Usulelo lwe-Fungal Infection lungenza i-AIDS Defining Illness
I-Cryptococcosis isifo esichengelayo esiyingozi esichaphazela abantu abangaphezu kwe-16 000 emhlabeni wonke ngosuku okanye malunga nesigidi sabantu ngamnye ngonyaka.
I-cryptococcosis ye-Extrapulmonary (equka i-cryptococcal meningitis) ihlelwe ngamaziko e-US for Control and Prevention as a- AIDS-conditioning condition . Ngokubanzi, i-cryptococcal meningitis iyona ntsholongwane exhaphakileyo yinkqubo yesantya ephakathi kunye neyesithathu nkxalabo edlalwa rhoqo kubantu abane- AIDS .
Ngokufika kwe- antiretroviral therapy (ART) , i-cryptococcosis incidence iye yancipha ngokukhawuleza kwihlabathi eliphuhlisiwe ukususela kwiminyaka ye-1990.
Nangona kunjalo, kumbono wehlabathi, inani lokufa kwabantu elibanjelwe kwi-meningitis ye-cryptococcal okwangoku ngaphezu kwama-625,000-kunye nokuxhaphaka kweyona ndawo ephezulu kwi-Afrika engaphantsi kwe-Sahara, apho kubakho ukufa kwabantu phakathi kwama-50% no-70%.
Ngokwahlukileyo, ukufa ngenxa ye-cryptococcosis e-US nakwezinye iintlanga eziphuhlisiwe zijikeleze i-12%.
I-Causal Agents
I-Cryptococcosis ibangelwa yi-fungus Cryptococcus neoformans kunye ne- Cryptococcus gattii . Ngaphambili, i-cryptococcosis yayibangelwa kuphela kwiCooformes , kodwa uphando luye lwahlukana kwaye luchonga zombini i-subspecies causative.
Phakathi kwabantu abane-HIV, ngaphezu kwekota yesithathu yamacala e-cryptococcosis abikwa kubantu abaneengxelo ze- CD4 ngaphantsi kwama-cell cell / mL. I-Cryptococcosis ayinakufaneka ukuba yenzeke kubantu abaneenkqubo ezikhuselweyo zokuzivikela.
Iimodeli zoTshintshelo
Kucetyiswa ukuba i-cryptococcosis ifunyenwe ngokukhupha i-spores yokuzala (basidiospores) yeCC neoformans okanye iCattii .
Nangona ii- neoformans eziqhelekileyo zitholakala kumhlaba oqulethe iintaka zeentaka, ikakhulukazi i-pigeon, i-inhalation isabonwa njengendlela enkulu yokusuleleka (ngokuchasene nokungena ngengozi okanye ukudibanisa nolusu).
Ngokwahlukileyo, iCC gattii ayifumaneki kwiinkomo ze-avian, kodwa kunemithi (ngokuqhelekileyo i-eucalyptus). I-fungus iyaziwa ukuba iqhutywe kwiindawo ezingcolileyo ezijikeleze iziseko zemithi.
Nangona i-cryptococcosis iqhubeka rhoqo kwizilwanyana, zombini izilwanyana kunye ne-avian, iziganeko zokusasazwa kwezilwanyana-kubantu-zintle kakhulu. Ukudluliselwa komntu kumntu kuya kuthathwa njengengqabile.
Iimpawu zeCryptococcosis
Ukubonakaliswa kwezitholampilo zesifo se- Crytococcal ngokubanzi kuqala ukusuka kwiinyanga ezimbini ukuya kwezi-11 emva kokuvezwa.
Usulelo lwe-cryptococcal lwe-pulmonary lungaphinda lube lukhuni kwizigulane, okanye lubone ngeempawu zokuphefumula ezingabalulekanga. Izigulane nge-cryptococcal pneumonia zihlala zifumana ukukhwehlela, iintlungu zesifuba, umkhuhlane we-low-grade, malaise, kunye nokuphefumula okufutshane. Kwezinye iimeko, kunokuhle kube nokulahleka kwesisindo, ukuvuvukala kwe-lymph glands ( lymphadenopathy ), ukuphefumula ngokukhawuleza ( tachypnea ), kunye neengqungquthela ezizwakalayo emphumputheni (imiba).
Ukuba isifo sisasazwa ngaphaya kwemiphunga (esongeziweyo), isininzi sichaza kwinkqubo yesistim ephakathi njenge-cryptococcal meningitis. Kulezi zihlandlo, izigulane zingabonakalisa okokuqala ngeempawu ezincinci ezifana nentloko, umkhuhlane, okanye utshintsho kwisimo sengqondo (umzekelo, ukulahleka kokuphaphama, ukungazi, ukunyaniseka).
