You are on page 1of 20

VI SINH VT NHM CU KHUN GY BNH

Ch s I. Hnh th Tnh cht bt mu Lin cu Ph cu C IM SINH HC - Hnh cu, K: 0,8 - 1micro M, ng t thnh - Hnh cu, ng thnh tng chui di - Hnh ngn nn, thng ng thnh m nh chm nho hoc ng ring l, thnh i ngn khc nhau, hoc thnh tng i, tng i (t khi ng ring l) hai hoc thnh chui ngn. hoc ring l u trn quay vo nhau - Bt mu Gr + - Bt mu gr + - Bt mu gr + - Khng c: v, lng, nha bo - Khng c: v, lng, nha bo - Khng c , lng, nha bo c v khi trong c th ngi - L VK hiu, k kh ty tin, P/t trong mi trng - L VK hiu, k kh ty tin, P/t trong - Kh nui trn mi trng thng nui cy thng thng, T0370c, PH 7,2 - 7,4 mi trng nui cy thng thng, thng, mc tt trong mi trng c 0 - Trong mi trng lng: 37 c 5 - 6h lm c mi T0370c, PH 7,2 - 7,4, nhng p/t tt hn mu, huyt thanh, kh trng 5trng, 24h lm c r, 24 - 48h lm lng cn v trong mi trng c mu, huyt thanh, 10%CO2 c vng mi trng kh trng c 5 - 10% CO2 - Trong mi trng lng PCK p/t 0 0 0 0 - Mi trng c: T 37 c/24h to khun lc dng S: - Trong mi trng lng: T 37 c/24h VK chm, trong mi trng lng c mt trn, li, bng, b r. 24h - 36h c sc t gm: khng lm c mi trng m thng b PCK b tan r sau 48h +. Sc t vng: S.aureus kt li thnh ht lng xung y, mi - Trong mi trng thch mu: +. Sc t vng chanh: S.citreus trng trn trong. T0370c/24h to khun lc dng S: +. Sc t trng: S.albus - Mi trng c: T0370c/24h to khun nh, trong, bng, b trn u nh 0 0 - Trong mi trng thch mu: T 37 c/24h to lc dng S: nh, trong, li, bng, b r ht sng, gia c nh nhon, khun lc dng S, xung quanh c vng tan huyt trong sut nh git sng xung quanh c vng tan mu alpha vi nhng mc khc nhau, thng nhn thy - Trong mi trng thch mu: hoc beta. 0 0 kiu tan mu Beta T 37 c/24h to khun lc dng S, xung - Mi trng thch mu Gentamycin quanh c vng tan huyt vi 3 dng: l mi trng chon lc i vi PCK +. Tan mu alpha: qung hp, khng hon ton mu xanh +. TM beta: Qung rng, trong, tan mu hon ton, c gii hn r rt +. TM gama: gi l khng tan mu - Ln men ng Manit - Khng c men Catalase, khng tan Ph cu b ly gii bi mt v sc t T cu

1.

2.

Tnh cht nui cy

3.

T/c

sinh

4.

5.

- Enzym coagulase: phn bit tu cu gy bnh S.aureus vi cc loi khc vt ha - Yu t tan mu hc: - Enzym Catalase: Phn bit t cu vi lin cu Cc t/c ny chn on xc nh v phn bit t cu gy bnh - Chu ng tt ngoi cnh - Chu nhit 800c/30ph - Nhy cm vi thuc st trng: phenol, tm Sc Gentian khng: - C kh nng khng nhiu thuc khng sinh thng thng nh Penicilin, tit ra men Penicilinase ph hy khng sinh - Vch c 2 loi khng nguyn: +. Polysaccharide +. Protein A C th cn c vo khng nguyn ny phn Cu trc nhm, tuy nhin phn ng huyt thanh khng c khng gi tr chn on nguyn: - nh type bng Phage: c vi chc Phage c hiu cho php chia tuuj cu thnh 4 nhm phage chnh: I, II, III, IV. nh type Phage c gi tr v dch t v chn on

trong mui mt, sc t mt (phn bit vi mt, khng mc c trong mi ph cu), lm ng sa trn mi trng trng Ethylhydrocuprein (Tes sa, trn mi trng Gelatin khng lm optochin +), men Catalase (-) long mi trng. Lin cu nhm A tan mu kiu Beta nhy cm vi Bacitracin Sng tng i dai trong m, trong m kh sng c vi thng, c kh nng chu lnh

II. 1.

- Khng nguyn C: (polysaccharid): l KN thn, c t/c c hiu nhm nn chia thnh cc nhm A, B, C....trong nhm A tan huyt loi beta quan trng nht - KN M: (Protein): cho php nh type ti cc nhm, nhm A c 12 type trong type 12 l quan trng nht - KN T: Protein - KN R: (Nucleoprotein): gi cho vch t bo lin cu cng rn, mang tnh c ca VK KH NNG GY BNH Yu t c TCK c th tit ra cc yu t v enzym: - Dung huyt t: (Hemolysin): l mt lc +. Yu t tan mu: (Hemolysin): 3 loi phc hp gm 2 cht: 0 - Tan mu alpha: gy tan hng cu th 37 c. l +. Streptolysin O: hu ht lin cu tan ngoi c t c tnh khng nguyn cao c th ch mu sinh ra men ny, d b bt hot bi thnh gii c t. l yu t ch yu gy ri lon oxy, l ngoi c t kch thch c th bnh l. sinh khng th Antistreptolysin O. trong 0 - Tan mu Beta: gy tan HC cu 4 c, t c hn chn on bn vim cu thn cp, thp

- KN thn: l loi Protein t c hiu v Polysaccharid chung cho cc loi ph cu - KN v l loi Polysaccharid c hiu type (khong 78 type khc nhau)

