Ukunyangwa kwesifo seCasgas kuxhomekeka xa isifo sifumaneka. Abantu abafunyaniswayo kwisigaba esiyingozi sesi sifo baphathwa ngokuhlukileyo kunezo zifunyaniswe kwisigaba esingapheliyo.
Ukunyanga iSifo esiPhakathi
Kuphela ithuba elifanelekileyo lokuphilisa isifo se-Chagas-oko kukuthi, ukuphelisa ngokupheleleyo iTanpanosoma cruzi (T.
cruzi) i-parasite evela emzimbeni-ukuba ngaba unyango lunokuqalisa ekuqaleni kwesi sifo, ngexesha lesiganeko.
Kunoma yimuphi umntu ofumene ukuba unesifo esichukumisayo seT. cruzi, okanye ukuba usana lufunyanwa ukuba lunentsholongwane yobuntwaba, unyango lufanele lunikezwe ngamachiza e-antitrypanosomal. Amachiza amabini aboniswe ukuba asebenzayo ngokumelene neT. cruzi yi-benznidazole kunye ne-nifurtimox. Abafazi abakhulelweyo akufanele bafumane ezi zi yobisi.
Ukuba ikhosi epheleleyo yeyeza kunye nenye yezi yobisi igqityiwe, ukuchithwa kweT. cruzi kufezekiswe kuma-85 ekhulwini kwexesha.
Benznidazole
I-Benznidazole ibinemiphumo embalwa yecala kwaye idla ngokunyanga. Esi siza kufuneka sithathwe iintsuku ezingama-60. Igalelo layo eliqhelekileyo eliqhelekileyo lilophuza.
Nifurtimox
I-Nifurtimox (engagunyaziswanga e-United States) idala ukubonakalisa iimpawu zesisu. Iyakwazi ukuvelisa ukulala, ukuphazamiseka, kunye ne- peripheral neuropathy .
Ezi ziphumo zithintela ukusetyenziswa kwayo. Esi sidakamizwa kufuneka sithathwe ubuncinane iintsuku eziyi-90.
Ukunyanga Ukwelashwa Okungapheliyo
Ngesi sifo esingapheliyo seCasgas, ukuphelisa i-T. cruzi i-parasite neyeza-antitrypanosom yinto enzima kunokuba yinto yesiganeko, kwaye ingenakwenzeka.
Sekunjalo, ezininzi iingcali zincoma ukuba unyango kunye ne-benznidazole okanye i-nifurtimox ukuba umntu osulelekileyo usesigxina sesifo esingapheliyo se-Chagas (oko kukuthi, akanalo isifo senhliziyo okanye isisu sesifo seChagas), kwaye uneminyaka engaphantsi kwe-50.
Abantu abangaphezu kweminyaka engama-50 banesiganeko esiphezulu semiphumo emibi evela kumachiza e-antitrypanosomal, kodwa unyango lunokuthi luqwalaselwe.
I-Antitrypanosomal therapy ayikhuthazwa ukuba isifo senhliziyo saseChagas sisekhona, ukuba isifo esibi sisifo se-Chagas sikhona (njenge- megacolon ), okanye ukuba isifo esibindiweyo okanye isifo seengqondo sifumanekile. Kula bantu abantu amathuba okuphelisa isifo seT. cruzi kakhulu, kwaye umngcipheko weempembelelo ziphezulu.
Ukunyangwa kweChagas Cardiac Disease
Unyango olwenziwe ngamachiza e-antitrypanosomal aluzuzi inqobo yesifo senhliziyo saseChagas. Kunoko, unyango kufuneka lujoliswe ngqo ekulawuleni isifo senhliziyo ngokwawo.
Isifo senhliziyo saseChagas luhlobo lwe- cardiomyopathy elixubileyo edla ngokuvelisa ukungaphumeleli kwentliziyo , kwaye abantu abanesi sifo kufuneka bafumane yonke imithi yokwelapha ye-cardiomyopathy .
Ukunyanga Ukungaphumeleli Kwintliziyo
Utyando lwezonyango luhlala lubandakanya unyango nge- beta blockers , i- ACE inhibitors , kunye ne-spironolactone. Utyando lwe-Diuretic lusetyenziselwa ukunceda ukunciphisa i-edema kunye ne-dyspnea.
Ukuguqulwa kwamagciwane e-cardiac (CRT) kubonakala ngathi luncedo kwisifo senhliziyo saseChagas njengalowo nawuphi na uhlobo lwesifo senhliziyo. Nangona kunjalo, ukusetyenziswa kwe-CRT ekuphatheni ukuhluleka kwentliziyo kuncinci kubantu abaye bashiya isigqeba segatsha , nokuba banesifo seChagas okanye nayiphi na enye indlela ye-cardiomyopathy.
Kwaye, ngelishwa, kwi-Chagas isigqeba segatsha esisezantsi kwesigqeba esivame kakhulu kunokuba isisigxina se-branch block-ngoko i-CRT ifanelekile kubantu abambalwa abanokuhluleka kwentliziyo yeChagas kunezinye iintlobo zentliziyo yokuhluleka.
Abantu abanesifo seCasgas kubonakala bekwenza ngokunjalo nokuguqulwa komzimba njengezigulane ezinezinye iintlobo zokwahluleka kwentliziyo. Enye inkxalabo ekwenzeni ukutyunjwa kwintlungu yesifo senhliziyo yeChagas yinto yokuba unyango olungapheliyo olufunekayo emva kokutshintshwa kwezinto lungenza ukuba isifo soT. cruzi siphumelele. Nangona kunjalo, uphando lwekliniki luboniswe ukuba ukusulela ukusuleleka emva kokutshintshwa kwezinto akubonakali kuyinkinga efanayo kwisifo senhliziyo saseChagas.
