Nghiên cứu đặc điểm dịch tễ học, lâm sàng bệnh tả và đề xuất các giải pháp phòng chống dịch ở việt nam

VAcdNCiNGHfi

2010

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TAI D6C L.4P C ^ NHA NUOC

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I

M.A S<5: BTSL, imS G/21

:;s» «BSB fM tri d l {*i: Vi6n Vf sinh dich tl Tniag ««ng
M --mm M m J
PGS. TS. !%By& Trla Hi&i

HIN6i-2010


BO KHOA HOC VA CONG NGHE

BO Y TE

DE TAI DOC LAP CAP NHA NUCC

BAO CAO TONG HOP
KET QUA KHOA HQC CONG NGHE DE TAI
NGHIEN CLTU DAC DIEM DICH TE HOC,
LAM S A N G BENH T A V A DE X U A T CAC GIAI P H A P

PHONG CHONG DICH d VIET NAM
MA SO: DTDL. 2008 G/21

Chii nhiem de tai

PGS. TS. Nguyen Tran Hien

PGS. TSTTfang ©irc Anh

Ban chu nhiem chuong trinh

Bp Khoa hpc va Cong nghe

Ha Noi-2010

Q[y(C) I lOiV


BOYTE
VIEN VE SINH DICH TE TRUNG VONG

CONG HOA XA HOl CHU NGHIA VIET NAM
Boc lap - Ty do - Hanh phijc
Hd Noi, ngdy

thdng

ndm 2010.

DAMH SACH TAC GIA THU'C HIEN
B E TAI KHCN CAP N H A NlTdC
(Danh sdch nhiing cd nhdn da ddng gop sang tao chit yen cho de tdi, du an
dugc sap xep theo thir ttr dd thoa thuan)
1. Fen de tai, du an: "Nghien ciiu dac diem dich te hpc, lam sang benh ta va de xuat
cac giai phap phong chong dich tai Viet Nam"
Mas6;

0TDL.2OO8 G/21

Thuoc:

- De tai doc lap cap nha nuoc ITnh vuc Y duoc

2. Thoi gian thuc hien : 01/2008- 3/2010
3. T6 chiic chii tri: Bp Y te
4. Co quan chu quan: Vien Ve sinh Djch te Trung ucmg
5. Tac gia thuc hien de tai tren gom nhiing ngucri co ten trong danh sach sau (khong
qud 10 ngudi):
So
TT
1.

Chirc danh khoa hgc, hgc vi,
ho vd ten
PGS. TS. Nguyen Tran Hien

To chirc cong tdc

Chieky
1,1

Vien Ve sinh dich te TtT

2.

TS. Nguyen Van Kinh

Benh vien Benh truyen
nhi€m Trung iroTig

3.

TS. Tran Nhu- Du-ong

Vien Ve sinh djch te TIT

4.

PGS. TS. Nguyen Binh Minh

Vien Ve sinh djch tl TIT

g y

44Z7/
VM^

JdL (
1

5.

Ths. Ngo Tuan CuoTig

Vien Ve sinh djch te T l /

6.

Ths. Tran Huy Hoang

Vien Ve sinh djch te TIT

/!Wff!fi^

7.

Ths. Le Thanh Huong

Vien Ve sinh djch te TlT

jmr--

8.

BS. Nguyen Quang Minh

Vien Ve sinh djch te TIT

ji^-^

9.

PGS. TS. Nguyen Thu Yen

Vien Ve sinh djch tl 1XS

10. PGS. TS. Phan Thj Nga
Chti nhiem de tai

Vien Ve sinh djch tl TU"
Thu tn

ti^^^^

- ^ ^ ^
J^^rfT^
chu tri de tai

.URUNG L
PGS. TS. Nguyin Tran Hien

PGSrTSflBang Dire Anh


BOYTE
VIEN VE SINH DICH TE TRUNG T/ONG

CQNG HOA X.i HQI CHU NGHIA VIET NAM
Doc lap - Tu- do - Hanh phiic
//ti jVpf. ngay

thdng nam 2010.

DANH SACH CAC TAG GIA THAM GIA THl/C HI^N
DK TAI KHCN CAP NHA NlTdC
1. Ten d6 tai, du an: "Nghi6n ciiu d^c diem dich te hpc. lam s^ng benh ta v^ de xuat
cac giai phap phong ch6ng djch t?i Vi$t Nam"
Masa:

0TDL.2OO8G/21

Thupc:

D^ tai dpc lap cap nha nuac ITnh virc Y duac

2. Thai gian thirc hien : 01/2008- 3/2010
3. 76 chitc chil ffi: Bp Y ti
4. Co quan chu quan: ViSn Ve sinh Dich te Trung uong
5. Tac gia tham gia thyc hien dl tai tren g6m nhiing nguoi co ten trong danh sach sau:

s6

Chiic danh khoa hgc, hgc vi,

TT

hg va tSn

Td chuc cong tdc

I.

BS. Vu Dinh ThiSm

Vien Ve sinh dich te Trung uoTig

2.

CN. Phjm Thj Cam Ha

Vien Ve sinh djch t€ Trung utfng

3.

BS. Ngo Huy Tii

Vien V | sinh djch te Trung uong

4.

Ths. BS. Nguyen C6ng Khanh

Vien Ve sinh djch tl Trung utmg

5.

BS. Ngu Duy Nghia

Vien Ve sinh djch te Trung uong

6.

Bs. Pham Dire Tho

Vien Ve sinh djch te Trung uong

7.

Ths. BS. Pham Quang Thai

Vien Ve sinh djch te Trung uong

8.

BS. Nguyen Hihi TSm

Vien Ve sinh djch te Trung uong

9.