Gy bnh bng ni c t, ngoi ra cn c yu t khc: tan mu, dit bch cu, lan trn

2.

dung huyt t alpha. - Tan mu Deta: C tc dng ln HC ngi ra v gy hoi t da, do c vai tr quan trng trong vic TCK xm nhp vo t chc +. Yu t ng huyt tng: (coagulase). C kh nng lm ng huyt tng ngi v th, l Protein bn vi nhit , c tnh khng nguyn yu, c th gy huyt khi trong tnh mch, l yu t gy nhim khun huyt +. Yu t gy hoi t da: (Dermonecrotoxin): gy hoi t da +. c t rut: (Enterotoxin): Do mt s t cu to thnh, c bit khi p/t nng CO2 cao (30%) v mi trng c va. Gy ng c thc n v vim rut, chu T0300c trong 30ph cng nh taqcs ng enzym rut. c 5 type huyt thanh A, B, C, D, E trong type A, B gy ng c thc n +. Yu t dit bch cu: (Leucocidin): lm BC khng di ng v ph hy nhn. +. Yu t lan trn: (Hyaluronidase): gy v cht c bn ca m lin kt do s thy phn ca axit Hyaluronic lm TCK lan xa hn +. Men Penicilinase: TCK tit ra lm mt t/d khng sinh Penicillin. +. Enzym lm tan t huyt, nuclease, lipase +. Gy Shock nhim trng: c ch nh ni c t +. Exfoliatin toxin hoc epidermolitic toxin: gy phng rp chc l da tr em: 85% l do phage nhm II, bn cht ca c t l Polypeptide gm 2 loi: loi A bn vng vi nhit ( 1000 Gy bnh Ch yu l cc bnh cp tnh: cho ngi: - Cc bnh nhim trng c m: mn nht, vim da,

khp cp vic nh lng n c ngha chn on xc nh. +. Streptolysin S: Bn vng hn, c kh nng lm tan huyt c trn b mt mi trng, tnh khng nguyn yu. - Streptokinase: lm tan t huyt, hot ha quanh vng tn thng gip LCK lan trn nhanh hn. - Hyaluronidase: Men c t/d thy phn axit hyaluronic gip VK lan trn, n cng c tnh khng nguyn kch thch c th sinh khng th. - Erythrotocine: Gy da trong bnh tinh hng nhit - Protinase: Phn hy protein

trong cc loi c kh nng gy bnh th 40 - 70% Tn ti trn c th ngi quan trng nht l Str. Pyogenes (nhm vng t hu, l nguyn nhn ng

vim SD-TN, vim xng.... - gy nhim trng huyt: thng xy ra trn c a ngi c sc khng yu (ngi gi, tr nh) v sau cc nhim khun trn - Nhim trng - nhim c thc n: xy ra nhanh, thi gian bnh 6 - 8h, iu tr sm khi nhanh. - Hi chng da phng rp - Hi chng shok nhim khun

3. III. 1. 2. 3.

Min dch

m, mu, m, dch no ty, thng ly cht dch ng mi hng bng tm bng vng t hu Nhum, soi Nhn nh c hnh dng s b ca VK nhng Bng Gr, nhn thy cu khun thnh tng VK bt mu Gr +, ng thnh tng trc tip khng gi tr chn on xc nh chui, khng v c th xc nh s b i, song cha kt lun c Nui cy L phng php quan trng chn on xc nh: - Vi cc cht m, dch: cy bnh phm - cy bnh phm vo mi trng v xc nh - Bnh phm l m, cht nn, thc n tha: cy vo mi trng thch mu 370c/24h. thch mu c Gentamycin 5 Bnh phm:

A) - NK ngoi da: mn nht, chc l.... - Vim: Hng, Amydal, tai - Vim ng tit niu, sinh dc - Thp khp, tim, vim mng trong tim bn cp, NK huyt - Vim rut (thng do lin cu nhm D) Cc di chng: Xut hin sau 2 - 3 tun sau nhim LC c bit l vim hng gm: - Vim cu thn cp: sau 1 - 3 tun, c bit l nhim cc type 12, 4, 49, 57 hng hoc da do s tc ng ca phc hp KN - KT ln mng c bn ca tiu cu thn. C gi thit cho rng, l s tc ng ca khng th chng li khng nguyn vch ca LC nhm A phn ng cho vi mng y cu thn. - Thp khp cp: l di chng nghim trng nht v gy tn thng c v van tim do LC nhm A c KN mng t bo phn ng cho vi c tim Sau khi nhim TCK c th c MD yu khng bn Sau khi nhim TCK c th c MD yu c th coi nh khng c MD khng bn CHN ON VI SINH VT Ty tng bnh, c th l: BP m; BP mu; BP cht Ty tng bnh, c th l m, mu, dch nn v thc n tha vim, nc tiu

hng th 2 gy nhim khun h hp cp tnh tr <5tui - Gy nhim khun h hp: vim hng, phi, p xe phi.... - Nhim khun cc mng: phi, mng trong tim, mo... - Nhim khun huyt

yu, khng bn vng

bnh phm vo mi trng thch mu 370c/24h. nhn nh hnh thi khun lc, kim tra t/c gy tan mu sau chuyn sang mi trng Chapman kim tra t/c ln men ng manit, xc nh t/c gy ng huyt tng tm kh nng sinh men coagulase v men Catalase ca VK. - Bnh phm l mu: ly 5ml mu (v khun) cho vo mi trng canh thang c Glucose 0,2%, t l mu v canh thang l 1/10. m 370c/24h, nu c hin tng VK mc: c mi trng, tan huyt, c vng th ly canh khun nhum Gr, nu thy cu t/c sinh vt khun th chuyn canh khun sang mi trng ha hc thch mu v lm nh trn, nu thy trc khun th thc hin nui cy phn lp theo hng trc khun.

