G OO 6 S GS SO OO fe sata se pa ea

1
???????? ???????? ???G??? ????O??O?6?
???S???????? ??????? ???G??S ??S????????O?
????O??O????f?µ??e?? ??s?µata se ??????
pa????? ??e?a?

• ?a??a ?????????
• ??d???? ?a??????? ???µ?????????, G.?.??????
  ?pp????te??
• 3 ??eµß???? 2006

2
???f?µ??e?? ??s?µata
???f?µ??e?? ??s?µata (?????? ???µ??e??) e??a?
ta ??s?µata p?? p???a????ta? ap? ?ata????s?
µ???sµ???? t??f?µ?? ? p?t??. ?????? ?a?
d?af??et???? pa??????? pa?????te? e??a? p??a?? ?a
µ??????? ta t??f?µa ?a? e? s??e?e?a t??
?????p?.
3
??sa????-?p?d?µ??????a ?

• ???f?µ??e?? ??s?µata p??sß????? pe??p?? 76
  e?at?µ???a ?t?µa µe 325000 ??s??e?e? ?at ?t??
  st?? ?.?.?. (?p?????sµ?? CDC)
• ??? ? ??s???t?ta e??a? p??? µe???? ? ???t?t?ta
  e??a? µ???? (pe??p?? 5000 ?t?µa pe?a????? ?at
  ?t??). S?????? p??? ??a ? ??????µ??a ?t?µa ?
  ?t?µa µe ?p??e?µe?? a??s??atast???.
• ?? p??sfate? a??a??? st?? t??p? ???? (ta??t?ta
  µetaf????) ?a??? ?a? ?? te??st?e? a??a??? p??
  e??a? ?? ap?t??esµa t?? µa????p???s? st??
  pa?a???? ?a? st?? d?a??µ? t??f?µ?? ?p?? ep?s??
  ?a? ? a?t??? t?? µ????ß??? ????? ?? ap?t??esµa
  t?? eµf???s? ???? µa?? µe t?? p???? pa?ad?s?a???
  µ??f?? t?? t??f?µ??e??? ???µ??e??.
• Practice Guidelines for the Management of
  Infectious Diarrhea. IDSA. CID 200132331-351

4
??sa????-?p?d?µ??????a ??

• ?? ????? pa????? ??e?a? ???? µa????? pa?a?????
  ?a? d?a????s?? t??f?µ?? ?a? pa???s?a? ?d?a?te?a
  e?pa??? at?µ?? e??a? s???? ped?? eµf???s??
  e???se?? ????sµ?t?? t?f?µ??e??? ???µ??e??.
• ?a t??f?µ??e?? ??s?µata de? d?af????? ?? p???
  t?? e?d???se?? e?te af????? t?? ?????t?ta e?te
  ?????? pa????? ??e?a?.
• ????te?? d?af????? d?????s? st??? ?????? pa?????
  ??e?a? d??t? ?p?????? p???? ???a a?t?a
  ?ast?e?te??t?da?-?d?a?te?a p??ß??µata
• ????? d??t?a ep?t???s?? ?a? ?ata??af?? pa??????
  s?st?µat??? ep?d?µ???????? st???e?a p?? af?????
  t?? ?????t?ta se p????? ???e?.(p?.FOOD-NET st??
  ???, ???????, ?F??)
• ?p? ?????? pa????? ??e?a? p????? µeµ???µ??e?
  pe????af?? µ????ep?d?µ??? µe t?? e?a??es? µe?????
  p???? s?st?µat???? st???e??? ap? ???sµ??e? ???e?(
  ?e?. ??etta??a ? ??st?a??a)

5
?p?d?µ??????a-??st??

• ??st?? St?? ?e?. ??etta??a 1.488 e? ??
  ???µ??e?? s?et???µe?e? µe ?????? pa????? ??e?a?.
• ?p?d?µ???? e???se?? ?ast?e?te??t?da? 12,5 t??
  s???????? ??st??? (sta ep?peda t??
  ???????µ??e??) 184 e?. (2002-2003)

Lopman Ben et al.. Epidemiology and costs of
Nosocomial Gastroenteritis, Avon,
England,2002-2003. HPA-CDSC Emerging Infectious
Diseases. 2004 10 1837-1934
6
?p?pt?se??

• ????a e?d???s? e??a? ? ?ast?e?te??t?da p???????
  e?t?se?? (?????? ??s???t?ta-? ???t?t?ta e??a?
  s?????? µ????)
• ?? ???µ?de?? pa?????te? p?? p???a????
  t??f?µ??e?e?? ???µ??e?? s?????? µetad?d??ta? p???
  e????a µe ?µes? ? ?µes? epaf? ap? ?t?µ? se ?t?µ?
  e?te µe t? ?e?? ?a? ta t??f?µa (t??f?µ??e?e??
  ???µ??e??) ?a? s???? p???a???? de?te???e?e??
  ep?d?µ???? e???se?? ????sµ?t?? a? de?
  a?a?????s???? ???a??a Current Opinion in
  Pharmacology 20055559-565

7
???e? ep?pt?se??

