{"id":22695,"date":"2023-04-21T23:19:49","date_gmt":"2023-04-21T16:19:49","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=22695"},"modified":"2023-04-21T23:19:49","modified_gmt":"2023-04-21T16:19:49","slug":"viem-mang-nao-tang-bach-cau-ai-toan-huong-dan-chan-doan-dieu-tri","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/21\/viem-mang-nao-tang-bach-cau-ai-toan-huong-dan-chan-doan-dieu-tri\/","title":{"rendered":"Vi\u00eam ma\u0300ng na\u0303o t\u0103ng ba\u0323ch c\u00e2\u0300u a\u0301i toan – H\u01b0\u01a1\u0301ng d\u00e2\u0303n ch\u00e2\u0309n \u0111oa\u0301n, \u0111i\u00ea\u0300u tri\u0323"},"content":{"rendered":"

Vi\u00eam ma\u0300ng na\u0303o t\u0103ng ba\u0323ch c\u00e2\u0300u a\u0301i toan l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd nghi\u00eam tr\u1ecdng \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn h\u1ec7 th\u1ed1ng th\u1ea7n kinh trung \u01b0\u01a1ng c\u1ee7a con ng\u01b0\u1eddi. \u0110\u00e2y la\u0300 m\u1ed9t b\u1ec7nh l\u00fd \u0111\u1eb7c bi\u1ec7t hi\u1ebfm g\u1eb7p, nh\u01b0ng l\u1ea1i c\u00f3 th\u1ec3 g\u00e2y ra nh\u1eefng h\u1eadu qu\u1ea3 nghi\u00eam tr\u1ecdng cho s\u1ee9c kh\u1ecfe v\u00e0 t\u00ednh m\u1ea1ng c\u1ee7a b\u1ec7nh nh\u00e2n. C\u00e1c chuy\u00ean gia y t\u1ebf \u0111ang ti\u1ebfp t\u1ee5c nghi\u00ean c\u1ee9u v\u00e0 ph\u00e1t tri\u1ec3n c\u00e1c ph\u01b0\u01a1ng ph\u00e1p m\u1edbi \u0111\u1ec3 ph\u00f2ng ng\u1eeba v\u00e0 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh vi\u00eam m\u00e0ng n\u00e3o t\u0103ng b\u1ea1ch c\u1ea7u \u00e1i toan hi\u1ec7u qu\u1ea3 h\u01a1n.<\/strong><\/p>\n

1.\u00a0 \u0110a\u0323i c\u01b0\u01a1ng v\u00ea\u0300 vi\u00eam ma\u0300ng na\u0303o t\u0103ng ba\u0323ch c\u00e2\u0300u a\u0301i toan<\/h2>\n

Vi\u00eam m\u00e0ng n\u00e3o (VMN) t\u0103ng b\u1ea1ch c\u1ea7u (BC) \u00e1i toan \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh khi d\u1ecbch n\u00e3o t\u1ee7y c\u00f3 tr\u00ean 10 b\u1ea1ch c\u1ea7u \u00e1i toan\/mm3<\/sup> v\u00e0\/ho\u1eb7c s\u1ed1 BC \u00e1i toan chi\u1ebfm tr\u00ean 10% s\u1ed1 b\u1ea1ch c\u1ea7u trong d\u1ecbch n\u00e3o t\u1ee7y.<\/p>\n

VMN t\u0103ng BC \u00e1i toan nhi\u1ec5m tr\u00f9ng th\u01b0\u1eddng li\u00ean quan \u0111\u1ebfn nhi\u1ec5m \u1ea5u tr\u00f9ng c\u1ee7a c\u00e1c lo\u00e0i giun s\u00e1n nh\u01b0 giun ph\u1ed5i chu\u1ed9t Angiostrongilus cantonensis<\/em><\/a>, giun \u0111\u0169a ch\u00f3 Toxocara canis<\/em>, giun gai Gnathostoma spinigerum <\/em>v\u00e0 m\u1ed9t s\u1ed1\u00a0 lo\u00e0i giun kh\u00e1c, b\u1ec7nh n\u1ea5m Coccidioido. VMN do c\u00e1c nguy\u00ean nh\u00e2n n\u00e0y th\u01b0\u1eddng di\u1ec5n bi\u1ebfn k\u00e9o d\u00e0i, m\u1ee9c \u0111\u1ed9 n\u1eb7ng ph\u1ee5 thu\u1ed9c v\u00e0o l\u01b0\u1ee3ng \u1ea5u tr\u00f9ng b\u1ecb nhi\u1ec5m; b\u1ea1ch c\u1ea7u \u00e1i toan c\u00f3 th\u1ec3 ch\u1ec9 xu\u1ea5t hi\u1ec7n tho\u00e1ng qua trong d\u1ecbch n\u00e3o t\u1ee7y ho\u1eb7c trong m\u00e1u v\u00e0 ch\u1ea9n \u0111o\u00e1n \u0111\u1eb7c hi\u1ec7u th\u01b0\u1eddng kh\u00f3 kh\u0103n; b\u1ec7nh c\u00f3 th\u1ec3 d\u1eabn t\u1edbi t\u1eed vong ho\u1eb7c di ch\u1ee9ng th\u1ea7n kinh n\u1eb7ng n\u1ec1.<\/p>\n

