12_infecciones e infestaciones en ginecologia - mgo.pdf

7/22/2019 12_INFECCIONES E INFESTACIONES EN GINECOLOGIA - MGO.pdf

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LEHGCCL@EGS G LEHGS[NCL@EGS GE DLEGC@B@DN

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LEHGCCL@EGS G LEHGS[NCL@EGS GE DLEGC@B@DN

Nspgct`s gsgeclnbgs

Bn cnusn is hrgcugetg kg lehgcclègs vubv`vndlenbgs gs bn Dnrkegrgbbnvndlenbls. Sle gionrd`, bn Cneklkngs bn qug is setìns pr`kucg.

Bn lehgccle p`r Dnrkegrgbbn pr`kucg ue hbuj` inb`blgetg drlscg`, pgr` slegionrd` gs p`c` anoltunb qug pr`kuzcn prurlt`. Gb klndestlc` kg bn vndle`slsonctgrlnen sg pugkg ancgr igklnetg bn prugon kg bns nilens, qug sgr p`sltlvn, yp`r vlsunblzncle kg bns cbug-cgbbs.

Ge gb trntnilget`, sg pugkg utlblznr igtrèlknz`b tplc` cì` hrinc` kg bgccle

` cbleknilclen tplcn. Gs òbldnk` gb trntnilget` kg t`kns bns dgstnetgs p`r gbrlgsd` kg pnrt` prgtrile`. E` gs egcgsnrl` gb trntnilget` kg bn pnrgjn kg h`rinrutlenrln, nuequg sl gst rgcìgeknk` ge cns`s kg rgclklvn.

Bn lehgccle p`r Cneklkn pr`kucg prurlt` ns`clnk` n bguc`rrgn obnc`-ninrlbbgetndrui`sn y vlsc`sn. Sè hnct`rgs kg rlgsd`: gionrnz`, netlcècgpcle a`riènb,klnogtgs, c`rtlc`lkgs ` netloltlc`s kg nipbl` gspgctr`.

Gb klndestlc` sg rgnblznr igklnetg gb cubtlv`, sl olge ue knt` qug pgriltgklhgrgeclnr bn lehgccle p`r Cneklknkg `trnsvubv`vndleltls gs gb agca` kg qug gbpA vndlenb e` sg i`klhlcn (2;.7).

Gb trntnilget` kg gbgccle cèslstg ge pnutnr kgrlvnk`s lilknzblc`s p`r vnvndlenb (cb`trlinz`b), ncèsgjek`sg gb trntnilget` p`r vn `rnb ge cns`srgcurrgetgs. Bn pnrgjn sg trntnr sl prgsgetn setìns.

Bn lehgccle p`r tr`cìèlnsls sugbg sgr nsletìtlcn. Bn bguc`rrgn gsnoueknetg, inb`blgetg y gspui`sn. Ge `cnslègs gs p`slobg qug sg vlsunblcgeagi`rrndlns puetlh`rigs ge gb crvlx.

Gb klndestlc` sg rgnblzn p`r vlsunblzncle kgb pnrslt` ge hrgsc`. Gb trntnilget` kggbgccle gs igtrèlknz`b vn `rnb.

B`s hnct`rgs hnv`rgcgk`rgs kg bn lehgccle p`r pnplbìnvlrus (A]X) sè bnprìlsculknk sgxunb, bn leiue`suprgsle, b`s c`rtlc`lkgs, bn dgstncle y gbtnonqulsi`. A`y sg cè`cg qug gst lehgccle gs ue cbnr` hnct`r kg rlgsd` kgnpnrlcle kg bgslègs prginbldens y cnrcleìn kg crvlx.


