ImpiloIzifo nemibandela

Bacillus sofuba: bangaki abantu, njengoba kubika? Iyini i-TB?

Isifo sofuba - isifo esikhohlisayo esithinta abadala nje kuphela kodwa futhi izingane. Ukuze umphumela umsebenzi isifo mycobacteria (imbewu eletha Koch sika) emzimbeni womuntu. Ekwelapheni pathologies isicelo nokwelashwa ngamakhemikhali multicomponent, engahlala izinyanga eziyisithupha noma ngaphezulu. Ngo-50% amacala, ukungabi ukwelashwa, isifo siphela ekufeni. Uyini imbewu eletha tubercle ka Koch, kuba njani ku umzimba womuntu nendlela yokuzigwema ukuze zingasivimbi ukuthuthukiswa isifo - zale mibuzo ngeke ukubhekana kulesi sihloko.

Umqondo mycobacteria

Isifo sofuba - i isifo esithathelwanayo esibangelwa amaqembu Mycobacterium kukhona isifo sofuba Mycobacterium (MBT). Lolu hlobo lwama-bacterium uvame ukubizwa ngokuthi imbewu eletha tubercle - ngegama usosayensi German Roberta Koha. Isayensi uyazi mayelana 74 zezintaka mycobacteria atholakala inhlabathi, amanzi, izilwane kanye nabantu. Mangisho ukuthi isifo sofuba kubangelwa tinhlobo letehlukene mycobacteria ihluke nomunye.

Tubercle imbewu eletha has a emgodleni ekhethekile zokuzivikela, esiza ama-bacterium ukuba basinde kule imvelo. MTB iqondile noma ukuma kancane lwalugobile, fixed, yakha kungekho ezinhlamvu noma amaphilisi, kancane kakhulu Ukhuthaza i kuhlukane aphansi aba amangqamuzana ezimbili, umjikelezo division amahora 14-18. Njengomthetho, ukukhiqizwa kabusha kwenzeka ngezindlela ezimbili - by luthela, ngaphansi ekhelini.

Mycobacterium Ubukhulu azinakwa: ubukhulu uyahluka 0.2-0.6 m, ubude - 1-10 microns. Tubercle imbewu eletha kungokwalabo isikhunta ngenxa yokufana kwawo iboniswa efanayo umoya-mpilo ukusetshenziswa. MTB koloni kancane (zingakapheli izinsuku 34-55) ezimila naphakathi okuqinile, abe ngaphezulu anolaka, wavuma esikhunjeni - pink-olintshi noma Milky.

Isakhiwo MTB amaseli

amaseli Amagcikwane of tubercle imbewu eletha aqukethe izinto ezilandelayo:

  • iseli udonga - ezakhiwe enezingxenye eziningana, Mycobacterium ngokuvikela ngokumelene kuhlasela mechanical futhi amakhemikhali; Inikeza usayizi njalo futhi ngendlela amaseli (endleleni, ingxenye containment yakhiwa waxy, okunamafutha izidakamizwa);
  • cytoplasm webhaktheriya nge inclusions luyimbudumbudu;
  • ulwelwesi cytoplasmic;
  • izidakamizwa zenuzi, kuyona DNA isiyingi.

MBT linamandla kakhulu amathonya kwemvelo futhi eside azigcina ukusebenza yayo. Zingaki izimpilo tubercle imbewu eletha? Mycobacteria angaba khona: kuze iminyaka 7. endaweni elina amnyama ezingeni lokushisa 23 ° C; izinyanga 12 endaweni emnyama futhi omile; izinyanga 6 enhlabathini; izinyanga 5 emanzini; izinyanga 3 izincwadi; izinyanga 2 othulini emgwaqweni; amaviki angu-2 ku ubisi noshizi; kuze kube unyaka emafutheni noshizi. sofuba Mycobacterium asesabi izinqubo zokuwohloka futhi ezinyangeni ezimbalwa kungase akhona wangcwatshwa izidumbu phansi. Nokho, imisebe eqondile kwelanga ukubhubhisa ILO ihora nesigamu, imisebe ye-altra - emva kwamaminithi ambalwa. disinfectors kampompi ukuxova umuthi wokugoma sibhekane ngokuphumelelayo imbewu eletha amahora 5. Mycobacteria futhi nozwelo i-hydrogen peroxide. Killed tubercle imbewu eletha ngu Ukushisa: imizuzu engu-20 60 ° C no-imizuzu 5 - 70 ° C.

