Cau 73: khnag gay benh cua xoan khuan G.Mai

Vk jang mai gay benh jang mai. Benh chi gap o ng. vk xam nhap vao co the chu yeu qua do txuc truc tiep qua dg sduc. 1 so it trg hop qua niem mac mat, mieg, da bi xay xat va truyen mau. Lsang co 2 the:

1/ G.Mai mac phai:co the lay qua niem mac mat, mieg or da bi say sat or dug cu bi nhiem nhug nhug trg hop nay hiem. viec lay truyen chu ye do txuc truc tiep qua dg sduc. xoan khuan vao co the, gay benh va benh dien bien qua 3 thoi ki:

a) G.Mai tky I: tu 2-10 tuan sau khi nhiem vk.

benh tich chu yeu la vet loet "sang" (chancre) o bo fan sduc; vet loet ko ngua, ko dau, loet nog va chan cug. kem theo co hach ran o vug lan can. trog dich tiet cua vet loet va dich trog hach co nhieu xoan khuan. Day la tky lay lan manh. Co dtri hay ko thi vet loet cung khoi va k de lai seo. tu hach Bach Huyet vk vao mau.

b) G.Mai tky II: tu 2-12 tuan sau khi co sang.

- bieu hien: da dang, co the nhuc dau, sot nhe, rung toc...va dien hinh la cac not hog ban(roseola) xh o tren da o bat ki vi tri nao cua co the nhug hay gap nhat o co. cac mun loet vug hau mon sduc, viem mang nao, nhan cau., gan, cau than, viem xg... G.Mai II tu khoi

c) G.Mai tky III: Gdoan G.Mai I, II goi la G.Mai som, khnag lay nhiem rat lon. 30% so trg hop G.Mai som se tu khoi hoan toan ko can dtri. so con lai se tien trien cham sau vai nam den vai chuc nam voi cac bieu hien lsang la cac ton thg dang Gom (gumma) o da, mag xg, gan, tkinh TU

ton thg he thog tim mach. hiem thay vk trog Gom. Day goi la G.Mai muon

2/ G.Mai bam sinh (GMBS): Me mag thai bi G.Mai co the truyen vk cho thai nhi qua rau thai trog 10-15 tuan dau tky thai nghen. Hau qua gay xay thai, thai chet luu, de non or dua tre sinh ra da mac benh G.Mai (GMBS): mu, rang Hutchinson...

- co 2 the GMBS: + GMBS som: xh ngay khi sinh ( 2 tuoi voi cac bhien ton thg da, niem mac, viem tuy xg, thieu mau, gan lach to...

+ GMBS muon: xh sau 2 nam voi cac bhien viem nhan cau co the gay mu, di tat rang, diec do ton thg day 8, G.Mai tkinh, viem tkinh TU gay liet, mui hinh yen ngua, diec...

3/ Phong: benh k co vacxin nen phog ko dac hieu la chinh: bien phap phog benh tot nhat la co loi song lanh manh, chung thuy, thanh toan nan mai dam. Phat hien benh nhan som, nganchan tiep xuc, dtri som va triet de.

4/ Dieu tri: - Benzathine penicillin 2,4 MUI tiem bap

lieu duy nhat cho G.Mai duoi 1 nam.

- Doi voi G.Mai tkinh: penicillin G 20 MUI/ngay x 2-3 tuan, tiem tinh mach

Co the gap pu khi dtri G.Mai II, G.Mai muon khoag 12h sau khi batdau dtri( b.nhan dau dau, buon non, sot nhe...( thg tu khoi (co the do vk chet ( gphong noi doc to ( tac dog len tk TU

Cau 74: cac ky thuat chan doan vk giang mai, ud

*/chan doan truc tiep

-tim xoan khuan GM chi ap dung cho GM tki 1

-lay dich o o loet,hach... soi tuoi tren nen kinh hien vi nen den hay nhuom fantna-tribondeau

-ud:neu ket qua(+ ro = ket hop tien+lam sang(co the ket luan dc benh

*/chan doan gian tiep

-tim khang the tronbg huyet thanh benh nhan, ap dunh cho giang mai tji 2 va 3

-gom pu dac hieu va pu ko dac hieu

1/phan ung ko dac hieu

-dung KN ko dac hieu la chat lipoid chiet xuat tu tim bo co cau truc gan giong lipoid cua xoan khuan GM -(phat hien regain(1 chat

-pu ket tua:VDRL (cai tien PPR), pu giot mau citochol

-pu ket hop bo the:

-ud:vi Kn ko dac hieu( co the (+ doi voi 1 so benh khac nhu sot ret, than hu nhiem mo,phu nu co thai >7 thang(ko chinh xac( can lam 2 lan de ktra ket qua

2/pu dac hieu:dung khang nguyen la xoan khuan GM

-pu TPI:pu bat dong xoan khuan GM.tron 1 giot mau cua benh nhan voi 1 giot xk GM lay tu tinh hoan tho bi viem quan sat duoi kinh hien vi nen den. neu co KT dac hieu vk bi bat dong

+/kho khan nhung(+ 100% o benh nhan GM bam sinh va Gm thoi ki 3 ko dieu tri

-pu FTA:pu mien dich huynh quang gian tiep. tron vk da bi chet voi huyet thanh benh nhan +

a-globulin-khang Kt gan huynh quang. neu KT dac hieu vk se phat sang duoi kinh hien vi huynh quang

ud: dac hieu + rat nhay

+pu TPHA:pu ngung ket hong cau thu dong: dung Kn tu xoan khuan Gm hap phu tren be mat te bao hong cau. do nhay cao