LEPTOSPIROZ

LEPTOSPIROZ (Leptospirosis), tabi obi, yak nav bemorii shadidi siroyati. Angezandaash leptospiraho meboshand. Leptospiraho taqriban 169 navu khel dorand. L. icterohaemorrhaqiae, L. canicola, L. tarassovi, L. pomona va g. Daroziashon 7 – 14 mkm, diametrashon 0,07 – 0,15 mkm. Bo usuli taqsimshavi meafzoyand. Leptospiraho dar ob to 26 va dar khurokvori (ravgan, shir) to 1 – 2 shaboruz zinda memonand. Onho hangomi ba gizo andokhtani namak, qand yo dar asnoi garm kardan, mahv meshavand. Ba tasiri penitsillin, tetrasiklin, levomitsetin tob nameorand. L.-ho vobasta ba angezanda az hamdigar farq nadorand, binobar in ba khelho judo karda nameshavand.
Manbai siroyat hayvonoti gunoguni vahshivu khonagi (mushu kallamushho, gov, khuk, sag) meboshad. Odamoni bemor hatto angezandahoi mariziro khorij namoyand ham, onro pahn namekunand. Angezandaho ba shakhsi solim asosan tavassuti ob, goho rustani, khurokvori, binobar aloqa bo chorvo yo mahsuloti siroyatyofta meguzarand. L. beshtar marizii kasbi ast. Ba on asosan deratizatorho, ashkhose, ki dar botloqjoyho kor mekunand, chorvodoron, qassobon, govdushho, chuponu podabonho giriftor meshavand. Marizi beshtar mohi avgust avj megirad.
Angezandahoi L. ba organizm tavassuti luobpardai rohi uzvhoi hozima, multahima va pust vorid meshavand. Darajai vazninii bemori va osebi uzvho (jigar, gurda, silsilai asab) az kheli angezanda dida, ba hassosiyati shakhs beshtar vobasta ast. Vale, bo vujudi in, kheli angezanda niz beahamiyat nest. Mas., hangomi L.-e, ki bar asari L. icterohaemorrhaqiae sar zadaast, beshtar zafarma va aloimi hemoravi (khunrez) ba nazar merasand. Leptospiraho bo rohi gematogeni ba uzvhoi retikuloendoteli vorid shuda (beshtar dar jigar), afzoish mekunand va sipas ba khun meguzarand. Adadi onho dar khun khususan haftai yakumi marizi bisyor ast. Leptospirahoro hatto dar moei harommagz mushohida kardan mumkin. Okhiri hafta dar khun podtanho (antitela) paydo meshavand va leptospiraho az khun baromada dar uzvho, khususan dar jigar va gurdaho, qaror megirand.
Davrai nihonii marizi 4 – 14 (beshtar 7 – 9) ruz ast. L. sabuk, miyona va vaznin meshavad. L.-i vaznin shaklhoi zafarmavi, gemorravi va ikterogemorravi dorad.
Bemori nogahon padid meoyad. Harorat ba 39 – 40°S rasida, mariz tablarza va sar dard mekunad, ishtiho gashta, tashnagi golib meoyad, khob gum meshavad; alomati khosi bemori – sakht dard kardani mushakho, bakhusus mushakhoi soqi po meboshad. Dard chunon toqatfarsost, ki mariz nametavonad roh ravad. Harorat 5 – 10 ruz dar sathi baland meistad. Dar baze bemoron tab pas az 3 – 12 ruz takror meyobad, vale on der davom namekunad.
Dar mavridi vaznin budani bemori az ruzhoi 3 – 5 chashm va sipas pust zard meshavad. Hangomi in dar 20 – 50% bemoron busurot (ekzantema) rukh menamoyad. Busurot dar pusti badan va dastu po paydo shuda, ba misli gulguna, surkhakon yo makhmalak ast. Badi nopadid gashtani donachaho dar joi onho karakhshai sabusakmonand boqi memonad. Bisyor vaqt tabkhol niz medamad. Bradikardiya, kund shudani ohangi dil, dar EKG – alomati tagyiroti diffuzii miokard paydo meshavad. Ruzhoi 4 – 5 qarib dar hamai marizon jigar va dar nisfi onho sipurz kalon meshavad. Dar khun leykositozi neytrofili, afzoishi SOE va boqimondai nitrogen, dar peshob afzoishi safeda, eritrositho, sillindrho ba nazar merasad.
L.-i sabuk bo tabi 2 – 3 ruza ogoz yofta ba uzvu sistemaho chandon ziyon namerasonad. Hangomi shaklhoi vaznini L. bemor asosan dar natijai nuqsi shadidi gurda va igmo (koma)-i uremiyavi mefavtad. Ensefalit, polinevrit, sarsom, mielit, iritho, iridosiklitho, uveitho, hamchunin zotuljanb (pnevmoniya), otitho, parotitho va pielitho orizahoi L. meboshand.
Muqarrar kardani shaklhoi sabuki L. dushvor ast. Bisyor vaqt onro bo gripp yo amrozi shadidi rohi nafas (ORZ) omekhta menamoyand. Vale boyad guft, ki bemorihoi mazkur dar tobiston bisyor kam duchor meoyand. Ruzhoi avvali bemori leptospirahoro dar khun bo mikroskop oshkor kardan mumkin ast. Dar muqarrar sokhtani L. khususan kishti peshob, khun, moei harommagz ahamiyati kalon dorad. Ba sifati muhiti gizo 5 ml ob va 0,5 ml zardobi (sivorotka) khargushro metavon istifoda burd.
Usuli asosii tabobati L. istifodai antibiotikho va gamma-globulini makhsus meboshad. Sari vaqt ogoz namudani tabobat ahamiyati kalon dorad, zero dar in vaqt angezahoi marizi hanuz dar khun mavjudand. Penitsillin, tetrasiklin va oksitetrasiklin niz tain kardan mumkin ast. Antibiotikhoro 8 – 10 ruz istifoda mebarand. Dar vaqti zahroludii sakht va rukh namudani alomathoi khunravi antibiotikho bo doruhoi kortikosteroidi yakjo tain karda meshavand. Gamma-globulini leptospiroziro badi behissozii qabli istifoda mebarand. Ba varid hamchunin 150 – 200 ml mahluli 4 – 5-foizai gidrokarbonati natriy firistodan lozim. Medaro meshuyand va mahluli 2-foizai gidrokarbonati natriyro huqna mekunand.
Az iflosi hifz namudani manbahoi ob, obbozi nakardan dar joyhoe, ki angezahoi bemori pahn shudaand, naoshomidani obi kulu havzho, nest kardani mushu kallamushho, hangomi kor dar botloqzor va nigohubinu kushtani chorvo pushidani libosi makhsus, jushonida istemol kardani shiri chorvoi kasal rohhoi asosii peshgirii L. meboshand. Bemoron baroi odamoni solim khavfnok nestand.
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.