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Phần 2: Cập nhật các nghiên cứu chuyên sâu về bệnh withmore hay melioidosis

Chúng ta hiện đang sông trong bối cảnh giao thoa giữa con người-mầm bệnh-động vật và môi trường xung quanh, do vậy có thể một ai đó không biết nếu mầm bệnh có thể tấn công bất cữ lúc nào và gây nên bệnh Melioidosis. Trung tâm CDC và các cơ quan đại diện liên bang khác đang quan tâm đến các cuộc tấn công sinh học (biological attacks), bao gồm cả sử dụng mầm bệnh gây nên Melioidosis. Tại sao mầm bệnh gây Melioidosis có thể coi như một vũ khí sinh học? Nếu một người hay một nhóm người muốn sử dụng các mầm bệnh như một vũ khí, họ có thể dùng các mầm bệnh mà có thể gây nên bệnh Melioidosis vì chúng có thể dễ dàng tìm thấy trong tự nhiên ở một số vùng trên thé giới, hơn nữa chúng dễ dàng gây bệnh nhiễm trùng nghiêm trọng, nếu không can thiệp điều trị kháng sinh sớm, bệnh nhân có thể tử vong.

Bệnh Melioidosis có thể là một bệnh rất nghiêm trọng, tác nhân gây bệnh có thể kháng tự nhiên với nhiều loại kháng sinh nên sẽ gây khó cho vấn đề lựa chọn điều trị cho bệnh nhân. Do vậy cỉ có một kháng sính có hiệu quả. Nếu không điều trị có thể 90% dẫn đế n tử vong, ngược lại nếu điều trị kháng sinh thích hợp chỉ có 40% tử vong. Điều trị cần có sự chăm sóc tích cực để giảm tử vong đến mức thấp nhất và nếu có thể cứu lấy 90% số ca. Cần lưu ý, một số trường hợp có bệnh lý nền như đái tháo đường, bệnh phổi mạn tính, nghiện rượu, bệnh thận mạn và các bệnh lý liên quan hệ thống miễn dịch có thể dẫn đến bệnh nặng nền hơn rất nhiều.

Các bệnh nhân mắc Melioidosis cần phải nhập viện điều trị, khi đã hồi phục thì mới trở về nhà, sau khi về nhà có thể còn phải dùng đến kháng sinh trong nhiều tháng nữa. Điều tị kéo dài với mục đích làm cho kháng sinh giết chết các mầm bệnh trong cơ thể người và ngăn ngừa bệnh tái phát. Đôi khi trong thực hành lâm sàng, bệnh có thể rất khó chẩn đoán và dễ bỏ sót. Các triệu chưng của bệnh thường giống với một số bệnh nhiễm trùng thông thường như viêm phổi mắc phải bệnh viện, cúm, hay lao. Chỉ có một vài người được chẩn đoán nhiễm Melioidosis mỗi năm tại Mỹ, đối tượng đó mắc bệnh thường phơi nhiễm mầm bệnh do quá trình họ đi du lịch đến một quốc gia nào đó mắc từ nguồn tự nhiên. Vì có một vài người ơt Mỹ mắc bệnh mà hầu hết các bác sỹ không nghĩ cũng như không làm quen với bệnh nên có thể làm chậm tiến độ chẩn đoán và điều trị.

Tấn công sinh học tiết ra các mầm bệnh trong đó có bệnh Melioidosis có mặt trong không khí, nước và thực phẩm nên sẽ có nguy cơ nhiều đối tượng nhiễm bệnh. Chẳng hạn, nếu các mầm bệnh đào thải vào trong không khí, đặc biệt những nơi đông đúc và nhiều người có thể hít phải mầm bệnh. Nếu mầm bệnh trong thức ăn, con người ăn phải các thực phẩm nhiễm cũng có thể nhiễm bệnh. Bất cứ một người nào phơi nhiễm với mầm bệnh thì đều nguy hiểm và dễ nhiễm bệnh.

Bạn có thể không nhìn thấy, không biết mùi hay vị của mầm bệnh, vì thế đối tượng không biết dể tránh xa. Tấn công của mầm bệnh không được lưu ý mãi cho đến khi các bác sỹ gặp bệnh nhân có sốt và biểu hiện các triệu chứng hô hấp. Một khi các bác sỹ chẩn đoán bệnh nhân mắc melioidosis, họ sẽ làm việc với các cơ quan chức năng y tế để xem xét làm thế nào bệnh nhân mắc mầm bệnh này. Melioidosis là bệnh lý nhiễm trùng xảy ra tự nhiễn ở một số nơi một cách tự nhiên trên toàn cầu như Đông Nam Á và phía bắc Úc. Chỉ những nơi có mầm bệnh Burkholderia pseudomallei xảy ra trong tự nhiên ở Mỹ là Puerto Rico. Thường người Mỹ (ngoài Puerto Rico) mắc bệnh đã cso tiến sử du lịch và phơi nhiễm mầm bệnh ở các vùng trong tự nhiên. Một trong những lý do mà các cơ quan chức năng quan tâm đến bệnh này vì chung có trong tự nhiên dễ phơi nhiễm và gây bệnh Melioidosis có thể sử dụng như tấn công sinh học. Các tấn công sinh học do ly giải mầm bệnh có thể gây bệnh hoặc dẫn đến tử vong cho con người, gia súc và vụ mùa.
 
