Kissing Bug (Triatomine) Bite, Romana’s Sign Chagas Disease Triage, n’obulwadde bwa Tsetse Fly oba Sandfly Leishmaniasis Oluvannyuma lw’okukwatibwa¶

Mu Amerika, Africa, Southern Europe, Middle East, ne Asia, ebiwuka bisatu eby’enjawulo ebitambuza ebiwuka ebirya omusaayi bitambuza obuwuka obuyitibwa systemic protozoan parasites obukola ebiwundu by’olususu oba ebikoola by’amaaso ebirina obulwadde nga tebinnalumba mutima, obwongo oba obusigo bw’amagumba: nocturnal Triatomine "Kissing Bugs" (Triatoma, Rhodnius, and Panstrongylus species okwetoloola Latin America n’ekitundu eky’obugwanjuba bwa Amerika), African Tsetse Flies (Glossina ekika okwetoloola Sub-Saharan Africa), ne Phlebotomine Sandflies (Lutzomyia mu Amerika ne Phlebotomus okubuna Mediterranean, Middle East, Africa, ne South Asia). Okwawukanako n’enseenene oba ensiri eya Tsetse efuyira obuwuka butereevu okuyita mu kitundu kyayo eky’amalusu nga eluma, Kissing Bug TESITA Trypanosoma cruzi (ekivaako obulwadde bwa Chagas) okuyita mu ntuuyo zaayo eziluma. Wabula, ekiwuka kino kiriisa mu maaso g’omuntu eyeebase ekiro awatali bulumi era kifulumya omusulo ogw’amazzi ogujjudde ebiwuka ebisiigibwa (infective metacyclic trypomastigotes) ku lususu. Omuntu eyeebase bw’azuukuka n’azuukuka n’asika oba n’asika omusulo gw’ekiwuka butereevu mu kifo ekifumitiddwa, emimwa, oba mu kitundu ky’amaaso eky’eriiso, ne kivaako oba ekizimba ky’amaaso ekizimba ku ludda olumu (chagoma) oba ekizimba ky’olususu ekikaluba (chagoma) oluvannyuma lwa wiiki emu ku bbiri. Olw’okuba obulwadde bwa Chagas obw’amaanyi buwona ebitundu 80 ku 99 ku buli 100 ng’omira Benznidazole oba Nifurtimox okumala ennaku 60 singa bukwatibwa mu kiseera ky’omutima ogw’amaanyi, nga obulwadde bwa Chagas cardiomyopathy obutakyukakyuka oba megacolon tebunnaba kukula, okulongoosa amangu obucaafu awatali kusiiga n’okukwata ekiwuka okukeberebwa mu PCR bye bikulu eby’amangu. Mu kiseera kye kimu, abatambuze balina okwawula ekirungo ekimyufu ekiruma Tsetse fly bite chancre (Trypanosoma brucei rhodesiense / gambiense, obulwadde bw’okwebaka mu Afirika) n’amabwa agakula mpola, agataliimu bulumi Sandfly volcanic crater ulcer (Leishmania, cutaneous or mucocutaneous leishmaniasis). Singa omuntu afuna omusujja ogw’amaanyi, okulumwa omutwe ennyo, okuzimba mu maaso/ebikoola by’amaaso, okulumwa mu kifuba, oba alergy eggalawo emimiro oluvannyuma lw’okulumwa ebiwuka, kuba essimu y’omu kitundu kyo ennamba z’amangu amangu ago. Era weetegereze ebiragiro bya baganda baffe ku... alergy n’okusannyalala, . okuluma enjuki n’enseenene, era okuluma enkwale n’enjuki.

