P2-UE8-Jaffar_Bandjee-Méningites_et_encéphalites_virales(suite)_10.04.2017

!
"!
!"#$%$&'$()*+',-$.,/'0-.'12$3$()45-'$
6*//*789*,:;''$
!
#$%&!'!"()(*)+(",!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!-.$/&!012$32&!'!"*04"50!
-2161!'!-+!+("5)+(",!
!
71893:%&:!'!!!!!!!!!!!!!!!!!!!!;8:&3/8$8%!'!<$==$24>$8?@&&!
A0B8$$!>1C&2!
DE9$8&!#$61F2!
!
<=,.,+.-'>$'-$',0=?4*(.-'>[email protected]*('>$
!
!
Note%:%Ce%cours%est%la%suite%du%cours%du%07/04/2017%
%
!
AAA$%$",0=?4*(.-'>$?B>-8.,/'0-.'1>'>$
G!H!IJ3?9631.1/3&!
>!H!-0C:31J$%01.1/3&!
K!H!K.383LF&!
#!H!#3$/81:%3E!
;!H!M2$3%&6&8%!
!
AC$%$<D=(.-'>$*.+1E>$
!G!H!-$2!$/2&::318!N32$.&!?32&E%&!
!>!H!-1:%438=&E%3&F:&:!
!
C$%$",0=?4*(BFD=(.-'>G$',0=?4*(.-'>$>1H*.+1'>$'-$
047B,.I1'>$
!G!H!O$!O;AA!
!>!H!O$!O;P-!
!K!H!PC9.3%&!?F&!$F!QMOR"!
!#!H!;8E9J0$.3%&:!$F!RSQ!
!;!H!#3$/81:%3E!?3==92&8%3&.!'!&8E9J0$.1J$%03&:!?F&:!$FT!J2318:!
!
!
!
!
!
!
!
!
+!
!
#$8:!.&:!$%%&38%&:!69838/14
&8E9J0$.3%3LF&:U!3.!C!$N$3%!'!
4 .&:!$3/F&:!
VWJ2363%3N&:X!NF&:!
J29E9?&66&8%!?$8:!.Y$F%2&!
E1F2:!Z!
4 .&:!&8E9J0$.3%&:!J1:%4
38=&E%3&F:&:[!
!
!
!
!
!
!
!
AAA$%$",0=?4*(.-'>$?B>-8.,/'0-.'1>'>$
!
!G!H!IJ3?9631.1/3&!
!
D8!:$3%!LF&!E&!:18%!%1F:!?&:!N32F:!?7=>',->$*1$0B17>$:)1,'$?7.FB8.,/'0-.B,!chez%l’enfant%(2ans%):%
rougeole,(rubéole,(oreillons,(varicelle,(EBV,(adénovirus,(VRS,(grippe[!OY&8=$8%U!$F!E1F2:!?&!E&%%&!
38=&E%318U!N$!J1FN132!=$32&!F8&!&8E9J0$.3%&!J1:%438=&E%3&F:&[!
!
OY38E3?&8E&!$!?3638F9!?&JF3:!LF&!3.!C!$!.$!N$EE38$%318!E18%2&!.$!21F/&1.&U!.$!2F\91.&U!.&:!12&3..18:[!
]9$86138:U!18!J&F%!N132!!?&:!&8E9J0$.3%&:!J1:%438=&E%3&F:&:!$N&E!.&:!J$%01/^8&:!J1F2!.&:LF&.:!3.!8YC!
$F@1F2?Y0F3!J$:!?&!N$EE38[!!
!
D8!J&F%!$N132!F8&!&8E9J0$.3%&!J1:%438=&E%3&F:&:!J1:%!N$EE38$.&!81%$66&8%!$N&E!.&!N$EE38!E18%2&!.$!
N$231.&!VJF3:LF&!EY&:%!F8!N$EE38!N3N$8%!$%%98F9X!
%raison%pour%laquelle%on%ne%fait%plus%de%vaccination%
généralisée%contre%la%variole,%surtout%que%cette%maladie%a%été%éradiquée%(risque%de%bioterrorisme%++%car%
population%pas%immunisée).%%
%
!>!H!-0C:31J$%01.1/3&!
