¶·È‰È·ÙÚÈ΋ B√ƒ∂ÿ√À ∂§§Õ¢√˜, 13: 109 - 123, 2001

∞¡∞™∫√¶∏™∏

¶ÚfiÏË„Ë Î·È ·ÓÙÈÌÂÙÒÈÛË ÏÔÈÌÒ͈Ó

Ô˘ ÌÂÙ·‰›‰ÔÓÙ·È Î¿ıÂÙ· ·fi ÙË ÌËÙ¤Ú· ÛÙÔ ·È‰›

μ. ¢ÚfiÛo˘-∞Á·Î›‰o˘

∞ã ¡ÂoÁÓoÏoÁÈ΋ ∫ÏÈÓÈ΋ ∞¶£, πoÎÚ¿ÙÂÈo °¶¡, £ÂÛÛ·ÏoÓ›ÎË

¶ÂÚ›ÏË„Ë. OÈ ¿ÍoÓ˜ Á‡Úˆ ·fi Ùo˘˜ oo›o˘˜ ÛÙÚ¤ÊÂÙ·È Ë ÚoÛ¿ıÂÈ· ÚfiÏ˄˘ Ù˘ οıÂÙ˘ ÌÂÙ¿‰oÛ˘ ÏoÈ-
ÌÒÍÂˆÓ ·fi ÙË ÌËÙ¤Ú· ÛÙo ·ËÌ· Î·È Ùo ÓÂoÁÓfi Â›Ó·È : ·) ∏ ÚˆÙoÁÂÓ‹˜ ÚfiÏË„Ë o˘ ·oÛÎo› ÛÙËÓ Úfi-
ÏË„Ë Ù˘ ÓfiÛo˘ ÛÙË ÌËÙ¤Ú· Î·È ÂÚÈÏ·Ì‚¿ÓÂÈ ÁÂÓÈο ̤ÙÚ· Î·È ÙËÓ ÂÓÂÚÁËÙÈ΋ ·ÓoÛoo›ËÛË ‚ÚÂÊÒÓ, ·È-
‰ÈÒÓ Î·È Â›ÓoÛˆÓ ÌË ÂÁ·ˆÓ Á˘Ó·ÈÎÒÓ ·Ó··Ú·ÁˆÁÈ΋˜ ËÏÈΛ·˜. ‚) ∏ ‰Â˘ÙÂÚoÁÂÓ‹˜ ÚfiÏË„Ë o˘ ·oÛÎo-
› ÛÙËÓ ÚfiÏË„Ë Ù˘ ÌÂÙ¿‰oÛ˘ Ïo›ÌˆÍ˘ ·fi ÌËÙ¤Ú·, o˘ ÂÎÙ¤ıËΠÛÙË ÓfiÛo ‹ ÓoÛ›, ÛÙo ·ËÌ· ‹ ÓÂoÁÓfi
Î·È ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ·ıËÙÈ΋ ·ÓoÛoo›ËÛË Ù˘ ÂÁ·o˘, ÙËÓ ¤ÁηÈÚË ‰È¿ÁÓˆÛË Î·È ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÏoÈ-
ÌÒÍÂˆÓ ÛÙËÓ ¤Á΢o, ÙËÓ ÂÈÏoÁ‹ Ùo˘ ηٿÏÏËÏo˘ ÙÚfio˘ Î·È ¯ÚfiÓo˘ ÙoÎÂÙo‡ Î·È ÙË Ï‹„Ë ÚoÏËÙÈÎÒÓ Ì¤-
ÙÚˆÓ ÛÙo ÓÂoÁ¤ÓÓËÙo. Á) ∏ ÙÚÈÙoÁÂÓ‹˜ ÚfiÏË„Ë o˘ Û˘ÌÂÚÈÏ·Ì‚¿ÓÂÈ Ù· ̤ÙÚ· ·ÓÙÈÌÂÙÒÈÛ˘ Ù˘ ÓfiÛo˘ ÛÙo
ÓÂoÁ¤ÓÓËÙo Î·È ·oÛÎo› ÛÙËÓ ÂÏ·¯ÈÛÙoo›ËÛË ÙˆÓ Û˘ÓÂÂÈÒÓ ÛÙo ·ËÌ· Î·È ÓÂoÁÓfi Î·È ÙË ‚ÂÏÙ›ˆÛË Ù˘
·ÒÙÂÚ˘ ÚfiÁÓˆÛ˘.
§¤ÍÂȘ-ÎÏÂȉȿ: Û˘ÁÁÂÓ›˜ ÏoÈÌÒÍÂȘ, ÂÚÈÁÂÓÓËÙÈΤ˜ ÏoÈÌÒÍÂȘ, ÓÂoÁÓfi, ÚfiˆÚo, ·ËÛË

Drossou-Agakidou V. Prevention and treatment of vertically transmitted infections. Dept of

Neonatology, Aristotle University of Thessaloniki. Paediatr N Gr 2001, 13: 109 - 123.
Measures for prevention of vertically transmitted infections include: a) general preventive measures and
active immunization of infants, children and non pregnant women of reproductive age aiming to prevent
infections of the pregnant women (primary prevention), b) prevention of transmission of the infections from
the exposed to the agent or infected mother to the fetus and the neonate through passive immunization of
the mother, early diagnosis and treatment of the infection in the mother, selection of the most proper way
and time of delivery and postnatal prevention (secondary prevention), and c) postnatal treatment of
infections to reduce or avoid symptoms and consequences in the infant (tertiary prevention).

Key words: neonatal infections, perinatal infections, neonate, premature, pregnancy

¶ÚoÛ‚oÏ‹ Ùo˘ ÂÌ‚Ú‡o˘ ‹ ΢‹Ì·Ùo˜ ÌoÚ› Ó·
ÚoÎÏËı› ÌÂÙ¿ ·fi Ïo›ÌˆÍË Ù˘ ÌËÙ¤Ú·˜ Û’ fiÏo
Ùo ¯ÚoÓÈÎfi ‰È¿ÛÙËÌ· ·fi ÙË Û‡ÏÏË„Ë, ‹ Î·È ÚÈÓ
·’ ·˘Ù‹Ó, ̤¯ÚÈ Î·È ÙËÓ ÂÚÈÁÂÓÓËÙÈ΋ ÂÚ›o‰o.
¶ÂÚÈÁÚ¿ÊÂÙ·È ¤Ó· Â˘Ú‡Ù·Ùo Ê¿ÛÌ· ÂΉËÏÒÛˆÓ
Ù˘ ÂÓ‰oÌ‹ÙÚÈ·˜ ÚoÛ‚oÏ‹˜ Ùo˘ ΢‹Ì·Ùo˜, o˘
oÈΛÏÏÂÈ ·fi ÂÓ‰oÌ‹ÙÚÈo ı¿Ó·Ùo ̤¯ÚÈ ·Û˘ÌÙˆ-
Ì·ÙÈ΋ Ïo›ÌˆÍË. ™ËÌ·ÓÙÈÎfi oÛoÛÙfi ·fi Ù· ‚Ú¤-
ÊË o˘ ÂÈ˙o‡Ó ÂÌÊ·Ó›˙ÂÈ Ì·ÎÚo¯ÚfiÓÈ· Úo‚Ï‹-
Ì·Ù·, ·ÎfiÌË ÎÈ’ ·Ó ‹Ù·Ó ·Û˘Ìو̷ÙÈο ÛÙË Á¤Ó-
ÓËÛË. ∏ ¤ÁηÈÚË Ï‹„Ë Ì¤ÙÚˆÓ ÚfiÏ˄˘ Î·È ·ÓÙÈ-
ÌÂÙÒÈÛ˘ ÌoÚ› Ó· ·oÙÚ¤„ÂÈ ÙËÓ Î¿ıÂÙË ÌÂÙ¿-
‰oÛË Ù˘ Ïo›ÌˆÍ˘ ‹ Ó· ÂÏ·¯ÈÛÙooÈ‹ÛÂÈ ÙȘ Û˘Ó¤-
ÂȘ ÛÙo ·ËÌ· Î·È ÓÂoÁÓfi1.
OÈ ¿ÍoÓ˜ Á‡Úˆ ·fi Ùo˘˜ oo›o˘˜ ÛÙÚ¤ÊÂÙ·È
Ë ÚoÛ¿ıÂÈ· ÚfiÏ˄˘ ÙˆÓ ÂÓ‰oÌ‹ÙÚÈˆÓ Î·È Â-
ÚÈÁÂÓÓËÙÈÎÒÓ ÏoÈÌÒÍÂˆÓ Â›Ó·È: ·) ∏ ÚˆÙoÁÂÓ‹˜
ÚfiÏË„Ë o˘ ÂÚÈÏ·Ì‚¿ÓÂÈ Ù· ̤ÙÚ· ÚfiÏ˄˘

109
110 ¶·È‰È·ÙÚÈ΋ B√ƒ∂ÿ√À ∂§§Õ¢√˜, 13, 2
Ù˘ ÓfiÛo˘ ÛÙË ÌËÙ¤Ú·. ‚) ∏ ‰Â˘ÙÂÚoÁÂÓ‹˜ ÚfiÏË-
„Ë o˘ ·oÛÎo› ÛÙËÓ ÚfiÏË„Ë Ù˘ ÌÂÙ¿‰oÛ˘
Ïo›ÌˆÍ˘ ·fi ÌËÙ¤Ú·, o˘ ¤¯ÂÈ ÂÎÙÂı› ÛÙË Ïo›Ìˆ-
ÍË ‹ ÓoÛ›, ÛÙo ·ËÌ· ‹ ÓÂoÁÓfi. Á) ∏ ÙÚÈÙoÁÂÓ‹˜
ÚfiÏË„Ë o˘ ÛÙo¯Â‡ÂÈ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ Ófi-
Ûo˘ ÛÙo ÓÂoÁ¤ÓÓËÙo ÒÛÙ ӷ ÚoÏËÊı› Ë ÂÌÊ¿ÓÈ-
ÛË Û˘ÌÙˆÌ¿ÙˆÓ Î·È ÌfiÓÈÌˆÓ ·Ó·ËÚÈÒÓ1-4.
O Ì·ÈÂ˘Ù‹Ú·˜ ¤¯ÂÈ ÛËÌ·ÓÙÈÎfi ÚfiÏo ȉȷ›ÙÂÚ·
ÛÙË ‰Â˘ÙÂÚoÁÂÓ‹ ÚfiÏË„Ë Î·È Ë ÛÙÂÓ‹ Û˘ÓÂÚÁ·Û›·
Ùo˘ Ì ÙoÓ ·È‰›·ÙÚo Â›Ó·È ··Ú·›ÙËÙË ÁÈ· Ó· ÂÍ·-
ÛÊ·ÏÈÛÙ› Ë Î·Ï‡ÙÂÚË ‰˘Ó·Ù‹ ÊÚoÓÙ›‰· ÛÙË ÌËÙ¤-
Ú· Î·È Ùo ·È‰›.
∞. ¶ÚˆÙoÁÂÓ‹˜ ÚfiÏË„Ë Û˘ÁÁÂÓÒÓ
ÏoÈÌÒ͈Ó
∏ ÛÙÚ·ÙËÁÈ΋ ÚfiÏ˄˘ ÙˆÓ ÏoÈÌÒÍÂˆÓ ÛÙË
ÌËÙ¤Ú· ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ÂÓÂÚÁËÙÈ΋ ·ÓoÛoo›Ë-
ÛË Î·È ÙË Ï‹„Ë ÁÂÓÈÎÒÓ Ì¤ÙÚˆÓ.
∂ÓÂÚÁËÙÈ΋ ·ÓoÛoo›ËÛË
°È· oÚÈṲ̂Ó˜ ÏoÈÌÒÍÂȘ, fiˆ˜ Â›Ó·È Ë ÂÚ˘ıÚ¿,
ÈÏ·Ú¿ Î·È Ë ·ÓÂÌ¢ÏoÁÈ¿, Ë ÂÓÂÚÁËÙÈ΋ ·ÓoÛoo›Ë-
ÛË ·oÙÂÏ› ÙoÓ ÌoÓ·‰ÈÎfi ÙÚfio ÚfiÏ˄˘ Ù˘ Û˘Á-
ÁÂÓo‡˜ Ïo›ÌˆÍ˘3. ∏ ÂÊ·ÚÌoÁ‹ Ù˘ ·Ú¯›˙ÂÈ oχ
ÚÈÓ ·fi ÙËÓ Î‡ËÛË Ì Ùo˘˜ Ù·ÎÙÈÎo‡˜ ÂÌ‚oÏÈ·-
ÛÌo‡˜ ÙˆÓ ‚ÚÂÊÒÓ Î·È ·È‰ÈÒÓ ·ÏÏ¿ Î·È ÙˆÓ Â›Óo-
ÛˆÓ ÌË ÂÁ·ˆÓ Á˘Ó·ÈÎÒÓ ·Ó··Ú·ÁˆÁÈ΋˜ ËÏÈΛ·˜,
ÒÛÙ ӷ Â›Ó·È ¿ÓoÛ˜ ÛÙË ‰È¿ÚÎÂÈ· Ù˘ ·ËÛ˘.
™ÙË ‰È¿ÚÎÂÈ· Ù˘ ·ËÛ˘ ˘¿Ú¯o˘Ó ÂÏ¿¯ÈÛÙ˜
ÂӉ›ÍÂȘ ÂÓÂÚÁËÙÈ΋˜ ·ÓoÛoo›ËÛ˘, fiˆ˜ Â›Ó·È o
ÂÌ‚oÏÈ·ÛÌfi˜ ÂÓ·ÓÙ›oÓ Ùo˘ ÙÂÙ¿Óo˘ Î·È Ù˘ Ë·Ù›ÙÈ-
‰·˜ μ Û Â›ÓoÛ˜ ¤ÁÎ˘Â˜ o˘ ·Ó‹Îo˘Ó Û oÌ¿‰Â˜
˘„ËÏo‡ ÎÈÓ‰‡Óo˘3. °ÂÓÈο, ηٿ ÙËÓ Î‡ËÛË ÂÈÙÚ¤-
ÂÙ·È Ë ¯oÚ‹ÁËÛË ÂÌ‚oÏ›ˆÓ ·fi ÓÂÎÚ¿ ÛÙÂϤ¯Ë ÌÈ-
ÎÚooÚÁ·ÓÈÛÌÒÓ (.¯. ÙÂÙ¿Óo˘, ÁÚ›˘) Î·È ÂÌ‚o-
Ï›ˆÓ o˘ ·Ú·Û΢¿˙oÓÙ·È Ì ÙËÓ Ù¯ÓÈ΋ Ùo˘
·Ó·Û˘Ó‰˘·Ṳ̂Óo˘ DNA (.¯. Ë·Ù›Ùȉ·˜ μ). ∞ÓÙ›-
ıÂÙ·, ··ÁoÚ‡ÂÙ·È Ë ¯oÚ‹ÁËÛË ÂÌ‚oÏ›ˆÓ ·fi ˙ˆ-
ÓÙ·Óo‡˜ ÂÍ·ÛıÂÓË̤Óo˘˜ Èo‡˜, fiˆ˜ Ù˘ ÂÚ˘ıÚ¿˜,
ÈÏ·Ú¿˜, ·ÚˆÙ›Ùȉ·˜ Î·È ·ÓÂÌ¢ÏoÁÈ¿˜, ÂÂȉ‹ Ù·
ÂÍ·ÛıÂÓË̤ӷ ÛÙÂϤ¯Ë ÙˆÓ ÈÒÓ ÙˆÓ ÂÌ‚oÏ›ˆÓ ÂÚ-
Óo‡Ó ÙoÓ Ï·Îo‡ÓÙ· Î·È ıˆÚËÙÈο o ΛӉ˘Óo˜
Û˘ÁÁÂÓo‡˜ Ïo›ÌˆÍ˘ ‰ÂÓ ÌoÚ› Ó· ·oÎÏÂÈÛÙ›5.
°ÂÓÈο ̤ÙÚ· ηٿ ÙËÓ Î‡ËÛË
™ÙË ‰È¿ÚÎÂÈ· Ù˘ ·ËÛ˘ fiϘ oÈ Á˘Ó·›Î˜ Ú¤-
ÂÈ Ó· Â›Ó·È È‰È·›ÙÂÚ· ÚoÛÂÎÙÈΤ˜ ÛÙË Ï‹„Ë Ì¤-
ÙÚˆÓ ·ÙoÌÈ΋˜ ˘ÁÈÂÈÓ‹˜ Î·È ÛÙËÓ Â·Ê‹ Ì Èı·Óo‡˜
¿Û¯oÓÙ˜ ·fi ÏoÈÌÒ‰Ë ÓoÛ‹Ì·Ù·. øÛÙfiÛo, ȉȷ›-
ÙÂÚË ÚoÛo¯‹ ··ÈÙÂ›Ù·È ÁÈ· ÙȘ ¤ÁÎ˘Â˜ o˘ ·Ó‹-
Îo˘Ó Û oÌ¿‰Â˜ ˘„ËÏo‡ ÎÈÓ‰‡Óo˘, fiˆ˜ ›ӷÈ6-10:
1. ∂ÚÁ·˙fiÌÂÓ˜ Û ‚ÚÂÊoÓËÈ·Îo‡˜ ÛÙ·ıÌo‡˜,
fio˘ Ë Â›ÙˆÛË Ù˘ Ïo›ÌˆÍ˘ ·fi ΢ÙÙ·ÚoÌÂ-
Á·Ïo˚fi Â›Ó·È È‰È·›ÙÂÚ· ˘„ËÏ‹.
2. ∂ÚÁ·˙fiÌÂÓ˜ Û ÙÌ‹Ì·Ù· fio˘ ÓoÛËχoÓÙ·È
·ÓoÛoηٷÛÙ·Ï̤ÓoÈ ·ÛıÂÓ›˜, ÛÙo˘˜ oo›o˘˜ Ë
Û˘¯ÓfiÙËÙ· ÏoÈÌÒÍÂˆÓ ·fi ¢ηÈÚÈ·Îo‡˜ ÌÈÎÚo-
oÚÁ·ÓÈÛÌo‡˜ fiˆ˜ ÙoÍfiÏ·ÛÌ·, ΢ÙÙ·ÚoÌÂÁ·-
Ïo˚fi Î.·. Â›Ó·È ÌÂÁ¿ÏË.
3. ∂ÚÁ·˙fiÌÂÓ˜ Û ÙÌ‹Ì·Ù· ÓÂoÁÓÒÓ o˘ Èı·ÓfiÓ
Ó· ¿Û¯o˘Ó ·fi Û˘Ìو̷ÙÈ΋ Ë ·Û˘Ìو̷ÙÈ-
΋ Û˘ÁÁÂÓ‹ Ïo›ÌˆÍË (ÂÚ˘ıÚ¿, ΢ÙÙ·ÚoÌÂÁ·Ïo-
˚fi˜, Î.·.).
4. ∂ÚÁ·˙fiÌÂÓ˜ Û ÓoÛoÎoÌ›·, Û ÌÈÎÚo‚ÈoÏoÁÈ-
ο ÂÚÁ·ÛÙ‹ÚÈ· Î·È ¿ÏÏo˘˜ ¯ÒÚo˘˜, fio˘ ›ӷÈ
ÂÎÙÂıÂÈ̤Ó˜ Û ÏoÈÌÒÍÂȘ o˘ ÌÂÙ·‰›‰oÓÙ·È ÌÂ
Ùo ·›Ì· Î·È Ù· ·Ú¿ÁˆÁ¿ Ùo˘ (Ë·Ù›Ùȉ· μ,
Û‡Ó‰ÚoÌo Â›ÎÙËÙ˘ ·ÓoÛoÏoÁÈ΋˜ ·ÓÂ¿ÚÎÂÈ-
·˜ ‹ AIDS).
5. °˘Ó·›Î˜ o˘ ¤¯o˘Ó oÏÏo‡˜ ÛÂÍo˘·ÏÈÎo‡˜ Û˘-
ÓÙÚfiÊo˘˜ ‹ οÓo˘Ó ¯Ú‹ÛË ÂÍ·ÚÙËÛÈoÁfiÓˆÓ o˘-
ÛÈÒÓ, oÈ oo›Â˜ ¤¯o˘Ó ·˘ÍË̤ÓË Èı·ÓfiÙËÙ· Ó·
ÓoÛ‹Ûo˘Ó ·fi ÛÂÍo˘·ÏÈο ÌÂÙ·‰È‰fiÌÂÓ· ÓoÛ‹-
Ì·Ù·, fiˆ˜ Û‡ÊÈÏË, Ë·Ù›Ùȉ· μ ‹ C, ¤ÚËÙ·
ÁÂÓÓËÙÈÎÒÓ oÚÁ¿ÓˆÓ, ÁoÓoÎoÎÎÈΤ˜ ‹ ¯Ï·Ì˘-
‰È·Î¤˜ ÏoÈÌÒÍÂȘ Î·È AIDS.
6. ªÂÙ·Ó¿ÛÙ˜ ·fi ¯ÒÚ˜ Ù˘ ∞Ó·ÙoÏÈ΋˜ ∂˘ÚÒ-
˘, ¡∞ ∞Û›·˜ Î·È ∞ÊÚÈ΋˜ fio˘ Ë Â›ÙˆÛË
ÓoÛËÌ¿ÙˆÓ, fiˆ˜ Ë Ê˘Ì·Ù›ˆÛË, Ë·Ù›Ùȉ· μ,
Û‡ÊÈÏË, AIDS Î.·., Â›Ó·È ÌÂÁ¿ÏË.
7. °˘Ó·›Î˜ o˘ ¤Ú¯oÓÙ·È ÛÂ Û˘¯Ó‹ Â·Ê‹ Ì Á¿-
Ù˜ ‹ Û˘ÓËı›˙o˘Ó Ó· ηٷӷÏÒÓo˘Ó ÌË Î·Ï¿
„Ë̤Óo ÎÚ¤·˜ (ÙoÍfiÏ·ÛÌ·).
8. °˘Ó·›Î˜ o˘ Û˘ÁηÙoÈÎo‡Ó Ì ¿Û¯oÓÙ˜ ·fi
ÓoÛ‹Ì·Ù· o˘ ÌÂÙ·‰›‰oÓÙ·È ÂÓ‰ooÈÎoÁÂÓÂȷο,
·Ó ‰ÂÓ ¤¯o˘Ó ÏËÊı› Ù· ηٿÏÏËÏ· ̤ÙÚ· (Ê˘-
Ì·Ù›ˆÛË, Ë·Ù›Ùȉ·).
9. ŒÁÎ˘Â˜ Ì ÌÈÎÚ¿ ·È‰È¿, Ù· oo›· ¤¯o˘Ó ÌÂÁ¿-
Ϙ Èı·ÓfiÙËÙ˜ Ó· ÂΉËÏÒÛo˘Ó ÏoÈÌÒ‰Ë ÓoÛ‹-
Ì·Ù·, ‹ ‚Ú¤ÊË o˘ ËÁ·›Óo˘Ó Û ‚ÚÂÊoÓËÈ·-
Îfi ÛÙ·ıÌfi.
