TCNCYH Phu trwung 80 (3A) - 2012
NHIEWI TRUNG CO HQI TREN TRE NHIEM HIV/AIDs D u ' g c DIEU TR! NOI TRU TAI BENH VIEN NHI TRUNG U'aNG
Do Thien Hai, Pham Nhat An, Tran Van Toan Benh vien Nhi Trung wang Sd tre nhiim HIV dwac phdt hidn ngay cdng nhiiu a Viet Nam Vdn dd phat hien sam. qudn ly va diiu th cd y nghTa quan trong trong viec gidm ty id tii' vong va nang cao chit Iwang cudc sdng cho tre ddng thai gidm ngudn lay nhidm trong cdng ddng, giam tin xudt mdc cdc nhiim triing ca hdi nang Nghien cuu nhdm tim hiiu cdn nguydn gdy nhidm trung ca hdi tren tre nhiim HIV/AIDs duoc diiu tn ndi tru Benh nhidm trung co hdi hay gdp Id vidm phdr 45,9%, Ndm mieng 19,3%,. Viem da. 16.6%,. Tieu chdy kdo ddi' 13,3%,; Lao: 12.7%o. Trong cdc cdn nguyen tim thiy thi EBV 28.1 %o vd CMV 22,8%,, Ndm Penicilin Mac- nerffei 20,6%,, trwc khuin Lao 18.31%a Cdn nguyen vi khuin duoc tim thiy d nhdm bdnh nhi khdng dwoc theo ddi Id 64,7%o so vdi nhdm bdnh nhi dwoc quan ly va diiu tn Id 35.3%,. Cdn nguydn vi riit duoc tim thiy d nhdm benh nhi mdi Id 61,9% so vdi nhdm bdnh nht cu Id 38.1 %
TCr khoa: suy giam miln djch nang, nhiem trung cc hoi, tre em, HIV/AIDs I. DAT V A N o e
Tir cull t h i ky XX d i u XXI, nhiim HlV/
AIDS nli len nhu mdt dai dich khlp toan elu.
So ngudi nhiim duac phdt hien ngay cang gia tang nhanh chdng, d khlp nai tren toan t h i gldi trong dd cd Viet Nam [1, 2] D i n nay, nhilu tiln bd trong ehan dodn, dtlu tn da mang lat eudc sing t i t han eho benh nhan V i n d l ehln doan sdm, xac dmh can nguyen cac benh nhiim triing ca hot la yiu to quan trong lam giam ty le tir vong va tang hieu qua eiJa dilu tn, phdng tranh lay lan trong cdng ding [5, 8]. Tai Viet Nam, benh nhi d i u tien duge phdt hien nam 1993 va sau do s l tre duae phat hien tang len nhanh chdng Tuy nhien, eon nhilu tre duge phdt hien d giai doan mudn vdt eac nhilm trung ea hpi va suy gtam miin dich nang gdy khd khan eho dilu tn. Do dd, nghien eiru nay duac thuc hien vdi muc tieu Xac dmh can nguyen gay nhiim trimg ca hoi tren benh nhi nhiem HIV/AIDs dwac dieu tn noi tru.
II. D 6 I TU'gNG VA PHU'aNG PHAP 1. Ddi tu'ang: Benh nht duac chin doan nhiim HlV/AlDs dwac dilu tn noi tru tai khoa
Truyln nhiim, benh vien Nht Trung uang tir 1/2009-9/2011.
Tieu chuin chan doan: dua theo Quylt dtnh 3003 do Bd Y t l ban hanh,
2. PhU'O'ng phap: Hoi eiru.
3. Cac b i l n nghien cii'u;
Lam sang Cac benh nhiim triing ea hot beHh nhan ed t h i mae
Can lam sang
Phan tieh t l bao mau: Hb, bach elu (Lympho, Trung tinh) TCD4, tilu cau,
cac xet nghiem tim vi riit, vt khuln trong eac dieh ca t h i : Soi, Cly, PCR, ELISA.
4. Thu thap thdng tin va xCr ly sd lieu Thdng tin duac lly tir cac ho sa luu trCr.
5. Xir ly sd lieu: Su dung phln mim SPSS 16 0
III. K^T QUA
1. Dac d i l m djch te, lam sang + Tull ehii y l u gap d tre dudi 3 tuli + Nhiim triing ea hoi duac chin doan sau khl dieu tn
TCNCYH Phu trwang 80 (3A) - 2012 Bang 1. C h i n doan lam Nhdm benh nhan _. , .-..
Benh Chung (n = 181) Viem phdi
-Nam mieng 1- Viem da
TCKD Lao Nam mau Tieu chay cap
83 (45,9) 35(19,3) 30(16,6) 24(13,3) 23 (12,7) 14 (7,7) 11(6,1)
sang sau qua trinh d)§u trj Md'i (n = 90)
46(51,1) 21 (23,3) 18 (20,0) 15 (16,7) 11 (12,2) 8 (8,9) 6 (6,7)
C u ( n = 91) p 37 (40,7)
14(15,4) , 0 005 12(13,2)
9 (9,9) 12(13,2)
6 (6,6) 5 (5,5) Nhiem trimg ea hdi hay gap la viem phoi vd nam mieng.
