29 Benh TN 2011- Viem Nao

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VIM NO SIU VI

BS. Nguyn Vn K

Mc tiu hc tp

1. Lit k c cc siu vi gy vim no, nhim trng trc tip v sau nhim

trng, c im dch t mt s siu vi chnh, thng gp

2. Gii thch c nhng c im chnh ca sinh bnh hc bnh vim no

siu vi

3. M t c cc triu chng lm sng, bin chng, di chng thng gp

ca vim no siu vi

4. Ghi v c c kt qu cc xt nghim cn thit chn on xc nh

bnh vim no

5. Trnh by c cch iu tr v phng bnh vim no siu vi

Ni dung

I. I CNG

Vim no (encephalitis) l bnh vim nhim m no lan ta hoc khu tr

bn cu no, tiu no, hoc thn no. Bnh thng cp tnh, biu hin vi hi

chng nhim trng khng chuyn bit, ri lon tri gic, du thn kinh nh v

v co git, c th li nhiu di chng thn kinh v gy t vong cao.

V vim mng no thng i km trong tin trnh vim ny, nn i khi gi

l vim no-mng no (meningoencephalitis), v vim no-mng no-ty sng

(meningoencephalomyelitis).

Mc tiu then cht x tr sm l phn bit r vi vim mng no n thun,

p-xe no, m di mng nhn, v vim tt tnh mch nhim trng, xc nh

mm bnh v iu tr thch hp.

Bnh do nhiu tc nhn gy ra, phn ln l siu vi. Trong khun kh bi

ny chng ta ch trnh by bnh vim no do siu vi, ngoi tr do HIV.

II. TC NHN GY BNH

Bnh vim no c th do siu vi gy tn thng trc tip (vim no nguyn

pht) hoc sau nhim trng (vim no th pht).

Enterovirus l tc nhn gy vim no siu vi thng nht, thuc h

picornavirus vi hn 50 type gy vim mng no v vim no. H ny gm

coxsackievirus A v B, echovirus v cc nhm enterovirus mi hn, cng nh

3 type poliovirus. Enterovirus 71 l type huyt thanh khm ph mi nht k t

nm 1969, gy bnh da v h thn kinh trung ng (bnh tay chn ming)

cc ni ri rc trn th gii. T u nm n thng 8 nm 2003, vin Pasteur

TP. HCM nh danh c 9 mu c enterovirus thuc type echo 3, 4, 9, 13,

25, 30 v ngy 4-8-2003 nh danh thm c enterovirus 71. Ngoi ra cng

tm c 11 mu c enterovirus nhng cha xc nh c tp no, gy vim

no cp tr em.

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BNG 1. SIU VI GY VIM NO CP

VIM NO NGUYN PHT

Togaviridae Alphavirus Eastern equine Western equine Venezuelan equine Flaviviridae St. louis Murray Valley West Nile Japanese Dengue Tick-borne complex Bunyaviridae La Crosse Rift Valley Toscana

Paramyxoviridae Paramyxovirus Mumps Morbillivirus Measles Henipavirus Hendra Nipah (Hendra-like) Arenaviridae Arenavirus Lymphocytic choriomeningitis Machupo Lassa Junin

Picornaviridae Enterovirus Poliovirus Coxsackievirus Echovirus Hepatitis A Reoviridae Colorado tick fever Rhabdoviridae Lyssavirus Rabies Filoviridae Ebola Marburg

Retroviridae Lentivirus HIV Herpesviridae Alphaherpesvirus HSV type 1 v 2 VZV Herpes B virus Betaherpesvirus Cytomegalovirus Human herpes-virus 6 Human herpes-virus 7 Gammaaherpesvirus Epstein Barr Adenoviridae Adenovirus

VIM NO SAU NHIM TRNG

Togaviridae Rubivirus Rubella Orthomyxoviridae Influenza

Paramyxoviridae Rubulavirus Mumps Morbillivirus Measles

Poxviridae Orthopoxvirus Vaccinia

Herpesviridae Herpesvirus Varicella-zoster virus Epstein-Barr virus

Arbovirus gm nhng tc nhn ca vi h truyn bi mui hoc ve (tick).

