MAHMALAK

MAHMALAK (Scarlatina), skarlatina, bemorii shadidi siroyatist, ki bo tab, gazaki bodomakhoi gulu va damidani donachahoi khurd dar pust padid meoyad. Barangezandai M. streptokokk ast (nig. Bakteriyaho). Beshtar kudakoni 2 – 7-sola M. meshavand. Bemori dar faslhoi tiramohu zimiston avj megirad.
Siroyat az kudaki bemor meguzarad (u baroi atrofiyon dar muddati bemori va hatto chand vaqt badi shifo yoftanash niz khavfnok ast). Hamchunin ashkhose, ki M.-ro bisyor sabuk va nomalum az sar guzaronidaand, manbai siroyat meboshand. Kudak az shakhsi giriftori angina ham siroyat meyobad (bazan odamoni kalonsol ba M. giriftor meshavand va bemorii aksari onho monandi dardi gulu ast). Angezandai M., ki dar qatrahoi balgam va obi dahon vujud dorand, hangomi surfa, atsa zadan va guftugu ba havo, bad tavassuti rohhoi nafas ba organizmi kudaki solim meguzarand. Angezandaho faoliyati khudro der nigoh medorand, az in sabab ashyoi bemor ham manbai siroyat mahsub meyobad.
Streptokokkho aksaran ba organizm az halq, bazan az pusti osebdida va luobpardaho yo shush dokhil meshavand. Streptokokk badi ba luobparda aftodanash dar on meafzoyad va boisi inkishofi gazak megardad. Zahre (toksin), ki streptokokk judo mekunad, ba khun guzashta, boisi beholi, damidani donachaho, illati sistemai asab va dilu ragho meshavad. Dar natijai vokunishi allergii organizm ba toksin (nig. Allergiya) dar haftai 2 – 3-yumi bemori illati bugumho, gurda va dil faro rasidanash mumkin ast. Agar muqobilati organizm sust boshad, streptokokkho metavonand ba khun guzashta, boisi siroyati umumii organizm – ufunat shavand. CHunin navi bemori beshtar dar kudakoni khurdsol (1 – 3-sola) ba mushohida merasad.
Angezandai M. dar organizmi odam muddati 2 – 7 ruz (bazan to 11 ruz) biduni yagon nishonai bemori (davrai nihoni) metavonad vujud doshta boshad. M. nogahon ogoz meyobad; harorati badan to 39 – 400 baland va bemor behol meshavad; gulu (hangomi furubari) dard mekunad, dil behuzur gashta, mariz qay menamoyad. Dar 10 – 12 soati avvali bemori pusti badan toza, khushk va garm ast. Dar halq, kom, zabon surkhii kholchador paydo meshavad. Donachaho dar okhiri shaboruzi yakum yo avvali shaboruzi duyumi bemori avval dar gardan, bayni shonaho va sina paydo shuda, minbad ba tamomi badan pahn megardand. Donachaho makhsusan dar rui dast, pahlu va poyoni shikam bisyor medamand. Rangi donachaho surkh yo gulobi buda, andozaashon ba tukhmi khashkhosh (kuknor) barobar ast; aksar vaqt pust khorish mekunad. Faqat manah va qismi boloi lab betagiyr monda, ba nom sekunjai safedi makhmalaki ba vujud meoyad. Zabon khushk shuda, onro guborpardai safedi zardchatob mepushad (dar ruzi 3-yum on toza va rangash gulobi megardad). Nishonahoi bemori 3 – 5 ruz boqi monda, minbad tadrijan nest meshavand. Dar okhiri haftai yakum yo avvali haftai duyum joi damidai donachaho varaq-varaq pust mepartoyad: avval gardan, narmai gush, minbad nugi angushtoni dastu poy va nihoyat kafi dastu poy. Pustpartoi badi 2 – 3 hafta ba okhir merasad.
M.-i vaznin kam vomekhurad. Jarayoni on beshtar sabuk ast; haror. badan to 37, 1 – 37, 30 baland shuda, 1 – 2 ruz yak khel memonad; bazan bemor tab namekunad. Luobpardai halq qadre surkh meshavad. Donachaho bazur namoyon shuda, chand soat boqi memonand. Kudak khudashro solim his mekunad.
M. bemoriest, ki dar surati sabuk guzashtan ham, ba dil, gurda, asabho va g. bodi noguvor boqi meguzorad. Solhoi okhir binobar tabobati bosamari M. orizahoi noguvori on kam shudaast. Bodi M. beshtar inhoyand: gazaki (bazan rimnok) uqdahoi limfavii gardan va zeri jog – limfadenit, iltihobi gushi miyona – otit, gazaki shush, gazaki gurda – nefrit, illati dil – miokardit, osebi bandu bugumho – sinovit, khuruji jarayoni tarbod.