TS. Hoang Van Tan

Vien Ve sinh djch te Trung uong

10. CN. Nguyin Hoai Thu

Vien Ve sinh djch te Trung uong

11. CN. Le Huy Hoang

Vien Vf sinh dich te Trung uong

12. Ths. BS. Ha Dinh Ngu-

Trung tam Y te du phong tinh Thanh Hoa


13. TS. BS. Trinh Duy Khang

Trung tam Y te du phong tinh Thanh Hoa

14. BS. Nguyen Van Hien

Trung tam V te dy phong tinh Ha Tinh

15. BS. Do Le Huan

Trung tam V te dy phong TP. Ha Noi

16. TS. Nguyen Nhat Cam

Trung tam Y te dy phong TP. Hii Nyi

17. TS. Le Thj Song Hu-ffng

Trung tam Y te dy phong TP. HSi Phong

18. TS. D6 Manh Cu'o'ng

Trung tam Y te dy phong TP. Hii Phdng

19. BS. VQ Hiru Viet

Trung tam Y te dy phong tinh Nam Djnh

20. Ths. Do Due Luu

Trung tSm Y te dy phong ti'nh Nam Djnh

21. PGS. TS. Nguyen Dire Hien

Benh vien Benh Nhi^t Ddi Trung uong

22. Ths. BSII. Nguyen HSng Ha

Benh viin Benh Nhift Ddi Trung vong

23. PGS. TS. Tnnh Thi Minh Lien

Bfnh vifn Bfnh Nhift Ddi Trung uong

24. PGS. TS. Ph?m Van Ca

Bf nh vifn Benh Nhift Ddi Trung uomg

25. Ths. BS. Nguyen Trung Cap

Benh vien Benh Nhiet Ddi Trung uong

26. Ths. Nguyen Tien Lam

Benh vien Bfnh Nhift Ddi Trung uong

27. PGS. TS. Nguyen Vii Trung

Bf nh vifn Bfnh Nhift Ddi Trung inmg

28. Ths. Dao Tuyet Trinh

Benh vien Benh Nhift Ddi Trung uong .^j;:

29. Ths. BS. T? Thi Dieu Ngan

Bfnh vifn Bfnh Nhiet Ddi Trung uong

30. BS CKII. Nguyen Minh Ha

Benh vifn Bfnh Nhift Ddi Trung uong

31. BS CKI. Doan Van Trung

Bfnh vifn Benh Nhift Ddi Trung uomg

Ths. BS. Tr4n Thi Phu-ong
32.

Thuy

Bfnh vien Bfnh Nhiet Ddi Trung irong

33. BS. Tran Thj Hai Ninh

Benh vifn Bfnh Nhift Ddi Trung uwng

34. Ths. BS. Trin Van Giang

Bfnh vifn Bfnh Nhiet Ddi Trung inmg

35. BS. Nguyen Thj Bich Dao

Bfnh vien Da Ichoa Dong Da, Ha Ngi

36. BS CKIL Ng. Thi Dire Hien

Bfnh vien Da khoa Sain Paul, Ha Noi


37. BS. Va Thuy Hanh

Benh vien 0a khoa Thanh Nhan, Ha Noi

38. BS. Nguyin Gia Thirc

Benh vien Da khoa Ha Ddng, Ha Noi

39. BS. Ha Hiru Tiing

Nfi

40. BS. Nguyen Quang Tuan

Benh viSn Bach Mai, Ha Noi

4!. BS. Nguyen Hanh Chung

Benh vien Da khoa tinh BSc Ninh

Benh vien Da khoa Bo Nong Nghiep, Ha

42. BS. Biii Due Long

Bfnh vien Da khoa tinh Hai Duong

43. BS. Le Trung Dung

Benh vien Da khoa Viet Tiep, Hai Phong

44. BS. Nguyen Hoai Nam

Benh vien Da khoa Quynh Luu, Nghe An

45. BS. Trkn Van Lugng

Bfnh vien Da khoa tinh Thanh Hoa

46. BS. LS Qui

Benh vien Da khoa tinh Ha TTnh

47. BS. Nguyin XuSn Hoa

Benh vien Da khoa tinh Nam Djnh

Chii nhiem de tai

PGS. TS. Nguyin TrSn Hien

Thu

ii tri de tai

PGS. TS. Dang Due Anh


Muc luc

DANH MVC CAC Ki Hl£U, CHU^ V I £ T T A T
DANH MVC CAC BANG

6
12

DANH MVC CAC HINH

18

DANH MVC CAC BifeU D 6

22

MdDAU

25

CHirONG 1. TONG QUAN
1.1. Tinh hinh nghien curu ngoai nirac lien quan den de tai
1.2. Tinh hinh nghien cihi trong nuac lien quan d^n dh tai
1.3. Dac diem sinh hpc ciia vi khuan td
1.3.1. DSc diem vi sinh vSt hpc
1.3.2. Chan doan vi khuSnta

29
29
32
34
34
37

1.4. Dac di6m dich tl hpc bSnh ta
1.4.1. Nguon truyen nhilm
1.4.2. Phucfng thiic liy truySn

1.4.3. Tinh cam nhiem
1.4.4. Cac yeu to nguy ca cua benh ta
1.5. Mpt so yeu to canh bao dich
1.6. Dac dilm lam sang cua benh ta
1.6.1. Tri$u chung cua b$nh ta
1.6.2. Chandoan
1.6.3. Dilu tri

38
38
39
42
43
44
45
45
46
46

1.7. Xiily 6 dich va dy phong benh ta

47

CHU^OfNG 2. VAT U ? U VA PHl/ONG PHAP NGHIEN ClTU
2.1. Dac diem dich te hoc va lam sang cua benh ta
2.1.1. Dac diem dich te hoc
2.1.1.1. Nghiin cuu mo td dgc diim djch te hoc cua vu dich
2.1.1.2. Xdy dung bdn do dich te binh td tgi Hd Noi bdng ung dung hy thu^t
he thdng dinh vi dia ly
2.1.1.3. Xdc dinh cdc yiu to nguy ca

