1

7 77 7 - -- -
2
3
4
IU KIN THUN LI CHO NM PHT TRIN
Nhit : 20 25
0
C
m: 65 70%
pH=5,5 7,5 (thch hp nht pH=7)
N, C hu c, khong cht
O
2
(Rhizopus cn iu kin ym kh)
nh sng
5
Mt s nm mc gy bnh thng gp
Si nm khng mu, c vch ngn (Hyalohyphomycetes)
Aspergillus, Fusarium, Trichoderma, Penicillium, Scopulariopsis.
Si nm khng mu, khng vch ngn (Zygomycetes)
Absidia, Mucor, Rhizopus, Rhizomucor.
Si nm c mu, c vch ngn (Phaeohyphomycetes)
Alternaria, Cladosporium, Curvularia, Bipolaris,
6
HNH TH NM MC QUAN ST KHV
ham mor o moI Iruong 8abouraud Iu 6 7 ngay
uan saI nam o khV sau khI nhuom LarIophanoI roIon bIua
7
Mt s bnh do Nm mc
D ng
Bnh nhim nm ngoi bin, cc xoang, c quan
(cha xm nhp su)
Vim ng tai ngoi, gic mc, mi, ph qun, ph nang
Bnh vi nm (nm xm nhp su vo c quan)
Bnh c t nm
8
C7W 7W9% 7A%
A57X9ZZ75
9
BNH NHIM NM ASPERGILLUS
Mc tiu
M t cc dng bnh m nm Aspergillus gy ra.
Trnh by cc biu hin lm sng ca bnh Aspergillus.
Thuc iu tr ca cc dng bnh Aspergillus.
Nu s cn thit ca vic cy bnh phm 37
0
C v
nhit phng
10
Aspergillus sp.
Aspergilus gp khp ni trn th gii.
Hin nay c >200 loi, c 20 loi gy bnh.
Cc loi thng gy bnh: A. fumigatus, A.
flavus, A. niger, A. nidulans,.
11
Aspergillus flavus
12
A. fumigatus A. glaucus
13
A. nidulans
14
A. niger
15
Aspergillus spp.
DCH T
Bnh nm Aspergillus c khp ni
Bnh nm ty thuc vo:
Nm (c lc, s lng)
K ch (tnh trng sc kho)
Thi gian tip xc vi nm
Nhim nm ch yu qua ng h hp
C hi thun li:
C a d ng, hen suyn
Tn thng: vim phi, vim ph nang, ghp c quan
Suy gim min dch: lao, tiu ng, bng nng, s dng ba
bi khng sinh v corticoid, nhim HIV/AIDS.
16
Bnh hc
D ng vi Aspergillus: vim ph qun phi do d ng
Vi nm sng hoi sinh cc xoang (khng xm nhp m)
* vim gic mc v ni nhn
* vim tai ngoi
* vim xoang mi
* vim c tim v mng trong tim
* cun nm trong hang phi (bu nm)
Aspergillus xm nhp m, pht tn khp c th (vim h thn kinh
trung ng, c quan tiu ha) thng gp bnh nhn suy gim
min dch.
Bnh c t nm
Aspergillus spp.
17
18
Vim ph qun d ng
(ABPA: Allergic Broncho Pulmonary Aspergillosis)
Si t nm an kt vi cht nhy to mt nt nhy
gy tt nghn ph qun xp phi.
Bnh nhn st nh, ho, cht nhy (m) c si t nm.
Thng gp bnh nhn nhim HIV/AIDS, hen suyn,
d ng.
19
Bu nm Aspergillus
85% do A. fumigatus
Khi trn kh to gm si nm, fibrin, cht nhy
Thng gp trong trng hp:
o Hang phi c sn
o Hang lao c (chim 15% trong cc ca lao)
Triu chng: ho ra mu t hay t (nguy him)
Aspergillus c i tnh vi mch mu, gy ho ra mu, bnh
din tin nhanh t vong.
