{"id":1031,"date":"2024-03-11T13:18:18","date_gmt":"2024-03-11T11:18:18","guid":{"rendered":"https:\/\/docsites.cgmlife.com\/puvl\/?p=1031"},"modified":"2024-03-11T13:18:18","modified_gmt":"2024-03-11T11:18:18","slug":"cerny-kasel-aktualni-informace","status":"publish","type":"post","link":"https:\/\/docsites.cgmlife.com\/puvl\/2024\/03\/11\/cerny-kasel-aktualni-informace\/","title":{"rendered":"\u010cern\u00fd ka\u0161el aktu\u00e1ln\u00ed informace"},"content":{"rendered":"\n<p><strong>Vzhledem ke zv\u00fd\u0161en\u00e9mu v\u00fdskytu \u010dern\u00e9ho ka\u0161le (p\u016fvodcem bakterie Bordetella pertussis) si dovoluji  up\u0159esnit doporu\u010den\u00ed pro diagnostiku a l\u00e9\u010dbu. <\/strong><br><strong>Inkuba\u010dn\u00ed doba onemocn\u011bn\u00ed je 5-21 dn\u00ed (nej\u010dast\u011bji 7-10 dn\u00ed).<\/strong> <strong>Inici\u00e1ln\u00ed p\u0159\u00edznaky infekce<\/strong> (katar\u00e1ln\u00ed st\u00e1dium, ve kter\u00e9m je naka\u017elivost nejvy\u0161\u0161\u00ed) j<strong>sou klinicky neodli\u0161iteln\u00e9 od projev\u016f jin\u00fdch respira\u010dn\u00edch infekc\u00ed \u2013 pacienti trp\u00ed r\u00fdmou, m\u00edrn\u00fdm ka\u0161lem, bolestmi v krku, z\u00e1n\u011btem spojivek. <br><\/strong><br>V prim\u00e1rn\u00ed p\u00e9\u010di tedy takov\u00e9ho pacienta, nem\u00e1me-li evidenci o kontaktu s naka\u017een\u00fdm s potvrzenou pertus\u00ed, zpravidla vy\u0161et\u0159ovat s ohledem na etiologii nebudeme.<br><br><strong> P\u0159enos je p\u0159ev\u00e1\u017en\u011b kap\u00e9nkov\u00fd, \u010d\u00e1ste\u010dn\u011b i prost\u0159ednictv\u00edm kontaminovan\u00fdch p\u0159edm\u011bt\u016f. <\/strong>Stejn\u011b jako v p\u0159\u00edpad\u011b ostatn\u00edch respira\u010dn\u00edch infekc\u00ed doporu\u010dujeme symptomatickou l\u00e9\u010dbu a omezen\u00ed soci\u00e1ln\u00edch kontakt\u016f, zejm\u00e9na s rizikovou populac\u00ed, pou\u017e\u00edv\u00e1n\u00ed ochrany nosu a \u00fast, \u010dast\u00e9 v\u011btr\u00e1n\u00ed, dle stavu vystavujeme pracovn\u00ed neschopnost<br>.<br><strong>Paroxysm\u00e1ln\u00ed st\u00e1dium trv\u00e1 n\u011bkolik t\u00fddn\u016f, projevuje se such\u00fdm dr\u00e1\u017ediv\u00fdm ka\u0161lem v z\u00e1chvatech, kter\u00e9 p\u0159ech\u00e1zej\u00ed v zaj\u00edk\u00e1n\u00ed a mohou b\u00fdt prov\u00e1zen\u00e9 a\u017e zmodr\u00e1n\u00edm<\/strong> . <br><br><strong>Po prod\u011blan\u00e9 pertusi m\u016f\u017ee dr\u00e1\u017ediv\u00fd ka\u0161el p\u0159etrv\u00e1vat n\u011bkolik t\u00fddn\u016f a\u017e m\u011bs\u00edc\u016f<\/strong>. Pro pertusi je typick\u00e1 p\u0159\u00edtomnost (peri)bronchitidy, vz\u00e1cnou komplikac\u00ed je bordetelov\u00e1 pneumonie nebo pneumonie zap\u0159\u00ed\u010din\u011bn\u00e1 jinou virovou \u010di bakteri\u00e1ln\u00ed koinfekc\u00ed\/superinfekc\u00ed. D\u00e1le onemocn\u011bn\u00ed m\u016f\u017ee b\u00fdt komplikov\u00e1no epistax\u00ed- krv\u00e1cen\u00edm z nosu, zlomeninou  \u017eeber, mdlobou poklesem cukru atp. Hlavn\u00edm rizikem zejm\u00e9na u novorozenc\u016f a kojenc\u016f je nedostate\u010dnost plic. <br><strong>Kdy, u kter\u00fdch pacient\u016f a jak\u00fdmi metodami vy\u0161et\u0159ovat pacienty?