{"id":912,"date":"2012-08-27T14:57:21","date_gmt":"2012-08-27T12:57:21","guid":{"rendered":"http:\/\/slanedeti.sk\/cms\/cysticka-fibroza-a-cestovanie-8-odporucania-pre-transplantovanych-pacientov-2\/201208"},"modified":"2014-01-02T11:49:40","modified_gmt":"2014-01-02T10:49:40","slug":"cysticka-fibroza-a-cestovanie-8-odporucania-pre-transplantovanych-pacientov-2","status":"publish","type":"post","link":"https:\/\/slanedeti.sk\/cms\/cysticka-fibroza-a-cestovanie-8-odporucania-pre-transplantovanych-pacientov-2\/912","title":{"rendered":"Cystick\u00e1 fibr\u00f3za a cestovanie 8: Odpor\u00fa\u010dania pre transplantovan\u00fdch pacientov"},"content":{"rendered":"

V \u00f4smej, poslednej \u010dasti seri\u00e1lu \u010dl\u00e1nkov o cestovan\u00ed s cystickou fibr\u00f3zou, sa budeme \u0161peci\u00e1lne venova\u0165 transplantovan\u00fdm pacientom, ktor\u00fdch n\u00e1roky pri cest\u00e1ch s\u00fa predsa len o nie\u010do vy\u0161\u0161ie.<\/p>\n

CF pacienti so zn\u00ed\u017eenou imunitou po transplant\u00e1cii p\u013e\u00fac alebo pe\u010dene potrebuj\u00fa pred cestou \u0161peci\u00e1lne poradenstvo. Tam, kde nie je k dispoz\u00edcii \u017eiadna literat\u00fara pre turistov, ktor\u00ed prijali p\u013e\u00facny alebo pe\u010de\u0148ov\u00fd transplant\u00e1t, existuj\u00fa spr\u00e1vy, ktor\u00e9 sa zameriavaj\u00fa na rizik\u00e1 a odpor\u00fa\u010dania pre turistov so zn\u00ed\u017eenou imunitou, vr\u00e1tane pr\u00edjemcov pevn\u00fdch org\u00e1nov. Treba tu rozl\u00ed\u0161i\u0165 tri z\u00e1kladn\u00e9 probl\u00e9my: po prv\u00e9, zv\u00fd\u0161en\u00fa n\u00e1chylnos\u0165 k chorob\u00e1m s\u00favisiacim s cestovan\u00edm a pr\u00edle\u017eitostn\u00fdm\/n\u00e1hodn\u00fdm infekci\u00e1m; po druh\u00e9, interakcie medzi be\u017en\u00fdmi liekmi (napr. imunosupres\u00edvami) a sprievodn\u00fdmi liekmi na choroby s\u00favisiace s cestovan\u00edm (napr. na profylaxiu mal\u00e1rie); po tretie, pou\u017eitie vakc\u00edn (napr. bezpe\u010dnos\u0165 \u017eiv\u00fdch vakc\u00edn, potenci\u00e1lne zn\u00ed\u017een\u00e1 \u00fa\u010dinnos\u0165 vakc\u00edn).<\/p>\n

