•NGUYINTHICHAU, v o THj PHUONG UNH, TONG MINH SON, TRAN THj MY HANH
• N G U Y I N THj "mu HUdNG, Lg VAN QUANG
•NGUYINTUANHUNG, N G U Y I N DINH TOAN DIEM D A N G THANH
• N G U Y I N QUANG NGHIA
•VU TUAN ANH, HOANG T H I P H O C
•CHU TH! HANH, DONG v 6 MEN, vO VAN GIAP
• N G U Y I N DUONG MY DUYEN, PhtAM V A N N A N G
•PHAM TRUNG KIEN, N G U Y S N TH! L E HA, N G U Y I N THANH TRUNG, TRAN THU HUONG
•TRUONG THANH SON, PHAM V A N N A N G
•TRINH H O A N G HA.
NGUYIN HOANG LONG
•TRAN HCru VINH
• N G U Y I N DINH MINH
• D U H O N G D O C , NGUYiNTHOYQUtNH
MUC LUC {Sd927)
=> Nhdn x l t mdu s i c rdng tiieo thang diem Vita 2D ti-dn nhom sinh vien 57 Hpc vien Ngoai giao
=^ Mdt sd ddc diem lam sang, d n lam sang ung thi/ p h i quan p h i i tai 60 Benh vien Dai hoc Y Ha Ndi
^ Nghidn cdu thue trang nguon nhdn l o t y te tai Benh vidn Da khoa 62 huyen Lang Giang, tinh Bac Giang ndm 2013
=> Lien quan giiia the b'ch gan d n lai vdi bien chiing suy gan sau mo d t 65
gan Idn ^
^ K i t qua thi IUC va OCT trong dieu trj phCi hodng diem do dai thao 68 dudng the khu tru b l n g Laser 532nm
=> Nhan xel k i t qua d i l u In Iran djch mang phoi do ung thif^bang bom 70 bdt Talc qua npi soi mdng phoi vd qua dng dan lUu mdng phoi tai Trung tam Hd hap Benh vien Bach Mai
^ K i t qua sdm cfla phau thudt ndi soi vd m6 md ddt manh ghep trong 74 d i l u trj thoat vi ben
=> ThUc trang cdng tdc chdm sdc tam I? bdnh nhan ndi tni tai mdt sd 76 benh vien phia Bac Viet Nam
=> Dieu trj thoat vi ben d ngUdi ldn tudi bang phuong phap ddt manh 79 ghep npi soi hodn todn ngodi phOc mac
^ Nghien cCfu si/tham gia cdc bdn Ndn quan cfla mdt sd tn/dng Dai hpc 81 trong xay dUng md hinh quan In Bai hoc cfla khoa Y DuWc, Bai hpc Qudc gia Ha Ndi
=> Nhan xet kei qua cfla phdu thudt mpt thi vd hai thi trong d i l u In l i e 85 rudt d p do ung thU dai trdng
=> Phuang phap nut mach dieu trj c h l y mdu do ton thUWng ddng mach 90 vClng Id tuy
=> Mdi lidn quan giiJa chan thUbng do vat sac nhpn va benh vidm gan B 93 n g h l nghidp trong nhan vien y le
TRU0NG HOP VIEM HACH DO NAM PENICILLIUM MARNEFFEI QT BENH NHAN HIV TAI BENH VIEN PHOI TRUNG inJNG
DUONG MINH PHUONG, Khoa Giai phau b§nh - BVPhoi Trung u<mg LE TRUNG THO, Bg mon Gidl phau benh - B?i hgc YHd N^i.
T6M TAT
Sdo cdo ca bdnh: Benh nhan nam. 32 tudi. cw iiu t^i Hd Ndi bi nhiem HIV. ed biiu hidn cac not sin d da, ndi h^eh ngo^i vl. ho, khd thd, da duQc chin doin la lao vd didu trj thuSe chong lao 2 thdng nhung khdng dd duQC ehuyin tdi b$nb vidn Phdi tmng uang. Xdt nghidm ddm dm tinh vdi lao, c6 nim SQI. Xdt nghidm FNA b$ch cd cbo thiy trdn phien dd ed cdc dai thijc bdo trong bdo tuong cd nha bdo nim. Nbudm pblen dd bing phuong pbdp Groeott vd PAS cbo thiy hinh dnh nim P. mameffei. Kdt qui nudi cay ddm sau dd thiy nim P. mameffei Sau khi ed kit qui xdt nghidm FNA, bdnh nhdn duge diiu tri kbdng sinh chdng nim, kit qud cde tridu ehOng lim sdng eii thidn rO rdt
TO'khda: HIV, nim P. mameffei.
