{"id":29009,"date":"2023-04-29T14:00:53","date_gmt":"2023-04-29T07:00:53","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=29009"},"modified":"2023-04-29T14:00:53","modified_gmt":"2023-04-29T07:00:53","slug":"tim-hieu-ve-viem-mang-nao-do-cryptococcus-neoformans","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/29\/tim-hieu-ve-viem-mang-nao-do-cryptococcus-neoformans\/","title":{"rendered":"T\u00ecm hi\u1ec3u v\u1ec1 vi\u00eam m\u00e0ng n\u00e3o do Cryptococcus Neoformans"},"content":{"rendered":"

Theo y v\u0103n, d\u01b0\u1eddng nh\u01b0 Hansemans (1906), Verse (1914) l\u00e0 nh\u1eefng t\u00e1c gi\u1ea3 \u0111\u00e3 t\u00ecm th\u1ea5y Cryptococcus Neoformans<\/a> trong b\u1ec7nh vi\u00eam m\u00e0ng n\u00e3o. T\u1eeb \u0111\u00f3 \u0111\u1ebfn nay, b\u1ec7nh \u0111\u01b0\u1ee3c mang t\u00ean vi\u00eam m\u00e0ng n\u00e3o Cryptococcus Neoformans (Cryptoccocal meningitis).\u00a0 C. neoformans l\u00e0 m\u1ed9t lo\u1ea1i vi n\u1ea5m h\u1ea1t men, t\u0103ng tr\u01b0\u1edfng theo ki\u1ec3u n\u1ea9y b\u00fap. L\u00e2m s\u00e0ng c\u1ee7a b\u1ec7nh c\u00f3 \u0111\u1eb7c \u0111i\u1ec3m l\u00e0 di\u1ec5n ti\u1ebfn b\u00e1n c\u1ea5p; m\u1ed9t gian \u0111o\u1ea1n d\u00e0i b\u1ec7nh nh\u00e2n kh\u00f4ng nh\u1eadp vi\u1ec7n; l\u00e2m s\u00e0ng t\u01b0\u01a1ng t\u1ef1 nh\u01b0 vi\u00eam m\u00e0ng n\u00e3o lao hay kh\u00f3 ph\u00e2n bi\u1ec7t m\u1ed9t u n\u00e3o. Cho \u0111\u1ebfn nay, vi\u1ec7c ch\u1ea9n \u0111o\u00e1n, \u0111i\u1ec1u tr\u1ecb v\u1eabn c\u00f2n l\u00e0 v\u1ea5n \u0111\u1ec1 ph\u1ee9c t\u1ea1p v\u00e0 kh\u00f3 kh\u0103n.<\/strong><\/p>\n

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Vi\u00eam m\u00e0ng n\u00e3o do Cryptococcus Neoformans<\/figcaption><\/figure>\n

1. D\u1ecbch t\u1ec5 h\u1ecdc<\/h2>\n

1.1. Vi n\u1ea5m h\u1ecdc<\/h3>\n

C. neoformans l\u00e0 m\u1ed9t lo\u1ea1i n\u1ea5m men h\u00ecnh \u01b0\u00f2n, \u0111\u00f4i khi c\u1ed1 h\u00ecnh b\u1ea7u d\u1ee5c; sinh s\u1ea3n b\u1eb1ng ph\u01b0\u01a1ng ph\u00e1p n\u1ea9y b\u00fap \u1edf b\u1ea5t k\u1ef3 v\u1ecb tr\u00ed n\u00e0o. T \u1ebf b\u00e0o n\u1ea5m \u0111\u01b0\u1ee3c bao b\u1ecdc b\u1edfi l\u1edbp v\u1ecf<\/p>\n

mucopolysaccharide c\u00f3 th\u1ec3 m\u1ecfng hay d\u00e0y g\u1ea5p \u0111\u00f4i b\u00e1n k\u00ednh t\u1ebf b\u00e0o. c. neoformans m\u1ecdc d\u1ec5 d\u00e0ng tr\u00ean c\u00e1c m\u00f4i tr\u01b0\u1eddng dinh d\u01b0\u1ee1ng, \u0111\u1eb7c bi\u1ec7t l\u00e0 m\u00f4i tr\u01b0\u1eddng Sabouroud- Glucosa, y\u1ebfm kh\u00ed v\u00e0 \u1edf nhi\u1ec7t \u0111\u1ed9 20-37\u00b0C.<\/p>\n