20
Vim phi
Thng do A. fumigatus
Xy ra :
Ngi m nng.
iu tr bng thuc gim min dch.
Triu Chng: st 40
0
C, kh th, ho ra mu.
Bnh nng c th lan ta ra cc c quan khc.
21
Th lan ta
ngi suy gim MD, ung th mu, gim BC ht.
Vi nm gy bnh: A. fumigatus, A. flavus
Vi nm vo mu, lan ra mng phi (90%), h thn kinh trung
ng, no, mi, thn, gan, lch, tim, bng quang (c quan c
nhiu mch mu).
Th no xut hin giai on cui ca bnh AIDS.
Bnh thng trm trng nhng khng c triu chng c bit, ch
c chn on khi m t thi.
Triu chng: st, kh th, au ngc, ho khan, ho ra mu nh.
22
CHN ON BNH ASPERGILLUS
Cc du hiu gip cho s chn on:
1. St 38
0
C ko di / 5-7 ngy. Khng p ng KS ph rng.
2. Cy mu cc VK ang lu hnh (-).
3. Virus, VK lao, xon khun,. khng c c s pht hin.
4. Cc du hiu cn c:
- Phi: kh th, ho ra mu, au ngc,
- Xoang: nhc u, chy nc mi, sng mt,..
- Gan, lch, CNS, cc c quan khcc du hiu bnh
5. Cc du hiu X quang c quan: cc nt p xe
6. nh tnh Aspergillus bng m hc hay nui cy (+)
Th xm nhp khi c 6 du hiu trn
23
Quan st trc tip (m, mu da, nc ra xoang mi)
STN phn nhnh kiu r i c trng (45
0
, Aspergillus nm lng hnh)
C ch trong ca bnh nm do d ng.*
Khng c ch trong ca nm xm nhp su.
Cy (quan trng nht l s ly trch nm t bnh phm)
MT Sabouraud - chloramphenicol, 37
0
C, nhit phng.
o Nhiu khm nm (cng mt loi nm)/ a petri.
o Cng mt loi nm/ nhiu t ly mu khc nhau.
Aspergillus l nm lng hnh:
- dng hoi sinh sinh sn c th c cung, bo t.
- dng xm ln: STN phn nhnh 45
0
CHN ON BNH ASPERGILLUS
24
Trc nghim da
Khng nguyn A. fumigatus
C ch trong chn on bnh d ng do Aspergillus.
Mn cm trn da tc th hay chm t 6 8h.
Chn on min dch
Tm khng th:
o Min dch khuch tn, md in di, ELISA to kit th
Bnh d ng nm, bnh bu nm Aspergillus.
o Test th da vi KN ngi bnh d ng nm Aspergillus
Tm khng nguyn:
ELISA sandwich (PP nhy), G-test (dch t nm), PCR(kt hp vi ELISA)
Bnh nm xm nhp, lan ta nhng ngi suy gim MD.
CHN ON BNH ASPERGILLUS
25
Aspergillus phi
26
Hang phi nhim nm
Si nm Aspergillus/ bnh phm
27
28
u mang bo t v si nm Aspergillus/ phi
Si nm/ m
29
Bnh nh khng cn iu tr
Bnh nng iu tr theo nguyn tc iu tr triu chng,
thuc lm gin ph qun, chng tit dch, loi b cn
nguyn do nm.
Prednisolon: 1 mg/ kg/ ngy n khi phi trong.
0,5 mg/ kg/ ngy x 2 tun.
Nc mui sinh l
iu tr bnh d ng do Aspergillus
30
iu tr bnh cun nm phi
Rt kh v tin lng xu.
Gii phu ct b thy phi loi b nm.
Itraconazol 200 mg/ngy c th 1 nm
Khng gii phu c:
Amphotericin B di dng phun m vo hang phi
hay truyn tnh mch chm hay tim di da.
