Pneumocystis nenyumoniya: izimbangela, izimpawu, ukwelashwa. Pneumocystis inyumoniya e abanegciwane

Impilo yinto ebaluleke kunazo zonke umuntu anayo. Wonke umuntu unethemba lokuthi uzohlala isikhathi eside futhi angabhekene nalesi sifo noma leso sifo. Lesi sifo sishintsha abantu abangenakuqashelwa - bacindezelekile, ukubukeka kwabo kushiya okuningi okudingekayo, kukhona ukungakhathaleli kukho konke okwenzekayo nxazonke, futhi kwezinye izikhathi lapho okuhle futhi ukuphendula kwabanye ukugula kwabantu kuphenduke ukuthukuthela futhi kungenangqondo.

Lesi sifo asigcini muntu. Ngisho nezinsana zingenaso ingozi yokuthola isifo. Ngaphezu kwalokho, ukuhlupheka akuhlangenwe nakho kuphela neziguli ngokwabo, kodwa nezihlobo zabo. Kunzima kakhulu ukubhekana nemizwelo nemizwa yabo kubazali abanezingane eziye zatholakala ukuthi zinalokhu noma leyo ngozi. Izingane ngenxa yobuncane bayo azikwazi ukuchaza ukuthi yini ehluphayo, lapho ingxenye yomzimba izwa ubuhlungu nokuthi ibonakala kanjani.

Isifo esingahambi kahle yi-pneumocystis pneumonia. Ungatheleleka kuphi futhi, ngokudabukisayo, ngisho nasezikhungweni zezokwelapha. Lesi simo siyinkimbinkimbi yokuthi kunzima ukubona ukuthi ukutheleleka kulesi sigaba sokuqala sentuthuko yayo. Ngokuvamile abantu bayaqonda ukuthi badinga usizo lwezokwelapha lapho isikhathi esiyigugu sesilahlekile kakade. Yingakho ukufa okuvela e-pneumocystis kuphezulu kakhulu. Odokotela abaphathi njalo ukugcina impilo yomuntu.

Uthole "i-pneumocystosis"

Abantu abangenalo lutho ngezokwelapha, ikakhulukazi, banolwazi oluthile lwegama lesidakamizwa sezokwelapha. Ngakho-ke, ngemva kokuzwa ukuxilongwa "kwe-pneumocystosis", noma "i-pneumocystis pneumonia", kukhona ukudideka, futhi ngisho nokuwa yi-stupor. Eqinisweni, ungesabi. Okokuqala, udinga ukuzola, uzidonsa ndawonye bese ubuza udokotela oya khona ngokuningiliziwe, ngamazwi alula ukuchaza ukuthi kuyini.

I-pneumocystis ivame ukubizwa ngokuthi i-pneumocystic pneumonia, okuyinto isifo se-protozoal esithinta amaphaphu. Ama-causative agents of pathology ama-microorganisms aziwa ngokuthi i-Pneumocystis carinii. Kuze kube yamuva, ososayensi babekholelwa ukuthi bangabesilwane se-protozoa. Kodwa-ke, maduzane, esekelwe kwizifundo eziningi, kwaphetha ngokuthi lezi zincane ezincane zinezici ezithile zezici zesikhunta. I-Pneumocystis carinii yi-parasite ehlasela abantu kuphela. Okungenani ezilwaneni, akatholakali kuze kube manje.

Kwenzekani esigulini nge-pneumocystis pneumonia?

Izinguquko emzimbeni ngenxa ye-pneumocystosis zixhomeke ezintweni ezimbili: yiziphi izinto eziphilayo eziyi-pathogens of pneumonia, kanye nesimo somzimba womzimba. Ama-pneumocysts, emva kokungena emzimbeni, baqale phambili ngomzila wokuphefumula, badlulise bese ufaka i-alveoli. Lapha uqala umjikelezo wabo wokuphila. Banda, bahlangana nomuntu osebenza ngokuzimela futhi bakhipha imetabolite enobuthi. I-T-lymphocytes, kanye ne-so-called macrophages alveolar, ilawulwa nge-Pneumocystis carinii. Kodwa-ke, isimiso somzimba sokuzivikela esibuthakathaka asikwazi nje ukuvikela isingeniso saso ekutheleleni, kepha ngisho nangokwemvelo - sinomthelela ohlukile: kuvuselela futhi kukhuthaze ukwanda kwenani le-pneumocysts.

