Bi 8 - Di hn

c im sinh hc
k sinh trng st rt

Ts nguyn ngc san

Mc tiu bi hc

- Nh c 4 loi KSTSR.
- Nm c vng i, sinh l v sinh thi ca
KSTSR.
- Lin h s hiu bit v c im sinh hc
KSTSR n chn on, iu tr v phng
chng SR.

Ti liu tham kho

1. B mn St rt - KST - CT, HVQY. K sinh trng Y hc.
NXB Qun i nhn dn. H Ni, 1994.
2. B mn K sinh trng, HYHN. K sinh trng Y hc.
NXBYH. H Ni, 2001.
3. B mn K sinh trng, HYD TP.HCM. K sinh trng Y
hc. NXB Nng, 2002.
4. B Y t - D n Quc gia PCSR. Bnh st rt: bnh hc,
lm sng v iu tr. NXBYH. H Ni, 2000.

5. Phm Song. Lm sng v iu tr bnh st rt. NXBYH.

H Ni, 1994.

Qu trnh pht sinh bnh st rt

Cc yu t t nhin

KSTSR

Mui

Con ngi

Cc yu t kinh t - x hi - chnh tr

1. Lch s pht hin k sinh trng st rt

- 1880, Laveran pht hin Oscillaria malariae

- 1886, Golgi quan st KST phn chia v gii
- 1890, Grassi & Feletti - P.vivax & P.malariae
- 1891, Romanovski tm ra PP nhum Giemsa
- 1895 - 1897, Ronald Ross chng minh vector

- 1897, Welch - P.falciparum

- 1922, Stephens - P.ovale

1. Lch s pht hin k sinh trng st rt

KSTSR ( P.falciparum) khng thuc

Quinin (1910)

(1952)

Proguanil (1949) Pyrimethamin

Chloroquin (1960) Amodiaquin (1961)

Fansidar (1968) Mefloquin (1982)

2. Phn loi k sinh trng st rt

- Ngnh Protozoa (n bo)

- Lp Sporozoa (trng bo t)

- Lp ph Haemosporina
- H Plasmodiidae

- Chi (ging) Plasmodium

2. Phn loi k sinh trng st rt

4 loi KSTSR:
+ Plasmodium falciparum ( P.falciparum)

+ Plasmodium vivax ( P.vivax ) (P.v)

+ Plasmodium malariae ( P.malariae )

+ Plasmodium ovale ( P.ovale )

2. Phn loi k sinh trng st rt

Cc phn loi ( chng)
- P.vivax
+ Chng Thi Bnh Dng (Chesson)
+ Chng phng Nam (P.vivax vivax)
+ Chng phng Bc (P.vivax hibernans)
- P.falciparum
+ n , Nigieria,
+ Chng Malayan ( Bc M Lai)
+ Chng Campuchia 1,2,3
+ Chng min Nam Vit Nam ( Cv, Sn)

2. Phn loi k sinh trng st rt

C cu 4 loi KSTSR c s thay i:

- Theo vng
- Do p dng cc bin php phng chng
T l hin nay:

Giemsa

PCR

+ P.f :

70 - 90%

72,2 - 82,3%

+ P.v :
+ P.m :
+ P.o :

10 - 30%
1 - 3%

14,8 - 20,9%
3,2 - 6,3%
1,3 - 2,8%

3. c im sinh hc k sinh trng st rt

3.1. Vng i ca KSTSR

- Giai on sinh sn v gii

- Giai on sinh sn hu gii
3.2. Sinh l ca KSTSR
- Chuyn ho
- H hp
- Hn nh i sng
- Quan h vi hng cu

3. c im sinh hc k sinh trng st rt

3.1. Vng i ca KSTSR

- Giai on sinh sn v gii trong c th ngi
+ giai on phn chia trong t bo gan
+ Giai on phn chia trong hng cu