1.2. Ngu\u1ed3n nhi\u1ec5m<\/h3>\n

M\u1ed9t ngu\u1ed3n b\u1ec7nh ngo\u1ea1i sinh \u0111\u01b0\u1ee3c ch\u00fa \u00fd nh\u1ea5t trong nhi\u1ec1u th\u1eadp k\u1ef7 qua l\u00e0 t\u00ecm th\u1ea5y C. neoformans trong t\u1ed3 v\u00e0 ph\u00e2n chim b\u1ed3 c\u00e2u. Immons \u0111\u00e3 ph\u00e2n l\u1eadp \u0111\u01b0\u1ee3c nhi\u1ec1u d\u00f2ng n\u1ea5m C. <\/strong>neoformans trong ph\u00e2n l\u00e2u n\u0103m tr\u00ean s\u00e2n th\u01b0\u1ee3ng c\u00e1c cao \u1ed1c, c\u00e1c ng\u00f4i th\u00e1p hay trong c\u00e1c t\u1ed5 chim trong th\u00e0nh ph\u1ed1; \u1edf mi\u1ec1n qu\u00ea l\u00e0 c\u00e1c v\u1ef1a l\u00faa, v\u1ef1a c\u1ecf nh\u1ecf m\u00e0 chim b\u1ed3 c\u00e2u l\u00e0m t\u1ed5 hay c\u01b0 ng\u1ee5. Ph\u00e2n c\u0169 c\u1ee7a m\u1ed9t v\u00e0i lo\u1ea1i chim kh\u00e1c c\u0169ng c\u00f3 c\u00e1c lo\u1ea1i n\u1ea5m n\u00e0y (chim s\u1ebb, \u0111\u00e0 \u0111i\u1ec3u…).<\/p>\n

1.3. \u0110\u01b0\u1eddng l\u00e2y<\/h3>\n

Ng\u01b0\u1eddi b\u1ecb\u00a0<\/strong>nhi\u1ec5m C. <\/strong>neoformans ch\u1ee7 y\u1ebfu qua \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p, b\u1ee5i, m\u00f4i tr\u01b0\u1eddng \u00f4 nhi\u1ec5m ph\u00e2n chim b\u1ed3 c\u00e2u v\u0111i m\u1ea7m b\u1ec7nh c\u00f2n s\u1ed1ng v\u1edbi \u0111\u1ea7y \u0111\u1ee7 \u0111\u1ed9c l\u1ef1c.<\/p>\n

N\u1ea5m c\u00f2n x\u00e2m nh\u1eadp qua da hay \u0111\u01b0\u1eddng ti\u00eau h\u00f3a. Nh\u1eefng t\u1ed5n th\u01b0\u01a1ng \u1edf m\u1eb7t, m\u0169i ho\u1eb7c c\u00e1c t\u1ed5n th\u01b0\u01a1ng \u1edf da c\u0169ng c\u00f3 th\u1ec3 l\u00e0 ngu\u1ed3n truy\u1ec1n b\u1ec7nh c\u00f2n \u0111ang \u0111\u01b0\u1ee3c b\u00e0n c\u00e3i. Nhi\u1ec5m c . neoformans l\u00e0 b\u1ec7nh kh\u00f4ng l\u00e2y, ch\u01b0a c\u00f3 b\u1eb1ng ch\u1ee9ng n\u00e0o x\u00e1c nh\u1eadn \u0111\u01b0\u1eddng l\u00e2y tr\u1ef1c ti\u1ebfp t\u1eeb ng\u01b0\u1eddi qua ng\u01b0\u1eddi.<\/p>\n

1.4. Gi\u1ea3i ph\u1eabu b\u1ec7nh<\/h3>\n

Nhi\u1ec5m C. <\/strong>neoformans th\u01b0\u1eddng k\u00e8m theo t\u00ecnh tr\u1ea1ng ph\u1ea3n \u1ee9ng vi\u00eam y\u1ebfu, ngay c\u1ea3 tr\u01b0\u1eddng h\u1ee3p t\u1eed vong do vi\u00eam m\u00e0ng n\u00e3o n\u1ea5m. V\u1ec1\u00a0<\/strong>\u0111\u1ea1i th\u1ec3 g\u1ea7n nh\u01b0 b\u00ecnh th\u01b0\u1eddng; v\u1ec1 vi th\u1ec3 c\u00f3 hai d\u1ea1ng t\u1ed5n th\u01b0\u01a1ng:<\/p>\n

    \n
  • T\u1ed5n th\u01b0\u01a1ng m\u1edbi v\u1edbi d\u1ea1ng nh\u00e0y (gelatineous hay mucinous).<\/li>\n
  • T\u1ed5n th\u01b0\u01a1ng c\u0169 v\u1edbi d\u1ea1ng h\u1ea1t (granulomatous).<\/li>\n<\/ul>\n

