5 2 TAP CHI PHONG C H 6 N G BgNH S6T RET vA CAc BgNH KY SINH TRUNG $6 4-2012
MOT SO DAC DIEM DICH TE HQC NHIEM TOXOCARA TREN BENH NHAN MAY DAY MAN TINH NHIEM
TOXOCARA TAI VIEN 103
L6 Trin Anh', Phgm Thj MS IIdng^ Le Thj Thu Huong'
Tdm tit
Mdy day Id mgt Irong nhO'ng bfnh thudng gap. nguyen nhan cd the do nhiem ky sinh iriing trong dd cd Toxocara. Chiing ldi lien hdnh thu thgp so lieu tren 47 bfnh nhan mdy day mdn linh nhiem Toxocara dugc chdn dodn vd dilu trj tgi vifn 103 tir 1/2010 den 6/2012 de xdc djnh nipt sd dgc diem dieh te hgc nhicni Toxocara. Ket qud : tudi bfnh nhdn tir 9 - 66 ludi, trung binh 32.66 ± 13,86 tuoi, nhdm tuoi 21-30 chilm ty If cao nhat (36,67%). N&mdc nhieu hon nam (chiem 55,32%). Bfnh g^p nhieu d ndng ddn (36,17%) so vdi cdc nhom ngdnh, nghe khac. 17.02% ed ngudi trong gia dinh hay ngudi xung quanh bj tuong ty. 21,28%
ed tien sii dj iing, hay gdp nhat Id viem mui dj iing (14,89%). Ty If nudi/tiep xiic vdi cho 57,44%, meo 51,06%. 27,66% hay dn rau sdng, 29,79% hay dn thjl sdng.
1. DAT VAN DE
Mdy day la mdt trong nhiing bfnh thudng gdp trong cdng ddng. Ndm trong nhdm bfnh di ling thi di nguyen Id mdt yeu Id khdng the thieu dugc trong co che hinh thdnh benh may day.
Mgt trong nhiing nguyen nhdn dugc ndi tdi Id nhiem trimg, trong dd cd cdc loai ky sinh triing.
Nhieu tac gid da chiing minh sy lien quan giiia nhiem Toxocara va may day mdn. Nude ta co khi hau nhiet ddi ndng am, nen kinh le ndng nghifp, thdi quen dn udng chua hgp vf sinh (dn tiet canh, rau sdng...) Id dieu kifn thuan Igi de bfnh giun san phdt sinh phdt trien, trong do co Toxocara. Da cd nhieu nghien ciiu ve ty If nhiem Toxocara d cgng ddng tuy nhien cdn il co nghien ciiu ve cae yeu td nguy co nhiem Toxocara tren mgi the bfnh eu ihl. Vdi kha nang ve vai trd ciia Toxocara chiing tdi tien hanh nghiSn ciiu nhdm myc lieu xdc dinh mpt sd ddc diem dich tl hpc nhilm Toxocara tren bfnh nhdn mdy day mdn tinh.
2. DOI TirgfNG VA PHI/ONG PHAP NGHIEN ClTU
- Ddi tugng nghien ciiu: 47 bfnh nhan dugc chan dodn lam sdng may day man tinh chua ro nguyen nhan, xet nghifm ELISA ed khdng the khdng Toxocara, ddng y tham gia nghiSn ciiu vd cung cip thdng tin.
' BO mdn Sot ret - Ky sinh triing - Cdn Uiing, Hpc vifn Quan y.
^ Bf m6n - khoa Da lieu, bfnh vifn 103, Hgc vifn Quan y.
^ Bg mdn Vi sinh & Sinh hgc, dgi hpc Dugc Ha Npi.
S 6 4-2012 TAP CHi PHONG C H 6 N G BENH S 6 T RET VA C A C BENH KY SINH TRUNS 53 - Vat lieu nghien ciiu : b?nh an nghien ciiu mau, bg dung cu xet nghiem ELISA, bg sinh phSm chin doiin TES-ELISA cua Trung tam Y dugc thanh phd Hd Chi Minh.
- Phuong phap nghien ciru: Khai th4c b?nh sir, tiln sir theo b?nh in nghien ciru.
- Thdi gian nghien cim: Tir 1/2010 din 6/2012.
- Xir ly sd li$u: Thong ke y hgc bing phin mim SPSS 13.0.
