Y BAN NHN DN THNH PH H NI

TRNG CAO NG Y T H NG

Gio trnh

Vi sinh - k sinh trng

Ti liu o to s cp dn s y t

H Ni - Nm 2011

Ti liu tham kho

1. Dng Thi, Nguyn th Minh Tm, Phm vn Thn, Phm Tr
Tu, inh Vn Bn Quyn I, II, II K sinh trng v bnh k sinh trng
ngi- Nh xut bn y hc 1973 1974
2. Dng Thi, Nguyn th Minh Tm, Phm vn Thn, Phm Tr
Tu, Phm Hong Th, Hong Tn Dn Bi ging k sinh trng y hc - Nh
xut bn y hc 1986
3. Nguyn th Minh Tm, Phm vn Thn, Phm Tr Tu, Phm Hong
Th, Hong Tn Dn, Trng Kim Phng, Phan Th Hng Lin - K sinh
trng y hc - Nh xut bn y hc 1998
4.

Phm Song Lm sng v iu tr st rt - Nh xut bn y hc 1994

5. K sinh trng y hc Trung tm o to v bi dng cn b y t TP

H Ch Minh 1994
6. V Th Phan Dch t hc bnh st rt v phng chng st rt Vit Nam Nh xut bn y hc 1996

Li ni u
Gio trnh mn hc Vi sinh- K sinh trng do tp th gio vin b mn y t
cng ng bin son bm st mc tiu, ni dung ca chng trnh khung, chng
trnh gio dc ngnh iu dng. Gio trnh mn hc Vi sinh- K sinh trng c cp
nht nhng thng tin, kin thc mi v lnh vc Vi sinh- K sinh trng, c i mi
phng php bin son to tin s phm gio vin v hc sinh c th p dng
cc phng php dy hc hiu qu.
Gio trnh mn hc Vi sinh- K sinh trng bao gm cc bi hc, mi bi hc c
3 phn ( mc tiu hc tp, nhng ni dung chnh v phn t lng gi). Gio trnh
mn hc Vi sinh- K sinh trng l ti liu chnh thc s dng cho vic hc tp v
ging dy trong nh trng.
B mn y t cng ng xin trn trng cm n cc chuyn gia u ngnh, cc
thy thuc chuyn khoa tham gia ng gp .Xin trn trng cm n Hi ng
nghim thu chng trnh, gio trnh cc mn hc ca trng Cao ng y t H ng
c nh gi v xp loi xut sc cho cun gio trnh mn hc Vi sinh- K sinh
trng.
Gio trnh mn hc Vi sinh- K sinh trng chc chn cn c nhiu khim
khuyt, chng ti rt mong nhn c nhng ng gp kin ca cc ng nghip,
cc thy c gio v hc sinh nh trng gio trnh mn hc ngy cng hon thin
hn.
Cc tc gi

MC LC
Trang
BI 1. I CNG VI SINH HC ............................................................................. 5
1. nh ngha v vi khun: ................................................................................... 5
3. Cc loi hnh th v kch thc ca vi khun:................................................ 5
4. Cu to ca t bo vi khun ............................................................................. 7
5. Sinh l ca vi khun: ...................................................................................... 8
6. nh hng ca cc yu t ngoi cnh i vi vi sinh vt ............................... 9
BI 2. I CNG V MIN DCH V NG DNG TRONG Y HC . 12
1. Nhim khun: ................................................................................................. 12
2. Truyn nhim: ................................................................................................ 13
3. Min dich: ...................................................................................................... 14
BI 3. MT S VI KHUN GY BNH THNG GP .............................. 18
1. T cu (Staphylococcus)................................................................................ 18
2. Lin cu (Streptococcus) ............................................................................... 20
3. Ph cu (Streptococcus phneumoniae) .......................................................... 21
4. No m cu (Neisseria meningitidis) ............................................................ 22
BI 4. MT S VI RT GY BNH THNG GP ...................................... 23
1. nh ngha v virut: ....................................................................................... 23
2. Mt s vi rt gy bnh thng gp ................................................................ 23
BI 5. K SINH TRNG ST RT .......................................................................... 27
1. K sinh trng st rt (Plasmodium) ............................................................... 27
2. Hnh th.......................................................................................................... 27
3. Chu k pht trin: .......................................................................................... 28
BI 6. GIUN A-GIUN MC-GIUN TC-GIUN KIM-GIUN CH ................ 32
1. Giun a (Ascaris lumbricoides) ................................................................... 32
2. Giun mc (Ancylostoma duodenale) ............................................................. 33
3. Giun tc (Trichiuris trichiura) ....................................................................... 34
4. Giun kim (Enterobius vermicularis) .............................................................. 35
5. Giun ch (Wuchereria bancofti, Brugia malayi) ............................................ 36
BI 7. AMIP - TRNG ROI - TRNG LNG ...................................................... 39
1. Amip (Entamoeba histolytica) ....................................................................... 39
2. Trng roi m o (Trichomonas vaginalis) ................................................... 40
BI 8. SN L- SN DY ............................................................................................. 43
1. i cng:...................................................................................................... 43
2. Sn l:............................................................................................................. 43
3. Sn dy:.......................................................................................................... 44
BI 9. PHNG PHP LY BNH PHM BO QUN BNH PHM
LM XT NGHIM VI SINH K SINH TRNG ....................................... 46
1. i cng ....................................................................................................... 46
2. K thut.......................................................................................................... 47
4

BI 1. I CNG VI SINH HC
MC TIU:
1. Nu c ch li ca vi sinh vt trong y hc.
2. Nhn bit c cc loi hnh th ca vi khun.
3. M t c thnh phn v cu to ca vi khun qua nu r c tnh
sinh l ca vi khun, cc yu t tc ng ln vi khun.
NI DUNG:
1. nh ngha v vi khun:
Vi khun l nhng sinh vt n bo rt nh kch thc ca chng trung bnh
vo khong 1-2m (1(m = 1/1000 mm), do phi nhn qua knh hin vi phng i
hng trm ln.
2. ch li ca vi sinh vt hc trong y hc:
- Chn on bnh: Tm vi sinh vt gy bnh trong cc bnh phm nh
m, phn, mu, nc tiu... hoc dng huyt thanh ca ngi bnh chn
on
- D phng cc bnh truyn nhim: Bng cch ra cc bin php v
sinh phng bnh v ch ng sn xut ra cc loi vcxin phng bnh nh lao,
si, bi lit...
- iu tr bnh: Bng khng c t ca vi sinh vt nh bch hu, un
vn....
hoc sn xut ra cc loi thuc khng sinh nh penicillin,
streptomycin...
3. Cc loi hnh th v kch thc ca vi khun:
3.1 Cu khun:
Gm nhng vi khun c hnh dng nh hnh cu, hnh bu dc, hnh ngn
nn v..v.. ng knh t 0,5 - 1 (m.
Cu khun sp xp theo nhiu cch khc nhau:
- Xp thnh i: cn gi l song cu: ph cu, lu cu, mng no cu
- Xp thnh tng m: T cu; Xp thnh chui: Lin cu.

3.2 Trc khun:

L nhng vi khun c dng hnh que, ng knh t 0,5(m -1(m v di t
0,8(m -20(m
Trc khun cng c nhiu kiu dng khc nhau nh: hai u trn, hai u
nhn, hai u vung, hai u phnh to, trc khun hnh que mnh, cong v..v..
Trc khun thng ng ring, tuy nhin c vi loi c s sp xp c bit
nh:
- Xp thnh chui nh trc khun gy bnh than:
- Xp thnh hnh hng ro nh trc khun bch hu:

- Xp thnh hnh b ci nh trc khun lao:

- C th cong nh hnh du phy gi l phy khun ( phy khun t):

3.3 Xon khun:

L nhng vi khun hnh l xo thng ng ring l. ng knh t 0,2-0,5(m
di t 5-500(m
C 3 loi xon khun gy bnh thng gp l xon khun giang mai
(Treponema ), borrelia, leptospira. Ba loi ny c hnh dng khc nhau v chiu di,
s vng xon, bin xon.

4. Cu to ca t bo vi khun
4.1 Nhn: Ch gm mt si ADN xon kp. Si ADN ny c coi l nhim
sc th duy nht ca nhn. Nhn khng c mng bao bc. Nhn c nhim v di
truyn nhng c tnh ca vi khun m cho vi khun con.
4.2 Bo tng: Thnh phn ho hc chnh l ARN. Trong bo tng cn c
nhiu ribosom l ni tng hp cc loi protein.
4.3 Mng bo tng: L lp mng bao bc bo tng. Mng c nhiu chc
nng quan trng:
- Thm thu chn lc: Kim sot s i qua ca cc cht dinh dng v cn b
- H hp cung cp nng lng
- iu khin s phn bo
- Tiu ho ti ch mt s thc n
4.4 Vch: L thnh phn bo v t bo v lm cho vi khun c hnh dng nht nh
- vi khun Gram dng vch t bo s gi mu tm ca thuc nhum
- vi khun Gram m vch t bo khng gi c mu tm nn s bt mu
ca thuc nhum
4.5 V: Ch c mt s vi khun, hp phn ca v mang tnh khng nguyn v
l mt yu t c hc ca vi khun