    V\u1ecb tr\u00ed m\u00e0ng n\u00e3o th\u01b0\u1eddng b\u1ecb l\u00e0 v\u00f9ng \u0111\u00e1y s\u1ecd v\u00e0 l\u01b0ng ti\u1ec3u n\u00e3o, \u1edf \u0111\u00f3 m\u00e0ng n\u00e3o d\u00e0y l\u00ean. Khi m\u1ea7m b\u1ec7nh x\u00e2m l\u1ea5n v\u00e0o nhu m\u00f4 n\u00e3o l\u00e0m cho vi\u00eam n\u00e3o n\u1ea5m. L\u00fac \u0111\u00f3 ng\u01b0\u1eddi ta nh\u1eadn th\u1ea5y v\u00f9ng m\u00f4 n\u00e3o b\u1ecb b\u1ec7nh c\u00f3 nh\u1eefng \u0111\u00e1m nh\u1ecf d\u1ea1ng nang ph\u00e2n b\u1ed1 \u1edf v\u00f9ng ch\u1ea5t x\u00e1m v\u1ecf n\u00e3o hay c\u00e1c ch\u1ea5t x\u00e1m gian n\u00e3o, ch\u1ea5t tr\u1eafng ti\u1ec3u n\u00e3o.<\/p>\n

    2. L\u00e2m s\u00e0ng vi\u00eam m\u00e0ng n\u00e3o do Cryptococcus Neoformans<\/h2>\n

    B\u1ec7nh nhi\u1ec5m cryptococcus h\u1ec7 th\u1ea7n kinh trung \u01b0\u01a1ng l\u00e0 th\u1ec3 l\u00e2m s\u00e0ng th\u01b0\u1eddng g\u1eb7p nh\u1ea5t. T\u1eeb khi c\u00f3 Amphotericine B, vi\u1ec7c \u0111i\u1ec1u tr\u1ecb \u0111\u00e3 l\u00e0m thay \u0111\u1ed5i t\u1ef7 l\u1ec7 t\u1eed vong m\u00e0 tr\u01b0\u1edbc \u0111\u00e2y khi m\u1eafc b\u1ec7nh n\u00e0y t\u1ef7 l\u1ec7 s\u1ed1ng s\u00f3t th\u1eadt hi\u1ebfm hoi.<\/p>\n

    C\u00f3 hai th\u1ec3 l\u00e2m s\u00e0ng th\u01b0\u1eddng g\u1eb7p: vi\u00eam m\u00e0ng n\u00e3o, vi\u00eam n\u00e3o-m \u00e0ng n\u00e3o.<\/p>\n

    – Th\u1ec3 vi\u00eam m\u00e0ng n\u00e3o l\u00e0 th\u1ec3 th\u01b0\u1eddng g\u1eb7p h\u01a1n.<\/p>\n

      \n
    • Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng r\u1ea5t \u0111a d\u1ea1ng, xu\u1ea5t hi\u1ec7n t\u1eeb t\u1eeb hay \u0111\u1ed9t ng\u1ed9t.<\/li>\n
    • \u0110au \u0111\u1ea7u l\u00e0 tri\u1ec7u ch\u1ee9ng s\u1edbm v\u00e0 th\u01b0\u1eddng g\u1eb7p \u1edf t\u1ea5t c\u1ea3 c\u00e1c b\u1ec7nh nh\u00e2n; \u0111au c\u00f3 th\u1ec3 \u1edf v\u00f9ng tr\u00e1n, th\u00e1i d\u01b0\u01a1ng hay \u1edf h\u1ed1c m\u1eaft. \u0110au t\u00e1i \u0111i t\u00e1i l\u1ea1i hay ng\u1eaft qu\u00e3ng v\u00e0 ng\u00e0y c\u00e0ng n\u1eb7ng, k\u00e9o d\u00e0i trong nhi\u1ec1u tu\u1ea7n.<\/li>\n
    • Th\u1eddi\u00a0\u00a0 gian v\u1ec1 sau c\u00e0ng d\u00e0i c\u00e0ng\u00a0\u00a0 xu\u1ea5t hi\u1ec7n nh\u1eefng tri\u1ec7u ch\u1ee9ng kh\u00e1c, s\u1ed1 t c\u0169ng th\u01b0\u1eddng th\u1ea5y, s\u1ed1t nh\u1eb9 38-38,5\u00b0c. S\u1ed1 t c\u0169ng r\u1ea5t th\u1ea5t th\u01b0\u1eddng trong ng\u00e0y; m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p kh\u00e1c th\u00e2n nhi\u1ec7t b\u00ecnh th\u01b0\u1eddng.<\/li>\n
    • D\u1ea5u hi\u1ec7u m\u00e0ng n\u00e3o nh\u01b0 c\u1ee9ng g\u00e1y, d\u1ea5u Brudzinski v\u00e0 Kemig c\u0169ng th\u01b0\u1eddng g\u1eb7p. D\u1ea5u hi\u1ec7\u1ee5 m\u1eaft: nh\u00ecn \u0111\u00f4i, gi\u1ea3m th\u1ecb l\u1ef1c, th\u1ecb tr\u01b0\u1eddng b\u1ecb thu h\u1eb9p, nystagmus, s\u1ee3 \u00e1nh s\u00e1ng, ph\u00f9 gai th\u1ecb.<\/li>\n
    • \u1ede giai \u0111o\u1ea1n mu\u1ed9n h\u01a1n xu\u1ea5t hi\u1ec7n c\u00e1c tri\u1ec7u ch\u1ee9ng t\u00e2m th\u1ea7n: r\u1ed1i lo\u1ea1n v\u1ec1 kh\u00ed s\u1eafc, bu\u1ed3n r\u1ea7u, lo l\u1eafng; c\u00e1c tri\u1ec7u ch\u1ee9ng n\u00e0y thay \u0111\u1ed5i trong ng\u00e0y. N\u1ebfu \u0111i\u1ec1u tr\u1ecb mu\u1ed9n hay kh\u00f4ng \u0111i\u1ec1u tr\u1ecb, b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 l\u00fa l\u1eabn.<\/li>\n<\/ul>\n

