Nam Moc Gay Benh

7/30/2019 Nam Moc Gay Benh

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NNNNmmmm mmmm

cccc


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IU KIN THUN LI CHO NM PHT TRIN Nhit : 20 250C

m: 65 70%

pH=5,5 7,5 (thch hp nht pH=7)

N, C hu c, khong cht

O2 (Rhizopuscn iu kin ym kh)

nh sng


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Mt s nm mc gy bnh thng gp

Si nm khng mu, c vch ngn (Hyalohyphomycetes)

Aspergillus, Fusarium, Trichoderma, Penicillium, Scopulariopsis.

Si nm khng mu, khng vch ngn (Zygomycetes)

Absidia, Mucor, Rhizopus, Rhizomucor.

Si nm c mu, c vch ngn (Phaeohyphomycetes)

Alternaria, Cladosporium, Curvularia, Bipolaris,


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HNH TH NM MC QUAN ST KHV

- Nam moc moi trng Sabouraud t 5 7 ngay

- Quan sat nam KHV sau khi nhuom Lactophenol coton blue


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Mt s bnh do Nm mcD ng

Bnh nhim nm ngoi bin, cc xoang, c quan

(cha xm nhp su)

Vim ng tai ngoi, gic mc, mi, ph qun, ph nang

Bnh vi nm (nm xm nhp su vo c quan)

Bnh c t nm


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BENH NHIEM NAMASPERGILLUS


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BNH NHIM NMASPERGILLUS Mc tiu

M t cc dng bnh m nm Aspergillusgy ra.

Trnh by cc biu hin lm sng ca bnh Aspergillus.

Thuc iu tr ca cc dng bnh Aspergillus.

Nu s cn thit ca vic cy bnh phm 37 0C v

nhit phng


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Aspergillus sp.

Aspergilusgp khp ni trn th gii.

Hin nay c >200 loi, c 20 loi gy bnh.

Cc loi thng gy bnh:A. fumigatus, A.

flavus, A. niger, A. nidulans,.


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11Aspergillus flavus


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12A. fumigatus A. glaucus


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13A. nidulans


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14A. niger


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Aspergillus spp.

DCH T

Bnh nmAspergillusc khp ni

Bnh nm ty thuc vo:

Nm (c lc, s lng)

K ch (tnh trng sc kho)

Thi gian tip xc vi nm Nhim nm ch yu qua ng h hp

C hi thun li:

C a d ng, hen suyn Tn thng: vim phi, vim ph nang, ghp c quan

Suy gim min dch: lao, tiu ng, bng nng, s dng ba

bi khng sinh v corticoid, nhim HIV/AIDS.


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Bnh hc D ng viAspergillus: vim ph qun phi do d ngVi nm sng hoi sinh cc xoang (khng xm nhp m)

* vim gic mc v ni nhn

* vim tai ngoi

* vim xoang mi

* vim c tim v mng trong tim

* cun nm trong hang phi (bu nm)

Aspergillusxm nhp m, pht tn khp c th (vim h thn kinh

trung ng, c quan tiu ha) thng gp bnh nhn suy gim

min dch.

Bnh c t nm

Aspergillus spp.


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Vim ph qun d ng

(ABPA: Allergic Broncho Pulmonary Aspergillosis)

Si t nm an kt vi cht nhy to mt nt nhy

gy tt nghn ph qun xp phi.

Bnh nhn st nh, ho, cht nhy (m) c si t nm.

Thng gp bnh nhn nhim HIV/AIDS, hen suyn,

d ng.


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Bu nmAspergillus

85% doA. fumigatus

Khi trn kh to gm si nm, fibrin, cht nhy

Thng gp trong trng hp:

o Hang phi c sn

o Hang lao c (chim 15% trong cc ca lao)

Triu chng: ho ra mu t hay t (nguy him)

Aspergillusc i tnh vi mch mu, gy ho ra mu, bnh

din tin nhanh t vong.


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Vim phi

Thng doA. fumigatus

Xy ra :

Ngi m nng.

iu tr bng thuc gim min dch.

Triu Chng: st 40 0C, kh th, ho ra mu.

Bnh nng c th lan ta ra cc c quan khc.


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Th lan ta

ngi suy gim MD, ung th mu, gim BC ht.

Vi nm gy bnh:A. fumigatus, A. flavus

Vi nm vo mu, lan ra mng phi (90%), h thn kinh trungng, no, mi, thn, gan, lch, tim, bng quang (c quan c

nhiu mch mu).

Th no xut hin giai on cui ca bnh AIDS.

