{"id":27191,"date":"2023-04-23T22:55:31","date_gmt":"2023-04-23T15:55:31","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=27191"},"modified":"2023-04-23T22:55:31","modified_gmt":"2023-04-23T15:55:31","slug":"viem-nao-mang-nao-do-naegleria-fowleri-chan-doan-va-dieu-tri","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/23\/viem-nao-mang-nao-do-naegleria-fowleri-chan-doan-va-dieu-tri\/","title":{"rendered":"Vi\u00eam n\u00e3o, m\u00e0ng n\u00e3o do Naegleria fowleri: Ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb"},"content":{"rendered":"

B\u1ec7nh vi\u00eam n\u00e3o m\u00e0ng n\u00e3o do \u0111\u01a1n b\u00e0o d\u1ea1ng amip\u00a0Naegleria fowleri<\/i>\u00a0<\/a>l\u00e0 b\u1ec7nh nhi\u1ec5m tr\u00f9ng c\u1ea5p t\u00ednh h\u1ec7 th\u1ea7n kinh trung \u01b0\u01a1ng. \u0110\u01a1n b\u00e0o s\u1ed1ng trong m\u00f4i tr\u01b0\u1eddng n\u01b0\u1edbc ng\u1ecdt, x\u00e2m nh\u1eadp v\u00e0o ni\u00eam m\u1ea1c m<\/span>\u0169i, qua c\u00e1c \u0111\u00e1m r\u1ed1i th<\/span>\u1ea7n kinh d\u01b0\u1edbi ni\u00eam m\u1ea1c \u0111<\/span>\u1ec3\u00a0v\u00e0o n\u00e3o, g\u00e2y n\u00ean t\u00ecnh tr\u1ea1ng vi\u00eam v\u00e0 t<\/span>\u1ed5n th\u01b0\u01a1ng c\u00e1c t\u1ebf b\u00e0o n<\/span>\u00e3o. <\/span>B\u1ec7nh ph\u00e1t tri\u1ec3n nhanh ch\u00f3ng trong v\u00f2ng v\u00e0i ng\u00e0y sau khi b\u1ecb l\u00e2y nhi\u1ec5m v\u00e0 th\u01b0\u1eddng g\u00e2y t\u1eed vong trong v\u00f2ng 1 -2 tu\u1ea7n sau khi m<\/span>\u1eafc b\u1ec7nh<\/span>. Ph\u00f2ng b\u1ec7nh l\u00e0 bi\u1ec7n ph\u00e1p t\u1ed1t nh\u1ea5t \u0111<\/span>\u1ec3\u00a0gi\u1ea3m t\u1ec9 l\u1ec7 m\u1eafc v\u00e0 t\u1eed vong.<\/span><\/strong><\/p>\n

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B\u1ec7nh vi\u00eam n\u00e3o m\u00e0ng n\u00e3o do \u0111\u01a1n b\u00e0o d\u1ea1ng amip\u00a0Naegleria fowleri<\/i>\u00a0<\/span><\/figcaption><\/figure>\n

 <\/p>\n

1. T\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh<\/h2>\n

\u0110\u01a1n b\u00e0o d\u1ea1ng amip\u00a0N. fowleri<\/i>\u00a0s\u1ed1ng trong m\u00f4i tr\u01b0\u1eddng n\u01b0\u1edbc ng\u1ecdt n\u00f3ng\u00a0<\/span>\u1ea9m t\u1ef1 nhi\u00ean nh\u01b0 trong c\u00e1c ao h\u1ed3, s\u00f4ng ng\u00f2i…\u00a0N. fow<\/i><\/span>l<\/i>eri<\/span><\/i>\u00a0b<\/span>\u1ec1n v\u1edbi nhi\u1ec7t v\u00e0 c\u00f3 th<\/span>\u1ec3\u00a0t\u1ed3n t\u1ea1i \u1edf nhi\u1ec7t \u0111\u1ed9 l\u00ean \u0111\u1ebfn 46\u00b0<\/span>C.<\/span><\/p>\n