4.6 Lng: C th xung quanh thn hoc mt hoc hai u vi khun. Lng
mang tnh khng nguyn ( khng nguyn H ) v gip cho vi khun c kh nng di ng.
4.7 Pili: Pili ging nh lng nhng mnh v ngn hn. C hai loi Pili:
- Pili chung: gip cho vi khun bm vo m
- Pili gii tnh: tham gia vo s vn chuyn di truyn
4.8 Nha bo:
- Nha bo l hnh thi tn ti c bit gip cho vi khun chu ng
c nhng nhn t ngoi cnh bt li nh: kh, nng, cht st khun...
- Nha bo c mt lp v cha rt t nc. Khi gp iu kin thun
li nha bo tr li trng thi bnh thng
- Nha bo thng thy trc khun gram dng

Cu to ca t bo vi khun

5. Sinh l ca vi khun:
5.1 Dinh dng:
Tt c vi khun gy bnh u l vi khun d dng. Nhu cu v dinh dng
ca vi khun gm axit amin, ng, mui khong, nc... Mt s vi khun khun
gy bnh phi hon ton k sinh trong t bo sng. S dinh dng ca vi khun
nh kh nng vn chuyn qua mng
5.2 Chuyn ho:
phn gii cc cht dinh dng vi khun tit ra cc loi enzym tng ng
vi tng cht

Qu trnh chuyn ho ca vi khun ngoi vic phc v cho sinh trng v pht
trin cn to ra mt s cht nh: c t, cht gy st, sc t, phn ho t....
5.3 H hp:
Mun tiu ho c thc n pht trin, vi khun cn mt s nng lng.
Nng lng cn thit ny do hin tng xy ho ca vi khun lm phn gii cc
cht dinh dng ( axit hu c, ng v..v.. )
V mt s dng xy ta chia vi khun lm hai loi:
- Hiu kh l vi khun cn c xy t do
- Ym kh l loi rt cn xy nhng khng sng c bng xy t do. Chng t
phn tch ly xy t cc hp cht nh nitrat v sunphat.
Hu ht cc vi khun vi khun gy bnh sng c c trong mi trng hiu
kh v ym kh, gi l hiu kh hay ym kh tu tin. Mt s hiu kh tuyt i nh:
T, mt s khc ym kh tuyt i nh un vn..
5.4 S sinh sn ca vi khun :
Vi khun sinh sn theo kiu trc phn, mi t bo phn chia thnh hai t bo
mi. Trong nhng iu kin thch hp s phn chia ny din ra rt nhanh (20-30
pht vi vi khun E.coli ), c nhng vi khun chm hn (36 gi vi vi khun lao).
6. nh hng ca cc yu t ngoi cnh i vi vi sinh vt
6.1 Yu t vt l:
- Nhit : Mi loi vi khun pht trin trong mt gii hn nhit nht
nh. Thng thng a s vi khun c th pht trin c trong khong t 18(C
40(C, thch hp nht l 37(C. Nhit thp nht vi khun khng cht nhng b c
ch khng pht trin. T 40(C tr ln, vi khun b tiu dit dn tu tng loi. i
vi vi khun khng c nha bo, nhit 60(C trong 30-60 pht b tiu dit, cn
100(C th c th cht ngay. i vi vi khun c nha bo c th chu ng c
100(C trong 10 pht n 2 gi.
- pH: a s vi khun thch hp vi pH trung tnh. Khi pH cao qu
hay thp qu gii hn s lm mt thng bng trao i cht gia mi trng v vi
khun, kt qu: vi khun s b tiu dit.
- p sut thm thu: Mng t bo vi khun c tc dng thm thu v vy p
sut ca mi trng xung quanh c tc ng n vi khun. a s vi khun thch
hp vi mi trng c p sut thm thu bng 7 ( 7-9 phn nghn NaCl ).
9

- Bc x: C kh nng dit khun do lm bin i cc phn ng sinh vt ca

axit nucleic.
- Phng php dng hi nng:
- Phng php dng bc x:
6.2 Yu t ho hc
- Cht ty u: l cht c kh nng st khun mnh nhng c hi cho c th
nn ch dng ty u vt.
- Cht kh khun: l cht chng li vi khun m khng c vi m sng ca
c th, dng bi ngoi da.
6.3 yu t sinh vt:
Cht i khng ( bacteriexin ): mt s vi khun nh E.coli, trc khun m
xanh, t cu... khi pht trin th tng hp nhng cht i khng vi cc vi khun
cng loi hoc cc vi khun thuc loi ln cn.
- Phagi hay virus gy bnh i vi vi khun: Khi chng xm nhp vo
vi khun th vi khun c th b tiu dit hoc cng tn ti.
- Cht kch thch: mt s vi khun khi pht trin tng hp ra mt cht
lm thun li vi khun khc pht trin
Hin tng i khng gip ta khai thc c t sinh vt mt s thuc khng
sinh.
Cu hi t lng gi
* Tr li ngn cc cu bng cch in t hoc cm t thch hp vo ch
trng
1. Vi sinh hc l khoa hc nghin cu...(A)...,cu to,..(B)...., v hot ng
ca cc sinh vt phc v con ngi.
A...............................
B...............................
2. Cc nhm vi sinh vt chnh gm:
A...............................
B...............................
C mt s nguyn sinh ng vt
D virus
10

3. K 3 li ch ca vi sinh vt hc trong y hc:

A..............................
B..............................
C..............................
4. K 2 ng dng ca vi sinh vt hc trong iu tr bnh:
A
B
5. Vi khun l nhng vi sinh vt..(A)..mi VK c hnh th nht nh
nh..(B)..ca chng
A
B
6. Trc khun thng ng...(A).....Tuy nhin c loi c s sp
xp..(B)........
A
B
7. Trc khun gm nhng vi khun c dng...(A)...,di t 3 n..(B)..
micromet
A
B
8..Xon khun l nhng vi khun...(A).....,thng ng.....(B)........
A
B
9. Mt s vi khun c hnh th trung gian nh vi khun dch hch,Brucella c
hnh...........
10. Cu khun gm nhng vi khun c hnh dng nh:
A.hnh cu
B
C

11

BI 2.
I CNG V MIN DCH V NG DNG TRONG Y HC
MC TIU:
1. Nu r mi lin h gia vi sinh vt gy bnh, i tng cm th v
yu t ngoi cnh trong qu trnh nhim khun
2. Trnh by c khi nim c bn v khng nguyn, khng th, vc
xin v huyt thanh.
3. Gii thch c qu trnh p ng ca c th khi c s xm nhp ca
mm bnh qua 2 kiu p ng: min dch dch th v min dch qua
trung gian t bo.

NI DUNG:
1. Nhim khun:
Trong cuc sng hng ngy con ngi v vi sinh vt lun lun tip xc vi
nhau. Trong mt hon cnh nht nh, vi sinh vt c th xm nhp vo c th con
ngi to nn mt phn ng phc tp ta gi chung l nhim khun .
1.1 Vi sinh vt gy bnh:
- c lc: L sc gy bnh. Nhiu hay t, nng hay nh l do c t v mt s
cht khc do VK1 sn sinh ra trong qu trnh chuyn ho.
- S lng mm bnh:
Vi sinh vt khi vo c th cn mt s lng nht nh mi gy c
bnh, bi v c th c chc nng t bo v n mt mc nht nh nn nu s
lng xm nhp qu t th b c th tiu dit m khng gy c bnh.
- ng xm nhp:
C nhng vi sinh vt mc d c s lng v c lc nhng khi xm nhp
vo c th bng con ng khng thch hp th vn khng gy c bnh.
1.2 Tnh cht phn ng ca c th: Vi sinh vt c xm nhp c vo c th
gy ra cc biu hin bnh l hay khng l tu thuc vo cc yu t:
1

Vi khun

12

- Hng ro bo v ca c th: Bao gm mt s yu t, bc u c tc dng

ngn chn vi sinh vt
1.3 Mi trng:
- Mi trng t nhin
Thi tit, kh hu, nhit , m, a d... u c nh hng n qu trnh
pht sinh bnh truyn nhim.
- Hon cnh x hi:
Bnh truyn nhim thng gp nhiu nhng nc ang pht trin hn l
cc nc pht trin, ni m hon cnh sng cc iu kin v sinh n thp.
2. Truyn nhim:
2.1 Ngun gc bnh truyn nhim:
C th chia thnh 2 loi:
- Bn ngoi: Ngi truyn bnh cho ngi. Cng c nhiu bnh truyn
nhim do ng vt truyn cho ngi. V d: dch hch (chut), bnh di
(ch), bnh than (tru, b).
- Bn trong: C mt s vi khun bnh thng vn sng da hoc trong
c th ngi m khng gy bnh g. Tuy nhin lc c th suy yu, sc
khng st km th chng pht trin mnh m v gy bnh.
2.2 Phng thc truyn nhim:
- Truyn nhim do tip xc.
- Truyn nhim qua ng h hp
- Truyn nhim qua ng tiu ho
- Truyn nhim do cn trng tit tc t
2.3 c im qu trnh sinh bnh:
Mi loi vi sinh vt ch gy mt loi bnh truyn nhim nht nh. din bin
ca bnh gm cc giai on: giai on bnh, giai on tin pht, giai on ton
pht v giai on kt thc hoc bnh nhn bnh phc hoc cht.
Thi k bnh ngn hay di tu thuc vo s lng, c lc ca vi khun v
tnh cht phn ng ca tng c th. Mt khc sau khi xm nhp, vi khun phi cn
mt thi gian sinh sn ti s lng nht nh hay lng c t gy bnh.
Nhng khng phi tt c bnh nhn u c triu chng v du hiu in hnh nn
mun xc nh bnh truyn nhim phi cn phi xt nghim mi quyt nh c.
13