nhn nh hnh thi khun lc, kim tra t/c gy tan mu, nhum soi li, nu thy cu khun Gr + xp thnh tng chui th tin hnh th nghim Baccitracin v Catalase. Phn bit vi ph cu bng th nghim Optochin v Neufeld. - Vi mu v nc no ty: Cy bnh phm vo canh thang Glucose theo di hng ngy, nu thy mi trng c lng trong sut v c lng cn th nhum soi, nu thy hnh nh ca lin cu th c th chn on v xc nh t/c sinh vt ha hc. vic theo di phi thc hin trong 15 ngy, nu VK khng mc mi coi l m tnh

microgam/1ml, kh trng 5 10%CO2, 370c/24h. nhn nh hnh thi khun lc, khun lc ca ph cu l khun lc c nh. Khi khun lc thun nht, nhum Gr, cy sang mt a thch mu khng c Gentamycin ri lm tip th nghim optochin chn on xc nh. - Th nghim optochin: Dn u VK trn mi trng thch mu a, cho kh mt thch ri t khoanh giy optochin, t m 370c/24h 5 10%CO2, nu xung quanh khoanh giy c vng v khun vi K trn 14mm th chn on xc nh l ph cu - Th nghim Neufels: Nu vng v khun trong th nghim optochin < 14mm th cy VK vo mi trng canh thang nc bng c thm mui mt, sau 24 - 48h nu thy canh khun trong (VK b ly gii) th chn on xc nh l ph cu

t c gi tr Chn on huyt thanh

4.

Tm khng th trong huyt thanh BN. Chun antistreptolysin O bng phn ng Aslo, nu < 200 l B/t, > 250 th chn on xc nh - P/ng trong da (Dick) xc nh tnh trng min dch ca c th vi LC tinh hng nhit - Song cu khun hnh ngn nn, Gr+

5.

Tiu chun - Cu khun Gr +, xp thnh m, gy tan mu chn on - Ln men ng Manit

- Gy ng huyt tng (c enzym coagulase) TCK trong phng th nghim 6.

- Khun lc c nh trn mi trng thch mu Gentamycin, tan mu @ - Th nghim optochin + - B ly gii bi mui mt (th nghim Neufels +)

Xc nh Bng Phage (nh ni trn) c ngha trong iu tra type VK dch t hc IV. PHNG BNH V IU TR - c hiu: Khng huyt thanh l gii c t hoc Cha c vacxin c hiu, ch yu l v - c hiu: vacxin polysaccharid ca vacxin l VK cho kt qu khng tt sinh: c nhn, n ung, mi trng... v ph cu Phng 1. - Khng c hiu: L ch yu: gi v sinh chung, - Khng c hiu: kh khn v PCK bnh m bo v trng trong phu thut, chng nhim ly theo ng h hp khun cho 2. iu tr Tt nht theo kt qu khng sinh Ampi, Peni, Teta...theo KS Peny, Teta, Ery, Chlocid....

CU KHUN GRAM M
TT I. 1.

Ch s
Hnh th, t/c bt mu

No m cu C IM SINH HC
- Hnh trn, ging ht c ph, hu ht nm trong bo tng bch cu a nhn (nu nhum trc tip t bnh phm), bt mu Gr - Khng di ng, khng v, khng sinh nha bo

Lu cu khun

2.

T/c nui cy

3.

T/c sinh vt ha hc

- Hiu kh, kh nui trn mi trng nui cy thng thng. mi trng phi giu dinh dng (c mu, huyt thanh, mt s axit amin), thng dng mi trng thch Chocolae, Thayer - Martin, nhit 370c, kh trng 10%CO2. - Trong mi trng thch mu: T0370c/24h to khun lc, trn nh, nhn lu khun lc to ln , b khng u, mt x x - Trn mi trng Chocolate: P/t thnh khun lc dng S, nh, li, xm hoc ng nh - Vi khun ln men khng sinh hi cc loi ng - Phn ng oxydase + Glucose, Galactose - Ln men khng sinh hi ng Glucose - Khng ln men ng lactose, sacarose - Khng ln men ng maltose, saccharose, levulose

- Hnh ht c ph xp thnh tng i hai mt dt xp quay vo nhau, bt mu Gr -, nhum xanh metilen c mu xanh. - trong trng hp BN mc bnh cp tnh VK nm trong t bo bch cu a nhn - trong trng hp BN mc bnh mn tnh, trn tiu bn t thy VK, thng VK nm ngoi t bo - Khng v, khng lng, khng sinh nha bo - LCK l vi khun hiu kh tuyt i, rt kh nui trn mi trng nui cy thng thng mi trng phi giu dinh dng c mu, huyt thanh v yu t pht trin, thng nui trong iu kin kh trng 10%CO2, thng s dng mi trng Thayer - Martin nui cy. - Trn mi trng c T0370c/48h lu cu p/t thnh khun lc nh, trn, dt mu xanh nht.

- Oxydase +, catalase +

4.

Sc khng

yu, ch sng trong dch nc no ty 3 - 4h sau khi ra khi c th, nhit 550c sau 30ph mi b dit, cc thuc st trng thng thng d dit

5.

