NG C THC N

PHM TH NGC THO

I. Nguyn nhn: 1. Thc phm b nhim vi khun, nhim siu vi, k sinh trng. 2. Thc phm c cha c cht ph gia thm nh ha cht bo qun, ha cht to mu, to mi, to v 3. Thc phm t n c cha c cht t nhin hoc do b nhim cc c cht do nhim mi trng. Nh vy, khi ni n ng c thc phm ta phi i chn on bao gm c 3 nguyn nhn trn, v phi tm xem c cht l g. Khi ni n nhim trng thc phm, ch l mt phn trong ng c thc phm. Cht c c trong tht, c n thi, ngi ta gi l cht putrescine v cadaverinem, l cht chnh gy ra ng c thc n do vi khun gy ra. Khng phi vi khun nhim vo thc n gy ra triu chng au bng, tiu chy, i, m do vi khun bin i t thc phm. C, tht c cu to bi nhng acid amin, R (COOH) (NH2), v gc R- thay i khc nhau cho ra nhiu loi acid amin khc nhau. Chnh vi khun bin i nhng acid amin thnh amin. Cc amin ny l c cht gy ra tnh trng ng c. Do , i khi ta nu chn thc n k khng c ngha l git cht vi khun, m nhng cht c vn cn v khng b hy bi nhit . Khi ta em cc mu tht c ny em lm xt nghim tm vi khun th kt qu m tnh, nhng vn c triu chng ng c xy ra nh dau bng, tiu chy, i. Mi loi amin s gy ra nhng triu chng khc nhau. Do , khi n c tht n khc nhau s b cc triu chng khc nhau ngoi cc triu chng thng thng au bng, tiu chy, nn i. Nh vy, bn cnh 2 cht c chnh ph thng l putrescine, cadaverine ca c tht n thi, cn c nhiu loi amin c khc nhau v c mi cng khc nhau ty loi c tht. Tm li, khi n protide b nhim trng th c 2 yu t gy bnh: - vi khun. - i cht do vi khun bin i protide to ra.. II. Ng c thc phm b nhim trng: Nhn chung, ng c thc phm loi ny thng l loi ng c nh, t khi bnh trong 24 gi. Tuy nhin, cng c nhng trng hp nng v c th t vong vi cc loi vi khuan nh Listeria, Samonella, Botulus, Escheria coli. Cc vi trng khc nh Crytosporidium v cychospora cng c th gy ng c nng cho nhng ngi c sc khng thp (tr em, ngi gi, HIV). Siu vi cng thng gy ng c thc phm hng lot. 1. C ch: C ch gy ng c l gy vim d dy rut bi vi khun hay bi c t vi khun. c t ny c th c hnh thnh trong thc phm trc khi n do k thut ch bin, tn tr trong iu kin km v sinh, thiu cn thn, hoc c t cng c th sinh ra khi vi khun d c n vo ng rut. Liu lng gy ng c thay i ty theo loi vi khun mnh, yu, nng c t trong thc phm, v sc khng ca c nhn ngi bnh. Mt vi loi c t vi khun nh c

t ca vi khun Staphylococ khng b hy hoi bi nhit cao nn d nu chn vn b ng c khi n. 2. Triu chng: Thng thi gian bnh t 2 gi n 3 ngy trc khi triu chng biu hin. Vim d dy rut: nn i, au qun bng, tiu chy. C th dn n ri lon nc, in gii nht l tr em, ngi gi. St, tiu ra mu, phn c bch cu khi b nhim vi khun nhiu. Nhim trng ton thn: C th xy ra vi cc loi vi khun Escheria Coli, Samonella, Shigella, Listeria. Vi Listeria: c th gy nhim trng ton thn nng, gy vim mng no nht l ngi gi, gim sc khng. Ph n c thai d b triu chng nh nhng cng c th gy nn nhim trng nng cho thai nhi, c th dn n cht thai nhi, hay vim mng no thai nhi. Vi Shigella v E. Coli 0157H7: gy triu chng vim xut huyt i trng. C th bin chng nng ure huyt cao v tn huyt, suy thn, t vong, nht l ngi gi, tr em, gim sc khng. 3. Chn on: Vic chn on ng c thc phm rt kh phn bit vi bnh nhn nhim siu vi ng rut. Ta ch chn on c ng c thc phm khi no c mt s ng ngi cng n mt loi thc n no , v c thi gian bnh ngn sau 1-2 gi. Trc mt trng hp bt k c vim d dy rut, ngoi ngh n do vi khun gy ra, m ta cng phi ngh n ngun thc phm khc nh n bin, nm c, botulus Xt nghim phn tm thy bch cu, iu ny c ngha rng c vi khun sinh sn tn cng ng rut. Cc xt nghim ch mang tnh tng qut ch khng c tnh c hiu: Cy phn: C th gip ta bit phn bit vi khun loi no.. Cy mu, dch no ty; c th gip tm ra vi khun nht l loi Listeria. Cy thc phm: Mc ch l tm vi khun no . Cc xt nghim thng quy khc theo di tnh trng nhim trng, ri lon in gii. 4. iu tr : - Cp cu v h tr: B nc, in gii (do i, tiu chy nhiu) - Thuc c hiu: khng c antidote. - Nu c vi khun sinh sn gy nhim trng, cy phn c vi khun: ta s dng khng sinh c tr. Nu nh khng cy phn hoc cha c kt qu cy phn, ta c th dng khng sinh nh ciprofloxacin hay trimethoprim-sulfamethoxazole (Bactrim). - Ph n c thai nu n phi thc phm c nhim Listeria th d c triu chng nh cng phi iu tr phng nga cho nhim trng thai nhi. Khng sinh c hiu cho Listeria l Ampicillin, c th km theo Gentamicin nu triu chng nng.