      – Th\u1ec3 vi\u00eam n\u00e3o – m\u00e0ng\u00a0 n\u00e3o: m\u1ed9t d\u1ea1ng l\u00e2m s\u00e0ng hi\u1ebfm g\u1eb7p h\u01a1n th\u1ec3 vi\u00eam m\u00e0ng n\u00e3o; b\u1ec7nh kh\u1edfi ph\u00e1t \u0111\u1ed9t ng\u1ed9t, n\u1eb7ng l\u00ean t\u1eeb ng\u00e0y\u00a0\u00a0 \u0111\u1ea7u; b\u1ec7nh nh\u00e2n\u00a0\u00a0 n\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb s\u1edbm, th\u00edch h\u1ee3p, s\u1ebd t\u1eed vong.<\/p>\n

        \n
      • T\u1ed5n th\u01b0\u01a1ng l\u00e0 m\u1ed9t u h\u1ea1t \u0111\u01a1n \u0111\u1ed9c, khu tr\u00fa trong n\u00e3o do cryptococcus c\u00f3 th\u1ec3 g\u00e2y ra tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng gi\u1ed1ng m\u1ed9t u n\u1ed9i s\u1ecd.<\/li>\n
      • B\u1ec7nh c\u1ea3nh l\u00e2m s\u00e0ng l\u1ea1i gi\u1ed1ng nh\u01b0 m\u1ed9t h\u1ed9i ch\u1ee9ng t\u0103ng \u00e1p l\u1ef1c n\u1ed9i s\u1ecd v\u0111i \u0111au \u0111\u1ea7u, n\u00f4n m\u1eeda, ph\u00f9 gai th\u1ecb v\u00e0 r\u1ed1i lo\u1ea1n t\u00e2m th\u1ea7n, k\u1ebft h\u1ee3p d\u1ea5u th\u1ea7n kinh c\u1ee5c b\u1ed9. M\u1ed9t ch\u1ec9 \u0111\u1ecbnh ch\u1ee5p CT-Scan n\u00e3o \u0111\u01b0\u1ee3c \u0111\u1eb7t ra k\u1ebft h\u1ee3p v\u1edbi l\u1ea5y d\u1ecbch n\u00e3o t\u1ee7y x\u00e9t nghi\u1ec7m \u0111\u1ec3 t\u00ecm t\u1ebf b\u00e0o n\u1ea5m (n\u1ebfu \u0111i\u1ec1u ki\u1ec7n cho ph\u00e9p).<\/li>\n
      • Nh\u1eefng t\u1ed5n th\u01b0\u01a1ng v\u00f9ng s\u00e0n s\u1ecd k\u1ebft h\u1ee3p vi\u00eam m\u00e0ng n\u00e3o n\u1ec1n th\u01b0\u1eddng g\u1eb7p, c\u00e1c th\u01b0\u01a1ng t\u1ed5n x\u00e2m ph\u1ea1m v\u00e0o d\u00e2y th\u1ea7n kinh th\u1ecb c\u00f3 th\u1ec3 c\u00f3 c\u00e1c tri\u1ec7u ch\u1ee9ng v\u1ec1 m\u1eaft: ph\u00f9 gai, xu\u1ea5t huy\u1ebft v\u00f5ng m\u1ea1c, gi\u1ea3m th\u1ecb l\u1ef1c m\u1ed9t hay hai m\u1eaft.<\/li>\n<\/ul>\n

