Les maladies infectieuses - IHU Méditerranée Infection

DIU Aide Médicale d’Urgence en milieu maritime
Urgences infectieuses en milieu
maritimes et risque épidémique
27 janvier 2014
Professeur Michel Drancourt
Laboratoire de Microbiologie-Hygiène
Hôpital de la Timone
[email protected]
http://www.mediterranee-infection.com/
Les maladies infectieuses
• Maladies
• Dues à un microorganisme
Microorganisme
− Bactérie
− Virus
− Parasite
− Champignon microscopique
Microorganisme
(ADN, ARN, ADN-ARN)
•
•
•
•
Réservoir : lieu de vie et de réplication
Transmission
Pouvoir pathogène
Sensibilité aux anti-infectieux
Sources des microorganismes
responsables des Maladies Infectieuses
•
Homme
•
Animaux
•
Eau
•
Autres
La chaine épidémiologique
RESERVOIR
TRANSMISSION
Bactéries
Virus
Directe
- Inhalation
- Ingestion
Vecteur
Champignons microscopiques
Instruments
PATIENTS
La chaine épidémiologique
Source unique
Transmission croisée
Plusieurs cas
Cas sporadique
sporadiques
Épidémie
Problèmes posés par les Maladies
Infectieuses
• Pronostic
− Mortalité
− Morbidité
• Contagiosité
− Spécifique des maladies infectieuses
Importance des Maladies
Infectieuses à bord
•
•
•
1,5 millions de journées
21% de consultations pour maladies infectieuses
68 épisodes épidémiques : infections respiratoires
Place des maladies infectieuses en milieu maritime
Dr. Samad MA, CMA Ships
35
30
1.
2.
3.
4.
5.
6.
7.
8.
9.
Abdominal related ( appendicitis, food poisoning, gastritis)
Back/disc/lumbago (degenerative conditions)
Kidney/urinary related ( Kidney/urine infections)
Skin related (allergic reactions, infections)
Heart/Chest related ( heart attacks)
Heat/nerves/fainting/tinnitus ( heat stroke)
Anal/colon related (anal prolapse, hemorrhoids )
Mental Illness
Infectous diseases (Tuberculosis, Chickenpox )
Joint/ligament/muscular related (tennis elbow)
25
20
Série3
2011
Série2
2012
15
Série1
2013
10
5
0
1
2
3
4
5
6
7
8
9
10
Milieu maritime
•
•
Isolement
•
Absolu
− Plateformes off-shore
− Sous-marin
− Navire de fret
•
Relatif
− Navire de croisière
Densité de population
−
•
Spécifique des maladies infectieuses
Moyens sanitaires limités
Isolement en milieu maritime
•
Difficultés diagnostiques
•
Difficultés thérapeutiques
•
Difficultés prophylactiques
Observation :
Microbiological testing influences the
management of patients if the result is
known during the time of care
Laboratoire Point-de-Soin (Point-of-care
POC) objectif:
To provide the results of microbiological analyses while
patients are staying in emergency unit
Marseilles’ P.O.C.
• Operating 7/7, 24 hours
• Resident in biology
• Senior supervisor
Criteria for analyses in POC
* Time limit of the result < 1 hour
* Reliability of the test
* The result should change the
management of the patient
Tests are totaly independent of the operator
In the past
Today
P.O.C.: immunochromatographic test
P.O.C.: tests done by PCR in actual timing
P.O.C. Results transmitted by text
massages
POC
Emergency
Doctor
P.O.C.: test menu based on clinical symptomatology
P.O.C.: test menu based on clinical symptomatology
List of 30 tests based on clinical syndrom
Respiratory infections
- PCR M. pneumoniae
- PCR C. burnetii
- PCR B. pertussis
- Antigenuria Legionella
- Antigenuria Pneumococcus
- PCR SARM
- ICT influenza
- ICT VRS
- PCR Pneumocystis
- Procalcitonine
- Streptotest
- MNI test
Obstetrics
- PCR S. agalactiae
- ICT HIV
- PCR Atopobium
- ICT N. gonorrhae
Neuro meningitis infections
- PCR N. meningitidis
- PCR S. pneumoniae
- PCR M. pneumoniae
- PCR enterovirus
- PCR HSV1-HSV2
- Cryptotest
Tropical fever
- ICT Dengue
- ICT malaria
- PCR malaria
Digestive infections
- ICT rotavirus
- ICT adenovirus
- ICT norovirus
- ICT C. difficile
- ICT H. pylori
Other
ICT Tetanus
Perspectives: POC mobile maritime
Diagnostic kits
Diagnostic kits
I.H.U
Hospitalization
Consultation
Diagnostic kits
Emergency room
P.O.C.