C\u00e1c nguy\u00ean nh\u00e2n kh\u00f4ng nhi\u1ec5m tr\u00f9ng g\u00e2y t\u0103ng BC \u00e1i toan trong d\u1ecbch n\u00e3o t\u1ee7y bao g\u1ed3m s\u1eed d\u1ee5ng thu\u1ed1c c\u1ea3n quang trong ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh h\u1ec7 th\u1ea7n kinh trung \u01b0\u01a1ng, d\u1eabn l\u01b0u n\u00e3o th\u1ea5t, d\u1ecb \u1ee9ng thu\u1ed1c, b\u1ec7nh m\u00e1u \u00e1c t\u00ednh, b\u1ec7nh Hodgkin v\u00e0 m\u1ed9t s\u1ed1 u \u00e1c t\u00ednh kh\u00e1c.<\/p>\n

2.\u00a0 Nguy\u00ean nh\u00e2n vi\u00eam ma\u0300ng na\u0303o t\u0103ng ba\u0323ch c\u00e2\u0300u a\u0301i toan<\/h2>\n

Giun ph\u1ed5i chu\u1ed9t Angiostrongilus cantonensis<\/em>: l\u00e0 nguy\u00ean nh\u00e2n ph\u1ed5 bi\u1ebfn nh\u1ea5t g\u00e2y VMN t\u0103ng BC \u00e1i toan. Ng\u01b0\u1eddi nhi\u1ec5m A.cantonensis <\/em>khi \u0103n ph\u1ea3i c\u00e1c \u0111\u1ed9ng v\u1eadt v\u00e0 rau nhi\u1ec5m \u1ea5u tr\u00f9ng giun ch\u01b0a \u0111\u01b0\u1ee3c n\u1ea5u ch\u00edn. Trong c\u01a1 th\u1ec3 ng\u01b0\u1eddi, \u1ea5u tr\u00f9ng A.cantonensis <\/em>x\u00e2m nh\u1eadp v\u00e0o h\u1ec7 th\u1ea7n kinh trung \u01b0\u01a1ng g\u00e2y vi\u00eam, xu\u1ea5t huy\u1ebft, ho\u1ea1i t\u1eed v\u00e0 s\u1ef1 h\u00ecnh th\u00e0nh c\u00e1c u h\u1ea1t quanh \u1ea5u tr\u00f9ng giun trong t\u1ed5 ch\u1ee9c n\u00e3o.<\/p>\n

C\u00e1c lo\u1ea1i giun s\u00e1n kh\u00e1c c\u00f3 th\u1ec3 g\u00e2y VMN t\u0103ng BC \u00e1i toan bao g\u1ed3m Toxocara canis <\/em>(giun \u0111\u0169a ch\u00f3), Gnathostoma spinigerum <\/em>(giun gai), Trichinella spiralis <\/em>(giun xo\u1eafn), Taenia solium <\/em>(s\u00e1n l\u1ee3n), v.v\u2026 Ng\u01b0\u1eddi nhi\u1ec5m c\u00e1c lo\u1ea1i giun s\u00e1n n\u00e0y khi \u0103n ph\u1ea3i c\u00e1c th\u1ee9c \u0103n ch\u1ee9a \u1ea5u tr\u00f9ng ch\u01b0a \u0111\u01b0\u1ee3c n\u1ea5u ch\u00edn, th\u01b0\u1eddng l\u00e0 th\u1ecbt \u0111\u1ed9ng v\u1eadt, c\u00f3 th\u1ec3 nhi\u1ec5m tr\u1ef1c ti\u1ebfp t\u1eeb m\u00f4i tr\u01b0\u1eddng. \u1ea4u tr\u00f9ng c\u1ee7a c\u00e1c lo\u1ea1i giun s\u00e1n n\u00e0y th\u01b0\u1eddng g\u00e2y b\u1ec7nh c\u1ea3nh \u1ea5u tr\u00f9ng di tr\u00fa (giun \u0111\u0169a ch\u00f3, giun gai) ho\u1eb7c t\u1ea1o th\u00e0nh nang ho\u1eb7c k\u00e9n (s\u00e1n l\u1ee3n, giun xo\u1eafn) trong c\u00e1c m\u00f4 m\u1ec1m v\u00e0 c\u00e1c c\u01a1 quan n\u1ed9i t\u1ea1ng, c\u00f3 th\u1ec3 x\u00e2m nh\u1eadp v\u00e0o h\u1ec7 th\u1ea7n kinh trung \u01b0\u01a1ng, g\u00e2y t\u1ed5n th\u01b0\u01a1ng c\u01a1 h\u1ecdc (xu\u1ea5t huy\u1ebft, ho\u1ea1i t\u1eed), v\u00e0 ph\u1ea3n \u1ee9ng vi\u00eam.<\/p>\n

Giun \u0111\u0169a g\u1ea5u tr\u00fac ch\u00e2u M\u1ef9 Baylisascaris procyonis <\/em>v\u00e0 n\u1ea5m Coccidioido l\u00e0 hai t\u00e1c nh\u00e2n g\u00e2y vi\u00eam m\u00e0ng n\u00e3o t\u0103ng b\u1ea1ch c\u1ea7u \u00e1i toan l\u01b0u h\u00e0nh \u1edf ch\u00e2u M\u1ef9.<\/p>\n

\"Vi\u00eam
Vi\u00eam ma\u0300ng na\u0303o t\u0103ng ba\u0323ch c\u00e2\u0300u a\u0301i toan<\/figcaption><\/figure>\n

3.\u00a0 Ch\u00e2\u0309n \u0111oa\u0301n vi\u00eam ma\u0300ng na\u0303o t\u0103ng ba\u0323ch c\u00e2\u0300u a\u0301i toan<\/h2>\n

