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 Bench Aids for the Diagnosis of Intestinal Parasites
O Worid Health Organization 1994 @ Introduction
Ldri n6i ddu

Xric dinh d0 dni ciia vi-mdt thi kfnh

Dd do tictr thrrdc cira vat c6 trong vi trudng, cdn c6 m6t thudc do o thi kinh (vi-met thi
kinh) cria kinh hidn vi. Tiry nhi€., tru6c khi ding, thu6c cdn phii duo. c xdc dinh dQ dai.
Vi-met thi kinh lh m6t dia thuj tinh phing trcn d6 c6 m6t thudc chia d0 drroc chia thhnh
50 hay 100 doan nho bang c\c vach kh5c. Nhfrng doan nh6 niy c6 gi6 rri dO dii kh6c
nhau phg thuoc vdo do ph6ng dai cui vat kinh sripuns.Gi6 rri d0 dhi ndy s6 du-o.c x6c
dinh bang c6ch dtng m6t vi-met ndn c6 khac mQt thu6c vdi c6c doan c6 dd dhi x6c dinh
trudcli 0, 1 mm duoc chia thdnh ciic doan nh6 hon 0,0 I mm.
Dd x6c dinh gi6 tri dO ddi cia vi-met thikinh, quri trinh duo. c tidnhinhnhu sau:

1. Nhdc thi kinh (dO ph6ng dai 10x hoac dO ph6ng dai khdc) kh6i kinh hidn vi vh vrn
th6o phia tr6n hoac thdu kinh ddy cia thi kinh, tuj,thu6c vdo cdch cdu tao cria n6.
Dat thrrdc do thi kinh & trcn vdng ch6n bdn rrong thi kinh sao cho mdr c6 chia d6
quay xudng dudi. Vdn lai thdu kinh vd dat lai thi kinh vdo kinh hidn vi.

2. Dat vi-met ndn tr6n mAm kinh hidn vi vd di6u chinh ti6u didm cira vAt kinh c6 d6
ph6ng dai nh6 vho m6t vii phdn ffen thudc, v6i thi kinh c6 d6 ph6ng dai 1 0x.

3. Di6u chinh vi-met ndn bang c6ch dich chuydn mAm kinh sao cho vach "0" cria vi-
met thi kinh tring khit m6t ciich chinh x6c vdi vach "0" cria vi-met ndn.

r,l r,'1,' l,'r r r I

Vi m6t thi kinh
I l'r lr 1| I
ll,
l,

Vi m6t ndn
rrri
Irttrlrrrrlrrrrlrrrrliriilrrl

4. Khdng di chuydn vi-met ndn, tim m6r didm kh6c & phia phdLi noi cd 2 vach cing
tring khit lOn nhau. Noi cd 2 vach tring khit thrl hai nhy sd phai o xa vd phia bOn
ph6i cria vach "0". Khoing c6ch niy sE thay drii tu), rheo vAr kinh sri aung. d dO
ph6ng dai cao hon, bd ddy cria c6c vach chia do c6 thd l6n, do d6 cdn phai x6c dinh
su tring khit ld & m6p phrii hoac m6p triii vach chia d6.

5. Dem sd doan tr€n vi-met thi kinh tr) vach "0" ddn vach trting khit ldn thrl hai. Vi du,
nhu o hinh v0, sd vach nly (drro. c chi boi c6c vach cham) tuong ducrng vdi 33 don vi
ovi-metthikinh.

Sau d6 ddm sd doan vach 0,1mm gifta vach "0" v) vach thf hai tring khit tr6n vi-
metndn, &ffCnhinh (duo. c chi banghinhmii ren) sdneylA O,22mm.

7. Tinh d6 ddi trOn vi-met thi kinh:

don vi thi kinh = 0,22mm
0.22
don vi thi kinh = mm = 0,0066 mm = 6,6 pm.
JJ
-
Nhu vay, 1 don vi thi kinh ld 6,6 pm cho ri0ng vdr kinh dang sri dung trOn. M6i vAr
kinh tren kinh hidn vi ph6i duo. c x6c dinh d6 dhi ri€ng biOt.

8. Khi tdt citcdcvdt kinh dl drroc x6c dinh do dii, chudn bi m6t bidu dd don giin dd
tnnh bdy so do do ddi cho m6i var kfnh.
Bench Aids for the Diagnosis of Intestinal Parasites
@ World Health Organization 1994 @ lntroduction
Ldri n6i ddu

PhAt hiOn Kj sinh tring dudng ruOt

Muc ti€u ctr' cdc nhh x6t nghiOm kinh hidn vi trong chdn dodn nhiOm kf sinh trirng
drrong ruOt ld x6c dinh su c6 r-at cira c6c ki sinh tritng trong phAn, c6 thd nh6 nhu k6n
aon bao hoac l6n nhu tnlng giun s6n, vd xdc dinh chring mOt c6ch chinh x6c' Trong
mor vhi truong hqp, sd.tuong c6c td chrlc nhy trong phan it, kh6ng dir dd c6 thd ph6t
hi6n duo.c Uang cacn x6t nghiem truc tidp vdi sd..luong phdn it, nghia-lh bang c6c tieu
biLn tryc tiep (iem bnng 1). Them 1 gioidung ciich Lugol vio tieu ban thuong lim 16
c6c dac didm hinh thd quan trong cria kf sinh trung, girip cho vioc x6c dinh chring.

Ph6t hiOn c6c thd Tiophozoites (trr du6ng) vh k6n don bho trong c6c ti6u ban phdn
kh6ng nhu6m lA mOt di6u kh6 khan, ngay ci v6i c6c x6t nghiOm vi0n c6 kinh nghi0m vir
& cac ai6u ti€n rhu rhdp vi chudn bi tiOu bin lf trrong. Trophozoites bi hui'hoai rAt
nhanh do d6 c,6c mAu ptta" phii duo. c x6t nghiOm n gay, cdc tiOu bin cd dinh chudn bi dd
nhudm hay c6c m6u vdt duo. c bio quAn trong c5c dung dich cd dinh nhu: merthiolate -
formalin - iodine (MIF) cdn duo. c x6t nghiOm cdng nhanh cdng tdt' Mac ddu x6t nghiQm
rruc ricp v6i c6c m5u phdn duoc bio quin bSng MIF kh6 tien loi, nhtmg c6c x6t nghiem
vi6n ptrii cO tinh nghiem trong viec nhAn dang kf sinh trirng tren c6c tiou bin udt.

Ngrrdi ta thudng y€u cdu c6c ti6u bin ph6n duoc nhuom cd dinh dd dinh loai cdc don
beo kf sinh. Tieu bin c6 thd duo. c chudn bi tir phdn tuoi hodc c6c mau phdn duo. c bio
quin trong polyvinyl alcohol (PVA) hay trong sodium acetate - acOtic axit - formalin
tSefl. Cic cn* bit qu6n ph6n khrdc nhrr formalin 107o, kh6ng ding dd chudn bi ti€u
bd.,n nhu6m. C6c chdt nhu6m cd dinh thudng duoc sit dung nhdt hi0n nay ld trichome vi
sat hematoxylin. Trichome dO srl dung vd dic bi6t tdt ddi v6i c6c ti6u bin ldm tt ph6n
tuoi hay tt mau phAn duoc bio quin bang PVA. Ngudi ta khuyon khdng non ding vdi
c6c mau phdn duoc bAo quAn bang SAF. Sat hematoxylin kh6 srl dung hon nhtmg cho
ker qui rat tdt v6i tdtcacdc loai mau phan. Trong mdt vhi trudng hqp d4c biet, ding c6c
ky thuat nhu6m dac biet, nhrr lh nhuOm nhanh bing axit (acid fast stains) s6 ph6t hiOn
cic td chrlc coccidia tOt hon, nhu ld Cryptosporidium vd Cyclospora. Tham chi cdc bho
ttr (spores) nh6 cira c6c loii tidu blo tri (microspore) cfrng c6 thd ph6t hiOn duo. c trong
phan nhd c6c phuong ph6p nhu6m dac biOt holc cii tidn.

