Ukwelashwa kwesifo se-Chagas kuncike ekutheni isifo sitholakala yini . Abantu abatholakala ukuthi besesigaba esiyinkimbinkimbi sesifo baphathwa ngendlela ehlukile kunelabo abatholakaliswa ngesikhathi sesiguli.
Ukwelapha Izifo Eziphuthumayo
Ithuba elilodwa kuphela elihle lokuphulukisa isifo seChagas-okungukuthi, sokuqeda ngokuphelele i-Trypanosoma cruzi (T.
i-cruzi) i-parasite evela emzimbeni-uma ngabe ukwelashwa kungaqaliswa ekuqaleni kwesifo, ngesikhathi sesisindo.
Kunoma yimuphi umuntu otholwe ukuthi une-T. cruzi isifo esiphuthumayo, noma uma usana selutholakala ukuthi lunesifo sokubeletha, ukwelashwa kufanele kunikezwe ngezidakamizwa ze-antitrypanosomal. Lezi zidakamizwa ezimbili eziye zaboniswa ukuthi ziyasebenza ngokumelene ne-T. cruzi yi-benznidazole ne-nifurtimox. Abesifazane abakhulelwe akufanele bathole lezi zidakamizwa.
Uma ukwelashwa okuphelele okukodwa komunye walezidakamizwa kugcwaliswa, ukuqedwa kukaT. cruzi kufezekiswe kumaphesenti angama-85 esikhathi.
I-Benznidazole
I-Benznidazole ngokuvamile inezimbangela ezimbalwa futhi kaningi imithi yokwelapha. Lesi sidakamizwa kufanele sithathwe izinsuku ezingu-60. Umphumela wayo ovame kakhulu ukuqhuma isikhumba.
I-Nifurtimox
I-Nifurtimox (engavunyelwe e-United States) ivame ukubangela izimpawu zamathumbu. Kungaphinda kubangele ukuleleka, ukuphazamiseka, kanye ne- peripheral neuropathy .
Le miphumela emibi ikwehlisa ukusizakala kwayo. Lesi sidakamizwa kufanele sithathwe okungenani izinsuku ezingu-90.
Ukwelapha Ukwelashwa Okungapheli
Njengoba isifo esingapheli se-Chagas, ukuqeda i-T. cruzi i-parasite nge-antitrypanosal therapy kunzima kakhulu kuneyesikhathi esinqunyiwe, futhi kungenzeka ukuthi akunakwenzeka.
Noma kunjalo, ochwepheshe abaningi batusa ukuphatha nge-benznidazole noma i-nifurtimox uma umuntu olelekile engxenyeni engapheli yesifo esingapheli se-Chagas (okungukuthi, akanawo inhliziyo noma isisu somzimba we-Chagas isifo), futhi ungaphansi kweminyaka engama-50.
Abantu abangaphezu kweminyaka engu-50 banomphumela ophezulu wemiphumela emibi evela emithini ye-antitrypanosomal, kodwa ukwelashwa kungase kubhekwe.
I-Antitrypanosomal therapy ayinconywa uma isifo senhliziyo saseChagas sesivele sikhona, uma isifo esibi kakhulu se-Chagas sisekhona (njenge- megacolon ), noma uma kukhona isibindi esibalulekile noma isifo sezinso. Kulaba bantu amathuba okuqeda ukutheleleka kwe-T. cruzi iphansi kakhulu, futhi ingozi yemiphumela emibi iphezulu.
Ukwelapha izifo ze-Chagas Cardiac
Ukwelapha ngezidakamizwa ze-antitrypanosomal akusizi inzuzo yesifo senhliziyo saseChagas. Esikhundleni salokho, ukwelashwa kumele kuhloswe ngokuqondile ekulawuleni isifo senhliziyo ngokwayo.
Isifo senhliziyo saseChagas sinhlobo lokuphelelwa yisifo sofuba oluvame ukuveza ukwehluleka kwenhliziyo , futhi abantu abanesifo kufanele bathole yonke imithi yokwelapha yokwelapha .