2.4 Cc hnh thc biu hin ca bnh truyn nhim:

- Biu hin cc b v ton thn:
Bnh truyn nhim l kt qu ca tc dng qua li gia c th vi vi sinh vt
Nu sc khng ca c th mnh, c lc ca vi sinh vt yu th vi sinh vt ch
pht trin trong mt gii hn nht nh nh mn u inh l biu hin cc b nhim
t cu vng. Nu sc khng c th km, c lc vi sinh vt cao va s lng tng
nhanh th s gy nhim ton thn.
- Biu hin cp tnh v mn tnh:
Bnh pht trin nhanh qu trnh bnh tng i ngn, gi l bnh cp tnh
3. Min dich:
3.1 Khng nguyn:
- nh ngha: Khng nguyn l mt cht l khi xm nhp vo c th sinh vt
th sinh vt c kh nng gy ra p ng min dch.
- Tnh cht:
+

Khng nguyn phi l mt cht l i vi c th:

+ V thnh phn ho hc, khng nguyn thuc loi protein hoc

phc hp protein vi gluxit v lipit.
+ Khng nguyn c trng lng phn t ln trn 10.000UI. Trng
lng phn t cng ln th khng nguyn cng cao
3.2 Khng th:
- nh ngha:
Khng th hay globulin min dch l cht do c th tng hp p
ng s kch thch ca khng nguyn.
- Tnh c hiu:
Khng th l nhng phn t globulin ca huyt thanh c kh nng kt
hp c hiu vi khng nguyn.
- Phn loi:
Cc globulin min dch c nhiu lp khc nhau: IgG, IgM, IgA, IgE
- Chc nng chnh ca khng th:

14

3.3. p ng min dch:

- p ng min dch dch th:
Do t bo lymph B m nhim, c kh nng sinh khng th. T bo
lymph B c ngun gc t tu xng. Tu theo cu trc ca khng nguyn, t bo
lymph B s c kch thch to ra khng th theo hai kiu:
+ Nu khng nguyn l nhng phn t c cu trc n gin:
Khi gp t bo lymph B, nhng khng nguyn s gn vo t bo, sau
s c a vo bn trong gy bin i trong t bo. T mt t bo lympho ht
nh s bin thnh nguyn tng bo ( plasmablast ) ri cui cng thnh tng bo.
T bo ny rt ln v c kh nng sn xut, tit ra khng th IgM. Sau khi sinh
khng th xong, t bo plasma s cht trong vi ngy.

KN
n gin

Nguyn tng bo

Tng bo

IgM

+ Nu khng nguyn l nhng phn t c cu trc phc tp nh vi khun,

virus, protein...
Trong qu trnh sinh khng th, t bo lympho B cn s gip ca t
bo lympho Th. T bo Th sau khi gp khng nguyn s b kch thch v tit ra ho
cht (lymphokin ). Cc lymphokin ny kch thch t bo lympho B bin i thnh
nguyn tng bo ri thnh tng bo c kh nng sinh khng th IgM Nhng bn
cnh nhng nguyn tng bo li quay li giai on t bo lympho ht nh vi
mt t thay i b mt. Nhng t bo ny gi l t bo nh v c kh nng nhn
bit khng nguyn v sn sng sinh khng th khi tip xc vi khng nguyn ln
sau.

KN
Phc tp

Th

Nguyn tng bo
T bo nh

15

Tng bo Ig M
Ig G
Ig A
Ig E

- p ng min dch qua trung gian t bo:

Trong kiu p ng ny vai tr ch yu l cc t bo lymph T. Cc t
bo ny cng c ngun gc t tu xng, nhng trong qu trnh bin ho chu nh
hng ca tuyn c. C nhiu loi lympho T khc nhau m vai tr quan trng trong
p ng min dch qua trung gian t bo l do t bo Tdh sinh ra phn ng qu mn
mun v t bo Tc gy c trc tip ln t bo ch.
T bo Tdh cn c kh nng kch thch cc i thc bo git cht cc
vi sinh vt ni bo ( cc vi sinh vt sng bn trong t bo ). nhng bnh nhn b
thiu Tdh ( VD: bnh nhn b bnh SIDA ) th sc khng rt yu do thng b
cht v cc bnh nhim khun.
Cho n nay, tm quan trng ca min dch qua trung gian t bo
c hiu r trong cc trng hp sau:
+

khng chng vi sinh vt ni bo

p ng min dch vi mt s khng nguyn ho tan

Mn cm do tip xc

Cc phn ng ca c th chng ung th v mnh ghp

Mt s bnh t min
cu hi t lng gi

* Tr li ngn cc cu hi sau bng cch in t hoc cm t thch hp

vo ch trng
1. K 3 kh nng gy nhim khun
A

C..............................
2. K 3 yu t nh hng n bnh nhim khun
A
B
C
16

3. Ni c t l cht c c bn...(A)...t bo VK ch khuch tn ra ngoi

khi t bo VK.....(B)...............
A
B
4. K 3 yu t lin quan n vi sinh vt gy bnh:
A. c lc
B
C
5. Tnh cht phn ng ca c th i vi s xm nhp ca VK tu thc vo:
A. Hng ro ngoi vi
B.
C. Ni tit
D.
E. Tui gii
6. Nhng vn c lin quan n yu t mi trng trong bnh nhim khun l:
A. Thi tit
B.
C
D. Phong tc tp qun
E. Ch x hi
7. Thi gian bnh tu thuc vo:
A. c lc ca vi sinh vt
B
C
8. Nu 2 v d v bnh Vi rut truyn bng ng tiu ho
A
B
9. Min dch l kh nng...(A).....ca c th chng li..(B)..ca mm bnh
A
B
17

10. K tn 3 loi min dch

A
B
C

BI 3. MT S VI KHUN GY BNH THNG GP

MC TIU:
1.M t hnh th, c im sinh hc ca cc loi vi khun gy bnh
thng gp
2. Trnh by kh nng gy bnh, ng xm nhp, ng bi xut ca
cc loi vi khun gy bnh thng gp.
NI DUNG:
1. T cu ( Staphylococcus )
Rober. Koch m t t nm 1878. T cu c nhiu loi: c loi gy bnh nh
t cu vng c loi khng gy bnh ch k sinh da va nim mc ; tuy nhin nu
gp iu kin thun tin loi khng gy bnh cng thng gy bnh.
1.1 c im sinh hc:
- Hnh th:
Trong bnh phm, t cu xp
thnh i hoc m nh chm nho
khng di ng khng sinh nha bo v
thng khng c v

- Cc cht do t cu sinh ra:

+ Cc c t:
Dung huyt t: c kh nng ly gii hng cu
c t dit bch cu ( leucocidin ): c tc dng c i vi bch cu a nhn
va v cc thc bo
18

c t rut: gy nhim c thc n v vim rut cp

+ Cc enzym:
Coagulase: lm ng huyt tng ngi, n c th to nn huyt cc trong
tnh mch v gy nhim khun huyt
Desoxyribonuclease: thu phn ADN
Fibrinolysin: lmv cc mu thnh mnh nh, nhng mnh ny ri ch v
gy tc mch gy ra nhim khun di cn cc b phn ( phi, no, gan...)
Hyaluronidasc: to iu kin cho vi khun lan trn
Penicillinasc: lm cho penicillin mt tc dng
1.2 Kh nng gy bnh:
Ngi l tc ch bnh thng ca t cu. Nhiu ngi lnh ( t 10(n 30( )
mang t cu vng mi hng v rut.
T cu c th lan truyn trc tip nhng thng thng l ly gin tip qua
khng kh, bi, qun o, thc n va bn tay ngi chm sc bnh nhn.
T cu thng gy nn cc tn thng mng m. Bnh thng gp l:
- Cc nhim khun ngoi da:
Cc tn thng nh nht, u inh, p xe v..v.. Tcu cn gy nn eczema
tr em v ngi ln c bit t cu c th gy bin chng vim nghn tnh mch
xoang-hang do t cu t inh ru xm nhp vo.
- Nhim khun huyt:
T cu t cc tn thng ngoi da vo mu gy nn nhim khun huyt nng.
Bnh thng gp ngi thch nn mn, nht, inh ru cn non.
- Nhim c thc n v vim rut cp tnh:
Bnh nhim c thc n xy ra rt cp tnh ch vi ba gi sau khi n phi thc
n c c t rut ca t cu. Ngi bnh c cc du hiu nh nn ma, a chy d
di mch nhanh dn ti tnh trng kit nc.
1.3 Chn on vi sinh vt:
Ch yu da vo phn lp. Ni chung chn on d dng, ch cn ly bnh phm
( mu, m, nc tiu, nc no tu v..v.. ) Trnh bi nhim t bn ngoi. Ly ng v
tr v ng thi gian. Trong trng hp bnh phm l mu c th ly nhiu ln.

19

2. Lin cu ( Streptococcus )
Lin cu c pht hin nm 1878. Da vo c tnh sinh hc c th phn
bit thnh cc nhm A, B, C, D
2.1. c im sinh hc:
- Hnh th:
Lin cu l nhng cu khun xp
thnh chui, un khc, di ngn khc
nhau khng di ng i khi c v, bt
mu Gram dng.

