{"id":23662,"date":"2023-04-24T15:14:11","date_gmt":"2023-04-24T08:14:11","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=23662"},"modified":"2023-04-24T15:14:11","modified_gmt":"2023-04-24T08:14:11","slug":"melioidosis-mot-nguyen-nhan-dac-biet-cua-viem-phoi","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/24\/melioidosis-mot-nguyen-nhan-dac-biet-cua-viem-phoi\/","title":{"rendered":"Melioidosis, m\u1ed9t nguy\u00ean nh\u00e2n \u0111\u1eb7c bi\u1ec7t c\u1ee7a vi\u00eam ph\u1ed5i"},"content":{"rendered":"<p><strong>Melioidosis (hay c\u00f2n g\u1ecdi b\u1ec7nh Whitmore) g\u00e2y ra do nhi\u1ec5m tr\u1ef1c khu\u1ea9n gram \u00e2m Burkholderia pseudomallei. B\u1ec7nh c\u00f3 bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng \u0111a d\u1ea1ng t\u1eeb vi\u00eam ph\u1ed5i c\u00f3 th\u1ec3 k\u00e8m nhi\u1ec5m tr\u00f9ng da t\u1edbi b\u1ec7nh lan t\u1ecfa nh\u01b0 nhi\u1ec5m tr\u00f9ng huy\u1ebft n\u1eb7ng. Vi\u1ec7t Nam l\u00e0 v\u00f9ng d\u1ecbch l\u01b0u h\u00e0nh c\u1ee7a b\u1ec7nh, g\u1ea7n \u0111\u00e2y t\u1ec9 l\u1ec7 m\u1eafc \u0111ang t\u0103ng, \u0111\u1eb7c bi\u1ec7t l\u00e0 v\u00e0o m\u00f9a m\u01b0a.<\/strong><\/p>\n<h2><strong>1. D\u1ecbch t\u1ec5 h\u1ecdc.<\/strong><\/h2>\n<p>B\u1ec7nh ph\u00e2n b\u1ed1 ch\u1ee7 y\u1ebfu \u1edf c\u00e1c nhi\u1ec7t \u0111\u1edbi \u0111\u1eb7c bi\u1ec7t \u0110\u00f4ng Nam \u00c1 v\u00e0 \u00dac.<\/p>\n<p>H\u00e0ng n\u0103m, tr\u00ean th\u1ebf gi\u1edbi c\u00f3 kho\u1ea3ng 165.000 ca m\u1eafc melioidosis, trong \u0111\u00f3 c\u00f3 89.000 ca t\u1eed vong. Vi\u1ec7t Nam \u0111\u01b0\u1ee3c coi l\u00e0 n\u01b0\u1edbc n\u1eb1m trong t\u00e2m \u0111i\u1ec3m l\u01b0u h\u00e0nh c\u1ee7a Melioidosis \u1edf c\u1ea5p b\u00e1o \u0111\u1ed9ng \u0111\u1ecf tr\u00ean b\u1ea3n \u0111\u1ed3 d\u1ecbch t\u1ec5 h\u1ecdc to\u00e0n c\u1ea7u v\u1edbi 10.430 ca m\u1eafc m\u1ed7i n\u0103m, trong \u0111\u00f3 c\u00f3 4.703 ca t\u1eed vong.<\/p>\n<p>Vi khu\u1ea9n B.pseudomallei s\u1ed1ng \u1edf \u0111\u1ea5t v\u00e0 n\u01b0\u1edbc nhi\u1ec5m b\u1ea9n, l\u00e2y nhi\u1ec5m qua v\u1ebft th\u01b0\u01a1ng h\u1edf, x\u00e2y x\u00e1t \u1edf da, h\u00edt ph\u1ea3i c\u00e1c h\u1ea1t b\u1ee5i \u0111\u1ea5t nhi\u1ec5m khu\u1ea9n. V\u00ec v\u1eady, \u0111a s\u1ed1 ng\u01b0\u1eddi m\u1eafc b\u1ec7nh l\u00e0 n\u00f4ng d\u00e2n, khi l\u00e0m vi\u1ec7c tr\u00ean \u0111\u1ed3ng ru\u1ed9ng kh\u00f4ng c\u00f3 b\u1ea3o h\u1ed9 lao \u0111\u1ed9ng. B\u1ec7nh c\u1ea1nh \u0111\u00f3, nh\u1eefng ng\u01b0\u1eddi m\u1eafc c\u00e1c v\u1ea5n \u0111\u1ec1 nh\u01b0 \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, nghi\u1ec7n r\u01b0\u1ee3u, s\u1eed d\u1ee5ng corticoit d\u00e0i ng\u00e0y, m\u1eafc b\u1ec7nh ph\u1ed5i v\u00e0 th\u1eadn m\u1ea1n s\u1ebd c\u00f3 kh\u1ea3 n\u0103ng nhi\u1ec5m b\u1ec7nh cao h\u01a1n nhi\u1ec1u l\u1ea7n so v\u1edbi ng\u01b0\u1eddi b\u00ecnh th\u01b0\u1eddng.<\/p>\n<p>M\u1ecdi nh\u00f3m tu\u1ed5i \u0111\u1ec1u c\u00f3 th\u1ec3 m\u1eafc melioidosis, nh\u00f3m tu\u1ed5i \u0111\u1ec9nh \u1edf ng\u01b0\u1eddi l\u1edbn t\u1eeb 40 &#8211; 60. T\u1ec9 l\u1ec7 m\u1eafc m\u1edbi v\u00e0 \u0111\u1ed9 n\u1eb7ng c\u1ee7a b\u1ec7nh ph\u1ee5 thu\u1ed9c v\u00e0o y\u1ebfu t\u1ed1 v\u1eadt ch\u1ee7, m\u00f4i tr\u01b0\u1eddng v\u00e0 \u0111\u1ed9c l\u1ef1c vi khu\u1ea9n.<\/p>\n<p>T\u1ec9 l\u1ec7 m\u1eafc \u1edf nam g\u1eb7p nhi\u1ec1u h\u01a1n n\u1eef, c\u00f3 th\u1ec3 do nam c\u00f3 nhi\u1ec1u y\u1ebfu t\u1ed1 nguy c\u01a1 ti\u1ebfp x\u00fac B.pseudomallei.<\/p>\n<p>B\u1ec7nh c\u00f3 t\u1ec9 l\u1ec7 t\u1eed vong cao 9 &#8211; 70% theo c\u00e1c nguy\u00ean c\u1ee9u.<\/p>\n<h2><strong>2. \u0110\u1eb7c \u0111i\u1ec3m vi sinh c\u1ee7a B.<em>pseudomallei.<\/em><\/strong><\/h2>\n<p>L\u00e0 tr\u1ef1c khu\u1ea9n gram \u00e2m hi\u1ebfu kh\u00ed, di \u0111\u1ed9ng, oxidase d\u01b0\u01a1ng t\u00ednh.<\/p>\n<p>S\u1ed1ng ho\u1ea1i sinh \u1edf trong \u0111\u1ea5t, n\u01b0\u1edbc \u1edf c\u00e1c v\u00f9ng b\u1ec7nh l\u01b0u h\u00e0nh. Ch\u1ecbu \u0111\u01b0\u1ee3c c\u00e1c m\u00f4i tr\u01b0\u1eddng kh\u1eafc nghi\u1ec7t nh\u01b0 nhi\u1ec7t \u0111\u1ed9 cao, m\u00f4i tr\u01b0\u1eddng acid, ki\u1ec1m, c\u00e1c ch\u1ea5t t\u1ea9y r\u1eeda v\u00e0 di\u1ec7t khu\u1ea9n.<\/p>\n<p>C\u1ea5y l\u00e0 ti\u00eau chu\u1ea9n v\u00e0ng trong ch\u1ea9n \u0111o\u00e1n melioidosis. C\u00f3 th\u1ec3 th\u1ef1c hi\u1ec7n v\u1edbi nhi\u1ec1u b\u1ec7nh ph\u1ea9m nh\u01b0 m\u00e1u, \u0111\u00e0m, m\u1ee7, d\u1ecbch kh\u1edbp, d\u1ecbch m\u00e0ng b\u1ee5ng, m\u00e0ng ngo\u00e0i tim. V\u1edbi c\u00e1c b\u1ec7nh ph\u1ea9m h\u1eefu tr\u00f9ng c\u1ea7n c\u1ea5y trong m\u00f4i tr\u01b0\u1eddng ch\u1ecdn l\u1ecdc nh\u01b0 MTSA, ASH, NAPA-A.<\/p>\n<h2><strong>3. Ch\u1ea9n \u0111o\u00e1n melioidosis ph\u1ed5i.