{"id":5744,"date":"2019-03-29T10:17:10","date_gmt":"2019-03-29T03:17:10","guid":{"rendered":"https:\/\/www.vnras.com\/drug\/?p=5744"},"modified":"2019-03-29T10:17:10","modified_gmt":"2019-03-29T03:17:10","slug":"tre-quay-khoc-kem-mun-san-toan-than","status":"publish","type":"post","link":"https:\/\/vnras.com\/drug\/tre-quay-khoc-kem-mun-san-toan-than\/","title":{"rendered":"Tr\u1ebb qu\u1ea5y kh\u00f3c k\u00e8m m\u1ee5n s\u1ea9n to\u00e0n th\u00e2n"},"content":{"rendered":"

Ge Qian; Ligong Hou; Wu Guo \u0110\u0103ng t\u1ea3i tr\u00ean JAMA ng\u00e0y 14\/01\/2019. doi:10.1001\/jama.2018.20666<\/p>\n

B\u00e9 trai xu\u1ea5t hi\u1ec7n m\u1ee5n s\u1ea9n c\u00f3 m\u1ee7 to\u00e0n th\u00e2n<\/h2>\n
Tr\u1ebb trai, 7 tu\u1ea7n tu\u1ed5i, ti\u1ec1n s\u1eed \u0111\u1ebb \u0111\u1ee7 th\u00e1ng, kho\u1ebb m\u1ea1nh, 4 tu\u1ea7n nay xu\u1ea5t hi\u1ec7n m\u1ee5n s\u1ea9n c\u00f3 m\u1ee7 to\u00e0n th\u00e2n, lan r\u1ed9ng, t\u0103ng d\u1ea7n, ban \u0111\u1ea7u ch\u1ec9 l\u00e0 c\u00e1c m\u1ee5n s\u1ea9n l\u00e1c \u0111\u00e1c v\u00f9ng ng\u1ef1c. Tr\u1ebb \u0111\u1ebb \u0111\u01b0\u1eddng \u00e2m \u0111\u1ea1o, m\u1eb9 31 tu\u1ed5i, \u0111\u01b0\u1ee3c ch\u0103m s\u00f3c tr\u01b0\u1edbc sinh th\u01b0\u1eddng qui. K\u1ec3 t\u1eeb khi n\u1ed5i s\u1ea9n, tr\u1ebb r\u1ea5t hay qu\u1ea5y kh\u00f3c v\u00e0 ng\u00e0y c\u00e0ng qu\u1ea5y v\u1ec1 \u0111\u00eam. Theo l\u1eddi cha m\u1eb9, ti\u1ec1n s\u1eed gia \u0111\u00ecnh kh\u00f4ng c\u00f3 ai ph\u00e1t ban. H\u1ecfi b\u1ec7nh k\u0129 h\u01a1n th\u00ec cha m\u1eb9 cho bi\u1ebft tr\u1ebb c\u00f3 ti\u1ebfp x\u00fac v\u1edbi ng\u01b0\u1eddi tr\u00f4ng tr\u1ebb, ng\u01b0\u1eddi n\u00e0y n\u00f3i r\u1eb1ng c\u00f3 b\u1ecb ng\u1ee9a nh\u1ea5t l\u00e0 v\u1ec1 \u0111\u00eam. Ng\u01b0\u1eddi n\u00e0y ch\u0103m s\u00f3c tr\u1ebb \u1edf nh\u00e0 b\u1eaft \u0111\u1ea7u t\u1eeb l\u00fac sinh ra cho \u0111\u1ebfn khi r\u1eddi \u0111i 3 tu\u1ea7n tr\u01b0\u1edbc \u0111\u00f3.<\/p>\n