μ. ¢Â˘ÙÂÚoÁÂÓ‹˜ ÚfiÏË„Ë Û˘ÁÁÂÓÒÓ
ÏoÈÌÒ͈Ó
Δ· ̤ÙÚ· ‰Â˘ÙÂÚoÁÂÓo‡˜ ÚfiÏ˄˘ ÙˆÓ Û˘Á-
ÁÂÓÒÓ ÏoÈÌÒÍÂˆÓ ÂÊ·ÚÌfi˙oÓÙ·È Û ¤ÁÎ˘Â˜ o˘
¤¯o˘Ó ÂÎÙÂı› ÛÙË ÓfiÛo. ¶ÂÚÈÏ·Ì‚¿Óo˘Ó ÙËÓ ·ıË-
ÙÈ΋ ·ÓoÛoo›ËÛË, ÙËÓ ¤ÁηÈÚË ‰È¿ÁÓˆÛË Î·È ·ÓÙÈ-
ÌÂÙÒÈÛË ÙˆÓ ÏoÈÌÒÍÂˆÓ ÛÙËÓ ¤Á΢o, ÙËÓ ÂÈÏoÁ‹
 ¶·È‰È·ÙÚÈ΋ B√ƒ∂ÿ√À ∂§§Õ¢√˜, 13, 2
Ùo˘ ηٿÏÏËÏo˘ ÙÚfio˘ Î·È ¯ÚfiÓo˘ ÙoÎÂÙo‡ Î·È ÙË
Ï‹„Ë ÚoÏËÙÈÎÒÓ Ì¤ÙÚˆÓ ÛÙo ÓÂoÁ¤ÓÓËÙo.
1. ¶·ıËÙÈ΋ ·ÓoÛoo›ËÛË
∏ ·ıËÙÈ΋ ·ÓoÛoo›ËÛË ÂÊ·ÚÌfi˙ÂÙ·È Û ¤Á-
Î˘Â˜ Á˘Ó·›Î˜ Ì ÈÛÙoÚÈÎfi ‡oÙ˘ Â·Ê‹˜ Ì ¿-
Û¯oÓÙ˜ ·fi ÏoÈÌÒ‰Ë ÓoÛ‹Ì·Ù·, fiˆ˜ ·ÓÂÌ¢Ïo-
ÁÈ¿, ÂÚ˘ıÚ¿, ÈÏ·Ú¿. ∏ ¯oÚ‹ÁËÛË ˘ÂÚ¿ÓoÛ˘ ‹ o-
Ï˘‰‡Ó·Ì˘ Á-ÛÊ·ÈÚ›Ó˘ ÙȘ ÚÒÙ˜ Ë̤Ú˜ ÌÂÙ¿
ÙËÓ ¤ÎıÂÛË Â›Ó·È ‰˘Ó·Ùfi Ó· ÙÚoooÈ‹ÛÂÈ ‹ Ó·
·oÙÚ¤„ÂÈ ÙËÓ ÎÏÈÓÈ΋ ÓfiÛËÛË Ù˘ ÂÁ·o˘ ·ÏÏ¿
Û˘Ó‹ıˆ˜ ‰ÂÓ ·oÙÚ¤ÂÈ Ùo ÛÙ¿‰Èo Ù˘ È·ÈÌ›·˜ ηÈ
ηٿ Û˘Ó¤ÂÈ· ‰ÂÓ ÂÍ·Ï›ÊÂÈ Ï‹Úˆ˜ ÙoÓ Î›Ó‰˘Óo
‰È·Ï·Îo˘ÓÙȷ΋˜ ÌfiÏ˘ÓÛ˘ Ùo˘ ΢‹Ì·Ùo˜5,11.
2. ¢È¿ÁÓˆÛË ÓfiÛo˘ ÛÙË ¤Á΢o
∏ ˘o„›· Ù˘ ÓfiÛo˘ ÛÙËÓ ¤Á΢o ı· ÙÂı› ·Ó
·Úo˘ÛÈ¿˙ÂÈ ‡oÙË ÎÏÈÓÈ΋ ÂÈÎfiÓ· ‹ ÈÛÙoÚÈÎfi
Â·Ê‹˜ Ì ¿Û¯oÓÙ˜. ∏ ÎÏÈÓÈ΋ ÂÈÎfiÓ· Û ϛÁ˜
ÂÚÈÙÒÛÂȘ ‚oËı¿, fiˆ˜ fiÙ·Ó ˘¿Ú¯ÂÈ ¯·Ú·ÎÙË-
ÚÈÛÙÈÎfi ÂÍ¿ÓıËÌ· (ÂÚ˘ıÚ¿, ·ÓÂÌ¢ÏoÁÈ¿, ÏoÈÌÒ-
‰Â˜ ÂÚ‡ıËÌ·, ÂÚËÙÈΤ˜ ‚Ï¿‚˜ ÁÂÓÓËÙÈÎÒÓ oÚÁ¿-
ÓˆÓ, ÎÏÈÓÈο ÛËÌ›· ‡oÙ· ÁÈ· Û‡ÊÈÏË). øÛÙfiÛo,
oÈ ÂÚÈÛÛfiÙÂÚ˜ ÏoÈÌÒÍÂȘ Â›Ó·È ·Û˘Ìو̷ÙÈΤ˜
ÛÙËÓ ¤Á΢o ‹ ÂΉËÏÒÓoÓÙ·È Ì ÁÂÓÈο Û˘ÌÙÒÌ·Ù·
o˘ ‰Â ‰È·Ê¤Úo˘Ó ·fi ÂΛӷ ooÈ·Û‰‹oÙ ÎoÈ-
Ó‹˜ ÈoÁÂÓo‡˜ Ïo›ÌˆÍ˘1,4,6.
™ËÌ·ÓÙÈ΋ Â›Ó·È Ë Û˘Ì‚oÏ‹ Ùo˘ ÈÛÙoÚÈÎo‡ ¤Î-
ıÂÛ˘ Û ÏoÈÌÒ‰Ë ÓoÛ‹Ì·Ù· ÏfiÁˆ Â·Ê‹˜ Ì ¿-
Û¯oÓÙ˜ ‹ ·Ó Ë ÌËÙ¤Ú· ·Ó‹ÎÂÈ Û oÌ¿‰· ˘„ËÏo‡
ÎÈÓ‰‡Óo˘.
™’ ooÈ·‰‹oÙ ÂÚ›ÙˆÛË Ë ÓfiÛo˜ Ú¤ÂÈ Ó·
ÂȂ‚·Èˆı› ÂÚÁ·ÛÙËÚȷο. O ÛËÌ·ÓÙÈÎfiÙÂÚo˜ ÙÚfi-
o˜ ÂÚÁ·ÛÙËÚȷ΋˜ ‰È¿ÁÓˆÛ˘ ÛÙËÓ Î·ıËÌÂÚÈÓ‹
Ú¿ÍË Â›Ó·È o oÚoÏoÁÈÎfi˜ ¤ÏÂÁ¯o˜12-14. ∞˘Ùfi˜ Ú¤ÂÈ
Ó· Á›ÓÂÙ·È ÚÈÓ ·fi ÙËÓ Î‡ËÛË ‹ Ùo˘Ï¿¯ÈÛÙoÓ ÛÙËÓ
·Ú¯‹ Ù˘, ÒÛÙ ӷ Â›Ó·È ÁÓˆÛÙ‹ Ë Î·Ù¿ÛÙ·ÛË ·ÓoÛ›-
·˜ Ù˘ ÌËÙ¤Ú·˜ ÁÈ· ‰È¿ÊoÚ˜ ÏoÈÌÒÍÂȘ Î·È Ó· Ìo-
Ú› Ó· ·ÍÈoÏoÁËı› Ë ·Ó‡ÚÂÛË ·ÓÙÈÛˆÌ¿ÙˆÓ ·ÚÁfi-
ÙÂÚ· ηٿ ÙËÓ Î‡ËÛË. ∂ÈϤoÓ, ·Ó ‚ÚÂı› fiÙÈ Ë Á˘-
Ó·›Î· Â›Ó·È ¿ÓoÛË ÌoÚ› Ó· ¤¯ÂÈ ÙË ‰È·‚‚·›ˆÛË
fiÙÈ ÌÈ· Ó¤· ÓfiÛËÛË Â›Ó·È ·›ı·ÓË ÁÈ· ÙȘ ÂÚÈÛÛfi-
ÙÂÚ˜ ÏoÈÌÒÍÂȘ, ÂÓÒ ÁÈ· ÂΛӘ fio˘ Â›Ó·È Èı·Ó‹
Ë ˘oÙÚo‹ ‹ Â·Ó·Ïo›ÌˆÍË ÛÙË ‰È¿ÚÎÂÈ· Ù˘ ·Ë-
Û˘ (΢ÙÙ·ÚoÌÂÁ·Ïo˚fi˜, ¤Ú˘ ÁÂÓÓËÙÈÎÒÓ oÚÁ¿-
ÓˆÓ) ı· ÂÓËÌÂÚˆı› fiÙÈ Ë Èı·ÓfiÙËÙ· Î·È ‚·Ú‡ÙËÙ·
Ù˘ Ïo›ÌˆÍ˘ Ùo˘ ΢‹Ì·Ùo˜ Â›Ó·È ÌÈÎÚ‹. ∞fi ÙËÓ ¿Ï-
ÏË ÏÂ˘Ú¿, ·Ó ‰È·ÈÛÙˆı› fiÙÈ Ë Á˘Ó·›Î· ›ӷÈ
Â›ÓoÛË, ı· ·˘Í‹ÛÂÈ ÙËÓ ÚoÛo¯‹ Ù˘ ÛÙË Ï‹„Ë ÁÂ-
ÓÈÎÒÓ ÚoÏËÙÈÎÒÓ Ì¤ÙÚˆÓ ÛÙË ‰È¿ÚÎÂÈ· Ù˘ ·Ë-
111
Û˘. ¶·Ú¿ Ù· Û·Ê‹ ÏÂoÓÂÎÙ‹Ì·Ù· Ùo˘ ÚoÏËÙÈ-
Îo‡ oÚoÏoÁÈÎo‡ ÂϤÁ¯o˘, ‰ÂÓ ˘¿Ú¯ÂÈ oÌoʈӛ· ˆ˜
Úo˜ ÙËÓ ·Ó·ÁηÈfiÙËÙ· ÂÊ·ÚÌoÁ‹˜ ÂϤÁ¯o˘ ‰È·Ïo-
Á‹˜ (screening test) Ûã fiϘ ÙȘ Á˘Ó·›Î˜, o oo›o˜
ıˆÚÂ›Ù·È oÈÎoÓoÌÈο ·Û‡ÌÊoÚo˜. Δo ‚¤‚·Èo ›ӷÈ
fiÙÈ o ÚoÏËÙÈÎfi˜ oÚoÏoÁÈÎfi˜ ¤ÏÂÁ¯o˜ ÂÈ‚¿ÏÏÂÙ·È
Ó· Á›ÓÂÙ·È Ûã fiϘ ÙȘ Á˘Ó·›Î˜ o˘ ·Ó‹Îo˘Ó Û ÌÈ·
·fi ÙȘ oÌ¿‰Â˜ ˘„ËÏo‡ ÎÈÓ‰‡Óo˘ o˘ Úo·Ó·Ê¤Ú-
ıËηÓ1,15-17.
™Â ¤Á΢o Ì ‡oÙË ÎÏÈÓÈ΋ ÂÈÎfiÓ· ‹ ¤ÎıÂÛË
Û οoÈo ÏoÈÌ҉˜ ÓfiÛËÌ·, Ú¤ÂÈ Ó· ÂϤÁ¯oÓÙ·È
Ù· ÂȉÈο IgG Î·È IgM ·ÓÙÈÛÒÌ·Ù·. ∏ ‰È·›ÛÙˆÛË
ÂȉÈÎÒÓ IgG ·ÓÙÈÛˆÌ¿ÙˆÓ ‰Â›¯ÓÂÈ ÙËÓ ‡·ÚÍË ·Óo-
Û›·˜ ¯ˆÚ›˜ Ó· ÌoÚ› Ó· ‰È·ÎÚ›ÓÂÈ ÌÂٷ͇ Úfi-
ÛÊ·Ù˘ Î·È ·Ï·È¿˜ Ïo›ÌˆÍ˘, ·Ó ‰ÂÓ Â›Ó·È ÁÓˆÛÙ‹
Ë ÚoËÁo‡ÌÂÓË Î·Ù¿ÛÙ·ÛË ·ÓoÛ›·˜. °È’ ·˘Ùfi, ›ӷÈ
··Ú·›ÙËÙo Ó· ÚoÛ‰ÈoÚÈÛÙo‡Ó Û ‰˘o ‰È·‰o¯Èο
‰Â›ÁÌ·Ù· oÚo‡ Ì ÌÂÛo‰È¿ÛÙËÌ· 2 ‚‰oÌ¿‰ˆÓ. ∏
·‡ÍËÛË Ùo˘ Ù›ÙÏo˘ ÙˆÓ ÂȉÈÎÒÓ IgG ·ÓÙÈۈ̿وÓ
ÛÙo ‰Â‡ÙÂÚo ‰Â›ÁÌ· Â›Ó·È ÂÓ‰ÂÈÎÙÈ΋ ÚfiÛÊ·Ù˘
Ïo›ÌˆÍ˘. ∂›Û˘, Ë ‰È·›ÛÙˆÛË IgM ·ÓÙÈۈ̿وÓ
Â›Ó·È ¤Ó‰ÂÈÍË ÚfiÛÊ·Ù˘ Ïo›ÌˆÍ˘. ∂Âȉ‹ fï˜
˘¿Ú¯ÂÈ ÛËÌ·ÓÙÈÎfi oÛoÛÙfi „¢‰ÒÓ ·oÙÂÏÂÛÌ¿-
ÙˆÓ, ÂÈ‚¿ÏÏÂÙ·È Ë ÂȂ‚·›ˆÛË ÙˆÓ ·oÙÂÏÂÛÌ¿-
ÙˆÓ ÚÈÓ ÏËÊı› ooÈ·‰‹oÙ ·fiÊ·ÛË1,14.
°È· ÙË ‰È¿ÁÓˆÛË Ù˘ Û‡ÊÈÏ˘ ¯ÚËÛÈÌooÈo‡ÓÙ·È
·Ú¯Èο oÈ ÌË ÙÚÂoÓËÌ·ÙÈΤ˜ ‰oÎÈ̷ۛ˜ VDRL
(Veneral Disease Research Laboratory) Î·È RPR
(Rapid Plasma Reagent), o˘ ·ÓȯÓ‡o˘Ó ·ÓÙÈÛÒÌ·-
Ù· ÂÓ·ÓÙ›oÓ Ùo˘ ÌË ÂȉÈÎo‡ ·ÓÙÈÁfiÓo˘ ηډÈoÏÈ›ÓË.
∏ ·Ó·˙‹ÙËÛË ÙˆÓ ÂȉÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ Ì ÙȘ ÙÚÂo-
ÓËÌ·ÙÈΤ˜ ‰oÎÈ̷ۛ˜ FTA-ABS (Fluorescence Tre-
ponemal Antibody–Absorption) Î·È MHA-TP (Mi-
crohemagglutination Assay for Antibodies to Trepo-
nema Pallidum) ·oÙÂÏ› ÙË ‰Â‡ÙÂÚË ÛÂÈÚ¿ ÂϤÁ¯o˘
ÁÈ· ÂȂ‚·›ˆÛË ÙˆÓ ıÂÙÈÎÒÓ ·oÙÂÏÂÛÌ¿ÙˆÓ ÙˆÓ
ÌË ÙÚÂoÓËÌ·ÙÈÎÒÓ ‰oÎÈÌ·ÛÈÒÓ2,14.
Δ· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ˘¿Ú¯o˘Ó ·ÎÚȂ›˜ ‰È·-
ÁÓˆÛÙÈΤ˜ ̤ıo‰oÈ o˘ ÛÙËÚ›˙oÓÙ·È ÛÙËÓ ·Ó›¯Ó¢-
ÛË Ùo˘ DNA/RNA Ùo˘ Èo‡ ‹ ·ÎfiÌË ÁoÓȉ›ˆÓ ÁÈ·
ÙÌ‹Ì·Ù· ÌÈÎÚo‚›ˆÓ (Û‡ÊÈÏË, ÙoÍoÏ¿Û̈ÛË) ÌÂ
ÙËÓ ·Ï˘ÛÛȉˆÙ‹ ·ÓÙ›‰Ú·ÛË oÏ˘ÌÂÚ¿Û˘ (polyme-
rase chain reaction, PCR)8,13,14,18,19.
ÕÏϘ ̤ıo‰oÈ ‰È¿ÁÓˆÛ˘ Ù˘ Ïo›ÌˆÍ˘ Ù˘
ÂÁ·o˘, o˘ fï˜ ‰ÂÓ ÂÊ·ÚÌfi˙oÓÙ·È Û˘¯Ó¿ ÛÙËÓ
ηıËÌÂÚÈÓ‹ Ú¿ÍË, Â›Ó·È Ë ·Ó·˙‹ÙËÛË Ùo˘ ˘‡-
ı˘Óo˘ ÌÈÎÚooÚÁ·ÓÈÛÌo‡ ÌÂ ¿ÌÂÛË ÌÈÎÚoÛÎfiËÛË
(.¯. Û‡ÊÈÏË) ‹ ηÏÏȤÚÁÂÈ· ·ıoÏoÁÈÎo‡ ˘ÏÈÎo‡
·fi ‡oÙ˜ ‚Ï¿‚˜ (.¯. ÂÚËÙÈΤ˜ ‚Ï¿‚˜, ÛÈÊ˘-
ÏȉÈο ¤ÏÎË, ∂¡À, ÎÏ)14,20,21.
Δ¤Ïo˜, ‰È·ÁÓˆÛÙÈο ÌoÚ› Ó· ‚oËı‹ÛÂÈ Ë ·Ó·-
112 ¶·È‰È·ÙÚÈ΋ B√ƒ∂ÿ√À ∂§§Õ¢√˜, 13, 2
˙‹ÙËÛË ÂȉÈÎÒÓ Î˘ÙÙ·ÚoÏoÁÈÎÒÓ ‚Ï·‚ÒÓ, fiˆ˜ ›ӷÈ
Ë ‰È·›ÛÙˆÛË ÂÓ‰o˘ÚËÓÈÎÒÓ Î·È ÂÓ‰o΢ÙÙ·ÚoÏ·Û-
Ì·ÙÈÎÒÓ ÂÁÎÏ›ÛÙˆÓ Û ·ÙÙ·Ú· ·fi ÏÂÌÊ·‰¤Ó˜ ·-
Û¯fiÓÙˆÓ ·fi ΢ÙÙ·ÚoÌÂÁ·Ïo˚fi ‹ ·Ïfi ¤ÚËÙ·1,6.
3. ∞ÓÙÈÌÂÙÒÈÛË ÓfiÛo˘ ÛÙËÓ ¤Á΢o
∏ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ÓfiÛo˘ ÛÙËÓ ¤Á΢o ÌoÚ›
Ó· ·oÙÚ¤„ÂÈ ÙË Ïo›ÌˆÍË Ùo˘ ΢‹Ì·Ùo˜ ‹ ÓÂoÁÓo‡,
ÂÊfiÛoÓ Á›ÓÂÈ ¤ÁηÈÚ·. §oÈÌÒÍÂȘ o˘ ÌoÚo‡Ó Ó·
·ÓÙÈÌÂÙˆÈÛÙo‡Ó ÛÙËÓ ¤Á΢o Â›Ó·È ‰È¿ÊoÚ˜ ÂȉÈ-
Τ˜ ÌÈÎÚo‚ȷΤ˜ ÏoÈÌÒÍÂȘ (Û‡ÊÈÏË, Ê˘Ì·Ù›ˆÛË,
ÁoÓfiÚÚoÈ·), ·Ú·ÛÈÙÈΤ˜ (ÙoÍoÏ¿Û̈ÛË), ÈoÁÂ-
Ó›˜ (¤Ú˘ ÁÂÓÓËÙÈÎÒÓ oÚÁ¿ÓˆÓ, ·ÓÂÌ¢ÏoÁÈ¿,
AIDS), ¯Ï·Ì˘‰È·Î¤˜ ÏoÈÌÒÍÂȘ ηıÒ˜ Î·È ÏoÈÌÒ-
ÍÂȘ ·fi ÎoÈÓ¿ ÌÈÎÚfi‚È·, fiˆ˜ ı· ·Ó·ÊÂÚıo‡Ó
ÛÙ· ÂÈ̤Úo˘˜ ÎÂÊ¿Ï·È·.
