VARAJA

VARAJA (Malaria) tabdard, tabi botloqi, malyariya, bemoriest, ki bo tablarza, kamkhuni (anemiya), kalon shudani jigar va sipurz padid meoyad. Angezai marizi plazmodiyahoi V. ba shumor meravand. V. beshtar dar kishvarhoi garmser rukh menamoyad.
Angezahoi V. ba tipi Protozoa, sinfi Sporozoa, oilai Plasmodiidae, jinsi Plasmodium mansuband. V.-ro 4 namudi angezandaho ba vujud meorand: P. falciparum – angezandai V.-i tropiki, P. vivax – angezai tabi seruza (tabi seyaka), P. ovale – angezai ovale varaja. P. malariae – angezai tabi chahorruza. Muqarrar shudaast, ki nishonahoi tabi seruza (ruzdarmiyon khuruj kardani marizi) ba du namudi angezanda – P. vivax va P. ovale vobasta ast.
Angezahoi V. dar organizmi homil va pashsha silsilai murakkabi inkishofro az sar meguzaronand. Dar mavridi siroyat yoftan, ba organizmi homil sporozoitho vorid meshavand. Onho na ba eritrosit, balki ba hujayrai boftaho dokhil gashta, ba shizontho tabdil meyoband. SHizontho numu mekunand, borho taqsim meshavand va merozoithoi sershumorro ba vujud meorand. Sipas, angezaho ba eritrositho meguzarand va shizogoniyai eritrositi ogoz meyobad. Merozoitho dar eritrositho inkishof mekunand va ba shizonthoi gayrijinsi (agamontho) va jinsi (gamontho) ibtido meguzorand. Dar natijai taqsim gashtani shizontho merozoitho tashakkul yofta, az digar ba erotrositho dokhil meshavand va silsila (sikl) takror meyobad.
SHizogoniya dar angezahoi tabi seruza va V.-i tropiki 48 soat, dar tabi chahorruza 72 soat davom mekunad. Dar organizmi pashsha sporogoniya badi bo khun vorid shudani fardhoi jinsii parazit ogoz meyobad. Dar medai pashsha az gamonthoi narina 4 – 8 qamchinak hosil meshavad. Onho gametahoi modinaro bordor mesozand. Hujayrai bordor (zigota) ba ookinetai mutaharrik tabdil meyobad. On tavassuti devorai meda vorid shuda, ba oosista mubaddal megardad. Hasta (yadro) – i oosista borho taqsim meshavad va sporozoithoi sershumor tashakkul meyoband. Onho ba tamomi organizmi pashsha pahn gashta, dar gadudhoi luobi dahon joy megirand. Az hamin lahza pashsha qobiliyati siroyatangezi kasb mekunad va in khususiyati u 30 – 45 ruz mahfuz memonad.
Manbai siroyati V. mariz yo odamoni solimi homili gameta meboshand. Odam hangomi gazidani pashsha yo ba organizm firistodani khuni shakhsi bemor siroyat meyobad. Goho dar batni modar siroyat yoftani tifl niz mumkin ast. Pashsha az mariz hamon vaqt siroyat meyobad, ki agar dar khun u gamonthoi bolig tashakkul yofta boshand. Dar asnoi tabi seruza va chahorruza in holat badi khurujhoi seyum, hangomi V.-i tropiki ruzhoi 7 – 10-umi bemori rukh menamoyad. Ba V. khususan kudakoni khurdsol hassos meboshand. V. khosiyati mavsimi dorad. Dar mintaqahoi iqlimash mutadil mavsimi siroyati angezaho 1,5 – 3 mohi tobiston, dar mavzehoi subtropiki 5 – 8 moh, dar mintaqahoi tropiki tamomi sol idoma meyobad.