<\/strong><br><strong>Po potvrzen\u00e9m kontaktu s pacientem s pertus\u00ed <\/strong>je u osob s jak\u00fdmikoliv p\u0159\u00edznaky respira\u010dn\u00edho onemocn\u011bn\u00ed indikov\u00e1no vy\u0161et\u0159en\u00ed a ve v\u011bt\u0161in\u011b p\u0159\u00edpad\u016f doporu\u010dena l\u00e9\u010dba antibiotiky<br><strong>U pacienta s protrahovan\u00fdm ka\u0161lem, nut\u00edc\u00edm ke zvracen\u00ed, zhor\u0161en\u00edm stavu, zejm\u00e9na bez klinick\u00e9 odezvy na pod\u00e1n\u00ed antibiotik ,u senior\u016f, chronicky nemocn\u00fdch, t\u011bhotn\u00fdch a osob s prim\u00e1rn\u00edm \u010di sekund\u00e1rn\u00edm imunodeficitem,<\/strong><br><strong>Jak se diagnostikuje? <\/strong><br> V  ohnisku n\u00e1kazy vy\u0161et\u0159ujeme prim\u00e1rn\u011b p\u0159\u00edm\u00fdmi diagnostick\u00fdmi metodami (detekce DNA pomoc\u00ed PCR, p\u0159\u00edpadn\u011b kultivace),<strong> zpravidla PCR z v\u00fdt\u011bru z nosohltanu. <\/strong><br><strong>Nep\u0159\u00edm\u00e1 diagnostika (s\u00e9rologie- krevn\u00ed test)je pro diagnostiku akutn\u00edho onemocn\u011bn\u00ed sp\u00ed\u0161e nep\u0159\u00ednosn\u00e9 (v\u011bt\u0161inou je pot\u0159eba prov\u00e9st 2 vy\u0161et\u0159en\u00ed v odstupu n\u011bkolika t\u00fddn\u016f, tzv. p\u00e1rov\u00e9 s\u00e9rum<\/strong>). Interpretace m\u016f\u017ee b\u00fdt obt\u00ed\u017en\u00e1 a v\u00e9st k nadu\u017e\u00edv\u00e1n\u00ed ATB se zv\u00fd\u0161en\u00fdm rizikem navozen\u00ed ATB rezistence. Nebyla tak\u00e9 stanovena ochrann\u00e1 hladina IgG protil\u00e1tek po o\u010dkov\u00e1n\u00ed.<br><strong>Kter\u00e9 pacienty l\u00e9\u010dit a \u010d\u00edm?<\/strong><br>\uf0b7 Osoby s prok\u00e1zanou infekc\u00ed Bordetella pertussis<br>\uf0b7 Symptomatick\u00e9 osoby po kontaktu s naka\u017een\u00fdm Bordetella pertusis<br><br><strong>ATB volby je klaritromycin, v d\u00e1vce 500mg 2x denn\u011b po dobu 7 dn\u00ed, alternativn\u011b azitromycin 500mg denn\u011b po dobu 5 dn\u016f<\/strong>. Pokud se podaj\u00ed antibiotika, je pacient pova\u017eov\u00e1n za nenaka\u017eliv\u00e9ho po 5 dnech. Jako ATB 2. volby \u010di p\u0159i zn\u00e1m\u00e9 alergii lze pou\u017e\u00edt kotrimoxazol nebo fluorochinolony (ne u gravidn\u00edch). <br><br><strong>Efekt ATB terapie na frekvenci a intenzitu z\u00e1chvat\u016f ka\u0161le nemus\u00ed b\u00fdt zna\u010dn\u00fd.