Kumuntu onempilo ephelele, ukukhiqizwa okusheshayo kwe-Pneumocystis carinii akusongeli. Kodwa isimo sishintsha kakhulu, uma isimo sesimiso sokuzivikela somzimba sishiya kakhulu. Kulokhu, lesi sifo sisebenza ngokushesha, futhi esikhathini esifushane kakhulu inani lamapneumocyst abanjwe emaphashini lifinyelela ku-biliyoni eyodwa. Kancane kancane, isikhala se-alveoli sigcwele ngokuphelele, okuholela ekubukeni kwe-foamy exudate, ukwephulwa kobuqotho bendwangu ye-leukocytes ye-alveoli, futhi ekugcineni ukulimaza futhi ngenxa yalokho, ukubhujiswa okulandelayo kwe-alveolocyte. Ngenxa yokuthi ama-pneumocyst afaneleka ngokuqinile kuma-alveolocytes, ukuphefumula kwamaphaphu kuncishisiwe. Ngenxa yomonakalo emathangeni amaphaphu uqala inqubo yokuthuthukiswa kokuvinjwa kwe-alveolar-capillary.

Ukwakha i-membrane yesitokisi, i-Pneumocystis carinii, i-phospholipids yesidayimani somuntu edingekayo. Ngenxa yalokho, kukhona ukuphazanyiswa kwesimiso sokungena emzimbeni osondelene nomzimba futhi i-hypoxia yamathisipha emaphaphu ikhushulwa kakhulu.

Ubani obungozi kakhulu besifo?

Eyaziwa ukuthi usukuthi, izinhlobo ze-pneumonia zihlukana komunye nomunye, kuhlanganise nokuthi ingozi yokugula igula izigaba ezahlukene zabantu. I-pneumocystosis ngale ndlela ayikho into. Ivame ukuqala ku:

• Izingane ezizalwa ngaphambili;
• Izinsana nezingane, lapho zibhekene nezifo ezinzima ze-bronchopulmonary zezinhlobo ezimbi, zaphoqeleka ukuba zihlale esibhedlela isikhathi eside futhi zithole ukwelashwa okunzima futhi okude;
• Abantu abanesifo somdlavuza kanye ne-hemopoiesis futhi bathola i-cytostatics ne-corticosteroids, kanye nalabo ababhekana nezinkinga ezihlukahlukene zezinso kanye nezicubu ezihlangene ezivele ngenxa yokufakelwa isitho sangaphakathi;
• Iziguli ezinesifo sofuba, okwathi isikhathi eside zathola izidakamizwa ezinamandla zokulwa ne-antibacterial;
• Abantu abanegciwane lesandulela ngculazi.

Njengomthetho, ukutheleleka kudluliselwa ngamaconsi amancane, futhi umthombo wayo unabantu abanempilo, ngokuvamile kaningi - izisebenzi zezokwelapha. Ukuqhubekela phambili kulokhu, iningi labososayensi lisho ukuthi isibhamu se-pneumocystic yisifo esisodwa esisodwa. Naphezu kwalokhu, kubalulekile ukucacisa ukuthi abanye odokotela basekela umbono wokuthi ukuthuthukiswa kwe-pneumocystosis esikhathini sokubeletha kungumphumela wokutheleleka kwe-fetus esibelethweni.

Yiziphi izimpawu eziyisibonakaliso mayelana nokuthuthukiswa kwe-pneumocystis pneumonia ezinganeni?

Amama nobaba bahlale bezwela kakhulu empilweni yezingane zabo. Ngakho-ke akumangazi ukuthi bafuna ukwazi ukuthi bangayithola kanjani ukuvuvukala kwemaphaphu ngesikhathi. Yiqiniso, ukuxilongwa kokugcina kungenziwa kuphela udokotela, kodwa noma yimuphi umzali oqaphelayo kufanele akwazi ukubona izibonakaliso zokuqala zesifo. Usuku ngalunye olulahlekile lungabangela ukuthi ingane ingabhekana ne-pneumonia yase-bilateral, i-pneumocystis nezinye izinkinga.