Hn 15 loi arbovirus khc nhau gy vim no nhng vng khc nhau trn

th gii. Vim no Nht bn (VNNB) tm thy hu ht Chu . Vit nam

thng thy hu ht a phng min Bc. Virus VNNB c kch thc nh,

ng knh 15-40nm, chu ng km nhit cao, c th nui cy trong

trng g ln, trn cc m phi g, t bo Hla, thn kh.

Vim no do HSV l vim no do siu vi duy nht c c tr hiu qu

(acyclovir), v vy trc tt c vim no lympho nn ngh ngay n n.

Adenovirus l virus h hp, ch l tc nhn him gy vim no/vim mng

no nng tr em.

Vim no sau nhim trng thng thy hn, a s nhim siu vi h hp

cp, si, thy u, quai b, Epstein Barr (EBV)

III. DCH T HC

Vim no siu vi gp ri rc quanh nm hu ht cc a phng. Tuy

nhin, t l mc c xu hng tng vo ma nng (t thng 3-8 hng nm). Mi

loi virus gy vim no c mt mu dch t hc ring.

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Hnh 1. Phn b vim no Nht Bn

VNNB lu hnh hu ht cc a phng nc ta, tn sut mc bnh cao nht

H ni v cc vng ln cn, thng xy ra t thng 4 9, gy dch vo cc

thng 5, 6, 7; gp nhiu nht vo la tui 2-8 tui, ly truyn qua mui t, ch

yu l cc loi mui Culex, Vit Nam vai tr truyn bnh ca Culex

tritaeniorhyncus c khng nh. Mui ny thng sinh sn ng rung,

ht mu ng vt c virus, c bit l ln, chim trong thi k nhim virus

huyt, c kh nng truyn bnh sut i v c th truyn virus sang th h

sau qua trng.

Vim no do

enterovirus xy ra quanh

nm, nhng nhiu hn vo

cc thng t 3-6, thng

gp tr nh v ly truyn

theo ng tiu ha (phn-

tay-ming).

Vim no do herpesvirus

cng xy ra quanh nm,

thng gp tr trn 2 tui

(HSV type 1). Tr s sinh

c th mc bnh vim no

cp do HSV type 2.

Lymphocytic

choriomeningitis virus (LCMV) l virus th vt quan trng gy vim no-mng

no. Ngi mc bnh do tip xc vi bi hoc thc phm nhim cht thi ca

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chut nh thng thng. Bnh ngi thng xy ra vo ma ng hn, khi

k ch t nhin c khuynh hng vo trong nh.

Cc loi virus khc t gp hn, xy ra ri rc quanh nm: virus si, quai

b, rubella, adenovirus, EBV, cytomegalovirus (CMV), Virus quai b lan rng

theo ng h hp, vi nhim trng xy ra quanh nm, nhng tng sut ma

xun, nam b vim no-mng no hn n gp 3 ln.

IV. SINH BNH HC V C IM BNH HC

1. Xm nhp: virus n h thn kinh trung ng qua 2 ng:

1.1. ng mu:

Thng thng nht. Ng vo v sinh sn u tin ca virus c th l ng h

hp (si, quai b, VZV, ), ng d dy-rut (st bi lit, coxsackievirus,

echovirus), hoc qua vt cn ca cn trng vo m di da (arbovirus, ).

- Nhim virus nguyn pht: virus xm nhp c th tip tc sinh sn hch bch

huyt vng, vo mu, sinh sn h lin vng ni m (gan, lch, hch).

- Nhim virus huyt th pht: khi virus sinh sn nhiu h lin vng ni m s

gy nhim virus th pht vi cc triu chng khng c hiu nh st, mt mi,

nhc u. a s lin quan n h thn kinh trung ng l hu qu bt thng

ca cc trng hp nhim trng thng thng. Trong tnh trng nhim virus

huyt th pht ny, cc virus c i tnh vi t bo thn kinh c th xuyn qua

hng ro mu no (bng cch sinh sn trong t bo ni m mch mu, hoc

trc tip xuyn qua hng ro ni m cng vi t bo lympho hay i thc bo

b nhim virus) v gy nhim trng t bo thn kinh.

1.2. ng thn kinh:

Gp trong vim no do virus di, HSV, poliovirus. Virus di lan ngc dng

theo thn kinh ngoi bin, HSV lan theo ng khu gic.