2.1.1.4. Xdc dinh tyle ngudi lanh mang vi khudn td a mot so vung co dich
2.1.1.5. Nghien cuu xdc dinh su luu hdnh cua vi khudn td/E.coli o moi
trudng nu&c, thuc phdm va d0ng vdt thuy sinh a cdc viing co dich
2.1.1.6. Nghien cuu xdc dinh s\e thich ung cua vi khudn td trong mdm torn
thuong phdm

48
48
48
48
57
52
63
65
76


2.1.1.7. Xac dinh miic dg khdng thuoc khing sinh cita cdc chiing vl khudn ta
vd kha nang sinh dgc Id theo dia du vd thai gian
2.1.2. Dac diem Idm sdng cua b^nh td
2.2. D5c diem djch tl hpc phan tii ciia bfnh td vd dp dyng trong dy bdo djch
2.2.1. DJc dilm djch te hpc phan til
2.2.2. Cdc chi so cdnh bdo djch td
2.3. Nghign cihi hodn thien quy trinh chin dodn vd di^u trj bfnh td
2.4. Nghign ciiu hodn thifn quy trinh xii \j 6 djch vd dy ph6ng bfnh ti
2.5. Dao ditc nghien ciiu
CHirONG 3. K t T QUA
3.1. D?c di^m djch tl hpc vd lam sdng bfnh td
3.1.1. DJc dilm djch tl hpc
3.1.1.1. Dac diim dich ti hgc ciia dich lit nim 2007-2009

3.1.1.2. Xdy dung bdn id djch ti benh ta lai Hd N0i bing mg dvng kp thudt
hfthSng dinh vi dia ly (GPS)
3 1.1.3. Xdc dinh Ciic yiu l6 nguy ca ciia b^nh td
3.1.1.4. Xdc dinh ty le ngudi lanh mang vi khudn tadm0l s6 vitng c6 dich
3.1.1.5. Xdc dinh syt luu hanh cita vi khudn td/E.coli d mdi trudng nude,
ihijtcphdm vd dong vat Ibuy sinh a cac vimg cd dich
3.1.1.6. Nghien ciru xdc dinh su thich ling cua vi khuin Id trong mdt s6
logi mdu thicc phdm
3.1.1.7. Xdc dinh muc dq khdng thuoc khdng sinh cua cdc chung vi khudn td
vd khd nang sinh doc id theo dia duvd thdi gian.
3.1.2. Mo td ddc dilm lam sdng bfnh td a miln Bdc Vift Nam 2009
3.1.2.1. Bgcdiemchung cim benh nhdn vd mat so yeu to nguy ca lien quan
den khd ndng nhiem td
3.1.2.2. Bac diim ldm sdng cua cdc benh nhdn mdc bfnh Id
3.1.2.3. Dien bien cdc trieu chirng:

79
90
'"^
113
115
' "
' '^
1 '7
"^
IH
HI
136
166
169

175
178
185
185
190
193

3.2. Ddc diem dich tl hpc phdn tii va dp dyng trong dy bdo djch
197
3.2.1. D|c dilm dich te hpc phdn hi
197
3.2.1.1. Chiing vi khudn
797
3.2.1.2. Bdc tinh kliu Mnh
;p7
3.2.1.3. D^c tinh kiiu gen
jgg
3.2.1.4. MSi lien quan dich te hoc giiia cdc chung
203
3.2.2. Cdc chi s6 cdnh bdo djch
212
3.2.2.1. Phdthi^n V.cholerae 01, 0139 va NAG trong moi trudng nuac
212
3.2.2.2. Kit qud phdn lap vibriophage va xdc dinh Ogc diim hinh dang cia
vibriophage
2I6
3.2.2.3. Hinh dgng vibriophage quan sdt dudi kinh hiin vi diln tic
217
3.2.2.4. Kit qud phat hiinfllamentousvd kappa phage
220

3.2.2.5. Bi xudt chi s6 dv bdo
222


3.3. Hoan thien quy trinh chan doan va dieu tri benh ta
3.3.1. Danh gia ve viec bu dich duong uong trong vu dich ta 2007 - 2009 tai
mi§n Bac Viet Nam
3.3.2. Danh gia vl dich truyen doi voi benh nhan ta
3.3.3. Kit qua khang sinh do va danh gia ve sil dung khang sinh
3.3.4. Danh gia vl tho'i gian tieu chay, thai gian nam vien va thai gian con
vi khuan trong phSn
3.3.5. Danh gid vl anh hudng cua thuoc chong tieu chay
3.3.6. Danh gia vl cd bi$n phap hoi sure benh nhan nSng

223

3.4. Hoan thien quy trinh xu ly va du phong benh t&
3.4.1. Dinh nghTa, phat hien ca benli
3.4.2. Xir lyo dich
3.4.2 1 Doi vai benh nhdn
3.4.2.2. Tieu chudn cho binh nhdn ra viin
3.4.2.3. Xulyphdn vd chdt thdi cua binh nhdn
3.4.2.4. Xu ly moi truong xung quanh
3.4.2.5. Xuly nguon nuac
3.4.2.6. Doi v&i nguai tiep xuc
3.4.2.7. Kit thuc 6 dich td
3.4.2.8. Phong chong dich
3.4.2.9. Kho khdn vd tdn tgi.