2. Dac diem can lam sang Suy glam miln dich t l bao CD4
Bang 2. Tinh trang suy giam m i l n djch te bao TCD4 Nhdm benh nhan
SGMD Chung n (%) Mdi (ni = 38) Cu(na=31)
Khdng 10(14,5) 4(10,5) 6(19,4)
Nhe Vu'a N?ng
6 (8,7) 5 (7,3) 48 (69,6)
69
2 (5,3) 2 (5,3) 30 (79,9)
38
4(12,9) 3 (9,7) 18(58,1)
31
< 0,005 Ty le benh nhi suy giam miin dich nang rit cao d nhdm nhap vien,
- Cae xet nghiem tim can nguyen vt khuln
Bang 3. Can nguyen vi k h u l n , nam gay nhiem trung c c hot Nhdm benh nhan
Tac nhan Chung Mdi Cu
n ^ 73 (%) ni = 36 (%) ng = 37 (%) Bukhoderia
Haemophiluslnfluense Staph. Areus Salmonella Typhi
Penicilin Macnerfei 15 (20,6) 9(25) 6(16,2) n ^ 4 3
Djch ndi khl quan S. Pneumoniae Nam
TB 1
Ty h l u
S. Pneumoniae K. Pneumoniae
= 34 6(17,7) 5(14,7)
n2==28
Dg day
Tong 46 25
200
TCNCYH Phu truung 80 (3A} - 2012 Can nguyen Nim chilm ty le Idn trong eac can nguyen gay nhilm triing ea hdi
- Cae xet nghiem tim can nguyen vi rut.
Bang 4: Can nguyen vi riit gay nhilm trung c a hoi
Tac nhar
Mau
Dich khi quan
Dich hau
ndi
ty
Nhdm benh nhan 1
CMV EBV HAV HBV HSV CMV EBV Rhino virus Adeno virus Mycoplasma Ciim A Cum B PCP CMV EBV Rhino virus Adeno virus Mycoplasma Cum A
Chung n = 57 (%)
13(22,8) 16(28,1)
2 2 0 n = 43 8(18,6) 7 (16,3) 3 4 0 6 3 1 n =62 17(27,4) 15(24,2)
8 5 1 1
Md'i n, = 32 (%)
6 8 1 2 0 n, = 16
5 4 3 1 0 6 3 1 n, =34
12 10 5 1 1 1
Cu n2 = 25 (%)
7 8 1 0 0 n2 = 7
3 3 0 3 0 0 0 0 02 = 28
5 5 3 4 0 0 Ciim B
Tdng
Can nguyen vi riit CMV, EBV ehilm phln ldn.
IV. BAN LUAN
Dac dilm nhdm nghien ciru: Trong nghien ciru nay, chiing tdi ed 181 benh nht du tieu chuin dua vao nghien ciru. Benh nht duae chia lam 2 nhdm la- nhdm mdt phat hien gom 90 b$nh nhi (49,7%) va nhdm dang duac theo dot tai phdng kham ngoat trii gom 91 benh nhi
(50,3%) Tudi benh nhi thudng gdp nhieu nhat la tir 3 tuoi trd xuing, trong nhdm mdi phat hien thi 51 % la tre dudi 3 tuli
Benh nhilm triing thudng gap O nhdm mdi phat hien, benh nhiim triing ca hpi thudng gap la suy dtnh dudng 78,9%, vtem phli" 51,1%, vtem da 20,3%, nam mieng. 23,3%.
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TCNCYH Phu truung 80 (3A) - 2012 O nhdm cu, benh thudng gap la: suy dinh dudng: 58,2%; viem phli: 40,7%; viem da:
13,2%, nim mieng 15,4% Cd su khdc btet ed y nghTa thing ke giQ'a 2 nhdm benh nhi (p
< 0,05). Dieu nay cho thly hieu qua viee phat hien sdm va du phdng tir ngay sau khi sinh, Khi nghien ciru v l bieu hien lam sang d mieng tre nhiim HIV tai Thai Lan va Campu- chia cho thly ty le n i m mieng thay d l i tir khoang 17 - 53% tuy nhom benh nhi duac hay khdng duge dilu tn du phdng [11]
Nghien ciru cua Puthanakit tai Chiang Mat, Thai Lan cung cho thly ring nguyen nhan nhap vien cua tre nhilm HIV chit y l u la viem phli (61,7%) [9].
Can lam sang va can nguyen gay nhiem triing ea hoi: Trong khi phdn tieh t i bao mau, ehiing tdi thly phln ldn benh nht ed thilu mau d mire dp vira va nang d ca 2 nhdm, lln lugt la: nhom mdl 67%, nhdm cu 7 1 %
T l bao miin dieh TCD4 cd su suy giam nang n l han d nhdm khdng dwac quan ly, dilu tri. O nhdm mdt phat hien thi ty le suy giam miln dich t l bdo nang la. 79,9% , d nhdm benh nhi duac theo doi thi ty le nay la 58,1%. Su khac biet nay cd y nghTa thong ke vdl p < 0,05.