MBT kungadala isifo emva kweminyaka emibili kuya kwemithathu khona futhi asymptomatic isikhathi eside emzimbeni ukuqalisa amasosha omzimba elwa ne-TB.

Iyini i-TB?

Kodwa njengoba sekushiwo ngaphambili, isifo sofuba - isifo esithathelanayo abangelwa izenzo Mycobacterium. Iningi isifo by ukutheleleka droplet lomuntu onegciwane koxhumana naye enempilo (ukukhwehlela, sneezing, ingxoxo). Ngezinye izikhathi lesi sifo singaba nohlobo ukudla (ubisi eluhlaza).

Engozini - abantu abahlala ezindaweni eyibeke ezindaweni ezingafanelekile sanitary - emajele, amakhaya abangenamakhaya. Lokhu kuhlanganisa iziguli ezine buthaka omzimba (abantu nge-HIV, umdlavuza iziguli). sikashukela; izingane; asebekhulile; amalungu omndeni abaphethwe isifo sofuba; ababhemayo; Abantu ne ukungondleki - lezi zigaba zabantu avame sihlasela imbewu eletha tubercle. amandla indlela kudinga engayitholi esiyisibopho amavithamini namaminerali ukuze asize ukubuyisela encishisiwe umsebenzi mzimba.

Izigameko zokushona sofuba kubangelwa izici ngamunye we umzimba, kanye kuhlobane ngokuqondile isimo ngokwengqondo umuntu. Ngokusho ziqu yobudala ubuswa iqembu labantu iminyaka 18-26 ubudala.

I engavamile walesi sifo ukuthi imbewu eletha TB ngokushesha ekubeni namandla okumelana nemithi, ngakho indlela yokwelapha ihilela ukusebenzisa imithi amaningi ngesikhathi esifanayo.

Ngokwe-WHO izibalo, cishe ingxenye eyodwa kwezintathu yabantu abasemhlabeni wonke itheleleke nge imbewu eletha tubercle, kodwa umzimba ophilile akuvumeli Office ukwanda. I zokugula kwenzeka emzimbeni womuntu kuphela ngaphansi kwezimo ezikahle salokhu - ngihlaliswa amasosha omzimba. Minyaka yonke emirarweni isifo sofuba, obulala abantu ababalelwa ezigidini ezintathu emhlabeni. Usuku lweWorld TB Kunenkolelo Mashi 24.

ukudluliswa TB endleleni

Kunezindlela ezine eziyinhloko lapho sofuba zibhebhetheka induku yilezi:

  • sisemoyeni lapho mycobacteria ufake umoya ngamaconsi uma ukhwehlela, sneezing ubekezele;
  • alimentary - ukutheleleka kwenzeka ngokusebenzisa pheshana emathunjini;
  • contact - ukutheleleka kwenzeka ngokusebenzisa amehlo conjunctiva (isifo esikhumbeni iyisici ezingavamile);
  • utero - abangenwe placenta onesifo ngesikhathi sokuzalwa kusuka kumama kuya enganeni.

Esimisweni umzimba ukuphefumula enempilo ivikelwe Ukungena mycobacteria isikhwehlela, okuyinto ezikhishwe namangqamuzana akhethekile. Nokho, ne ukuvuvukala umgudu wokuphefumula, kanye bedle ubuthi "Ukuvikelwa" akusebenzi. Amathuba ukutheleleka nge alimentary kuncike isimo odongeni emathunjini, ukumuncwa yayo umthamo.

Njengoba tubercle imbewu eletha itholakala ngaphandle cell andise kancane izicubu isikhashana ukugcina isakhiwo zabo ziphile kahle, Mycobacterium isikhathi esithile ukuze singene ukugeleza lymph lymph node kanye zasakazekela umzimba. I evumayo kakhulu mycobacteria nemizimba nge microvasculature athuthukile (lung, cortex kwezinso, neminyango amashubhu fallopian). Njengoba nje Office zingene Amaseli angaphakathi, baqala kulimaze isimo sawo futhi wabelane.

zokugula nokwakheka

Ngo izitho ukutheleleka abathintekayo kwenzeka "abandayo" ukuvuvukala okuholela ukwakheka granulomas sebuningini - hillocks zithambekele nokucekelwa. Basabela kanjani umzimba kuboniswa emasontweni ambalwa emva kokutheleleka. kwakhiwa amasosha omzimba yeselula ngemva kwezinyanga ezimbili. I esigabeni esilandelayo sokuthuthuka yenqubo sokugembula libhekene Office ukukhula kancane, impendulo ukuvuvukala kulahleka, Nokho, lapho i-ejenti causative of focus ukuvuvukala is hhayi iqedwe ngokuphelele.

