Ubangelwa Lassa yosulelo fever. Iimpawu, Treatment kunye Diagnosis

Lassa fever sisifo ngoweqela lwezifo ukopha wentsholongwane egazini. Ngenxa yoko, oko kuchaphazela izintso, isibindi ibhuqiwe, ukuphuhlisa umkhuhlane omkhulu. Isifo luphawulwa etsolo capillary toxicosis, xa uhamba kunye nesikhumba zonakaliswe yi izitya komhlaba kunye nokunyuka permeability yazo kakhulu. isifo ezisongela ubomi kanye, ukufa kwenzeka-40% yamatyala. Qho ngonyaka a kwesiqingatha sesigidi abantu bayahlupheka ukusuka Lassa fever. Isifo kwenzeka ngeeveki ezimbini, kunzima ngakumbi ukuze athwale icesina abafazi kwisiqingatha sesibini yokukhulelwa, kulo mzekelo, izinga lokusweleka yi malunga ne-80%.

iindawo Geographic ze sisasazeke

Ngowe-1969, oosonzululwazi Nigerian ukuqinisekisa fever phakathi kwabahlali kwedolophu sifo Lassa zibethwa abaphandi kunye nabongikazi ononophelo. Kuzo zonke iimeko ezintlanu zokuqala, ezintathu kwakhokelela ekufeni kwizigulane. Microbiologists konyaka kamva ukuchonga-arhente causative. Lassa fever ngeli xesha lugubungela amazwe e West Afrika, ezifana :. Guinea, Mali, Nigeria, Senegal, kunye nabanye musa barhuqe emva ngokwemiqathango-mnyango kwezifo kunye iindawo central kwelizwekazi leAfrika. Ngamanye amaxesha izilonda zenzeka kumazwe aseYurophu, Sirayeli, USA, Japan, apho pathogen intsholongwane idluliselwa abemi abahambahambayo.

Inkcazelo fever lwegciwane

Iarhente causative of Lassa fever usapho ummeli RNA wentsholongwane egazini genomic, ayinazo DNA njengoko yemfuza ukuyifunda omnye okanye neentsontelo ezimbini RNA. Isakhiwo ingqamana isakhiwo intsholongwane eBolivia kunye Argentine fever lwegciwane choriomeningitis. Viral virion sangqa NM nje 80-160, oko livalelwe kwimvulophu setyhula lipid umgangatho lakhe ligutyungelwe kwimicu. Uviwo ngemicroscope ityhila amasuntswana wentsholongwane egazini phakathi ribosomes ezilishumi emele granules ashinyeneyo entle.

Ngenxa yobukho amasuntswana zangaphakathi, iinkozo ezifanayo, virus Arenavirus ifumana igama lentsapho Arenaviridae (in arenaceus Latin kubonisa isanti). Kule minyaka ilishumi idlulileyo izazinzulu ziye zafunyanwa subgroups 4, leyo Lassa fever kwaye zasasazwa kwiindawo ezahlukeneyo eAfrika. Virus ukumelana neenguqu kummandla ongqongileyo ukuba ubuchule layo ngokwamandla ukuhlala zadibana negazi okanye emzimbeni iimfihlelo ayilahleki ixesha elide. Ukunciphisa umsebenzi wayo kusetyenziswa chloroform kunye kaEtere.

Imithombo kunye waBathengisi virus

Abathwali intsholongwane zithathwa amabuzi multimammate kwelizwekazi i-Afrika, imboniselo Mastomys natalensis. kwiindawo ezinobungozi epidemiological inani labantu abosuleleka yi 14-18% yabemi bebonke yeempuku, kwanempuku yintsholongwane abosulelekileyo ubomi, ngamanye amaxesha ngaphandle iimpawu zesifo. Umthombo losulelo naye umntu ogulayo, wonke ulwelo ezo ezosulelayo emzimbeni abanye.

iimeko usulelo fever Lassa akumi ukudluliselwa kusulelo emoyeni amathontsi ulwelo xa ukhohlela, uthimla, ukuphefumla. Usuleleko ifumaneka ilindle kunye nomchamo yeempuku, leyo onokuthi ulufumane ukutya kunye nesikhumba somntu. Usulelo kwiindawo ezingcolisekileyo kwenzeka xa umoya ukurhogele atomized incinane ilindle zezilwanyana, ukusetyenziswa komisa umthombo wamanzi ekungcolisweni iintsholongwane kunye neempuku inyama ngokwaneleyo zokupheka ukutya ngokuqhelekileyo ziphele.