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Kghlelcle y cècgpt`s

Bns i`bgstlns vubv`vndlenbgs sè ue i`tlv` kg cèsubtn iuy hrgcugetg p`r bn gbgvnkn leclkgecln kg

bns lehgcclègs dlegc`bdlcns ge vndlen y ge vubvn.Bn vndlen gs ue cèkuct` cnrgetg kg dbekubns pr`plns qug gst tnplznk` p`r gpltgbl` pbne`p`blgstrntlhlcnk`. Gb hbuj` vndlenb e`rinb gs obnec`, e` aì`deg` g le`k`r`. ]r`vlgeg kgb krgenjg gebn vndlen kg klhgrgetgs dbekubns (dbekubns vgstloubnrgs, dbekubns kg Onrta`ble`, kgb crvlx, kgbgekìgtrl` y kgb gek`sbplex), kgb bqulk` trnsuknk` kg bn pnrgk vndlenb y kg cbubns vndlenbgskgscninkns. Bns a`rièns sgxunbgs (gstrdge`s y pr`dgstgrèn) lehbuyge ge bns cnrnctgrstlcns gebn sgcrgcle y hb`rn vndlenbgs.

Bn vndlen ge cèklclègs e`rinbgs tlgeg ue igkl` clk`. Gb onclb` kg Kkgrbgle gs gb rgspèsnobg kgnclklhlcnr gb igkl` pugst` qug pr`kucg clk` bctlc` anclgek` qug gb pA sgn kg ; ge bn iujgr ge gknk

hrtlb. Ge bn kghlclgecln kg gstrdge`s (p. gj.: ge bn ige`pnusln), gb pA sugbg sgr supgrl`r n 8. Bn hb`rnvndlenb e`rinb gst cèstltulkn p`r ilcr``rdnelsi`s ngròl`s y nengròl`s. Ge gbbn gs p`slobggecètrnr ilcr``rdnelsi`s qug sè pntdge`s onj` clrcuestneclns cì` G. c`bl, Onctgr`lkgs hrndlbls,S. ngrgus, Strgpt`c`ccuskgb drup` O y gspgclgs kg Cneklkn.

Ge b`s kns pgrl`vubnt`rl`s kg bn iujgr ge gknk hrtlb, ge bn pogr y ge bn p`stige`puslcn, gb pAnsclgekg, pgriltlgek` bn degsls kg bns lehgcclègs vndlenbgs drnvgs.

Sg cèslkgrn n pnrtg bn onrta`bleltls, cuyn cnusn is hrgcugetg gs bn òstruccle kgb cnenb gxcrgt`rkg bn dbekubn, slgek` bn lehgccle cnusnkn p`r bn hb`rn b`cnb. Nuequg ge ue prleclpl` gs p`slobg ancgrue trntnilget` iklc` cè hbùrqule`bèns ` cghnb`sp`rlens is igtrèlknz`b, cè hrgcugecln

rgqulgrg trntnilget` qulrrdlc`, qug pugkg cèslstlr ge inrsuplnblzncle kg bn dbekubn: sg suturn bnpnrgk kgb qulstg n bn pnrgk vgstloubnr, ` olge sg pugkg rgnblznr leclsle y krgenjg slipbg kg bndbekubn. Sg prnctlcnr bn gxrgsls dbnekubnr t`tnb ge cns` kg rgclklvns.

Gtl`b`dn

Is kgb 7-?=%): Gs cèslkgrnkn uen lehgccle kg trnesilsle sgxunb (L[S).

Gb >=% rgstnetg lecbuyge: vndleltls p`r cugrp` gxtrn`, vndleltls ntrhlcn, Cabniyklns, dè`c`c`s,ilc`pbnsins, agrpgs dgeltnb, pnrslt`s (`xlur`s ge elns), vndleltls nbrdlcns, getrg `trns). Sl gxlstgeubcgrncle vubvnr, sg kgog pgesnr ge: shlbls, agrpgs, canecr`lkg, bleh`drneubìn vgerg`, drneubìnledulenb, sòrglehgccle kg cèklbìn, i`bbuscui cètndl`sui, snren, trnuintlsi`, eg`pbnsln,grltgin iubtlh`rig ` sekrìg kg Ogagt.


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Dnrkegrgbbn vndlenbls(vndle`sls onctgrlnen)

Gs egcgsnrl` rgc`rknr qug gs bn lehgccle vndlenb is prgkìlenetg ge iujgrgs ge gknkrgpr`kuctlvn kg pnsgs kgsnrr`bbnk`s. _gsubtn kg bn sustltucle kg bn hb`rn vndlenb snpr`hltn e`rinbp`r nbtns cècgetrnclègs kg Dnrkegrgbbn vndlenbls, Ilc`pbnsin aìlelsy onctgrlns nengròlns.