I-pneumocystis pneumonia ezinganeni zivame ukuqala ezinyangeni ezimbili ubudala. Ngokuvamile, lesi sifo sithinta lezo zingane ezazingenalo ukutheleleka kwe-cytomegalovirus. Lesi sifo senzeke kubo njenge-pneumonia yakudala ye-interstitsianalnoy. Ngeshwa, odokotela bayavuma ukuthi ngesikhathi sokuqala cishe akunakwenzeka ukuthola lesi sifo njenge-pneumocystis pneumonia. Izimpawu zivele kamuva. Izimpawu ezisemqoka ezikhombisa ukuthuthukiswa okusheshayo kokutheleleka kufaka:

• Ukukhwehlela okunamandla kakhulu kwe-pertussis;
• Ukuqubuka kwezikhathi zokuphefumula (ikakhulukazi ebusuku);
• Kwezinye izingane, i-sprayum, i-vitreous, i-foamy, i-gray sputum ne-viscous.

Isikhathi sokukhushulwa kwesifo siyizinsuku ezingama-28. Uma kungekho ukwelashwa okwanele nesikhathi esifanele, ukufa kwezingane ezine-pneumocystis kungama-60%. Ngaphezu kwalokho, ezinganeni ezisanda kuzalwa, ezine-pneumocystis pneumonia ezenzeka ngaphandle kwezibonakaliso ezibonakalayo, kunomthelela omkhulu we-obstructive syndrome okwenzeka esikhathini esizayo esiseduze. Lokhu kubangelwa ukuvuvukala kwamagundane emangcwabeni. Uma ingane inganikezwa ngokushesha ngokunakekelwa kwezokwelapha okufanelekile, i-obstructive syndrome ingashintshwa ibe yi-laryngitis, futhi kubantwana abadala - ku-asthmatic syndrome.

Izimpawu zesifo esibonakala kubantu abadala

I-pneumonia asebekhulile, kanye nabantu abasha, ifaka ngendlela eyinkimbinkimbi kunabantwana abasha kanye nezingane ezincane. Lesi sifo sihlaselwa ikakhulukazi abantu abazalwa abane-immunodeficiency, noma labo abaye bahlakulela kulo lonke ukuphila. Noma kunjalo, lokhu akuwona umthetho ongahambisani nokuphambuka okuncane. Kwezinye izimo, i-pneumocystis pneumonia iqala iziguli ezinezifo zomzimba eziphilile ngokuphelele.

Isikhathi sokugxilwa kwesifo sisukela ezinsukwini ezimbili ukuya kwezingu-5. Isiguli sinempawu ezilandelayo:

• Fever,
• I-Migraine,
• Ubuthakathaka emzimbeni wonke,
• Ukujuluka okukhulu,
• Ubuhlungu, obunomlomo esifubeni,
• Ukuhluleka okukhulu kokuphefumula, okuhambisana nokukhwehlela owomile noma okumanzi kanye ne-tachypnea.

Ngaphandle kwezimpawu ezisemqoka ezibalwe ngenhla, ngezinye izikhathi izimpawu ezifana ne-acrocyanosis, ukuxoshwa kwezikhala phakathi kwezimbambo, i-cyanosis (blueing) yenxantathu ye- nasolabial kuphawulwe .

Ngisho nangemva kokuqeda ukwelashwa okugcwele, ezinye iziguli zithola izinkinga ezithile ze-pneumocystis pneumonia. Ezinye iziguli zithola ukuphindaphindiwe. Odokotela bathi uma ukuphindaphinda kungakapheli izinyanga ezingu-6 kusukela kwesibhedlela sokuqala, lokhu kubonisa ukuthi umzimba uqala ukutheleleka. Futhi uma ifika ezinyangeni ezingaphezu kwengu-6, isivele isifo esisha noma ukuphindaphinda.

Ngaphandle kokwelashwa okwanele, ukufa kwabantu abadala abane-pneumocystis kusuka ku-90 kuya ku-100%.

