Y HOC VIET NAM THANG 10 - SO 2/2013
NGHIEN CUU MOT SO DAC DIEM LAM S A N G XET NGHIEM VA DIEU TRI BENH SOT Mb DO RICKETTSIA TSUTSUGAMUSHI 6 TRE EM TAI
BENH VIEN NHI NGHE AN TRONG 3 N A M ( 2 0 0 9 - 2 0 1 2 ) Nguyen Van Son*
T O M TAT
Muc tieu: Nghien cffu mdt sd dac diem lam sang, xet nghiem va dieu trj
Phu'dng phap: Nghien cffu md ta mot loat ca benh
Ket qua nghien cii'u: Nghien cffu tren 42 tre vao benh vien dieu tri. Ket qua cho thay (66,7%) ddi tffdng la nam. 88,3% ddi tffdng song 6 khu vffc nong thon. (78,6%) ddi tffdng cd bo me lam rupng 4 , 8 % bd me la cdng chffc va 7 , 1 % cdn lai cd bo me lam cdng nhan hoac budn ban. 78.5% tre cd bleu hien sdt cao. Phat ban d tuan thff nhat va thff 2 (70-78%), gan to tuan thff 2 (>80%), dau Eschar gap d mgl ndi nhieu d ngffc bung bg phan sinh due 30-40%. 85% cd thieu mau, 83,9% tre cd tang men gan GOT, 73% tre cd dau hieu tang GPT. Almumin giam vffa, nang 78%. Cac thuoc Cloramphenlcol, Azythromyxin, Doxycyclln deu cd tac dung dieu trj. Ket luan: Rickettsia la mot nguyen nhan gay sot keo dai kem theo tang men gan d tre em, dap ling tot vdi dieu t n bdi Cloramphenlcol, Azythromyxin, Doxycyclin.
Tu'khda: Sdt md, Rickettsia
SUMMARY
STUDY THE CLINICAL CHARACTERIC TESTING AND TREATMENT OF SCRUB TYPHUS" BY RICKETTSIA TSUTSUGAMUSHI
I N CHILDREN AT NGHE AN CHILDREN HOPSHAL I N 3 YEARS ( 2 0 0 9 - 2 0 1 2 )
*Benh vi$n nhi Nghe An
Phan bi^n khoa hpc: TS. TrAn Thanh Tu
Objective: To study some clinical features, testing and treatment of "scrub typhus "
Results and methods:
From January 2009 to December 2012, 42 children were admitted In the hospital.
Results show/ed that 66.7% of the patients were male. 88.3% of them were from rural areas. The parents of 78.5% of the patients are farmers, parents of 4.8% of them are officers and parents of 7 . 1 % of them are workers or free labours.
78.5% of the patients had high fever. Rash appeared in the first and second week in 70- 78%, Hepatomegaly appeared in 2""^ week In >
80%, Eschar signs were seen In chest, abdomen and genital organs in 30-40% of the patients.
Anemia happened In 85%, GOT increased in 83.9% and GPT increased in 73% of the patients.
Albumin decreased moderately and severely In 68% of the patients
Chloramphenicol, Azythromyxin, doxycycllne are effective in treatment.
Conclusions: Rickettsia is the cause of prolonged fever with Increased GOT in children.
Chloramphenicol, Azythromyxin, doxycydine have been shown to be effective In the treatment of
"scrub typhus".
I. DAT VAN OE
Benh sdt md la mdt benh truyen nhiem cap tinh do Rickettsia Tsutsugamushi gay nen. cd 6 dich trong thien nhien la cac loai gam nham, nhan to truyen benh la cac Ioai cdn trung nhu ve, md . [1], [2]
HOl NGHI TOAN QU6C Vg CAC BgNH NHI^M TRONG VA HIWAIDS 6 TR£ EM NAM 2013
Benh sdt md do Rickettsia Tsutsugamushi la mdt b?nh thudng g^p cd dien bi^n lam sang phong phu vdi rk nhieu trieu chff'ng khong dac hidu, thuang^ ton d nhiki CO quan khac nhau nen dc nham vol cac bgnh kh^c gSy khd khan cho vi?c chSn doan cung nhu dieu tn... [1] [2] [3]
Trong nhffng nam gan day lai benh vignh nhi Nghe an cd nhieu ca benh vao vien dugc chdn doan Sdt md muon. Vi?c sff dyng khang sinh ngay cang rgng rai, do v|iy khang sinh nhu cloramfenicol, Tetracyclin von rat nhay cam vdi Rickettsia Tsutsugamushi rat cd the thay ddi.
Da cd nhung nghien cffu trong va ngoai nude \k sdt md nhung chff yeu lam a ngudi Idti. nghien cffu benh d tre em chua dugc nhieu. Vi vay chung tdi nghien cffu de tai nay nham cac muc tieu:
Nghien cffu mot so dac diem lam sang
\k x6t nghiem benh sot md d' tre em tai benh vi?n nhi Nghe an trong 3 nam (2009 -2012)
Birffc dau nhan xet ve ket qua dieu tri benh sot mo tai benh vien nhi Nghe an
II. D6ITU'(?NG VA PHl/OTJG PHAP NGHIEN COU 2.1. Doi tu-g-ng nghien cihi
Benh nhan vao dilu tri tai benh vien nhi Ngh? an dirge chdn doan sdt mo
Tieu chuan chgn benh nhan : - Sot lien tuc > 5 ngay cd
Xel nghiem ELISA - IgM vdi R.
