Maperembudzi (maperembudzi): etiology, pathogenesis, zviratidzo uye zvinhu zvekurapa

Izwi rokuti "leper" kunyange munguva yedu rinopa ruzivo rwakashata. Pfungwa ye "maperembudzi" kune vakawanda ndeyekuti, kunyange isinganzwisisiki, asi haisi kufadza, asi zvisati zvave zvichityisa uye zvinotyisa zvachose. Muchikamu chino tichakuudza kuti rudzi rwechirwere chii - maperembudzi, chii zviratidzo zvaro, etiology, epidemiology, pathogenesis, rudzi rwekurapa huripo, uye kunyanya kukosha, kuti utye vanhu vane maperembudzi uye kuti ungawana sei kwavari.

Maperembudzi kana maperembudzi?

Pane chirwere umo chiso chinova chinonyangadza, uye maoko nemakumbo zvinosvibiswa nekuda kwekurasikirwa kweminwe. Ane mazita anenge gumi. Kune zvirwere zvisingaiti - chirwere chinoshungurudza, chirwere cheFenike, rufu rune usimbe. Iko kune maitiro akaoma, somuenzaniso, hansenose kana chronic granulomatosis, asi kune dzakajairika, zvakadai semaperembudzi kana maperembudzi, izvo zvakaunza shoko rinotyisa rokuti "leper". Zita roga roga rinosimbisa chimwe chinhu kana chimwe chiitiko cherwere. Semuenzaniso, "hansenosis" yakaonekwa mukuremekedzwa musayendisiti Hansen, uyo akawana kuti causative agent we chirwere ichi, uye "lepra" yakatanga kubva kumazana echiGiriki ekare, kureva, "zviyero". Sezviri pachena, yakarangarira vaGiriki vekare vekukura uye nenyota dzinotyisa pazviso zvevanorwara. IvaSlav vekare, kuburikidza nemashoko okuti "pro" uye "kaz", ndiko kuti, kuchinja kuonekwa, kunonzi "maperembudzi" akaipa. Etiology, pathogenesis, uye kunyanya kurapwa kwechirwere kuchiri kukonzera kukakavadzana uye kusawirirana, uye vanhu vasati vaziva zvachose pamusoro pazvo, saka vaitya. Chechi yakaratidza kuti chirwere ichi chirango chezvivi zvaMwari, uye vatendi havana kungwarira kusava nechokwadi nazvo. Ndiyo nzira chete yekurapa kwekuvanza kwezvivi.

Zvishomanana zvezvakaitika kare

Masayendisiti akamboita tsanangudzo yezvakasara zvekare uye akawana kuti kwemakore anopfuura 6 000, vanhu vakaziva kushamiswa kwezita remaperembudzi. Etiology, iyo pathogenesis yechirwere ichirondedzerwa naHippocrates, asi akanganisa akabatanidza zvakafanana uye psoriasis. Nyika yekumaperembudzi inoonekwa seAfrica (maererano nedzimwe nzvimbo, Asia, saka chirwere cheFenike), "vakashinga" vakadzvinyirira vakaunza kuEurope kuparadzirwa, uye kuAmerica mapiyona ayo nevateveri vavo. Sezvo takagamuchira nhamba huru yevatsva uye tisati tatarisana nezvipingamupinyi, chirwere ichi chakakunda zviri nyore zvepabonde zvenyika. Hapana aisaziva, maperembudzi - chii icho? Etiology uye pathogenesis yemaperembudzi yakaderedzwa kusvika pakuti munhu akangoerekana asununguka, minwe yake yakawira patsoka dzake, uye iye pachake akazora ari mupenyu. Vanhu vaityisa kutya uye vakabvisa maperembudzi nenzira dzose. Pakupedzisira, vakangodzingwa. Paiva nemitambo ye "kuvigwa" yeaisuru, panguva iyo akaiswa mubhokisi, akabatanidzwa, akadonhera mugomba uye kunyange akasaswa pasi. Mushure mokunge, zvakadaro, ndakawana, asi vanhu vose pakati pevapenyu vakanga vasisipo. Mumamiriro ezvinhu akaipisisa, munhu anorwara akaurayiwa nokuda kwechokwadi. Chero zvazviri, hazvizivikanwi, asi zvakaitika zvisingaitike - Europe yakarwiswa neimwe hutachiona hunouraya iyo yakasimuka yekutanga. Pashure pehosha yehosha, maperembudzi akazova chinhu chisingawanzoitiki.