Nhng vi khun thng gy ng c thc phm Vi khuan Bacillus Cereus bnh 1-6h (i) hay 8-16h (tiu chy) 1-2 ngy 6-16h 12-72h 9-32h 12-36h 1-7 ngy 1-6h 8-30h 3-7 ngy C ch Loi thc phm Do c t trong thc phm v Go, bt sy kh hm rut nng. Nhim trng Nc ung, tip xc c t trong thc phm, v Tht, ph sn ca tht gia rut sc c t trong rut Nc ung, tht Nhim trng Sa, b, fromage Nhim trng Tht, sa, bnh, nc ung, tip xc. Nhim trng Nc, rau, qu c t trong thc phm Tht ngui, tm, c, trng, sa, b, bnh kem, Nhim trng + c t rut Nghu, s, nc Nhim trng Nc, tht, sa, b, u h

Camylobacter Clostridium perfringens E. Coli Listeria Samonella Shigella Staphylococcus Aureus Vibrio parahemolyticus Yersinia Enterocolitica

- Bacillus Cereus: kh ph bin, sng dng bo t, gy ra 2 dng lm sng: dng i ma do c t trong thc phm, khng b hy bi nhit cao hay dch v, v dng tiu chy. C 2 dng u khng st. Loi ny thng nh v t khi. - Staphylococcus Aureus: y l loi vi khun gy ng c ph bin thc n ph bin nht. Vi khun ny sng nhit 30 40oC, v tit ra c t nhit ny trong thc phm, sau khi vo rut. Triu chng ko di khong 20h vi nn i d di, tiu chy, au bng, khng st. Ch cn liu 1g/100g thc phm gy triu chng ng c. Chn on dng tnh khi khi xt nghim o c 1ng/1g thc phm. iu tr h tr l chnh. - Clostridium Perfringens: tit ra c t trong thc phm v rut. c t ny gy vim rut v gy tn huyt. Tiu chy nc l chnh, khng i, khng st, t au bng. T khi sau 24h. - Shigella: thot u tiu chy nhiu, sau 24 h c tiu ra mu, mt nhiu. Tr em c th c co git. Loi Shigella Sonnei gy t vong cao, loi Shigella Dysenteriae gy t vong thp. xt nghim trong phn c bch cu cao. iu tr vi khng sinh TMP-SMZ (Bactrim, Cotrim), v ampicillin. Nu Ampicillin v TMP-SMZ b khng, ta c th cho ceftriaxone, Flouroquinolone (ciprofloxacin, oxflocacin), azithromycin. Nhm flouroquinolone khng cho ngi di 18 tui. - Samonella: thng c loi b st nh rn, trng, sa.. C 4 dng lm sng: dng vim ng rut, nhim trng ton thn vi nhim trng khu tr ngoi ng rut, bnh v rut c