V\u00f2ng \u0111\u1eddi c\u1ee7a\u00a0N. fow<\/i><\/span>l<\/i>eri<\/span><\/i>\u00a0c\u00f3 3 giai \u0111o\u1ea1n: giai \u0111o\u1ea1n t\u1ef1 d\u01b0<\/span>\u1ee1ng, giai \u0111o\u1ea1n t\u1ea1o roi v\u00e0\u00a0<\/span>giai \u0111o\u1ea1n b\u00e0o nang, trong \u0111\u00f3 th\u1ec3 t\u1ef1 d\u01b0<\/span>\u1ee1ng l\u00e0 th<\/span>\u1ec3\u00a0g\u00e2y b\u1ec7nh cho ng\u01b0\u1eddi.<\/span><\/p>\n

M\u1ed9t s\u1ed1 nguy c\u01a1 ti\u1ebfp x\u00fac v\u1edbi Naegleria fowleri bao g\u1ed3m b\u01a1i l\u1ed9i, \u0111\u00e1nh c\u00e1, t\u1eafm ho\u1eb7c ti\u1ebfp x\u00fac v\u1edbi n\u01b0\u1edbc trong khu v\u1ef1c c\u00f3 m\u1ef1c n\u01b0\u1edbc th\u1ea5p, ho\u1eb7c s\u1eed d\u1ee5ng n\u01b0\u1edbc m\u00e1y kh\u00f4ng \u0111\u01b0\u1ee3c s\u00e1t khu\u1ea9n \u0111\u1ea7y \u0111\u1ee7. Tuy nhi\u00ean, Naegleria fowleri kh\u00f4ng g\u00e2y nhi\u1ec5m tr\u00f9ng khi u\u1ed1ng n\u01b0\u1edbc ch\u1ee9a vi khu\u1ea9n n\u00e0y, m\u00e0 ch\u1ec9 khi n\u01b0\u1edbc \u0111\u01b0\u1ee3c h\u00edt v\u00e0o m\u0169i ho\u1eb7c ti\u1ebfp x\u00fac v\u1edbi ni\u00eam m\u1ea1c m\u0169i ho\u1eb7c h\u1ecdng.<\/p>\n

2. Ch\u1ea9n \u0111o\u00e1n<\/h2>\n

Ch\u1ea9n \u0111o\u00e1n d\u1ef1a tr\u00ean c\u00e1c y\u1ebfu t\u1ed1 d\u1ecbch t\u1ec5, b\u1ec7nh c\u1ea3nh l\u00e2m s\u00e0ng v\u00e0 x\u00e9t nghi\u1ec7m<\/span><\/p>\n

2.1. Y\u1ebfu t\u1ed1 d\u1ecbch t\u1ec5:<\/span><\/b><\/h3>\n

C\u00f3 ti\u1ec1n s\u1eed ph\u01a1i nhi\u1ec5m v\u1edbi ngu\u1ed3n n\u01b0\u1edbc ng\u1ecdt, n\u01b0\u1edbc \u1ea5m t\u1ef1 nhi\u00ean b\u1ecb nhi\u1ec5m \u0111\u01a1n b<\/span>\u00e0o\u00a0N.\u00a0<\/i><\/span>f<\/i>o<\/span>w<\/i>leri<\/span><\/i>\u00a0trong v\u00f2ng 1 tu<\/span>\u1ea7n tr\u01b0<\/span>\u1edbc khi b\u1ec7nh kh<\/span>\u1edfi ph<\/span>\u00e1t.<\/span><\/p>\n

2.2. <\/b>L\u00e2m s\u00e0ng:<\/span><\/b><\/h3>\n

B\u1ec7nh bi\u1ec3u hi\u1ec7n c\u1ea5p t\u00ednh gi\u1ed1ng nh\u01b0 vi\u00eam n<\/span>\u00e3o, m\u00e0ng n\u00e3o v\u1edbi c\u00e1c tri\u1ec7u ch\u1ee9ng:<\/span><\/p>\n