Iimpawu zisoloko zisisigxina ekuqalekeni, zibuhlungu ngokuqhubekayo kwiinyanga eziliqela.
Iimpawu ezinzima kunye neempawu ezingapheliyo zokuthi i-cryptococcal meningitis ingaquka:
- Isihlunu kunye nokuhlanza
- Umbono ongezantsi
- Ukuqonda ukukhanya
- Ukuva ukuphazamiseka okanye ukulahleka
- Ukunyuka kwengcinezelo
- Iintloko ezinzulu
- Intamo yentsimbi
- Utshintsho lwabantu
- Ukunzima ukuthetha, ukufunda okanye ukubhala
- Ukuhluthwa okanye ukulahlekelwa kwe-muscular coordination
- Hallucinations
- Coma
Ekubeni ezinye zeempawu ezinxulumene ne-classic meningitis (njengezintamo ezinzima kunye nokuvakalelwa ekukhanyeni) azikho kwizigulane ezininzi ezine-cryptococcal meningitis, ukuqaphela ngeemeko ngamanye amaxesha uphoswa, ukulibazisa unyango lweeveki kunye neenyanga ukuya kuvela iimpawu.
Ngaphandle kwemiphunga kunye nenkqubo ye-nervous central, i-infection ye-cryptococcal ingabonakaliswa elukhumbeni njengezilonda, izilonda, i-plaque, i-abscesses, kunye naziphi na ezinye zeemeko ezinqamlekileyo (okanye ezingaphantsi). Iyakuchukumisa i-adrenal glands, i-prostate, kunye nezinye iinkqubo zesebe.
Ukuxilongwa kwe-Cryptococcosis
Ukuxilongwa kwe-cryptococcosis kuxhaswa yinkcazo yeempawu zekliniki kunye neempawu ze-symptomatology, kwaye ziqinisekiswe ngokuhlalutya kwegazi, izicubu, i-cerebrospinal fluid, okanye ezinye izifo zomzimba. Izindlela zokuxilongwa zingabandakanya:
- Ukuhlolwa kwe-antiptococcal antigen yegazi okanye i-cerebrospinal fluid
- Uviwo lweMicroscopic kunye / okanye inkcubeko yamathambo, igazi okanye i-cerebrospinal fluid
- Inkcubeko ye-bronchoalveolar yokuhlamba impahla
Nangona i-x-rays esifubeni ingabonakalisa indawo okanye idlulele kwiimiphunga kwiimeko zentsholongwane ye-pulmonary, ekugqibeleni zixhasa kunokuba ziqinisekise ukuxilongwa.
Unyango lwe-Cryptococcosis
Ukufumana izigulana ezingenakulungelelaniso ezinezifo eziphikisayo okanye ezicwangcisiweyo zokugula, ikhosi ye- antifungal therapy (i-fluconazole, itraconazole) inokumiselwa ukusulela ukusuleleka kwintsholongwane.
Kwimeko yesifo esibi, unyango luvame ukuqala nge-amphotericin B, ngokuqhelekileyo kudibene ne-flucytosine. Ngokuqhelekileyo kulandelwa unyango oluqhubekayo olusetyenziswayo usebenzisa i-dose yemihla ngemihla yeyeza-antifungal (kunye nokuqaliswa kwe-ART ukuba isiguli asikabikho unyango).
Ulwaphulo lokulondolozwa lufanele luqhutywe de kube lixesha elinjalo njengokuba i-CD4 count ingaphezu kweeseli ezili-100 / mL kwaye umthamo wegciwane lesigulane unogxininiswa rhoqo kumanqanaba angabonakaliyo. Ukuba i-CD4 iwela ngaphantsi kwe-100, unyango kufuneka luqaliswe kwakhona ukukhusela ukuphindaphinda kwesifo.
E-US nakumazwe amaninzi athuthukileyo, uncedo oluphambili (ukuthintela) i-protiflaxal prophylaxis alukhuthazwa, nangona ukuhlolwa kokuhlolwa kwe-antigen kunokuqwalaselwa kwizigulane kwingozi enkulu okanye kwimimandla yemithwalo ephezulu yezifo.
Izibhengezo:
- krip-to-kaw-KO-sus
- i-KOK-ul-nin-JYE-tus
Kwaziwa njenge:
- Crypto (slang)
- Izifo ze-Crypotococcal
Imithombo:
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