<\/strong><\/h2>\n<p>Vi\u00eam ph\u1ed5i do B.pseudomallei hay b\u1ec7nh melioidosis ph\u1ed5i chi\u1ebfm h\u01a1n 50% c\u00e1c bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng c\u1ee7a nhi\u1ec5m B.pseudomallei. Tri\u1ec7u ch\u1ee9ng k\u00e9o d\u00e0i &lt;2 th\u00e1ng \u0111\u01b0\u1ee3c xem l\u00e0 giai \u0111o\u1ea1n c\u1ea5p\/b\u00e1n c\u1ea5p, t\u1eeb 2 th\u00e1ng \u0111\u01b0\u1ee3c xem l\u00e0 m\u1ea1n t\u00ednh.<\/p>\n<p>Ph\u1ea1m vi b\u00e0i n\u00e0y ch\u1ec9 \u0111\u1ec1 c\u1eadp \u0111\u1ebfn melioidosis ph\u1ed5i c\u1ea5p\/b\u00e1n c\u1ea5y. Ch\u1ea9n \u0111o\u00e1n theo ti\u00eau chu\u1ea9n sau \u0111\u00e2y:<\/p>\n<ul>\n<li>C\u00f3 tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng c\u1ee7a vi\u00eam ph\u1ed5i: s\u1ed1t, ho \u0111\u00e0m, \u0111au ng\u1ef1c ki\u1ec3u m\u00e0ng ph\u1ed5i, kh\u00f3 th\u1edf, ho m\u00e1u.<\/li>\n<li>D\u1ea5u hi\u1ec7u vi\u00eam ph\u1ed5i tr\u00ean h\u00ecnh \u1ea3nh h\u1ecdc.<\/li>\n<li>Ph\u00e2n l\u1eadp \u0111\u01b0\u1ee3c B.pseudomallei t\u1eeb b\u1ea5t k\u00ec b\u1ec7nh ph\u1ea9m n\u00e0o.<\/li>\n<\/ul>\n<p>V\u1edbi nhi\u1ec5m c\u1ea5p, th\u1eddi k\u00ec \u1ee7 b\u1ec7nh trung b\u00ecnh 9 ng\u00e0y (1 &#8211; 21 ng\u00e0y). G\u1eb7p nhi\u1ec1u v\u00e0o m\u00f9a m\u01b0a. \u0110\u1ed1i t\u01b0\u1ee3ng l\u00e0 n\u00f4ng d\u00e2n, ng\u01b0\u1eddi th\u01b0\u1eddng xuy\u00ean ti\u1ebfp x\u00fac n\u01b0\u1edbc b\u1ea9n, \u0111i ch\u00e2n \u0111\u1ea5t. C\u00f3 th\u1ec3 k\u00e8m sang th\u01b0\u01a1ng\/ng\u00f5 v\u00e0o \u1edf da. Sau h\u00edt ph\u1ea3i b\u1ee5i b\u1ea9n. H\u00ecnh \u1ea3nh h\u1ecdc th\u1ea5y c\u00f3 th\u1ec3 th\u1ea5y th\u00e2m nhi\u1ec5m ph\u1ed5i \u00edt, t\u1ea1o hang (th\u01b0\u1eddng g\u1eb7p \u1edf th\u00f9y tr\u00ean) ho\u1eb7c th\u00e2m nhi\u1ec5m lan t\u1ecfa 2 ph\u1ebf tr\u01b0\u1eddng. L\u00e2m s\u00e0ng k\u00e9m \u0111\u00e1p \u1ee9ng v\u1edbi kh\u00e1ng sinh \u0111i\u1ec1u tr\u1ecb <a href=\"https:\/\/www.vinmec.com\/vi\/tin-tuc\/thong-tin-suc-khoe\/suc-khoe-tong-quat\/cac-loai-viem-phoi-thuong-gap\/\">vi\u00eam ph\u1ed5i c\u1ed9ng \u0111\u1ed3ng<\/a> th\u00f4ng th\u01b0\u1eddng l\u00e0 y\u1ebfu t\u1ed1 nghi ng\u1edd. Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh d\u1ef1a v\u00e0o c\u1ea5y \u0111\u1ecbnh dinh tr\u00ean m\u00f4i tr\u01b0\u1eddng ch\u1ecdn l\u1ecdc.