mn Bs. Vi Quéc Dat 8 mén Truyén nhiém — Dai hgc ¥ Ha Néi Myc tiéu hoe tap: saw khi hoc bai nay, sinh vign cé kha ning 41. Néu duige mot s6 dic diém dich t8 chinh lién quan dén nhiém no m6 cau, 2. Trinh bay dugc trigu chiing lim sng va chin dodn duge cdc thé bénh hay gép do nhiém no m6 cau 3. Trinh bay duge phurong phép diéu tri va phong bénh do nhiém nao mé cau. 1. Bai cong Bénh no mé cau [a bénh nhiém tring do vi khuan Neisseria meningitidis (N. meningitis) gay ra. Bénh lay qua durimg hé hp, c6 kha nang gay dich véi bénh cénh lam sng quan trong la nhiém khun huyét va viém mang ndo. Viée chan doan xac dinh bénh diva vio két qua soi, nudi dy tim vi khudn gay bénh, hoc tim khang nguyen vi khudn dc higu trong dich no ty. C6 tinh trang ngudi lanh mang vi khudn. Hign tai da cé vac xin dé phdng bénh. 2. Bac diém vi sinh vat hoc, dich t8 hoc va kha nang gay bénh 2.1. Bc diém vi sinh hoc Nao mé cau (Neisseria meningitides) thudc ho Neisseriaceae, la mét song cau hiéu khi Gram 4m, hinh hat ca phé va chi c6 trén nguéi. Dura vao khang nguyén polysachcharide, no mé cu dugc phan thanh it nhét 13 nhém. khdng nguyén: A, B, C, D; X, Y, Z, E, W-135; H, I, K; va L, trong d6 cdc nhém A, 8, C thudng gay thanh dich. 2.2. Kha nang gay bénh ‘Vung mai hong 18 not luu tra thuréng xuyén nhét cia vi khudn va cting la ngudn chinh phat tan sang ngudi khac, ‘¢ No mé cau gay tén thong nGi mé, dan tdi tang tinh thm thanh mach, d6ng mau noi mach (dn dén sy xudt hién hinh anh ban xudt huyét tdi cp), r6i loan chifc nang co'tim.Thursday, April 28, 2016 Thoat dich va dign giai tir mao mach vao m6 dn dén gidm thé tich tun hoan, phi md, ph phdi- suy h6 hp va s6c nhiém khudn. 2.3. Bc diém dich t8 Nhém khang nguyén B thurdng gay dich & cdc nude phat trién, nhém C xdy ra & cd cdc nude phat trign va dang phat trién. Dich bénh do nhém khéng nguyén A xay ra tai cdc quéc gia kém phat trién hon, TiI@ tir vong trong viém mang ndo do N. meningitidis tir 7% (& cdc nue phat trién) dén 10% (6 m@t s6 nuréc dang phat trién) Tile thr vong trong nhiém khun huyét do N. meningitidis tir 19% (8 cde nurdc phét trién) cé thé dén 70% (& mot s6 nuéc dang phat trién) ¢ Ngudn lay: Ngudi 18 nguén lay duy nhat ca no mé cu, © Budng lay: chinh Ia qua tiép xic tru tiép véi giot ban ciia dung hé hap ngudi bénh. ‘© Thai diém biing phat: xay ra quanh n&m, tuy nhién ty Ié mac cao nhét la vao cudi mila déng va du mia xuan 2.4. Yéuté nguy co © Yéu t6 vat cht — Co cde thiéu hyt cia hé mién dich theo con duéng bé thé Cat lich — Yéu t6 di truyén © Yéu td moi trurdng Nhiém virus duding hé hp true dé — Séng tai ving dan cu tap trung déng hoc trong gia dinh cé ngudi nhiém ndo mé cau — Huit thudc Id chi dong va thy d6ng, —_ Ngh@ nghiép: Nhiing ngudi lam trong phdng xét nghiém vi sinh Biéu hign lam sang Cac biéu hign lam sang khé da dang va c6 thé tir s6t thodng qua, nhiém khugn huyét hoc vim mang no va c6 thé dan dén tir vong trong vong vai gid sau khi khdi phat cdc triéu ching lam sang. Bénh nhan c6 thé biéu hién & mét hoc nhiéu thé bénh. 3.1. Viém mang néo mi do ndo mé ciu Bs. Vi Quéc Bat ~ BS mén Truyén nhiémThursday, April 28, 2016 Viém mang nao la biéu hién phé bién nhét cla bénh do nao mé cau. Bénh khéi phat dot ng6t véi s6t cao, nhitc dau, va ciing gay, thong kem theo cdc triéu ching khdc nhu budn nén, n6n, so’ dnh sng, kém theo céc ri loan ¥ thtte (lib, kich thich vat va..). O'tré so’ sinh va tr nhé biéu hign lam sang c6 thé khéng din hinh. Ban xudt huyét da dang, cd thé & dang chéim, mang, dém xudt huyét hoai tir tong quan voi Voi mite dé gidm