km st, dng khng triu chng. iu tr vi Cloramphenicol khi cha c khng sinh . Dng Ampicillin hoc TMP-SMZ sau khi c khng sinh chng minh c hiu qu. - Yersina Enterocolitica: vi khun ny sng nhit ca t lnh. Tr em <5 tui thng b vim rut tiu chy, c khi c mu, st, au bng, i, da ni , au nhc khp. tr ln c th c triu chng vim hch bch huyt bng, i khi nhm ln vi vim rut tha. ngi ln i khi c nhim trng ton thn, hi chng Reiter, vim cu thn, abcess gan, vim a khp, i khi c th lm thng rut dn n vim phc mc. Vi khun Yersinia hp thu cht st lm cht dinh dng pht trin, nn nu bnh nhn ang ung thuc st s lm vi khuan pht trin mnh hn. Dng phng php xt nghim huyt thanh chn on. iu tr vi bnh nng cho tetracycline v cho TMP-SMZ cho trng hp va v nh. - Campylobacter: y l loi ng c ph bin nht. tiu chy c nc hay c mu km st, i, au bng, nhc u, co khi dau nhc c, au khp, ni da. Kh phn bit vi nhim Shigella. Bnh ko di 3 -4 ngy. C khi bin chng co git ton thn, vim mng no, xut huyt mng no nu ngi c sc khng yu. Xt nghim tm vi khun. iu tr c th cho erythromycine. 5. Ng c thc phm c vi khun Botulus: Vi khun Clostridium Botulinum l loi vi khun ym kh, c bo t, hin hu nhiu trong t, nhum gram dng. C nhiu dng Botulus A, B, C, D, E, F, G. Mi dng tit ra mt c t ring, dng A, B, E gp ph bin nht. Bo t n ra vi khun trong mi trng ym kh, trung ha, hay aicd nh. Do , khi n thc n c cha vi khun Botulus n s d b ng c hn c cha bo t. Thc n ti sng khng gy ng c Botulus. Thc n ng hp, ng gi, phi sy lu, da mui ng hp lu l mi trng ym kh, nn nu c nhim bo t s d n ra thnh vi khun Botulus s gy ng c khi n. - Triu chng c nn i, au bng, bng chng, thng to bn v lit rut. - Triu chng thn kinh nh lit hnh ty v c vn ng lan t trn xung, nhn m, nhn i, s nh sng, sp mi, dn ng t, chng mt, ni , kh nut, kh ming, yu lit c, c th lit c h hp lm suy h hp. - Chn on da vo bnh s (c n hp, da mm, mui), xt nghim phn, mu c c t botulus. Bnh ng c Botulus rt ging vi cc bnh ni khoa khc nh Guillain -Barre, st t lit, nhc c, hi chng Lumbert-Eaton, lit Tick, ng c phosphor hu c, atropine. - iu tr khng c thuc c hiu, ch c huyt thanh liu php antibotulus l Botulism Immune Globulin (BIG) lm gim tin trin ca bnh v mac nng ca bnh, ch khng cu khi khi c b lit, do ch trung ha c toxin trong mu , ch khng trung ha c toxin gn ti ch ni thn kinh. Dng BIG trong vng 24 h u s hiu qu, tr hn s khng hiu qu. - Phng nga: Ng c Botulus rt nguy him, nn ta cn ch khng n hp c, hp b phng ln, da mui qu lt, mm ng chai, l qu lt u c th cha Botulus bo t n. Phi nu chn k 15 trc khi n hp. III. Ng c thc phm c siu vi: Thng gp 2 dng ph thng :

Do Rotavirus v adenovirus: gy vim ng rut, xut hin nh mt dch. Thi k bnh l 24 72h. Tiu chy, i ma xut hin t ngt ri t khi, sau tiu chy ko di 4 -7 ngy. Do Parvovirus: ngi ln, thi k bnh l 24 36h. Triu chng c i, tiu chy, au bng nh. IV. Phng nga: - n thc n tht c ti sng, rau qu ti, trng cn nguyn vn khng nt v, trng c. - Khng n hp ng gi, nu n phi nu chn k cc thc n hp trc khi n. - Khng n b, sa hay cc sn phm t b sa qu lu. - Tht c ti cn b vo bao sch vo ngn ca t lnh. Nu ly ra nu th cn n ht, khng nn ly ra r ng ri ct li dnh. - Thc n t lnh ch dc 1-2 ngy l khng nn n na v vi khun c th sinh sn trong . - Thc n c mi l phi b i. - Khng n c tht n hay va mi bt u n. - Khi i du lch, cn thn khi n ung dc ng. Ti liu tham kho 1. Principles of critical care, 3rd edition. 2. Intensive care medicine, 6th edition. 3. The ICU book, 3rd edition. 4. Emergency medicine: concepts and clinical practice, 6th edition. 5. Emergency toxicology (1998), 2nd edition, Lippincott-Raven. 6. Current Diagnosis & Treatment Emergency Medicine (2008), 6th edition, McGraw-Hill. 7. Goldfrank's Toxicologic Emergencies, (2006) 8th edition, McGraw-Hill.