Phakathi kwabo iimpuku ukugqithisela intsholongwane phezu umfowunelwa, ukusela, isondlo, zizalele nakuzo. Ukusuka umntu esosulelwa lolunye iindlela umntu ekuqhagamshelwana ezahlukeneyo ngokwesondo. unina Pregnant eyipasile umzimba intsholongwane elusaneni. abasebenzi basekliniki izifo ezosulelayo ayichole ngexesha unyango igazi kunye nongenelelo utyando, notyando, ukukhonza izigulane ezineempawu kakhulu catarrhal. Egazini izigulane emva sifo, Lassa fever ishiya omzimba, zisekhona ukuya kwiminyaka-7, leyo ke obnaruzht kuphando elebhu.

Imeko epidemiological

Isifo ithathwa ukuba lemikhuhlane focal wentsholongwane egazini. Abo kakhulu olusemngciphekweni abemi kwinxalenye esentshona Afrika. Usulelo kungenzeka ngokufanayo kuzo zombini elalini, nakuwo umzi, ngenxa yabahlali abaninzi yeempuku multimammate. Ngaphezu kwesiqingatha amatyala ziyabulala.

Livela sifo ukuya sifo ephindaphindekayo kancinane ngaye, kodwa iimeko ezinjalo zosulelo maxa wambi kwenzeka, kunye nonyango ngokuphindaphindiweyo nokuthintelwa Lassa fever ayifuni kufuna umgudu, esi sifo emiphungeni. phantse zonke iindawo usuleleko Afrika waqondisisa kakuhle unyaka wonke, kodwa ke nani likhulu asinto ngexesha abandayo, xa inqwaba yeempuku esondela kufutshane ebantwini yezindlu.

Amatyala intsholongwane yisa lizwe kwilizwekazi eYurophu uthatha indawo, kodwa ukunqanda ukusasazeka enjalo yonke yicesina zizifo zixhomekeke accounting engqongqo kumgangatho wehlabathi. Abantu amadoda namabhinqa, ngokulinganayo, basemngciphekweni wosulelo. Le ntsholongwane kakhulu kakhulu kuthe kwaqhenqetha kakhulu kwiindawo nococeko amahlwempu, kwimimandla ehluphekayo enabantu abaninzi.

Le Pathogenesis kwesifo

Le inwebu kwiinwebu umzimba womntu esangweni for usulelo otyiwa. Virus ngenxa elingaphesheya okuthatha, yenzelwe kwindawo nkovu ekupheleni isigaba sexesha etsolo febrile luqala ukusasazeka amasuntswana phezu kwazo zonke iinkqubo zomzimba. Iiseli ze amalungu abalulekileyo, equlethe intsholongwane, kuba kwiinkxwaleko lymphocyte cytotoxic, kukho Lassa fever. Iimpawu kunye nonyango esi sifo baba nomdla phakathi ziingcali. Xa indlela yokuphuhlisa isifo necrosis kwesibindi kunye nezintso, udakada kunye nokonakaliswa umsipha.

Ubungqongqo sifo ixhomekeke omzimba le ephilayo, ngoko esele iimpendulo iseli ukungathobeli obulalayo. Ukuba ixesha febrile kukho isifo ukubunjwa antibodies ukuphelisa iintsholongwane emsebenzini kwaye walibala - ukuthi kuziveza njengoko Lassa fever. Photo of the isigulane thaca ngezantsi.

