INFECTIEZIEKTEN
PAUL DE MUNTER
Inhoudsopgave
INLEIDING...................................................................................................... 5
H1: PATHOFYSIOLOGIE VAN INFECTIEZIEKTEN.................................................6
DEFINITIES.......................................................................................................................... 6
PATHOFYSIOLOGIE................................................................................................................ 7
MICROBIELE VIRULENTIE......................................................................................................... 7
PATHOGENESE VAN INFECTIES................................................................................................. 9
AFWEERMECHANISME VAN GASTHEER.....................................................................................10
CASUS............................................................................................................................. 11
H2: EPIDEMIOLOGIE VAN INFECTIEZIEKTEN....................................................14
BESCHRIJVENDE EPIDEMIOLOGIE............................................................................................. 14
SURVEILLANCE................................................................................................................... 16
MORTALITEIT EN LETALITEIT.................................................................................................. 16
H3: KLINISCHE ASPECTEN VAN INFECTIEZIEKTEN EN AANVULLENDE
DIAGNOSTIEK............................................................................................... 18
KLINISCHE ASPECTEN.......................................................................................................... 18
KOORTS........................................................................................................................... 18
HYPERTHERMIE.................................................................................................................. 21
AANVULLENDE DIAGNOSTIEK................................................................................................. 22
CASUSSEN........................................................................................................................ 22
H4: SEPSIS................................................................................................... 24
DEFINITIES........................................................................................................................ 24
ETIOLOGIE, PATHOGENESE, PROGNOSE, BEHANDELING...............................................................25
BIJZONDERE VORMEN.......................................................................................................... 27
CASUSSEN........................................................................................................................ 28
H5: KOORTS BIJ TERUGKEER UIT (SUB)TROPEN..............................................30
ELEMENTEN VOOR EVALUATIE............................................................................................... 30
OORZAKEN KOORTS NA TROPEN............................................................................................ 30
INCUBATIETIJD.................................................................................................................... 30
SPECIFIEKE BLOOTSTELLING.................................................................................................. 32
KLINISCHE AANKNOPINGSPUNTEN........................................................................................... 32
SPECIFIEKE AANDOENINGEN.................................................................................................. 32
DIAGNOSTISCH BELEID: FLOW-CHART..................................................................................38
,H6: INFECTIEUZE DIARREE............................................................................40
(ACUTE) DIARREE............................................................................................................... 40
Epidemiologie............................................................................................................. 40
Voedselintoxicatie...................................................................................................... 41
Secretoire diarree....................................................................................................... 41
Invasieve diarree........................................................................................................ 41
Pathogenese.............................................................................................................. 42
Diagnose.................................................................................................................... 43
Behandeling............................................................................................................... 44
ANTIBIOTICA-GEASSOCIEERDE DIARREE...................................................................................44
oorzaken.................................................................................................................... 44
epidemiologie............................................................................................................. 45
Clostridioides difficile infectie (CDI)............................................................................45
Pathogenese.............................................................................................................. 45
Klinische presentatie..................................................................................................45
Diagnose.................................................................................................................... 46
Behandeling............................................................................................................... 46
Preventie.................................................................................................................... 47
H7: HIV/AIDS................................................................................................ 47
EPIDEMIOLOGIE.................................................................................................................. 47
TRANSMISSIE..................................................................................................................... 47
HIV 1 EN 2...................................................................................................................... 48
PATHOGENESE HIV-VIRUS.................................................................................................... 49
KLINISCH VERLOOP............................................................................................................. 49
INITIELE EVALUATIE............................................................................................................. 50
KLINISCHE CLASSIFICATIE..................................................................................................... 50
BEHANDELING EN OPVOLGING............................................................................................... 51
PREVENTIE........................................................................................................................ 53
Bij zorgverleners........................................................................................................ 53
Bij niet-professionele risico’s......................................................................................54
H8: SEKSUEEL OVERDRAAGBARE AANDOENINGEN..........................................55
