Infektsioonhaigused 21. sajandil
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1 Infektsioonhaigused 21. sajandil Irja Lutsar Eesti Arstide Päevad
2 Infektsioonhaigused läbi aegade: Inglismaa ja Wales
3 Infektsioonhaigused 20.sajandil Läkaköha Eestis Difteeria Eestis
4 Mida toob 21. sajand? Inimeste ajutise või alalise ümberpaiknemise Meditsiin muutub üha võimsamaks Lääneriikide ühiskonna vananemine Turism Majanduslik/poliitiline migratsioon Eneseharimine võõrastes maades Diagnostika Intensiivravi Pahaloomuliste kasvajate ravi Organite, kudede, geenide, tüvirakkude siirdamised
5 HIV, HCV and HBV in Estonia
6 Globaalne soojenemine Troopilised putukad on võimelised elama põhjapool Dengue palavik Malaaria? Troopilised haigused?
7 Dengue palavik Aedes aegypti miljonit haigusjuhtu igal aastal
8 Inimeste käitumise ja keskkonna muutumine Migratsioon Majandusmigrandid Poliitilised migrandid Turism Inimeste reisimine Haigusvektorite reisimine Mikroorganismide reisimine
9 Migratsiooni saldo 2013 aastal miljonit immigranti maailmas
10 Linnastumine % maailma elanikest elab linnas % maailma elanikest elab linnas Ülerahvastumine TB - levikuks tihedad kontaktid Seksuaalsel teel levivad haigused HIV/AIDS Puhas vesi ja kanalisatsioon Mega-koolid ja toiduga levivad infektsioonid Puhta vee puudus Megapolis
11 Migratsioon ja infektsioonid Vaesemad kui põhielanikkond Migrantidel Kehvemad elu ja töötingimused Kehvem ligipääs arstiabile Puudub sotsiaalne võrgustik Erinevad toitumusharjumused Enam STD Enam HIV Enam TB
12 Ülemaailmne turism suureneb aasta-aastalt
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15 Infektsioonid reisijatel Nature Reviews Microbiology 7, (December 2009)
16 Lääne Niiluse viiruslik entsefaliit
17 West-Nile encephalitis in US Number of cases total cases deaths %
18 Mitte klassikalised reisiinfektsioonid Antibiootikum-resistentsuse levik NDM enterobakterite levik PRSP klonaalne levik Euroopas Uute infektsioonide levik HIV SARS koroonaviirus MERS-koroonaviirus Gripiviirus Noroviiruse puhangud
19 Antibiootikum-resistentsuse migratsioon Nature 2013; 499:
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22 Moodne meditsiin ja infektsioonid Antibiootikum-resistentsuse epideemia HepC VAP/HAP Kateetrite/võõrkehade infektsioonid Immuunpuudulikkusega isikud CMV, EBV KNS krüptokokk-infektsioon Tundmatud viirused - ülekanne
23 Antibiootikumresistentsus vs uued antibiootikumid
24 The history of Neisseria gonorrhoeae antimicrobial resistance Nature Reviews Microbiology 12, (2014)
25 K.pneumoniae resistentsus 3. pk tsefalosporiinidele (%) Eesti, Soome, Läti EARS-Net Eesti Eesti Soome Läti Soome Läti
26 P.aeruginosa karbapeneem-resistentsus (%) EARS-Net 2012 Eesti, Soome, Läti Eesti Soome Läti Eesti Soome Läti
27 MRSA esinemine: Eesti, Läti, Soome Eesti EARS-Net 2012 Soome Läti
28 Infektsioonhaiguste diagnostika on oluliselt paranenud
29 Identifitseeritud mikroobiliigid
30 Moodne mikrobioloogiline diagnostika Uued mikroorganismid Kiirem ja operatiivsem diagnostika ja ravi Personaalne meditsiin Nature Reviews Microbiology 11, (2013)
31 Uued viirusinfektsioonid Nature Reviews Immunology 13, (2013)
32 Enamus (uusi) viirusinfektsioone on zoonoosid
33 Kokkuvõtteks Infektsioonhaigused muutuvad vastavalt sellele kuidas muutub maailm meie ümber 21 sajandil tuleb kohaneda Kasvava turismi ja migratsiooniga Moodsa meditsiiniga Uute viiruste tekkega Uute viiruste bakterite teke on ilmselt kiirem kui uute ravimimeetodite (sh. ravimite) turuletulek Diagnostika ja ravi muutuvad personaalsemaks
34 The four waves of antibiotic resistance in Staphylococcus aureus Nature Reviews Microbiology 7, (September 2009)
35 A minimum spanning tree based on 21 MIRU-VNTR genotyping of MTB isolates from Taiwan, Japan, and South Korea PLoS One. 2012; 7(7): e39792.
36
37 Nature Reviews Microbiology 5,
38 Current applications of MALDI TOF mass spectrometry in the clinical microbiology laboratory
39 Examples of infectious disease outbreaks that were investigated using next-generation sequencing
40 Diagnosis of infectious diseases using point-of-care assays
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43 Pestitsiidide kasutamine Eestis (roosa), Lätis, Leedus, Tsehhis ja Sloveenias Irja Lutsar, 2011
44 Metskitsed ( ), metssead ( ) ja hundid ( ) Leedus (A), Lätis (B) ja Eestis (C) Irja Lutsar, 2011
45 Puukentsefaliit Leedus (A), Lätis (B), Eestis (C) Rev. Med. Virol. 2008; 18: Irja Lutsar, 2011
46 HIV, HCV and HBV in Estonia IDUs HIV-1 alatüüp B HIV-1 CRF06_cpx
47 E.Coli O104:H4 (EAHEC) Stx phage EAEC Esineb valdavalt inimestel Puhangud kirjeldatud Sorbitool-neg aggr geen pos EHEC (STEC; VTEC) Sageli loomadel (30%) O157:H7 Non-O157 tüved stx2 geen pos E.coli O104:H4 Isoleeritud inimestelt Levik inimeselt inimesele näidatud Puudub kariloomadel (puhangu piirkonnas) Horisontaalne geenide ülekanne 3816 haigusjuhtu; suremus 4,2%, keskmine vanus 42 a
48 E.coli O104:H4
49 Novel coronavirus: phylogenetic tree
50 Täiskasvanud Lapsed
51
52 Enamus uusi infektsioone pärinevad loomadelt/lindudelt Nature Medicine 10, (2004)
Chain of Infection Agent Mode of transmission Contact (direct, indirect, droplet spread) Airborne Common-vehicle spread Host
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