249

249
250
250
251
251
253
254
254
255
256
256

223
227
231
237
243
247

CHU'ONG 4. BAN LUAN
258
4.1. Dac dilm dich te hpc va lam sang ciia benh ta
258
4.1.1. Dac diem dich te hoc cua benh ta
258
4.1.1.1. Dgc di&m dich ti hoc cita dich td ndm 2007 - 2009
258
4.1.1.2. Phdn bo benh nhdn theo giai
262
4.1.1.3. Phdn bo benh nhdn theo nhom tuoi

262
4.1.1.4. Phdn bo benh nhdn theo nghe nghiep
263
4.1.1.5. Xdy dung bdn do dich te benh td lgi Hd Noi bang ung dung ky thudt
hi thdng dinh vi dia ly (GPS)
264
4.1.1.6. Xdc dinh cdcyeu td nguy ca ciia binh td
265
4.1.1.7. Xdc dinh tyle nguai lanh mang vi khudn td dmot sd vungco dich
276
4.1.1.8. Xdc dinh su luu hdnh cua vi khudn td/E. coli a moi truong nuac,
thucphdm vd ddng vat thuy sinh d cdc viingco dich
278
4.1.1.9. Xdc dinh muc do khdng thuoc khdng sinh cua cdc chung vi khudn td
vd khd ndng sinh dpc td theo dia duvd thcri gian
283
286
A.X.I. Dac diem lam sang cua b$nh ta
4.1.2.1. Phdn bd cdc ca benh nhgp viin theo diadu
286
4.1.2.2. Phdn bo benh nhdn trong thai gian co dich
286
287
4.1.2.3. Dgc diim ldm sdng binh nhdn mdc td
4.1.3. Dgc dilm can lam sang benh ta
290
4.1.3.1. Vihuyithoc
290

41.31 vi sinh hoa
4.2. Ddc diem djch tl hpc phan tir vd dp dyng trong dy bdo djch
4.2.1. Ddc di6m djch tl hpc phan til
4.2.2. Cdc chi s6 canh bdo djch
4.2.3. Hodn thifn quy trinh chan dodn vd di^u trj bfnh td
4.2.3.1. Lieu phdp bil dich duang uong
4.2.3.2. Lieu phdp iruyin dich
•
4.2.3.3. vi so luQmg dich Iruyin trong 5 ngdy ddu.
4.2.3.4. Anh hucmg cua truyin djch din Natri vd Kali mdu
4.2.3.5. Vdn di sti difng khdng sinh va do nhay cdm cua vi khudn la vdi
khdng sinh
4 2.3.6. vi thai gian tieu chdy, thai gian ndm vien, thai gian cdn vi khudn
Irong phdn
4.2.3.7. Anh huang cua cdc thudc chdng tiSu chdy
4.2.3.8. Bdnh gid cdc bien phdp hoi siic bfnh nhdn ndng

^^'
292
^'^
2'*
302
^"^
•'''•'
•'"(J
307

4.3. Hodn thifn quy trinh xii ly vd dy ph6ng bfnh td

314

CHU'ONG 5. K^TLUAN
5.1. DJc di^m djch ti hpc vd lam sdng bfnh td
5.1.1. Dich tl hpc bfnh td ndm 2007 - 2009 tjii mien Bdc
5.1.1.1. Ddc diem dich te hoc ciia vu dich
5.1.1.2. Cdcyeu to nguy co vd nguon gdc vii dich
5.1.1.3. Ty le nguai idnh mang vi khudn td trong vu dich, 2007-2009
5.1.1.4. Sv luu hdnh ciia V.cholerae/E.coli a mdi trudng nuoc, thucphdmvd
cdc dpng vdl thtiy sinh tai cdc viing co dich
5.1.1.5. Mac da khdng thudc Ididng sinh vd khd ndng sinh d0c tS cua
cdc chiing vi khudn Id theo dia duvd thai gian
5.1.2. Dac diem lam sang benh td

^08
HO
312
313
316
316
316
316
316
3J7
317
317
318

5.2. Ddc dilm dich tl hgc phdn tii vd dp dyng trong dy bdo djch
5.2.1. Ddc di^m chiing vi khuk td Vift Nam gdy djch
5.2.2. Cac chi so cdnh bdo djch td

318
318
318

5.3. Hoan thifn quy trinh chan dodn va dilu trj bfnh td
5.3.1. Hodn thifn quy trinh chan dodn bfnh td
5.3.2. Hodn thifn quy trinh dilu hi bfnh td
5.3.3. Hodn thifn quy trinh xii 1^ 6 djch vd dy phdng bfnh td
5.3.4. Xdy dyng quy trinh sdn xuat khdng huylt thanh td djc hifu 6 qui mo
phdng thi nghif m

318
318
318
319
319

5.4. Xay dyng quy trinh sdn xudt bp sinh pham chan dodn nhanh vi khuan ta a
qui mo phong thi nghif m
319
5.5. Xay dyng tieu chuan co sd ciia huylt thanh khdng td djc hifu vd bp sinh
319
pham chin dodn nhganh vi khudn td


5.6. Sdn xudt 3000 mdu huyet thanh khdng ta moi loai: (da gid nhom Ol, da gid
319
nhom 0139, don gid Ogawa, don gid Inaba) dat tieu chudn co sd
5.7. San xudt dupe 100 bp sinh phdm chan dodn nhanh vi khudn ta mdi bp 1 test

djt ti6u chudn co sd
319
CHU'ONG 6.

KIEN NGHJ

TAI LIEU THAM KHAO

320
321

PHV LVC
Phu lyc 1:
Phu luc 2:
Phu luc 3:
Phu luc 4:
Phu luc 5:
Phu
Phy
Phu
Phu
Phu

330
QUY TRINH CHAN DOAN SCiM BENH TA
331
QUY T R I N H DIEU TRI BENH TA
337
QUY TRINH DU PHONG BENH TA
350

QUY TRJNH XL/LY 6 DICH TA
354
HUdNG DAN SIT DUNG CAC HOA CHAT KBIT TRUNG
CHLTA CLO TRONG CONG TAC PHONG C H 6 N G DICH
364
luc 6: PHIEU DIEU TRA B £ N H NHAN TIEU CHAY CAP TINH
NANG
368
luc 7: BQ CAU HOI NGHIEN ClTU BENH CHLTNG
373
lyc 8: SO D 6 C A C B U 6 C DIEU TRA NGHIEN CUU XAC DINH
380
YEU TO NGUY CO VA NGUON GOC VU DICH
lyc 9: BIEN B A N HQP v A KET LUAN CUA HOI D 6 N G Y DlTC 381
luc 10: G I A Y CHLTNG N H A N KIEM DICH DONG V A T NHAP KHAU
382

