I CNG K SINH TRNG

1. Cc hin tng k sinh: a. Cng sinh (+ v +) b. Hi sinh (+ v 0): Entamoeba coli, Escherichia coli c. Hoi sinh: i. Ngoi hoi sinh: Aspergillus, giun ln ii. Ni ngoi sinh: Candida spp. d. K sinh (+ v -) 2. Cc loi KST: a. KST bt buc: i. Ngoi KST: - sng da/ xoang thin nhin: ci gh, nm da - sng bn ngoi, truyn bnh: mui, b cht ii. Ni KST: sng cc c quan su b. KST lc ch: giun mc ch (gy bnh u trng di ng da ngi), giun a ch mo. c. KST lc ch: giun a Ascaris lumbricoides d. KST c hi: t ni ngoi sinh gy bnh (Candida albicans) e. KST ngu nhin: t ngoi hoi sinh gy bnh (Aspergillus spp.) 3. Tnh c hiu k sinh: a. c hiu v k ch/ KST lc ch: i. Hp: Ascaris lumbricoides ii. Rng: Toxoplasma gondii b. c hiu v ni k sinh/ KST lc ch: i. Hp: Ascaris lumbricoides, Enterobius vermicularis ii. Rng: Toxoplasma gondii, Giardia 4. Chu trnh pht trin ca KST: a. Chu trnh trc tip: ngi l k ch duy nht: (Ascaris lumbricoides, E. vermicularis, E. histolytica) i. Chu trnh trc tip ngn: trng roi, amip, giun kim ii. Chu trnh trc tip di: giun a, giun mc, giun tc, giun ln. b. Chu trnh gin tip: cn 2 k ch (Toenia solium, T. saginata); 3 k ch, Sn di heo ( ngi KCVV)t sn, trngnang sn (heo KCTG) Sn l nh gan (ngi KCVV) trng, u trng lng bo t nang; redia (c KCTG I) - u trng ui nang trng (c KCTG II) 5. ng ly nhim: a. ng tiu ha: trng, bo nang, b. Qua da: u trng, c. ng h hp, giao hp, nhau thai, truyn mu 6. Ngun nhim: t, nc, thc phm, t nhim, ngi, th, 7. Chn on bnh: a. Chn on lm sng: b. Chn on KST c. Xt nghim trc tip: i. Tm KST trong phn: - n bo (amip, trng roi ng rut), giun, sn - i vi TH suy gim min dch: tm Cryptosporidium spp., Microsporidia, giun ln ii. Tm KST trong mu: n bo (Plasmodium spp., Trypanosoma spp.), u trng giun ch iii. Nc tiu: Trichomonas vaginalis, u trng giun ch, nm men, trng S. haematobium iv. m: trng sn l phi, Aspergillus, Cryptococcus neoformans v. Dch t trng: trng v u trng giun ln, trng giun mc, Giardia lamblia, vi nm, d. Xt nghim gin tip = Min dch chn on: i. Tng bch cu toan tnh (giun sn, u trng di ng) ii. Tng bch cu a nhn (st rt, amip gan) iii. Gim bch cu a nhn ( st rt mn tnh) iv. Tng bch cu n nhn (bnh Toxoplasma) - Phn ng ngng kt hng cu: tm khng th amip, sn mng, sn l gan, bu sn, vi nm - Min dch hunh quang - Min dch in di - Min dch men ELISA: tm khng th n bo, vi nm Candid 1

N BO (1 t bo)
1. TB cht: a. Ngoi sinh cht: m c, n hi (di chuyn, tiu ha, bi tit, h hp v bo v) b. Ni sinh cht: lng, cha nhiu ht, cha nhn (sinh sn), khng bo tiu ha, th bt mu 2. Nhn th: phn bo, phn bit cc loi Ngnh Sarcomastigophora (trng roi v trng chn gi amip) Ngnh ph Sarcodina (trng chn gi) Mastigophora K sinh ng tiu ha (trng roi) v ng sinh dc K sinh trong mu Ciliophora (trng lng) Apicomplexa (trng bo t) Lp Coccidia Lp Haematozoa (k sinh trong mu) Chi - Entamoeba - Endolimax, Iodamoeba, Acanthamoeba - Giardia - Trichomonas - Dientamoeba, Chilomatix - Trypanosoma - Leishmania - Balantidium coli - Cryptosporidium - Isospora - Toxoplasma - Plasmodium - l amip - vim rut - vim niu sinh dc - bnh ng, bnh chagas - vim no; nhim trng da, nim mc - bnh l - tiu chy - tiu chy - bnh Toxoplasma - bnh st rt Gy bnh

1. Entamoeba (trng chn gi) a. K sinh rut gi: E. histolytica, E. dispar, E. hartmani v E. coli. b. K sinh ming: E. gingivalis. 2. Giardia lamblia (trng roi) 3. Trichomonas vaginalis (trng roi), Trichomonas intestinalis(trng roi) 4. Plasmodium spp. (k sinh trng st rt) 5. Toxoplasma gondii

L n bo k kh (E.coli, E. hartmani: hoi sinh, khng gy bnh)

Tn v Tn khoa hc

Hnh th v chc nng (hnh v)

Trng chn gi Entamoeba - 1 nhn, nhn cha nhn th gia nhn hay lch 1 bn. - Ht nhim sc xp xung quanh, pha trong mng nhn. - C khng bo tiu ha, khng c th Golgi v ti th. - Th hot ng cha n 40 loi ribonucleoprotein E. histolytica E. coli - th hot ng: chn gi di; - sng hi sinh, khng nhn lch 1 bn, hnh cu; gia xm nhp m ca k nhn c 1 nhn th nh, r; c ch. cc si khng sc; c khng bo - th hot ng: chn tiu ha, c hng cu, th bt gi ngn; nhn nm mu, khng c ti th. gia hay gn gia; - th hot ng ra ngoi khng nhn th kh to, nm th chuyn thnh bo nang. lch ra ngoi - tin bo nang: c khng bo - bo nang rt chit cha glycogen, c th bt mu. quang, c v bc cha - bo nang khng b tiu dit 8 nhn. nng clorid ty trng nc. th hot ng tin bo nang bo nang hu bo nang th hot ng hu bo nang - ng tiu ha. - qua da (tay bn) - bo nang - bo nang (1, 2, 4 nhn) v th hot ng - n rut non: v bo nang mt i 8 amip con - amip: rut gi

Trng roi Giardia lamblia - th hot ng: hnh con diu, pha lng li, na trc bng lm; 2 nhn ln, mi nhn c 1 nhn th gia; 8 roi (6 roi trc, 2 roi ngn sau); 1 sng thn, C lc l - sinh sn bng cch nhn i - th hot ng vo rut kt chuyn thnh bo nang. - bo nang: vch dy, hnh bu dc, chit quang, c sc khng cao, trng thnh c 4 nhn - tr em d b nhim hn ngi ln.

Trng roi (Trichomonas) T. vaginalis T. intestinalis - ch c th hot ng. - mng ln - hnh qu l, c 1 sng thn sng chy dc cng, 5 roi (4 roi hng v sut thn pha trc v 1 roi v pha ui) to thnh mng ln sng 1/3 chiu di thn; 1 nhn to (d thy khi nhum vi hematoxylin feric) - th hot ng: di chuyn kiu lc l v xoay vng - pht trin tt 35-37oC v k kh, pH 5.5 6 - pH acid (3.8 4.4): khng sng c

Chu trnh pht trin ng ly nhim G/ ly nhim G/ pht tn ra MT

- ng tiu ha. - qua da (tay bn) - bo nang 8 nhn

- ng tiu ha - bo nang - bo nang, th hot ng

- giao hp, m truyn sang con - th hot ng

- ng tiu ha - th hot ng

Ni sng chnh

- ban u: manh trng ri xung rut kt. - rut gi v sinh sn mnh MT kim

- rut

- c quan sinh dc (nam v n) - N: m h, m o, c t cung (khng ly sang t cung) - Nam: tuyn tin lit, ti tinh, niu o

- rut gi

Ni sng ph

Bnh hc (triu chng)

- gan, phi, no, da - gy bnh l amip. + rut: 1/ tiu chy (10-15 ln/ngy, phn t, c cht nhn, vt mu) 2/ au bng tht (mun i tiu gi to) 3/ but mt hu mn 4/ thn nhit gn bnh thng l do VK Shingella: st cao 5/ tn thng hnh tn nm. + gan: 1/ au pha di sn phi. 2/ gan vim, rt au khi g ngn tay vo, lch ko to, ko vng da; st cao 1/ Lm sng: xc nh trong rut hay ngoi rut. 2/ Xt nghim: - rut: xem phn ngay sau khi i tiu (coi hng cu) - Ngoi rut: pp huyt thanh + siu m + chp ct lp - coi th hot ng (khng c hng cu)

- tiu chy, phn lng, st/ c, c mi hi - gim cn, au bng, y hi

- gy vim nh - N: m o b vim, rt, nga ngy, huyt trng, c m. - c th gy v sinh. - Nam: vim ng tiu, c git m trng vo bui sng, tiu kh v au khi tiu.