- Cc enzym:
+ Dung huyt t:
Streptolysin O: l loi khng nguyn mnh c kh nng kch thch c th hnh
thnh khng th (antistreptolysinO ASLO). Vic nh lng khng th ny c gi tr
trong chn on bnh do lin cu gy ra, c bit l bnh thp tim (RAA).
Streptolysin S: c tnh khng nguyn km nn khng dng chn on bnh.
Hai loi dung huyt ny c c tnh cao, c kh nng gy c vi tim v no.
+ Proteinase: c tc dng phn hu protein gy thng tn tim
Ngoi ra cn nhiu enzym khc gy c cho c th tc ch
2.2 Kh nng gy bnh:
Lin cu c t hu v rut
- Bnh do lin cu nhm A:
+ Nhim khun ngoi da: eczema, nhim khun vt thng, vim t hu
+ Cc nhim khun khu tr th pht: nhim khun huyt sau nhim khun t
cung, da, t hu. Vim mng trong tim, vim thn vim phi vim mng no
+ Bnh thp tim
- Bnh do lin cu nhm D:
Thng gy nhim khun ng tit niu c kh nng khng vi penicillin
- Bnh do cc lin cu nhm khc (B C):
Gp trong cc nhim khun tin trin chm, bnh thng nh
20

2.3 Chn on vi sinh:

Xt nghim cc bnh phm t ni tn thng: mu, nc no tu, pxe cha
v. Ch khi ly bnh phm phi tuyt i v khun
C th xt nghim trc tip, phn lp vi khun v tm khng th trong mu
bnh nhn.
3. Ph cu ( Streptococcus phneumoniae )
3.1 c im sinh hc:
- Hnh th:
Ph cu l nhng cu khun
hnh ngn nn, thng xp i, pha
u ging nhau gip vo nhau.
Gram dng khng di ng, khng
sinh nha bo. Trong bnh phm
thng c v.
- Sc khng:
D b tiu dit bi ho cht st khun thng thng v nhit ( 60(C trong
30 pht )
3.2 Kh nng gy bnh:
Thng gp ph cu vng t hu ca ngi lnh vi t l kh cao
khong 40 70 ( )

Ph cu c th gy bnh ng h hp, din hnh l vim phi ph qun phi, pxe phi, vim mng phi. Vim phi do ph cu thng l mt bnh xy ra
sau khi ng h hp b tn thng do nhim virus (nh virus cm ) hoc do cc
ho cht Ngoi ra ph cu cn gy vim xoang, vim hng, vim mng no, vim
mng bng, mng tim, vim thn, vim tinh hon...
cc ni tn thng ph cu hnh thnh mt lp v dy, lm cho thuc
khng sinh kh c tc dng. Do dng khng sinh cha bnh phi cha sm va
trit .

21

3.3 Chn on vi sinh:

Ch yu l chn on trc tip phn lp t bnh phm.
4. No m cu ( Neisseria meningitidis )
No m cu c tm thy nm 1887. l mt vi khun k sinh tuyt i
ngi v c th gy bnh vim mng no - tu thnh dch ln ngi. Bnh hay
gp thanh thiu nin.
4.1 c im sinh hc:
- Hnh th:
Trn tiu bn nhum Gram t cn nc no tu,
sau khi ly tm, thy c nhng bch cu a nhn cn
nguyn vn v nhng bch cu a nhn ang b ly gii.
Bn cnh c nhng song cu hnh ht c ph, bt mu
Gram m, ng ring l hoc ng thnh m nh ( 2
hoc 3 i ), mt s nm trong bch cu a nhn
+ Sc khng:
Trong nc no tu, no m cu ch tn ti 3-4 gi. Sau khi ra ngoi c th, b
tiu dit nhanh bi nhit ( 55(C trong 30 pht hoc 60(C trong 10 pht ) lnh t b
nh hng ( c th tn ti -20(C )
4.2 Kh nng gy bnh:
No m cu l loi vi khun k sinh tuyt i ngi. Thng thy
nim mc ng h hp trn. Trong mt s iu kin no , vi khun gy vim hu
hng. mt s ngi vi khun gy nn vim mng no tu. Bnh truyn nhim theo
ng h hp, qua nhng git nc bt ca bnh nhn hoc ngi lnh mang vi
khun.
No m cu cn c th gy nhim khun huyt rt nng, km theo ban xut
huyt v shock nhim khun.
4.3 Chn on vi sinh:
Cc bnh phm ( mu, nc no tu, ngoy hng ), chuyn ngay ti phng
xt nghim cng sm cng tt v ra ngoi cnh vi khun cht rt nhanh. Ch yu
chn on trc tip hoc phn lp vi khun bng nui cy.

22

Cu hi lng gi:
Cu hi truyn thng
1.M t hnh th, c im sinh hc ca cc loi vi khun gy bnh thng
gp
2. Trnh by kh nng gy bnh, ng xm nhp, ng bi xut ca cc loi
vi khun gy bnh thng gp.

BI 4. MT S VI RT GY BNH THNG GP
MC TIU:
1. Nu nh ngha v c tnh chung ca virut.
2. Trnh by kh nng gy bnh, ng xm nhp, ng bi xut
ca mt s vi rt gy bnh thng gp.

NI DUNG
1. nh ngha v virut:
Virut l mt hnh thi ca s sng n gin, kch thc rt nh trung bnh
khong 10 300 milimicromet (1 milimicromet = 1/1000 ( ), do phi nhn qua
knh hin vi in t phng i hng vn ln.
2. Mt s vi rt gy bnh thng gp
2.1 Vi rt cm
Vi rt cm trong nc mi, c hng ca ngi bnh, khi ho bn ra thnh
nhng git nc bt nh xm nhp vo c th ngi khc, theo ng h hp. Vi
rt cm c trong nc mi ming mt ngy trc v hai ngy sau khi pht bnh
v ly trc tip nn gy rt nhiu kh khn trong vic phng dch. Khi vi rt cm
pht trin, n lm cho kh nng min dch ca c th gim st, to iu kin cho s
xm nhp ca ph cu v lin cu.v..v...v gy bin chng nh vim ph qun, vim
phi....

23

Chng A gy dch cm rng ln khp th gii, chng B c tnh cht dich a

phng, chng C, D dch nh, nh.
Khi ri, min dch khng qu 1-2 nm, khng c min dch cho gia cc
chng A,B,C,D
2.2 Vi rt di
Vi rt di c nhiu trong nc bt ca sc vt b bnh di, qua nhng vt
thng b cn xm nhp vo c th, theo ng dy thn kinh t ngoi da n no
tu ri ln i no t li theo dy thn kinh xung n hch nc bt m bi tit
ra ngoi. Vi rt tp trung nhiu nht no nn gy ra nhng hin tng thn kinh
nh tng cc phn x hng phn v co git, c bit l cc c nut v c h hp,
lm cho bnh nhn s gi, s nc v co git.
Nhng ng vt c v u d cm nhim vi vi rt di.
2.3 Vi rt bi lit ( polio vi rut)
Vi rut bi lit c sc khng cao, trong nc bn, trong sa sng c
hn ba thng, trong phn: trn 6 thng chu c pH t 4 n 10.
Vi rut vo c th qua ng tiu ho, pht trin trong rut ri vo mu, qua h
thn kinh trung ng v t mi xung tu sng gy ra bi lit
Vi rt bi lit cn vo c th qua ng h hp theo h thng bch huytvo
mu ri vo i no ri mi xung rut bi tit ra ngoi theo phn.
Khi nhim khun a s bnh nhn th n, mt s t c biu hin lm sng
v khi lnh c min dch lu di
2.4 Vi rt si:
Mc bnh si l do ht phi nhng git nc bt rt nh trong khng kh. sau
khi vo ng h hp trn, vi rt xm nhp vo mu v gy nhim cc t chc ca
ng h hp.. Bnh si bt u ly t ngy u thi k tin pht v ko di cho n
ngy th 8-10. Sau khi nhim si c min dch chc chn sut i
Cu hi t lng gi
* Tr li ngn cc cu hi sau bng cch in t hoc cm t thch hp
vo ch trng
1. Mi mt chng vi rut ch pht trin trn .......................................ngi
24

2. Vi rt c th chu c lnh...( A)...... trong hng....( B)...

A................................................................
B.................................................................
3. Vi rt c min dch:
A................................................................
B.................................................................
C..................................................................
4. Hai phng php xt nghim vi rut chn on:
A................................................................
B.................................................................
5. Vi rt cm c trong nc mi ming (A) ngy trc v (B) ngy sau khi
pht bnh
A................................................................
B.................................................................
6. VR di xm nhp vo c th, theo ng (A) t ngoi da ln n (B)
A................................................................
B.................................................................
7. Sau khi xm nhp bng ng tiu ho, vi rut bi lit i qua 4 v tr trong
c th:
A..rut.
B.................................................................
A................................................................
B..Tu sng.
8. Sau khi xm nhp qua ng h hp, vi rt si xm nhp vo (A) v gy
nhim cc t chc ca ng (B)..
A................................................................
B.................................................................

25

*Phn bit ng, sai cc cu hi sau bng cch nh du X vo ct () cho

cu ng, ct (s) cho cu sai

9. Vi rut khng c cc loi men chuyn ho

10. Mi loi vi rut chu tc ng ca mt loi khng
sinh thch hp
11. Virus c kh nng pht trin v t nhn ln
12. Virus ch gy bnh cho ngi
13. Tm vi rut bng phng php phn lp, bnh phm
phi ly l huyt thnh
14. T bo virus cha 2 loi axit nucleic
15. Vi rut cm khng c min dch cho gia cc
chng A,B,C,D
16. Vi rut bi lit c sc khng thp ngoi cnh
17. Vi rt bi lit c th vo c th qua ng h hp
18. Khi nhim vi rut bi lit a s bnh nhn th
n, mt s t c biu hin lm sng
19. Sau khi mc vi rut bi lit, ngi bnh c min
dch khng vng bn
*La chn cu tr li ng nht bng cch khoanh trn vo ch ci u
cu
20. Virus ch c th nhn ln khi xm nhp vo c th sng khc, do t bo VR:
A. Ch cha 1 loi axit nucleic
B. Khng sng c ngoi cnh.
C. Ch cha 2 loi axit nucleic
D. C kch thc rt nh
E. C th ngi c nhit thch hp vi s pht trin ca VR

26

A.
* Cu hi truyn thng
22. Trnh by kh nng gy bnh ca Vi rt cm?
23. Trnh by kh nng gy bnh ca Vi rt di ?
24. Trnh by kh nng gy bnh ca Vi rt bi lit ?