<\/p>\n<figure id=\"attachment_23982\" aria-describedby=\"caption-attachment-23982\" style=\"width: 683px\" class=\"wp-caption alignnone\"><img decoding=\"async\" loading=\"lazy\" class=\"wp-image-23982\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/AJGP-05-2019-Professional-Chakravorty-Melioidosis-Fig-2-300x116.jpg\" alt=\"\" width=\"683\" height=\"264\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/AJGP-05-2019-Professional-Chakravorty-Melioidosis-Fig-2-300x116.jpg 300w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/AJGP-05-2019-Professional-Chakravorty-Melioidosis-Fig-2.jpg 760w\" sizes=\"(max-width: 683px) 100vw, 683px\" \/><figcaption id=\"caption-attachment-23982\" class=\"wp-caption-text\">H\u00ecnh \u1ea3nh t\u1ed5n th\u01b0\u01a1ng c\u1ee7a Melioidosis ph\u1ed5i \u1edf m\u1ed9t b\u1ec7nh nh\u00e2n nam 54 tu\u1ed5i, \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng type 2 ki\u1ec3m so\u00e1t k\u00e9m. Ngu\u1ed3n: AJGP-04-18-4558.<\/figcaption><\/figure>\n<p>B\u1ec7nh melioidosis ph\u1ed5i m\u1ea1n c\u00f3 bi\u1ec3u hi\u1ec7n t\u01b0\u01a1ng t\u1ef1 lao: ng\u01b0\u1eddi b\u1ec7nh c\u00f3 s\u1ed1t, ho \u0111\u00e0m, s\u1ee5t c\u00e2n. X quang c\u00f3 th\u00e2m nhi\u1ec5m th\u00f9y tr\u00ean.<\/p>\n<h2><strong>4. \u0110i\u1ec1u tr\u1ecb b\u1ec7nh melioidosis:<\/strong><\/h2>\n<p>Ch\u1ec9 \u0111\u1ecbnh nh\u1eadp vi\u1ec7n: \u0111i\u1ec1u tr\u1ecb t\u1ea1i khoa h\u00f4 h\u1ea5p ho\u1eb7c khoa h\u1ed3i s\u1ee9c n\u1ebfu vi\u00eam ph\u1ed5i m\u1ee9c \u0111\u1ed9 n\u1eb7ng. \u0110\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a b\u1ec7nh theo c\u00e1c thang \u0111i\u1ec3m: ATS\/IDSA 2007, SMART-COP, CURB-65, PSI.<\/p>\n<p>\u0110i\u1ec1u tr\u1ecb b\u1ec7nh melioidosis g\u1ed3m nhi\u1ec1u giai \u0111o\u1ea1n: \u0111i\u1ec1u tr\u1ecb t\u00edch c\u1ef1c ngay l\u00fac ch\u1ea9n \u0111o\u00e1n, c\u1ea5y m\u00e1u tr\u01b0\u1edbc khi s\u1eed d\u1ee5ng kh\u00e1ng sinh; \u0111i\u1ec1u tr\u1ecb ti\u1ec7t tr\u1eeb, \u0111i\u1ec1u tr\u1ecb b\u1ec7nh t\u00e1i ph\u00e1t v\u00e0 d\u1ef1 ph\u00f2ng sau ph\u01a1i nhi\u1ec5m.<\/p>\n<h3><strong>4.1. \u0110i\u1ec1u tr\u1ecb t\u00edch c\u1ef1c.<\/strong><\/h3>\n<p>L\u1ef1a ch\u1ecdn c\u00e1c kh\u00e1ng sinh:<\/p>\n<p>Meropenem \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch (IV), li\u1ec1u 25mg\/kg \u0111\u1ebfn 1g 3 l\u1ea7n\/ng\u00e0y, 50mg\/kg -2g x3 l\u1ea7n\/ng\u00e0y n\u1ebfu nhi\u1ec5m tr\u00f9ng th\u1ea7n kinh trung \u01b0\u01a1ng.<\/p>\n<p>Ceftazidime IV: 50mg\/kg &#8211; 2g m\u1ed7i 6h. Ho\u1eb7c truy\u1ec1n li\u00ean t\u1ee5c 6g\/d.