I CNG

K SINH HC

I CNG
K sinh trng y hc truyn thng nghin cu 3
lnh vc chnh:
n bo k sinh
Giun sn k sinh
ng vt chn khp
i dch HIV/AIDS lm gia tng:
Bnh KST, KST c hi
Bnh do vi nm
Vi nm k sinh gy bnh c xp thnh gii
ring: gii vi nm

I CNG
Bnh do k sinh trng v vi nm thng gp :
Cc nc ang pht trin: mi trng sng ca
a s nhn dn lao ng cha c ci thin
ng mc.
Cc nc nhit i & cn nhit i: iu kin
kh hu
thch hp cho s pht trin ca KST
Kin thc c bn v k sinh trng hc v vi nm
3

NI DUNG GIO TRNH

Phn i cng:
Gii thch cc mi lin h gia cc sinh vt
c im ca KST
C ch gy bnh ca KST
khng ca k ch
c im bnh KST
Chn on bnh KST
Phn loi KST

NI DUNG GIO TRNH

Phn 2: K sinh trng gy bnh ngi v bnh
do chng gy ra.
Cc chng ny bao gm:
M t cc c im c bn ca bnh hc
Bnh sinh do KST
khng ca k ch v dch t hc
Biu hin lm sng, chn on, v kim sot
bnh.

NI DUNG GIO TRNH

Phn 3: Vi nm hc
Vi nm i cng
Vi nm gy bnh

MC TIU MN HC KST
Trang b cho sinh vin nhng kin thc c bn
v nhng k sinh trng quan trng Vit
Nam nhm:

Gii thch c cc kt qu chn on

Bit cch s dng thuc iu tr
Bit cch phng nga bnh

MC TIU MN HC KST

Sau khi hc, sinh vin phi t c cc mc

tiu sau:
KIN THC
Trnh by tnh ph bin ca s nhim KST
Trnh by mi quan h gia:
Ngi KST Mi trng ng vt.
Trnh by c im ca KST & vi nm: hnh
th, chu trnh pht trin, dch t, tnh cht
gy bnh.

MC TIU MN HC KST
K NNG
Nhn bit mt s KST v vi nm ph bin VN
Gii thch c ngha ca cc XN chn on
KST & vi nm.

VN DNG KIN THC VO THC T VO CC

MN HC KHC.
9

I CNG V K SINH TRNG

10

K sinh trng
Sinh vt d dng
Sng trn/trong c th ca mt sinh vt khc
:
Tm thc n
Tm ni tr n
S k sinh c th:
lin tc (vnh vin)
khng lin tc (tm thi)

11

Khi nim c bn
1.Cc hin tng k sinh
Cng sinh
Hi sinh
Hoi sinh
K sinh
2. K sinh trng
12

Cc hin tng k sinh

S Cng sinh (symbiosis): sng cng nhau:

Hi sinh (commensalism; + & 0) :

Escherichia coli; Entamoeba coli
Tng sinh (mutualism; + & +): con mi & n
bo
K sinh (parasitism; + & -): giun a ngi
13

S hoi sinh (saprophytism)

SV sng trong thin nhin hoc ngi
S dng cc cht hu c b phn hy hoc cht
b

ca c th
Ngoi hoi sinh (exosaprophytism):
Aspergillus, giun ln
Ni hoi sinh (Endosaprophytism): Candida spp.

14

Cc loi k sinh trng

1. KST bt buc
Ngoi KST:
Sng da /xoang thin nhin (ci gh, nm da)
Sng bn ngoi nhng truyn bnh (Mui, b cht)
Ni KST: sng cc c quan su (giun sn ng
tiu ha, Plasmodium/mu,

15

Cc loi k sinh trng

2. KST lc ch
Giun mc ch: Gy bnh u trng di ng da
ngi
u trng gy bnh ni tng (giun a ch mo).
3. KST lc ch:
KST i lc sang c quan khc hn c quan chng
thng sng (giun a Ascaris lumbricoides/ ng
mt)

16

Cc loi k sinh trng

4. KST c hi: t ni hoi sinh gy bnh
th d: Candida albicans
5. KST ngu nhin: t ngoi hoi sinh gy bnh
th d: Aspergillus sp.

17

C IM CA KST
HNH TH
n bo: cu, bu dc, qu l, v nh hnh
(amip)
a bo
KCH THC
Nh: n bo, vi nm
Ln/ rt ln
SINH SN
V tnh: ct i, ny chi