- tiu chy - phn c cht nhn, mu v mi hi

Chn on

1/ phn c: tm bo nang 2/ phn lng: tm bo nang v th hot ng 3/ xem dch t trng. 4/ K thut vin nhng t trng 5/ Min dch men ELISA

1/ xem trc tip cht nhn m o, nhiu o. 2/ xt nghim: cht nhn + 1 git nc mui sinh l hay dng cn 90o, nhum bng Giemsa hay Hematoxylin. 2/ Nui cy: MT c v lng khng TB; trong m; trong phi g con. 1/ iu tr ton thn: - Metronidazol (cn trng cho ph n c thai) - Tinidazol (thay th) 2/ iu tr ti ch: - Thuc t m o, vin nn ph khoa: Gynoplix, Flagyl 3/ TH khng thuc: - Nimorazole (Naxogyn) - Nitazoxanide / Hamycin

- khm i trng

iu tr (kt hp nhm metronidazol vi 1 thuc khng hp thu rut dit bo nang)

1/ Emetin (nhiu phn ng ph) 2/ 5-nitroimidazol (hp thu tt rut) - Metronidazol (Flagyl) - Tinidazol - Secnidazol - Ornidazol (p xe gan) 3/ Dit bo nang: - Furamide - Iodoquinol (Yodoxin) - Paromomycin (Humatin)

1/ 5-nitroimidazol: Metronidazol, Tinidazol 2/ Furazolindon (Furoxone): dng cho tr em 5/ Paromomycin (Humatin): dng cho ph n c thai 6/ TH khng thuc: - Metronidazol v Albendazol - Nitazoxanide - Quinacrine v Metronidazol

Tn v Tn khoa hc

Hnh th v chc nng (hnh v)

ng ly nhim Th ly nhim Ni sng chnh Bnh hc (triu chng)

Trng bo t Toxoplasma gondii - 2 giai on pht trin: - tn ti 3 th: 1/ Sinh sn v tnh (s lit sinh): xy ra ngi, gm 2 pha: 1/ Th hot ng (th tng trng + Pha tin (ngoi) hng cu trong m gan: thoa trng th phn lit ngoi hng cu mnh trng nhanh): hnh li lim/ hnh tri ngoi hng cu chui, 1 u nhn; u kia trn, - Chu k ngoi hng cu cng din ra vi chu k hng cu cha 1 nhn. - P. vivax v P. ovale: th ng tn ti trong gan - sinh sn bng ct lit theo chiu + Pha hng cu trong mu: mnh trng th t dng (sc t mu en hmozoin) th phn lit dc, b HCl trong d dy hy nhanh th hoa hng mnh trng ni hng cu 2/ Th nang: hnh trn/ hnh bu 2/ Sinh sn hu tnh (bo t sinh): giai on u xy ra ngi, sau xy ra mui Anopheles dc, cha rt nhiu thoa trng, ci (giao t c+ci trng di non non nang thoa trng) khng b nh hng bi nhit di 450C v HCl ca dch v. P. falciparum (c nht) P. vivax P. malariae 3/ Th trng nang: hnh bu dc, - Pha ngoi hng cu: 10-12 ngy - Pha ngoi hng cu: 15- Pha ngoi hng v dy, to ra t ss hu tnh, khng - Th t dng non: hnh chic nhn, nhn , 21 ngy cu: 3-6 tun b nh hng bi HCl ca dch v; TB cht xanh dng, khng bo ko mu. - K sinh trng c th tn - K sinh trng: tn - Hng cu b nhim khng phnh to, c m ti trong gan 2 nm. ti trong gan t nht 3 - cha 2 bo t nang. - mi bo t nang: 4 thoa trng Maurer. - Th t dng non & gi: nm - Th t dng gi: khng c trong mu ging P. falciparum - Th t dng non: Gm 2 th thc pht trin: ngoi bin; ht sc t to, mu nu vng m, - Hng cu b nhim phnh hnh nhn, 1 ht sc 1/ Chu trnh hon chnh (xy ra nm ri rc. to, c ht Schiifner mu t. mo KCVV): gm chu trnh lit - Th phn lit: nhn 1 u, hnh qu l, hnh nu nh - Th t dng gi: sinh v tnh v chu trnh giao t ngn nn. - Giao bo c: 1 TB cht nhiu ht sc t, mu sinh hu tnh - Giao bo c: di, mp gia, 2 u cn mu tm, 1 nhn to, di nu en - Th phn tn ra MT: trng (nh iu x g), TB cht mu tm c. - Giao bo ci: 1 TB cht - Th phn lit hnh nang khng cha bo t nang - Giao bo ci: hnh li lim (hnh tri mu tm lt/ xanh dng , hoa hng 2/ Chu trnh v tnh, ko trn vn chui), TB cht mu xanh dng 1 nhn m c, nm 1 ( KCTG: ngi, V n tht) - Mu ngoi bin: ch c th nhn & giao bo bn - thoa trng th hot ng - mui chch, truyn mu, m truyn cho con - n tht sng cha nang - thoa trng (pht trin mnh gan) - trng nang (g/ bo t nang) - khng tn ti gan - hng cu tr, t bo li - hng cu gi, c - trong mu - hng cu gi v tr khuynh hng teo li - bnh st hng ngy/ bnh st cch nht nng - bnh st cch nht nh - bnh st ngy bn, 1/ Bnh Toxoplasma mc phi: (cch 48 gi ti pht) (cch 48 gi ti pht) cch 3 ngy ti pht + nhim sau khi sinh (5-25t) 5

K sinh trng st rt Plasmodium spp.

Vn khng thuc

Chn on

iu tr

1/ S (Sensibility): nhy cm: sch KST trong 7 ngy; khng ti pht trong 3 tun tip theo. 2/ R (Resistance): khng thuc - RI: khng mun: sch KST trong 7 ngy; ti pht trong 28 ngy sau . - RII: khng sm: gim th v tnh nhng khng sch KST trong tun u. - RIII: khng hn: th v tnh khng gim hoc tng trong tun u. - Thi k tim n: gm 2 chu k ngoi hng cu, t nht 1 hay 2 chu k ni hng cu. - Thi k tin trin: cn rt ko di 1-2h, lnh ton thn, thn nhit tng ln 390C; sau nng st ko di, da nng, thn nhit ln 40-410C; sau m hi 2-4h, nhit gim nhanh. - lch to, tn thng gan: gim albumin, cholesterol, prothrombin trong mu. 1/ St rt th c tnh: nghn mch, to huyt khi, thiu mu cc b - P vivax, P. malariae, P. ovale: ch nhim hng cu gi hay tr - P. falciparum: c th nhim c 2 - St rt th no: thn nhit tng, tim p nhanh v yu, da nht nht; m sng, l ln 2/ St rt th tiu ra huyt sc t: thn nhit tng, au lng d di, i ra mt, nc tiu mu 1/ Lm sng: (pb vi thng hn, cm) - st c chu k, giai on rt-nng-tot m hi - lch to, vng st rt 2/ Xt nghim: - Xt nghim mu: PP lam mu mng hay PP git mu dy 3/ PP min dch hunh quang (tm trong mu) 4/ PP huyt thanh hc 1/ Dit th phn lit trong mu (th v tnh): - Quinin: hp thu nhanh, thi tr nhanh - Artemisinin (Quinghaosu): dng cho P. falciparum, tc dng chm - Amino 4-quinolein: Cloroquin, Amodiaquin: hp thu nhanh, thi tr chm - Amino-ancol: Mefloquin, Halofantrin: hp thu chm, thi tr chm - Thuc khng acid folinic, khng acid folic: tc dng chm, d b khng Sulfadoxin + Pyrimethamin (Fansidar): ngi ln (khng dng cho ph n c thai) Fansidar + Mefloquin: tr em Quinin + tetracyclin/doxycyclin/clindamycin: dng trong TH khng thuc (khng dng cho ph n c thai, tr em di 8 tui) 2/ Dit giao bo (th hu tnh): - Amino 8-quinolein; Artemisinin hay Artesunat (tr em < 3 tui: dihydroartemisinin-piperaquin) - St rt c tnh: dng Artesunat tim tnh mch - CV8: dit th ng (ph n c thai trn 3 thng) - Ph n c thai di 3 thng: Quinin + clindamycin