Phu lyc 11: B A N G MPN CHO 3 ONG 3 NONG D Q 1 ; 0 , 1 ; 0 , 0 1 ml

383

Phu lyc 12: B A N G MPN CHO 3 ONG 3 NONG D Q 0,1; 0,01; 0,001 gam.... 385
Phu luc 13: T A C H CHIET ADN VI BCHUAN B A N G P H U O N G P H A P

PHENOL - CHLOROFORM
387
Phu lyc 14: KET QUA KHOANH GL\Y K H A N G SINH KHUECH T A N CUA
CAC CHUNG V.cholerae Ol
388
Phu luc 15: KET QUA KHANG SINH DO CUA CAC CHtJNG V.cholerae 01

BANG KY THUAT MIC
389


DANH MVC CAC KY HI$U, CHU" VIET TAT

ADN

Acid desoxyribonucleotid
(Deoxyribonucleic acid)

AIDS

H6i chiing suy giam mien djch mSc ph^i

ATCC

American Type Culture Collection

BGLB

Canh thang BGLB
(Brilliant Green Lactose Bile)

BUI

Canh thang nao tim
(Brain Heart Infusion)

BN

Benh nhan

BS

Bac sy

Candida
CBTNNDQG

Nam Candida
Cac benh truyen nhiem va nhiet dai qu6c gia

CDC

Trung tam kiem soat dich benh Hoa Ky

CFA

Ta duoc Freunds hoan toan

CPU
CHO

Colony Forming Unit
Te bao tning chupt dat vang

CI

Khoang tin cay

(Centre for Diseases Control)

(Complete Freunds adjuvant)

(Chinese Hamster Ovary)

(Confidence Interval)
Cl.perfringens
CLSI

Clostridium perfringens
Vien Tieu chuan xet nghifm va lam sang
(Clinical and Laboratory Standards Institute)


Colloidal Gold

Chat keo vang

cs.

Cong ST
I

CT

Doc td ta
(Cholera Toxin)

DCA

Thach Deoxycholate Citrate
(Deoxycholate Citrate Agar)

DMEM

Dulbecco's Modified Agles Medium

DMSO

Dimethyl sulfoxide

E.coli

Escherichia coll

ELISA

Thii nghiem mien dich gan men

ER

Moi truong ER

FAO

To chiic nong luong quoc te

FDA

Co quan Quan ly thuoc va thuc pham, My

GAP

Thuc hanh nong nghiep tot

(Enzyme-linked Immunosorbent Assay)

(Food and Agriculture Organization)
(Food Drug Adminitration)

(Good Agricultural Practice)
GIS

He thong thong tin dia ly
(Geographic Information System)

GPS

He thong dinh vj toan cau
(Global Position System)

HA

Huyet ap

HAT

Hypoxanthine Aminopterin Thymidine

HAtt

Huyet ap toi thieu

HBV

Vi nit viem gan B
(Hepatitis B virus)

HEPES

Hydroxy Ethyl Pipeiazineethane Sulfonic acid


mv

Vi rut gay suy giam miln djch d ngudi
(Human immunodeficiency virus)

HT

Hypoxanthine Thymidine

HT

Huyet thanh

IFA

Td dup'c Freunds kh6ng hoin toan
(Incomplete Freunds adjuvant)

KHT

Khang huyet thanh

KHVDT

Kinh hien vi di?n tii

KL

Khuan lac

KS

Khang sinh

LB

Canh thang LB
(Luria Bertani)

LDC

Lysin decaborxylaza

LPS

Lipopolysaccharide

LST

Lauryl tryptose broth

MAb

Khang the don dong
(Monoclonal Antibody)

MIC

N6ng dp lie che t6i thieu
(Minimum Inhibitory Concentration)

MPN

So C the nhat
O
(Most Possible Number)

NAG

Vibrio khong ngung ket
(Non Agglutination vibrios)

NCCLS

Uy ban Quoc gia v6 Cac tieu chuSn can lam sa

(National Committee for Clinical Laboratory
Standards)

OD

Mat do quang hpc/Do due


(Optical Density)
OR

Ty suat chenh
(Odds Ratio)

ORS

Dung dich Oresol

PBS

Nuac muoi dem Phosphate
(Phosphate Buffered Saline)

PCR

Phan ling chuoi men
(Polymerase Chain Reaction)

PEG

Poly Ethylene Glycol

PFGE

Dien di xung truong
(Pulsed Field Gel Electrophoresis)

phage

Thuc khuan the

PTNVKDR

Phong thi nghiem Vi khuan duang rupt

R/I/S

Khang hoan toan/Khang trung gian/Nhay cam
(Resistance/Intermediate/Sensitive)

RAPD

Khuyech dai ngau nhien cac doan DNA da hinh
(Randomly Amplified Polymorphic DNA)

RPLA

Ky thuat ngung ket latex thu dong dao ngupc
(Revered Passive Latex Agglutination)

S. aureus

Staphylococcus aureus

SR

Moi truong SR

TAE

Dung dich dem TAE
(Tris Aeetat EDTA)

TBE

Dung dich dem TBE
(Tris Borat EDTA)

TCBS

Muoi mat Thiosulfate Citrat
(Thiosulfate Citrat Bile Salt)

TCP

Yeu to xam nhap


(Toxin Coregulated Pilus)
TCVN

Tieu chudn Vift nam

TCYTTG

To chtic Y te The gidi

TE

Dung djch d?m TE
(Tris EDTA)

TSKL

Tong so khuan l?c

TSVK

Tong s6 vi khuin

TTYT

Trung tam Y te

TTYTDP

Trung tam Y te Dy phdng

TW

Trung uang

V.cholerae

Vibrio cholerae

v.p.

