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BRUTSELLYOZ

brucellosisBRUTSELLYOZ (Brucellosis), bemorii siroyatii muzmin, ki dar mavridi on beshtar dastgohi takyavu harakat, silsilai asab va uzvhoi jinsi oseb meyoband. B. bo nomhoi tabi bahrimiyonazamini, bemorii Bryus, bemorii Bang niz mamul ast.
Angezai B. brutsellaho nom bakteriya buda, onho spora hosil namekunand. Brutsellaho dar muhiti gizoii muqarrari numu meyoband, ba tasiri omilhoi muhit va sarmo tob meorand. Andozai brutsellaho 0,3 – 2,5 mkm buda, onho 6 namud dorand; Br. melitensis – dar jismi chorvoi mayda (buzu gusfand) zindagi mekunad va baroi odam bemoriovar ast; Br. abortus bovis – angezandai B.-i gov buda, baroi odam bemoriovar meboshad; Br. abortus suis – asosan dar jismi khuk zindagi menamoyad; Br. canis – B.-i sagro ba vujud meorad va baroi odam bemoriovar ast; Br. neotomae – homili asosii on kallamushhoi darakhtgard meboshand; Br. ovis – homili asosii on gusfand buda, ziyoni on baroi odam aniq muqarrar nashudaast.
B. mansub ba amrozi zoonozi buda, khosi moli mayda (buzu gusfand, khuk) va gov, hamchunin gavazn meboshad. Beshtar dar mavzehoi chorvodori ba nazar merasad. Odam hangomi istemoli shir va mahsuloti shirii chorvoi kasal, hamchunin dar asnoi nigohubin va zoyondani chorvo, kushtanu pora kardani gusht siroyat meyobad. B. az odam ba odam nameguzarad. Brutsellaho az organizmi chorvo ba vositai peshob, akhlot, shir, muhtavoi bachadon khorij meshavand. Dar tarkibi mahsuloti shirii khom brutsellaho 15 – 60 ruz, dar tarkibi gusht to 20 ruz mahfuz memonand. Angezahoi B. ba organizmi odam metavonand tavassuti zarrahoi pashm, poru, tagandozi chorvo va khok niz siroyat bikunand. Nisbati B. masuniyat (immunitet)-i bardavom ba vujud nameoyad.
Brutsellaho ba vositai pust yo luobpardaho voridi organizmi odam shuda, avval ba guddahoi limfavi va sipas ba khun meguzarand. Onho az khun ba jigar, sipurz, magzi ustukhon, guddahoi limfavi guzashta, dar on jo manbai duyumini siroyatro ba vujud meorand. Az lahzai ba organizm vorid shudani brutsellaho bayni onho va homil muboriza ba vuqu mepayvandad. Agar darajai siroyatangezi va voyai brutsellaho kam boshad, pas onho dar guddahoi limfavi mahv megardand. Brutsellaho qisman zeri tasiri fagositozi khun va quvvai muhofizii khudi organizm niz mahv meshavand va endotoksin ikhroj menamoyand. Brutsellahoi favtida va zahri onho dar majroi khun gardish karda, ba hujayravu boftahoi organizm tasir merasonand. Dar natija dar organizm vokunishoti allergi rukh menamoyad, ki nishonahoi on iltihobi dastgohi takyavu harakat, silsilai asabhoi kanori, uzvhoi jinsi va g. meboshand. Hamin tavr, manbahoi illat, yane metastazaho tashakkul meyoband. Vobasta ba paydoishi masuniyat brutsellaho az jigar, sipurz, guddahoi limfavi va magzi ustukhon qisman ba berun ikhroj shuda, qisman zeri tasiri mekhanizmhoi muhofizi mahv megardand; bazei onho chand moh dar joi khud mahfuz memonand. Mavridi faroham omadani sharoiti musoid (sust shudani quvvai muhofizii organizm bar asari khastagi, sarmo zadan, asabi shudan va g.) brutsellahoi dar organizm vujuddoshta faol meshavand. Onho dar chunin mavridho dubora ba khun guzashta, ba uzvu boftaho pahn megardand. Hamin tavr, bemori goh khuruj kardavu goh khomush shuda, duru daroz davom mekunad.
Davrai nihonii B. 7 – 30 ruz ast. Alomathoi on khele gunogunand. Dar manbai bemori goho B.-i nihoni mushohida meshavad. Dar mavridi chunin tarzi marizi brutsellaho dar shakli «orom» qaror dorand. Vale hangomi daqiq muoina kardani chunin ashkhos, alomathoi B.-ro oshkor binmudan dushvor nest (kalon shudani guddahoi limfa, ikhtiloli vazoifii silsilai asab, buzurg shudani jigar, sipurz va g.).