<\/strong><br>V p\u0159\u00edpad\u011b dozn\u00edvaj\u00edc\u00edch p\u0159\u00edznak\u016f (dr\u00e1\u017ediv\u00fd ka\u0161el) bez laboratorn\u00edch a RTG zn\u00e1mek akutn\u00ed infekce 3 a v\u00edce t\u00fddn\u016f od jejich po\u010d\u00e1tku je p\u0159\u00ednos ATB terapie minim\u00e1ln\u00ed.<br><strong>Symptomaticky vol\u00edme antitusika, benefit antihistaminik a inhala\u010dn\u00edch, ani celkov\u00fdch kortikoid\u016f nebyl prok\u00e1z\u00e1n.<\/strong><br><strong>Postexpozi\u010dn\u00ed ATB profylaxe kdy? <\/strong><br>\uf0b7 \u00dazk\u00fd kontakt s infikovanou osobu (do 21 dn\u00ed od kontaktu)<br>\uf0b7 Neo\u010dkovan\u00e9 \u010di ne\u00fapln\u011b o\u010dkovan\u00e9 mal\u00e9 d\u011bti, nep\u0159eo\u010dkovan\u00e9 \u017eeny ve 3. trimestru gravidity,<br>pacienti s dysfunkc\u00ed imunity, pacienti s v\u00fdznamn\u00fdm org\u00e1nov\u00fdm posti\u017een\u00edm (zejm\u00e9na plic) NEBO osoby, kter\u00e9 jsou v \u00fazk\u00e9m kontaktu s v\u00fd\u0161e uveden\u00fdmi skupinami pacient\u016f (a hroz\u00ed tedy, \u017ee by je mohly nakazit)<br>\uf0b7 D\u00e1le lze zv\u00e1\u017eit ATB profylaxi u v\u0161ech \u010dlen\u016f dom\u00e1cnosti pacienta infikovan\u00e9ho B. pertussis <br><strong>D\u00e1viv\u00fd ka\u0161el podl\u00e9h\u00e1 v \u010cR povinn\u00e9mu hl\u00e1\u0161en\u00ed. <\/strong><br>Prevence &#8211; o\u010dkov\u00e1n\u00ed<br><strong>Z\u00e1kladn\u00edm preventivn\u00edm opat\u0159en\u00edm je o\u010dkov\u00e1n\u00ed.<\/strong> <\/p>\n\n\n\n<p><strong>Je siln\u011b doporu\u010deno p\u0159edev\u0161\u00edm v\u0161em t\u011bhotn\u00fdm \u017een\u00e1m po 27. t\u00fddnu gravidity,<\/strong> a to bez ohledu na datum p\u0159edchoz\u00edho o\u010dkov\u00e1n\u00ed proti tetanu (a v ka\u017ed\u00e9 gravidit\u011b). Mezi nejrizikov\u011bj\u0161\u00ed skupinu pat\u0159\u00ed dosud neo\u010dkovan\u00e9 d\u011bti do 2 m\u011bs\u00edc\u016f v\u011bku, o\u010dkov\u00e1n\u00ed matky chr\u00e1n\u00ed novorozence a dosud neo\u010dkovan\u00e9 kojence pasivn\u011b p\u0159enesen\u00fdmi protil\u00e1tkami. <strong>O\u010dkov\u00e1n\u00ed je siln\u011b doporu\u010deno senior\u016fm, chronicky nemocn\u00fdm (zejm\u00e9na s onemocn\u011bn\u00edm plic), osob\u00e1m<br>s prim\u00e1rn\u00edm a sekund\u00e1rn\u00edm imunodeficitem a zam\u011bstanc\u016fm pracovi\u0161\u0165 pe\u010duj\u00edc\u00edm o nejv\u00edce ohro\u017een\u00e9 osoby <\/strong><br><strong>P\u0159eo\u010dkov\u00e1n\u00ed kombinovanou acelul\u00e1rn\u00ed vakc\u00ednou proti tetanu, z\u00e1\u0161krtu a \u010dern\u00e9mu ka\u0161li (Boostrix, Adacel), p\u0159\u00edpadn\u011b tetanu, z\u00e1\u0161krtu, \u010dern\u00e9mu ka\u0161li a d\u011btsk\u00e9 p\u0159enosn\u00e9 obrn\u011b (Adacel polio, Boostrix polio) doporu\u010deno v\u0161em dosp\u011bl\u00fdm alespo\u0148 1x v dosp\u011blosti. <\/strong>Vn\u00edmavou populac\u00ed jsou v\u0161ichni, prod\u011blan\u00e9 onemocn\u011bn\u00ed, ani o\u010dkov\u00e1n\u00ed nezaru\u010duje dlouhodobou ochranu.