 
 
 
 
 

Nhằm giúp cho các đồng nghiệp và bạn đọc quan tâm căn bệnh nhiễm trùng nguy hiểm này, chúng tôi xin chia sẻ các công trình nghiên cứu trong thời gian gần đây:

1.Stanton AT, Fletcher W (1921). "Melioidosis, a new disease of the tropics". Far Eastern Association of Tropical Medicine: Transactions of the Fourth Congress. Batavia, Dutch East Indies: Javasche Boekhandel en Drukkerij.

2.A J Simpson; Suputtamongkol Y; Smith MD; et al. (1999). "Comparison of imipenem and ceftazidime as therapy for severe melioidosis". Clinical Infectious Diseases. 29 (2): 381–387. doi:10.1086/520219. PMID 10476746.

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14.Ngauy V, Lemeshev Y, Sadkowski L, Crawford G (2005). "Cutaneous Melioidosis in a Man Who Was Taken as a Prisoner of War by the Japanese during World War II". Journal of Clinical Microbiology. 43 (2): 970–972. doi:10.1128/JCM.43.2.970-972.2005. PMC 548040 . PMID 15695721.

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17.Dance DA, White NJ, Suputtamongkol Y, Wattanagoon Y, Wuthiekanun V, Chaowagul W (1990). "The use of bone marrow culture for the diagnosis of melioidosis". Transactions of the Royal Society of Tropical Medicine and Hygiene. 84 (4): 585–587. doi:10.1016/0035-9203(90)90050-O. PMID 2091358.

18.Peacock SJ, Chieng G, Cheng AC, et al. (2005). "Comparison of Ashdown's Medium, Burkholderia cepacia Medium, and Burkholderia pseudomallei Selective Agar for Clinical Isolation of Burkholderia pseudomallei". Journal of Clinical Microbiology. 43 (10): 5359–5361. doi:10.1128/JCM.43.10.5359-5361.2005. PMC 1248505 . PMID 16208018.

19.Francis A, Aiyar S, Yean C, Naing L, Ravichandran M (2006). "An improved selective and differential medium for the isolation of Burkholderia pseudomallei from clinical specimens". Diagnostic Microbiology and Infectious Diseases. 55 (2): 95–99. doi:10.1016/j.diagmicrobio.2005.11.008. PMID 16626918.

20.Puthucheary SD, Anuar AS, Tee TS (2010). "Burkholderia thailandensis whole cell antigen cross-reacts with B. pseudomallei antibodies from patients with melioidosis in an immunofluorescent assay". The Southeast Asian Journal of Tropical Medicine and Public Health. 41 (2): 397-400. PMID 20578523.

21.Limmathurotsakul D, Chantratita N, Teerawattanasook N, et al. (2011). "Enzyme-Linked Immunosorbent Assay for the Diagnosis of Melioidosis: Better Than We Thought". Clinical Infectious Diseases. 52 (8): 1024–1028. doi:10.1093/cid/cir080. PMC 3070030 . PMID 21460318.

22.Peacock SJ, Cheng AC, Currie BJ, Dance DA (2011). "The Use of Positive Serological Tests as Evidence of Exposure to Burkholderia pseudomallei". American Journal of Tropical Medicine and Hygiene. 84 (6): 1021–1022. doi:10.4269/ajtmh.2011.11-0114a. PMC 3110358 . PMID 21633045.

23.Lim KS, Chong VH (2010). "Radiological manifestations of melioidosis". Clinical Radiology. 65 (1): 66–72. doi:10.1016/j.crad.2009.08.008. PMID 20103424.

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25.White NJ, Dance DA, Chaowagul W, et al. (1989). "Halving of mortality of severe melioidosis by ceftazidime". Lancet. 2 (8665): 697–701. doi:10.1016/S0140-6736(89)90768-X. PMID 2570956.

26.Chierakul W, Anunnatsiri S, Chaowagul W, et al. (2007). "Addition of trimethoprim-sulfamethoxazole to ceftazidime during parenteral treatment of melioidosis is not associated with a long-term outcome benefit". Clinical Infectious Diseases. 45 (4): 521–523. doi:10.1086/520010. PMID 17638209.