Ukwelashwa Kwehluleka Inhliziyo
Ukwelapha kwezokwelapha kuvame ukufaka ukwelashwa nge- beta blockers , i- ACE inhibitors , ne-spironolactone. I-diuretic therapy isetshenziselwa ukusiza ukunciphisa i-edema ne-dyspnea.
Ukwelashwa kabusha kwe-cardiac ukuguqulwa kwe-cardiac (CRT) kubonakala kuwusizo e-Chagas isifo senhliziyo njenganoma iyiphi enye indlela yokuhluleka kwenhliziyo. Kodwa-ke, ukubaluleka kwe-CRT ekwelapheni ukuhluleka kwenhliziyo ikakhulukazi kunomkhawulo kubantu abaye bashiya isikhwama segatsha , kungakhathaliseki ukuthi banesifo seChagas noma ngabe yiluphi uhlobo lwe-cardiomyopathy ehlanjululwe.
Futhi, ngeshwa, ku-Chagas isifo segatsha esivumelwaneni esivumelwaneni esivame kakhulu kunasese kwesigatshana segatsha-ngakho-ke i-CRT ifanele kubantu abambalwa abanokuhluleka kwenhliziyo ye-Chagas kunokuba nezinye izinhlobo zenhliziyo ehluleke.
Abantu abanesifo seCasgas kubonakala sengathi benza kanye nokufakelwa kwesifo senhliziyo njengeziguli ezinezinye izinhlobo zokuhluleka kwenhliziyo. Okunye okukhathazayo ekwenzeni ukuhlinzwa kokufakelwa kokushisa e-Chagas isifo senhliziyo sekuwukuthi ukwelapha umzimba okudingekayo emva kokufakelwa kwesitshalo kungabangela ukuthi ukutheleleka kwe-T. cruzi kuvuseleleke. Kodwa-ke, izifundo zokwelashwa zibonise ukuthi ukuvuselelwa kokutheleleka ngemuva kokufakelwa kwesitshalo akubonakali kuyinkinga ejwayelekile esifozweni senhliziyo yeChagas.
Ingozi ye- thromboembolism (isimo esivame ukukhiqiza inhlanzi ejulile enamandla , ukuvuthwa kwe-pulmonary or stroke ) yanda kunoma ubani onokwehluleka kwenhliziyo, kodwa kubonakala sengathi ingozi ethile kubantu abane-Chagas isifo senhliziyo. Iningi labantu abanesifo senhliziyo saseChagas kufanele lifakwe ku- anticoagulant therapy ( neCoumadin noma i- NOAC drug ), noma i- aspirin ye-prophylactic yokunciphisa ingozi enkulu ye-thromboembolism.
Ukwelapha i-Cardiac Arrhythmias Nokuvimbela Ukufa Okungazelelwe
Ukwelapha ukuvimbela noma ukwelapha ama- arrhythmias enhliziyo ejulile kuvame ukudingeka kubantu abane-Chagas isifo senhliziyo ngoba basengozini enkulu kokubili i- bradycardias (izinhliziyo ezincipha kancane) kanye ne- tachycardias (imizwa yenhliziyo esheshayo).
I-Bradycardias iyenzeka ngezikhathi ezithile kubantu abane-Chagas. I-bradycardias ibangelwa kokubili izifo zesisindo se-sinus kanye ne- block block . Uma i-slow rhythm iveza izimpawu, noma uma kubonakala sengathi iveza izimpawu ezinzima ezifana ne- syncope , ukwelashwa nge- pacemaker kuyadingeka.
Ukukhathazeka okukhulu ngempela okuhlobene nama-arrhythmias enhliziyo kubantu abane-Chagas isifo senhliziyo, noma kunjalo, ukufa okungazelelwe kubangelwa yi- ventricular tachycardia noma i- fibrication ye-ventricular . Ingozi yokuba nalezi zinhlobo zokusongela impilo zihlobene nobuhlungu bomonakalo wenhliziyo okwenziwe nguChagas.