<br>O\u010dkov\u00e1n\u00ed kombinovanou vakc\u00ednou proti tetanu, z\u00e1\u0161krtu a d\u00e1viv\u00e9mu ka\u0161li (ev. + d\u011btsk\u00e9 p\u0159enosn\u00e9 obrn\u011b) pat\u0159\u00ed mezi pacientem hrazen\u00e1 o\u010dkov\u00e1n\u00ed, <strong>Po p\u0159edchoz\u00edm o\u010dkov\u00e1n\u00ed kombinovanou vakc\u00ednou je doporu\u010deno pravideln\u00e9 p\u0159eo\u010dkov\u00e1n\u00ed proti tetanu v intervalu 10 let nez\u00e1visle na v\u011bku. <\/strong><\/p>\n\n\n\n<p><strong>Vakc\u00edny nejsou t\u010d. k dispozici, poda\u0159ilo se objednat n\u011bkolik kus\u016f Adacel polio, cena je 1290.- K\u010d, z\u00e1jemci pi\u0161t\u011b na email: mudr.hrabankova@seznam.cz nebo p\u0159es eServices. <\/strong><br>ZDROJ informac\u00ed web SPL<br><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Vzhledem ke zv\u00fd\u0161en\u00e9mu v\u00fdskytu \u010dern\u00e9ho ka\u0161le (p\u016fvodcem bakterie Bordetella pertussis) si dovoluji up\u0159esnit doporu\u010den\u00ed pro diagnostiku a l\u00e9\u010dbu. Inkuba\u010dn\u00ed doba onemocn\u011bn\u00ed je 5-21 dn\u00ed (nej\u010dast\u011bji 7-10 dn\u00ed). Inici\u00e1ln\u00ed p\u0159\u00edznaky infekce (katar\u00e1ln\u00ed st\u00e1dium, ve kter\u00e9m je naka\u017elivost nejvy\u0161\u0161\u00ed) jsou klinicky neodli\u0161iteln\u00e9 od projev\u016f jin\u00fdch respira\u010dn\u00edch infekc\u00ed \u2013 pacienti trp\u00ed r\u00fdmou, m\u00edrn\u00fdm ka\u0161lem, bolestmi v krku, z\u00e1n\u011btem [&hellip;]<\/p>\n","protected":false},"author":591,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"wds_primary_category":0,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-1031","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/docsites.cgmlife.com\/puvl\/wp-json\/wp\/v2\/posts\/1031","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/docsites.cgmlife.com\/puvl\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/docsites.cgmlife.com\/puvl\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/docsites.cgmlife.com\/puvl\/wp-json\/wp\/v2\/users\/591"}],"replies":[{"embeddable":true,"href":"https:\/\/docsites.cgmlife.com\/puvl\/wp-json\/wp\/v2\/comments?post=1031"}],"version-history":[{"count":2,"href":"https:\/\/docsites.cgmlife.com\/puvl\/wp-json\/wp\/v2\/posts\/1031\/revisions"}],"predecessor-version":[{"id":1034,"href":"https:\/\/docsites.cgmlife.com\/puvl\/wp-json\/wp\/v2\/posts\/1031\/revisions\/1034"}],"wp:attachment":[{"href":"https:\/\/docsites.cgmlife.com\/puvl\/wp-json\/wp\/v2\/media?parent=1031"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/docsites.cgmlife.com\/puvl\/wp-json\/wp\/v2\/categories?post=1031"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/docsites.cgmlife.com\/puvl\/wp-json\/wp\/v2\/tags?post=1031"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}