{"id":2339,"date":"2018-11-19T15:13:36","date_gmt":"2018-11-19T15:13:36","guid":{"rendered":"https:\/\/robot.yeupet.vn\/nhiem-trung-lao-tren-cho-meo-mycobacterial-infections\/"},"modified":"2018-11-19T15:13:36","modified_gmt":"2018-11-19T15:13:36","slug":"nhiem-trung-lao-tren-cho-meo-mycobacterial-infections","status":"publish","type":"post","link":"https:\/\/robot.yeupet.vn\/index.php\/2018\/11\/19\/nhiem-trung-lao-tren-cho-meo-mycobacterial-infections\/","title":{"rendered":"Nhi\u1ec5m Tr\u00f9ng Lao Tr\u00ean Ch\u00f3, M\u00e8o (Mycobacterial Infections)"},"content":{"rendered":"

1 Gi\u1edbi thi\u1ec7u chung v\u1ec1 Mycobacteria
\nNhi\u1ec5m tr\u00f9ng lao l\u00e0 b\u1ec7nh do vi khu\u1ea9n thu\u1ed9c h\u1ecd Mycobacteriaceae, l\u1edbp Actinomycetales.Mycobacterium l\u00e0 m\u1ed9t gi\u1ed1ngc\u00f3 h\u00ecnh th\u00e1i gi\u1ed1ng nhau, hi\u1ebfu kh\u00ed, kh\u00f4ng b\u00e0o t\u1eed, kh\u00f4ng di \u0111\u1ed9ng, c\u00f3 nhi\u1ec1u l\u00f4ng roi c\u00f3 s\u1ef1 thay \u0111\u1ed5i l\u1edbn tr\u00ean c\u01a1 th\u1ec3 v\u1eadt ch\u1ee7 c\u00f3 m\u1ed1i quan h\u1ec7 th\u00e2n thu\u1ed9c v\u00e0 c\u00f3 kh\u1ea3 n\u0103ng g\u00e2y b\u1ec7nh.<\/span><\/p>\n

\"nhiem-trung-lao-tren-cho-meo\"<\/p>\n

Mycobacteria c\u00f3 kh\u1ea3 n\u0103ng ch\u1ecbu \u0111\u01b0\u1ee3c nhi\u1ec7t, pH thay \u0111\u1ed5i v\u00e0 c\u00e1c ch\u1ea5t kh\u1eed tr\u00f9ng th\u00f4ng th\u01b0\u1eddng.Mycobacteria r\u1ea5t d\u1ec5 nh\u1ea1y c\u1ea3m v\u1edbi phenol pha lo\u00e3ng (5%) ho\u1eb7c \u00e1nh s\u00e1ng m\u1eb7t tr\u1eddi tr\u1ef1c ti\u1ebfp. M\u1eb7c d\u00f9 ch\u00fang t\u01b0\u01a1ng \u0111\u1ed1i \u1ed5n \u0111\u1ecbnh trong c\u01a1 th\u1ec3 v\u1eadt ch\u1ee7, mycobacteria b\u1ecb di\u1ec7t b\u1edfi thu\u1ed1c t\u1ea9y gia d\u1ee5ng pha lo\u00e3ng (5%) trong v\u00f2ng 15 ph\u00fat \u1edf nhi\u1ec7t \u0111\u1ed9 ph\u00f2ng.Mycobacteria g\u00e2y b\u1ec7nh g\u00e2y ra 2 th\u1ec3 l\u00e0 th\u1ec3 g\u00e2y lao v\u00e0 th\u1ec3 kh\u00f4ng g\u00e2y lao.<\/p>\n