!
OY&8E9J0$.3%&!J1:%438=&E%3&F:&!&:%!F8&!$%%&38%&!?&!.$!:F\:%$8E&!\.$8E0&!VE12J:!8&F218$FTX!___!1F!
/23:&!V$T18&:X[!KY&:%!F8!F=0*,.>F'$*1-B$.FF1,!J$:!6369%3:6&!E18%2&!.&!A]K[!!
Lorsque%des%enfants%font%une%primo%infection,%ils%vont%développer%des%Ac%antiFrougeole%et%probablement%
dans%leur%organisme,%il%doit%y%avoir%des%Ag%a.n.%du%cerveau%qui%ont%une%antigénicité%croisée%avec%les%Ac%
contre%la%rougeole%:%ces%Ac%vont%aller%abîmés%les%structures%du%SNC.%
%
%K!H!K.383LF&!
!
KY&:%!F8&!6$.$?3&!38=.$66$%132&!?96C9.383:$8%&!LF3!N$!&8%2$38&2!F8&!?&:%2FE%318!?&!.$!6C9.38&!?F!
A]K[!K&%%&!J$%01.1/3&!N$!:Y38:%$..&2!?$8:!.&:!+!`!a(!@1F2:!$J2^:!.Y38=&E%318[!
!
!
a!
;8!/9892$.&U!EY&:%!F8!%$\.&$F!?Y&8E9J0$.1J$%03&!$3/F&!$N&E!?&:!:3/8&:!8&F21.1/3LF&:!6F.%3=1E$FT[!D8!$!
?&:!%$\.&$FT!!LF3!:18%!E$2$E%923:%3LF&:!?&!E&2%$38&:!J$%01.1/3&:!'!$%$T3&!E929\&..&F:&!VW81%318!
?Y9LF3.3\2&X!J1:%4RbRU!0963J.9/3&!J1:%4RbR!1F!J1:%!2F\91.&[!
!#!H!#3$/81:%3E!
!
O&!?3$/81:%3E!$[8[!?F!OK7!'!3.!C!$!F8&!29$E%318!E&..F.$32&!LF3!&:%!?&!8$%F2&!.C6J01EC%$32&[!K166&!
.Y&8E9J0$.3%&!J1:%438=&E%3&F:&!&:%!?9E$.9&!J$2!2$JJ12%!`!.$!J0$:&!$3/FcU!18!8&!2&%21FN&!?*>$:'[email protected]>$'-$
:).,-'7/=7B,$α$:*,>$('$JKLM!!
!
K&!LF3!N$!81F:!$3?&2!J1F2!.&!?3$/81:%3E!&:%!.$!:921.1/3&!LF3!N$!81F:!J&26&%%2&!?&!6&%%2&!&8!9N3?&8E&!
F8&!:921E18N&2:318!E$2!.&:!:C8?216&:!J1:%!38=&E%318:!:18%!%21J!%$2?3=:!J$2!2$JJ12%!`!.$!N32963&!J1F2!
LFY18!2&%21FN&!.&!N32F:!LF&!E&!:13%!?$8:!.&!:$8/!1F!?$8:!.&!OK7[!
!
d!.Y36$/&23&U!E&!LF3!E$2$E%923:&!E&!:C8?216&!J1:%438=&E%3&FT!:18%!?&:!.9:318:!6F.%3=1E$.&:!?&!.$!
:F\:%$8E&!\.$8E0&[!!
!
!;!H!M2$3%&6&8%!
!
K166&!EY&:%!F8!J09816^8&!38=.$66$%132&U!18!N$!?188&2!?&:!E12%3E1e?&:[!D8!N$!=$32&!?&:!
J.$:6$J092^:&:!'!18!N$!=3.%2&2!.&:!S/!V366F81/.1\F.38&:X!&%!18!N$!$F::3!?188&2!?&:!S/!6:!J$:!?323/9&:!
N&2:!E&:!J$%01/^8&:!.`!!M2$3%&6&8%!366F81.1/3LF&[!;8!/9892$.&U!.Y9N1.F%318!&:%!=$N12$\.&!:1F:!.&!