–\u00a0S\u1ed1t cao li\u00ean t\u1ee5c<\/span><\/p>\n

–\u00a0\u0110au \u0111\u1ea7u, bu<\/span>\u1ed3n n\u00f4n v\u00e0 n\u00f4n<\/span><\/p>\n

–\u00a0H\u1ed9i ch\u1ee9ng m\u00e0ng n\u00e3o r\u00f5<\/span><\/p>\n

–\u00a0C\u00f3 th\u1ec3 li\u1ec7t c\u00e1c d\u00e2y th\u1ea7n kinh s\u1ecd: th\u01b0\u1eddng g\u1eb7p l\u00e0 li\u1ec7t d\u00e2y III, d\u00e2y IV, d\u00e2y VI. C\u00e1c tri\u1ec7u ch\u1ee9ng th\u01b0\u1eddng ti\u1ebfn tri\u1ec3n n\u1eb7ng l\u00ean nhanh ch\u00f3ng, d\u1eabn t\u1edbi co gi\u1eadt, r<\/span>\u1ed1i lo\u1ea1n \u00fd th\u1ee9c v\u00e0 h\u00f4n m\u00ea. Ph\u1ea7n l\u1edbn c\u00e1c tr\u01b0\u1eddng h\u1ee3p t\u1eed vong trong v\u00f2ng 1 tu<\/span>\u1ea7n t\u1eeb khi c\u00f3 tri\u1ec7u ch\u1ee9ng.<\/span><\/p>\n

2.3. <\/b>C\u1eadn l\u00e2m s\u00e0ng<\/span><\/b><\/h3>\n

a)\u00a0S\u1ed1 l\u01b0\u1ee3ng b\u1ea1ch c\u1ea7u m\u00e1u ngo\u1ea1i vi th\u01b0\u1eddng t\u0103ng, ch\u1ee7 y\u1ebfu l\u00e0 b\u1ea1ch c\u1ea7u \u0111a nh\u00e2n trung t\u00ednh.<\/span><\/p>\n

b)\u00a0D\u1ecbch n\u00e3o t\u1ee7y bi\u1ebfn \u0111\u1ed5i gi\u1ed1ng nh\u01b0 vi\u00eam m\u00e0ng n\u00e3o m\u1ee7<\/span><\/p>\n

–\u00a0T\u0103ng protein, glucose gi\u1ea3m, ph\u1ea3n \u1ee9ng Pandy d\u01b0\u01a1ng t\u00ednh.<\/span><\/p>\n

–\u00a0B\u1ea1ch c\u1ea7u t\u0103ng cao, th\u01b0\u1eddng tr\u00ean 500 t\u1ebf b\u00e0o\/mm3<\/sup>, b\u1ea1ch c\u1ea7u \u0111a nh\u00e2n trung t\u00ednh chi\u1ebfm \u01b0u th\u1ebf, c\u00f3 th<\/span>\u1ec3\u00a0th<\/span>\u1ea5y h\u1ed3ng c<\/span>\u1ea7u.<\/span><\/p>\n

c)\u00a0X\u00e9t nghi\u1ec7m vi sinh:<\/span><\/p>\n

–\u00a0Soi t\u01b0\u01a1i d\u1ecbch n\u00e3o t\u1ee7y (kh\u00f4ng ly t\u00e2m): h\u00ecnh \u1ea3nh \u0111\u01a1n b\u00e0o d\u1ea1ng amip, c\u00f3 ch\u00e2n gi\u1ea3 v\u00e0 m\u1ed9t nh\u00e2n l\u1edbn n\u1eb1m \u1edf trung t\u00e2m. C\u00f3 th\u1ec3 nhu\u1ed9m Giemsa-Wright.<\/span><\/p>\n

–\u00a0PCR: PCR ho\u1eb7c realtime PCR \u0111\u1eb7c hi\u1ec7u cho\u00a0N.\u00a0<\/i><\/span>f<\/i>o<\/span>w<\/i>leri\u00a0<\/span><\/i>\u0111\u01b0\u1ee3c d\u00f9ng \u0111<\/span>\u1ec3\u00a0x\u00e1c \u0111\u1ecbnh nhanh am\u00edp n\u00e0y v\u1edbi \u0111\u1ed9 nh\u1ea1y v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u cao.<\/span><\/p>\n

