Nsusu ọnụ (Triatomine) Ata, Akara Ọrịa Romana Chagas, na Tsetse Fly ma ọ bụ Sandfly Leishmaniasis Post-Exposure¶

N'ofe America, Africa, Southern Europe, Middle East, na Eshia, ụmụ ahụhụ na-eri ọbara atọ dị iche iche na-ebufe nje nje protozoan nke na-emepụta akpụkpọ anụ ma ọ bụ nkuchianaya anya tupu ha abanye n'ime obi, ụbụrụ, ma ọ bụ ụmị ọkpụkpụ: ** Triatomine nocturnal "Kissing Bugs" *** (* Triatomaus n'ofe Latin America * na Plus St. Ndịda ọkara nke United States), ** Africa Tsetse ijiji ** (* Glossina * ụdị gafee Sub-Saharan Africa), na ** Phlebotomine Sandflies ** (* Lutzomya * na America na * Phlebotomus * gafee Mediterranean, Middle East, Africa, na South Asia). N'adịghị ka ijiji Tsetse ma ọ bụ anwụnta nke na-agbanye nje nje ozugbo site na proboscis salivary ya n'oge a na-ata ahụhụ, ** Kissing Bug anaghị ebufe Trypanosoma cruzi (ihe kpatara ọrịa Chagas) site na mmiri na-ata**. Kama nke ahụ, ahụhụ ahụ na-eri ihu onye na-ehi ụra n'abalị na ** na-ekpochapụ nsị mmiri na-ejupụta na metacyclic trypomastigotes na-efe efe na akpụkpọ ahụ . Mgbe onye na-arahụ ụra na-eteta na ** na-ehicha ma ọ bụ na-akpụ aru na-egbuke egbuke , ha na-ehichapụ nsị ahụhụ ozugbo n'ime ntanye, egbugbere ọnụ, ma ọ bụ conjunctiva nke anya, na-ebute ma ọ bụ ** nku anya na-egbuke egbuke na-enweghị ihe mgbu (akara Romana) ma ọ bụ ihe na-eme ka akpụkpọ anụ ahụ na-emepe emepe ruo izu abụọ. N'ihi na ** nnukwu ọrịa Chagas dị pasent 80 ruo 99 nwere ike ịgwọ ya na usoro ọnụ ụbọchị 60 nke Benznidazole ma ọ bụ Nifurtimox ** ma ọ bụrụ na ejide ya n'oge nnukwu oge, tupu Chagas cardiomyopathy ma ọ bụ megacolon na-adịghị ala ala amalite, mmetọ ozugbo na-enweghị nhicha na ijide ahụhụ maka ule PCR bụ ihe dị mkpa ngwa ngwa. N'otu oge, ndị njem ga-amata ọdịiche na-acha uhie uhie na-egbu mgbu Tsetse ijiji bite chancre (Trypanosoma brucei rhodesiense / gambiense, ọrịa ihi ụra nke Africa) na nke na-eto ngwa ngwa, na-enweghị mgbu Sandfly mgbawa ugwu ọnya ( Leishmania, akpụkpọ anụ ma ọ bụ mucocutaneous leishmaniasis). Ọ bụrụ na mmadụ enwee ahụ ọkụ dị elu, isi ọwụwa siri ike, ọzịza ihu/ nkuchi anya, mgbu obi, ma ọ bụ mmeghachi ahụ nfụkasị na-emechi akpịrị ma ọ tachaa ahụhụ, kpọọ mpaghara gị. nọmba mberede ozugbo. Nyochaakwa ntuziaka ụmụnna anyị na mmeghachi omume nfụkasị na anaphylaxis, anu na usi, na akọrọ na ududo taa.

Ihe kacha gị mkpa ozugbo ị chọpụta ihe a na-enyo enyo ** Kissing Bug *** n'ihu gị, akwa gị, ma ọ bụ akpụkpọ ahụ gị bụ ** MMADỊGHỊ ehichapụ, kpụchaa, ma ọ bụ gwerie ahụhụ ahụ n'akpụkpọ ahụ gị **, jiri ** ncha na mmiri na-agba ọsọ saa akpụkpọ ahụ ozugbo (ma ọ bụ were saline na-adịghị mma) wepụ ihe ọ bụla Trypanosoma cruzi - nsị butere tupu ha abanye n'ime oghere plastik. akpa *** maka ngalaba ahụike steeti ma ọ bụ nyocha CDC PCR, wee lelee akara ** Romana (ọzịza nkuku anya na-enweghị otu akụkụ), chagoma akpụkpọ ahụ, ma ọ bụ ahụ ọkụ n'ime ụbọchị 7 ruo 30 na-esote *** yabụ ọgwụgwọ antiparasitic n'oge nwere ike ịmalite.