Bazan dar haftai 3 – 4-umi bemori takror yoftani on (az nav tab barovardan, dardi gulu, damidani donachaho) az ehtimol dur nest. Aksaran in holat ba siroyati takrori vobastagi dorad, zero holo ba M. masuniyat (immunitet) paydo nashudaast. Masalai ba bemorkhona joygir namudani bemorro dukhtur hal mekunad. Agar jarayoni bemori vaznin naboshad, marizro dar khona zeri nazorati dukhtur tabobat kardan mumkin ast.
Hangomi M. (sarfi nazar az shakli on) bistari kardani bemor zarur ast. Agar harorati badan mutadil boshad va mariz khudashro khub his kunad, ba u baroi ba hojatkhona raftan, khesta nishastan ijozat doda meshavad. Minbad bo ijozati dukhtur kudak metavonad dar khona kame roh gardad, bad daroz kashad yo dar bistar nishasta bozi kunad. Tanho dukhtur metavonad baroi kudakro ba tartibi muqarrari guzarondan ijozat dihad, chunki hatto badi mutadil gashtani harorat va nest shudani nishonahoi bemori niz illati silsilai dilu ragho mushohida meshavad. Bemorro dar khonai alohida joygir mekunand yo az bayn parda kashida, joi khobashro judo menamoyand. Hurok boyad ba sinni kudak muvofiq boshad, vale hangomi dardi gulu dar ruzhoi avval istemoli gizoi naboti va shiri matlub ast. Ba kudak ruze 5 – 6 marotiba dar soathoi muayyan khurok mekhuronand. Dukhtur bo mururi shifoi kudak ba u muvofiqi sinnu sol ba istisnoi khuroki tundu tez va gushtobi sergizo parhez tain mekunad. Ba kudak zud-zud limuchoy, afshurai sabzavotu meva dodan zarur ast. Mebel va jihozi khonai bemorro ruze du marotiba bo lattai nam pok karda, farshi onro bo lattae, ki ba mahluli khloramin tar karda shudaast, meshuyand. Mebeli narm va qolinro az khonai kudaki bemor barovardan yo har ruz bo changkashak toza kardan mufid ast. Honaro shamol dodan lozim. Dar havoi garm tirezai khona boyad doimo kushoda boshad; dar sarmo bodkhoni khonaro badi har du soat 15 – 20 daq. kushoda memonand. Kudak boyad kosavu tabaq, sarulibos va bozichahoi alohida doshta boshad. Kosavu tabaqi kudakro judo shusta, bad mejushonand. Sarulibos, joypush, sachoq va ruymolchai bemorro jushondan hatmist. Parastori bemor boyad dar tan khilat yo kurtai makhsus doshta boshad, ba dahonu bini bandinai dokagi (3 – 4 qabat) bandad. Badi az nazdi bemor baromadan, dastro bo sobun shusta, khilatro mekashand (onro har ruz darzmol mekunand).
Hamin ki tabi kudak mutadil gasht, u metavonad bo ijozati dukhtur obbozi kunad. Kudakoni khurdsolro har ruz yo ruz dar miyon dar obi haror. 380 (10 daq.), kudakoni kalonro badi 3 – 5 ruz (dar vaqti pustpartoi badi 1 – 2 ruz) obbozi medorand (badanro bo dastmol nameshakand). Kudakon boyad dahonashonro muntazam bo mahluli sodai khuroki (yak qoshuqcha ba yak istakon ob) mazmaza kunand. Dukhtur qati nazar az darajai vazninii bemori baroi tabobat va peshgirii orizai M. doru tain mekunad. Doruro hatman dar hamon voya va soati tainkardai dukhtur dodan lozim ast. Agar tabi kudak mutadil va ahvolash behtar shavad, ba hej vajh tabobatro qat kardan lozim nest. Hamai masalahoi nigohubin va tabobati kudakro bo dukhtur hal boyad kard.
Har bemor boyad ba bemorkhona khobonda yo dar khona judo nigoh doshta shavad. Ba bemor yak-du nafar nigohubin mekunad. Marizro 10 ruz judo nigoh doshtan lozim ast. Kudakoni sinni tomaktabi va talabagoni sinfhoi 1– 2 faqat badi 12 ruzi az bemorkhona javob shudan yo dar khona judo nigoh doshtan, yane badi 22 ruzi ogozi bemori, ba muassisahoi bachagona yo maktab roh doda meshavand. Kudakoni solim va bo mariz tamosdoshtaro dar muddati 7 ruzi judo nigoh doshtani bemor ba muassisai bachagona va maktab roh namedihand. Ba kudakoni az 8-sola bolo, inchunin ba kormandoni muassisahoi bachagona dar muddati 7 ruz muoinai tibbi muayyan karda khohad shud.
Dar surati dard kardani gului odami kalonsol kudakro az u judo nigoh doshtan lozim ast. Zero bazan sababi chunin guludard M. buda, boisi ba on giriftor shudani kudak megardad.
Ad.: Detskie bolezni: noveyshiy spravochnik, SPb., 2004; Detskie infeksii, M., 2005; Saveleva YU., Detskie bolezni, M., 2005.
N. A. Rahmatov.