Kh\u00e1m th\u1ea5y tr\u1ebb kh\u00f4ng s\u1ed1t, d\u1ea5u hi\u1ec7u sinh t\u1ed3n b\u00ecnh th\u01b0\u1eddng. To\u00e0n th\u00e2n c\u00f3 nhi\u1ec1u m\u1ee5n s\u1ea9n ch\u1ee9a m\u1ee7, ph\u00f9, c\u1ee1 \u0111\u1ea7u \u0111inh ghim, lan to\u1ea3 v\u00e0 c\u00e1c n\u1ed1t c\u00f3 v\u1ea3y c\u1ee9ng, h\u1ee3p l\u1ea1i v\u1edbi nhau c\u00f3 k\u00edch th\u01b0\u1edbc 5-10 mm; m\u1ed9t s\u1ed1 c\u00f3 h\u1ea7m h\u00ecnh b\u1ea7u d\u1ee5c \u0111\u1ebfn h\u00ecnh d\u00e0i thu\u00f4n, h\u00ecnh gi\u1ed1ng con giun ho\u1eb7c h\u00ecnh ch\u1eef J (H\u00ecnh 1). Kh\u00f4ng th\u1ea5y hi\u1ec7n t\u01b0\u1ee3ng tr\u00f3c da. Test Tzanck kh\u00f4ng th\u1ea5y c\u00e1c t\u1ebf b\u00e0o \u0111a nh\u00e2n kh\u1ed5ng l\u1ed3 \u1edf c\u00e1c ph\u1ea7n c\u00f3 m\u1ee7. Nhu\u1ed9m Gram v\u00e0 test KOH c\u00e1c ph\u1ea7n c\u00f3 m\u1ee7 kh\u00f4ng th\u1ea5y vi khu\u1ea9n hay n\u1ea5m. Nu\u00f4i c\u1ea5y ph\u1ea7n c\u00f3 m\u1ee7 kh\u00f4ng m\u1ecdc vi khu\u1ea9n hay n\u1ea5m. C\u00f4ng th\u1ee9c m\u00e1u to\u00e0n ph\u1ea7n th\u1ea5y c\u00f3 12% b\u1ea1ch c\u1ea7u \u00e1i toan. C\u00e1c k\u1ebft qu\u1ea3 x\u00e9t nghi\u1ec7m kh\u00e1c kh\u00f4ng ph\u00e1t hi\u1ec7n b\u1ea5t th\u01b0\u1eddng.<\/p>\n
$\"tr\u1ebb$
H\u00ecnh 1. T\u1ed5n th\u01b0\u01a1ng da v\u00f9ng th\u00e2n m\u00ecnh c\u1ee7a tr\u1ebb.<\/figcaption><\/figure>\n
L\u00e0m g\u00ec ti\u1ebfp theo cho tr\u1ebb n\u00e0y?<\/h3>\n
A. D\u00f9ng kh\u00e1ng sinh ph\u1ed5 r\u1ed9ng \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch.
\nB. B\u00f4i corticoid t\u1ea1i ch\u1ed7.
\nC. C\u1ea1o \u0111\u01b0\u1eddng h\u1ea7m tr\u00ean da \u1edf nhi\u1ec1u v\u1ecb tr\u00ed.