3. KET QUA VA BAN LUAN
Cac tdn thuong trong bfnh Toxocara do iu trimg gay ra, hai thl ISm stag hay gSp nhit la the au trimg di chuyin ndi tang (visceral larva migrans - VLM) va iu triing di chuyin d mit (ocular larva migrans - OLM). Bilu hien d da cd mat trong khoang 24% cac tradng hgp toxocariasis cd tdn tliuong ngoai mit [5]. Tdn thuong da thudng la ngira, ban, may day man tinh, rat it trudng hgp cd may day cap tinh [8], [4]. Trong mgt vai tradng hgp tdn thuong d da la bieu hien duy nhit cua benh [4]. May day, ngira cd lien quan chat che din khang thl trong mau so vdi cac loai tdn thucmg da khac [6]. Xuit phdt tir dac dilm sinh benh hgc nhu vay chimg tdi tien hanh nghien cim mgt sd dSc diem dich tl hgc dl tim ra td nguy co nhilm Toxocara tren nhimg benh nhan may day man tinh.
Bang 1. Phan bd benh theo tudi (n=47) Nhdm tuoi
9-10 11-20 21-30 31 -40 41-50 51-60 60-66
So lugng 2 5 17 9 9 3 2
Ty le (%) 4,26 10,64 36,17 19,15 19,15 6,38 4,26
Tudi trung binh cua nhdm nghiSn ciiu Id 32,66± 13,86, gdp ehii y6u d tudi 20 - 50 (35 trudng hgp = 74,47%). Tre em dudi 10 tudi chi ed 2 benh nhdn (4,3%). Do dgc dilm nhilm cua Toxocara lien quan tdi yeu td vf sinh ca nhdn, hay tiep xiic vdi ddt, hay choi vdi chd, meo con... nen nhilm thudng d tre em [5]. Nhung do tieu ehuan lya chpn bfnh nhdn trudc hit Id cd may day man tinh chua ro nguyen nhan, la bfnh thudng xuat hifn d ngudi trudng thdnh, it gap d tre em [2]. Mat khac ddi tugng den kham tai bfnh vifn 103 thudng la quan nhan, ngudi Idn nen ty If tre em it gap trong nghiSn ciiu cua ehiing tdi ciing Id phii hgp.
54 TAP CHi PHONG CHONG BgNH S 6 T RET vA c A C BgNH KY SJNH tRUNS SO 3-2dl2
DNCr a Nam
Bieu do 1. Phan bo bfnh theo gidi linh
Ty If bfnh nhan nii hi mdy day mdn tinh nhiem Toxocara eao hem so vdi nam. Sy chenh Ifch ndy do may day mdn tinh chii yeu o nu gidi, theo mgt so Idc gid, khodng 75% bfnh nhan mdy day mdn tinh Id
nO: gidi [2]. Mac dii ca ehe eiia sy khdc bifl ndy la ehua rd, nhung nhthig bfnh cd co che ty mien thudng gdp nhieu hem d phu nS [3]. Nghien cim ciia Humphreys, Hunter (1998) Iren 390 bfnh nhdn mdy day ihay 61% Id phu nii [7].
Bdng 2. Phan bo bfnh theo nghe nghifp Nghe nghifp
Ndng dan Hgc sinh, sinh vien Cdng nhan Bd ddi, cdng an Nghe khac Tdng cgng
So lu-Qng 17 13 10 4 3 47
Tylf(%) 36,17 27,66 21,28 8,51 6,38
Ty If gdp d ndng dan, hgc sinh- sinh vien cao hon cdc ngdnh, nghe khde.
Bdng3. Phan bd bfnh theo trinh do vdn hda (n-47) Trinh dO
Phd thdng co sd Phd thdng trung hgc Trung hgc Cao dang, dai hgc
So lu'g'ng 7 18 10 12
Ty le (%) 14,89 38,30 21,28 25,53
Bfnh gdp d cd hge sinh, sinh vien va ngudi cd trinh do cao ddng, dgi hgc.Bfnh phan b6 tuong ddi ddng deu d cac nhdm ngdnh, nghe, tuy nhien thay ty If gdp nhilu d ndng ddn (36,17%), hgc sinh- sinh vien (27,66%) so vdi cae nhdm ngdnh, nghi khdc (bg dgi, cdng an,
S6 4-2012 T»P CHi PHONG CHONG BgNH S6T RET VA CAC BENH KY SINH TRUNG 5 5
cdng nhan, can bd van phdng, budn ban...), gap d ca ngudi cd trlnh dg pho thong co sd din ngudi cd trinh do cao ding, dai hgc. Su phSn bd nay phan anh su kit hgp ty le mic ciia nhilm Toxocara va may day man tinh. Tinh trang nhiem Toxocara thudng lien quan tdi tinh trang kinh te, xa hgi, noi sinh sdng (ndng thdn hay thanh thi), nhimg nghe hay tilp xiic vdi dit nhu ndng dan se cd ty le nhilm cao hem [5] nhung ty 1? hi?n mic may day khdng khac biet giQa ttinh do hgc vin, chiing tgc, nghi nghiep hay tliu nhap [3].