Dar surati bo rohi tabii az pashsha siroyat yoftan, V. siroyati sporozoiti ba shumor meravad. Hini siroyati batni yo rahimi siroyat shizonti ast, zero ba organizm na sporozoitho, balki shizontho roh meyoband. Davomoti davrai nihonii siroyati sporozoiti ba namudi (vid) angezanda vobastagi dorad. Dar ibtidoi marizi, vaqte ki shizonthoi boftai guruh – guruh ba khun guzashta, boisi tashakkuli naslhoi gunogun meshavand, tabi nomuttasil padid meoyad. Minbad inkishofi angezaho sinkhroni shuda, V. khususiyati khurujmonand megirad. Huruj binobar taqsim gashtani shizonthoi eritrositho (dar davrai bisyor tajziya shudani eritrosithoi siroyatyofta va ba khun guzashtani angezaho) ba vujud meoyad. Binobar in dar mavridi tabi seruza, V.-i tropiki va ovale-varaja khurujho badi 48 soat, dar vaqti tabi chahorruza boshad, pas az 72 soat takror meyoband. Tab dar natijai ba khungardish hamroh shudani safedai gayr (begona), ki hini tajziyai eritrositho khorij meshavad, ba vujud meoyad. Dar natija kamkhuni sar mezanad. Sababi kalon shudani jigar va sipurz afzoishi hujayrahoi limfavi va shabakavi (retikulavi) meboshand. Sar zadani igmo (koma)-i varajagiro ba ikhtiloli gardishi khuni mayna vobasta medonand. Binobar khalal yoftani faoliyati andarunparda (endoteliy) eritrosithoi siroyatyofta dar organizm boqi memonand, onho mechaspand, taboh megardand va hamin tavr murag (kapillyar)-ho basta meshavand.
Hangomi V. masuniyat (immunitet)-i noustuvor tashakkul meyobad. Binobar in badi chand muddat mumkin ast shakhs az namudhoi gayrimamuli (geterologi) va mamuli (gemologi)-i parazitho siroyat yobad.
Davrai nihonii V.-i tropiki 8 – 10 ruz, tabi seruzai kutohmuddat va ovale-varaja 10 – 16 ruz, tabi chahorruza 20 – 25 ruz ast. Dar asnoi az angezahoi tabi seruzai bardavom siroyat yoftan, khurujhoi marizi pas az 8 – 14 moh (dar mavsimi epidemiyai digar) rukh menamoyand.
V. se davra dorad: tablarza, tab va araq. Bemori, odatan, pagohiruzi (hangomi ovale-varaja soathoi 18 ¬¬– 20) khuruj mekunad. Tablarza banogoh sar shuda, 1 – 1/2 soat tul mekashad. Davomoti hamai in khuruj dar mavridi tabi seruza va ovale-varaja 6 – 8 soat, tabi chahorruza 12 – 24 soat ast; khuruji V.-i tropiki bardavom meboshad. Badi tablarza mariz tab karda, bo ogozi faromadani harorati badan araq menamoyad va khudro behtar his mekunad; u orom meshavad, bisyor vaqt khob meravad. Dar davrai betabi (apireksiya) vazi salomatii bemor komilan qanoatbakhsh va khudi u korshoyam ast. Hurujhoi tabi seruza – ruzdarmiyon, tabi chahorruza – badi har du ruz ba miyon meoyand; varajai tropiki mumkin ast har ruz khuruj kunad. Hanuz badi khurujhoi avval (khurujhoi 2 – 3) jigar va sipurz kalon meshavand.
Dar mavridi muoinai mariz tabkhol, qadre zard budani pust, paridani rangi ruy ba nazar merasand; pust binobar pay dar pay khuruj kardani bemori tadrijan khokistarrang (binobar tah nishastani pigmenti varaja) khohad shud.
Orizahoi bemori: igmoi varajai, tabi gemoglobinuriyavi, kafidani sipurz.
Igmoi V. sababi asosii favti mariz hangomi V.-i tropiki ast. Faqat dar mavridi V.-i tropiki ba vujud meoyad. Dar davrai qabliigmoi mariz oshuftakhotir va purhayajon buda, aql tira megardad, tavattur (tonus)-i mushakhovu refleksi payho meafzoyad, gavharaki chashm tang meshavad; dar davrai igmo bemor az hush meravad. SHakhs mumkin ast badi chand soati ogozi igmo favtad.