3.1. L\u00e2m s\u00e0ng<\/strong><\/h3>\n
    \n
  • Giai \u0111o\u1ea1n \u1ee7 b\u1ec7nh c\u00f3 th\u1ec3 k\u00e9o d\u00e0i t\u1eeb 6 ng\u00e0y \u0111\u1ebfn 30 ng\u00e0y, trung b\u00ecnh 1 \u0111\u1ebfn 2 tu\u1ea7n \u0111\u1ed1i v\u1edbi cantonensis<\/em>.<\/li>\n
  • Kh\u1edfi ph\u00e1t c\u00f3 th\u1ec3 \u0111\u1ed9t ng\u1ed9t ho\u1eb7c b\u00e1n c\u1ea5p.<\/li>\n
  • \n
      \n
    • \u0110au \u0111\u1ea7u n\u1eb7ng, bu\u1ed3n n\u00f4n, n\u00f4n, r\u1ed1i lo\u1ea1n c\u1ea3m gi\u00e1c;<\/li>\n
    • S\u1ed1t c\u00f3 th\u1ec3 c\u00f3 ho\u1eb7c kh\u00f4ng;<\/li>\n
    • D\u1ea5u hi\u1ec7u m\u00e0ng n\u00e3o t\u1eeb k\u00edn \u0111\u00e1o \u0111\u1ebfn r\u00f5 r\u00e0ng;<\/li>\n
    • R\u1ed1i lo\u1ea1n tinh th\u1ea7n v\u00e0 t\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh khu tr\u00fa c\u00f3 th\u1ec3 g\u1eb7p \u1edf m\u1ed9t s\u1ed1 ng\u01b0\u1eddi b\u1ec7nh n\u1eb7ng.<\/li>\n<\/ul>\n<\/li>\n
    • Nhi\u1ec5m \u1ea5u tr\u00f9ng giun gai c\u00f3 th\u1ec3 \u0111i k\u00e8m bi\u1ec3u hi\u1ec7n ph\u00f9 \u1edf m\u1eb7t v\u00e0 chi, \u0111au d\u1ecdc c\u00e1c d\u00e2y th\u1ea7n kinh, r\u1ed1i lo\u1ea1n c\u1ea3m gi\u00e1c v\u00e0 v\u1eadn \u0111\u1ed9ng t\u1ea1i nh\u1eefng n\u01a1i \u1ea5u tr\u00f9ng giun di tr\u00fa; s\u1ef1 x\u00e2m nh\u1eadp c\u1ee7a \u1ea5u tr\u00f9ng v\u00e0o m\u1eaft c\u00f3 th\u1ec3 g\u00e2y ph\u1ea3n \u1ee9ng vi\u00eam m\u00e3nh li\u1ec7t, c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn m\u00f9.<\/li>\n
    • T\u1ed5n th\u01b0\u01a1ng m\u1eaft c\u00f3 th\u1ec3 g\u1eb7p trong nhi\u1ec5m \u1ea5u tr\u00f9ng giun \u0111\u0169a ch\u00f3, nhi\u1ec5m \u1ea5u tr\u00f9ng s\u00e1n l\u1ee3n.<\/li>\n
    • Nhi\u1ec5m \u1ea5u tr\u00f9ng s\u00e1n l\u1ee3n th\u01b0\u1eddng \u0111i k\u00e8m v\u1edbi nang s\u00e1n d\u01b0\u1edbi da, trong c\u01a1 v\u00e0 c\u00e1c c\u01a1 quan n\u1ed9i t\u1ea1ng kh\u00e1c ngo\u00e0i n\u00e3o v\u00e0 m\u00e0ng n\u00e3o.<\/li>\n
    • Nhi\u1ec5m giun xo\u1eafn spiralis <\/em>\u0111i k\u00e8m v\u1edbi \u0111au c\u1ee9ng c\u01a1 to\u00e0n th\u00e2n, ph\u00f9.<\/li>\n<\/ul>\n

      3.2. C\u1eadn l\u00e2m s\u00e0ng<\/h3>\n

      D\u1ecbch n\u00e3o t\u1ee7y (DNT): d\u1ecbch n\u00e3o t\u1ee7y th\u01b0\u1eddng trong, \u00e1p l\u1ef1c t\u0103ng, c\u00f3 th\u1ec3 l\u1eabn m\u00e1u trong nhi\u1ec5m \u1ea5u tr\u00f9ng giun<\/p>\n

        \n
      • Sinh h\u00f3a DNT: protein t\u0103ng, \u0111\u01b0\u1eddng b\u00ecnh th\u01b0\u1eddng, c\u00f3 th\u1ec3 t\u0103ng trong m\u1ed9t s\u1ed1 \u00edt tr\u01b0\u1eddng h\u1ee3p;<\/li>\n
      • T\u0103ng b\u1ea1ch c\u1ea7u \u00e1i toan trong DNT l\u00e0 d\u1ea5u hi\u1ec7u c\u00f3 gi\u00e1 tr\u1ecb ch\u1ea9n \u0111o\u00e1n; t\u1ef7 l\u1ec7 BC \u00e1i toan th\u01b0\u1eddng t\u0103ng tr\u00ean 10%, c\u00f3 th\u1ec3 cao h\u01a1n, nh\u01b0ng c\u00f3 th\u1ec3 ho\u00e0n to\u00e0n b\u00ecnh th\u01b0\u1eddng.<\/li>\n<\/ul>\n

        B\u1ea1ch c\u1ea7u \u00e1i toan trong m\u00e1u ngo\u1ea1i vi c\u00f3 th\u1ec3 t\u0103ng \u0111\u01a1n \u0111\u1ed9c, tho\u00e1ng qua, c\u00f3 th\u1ec3 \u0111i k\u00e8m v\u1edbi t\u0103ng b\u1ea1ch c\u1ea7u \u00e1i toan trong d\u1ecbch n\u00e3o t\u1ee7y.<\/p>\n