\nD. Kh\u00f4ng l\u00e0m g\u00ec v\u00e0 tr\u1ea5n an cha m\u1eb9.<\/p>\n
\u0110\u00e1p \u00e1n: C. Ch\u1ea9n \u0111o\u00e1n: Gh\u1ebb s\u01a1 sinh<\/h2>\n
B\u00e0n lu\u1eadn:<\/p>\n
M\u1ea5u ch\u1ed1t \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n \u0111\u00fang l\u00e0m t\u1ed5n th\u01b0\u01a1ng vi\u00eam da c\u00f3 \u0111\u01b0\u1eddng h\u1ea7m lan r\u1ed9ng kh\u00f4ng k\u00e8m tr\u00f3c da, ti\u1ec1n s\u1eed ti\u1ebfp x\u00fac v\u1edbi ng\u01b0\u1eddi tr\u00f4ng tr\u1ebb c\u00f3 tri\u1ec7u ch\u1ee9ng ph\u00f9 h\u1ee3p v\u1edbi gh\u1ebb, hi\u1ec7n t\u01b0\u1ee3ng qu\u1ea5y kh\u00f3c v\u00e0 ng\u1ee7 kh\u00f4ng y\u00ean v\u1ec1 \u0111\u00eam tr\u00ean n\u1ec1n tr\u1ebb s\u01a1 sinh kho\u1ebb m\u1ea1nh. Kh\u00f4ng nh\u01b0 \u1edf ng\u01b0\u1eddi l\u1edbn, t\u1ed5n th\u01b0\u01a1ng da \u0111\u1eb7c tr\u01b0ng do gh\u1ebb \u1edf tr\u1ebb s\u01a1 sinh hay g\u1eb7p \u1edf gan tay, gan ch\u00e2n, th\u00e2n m\u00ecnh v\u00e0 da ph\u00eda tr\u00ean c\u1ed5. Vi\u1ec7c ti\u1ebfp x\u00fac v\u1edbi m\u1ed9t ng\u01b0\u1eddi c\u00f3 d\u1ea5u hi\u1ec7u v\u00e0 tri\u1ec7u ch\u1ee9ng c\u1ee7a gh\u1ebb g\u1ee3i \u00fd nhi\u1ec1u \u0111\u1ebfn ch\u1ea9n \u0111o\u00e1n gh\u1ebb.
\nGh\u1ebb g\u1eb7p \u1edf h\u01a1n 300 tri\u1ec7u ng\u01b0\u1eddi m\u1ed7i n\u0103m. B\u1ec7nh gh\u1ebb l\u00e0 t\u00ecnh tr\u1ea1ng t\u1ed5n th\u01b0\u01a1ng da c\u00f3 t\u00ednh l\u00e2y nhi\u1ec5m cao do c\u00e1i gh\u1ebb (Sarcoptes scabiei) g\u00e2y n\u00ean [1]. Gh\u1ebb th\u01b0\u1eddng g\u1eb7p \u1edf tr\u1ebb em, v\u1edbi bi\u1ec3u hi\u1ec7n thay \u0111\u1ed5i theo c\u00e1c nh\u00f3m tu\u1ed5i kh\u00e1c nhau [2]. V\u00ec tr\u1ebb s\u01a1 sinh kh\u00f4ng g\u00e3i \u0111\u01b0\u1ee3c n\u00ean gh\u1ebb s\u01a1 sinh hay g\u1eb7p c\u00e1c tri\u1ec7u ch\u1ee9ng qu\u1ea5y kh\u00f3c, k\u00edch th\u00edch v\u00e0 \u0111\u00eam ng\u1ee7 kh\u00f4ng y\u00ean, h\u01a1n l\u00e0 c\u00e1c tri\u1ec7u ch\u1ee9ng g\u00e3i v\u00e0 tr\u00f3c da th\u1ee9 ph\u00e1t do g\u00e3i. \u1ede tr\u1ebb s\u01a1 sinh, nhi\u1ec5m gh\u1ebb r\u1ea5t th\u1ea7m l\u1eb7ng v\u00e0 k\u00e9o d\u00e0i t\u01b0\u01a1ng \u0111\u1ed1i l\u00e2u, th\u01b0\u1eddng g\u00e2y ra nhi\u1ec1u t\u1ed5n th\u01b0\u01a1ng \u1edf c\u00e1c giai \u0111o\u1ea1n ti\u1ebfn tri\u1ec3n kh\u00e1c nhau t\u1eeb m\u1ee5n s\u1ea9n c\u00f3 m\u1ee7 \u0111\u1ebfn c\u00e1c n\u1ed1t