Uma umsebenzi wenhliziyo ucindezelekile kuze kube yilapho lezi zigaba eziyingozi zingase zenzeke, ukungena kwe-defibrillator engasetshenziswa kufanele kucatshangelwe ngokuqinile. Kodwa-ke, ikakhulukazi eLatin America, lapho ukwelapha okutholakala khona kwe-defibrillator ngokuvamile kungatholakali kalula, iziguli ezinezifo ze-Chagas cishe zizokwelapha nge-antiodrhythmic drug amiodarone kunalokho, ngomzamo wokunciphisa ingozi yokufa kungazelelwe.
Ukwelapha Izifo Zomzimba
I-Antitrypanosomal therapy ayiphuthumisi izifo zamathumbu ezibangelwa yiChagas. Ukwelashwa kuhloswe ukunciphisa izimpawu ngokunciphisa i- reflux yamathumbu nokulawula ukunxanxathela nokuqotshwa ngemithi nokudla. Ukungenelela kokuhlinzwa kungadingeka uma i-megacolon noma i-megaesophagus ikhona.
Ukuvimbela
Emashumini eminyaka ambalwa amazwe amaningana aseLatin America ayenze imizamo emikhulu yokuqeda noma okungenani ukunciphisa isifo seCasgas.
Ngokuvamile, le migudu igxile ekuqedeni i-vector yesifo-okungukuthi, "izimbungulu zokuwanga" ezithumela i-T. cruzi parasite kusukela kubantu kuya kubantu. Ukuqedwa kwezimbungulu zokubanga kuye kwazama ukusebenzisa izinambuzane ezihlala isikhathi eside emakhaya abantu. Le mizamo isize kakhulu kepha ayizange isuse inkinga-futhi isifo seCasgas sihlala sisendaweni eziningi zasemaphandleni eLatin America.
Ukuhlolwa kokubeletha kukaT. cruzi kuye kwasiza ekunciphiseni ukudluliselwa kwesifo. Abesifazane abakwazi ukuphathwa ngezidakamizwa ze-antitrypanosom ngenkathi bekhulelwe, kodwa ukwelashwa ngaphambi kokukhulelwa kuvame ukusebenza kahle. Abesifazane okwamanje abanesifo sikaT. cruzi nabo bayelulekwa ukuthi bangalusisi, nakuba ukudluliselwa kwesifo ngokusebenzisa ubisi lwebele akuzange kuboniswe.
> Imithombo:
> Andrade JP, Marin Neto JA, Paola AA, et al. Izinkombandlela zaseLatin American for the Diagnosis And Treatment Of Chagas 'Inhliziyo: Isifinyezo Esiphezulu. I-Arq Bras Cardiol 2011; 96: 434.
> Izifo zeBern C. Chagas '. N Engl J Med 2015; 373: 456.
> Martí-Carvajal AJ, Kwong JS. Ukwelashwa Kwemithi Yokuphatha Ukwehluleka Kwezinhliziyo Ezigulini Eziphethe I-Chagas Cardiomyopathy. I-Cochrane Database Syst Rev 2016; I-7: Cd009077.
> Pinazo MJ, Cañas E, Elizalde JI, et al. Ukuxilongwa, Ukuphathwa Nokuphathwa Kwezifo Zasemathunjini Ezigulayo Zamazinyo Emiphandleni Lapho ukuhlolwa kwesifo se-Trypanosoma Cruzi Akukhona. I-Gastroenterol Hepatol 2010; 33: 191.
> Pinazo MJ, Muñoz J, Posada E, et al. Ukubekezela Kwe-Benznidazole Ukwelashwa Kwezifo Ze-Chagas Kubantu abadala. Ama-Antimicrob Agents Chemother 2010; 54: 4896.