Iimpawu zesi sifo Lassa

Ithuba elisuke ithatha iveki enye ukuya kwezintathu, ngoko iqala kwisigaba zale sifo kunye neempawu uphawu:

• karhulumente bomkhuhlane kuqala ukwanda okungephi lobushushu emzimbeni;
• oluthile abonisa, ukuziva ubuthathaka;
• apho myalgia, iintlungu emqaleni xa ukuginya;
• bachatshazelwa conjunctivitis amehlo;
• kunye nokwanda lobushushu emzimbeni ukuba obandayo ubuthathaka ziyanyuswa;
• ezibangela intlungu kakhulu ngasemva, isisu, esifubeni;
• maxa wambi kukho isicaphucaphu, isifo sorhudo, yombono;
• ekhohlela uba ihlanza;
• Umbono aphazamiseke isithuba olubonakalayo.

Ukuhlolisisa yesigulana

Soloko obekhona ukufukuka ukuhlolwa entanyeni nasebusweni, indawo esifubeni, kukho iziphumo ukopha kwiindawo ezahlukeneyo, Ngokucofa waphawula ukunyuka kakhulu kwiindawo nkovu. iimviwo laryngeal ityhila izilonda, mucosal luphawulwa imbonakalo amatshatshazi amhlophe, harbingers izilonda ezilandelayo olunika Lassa fever. Iimpawu iimviwo wentliziyo ziboniswe ngezandi wu-, bradycardia, kunye nokwanda okanye izinciphiso uxinzelelo lwegazi. Ne indlela ngakumbi esi sifo ukuphuhlisa myocarditis, bradycardia kunye tachycardia indawo.

Survey of izifo olukrokrelwayo kuzisa phezu eluswini hemorrhages yezigulane eziliqela, ukongeza kubo, kukho amabala, papules, roseola, maxa wambi kwamaqhakuvana kuhlobo ukhumbuza okubonakalisa yimasisi. Intliziyo yenziwe yabanzi, isigulana ochaphazelekayo malunga ukuphelelwa umoya, ukukhohlela, ukutswina emiphungeni umlinganiswa ezimanzi okanye ezomileyo. Ummandla lwangaphakathi peritoneum ukuba waziva intlungu, ukuduma esiswini, urhudo. Kuphononongo lwe isibindi eyandisiweyo. ukuphazamiseka luvo kwakhona kuziveza fever Lassa. Epidemiology uphawula amatyala yokulahlekelwa osezingqondweni, ukuva ilahleko, ukuduma, kukho epheleleyo okanye kwinxenye intloko balding.

izifundo zeLebhu zityhila leukopenia igazi, ngoko leukocytosis, ngaloo lususwa wbc ngasekhohlo, ebalasele zegazi ukwanda ukubala nokwehla prothrombin, landa ESR ukuya 50-80 mm / h. kunciphisa igazi ekunqandeni, ixesha prothrombin ukwanda kwenzeka. Kidney ukungaphumeleli yenza kwaziwe isiqulatho eliphezulu urea egazini, uphando ichaza umchamo kunye proteinuria cylindruria yesigulana. Umchamo iqulethe leukocytes, erythrocytes, iiproteins ubumdaka iisilinda granular.

Ekubeni Lassa fever libhekisela sifo lwendalo focal yintsholongwane okukrokrelwayo ikhutshwa phandle imbali epidemiological, achonge imiqathango ukutyhileka sifo ngenxa ukuhlala yomguli kwi kwimimandla ingcolisekile. Njengesixhobo uphando kusetyenziswa X-ray, FDSG, ultrasound, MRI ezonakeleyo amalungu kunye neenkqubo zomzimba. Ngomhla kwenkcazo sifo, izigulane bafuna ngengcebiso pulmonologist, cardiologist, luvo, gastroenterologist.

ikhondo Severe kanye nobunzima

Ngowe-37-52% amatyala, ubungqongqo sifo kukhokelela izibhaxu kwemiphunga (inyumoniya ubungqongo ezishiyanayo), intliziyo (myocarditis), isibindi (ukuqina), zezintso (ukusilela). nokudumba ezimandundu iindawo pleural umzimba ubonisa Lassa fever. Epidemiology, iimpawu yiklinikhi, uthintelo ayisoloko ukunika Ingxelo eyakhayo kwaye neziphumo yokunyanga. Ngaphezu kwesiqingatha amatyala kwangaphambili ukufa isigulana emva kweeveki ezimbini abaqala kuyo. isifo Ifanele iyaqhubeka iiveki ezi-3, kwaye ke iqala ukunciphisa ubushushu. Angalulama kade, iimpawu kwakhona umboniso-ukususela kumaxesha ngamaxesha kukho likakade.