2 Mycobacteria g\u00e2y lao \u2013 Tuberculous Mycobacteria
\n2.1 Nguy\u00ean nh\u00e2n g\u00e2y b\u1ec7nh \u2013 Etiology
\nG\u00e2y ra b\u1edfi m\u1ed9t nh\u00f3m vi khu\u1ea9n c\u00f3 \u0111\u1ed9c l\u1ef1c cao (Mycobacterium tuberculosis ph\u1ee9c t\u1ea1p) bao g\u1ed3m M. tuberculosis v\u00e0 M.bovis. R\u1ea5t kh\u00f3 ph\u00e2n bi\u1ec7t c\u00e1c vi khu\u1ea9n, ngo\u1ea1i tr\u1eeb b\u1eb1ng c\u00e1ch s\u1eed d\u1ee5ng m\u1ed9t v\u00e0i x\u00e9t nghi\u1ec7m sinh h\u00f3a v\u00e0 \u0111\u1ea7u d\u00f2 acid nucleic. Ch\u00fang k\u00fd sinh t\u00f9y \u00fd ho\u1eb7c b\u1eaft bu\u1ed9c trong c\u00e1c m\u00f4 c\u1ee7a c\u01a1 th\u1ec3 n\u01a1i c\u00f3 nhi\u1ec1u oxy nh\u01b0 ph\u1ed5i. M. tuberculosis l\u00e0 lo\u00e0i g\u00e2y b\u1ec7nh v\u00e0 l\u00e0 lo\u00e0i g\u00e2y b\u1ec7nh \u0111\u1ea7u ti\u00ean cho con ng\u01b0\u1eddi. M. bovis g\u00e2y b\u1ec7nh nhi\u1ec1u tr\u00ean \u0111\u1ed9ng v\u1eadt, l\u00e0 lo\u00e0i vi khu\u1ea9n c\u00f3 t\u1eeb l\u00e2u \u0111\u1eddi, n\u00f3 b\u1ed9c ph\u00e1t khi ng\u01b0\u1eddi u\u1ed1ng s\u1eefa gia s\u00fac nu\u00f4i.
\n2.2 D\u1ecbch t\u1ec5 h\u1ecdc \u2013 Epidemiology
\nCon ng\u01b0\u1eddi ch\u1ec9 l\u00e0 v\u1eadt ch\u1ee7 ch\u1ee9a M. tuberculosis. Ch\u00f3 v\u00e0 m\u00e8o d\u1ec5 b\u1ecb nhi\u1ec5m v\u1edbi M.tuberculosis v\u00e0 M. bovis. M\u00e8o c\u00f3 s\u1ee9c \u0111\u1ec1 kh\u00e1ng v\u1edbi M. tuberculosis t\u1ed1t h\u01a1n M. bovis.Ch\u00f3 v\u00e0 m\u00e8o nhi\u1ec5m M. tuberculosis \u0111\u01b0\u1ee3c coi l\u00e0 m\u1ed9t b\u1ec7nh truy\u1ec1n l\u00e2y t\u1eeb ng\u01b0\u1eddi sang \u0111\u1ed9ng v\u1eadt, xem s\u1ef1 truy\u1ec1n b\u1ec7nh t\u1eeb ng\u01b0\u1eddi sang \u0111\u1ed9ng v\u1eadt (H\u00ecnh 48-1). M\u1eb7c d\u00f9 v\u1eadt nu\u00f4i b\u1ecb l\u00e2y nhi\u1ec5m t\u1eeb con ng\u01b0\u1eddi, nh\u01b0ng b\u1ec7nh l\u00e2y lan ng\u01b0\u1ee3c l\u1ea1i t\u1eeb ch\u00f3 ho\u1eb7c m\u00e8o sang ng\u01b0\u1eddi th\u00ec kh\u00f4ng \u0111\u01b0\u1ee3c n\u00f3i \u0111\u1ebfn. Ch\u00f3 c\u00f3 t\u1ef7 l\u1ec7 nhi\u1ec5m M. tuberculosis cao h\u01a1n so v\u1edbi m\u00e8o. Ch\u00f3 b\u1ecb lao ph\u1ed5i c\u0169ng c\u00f3 nh\u1eefng h\u1ea1t lao trong ph\u1ebf nang c\u0169ng gi\u1ed1ng nh\u01b0 ng\u01b0\u1eddi.<\/p>\n

\"nhiem-trung-lao-tren-cho-meo1\"<\/p>\n

H\u00ecnh 1 S\u1ef1 truy\u1ec1n l\u00e2y b\u1ec7nh lao t\u1eeb ng\u01b0\u1eddi sang \u0111\u1ed9ng v\u1eadt<\/p>\n