        3.3. Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh<\/h3>\n

        VMN t\u0103ng BC \u00e1i toan \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n ch\u1ee7 y\u1ebfu tr\u00ean c\u01a1 s\u1edf t\u0103ng BC \u00e1i toan trong DNT v\u00e0\/ho\u1eb7c trong m\u00e1u ngo\u1ea1i vi; ti\u1ec1n s\u1eed \u0103n c\u00e1c th\u1ee9c \u0103n ch\u01b0a n\u1ea5u ch\u00edn t\u1eeb \u0111\u1ed9ng v\u1eadt (\u1ed1c s\u00ean, t\u00f4m, \u1ebfch, v.v…) v\u00e0 rau xanh c\u00f3 gi\u00e1 tr\u1ecb h\u1ed7 tr\u1ee3 ch\u1ea9n \u0111o\u00e1n nh\u01b0ng r\u1ea5t \u00edt khi c\u00f3 th\u1ec3 khai th\u00e1c \u0111\u01b0\u1ee3c t\u1eeb ng\u01b0\u1eddi b\u1ec7nh. C\u00e1c x\u00e9t nghi\u1ec7m ch\u1ea9n \u0111o\u00e1n \u0111\u1eb7c hi\u1ec7u hi\u1ec7n r\u1ea5t hi\u1ebfm v\u00e0 kh\u00f3 ti\u1ebfp c\u1eadn.<\/p>\n

        \u1ea4u tr\u00f9ng A.cantonensis <\/em>r\u1ea5t hi\u1ebfm khi \u0111\u01b0\u1ee3c t\u00ecm th\u1ea5y trong DNT. Ch\u1ee5p c\u1ed9ng h\u01b0\u1edfng t\u1eeb s\u1ecd n\u00e3o (MRI) trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p nhi\u1ec5m A.cantonensis <\/em>n\u1eb7ng c\u00f3 th\u1ec3 th\u1ea5y h\u00ecnh \u1ea3nh t\u1ed5n th\u01b0\u01a1ng m\u00e0ng n\u00e3o, c\u00e1c t\u1ed5n th\u01b0\u01a1ng d\u01b0\u1edbi v\u1ecf; t\u0103ng t\u00edn hi\u1ec7u tr\u00ean T2 \u1edf v\u00f9ng d\u01b0\u1edbi v\u1ecf v\u00e0 r\u00eca n\u00e3o th\u1ea5t. X\u00e9t nghi\u1ec7m kh\u00e1ng th\u1ec3 b\u1eb1ng ph\u01b0\u01a1ng ph\u00e1p Western blot cho th\u1ea5y c\u00f3 \u0111\u00e1p \u1ee9ng v\u1edbi kh\u00e1ng nguy\u00ean 31 kDa c\u1ee7a A.cantonensis<\/em>, nh\u01b0ng x\u00e9t nghi\u1ec7m n\u00e0y hi\u1ec7n ch\u01b0a c\u00f3 t\u1ea1i Vi\u1ec7t Nam.<\/p>\n

        Nhi\u1ec5m \u1ea5u tr\u00f9ng s\u00e1n l\u1ee3n cho h\u00ecnh \u1ea3nh c\u00e1c k\u00e9n s\u00e1n trong t\u1ed5 ch\u1ee9c n\u00e3o tr\u00ean phim ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh v\u00e0 ch\u1ee5p c\u1ed9ng h\u01b0\u1edfng t\u1eeb. X\u00e9t nghi\u1ec7m huy\u1ebft thanh h\u1ecdc – ng\u01b0ng k\u1ebft h\u1ed3ng c\u1ea7u gi\u00e1n ti\u1ebfp trong DNT v\u00e0 ELISA trong huy\u1ebft thanh – c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng \u0111\u1ec3 kh\u1eb3ng \u0111\u1ecbnh ch\u1ea9n \u0111o\u00e1n.<\/p>\n

        Nhi\u1ec5m \u1ea5u tr\u00f9ng giun \u0111\u0169a ch\u00f3 c\u00f3 th\u1ec3 kh\u1eb3ng \u0111\u1ecbnh b\u1eb1ng x\u00e9t nghi\u1ec7m t\u00ecm \u1ea5u tr\u00f9ng trong m\u00f4 b\u1ecb t\u1ed5n th\u01b0\u01a1ng qua x\u00e9t nghi\u1ec7m m\u00f4 b\u1ec7nh h\u1ecdc ho\u1eb7c ly gi\u1ea3i m\u00f4. X\u00e9t nghi\u1ec7m ELISA s\u1eed d\u1ee5ng s\u1ea3n ph\u1ea9m t\u1eeb \u1ea5u tr\u00f9ng T.canis <\/em>c\u00f3 t\u00ednh \u0111\u1eb7c hi\u1ec7u v\u00e0 c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng \u0111\u1ec3 kh\u1eb3ng \u0111\u1ecbnh ch\u1ea9n \u0111o\u00e1n. Tuy nhi\u00ean, hi\u1ec7u gi\u00e1 kh\u00e1ng th\u1ec3 v\u1edbi Toxocara <\/em>trong qu\u1ea7n th\u1ec3 d\u00e2n c\u01b0 kh\u00f4ng c\u00f3 bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng c\u00f3 th\u1ec3 dao \u0111\u1ed9ng \u0111\u00e1ng k\u1ec3, v\u00e0 m\u1ed9t hi\u1ec7u gi\u00e1 kh\u00e1ng th\u1ec3\u00a0 t\u0103ng kh\u00f4ng th\u1ec3 kh\u1eb3ng \u0111\u1ecbnh ch\u1ea9n \u0111o\u00e1n m\u1ed9t c\u00e1ch ch\u1eafc ch\u1eafn.<\/p>\n