Ekintu kyosookera ddala ng’ozudde ekiwuka ekiteeberezebwa okuba Kissing Bug ku maaso go, ekitanda kyo, oba ku lususu kwe TOSIKA, kusika, oba kunyiga kiwuka ku lususu lwo, okunaaba amangu ddala olususu ne ssabbuuni n’amazzi agakulukuta (oba okunaaza eriiso n’omunnyo ogutaliimu buwuka) okunaaba omusulo gwonna ogulina Trypanosoma cruzi nga tegunnayingira mu kinnya ky’ebinyogo, okutega ekiwuka ekitaliiko kamogo munda mu ekibbo ky’endabirwamu ekissiddwa oba akaveera okukeberebwa ekitongole ky’ebyobulamu ekya gavumenti oba CDC PCR, era weetegereze akabonero ka Romana (okuzimba ekibikka ku ludda olumu nga tewali bulumi), chagoma y’olususu, oba omusujja mu nnaku 7 ku 30 eziddako olwo okuwona amangu eddagala eritta obuwuka kusobole okutandika.

Kino kikole kati¶

1. TOSIiga maaso go, okukunya ekiluma, oba okukuba/okumenya Kissing Bug butereevu ku lususu lwo. Trypanosoma cruzi parasites zibeera mu Kissing Bug's hindgut and liquid feces yokka, never mu nnywanto zaayo ez'amalusu. Okunyiga ekiwuka kino mu maaso go oba okusiiga ekiwuka ekisiiwa kisiiga obukadde n’obukadde bw’ebiwuka ebitambula butereevu mu kifo ekifumita ekiwuka ekitono oba okubuna obuwuka obuyitibwa mucous membranes obw’eriiso lyo n’akamwa.
2. Mangu ddala naaba bulungi ekifo w’oluma n’olususu olugyetoolodde ne ssabbuuni omugonvu n’amazzi amayonjo agakulukuta (oba okufukirira eriiso n’omunnyo ogutaliimu buwuka okumala eddakiika 10 bw’oba ​​ng’oli kumpi n’ekibikka ky’eriiso). Siiga mpola, tosiimuula, olususu n’omwenge gwa isopropyl ebitundu 70% oba ssabbuuni ow’okuziyiza obuwuka okuggyamu n’okusengejja amatondo gonna ag’omusulo ogw’okungulu nga trypomastigotes tennayingira mu lususu.
3. Kebera mangu obulwadde bwa Kissing Bug salivary anaphylaxis era kuba ku nnamba yo ey’amangu mu kitundu kyo bw’oba eriwo. Kuba 911 mu Amerika, Canada, ne Mexico, 192 mu Brazil, 112 okwetoloola omukago gwa Bulaaya, oba kebera ku ndagiriro yaffe ey’ensi yonna eya ennamba z’amangu. Mu bukiikaddyo bw’amaserengeta n’obugwanjuba bwa Amerika (Triatoma protracta, Triatoma rubida, Triatoma sanguisuga), Kissing Bug saliva kye kisinga okuvaako ekiro IgE-mediated anaphylactic shock: abakoseddwa bazuukuka ekiro nga balina generalized hives, okuzimba emimiro, okuwunya, n’okusannyalala nga kyetaagisa amangu Empiso ya Epinephrine mu binywa (EpiPen).
4. Wamba Kissing Bug bulungi nga tokwatagana na ngalo obwereere (kyusa ekibbo oba ekikopo ky’akaveera waggulu waakyo, serengesa empapula enkalu wansi, ozisibe mu kibya ekirimu omwenge 70% oba oziteeke mu firiigi). Tokwata ku Kissing Bug oba emisuwa gyayo egy’omusulo enzirugavu ku bedsheets ng’olina engalo obwereere. Waayo ekigezo kino ng’oyita mu musawo wo oba ekitongole ky’ebyobulamu mu kitundu kyo okuzuula ebiwuka n’okukeberebwa Trypanosoma cruzi PCR, era onaabe ebitanda byonna ebirimu obucaafu mu mazzi agookya.
5. Kebera ekifo w’oluma buli lunaku okumala wiiki 4 era onoonye okukeberebwa amangu endwadde ezisiigibwa (blood smear + T. cruzi PCR) singa ofuna akabonero ka Romana, chagoma, oba omusujja ogutategeerekese. Singa eriiso erimu lifuna obuzimba obutaliimu bulumi, obumyufu obwa kakobe mu bikowe byombi ebya waggulu n’ebya wansi nga waliwo okukula kw’ennywanto z’amaaso nga tegannabaawo (Romana’s akabonero), oba singa ekizimba ky’olususu ekinywevu ekya violet-red (chagoma) oba omusujja ogw’ekiseera ekiwanvu kirabika oluvannyuma lw’ennaku 5 ku 30 ng’ofunye, tandika Oral Benznidazole oba Nifurtimox amangu ddala ng’emiwendo gy’okuwona gisemberera ebitundu 90 ku 100 ku buli 100.
6. Singa eluma mu Sub-Saharan Africa enseenene ya Tsetse oba mu bitundu eby’obutiti/Mediterranean enseenene ya Sandfly, kwata ekifaananyi era otegeeze olunaku lw’ekiwundu era olondoole bbendera emmyufu ezikwata ku vector. Ekizimba ekiruma, ekimyufu ekyokya (trypanosomal chancre) ekikula ennaku 5 ku 15 oluvannyuma lw’okuluma enseenene ya Tsetse emisana mu Buvanjuba oba mu masekkati nga kiwerekerwa omusujja omungi ye embeera ey’amangu ey’obujjanjabi (Trypanosoma brucei rhodesiense) eyeetaaga okusiigibwa omusaayi mu ddwaaliro mu bwangu; papule etaliimu bulumi efuumuuka mpola mu raised-border "volcanic crater" nga wayise wiiki 2 ku 8 oluvannyuma lw'okulumwa enseenene z'omusenyu yeetaaga dermatology biopsy/PCR for Leishmaniasis.