2.3 C\u00e1ch sinh b\u1ec7nh \u2013 Pathogenesis
\nTr\u1ef1c khu\u1ea9n lao v\u00e0o c\u01a1 th\u1ec3 th\u00f4ng qua \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p, \u0111\u01b0\u1eddng ti\u00eau h\u00f3a, th\u00e2m nh\u1eadp qua da,\u2026N\u01a1i \u0111\u1ea7u ti\u00ean vi khu\u1ea9n nh\u00e2n l\u00ean l\u00e0 t\u1ea1i c\u00e1c h\u1ea1ch lympho. M. tuberculosis d\u1ec5 d\u00e0ng l\u00e2y nhi\u1ec5m \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p do y\u00eau c\u1ea7u oxy cao.N\u1ebfu \u0111\u01b0\u1ee3c ch\u1eefa b\u1ec7nh ph\u1ea3n \u1ee9ng vi\u00eam ban \u0111\u1ea7u c\u00f3 th\u1ec3 gi\u1ea3m d\u1ea7n v\u00e0 \u0111\u01b0\u1ee3c gi\u1ea3i quy\u1ebft v\u00e0 tr\u1ef1c khu\u1ea9n lao g\u00e2y x\u01a1 c\u1ee9ng \u0111\u01b0\u1ee3c lo\u1ea1i b\u1ecf.N\u1ebfu s\u1ee9c \u0111\u1ec1 kh\u00e1ng gi\u1ea3m, c\u00e1c mycobacteria ch\u1ec9 tr\u1edf th\u00e0nh gi\u1edbi h\u1ea1n trong c\u00e1c t\u1ebf b\u00e0o th\u1ef1c b\u00e0o, ch\u00fang ti\u1ebfp t\u1ee5c nh\u00e2n l\u00ean v\u00ec kh\u1ea3 n\u0103ng lo\u1ea1i b\u1ecf t\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh c\u1ee7a c\u01a1 th\u1ec3 kh\u00f4ng hi\u1ec7u qu\u1ea3.<\/p>\n

2.4 D\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng \u2013 Clinical Findings
\nD\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng \u1edf ch\u00f3 v\u00e0 m\u00e8o c\u00f3 d\u1ea5u hi\u1ec7u u h\u1ea1t. (H\u00ecnh 48-2). M. bovis g\u00e2y b\u1ec7nh ph\u1ed5 bi\u1ebfn nh\u1ea5t \u1edf ch\u00f3 l\u00e0 \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p, vi\u00eam ph\u1ebf qu\u1ea3n ph\u1ed5i, h\u00ecnh th\u00e0nh h\u1ea1ch ph\u1ed5i v\u00e0 d\u00e2y th\u1ea7n kinh h\u1ea1ch b\u1ea1ch huy\u1ebft l\u00e0m ch\u00f3 s\u1ed1t, gi\u1ea3m c\u00e2n, ch\u00e1n \u0103n v\u00e0 ho khan.Tri\u1ec7u ch\u1ee9ng ph\u1ed5i \u1edf m\u00e8o th\u01b0\u1eddng g\u00e2y ra kh\u00f3 th\u1edf v\u00e0 ho.Ch\u00f3 v\u00e0 m\u00e8o th\u01b0\u1eddng b\u1ecb kh\u00f3 nu\u1ed1t, n\u00f4n khan, t\u0103ng ti\u1ebft v\u00e0 m\u1edf r\u1ed9ng h\u1ea1ch h\u1ea1nh nh\u00e2n, do h\u1eadu qu\u1ea3 c\u1ee7a t\u1ed5n th\u01b0\u01a1ng lo\u00e9t h\u1ea7u h\u1ecdng. B\u1ec7nh ph\u1ed5i c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i ho\u1eb7c m\u00e0ng ngo\u00e0i tim c\u00f3 d\u1ea5u hi\u1ec7u kh\u00f3 th\u1edf, t\u00edm t\u00e1i v\u00e0 suy tim.<\/p>\n

\"nhiem-trung-lao-tren-cho-meo2\"<\/p>\n

H\u00ecnh. 2 C\u1ee5c u (A) v\u00e0 ung lo\u00e9t (B) do Mycobacterium microti g\u00e2y ra \u1edf m\u00e8o. (Courtesy D. Gunn-Moore, University of Edinburgh, Edinburgh, Scotland.)<\/p>\n

\u00a03 Mycobacteria kh\u00f4ng g\u00e2y lao \u2013 Nontuberculous Mycobacteria<\/p>\n