        – Nh\u1eefng d\u1ea5u hi\u1ec7u th\u1ea7n kinh kh\u00e1c:<\/p>\n

          \n
        • Li\u1ec7t th\u1ea7n kinh VI hai b\u00ean.<\/li>\n
        • Li\u1ec7t th\u1ea7n kinh VII\u00a0<\/strong>trung \u01b0\u01a1ng v\u00e0 ngo\u1ea1i bi\u00ean.<\/li>\n
        • Li\u1ec7t n\u1eeda ng\u01b0\u1eddi.<\/li>\n
        • \u0110\u1ed9ng kinh c\u1ee5c b\u1ed9.<\/li>\n
        • Gi\u1ea3m th\u00ednh l\u1ef1c v\u00e0 nystagmus do t\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh VIII.<\/li>\n
        • R\u1ed1i lo\u1ea1n ti\u00eau h\u00f3a: t\u00e1o b\u00f3n…<\/li>\n
        • Ph\u1ea3n x\u1ea1 nh\u1ea1y t\u1ee9 chi, d\u1ea5u hi\u1ec7u Babinski, Hoffmann,<\/li>\n<\/ul>\n

          – Tri\u1ec7u ch\u1ee9ng v\u1ec1 t\u00e2m th\u1ea7n, bi\u1ec3u hi\u1ec7n v\u1ec1 t\u00e2m th\u1ea7n nhi\u1ec1u khi r\u00f5 r\u1ec7t v\u1edbi tr\u1ea1ng th\u00e1i k\u00edch th\u00edch l\u00e0m b\u1ec7nh nh\u00e2n \u0111i l\u1ea1i l\u1ed9n x\u1ed9n, k\u00edch \u0111\u1ed9ng, la h\u00e9t, b\u1ef1c t\u1ee9c, n\u00f3i nhi\u1ec1u ho\u1eb7c ng\u01b0\u1ee3c l\u1ea1i l\u00e0 v\u00f4 c\u1ea3m, tr\u00ec tr\u1ec7 t\u00e2m th\u1ea7n, l\u00fa l\u1eabn, khi\u1ebfm khuy\u1ebft tr\u00ed nh\u1edb, \u1ea3o gi\u00e1c, \u1ea3o th\u00ednh hay m\u1ed9t r\u1ed1i lo\u1ea1n t\u00e2m th\u1ea7n th\u1ef1c s\u1ef1.<\/p>\n

          3. C\u00e1c x\u00e9t nghi\u1ec7m<\/h2>\n

          3.1. Vi n\u1ea5m h\u1ecdc<\/h3>\n

          Kh\u1ea3o s\u00e1t tr\u1ef1c ti\u1ebfp c\u00e1c d\u1ecbch sinh h\u1ecdc nh\u01b0: d\u1ecbch n\u00e2o t\u1ee7y, \u0111\u1eddm, n\u01b0\u1edbc ti\u1ec3u, d\u1ecbch m\u00e0ng ph\u1ed5i \u0111\u1ec1u c\u00f3 th\u1ec3 t\u00ecm th\u1ea5y vi n\u1ea5m g\u00e2y b\u1ec7nh.<\/p>\n

          – Ph\u01b0\u01a1ng ph\u00e1p soi t\u01b0\u01a1i: \u0110\u1eb7t m\u1ed9t gi\u1ecdt m\u1ef1c t\u00e0u l\u00ean lam s\u1ea1ch; tr\u1ed9n th\u00eam m\u1ed9t gi\u1ecdt d\u1ecbch n\u00e3o t\u1ee7y r\u1ed3i tr\u1ed9n \u0111\u1ec1u; sau \u0111\u00f3 soi tr\u1ef1c ti\u1ebfp tr\u00ean kinh hi\u1ec3n vi s\u1ebd t\u00ecm th\u1ea5y c\u00e1c b\u00e0o t\u1eed C.neoformans.<\/p>\n

          – Ph\u01b0\u01a1ng ph\u00e1p nu\u00f4i c\u1ea5y: c \u1ea5 y b\u1ec7nh ph\u1ea9m tr\u00ean m\u00f4i tr\u01b0\u1eddng th\u1ea1ch Sabouraud glucosa (SGA), b\u1ec7nh ph\u1ea9m l\u00e0 d\u1ecbch n\u00e3o t\u1ee7y (0,5-3ml d\u1ecbch n\u00e3o t\u1ee7y) quay ly t\u00e2m l\u1ea5y c\u1eb7n; \u1ee7 \u1edf nhi\u1ec7t \u0111\u1ed9 25-37\u00b0C; th\u1eddi gian t\u1eeb 2-7 ng\u00e0y. Sau th\u1eddi gian n\u00e0y xu\u1ea5t hi\u1ec7n c\u00e1c c\u1ee5m C. neoformans. X\u00e9t nghi\u1ec7m n\u00e0y c\u00f3 th\u1ec3 \u00e2m t\u00ednh v\u00ec nhi\u1ec1u y\u1ebfu t\u1ed1, trong \u0111\u00f3 c\u00f3 y\u1ebfu t\u1ed1 k\u1ef9 thu\u1eadt.<\/p>\n