l\u1edbn. So v\u1edbi c\u00e1c \u0111\u01b0\u1eddng h\u1ea7m gh\u1ebb nguy\u00ean v\u1eb9n g\u1eb7p ch\u1ee7 y\u1ebfu \u1edf v\u00f9ng k\u1ebd ng\u00f3n v\u00e0 \u0111\u1ea7u chi \u1edf ng\u01b0\u1eddi l\u1edbn, tr\u1ebb s\u01a1 sinh l\u1ea1i c\u00f3 bi\u1ec3u hi\u1ec7n l\u00e0 c\u00e1c \u0111\u01b0\u1eddng h\u1ea7m b\u1ecb vi\u00eam n\u1eb7ng tr\u00ean to\u00e0n b\u1ed9 c\u01a1 th\u1ec3, \u0111\u1eb7c tr\u01b0ng b\u1edfi c\u00e1c hi\u1ec7n t\u01b0\u1ee3ng s\u1ea9n, m\u1ee5n n\u01b0\u1edbc v\u00e0 n\u1ed1t tr\u00ean da ph\u00f9, \u0111\u1ecf, h\u00ecnh b\u1ea7u d\u1ee5c cho \u0111\u1ebfn thu\u00f4n d\u00e0i, h\u00ecnh con giun ho\u1eb7c h\u00ecnh ch\u1eef J.<\/p>\n
Gh\u1ebb l\u00e2y qua ti\u1ebfp x\u00fac g\u1ea7n g\u0169i v\u1edbi ng\u01b0\u1eddi ho\u1eb7c v\u1eadt d\u1ee5ng c\u00e1 nh\u00e2n b\u1ecb nhi\u1ec5m gh\u1ebb, bao g\u1ed3m qu\u1ea7n \u00e1o, ch\u1ed7 n\u1eb1m ng\u1ee7, kh\u0103n v\u00e0 g\u0103ng tay [3,4]. C\u00e1c tri\u1ec7u ch\u1ee9ng xu\u1ea5t hi\u1ec7n trong v\u00f2ng 2 \u0111\u1ebfn 6 tu\u1ea7n sau khi b\u1ecb nhi\u1ec5m [3]. Do bi\u1ec3u hi\u1ec7n \u0111a d\u1ea1ng kh\u00e1c v\u1edbi gh\u1ebb kinh \u0111i\u1ec3n v\u00e0 \u0111\u1ed9 hi\u1ebfm g\u1eb7p c\u1ee7a b\u1ec7nh gh\u1ebb \u1edf tr\u1ebb s\u01a1 sinh, gh\u1ebb s\u01a1 sinh th\u01b0\u1eddng \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n mu\u1ed9n ho\u1eb7c ch\u1ea9n \u0111o\u00e1n nh\u1ea7m. \u1ede tr\u1ebb s\u01a1 sinh nghi ng\u1edd m\u1eafc gh\u1ebb, vi\u1ec7c trong gia \u0111\u00ecnh c\u00f3 1 ho\u1eb7c nhi\u1ec1u th\u00e0nh vi\u00ean bi\u1ec3u hi\u1ec7n ban ho\u1eb7c ng\u1ee9a \u0111i\u1ec3n h\u00ecnh gi\u00fap t\u0103ng kh\u1ea3 n\u0103ng \u0111\u01b0a ra ch\u1ea9n \u0111o\u00e1n. C\u1ea7n ki\u1ec3m tra c\u1ea3 nh\u1eefng ng\u01b0\u1eddi ti\u1ebfp x\u00fac tho\u00e1ng qua v\u1edbi \u0111\u1ee9a tr\u1ebb, bao g\u1ed3m ng\u01b0\u1eddi gi\u00fap vi\u1ec7c, ng\u01b0\u1eddi ch\u0103m s\u00f3c \u1edf trung t\u00e2m ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng, trung t\u00e2m ch\u0103m s\u00f3c d\u00e0i h\u1ea1n v\u00e0 ng\u01b0\u1eddi gi\u1eef tr\u1ebb, nh\u1ea5t l\u00e0 khi trong nh\u00e0 kh\u00f4ng c\u00f3 ng\u01b0\u1eddi m\u1eafc b\u1ec7nh [4,5].<\/p>\n
Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh gh\u1ebb d\u1ef1a tr\u00ean vi\u1ec7c c\u1ea1o \u0111\u01b0\u1eddng h\u1ea7m \u1edf nhi\u1ec1u v\u1ecb tr\u00ed \u0111\u1ec3 t\u00ecm ki\u1ebfm c\u00e1i gh\u1ebb v\u00e0 \u1ea5u tr\u00f9ng gh\u1ebb, d\u1ec5 d\u00e0ng ph\u00e1t hi\u1ec7n tr\u1ef1c ti\u1ebfp ho\u1eb7c khi l\u00e0m x\u00e9t nghi\u1ec7m Tzanck v\u00e0 test KOH [6]. \u1ede tr\u1ebb n\u00e0y, \u0111\u1eb7c \u0111i\u1ec3m ban k\u00e9o d\u00e0i 4 tu\u1ea7n kh\u00f4ng k\u00e8m theo tri\u1ec7u ch\u1ee9ng to\u00e0n th\u00e2n v\u00e0 \u0111\u00e1p \u1ee9ng h\u1ec7 th\u1ed1ng, kh\u00f4ng ph\u00f9 h\u1ee3p v\u1edbi ch\u1ea9n \u0111o\u00e1n nhi\u1ec5m Varicella hay Herpes [7]. So v\u1edbi gh\u1ebb s\u01a1 sinh, m\u1ee5n n\u01b0\u1edbc, m\u1ee5n m\u1ee7 hay b\u1ecdng n\u01b0\u1edbc trong ch\u1ed1c nhi\u1ec5m khu\u1ea9n th\u01b0\u1eddng c\u00f3 d\u1ecbch m\u00e0u v\u00e0ng trong ho\u1eb7c \u0111\u1ee5c. Ph\u00e1t ban kh\u00f4ng tri\u1ec7u ch\u1ee9ng trong ban \u0111\u1ecf nhi\u1ec5m \u0111\u1ed9c s\u01a1 sinh x\u1ea3y ra trong v\u00f2ng v\u00e0i ng\u00e0y \u0111\u1ea7u \u0111\u1eddi v\u00e0 t\u1ef1 h\u1ebft [8]. \u1ede Hoa K\u00ec C\u01a1 quan qu\u1ea3n l\u00ed D\u01b0\u1ee3c v\u00e0 Th\u1ef1c ph\u1ea9m kh\u00f4ng c\u1ea5p ph\u00e9p cho b\u1ea5t c\u1ee9 thu\u1ed1c \u0111i\u1ec1u tr\u1ecb gh\u1ebb n\u00e0o cho tr\u1ebb d\u01b0\u1edbi 2 th\u00e1ng tu\u1ed5i. Tuy nhi\u00ean, m\u1ee1 l\u01b0u hu\u1ef3nh (5-10%) v\u00e0 kem permethrin c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng an to\u00e0n cho tr\u1ebb s\u01a1 sinh [2,9]. C\u00f3 th\u1ec3 thay th\u1ebf b\u1eb1ng crotamiton d\u00f9ng ngo\u00e0i ho\u1eb7c ivermectin \u0111\u01b0\u1eddng u\u1ed1ng; tuy nhi\u00ean c\u00f3 \u00edt b\u1eb1ng ch\u1ee9ng \u1ee7ng h\u1ed9 cho vi\u1ec7c d\u00f9ng c\u00e1c thu\u1ed1c n\u00e0y \u1edf tr\u1ebb s\u01a1 sinh [1]. \u0110\u1ed3ng th\u1eddi c\u0169ng c\u1ea7n \u0111i\u1ec1u tr\u1ecb cho nh\u1eefng ng\u01b0\u1eddi ti\u1ebfp x\u00fac v\u1edbi tr\u1ebb.<\/p>\n
K\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb<\/h2>\n
B\u1ec7nh nh\u00e2n v\u00e0 ng\u01b0\u1eddi tr\u00f4ng tr\u1ebb \u0111\u01b0\u1ee3c c\u1ea1o v\u1ea3y da v\u00e0 soi th\u1ea5y nhi\u1ec1u c\u00e1i gh\u1ebb (H\u00ecnh 2). Tr\u1ebb \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng m\u1ee1 l\u01b0u hu\u1ef3nh (5%) trong 3 ng\u00e0y li\u1ec1n v\u00e0 l\u1eb7p l\u1ea1i 1 tu\u1ea7n sau \u0111\u00f3. Tr\u1ebb nhanh ch\u00f3ng tr\u1edf v\u1ec1 tr\u1ea1ng