Tubercle imbewu eletha emzimbeni kugcinwa isikhathi eside, futhi umuntu kungaba othwala ukuphila ILO. Nge buthakathaka amasosha omzimba asele labantu Office ngeke ngenkuthalo ukwabelana, abangela zavela kancane kancane isifo sofuba. Ingozi yokuba nesifo e umuntu wokuqala onegciwane 10% phakathi neminyaka emibili yokuqala emva kokutheleleka. Nge kwesikhathi uzokwehla amathuba isifo.

Lapho amasosha omzimba buthaka umzimba akuyona bakwazi ukumelana Lokusakaza amagciwane amaseli kwenzeka exponentially. Ukuze ukuphila kwakheka MTB imvelo ekhethekile evumayo lapho granulomas angawodwa iyahlanganiswa emqulwini ezivamile, kanjalo ukusho ukuthi ukutheleleka okuyisisekelo wabe lwesigaba sofuba emtholampilo. Ukuvuvukala zibhebhetheka okwengeziwe yonkana uhlelo sokusebenza.

Amafomu kanye nezinhlobo sofuba

Ngemva ukutheleleka zokugula kuba ifomu esicashile, isb. E. Iningi ngokuvamile asymptomatic. eyodwa kuphela kuzo amacala ayishumi, iya ku-i isigaba asebenzayo. Coli TB ikakhulukazi kuthinta emaphashini kodwa kungathinta nezinye izinhlelo umzimba.

Hlukanisa izinhlobo ezimbili-TB:

  • evulekile,
  • evaliwe.

Lapho khona ifomu evulekile imbewu eletha tubercle kalula ezitholakele isikhwehlela noma kwezinye uketshezi nesineke (umchamo, indle). Ukwehluleka ukubona izinyathelo zokuphepha yokuhlanzeka kuleli fomu kungaholela ukutheleleka yabanye. Ngendlela avaliwe mycobacteria ayitholiwe, kanye neziguli musa ziyingozi abanye.

Kuye uhlobo uhlelo functional echayeke imbewu eletha tubercle, zokugula oluthathwa kanje:

  • isifo sofuba yamaphaphu,
  • sofuba extrapulmonary.

Kuye ngokuthi lakhiwe kanjani zokugula sandile umzimba, ababonakali ngezikhundla:

  • sofuba esicashile,
  • sofuba eqonda,
  • sofuba ebalulekile,
  • inyumoniya caseous,
  • lamachubu
  • fibro-cavernous sofuba,
  • sofuba cirrhotic,
  • sofuba pleural, umphimbo noma kuqhoqhoqho - into ngempela ezingavamile.

sofuba Extrapulmonary kuthinta yimuphi umgwamanda, lapho zokugula libhekwa ku:

  • sofuba CNS futhi meninges - lesi sifo sihlasela emgogodleni ubuchopho, igobolondo kanzima;
  • wokugaya ukudla, lapho ngokuvamile kuthinta mncane futhi caecum;
  • Isifo sofuba we sphere urogenital kuthinta izinso, ngomgudu womchamo, Izitho zokuzala;
  • izakhiwo bone;
  • lupus;
  • Isifo sofuba amehlo.

I ukubonakaliswa basemtholampilo isifo. sofuba we isimiso sezinzwa esiyinhloko

Njengoba ngishilo ngaphambili, ngenxa yokuthi imbewu eletha tubercle uhlukanisa kancane kakhulu, bakuthola at isikhathi ngokushesha ngangokunokwenzeka. Ngakho-ke zokugula kungaba eside ukuzibonakalisa, futhi kamuva kwatholakala ngengozi luvivinywa fluoroscopy noma tuberculin. Ngaphezu kwalokho, izimpawu ezithile zalesi sifo, eqinisweni, alikho. Iqiniso lokuthi umzimba ukudakwa, kungase kubonise pallor, ukukhathala okungamahlalakhona, noma ukozela, ukunganakwa, ukukhuphuka kancane lokushisa komzimba (mayelana 37 ° C), ukujuluka anda, ukuncipha emzibeni, kweNdikimba zamanzi.

