Lokālās infekcijas neonatālā periodā. Acis. Elizabete Pumpure MFIV Page 5.grupa 1

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1 Lokālās infekcijas neonatālā periodā. Acis. Elizabete Pumpure MFIV Page 5.grupa 1

2 Infekcijas slimības ir biežs un nozīmīgs neonatālā perioda (no dzimšanas līdz 28.dienai) saslimstības un mirstības iemesls. Ap 2% augļu saslimst in utero, un līdz pat 10% jaundzimušo - 1.dzīves mēnesī. Page 2

3 Intrauterīns Mātes Ascendējošs Dažādi pārneses ceļi Priekšlaicīgi, ļoti zema dzimšanas svara bērni paildzināts uzturēšanās laiks slimnīcā. Postnatāli Neonatālas infekcijas Imunoloģiskais statuss Neu, Ig Komplementa sistēmas nestabilitāte Plašs m/o klāsts Blakus saslimšanas Subklīniska; Viegla; Smaga KLĪNISKĀ MANIFESTĀCIJA Iedzimtie sindromi Fokāla; Sistēmiska Page 3

4 Oftalmiskā izmeklēšana Sārtas, asarojošas acis saistaudu saslimšana (polyarteritis nodosa); Plakstiņu konjunktivīts masalas, Coxsackievirus, tbc, infekciozā mononukleoze, lymphogranuloma venereum un cat-scratch disease; Bulbārs konjunktivīts Kawasaki slimība, leptospiroze; Petehiāli konjunktīvas asinsizplūdumi endokardīts Uveīts sarkoidoze, Kawasaki, Behet slimība, vaskulīts. Horioretinīts CMV, toksoplazmoze, sifiliss. Proptosis orbītas tumors, tireotoksikoze, mts, orbītas infekcija, Wegener granulomatoze. Page 4

5 Page 5

6 Normāla acs mikroflora Chlamydia trachomatis, Chlamydophila pneumoniae, Haemophilus aegyptius, Haemophilus influenzae, Moraxella spp, Neisseria spp, Staphylococcus aureus, Staphylococcus epidermidis nelielā daudzumā. Streptococcus viridians, Staphylococcus epidermidis,propionibacterium acnes dominē Reizēm Staphylococcus aureus, streptococci, Haemophilus sp. and Neisseria sp. Lizocīms, IgA; acs sekrēts. Bloķēts asaru izvadkanāls 2..4/100. Source: Boundless. Normal Eye Microbiota. Boundless Microbiology. Boundless, 06 Feb Retrieved 17 Feb from diseases-15/microbial-diseases-of-the-eye-169/normal-eye-microbiota / Page 6

7 Conjunctival microbiota and antibiotics resistance in preterm newborns hospitalized in neonatal intensive care unit Daniela Endriss I ; Carlos Teixeira Brandt II ; Célia Maria Machado Barbosa de Castro III ; Vladimir Fontes Oliveira IV ; Maria de Fátima Alves Diniz V CONCLUSIONS: Conjunctival bacterial flora among newborns in NICU is varied, mainly Grampositive, usually multiresistant to antibiotics. script=sci_arttext&pid=s &lng =es&nrm=iso&tlng=es Page 7

8 Transplacentārās infekcijas; to manifestācija. Page 6

9 Page 7

10 Iedzimti anatomiski defekti Katarakta masaliņas Microphthalmos CMV, masaliņas, toksoplazmoze Toxoplasmosis-Health-Implications-Pathology- Clinical-Manifestations-Treatment-And-Prevention Page 8

11 Neonatālo orgānu (acu) iesaiste Retinīts CMV, HSV,limfocītiskais horiomeningīta vīruss, masaliņas, toksoplazmoze, T.pallidum, West Nile vīruss Page 9

12 cases/91-lcmv.htm Page 10

13 Vēlīnas sekas Acu patoloģijas HSV, masaliņas, toksoplazmoze, T.cruzi, T.pallidum, VZV Page 11

14 Neonatālu bakteriālu infekciju manifestācija acīs. Page 12

15 Page 13

16 Ophthalmia neonatorum Visbiežākā jaundzimušo acu saslimšana; Dažādi m/o; dažāda virulence, dažādas sekas (no viegla lokāla iekaisuma līdz pat radzenes perforācijai, aklumam un nāvei). Risks ON atkarīgs no: Mātes infekcijām; Profilaktiskajiem pasākumiem; Grūtniecības un dzemdību norises; Pēcdzemdību aprūpes. Page 14

17 ON epidemioloģija Pamatā vaginālu dzemdību laikā, netiešs STS rādītājs. 1880g. 10% Eiropas bērnu pēc dzimšanas gonokokāls konjunktivīts. ON galvenais akluma iemesls. Page 15

18 Carl Siegmund Franz Credé Vācu ginekologs un dzemdību speciālists. 3 gadu periodā no 1160 jaundzimušajiem, kurus Crede profilaktēja, tikai 2 attīstījās ON g. ziņojums, ka gonokokāla ophthalmia samazinājusies no 10%! 0.3%. Šobrīd U.S. gonokoku ON 0.3/1000; Chl.trachomatis 8.2/ XII III Page 16