vong/phiit

V.parahaemolyticus

Vibrio parahaemolyticus

v.v...

van van

VK

Vi khuan

VSDT

Ve sinh dich tl

VSDTTU

Ve sinh Dich te Trung ucmg

WHO

World Health Organisation
(T6 chijrc Y tl Thi giai)

YTDP

Y tl du phong

10


KY HIEU CUA MQT SO LOAI KHANG SINH
(theo WHO-NET)
AMP

Ampicillin

AXS

Ampicillin/Sulbactam

AUG

Augmentin

AZM

Azithromycin

CHL

Chloramphenicol

CEF

Cefiiroxime

CFX

Ceftriaxone

CIP

Ciprofloxacin

CL

Clindamycin

DOX

Doxycycline

GEN

Gentamicin

KAN

Kanamycin

LVX

Levofloxacin

NAL

Nalidixic acid

NOR

Norfloxacin

PIP

Piperacillin

STR

Streptomycin

SXT

Trimethoprim-Sulfamethoxazole

TCY

Tetracycline

DANH MVC CAC BANG
Bdng 2-1.

Trinh tu cdc cdp mdi dung cho phdn ung PCR xdc dinh vi khuan
'
...73
,.
ta

Bdng 2-2.

Cdc cap mdi dung trong phdn img PCR xdc dinh muc dp khdng
khdng sinh ciia cdc chung vi khuan td
°'

Bdng 2-3.

Dgc diim phdn bi?t typ sinh hpc co dien vd El Tor

95

Bdng 2-4. Mqt sd cap mdi sic dung trong ky thuat PCR xdc dinh dac tinh
CTX cassette
^*
Bdng 2-5.

Trinh tic mdi trong ky thudt PCR xdc dinh ddc tinh CTX.

98

Bdng 2-6.

Trinh tu cdc moi sic dung trong ky thugt RAPD

Bdng 2-7.

Trinh tu mdi sir dung trong ky thudt PCR gidi trinh tu gen ctxB
103

Bdng 2-8.

Trinh tie cdc cap moi dp dung trong nghien cuu vibriophage.. Ill

Bdng 3-1.

Phdn bd theo dia du cdc trucmg hap mdc td mien Bdc, Viet Nam,
2007-2009
125

Bdng 3-2.

Thai gian keo ddi cdc dat dich trong vu dich ndm 2007 - 2009
130

IOO

Bdng 3-3. Kit qud cdc chiim ca benh td ldm sang tgi Hd Noi xdc dinh bang
phdn mem STatScan
135

Bdng 3-4. Ket qud dieu tra dich te 4 ca binh ddu tien trong cdc d0 dich tit
2007-2009
137
Bdng 3-5.

Ty le benh nhdn dn cdc thuc phdm cd nguy ca trong vdng 5 ngay
truac khi khai phdt cua cdc trudng h(ifp mdc td trong 2 tuan ddu
cua cdc dot dich
138

Bdng 3-6. Ty le dn cdc thuc phdm co nguy ca trong vong 5 ngay truac khi
khai phdt bfnh cua cdc truong hap mdc td d giai dogn sau cua
cdc dat dich
jsg

12


Bdng 3-7. Ket qud xet nghiem mdu nuac cdc logi trong 2 tudn ddu cua cdc
dot dich td til ndm 2007 -2009
140
Bdng 3-8. Kit qud xet nghiem mdu nude cdc logi a giai dogn sau ciia cdc
dot dich td tic ndm 2007-2009
141
Bdng 3-9. Ket qud xet nghiem mdu nude dinh ky tie thdng 4/2008 den thdng
3/2009
142
Bdng 3-10. Kit qud xet nghiem mdu rau tham, rau sdng tgi cdc cira hdng
lien quan din benh nhdn td trong 3 dat dich 2007 - 2008. 143
Bdng 3-11. Kit qud xet nghiem mdu rau tham, rau sdng tgi cdc cha ddu mdi

144
Bdng 3-12. Kit qud xet nghiem mdu rau tham, rau sdng tgi cdc trgng
146
trgi/vudn vg viing chuyen canh rau
Bdng 3-13. Kit qud xet nghiem mdu rau tham, rau sdng dinh ky tit thdng
4/2008 din thdng 3/2009
147
Bdng 3-14. Kit qud xet nghiem mdu mdm tdm tgi cdc ciia hang lien quan din
binh nhdn td
148
Bdng 3-15. Kit qud xet nghiem mdu mdm tdm tgi cdc cita hdng, chg ddu
148
mdi, casd sdn xudt
Bdng 3-16. Kit qud xet nghiem cdc mdu binh phdm tgi mot sd cira hdng thit
149
cho trong vu dich ndm 2007 - 2009
Bdng 3-17. Hinh thiec cung cdp thit chd cho cdc cua hdng

150

Bdng 3-18. Tinh trgng chd khi mang din cdc cua hdng

150

Bdng 3-19. Kit qud xet nghiem cdc mdu nghi ngd

151

Bdng 3-20. Kit qud lay mdu khu giit md chd vd xet nghiem

154

Bdng 3-21. Ty li mdu ducmg tinh theo diim lay mdu

155

Bdng 3-22. Kit qud xet nghiem mdu phdn chd lay qua tdm bdng ngody hdu
mdn cho tai xd Thdnh Loc
156


Bdng 3-23. Kit qud xet nghiim cdc mdu binh phdm khac tgi xa Thdnh U"^
156
Bdng 3-24. Dgc diim vi ddi tugng vd dia diim nghiin cuu binh chiing... 162
Bdng 3-25. Cdc dgc diim nhdn khdu hgc ciig nhdm binh vg nhdm chung. 163
Bdng 3-26. Mgt sd yiu td nguy ca liin qugn vdi dich tg trong phdn tich da
biin
'64
Bdng 3-27. Biiu hiin ldm sdng cita cdc nhdm chd thitc nghiim