18

C IM HNH TH CA KST

19

C IM HNH TH CA KST

Ascaris lumbricoides

Fasciola hepatica

20

C IM CA KST

Mui vn: Aedes

Giardia

Vi nm

21

TNH C HIU K SINH

c hiu v k ch / KST lc ch
Hp (Ascaris lumbricoides)
rng (Toxoplasma gondii)
c hiu v ni k sinh / KST lc ch
Hp: Ascaris lumbricoides, Enterobius
vermicularis
Rng: Toxoplasma gondii, Giardia
22

CHU TRNH PHT TRIN CA KST

MM
XM NHP KC
MI
XM NHP
KC
SINH SN

23

C IM / CHU TRNH PHT TRIN CA

KST
Thay i v hnh dng v mi trng sng ca
KST
Mui TT

Nhng

Trng / nc

u
trng/nc

24

C IM / CHU TRNH PHT TRIN CA

KST
Cn 1 hoc nhiu k ch trong CTPT
KC vnh vin (KCVV)= K ch chnh:
KST sng G con trng thnh hoc SSHT

K ch trung gian (KCTG):

khi KST sng G u trng
25

CTPT ca KST
CTPT cn 1 KC = CT trc tip: ngi l KC duy
nht
u trng G
2

u trng G
1

Trng

Chu trnh pht trin ca

u
trng
G 3

26

CHU TRNH TRC TIP

(Ascaris lumbricoides, Enterobius vermicularis, E.
histolytica)
Ngi bnh

Ngi lnh

Mi trng
(1) CT trc tip ngn: trng roi, amip, giun kim.
(2) CT trc tip di: giun a, giun mc, giun tc, giun
ln.
27

CTPT ca KST
CTPT cn 2 KC: 1 KCVV, 1 KCTG = CT gin
tip
(Toenia solium/T. saginata)
Sn di heo TT
Ngi = KCVV

Nang sn (go heo)

Heo = KCTG

t sn, trng

Xm nhp heo

28

CN 3 K CH TRONG CTPT (1 KCVV, 2 KCTG)

CT gin tip
Sn l nh gan TT
Ngi = KCVV

Nang trng/ c
C = KCTG II

u trng ui

Trng / nc/ c
u trng lng

Bo t nang;
redia/c c = KCTG I
29

CHU TRNH GIN TIP

KCVV
KST G trng
thnh
KCTG
KST G u trng

KCTG II

KCTG I

30

PHN BIT MT S K CH
K ch vnh vin: KST sng G trng thnh hoc
SSHT
K ch trung gian: KST sng G u trng
Sn di heo b: b/heo l KCTG
Sn l nh gan: c l KCTG 1; C l KCTG 2
Trung gian truyn bnh:
TGTB sinh hc: mui truyn bnh st rt, giun ch
TGTB c hc: rui nh truyn vi khun, n bo, .
31

YU T LIN QUAN N QU TRNH LY NHIM

NG LY NHIM
ng tiu ha: trng, bo nang
Qua da: u trng giun mc,giun ln,
TGTB, ht qua ng h hp, giao hp, nhau
thai, truyn mu
NGUN NHIM:
t, Nc, Thc phm

Ngi

Th

T nhim

32

ng xm
nhp

Ni KST nh c
Ni tng: gan, phi,
CNS

MIN
GTrng, u trng

H tiu ha: di ng
hay khng di ng

(nc, phn,
KCTG)
Da v
h bch
huyt

u trng qua da theo

vt cn ca cn
trng

S xm
nhp

u trng xuyn qua

da

Mt

Cc mch mu
(quanh ti mt v
rut)
33

LIN QUAN GIA KST KC

KST

KC

34

TC HI CA KST I VI KC
Tc ot thc n
Gy thiu mu: giun mc, Plasmodium,
Diphyllobothrium latum
Tit cht c: hemolysin, histiolysin
Lm gim khng ca KC
Chuyn ch mm bnh khc vo c th KC (u
trng giun)
Gy d ng: hen suyn, m ai (giun a, vi nm)
Gy tc nghn c hc: u trng Echinococcus

35

Thay i t bo ca m:
T bo ph to (qu dng-hypertrophy):
hng cu nhim P. vivax
S lng t bo tng (tng sn
hyperplasia): SLN/ng mt
T bo bin thnh loi khc (chuyn sn
metaplasia): SL phi

T bo tng trng hn lon (tn sinh

neoplasia): trng sn mng/bng quan,
Opisthorchis viverrinii (ung th gan)
Gia tng t bo + tng trng t bo hn
36
lon (Clonorchis sinensis trong ng dn mt)

