{"id":32494,"date":"2023-05-14T20:40:16","date_gmt":"2023-05-14T13:40:16","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=32494"},"modified":"2023-05-14T20:40:16","modified_gmt":"2023-05-14T13:40:16","slug":"tong-quan-benh-viem-nao-cap-tinh-do-virus","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/14\/tong-quan-benh-viem-nao-cap-tinh-do-virus\/","title":{"rendered":"T\u1ed5ng quan b\u1ec7nh vi\u00eam n\u00e3o c\u1ea5p t\u00ednh do virus"},"content":{"rendered":"

Vi\u00eam n\u00e3o c\u1ea5p t\u00ednh do virus l\u00e0 nguy\u00ean nh\u00e2n ch\u00ednh g\u00e2y ra b\u1ec7nh t\u1eadt v\u00e0 t\u1eed vong, t\u1ea1o ra m\u1ed9t g\u00e1nh n\u1eb7ng kinh t\u1ebf n\u1eb7ng n\u1ec1. \u0110i\u1ec1u tr\u1ecb tr\u1ecb ch\u1ee7 y\u1ebfu l\u00e0 kinh nghi\u1ec7m, ngo\u1ea1i tr\u1eeb acyclovir cho vi\u00eam n\u00e3o HSV, nh\u01b0ng kh\u00f4ng \u0111\u01b0\u1ee3c h\u1ed7 tr\u1ee3 b\u1edfi b\u1eb1ng ch\u1ee9ng \u0111\u1ed9 tin c\u1eady cao t\u1eeb c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng.<\/strong><\/p>\n

\"mang-nao-bi-viem\"
\u1ea2nh m\u00f4 t\u1ea3 vi\u00eam m\u00e0ng n\u00e3o<\/figcaption><\/figure>\n

1. Gi\u1edbi thi\u1ec7u<\/h2>\n

Vi\u00eam n\u00e3o l\u00e0 m\u1ed9t h\u1ed9i ch\u1ee9ng \u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi s\u1ef1 thay \u0111\u1ed5i tr\u1ea1ng th\u00e1i tinh th\u1ea7n v\u00e0 k\u1ebft h\u1ee3p v\u1edbi nhi\u1ec1u tri\u1ec7u ch\u1ee9ng nh\u01b0 s\u1ed1t, co gi\u1eadt, khi\u1ebfm khuy\u1ebft th\u1ea7n kinh, t\u0103ng t\u1ebf b\u00e0o lympho trong d\u1ecbch n\u00e3o t\u1ee7y (CSF)<\/a>, b\u1ea5t th\u01b0\u1eddng h\u00ecnh \u1ea3nh h\u1ecdc h\u1ec7 th\u1ea7n kinh v\u00e0 \u0111i\u1ec7n n\u00e3o \u0111\u1ed3<\/a> ( EEG). H\u1ed9i ch\u1ee9ng n\u00e0y c\u00f3 nhi\u1ec1u nguy\u00ean nh\u00e2n; nh\u1eefng nguy\u00ean nh\u00e2n \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh th\u01b0\u1eddng g\u1eb7p nh\u1ea5t l\u00e0 nhi\u1ec5m virus h\u1ec7 th\u1ea7n kinh. Nguy\u00ean t\u1eafc chung trong ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb vi\u00eam n\u00e3o virus \u0111\u01b0\u1ee3c tr\u00ecnh b\u00e0y trong t\u1ed5ng quan n\u00e0y.<\/span><\/p>\n

2. \u0110\u1eb7c \u0111i\u1ec3m d\u1ecbch t\u1ec5 h\u1ecdc<\/strong><\/h2>\n

T\u1ea1i M\u1ef9 m\u1ed7i n\u0103m c\u00f3 kho\u1ea3ng 7 b\u1ec7nh nh\u00e2n nh\u1eadp vi\u1ec7n v\u00ec vi\u00eam n\u00e3o tr\u00ean 100000 d\u00e2n. Nguy\u00ean nh\u00e2n kh\u00f4ng r\u00f5 chi\u1ebfm kho\u1ea3ng m\u1ed9t n\u1eeda c\u00e1c tr\u01b0\u1eddng h\u1ee3p n\u00e0y.Trong s\u1ed1 c\u00e1c tr\u01b0\u1eddng h\u1ee3p bi\u1ebft \u0111\u01b0\u1ee3c nguy\u00ean nh\u00e2n, 20 – 50% l\u00e0 do virus Herpes Simplex (HSV) <\/a><\/span>chi\u1ebfm 50 -75% tr\u01b0\u1eddng h\u1ee3p virus \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh, c\u00f2n l\u1ea1i l\u00e0 Varicella-zoster virus ( VZV), enterovirus v\u00e0 arbovirus chi\u1ebfm ph\u1ea7n l\u1edbn. Vi\u00eam n\u00e3o do HSV x\u1ea3y ra \u1edf t\u1ea5t c\u1ea3 l\u1ee9a tu\u1ed5i v\u00e0 kh\u00f4ng c\u00f3 \u0111\u1eb7c \u0111i\u1ec3m theo m\u00f9a ho\u1eb7c ki\u1ec3u \u0111\u1ecba l\u00fd, trong khi vi\u00eam n\u00e3o do arbovirus<\/a> c\u00f3 s\u1ef1 kh\u00e1c nhau v\u1ec1 l\u1ee9a tu\u1ed5i trong tr\u01b0\u1eddng h\u1ee3p x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c, x\u1ea3y ra theo m\u00f9a v\u00e0 thay \u0111\u1ed5i t\u1ef7 l\u1ec7 m\u1eafc theo khu v\u1ef1c \u0111\u1ecba l\u00fd, ph\u1ea3n \u00e1nh sinh th\u00e1i l\u00e2y truy\u1ec1n c\u1ee7a arbovirus. C\u00e1c \u0111\u1eb7c \u0111i\u1ec3m v\u1ec1 s\u1ef1 xu\u1ea5t hi\u1ec7n c\u1ee7a arbovirus theo khu v\u1ef1c \u1edf M\u1ef9 \u0111\u01b0\u1ee3c t\u00f3m t\u1eaft trong b\u1ea3ng 1<\/span><\/p>\n