27.Cheng AC, Fisher DA, Anstey NM, et al. (2004). "Outcomes of Patients with Melioidosis Treated with Meropenem". Antimicrob Agents Chemother. 48 (5): 1763–65. doi:10.1128/AAC.48.5.1763-1765.2004. PMC 400582 . PMID 15105132.

28.Chetchotisakd P, Porramatikul S, Mootsikapun P, Anunnatsiri S, Thinkhamrop B (2001). "Randomized, double-blind, controlled study of cefoperazone-sulbactam plus cotrimoxazole versus ceftazidime plus cotrimoxazole for the treatment of severe melioidosis". Clinical Infectious Diseases. 33 (1): 29–33. doi:10.1086/320878. PMID 11389491.

29.Dance DA, Wuthiekanun V, White NJ, Chaowagul W (1988). "Antibiotic resistance in Pseudomonas pseudomallei". Lancet. 1 (8592): 994–995. doi:10.1016/S0140-6736(88)91810-7. PMID2896855.

30.Suputtamongkol Y, Rajchanuwong A, Chaowagul W, et al. (1994). "Ceftazidime vs. amoxicillin/clavulanate in the treatment of severe melioidosis". Clinical Infectious Diseases. 19 (5): 846–853. doi:10.1093/clinids/19.5.846. PMID 7893868.

31.University of Oxford (18 December 2007). "A randomized double blinded comparison of ceftazidime and meropenem in severe melioidosis (ATOM)". ClinicalTrials.gov. National Institutes of Health. Retrieved 27 Jan 2011.

32.Simpson, A. J. H.; Opal, S. M.; Angus, B. J.; Prins, J. M.; Palardy, J. E.; Parejo, N. A.; Chaowagul, W.; White, N. J. (2000). "Differential antibiotic-induced endotoxin release in severe melioidosis". Journal of Infectious Diseases. 181 (3): 1014–1019. doi:10.1086/315306. PMID 10720525.

33.Bilgrami, I.; Roberts, J. A.; Wallis, S. C.; Thomas, J.; Davis, J.; Fowler, S.; Goldrick, P. B.; Lipman, J. (2010). "Meropenem Dosing in Critically Ill Patients with Sepsis Receiving High-Volume Continuous Venovenous Hemofiltration". Antimicrobial Agents and Chemotherapy. 54 (7): 2974–2978. doi:10.1128/AAC.01582-09. PMC 2897321 . PMID 20479205.

34.Shih H-I; Chuang Y-C; Cheung BM-H; et al. (February 2008). "Sporadic and outbreak cases of melioidosis in southern Taiwan: clinical features and antimicrobial susceptibility". Infection. 37 (1): 9–15. doi:10.1007/s15010-008-7324-8. PMID 18854938.

35.Harris P, Engler C, Norton R (2011). "Comparative in vitro susceptibility of Burkholderia pseudomallei to doripenem, ertapenem, tigecycline and moxifloxacin". International Journal of Antimicrobia Agents. 37 (6): 547–549. doi:10.1016/j.ijantimicag.2011.02.001.

36.Thamlikitkul V, Trakulsomboon S (2010). "In vitro activity of biapenem against Burkholderia pseudomallei". International Journal of Antimicrobia Agents. 35 (5): 514. doi:10.1016/j.ijantimicag.2010.01.002. PMID 20188524.

37.Cheng AC, Limmathurotsakul D, Chierakul W, et al. (2007). "A randomized controlled trial of granulocyte colony-stimulating factor for the treatment of severe sepsis due to melioidosis in Thailand". Clinical Infectious Diseases. 45 (3): 308–314. doi:10.1086/519261. PMID 17599307.

38.Chierakul W, Anunnatsiri S, Short JM, et al. (2005). "Two randomized controlled trials of ceftazidime alone versus ceftazidime in combination with trimethoprim-sulfamethoxazole for the treatment of severe melioidosis". Clinicl Infectious Diseases. 41 (8): 1105–1113. doi:10.1086/444456. PMID 16163628.

39.Chierakul W, Anunnatsiri S, Chaowagul W, Peacock SJ, Chetchotisakd P, Day NP (2007). "Addition of trimethoprim-sulfamethoxazole to ceftazidime during parenteral treatment of melioidosis is not associated with a tong-term outcome benefit". Clinical Infectious Diseases. 45 (4): 521–523. doi:10.1086/520010. PMID 17638209.

40.Chaowagul W, Simpson AJ, Suputtamongkol Y, et al. (1999). "A comparison of chloramphenicol, trimethoprim-sulfamethoxazole, and doxycycline with doxycycline alone as maintenance therapy for melioidosis". Clinical Infectious Diseases. 29 (2): 375–380. doi:10.1086/520218. PMID 10476745.

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