+ nut trng nang + n tht sng cha nang a/ Th hch: st, ni hch, mt mi (t khi, ko cn iu tr) b/ Th nng (him gp) gm: - dng pht ban, vim mng no, - dng tn thng y mt. 2/ Bnh Toxoplasma bm sinh (do m truyn sang thai nhi) - Bnh phm: mu, m, ty xng, dch no ty. 1/ Quan st di KHV (nhum Giemsa/ nhum Schiff) 2/ PP tim bnh phm cho th 3/ PP huyt thanh hc: - th nghim mu Sabin-Feldman - th nghim ngng kt hng cu - th nghim khng th hunh quang gin tip - th nghim ELISA - th nghim c nh b th 1/ TH mc phi: - Rovamycin + vitamin C. 2/ TH bm sinh/ suy gim min dch: - Rovamycin + Fansidar + acid folinic + corticoid. - Ph n c thai: ch Rovamycin

GIUN SN
1. Giun (Nematoda): thn hnh ng, v cng a. Nhm k sinh rut: i. Giun a (Ascaris lumbricoides) ii. Giun kim (Enterobius vermicularis) iii. Giun mc (Ancylostoma duodenale v Necator americanus) iv. Giun tc (Trichuris trichiura) v. Giun ln (Strongyloides stercoralis) b. Nhm k sinh rut v t chc: Giun xon (Trichinella spiralis) c. Nhm k sinh mu v cc t chc: i. K sinh h bch huyt: Giun ch Bancroft (Wuchereria Bancrofti); Giun ch M lai (Brugia malayi) ii. K sinh di da: Onchocerca volvulus, Loa loa d. Nhm k sinh lc ch gy hi chng Larva migrans: i. u trng di chuyn da: Ancylostoma caninum (k sinh ch), Ancylostoma brasiliense (k sinh ch v mo) ii. u trng di chuyn ni tng: Toxocara canis (k sinh ch), Toxocara cati (k sinh mo) 2. Lp sn l (Trematoda): thn hnh l, dp, khng c v cng a. Sn l (Flukes) b. Sn l gan ln (Fasciola hepatica), Sn l gan nh (Clonorchis sinensis) c. Sn l rut (Fasciolopsis buski) d. Sn l phi (Paragonimus westermani) 3. Sn mng (Schistosoma): S. haematobium, S. mansoni, S. japonicum, S. mekongi 4. Lp sn dy (Cestoda): nhiu t dp, hnh dy bng, khng c v cng. a. K sinh ngi trong giai on trng thnh (sng trong rut): i. Sn dy ln (Toenia solium) ii. Sn dy b (Toenia saginata) iii. Sn dy c (Diphyllobothrium latum) iv. Sn dy ch (Dipylidium caninum) v. Sn dy ln (Hymenolepis nana) b. K sinh ngi trong giai on u trng (sng trong ph tng): i. Cysticercus: u trng sn dy ln v sn dy b. ii. Hydatid: u trng sn dy Echinococcus granulosus. iii. Sparganum: u trng g/ 2 ca sn dy Spirometra erinacei.

Tn v Tn khoa hc

Giun a Ascaris lumbricoides - mu trng c/ hng nht, c vn ngang; u c 3 mi quanh ming - con c: ui cong, 2 gai giao hp ngn, bng nhau - con ci: ui thng, hnh nn - trng: c v dy, c lp albumin x x, vng nu - trng ko th tinh: hnh thun, di, c ht chit quang ko u n. - nhim giun c: khng c trng - pht trin trc tip di: 2 tun - trng cha phi bo trng c phi - u trng giun a - ng tiu ha, h hp - trng c phi - trng cha phi bo - rut non

Giun kim Enterobius vermicularis - mu trng, u hi phnh, c 2 gn dc 2 bn thn. - ming c 3 mi - thc qun c phnh hnh c hnh. - con c: ui cong, 1 gai - con ci: ui thng, nhn - trng: hnh bu dc, hi dt 1 pha, v dy - con ci trng hu mn vo ban m

Hnh th v chc nng (hnh v)

Giun mc Ancylostoma Necator duodenale americanus - mu trng sa/ - ngn hn hng nht; - khng c 2 - u c bao cp mc pha ming phnh ra, bng m c 2 cong v pha thn rng hnh - sn lng chia li dao 2 nhnh, mi - sn lng nhnh ch 3. chia 2 nhnh, - c: ui xe ra mi nhnh hnh chung, 2 ch 2. gai giao hp di - trng di v - ci: ui cn thon hn - trng: bu dc, v mng

Giun tc Trichuris trichiura - mu trng c/ hng nht - u thun nh, ui phnh to - c: ui cong, c gai - ci: ui thng, bu - trng: bu dc, nu, v dy, 2 cc c nt cht nhy

Giun ln Strongyloides stercoralis - rt nh, sng k sinh hay sng t do - dng k sinh: ch gm con ci trinh sn, thc qun di, t cung c 4-5 trng - dng t do: + c: ui cong, 2 gai giao hp = nhau + ci: ui nhn

Chu trnh pht trin ng ly nhim Th ly nhim Th pht tn ra MT Ni sng chnh Ni sng ph (lc ch)

- pht trin trc tip - trng cha phi bo - u trng ngn, t nhim thc qun phnh - u trng thc - trng c phi - u trng qun hnh ng giun mc giun kim - ng tiu ha, t nhim - trng c phi - trng c phi - u trng: phn cui rut non - trng thnh: manh trng - hu mn - qua da - u trng thc qun hnh ng - trng cha phi bo - t trng

- trng cha phi bo trng c phi - u trng giun tc - ng tiu ha - trng c phi - trng cha phi bo - manh trng rut gi - rut non, rut tha

- trc tip: u trng thc qun hnh ng - gin tip: u trng thc qun c phnh - qua da, t nhim - u trng thc qun hnh ng - u trng thc qun c phnh - rut non (ch gm con ci trinh sn) - tim, phi, t trng, gan, cc hch 8

- gan, phi, rut tha, ng ty, ming, mi

- phi, rut non

Bnh hc (triu chng)

1/ Giai on u trng: - gy hi chng Loeffler: + ho khan, au ngc, st nh. + bch cu toan tnh tng cao (20-40%) 2/ G/ trng thnh: - t: bun nn, n ko tiu, au bng, tiu chy. - nhiu: au bng, nn ra giun, tc rut, vim rut tha, thng rut, tc mt

1/ ri lon rut: - nga hu mn (ban m) - au bng, bun nn, tiu chy 2/ ri lon thn kinh ( tr em): mt ng, khc m, i dm, co git 3/ ri lon c quan sinh dc n: vim m h, m o

1/ G/ m (sng cc c quan): - ho khan khng m, khn ting, pht m kh 2/ G/ rut: - ri lon tiu ha: vim t trng, au vng thng v; i cn co, chn n - thiu mu v ri lon tun hon: bch cu toan tnh tng nhanh, da kh v ti nht, m mt b ph, mt sng hp, kh th, mch nhanh, tai, chng mt - ri lon thn kinh: nhc u, d qun, suy sp thn kinh. 1/ tm trng trong phn 2/ cy phn 3/ PP huyt thanh hc

- ging nh kit l - au bng, i tiu nhiu ln, phn t - nhiu: thiu mu nhc sc

Chn on

1/ Giai on u trng: - da trn lm sng v cng thc mu 2/ G/ trng thnh: - tm trng trong phn

1/ Lm sng: nga hu mn 2/ Cn lm sng: dng PP Graham, ly bng keo trong

1/ tm trng trong phn 2/ PP phong ph ha

iu tr

1/ Pamoat pyrantel (thn trng cho tr < 2t) 2/ Mebendazol (Vermox, Fugacar): ko dng cho tr di 2 tui 3/ Albendazol (Zentel) 4/ Flubendazol (Fluvermal) tt c ch git c giun trng thnh, ko git c trng/ u trng (lp li iu tr 2-3 tun)

1/ Pamoat pyrantel 2/ Mebendazol (Vermox) 3/ Albendazol (Zentel) 4/ Flubendazol (Fluvermal) iu tr tp th