SUMMARY
We reported the first case of P. mameffei in the Nation Lung Hospital, HlV-in^eted patient ivho had lived in a P. mameffei endemic area. Penicilliosis in HIV-infected patients may be misdiagnosed as Mycobacterium tuberculosis because multiple nodules and mediastinal lymphadenopathy are radiologic findings of penieilliosis. Fungal cultures or dlied staining of infected tissues is equlred to differentiate penicilliosis from tuberculosis. Penicilliosis may also to misdiagnosed as Pneumocystis jirovecii pneumon/a.
PCP rarely reveals pleural effusions, while P.
mameffei infection sometimes accompany pleur^
effusion. Sputum examination may also be halpfiJl to differentiate PCP from a P. Mameffa/nfecfcn. V^
Y HOC THUC HANH (927) - S6 8/2014
suppose that it is important to consider P. mameffei when immunocompromised patients witii histories of visits to areas of endemicity reveal respiratory disease, gener^ized lymphadenopathy, and central umbilicated veskxjiarskin lesbns.
Keywords: HIV, Penicillium mameffei, FNA.
BAT VAN Dg
PenieUlium mameffei d till gay ra nhilm n i m todn thdn de dpa tfnh mgng con ngudi ddi vdi d c b$nh nhdn HIV/AIDS. Bdnh p h i b i l n d Odng Nam A, bao gdm Thdi Lan, ddng b i c An Dd, m i l n nam Trung Quic, Hdng Kdng, Vl$t Nam vd Dai Loan. Tuy nhidn, dich t l hpc vd cdc y l u t l d u bdo ve k i t qua d i l u tri nhilm n i m Penicillium d bdnh nhdn HiV/AIDS chua ro rdng [1, 2, 3]. Nhilm HIV/AIDS dang ngdy cdng tdng d nhilu khu v y c trdn t h l gidi, Tinh d i n h i t 31/5/2013 d Vi§t Nam s6 tm-dng hap nhilm HIV hi$n cdn s i n g Id 213.413 trudng hp'p, so bpnh nhdn AIDS cdn sdng Id 63.373 vd 65.133 trudng hp'p tu- vong do AIDS [4]. 0" Vi$t Nam, d c bdnh nhilm triing c a hpi d b$nh nhdn HIV/AIDS khd p h i bien, tuy nhidn cdc bdo cdo v l nhilm triJng c a hpi do n i m khdng nhieu [5].
Dufd\ ddy, d f l n g tdi bdo cdo 1 ca bdnh bj vidm hgch do n i m Penicillium mameffei d benh nhdn HIV/AIDS tgi khoa B$nh Phdi Nhilm Trting bpnh vidn Phii TW dup-c phdt hidn ti-dn cdc philn dd chpc hgch b l n g phuang phdp nhupm Giemsa, PAS vd Groeott sau dd dup'c xdc nhSn bdi nudi c l y n i m .
GI6ITHI|UB$NHAN
- Ho tdn bdnh nhdn: Phgm Trudng L, 32 tudi, Gidi: Nam
- Dia chl: Thudng Tin - Hd Npi. N g h l nghi§p:
Cdng nhdn Idi mdy xfle
- Vdo viin: 15/8/2013. L^ do vdo vipn: Ho ra mdu, lu'c ngyc, khd thd.
- Bdnh siy. Bdnh nhdn x u l t hi$n s i t cao nhilu fin/ngdy, kdm theo ho khan, ddng thdi x u l t hi$n nhO'ng ndt s i n trdn da k h i p todn tiidn tir nhilu thdng trvdc. Sau dd ho ngdy cdng nhilu, khgc ddm xanh l l n mdu, d m gidc tCrc ngyc, khd thd d i n khdm tgi bdnh vi$n 103 c h i n dodn lao phdi, dd d i l u trj Ihudc lao 2 thdng nhung khdng dd. B^nh nhdn dupc chuyin d i n b§nh vl0n Phii TW.
- Tiin siy. Khdng rd t i l n sili' tidm chfch ma tuy; mdi phdt hl$n nhilm HIV vd gia dinh khflng ai mac b$nh lao.
- Khim Idm sdng:
+ T h l y nhilu not s i n Idm trung tdm d' khip todn thdn.
+ N i m d mi$ng, hpng.
+ Hgch sung to thdnh ddm ldn 2 bdn d (>1cm dud'ng kinh).