3.1 Nguy\u00ean nh\u00e2n g\u00e2y b\u1ec7nh \u2013 Etiology
\nDo Mycobacterium avium Complex (MAC). L\u00e0 lo\u00e0i g\u00e2y b\u1ec7nh c\u01a1 h\u1ed9i, mycobacteria ho\u1ea1i sinh sinh ra u h\u1ea1t nh\u01b0 l\u00e0 b\u1ec7nh u h\u1ea1t, c\u00e1c lo\u00e0i li\u00ean quan bao g\u1ed3m M. avium.M.avium ph\u00e2n l\u1eadp t\u1eeb c\u00e1c lo\u00e0i chim v\u00e0 qu\u00e1 tr\u00ecnh ti\u1ebfn h\u00f3a c\u1ee7a M. avium subsp c\u00f3 ngu\u1ed3n g\u1ed1c t\u1eeb heo ho\u1eb7c con ng\u01b0\u1eddi.S\u1ef1 t\u0103ng tr\u01b0\u1edfng ch\u1eadm trong nu\u00f4i c\u1ea5y t\u01b0\u01a1ng t\u1ef1 nh\u01b0 vi khu\u1ea9n lao. \u1ede ng\u01b0\u1eddi tr\u01b0\u1edfng th\u00e0nh, MAC th\u00e2m nhi\u1ec5m ph\u1ed5i v\u00e0 g\u00e2y b\u1ec7nh x\u01a1 c\u1ee9ng, \u1edf c\u00e1c v\u1eadt ch\u1ee7 suy gi\u1ea3m mi\u1ec5n d\u1ecbch. \u1ede m\u00e8o v\u00e0 tr\u1ebb em, vi\u00eam h\u1ea1ch b\u1ea1ch huy\u1ebft c\u1ee5c b\u1ed9 c\u00f3 th\u1ec3 x\u1ea3y ra. Khi th\u1ef1c hi\u1ec7n ph\u01b0\u01a1ng ph\u00e1p ph\u00e2n t\u00edch di truy\u1ec1n m\u1edbi, m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p \u0111\u01b0\u1ee3c coi nh\u01b0 gi\u1ed1ng h\u1ed9i ch\u1ee9ng b\u1ec7nh phong \u1edf m\u00e8o, \u0111\u01b0\u1ee3c cho l\u00e0 nhi\u1ec5m tr\u00f9ng MAC.B\u1ec7nh MAC th\u01b0\u1eddng tr\u1edf n\u00ean ph\u1ed5 bi\u1ebfn \u1edf ch\u00f3 v\u00e0 m\u00e8o. Nhi\u1ec5m tr\u00f9ng MAC l\u00e0m cho v\u1eadt ch\u1ee7 suy gi\u1ea3m mi\u1ec5n d\u1ecbch. Trong s\u1ed1 mycobacteria c\u01a1 h\u1ed9i \u1edf ng\u01b0\u1eddi v\u00e0 \u0111\u1ed9ng v\u1eadt, MAC c\u00f3 nhi\u1ec1u kh\u1ea3 n\u0103ng sinh ra vi khu\u1ea9n v\u00e0 g\u00e2y b\u1ec7nh x\u01a1 c\u1ee9ng \u1edf nhi\u1ec1u c\u01a1 quan.
\n3.2 D\u1ecbch t\u1ec5 h\u1ecdc \u2013 Epidemiology
\nMycobacterium avium Complex (MAC). C\u00f3 \u1edf kh\u1eafp m\u1ecdi n\u01a1i tr\u00ean to\u00e0n th\u1ebf gi\u1edbi trong \u0111\u1ea5t v\u00e0 n\u01b0\u1edbc trong c\u00e1c \u0111i\u1ec1u ki\u1ec7n nh\u1ea5t \u0111\u1ecbnh. MAC c\u00f3 trong m\u00f4i tr\u01b0\u1eddng axit (pH 5,0-5,5) v\u00e0 \u0111i\u1ec1u ki\u1ec7n \u0111\u1ea5t c\u00f3 k\u1ebft c\u1ea5u h\u1eefu c\u01a1 cao. Ph\u00e2n c\u1ee7a lo\u00e0i c\u1ea7m nhi\u1ec5m b\u1ec7nh c\u00f3 ch\u1ee9a s\u1ed1 l\u01b0\u1ee3ng l\u1edbn c\u00e1c tr\u1ef1c khu\u1ea9n v\u00e0 nhi\u1ec5m qua ch\u00f3 v\u00e0 m\u00e8o (xem h\u00ecnh. 48-1). Kh\u00f4ng gi\u1ed1ng nh\u01b0 M. tuberculosis v\u00e0 M. bovis, MAC v\u1eabn s\u1ed1ng \u00edt nh\u1ea5t 2 n\u0103m trong m\u00f4i