Mee nke a ugbu a¶

1. Ejila anya gị, kpụchaa ọtịta ahụ, ma ọ bụ tia/akụpịa ahụhụ nsusu ọnụ ozugbo n'akpụkpọ ahụ gị. Trypanosoma cruzi nje nje na-ebi naanị na Kissing Bug's hindgut and liquid feces, ọ dịghị mgbe ọ dị n'ime gland salivary ya. Ịkụpịa ahụhụ ahụ n'ihu gị ma ọ bụ na-ehicha aru na-egbuke egbuke na-eme ka ọtụtụ nde nje nje ndị na-agagharị agagharị na-abanye ozugbo n'ime nhụsianya a na-ahụ anya ma ọ bụ n'ofe mucous nke anya na ọnụ gị.
2. ** Ozugbo ahụ, saa ebe a na-ata ahụhụ na akpụkpọ ahụ gbara ya gburugburu nke ọma na ncha dị nro na mmiri na-agba ọsọ dị ọcha (ma ọ bụ gbanye anya ya na saline na-adịghị mma maka nkeji 10 ma ọ bụrụ na nso nkuchianaya).
3. ** Ihuenyo ozugbo maka Kissing Bug salivary anaphylaxis wee kpọọ nọmba mberede mpaghara gị ma ọ dị.** Kpọọ 911 na United States, Canada, na Mexico, 192 na Brazil, 112 gafee European Union, ma ọ bụ lelee akwụkwọ ndekọ aha zuru ụwa ọnụ nke anyị. nọmba mberede. N'ebe ndịda ọdịda anyanwụ na ndịda United States (* Triatoma protracta *, * Triatoma rubida , * Triatoma sanguisuga), Kissing Bug saliva bụ ihe na-ebute ụzọ na-akpata ujo anaphylactic nke IgE na-eme n'abalị **: ndị a na-eteta n'abalị na-enwe o nfụkasị ahụ, ọzịza akpịrị, na-afụ ụfụ, na syncopein na-eme ihe na-eme ngwa ngwa. (EpiPen)**.
4. Weghara ahụhụ Kissing ahụ n'enweghị nsogbu ọ bụla (tụgharịa ite ma ọ bụ iko rọba n'elu ya, sụọ akwụkwọ siri ike n'okpuru, ma mechie ya n'ime akpa nwere mmanya mmanya 70% ma ọ bụ ifriizi ya). Nyefee ihe nlele ahụ site n'aka dibịa gị ma ọ bụ ngalaba ahụike ọha na mpaghara maka ** njirimara entomological na Trypanosoma cruzi PCR, wee saa akwa akwa niile emetọọ na mmiri ọkụ.
5. ** Nyochaa ebe a na-ata ahụhụ kwa ụbọchị maka izu 4 wee chọọ nyocha ọrịa ozugbo (ọbara smear + T. cruzi PCR) ma ọ bụrụ na ị na-ebute akara Romana, chagoma, ma ọ bụ ahụ ọkụ na-akọwaghị.* nodule (chagoma) ma ọ bụ ahụ ọkụ ogologo oge na-apụta ụbọchị 5 ruo 30 ka ekpughere ya, malite ** ọnụ Benznidazole ma ọ bụ Nifurtimox ** ozugbo ọnụ ọgụgụ ọgwụgwọ na-erute pasent 90 ruo 100.
6. ** Ọ bụrụ na ijiji Tsetse ata ya na Sub-Saharan Africa ma ọ bụ n'ebe okpomọkụ / Mediterenian site na Sandfly, see foto na dee ọnya ahụ na nyochaa maka ọkọlọtọ uhie na-acha uhie uhie kpọmkwem.* ** nnukwu ọnọdụ ahụike mberede (Trypanosoma brucei rhodesiense)** chọrọ smear ọbara n'ụlọ ọgwụ ozugbo; papule na-adịghị ahụ mgbu nke ji nwayọọ nwayọọ na-abanye n'ime oke "oke mgbawa ugwu" izu 2 ruo 8 ka atachara ájá ájá** chọrọ biopsy/PCR dermatology maka Leishmaniasis.

Osisi mkpebi: Kissing Bug vs Tsetse Fly vs Sandfly bite triage na nlekọta mkpughe gachara.¶