th\u00e1i tinh th\u1ea7n b\u00ecnh th\u01b0\u1eddng, ng\u1ee7 ngoan v\u00e0 kh\u1ecfi ho\u00e0n to\u00e0n c\u00e1c ban tr\u00ean da. Ng\u01b0\u1eddi tr\u00f4ng tr\u1ebb \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng kem permethrin 5% v\u00e0 l\u1eb7p l\u1ea1i 1 tu\u1ea7n sau \u0111\u00f3, t\u1ea5t c\u1ea3 c\u00e1c th\u00e0nh vi\u00ean trong gia \u0111\u00ecnh \u0111\u01b0\u1ee3c d\u1ef1 ph\u00f2ng b\u1eb1ng m\u1ed9t \u0111\u1ee3t permethrin. Ngo\u00e0i vi\u1ec7c v\u1ec7 sinh c\u00e1c v\u1eadt d\u1ee5ng v\u00e0 \u0111\u1ed3 \u0111\u1ea1c, t\u1ea5t c\u1ea3 ch\u0103n chi\u1ebfu, qu\u1ea7n \u00e1o v\u00e0 kh\u0103n \u0111\u1ec1u \u0111\u01b0\u1ee3c gi\u1eb7t b\u1eb1ng n\u01b0\u1edbc n\u00f3ng v\u00e0 s\u1ea5y kh\u00f4 \u1edf nhi\u1ec7t \u0111\u1ed9 cao \u0111\u1ec3 kh\u1eed tr\u00f9ng [3]. Ba th\u00e1ng sau, tr\u1ebb v\u00e0 nh\u1eefng ng\u01b0\u1eddi ti\u1ebfp x\u00fac \u0111\u1ec1u kh\u00f4ng c\u00f3 bi\u1ec3u hi\u1ec7n gh\u1ebb.<\/p>\n
$\"gh\u1ebb$
H\u00ecnh 2. C\u00e1i gh\u1ebb quan s\u00e1t d\u01b0\u1edbi k\u00ednh hi\u1ec3n vi x40 khi c\u1ea1o da<\/figcaption><\/figure>\n
T\u00e0i li\u1ec7u tham kh\u1ea3o<\/h2>\n
1. Hill TA, Cohen B. Scabies in babies. Pediatr Dermatol. 2017;34(6):690-694. doi:10.1111\/pde.13255
\n2. Subramaniam S, Rutman MS, Wenger JK. A papulopustular, vesicular, crusted rash in a 4-week-old neonate. Pediatr Emerg Care. 2013;29(11):1210-1212. doi:10.1097\/PEC.0b013e3182aa1411
\n3. Tarbox M, Walker K, Tan M. Scabies. JAMA. 2018;320(6):612. doi:10.1001\/jama.2018.7480
\n4. Ross BG, Wright-McCarthy JK, DeLaMora PA, Graham PL III. Transmission of scabies in a newborn nursery. Infect Control Hosp Epidemiol. 2011;32(5):516-517. doi:10.1086\/659954
\n5. Obasanjo OO, Wu P, Conlon M, et al. An outbreak of scabies in a teaching hospital: lessons learned. Infect Control Hosp Epidemiol. 2001;22(1):13-18. doi:10.1086\/501818
\n6. Zou Y, Hu W, Zheng J, Pan M. Nail infestation: an atypical presentation of typical scabies. Lancet. 2018;391(10136):2272. doi:10.1016\/S0140-6736(18)31079-1
\n7. Ladizinski B, Rukhman E, Lee KCA. A 4-day-old neonate with a widespread vesicular rash. JAMA. 2013;310(9):971-972. doi:10.1001\/jama.2013.276963
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\nNgu\u1ed3n: JAMA.<\/p>\n
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