          3.2. C\u00e1c th\u1eed nghi\u1ec7m kh\u00e1c c\u00f3 th\u1ec3 th\u1ef1c hi\u1ec7n \u0111\u01b0\u1ee3c<\/h3>\n
            \n
          • Th\u1eed nghi\u1ec7m sinh h\u1ecdc<\/li>\n
          • Th\u1eed nghi\u1ec7m \u0111\u1ed3ng h\u00f3a \u0111\u01b0\u1eddng.<\/li>\n
          • Th\u1eed nghi\u1ec7m \u0111\u1ed3ng h\u00f3a<\/li>\n
          • G\u00e2y b\u1ec7nh th\u1ef1c nghi\u1ec7m tr\u00ean v\u1eadt th\u00ed nghi\u1ec7m.<\/li>\n<\/ul>\n

            Nh\u00ecn chung, c\u00e1c x\u00e9t nghi\u1ec7m tr\u00ean c\u00f3 th\u1ec3 cho k\u1ebft qu\u1ea3 d\u01b0\u01a1ng t\u00ednh nh\u01b0ng th\u1eddi gian th\u1ef1c hi\u1ec7n k\u00e9o d\u00e0i v\u00e0 k\u1ebft qu\u1ea3 kh\u00f4ng ch\u1eafc ch\u1eafn b\u1eb1ng soi tr\u1ef1c ti\u1ebfp.<\/p>\n

            3.3. Huy\u1ebft thanh ch\u1ea9n \u0111o\u00e1n<\/h3>\n

            Th\u1eed nghi\u1ec7m huy\u1ebft thanh h\u1ecdc \u0111\u01b0\u1ee3c xem l\u00e0 c\u00f3 gi\u00e1 tr\u1ecb nh\u1ea5t trong ch\u1ea9n \u0111o\u00e1n v\u00e0 ti\u00ean l\u01b0\u1ee3ng b\u1ec7nh bao g\u1ed3m:<\/p>\n

              \n
            • IFA (indirect fluorescent antibody).<\/li>\n
            • TA (tube agglutination).<\/li>\n
            • LA (latex agglutination).<\/li>\n<\/ul>\n

              – Th\u1eed nghi\u1ec7m LA ph\u00e1t hi\u1ec7n kh\u00e1ng nguy\u00ean C\u00a0. <\/strong>neoormans. LA c\u00f3 \u0111\u1ed9 chuy\u00ean bi\u1ec7t cao, c\u00f3 gi\u00e1 tr\u1ecb ch\u1ea9n \u0111o\u00e1n nh\u1ea5t l\u00e0 th\u1ec3 vi\u00eam m\u00e0ng n\u00e3o; 90% m\u1eabu d\u1ecbch n\u00e3o t\u1ee7y d\u01b0\u01a1ng t\u00ednh v\u1edbi test LA.<\/p>\n

              – Th\u1eed nghi\u1ec7m TA ph\u00e1t hi\u1ec7n kh\u00e1ng th\u1ec3 kh\u00e1ng C\u00a0. <\/strong>neoformans.<\/p>\n

              3.4. C\u00e1c x\u00e9t nghi\u1ec7m b\u1ed5 tr\u1ee3<\/h3>\n

              – L\u1ea5y d\u1ecbch n\u00e3o t\u1ee7y: l\u00e0 k\u1ef9 thu\u1eadt c\u1ea7n ti\u1ebfn h\u00e0nh s\u1edbm khi c\u00f3 ngh\u0129 \u0111\u1ebfn ch\u1ea9n \u0111o\u00e1n vi\u00eam m\u00e0ng n\u00e3o n\u1ea5m. Trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb, vi\u1ec7c ti\u1ebfn h\u00e0nh k\u1ef9 thu\u1eadt n\u00e0y nh\u1eb1m theo d\u00f5i b\u1ec7nh v\u00e0 \u0111i\u1ec1u tr\u1ecb khi s\u1eed d\u1ee5ng Amphotericine B ti\u00eam d\u01b0\u1edbi nh\u1ec7n qua ch\u1ecdc d\u00f2 \u1ed1ng s\u1ed1ng.<\/p>\n

                \n
              • \u00c1p l\u1ef1c: c\u00f3 th\u1ec3 b\u00ecnh th\u01b0\u1eddng hay t\u0103ng nh\u1eb9<\/li>\n
              • M\u00e0u s\u1eafc: \u0111a s\u1ebf tr\u1eafng trong, m\u1ed9t s\u1ea5 \u00edt c\u1ed1 th\u1ec3 v\u1ea9n \u0111\u1ee5c do l\u01b0\u1ee3ng \u0111\u1ea1m t\u0103ng cao.<\/li>\n
              • Sinh h\u00f3a: \u0111\u1ea1m trong d\u1ecbch n\u00e3o t\u1ee7y thay d\u1ed5i t\u1eeb 40-600mg%, trung b\u00ecnh th\u01b0\u1eddng g\u1eb7p 50-100mg%; \u0111\u01b0\u1eddng gi\u1ea3m v\u00e0 clo c\u00f3 th\u1ec3 b\u00ecnh th\u01b0\u1eddng.<\/li>\n
              • T\u1ebf b\u00e0o: d\u01b0\u1edbi 800\/mm3, \u0111a s\u1ed1 l\u00e0 lympho.<\/li>\n<\/ul>\n

