MdT SO BIEU HIEN DjCH TE, LAM SANG BENH VIEM MAC - MANG NAO DO TOXOCARA CANIS
Biii Vu Huy''\ Nguyen Van Thdng^, Dang Thi ThuyS Nguyen Van Kinh'-^.
Muc dich: De tim higu ddc diem cua benh viem nao - mang nao do Toxocara Canis, cfaiing tdi tien faanh ngfaien ciiu fadi ctiu 7 trudng fagp viem nao - mang nao do T. Canis dugc didu tri tgi Bertii vien Benh Nfaiet ddi Trung uong. Ket qud: bertii viem nao - mang nao do T. Canis gap d ca hai gidi, mgi lua tudi, cd lien quan vdi nghl ldm ruOng vd ngudi bgnfa tfaudng nfadp vign mugn. Cdc bieu hien ldm sang xuat hifn tu tti, that thudng, faay gap Id sdt, dau ddu, ndn, gay Cling, muOn faan la rdi logn y tfatic va cd Hgt kfau tru, ty le bgch cdu di toan ttong mau vd ttong dicfa nao tuy tdng fren 10%. Kit ludn: frong viem nao - mang nao tang bach cau di toan cdn ngfaT den T. Canis khi ty le bach cau ai toan ttong mdu, hoac dich nao tuy tang cao.
Tir khda: Vigm mang nao tang bach cau ai toan, Toxocara canis.
DAT VAN DE
Viem nao - mang nao la mpt benh ly hay gap tren lam sang do nhieu nguyen nhan khac nhau gay nen. Ngoai cac can nguyen hay gap nhu'vi nit, vl khuan thi mpt nhom cac can nguyen khac vdi dac diem cd su" tang chi sd bach cau ai toan tang trong mau va djch nao tuy, ciJng da du'dc cac y van va nghien cu'u de cap. Trong nhom nay ciing do nhieu can nguyen khac nhau, nhu' do cac loai ky sinh trung, cac loai ddn bao...[i]'Pi.
Toxocara canislh loai giun dua ky sinh va gay benh 6 cho va meo. Khi con ngu'di cd tiep xuc gan, nhu" khi chdi, cham soc cho meo va trong nhuTig tru'dng hpp ngau nhien se bj nhiem phai trulig cua ky sinh trung nay Trong khi di chuyen ciia au triing co the gay nen ton thu'dng tai mat, he than kinh trung Udngt'J!^]. Khi au triing Toxocara canis dl chuyen va gay nen benh ly viem nao - mang nao la mpt benh canh lam sang nang, anh hu'dng den chat lu'dng sdng cua ngu'di benh, co the dan den t t i vong neu khong du'dc dieu trlt^'.
<"BQ man Truyen nhiem. Truang Dm ht^c Y Hd Not "'B^nh vi^n Benh nhiet dcfi Trung uong. "'Hpi Truyen nhiem Viel Nam.
Ngiy nh?n bii: 28/3/2016 Ngay phan bifn xong: 15/7/2016.
Ngay duyet dang: 18/8/2016
NgiiM chiu trdcii nhifm n$i dung khaa h9c: Bm VU Huy. Truang Bgi hoc YHaNoi
Dien thoai 0903253828 E-mail [email protected]
Da CO nhieu bao cao de cap den benh ly do I C^n/s d ngu'di, tren the gidi, de gop phan tim hieu them ve benh viem nao - mang nao do can nguyen nay tai Viet Nam, chiing toi tien hanh nghien ctiu: "Mot so bieu hien dich te, lam sang benh viem nao - mang nao do Toxocara canis"ii 07 benh nhan du'dc dieu tn tai Benh vi^n Benh nhiet ddi Trung Udng.
0 0 1 Tl/ONG VA PHl/aNG PHAP f)cl tUtfng nghien cuU
Gom nhOtig ca benh du'dc chan doan viem nao - mang nao do T. Canis, khong phan biet gidi tinh, du'dc dieu tri tai Benh vien Benh Nhiet ddi Trung Udng, trong thdi gian tCr nam 2009 den 2014.