tr\u01b0\u1eddng, k\u1ec3 c\u1ea3 c\u00e1c v\u1eadt li\u1ec7u, n\u01b0\u1edbc, \u0111\u1ea5t, c\u00e1c s\u1ea3n ph\u1ea9m s\u1eefa v\u00e0 c\u00e1c m\u00f4 c\u1ee7a c\u00e1c lo\u00e0i chim v\u00e0 \u0111\u1ed9ng v\u1eadt c\u00f3 v\u00fa. Ngu\u1ed3n n\u01b0\u1edbc t\u1ef1 nhi\u00ean, n\u01b0\u1edbc u\u1ed1ng, v\u00e0 th\u1eadm ch\u00ed \u1edf v\u00f9ng \u00f4n \u0111\u1edbi v\u00e0 nhi\u1ec7t \u0111\u1edbi c\u00f3 th\u1ec3 ch\u1ee9a mycobacteria nontuberculous
\n3.3 C\u00e1ch sinh b\u1ec7nh \u2013 Pathogenesis
\nNhi\u1ec5m MAC th\u01b0\u1eddng b\u1eaft \u0111\u1ea7u th\u00f4ng qua \u0111\u01b0\u1eddng \u0103n u\u1ed1ng t\u1eeb m\u00f4i tr\u01b0\u1eddng ngo\u00e0i nh\u01b0 th\u1ef1c ph\u1ea9m b\u1ecb \u00f4 nhi\u1ec5m ho\u1eb7c n\u1ed9i t\u1ea1ng nhi\u1ec5m b\u1ec7nh ch\u01b0a n\u1ea5u ch\u00edn. MAC \u1edf ch\u00f3 v\u00e0 m\u00e8o th\u01b0\u1eddng \u0111\u01b0\u1ee3c ph\u1ed5 bi\u1ebfn kh\u1eafp b\u1ea1ch huy\u1ebft v\u00e0 nhi\u1ec1u m\u00f4 kh\u00e1c, m\u00e0 kh\u00f4ng c\u00f3 d\u1ea5u hi\u1ec7u c\u1ee7a m\u1ed9t u h\u1ea1t t\u1ea1i n\u01a1i nhi\u1ec5m ban \u0111\u1ea7u.
\n3.4 D\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng \u2013 Clinical Findings
\nCh\u00f3 b\u1ecb b\u1ec7nh MAC th\u01b0\u1eddng c\u00f3 u h\u1ea1t r\u1ed9ng l\u1edbn \u1edf ru\u1ed9t, l\u00e1 l\u00e1ch, gan v\u00e0 c\u00e1c h\u1ea1ch b\u1ea1ch huy\u1ebft m\u00e0ng treo ru\u1ed9t. H\u1ea7u h\u1ebft ch\u00f3 b\u1ec7nh th\u01b0\u1eddng d\u01b0\u1edbi 4 tu\u1ed5i, gi\u1ea3m c\u00e2n v\u00e0 m\u1ec7t m\u1ecfi. N\u00f4n m\u1eeda, ch\u00e1n \u0103n, s\u1ed1t, ti\u00eau ch\u1ea3y v\u00e0 ti\u00eau ra m\u00e1u c\u00f3 th\u1ec3 x\u1ea3y ra nh\u01b0ng kh\u00f4ng li\u00ean t\u1ee5c.M\u00e8o b\u1ecb nhi\u1ec5m tr\u00f9ng MAC c\u00e1c h\u1ea1ch b\u1ea1ch huy\u1ebft th\u01b0\u1eddng m\u1edf r\u1ed9ng v\u00e0 s\u01b0ng d\u01b0\u1edbi da, \u0111\u1eb7c bi\u1ec7t l\u00e0 xung quanh \u0111\u1ea7u v\u00e0 m\u1eb7t, m\u1ed9t s\u1ed1 m\u00e8o vi\u00eam ni\u00eam m\u1ea1c (H\u00ecnh 3). C\u00e1c b\u1ec7nh nhi\u1ec5m tr\u00f9ng th\u01b0\u1eddng theo v\u1ebft c\u1eafn ho\u1eb7c qua v\u1ebft c\u00e0o v\u00e0o m\u1eb7t. Gi\u1ea3m c\u00e2n, ch\u00e1n \u0103n, s\u1ed1t. M\u00e8o c\u00f3 th\u1ec3 ph\u00e1t tri\u1ec3n b\u1ec7nh n\u1ed9i t\u1ea1ng t\u01b0\u01a1ng t\u1ef1 ch\u00f3 nh\u01b0 v\u00f2ng ru\u1ed9t d\u00e0y, gan to, l\u00e1ch to v\u00e0 h\u1ea1ch b\u1ea1ch huy\u1ebft \u0111\u01b0\u1eddng ru\u1ed9t m\u1edf r\u1ed9ng c\u00f3 th\u1ec3 s\u1edd \u0111\u01b0\u1ee3c ho\u1eb7c quan s\u00e1t.<\/p>\n

