Clostridioides yakaoma hutachiona yakajairika mazuva ano. Iyo inoshanda kune 10-20% yemanyoka, 50-70% colitis, anopfuura 90% pseudomembranous colitis yakabatana neantibiotic kurapwa. Kunyangwe iyo isiri chirwere chitsva, kuwedzera kwemari kuri kumiririra yakakura uye iripo nyaya.

Clostridioidesntyile (Cd) ndeyeGram + microorganism, sporogenic, ubiquitous, yakapararira muvhu, mvura, nzizi, madziva ekushambira, miriwo yakasviba, kunyangwe, iri hombe tank nharaunda yechipatara nharaunda zvivakwa zvehutano. Taigona sei kutapukirwa? Zvine njodzi here? Asi, pamusoro pezvose, nei zviripo izvozvi?

 

Ichi chirwere chinouya sei uye ndedzipi nyika dzakakanganiswa?

Iyo iripo zvakare mune colon ye3% yevakuru vane hutano uye mune 15-20% yevarwere pane mishonga inorwisa mabhakitiriya. Kuvapo kwayo kwega haisi chiratidzo chehurwere. Kupararira kwechirwere kunofambiswa kwazvo ne kupona kwe spores kwemwedzi yakawanda munzvimbo. Iko kuwedzera kwaive kwakanyanya kwakanyanya muboka re61-80 zera. Zvinogona kudaro kuramba mishonga yekurwisa mabhakitiriya uye yakagadziriswa maitiro akaomarara evarwere angave ainawo basa rekuwedzera chiitiko chetachiona ichi.

Munzvimbo yehutano hutano hunobatana nehutachiona, Clostridioides inotungamira 70.9% yehunhu hwehutachiona hwegomarara munzvimbo yehutano huri, nepo hutachiona seStaphylococcus aureus, Klebsiella pneumonia, Escherichia coli uye vamwe vanongowanikwa chete vane musiyano chaiwo mumarudzi akasiyana. Mukati meEuropean, Italy iri pachinzvimbo chechitatu mushure meEngland neFrance, ichiteverwa neGerman neSpain.

Kwemakumi emakore apfuura, chiitiko chehutachiona hweCD chave chichiwedzera zvishoma nezvishoma pasirese: huwandu hwehutachiona muUSA hwakapetwa katatu kubva 2000 mune varwere vari muchipatara. MuItari, huwandu hwacho hwakakwira kubva pa0.3
episode / 10,000 mazuva-murwere muna 2006 kusvika 2.3 episode / 10,000 mazuva-murwere mu2011.

Mhedzisiro yevarwere uye yezvivakwa zvehutano:

- murwere, uyo ari kutambura nezvimwe hutachiona, anotambura zvakanyanya uye anogona kukanganiswa zvakanyanya mumuviri;
- murwere anofanirwa kurapwa kumwe kubva kumhedzisiro;
- murwere, uye nezvechimiro, nekuti chirwere ichi chinowanzoitika: mushure mechikamu chekutanga chinotapukira mukana wekudzokazve watove ne20%, zvakapetwa kekutanga kudzokororwa, katatu kusvika kuchipiri kudzokororwa zvichingodaro;
- Clostridioides utachiona hunoita basa rinobvumidza mukuenderera mberi kwehutachiona hutachiona hunobuda (Candida, Klebsiella);
- mari inokwira muchiitiko chekuda kubhadharwa kwechero kwakashata shanduko yekiriniki kesi.

 

Clostridioides transmission uye basa re albin

Kuparadzirwa kwechirwere ichi kunowanzoitika nenzira yefaecal-yemuromo, saka maoko evashandi vese vehutano ndiyo mota huru yekufambisa, zvese nekubata zvakananga nemurwere uye / kana nemurwere wega zvakashatiswa zvinhu zvehupenyu, kungave nekusangana zvisina kunangana kuburikidza chaiyo mhedzisiro, zvinhu zvevarwere kana chero chimwe chinhu
zvinhu zvakabatwa nazvo mukamuri inpatient kunge doorknobs, mabhero pamasuo, kure kure kutonga, madziro, nezvimwe.

Kamwe kumedza kweaya mafomu eClostridioides spores, nepo iwo ekutanga achiurayiwa mudumbu, wechipiri anorarama kunzvimbo ine acidic uye, akavezwa bile bile mudumbu diki, anoramba achikura. Kufamba kwemukati wechibereko villi inofambisa kufambira mberi kwekoloni uko iyo Cd inogona kuwanda uye kuomerera zvine gumi mucosa.

Zvidzidzo zvakawanda mumabhuku zvakataura basa rakasarudzika seramu albin muchirongwa ichi, kuramba hypothesis iyo hypoalbuminemia ingangove mhedzisiro yemanyoka Cd yakakonzerwa proteinodisperdent: albin inokwanisa kusunga masosi ekudzivirira kupinda mukati memaseru uye kudzivirira mucosa kubva pamhedzisiro ye
cytopathic. Saka yakaderera manhamba ealbinoin, ayo anogona kuwanikwa mune varwere asingadzivirire kune mamwe maProducton, anogona kukurudzira kufambira mberi kwehutachiona hweCd.