Bemoroni mubtaloi B. duru daroz tabu tablarza karda, bisyor araq menamoyand, jigaru sipurz behad kalon meshavad (gepatosplenomegaliya), dastgohi takyavu harakat zaf meyobad, silsilai asab, dilu ragho, ikhroji peshob kharob megardad.
CHandin tasnifoti B. vujud dorad, vale nisbatan asosiash tasnifoti G.P. Rudnev (1955) ast. Muvofiqi on B. shadid (to 3 moh), shadidmonand (to 6 moh), muzmin (ziyoda az 6 moh) va boqimonda (reziduali) meshavad. Dar tasnifoti mazkur nafaqat davomoti marizi, balki darajai vaznini (sabuk, miyona, vaznin) va davrahoi ravandi bemori niz ba etibor girifta shudaand.
Qabl az ogozi B.-i shadid va shadidmonand davrai peshkhabar vujud dorad, ki 3 – 5 ruz tul mekashad: sustivu beholi, bedimogi, zud khasta shudan, sim – sim dard kardani sar, kam gashtani ishtiho. Dar okhiri davrai peshkhabar alomathoi zahroludi meafzoyand va nishonahoi asosii marizi padid meoyand: gipertermiya, ki bo tabu tasf va seraraqi rukh menamoyad, hamchunin gepatosplenomegaliya. Tab duru daroz ast. Qati nazar az in vazi salomati tagyir nakhohad yoft.
B.-i shadid bo tablarzai sakht ogoz meyobad. Saravval harorati badan az meyor past shuda, sipas mariz tasf mekunad, dahon mekhushkad, harorat tadrijan baland megardad, araqi bisyor ba vujud meoyad. Guddahoi limfavi, khususan guddahoi gardan va zeri kash, ba qadri lubiyo kalon meshavand; onho dard namekunand va az boftahoi atrof judo meboshand. Dar nasji zeri pust, dar mavzei ragu pay va mushakho guddahoi sakhti dardmand – fibrozitho va sellyulitho paydo meshavand.
Dili bisyor bemoron az andoza kalontar va ohangi on sust khohad shud; hatto mumkin ast miokardit, endokardit, perikardit rukh namoyad. Ba vujud omadani bronkhit, bronkhopnevmoniya, bronkhoadenitho niz az ehtimol dur nest. Jigar va sipurz kalon, muloim, dardmand (hini molish dodan) meshavad; nishonai oseb yoftani jigar sim – sim dard kardani zeri qaburgai rost ast. Dar holathoi vaznini B. ikhtiloli ruhiya va sarsom sar mezanad. Jarayoni sarsom sust, biduni padidahoi asosi ast (sarsomi brutsellyozi, odatan, khususiyati serozi dorad).
Dar mavridi B.-i shadid goho dastgohi takyavu harakat niz zaf meyobad; dardi bandu bugum barobari kam gashtani alomathoi zahroludi nest khohad shud.
B.-i shadidmonand dar natijai der tashkhisu tabobat kardan ba vuqu mepayvandad. Vale in sababi asosi nest. Dar paydoishi on mayl ba jarayoni muzmin doshtani khudi marizi ham ahamiyati kalon dorad. Dar chunin holatho badi muolijai etiotropi (ba sababgori marizi tasir mekunad) niz dar organizmi bemoron brutsellaho boqi memonand.
Dar organizm duru daroz mahfuz mondani brutsellaho va baroi paydoishi marizi faroham omadani sharoiti musoid (zafi jismonivu ruhi, khunuk khurdan, yakbora khalaldor shudani ravandhoi mubodila va g.) boisi takror yoftani B. khohad shud. Bemori metavonad badi 1 – 2 mohi shifo yoftani mariz yo badtar takror shavad. Mariz tablarza karda, araqi bisyor mekunad. Beshtar dastgohi takyavu harakat ziyon mebinad. Barkhe az marizon dar natijai sarivaqt va durust tabobat kardan, pas az 1 – 2 soli ogozi marizi komilan ofiyat meyoband. Vale bisyor vaqt bemori bardavom va jarayoni on muzmin khohad shud.
B.-i muzmin dar natijai az sar guzaronidani shaklhoi shadid va shadidmonandi bemori paydo meshavad, ammo on bevosita badi davrai nihoni niz metavonad rukh namoyad. B.-i muzmin muvofiqi tasnifi G.P. Rudnev (1966) ba chunin shaklho judo karda meshavad: ahshoi ( dilu ragi, shushi, jigarivu sipurzi); bandu ustukhoni (illati bandho, illati ustukhonho, illati ustukhonbandii narm, mushtarak); asabi (illati asabiyai kanori, illati silsilai asabhoi markazi, psikhobrutsellyoz); urogenetali (mansub ba uzvhoi bavlu tanosul); mushtarak; B.-i omekhtai muzmin (B. bo varaja, B. bo sil, B. bo sifilis va bemorihoi siroyatii digar).