NaI, Natamycin, Miconazol, Ketoconazol.
D phng
Trnh lm dng khng sinh, corticoid.
31
Bnh nhn b bnh Aspergillus xm nhp v bnh BC cp
Cn iu tr sm sau 4 ngy nm xm nhp.
Tin lng xu nu lng BC khng hi phc.
AmphoB: liu 1,5 mg/kg/ngy; 1mg/kg/ngy; 0,6-0,8 mg/kg/ngy (theo
di c tnh ca AmphoB trn thn, mu)
iu tr lin tc n khi BC trung tnh hi phc, mt du hiu nm cc
hnh nh X quang, CT scans.
AmphoB
- cu trc lipid phc hp (tng hiu qu, gim tc dng ph)
- cu trc liposom nh liposomal amphoB
- cu trc phn tn keo (AmphoB + cholesterol sulphat)
Voriconazol (tt cho ngi suy gim MD)
Itraconazol, AmphoB + Flucytosin
iu tr bnh Aspergillus xm nhp
32
Phng bnh Aspergillus
V sinh v lm thng thong mi trng
(HEPA: High Efficiency Particulate Air filter, lc khng kh hiu
qu cao)
Loi b cn nguyn nm
bnh nhn chun b ghp ty:
Ampho B (phun m hay tim truyn tnh mch)
Itraconazol (ung)
33
Ce .e a
}x:a-.x
34
Fusarium spp.
Chng nm gy bnh:
F. oxyspoum, F.solanum,
F. moniliforme,
Bo t vch dy
35
Fusarium spp.
Hoi sinh t
ng xm nhp: ng h hp, da.
c t nm:
o Trichothecene, Fumonisin
o Gy c ch min dch ca k ch, gy tn thng m
Dnh vo knh st trng, ng thng
Nhim ngoi vi, xm nhp ti ch, lan ta
36
Mt s bnh do Fusarium spp.
Nhim trng lan ta
Nhim trng phi-xoang
p-xe no
Vt thng da
Vim phc mc
Vim gic mc
Vim ni nhn
Xng v khp
Da
Mng
Bu nm
Vim phc mc
Ngi suy gim min dch Ngi bnh thng
37
Bnh do Fusarium ngi khe mnh
Vim gic mc
eo knh st trng
Chn thng
Nh thuc nh mt corticoid (gy SGMD ti ch)
Nm mng, da (ngi i chn t)
Vim phc mc
Nhim vt thng
38
Bnh do Fusarium ngi khe mnh
Nhim trng lan to gy
Vim ni nhn,
Vim ty xng
Vim khp,
Vim phi,
p xe no,
Vim bng quang,
Vim phc mc (thm phn mng bng)
39
Bnh Fusarium ngi suy gim min dch
Triu chng: st ko di khng p ng vi thuc.
Cc dng bnh: vim xoang, vim mng no, vim phi, vim ni vng
mc,
Yu t nguy c gy nhim ti ch
Chn thng gy dp m
Suy gim MD
Yu t nguy c gy nhim Fusarium lan to
Ung th mu
Ghp c quan, ghp ty
Suy gim MD nng
Gy t vong cao (50 80%) th nh sau bnh Aspergillus
40
Chn on
Lm sng:
Vim nhim ngn tay, ngn chn, da.
X quang phi cho hnh nh thm nhim phi.