2. Gy tn thng thn kinh trung ng

Vo h thn kinh trung ng, cc virus c th gy tn thng theo t nht 3

cch khc nhau:

- Nhim trng trc tip lm hy hoi t bo thn kinh v cc t bo khc ca

thn kinh trung ng.

- p ng min dch ca k ch qua min dch t bo, phng thch cc cytokin

gy vim v khng th lm tn thng mch mu hoc m thn kinh.

- Nhim trng v vim gy ph m no, tng p lc ni s, thay i ti mu

no, hu qu l tn thng no khng hi phc do thiu oxy m.

Tc nhn nhim trng c th gy triu chng lm sng h thn kinh trung

ng bng cch gy tn thng trc tip hoc gin tip trn t chc thn kinh.

Mt khi vo h thn kinh trung ng, ch vi t bo c th b nhim, gy cc

biu hin lm sng thay i. Nhim t bo thn kinh c th gy co git, khu tr

hoc ton thn, ty vng tn thng. Nhim t bo thn kinh m t nhnh c

th gy thoi ha myelin n c. Nhim v no hoc vim nhu m phn ng

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c th lm thay i tnh trng tri gic, v nhim t bo thn kinh thn no

chuyn bit c th gy hn m hoc suy h hp. Nhim t bo thn kinh m

nh v i thc bo c th dn n ri lon chc nng thn kinh qua hiu qu

gin tip trn chc nng t bo thn kinh.

Trong vim no siu vi, nhim t bo thn kinh, t bo m v ngay c ni b

mch mu dn n ri lon chc nng v i khi cht t bo. p ng vim

xy ra. Triu chng lm sng ty thuc vo s phn phi ca nhim trng, v

vo c hiu qu trc tip ca virus v phn ng vim th pht trong t chc. S

phn b tng i mi ri lon chc nng no ty thuc tng virus ring bit.

Mc hi phc ng k nhiu bnh nhn gi rng cc p ng vim v

min dch thng ni bt.

Vim no do virus sinh sn t bo thn kinh hoc t bo m t gp, nh virus

HSV tp I v II, enterovirus, HIV, EBV, CMV, adenovirus, virus di. Thng

gp hn nhiu l vim no sau nhim trng, mm bnh t hoc khng gy ra

sang thng trc tip, l ngun gc ca phn ng min dch, vim, vi thoi

ha myelin quanh tnh mch, tr hn so vi nhim trng ban u.

Nhng th vi trong nhn tm thy trong nhim HSV, adenovirus, v th bn

cp v mn tnh ca nhim siu vi si. Nhim CMV gy thay i bnh l c

trng vi cc t bo to cha cc th vi. Th vi Negri tm thy trong vim no

do virus di.

Khi bnh thoi ha myelin cp bin chng pht ban siu vi, nhim h hp hoc

d dy rut, khng bit s xm ln vo h thn kinh trung ng c phi l iu

tin quyt gy bnh. Sinh bnh hc ca hi chng ny ngh l lin quan n s

gy ra mt p ng min dch vi myelin ca h thn kinh trung ng. C ch

ny ging bin chng thn kinh do vc-xin di sn xut t m thn kinh.

Mt khc, hi chng Reye l mt bnh cnh no cp c bit kt hp vi ri

lan chc nng thng xy ra sau nhim siu vi. Hi chng ny tn hi tr em

v c im bi gan nhim m cp v ph no khng vim, kt hp thng

nht vi nhim virus cm v thy u, lin quan dch t vi vic cho salicylate

trong khi nhim trng.

V. TRIU CHNG LM SNG

Rt a dng, t cc biu hin n gin vi st nh t ngt, din tin nhanh

chng vo hn m v t vong, n nhng th lm sng phc tp vi st cao, co

git nhiu ln, tn thng no lan ta, ko di nhiu ngy, dn n nhiu di

chng trm trng.

1. Thi k khi pht

- St: l triu chng ph bin, xy ra t ngt. St thng lin tc 39-40oC,

nhng i khi khng cao.

- Nhc u, km linh hot, tr nh nhi thng quy khc, bt rt.

- Bun nn, i.

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Ty lai virus, c th c cc triu chng khc nh:

- Ho, s mi.

