Phoso ea Fungal e ka Etsa Pele ho Tlhaloso ea AIDS
Cryptococcosis ke lefu le bolaeang la fungal le amang batho ba fetang 16 000 lefatšeng lohle ka letsatsi kapa batho ba ka bang milione selemo se seng le se seng.
Extrapulmonary cryptococcosis (e akarelletsang cryptococcal meningitis) e hlalositsoe ke Litsi tsa US bakeng sa Taolo le Thibelo ea Maloetse e le boemo bo hlalosang AIDS . Ka kakaretso, cryptococcal meningitis ke tšoaetso e tloaelehileng ka ho fetisisa ea tsamaiso ea methapo ea methapo le bothata ba boraro ka ho fetisisa ho batho ba nang le AIDS .
Ka ho qala ha phekolo ea meriana e thibelang li-antiretroviral (ART) , lefu la cryptococcosis le fokotsehile ka potlako lefatšeng le tsoetseng pele ho tloha bohareng ba bo-1990.
Leha ho le joalo, ho ea ka pono ea lefatše lohle, palo ea selemo le selemo ea batho ba shoang ka lebaka la cryptococcal meningitis hona joale e feta 625 000-e nang le sekhahla se phahameng ka ho fetisisa sa Afrika Boroa ho Sahara, moo ho hakanngoa hore batho ba bolaeang ba pakeng tsa 50% le 70%.
Ka lehlakoreng le leng, batho ba shoang ka lebaka la cryptococcosis ho US le linaheng tse ling tse tsoetseng pele ke hoo e ka bang 12%.
Causal Agents
Cryptococcosis e bakoa ke fungus Cryptococcus neoformans le Cryptococcus gattii . Nakong e fetileng, cryptococcosis e ne e bitsoa feela ho C neoformans , empa lipatlisiso li tloha ka nako e le 'ngoe li bile li khetholla li-subspecies tse kotsi.
Har'a batho ba nang le tšoaetso ea HIV, likarolo tse fetang tse tharo tsa linyeoe tsa cryptococcosis li tlalehoa ka batho ba nang le lintlha tsa CD4 tse ka tlaase ho 50 lisele / mL. Hangata batho ba nang le mekhoa ea 'mele ea ho itšireletsa mafung ha ba e-na le cryptococcosis.
Mekhoa ea Phaliso
Ho boleloa hore Cryptococcosis e fumanoa ka ho hlahisa li-spores tse hlahisang (basidiospores) tsa C. neoformans kapa C. gattii .
Le ha C-neoformans e atisa ho fumanoa mobu o nang le li-droppings tsa linonyana, haholo-holo pigeon, inhalation e ntse e nkoa e le tsela e ka sehloohong ea tšoaetso (ho fapana le ho kenngoa ha kotsi kapa ho kopana le letlalo).
Ka lehlakoreng le leng, C. gattii ka kakaretso ha e fumanoe ka limela tsa linonyana, empa ho e-na le lifate (hangata li-eucalyptus). Bo-fungus bo tsejoa hore bo ata ka litšila tse pota-potileng likoti tsa lifate.
Ha cryptococcosis e hlaha khafetsa liphoofolong, liphoofolo tse peli le liphoofolo tse ling tse phelang, likokoana-hloko tsa liphoofolo ho isa ho batho ha li fumanehe haholo. Ho fetisetsa batho ho isa ho batho ho nkoa e le ntho e sa tloaelehang.
Matšoao a Cryptococcosis
Litšebetso tsa meriana ea tšoaetso ea Crytococcal hangata li qala likhoeli tse peli ho isa ho tse 11 ka mor'a ho pepesa.
Ho tšoaetsoa ke lefu la sefapane hangata ho ka 'na ha e-ba le pheko e nepahetseng ho bakuli, kapa hona ho ba le matšoao a ho hema a sa tekaneng, a sa ikhethang. Bakuli ba nang le pneumonia ea cryptococcal ba atisa ho ba le khohlela, bohloko ba sefuba, feberu e tlaase, malaise le phefumoloho e khutšoanyane. Maemong a mang, ho ka ba le ho lahleheloa ke boima ba 'mele, ho ruruha ha li-lymph gland ( lymphadenopathy ), ho hema ka potlako ( tachypnea ), le maqhubu a utloahalang matšoafong (lipalesa).
Haeba tšoaetso e fetisetsoa ho feta matšoafo (extrapulmonary), hangata e hlahisa tsamaiso ea methapo ea bohareng e le cryptococcal meningitis. Maemong ana, bakuli ba ka 'na ba hlahisa matšoao a sa tšoaneng a kang hlooho, feberu, kapa liphetoho tsa boemo ba kelello (mohlala, tahlehelo ea ho falimeha, ho se tsotelle, ho tsitsa).