• S?st?µat??? ??s?? ?p?? ? t?f?e?d?? p??et??,
  ??ste???s? (µ??????t?da, s???), ?e??ta???
  p??et??, ????p?asµa, t??????s?
• ?e????????? ??s?? ???a?t?as?, ??ste???s?
  (µ??????t?da), nvCreutzefelt-Jakobs(??s?? t?e???
  a?e??d??), µa??t???a, tet?ad?t?????
• S?ßa??? µa????????e? ep?p?????
• a?µ???t??? ???a?µ??? s??d??µ? ?a? ?ef????
  a?ep???e?a s?et???µe?? µe E.Coli 0-157 ?7
  (STEC ? e?te??a?µ???a???? ? VTEC)
• s??d??µ? Guillain-Barre µet? ap? ???µ??? µe C.
  jejuni
• Diagnosis and Management of foodborne
  illnesses CDC MMWR 200453(No RR-4)

8
S?µpt?µata

• ?a s????? s?µpt?µata t?? t??f?µ??e??? ???µ??e??
  af?????
• ?at? ????? ???? t? ?ast?e?te???? s?st?µa?
• ?a?t?a.
• ?µet??.
• ?????a?? ?????.
• ???????e?.
• ?????? p??et??
• Spa???te?a s?µpt?µata
• ??µa sta ??p?a?a
• Spa???te?a s?µpt?µata ?a? ap? ???a s?st?µata
• ?e????????? s?µpt?µata
• S?st?µat??? s?µpt?µata

9
???f???? d???t????se??
????????a??sµ?? se ?p?pt? t??f?. ?
t????? pa???eta? st?? ???a??sµ?
??s?? p?? p???a????ta? ap? t????e? ? ßa?t???a p??
pa?????? t?????, p?? ß??s???ta? st?? t??f? p??
?ata?a???eta?. Sp???a e??a? ? pe??pt?s?
?a?at?f???? as???e?a? ap? t?? e??t????? t??
???st???d??? t?? a?a?t?as?? (Clostridium
botulinum).
10
?a?????a p?? p???a???? t??f?µ??e?e?? ???µ??e??

• ?p? ta 250 ?a? p???? pa?????a p?? p???a????
  t??f?µ??e?e?? ???µ??e?? ta s????te?a e??a?
• ?a?t???a Salmonella spp ,Shigella spp,
  .Campylobacter spp E Coli ?157 ?7. Listeria
  spp Yersinia, Clostiridium perfingens
• ?a??s?ta Cryptosporidium, Giardia Lamblia,
  Entamoeba histolytica
• ??? Norwalk virus Rotavirus, Adenovirus,,
  ?epatitis A virus
• S????te?a ta?t?p?????ta? ?? µ????ß?a???
  pa?????te? a? ?a? s????te?e? e??a? ?? ???e?e??
  t?f?µ??e?e?? ???µ??e?? a??? ?? ??? ta?t?p?????ta?
  d?s???a.
• Diagnosis and Management of foodborne illnesses
  CDC MMWR 200453(No RR-4)

11
S????? a?t?a t??f?µ??e??? ???µ??e??
12
S????? a?t?a t??f?µ??e??? ???µ??e??

• Diagnosis and Management of foodborne illnesses
  CDC MMWR 200453(No RR-4)

13
(No Transcript)
14
?? ???µ?d? a?t?a t??f?µ??e??? ???µ??e??
1. ?????e? ?a???? (CIGUATERA, Puffer
fish-tet??d?t?????) 2. ?a??a µ?ta??a (Cadmium,
?d????????) 3. ?a??t???a 4. ??t???? 5.
???a????t??a, ?a?as?t??t??a (???a??f?sf??????
est??e?) ???a?a ? ?a? ??e??µ??? d????f????
(ß??t??µ???at?a)
15
?p?d?µ???? e???se?? (outbreak) ??????? st??
?????a ?a? ?e?. ??etta??a 1990-5
D. Dedman et al. Surveillance of small round
structured virus (SRSV) infection in England and
Wales, 1990-5 Epidemiol. Infect.(1998)121
139-149
16
?p?d?µ???? e???se?? ??????? st?? ?????a ?a? ?e?.
??etta??a 1990-5
D. Dedman et al. Surveillance of small round
structured virus (SRSV) infection in England and
Wales, 1990-5 Epidemiol. Infect.(1998)121
139-149
17
?p?d?µ???? e???se?? ???µ?d??? ?ast?e?te??t?da?
sta ??s???µe?a st?? ?????a ?a? ?e?. ??etta??a
1992-200
S. M. Meakins, G. K. Adak, B. A. Lopman and S. J.
O'Brien General outbreaks of infectious
intestinal disease (IID) in hospitals, England
andWales, 19922000 Gastrointestinal Disease
Division, PHLS Communicable Diseases
Surveillance Centre, London, UK Journal of
Hospital Infection (2003) 53 15
18
(No Transcript)
19
?p?d?µ???? e???se?? ???µ?d??? ?ast?e?te??t?da?
sta ??s???µe?a st?? ?????a ?a? ?e?. ??etta??a
1992-2000???f?µ??e?e?? ???µ??e??

