limpede
- <5 monocite
PMN absente
proteine 0,2-0,4 g/l
glucoza 2/3-1/2 din plasma

17
Q

PL- LCR M. VIRALA

A
  • lichid limpede/tulbure
  • monocite 10-100
  • pmn absente ( pot exista la inceputul unei meningite sau encefalite virale dar dupa dispar )
  • proteinele 0,4-0,8
  • glucoza >1/2
18
Q

PL-LCR M.BACTERIANA ACUTA

A
  • lichid tulbure/purulent
  • monocite <50
  • PMN 200-300
  • proteine 0,5-2
  • glucoza <1/2
19
Q

PL- LCR M. TBC

A
  • lichid tulbure/ vascos
  • monocite 100-300
  • PMN 0-200
  • proteine 0,5-3
  • glucoza <1/2
20
Q

CAUZE DE MENINGITA CRONICA

A

Sifilis
Tbc
Criptococica
Behcet
Sarcoidoza

21
Q

Profilaxia meningitei meningococice

A
  • RIFAMPICINA
  • CIRPOFLOXACINA la toti contactii
  • CEFTRIAXONA
22
Q

Semne ale meniingite cronice

A
  • cefalee usoara
  • oboseala
  • anorexie
  • varsaturi

SE INSTALEAZA IN CATEVA SAPTAMANI

frecvente ulterior
- SOMNOLENTA
- SEMNE FOCALE ( DIPLOPIE, EDEM PAPILAR SI HEMIPAREZA )
- CONVULSII

23
Q

RMN in TB

A
  • poate fi si normal
  • MARIREA MENINGELOR
  • TUBERCULOAME
  • HIDROCEFALIE
24
Q

Trat pentru M. TBC

A
  • RIFAMPICINA
  • IZONIAZIDA
  • PIRAZINAMIDA
    cel putin 9 luni ( la TBC - ca administrezi 12 luni trat pentru TBC SNC )

NU ADM etambutol ( riscurile de complicatii oculare )
+ CSadjunvanti- PREDNISOLON 60 mg pt 3 SAPT

25
Q

Mortalitatea

A
  • de m. bacteriana acuta - 15%
  • de tbc - 60% si cu tratament precoce ( C : CONVULSII, HIDROCEFALIE )
26
Q

Cauze de pleiocitoza- meningite

A
  • meningita partial tratata ( bact )
  • meningita virala
  • meningita TBC/fungi
  • meningita maligna
27
Q

Encefalita

A

= inflamatiaparenchimului cerebral
- frecvent de etiologie virala
- are semne de meningism si febra ( 90% )
- PRECOCE: TULB DE PERSONALITATE SI COMPORTAMENT care pot duce progresiv catre scaderea constientei si coma
- obisnuit CRIZA CONVULSIVE FOCALE/GENERALIZATE
- FRECVENT : semne neurologice FOCALE ( de ex HSV- TULB DE VORBIRE )

28
Q

Encefalita HSV

A
  • apar frecvent tulburari de vorbire
  • este frecvent localizata incipient la nivelul LOBILOR TEMPORALI CU O DISTRIBUTIE ASIMETRICA
29
Q

EEG IN ENCEFALITA

A

Unde ascutite si lente

30
Q

Tratament encefalita virala

A
  • suspiciune de HSV/VZV = aciclovir 10mg/kgc de 3 x pe zi timp de 14-21 zile
31
Q

Complicatii pe termen lung ale encefalitei

A
  1. AFECTAREA MEMORIEI
  2. SCHIMBAREA PERSONALITATII
  3. EPILEPSIA
32
Q

Encefalita autoimuna- cea limbica simptome

A
  • tulb psihice
  • tulb de memorie
  • convulsii
  • confuzie
    IN general implicati LOBUL TEMPORAL- HIPOCAMP- LT MEZIALI
  • evolueaza pe sapt/luni
33
Q

Encefalita AI

A
  • paraneoplazica
  • implicarea canalelor K voltaj dependente
  • Ac anti rec NMDA
34
Q

PLE

A
  • observata secundar C cu cel mici pulmonar/ TESTICULE
  • AC anti HU si MA2 ( 60% )
  • RMN ai semnal crescut in hipocamp
    PRECEDE DG DE CANCER
  • raspunde mai putin la tratament ( probabil pt ca e asociata cu cancer )
35
Q

VGKC

A

Ac VGKC ce pot fi testati
- ENCEFALITA LIMBICA CU CONVULSII DISTONICE FACIO-BRAHIALE CARACTERISTICE
- confuzie
-AGITATIE
- HIPONATREMIE

Manifestarile apar dupa varsta de 50 de nai DAR SUNT RAR ASOCIATE CU CANCERE ( TIMOM )

T: STEROIZI IN DOZA MARE

  • acesti anticorpimai pot fi asociati cu
  • NEUROMIOTONIA
  • SD DE HIPEREXCITABILITATE DE NV PERIFERICI
36
Q

Cu ce sunt asociati Ac VGKC

A
  • encefalita limbica ( carac : convulsii distonice facio-brahiale )
  • neuromiotonia
  • sd de hiperexcitabilitate a nv periferici
37
Q

NMDA ( md dai din gura )

A
  • encefalita limbica + coma + status epilepticus ( CARAC: DISKINEZII OROFACIALE )
  • asociata cu TERATOAME ( ovariene )
  • tineri
38
Q

Trat

A
  • imunoterapie
  • plasmafereza
    -steroizi
  • rituximab
  • ciclofosfamida

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