∂ȉÈ΋ ·Ó·ÊoÚ¿ Ú¤ÂÈ Ó· Á›ÓÂÈ ÛÙ· Úo‚Ï‹-
Ì·Ù· Û¯ÂÙ›˙oÓÙ·È Ì ÙË ¯oÚ‹ÁËÛË ·ÓÙÈ-ÈÈÎÒÓ Ê·Ú-
Ì¿ÎˆÓ ÛÙËÓ ¤Á΢o. ∏ ·Î˘ÎÏo‚›ÚË Â›Ó·È Ùo ÛËÌ·-
ÓÙÈÎfiÙÂÚo ·ÓÙÈ-ÈÈÎfi Ê¿ÚÌ·Îo o˘ ¤¯ÂÈ ¯oÚËÁËı›
ÛÙË ‰È¿ÚÎÂÈ· Ù˘ ·ËÛ˘, ·ÏÏ¿ Ù· ‰Â‰o̤ӷ o˘
˘¿Ú¯o˘Ó Úo˜ Ùo ·ÚfiÓ ÁÈ· ÙËÓ ·ÛÊ¿ÏÂÈ¿ Ù˘ ›-
Ó·È ·ÓÂ·Ú΋, ÒÛÙ oÈ ·fi„ÂȘ ÁÈ· ÙË ¯oÚ‹ÁËÛ‹
Ù˘ ÛÙËÓ ¤Á΢o ·Ú·Ì¤Óo˘Ó ·ÓÙÈÎÚo˘fiÌÂÓ˜6. ∏
·Î˘ÎÏo‚›ÚË ÌoÚ› Ó· ÂÓۈ̷وı› ÛÙo DNA Ùo˘
Èo‡ Î·È ÙˆÓ Î˘ÙÙ¿ÚˆÓ Ùo˘ ÍÂÓÈÛÙ‹. °È’ ·˘Ùfi, ¤¯ÂÈ
··Û¯oÏ‹ÛÂÈ È‰È·›ÙÂÚ· Ë Èı·ÓfiÙËÙ· ÙÂÚ·ÙoÁfiÓo˘
‰Ú¿Û˘. ªÂϤÙ˜ Û ÂÈÚ·Ì·Ùfi˙ˆ· ‰ÂÓ ·¤‰ÂÈÍ·Ó
ÙÂÚ·ÙoÁfiÓo ‰Ú¿ÛË Ì ÙȘ ‰fiÛÂȘ o˘ Û˘Ó‹ıˆ˜ ¯o-
ÚËÁo‡ÓÙ·È. ∂›Û˘, ·fi ÙË Û˘ÛÙËÌ·ÙÈ΋ ηٷÁÚ·-
Ê‹ Î·È ·Ú·ÎoÏo‡ıËÛË Á˘Ó·ÈÎÒÓ o˘ ‹Ú·Ó ·Î˘-
ÎÏo‚›ÚË ÛÙË ‰È¿ÚÎÂÈ· Ù˘ ·ËÛ˘ ‰ÂÓ ‰È·ÈÛÙÒıË-
ΠÚo˜ Ùo ·ÚfiÓ ‚Ï·ÙÈ΋ Â›‰Ú·ÛË ÛÙo ·ËÌ·
(Û˘ÁÁÂÓ›˜ ‰˘ÛϷۛ˜ ‹ ÓÂÊÚoÙoÍÈÎfiÙËÙ·)22,23. ∏
ηٷÁÚ·Ê‹ Û˘Ó¯›˙ÂÙ·È Î·È Ì¤¯ÚÈ Ó· ÂÍ·¯ıo‡Ó
oÚÈÛÙÈο Û˘ÌÂÚ¿ÛÌ·Ù· Ë ·Î˘ÎÏo‚›ÚË Î·Ù·Ù¿Û-
ÛÂÙ·È ÛÙËÓ Î·ÙËÁoÚ›· C ÙˆÓ Ê·Ú̿ΈÓ. ™ÙËÓ Î·-
ÙËÁoÚ›· ·˘Ù‹ ˘¿ÁoÓÙ·È Ê¿Ú̷η ÁÈ· Ù· oo›·
‰ÂÓ ¤¯ÂÈ ·o‰ÂȯÙ› Ë ·ÛÊ¿ÏÂÈ· ÁÈ· Ùo ¤Ì‚Ú˘o ηÈ
¯oÚËÁo‡ÓÙ·È ÌfiÓo ·Ó o ˘oÏoÁÈ˙fiÌÂÓo˜ ΛӉ˘Óo˜
ÁÈ· Ùo ¤Ì‚Ú˘o ·fi ÙË ÓfiÛo Â›Ó·È ÌÂÁ·Ï‡ÙÂÚo˜ ·’
fiÙÈ ·fi Ùo Ê¿ÚÌ·Îo22,23. OÈ ÂÚÈÛÛfiÙÂÚoÈ Û˘ÁÁÚ·-
Ê›˜ Û˘ÌʈÓo‡Ó fiÙÈ Ë ¯oÚ‹ÁËÛË Ù˘ ·Î˘ÎÏo‚›Ú˘
Â›Ó·È ·ÛÊ·Ï‹˜ ÛÙoÓ ÙÂÏÂ˘Ù·›o Ì‹Ó· Ù˘ ·ËÛ˘ ηÈ
ÌoÚ› Ó· ‰oı› ·Ó Ë ¤Á΢o˜ ·Úo˘ÛÈ¿ÛÂÈ ¤ÚËÙ·
ÙˆÓ ÁÂÓÓËÙÈÎÒÓ oÚÁ¿ÓˆÓ ‹ ·ÓÂÌ¢ÏoÁÈ¿. ÕÏÏ·
·ÓÙÈ-ÈÈο Ê¿Ú̷η o˘ ¯ÚËÛÈÌooÈo‡ÓÙ·È ÁÈ· ÙËÓ
·ÓÙÈÌÂÙÒÈÛË Ûo‚·ÚÒÓ ÏoÈÌÒÍÂˆÓ ·fi ΢ÙÙ·Úo-
ÌÂÁ·Ïo˚fi Û ·ÓoÛoηٷÛÙ·Ï̤Óo˘˜ ·ÛıÂÓ›˜ ›ӷÈ
Ë ganciclovir, foscarnet Î·È cidofovir, o˘ fï˜ ‰ÂÓ
¤¯o˘Ó ¯oÚËÁËı› Û ¤ÁÎ˘Â˜6,22,23.
™Â ¤ÁÎ˘Â˜ o˘ ¿Û¯o˘Ó ·fi AIDS ‹ Â›Ó·È Êo-
Ú›˜ Ùo˘ Èo‡ Ù˘ Â›ÎÙËÙ˘ ·ÓoÛoÏoÁÈ΋˜ ·ÓÂ¿Ú-
ÎÂÈ·˜ (Human Immunodeficiency Virus, HIV) Ë
ÂȉÈ΋ ·ÓÙÈÚÂÙÚo˚È΋ ıÂÚ·›· o˘ ·Ú¯›˙ÂÈ ·fi ÙË
14Ë Â‚‰oÌ¿‰· ¤¯ÂÈ ÌÂÈÒÛÂÈ ÛËÌ·ÓÙÈο ÙË Û˘¯ÓfiÙË-
Ù· οıÂÙ˘ ÌÂÙ¿‰oÛ˘ Ùo˘ Èo‡24.
4. ¶ÚoÏËÙÈο ̤ÙÚ· ηٿ ÙoÓ ÙoÎÂÙfi
Δ· ÚoÏËÙÈο ̤ÙÚ· ηٿ ÙoÓ ÙoÎÂÙfi ÛÙo¯Â‡-
o˘Ó ÛÙËÓ ÚfiÏË„Ë ÌÂÙ¿‰oÛ˘ ÏoÈÌÒÍÂˆÓ ÛÙË ‰È-
¿ÚÎÂÈ· Ùo˘ ÙoÎÂÙo‡ ·fi ÙȘ ÌoÏ˘Ṳ̂Ó˜ ÎoÏÈΤ˜ ÂÎ-
ÎÚ›ÛÂȘ ‹ Ùo ·›Ì· Ù˘ ÌËÙ¤Ú·˜. ∂ÎÙfi˜ ·fi ÙË ¯oÚ‹-
ÁËÛË ÙˆÓ ·ÓÙÈÌÈÎÚo‚È·ÎÒÓ Î·È ·ÓÙÈ-ÈÈÎÒÓ Ê·Ú̿ΈÓ
o˘ Úo·Ó·Ê¤ÚıËηÓ, Û˘ÌÂÚÈÏ·Ì‚¿Óo˘Ó ÙËÓ ÂÈ-
ÏoÁ‹ Ùo˘ ηٿÏÏËÏo˘ ÙÚfio˘ Î·È ¯ÚfiÓo˘ ÙoÎÂÙo‡.
∂ÈÏoÁ‹ Ùo˘ ηٿÏÏËÏo˘ ÙÚfio˘ ÙoÎÂÙo‡
O ÙoÎÂÙfi˜ Ì ηÈÛ·ÚÈ΋ ÙoÌ‹ ÂӉ›ÎÓ˘Ù·È ÁÈ·
ÙËÓ ÚfiÏË„Ë Ù˘ ÂÚÈÁÂÓÓËÙÈ΋˜ ÌÂÙ¿‰oÛ˘ Ùo˘
Èo‡ HIV Î·È Ùo˘ Èo‡ Ùo˘ ·Ïo‡ ¤ÚËÙ·24,14. ∞ÓÙ›-
ıÂÙ·, ÎoÏÈÎfi˜ ÙoÎÂÙfi˜ Û˘ÛÙ‹ÓÂÙ·È Û ÌËÙ¤Ú˜ Êo-
Ú›˜ Ùo˘ HBsAg, ÁÈ·Ù› ıˆÚÂ›Ù·È fiÙÈ Ë Û˘ÁΤÓÙÚˆ-
ÛË Ùo˘ Èo‡ Ù˘ Ë·Ù›Ùȉ·˜ μ Â›Ó·È ÌÈÎÚfiÙÂÚË ÛÙȘ
ÂÎÎÚ›ÛÂȘ Ùo˘ ÎfiÏo˘ Û˘ÁÎÚÈÙÈο Ì ÙË Û˘ÁΤ-
ÓÙÚˆÛ‹ Ùo˘ ÛÙo ·›Ì·9,25,26.
∂ÈÏoÁ‹ Ùo˘ ηٿÏÏËÏo˘ ¯ÚfiÓo˘ ÙoÎÂÙo‡
Œ¯ÂÈ ÛËÌ·Û›· ÁÈ· ÏoÈÌÒÍÂȘ fiˆ˜ Ë ·ÓÂÌ¢Ïo-
ÁÈ¿ Î·È Ë ÈÏ·Ú¿, fio˘ Ù· ÌËÙÚÈο ·ÓÙÈÛÒÌ·Ù· ¤¯o˘Ó
ÌÂÁ¿ÏË ÛËÌ·Û›· ÁÈ· ÙË Û˘¯ÓfiÙËÙ· Î·È ‚·Ú‡ÙËÙ·
ÚoÛ‚oÏ‹˜ Ùo˘ ÓÂoÁÓo‡. ŸÙ·Ó ÏoÈfiÓ Ë ÌËÙ¤Ú·
ÓoÛ‹ÛÂÈ ÛÙËÓ ÂÚÈÁÂÓÓËÙÈ΋ ÂÚ›o‰o, ‰ÂÓ Ú¤ÂÈ Ó·
ÂÈÛ¢Ûı› o ÙoÎÂÙfi˜ ·ÏÏ¿ Ó· ηı˘ÛÙÂÚ‹ÛÂÈ fiÛo
Â›Ó·È ‰˘Ó·Ùfi Î·È ·ÛʷϤ˜ ÁÈ· Ùo ·È‰›, ÒÛÙ ӷ
ÚoÏ¿‚ÂÈ Ë ÌËÙ¤Ú· Ó· ·Ó·Ù‡ÍÂÈ ·ÓÙÈÛÒÌ·Ù· (Ùo˘-
Ï¿¯ÈÛÙoÓ 4 Ë̤Ú˜ ÌÂÙ¿ ÙËÓ ÂÌÊ¿ÓÈÛË Ùo˘ ÂÍ·Óı‹-
Ì·Ùo˜), Ù· oo›· ÂÚÓÒÓÙ·˜ ‰È· ̤Ûo˘ Ùo˘ Ï·Îo‡-
ÓÙ· ı· ÚoÛʤÚo˘Ó ·ıËÙÈ΋ ·ÓoÛ›· ÛÙo ÓÂoÁÓfi1.
°È· ÙȘ ˘fiÏoÈ˜ ÏoÈÌÒÍÂȘ ‰ÂÓ ˘¿Ú¯ÂÈ Î·ÌÈ¿ ¤Ó-
‰ÂÈÍË Â›Û¢Û˘ ‹ ηı˘ÛÙ¤ÚËÛ˘ Ùo˘ ÙoÎÂÙo‡.
5. ¶ÚoÏËÙÈο ̤ÙÚ· ÛÙo ÓÂoÁ¤ÓÓËÙo
™ÙȘ ÏoÈÌÒÍÂȘ o˘ ÌÂÙ·‰›‰oÓÙ·È ‰È·Ï·Îo˘-
ÓÙȷο Ë ÚoÛ‚oÏ‹ Ùo˘ ΢‹Ì·Ùo˜ ¤¯ÂÈ Á›ÓÂÈ oχ
ÚÈÓ ÙoÓ ÙoÎÂÙfi, ÒÛÙ ‰ÂÓ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· Á›ÓÂÙ·È
Û˘˙‹ÙËÛË ÁÈ· Ï‹„Ë ÚoÏËÙÈÎÒÓ Ì¤ÙÚˆÓ ÌÂÙ¿ ÙË
Á¤ÓÓËÛË. °È· ÙȘ ÏoÈÌÒÍÂȘ fï˜ o˘ ÌÂÙ·‰›‰oÓÙ·È
ÂÚÈÁÂÓÓËÙÈο, ηٿ ÙoÓ ÙoÎÂÙfi ‹ ·Ì¤Ûˆ˜ ÌÂÙ¿ ·’
·˘ÙfiÓ (Ë·Ù›Ùȉ· μ, ·ÓÂÌ¢ÏoÁÈ¿, Ê˘Ì·Ù›ˆÛË,
 ¶·È‰È·ÙÚÈ΋ B√ƒ∂ÿ√À ∂§§Õ¢√˜, 13, 2
Î.·.), ˘¿Ú¯ÂÈ ‰˘Ó·ÙfiÙËÙ· ÚfiÏ˄˘ Ì ÂÓÂÚÁËÙÈ-
΋ ‹/Î·È ·ıËÙÈ΋ ·ÓoÛoo›ËÛË Î·È ¯oÚ‹ÁËÛË
·ÓÙÈÌÈÎÚo‚È·ÎÒÓ/·ÓÙÈ-ÈÈÎÒÓ Ê·Ú̿ΈÓ2.
OÈ ÂӉ›ÍÂȘ ÂÓÂÚÁËÙÈ΋˜ ·ÓoÛoo›ËÛ˘ ÛÙo
ÓÂoÁ¤ÓÓËÙo Â›Ó·È ÂÏ¿¯ÈÛÙ˜ Î·È ·ÊoÚo‡Ó ΢ڛˆ˜ ÙËÓ
ÚfiÏË„Ë Ù˘ οıÂÙ˘ ÌÂÙ¿‰oÛ˘ Ù˘ Ë·Ù›Ùȉ·˜ μ
Î·È Ù˘ Ê˘Ì·Ù›ˆÛ˘ Û ÓÂoÁÓ¿ ˘„ËÏo‡ ÎÈÓ‰‡Óo˘.
∂Ӊ›ÍÂȘ ·ıËÙÈ΋˜ ·ÓoÛoo›ËÛ˘ Ùo˘ ÓÂo-
Á¤ÓÓËÙo˘ Â›Ó·È Ë ÓfiÛËÛË Ù˘ ÌËÙ¤Ú·˜ ·fi ·ÓÂÌ¢-
ÏoÁÈ¿ (˘ÂÚ¿ÓoÛË Á-ÛÊ·ÈÚ›ÓË) ‹ ÈÏ·Ú¿ (ÎoÈÓ‹ Á-
ÛÊ·ÈÚ›ÓË) ÛÙËÓ ÂÚÈÁÂÓÓËÙÈ΋ ÂÚ›o‰o Î·È Ë Êo-
Ú›· HμsAg (˘ÂÚ¿ÓoÛË Á-ÛÊ·ÈÚ›ÓË).
∏ ÚoÏËÙÈ΋ ¯oÚ‹ÁËÛË ·ÓÙÈÌÈÎÚo‚È·ÎÒÓ
Ê·ÚÌ¿ÎˆÓ ÛÙo ÓÂoÁ¤ÓÓËÙo ¯ˆÚ›˜ ÂӉ›ÍÂȘ Ïo›Ìˆ-
͢ ÂӉ›ÎÓ˘Ù·È Û ϛÁ˜ ÂÚÈÙÒÛÂȘ, fio˘ ˘¿Ú-
¯ÂÈ ÌÂÁ¿ÏË Èı·ÓfiÙËÙ· ÌfiÏ˘ÓÛ˘ Ùo˘ ÓÂoÁÓo‡ Â-
ÚÈÁÂÓÓËÙÈο (.¯. ÌËÙ¤Ú· Ì ÚˆÙo·ı‹ ¤ÚËÙ·
ÁÂÓÓËÙÈÎÒÓ oÚÁ¿ÓˆÓ ÛÙËÓ ÂÚÈÁÂÓÓËÙÈ΋ ÂÚ›o‰o
‹ Ì ÂӉ›ÍÂȘ ÂÓÂÚÁo‡ Ê˘Ì·Ù›ˆÛ˘) ‹ ·Ó Ë ÓfiÛo˜
ÛÙË ÌËÙ¤Ú· ‰ÂÓ ·ÓÙÈÌÂÙˆ›ÛÙËΠۈÛÙ¿ (Û‡ÊÈÏË)2.
°. ΔÚÈÙoÁÂÓ‹˜ ÚfiÏË„Ë Û˘ÁÁÂÓÒÓ ÏoÈÌÒ͈Ó
∏ ÙÚÈÙoÁÂÓ‹˜ ÚfiÏË„Ë ·oÛÎo› ÛÙËÓ ÚfiÏË-
„Ë Ù˘ Û˘Ìو̷ÙÈ΋˜ ÓfiÛo˘ ÛÙo ÓÂoÁÓfi Î·È ÛÙËÓ
·oÊ˘Á‹ ‹ ÂÏ·¯ÈÛÙoo›ËÛË ÙˆÓ Ì·ÎÚo¯ÚfiÓÈˆÓ ÂÈ-
ÙÒÛÂˆÓ Î·È ‚·Û›˙ÂÙ·È ÛÙË ‰È¿ÁÓˆÛË Î·È ·ÓÙÈÌÂÙÒ-
ÈÛË ÓfiÛo˘ ÛÙo ·ËÌ· Î·È ÓÂoÁ¤ÓÓËÙo. ŒÙÛÈ, ·Ó
‰È·ÁÓˆÛÙ› Ïo›ÌˆÍË ÛÙËÓ ¤Á΢o, Ú¤ÂÈ Ó· ·Ú·Îo-
Ïo˘ıÂ›Ù·È Ùo ·ËÌ· ÁÈ· ÂӉ¯fiÌÂÓË ÚoÛ‚oÏ‹ Ùo˘.
∏ ·Ú·ÎoÏo‡ıËÛË Ùo˘ ΢‹Ì·Ùo˜ ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ
·ÌÓÈo·Ú·Î¤ÓÙËÛË Î·È ·Ó·˙‹ÙËÛË ÙˆÓ ÌÈÎÚooÚÁ·-
ÓÈÛÌÒÓ ÛÙo ·ÌÓÈ·Îfi ˘ÁÚfi (Û‡ÊÈÏË) ‹ ¤ÏÂÁ¯o ÌÂ
PCR ÁÈ· ·Ó›¯Ó¢ÛË Ùo˘ RNA/DNA Ùo˘ Èo‡, ‹ ÙÌË-
Ì¿ÙˆÓ Ùo˘ DNA ÌÈÎÚo‚›o˘ ‹ ·Ú·Û›Ùo˘8,13,14,18,19.
∂›Û˘, o ˘ÂÚ˯oÁÚ·ÊÈÎfi˜ ¤ÏÂÁ¯o˜ Ùo˘ ΢‹Ì·Ùo˜
ÌoÚ› Ó· ‰ÒÛÂÈ ÂӉ›ÍÂȘ ÂÓÂÚÁo‡ Ïo›ÌˆÍ˘ (ÂÌ-
‚Ú˘˚Îfi˜ ‡‰Úˆ·˜, ˘‰ÚoΤʷÏo˜, Â·Û‚ÂÛÙÒÛÂȘ,
Î.·.)1. OÈ oÚoÏoÁÈΤ˜ ‰oÎÈ̷ۛ˜ ÛÙo ·›Ì· Ùo˘ oÌ-
Ê¿ÏÈo˘ ÏÒÚo˘ ÌoÚo‡Ó Ó· ‚oËı‹Ûo˘Ó, ·ÏÏ¿ ›ӷÈ
‰˘Ó·Ùfi Ó· ˘¿Ú¯ÂÈ ·Ó¿ÌÈÍË Ì Ùo ·›Ì· Ù˘ ÌËÙ¤Ú·˜.
ŸÏ· Ù· ÓÂoÁ¤ÓÓËÙ· ÌËÙ¤ÚˆÓ Ì ‰È·ÁÓˆṲ̂ÓË
‹ ‡oÙË Ïo›ÌˆÍË ÛÙËÓ Î‡ËÛË Î·ıÒ˜ Î·È ÂΛӷ
o˘ ·Úo˘ÛÈ¿˙o˘Ó Û˘ÌÙÒÌ·Ù· Ú¤ÂÈ Ó· ˘o-
‚¿ÏÏoÓÙ·È Û ÏÂÙoÌÂÚ‹ ÎÏÈÓÈÎfi Î·È ÂÚÁ·ÛÙËÚÈ·-
Îfi ¤ÏÂÁ¯o.
∏ ¯oÚ‹ÁËÛË ·ÓÙÈÌÈÎÚo‚È·ÎÒÓ/·ÓÙÈ-ÈÈÎÒÓ Ê·Ú-
Ì¿ÎˆÓ ÛÙo ÓÂoÁ¤ÓÓËÙo ÂӉ›ÎÓ˘Ù·È ‹ ÂÈ‚¿ÏÏÂÙ·È
fiÙ·Ó ÂΉËÏÒÛÂÈ Û˘ÌÙÒÌ·Ù· Û˘ÁÁÂÓo‡˜ Ïo›ÌˆÍ˘,
.¯. ¤ÚËÙ·˜, ·ÓÂÌ¢ÏoÁÈ¿, Ïo›ÌˆÍË ·fi ΢ÙÙ·Úo-
ÌÂÁ·Ïo˚fi, ÙoÍoÏ¿Û̈ÛË Î.·. ηıÒ˜ Î·È Û ÓoÛ‹-
113
Ì·Ù· fiˆ˜ Ë Û‡ÊÈÏË, Ë ÁoÓfiÚÚoÈ· Î.·., fiÙ·Ó Ë ÓfiÛo˜
ÛÙËÓ ¤Á΢o ‰ÂÓ ·ÓÙÈÌÂÙˆ›ÛÙËΠηıfiÏo˘ ‹ ·ÓÙÈÌÂ-
Ùˆ›ÛÙËΠ·ÓÂ·ÚÎÒ˜, ·ÓÂÍ¿ÚÙËÙ· ·fi ÙËÓ ‡·ÚÍË
Û˘ÌÙˆÌ¿ÙˆÓ ÛÙo ÓÂoÁÓfi2.
ª¤ÙÚ· ÚfiÏ˄˘ Î·È ·ÓÙÈÌÂÙÒÈÛ˘ ÙˆÓ ÛË -
Ì·ÓÙÈÎfiÙÂÚˆÓ Û˘ÁÁÂÓÒÓ ÏÔÈÌÒ͈Ó
∂Ú˘ıÚ¿
O ÌfiÓo˜ ÙÚfio˜ ÚfiÏ˄˘ Ù˘ Û˘ÁÁÂÓo‡˜ ÂÚ˘-
ıÚ¿˜ Â›Ó·È o ·ÓÙÈÂÚ˘ıÚÈÎfi˜ ÂÌ‚oÏÈ·ÛÌfi˜ (¶›Ó. 1). O
ÂÌ‚oÏÈ·ÛÌfi˜ Á›ÓÂÙ·È Û’ fiÏ· Ù· ‚Ú¤ÊË Ùo 15o Ì‹Ó·
˙ˆ‹˜ Î·È Â·Ó·Ï·Ì‚¿ÓÂÙ·È ÙoÓ 4o-6o ¯ÚfiÓo. ∂›-
Û˘, Û˘ÓÈÛÙ¿Ù·È o ÂÌ‚oÏÈ·ÛÌfi˜ fiÏˆÓ ÙˆÓ Â›ÓoÛˆÓ
Á˘Ó·ÈÎÒÓ Ù˘ ·Ó··Ú·ÁˆÁÈ΋˜ ËÏÈΛ·˜ ·ÏÏ¿ Ú¤-
ÂÈ Ó· ÌÂÛoÏ·‚› ‰È¿ÛÙËÌ· Ùo˘Ï¿¯ÈÛÙoÓ 3 ÌËÓÒÓ
ÌÂٷ͇ ÂÌ‚oÏÈ·ÛÌo‡ Î·È Û‡ÏÏ˄˘.