                – T\u00ecm n\u1ea5m tr\u1ef1c ti\u1ebfp trong d\u1ecbch n\u00e3o t\u1ee7y l\u00e3 th\u1eed nghi\u1ec7m c\u00f3 gi\u00e1 tr\u1ecb ch\u1ea9n \u0111o\u00e1n quy\u1ebft \u0111\u1ecbnh t\u00ecnh tr\u1ea1ng nhi\u1ec5m b\u1ec7nh.<\/p>\n

                – CT-Scan\u00a0 n\u00e3o l\u00e0 k\u1ef9 thu\u1eadt ch\u1ea9n \u0111o\u00e1n h\u1eefu \u00edch. K t qu\u1ea3 c\u1ee7a k\u1ef9 thu\u1eadt ch\u1ea9n \u0111o\u00e1n n\u00e0y kh\u00f4ng \u0111\u1eb7c hi\u1ec7u cho ch\u1ea9n \u0111o\u00e1n vi n\u1ea5m nh\u01b0ng s\u1ebd h\u1ed7 tr\u1ee3 cho ch\u1ea9n do\u00e1n.<\/p>\n

                4. Ch\u1ea9n \u0111o\u00e1n vi\u00eam m\u00e0ng n\u00e3o do Cryptococcus Neoformans<\/h2>\n
                  \n
                • \u0110au \u0111\u1ea7u t\u00e1i ph\u00e1t ho\u1eb7c li\u00ean t\u1ee5c v\u00e0 n\u1eb7ng d\u1ea7n trong nhi\u1ec1u tu\u1ea7n.<\/li>\n
                • D\u1ea5u m\u00e0ng n\u00e3o (c\u1ee9ng g\u00e1y. Kernig, Brudzinski).<\/li>\n
                • S\u1ed1t kh\u00f4ng \u0111i\u1ec3n h\u00ecnh.<\/li>\n
                • T\u1ed5n th\u01b0\u01a1ng d\u00e2y th\u1ea7n kinh s\u1ecd<\/li>\n
                • R\u1ed1i lo\u1ea1n t\u00e2m th\u1ea7n.<\/li>\n
                • D\u1ecbch n\u00e3o t\u1ee7y b\u1ea5t th\u01b0\u1eddng v\u1ec1 m\u1eb7t sinh h\u00f3a v\u00e0\u00a0 t\u1ebf b\u00e0o.<\/li>\n
                • T\u00ecm vi n\u1ea5m trong d\u1ecbch n\u00e3o t\u1ee7y (+).<\/li>\n
                • Huy\u1ebft thanh h\u1ecdc d\u01b0\u01a1ng t\u00ednh.<\/li>\n<\/ul>\n

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

                  C\u00e1c thu\u1ed1c \u0111\u1eb7c bi\u1ec7t kh\u00e1ng n\u1ea5m<\/p>\n

                  – Amphotericine B l\u00e0 thu\u1ed1c d\u00f9ng \u0111\u01b0\u1eddng t\u00ednh m\u1ea1ch; thu\u1ed1c c\u00f3 \u0111\u1ed9c t\u00ednh tr\u00ean th\u1eadn, h\u1ea1 kali\/m\u00e1u v\u00e0 nhi\u1ec1u t\u00e1c d\u1ee5ng ph\u1ee5. c \u1ea7n th\u1eadn tr\u1ecdng khi d\u00f9ng v\u00e0 theo d\u00f5i s\u00e1t kali\/m\u00e1u.<\/p>\n

                  – Flucytocin: d\u00f9ng \u0111\u01b0\u1eddng u\u1ed1ng v\u00e0 ti\u00eam; vi\u00ean n\u00e9n 500mg, lo\u1ea1i \u00a0ti\u00eam 2,5g\/250ml, \u1ed1ng 50mg\/5ml.<\/p>\n

                  – Fluconazole: vi\u00ean 50mg, 150mg d\u00f9ng d\u01b0\u0111i d\u1ea1ng u\u1ed1ng, u\u1ed1ng\u00a0\u00a0 400mg\/ng\u00e0y, li\u1ec1u duy tr\u00ec khi t\u00ecnh h\u1ea1ng l\u00e2m s\u00e0ng \u1ed5n \u0111\u1ecbnh l\u00e0 200mg\/ng\u00e0y. Trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p nguy c\u01a1 cao v\u00e0 t\u00e1i ph\u00e1t, k\u1ebft h\u1ee3p Amphotericin<\/p>\n

