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VIM NO TR EM

A. MC TIU BI GING
1. Trnh by sinh l bnh v bnh nguyn ca vim no.
2. Chn on vim no.
3. iu tr vim no: nu nguyn tc iu tr.
4. K cc bin php d phng vim no.
B. NI DUNG BI GING
5. t vn .
6. Sinh l bnh v bnh nguyn.
7. Chn on vim no.
8. Chn on, phn bit vim no.
9. iu tr vim no.
10. Phng nga vim no.
I. T VN :
Vim no cp tr em l tnh trng nhim trng khng
mng m ca nhu m no.
- Bnh thng nng, t gp, bnh cng lm sng a dng.
- Him c vim no n thun, thng km vim mng no,
do t nhiu c thay i DNT.
- Thng l iu tr t/c.
- i khi iu tr c hiu nh /v Herpes ( Aciclovir) hay
v Plasmodium ( Quinine).
II. SINH L BNH- GII PHU BNH- BNH NGUYN:
A. Sinh l bnh:
C 3 lai vim no;
+ Nguyn pht: Encphalite infectieuse.
+ Th pht: Encphalite post infectieuse.
+ K cn: Encphalite parainfectieuse.
C ch v nguyn nhn gy bnh ca vim no.
C ch

infectieux

postinfectieux

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parainfectieux

Nhm Herpes:
- Herpes simples
- Herpes zoster
-Virus Epstein Barr
- Cytomgalo virus
Virus khc:
- Rougeole, rubole,
orellons
- Adnovirus
- Para-influenza,
influenza
- Echovirus,
influenza
- Polio (virus
vaccinal ou sauvage)
- Arbovirus, VIH-1,
rage
Protozoaires:
- Toxoplasma.
Trypanosomia
- Plasmodium
Nguyn nhn khc:
- Vaccine nga si
- Vaccine nga ho g
-Bordetella, Shigella,
Salmonella
- Mycoplasma
pneumonia
- Mycoses
- Leuco-encphalite
hu NT

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Him
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1. Vim no nguyn pht:


ng xm nhp: mu, thn kinh. Interferon /DNT+.
- ng mu : virus xm nhp h thng bch huyt ca ca k
ch qua ht vo
( virus respiratoires) hay nut vo ( enterovirus) hay qua vt
chch ca cn trng(arbovirus).
- ng thn kinh: virus xm nhp v di chuyn bng ng
thn kinh ( virus Herpes, virus bnh di).
2. Vim no th pht:
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- L hu qu ca p ng min dch b ri lan bi siu vi, c


th chng li mt trong cc thnh phn ca no.
- Khng c interferon, khng th c hiu/ DNT+, cy DNT
( -).
- Xut hin nhiu ngy hay nhiu tun sau giai an st ca
bnh.
- Mt s trng hp do phn ng d ng thuc.
3. Vim no k cn: (E.parainfectieuse).
Sinh l bnh t r, c th do c t ca VT gy tn thng
thn kinh trung ng -> gp nhim Shigella, Salmonella,
Bordetella, Pertussis.
B. Gii phu bnh:
Vim no nguyn pht: c bit trong vim no do Herpes.
- i th:
No b ph n tan b hay mt bn cu.
Tn thng thng lan ta nhng c khuynh hng ni
bt mt bn cu, c bit thy thi dng.
B khuy( cingulum).
Hi hi m ( hippocampe).
Thy mt ( lobes orbitaires).
Cc vng o ( region insulaire).
- Vi th:
Tn thng thng hai t m cht xm, v no.
C hin tng vim: m m c nt cc+ thm nhim
quanh mch mu c thm nhim lymphocytes.
Th vi i toan/ nhn t bo m & t bo thn kinh: cn
gi l cht vi Cowdry type A, gm mt khi i toan
gia, trn, bao bc bi vng sng, y nhn & NST v mt
pha.
Cc th vi ny khng c hiu cho Herpes, cn c trong
CMV, varicella, vim no bn cp ca si.
tr s sinh, tn thng lan ta hn, hoi t nhiu hn,
thng nh hng cht trng hoc v no.
Mt s cas c tn thng k trn( hai t m cht xm, v
no).
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C. Bnh nguyn:
1. Virus:
- H/C Torche ( Toxoplasmose, Rubole, CMV, Herpes,
Enterovirus, Syphilis, HIV-1) gy vim no nguyn pht
bm sinh.
- Adenovirus : nhiu types(1,2,3,6,7,12).
Ring type 7 thng gy vim no nng kt hp vi vim
phi, vim gan.
- Arbovirus : 400 loi, thng gp virus vim no Nht
Bn, vim no Saint Louis, vim no California, truuyn
bnh qua mui hay ve.
- Enterovirus:
Enchovirus
Coxackie
thng gp vo ma h.
Poliomelite
-