- Tiu chy, phn khng c nhy, mu.

- Pht ban: mn , bng nc hoc ban lng bn tay, bn chn, km let

ming (bnh tay-chn-ming gp vim no do enterovirus 71).

2. Thi k ton pht

Cc biu hin tm-thn kinh xut hin nhanh chng:

- Ri lon tri gic: t nh n nng, nh ng g, li b, l m n hn m.

- Tm thn bt thng: o gic, kch ng, thay i nhn cch, hnh vi bt

thng,

- Du hiu vim mng no: nhc u, nn i, c gng hoc cng, c du

Kernig, Brudzinski.

- Du thn kinh khu tr hoc lan ta: thng c co git khu tr hay tan thn,

mt ngn ng, tht iu, lit na ngi (phn x gn xng tng, c du

Babinski), lit thn kinh s (lit mt, lit mt),

- C th c c ng bt thng, run v gng cng kiu Parkinson do tn thng

hch nn v i th, thng gp trong vim no Nht bn.

- Ph no gy cc biu hin tng p lc ni s: ph gai th, lit thn kinh s III v

VI, nhp tim chm v tng huyt p.

- Tn thng ty sng: gy lit mm, gim phn x gn xng, lit rut v bng

quang.

- C th c suy h hp, ph phi cp, suy tim hoc sc.

Trong vim no do Herpes simplex, triu chng thng gm thay i c tnh,

o gic, v mt ting ni, ngh n tn thng khu tr thy thi dng in

hnh ca nhim trng ny.

Trong vim no Nht bn thng gp hi chng Parkinson.

Vim ty c th xy ra, cng vi hoc khng c vim no. Vim ty ct ngang

vi yu chi, ri lon cm gic, v mt kim sot rut v bng quang. Vim ty

hng ln dn n lit mm hng ln v mt cm gic, c im bi tn

thng bng quang v rut sm.

Trong vim no ty sau nhim trng, khong thi gian gia biu hin nhim

siu vi u tin v bt u triu chng lin quan n h thn kinh gia 2 v 12

ngy. Khi pht thng t ngt, vi gim tri gic hoc co git.

Khm thc th ton thn c bit quan trng l pht ban trong bnh thy u,

herpesvirus v zona. Pht ban thnh thong cng thy vi nhim coxsackievirus

v echovirus.

VI. XT NGHIM

1. Cng thc mu

Bch cu bnh thng, gim, hoc tng va. Lympho khng in hnh c trong

nhim EBV.

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2. Dch no ty

- p lc c th tng.

- T bo tng 10-2000 /mm3, thng ch yu l t bo n nhn, mc d trong

giai on sm c th khng c t bo, hoc rt nhiu t bo a nhn. Lympho

bo khng in hnh c th thy trong vim no do EBV, t hn do CMV v

HSV. Khong 20% vim no do HSV hng cu c th tng ng k (> 500

/mm3).

- Protein thng cao, trong nhim trng mn tnh t l protein tng ny l IgG

(Bnh thng < 12%).

- Glucose thng trong gii hn bnh thng, ch c th gim trong quai b,

LCMV, vim no do HSV tin trin.

- Phn lp virus: cng sm cng tt, enterovirus d phn lp nht mc d t l

tm thy him khi vt qu 70%. Cy hu nh m tnh trong vim no do

HSV-1.

- PCR: chn an trc tin vim no do HSV, hin nay PCR s dng rng ri

nh l xt nghim chn on trong vim no do CMV, EBV, VZV, v cc

enterovirus.

- Khng th chuyn bit: so snh vi mc khng th huyt thanh c th hu ch

(nu khng th vi mm bnh c bit trong dch no ty cao hn trong huyt

thanh v protein ch tng va, chng t nhim trng h thn kinh trung ng do

mm bnh ).

3. Phn lp virus

Ngoi dch no ty, virus gy vim no cn c th phn lp trong:

- Mu: arbovirus, mt s enterovirus, LCMV.

- Phn: enterovirus v adenovirus.

- Nc tiu: virus quai b, CMV.

- Nc ra c hng: enterovirus, adenovirus, virus quai b.

- Dch bng nc: enterovirus 71

4. Phn ng huyt thanh

Ly mu trong giai on cp, so snh vi mu ly sau 1-3 tun chng t khng

th tng ng k.

