Ukutheleleka kwe-Fungal Kungakhuthaza Ukugula Ukuchaza Ingculaza
I-cryptococcosis isifo esibulalayo esingabhubhisa abantu abangaba ngu-16 000 emhlabeni wonke ngosuku noma cishe abantu abayizigidi ezilodwa ngonyaka.
I-cryptococcosis yangaphandle (okufaka phakathi i-cryptococcal meningitis) ihlukaniswa yi-US Centers for Disease Control and Prevention njengesimo esichaza i- AIDS . Ngokuvamile, i-cryptococcal meningitis yi-infection evamile kakhulu yesistimu yezinzwa zomphakathi kanye nenkinga yesithathu evame kakhulu kubantu abane- AIDS .
Njengoba kutholakala ukwelashwa kwe-antiretroviral (i-ART) , i-cryptococcosis incidence iye yehla kancane ezweni elithuthukile kusukela phakathi nawo-1990.
Kodwa-ke, kusukela kumbono womhlaba jikelele, inani labantu abafa ngokubhekwa ngokuthi i-cryptococcal meningitis njengamanje lidlula kuka-625,000-kanti ukukhula okuphezulu kunokwenzeka e-Afrika engaphansi kweSahara, lapho kubalwa khona ukufa okuphakathi kuka-50% no-70%.
Ngokuphambene nalokho, ukufa ngenxa ye-cryptococcosis e-US nakwamanye amazwe athuthukile ku-12%.
Ama-Causal Agents
I-cryptococcosis ibangelwa i-fungus Cryptococcus neoformans ne- Cryptococcus gattii . Esikhathini esidlule, i-cryptococcosis yayibhekiswe kuphela ku- C. neoformans , kodwa ucwaningo lwalulokhu luhlukanisiwe futhi lubona kokubili i-subspecies causative.
Phakathi kwabantu abanesandulela ngculaza, okungaphezu kwengxenye yesithathu yamacala e-cryptococcosis abikwa kubantu abanezibalo ze- CD4 ngezansi kwamaseli angu-50 / mL. I-cryptococcosis ayikwazi ukuvela kubantu abanamasosha omzimba aqinile.
Amamodeli wokuThunyelwa
Kuthiwa ukuthi i-cryptococcosis itholakele ngokufaka izinhlamvu ezizalisayo (basidiospores) ze- C . neoformans noma i- C . gattii .
Nakuba i- C. neoformans ivame ukutholakala enhlabathini equkethe ama-drop droppings, ikakhulukazi amajuba, inhalation isabhekwa njengendlela enkulu yokutheleleka (okungafani nokufaka ngengozi noma ukuxhumana nesikhumba).
Ngokuphambene, i- C. gattii ngokuvamile ayitholakali emanzini asezinyosi, kodwa kunemithi (ikakhulukazi i-eucalyptus). I-fungus iyaziwa ukuthi iyanda ezindaweni ezimbiza ezizungeze izisekelo zemithi.
Ngenkathi i-cryptococcosis ivela njalo ezilwaneni, kokubili okudliwayo kanye nezinyoni zezilwane, amacala okudluliswa kwesilwane kuya kubantu ajwayelekile kakhulu. Ukudluliselwa komuntu kuya kubantu kuyabhekwa njengokungavamile.
Izimpawu ze-Cryptococcosis
Ukubonakaliswa kwemitholampilo yokutheleleka kwe- Crytococcal ngokuvamile kuqala noma kuphi kusukela ezinyangeni ezimbili kuya kwezingu-11 emva kokuvezwa.
Ukutheleleka kwe-cryptococcal yepulmonary ngokuvamile kungabonakali ngezigulane, noma kubonise ngezimpawu zokuphefumula okungezona eziqondile. Iziguli ezine-pneumonia ye-cryptococcal zivame ukukhwehlela, izinhlungu zesifuba, imfiva ephansi, i-malaise, nokuphefumula. Kwezinye izimo, kungase kube nokulahleka kwesisindo, izilonda ze- lymphadenopathy (i- lymphadenopathy ), ukuphefumula okusheshayo (i- tachypnea ), nama-crackles avela emaphaphu (imibono).
Uma ukutheleleka kusakazwa ngapha kwamapayipi (okungekho emthethweni), ngokuvamile kubonisa uhlelo lwesimiso esiyinhloko njengesi-cryptococcal meningitis. Kulezi zimo, iziguli zingase zivele zinezibonakaliso ezincane ezifana nokukhanda ikhanda, umkhuhlane, noma izinguquko esimweni sengqondo (isib. Ukulahlekelwa kokuqapha, ukungahloniphi, ukuzithemba).
Izimpawu zivame ukuhamba kancane lapho ziqala, zikhula ngokuqhubekayo ngokuhamba kwesikhathi kwamasonto amaningana.