Public Hospitals of
Marseille
Other
Core Laboratory
Clinics, hospitals, laboratories
In France and abroad
Remote POC
Remote, mobile POC
Remote POC in
patient’s premices
Le POC maritime
Avancée du projet POC Maritime
1. Bouricha M. et al. J Travel Med, 2014
What is the importance of
POC on board of vessels?
• To realise the correct diagnostic for better
medical care
• Avoid spread of disease
• Avoid changing course and abusive
desembarquement
• Offer a new service to cruise passengers
POC maritime, Cruise ship
What typ of test?
Symptoms ?
What typ of test test should be
done?
What typ of suitcase ?
Fièvre isolée
Fièvre aux tropiques
Vomissements
ou diarrhée
Toux ou gêne
respiratoire
Angine
Brûlures
mictionnelles
Blessure
M.S.T.
Urines
Bandelette urinaire
1 goutte de sang
Tests paludisme et dengue
Selles
Tests norovirus, adénovirus, rotavirus
Urines et mouchage
Test Legionella, test pneumocoque,
test grippe,
Ecouvillon de gorge
Test Streptocoque A
Urines
Bandelette urinaire
1 tube de sang/EDTA
Test tétanos
H.S.V., H.I.V. N. gonorrhea
Intégration informatique
iPhone with EpiCollect
application :
--> Available at
AppStores
Review of the
patients symptoms ,
date and address by
GPS (Electronis chip)
Photographs
permitted
Press New Entry for
new patient
Resistant to chocs,scratchs dust and water
Certified by the Military
10H of Autonomy
890 euros less tax
POC training
•
Video included for every test
o
Pedagogical efficiency
o
Could be installed in :USB key;I Pad;
and Internet.
•
Instructions and Procedures are
plastified for better protection
o
Agreed by nurse
o
Simple use on board
Kits urines
•
•
Legionelle, pneumoocque
Quick Tests; good
sensitivity and specificity
•
For Lgionnellose : the
vessel is a high risk place
•
Necessecity of immediat
care
Kit Pneumocoque et Legionella
•
Symptom: Cough:
o Frequently occuring
o Simple to use by nurse
o Symptome à dépister
o Maid compliance with the
collection of urines
o Screening
•
•
Central air conditioning
Change of Environment
Kit Streptocoque A
•
•
•
During the cruise
o
4 test
o
Simple to use
o
Helpful
Epidemic onset
o
30 strp tonsillitis every cruise
o
Very useful test
Avoid unnecessary antibiotherapy
Kit Grippe
•
•
First Symptom: Cough:
o
8 patients
o
Analysis of Sputum
o
How to detect?
It’s imprtant:
o
Treatment by antiviral dice the first sign
o
Avoid contagion and sensibilisation to
prevention
Kit Selles - Rotavirus Adénovirus /
NOROVIRUS
•
First symptom:
Diarrhea;vomiting,nausea:
o
3 patients
• All tests negatifs
• Difficult collection of saddles
o
Detection
Kit Selles - Rotavirus Adénovirus /
NOROVIRUS
Kit Tropical Fever
•
•
Test Malaria / Dengue
o
Fiever
o
Interesting tests
o
Easy and quick
Problèmes
o
•
•
Some minor technical problems
Malaria :Identification of 3type in 15 minutes
Some problem with Sample of blood
Blood sampling
•
Matériel
o
Autopiqueur à usage unique.
o
Compresses.
o
Savon doux.
o
Antiseptique ou alcool modifié à 70°.
o
Gants non stériles à usage unique.
o
Plateau désinfecté.
o
Container à déchets contaminés piquants.
o
Désinfectant de surface et chiffonnette.
o
Nécessaire à l'hygiène des mains.
VIH
•
Non useful test
o
No possibility of centrifugationProblème de résultat
• If Positive: We can’t have confirmation
• The announcement of disease is compicate?
