MOT SO DAC DIEM DKH TE, LAM SANG d BENH NHAN VIEM NAO - M A N G NAO DO ANGIOSTRONGYLUS CANTONENSIS
Bii Vii Huy''^, Dang Thi ThiiyS Tran Quang Vinh\ Nguyen Van Kinh^'^.
Muc tieu: Tim hieu mpt so dac diem dich te, lam sang a benh nhan viem nao - mang nao (VN -MN) do A.cantonensis. Doi tuang vd phucmg phdp: Nghien cim moth hoi cmi. 14 benh nhan dugc chan doan VN-MN do A. eantonensis, diSu tri tai Benh vien Benh nhiet dai Trung uffng duac chpn vao nghien cmi. Kit qud vd Ket lugn: (l).Dac dilm dich t^: benh gap a mpi nhom tuoi, hay gap a do tuoi lao dpng 21-60 tuoi (71,4%), ty le Nam/Nu =1,3, hay gap df nghS lam rupng (57,1%) va hpc sinh, sinh vien (28,5%). (2).Lam sang: hay gap cac bieu hien sot that thuang (100%), dau dSu (100%), non (100%) va gay cung (92,9 %), ngoai ra con gap r6i loan y thuc, liet khu tru, roi loan dai tieu tien. (3).Can lam sang: Co tinh trang tang BCAT trong mau ngoai vi (trung binh 25,8%) va trong DNT (trung binh 45,4%). Thay d6i thanh phan t6 bao va protein trong DNT giong VN - MN tang bach cau lympho.
Tif khoa: Viem mang nao tang bach cau ai toan, Angiostrongylus eantonensis.
DATVAN DE
Angiosdongylus eantonensis la mot loai giun ky sinh va du'dc xac dinh gay benh d ehupt. Trong chu ky sinh hoc, Acaninnensis ky sinh trong vat ehii bung gian la mot so loai oc. Khi ehupt, ke ca con ngu'di, an cac vat chu trung gian nay (hoac rau) chu^ nau chin se nhiim A.ean- tonensi^^'^'^^\
6 loai ngu'di, khi nhiem A.cantonensis co the gay benh canh viem nao (VN) - mang nao (MN). Benh da dUde thong bao lulj hanh d vung Vien Dong, mpt so dao d Thai Binh Du'dng, Oong Nam A, nhu' Dai Loan, Nhat Ban, Thai Lant^i'f^i. Rieng tai Viet Nam, tu" nam 1960 cac ca benh VN - MN do A.cantonensis da du'dc bao cao, dac biet Trjnh Ngpc Phan va CS. (1974) da tim du'dc bang Chung loai giun nay tren ket qua giai phau benh. Tuy nhien benh VN - MN do A.cantonensis mdi ehi dUdc cac
' " S p mon Truyin nhiem Tntirng Difi Hpc YHd Npi. '''Benh vifn Benh nhi?l dai Trung itang. '"Bfnh vifn da khoa linh Phuc Yen Ngay n h ^ n b i i : 20/8/2015.
N g i y p h a n bifn isong: 22/9/2015.
Nliai a»y^xAi.a%i30,IO/2QlS.
Nfiiroi chiu t r i c h nhifm ngi dung ithoa hpc: Bui Vu Huy. Sp mon TruMJii nhem TruaxK Dgi hqcyHd NQI.
0,-„ ,hogi 0903253828 E-mail dr.vuhiiy%yalioo-com
thay thuoe lull tam trong 10 nam qua, vdi so ca benh dUdc thdng bao cd xu hu'dng tang tren pham vi toan quoefw^M'']. Do trieu chuTig cua benh thu'dng khong dien hinh, viec xac djnh sd cd mat ciia ky sinh trung gap khd khan™'™^], nen chan doan benh co su" han che va cac bao cao thu'dng la cac ca benh rieng le'^'if^J't*].