Phtitfng phap
Thiet ke nghien cuti; mo ta hoi ctiu
Tieu chuan chpn vao nghien cuUr thoa man dii 4 tieu chuan sau^^^
- Du'dc chan doan lam sang viem nao - mang nao.
- Co so lu'dng bach cau ai toan trong djch nao tuy
>10/mm^
• Ket qua hieu gia khang the khang T. Canis trong huyet thanh > 1/800, bang ky thuat EUSA.
- Dap ting vdi phac do dieu tri chuan Albendazol va/hoac Ivermectin.
2 - TRUYINNHIEM V I E T N A M * s o 3(15} - 2016
Tieu chuan loai trur:
- Cd bang chting nhiem cac benh nhiem triing cap tinh, hoac cac loai ki sinh triing khac kem theo.
- Co benh suy giam mien djch mac phai (HIV/AIDS) Thu thap so lidu: Bang mau benh an nghien cutj thiet ke s i n .
Phan tich sS lieu: Bang phan mem SPSS 16.0.
Oao atic nghien cihi: Day la nghien ctiu hoi ctiu, so lieu di/dc thu thap t t i benh an luU tru" tai benh vien, mpi thong tin ca nhan du'dc bao mat.
KrrQUA
Trong thdi gian nghien ctiu chung tdi xac djnh du'dc 51 ca benh co bleu hien viem nao mang nao tang bach cau ai toan, frong dd cd 7 trUdng hdp nhiem T. Canis ddn thuan, 19 tiUdng hpp nhiim A. cantonensis, 14 trUdng hdp dong nhiem ca T. Canis va A. cantonensis va 11 trudng hdp chua xac djnh 6MC can nguyen.
Bang 1 . Bieu hien djch te cua 7 ca benh viem nao ~ mang nao do T. Canis
Bang 2. Cac bieu hien lam sang hay gap cua viem nao - mang nao do T. Canis
{)|c diem
Tuoi (nam)
Gidi
Nghe nghiep
Tlidi gian ti^ khi bi benh den Ichi
vao vien
<20 21-60
>61 Tuoi trung binh
(dao dgng) Nam
NS L^m rupng
Khac
< 10 ngay
> 10 ngay Trung binh (dao dong]
n(%}
0 6 (85,7) 1 (14,3) 42,8 ± 17,4 (23 - 70 tuoi)
2 (28,6) 5 (71,4) 6 (85,7) 1 (H3) 3 (42,8) 4(57,1) 42,9 ± 17,4
(23 - 70) Nhan xet: Benh viem nao - mang nao do T. Canis hay gap d do tuoi lao ddng (21 - 60 tuoi), lien quan nhieu vdi nghe ndng, nti chiem uli the va ngUdi benh thudng nhap vien mudn.
Bieu hien lam sang
Sot that thudng Oau dau Gay cuhg Non ROI loan y thUc Liet l<iiu tru Roi loan dai tieu tien
7. <:anis n (%) 7 (100,0) 7 (100,0) 6 (85,7) 5(71,4) 4(57,1) 2 (28,6) 1 (14,3) Nhan xet: Bieu hien lam sang hay gap trong viem nao - mang nao do T. Canis la sot, dau dau, gay cting va ndn.
Bieu hien lam sang it gdp hdn la rdi loan y thtic, liet khu tru va roi loan dai tieu tien.