Cu trc khng nguyn Vch VK c cha KN polysaccharid c hiu type, da vo chia ra 4 nhm chnh A, B, C, D. Ngoi ra cn KN Protein c t Gy bnh cho ngi Gy bnh bng ni c t gn vi phc hp lipopolisaccharide, ni c t vng bn vi nhit - L loi VK k sinh tuyt i ngi, thng thy nim mc ng h hp trn, bnh ly theo ng h hp, VK c th gy vim t hu ri gy vim mng no (thng gp tr nh, c th gy thnh dch) - Rt t khi gy nhim khun huyt nhng nu nhim th rt nng, c th dn n vim mng khp, mng phi, mng tim

c th da vo tnh khng ln men ng phn bit lu cu v no m cu: Vi khun G.ose M.ose L.ose Lu cu + No m cu + + km, ra khi c th BN cht nhanh, d b tiu dit nhit 580c /1h. cc cht st khun thng thng: Ax. Phenic 1%; formon 0,1% c kh nng git cht vi khun trong 2 - 5 ph c KN c hiu cho nhm hoc cho type nhng khng c ngha trong chn on xc nh VK

II. 1. 2.

KH NNG GY BNH
gy bnh bng ni c t - ch thy LCK ngi khng thy trong thin nhin, bnh truyn trc tip t ngi sang ngi ch yu qua ng tnh dc, c th bng ng da, nim mc, gic mc. - VK gy vim niu ov c th gy vim cc b phn khc ca ng sinh dc nh vim: tuyn tin lit, mo tinh hon, c t cung, vi trng. nu khng iu tr kp thi s li hu qu v sinh. - ngoi ra cn gy vim khp, nhim khun huyt, vim mng trong tim, vim kt mc tr s sinh khi qua ng sinh dc ca m mc lu

3. 4. III. 1.

Gy bnh thc nghim Min dch

Khng lm cho xc vt v kt qu khng in hnh C min dch ty theo tng nhm, tr nh c th c c th gy min dch dch th (dch tit m o) nhng min dch th ng do m truyn cho con khng c vai tr bo v

CHN ON VI KHUN HC
Bnh phm Cht nhy hng, mu, dch no ty - nam: ly m niu o vo sng sm trc khi i tiu ln u trong ngy

2.

Nhum soi trc tip

3.

Nui cy v phn lp

- n: ly m l niu o, c t cung, l tuyn m o Thy VK hnh ht c ph, nm trong hoc ngoi t - bnh phm c nhum Gr, hay xanh metilen, thy rt bo bch cu a nhn, bt mu Gr -, nhum xanh nhiu bch cu a nhn, trong c mt s cha nhiu mitilen bt mu xanh song cu ....khng ln vi VK no khc th c th chn on x bnh lu cp. - trng hp lu mn th t thy VK, VK nm ngoi t bo, c th c nhiu tp khun khc, vic chn on kh khn do cn nui cy phn lp VK - Nu khng ly c m c th ly nc tiu quay ly tm ly cn nhum soi hoc nui cy nhng thng t kt qu. - Cy bnh phm vo mi trng chocolate c VCN cy bnh phm vo mi trng Thayer - Martin nhit (vancomycin, colistin, nistatin) nhit 370c/24h, kh 370c/48h, kh trng 10%CO2 xem hnh thi khun lc, trng 10%CO2, nhum soi li chn khun lc in nhum soi li, nu thy song cu Gr - th lm cc phn hnh cy sang a thch Mueler - Hinton lm cc ng sinh vt ha hc xc nh lu cu th nghim xc nh t/c sinh vt ha hc, c th lm +. Chn on gin tip: trong mt s th bnh nht l phn ng ngng kt vi khng huyt thanh mu c vim khp do lu cu vic nui cy kt qu thng m hiu nhm A, B, C, D. tnh, c th lm phn ng huyt thanh chn on. - Nu l bnh phm mu: cy vo mi trng canh Thng dng l phn kt hp b th vi khng nguyn l thang Mueler - Hinton khi thy vi khun mc th VK lu ly gii, phn ng ny c hiu v c gi tr chuyn sang mi trng chn lc chn on

IV. 1.

PHNG BNH V IU TR
Phng bnh Vacxin t tc dng, ch yu gi v sinh pht hin sm Vacxin t tc dng, ch yu gi v sinh pht hin sm ngi lnh mang mm bnh x l iu tr trit cho BN, bn cnh phi gii quyt tt t nn XH, tuyn truyn phng chng bnh hoa liu trong quan h nam n Penicilin v Sulphamid t/d tt, tt nht l dng theo Penicilin, nay khng thuc nhiu, tt nht iu tr theo khng sinh khng sinh .

2.

iu tr

TRC KHUN GRAM M


Lng Tin Hng CTY 43D - Tng hp TT I. 1.

Ch s
Hnh th, t/c bt mu

Trc khun thng hn (Sh.mogella) Trc khun l (Shigenla) C IM SINH HC


- Hnh trc, Gr -, kch thc: 1 - 3 x 0,5 - 0,7 microM - Nhiu lng xung quanh thn nn di ng c, khng v, klhoong sinh nha bo - L VK hiu, k kh ty tin, P/t trong mi trng nui cy thng thng, PH 6 - 8 - Trong mi trng lng: 5 - 6h lm c nh mi trng, 18 - 24h lm c u - Mi trng c: 24h to khun lc dng S: trong, nhn, t, to (2 -4 mm) c th gp khun lc dng M

E.coli

Hnh trc ngn 1 - 3 microM, hnh trc, c lng nn di ng Khng: v, lng, nha bo; Gr c, khng sinh nha bo

2.

T/c nui cy

- L VK hiu, k kh ty tin, P/t trong mi trng nui cy thng thng, PH 6,6 - 8,8, nhit thch hp nht 370c - Trong mi trng lng pepton, VK mc sm lm c u mi trng - Mi trng c: to khun lc dng S: trn, trong, b u, hi li, nh hn khun lc ca salmonella. C th bin dng sang th R (khi khng c na)

3.