Najbe\u017enej\u0161ie choroby s\u00favisiace s cestovan\u00edm s\u00fa potravinov\u00e9 infekcie, s\u00favisiace s manipul\u00e1ciou s potravinami. Niektor\u00e9 \u0161pecifick\u00e9 bakteri\u00e1lne infekcie, napr. net\u00fdfusov\u00e9 infekcie Salmonella spp., Shigella spp. a Microsporidia s\u00fa v\u00e1\u017enej\u0161ie u hostite\u013eov s potla\u010denou imunitou. Aj ke\u010f si uvedomuj\u00fa limity \u201eprevent\u00edvnych opatren\u00ed, pokia\u013e ide o vodu a potraviny\u201c, turistom so zn\u00ed\u017eenou imunitou by sa malo odporu\u010di\u0165 ich pr\u00edsne dodr\u017eiavanie, napr. aby konzumovali v re\u0161taur\u00e1ci\u00e1ch tepl\u00e9 jedl\u00e1, aby dodr\u017eiavali bezpe\u010dnos\u0165 aj pri pit\u00ed (voda balen\u00e1, prevaren\u00e1 alebo filtrovan\u00e1) a aby sa vyhli nepasterizovan\u00fdm mlie\u010dnym v\u00fdrobkom. Ka\u017ed\u00fd turista so zn\u00ed\u017eenou imunitou, najm\u00e4 tak\u00fd, u ktor\u00e9ho sa v minulosti u\u017e vyskytla disfunkcia \u013eadv\u00edn, alebo, ktor\u00fd u\u017e\u00edva nefrotoxick\u00e9 lieky (napr. cyklospor\u00edn A), by si mal by\u0165 vedom\u00fd v\u00fdznamu hydrat\u00e1cie a mo\u017enost\u00ed or\u00e1lnej hydrat\u00e1cie. Profylaktick\u00e9 antimikrobi\u00e1lne l\u00e1tky sa be\u017ene neodpor\u00fa\u010daj\u00fa, ale mo\u017eno ich pou\u017ei\u0165 v obmedzenom \u010dasovom obdob\u00ed. Pacienti by mali ma\u0165 so sebou rezervn\u00fa z\u00e1sobu antibiot\u00edk, (napr. Ciprofloxac\u00edn, Azitromic\u00edn a Metronidazol) a odpor\u00fa\u010da sa im v pr\u00edpade hor\u00fa\u010dky alebo hna\u010dky za\u010da\u0165 s lie\u010dbou v\u010das. H\u013eada\u0165 odborn\u00fa lek\u00e1rsku radu, pr\u00edpadne sa rozhodn\u00fa\u0165 pre preru\u0161enie dovolenky treba v \u010do najkrat\u0161om \u010dase.<\/p>\n

CF pacienti so zn\u00ed\u017eenou imunitou by sa mali v z\u00e1ujme zabr\u00e1nenia riziku oport\u00fannej infekcie d\u00f4kladne poradi\u0165.<\/strong><\/p>\n

Mnoh\u00e9 be\u017en\u00e9 lieky predpisovan\u00e9 pr\u00edjemcom transplant\u00e1tu reaguj\u00fa s liekmi, ktor\u00e9 s\u00fa metabolizovan\u00e9 syst\u00e9mom CYP3A4. Napr. profylaxia mal\u00e1rie chloroch\u00ednom zvy\u0161uje v s\u00e9re \u00farovne Cyklospor\u00ednu A, FK 506 (tacrolimus), alebo Rapamyc\u00ednu. Av\u0161ak mno\u017estvo inform\u00e1ci\u00ed o interakci\u00e1ch imunopres\u00edv (\u201eanti-rejection drugs) a v\u00e4\u010d\u0161iny liekov, spojen\u00fdch s cestovan\u00edm, je obmedzen\u00e9. Pacientom sa odpor\u00fa\u010da za\u010da\u0165 u\u017e\u00edva\u0165 sprievodn\u00e9 lieky (napr. na profylaxiu mal\u00e1rie) nieko\u013eko t\u00fd\u017ed\u0148ov pred cestou, aby mohli sledova\u0165 a prisp\u00f4sobi\u0165 \u00farovne imunosupres\u00edv v s\u00e9re.<\/p>\n