tiéu cu va déng mau ndi mach lan tda. 3.2, Nhiém khudin huyét do néio mé cau ‘Bay la tinh trang bénh nhén bi nhiém tring huyét ma khdng c6 viém mang nao kem theo. Nhiém khudn huyét do nao mé cau ¢6 thé biéu hién duéi dang: ‘+ Nhiém khudn huyét t6i edip: Dién hinh la héi ching Waterhouse-Friderichsen (gdm ban xuat huyét, réi loan déng mau, xudt huyét thurgng thén va séc nhiém khudn). ‘+ Nhiém khudn huyét cp tinh: bénh nhan o6 tinh trang nhiém khusn cép tinh, ngudi mét méi khé chiu, suy nhurgc, nhite dau, dau co bap, huyét dp cé thé ha, bach cu mau tang cao. ‘¢Nhiém khudin huyét man tinh do nao mé cau: hiém gép. Triéu chiing kim sang bao gém sét tug dot, phat ban, dau khép va c6 thé kéo dai hang tun dén vai thang, Néu khéng dug igu tri, 06 thé tién trign thanh viém mang ndo, nhiém khudn huyét tdi cp. 3.3. Céc thé nhiém néio m6 cau khéc Nao mé cu gay bénh 6 mot co quan nhung khéng gay nhim khudn huyét. ‘© Viém phéi do nao mé cau ‘* him khudn duréng hé hap trén do no mé cu: gdm viém mai hong, viém hong, viém nép thanh quan, viém tai gidta © Cac co quan khéc: Viém khép, viém nigu dao do ndo mé cau 4. Bién chirng cua bénh do nao mé cau ‘© Khoang 10% bénh nhan bj bénh viém mang nio ti vong mac dir da diéu tri khéing sinh, © Bign ching thudng gép: — Hogi tir da do tén thutong xuat huyét. Dic, mat thinh Ie — Tén thong cdc day than kinh so ndo: dc biét Ia day s6 VI, VIl va VII Bs. Vi Quéc Bat ~ BS mén Truyén nhiémThursday, April 28, 2016 — Réiloan tam ly — Tén thong than hoc suy than — Mét sé bién ching khdc: viém khép, viém mang ngoai tim 5._Xét nghiém S.A, Cac xét nghiém chan doan 5.1.1. Nhugm soi © Bénh pham: Dich no tiiy © Phat n hinh anh no mé cu 6 85% céc truong hop viém mang ndo do nao mé cau 5.1.2. Nubi céiy ‘La tiéu chugn vang chan dodn bénh do nao mé cau ‘© Bénh pham: mau, dich ndo ty, dich mang phéi, dich mang ngoai tim, hoat dich, ti ban... ‘© 86 nhay cia phutong phap nudi cdy gidm di néu da digu tri khang sinh. ‘* Mu dy bénh phém hong mui duong tinh chi xéc dinh dugc tinh trang ngudi lanh mang. tring chit khong khang dinh dug bénh do ndo mé cau. 5.1.3. PCR © PCR c6 gid tri voi ning trudng hop bénh nhan da diéu tri khang sinh trudc a6. © Bénh pham: Dich ndo tiiy © D6 nhay va do dic higu cao (90%) 5.1.4. Xét nghiém khéng nguyén va huyét thanh khéc © Phan ting ngung két hat latex trong dich nao tly ‘© Xét nghiém min dich hap phy gén enzyme (ELISA). 5.1.5. Céc xét nghiém khdc © Céng thitc mau: bach cau tng, chil yéu la bach cu da nhn trung tinh, tigu cau gidm. Truong hgp nhiém khudn huyét tdi cp, bach cau cé thé binh thuréng hoac ha. ‘© Xét nghiém sinh héa: Trong cdc trurdng s6c hod suy da tang, xét nghiém chite nang thén, ign giai d®, khi méu, lactat mau bj r6i loan. ‘+ Xét nghiém dich nao tly: bach cau tang tir vai tréim toi vai nghin, da sé la bach cu da nhan trung tinh, protein dich tang, dudng giam. 6. Chan doan 6.1. Chén doan ca benh Bs. Vi Quéc Bat ~ BS mén Truyén nhiémThursday, April 28, 2016 6.1.1. Cabénh nghingd ‘© C6 ban xuat huyét trén lam sing va khéng c6 két qua nudi cdy mau durong tinh; HOAC ‘*Nhugm soi bénh phém v6 khugn (vi du, mau hodc dich no tay) thay song cau Gram am. 6.1.2. Cabénh cé thé ‘* PCR chén doan nao mé cau durong tinh & bénh phdm v6 triing nhur mau hodc dich nao ty HOAC ‘© Phat hién cic khdng nguyén cuando mé cau bang phyong phdp c6 dinh mé mién dich hdc bang phan dig ngung KEL latex trong diet nau tay. 6.1.3. Ca bénh xd dinh: Phan lp durgc no m6 chu ‘© Tirmét bénh phdm v6 khudn (vi dy, mau ho8c chat dich nao ty, hotc, it phé bién hon a hoat dich, dich mang phéi, hoac dich mang ngoai tim), HOAC © Tir tén thurong xuat huyét. 