tailieunhanh - Medical Microbiology made memorable - part 5

Nfection của gan và tuyến tụy xảy ra thông qua dòng máu, hiếm khi từ đường tiêu hóa, ngay cả khi con đường của việc mua lại là phân-miệng. Nhiễm trùng đường mật và viêm phúc mạc, ngược lại, do địa phương lan truyền nhiễm trùng. Bộ ba cổ điển lâm sàng viêm gan vàng da, nước tiểu đậm màu và phân nhạt kèm theo sốt | M E D I C A L MICROBIOLOGY ll Hepatitis and pancreatitis I nfection of the liver and pancreas occurs via the blood stream rarely from the gastrointestinal tract even when the route of acquisition is faecal-oral. Biliary tract infection and peritonitis are conversely due to locally spread infection. Hepatitis The classic clinical triad of jaundice dark urine and pale stools accompanying fever is often missing particularly in children who are more often asymptomatic. The vast majority of cases are of viral aetiology with hepatitis A B and C being the commonest Table . Diagnosis of viral and leptospiral infection is serological by either detection of antigen or specific antibody. The detection of hepatitis B surface antigen HBsAg confirms the diagnosis of hepatitis B virus and the presence of hepatitis B e antigen HBeAg indicates a high infectious risk. Other markers are determined in specific cases Fig. . Jaundice in carriers in whom HBsAg persists for 6 months or more is most likely to have another cause which should be sought. Hepatitis A virus HAV infection is diagnosed by anti-HAV 1gM. Serological assays for the diagnosis of hepatitis C do not offer early diagnosis as they are based on the detection of specific IgG which may take several weeks diagnosis is thus retrospective but can be made early by gene amplification methods such as PCR. Management of acute viral hepatitis is supportive with bed rest at the peak of liver inflammation. Chronic hepatitis therapy is evolving with drugs such as interferon immunomodulators and ribavirin being used with moderate success in delaying progression of liver disease although viral eradication is not achieved. Prevention of infection involves public health measures and vaccination for hepatitis A and hepatitis B. Travellers from the UK to higher-prevalence areas outside northern and western Europe and North America should consider vaccination for hepatitis A. Although universal vaccination for hepatitis B is being