–\u00a0Nu\u00f4i c\u1ea5y d\u1ecbch n\u00e3o t\u1ee7y: t\u00ecm\u00a0N.fowleri<\/i>\u00a0n<\/span>\u1ebfu c\u00f3 \u0111i<\/span>\u1ec1u ki\u1ec7n.<\/span><\/p>\n

2.4. <\/b>Ch<\/span>\u1ea9<\/b>n \u0111o\u00e1n ph\u00e2n bi\u1ec7t<\/span><\/b><\/h3>\n

C<\/span>\u1ea7n ph\u00e2n bi\u1ec7t v\u1edbi vi\u00eam m\u00e0ng n\u00e0o do vi khu<\/span>\u1ea9n.<\/span><\/p>\n

3. \u0110i\u1ec1u tr\u1ecb<\/h2>\n

3.1. <\/b>Nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb:<\/span><\/b><\/h3>\n

–\u00a0\u0110i\u1ec1u tr\u1ecb ngay b<\/span>\u1eb1ng thu\u1ed1c \u0111\u1eb7c hi\u1ec7u v\u00e0 corticosteroids khi nghi ng\u1edd c\u00f3 nhi\u1ec5m \u0111\u01a1n b\u00e0o\u00a0N.\u00a0<\/i><\/span>F<\/i>o<\/span>w<\/i>leri\u00a0<\/span><\/i>trong d\u1ecbch n\u00e0o t\u1ee7y.<\/span><\/p>\n

–\u00a0H\u1ed7 tr\u1ee3 h\u00f4 h\u1ea5p tu\u1ea7n ho\u00e0n.<\/span><\/p>\n

3.2. <\/b>\u0110i\u1ec1u tr\u1ecb c\u1ee5 th<\/span>\u1ec3<\/b>:<\/span><\/b><\/h3>\n

3.2.1. <\/i><\/b>Thu\u1ed1c \u0111i\u1ec1u tr\u1ecb N.\u00a0<\/span>f<\/i><\/b>o<\/span>w<\/i><\/b>leri<\/span><\/i><\/b><\/h4>\n

–\u00a0Amphotericin B ph\u1ed1i h\u1ee3p v\u1edbi Rifampicin:<\/span><\/p>\n

+ Amphotericin B: truy\u1ec1n t\u0129nh m\u1ea1ch, li\u1ec1u 1,5 mg\/kg\/ng\u00e0y chia th\u00e0nh 2 li<\/span>\u1ec1u trong 3 ng\u00e0y \u0111\u1ea7u, sau \u0111\u00f3 1 mg\/kg\/ng\u00e0y trong 6 ng\u00e0<\/span>y\u00a0ti<\/span>\u1ebfp theo.<\/span><\/p>\n

+ Ri<\/span>fampicin:\u00a0<\/span>10mg\/k<\/span>g\/n<\/span>g\u00e0y u\u1ed1n<\/span>g\u00a0m\u1ed7i 24\u00a0<\/span>gi\u1edd.<\/span><\/p>\n

–\u00a0Dexamethasone 0,4mg\/kg ti\u00eam t\u0129nh m\u1ea1ch m\u1ed7i 6 gi\u1edd, trong 2 ng\u00e0y.<\/span><\/p>\n

–\u00a0C\u00f3 th<\/span>\u1ec3\u00a0c\u00e2n nh<\/span>\u1eafc ph<\/span>\u1ed1i h\u1ee3p v\u1edbi nh<\/span>\u00f4m imi<\/span>dazole, bao g\u1ed3m miconazole v\u00e0 fluconazole.<\/span><\/p>\n

3.2.2. <\/i><\/b>\u0110i\u1ec1u tr\u1ecb h\u1ed7 tr\u1ee3:<\/span><\/i><\/b><\/h4>\n