IgM chuyn bit trong huyt thanh v dch no ty thng cho php chn on

sm.

- Vim no Nht bn:

Ba th nghim huyt thanh hc thng dng l phn ng kt hp b th, phn

ng trung ha, phn ng c ch ngng kt hng cu g.

Phi lm huyt thanh chn on 2 ln vo ngy 45 ca bnh v vo tun th 3

ca bnh. Chn on xc nh khi hiu gi khng th ln 2 cao gp 4 ln so vi

ln u. Vi huyt thanh n dng tnh phi c hiu gi khng th > 1/320.

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nc ta, Vin v sinh dch t hc H ni sn xut b sinh phm MAC-

ELISA, c th chn on vo khong ngy th 3 4 sau khi bt u triu

chng.

- Enterovirus 71:

nc ta s dng thuc th Oncoprob VE-71, dng phng php ELISA tm

khng th c hiu IgM, chn on vim no / lit mm do Enterovirus 71

trong vng 3 thng sau khi nhim.

5. in no (EEG)

Bt thng trong >90% vim no do HSV.

6. CT scan

C ch loi ra cc sang thng chon ch (p-xe, trn dch di mng cng).

Trong vim no thng thy bnh thng. C th c li chn on sau khong

thi gian vi ngy: m gim khu tr thy thi dng trong vim no do

HSV

7. MRI scan

Cho php thy ty sng tt hn, l mt ch th nhy cho s thoi ha myelin v

c th gip pht hin hin tng ph n thng thy sm trong vim no. MRI

cn l k thut chn la trong vim no do HSV, tn thng thy thy thi

dng.

Hnh 2. Hnh nh vim no trn phim CT scan s no

A. Lc nhp vin B. 14 ngy sau C. Tn thng thy thi dng trong vim no do HSV

VII. CHN ON

1. Chn on xc nh: da vo cc yu t:

HNH 3

1.1. Dch t.

1.2. Lm sng:

- Hi chng nhim trng: st, au c hoc khng, v cc triu chng ring

bit ty mm bnh.

- Ri lon tri gic: t u m n thun n hn m su. C th ri lon hnh vi

trc.

- Cn co git: nhiu kiu, c th ton thn hoc khu tr.

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- Triu chng thn kinh: yu lit vn ng (mt chi, na ngi, lit thn kinh

s, vim ty), hoc c ng bt thng (lon trng lc, git rung c, run).

- Hi chng vim mng no: st, nhc u, nn i, cng gy c th i km.

1.3. Cn lm sng:

- Kho st dch no ty.

- Phn lp virus.

- Phn ng huyt thanh.

- CT, MRI scan, EEG.

2. Chn on nguyn nhn

2.1. Vim no do HSV:

- Mm bnh: HSV1 = 90%, HSV2 = 10% (ngai la tui s sinh).

- Lm sng: st, nhc u, mt nh hng, thay i tnh cch, mt ging, o

khu-v gic, mt khu gic hoc ri lon tr nh, co git khu tr hoc ton

thn, du thn kinh nh v khc.

- Cn lm sng:

Dch no ty: tng bch cu, lc u bch cu a nhn, v sau n nhn u th.

ng bnh thng, him khi gim. Protein tng 100-300mg/dl.

Phn lp virus. PCR.

Huyt thanh chn on: i vi dch no ty, hiu gi khng th tng 4 ln

gia 2 ln xt nghim cc nhau 2 tun. i vi mu, khng c gi tr v

hu ht ngi ln c kt qu dng tnh.

T l khng th mu/DNT 20/1, rt c gi tr.

EEG: sng dng ng kinh mt bn c chu k.

CT/MRI: sang thng vng gia v di thy thi dng, vng di thy trn.

2.2. Vim no Nht bn:

- Dch t: vng lu hnh dch bnh vim no Nht bn, b mui t.

- Lm sng:

Khi pht: st cao t ngt, hi chng mng no, ri lon tri gic.

Ton pht: hn m su hn, ri lan thn kinh thc vt (v m hi, ri lon

nhp th, v tng tit m nht, mch nhanh yu, da lc lc ti), cung sng,

o gic, kch ng, co git, cm. Yu tng trng lc c, tng phn x v cc

phn x bnh l dng tnh ton thn. Ph gai th < 10%, v 33% lit thn kinh

s. Du hiu ngai thp thng gp nh v mt v cm, run, gng cng, ma

git ma vn. Th nhanh do trung ng.