SEKSUELE GEZONDHEID....................................................................................................... 55
SEKSUELE OVERDRAAGBARE AANDOENINGEN (SOA’S)...............................................................56
Syphilis....................................................................................................................... 57
Gonococcen................................................................................................................ 60
Chlamydia.................................................................................................................. 61
Urethritis/cervicitis..................................................................................................... 61
proctitis...................................................................................................................... 61
proctocolitis................................................................................................................ 62
Herpes genitalis......................................................................................................... 62
Condylomata accuminata...........................................................................................63
hepatitis virussen....................................................................................................... 63
mpox.......................................................................................................................... 64
ectoparasieten........................................................................................................... 64
Implicaties van SOA diagnose....................................................................................64
H9: CAPITA SELECTA BACTERIËLE INFECTIES..................................................65
BUIKTYFUS........................................................................................................................ 65
NON-TYPHI SALMONELLOSEN................................................................................................. 65
LEPTOSPIROSE................................................................................................................... 66
, KATTENKRABZIEKTE............................................................................................................ 66
BIJTWONDEN..................................................................................................................... 67
ZIEKTE VAN LYME............................................................................................................... 68
TETANUS (WONDKLEM)........................................................................................................ 70
PERTUSSIS (KINKHOEST)...................................................................................................... 71
H10: CAPITA SELECTA VIRALE INFECTIES.......................................................73
INFLUENZA........................................................................................................................ 73
HERPES VIRUS................................................................................................................... 75
herpes simplex virus.................................................................................................. 75
Varicella zoster virus.................................................................................................. 76
Mononucleosis infectiosa............................................................................................ 77
Cytomegalovirus........................................................................................................ 78
MAZELEN.......................................................................................................................... 79
HANTA-VIRUS.................................................................................................................... 79
CORONAVIRUS.................................................................................................................... 79
H11: CAPITA SELECTA FUNGALE INFECTIES....................................................82
CANDIDIASE...................................................................................................................... 82
ASPERGILLOSE................................................................................................................... 84
CRYPTOCOCCUS................................................................................................................. 86
PNEUMOCYSTIS JIROVECI...................................................................................................... 87
H12: CAPITA SELECTA PARASITAIRE INFECTIES..............................................87
TOXOPLASMOSE GONDII....................................................................................................... 87
MALARIA.......................................................................................................................... 89
H13: VACCINATIES BIJ VOLWASSENEN...........................................................89
TETANUS-DRIFTERIE (TD)..................................................................................................... 91
INFLUENZA VACCIN............................................................................................................. 92
PNEUMOKOKKENVACCIN....................................................................................................... 93
SARS-COV-2.................................................................................................................... 94
RESPIRATORY SYNCYTIAL VIRUS............................................................................................. 95
VARICELLA-ZOSTER VIRUS.................................................................................................... 95
VACCINWEIGERIN EN VACCINE-HESITANCY................................................................................96
H14: RELATIONELE ANTIMICROBIËLE THERAPIE..............................................97
MICROBIOLOGISCHE BASIS VAN ANTIBIOTICA THERAPIE...............................................................97
Werkingsmechanisme AB........................................................................................... 98
microbiële resistentie............................................................................................... 100
FARMACOLOGISCHE BASIS VAN ANTIMICROBIËLE THERAPIE........................................................102
KLINISCHE BASIS VAN ANTIMICROBIËLE THERAPIE....................................................................103
PROBLEEMOPLOSSENDE KLINIEK.................................................................106
CASUS 1........................................................................................................................ 106
CASUS 2: STATIONSPROEF VOORBEREIDING...........................................................................106
CASUS 3........................................................................................................................ 107
CASUS 4........................................................................................................................ 107
CASUS 5........................................................................................................................ 107
VOORBEELDVRAGEN...................................................................................108
EXAMENINFO.............................................................................................. 110
,
PAUL DE MUNTER