Bnh thng trm trng nhng khng c triu chng c bit, ch

c chn on khi m t thi.

Triu chng: st, kh th, au ngc, ho khan, ho ra mu nh.


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CHN ON BNH ASPERGILLUSCc du hiu gip cho s chn on:

1. St 380C ko di / 5-7 ngy. Khng p ng KS ph rng.

2. Cy mu cc VKang lu hnh (-).

3. Virus, VK lao, xon khun,. khng c c s pht hin.4. Cc du hiu cn c:

- Phi: kh th, ho ra mu, au ngc, - Xoang: nhc u, chy nc mi, sng mt,..

- Gan, lch, CNS, cc c quan khc c du hiu bnh

5. Cc du hiu X quang c quan: cc nt p xe

6. nh tnhAspergillusbng m hc hay nui cy (+)

Th

xm nhp khi c 6 d

u hi

u trn


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Quan st trc tip (m, mu da, nc ra xoang mi) STN phn nhnh kiu r i c trng (450,Aspergillusnm lng hnh)

C ch trong ca bnh nm do d ng.*

Khng c ch trong ca nm xm nhp su.

Cy (quan trng nht l s ly trch nm t bnh phm)

MT Sabouraud - chloramphenicol, 37 0C, nhit phng.

o Nhiu khm nm (cng mt loi nm)/ a petri.

o Cng mt loi nm/ nhiu t ly mu khc nhau.

Aspergillus l nm lng hnh:

- dng hoi sinh sinh sn c th c cung, bo t.

- dng xm ln: STN phn nhnh 450

CHN ON BNH ASPERGILLUS


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Trc nghim da Khng nguynA. fumigatus

C ch trong chn on bnh d ng doAspergillus.

Mn cm trn da tc th hay chm t 6 8h. Chn on min dch

Tm khng th:

o Min dch khuch tn, md in di, ELISA to kit th

Bnh d ng nm, bnh bu nm Aspergillus.

o Test th da vi KN ngi bnh d ng nm Aspergillus

Tm khng nguyn:

ELISA sandwich (PP nhy), G-test (dch t nm), PCR(kt hp vi ELISA)

Bnh nm xm nhp, lan ta nhng ngi suy gim MD.

CHN ON BNH ASPERGILLUS


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Aspergillus phi


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Hang phi nhim nm Si nmAspergillus/ bnh phm


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u mang bo t v si nm Aspergillus/ phi Si nm/ m


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Bnh nh khng cn iu tr

Bnh nng iu tr theo nguyn tc iu tr triu chng,

thuc lm gin ph qun, chng tit dch, loi b cnnguyn do nm.

Prednisolon: 1 mg/ kg/ ngy n khi phi trong.

0,5 mg/ kg/ ngy x 2 tun.

Nc mui sinh l

iu tr bnh d ng do Aspergillus


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iu tr bnh cun nm phi

Rt kh v tin lng xu.

Gii phu ct b thy phi loi b nm.

Itraconazol 200 mg/ngy c th 1 nm

Khng gii phu c:

Amphotericin B di dng phun m vo hang phi

hay truyn tnh mch chm hay tim di da.

NaI, Natamycin, Miconazol, Ketoconazol.D phng

Trnh lm dng khng sinh, corticoid.


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Bnh nhn b bnhAspergillusxm nhp v bnh BC cp

Cn iu tr sm sau 4 ngy nm xm nhp.

Tin lng xu nu lng BC khng hi phc.

AmphoB: liu 1,5 mg/kg/ngy; 1mg/kg/ngy; 0,6-0,8 mg/kg/ngy (theodi c tnh ca AmphoB trn thn, mu)

iu tr lin tc n khi BC trung tnh hi phc, mt du hiu nm cchnh nh X quang, CT scans.

AmphoB

- cu trc lipid phc hp (tng hiu qu, gim tc dng ph)

- cu trc liposom nh liposomal amphoB- cu trc phn tn keo (AmphoB + cholesterol sulphat)

Voriconazol (tt cho ngi suy gim MD)

Itraconazol, AmphoB + Flucytosin

iu tr bnhAspergillusxm nhp


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Phng bnhAspergillus

V sinh v lm thng thong mi trng

(HEPA: High Efficiency Particulate Air filter, lc khng kh hiuqu cao)

Loi b cn nguyn nm

bnh nhn chun b ghp ty:

Ampho B (phun m hay tim truyn tnh mch)

Itraconazol (ung)


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Benh nhiem namFusarium


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Fusariumspp.