Merozoites
trong t bo
nhu m gan

Vng i ca K sinh trng st rt

Giai on trong c th ngi

Giai on trong c th mui

G trong TB gan

G trong mui

G hng cu

3.1. Giai on sinh sn v gii trong c th ngi

Giai on phn chia trong t bo gan

Mui Anopheles Sporozoit T bo gan
Merozoit

P. f
P.v
P.o
P.m

to ra
to ra
to ra
to ra

40.000
10.000
15.000
2.000

merozoit
merozoit
merozoit
merozoit

Vng i ca K sinh trng st rt

Giai on trong c th ngi

Giai on trong c th mui

G trong TB gan

G trong mui

G hng cu

3.1. Giai on sinh sn v gii trong c th ngi

Giai on phn chia trong t bo gan

Thi gian phn chia (thi k bnh):
P. f

cn

P.v cn
P.o cn
P.m cn

5-6

ngy

7 - 8 ngy
9 - 10 ngy
11 - 13 ngy

Vng i ca K sinh trng st rt

Giai on trong c th ngi

Giai on trong c th mui

G trong TB gan

G trong mui

G hng cu

3. c im sinh hc k sinh trng st rt

3.1. Vng i ca KSTSR

- Giai on sinh sn v gii trong c th ngi
+ giai on phn chia trong t bo gan
+ Giai on phn chia trong hng cu

Vng i ca K sinh trng st rt

Giai on trong c th ngi

Giai on trong c th mui

G trong TB gan

G trong mui

G hng cu

3.1. Giai on sinh sn v gii trong c th ngi

Giai on phn chia trong hng cu

Merozoit ( t gan vo hng cu)
Trophozoit non
Trophozoit trng thnh

Trophozoit gi
Schizont non
Schizont gi
Merozoit ( microgametocyt &
macrogametocyt )

3.1. Giai on sinh sn v gii trong c th ngi

Giai on phn chia trong hng cu

S lng Merozoit to ra sau mt G pht trin:
P. f :

18 merozoit

P.v :

12 merozoit

P.o :

P.m :

8
8

merozoit
merozoit

3.1.Giai on sinh sn v gii trong c th ngi

Giai on phn chia trong hng cu

Thi gian hon thnh mt G hng cu:
P. f :

48 gi

P.v :

48 gi

P.o :

48 gi

P.m :

72 gi

3.1. Giai on sinh sn v gii trong c th ngi

Giai on phn chia trong hng cu

V tr din ra giai on hng cu:
- Mu ngoi vi: P. v, P.o & P.m
- Mu mao mch ni tng: P.f

3.2. Giai on sinh sn hu gii

trong c th mui

Vng i ca K sinh trng st rt

Giai on trong c th ngi

Giai on trong c th mui

G trong TB gan

G trong mui

G hng cu

3.2. Giai on sinh sn hu gii trong c th mui

Mui Anopheles ht mu ngi c giao bo

(gametocyt ) ca KSTSR vo d dy :
- Giao bo ci giao t ci (GT ci)

- Giao bo c 8 giao t c (GT c)

- GT c chui vo GT ci Hp t ( zygot )
Trng (ookinet ) Nang trng ( oocyst )
Thoa trng ( Sporozoit )

Vng i ca K sinh trng st rt

Giai on trong c th ngi

Giai on trong c th mui

G trong TB gan

G trong mui

G hng cu

3.2. Giai on sinh sn hu gii trong c th mui

Thoa trng ( Sporozoit ) :

- C hnh thoi
- S lng 100.000

- i khp c th
- Sau tp trung tuyn nc bt

- C th sng trong c th mui: 1,5 - 2 thng

3.2. Giai on sinh sn hu gii trong c th mui

iu kin KSTSR pht trin trong mui :

- Mui Anopheles
- Mui sng lu oocyst sporozoit
- Phi c T0 thch hp cho mi loi KSTSR
P.f & P.m cn T0 ti thiu > 160 C
P.v cn T0 ti thiu > 14,50 C

(1) Nang trng

(Oocyst)
(2) Thoa trng
(Sporozoit)

Tm tt
Vng i ca K sinh trng st rt

Giai on trong c th ngi

Giai on trong c th mui

G trong TB gan

G trong mui

G hng cu

3.2. Sinh l k sinh trng st rt

3.2.1. Dinh dng v chuyn ho

3.2.2. H hp ca KSTSR

3.2.3. Hn nh i sng ca KSTSR

3.2.4. Quan h gia KSTSR vi hng cu

3.2.5. Thch nghi v bin d ca KSTSR.

3.2.1. Sinh l chuyn ho k sinh trng st rt

- Chuyn ho carbonhydrat
- Chuyn ho lipit
- Chuyn ho protit
- Chuyn ho axit nhn
- Chuyn ho vitamin,
cht khong v cc cht khc

Sinh l chuyn ho ca k sinh trng st rt

Chuyn ho carbonhydrat
Glucose rt cn cho s sng v pht trin ca
KSTSR, chng khng c hoc t c kh nng

d tr carbonhydrat
KSTSR chuyn ho glucose axit lactic
Khi chuyn ho KSTSR cn cc men:
Hexokinaza, lactatdehydrogenaza,
glucosephosphatisomeraza.