Hdu hdt cdc loai don bio c6 thd x6c dinh duoc & ti6u bin nhu6m cd dinh. Tham chi c6c
ddu hieu tinh td vi nh6 nhdt cira c6cky sinh trung niy cflng c6 thd nhin thdy duoc. Nhu
dd tha'y tr€n c6c hinh inh chup o kinh hidn vi, miru cita c6c k! sinh trirng vd c6c ydu td
c6 trong phAn c6 thd thay ddi d6ng kd, ngay ci khi sri dung cing mot chdt nhu6m. Mdc
dAu trrmg giun s6n c6 thd ph6t hiOn duo. c tr€n nhfrng ti€u ban phdn trroi truc tidp, hiOu
qua ph6ihien c6 thd cao hon ndu c6c phdng x6t nghiem dirng phuong ph6p tap trung
O^* gla, (xem bing 2) dd tr6nh b6 s6t c6c k! sinh trung c6 sd luong rAt it trong phAn.
Trong m6t vdi truhng hqp, vi du di6u tra trong m6t c6ng d6ng lon, nhfrng muc tiOu riOng
biot s6 duoc gi6i h4n dd phSt hien siin m6ng hay giun truydn qua ddt (giun dfia, giun t6c,
giun m6c). M6t cii tien cta phuong ph6p x6t nghiem truc tidp, k! thuAt Kato-Katz (xem
LAng 3) dac bi6t thich ho,p cho di6u tra thqc dia cdc benh k! sinh trung ndy vi n6 c6 thd
girip aann gi6 cudng d6 nhiem. Chring t6i cung cdp nhfng hinh inh cria c6c loai tnlng
glu.r ran dudng ru6t phd bidn nhAt thuong gap & trong phan, vi trong vdi truong hqp,
tr6n c6c ti6u bin Kato-Katz.

Cudi cing, didu hdt srlc quan trong ld c6cki thudt vi€n phii c6 khi nang do nhfrng vdt
xudt hieritrong vi trudng. Viec d6nh gi6 chinh x6c kich thu6c cira kf sinh tring lh di6u
quan trong Oditrdn do6n dring. Thu6c do thi kinh c6 khA nang st dung cho hdu hdt c6c
lbai kinh hidn vi. Thrr6c do phAi duo.c x6c dinh do dii vdi su girip dd ctra m6t vi-met
ndn, bang c6ch srl dung nhfng chi dAn duoc cung cAp 6 trang sau.

Tham khio th6m

Ash L R, Orihel T C. Parasites: a guide to ltbot'tttt)t'J'protedures.and identification' Chicago'
ASCPPress 1991. (Kf sinh tring: Hu6ng den k, thuat va dinh loai ophdng x6t nghiem).
AshLR, Orihel TC. Ar las ot''hulmanpaisitololgy,3'i ed.Chicago,ASCPPress, 1990. (At - l6tki
sinh trirng ongudi)
Basic laioraiory methocls in medical parasitology. Geneva, World Health Organisation, 1991.
(K! thuat cobin phdng x6t nghiOm trong ky sinh trung y hoc)
Bench Aids for the Diagnosis of lntestinal Parasites Plate I
@ World Health Organization 1994 Bing I
Ti6u bin phAn truc tidp - Ti6u bin bang nudc mudi
sinh lf vi lugol

Dung cu vi ho6 chdt:

1. Que h'y phan
2. Larnkinh (75x 25mm)
3. L6 kinh (lamelle)
4. Bithodc dung cu dd ghi nhdn khong bi nhob, xo6.
5. Lo nh6 giot c6 chrla i
Dung dich nudc mu6i sinh lf (O,85Vo - 8,5 g4)*
Dung dich lugol (dung dichi6tl%o)
* Dd chudn bi ho6 chat, c6 thd xem tdi liOu WHO, Basic laboratory methods in medical
parasitology, l99l (ISBN 92 4 159410 4). (Ky thuat co ban phbng x6t nghi€m trong ky sinh
trirngyhoc).

1. Dung brit chi s6p hoac dgng cu ghi nhdn kh6c, vidt tOn b0nh nhAn hoac sd hieu m6u
phAn vingiy x6t nghiOm &phiatr6i crialamkinh.
2. Nh6 m6t giot nudc mudi sinh lf vio phdn gita nta b€n tr6i lam kinh vi nh6 m6t
giot lugol vdophdn gifa nrlabOn phii lam kinh.
(Ghi chfi: tiOu ban bang lugol thuong ding dd x6t nghi€m don bdo, it ding ddi vdi
x6t nghi€m giun s6n).
Ding que ldy phAn, ldy mOt m6u nh6 cira phAn (khoang 2 mg, c6 kich thudc bang
khoang ddu que diOm) vd dAt vao giot nudc mudi sinh lf, th6m m6t m6u phan tudng
tuvho giot lugol. Ti6n ddu phAn v6ri giot dung dich dd tao thanh mOt dich treo
Gnnh2).
Phir m6i giot blng m6t 16 kinh theo c6ch: cdm 16 kinh & m6t g6c, cham m6t canh
m6p cira 16 kinh vdo giot dich treo vdL ha tt ti 16 kinh trOn phidn kinh sao cho khOng
tao thinh c6c bot khi (Hinh 3).
(Ghi chil: tiOu ban lf tuong c6 chrla 2mg phan phii ld m6t tiOu b6n ddng nhdt kh6ng
qud diy dd c6c mdu phan c6 thd che ldp tnlng giun sdn vh khdng qu6 m6ng dd c6 thd
thdy nhftng phdn trdng).
5. X6t nghiCm tiOu bin bang vAt kinh 10x, hodc n€u cdn dinh loai, ding v6t kinh c6 d6
ph6ng dai cao hon m6t c6ch c6 h0 thdng (nghla ld hoic soi theo chidu l6n hodc
xudng, hodc soi theo chidu ngang 2 b0n) dd dim bAo quan s6t toan bO c6c phdn nam
trong 16 kinh (fnnh 4). Khi c6 vAt thd hodc td chfc nghi ngd, chuydn sang dO ph6ng
dai cao hon dd quan s6t hinh thd chi ti6t cria c6c vit nghi ngd.

lnnh 4

ffiH
 /A
iench Aids for the Diagnosis of Intestinal Parasites Plate 1

O Wo.n Health Organization 1994

W Bingl-Giunsdn
-/<-

\
I
::

55-75 pm x 35-50- pm' miru Tnlng Ascaris (gtun <iria) rhu tiirii didn hinh trcn
Trdns Asr.aris lumbricoidcs rgiun dta) rhu rinh binh thudne. kich thtldc co cric nhii d6 thav tren tieu ben Kalo-Kalz.
?jli'#1,';f;;iil;';;"6;t;t';;;';ai,; i;ilr'i'i uui tiei theo phrn rning
'ti;i
Mmat. fl

&*

Trring
.i+

(giun tlfia) chua thu tinh didn h)nh. Nh{lng trrlng niy ddi v)r c6 kich thuoc
+ ...-

l6n hon nhidu

ITnmg (giun dfia) thu tinh (phia tr€n'
b6n phei) vir chua thu tinh trcn ticu bin Kato
trfng thudng lh c6c
(a5_is um x $141 pm),v6 m6ng va m6t lop nhd xi xi, rho, kh6ng ddu. Bon trong Katz.
hat vi kh6ng c6 bdt k! mOt td chrlc nio.

q
,&

:
t-

..?

