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BOTULIZM

botulizmBOTULIZM (Botulismus; az botulus – hasib, kolbasa), zahroludii shadidi siroyati az khurok. B.- ro allantiazis yo ikhtiizm niz menomand. B. bemorii vaznin buda, binobar az tasiri botulotoksin oseb yoftani magzi darozruya va harommagz paydo meshavad. B. beshtar bo bartarii sindromi falaji chashm va maynai darozruya jarayon megirad. Angezai B. Clostridium botulinum buda, dar muhiti beoksigen (nig. Anaerobho) zindagi va sporavu zahri qotil (voyai margovari on baroi odam taqr. 0,3 mkg ast) hosil mekunad. Hamagi 7 navi angezai B. vujud dorad: A, V, S (Sα va Sβ), D, E, F, G. Onho az jihati khosiyati morfologi monand meboshand, vale sokhtori antigenii zahrashon gunogun ast. Baroi inson khususan angezahoi navi A, V va E khavf dorand. Hangomi garm kardan, botulotoksin tajziya va dar natijai jushondan, zud mahv meshavad; on dar muhiti ishqori (pH ziyoda az 8) tajziya megardad. Ba botulotoksin namaki oshi tasir namerasonad; on zeri tasiri formalin ba anatoksin tabdil meyobad. Sporahoi angezanda hangomi jushonidan to 5 soat va dar harorati 1050S to 2 soat mahfuz khohand mond (onho faqat dar harorati 1200S badi 20 daqiqa mahv meshavand).
Angezandahoi B. va zahri onho ba organizmi odam dar mavridi istemoli gizoi siroyatyofta vorid meshavand. Dar meda zahr zeri tasiri fermentho purtasir megardad. Tasiri yakborai chand navi angezaho ba taqviyati zahroludi musoidat khohad kard.
Botulotoksin tavassuti luobpardai meda va ruda ba khun guzashta, boisi falaji mushakhoi sufta, tang va minbad falaj gashtani raghoi khun, murd shudani muragho (kapillyarho) meshavad. Ba tasiri botulotoksin khususan neyronhoi muharriki harommagz va magzi darozruya hassos meboshand. Botulotoksin ikhroji atsetilkholinro dar nugi asabhoi kholinergi qat karda, bo hamin ba inkishofi falaji asabhoi kanori musoidat menamoyad.
YAke az khususiyathoi B. gipoksiya ast. Sababi rukh namudani illati shadidi nafasgiri kharob gashtani faoliyati motoneyronhoi kalon, ki mushakhoi azoi nafasro bo asab tamin menamoyand, ba shumor meravad. Gipoksiya dar natijai ba bronkhho roh yoftani mavodi qay, obi dahon va khurok, ki binobar falaji mushakhoi gulu, khalqum va gadudi boloi hanjara sar mezanad, metavonad jarayoni vaznin kasb kunad.
Davrai nihonii B. az 2 – 12 soat to 7 shaboruz ast. Marizi ba tavri shadid ogoz meyobad. Sari dil dard karda, dilbehuzuri, qay, ishol paydo meshavad; qay va ishol, ki natijai toksinemiya meboshand, chandon ziyod davom namekunand. Harorati badan mutadil ast; bemor khasta va mushakho zaif khohand shud. Badi 3 – 4 soati ogozi bemori alomathoi osebi asabhoi magzi sar ba nazar merasand.
Bisyor vaqt alomati avvalini B. khushk shudani dahon va tira gashtani chashm ast. Peshi chashmi marizro «parda» yo «tuman» megirad. u binobar falaji tatobuq va dubini kitob khonda nametavonad. Aksulamal ba rushnoi sust yo umuman nest meshavad, guzai chashm beharakat va pilki bolo ovezon gashta, ahvali rukh menamoyad. Ovoz megirad, sukhanroni nofahmo va tavassuti bini khohad shud. Binobar falaji mushakhoi halqum va komi narm bemor khurokro furu burda nametavonad, gizoi obaki az biniash meoyad.
B. boisi ikhtiloli kori silsilai dilu ragho meshavad. Nishonahoi ikhtiloli faoliyati uzvhoi hozima khushkidani dahon, tashnagii toqatfarso, damishi shikam, qabziyat va falaji ruda meboshand. Mariz bo dushvori nafas megirad, gumon mekunad, ki ba sanduqi sinaash fishor meorand, baroi oson shudani nafasgiri mavqei muvofiq mejuyad. YAke az sababhoi asosii favti bemoron hangomi B. mahz qati nafasgiri ast. Inkishofi pnevmoniya nafasgiriro boz ham vaznintar megardonad. Davrai ofiyat yoftani bemor duru daroz, taqriban 1 – 1,5 moh davom mekunad. Sardard, bo bini harf zadan, osebhoi chashm va qalb muddati ziyod boqi memonand; asteniya to nim sol tul mekashad.