1/ Pamoat pyrantel 2/ Mebendazol (Vermox, Fugacar) 3/ Albendazol (Zentel) 4/ Flubendazol (Fluvermal) 5/ Bephenium hydroxynaphtoat (Alcopar)

1/ Mebendazol (Vermox, Fugacar) 2/ Albendazol (Zentel) 3/ Flubendazol (Fluvermal)

1/ Da: da sn , nga, nhng vng u trng i qua ni my ay, nga ngy 2/ Phi: - ho khan, ko di; - cn suyn, ti pht nhiu ln/ ngy - bch cu toan tnh tng cao 3/ Rut: - vim t trng, au vng thng v, - tiu chy + to bn, phn lng 1/ tm u trng trong phn, xt nghim ngay (pb u trng giun mc) 2/ PP Baernann 3/ Ht dch t trng 4/ tm khng th trong huyt thanh ng. bnh 1/ Thiabendazol (Mintezol) 2/ Albendazol (Zentel) 3/ Ivermectin (Stromectol)

Tn v Tn khoa hc

Hnh th v chc nng (hnh v)

Giun xon Trichinella spiralis - mu trng c - c: ui hi cong, ko c gai giao hp, c 2 th ph hnh nn giao hp - ci: phi - u trng ch cht khi un si khong 30 pht

Giun ch - ging si ch mm, mu trng c - c: 2 gai giao hp di, khng u - ci: di hn c, phi, bc bi 1 bao Giun ch Bancroft Giun ch M lai Wuchereria Bancrofti Brugia malayi - c + ci: v ngoi lng, - phi: bao ngn hn, rt n sng cun vo nhau mu; thn un o ko u n; - phi: ui nhn, thn un ht nhim sc i n gn mt o u n; ht nhim sc ui; ui c ch phnh nh th khng i n mt ui

u trng di chuyn da - A. braziliense: ming c 2 cp rng hnh mc - A. caninum: ming c 3 cp rng hnh mc

u trng di chuyn ni tng - T. canis

Chu trnh pht trin ng ly nhim Th ly nhim Th pht tn ra MT Ni sng chnh Ni sng ph (lc ch) Bnh hc (triu chng)

- phi kn cha u trng - phi xut hin trong mu ngoi bin vo ban m - u trng giun xon - ng tiu ha - phi cha u trng - rut non - c, mu 3 giai on: 1/ G/ vim rut: - tiu chy nhiu, au bng, nhc u, bun nn, st cao lin tc (ch c giun xon) 2/ G/ ton pht: - ph mt, m mt, c - d ng: da nga ngy, ni mn, c nt - qua rui, mui - mui Culex v Anopheles - phi cha u trng - qua da nhng - ng tiu ha - mui Anopheles v Mansonia khng vo mch mu - u trng c thc - u trng qun hnh ng - di da - gan, phi, mt, no - st nh, ko di, bing n, st cn, ri lon tiu ha - ho khc ra m, bch cu toan tnh tng, kh th - da ni , my ay, nga - gan to cng, khng au 10

- giun trng thnh: sng m - giun ci: sng h bch huyt hay m - h tun hon - c th k sinh ngoi ngi - ch k sinh ngi (kh, ch mo) - vim cc b - ch yu gy ph voi chn - tc nghn mch bch huyt - gy x cng, ph i m 1/ Thi k nung: ko r rt 2/ Thi k khi pht: - mi mt chi, au nch, hng, bi, tinh hon - st nh (38.50C), ni ban, nga, au khp xng

- da c vt sn , nga ngy, mng nc, ni mn - u trng A. caninum vo mt to ht

3/ G/ u trng thnh kn: au c, khp xng, nhai kh, th kh, st gim, d ng gim

3/ Thi k ton pht: - vim hch bch huyt 4/ Thi k mn tnh (di chng): tc mch bch huyt, gy hin tng ph voi b phn sinh dc, v, tay chn 1/ Lm sng: - tng nhanh bch cu toan tnh, xut hin d dng 2/ Xt nghim: - PP tt nht: ly mu ngoi bin v m - t phi: PP Harris - Tm phi trong nc tiu - Phn ng huyt thanh hc (min dch in di, min dch men, min dch hunh quang) 1/ Lm sng 2/ Da vo dch t c tip xc vi t nhim phn ch, mo 1/ bch cu toan tnh tng rt cao 2/ -globulin tng cao 3/ Lm sinh thit tm u trng m 4/ PP huyt thanh hc: min dch in di, min dch hunh quang, min dch men ELISA (c hiu hn c) 1/ Thiabendazol (Mintezol) 2/ Albendazol (Zentel) 3/ Mebendazol (Vermox)

Chn on

1/ G/ khi pht: - tm trong phn 2/ G/ ton pht: - xt nghim mu: tm u trng, s lng bch cu toan tnh tng nhanh - xt nghim gin tip: phn ng khng nguyn khng th; min dch in di; ngng kt hng cu 3/ G/ thnh kn: - lm sinh thit c, xem KHV (u trng trong kn) 1/ Thiabendazol (Mintezol) 2/ Albendazol (Zentel) 3/ Mebendazol (Vermox)

1/ Diethylcarbamazin (Notzine, Hetrazan) 2/ Ivermectin (Stromectol) + Albendazol

iu tr

1/ Thiabendazol (Mintezol) 2/ Albendazol (Zentel) 3/ Flubendazol (Fluvermal) 4/ Ivermectin

D phng

- ung Notezine

11

Tn v Tn khoa hc

Sn l Flukes

Sn l gan ln Fasciola hepatica

Sn l gan nh Clonorchis sinensis

Sn l rut (to nht) Fasciolopsis buski

Sn l phi Paragonimus westermani - l sinh dc sau. - thn mp, mu nu/ , mt bng dp, mt lng li - tinh hon t phn nhnh - bung trng to, chia thy - trng: hnh bu dc, nu sm; c np bng, t li - trong nang trng: c 2 sn v 1 dch m

Hnh th v chc nng (hnh v)

Chu trnh pht trin ng ly nhim Th ly nhim Th pht tn ra MT Ni sng chnh Ni sng ph (lc ch) u trng ui bin thnh nang trng K ch trung gian

- thn dp, hnh chic l, c a ht, khng phn on, khng c ng tiu ha hon chnh, khng c hu mn. - l sinh dc trc a ht bng - bc bi tiu b - c th hnh nn pha - thn mu nht - thn dy, mu nu/ - lp c: u. - ng tiu ha khng xm + c vng ngoi, - thn dy, mu trng/ phn nhnh - khng c th hnh + c cho gia, xm - 2 tinh hon phn nn u + c dc trong - manh trng, tinh hon, nhnh t, nm trn - manh trng khng bung trng phn nhnh di phn nhnh co gin theo 3 chiu nhiu - trng: hnh bu dc, - bung trng, tinh - c 2 a ht: a ht - trng: hnh bu dc, c hi phnh gia, c np, hon phn nhnh nhiu ming v a ht bng np, v dy mu nu c 1 gai nh i din - trng: hnh bu dc, - khng c c quan h np. mu nu sm, c np, hp v tun hon - trng c phi lc mi hi phnh gia - thng lng tnh sinh - TB non phng chit - non phng: ni trng quang nhiu hn c to thnh - t cung: ni cha trng - trng c np - trng u trng bo t nang redia nang trng sn l trng thnh - ng tiu ha - nang trng - trng c np - ng dn mt, rut, phi

- vo t trng: nang trng thnh sn non

- ng dn mt ca gia sc v ca ngi - gan - thc vt thy sinh - c Limnea

- trng c phi, c np - ng dn mt

- trng c np - rut non

- ph qun (phi) - di da, xoang bng, gan, tinh hon, no - cua/ tp - c Melania 12

- c h Cyprinidae - c Bithynia - c h Cyprinidae

- thc vt thy sinh - c Planorbis

Bnh hc (triu chng)

1/ Thi k xm nhp ( gan): gan to, cng, s thy au - st bt thng, ni mn, au bng, bing n, bun nn; bch cu toan tnh tng nhanh 2/ Thi k ton pht ( ng dn mt): to bn + tiu chy, vng da, gy, thiu mu; bch cu toan tnh gim (cn 5-10%) 1/ Thi k xm nhp: - Tm trng trong phn - Phn ng huyt thanh 2/ Thi k ton pht: - xt nghim phn/ dch t trng tm trng. - trng t: PP phong ph ha 1/ 2-dehydro emetin 2/ Bithionol (Bitin, Actamer) 3/ Triclabendazol (Fasinex)