–\u00a0H\u1ed7 tr\u1ee3 h\u00f4 h\u1ea5p: \u0110\u1ea3m b\u1ea3o oxy ho\u00e1 m\u00e1u (Sp<\/span>O2<\/span><\/sub>\u00a0> 92%) b\u1eb1ng th\u1edf oxy ho\u1eb7c th\u00f4ng kh\u00ed nh\u00e2n t\u1ea1o.<\/span><\/p>\n

–\u00a0Ch\u1ed1ng co gi\u1eadt.<\/span><\/p>\n

–\u00a0\u0110\u1ea3m b\u1ea3o huy\u1ebft \u0111\u1ed9ng, \u0111i<\/span>\u1ec1u ch<\/span>\u1ec9nh r\u1ed1i lo\u1ea1n \u0111i\u1ec7n gi\u1ea3i v\u00e0 th\u0103n<\/span>g\u00a0b\u1eb1ng ki\u1ec1m toan.<\/span><\/p>\n

–\u00a0Ch\u0103m s\u00f3c v\u00e0 dinh d\u01b0\u1ee1ng<\/span><\/p>\n

4. Ph\u00f2ng b\u1ec7nh<\/h2>\n

–\u00a0<\/i>N.fowleri<\/span><\/i>\u00a0r\u1ea5t nh\u1ea1y c\u1ea3m v\u1edbi clo, n\u00ean kh\u1eed tr\u00f9ng c\u00e1c h\u1ed3 b\u01a1i \u0111\u1ea7y \u0111\u1ee7 b\u1eb1ng clo.<\/span><\/p>\n

–\u00a0Trong tr\u01b0\u1eddng h\u1ee3p c\u00f3 tham gia v\u00e0o c\u00e1c ho\u1ea1t \u0111\u1ed9ng\u00a0<\/span>\u1edf\u00a0d\u01b0\u1edbi n\u01b0\u1edbc, n\u00ean tr\u00e1nh \u0111\u1ec3 n\u01b0\u1edbc x\u00e2m nh\u1eadp v\u00e0o m<\/span>\u0169i.<\/span><\/p>\n

–\u00a0Kh\u00f4ng t<\/span>\u1eafm v\u00e0 l\u1eb7n ng\u1ee5p \u1edf ao h\u1ed3 n\u01a1i c\u00f3 ngu\u1ed3n n\u01b0\u1edbc kh\u00f4ng \u0111\u1ea3m b\u1ea3o v\u1ec7 sinh.<\/span><\/p>\n

–\u00a0N\u00ean c\u1ea3nh b\u00e1o t\u1ea1i \u0111\u1ecba \u0111i\u1ec3m n\u00e0o \u0111\u00f3 n\u1ebfu \u0111<\/span>\u00e3\u00a0x\u1ea3y ra m\u1ed9t tr\u01b0\u1eddng h\u1ee3p vi\u00eam n\u00e3o, m\u00e0ng n\u00e3o do \u0111\u01a1n b\u00e0o\u00a0N.\u00a0<\/i><\/span>f<\/i>o<\/span>w<\/i>leri<\/span>.<\/i><\/p>\n

–\u00a0V\u1ec7 sinh m\u0169i s\u1ea1ch s\u1ebd sau khi c\u00f3 nh\u1eefng ho\u1ea1t \u0111\u1ed9ng, d\u01b0\u1edbi n\u01b0\u1edbc. Kh\u00f4ng r\u1eeda m\u0169i xoang b\u1eb1ng c\u00e1c dung d\u1ecbch t\u1ef1 pha ch\u1ebf.<\/span><\/p>\n

–\u00a0Khi c\u00f3 bi<\/span>\u1ec3u hi\u1ec7n tri\u1ec7u ch\u1ee9ng, \u0111<\/span>\u1ebfn kh\u00e1m ngay t\u1ea1i b\u1ec7nh vi\u1ec7n \u0111\u1ec3 \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi.<\/span><\/p>\n