Omuti gw’okusalawo: Kissing Bug vs Tsetse Fly vs Sandfly bite triage n’okulabirira oluvannyuma lw’okukwatibwa¶

flowchart TD
    A["Kiteeberezebwa nti Okulumwa obuwuka oba okulumwa mu bitundu eby’obutiti (tropical Cutaneous/Ocular Lesion)."] --> B{"Ensonga y’okubikkulwa n’okuwulira okuluma kwali ki?"}
    B -->|Americas / Southern US: Painless nighttime bite on face/arm indoors; flat cone-nosed bug with striped border| C["Kissing Bug (Triatomine) Exposure: Trypanosoma cruzi Obulabe + Obulabe bw’okusannyalala kw’amalusu"]
    B -->|Sub-Saharan Africa Safari / Bush: Sharp painful daytime bite by large brownish fly with crossed wings| D["Tsetse Fly (Glossina) Okuluma: Obulabe bwa African Trypanosomiasis (Obulwadde bw’okwebaka)."]
    B -->|Tropics / Mediterranean / Middle East: Tiny 2-mm hairy golden fly with V-wings at dusk; painless or stinging papule| E["Okulumwa enseenene z’omusenyu eza Phlebotomine: Obulabe bw’obulwadde bwa Leishmaniasis"]
    C --> F{"Okuzimba kwonna okw’amangu, okuzimba emimwa/emimiro, okuwunya, oba okuziyira ng’ozuukuse?"}
    F -->|Yes: Nocturnal Triatomine Salivary Anaphylaxis| G["Kuba 911 / Ennamba y'amangu KATI; empiso ya IM Epinephrine 0.3 mg mu kisambi"]
    F -->|No: Local bite or bug found in bed| H["TOSIiga liiso oba okukunya kuluma; okunaaba olususu ne ssabbuuni & amazzi oba okunaaba eriiso n’omunnyo; okukwata ekiwuka mu kibbo ekissiddwako ssimu"]
    H --> I{"Mu nnaku 5 okutuuka ku 30: Okuzimba kw’ebikowe by’amaaso ebya kakobe ebitaliimu bulumi ku ludda olumu (akabonero ka Romana), chagoma y’olususu, oba omusujja?"}
    I -->|Yes: Acute Chagas Disease| J["Okukola amangu mu ddwaaliro / ID: Omusaayi gwonna T. cruzi PCR + Okusiiga omusaayi + ECG -> Tandika ennaku 60 Oral Benznidazole oba Nifurtimox"]
    I -->|No symptoms| K["Waayo ekiwuka ekyakwatibwa okukola PCR; kola baseline ne wiiki 6 ku 8 T. cruzi IgG serology & PCR singa ekiwuka kiba positive"]
    D --> L{"Ku nnaku 5 okutuuka ku 15: Obulumi red indurated nodule (Tsetse Chancre) + omusujja omungi, omutwe oba ennywanto z’ensingo?"}
    L -->|Yes: Acute Human African Trypanosomiasis| M["OKUTANDIKA MU DDWALIRO MU MANGU: Okusiiga omusaayi mu Chancre aspirate & Giemsa + Okufumita mu kifuba -> Oral Fexinidazole oba IV Suramin/NECT"]
    E --> N{"Ku wiiki 2 okutuuka ku 12: Papule etaliimu bulumi egaziwa n’efuuka amabwa agatali gawona agatali gawona nga galina ensalosalo ‘ey’olusozi’ egulumiziddwa?"}
    N -->|Yes: Cutaneous or Mucocutaneous Leishmaniasis| O["TOSIKA oba okusala ng’ekifumba kya bakitiriya; punch biopsy/okusenya okuva ku mabbali g’amabwa agagulumiziddwa ku Leishmania PCR + Miltefosine/Amphotericin"]