%2$3%&6&8%!6:!EY&:%!F8!E18=.3%!366F81.1/3LF&U!f$!8&!6&%!?18E!J$:!`!.Y$\23!?YF8&!29E3?3N&!$N&E!F8!$F%2&!
J$%01/^8&!V`!.Y1EE$:318!?YF8&!$F%2&!J2361!38=&E%318X[!
!
AC$%$<D=(.-'>$*.+1E>$
!
KY&:%!F8&!38=&E%318:!$3/Fc:!$[8[!$T18$.&[!
!
!G!H!-$2!$/2&::318!N32$.&!?32&E%&!
!
-$2!&T&6J.&!$F!E1F2:!?&!.$!J1.316C9.3%&!'!!
O&!N32F:!?&!.$!J1.31!N$!J21N1LF&2!?&:!J$2$.C:3&:!?&!.Y&8=$8%!?$8:!.&:!J$C:!%21J3E$FT!&8!N13&!?&!
?9N&.1JJ&6&8%!&%!?188&!F8!%$\.&$F!?&!6C9.3%&!$3/Fc!E$2!3.!N$!&8%2$38&2!.$!.C:&!?&:!8&F218&:!?&!.$!
E128&!$8%923&F2&!?&!.$!61&..&!V!N13&!61%23E&X[!!
O$!:9N923%9!&:%!.39&!`!.Y$%%&18%&!2&:J32$%132&!J$2!$%%&38%&!?&!.$!E166$8?&!\F.\$32&!1F!69?F..$32&[!!
O&!OK7!618%2&!F8&!29$E%318!.C6J01EC%$32&!$N&E!F8&!J21%93812$E03&!9.&N9&[!!
S.!C!$!?&!2$2&:!E$:!J1:%4N$EE38!N3N$8%!$%%98F9[!
!
K0&g!.&:!:F@&%:!366F81?9J2369:U!&8!/9892$.!f$!E18E&28&!.&:!N32F:!?&!.$!=$63..&!Q&2J^:U!!
]1%$66&8%!$N&E!.&!CNCU!18!J&F%!$N132!F8&!92FJ%318!EF%$889&!&8!2&/$2?!?F!%&223%132&!69?F..$32&!.9:9!Z!
GN&E!.Y0&2J^:!?&!%CJ&!+!VOPCQX!$N&E!F8&!92FJ%318!/983%$.&!1F!:$E29&!Z!
K0&g!.&:!?*-.',->$CAOG$K<C$B1$"9C[!
!
!>!H!-1:%438=&E%3&F:&:!
!
KY&:%!?&:!E$:!LF3!:18%!2$2&:U!J1:%!38=&E%3&FT!VJ29E9?9&:!?&!:3/8&:!38=&E%3&FTX[!O$!21F/&1.&!&:%!.&!E$:!.&!
J.F:!=29LF&8%U!JF3:!18!J&F%!$N132!2F\91.&!V&T%2h6&6&8%!2$2&!E0&g!81F:!E$2!J1JF.$%318!N$EE389&X[!
K166&!EY&:%!J1:%!38=&E%3&FT!18!8Y$F2$!J$:!.&!N32F:U!.&!:.*+,B>-.0$>'7*$*(B7>$>=7B(B+.I1'[!D8!J&F%!
$N132!?&:!E$:!&TE&J%3188&.:!?&!6C9.3%&:!J1:%4!N$EE38$.&:[!!
!
C$%$",0=?4*(BFD=(.-'>G$',0=?4*(.-'>$>1H*.+1'>$'-$047B,.I1'>$
!
!
*!
K&:!%$\.&$FT!:18%!.39:!`!.$!J&2:3:%$8E&!?F!N32F:!LF3!N$!&8%2$38&2!?&:!%21F\.&:!8&F21.1/3LF&:!:J9E3=3LF&:!
?&!.Y$/&8%!9N1.F$8%!:F2!F8!61?&!:F\$3/F!1F!E02183LF&[!;..&:!8&!:18%!J$:!$::1E39&:!`!F8!:C8?216&!