<\/p>\n<p>Trimethoprim- sulfamethoxazole: 320\/1600mg 2 l\u1ea7n\/ng\u00e0y, acid folic (0.1mg\/kg &#8211; 5mg \u1edf tr\u1ebb em) 1 l\u1ea7n\/ng\u00e0y trong tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh n\u1eb7ng.<\/p>\n<p>Th\u1eddi gian \u0111i\u1ec1u tr\u1ecb: 10 &#8211; 14 ng\u00e0y trong vi\u00eam ph\u1ed5i\/nhi\u1ec5m tr\u00f9ng da\/nhi\u1ec5m tr\u00f9ng huy\u1ebft to\u00e0n th\u00e2n.<\/p>\n<p>D\u00f9ng \u0111\u01b0\u1eddng IV trong 4 &#8211; 8 tu\u1ea7n n\u1ebfu b\u1ec7nh n\u1eb7ng ho\u1eb7c l\u00e2m s\u00e0ng x\u1ea5u \u0111i ho\u1eb7c vi\u00eam ph\u1ed5i c\u00f3 bi\u1ebfn ch\u1ee9ng, nhi\u1ec5m tr\u00f9ng s\u00e2u, nhi\u1ec5m tr\u00f9ng x\u01b0\u01a1ng kh\u1edbp, th\u1ea7n kinh trung \u01b0\u01a1ng.<\/p>\n<p>\u0110i\u1ec1u tr\u1ecb h\u1ed7 tr\u01a1: c\u1eaft l\u1ecdc r\u1eeda, d\u1eabn l\u01b0u n\u1ebfu v\u1ecb tr\u00ed sang th\u01b0\u01a1ng kh\u00f3 th\u1ea5m nh\u1eadp kh\u00e1ng sinh.<\/p>\n<h3><strong>4.2. \u0110i\u1ec1u tr\u1ecb ti\u1ec7t tr\u1eeb.<\/strong><\/h3>\n<p>Kh\u1edfi \u0111\u1ea7u ngay sau \u0111i\u1ec1u tr\u1ecb t\u00edch c\u1ef1c \u0111\u1ec3 ph\u00f2ng t\u00e1i ph\u00e1t.<\/p>\n<p>Kh\u00e1ng sinh: Trimethoprim- sulfamethoxazole: 320\/1600mg 2 l\u1ea7n\/ng\u00e0y. Doxicycline n\u1ebfu kh\u00f4ng d\u1ee5ng n\u1ea1p ho\u1eb7c t\u00e1c d\u1ee5ng kh\u00f4ng mon g mu\u1ed1n.<\/p>\n<p>Amoxicillin\/clavulanic l\u00e0 thu\u1ed1c h\u00e0ng 3 n\u1ebfu \u0111i\u1ec1u tr\u1ecb th\u1ea5t b\u1ea1i ho\u1eb7c t\u00e1i ph\u00e1t.<\/p>\n<p>Th\u1eddi gian \u0111i\u1ec1u tr\u1ecb 3 -6 th\u00e1ng t\u00f9y \u0111\u00e1p \u1ee9ng l\u00e2m s\u00e0ng.<\/p>\n<p>Theo d\u00f5i: tu\u00e2n th\u1ee7 c\u1ee7a b\u1ec7nh nh\u00e2n, huy\u1ebft h\u1ecdc, sinh h\u00f3a, d\u1ea5u \u1ea5n c\u1ee7a b\u1ec7nh.<\/p>\n<h3><strong>4.3. \u0110i\u1ec1u tr\u1ecb t\u00e1i ph\u00e1t.<\/strong><\/h3>\n<p>X\u00e1c \u0111\u1ecbnh nguy\u00ean nh\u00e2n t\u00e1i ph\u00e1t.<\/p>\n<p>Th\u1eed l\u1ea1i \u0111\u1ed9 nh\u1ea1y c\u1ea3m v\u1edbi kh\u00e1ng sinh (kh\u00e1ng sinh \u0111\u1ed3).<\/p>\n<p>B\u1eaft \u0111\u1ea7u l\u1ea1i pha \u0111i\u1ec1u tr\u1ecb t\u00edch c\u1ef1c.<\/p>\n<h3><strong>4.4. \u0110i\u1ec1u tr\u1ecb d\u1ef1 ph\u00f2ng sau ph\u01a1i nhi\u1ec5m.<\/strong><\/h3>\n<p>X\u00e9t nghi\u1ec7m l\u1ea1i, \u0111\u00e1nh gi\u00e1 s\u1ef1 c\u1ea7n thi\u1ebft c\u1ee7a d\u1ef1 ph\u00f2ng.<\/p>\n<p>Kh\u00e1ng sinh: Trimethoprim- sulfamethoxazole: 320\/1600mg 2 l\u1ea7n\/ng\u00e0y.