\"nhiem-trung-lao-tren-cho-meo3\"<\/p>\n

H\u00ecnh. 3 T\u1ed5n th\u01b0\u01a1ng l\u1edbn \u1edf tr\u00ean v\u00f2m mi\u1ec7ng v\u00e0 h\u00e0m tr\u00ean c\u1ee7a m\u1ed9t con m\u00e8o nhi\u1ec5m Mycobacterium avium-intracellulare.<\/p>\n

4Nh\u1eefng d\u1ea5u hi\u1ec7u b\u1ec7nh l\u00fd \u2013 Pathologic Findings
\n\u1ede ch\u00f3 v\u00e0 m\u00e8o tr\u1ea1ng th\u00e1i con v\u1eadt g\u1ea7y m\u00f2n. C\u00e1c u h\u1ea1t t\u1eeb x\u00e1m-tr\u1eafng chuy\u1ec3n sang m\u00e0u v\u00e0ng, u h\u1ea1t t\u1ed5n th\u01b0\u01a1ng v\u00e0 xu\u1ea5t hi\u1ec7n \u1edf nhi\u1ec1u c\u01a1 quan. Ph\u1ed5i v\u00e0 c\u00e1c h\u1ea1ch b\u1ea1ch huy\u1ebft ph\u1ebf qu\u1ea3n th\u01b0\u1eddng l\u00e0 v\u1ecb tr\u00ed t\u1ed5n th\u01b0\u01a1ng \u0111\u1ea7u ti\u00ean. \u1ede ch\u00f3 x\u1ea3y ra ph\u1ed5 bi\u1ebfn h\u01a1n \u1edf m\u00e8o; m\u00e0ng ph\u1ed5i, m\u00e0ng ngo\u00e0i tim, gan, th\u1eadn, tim, ru\u1ed9t v\u00e0 t\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh trung \u01b0\u01a1ng.T\u1ed5n th\u01b0\u01a1ng b\u1ed9 ph\u1eadn sinh d\u1ee5c c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c quan s\u00e1t th\u1ea5y \u1edf ch\u00f3 v\u00e0 m\u00e8o v\u00e0 t\u1ed5n th\u01b0\u01a1ng k\u1ebft m\u1ea1c \u0111\u00e3 \u0111\u01b0\u1ee3c quan s\u00e1t th\u1ea5y \u1edf m\u00e8o v\u00e0 ch\u1ed3n.
\n5\u0110i\u1ec1u tr\u1ecb \u2013 Therapy
\nB\u1ea3ng 1 M\u1ed9t s\u1ed1 lo\u1ea1i kh\u00e1ng sinh tr\u1ecb lao<\/p>\n

\"nhiem-trung-lao-tren-cho-meo4\"<\/p>\n

\u0110i\u1ec1u tr\u1ecb ch\u00f3 v\u00e0 m\u00e8o b\u1ecb nhi\u1ec5m b\u1ec7nh ph\u1ea3i th\u1ef1c hi\u1ec7n nghi\u00eam t\u00fac,\u2026Kh\u00f4ng n\u00ean ch\u1ec9 s\u1eed d\u1ee5ng m\u1ed9t lo\u1ea1i thu\u1ed1c trong \u0111i\u1ec1u tr\u1ecb b\u1ea5t k\u1ef3 ca nhi\u1ec5m tr\u00f9ng do mycobacteria tr\u00ean \u0111\u1ed9ng v\u1eadt.Thay v\u00e0o \u0111\u00f3, cho hi\u1ec7u qu\u1ea3 t\u1ed1t nh\u1ea5t, \u0111i\u1ec1u tr\u1ecb k\u1ebft h\u1ee3p lu\u00f4n lu\u00f4n c\u1ea7n thi\u1ebft (B\u1ea3ng 48-4).<\/p>\n