Chng nm gy bnh:

F. oxyspoum, F.solanum,

F. moniliforme,

Bo t vch dy

F i


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Fusariumspp. Hoi sinh t

ng xm nhp: ng h hp, da.

c t nm:o Trichothecene, Fumonisin

o Gy c ch min dch ca k ch, gy tn thng m Dnh vo knh st trng, ng thng

Nhim ngoi vi, xm nhp ti ch, lan ta


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Mt s bnh do Fusariumspp.

Nhim trng lan ta

Nhim trng phi-xoang

p-xe no

Vt thng da

Vim phc mc

Vim gic mc

Vim ni nhn

Xng v khp

Da

MngBu nm

Vim phc mc

Ngi suy gim min dchNgi bnh thng


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Bnh do Fusarium ngi khe mnh

Vim gic mc

eo knh st trng

Chn thng

Nh thuc nh mt corticoid (gy SGMD ti ch)

Nm mng, da (ngi i chn t)

Vim phc mc

Nhim vt thng


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Bnh do Fusarium ngi khe mnh

Nhim trng lan to gy

Vim ni nhn,

Vim ty xng

Vim khp,

Vim phi, p xe no,

Vim bng quang, Vim phc mc (thm phn mng bng)

Bnh Fusarium ngi suy gim min dch


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Bnh Fusarium ngi suy gim min dch

Triu chng: st ko di khng p ng vi thuc.Cc dng bnh: vim xoang, vim mng no, vim phi, vim ni vng

mc,

Yu t nguy c gy nhim ti chChn thng gy dp m

Suy gim MD

Yu t nguy c gy nhim Fusariumlan toUng th mu

Ghp c quan, ghp ty

Suy gim MD nng

Gy t vong cao (50 80%) th nh sau bnh Aspergillus


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Chn onLm sng:

Vim nhim ngn tay, ngn chn, da.

X quang phi cho hnh nh thm nhim phi.

Chn on xc nh:

Ly trch bnh phm

Sinh thit m

Phn ng min dch (phn bitAspergillusv Fusarium)


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iu tr Amphoterincin B, Ambisome

VoriconazolPhng bnh

Trnh tip xc vi mm bnh

Vi nm/ vi nc

V sinh mi trng (b mt tip xc nc)

Khi chn thng dp m: trnh tip xc nc


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Benh nhiem namZygomycetes


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i cng

Vi nm gy bnh thuc nhm nm:

Si t nm khng vch ngn, phn nhnh

ng knh s

i nm l

n

Sinh sn bng bo t nm trong 1 ti

a nhit, pht trin tt nhit > 37 oC


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Cc tc nhn gy bnh thng gpLp Zygomycetes

B Mucorales

H MucoraceaeAbsidia

MucorRhizopus

H Cunninghamellaceae

Cunninghamella

B Enthomophthorales

Nhim trng din rng

Gy t vong cao

Dch t


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Dch t

Vi nm trong b MucoralesPhn b rng ri

Chu c nhit (> 37 oC)

Pht trin nhanh trn mi trng giu carbohydrat

Bo t phng thch vo mi trng

Tm thy:

- H thng iu ha, bng gc

- Thc vt phn hy- Thc phm, tri cy

- t, phn sc vt


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Bnh hc

Qua ng h hp (ht bo t)Gy bnh vim xoang

vim phiNhim trng lan ta


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Bnh hcNhim c hi:

Bo t

nm v s

i n

m/ h

th

ng my l

nh

Dng c bng b vt thng

Vim phc mc (th

m phn mng b

ng)

Nhim trng lan ta (truyn dch b nhim)

Nhim trng da (t catheter), thay van timnhn to, knh st trng


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Yu t nguy ci tho ng: glucose kch thch s pht trin ca

zygomycetesLiu php c ch min dch

Bnh bch cu, suy thn

HIV , tim chch ma ty

Ngi khe mnh: bnh xy ra sau khi chn thng

Bnh hc


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Bnh hc

Vim xoang mi (tiu ng, nhim acid v ceton)

Vim phi, nhim nm lan ta: bnh bch cu, liu

php corticoid, chch ma ty, tr suy dinh dng, tiu

ng, ghp c quan, suy thn.

C quan tiu ha: lot d dy, sau phu thut rut,

chn thng, thc phm nhim vi nm

Bnh hc


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Bnh hc

Da: kt qu ca nhim trng lan ta, hng ro c

hc b ph v

AIDS, chch ma ty thng b nhim nm thn, da,

xoang mi, no

Trng hp khc: phu thut, phng, chn thng, vt

cn trng cn.


