LEYSHMANIOZ

LEYSHMANIOZ (Leishmaniosis), nomi umumii amrozi protozoyii khun. Angezai L. parazithoi dokhilihujayravi meboshand. Onhoro kurpashshaho meguzaronand. Beshtar uzvhoi daruni (leyshmaniozi dokhili), pust va luobpardaho (leyshmaniozi pust) oseb meyoband.
Angezandahoi L. ba jinsi Leishmania, oilai Trypanosomatidae, sinfi Zoomastigophorea, tipi Protozoa mansuband. Hayoti leyshmaniyaho az du davra iborat ast: amastigota yo beqamchinaki – dar organizmi jonvaroni muhrador va odam; promastigota yo qamchinakdori – dar organizmi bandpoyho (kurpashsha). Leyshmaniyahoi amastigoti bayzashakl (andozaashon 3 – 5 kh 1 – 3 mkm) va leyshmaniyahoi promastigoti dukshakl (daroziashon to 10 – 20 mkm, barashon to 4 – 6 mkm) meboshand. Leyshmaniyahoro kurpashshahoi jinsi Phlebotomus va Lutzomyia pahn mekunand.
L. daruni (visserali) va beruni (pust) meshavad.
L.-i daruni (Leishmaniosis visceralis) bemorii muzmin buda, bo tabi noustuvor, splenomegaliya, gepatomegaliya, kamkhuni, leykopeniya, trombositopeniya, kakheksiya jarayon megirad. L.-i daruni antroponozi va zoonozi meshavad. Ba L.-i darunii antroponozi kala-azari hindi, ba L.-i darunii zoonozi – L.-i darunii bahrimiyonazamini-osiyoimiyonagi yo kala-azari kudakon, L.-i darunii Afriqoi SHarqi, L.-i darunii Olami Nav mansuband.
Dar qalamravi IDM (az jumla Tojikiston) L.-i darunii bahrimiyonazamini-osiyoimiyonagi duchor meoyad. Onro L.-i kudakon, kala-azari kudakon niz menomand. Angezandaash L. infantum ast; bemorii zoonozist. Manbahoi siroyati on asosan se guruhand: 1) tabii – leyshmaniyaho dar bayni jonvaroni vahshi (shagol, ruboh, qashqaldoq, sugur) vomekhurand; 2) qariyai – leyshmaniyaho asosan dar bayni sagho duchor meoyand; 3) shahri – manbai siroyat sagho meboshand, vale angezandaho dar bayni kallamushho niz ba chashm merasand. Beshtar kudakoni 1 – 5-sola bemor meshavand.
Leyshmaniyaho az joe, ki ba organizm vorid shudaand, tavassuti khun ba hujayrahoi pahn megardand. Onho dar hujayraho afzoish karda, faoliyati jigar va sipurzro khalaldor mesozand, illati magzi ustukhon va rohi uzvhoi hozimaro ba vujud meorand.
Dar jarayoni bemori, garchi nisbatan sust boshad ham, podtanhoi makhsus gun meshavand. Onho mansubi immunoglobulinhoi M va G meboshand. Mahsuli mubodilai moddaho va mahv shudani leyshmaniya boisi inkishofi zahroludi megardad. Badi shifo yoftan masuniyati ustuvori yakumri paydo meshavad.
Davrai nihonii L. az 20 ruz to 3 – 5 moh ast. Dar joi gazidai kurpashsha dar kudakoni 1 – 1,5 sola, goho dar kudakoni digar va kalonsolon, yarachai karakhshdor paydo meshavad. In alomati asosi buda, to zuhuroti umumii marizi rukh menamoyad. L.-i daruni az davrahoi ogoz, avj va terminali iborat ast.