• ?e??ss?te?e? ap? 1 t??f?? e????p?????a? se 2/25
  e???se??
• ?pe????e? t??f??
• ??????? ???a? 16 (4/25)
• ???? 16.0 (4/25)
• ??t?p???? 8.0 (2/25),
• Sa?at??? ?a? f???ta 8.0 (2/25)
• ?p?d??p?a, d??f??a 8.0 (2/25)
• ?e? a?e????? ?pe????? t??f? 52.0(13/25)
• ?a?t???a?? a?t?a ep?ßeßa?????e se 84 (21/25)
• ? ???t?t?ta ?ta? µe?a??te?? se s?????s? µe
  a?t?st???e? e???se??
• st?? ?????t?ta. ???? t?? e?p??e?a? t?? as?e???
• ded?µ???? ?t? s????te?a eµp?????ta? ????at?????
• ?a ??s???µe?a ?ta? de?te?a µet? ap? t??? ??????
  f???t?da?
• ??????µ???? µe pa??µ??a ep?d?µ????????
  ?a?a?t???st???

20
?p?d?µ???? e???se?? ???µ?d??? ?ast?e?te??t?da?
sta ??s???µe?a st?? ?????a ?a? ?e?. ??etta??a
1992-2000T??t?t?ta

• 1396 ??s???µe?a??? e???se?? ????sµ?t??
• S????? pe??pt?se??29 507 ( 2552)
• 82 ???at??
• ?? p??s?p??? p??seß???? st? 55.9
• ? ???d???? ?a??t?? ?ta? ?????te??? st??
  ??s???µe???? (0.003)
• se s??s? µe ???e? e???se?? ????sµ?t??0.001)
  relative risk 2.00 (95
• CI 1.522.63) Plt0.001.
• ? ???d???? ?a??t?? ?ta? ?????te???(0.008) st??
  t??f?µ??e?e??
• ???µ??e?? relative risk 3.22
• (95 CI 1.417.36) P 0.003.

21
Laboratory reporting of selected GI pathogens in
England Wales - 1977 to 2002.
22
Laboratory reporting of selected GI pathogens
Food-net U.S.A.
23
????-2004
24
???sµ??

• ???????a ????s? t?? ß????? t?? ??p????? gt 250gr
  a?? 24???.
• ????s? t?? ?e?st?t?ta? t?? ??p????? (µa?a?? ?
  ?da?? ??p?a?a) e?te a???s? t?? ????? t??? e?te
  a???s? t?? s????t?ta? t?? ?e??se?? se
  pe??ss?te?e? ap? t?e?? ?µe??s???
• ??s???µe?a?? ???????a ?µf???s? 72 ??e? µet? t??
  e?s?d? t?? as?e???? st? ??s???µe??
• ??? d?a?????? s??d??µ? ?????e?a lt 14
  ?µ??e? (? ?a? µ???? t?e?? ßd?µ?de? ?at
  ???sµ?????).
• ?p?µ??? d?a?????? s??d??µ? gt14 ?µ??e?
• ?????? d?a?????? s??d??µ? gt 1 µ??a
• F?e?µ???d?? d??????a ?????a?? ?????,
  te??esµ??, pa???s?a a?µat?? , ?e?????t???? st?
  ??p?a?a

25
???t???a ??a t? d?????s? t?? ?ast?e?te??t?da?
???t?? ??????? ??d???? ???µ??e??

• ???t???? 1 (???a??) ? as?e??? eµfa???e? ap?t?µ?
  d??????a (?da?? ??p?a?a ??a pa?ap??? ap? 12 ??e?)
  µe ? ????? eµ?t??? ? p??et? (gt38 ?C), ?a? ?????
  t?? pa???s?a eµfa???? µ? ???µ?d??? a?t?a? (p?.
  ??????s? fa?µ????, ??e?a pa?????s? ?????a? ??s??
  ? ?????????? stress)

26
???t???a ??a t? d?????s? t?? ?ast?e?te??t?da?
???t?? ??????? ??d???? ???µ??e??

• ???t???? 2 (?eßa??µ???)? as?e??? eµfa???e? 2
  t??????st?? ap? ta a??????a s?µe?a s?µe?a ?
  s?µpt?µata ????? ?a ?p???e? ???? a?a?????sµ???
  a?t?a
• ???et?? (gt38 ?C,?a?t?a, ?µet?? ,?????a?? ?????
  ,? e?a?s??s?a)
• ?a? t??????st?? 1 ap? ta a??????a
• 1. Tet??? ?a??????e?a ??a e?te???? pa?????? ap?
  ta ??p?a?a ? ap? de??µat?????a ????? µe st??e?
• 2. ??e??es? e?te????? pa??????? µe µ????s??p?s?
  (µe ????? ? ??e?t?????? µ????s??p?? )
• 3. ??e??es? e?te????? pa??????? µ?s? a?t????????
  ? a?t?s?µat???? a????s?? st? a?µa ? sta ??p?a?a
• 4. ??de??e?? ??a t?? pa???s?a e?te????? pa???????
  p?? a????e?eta? d?a ?st???? ?a??????e?a?
  (a????e?s? t??????)
• 5. ??a???st??? µ????? t?t?? a?t?s?µ?t?? (IgM) ?
  tet?ap?as?asµ? t?? t?t??? t?? e?d???? ??a t?
  pa?????? a?t?s?µ?t?? .(IgG)

27
??e?e???s? s?????? ????sµ?t?? t??f?µ??e???
???µ??e??