1/ G/ khi pht: - ri lon d dy, chn n, bun nn, tiu chy + to bn - bch cu toan tnh tng 2/ G/ ton pht: - thiu mu, gy, ph n chi di, c trng - gan to r rt, s au - tc ng mt, vng da

1/ G/ khi pht: - ho c m ln mu, - nhiu: mi mt, xanh m mu g st xao, suy nhc 2/ G/ ton pht: - au bng vng h v, tiu chy, phn lng ko c mu nhng nhy, vng nht, rt hi - bng b trng - bch cu toan tnh tng - nhiu: tc rut, ph n - xt nghim phn tm trng 1/ xt nghim m tm trng khng nhum 2/ xt nghim phn tm trng 3/ Phn ng huyt thanh hc (dng cho tr em) 4/ Siu m, CT scan 1/ Niclofolan (Bilevon) 2/ Bithionol (Bitin, Actamer) 3/ Praziquantel (Biltricide)

- tm trng trong phn hay trong dch t trng

Chn on

iu tr

1/ Bithionol (Bitin) 2/ Cloxyl 3/ Praziquantel (Biltricide) - Opisthorchis viverrini nguy him hn, c th gy ung th gan

1/ Niclosamid (Trdmine, Yomesan) 2/ Praziquantel (Biltricide) 3/ Ht cau, sc ung

D phng

13

Tn v Tn khoa hc Hnh th v chc nng (scan hnh /149)

Sn dy ln Sn dy b Toenia solium Toenia saginata - chung: u c u, c v t - 1 ngi ch cha 1 con - u: khng c chy v - u: 4 a ht trn, 1 mc; c 4 a ht hnh chy ngn; chn chy bu dc c 2 hng mc. - t gi: rng tng t, - t gi: khng t ng ri nhau, c kh nng b b ra ngoi ra ngoi - l sinh dc: bn hng - l sinh dc: bn hng, v xen k tng i u. xen k khng u - trng: hnh cu, v - trng: hnh bu dc mu nu sm v c tia - trng cha phi nang u trng sn

Sn dy c (di nht) Diphyllobothrium latum - u: hnh bu dc, khng c a ht, khng c mc; ch c 2 rnh ht su v di - t gi: khng tch ri khi thn - l sinh dc: nm gia t - trng: hnh bu dc, mu nu, c np; khng c phi lc sinh ra - trng ko phi trng c phi 6 mc u trng procercoid u trng plrocercoid sn - u trng plrocercoid - trng khng phi - rut - gip xc h Cyclops - c

Sn dy ch Dipylidium caninum - u: 4 a ht hnh chn; chy c 3-4 hng mc - t gi: mang trng hnh ht da leo - l sinh dc: c 2 bn - trng: hnh cu, 6 mc, kt dnh thnh tng m

Sn dy ln Hymenolepis nana - u: 1 chy ch c 1 hng mc - l sinh dc: bn tri - trng: hnh bu dc, v dy, trong sut, c phi 6 mc

Chu trnh pht trin

- trng nang u trng c ui sn - n thc n cha b cht - nang u trng - trng cha phi 6 mc - rut non - b cht ch, mo

- trng nang u trng c ui sn - trc tip t tiu ha/ n bnh m nng ko chn - trng cha phi 6 mc - rut non

ng ly nhim Th ly nhim Th pht tn ra MT Ni sng chnh K ch trung gian

- ng tiu ha - nang u trng - trng cha phi 6 mc - rut non - ln - nang u trng - trng cha phi - rut - b

Bnh hc (triu chng) 1/ ri lon tiu ha: bun nn, tiu chy + to bn 2/ ri lon thn kinh: nhc u, mt ng, suy nhc TK 3/ ri lon gic quan: nhn m, tai 4/ ri lon tim mch: nh trng ngc, au trc pha tim, ngoi tm thu 5/ ri lon h hp: ho c cn, kh th. 6/ ri lon da: nga ngy, ni m ay. Chn on 1/ xem phn bng mt: coi t sn; bng knh hin vi: coi trng sn 2/ PP Graham (ging tm trng giun kim) iu tr 1/ Niclosamid (Trdmine, Yomesan) 3/ Ht b (b ng): n sng/ rang chn 2/ Praziquantel 4/ Ht cau: sc nc ung

1/ Niclosamid 2/ Praziquantel 14

Tn v Tn khoa hc

Hnh th v chc nng

Sn mng Cysticercus cellulosae Schistosoma (u trng sn dy ln) - c: mu trng c, phn thn trc hnh tr, phn - u: 4 a ht; chy thn cn li dp; 2 mp thn cong li to 1 rnh mang hng mc hnh mng, cha con ci - trng: c 1 ca bn hng/ mt ui, khng c np S. haematobium S.mansoni S.japonicum - on manh - on manh - on manh trng ngn hn trng di hn trng di hn thn thn thn - c: 4-5 tinh - c: 8-9 tinh - c: 6-8 tinh hon hon hon - trng: c ca - trng: c ca - trng: c ca mt ui, thi bn hng, thi bn hng, cn, theo nc tiu theo phn thi theo phn

Hydatid (u trng sn dy nh) Echinococcus Echinococcus granulosus multilocularis

Sparganu m

- u: 1 chy li, 2 - kch thc nh hng mc, 3-4 t hn - u trng sau 5 thng ln hn sn trng thnh c trm ln: + 1 v bc ngoi, c vn, dy, trng c, khng c nhn + 1 mng sinh mm mng gm nhiu TB c nhn + nang sinh mm

Chu trnh pht trin ng ly nhim Th ly nhim Th pht tn ra MT Ni sng chnh Ni sng ph (lc ch)

- trng u trng lng bo t nang u trng ui ch 2 sn - khng c g/ redia hay nang trng - qua da - u trng ui - trng cha u trng lng - tnh mch ca tnh mch lch, bng quang

- n ung - trng c phi - t nhim

- n ung - trng c phi 6 mc (phi c bu) - gan (70%) - trng

- n Cyclops

- tnh mch ca - tnh mch - c, m di da m ri tnh ca ng mch mch mc treo phi trng di - mt, no, tim, gan, phi, thn

- gan

- rut non ch, mo

- phi (15%), thn, lch,

- phi, no 15

K ch trung gian

- c Bullinus

- c Planorbis

- c Oncomelania 1/ c: nhc mi, st cn, cu gt 2/ m di da: nt nh di ng, khng au 3/ mt: ri lon th gic 4/ c tim: nhp tim p nhanh, kh th, ngt xu 5/ no: nhc u, chng mt, cu knh, ng kinh, lit

- loi gm nhm nh, chut ng 1/ gan: xut hin 1 - Nang nhiu l nang to dn, s ko au ging t ong 2/ phi: khc ra mu, ho lin tc, c th to p xe phi 3/ no: tng p lc trong s, gy ng kinh 4/ thn: suy nhc chc nng 1/ C 1 bu lnh ang - PP min dch tin trin hc 2/ Chp hnh gan bng pp ng v phng x 3/ Chp X quang 4/ Phn ng min dch 5/ K thut siu m: pht hin nang sn 1/ M ly nang 2/ Bm formol 10% hay cetrimid: dit u sn v mng sinh mm 3/ Albendazol 1/ Gii phu loi b nang 2/ Albendazol (KST khng vi Praziquantel) - Rch v gp ra - nh, gy au, nga - vo mt gy vim lot gic mc, vim dy TK th gic

Bnh hc (triu chng)

1/ Tm trng trong phn 2/ Tm trng trong cn nc tiu (S.haematobium) 3/ Tm trng trong m khi sinh thit trc trng 4/ PP huyt thanh hc Chn on

1/ Tm nang u trng qua sinh thit, X quang 2/ PP min dch ELISA

iu tr

1/ Niridazol (Ambilhar) S.haematobium 2/ Oxamniquin (Vansil) S.mansoni 3/ Metrifonat (Bilarcil) S.haematobium 4/ Oltipraz S.mansoni & S.haematobium 5/ Praziquantel (tt c)

1/ Phu thut 2/ Praziquantel 3/ Albendazol (Zentel)