\u00a0Vi\u1ec7n ph\u00ed trung b\u00ecnh \u01b0\u1edbc t\u00ednh cho m\u1ed9t b\u1ec7nh nh\u00e2n vi\u00eam n\u00e3o do virus l\u00e0 $89.6000 \u0111\u1ed1i v\u1edbi vi\u00eam n\u00e3o do virus West NIle l\u00e0 $ 58.000 \u0111\u1ed1i v\u1edbi vi\u00eam n\u00e3o HSV. C\u00f3 kho\u1ea3ng 6000 l\u01b0\u1ee3t nh\u1eadp vi\u1ec7n v\u00ec vi\u00eam n\u00e3o c\u1ea5p t\u00ednh do virus m\u1ed7i n\u0103m \u1edf M\u1ef8; t\u1ed5ng chi ph\u00ed h\u00e0ng n\u0103m x\u1ea5p x\u1ec9 350 tri\u1ec7u $ \u0111\u1ebfn 540 $, kh\u00f4ng bao g\u1ed3m chi ph\u00ed ch\u0103m s\u00f3c sau khi xu\u1ea5t vi\u1ec7n, chi ph\u00ed cho ng\u01b0\u1eddi th\u00e2n ch\u0103m s\u00f3c v\u00e0 thu nh\u1eadp b\u1ecb m\u1ea5t li\u00ean quan b\u1ec7nh t\u1eadt.<\/span><\/p>\n

\"dac-diem-xuat-hien-arboviruses-o-My\"
B\u1ea3ng 1:<\/strong> C\u00e1c \u0111\u1eb7c \u0111i\u1ec3m v\u1ec1 s\u1ef1 xu\u1ea5t hi\u1ec7n c\u1ee7a arbovirus theo khu v\u1ef1c \u1edf M\u1ef9<\/figcaption><\/figure>\n

3. Y\u1ebfu t\u1ed1 k\u00fd ch\u1ee7<\/strong><\/h2>\n

C\u00e1c y\u1ebfu t\u1ed1 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn t\u00ednh nh\u1ea1y c\u1ea3m v\u1edbi vi\u00eam n\u00e3o ch\u01b0a \u0111\u01b0\u1ee3c hi\u1ec3u r\u00f5. M\u1ed9t s\u1ed1 virus, nh\u01b0 La Crosse, g\u00e2y b\u1ec7nh h\u1ec7 th\u1ea7n kinh trung \u01b0\u01a1ng \u1edf tr\u1ebb em, v\u00e0 c\u00e1c virus kh\u00e1c, ch\u1eb3ng h\u1ea1n nh\u01b0 West Nile virus<\/a>, c\u00f3 xu h\u01b0\u1edbng g\u00e2y ra b\u1ec7nh th\u1ea7n kinh trung \u01b0\u01a1ng n\u1eb7ng n\u1ec1 \u1edf ng\u01b0\u1eddi l\u1edbn tu\u1ed5i, trong khi HSV g\u00e2y vi\u00eam n\u00e3o tr\u00ean ng\u01b0\u1eddi \u1edf c\u1ea3 hai \u0111\u1ea7u \u0111\u1ed9 tu\u1ed5i. Gi\u1ea3m mi\u1ec5n d\u1ecbch b\u1ea9m sinh<\/a> v\u00e0 thu \u0111\u01b0\u1ee3c li\u00ean quan \u0111\u1ebfn tu\u1ed5i t\u00e1c, bao g\u1ed3m bi\u1ec3u hi\u1ec7n gi\u1ea3m c\u00e1c th\u1ee5 th\u1ec3 toll-like (TLR) v\u00e0 c\u00e1c th\u1ee5 th\u1ec3 t\u01b0\u01a1ng t\u1ef1 retinoic acid-inducible gen 1 ( RIG-I), gi\u1ea3m kh\u1ea3 n\u0103ng th\u1ef1c b\u00e0o, v\u00e0 gi\u1ea3m ho\u1ea1t \u0111\u1ed9ng g\u00e2y \u0111\u1ed9c ( gi\u1ebft) v\u00e0 \u0111\u1ed9c t\u1ebf b\u00e0o T, c\u00f3 th\u1ec3 g\u00f3p ph\u1ea7n v\u00e0o t\u00ednh nh\u1ea1y c\u1ea3m \u1edf ng\u01b0\u1eddi l\u1edbn tu\u1ed5i. Ng\u01b0\u1ee3c l\u1ea1i, so v\u1edbi ng\u01b0\u1eddi l\u1edbn, tr\u1ebb em c\u00f3 th\u1ec3 b\u1ecb gi\u1ea3m t\u00edn hi\u1ec7u interferon type I, m\u1ed9t \u0111\u1eb7c \u0111i\u1ec3m c\u00f3 li\u00ean quan \u0111\u1ebfn t\u00ednh nh\u1ea1y c\u1ea3m v\u1edbi La Crosse virus \u1edf chu\u1ed9t.<\/span><\/p>\n

