INFECTIEZIEKTEN
INHOUDSOPGAVE
1. Pathofysiologie van infectieziekten ............................................................................................................... 5
1.1 INHOUD ............................................................................................................................................................................... 5
1.2 DEFINITIES............................................................................................................................................................................ 5
1.3 PATHOFYSIOLOGIE ........................................................................................................................................................... 5
1.4 MICROBIELE VIRULENTIE .................................................................................................................................................. 5
Primair/Obligaat pathogene micro-organismen ............................................................................................................ 5
Potentieel pathogene micro-organismen .......................................................................................................................... 5
Opportunistisch pathogene micro-organismen................................................................................................................. 6
1.5 PATHOGENESE VAN INFECTIES ...................................................................................................................................... 6
1.6 afweermechanismen van de gastheer ............................................................................................................................... 7
Huid- en mucosa-barrière .................................................................................................................................................... 7
Humorale afweermechanismen ........................................................................................................................................... 7
Cellulaire afweermechanismen ........................................................................................................................................... 8
2. Epidemiologie van infectieziekten ................................................................................................................. 9
2.1 INHOUD ............................................................................................................................................................................... 9
2.2 BESCHRIJVENDE EPIDEMIOLOGIE ............................................................................................................................ 9
2.3 SURVEILLANCE ................................................................................................................................................................. 10
3. Klinische aspecten van infectieziekten en aanvullende diagnostiek ........................................................... 10
3.1 INHOUD ............................................................................................................................................................................ 10
3.2 KLINISCHE ASPECTEN .................................................................................................................................................... 10
Koorts .................................................................................................................................................................................... 10
Systeem van thermoregulatie: ......................................................................................................................................... 11
Koortspatronen ................................................................................................................................................................... 11
Behandeling van koorts ..................................................................................................................................................... 12
Aanvullende diagnostiek................................................................................................................................................... 12
4. Sepsis ........................................................................................................................................................... 13
4.1 INHOUD ............................................................................................................................................................................ 13
4.2 DEFINITIES......................................................................................................................................................................... 13
Sepsis .................................................................................................................................................................................... 13
Septische chock ................................................................................................................................................................... 14
Bacteriëmie .......................................................................................................................................................................... 14
4.3 ETIOLOGIE ........................................................................................................................................................................ 15
4.4 PROGNOSE ...................................................................................................................................................................... 16
4.5 PATHOGENESE ................................................................................................................................................................. 16
Fase 1: Excessieve inflammatie, vaatverwijding, hypotensie en capillaire lekkage (minuten tot uren) ............ 16
Fase 2: Orgaanfalen, metabole ontregeling en verhoogde mortaliteit ................................................................. 17
Fase 3: Persisterende immuun disfunctie en verhoogd risico op secundaire infecties ........................................... 17
Conclusie: ............................................................................................................................................................................. 17
4.6 BEHANDELING .................................................................................................................................................................. 18
, Anti-infectieus beleid: ........................................................................................................................................................ 18
Anti-inflammatoire modulatie .......................................................................................................................................... 18
4.7 BIJZONDERE GEVALLEN VAN SEPSIS (zie casussen les) .......................................................................................... 18
5. HIV/AIDS ...................................................................................................................................................... 19
5.1 INHOUD ............................................................................................................................................................................ 19
5.2 EPIDEMIOLOGIE .............................................................................................................................................................. 19
Epidemiologie in België .................................................................................................................................................... 19
Globale epidemiologie ..................................................................................................................................................... 19
5.3 TRANSMISSIE ................................................................................................................................................................... 19
HIV screeningtest ................................................................................................................................................................ 20
5.4 KLINISCH VERLOOP ....................................................................................................................................................... 21
5.5 INITIELE EVALUATIE......................................................................................................................................................... 22
Indicatoraandoeningen ..................................................................................................................................................... 22
Immunologie: CD4 (absoluut aantal en %) .................................................................................................................... 22
Virologie: viral load en resistentiebepaling.................................................................................................................. 22
5.6 KLINISCHE CLASSIFICATIE ............................................................................................................................................ 22
Klinische categorie A: ........................................................................................................................................................ 23