Dar davrai ogozi bemori sustivu beholi, kamishtihoi, adinamiya, buzurg shudani sipurz ba nazar merasad. Davrai avji bemori bo tablarza ogoz meyobad. Bemor ruzho va mohho tab (39 – 40°S) mekunad. Alomati hameshagii L.-i daruni kalon va sakht shudani jigar, khususan sipurz ast. Sipurz dar muddati 3 – 6 mohi avvali marizi tez kalon meshavad. Hangomi molish dodan, jigar va sipurz sakht buda, dard namekunand.
Mavridi L.-i darunii bahrimiyonazamini-osiyoimiyonagi guddahoi limfavii kanori, masoriqai, girdibronkhi niz illat khohand yoft. Dar marizon limfadeniti kanori, goho mezadenit ba mushohida merasad.
Vazi bemor batadrij bad va khudi u kharobu logar megardad. Kamkhuni illati magzi ustukhonro taqviyat medihad. Dar natijai kalon shudani jigar, sipurz va bolo joy giriftani diafragma dil ba tarafi rost megejad, ohangi on kund meshavad. Bo inkishofi kamkhuni va zahroludi alomathoi osebi dil meafzoyand. Dar davrai terminalii bemori kakheksiya paydo shuda, tonusi mushakho sust, pust tunuk megardad, tarhi kalon shudani jigar va sipurz baralo namuda meistad; rangi pust parida, kamkhunii sakht ba vujud meoyad.
L.-i bahrimiyonazamini-osiyoimiyonagi shadid, shadidmonand va bardavom meshavad. L.-i shadid dar kudakoni khurdsol ba chashm rasida, dar surati sari vaqt muolija nakardan, oqibati nokhush ba bor meorad. L.-i shadidmonand nisbatan beshtar vomekhurad. On 5 – 6 moh tul mekashad. Dar surati muolija nakardan, mariz mefavtad. L.-i bardavom dar kudakoni kalontar va odamoni kalon duchor meoyad.
Dar manbai endemi tashkhisi L. dushvor nest. Baroi tasdiqi tashkhis az usuli parazitologi istifoda meshavad. Hini L.-i darunii bahrimiyonazamini-osiyoimiyonagi leyshmaniyahoro bazan dar khun oshkor mesozand. Usuli az hama boetimod dar andudahoi magzi ustukhon yoftani leyshmaniyaho meboshad. Goho az usuli biopsiyai guddahoi limfavi, sipurz va jigar niz istifoda mekunand.
L.-ro az varaja, gripp, tif, leykoz, ufunat, limfogranulematoz, brutsellyoz farq kardan lozim ast.
Dar mavridi L.-i dokhili doruhoi surmai panjvalenta mufidand (solyusurmin, neostibozan, glyukantim). Solyusurmin (solyustibozan, stibanol, pentostam)-ro har ruz ba varid boyad firistod (hamagi 7 – 16 ruz). Dar mavridi natijai dilkhoh nadodani doruhoi surmai panjvalenta ba mushak pentamidin (har ruz yo ruzdarmiyon) firistoda meshavad.
Voyai istifodai solyusurmin (N. A. Mirzoyan)
Sinnu sol va vazi mariz Voyai doru bo g ba 1 kg vazni mariz
Dorufiristii yakum Dorufiristii duvvum Dorufiristii savvum va minbad Muhlati khotimai tabobat (bo ruz)
Kudakoni to 7-sola biduni tagyiroti distrofi
Kudakoni to 7-sola bo tagyiroti distrofi va amrozi digar
Kudakoni 7 – 14-sola
Bemoroni az 15-sola bolo

0,05

0,04

0,04

0,04

0,1

0,08

0,07

0,07

0,15

0,12

0,12

0,1

10 – 12

14 – 15

12 – 14

14 – 16

Bo maqsadi peshgirii L. boyad saghoi daydu va kasal, kurpashshaho nest karda shavand.
Ad.: Qamardinov H. K, Bemorihoi siroyati, D., 2000; Kamardinov H. K., Infeksionnie bolezni cheloveka, D., 2005; Hamon mual., Infeksionnie i parazitarnie bolezni cheloveka, D., 2009.
H. Q. Qamardinov.