\u00a0C\u00e1c bi\u1ebfn \u0111\u1ed5i trong v\u00f9ng HLA c\u00f3 kh\u1ea3 n\u0103ng \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn hi\u1ec7u qu\u1ea3 c\u1ee7a \u0111\u00e1p \u1ee9ng mi\u1ec5n d\u1ecbch thu \u0111\u01b0\u1ee3c<\/a>, c\u00f3 li\u00ean quan \u0111\u1ebfn t\u00ednh nh\u1ea1y c\u1ea3m v\u1edbi nhi\u1ec5m herpesvirus v\u00e0 arbovirus. C\u00e1c y\u1ebfu t\u1ed1 di truy\u1ec1n k\u00fd ch\u1ee7 kh\u00e1c li\u00ean quan \u0111\u1ebfn t\u00ednh nh\u1ea1y c\u1ea3m virus th\u1ea7n kinh \u0111\u00e3 \u0111\u01b0\u1ee3c xu\u1ea5t l\u00e0 do t\u00ednh \u0111a \u0111a h\u00ecnh c\u1ee7a gen m\u00e0 n\u00f3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn c\u1ea3 mi\u1ec5n d\u1ecbch b\u1ea9m sinh v\u00e0 thu \u0111\u01b0\u1ee3c. V\u00ed d\u1ee5, s\u1ef1 m\u1ea5t ch\u1ee9c n\u0103ng th\u1ee5 th\u1ec3 chemokine-5 l\u00e0m gi\u1ea3m v\u1eadn chuy\u1ec3n t\u1ebf b\u00e0o lymphocyte v\u00e0o h\u1ec7 th\u1ea7n kinh trung \u01b0\u01a1ng, d\u1eabn \u0111\u1ebfn t\u0103ng t\u00ednh nh\u1ea1y c\u1ea3m v\u1edbi c\u1ea3 hai lo\u1ea1i vi\u00eam n\u00e3o do b\u1ecd ve<\/a> v\u00e0 West Nile virus. c\u00e1c \u0111\u1ed9t bi\u1ebfn ho\u1eb7c \u0111a h\u00ecnh trong gen m\u00e3 h\u00f3a c\u00e1c th\u00e0nh ph\u1ea7n c\u1ee7a qu\u00e1 tr\u00ecnh mi\u1ec5n d\u1ecbch b\u1ea9m sinh – \u0111\u00e1ng ch\u00fa \u00fd l\u00e0 TLR3 v\u00e0 t\u00edn hi\u1ec7u interferon c\u00f3 li\u00ean quan \u0111\u1ebfn vi\u00eam n\u00e3o do HSV \u1edf tr\u1ebb em, vi\u00eam anox do VZV, \u00a0 vi\u00eam n\u00e3o to\u00e0n b\u1ed9 x\u01a1 h\u00f3a b\u00e1n c\u1ea5p do s\u1edfi<\/a>, virus vi\u00eam n\u00e3o Nh\u1eadt B\u1ea3n<\/a>, enterovirus-71<\/a>, v\u00e0 b\u1ec7nh n\u00e3o li\u00ean quan \u0111\u1ebfn virus c\u00fam A. C\u00e1c nghi\u00ean c\u1ee9u t\u01b0\u01a1ng quan to\u00e0n b\u1ed9 nhi\u1ec5m s\u1eafc th\u1ec3 c\u0169ng li\u00ean k\u1ebft c\u00e1c \u0111a h\u00ecnh trong t\u00edn hi\u1ec7u interferon v\u1edbi t\u0103ng nguy c\u01a1 nhi\u1ec5m tr\u00f9ng ban \u0111\u1ea7u v\u00e0 vi\u00eam n\u00e3o n\u1eb7ng c\u00f3 tri\u1ec7u ch\u1ee9ng do West Nile virus.<\/span><\/p>\n

4. \u0110\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng c\u1ee7a vi\u00eam n\u00e3o c\u1ea5p t\u00ednh do virus<\/strong><\/h2>\n