CMV: gy vim no bm sinh, tin lng xu BN suy


gim min dch.
Herpes simplex type 1:
Gy vim no nng -> i khi c gi l vim
no hoi t cp, hay gp nh nhi.
Herpes simplex type2 : Gy bnh trong thai k hay lc
sinh gy vim no s sinh-> thng gy bnh tan thn :
gan lch to, pht ban da, ri lan ng mu.
Herpes Zoster c th gy vim no nguyn pht nng ->
t vong,xy ra tr nh hay suy gim min dch, triu
chng thn kinh xut hin vo ngy 5-12 giai an pht
ban.
Varicella : thng gp vim no th pht, him khi nng,
thng tiu no b tn thng, c khi lit na ngi.
Mumps :Vim no th pht sau quai b thng lnh tnh,
nhng c khi t vong. Chn an = cy, IgM, IgG c hiu
ca quai b.
Rabies: Biu hin tng tit nc bt, hung d, m sng, co
git. Chn an da vo th Negri trong no +
Rubeola (Measles): gy vim no theo 2 cch:
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+ Vim no nguyn pht: xy ra trong giai an


pht ban.
+ Vim no th pht: dng ny nng hn 10-15%
+ 25% sng c di chng no nng.
Rubole bm sinh cng gy vim no ging CMV.
Mt s cas cht sau giai an s sinh. Chn an bng cy
hay huyt thanh chn an Rubole.
HIV 1: gy vim no tin trin chm. Thng km bt
nhim phi
( pneumocystis, CMV)hay vim no ( Toxoplasma, CMV.)
Estein- Barr (EBV): l nguyn nhn gy vim no nng
th t sau Herpes Simplex, Adenovirus, Herpes zoster,
cc nc chch nga si ph bin.
Chn an bng test Paul Bunnell (+) hay Ig chng v
EBV.
2. Vi trng; mycoplasma:
- Bordetella pertussis c th gy vim no nng. Sinh l
bnh cha r, gi thuyt do thiu O2 sau cc cn ho v t
thit cho thy tn thng lai thiu mu cc b.
Thng xy ra tr <1 tui, biu hin co git ->hn m
yu na ngi, tht iu, cm, ic, m. ALNS. Chn
an bng bnh cnh lm sng hay immunofluorescence.
Bnh Lyme:
Do Borrelia Burgdorferi gy ra, i khi gy vim no,
thng lnh tnh, ly bi ve.
Bnh mo co: do VT Gr (-), c th gy vim no nng
VT: Afibia felis hay Rochalimax Henselea. Gy bnh vim
no th pht. Bnh c trng bi cc hch xut hin
di cc hch bch huyt dn n vt cn hay vt co ca
vt nui trong nh( ch, mo.).
Mycoplasma: i khi him gy vim no th pht
Chn an: - huyt thanh chn an.
cy DNT, tm ADN c
hiu/ DNT.
Salmonella, Shigella:
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Gy vim no k cn, c th do c t VT, c trng bi


nh hng ln tri gic v co git. DNT
3. K sinh trng:
- St rt: vim no c ch k cn. DNT
- Tania: gy vim no bng cch to kn/ m no nu c
s ti nhim hu mn- ming.
- Toxoplasma bm sinh thng km vim no.
4. Nm:
- Him gp, gy vim no rt nng.
- Thng do Aspergilus, Candida, Cryptococcus.
- DNT >50% trng hp.
- Chn an bng cy DNT hay sinh thit no.
5. Cc nguyn nhn khc:
- Mt s vim no xut hin sau chch vc- xin, thng
gp do vaccin hog & si, i khi c ngun gc t mt
vim no nng.
- Vim no cht trng th pht sau bnh do siu vi thng
lnh tnh v p ng vi Corticoide.
III. CHN AN VIM NO:
A. Lm sng:
1.
H/C nhim trng: st cao hay gp.
2.
Tnh trng ri lan tri gic t nh ->
hn m.
3.
Biu hin ALNS: nn i, nhc
u, thp phng, ph gai th; HA, chm nhp tim, th khng
u & chm.
4.
Du thn kinh nh v:
Co git khu tr.
Lit khu tr.
Ni kh.
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Du tn thng thn no( ri lan thn kinh thc vt, st


cao, tht iu, nystagmus).
Lit cc dy thn kinh s( VI,VII,IX,X).
5. Du mng no: c cng, Kernig, Brudzinski, vch mng no
+).
6. Pht ban da.
7. Vim ng h hp trn.
8. Du vt mui t, ve t. trn da.
B. Cn lm sng:
1. Chc DNT:
Sinh ha: ng , m < 1g/l.
T bo: 0-1000, a s lymphocyte.
Vi trng: nhum Gr, cy(-).
Siu vi: cy virus (+) 5%.
Min dch: tm khng th chng virus: sau 15 ngy bnh.
Thng thy Herpes simplex, Rubeola, Epstein Barr.

nh lng interferon : -> vim no nguyn pht.


in di protein : vi tun sau khi bnh :
IgG n dng xut hin vi tun sau vim no nguyn
pht.
IgG a dng xut hin sm hn vim no th pht.
2. EEG:
- Thng thay i, c gi tr chn an & tin lng:
* Trong vim no nguyn pht thng xut hin sng
nhn hay sng dng im tan th nhng khng ng b, c dng
ging ng kinh hay sng chm chu k c trng ca hoi t.
* Trong vim no th pht: sng chm ng dng delta
hoc thta trn tan b chuyn o, xen k.
- EEG bnh thng khi tn thng tiu no, thn no.
3.TDM( Scanner):
Gip pht hin ph no,vng hai t, abcs no, vng nhi
mu, khi u, trn dch di mng cng.
4. Sinh thit no: vn cn bn ci.
5. Cc xt nghim khc:
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-Tm k sinh trng st rt/ 4 gi nu vng dch t bo st rt.