T/c sinh vt ha hc

- C kh nng di ng - Ln men ng Glucose km theo sinh hi - Khng ln men ng lactose - Sinh H2S, khng sinh Indole, khng phn gii Ure - VP(-), RM(+)

- L VK hiu, k kh ty tin, P/t trong mi trng nui cy thng thng, T0370c, PH 7 - 7,2 - Trong mi trng lng: 4 - 5h lm c nh mi trng, cng lu cng c nhiu, sau vi ngy c th c vng mng, lu lng. - Mi trng c, sau 18 - 24h p/t thnh khun lc: trn, li, bng, b u, khng mu hoc mu xanh xm nh - Ln men ng Glucose khng - Ln men, sinh hi mt s sinh hi ng:lactose,manitol,glucose - Khng ln men ng lactose cn c kh nng ln men lactose - H2S (-), urease (-), indole (-) phn bit vi VK ng rut khc

10

4.

Sc khng

5.

Cu trc khng nguyn

- kh tt, sng lu trong mi trng t nhin, chu c nhit cao - C th tn ti trong nc 2 - 3 tun, trong phn v trong nc sng 2 - 3 thng, cht 50 oc/1h hay 100oc/5ph, nhy cm vi thuc st trng thng thng - Nhiu thuc khng sinh tc dng tt vi VK, nhng hin nay khng thuc nhiu C 3 khng nguyn: - KN O: hin nay tm thy 65 yu t khc nhau, da vo KN O chia Salmonella thnh cc nhm A,B,C,D.... - KN H: chia thnh cc type huyt thanh - KN Vi: KN b mt, khng tham gia gy bnh, ch c mt s chng ca S. typehy mi c KN ny

- H2S (-), urease (-), indole (+) - Km, nh nng chiu thng yu, thuc st khun thng cht/30ph, 58 - 600C tn ti 10 - thng dit trong 2 - 4ph, cht 30ph, 1000C 2ph, d cht bi thuc 55oc/1h hay 60oc/30ph kh trng thng thng. - qun o BN tn ti 1 tun, trong s sng vi tun n vi thng, trong phn tn ti vi gi TKL u c KN thn O, mt s chng c KN b mt A, khng c KN H Da vo KN thn v cc t/c SVHH, TKL chia thnh 4 nhm: +. Nhm A: Khng ln men ng manitol, c 10 type huyt thanh, cc type khng c quan h v KN vi cc nhm khc v vi cc type trong nhm +. Nhm B: c 6 type huyt thanh, cc type ny c c thnh phn KN c hiu type v KN chung cho c 6 nhm. +. Nhm C: c 15 type huyt thanh +. Nhm D: ch c 1 type huyt thanh nhm A, B u c mt nc ta, nhm A c type I (Sh. Shiga) gy bnh bng c ni v ngoi c t nn bnh rt nng phc tp, c 3 KN: O,H,K - KN thn O: c 142 loi do da vo chia thnh 142 type huyt thanh - KN b mt K: da vo s nhy cm ca n chia 3 loi: A, B, L. KN A bn vng vi nhit , KN L khng bn vi N, KN B c t/c trung gian gia A v L - KN lng H: c ghi bng s 1,2,3...c 48 loi Cn c KN O, K, H chia E.coli thnh nhiu nhm v type khc nhau.

6.

Phn loi

- S. typehy: l Salmonella gy bnh tuyt i ngi, bnh thng hn ch yu do S. typehy gy

Cc nhm E.coli da vo t/c gy bnh"

11

nn - S. paratypehyA: ch gy bnh cho ngi v hay gp nc ta sau S. typehy - S. paratypehyB: gy bnh ch yu cho ngi nhng cng c th phn lp c ng vt. bnh thng gp cc nc chu u - S. paratypehyC: gy bnh thng hn, vim d dy v rut, nhim khun huyt. bnh thng gp nhng nc ng nam - S. typehymurium v S. enteritidis: gy bnh cho ngi v gia xc trn ton th gii, chng l nguyn nhn gy nhim trng, nhin c thc n do n phi thc n nhim salmonella. - S. chorerae suis: l loi hay gy nhim khun huyt II. 1.

- Nhm ETEC: (Enteretoxigenic E.coli): L E.coli sinh c t rut - Nhm EIEC: (Enteroinvasive E.coli): Gy bnh bng cch xm nhp vo i trng v bng ni c t Nhm EPEC: (Enteropathogenic): gy vim rut thnh dch hoc l t - EHEC: (Enterohaemorrhagic): cha r c ch gy bnh - EAEC:(Enteroadherent E.coli) bm dnh ng rut Bng ni c t (mt s c c ni v ngoi c t Shigenla gy bnh l trc khun v vim rut a chy, ch c ngi v kh. VK vo c th bng ng tiu ha, c tr v sinh sn rt nhanh nim mc i trng, gy bnh bng c ch xm nhp bng ni v c khi c ngoi c t. VK bm v xm nhp su vo nim mc i trng chng nhn ln nhanh trong lp nim mc. VK cht gii phng ra ni c t gy ph n, xung huyt, xut huyt to thnh lot v mng hoi t, ni c t cn tc ng ln TK giao cm gy co tht v - Nhm ETEC: (Enteretoxigenic E.coli): L E.coli sinh c t rut, gy bnh bng 1, 2 c t rut LT v ST, c t trn do Plasmid quyt nh. C ch l ht nc v in gii vo lng rut v vy BN nn v i ngoi nhiu nc, trong phn khng c mu. Thng gy ra nhng v a chy nng. - Nhm EIEC: (Enteroinvasive E.coli): Gy bnh bng cch xm nhp vo i trng v bng ni c t nh trc khun l nn

KH NNG GY BNH
Yu t c lc Gy bnh cho ngi c ni c t rt mnh gy vim rut non xung huyt, c th b hoi t dn ti thng rut, tc ng vo h thn kinh gy nhim c thn kinh a). Gy bnh thng hn: Tn thng ch yu ng tiu ha, xm nhp vo ng tiu ha qua ming - d dy - rut non. Ti rut non, VK bm vo t bo nim mc rut, qua nim mc rut vo h thng bch huyt mc treo, y VK sinh sn nhanh (cha c triu chng lm sng) - T hch VK vo mu (bt u c triu chng LS) theo mu n mt s c quan (gan, lch), t VK vo mu tng t. sau khi qua gan, VK theo ng dn mt vo rut v c o thi ra ngoi theo phn. Hoc t mu, VK n thn v c o thi ra ngoi theo nc tiu. - hch, mt s ln VK b dung gii, gii phng ra ni c t gy triu chng: kch thch trung tm thn

2.