Okugeraageranya omutwe ku mutwe: Kissing Bug (Chagas) vs Tsetse Fly (Obulwadde bw’okwebaka) vs Sandfly (Leishmaniasis)¶

Olw’okuba abatembeeyi, abatuuze b’omu byalo, n’abasawo batera okutabula obulwadde buno obusatu obukwata obulwadde bwa protozoan vector syndromes, okwawula ku mabbali ku mabbali kikulu nnyo:

Kissing Bugs (Triatomines), Akabonero ka Romana, n’Obulwadde bwa Acute Chagas¶

1. Lwaki enkola ya Kissing Bug ey’okuliisa n’okufulumya omusulo y’esalawo okukwatibwa obuwuka¶

Ebiwuka ebiyitibwa Triatomine (Triatoma infestans, Rhodnius prolixus, Panstrongylus megistus, Triatoma dimidiata mu Latin America; ne Triatoma sanguisuga, Triatoma gerstaeckeri, Triatoma protracta, ne Triatoma rubida mu Amerika) byekukuma emisana mu nnyatika z’ebisenge, obusolya obw’obusa, ebiyumba by’embwa, entuumu z’enku, ne wansi w’emitto, nga zifuluma ekiro nga zisikiriza kaboni dayokisayidi (CO2) n’ebbugumu ly’omubiri. - Lwaki Ziyitibwa "Kissing Bugs" (Barbeiros mu Brazil, Vinchucas mu Andes, Chinches Besuconas mu Mexico): Olw'okuba omuntu eyeebase atera okukuuma omubiri gwe n'amagulu wansi w'omufaliso, ekiwuka kino kyekulukuunya ku ffeesi, amatama, emimwa, n'ebikowe ebirabika okulya. - Emmere y’omusaayi mu ddakiika 15 ku 30 etaliimu bulumi: Ekiwuka kino kibikkula ekifo kyakyo ekigolokofu, ekirimu ebitundu bisatu (proboscis) ne kikuba empiso z’amalusu agalimu nitrophorins (vasodilators), apyrases (platelet inhibitors), n’eddagala eribudamya mu kitundu. Olw’okuba okuluma tekuluma, eyeebase tazuukuka ate ng’ekiwuka kijjula okumala eddakiika 15 ku 30. - Omutego gw’okutambuza omusulo: Olubuto lw’ekiwuka bwe luzimba (naddala mu biwuka ebifulumya omusulo amangu nga Triatoma infestans ne Rhodnius prolixus), kifulumya akatonnyeze k’omusulo enzirugavu amazzi butereevu ku ttama oba ekibikka ky’amaaso nga tekinnaserengeta. - Ekintu ekikulu eky'omubiri: Olususu lw'omuntu olutaliiko kamogo, olutamenyese kiziyiza Trypanosoma cruzi metacyclic trypomastigotes tezisobola kuyingira ku bwazo. Yinfekisoni ebaawo yokka ng’omuntu eyeebase asiiga oba akunya ekiluma mu butamanya (okusiimuula akatonnyeze k’omusulo mu kiwundu ekitono ekifumitiddwa oba olususu oluvuddemu) OBA ansiimuula akatonnyeze k’omusulo okubuna oluwuzi lw’omusulo olw’omusulo gw’amaaso (eriiso) oba omusulo gw’omu kamwa (emimwa).