Klinische categorie B: ......................................................................................................................................................... 23
Klinische categorie C: AIDS-definiërende aandoeningen .......................................................................................... 23
5.7 BEHANDELING EN OPVOLGING VAN DE HIV PATIENT.......................................................................................... 24
Antiretrovirale therapie (ART).......................................................................................................................................... 24
Beschikbare producten: ..................................................................................................................................................... 24
Profylaxe opportunistische infecties ............................................................................................................................... 25
Andere preventieve maatregelen................................................................................................................................... 25
5.8 PREVENTIE BIJ ZORGVERLENERS ................................................................................................................................. 26
Standaardvoorzorgsmaatregelen .................................................................................................................................. 26
Post-exposure profylaxe (PEP) ........................................................................................................................................ 26
5.9 PREVENTIE BIJ NIET-PROFESSIONELE RISICO’S ....................................................................................................... 26
Voorzorgsmaatregelen ..................................................................................................................................................... 26
Post-exposure profylaxe (PEP) ........................................................................................................................................ 26
Pre-exposure profylaxe (PrEP)........................................................................................................................................ 26
6. Koorts bij terugkeer uit de (sub)tropen......................................................................................................... 27
6.1 Inleiding: Casus .......................................................................................................................................................... 27
6.2 Epidemiologie .................................................................................................................................................................... 27
6.3 Malaria .............................................................................................................................................................................. 27
Pathogenese ........................................................................................................................................................................ 27
Epidemiologie ..................................................................................................................................................................... 28
Klinisch beeld ...................................................................................................................................................................... 28
Diagnose .............................................................................................................................................................................. 28
Behandeling ......................................................................................................................................................................... 28
Preventie .............................................................................................................................................................................. 28
6.4 Arbovirale infecties: dengue en chikungunya ............................................................................................................... 29
Dengue (Denguevirus/flavivirus/“knokkelkoorts”) ....................................................................................................... 29
Chikungunya ........................................................................................................................................................................ 29
6.5 Virale hemorrhagische koortsen ..................................................................................................................................... 29
,7. Capita selecta bacteriële infecties: lyme borreliose ..................................................................................... 30
Besmetting zonder infectie................................................................................................................................................ 30
Erythema migrans ............................................................................................................................................................... 30
Niet-Lyme infecties ............................................................................................................................................................. 30
Vroege neuroborreliose .................................................................................................................................................... 30
Lyme carditis ....................................................................................................................................................................... 30
Lymphocytoma .................................................................................................................................................................... 30
Lyme-artritis ......................................................................................................................................................................... 30
Chronische neuroborrelioses ............................................................................................................................................. 31
8. preventie infecties: vaccinaties .................................................................................................................... 31
8.1 algemene informatie omtrent vaccinatie ....................................................................................................................... 31
8.2 vaccinatieplanning ............................................................................................................................................................ 33
Tetanusvaccinatie ..................................................................................................................................................................... 34
Eigenschappen van een clostridium tetani infectie: ...................................................................................................... 34
Vaccinatiecampagne omtrent clostridium tetani:.......................................................................................................... 34
Influenza.................................................................................................................................................................................... 34
COVID-19 ................................................................................................................................................................................ 34
Pneumokokken .......................................................................................................................................................................... 35
Eigenschappen van een pneumokokken infectie: ......................................................................................................... 35
Vaccinatiecampagne omtrent pneumokokken: ............................................................................................................. 35
respiratory syncytial virus ....................................................................................................................................................... 35
Eigenschappen van een RSV infectie: ............................................................................................................................. 35
Vaccinatiecampagne omtrent RSV: ................................................................................................................................. 35
Herpes/ Varicella zoster virus ............................................................................................................................................... 35
Eigenschappen van een varicella-zoster virus infectie: ............................................................................................... 35
Vaccinatiecampagne omtrent varicella-zoster virus: ................................................................................................... 36
Asplenie ..................................................................................................................................................................................... 36
Vaccine hesitancy ..................................................................................................................................................................... 36
