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Bráð blóðborin beinsýking barna

Bráð blóðborin beinsýking barna. (BBBB) Acute hematogen Osteomyelitis (AHO). Guðmundur K Jónmundsson Barnaspítali Hringsins. Frekar sjaldgæf sýking. Tíðni ? E.t.v. Um 10 á ári hérlendis Drengir: Stúlkur 2-3 : 1 Oftast á aldrinum 2-5 ára >80% < 16 ára. Pathogenesis.

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Bráð blóðborin beinsýking barna

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  1. Bráð blóðborin beinsýking barna (BBBB) Acute hematogen Osteomyelitis (AHO) Guðmundur K Jónmundsson Barnaspítali Hringsins

  2. Frekar sjaldgæf sýking Tíðni ? E.t.v. Um 10 á ári hérlendis Drengir: Stúlkur 2-3 : 1 Oftast á aldrinum 2-5 ára >80% < 16 ára

  3. Pathogenesis Metaphysis langra beina Algengasta staðsetningin vegna anatomiu og blóðrásar Ganglimir í > 70% tilfella

  4. Osteomyelitis

  5. Beingerð

  6. Beingerð Section parallel to the surface from the body of the femur. X 100. a, Haversian canals; b, lacunæ seen from the side; c, others seen from the surface in lamellæ, which are cut horizontally.

  7. Haversian canals

  8. Staðsetning aho Femur 36% Tibia 33% Humerus 10% Fibula 7% Radius 3% Ulna 2% Calcaneus 3%

  9. Sýklar Staphylococcus aureus >70% Streptococcus Gr.B Strept. Pyogenes Strept. Epidermidis E.Coli Pseudomonas aeruginosa Hemophilus influenzae o.fl.

  10. AHO Smábörn (< 1 árs) 1 – 16 ára >16 ára Gr. B streptococca Staph.aureus Staph. aureus Staph aureus Strept. Pyogenes St. epidermidis E.coli Hemophilus infl. Pseudom. aerug. Kingela kingae Serratia marcescence E.coli

  11. Osteomyelitis 241 barn (Panama 1974-1992) 92 % acut, 8 % chronic Pos. ræktanir 57% Staph. aureus 40% Pseudomonas aeruginosa 4% Salmonella 3% Haemophilus influenzae gr. B 3%

  12. Einkenni við akút hematogen osteomyelitis Eymsli 88% Hitahækkun 75% Bólga 50% Hreyfihindrun 45%

  13. BBBBMismunagreining Arthritis rheumatoides Septiskur arthritis Cellulitis Ewing´s sarcom Hvítblæði Æðabólga Beininfarkt (sickle cell anemia) Toxiskur synovitis (coxitis simplex)

  14. Rannsóknir Blóðstatus Sökk CRP Blóðræktun Aspirat í ræktun Beinaskann Rtg., CT, MRI

  15. Meðferð 0 – ½ árs: Cloxacillin+Aminoglysoid >1/2 árs: Cloxacillin +/- Cephalosporin

  16. AHO Til að breyta frá i.v. lyfjagjöf í oral þarf að tryggja: Að góður árangur hafi verið af lyfjagjöfinni í æð. Meðferðarhlýðni (compliance) Sýkillinn verður að vera til staðar í ræktun og næmi gott fyrir því lyfi, sem ætlunin er að nota. 4. Halda verður drápsþéttni (bactericidal titer) =eða> 1:2

  17. Staðsetning sept. arthritis Hné 38% Mjöðm 32% 81% Ökkli 11% Úlnliður 4% Olnbogi 8% Öxl 5%

  18. OrsakirSEPTISKSARTHRITIS STAPH. AUREUS 56% STREPT GR.A 22% PNEUMOCOCCI 6% HEMOPHILUS INFLUENZAE 14% SALMONELLA 1% AÐRAR ENTEROBACTERIUR 7%

  19. MEÐFERÐ • CLOXACILLININ +/- CEPHALOSPORIN

  20. ARTHRITIS • INFEKTIONIR • Staphylococci TBC • Hemophilus infl. LUES • Streptococci LEPRA • Meningococci • Pneumococci • Salmonella • Gonococci • Hettusótt, Rauðir hundar, Mycoplasma

  21. JRA Febris rheum. Vasculitis / Henoch-Schönlein Collagen sjd. Reiter Colitis ulcerosa Psoriasis Lyme TRAUMA SYSTEMSJD.

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