Ascaris (giun d[a): trfng binh thuong vd bi Tnlng Ascaris (giun dta) (dudi) vi trung
Asccris (Giun dfla): D6i khi tnlng thu tinh binh Triciuris (giun t6c) (tron) tren tiOu bAn Kato-
mdt v6 (rcn, bcn phAi) trcn tieu ban Kato-
thuimg kh6ng c6 lop nhri vd duoc xem nhu ld Kalz.
tr(mgbi "matv6". KaIZ.
t-
Bench Aids for the Diagnosis of Intestinal Parasites
@ World Health Organizatron 1994 @ Plate
Bing
l
2

X6t nghiem tip trung trfrng - formalin-ete /

etyl axetate/ xang
Dung cu vir h6a chdt
1. M6y ly tAm c6 cdc hd chrla dttoc c6c dng ly t6m 15ml d6y nhon. Ding mdy c6 nip i*Ether
dAy kin. Fnnh 1
+Manh chdt beo

2. dng ly tAm, 15 mld6y nhon (d6nh ddu vach 10 ml'bing brit chi md).
3. Binh, dd pha chdhodc "squeeze" bang nhua, the tich 250 hoac 500 ml.
4. Quequdy l45x2mm. l*Formalin
5. Cdc dongnh6 25, 50hoac 100mI.
6. Gac ngo4i khoa hoac lu6i loc kim loai hay nhua c6 kich thudc 16loc 400pm.
7. Phi0nkinh (lam) 75 x 25 mm.
8. Lri kfnh. \i
3
I
9. Pipet, dng hrit pasto c6 qui b6p cao su. \/o
10. Nritcao su cho dng ly tAm. Y ican i
11. Gi6ddtube
12. Dung dich formalin 107o*.
13. Ete, etyl axetat hay ndu khOng c6 cdc dung m6i nhy c6 thd ding xang (Chri j': Ete ld
mdt chdt dO bay hoi vd sC ch6y ngay lAp trlc ndu gdn mdt ngon hla hay tia lira. BAo
quin trong c6c binh holc lo rOng dat trOn c6c gi6 tho6ng & noi m6t trong phbng thi
nghi€m. Khdng dat cdc binh chrla ete di m6 trong ttr lanh vi hoi sE thoiltra ddy trong
tir vh c6 thd gay ra nd khi m& cta tir).
14. Lonh6giotc6chrla: Ilinh 2
Dung dich nu6c mudi sinh lf (0,85Vo - 8,5 gfi)
Dung dich lugol (dung dich i6tlVo)

* Dd pha ch6 h6a chdt, tham khio tii li€u WHO, Basic laboratory methods in medical
parasitology, 1991 (ISBN 92 4 15 4410 4). (Ky thuat co bin phdng x6t nghiOm trong ky sinh
trtng y hoc).

Ti6n hDrnh
1. Ding que ldy phan ldy 1-1,5 g phAn cho vdo 10 ml formalin trong tube ly tdm vd qudy
ddu tao thdnh m0t dich treo. o
I
2. Loc dich treo qua ludi loc c6 kich thudc 16 loc 400 pm hay qua 2 lop vii gac vho 1 tube ly i
tAm khdc hod'c vlo I cdc dong nh6. 86 ludi loc.
3. Th0m formalh1.07o vdo chdt dich trong tube dd dat drro. c thd tich 10m1.
4. Th0m 3,0 ml ete (ho5c etyl axetat ho6c xdng) vho dich treo & trong tube vh trOn ddu bang lnnh 3
c6ch ddy n6p cao su vi l6c manh trong vdng 10 giay.
5. Md nip cao su, dat tube vho m6y ly tAm, cAn bang tube vd ly tAm o tdc do 400-500 g
trong 2-3 phrit.
6. LAy tube ra kh6i m6y ly tdm, ch0t dich trong tube chia thnnh 4 lop:
- Ldp trOn cing: ete (hay etyl axetat hodc xing)
-Loptht2i motnft gdm c6c minh chdt b6o dinh vio thhnh dng.
- Lop thr13: l6p formalin
-Ldptht4: can(H1)
1. D[ng que ldy nhg nh]ng lop chat b6o ra kh6i thdnh dng bang c6ch xo6y theo hinh xo6n
vi sau d6 dd 3 l6p trOn ctng bang mOt dOng tiic nhanh gon, d6c nguoc dng ly tam it nhat 5
giAy. Sau khi llLm xong dOng t6c tr6n sE c6 m6t luong nh6 ch6t dich cdn lai tr0n thdnh dng
chAy tr& lai can o ddy Ong (H2, H3).
8. Tr0n chdt dich vdi can (dOi khi ndu cdn thOm 1 giot nu6c mudi sinh lf dd c6 dir dich hda
cln) bang pipet thiry tinh. Lay I giot can nh6 l6n phidn kinh, phir 16 kinh vi x6t nghi6m.
Cf,ng c6 thd liLm thOm 1 ti6u bin nhu6m lugol (H4).
9. X6t nghiOm ti0u bin m6t c6ch c6 h€ thdng ad aim bio soi todn b0 bd mat 16 kinh &vdt
kfnh 10x, vh ndu cdn dinh loai, soi & vat kinh c6 d0 ph6ng dai lon hon (xem bing 1, H4).
Khi c6 vat thd nghi ngd, ding d6 ph6ng dai cao hon dd quan s6t hinh thd chi tidt ldn hdn
cira v6t thd nghi ngd.
Bench Aids for the Diagnosis of Intestiqql PiI4q(qs Plate 2
@ World Health Organization 1994 Bing 2- Giun s6n

ffi'

"
,T1,
;J;
,::.fq
!, .

-*
'*'
Tnitrg ..i.rrrr;'i.i (giun ilila) (tr6n), 7i ir:lruris (giun Tr(mg Trichuris trichura (giun t6c) didn hinh, Tr€n tiOu bin Kato-Katztr(nlg Iilcftrrris (giun
t6c) (gita) vi *a akwoyn (giun m6c) (du6i) trong kich thudc 50-55 pm x 22-24 pm, v6 nhdn, mdu t6c) c6 thd tr6ng l6n hon vi bi phdng 16n, b6n
cr)ng m6t vi trudng, minh hoa sutufirg quan kich n6u, nh6 l€n o 2 ddu (n6p) vn c6 chrla mOt td bio trong bi tho6i h6a. Phdn nhd & 2 ddu vi ct{c lop
thudc cira chring. trrfug duy nhdt. v6 kh6ng x6c dinh16.

%_3

a
I
Tnlng f{uokw;.rrrn (giun m6c) & trong phin co hinh bAu duc didn hinh, v6 m6ng, trong .odt, ti.h thud. 6O-
Thlng F{rxrflrw*r'rm (giun m6c) tr€n ti€u bin
Kato-Katz thudng kh6 trdnvlnhAn phAn chia
75 pm x 36-40 pm. Trung thuong o giai doan 4-8 nhdn hoic 6 giai doan ph6t tridn mu6n hcm trong m6u
kh6 nhin thay. I(hf hau n6ng.-glyxerin se lirm
phAn duo. c gifr6nhi€tddphdng x6tnghiOm thdm chichitrong vdng vii gid.
tnirrg quri trong vh khong thd nh)n thAy duoc
sau khi lirm ti6u ban 30-60 phrit.