Laboratory ukuhlaziya igazi iziguli zesifo sofuba kuthola yensimbi ukuntuleka kwamavithamini, ukungezwani nokuncipha kwenani amangqamuzana amhlophe egazi. Kamuva, lapho isifo ingena esigabeni ngaphezulu asebenzayo, ukuze ujoyine izimpawu ngenhla izimpawu ezicacile zokugula isitho ethintekile.

Uma Mycobacterium kuthinta isimiso sezinzwa esiyinhloko, isiguli siyenzeka, ngaphezu lokushisa eliphezulu, inkinga yokulala, ubudlova, izinhlungu zekhanda ezinamandla, ukuhlanza. Ekupheleni lweviki ukuqala izimpawu zokuqala izinguquko yesibili zenzeka ebuchosheni ulwelwesi izakhiwo, izimpawu ukungezwani kwemisipha entanyeni ukungakwazi ucindezela kwesilevu sakho esifubeni sakho, yokwelula izinyawo zakho ngangokunokwenzeka. I abanesifo sikashukela ingozi zone noma abathwali immunodeficiency virus. Akukhona nesenzakalo into engavamile ngemuva kwalesi zokugula elokugula ngengqondo kanye ukwazi kahle, ukuzwela, ukuhamba zamehlo.

Ngokungafani isifo omdala womuntu tubercle imbewu eletha ezinganeni ngenye kubangela isifo ngokushesha futhi obunzima, ngezinye izikhathi okuholela ekufeni. It ulungisiswa uhlelo ngokuyinhloko ampofu ingane sokuzivikela. Sichayeke lesi sifo ngokuvamile kunezingane enisezweni nemibandela kahle kwendle, ukungondleki kahle, njalo esetshenzwa ngokweqile. Tubercle imbewu eletha ezinganeni kubangela izimpawu emzimbeni eziqondile, ngakho abazali kudingeka ukuziqhakambisa ukuhlanza, ukukhathala ingane, ukunakekela encishisiwe, ukungakuthandi ukudla, kwesisindo, imfiva.

Isifo sofuba nezinye izinhlelo sokusebenza

Ngaphezu wamaphaphu amaseli bese sezinzwa uhlelo zokugula kungaba ukuhlasela nezinye izitho zomzimba womuntu eziyinkimbinkimbi, ezifana umgudu wokuphefumula. Ngakho, pleurisy tuberculous - ukunqotshwa ulwelwesi pleura ukuthi ihlanganisa emaphashini. Lokhu zokugula kungaba isifo ezimele, noma zenzeka ngenxa kuyinkimbinkimbi yamaphaphu sofuba uhlelo. Enye inkinga ka isifo sofuba yamaphaphu kungaba sofuba engenhla ipheshana zokuphefumula, lapho ukuvuvukala kuhilela pharynx futhi amalaka. Izimpawu leso sifo ngaphezu eshiwo ngenhla kukhona hoarseness noma ubunzima ukugwinya.

Ukunqotshwa kwe-imbewu eletha tubercle ibizwa ngokuthi i-lymph node sofuba lymphadenitis. Ngokuvamile ngaphansi ukuhlasela supraclavicular noma wesibeletho lymph node ukuthi kukhona lakhulisiwe kodwa kobuhlungu.

MTB kungathikameza izinhlaka uhlelo urogenital. Lesi sifo livezwa izinhlungu elibukhali okhalweni noma emuva, lokushisa emzimbeni okusezingeni eliphezulu. Lapho ukuchama kungenzeka ukubeka amabala. I zokugula kwenzeka amanani alinganayo kwabesifazane nabesilisa.

Isifo sofuba ithambo izicubu libhekene waphuka njalo, nobuhlungu obukhulu endaweni ethintekile, ukungakwazi ukuhambisa ngendlela evamile. amafomu Running zokugula enjalo ngokuvamile iholela ekufeni.

Ukuxilongwa kanye nokwelashwa

Ngo sitholakele isifo sofuba asebenzayo izindlela ethandwa iningi isikhwehlela smear microscopy futhi-X-ray. Ukuhlaziywa smear, Nokho, asikwazi kubhekwa indlela inobuqiniso nokuthembeka, kusukela kusaqalwa isifo, kanye emacaleni lokugula ezinganeni yokutadisha kuzenza yalokho ezimbi.

-X-ray izindlela zokuxilonga aphumelela ikakhulukazi isifo eziphambili. Ngaphezu kwalezi izindlela zokuxilonga avame ukusetshenziswa tuberculin isikhumba test, ethiwa ezivamile Mantoux ukuphendula.

