LEPTOSPIROZA

I.DIAGNOSTIC PARACLINIC

1.DIAGNOSTIC NESPECIFIC

*Hemoleucograma(Hb,Ht,NL,FL,TR);VSH,CRP,Fibrinogen;

*uree,creatinina,TGP,TGO,BT,BD,FA[U41] ,γgt,IQ(Indice de protrombina)

*ionograma serica,CPK

*sumar urina-albuminurie,hematurie,cilindri hematici,leucociturie

-pigmenti biliari +

*in CID-ul din Leptospiroza-scaderea IQ,FG,TR,

-cresterea TH,TQ

*in meningita leptospirotica-Punctie lombara PL-LCR-clar,xanto,20-300 leuc./mm cub,limf-60-90%,alb<1g/l,cl=n,gl=n.

3.EXPLORARI IMAGISTICE

*Rg.toracica-fata,profil

*EKG-in miocardita

*Ecografie abdomino-pelvina

4.DIAGNOSTIC ETIOLOGIC

*RFC-Leptospire-serI +ser II(la 10-14 zile de la serul I)-Reactia de fixare a complementului

*RAL-Reactia de aglutinare liza

*IgM anti leptospire (ELISA,RIA)

5.CONSULTURI INTERSECTII NECESARE

*cardiologic,nefrologic,neurologic,oftalmologic

II.TRATAMENT

1.Igieno-dietetic-izolare+spitalizare;repaus la pat;

-regim alimentar de protectie hepatica,hiposodat in corticoterapie

2.Tratament etiologic

*PenicilinaG-6-8mil/zi la 6h iv 7-10 zile

*Ampicilina 6-8g/zi la 6h iv 7-10 zile;

*Amoxicilina/acid clavulanic 2,4g la 8 h iv;Ampicilina/sulbactam 3g la 8 ore iv;

-in formele usoare-Amoxicilina 4-8g/zi-3prize po.

*Cefalosporinele gen.3(Cefotaxim,Ceftriaxon,Latamoxef)-insuficient experimentate clinic

*Alergici la peniciline-in forme usoare-Doxiciclin100mgx2/zi-7zile,Tetraciclina 2-3g/zi la 6h;    -Eritromicina 2-4g/zi la 6h,Claritromicina 1g/zi la 12h-po,iv. -Cloramfenicol 3g/zi la 8h im,iv.

3.Tratament patogenic

*combaterea socului-umplere vasculara-coloizi:dextran,gelofusine,haess

-cristaloizi:ringer,ser fiziologic,hartman

-dopamina-5 g/kg/min;

-corticoterapie-HHC-400mg/zi la 6h;

*reechilibrare volemica,H-E,A-B-glucoza5%,ringer,ser fiziologic,bicarbonat de Na,

*corectarea sdr.hemoragic-sange integral,plasma,hemostatice-    etamsilat,adrenostazin,vitam.K,vitam.C,calciu gluconic,venostat

*hepatoprotectoare-vitam.B1,B6,aspatofort,sargenor,LIV52

*amoniofixatoare-multiglutin,arginina-sorbitol,normix

*in formele severe cu IRA-Insuficienta renala acuta-,dupa umplere vasculara-diuretice-furosemid 100mg iv in pev. in SF(200-400 mg/zi-5f la 6h);manitol20% 1-2g/kg/zi;dopamina 2-3 g/kg/min→esec:Hemodializa

*combaterea hiperK-calciu gluconic 2f-iv;kayexalate;furosemid 1-2 f in pev

-glucoza5%+insulina R 1U la 5g glucoza;bicarbonat de Na

*corticoterapie in-miocardita,afectare pulmonara grava si meningiana

-HSHC 100mg la 6h iv 3-4 zile,ulterior prednison 1mg/kg/zi 10-14 zile

-dexametazona-0,4mg/kg/zi iv 2-3 prize

-solumedrol-2-4mg/kg/zi

*antiedematoase cerebrale in meningita:manitol20% 1-2g/kg/zi,glucoza hipertona,furosemid 1f la 12h,MgSO4,

*AINS

4.Tratament simptomatic

-antiemetice,antialgice,antitermice,sedative

4.Durata medie de spitalizare:14 -18zile