Inhoudsopgave
INLEIDING...................................................................................................... 5
H1: PATHOFYSIOLOGIE VAN INFECTIEZIEKTEN.................................................6
DEFINITIES.......................................................................................................................... 6
PATHOFYSIOLOGIE................................................................................................................ 7
MICROBIELE VIRULENTIE......................................................................................................... 7
PATHOGENESE VAN INFECTIES................................................................................................. 9
AFWEERMECHANISME VAN GASTHEER.....................................................................................10
CASUS............................................................................................................................. 11
H2: EPIDEMIOLOGIE VAN INFECTIEZIEKTEN....................................................14
BESCHRIJVENDE EPIDEMIOLOGIE............................................................................................. 14
SURVEILLANCE................................................................................................................... 16
MORTALITEIT EN LETALITEIT.................................................................................................. 16
H3: KLINISCHE ASPECTEN VAN INFECTIEZIEKTEN EN AANVULLENDE
DIAGNOSTIEK............................................................................................... 18
KLINISCHE ASPECTEN.......................................................................................................... 18
KOORTS........................................................................................................................... 18
HYPERTHERMIE.................................................................................................................. 21
AANVULLENDE DIAGNOSTIEK................................................................................................. 22
CASUSSEN........................................................................................................................ 22
H4: SEPSIS................................................................................................... 24
DEFINITIES........................................................................................................................ 24
ETIOLOGIE, PATHOGENESE, PROGNOSE, BEHANDELING...............................................................25
BIJZONDERE VORMEN.......................................................................................................... 27
CASUSSEN........................................................................................................................ 28
H5: KOORTS BIJ TERUGKEER UIT (SUB)TROPEN..............................................30
ELEMENTEN VOOR EVALUATIE............................................................................................... 30
OORZAKEN KOORTS NA TROPEN............................................................................................ 30
INCUBATIETIJD.................................................................................................................... 30
SPECIFIEKE BLOOTSTELLING.................................................................................................. 32
KLINISCHE AANKNOPINGSPUNTEN........................................................................................... 32
SPECIFIEKE AANDOENINGEN.................................................................................................. 32
DIAGNOSTISCH BELEID: FLOW-CHART..................................................................................38
,H6: INFECTIEUZE DIARREE............................................................................40
(ACUTE) DIARREE............................................................................................................... 40
Epidemiologie............................................................................................................. 40
Voedselintoxicatie...................................................................................................... 41
Secretoire diarree....................................................................................................... 41
Invasieve diarree........................................................................................................ 41
Pathogenese.............................................................................................................. 42
Diagnose.................................................................................................................... 43
Behandeling............................................................................................................... 44
ANTIBIOTICA-GEASSOCIEERDE DIARREE...................................................................................44
oorzaken.................................................................................................................... 44
epidemiologie............................................................................................................. 45
Clostridioides difficile infectie (CDI)............................................................................45
Pathogenese.............................................................................................................. 45
Klinische presentatie..................................................................................................45
Diagnose.................................................................................................................... 46
Behandeling............................................................................................................... 46
Preventie.................................................................................................................... 47
H7: HIV/AIDS................................................................................................ 47
EPIDEMIOLOGIE.................................................................................................................. 47
TRANSMISSIE..................................................................................................................... 47
HIV 1 EN 2...................................................................................................................... 48
PATHOGENESE HIV-VIRUS.................................................................................................... 49
KLINISCH VERLOOP............................................................................................................. 49
INITIELE EVALUATIE............................................................................................................. 50
KLINISCHE CLASSIFICATIE..................................................................................................... 50
BEHANDELING EN OPVOLGING............................................................................................... 51
PREVENTIE........................................................................................................................ 53
Bij zorgverleners........................................................................................................ 53
Bij niet-professionele risico’s......................................................................................54
H8: SEKSUEEL OVERDRAAGBARE AANDOENINGEN..........................................55
