BENH SOT RETTS. Nguyen Duy PhongBo mon Nhiem - HYD

DAN BAI1- ai cng2- Tac nhan gay benh3- Cac yeu to dch te4- Benh canh lam sang Xet nghiem 5- Nguyen tac chan oan6- Nguyen tac ieu tr7- Cac bien phap phong nga

1- ai cng: Plasmodium ky sinh trong hong cau

Bieu hien chnh: cn sot ret ien hnh (lanh run sot va mo hoi, het sot), kem gan to, lach to va thieu mau.

Ton thng c quan khac bien chng gay t vong: hon me, suy than, ha huyet ap

2- Tac nhan gay benh + 4 loai KST gay benh Sot Ret ngi: - Plasmodium falciparum - Plasmodium vivax - Plasmodium ovale - Plasmodium malariae + Plasmodium ky sinh 2 ky chu: muoi Anopheles (muoi on xoc) va ngi (hay ong vat co xng song) - Muoi: ky chu vnh vien (hu tnh) - Ngi: ky chu tam thi (vo tnh)

AnophelesAedesCulex

Chu ky cua KST SRMuoi Anopheles (muoi on xoc)trong c the ngiky sinh trung sot rettrong c the Muoi

Phan bo benh sot ret tren the gii

Phan bo benh sot ret tai Viet namSource : Mekong-malaria forum December 2001

3- Cac yeu to dch te (1): Phan bo benh: nhiet i: nong am, rng ram: muoi Anopheles sinh song.Tai VN: Tay bac, Thanh hoa, Quang nam, Tay nguyen, rng U minh, Phu quoc, Can gi.

Hien nay t le benh mi tang do di dan

3- Cac yeu to dch te (2): - Nguon lay: Ngi benh hoac ngi mang KSTSR the gia lanh (khong bieu hien LS).

- ng lay: muoi Anopheles la vat trung gian, lay t ngi ngi do truyen mau, dung chung kim chch.

- Nhom nguy c mac benh nang: Ngi mi vao vung SR lu hanh, thai phu, tre em: 6-9th., nghien x ke, BN ieu tr khong u lieu.

4- Benh canh lam sang XN(1): 4 thi ky: 4.1- U benh: muoi chch tr/chng: cn sot au tien (12-28 ngay), BN khoe hoac ch n lanh.

4.2- Khi phat khong ro.

4- Benh canh lam sang XN(2):4.3- Toan phat: Cn sot ret ien hnh: 3 giai oan

Ret run: 15-60 ph, met moi, nhc au, non oi, da lanh, mach nhanh.

Sot cao ot ngot T=39-40C, da kho, 1/2- 6gi.

Va mo hoi sau sot, T giam dan, am mo hoi, mach cham, da am, BN buon ngu, de chu.+ ac iem cn sot ret: trnh t 3 giai oan, chu ky tuy KST, gia cac cn BN cam thay khoe manh.

4- Benh canh LSXN(3): + BN ang cn sot ret: Tnh, , gan to, an au, lach to, da niem kem hong.+ Bien chng do P.falciparum SR ac tnh: the nao (hon me), suy than, vang da, thieu mau nang, xuat huyet, ha HA, tieu huyet sac to (tieu sam en), ha ng huyet, toan mau, lactate mau tang. 4.4- Hoi phuc:Sau vai tuan, BN co the t lanh benh (ieu tr lam dt cn sot sm).

Cac xet nghiem: + Cac xet nghiem thng quy: CTM, chc nang gan, than, Ion o mau, Xquang phoi, ng huyet.

+ XN ac hieu: Phet mau nhuom Giemsa, Paracheck (Parasight-F), Optimal test.Dng bao P.falciparum the nhan trong hong cauParacheckDng tnh

P.falciparum ky sinh trong hong cau ngi

5- Nguyen tac chan oan: Theo Bo Y te: 2 tr/hp chan oan SOT RET 5.1- Sot: T o nach 37,5C, sot thanh cn hoac lien tuc trong vong 3 ngay gan ay va phet mau thay co KST SR the vo tnh trong mau.

5.2- Neu khong co XN mau: - Sot: T nach 37,5 C, sot thanh cn hoac lien tuc trong vong 3 ngay gan ay. - ang hoac lui ti vung SR lu hanh trong vong 6 th gan ay. - Khong tm thay bat c ng/nhan nao khac gay sot.

6- Nguyen tac ieu tr (1): + Che o dinh dng, ngh ngi. + ieu tr ac hieu: thuoc khang KSTSR: 6.1- SR do P.vivax, P.ovale hoac do P.malariae : CHLOROQUINE: vien 250 mg[N1= 4 vien(10mg/kg); N2-N4 = 2 vien 10 vien] PRIMAQUINE: vien 13,2mg (7,5 mg base) [0,3 mg/kg x 5-14 ngay (CC: thai phu)]

6- Nguyen tac ieu tr(2):6.2- SR do P.falciparum : 6.2.1- SR nhe (sot ret cn): ARTESUNATE vien 50mg [ N1: 4mg/kg ; N2-N5: 2mg/kg] 6.2.2- SR nang (SR ac tnh): ARTESUNATE 0,06g TB hoac TM [ N1: 2mg/kg ; N2-N5: 1mg/kg] + Phoi hp Mefloquine (15mg/kg) hoac Doxycycline (100mgx2/ngx 5 ngay) hoac Artekin (DHA + Piperaquine) [ ngay au 2vien x2, sau o 2v/ng x 2 ngay 8 vien]

Artemisia annua

7- Phong nga:+ Khong ac hieu: Ve sinh moi trng, ngu mung + ac hieu: MEFLOQUINE vien 50 mg; 250 mg Tuan au= 3 vien chia 3 ngay, sau o 1v/ tuan. Sau khi ra khoi vung SR lu hanh, uong tiep trong 4 tuan: 1v/ tuan.

7- Phong nga (2): + Khi vao vung SR trong thi gian dai: CHLOROQUINE 0,25g: uong 3 6 thang au khi mi vao, 2 vien / tuan.

+ Thai phu: di 3 th. Khong dung ARTEMISININE, DOXYCYCLINE, PRIMAQUINE

+ Khong phoi hp QUININE vi MEFLOQUINE

Sot Ret?

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