Casussen .................................................................................................................................................................................... 36
9. Seksueel overdraagbare aandoeningen (SOA) ............................................................................................ 37
9.1 inleiding.............................................................................................................................................................................. 37
9.2 SOA’s verbonden met genitale* ulceraties ................................................................................................................... 37
Syphilis ................................................................................................................................................................................. 37
Herpes Simplex................................................................................................................................................................... 38
Mpox .................................................................................................................................................................................... 38
Lymphogranuloma venereum ........................................................................................................................................... 38
9.3 soa’s verbonden met genitaal verlies............................................................................................................................. 38
Neisseria gonorrhoeae ...................................................................................................................................................... 39
Chlamydia trachomatis...................................................................................................................................................... 39
Lymfogranuloma venereum .............................................................................................................................................. 39
9.4 genitale wratten (condylomata acuminata) .................................................................................................................. 39
9.5 proctitis (ontsteking van de anus) .................................................................................................................................. 40
9.6 koorts bij SOA’s ............................................................................................................................................................... 40
9.7 ectoparasieten ................................................................................................................................................................... 40
Scabies ................................................................................................................................................................................. 40
, Pediculosis pubis ................................................................................................................................................................. 40
9.8 niet-genitale manifestaties ............................................................................................................................................... 40
Hepatitis ............................................................................................................................................................................... 41
Secundaire syfilis: gaat ook vaak gepaard met cholestase...................................................................................... 41
10. Rationele antimicrobiële therapie .............................................................................................................. 41
10.1 inleiding ........................................................................................................................................................................... 41
Het belang van rationeel antibioticagebruik ............................................................................................................... 41
Basis van infecties en rationeel antibioticagebruik...................................................................................................... 41
10.2 Drie pijlers van antibioticatherapie.............................................................................................................................. 42
10.3 microbiologische en farmacologische basis – niet kennen zie microbiologie ........................................................ 42
10.4 Klinische benadering van infecties ............................................................................................................................... 42
INHOUDSOPGAVE
1. Pathofysiologie van infectieziekten ............................................................................................................... 5
1.1 INHOUD ............................................................................................................................................................................... 5
1.2 DEFINITIES............................................................................................................................................................................ 5
1.3 PATHOFYSIOLOGIE ........................................................................................................................................................... 5
1.4 MICROBIELE VIRULENTIE .................................................................................................................................................. 5
Primair/Obligaat pathogene micro-organismen ............................................................................................................ 5
Potentieel pathogene micro-organismen .......................................................................................................................... 5
Opportunistisch pathogene micro-organismen................................................................................................................. 6
1.5 PATHOGENESE VAN INFECTIES ...................................................................................................................................... 6
1.6 afweermechanismen van de gastheer ............................................................................................................................... 7
Huid- en mucosa-barrière .................................................................................................................................................... 7
Humorale afweermechanismen ........................................................................................................................................... 7
Cellulaire afweermechanismen ........................................................................................................................................... 8
2. Epidemiologie van infectieziekten ................................................................................................................. 9
2.1 INHOUD ............................................................................................................................................................................... 9
2.2 BESCHRIJVENDE EPIDEMIOLOGIE ............................................................................................................................ 9
2.3 SURVEILLANCE ................................................................................................................................................................. 10
3. Klinische aspecten van infectieziekten en aanvullende diagnostiek ........................................................... 10
3.1 INHOUD ............................................................................................................................................................................ 10
3.2 KLINISCHE ASPECTEN .................................................................................................................................................... 10
Koorts .................................................................................................................................................................................... 10
Systeem van thermoregulatie: ......................................................................................................................................... 11
Koortspatronen ................................................................................................................................................................... 11
Behandeling van koorts ..................................................................................................................................................... 12
Aanvullende diagnostiek................................................................................................................................................... 12
4. Sepsis ........................................................................................................................................................... 13
4.1 INHOUD ............................................................................................................................................................................ 13
4.2 DEFINITIES......................................................................................................................................................................... 13