flowchart TD
    A["Vector a na-enyo enyo ma ọ bụ ọnya oyi na-ahụ anya"] --> B{"Gịnị bụ ọnọdụ mkpughe na mmetụta ata?"}
    B -->|Americas / Southern US: Painless nighttime bite on face/arm indoors; flat cone-nosed bug with striped border| C["Ahụhụ Kissing (Triatomine) Nkpughe: Trypanosoma cruzi Risk + Salivary Anaphylaxis Risk"]
    B -->|Sub-Saharan Africa Safari / Bush: Sharp painful daytime bite by large brownish fly with crossed wings| D["Tsetse Fly (Glossina) Ata: Trypanosomiasis Afrika (ọrịa ụra) ihe ize ndụ"]
    B -->|Tropics / Mediterranean / Middle East: Tiny 2-mm hairy golden fly with V-wings at dusk; painless or stinging papule| E["Phlebotomine Sandfly Ata: Ihe ize ndụ Leishmaniasis"]
    C --> F{"Enwere hives ozugbo, ọzịza egbugbere ọnụ/akpịrị, iku ume, ma ọ bụ dizziness na iteta?"}
    F -->|Yes: Nocturnal Triatomine Salivary Anaphylaxis| G["Kpọọ 911 / Nọmba Mberede UGBUA; gbanye IM Epinephrine 0.3 mg n'ime apata ụkwụ"]
    F -->|No: Local bite or bug found in bed| H["ADỊGHỊ ete anya ma ọ bụ ọkọ ata; jiri ncha na mmiri saa anụ ahụ ma ọ bụ were saline hichaa anya; jide ahụhụ n'ime ite ejiri akara"]
    H --> I{"N'ime ụbọchị 5 ruo 30: nkukuanya na-acha odo odo na-enweghị mgbu na-enweghị mgbu (akara Romana), chagoma akpụkpọ, ma ọ bụ ahụ ọkụ?"}
    I -->|Yes: Acute Chagas Disease| J["Ụlọ ọgwụ ozugbo / Ọrụ ID: ọbara dum T. cruzi PCR + ọbara smear + ECG -> Malite ụbọchị 60 Oral Benznidazole ma ọ bụ Nifurtimox"]
    I -->|No symptoms| K["Nyefee ahụhụ weghaara maka PCR; mee ntọala na 6-to-8 izu T. cruzi IgG serology & PCR ma ọ bụrụ na ahụhụ dị mma."]
    D --> L{"Na ụbọchị 5 ruo 15: nodule na-acha uhie uhie na-egbu mgbu (Tsetse Chancre) + oke ahụ ọkụ, isi ọwụwa, ma ọ bụ ọnụ olu?"}
    L -->|Yes: Acute Human African Trypanosomiasis| M["Mbanye ụlọ ọgwụ mberede: Chancre aspirate & Giemsa blood smear + Lumbar puncture -> Oral Fexinidazole ma ọ bụ IV Suramin/NECT"]
    E --> N{"Na izu 2 ruo 12: papule na-enweghị mgbu na-abawanye n'ime ọnya ọnya na-adịghị agwọ ọrịa nke nwere oke 'volcanic' dị elu?"}
    N -->|Yes: Cutaneous or Mucocutaneous Leishmaniasis| O["Adịla afanyekwa ma ọ bụ bee dị ka a otutu nje; Punch biopsy/nyocha site na oke ọnya dị elu maka Leishmania PCR + Miltefosine/Amphotericin"]

ntụnyere isi na isi: Kissing Bug (Chagas) vs Tsetse Fly (Sleeping Sickness) vs Sandfly (Leishmaniasis)¶

N'ihi na ndị njem, ndị bi n'ime ime obodo, na ndị na-ahụ maka ụlọ ọgwụ na-emekarị mgbagwoju anya atọ ndị a protozoan vector syndromes, ọdịiche dị n'akụkụ n'akụkụ dị oke mkpa:

Nchichi isusu ọnụ (Triatomines), Akara Romana, na Ọrịa Chagas siri ike¶

1. Ihe kpatara nri na-esi na-eri nri na mkpochapụ ahụhụ nke Kissing Bug ji ekpebi ọrịa¶

Triatomine chinchi (Triatoma infestans, Rhodnius prolixus,* Panstrongylus megistus*, Triatoma dimidiata na Latin America; na Triatoma sanguisuga, Triatoma gerstaeckeri, Triatoma protracta, na Triatoma protracta, na Triatoma dimidiata na-ezo n'elu ụlọ nke United States n'ụbọchị. ụlọ nkịta, ikpo nkụ, na n'okpuru matraasi, na-apụta n'abalị nke carbon dioxide (CO2) na okpomọkụ na-adọta. - ** Ihe mere e ji kpọọ ha "Nchichi Kissing" (* Barbeiros * na Brazil, * Vinchucas * na Andes, * Chinches Besuconas * na Mexico):** N'ihi na mmadụ na-ehi ụra na-edobe ọkpụkpụ ya na ụkwụ ya n'okpuru blanketị, ahụhụ ahụ na-abanye n'ihu ** ihu, cheeks, egbugbere ọnụ na nku anya *** iji rie nri. - Nri ọbara nkeji iri na ise ruo nkeji iri atọ na-enweghị mgbu:** ahụhụ ahụ na-ekpughe rostrum nke nwere akụkụ atọ (proboscis) na ịgba mmiri nwere nitrophorins (vasodilators), apyrases (platelet inhibitors), na anestetiiki mpaghara . Ebe ọ bụ na ata ya enweghị mgbu, onye na-arahụ ụra anaghị eteta ebe ahụhụ na-eri ihe karịrị nkeji iri na ise ruo iri atọ. - ** Ọnyà nnyefe fecal: Ka afọ ahụhụ ahụ na-aza (karịsịa na vectors na-ekpochapụ ngwa ngwa dị ka Triatom infestans na Rhodnius prolixus), ọ ** na-ekpochapụ eriri mmiri gbara ọchịchịrị nke nsị ozugbo na ntì ma ọ bụ nku anya mmadụ *** tupu ọ pụọ. - Eziokwu Pathophysiological isi: Akpụkpọ anụ mmadụ agbajighị agbaji bụ ihe mgbochi na Trypanosoma cruzi metacyclic trypomastigotes ** enweghị ike ịbanye n'onwe ha. Ọrịa na-apụta ** naanị *** mgbe onye na-arahụ ụra n'amaghị ama ** na-ete ma ọ bụ kpụchaa ata ahụ** (na-ehichapụ eriri afọ n'ime obere ọnya ọnya ma ọ bụ akpụkpọ ahụ kpụpụrụ) MA ọ bụ ** na-ehichapụ eriri afọ n'ofe akpụkpọ ahụ mucous nke conjunctiva (anya) ma ọ bụ mucosa ọnụ (egbugbere ọnụ)**.