BI 5. K SINH TRNG ST RT
MC TIU:
1. Nu c cc loi k sinh trng st rt
2. Trnh by c chu k pht trin ca chng
NI DUNG:
1. K sinh trng st rt ( Plasmodium)
Plasmodium thuc b bo t trng, c khong 120 loi k sinh trng st rt
khng nhng gy bnh cho ngi m c cho ng vt. c xng sng.
Plasmodium gy bnh cho ngi c 4 loi ;
- Plasmodium falciparum
- Plasmodium vivax
- Plasmodium malariae
- Plasmodium ovale
2. Hnh th
Trong qu trnh pht trin ngi cng nh mui, Plasmodium lun bin
i v hnh th. ngi trn tiu bn git n ( git mu mng) nhum Giemsa,
Plasmodium c 3 loi hnh th:

27

Th

P. falciparum

P. vivax

T dng Ging hnh nhn nh v mnh, Nhn tng i dy v gn,

thng ra hng cu
th gi trng ging hnh amip
Phn lit

8 32 mnh

14-24 mnh

Rt him thy mu ngoi vi

Giao bo

Hnh li lim hoc hnh qu Hnh trn

chui

Sc t

Sc t t, nh, mu en

Sc t hnh gy, mu nu

Hng cu Hnh dng kch thc bnh Ln hn bnh thng, mo m

b k sinh thng
3. Chu k pht trin:
Chu k pht trin ca Plasmodium i hi phi qua hai vt ch l ngi v
mui.
- Chu k pht trin trn c th ngi ( chu k sinh sn v gii)
S pht trin ca Plasmodium trong c th ngi bao gm 2 giai on.
+ Giai on gan ( giai on tin hng cu): Thoa trng ca k sinh trng
st rt trong hch nc bt ca mui Anopheles ci truyn bnh.trong khi mui t
ngi, thoa trng vo mu lu thng trong mu, sau 30 pht ton b thoa trng
chui vo gan pht trin trong t bo gan. trong t bo gan thoa trng pht trin
thnh th phn lit. Phn lit v gii phng ra cc mnh trng, nhng mnh trng
ny s vo mu k sinh trong hng cu.
+ Giai on mu:
Cc mnh phn trng t gan xm nhp vo hng cu, lc u l th t dng
ri pht trin thnh th phn lit. sau khi pht trin y cc mnh phn lit gi s
ph v hng cu gii phng ra nhng mnh trng. Lc ny tng ng vi cn st
xy ra trn lm sng.
Hu ht nhng mnh trng ny quay tr li k sinh trong hng cu mi, cn
mt s mnh trng pht trin thnh hu gii, l giao bo c v giao bo ci.
Nhng giao bo ny nu c mui ht vo d dy s tip tc pht trin trong c th
mui. Nu khng c mui ht, giao bo li mu ri b tiu hu i.

28

- Chu k pht trin trong c th mui ( chu k sinh sn hu gii)

Giao bo c ci vo d dy pht trin thnh giao t c v ci trng thnh.
Giao t c ho hp vi giao t ci to nn hp t chuyn ng v thnh trng.
Trng chui qua thnh d dy mui pht trin t nh n ln ( trng nang gi) bn
trong c nhiu thoa trng. Trng nang gi v, thoa trng n tp trung trong hch
nc bt ca mui, khi mui t thoa trng s xm nhp vo c th gy bnh.

29

30

Cu hi t lng gi
* Tr li ngn cc cu hi sau bng cch in t hoc cm t thch
hp vo ch trng
1. K tn 4 loi Plasmodium gy bnh cho ngi ;
A. Plasmodium....................................
B. Plasmodium......................................
C. Plasmodium malariae
D. Plasmodium ovale
2. Th phn lit ca P..(A).t gp ..(B)..
A................................................................
B.................................................................
3. in tn 3 th ca KST st rt trong vi trng sau y:

A.......................
C.......................
B.......................

4. S pht trin ca Plasmodium trong c th ngi bao gm 2 giai

on:
A................................................................
B.................................................................
5. KST st rt gy..(A).. Tng ng vi cn...(B)..trn lm sng
A................................................................
B.................................................................
* Cu hi truyn thng:
6. Trnh by chu k pht trin ca KST st rt

31

BI 6. GIUN A-GIUN MC-GIUN TC-GIUN KIM-GIUN CH

MC TIU:
1. nh ngha c cc loi giun a, kim, mc, ch
2. Trnh by chu k pht trin ca chng
NI DUNG:
1. Giun a ( Ascaris lumbricoides )
1.1 Hnh th:
Giun a l loi giun ln k sinh ng tiu ho. Mu trng, hai u
thon, thn trn di. Giun ci di trung bnh 20-25 cm. u giun a c ba
mi. ui giun ci thng, ui giun c cong.
Trng giun a mi bi xut khi c th thng c mu vng, v dy,
x x, hnh bu dc, kch thc 45-75 (m ( Hnh... ). Ngoi ra trng giun
a cn c nhng hnh dng khc.
1.2 Chu k pht trin:
Giun a c chu k n gin, c giai on pht trin trn ngi v
giai on pht trin ngoi cnh.
Giun a sng ch yu rut non. Trng c bi tit theo phn ra
ngoi cnh. Gp iu kin thch hp ( m 70%, nhit 25-30(C ) sau
mt thi gian trng pht trin thnh trng c u trng. Khi trng c u trng
vo ng tiu ho, do tc dng co bp ca d dy, rut, tc dng ca dch
v, u trng ph v v trng theo h thng mch mu t rut ti gan, v tim,
ln phi, thay v v ln dn ln. T phi u trng ln hng ri xung rut
pht trin thnh giun trng thnh.
Din bin ca giai on trong c th mt khong 60 ngy. Giun a
sng khong 1 nm.

32

Giun a
( rut non )

Trng
( phn )
Trng c u trng
( Ngoi cnh )

Hu
u trng thay v
( Phi
Gan )

u trng
( Mu
D dy , rut )

Bnh giun a thng ph bin vng dn c tp trung ng c,

iu kin v sinh km.
Trng ngoi cnh c trong t ct, nc, thc phm, trn mt cc
vt dng trong gia nh... t do xm nhp vo c th qua ng tiu ho.
1.3Chn on xt nghim: Ch yu bng xt nghim phn tm trng
giun a.
2. Giun mc ( Ancylostoma duodenale )
2.1 Hnh th:
Giun mc mu trng ng, giun ci di 10-12 mm, giun c di 8-10
mm.
Trng giun mc hnh bu dc, khng c mu c bit. Kch thc 60
(m. Trng mi bi xut c t 2-4 mi nhn ( Hnh... )
2.2 Chu k pht trin:
Giun ci t trng, trng theo phn ra ngoi cnh. Trong ngoi
cnh c iu kin m v m, trng pht trin thnh trng c u trng. u
trng thot khi trng trong vng 24 gi v pht trin thnh u trng c kh
nng ly nhim sau 7-10 ngy. Chng gi c kh nng truyn bnh trong
t nhiu tun hoc hng thng. u trng c kh nng ly nhim tm vt ch
xm nhp qua da, thng thng qua da bn chn nhng ngi i chn
t ( i khi xm nhp bng ng tiu ho ). Theo ng mu v bch
huyt ln phi, hng v xung rut non bm vo thnh rut non v tr thnh
giun trng thnh.
Din bin chu k giai on trong c th mt khong 6-8 tun.

33

Tui th ca giun mc trung bnh 10-12 nm do c giai on ng,

ngng pht trin trong nhiu thng.
Nhim giun mc thng l nguyn nhn gy thiu mu,
thiu cht st nng dn, cng nhn vng m.
Giun mc
( T trng )

Trng
( Phn )

( Phi )
( Mu )
( Da )

Trng c u trng
u trng thay v
u trng
( Ngoi cnh )

3. Giun tc ( Trichiuris trichiura )

3.1 Hnh th:
Giun tc c th chia lm hai phn: phn u nh v di, phn thn to v
ngn. Kch thc di t 3-5 cm.
Trng giun tc hnh bu dc hoc hnh thoi, v dy, hai u c nt
(Hnh...)
3.2 Chu k pht trin:
Giun tc k sinh i trng, giun cm su phn u vo nim mc
rut ht dch t bo. Giun ci vi ngn trng 1 ngy. Trng c bi
xut ra ngoi qua phn. Sau khong 2 tun pht trin trong t m v m,
trng pht trin thnh trng c u trng va bt u gy nhim. Nu ngi n
phi trng c u trng, u trng c gii phng ra khi trng v pht trin
trng thnh ti i trng (manh trng, i trng, trc trng ).
Thi gian t khi nut phi trng n khi giun trng thnh l 3 thng
Giun tc c th sng ti 7-8 nm.