O ·ÓÙÈÂÚ˘ıÚÈÎfi˜ ÂÌ‚oÏÈ·ÛÌfi˜ ÛÙË ‰È¿ÚÎÂÈ·
Ù˘ ·ËÛ˘ ·ÓÙÂӉ›ÎÓ˘Ù·È. øÛÙfiÛo, o Ù˘¯·›o˜ ÂÌ-
‚oÏÈ·ÛÌfi˜ Ùo ÙÂÏÂ˘Ù·›o ÙÚ›ÌËÓo ÚÈÓ ÙË Û‡ÏÏË„Ë
̤¯ÚÈ Î·È Ùo˘˜ 3 ÚÒÙo˘˜ Ì‹Ó˜ Ù˘ ·ËÛ˘ ‰ÂÓ ·o-
ÙÂÏ› ¤Ó‰ÂÈÍË ‰È·Îo‹˜ Ù˘ ·ËÛ˘, ÁÈ·Ù› ‰ÂÓ ¤¯ÂÈ
‰È·ÈÛÙˆı› Û‡Ó‰ÚoÌo Û˘ÁÁÂÓo‡˜ ÂÚ˘ıÚ¿˜ ‹ Û˘Á-
ÁÂÓ›˜ ‰È·Ì·Úٛ˜ Û ¤Ì‚Ú˘· o˘ ÌoχÓıËÎ·Ó ·fi
ÙoÓ Èfi Ùo˘ ÂÌ‚oÏ›o˘ Ù˘ ÂÚ˘ıÚ¿˜1,5,27. O ÂÌ‚oÏÈ·-
ÛÌfi˜ ÙˆÓ ·È‰ÈÒÓ ÛÙo ÂÚÈ‚¿ÏÏoÓ Ù˘ ÂÁ·o˘ ‰ÂÓ
··ÁoÚ‡ÂÙ·È, ÁÈ·Ù› o Èfi˜ Ùo˘ ÂÌ‚oÏ›o˘ ‰Â ÌÂÙ·‰›-
‰ÂÙ·È ÛÙo ÂÚÈ‚¿ÏÏoÓ28,29.
∞Ó Ë ¤Á΢o˜ ÂÎÙÂı› ÛÙË ÓfiÛo, ‰ÂÓ ˘¿Ú¯ÂÈ
‰˘Ó·ÙfiÙËÙ· ÚfiÏ˄˘ Ù˘ οıÂÙ˘ ÌÂÙ¿‰oÛ˘,
ÂÂȉ‹ Ë ÎoÈÓ‹ Á-ÛÊ·ÈÚ›ÓË ‰ÂÓ ÚoÏ·‚·›ÓÂÈ ÙËÓ
È·ÈÌ›· ‹ ÙË Ïo›ÌˆÍË1,2. øÛÙfiÛo, ·Ó Ë ÌËÙ¤Ú· o˘
ÂÎÙ¤ıËΠÛÙËÓ ÂÚ˘ıÚ¿ ÓˆÚ›˜ ÛÙËÓ Î‡ËÛË ‰ÂÓ ÂÈ-
ı˘Ì› ÁÈ· ηӤӷ ÏfiÁo Ó· ‰È·Îfi„ÂÈ ÙËÓ Î‡ËÛË,
ÌoÚ› ηÓ›˜ Ó· ÛÎÂÊı› ÙË ¯oÚ‹ÁËÛË Á-ÛÊ·ÈÚ›-
Ó˘. ™ÙËÓ ÂÚ›ÙˆÛË ·˘Ù‹ Ë ¯oÚ‹ÁËÛË 20 mL ÎoÈ-
Ó‹˜ Á-ÛÊ·ÈÚ›Ó˘ ̤۷ ÛÙȘ ÚÒÙ˜ 72 ÒÚ˜ ·fi ÙËÓ
¤ÎıÂÛË ÛÙË ÓfiÛo ÌoÚ› Ó· ÌÂÈÒÛÂÈ, ·Ó Î·È ‰ÂÓ
¶›Ó·Î·˜ 1. ∞ÓoÛoÚoʇϷÍË ·fi Û˘ÁÁÂÓ‹ ÂÚ˘ıÚ¿
1. ∂È‚¿ÏÏÂÙ·È ÂÌ‚oÏÈ·ÛÌfi˜ ‚ÚÂÊÒÓ, ·È‰ÈÒÓ Î·È
Â›ÓoÛˆÓ ÌË ÂÁ·ˆÓ Á˘Ó·ÈÎÒÓ ·Ó··Ú·ÁˆÁÈ΋˜
ËÏÈΛ·˜
2. ∞ÓÙÂӉ›ÎÓ˘Ù·È o ÂÌ‚oÏÈ·ÛÌfi˜ Ù˘ ÂÁ·o˘ (3 Ì‹-
Ó˜ ÚÈÓ ÙË Û‡ÏÏË„Ë Ì¤¯ÚÈ Î·È Ùo˘˜ 3 ÚÒÙo˘˜
Ì‹Ó˜ Ù˘ ·ËÛ˘)
3. ¢ÂÓ ·ÓÙÂӉ›ÎÓ˘Ù·È o ‚oÏÈ·ÛÌfi˜ ·È‰ÈÒÓ ÛÙo Â-
ÚÈ‚¿ÏÏoÓ Ù˘ ÂÁ·o˘ Î·È o ÂÌ‚oÏÈ·ÛÌfi˜ ÛÙË
‰È¿ÚÎÂÈ· Ù˘ Á·Ïo˘¯›·˜
4. ¢Â ‚oËı¿ Ë ¯oÚ‹ÁËÛË Á-ÛÊ·ÈÚ›Ó˘ ÛÙËÓ ¤Á΢o
114 ¶·È‰È·ÙÚÈ΋ B√ƒ∂ÿ√À ∂§§Õ¢√˜, 13, 2
ÂÍ·Ê·Ó›˙ÂÈ, ÙoÓ Î›Ó‰˘Óo Ù˘ Û˘ÁÁÂÓo‡˜ ÂÚ˘ıÚ¿˜2.
O ÂÌ‚oÏÈ·ÛÌfi˜ ÌËÙ¤ÚˆÓ o˘ ıËÏ¿˙o˘Ó ‰ÂÓ ·o-
ÙÂÏ› ¤Ó‰ÂÈÍË ‰È·Îo‹˜ Ùo˘ ıËÏ·ÛÌo‡ o‡Ù ÚoÛˆÚÈ-
Ó¿, ·Ó Î·È o Èfi˜ Ùo˘ ÂÌ‚oÏ›o˘ ·o‚¿ÏÏÂÙ·È ÛÙo Á¿Ï·
Î·È ÌoÚ› Ó· ÌÂÙ·‰oı› ÛÙo ‚Ú¤Êo˜, ÛÙo oo›o
fï˜ Ë Ïo›ÌˆÍË ·Ú·Ì¤ÓÂÈ ·Û˘Ìو̷ÙÈ΋30,31.
§o›ÌˆÍË ·fi ΢ÙÙ·ÚoÌÂÁ·Ïo˚fi
1. ∞ÓoÛoÚoʇϷÍË
¶Úo˜ Ùo ·ÚfiÓ ‰ÂÓ ˘¿Ú¯ÂÈ ‰˘Ó·ÙfiÙËÙ· ·ÓoÛo-
ÚoʇϷ͢ ·fi ÙË Û˘ÁÁÂÓ‹ Ïo›ÌˆÍË ·fi ΢ÙÙ·Úo-
ÌÂÁ·Ïo˚fi, ·Ó Î·È ˘¿Ú¯ÂÈ ÂȉÈ΋ Á-ÛÊ·ÈÚ›ÓË Î·È ÂÌ-
‚fiÏÈo ·fi ÂÍ·ÛıÂÓË̤Óo˘˜ Èo‡˜, o˘ ¯oÚËÁo‡ÓÙ·È ÛÂ
·ÓoÛoηٷÛÙ·Ï̤Óo˘˜ ·ÛıÂÓ›˜32-34. ∏ ¯oÚ‹ÁËÛË ÂÈ-
‰È΋˜ Á-ÛÊ·ÈÚ›Ó˘ ÛÙËÓ ¤Á΢o Ú·ÎÙÈο Â›Ó·È ‰‡ÛÎo-
Ïo Ó· ÂÊ·ÚÌoÛÙ›, ÁÈ·Ù› ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒ-
ÛÂȘ Ë ÓfiÛo˜ ‰È·‰Ú¿ÌÂÈ ·Û˘Ìو̷ÙÈο ‹ Û·Ó ‹È·
ÈoÁÂÓ‹˜ Ïo›ÌˆÍË Î·È ‰ÂÓ ‰È·ÁÈÁÓÒÛÎÂÙ·È. ∂ÈϤoÓ,
fiÙ·Ó ÂÌÊ·ÓÈÛÙo‡Ó Ù· Û˘ÌÙÒÌ·Ù· Ù˘ ÓfiÛo˘ ÛÙË ÌË-
Ù¤Ú·, ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ ˘¿Ú¯o˘Ó ‹‰Ë
ÛÙoÓ oÚfi Ù˘ CMV-IgG Î·È CMV-IgM ·ÓÙÈÛÒÌ·Ù·.6
ªÂÏÏoÓÙÈÎfi˜ ÛÙfi¯o˜ Â›Ó·È Ë ·Ú·Û΢‹ ÂÌ‚oÏ›o˘
·fi ÌË ÏoÈÌoÁfiÓ· ·ÓÙÈÁoÓÈο ÙÌ‹Ì·Ù· Ùo˘ Èo‡, fiˆ˜
Â›Ó·È oÈ ÂÈÊ·ÓÂȷΤ˜ ÁÏ˘ÎoÚˆÙ½Ó˜ Î·È ¿ÏϘ
ÚˆÙ½Ó˜ Ùo˘. ◊‰Ë ‚Ú›ÛÎoÓÙ·È Û ÂͤÏÈÍË ÌÂϤÙ˜
ÁÈ· ÙËÓ ·oÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Î·È ·ÛÊ¿ÏÂÈ· ·Ó·Û˘Ó-
‰˘·ÛÌ¤ÓˆÓ ÂÌ‚oÏ›ˆÓ3,6,33,34.
ªÂ Ù· ‰Â‰o̤ӷ ·˘Ù¿, Ë ÚfiÏË„Ë Ù˘ Û˘ÁÁÂ-
Óo‡˜ Ïo›ÌˆÍ˘ ·fi ÙoÓ Î˘ÙÙ·ÚoÌÂÁ·Ïo˚fi ‚·Û›˙Â-
Ù·È ÛÙË Ï‹„Ë ÁÂÓÈÎÒÓ ÚoÏËÙÈÎÒÓ Ì¤ÙÚˆÓ Î·È ÙËÓ
·ÓÙÈÌÂÙÒÈÛË Ù˘ ÓfiÛo˘ ÛÙo ÓÂoÁÓfi:
2. °ÂÓÈο ÚoÏËÙÈο ̤ÙÚ·
OÈ ¤ÁÎ˘Â˜ Ú¤ÂÈ Ó· ·oʇÁo˘Ó ¯ÒÚo˘˜,
fiˆ˜ oÈ ‚ÚÂÊoÓËÈ·Îo› ÛÙ·ıÌo› Î·È Ù· ÙÌ‹Ì·Ù·
fio˘ ÓoÛËχoÓÙ·È ÓÂoÁÓ¿ ‹ ·ÓoÛoηٷÛÙ·Ï̤ÓoÈ
·ÛıÂÓ›˜, fio˘ Ë Èı·ÓfiÙËÙ· ÊoÚ¤ˆÓ Ùo˘ Èo‡ ›ӷÈ
ÌÂÁ¿ÏË6,12. ∞Ó ÛÙo ÂÚÈ‚¿ÏÏoÓ Ù˘ ÂÁ·o˘ ˘¿Ú¯ÂÈ
·È‰› o˘ ¿ÂÈ Û ‚ÚÂÊoÓËÈ·Îfi ÛÙ·ıÌfi, Ë ¤Á΢o˜
Ú¤ÂÈ Ó· ·›ÚÓÂÈ Û¯oÏ·ÛÙÈο ̤ÙÚ· ·ÙoÌÈ΋˜ ˘ÁÈ-
ÂÈÓ‹˜, fiˆ˜ ηÏfi χÛÈÌo ÙˆÓ ¯ÂÚÈÒÓ ÌÂÙ¿ ·fi ·Ï-
Ï·Á‹ ¿Ó·˜ Ùo˘ ‚Ú¤Êo˘˜, Î.·. ∂›Û˘, Ú¤ÂÈ Ó·
·oʇÁÂÈ Ó· ¯ÚËÛÈÌooÈ› Û·Ë, fiˆ˜ oÙ‹ÚÈ·,
o˘ ¤¯o˘Ó ¯ÚËÛÈÌooÈ‹ÛÂÈ ¿ÏÏ· ¿ÙoÌ·6.
™Â ‡oÙË ‹ ‚¤‚·ÈË Ïo›ÌˆÍË Ù˘ ÂÁ·o˘, ÌoÚ›
Ó· Á›ÓÂÈ ‰È¿ÁÓˆÛË ÙˆÓ Úoۂ‚ÏËÌ¤ÓˆÓ ÂÌ‚Ú‡ˆÓ ÌÂ
·ÌÓÈoΤÓÙËÛË ÌÂÙ¿ ÙËÓ 21Ë Â‚‰oÌ¿‰· Ù˘ ·ËÛ˘ ÌÂ
ηÏÏȤÚÁÂȘ Ùo˘ Èo‡ ‹ PCR, ·ÏÏ¿ ‰ÂÓ ˘¿Ú¯ÂÈ ‰˘-
Ó·ÙfiÙËÙ· ÚfiÏË„Ë ·ÎfiÌË Î·È ·Ó ‰È·ÁÓˆÛÙ› Ë Ófi-
Ûo˜19,20. ¶ÚfiÛÊ·Ù· ÂÚÈÁÚ¿ÊËÎ·Ó ‰˘o ÂÚÈÙÒÛÂȘ
ÂÓ‰oÂÚÈÙoÓ·˚΋˜ ¯oÚ‹ÁËÛ˘ CMV Á-ÛÊ·ÈÚ›Ó˘ ÛÂ
¤Ì‚Ú˘· o˘ Ë ÌËÙ¤Ú· Ùo˘˜ ·Úo˘Û›·Û CMV Ïo›Ìˆ-
ÍË ÛÙË ‰È¿ÚÎÂÈ· Ù˘ ·ËÛ˘. ∏ ¯oÚ‹ÁËÛ‹ Ù˘ ‰ÂÓ
·¤ÙÚ„ ÙË Ïo›ÌˆÍË Ùo˘ ÂÌ‚Ú‡o˘, ·ÏÏ¿ oÈ Û˘ÁÁÚ·-
Ê›˜ ıˆÚo‡Ó Èı·Ófi fiÙÈ ÂÏ¿ÙÙˆÛ ÙË ‚·Ú‡ÙËÙ· Ù˘
ÓfiÛo˘ Û’ ·˘Ùfi35,36. OÈ ‰˘o ·˘Ù¤˜ ÂÚÈÙÒÛÂȘ ‰ÂÓ Â›-
Ó·È ·ÚÎÂÙ¤˜ ÁÈ· Ó· ÙÂÎÌËÚÈÒÛo˘Ó ooÈ·‰‹oÙ o‰Ë-
Á›· ·Ó·ÊoÚÈο Ì ÙËÓ ¯oÚ‹ÁËÛË ˘ÂÚ¿ÓoÛ˘ Á-ÛÊ·-
Ú›ÓË Î·Ù¿ ÙËÓ Î‡ËÛË.
3. ∞ÓÙÈÌÂÙÒÈÛË Ù˘ ÓfiÛo˘ ÛÙo ÓÂoÁ¤ÓÓËÙo
ªÂÙ¿ ÙË Á¤ÓÓËÛË ÌoÚ› Ó· ¯oÚËÁËı› ·ÓÙÈ-ÈÈ-
΋ ıÂÚ·›· ÛÙo ÓÂoÁÓfi. Δ· Û˘Ó‹ıË ·ÓÙÈ-ÈÈο
Ê¿Ú̷η ‰ÂÓ ·o‰Â›¯ıËÎ·Ó ·oÙÂÏÂÛÌ·ÙÈο ÁÈ·
ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ Û˘ÁÁÂÓo‡˜ Ïo›ÌˆÍ˘ ·fi
CMV. Δ· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ‰oÎÈÌ¿˙ÂÙ·È Ë ÁηÓÛÈ-
ÎÏo‚›ÚË [9- (1, 3-‰È˘‰Úo͢Úoo͢ÌÂı˘Ï) Áo˘·Ó›-
ÓË]. OÈ ÚÒÙ˜ ÌÂϤÙ˜ Û ÓÂoÁÓ¿ ÌÂ Û˘ÁÁÂÓ‹ Ïo›-
̈ÍË ·fi Î˘Ù·ÚoÌÂÁ·Ïo˚fi ¤‰ÂÈÍ·Ó fiÙÈ Ë ¯oÚ‹ÁËÛË
ÁηÓÛÈÎÏo‚›Ú˘ ÛÙo ÓÂoÁÓfi ÛÙÂÚÂ›Ù·È Ûo‚·ÚÒÓ
·ÚÂÓÂÚÁÂÈÒÓ Î·È ÂÏ·ÙÙÒÓÂÈ ÛËÌ·ÓÙÈο ÙËÓ ·o-
‚oÏ‹ Ùo˘ Èo‡37,38. øÛÙfiÛo, Úo˜ Ùo ·ÚfiÓ Ë ÁηÓ-
ÛÈÎÏo‚›ÚË ‰ÂÓ ÌoÚ› Ó· ¯oÚËÁËı› Û·Ó ıÂÚ·›·
Úo˘Ù›Ó·˜ Û’ fiÏ· Ù· Úoۂ‚ÏË̤ӷ ÓÂoÁÓ¿, ̤¯ÚÈ
Ó· ‰ËÌoÛÈ¢Ùo‡Ó Ù· ·oÙÂϤÛÌ·Ù· ηϿ oÚÁ·Óˆ-
Ì¤ÓˆÓ ÌÂÏÂÙÒÓ.
πÏ·Ú¿
O ΢ÚÈfiÙÂÚo˜ ÙÚfio˜ ÚfiÏ˄˘ Ù˘ Û˘ÁÁÂÓo‡˜
ÈÏ·Ú¿˜ Â›Ó·È o ÂÌ‚oÏÈ·ÛÌfi˜ ‚ÚÂÊÒÓ Î·È ·È‰ÈÒÓ. O
·ÓıÈÏ·ÚÈÎfi˜ ÂÌ‚oÏÈ·ÛÌfi˜ Ù˘ ÂÁ·o˘ ·ÓÙÂӉ›ÎÓ˘-
Ù·È, ·ÏÏ¿, fiˆ˜ Î·È Ì ÙËÓ ÂÚ˘ıÚ¿, ‰ÂÓ ·ÓÙÂӉ›ÎÓ˘-
Ù·È o ÂÌ‚oÏÈ·ÛÌfi˜ ·ÙfiÌˆÓ Ùo˘ ÂÚÈ‚¿ÏÏoÓÙfi˜ Ù˘5.
∞Ó Ë ¤Á΢o˜ ÂÎÙÂı› ÛÙË ÓfiÛo, Û˘ÓÈÛÙ¿Ù·È Ë ¯o-
Ú‹ÁËÛË ÎoÈÓ‹˜ Á-ÛÊ·ÈÚ›Ó˘ Û ‰fiÛË 0,25 mL/kg ‚¿-
Úo˘˜ ÛÒÌ·Ùo˜ ̤۷ ÙȘ 3 ÚÒÙ˜ Ë̤Ú˜ ·fi ÙËÓ ¤Î-
ıÂÛË5.
∞Ó Ë ÌËÙ¤Ú· ·Úo˘ÛÈ¿ÛÂÈ ÈÏ·Ú¿ ÛÙËÓ ÂÚÈÁÂÓ-
ÓËÙÈ΋ ÂÚ›o‰o, ÛÙo ÓÂoÁ¤ÓÓËÙo ¯oÚËÁÂ›Ù·È ÎoÈÓ‹ Á-
ÛÊ·ÈÚ›ÓË5.
§o›ÌˆÍË ·fi ÙoÓ Èfi ·ÓÂÌ¢ÏoÁÈ¿˜ - ˙ˆÛÙ‹Ú·
∏ ÚfiÏË„Ë Ù˘ Û˘ÁÁÂÓo‡˜ Ïo›ÌˆÍ˘ ·fi ÙoÓ
Èfi ·ÓÂÌ¢ÏoÁÈ¿˜–˙ˆÛÙ‹Ú· ‚·Û›˙ÂÙ·È Î˘Ú›ˆ˜ ÛÙË
¯oÚ‹ÁËÛË ÂȉÈ΋˜ Á-ÛÊ·ÈÚ›Ó˘ Î·È ·ÓÙÈ-ÈÈÎÒÓ Ê·Ú-
Ì¿ÎˆÓ ÛÙËÓ ¤Á΢o Î·È Ùo ÓÂoÁÓfi (¶›Ó. 2).
™Â Â›ÓoÛ˜ ¤ÁÎ˘Â˜ o˘ ÂÎÙ¤ıËÎ·Ó ÛÙoÓ Èfi Á›-
ÓÂÙ·È ÚoÛ¿ıÂÈ· ÚfiÏ˄˘ Ù˘ ÓfiÛo˘ Ì ÙË ¯oÚ‹-
ÁËÛË ˘ÂÚ¿ÓoÛ˘ Á-ÛÊ·ÈÚ›Ó˘ ̤۷ ÛÙȘ ÚÒÙ˜ 4-
6 Ë̤Ú˜ ·fi ÙËÓ ¤ÎıÂÛ‹ Ù˘ ÛÙoÓ Èfi, ÁÈ· ÙËÓ oo›·
 ¶·È‰È·ÙÚÈ΋ B√ƒ∂ÿ√À ∂§§Õ¢√˜, 13, 2
¶›Ó·Î·˜ 2. ¶ÚfiÏË„Ë Î·È ·ÓÙÈÌÂÙÒÈÛË Û˘ÁÁÂÓo‡˜
Ïo›ÌˆÍ˘ ·fi ÙoÓ Èfi ·ÓÂÌ¢ÏoÁÈ¿˜–˙ˆÛÙ‹Ú·
1. ŒÎıÂÛË Â›ÓoÛ˘ ÂÁ·o˘ ÛÙoÓ Èfi
ñ ÂȉÈ΋ Á-ÛÊ·ÈÚ›ÓË ÛÙȘ ÚÒÙ˜ 4-6 Ë̤Ú˜
·fi ÙËÓ ¤ÎıÂÛË
2. ¡fiÛËÛË ÂÁ·o˘ ·fi ·ÓÂÌ¢ÏoÁÈ¿
ñ ·Î˘ÎÏo‚›ÚË;
3. ¡fiÛËÛË ÂÁ·o˘ ÙȘ ÙÂÏÂ˘Ù·›Â˜ 4 Ë̤Ú˜ ÚÈÓ ÙoÓ
ÙoÎÂÙfi ̤¯ÚÈ Î·È 4 Ë̤Ú˜ ÌÂÙ¿ ·’ ·˘ÙfiÓ
ñ ·Î˘ÎÏo‚›ÚË ÛÙË ÌËÙ¤Ú·
ñ ÂȉÈ΋ Á-ÛÊ·ÈÚ›ÓË ÛÙo ÓÂoÁÓfi
ñ ·oÌfiÓˆÛË Î·È ÛÙÂÓ‹ ·Ú·ÎoÏo‡ıËÛË Ùo˘
ÓÂoÁÓo‡
4. ¡fiÛËÛË Ùo˘ ÓÂoÁÓo‡ ·fi ·ÓÂÌ¢ÏoÁÈ¿
ñ ∞΢ÎÏo‚›ÚË ÛÙo ÓÂoÁÓfi
‰È·ÈÛÙÒıËΠfiÙÈ o˘ÛÈ·ÛÙÈο ÂÍ·Ê·Ó›˙ÂÈ ÙoÓ Î›Ó-
‰˘Óo Û˘Ìو̷ÙÈ΋˜ Ïo›ÌˆÍ˘ Ùo˘ ΢‹Ì·Ùo˜3.