• ???e ??a?s? ????sµ?t?? a????e? µe ??a as?e?? p??
  µp??e? ?a µ?? e??a? ?d?a?te?a p?s???
• ?a s?µpt?µata e??a? s?????? p??? ?????
  (e?d???se?? ?ast?e?te??t?d??) ????? ?a
  ap???e???ta? ?a? p???? s?st?µat???.
• S?µa?t??? st???e?a
• ?????? ep?as?? (p??s??? a? e??a? µa????)
• ?????e?a ?p???e?µµat???? ??s??
• ????a ??????? s?µe?a ?a? s?µpt?µata
• ?p?pte? t??f??
• ? p????sµ?? p?? e?t????e
• ???a ?t?µa µe s????? se ?????, ???? µe pa??µ??a
  s?µpt?µata
• ?p???????? ??s??-f??e?a

28
?ata????s? ?p?pt?? t??f??

• ???f?? p?? ?ata?a?????ta? f??s??e? ? a?epa????
  ??µ??e?
• F??s?a ? µ?s???µ??a a??? (µa??????a), ?st?a?a,
  ???ata (??t?p???a, ??µ??), ????a, µ? paste???µ??a
  ???ata ? p?????ta ???a?t?? ? f???t???µ??,
  ???s??ße?, ?a?a???? ? µa?a?? t???? ap? µ?
  paste???µ??? ???a

29
??de??? ??s???µe?a??? ep?d?µ?a? ?ast?e?te??t?da?

• ? eµf???s? d?? ? pe??ss?te??? pe??pt?se??
  ??s???µe?a??? ???µ?d??? ?ast?e?te??t?da? p??
  p????????a? ap? t?? ?d?? µ???????a??sµ? µ?sa se
  µe????? ßd?µ?de? ?a p??pe? ?a ??t??? ?p????a
  t???? s?s??t?s?? µeta?? t???.
• ? d?e?e???s? t?? pe??stat???? µp??e? ?a µ??
  a?ade??e? t?? p??? t?? ???µ??e??. ? pa?a???????s?
  t?? ?a???e??e??? ????? ??s??e??µ???? as?e??? st??
  ?d?e? pe?????? ??s??e?t???? f???t?da? t?? as?e??
  µe ?ast?e?te??t?da, ß???? st?? a?a?????s? t??
  as?µt?µat???? as?e???.
• S???pa??? pe??pt?se?? ?ast?e?te??t?da? se
  p??s?p??? ?a? as?e?e??
• ??????????ta? ?? ?a???e? d?e?e???s??
  ??s???µe?a??? ep?d?µ?a?

30
??????s?
31
??????s?

• ?ept?µe?e? ?st????? ?a? ??????? e??tas? t??
  as?e???? p?? ß??s?eta?
• ?p? ?at???? pa?a???????s? ?a? ? ?e??p?? ?at???
  ap?fas??e? e??
• apa?te?ta? pe?a?t??? e??ast???a??? ??e????.
• ? ?p????a ep?d?µ???? ??a?s?? ????sµ?t?? ?
  t??f?µ??e???? ???µ??e??
• ap?te?e? ??de??? ?a ap?sta?e? ?a??????e?a
  ??p????? a??µ?
• ?a? ep? e?af??? ??s??

32
????????s? as?e???? µe ?p????a t??f?µ??e????
??s???µe?a??? ?ast?e?te??t?da?

• ?e??ss?te?? ap? t? 90 t?? as?e??? ????? ?p?a,
  a?t???µe?? ??s?,
• p?? ?p????e? e?t?? 5 ?µe??? ?a? apa?te?ta? µ???
  ap?? e??d?t?s?
• ?a? e?de??µ???? ?p?a a?t?d?a?????? a????.
• ??a???st???? e?et?se?? ?a? a?t?ß??t??? a???? de?
  apa?te?ta? se a?t???.
• ?p?µ???? e??a? p??? s?µa?t??? ? a?????
  a???????s? t?? as?e??? ?a? ?at?ta?? se a?t??? p??
  e????
• ?p?a, a?t?pe???????µe?? ??s? ?a?
• se a?t??? p?? ????? p?? s?ßa?? ??s? ?a?
  ??e?????ta? p?? ep??et??? a?t?µet?p?s?
• ?p????a ep?d?µ???? ??a?s?? ????sµ?t?? st??
  ?????t?ta.

33
??te p??pe? ?a st???eta? ?a??????e?a
??p????????? e??a? t? s?st?
1. Se ???e pe??pt?s? d?a??????? s??d??µ?? 2. Se
d?a?????? s??d??µ? p?? s???de?eta? ap? p??et?
gt38,3?C, ?????a?? ?????, te??esµ?, p??? sta
??p?a?a, pa???s?a ?e?????tt???? sta ??p?a?a 3.
Se ?p????a ep?d?µ???? ??a?s?? ????sµ?t?? st??
?????t?ta 4. Se pa?d?? lt3 et?? 5. ?? 23 6.
?a???a ap? ta pa?ap???
34
??te p??pe? ?a st???eta? ?a??????e?a ??p????? ??a
????? e?te???? pa?????a
1. Se ???e pe??pt?s? d?a??????? s??d??µ?? 2. Se
d?a?????? s??d??µ? p?? s???de?eta? ap? p??et?
gt38,3?C, ?????a?? ?????, te??esµ?, p??? sta
??p?a?a, pa???s?a ?e?????tt???? sta ??p?a?a 3.
Se ?p????a ep?d?µ???? ??a?s?? ????sµ?t?? st??
?????t?ta 4. Se pa?d?? lt3 et?? 5. ?? 23 6.
?a???a ap? ta pa?ap???
35
??te st????µe ?a??????e?a ??p????????te
s???st?ta? d?a???st??? d?e?e???s??