Izimpawu ezibonakalayo ezinzima futhi ezingapheliyo ze-cryptococcal meningitis zingafaka:
- I-nausea nokuhlanza
- Umbono ophundlekile
- Ukuzwela ukukhanya
- Ukuzwa ukukhubazeka noma ukulahlekelwa
- Ukunyuka kwengcindezi ye-cranial
- Inhloko ekhanda
- Intamo yentamo
- Izinguquko zomuntu
- Kunzima ukukhuluma, ukufunda noma ukubhala
- Ukuqothulwa noma ukulahlekelwa kwemisipha
- Ama-hallucinations
- I-Coma
Njengoba ezinye zezimpawu ezihambisana ne-classic meningitis (njengezintamo ezinzima nokuzwela ekukhanyeni) aziveli ezigulini eziningi ezine-cryptococcal meningitis, ukuqwashisa ngesimo ngezinye izikhathi kuphuthelwa, ukubambezela ukunakekelwa kwezempilo amasonto ngisho nezinyanga kuze kube khona ukukhanya okukhulu izimpawu.
Ngaphandle kwamaphaphu kanye nesistimu yomphakathi, ukutheleleka kwe-cryptococcal kungabonakaliswa esikhumbeni njengezilonda, izilonda, ama-plaque, ama-abscesses, nanoma iyiphi enye yezinye izimo ezincane (noma ezingaphansi). Kungaphinda kuthinte izigulane ezinjenge-adrenal, i-prostate, nezinye izinhlelo zesitho.
Ukuxilongwa kwe-Cryptococcosis
Ukuxilongwa kwe-cryptococcosis kusekelwa ukuboniswa kwezici zomtholampilo kanye ne-symptomatology, futhi kuqinisekiswe ukuhlaziywa kwegazi, izicubu, uketshezi oludakayo noma ezinye izikhukhula zomzimba. Izindlela zokuxilongwa zingabandakanya:
- Ukuhlolwa kwe-antiptococcal antigen yegazi noma uketshezi lwe-cerebrospinal
- Ukuhlolwa okuncane kanye / noma isiko lesishukela, igazi noma uketshezi lwe-cerebrospinal
- Amasiko we-bronchoalveolar ukugeza ukugeza
Ngenkathi i-chest x-rays ingabonisa ukuthi i-localized noma ihlukanisa ukungena emaphashini ngezifo zokutheleleka kwe-pulmonary, ekugcineni isekela esikhundleni sokuqinisekisa ukuxilongwa.
Ukwelashwa kwe-Cryptococcosis
Ukuze iziguli ezingakwazi ukuzivivinya ezinezifo ze-cryptococcal ezingenangqondo noma ezingenangqondo, inkambo ye- antifungal therapy (fluconazole, itraconazole) ingahle yenziwe kuze kube yilapho isifo sofuba sinqunywa.
Uma kwenzeka izifo ezinzima, ukwelashwa kuvame ukuqala nge-amphotericin B, evame ukuhambisana ne-flucytosine. Lokhu kuvame ukulandelwa ukwelapha okuqhubekayo kokunakekelwa ngokusebenzisa umthamo wansuku zonke wemithi yokuvikela (kanye nokuqaliswa kwe-ART uma isiguli singakabi ukwelashwa).
Ukwelashwa kwesondlo kufanele kuqhutshwe kuze kube isikhathi sokuthi inani le-CD4 lingaphezu kwamangqamuzana angu-100 / mL futhi umthamo wegciwane lesiguli uqhutshwa njalo kumazinga angatholakali. Uma i-CD4 ingena ngaphansi kwe-100, ukwelapha kufanele kuqaliswe kabusha ukuvimbela ukuphindaphinda kwesifo.
E-US nakwamanye amazwe athuthukile, ukuvimbela okuyisisekelo (okuvimbelayo) i-antifungal prophylaxis akukhuthazwa, nakuba ukuhlolwa kokuhlolwa kwe-antigen kungacatshangelwa iziguli engozini enkulu noma ezindaweni eziphezulu zomthwalo wesifo.
Izincazelo:
- krip-to-kaw-KO-sus
- krip-to-KOK-ul mina-nin-JYE-tus
Obeye aziwe njengo:
- I-Crypto (i-slang)
- Izifo ze-Crypotococcal
Imithombo:
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Amasevisi aseMelika okuLawula nokuvimbela izifo (CDC). "I-Cryptococcal meningitis: isifo esibulalayo phakathi kwabantu abaphila negciwane lesandulela ngculaza nengculaza." I-Atlanta, Georgia; idokhumenti CS21371B; Kugcine ukubuyekezwa ngo-Okthoba 2, 2012.
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URhein, J. noBoulware, D. "Ukuchazwa nokuphathwa kwe-cryptococcal meningitis ezigulini ezine-infection immunodeficiency virus infection". Imithi ye-HIV ye-Neurobehavioral. Juni 12, 2012; 2012 (4): 45-61.
Kanji, S .; I-Kakai, R .; kanye no-Onyango, R. "I-Cryptococcal meningitis phakathi kweziguli zegciwane lesandulela ngculaza eziya esibhedlela esikhulu eSibumu, eNtshonalanga Kenya." I-Archives ye-Clinical Microbiology. 2011; 2 (12); doi: 10: 3823/220.
Okuphelele, J .; Ukudideka, W .; I-Dromer, F .; et al. "Imihlahlandlela Yokusebenza Ngokwemitholampilo Yokuphathwa Kwezifo Zama-Cryptococcal: 2010 Ukuvuselelwa yi-Infectious Diseases Society of America." Izifo Ezithathelwanayo Emitholampilo. . 2010: 50 (3): 291-322.