Primaarne HIV-infektsioon. Haigusjuhu kirjeldus

Primaarne HIV-infektsioon (PHI) – äge retroviiruslik sündroom – esineb esimestel nakatumisjärgsetel nädalatel 40–90%-l nakatunutest. Sagedamini ilmneb see lühiaegse haigestumisena: palaviku, makulopapulaarse lööbega nahal ning lümfadenopaatiaga. Sümptomid kestavad 7–10 päeva. HIV-nakkuse selles faasis on iseloomulik viiruse RNA koopiate arvu suurenemine veres ning T-lümfotsüütide arvu vähenemine. Viirusevastased antikehad ei ole haiguse selles staadiumis veel välja kujunenud. HIV-nakkuse lõplik diagnoos kinnitatakse HIV antikehade ilmnemisel veres. Eesti Arst 2009; 88(4):274−27

Fulminantne müokardiit. Haigusjuht ja kirjanduse ülevaade

Müokardiit on heterogeenne haigus nii etioloogia kui ka kliinilise kulu poolest. Haiguse aluseks on põletikuline südamelihase kahjustus, mis kulgeb ägeda, enamasti taaspöörduva sündroomina. Ebasoodsa kulu korral võib tekkida krooniline dilateeriv kardiomüopaatia, mis võib viia progresseeruva südamepuudulikkuseni. Äge müokardiit võib kulgeda ka eluohtliku seisundina ning sel puhul on tegu fulminantse müokardiidiga. Selle harva, kuid raske kuluga haiguse puhul võib olla vaja rakendada kehavälist vereringetoetust. Fulminantse müokardiidi kahtluse korral tuleb patsient suunata keskusesse, kus on võimalik müokardiidi spetsiifiline diagnostika ning ravi, sealhulgas MRTuuringute ning EMB tegemine. Müokardiidi diagnoosimisel on oluline järgida rahvusvahelisi diagnostilisi kriteeriume ning vältida ühelt poolt valediagnoose ning teiselt poolt diagnoosimise ja ravi hilinemisest tingitud püsivat elukvaliteedi halvenemist. Raviprotsessis tuleb lähtuda juhtivast kliinilisest sündroomist – südamepuudulikkust tuleb ravida tõenduspõhiste meetodite ja ravimiannustega, rindkerevalu valuvaigistitega. MSPVAde kasutamine on näidustatud valusündroomi või perikardi haaratuse korral. Dilateeriva kardiomüopaatia põhjuseks võib olla krooniline müokardiit ning võimaluse korral tuleks nendel patsientidel teha EMB ning otsida seerumist patogeenseid autoantikehi. Ägeda müokardiidi põdemise järel on soovitatav patsiendile teha kordusuuringuna ehhokardiograafia ning müokardi düsfunktsiooni korral on soovitatav jälgimine kardioloogi poolt. Müokardiidi diagnostika ning ravi põhineb senini vähesel tõenduspõhisusel ning vajalikud on täpsustavad uuringud.Eesti Arst 2018; 97(1):29–3

Postoperative Staphylococcus aureus Infections in Patients With and Without Preoperative Colonization