================================================================================
   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. Okutegeera Akabonero ka Romana vs a Bacterial Stye oba Periorbital Cellulitis¶

Wakati wa ennaku 5 ne 14 oluvannyuma lwa T. cruzi fecal trypomastigotes zikwatagana n’ekitundu ky’amaaso eky’eriiso erimu, omulwadde afuna akabonero akamanyiddwa ennyo ak’obulwadde bwa acute ocular Chagas disease, akabonero ka Romana (akanyonyolwa Cecilio Romaña mu 1935): - Ebikwata ku bujjanjabi bw'akabonero ka Romana: 1. Strictly Unilateral (One Eye Only): Ekwata eriiso lyokka eririmu obucaafu. 2. Etaliimu bulumi, Violaceous (Purple-Pink) Bipalpebral Edema: Ebikowe byombi ebya waggulu n’ebya wansi bizimba nnyo, ebiseera ebisinga ne biggalawo enjatika y’engalo, nga binywevu, ebitali bya binnya, okukyuka langi ya reddish-violet, naye obutafaananako kizimba kya bakitiriya oba orbital cellulitis, tekiruma era tekigonvu kukwata era waliwo tewali mazzi ga kyenvu agafuukuuse. 3. Obulwadde bw’amaaso, Dacryoadenitis, ne Preauricular Node: Okuzimba kw’endwadde y’amaziga (tear) gland ey’oku ludda olulala (ipsilateral lacrimal (tear) gland) n’ennywanto y’amazzi agayitibwa preauricular oba submandibular lymph node nga egaziye nga kirabika, ku ludda lwe lumu olwa ffeesi. 4. Ebbanga n’Enkulaakulana y’Ensengekera: Akabonero ka Romana kasigala okumala wiiki 2 ku 4 wadde ng’atonnya amatondo g’amaaso agatta obuwuka oba eddagala eriweweeza ku buwuka obuleeta endwadde, nga buwerekerwako omusujja ogw’omutindo ogwa wansi oba ogw’amaanyi ogw’ekiseera ekiwanvu, okulemererwa, obulwadde bw’amazzi mu bitundu by’omubiri (generalized lymphadenopathy), n’okukendeera kw’ekibumba okutono.