12

kinh thc vt gy st ly b v chnh lch gia mch v nhit (mch nhit phn ly) N tng nhng nhp tim gim. - T mu, VK n cc c quan bch huyt rut (nh mng payer), chng sinh sn y v vy gy y hi i lng, c th gy sng, lot hay hoi t mng payer, c th chy mu v dn n thng rut nu BN n cc thc n cng, BN li b, hn m, try tim mch, t vong - Sau khi khi, BN vn c th o thi VK ra ngoi theo phn, thng 2 - 3 tun, c trng hp 6 thng n 1 nm b). Ngoi ra cn gy nhim trng huyt, nhim trng, nhim c thc n

tng nhu ng rut, trn lm sng BN c triu chng: au bng qun, i ngoi nhiu ln, phn c nhy mu. ngoi c t ca Sh. Shiga c c tnh vi TK trung ng c th gy vim mng no v hn m. Tuy nhin VK ch sinh ra ngoi c t khi xm nhp vo i trng bnh thng th cp tnh, mt t l nh chuyn sang mn, nhng BN ny thnh thong a chy v thi VK ra ngoi mi trng theo phn l ngun ly quan trng Min dch dch th khng c vai tr bo v, vai tr bo v ch yu nh IgA tit ra ti rut

triu chng LS ging L trc khu -Nhm EPEC: (Enteropathogenic): gy vim rut thnh dch hoc l t - EHEC: (Enterohaemorrhagic): cha r c ch gy bnh - EAEC:(Enteroadherent E.coli) bm dnh ng rut, bm vo nim mc v gy tn thng chc nng rut Gn y, E.coli c coi l mt trong nhng chng gy nhim trng bnh vin quan trng c kh nng khng a khng sinh vi t l cao

3. 4.

Gy bnh thc nghim Min dch

- Khng th O xut hin trong mu sau mc bnh 7 10 ngy. - Khng th H xut hin mun hn (sau 2 tun) v tn ti hng nm. - Khng th O v Vi u c vai tr5of bo v vi bnh thng hn, khng th H khng c vai tr bo v. - vai tr min dch ti ch nim mc ng tiu ha rt quan trng ngn cn VK xm nhp.

III. 1.

CHN ON VI KHUN HC
Phn lp, nui cy

13

1.1

Bnh phm

Ty trng hp m ly: Phn, mu, cht nn, thc L ni c nhy mu, nu phi a i xa n tha th cho bnh phm vo dung dch bo qun: Glyxerin 250ml; NaCl 5g; Nc ct 750ml

1.2

Phng php

a) Cy mu: - Ly 5 - 10ml mu TM ngay vo tun u ca bn cy vo bnh canh thang, m 370c, theo di hng ngy. Khi VK mc lm mi trng c v c vng th nhum soi kim tra hnh th. Nu trc khun Gr th chuyn sang mi trng ch lc v xc nh t/c sinh vt hc. nu 2 tun trong bnh canh thang m VK khng mc th kt lun m tnh. - Bnh thng hn nu cha iu tr khng sinh bng phng php cy mu tun l u t l (+) t 90%, tun th 2 t 70 - 80%, tun th 3 t 40 60%. Cy mu c gi tr nht trong chn on. b) Cy phn: Nn cy vo mi trng tng sinh VK pht trin nhiu v km hm VK khc sau cy chuyn vo mi trng phn lp thch hp nht l mi trng SS, thng dng l mi trng Endo hoc Istrati. Sau 24h nui cy, chon khun lc in hnh cy chuyn sang mi trng sinh vt ha hc. i vi ng c thc n, bnh phm l phn hay cht nn cng c nui cy nh bnh thng hn. c) Xc nh t/c sinh vaath ha hc: Chn nhng khun lc t mi trng phn lp cy chuyn tip vo mi trng xc nh t/c sinh vt hc, thng dng 4 mi trng l: Kligler, Ure-indole, manit di ng, DCL. t m 370c, c kt qu xc nh t/c sinh vt ca Salmonella.

Bnh phm c cy vo mi trng istrati, ch phi cy phn cng sm cng tt. sau khi 370c/24h xem hnh thi khun lc, chn khun lc nghi ng cy vo mi trng SVHH (mi trng Kligler, ure - indole, manit di ng) Sau khi xc nh t/c SVHH, ly VK trn mi trng thch thng lm phn ng ngng kt vi khng huyt thanh mu

ty theo: mu, phn, nc tiu m, dch...khi ly ch trnh nhim khun t ngoi vo, vi ph n phi ly nc tiu bng ng thng, bnh phm l nc tiu phi ly tm ly cn a) Bnh phm l mu: cy vo bnh canh thang, theo di hng ngy, nu thy mi trng c th nhum soi VK nu c trc khun Gr - th tip tc cy sang mi trng SVHH. b) Bnh phm l phn, nc tiu, dch: cy vo mi trng chn lc nh Istrati, SS...sau 24h nhn xt khun lc, chon khun lc nghi ng cy sang mi trng SVHH. +. Xc nh t/c SVHH: VK c cy sang mi trng Kligler, ure - indole, manit di ng, DCL, t m 37oc, c kt qu sau 18 - 24h Khi kt lun cn ch : trong vim ng tit niu, nu bnh phm c nhiu bch cu th s c mt ca E.coli l c gi tr chn on. Bnh phm l phn th ch chn on X khi pht hin cc type E.coli c bit

14

2.