Can nguyen vi khuln dugc tim thay d nhdm benh nhi mdi cung nhilu han so vdi nhdm benh nhi eu, tuang irng la 64,7% so vdi 35,3%. Trong s l nay chij y l u la nim Peniellln Macnerfei 20,6% vd truc khuln Lao 18,31%. Nghien ciru cua Gray, H.J. Zar tai Nam My eho thly can nguyen gay viem phli thudng gap la Streptococcus pneumoniae.
Staphylococcus aureus. Mycobacterium tu- berculosis. Pneumocystis jirovecii (PCP) cung la can nguyen quan trong [6] Thuc t l , g i n day viec du phdng PCP cho k i t qua kha tit, lam giam ty le mac PCP [5, 6).
Can nguyen vl rut duge tim thly d nhdm
benh nhi mdi cung nhilu han so vdi nhdm benh nht cti, tuang irng la. 61,9% so vdi 38,1% Can nguyen vt riit chit y l u gap 2 loai vi riit la EBV 28,1% va CMV 22,8%. Cae nghiem eiru khae eung eho thly ty le nhiim vi riit CMV kha eao tren benh nhi nhtim HIV, mac cac benh nhilm triing ca hdi [5, 7] Cae can nguyen vt khuln va vt riit khac eimg cd gap nhung vdi t i n suit it han
Nghiem eiru cua Ramos AN Jr tai My cung cho thly benh nhiim triing ca hdi trln tre nhiem HIV se giam nlu duge ehln doan vd du phdng sdm [10]
V. KET LUAN
Benh nhiim triing ca hdi thudng gap tren lam sang: dinh dudng, viem phoi, viem da, nim mieng.
Ty le benh nhi suy giam miin dieh mire do nang cung gap nhiiu han d nhdm khdng duge quan ly dieu tri
Can nguyen cac nhiim trimg ca hdi:
thudng gap la n i m Penicilin Macnerfei, true khuln Lao, EBV. CMV va gap nhilu han d nhom khong duac theo ddi va dilu tri thudng xuyen.
TAI LIEU THAM KHAO 1. Bg Y t l (2010). Bao cao Phd Thii tudng Truang VTnh Trong cdng tae phdng, ehing HIV/AIDs 9 thang d i u nam 2010.
2. Pham Song. HIV/AIDs, Tong hap, cap nhat va hien dai". NXB Y hpe 2006
3. Q u y l t djnh s6 3003/QO-BYT ngay 19/8/2010 eua Bd trudng Bg Y t l v l viee ban hanh Hudng d i n chin dodn va dilu tri HIV/AIDs
4. Q u y l t dmh sd 4746/QD-BYT ngay 8/12/2010 eiia Bd trudng Bo Y te v l viee ban hanh tai lieu "Dilu tq va cham sdc ca ban cho tre em nhiim HIV/AIDS.
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TCNCYH Phu tmung 80 (3A) - 2012 5. D.M. Gray; H.J. Zar (2010). Community
-acquired Pneumonia In HlV-infeeted Chil- dren- A Global Perspective Posted 04/26/2010, Curr Opin Pulm Med 2010,16 (3): 208 - 216. © 2010 Lippineott Williams &
Wilkins.
6. Geoffrey A. Preidis (2011). PhD Pneumonia and Malnutrition are Highly Pre- dictive of Mortality among Afnean Children Hospitalized with Human Immunodeficiency Virus Infection or Exposure tn the Era gf An- tlretrgviral Therapy The Jeurnal of Pediatrics 159 (3): 484-489
7. Lisa M. Butler, Debbie Bain Brickley, (2010). Rate and determinants of adherence to ART in infants, children, adolescents: sys- tematic review.
8. Puthanakit T, Aurpibul L, et al (2007).
Hospitalization and mortality among HIV- infected children after receiving highly active antiretroviral therapy Clin Infect Dis; 44 (4) 599 - 604
9. Ramos AN Jr, Matida LH (2011). Op- portunistic illnesses in Brazilian children with AIDS results from two national cohort stud- ies, 1983-2007 AIDS Res Ther 8 23 Summary
OPPORTUNITY INFECTIONS ON HIV/AIDS CHILDREN
Early diagnosis and management children suffer from HIV are very important It reduce op- portunity Infections and improve quality of child life. Airm of study was to identify etiology of opportunity infections in HIV children who hospitalized in National Hospital of Pediatric Results showed that pneumonia was the most common (45,9%,). skin diseases: 16.6%; oral candidiasis (19.3%); persistant diarrhoea: 13.3%: TB 12 7% Hight rate of anemia: 67% in new patients;
71% In managemented patients Etiology of 01. Penicilin Macnerfei 20 6%,, TB 18 31%, EBV 28 1% and CMV 22 8% Severe immunodeficiency in new patients (78 9% ) was higher than managemented patients (58 06%) with p <0 005.
Keyworlds: Opportunity infection, HIV, children, severe immunodeficiency