+ Nghe p h i i d rai nd r l i rdc khdp 2 bdn p h i i - C$n Idm sdng:
+ CTM: BC: 2.72G/I (TT: 65,1%, Lympho:17,6%, mono:11,8%, eosin: 5 , 1 % , base: 0,4%). HC:4,27T/I.
Hb:108g/I.TC:173G/I.
+ AFB ddm dm tinh + HIV: duang tinh
+ Nhupm soi ddm tim n i m : n i m spi (+), n i m men + Nudi d y ddm: Phdt hi$n n i m P. mameffei, n i m Candida.
+ Chgp phoi cd ddm m d rpng phdi trdi vd rai rdc cd d c dam md hai phoi.
+ Chpc hut h g d bdng kim nhd, nhudm Giemsa, PAS vd Gomori: C h i n dodn hgch vidm do nam P.
mameffei
+ Nudi d y hach: Thay n i m P. mameffei Chan doan xac dinh: Nhidm n i m P. mameffei trdn fa$nh nhdn HIV/AIDS.
D i l u tri n i m sau 3 t u l n , b#nh nhan mat cae not s i n d da, cdc hach nhd Igi (£0,5cm), m l t ddm m d ldn d phii, chf cdn cdc ddm m d nhd, rai rdc.
BANLUAN
1. Ty Id nhidm va dac d i l m sinh hpc cua n i m Penicillium mameffei
N i m P. mameffei duac phdn l$p d l u tidn d lodi chudt tre (Rhizomys Sinensis) tgi mien nam Viet Nam vdo nam 1956 [6]. Trudng hp'p nhilm nam P.
mameffei til nhien dau tien trdn ngudi dupc d n g b6 d l u tidn vdo ndm 1973 bdi Di Salvo, bdnh nhdn Id 1 ngudi M^ bj bdnh Hodgkin dd s i n g d Ddng Nam A [7]. Ndm 1984 ngudi ta phdt hidn 5 trudng hpp nhilm n i m P. mameffei tgi Thdi Lan. Sau dd nhilu nudc dd cdng b l phdt hi§n nhidm n i m P. mameffei nhung deu gdp trdn bdnh nhdn HIV/AIDS. Cde nhidm triing gdy ra bdi n i m P. mameffei Id lodi d$c hij'u d Nam vd Ddng Nam A vd Id mpt p h i biln cua b§nh nhdn nhidm HIV, lidn quan d i n nhilm trung ca hpi, dfl'ng thfl' ba sau bdnh lao vd vidm mdng ndo d Thdi Lan; sau vidm phdi do Pneumocystis jiroveci vd b$nh lao d Hing Kong [1-3], Tgi Vi$t Nam, 4 trudng hp'p nhilm n i m P. mameffei d ngudi HIV/AIDS dupc phdt hidn l l n d l u tidn tgi bdnh vi$n Nhi$t ddi tiidnh phd Hd Chi Minh 1996-1997 [8]. Tfl- tiidng 3/2005 bdnh do n i m P. mameffei dd dupe Bp Y T l nufl'c ta dua vdo tieu ehuan c h i n dodn AIDS trdn ngudi nhilm HIV.
N i m P. mameffei Id logi n i m luQ'ng hinh, phdt triln gidng nhu t l bdo n i m men khi sdng d md t l bdo hodc nufli d y d mdi trudng gidu dmh dudng d 37°C vd gidng dgng spi khi nudi c l y d 25-30°C. 6*
dgng n i m spi (25-30°C), P. mameffei tgo ra khuin Igc ldp trung thdnh cum mdu hai xanh xdm, trong qud trinh hinh thdnh khuin Igc, P. mameffei tgo ra s i c td do d$c trung khulch tdn vdo mdi trudng thgch vd tinh chit ndy dupc cho Id tidu chuin d gid tn c h i n dodn P. mameffei Ct dgng n i m men (37°C) n i m phdt triln gidng n i m men hinh thdnh cdc khuin Igc nhin, m i m mdu ti^ng d i n ndu nhgt vd khdng hinh thdnh d c t l do. Trdn kinh h i l n vi, n i m men ndy cd hinh d u ho$c dgng oval vd ed hinh I n h vdch chia dfli.