================================================================================
   HOW KISSING BUGS TRANSMIT TRYPANOSOMA CRUZI & WHY YOU MUST NEVER RUB
================================================================================

  [1. Nighttime Blood Meal]             [2. The Rubbing Trap (Romana's Sign)]
  -------------------------             -------------------------------------
   Kissing Bug feeds on cheek/eyelid     Sleeper wakes up -> Rubs itchy face
   for 15-30 min (Painless saliva).               |
          |                                       v
          v                              Hand wipes liquid bug feces into:
   Bug defecates liquid droplet          * Eye Conjunctiva -> ROMANA'S SIGN
   of T. cruzi trypomastigotes             (Unilateral painless purple swollen
   NEXT to the bite puncture.               upper & lower eyelids at Day 7-14)
                                         * Bite Puncture   -> SKIN CHAGOMA
  --> STOP TRANSMISSION NOW: Wash with soap & water or saline WITHOUT rubbing
================================================================================

2. Ịghọta akara Romana vs a bacteria Stye ma ọ bụ Periorbital Cellulitis¶

N'etiti 5 na 14 ụbọchị ** mgbe * T. cruzi * fecal trypomastigotes na-akpọtụrụ conjunctiva nke otu anya, onye ọrịa na-etolite akara ngosi nke nnukwu ọrịa Chagas anya, ** akara Romana ** (nke Cecilio Romaña kọwara na 1935): - ** Akụkụ ụlọ ọgwụ nke akara Romana: *** 1. ** Naanị otu anya (naanị otu anya): Na-emetụta naanị anya emeru. 2. ** Na-enweghị ihe mgbu, Violaceous (Purple-Pink) Bipalpebral Edema: ** Ma nku anya elu na nke ala na-aza nke ọma, na-emechikarị fissure palpebral, na-ejisi ike, nke na-adịghị mma, ** red-violet discoloration , ma n'adịghị ka abscess nje ma ọ bụ orbital cellulitis na-adịghị emetụ n'ahụ na-enweghị ihe ọ bụla. agba odo. 3. ** Conjunctivitis, Dacryoadenitis, na Preauricular Node:** Ọzịza nke ipsilateral lacrimal (akwa) gland na a na-ahụ anya gbasaa, siri ike ** preauricular ma ọ bụ submandibular lymph node ** n'otu akụkụ nke ihu. 4. ** Ogologo oge na Ọganihu Sistemu: ** Akara Romana na-adịgide ruo izu 2 ruo 4 ** n'agbanyeghị na anya ọgwụ nje na-adaba ma ọ bụ antihistamines, na-esonyere ** ogologo obere ọkwa dị ala ma ọ bụ ahụ ọkụ na-efe efe, malaise, lymphadenopathy generalized, na hepatosplenomegaly dị nro.

3. Inweta ahụhụ ahụ, Nnwale nyocha, yana ọgwụgwọ Antiparasitic nke ụbọchị 60.¶

1. ** Otu esi ejide ma nyefee ahụhụ nsusu ọnụ n'enweghị nsogbu:**
2. Ejila mkpịsị aka efu emetụ ahụhụ ahụ **** Yiri gloves enwere ike iwepụ ma ọ bụ tụgharịa ite iko n'elu ahụhụ ahụ, gbanye kaadị n'okpuru, ma mechie mkpuchi.
3. Leba anya nke ọma na ** isi na proboscis **: chinchi na-enye akwụkwọ nri nwere ụkwụ ụkwụ sara mbara yana ogologo proboscis gbachiri agbagọ, ebe anụ ọhịa ** egbu egbu ahụhụ / nchigharị wheel ** nwere nnukwu raptor dị ka proboscis ma ghara ** ebu * T. cruzi; ezi ** Triatomine Kissing Bugs *** nwere ** ogologo, dị gịrịgịrị, isi cone nwere ogologo ogologo, proboscis dị gịrịgịrị dabara adaba n'okpuru thorax *** yana akara oroma/acha uhie uhie/edo edo n'akụkụ nsọtụ afọ.
4. Nyefee ahụhụ ahụ site na ** State Department of Health, mmemme ndọtị mahadum, ma ọ bụ CDC Division of Parasitic Diseases and Malaria (DPDM)** maka Nnwale PCR maka Trypanosoma cruzi DNA (n'ofe ndịda US, ** 30 ruo 55 percent of wild Kissing Bugs test positive for T. cruzi**).
5. ** Nchọpụta ụlọ nyocha n'ime onye ọrịa ahụ ekpughere:**
6. ** N'oge nnukwu windo (izu 1 ruo 8 mgbe mkpughe gachara, ma ọ bụ mgbe akara Romana / ahụ ọkụ dị):** Serology (ọgwụ mgbochi IgG) na-adịkarị njọ n'oge. Nnwale ọkọlọtọ ọla edo bụ ** Ọbara dum *Trypanosoma cruzi * PCR oge dị adị ** NA ** nyocha microscopic nke ọbara ọhụrụ anticoagulated (mkpụrụ mmiri mmiri maka motile trypomastigotes) na ọbara Giemsa nwere nnukwu ma dị gịrịgịrị smears.
7. ** Mgbe izu 6 ruo 8 gachara (nyocha nyocha / enweghị njedebe):** Nye iwu ** abụọ dị iche * T. cruzi * IgG serologic tests na-eji iche iche antigen preparations ** (ELISA gbakwunyere immunoblot ma ọ bụ IFA) iji gosi ma ọ bụ wepụ seroconversion, n'akụkụ a ** baseline 12-lead ECG ** (nyocha maka RBBB, LAFB, ma ọ bụ PR prolongation).
8. ** Ọgwụgwọ Antiparasitic doro anya (Benznidazole na Nifurtimox):**
9. Ma Benznidazole na Nifurtimox (Lampit) bụ FDA-akwadoro na United States wee depụta ya na ** World Health Organisation (WHO)**:
   • **Benznidazole (Akara mbụ): ** 5 ruo 7.5 mg / kg / ụbọchị na-ekewa ọnụ n'ime 2 doses kwa ụbọchị maka ụbọchị 60 ** (ruo 8 ruo 10 mg / kg / ụbọchị na ndị ọrịa ụmụaka). Nyochaa maka ihe ọkụ ọkụ, neuropathy akụkụ, yana CBC/imeju enzymes.
   • Nifurtimox: ** 8 ruo 10 mg / kg / ụbọchị ọnụ na-ekewa n'ime usoro 3 kwa ụbọchị yana nri maka ụbọchị 60 ** na ndị okenye (10 ruo 20 mg / kg / ụbọchị n'ime ụmụaka).