• Se ?p????a ep?d?µ???? ??a?s?? ????sµ?t?? st??
  ?????t?ta ?
• st? ??s???µe??
• Se s?ßa?? d?a?????? s??d??µ? (as?e?e?? p?? ?????
  p?? s?ßa?? ??s?
• ?a? ??e?????ta? p?? ep??et??? a?t?µet?p?s?)
• Se ?a?e as?e?? µe
• p??et?
• ?a? ????t?da
• pa???s?a ?e?????tt???? sta ??p?a?a
• ???pe? ?a st???eta? ?a??????e?a ??p?????.

36
??a??t?s? p???µ??f?p??????
37
??a???st??? p??s????s? se s?ßa?? d?a??????
s??d??µ?? s?µas?a t?? ?a??????e?a? ??p?????

• ?p?????? e??t?µat??? ??a t?? ???s?µ?t?ta t??
  ded?µ???? t??
• p??? µ????? p?s?st?? ?et???? ?a???e??e???
  ??p????? ???t??a?
• St?? ??? t? 1996 se 264 e??ast???a
• 233.212 ?a??????e?e? ??a Salmonella ?a? Shigella
• Tet???? 0,9 ??a Salmonella ?a? 0,6 ??a
  Shigella
• ???e? µe??te? d????? p?s?st? ?et????
  ?a???e??e??? ap? 1,5-2,9
• Practice Guidelines for the Management of
  Infectious Diarrhea. IDSA. CID 200132331-351

38
??a???st??? p??s????s? se s?ßa?? d?a??????
s??d??µ?? s?µas?a t?? ?a??????e?a? ??p?????

• ?a??????e?a ??p????? se ???e pe??pt?s?
  d?a???????
• s??d??µ?? ? ap?µ???s? µ????ß?a??? pa??????? lt3
• ?a??????e?a ??p????? se f?e?µ???de? d?a??????
• s??d??µ? ? ap?µ???s? µ????ß?a??? pa??????? gt 20
• ?a???a? t?? p??a? t?? 3 ?µe??? ??a
  ??s??e??µe???? as?e?e??

39
??????s?

• ?e t?? ?a??????e?a ??p????? ap?µ??????ta? ??????
• Salmonella spp , Campylobacter jejuni,
  Shigella spp., ste???? ?. Coli.
• ?e t?? s????e?? ?a??????e?e? ??p????? de?
  d?a???????ta?
• ta ??te??a?µ???a???? (STEC) ap? t? ETEC ?a?
  EAEC ap? t?? µ? pa?????? E. Coli.
• ???pe? ?a a?a??t???ta? µe e?d???? te?????? ?p??
  ?a? ?? t????e?
• µ????ß???
• ?? ??? ep?s?? de? ?a???e?????ta? se ?a??????e?a
  ??p?????.

40
??a???st??? p??s????s? se ?p????a t??f?µ??e????
??s???µe?a??? ?ast?e?te??t?da?-?
41
??a???st??? p??s????s? se ?p????a t??f?µ??e????
??s???µe?a??? ?ast?e?te??t?da?-??
42
??a???st??? p??s????s?-Real time PCR

• ? ?a??????e?a ??p????? ap?te?e? t? gold-standard
• ?p?te??sµata se 3-5 ?µ??e?
• ?p? a??pt??? ??e? ta?e?e? µ???a??? te?????? ??a
  t?? ???????
• ta?t?p???s? t?? ?????te??? ßa?t???a??? a?t???
• Salmonella enterica,
• Campylobacter jejuni,
• Vibrio parahaemolyticus
• Shiga toxin E. coli

43
??????s?

• Se pa?atetaµ??a p??e??????ta s?µpt?µata ap? t?
  a??te?? pept??? (?a?t?a ,e?????) pa?as?t???????
  ??p????? ??a G. lamblia ?a? cyclospora .
• ?et? ap? pa???e?s? ?µe??? ?a? eµµ??? s?µpt?µ?t??
  gt 7 ?,
• ???s? ??e??t??? ? t?p?p???µ??? ??e??t????
  Cryptosporidium, Isospora, and Cyclospora.
• Se a??s??atesta?µ??a ?t?µa (AIDS µe CD4 clt100
  cells/µL, t?????µ?? ???s? ??a Microsporidium

44
Te?ape?t??? p??s????s? se t??f?µ??e????
??s???µe?a??? ?ast?e?te??t?da?

• 1. ?p?st????t??? a???? ?a? e??d?t?s?
• 2. S?µpt?µat??? a?t?d?a?????? a????
• 3. ?µpe????? a?t?ß??t??? a????
• ?? pe??ss?te??? as?e?e?? (gt90) e???? ?p?a,
  a?t???µe?? ??s?,
• p?? ?p????e? µet? ap? t? p??? 3-5 ?µ??e? ?a?
  apa?te?ta? µ???
• ap?? e??d?t?s? ?a? e?de??µ???? ?p?a
  a?t?d?a?????? a????.
• ??a???st???? e?et?se?? ?a? a?t?ß??t??? a???? de?
  apa?te?ta? se a?t???