34

Giun tc
( i trng )

Trng
( Phn )

u trng
( D dy, rut )

Trng c u trng
( Ngoi cnh )

Nhim giun tc thng khng c biu hin lm sng, nhng nu

nhim nhiu c th gy a chy, phn c mu v cht nhy.
4. Giun kim ( Enterobius vermicularis )
4.1Hnh th:
Giun kim c kch thc nh, mu trng. Giun ci di 10-12 mm, ui
nhn thng. Con c nh hn di 2-5 mm ui cong.
Trng giun kim hnh bu dc, lp mt gc. V trng mng, trong.
Trng giun kim thng sm pht trin thnh trng c u trng.
4.2 Chu k:
Giun kim sng gc hi manh trng. Giun kim c cht sau khi giao
hp. Giun ci trng vng nim mc hu mn vo ban m. Sau khi
ht trng giun kim ci cht. V vy tui th ca giun kim rt ngn, ch sng
khong 1-2 thng.
Trng giun kim pht trin thnh trng c u trng sau 4-8 gi. Nu
ngi n phi trng c u trng vo ng tiu ho, u trng ph v v
pht trin thnh giun trng thnh.
Mt khc, 1 s trng hu mn n thnh u trng, u trng chui vo
hu mn ln rut d pht trin. Do vy vic ti nhim giun kim rt d dng.
Giun kim
(Hi manh trng)

Trng
(Hu mn)
u trng
( Hu mn )
u trng
(D dy, rut)
35

Trng c u trng

Giun kim thng gy triu trng nga hu mn, mt ng hoc bi

nhim do gi. ph n c th vim m o, vim vi trng.
5. Giun ch ( Wuchereria bancofti, Brugia malayi )
5.1 Hnh th:
Giun ch trng thnh trng ging nh si ch t di t 5-10 cm mu
trng sa.
u trng giun ch di khong 250m (Hnh.. )
5.2 Chu k pht trin:
Giun ch sng ch yu h bch huyt ti bn v nch, giun ci ra
u trng, u trng t h bch huyt vo mu. Ban ngy u trng su trong
mch mu ni tng. Ban m ( t 21 gi n 3 gi sng ) u trng xut hin
mu ngoi vi. u trng giun ch c th sng khong mt nm hoc lu hn.
u trng ny nu c mui truyn bnh ht vo d dy s pht trin thnh
u trng gy nhim ri tin ti vi ca mui. Khi mui t ngi u trng t
mui vo mu ri ti h bch huyt tr thnh giun trng thnh.
Giun ch sng khong 10 nm.
Giun ch
u trng
( H bch huyt )
( Mu )

( Mu )

u trng gy nhim
( Mui )

u trng giun ch thng gy tc h thng bch huyt vi cc biu

hin nh ph chn voi, trn dch mng tinh hon, i ra dng chp (nu b
v h thng bch huyt v ng tit niu).

36

Cu hi t lng gi
* Tr li ngn cc cu hi sau bng cch in t hoc cm t thch
hp vo ch trng
1. K 3 l do lm cho t l bnh giun mc tng cao vng trng rau:
A.
B.
C.
2. Ba v tr c giun ch trong chu trnh pht trin:
A Mch v hch bch huyt ngi
B.
C.
3. Ba bin php c bn phng bnh giun ch:
A.
B.
C.
4. in vo ch trng trong s sau:
Giun a
( A )

Trng
( Phn )

( Hu )

(B)
( Ngoi cnh )

(C)
( Phi

u trng
( D dy )

gan )

37

5. in vo ch trng trong s sau:

Giun mc
Trng
( T trng )
( Phn )

( Phi )

(A)

Ngoi

u trng
u trng
( Mu )

Cnh
(B)

6. K tn th t cc v tr giun a di chuyn trong c th ngi:

A. D dy, rut.
B. .
C. Gan, tim
D. .
E. Hng ri xung rut
7.*Phn bit ng, sai cc cu hi sau bng cch nh du X vo ct
() cho cu ng, ct (s) cho cu sai

8. u trng Giun a thay v gan

9. t phn bn ti sau nhiu tun vn c kh nng nhim giun mc
10. Giun tc k sinh rut non
11. Trng giun ch c kch thc 70 (m
12. Trng giun kim c th n ngay ti hu mn
13. Giun ch k sinh h bch huyt
14. u giun a tn cng bng ba mi
15. Trng giun a ngoi cnh pht trin thnh u trng
16. u trng giun mc ch c kh nng truyn bnh trong t vi ngy

38

BI 7. AMIP - TRNG ROI - TRNG LNG

MC TIU:
1- M t hnh th cc loi k sinh trng
2- Trnh by chu k pht trin ca Amip,trng roi, trng lng

NI DUNG:
1. Amip ( Entamoeba histolytica)
1.1 Hnh th
Amip l loi n bo, di chuyn nh chn gi hnh thnh t nguyn
sinh cht. Amip c 3 dng hnh th khc nhau:
- Th n hng cu:
l th gy bnh thng thy phn ngi b bnh l amip, hoc
khu tr cc p xe thnh rut, hoc cc ph tng do amip di chuyn ti v
gy nn. Th n hng cu c kch thc t 20- 40 (m. soi ti thy n di
chuyn nhanh bng cch phng ra mt chn gi trong sut ( do nguyn sinh
cht pha ngoi ( ngoi nguyn sinh cht) to thnh. Pha trong nguyn sinh
cht ( ni nguyn sinh cht) c cc ht nh v cha hng cu do amip n
vo. Nhn nm trong, gia nhn c trung th.
- Th hot ng cha n hng cu (minuta)
Cng ging nh th hot ng n hng cu nhng nh hn 10 12
(m, trong ni nguyn sinh cht khng c hng cu
+ Th bo nang ( th kn )
l th bo v v pht tn amip. Bo nang c hnh cu, kch thc
10 12 (m, v dy v chit quang, khng chuyn ng. Bo nang non cha
1 hoc 2 nhn, 1 khng bo v mt vi th hnh que, Bo nang gi c 4 nhn.
1.2 Chu k pht trin:
Ngi nhim amip do n phi bo nang, gin tip qua s nhim ca
mi trng. Cc dch tiu ho lm tan v ca bo nang, 4 nhn v nguyn
39

sinh cht phn chia thnh 8 amp th minuta. Di cc nh hng khc

nhau, cc minuta ny c th tr li thnh bo nang. Gp iu kin thun li,
minuta tr thnh th n hng cu c kh nng gy bnh. Chng xm nhp
vo thnh ca i trng, to nn nhng p xe hnh cc o gy hi chng l
vi cc triu chng i ngoi phn nhy mu, v cc cn au qun rut.
Mt s trng hp amip vo h thng tun hon mc treo v ti tnh mch
ca vo gan, gy p xe gan hoc ti phi gy bnh amip phi.

2. Trng roi m o (Trichomonas vaginalis)

Trng roi l nhng nguyn sinh ng vt c mt hoc nhiu roi.
Trng roi ng v phng din y hc chia thnh 2 nhm: Nhm k sinh
ng tiu ho v m o gm Trichomonas, Giardia, Chilomastix. Nhm
k sinh ng mu gm Trypanosoma, Leishmania. Vit Nam ch c
nhm ng tiu ho v m o gy bnh cho ngi.
Trichomonas vaginalis ch c vt ch l ngi, k sinh ch yu m
o. Bnh ly do tip xc trc tip qua ng sinh dc, ngoi ra cn lin
40

quan n v sinh c nhn, ra nc ao h d b bo nang xm nhp vo

ng sinh dc. T.vaginalis bm cht vo nim mc sinh dc, chuyn pH t
toan sang kim, do pH thay i nn to iu kin cho vi khun trong m
o sinh sn gy vim m o, phn ph, vim lot c t cung dn n v
sinh, vim ng tit niu... Chu k pht trin ph thuc vo chu k kinh
nguyt, trc v sau ngy thy kinh nu khm d thy c nhiu k sinh
trng. nam gii bnh khng ph bin
Cu hi t lng gi
* Tr li ngn cc cu hi sau bng cch in t hoc cm t thch
hp vo ch trng
1. Ba dng hnh th ca amip l:
A................................................................
B.................................................................
C..................................................................
2. Khi soi ti thy amip di chuyn nhanh bng cch phng ra..(A)..
do..(B).. to thnh
A................................................................
B.................................................................
3. Th hot ng n hng cu A mp, pha trong nguyn sinh cht
c..(A)..Nhn nm trong, gia nhn c..(B)..
A................................................................
B.................................................................
4. Th bo nang amip l th..(A).., bo nang gi c 4...(B)..
A................................................................
B.................................................................
5. Amip gy..(A).. vi cc triu chng i ngoi phn nhy mu v cc
cn..(B)... rut
A................................................................
B.................................................................
6. Amip vo h thng tun hon..(A).. v ti tnh mch ca vo..(B)..
41

A................................................................
B.................................................................
*La chn cu tr li ng nht bng cch khoanh trn vo ch
ci u cu
7. Amip l loi n bo di chuyn bng:
A.

Roi

B.

Chn gi

C.

Lng

D.

Khng di chuyn

8. Th n hng cu ca amip c kch thc:

A.

5 -10 micromet

B.

10-20 micromet

C.

20-40 micromet

D. trn 40 micromet
9. Ly bnh phm xt nghim trng roi m o nn ly vo:
A.

Sau ngy thy kinh 14 ngy

B.

Ngay trc v sau ngy thy kinh

C.

Bt c ngy no trong chu k kinh nguyt

D.

Trc ngy thy kinh 10 ngy

10. a s ngi nhim amip do n phi

A.

Th hot ng n hng cu

B.

Th hot ng cha n hng cu

C.

Th bo nang

D.

Th A v B

E.

C ba th A,B,C

11. Amip sng lu ngoi mi trng phn ln th

A.

Hot ng n hng cu

B.

Hot ng cha n hng cu

C.