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Vim no xoang

Mi

Vm ming

Xoang mi

Hc mt

Mt

No

Triu chng:

St, au u (vng trn) au vng mt

Ph n quanh mi

Lot hai t quanh mi (en)

Mt: au hc mt, nhn i, lot vng mc

Mu, no


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Vim no xoang


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Vim no xoang


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Vim phi


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Da: kt qu ca nhim trng lan tati ch: bng, chn thng


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Tiu haau bng

Tiu chy, phn ln mu

C th t vong do xut huyt nng, thng rut


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Chn onXt nghim trc tp

Mu bnh phm: m, dch mi, dch ra ph nang, m.

Quan st: vi KOH 10%

Si nm rng ( 7 m)khng vch ngn

khng mu

Phn nhnh 90o


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Cy

Mi trng cha khng sinh

Khng cha cycloheximide

To 25 oC 37 oC

Khm nm pht trin nhanhsau 24h


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61Mucor


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Rhizomucor


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63Absidia


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Cunninghamella

iu tr


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iu tr

KI 30 mg/kg/ngy chia 1-3 ln/ngy

KTZ 400 mg/ ngy

ITZ 400 mg/ngy

FLZ 400 mg/ngy

Zygomycosis mn tnh

AMB (1-1,5 mg/kg/ngy n khi

lnh bnh

Zygomycosis cp & bn cp

Phu thut loi b m hai t, iu tr cc bnh mn tnh.

Mt s bnh nhim nm thng gp


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Mt s bnh nhim nm thng gp

Amphotericin B

ItraconazolKetoconazolKI

Vim tai

Vim no xoangVim phiNhim nm tiu haNhim nm lan ta

Rhizopus

MucorAbsidia.

Amphotericin BItraconazolVoriconazol

Vim gic mcNhim nm lan taFusarium spp.

Amphotericin B

Itraconazol

Vim tai

Vim miVim phiNhim nm lan ta

A. fumigatus

A. flavusA. niger

Thuc trBnhVi nm


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Benh vi nam si mau


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Bipolarissp.Curvulariasp.


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Chaetomiumsp. Cladosporiumsp.


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Nigrosporasp. Rhinocladiellasp.

Bnh do vi nm si mu


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Bnh da v mng

Lm sng: tng t nh bnh do nm da.

Nm gy bnh thng lAlternaria, Scytalidium

Cn lm sng: soi trn KHV vi KOH 30% hay DMSO 40%

si nm c mu. iu tr: kh khn.

Nm da dng Whitfield hiu qu.

(thuc m Benzosali gm A. salicylic, A. benzoic)

Bnh do vi nm si mu


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Vim gic mc Chim 6-53% trng hp lot gic mc, c th gy m.

Curvularia, Alternaria, Bipolaris,

Bnh thng do xut pht t vt try, dng corticoid, khng sinhkhng ng.

Chn on:

Quan st trc tip: vi KOH 10-20% hay nhum vi Giemsa, LPCB.

Cy: mt Sab., thch mu

iu tr: lm sch nm, dng thuc khng nm:

Dd Natamycin 5%

AmphoB 0,1-1%

Azol: Miconazol, Ketoconazol (Curvularia)

Bnh do vi nm si mu


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Vim xoang mi d ng i tng: c a d ng, vim xoang mn tnh, polyp mi,

hen suyn, sng vng kh hu nng-m.

Nm Bipolaris, Curvularia, Alternaria, Cladosporium.

Nm khng si mu:Aspergillus, Fusarium, Rhizomucor,

Chn on: theo di nm 4 tun trc khi kt lun m tnh. iu tr: Lm thng thong mi.

- Phun m Steroid- Nh nc mui sinh l trong thi gian di ngn nga tipht.

Bnh do vi nm si mu


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Vim xoang mi mn tnh Nm xm nhp vo xoang mi.

Lm thng thong xoang mi. Gii phu.

iu tr: AmphoB, Ketoconazol, Itraconazol.

Cun nm trong xoang mi

Triu chng: nght mi, au xoang mi, thay i khu gic.

Chn on: X quang, m hc

iu tr: NaCl 0,9% lm sch nm v thng thong mi.


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Benh oc to nam

BNH C T NM


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c t nm (mycotoxin): cht bin dng th cp do vi nm phngthch vo thc phm / thc n gia sc.

Nhim c t nm thng qua ng tiu ha, ngoi ra qua ng

h hp hay tip xc da.

Bnh c t nm c th cp tnh hay mn tnh:

Gy cht nhanh hoc to thnh khi u nh hng h MD d b nhim nhng bnh khc

Cp tnh: nhim c thn kinh, tn thng thn, xut huyt, hoi

t,..