16

TIT TC (Arthropoda)
1. Ngnh ph th bng mang: lp Gip xc (tm, cua) 2. Ngnh ph th bng kh qun: a. Lp Nhn, B Ve mt (Acarina) i. Ci gh ii. Ve iii. Mt b. Lp cn trng i. Bin i hnh thi hon ton: 1. B 2 cnh (Diptera): Rui, mui 2. B khng cnh (b B cht Siphonaptera): a. Ch c lng t: i. Pulex irritans (sng ngi): 1 lng t trc mt v 1 lng t sau u ii. Xenopsylla cheopis (sng chut): 1 lng t trc mt, nhiu lng t sau u; chn cc lng t xp hnh ch V. b. Ch c lc: i. Ceratophyllus fasciatus = Nosophyllus fasciatus (sng chut): ch c 1 lc ngc trc ii. Ctenocephalides canis (sng ch): c 2 lc: 1 ngc trc, 1 gn ming ii. Bin i hnh thi khng hon ton: 1. B khng cnh (Anoploura) a. Chy (Pediculus humanus) b. Rn (Phthirus inguinalis) 2. B 4 cnh na (Hemiptera): Rp (Cimex lectularius)

17

Tn v Tn khoa hc

Hnh th v chc nng

Ci gh (nh) Sarcoptes scabiei - thn: hnh bu dc, mu xm, v bc ngoi c ln song song nhau; th qua da - 4 cp chn: 2 cp trc nm hn v trc thn; 2 cp sau nm ng sau thn - c: 2 cp chn sau mang a ht - ci: cp chn th 3 mang a ht, cp chn th 4 tn cng bng lng t di - u gi rt ngn, ko c mt, ch c 2 cu hnh kp

Ve - thn: hnh bu dc, khng c lng/ lng ngn - c l th gia hay sau thn - c chy gm: + 1 h khu pha bng + 2 cu pha lng + 2 tc xc hnh chy - u trng: 3 cp chn; 1 chy mt u; bn chn ht th s - b phn ming nh ra v c rng H Ixodidae H Argasidae - ve cng, chy mt u, mai lng - ve mm, chy nm di - chn tn cng bng bn chn ht bng, khng l ra ngoi - Chy ngn, rnh bc hu mn pha - khng c mai trn lng sau hu mn: - khng c bn chn ht + chn chy hnh 6 gc: Rhipicephalus + Argas: thn gy, dp, lng, + chn chy hnh ch nht: Dermacentor c 1 ln phn chia r rt lng - Chy di, rnh hu mn nm pha v bng trc hu mn: Ixodes + Ornithodorus: thn mp, sn si, khng c ln phn chia r rt bng v lng - trng u trng 3 cp chn nhng 4 cp chn ve - trn th, ngi - bnh st pht ban (st m xut huyt): do Dermacentor gy nn - bnh st ni mn (st nt): do Rhipicephalus gy nn - bnh t lit do ve ( tr em) - Phng nga: bi Butyl hexachlorid - bnh st hi quy: do Ornithodorus truyn xon khun Borrelia duttoni

Mt (m) - thn: ph y lng t, mu vng cam/ , c hnh s 8 - u trng: hnh bu dc, 3 cp chn - b phn ming n, khng c rng

Chu trnh pht trin ng ly nhim Ni sng chnh Bnh hc (triu chng)

- trng u trng 6 chn nhng 8 chn ci gh - qua da - ni da mng, c np nhn, khng c mt - nga, thng v m - c nhng ng hm c trng trong biu b, nt nh li ti 1/ Thuc m c lu hunh 2/ dd benzoat-benzyl (Ascabiol) 3/ Lindan 1% trn bt hot thch 4/ Pyrethrinoid (Sprgal) 5/ Crotamiton (Eurax)

- bnh st pht ban bi hoang do u trng Trombicula akamushi truyn Rickettsia orientalis

iu tr

18

Tn v Tn khoa hc

B 2 cnh (Diptera) - 2 cnh trc th mng, 2 cnh sau thay th bng con lc - gm 2 b ph da vo s t ca ru: + B ph ru ngn (Brachycera): ru di 3 t; thn mp; cnh rng; mt kp, rt n nang, thng dnh lin nhau con c. + B ph ru di (Nematocera): ru trn 3 t; thn mnh khnh; cnh di, hp; mt t n nang Rui (B ph ru ngn) Mui 1/ Ging rui chch v - c nhng vy nh ht mu: rui tru - c: ru c lng t di v rm; ht nha cy (Tabanidae) - ci: ru c lng tha v ngn; ht mu - c 1 vi chch - mi di v mi trn: un cong thnh vi - ngc en, c rch vng, - 2 hm trn v 2 hm di: xuyn thng da bng mu vng Mui ci trng cn 3 k: nng (25-30oC), m t v ht mu - c: 2 mt dnh lin; - Mui thch mu en, xanh bin, ht dch ca hoa - Mu trng, vng: t li cun mui - ci: 2 mt cch xa; ht Ph h Anophelinae Ph h Culicinae mu sc vt (ging Anopheles mui Ging Culex Ging Aedes (mui vn/ Ging Mansonia 2/ Ging rui ko chch: n sc) mui m) - rui nh (Musca - u xin, mu en ton - u song song, mu nu - u song song, nh, mu - gn ging domestica) thn, cnh c m en trng nht/ nu sm en nu, c m trng bc Culex - mi trn v thng yt - c: xc bin hm di hn chn - thn vng nu/ - xc bin hm di vi hu ngn - bng mui: c bng nu - c: xc bin hm phnh ra vi - mi di hnh vi mm 2 u ging ci bay - ci: xc bin hm di ngang, mu trng - chn v thn c - khng c hm trn hay khong 1/3 vi - c: ging Culex m, vy cnh to, - ci: xc bin hm sun hm di; ch c xc bin - trng: ring l, c 2 phao - u trng c ng th di v - ci: ging Culex c ch m ch hm hp t p cht - ui nhn lt 2 bn hng. - nhiu lng ngn - ng th u trng ngn v - u trng: ko c ng th; ch - ui cn rng hn Culex c 2 l th t p cht bng - trng u trng nhng - trng u trng (b gy, lng qung) nhng mui rui - bnh giun ch Loa loa: - bnh giun ch Bancroft: do - bnh st xut huyt: do - bnh giun ch do ging rui Chrysops Culex quinquefasciatus Aedes aegypti truyn M Lai: do - bnh ng Phi chu: do - bnh vim no Nht Bn B virus Dengue Mansonia ging rui Glossinia do Culex tritaeniorhynchus truyn Trypanosoma - bnh gii rui 19

Hnh th v chc nng

Chu trnh pht trin Bnh hc (triu chng)

Tn v Tn khoa hc

B cht

Hnh th v chc nng

Ni k sinh Chu trnh pht trin

Bnh hc (triu chng)

iu tr

- u nh so vi ngc, khng c cnh; 3 cp chn, cp cui di v khe nht, gip nhy xa - bng 10 t - c: dng vt v pha cui t cht - ci: c ti cha tinh trng - u trng: hnh con su, c 1 sng u - c gai chitin c hnh lng t hay hnh lc u hay ngc - ngoi k sinh trng - trng u trng nhng b cht - bnh dch hch: do VK - bnh st pht ban, st hi quy Yersinia pestis = Pasteurella pestis gy ra 1/ Th ni hch (thng gp nht): chng mt, nng lnh, i ma; c hch hng, nch, m rt hi v nhiu VK 2/ Dch hch phi: lan truyn ngi qua ngi bi nc bt; st nng, kh th, tc ngc, ho ra m mu; gan v lch to, ph phi cp 3/ Nhim khun huyt (dch hch en): b st, i ma, m man, xut huyt 1/ Streptomycin 1/ Pyrethrin + Butoxyd piperonil: 2/ Tetracyclin a/ Neopyramin (Lenpoucid) 3/ Sulfamid (Sulfadiazin, b/ Sumithrin (Parasidose) Sulfadoxin) c/ Bioallethrin (Parapoux)

Chy Pediculus humanus - thn di, ngc hp hn bng, phn chia r rt vi bng. - sng trn u v sng trong mnh - sng trn u: mu xm, ch yu tc - sng thn: mu trng bn, ln hn - trng: hnh bu dc, c np, dnh 1 cc vo lng/ tc nh 1 cht nha - u v thn

Rn Phthirus inguinalis - thn thun li, ngc ln hn bng, khng phn chia r rt - u: tng i ngn v nm trong lm ca ngc - chn: c mng di v khe, cong li

Rp Cimex lectularius - mu nu, mp b ngang - u: nh, tht vo 1 lm ngc trc - 2 mt to, 2 ru ln - ngc trc: lm pha di, n ngang, vnh 2 bn - ngc gia: c 1 cp cnh rt nh, hnh bu dc - c: 1 gai giao hp cong ln - ci: 2 l sinh dc - nc bt ca rp rt c - trng u trng rp