Ijiji Tsetse Africa (* Glossina*) Ata na ụmụ mmadụ Trypanosomiasis (ọrịa ụra)¶

1. Ịmata ijiji Tsetse na Chancre Trypanosomal¶

Ndị njem na safaris anụ ọhịa dị na East na South Africa (Serengeti, Ngorongoro, Masai Mara, Luangwa Valley, Zambezi, Okavango) ma ọ bụ na-arụ ọrụ na mpaghara osimiri nke Central na West Africa (Democratic Republic of the Congo, Central African Republic, Angola, South Sudan) na-ezutekarị ** Tsetse iji ** (* Glossina ). - ** Gịnị kpatara DEET naanị anaghị akwụsị ijiji Tsetse:* ijiji Tsetse buru ibu (8 ruo 15 mm), ngwa ngwa ehihie na-akụ nku nwere nku na-agafe agafe nke ** na-adọrọ mmasị na ụgbọ ala safari na-akpụ akpụ, uzuzu uzuzu, na akwa na-acha anụnụ anụnụ ma ọ bụ akwa ojii , na enweghị mmetụta na-enweghị isi maka ọkọlọtọ DEET. Ha bayonet dị ka proboscis na-adụpu uwe elu khaki, sọks, na jeans denim, na-eme ka ụta dị nkọ, na-egbu mgbu nke na-adọta ntaba ọbara. - The Trypanosomal Chancre (Ụbọchị 5 ruo 15 Post-Bite): - Ọ bụ ezie na ihe karịrị 99% nke ijiji tsetse na-adịghị efe efe, ata sitere na ijiji na-ebu Trypanosoma brucei rhodesiense (East African), na-adịkarịghị Trypanosoma brucei gambiense (West/Central African), na-etolite pathognomonic Trypanosomal na-esote ụbọchị 5: - ** Ọdịdị: Ihe siri ike, na-ekpo ọkụ, dị nro, nke gbara gburugburu ** nodule na-acha uhie uhie na-violaceous ma ọ bụ plaque dị ihe dị ka sentimita 2 ruo 5 n'ofe, nke ọnya etiti ma ọ bụ eschar ojii gbachie ya ma nwee erythematous halo gbara ya gburugburu, na-esonyere ya na nnukwu ọnụ lymph mpaghara. - ** Gịnị kpatara T. b. rhodesiense bụ ihe mberede ahụike:* - N'ime izu 1 ruo 3 nke aru ahụ**, onye ọrịa na-agbawa na ** ahụ ọkụ dị elu, mgbakasị ahụ, isi ọwụwa siri ike, myalgias, oke ọkụ ọkụ (trypanids), thrombocytopenia, nnukwu myocarditis, na mbuso agha CNS , nke bụ ** 100% na-egbu egbu n'ime izu ruo ọnwa ole na ole ma ọ bụrụ na achọpụtara ya dị ka ọrịa ịba. - ** Usoro ụlọ ọgwụ ozugbo: Onye njem ọ bụla si Sub-Saharan Africa na-alọta nwere nodule anụ ahụ na-acha uhie uhie na-adịgide adịgide (chancre) na ahụ ọkụ chọrọ ** nnabata ụlọ ọgwụ otu ụbọchị **, ** nyocha microscopic nke mmiri sitere na oke chancre gbakwunyere Giemsa nwere ntụpọ ọbara dị gịrịgịrị ma dị gịrịgịrị smears ** NS, ** CSmbar na nyocha ozugbo. ọgwụgwọ na ** ọnụ Fexinidazole ** ma ọ bụ ** IV Suramin / Melarsoprol / Pentamidine / NECT **.