165

Bdng 3-28. Thai gian ddo thdi vi khudn tg ra phdn cua chd sau khi gdy
nhiim
'"6
Bdng 3-29. Ty li ngudi lanh mang vi khudn td d trong 6 dich cd ngudi lanh
mang trimg
167
Bdng 3-30. Kit qud xet nghiim vi sinh vdt trong mdu mdm tdm thucmg phdm
175

Bdng 3-31. Kit qud nudi cdy phdn ldp trin mdu mdm tdm thii nghiim

/ 76

Bdng 3-32. Thdng tin vi sd lugng vd dia diem cua chung nghien cuu
179
Bdng 3-33. Kit qud khoanh gidy khdng sinh khuich tdn ciia cdc chiing V.
cholerae 01
180
Bdng 3-34. Kit qud khdng sinh do cua cdc chung V.cholerae Ol bdng ky
thudt MC
181
Bdng 3-35. Kit qud khdng sinh do vd gen khdng khdng sinh cua cdc chung vi
khudn td
182
Bdng 3-36. Kit qud dinh lugng dgc td td cua cdc chung V.cholerae Ol.... 184
Bdng 3-37. Phdn bd tudi cua cdc binh nhdn mdc td miin Bdc, Viit Nam,
2009
185
Bdng 3-38. Phdn bd vi nghi nghiip

186

Bdng 3-39. Phdn bd vi dia du hdnh chinh

187

Bdng 3-40. Ty U binh nhdn cd binh mgn tinhphdi hgp

188

Bdng 3-41. Tylicdc logi thicc dn nghi ngd truyin binh

189

Bdng 3-42. Thdi gign nhdp viin tie khi cd triiu chiing ddu tiin

191

Bdng 3-43. Cdc biiu hiin ldm sdng khi nhgp viin

192

Bdng 3-44. Ty li binh nhdn cd cdc bien chimg

193

Bdng 3-45. Thay dd ve huyit hgc d binh nhdn td

194

Bdng 3-46. Thay do creatinin mdu a binh nhdn td

195

Bdng 3-47. Thay ddi vi khi mdu a binh nhdn td

196

Bdng 3-48. Thay ddi Kali mdu d binh nhdn td

196

Bdng 3-49. Ket qud dinh typ sinh hgc

198

Bdng 3-50. Trinh tu cdc a xit amin trong tiiu phdn B cua dgc td td tuang ting
vdi trinh tugen ctxB
Bdng 3-51. Kit qud NAG phdn ldp tic mdu nude be mg
Bdng 3-52. Kit qud phdn lap Vibriophage tie mdu ggc tdm

211
215
276

Bdng 3-53. Ket qud kiiu hinh vibriophage tgi Hdi Phdng vd Thdi Binh (Quan
sdt dudi KHVDT)
Bdng 3-54. Kit qud phdt hiinfsl,fs2 tgi Hdi Phdng vd Thdi Binh

218
221

Bdng 3-55. Kit qud phdt hiin kappa phage tgi Hdi Phdng vd Thdi Binh... 222
Bdng 3-56. Ty le benh nhdn duac bii dich trudc khi din viin

223

Bdng 3-57. Ty li binh nhdn sie dung cdc biin phdp bil dich tgi nhd

224

Bdng 3-58. Lien quan giiig bii dich tgi nhd vd natri mdu khi vdo viin

225

Bdng 3-59. Lien quan giiig bii dich tgi nhd vd kgli mdu khi vdo viin

225

Bdng 3-60. Anh hudng cua bii dich dudng udng trudc khi vdo viin vd ty li
sdc

226

Bdng 3-61. Lugng ORS chi dinh hdng ngay trong binh viin

226

Bdng 3-62. Tuang quan dich truyen vd ORS udng

227


Bdng 3-63. Sd lugng dich truyin dich trong gid ddu

2^'

Bdng 3-64. Sd lugng dich truyin trong ngdy ddu

2^°

Bdng 3-65. Sd lugng cdc logi dich truyin trong cdc ngdy

228

Bdng 3-66. Anh hudmg cua truyin dich din Natri mdu

229

Bdng 3-67. Anh hudng ciia truyen dich din kali mdu

229

Bdng 3-68. Anh hudng ciia truyin dfch din pH mdu binh nhdn cd sdc

230

Bdng 3-69. Anh hudng ciia truyin d\ch din pH mdu binh nhdn khdng s6c230
Bdng 3-70. Ty li binh nhdn dugc diing thudc trudc khi vdo viin.

231

Bdng 3-71. Mice dg nhgy cdm vdi khdng sinh dua vdo MIC (E-test)

233

Bdng 3-72. Kiiu di khdng cua V.cholerae Ogawa ndm 2008.

234

Bdng 3-73. So sdnh su khde biit vi ty li nhgy cdm vdi khdng sinh cOa cdc
chiing V. cholerae Ol Ogawa bdng 2 phuang phdp
235
Bdng 3-74. So sdnh su khde biit vi ty li trung gian cua cdc chiing
V.cholerae Ol Ogawa bdng 2 phuang phdp
236
Bdng 3-75. So sdnh su khde biit vi ty li khdng ciig cdc chiing V.cholerae Ol
Ogawa bdng 2 phuang phdp
236
Bdng 3-76. Thdi gian hit tiiu chdy sau khi dimg khdng sinh

237

Bdng 3-77. So ngdy diiu tri di cdy phdn benh nhdn trd ve dm tinh

238

Bdng 3-78. Thdi gian sgch vi khudn td sau khi dimg khdng sinh

239

Bdng 3-79. Anh hudng cua dg tudi din thdi gian ndm viin

239

Bdng 3-80. Anh hudng cua do tudi din thdi gian hit tiiu chdy

240

Bdng 3-81. Anh hudng cua dg tudi din thai gian cdn vi khudn trongphan240
Bdng 3-82. Ty li binh nhdn td cd biin chiing