6\u0110i\u1ec1u tr\u1ecb b\u1ed5 tr\u1ee3 \u2013 Adjunctive Therapy
\nS\u1eed d\u1ee5ng c\u00e1c m\u1ee9c th\u1ea5p h\u00e0ng ng\u00e0y c\u1ee7a m\u1ed9t lo\u1ea1i thu\u1ed1c nh\u01b0 acepromazine c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c xem x\u00e9t \u0111i\u1ec1u tr\u1ecb h\u1ed7 tr\u1ee3 \u0111\u1ec3 gi\u00fap t\u1ea1o \u0111i\u1ec1u ki\u1ec7n cho hi\u1ec7u qu\u1ea3 kh\u00e1ng khu\u1ea9n.Li\u1ec1u kh\u00e1ng vi\u00eam glucocorticoid th\u1ea5p \u0111\u00e3 \u0111\u01b0\u1ee3c tr\u1ecb cho nh\u1eefng ng\u01b0\u1eddi suy gi\u1ea3m mi\u1ec5n d\u1ecbch nhi\u1ec5m M. avium khi \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh \u0111\u00e3 th\u1ea5t b\u1ea1i. S\u1ed1t v\u00e0 kh\u00f3 ch\u1ecbu \u0111\u00e3 gi\u1ea3m xu\u1ed1ng v\u00e0 nhi\u1ec5m tr\u00f9ng c\u01a1 h\u1ed9i m\u1edbi t\u0103ng l\u00ean kh\u00f4ng \u0111\u00e1ng k\u1ec3.<\/p>\n

7 Ki\u1ec3m tra lao \u2013 Tuberculin testing
\nKh\u00e1ng nguy\u00ean ki\u1ec3m tra lao l\u00e0 m\u1ed9t protein tinh khi\u1ebft (PPD) \u0111\u01b0\u1ee3c d\u1eabn xu\u1ea5t t\u1eeb M.tuberculosis. Ng\u01b0\u1eddi ho\u1eb7c \u0111\u1ed9ng v\u1eadt b\u1ecb nhi\u1ec5m vi khu\u1ea9n lao s\u1ea3n xu\u1ea5t ph\u00e1t tri\u1ec3n m\u1ed9t ph\u1ea3n \u1ee9ng qu\u00e1 m\u1eabn ch\u1eadm khi kh\u00e1ng nguy\u00ean n\u00e0y \u0111\u01b0\u1ee3c ti\u00eam trong da. Vi khu\u1ea9n kh\u00f4ng g\u00e2y lao c\u00f3 c\u1ea5u tr\u00fac protein t\u01b0\u01a1ng t\u1ef1 M. tuberculosis v\u00e0 n\u00f3 t\u1ed3n t\u1ea1i \u0111\u00e1ng k\u1ec3 trong ph\u1ea3n \u1ee9ng.Ki\u1ec3m tra trong da nh\u01b0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p tr\u1ee3 gi\u00fap cho vi\u1ec7c x\u00e1c \u0111\u1ecbnh v\u00e0 ch\u1ea9n \u0111o\u00e1n b\u1ec7nh lao \u1edf ng\u01b0\u1eddi v\u00e0 \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 tr\u00ec ho\u00e3n \u0111\u1ed9 qu\u00e1 m\u1eabn \u1edf th\u00fa. Hai lo\u1ea1i lao \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 th\u1eed nghi\u1ec7m trong da \u0111\u01b0\u1ee3c t\u00f3m t\u1eaft trong B\u1ea3ng 48.3.
\n8 Ph\u00f2ng ch\u1ed1ng \u2013 Prevention
\nPh\u1ea3i ch\u1ea5m d\u1ee9t vi\u1ec7c cho \u0103n s\u1eefa ch\u01b0a \u0111\u01b0\u1ee3c ti\u1ec7t tr\u00f9ng ho\u1eb7c b\u1ed9 ph\u1eadn n\u1ed9i t\u1ea1ng v\u1eadt nu\u00f4i. V\u1eafc-xin s\u1ed1ng BCG \u0111\u01b0\u1ee3c ti\u00eam \u0111\u1ec3 b\u1ea3o v\u1ec7 con ng\u01b0\u1eddi ch\u1ed1ng l\u1ea1i M. tuberculosis. V\u1eafc-xin t\u00e1i t\u1ed5 h\u1ee3p DNA tr\u1ef1c ti\u1ebfp \u0111\u00e3 \u0111\u01b0\u1ee3c s\u1ea3n xu\u1ea5t b\u1eb1ng c\u00e1ch s\u1eed d\u1ee5ng m\u1ed9t d\u1ea1ng mycobacteria. Hi\u1ec7u qu\u1ea3 c\u1ee7a c\u00e1c s\u1ea3n ph\u1ea9m \u0111ang \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 tr\u00ean c\u01a1 s\u1edf th\u1ef1c nghi\u1ec7m. So v\u1edbi vi khu\u1ea9n g\u00e2y b\u1ec7nh kh\u00e1c, mycobacteria l\u00e0 m\u1ed9t trong nh\u1eefng sinh v\u1eadt kh\u00e1ng v\u1edbi ch\u1ea5t kh\u1eed tr\u00f9ng, nhi\u1ec7t \u0111\u1ed9 cao ho\u1eb7c \u00e1nh s\u00e1ng t\u1eed ngo\u1ea1i. Hi\u1ec7u qu\u1ea3 kh\u1eed tr\u00f9ng ph\u1ee5 thu\u1ed9c v\u00e0o c\u00e1c ch\u1ea5t h\u00f3a h\u1ecdc, th\u1eddi gian s\u1eed d\u1ee5ng, n\u1ed3ng \u0111\u1ed9 v\u00e0 th\u1eddi gian ti\u1ebfp x\u00fac.
\n9 S\u1ef1 quan t\u00e2m v\u1ec1 s\u1ee9c kh\u1ecfe c\u1ed9ng \u0111\u1ed3ng \u2013 Public Health Considerations
\nM\u1ed9t t\u1ef7 l\u1ec7 cao b\u1ec7nh lao do M. tuberculosis quan s\u00e1t th\u1ea5y \u1edf nh\u1eefng ng\u01b0\u1eddi b\u1ecb nhi\u1ec5m HIV \u2013 AIDS. V\u01b0\u1eddn th\u00fa l\u00e0 m\u1ed1i quan t\u00e2m s\u1ee9c kh\u1ecfe c\u1ed9ng \u0111\u1ed3ng.<\/p>\n