Nhi6m giun ltton Strongyloi.des stercoralis

Tning giun 'frichostrongyle rdt gidng tnfug Ternidens deminutus ld mdt loii giun strongyle
khdc nhi6m cho ngudi, chri ydu & ving Nam Chdu thudng duoc chdn do6n bing su c6 mat ffong
giun m6c, nhtmg l6n hon (75-95 pm x 40-50
Phi. Trrlng rdt gidng tnfug giun m6c, kich thu6c phAn cria du trung rhabditoid (dang que) giai
pm) vi hinh dii hon. Tnlng thudng & giai doan
ph6t tridn muOn cira su phAn chia nhin khi bii khoing 85 x 50 pLm. Trring thudng & giai doan x 14-
tloan ddu ti0n, kich thu6c 180-380 pm
xudt theo ph6n. phin chia mu6n khi bii xudt theo phAn. 20 pm. Au tring c6 klioang mi6ng ngan,
du6i manh vd mdm sinh duc 16 . (mfli ten)
Rencle Aids fon the Dra nosis of Intestinal Panasites Dl.r^ ?
@ \Yorld Health Organization 199.1
i1dr5
1{f' tliuat l{ato-" ittt"z - Lim tieu b6n ptrran d}y bang
c;llcunrane
l:ra{
-1 t\..r".1
1
D:3ng c'+ vi h-i chdt t)
1. Que ldy phda \\
2- LuOi loc ba-ng thdp kJr0ng gi, ni-lon hay plastic.: 60-105 mar lu6i (H1). tl l1 \i
3. Txm c5 ho tiong bing rhdp kh0ng gi, plastic irly Uia (Ht).
Hd done phin c6 kich thu6c iiir6c nhau do'nhidu nu6c khdc nhau sin xuft. ivlot ho
drr&rg i<inh 9 mm tr0n mdt tdn-r dly 1 mm chiia tiuoc 50 mg phAn, m6t hd dulng
kinh 6mm tr€n mQt tflm dly 1,5 mm chrla drroc 41,7 mg phtn vI m6t h6 dulng Hnh
i{.il.h l
,r --- I

r
6,5 mm trOn mQt t{m d}y 0,5 mm chrfa duoc 20 mg phin- Tdn.r duc l6 phai duoc riJu
chudn hod trong tlng nu6c vI phii iuon luon sri Jung ho dong iinq ii.h thu6. cc
<ji.m bio khi. nang so s6nh cic s6 1i0u x6t. nghi3m vi ri 1e r'i cuong d0 nhiim.
4. Que gat phan bang nhu. a (H1)
5. Phi0n krnh (75 x 25 mm)
6. Cidy cellcphane th{m nrr6c, diy 40-50 uni, cl,t than;r tu.;r: mie'nt ;i ^<i;n lhuic
x 50 pm hay 25 x 35 um (H2).
7. Lo tliy bang c6 n6p (H2).
8. i(gp (pince)
9. Gify v€ sinh hoic gify thdm. 't.
10. Ci{y bdo.
11.Dung dich glyx0rin - xanh malach:t :or.; s:.,'t:-n - r3n; lii:;rvie:r 'l rtl .lurs ii:n
3Vo xenh malactrit hoac3Tc xanh melhrle;l :r.n: nui: :h:n .,rc liC inl tirx:nn ..e
100 ml nudc c{t, trdn diu). Cic ma::h ::llorh:n: J'ro: ;lsarn irc;r: dung uich niv ii
nhat 24 h tru6c ]Jri st ou;ri.

Tien liinh
1. Dat mOt miu phan;iho :icn,eiiv bio hoac giay loai va in manh luoi loc rrtn nr;iu
phln sao cho i phin :iin sJ duoc loc oua minh lu,ii loc va tu lai & phfa tren luoi ioc
(Fi3). | :.1':-.:. l- l
2. DDn-q cii cat pran co cenh phing nao trCn miit ludi di tip trung lutrne phlrn tii tlutrc
ioc (H.i).
J. Dit tam c6 hd dong vio giua phieh kinh vi lay phin ri ciii gat phAn cho vio h,r
i,;ng sao chc i.rp ijiv hcan toi.n hd dong (H5). Ding mdt canh crla ciii gat phln gat Inni. -l ,tila.:,t9
phia tr0n hd dd lay rii phiin phin rhla kh6i mip hd (cdi gar phen vi lrr6i ioc co thd U5
di, hoac nOu nra cin thXn cd thj dDnr lai).
A
Cdn thAn nh{c tfm dong, sao cho phdn phAn trong hO dulyc gifi lai tr0n phi0n ljnh.
5. Pht phan bang minJr celiophan dI duoc ngam rru6c v?ro clung dich mlu (I-i6). N1inh
cellophan phii r{:. ir6t nCu phen khd v} cd rhi ft u6t hcm niu phan mtim (n0u qu{
thrla dung dich glyxerin tr0n bd mat phia tr0n cia minh ccllophan, c6 thd rhlm balg
giay vQ sinh). 'l noi khi hlu kh6, glyxerin qud thr)a sE lim chflm, nhtrng klOng thi
trdnh duoc qu6 trinh kho. _ilrntr. 5
6. LAt sfp phieir li,nh v) 6p r,,anh m6u ph1n duoc phri minh celiophan tren 1 prrin
krn.tr khiic hoac tr0n mOt tr3 rnat cdrrg nhdn nhu l) phijn dd hay ng6i phan.q. I)lr.ln s::
trii ciiu gita phiOn kinh r,) rrinh c"llophan (H7). Sau khi ri0u bin dI C',rcrc iinr
ironc, niin q.ra tieu ban phii c5 xha ning doc duoc chI in rr0n bio (H8). ,t-il
1. \hi; cin',han phiJn li.rnh birlr :rich truot nhe nhinc n.i vi mor ban di rriih i:i:r __= =_-_-_ )
ri:h hoic ji:-: ticr r:inn gil_v cciiophan. Dar liCu ban rren nrlnt L:tnh, mit c5 _ria;.
ceilc:-,,..r.1 -:r. \,;6; c:r'hoi lrcn,l !-"i ,.lr:ter:n larn ir:n: miu p:t;:t. riinir.6
8. -D5i voi cdc ioai tru::: (tn: l;.j-rr giua mo:t gi[ lieu bin i
5ij hoac liu hon d nhi0t
do uong phdng Cj iim r;ons ;:.iiu r.r:n lnr,-c.:;ri xil nrrlem rrin kinh hiin vi. Di
li.m rrong ntanh, tiOu ba.r c5 rhi i;t iron: ri am r0 tC na) tr-.l. lisr duoi 6nh mat
trii trong vii phrit.
9. Trung Ascark vh. Trichuis cbn c6 thd quan sdt duoc vi nhln bi& sau nhidu thdne
bin nly. Trunq siun nr6c duoc lim trong nhanh v] khOng quan sdt they saLr
tr0n ti0u
I-ihh. 7
30-60 phrit. Tni:rg s/rrr i,ring cil thd nhen biOt duoc sau nhidu rhdng, nl;ng d ving c6
b3,-, s5.n nSng luu hanh, t6t nhdt 1) nOn x6t nghiOm ti0u bAn trong vdng 21, gid.
10. Ti0u 5in cdn duoc xJt ngiritm mQt c6ch c5 h0 rhdng (bing1, hinh 4) vi sd tring cia
n:ii lo).i cucc ghi iai. Sau ti5 nha;r ,,.:i h$ s6 tuong ring s0 cl:o sd tr6ng trong lglhan
( nhAn vfi 20 ndu <ir)ng hd clong 50 mg,, nhln vrii 50 cho h6 dong 20 mg vI nhin r,6i
2'i cl:o hd cionr ,t1,7 mg). Truing. I -r sd lrrong tning kin, dd duy tri nrQt phucrr
:h1l cl.1:.1: x;J tio:1. lJri r::';-:r rl:r-r rl:,i gian soi, nsuui ta khuy0n nen ciini: l'.:.;t:
t'in3:llurr-.:':.i: l:,,- lr-.:r-. ! c.l ..,J: C,:r:1..j:.:h \,'lil 0,i nrolllit. Filnir. 3
()ien !::.;;c !cbcrarcn'ttc!|;c:!.r ::t ne.l!ccl pcrc:i:--!c1..., ',"1lC, 1991). (I(i .h:rit co
b:in pi:dng xdt trons :7 s;rh ti)ng y hoc)
r

Plote 3 - Helminths
@ Worlcj Heaflh Organization 1SX br, A i rnea!