Matšoao a atisa ho atleha haholo ha a qala, a mpefala hanyane ka hanyane ho feta libeke tse 'maloa.
Litšoaneleho tse matla le tse sa foleng tsa cryptococcal meningitis li kenyeletsa:
- Nosea le ho hlatsa
- Pono e fosahetseng
- Ho ba le kutloisiso ho khanyetsa
- Ho utloa bokooa kapa tahlehelo
- Khatello ea khatello ea kokoana-hloko
- Ho tšoaroa ke hlooho e bohloko
- Khoele e thata
- Liphetoho tsa botho
- Ho thata ho bua, ho bala kapa ho ngola
- Ho lahleheloa kapa ho lahleheloa ha meriana
- Hallucinations
- Coma
Kaha matšoao a mang a amanang le maningitis a tloaelehileng (a kang molala o thata le kutloisiso ea leseling) ha a hlahe ho bakuli ba bangata ba nang le cryptococcal meningitis, ho lemoha boemo boo ka linako tse ling bo hlolohetsoeng, ho lieha ho phekoloa ka libeke kapa likhoeli ho fihlela ho hlaha habonolo matšoao.
Ka ntle ho matšoafo le tsamaiso ea methapo ea tšoaetso, tšoaetso ea cryptococcal e ka boela ea bonahala letlalong joaloka liso, li-ulcers, plaques, abscesses, le maemo a mang a mangata (kapa a tlaase). E ka boela ea ama li-gland tsa adrenal, prostate le mefuta e meng ea likarolo.
Tlhahlobo ea Cryptococcosis
Ho hlahlojoa ha cryptococcosis ho tšehetsoa ke ho hlahisa likarolo tsa bongaka le matšoao a matšoao, 'me ho tiisitsoe ke ho hlahlojoa ha mali, lisele, mokelikeli oa motsoako oa metsi, kapa metsi a mang a' mele. Mekhoa ea ho hlahloba e ka kenyelletsa:
- Tlhahlobo ea antiptococcal antigen ea mali kapa ea methapo ea mali
- Tlhahlobo ea Microscopic le / kapa setso sa metsoako, mali kapa cerebrospinal fluid
- Tloaelo ea li-bronchoalveolar li hlatsoa liaparo
Ha sefubelu x-ray se ka senola libaka tsa matšoafo kapa li fapane ka matšoafong matšoafo a tšoaetsano ea pulmone, qetellong li tšehetsa ho e-na le hore li tiise hore na li fumane eng.
Kalafo ea Cryptococcosis
Bakeng sa bakuli ba sa itekanetseng ba nang le mafu a cryptococcal kapa a bobebe ho isa tekanyong, mokhoa oa antifungal therapy (fluconazole, itraconazole) o ka be o laeloa ho fihlela tšoaetso ea fungal e rarolloa.
Ha lefu le le matla, hangata phekolo e qala ka amphotericin B, hangata e kopantsoe le flucytosine. Hangata sena se lateloa ke phekolo ea meriana e tloaelehileng e sebelisoang letsatsi le leng le le leng ka meriana e thibelang mafu (hammoho le ho qaloa ha ART haeba mokuli a e-s'o phekoloe).
Phekolo ea tlhokomelo e lokela ho ts'oaroa ho fihlela nakong eo CD4 count e ka holimo ho lisele tse 100 / mL 'me tekanyo ea kokoana-hloko ea mokuli e ntse e hatelloa ho mekhahlelo e sa bonahaleng. Haeba CD4 e oela tlase ho 100, phekolo e lokela ho tsosolosoa ho thibela ho boela ho kula.
Linaheng tsa Amerika le linaha tse tsoetseng pele, thibelo ea pele (antivungal prophylaxis) ha e khothalletsoe, le hoja tlhahlobo ea antigen ea pele e ka nkoa e le ea bakuli boemong bo eketsehileng ba kotsi kapa libakeng tse phahameng tsa meroalo ea mafu.
Litlhaloso:
- krip-to-kaw-KO-sus
- krip-to-kOK-ul ka-nin-JYE-ka
E boetse e tsejoa e le:
- Crypto (slang)
- Lefu la Crypotococcal
Lisebelisoa:
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E phethehile, J .; Lihlong, W .; Dromer, F .; et al. "Litlhahiso tsa mekhoa ea meriana ea boipheliso bakeng sa tsamaiso ea mafu a Cryptococcal: 2010 Ts'ebetso ea Infectious Diseases Society of America." Maloetse a tšoaetsanoang a mafu a meriana. . 2010: 50 (3): 291-322.