Bang 3. Dac diem can lam sang viem nao - mang nao T. Canis
Cac clii si T. Canis
Mau ngoai vl Hemoglobin (g/1)
Bach cau (G/L)
Te bao ai toan (%)
/\sr ALT
Hieu gia khang the Ifhang T. Canis Djch nao tuy Tong so te bao (G/L) Bach cau lympho (%) Bach cau trung tinh (%) Bach cau ai toan (%)
Protein (g/1) Glucose (mmol/l) Mau sac
Ap luc tang (n; %)
2 120
<120
> 10.000
< 10.000
>10 2-10
< 2
>80
>80
> 1/1600 1/800 -1/1600
X X i S D XX ±50 XX±a3 XX±SD
> 10 % 2 -10 %
< 2 % X X i S D XX±SD Trong (n; %) Lb due (n; %)
7 (100,0) 0 3 (42,8) 4(51,1) 6 (85,7) 0 1 (14,3)
0 1 (14,3) 5(71,4) 2 (28,6)
650 ± 328,1 42,1 ± 15,1 6,1 ± 15,4 43 ± 15,1 6 (85,7)
0 1 (14,3) 0,85 ± 0,29
2,5 ± 0,99 4(57,1) 3 (42,8) 3/7 (42,8) Nhan xet: Trong viem nao - mang nao do T. Canis,
THUYDNNH&WIVieTNAM*SO 3(15) - 2016 - 3
nhiing bien doi ve cdng thu'c mau ngoai vi va men gan khong cd gi dac biet, ngoai 85% sd trUdng hdp co ty le te bao bach cau ai toan tang tren 10%. Ve dich nao tuy:
100% cd so lUdng te bao tang, ttong do 85,7% cd ty le bach cau ai toan tang tren 10%. Nong dp protein tang nhe. Mau sac djch due chiem 42,8%.
Bang 4. Ket qua dieu trj viem nao - mang nao do Toxocara canis
Ket qua dieu tri Khoi
DichiiVig Tli vong
Tong so
T. Canis 3 (42,8) 4 (57,1) 0 7 (100,0)
Nhan xet: Du dUdc dieu tii bang thuoc dac hieu Al- bendazol hoac Ivermectin ket qua dieu tij thap.
BAN LUAN
Chung toi da tim hieu mot so bao cao lien quan vdi viem nao - mang nao do I Canis, tuy nhien hau het cac bao cao chi thdng bao ve cac ca benh ddn le[''i'[=]'[^>. Benh dUdc cho rang hay gap 6 tre em, do thoi quen thudng xuyen chdi vdi meo'^'. Tuy nhien bao cao nay ctia chung tdi dio thay cac ca benh gap d ca ngu'di trUdng thanhf^'^ra.
Ket qua nghien ciili cung cho thay benh gap nhieu ti gidi NiJ hdn so vdi Nam (5/7ca) va cd lien quan vdi ngUdi lam nghe nong. Tim hieu tien sti lien quan chung tdi chi ghi nhan dUdc nhiing trUdng hdp mac benh tten deu co tiidi quen dn rau song. Theo y Iden ciia chiing toi, viec an rau song chu^ the la yeu to tin cay lien quan vdi mac 7; Canis.
Tac gia Caldera ghi nhan ca benh cd lien quan vdi an dc nUdng tiUdc khi bi benh 3 tuan^^J- Cung nhu ket qua nghien culi cua chung tdi cac nghien CUIJ trUdc day deu nghi nhan ngUdi benh viem nao - mang nao do T. Canis thudng dUdc nhap vien muonf^t^J.
Ve bieu hien tam sang, trong nghien ctiu cua chung tdi, cac bieu hien lam sang dUdc ghi nhan xuat hm vdi xu hudng tii'hi'va tang dan. Ban dau la bieu hien dau dau thoang qua, sau dd tang dan, tiep theo la sot nhe va CO xu hudng mau dan len, cuoi ciing mudn hdn la cac dau hieu liet khu tru, rdi loan dai tieu tien hoac roi loan y thtic xuat hien vao tuan tiiti 3 - 4 cua benht^t*], tham chi co trudng hdp muon hdn. Ca benh ciia Christian Sick dUdc nhap vien sau 3 ngay cd bieu hien dau dau, nen tac gia khong phat hien dUdc bat ky dau hieu lam sang nao khad^l Co the do cac bieu hien lam sang khdng ram rp lien quan vdi tinh trang ngUdi benh nhap vien muon.
Tham kham lam sang, nhd cac dau hieu ton thUdng than kmh, hoac it nhat cd dau hieu cd cting nen ngUdi benh dUdc xet nghiem djch nao tiiy de chan doan benh.