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!r()nt va I gai rir d
Ul .Srrfr, ttn lront c6 nriracir.lium (ru uirng lOng). Ndu gai bi clrc ldp, tn nh: vio ld kinlr phri (l:urEn) c6 rdc dinh nlrd vlo kfch 0rudr-, hinh ,llrns vl su
tlri l)nr ruCt hifn clrtiog. c6 ntnl cir tai bcn.

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I rrnrg Sciirlorona japonicum nlld lrdn tnnrg maasoai vi tnm8 S. hcmolohiua. Krc[ thrrrlu 70- l(X) l{u
S.
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'lron rreu b,in i(iio-Ki,tz gri :ue riln)r
r 55'65 plr, ltlrilr rJarg cd khuynh hudng tu trt)n toi bliu rluc, v6 rrrong, til lxtn nhd vi lhong rd.'lnhlg cd liaponicum r0l lrieltl nhln tlrlv vil rru.tr r'llrr'
.'lrur rnlra<;idiurrr. lltudng r:ic rttirilr plrArr tlilrlr v]o bd rrml lnmB ya c() thi e lr l:'lp gur. trd ntrrr klrrlng rir rCt nlrurlt. X.i.: rlirrlr 'rIrr r, rr
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& plrlr.:u.1i vit I rrnrg,,:i.r S. inlcrctrhrlum tlrurnrg l,"rr tr,rr tr
,,rrr lnntllr,:rrslnniyrlrudngritntlrlytitr0rrlinrt6clrLiu,nhurg,l0rIlrr,irng,rltlrC ttrtttlrdytrortgphlrr S. heomololiunr, kiclr tlrtrit: llrorirrp l.llt
lrr, tlrl('JnI llIIl llrly lr(,r)f 1,11{11 r.l ,r, rs I 1 i
Bench Aids for the Diagnosis of Intestinal Parasites
@ World Health Organization 1994 @
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@ World Health Organization 1994 @
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Bhng$- Giun s6n
Plate 4

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Tr(tngClonorchis sinensis kich thudc 27-35 pm Tr(rng }fetagonimus lokogav'al c6 kich thudc Tr(tng Fasciola hepatica thudng c6 kich thudc
x 12-19 pm, c6 1 nip diy vd thulng c6 1 gai nh6 20-30 pm x 15-17 pm, c6 m6t n6p kh6ng 16 vir 130-150 pm x 63-90 pm, c6 1 nip kh6ng r5,
E phia ddi dicn. V6 tnlng c6 thd c5 c6c minh khdng c6 nhri hoac gai o phia ddi diOn. V6 tnrng khdng c6 ph6i vi v6 thudng kh6ng cdn cldi E phia
b6m nh6. Tning trong phdn thudtng c6 1 thuirng kh6ng c6 ciic minh bdm. Tning trong ddi dicn (phdn niy kh6ng nhAn thdy A trung
miracidium. Tnlng c0ng tuong tu. ph1n c6 chrla 1 miracidium. cung c6 hinh the tuong tu).

Tr(tng Paragonimus westermani thudng c6 lrimg m6t loii o Diphyllobothrium latum Tnlng lodi s6n dAy c6
kich thudc 80-120 pm x 45-70 pm, miu vlng Chdu Phi, thuong nh6 hon trfng nip niy thudng kich thudc 58-75 pm x 40-50
ndu, v6 diy, kh6ng c6 phdi khi 6 trong phdn hodc kich thudc 50-95 pm x 35-55 pm, vinip it16hcrn. pm, khi 6 trong phan kh6ng c6 ph6i vi c6 thd c6
dirm vd c6 7 nap rdr ro. V6 ddy 6 phia ddi di€n u hoac 16i nh6 0phia ddi dicn n6p.

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Trung lodi Taeniuthtdnggidng nhau, duimg kinh
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kich thu6c 70-85 Tr(mg Hymenolepis nana thudng hinh cdu,

31-43 pm, c6 thlnh v6 dhy, gi6ng hinh 6ng vi pm x 60-80 pm, hinh cdu, miLu nAu vang, c6 1 ph6i duong kinh 30-47 pm, c6 v6 m6ng, ffong va 1
chfa I ph6i 6 m6c, goi ld oncosphere (Au trirng 6 6m6c. Kh0ng c6 cdc soi nh6 nhutrrlng oncosphere 6 m6c. C6 2 cuc diy 6 trOn mdng
m6c).50i khi xung quanh c6c tnlng ndy c6 thd tdn xung quanh oncosphere, ft d6 c6 4-8 soi nho k6o
tai 1 ming ph6i nguy0n thiry m6ng vd trong ddi vdb trong khoAng khOng gian nim gita
oncosphere vi lop ming ngoiti.
Bench Aids for the Diagnosis of Intestinal Parasites Plate 5
@ World Health Organization 1994 Bing 5

C6c phuong phrip nhuOm dtrn bio 6 trong phAn

Vi6c srl dung lugol dd nhuOm tiOu b6n u6t tr) c6c m6u phAn tuoi hodc bio quan bang
formalin d6 duo. c mO ti 0 bing 1. O day trinh bdy 1 vii phrrong ph6p dd nhu0m ldu ddi c6c
ti€u b6n chudn ti tt m6u phan-tuoi, bio quin trong PVA hoac SAn futrldu chi tidt vd chudn \
bi ti6u bin phAn vh srl dung cdc phuong ph6p nhu6m kh6c nhau cflng duo. c trinh bdy trong

\
Nhu0m lAu dii c6c ti6u bin phAn
A. Nhu0m trichrome:
Srldung:
1.
Nhu6mrdttdtd6i v6i c6c tiOu binphAn tuoi hoac bio quAn &PVA. kdt quinhuOmkhdng tdt
ddi vdi c6c mdu phdn bAo quAn bAng SAF.
2. Chudn bi:
Th0m 10 ml axit ax0tic lanh (glacial) vio 6 g chromotrope 2R, 3 g SF xanh 16 cay Qight
green SF) vi 7 g axit photphotungstic trong 1 binh thiy tinh sach. L6c trdn dd trOn ddu vd dd
yOn 30 phrit. ThOm 1000 ml nudc cdt vi trOn ky, chat nhuOm sE c6 miu tim s6m. Bio quin
trong binh thiry tinh nrit mli, chAt nhuOm bdn vfrng vh duo. c ding khOng hba lodng.
3.Tidn hinh nhu0m:
Nhungti6ubanddc6dinhtrong dungdichcddinhSchaudinnhoacPVA, vdoc6nTOotrong 2phrit.
Th0m dung dich i6t d6 duo. c hda lodng (Lugol) vdo cdn etylic 700 dd c6 mdu nudc chb ddm.
Dat ti6u bin vdo dung dich ndy trong 5 phrit. Chuydn tiOu ban qua 2 ldn cdn 700.
Nhu0m tiOu bAn trong chdt nhu6m trichrome khOng hda lo6ng trong 10 phrit.
Nhdc tiOu b6n ra, dd chiy hdt chdt mdu vd sau d6 nhring vdo cdn 900 da duo. c axit h6a (chudn
bi bAng thOm 4,5m1 axit ax6tic lanh vio 1 lit cdn ethanol 900) trong 2-3 giay.
Nhfng ti0u bAn vho cdn 950 dd rrla, sau d6 khrl nudc bang c6ch chuydn qua c6n ethanol
1000 vi xylene hodc h6n hop carbol - xylene. Ding chdt gin trung tinh, dat I 16 kinh lOn
tr€n ti6u bdn.
ts. Nhu0m sit-haematoxvlin :