3. Okukwata Ekiwuka, Okukebera Okuzuula, n’okuwonya eddagala eritta obuwuka okumala ennaku 60¶

1. Engeri y'okukwata n'okuweereza ekiwuka ekinywegera mu ngeri ey'obukuumi:
2. Tokwata to kukwata ku kiwuka n'engalo obwereere. Yambala ggalavu ezikozesebwa omulundi gumu oba kyusa ekibbo ky’endabirwamu ku kiwuka, ssika kaadi wansi, era osibe ekibikka.
3. Laba bulungi omutwe ne proboscis: ebiwuka ebirya ebimera ebirina ebigere by’amakoola birina amagulu amagazi ag’emabega n’ekiwujjo ekiwanvu ekikoona, ate ebirya assassin bugs / wheel bugs birina proboscis enzito, enkoona eringa raptor era tezitwala T. cruzi; kituufu Triatomine Kissing Bugs zirina omutwe omuwanvu, omugonvu, ogw’engeri ya kkooni nga guliko ekikuta ekigolokofu, ekigonvu nga kikutte wansi w’ekifuba n’obubonero obw’emicungwa/emmyufu/emmyufu ku mabbali g’olubuto.
4. Waayo ekiwuka kino ng’oyita mu State Department of Health, university extension program, oba CDC Division of Parasitic Diseases and Malaria (DPDM) okukeberebwa PCR okukeberebwa Trypanosoma cruzi DNA (okubuna obugwanjuba bwa Amerika, ebitundu 30 ku 55 ku buli 100 eby’ebiwuka ebiyitibwa Kissing Bugs eby’omu nsiko bizuuliddwa nga bizuuliddwa T. cruzi).
5. Okuzuula obulwadde mu laboratory mu mulwadde alina obuzibu:
6. Mu kiseera kya Acute Window (Wiiki 1 okutuuka ku 8 oluvannyuma lw’okukwatibwa, oba nga akabonero / omusujja gwa Romana guliwo): Serology (IgG antibodies) etera okuba nga ekyali negativu nga bukyali. Ebigezo ebirina omutindo gwa zaabu bye bino Whole-Blood Trypanosoma cruzi Real-Time PCR NE okukebera obutereevu mu microscopic omusaayi omuggya oguziyiza okuzimba (wet mount for motile trypomastigotes) n’okusiiga omusaayi omunene n’omugonvu ogusiigiddwa Giemsa.
7. Oluvannyuma lwa wiiki 6 okutuuka ku 8 (Okukebera okuwona / okutategeerekeka): Lagira bibiri eby'enjawulo T. cruzi IgG serologic tests nga tukozesa enteekateeka za antigen ez’enjawulo (ELISA plus immunoblot oba IFA) okukakasa oba okugaana seroconversion, ku mabbali ga baseline 12-lead ECG (okukebera RBBB, LAFB, oba PR prolongation).
8. Eddagala eriweweeza ku buwuka (Benznidazole ne Nifurtimox):
9. Benznidazole ne Nifurtimox (Lampit) byombi bikkirizibwa FDA mu Amerika era nga biwandiikiddwa ekitongole ky’ebyobulamu mu nsi yonna (WHO):
   • Benznidazole (First-Line): 5 ku 7.5 mg/kg/olunaku mu kamwa nga ogabanyizibwamu dose 2 buli lunaku okumala ennaku 60 (okutuuka ku 8 ku 10 mg/kg/olunaku mu balwadde b’abaana). Londoola okusiiyibwa, obulwadde bw’obusimu obw’okumpi, n’enziyiza za CBC/ekibumba.
   • Nifurtimox: 8 ku 10 mg/kg/olunaku mu kamwa nga ogabanyizibwamu dose 3 buli lunaku n’emmere okumala ennaku 60 mu bantu abakulu (10 ku 20 mg/kg/olunaku mu baana).

Enseenene ya African Tsetse Fly (Glossina) Okuluma n’Omuntu African Trypanosomiasis (Obulwadde bw’okwebaka) .¶