Tabi gemoglobinuriyavi beshtar dar mavridi V.-i tropiki mushohida meshavad. Binobar bo ginagina (khinin) tabobat kardani marizon sar mezanad. Badi khuruji vaznini tabu tablarza jigaru miyon sakht ba dard medaroyad, khohishi zud-zud peshob kardan paydo meshavad, peshob jigari yo qarib siyohrang ast. Badi faromadani harorati badan, vazi mariz behtar va rangi peshob muqarrari khohad shud; bisyor vaqt pust zard meshavad.
Kafidani sipurz nogahon ba vuqu mepayvandad. Qismi boloi shikam sakht dard karda, mushakhoi devorai on tarang meshavand, dard tadrijan ba kitfi chap meguzarad. Rangi bemor mekanad, fishori sharayon past mefaroyad. Barobari afzudani alomathoi khunshorii daruni sadama (shok) rukh menamoyad.
V.-ro dar asosi alomathoi saririi khos (bo navbat paydo shudani tablarza, tab va araq, kalon shudan va dard kardani jigaru sipurz, kamkhuni) muqarrar mekunand. Ilova bar in, dar khun oshkor kardani angeza niz zarur ast. Naboyad faromush sokht, ki hangomi khurujhoi avval (1 – 2) miqdori parazitho dar khun kam va oshkor kardani onho dushvor ast. Agar badi se khuruj dar khun angezai marizi yoft nashavad, pas dar gumon ast, ki on bemorii V. boshad. Anduda (mazok) va qatrai kaloni khunro boyad to ogozi muolija girift (khunro az angusht yo varid megirand). Bemoronro hatman dar bemoriston khobondan lozim. Ba onho doruhoi etiotropi (ba sababgori marizi tasirrason) tain karda meshavand.
Bahri peshgirii V. sarivaqt oshkor sokhtanu muolija namudani homiloni angezandaho ahamiyati kalon dorad. Ilova bar in mahv kardani pashshahoi jinsi Anopheles va kirminai onho zarur ast.
Bo maqsadi peshgirii fardi az doruhoi gematoshizotrop (khingamin, fansidar, khinin va g.) istifoda mekunand. Onho 3 – 5 ruz qabl az safar ba mavzei endemi, dar tamomi muhlati on jo budan va 4 – 8 haftai badi bozgashtan, istemol karda meshavand. Istifodai har guna turhoi muhofizi (baroi nagazidani pashshaho) va moddahoi hasharakhuson (reppelentho) niz ravost.
KL
Naqshai sikli hayoti Plasmodium vivax: 1 – az majroi gadudi obi dahon khorij va ba hujayrai jigar vorid shudani takhi- va bradisporozoitho; 2a – trofozoiti boftai; 2b – yadroi gepatosit; 3 – baromadani merozoithoi boftai; 4 – merozoite, ki ba eritrosit dokhil meshavad; 5 – 7 – trofozoitho; 8 – 9 – shizontho; 10 – merozoitho; 11 – 12 – gematosithoi mardona va zanona; 13 – eksflagellyatsiya; 14 – mikrogameta; 15 – makrogameta; 16 – bordorshavi; 17 – zigota; 18 – ookineta; 19 – 21 – oosistaho; 22 – sporozoitho dar gadudi obi dahon; 23 – shizonti boftani takhirnok (gipnozoit).

Ad.: Alekseeva M.I. (va dig.), Klinika, lechenie i khimioprofilaktika malyarii, M., 1983; Tropicheskie bolezni, M., 1989; Mikroskopicheskaya diagnostika malyarii, Kopengagen: VOZ, 2000; Aliev S.A., Epidemiya malyarii v Tadjikistane, D., 2005; Kamardinov H.K., Infeksionnie i parazitarnie bolezni, D., 2009.
H.Q. Qamardinov.