19 Klīniskā manifestācija Konjunktīvas apsārtums un tūska; Plakstiņu tūska; Izdalījumi, kuriem varētu būt purulents raksturs.! obligāti jāveic arī sistēmisks organisma izvērtējums!! Page 17

20 IP 2..5d. Viegls iekaisums+ serosangvinozi izdalījumi (24h)! izdalījumi kļūst biezi un strutaini, pievienojas plakstiņu un konjunktīvas tūska! Iesaistās dziļāki konjunktīvas un radzenes slāņi. KOMPLIKĀCIJAS: radzenes čūlošanās un perforācija, iridociklīts, priekšējā sinehija, reti panoftalmīts. " Priekšējā sinehija varavīksne adherē ar radzeni. Iridociklīts iekaisuma process varavīksnenē, acs priekšējā kamerā un starenē.! Page 18

21 IP 5-14d. Viegls iekaisums! smaga plakstiņu tūska ar lielu daudzumu strutainu izdalījumu. Pamatā skar tarsālo konjunktīvu, radzeni ļoti reti. Līdzīga norise arī St.aureus un citiem izraisītājiem. Ps.aeruginosa reta, hospitāli iegūta, nopietna konjunktivīta izraisītāja. IP dienas! tūska, plakstiņu eritēma, strutaini izdalījumi! endoftalmīts! sepse!šoks! nāve. Page 19

22 Crede s profilakse 1% sudraba nitrāta sķīduma instillācija uz konjunktīvas kā ophthalmia neonatorum profilakse 2001, WHO: Is CREDE S prophylaxis for ON still valid? - Samazinās STS grūtniecēm (tiek uzraudzītas); - Darbojas pret gonokokiem, bet tagad biežākais izraisītājs ir hlamīdijas; - Padārga metode 7.30$ viena deva, bet povidonjodam 5ml 0.10$+ plašāka darbība arī pret vīrusiem; - Rada ķīmisku iekaisumu un depozītus; 2004, Brazīlija 86% dzemdību namu Izmanto Crede s profilaksi. Gerhard Lang Ophthalmology: A Pocket Textbook Atlas PMC /pdf/ pdf Page 20

23 Diagnoze Konjunktivīts 48h pēc dzimšanas: Purulento izdalījumu Gr krāsojums + kultūra; Aizdomas uz vīrusu audu kultūra! vīrusa izolācija. Chlamidia Giemsas krāsojums tarsālās konjunktīvas epitēlija šūnu noskeāpējumam (i/ citoplazmatiski ieslēgumi), audu kultūras, IF krāsojums, Ag un DNS testi. Difdg: dakriocistīts iedzimta nasolakrimālā kanāla obstrukcija Page 21

24 Gr i/c Gr- diplokoki = gonococcus Ceftriaksons 50mg/kg/24h 1 devā [<125mg] iv Cefotaksīms 100mg/kg/24h i/v vai i/m 7 dienas vai kā 1 deva. Acs skalošana ar sāls šķīdumu ik pēc 10-30min, pakāpeniski palielinot intervālu līdz 2h, līdz izzūd strutainie izdalījumi. Sepse, ekstraokulāri paildzina th. Page 22

25 Chlamydia p/o eritromicīns 50mg/kg/24h [sadalīts 4 daļās] 2 nedēļas Gan konjunktivītam, gan pneimonijas profilaksei. Pseudomonas sistēmiskie a/b Aminoglikozīdi + sāls šķ. skalošana + gentamicīna ziede. Staphylococcus p/o meticilīns + sāls šķ. Skalošana Herpes simplex aciklovīrs iv 60mg/kg24h dalītās devās 14d. Keratīts 1% trifluridīna pilieni vai 3% viradabīna ziede» Sekundāru bakteriālu infekciju proflakse Page 23

26 Endoftalmīts Stiklveida ķermeņa iekaisums, pamatā tiek diagnosticēts priekšlaicīgi dzimušajiem neonatālā periodā (1465±580g; 29±8g.ned.). Endogēns endoftalmīts acs infekcija sekundaŗi septicēmijai (20% endoftalmītu). Ps.aeruginosa 75% Page 24

27 Neonatal endogenous endophthalmitis: a report of six cases. Basu S1, Kumar A, Kapoor K, Bagri NK, Chandra A. Reta neonatālas sepses komplikācija, bet potenciāli padara bērnu aklu; Th: sistēmiskas un intravitreālas a/b; vitrektomija 6 VLBW, priekšlaicīgi dzimuši NICU Early-onset sepsis 2/2 exitus Late-onset sepsis ¼ exitus, 2 n redze, 1 phthisis bulbi 2 Klebsiella pneumoniae, 2 Ps.aeruginosa, 1 MRSA, 1 C.albicans ar rezistenci uz 1.kārtas medikamentiem! Page 25

28 Bacterial endophthalmitis in neonates R. Lohrer, B. H. Belohradsky Page 26

29 view/98/html Page 27

30 Chorioretinitis in infants. Modrzejewska M1, Lachowicz E, Karczewicz D, Zdanowska A. Toksoplazmoze, masaliņas, CMV. Risks priekšlaicīga dzimšana, intrauterīna pārnese, krūtsbarošana, blakussaslimšanas. Page 28

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