        Nhi\u1ec5m giun xo\u1eafn c\u00f3 th\u1ec3 kh\u1eb3ng \u0111\u1ecbnh b\u1eb1ng sinh thi\u1ebft c\u01a1 v\u00e0 x\u00e9t nghi\u1ec7m m\u00f4 b\u1ec7nh h\u1ecdc t\u00ecm giun trong t\u1ed5 ch\u1ee9c c\u01a1 v\u00e2n, x\u00e9t nghi\u1ec7m huy\u1ebft thanh h\u1ecdc.<\/p>\n

        Nhi\u1ec5m \u1ea5u tr\u00f9ng giun gai th\u01b0\u1eddng \u0111i k\u00e8m v\u1edbi c\u00e1c v\u00f9ng xu\u1ea5t huy\u1ebft trong t\u1ed5 ch\u1ee9c n\u00e3o tr\u00ean phim CT, c\u00f3 th\u1ec3 nh\u1ea7m v\u1edbi xu\u1ea5t huy\u1ebft do tai bi\u1ebfn m\u1ea1ch n\u00e3o; d\u1ecbch n\u00e3o t\u1ee7y th\u01b0\u1eddng c\u00f3 m\u00e0u v\u00e0ng ho\u1eb7c l\u1eabn m\u00e1u; \u1ea5u tr\u00f9ng giun th\u01b0\u1eddng kh\u00f4ng th\u1ec3 t\u00ecm th\u1ea5y trong d\u1ecbch n\u00e3o t\u1ee7y; b\u1ea1ch c\u1ea7u \u00e1i toan trong m\u00e1u th\u01b0\u1eddng t\u0103ng cao h\u01a1n so v\u1edbi nhi\u1ec5m giun ph\u1ed5i chu\u1ed9t. C\u00e1c x\u00e9t nghi\u1ec7m huy\u1ebft thanh h\u1ecdc ch\u1ea9n \u0111o\u00e1n nhi\u1ec5m giun gai hi\u1ec7n ch\u01b0a ph\u1ed5 bi\u1ebfn \u1edf Vi\u1ec7t Nam.<\/p>\n

        3.4. Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t<\/h3>\n

        Vi\u00eam m\u00e0ng n\u00e3o m\u1ee7 do vi khu\u1ea9n th\u01b0\u1eddng kh\u1edfi ph\u00e1t \u0111\u1ed9t\u00a0 ng\u1ed9t; ng\u01b0\u1eddi b\u1ec7nh th\u01b0\u1eddng s\u1ed1t cao; r\u1ed1i lo\u1ea1n tinh th\u1ea7n c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n s\u1edbm n\u1ebfu ng\u01b0\u1eddi b\u1ec7nh kh\u00f4ng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb ph\u00f9 h\u1ee3p; DNT th\u01b0\u1eddng bi\u1ebfn lo\u1ea1n \u0111i\u1ec3n h\u00ecnh v\u1edbi t\u0103ng protein, \u0111\u01b0\u1eddng h\u1ea1; s\u1ed1 l\u01b0\u1ee3ng b\u1ea1ch c\u1ea7u t\u0103ng r\u1ea5t cao, t\u1eeb v\u00e0i tr\u0103m \u0111\u1ebfn h\u00e0ng ch\u1ee5c ng\u00e0n, ch\u1ee7 y\u1ebfu l\u00e0 BC \u0111a nh\u00e2n trung t\u00ednh; s\u1ed1 l\u01b0\u1ee3ng BC v\u00e0 t\u1ef7 l\u1ec7 BC \u0111a nh\u00e2n trung t\u00ednh trong m\u00e1u ngo\u1ea1i vi c\u0169ng t\u0103ng cao; s\u1ed1 l\u01b0\u1ee3ng v\u00e0 t\u1ef7 l\u1ec7 b\u1ea1ch c\u1ea7u \u00e1i toan kh\u00f4ng t\u0103ng trong c\u1ea3 DNT v\u00e0 m\u00e1u ngo\u1ea1i vi. Vi khu\u1ea9n g\u00e2y b\u1ec7nh c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh qua nhu\u1ed9m soi DNT, nu\u00f4i c\u1ea5y DNT v\u00e0 m\u00e1u.<\/p>\n

        Vi\u00eam m\u00e0ng n\u00e3o do virus c\u00f3 th\u1ec3 kh\u1edfi ph\u00e1t \u0111\u1ed9t ng\u1ed9t ho\u1eb7c b\u00e1n c\u1ea5p. Ng\u01b0\u1eddi b\u1ec7nh th\u01b0\u1eddng c\u00f3 s\u1ed1t; c\u00e1c d\u1ea5u m\u00e0ng n\u00e3o c\u00f3 th\u1ec3 k\u00edn \u0111\u00e1o ho\u1eb7c r\u00f5 r\u00e0ng; t\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh khu tr\u00fa hi\u1ebfm g\u1eb7p. DNT c\u00f3 t\u0103ng nh\u1eb9 protein, t\u0103ng t\u1ebf b\u00e0o, ch\u1ee7 y\u1ebfu l\u00e0 b\u1ea1ch c\u1ea7u \u0111\u01a1n nh\u00e2n. S\u1ed1 l\u01b0\u1ee3ng v\u00e0 t\u1ef7 l\u1ec7 b\u1ea1ch c\u1ea7u \u00e1i toan kh\u00f4ng t\u0103ng trong c\u1ea3 DNT v\u00e0 m\u00e1u ngo\u1ea1i vi.<\/p>\n