Cbelcn

Npr`xlinknigetg ue 7=-4=% kg bns iujgrgs cè uen vndle`sls gste nsletìtlcns. Gb rgst` rghlgrgue nuiget` kg hbuj`, kgb c`b`r obnec`-drlscg`, y, ge `cnslègs, inb`blgetg. E` sg ns`clne slde`slehbnint`rl`s kg gkgin ` grltgin vubvnr. E` sg trntn kg uen lehgccle kg trnesilsle sgxunb. Sèhnct`rgs kg rlgsd` bn dgstncle prgvln y gb us` kgb KLW.

Klndestlc`

Gb pA vndlenb gs 5 ;.7. ]rugon kg nilens: ]`sltlvn. Cèslstg ge nnklr ge ue p`rtnòjgt`s cè uen iugstrn kg

hbuj` vndlenb uen d`tn kg alkrxlk` p`tslc` nb >=%. Leigklntnigetg sg pr`kucg bnblogrncle kg nilens qug cèbbgvn n bn npnrlcle kg `b`r htlk`.

Hr`tls cè tlecle kg Drni: ]rgsgecln kg bns cbug cgbbs (hljncle kg c`cònclb`s ge bnsupgrhlclg kg bns cbubns vndlenbgs).

[rntnilget`

Bn lip`rtnecln kg bn vndle`sls onctgrlnen sg kgog n bns cìpblcnclègs cè bns qug sg rgbnclèn. Gegb gionrnz` pugkg gstnr rgbnclènkn cè gb pnrt` prgtrile`, bn r`turn kg igiornens y bngekìgtrltls p`stpnrt` ` p`stno`rt`. Ge iujgrgs e` dgstnetgs gs p`slobg qug pr`kuzcn uelecrgiget` ge gb rlgsd` kg pnkgcgr uen gehgrigknk lehbnint`rln pbvlcn (GL]) y `trns lehgcclègs,prleclpnbigetg kg trnesilsle sgxunb, lecbulk` gb XLA.

Gstnr leklcnk` trntnr n bns iujgrgs sletìtlcns, n bns dgstnetgs y n bns iujgrgs nsletìtlcns slvne n sgr sìgtlkns n letgrvgeclègs dlegc`bdlcns. E` gs egcgsnrl` trntnr n bn pnrgjn kg inegrnrutlenrln pgr` sl ge cns`s kg rgclklvn.

Gxlstge vnrlns pnutns:

Kg prligrn gbgccle:` Igtrèlknz`b p`r vn vndlenb clec` kns.` Cbleknilclen ge dgb slgtg kns.` Igtrèlknz`b vn `rnb slgtg kns.

Cì` nbtgrentlvn:` Igtrèlknz`b `rnb iè`k`sls.


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` Cbleknilclen `rnb slgtg kns.` Cbleknilclen vub`s trgs kns.

Cneklklnsls

Cbelcn

Ge gb 1=-


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IKWB@ DLEGC@B@DN \ @OS[G[_LCLN | LEHGCCL@EGS G LEHGS[NCL@EGS GE DLEGC@B@DN '

(tniole b`cnb) (tniole `rnb) `cbleknilclen

Lehgcclègs vlrnbgs

Lehgccle p`r pnplbìnvlrus (A]X)

