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Spørsmål : Har han en infeksiøs bronkitt ? KOLS? Reaktiv postinfeksiøs bronkitt ? Anamnese :

Kasuistikk - Luftveisinfeksjoner Lars Heggelund, S eksjon for infeksjonssykdommer , Medisinsk avdeling , Drammen sykehus , Vestre Viken HF. Spørsmål : Har han en infeksiøs bronkitt ? KOLS? Reaktiv postinfeksiøs bronkitt ? Anamnese : Tobakk Arbeidskarriere ? TBC eksponering ?

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Spørsmål : Har han en infeksiøs bronkitt ? KOLS? Reaktiv postinfeksiøs bronkitt ? Anamnese :

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  1. Kasuistikk - LuftveisinfeksjonerLars Heggelund, Seksjon for infeksjonssykdommer, Medisinskavdeling, Drammen sykehus, VestreViken HF • Spørsmål: • Harhan en infeksiøsbronkitt? • KOLS? • Reaktivpostinfeksiøsbronkitt? • Anamnese: • Tobakk • Arbeidskarriere? • TBC eksponering? • Aspirasjonsproblematikk?

  2. Diagnostiskebetraktninger • Lav CRP, normaltrtg thorax • “Ble bra avEry-Max” • Reellendobronkialinfeksjon • Detnaturligeforløp– tidsfaktoren • Evtimmunmodulerendeeffekt

  3. Diagnostiskebetraktninger • Supplerendemikrobiologiskdiagnostikk: • Produktivhoste – dyrkning + utvidet viral PCR us av “morgengruff” • Serologikanvurderes • Annendiagnostikk: • Klinisk us. - obstruktiv? • Nyttrtg thorax. • Vurder CT thorax, spesieltvedrøykeanamnese • Spirometriutenog med bronkodilatator

  4. Akuttbronkitt - etiologi • Oftestviraltbetinget • Influensa, RS • Av ogtil: • Mycoplasma, Chlamydophila, Pertussis • Pneumokokker, Haemophilus, Moraxella • Harantibiotikaeffekt? • Nasjonal faglig retningslinje for antibiotikabruk i primærhelsetjenesten: • ”Det er ikke dokumentert klinisk relevant effekt av antibiotika ved akutt bronkitt. Til tross for dette skrives det i Norge ut antibiotika til mer enn halvparten av de som får denne diagnosen.”

  5. Akuttbronkitt – Cochrane Review • Mars 2014: • ”Antibiotictreatment for peoplewith a clinicaldiagnosisofacutebronchitis” • 17 randomiserte kliniske studier med ca 4000 deltakere. • Inkluderer en studie med ca 1000 deltakere fra 12 land: svært liten men statistisk signifikant gunstig effekt: ½ dag kortere symptomer. • ”The availableevidencesuggeststhatthere is nobenefit in usingantibiotics for acutebronchitis in otherwisehealthyindividualsthough more research is neededontheeffect in frail, elderlypeoplewithmultimorbiditieswhomay not have beenincluded in theexistingtrials”

  6. Community-acquired pneumonia in Norway: etiology and value of extensive microbial diagnostic testing PneumoniprosjektetiBuskerudCharacterize the etiology of CAP in NorwayInvestigate potential benefit of PCR Jan Cato Holter, PhD. Student, 23 May 2014

  7. MethodsMicrobiological techniques Conventional “New” Complete samling • Mycoplasma pneumoniae • Chlamydophilapneumoniae • Bordetella pertussis • Influensa virus A+B (H1N1) • Parainfluensa virus 1-3 • RSV • hMPV • Enterovirus • Adenovirus • Streptococcus pneumoniae • Real-time PCR • qPCR Blood culture Pleural fluid • Streptococcus pneumoniae • Legionella pneumophila • BinaxNow (Binax, ME, USA) Urinary antigen BAL • Dyrkning • L. pneumophilareal-time PCR • Mycoplasma pneumoniae • Chlamydophilapneumoniae • Bordetella pertussis • Influensa virus A+B • KBR • ELISA Sputum NP swab culture NP swab PCR OP swab PCR Serology

  8. 267 Full cohort ResultsEtiology- filling the gap Streptococcus pneumoniae 11.3 25.9 30% Bacteremia: 9% - S. pneumoniae84% - - Bordetella pertussis 6% 6.3 4 Haemophilusinfluenzae 5% 63% Bacteria: 47% Copathogen: 26% 4.1 7.5 Mycoplasma pneumoniae 4% 5.9 7 Chlamydophilapneumoniae 3% 4.8 4.9 Legionella Viruses: 34% 3% 5.3 2.7 Gram-negative enteric bacteria 2% 1.2 2.5 Moraxella catarrhalis 2% 8 2.2 Miscellaneous 1% Influenza virus: 15% Rhinovirus: 12% - - Haemophilusparainfluenza 1% Viruses 8.9 10.9 34% Unknown 40.7 43.8 37%

  9. 64 Complete samples ResultsSeasonality- combined infection January and February

  10. 64 Complete samples ResultsMicrobial findings Antibiotic naïve (n = 43): 79% Total yield: 73% ≥ Copathogen: 47% • Bacterial yield: 58% • ≥ Copathogen: 57% • Virus 43% • Viral yield: 41% • ≥ Copathogen: 65% • Bacteria: 62% • S. pneumonae: 35% • S. pneumoniae: 31% • ≥ Copathogen: 60% • Virus 45%

  11. 64 Complete samples ResultsMethods 5% 7% 19% 15%

  12. Conclusion 1 3/4 of patients may receive a microbiological diagnose. 2 PCR-based techniques were particularly useful in diagnosing viral infections as well as coinfection (1/3 of patients). 3 Combined bacterial and viral infection was more common during winter and spring than either infection alone.

  13. Research group and collaborators • Jan C. Holter, MD • Fredrik Müller, MD, PhD • Ola Bjørang, MSc • HelviH. Samdal, MD • Jon B. Marthinsen, MD • PålJenum, MD, PhD • Thor Ueland, PhD • StigS. Frøland, MD, PhD • PålAukrust, MD, PhD • EinarHusebye, MD, PhD • Lars Heggelund, MD, PhD.

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