Phlebotomine Sandfly Ata na Cutaneous ma ọ bụ Mucocutaneous Leishmaniasis¶

1. Ịmata Ulcer "Volcanic Crater" nke na-adaba ọgwụ nje bacteria.¶

N'ofe ebe okpomọkụ Latin America, basin Mediterranean, Middle East, North / East Africa, na South / Central Asia, obere abalị ** Phlebotomine sandflies ** (* Lutzomyia * na * Phlebotomus * ụdị, naanị 2 millimeters n'ogologo) na-ebufe intracellular *** Leishmania * nje nje protozoan. - ** Ihe dị ka izu 2 ruo 8 ** mgbe ọ lọtara site na njem mmiri ozuzo, mbugharị ndị agha, ma ọ bụ ezumike Mediterranean, obere aja aja na-acha uhie uhie na-acha uhie uhie na ụkwụ ala ekpughere, ọkpọ ọkpọ, ntị, ma ọ bụ ihu ** jụrụ ịgwọ . Kama idozi n'ime otu izu dị ka anwụnta anwụnta, ọ na-eji nwayọọ nwayọọ na-abawanye n'ime ọnyá ** 1 ruo 5 centimita nke nwere ebe dị ọcha ma ọ bụ crusted granulating center na nnukwu, nke dị elu, nke a na-agbagharị agbagharị na-acha odo odo (dị ka mgbawa ugwu mgbawa) nke na-enweghị ihe mgbu na-enweghị mgbu ma ọ bụrụ na ọ butere ọrịa nke abụọ. - ** Gịnị kpatara mbepụ & igbapu na Cephalexin dara:** Ndị dọkịta na-enyochakarị leishmaniasis nke akpụkpọ dị ka obụpde staph ma ọ bụ udide ududo, na-edepụta cephalexin ma ọ bụ na-eme mbepụ na drainage, nke ** na-akawanye njọ anụ ahụ na-enweghị imetụ eriri afọ * Leishmania* amastigotes. - ** Ihe egwu mucocutaneous dị na ụwa ọhụrụ (Viannia) ụdị:** Ọ bụrụ na enwetara ọrịa ahụ na Central ma ọ bụ South America site na **Leishmania (Viannia) braziliensis , * L. panamensis, ma ọ bụ L. guyanensis , nje nje nwere ike gbasaa site na ọnya anụ ahụ gaa na ** imi septum, palate, pharynx, na larynx ọnwa ruo ọtụtụ afọ ka e mesịrị (* mucocutaneous leishmaniasis / * espundia ), na-emebi cartilage imi na-eme ka ikuku ma ọ bụ nkwụsịtụ ma ọ bụrụ na a naghị agwọ ya n'usoro. - ** Usoro nyocha na ọgwụgwọ: *** - Rụtụ aka na ọrịa na-efe efe ma ọ bụ ọkachamara na-ahụ maka ebe okpomọkụ maka ** 3- ruo 4-mm punch biopsy, dermal scraping, ma ọ bụ ezigbo agịga nke ewepụtara ozugbo site na arụ ọrụ, welitere oke ọnya ọnya *** (ọ dịghị mgbe biopsy naanị necrotic center). - Zipu anụ ahụ maka ** ụdị-kpọmkwem * Leishmania * PCR ** (chọrọ ịmata ọdịiche dị n'ụdị New World * Viannia * nke chọrọ usoro ọgwụgwọ usoro sitere na ụdị ụwa ochie), ** Giemsa histopathology ** (na-achọ anụ ahụ intracellular ** Leishman-Donovan ahụ [amastigotes] *** n'ime macrophages), na omenala ** NVN-Nico. - Na-emeso dị ka ụdị na ọdịdị ala na ** ọnụ Miltefosine (Impavido, 50 mg PO ugboro atọ kwa ụbọchị maka ụbọchị 28), IV Liposomal Amphotericin B (AmBisome), ma ọ bụ ** pentavalent antimonials ma ọ bụ mpaghara thermotherapy maka mgbagwoju anya Old World * L. nnukwu ọnya.

Nọmba mberede mpaghara na ụkpụrụ ụlọ ọrụ¶

• United States na Canada:
• Kpọọ 911 maka anaphylaxis Kissing Kissing nke abalị, nnukwu myocarditis, ma ọ bụ ọrịa ajọ ahụ ọkụ ka emechara njem.
• Kpọtụrụ ** CDC Parasitic Diseases Hotline na +1-404-718-4745** ma ọ bụ CDC Emergency Operations Center na +1-770-488-7100 maka ndụmọdụ dọkịta na Blood dum Trypanosoma cruzi PCR, Leishmania, antiparasiazole, PCR Nifurtimox, Fexinidazole, Suramin, Miltefosine*
• Na **Texas, Arizona, California, Louisiana, na Gulf of Mexico states *, nyefee chinchi Kissing ejidere site na State Department of Health gị ma ọ bụ ** Texas A&M University Kissing Bug Research Lab.
• Latin America (Brazil, Mexico, Argentina, Bolivia, Colombia, Peru):
• Kpọọ 192 (SAMU) na Brazil, 911 na Mexico na Argentina, 123 na Colombia, ma ọ bụ 106 na Peru.
• Soro PAHO na Ministério da Saúde do Brasil Doença de Chagas Aguda ntụzịaka: mkpesa ozugbo maka nnukwu Chagas ọ bụla a na-enyo enyo, microscopy ọbara dịpụrụ adịpụ, yana inye n'efu nke ụbọchị 60 Benznidazole.
• United Kingdom: Kpọọ 999******************************************** ma ọ bụ NHS 111, ma ziga ndị njem na-alọta nwere ihe a na-enyo enyo bụ Tsetse chancre, akara Romana, ma ọ bụ ọnya Leishmania na ** Hospitallọ Ọgwụ maka Ọrịa Okpomọkụ (London)** ma ọ bụ Liverpool School of Tropical Medicine.
• European Union: Kpọọ 112. Tụtụ aka na ndị njem na-alọghachi na ebe a na-ahụ maka ọgwụ okpomọkụ nke mba wee jikọta ya na ** WHO Headquarters (Geneva)** maka mwepụta mberede nke Fexinidazole, Suramin, ma ọ bụ NECT.
• ** Sub-Saharan Africa:** Kpọọ 112 / 999 ma ọ bụ 10177 (South Africa) na kọntaktị AMREF Flying Doctors (+254 20 699 2299) na Nairobi ma ọ bụ National Ministry of Health Trypanosomiasis Control Programs maka ozugbo smear smearazole na /Feamin.