6.2. Chan dodn phan biét ‘© Bénh do lién c3u lon (Streptococcus suis) © Sot xudt huyét Dengue ‘+ Nhiém khuin huyét do cdc vi khudn khéc ‘© Vim mang ndo mii do céc cn nguyén kha ‘© Ban xuat huyét Schénlein-Henoch 7. dibutri 7.1, Nguyén tic diéu tri * Bénh no mé cau cé khd néng gay tir vong nén phai durge xem la mot cp cttu y khoa. * Phdi nap vién dé choc va kiém tra dich nao ty phyc vy cho chin dosn va diéu tri * Bigu tri khang sinh két hop véi digu tri hé tro. 7.2. biéu tri cin nguyén Ding khng sinh 48 dimg sy gia tng vi khudn ngay Igp tec. ‘Thong thuéng, diéu tri khang sinh trong 7-14 ngay. Thos gian digu tri khang sinh s@ phy thudec vao lam sang va dap ting cia bénh nhan. © Cac khng sinh duoc khuyén cdo diéu tri: — Ceftriaxon — Cefotaxime Bs. Vi Quéc Bat ~ BS mén Truyén nhiémThursday, April 28, 2016 = Penicillin G (khi ndio m6 cu cdn nhay cém penicilin) — Chloramphenicol (néu bénh nhan dij ting penicillin va cephalosporin) — Meropenem 7.3, Biéu tri hé tre ‘* 4m bao dui khdi lugng tun hoan bang bil dich ‘+ Sir dung thuée van mach theo diing chi dinh dé dat céc muc tiéu v8 hi ste ‘* Loc than nhan tao dé kiém soat tinh trang qué tai dich, toan chuyén héda va suy thn cap. 8. Phong bénh 8.1. Bidu tri dy phong ndo mé cau ‘© Chidinh cho nhiing ngudi cé tip xic truc tip véi dich tiét cua ngudi bénh. © Khang sinh dug khuyén cdo dé phong bénh nao mé cau la rifampin, cefrtiaxone, ciprofixacin, hoc azithromycin ‘© bigu tri dy phong t6t o6 thé dat higu qua phong bénh ndo mé cau tir 90% dén 95%. 8.2, Phong bénh khéng dic higu ‘© Tranh tip xtc gin voi cdc truéng hop duge chan doan hodc nghi ng cé bénh nao mé cau, bao vé nhiing cé thé nhay cdm va cét dung lay cla nao mé cau. © Kha nang lay lan gidm nhanh sau khi bénh nhén bat dau durgc digu tri khang sinh, 8.3. Phong bénh dic higu 8.3.1. Vaccine vé polysaccharide nao mé ctu (MPSV4) ‘© Cac dang vaccine hién c6 trén thi trutdng la vaccine polysaccharide tr gid A,C,W.Y ‘© Sir dung tiém dudi da 8.3.2. Cac logi vaccine néo mé cu lién hyp (MenACWY) La loai duge uu tién sit dung. Ba loai vic-xin ndo mé cu lién hop due cp phép chinh la hai loai vlc xin don gid (Menactra (MenACWY-D) va Menveo (MenACWY-CRM)) va mét vaccine két hop voi Hib (MenHibrix (Hib-MenCY-TT)) 8.3.3. Lich tiém ching ‘© 861 véi vaccine vé polysaccharide nao mé cau (MPSV4): khéng khuyén céo tiém chung. ‘thuéng quy cho tat ca moi ngu’éi ma nén ding cho ngudi trén 55 tudi hoac khéng co Menacwy. © 861 véi vaccine lién hyp: Bs. Vi Quéc Bat ~ BS mén Truyén nhiémThursday, April 28, 2016 — Béi véi tré c6 nguy co cao 2-18 thang: tiém vao thang 2, 4, 6 va 12-15 thang — Béi véi tré nguy co’ cao 19-24 thang chua hoan thanh lich tiém chiing: tiém 2 ligu cach nhau it nhat 3 thang — BGi véi tiém phong thung quy: nén tiém vaccine MenACWY liic 11 hoac 12 tuéi, va tiém nhac Iai luc 16 tuéi — Ngudi khde manh da tiém vaccine lién hp tir sau 16 tudi khéng cn tiém nhac lai Khang can tiém vaccine thu’ng quy cho nhiing ngudi khde manh trén 21 tuéi trir khi ho c6 nguy co phai nhiém cao. Tai ligu tham khdo Mandell, G. L, J. €. Bennett, et al. (2010). Mandell, Douglas, and Bennett's principles and Practice of infectious diseases. Philadelphia, PA, Churchill Livingstone/Elsevier. — Centers for Disease Control and Prevention. Epidemiology and Prevention of Vaccine- Preventable Diseases. Hamborsky J, Kroger A, Wolfe S, eds. 13th ed. Washington D.C. Public Health Foundation, 2015. Bs. Vi Quéc Bat ~ BS mén Truyén nhiém