Izimpawu zesifo esine-HIV

I-pneumocystis pneumonia kubantu abanegciwane lesandulela ngculazi, ngokungafani nabantu abangenawo leli gciwane, likhula kancane kancane. Kusukela lapho ama-prodromal phenomena eqala, futhi ngaphambi kokuba izimpawu zamapulmoni ezivezwe ngokucacile zize, zingathatha amasonto amane kuya ku-8-12. Ngakho-ke, odokotela ngokusola okuncane kakhulu kokuthi kukhona ukutheleleka emzimbeni, ngaphandle kwezinye izivivinyo, batusa iziguli ezinjalo ukuba zenze i-fluorography.

Izimpawu eziyinhloko ze-pneumocystosis ezigulwini ze-AIDS yizi:

• Ukushisa okuphezulu (kusuka ku-38 kuya ku-40 ° C), engabeki izinyanga ezingu-2-3;
• Ukulahleka okujulile kwesisindo somzimba;
• Ukukhwehlela okumile;
• Ukuphefumula;
• Ukwandisa ukuhluleka kokuphefumula.

Abasosayensi abaningi banombono wokuthi ezinye izinhlobo ze-pneumonia kubantu abanegciwane lesandulela ngculaza banezibonakaliso ezifanayo njenge-pneumocystis. Ngakho-ke, ekuqaleni kwezinyathelo zokuthuthukiswa kwesifo, cishe akunakwenzeka ukucaca ukuthi iyiphi uhlobo lwe-pneumonia isiguli esiphelile. Ngeshwa, uma isibhamu se-pneumocystic kubantu abanegciwane lesandulela ngculaza sitholakale, sekuyisikhathi esiningi sishonile, futhi kunzima kakhulu kunomzimba ophelile ukulwa nokutheleleka.

I-pneumocystosis ihlolwe kanjani?

Ngokuqinisekile wonke umuntu uyazi ukuthi amaphaphu omuntu abukeka kanjani. Isithombe salo mzimba sakhishwa ngaphakathi kwincwadi yokufunda nge-anatomy, noma ema-polyclinic, noma kunoma yimiphi imithombo. Ulwazi lwanamuhla alukho ukusweleka. Ngaphezu kwalokho, njalo ngonyaka, odokotela bakhumbuza zonke iziguli zabo ukuthi kufanele benze u-fluorography. Ngokuphambene nemibono yabaningi, lokhu akusiyo i-"worm" odokotela, kodwa isidingo esiphuthumayo. Ngenxa yalokhu, kungenzeka ukubona ukukhanya kwamaphaphu ku-X-ray ngesikhathi futhi uqale ukwelashwa ngaphandle kokulahlekelwa isikhathi. Uma usheshe uqaphele lesi sifo, cishe kuyoba ukubuyiswa.

Noma kunjalo, akekho kithi owaziyo ukuthi i-pneumocystis pneumonia ibonisa kanjani ama-X-ray. Izithombe zalolu hlobo ezincwadini zesikole azikwazi ukutholakala, futhi izincwadi zezincwadi zezokwelapha kanye nama-encyclopedias kubantu abaningi abavamile azibangeli isithakazelo. Ngaphezu kwalokho, asikwazi ngisho nokuthi lesi sifo siyatholakala kanjani, nakuba kungenakulimaza ukwazi.

Okokuqala, kutholakala ukuxilongwa kwangaphambili. Udokotela unesithakazelo ngesiguli mayelana noxhumana nabo nabantu abasengozini (abagulayo abanegciwane lesandulela ngculaza kanye ne-AIDS).

Emva kwalokhu, ukuxilongwa kokugcina kwenziwa. Izifundo ezilandelayo ze-laboratory-instrumental zisetshenziswa:

1. Udokotela ubeka isiguli ukuthi sithunyelwe ngokuhlolwa kwegazi jikelele. Ukuqaphela ikakhulukazi kukhishwa izinga eliphakeme lama-eosinophils, i-lymphocytes, amaseli egazi amhlophe nama-monocytes. Iziguli ezine-pneumocystis zingaba ne-anemia emnene futhi iyanciphise kancane i-hemoglobin.
2. Ucwaningo lwezinsimbi ezikhethiwe. Umbuzo we-rayography lapho usizo oluchaza khona isigaba sokuthuthukiswa kwezifo. I-X-ray yenziwa, lapho amaphaphu omuntu ebonakala ngokucacile. Isithombe sinamathele ekhadini lesiguli. Esigabeni sokuqala, ukwanda kwephethini yamaphaphu kuyabonakala. Uma i-pneumocystosis idlulile esigabeni sesibili, ukukhanya kwamaphaphu ku-x-ray kubonakala ngokucacile. Ukutheleleke ngepulaphu noma kwesokudla kuphela, noma kokubili kungathinteka.
3. Ukuze kutholakale ukuthi kukhona i-pneumocystosis, udokotela uvame ukukhetha ukuhlola i-parasitological. Kuyini? Okokuqala, isiguli sithatha isampula se-mucus sokuhlaziywa. Ukwenza lokhu, sebenzisa izindlela ezifana ne-bronchoscopy, i-fibrobronchoscopy ne-biopsy. Ngaphezu kwalokho, isampula ingatholakala ngokusebenzisa indlela okuthiwa ukukhwehlela ukukhwehlela.
4. Ukuze kutholakale ama-antibodies ngokumelene ne-pneumocysts, isifundo se- serological senziwa, okuhlanganisa ukuthi, umahluko wamasonto amabili, isiguli sithathwa ukuze kuhlaziywe u-2 sera. Uma ngamunye wabo ngokweqile kwenani elijwayelekile le-titer limakwe okungenani izikhathi ezingu-2, kusho ukuthi umuntu uyagula. Lolu cwaningo luqhutshwa ukuze lungabandakanyi umphathiswa ojwayelekile, ngoba ama-antibodies atholakale kubantu abangaba ngu-70%.
5. Ukuxilongwa kwe-PCR kwenziwa ukuze kutholakale ama-antigens we-parasite ku-sputum, nakwe-specimen ye-biopsy nokuhlanzwa kwe-broncho-alveolar.

Izigaba ze-pneumocystosis

Kunezigaba ezintathu ezilandelanayo ze-pneumocystis pneumonia:

• Ama-Edematous (amasonto angu-1-7);
• Atelectakticheskuyu (isilinganiso samasonto amane);
• Emphysematous (yezinga elihlukile).

Isigaba esicacile se-pneumocystosis sibonakala kuqala ngokubonakala kobuthakathaka emzimbeni wonke, ubuchopho, bese kuthi ukukhwehlela okungavamile kukhule kancane kancane, futhi kuphela ekupheleni kwesikhathi - ngokukhwehlela okunomile okuqinile nokuphefumula ngesikhathi sokuzikhandla ngokomzimba. Amantombazane angancelisi kahle, angabi nesisindo, futhi ngezinye izikhathi abese enqabe ubisi lukanina. Azikho izinguquko eziphawulekayo ezitholakala kwi-X-ray yamaphaphu.

Phakathi nesigaba se-atelectatic febrile fever ibonakala. Isikhukhula sanda kakhulu, futhi i-foamy sputum ivela. UDyspnea ubonakalisa ngisho nokuzikhandla okungokwenyama. Ku-X-ray, izinguquko ze-atelectatic ziyabonakala.

Ezigulini ezasinda ezinyangeni ezimbili zokuqala, i-emphysema isigaba se-pneumocystosis iqala, ngesikhathi lapho imingcele yokusebenza yokuphefumula iyancipha kanye nezibonakaliso ze- emphysema.

Amamaki we-pneumonia

Kuzokwelapha, kuvamile ukuhlukanisa phakathi kwamazinga alandelayo okuqina kwesifo:

• Ukukhanya, okubhekene nokudakwa obuthakathaka (izinga lokushisa elingadluli u-38 ° C kanye nolwazi olungenalutho), akukho ukuphefumula okuphumule ekuphumuleni, ukukhanya okuncane komphuphu ku-x ray;
• Medium, ebonakala ngokudakwa ngokweqile (izinga lokushisa lidlula u-38 ° C, isilinganiso senhliziyo sifinyelela ku-100 beats ngomzuzu, isiguli sikhala ngokukhukhumeza ngokweqile , njll), i-dyspnea ibonakala ngokuphumula, i-X-ray ibonisa ngokucacile ukuphunga kwamaphaphu;
• Ekulu kakhulu, egeleza kakhulu ngokweqile (izinga lokushisa lidlula u-39 ° C, ama-palpitations angaphezu kwezingu-100 ngomzuzu, ukukhohlisa kuqhubeka), ukuhluleka kokuphefumula kuyaqhubeka, futhi i-x-ray ibonisa ukungena kwamapayipi amaningi, amathuba okuhlukunyezwa okuhlukahlukene aphezulu.