Maperembudzi mazuva ano

Kunyangwe muMiddle Ages, vatemberi vakavaka dzimba kune vane maperembudzi, kwavakagara kusvikira vafa. Vakatumidzwa leprosariums. Muna 1873, musayendisiti Hansen, uyo akashanda mune rimwe remasangano aya, akagona kuwana mune zvakanyorwa kubva murwere, mabhakitiriya asina kumboitika. Vakatumidzwa kuti Hansen zvimedu. Asi mamwe makore mazhinji akapfuura vasati vaona kubatana kwavo nehosha yakadaro semaperembudzi. Etiology, pathogenesis uye nzira dzokurapa zvino dzava kunyatsonzwisisika. Pane imwe nyika munyika maiva nezviuru zve leprosariums, nokuti vane maperembudzi vakange vave vanopfuura mamiriyoni makumi maviri. KuRussia chete kwaiva ne 19 leprosoria. Kutenda mishonga yakawanikwa, pakupera kwezana ramakore rechi20 nhamba yevarwere munyika yose yakanga yasvika kumamiriyoni gumi nemaviri, uye panguva ino kune mamiriyoni mashanu. Zvisinei, nhamba dzegore ra2015 dzakaratidza zvakare kuwedzera kuduku kwenhamba yevarwere. MuRussia, leprosariums iye zvino chete 4, uye maperembudzi varwere 600 vanhu. Vakawanda ve "vane maperembudzi" iye zvino vari kuIndia, China, dzimwe nyika dzeSouth Asia, munharaunda yeAfrica, kusanganisira Madagascar, kuSouth America, Arabia Peninsula, Philippines, Caribbean.

Mufananidzo we pathogen

Iyo pathogenesis yemaperembudzi inotanga nekupinda kwaHanden's wand muviri womunhu. Iyo ibhakitiriya ine microscopic ine urefu hwakareba kusvika 8 μm, uye yakareba kusvika kusvika ku 0.5 μm. Iti tsitsi dzakarodza kana kuti dzakasvikidzika uye dziri dzakafukidzwa nemakumbo mana emadzimai akaoma kwazvo, anovadzivirira kubva kune zvinokonzera kunze. Iyo haishamisiki, usati uumba spores, uwedzere zvishoma nezvishoma zvishoma nezvishoma. Kuparadzaniswa kwebhakitiriya imwe kunotora mazuva anenge 14. Tora tsvimbo mumapoka, zvino dzinofanana nemasaga akapararira. Dzimwe nguva zvipembenene zvinogona kuwanikwa uye chimwe nechimwe. Vanorarama chete mumasero evanovhiringidzika, saka, vachirova nzvimbo yekunze, nokukurumidza kufa. Maitiro aHansen anoparadzira vanhu chete, asi pane maonero avanogona kuuraya mhando, armadillos, chipmunks nemamwe marudzi emonke. Etiology uye pathogenesis yemaperembudzi zvakaoma kudzidza, nokuti makoroni aHansen anonamatira pamusana wezvokudya mu laboratories anokura zvisingaenzaniswi zvakanaka uye zvishoma-kubva pamasvondo matanhatu, zvichienderana nemaawa akawanda kune mamwe mabhakitiriya. Imwe dambudziko ndeyekuti kunze kwechipinda vanova vasina-pathogenic, uye mumhuka dzinoedza ivo vanoita sevasingazivi. Kunyange zvakadaro, zvaive zvichibvira kudzidza kuti maHanen na Koch matanda (anoita kuti tuberculosis) atange kubva kune rimwe bhakitiriya, asi munguva yekushanduka-shanduka ivo vakashandura zvivakwa zvavo. Uye muna 2009, imwe mhando yebhakitiriya iyi yakawanikwa, iyo inokonzera kuparadzaniswa nemaperembudzi epromatous.