38=&E%3&FT[!
!
!G!H!O$!O;AA!V.&FE14&8E9J0$.3%&!:E.921:$8%&!:F\$3/Fc!?&!.$!21F/&1.&X!
!
O&FE14&8E9J0$.3%&!!$%%&38%&!?&!.$!:F\:%$8E&!\.$8E0&!
!
K$:!%CJ3LF&!'!;8=$8%!i4"i!$8:!:$8:!?9=3E3%!366F83%$32&!9N3?&8%!$C$8%!=$3%!F8&!21F/&1.&!$N$8%!.YB/&!?&!+!
$8:!V38%92h%!?&!N$EE38&2!__X[!
!
O&!69E$83:6&!&:%!lié$à$la$présence$de$mutants$viraux$défectifs!V6F%$%318!$[8[!?F!N32F:!LF3!8&!J&F%!J$:!
:&!6F.%3J.3&2XU!6$3:!J$2!E18%2&!3.!C!$!$EEF6F.$%318!?&!8FE.91E$J:3?&:!N32$.&:!?$8:!.&:!E&..F.&:!
8&2N&F:&:!E&!LF3!&8%2$j8&!.$!?&:%2FE%318!E&..F.$32&[!!
!
AF2!.&!J.$8!?&!.$!E.383LF&U!.$!?9%92312$%318!38%&..&E%F&..&!$N&E!$JJ$23%318!?&:!6C1E.183&:U!?&:!?9=3E3%:!
61%&F2:!:18%!9N1E$%&F2:[!!
!
O&!OK7!?188&!F8!$:J&E%!1.3/1E.18$.!?&:!S/k!`!.Y9.&E%21J012^:&[!D8!J&F%!6&:F2&2!.&!%$FT!?YGE!$8%34
21F/&1.&!?$8:!.&!OK7!LF3!N$!618%2&2!F8&!:9E29%318!9.&N9&!?YGE!$8%3421F/&1.&[!D8!J&F%!E18E.F2&!LFY3.!C!
$!F8&!:9E29%318!38%2$4%09E$.&!?YGE!'!18!N$!?18E!E16J$2&2!.&!%3%2&!?&!E&:!GE!?$8:!.&!OK7!J$2!2$JJ12%!$F!
%3%2&!?$8:!.&!:92F6!V18!N&22$!F8!%3%2&!J.F:!9.&N9!?$8:!.&!OK7!LF&!?$8:!.&!:92F6X[!O$!2&E0&2E0&!?F!N32F:!
&:%!89/$%3N&!?$8:!.&!OK7!JF3:LF&!EY&:%!LLE0!LF3!&:%!$F!.18/!E1F2:U!EY&:%!`!.Y38%923&F2&!?&:!E&..F.&:!V?18E!
3.!8YC!&8!$!J$:!?$8:!.&!OK7X[!-$2=13:U!:3!3.!C!$!F8&!\31J:3&!E929\2$.&U!18!J&F%!$N132!F8&!-K7!J1:3%3N&[!
!
!>!H!O$!O;P-!V.&FE14&8E9J0$.3%&!6F.%3=1E$.&!J21/2&::3N&X!
!
KY&:%!F8!%$\.&$F!LFY18!2&8E18%2&!E0&g!.Y366F81?9J2369!VRSQX[!KY&:%!.39!`!.$!7=*0-.@*-.B,$:1$
?B(.BF*@.71>$6K[!S.!N$!C!$N132!F8!N32F:!LF3!N$!:&!29$E%3N&2!?$8:!.&:!E&..F.&:U!E&.$!N$!&8%2$38&2!F8&!
:'>-710-.B,$:'>$B(.+B:',:7B0D-'>$*@'0$1,'$:=FD=(.,.>*-.B,[!D8!$F2$!?18E!F8&!?9%92312$%318!
38%&..&E%F&..&!$::1E39&!$F!E$2$E%^2&!6F.%3=1E$.!&%!$:C69%23LF&!?&:!.9:318:[!O&!N32F:!9%$8%!29$E%3N9U!18!