1. Srldung:
Nhudmrdttdtcho cdc ti€ubinphAn tuoi holc phdn duo. c bio quin trong PVAhay SAF.
2. Chudnbi:
- Dung dich dutrtA: hda I g haematoxylin tinh thd vio 100 ml cdn 950, dd yOn dung dich
ngodi 5nh s6ng 1 tudn vh sau d6 loc.
- Dung dich du trfr B: tr6n 1 g sit 2-ammon sulfate, 1g sAt 3-ammon sulfate vir I ml axit HCI
trong 97 ml ntrdc cat.
C.hudn bi dung dich nhudm bang c6ch trOn 25 ml dung dich A v6i 25 ml dung dich B, trudc
khi nhuOm itnhdt3-4 gid. Chudn bi dung dich axit picric dd ldm nhat mdu blng c6ch thdm
2-5 rnl dung.dich axit picric hio hda tron-{ nudc r,iro 2-5 ml nudc cit.
3. Tien hanh nhuom:
Dat ti6u bin trong c6n TOutrong 5 phiit, sau d6 chuydn sang c6n 500 trong 2 phrit, dat
dudi vdi nu6c 5 phft, cho vio dung dich nhu6m haematoxylin 10 phft, nudc cdt 1 phrit,
dung dich axit picric 1 phrit, dat dudi vdi nu6c chiy 10 phrit, chuydn sang cdn 700 c6
th6m 1 giot amoniac 5 phrit vi cudi cing sang c6n 950 trong 5 phrit. Khri nudc bang
c6ch chuydn qua c6n €tyhc l00%o, xylene hodc qua h6n hqp carbol- xylem. Ding chdt
gan trung tinh, dat I 16 kfnh 16n tiOu ban.

{1. Ky thu:it Ziehl^),leelsen c:ii tien (nhuom arit nhanh)

I . Sir dung:
Dd ph6t hi6n Cryptosporidium, Cyclospora vd cdc trudng hqp nhiOm coccidian kh6c.
2.H6achdt
Carbol-fuchsin, formalin, dung dich c6n Otylic-axit chlohydric, dung dich glyxerin - xanh
malachite (ho6c xanh methylen), dung dich cdn methylic - axit chlohy dric. Dd chudn bi h6a
chdt nhuOm, xem thi liOu WHO Ba sic laboratory methods in medical parasitology, 1991".
(K! thudt co ban phdng x6t nghiOm trong kf sinh trung y hoc).
3. TiCh hinh nhuom:
Chudn bi 1 ti6u bin phdn m6ng, dd khO ngohi khdng khi vh cd dinh & cdn m6tylic trong2-3
phtit. Nhu6m v6i carbol-fuchsin lanh trong 10 phrit. Phan miu & dung dich cdn otylic-axit
chlohydric l7o cho tdi khi mdu cria tiOu bin ngilrg th6i. Rrla dudi vbi nudc chAy. NhuOm
ndn v6i 0,257o xanhmalachit (hoac xanh metylen) trong 30 gi6y. Rrta dudi vdi nu6c. Thdm
hoac dd chiy cho kh6.
Bench Aids for the Diagnosis of Intestinal Parasites Plate 5
@ World Health Organizattonl994 Bing 5- Don bio

Entamoeba histolytica vi Entamoeba hartmanni

Tr6i: k6n E. histolytica 2 nhdn tr6n ti6u bin rrdt Trophozoite cbn sdng c:t;a E. histolytica c6 chtta K6n
a

ff 1 nhin.
MIF, kh6ng bdo glycogen l6n n5m & phdn gita nhidu hdng cdu tr6n tiOu ban udtkh6ng nhu6m. Tr6i: thdy kh6ng bio glycogen vi ciic thti
c6c nhdn. PhAi: k6n E. histolytica truimg thdnh chromatin. nhuom trichrome.
0 tidu bin udt nhu6m i6t, tr6ng thdy 3 trong sd Phii: thdy cdc thd chromatin, nhu6m sir-
n. haematoxylin.
*
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".
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Ti6i: k6n E. hisltolytica 1 nhan (phia trOn) vh 2 Trophozoite cia r. nhu6m trichrome. Trrii: k6n.6'. hartmanni tnt(mg thinh c6 4 nhan.
nhan, m6i k6n ddu c6 kh6ng bio glycogen vi cdc nhu6m trichrome.
thd chromatin, nhu6m trichrome. PhAi: k6n 2 nh1n, trong d6 c6 1 nhAn duoc didu
Phii: k6n E. histolytica 1 nhAn, thdy c6c thd chinh nhin r5 vi c6 cdc thd chromatin. nhu6m
chromatin, nhudm sit-haematoxylin. sat-haematoxylin.

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KEn E. histolytica trufing thi.mh c6 4 nhdn vi c6c Trophozoite c:0,a E. histolytica c6 cdc h6ng cdu bi Tiophozoite ctra E. hartmanni
thd chromatin, nhu6m trichrome. thuc bdo, mdu <16, nhdn nhin thdy doc theo phdn Ti6i: nhuOm trichrome.
m6p dudi (margin) cira trophozoite, nhudm Phdi : nhubm sdt-haematoxylin.
trichrome.

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Ken E. histolytica truimg thirnh, tha'y 3 trong so Trophozoite cl&la E. histolytict nhu6m s6f Trophozoitecria (phii)vd
4 nhtn vh ciic thd chromatin khong nam rong haematoxylin. (tr6i), nhu6m trichrome
ti6u didm, nhu6m sithaematoxylin. Chri f sukh6c nhau vd kich thudc.
Bench Aids for the Drag Plate 6
@ World Health Organrzation 1994 Bing 6

Khor{ dinh loai trophozoites cira amip trdn ti6u bin nhuom

Trophozoite 1 nhAn

Nhdn c6 chromatin NhAn kh6ng c6 chromatin

(chdt nhi6m s6c) ngoai vi tchdt nhi6m sic) ngoai vi

Chromalin ngoai vi th6 Cluomatin ngoai vi nh6.

vh kh6ng ddu, karyosome xdp d6u din.-Karyosome
(thd nhi6m s6c) lon, hat th6, (tho nhi6m s6c) nh6, tC blo
td blo chdr "bA'n", cd ciic vi chdt c6 c6c hat min.
khudn vi men bi thrrc bio,
nhrng khdng c6 hdng c6u.