Nzira dzehutachiona

Mhuka yemaperembudzi inogona kungova munhu anotambura nechirwere ichi mune fomu inoshanda. Asi maererano nemamwe mitsara, dzimwe nguva chinokonzera utachiona ibasa risina magirazi nemhuka, izvo zvinokanganisa bhakitiriya raHansen. Ndeipi pathogenesis yemaperembudzi? Zvirwere zvinoparadzirwa nemadonhwe emhepo zvinogara zvichinyanya kuipa uye zvinogona kuuraya vakawanda. Asi mune remaperembudzi izvi hazviitiki nokuda kwezvikonzero zvisingazivikanwe zvisati zvazivikanwa. Inongozivikanwa chete kuti huni dzaHansen dziri kuramba dzichiwedzera munzvimbo dzomuviri dzinogona kuporesa mhepo, iyo, mumuchu membrane yemuromo. Kubva pakurwara kusvika kune hutano, vanoparidzirwa nekunyomba, kutsvoda, kukwezva, kukurukurirana mupfungwa. Mukuwedzera, microbe inogona kuparidzirwa neropa remurwere kana apo yakasununguka, yakazara nemaronda, zvakananga kune ganda rakakuvadzwa remutsva.

Matambudziko emapoka

Nzira yakakwirira yekutapukirwa nevaya vane mhuri dzine murwere ane maperembudzi. Chokutanga, nekuda kwekuti zvakaoma kudzivisa nguva yakareba yekukurukurirana pakati pemhuri, uye yechipiri, nokuti kune chimiro chekuberekwa kwechirwere ichi. Vakaroorana vakaroorana vanorambidzwa kuti vagari venhaka. Asi mumadzimai anorwara, vana vanozvarwa vakagwinya. Kana vana vakadaro vadaro vari voga, havakanganisi zvachose nemaperembudzi (maperembudzi). Iroticology yechirwere ichi haisati yatsanangurwa nekuremekedza mamwe mungozi pakati pevanhu. Kunyange zvazvo yakanyatsogadziriswa, kuti chirwere ichi chinowedzera kune vanhu vane utachiona husina simba. Pane zviitiko apo vanhu vanotarisira vane maperembudzi vakaramba vaine hutano, asi hama dzavo dzakarwara, havana kutora chikamu munharaunda. Chiremba Dhaniel Danielson kwemakore akawanda akapinza ropa revarume vane maperembudzi, akaiswa mumaronda ake akabuda kubva kuma tubercles mumuviri wavo, asi haana kumbobvira atapukirwa. Muzhinji, chirwere chacho chinonyanya kunge chiripo pasi pemaitiro ehupenyu.

Iyo pathogenesis yemaperembudzi

Zvichida, nekuda kwekuwedzera kuderera kweaHenen bacteria, maperembudzi anokonzerwa navo ari kukura kwenguva refu. Etiology, pathogenesis yechirwere ndeyotevera: iyo causative agent, iyo yakawana mucous kana muchironda, inopinda muropa uye lymph, uye neaya mvura inopinda mumuitiro wenheyo uye dzimwe nhengo dzomukati. Iko, mabhakitiriya anoita granulomas ane macrophage akawanda. Kana kamwe utapukirwa, munhu anogona kurarama kwemaakumi emakore uye asingafungi nezvekurwara kwake. Nguva yekudzidzira vamwe inopedza mwedzi mitanhatu, kakawanda anenge makore mashanu, uye mune dzimwe nguva 20 uye kunyange makore makumi mana. Mukuwedzera kumubatanidzwa, kune nguva yakaderera (nguva iyo munhu ane utachiona anokwanisa kuuraya vamwe). Pamaperembudzi, pane zvishoma zvishoma. Murwere panguva ino angave asina zviratidzo zvachose, kana zvishoma nezvishoma, kurasikirwa kwechido, kuneta kusinganzwisisiki, asi haarati chirwere chakakomba, kunyange achitotapukisa.