• No treatment available on board
Other utility
1. Test Gonocoque / HSV
• First symptom: mictionnel burns:
o
Many consultaions
o
Simple and useful test
o
Confidentiality
2.Tetanos – Equipage
Confirm or not the vaccination
Urines
•
•
•
pH : en complément d’autres paramètres.
Leucocytes : symptôme d'infection urinaire.
Nitrite : infection bactérienne des reins ou
des voies urinaires.
•
•
Densité : symptôme d'infection urinaire.
Glucose : dépistage et contrôle du diabète
sucré ou d'une hyperglycémie.
•
Cétone : anomalies du métabolisme, danger
de céto-acidose. Témoins d'une
hyperglycémie.
Infections neurologiques
épidémiques
•
Neisseria meningitidis
Stefanelli P, et al. Eurosurveillance 2012
Infections cutanées épidémiques
•
Varicella – Zona - Virus
Acevedo F, et al. Int Marit Health, 2012
Infections respiratoires
•
Bactériennes
- Legionellose: Legionella spp.
•
Virales:
- Grippe Influenza virus
Infections digestives
•
•
Vomissements, diarrhée, fièvere
Bactériennes:
- Escherichia coli,
enterotoxinegène
•
Virales:
- Norovirus
•
Parasitaires:
- Cyclospora
Traitement
Internat. Marit. Health, 2009, 60, 1-2
Guidance to the International Medical Guide for Ships 3rd edition:
Interim advice regarding the best use of the medical chest
for ocean-going merchant vessels without a doctor onboard
Ite
m
No.
Recommended Item
Dosage form,
Strength
per
10
per
20
per
30
per
40
Indications (on board ships)
Added comments
Aciclovir 400mg tbl.
35
35
70
70
- treatment of primary or recurrent herpes
simplex virus infection;
- may be useful for severe varicella and
herpes zoster infection (doctor should be
consulted)
See pages 125-126, 198-199, 256
Amoxicillin + clavulanate
tablets 875mg/125mg
15
30
30
45
- to treat infections responsive to this
antibiotic
See pages 7-776, 140-144, 181-183, 204,
216-217, 221-223, 262 and 288
Artemether
Ampoule 1 ml = (80mg)
5
5
5
5
Treatment of severe malaria. See pages
265-269
required only for voyages to areas where
malaria transmission is a risk
Artemether +
Lumefantrine
tablets 20mg + 120mg
24
24
48
48
Treatment of malaria. See pages 265-269
required only for voyages to areas where
malaria transmission is a risk
Traitement
Recommended Item
Dosage form,
Strength
per
10
per
20
per
30
per
40
Indications (on board ships)
Added comments
Ceftriaxone
ampoule 1g powder for injection
(dissolve in water for injection)
15
30
45
60
- to treat infections responsive to this antibiotic. See
pages 16, 141-144, 153, 160-161, 172, 175, 187, 194,
195-207, 269-270
Ciprofloxacin
tablet 250mg
40
40
40
40
- to treat infections responsive to this antibiotic See
pages 77, 156-157, 181-183, 195-207, 221-223, 262
and 277
Doxycycline
tablet 100mg
20
20
40
40
as recommended in IMGS3 for the specific infection.
See pages 195-207, 209-210, 221-223, 271- 272.
Mebendazole
tablet 100mg
10
10
20
20
- to treat intestinal worm infections not effective for
tapeworm infection or hydatid disease See pages 281284
Metronidazole
tablet 500mg
30
30
30
30
to treat infections responsive to antibiotics . See pages
160-163, 172, 203-204
Permethrin 1%
lotion 250 ml
1
1
2
2
to eliminate hair, pubic, and body lice. See pages 219221
Permethrin 5%
Lotion, vial of 250 g
1
1
2
2
to treat scabies. See pages 219-221
Povidone iodine ointment
10% 25 to 50 g
2
3
4
5
to disinfect skin and wounds. See pages 67- 77, 215219
Povidone iodine solution
10% 30 to 120ml
2
3
4
5
5to disinfect skin and wounds. See pages 67- 77, 215219
Tetanus Immunoglobulin
ampoule. (keep at 2-8°C)
1
1
1
1
Part of wound care if state of vaccination. is unknown,
see page 68
Tetanus toxoid
vaccination ampoule (keep at 2-8°C)
1
1
1
1
Part of wound care if state of vaccination is unknown,
see page 68