Sinh l chuyn ho ca k sinh trng st rt

Chuyn ho lipit
KSTSR khng tng hp c axit bo, nhng to ra c
t axit bo v alcol ca vt ch

KSTSR chim lipit trong trao i cht ca HC

KSTSR hp nht 2 axit bo oleic v cisvaccenic nn
nng tng cao HC nhim v huyt tng thay
i tnh thm mng HC mng HC d v

Sinh l chuyn ho ca k sinh trng st rt

Chuyn ho protit
KSTSR tng hp axit amin hn ch
Ngun axit amin trong huyt tng khng
KSTSR phn hu hemoglobin ly axit amin
v gii phng ra sc t (haemozoin)
Sc t lm cho da v nim mc b sm en

S Fitch
Hemoglobin
Cathepsin
Amino peptidase
Feriprotoporphyrin IX (Hematin)
(Do ging ho Hemoglobin v KST)

Protein gn Hematin
do KST sinh ra
Phc hp FP-Protein
Ngng ng
Haemozoin
v
(Sc t st rt)

+ Chloroquin

Phc hp Chloroquin + FP
Tiu hu nguyn sinh cht KST
do lm thay i thm thu
y K+ ra ngoi

Sinh l chuyn ho ca k sinh trng st rt

Chuyn ho axit nhn

KSTSR tng hp ADN ch yu Gon th
trophozoit non n trophozoit gi
KSTSR chim PABA to ra purin &
pyrimidin ri axit nhn

PABA
+
dihydropteridin

+ acid glutamic
dihydropteroat synthetase (DHPS)
DHFA

( acid dihydrofolic )
dihydrofolat reductase (DHFR)

THFA

( acid tetrahydrofolic )

Tng hp cc base puric v pyrimidic

Sinh l chuyn ho ca k sinh trng st rt

Chuyn ho vitamin, cht khong v cc cht

- KSTSR cn cc loi vitamin: vitamin C, B..

- Nng Kali, calci, phospho v natri cao hn
trong hng cu b KSTSR k sinh
- Ngoi ra KSTSR cn cn cc cht khc:
pyruvat, coenzym A, insulin ....

3.2.2. H hp ca k sinh trng st rt

- KSTSR h hp cn mt lng ln glucose

v oxy - hemoglobin
- B c ch bi carbonmonoxit, xyanit v
mt s thuc st rt
- KSTSR thch k sinh v tr c nhiu
glucose, lactat, glycerol & axit amin

3.2.3. Hn nh i sng ca k sinh trng st rt

- Khng iu tr th v tnh KSTSR

trong HC sau mt thi gian s cht
- Hn nh i sng KSTSR:
+ P.f : 6 - 20 thng
+ P.v : 1,5 - 2 nm ( 3 nm)
+ P.o : 2 - 3 nm (4 nm 4 thng)
+ P.m : 4 - 5 nm (10 - 52 nm)

3.2.4. Quan h gia k sinh trng st rt

vi hng cu

- HC b KSTSR k sinh:
+ Thay i hnh th
+ Xut hin cc vt th l
+ Lm thay i tnh thm ca mng
+ Ri lon chuyn ho
- Hu qu c hc:
+ To thnh cc th kt t HC
+ Gy tc cc mao mch mu ni tng

Mch mu no b tc bi s pht
trin ca P.falciparum

3.2.5. Thch nghi v bin d

ca k sinh trng st rt

- tn ti KSTSR phi thay i ph hp:

+ Cu trc gen

+ Cc c tnh l, ho, chuyn

ho...
- Hu qu ca s thay i:

+ To ra nhiu chng KSTSR

+ To ra chng khng thuc

Cu hi n tp
1. Trnh by cc mc thi gian v tc gi pht

hin theo th t 4 loi k sinh trng st rt

gy bnh cho ngi ?
2. Trnh by giai on pht trin k sinh trng
st rt trong c th mui v trong c th ngi
?

3. Trnh by cc c im sinh l chuyn ho

ca k sinh trng st rt gy bnh cho ngi ?