J1F22$!.&!2&%21FN&2!$F!83N&$F!?F!OK7!$N&E!F8&!-K7[!!
!
!K!H!PC9.3%&!?F&!$F!QMOR"!
!
S.!C!$!?&!=$f18!E$2$E%923:%3LF&!F8&!J$2$J$29:3&!V%21F\.&!?&!.$!:&8:3\3.3%9!$[8[!?&:!+!@$6\&:X!:J$:%3LF&!
%21J3E$.&!VK$2$e\&:U!<$J18X[!O&!%$\.&$F!LFY18!J&F%!1\:&2N&2!EY&:%!F8&!6yélopathie+démyélinisante+
J21/2&::3N&!:$8:!2963::318!$::1E3$8%!%21F\.&:!61%&F2:U!:&8:3%3=:!&%!:J038E%923&8:[!D8!=$3%!.&!?3$/81:%3E!
$N&E!F8&!:921.1/3&!LF3!N$!h%2&!%2^:!J1:3%3N&[!HTLV1%est%un%lentivirus%(comme%le%VIH),%cad%que%si%l’on%ne%
fait%rien,%ce%sont%des%virus%qui%s’installent%au%fil%des%années%et%qui%va%entrainer%ces%troubles%(donc%avec%une%
sérologie%très%positive,%pas%de%doute%sur%l’étiologie,%on%peut%le%soigner%rapidement).%O$!-K7!:&2$!J1:3%3N&!
&8!=18E%318!?&:!J9231?&:U!il%y%aura%des%périodes%où%il%doit%y%avoir%des%sécrétions%et%des%périodes%où%il%y%en%
a%moins).%%
%
%#!H!;8E9J0$.3%&!$F!RSQ!
!
;..&!:F2N3&8%!`!F8!:%$?&!%$2?3=!?&!.$!6$.$?3&!$N&E!F8&!?96&8E&!J21/2&::3N&[!D8!8&!:$3%!J$:!$F@1F2?Y0F3!
:3!3.!C!$!F8!2l.&!?&:!EC%1m38&:!LF3!38%&2N3&8%!?$8:!.&!69E$83:6&[!!
!
!;!H!#3$/81:%3E!?3==92&8%3&.!'!&8E9J0$.1J$%03&:!?F&:!$FT!J2318:!
!
!
i!
O&!J2318!8Y&:%!J$:!F8!$/&8%!38=&E%3&FTU!EY&:%!F8&!J21%938&[!OY$/&8%!&:%!F8&!J21%938&!E1?9&!J$2!.&!/^8&!
-2J[!KY&:%!J$:!J$%01/^8&!:$F=!.12:LFY3.!C!$!F8!J$::$/&!?&!.$!\$223^2&[!K166&!E&!8Y&:%!J$:!F8!$/&8%!
38=&E%3&FTU!3.!8YC!$!J$:!?&!29$E%318!38=.$66$%132&[!O&!?3$/81:%3E!:&!=$3%!J$2!.&!?1:$/&!?&!.$!J21%938&!"*4
a4aU!&%!.&!?3$/81:%3E!?&!E&2%3%F?&!:&!=&2$!:F2!\31J:3&!?F!E&2N&$F[!
!
G88$.&:!+("i!
52. Les encéphalites post-infectieuses :
A. surviennent lors de la phase aiguë de la primo-infection (rougeole, rubéole...). !
B. peuvent s’observer en post-vaccinal. !
C. correspondent uniquement à l’atteinte de la substance blanche. !
D. font intervenir un mécanisme direct par agression direct du virus. !
E. font intervenir un mécanisme auto-immun. !
!
1 / 5 100%

P2-UE8-Jaffar_Bandjee-Méningites_et_encéphalites_virales(suite)_10.04.2017

La catégorie de ce document est-elle correcte?
Merci pour votre participation!

Faire une suggestion

Avez-vous trouvé des erreurs dans linterface ou les textes ? Ou savez-vous comment améliorer linterface utilisateur de StudyLib ? Nhésitez pas à envoyer vos suggestions. Cest très important pour nous !