45
Te?ape?t??? p??s????s? t??f?µ??e????
??s???µe?a??? ?ast?e?te??t?da? S?µpt?µat???
a?t?d?a?????? a????. ??te

• ?p??e? ?a ???????e? ?ta? de? ?p???e? e????a
  f?e?µ???d??? d??????a?
• se ?p?? ? µ?t??a? ßa??t?ta? d?a?????? s??d??µ?
• (??? se p??et?, a?µat???? ?e??se??, ??t???
  ?????a?? ????? ?a?
• s?st?µat??? t?????t?ta)
• Ta p??pe? ?a d?a??pt??ta? ef?s?? ta s?µpt?µata
  s??e?????ta? µet? ap? 2 ?µ??e?.
• ?? ?????e?ta?
• ?p????a ??pe?aµ?d?
• Bismuth subsalicylate (Pepto-Bismol)
• Racecadotrila?ast???a? e??efa????s?? se ?da??
  d?a?????? s??d??µa

46
Te?ape?t??? p??s????s? t??f?µ??e????
??s???µe?a??? ?ast?e?te??t?da? ?µpe?????
a?t?ß??t??? a????. ??te

• ?µpe????? a???? µe a?t?ß??t??? de? d?deta? se
  ????? t??? as?e?e?? µe f?e?µ???d? d??????a.
• ?????e?ta? µ??? ?ta? ?p???e? s?ßa?? d?a??????
  s??d??µ? µe
• p??et?,
• te??esµ?,
• a?µat??? ??p?a?a ?
• pa???s?a ?e?????tt???? sta ??p?a?a.

47
Te?ape?t??? p??s????s? t??f?µ??e????
??s???µe?a??? ?ast?e?te??t?da? ?µpe?????
a?t?ß??t??? a????. ????

• Te?ape?a e?????? eµpe?????? a????? (e? a?aµ???
  ?a???e??e???)
• F?????????????e? ciprofloxacin, levofloxacin,
  norfloxacin ??a 3-5 ?µ??e?.
• ???S???! ????µe?? a?t??? t?? ????????? st?
  Campylobacter jejuni ?a? st?? Salmonella
• ??a??a?t??? t??µe??p??µ?-s???faµe???a???? ?
  e?????µ????? µet????da???? se ?p????a Giardia ?
  se ?p????a ?e?d?µeµß?a??d??? ????t?da?
• Pichler, HE, Diridl, G, Stickler, K, Wolf, D.
  Clinical efficacy of ciprofloxacin compared with
  placebo in bacterial diarrhea. Am J Med 1987
  82329.

48
Te?ape?t??? p??s????s? t??f?µ??e????
??s???µe?a??? ?ast?e?te??t?da? ??t?ß??t???
a????. Se p??? pa?????a e??a? apa?a?t?t?

• ?p???e?t??? ?e?ape???ta? µe a?t?ß??t??? ef?s??
  ap?µ???????
• Shigella
• Salmonella µe e??e?te????? e?d???se??
• Cholera
• Amebiasis
• Giardiasis
• Cyclospora
• ???????a ta??d??t??
• C. Difficile
• Se???a????? µetad?d?µe?a a?t?a
• ?p?s?? s?????? d?deta? a???? se Yersinia,
  Campylobacter , e?te??pa???????? ?.coli, Vibria
  ???a e?t?? ?????a?

49
Te?ape?t??? p??s????s? se d?a?????? s??d??µ?
??t?ß??t??? a????. ??te de? ?????e?ta?

• Sa?µ?????e? a??e? e?t?? t?f?e?d??? ?e?ape???ta?
  µ??? ep? a??s??atast???? ?a? ?p????a d????t????
  ??s??.
• ???s???!!se e?te??a?µ???a???? E. Coli (STEC ?
  VTEC ? OXI a?t?ß??t???, a????e? ? ???d????
  a?µ???t???? ???a?µ???? s??d??µ??.

50
Salmonella entericaGast?e?te??t?da

• ?e??ss?te?? ap? 2000 ???t?p??
• ?p?as? 8-48 ??e?
• ???et??, ?a?t?a ,?µet??, d??????a (e?de??µe??
  p??sµ??? a?µat??), ?????a?? ?????
• ??t???µe?? a??? µp??e? ?a p??????e? µ????ß?a?µ?a
  µe e?t?p?se?? se ?st?, a????se??,
• ?a?d??, a??e?a
• ?p????? at?µ?? ?????? ???d???? p?? ?a ??ß???
  a?t?µ????ß?a?? a????
• Ciprofloxacin 750 mg X2
• ??t??? st?? ???????e? p???a??e?t???
• Salmonella typhimurium DT 104
• ???f?µa a???, p?????ta a???? (µa??????a),
  ??t?p???a

51
Salmonella entericaGast?e?te??t?da
52
Salmonella-2004 Whonet. gr
53
????pa??? d??t?? ep?t???s?? Sa?µ??e???se???a?
E.coli (STEC ? VTEC ? e?te???a?µ???a????)
ENTER-NET ???t?? ep?t???s?? ??t????
s?µpe???aµßa??µ???? ?a? Sa?µ??e???se?? µe
e??ast???a ??af???? WHONET ?p?d?µ????????
ep?t???s? ???????
54
Salmonella-2004 Whonet. gr
S????? 1215 ste???? Enteritidis
916 (75,4) Typhimurium 108 (8,9) Blockley
24 (2)
55
Salmonella-2004?????ß?a?? a?t??? whonet.gr
56
Salmonella-2004?????ß?a?? a?t??? whonet.gr
57
Salmonella-2004?????ß?a?? a?t??? whonet.gr
58
Shigella

• A??µ? ?a? ?aµ??? d?s? t?? ???a??sµ?? a?t?? e??a?
  ???µ??????.
• ?p??e? ?a pa???s???eta? µe a?µat???? d??????e?
• Ge????
• s?µpt?µata
• ???et?.
• ????t?da,
• te??esµ? ,
• t?s? ??a af?de?s?,
• ?????a?? ?????.