Tsutsugamushi (+)
2.2. Phuong phap nghien cihi , Nghien cffu md la mdt loat cac ca benh
III. K^T QUA NGHllN CU'U
3.1. D3c di^m chung doi tuong ngien cihi 3.1.1. Tuoi, gi&i vd dia dw
Nghien cffu dugc tien hanh tren 42 tre vao khoa lay benh vien nhi Nghe an. Ket qua cho thay (66.7%) ddi tugng la nam. 88.3%
ddi tugng sdng a khu vuc nong thon. 7%
sdng d thanh thi va 9.5 % sdng o khu vuc mi6n nui. 78,6% ddi tugng cd bo m? lam rupng 4.8% bd me la cdng chffc va 7.1% cdn Iai cd bo me Iam cdng nhan hoac budn ban
3.1.2, Bieu hien lam sang
Tat ca tre cd bieu hien sdl 100% . 78.5 % cd bieu hien cap tinh sdt cao ngay tff dau . sdt lien tuc 73.8% . sdt can 26.2%. Bieu hien xung huyet da thay rang xung huyet da thudrng d tuan dau 87% sau mdt vai ngay dau tuan thff 2 cua benh 70%. Hach to cung thudng xuat hien tuan dau cua benh 50% nhOng tuan sau dd ihi il htm va nho dan . hach chu yeu la hach tai chd cd dau Eschar dan thuan , Gan to tre dugc chan doan muon thi ty le gan to nhieu han tuan dau 45% tuan thff 2: 85% luan thff 3. Lach lo il han so vdi gan.
Bang 1: Bieu hien Iam sang Bieu hien iam
sang Sot iien tuc Sot con Co xung huyet da Gan to lach to Hach to Phil
< 1 tuan n = 8
8 0 7 5 3 4 0
%
100%
0%
87%
45%
21%
50%
0%
1 - 2tuan n = 3l
22 9 20 17 14 14 4
%
71%
29%
70%
85%
46%
46%
13%
> 2 tuan n = 3
1 2 0 2 1 0 3
%
33.5%
66,5%
0%
100%
50%
0%
100%
T6ng chung n = 42
31 11 27 24 18 18 7
%
73,8%
26.2%
64,2%
57% 43% 43% 22.5%
Y HOC VIET NAM THANG 10 - SO 2/2013
3.1.3. Biiu hien c^n Iam sdng Bang 2: Cac chi s6 huv§t hoc
Dau hieu can lam sang S6 luomg BC giam duoi 5G/1 sa lucmg BC tang tren 10 G/1 HSTgiamdu6i<100G/l HST tir #100-<120 G/1 S61u(;mgTC 100-150 G/1 S61u<;mgTC<100G/l
n=42 6 14 36 1 13 7
Ty la % 14.28%
33.34%
85.7%
2.4%
30.96%
16.66%
Kit qua nghien ciru Bang 2 cho thdy, s6 luang bach cau tang khong ddng ke co 33% nhung huyit sic 16 thuang giam tai 85.7% gidm dual lOOg/l. Trong s6 chimg toi nghien cm ca truang hap vao phdi truyin mdu. NhUng tre vao vien muon tuoi cdng nho cdng thieu mau nang. 50% tre co .so luang tieu cdu gidm < 150G/1.
Bang 3: Cac chi so sinh hoa GOT tang nhe (41-120 IU/1) GOT tang vira (121-200 lU/1)
GOT tang cao (>2001U/1) GPT tang nhe (41-120 lU/1) GPT tang vita (121-200 lU/1) GPT tang cao (>200 IU/1)
Albumin giam vira Albumin giam nang
9 16 10 18 7 6 17 4
21.95%
39.02%
24.39%
43,9%
17.07%
14.64%
54.8%
13.2%
Kit qua nghien ahi Bdng 3 cho thdy 80% tre GOT > 40UI/1 trong do cd 63%i, Idng >120 UI/I vd 24,3% tdng > 200UI/1. Khong co su khac biet ve tdng men gan theo nhom tudi (p>0,005 ,test ^K Almumin gidm 68% trong do gidm nang chiem 13.2% co truc'mg hap phai truyen
3.1.4. Biiu tri
Cloramenicol c6 tac dung t6t benh nhan nhiet do giam d4n theo thoi gian dieu tri, nhihig tre co dap iitng t6t deu giam dan sau mot ngay diiu tri co 2 trucmg hop sau 5 ngay diSu tri diing cloramfenicol tre van sot va mot truang hop tuySn truoc da diing doramfeniciol nhung vin s6t chung toi phai thay khang sinh Docyclin hoac Azythromyxin dSu co kk qua khoi benh
IV. BAN LU$N
T4t ca tre co biSu hien s5t I00%i. 78,5%
CO biSu hien cjp tinh s6t cao ngay tii dk, s6t
lien tuc 73,8%. sot con 26,2%. Ket qua nghien ciru ciia chiing toi phii hop voi ket qua nghien ciru ctia Cao Van Vien 98%), Le Dang Ha 90%) benh nhan sot lien tuc. Trong giai doan nay rat kho chan doan rat de nham voi nhieu benh khac .