Oqibati B. jiddi ast. Dar surati sarivaqt va durust tabobat nakardan, favti marizon ba 25 foiz merasad.
B.-ro dar asosi nishonahoi sariri, malumoti epidemiologi va natijahoi sanjishi laboratori tashkhis menamoyand. Tashkhisi laboratori ba oshkor sokhtani botulotoksin va angezandai B. dar mavodi az mariz va khurokvori girifta (khun, mavodi qay, obi baroi shustani meda istifodashuda, akhlot) asos yoftaast. Hunro az varid (8 – 10 ml) to ba organizm firistodani zardobi shifobakhsh megirand.
B.-ro az digar zahrsiroyathoi gizoi, zahroludi az zanburugho, atropin, bemorii guluzindonak, poliomielit va amrozi guoguni silsilai asabhoi markazi boyad farq kard. Marizon hatman dar bemorkhona khobonda meshavand. Medai bemorro shusta ba u huqna (bo mahluli 5 foizai gidrokarbonati natriy; 10 litr) tayin mekunand. Dar ruzhoi 1 – 3 bemori bo maqsadi bezarar sokhtani botulotoksin zardobi ziddi B. istifoda karda meshavad.
Agar navi zahr nomalum boshad, pas firistodani har se navi zardob (A, V, E) zarur ast. Dar asnoi vaznin budani marizi, voyai avvali zardobro ba varid va dar mavridhoi digar ba mushak mefiristand. Nakhust 10 haz. ME zardobi A va E va 5 haz. ME zardobi V ravon karda meshavad. Voyahoi minbadaro vobasta ba darajai vazninii B. va inkishofi alomathoi on muqarrar menamoyand. Hamchunin istifodai kristalloidho va kolloidho, doruhoi peshobron, doruhoi dil, vitaminho niz ravost.
Dar ayni tabobati B. vazifai asosi barqaror sokhtani nafaskashi va raf binmudani gipoksiya ast. Bo in maqsad oksigennatsiyai giperbari (GBO) kor farmuda meshavad. Agar mushakhoi nafaskashi falaj va zarfiyati hayotii shush to 30 foiz kam shuda boshand, hamchunin dar surati varami shush, atelektazaho, takhipnoe (teznafasi; dar 1 daq. ziyoda az 40 marotiba) ba nafasdihii suni dast mezanand. Pnevmoniya bo antibiotikho darmon karda meshavad.
Nazorati sanitari hangomi tayyor kardani konservho dar istehsolot az muhimtarin tadbirhoi peshgirii B. meboshad. Zeri tasiri harorati baland (1200) sporahoi mikrob mahv megardand. Azbaski chunin usuli bezarargardoniro dar sharoiti khona ba amal ovardan mumkin nest, konserv kardani gushtu mohi dar chunin sharoit khele khatarnok ast. Zanburug va mevayu sabzavotro dar sharoiti khona bo miqdori kofii namaku sirko va korkardi hatmii harorati konserv kardan lozim (nig. Konservoni). Konservhoi az sabzavotu zanburug tahiyashudaro hamon lahza pesh az istemol bo bankaashon dar ob guzoshta 10 – 15 daq. jushoned. Sabzavothoi mayda pora kardaro dar sharoiti khona konserv kardan tavsiya nameshavad.
Holathoi ba B. beshtar giriftor shudani odamon dar Tojikiston az solhoi 70-umi a. 20 ibtido megirad. Dar bemorkhonahoi shahru nohiyahoi jumhuri sole dahho oila bo tashkhisi bemorii B. bistari gardonda meshavand, ki sababi on istemoli konservhoi sabzavoti, khususan boimjon, bodiring, zanburug, sir, qalamfur va karam ast. Baroi peshgirii B. ba qoidahoi tayyor kardani konserv dar khona (khususan korkardi harorati) va nigahdorii onho qati rioya kardan lozim ast. Konservhoi sarpushashon damida va zangzadaro istemol kardan joiz nest. Nig. niz Nigahdorii khurokvori.
Ad.: Qamardinov H.K., Bemorihoi siroyati, D., 2000; Hamon muallif, Infeksionnie i parazitarnie bolezni, D., 2009

E.R. Rahmonov.

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