Bang 4: Gia dinli, ngudi xung quanli mic benh tuong tu (n=47) Gia dinh, nguoi xung quanh
Ong ba Bd me
Anh chi em, chu bac Con
Ngudi xung quanh hi tuong tu Tdng
So lu'g'ng 1 3 2 1 1 8
Ty lc (%) 2,13 6,38 4,26 2,13 2,13 17,02
17,02% cd ngudi trong gia dinh hay ngudi xung quanh bj luong tu. Ty If nay hai thip hon so vdi nghien ciiu cua mdt so tac gid khac tren nhung benh nhdn may day man tinh.
Nghien ciru eua Ferrer M (2005) thay sy lien quan ro rang tiln sir di img gia dinh vdi bfnh may day mdn tinh [3]. Cd the do nhdm benh nhdn cua chiing tdi ngoai bi mdy day man tinh cdn bi nhiem Toxocara, yeu td ndy lien quan chii yeu tdi mdi trudng hon la yeu td di truyen.
Trong sd benh nhan nghien ciiu ed 2,13% bfnh nhdn cd ngudi xung quanh bi tuong ty, cd the do cimg an udng, sinh hogt va eimg bi nhiem tning giun.
Bang 5: Tien sii di irng, tiep xiic, dn udng ciia bdn thdn (n^47) Tien su
Di img
Tiep xiic
An udng
Viem miii di irng Viem ket mac di ling Hen
Viem phe quan di img Di ling thdi tiSt Tdng
Nudi/tilp xiic vdi chd Nudi/ tilp xuc vdi meo Hay tiep xiic vdi dat Rau sdng
Thjt sdng (nem, gdi...)
So lugng 7 2 1 1 1 10 27 24 16 13 14
Ty le (%) 14,89
4,26 2,13 2,13 2,13 21,28 57,44 51,06 34,04 27,66 29,79
5 6 TAP CHI P H 6 N G C H 6 N G BgNH S6T RET VA C A C BgNH KY SINH TRlJNG s6 4-2012
21,28% BN cd lien sir di img, hay g^p Id viem mui dj img (14,89%), ngodi ra cdn g$p hen, dj iing thdi tilt...). T. canis gay ede trifu chirng mdy day do chiing sdn xuit ra cdc khdng nguy§n ngogi tiet. bieu hifn ldm sdng phy thudc vdo cudng dd vd tin suit nhilm [I I]. May day vd phu mgch khd thudng xuyen, thudng kdm theo cdc phdn img dj irng nhu hen suyen, viem mui. viem ket mgc.
Ty If nudi hay thudng xuyen tiep xOe vdi chd Id 57,44%, mdo Id 51,06%. Mdc dii nhiem Toxocara dugc cho Id hay g$p d nhOng ngudi nudi hay thudng xuyen tilp xuc vdi chd m6o nhmig mgt so nghien ciru thiy khdng ed sy Men quan r5 rdng. Theo P.A.M. Overgaauw vd cgng sy (1997), khdng thdy tdng ty If nhiem Toxocara d nhthig ngudi ldm vifc d bfnh vifn thii y, ngudi \ e sinh chuong trgi dgng vdt hay ngudi nudi m^o, cd the do sy vf sinh tot ciia timg cd nhdn [10]. Theo Ferrer M (2005) ly If hifn mdc mdy day khdng khdc bift giQ-a ngudi cd ihu nudi trong nhd [3]. Bfnh do Toxocara d ngudi dugc coi Id bfnh tir dgng vat lay truyen qua ddt, thdi quen "dn dat" d^c bift d tr6 em song d nhd cd thii nudi khdng dugc lay giun [8].
Tu\ va\ t\ If thudng xuyen tiep xiic vdi dat trong nghien ciiu ciia chung ldi chi cd 34,04%. do dd cdn quan tam nhOng dudng lay khdc nhu dn rau s6ng, thjt sdng.