Importance Staphylococcus aureus surgical site infections (SSIs) and bloodstream infections (BSIs) are important complications of surgical procedures for which prevention remains suboptimal. Contemporary data on the incidence of and etiologic factors for these infections are needed to support the development of improved preventive strategies.Objectives To assess the occurrence of postoperative S aureus SSIs and BSIs and quantify its association with patient-related and contextual factors.Design, Setting, and Participants This multicenter cohort study assessed surgical patients at 33 hospitals in 10 European countries who were recruited between December 16, 2016, and September 30, 2019 (follow-up through December 30, 2019). Enrolled patients were actively followed up for up to 90 days after surgery to assess the occurrence of S aureus SSIs and BSIs. Data analysis was performed between November 20, 2020, and April 21, 2022. All patients were 18 years or older and had undergone 11 different types of surgical procedures. They were screened for S aureus colonization in the nose, throat, and perineum within 30 days before surgery (source population). Both S aureus carriers and noncarriers were subsequently enrolled in a 2:1 ratio.Exposure Preoperative S aureus colonization.Main Outcomes and Measures The main outcome was cumulative incidence of S aureus SSIs and BSIs estimated for the source population, using weighted incidence calculation. The independent association of candidate variables was estimated using multivariable Cox proportional hazards regression models.Results In total, 5004 patients (median [IQR] age, 66 [56-72] years; 2510 [50.2%] female) were enrolled in the study cohort; 3369 (67.3%) were S aureus carriers. One hundred patients developed S aureus SSIs or BSIs within 90 days after surgery. The weighted cumulative incidence of S aureus SSIs or BSIs was 2.55% (95% CI, 2.05%-3.12%) for carriers and 0.52% (95% CI, 0.22%-0.91%) for noncarriers. Preoperative S aureus colonization (adjusted hazard ratio [AHR], 4.38; 95% CI, 2.19-8.76), having nonremovable implants (AHR, 2.00; 95% CI, 1.15-3.49), undergoing mastectomy (AHR, 5.13; 95% CI, 1.87-14.08) or neurosurgery (AHR, 2.47; 95% CI, 1.09-5.61) (compared with orthopedic surgery), and body mass index (AHR, 1.05; 95% CI, 1.01-1.08 per unit increase) were independently associated with S aureus SSIs and BSIs.Conclusions and Relevance In this cohort study of surgical patients, S aureus carriage was associated with an increased risk of developing S aureus SSIs and BSIs. Both modifiable and nonmodifiable etiologic factors were associated with this risk and should be addressed in those at increased S aureus SSI and BSI risk

Postoperative Staphylococcus aureus infections in patients with and without preoperative colonization

Abstract: Importance Staphylococcus aureus surgical site infections (SSIs) and bloodstream infections (BSIs) are important complications of surgical procedures for which prevention remains suboptimal. Contemporary data on the incidence of and etiologic factors for these infections are needed to support the development of improved preventive strategies. Objectives To assess the occurrence of postoperative S aureus SSIs and BSIs and quantify its association with patient-related and contextual factors. Design, Setting, and Participants This multicenter cohort study assessed surgical patients at 33 hospitals in 10 European countries who were recruited between December 16, 2016, and September 30, 2019 (follow-up through December 30, 2019). Enrolled patients were actively followed up for up to 90 days after surgery to assess the occurrence of S aureus SSIs and BSIs. Data analysis was performed between November 20, 2020, and April 21, 2022. All patients were 18 years or older and had undergone 11 different types of surgical procedures. They were screened for S aureus colonization in the nose, throat, and perineum within 30 days before surgery (source population). Both S aureus carriers and noncarriers were subsequently enrolled in a 2:1 ratio. Exposure Preoperative S aureus colonization. Main Outcomes and Measures The main outcome was cumulative incidence of S aureus SSIs and BSIs estimated for the source population, using weighted incidence calculation. The independent association of candidate variables was estimated using multivariable Cox proportional hazards regression models. Results In total, 5004 patients (median [IQR] age, 66 [56-72] years; 2510 [50.2%] female) were enrolled in the study cohort; 3369 (67.3%) were S aureus carriers. One hundred patients developed S aureus SSIs or BSIs within 90 days after surgery. The weighted cumulative incidence of S aureus SSIs or BSIs was 2.55% (95% CI, 2.05%-3.12%) for carriers and 0.52% (95% CI, 0.22%-0.91%) for noncarriers. Preoperative S aureus colonization (adjusted hazard ratio [AHR], 4.38; 95% CI, 2.19-8.76), having nonremovable implants (AHR, 2.00; 95% CI, 1.15-3.49), undergoing mastectomy (AHR, 5.13; 95% CI, 1.87-14.08) or neurosurgery (AHR, 2.47; 95% CI, 1.09-5.61) (compared with orthopedic surgery), and body mass index (AHR, 1.05; 95% CI, 1.01-1.08 per unit increase) were independently associated with S aureus SSIs and BSIs. Conclusions and Relevance In this cohort study of surgical patients, S aureus carriage was associated with an increased risk of developing S aureus SSIs and BSIs. Both modifiable and nonmodifiable etiologic factors were associated with this risk and should be addressed in those at increased S aureus SSI and BSI ris