Gy cc bin i huyt hc
Gia tng bch cu toan tnh theo biu
Lavier
Gim s lng hng cu: giun mc, sn di c

37

Mt s KST gy tng BCTT

Giun sn: giun a, giun mc, giun xon, sn di
heo b, sn l, sn mng, giun ch.
Cn trng:
Gii rui da (40-50%)
ci gh (10%)
u trng di ng
AT di ng da: Ancylostoma caninum
AT di ng ni tng: giun a ch (50-80%),
Gnathostoma spinigerum (50-80%)

38

PHN NG CA KC I VI KST
khng t nhin (innate immunity): y l c
ch khng khng cn tip xc trc vi vt l
xm nhp
Min dch mc phi (acquired immunity): y l
c ch khng mang tnh cht chuyn bit vi vt
l xm nhp (nhng vt cht khng phi ca k ch
= nonself material), cn thi gian pht trin, xy
ra nhanh v mnh m hn trong p ng ln th 2.
39

S khng t nhin khng chuyn bit:

KST ng rut/KST ngu nhin
Dch acid ca d dy
Dch rut
u trng giun khi i ngang qua da
Cht tit ca da
Phn ng vim ca da
m ca da
Thiu cht c hiu cn cho s pht trin, gy
phn ng vim, KST pht trin ko di G
u trng (Toxocara)
40

Mt s cht trong sa m
(lysozym, IgA, bch cu, interferron)

Bo v tr s sinh trnh c s nhim mt s n bo

gy bnh ng rut nh Giardia lamblia, Entamoeba
histolytica.

41

s thc bo
Bch cu n nhn-i bch bo
T bo lympho
Bch cu a nhn (bch cu ht):
Bch cu trung tnh (60-70%)
Bch cu a acid chim khong 2-5%
Bch cu a kim chim khong 0,5%

42

S khng chuyn bit: Min dch mc

phi
Tnh cht bo v km: tin min nhim
Trong vng ni dch, s nhim ko di nhiu nm
D dng ti nhim sau khi iu tr

Gip chn on KST (phn ng khng nguyn

khng th)
43

S pht trin MD mc phi

v phng cch KST thot khi p ng MD
Khng nguyn
KST
TB trnh din Khng
nguyn
P /KC

Trnh

khng
KST

TB lympho
B

TB lympho
T

Khng th

Tnh c TB

Thay i KN

c ch MD

Che du KN

Kha KT
Thay i
MD

TB ty xng
P vim
Chng li
phn ng
vim
44

BNH DO KST
c im ca bnh KST

Ph bin theo vng

C tnh x hi
C thi hn
Biu hin m thm

45

BNH DO KST
Din bin ca bnh KST
Cp tnh > mn tnh > KST b dit > min dch
thu

bin mt
c im dch t hc ca bnh KST
C th thnh dch, dch din ra t t v ko

46

T L BNH & T L T VONG DO KST GY

RA
KST

T l
bnh/nm

T l t
vong/nm

Giun a

1 t

20.000

Giun mc

900 triu

60.000

Sn mng
Giun tc

600 triu
500 triu

60.000
-

Amip
Giardia

400 triu
200 triu

30.000
-

50 triu
50 triu

50.000
-

Sn di
Giun ln

47

HI CHNG BNH KST

Hin tng vim
Hin tng nhim c
Hin tng hao tn
Hin tng d ng

CHN ON BNH KST

Chn on lm sng
Chn on KST
Xt nghim trc tip
Xt nghim gin tip = min dch chn on

48

PHNG PHP CHN ON TRC TIP

Xt nghim trc tip tm KST trong phn khi:

Tiu chy hay to bn

au bng,au vng thng v, no hi, bun
nn, nn
Nga hu mn
T l bch cu toan tnh tng cao
49

PHNG PHP CHN ON TRC TIP

XN phn tm cc KST sau:
n bo: amip, trng roi ng rut
Giun
Sn
i vi bnh nhn SGMD cn tm:
Cryptosporidium sp, Microsporidia, giun
ln.
50

XT NGHIM MU
Tm k sinh trng trong mu:
n bo: Plasmodium sp, Trypanosoma sp.
u trng giun ch (Brugia malayi, Wuchereria
bancrofti)
Cch XN:
Soi ti trc tip
Sau khi nhum: (nhum git mu dy, pht mu
mng)

