imported>Maximilian.schons@uk-koeln.de |
imported>Maximilian.schons@uk-koeln.de |
| (5 intermediate revisions by 2 users not shown) |
| Line 1: |
Line 1: |
|
| | Die '''Postexpositionsprophylaxe bei HIV''' ist stark abhängig vom Typ der Übertragung. |
| ====<span class="mw-headline" id="Sofortma.C3.9Fnahmen_bei_beruflicher_Exposition" style="box-sizing: inherit;">Sofortmaßnahmen bei beruflicher Exposition</span><span class="mw-editsection" style="box-sizing: inherit; user-select: none; font-size: 12px; font-weight: normal; margin-left: 1em; vertical-align: baseline; line-height: 1em; display: inline-block; white-space: nowrap; unicode-bidi: isolate; visibility: hidden; opacity: 0; transition: visibility 0s ease 0s, opacity 0.5s linear 0s;">[https://infektiopedia.de/w/index.php?title=DGI:Postexpositionsprophylaxe/HIV&veaction=edit§ion=T-2][https://infektiopedia.de/w/index.php?title=DGI:Postexpositionsprophylaxe/HIV§ion=T-2&veaction=editsource]</span>====
| |
|
| |
|
| ABBILDUNG MIT MERMAID MACHEN
| | Wichtige Kategorien sind berufliche Exposition, parenteraler und sexueller Übertragungsweg. |
| | |
| <code style="box-sizing: border-box; font-family: ui-monospace, SFMono-Regular, "SF Mono", Consolas, "Liberation Mono", Menlo, monospace; font-size: 13.6px; padding: 0px; margin: 0px; background: transparent; border-radius: 6px; word-break: normal; white-space: pre; border: 0px; display: inline; overflow: visible; line-height: inherit; overflow-wrap: normal;"><nowiki>
| |
|
| |
| {{#mermaid:sequenceDiagram
| |
| participant Alice
| |
| participant Bob
| |
| Alice->John: Hello John, how are you?
| |
| loop Healthcheck
| |
| John->John: Fight against hypochondria
| |
| end
| |
| Note right of John: Rational thoughts <br/>prevail...
| |
| John-->Alice: Great!
| |
| John->Bob: How about you?
| |
| Bob-->John: Jolly good!
| |
| }}</nowiki></code>
| |
| | |
| | |
| | |
| <nowiki>{{#mermaid:graph TD;</nowiki>
| |
| <span style="color: #880000">graph</span> <span style="color: #000000">TD</span>
| |
| | |
| <span style="color: #000000">A</span><span style="color: #aa8500">[Stich- oder Schnittverletzung, Kontamination geschädigter Haut]</span>
| |
| | |
| <span style="color: #000000">B</span><span style="color: #aa8500">["Kontamination (Auge oder Mundhöhle)</span><span style="color: #000000">"]</span>
| |
| | |
| <span style="color: #000000">A</span><span style="color: #008800">--></span><span style="color: #000000">C</span><span style="color: #aa8500">[Spülung mit Wasser und Seife bzw. einem Antiseptikum, welches begrenzt viruzide Wirksamkeit aufweist]</span>
| |
| | |
| <span style="color: #000000">B</span><span style="color: #008800">--></span><span style="color: #000000">D</span><span style="color: #aa8500">[Spülung mit Wasser von Auge und Mundhöhle]</span>
| |
| | |
| <span style="color: #000000">C</span><span style="color: #008800">--></span><span style="color: #000000">E</span><span style="color: #aa8500">[Entscheid über systematische, medikamentöse Postexpositionsprophylaxe*]</span>
| |
| | |
| <span style="color: #000000">D</span><span style="color: #008800">--></span><span style="color: #000000">E</span>
| |
| | |
| <span style="color: #000000">E</span><span style="color: #008800">--></span><span style="color: #000000">F</span><span style="color: #aa8500">["Unfalldokumentation (D-Arzt/Betriebsarzt)</span><span style="color: #000000">"]</span>
| |
| | |
| <span style="color: #000000">F</span><span style="color: #008800">--></span><span style="color: #000000">G</span><span style="color: #aa8500">[Ausgangsstatus HIV- und Hepatitis-Serologie]</span>
| |
| | |
| <span style="color: #000000">style A fill:#ccc,stroke:#333</span>