        Lao m\u00e0ng n\u00e3o th\u01b0\u1eddng kh\u1edfi ph\u00e1t t\u1eeb t\u1eeb; \u0111au \u0111\u1ea7u v\u00e0 s\u1ed1t t\u0103ng d\u1ea7n; c\u00e1c d\u1ea5u m\u00e0ng n\u00e3o th\u01b0\u1eddng k\u00edn \u0111\u00e1o; c\u00e1c d\u1ea5u th\u1ea7n kinh khu tr\u00fa th\u01b0\u1eddng xu\u1ea5t hi\u1ec7n t\u1eeb tu\u1ea7n b\u1ec7nh th\u1ee9 hai v\u00e0 th\u1ee9 ba; c\u00e1c bi\u1ebfn lo\u1ea1n DNT bao g\u1ed3m t\u0103ng protein, \u0111\u01b0\u1eddng v\u00e0 chlor gi\u1ea3m, t\u0103ng t\u1ebf b\u00e0o lympho v\u00e0 trung t\u00ednh h\u1ed7n h\u1ee3p; s\u1ed1 l\u01b0\u1ee3ng v\u00e0 t\u1ef7 l\u1ec7 b\u1ea1ch c\u1ea7u \u00e1i toan kh\u00f4ng t\u0103ng trong c\u1ea3 DNT v\u00e0 m\u00e1u ngo\u1ea1i vi. C\u00e1c t\u1ed5n th\u01b0\u01a1ng th\u01b0\u1eddng th\u1ea5y tr\u00ean phim ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh v\u00e0 c\u1ed9ng h\u01b0\u1edfng t\u1eeb (MRI) s\u1ecd n\u00e3o l\u00e0 c\u00e1c \u1ed5 nh\u1ed3i m\u00e1u trong nhu m\u00f4 n\u00e3o. Vi khu\u1ea9n lao c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh qua nhu\u1ed9m ki\u1ec1m toan (t\u1ef7 l\u1ec7 d\u01b0\u01a1ng t\u00ednh r\u1ea5t th\u1ea5p), nu\u00f4i c\u1ea5y, v\u00e0 ph\u1ea3n \u1ee9ng nh\u00e2n chu\u1ed7i men polymerase (PCR).<\/p>\n

        Vi\u00eam m\u00e0ng n\u00e3o do n\u1ea5m Cryptococcus neoformans <\/em>th\u01b0\u1eddng g\u1eb7p \u1edf ng\u01b0\u1eddi nhi\u1ec5m HIV ho\u1eb7c c\u00f3 b\u1ec7nh l\u00fd suy gi\u1ea3m mi\u1ec5n d\u1ecbch ti\u1ec1m t\u00e0ng. B\u1ec7nh th\u01b0\u1eddng di\u1ec5n bi\u1ebfn k\u00e9o d\u00e0i; DNT bi\u1ebfn lo\u1ea1n nh\u1eb9 ho\u1eb7c ho\u00e0n to\u00e0n b\u00ecnh th\u01b0\u1eddng; s\u1ed1 l\u01b0\u1ee3ng v\u00e0 t\u1ef7 l\u1ec7 b\u1ea1ch c\u1ea7u \u00e1i toan kh\u00f4ng t\u0103ng trong c\u1ea3 DNT v\u00e0 m\u00e1u ngo\u1ea1i vi. N\u1ea5m C.neoformans <\/em>g\u00e2y b\u1ec7nh c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n qua nhu\u1ed9m soi DNT b\u1eb1ng m\u1ef1c t\u00e0u v\u00e0 nu\u00f4i c\u1ea5y.<\/p>\n

        M\u1ed9t s\u1ed1 b\u1ec7nh n\u1ed9i khoa (lupus ban \u0111\u1ecf h\u1ec7 th\u1ed1ng, leukemia, d\u1ecb \u1ee9ng thu\u1ed1c, s\u1eed d\u1ee5ng thu\u1ed1c c\u1ea3n quang trong ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh h\u1ec7 th\u1ea7n kinh trung \u01b0\u01a1ng, v.v…) c\u00f3 th\u1ec3 c\u00f3 bi\u1ec3u hi\u1ec7n m\u00e0ng n\u00e3o v\u00e0 t\u0103ng b\u1ea1ch c\u1ea7u \u00e1i toan; ng\u01b0\u1eddi b\u1ec7nh c\u00f3 \u0111au \u0111\u1ea7u v\u00e0 s\u1ed1t. C\u1ea7n ph\u00e2n bi\u1ec7t bi\u1ec3u hi\u1ec7n m\u00e0ng n\u00e3o trong c\u00e1c b\u1ec7nh n\u00e0y v\u1edbi VMN t\u0103ng BC \u00e1i toan tr\u00ean c\u01a1 s\u1edf c\u00e1c bi\u1ec3u hi\u1ec7n ti\u1ec1m t\u00e0ng c\u1ee7a b\u1ec7nh n\u1ed9i khoa.<\/p>\n

        4.\u00a0 \u0110i\u00ea\u0300u tri\u0323 vi\u00eam ma\u0300ng na\u0303o t\u0103ng ba\u0323ch c\u00e2\u0300u a\u0301i toan<\/h2>\n

        4.1. M\u1ee5c ti\u00eau v\u00e0 nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb<\/strong><\/h3>\n

        \u0110i\u1ec1u tr\u1ecb VMN t\u0103ng BC \u00e1i toan ch\u1ee7 y\u1ebfu l\u00e0 ch\u1ed1ng vi\u00eam v\u00e0 \u0111i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng; \u0111i\u1ec1u tr\u1ecb c\u0103n nguy\u00ean \u00edt c\u00f3 t\u00e1c d\u1ee5ng.<\/p>\n

