GULuZINDONAK

GULuZINDONAK (Diphtheria), bodzahra, bugma, khurusak, difteriya, bemorii bisyor shadid, ki asosan dar halq va gulu paydo meshavad. Angezandai G. qalamchabakteriyai Lyoffler (Corinebacterium diphtheriae) ast; daroziash 2 – 7 mkm. Bakteriyai beharakat, spora hosil namekunad, dar anduda (mazok)-ho juft-juft joy megirad (ba shakli raqami V). On dar mavodi (muhiti) zardobi va agari khun, mavodi Ru va Lyoffler mesabzad. Baroi rushdi angezanda khususan muhiti Klauberg muvofiq ast (agari khun bo ilovai namakhoi tellur). Mikrobhoi G. du nav – zahrogin va bezahr meshavand. G.-ro faqat shtammhoi zahrogini korinebakteriyaho ba vujud meorand. Onho ekzotoksin hosil mekunand.
Darajai zahroginii mikrobhoi G. gunogun ast. Vohidi chenaki quvvai zahr voyai aqallii margovar Dosis letalis minima (DLM), yane on miqdori kamtarini zahr, ki khukchai bahrii vaznash 250 grammro dar tuli 3 – 4 shaboruz mekushad, ba shumor meravad.
Angezandai G. gayr az ekzotoksin dermonekrotoksin, gemolizin, neyraminidaza va gialuronidaza niz hosil mekunad. Korinebakteriyahoi G. ba tasiri khunuki purbardosht buda, dar rui chizhoi khushk muddati madid mahfuz memonand. Onho zeri tasiri nami va rushnoi zud befaoliyat megardand. Dar mavridi istifodai mahluli gandzudo badi 1 – 2 daqiqa, hangomi jushondan, hamon lahza mahv meshavand.
Manbai siroyat bemor yo homili angezai zahrogin ast. Bemor baroi digaron az lahzai okhirini davrai inkubatsiya to purra az angezaho ozod shudani organizm, siroyatangez meboshad. Ashkhosi homili bakteriya baroi muassisavu korkhonahoi serodam, kudakistonho, maktabho khavfi jiddi dorand. Angezahoi bemori tavassuti obi dahonu havo va havovu chang intiqol meyoband. Hatto az bozicha, saru libos, joypush niz siroyat yoftan mumkin ast. Darajai hassosi ba angezahoi G. az saviyai masuniyat (immunitet)-i antitoksini vobasta meboshad. Angezaho beshtar dar halqubini va rohi boloi nafas joy megirand.
Daromadgohi angezahoi siroyat luobpardai halq, gulu, bini meboshand. Mikrob dar joi ba organizm daromadaash afzoish karda, ekzotoksin hosil menamoyad. Ekzotoksin boisi nekrozi pustparda (epiteliy), rukudi khun dar muragho va afzoishi qobiliyati intiqolii onho megardad. Az ragho rashha (ekssudat)-i moe metarovad, ki doroi fibrinogen ast. Fibrinogen zeri tasiri trombokinazai boftai nekrozi lakhta mebandad va pardai fibrini hosil mekunad. Dar luobpardai halq, trakheya, bronkhho iltihob inkishof meyobad, ki pardai on ba osoni bejo khohad shud. Dar natija tarashshuhi fibrinozi ba magz andar magzi luobparda guzashta, ba boftai poin payvast megardad. Tasiri umumii zahr binobar ba khun hamroh shudanu ba silsilai dilu ragho, gadudi boloi gurda va gurdaho ziyon rasondani on padid meoyad.
Marg asosan dar natijai illati shadidi silsilai gipofizu – favqigurdavi, miokarditi zahri (toksiki), falaji mushakhoi nafaskashi, bugi gashtan faro merasad. Badi az sar guzarondani marizi masuniyati ustuvor boqi memonad. Pas az immunizatsiya masuniyat 3 – 5 sol davom khohad kard. Dar kudakon va kalonsolone, ki moyakubi (privivka) shudaand, G. sabuk meguzarad. Davrai nihonii G. az 2 to 10 ruz (beshtar 3 – 5 ruz) ast.