- vng lng b phn sinh dc - khng truyn bnh, ch xut hin nt nh, rt nga - c mn c 1 qung xung quanh, rt nga

20

VI NM HC
- Da vo phng thc sinh sn hu tnh: 4 lp 1. Bng trng, si t nm thng sut: Nm to (Phycomyctes) 2. Bng ti, si nm c ngn: Nm ti (Ascomyctes) 3. Bng m, si nm c ngn: Nm m (Basidiomyctes) 4. Khng c b phn sinh sn hu tnh: Nm khuyt (Adlomyctes) - Da vo bnh hc: 1. Bnh nm ngoi bin 2. Bnh nm da 3. Bnh nm di da 4. Bnh nm ni tng 5. Bnh nm c hi 6. Bnh c t nm

1. Nm men gy bnh: a. Candida spp. (vi nm a hnh) b. Cryptococcus neoformans (nm men c nang) c. Malassezia spp. (nm men a cht bo) 2. Nm da (Dermatophytes): nm a keratin thuc h Gymnoasceceae, 3 chi: Trichophyton, Microsporum v Epidermophyton. 3. Nm lng hnh: 2 dng hnh th: dng nm si v dng nm men a. Sporothrix schenckii b. Penicillium marneffei c. Histoplasma capsulatum 4. Nm mc gy bnh: a. Hyalohyphomycetes: si nm khng mu, c vch ngn: Aspergillus spp., Fusarium spp. b. Zygomycetes: si nm khng mu, khng vch ngn c. Phaeohyphomycetes: si nm c mu 5. Nm si mu (Dematiaceous fungi) a. C dng nm men: i. Nm men: Phaeoannellomyces, Phaeococcomyces, Aureobasidium, Hormonema. ii. Giai on u ging nm men: Exophiala, Wangiella dermatiditis b. Thuc nm si: i. Cung bo t dng ghp hnh sim: 1. Bo t nh ln: vch ngn nm ngang hay vch ngn dng muriform 2. Bo t nh nh: ii. Sn xut th bnh: Phialophora, Phaeoacremonium iii. Bo t nh nh hp thnh chui: Cladosporium, Cladophialophora. iv. Cu trc sinh sn phc tp: Chaetonium 21

Tn v Tn khoa hc

Candida spp. (Candida albicans) - c th to thnh bo t bao dy (chit quang)

Cryptococcus neoformans - nm men c nang (v bc bng polysaccharid) - hnh cu/ bu dc, sinh sn bng ny chi/ bo t m - khng ln men, ng ha inositol - sn xut ure, phn ng vi xanh diazonium B - thnh phn polysaccarid: glucuroxylomanman v mannoprotein

c im v chc nng

Nm da Dermatophytes - nm men a cht bo - 2 g/ sinh sn: sinh sn v tnh v hu tnh - mu kem, trn nhn + tn gi g/ ss hu tnh ca: - hnh cu/ bu dc/ tr Microsporum: Nannizzia - sinh sn bng ny chi 1 Trichophyton: Arthroderma cc trn y rng - thuc nm si, c vch ngn, phn nhnh - sinh sn a chi khng - a s ss v tnh bng bo t nh ln hay bo xy ra t nh nh - c im bo t nh ln: + Microsporum: hnh thoi, vch dy, nhn, c gai mn. + Trichophyton: vch mng, trn + Epidermophyton: vch trn, hnh chy, khng c bo t nh nh

Malassezia spp.

Yu t lin quan n c lc

Chu trnh pht trin

ng ly nhim

1/ kt dnh vo m nh tng tc receptor ligand; lc VanderWalls, lc tnh in 2/ vi nm lng hnh 3/ tnh k nc b mt TB do s glycosyl ha mannoprotein 4/ bo t chi thn nc 5/ cc enzym bo v chng li khng th - TB men hnh cu bo t chi dng si nm gi ngn v di si nm - ngun ly nhim chnh: ngun ni sinh - K cn: suy gim hng ro bo v ca k ch - t vt dng b nhim - t ngi sang ngi - t m sang con

- k ch khng nh: i bch bo ph nang; TB thc bo, TB T v B 1/ kh nng pht trin 37oC 2/ kh nng ti to nang polysaccarid dy 3/ sinh tng hp melanin

- ng h hp

22

Th ly nhim Ni sng chnh Ni sng ph (lc ch) K ch trung gian - sng hoi sinh c quan tiu ha - ming, m o, niu o, da v di mng 1/ ming hu: - vim cc b phn ming, xut hin cc m trng thnh mng trng mm d trc, au hng 2/ Thc qun v rut: - lot mng nhy c/ ko c mng gi - tiu chy, phn c mu - si bng, nga hu mn, hu mn au khi i tin 3/ m h - m o: - nga, rt bng, sng m h, ra huyt trng c nh sa, khng c mi hi, nhiu mng trng 4/ da v nim mc: - mn khng c b r rt, mng ban chy nc mng m 5/ Nm mng v vim quanh mng: - mng tr nn c, sn si, b mt nu nht, phn mm sng , au, d chy m trng

- TB nm men mt nang - phi - da, h thn kinh - phn b cu 1/ Th phi nguyn pht: - ho, au ngc, st nh, khc m c mu, mt mi, st cn 2/ H TK trung ng: - nhc u, st, kch thch mng no, ri lon th gic 3/ Da: - nt nh, ko au - bu, ung lot, ban xut huyt 3/ Xng: - vim ty xng, vim khp, c th khng triu chng

- sng hoi sinh da

- da, tc, mng

Bnh hc (triu chng)

1/ bnh lang ben: - m da b i mu, nht mu hn/ nu nht 2/ vim tng tit b: - mng , ng vy, nga 3/ gu: - bong vy da u, nga 4/ vim nang lng: - rt nga nht l lc m hi/ tm; mn nc, mn m nang lng 5/ nhim trng mu: - st, tng bch cu, gim tiu cu - kh th, nhp tim chm, ng lm, xanh tm, nhp th nhanh/ lch to

1/ Bnh da nhn: - hc lo: thng tn hnh vng lan rng, b hi g cao c vy, mn rp, gia c mu lt - vy rng: do T. concentricum mc 1 im ri lan dn c thn tr mt v u; da khng vim nhng trc vy to nhiu vng trn ng tm 2/ Nm bn: (ch yu nam): - ni mn, ban , b bong vy, rt nga; - thng tn i xng 2 bn bn, lan xung i: do E.floccosum gy ra - 2 mng bn ko i xng, lan xung mng: do T. rubrum v T. mentagrophytes 3/ Nm chn: k chn trc vy nh, chy nc v nga, ni mn nc lng bn chn: do T. mentagrophytes gy ra 4/ Nm mng: 2 dng - t b mng, 2 ra mng, mng dy v cong: do T. rubrum - t mt trn mng: do T. mentagrophytes 5/ Nm tc: - kiu ni pht (bo t nm trong thn tc): tc gy rng ngang mc vy da, ban , bong vy da - kiu ngoi pht (bo t nm bao quanh tc): tc gy rng cch da u vi mm, da u vim - favus: do T.schoenleinii: tc rng, ng vy cng/ vy cm xung quanh tc, vy da u hi mi chut 23

6/ m su: - bnh Candida mu: + gia tng c nh ca Candida spp. + thay i tnh nguyn vn ca nim mc + suy gim min dch ti ch - bnh Candida lan ta ( ngi ung th mu) 1/ Lm sng: cc bnh da v nim mc 2/ Xt nghim: mng trng trong ming, bt mng, huyt trng, mu, a/ Coi knh hin vi (trong nc mui sinh l) b/ Ly trch 3/ PP huyt thanh - Ung: itraconazol v fluconazol - Ngm/ Bi: nystatin, clotrimazol, amphotericin B - Tm vi nm trong m, dch ra ph qun, ph nang/ dch no ty 1/ Nhum mc tu xem 2/ Ly tm - Cy vo MT Sabouraud cloramphenicol xem KHV 3/ PP huyt thanh: dng th nghim Latex 1/ Phi: - Amphotericin B - Fluconazol 2/ No: - Amphotericin B+flucytosin - Fluconazol 1/ quan st bng mt 2/ co vy da, dng dd KOH 20%/ dng bng keo trong dnh da, coi KHV 3/ cy mu v nh danh nm 1/ Xt nghim trc tip - ly vy pht KOH 10-20%, quan st KHV 2/ Cy (MT Sabouraud c cloramphenicol v cycloheximid) quan st