De gop phan tim hieu them ve benh VN - MN do yl.canfDne/is/s chung toi tien hanh nghien ciJli nham muc dfch tim hieu: "Mot so dac diem dieh te, lam sang dbenh nhan VN-MN do A.cantonensis"dddc dieu tri tai Benh vien Benh nhiet ddi Trung Udng (BNDTU).
OOI TUgNG VA PHU'ONG PHAP
Ooi tu'dng nghien citu: Gdm 14 benh nhan dUdc chan doan VN - MN do Acantonensis, khong phan biet gidi tinh, du'dc dieu tri tai Benh vien BNDTL/, trong thdi gian tif nam 2009 den 2014.
Phu'dng phap:
Thiet ke nghien euV: Mo ta hoi culi.
Jleu chuan chon benh nhan vao nghien edU: Thda man du 4 tieu chuan sauf'l
DUdc chan doan tren lam sang VN, hoac VMN, hoac VN - MN.
T R U Y ^ N H I ^ M V I 6 T N A M * S 6 4 ( 1 2 ) - 2 0 1 5 - 15
Co so lu'dng bach cau ai toan tixtng djch nao biy >10 BCAT/mm^t^lPl.
Xet nghiem ELISA phat hien dUdc khang the khang A.eanton&isis trong huyet thanh va/hoac djch nao tiiy (DNT) > 1/400.
Dap utig vdi phac do dieu tri chuan.
Tteu chuan loai trd:
Benh nhan m3c benh suy giam mien dich mac phai (HIV/AIDS).
Cd bang chuYig mac eac benh nhiem tiling cap kem theo.
Xet nghiem EQSA tixing huyet tiianh/dich nao tiJy cd bang chutig dong nhiem them cac loai KST khac.
Thu thap so li|u: Bang mau benh an nghien culJ thiet ke sin.
Phan tich so lieu: Bang phan mem SPSS 16.0.
KET QUA
Trong thdi gian nghien CUIJ, 14 benh nhan du tieu chuan du'dc ehiing toi tuyen chpn vao de danh gia va phan tfch.
Bang 1 : Dac (^em djch t i tam sang cua benh nhan nghien cihi
binh la 14 ngay.
Bang 2: Cac bieu hien lam sang hay gap cua VN - MN do A.cantimensis
Cdc d i i sd
TUOI
Gicri
Nghl ngtiiep
Tien air Sn uong
ThtJi gian tu" khi bi benh den khi vao Vlln
<20 21-60
> 6 1
Tuoi trung binh
Nam Nu' Lim njong Hoc sinh/sinh vien
Khac An rau song
< 10 ngay
> 10 ngay
Tmng binh
n 0^
3 21,4 10 71,4 I 7,1
33,7 ± 17,5 (Tbap nhat: 13 tuoi - cao
nhat: 61 tuo[) 8 57,1 6 42,9 8 57,1 4 23,5 2 14,2 14 100,0
21,4 78,6 14,07 ± 4,5 (Sdm nhat - muon nhat:
7 - 24 ngay)
Nhin xet: Benh VN • MN do Acantonensis hay gap H dp tuoi lao dong (21-60 tuoi), lien quan diCi yeu vdi nghe lam ruong, nguft co thoi quen an rau song va Nam chiem u\i the, Thcli gian ttr khi bi benh den i<hi vao vien trung
Bieu h i e n l a m s a n g Sot
Dau dau Gay cutig Non Rffi loan y thu'c Liet khu tnj Roi loan dai tieu tien
n 14 14 13 12 4 1 1
%
100,0 100,0 92,9 85,7 28,6 7,1 7,1 Nhan xet: Bieu hien lam sang hay gap d benh nhan VN - I^N do A.cantonensis la sot, dau dau, non va gay cuTig. Cac bieu hien rdi loan y thu'c, liet khu tru, roi loan dai tieu tien it gap. Sdt thu'dng bieu hien that thu'dng vdi nhiet do < 38°C.