                  Nh\u1eefng h\u1ea1n ch\u1ebf k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb hi\u1ec7n nay c\u00f3 th\u1ec3 g\u1eb7p l\u00e0: \u0111i\u1ec1u tr\u1ecb \u1edf giai \u0111o\u1ea1n mu\u1ed9n, tr\u1edf ng\u1ea1i v\u1ec1 kinh t\u1ebf, vi\u00eam m\u00e0ng n\u00e3o C. <\/strong>neoformans d\u1ec5 t\u00e1i ph\u00e1t, b\u1ec7nh th\u01b0\u1eddng k\u1ebft h\u1ee3p v\u1edbi t\u00ecnh tr\u1ea1ng suy gi\u1ea3m mi\u1ec5n d\u1ecbch.<\/p>\n

                  6. Ti\u00ean l\u01b0\u1ee3ng<\/h2>\n

                  B\u1ec7nh d\u1ec5 t\u00e1i ph\u00e1t, t\u1ef7 l\u1ec7 t\u1eed vong cao. \u1ede khoa Th\u1ea7n kinh BV Ch\u1ee3 R\u1eaby, t\u1ef7 l\u1ec7 t\u1eed vong l\u00e0 58% c\u00e1c tr\u01b0\u1eddng h\u1ee3p. Theo y v\u0103n, kh\u1ecfi b\u1ec7nh l\u00e0 40%, t\u1ef7 l\u1ec7 t\u1eed vong t\u1eeb 20-30%; \u1edf b\u1ec7nh nh\u00e2n AIDS t\u1ef7 l\u1ec7 t\u1eed vong l\u00e0 50-60% c\u00e1c tr\u01b0\u1eddng h\u1ee3p. B\u1ec7nh d\u1ec3 l\u1ea1i di ch\u1ee9ng: \u0111i\u1ebfc m\u1ed9t b\u00ean hay hai b\u00ean, vi\u00eam th\u1ecb-th\u1ea7n kinh, t\u0103ng \u00e1p l\u1ef1c n\u1ed9i s\u1ecd, \u0111\u1ed9ng kinh, r\u1ed1i lo\u1ea1n t\u00e2m th\u1ea7n.<\/p>\n

                  Ngu\u1ed3n tham kh\u1ea3o: Th\u1ea7n kinh h\u1ecdc – \u0110H Y TP H\u1ed3 Ch\u00ed Minh<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

                  Theo y v\u0103n, d\u01b0\u1eddng nh\u01b0 Hansemans (1906), Verse (1914) l\u00e0 nh\u1eefng t\u00e1c gi\u1ea3 \u0111\u00e3 t\u00ecm th\u1ea5y Cryptococcus Neoformans trong b\u1ec7nh vi\u00eam m\u00e0ng n\u00e3o. T\u1eeb \u0111\u00f3 \u0111\u1ebfn nay, b\u1ec7nh \u0111\u01b0\u1ee3c mang t\u00ean vi\u00eam m\u00e0ng n\u00e3o Cryptococcus Neoformans (Cryptoccocal meningitis).\u00a0 C. neoformans l\u00e0 m\u1ed9t lo\u1ea1i vi n\u1ea5m h\u1ea1t men, t\u0103ng tr\u01b0\u1edfng theo ki\u1ec3u n\u1ea9y b\u00fap. L\u00e2m s\u00e0ng […]<\/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":"\nT\u00ecm hi\u1ec3u v\u1ec1 vi\u00eam m\u00e0ng n\u00e3o do Cryptococcus Neoformans<\/title>\n<meta name=\"description\" content=\"L\u00e2m s\u00e0ng c\u1ee7a b\u1ec7nh Vi\u00eam m\u00e0ng n\u00e3o do Cryptococcus Neoformans c\u00f3 \u0111\u1eb7c \u0111i\u1ec3m l\u00e0 di\u1ec5n ti\u1ebfn b\u00e1n c\u1ea5p; m\u1ed9t gian \u0111o\u1ea1n d\u00e0i b\u1ec7nh nh\u00e2n kh\u00f4ng nh\u1eadp vi\u1ec7n ,,,\" \/>\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=\"T\u00ecm hi\u1ec3u v\u1ec1 vi\u00eam m\u00e0ng n\u00e3o do Cryptococcus Neoformans\" \/>\n<meta property=\"og:description\" content=\"L\u00e2m s\u00e0ng c\u1ee7a b\u1ec7nh Vi\u00eam m\u00e0ng n\u00e3o do Cryptococcus Neoformans c\u00f3 \u0111\u1eb7c \u0111i\u1ec3m l\u00e0 di\u1ec5n ti\u1ebfn b\u00e1n c\u1ea5p; 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