        4.2. \u0110i\u1ec1u tr\u1ecb h\u1ed7 tr\u1ee3<\/h3>\n

        \u0110i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng: \u0111i\u1ec1u tr\u1ecb c\u00e1c thu\u1ed1c gi\u1ea3m \u0111au, ch\u1ed1ng n\u00f4n, h\u1ea1 s\u1ed1t, an th\u1ea7n, v.v… t\u01b0\u01a1ng t\u1ef1 nh\u01b0 c\u00e1c vi\u00eam m\u00e0ng n\u00e3o v\u00e0 b\u1ec7nh nhi\u1ec5m tr\u00f9ng kh\u00e1c. Ch\u1ecdc d\u00f2 v\u00e0 d\u1eabn l\u01b0u DNT\u00a0 \u0111\u1ec3 gi\u1ea3m \u00e1p l\u1ef1c n\u1ed9i s\u1ecd c\u00f3 t\u00e1c d\u1ee5ng c\u1ea3i thi\u1ec7n t\u00ecnh tr\u1ea1ng l\u00e2m s\u00e0ng.<\/p>\n

        \u0110i\u1ec1u tr\u1ecb c\u00e1c thu\u1ed1c steroid: \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh cho c\u00e1c tr\u01b0\u1eddng h\u1ee3p VMN n\u1eb7ng. C\u00e1c thu\u1ed1c steroid c\u00f3 t\u00e1c d\u1ee5ng l\u00e0m gi\u1ea3m \u0111au \u0111\u1ea7u, c\u1ea3i thi\u1ec7n nhanh c\u00e1c tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng kh\u00e1c (s\u1ed1t, bu\u1ed3n n\u00f4n, n\u00f4n). Li\u1ec1u prednisolon ph\u1ee5 thu\u1ed9c v\u00e0o m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a b\u1ec7nh v\u00e0 c\u1ea7n gi\u1ea3m d\u1ea7n li\u1ec1u trong v\u00f2ng 2 tu\u1ea7n. Ng\u01b0\u1eddi b\u1ec7nh c\u00f3 tri\u1ec7u ch\u1ee9ng t\u00e1i ph\u00e1t sau khi ng\u1eebng steroid c\u00f3 th\u1ec3 c\u1ea7n \u0111i\u1ec1u tr\u1ecb nh\u1eafc l\u1ea1i b\u1eb1ng m\u1ed9t \u0111\u1ee3t m\u1edbi. Ng\u01b0\u1eddi b\u1ec7nh nhi\u1ec5m \u1ea5u tr\u00f9ng s\u00e1n l\u1ee3n c\u00f3 ch\u1ec9 \u0111\u1ecbnh d\u00f9ng steroid \u0111\u1ec3 ng\u0103n ng\u1eeba ph\u1ea3n \u1ee9ng vi\u00eam do \u1ea5u tr\u00f9ng b\u1ecb ch\u1ebft h\u00e0ng lo\u1ea1t khi \u0111i\u1ec1u tr\u1ecb c\u00e1c thu\u1ed1c ch\u1ed1ng \u1ea5u tr\u00f9ng nh\u01b0 praziquantel ho\u1eb7c albendazol.<\/p>\n

        4.3. \u0110i\u1ec1u tr\u1ecb c\u0103n nguy\u00ean<\/h3>\n

        C\u00e1c thu\u1ed1c ch\u1ed1ng giun s\u00e1n c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng trong \u0111i\u1ec1u tr\u1ecb VMN t\u0103ng BC \u00e1i toan bao g\u1ed3m albendazol, thiabendazol, mebendazol, levamizol, diethylcarbamazin, v\u00e0 m\u1ed9t s\u1ed1 thu\u1ed1c kh\u00e1c. Albendazol th\u01b0\u1eddng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u1edf li\u1ec1u 400 mg, u\u1ed1ng 2 l\u1ea7n\/ng\u00e0y x 10-14 ng\u00e0y. Tuy nhi\u00ean, c\u00e1c thu\u1ed1c n\u00e0y \u00edt c\u00f3 t\u00e1c d\u1ee5ng v\u1edbi c\u00e1c \u1ea5u tr\u00f9ng \u0111\u00e3 x\u00e2m nh\u1eadp v\u00e0o t\u1ed5 ch\u1ee9c n\u00e3o. Nhi\u1ec5m \u1ea5u tr\u00f9ng giun gai c\u00f3 th\u1ec3 \u0111i\u1ec1u tr\u1ecb b\u1eb1ng albendazol 400 mg, 2 l\u1ea7n m\u1ed9t ng\u00e0y trong 21 ng\u00e0y ho\u1eb7c ivermectin u\u1ed1ng 200 mcg\/kg\/ng\u00e0y trong 2 ng\u00e0y.<\/p>\n

        5.\u00a0 Ti\u00ea\u0301n tri\u00ea\u0309n va\u0300 bi\u00ea\u0301n ch\u01b0\u0301ng vi\u00eam ma\u0300ng na\u0303o t\u0103ng ba\u0323ch c\u00e2\u0300u a\u0301i toan<\/h2>\n

        Ng\u01b0\u1eddi b\u1ec7nh vi\u00eam m\u00e0ng n\u00e3o t\u0103ng b\u1ea1ch c\u1ea7u \u00e1i toan khi \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb ch\u1ed1ng vi\u00eam\u00a0 v\u00e0 thu\u1ed1c ch\u1ed1ng giun s\u00e1n th\u01b0\u1eddng ti\u1ebfn tri\u1ec3n t\u1ed1t h\u01a1n v\u1ec1\u00a0 l\u00e2m s\u00e0ng: gi\u1ea3m s\u1ed1t, gi\u1ea3m \u0111au \u0111\u1ea7u; d\u1ecbch n\u00e3o t\u1ee7y c\u1ea3i thi\u1ec7n, gi\u1ea3m protein v\u00e0 t\u1ebf b\u00e0o. C\u00e1c tri\u1ec7u ch\u1ee9ng c\u00f3 th\u1ec3 t\u00e1i ph\u00e1t khi gi\u1ea3m ho\u1eb7c ng\u1eebng corticoid, v\u00e0 ng\u01b0\u1eddi b\u1ec7nh c\u1ea7n \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh\u00a0 l\u1ea1i \u0111i\u1ec1u tr\u1ecb ch\u1ed1ng\u00a0 vi\u00eam\u00a0 v\u00e0 gi\u1ea3m \u0111au.<\/p>\n