Bieu hien xung huyet da thay rang xung huyet da thuong a tuan dau 87%) sau mpt vai ngay dau tuan thir 2 ctia benh 70%) nhirng ngay sau do thi xung huyet da khong con nira. Gan, lach. hach to ...
Hach to cung thuong xuat hien tuan dau ciia benh 50% nhtmg tuan sau do thi it hon 23
HOl NGHj T O A N Q U 6 C V £ CAC B E N H N H | £ M TRUNG VA HIWAIDS 6 TRg EM N A M 2013
va nhd ddn , hach chu ydu la hgch tai cho cd dau Eschar don thuan.
Gan to tre dugc chan dodn mugn thi ty I?
gan to nhiSu han tudn dau 4 5 % tuan thff 2:
85% tuan thff 3: 100% cd gan to trung binh 57%. Kdt qua nghien cffu phu hgp vdi mgt sd tdc gia Vu Vdn Ngg 64%. Do van thanh 58%. Cao van vien 52,3%
Lach to It hem so vdi gan to chffng toi trung binh vdi cdc thdi gian bi b?nh la 4 3 % Phu hgp vdi Berman SJ 4 3 %
Ddu hi?u phu gdp 22,5% sd tr6 bj sdt md nhung nhffng tre cd phii thudng phu nhe gdp d tre Idn cdn Ire cang nhd ty 1? phu chiem ty le cao han, khi do xet nghiem albumin thap cd tre phu nhu hoi
chffng than hu Albumin chi cd 25g/l. Vu Van Ngg 15% Cao Vdn Vien 12% cd h\h chffng Than
Trong cac tre chung toi nghien cffu d day cd 77,7% cd dau Eschar. Mgi vj tri tren ca the ngudi cd the cd vet loet nhung nhieu nhat van la nguc- limg - bung 34.5% sau dd ben 20%
bg ph^n sinh dye. Kel qua cffa chffng toi thap han kel qua cua Cao Van Vien ddu Eschar d thdn minh 52%. Tat ca nhung tre cd dau Eschar deu cd vet loet hodc dd ddng vay khdng cd trudng hgp nao dang cd phdng nude
V. KET LUAN 5.1. Dac diem lam sang
Benh gdp d ffe trai 66,6%. gdp 6 mgi IUH mdi Benh rat de chan doan nham vdi nhieu ben khac
Khdi phat cap tinh, sdt cao, gan to (57%) lach to, hach to (43%)
Xung huyet da giai doan sam . phu gdp giai doan muon
5.2. Dac diem ve xet nghiem
Bach cdu tang (33.34%). Thieu mau (85,7%), Tieu cdu giam (50%)
GOT tdng (>80%), GPT tang (31.64%), Almumin giam (68%)
5.3. Ve dieu tri
Khang sinh cloramphenicol. Doxycycil.
Azythromyxin cd tac dung tdt , da cd hien tugng khdng thudc (cloramphenicol)
VI. KI^N NGHj
Tre sdt tren 5 ngay khong tim thiy nguyen nhan gay sdt khac cd cdc yeu td chi diem nhu thidu mdu gan, lach, hach to. GOT, GPT tdng cao. Tieu cdu gidm, hoac Almumin giam nhat Id cd vet loet ddc trimg nen dieu In Sdt md
Cdc CO so y te cdn c6 xet nghi?m ELISA dd chan doan sdt md khi tre sdt tren 5 ngay.
TAI Ll|U THAM KHAO
1. Bo mon vi sinh (1982) Dai hgc Y HaNnoi . Rickettsia, Vi sinh vat > hgc tap . Tap II. Nha xuat ban y hgc Ha Ngi. tr 153-191 2. Nguyen Tran Chinh va CS (1994) "Sot mo",
Benh truyen nhiem , Nha xuat ban y hpc tr 366-386 .
3. Le Dang Ha Cao Van Vien va CS (2001) Nghien cffu dac diem lam sang . xet nghiem , chan doan va dieu trj b^nh sdt md do rickettsia Tsutsugamushi tai Vi?n Y hoc Lam sang cac benh nhiet ddi De tai nghien cffu khoa hoc cap bg . Vien Y hoc Lam sang cac benh nhiet ddi. Bg > te Ha Ngi
4. Vu Viin Ngo, Pham Thi Van Hanh (2002)"
Nghien cffu lam sang , xet nghi?m dieu tri b?nh sdt md Nhi khoa t^p 10 nha xuat ban y hgc. Ha ngi
5. Berman SJ, Brown GW, robinson Dm huxsoll Dl et al Scrub typhus in saut Viet nam a study of 87 cas. Annuals of internal medicin 1973-1979. p26-30