SEKSUELE GEZONDHEID....................................................................................................... 55
SEKSUELE OVERDRAAGBARE AANDOENINGEN (SOA’S)...............................................................56
Syphilis....................................................................................................................... 57
Gonococcen................................................................................................................ 60
Chlamydia.................................................................................................................. 61
Urethritis/cervicitis..................................................................................................... 61
proctitis...................................................................................................................... 61
proctocolitis................................................................................................................ 62
Herpes genitalis......................................................................................................... 62
Condylomata accuminata...........................................................................................63
hepatitis virussen....................................................................................................... 63
mpox.......................................................................................................................... 64
ectoparasieten........................................................................................................... 64
Implicaties van SOA diagnose....................................................................................64
H9: CAPITA SELECTA BACTERIËLE INFECTIES..................................................65
BUIKTYFUS........................................................................................................................ 65
NON-TYPHI SALMONELLOSEN................................................................................................. 65
LEPTOSPIROSE................................................................................................................... 66
, KATTENKRABZIEKTE............................................................................................................ 66
BIJTWONDEN..................................................................................................................... 67
ZIEKTE VAN LYME............................................................................................................... 68
TETANUS (WONDKLEM)........................................................................................................ 70
PERTUSSIS (KINKHOEST)...................................................................................................... 71
H10: CAPITA SELECTA VIRALE INFECTIES.......................................................73
INFLUENZA........................................................................................................................ 73
HERPES VIRUS................................................................................................................... 75
herpes simplex virus.................................................................................................. 75
Varicella zoster virus.................................................................................................. 76
Mononucleosis infectiosa............................................................................................ 77
Cytomegalovirus........................................................................................................ 78
MAZELEN.......................................................................................................................... 79
HANTA-VIRUS.................................................................................................................... 79
CORONAVIRUS.................................................................................................................... 79
H11: CAPITA SELECTA FUNGALE INFECTIES....................................................82
CANDIDIASE...................................................................................................................... 82
ASPERGILLOSE................................................................................................................... 84
CRYPTOCOCCUS................................................................................................................. 86
PNEUMOCYSTIS JIROVECI...................................................................................................... 87
H12: CAPITA SELECTA PARASITAIRE INFECTIES..............................................87
TOXOPLASMOSE GONDII....................................................................................................... 87
MALARIA.......................................................................................................................... 89
H13: VACCINATIES BIJ VOLWASSENEN...........................................................89
TETANUS-DRIFTERIE (TD)..................................................................................................... 91
INFLUENZA VACCIN............................................................................................................. 92
PNEUMOKOKKENVACCIN....................................................................................................... 93
SARS-COV-2.................................................................................................................... 94
RESPIRATORY SYNCYTIAL VIRUS............................................................................................. 95
VARICELLA-ZOSTER VIRUS.................................................................................................... 95
VACCINWEIGERIN EN VACCINE-HESITANCY................................................................................96
H14: RELATIONELE ANTIMICROBIËLE THERAPIE..............................................97
MICROBIOLOGISCHE BASIS VAN ANTIBIOTICA THERAPIE...............................................................97
Werkingsmechanisme AB........................................................................................... 98
microbiële resistentie............................................................................................... 100
FARMACOLOGISCHE BASIS VAN ANTIMICROBIËLE THERAPIE........................................................102
KLINISCHE BASIS VAN ANTIMICROBIËLE THERAPIE....................................................................103
PROBLEEMOPLOSSENDE KLINIEK.................................................................106
CASUS 1........................................................................................................................ 106
CASUS 2: STATIONSPROEF VOORBEREIDING...........................................................................106
CASUS 3........................................................................................................................ 107
CASUS 4........................................................................................................................ 107
CASUS 5........................................................................................................................ 107
VOORBEELDVRAGEN...................................................................................108
EXAMENINFO.............................................................................................. 110
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