        M\u1ed9t s\u1ed1 ng\u01b0\u1eddi b\u1ec7nh b\u1ecb vi\u00eam m\u00e0ng n\u00e3o n\u1eb7ng c\u00f3 th\u1ec3 c\u00f3 c\u00e1c di ch\u1ee9ng v\u1ec1 th\u1ea7n kinh; c\u00e1c di ch\u1ee9ng n\u00e0y c\u00f3 th\u1ec3 ph\u1ee5c h\u1ed3i d\u1ea7n sau khi kh\u1ecfi b\u1ec7nh. Nhi\u1ec5m \u1ea5u tr\u00f9ng giun gai c\u00f3 th\u1ec3 \u0111\u1ec3 l\u1ea1i di ch\u1ee9ng v\u0129nh vi\u1ec5n do t\u1ed5n th\u01b0\u01a1ng n\u00e3o n\u1eb7ng.<\/p>\n

        6.\u00a0 Pho\u0300ng b\u00ea\u0323nh vi\u00eam ma\u0300ng na\u0303o t\u0103ng ba\u0323ch c\u00e2\u0300u a\u0301i toan<\/h2>\n

        VMN t\u0103ng BC \u00e1i toan do nhi\u1ec5m \u1ea5u tr\u00f9ng c\u00e1c lo\u1ea1i giun s\u00e1n c\u00f3 th\u1ec3 d\u1ef1 ph\u00f2ng b\u1eb1ng c\u00e1ch n\u1ea5u ch\u00edn k\u1ef9 c\u00e1c th\u1ee9c \u0103n c\u00f3 kh\u1ea3 n\u0103ng mang m\u1ea7m b\u1ec7nh nh\u01b0: \u1ed1c s\u00ean, t\u00f4m, cua, \u1ebfch, c\u00e1c lo\u1ea1i rau m\u1ecdc \u1edf n\u01a1i c\u00f3 \u1ed1c s\u00ean v\u00e0 chu\u1ed9t; gi\u1eef v\u1ec7 sinh, tr\u00e1nh ph\u01a1i nhi\u1ec5m v\u1edbi m\u00f4i tr\u01b0\u1eddng nhi\u1ec5m ph\u00e2n ch\u00f3 v\u00e0 ph\u00e2n l\u1ee3n; v.v\u2026<\/p>\n

        T\u00c0I LI\u1ec6U THAM KH\u1ea2O<\/h2>\n
          \n
        1. Nash T.E. Visceral Larva Migrans and Other Unusual Helminth Infections. In Mandell, Bennett and Dolin (eds): Principles and Practice of Infectious Diseases, 7th edition. Churchill Livingstone, 2010; pp 3617-23.<\/li>\n
        2. Kazura J.W. Tissue Nematodes Including Trichinosis, Dracunculiasis, and the Filariases. In Mandell, Bennett and Dolin (eds): Principles and Practice of Infectious Dieases, 7th edition. Churchill Livingstone, 2010; pp 3575-94.<\/li>\n
        3. Weller P.F. Trichinella and other tissue nematodes. In Fauci, Braunwald et (eds): Harrison\u2019s Principles of Internal Medicine 17th edition. McGraw-Hill Companies, New York, 2008; pp 1316-1319.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

          Vi\u00eam ma\u0300ng na\u0303o t\u0103ng ba\u0323ch c\u00e2\u0300u a\u0301i toan l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd nghi\u00eam tr\u1ecdng \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn h\u1ec7 th\u1ed1ng th\u1ea7n kinh trung \u01b0\u01a1ng c\u1ee7a con ng\u01b0\u1eddi. \u0110\u00e2y la\u0300 m\u1ed9t b\u1ec7nh l\u00fd \u0111\u1eb7c bi\u1ec7t hi\u1ebfm g\u1eb7p, nh\u01b0ng l\u1ea1i c\u00f3 th\u1ec3 g\u00e2y ra nh\u1eefng h\u1eadu qu\u1ea3 nghi\u00eam tr\u1ecdng cho s\u1ee9c kh\u1ecfe v\u00e0 t\u00ednh m\u1ea1ng c\u1ee7a b\u1ec7nh nh\u00e2n. […]<\/p>\n","protected":false},"author":42,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[10,33],"tags":[],"yoast_head":"\nVi\u00eam ma\u0300ng na\u0303o t\u0103ng ba\u0323ch c\u00e2\u0300u a\u0301i toan - H\u01b0\u01a1\u0301ng d\u00e2\u0303n ch\u00e2\u0309n \u0111oa\u0301n, \u0111i\u00ea\u0300u tri\u0323<\/title>\n<meta name=\"description\" content=\"Vi\u00eam ma\u0300ng na\u0303o t\u0103ng ba\u0323ch c\u00e2\u0300u a\u0301i toan l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd nghi\u00eam tr\u1ecdng \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn h\u1ec7 th\u1ed1ng th\u1ea7n kinh trung \u01b0\u01a1ng c\u1ee7a con ng\u01b0\u1eddi.\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Vi\u00eam ma\u0300ng na\u0303o t\u0103ng ba\u0323ch c\u00e2\u0300u a\u0301i toan - 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