Chn on huyt thanh

Cui cng lm phn ng ngng kt vi khng huyt thanh mu trn phin knh nh type VK gy bnh. Lm phn ng Widal xc nh khng th trong huyt thanh BN phn ng Widal l phn ng ngng kt, huyt thanh BN c pha long thnh nhiu m khc nhau, trn ring bit vi khng nguyn O v khng nguyn H xc nh hiu gi khng th O, H. trong giai on u c th ch thy khng th O, n giai on ton pht th c c O v H, phn ng cn c lm 2 ln xc nh ng lc khng th. Ln 1 ly mu nhng ngy u ca bnh, ln 2 sau ln 1 t 7 - 10 ngy. Ch xc nh BN mc bnh khi ng lc khng th 2.

++. Phn ng ngng kt: sau khi nh hng bng t/c SVHH th phi lm PNK vi khng huyt thanh mu trn lam knh

IV. 1.

PHNG BNH V IU TR
Phng bnh - Khng c hiu: ch yu l v sinh n ung v mi trng, tiu dit rui nhng, pht hin ngi lnh mang mm bnh iu tr trit - c hiu: Vacxin cht TAB nhng khng bn. Phng bnh ti nim mc rut bng khng th - Khng c hiu: ch yu l v sinh n ung v mi trng, tiu dit rui nhng - c hiu: Vacxin cha c kt qu tt - Gii c t c kt qu nhng ch yu vi Sh. Shiga Chloramphenicol, Ampicilin nhy cm nht, nhng hin nay khng thuc nhiu nn tt nay t l khng thuc ngy cng tng nht iu tr theo khng sinh - Khng c hiu: ch yu l v sinh n ung nh cc bnh ng rut khc, ch khi c dch vin d dy rut tr - c hiu: hin nay c Vacxin ung cho tr s sinh theo kt qu khng sinh

2.

iu tr

15

MYCOBACTERIUM GY BNH
Lng Tin Hng CTY 43D tng hp TT I. 1.

Ch s
Hnh th, t/c bt mu

LAO (M.tuberculosis) C IM SINH HC


- Hnh que mnh, kch thc 2 - 4 microM x 0,3 - 1,5 nicroM, ng ring l hoc hnh ch N, Y, V hoc thnh dy phn nhnh nh cnh cy. - Khng di ng, khng sinh nha bo, nui cy trong mi trng nhn to c huyt thanh c th c v. - c bao bn ngoi bi lp sp nn kh bt mu thng thng - Thng nhum theo phng php Z-Neelsen, s dng thuc nhum c, nng, thi gian ko di; trc khun Lao AFB bt mu , cc t bo hoc VK khc bt mu xanh. - L VK a kh bt buc, To thch hp l 370c, hu nh khng mc To< 37oc v > 42oc, 40oc vn mc tt - Khng nui c mi trng thng thng, mi trng phi giu dinh dng cha: trng, khoai ty, citrate, glyxerol (mi trng c Loewenstein, mi trng lng Sauton) - Pht trin chm, 9 - 10 ngy sau nui cy khun lc mi xut hin nhng phi 4 - 6 tun sau khun lc mi in hnh. Khun lc dng L: kh, x x nh hoa xp l, mu vng kem, d ly

PHONG HI (M. leprae)


- Ging Lao, TKH nm trong t bo ni mc hoc t bo bch cu n nhn, thng xp thnh hnh b m hoc b ci - Khng sinh nha bo, khng di ng, khi trong t bo sng th hnh thnh v nhng khi nhum Fuchsin th v b ph hy - TKH khng cn - axit, bt mu Z-Neelsen - TKH c tm thy trong tiu bn t da, nim mc, dch tit ca mi, u cc hi cha nui caaysa c trn mi trng nhn to, c th nui cy gan bn chn chut

2.

T/c nui cy

16

khi mi trng nhng rt kh tan trong nc - Trong mi trng lng pht trin thnh vng 3. 4. T/c sinh vt ha hc Sc khng - Tng i cao vi kh hanh, cht ty u, kh trng v cc yu t ngoi cnh khc. - Trong m sng c nhiu tun - D b tiu dit nhit m - Phenon 5%/24h dit c VK trong m. HCL 3%, NaOH 4% khng dit c VK lao trong m, do ch s dng 2 cht ny trong x l thun nht bnh phm. - B dit 100oc/5ph - Nhy cm vi khng sinh Streptomycin, INH..... Cu trc khng nguyn C hai loi KN: - KN Protein: c th gy qu mn trong phn ng Tubeculin, cn c KN ny chia TK Lao thnh cc typ - KN polysaccharid

5.

II. 1.

KH NNG GY BNH
c t - Mycobacterium sinh ra c t nhng khng c ngha l gy bnh - c lc ca TKL c lin quan n yu t "Cordfato" c bn cht l lipid, c kh nng gy c ch t bo bch cu gy nn nhng u, ht mn tnh Lao phi (ch yu do bin chng M.tuberculosis hominis, chim 96 - 97%); ngoi ra c cc th lao khc nh: thn, mng no, xng, hch, da ng xm nhp qua: h hp, da, tiu ha, kt mc mt KH NNG GY BNH Ngi l vt ch duy nht, VK xm nhp vo bo tng ca t bo c th, khng vo nhn, him khi thy ngoi t bo Cch ly truyn: - Trc tip t ngi sang ngi, t l thp v rt kh ly, t l lt gia con c b m b bnh l 1 - 5%, gia cp v chng 3 - 6% - S ly nhim b hn ch bi vx BCG v thuc iu tr, th d ly nht l th hi c - TKH bi xut ra ngoi c th qua nim mc mi hng v tn thng da, v tr u tin tn thng thng l vng da h. do vy ly bnh l do tip xc; trc tip qua da, nim mc b xy st

2.