Ajụjụ a na-ajụkarị¶

Otu ahụhụ Kissing na-agbanye ọrịa Chagas ozugbo site na aru ya dị ka anwụnta na-agbaba ịba?¶

Ee e. N'adịghị ka anwụnta ma ọ bụ tsetse ijiji, nje nje Trypanosoma cruzi nke na-akpata ọrịa Chagas adịghị ebi n'ime gland salivary Kissing Bug, ọ dịghịkwa mgbe ọ bụla a na-ata ya n'onwe ya gbanye ya. Kama nke ahụ, nje nje ahụ na-ebi na hindgut nke ahụhụ ahụ ma na-ebufe ya na nsị mmiri mmiri nke ahụhụ ahụ na-esi n'ahụ ahụ ma ọ bụ obere oge ka ọ richara nri n'abalị. Naanị ị na-ebute ọrịa ahụ ma ọ bụrụ na ị na-ehicha ma ọ bụ kpachapụta ata ahụ na-egbu mgbu, nke na-ehichapụ nsị nke ahụhụ ahụ ozugbo n'ime obere nsị ma ọ bụ n'ofe akpụkpọ anụ mucous nke anya gị (conjunctiva) ma ọ bụ ọnụ gị.

Kedu ihe bụ akara Romana, kedu ka m ga-esi ama ya ma e wezụga ịta ahụhụ pinkeye ma ọ bụ ahụhụ na nkuchianaya?¶

Akara Romana bụ akara ịdọ aka na ntị mbụ nke nnukwu ọrịa Chagas nke na-apụta ụbọchị 5 ruo 14 ka a na-etesa nsị nsusu ọnụ nke Trypanosoma cruzi n'ime otu anya. N'adịghị ka anwụnta na-ata na nkuchianaya (nke na-aza ozugbo, itching nke ukwuu, ma na-ada n'ime ụbọchị 2 ruo 3) ma ọ bụ nje pinkeye (nke na-emetụta anya abụọ na-acha odo odo), ihe ịrịba ama Romana bụ nke nwere otu akụkụ, na-amalite 1 ruo 2 izu mgbe ikpughe, na-akpata ike, enweghị mgbu, odo odo-pink anya nke ma elu na nke ala anya bụ ọzịza nke elu na nke ala anya. ọnụ ọnụ lymph fụrụ akpụ n'ihu ntị na ahụ ọkụ na-adịru ọtụtụ izu.

Kedu ihe m ga-eme ma ọ bụrụ na ahụtara m ahụhụ nsusu ọnụ n'ihe ndina m ma ọ bụ n'akpụkpọ ahụ m?¶

Nke mbụ, ehichapụla anya gị ma ọ bụ kpachie ahụ gị ozugbo, were ncha na mmiri na-asọ asọ saa akpụkpọ ahụ ozugbo (ma ọ bụ were saline na-adịghị mma were anya na-ekpochapụ anya) iji wepụ ụmụ irighiri mmiri ọ bụla na-ahụ anya tupu nje nje abanye n'ime akpụkpọ ahụ. Nke abụọ, ejila aka gị kụpịa ahụhụ ahụ; jide ya n'okpuru ite ma ọ bụ iko, mechie ya n'ime akpa, ma saa akwa akwa niile na mmiri ọkụ. N'ikpeazụ, kpọtụrụ ngalaba ahụike steeti ma ọ bụ dọkịta ka PCR nwalee ahụhụ ahụ maka Trypanosoma cruzi wee nyochaa onwe gị maka ụbọchị 30 maka ahụ ọkụ, ọzịza nkuchianaya, ma ọ bụ nodule akpụkpọ siri ike.