Kich thu6c : 10-25 pm Kich thu6c : 1-5-50 prm NhAn c6 karyosome Nhdn c6 karyosome
Th0ng thrrlng: 15-29 pm Thdng thrrcxrg : 20-25 pm lon, kh6ng ddu. l6n. c6 thd co c6c hal
kh0ng miu.
/\ I I
Kich thudc : 6-12 1tm Kich thudc : 8-20 pm
Thdng thudng: 8-i0 pm Thdng thulng: 12-15 pm

/Til\^

@
Endolimax Iodamoeba
nana butschlii

C6 vi khudn vi khdng c6 C6 thd thdy hoac

bach cdu nhmg h6ng cdu kh6ng thdy hdng cdu,
kh6ng c6 hdng cdu c6c thdkh6ng xAm nhflp
c6 thd thdv vi khudn
I
I I t'
Kich thu6c : 6-40 pm Kich thrrdc : 5-12 pm Kich thudc : 15-60 pm
Th6ng thuirng: 10-20 pm Th0ng thuong: 8-10 pm Th0ng thutnrg: 15-20 pm
Kfch thrr6c >20 pm (kh6ng xdm nh0p)

Entamoeba Enlamoeba Entamoeba

gingwalis harmanni hystolytica
 ,lrPA,
- Diagnosis of Intestinal
ench Aids for the Di
Bench
@ World Health Organization 1994
Parasites
Nry
VWU,,y
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PIate 6

Cdc Amip hQi sinh (Commensal amoebae)

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K6n truong thinh cua K€n lorlamoebu hutsclrlii trcn tieu brin nhu6m KdnEndolimax rutna a ticl btin ucni Trir: r::c
Trdi: ti€u bin formalin kh6ng nhu6m. lugol. ChLi 1i: c:lc kh6ng biro chfa glycogen bit k6n nhu6m lugol, nhin thdy 3 trong so-l nh::

,ffi
Phii: tiOu bdn nhuOnr Iueol. miu ndu q m6i kdn, nhin dieu hinti khong nhin Phrii: ba k6n trong dung dich NIIF. ken r:e
thdy tren c6c tieu bin niy. cilng nh)n thtry 3 trong s6.1 nhdn.

t.

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K6n trudng thinh cira E. colrl nhudm trichrome K6n cua L hwlschlii. B0n trdi: nhudm trichrome, K6nE. nurut. Tr6i: nhin thay 3 trong so -1 nhan
(tr:ii) vi sdt-haematoxylin (phai). kh6ng biro khOng nh)n 16 nhLr cr b€n phiii nhuOm khi nhudm trichrome. Pheii: nhin thdy ca -1 nhan
bang sit haematoxylin, v6i cric phuong phdp khi nhu6m bang s6t-haematoxylin.
nhuOnr niy nhin duy nhit v6i karyosome (th€
nhiOm sic) l6n il€ nhin thdy'.

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'Irophozoite ciaE. coli, nhu6m trichrome. Chri Trophozoite L butschlli . lrhuOnr trichrome TrophozoiteE. nana, nhubm trichrome. Kich
!: chromatin (chdt nhiem sic) ngoai vi khong thu6c trophozoite nho vi karysome (th€ nhi€nr
ddu o ming nhtrn. sic) ldn chidm gdn hdt nhan, nhin kh6ng c5
chromatin lchlr nhiem sac.) ngoai vi.

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haematoxylin. Chf f: karyosome l6n, kh6ng haematoxylin. haematoxylin.
nam d trung tAm nhdn.
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Bench Aids for the Diagnosis of Intestinal Parasites f-i.a
@ World Health Organization 1994 Bang 7- Don bao

Trine roi dudns ruOt

&

t.it
,...6
't' r
f.

\l =

K6n , nhu6.m lugol. KdnChilomnr , nhu6m lugol. 2 k6n &b6n Trophozoite 2 nhAn cua
trrii c6 dQ ph6ng dai nh6 hon vlL c6 hinh quiiL chanh nhu6m trichrome. Illnh bOn tr6i. chr I tror-.: l
didn hinh. K6n b6n phAi c6 do ph6ng dai lon hon, nhAn nhin ro. Khi nhu6m tnchrome. .-:.
nhin thdy nhAn vi cytostome mdmd. trophozoite c6 dac didm lir se bit miru nhei. D'
vdi lodi ndy kh6ng c6 giai dolan k6n.

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K6n , nhu6m trichrome (ffei), K6n . Nhu6m trichrome (trdi), v) sat- Trophozoite nhuom iai
vh nhu6m s6t-haematoxylin (phAi). haematoxylin (phni). Cn 2 ddu c6 hinh quA chanh haematoxylin. BOn trdi: thd mdt nhdn ror
didn hinh vi 6 hinh bcn phAi cytostome nhin thAy karyosome duoc chia thinh 3 minh. B€n phai: I
mdmd. nhdn, ci 2 ddu thdy su phAn Coan cua
karyosome.

Trophozoite cia ,nhuOmtrichrome. Trophozoite cira , nhudm trichrome. Mot trophozoite 2 nhin cta . bar
Vdi nhu6m trichrome, cdc trophozoite thuong b6t mdu kh6 16, nhin thAy E gi0a 1 trophozoite cua
miu nhat (nhu nhin thdy 0 hinh ffcn). Mot E. histolytica (trcn, phii) vi 1 k6n mot nhan.
Trophozoite c6 phAn du6i nhon, minh vi nh6 hon cia E. histolytica c6 chrla the
cytostome b6t miu nhat. chromatin.
Chri f: su khiic nhau vd kich thudc. Nhu6m
trichrome.
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Tiophozoite cria , nhu6m sit- Trophozoite c:&.a C. mesnili, nhu6m sit- Tiophozoite cua Pentatrichomonas hominis
haematoxylin. Ba duo,'c nhin &phia bung cia cdc haematoxylin. Chri j: nhan 6 phia trudc vI phdn nhu6m trichorome (tr6i) vd nhu6m s6t-
Trophozoites vd 2 nhin 6phia b6n. dudi nhon mAnh 6phia sau. haematoxylin (phai). Chri 1: nItu vd axostyle
(sdng tnlc) 6 trophozoite b6n tr5i vd roi hrr6ng vd
phfatru6c, b6tmdu nhat &trophozoitebcnphii.
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 Bench Aids for the Diagnosis of Intestinal Parasites Plate 8
@ World Health Organization 1994 BAng8-Donbio

Don bio khOng phd bidn vi c6c hinh gie ki sinh tring
$= i.$;

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'tr?

K6n 1 nhAn cia llntamoeba polecki, nhu6m Trophozoite cua , nhu6m sf,! K€n Balantidium coli ndn ti6u ban uot kh6ng
trichrome. Chri thd \,ui dam dac, trbn b phiatrli
f: haematoxylin. Loai amip ndy khdng c6 giai doan nhu6m. Nhin ldn tr6ng nhu mOt ving s6ng 6
cia k6n vi nhin 6 phia phAi. Nhftng k6n didn hinh k6n ve thudng gap o nhlrng ti6u bin 1dy ti c6c chAt phiaphii cira k6n.
1 nhAn, c6 thd c6 hoac khong c6 thd vui.
& gifra rang vi ioi. Trophozoite c5 nhin gi6ng
E.histolytica vi thudng c6 bach cAu vd vi khudn bi
thrtc bho.
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K6n 1 nhAn cual!.polecki, nhu6m trichrome. NhAn Trophozoite vi k6n c6 2 nhln (tr6i) cfra Tiophozoite c]id,a R.cttli, trcn ticu ban u6t MIF.
6 phia trdi bi che lAp boi s6 lon c6c thd nhi6m s6c Enteromonas hominis, nhu6m s6t-haematoxylin. Mi6ng (Cytostome) nhin thdy d dinh cira
(ctn'omatoid) c6 kich thu6c kh6c nhau. K6n thrrdng Tiophozoite 0 bOn tr6i vd nhAn c6 6 ci 2 ddu crja trophozoite vi ving srlng l6n 6 d6y li nhan
c6 nhidu ci4c thd chromatoid, c6 hoic kh6ng c6 thd k6n. K6n tru&ng thdnh (phAi) didn hinh c6 4 nhAn, khdng 1d. LOng duoc trdng thay trOn bd mat.
vii. m6i ddu 2 nhAn, nhuOm s6t-haematoxylin.