- Cn lm sng:

Dch no ty: p lc m thng bnh thng.

Protein tng nh.

T bo c 10 n vi trm bch cu n nhn.

Phn lp virus rt kh tr trng hp t vong hoc bnh nng.

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Huyt thanh chn on: Tm IgM (ELISA) trong mu hoc DNT. nhy gn

100% khi th c mu v DNT. C th m gi nu th sm trong tun u.

Phn lp virus trong mu: trong tun u ca bnh.

EEG: pht hin sng delta lan ta lin tc chm hoc kiu sng delta nhn.

CT/MRI: xut huyt i th, tn thng hch nn, cu no, ty sng, tiu no.

3. Chn on phn bit

Cn loi tr cc bnh:

- Vim mng no m, p-xe no.

- Vim mng no do lao, nm, k sinh trng.

- St rt nng th no.

- Co git do st cao.

- ng kinh.

- Ng c cp.

- Xut huyt no-mng no.

VII. IU TR

1. iu tr c hiu

Vi vim no do Herpes simplex, iu tr hiu qu c gi tr vi acyclovir.

Cn cho sm, liu dng 30-45mg /kg /24gi, chia lm 3 ln truyn tnh mch,

trong 21 ngy.

Vim no do virus thy u-zona cng c th iu tr vi acyclovir v vim

no do Cytomegalovirus vi ganciclovir hoc foscarnet, nhng hiu qu cha

c cng c.

Bnh thn kinh kt hp vi HIV c th ci thin vi iu tr zidovudine.

Nhng khng c iu tr no loi tr c trng thi tim n ca nhng virus

ny.

Vim no do Enterovirus e da tr s sinh iu tr thnh cng trong vi

trng hp vi immunoglobulin cha lng cao khng th chng virus ang

nhim.

2. iu tr triu chng

Gm: thng ng th, iu tr suy tun hon, st, nga lot t th, cn

bng nc-in gii v nng lng, iu tr co git, ph no.

Bnh nhn hn m c th phc hi ng k ngay c thi gian mt tri gic

ko di. V vy cn ch nh iu tr nng tch cc, v cc bin chng do

gip th, ng thng, ng tnh mch v.v nn trnh v iu tr mnh m nu

chng xy ra. Nn theo di cht ch mc ng huyt v in gii trong mu,

v vng h i c th b tn thng.

Kim sot co git vi diphenylhydantoin hoc phenobarbital. Vi trng

hp st c th c li, nhng tng nhit qu cao, cng nh gim oxy c th lm

nng cc cn co git.

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Kim sot ph no vi glucose 20-30% hoc mannitol, nhng corticoide

cn cha thng nht.

VIII. PHNG BNH

Ty tc nhn gy bnh:

1. V sinh phng bnh

- Cch ly bnh nhn, nht l khi mc cc bnh si, thy u quai b ...

- X l phn ng cch.

- V sinh thc phm. Ra tay sch s khi tip xc vi bnh nhn, trc

khi n v sau khi i tiu.

2. Gim st cc vt ch trung gian gy vim no do nhm Arbovirus

- Kh thc hin v bao gm nhiu loi : ngi, sc vt c v, chim.

Hin nay chng ta cng t hiu bit v cc d tr hay cc vt ch

trung gian mang virus trong ma ng.

- nc ta nn dit mui Culex tritaeniorhyncus, chng mui t c

nhn. Nui heo xa nh v heo l cha, mui t heo s lan trn virus

ra xa.

3. Tim chng

Hin nay c nhiu vc-xin tim chng cc bnh nhim virus nh si,

quai b, thy u, st bi lit ... nn c kh nng lm gim vim no do

cc loi virus ny.

Ngoi ra cn c cc loi vc-xin :

3.1. Vc-xin phng vim no Nht bn:

- Ch t virus bt hot no chut, do Vin V sinh DTH H ni sn

xut theo chuyn nhng k thut ca Vin Kanonji, Nht bn. C

p ng min dch 100% nh vc-xin Biken Nht bn.