L\u1ecbch s\u1eed n\u00f3i r\u1eb1ng trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p vi\u00eam n\u00e3o n\u00ean xem x\u00e9t th\u00eam v\u1ec1 m\u00f9a m\u00e0 b\u1ec7nh nh\u00e2n b\u1ecb, v\u1ecb tr\u00ed \u0111\u1ecba l\u00fd, l\u1ecbch s\u1eed \u0111i l\u1ea1i v\u00e0 ti\u1ebfp x\u00fac, ti\u1ebfp x\u00fac \u0111\u1ed9ng v\u1eadt, s\u1ee9c kh\u1ecfe c\u1ee7a ng\u01b0\u1eddi th\u00e2n, ti\u1ebfp x\u00fac v\u1edbi ng\u01b0\u1eddi b\u1ec7nh v\u00e0 c\u00e1c tr\u01b0\u1eddng h\u1ee3p vi\u00eam n\u00e3o \u0111\u00e3 bi\u1ebft trong khu v\u1ef1c. B\u00e1c s\u0129 l\u00e2m s\u00e0ng n\u00ean t\u00ecm hi\u1ec3u v\u1ec1 ngh\u1ec1 nghi\u1ec7p, s\u1edf th\u00edch, c\u00e1c ho\u1ea1t \u0111\u1ed9ng gi\u1ea3i tr\u00ed, ch\u1ebf \u0111\u1ed9 \u0103n u\u1ed1ng, sinh ho\u1ea1t gi\u1edbi t\u00ednh, s\u1eed d\u1ee5ng thu\u1ed1c v\u00e0 t\u00ecnh tr\u1ea1ng s\u1ee9c kh\u1ecfe ( ti\u00eam ch\u1ee7ng, c\u00e1c v\u1ea5n \u0111\u1ec1 y t\u1ebf v\u00e0 thu\u1ed1c, \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch c\u00f3 th\u1ec3 do HIV, thu\u1ed1c ho\u1eb7c c\u00e1c y\u1ebfu t\u1ed1 kh\u00e1c). Kh\u00e1m th\u1ef1c th\u1ec3 v\u00e0 th\u1ea7n kinh c\u00f3 th\u1ec3 cung c\u1ea5p manh m\u1ed1i v\u1ec1 c\u00e1c nguy\u00ean nh\u00e2n c\u00f3 kh\u1ea3 n\u0103ng v\u00e0 c\u00f3 th\u1ec3 h\u01b0\u1edbng \u0111\u1ebfn x\u00e9t nghi\u1ec7m. S\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a ngo\u1ea1i ban ho\u1eb7c n\u1ed9i ban gi\u00fap x\u00e1c \u0111\u1ecbnh m\u1ed9t s\u1ed1 d\u1ea1ng vi\u00eam n\u00e3o do virus nh\u01b0ng kh\u00f4ng c\u00f3 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u cao.\u00a0<\/span><\/p>\n

M\u1ed9t s\u1ed1 h\u1ec7 th\u1ed1ng k\u1ebft h\u1ee3p c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m n\u00e0y \u0111\u00e3 \u0111\u01b0\u1ee3c ph\u00e1t tri\u1ec3n \u0111\u1ec3 h\u1ed7 tr\u1ee3 x\u00e1c \u0111\u1ecbnh c\u00e1c t\u00e1c nh\u00e2n l\u00e2y nhi\u1ec5m trong tr\u01b0\u1eddng h\u1ee3p vi\u00eam n\u00e3o. Nh\u1eefng n\u1ed7 l\u1ef1c ch\u1ea9n \u0111o\u00e1n ban \u0111\u1ea7u t\u1eadp trung v\u00e0o vi\u1ec7c ph\u00e2n bi\u1ec7t vi\u00eam n\u00e3o do virus v\u00e0 vi\u00eam n\u00e3o t\u1ef1 mi\u1ec5n<\/a>, ph\u00e2n bi\u1ec7t vi\u00eam n\u00e3o HSV v\u1edbi c\u00e1c virus kh\u00e1c. C\u00e1c b\u00e1o c\u00e1o tr\u01b0\u1edbc \u0111\u00e2y so s\u00e1nh vi\u00eam n\u00e3o HSV v\u00e0 vi\u00eam n\u00e3o kh\u00f4ng ph\u1ea3i HSV ( nonHSV) ghi nh\u1eadn r\u1eb1ng ch\u00fang kh\u00f4ng kh\u00e1c bi\u1ec7t nhi\u1ec1u v\u1ec1 c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng nh\u1eefng vi\u00eam n\u00e3o HSV \u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi t\u0103ng b\u1ea1ch c\u1ea7u lympho trong CSF r\u00f5 r\u1ec7t h\u01a1n v\u00e0 c\u00e1c b\u1ea5t th\u01b0\u1eddng t\u1eadp trung th\u01b0\u1eddng h\u01a1n tr\u00ean EEG v\u00e0 h\u00ecnh \u1ea3nh h\u1ecdc h\u1ec7 th\u1ea7n kinh.<\/span><\/p>\n