Mn tnh: x gan, ung th gan.

Bnh khng ly lan, khng c thuc iu tr.

Mt s c t nm thng gp


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Stachybotrys atraStachybotryotoxin

MucorDicoumarol

FusariumZearalenonP. IslandicumIslanditoxin

A. fumigatus, C. albicansGliotoxin

Fusarium moniliformeFumonicin

Fusarium, Trichoderma,Stachybotrys

Trichothecen

A. ochraceus, P. viridicatumOchratoxin

A. flavus, A. parasiticusAflatoxinVi nm sn xutc t nm

Aflatoxin


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Aflatoxin: sn xut biAspergillus flavus, A. parasiticus, A. nomius,

Penicillium citrinum, P. expansum, P. frequentans.

Cc loi Aflatoxin: B1, B2, G1, G2, M1, M2 (trong sa b)

*Thc phm thng b nhim t nguyn liu giu tinh bt, ht c du:

bp, u phng*, ng cc, c ph, nc tng, chao, bnh mt, ko,

sa u nnh, sa b ti

Thuc t dc liu (tr gim bo 3 c gi), thc n gia sc

B Y t VN quy nh mc gii hn aflatoxin/ thc phm l 10ppb

Bnh aflatoxin


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Bnh Aflatoxin cp

Vim gan cp tnh do n thc n nhim nng aflatoxin.

Triu chng: vng da, st nh, trm cm, bing n,tiu chy, thay i thai ha m gan,

Sinh thit m: hoi t thy gia v nhim m.

Bnh aflatoxin


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Bnh c t nm do nhim aflatoxin thng lin quan vi bnh

Kwashiokor (suy dinh dng tr em do thiu protein):

tr em bnh Kwashiokor thiu kh nng ng ha protein b

sung cho khu phn n m l bt lc Tr b tn thng

gan.

Bnh aflatoxin mn tnh

Gy ung th gan

(13% ngi nghin ru)*

Ochratoxin


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Ochratoxin A, B, C & D

DoA. ochraceus , Penicillium verrucosumsn xut

Nhim thc phm: la mch, ht c ph, bp, la m, uphng, hoa qu sy kh, ru vang.

Ochratoxin A: c thn, gan (liu cao), qui thai, ung th

Gy bnh thn heo.

Cht gy ung th chut.

Bnh thn (ni dch vng Balkan-1956) Khong 50% dn s Chu u tip xc vi ochratoxin.

Trichothecene


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Trichothecene: c t nhm sesquiterpenoid

Gp lng thc chu nhit (ng), ng cc (u nnh)

Nm sn xut trichothecene:

Fusarium: F. poae, F. sporotrichoides, F. solani

Nm khc: Trichothecium, Trichoderma, Stachybotrys,

Cephalosporium.

Trichothecene c ch protein mnh gy nhiu nh

hng trn th.

Bnh Trichothecene


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Trichothecene gy bnh ATA (Alimentary Toxic Aleukia):

xy ra nhanh sau khi n thc phm nhim c t

Triu chng:

Nn ma, tiu chy, au bng, cm gic nng rt

thng v.

Tip sau: m xut huyt da, xoang ming, vt

thng hoi t v phnh to hch bch huyt

Bnh Trichothecene


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iu tr bnh ATA

Truyn mu,

Ch phm acid nucleic v calcium

Khng sinh

Vitamin C, vitamin K

Thay i khu phn n dinh dng.

Fumonisin


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Fumonisin B1, B2

Gp lng thc (ng, go), ng cc

Gy bnh ung th thc qun, ung th bung trng, vim gan, trn

dch mng phi

Vi nm sn xut: Fusarium moniliforme, F. proliferatum Thai ph n nhiu bp/ 3 thng u nguy c sinh con b khuyt tt

cao gp 2,5 ln (NC ca Trung tm phng v kim sot bnh ca M)

do Fumonisin lm v hiu ha acid folic.

iu tr


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--RRRI-RScopulariopsis spp.

-SRSRSAcremoniumspp.-I-SISRIPaecylomycesspp.

-RRRRRScedosporium

-SI-SSISP. marneffei

RI-RRRRI-RFusariumspp.

CaspofunginVRZFLUITZFLZAMBMm bnh

Amphotericin B, Fluconazol, Itraconazol, Flucytosin, Voriconazol


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KeKeKeKetttt thuthuthuthucccc phaphaphaphannnn NaNaNaNammmm momomomocccc

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Date post:	04-Apr-2018
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