Bang 3: Dac diem can lam sang VN - MN tang BCAT do A.cantonensis
Cac chi so j i r ± S D ThSp nhit-Cao nhSt Mau ngoai vi
Hong cau (T/L) Hemoglobin (g/1) Bacti cau (G/L) BCAT(%) BCAT (G/L)
4.5 ±0.5 130,1 ± 17.0
11.3 ±3.4 25,8 ± 9,5 2,99 ± 0,9
3.2 - 6.2 68-167 5.4 - 22.9 95% a 5,4-46,3
95% a 1,0-4,9 Djch nao tuy
Tebao - Te bao ai toan
(%)
-Tebao lympho {%) Protein (g/l) Glucose (mmol/l) Mau sac khong trong (n;%) ApWct^ng (n;%)
1056,3 ± 514,6,0 492,7 ± 80,9 (45,4 ± 22,8) 389,9 ± 41,7 (37,2 ± 17,3) 0,81 ± 0,53 2,5 ± 0,71
352- 2450 95% a 330-655,2
(15,2-61,0) 95% a 306,0-473,7
(12,0-68,0) 0,35-2,50 1,8-4,0 11/14 (78,5 %) 2/14(14,3%)
Nhan xet: Tren benh nhan VN - I^N do A.cantnnensis
• Trong mau ngoai vi BCAT tang, trung binh chiem 25,8% va so Wang la 2,99 (G/L).
Trong DNT: 78,6% CO mau sac khong trong, so lu'dng te bao tang (trung binh la 1.056te bao/mm'), BCAT chiem uU the (45,4%). Nong do protein tmng binh la 0,81g/ml, nong dp glucose trong gidi han binh thu'dng.
1 6 - - m U Y ^ i » ^ U V1£T NAM • s 6 4(12)-2015
Bang 4: Ket qua dieu tri benh VN - MN tang BCAT do A.cantxmensis
Ket qua dieu tri Khoi DichuVlg Tir vong l o n g so
n 13 1 0 14
%
92,9 7,1 0,0 100,0 Nhan xet: Bieu trj bang phac do khang ky sinh trung, so benh nhan du'dc dieu trj khdi la 92,9 % va 7,1 % cd di chiilng.
BAN LUAN
- Ve djch te lam sang: ket qua nghien culi ciia chung toi cho thay VN - MN do ^.cantonens/s gap 6 moi luS hJoi, dac biet la lira tuoi lao dpng, hay gap d ngu'di lam nghe nong (57,1%) tiep theo la hoc sinh, sinh vien (28,5%).
Benh gap d ca hai gidi. Nam gidi cd xu hu'dng mac cao hdn, benh nhan thu'dng nhap vien mupn (bang 1). Ket qua nghien culj cua cac tac gia trong va ngoai nu'dc cung CO nhan xet tu'dng td nhu" cua chung toi. Tai Oai loan, Tseng Y.T va cong si/^J da hoi cu\j 37 trudng hdp VN - MN do /l.cantonens/s(da nhap vien trong 18 nam), cijng nhan xet VN - MN do /l.cantDnens/schu yeu gap d ngu'di tru'dng thanh, Nam chiem ty le cao hdn, lien quan vdi an do tdd\, song (dc, ech, nUdc rau ep). Tai Viet Nam, cac bao cao tru'dc day cung nhan xet tu'dng ti/^-ra. Tac gia Pham Thi Hal Men danh gia tren 36 benh nhan VN - MN do A.can- tonensis, bao gom ca ngu'di tru'dng thanh va tre em cung nhan thay benh gap chii yeu (72%) d \da tuoi 15 - 50 hJOi, tuoi mac benh trung binh la 29,8 tuoi va thdi gian nhap vien trung binh la 2 tuan ke tir khi cd dau hieu dau tient^i. Khac vcfi cac nghien culi tren, chiing toi khong khai thac du'dc tien sd an cac loai thiiy sinh song (oc, ech..) ma chi an cac loai rau song, tuy nhien can lull y la benh nhan ciia chiing toi chii yeu lam nghe nong va hpc sinh, sinh vien, viec an do chda nau chin ky, trong do cd cac ioai thuy sinh cd the khong tranh khdi.