Ukwahlula uphethwe kunye nezinye izifo

Ngokutsho ezininzi iimpawu ukubonakalalisa isifo efanayo lemikhuhlane ukopha kwezinye iintlobo. Yesifo, shock fever, icesina emthubi, Kyasanur isifo ehlathini, West Nile, Chikungunya, Malaria efudumeleyo, ifiva nebomvu, meningitis kufana Lassa fever. YeMarburg, Ebola nayo ngezizathu banezinto ezininzi ngazo kwaye kufuneka mabangezi esi sifo okusolwayo.

Malaria iyafana iimpawu Lassa yokuba xa omabini izifo kukho izibonisi ubushushu bomzimba phezulu, intloko ebuhlungu, yellowing kwesikhumba. Umahluko siyifumana yokuba seengcongconi alupheleli kukuvela izilonda necrotic emqaleni, kwaye kukho ukwanda kakhulu kwiindawo nkovu, kunqabile ukuphuhlisa haemorrhagic syndrome. Ukongeza, isifo seengcongconi luphawulwa eluswini libunile, ukubila ngokugqithiseleyo nokubonakalaliswa ngokungalinganiyo ifiva, kwamaqhakuvana zineengxaki.

Sophele fever ne sezintso syndrome luphawulwa iimpawu eziqhelekileyo izifo Lassa, kuboniswa inimba intloko izihlunu amahlaba, sclerite, conjunctivitis, oliguria. Kodwa ke oko akuthethi ukuba HFRS ebantwini gqolo ukugabha, pharyngitis sisilonda kunye norhudo. Ngokungafaniyo isifo Lassa flow ukususela ngomhla wokuqala sifo kwenzeka umlomo owomileyo, unxaniwe, buthathaka kakhulu izihlunu.

Kuba iimpawu ezinxulumene Leptospirosis Uphawu njengoko fever, intloko ebuhlungu, myalgia, conjunctivitis, scleritis, oliguria. Kodwa ke ukungabikho Leptospirosis kunye izilonda necrotic ngokwesimo emlonyeni izahlule Lassa fever. Ukuba Leptospirosis ayenziwanga ukukhohlela, urhudo, ubuqhophololo, akukho iintlungu esifubeni akukho labonwa izifundo laboratory leukopenia, bradycardia. Iimpawu kakhulu ezahlukene Lassa fever. Amafoto bachatshazelwa sesi sifo ithiwe thaca apha ngasezantsi.

IMarburg fever i abapase wentsholongwane egazini etsolo iimpawu kakhulu, kunye neempawu ezifana nesifo Lassa. A iqondo eliphezulu ukufa, uphuhliso ifiva, ukopha syndrome, izibhaxu amalungu angaphakathi kunye nenkqubo luvo. Umthombo losulelo ayifani ncam lusekiwe, kukholelwa ukuba intsholongwane sisasazwa ukuba abantu uhlaza nyani kwamathana okanye umoya iindlela kunye wadibana khona isilwanyana.

iindlela zonyango

Zonke izigulane ekucingelwa ukuba bosulelwe kuya kuxhomekeka esibhedlele ngokunyanzelekileyo kwiiklinikhi ezizodwa. Xa umxholo umguli kunyango waphawula umbuso engqongqo amakheswa ngaphandle nakuphi na ukunyhashwa. Emiselweyo indawo ibhedi tyaba, umthwalo ngaphandle, unyango lujoliswe yokunqanda iimpawu zesi sifo zenzeke. Kwiiveki zokuqala oonobangela sizimisele, kunye nonyango lwe Lassa fever kwindawo yokuqala ukusetyenziswa yokuchachela plasma. Oku kusebenza kuphela ekuqaleni kwesi sifo, ekubeni kusetyenziswe amayeza umkhuhlane elide ngexesha bakuphathe kwezinye iimeko, ukonakala kweendlela sifo kunye nophuhliso iingxaki.