Chn on xc nh:
Ly trch bnh phm
Sinh thit m
Phn ng min dch (phn bit Aspergillus v Fusarium)
41
iu tr
Amphoterincin B, Ambisome
Voriconazol
Phng bnh
Trnh tip xc vi mm bnh
Vi nm/ vi nc
V sinh mi trng (b mt tip xc nc)
Khi chn thng dp m: trnh tip xc nc
42
Ce .e a
jy,sy-e:e:
43
i cng
Vi nm gy bnh thuc nhm nm:
Si t nm khng vch ngn, phn nhnh
ng knh si nm ln
Sinh sn bng bo t nm trong 1 ti
a nhit, pht trin tt nhit > 37
o
C
44
Cc tc nhn gy bnh thng gp
Lp Zygomycetes
B Mucorales
H Mucoraceae
Absidia
Mucor
Rhizopus
H Cunninghamellaceae
Cunninghamella
B Enthomophthorales
Nhim trng din rng
Gy t vong cao
45
Dch t
Vi nm trong b Mucorales
Phn b rng ri
Chu c nhit (> 37
o
C)
Pht trin nhanh trn mi trng giu carbohydrat
Bo t phng thch vo mi trng
Tm thy:
- H thng iu ha, bng gc
- Thc vt phn hy
- Thc phm, tri cy
- t, phn sc vt
46
Bnh hc
Qua ng h hp (ht bo t)
Gy bnh vim xoang
vim phi
Nhim trng lan ta
47
Bnh hc
Nhim c hi:
Bo t nm v si nm/ h thng my lnh
Dng c bng b vt thng
Vim phc mc (thm phn mng bng)
Nhim trng lan ta (truyn dch b nhim)
Nhim trng da (t catheter), thay van tim
nhn to, knh st trng
48
Yu t nguy c
i tho ng: glucose kch thch s pht trin ca
zygomycetes
Liu php c ch min dch
Bnh bch cu, suy thn
HIV , tim chch ma ty
Ngi khe mnh: bnh xy ra sau khi chn thng
49
Bnh hc
Vim xoang mi (tiu ng, nhim acid v ceton)
Vim phi, nhim nm lan ta: bnh bch cu, liu
php corticoid, chch ma ty, tr suy dinh dng, tiu
ng, ghp c quan, suy thn.
C quan tiu ha: lot d dy, sau phu thut rut,
chn thng, thc phm nhim vi nm
50
Bnh hc
Da: kt qu ca nhim trng lan ta, hng ro c
hc b ph v
AIDS, chch ma ty thng b nhim nm thn, da,
xoang mi, no
Trng hp khc: phu thut, phng, chn thng, vt
cn trng cn.
51
Vim no xoang
Mi
Vm ming
Xoang mi
Hc mt
Mt
No
Triu chng:
St, au u (vng trn)
au vng mt
Ph n quanh mi
Lot hai t quanh mi (en)
Mt: au hc mt, nhn i, lot vng mc
Mu, no
52
Vim no xoang
53
Vim no xoang
54
Vim phi
55
Da: kt qu ca nhim trng lan ta
ti ch: bng, chn thng
56
Tiu ha
au bng
Tiu chy, phn ln mu
C th t vong do xut huyt nng, thng rut
57
Chn on
Xt nghim trc tp
Mu bnh phm: m, dch mi, dch ra ph nang, m.
Quan st: vi KOH 10%
Si nm rng ( 7 m)
khng vch ngn
khng mu
Phn nhnh 90
o
58
Rhizopus/m
59
Cy
Mi trng cha khng sinh
Khng cha cycloheximide
T
o
25
o
C 37
o
C
Khm nm pht trin nhanh
sau 24h
60
Rhizopus
61
Mucor
62
Rhizomucor
63
Absidia
64
Cunninghamella
65
iu tr
KI 30 mg/kg/ngy chia 1-3 ln/ngy
KTZ 400 mg/ ngy
ITZ 400 mg/ngy
FLZ 400 mg/ngy
Zygomycosis mn tnh
AMB (1-1,5 mg/kg/ngy n khi
lnh bnh
Zygomycosis cp & bn cp
Phu thut loi b m hai t, iu tr cc bnh mn tnh.
66
Mt s bnh nhim nm thng gp
Amphotericin B
Itraconazol
Ketoconazol
KI
Vim tai
Vim no xoang
Vim phi
Nhim nm tiu ha
Nhim nm lan ta
Rhizopus
Mucor
Absidia
.