∞Ó Ë ¤Á΢o˜ ÂΉËÏÒÛÂÈ ·ÓÂÌ¢ÏoÁÈ¿, Ë ¯oÚ‹ÁË-
ÛË Á-ÛÊ·ÈÚ›Ó˘ ‰ÂÓ ÚoÊ˘Ï¿ÛÛÂÙ·È Ùo ¤Ì‚Ú˘o ·fi
ÙË Ïo›ÌˆÍË39,40. ™ÙËÓ ÂÚ›ÙˆÛË ·˘Ù‹ oÏÏo› Û˘ÛÙ‹-
Óo˘Ó ÙË ¯oÚ‹ÁËÛË ·Î˘ÎÏo‚›Ú˘ ÛÙË ÌËÙ¤Ú· (800mg
à 5 ÊoÚ¤˜ ÙËÓ Ë̤ڷ ·fi Ùo ÛÙfiÌ· ‹ 500 mg/8ˆÚo
ÂÓ‰oÊϤ‚È·). ∏ ¯oÚ‹ÁËÛË ·Î˘ÎÏo‚›Ú˘ ÛÙË ‰È¿Ú-
ÎÂÈ· Ù˘ ·ËÛ˘ ‰ÂÓ ¤¯ÂÈ Û˘Ó‰Âı› Ì ÙÂÚ·ÙoÁfiÓo
‰Ú¿ÛË, ·ÏÏ¿ ‰ÂÓ ˘¿Ú¯o˘Ó ·ÎfiÌË ·ÚÎÂÙ¿ ‰Â‰o̤ӷ
o˘ Ó· ÛÙËÚ›˙o˘Ó ÙËÓ ·ÛÊ¿ÏÂÈ· Î·È ·oÙÂÏÂÛÌ·ÙÈ-
ÎfiÙËÙ· Ù˘ ıÂÚ·›·˜ ·˘Ù‹˜ ÁÈ· Ùo ·ËÌ·22,23.
∞Ó Ë ÌËÙ¤Ú· ·Úo˘ÛÈ¿ÛÂÈ ¤ÚËÙ· ˙ˆÛÙ‹Ú·
ÛÙË ‰È¿ÚÎÂÈ· Ù˘ ·ËÛ˘, ‰Â ¯ÚÂÈ¿˙ÂÙ·È ·ÓoÛoÚo-
ʇϷÍË11, ÁÈ·Ù› ‰ÂÓ ¤¯ÂÈ ÂÚÈÁÚ·Ê› ÌÂÙ¿‰oÛË Ùo˘
Èo‡ ÛÙo ·ËÌ·.
∞Ó Ë ÌËÙ¤Ú· ·Úo˘ÛÈ¿ÛÂÈ ·ÓÂÌ¢ÏoÁÈ¿ ÙȘ ÙÂ-
ÏÂ˘Ù·›Â˜ 4 Ë̤Ú˜ ÚÈÓ ÙoÓ ÙoÎÂÙfi ‹ ·Ì¤Ûˆ˜ ÌÂÙ¿
·’ ·˘ÙfiÓ, Ë ÓfiÛo˜ ÛÙo ÓÂoÁ¤ÓÓËÙo Â›Ó·È È‰È·›ÙÂÚ·
Û˘¯Ó‹ (ÂÚ›o˘ Ùo 50% ÓoÛo‡Ó) Î·È ‚·ÚÈ¿ Ì ˘„Ë-
Ï‹ ıÓËÙfiÙËÙ· (30%)4. °È’ ·˘Ùfi, ÂӉ›ÎÓ˘Ù·È Ë ¯oÚ‹-
ÁËÛË ÛÙo ÓÂoÁÓfi ˘ÂÚ¿ÓoÛ˘ Á-ÛÊ·ÈÚ›Ó˘ (125
ÌoÓ¿‰Â˜, ÂÊ’ ¿·Í, ∂ª), Ë oo›· ÌÂÙÚÈ¿˙ÂÈ ÙË ‚·-
Ú‡ÙËÙ· Ù˘ ÓÂoÁÓÈ΋˜ ·ÓÂÌ¢ÏoÁÈ¿˜ Î·È ÂÏ·ÙÙÒÓÂÈ
ÛËÌ·ÓÙÈο ÙoÓ Î›Ó‰˘Óo ı·Ó·ÙËÊfiÚ·˜ ¤Î‚·Û˘4,40.
¶Ú¤ÂÈ fï˜ Ó· Ï·Ì‚¿ÓÂÙ·È ˘fi„Ë Ùo ÁÂÁoÓfi˜ fiÙÈ
Ë ¯oÚ‹ÁËÛË ˘ÂÚ¿ÓoÛ˘ Á-ÛÊ·ÈÚ›Ó˘ ÛÙo ÓÂoÁ¤Ó-
ÓËÙo ÌoÚ› Ó· ÂÈÌË·ÓÂÈ Ùo ¯ÚfiÓo ÂÒ·Û˘ ·fi
11 Û 30 Ë̤Ú˜, ofiÙ ·˘Í¿ÓÂÙ·È Ùo ‰È¿ÛÙËÌ· ÛÙo
oo›o Ùo ÓÂoÁÓfi Ú¤ÂÈ Ó· ·Ú·ÎoÏo˘ıÂ›Ù·È ÛÙÂ-
Ó¿ ÁÈ· ÂӉ¯o̤ÓË ÂÌÊ¿ÓÈÛË Û˘Ìو̿وÓ39,41.
Δ·˘Ùfi¯ÚoÓ· Û˘ÛÙ‹ÓÂÙ·È Ë ·oÌfiÓˆÛË Ùo˘ ·È‰Èo‡
·fi ÙË ÌËÙ¤Ú· ÁÈ· 1 ‚‰oÌ¿‰· ÂÚ›o˘.
∞Ó Ùo ÓÂoÁÓfi ÂΉËÏÒÛÂÈ ·ÓÂÌ¢ÏoÁÈ¿, Ú¤ÂÈ
Ó· ¿ÚÂÈ ıÂÚ·›· Ì ·Î˘ÎÏo‚›ÚË ÂÓ‰oÊϤ‚È· (10
115
-15mg/kg οı 8 ÒÚ˜) ÁÈ· 5-7 Ë̤Ú˜ ‹ ̤¯ÚÈ Ó·
ÂÊÂÏÎȉooÈËıo‡Ó fiϘ Ë ‰ÂÚÌ·ÙÈΤ˜ ‚Ï¿‚˜ ‹ Ó·
ÛÙ·Ì·Ù‹ÛÂÈ ‹ ¤Îı˘ÛË Ó¤ˆÓ ÛÙoȯ›ˆÓ4,42.
O ÁÂÓÈÎÂ˘Ì¤Óo˜ ÂÌ‚oÏÈ·ÛÌfi˜ fiÏˆÓ ÙˆÓ ·È‰È-
ÒÓ Î·Ù¿ Ù˘ ·ÓÂÌ¢ÏoÁÈ¿˜ ‰ÂÓ ¤¯ÂÈ ıÂÛÈÛÙ› ·Îfi-
ÌË ÛÙË ¯ÒÚ· Ì·˜ Î·È ‰ÂÓ Î˘ÎÏoÊoÚ› Ùo ÂÌ‚fiÏÈo
Ù˘ ÓfiÛo˘. øÛÙfiÛo, ÛÙȘ ∏¶ ΢ÎÏoÊoÚ› ÂÌ‚fiÏÈo
·fi ˙ˆÓÙ·Óo‡˜ ÂÍ·ÛıÂÓË̤Óo˘˜ Èo‡˜, o˘ Úoη-
Ï› ·ÓoÛ›· ‰È¿ÚÎÂÈ·˜ Ùo˘Ï¿¯ÈÛÙoÓ 10 ¯ÚfiÓˆÓ Î·È
ÂÊ·ÚÌfi˙ÂÙ·È ÁÂÓÈÎÂ˘Ì¤Óo˜ ÂÌ‚oÏÈ·ÛÌfi˜ fiÏˆÓ ÙˆÓ
·È‰ÈÒÓ41.
§o›ÌˆÍË ·fi ÙoÓ Èfi Ùo˘ ·Ïo‡ ¤ÚËÙ·
Δo ÓÂoÁÓfi Û˘Ó‹ıˆ˜ ÌoχÓÂÙ·È ·fi ÙoÓ Èfi Ùo˘
·Ïo‡ ¤ÚËÙ· ηٿ ÙË ‰È¿ÚÎÂÈ· Ùo˘ ÎoÏÈÎo‡ Ùo-
ÎÂÙo‡, fiÙ·Ó ˘¿Ú¯o˘Ó ÂÓÂÚÁ›˜ ÂÚËÙÈΤ˜ ‚Ï¿‚˜
Ùo˘ ÁÂÓÓËÙÈÎo‡ ۈϋӷ. ™·ÓÈfiÙÂÚ· ÌoÚ› Ó· Ìo-
Ï˘Óı› ÂÓ‰oÌËÙÚ›ˆ˜ ‹ ÌÂÙ¿ ÙoÓ ÙoÎÂÙfi. ∏ ÚfiÏË„Ë
Ù˘ οıÂÙ˘ ÌÂÙ¿‰oÛ˘ ‚·Û›˙ÂÙ·È Î˘Ú›ˆ˜ ÛÙËÓ
·ÓÙÈÌÂÙÒÈÛË Ù˘ ÓfiÛo˘ ÛÙË ÌËÙ¤Ú· Î·È ÙËÓ ÂÈÏo-
Á‹ Ùo˘ ηٿÏÏËÏo˘ ÙÚfio˘ ÙoÎÂÙo‡, ÂÓÒ ‰ÂÓ ˘¿Ú-
¯ÂÈ ‰˘Ó·ÙfiÙËÙ· ÂÓÂÚÁËÙÈ΋˜ ‹ ·ıËÙÈ΋˜ ·ÓoÛo-
ÚoʇϷ͢ Úo˜ Ùo ·ÚfiÓ (¶›Ó. 3)20,43.
1. ∞ÓÙÈÌÂÙÒÈÛË Ù˘ ÓfiÛo˘ ÛÙËÓ ¤Á΢o
∞Ó Ë ¤Á΢o˜ ·Úo˘ÛÈ¿ÛÂÈ ¤ÚËÙ· ÁÂÓÓËÙÈÎÒÓ
oÚÁ¿ÓˆÓ ÂӉ›ÎÓ˘Ù·È Ë ¯oÚ‹ÁËÛË ·ÓÙÈ-ÈÈ΋˜ ·Áˆ-
Á‹˜, o˘ ·oÛÎo› ÛÙËÓ ·Ó·Îo‡ÊÈÛË Ù˘ ›‰È·˜
·fi Ù· Û˘ÌÙÒÌ·Ù· Î·È ÛÙoÓ ÂÚÈoÚÈÛÌfi Ùo˘ ÎÈÓ-
‰‡Óo˘ οıÂÙ˘ ÌÂÙ¿‰oÛ˘. OÈ ·fi„ÂȘ, fï˜, ÁÈ·
ÙË ¯oÚ‹ÁËÛË ·Î˘ÎÏo‚›Ú˘ ÛÙËÓ ¤Á΢o ·Ú·Ì¤Óo˘Ó
·ÓÙÈÎÚo˘fiÌÂÓ˜ Î·È ¯oÚËÁÂ›Ù·È ÌfiÓo ·Ó o ˘oÏoÁÈ-
˙fiÌÂÓo˜ ÁÈ· Ùo ¤Ì‚Ú˘o ΛӉ˘Óo˜ ·fi ÙË ÓfiÛo ›ӷÈ
ÌÂÁ·Ï‡ÙÂÚo˜ ·’ fiÙÈ ·fi Ùo Ê¿ÚÌ·Îo7,22,23. OÈ Â-
ÚÈÛÛfiÙÂÚoÈ ÂÚ¢ÓËÙ¤˜ Û˘ÌʈÓo‡Ó fiÙÈ Â›Ó·È ·ÛÊ·-
Ï‹˜ Ë ¯oÚ‹ÁËÛ‹ Ù˘ ÛÙo Ù¤Ïo˜ Ù˘ ·ËÛ˘7.
¢ÂÓ ˘¿Ú¯ÂÈ ‰˘Ó·ÙfiÙËÙ· ·ıËÙÈ΋˜ ·ÓoÛoo›-
ËÛ˘ Ù˘ ÂÁ·o˘, ÁÈ·Ù› Ë oÏ˘‰‡Ó·ÌË ÂÓ‰oÊϤ‚È· Á-
ÛÊ·ÈÚ›ÓË o˘ ΢ÎÏoÊoÚ› ‰ÂÓ ÚoÛʤÚÂÈ ÚoÛÙ·-
Ù¢ÙÈο Â›‰· ·ÓÙÈÂÚËÙÈÎÒÓ ·ÓÙÈۈ̿وÓ7,43. Δ·
ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· Á›ÓÂÙ·È ÚoÛ¿ıÂÈ· ·Ú·ÁˆÁ‹˜ ÂÈ-
‰È΋˜ Á-ÛÊ·ÈÚ›Ó˘ Î·È ÌoÓoÎψÓÈÎÒÓ ·ÓÙÈۈ̿وÓ
ηٿ Ùo˘ Èo‡ Ùo˘ ·Ïo‡ ¤ÚËÙ·20.
2. ¶ÚoÏËÙÈο ̤ÙÚ· ÛÙoÓ ÙoÎÂÙfi
∫¿ı ¤Á΢o˜ Ú¤ÂÈ Ó· ÂÍÂÙ¿˙ÂÙ·È ÚoÛÂÎÙÈ-
ο ÁÈ· ÙËÓ ‡·ÚÍË ÂÚËÙÈÎÒÓ ‚Ï·‚ÒÓ ÛÙoÓ o˘Úo-
ÁÂÓÓËÙÈÎfi ۈϋӷ Î·È ÙËÓ ÂÚÈo¯‹ Ùo˘ ÂÚÈÓ¤o˘,
ȉȷ›ÙÂÚ· ·Ó ·Ó·Ê¤ÚÂÙ·È ÈÛÙoÚÈÎfi ˘oÙÚoÈ¿˙o-
ÓÙ· ¤ÚËÙ· ÁÂÓÓËÙÈÎÒÓ oÚÁ¿ÓˆÓ ÛÙËÓ ›‰È· ‹ Ùo ÛÂ-
116 ¶·È‰È·ÙÚÈ΋ B√ƒ∂ÿ√À ∂§§Õ¢√˜, 13, 2
¶›Ó·Î·˜ 3. ¶ÚfiÏË„Ë Î·È ·ÓÙÈÌÂÙÒÈÛË Ïo›ÌˆÍ˘ ΢-
‹Ì·Ùo˜ Î·È ÓÂoÁÓo‡ ·fi ÙoÓ Èfi Ùo˘ ·Ïo‡ ¤ÚËÙ·
1. ∞ÓÙÈÌÂÙÒÈÛË Ù˘ ÓfiÛo˘ ÛÙËÓ ¤Á΢o
I. ∞΢ÎÏo‚›ÚË (·ÛÊ·Ï‹˜ ÛÙo Ù¤Ïo˜ Ù˘ ·ËÛ˘)
2. ¶ÚoÏËÙÈο ̤ÙÚ· ÛÙËÓ Î‡ËÛË Î·È ÙoÎÂÙfi
π. ¶ÚoÛÂÎÙÈ΋ ÂͤٷÛË Ù˘ ÂÁ·o˘ ÁÈ· oÚ·Ù¤˜
‚Ï¿‚˜
ππ. ∫·ÏÏȤÚÁÂÈ· ÎoÏÈÎo‡ ÂȯڛÛÌ·Ùo˜ fiÙ·Ó
˘¿Ú¯o˘Ó: ÂÚËÙÈΤ˜ ‚Ï¿‚˜, ÈÛÙoÚÈÎfi ˘oÚo-
È¿˙oÓÙ· ¤ÚËÙ·, ¤ÚËÙ·˜ ÁÂÓÓËÙÈÎÒÓ oÚÁ¿-
ÓˆÓ ÛÂÍo˘·ÏÈÎo‡ Û˘ÓÙÚfiÊo˘
πππ. ΔoÎÂÙfi˜:
·) ∫·ÈÛ·ÚÈ΋ ÙoÌ‹ (<4 ÒÚ˜ ·fi ÙË Ú‹ÍË ÂÌ-
‚Ú˘˚ÎÒÓ ˘Ì¤ÓˆÓ) ·Ó ÙËÓ ÙÂÏÂ˘Ù·›· ‚‰oÌ¿-
‰· Úo Ùo˘ ÙoÎÂÙo‡ ‚ÚÂıo‡Ó ÂÚËÙÈΤ˜ ‚Ï¿-
‚˜ ÎfiÏo˘-ÂÚÈÓ¤o˘ ‹ ·oÌoÓˆı› o Èfi˜
·fi ÙoÓ ÎfiÏo.
‚) ∫oÏÈÎfi˜, ·Ó ‰ÂÓ ˘¿Ú¯o˘Ó oÈ ·Ú·¿Óˆ
Úo¸oı¤ÛÂȘ.
3. ª¤ÙÚ· ÛÙo ÓÂoÁ¤ÓÓËÙo o˘ ÁÂÓÓ‹ıËΠ·fi ÌËÙ¤-
Ú· Ì ÂÚËÙÈΤ˜ ‚Ï¿‚˜ ‹ ıÂÙÈΤ˜ ηÏÏȤÚÁÂȘ ÎoÏ-
ÈÎo‡ ÂȯڛÛÌ·Ùo˜
π. ∞Ó ÁÂÓÓ‹ıËΠ̠ηÈÛ·ÚÈ΋ ÙoÌ‹ :
·) ηÏÏȤÚÁÂȘ ÂÈÊ·ÓÂÈÒÓ ÛÒÌ·Ùo˜ Î·È o‡-
ÚˆÓ Î·È ·Ú·ÎoÏo‡ıËÛË
ππ. ∞Ó ÁÂÓÓ‹ıËΠ̠ÎoÏÈÎfi ÙoÎÂÙfi ·fi ÌËÙ¤Ú·
Ì ˘oÙÚoÈ¿˙oÓÙ· ¤ÚËÙ· ÛÙËÓ Î‡ËÛË :
·) ηÏÏȤÚÁÂȘ ÂÈÊ·ÓÂÈÒÓ ÛÒÌ·Ùo˜, o‡ÚˆÓ,
·›Ì·Ùo˜ Î·È O¡¶
‚) ·Ú·ÎoÏo‡ıËÛË
Á) ·Î˘ÎÏo‚›ÚË ·Ó ÂΉËÏÒÛÂÈ Û˘ÌÙÒÌ·Ù·
πππ. ∞Ó ÁÂÓÓ‹ıËΠ̠ÎoÏÈÎfi ÙoÎÂÙfi ·fi ÌËÙ¤Ú·
Ì ÚˆÙo·ı‹ ¤ÚËÙ· ÛÙËÓ Î‡ËÛË:
·) ηÏÏȤÚÁÂȘ ÂÈÊ·ÓÂÈÒÓ ÛÒÌ·Ùo˜, o‡ÚˆÓ,
·›Ì·Ùo˜ Î·È O¡¶
‚) ·Î˘ÎÏo‚›ÚË
Ío˘·ÏÈÎfi Ù˘ Û‡ÓÙÚoÊo. ™ÙȘ ÙÂÏÂ˘Ù·›Â˜ ÂÚÈÙÒ-
ÛÂȘ Û˘ÓÈÛÙ¿Ù·È Ë Ï‹„Ë Î·ÏÏÈÂÚÁÂÈÒÓ ÂȯÚÈÛÌ¿-
ÙˆÓ Ùo˘ ÎfiÏo˘ ÙoÓ ÙÂÏÂ˘Ù·›o Ì‹Ó· Ù˘ ·ËÛ˘ ‹
ÚÈÓ ÙoÓ ÙoÎÂÙfi, ·ÎfiÌË ÎÈ’ ·Ó ‰ÂÓ ˘¿Ú¯o˘Ó oÚ·-
Ù¤˜ ÂÚËÙÈΤ˜ ‚Ï¿‚˜7,20.
∞Ó Ë ÌËÙ¤Ú· ¤¯ÂÈ ÂÚËÙÈΤ˜ ‚Ï¿‚˜ ‹ ·oÌo-
Óˆı› o Èfi˜ ·fi ÙoÓ ÎfiÏo ÙËÓ ÙÂÏÂ˘Ù·›· ‚‰oÌ¿-
‰· ÚÈÓ ÙoÓ ÙoÎÂÙfi, ÂӉ›ÎÓ˘Ù·È Ë ‰ÈÂÓ¤ÚÁÂÈ· ηÈ-
Û·ÚÈ΋˜ ÙoÌ‹˜. ∏ ηÈÛ·ÚÈ΋ ÙoÌ‹ Ú¤ÂÈ Ó· Á›ÓÂÈ
ÚÈÓ ·fi ÙË Ú‹ÍË ÙˆÓ ÂÌ‚Ú˘˚ÎÒÓ ˘Ì¤ÓˆÓ ‹ ̤۷
ÛÙȘ ÚÒÙ˜ 6 ÒÚ˜ ÌÂÙ¿ ÙË Ú‹ÍË (̤¯ÚÈ 24 ÒÚ˜ Ùo
·ÚÁfiÙÂÚo), ÁÈ·Ù› ‰È·ÊoÚÂÙÈο ‰ÂÓ ÚoÛٷهÂÈ Ùo
ÓÂoÁÓfi ·fi ÙË ÌfiÏ˘ÓÛË. ∞Ó ‰ÂÓ ˘¿Ú¯o˘Ó ÂÚËÙÈ-
Τ˜ ‚Ï¿‚˜ ÛÙoÓ ÎoÏÈÎfi ۈϋӷ ‹ ÙËÓ ÂÚÈÓÂ˚΋
ÂÚÈo¯‹ Î·È oÈ Î·ÏÏȤÚÁÂȘ Â›Ó·È ·ÚÓËÙÈΤ˜ o
ÙoÎÂÙfi˜ ÌoÚ› Ó· Á›ÓÂÈ ÎoÏÈο7,20,44.