Enwere ike ịgwọ ọrịa Chagas kpamkpam ma ọ bụrụ na ejidere ya n'oge ka atachara ahụhụ Kissing?¶

Ee. Mgbe achọpụtara ọrịa Chagas n'oge nnukwu oge (izu mbụ 2 ruo 8 mgbe ekpughere ya, mgbe nje nje na-ekesa n'ọbara ma nwee ike ịchọpụta ya site na PCR zuru oke ma ọ bụ smear ọbara), usoro ụbọchị 60 nke mbadamba ọgwụ mgbochi ọnụ (Benznidazole ma ọ bụ Nifurtimox) na-enweta 80 ruo 10% ụmụaka na ihe fọrọ nke nta ka ọ bụrụ pasent 90 na ụmụaka. nkụda mmụọ na-adịghị ala ala, arrhythmias, na mmebi nri digestive nke na-etolite 10 ruo 30 afọ mgbe e mesịrị.

Kedu otu m ga-esi amata chancre ijiji Tsetse ka emechara safari Africa, gịnị kpatara o jiri bụrụ ihe mberede?¶

N'adịghị ka ahụhụ Kissing nke na-ata ahụhụ n'abalị n'ime ụlọ, ijiji Tsetse (Glossina) nke Africa na-ata ahụhụ n'oge ehihie na ogige egwuregwu savanna ma ọ bụ n'ala ọhịa. Ọ bụrụ na ijiji na-ebu Trypanosoma brucei rhodesiense (ọrịa ihi ụra nke dị n'Ebe Ọwụwa Anyanwụ Africa), ebe a na-ata ahụhụ na-etolite nodule na-egbu mgbu, na-ekpo ọkụ, rubbery red-purple nodule (2 ruo 5 centimeters wide) nke a na-akpọ chancre trypanosomal 5 ruo 15 ụbọchị mgbe ọ nwụsịrị, na-esote ngwa ngwa site na nnukwu ọkụ ọkụ, nnukwu isi ọwụwa, isi ọwụwa. N'ihi na ọrịa ihi ụra nke East Africa nwere ike ịwakpo ụbụrụ wee bute obi na-egbu egbu na mmebi akụkụ ahụ dị iche iche n'ime izu 3 ruo 6, onye njem safari ọ bụla nwere nodule anụ ahụ na-egbu mgbu na ahụ ọkụ chọrọ nyocha ọbara n'ụlọ ọgwụ otu ụbọchị yana ọgwụgwọ na Fexinidazole ma ọ bụ Suramin.

Kedu ihe kpatara ntakịrị ntanarị aja ji ghọ ọnya ọnya na-enweghị mgbu ka izu ole na ole m gachara?¶

Obere ájá Phlebotomine dị milimita 2 dị na Latin America, Mediterranean, Middle East, Africa, na Asia na-ebufe nje nje Leishmania ozugbo n'ime akpụkpọ ahụ mgbe ọ na-ata ahụhụ. Mgbe oge incubation nke izu 2 ruo 8 gachara, obere mkpọ pink na-ebuwanye ibu ma mepee n'ime ọnya na-adịghị ala ala, nke na-adịghị ahụ mgbu, nke na-adịghị agwọ ọrịa nke nwere oke gbara agba, nke dị elu, na-acha odo odo na-acha odo odo nke dị ka ugwu mgbawa ugwu (cutaneous leishmaniasis). N'ihi na ọ na-akpata ya bụ protozoan intracellular kama nje bacteria, ude ọgwụ nje na ọgwụ nje staph nke ọnụ anaghị arụ ọrụ; Dọkịta ga-ewererịrị ntakịrị biopsy ma ọ bụ kpụchasịa site na oke ebili elu maka Leishmania PCR wee nye iwu ọgwụ mgbochi leishmanial ezubere iche dị ka miltefosine ọnụ.

Isi mmalite na nduzi ọchịchị¶

• ** Centers for Disease Control and Prevention (CDC, United States):*** Ọrịa Chagas (Trypanosoma cruzi): Triatomine Vector Identification, Acute Phase PCR Diagnosis, Romana's Sign, and Benznidazole / Nifurtimox Treatment Protocols*.
• ** Òtù Ahụ Ike Ụwa (WHO) & Pan American Health Organisation (PAHO):** * Ntuziaka maka nchọpụta na ọgwụgwọ nke ọrịa Chagas*; * Ntuziaka WHO maka ọgwụgwọ ụmụ mmadụ Trypanosomiasis (Fexinidazole)*; na * Njikwa nke Leishmaniases *.
• ** Ọrịa na-efe efe Society of America (IDSA) & ASTMH:** * Usoro ọgwụgwọ ọgwụgwọ maka nchoputa na njikwa nke Leishmaniasis* (Aronson et al., * Ọrịa na-efe efe na-efe efe na-efe efe *).
• ** American Heart Association (AHA):** * Nchọpụta na njikwa nke ndị ọrịa na-etinye aka na myocardial na ọrịa Chagas * (Nunes et al., * Circulation *).
• ** Akwụkwọ akụkọ nke Allergy na Clinical Immunology (JACI):** Triatomine (Kissing Bug) Salivary Procalin Anaphylaxis na Southwwest United States (Klotz et al.).

Ntuziaka emetụtara¶

• Mmeghachi omume nfụkasị na nlekọta mberede anaphylaxis
• Anụ, ahịhịa, na hornet na-agba ọsọ enyemaka mbụ
• Akọrọ na ududo na-ata enyemaka mbụ
• Mgbakwunye Leech na anya, akpịrị, ma ọ bụ akpụkpọ ahụ, granuloma akọrọ, na mmịpụta botfly
• Nọmba mberede site na obodo