- 1. BNH MT HTBS.PHM THNH LUN
2. 1. NH NGHA v NGUYN NHN : Bnh mt ht (BMH) l mt vim kt gic mc
chiu, ly lan, tin trin mn tnh ngi, gy ra do tc nhn Chlamydia
trachomatis. Tn thng c trng kt gic mc bi: ht mt ht, tng sn nh gai,
mng mu, cui cng l so ho kt gic mc, gy lng qum, lng siu v dn n m lo.
3. 2. TN THNG C BN TI KT MC , GIC MC Thm nhim: Ht So Nh Tn mch. Mng
mu. 4. 3.CHN ON V PHN LOI. 3.1. Tiu chun chn on lm sng Ht trn kt mc
sn mi trn: ch tnh ht vng trung tm, khng tnh ht hai gc v b trn sn.
Cn phn bit ht vi sn vi, nang nh v chp. So in hnh trn kt mc sn mi
trn. Cn phn bit vi so do bng hoc so trong vim kt mc c gi mc. Ht vng
ra cc trn hoc di chng ht (lm ht). Mng mu trn gic mc. Cn c 2 trong 4
tiu chun chn on xc nh bnh mt ht. nhng vng mt ht nng c t l cao, ch
cn 1 trong 4 tiu chun. 5. 3.CHN ON V PHN LOI 3.2. Phn loi ( theo
WHO) - Bnh Mt ht c ht (Trachomatous inflamation Follicular - TF): c
t nht 5 ht trn kt mc sn mi trn, ht phi c kch thc t 0,5 mm tr ln. T
l TF ni ln s ly lan ca BMH trong cng ng. - Bnh Mt ht vim nng
(Trachomatous inflamation Intense - TI): kt mc sn mi trn b thm lu
(, dy ln), thm lu che m 1/2 cc mch mu trn kt mc sn mi trn. T l TI
ni ln s trm trng ca BMH trong cng ng. - So kt mc do Mt ht
(Trachomatous Scarring - TS): c so trn kt mc sn mi trn, So kt mc
phi d thy nh hnh di, vch hoc hnh sao, t l TS ni ln s tn ti trc kia
ca BMH trong cng ng. - Lng xiu, lng qum do mt ht (Trachomatous
Trichiasis - TT): c t nht 1 lng mi chc vo nhn cu, hoc c bng chng v
vic mi nh lng xiu, t l TT ni ln tim nng gy m ca BMH cho cng ng. -
So c gic mc do Mt ht (Corneal Opacity - CO): t l CO ni ln hu qu gy
m ca BMH cho cng ng. 6. 3.CHN ON V PHN LOI 3.3. Chn on phn bit. -
Vim kt mc cp: kt mc cng t ton b, nhiu r mt, khng c ht trn kt mc sn
mi trn. - Vim kt mc d ng: hay nhm ln v trn tr em hay gp c bit vim
kt mc ma xun, 7. 4. DCH T HC 4.1. Cch ly truyn bnh mt ht:B ti nhim
Chlamydia nhiu ln. Bnh mt ht ly lan d dng c bit l tr em.Tui mc bnh:
Trong cc cng ng b mt ht nng nht hu ht tr em u mc bnh 1-2 tui ( c tr
6 thng mc bnh), tr em c bnh mt ht hot tnh chnh l nhng ly truyn ch
yu trong cng ng.Cch thc ly truyn: qua ng tip xcRui: Rui mang tc nhn
gy bnh c trong d mt ngi bnh u vo mt ngi lnh v truyn bnh (ly truyn
cng ng).Khn mt, vi bn: Khn mt c dnh d mt ngi bnh nu dng chung s a
vi khun gy bnh vo mt ngi lnh, Ngn tay bn, Ngi trong cng gia nh 8.
4.2 Cc yu t nguy c i vi bnh mt ht: Thiu nc sch dn n mt bn, mt c
nhiu d, tay bn, qun o bn. Bi bm lm cho mt b kch thch tit nhiu d hn.
Bn: Mi trng c nhiu phn sc vt, phn ngi, rc thi s to iu kin rui pht
trin nhiu hn. Cht tit: D mt, nc mi v c th c cht tit ng sinh dc cha
nhiutc nhn gy bnh v d truyn bnh cho ngi khc. ng ngi sng trong gia
nh: Cng ng ngi sng trong mt cn nh chthp, kh nng tip xc kh nng tip
xc v ly nhim bnh gia ngi bnh v ngi lnh cng cao. 9. 4.3 CC GIAI ON
CA BNH I: Giai on bt u ca bnh Thng gp tr em la tui 2 - 5 tui. Tn
thng : thng l ht non, ht pht trin. Giai on I thng ko di t 3 thng n
2 nm. II: Giai on ton pht 1 - 3 nm Nhiu ht pht trin, chn, thm nhim
lm kt mc dy . Trn gic mc c th thy ht, mng mu. III: Giai on thoi
trin. Ht cn t hoc ht. Thm nhim to lan hoc khu tr. So nhiu. Giai on
ny ko di nhiu nm,gy bin chng. IV: Ch cn so trn kt mc, khi bnh. 10.