51

CC XT NGHIM KHC
Nc tiu:
Trichomonas vaginalis, u trng giun ch,
trng S. haematobium), nm men (Candida sp)
m:
Trng sn l phi, Aspergillus, Cryptococcus
neoformans
Dch t trng:
Trng v u trng giun ln, trng giun mc,
52

XT NGHIM GIN TIP = MIN DCH CHN

ON
Cng thc mu (XN nh hng ):

Tng bch cu toan tnh: (giun sn, u trng di

ng)
Tng bch cu a nhn (st rt; amip gan)
Gim bch cu a nhn ( SR mn tnh)
Tng bch cu n nhn (bnh Toxoplasma)
53

K THUT SINH HC PHN T

Chn on
Mi lin h gia cc KST
Pht trin vaccin mi

54

PHNG V TR BNH KST

Ph v CTPT ca KST:
iu tr ngi bnh
iu tr hoc dit KCTG
Ct t ng ly nhim
Nng cao th trng bnh nhn
Gio dc thc v sinh trong cng ng

55

Yu t x hi,
thi tit,
phong tc a
phng,
kinh t ton cu

KIM SOT KST

Dc l hc
Ha sinh hc
Y hoc lm sng

56

DANH PHP KST

Danh php quc t:
Tn ging +
(vit hoa)

Tn loi
(khng vit
hoa)

Tn tc gi +
nm

Tn ging v loi phi in nghing hoc gch

di
V d:
1878

Paragonimus westermani Kerbert,

biu din loi ph, dng 3 ch La tinh

57

PHN LOI KST

1.M t
2.Nghin cu ADN; protein.
3.Ni sinh thi v phn b a l

58

PHN LOI KST CHNH

NGI
KST THUC GII
NG VT
n bo (Protozoaires)
Trng chn gi (Rhizopodes): amip ng
rut
Trng roi (Flagelles)
Trng lng (Cilies)
Trng bo t (Sporozoaires)
a bo (Metazoaires)
Giun sn (Helminthes)
Chn khp (Arthropodes)

59

KST THUC GII NM

Nm To (Phycomycetes): Mucor, Rhizopus
Nm m (Basidiomycetes): nm n c,
nm c
Nm Ti (Ascomycetes): Aspergillus,
Penicillium,
Saccharomyces
Nm bt ton (Fungi Imperfecti)
60

CHN ON XT NGHIM GIN TIP

Chn on:
KST non cha trng (Sn l gan, Sn mng).

Bnh mn tnh
KST ni tng su: Bu sn, go heo.
u trng di chuyn.
Mt KST thp.

iu tr:
Theo di lng KT trong huyt thanh.
Dch t hc.

61

CHN ON XT NGHIM GIN TIP

Khng nguyn KST
Nui cy in vitro:
Plasmodium, Toxoplasma, vi nm
Nui cy trn th:
sn mng, giun xon.
Khng nguyn hu hnh:
KST nguyn vn, tiu bn ct ngang.
Khng nguyn ho tan.
62

XT NGHIM GIN TIP = MIN DCH CHN ON

Cc XN huyt thanh thng dng:
Phn ng ngng kt hng cu
Min dch hunh quang (trc tip/ gin tip)
Min dch in di
Min dch men (ELISA: Enzyme Linked immuno-Sorbent
Assay)
63

Phn ng ngng kt hng cu

(hmagglutination test).

64

Phn ng ngng kt hng cu (hmagglutination test).

Nhng b th nghim pht hin khng th:

Amip ni tng
Sn mng, Sn l gan, Bu sn
Echinococcus

granulosus

Vi nm: Aspergillus, Candida.

65

Phn ng min dch in di

(immunoelectrophoresis)

66

Phn ng min dch hunh quang

(immunofluorescence).

Phn ng min dch hunh quang trc tip.

Phn ng min dch hunh quang gin tip.

67

Phn ng min dch hunh quang trc

tip

B th nghim tm khng ngun Trichomonas.

68

Phn ng min dch hunh quang gin

tip

69

B th nghim tm khng th:

n bo: St rt, amip ni tng,Toxoplasma.
Vi nm Candida.

B th nghim tm khng nguyn

n bo: St rt, Toxoplasma, Giardia
lamblia.
70

Phn ng min dch men ELISA

(Enzym Linked Immuno Sorbent Assay)

71

P dng phn ng min dch men

ELISA
B th nghim tm khng th: tm go heo

B th nghim tm khng nguyn:

Giardia lamblia

Trichomonas
Cryptococcus
Aspergillus
72