- Ve lam sang: Cac bieu hien lam sang dUdc chiing toi ghi nhan la sdt vdi nhiet do that thu'dng va thu'dng du'di 380C, dau dau (100%), gay cutig (92,9%), non (85,7%), ngoai ra cdn g|p mot so dau hieu chi diem ton thu'dng nao hoac hiy song, nhU roi loan y thii'e (28,6%), liet khu bni, hoac roi loan dai tieu tien (deu gap 7,1%). Tuy ghi
nhan vdi cac tan xuat khac nhau, nhutig cac ket qua nghien ciiU ciia cac tac gia trong nu'dd^ii^'-f'^ va ngoai nuidcPi deu ghi nhan dude d benh nhan VN - MN do Acan- tonensis cac dau hieu tren, bao gom ca sot.
- Vg can lam sang: Dang chu y nhat la sd hien dien aia BCAT tang bong mau ngoai w va biDng DNT. Trong mau ngoai vi, ti le BCAT bung binh la 25,8% va giao dpng tCr 5%
den 46%. Tu'dng td, ti ie dung binh BCAT frong DNT la 45,4 ± 22,8 va dao dpng tir 15 - 6 1 % . Day la dau hieu dang IUIJ y nhat trong VN - MN do A.cantonensis ma cac y van^^ui] cung nhu' cac nghien culi™!"]-'^]-™^'da de cap.
Ngoai ra, trong xet nghiem mau ngoai vi, ket qua nghien ciiu cung cho thay cd hien tudng tang so lu'dng bach cau trong mau, nhU mot sd nghien ciili da nhan xept^'-t*]. Hc^
nda, chiing toi cung ghi nhan du'dc tinh trang thieu mau, nhutig chda dddc cac nghien cuU b-udc day de cap. Bieu hien nay cd the lien quan vdi tinh ti'ang nhiem ky smh bxing keo dai nhutig ngu'di benh khong du'dc kham va dieu bi kip thdi. Ngoai hien tu'dng tang ty le BCAT, ket qua nghien ciilJ ciia Chung toi cho thay DNT co sy" thay doi gidng nhu" VN - MN tang bach cau lymphoi''''^! vdi te bao tiong DNT bung binh la 1.056 bach cau/mm^, nong dp protein trung binh la 0,81g/l, glucose tiong gidi han binh thu'dng. Dieu dang luti y la 78,6% so tru'dng hdp cd mau sac DNT khong trong.
Tuy nhien, cac tac gia nghien cuti mau sac Dm mjng VN - MN do A.cantonensis cung cd nhan xet tu'dng tU, Pham Thj Hai Men ghi nhan 56%'^, Nguyen Van Be gap 3/5 benh nhant^i va Tseng YT^^i gap 7/37 benh nhan. Trong nghien ciru CLia chiing toi, ty le DNT co mau sac khong tix)ng cao hdn cac nghien cuti khac cd lien quan vdi so lu'dng te bao tix)ng DNT tang cao. Ket qua dieu tii cho thay 14 benh nhan VN - MN tang BCAT do A.cantonensis nghien aiti deu dap iitig vdi dieu trj bang Albendazol va, hoac Ivermectin ket hdp vdi thudc khang viem MeUiylprednisolon, trong dd 92,9
% so benh nhan dddc dieu tij khdi va 7,1 % c6 de lai dl chirng, khong cd benh nhan nao tiT vong.
KET LUAN
Qua ket qua nghien ciiti tren 14 benh nhan VN - MN tang BCAT do A.cantonensis da du'dc dieu tri tai BVBNOTL/, chung toi rut ra ket luan:
- Ve dae diem dieh te: benh gap d mpi nhom tuoi, hay gap d dp tuoi lao dpng 21 - 60 tuoi (71,4%), ty le Nam/Nu' = 1,3, hay gap d nghe lam rupng (57,1%) va hoc sinh, smh vien (28,5%).
THUYEN NHliM Vi$T NAM * 304(12)-2015- 17
- Ve lam sang: hay gap cac bieu hien sot that thu'dng (100%), dau dau (100%), non (100%) va gay culig (92,9
% ) , ngoai ra con gap roi loan y thu'c, liet khu tru, roi loan dai tieu tien.