.fg.
.:;ffi ':." .@.":.

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Trophozoite cta nhu0m trichrome. K6n2nhincria , nhu6m trichrome Trophozoite cia R. tali, nhu6m trichrome.
Nhan tuong tu vd hinh thd v6ri nhan cria trophozoite Mi0ng (Cytostome) nhin thdy d phdn trOn cira
E.histolytica, nghia ld c6 1 karyosome nh6 vi trophozoite, nhin khdng ld ld 1 cAu tnic b6t
chromatine ngoai vi miinh tr6n l6p ming cria nhAn. mau o gita trophoioire. Long nhin thay
'5m
trOn bd mat.

+,

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C6c nhu6m trichrome. Bach ciu da nhin c6 thd nhin thdy tap trung Blastocystis hominis nhu6m trichrome (tri4i)
Nhfrng ttrd ddi vi nhon, b6t mdu hdng li ci{c sin thd,nh dr4m d tieu ben nhu6m trichrome. Mdc ddu vi nhu6m s6rhaematoxylin (phii). Nhtng thd
phrim phan huy cira bach cdu 6i toan, c6 thd thay chring c6 thd nhdm voi amip, kich thudc l6n cta gidng nhan, trdn, bao quanh m6t khOng blo
thudng xuy6n 6 trong phAn vd dbrn cira ciic h6nh nhAn so v6i t0 bdo chdt (cytoplasm) cria td bio vd trung tam dugc nhin thdy 6 phdn ngoai vi cira
nh0n m6c c6c loai b6nh nhi6m trDng khiic nhau. ciu tnic ctra chring cho thi'y d6 1I nhtng td bdo cA 2 hinh.
vi0m.
 ,/Zhl-
Bench Aids for the Diagnosis of Intestinal Parasites
@ World Health Organizaion 1991
-/--
@ ;'#:;
C6c dac diim di chdn dofn coccidia kf sinh vi microsporidia 6 dudng tieu
hori cfra ngudi

TOn sinh
kf Giai doan Kich thudc Phuong ph6p Kf sinh 0 cr{c td chric kh6c
tring trong phAn nhu6m thich hqp
t

Cruptosltoridium trl Rhodamine- hO hAp, c6 thd c6c td chfc kh6c

auramrne 0

yst

c6 bio tu l0-19 pm chrlc kh6c, dl c6 b6o ciio gip o

phdi

y,u
hontini.g tu vh 1-5-19 pm x k6n 6 td chfrc g+p o c5c dOng vdt
S. suihontirti,s Sporocyst 1-5-20 pm kh6c (1i nhfrng VAt chu trung
Sporocyst: gian)
15-19 pm x
8-10 pm

En.terotytozoott Bho trr 1,-5 pm x NhuQm trichrome C6 kha ning phAn b6 r6ng rdi
ltieneu,ci microsporidian 1,0 pm cii ti€n hay "super" trong cothd
nhuom calcofluor-
white. nhudm
Warthin- Starry

Septutu Bio ttr 2,2 pm x Nhudm trichrome C6 khd nang phAn bO i6ng rdi
inte.stinuli,s microsporidian 1.2 prm cii tidn hay "super" trong cothd
nhu6m calcofluor-
white, nhu6m
Warthin- Stan-y

Itellem sporidian'-' 1,5 pm chrlc trong co thd

(*)
Bin t,i L'. hellem c6thd tim thdy trong nu6c tidu rfirnrg chua c6 hiio cdo tim thdy o trong Jrhin,
 Bench Aids for the DiagnoSis of Intestinal Parasites Plate 9
@ World Health Organization 1994 Bing 9- Don biro

Coccidians vi microspora dudng ru0t

;"&\
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K6n hop ttr (oocysts) cia Crytosporidium K6n hop trr (omysts) kh6ng c6 bio trr cua K6n hqp tU (oocysts) cua lrrrl),/rd i'...r. lre-
parvum ffcn ticu b:in trot formalin. Chdn dodn Cyclctspora cayelanensis, ti0u brin ucn formalin bein Lto't formalin. K6n kh6ng co bio tu t h; ::.
dua vlo kich thudc nho (4-6 pm) vi ciic hat mlu (trii) c6 chria nhidu thr! hinh cdu. Ben phiii: vdi d0 xudt theo phhn vi l6n hon cdc ker c::
den b€n trong k6n. ph6ng dai ldn hon, k6n o giai doan bio trr c6 chrla (-r.l'fo:ltctr iLlittmhay { l i j,, '.',, .: rdt nhreu

Oocysts 1. belli, nhtdm axit nhanh.

thu6c nh6, miu do xirn vi'chlin do:in dua vlo su nhudm axit nhanh. V6i chi't nhudm n)y, miu B6n trdi: oocysts khdng dr0n hrnh lrong nhu
c6 mit cira c:ic hat m)u den. oocysts c6 th€ thay ddi do, hdi xanh hoic holn r6ng: hinh dang nly thudnS gap o nhirng benh
toirn kh6ng b.'it miu. Ddu hi€u niy vir kich thudc nhAn dang didu tri.
ldn cira chfng (8 l0 pm) gitip phan biOt chf ng v6i BOn phAi: oocysts diOn hinh c5 chfa chAt bio tu
cic oocysls ci;s. (' r.v I o ;
1
t tt t.-i t I i t l t t bdt m)u d6.
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fiF ,
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Oocysts C. cayetanensis. axit nhanh Biro t'it Encephalitozoom hellem, nhulm gram.
cric czii tidn khdc nhau cua phuong phip nhu6m Oocysts o bon tril khong bit miiu trong khi o bOn Bio ttr cua loii tidu blo tu niy thdy trong cdn
axit nhanh, oocysts cti thd bit mdu tir do ddn ph:ii oocysts bit miu do didn hinh. nu6c tidu, rat de nhan bidt nhd kich thrroc nho
hdng (nhu hinh tren), ciic hat miiu den cung nhilt cua chring.

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t
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Oocysts cia C. parvum. nhu6m trichronre. Oocysts co bio tu vi k6n bio ttr (sporocyst) cua Bdo ttl cua m6t loii tidu bio trr (microsporidian)
Oocysts thudng khong b6t nriu v6i (richrome, loii Sarcocysli.r, tieu brin Lrot formalin. Oocysts dudng tiOu hod Enterocytozoom bieneusi 11vy
nhrrng khi b5t miu, c6 thO tha'y .1 hat b)o trr vo mong co chd,a 2 sporoclsl. rrhrrng chdng de bi Septata intestinalis, tr1n ti6u ban KOH-
(trophozoites) bcn trong chfng. nhu minh hoa o phri huy do d6 sporocyst tu do thrrdng tirn thay calcofluor drroc chi6u sing tia trr ngoai. Kich
hinh tron. rrong phin, nhu hinh tren. Kich thu6c oocysts cila thu6c nho cia cA 2 loii dl loai trt su dinh Ioai
tit cri ciic Ioii Scrcncyslls dilu tLtong tu nl.ru nhau. loii o c6c tiOu biin niy.
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