Bo nang
42

D.
E.

Th A v B
C ba th A,B,C

12. Trng roi l nhng nguyn sinh ng vt, Vit Nam trng roi thng k
sinh:
A.

ng tiu ho

B.

m o

C.

ng mu

D.

C A,B ng

E.

C B,C ng

* Cu hi truyn thng:
13. Trnh by chu k pht trin ca amip
14. Trnh by chu k pht trin ca trng roi m o

BI 8. SN L- SN DY
MC TIU:
1. M t hnh th ca sn dy, sn l
2.Trnh by c chu k pht trin ca chng
NI DUNG:
1.i cng:
K sinh trng sng trn mt da, trong ni b, cc hc t nhin, mu,
ni tng c th. Chng ht mu ng thi tit ra c t c ch h thng
sinh huyt, gy qu mn.
2. Sn l:
C 3 loi sn l: Sn l rut, sn l gan, sn l phi.
c im chung:
- Hnh l dt. y l loi lng tnh, trn c th c b phn sinh dc
c v ci.

43

- Chu k pht trin: phc tp hn giun, phi qua nhiu vt ch trung

gian, do bnh do sn t gp hn bnh giun.
2.1 Sn l rut:
- Mu hi , di v dt, l loi c kch thc to nht trong cc loi
sn ngi, di 2 7 cm, rng 8 20 mm.
- Chu k pht trin: Trng sn ra ngoi mi trng nhit thch
hp t 27 30o C.
Sau 3 n 7 tun pht trin thnh u trng ri ph np chui ra thnh
mao u trng v bm vo mt loi c. Trong c th ca c, n pht trin to
ra mt ti c nhiu u trng ui. u trng ri c bm vo nhng loi thc
vt sng di nc nh c u, ng sen, bo, cc loi rong to thnh nang
trng. Ngi n phi nang trng s b bnh.
- iu tr: dng nc sc ht cau 1g/ kg/ 3 ngy.
2.2. Sn l gan:
- Sn l gan nh v trng di t 5 10mm, rng t 3 5mm.
- Chu k pht trin: trng sn theo ng mt vo rut ri theo phn
ra ngoi. Sau khi ri vo nc, n bm vo 1 loi c tr thnh u trng c
ui. u trng ra ngoi nc k sinh vo c to thnh nang trng. Ngi v
ng vt n phi c c nang trng s mc bnh.
- iu tr: Dng Cloroquin.
2. 3. Sn l phi:
- Hnh th: hnh ht c ph, di t 7 10 mm, rng t 4 6mm.
- Chu k pht trin: Sn l phi sng trong ph qun v trng. Trng
theo m v phn ra ngoi ri xung nc. Sau 16 42 ngy s pht trin
thnh u trng lng, ph v ra ngoi k sinh vo c thnh u trng ui. u
trng ui ra nc k sinh cua ng di dng nang trng. Ngi n phi
nang trng s b bnh sn l phi.
- iu tr: Ging sn l gan.
3. Sn dy:
Sn dy l loi sn ln, c th gm nhiu t, mi t c y b
phn sinh dc c v sinh dc ci.

44

3.1 Sn dy ln:
- Hnh th: Sn trng thnh di t 2 8m, c t 800 1000 t, nhng
t gi (cha y trng) cui rng theo phn ra ngoi 4 5 t lin nhau.
- Chu k pht trin: t sn gi ti rut phng thch trng trong rut
gi, trng theo phn ra ngoi, trng c sn phi 6 mc nn c kh nng
nhim bnh ngay. Trng c ln trong rau, t, nu ln n phi th phi 6
mc rut n ra ri vo mu, tr v tim theo i tun hon n nh v c
bp, c quan ni tng. Ti y, chng pht trin thnh nang u trng sau 9
10 tun.
- Ngi n phi tht ln go (ln mc u trng) cn sng nh nem
chua, nem thnh hoc cha nu chn s mc bnh sn trng thnh sau 8
10 tun.
- Thng mi ngi ch nhim 1 sn trng thnh, sn c th sng 25
nm v c nguy c nhng t gi tro ngc ln d dy, ri gii phng trng
sn ngi s mc bnh u trng.
- Rau sng nu bn phn tui c nhim trng sn th ngi v ln n
phi s mc bnh. V vy khng nn dng phn ti ti cy.
- iu tr: Niclosamid liu duy nht 2g.
3.2. Sn dy b:
- Sn trng thnh di t 4 10m, c 1000 2000 t sn, u khng
c un mc. t sn gi khi rng tng t c kh nng t ng b ra khi
ng tiu ho, ri ra qun o hoc ging, nn bnh nhn t bit c bnh.
- Trng sn ra ngoi c sn phi 6 mc nn tnh ly nhim rt cao. Khi
b hay cu n phi, phi 6 mc n trong rut, vo mu, tr v tim, theo i
tun hon n nh v bp tht v cc c quan ni tng. Ti y chng pht
trin thnh nang u trng trong vng 3 4 thng. Ngi n tht b c u
trng cha nu chn s mc sn trng thnh.
- iu tr: Niclosamid.
Khi ty sn nn kin nhn, khng nn nng v c th lm t u sn
v tht bi trong iu tr.

45

Cu hi lng gi
1. Sn dy b:
A.

u c 4 hp khu v 2 vng mc

B.

Thn dt v lng tnh

C.

t c c b phn sinh dc ci pht trin

D.

t cui thn c b phn sinh dc c pht trin

E.

t gi thng theo phn ra ngoi cnh

2. Trong bnh sn dy b:
A.

Ngi c th mc bnh u trng

B.

T l bnh nhiu hn bnh sn dy ln

C.

Sn trng thnh k sinh i trng

D.

u trng thng gp ph tng b

E.

Sn bi xut trng ra phn

* Cu hi truyn thng:
3. Trnh by chu k pht trin ca sn dy ln
4. Trnh by chu k pht trin ca sn dy b

BI 9. PHNG PHP
LY BNH PHM BO QUN BNH PHM
LM XT NGHIM VI SINH K SINH TRNG

MC TIU:
1.Trnh by c mc ch ca phngg php ly bnh phm,bo
qun bnh phm lm xt nghim vi sinh k sinh trng.
2.Thc hin c ng quy trnh k thut ly bnh phm v bo qun
bnh phm lm xt nghim
1. i cng
Trong vic thm khm, cha bnh, ngoi vic khai thc cc du hiu
lm sng do thy thuc lm, cn phi lm cc xt nghim nhm mc ch:
46

- Gip thy thuc chn on v theo di bnh c chng xc, khch quan
-Gip cho vic chn on bnh t kt qu tt hn.
Do vic ly bnh phm lm xt nghim rt quan trng. Ngi iu
dng phi chun b v tin hnh ly bnh phm ng k thut.
2. K thut
2.1. Cch ly mu lm xt nghim:
C rt nhiu xt nghim v mu nh xt nghim sinh ha, t bo, vi khun...
C hai cch: ly mu tnh mch v mao mch.
2.1.1 Ly mu tnh mch:
a) Chun b dng c:
- V khun
+ Bm tim (Ty s lng mu lm xt nghim)
+ Kim tim
- Nhng dng c khc
+ Bng tm cn.
+ L hoc ng nghim dn nhn tn, tui ca bnh nhn, s ging,
khoa phng. C cht chng ng hay khng ty loi xt nghim.
+ Dy ga r.
+ Khay qu u c nc.
+ Ti giy.
+ Gi nh bc nylon.
b) Chun b bnh nhn:
- Bo v gii thch cho bnh nhn bit r v mc ch, vic lm (nu
bnh nhn tnh), bnh nhi v bnh nhn hn m phi gii thch cho ngi
nh bnh nhn.
- Tay bnh nhn phi sch, nu bn th trc khi ly mu phi ra tay
bnh nhn bng x phng.
c) Tin hnh:
- Cho bnh nhn nm thoi mi trn ging, nu l tr nh phi c
ngi gi tr khi giy gia.
- Chn tnh mch thch hp thng ly mu np gp khuu tay (h
thng M tnh mch), t gi di ch nh ly mu, tr nh thng ly
tnh mch thp, tnh mch c, tnh mch thi dng, tnh mch thy r m
khng di chuyn.
- Lp kim vo bm tim v kim tra xem kim c thng khng.
- Buc gy ga r cch ch tim 5cm v pha trn.
47

- St khun da tht k v kh.