- Ve can lam sang: Co tinh trang tang BCAT trong mau ngoai vi (trung binh 25,8%) va trong DNT (trung
binh 45,4%). Thay doi thanh phan te bao va protein trong DNT giong V N - M N tang bach a u lympho.
KIEN NGHI
Can nghT den VN - MN do ky sinh trung khi BCAT trong mau va DNT tang tren nguQng binh thu'cing.
TAI LIEU THAM KHAO
1. Carlos Graeff - Teixeira, Ana Cristina Aramburu da Silva, Kentaro Yoshimura (2009). Update on Eosinophilic Meningoencephalitis and Its Clinical Relevance. Cim. Mi- crobiol. Rev, 22(2), 322.
2. Wang Q.P, Wu Z.D, Wei J et al (2012). Human An- giostrongylus eantonensis: an update. Eur J Clin Microbiol WectD/s, 31(4), 389-95.
3. Tseng Y.T, Tsai H.C, Lee S.S et al (2011). Clinical manifestations of eosinophilic meningitis caused by An- giostrongylus eantonensis: 18 years' experience in a med- ical center in southern Taman. J Microbiol Immunol Inlect, 44(5), 382 - 9.
4. Pham Nhat An (2002). Mot so nhan xet ve benh viem mang nao tang bach cau ai toan d tre em gap tai Vien Nhi Quoc gia tiT nam 1995 - 2000. Tap chi Y hoc T/ll/cftanh, 3, 6 6 - 6 9 .
5. Pham Thi Hai Men, Nguyen Tran Chfnh, Le Thj Xuan (2007). Viem mang nao do Angiostronggilus eantonensis tai Benh vien Benh nhiet ddi tir nam 2002 den 2005. Y Hoc thanh pho Ho Chi Minh, 11(1), 416 - 421.
6. Nguyin Van Oe, Pham Nhat An, Tran Thj Thu Hi/dng (2008). Benh viem mang nao tang bach cau ai toan do Angiostrongylus. Tap chf Thong tin Y Dutfc, 11,9- 13.
7. Apichat Vitta (2012). Revievw article: Diagnosis of human angiostrongyliasi. ,4s/an Biomediclne, 6(2), 141 - 150.
8. Gerald S, Murphy M.D, Stuart Johnson M.D (2013).
Clinical Aspects of Eosinophilic Meningitis and Menin- goencephalitis caused by Angiostrongylus eantonensis, the Rat Lungworm. Hawaii Journal of Medicine & Public Health, 72(6), 35 - 40.
SOME CHARACTERISTICS ON EPIDEMIOLOGICAL AND CLINICAL I N PATIENTS MENINGO-ENCEPHALinS CAUSED
BY ANGIOSTRONGGYLUS CANTONENSIS
Summary
Objective: To find characteristics on epidemiological, clinieal in patients Meningo-encephaliSs caused by A.can- tonensis. Methods: Retrospective descripUve study. 14 pa- tients were diagnosed Meningo-encephalitis caused by A.cantonensis, boated at die National hospital for Tropical Diseases was analysed. Results: Age mainly in the work- ing age (71.4%), the proportion of male/female = 1.3, common in farmer (57.1%) and students (28.5%). Com- mon clinical manifestahons were mild and irregular fever
(100%), headache (100%), hardback (92.9%), vomiting (85.7%), less common were disorder awareness, localized paralysis, bowel disorders. Laboratory finding: The per- centage of eosinophils increased in the peripheral blood (average 25.8%) and in the cerebrospinal fluid (CSf=) (av- erage 45.4%). Change the cell and protein in CSF like in Meningoencephalitis increased lymphocytes. Conclusion:
In patients with Meningoencephalitis, increasing of eosinophils cells suggest parasite ebology.
Key words; Eosinophilic meningitis, Angiostrongylus eantonensis.
1 8 - T R U Y & I N H i e M V I | T N A M * s 6 4(12)-2015
