Infektiologie Flashcards
Stadien der HIV-Infektion
Stadium I: akute Infektion 1-6 Wochen nach Erstinfektion, asymptomatisch bzw. Mononukleose-ähnliches Bild
Stadium II: Latenzstadium, asymptomatisch, Träger sind jedoch infektiös
Stadium III: nach > 3 Monaten, Lymphadenopathie-Syndrom
Stadium IV: AIDS
Kaposi-Sarkom
- mesenchymaler Tumor aus Endothelzellen und Fibroblasten
- histologisch schlitzförmige Kapillaren mit Extravasat und Hämosiderin Ablagerungen
- 4 Formen: klassisch (ältere Männer, v.a. kutan, indolent), epidemisch HIV-assoziiert, Immunsuppression-assoziiert (wie HIV diverse Verläufe), epidemisch (Kinder/junge Erwachsene in Afrika, häufig aggressiv)
- bei HIV-assoziiertem Kaposi-Sarkom: Makula –> Plaque –> Nodulus-Stadium
- betroffen Haut und in 30% Schleimhaut (GIT, u.a. Gallenwege, Bronchien)
- Therapie: cART, bei lokalem Verlauf Exzision, bei generalisiertem Verlauf Chemotherapie (Doxorubicin, Bleomycin), Immuntherapie (Interferon-a)
- DD: bazilläre Angiomatose, kutane Lymphome, Hämangiome und Hämangiosarkome, Melanommetastasen
Peritonitis
PRIMÄRE Peritonitis: Cephalosporine
LOKALISIERTE Peritonitis bei FRISCHER Perforation
• 2G/3G-Fluorchinolone + Metronidazol
• Ceftriaxon + Metronidazol
DIFFUSE Peritonitis bei ÄLTERER Perforation
• Piperacillin/Tazobactam
• 2G-Carbapenem (Ertapenem)
NOSOKOMIALE, TERTIÄRE Peritonitis
• 1G-Carbapenem (Meropenem bzw. Imipenem/Cilastatin): 3MRGN
• bei septischem Schock: plus Tigecyclin
• bei VRE-Risiko: plus Linezolid oder Daptomycin
• (5G)Ceftolozan/Tazobactam + Metronidazol: 3MRGN + PA
• (3bG)Ceftazidim/Avibactam + Metronidazol: 4MRGN + PA
Schwangerschaft und Postpartum bei HIV-positiven Müttern
- < 1–2% risk of mother-to-child transmission if maternal viral loads < 1,000 copies/mL independent of the route of delivery or duration of ruptured membranes before delivery.
- Maternal viral load > 1,000 copies/mL at or near delivery, independent of antepartum antiretroviral therapy prelabor cesarean delivery at 38 0/7 weeks of gestation
- intravenous zidovudine (ZDV), ideally 3 hours preoperatively as a 1-hour intravenous loading dose (2 mg/kg), followed by continuous infusion over 2 hours (1 mg/kg/hr) until delivery
- use of ergotamines with protease inhibitors or cobicistat exaggerated vasoconstrictive responses.
- Zidovudine (Retrovir) prophylaxis is recommended for most infants exposed to HIV in utero to decrease the risk of vertical transmission. 5 Beginning eight hours after birth, these neonates should receive zidovudine in a dosage of 2 mg per kg every six hours for at least six weeks.
Mukormykose
- Vertreter: Rhizopus oryzae
- RF: Immunsuppression, Diabetes, Eisenüberladung (terminale Stadien der Niereninsuffizienz)
- Klinik: rhinoorobitozerebral (häufigste Form: Orbita, Sinus ethmoidalis), pulmonal, kutan, gastrointestinal, disseminiert
- Therapie: Amphotericin B, chirurgisches Debridement, Ausgleich der Immunsuppression, keine Gabe von Eisenpräparaten, ggf. hyperbare O2-Therapie
- Amphotericin B: geringe Penetration ins ZNS, nephrotoxisch
- liposomales Amphotericin B: weniger nephrotoxisch als Amphotericin B, sehr gute ZNS-Gängigkeit, teuer
Management der respiratorischen Insuffizienz durch Epiglottitis
- 100% Sauerstoff durch Maske (weil komplizierte Atemwege antizipiert)
- endotracheale Intubation
Emergency cricothyroidotomy is indicated in a cannot intubate-cannot ventilate (CICV) scenario, which is usually defined as the failure to intubate after three attempts or to maintain oxygenation or ventilation in between intubation attempts. In adult patients with acute epiglottitis, however, only one attempt at endotracheal intubation should be made before an emergency cricothyroidotomy is performed at the bedside. Patients with epiglottitis can develop worsening respiratory distress despite appropriate bag-mask ventilation, and they are predisposed to rapid progression to complete airway obstruction following any manipulation of the epiglottis. Therefore, as soon as epiglottitis is suspected, a physician with expertise in the management of difficult airways (e.g., anesthesiologist or otolaryngologist) should be notified and an intubation kit that includes the most advanced difficult airway adjuncts available (e.g., video laryngoscope, flexible fiberoptic bronchoscope) should be obtained.
In children under 12 years of age with epiglottitis, needle cricothyroidotomy is preferred because of the funnel shape and narrowness of the trachea at the height of the cricoid ring as opposed to adults, in whom the trachea is narrowest at the level of the vocal cords.
PEP Tuberkulose
A 4-month course of rifampin monotherapy is one regimen for the treatment of latent TB infection (LTBI). Children < 5 years of age have an underdeveloped immune system, which increases the likelihood of false-negative TST results, a rapid progression from LTBI to active TB, and a severe disease course. Window prophylaxis should therefore be offered to all children of this age with significant exposure to TB in the past 8 weeks, regardless of the initial examination findings and/or test results. A follow-up TST should be performed 8–12 weeks after the child was last exposed to TB. If the follow-up TST is negative and there is no suspicion of a false-negative result, the treatment may be discontinued. HIV-positive individuals should be managed similarly but receive full-length prophylaxis, even if the follow-up TST is negative. Isolation measures apply only to those with suspected or confirmed active TB.