| |
| | |
| <span style="color: #000000">style B fill:#ccc,stroke:#333</span>
| |
| | |
| <span style="color: #000000">style C fill:#fff,stroke:#333</span>
| |
| | |
| <span style="color: #000000">style D fill:#fff,stroke:#333</span>
| |
| | |
| <span style="color: #000000">style E fill:#fff,stroke:#333</span>
| |
| | |
| <span style="color: #000000">style F fill:#fff,stroke:#333</span>
| |
| | |
| <span style="color: #000000">style G fill:#fff,stroke:#333</span>
| |
| | |
| <nowiki>}}</nowiki><span class="mw-editsection" style="box-sizing: inherit; user-select: none; font-size: 12px; font-weight: normal; margin-left: 1em; vertical-align: baseline; line-height: 1em; display: inline-block; white-space: nowrap; unicode-bidi: isolate; visibility: hidden; opacity: 0; transition: visibility 0s ease 0s, opacity 0.5s linear 0s;"><span class="mw-editsection-bracket" style="box-sizing: inherit; margin-right: 0.25em; color: rgb(84, 89, 93);"></span><span class="mw-editsection-divider" style="box-sizing: inherit; color: rgb(84, 89, 93);"></span><span class="mw-editsection-bracket" style="box-sizing: inherit; margin-left: 0.25em; color: rgb(84, 89, 93);"></span></span><span class="mw-editsection" style="box-sizing: inherit; user-select: none; font-size: 12px; font-weight: normal; margin-left: 1em; vertical-align: baseline; line-height: 1em; display: inline-block; white-space: nowrap; unicode-bidi: isolate; visibility: hidden; opacity: 0; transition: visibility 0s ease 0s, opacity 0.5s linear 0s;"><span class="mw-editsection-bracket" style="box-sizing: inherit; margin-right: 0.25em; color: rgb(84, 89, 93);"></span><span class="mw-editsection-divider" style="box-sizing: inherit; color: rgb(84, 89, 93);"></span><span class="mw-editsection-bracket" style="box-sizing: inherit; margin-left: 0.25em; color: rgb(84, 89, 93);"></span></span><span class="mw-editsection" style="box-sizing: inherit; user-select: none; font-size: 12px; font-weight: normal; margin-left: 1em; vertical-align: baseline; line-height: 1em; display: inline-block; white-space: nowrap; unicode-bidi: isolate; visibility: hidden; opacity: 0; transition: visibility 0s ease 0s, opacity 0.5s linear 0s;"><span class="mw-editsection-bracket" style="box-sizing: inherit; margin-right: 0.25em; color: rgb(84, 89, 93);"></span><span class="mw-editsection-divider" style="box-sizing: inherit; color: rgb(84, 89, 93);"></span><span class="mw-editsection-bracket" style="box-sizing: inherit; margin-left: 0.25em; color: rgb(84, 89, 93);"></span></span><span class="mw-editsection" style="box-sizing: inherit; user-select: none; font-size: 12px; font-weight: normal; margin-left: 1em; vertical-align: baseline; line-height: 1em; display: inline-block; white-space: nowrap; unicode-bidi: isolate; visibility: hidden; opacity: 0; transition: visibility 0s ease 0s, opacity 0.5s linear 0s;"><span class="mw-editsection-bracket" style="box-sizing: inherit; margin-right: 0.25em; color: rgb(84, 89, 93);"></span><span class="mw-editsection-divider" style="box-sizing: inherit; color: rgb(84, 89, 93);"></span><span class="mw-editsection-bracket" style="box-sizing: inherit; margin-left: 0.25em; color: rgb(84, 89, 93);"></span></span><span class="mw-editsection" style="box-sizing: inherit; user-select: none; font-size: 12px; font-weight: normal; margin-left: 1em; vertical-align: baseline; line-height: 1em; display: inline-block; white-space: nowrap; unicode-bidi: isolate; visibility: hidden; opacity: 0; transition: visibility 0s ease 0s, opacity 0.5s linear 0s;"><span class="mw-editsection-bracket" style="box-sizing: inherit; margin-right: 0.25em; color: rgb(84, 89, 93);"></span><span class="mw-editsection-divider" style="box-sizing: inherit; color: rgb(84, 89, 93);"></span><span class="mw-editsection-bracket" style="box-sizing: inherit; margin-left: 0.25em; color: rgb(84, 89, 93);"></span></span><span class="mw-editsection" style="box-sizing: inherit; user-select: none; font-size: 12px; font-weight: normal; margin-left: 1em; vertical-align: baseline; line-height: 1em; display: inline-block; white-space: nowrap; unicode-bidi: isolate; visibility: hidden; opacity: 0; transition: visibility 0s ease 0s, opacity 0.5s linear 0s;"><span class="mw-editsection-bracket" style="box-sizing: inherit; margin-right: 0.25em; color: rgb(84, 89, 93);"></span><span class="mw-editsection-divider" style="box-sizing: inherit; color: rgb(84, 89, 93);"></span><span class="mw-editsection-bracket" style="box-sizing: inherit; margin-left: 0.25em; color: rgb(84, 89, 93);"></span></span><br />
| |
| | |
| ====<span class="mw-headline" id="Basis-_und_Kontrolluntersuchungen" style="box-sizing: inherit;">Basis- und Kontrolluntersuchungen</span>====
| |
| {| class="wikitable"
| |
| |+
| |
| ! class="col-blue-dark-bg" |
| |
| ! class="col-blue-dark-bg" |Indexperson^0
| |
| ! colspan="4" class="col-blue-dark-bg" |Exponierte Persono
| |
| |-
| |
| | class="col-blue-dark-bg" |
| |
| | class="col-blue-dark-bg" |
| |
| | class="col-blue-dark-bg" |Ausgangsuntersuchung
| |
| | class="col-blue-dark-bg" |2 Wochen
| |
| | class="col-blue-dark-bg" |6 Wochen/nach PEP: 10 Wochen [122]
| |
| | class="col-blue-dark-bg" |12 Wochen nach PEP: 16 Wochen
| |
| |-
| |
| |HIV-Antikörper
| |
| |X
| |
| |X
| |
| |
| |
| |X
| |
| |X
| |
| |-
| |
| |HBsAg^
| |
| |X
| |
| |X
| |
| |
| |
| |
| |
| |
| |
| |-
| |
| |Anti HBc- und Anti HBs-Antikörper^
| |
| |
| |
| |X
| |
| |
| |
| |X*
| |
| |X*
| |
| |-
| |
| |HCV-Antikörper^^
| |
| |X
| |
| |X
| |
| |
| |
| |X*
| |
| |X*
| |
| |-
| |
| |HCV-RNA^^
| |
| |(X)
| |
| |
| |
| |X
| |
| |X
| |
| |
| |
| |-
| |
| |ärztliche Untersuchung
| |
| |
| |
| |X
| |
| |X**
| |
| |X
| |
| |
| |
| |-
| |
| |Medikamentenanamnese**
| |
| |X^1
| |
| |X^2
| |
| |X^2
| |
| |
| |
| |
| |
| |-
| |
| |Blutbild**
| |
| |
| |
| |X
| |
| |X
| |
| |
| |
| |
| |
| |-
| |
| |Transaminasen
| |
| |
| |
| |X
| |
| |X
| |
| |
| |
| |X^^
| |
| |-
| |
| |Kreatinin/Harnstoff**
| |
| |
| |
| |X
| |
| |X
| |
| |
| |
| |
| |
| |-
| |
| |'''Bei sexuellem Risiko'''
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |-
| |
| |Weiteres STDs (Syphilis, Gonorrhö, Chlamydien)
| |
| |X*
| |
| |X*<br />
| |
| |X*<br />
| |
| |X*<br />
| |
| |
| |
| |-
| |
| |(bei MSM) Kontrolle des HAV- Impfstatus^^^
| |
| |X
| |
| |X
| |
| |
| |
| |
| |
| |
| |
| |}
| |
| <small>° falls Person bekannt, aber Infektionsstatus unklar, Einwilligung erforderlich, ggf. Einsatz eines Schnelltestes</small>
| |
| <small>^ bei ausreichendem Impfschutz des Verletzten (Anti HBs>100 IE/ml innerhalb der letzten 10 Jahre) ist eine Testung der Indexperson auf HBsAg nicht erforderlich – bei fehlender Impfanamnese und bestehender Impfindikation Impfung empfehlen (siehe Impfempfehlung der STIKO: [https://www.rki.de/DE/Content/Infekt/EpidBull/Archiv/2013/Ausgaben/34_13.pdf?__blob=publicationFile <span style="font-family:"Calibri",sans-serif;mso-bidi-font-family:"Times New Roman"">https://www.rki.de/DE/Content/Infekt/EpidBull/Archiv/2013/Ausgaben/34_13.pdf?__blob=publicationFile</span>] , S.341-342)</small>
| |
| | |