ingxaki kwesifo iphathwa kunye antibiotics eyomeleleyo kunye corticosteroids. etiotropic In kwishishini loxubo zonyango mihla liphuhlise amachiza amatsha okugonya. Ngempumelelo uhlala namhlanje ukusetyenziswa kweziyobisi kwi unyango virazole, ribamidil, ribavirin. Bona ezibanjiswe lokuqala sifo ngomlomo, xa imali 1000ed ngosuku. Reception musa ayeke iintsuku ezili-10. Yegazi ilawulwa amayeza ngokwaneleyo iintsuku-4, nto leyo inceda ukuphucula indlela isifo kwaye sehlise izinga lokufa.

Yokuthintela isigulo

ilahleko enkulu kakhulu wokuphila ukuba umkhuhlane Lassa. zokuthintela izifo kubaluleke kakhulu kwiindawo ezisemngciphekweni kwezifo. Ukuthintela kwii yokuhlala abantu intsholongwane, ayeke ukufikelela kuyo amabuzi multimammate kunye nezinye iintlobo namabuzi. Ngokuqhelekileyo, ukutya kunye namanzi okusela amaqula yeemveliso ezintsha ukufuya ngenyameko ukuze kupheliswe ukungena umchamo kunye ilindle kweempuku. Njengoko prophylaxis zikufake yonke iimpuku kulandele ngokutshiswa izidumbu.

ixabiso elikhulu lokunqanda ihlawulwe ukuphucula umgangatho wokuphila abantu bomthonyama Afrika, nokuphucula umgangatho ukutya ukuvela ukhuselo olwaneleyo omzimba eziphilayo. babambe kunye neentetho ukwandisa yenkcubeko - kwinqanaba nendlu, ucacisa imfuneko ngokuhambelana nemigangatho yempilo ngamnye umntu ngamnye.

Oogqirha kunye nezinye iikliniki usulelo abasebenzi bezonyango babophelelekile ukuba baqinisekise ukuba iindlela eziyimfuneko lobuqu prophylaxis, ezifana neeglavu kunye iimaski yokhathalelo nomonde. Baqeqeshiwe kwaye wathumela kwindawo umngcipheko epidemiological oogqirha zendawo yokuziphatha efanelekileyo nangokhuseleko ngobungxamo nokuqinisekisa ukuba anti-bhubhane umbuso.

Ekuqhubeni imisebenzi kokuqhambuka zisenzeka bhubhane

izenzo yedwa ngendlela ngokuyimfuneko kwenzeka, ukuba kuyo nayiphi na indawo kukho Lassa fever. Amanyathelo olawulo zenziwa ngokukhawuleza ngaphandle kokulibazisa. Bona ezijoliswe ekulungiseleleni lo wokuvalelwa nzima bohlukaniswe ngokupheleleyo yezigulane ezosulelayo kwiibhokisi, abantu basekuhlaleni osisilumkiso kokuqala kwalo bhubhane. Bonke abasebenzi abachaphazelekayo kufuneka banxibe izinxibo anti-isibetho kunye nezixhobo zokukhusela zobuqu.

Kuyinto esibhedlele enyanzelekileyo yabantu ekucingelwa ukuba wadibana nabagulayo, livutha kungekho ixabiso eziphathekayo izinto kunye izinto nendlu Bolney kunye nabantu, kokutsha olawulo izidumbu zesi sifo, kweentsholongwane kwizakhiwo kunye namakhaya. Abantu abafika kwiindawo "acocekileyo" ye iindawo ubhubhane, idla kwizibhedlele apho sola incinane ingenzeka kwesi sifo.

Xa ndiqukumbela, kufanele kuqatshelwe ukuba ifiva esibulalayo ukufiphala, ukuba wenziwe ngokungqongqo ukuqinisekisa amanyathelo okhuseleko zenziwa ngaphandle amanyathelo asebenzayo ukunciphisa ingozi yesifo, unyango ngexesha iqalisiwe.