3. ¶ÚoÏËÙÈο ̤ÙÚ· ÛÙo ÓÂoÁÓfi
¡ÂoÁÓ¿ o˘ ÁÂÓÈo‡ÓÙ·È ·fi ÌËÙ¤Ú· ÌÂ ÂÓÂÚ-
Á›˜ ÂÚËÙÈΤ˜ ‚Ï¿‚˜ ‹ ıÂÙÈΤ˜ ηÏÏȤÚÁÂȘ ÙˆÓ
ÎoÏÈÎÒÓ ÂȯÚÈÛÌ¿ÙˆÓ, ÂÊfiÛoÓ ÁÂÓÓËıo‡Ó Ì ηÈ-
Û·ÚÈ΋ ÙoÌ‹ Ù›ıÂÓÙ·È Û ·Ú·ÎoÏo‡ıËÛË Î·È Ï·Ì-
‚¿ÓoÓÙ·È Î·ÏÏȤÚÁÂȘ ·fi ÙȘ ÂÈÊ¿ÓÂȘ Ùo˘ ÛÒ-
Ì·Ùo˜ Î·È Ù· o‡Ú·. ∞Ó fï˜ ÁÂÓÓËıo‡Ó Ì ÎoÏÈÎfi
ÙoÎÂÙfi, Ú¤ÂÈ Ó· ˘o‚ÏËıo‡Ó Û Ï‹ÚË ¤ÏÂÁ¯o o˘
Û˘ÌÂÚÈÏ·Ì‚¿ÓÂÈ Î·ÏÏȤÚÁÂȘ ·›Ì·Ùo˜ Î·È oÛÊ˘o-
ÓˆÙÈ·›· ·Ú·Î¤ÓÙËÛË. ∂ÈϤoÓ, ·Ó Ë ÌËÙ¤Ú· ¿-
Û¯ÂÈ ·fi ÚˆÙo·ı‹ ¤ÚËÙ·, Ú¤ÂÈ Ó· ·Ú¯›Ûo˘Ó
·Ì¤Ûˆ˜ ·ÁˆÁ‹ Ì ·Î˘ÎÏo‚›ÚË (10mg/kg/8ˆÚo, ∂º,
ÁÈ· 7-10 Ë̤Ú˜). ¢È·ÊoÚÂÙÈο Ë ·Î˘ÎÏo‚›ÚË ı· ¯o-
ÚËÁËı› ·Ó Ùo ÓÂoÁÓfi ÂΉËÏÒÛÂÈ Û˘ÓÙÒÌ·Ù·20.
∏·Ù›Ùȉ˜
∏·Ù›Ùȉ· μ
™ÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ Ë Î¿ıÂÙË ÌÂ-
Ù¿‰oÛË Ùo˘ Èo‡ Ù˘ Ë·Ù›Ùȉ·˜ μ Û˘Ì‚·›ÓÂÈ ÙËÓ
ÒÚ· Ùo˘ ÙoÎÂÙo‡ ·fi ÙȘ ÌoÏ˘Ṳ̂Ó˜ ÎoÏÈΤ˜ ÂÎ-
ÎÚ›ÛÂȘ ‹ Ùo ·›Ì· Ù˘ ÌËÙ¤Ú·˜. ŒÙÛÈ, Ë Ï‹„Ë Î·-
Ù¿ÏÏËÏˆÓ Ì¤ÙÚˆÓ ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙoÓ ÙoÎÂÙfi ÌoÚ›
Ó· ÚoÏ¿‚ÂÈ ÙË ÓfiÛo ÛÙo ÓÂoÁÓfi ÛÙo 90% ÙˆÓ Â-
ÚÈÙÒÛˆÓ. ™Ùo ˘fiÏoÈo 10% ÙˆÓ ÓÂoÁÓÒÓ Ë Ìfi-
Ï˘ÓÛË ¤¯ÂÈ Á›ÓÂÈ ‰È·Ï·Îo˘ÓÙȷο Î·È ÁÈ’ ·˘Ùfi Ù·
ÚoÏËÙÈο ̤ÙÚ· o˘ ÂÊ·ÚÌfi˙oÓÙ·È ÌÂÙ¿ ÙoÓ
ÙoÎÂÙfi ·oÙ˘Á¯¿Óo˘Ó25.
∏ ÛÙÚ·ÙËÁÈ΋ Ù˘ ÚfiÏ˄˘ Ù˘ οıÂÙ˘ ÌÂ-
Ù¿‰oÛ˘ Ù˘ Ë·Ù›Ùȉ·˜ μ ÂÚÈÏ·Ì‚¿ÓÂÈ Î˘Ú›ˆ˜
ÙËÓ ·ÓoÛoÚoʇϷÍË Ùo˘ ÓÂoÁÓo‡ Î·È ÙËÓ ÂÈÏoÁ‹
Ùo˘ ηٿÏÏËÏo˘ ÙÚfio˘ ÙoÎÂÙo‡.
∞. ∏ ·ÓoÛoÚoʇϷÍË ·fi ÙËÓ Ë·Ù›Ùȉ· μ
ÂÍ·ÚÙ¿Ù·È ·fi ÙËÓ Î·Ù¿ÛÙ·ÛË ·ÓÙÈÁoÓ·ÈÌ›·˜ Ù˘
ÌËÙ¤Ú·˜25,45-47:
1.¡ÂoÁÓ¿ o˘ ÁÂÓÓÈo‡ÓÙ·È ·fi ÌËÙ¤Ú˜ ÊoÚ›˜
Ùo˘ HμsAg.
¶Ú¤ÂÈ Ó· ·Ú¯›Ûo˘Ó ·ÓoÛoÚoʇϷÍË ÌÂ
˘ÂÚ¿ÓoÛË Á-ÛÊ·ÈÚ›Ó˘ (0.5 ml ∂ª) Î·È ÂÌ-
‚fiÏÈo (Recombivax ‹ Engerix, 0.5 ml ∂ª),
o˘ ¯oÚËÁo‡ÓÙ·È Ì¤Û· Û 12 ÒÚ˜ ·fi ÙË
Á¤ÓÓËÛË, Û ‰È·ÊoÚÂÙÈΤ˜ ı¤ÛÂȘ. ∂·Ó·ÏË-
ÙÈΤ˜ ‰fiÛÂȘ Ùo˘ ÂÌ‚oÏ›o˘ Á›ÓoÓÙ·È ÛÙoÓ 1o-
2o Ì‹Ó· Î·È ÛÙoÓ 6o Ì‹Ó· ˙ˆ‹˜34. ™Â ÚfiˆÚ·
Ì ‚¿Úo˜ Á¤ÓÓËÛ˘ οو ÙˆÓ 2kg Û˘ÛÙ‹ÓÂÙ·È
Ë ¯oÚ‹ÁËÛË ÌÈ·˜ ÂÈϤoÓ ‰fiÛ˘ ÂÌ‚oÏ›o˘
Î·È Ë oÚoÏoÁÈ΋ ·Ú·ÎoÏo‡ıËÛ‹ Ùo˘ ÌÂÙ¿ ÙË
Û˘ÌÏ‹ÚˆÛË Ùo˘ ‚·ÛÈÎo‡ ÂÌ‚oÏÈ·ÛÌo‡46,47.
2.¡ÂoÁÓ¿ o˘ ÁÂÓÓÈo‡ÓÙ·È ·fi ÌËÙ¤Ú˜ ÌÂ
¿ÁÓˆÛÙË Î·Ù¿ÛÙ·ÛË ·ÓÙÈÁoÓ·ÈÌ›·˜ ÁÈ· ÙËÓ
 ¶·È‰È·ÙÚÈ΋ B√ƒ∂ÿ√À ∂§§Õ¢√˜, 13, 2
Ë·Ù›Ùȉ· μ.
¶Ú¤ÂÈ Ó· ÂÌ‚oÏÈ·ÛÙo‡Ó ̤۷ ÛÙȘ ÚÒÙ˜
12 ÒÚ˜ ·fi ÙË Á¤ÓÓËÛË. ™˘Á¯ÚfiÓˆ˜ Á›ÓÂÙ·È
¤ÏÂÁ¯o˜ Ù˘ ÌËÙ¤Ú·˜ Î·È ·Ó ·o‰Âȯı› fiÙÈ
Â›Ó·È ÊoÚ¤·˜ Ùo˘ HμsAg, ¯oÚËÁÂ›Ù·È Î·È
˘ÂÚ¿ÓoÛË Á-ÛÊ·ÈÚ›ÓË Ùo Û˘ÓÙoÌfiÙÂÚo ‰˘-
Ó·Ùfi, Î·È oˆÛ‰‹oÙ ̤۷ ÛÙȘ ÚÒÙ˜ 48
ÒÚ˜ ·fi ÙË Á¤ÓÓËÛË34,40.
3.¡ÂoÁÓ¿ o˘ ÁÂÓÓÈo‡ÓÙ·È ·fi ÌËÙ¤Ú˜ Ì ·Ú-
ÓËÙÈÎfi HBsAg.
ŒÓ·ÚÍË ÂÌ‚oÏÈ·ÛÌo‡ ̤۷ ÛÙo˘˜ ‰˘o ÚÒ-
Ùo˘˜ Ì‹Ó˜ Ù˘ ˙ˆ‹˜45.
μ. ΔÚfio˜ ÙoÎÂÙo‡. ™˘ÛÙ‹ÓÂÙ·È ÎoÏÈÎfi˜ Ùo-
ÎÂÙfi˜, ÂÎÙfi˜ ·Ó ˘¿Ú¯ÂÈ Î¿oÈ· ·fiÏ˘ÙË ¤Ó‰ÂÈÍË
‰ÈÂÓ¤ÚÁÂÈ·˜ ηÈÛ·ÚÈ΋˜ ÙoÌ‹˜, ηıÒ˜ Ë Û˘ÁΤ-
ÓÙÚˆÛË Ùo˘ Èo‡ ÛÙȘ ÎoÏÈΤ˜ ÂÎÎÚ›ÛÂȘ Â›Ó·È ÌÈ-
ÎÚfiÙÂÚË ·ã fiÙÈ ÛÙo ·›Ì· Ù˘ ÌËÙ¤Ú·˜25.
∏·Ù›Ùȉ· A
¢ÂÓ ˘¿Ú¯ÂÈ ¤Ó‰ÂÈÍË ÂÓÂÚÁËÙÈ΋˜ ‹ ·ıËÙÈ΋˜
·ÓoÛoÚoʇϷ͢ ÛÙË ‰È¿ÚÎÂÈ· Ù˘ ·ËÛ˘ ‹ ÛÙË
ÓÂoÁÓÈ΋ ÂÚ›o‰o. πÛ¯‡o˘Ó, ˆÛÙfiÛo, oÈ ÁÂÓÈΤ˜ ÂÓ-
‰Â›ÍÂȘ ·ÓoÛoÚoʇϷ͢ ÏËı˘ÛÌÒÓ fio˘ Ë Â›-
ÙˆÛË Ù˘ ÓfiÛo˘ Â›Ó·È ·˘ÍË̤ÓË34,46.
∏·Ù›Ùȉ· D
O Èfi˜ Ù˘ Ë·Ù›Ùȉ·˜ D ÚoηÏ› Ë·Ù›Ùȉ·
ÌfiÓo Û ¿ÙoÌ· Ì ٷ˘Ùfi¯ÚoÓË Ïo›ÌˆÍË ·fi ÙoÓ Èfi
Ù˘ Ë·Ù›Ùȉ·˜ μ. °È’ ·˘Ùfi, Ë ÌÂÙ¿‰oÛË ·fi ÌËÙ¤Ú·
Û ÓÂoÁÓfi Â›Ó·È ·Û˘Ó‹ıÈÛÙË. ™Â ÂÚ›ÙˆÛË ÌËÙ¤-
Ú·˜ Ì Ë·Ù›Ùȉ· D, Û˘ÛÙ‹ÓÂÙ·È ÁÈ· Ùo ÓÂoÁÓfi Ë
›‰È· ·ÓoÛoÚoʇϷÍË Î·Ù¿ Ù˘ Ë·Ù›Ùȉ·˜ μ, o˘
Á›ÓÂÙ·È fiÙ·Ó Ë ÌËÙ¤Ú· Â›Ó·È ÊoÚ¤·˜ Ùo˘ HμsAg
(ÂÌ‚fiÏÈo Î·È ˘ÂÚ¿ÓoÛË Á-ÛÊ·ÈÚ›ÓË)26.
°È· Ù· ÓÂoÁÓ¿ ÌËÙ¤ÚˆÓ Ì Ë·Ù›Ùȉ· C, ∂ ‹ G
‰ÂÓ ˘¿Ú¯ÂÈ ‰˘Ó·ÙfiÙËÙ· ÚfiÏ˄˘26,48,49.
§o›ÌˆÍË ·fi ÙoÓ Èfi Ù˘ Â›ÎÙËÙ˘ ·ÓoÛoÏoÁÈ΋˜
·ÓÂ¿ÚÎÂÈ·˜ (HIV)
∏ οıÂÙË ÌÂÙ¿‰oÛË Ùo˘ Èo‡ HIV Â›Ó·È ˘‡-
ı˘ÓË ÁÈ· Ùo 90% ÙˆÓ ÂÚÈÙÒÛÂˆÓ Ùo˘ Û˘Ó‰ÚfiÌo˘
Â›ÎÙËÙ˘ ·ÓoÛoÏoÁÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜ (AIDS) ÛÙ·
·È‰È¿. ∏ ÌÂÙ¿‰oÛË ÛÙo ·È‰› ÌoÚ› Ó· Û˘Ì‚Â›
ÚoÁÂÓÓËÙÈο ·ÏÏ¿ Û˘Ó‹ıˆ˜ Û˘Ì‚·›ÓÂÈ ÛÙË ‰È¿Ú-
ÎÂÈ· Ùo˘ ÙoÎÂÙo‡ (¿Óˆ ·fi 50%) Î·È ·fi Ùo Á¿-
Ï· Ù˘ ÌËÙ¤Ú·˜ (14%)24,50,51. ∏ Û˘¯ÓfiÙËÙ· οıÂÙ˘
ÌÂÙ¿‰oÛ˘ oÈΛÏÏÂÈ ·fi 14% ̤¯ÚÈ 40%52 ηÈ
ÂÍ·ÚÙ¿Ù·È ·fi Ùo ÛÙ¿‰Èo Ù˘ ÓfiÛo˘ ÛÙË ÌËÙ¤Ú·,
ÙoÓ ·ÚÈıÌfi ÙˆÓ CD4+ ΢ÙÙ¿ÚˆÓ Î·È Ùo ÈÈÎfi ÊoÚ-
Ù›o Ù˘ ÌËÙ¤Ú·˜24,51-53.
117
1. ¶ÚˆÙoÁÂÓ‹˜ ÚfiÏË„Ë
°È· ÙËÓ ÚfiÏË„Ë Ù˘ Û˘ÁÁÂÓo‡˜ Ïo›ÌˆÍ˘ ·fi
ÙoÓ Èfi HIV Â›Ó·È ÛËÌ·ÓÙÈ΋ Ë ÚˆÙoÁÂÓ‹˜ ÚfiÏË-
„Ë Ì ÙËÓ ÂÓË̤ڈÛË Î·È ÂÎ·›‰Â˘ÛË ÙˆÓ Á˘Ó·È-
ÎÒÓ ÁÈ· Ùo˘˜ ÙÚfio˘˜ ÌÂÙ¿‰oÛ˘ Ùo˘ Èo‡ Î·È Úo-
ʇϷ͢ ·fi Ùo AIDS.
2. ¶ÚfiÏË„Ë Ù˘ ÌÂÙ¿‰oÛ˘ ÛÙo ·ËÌ· Î·È ÓÂo-
ÁÓfi, ·Ó Ë ¤Á΢o˜ ÓoÛ› ‹ Â›Ó·È ÊoÚ¤·˜ Ùo˘ Èo‡
·) ÃoÚ‹ÁËÛË ·ÓÙÈÚÂÙÚo˚È΋˜ ıÂÚ·›·˜ ÛÙË ÌËÙ¤-
Ú· Ì zidovudin ·fi Ùo ÛÙfiÌ· ·fi ÙË 14Ë Â‚‰o-
Ì¿‰· Ù˘ ·ËÛ˘ Î·È ÂÓ‰oÊϤ‚È· ÙËÓ ÒÚ· Ùo˘
ÙoÎÂÙo‡24.
‚) ΔoÎÂÙfi˜ Ì ηÈÛ·ÚÈ΋ ÚÈÓ ·fi ÙË Ú‹ÍË ÙˆÓ
ÂÌ‚Ú˘˚ÎÒÓ ˘Ì¤ÓˆÓ Î·È ·oÊ˘Á‹ ÙÚ·˘Ì·ÙÈÛÌÒÓ
Ùo˘ ‰¤ÚÌ·Ùo˜ Ùo˘ ΢‹Ì·Ùo˜/ÓÂoÁÓo‡ (.¯.
ÚoÛÎfiÏËÛË ËÏÂÎÙÚo‰›ˆÓ ̤ÙÚËÛ˘ Ùo˘ pH ÛÙo
ÙÚȯˆÙfi Ùo˘ ÎÂÊ·ÏÈo‡)8,24,53,54.
Á) ÃoÚ‹ÁËÛË ÚoÏËÙÈ΋˜ ıÂÚ·›·˜ ÛÙo ÓÂoÁ¤Ó-
ÓËÙo. ªÂÙ¿ ÙoÓ ÙoÎÂÙfi Â›Ó·È ‰‡ÛÎoÏo Ó· Á›ÓÂÈ Ë
‰È¿ÎÚÈÛË ÙˆÓ ÓÂoÁÓÒÓ o˘ ÌoχÓıËηÓ. °È’ ·˘-
Ùfi fiÏ· Ù· ‚Ú¤ÊË o˘ ÁÂÓÓÈo‡ÓÙ·È ·fi ÌËÙ¤Ú˜
¿Û¯o˘Û˜ ‹ ÊoÚ›˜ Ùo˘ HIV Ú¤ÂÈ ¿Úo˘Ó
ÚoÏËÙÈ΋ ıÂÚ·›· Ì zidovudin ÁÈ· 6 ‚‰o-
Ì¿‰Â˜. ªÂ ÙË Û˘Ó‰˘·Ṳ̂ÓË ·ÓÙÈÚÂÙÚo˚È΋ ıÂ-
Ú·›· ÌËÙ¤Ú·˜ Î·È ÓÂoÁÓo‡ ÂÏ·ÙÙÒÓÂÙ·È Ë Û˘-
¯ÓfiÙËÙ· οıÂÙ˘ ÌÂÙ¿‰oÛ˘ ÛÙo 8% ÂÚ›-
o˘55,56.
‰) O ıËÏ·ÛÌfi˜ ‰Â Û˘ÛÙ‹ÓÂÙ·È ÛÙ· ÓÂoÁÓ¿ ÌËÙ¤-
ÚˆÓ ÊoÚ¤ˆÓ Ùo˘ Èo‡ ‹ ·Û¯fiÓÙˆÓ, ÂÎÙfi˜ ·Ó oÈ
ÎoÈÓˆÓÈÎooÈÎoÓoÌÈΤ˜ Û˘Óı‹Î˜ ηıÈÛÙo‡Ó
··ÁoÚ¢ÙÈ΋ ÙË ‰È·ÙÚoÊ‹ Ì ͤÓo Á¿Ï·24,55,56.
3. ¢È¿ÁÓˆÛË Ù˘ ÓfiÛo˘ ÛÙo ÓÂoÁ¤ÓÓËÙo
O ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯o˜ ÛÙo ÓÂoÁ¤ÓÓËÙo
Ú·ÎÙÈο Á›ÓÂÙ·È ÙoÓ 1o-2o Ì‹Ó· Ù˘ ˙ˆ‹˜, ofiÙÂ
ÌoÚ› Ó· ·ÓȯÓ¢ı› Ùo DNA Ùo˘ Èo‡ Ì PCR. ∏
ÂͤٷÛË Â·Ó·Ï·Ì‚¿ÓÂÙ·È ÚÈÓ ·fi ÙoÓ 6o Ì‹Ó·.
∏ ¢·ÈÛıËÛ›· Ù˘ PCR Êı¿ÓÂÈ Ùo 90%, Î·È ·Ó ‚ÚÂ-
ı› ıÂÙÈ΋ Ûã ooÈo‰‹oÙ ‰Â›ÁÌ·, Ú¤ÂÈ Ó· Â·-
Ó·ÏËÊı›52.
4. ÀoÛÙËÚÈÎÙÈ΋ ·ÁˆÁ‹ ÛÙo ‚Ú¤Êo˜ o˘ Ìo-
χÓıËÎÂ24,52
π. ∞ÓÙÈÚÂÙÚo˚È΋ ·ÁˆÁ‹
ππ. ∫·Ù·oϤÌËÛË Â˘Î·ÈÚÈ·ÎÒÓ ÏoÈÌÒ͈Ó
πππ.Δ· ‚Ú¤ÊË Ì AIDS Ú¤ÂÈ Ó· ÂÌ‚oÏÈ¿˙oÓÙ·È
ηÓoÓÈο fiˆ˜ Ù· Ê˘ÛÈoÏoÁÈο ‚Ú¤ÊË, ·ÏÏ¿ oÈ
ÂÌ‚oÏÈ·ÛÌo› ηٿ ÙˆÓ ÈoÁÂÓÒÓ ÏoÈÌÒÍÂˆÓ Ú¤-
ÂÈ Ó· Á›ÓoÓÙ·È Ì ·‰Ú·ÓooÈË̤Óo˘˜ Èo‡˜2,56.
118 ¶·È‰È·ÙÚÈ΋ B√ƒ∂ÿ√À ∂§§Õ¢√˜, 13, 2
º˘Ì·Ù›ˆÛË
∞Ó Î·È Ë Û˘ÁÁÂÓ‹˜ Ê˘Ì·Ù›ˆÛË Â›Ó·È Û¿ÓÈ·, Ë
¤Í·ÚÛË o˘ ·Úo˘ÛÈ¿˙ÂÈ Ë ÓfiÛo˜ ÛÙo˘˜ ÂÓ‹ÏÈΘ
Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÂÊÈÛÙ¿ ÙËÓ ÚoÛo¯‹ ÁÈ· Ùo ÂÓ-
‰Â¯fiÌÂÓo ÂÌÊ¿ÓÈÛ˘ Ê˘Ì·Ù›ˆÛ˘ Û ÓÂoÁÓ¿ ·-
Û¯fiÓÙˆÓ ÌËÙ¤ÚˆÓ, ÁÈ· Ù· oo›· Ú¤ÂÈ Ó· Ï·Ì‚¿-
ÓoÓÙ·È Ù· ηٿÏÏËÏ· ̤ÙÚ· ÚfiÏ˄˘ Î·È ¤ÁηÈ-
Ú˘ ·ÓÙÈÌÂÙÒÈÛ˘57,58.
