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Cập nhật công trình nghiên cứu về bệnh lý viêm da do ngoại ký sinh trùng Demodex spp.
Viêm da gây ngứa và dị ứng do một loài ký sinh trùng nhỏ thuộc nhóm chân khớp Demodex spp lây truyền từ động vật sang người. Demodex là một giống các con vật ký sinh trùng rất nhỏ (tiny parasitic mites) sống trên hoặc gần các nang lông của động vật. Hơn một trăm loài khác nahu của Demodex được biết đến là các động vật chân khớp nhỏ nhất. Bệnh da do loài D. folliculorum và D. brevisDemodex folliculorum (D. folliculorum) và Demodex brevis (D. brevis) thường được phát hiện nhiễm trên người. Loài D. folliculorum lần đầu tiên được mô tả vào năm 1842 bởi tác giả Simon; D. brevis được xác định như một loài riêng biệt vào năm 1963 do tác giả Akbulatova. D. folliculorum được tìm thấy trên các nang chân tóc hoặc nang lông, trong khi đó loài D. brevis lại sống trong các tuyến bả nhờn liên kết với nang lông. Cả hai loài đầu tiên phát hiện trên mặt, gần cánh mũi, lông mi và lông mày nhưng cũng có thể phát hiện một số nới nào đó trên cơ thể người. Việc chẩn đoán nhiễm Demodex spp. trên người không phải là quá khó khăn vì kỹ năng xét nghiệm đối với loài động vật chân đốt này hiện tại đã thành thường quy xét nghiêm tại các cơ sở khám và điều trị bệnh chuyên khoa, nhất là các bệnh lý viêm da do Demodex spp. Gần đây, nhiều công trình nghiên cứu chuyên sâu về chẩn đoán, sinh lý bệnh và điều trị về các loài Demodex spp. cũng như phòng bệnh rất nhiều. Loài Demodex canis sống chủ yếu trên các con chó nhà, nhưng có thể thỉnh thoảng gây nhiễm trên con người. Mặc dù phần lớn nhiễm trùng do hội sinh (commensal) và do đó biểu hiện dạng tiền lâm sàng, chúng có thể phát triển thành một tình trạng goi là bệnh ghẻ lở do Demodex (demodectic mange). Do thói quen của chúng sống sâu trên các lớp bì, sự lan truyền thường chỉ có thể xảy ra thông qua con đường tiếp xúc và phơi nhiễm kéo dài, như lây truyền giữa chó mẹ và con qua trong quá trình bú sữa. Kết quả, các vị trí thường gặp nhất cho xuất hiện sớm các thương tổn do Demodex (demodicodic lesions) là trên mặt, mõm, chân trước và vùng quanh mắt. Bệnh Demodicosis có đặc điểm thương tổn gồm hai loại: Dạng có vảy (squamous) gây ra rụng tóc, rụng lông khô và dày da và dạng mụn mủ (pustular) thể này nghiêm trọng hơn, gây nen nhiễm trùng thứ phát (thường do tụ cầu) Staphylococcus có đặc trưng da đỏ, mụn mủ và nhiều nếp da gấp. Sự leo thang của hội sinh nhiễm trùng D. canis cần chú ý về mặt lâm sàng thường liên quanđến các yếu tố của phức hợp miễn dịch. Bệnh demodicosis có thể theo sau một tình trạng ức chế miễn dịch hoặc điều trị thuốc ức chế miễn dịch, hoặc có thể liên quan đến thiếu hụt miễn dịch di truyền. Điều này rất phức tạp vì bản thân Demodex được xem là ức chế đáp ứng miễn dịch T-lymphocyte bình thường. Cũng như thế, một số giống như là Dalmatian, loại chó American Bulldog và American Pit Bull Terrier dễ nhạy cảm với nhiễm loài này. Nhân đây, chúng tôi xin chia sẻ một số công trình nghiên cứu trên phạm vi toàn cầu về bệnh lý này để quý đồng nghiệp và bạn đọc theo dõi và rút kinh nghiệm. 1. [Demodex folliculorum a hidden cause of blepharitis]. Gunnarsdottir S, Kristmundsson A, Freeman MA, Bjornsson OM, Zoega GM. Laeknabladid. 2016 May;102(5):231-5. doi: 10.17992/lbl.2016.05.81. Icelandic. PMID: 27197131 Similar articles 2. Recent advances on ocular Demodex infestation. Cheng AM, Sheha H, Tseng SC. Curr Opin Ophthalmol. 2015 Jul;26(4):295-300. doi: 10.1097/ICU.0000000000000168. Review. PMID: 26058028 Similar articles 3. Blepharitis: always remember demodex. Bhandari V, Reddy JK. Middle East Afr J Ophthalmol. 2014 Oct-Dec;21(4):317-20. doi: 10.4103/0974-9233.142268. PMID: 25371637 Free PMC Article 4. Demodex blepharitis mimicking eyelid sebaceous gland carcinoma. Galea M, Sharma R, Srinivasan S, Roberts F. Clin Exp Ophthalmol. 2014 Mar;42(2):208-10. doi: 10.1111/ceo.12116. Epub 2013 Apr 25. No abstract available. 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