| <small>^^ HCV-RNA-Bestimmung bei der Indexperson falls diese anti-HCV positiv ist; nach beruflicher Exposition (z.B. NSV) Vorgehen bzgl. HCV gemäß S3-Leitlinie (<nowiki>http://www.awmf.org/leitlinien/detail/ll/021-012.html</nowiki>). HCV-RNA-Bestimmung bei der verletzten (exponierten) Person bei relevantem HCV-Übertragungsrisiko<span style="mso-spacerun:yes"> </span>und bekannter oder möglicher HCV-Infektion der Indexperson) nach 2-4 und falls negativ 6 – 8 Wochen nach Exposition. Abschlusskontrolle (HCV-Antikörper und Transaminasen) nach HCV-Exposition nach 6 Monaten.</small>
| |
| | |
| <small>^^^ falls nicht gegen Hepatitis A geimpft, Hepatitis A-oder Hep.A/B –Kombinationsimpfung empfehlen</small>
| |
| | |
| <small>* falls indiziert/ falls Exposition vorlag</small>
| |
| | |
| <small>** falls PEP genommen wird</small>
| |
| | |
| <small>1 Behandlungsanamnese mit antiretroviralen Medikamenten (Abschätzung der Resistenzsituation)</small>
| |
| | |
| <small>2 Einnahme anderer Medikamente? (cave! Wechselwirkungen) Verträglichkeit der PEP?</small>
| |
| | |
| <br /><span class="mw-editsection" style="box-sizing: inherit; user-select: none; font-size: 12px; font-weight: normal; margin-left: 1em; vertical-align: baseline; line-height: 1em; display: inline-block; white-space: nowrap; unicode-bidi: isolate; visibility: hidden; opacity: 0; transition: visibility 0s ease 0s, opacity 0.5s linear 0s;"><span class="mw-editsection-bracket" style="box-sizing: inherit; margin-right: 0.25em; color: rgb(84, 89, 93);"></span><span class="mw-editsection-divider" style="box-sizing: inherit; color: rgb(84, 89, 93);"></span><span class="mw-editsection-bracket" style="box-sizing: inherit; margin-left: 0.25em; color: rgb(84, 89, 93);"></span></span><span class="mw-editsection" style="box-sizing: inherit; user-select: none; font-size: 12px; font-weight: normal; margin-left: 1em; vertical-align: baseline; line-height: 1em; display: inline-block; white-space: nowrap; unicode-bidi: isolate; visibility: hidden; opacity: 0; transition: visibility 0s ease 0s, opacity 0.5s linear 0s;"><span class="mw-editsection-bracket" style="box-sizing: inherit; margin-right: 0.25em; color: rgb(84, 89, 93);"></span><span class="mw-editsection-divider" style="box-sizing: inherit; color: rgb(84, 89, 93);"></span><span class="mw-editsection-bracket" style="box-sizing: inherit; margin-left: 0.25em; color: rgb(84, 89, 93);"></span></span><span class="mw-editsection" style="box-sizing: inherit; user-select: none; font-size: 12px; font-weight: normal; margin-left: 1em; vertical-align: baseline; line-height: 1em; display: inline-block; white-space: nowrap; unicode-bidi: isolate; visibility: hidden; opacity: 0; transition: visibility 0s ease 0s, opacity 0.5s linear 0s;"><span class="mw-editsection-bracket" style="box-sizing: inherit; margin-right: 0.25em; color: rgb(84, 89, 93);"></span><span class="mw-editsection-divider" style="box-sizing: inherit; color: rgb(84, 89, 93);"></span><span class="mw-editsection-bracket" style="box-sizing: inherit; margin-left: 0.25em; color: rgb(84, 89, 93);"></span></span><span id="Abklärung_akuter_HIV-Infektion" style="box-sizing: inherit;"></span><span class="mw-editsection" style="box-sizing: inherit; user-select: none; font-size: 12px; font-weight: normal; margin-left: 1em; vertical-align: baseline; line-height: 1em; display: inline-block; white-space: nowrap; unicode-bidi: isolate; visibility: hidden; opacity: 0; transition: visibility 0s ease 0s, opacity 0.5s linear 0s;"><span class="mw-editsection-bracket" style="box-sizing: inherit; margin-right: 0.25em; color: rgb(84, 89, 93);"></span><span class="mw-editsection-divider" style="box-sizing: inherit; color: rgb(84, 89, 93);"></span><span class="mw-editsection-bracket" style="box-sizing: inherit; margin-left: 0.25em; color: rgb(84, 89, 93);"></span></span><br />
| |