Δ· ÚoÏËÙÈο ̤ÙÚ· ÛÙËÓ ¤Á΢o Î·È Ùo ÓÂo-
Á¤ÓÓËÙo ÂÍ·ÚÙÒÓÙ·È ·fi ÙËÓ ‡·ÚÍË ıÂÙÈ΋˜ Man-
toux ÛÙËÓ ¤Á΢o, Ù· Â˘Ú‹Ì·Ù· Ù˘ ·ÎÙÈÓoÁÚ·Ê›·˜
ıÒڷη, ÙËÓ ‡·ÚÍË Û˘ÌÙˆÌ¿ÙˆÓ Î·È ÙËÓ ·oÌfi-
ÓˆÛË Ùo˘ Ì˘Îo‚·ÎÙËÚȉ›o˘ ·fi ÙËÓ Î·ÏÏȤÚÁÂÈ·
Ù˘¤ÏˆÓ Ù˘ ÌËÙ¤Ú·˜. Δ· ̤ÙÚ· ·˘Ù¿ Û˘ÓoÙÈο ›-
Ó·È Ù· ·Ú·Î¿Ùˆ59,60:
1. ∞Û˘Ìو̷ÙÈ΋ ÌËÙ¤Ú· Ì ıÂÙÈ΋ Mantoux
Î·È ·ÚÓËÙÈ΋ ·ÎÙÈÓoÁÚ·Ê›· ıÒڷη
·) ÃoÚ‹ÁËÛË ÛÙË ÌËÙ¤Ú· ÈÛoÓÈ·˙›‰Ë˜ Î·È ˘Úȉo-
͛Ӣ ÌÂÙ¿ Ùo 1o ÙÚ›ÌËÓo ‹ ÌÂÙ¿ ÙoÓ ÙoÎÂÙfi
‚) Ÿ¯È ·oÌ¿ÎÚ˘ÓÛË Ùo˘ ·È‰Èo‡
Á) ¡·È ÛÙo ıËÏ·ÛÌfi
‰) ŒÏÂÁ¯o˜ Ù˘ oÈÎoÁ¤ÓÂÈ·˜
Â) Mantoux ÛÙo ‚Ú¤Êo˜, ·Ó o ¤ÏÂÁ¯o˜ Ù˘ oÈÎoÁ¤-
ÓÂÈ·˜ ‰Â›ÍÂÈ ¿Û¯oÓÙ· ·fi ÂÓÂÚÁfi ÓfiÛo.
2. ªËÙ¤Ú· Ì ıÂÙÈ΋ Mantoux Î·È ·ıoÏoÁÈ΋
·ÎÙÈÓoÁÚ·Ê›· ıÒڷη, ·ÏÏ¿ ¯ˆÚ›˜ ÂӉ›ÍÂȘ ÂÓÂÚ-
Áo‡ ÓfiÛo˘ (·Û˘Ìو̷ÙÈ΋ Ì ·ÚÓËÙÈΤ˜ ηÏÏȤÚ-
ÁÂȘ Ù˘¤ÏˆÓ)
·) ∞ÓÙÈÊ˘Ì·ÙÈ΋ ·ÁˆÁ‹ ÛÙË ÌËÙ¤Ú·, ·Ó ‰ÂÓ ‹ÚÂ
ÛÙo ·ÚÂÏıfiÓ
‚) ¶·Ú·ÎoÏo‡ıËÛË Ùo˘ ‚Ú¤Êo˘˜
Á) ¡·È ÛÙo ıËÏ·ÛÌfi
‰) ŒÏÂÁ¯o˜ Ù˘ oÈÎoÁ¤ÓÂÈ·˜
Â) Mantoux ÛÙo ‚Ú¤Êo˜ ÌÂÙ¿ ·fi 6 ‚‰oÌ¿‰Â˜
3. ªËÙ¤Ú· Ì ÎÏÈÓÈΤ˜ Î·È ·ÎÙÈÓoÏoÁÈΤ˜ ÂӉ›-
ÍÂȘ ÂÓÂÚÁo‡ ÓfiÛo˘ ‹ ıÂÙÈΤ˜ ηÏÏȤÚÁÂȘ Ù˘¤ÏˆÓ
π. ∞ÓÙÈÊ˘Ì·ÙÈ΋ ·ÁˆÁ‹ ÛÙË ÌËÙ¤Ú· Ì ÈÛoÓÈ·˙›‰Ë
Î·È ÚÈÊ·Ì˘Î›ÓË ÁÈ· 6-9 Ì‹Ó˜ Ì·˙› Ì ·Èı·-
Ìo˘ÙfiÏË ÁÈ· Ùo˘˜ ÚÒÙo˘˜ 2 Ì‹Ó˜ Ù˘ ıÂÚ·-
›·˜. ∏ ˘oÏoÁÈ˙fiÌÂÓË Û˘¯ÓfiÙËÙ· Û˘ÁÁÂÓÒÓ
‰È·Ì·ÚÙÈÒÓ Â›Ó·È ÂÚ›o˘ 1%, 2% Î·È 3% ÁÈ·
ÙËÓ ÈÛoÓÈ·˙›‰Ë, ·Èı·Ìo˘ÙfiÏË Î·È ÚÈÊ·Ì˘Î›-
ÓË, ·ÓÙ›ÛÙoȯ·.58,61 ÕÏÏ· ·ÓÙÈÊ˘Ì·ÙÈο, fiˆ˜ Ë
ÛÙÚÂÙoÌ˘Î›ÓË, Ë ˘ÚÈ˙ÈÓ·Ì›‰Ë Î·È Ë Î˘ÎÏoÛÂ-
Ú›ÓË, Â›Ó·È ÙÂÚ·ÙoÁfiÓ· ‹ ‰ÂÓ ¤¯ÂÈ ‰È¢ÎÚÈÓÈÛÙ›
Ë Â›‰Ú·Û‹ Ùo˘˜ ÛÙo ·ËÌ·58-61.
ππ. §ÂÙoÌÂÚ‹˜ ¤ÏÂÁ¯o˜ Ùo˘ ÓÂoÁÓo‡ ÁÈ· Û˘ÁÁÂÓ‹
Ïo›ÌˆÍË (ÎÏÈÓÈÎfi˜, ·ÎÙÈÓoÁÚ·Ê›·, Mantoux).
ππ·) ∞Ó o ¤ÏÂÁ¯o˜ ÛÙo ÓÂoÁÓfi Â›Ó·È ÂÓ‰ÂÈÎÙÈ-
Îfi˜ Û˘ÁÁÂÓo‡˜ Ê˘Ì·Ù›ˆÛ˘ ı· ¿ÚÂÈ ·ÁˆÁ‹ Ì 4
·ÓÙÈÊ˘Ì·ÙÈο Ê¿Ú̷η (ÈÛoÓÈ·˙›‰Ë, ÚÈÊ·ÌÈΛÓË
Î·È ˘ÚÈ˙ÈÓ·Ì›‰Ë Ì·˙› Ì Âı·Ìo˘ÙfiÏË ‹ ÛÙÚÂÙo-
Ì˘Î›ÓË).
ππ‚) ∞Ó o ¤ÏÂÁ¯o˜ ÛÙo ÓÂoÁÓfi Â›Ó·È ·ÚÓËÙÈÎfi˜
Û˘ÓÈÛٿٷÈ:
∞. ∞oÌ¿ÎÚ˘ÓÛË ·fi ÙË ÌËÙ¤Ú· ̤¯ÚÈ Ó· ·Ú-
¯›ÛÂÈ ÚoÏËÙÈ΋ ·ÁˆÁ‹ Ì ÈÛoÓÈ·˙›‰Ë.
μ. ¶ÚoÏËÙÈ΋ ¯oÚ‹ÁËÛË ÛÙo ÓÂoÁÓfi ÈÛoÓÈ·-
˙›‰Ë˜, o˘ Û˘Ó¯›˙ÂÙ·È ÁÈ· 3 Ì‹Ó˜ ÌÂÙ¿ ÙËÓ
·ÚÓËÙÈÎoo›ËÛË ÙˆÓ Ù˘¤ÏˆÓ Ù˘ ÌËÙ¤Ú·˜,
Î·È ÛÙË Û˘Ó¤¯ÂÈ· ‰ÈÂÓ¤ÚÁÂÈ· Mantoux.
μ1.∞Ó Ë Mantoux Â›Ó·È ıÂÙÈ΋, ı· Á›ÓÂÈ ÎÏÈÓÈÎfi˜
Î·È ·ÎÙÈÓoÏoÁÈÎfi˜ ¤ÏÂÁ¯o˜. ∞Ó o ¤ÏÂÁ¯o˜ ›-
Ó·È Ê˘ÛÈoÏoÁÈÎfi˜, ı· Û˘Ó¯›ÛÂÈ Ì ÈÛoÓÈ·˙›-
‰Ë ÁÈ· 9 Ì‹Ó˜. ∞Ó o ¤ÏÂÁ¯o˜ Ùo˘ ·È‰Èo‡ ›-
Ó·È ·ıoÏoÁÈÎfi˜, ı· ¯oÚËÁËı› ·ÓÙÈÊ˘Ì·ÙÈ-
΋ ·ÁˆÁ‹ ÌÂ Û˘Ó‰˘·ÛÌfi ·ÓÙÈÊ˘Ì·ÙÈÎÒÓ
Ê·Ú̿ΈÓ.
μ2. ∞Ó Ë Mantoux ÛÙo ‚Ú¤Êo˜ Â›Ó·È ·ÚÓËÙÈ΋
ı· ‰È·Îo› Ë ÈÛoÓÈ·˙›‰Ë, ı· Á›ÓÂÈ BCG
Î·È ı· ÂÍ·ÎoÏo˘ı‹ÛÂÈ Ë ·Ú·ÎoÏo‡ıËÛË
Ùo˘ ‚Ú¤Êo˘˜. Mantoux ı· Í·Ó·Á›ÓÂÈ ÌÂÙ¿
·fi 6-12 Ì‹Ó˜.
∏ Ê˘Ì·ÙÈÓo·ÓÙ›‰Ú·ÛË ‰Â ‚oËı¿ ÛÙËÓ ÚÒÈÌË
‰È¿ÁÓˆÛË Ù˘ Û˘ÁÁÂÓo‡˜ Ê˘Ì·Ù›ˆÛ˘, ÁÈ·Ù› ıÂÙÈ-
ÎooÈÂ›Ù·È 6-8 ‚‰oÌ¿‰Â˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË57. ∞Ó Ùo
BCG Á›ÓÂÈ ÛÙË ÓÂoÁÓÈ΋ ËÏÈΛ·, Ë ·oÙÂÏÂÛÌ·ÙÈÎfi-
ÙËÙ· Êı¿ÓÂÈ Ì¤¯ÚÈ 83%59-62. ∂ȉÈο ÁÈ· Ù· ÚfiˆÚ·,
ÚfiÛÊ·Ù˜ ÌÂϤÙ˜ ¤¯o˘Ó ‰Â›ÍÂÈ fiÙÈ Ë ·oÙÂÏÂÛÌ·-
ÙÈÎfiÙËÙ¿ Ùo˘ BCG Â›Ó·È Î·Ï‡ÙÂÚË ·Ó Á›ÓÂÈ ·Êo‡ Ùo
ÓÂoÁ¤ÓÓËÙo Û˘ÌÏËÚÒÛÂÈ ÙȘ 34-35 ‚‰oÌ¿‰Â˜ ÌÂ-
Ù¿ ÙË Û‡ÏÏË„Ë.64.
™‡ÊÈÏË
Δo ÙÚÂfiÓËÌ· Ùo ˆ¯Úfi, o ·ÈÙÈoÏoÁÈÎfi˜ ·Ú¿Áo-
ÓÙ·˜ Ù˘ ÓfiÛo˘, ÌoÚ› Ó· ÂÚ¿ÛÂÈ ÙoÓ Ï·Îo‡ÓÙ·
Î·È Ó· ÚoÛ‚¿ÏÏÂÈ Ùo ·ËÌ· Û’ fiÏË ÙË ‰È¿ÚÎÂÈ· Ù˘
·ËÛ˘ ‹ ÛÙoÓ ÙoÎÂÙfi.17,65 øÛÙfiÛo, oÈ ‚Ï¿‚˜ Ù˘
Û˘ÁÁÂÓo‡˜ Û‡ÊÈÏ˘ ‰ÂÓ ·Ó·Ù‡ÛÛoÓÙ·È ÚÈÓ ·fi ÙËÓ
20Ë Â‚‰oÌ¿‰·, ÏfiÁˆ ·‰˘Ó·Ì›·˜ Ùo˘ ΢‹Ì·Ùo˜ Ó·
·Ó·Ù‡ÍÂÈ ÊÏÂÁÌoÓÒ‰Ë ·ÓÙ›‰Ú·ÛË ÚÈÓ ·fi ÙËÓ ËÏÈ-
Λ· ·˘Ù‹. ∏ Û˘¯ÓfiÙËÙ· Î·È ‚·Ú‡ÙËÙ· ÚoÛ‚oÏ‹˜ Ùo˘
΢‹Ì·Ùo˜ ÂÍ·ÚÙÒÓÙ·È ·fi Ùo ÛÙ¿‰Èo Ù˘ ÓfiÛo˘ ÛÙË
ÌËÙ¤Ú· Î·È ÙË ¯oÚ‹ÁËÛË Â·ÚÎo‡˜ ıÂÚ·›·˜ Û’ ·˘-
Ù‹Ó17,65. ™Â ÓfiÛo ÚÒÙo˘ ‹ ‰Â˘Ù¤Úo˘ ÛÙ·‰›o˘ Ë Û˘-
¯ÓfiÙËÙ· ÂÓ‰oÌ‹ÙÚÈ·˜ ÌÂÙ¿‰oÛ˘ Â›Ó·È ÂÚ›o˘
100%, ·Ó ‰ÂÓ ·ÓÙÈÌÂÙˆÈÛÙ› Ë ÓfiÛo˜ ÛÙËÓ ¤Á΢o,
 ¶·È‰È·ÙÚÈ΋ B√ƒ∂ÿ√À ∂§§Õ¢√˜, 13, 2
Î·È ÂÏ·ÙÙÒÓÂÙ·È ‚·ıÌÈ·›· fiÛo ·˘Í¿ÓÂÙ·È Ë ‰È¿Ú-
ÎÂÈ· Ù˘ ÓfiÛo˘ ÛÙË ÌËÙ¤Ú·. ∏ ·ÓÙÈÌÂÙÒÈÛË Ù˘ Ófi-
Ûo˘ ÛÙË ÌËÙ¤Ú· ÚoÛٷهÂÈ Ï‹Úˆ˜ Ùo ·ËÌ·17,65.
Δ· ̤ÙÚ· ÚfiÏ˄˘ Ù˘ Û˘ÁÁÂÓo‡˜ Û‡ÊÈÏ˘
ÂÚÈÏ·Ì‚¿Óo˘Ó ÙË ‰È¿ÁÓˆÛË Î·È ·ÓÙÈÌÂÙÒÈÛË Ù˘
ÓfiÛo˘ ÛÙË ÌËÙ¤Ú· Î·È ÙË ¯oÚ‹ÁËÛË ıÂÚ·›·˜ ÛÙo
ÓÂoÁÓfi ÂÊfiÛoÓ ˘¿Ú¯o˘Ó Û˘ÁÎÂÎÚÈ̤Ó˜ ÂӉ›-
ÍÂȘ8,17,65,66.
1. ¢È¿ÁÓˆÛË Ù˘ ÓfiÛo˘ ÛÙËÓ ¤Á΢o
ñ ŸÏ˜ oÈ ¤ÁÎ˘Â˜ Ú¤ÂÈ Ó· ÂϤÁ¯oÓÙ·È Ì VDRL
Î·È RPR ÛÙËÓ ÚÒÙË Ùo˘˜ Â›Û΄Ë. ∞Ó Ù· ·o-
ÙÂϤÛÌ·Ù· ÙˆÓ ÌË ÙÚÂoÓËÌ·ÙÈÎÒÓ ‰oÎÈÌ·ÛÈÒÓ
Â›Ó·È ıÂÙÈο ‹ ·ÌÊ›‚oÏ·, Á›ÓÂÙ·È ÂȂ‚·›ˆÛË
Ì ‰oÎÈ̷ۛ˜ o˘ ·ÓȯÓ‡o˘Ó ÂȉÈο ·ÓÙÈÙÚÂo-
ÓËÌ·ÙÈο ·ÓÙÈÛÒÌ·Ù· (FTA-ABS, MHA-TP).
°ÂÓÈο, ÁÈ· ÙË ‰È¿ÁÓˆÛË ··ÈÙÂ›Ù·È o Û˘Ó‰˘·-
ÛÌfi˜ ÌÈ·˜ ÙÚÂoÓËÌ·ÙÈ΋˜ Î·È ÌÈ·˜ ÌË ÙÚÂoÓË-
Ì·ÙÈ΋˜ ‰oÎÈÌ·Û›·˜ (¶›Ó. 4). ∏ ·Ú·ÎoÏo‡ıËÛË
Ù˘ ıÂÚ·›·˜ Á›ÓÂÙ·È Ì ÌË ÙÚÂoÓËÌ·ÙÈ΋ ‰o-
ÎÈÌ·Û›·, ÁÈ·Ù› o Ù›ÙÏo˜ ÙˆÓ ÂȉÈÎÒÓ ·ÓÙÈۈ̿وÓ
¤¯ÂÈ ÊÙˆ¯‹ Û˘Û¯¤ÙÈÛË Ì ÙËÓ ÂÓÂÚÁfiÙËÙ· Ù˘ Ófi-
Ûo˘ Î·È ÌoÚ› Ó· ·Ú·Ì›ÓÂÈ ·˘ÍË̤Óo˜ ηÈ
ÌÂÙ¿ ÙËÓ Ï‹ÚË ıÂÚ·›· Ù˘ ÓfiÛo˘2.
ñ ∞Ó›¯Ó¢ÛË ÛÂÈÚo¯·ÈÙÒÓ Û ˘ÏÈÎfi ·fi ‡oÙ˜
‚Ï¿‚˜ Ì ÌÈÎÚoÛÎfiËÛË Û ÛÎoÙÂÈÓfi ‰›o
Î·È ·ÓoÛoÊıoÚÈÛÌfi.
2. ∞ÓÙÈÌÂÙÒÈÛË Ù˘ ÓfiÛo˘ ÛÙËÓ ¤Á΢o
ñ μÂÓ˙·ÓıÈÓÈ΋ ÂÓÈÎÈÏÏ›ÓË G 2,4 mU ∂ª ·Ó¿
‚‰oÌ¿‰· ÁÈ· 1-3 ‚‰oÌ¿‰Â˜.
ñ ™Â Ó¢ÚoÛ‡ÊÈÏË ¯oÚËÁÂ›Ù·È ÎÚ˘ÛÙ·ÏÈ΋ ÂÓÈ-
ÎÈÏÏ›ÓË G 2,4 mU ∂º ÁÈ· 10-14 Ë̤Ú˜ Î·È ÛÙË
¶›Ó·Î·˜ 4. ∂ÚÌËÓ›· ÙˆÓ ·oÙÂÏÂÛÌ¿ÙˆÓ Ùo˘ oÚoÏoÁÈÎo‡ ÂϤÁ¯o˘ ÌËÙ¤Ú·˜ Î·È ·È‰Èo‡ ÁÈ· Û›Ê˘ÏË2
ªË ÙÚÂoÓËÌ·ÙÈΤ˜ ∂ȉÈΤ˜ ÙÚÂoÓËÌ·ÙÈΤ˜
‰oÎÈ̷ۛ˜ ‰oÎÈ̷ۛ˜
(VDRL, RPR) (FTA-ABS, MHA-TR)
ªËÙ¤Ú· ¡ÂoÁÓfi ªËÙ¤Ú· ¡ÂoÁÓfi
-- -- -- --
+ + -- --
+ +/-- + +
+ + + +
-- -- + +
119
Û˘Ó¤¯ÂÈ· Úoη˚ÓÈ΋ ÂÓÈÎÈÏÏ›ÓË G 12-24 mU
∂ª Ì·˙› Ì Úo‚ÂÓÂΛ‰Ë (500mg/kg/∏ Û 4 ‰fi-
ÛÂȘ ·fi Ùo ÛÙfiÌ· ÁÈ· 10-14 Ë̤Ú˜). ªoÚ›
Ó· ·ÎoÏo˘ı‹ÛÂÈ ‚ÂÓ˙·ÓıÈÓÈ΋ ÂÓÈÎÈÏÏ›ÓË G
2,4 mU ·Ó¿ ‚‰oÌ¿‰· ÁÈ· 3 ‚‰oÌ¿‰Â˜.
3. ¢È¿ÁÓˆÛË ÚoÛ‚oÏ‹˜ Ùo˘ ΢‹Ì·Ùo˜
ñ ∞ÌÓÈo·Ú·Î¤ÓÙËÛË Î·È Ï‹„Ë ·ÌÓÈ·Îo‡ ˘ÁÚo‡
ÁÈ· ÙËÓ ·Ó‡ÚÂÛË ÛÂÈÚo¯·ÈÙÒÓ, o˘ ÌoÚ› Ó·
Á›ÓÂÈ Ì ÌÈÎÚoÛÎfiËÛË Û ÛÎoÙÂÈÓfi ‰›o ‹ ÌÂ
PCR.
ñ ÀÂÚ˯oÁÚ¿ÊËÌ· ÂÌ‚Ú‡o˘ ÁÈ· ·Ó‡ÚÂÛË ÂÓ-
‰Â›ÍÂˆÓ ÂÌ‚Ú˘˚Îo‡ ‡‰Úˆ·.