Zviratidzo

Iyo microbe inokanganisa kwete mucheche chete mumuromo, asiwo mumapapu, pamwe chete nemasero ari mumagumo ekupedzisira (Schwann's). Nekuwedzera kwechirwere, mabhakitiriya anowanikwa mumaziso, muropa, kunyange muuropi. Chiratidzo chekutanga chekurwara chinorwadza zvikuru pamigumo, kumashure. Panguva imwe chete, varwere vanogona kunyunyuta pamusoro pokushaya simba, kurara, kurasikirwa kwechido, kuvhiringidzika kwepachivi. Munguva yemberi, marwadzo anotsiviwa nekunzwa kwekuchema, uye zvino munhu anowanzorasikirwa nekunzwisisa munzvimbo dzakakanganiswa. Izvi zvinowanzokonzera kukuvadzwa, hutachiona nehumwe hutachiona uye, pakupedzisira, kurasikirwa kweminwe, ruoko rusingaregereki uye tsoka dzetsoka. Mawaniro aHansen pachawo haabvumi miviri yakaremara ivo pachavo. Maperembudzi anosiyana nemhando mbiri miviri - chirwere che tuberculoid uye lepromatous. Zviratidzo zvazvo zvakasiyana, saka funga mumwe nomumwe zvakadzama.

Tuberculoid maperembudzi, etiology, zviratidzo, kurapa

Urwu urwere hwehutano hunoonekwa mune zvitatu zvakasiyana:

• Polar;
• Border crossing point;
• Undifferentiated.

Chiratidzo chikuru che maperembudzi ane tuberculoid inoratidzika paganda rejekiti hypopigmented (chiedza) patch. Nzira isina kufanira inokwanisa kuporesa pachayo, kana kutamira kune yakaoma. Pakutanga, ganda panzvimbo yeiiyo inenge yakanyanyisa, asi munguva pfupi iyo nzvimbo inotanga kuwedzera, miganhu yayo inoputika, uye chikamu chikuru, pane chinopesana, chinonyura. Hakuna mazhenje ejinga, bvudzi rinonyangarika, ganda rinorasikirwa nekunzwisisa. Kunze kwemavara, nerve thicken, saHenen's sticks, kukura, kuvhara masero akabatwa. Kutapukirwa kwemitsipa kunokonzera musero atrophy, kubvumirana kwetsoka nemaoko. Apo mabhakitiriya anorwisa musana wepiso, varwere vanoita zvirwere zvemaziso zvinozopedzisira zvichitungamirira kupofu.

Lepromatous leprosy

Urwu urwere hwehutachiwana hwakanyanya uye hwakaipisisa kune vanhu vari munharaunda yemurwere. Kune miviri miviri:

• Polar;
• Frontier.