Amphotericin B
Itraconazol
Voriconazol
Vim gic mc
Nhim nm lan ta
Fusarium spp.
Amphotericin B
Itraconazol
Vim tai
Vim mi
Vim phi
Nhim nm lan ta
A. fumigatus
A. flavus
A. niger
Thuc tr Bnh Vi nm
67
Ce . a :s. ax
68
Bipolaris sp.
Curvularia sp.
69
Chaetomium sp.
Cladosporium sp.
70
Nigrospora sp. Rhinocladiella sp.
71
Bnh do vi nm si mu
Bnh da v mng
Lm sng: tng t nh bnh do nm da.
Nm gy bnh thng l Alternaria, Scytalidium
Cn lm sng: soi trn KHV vi KOH 30% hay DMSO 40%
si nm c mu.
iu tr: kh khn.
Nm da dng Whitfield hiu qu.
(thuc m Benzosali gm A. salicylic, A. benzoic)
72
Vim gic mc
Chim 6-53% trng hp lot gic mc, c th gy m.
Curvularia, Alternaria, Bipolaris,
Bnh thng do xut pht t vt try, dng corticoid, khng sinh
khng ng.
Chn on:
Quan st trc tip: vi KOH 10-20% hay nhum vi Giemsa, LPCB.
Cy: mt Sab., thch mu
iu tr: lm sch nm, dng thuc khng nm:
Dd Natamycin 5%
AmphoB 0,1-1%
Azol: Miconazol, Ketoconazol (Curvularia)
Bnh do vi nm si mu
73
Vim xoang mi d ng
i tng: c a d ng, vim xoang mn tnh, polyp mi,
hen suyn, sng vng kh hu nng-m.
Nm Bipolaris, Curvularia, Alternaria, Cladosporium.
Nm khng si mu: Aspergillus, Fusarium, Rhizomucor,
Chn on: theo di nm 4 tun trc khi kt lun m tnh.
iu tr: Lm thng thong mi.
- Phun m Steroid
- Nh nc mui sinh l trong thi gian di ngn nga ti
pht.
Bnh do vi nm si mu
74
Vim xoang mi mn tnh
Nm xm nhp vo xoang mi.
Lm thng thong xoang mi.
Gii phu.
iu tr: AmphoB, Ketoconazol, Itraconazol.
Cun nm trong xoang mi
Triu chng: nght mi, au xoang mi, thay i khu gic.
Chn on: X quang, m hc
iu tr: NaCl 0,9% lm sch nm v thng thong mi.
Bnh do vi nm si mu
75
Ce xs- :s a
76
BNH C T NM
c t nm (mycotoxin): cht bin dng th cp do vi nm phng
thch vo thc phm / thc n gia sc.
Nhim c t nm thng qua ng tiu ha, ngoi ra qua ng
h hp hay tip xc da.
Bnh c t nm c th cp tnh hay mn tnh:
Gy cht nhanh hoc to thnh khi u
nh hng h MD d b nhim nhng bnh khc
Cp tnh: nhim c thn kinh, tn thng thn, xut huyt, hoi
t,..
Mn tnh: x gan, ung th gan.
Bnh khng ly lan, khng c thuc iu tr.
77
Mt s c t nm thng gp
Stachybotrys atra Stachybotryotoxin
Mucor Dicoumarol
Fusarium Zearalenon
P. Islandicum Islanditoxin
A. fumigatus, C. albicans Gliotoxin
Fusarium moniliforme Fumonicin
Fusarium, Trichoderma,
Stachybotrys
Trichothecen
A. ochraceus, P. viridicatum Ochratoxin
A. flavus, A. parasiticus Aflatoxin
Vi nm sn xut c t nm
78
Aflatoxin: sn xut bi Aspergillus flavus, A. parasiticus, A. nomius,
Penicillium citrinum, P. expansum, P. frequentans.