Sepsis .................................................................................................................................................................................... 13
Septische chock ................................................................................................................................................................... 14
Bacteriëmie .......................................................................................................................................................................... 14
4.3 ETIOLOGIE ........................................................................................................................................................................ 15
4.4 PROGNOSE ...................................................................................................................................................................... 16
4.5 PATHOGENESE ................................................................................................................................................................. 16
Fase 1: Excessieve inflammatie, vaatverwijding, hypotensie en capillaire lekkage (minuten tot uren) ............ 16
Fase 2: Orgaanfalen, metabole ontregeling en verhoogde mortaliteit ................................................................. 17
Fase 3: Persisterende immuun disfunctie en verhoogd risico op secundaire infecties ........................................... 17
Conclusie: ............................................................................................................................................................................. 17
4.6 BEHANDELING .................................................................................................................................................................. 18
, Anti-infectieus beleid: ........................................................................................................................................................ 18
Anti-inflammatoire modulatie .......................................................................................................................................... 18
4.7 BIJZONDERE GEVALLEN VAN SEPSIS (zie casussen les) .......................................................................................... 18
5. HIV/AIDS ...................................................................................................................................................... 19
5.1 INHOUD ............................................................................................................................................................................ 19
5.2 EPIDEMIOLOGIE .............................................................................................................................................................. 19
Epidemiologie in België .................................................................................................................................................... 19
Globale epidemiologie ..................................................................................................................................................... 19
5.3 TRANSMISSIE ................................................................................................................................................................... 19
HIV screeningtest ................................................................................................................................................................ 20
5.4 KLINISCH VERLOOP ....................................................................................................................................................... 21
5.5 INITIELE EVALUATIE......................................................................................................................................................... 22
Indicatoraandoeningen ..................................................................................................................................................... 22
Immunologie: CD4 (absoluut aantal en %) .................................................................................................................... 22
Virologie: viral load en resistentiebepaling.................................................................................................................. 22
5.6 KLINISCHE CLASSIFICATIE ............................................................................................................................................ 22
Klinische categorie A: ........................................................................................................................................................ 23
Klinische categorie B: ......................................................................................................................................................... 23
Klinische categorie C: AIDS-definiërende aandoeningen .......................................................................................... 23
5.7 BEHANDELING EN OPVOLGING VAN DE HIV PATIENT.......................................................................................... 24
Antiretrovirale therapie (ART).......................................................................................................................................... 24
Beschikbare producten: ..................................................................................................................................................... 24
Profylaxe opportunistische infecties ............................................................................................................................... 25
Andere preventieve maatregelen................................................................................................................................... 25
5.8 PREVENTIE BIJ ZORGVERLENERS ................................................................................................................................. 26
Standaardvoorzorgsmaatregelen .................................................................................................................................. 26
Post-exposure profylaxe (PEP) ........................................................................................................................................ 26
5.9 PREVENTIE BIJ NIET-PROFESSIONELE RISICO’S ....................................................................................................... 26
Voorzorgsmaatregelen ..................................................................................................................................................... 26
Post-exposure profylaxe (PEP) ........................................................................................................................................ 26
Pre-exposure profylaxe (PrEP)........................................................................................................................................ 26
6. Koorts bij terugkeer uit de (sub)tropen......................................................................................................... 27
6.1 Inleiding: Casus .......................................................................................................................................................... 27
6.2 Epidemiologie .................................................................................................................................................................... 27
6.3 Malaria .............................................................................................................................................................................. 27
Pathogenese ........................................................................................................................................................................ 27
Epidemiologie ..................................................................................................................................................................... 28
Klinisch beeld ...................................................................................................................................................................... 28
Diagnose .............................................................................................................................................................................. 28
Behandeling ......................................................................................................................................................................... 28
Preventie .............................................................................................................................................................................. 28
6.4 Arbovirale infecties: dengue en chikungunya ............................................................................................................... 29
Dengue (Denguevirus/flavivirus/“knokkelkoorts”) ....................................................................................................... 29
Chikungunya ........................................................................................................................................................................ 29
6.5 Virale hemorrhagische koortsen ..................................................................................................................................... 29