Trong t\u1ed5ng quan c\u00e1c tr\u01b0\u1eddng h\u1ee3p vi\u00eam n\u00e3o c\u1ea5p \u1edf ng\u01b0\u1eddi l\u1edbn \u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u01b0\u1edfi b\u1ea5t th\u01b0\u1eddng trong th\u00f9y th\u00e1i d\u01b0\u01a1ng tr\u00ean h\u00ecnh \u1ea3nh c\u1ed9ng h\u01b0\u1edfng t\u1eeb MRI \u0111\u1eb7c \u0111i\u1ec3m \u1ee7ng h\u1ed9 HSV h\u01a1n c\u00e1c nguy\u00ean nh\u00e2n kh\u00e1c bao g\u1ed3m l\u1edbn tu\u1ed5i, bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng c\u1ea5p t\u00ednh ( \u1edf 88% b\u1ec7nh nh\u00e2n vi\u00eam n\u00e3o HSV so v\u1edbi 64% b\u1ec7nh nh\u00e2n vi\u00eam n\u00e3o do c\u00e1c nguy\u00ean nh\u00e2n kh\u00e1c), s\u1ed1t( 80% vs 49%), tri\u1ec7u ch\u1ee9ng ti\u00eau h\u00f3a (37% vs 19%), m\u1ea5t \u0111i\u1ec1u khi\u1ec3n c\u01a1 th\u1ec3 th\u1ea5p h\u01a1n (18% vs33%) v\u00e0 ph\u00e1t ban th\u1ea5p h\u01a1n (2% vs 15%). B\u1ec7nh nh\u00e2n c\u00f3 nhi\u1ec1u kh\u1ea3 n\u0103ng vi\u00eam n\u00e3o HSV h\u01a1n vi\u00eam n\u00e3o t\u1ef1 mi\u1ec5n l\u00e0 nam gi\u1edbi( 50% vs 14%) v\u00e0 vi\u00eam n\u00e3o HSV \u00edt c\u00f3 kh\u1ea3 n\u0103ng b\u1ecb r\u1ed1i lo\u1ea1n t\u00e2m th\u1ea7n (5% vs 20%) ho\u1eb7c ph\u00e1t ban (2% vs 21%). H\u1ea7u h\u1ebft c\u00e1c tri\u1ec7u ch\u1ee9ng th\u1ea7n kinh, bao g\u1ed3m gi\u1ea3m \u00fd th\u1ee9c, l\u00fa l\u1eabn, m\u1ea5t ng\u00f4n ng\u1eef, \u1ea3o gi\u00e1c, v\u00e0 r\u1ed1i lo\u1ea1n v\u1eadn \u0111\u1ed9ng th\u00ec kh\u00f4ng kh\u00e1c bi\u1ec7t gi\u1eefa c\u00e1c lo\u1ea1i vi\u00eam n\u00e3o kh\u00e1c nhau. <\/span><\/p>\n

Tr\u00ean MRI, nh\u1eefng \u0111\u1eb7c \u0111i\u1ec3m v\u1ec1 xu\u1ea5t huy\u1ebft, t\u0103ng t\u00edn hi\u1ec7u v\u00e0 khu\u1ebfch t\u00e1n b\u1ecb h\u1ea1n ch\u1ebf c\u0169ng kh\u00f4ng kh\u00e1c nhau gi\u1eefa c\u00e1c lo\u1ea1i, m\u1eb7c d\u00f9 b\u1ec7nh nh\u00e2n vi\u00eam n\u00e3o nonHSV th\u01b0\u1eddng c\u00f3 t\u1ed5n th\u01b0\u01a1ng hai b\u00ean th\u00e1i d\u01b0\u01a1ng h\u01a1n, c\u0169ng nh\u01b0 t\u1ed5n th\u01b0\u01a1ng b\u00ean ngo\u00e0i th\u00f9y th\u00e1i d\u01b0\u01a1ng, th\u00f9y \u0111\u1ea3o v\u00e0 h\u1ec7 vi\u1ec1n.<\/span><\/p>\n

\"dau-hieu-va-trieu-chung-cac-vung-nao-cu-the-trong-viem-nao-do-virus\"<\/p>\n

C\u00e1c nghi\u00ean c\u1ee9u h\u1ed3i c\u1ee9u \u1edf b\u1ec7nh nh\u00e2n vi\u00eam n\u00e3o c\u1ea5p t\u00ednh \u0111\u00e3 s\u1eed d\u1ee5ng c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng v\u00e0 MRI \u0111\u1ec3 x\u00e2y d\u1ef1ng c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m b\u1ec7nh l\u00fd “Ri\u00eang” v\u00e0 “Chung” . M\u1ed9t s\u1ed1 lo\u1ea1i virus c\u00f3 xu h\u01b0\u01a1ng g\u00e2y ra c\u00e1c v\u00f9ng MRI b\u1ea5t th\u01b0\u1eddng v\u00e0 \u0111\u00f4i khi c\u00f3 th\u1ec3 b\u1ecb nghi ng\u1edd d\u1ef1a tr\u00ean c\u00e1c h\u00ecnh \u1ea3nh MRI n\u00e0y ( H\u00ecnh 1). C\u00e1c \u0111\u1eb7c \u0111i\u1ec3m “Ri\u00eang” bao g\u1ed3m c\u00e1c d\u1ea5u hi\u1ec7u v\u00e0 tri\u1ec7u ch\u1ee9ng do c\u00e1c v\u00f9ng n\u00e3o c\u1ee5 th\u1ec3, v\u00e0 \u00e1c \u0111\u1eb7c \u0111i\u1ec3m Chung li\u00ean quan \u0111\u1ebfn r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng n\u00e3o lan t\u1ecfa,bao g\u1ed3m ph\u00f9 n\u00e3o lan t\u1ecfa, \u0111\u1ed9ng kinh to\u00e0n th\u1ec3 v\u00e0 r\u1ed1i lo\u1ea1n t\u00e2m th\u1ea7n. C\u00e1ch ti\u1ebfp c\u1eadn n\u00e0y c\u00f3 th\u1ec3 gi\u00fap \u01b0u ti\u00ean x\u00e9t nghi\u1ec7m v\u00e0 \u0111\u00e1nh gi\u00e1 trong ch\u1ea9n \u0111o\u00e1n \u0111\u1ed1i v\u1edbi c\u00e1c lo\u1ea1i virus c\u1ee5 th\u1ec3 ho\u1eb7c ch\u1ec9 ra c\u00e1c nguy\u00ean nh\u00e2n kh\u00f4ng ph\u1ea3i virus.<\/span><\/p>\n