Injongo eyinhloko ekukhetheni ukwelashwa kwe-circuit isiguli ukufunda yokumelana nomuthi, isb. E. nozwela mycobacteria isiko esekhulile elabhorethri, ukuze amalungiselelo medicamentous.

Namuhla, indlela eyinhloko ekwelapheni isifo sofuba esivuna ezelashelwa isifo sofuba, okuyinto multicomponent. Hlukanisa ternary, quaternary futhi quinary ukwelashwa lwemithi.

umdwebo ternary eqala ukusetshenziswa kwezidakamizwa ezintathu eziyisisekelo - "streptomycin" "INH" futhi-para-aminosalicylic acid (PAS). Leli cebo a classic Nokho, kuyaqabukela asetshenziswa namuhla ngenxa ubuthi eliphezulu PAS. Inqubo esetshenziswa chetyrohkomponentnoy "rifampicin" ( "Rifabutin") "INH" "Pyrazinamide" "Ethambutol". izikhungo eziningi zokwelapha zisebenzisa inqubo ngisho okuthuthukile - ezinhlanu-scheme ukuthi, ngaphezu okungenhla izidakamizwa amane asebenzisa "Ciprofloxacin".

Mangisho ukuthi isifo sofuba - isifo esikhohlisayo, okuyiwona ukuthuthukiswa kuyinto imbewu eletha tubercle kubangela emzimbeni womuntu. Ukwelashwa okufanele kube ezamanje futhi elungile, ngoba ukungabi nekufa yokwelapha isifo eqeda 50% amacala. umphumela Lethal kwenzeka eminyakeni embalwa kusuka kokuqala isigaba asebenzayo lesi sifo. Labo abasele abanga-50% amacala kuholele ifomu njalo lesi sifo. Ngaphezu kwalokho, lesi siguli, oke sofuba esingelapheki kuyingozi kwabanye, njengoba avelele mycobacteria imvelo.

zokuvimbela

Izinyathelo ngokumelene sofuba namuhla akunakubangelwa, mhlawumbe nje, umgomo i BCG okuyinto ngempumelelo zivikela yezindlela eziyingozi kakhulu isifo sofuba - tuberculous meningitis. Ngokwe-National Ukugoma Isheduli, ukugoma ingane namanje esibhedlela phakathi nezinsuku zokuqala 3-7 zokuphila. Ngokulandelayo, ngo-7 nango-14, wenziwa khona ngaphansi isimo booster negative Mantoux ukuphendula kanye ukungabikho Izimo.

BCG (Bacillus Calmette-Zherena) sikhombisa imiphumela emihle kakhulu, kodwa lokugoma saziso ngokumelene sofuba kungamukelwa kuwo wonke amazwe emhlabeni, konke kuncike ezingeni TB esifundeni. Ngemva kwezinyanga ezimbalwa lokugoma ngesikhathi umjovo indawo isikhumba ukuphendula livela - uphawu elincane.

Ukugoma ingane is contraindicated kulezi zimo ezilandelayo:

  • ewusana olusanda kuzalwa immunodeficiency kutholakala ukuthi uphethwe yini, kanye nomndeni has a baby, abaphethwe yilesi sifo;
  • wayenabo abafowabo nodadewabo ka yezinkinga osanda kuzalwa kuphakama emva yokugoma ezinjalo;
  • ingane, kukhona ukukhubazeka azalwa naso we isimiso sezinzwa esiyinhloko.

Ukugonywa kufanele ayilibalanga uma:

  • umntwana usuke engakabi donoshen,
  • Wafumana yisiphi isifo esithathelwanayo,
  • umama nengane ihlukile RH isici.

Kubalulekile ukukhumbula ukuthi i-Izifo Ezingalapheki kubangela imbewu eletha tubercle. Ezokudla nesineke wobuntu imishanguzo idinga ukuba enempilo futhi zilungile. Gwema ukusetshenziswa ngokweqile ukudla okunamafutha. Nokwenziwa ukudla e-TB kuba nzima. Lokhu kungenxa isakhiwo yokwakheka MTB amaseli - igobolondo iqukethe eningi fat. Umuntu zokugula idinga ukudla ecebile amaprotheni, ama-carbohydrate, amavithamini kanye microelements.

Ukunciphisa amathuba okutheleleka eyinhloko ekhaya, kubalulekile ukuba uhlanzeke siqu, ukuba uchithe isikhathi esiningi ngaphandle, hang yoboya ukotini imikhiqizo ilanga.

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