Cc loi Aflatoxin: B1, B2, G1, G2, M1, M2 (trong sa b)
*Thc phm thng b nhim t nguyn liu giu tinh bt, ht c du:
bp, u phng*, ng cc, c ph, nc tng, chao, bnh mt, ko,
sa u nnh, sa b ti
Thuc t dc liu (tr gim bo 3 c gi), thc n gia sc
B Y t VN quy nh mc gii hn aflatoxin/ thc phm l 10ppb
Aflatoxin
79
Bnh Aflatoxin cp
Vim gan cp tnh do n thc n nhim nng aflatoxin.
Triu chng: vng da, st nh, trm cm, bing n,
tiu chy, thay i thai ha m gan,
Sinh thit m: hoi t thy gia v nhim m.
Bnh aflatoxin
80
Bnh c t nm do nhim aflatoxin thng lin quan vi bnh
Kwashiokor (suy dinh dng tr em do thiu protein):
tr em bnh Kwashiokor thiu kh nng ng ha protein b
sung cho khu phn n m l bt lc Tr b tn thng
gan.
Bnh aflatoxin mn tnh
Gy ung th gan
(13% ngi nghin ru)*
Bnh aflatoxin
81
Ochratoxin A, B, C & D
Do A. ochraceus , Penicillium verrucosum sn xut
Nhim thc phm: la mch, ht c ph, bp, la m, u
phng, hoa qu sy kh, ru vang.
Ochratoxin A: c thn, gan (liu cao), qui thai, ung th
Gy bnh thn heo.
Cht gy ung th chut.
Bnh thn (ni dch vng Balkan-1956)
Khong 50% dn s Chu u tip xc vi ochratoxin.
Ochratoxin
82
Trichothecene: c t nhm sesquiterpenoid
Gp lng thc chu nhit (ng), ng cc (u nnh)
Nm sn xut trichothecene:
Fusarium: F. poae, F. sporotrichoides, F. solani
Nm khc: Trichothecium, Trichoderma, Stachybotrys,
Cephalosporium.
Trichothecene c ch protein mnh gy nhiu nh
hng trn th.
Trichothecene
83
Bnh Trichothecene
Trichothecene gy bnh ATA (Alimentary Toxic Aleukia):
xy ra nhanh sau khi n thc phm nhim c t
Triu chng:
Nn ma, tiu chy, au bng, cm gic nng rt
thng v.
Tip sau: m xut huyt da, xoang ming, vt
thng hoi t v phnh to hch bch huyt
84
iu tr bnh ATA
Truyn mu,
Ch phm acid nucleic v calcium
Khng sinh
Vitamin C, vitamin K
Thay i khu phn n dinh dng.
Bnh Trichothecene
85
Fumonisin
Fumonisin B1, B2
Gp lng thc (ng, go), ng cc
Gy bnh ung th thc qun, ung th bung trng, vim gan, trn
dch mng phi
Vi nm sn xut: Fusarium moniliforme, F. proliferatum
Thai ph n nhiu bp/ 3 thng u nguy c sinh con b khuyt tt
cao gp 2,5 ln (NC ca Trung tm phng v kim sot bnh ca M)
do Fumonisin lm v hiu ha acid folic.
86
iu tr
- - R R R I-R Scopulariopsis spp.
- S R S R S Acremonium spp.
- I-S I S R I Paecylomyces spp.
- R R R R R Scedosporium
- S I-S S I S P. marneffei
R I-R R R R I-R Fusarium spp.
Caspofungin
VRZ FLU ITZ FLZ AMB Mm bnh
Amphotericin B, Fluconazol, Itraconazol, Flucytosin, Voriconazol
87
7e 7e 7e 7e : :: : :x :x :x :x - -- - oa oa oa oa 7a 7a 7a 7a s s s s - -- -
qx- s. x.ex :s: ta