<\/p>\n<p>Amoxicillin\/Clavuclanic 875\/125 3 2 l\u1ea7n\/ng\u00e0y.<\/p>\n<p>\u0110i\u1ec1u tr\u1ecb 21 ng\u00e0y, theo d\u00f5i d\u1ea5u hi\u1ec7u nhi\u1ec5m tr\u00f9ng.<\/p>\n<h2><strong>5. Ti\u00ean l\u01b0\u1ee3ng b\u1ec7nh melioidosis.<\/strong><\/h2>\n<p>T\u1ec9 l\u1ec7 t\u1eed vong to\u00e0n c\u1ea7u c\u1ee7a b\u1ec7nh melioidosis c\u1ea5p 20 &#8211; 50%. T\u1ec9 l\u1ec7 c\u00f3 th\u1ec3 cao h\u01a1n \u1edf c\u00e1c n\u01b0\u1edbc \u0111ang ph\u00e1t tri\u1ec3n. K\u1ebft c\u1ee5c li\u00ean quan v\u1edbi m\u1ed9t s\u1ed1 y\u1ebfu t\u1ed1 nh\u01b0 nh\u1eadn di\u1ec7n s\u1edbm\/mu\u1ed9n, kh\u00e1ng sinh ph\u00f9 h\u1ee3p v\u00e0 b\u1ec7nh n\u1ec1n. Trong \u0111\u00f3 b\u1ec7nh \u0111\u1ed3ng m\u1eafc c\u1ee7a k\u00ed ch\u1ee7 l\u00e0 y\u1ebfu t\u1ed1 quy\u1ebft \u0111\u1ecbnh \u0111\u1ed9 n\u1eb7ng c\u1ee7a b\u1ec7nh.<\/p>\n<p>T\u00e0i li\u1ec7u tham kh\u1ea3o:<\/p>\n<p class=\"heading-title\">Melioidosis: An updated review. Aust J Gen Pract . 2019 May;48(5):327-332.<\/p>\n<p>B\u1ec7nh melioidosis \u1edf Vi\u1ec7t Nam: Nh\u01b0ng n\u1ed5 l\u1ef1c n\u00e2ng cao hi\u1ec7u qu\u1ea3 ch\u1ea9n \u0111o\u00e1n v\u00e0 d\u1ef1 ph\u00f2ng. T\u1ea1p ch\u00ed khoa h\u1ecdc v\u00e0 c\u00f4ng ngh\u1ec7 Vi\u1ec7t Nam.<\/p>\n<p>Severity assessment in melioidosis pneumonia: what is the most appropriate score or factor?<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Melioidosis (hay c\u00f2n g\u1ecdi b\u1ec7nh Whitmore) g\u00e2y ra do nhi\u1ec5m tr\u1ef1c khu\u1ea9n gram \u00e2m Burkholderia pseudomallei. B\u1ec7nh c\u00f3 bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng \u0111a d\u1ea1ng t\u1eeb vi\u00eam ph\u1ed5i c\u00f3 th\u1ec3 k\u00e8m nhi\u1ec5m tr\u00f9ng da t\u1edbi b\u1ec7nh lan t\u1ecfa nh\u01b0 nhi\u1ec5m tr\u00f9ng huy\u1ebft n\u1eb7ng. Vi\u1ec7t Nam l\u00e0 v\u00f9ng d\u1ecbch l\u01b0u h\u00e0nh c\u1ee7a b\u1ec7nh, g\u1ea7n \u0111\u00e2y t\u1ec9 l\u1ec7 [&hellip;]<\/p>\n","protected":false},"author":69,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[20,33],"tags":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v20.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Melioidosis, m\u1ed9t nguy\u00ean nh\u00e2n \u0111\u1eb7c bi\u1ec7t c\u1ee7a vi\u00eam ph\u1ed5i - Vinmec<\/title>\n<meta name=\"description\" content=\"Melioidosis (Whitmore) g\u00e2y ra do vi khu\u1ea9n B.pseudomallei. 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