4.4 DI CHNG V BIN CHNG Bnh mt ht c th gy m hoc khng gy m hon ton tu
thucvo s tc ng qua li ca ba yu t chnh l vt ch (con ngi), cc yu t mi
trng v tnh gy bnh ca tc nhn Chlamydia trachomatis. Ti nhng ni c cc
iu kin v sinh mi trng tt, bnh mt ht nh, t ly lan. Bnh c th t khi
khng gy m lo. Ti nhng ni iu kin v sinh mi trng v v sinh c nhn km
thbnh mt ht li tin trin v ly lan mnh, bin chng nng (so, gim th
lc...) gy m lo. Nhng vng gi l nhng mt ht lu a vbnh mt ht chnh l bnh
mt ht gy m. 11. 5. IU TR V D PHNG. 5.1 iu tr. Thuc tra mt m
Tetracyclin 1% iu tr lin tc: tra mt ngy 2 ln lin tc trong 6 tun
lin. iu tr ngt qung: tra mt 1 ln vo bui ti trc ng 10 ngy trong1
thng x 6 thng lin. Hoc tra 2 ln/ngy x5 ngy trong 1 thng x 6 thng.
Thuc tra mt m Tetracyclin 1% c u im l d mua, r tin, c th tra cho tr
di 1 tui v ph n c thai, nhng nhc im l tra mt ko di nn kh thc hin
ng. 12. Thuc khng sinh theo ng ton thn:Ch nh trong nhngtrng hp mt
ht nng. Erythromycin 250 mg ung 4 vin/ngy x 3 tun. Zithromax
(Azythromycin) dng cho bnh mt ht hot tnh. Azythromycin tng t nh
erythromycin thm nhp mnh vo cc m t bo, m thuc tp trung cao v ko di
vi 1 liu dng duy nht ng 1 ln /2 nm. Ch nh: c gia nh ca bnh nhn b mt
ht hot tnh vng m trn tr em di 10 tui c t l TI 5%, TF 20%. Khng nn
lm dng khi tnh trng BMH khng qu trm trng. Liu lng : Ngi ln v tr trn
16 tui: ung 1ln 1g/nm (4 vin 0,25g). Tr em t 5 - 15 tui: 20 mg/1 kg
cn nng (thuc vin). Tr em t 1 - 4 tui: 20 mg/1 kg cn nng (thuc nc).
iu tr nhc li sau nm th hai vi liu tng t. 13. iu tr cc bin chng Vim
kt mc, b mi. Vim lot gic mc. Vim m ti l: M ni thng l mi. Kh mt: Tra
thuc, nc mt nhn to. M qum: y l phng php iu tr cn thit, khn cp phng
m la do bnh mt ht. Nu c di 5 lng xiu mc chc vo mt cha nhiu, cha c
iu kin i m ngay th phi nh lng xiu thng xuyn v tra thuc m
tetracyclin 1% hng ngy ri i m sau. Nu c t 5 lng xiu tr ln cn phi i
m qum ngay. 14. 5.2 Cc bin php phng chng dch 5.2.1. Bin php d
phng:- Tuyn truyn gio dc sc kho. - V sinh c nhn: ra mt hng ngy bng
khn sch ring. Ci thin iu kin sng: to ngun nc sch, dit rui, x l phn,
rc thi. 15. 5.2.2. Bin php chng dch T Chc Y t Th gii a ra chin lc
SAFE c p dng nhiu nc mni dung l: - S (Surgery): m qum sm nguyn nhn
trc tip gy m, x tr lng xiu bng t lng siu. - A (Antibiotics): iu tr
mt ht hot tnh bng khng sinh, nhm tiu dit nhim khun v hn ch ly lan
bnh - F (Face Washing): ra mt hng ngy bng nc sch, khn mt ring, 3
ln/ ngy nhm loi b cht tit kt mc, hn ch ly bnh trong gia nh v cng
ng. - E (Environment Improvements): ci thin v sinh mi trng cung cp
ngun nc sch, xy h x hp v sinh, chung gia sc xa nh, k hoch ho gia
nh, to ni sch s, rng ri. Cc chng trnh iu tr bnh mt ht ch yu da trn
vic duy tr khng sinhtra mt hng lot. Bt u iu tr tch cc v rng ri bng
thuc c kh nng lm gim ngun ly lan Chlamydia mt trong nhn dn. Sau tip
tc tra thuc ngt qung trong tng gia nh khng ch thm s lan truyn
Chlamydia t mt sang mt.