59
Campylobacter jejuni

• Campylobacter eµfa?????ta? µe a?µat??? d??????a
  ?a? p??et?.
• ???ß??µa ? a?t?stas? t?? ????????? ?a?
  a?????µ??????.
• ????t?da,te??esµ? ,t?s? ??a af?de?s?,?????a??
  ????? ?a? a?µa sta ??p?a?a (s????)

60
(No Transcript)
61
Transmission pathways for Campylobacter INFECTION
62
Meat Products Associated with Transmission of E.
coli O157(e?te??a?µ???a????)

• Ground beef products
• Other red meats
• Roast beef
• Dry cured salami
• Cooked meat products
• Turkey meat

63
Dairy Products and other Foods Associated with
Transmission of E. coli O157 (e?te??a?µ???a????)

• Vegetables
• Salad vegetables
• Mayonnaise
• Apple cider (USA)
• Fruit

• Raw milk
• Pasteurised milk
• Yoghurt
• Cheese
• Cream

64
?aµß??as?
65
Vibrio spp.

• ?? ????? Vibrio parahaemolyticus ?a? non-O-group
  1 Vibrio cholerae µp??e? ?a s??d?eta? µe t? ß??s?
  ?µ?? ? ?a?? µa?e??eµ???? ?a????.
• .

66
?a??s?ta

• ?? s????te??? ???a??sµ?? t?? ?at?????a? a?t??
  e??a?
• Giardia intestinalis,
• Cryptosporidium parvum,
• Cyclospora cayetanensis,
• Entamoeba histolytica,
• ?a? Dientamoeba fragilis.
• Entamoeba histolytica

67

???????
1. ?fa?µ??? t?? ßas???? p??f????e??
(???t?a,??µpa) ?a? t?? p??f????e?? epaf?? se
pe??pt?se?? ?ast?e?te??t?da? st? ???? t??
??s???µe??? 2. ?? p??s?µ? t?? ?e???? ??µß???
s?µe?? st?? p?????? 3. ??a??es? p?s???t??
p??s?p???? ap? ?ast?e?te??t?de? ap? t?? e??as?a
t?? 4. ??de??µe?? a?ast??? e?sa????? st??
????de? p?? ????? p??ß??µa (?ta? ???e??a?
???a??a (lt4?µ) ?? µ???de? pe???????ta? p??
??????a ep?d?µ???? e???se?? 7,9 ??a?t? 15,4
?µ??e?) 5. ???a??? a?a?????s? ?a? ?e?ape?a
f????? Salmonella p?? e??????ta?st?? pa?as?e??
t??f?µ??
Lopman Ben et al.. Epidemiology and costs of
Nosocomial Gastroenteritis, Avon,
England,2002-2003. HPA-CDSC Emerging Infectious
Diseases. 2004 10 1837-1934
68

???????
1.?at? t? d????e?a µ?a? ep?d?µ???? ??a?s??
????sµ?t?? e?t?? ap? t?? ßas???? p??f????e??
(??µpa, ???t?a, p??s?µ? ?e????) ????eta? s??p?µ?
?? as?e?e?? ?a ??s??e???ta? se µ???s?
(p??f????e?? epaf?? ) ?a? a? a?t? de? e??a?
ef??t?, t??????st?? ?? as?e?e?? µe d?????a ?a
???s?µ?p????? ????st?? t??a??te?. 2. G?a t???
??????e?? as?e?e?? ???s?µ?p?????ta? s???aµ?de?
at?µ????, ?? ?p??e? µet? t? ???s? t???
ap???µa????ta? ? µ?a? ???se?? ?? ?p??e? µet? t?
???s? t??? a???ste???ta? µe t? e?dede??µ???
asfa?? t??p?. 3. ??a??a?a e??a? ? e?pa?de?s?
t?? as?e?? ?a p???e? s???ast??? ta ????a t??
µet? t? ???s? t?? t??a??ta?. 4. ???sp??e?a
pa?as?e??? eµß????? ?????a, ??ta???,Salmonella
typhi, ?pat?t?da ? Campylobacter, Shigella J.
Wilson Preventing Gastrointestinal infection
The Principles of food Hygiene Infection
Control in Clinical Practice, 1999
69
???????

?a µ?t?a p??????? ?a? e?????? af????? 1. ??t?a
ep?t???s?? µe ?µes?? ?ata??af?? ?a a?af???? st??
?p?t??p? ??s???µe???? ???µ??e?? ?a? st? ???????
???e ?p?pt?? pe??pt?s?? 2. ?pa??? ?a? efa?µ???
s???e???µ???? ??µ?? ?a? ?a????sµ?? p?? af?????
t?? ???e??? ?a? asf??e?a t?? t??f?µ?? (HACCP) 4.
S?µa?t??? ? pa???s?a e?d???? te???????? t??f?µ??
?a? µ????ß??????? ?a? µ??a????? st??? ??????
pa????? ??e?a?. 3. ??t?a p?? af????? t?? ???e???
???s?p????-?????- S?e??? ?a? ???atast?se?? J.
Wilson Preventing Gastrointestinal infection
The Principles of food Hygiene
Infection Control in Clinical Practice, 1999
70
??f?e?d?? p??et??