Tning cua Toxocara khi vdo vgt chii khdng phdi vgt chu chinh di chuyen vd igo ihdnh nang trong id chiic, khdng phai trien thdnh giun trudng thdnh ggi Id vgt chu chiia (paratenic host). Au triing cd the sdng d ddy thdi gian dai, tren thuc nghifm thdy au trimg sdng dugc 9 ndm d khi, suot ddi d ddng vat gdm nham [I]. Khi cdc dgng vat khac nhiem nang i u trimg lir vat chii chiia nay cung ed the nhiem Toxocara, neu chd, meo dn vdt chii chiia du Irimg ed the tiep tue vdng ddi ma khdng can di cu qua phdi [1]. Do do benh cd the Idy do vf sinh dn udng kem, dn rau sdng, dn thit sdng tir vdt chii chiia nhu ga, cim, thd ... [8]. Nghien cuu ciia Nam-Hee Kwon \ a cgng sy (2006) tren nhiing bfnh nhan mdy da> mdn tinh thdy 65,1% benh nhdn chin dodn nhiem Toxocara cd tien sii dn thit sdng Uong vdng 1 ndm, ty suat chenh ciia dn gan sdng so vdi ngudi khdng dn gan sdng Id 7,8; ty le Toxocara duong tinh d ngudi dn thit sdng Id 85,7% so vdi 61,3% d ngudi khdng dn thit sdng [9].
Trong nghien ciiu nay ciing cd 27,66% bfnh nhan hay an rau sdng, 29,79% hay dn thit sdng.
K E T LUAN
Qua nghien cuu 47 bfnh nhan may day man linh nhiem Toxocara chiing tdi nit ra mpt so kel lugn sau :
- Tudi bfnh nhdn tir 9 - 66 tudi, trung binh 32,66 ± 13,86 tuoi, nhdm tudi 21 - 30 ehilm ty If eao nhdt (36,67%).
- NG mdc nhieu hon nam (chiem 55,32%).
- Bfnh gap nhieu d ndng dan (36,17%) so vdi cdc nhdm ngdnh, nghi khac.
- 17,02% ed ngudi trong gia dinh hay ngudi xung quanh bi tucmg tu.
- 21,28% ed tien sir di iing, hay gap nhat la viem miii di ung (14,89%).
- Ty le nudi/lilp xiic vdi chd 57,44%, m6o 51,06%. 27,66% hay dn rau sdng, 29,79% hay 3n thit sdng.
$64-2012 T»P CHi P H 6 N 6 C H 6 N G BiNH S6T RET VA CAC BENH KY SINH TRUNG 5 7
TAI LllfU THAM KHAO
1. Center for Food Security and Public Health, College of Veterinary Medicine Iowa State Umversity,Toxocariasis (2005)
http://www.cfsph.iastate.edu/Factsheets/Ddfs/toxocariasis.pdfl
2. Fgnacier LS., Dreskin SC, Dnnald Y.M.(2010), Leung Allergic skin diseases, J Allergy Clin Immunnl, 2010, Vol.125 (2), pp.138 149.
3. Ferrer M. Epidemiology, healthcare, resources, use and clinical features of different types of urticaria. Alergoldgica 2005. J Investig Allergol Clin Immunol 2009; Vol.19 pp. 2:21.
4. Gavignet B.. Pianoux R., Aubin P.. Millon L., Humbert P, (2008), "Cutaneous manifestations of human toxocariasis". Jam Acad Dermatol, pp. 1031 -1042.
5. H. Pelloux, O. Faure (2003), "Toxocarose de Tadulte, La revue de medicine inteme"
Vol.25, pp.201-206.
6. Humbert P. Niezborala M, Salembier R, Aubin F, Pian-oux R, Buchet S, et al.(2000)
"Skin manifestations associated with toxocariasis: a case-control study. Dermatology"
Vol.201 :pp.230-4.
7. Humphreys, Hunter (1998), The characteristics of urticaria in 390 patients. British Journal of Dermatology Vol.138 pp.635-638.
8. Magnaval JF, Glickman LT, Dorchies P, Morassin B.(2001), Highlights of human toxocariasis. Korean J Parasitol, Vol 39pp.l-11.
9. Kwon Nam-Hee, Mi-Jung Oh, Sang-Pyo Lee, Byung-Jae Lee, Dong-Chull Choi (2006) The prevalence and diagnostic value of toxocariasis in unknown eosinophilia. Arm Hematol,Vol. 85 pp.233-238.
10. P.A.M. Overgaauw (1997), General introduction Aspect of Toxocara epidemiology.
Human toxocarosis. Critical Reviews in Microbiology ;Vol. 23pp. 215-31.
11. Wolfrom E., Chene G., Boisseau H., Beylot C, Geniaux M., Tale A.(1995), "Chronic urticaria and Toxocara canis", The Lancet, Vol.345 (21), pp.196.