Ve x e t nghiem, ket qua dieu tra d 7 ca benh viem nao, mang nao do 7: Canis cho thay cac bien doi khong ddc hieu. Ke ca thay doi djch nao tuy ding tUdng tU nhU trong viem nao, mang nao do vi nit, vdi so lUdng te bao djch nao tuy trung binh la 650 G/L va ndng dp protein la 0,85 g/L, djch khong ttong 3/7 trUdng hdp. Day ding la nhan xet chung ciia cac nghien cutit'if^5.[6i, j u y nhien chung toi cung thdng nhat vdi cac nghien cuti tiUdc dayfiiW'tsLM nhd ty le bach cau ai toan tang cao ca trong mau va trong djch nao tuy tien 10% da gdi y de lam xet nghiem huyet thanh chan doan I Canis.
KET LUAN
Qua nghien ctiu 7 trUdng hdp viem nao - mang nao do Toxocara canis dUdc dieu tri tai Benh vien Benh nhiet ddi Trung Udng, chung toi rut ra ket luan: Benh viem nao - mang nao do 7^ Canis gap d ca hai giS, mpi lu^ tuoi, co lien quan vdi nghe lam rupng, ngUcfi benh thUcfng nhap vien mudn. Cac bieu hien lam sang xuat hien tti tii", that thudng, hay gap la sdt, dau dau, ndn, gay cting, muon hdn la roi loan y thu'c va cd liet khu tni, ty le bach cau ai toan trong mau va hong djch nao tuy tang tren 10%.
4 - T R U Y ^ N H ^ Vl£T NAM * s d 3
TAI LIEU THAM KHAO
1. Carlos GraefF - Teixeira, Ana Cristina Aramburu da Silva, Kentaro Yoshimura (2009). Update on Eosinophilic Meningoencephalitis and Its Clinical Relevance. Clin. Mi- crobiol. Rev, 22(2), 322.
2. Macpherson C N . (2013). The epidemiology and public health importance of toxocariasis: a zoonosis of global importance. Int J Parasitol, 43 (12 - 13), 999 - 1008.
3. Nguyen Van De, Nguyen Vu Trung, Le Van Duyet and Jong - Yii Chai (2013). Molecular Diagnosis of an Oc- ular Toxocariasis Patient in Vietnam. Korean J Parasitol, ( 5 1 ) 5 , 1 - 5 .
4. Christian Sick, Michael G. H. (2014), Expect the Un- expected: A Case of Isolated Eosinophilic Meningitis in Toxocariasis, Case Rep Neurol; 6(3): 259 - 263.
5. Lee D., Lee S.H., Yoon S.S., Ahn TB., (2012) Eosinophilic Meningitis without Peripheral Eosinophilia, Eur Neurol 2012; 67: 2 1 7 - 2 1 9
6. Caldera F l , Burlone ME, Genchi C, Pirisi M, Bartoli E. (2013), Toxocara encephalitis presenting with au- tonomous nervous system involvement. Infection. Eur Neurol 2012; 67: 217 - 219 (DOI: 10.1159/000335250).
EPIDEMIOLOGY AND CLINICAL CHARACTERISHCS OF MENINGOENCEPHALITIS CAUSED BY TOXOCARA CANIS
Summary
Objective: To find the epidemiology and clinical char- acteristics of meningoencephalitis caused by Toxocara Canis, w/e conducted a retrospective study of 7 cases of meningoencephalitis caused by T Canis, treated at the National Hospital for Tropical Diseases. Results: menin- goencephalitis caused by T. Canis occured in both man and woman, all ages, related with farming profession and Key words: Eosinophilic meningitis. Toxocariasis.
patients were hospitalized late. The clinical signs appeared slowly, erratically, such as fever, headache, vomiting, stiff neck, lately unconscious and localized paralysis and the rate of eosinophils in the blood and in CSF was over 10%.
Conclusion: in the case of meningoencephalitis with in- creased eosinophils sugested etiology of I Canis.
T R U Y ^ I U H l i M V l € T N A M * s 6 3 ( 1 5 ) - 2016 - 5