- a kim vo tnh mch, m dy ga r (nu th mu v sinh ha).
- Ko lui nng nh nhng v rt s mu cn thit trnh to bt kh.
- Tho dy ga r, rt kim ra, n nh bng ni tim, bo bnh nhn gp
tay li.
- Tho kim ra, bm mu nh nhng vo ng nghim, y nt li.
+ t bm tim chch vi thnh ng nghim mt gc 45o.
+ Bm t t mu theo thnh ng trnh lm v hng cu.
- Gi bnh phm v giy xt nghim n phng xt nghim.
d) Thu dn v bo qun dng c
- Ra bm tim, kim tim vi nc x phng tht sch.
- Lau kh v gi i tit khun.
e) Ghi h s:
- Ngy gi ly mu.
- S lng mu.
- Loi xt nghim.
- Tn ngi thc hin.
g) Nhng im cn 1u :
- Chun b bnh nhn cn thn trc khi ly mu.
- Bm, kim tim phi tht kh v v khun.
- Trng hp cy mu nn ly trc khi dng khng sinh.
1.2.2 Ly mu mao mch:
p dng trong:
- Tm k sinh trng st rt, ly mu khi bnh. nhn ln cn st.
- Tm u trng giun ch: ly mu lc 12gi tra hoc 24 gi m.
a) Chun b dng c:
- 5 phin knh tht sch v kh, la 1 phin knh c cnh nhn lm
knh ko.
- Kim v khun hoc lan xt (lancett).
- Bng tm en.
- Bng kh.
- Bt ch, ti giy.
b) Chun b bnh nhn: ging nh phn ly mu tnh mch.
c) Tin hnh:
- Lau sch u ngn tay, thng l ngn p t hay di tai, bng tm cn
(Ngn tay ny t s dng n).
48

- iu ng vin dng ngn ci v ngn tr bp cht u ngn tay

nhn (trnh mu b lan rng).
- Dng kim m mt bn u ngn tay vi ng tc nhanh. Vt chch
va phi mu tro ln thnh git nh khi bp nh.
- Lau b git mu u.
- Ly git mu th hai ln gia knh, t cnh knh cho cho tip xc
vi git mu mt gc 30. i mu phn tn qua knh 1 v 2.
- y knh ko ln pha trc vi ng tc u v nhanh c ln mu
mng, u n, khng dng li khi ln mu cn ngn v cc t bo chng ln
nhau.
- Lau kh ngn tay ln na, bp nh c git mu ln v trn, lm
git mu c.
- Cm hai cnh ca knh pha ui ln mu, chm u kia phin knh
vo nh git mu.p mt knh c mu xung pha di khng cho knh
chm vo u ngn tay.
- Dng gc cnh ca knh trn git mu theo chuyn ng trn ng
knh lm trnh tan si fibrin, trnh che khut k sinh trng.
- Ngng ng tc ngoy trung tm lp mu to git mu c vin mng.
- Ghi tn bnh nhn, s ging ln knh.
- kh gi li, gi phng xt nghim.
d) Ghi h s.
- Ngy gi ly mu.
- Tn ngi ly.
e) Nhng im cn lu .
ng lm git mu qu c v khi kh s b nt v trc khi knh. Git
mu c va phi l khi git mu cn t, t knh ln t bo nhn thy ch in.
- Ln mu mng phi tht mng khng c sc v loang
- Cc vin ca ln mu mng phi nm trn knh.
2.2 Cch ly m, phn, m xt nghim:
2.2.1 Chun b dng c:
- Khay v khun c ph khn v khun.
+ Bm tim, kim tim.
+ Tm bng.
+ Kp.
- Dng c khc:
+ L nh hp hoc luc sch.
49

+ Phin knh hoc ng nghim v khun.

+ n cn.
+ Khay qu u.
Phi v khun khi th v vi khun.
2.2.2 Tin hnh:
a) m: Ly m tm vi khun.
- P DNG: trong nhng bnh v h hp.
- K thut:
+ Cho bnh nhn nh rng, xc ming lm bt tp khun trong ming
v hng:
+ Bo bnh nhn ho mnh, khc m vo vt cha.
+ Dng que ly mt cht m, cho vo ng tit khun, y kn li. Ly
ch c m ch khng phi nc bt.
+ C th dng tm bng v khun qut vo nim mc ming hng ri
pht ln phin knh hoc c tm bng vo ng nghim tit khun gi ln
phng xt nghim. (Trng hp bnh nhn t m, hoc khng khc c
m).
b) Phn:
- Ly phn nhm mc ch:
+ Th nghim sinh ha: mu, sc t mt, m.
+ Tm vi khun v k sinh trng ng rut.
- p dng: Trong nhng bnh v tiu ha v nhng c quan lin quan
nh gan, ty...
- K thut:
+ Cho bnh nhn i tiu, hng nc tiu ring. Trng hp cy vi
khun dng khay qu u to tit khun v phi ra hu mn trc.
+ Cho bnh nhn i ngoi vo b dt (khng ln nc tiu).
+ Dng que ly phn (10-15g) ngay ch gia bi phn u hoc nghi
ng, cho phn vo l y kn li. Ly phn ni c m, mu, m trong bnh
l amib.
- Ch :
+ i vi amib: khi tri lnh phi gi l phn m, gi ln ngay phng
xt nghim.
+ Dng tm bng cho vo hu mn ngoy ri pht ln knh nu cn tm
giun kim, trng giun.
- Nhng im cn lu :

50

+ Trng hp tm mu trong phn, bnh nhn phi king n tht nc

hoc khng ung thuc c cht st, bismuth trong vng 48 gi.
Lu khng nhm ln mu t b phn sinh dc.
+ Khng ly phn ln vi nc tiu.
c) M
- Mc ch: Tm cc vi khun gy m tr bnh. Lm khng sinh .
- p dng trong cc vt thng c m nh p xe v hoc cha v, l r....
- K thut:
Vt thng h:
- Phng php pht ln knh:
+ M vt thng.
+ Dng tm bng v khun ly t m, pht ln gia phin knh, kh,
t mt phin knh khc ln trn. kh t nhin hoc h ln la nhng
khng h nng qu lm hng bnh phm.
+ Dn nhn vo mu, gi ngay ln phng xt nghim:
+ Ra v bng vt thng li.
Phng php b vo ng nghim:
+ M np ng nghim, h ming ng nghim trn la (n cn).
+ Dng bm tim ht m cho vo ng hoc iu dng dng tm bng
ly m cho vo ng nghim. B b u que cm tay.
+ H ming ng li ln th hai, t vin bng t ng ri y li.
Trng hp m cha v: St khun da ca bc m, m kim vo ht
m, bm m vo ng nghim hoc pht ln phin knh. Trng hp m t:
y u kim, gi nguyn bm tim, gi ngay ln phng xt nghim. Vic
m kirn vo bc m do bc s thc hin.
+ Ra tt c cc dng c vi nc v x phng tht sch, lau kh ri
gi i tit khun.
e) Ghi h s
- Ngy gi ly bnh phm.
- Cht th.
- Loi thuc s dng (nu c).
- Tn iu dng vin thc hin.
2.3 Cch ly nc tiu xt nghim:
2.3.1 Chun b dng c:
- 1 khay thng tiu nh trong bi thng tiu.
- NG NGHIM v khun nu th nghim v vi khun.
- Bnh cha nc tiu c vch o th tch.
51

- n cn.
- Vi cao su (tm nylon).
- Bnh phong.
2.3.2 Tin hnh:
C nhiu cch:
a) Kim tra nc tiu v s lng, mu sc trong 4 gi:
Khong 8h sng cho bnh nhn i tiu ly ht nc bng quang,
xong nc tiu y i, ly bnh nc tiu sch, ghi tn bnh nhn, s
ging. Cho bnh nhn cha tt c cc nc tiu ngy hm trong bnh.
n 8h sng hm sau bo bnh nhn i tiu ln cui vo bnh. Sau o s
lng nc tiu 24 gi. Ghi vo h s.
- Cn dn bnh nhn hng nc tiu mi khi i tiu.
- Blnh nc tiu y kn ch mt.
- Trnh cho nc tiu phn hy, dng cc dung dch:
+ Cho thymol trong ru 1% 1ml/100ml nc tiu.
+ 1 git phenol trong 30ml nc tiu.
b) Kim tra t bo v k sinh trng.
- Ra b phn sinh dc ngoi bng x phng nc hoc thuc st khun
v nc chn.
- Bnh nhn i tiu, b phn nc tiu u. Ly phn gia cho vo ng
nghim. Nn ly vo bui sm.
- Gi ngay ln phng xt nghim: trnh amoniac trong nc tiu tr
thnh kim lm hy hoi t bo.
c) Tm vi khun:
N: thng tiu, th thut phi c thc hin ng k thut m bo
v khun tuyt i.
Nam:
+ St khun quy u, u niu o, ra li bng nc v khun.
+ B nc tiu u, ly phn gia.
+ Cho nc tiu vo ng nghim v khun.
Nh h ming ng nghim trc v sau khi ly nc tiu trn ngn la
n cn.
- Tr em gi s sinh:
+ Ra k b phn sinh dc.
+ p ln m h mt lp bng thm nc v khun.
+ Sau khi tr tiu xong, vt bng ly nc tiu.
- Tr em trai:
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+ Ra b phn sinh dc ngoi.

+ dng vt tr vo ng nghim v khun, c nh bng bng dnh.
d) Ly nc tiu theo gi.
Ty theo ch nh, thng p dng cho bnh nhn i tho ng.
C th ly nc tiu t 6-12h; 12-18h; 18-24h; 24-6h.
Ly tt c nc tiu bnh nhn i tiu hoc:
- T trc ba n sng n ba n tra.
- T trc ba n tra n trc ba n ti.
- T trc ba n ti n 24h.
- T 24h n trc ba n sng.
Cha nc tiu trong mt bnh ring lc u, ly 50ml nc tiu gi
ngay ln phng xt nghim.
Ly nc tiu 1 gi hoc 2 gi trong trng hp:
- Bnh nhn b nhim acid.
- Bnh nhn hn m (Tm ng v aceton)
Lu :
- Ly nc tiu trc khi n.
- Ly nc tiu khi tim Insulin.
2.3.3 Dn dp v bo qun dng c:
- Ra sch tt c dng c vi x phng v nc.
- Lau kh v gi i tit khun.
2.3.4 Ghi h s:
- Ngy gi ly bnh phm.
- Loi xt nghim.
- Tn iu dng vin thc hin
Cu hi lng gi
1.K 2 mc ch ly phn lm xt nghim
A
B
2.K 2 trng hp p dng ly mu mao mch
A.
B.
3.Mc ch ly bnh phm lm xt nghim gip cho thy thuc chn
on.(A)v iu tr..(B).
4.Ly mu mao mch tm u trng giun ch phi ly
lc.(A).hoc.(B)
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