Tim di da, 1ml ( 3 tui) hoc 0,5ml (< 3 tui). Min dch c bn

3 liu : liu I v liu II cch nhau 1 - 2 tun, 1 nm sau tim liu III.

Tim nhc li mi 3 nm 1 liu.

- Japanese Encephalitis Vaccine - KGCC nhp ca Hn Quc, to

min dch c bn v tim nhc nh trn:

Tim bp, 1ml ( 3 tui) hoc 0,5ml (< 3 tui) /liu.

3.2. Vc-xin phng Enterovirus 71:

Vc-xin Sabin: dng trong v dch Bulgaria, ngn chn dch

enterovirus 71 lan rng, nhng thiu chng c hiu qu c ngha.

Vc-xin enterovirus cht c sn xut dng trong v dch ny,

nhng khng dng ngi.

Gio trnh Bnh nhim

445

TI LIU THAM KHO

1. L c Hinh. Bnh vim no Nht bn. Hi tho khoa hc BNH VIM

NO NHT BN V D PHNG BNG VC-XIN, VIN V SINH

DCH T - B Y T, H ni, 1998 (trang 1 12).

2. Nguyn Th Xuyn. HNG DN CHN ON V X TR BNH

VIM NO CP DO VIRUS TR EM. Ban hnh km theo Quyt nh

s 2322/Q-BYT ngy 30-6-2006 ca B trng B Y t.

3. Trn Vn Tin. Dch t hc bnh vim no Nht bn v bin php phng

chng. Hi tho khoa hc BNH VIM NO NHT BN V D

PHNG BNG VC-XIN, VIN V SINH DCH T - B Y T, H ni,

1998 (trang 13 22).

4. APPIT. Encphalites et encphalopathies dorigine infectieuse. Dans

Maladies Infectieuses et Tropicales, E. Pilly, 17 dition, 2M2, 2000,

Chapitre 43 (p. 261 264).

5. Diane E. Griffin. Encephalitis, myelitis, and neuritis. In Mandell, Douglas

and Bennetts Principles and Practice of Infectious Diseases, 6th edition,

2005, Chapter 83 (p. 1143 1148).

6. John F. Modlin. Coxsackieviruses, Echoviruses, and Newer

Enteroviruses. In Mandell, Douglas and Bennetts Principles and Practice

of Infectious Diseases, 6th edition, 2005, Chapter 169 (p. 2148 2157).

7. Karen L. Ross, Kenneth L. Tyler. Meningitis, encephalitis, brain abscess,

and empyema. In Harrisons principles of Internal medicine, 16th edition,

2005, Chapter 360 (p.2535 2549).

8. Lawrence Corey. Herpes Simplex Virus. In Mandell, Douglas and

Bennetts Principles and Practice of Infectious Diseases, 6th edition, 2005,

Chapter 132 (p. 1762 1774).

9. Richard W. Price. Acute viral meningitis and encephalitis. In Cecil

Textbook of Medicine, 20th edition CD - ROM, Chapter 424.

Gio trnh Bnh nhim

446

CU HI TRC NGHIM

1. Chn cu sai trong vim no siu vi:

a. Thng i km vi vim mng no

b. Him khi km ri lon tri gic

c. C th do Herpes simplex virus

d. C th do virus gy bnh quai b

2. Bnh vim no Nht bn ly theo ng:

a. H hp

b. Tiu ha

c. Qua trung gian mui Culex

d. Qua trung gian mui Anophele

3. Vai tr ca chn on hnh nh (CT hay MRI) trong vim no siu vi:

a. Gip loi tr sang thng chon ch

b. Cho thy hnh nh ph nhu m no trong vim no

c. Da vo v tr tn thng gip gi nguyn nhn vim no siu

vi

d. C a, b v c

4. c im ca vim no do HSV (Herpes simplex virus):

a. Bnh ly truyn qua trung gian mui Culex

b. Chn on hnh nh thy tn thng thy trn hay thy thi

dng

c. iu tr hiu qu vi Acyclovir

d. C b v c

5. iu tr vim no siu vi:

a. Khng sinh

b. Khng c t

c. iu tr triu chng

d. Acyclovir trong vim no do Enterovirus

P N: 1. b 2. c 3. d 4. d 5. c