G. tadrijan ogoz meyobad; padidahoi zahroludii umumi mutadil ast. Alomati asosii on inqiboz (stenoz)-i hanjara meboshad. Jarayoni bugma az 3 davra iborat ast. Davrai avval (ovozvayroni) bo khirrigii ovoz, surfai makhsus va noforami hushtakdor, dard kardani hanjara sar meshavad. Dar davrai duyum (inqibozi) nafas khirrosi shuda, ovoz megirad, hini nafaskashi mushakhoi yovar niz faoliyat mekunand. Davrai mazkur az chand soat to 2 – 3 shaboruz idoma meyobad. Dar okhiri davrai inqibozi marhalai pesh az bugi shudan ogoz meyobad, ki dalolat ba jarrohi binmudan ast. Bemor bezobita va dar haros meboshad, dilashro vahm zer mekunad, laboni u kabud meshavand, bisyor araq menamoyad. Dar surati tabobat nakardan, davrai asfiksiya (bugishavi) faro merasad. Nafasgiri tez va kutohu ruyaki, vale nisbatan besado ast, vazi mariz taboh megardad. Pust safedi khokistarrang, lab, nugi bini, angushtoni dastu po kabudtob ast. Tonusi mushakho sust va dastu po sard, gavharaki chashm vase meshavad. Minbad mariz az hush meravad, dar joi khob shakh meshavad va beikhtiyor dar jogah tar mekund.
Dar natijai sarivaqt va durust muolija kardan, tartibi khurujhoi bugma khalal meyobad. Badi 18 – 24 soati ba organizm firistodani zardobi ziddi G. alomathoi saririi bemori tadrijan nest meshavand. Goho pardai bejoshuda boisi nogahon bugi shudani bemor megardad.
Orizahoi G. makhsus va gayrimakhsus meshavand. Orizahoi makhsus beshtar hangomi G.-i zahrogin ba nazar merasand, mas., miokardit, mononevritho, polinevritho, aloimi nefrozi va g.
Miokarditho du nav – betakhir va botakhir shudanashon mumkin ast. Miokarditi betakhir okhiri haftai yakum – avvali haftai duyumi marizi rukh menamoyad. Bemor bezobita ast, shikam dard mekunad, qay menamoyad, fishori sharayon yakbora past va jigar kalon meshavad. Miokarditi botakhir dar haftahoi 3 – 4 ba vujud omada, jarayoni on nisbatan bekhavf ast.
Falaji asab az jumlai orizahoi khosi G. meboshad. Falaji barmahali asabhoi jumjuma dar haftai duyumi ogozi bemori sar mezanad. Mariz fungi shuda, bo dushvori harf mezanad, otashi shamro nametavonad «puf» karda khomush bisozad, hangomi furu dodan, khurok az bini meoyad, mazzai taomro his namekunad. Goho u khonda va chizhoi khurdro farq karda nametavonad. Falaji botakhir haftahoi 4 – 5 rukh menamoyad. Refleksi payho sust, mushakho zaif meshavand. Mariz kalavidavu noustuvor roh meravad. Dar asnoi oseb yoftani mushakhoi gardan va badan bemor nishasta va sarashro doshta nametavonad. Mumkin ast falaji halqum, gulugoh, diafragma niz paydo shavad. Dar chunin holatho surfa besado megardad, mariz ovoz barovarda yo khurok va obi dahonashro furu doda nametavonad. Poliradikulonevritho badi 1 – 3 moh purra raf shuda, faoliyati mushakho komilan barqaror meshavad.
Ba orizahoi gayrimakhsusi G. pnevmoniya, otitho, limfadenitho va g. taalluq dorand.
Mariz 5 – 7 hafta hatman bistari karda meshavad. Dar surati paydo shudani nevrit va falaji sust, az ruzhoi avval sar karda vitamini V1, strikhnin, prozerin, dibazol tayin menamoyand. Bugmai G.-ro bo rohi qabuli vanna, ingalyatsiyai bug, istifodai dimedrol, diprazin, tavegil, eufillin, efedrin tabobat mekunand.
Muoinai bakteriologii ashkhose, ki bo bemor tamos doshtaand, hamchunin gandzudoi binmudani chizu chorai utoqi mariz az jumlai tadobirhoi peshgirii G. ba shumor meravand. Homiloni mikrobhoi G.-i zahroginro az digaron judo doshtan lozim. Moyakubi kardani atfol niz hatmist. Kudakonro az dumohagi sar karda badi har 1,5 moh 3 marotiba boyad moyakubi binmud. Badi 1,5 – 2 sol moyakubii takrorii avvalini AKDS guzaronda meshavad. Moyakubihoi minbada dar 9 va 16-solagi va badi har 10 sol to 56-solagi bo ADS – M amali khohand gasht.
Ad.: Qamardinov H.Q., Bemorihoi siroyati, D., 2000; Hamon muallif, Infeksionnie bolezni cheloveka, D., 2005; Hamin muallif, Infeksionnie i parazitarnie bolezni cheloveka, D., 2009.
H.Q. Qamardinov.