5. Ch\u1ea9n \u0111o\u00e1n vi\u00eam n\u00e3o c\u1ea5p t\u00ednh<\/strong><\/h2>\n

X\u00e9t nghi\u1ec7m virus th\u01b0\u1eddng quy \u0111\u1ed1i v\u1edbi vi\u00eam n\u00e3o c\u1ea5p t\u00ednh bao g\u1ed3m PCR v\u00e0 RT-PCR<\/a> c\u1ee7a m\u1eabu th\u1eed CSF. PCR l\u00e0 \u0111\u1ec3 ph\u00e1t hi\u1ec7n DNA virus c\u00f2n RT-PCR \u0111\u1ec3 ph\u00e1t hi\u1ec7n RNA virus. X\u00e9t nghi\u1ec7m ban \u0111\u1ea7u v\u1ec1 kh\u1ea3 n\u0103ng \u0111\u1ec1 kh\u00e1ng c\u1ee7a k\u00fd ch\u1ee7 bao g\u1ed3m PCR v\u00e0 RT-PCR cho CSF \u0111\u1ed1i v\u1edbi HSV-1, HSV-2, VZR, enterovirus, v\u00e0 \u1edf tr\u1ebb em d\u01b0\u1edbi 3 tu\u1ed5i l\u00e0 parechovirus ng\u01b0\u1eddi. N\u1ebfu c\u00e1c x\u00e9t nghi\u1ec7m ban \u0111\u1ea7u n\u00e0y kh\u00f4ng \u0111\u01b0a ra \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n, c\u00f3 th\u1ec3 ti\u1ebfn h\u00e0nh x\u00e9t nghi\u1ec7m b\u1ed5 sung ( B\u1ea3ng 3). C\u00e1c x\u00e9t nghi\u1ec7m ti\u1ebfp theo bao g\u1ed3m PCR cytomegalovirus ( CMV)<\/a> trong CSF, herpesvirus -6 v\u00e0 -7<\/a>, Epstein-Bar virus ( EBV)<\/a> v\u00e0 HIV. C\u00e1c x\u00e9t nghi\u1ec7m n\u00e0y th\u01b0\u1eddng l\u00e0 m\u1ed9t ph\u1ea7n c\u1ee7a \u0111\u00e1nh gi\u00e1 ban \u0111\u1ea7u \u1edf b\u1ec7nh nh\u00e2n suy gi\u1ea3m mi\u1ec5n d\u1ecbch. C\u00e1c x\u00e9t nghi\u1ec7m huy\u1ebft thanh, bao g\u1ed3m x\u00e9t nghi\u1ec7m m\u1eabu huy\u1ebft thanh trong giai \u0111o\u1ea1n c\u1ea5p v\u00e0 giai \u0111o\u1ea1n v\u1eeba kh\u1ecfi b\u1ec7nh v\u00e0 m\u1eabu CSF c\u0169ng l\u00e0 ph\u1ea7n c\u1ea7n thi\u1ebft trong \u0111\u00e1nh gi\u00e1 ch\u1ea9n \u0111o\u00e1n v\u1edbi arbovirus, v\u1edbi c\u00e1c x\u00e9t nghi\u1ec7m \u0111\u1eb7c hi\u1ec7u cho virus \u0111\u01b0\u1ee3c quy\u1ebft \u0111\u1ecbnh b\u1eb1ng c\u00e1c y\u1ebfu t\u1ed1 nh\u01b0 v\u00f9ng \u0111\u1ecba l\u00fd, m\u00f9a v\u00e0 ti\u1ec1n s\u1eed ti\u1ebfp x\u00fac. X\u00e9t nghi\u1ec7m huy\u1ebft thanh h\u1ecdc<\/a> c\u1ee7a IgM CSF c\u00f3 th\u1ec3 gi\u00fap ch\u1ea9n \u0111o\u00e1n vi\u00eam n\u00e3o do arbovirus, VZR, EBV, virus s\u1edfi, virus quai b\u1ecb, virus rubella, virus d\u1ea1i ho\u1eb7c c\u00e1c nguy\u00ean nh\u00e2n kh\u00e1c. PCR ho\u1eb7c RT-PCR virus c\u1ee7a m\u1eabu b\u1ec7nh ph\u1ea9m t\u1eeb c\u1ed5 h\u1ecdng v\u00e0 m\u0169i h\u1ecdng c\u00f3 th\u1ec3 gi\u00fap x\u00e1c \u0111\u1ecbnh ch\u1ea9n \u0111o\u00e1n nhi\u1ec5m adenovirus, c\u00fam, ho\u1eb7c s\u1edfi; x\u00e9t nghi\u1ec7m n\u01b0\u1edbc b\u1ecdt c\u00f3 th\u1ec3 gi\u00fap ch\u1ea9n \u0111o\u00e1n b\u1ec7nh quai b\u1ecb ho\u1eb7c d\u1ea1i; x\u00e9t nghi\u1ec7m m\u1eabu ph\u00e2n c\u00f3 th\u1ec3 gi\u00fap ch\u1ea9n \u0111o\u00e1n enterovirus. Ch\u1ea9n \u0111o\u00e1n b\u1ec7nh d\u1ea1i bao g\u1ed3m x\u00e9t nghi\u1ec7m huy\u1ebft thanh h\u1ecdc c\u1ee7a m\u1eabu huy\u1ebft thanh v\u00e0 CSF, x\u00e9t nghi\u1ec7m RT-PCR c\u1ee7a CSF v\u00e0 m\u1eabu n\u01b0\u1edbc b\u1ecdt, x\u00e9t nghi\u1ec7m h\u00f3a m\u00f4 mi\u1ec5n d\u1ecbch<\/a> v\u00e0 k\u00ednh hi\u1ec3n vi \u0111i\u1ec7n t\u1eed m\u1ed9t m\u1eabu sinh thi\u1ebft da c\u00f3 ch\u1ee9a nang l\u00f4ng, \u0111\u1ee7 d\u00e0y da t\u1eeb ph\u00eda sau c\u1ed5.<\/span><\/p>\n