2. Vd ca bdnh
Trudc ddy. bgnh nhilm n i m P. mameffei r l t h i l m g$p ndn kinh nghi$m, k i l n thu'c l l n sy nhgy bdn trong Idm sdng cfla bdc sT d l phdt hidn b$nh rat hgn c h l , d i n d i n vide bd sdt ho$c phdt hi$n mufln gdy
Y HOC THVC HANH (927) - S6 8/2014
khd khdn trong d i l u trj. Et$nh nhdn vao vi$n d b i l u hidn Idm sdng cua suy giam m i l n djch, b i l u hien ton thuang da, dudng hd hap, hach ngoai vi to...Hau nhu d c b$nh nhdn d b i l u hidn hgch n^oai w to deu duac xdt nghiem chpc hflt t l bdo bang kim nho (FNA), tuy nhien, trdn d c phien dd h l u h i t cho thay hinh anh cfla nidt t i n thuang viem man tinh vdi Lympho bdo, lympho dang tuong bdo, dgi thyc bdo, it bgch c l u dl toan, mpt so vung gidu t l t}do xoya sai keo l l n vdi d c t i bdo dang bieu md nen r l t de chan dodn vidm lao (mdt phan do vidm lao la bdnh nhiem triling ea hpi p h i iDiln d bdnh nhdn HIV/AIDS). Diem
gcri y quan ti'png la khi quan sdt p h i l n d l d dp phdng dai Idn mdt d c h ty m f d the phdt hidn tiily cdc hinh thdi d a nha bdo trong bao tuang cfla d c dgi Uiirc bao. Cdc nha bao ti'dn, d . vd bpc rd, kich thud'c nhp, gai hinh anh Halo. D$c diem ndy r l t quan ti^ng ^ nghi ngd d n i m P. mameffei B e xdc djnh, chflng ta tiln hanh nhuom Groeott cho t h l y cac nha bdo n^m b i t mau den dien hinh. Tu- c h i n dodn ndy, chflng # ' ^ gfl'i khoa vi sinh d l nudi d y vd khuin Igc P.
mameffei da mpc va dup'c ket ludn vidm hgch do P.
mameffei.
i ^
-^^ — {9^ A ^
^ A
XQ ph6i (dSm md ldn trirdc C^c dim md nho Igi sau dieu tn dilu trj)
T A I U $ U THAM K H A O
I.Supparatpinyo K, Khamwan C, Baosoung V, Nelson KE, Sirisanthana T (1994), Disseminated P.
mame/fe; infection in southeast Asia. Lancet, 344.110- 3.
2. Wong KH, Lee SS (1998), Comparing tiie first and second hundred AIDS cases in Hong Kong. Singapore Med J; 39:236-40.
3. Duong TA (1996), Infection due l o P . mameffei, an emerging pathogen: review of 155 reported cases. Clin Infect Dis; 23:125-30.
4. Cue Phdng, chdng HIV/AIDS, Tinh hinh nhilm HIV/AIDS trong todn quic, hltp'//www.vaac.gov vn
5. Thuy Le, Marcel Wolbers, Nguyen Huu Chi, Vo Minh Quang et al (2011), Epidemiology, Seasonality,
Nha bSo nim P. mameffei (mQi t6n) Nha bSo nim P ^ trfen philn dd digc hi3t hgch blng ldm mameffei trdn phim nho nhupm Giemsa x 400 dd chgc hilt tigchHI blng kim ntiiS 'g nhupm Groeott X
400 and Predictors of Outcome of AlDS-Associated Penicillium mameffei Infection in Ho Chi Minh City, Viet Nam. C//n Infect Dis, 52 (7), 945-952.
6. Capponi M, Sureau P, Segretain G (1956), Penicilliosis de Rhizomys sinensis. Bull Seo Pathol Exot Filiales. 49:418-421.
7. DiSalvo AF, Picking AM, Ajello L (1973), Infection caused by Penicillium mameffei: description of first natural infection in man. Am J Clin PathoL 60:259-263.
8. Hien TV. Loc PP, Hoa NTT, et al (2001), First cases of disseminated penicilliosis mameffei infection among patients with acquired immunodeficiency syndrome in Viet nam. Clin Infect Dis. 32:e78-80.
DANH GIA HIEU QUA NUT MACH
DIEU TR! Dj DANG DUNG TINH MACH VUNG DAU MAT CO
NGUYIN DINH MINH, NGUYIN HONG HA B^nh vi^n hHu nghj Vi^t Due T 6 M T A T 26 benh nhin (bn) tfugc nOt m^ch didu trj cf-AVM W Miic tieu: Binh gii hiiu qui ndt mach aiu tri dl Binh vi0n Vi$t Oiic tir thing 1/2011 din 4/2014. K « d^ng ding Unh mach vOng d^u m^ c6 (cf-AVM). Ddi qui: gdm 26 bn (19 nam vi 7 nO), tu6i tnjng binh li tuong vi phuong phip: Nghiin cuv md ti cM ngang 32,46. Phin chia giai doan lim sing theo Schobinger.
Y HOC THUC HANH (927) - S6 8/20M