Ch\u1ea9n \u0111o\u00e1n s\u1edbm v\u00e0 \u0111i\u1ec1u tr\u1ecb nhanh ch\u00f3ng l\u00e0 r\u1ea5t quan tr\u1ecdng trong vi\u1ec7c \u0111i\u1ec1u tr\u1ecb b\u1ec7nh vi\u00eam n\u00e3o v\u00e0 m\u00e0ng n\u00e3o do Naegleria fowleri. Tuy nhi\u00ean, b\u1ec7nh n\u00e0y th\u01b0\u1eddng \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n kh\u00f3 kh\u0103n v\u00ec c\u00e1c tri\u1ec7u ch\u1ee9ng ban \u0111\u1ea7u r\u1ea5t t\u01b0\u01a1ng \u0111\u1ed3ng v\u1edbi c\u00e1c b\u1ec7nh nhi\u1ec5m tr\u00f9ng kh\u00e1c, nh\u01b0 s\u1ed1t, \u0111au \u0111\u1ea7u, bu\u1ed3n n\u00f4n v\u00e0 n\u00f4n. Kh\u00f4ng nh\u1eefng v\u1eady, b\u1ec7nh n\u00e0y c\u00f3 t\u1ef7 l\u1ec7 t\u1eed vong r\u1ea5t cao, th\u01b0\u1eddng v\u01b0\u1ee3t qu\u00e1 95%. Do \u0111\u00f3 vi\u1ec7c ph\u00f2ng ng\u1eeba b\u1ec7nh l\u00e0 r\u1ea5t quan tr\u1ecdng. Vi\u1ec7c tr\u00e1nh ti\u1ebfp x\u00fac v\u1edbi n\u01b0\u1edbc ng\u1ecdt c\u00f3 ch\u1ee9a vi khu\u1ea9n Naegleria fowleri v\u00e0 s\u1eed d\u1ee5ng m\u0169 b\u1ea3o v\u1ec7 khi b\u01a1i l\u1ed9i ho\u1eb7c c\u00e1c ho\u1ea1t \u0111\u1ed9ng li\u00ean quan \u0111\u1ebfn n\u01b0\u1edbc, v\u1ec7 sinh m\u0169i s\u1ea1ch s\u1ebd c\u0169ng l\u00e0 nh\u1eefng bi\u1ec7n ph\u00e1p ph\u00f2ng ng\u1eeba quan tr\u1ecdng.<\/p>\n

Ngu\u1ed3n tham kh\u1ea3o: B\u1ed9 Y t\u1ebf<\/p>\n","protected":false},"excerpt":{"rendered":"

B\u1ec7nh vi\u00eam n\u00e3o m\u00e0ng n\u00e3o do \u0111\u01a1n b\u00e0o d\u1ea1ng amip\u00a0Naegleria fowleri\u00a0l\u00e0 b\u1ec7nh nhi\u1ec5m tr\u00f9ng c\u1ea5p t\u00ednh h\u1ec7 th\u1ea7n kinh trung \u01b0\u01a1ng. \u0110\u01a1n b\u00e0o s\u1ed1ng trong m\u00f4i tr\u01b0\u1eddng n\u01b0\u1edbc ng\u1ecdt, x\u00e2m nh\u1eadp v\u00e0o ni\u00eam m\u1ea1c m\u0169i, qua c\u00e1c \u0111\u00e1m r\u1ed1i th\u1ea7n kinh d\u01b0\u1edbi ni\u00eam m\u1ea1c \u0111\u1ec3\u00a0v\u00e0o n\u00e3o, g\u00e2y n\u00ean t\u00ecnh tr\u1ea1ng vi\u00eam v\u00e0 t\u1ed5n th\u01b0\u01a1ng c\u00e1c […]<\/p>\n","protected":false},"author":5,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[10,33],"tags":[],"yoast_head":"\nVi\u00eam n\u00e3o, m\u00e0ng n\u00e3o do Naegleria fowleri: Ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb<\/title>\n<meta name=\"description\" content=\"B\u1ec7nh vi\u00eam n\u00e3o m\u00e0ng 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