\"MRI-nao-o-benh-nhan-viem-nao-do-virus\"<\/p>\n

H\u1ea7u h\u1ebft c\u00e1c ph\u01b0\u01a1ng ph\u00e1p ch\u1ea9n \u0111o\u00e1n virus hi\u1ec7n c\u00f3 \u0111\u1ec1u ch\u1ec9 ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c m\u1ed9t lo\u1ea1i vi sinh v\u1eadt v\u00e0 \u0111\u01b0\u1ee3c y\u00eau c\u1ea7u ri\u00eang l\u1ebb t\u1eeb c\u00e1c ph\u00f2ng x\u00e9t nghi\u1ec7m ch\u1ea9n \u0111o\u00e1n. C\u00f3 th\u1ec3 th\u1ef1c hi\u1ec7n ph\u00e2n t\u00edch to\u00e0n di\u1ec7n m\u1ed9t b\u1ea3ng l\u1edbn kh\u00e1ng th\u1ec3 kh\u00e1ng virus ch\u1ed1ng l\u1ea1i c\u00e1c virus ng\u01b0\u1eddi \u0111\u00e3 bi\u1ebft, \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 qu\u00e9t epitope virus h\u1ec7 th\u1ed1ng, m\u1eb7c d\u00f9 ph\u01b0\u01a1ng ph\u00e1p n\u00e0y ch\u01b0a c\u00f3 s\u1eb5n tr\u00ean th\u1ecb tr\u01b0\u1eddng. FDA \u0111\u00e3 ch\u1ea5p nh\u1eadn m\u1ed9t b\u1ea3ng ch\u1ea9n \u0111o\u00e1n h\u1ed7n h\u1ee3p cho ph\u00e9p d\u1ef1a tr\u00ean PCR nhanh \u0111\u1ec3 ph\u00e1t hi\u1ec7n nhi\u1ec1u t\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh li\u00ean quan \u0111\u1ebfn vi\u00eam m\u00e0ng n\u00e3o<\/a> v\u00e0 vi\u00eam n\u00e3o trong m\u1eabu CSF, bao g\u1ed3m 7 lo\u1ea1i virus ( HSV1, HSV2, VZR, enterovirus, CMV, HHV-6 v\u00e0 parechovirus ng\u01b0\u1eddi). Arbovirus kh\u00f4ng c\u00f3 tr\u00ean b\u1ea3ng ch\u1ea9n \u0111o\u00e1n n\u00e0y m\u1eb7c d\u00f9 n\u00f3 c\u00f3 t\u1ea7m quan tr\u1ecdng trong l\u00e2m s\u00e0ng. C\u00e1c x\u00e9t nghi\u1ec7m h\u1ed7n h\u1ee3p c\u00f3 s\u1eb5n c\u00f3 \u0111\u1ed9 nh\u1ea1y chung t\u1eeb 86% \u0111\u1ebfn 100% v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u h\u01a1n 99,5%. Tuy nhi\u00ean, c\u00e1c nghi\u00ean c\u1ee9u th\u00eam trong qu\u1ea7n th\u1ec3 r\u1ed9ng v\u00e0 c\u00e1c b\u1ed1i c\u1ea3nh kh\u00e1c nhau l\u00e0 c\u1ea7n thi\u1ebft \u0111\u1ec3 x\u00e1c nh\u1eadn \u0111\u1ed9 nh\u1ea1y v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u c\u1ee7a ch\u00fang.\u00a0<\/span><\/p>\n