,7. Capita selecta bacteriële infecties: lyme borreliose ..................................................................................... 30
Besmetting zonder infectie................................................................................................................................................ 30
Erythema migrans ............................................................................................................................................................... 30
Niet-Lyme infecties ............................................................................................................................................................. 30
Vroege neuroborreliose .................................................................................................................................................... 30
Lyme carditis ....................................................................................................................................................................... 30
Lymphocytoma .................................................................................................................................................................... 30
Lyme-artritis ......................................................................................................................................................................... 30
Chronische neuroborrelioses ............................................................................................................................................. 31
8. preventie infecties: vaccinaties .................................................................................................................... 31
8.1 algemene informatie omtrent vaccinatie ....................................................................................................................... 31
8.2 vaccinatieplanning ............................................................................................................................................................ 33
Tetanusvaccinatie ..................................................................................................................................................................... 34
Eigenschappen van een clostridium tetani infectie: ...................................................................................................... 34
Vaccinatiecampagne omtrent clostridium tetani:.......................................................................................................... 34
Influenza.................................................................................................................................................................................... 34
COVID-19 ................................................................................................................................................................................ 34
Pneumokokken .......................................................................................................................................................................... 35
Eigenschappen van een pneumokokken infectie: ......................................................................................................... 35
Vaccinatiecampagne omtrent pneumokokken: ............................................................................................................. 35
respiratory syncytial virus ....................................................................................................................................................... 35
Eigenschappen van een RSV infectie: ............................................................................................................................. 35
Vaccinatiecampagne omtrent RSV: ................................................................................................................................. 35
Herpes/ Varicella zoster virus ............................................................................................................................................... 35
Eigenschappen van een varicella-zoster virus infectie: ............................................................................................... 35
Vaccinatiecampagne omtrent varicella-zoster virus: ................................................................................................... 36
Asplenie ..................................................................................................................................................................................... 36
Vaccine hesitancy ..................................................................................................................................................................... 36
Casussen .................................................................................................................................................................................... 36
9. Seksueel overdraagbare aandoeningen (SOA) ............................................................................................ 37
9.1 inleiding.............................................................................................................................................................................. 37
9.2 SOA’s verbonden met genitale* ulceraties ................................................................................................................... 37
Syphilis ................................................................................................................................................................................. 37
Herpes Simplex................................................................................................................................................................... 38
Mpox .................................................................................................................................................................................... 38
Lymphogranuloma venereum ........................................................................................................................................... 38
9.3 soa’s verbonden met genitaal verlies............................................................................................................................. 38
Neisseria gonorrhoeae ...................................................................................................................................................... 39
Chlamydia trachomatis...................................................................................................................................................... 39
Lymfogranuloma venereum .............................................................................................................................................. 39
9.4 genitale wratten (condylomata acuminata) .................................................................................................................. 39
9.5 proctitis (ontsteking van de anus) .................................................................................................................................. 40
9.6 koorts bij SOA’s ............................................................................................................................................................... 40
9.7 ectoparasieten ................................................................................................................................................................... 40
Scabies ................................................................................................................................................................................. 40
, Pediculosis pubis ................................................................................................................................................................. 40
9.8 niet-genitale manifestaties ............................................................................................................................................... 40
Hepatitis ............................................................................................................................................................................... 41
Secundaire syfilis: gaat ook vaak gepaard met cholestase...................................................................................... 41
10. Rationele antimicrobiële therapie .............................................................................................................. 41
10.1 inleiding ........................................................................................................................................................................... 41
Het belang van rationeel antibioticagebruik ............................................................................................................... 41
Basis van infecties en rationeel antibioticagebruik...................................................................................................... 41
10.2 Drie pijlers van antibioticatherapie.............................................................................................................................. 42
10.3 microbiologische en farmacologische basis – niet kennen zie microbiologie ........................................................ 42
10.4 Klinische benadering van infecties ............................................................................................................................... 42