Iyiphi imithi yokwelashwa enikezwe iziguli ezine-PCP?

Ngokungangabazeki, ukwazi ukuthi unquma kanjani isibungu se-pneumonia kuyinto enkulu kunawo wonke umuntu. Nokho, lokhu akwanele. Asibona odokotela futhi asikwazi ukunikeza ukuxilongwa okuqondile. Ayikho uhlobo olulodwa lwe-pneumonia, futhi i-pneumonia eyodwa noma emaceleni amabili, i-pneumocystis nezinye izinhlobo zokugula azikwazi ukunqunywa ngumuntu obeka eceleni. Ngakho-ke, ukuzivocavoca akukwazi ukuhamba ngaphandle kwenkulumo. Into esemqoka akusiyo ukubambezeleka nokuthembela odokotela. Ngemuva kokuba enze ucwaningo oludingekile, udokotela uzokwazi ukwenza isiphetho esiqondile mayelana nokuthi i-PCP iyimbangela yesimo esibi sempilo yesiguli. Ukwelashwa kuqokwa kuphela ngemva kokuqinisekiswa kokuxilongwa futhi kuqukethe ukuqhuba izinyathelo zenhlangano kanye nokwelashwa kanye nokwelapha izidakamizwa.

Izinyathelo zombuso zibandakanya ukunakekelwa kwesiguli esibhedlela. Esibhedlela, isiguli sithola imithi futhi siyayibona ukudla okuphakanyiswe udokotela.

Ukwelashwa kwemithi kunokwelashwa kwe-etiotropic, i-pathogenetic kanye ne-symptomatic. Iziguli zivame ukusetshenziswa izidakamizwa "Pentamidine", "Furazolidon", "Trichopolum", "Biseptol", kanye nezidakamizwa ezihlukahlukene zokulwa nezidakamizwa, imishanguzo esiza ukuhluma futhi ihlinzekwe ukuhlolwa kwe-expectoration, i-mucolytics.

"I-Biseptol" isetshenziswa ngomlomo noma nge-intravenously. Isidakamizwa sibekezeleleke futhi sikhethwe "Pentamidine" lapho sinikezwa iziguli ezingenayo i-AIDS. "I-Pentamidine" ilawulwa nge-intramuscularly noma nge-intravenously.

Iziguli ezinegciwane lesandulela ngculazi, phakathi kwezinye izinto, zithola ukwelashwa kwe-antiretroviral, ngoba bane-pneumocystis pneumonia ngenxa yesimiso sokuzivikela somzimba esibuthakathaka. Ukuze ukwelashwa kwe-pneumocystisis ezigulwini ze-AIDS, i-alpha-difluoromethylornithine (i-DFMO) isanda kusetshenziselwa kamuva.

Ukuvimbela

Ukuvimbela i-pneumocystosis kuhlanganisa imisebenzi eminingi, okumele kuphawulwe kulokhu okulandelayo:

1. Ukukhipha ukutheleleka ezikhungweni zezokwelapha zezingane, ezibhedlela lapho iziguli ze-oncology kanye ne-hematology ziphathwa khona, bonke abasebenzi, ngaphandle kokunye, kufanele bahlolwe ngezikhathi ezithile ukutheleleka.
2. Imithi prophylaxis yabantu abasengozini. Lokhu kuvinjelwa kunemihlobo emibili: okuyisisekelo (ngaphambi kokuba lesi sifo siqale ukuthuthukisa) kanye nesibini (ukuvimbela emva kokuthola ngokugcwele ukuze kuvimbele ukubuyela emuva).
3. Ukutholakala kwesikhashana kwe-PCP nokuhlukaniswa okusheshayo kwesiguli.
4. Ukususwa kwe-disinfection njalo ezindaweni lapho kuqubuka khona ukuqhuma kwe-pneumocystosis. Ukuze wenze lokhu, yenza ukuhlanza okumanzi, usebenzisa isixazululo esingu-5% se-chloramine.