Chimwe chezviratidzo zvechirwere ichi chizerewo mavara, asi vane mufananidzo wakasiyana-siyana-iwo akareba, akaenzana maererano nechepakati pemigumo yemuviri wemunhu, nemiganhu yakazara uye dense convex pakati. Mukuwedzera kune mavara, maruva aya anogona kutaridzika semavhutura, blips kana papules. Zvose izvi zvinonzi leproms uye dzine zviuru zveHansen tsvimbo mukupinda. Ihwo hunhu hunhu hunoitika panguva yemaperembudzi ane zviso zvevarwere. Vanodonha eyelashes nemashizha, mhuno (zvishoma nezvishoma) zvinokundikana, maitiro e nzeve anokanganisa (akaomeswa), ganda riri pamusoro ("muzhu mutsva"), mimicry inoputsika. Zvimwe zviratidzo:

• Matambudziko nemhuno (kunyanya, kunetseka kufema, dzimwe nguva kubva mumhino inoenda ropa);
• Kuchinja kwezwi (kunowedzera);
• Zvinetso nemaziso (keratitis, iridocyclitis);
• Yakakura lymph nodes mukura;
• Kupindira kwezviputi mumatete;
• Kuumbwa panzvimbo yeeprom yakasvibiswa yekudzivisa maronda;
• Utera hwemagumisiro, atrophy, nekuwedzera necrosis.

Kune mimwe yakasanganiswa yemaperembudzi, umo zviratidzo zve tuberculoid nemapapu epepromatous pamwe chete zvinowanikwa pamwe chete.

Diagnostics

Matenda emaperembudzi, etiology uye pathogenesis ayo achiri kuongororwa, anoongororwa nedzimwe nzira.

1. Clinical. Inoumbwa nekuona kuonekwa kweganda revarwere, nekuratidza kusava nehanya mucous membrane uye nzvimbo dzeganda.
2. Microscopic. Mukati nasopharynx unonyatsoda (kusvikira ropa) richikanda, tora zvinhu kubva kune lymph nodes. Iyo microscope inoratidzira murwere kuvapo kwechimiro chemashizha kana mapuropa emaperembudzi. I-smears yakasvibiswa uchishandisa nzira yeZiehl-Nielsen, zvichiita kuti matanho akare aHenenen atange akajeka uye vaduku vari vazhinji bhuruu.
3. Allergic test (Mitemo). Pasi peganda jai lepromine (yakagadzirirwa kubva kumatekisi anotorwa kubva kune varwere vane maperembudzi). Kana nyaya yacho iine hutachiwana, mushure pezuva rimwe ganda rake rinokura uye rinoputika.
4. Iyo serological method.

Kurapa

Procave inobatwa kwenguva yakareba, kusvika pamwedzi 12, uye dzimwe nguva makore akawanda. Therapy inongova yakaoma nekubatanidzwa kweophthalmologists, orthopedists, neuropathologists. Antibacterial drugs zvinoshandiswawo mune zvakaoma. Iri ndiro "Dapson" mumutauro we "Clofazimine" uye "Rifampicin". Kune mumwe murwere, doses uye chirongwa chekuita mishonga ndeyega. Dzimwe mhando dzechirwere chinogona kurapwa nekushandiswa kwemaviri chete emishonga inorwisa mabhakitiriya matatu, iyo inotsanangurwa nachiremba. Iye zvino miedzo yezvinodhaka "Minocycline", "Clarithromycin", "Ofloxacin" semishonga inopikisa maperembudzi iri kuitwa. Somugumisiro, maperembudzi ose anouraya muvarwere, asi kukanganisa kwavakaita kune nhengo uye neganda (kana zvatove zvasvika) zvinoramba.

Forecast

Kana kurapwa kunotanga panguva, chiitiko chacho chakanaka. Varwere vangasazoramba vari paganda. Mune zvikamu zvisingarambiki, hutano hahugoni kudzorerwa, munhu wacho anoramba asina chinhu chehupenyu, asi anogona kudzorera nhengo dzomukati, izvo zvinomubvumira kuti awedzere hupenyu hwake.

Kudzivirira kwechirwere kunosanganisira:

• Utano, kunyanya kana huri munzvimbo dzakasviba maperembudzi;
• Kutanga kuongororwa uye kurapwa;
• Kudzivirira kudzivirira kwevose avo vanosangana kwenguva refu nemaperembudzi anorwara (vanachiremba, mhuri).