Umngcipheko we- thromboembolism (imeko edla ngokuvelisa i-thrombosis enzulu , i- pulmonary embolism , okanye i- stroke ) yanda kunani na onentliziyo engaphumeleli, kodwa ibonakala ingozi ebantwini abanesifo senhliziyo saseChagas. Uninzi lwabantu abanesifo senhliziyo saseChagas kufuneka lubekwe kwi- antiticoagulant therapy (kunye neCoumadin okanye i- NOAC drug ), okanye i- aspirin yeprophylactic ukunciphisa ingozi enkulu ye-thromboembolism.
Ukunyanga i-Cardiac Arrhythmias nokukhusela ukufa ngokukhawuleza
Unyango lokuthintela okanye unyango olunzulu lwe- cardiac arrhythmias luyimfuneko kubantu abanesifo senhliziyo saseChagas kuba banomngcipheko ophezulu kubini bradycardias ( iincinci zentliziyo esicothayo) kunye ne- tachycardias (imiqobo yeengqondo ezikhawulezayo).
I-Bradycardias iyenzeka ngezinye izilwanyana kubantu abane-Chagas. I-bradycardias ibangelwa zizifo zesifo se sinus kunye ne- block block . Ukuba intliziyo ecothayo ivelisa iimpawu, okanye ukuba ibonakala ngathi ivelise iimpawu ezinzima ezifana ne- syncope , unyango lwe- pacemaker luyimfuneko.
Ukukhathazeka ngokwenene okuhlobene neentliziyo zentliziyo kubantu abanesifo senhliziyo saseChagas, nangona kunjalo, ukufa ngokukhawuleza kubangelwa yi- tachycardia ye-ventricular okanye i- fibrillation ye-ventricular . Umngcipheko wokuba iziqhelo zokusongela ubomi zihambelana nobunzima bomonakalo wentliziyo owenziweyo nguChagas.
Ukuba umsebenzi wentliziyo uxinezelekile kangangokuba ezi zixhobo eziyingozi ziyakwenzeka ngokukodwa, ukungeniswa kwe- defibrillator enokutsha kufuneka kuqwalaselwe. Nangona kunjalo, ngokukodwa kwiLatin America, apho i-defibrillator ye-anti-hydrhythmic i- amiodarone isenokuthi ayifumaneke ngokuthe tye, izigulane ezine-Chagas isifo sinokuthi zingaphathwe nge-antiarrhythmic drug.
Ukunyanga izifo zesisu
I-Antitrypanosomal therapy ayiphuculanga isifo sesisu esibangelwa yiChagas. Unyango lujoliswe ekunciphiseni iimpawu ngokunciphisa i- reflux yesisu kunye nokulawula isicupunu kunye nokuqhawula ngamachiza kunye nokutya. Ingenelelo yokuphanda inokufuneka ukuba i-megacolon okanye i-megaesophagus ikhona.
Thintelo
Kwiminyaka emininzi yamashumi ambalwa amazwe aseLatin American enza imizamo emikhulu yokuphelisa okanye ubuncitshiswe kakhulu isifo seCasgas.
Ngokuqhelekileyo, le migudu ijolise ekukhutsheni i-vector yesifo-oko kukuthi, "iibhugi zokubanga" ezithumela i-T. cruzi parasite ukusuka kubantu ukuya kubantu. Ukuxothwa kweebhugs zokubanga kuye kwazama ukusetyenziswa kwee-insecticide zesikhathi eside ezindlini zabantu. Le migudu iye yanceda kakhulu kodwa ayizange ikhuphe ingxaki-kwaye isifo seChagas sihlala sisendaweni ezininzi ezisemaphandleni eLatin America.
Ukuvavanywa kwangaphambi kokubeleka kukaT. cruzi kuye kwanceda ukunciphisa ukusasazeka kokuzalwa kwesifo. Abasetyhini abanako ukuphathwa ngamachiza okuxhatshazwa xa bekhulelwe, kodwa unyango ngaphambi kokukhulelwa kudla ngokusebenzayo. Abasetyhini abanokusulelwa nguT. cruzi bayacetyiswa ukuba bangabelisi, nangona ukuhanjiswa kwesifo ngenxa yobisi lwebele akubonakalwanga.
> Imithombo:
> Andrade JP, uMarin Neto JA, Paola AA, et al. I-I-Latin American Izikhokelo Zokuxilongwa Nokunyangwa Kweengxaki ze-Chagas 'Heart: Isishwankathelo seSigqeba. Arq Bras Cardiol 2011; 96: 434.
> I-Bern C. Chagas 'Izifo. N Engl J Med 2015; 373: 456.
> Martí-Carvajal AJ, Kwong JS. Ukungenelela kwe-Pharmacological for Treatment Heart Failure In Iziguli ezineChagas Cardiomyopathy. Cochrane Database Syst Rev 2016; 7: Cd009077.
> Pinazo MJ, Cañas E, Elizalde JI, et al. Ukuxilongwa, ukuLawula kunye nokuPhathwa kweZifo eziSigxina sikaGawulayo kwiiNdawo apho i-Trypanosoma Cruzi Infection ayikho. Gastroenterol Hepatol 2010; 33: 191.
> Pinazo MJ, Muñoz J, Posada E, et al. Ukunyamezela kweBenznidazole Xa unyango lwee-Chagas 'zizifo zabantu abadala. I-Antimicrob Agents Umama 2010; 54: 4896.