- Huyt thanh chn an: Herpes, si , HIV, giang mai, vim no
Nht Bn
- Tm VT lao : IDR, cy tm BK/ dch d dy trong 3 ngy lin
tip.
BK/DNT.
Tm li, trong vim no do nguyn nhn & c ch sinh bnh a
dng -> trong mi trng hp nn ngh n cc nguyn nhn c
th iu tr c trc:
+ Nhim trng.
+ St rt.
+ Herpes.
+
IV. CHN AN PHN BIT:
1. Vim mng no m:
t khi c du hiu ri lan tri gic km theo. Ring VMNM
s sinh thng km t nhiu tn thng no (nhu m),
chn an phn bit da vo thay i ca DNT ( sinh ha,
tb). Ring VMNM do Listeria kh phn bit v DNT ging
nh vim no siu vi.
2. Vim mng no tn sinh:
Trong ung th mu hay u no, do s xm nhp ca u tn
sinh vo h thn kinh trung ng gy vim mng no.
Bnh cm lm sng v DNT i khi ging vim no siu
vi hay vim mng no lao.
3. Abcs no:
- Kh chn an phn bit trn lm sng v DNT.
- Chn an bng EEG, TDM, Biopsie.
4. Vim mch mu no:
- Vim bnh l gy vim ( xut huyt gim tiu cu v cn,
lupus , huyt tn ur mu cao nh nhi) gy vim mch
mu -. Tc nghn mch mu ca h thn kinh trung ng:
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i khi gy tai bin mch mu no nu tc nghn


ln.
C khi gy bnh cnh vim no siu vi nu tc
mch nh.
Thng km tiu cu ( khng c trong vim no siu vi
hay d ng.)

5. T mu di mng cng :
- Thng xy ra sau chn thng.
- Soi y mt : thng c xut huyt vng mc( khng c
trong vim no siu vi).
6. Lan dng cht trng:
- Biu hin lm sng gm vim no siu vi.
- Chn an bng TDM: m ( hypodense) tan b
cht trng + Calci ha.
7. Cc bnh no bm sinh hay mc phi:
- Bnh ri lan chuyn ha bm sinh.
- Bnh ng c ch, ng c thuc.

Interferon/DNT (+)virus:
Aciclovir khi cha loi V.no
V. IU TR VIMdo
NO
(s ).
Herpes

A. iu
tr bnh cn
Vim no
nguyn pht <
2 tui
T/C cp:

Vim no th
pht
+ V.no k cn
>4.5 tui
C a suy gim
min dch

Interfero
n (-)

Quinine nu do st rt c tnh.
Erythromycine nu do
mycoplasma

V. no cht trng
iu tr
Corticoide
Nguyn nhn khc
iu tr triu
chng.
Herpes simplex: Aciclovir.
CMV: gancyclovir, immunoglobulines
VIH1 (Aids): triu chng.
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Toxoplasma: sulfamthoxazole &
pyrimthamine.
Nm: Amphotericine, flucytosine.

Interferon/DN
T (-)
+EEG ph
hp

B.iu tr triu chng:


1. iu tr tng ALNS:
- Tng thng kh.
- Nm u cao 30 0 .
- Furosemide Manitol.
- iu tri co git : Gardenal hay Dilantin.

2. H st.
3. Hn ch nc.
4. iu chnh thng bng kim toan & nc, in gii.
5. Chm sc bnh nhn hn m:
- Theo di: vim no Herpes c th tr bnh li 2 thng
sau, d iu tr-> phi theo di bnh nhn nhiu tun
sau ra vin.
- Bin chng t vong cng cao khi tui cng nh:
- 70-80% t vong vim no s sinh do Herpes, 80-90%
c di chng.
- 60-70% t vong vim no nh nhi do herpes, 80-90%
c di chng.
- d hu ty vo:
* nng ca bnh cnh lm sng
* Bnh nguyn.
* Tui.
VI. D PHNG VIM NO:
Chng nga st bi lit, si, quai b, rubole
Chng nga bnh di nu c vt nui trong nh.
Chng nga vim no do Arbovirus mi thc hin
c i vi vim no Nht bn, cha thc hin
c i vi cc Arbovirus khc nhng c th xt
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thuc tiu dit tn gc cc cn trng ht mu


cng lm gim s ngi mc bnh ny.
CU HI LNG GI.
1. Chn an vim no.
2. iu tr vim no : nu nguyn tc.
3. Phng bnh vim no.

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