\"201208271452_lieky_8\"<\/div>\n

Ka\u017ed\u00e1 ned\u00e1vna alebo s\u00fa\u010dasn\u00e1 lie\u010dba imunosupres\u00edvami vr\u00e1tane or\u00e1lnych kortikosteroidov, trvaj\u00faca dlh\u0161ie ako jeden mesiac m\u00f4\u017ee vo ve\u013ek\u00fdch d\u00e1vkach ohrozi\u0165 \u00fa\u010dinnos\u0165 ka\u017edej vakc\u00edny. Pri \u017eiv\u00fdch vakc\u00ednach existuje nebezpe\u010denstvo ochorenia chorobou, proti ktorej prebieha o\u010dkovanie. Inhalovan\u00e9 steroidy, okrem ve\u013emi vysok\u00fdch d\u00e1vok, nie s\u00fa kontraindik\u00e1ciou aplik\u00e1cie vakc\u00edny.
\nPo transplant\u00e1cii p\u013e\u00fac alebo pe\u010dene by sa o ka\u017edej navrhovanej vakc\u00edne malo uva\u017eova\u0165 z dvoch h\u013ead\u00edsk; z h\u013eadiska bezpe\u010dnosti a z h\u013eadiska mo\u017enej zn\u00ed\u017eenej \u00fa\u010dinnosti v s\u00favislosti so z\u00e1kladn\u00fdm potl\u00e1\u010dan\u00edm imunity.<\/p>\n

V\u00e4\u010d\u0161inou by sa CF pacienti u\u017e\u00edvaj\u00faci imunosupres\u00edva mali striktne vyh\u00fdba\u0165 \u017eiv\u00fdm vakc\u00ednam. Najbe\u017enej\u0161ie \u017eiv\u00e9 vakc\u00edny s\u00fa vakc\u00edna proti ov\u010d\u00edm kiah\u0148am, or\u00e1lna vakc\u00edna proti detskej obrne, vakc\u00edna proti os\u00fdpkam \u2013 mumpsu – rubeole, vakc\u00edna proti \u017eltej zimnici a BCG. Riziko vystavenia sa nebezpe\u010denstvu choroby mus\u00ed by\u0165 porovnan\u00e9 s rizikami vakcin\u00e1cie a stup\u0148om potl\u00e1\u010dania imunity u konkr\u00e9tneho jednotlivca. Preto je ve\u013emi d\u00f4le\u017eit\u00e9 pre ka\u017ed\u00e9ho kandid\u00e1ta bud\u00facej transplant\u00e1cie ma\u0165 pred transplant\u00e1ciou kontrolu o\u010dkovania. Pl\u00e1novan\u00e9 o\u010dkovania by mali by\u0165 ukon\u010den\u00e9 minim\u00e1lne dva t\u00fd\u017edne pred transplant\u00e1ciou.<\/p>\n

Zdroj: Travelling with cystic fibrosis: Recommendations for patients and care Team members <\/em>http:\/\/www.ecfs.eu\/ecfs_guidelines<\/em><\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

V ôsmej, poslednej časti seriálu článkov o cestovaní s cystickou fibrózou, sa budeme špeciálne venovať transplantovaným pacientom, ktorých nároky pri cestách sú predsa len o niečo vyššie. CF pacienti so zníženou imunitou po transplantácii pľúc alebo pečene potrebujú pred cestou … Continued<\/a><\/p>\n","protected":false},"author":3,"featured_media":1125,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"kt_blocks_editor_width":"","footnotes":""},"categories":[250],"tags":[226],"class_list":["post-912","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-zivot-s-cystickou-fibrozou","tag-transplantacia"],"yoast_head":"\nCystick\u00e1 fibr\u00f3za a cestovanie 8: Odpor\u00fa\u010dania pre transplantovan\u00fdch pacientov - Slan\u00e9 deti<\/title>\n<meta name=\"description\" content=\"V poslednej \u010dasti seri\u00e1lu \u010dl\u00e1nkov sa venujeme transplantovan\u00fdm pacientom, ktor\u00fdch n\u00e1roky pri cest\u00e1ch s\u00fa predsa len o nie\u010do vy\u0161\u0161ie.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/slanedeti.sk\/cms\/cysticka-fibroza-a-cestovanie-8-odporucania-pre-transplantovanych-pacientov-2\/912\" \/>\n<meta property=\"og:locale\" content=\"sk_SK\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Cystick\u00e1 fibr\u00f3za a cestovanie 8: Odpor\u00fa\u010dania pre transplantovan\u00fdch pacientov - 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