Sg trntn kg ue ]np`vlrlkng, qug gs ue KEN-vlrus, kgb cunb sg rgcè`cge is kg >7= tlp`s vlrnbgs. Gbcètndl` p`r X]A sg pr`kucg p`r ilcr`trnuintlsi`s n trnvs kgb c`lt` cè uen pgrsèn lehgctnkn,p`r gb cnenb kgb pnrt`, ` p`r igkl` kg hiltgs, cè ue pgrl`k` kg lecuoncle kg getrg k`s y trgsigsgs kg prìgkl` (`sclbnek` kg ue` n `ca` igsgs). Cèstltuyg bn L[S is cìe, slgek` bnprgvnbgecln kg ue >=.;% kg igkln ge iujgrgs nsletìtlcns, cè clhrns is nbtns (??%) ge iujgrgsjvgegs (?= n`s)6 ge vnrègs bn prgvnbgecln gs ige`r, cè vnb`rgs ixli`s ge bn cunrtn kcnkn kg

bn vlkn. Eugvg igsgs kgspus kg bn rgspugstn leiueltnrln pugkg pr`kuclrsg olge uen rgilsle òlge uen lehgccle pgrslstgetg. Sg gstlin qug sb` ue >% kg b`s p`rtnk`rgs kg A]X tlgege lehgcclecbelcn. B`s hnct`rgs hnv`rgcgk`rgs kg klcan lehgccle sè bn prìlsculknk sgxunb, bnleiue`suprgsle (tnet` p`r qulil`tgrnpln cì` p`r A]X), b`s cnrtlc`lkgs, bn dgstncle y gb tnonc`.

B`s klstlet`s tlp`s vlrnbgs sg klvlkge ge k`s drup`s: Onj` rlgsd` èc`bdlc` (b`s is hrgcugetgs sèb`s tlp`s 8 y >>) y kg nbt` rlgsd` èc`bdlc` (b`s is anoltunbgs sè b`s tlp`s >8 y >1, qug npnrgcgege gb 4=% kg b`s cnrcleìns kg crvlx). Sg an kgi`strnk` qug ge gb 1, 3>, 33, 37, 3, 7?, 78, 71, 7>, ;=, ;?, ;3, ;;, 7;, 8>, 4=, 4?, 1>

Bn kgtgccle kg A]X-N_ gs tlb ge b`s sldulgetgs cns`s:

]rgvgecle sgcueknrln ge cìolencle cè bn clt`b`dn ` cì` prugon elcn pnrn bnkgtgccle kg bgslègs prgcnecgr`sns kgb cecgr kg cugbb`.

Sgbgccle kg bns iujgrgs cè clt`b`dns qug prgsgetne nbtgrnclègs ige`rgs qugrgqulgrge rggvnbuncle pnrn klndestlc` y gvgetunb trntnilget`.


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Cbelcn

Gs p`slobg gecètrnr vnrl`s tlp`s kg lehgccle y kg bgslègs:

Lehgccle bntgetg:KEN vlrnb p`sltlv` sle elede tlp` kg bgsle clt`-alst`bdlcn. Lehgccle suocbelcn: Bgslègs c`bp`scplcns ncgtòbnecns (bguc`pbnsln) y klspbnsln. Lehgccle cbelcn: Bns vgrrudns ` b`s cèklbìns dgeltnbgs sè bns bgslègs is

hrgcugetgs kgb npnrnt` dgeltnb gxtgre`. Cèslstge ge bgslègs gx`htlcns vubvnrgs ypgrlnenbgs prurldle`sns kg cèslstgecln obnekn y kg c`b`rncle drlscgn ` r`snkn. B`sdge`tlp`s is hrgcugetgs lipblcnk`s sè A]X-8 y A]X->>.

Klndestlc`

N slipbg vlstn sg òsgrvne bns tplcns bgslègs cgrgorlh`rigs (cèklbìns). Ge bn clt`b`dn sg

gecugetrne c`lb`clt`s (cbubn gpltgblnb cè ecbg` gedr`snk`, alpgrcrìtlc` y anb` ` vncu`blznclepgrleucbgnr). Cè c`bp`sc`pln sg nprgclne zèns kg bguc`pbnsln trns bn npblcncle kg clk` nctlc`,bns cunbgs sg kgoge ol`pslnr. Gs p`slobg rgnblznr gb gstukl` vlr`bdlc` ge c`rtgs tlsubnrgs (]C_ àlorlkncle le sltu) sòrg gxtgeslègs clt`bdlcns (]C_, alorlkncle le sltu ` cnpturn kg aorlk`s).