Gy bnh cho ngi

17

- Nhng ngi khe mnh, bnh thng ti sng vng t l phong cao c th b ly bnh hu ht mi t chc ca c th u b TKH xm nhp: thn, gan, lch, tkTW. Bnh tin trin trong nhiu nm, triu chng sm nht l ri lon cm gic v ni u cc, mun hn l ri lon: dinh dng, vn ng, chuyn ha Ca, P, gy bin dng u xng, tiu rt lm BN mt kh nng lao ng 3. 4. Gy bnh thc nghim Min dch L min dch t bo, c xut hin khng th trong mu nhng - C th khng mnh vi TKH, phi nhiu khng bo v c th. S thay i hiu gi khng th khng nm sau nhim bnh BN mi t vong do nhiu tng ng vi thi gian, din bin bnh trn LS tn thng khc - c th c p ng min dch dch th nhng khng cao

III. 1.

CHN ON CN LM SNG
Bnh phm v x l bnh phm - Ty tn thng m ly bnh phm: m, dch mng phi, dch no ty, nc tiu.... - Tt c cc trng hp nghi lao phi phi xt nghim m t nht 2 mu, tt nht l 3 mu: mu 1 ly ti ch khi BN n khm; mu 2 ly vo bui sng sm trc khi BN ng dy; mu 3 ly ti ch khi BN em maauxx 2 n xt nghim. - Thun nht bnh phm m: trn 1 th tch m vi 2 th tch NaOH 4% ri lc bng my lc trong 30ph (nu khng c my lc th dng bi thy tinh lc tay) cho m long ra. Sau cho thm nc ct v trng khuy u ri ly tm 2000 vng/15ph, ht nc b i, trung ha cn m bng HCL 4%. Kim tra PH trung tnh bng dung dch Phenonphtalein 1% - Nu bnh phm l dch no ty ch cn ly tm, bnh phm l nc tiu th ly tm v dit tp khun. a) Nhum, soi m trc tip tm AFB: Nhum bnh phm bng phng php Z - Neelsen, TKL bt mu , cc t bo v VK CHN ON VI SINH VT: Ch yu ly bnh phm nhum Z.neelsen tm TKH: - Tm TKH trong hc mi: dng tm bng v trng ly dch tit hc mi lm tiu bn nhum, phi c lm lin tc trong 3 - 7 ngy mi kt lun c. nu BN khng c nc mi c th cho ung thuc kch thch xut tit ly - Tm TKH trong cc tn thng: ly mt ming da vng tn thng, pht ln knh, nhum soi

2.

Phng php chn on

18

3.

Chn on xc nh

khc bt mu xanh Cch nh gi kt qu tiu bn nhum m (xem sch) b) Nui cy tm TKL: Bnh phm c x l nui cy trn mi trng c Loewenstein, theo di 37oc trong 6 - 8 tun. chn khun lc R xc nh phn ng Niacin v Catalase, nu l TKL th 2 p ny u (+), nui cy trn mi trng lng (MGIT, BATEC) cho kt qu khong 10 ngy c) Xquang phi chun: Hnh nh l: Thm nhim, nt, x hang, c th co ko 1/3 trn ca ph trng 1 hoc 2 bn. ngi c HIV t thy hnh hang, tn thng khong k nhiu hn v c th vng thp ca phi. d) Tm d ng lao: (P Mantous - Tuberculin test): (xem sch GK) e) K thut PCR: pht hin gen c hiu ca TKL f) Gy bnh cho chut lang: (xem sch) +. Lao phi AFB (+) tha mn 1 trong 3 K sau: - Ti thiu c 2 tiu bn (+) t 2 mu m khc nhau - 1 tiu bn (+) v c hnh nh Xquang lao tin trin - 1 tiu bn m (+) v nui cy (+) +. Lao phi AFB (-) tha mn 1 trong 2 K sau: - m AFB (-) qua 2 ln khm, mi ln x/n 3 mu m cch nhau 2 tun v c tn thng nghi lao trn Xquang v c hi chn vi BS chuyn khoa lao - m (-) nhng nui cy (+). Ring vi BN c HIV (+) ch cn 2 tiu bn m (-), iu tr khng sinh ph rng khng kt qu, c hnh nh Xquang nghi lao, v BS chuyn khoa quyt nh l lao phi (-)

IV. 1.

PHNG BNH V IU TR
Phng bnh c hiu bng vacxin BCG c hiu bng vacxin BCG vng c dch lu hnh, ung thuc cho ngi tip xc vi ngi b bnh +. iu tr: Khng sinh, iu tr di chng

2.

iu tr

Nguyn tc:

19

- Phi hp cc thuc chng lao: Streptomycin, PAS v INH +. Tiu chun than h ton bnh phong: hoc Ethambutol, INH v Rifampicin - Tt c mi BN trong vng u c cha - ng liu khi - u n - Khng c ng mc bnh trong 6 nm lin tc, - thi gian theo 2 giai on: tn cng v duy tr nu c phi pht hin v iu tr sm - Ngi dn phi c kin thc c bn v bnh phong

CC BN LU : Hc xui treo chiu dc, hc so snh theo chiu ngang theo tng nhm

20

You might also like