Dar mavridi B.-i muzmin beshtar illati dastgohi takyavu harakat sar mezanad: artrit (gazaki bugumho), bursit, tendovaginit (gazaki niyomi pay), periostit (gazaki ustukhonparda), perikhondrit (gazaki tagoyakparda). Bandu bugumho surkh shuda, varam mekunand, harakati onho mahdud megardad. Bazan bandu bugumho az darun niz illati meshavand, ki dar natija artroz, spondiloartroz va ankiloz sar mezanad. Hamai in nojuriho bo dardi jonkoh surat megirand; bemor sustu behol va asaboni ast, bekhobi mekashad.
Bar asari B.-i muzmin bisyor vaqt uzvhoi bavlu tanosul niz oseb mebinand (orkhit, epididimit, ooforit, salpingit, endometrit, ikhtiloli hayz, qati haml). Goho faoliyati gadudi siparshakl va gadudhoi boloi gurda tagyir meyobad (leykopeniya, limfositoz, eozinopeniya, trombositopeniya rukh menamoyand). Mariz kornoshoyam va hatto mayub meshavad.
Anjomi bemori baroi hayot asosan khavfnok nest. Hodisai favt khele kam meboshad.
B.-ro dar asosi malumoti epidemiologi, sariri va laboratori tashkhis mekunand. Nishonahoi gematologi: leykopeniya, limfositoz, neytropeniyai moil ba chap, monositoz, eozinopeniya. Baroi tashkhisi B. judo kardani angezanda (kishti khun, kishti magzi ustukhon) ahamiyati kalon dorad, vale in usulro metavon faqat dar laboratoriyahoi makhsus ijro kard. Gayr az in brutsellaho dar muhiti gizo nihoyat sust (to 30 ruz) mesabzand. B.-ro az varaja, ufunat (sepsis), domana, tarbod, artriti tarbodmonand farq kardan lozim ast.
Dar vaqti B.-i shadidi ufuni tetrasiklin va levomitsetin tayin karda meshavad. Pas az raf shudani padidahoi shadidi bemori vaksinoterapiya naf meorad. Vaksinoterapiya dar asnoi B.-i muzmini metastazi rohi asosii tabobat ast. Vaksina ba zeri pust, dokhili pust, mushak va varid firistoda meshavad. Baroi tabobati B. loyqashifoi niz mufid ast. Ba marizho 10 – 12 obzan (vanna)-i sulfidi (60 – 80 mg/l) tayin karda meshavad, ki harorati onho 36 – 370S ast. Davomoti qabuli prosedura 10 – 15 daq. meboshad. Varzishi shifoi, rioyai nizomi koru istirohat va mash niz mufidand.
Baroi peshgirii B. sarivaqt oshkor namudani hayvoni kasal va judo nigoh doshtani on muhim ast. Inchunin ba jonvaron moya (vaksina) meguzaronand, onhoro dar maydonchahoi makhsus bo rioyai tadbirhoi makhsus mekushand. Binoero, ki hayvoni kasal nigoh doshta shuda bud, bezarar kardan zarur ast. Ba in maqsad az mahluli doruhoi bezarargardon istifoda mekunand; hamli saqatshuda, hamrohak, tarashshuhoti badi zoish, sargin va pakhol, koh, arramaydai oludaro mesuzonand. Pusti hayvoni zabhshudaro baroi bezarar kardan, 2 moh dar namak mekhobonand; pashmi onhoro bo bromidi metil bezarar megardonand.
Dar khojagihoe, ki B. paydo shudaast, jurgot, panir va g.-ro az shiri jushonida tayyor mekunand. Panirro dar namakob 60 shaboruz nigoh medorand, gushtro 3 soat mepazand yo 2 moh ba namak mekhobonand.
SHakhsoni bo hayvonoti kasal sarukordoshta, korgaroni korkhonahoi sanoati (kombinathoi gusht, korkardi pashm, qaroqulparvari, korkhonahoi charmgari, panirpazi va g.) boyad libosi makhsus (dastpushakhoi rezini, korjoma, poyafzori rezini) doshta boshand (onhoro badi kor bo mahluli lizol yo khloramin bezarar megardonand). Navrason va zanhoi homilaro ba in guna korho roh namedihand. Korgaroni chunin korkhonaho har sol moyakubi karda meshavand.
Ad.: Rukovodstvo po klinike, diagnostike i lecheniyu opasnikh infeksionnikh bolezney, M., 1994; Kamardinov H.K., Infeksionnie bolezni, D., 2005; Hamon muallif, Infeksionnie i parazitarnie bolezni, D., 2009.

H. Q. Qamardinov.

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