• S???st?µe??? (recommended)
• ??f?e?d?? p??et?? ?. ?s?a (pe????? ??d???),
  ?f???? (a??µ? ?a? ???e???) ?a? ?at????? ?µe????.
  ????a??e?t??? ste???? Salmonella. ??te??st?µat???
  ?d?? µetad?se??. S????t?ta 6 -118 pe??pt?se??
  /106 ta??d??te? a??µa ?a? µ???? d????e?a
  ta??d??? se ???a ?????? ???d????
• ?????? ?a??d??te? se a?apt?ss?µe?? ???a µe
  pa?atetaµ??? ???es? se µ???sµ??a t??f?µa ?a?
  ?e??. ???µa ?a? business travelers (?e?????
  ??d??? gt 2 ßd?µ?de?)
• ?µß???a
• 1. ?p? t?? st?µat?? (Viv?tif Berna). ???
  e?as?e??µ??? Ty21 st??e??? S. Typhi gt 6 et??. 4
  ??????e?. ???a pa?? µ??a d?? ßd?µ?de? p?? t??
  a?a????se??. ???s???! ???e??. ??? µa?? µe
  a?t?ß??t??? ? µef??????
• 2. ????sa??a??d??? eµß???? ????? ??a pa?e?te????
  ???s? (Typhim Vi, Aventis Pasteur 1 d?s?
  e?d?µ????? gt 2 et??
• ?p?te?esµat???t?? 50-80

71
??? eµß???? ??a?t? t?? ??ta???
FDA Home Page CBER A-Z Index CBER Search
Contact CBER CBER Home Page Product
Approval Information - Licensing Action Proper
name Rotavirus Vaccine, Live, Oral,
PentavalentTradename RotaTeqManufacturer
Merck Co., Inc, West Point, PA, License
0002Indication for Use Prevention of rotavirus
gastroenteritis in infants and children caused by
the serotypes G1, G2, G3, and G4 when
administered as a 3-dose series to infants
between the ages of 6 to 32 weeksApproval Date
2/3/2006Type of submission Biologics license
applicationSTN 125122 / 0 Updated February 3,
2006  FDA / Center for Biologics Evaluation and
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72
??de??t???? p???? p????f????? ??? t?? ??at??

• ??? www.who.int
• London school of hygiene and
• tropical medicine www. lshtm.ac.uk
• Eurosurveillance www.eurosurv.org/update
• Centers for disease Control and
  www.cdc.gov/foodsafety
• prevention (CDC)
• H?? Foodsafety Information www.foodsafety.gov
  
• ??????? mednet/whonet.gr whone

• Practice Guidelines for the Management of
  Infectious Diarrhea. IDSA. CID 200132331-351
• DuPont HL et al. Guidelines on acute infectious
  diarrhea in adults. The Practice parameters
• Committee of the American College of
  Gastroenterology. Am J Gastroenterology.1997 Nov
• 92(11)1962-75

73
S?µpe??sµata-?

• ???a??? a?a?????s? t?? p??a??t?ta? t??f?µ??e????
  ???µ??e?? st? ??s? e??? as?e??.
• ??a??t?s? ?a? ????? ????sµ?t??. ???t??????
  d?e?e???s?? ??s???µe?a??? ep?d?µ?a?
• ?at? ?a???a a??? ??? p??ta ????a????? ta
  ?ast?e?te???? s?µpt?µata
• ???a??? ap?st??? ?a???e??e??? ??p????? a??? ?a?
  a?aa??t?s? e?d???? pa??????? µe e?d????
  d?a???st???? d???µas?e? (E.Coli 0157-H7, Vibrio
  spp.)
• ?at? pe??pt?s? ?a??????e?a ?p?pt?? t??f?? ?
  a?a??t?s? t??????

74
S?µpe??sµata-??

• ??af??? st?? ep?t??p? ??s???µe?a??? ???µ??e?? ?a?
  st?? ?p??es?e? ??µ?s?a? ??e?a?
• ???e as?e??? µe t??f?µ??e?? ???µ??? µp??e? ?a
  ap?te?e? t?? p??t? e?de??t??? pe??pt?s? µ???
  µe?a??te??? s?????? ????sµ?t??
• ?pa?a???????s? t?? µ?t??? e?????? ?a? p???????

75
S?µpe??sµata

• ?e t?? pa???sµ??p???s? ?a? t?? µa????p???s? t??
  pa?a????? t?? pa?a????? t??f?µ?? ?a?
• t?? a?t??? sta a?t?ß??t???
• ta t??f?µ??e?? ??s?µata st??? ?????? pa?????
  ??e?a? ap?te???? ??a s?ßa?? pa???sµ?? p??ß??µa
  ??e?a? p?? af??? e??s?? a?apt??µ??e? ?a?
  a?apt?ss?µe?e? ???e?

76
?as???? p??f????e?? (standards precautions)
???s? ?a?t???
???e??? ?e????
Sa? e??a??st?