240

Bdng 3-83. Anh hu&ng cOa gidi din thai gian ndn viin, thdi gian cdn tieu
chdy, thdi gian cdn vi khudn td trongphdn
241


Bdng 3-84. Anh hudng cug gidi din ty li biin chimg

242

Bdng 3-85. Anh huang cua binh nin din thdi gian cdn tieu chdy

242

Bdng 3-86. Ty li binh nhdn diing thudc chdng tieu chdy trudc khi den viin
243
Bdng 3-87. Anh hudng ciia thudc chdng tieu chdy den tinh trgng mdt nude
244
Bdng 3-88. Anh hudng cua thudc chdng tieu chdy den thai gian ndm vien
245
Bdng 3-89. Anh hudng cua thudc chdng tieu chdy din thdi gian tieu chdy 245
Bdng 3-90. Anh hudng ciia thudc chdng tiiu chdy din thai gian cdn vi khudn
td trong phdn
246
Bdng 3-91. Anh hudng cua thudc chdng tieu chdy din biiu hien chudng

bung
246
Bdng 3-92. Ty li benh nhdn cd diin biin ndng

247

Bdng 3-93. Ty li binh nhdn cd suy thdn

247

Bdng3-94. Cdc biin phdp xie tri suy thdn

248

Bdng 3-95. Xu tri toan hda mdu sau khi binh nhdn da thoat sdc

249

Bdng 3-96. Xu tri hg kali mdu

249


DANH MVC CAC H!NH
Hmh 1-1.

Phdn bd dich td trin thi gidi ndm 2008

^2

Hinh 1-2. Sa dd cdu true ciia CTX cassette

^6

Hinh 1-3.

37

Sa do cdu true ciia RSI va RS2

Hmh 1-4. Su luu hdnh ciia vi khudn td d mdi trudng vd d ngudi

39

Hinh 2-1.

Sa dd thirc hiin phuang phdp MPN.

69

Hmh 2-2.

Cdch dgc kit qud phuang phdp MPN.

70

Hinh 2-3.

Khudn lgc E.coli tren mdi trudng Endo

71

Hmh 2-4.

Tinh chdt sinh hda ciia E.coli

72

Hmh 2-5.

Sa dd quy trinh cdy thic nghiim sye thich ung cua vi khudn td
trong mdm tdm
79

Hinh 2-6.

Kit qud ducmg tinh cdc miic dg

Hinh 2-7.

Chudn bi mdu ggc tdm

104

Hinh 2-8.

Hinh dnh dgt vd thu thgp mdu ggc tdm

108

Hinh 2-9.

Sa do phdn ldp vibriophage theo phuang phdp cua Shimidori 109

Hinh 3-1.

Bdn do phdn bd cdc ca binh td tgi Hd Ngi trong 2 tudn ddu tiin
ciia Vlf dich 2007 - 2009
120

Hinh 3-2.

Bdn do cdc tinh cd binh nhdn mdc td theo tiing d0 dich ndm
2007-2009.
126

Hinh 3-3.

Bdn do dia diim thttc hiin nghien ciiu

Hinh 3-4.

Bdn dd phdn bd cdc ca binh td tgi Hd Ngi theo kit qud GPS
trong thdi gian ddu cua vu dich 10/2007 - 04/2008
752

Hinh 3-5.

Bdn do phdn bd mice do tgp trung cdc ca binh td tgi Hd Ngi theo
kit qud GPS trong thdi gian ddu cua v^ dich 10/2007 - 04/2008

133

18

86

131


Hinh 3-6. Bdn do phdn bd cdc chiim ca binh td ldm sdng tgi Hd Ndi sti
dung phdn tich khdng gian thdi gian ddu cua vu dich 10/2007 04/2008
134
Hinh 3-7. Bdn dd phdn bd cdc ca binh td tgi Hd Ngi theo quy md
xd/phudng dgt dich td 1 vd 2
135
Hmh 3-8.

Bdn do phdn bd cdc ca binh td tgi Hd Ngi theo quy md
xa/phudng dgt dich td 3 vd 4
136

Hinh 3-9.

Bdn dd mgng ludi phdn phdi thit chd lir mdt Id md tgi
Duang Ndi vd su xudt hiin cdc ca benh td tren dia bdn Hd Ngi
154
ndm 2008.

Hinh 3-10. Trai nudi chd tap trung tgi Thanh Lgc, Hdu Lgc, Thanh Hda. 157
Hmh 3-11. Bdn do dudng nhdp khdu chd tie Lao vdo Viit Nam qua ciia khdu

Cdu Treo, Hd Tinh
159
Hinh 3-12. Xe chd chd ciia cdng ty nhgp khdu tgi Trgm kiim dich ddng vdt
Cdu Treo, Hd Tinh
160
Hinh 3-13. Thuyin chuyin chd nhgp khdu vdo ndi dia Viet Nam

161

Hinh 3-14. Chuyin chd tiexe cita Lao sangxe ciia Viet Nam

161

Hinh 3-15. Chd mdc td diin hinh, mdt nude vd chit sau khi gdy nhiem thuc
nghiim
165
Hinh 3-16. Kit qud diin di sdn phdm phdn ting PCR da mdi phdt hiin vi
khudn td trong mdm tdm
174
Hinh 3-17. Kit qud diin di sdn phdm phdn iing PCR da mdi phdt hiin vi
khudn td trong mdu mdm tdm thienghiem
178
Hinh 3-18. Kit qud dgi diin cdc gen khdng khdng sinh vd yiu td SXT ciia vi
khudn td
182
Hinh 3-19. Phdt Men gen ctxA bdng 1^ thudt PCR

184

Hinh 3-20. Hinh dnh ky thudt RPLA xdc dinh ndng dd ddc td td cda

V.cholerae Ol
184