Chn on

iu tr

1/ Bi: selenium sulfid; ketoconazol; miconazol 2/ Ung: Itraconazol hay fluconazol 3/ Nhim trng huyt: tim tnh mch amphotericin B

1/ Bnh da nhn, nm bn, nm chn: bi - dd BSI (acid benzoic, acid salicylic, iod) - dn xut imidazol: miconazol, clotrimazol, ketoconazol - Ung: Griseofulvin/ Terbinafin/ Itraconazol/ Fluconazol 2/ Chc u, nm mc: ung nh trn

24

Tn v Tn khoa hc

c im v chc nng

Sporothrix schenckii (sng hoi sinh) - dng si: trng bn, trn/ nhn; bo t hnh git nc, dng chy - dng nm men: trng vng kem; TB hnh iu xig, sinh sn bng ny chi - ht, tip xc trc tip bo t - dng nm men - bo t nh nh (dng nm si) - sng hoi sinh 1/ Th da mch bch huyt (bnh mn tnh): t nt - tm en, mm, m st vng, lan theo mch bch huyt 2/ Th da c nh: - vt lot ht v tr tip xc (mt); nt v tinh mng m xung quanh 3/ Th lan ta: - cc u nh, cng, t khi lot 4/ Th nguyn pht phi (do ht bo t): ni hch

Nm lng hnh Penicillium marneffei - gy bnh mn tnh -

ng ly nhim Th ly nhim Th pht tn ra MT Ni sng chnh Bnh hc (triu chng)

- bo t - bo t

Histoplasma capsulatum - ht men nh trong cc TB, i thc bo, bch cu n nhn to - bo t nh nh: hnh trn/ git nc trn 1 bo i ngn - bo t nh ln: to, v c gai/ hnh trn, nhiu cc u nh trn b mt - ht (khng ly trc tip ngi sang ngi) - bo t

Nm mc gy bnh (sng ngoi sinh) Aspergillus spp. Fusarium spp. Zygomycetes (A. fumigatus) - ko mu, c vch ngn, - pht trin MT - a nhit, pht trin phn nhnh. khng cha t0 > 370C - nhiu bo t trn 1 cycloheximid cung bo t di, thng - bo t ln: hnh ng, mc ln t TB thoi gc - bo t nh: bu - u mang bo t gm: dc bo t, th bnh, bng, cung bo t - ht - ht

- bo t - t, phn di, phn chim b cu, 1/ X nhim phi: - au ngc, khn c, mt mi, st va, au bp tht, au khp xng 2/ Bnh phi mn tnh: - ho khc m c mu, kh th, st, suy h hp 3/ Dng lan ta: - ni hch ton thn, gan lch to, tn thng xng, ty, h TK, tim, mt, thn

- bo t

- bo t

- st, chn n, - gim bch cu, gim tiu cu - st cn, tiu chy, gan lch to - vim hch bch huyt - da: xut hin cc mn nc c rn trung tm

1/ cung phi d ng, vim xoang mi, cun nm, hen suyn 2/ vim gic mc, ni nhn: bt u l 1 cc nh hi g cao, trng xm, xung quanh c 1 vng rng xm nht - au nhc mt, vt lot, d bc thnh tng mng, lot p xe 3/ vim ng tai ngoi 4/ vim c tim v mng trong tim ( van M ch, van 2 l)

1/ vim gic mc, nm da, nm mng 2/ ngi suy gim min dch: st ko di, vim cc c quan - cy mu dng tnh

1/ nhim nm xoang mi 2/ vim phi 3/ nhim nm lan ta 4/ vim da 5/ vim mng bng 6/ vim 1 s c quan khc

25

5/ st ko di: 38oC trong 5-7 ngy 3/ ho, kh th, ho ra mu, au ngc 4/ xoang, gan, h TK trung ng: c vn 5/ chp X quang: c nt hay p xe 1/ Quan st trc tip: ht men di hnh iu xg, th sao nhiu cnh 2/ Cy (MT Sabouraud; thch BHI hay thch mu) coi KHV 3/ Gy nhim trn th: TB men bt mu Gram (+), di nh iu x g 1/ Lm sinh thit mu, da nhum PAS hay May Grunwald Giemsa 2/ Cy MT Sabouraud coi KHV 3/ Min dch khuyt tn 1/ Lm sng: X quang ging nh lao 2/ Phn ng ni b vi Histoplasmin (+) 3/ Xt nghim: - coi vt lot, nhum hay vi phu (ging ct 2) - Cy MT Sabouraud 1/ Quan st trc tip m 2/ Cy, ly trch t m/ cy mu m tnh vi cc VK gy bnh 3/ Trc nghim da vi khng nguyn 4/ PP huyt thanh hc 5/ Th nghim tm khng th/ khng nguyn 6/ Phn ng PCR 1/ Lm sng 2/ Chp X quang 3/ Ly trch, sinh thit m 1/ Xt nghim trc tip: m, dch mi, dch ra ph nang, m 2/ Cy

Chn on

iu tr

1/ Th da: - dd KI bo ha - Itraconazol - Fluconazol 2/ Phi: - Itraconazol: nh - Amphotericin B: nng 3/ Xng khp: nh phi

1/ Amphotericin B (+ flucytosin) 2/ Itraconazol hay ketoconazol

1/ Amphotericin B: tim nh git vo tnh mch 2/ Itraconazol

1/ Bnh d ng: nh 1/ Amphotericin B - Prednison 2/ Natamycin: vim 2/ Bnh cun nm gic mc phi, vim ni nhn, da: Amphotericin B 3/ Hoi t phi cp: - Amphotericin B + phu thut ct b m 4/ Vim xoang mi: - phu thut ct b - Itraconazol

1/ Cp tnh: Amphotericin B + phu thut 2/ Mn tnh: - KI bo ha - Ketoconazol - Itraconazol 4/ Fluconazol

26

Tn v Tn khoa hc c im v chc nng ng ly nhim Th ly nhim Th pht tn ra MT Ni sng chnh Bnh hc (triu chng) Chn on iu tr

Nm si mu (Dematiaceous fungi) - cho mu ti t oliu, nu n en do sc t dihydroynaphthalen melanin thnh TB

1/ Bnh da v mng: ch nh hng phn m sng ha, mng sm mu, vim quanh mng 2/ Vim gic mc, c th gy m, gp nhiu nam gii 3/ Vim xoang mi d ng, mn tnh hay cun nm trong mi xoang 1/ Quan st trc tip: nhum vi KOH 10-20% hay Giemsa, Schiff, 2/ Cy (MT Sabouraud), thch mu 3/ Chp X quang 1/ Vim gic mc: 2/ Vim xoang mi d ng: - dd natamycin 5% - phu thut + nh nc mui sinh l - Amphotericin B 0.1-1% 3/ Vim xoang mi mn tnh: - Azol: Miconazol, Ketoconazol, Itraconazol, - phu thut + cht khng nm Fluconazol 4/ Cun nm trong mi xoang: - Corticosteroid + cht khng nm - gii phu, khng cn thuc khng nm Ni sng chnh - ht u phng, ht bp, k, h o - ht ng cc, go, rau, tri cy - ru vang, bia, sa Bnh hc 1/ Bnh cp: - Vim gan cp tnh: do n bp: vng da, st nh, suy nhc, chn n, tiu chy, thoi ha cht bo gan - Bnh Kwashiorkor, hi chng Reyes: 2/ Bnh mn tnh: - Ung th gan: aflatoxin B1, t bin gen p53, chuyn G thnh T v tr 3 ca codon 249 - gy c thn v gan - gy bnh gim bch cu (ATA): teo ty xng, mt bch cu ht, vim hng hoi t, xut huyt - nn ma, tiu chy, au bng - m xut huyt da, xoang ming, phnh hch bch huyt - ung th thc qun ngi - ung th gan chut cng, ph phi ln, bnh no nga 27

c t Afatoxin

Nm mc gy bnh - A.flavus, A.parasiticus, A.nomius - Aflatoxin B1, B2, G1 v G2 - Aflatoxin B1: c tnh cao nht - Afatoxin M1 v M2: trong sa b

- A.ochraceus, Penicillium verrucosum - Ochratoxin A th (heo, chut) Trichothecen - Fusarium spp., Trichothecium, Trichoderma, Stachybotrys, Fumonisin - Fusarium moniliforme, F. proliferatum - c ch N-acyltransferase

Ochratoxin

- la mch, ht c ph

- bp v thc phm cha bp

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