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Gi\u1ea3i tr\u00ecnh t\u1ef1 th\u1ebf h\u1ec7 m\u1edbi \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh nguy\u00ean nh\u00e2n g\u00e2y b\u1ec7nh trong CSF ho\u1eb7c m\u00f4 n\u00e3o g\u1ea7n \u0111\u00e2y \u0111\u00e3 c\u00f3 tr\u00ean th\u1ecb tr\u01b0\u1eddng. \u0110\u00e2y l\u00e0 m\u1ed9t k\u1ef9 thu\u1eadt kh\u00f4ng sai l\u1ec7ch, trong \u0111\u00f3 nucleic acid t\u1eeb k\u00fd ch\u1ee7 ho\u1eb7c t\u1eeb b\u1ea5t k\u1ef3 t\u00e1c nh\u00e2n b\u1ec7nh n\u00e0o hi\u1ec7n di\u1ec7n, \u0111\u01b0\u1ee3c chi\u1ebft xu\u1ea5t t\u1eeb CSF ho\u1eb7c m\u00f4 n\u00e3o \u0111\u01b0\u1ee3c l\u00e0m tinh khi\u1ebft v\u00e0 gi\u1ea3i tr\u00ecnh t\u1ef1. Th\u01b0 vi\u1ec7n DNA \u0111\u01b0\u1ee3c chu\u1ea9n b\u1ecb t\u1eeb DNA \u0111\u01b0\u1ee3c tinh khi\u1ebft v\u00e0 t\u1eeb RNA \u0111\u01b0\u1ee3c chuy\u1ec3n th\u00e0nh DNA b\u1ed5 sung v\u00e0 \u0111\u01b0\u1ee3c gi\u1ea3i tr\u00ecnh t\u1ef1 th\u1ebf h\u1ec7 m\u1edbi. C\u00e1c k\u1ef9 thu\u1eadt vi t\u00ednh \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 l\u1ecdc ra c\u00e1c chu\u1ed7i d\u01b0 th\u1eeba v\u00e0 t\u1eadp h\u1ee3p c\u00e1c chu\u1ed7i ch\u1ed3ng ch\u00e9o. V\u1edbi vi\u1ec7c s\u1eed d\u1ee5ng nh\u1eefng ti\u1ebfp c\u1eadn tin-sinh h\u1ecdc, h\u00e0ng tri\u1ec7u l\u1ea7n \u0111\u1ecdc \u0111\u00e3 thu \u0111\u01b0\u1ee3c \u0111em so s\u00e1nh v\u1edbi nh\u1eefng th\u00f4ng tin trong c\u01a1 s\u1edf d\u1eef li\u1ec7u tham chi\u1ebfu \u0111\u1ec3 l\u1ecdc ra chu\u1ed7i c\u1ee7a k\u00fd ch\u1ee7 v\u00e0 x\u00e1c \u0111\u1ecbnh tr\u00ecnh t\u1ef1 m\u1ea7m b\u1ec7nh ti\u1ec1m n\u0103ng. Trong c\u00e1c m\u1eabu b\u1ec7nh ph\u1ea9m l\u00e2m s\u00e0ng nh\u01b0 CSF v\u00e0 m\u00f4 n\u00e3o, ch\u1ec9 m\u1ed9t ph\u1ea7n nh\u1ecf (<1%) tr\u00ecnh t\u1ef1 \u0111\u1ecdc v\u1ea1ch ra t\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh, v\u00ec ph\u1ea7n l\u1edbn l\u00e0 ngu\u1ed3n g\u1ed1c c\u1ee7a k\u00fd ch\u1ee7. S\u1ef1 h\u1ee9a h\u1eb9n c\u1ee7a gi\u1ea3i tr\u00ecnh t\u1ef1 th\u1ebf h\u1ec7 m\u1edbi \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh b\u1eb1ng vi\u1ec7c x\u00e1c \u0111\u1ecbnh m\u1ea7m b\u1ec7nh trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p vi\u00eam n\u00e3o kh\u00f4ng \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n do leptospira, Cache Valley virus, astrovirus, v\u00e0 virus vi\u00eam gan E, c\u0169ng nh\u01b0 c\u00e1c nguy\u00ean nh\u00e2n l\u00e2y nhi\u1ec5m kh\u00e1c.<\/span><\/p>\n

S\u1ebd r\u1ea5t c\u00f3 \u00edch khi x\u00e1c \u0111\u1ecbnh xem li\u1ec7u c\u00f3 d\u1ea5u hi\u1ec7u sinh h\u1ecdc v\u1ec1 di truy\u1ec1n hay protein <\/span>trong CSF n\u00e0o m\u00e0 n\u00f3 \u0111\u1eb7c hi\u1ec7u cho vi\u00eam n\u00e3o nhi\u1ec5m tr\u00f9ng hay kh\u00f4ng. M\u1ed9t trong nh\u1eefng c\u00e1ch ti\u1ebfp c\u1eadn \u0111\u00f3 l\u00e0 ki\u1ec3m tra CSF v\u1edbi vi\u1ec7c s\u1eed d\u1ee5ng c\u00e1c k\u1ef9 thu\u1eadt h\u1ed7n h\u1ee3p cho ph\u00e9p ph\u00e1t hi\u1ec7n \u0111\u1ed3ng th\u1eddi c\u00e1c cytokine v\u00e0 chemokine. Tuy nhi\u00ean, h\u1ea7u h\u1ebft c\u00e1c nghi\u00ean c\u1ee9u \u0111\u1ec1u th\u1ea5y r\u1eb1ng m\u1ee9c cytokine v\u00e0 chemokine ti\u1ec1n vi\u00eam \u0111\u1ec1u t\u0103ng cao \u1edf b\u1ec7nh nh\u00e2n vi\u00eam n\u00e3o, b\u1ea5t k\u1ec3 nguy\u00ean nh\u00e2n g\u00ec v\u00e0 kh\u00f4ng c\u00f3 cytokine ri\u00eang bi\u1ec7t \u0111\u1ea1i di\u1ec7n gi\u00fap ph\u00e2n bi\u1ec7t vi\u00eam n\u00e3o do virus hay kh\u00f4ng do virus.<\/span><\/p>\n

6. \u0110i\u1ec1u tr\u1ecb v\u00e0 ph\u00f2ng ng\u1eeba<\/strong><\/h2>\n