 

Kurapa kungaitika

Kubva pamakiriniki ekuona isu tinosiyanisa:
- zvinyoro / mafomu ane mwero: nemanyoka, asi pasina systemic zviratidzo zvehutachiona, unofarirwa nekugara munzvimbo dzehutano, kushandiswa kwemishonga inorwisa mabhakitiriya uye IPP, chemotherapy, chemotherapy, uye kudya kwekugadzira;
- yakaoma mafomu: nemanyoka uye systemic zviratidzo zvehutachiona, akawandisa muvarwere vakwegura, kazhinji nekuda kweiyo hypervirulent NAP1 / 027 dhinhi;
- akanyanya kuomesa mafomu: nemanyoka, systemic zviratidzo zvehutachiona, ileus uye megacolon, anofarira IBD uye ichangoburwa ematumbo turakiti rekuvhiya;
- kudzokorora mafomu: kuitika mukati memavhiki masere mushure mekupera kwekurapa kwakabudirira, mune varwere vakura vane comorbidity uye yakawedzera kuomarara kwechikamu chekutanga.

Kubva pakiriniki yekutarisa, kuvapo kwezvinenge zvitatu zvaburitswa zvemanyoka zvisina mafomu ekutemesa kwemhando 3, 5, 6 yeiyo Bristol chiyero, kana pasina chimwe chikonzero, unofanirwa kuita kufungidzira iyo pathology uye kurudzira kuti utore icho chigaro sampuro. Mushure meawa rimwe chete kuenda kwirabhoritari, inodzivirira kushatiswa kwematuru, kunyanya kutsvaga glutamatodehydrogenase (GDH). Iyi enzyme inogadzirwa muhuwandu hwakawanda necherogenic michero kubva kune isiri-toxinogenic, saka ichangoratidza kuvapo kweClostridioides, zvisinei nerudzi.

Kurapa kwechirwere kune nhoroondo yakavakirwa pakushandisa Metronidazole uye Vancocin uri wega kana musanganiswa uye musiyano madhisidhi zvichienderana nemakiriniki mafomu. Kwemamwe makore ikozvino, ivo vakawedzera Fidaxomycin, inova, zvisinei, mushonga unorwisa mabhakitiriya unonyanya kushandiswa mumafomu akaomarara uye anopesana, [Nhungamiro dzeInfuruwara Zvirwere Society of America (ISDA) uye Society for Healthcare Epidemiology of America (SHEA).

 

Matanho matsva ekurapa kwaClostridioides

Vatsvaguri vari kudzidza maantibiotic matsva muchikamu chechipiri uye chechitatu miedzo, asi hapana panguva yacho achiri kupinda mukushandisa kwechipatara. Tsvagudzo mukushandiswa kwema antibodies monoclonal yakaona mashoma kushandiswa kwayo vorongodza, inokwanisa kusunga nekusapindirana kweB toxin uye yakabvumidzwa munguva pfupi yapfuura kudzivirira kudzokororwazve muvarwere vane njodzi zvakanyanya. Vaccinine ane inactivated A uye B ma toxin ari kudzidziswawo nezvekudzivirira uye kurapwa.

Kune rimwe divi, faecal transplantation, kana zvirinani kutaura kushandurwa kwehutachiona, chave chiri chisarudzo chine musoro mumakore achangopfuura. Chinangwa ndechekuvandudza hutachiona hwehutachiona hweanyama. Chiratidzo chekushandurwa ndechevarwere vari panjodzi yekudzokazve kana zvakadaro mushure mekutanga kudzokerazve.

Maitiro aya ikozvino akaenzana munzvimbo dzakatenderwa, uye inovimbisa kusarudzwa kwakasimba kweanopa anenge achifanira kuve noutano hwakakwana uye obva aiswa pasi rose rakatevedzana kiriniki uye kwerabhoritari bvunzo kusabatanidzira hutachiona, metabolic, autoimmune, neoplastic, IBD, nezvimwe. hosha. Fundesheni dzemupi anopa dzinoongororwa kwete chete pakuvapo kweClostridioides asiwo Enterobacteria, protozoa, helminths, Gram-MDR, VRE hutachiona.

ONGORORA

Serum Institute of India neOxford University paCOVID-19 yekudzivirira miedzo: inokurudzira mhedzisiro uye yakagadzirira kugadzirwa

Albumin Kudzokera Muvarwere vane Sepsis Yakanyanya kana Septic Shock

Tsvaga pepa rekudzidza repamutemo naAtti Della Accademia Lancisiana

Bristol Scale

Mirayiridzo yeiyo Inotapukira Zvirwere Society of America (ISDA) uye Society for Healthcare Epidemiology yeAmerica