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

13

14

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:

20

21

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

41

42

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)

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