4. ¢È¿ÁÓˆÛË ÛÙo ÓÂoÁÓfi
ñ º˘ÛÈ΋ ÂͤٷÛË
ñ O oÚoÏoÁÈÎfi˜ ¤ÏÂÁ¯o˜ ÛÙo ÓÂoÁÓfi Û˘ÌÂÚÈÏ·Ì-
‚¿ÓÂÈ: ·) ΔË ‰ÈÂÓ¤ÚÁÂÈ· ÙˆÓ ÌË ÙÚÂoÓËÌ·ÙÈÎÒÓ
‰oÎÈÌ·ÛÈÒÓ (VDRL Î·È RPR) ÛÙoÓ oÚfi Ùo˘
ÓÂoÁÓo‡ Î·È ÙË Û‡ÁÎÚÈÛ‹ Ùo˘˜ Ì Ùo˘˜ Ù›ÙÏo˘˜
ÛÙË ÌËÙ¤Ú·. ∞Ó Â›Ó·È ıÂÙÈΤ˜ Î·È ÛÙo˘˜ ‰˘o ›ӷÈ
oχ Èı·Ó‹ Ë Ïo›ÌˆÍË Ùo˘ ÓÂoÁÓo‡, ȉȷ›ÙÂÚ·
·Ó o Ù›ÙÏo˜ ÛÙo ÓÂoÁÓfi Â›Ó·È ÙÂÙÚ·Ï¿ÛÈo˜ ·’
fiÙÈ ÛÙË ÌËÙ¤Ú·. Δ· ÌËÙÚÈο ÌË ÙÚÂoÓËÌ·ÙÈο
·ÓÙÈÛÒÌ·Ù· ·Ú·Ì¤Óo˘Ó ÛÙo ‚Ú¤Êo˜ ̤¯ÚÈ ÙoÓ
4o-6o Ì‹Ó· ÌÂÙ¿ ÙË Á¤ÓÓËÛË. ‚) ΔËÓ ·Ó·˙‹ÙËÛË
ÂȉÈÎÒÓ ÙÚÂoÓËÌ·ÙÈÎÒÓ ·ÓÙÈۈ̿وÓ, Ù· oo›·
fï˜ ‰ÂÓ ‚oËıo‡Ó ÛËÌ·ÓÙÈο, ÁÈ·Ù› Ù· ÂȉÈο
ÙÚÂoÓËÌ·ÙÈο ·ÓÙÈÛÒÌ·Ù· ÌËÙÚÈ΋˜ Úo¤Ï¢-
Û˘ ÌoÚ› Ó· ·ÓȯÓ‡oÓÙ·È ÛÙoÓ oÚfi Ùo˘ ‚Ú¤-
Êo˘˜ ·Ú¿ ÙËÓ ÂÈÙ˘¯‹ ıÂÚ·›· Ù˘ ÌËÙ¤Ú·˜
Î·È Ó· ·Ú·Ì¤Óo˘Ó ÁÈ· ¤Ó· ¯ÚfiÓo ‹ Î·È ÂÚÈÛ-
ÛfiÙÂÚo. ∏ ·Ó‡ÚÂÛË ÂȉÈÎÒÓ IgM ·ÓÙÈۈ̿وÓ
∂ÚÌËÓ›·
¢ÂÓ ˘¿Ú¯ÂÈ Û›Ê˘ÏË ÛÙË ÌËÙ¤Ú· ‹ ·È‰›
Ÿ¯È Û›Ê˘ÏË ÛÙË ÌËÙ¤Ú· („¢‰Ò˜ ıÂÙÈΤ˜ ÌË ÙÚÂÔÓËÌ·-
ÙÈΤ˜ ‰oÎÈ̷ۛ˜ Ì ·ıËÙÈ΋ ‰›o‰o ÛÙo ·È‰›)
™›Ê˘ÏË ÌËÙ¤Ú·˜ Ì Èı·Ó‹ Ïo›ÌˆÍË ·È‰Èo‡, ‹ ıÂÚ·¢-
ı›۷ Ïo›ÌˆÍË ÌËÙ¤Ú·˜ ÛÙËÓ Î‡ËÛË, ‹ ÌËÙ¤Ú· Ì ÙÚÈÙÔ-
ÁÂÓ‹ Û›Ê˘ÏË Î·È Èı·Ó‹ Ïo›ÌˆÍË ·È‰Èo‡
¶ÚfiÛÊ·ÙË ‹ ·ÏÈ¿ Ïo›ÌˆÍË Ù˘ ÌËÙ¤Ú·˜, Èı·Ó‹ Ïԛ̈-
ÍË ·È‰Èo‡
£ÂÚ·¢ı›۷ Û›Ê˘ÏË Ù˘ ÌËÙ¤Ú· ÚÈÓ ‹ ÛÙËÓ ·Ú¯‹ Ù˘
·ËÛ˘ ‹ „¢‰Ò˜ ıÂÙÈΤ˜ ‰oÎÈ̷ۛ˜ ÛÙo ·È‰›
120 ¶·È‰È·ÙÚÈ΋ B√ƒ∂ÿ√À ∂§§Õ¢√˜, 13, 2
Â›Ó·È ¯Ú‹ÛÈÌË ÁÈ· ÙË ‰È¿ÁÓˆÛË. ∏ ÂÚÌËÓ›· ÙˆÓ
·oÙÂÏÂÛÌ¿ÙˆÓ Ùo˘ oÚoÏoÁÈÎo‡ ÂϤÁ¯o˘ ÌËÙ¤-
Ú·˜ Î·È ·È‰Èo‡ Û˘Óo„›˙ÂÙ·È ÛÙoÓ ›Ó·Î· 4.
ñ ∂ͤٷÛË Ùo˘ ∂¡À Ì VDRL Î·È ÁÈ· ·˘ÍË̤ӷ
·ÙÙ·Ú· Î·È Ï‡Έ̷.
ñ °ÂÓÈ΋ ÂͤٷÛË ·›Ì·Ùo˜ Î·È ·ÎÙÈÓoÁڷʛ˜ Ì·-
ÎÚÒÓ oÛÙÒÓ.
5. ∞ÓÙÈÌÂÙÒÈÛË ÌÂÙ¿ ÙË Á¤ÓÓËÛË
∏ ıÂÚ·›· Ùo˘ ÓÂoÁÓo‡ Û˘Ó›ÛÙ·Ù·È ÛÙË ¯o-
Ú‹ÁËÛË ÎÚ˘ÛÙ·ÏÈ΋˜ ÂÓÈÎÈÏÏ›Ó˘ G 50 000U/kg
∂º Û 2-4 ‰fiÛÂȘ (·Ó¿ÏoÁ· Ì ÙËÓ ËÏÈΛ· ·ËÛ˘)
ÁÈ· 10-14 Ë̤Ú˜ ‹ Úoη˚ÓÈ΋ ÂÓÈÎÈÏÏ›ÓË G 50
000 U/kg ∂ª ÁÈ· 10-14 Ë̤Ú˜. OÈ ÂӉ›ÍÂȘ ıÂÚ·-
›·˜ Ùo˘ ÓÂoÁÓo‡ ›ӷÈ:
·) ¶Èı·Ó‹ ‹ ‚¤‚·ÈË ÓfiÛo˜ ÛÙo ÓÂoÁÓfi (ÎÏÈÓÈο,
ÂÚÁ·ÛÙËÚȷο ‹ ·ÎÙÈÓoÏoÁÈο Â˘Ú‹Ì·Ù· Ïo›-
̈͢)
‚) ∞Û˘Ìو̷ÙÈÎfi ÓÂoÁÓfi ¿Û¯o˘Û·˜ ÌËÙ¤Ú·˜
fiÙ·Ó ‰ÂÓ Â›Ó·È ÁÓˆÛÙfi ·Ó ‹Ú ıÂÚ·›· ‹ ·Ó
‹Ú ·ÙÂÏ‹˜ ‹ ηÌÈ¿ ıÂÚ·›·. ∂›Û˘, ·Ó Ë
ÌËÙ¤Ú· ‹Ú ıÂÚ·›· Ì ʿÚ̷η ¿ÏÏ·
ÂÎÙfi˜ Ù˘ ÂÓÈÎÈÏÏ›Ó˘ (.¯. ÂÚ˘ıÚoÌËΛÓË) ‹
‹Ú ıÂÚ·›· ÌfiÓo ÙȘ ÙÂÏÂ˘Ù·›Â˜ 4 ‚‰oÌ¿-
‰Â˜ Ù˘ ·ËÛ˘.
Á) ∞Û˘Ìو̷ÙÈÎfi ÓÂoÁÓfi ÌËÙ¤Ú·˜ o˘ ¤Î·ÓÂ
ÈηÓooÈËÙÈ΋ ıÂÚ·›· ÁÈ· Ù’o oo›o fï˜
Â›Ó·È ·‚¤‚·ÈË Ë Ù·ÎÙÈ΋ ·Ú·ÎoÏo‡ıËÛË.
‰) μÚ¤ÊË o˘ Ë ÌËÙ¤Ú· Ùo˘˜ ÂÌÊ¿ÓÈÛ ÂΉËÏÒ-
ÛÂȘ ‰Â˘ÙÂÚoÁÂÓo‡˜ ‹ ÙÚÈÁÂÓo‡˜ Û‡ÊÈÏ˘ ̤۷
ÛÙoÓ ÚÒÙo ¯ÚfiÓo ÌÂÙ¿ ÙoÓ ÙoÎÂÙfi Ú¤ÂÈ Ó·
ÂÏÂÁ¯ıo‡Ó ηÈ, ·Ó o ¤ÏÂÁ¯o˜ Â›Ó·È ·ıoÏoÁÈ-
Îfi˜, Ó· ¿Úo˘Ó ıÂÚ·›·.
6. ¶·Ú·ÎoÏo‡ıËÛË Ùo˘ ‚Ú¤Êo˘˜
·) ∂·Ó¿ÏÏË„Ë ÙˆÓ ÌË ÙÚÂoÓËÌ·ÙÈÎÒÓ ‰oÎÈÌ·-
ÛÈÒÓ ÛÙo˘˜ 3, 6 Î·È 12 Ì‹Ó˜ ÌÂÙ¿ ÙË ıÂÚ·›·
‹ ̤¯ÚÈ Ó· ·ÚÓËÙÈÎooÈËıo‡Ó. ∏ VDRL ·ÚÓË-
ÙÈÎooÈÂ›Ù·È Ì¤¯ÚÈ ÙoÓ 3o-6o Ì‹Ó· ·Ó Â›Ó·È ÌË-
ÙÚÈ΋˜ Úo¤Ï¢Û˘ Î·È Ì¤¯ÚÈ ÙoÓ 9o Ì‹Ó· ·Ó
ÚfiÎÂÈÙ·È ÁÈ· Ïo›ÌˆÍË Ùo˘ ‚Ú¤Êo˘˜. ∞Ó oÈ Ù›Ù-
ÏoÈ ·Ú·Ì¤Óo˘ ˘„ËÏo› Èı·ÓÒ˜ Ó· ¯ÚÂÈ·ÛÙ›
Â·Ó¿ÏÏË„Ë Ù˘ ıÂÚ·›·˜.
‚) Δ· ‚Ú¤ÊË o˘ ıÂÚ·‡ÙËÎ·Ó ÁÈ· Ó¢ÚoÛ‡ÊÈÏË,
Ú¤ÂÈ Ó· ˘o‚¿ÏÏoÓÙ·È Û ÂͤٷÛË Ùo˘ ∂¡À
οı 6 Ì‹Ó˜ ̤¯ÚÈ Ù· ·oÙÂϤÛÌ·Ù· Á›Óo˘Ó
Ê˘ÛÈoÏoÁÈο (·ÚÓËÙÈÎooÈËı› Ë VDRL ÛÙo
∂¡À). ∞Ó ÛÙo˘˜ 6 Ì‹Ó˜ Ë VDRL Â›Ó·È ıÂÙÈ΋
‹ Ù· ·ÙÙ·Ú· ÂÍ·ÎoÏo˘ıo‡Ó Ó· Â›Ó·È ·ıoÏoÁÈ-
ο Û˘ÛÙ‹ÓÂÙ·È Â·Ó¿ÏË„Ë Ù˘ ıÂÚ·›·˜.
ΔoÍoÏ¿Û̈ÛË
OÊ›ÏÂÙ·È ÛÙo ÚˆÙfi˙ˆo ÙoÍfiÏ·ÛÌ· gondii,
Ì ·ÚÈo ÍÂÓÈÛÙ‹ ÙË Á¿Ù· Î·È ÂӉȿÌÂÛo˘˜ ÍÂÓÈÛÙ¤˜
Ù· ‚ooÂȉ‹, ·ÈÁoÚfi‚·Ù· Î.·. O ¿ÓıÚˆo˜ Ìoχ-
ÓÂÙ·È ·fi ηٷӿψÛË ÌË Î·Ï¿ „Ë̤Óo˘ ÎÚ¤·Ùo˜
‹ ·fi Â·Ê‹ Ì ÂÚÈÙÙÒÌ·Ù· Á¿Ù·˜, o˘ ÂÚȤ-
¯o˘Ó ÙȘ ˆo·ÛÙÂȘ Ùo˘ ·Ú·Û›Ùo˘. ™Ùo ·ËÌ· ÌÂ-
Ù·‰›‰ÂÙ·È ÌfiÓo ηٿ Ùo ÛÙ¿‰Èo Ù˘ ·Ú·ÛÈÙ·ÈÌ›·˜
Ù˘ ÌËÙ¤Ú·˜, ÛÙËÓ oo›· Ë Ïo›ÌˆÍË ‰È·‰Ú¿ÌÂÈ ·Û˘-
Ìو̷ÙÈο ÛÙo 80%-90% ÙˆÓ ÂÚÈÙÒÛˆÓ. ∏
οıÂÙË ÌÂÙ¿‰oÛË Â›Ó·È ‰˘Ó·Ù‹ Û’ fiÏË ÙË ‰È¿ÚÎÂÈ·
Ù˘ ·ËÛ˘, ·ÏÏ¿ oÈ Û˘Ó¤ÂȘ ÛÙo ·ËÌ· Â›Ó·È Èo
Ûo‚·Ú¤˜ ÛÙËÓ ·Ú¯‹ Ù˘ ·ËÛ˘67,68. Δ· ÚoÏËÙÈο
̤ÙÚ· o˘ Ú¤ÂÈ Ó· ÏËÊıo‡Ó ›ӷÈ:
∞. ¶ÚˆÙoÁÂÓ‹˜ ÚfiÏË„Ë
™ˆÛÙ‹ ÂÓË̤ڈÛË ÁÈ· Ùo˘˜ ÙÚfio˘˜ ÌÂÙ¿‰o-
Û˘ Ù˘ Ïo›ÌˆÍ˘ (Á¿Ù˜, ÌË Î·Ï¿ „Ë̤Óo ÎÚ¤·˜)
Î·È ·oÊ˘Á‹ ÙˆÓ ÂÛÙÈÒÓ Ïo›ÌˆÍ˘16,68.
μ. ¢Â˘ÙÂÚoÁÂÓ‹˜ ÚfiÏË„Ë
1. ¢È¿ÁÓˆÛË Ù˘ ÓfiÛo˘ ÛÙËÓ ¤Á΢o
OÚoÏoÁÈÎfi˜ ¤ÏÂÁ¯o˜ Á›ÓÂÙ·È Û ·) ¤ÁÎ˘Â˜ ÌÂ
‡oÙË ÎÏÈÓÈ΋ ÂÈÎfiÓ· (‰fiÁΈÛË ÏÂÌÊ·‰¤ÓˆÓ, ˘-
ÚÂÙfi˜), ‚) ÂӉ›ÍÂȘ Ïo›ÌˆÍ˘ Ùo˘ ΢‹Ì·Ùo˜ (˘Â-
Ú˯oÁÚ·ÊÈΤ˜), Á) ÛÙ· Ï·›ÛÈ· oÚoÏoÁÈÎo‡ ÂϤÁ-
¯o˘ ‰È·ÏoÁ‹˜ (screening) ÁÈ· ·Ó›¯Ó¢ÛË ·Û˘ÌÙˆ-
Ì·ÙÈÎÒÓ ÂÚÈÙÒÛˆÓ. ∏ ·Ó‡ÚÂÛË IgG (Úoo‰Â˘-
ÙÈ΋˜ ·‡ÍËÛ˘ Ùo˘ Ù›ÙÏo˘) ‹ IgM ·ÓÙÈÛˆÌ¿ÙˆÓ ÛË-
Ì·›ÓÂÈ ÚfiÛÊ·ÙË Ïo›ÌˆÍË Î·È Ú¤ÂÈ Ó· ·ÓÙÈÌÂÙˆ-
ÈÛÙ› Ë ÓfiÛo˜ ÛÙËÓ ¤Á΢o.2,67
2. ¢È¿ÁÓˆÛË ÓfiÛo˘ ÛÙo ·ËÌ·
∞Ó ‰È·ÁÓˆÛÙ› ÙoÍoÏ¿Û̈ÛË ÛÙËÓ ¤Á΢o,
Ú¤ÂÈ Ó· ·Ú·ÎoÏo˘ıÂ›Ù·È Ùo ·ËÌ· ÁÈ· ÂӉ¯fi-
ÌÂÓË ÚoÛ‚oÏ‹ Ùo˘ ÌÂ:
·) ∞ÌÓÈo·Ú·Î¤ÓÙËÛË Î·È ¤ÏÂÁ¯o Ì PCR ÁÈ· ·Ó›-
¯Ó¢ÛË ÙÌËÌ¿ÙˆÓ Ùo˘ DNA Ùo˘ ·Ú·Û›Ùo˘.
‚) ÀÂÚ˯oÁÚ¿ÊËÌ· ÁÈ· ‰È·›ÛÙˆÛË ÂӉ›ÍˆÓ
ÂÓÂÚÁo‡ Ïo›ÌˆÍ˘ (˘‰ÚoΤʷÏo˜, Â·Û‚ÂÛÙÒ-
ÛÂȘ, Î.·.)
Á) OÚoÏoÁÈΤ˜ ‰oÎÈ̷ۛ˜ ÛÙo ·›Ì· Ùo˘ oÌÊ¿ÏÈo˘
ÏÒÚo˘.
3. ∞ÓÙÈÌÂÙÒÈÛË ÓfiÛo˘ ÛÙËÓ ¤Á΢o2,17,67
·) ¶ÚÈÓ ÙË 16Ë Â‚‰oÌ¿‰· ·ËÛ˘: ÛÂÈÚ·Ì˘Î›ÓË
ÁÈ· 4 ‚‰oÌ¿‰Â˜
‚) ªÂÙ¿ ÙË 16Ë Â‚‰oÌ¿‰· ·ËÛ˘:
‚1) ∞Ó o ¤ÏÂÁ¯o˜ Ïo›ÌˆÍ˘ Ùo˘ ΢‹Ì·Ùo˜ ›ӷÈ
·ÚÓËÙÈÎfi˜ ı· ¯oÚËÁËı› ÌfiÓo ÛÂÈÚ·Ì˘Î›-
ÓË Ì¤¯ÚÈ ÙoÓ ÙoÎÂÙfi.
‚2) ∞Ó ˘¿Ú¯o˘Ó ÂӉ›ÍÂȘ Ïo›ÌˆÍ˘ Ùo˘ ΢‹-
 ¶·È‰È·ÙÚÈ΋ B√ƒ∂ÿ√À ∂§§Õ¢√˜, 13, 2
Ì·Ùo˜ ‹ Â›Ó·È ¿ÁÓˆÛÙË Ë ‡·ÚÍË Ïo›ÌˆÍ˘
Ùo˘ ΢‹Ì·Ùo˜ ı· ¯oÚËÁËı› ˘ÚÈÌÂı·Ì›ÓË
Ì Ûo˘ÏÊ·‰È·˙›ÓË Î·È Ê˘ÏÏÈÎfi o͇ ÁÈ· 4
‚‰oÌ¿‰Â˜ Î·È ÛÂÈÚ·Ì˘Î›ÓË ÁÈ· ¿ÏϘ 4
‚‰oÌ¿‰Â˜. Δ· ‰˘o Û¯‹Ì·Ù· ı· ¯oÚËÁo‡-
ÓÙ·È ÂÓ·ÏÏ·ÎÙÈο ̤¯ÚÈ ÙoÓ ÙoÎÂÙfi. ∏ ˘-
ÚÈÌÂı·Ì›ÓË Î·È Ë Ûo˘ÏÊ·‰È·˙›ÓË ÂÚÓo‡Ó
ÙoÓ Ï·Îo‡ÓÙ· Î·È ·ÓÙÈÌÂÙˆ›˙o˘Ó ÙË ÓfiÛo
ÛÙo ·ËÌ·, ·ÏÏ¿ ‰ÂÓ ÂÈÙÚ¤ÂÙ·È Ë ¯oÚ‹-
ÁËÛ‹ Ùo˘˜ ÚÈÓ ÙË 16Ë Â‚‰oÌ¿‰· ·ËÛ˘
ÏfiÁˆ Èı·Ó‹˜ ÙÂÚ·ÙoÁfiÓo˘ ‰Ú¿Û˘.
°. ¢È¿ÁÓˆÛË Î·È ·ÓÙÈÌÂÙÒÈÛË Ù˘ ÓfiÛo˘ ÛÙo
ÓÂoÁ¤ÓÓËÙo67
1. ¢È¿ÁÓˆÛË ÓfiÛo˘ ÛÙo ÓÂoÁÓfi
·) ∫ÏÈÓÈ΋ ÂÈÎfiÓ·
‚) OÚoÏoÁÈÎfi˜ ¤ÏÂÁ¯o˜ (·˘ÍË̤ÓË ÂȉÈ΋ IgM
‹ Úoo‰Â˘ÙÈ΋ ·‡ÍËÛË Ù˘ ÂȉÈ΋˜ IgG ÌÂ
ÙÂÙÚ·Ï·ÛÈ·ÛÌfi Ùo˘ Ù›ÙÏo˘ Û 6 ‚‰oÌ¿‰Â˜
‹ Ù›ÙÏo˜ ÂȉÈÎÒÓ IgG ·ÓÙÈÛˆÌ¿ÙˆÓ ÛÙo ÓÂo-
ÁÓfi ˘„ËÏfiÙÂÚo˜ ·fi ÙË ÌËÙ¤Ú·).
Á) ∞ÎÙÈÓoÏoÁÈο Î·È ˘ÂÚ˯oÁÚ·ÊÈο ¢ڋ-
Ì·Ù· ·fi Ùo ∫¡™, ‚˘ıoÛÎoÈο Â˘Ú‹Ì·Ù·
¯oÚÈo·ÌÊÈ‚ÏËÛÙÚoÂȉ›Ùȉ·˜.
2. ∞ÓÙÈÌÂÙÒÈÛË Ù˘ ÓfiÛo˘ ÛÙo ÓÂoÁÓfi2
·) ™˘Ìو̷ÙÈ΋ ÓfiÛo˜:
·1) °È· Ùo˘˜ ÚÒÙo˘˜ 6 Ì‹Ó˜ ˙ˆ‹˜ ˘ÚÈÌÂ-
ı·Ì›ÓË Ì·˙› Ì Ûo˘ÏÊ·‰È·˙›ÓË Î·È Ê˘Ï-
ÏÈÎfi o͇.
·2) °È· Ùo ‰Â‡ÙÂÚo 6ÌËÓo ˙ˆ‹˜: ÛÂÈÚ·Ì˘Î›-
ÓË ÁÈ· 4 ‚‰oÌ¿‰Â˜, o˘ ÂÓ·ÏÏ¿ÛÛÂÙ·È
Ì ˘ÚÈÌÂı·Ì›ÓË+Ûo˘ÏÊ·‰È·˙›ÓË+Ê˘Ï-
ÏÈÎfi o͇ ÁÈ· ¿ÏϘ 4 ‚‰oÌ¿‰Â˜, ̤¯ÚÈ
Ùo Ù¤Ïo˜ Ùo˘ ÚÒÙo˘ ¯ÚfiÓo˘ ˙ˆ‹˜.
‚) ∞Û˘Ìو̷ÙÈ΋ ÓfiÛo˜: ˘ÚÈÌÂı·Ì›ÓË+
Ûo˘ÏÊ·‰È·˙›ÓË+Ê˘ÏÏÈÎfi o͇ ÁÈ· 6 ‚‰o-
Ì¿‰Â˜ o˘ ÂÓ·ÏÏ¿ÛÛÂÙ·È Ì ÛÂÈÚ·Ì˘Î›ÓË
ÁÈ· ¿ÏϘ 6 ‚‰oÌ¿‰Â˜, ̤¯ÚÈ Ùo Ù¤Ïo˜ Ùo˘
ÚÒÙo˘ ¯ÚfiÓo˘ ˙ˆ‹˜2.
μÈ‚ÏÈoÁÚ·Ê›·
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123
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AÏÏËÏoÁÚ·Ê›·:
μ·ÛÈÏÈ΋ ¢ÚfiÛo˘-∞Á·Î›‰o˘
°ÏËÓo‡ 28
54352 £ÂÛÛ·ÏoÓ›ÎË
ΔËÏ. 924717, 992993 º∞à 992787
e-mail: agaki@med.auth.gr
Corresponding author:
V Drosou-Agakidou
28 Glinou Str.
Thessaloniki 54352
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e-mail: agaki@med.auth.gr