[rntnilget`

Gb trntnilget` kg b`s cèklbìns kgpgekg kg su b`cnblzncle y kg su gxtgesle, slgek` suòjgtlv` cnsl slgiprg gsttlc` yn qug bn lehgccle pgrinegcgr bntgetg.

[rntnilget` iklc`:` clk` trlcb`r`nctlc` n cècgetrnclègs kgb 17% ge npblcncle sginenb. _gilslègs

kgb 3=%. Gs gb trntnilget` iklc` kg gbgccle ge gionrnznkns.` ]`k`hlb`t`xlen nb =.7%: [rgs npblcnclègs sginenbgs kurnetg sgls sginens.

_gilslègs kgb 4=%.` Lilquli`k nb 7%: [rgs npblcnclègs sginenbgs ue ixli` kg >8 sginens.

_gilslègs kgb 8=-4=%.` 7-hbu`rnclb`.

[rntnilget` qulrrdlc`: Gxtlrpncle qulrrdlcn, gbgctr`klntgriln, crl`tgrnpln, bsgr kgC@?.

]r`hlbnxls

Nctunbigetg any cìgrclnblznkns k`s vncuens (olvnbgetg y tgtrnvnbgetg) pnrn prgvgelr bn lehgcclep`r A]X, cìpugstns p`r pnrtcubns slilbnrgs nb vlrus (XB], vlrus-blfg-pnrtlcbg), pr`kuclkns igklnetgcbèncle kgb dge prleclpnb kg bn cpslkg vlrnb (B>) kg b`s klstlet`s tlp`s kg X]A6 p`r tnet`, gstnsvncuens e` sè lehgccl`sns el èc`delcns, knk` qug e` p`sgg NKE. Bn vncuen olvnbgetg cèhlgrgpr`tgccle hrgetg n b`s tlp`s >8 y >1, p`r cèsldulgetg gst kgstlenkn n rgkuclr bns klspbnslns y b`scecgrgs kg crvlx pr`v`cnk`s p`r gst`s tlp`s, e` pr`tgdlgek` hrgetg n cèklbìns. Bn vncuentgtrnvnbgetg cèhlgrg pr`tgccle hrgetg n b`s tlp`s 8, >>, >8 y >1, p`r b` qug pr`tgdg hrgetg n b`scèklbìns, nkgis hrgetg n bns klspbnslns y cecgrgs kg crvlx p`r klca`s tlp`s.


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IKWB@ DLEGC@B@DN \ @OS[G[_LCLN | LEHGCCL@EGS G LEHGS[NCL@EGS GE DLEGC@B@DN )

Bns vncuens ane kgi`strnk` sgr sgdurns, leiuedgens y iuy ghlcncgs pnrn bn prgvgecle kg bnlehgccle, kgb CLE ?/3 y kgb nkge`cnrcleìn le sltu pr`kuclk`s p`r b`s tlp`s vlrnbgs lecbulk`s ge bnvncuen6 tniole sgrne ghlcncgs pnrn bn prgvgecle kg vgrrudns dgeltnbgs y `trns bgslègs dgeltnbgsgxtgrens cì` gb XNLE y gb XLE.

Bn rgkuccle kgb lipnct` kgb cecgr kg crvlx ge bn pòbncle vncuenkn e` sg vgr anstn kg ?=-3=n`s, kgolk` nb pgrl`k` kg lecuoncle tne bnrd` kg gstn pnt`b`dn. E` òstnetg, e` pugkg kgtgegrsggb crlonk` kg bgslègs prgcnecgr`sns nb letr`kuclr gstn vncuen, knk` qug e` pr`tgdg hrgetg n t`k`sb`s tlp`s kg X]A nuequg sl p`krn cniolnr bns gstrntgdlns kg scrggeled kgb cecgr kg crvlx, slgek`bn prugon cbnvg bn kgtgccle kg X]A, ge budnr kg bn clt`b`dn cgrvlc`vndlenb, anstn na`rn, qugknek`rgbgdnkn gstn btlin n pnclgetgs cè A]X +.

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12_infecciones e infestaciones en ginecologia - mgo.pdf

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