N\u1ebfu copy b\u00e0i, xin \u0111\u1ec3 l\u1ea1i m\u1ed9t link s\u1ed1ng v\u1ec1 trang n\u00e0y. Xin c\u1ea3m \u01a1n!<\/p>\n","protected":false},"excerpt":{"rendered":"

1 Gi\u1edbi thi\u1ec7u chung v\u1ec1 Mycobacteria Nhi\u1ec5m tr\u00f9ng lao l\u00e0 b\u1ec7nh do vi khu\u1ea9n thu\u1ed9c h\u1ecd Mycobacteriaceae, l\u1edbp Actinomycetales.Mycobacterium l\u00e0 m\u1ed9t gi\u1ed1ngc\u00f3 h\u00ecnh th\u00e1i gi\u1ed1ng nhau, hi\u1ebfu kh\u00ed, kh\u00f4ng b\u00e0o t\u1eed, kh\u00f4ng di \u0111\u1ed9ng, c\u00f3 nhi\u1ec1u l\u00f4ng roi c\u00f3 s\u1ef1 thay \u0111\u1ed5i l\u1edbn tr\u00ean c\u01a1 th\u1ec3 v\u1eadt ch\u1ee7 c\u00f3 m\u1ed1i quan h\u1ec7 th\u00e2n thu\u1ed9c v\u00e0 […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-2339","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/robot.yeupet.vn\/index.php\/wp-json\/wp\/v2\/posts\/2339","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/robot.yeupet.vn\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/robot.yeupet.vn\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/robot.yeupet.vn\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/robot.yeupet.vn\/index.php\/wp-json\/wp\/v2\/comments?post=2339"}],"version-history":[{"count":0,"href":"https:\/\/robot.yeupet.vn\/index.php\/wp-json\/wp\/v2\/posts\/2339\/revisions"}],"wp:attachment":[{"href":"https:\/\/robot.yeupet.vn\/index.php\/wp-json\/wp\/v2\/media?parent=2339"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/robot.yeupet.vn\/index.php\/wp-json\/wp\/v2\/categories?post=2339"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/robot.yeupet.vn\/index.php\/wp-json\/wp\/v2\/tags?post=2339"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}