1. Okutegeera Enseenene ya Tsetse ne Trypanosomal Chancre¶

Abatambuze ku safaali z’ebisolo by’omu nsiko mu Buvanjuba n’obugwanjuba bwa Afrika (Serengeti, Ngorongoro, Masai Mara, Luangwa Valley, Zambezi, Okavango) oba abakola mu bitundu by’emigga mu Central ne West Africa (Democratic Republic of the Congo, Central African Republic, Angola, South Sudan) batera okusisinkana enseenene Tsetse fly (Glossina). - Lwaki DEET Yokka Teyimiriza Nseenene za Tsetse: Enseenene za Tsetse nnene (mm 8 ku 15), ziluma amangu emisana nga zirina ebiwaawaatiro ebisalagana n’akasero nga zisikiriza nnyo mmotoka za safaali ezitambula, ebiwujjo by’enfuufu, n’emifaliso egya bbululu omuddugavu oba emiddugavu, era teziwulirwa nnyo ddagala lya DEET erya bulijjo. Proboscis yaabwe eringa bayonet efumita essaati za khaki, amasokisi ne jjiini za denim, ne zikola ekiwundu ekisongovu ekiruma ekisika ettondo ly’omusaayi. - The Trypanosomal Chancre (Ennaku 5 okutuuka ku 15 oluvannyuma lw'okuluma): - Wadde nga ebitundu ebisukka mu 99% eby’enseenene za tsetse tezisiiga, okulumwa ensekere etisse Trypanosoma brucei rhodesiense (East African), era nga tezitera kubaawo Trypanosoma brucei gambiense (West/Central African), efuna obulwadde Trypanosomal Chancre mu kifo kyennyini we yaluma ennaku 5 okutuuka ku 15 oluvannyuma: - Endabika: Ensigo oba ekikuta ekinywevu, ekyokya, ekigonvu, ekizingiddwako ekimyufu okutuuka ku kiwujjo ekipima sentimita 2 ku 5 mu buwanvu, waggulu nga kiriko ekizimba ekiri wakati oba eschar enzirugavu era nga kyetooloddwa erythematous halo, nga kiwerekerwako ennywanto z’amazzi ez’omu kitundu ezigaziwa. - Lwaki T. b. rhodesiense Ye Busawo obw'amangu: - Mu wiiki 1 ku 3 oluvannyuma lw’okuluma, omulwadde afuna omusujja ogw’amaanyi ogw’amaanyi, okukaluba, okulumwa ennyo omutwe, okulumwa emisuwa, okusiiyibwa kw’omugongo (trypanids), okukendeera kw’obutoffaali obukola omusaayi (thrombocytopenia), okuzimba emisuwa gy’omutima egy’amaanyi, n’okuyingira mu CNS, ekitta 100% mu wiiki okutuuka ku myezi mitono singa azuulibwa mu bukyamu ng’omusujja oba obuwuka obulwadde bwa cellulitis. - Immediate Hospital Protocol: Omutambuze yenna akomawo okuva mu Sub-Saharan Africa ng’alina ekizimba ky’olususu ekimyufu ekitaggwaawo (chancre) n’omusujja yeetaaga okuweebwa ekitanda mu ddwaaliro ku lunaku lwe lumu, okukebera obutereevu microscopic amazzi agafuumuuddwa okuva ku chancre margin plus Giemsa-stained thick and thin blood smears, lumbar puncture (CSF analysis) okutuuka ku mutendera CNS involvement, ne obujjanjabi obw’amangu n’eddagala lya Fexinidazole ery’omu kamwa** oba IV Suramin / Melarsoprol / Pentamidine / NECT.

Okulumwa enseenene z’omusenyu eza Phlebotomine n’obulwadde bwa Leishmaniasis obw’olususu oba mu lususu¶

1. Okutegeera Amabwa ga "Volcanic Crater" agalemererwa Eddagala eritta obuwuka eriyitibwa Bacterial Antibiotics¶

Mu bitundu bya Latin America eby’obutiti, ekitundu kya Mediterranean, Middle East, North/East Africa, ne South/Central Asia, ebika by’enseenene ebitonotono ebibeera ekiro Phlebotomine sandflies (Lutzomyia ne Phlebotomus, obuwanvu bwa milimita 2 zokka) bitambuza obuwuka obuyitibwa protozoan parasites**: - The Classic Clinical Trap: Nga wiiki 2 ku 8 oluvannyuma lw’okudda okuva mu kutambula mu bibira by’enkuba, okusindikibwa mu magye, oba okuwummulira mu Mediterranean, akawuka akatono aka red sandfly kaluma papule ku kigere ekya wansi, omukono ogw’omu maaso, okutu, oba ffeesi okubikkuddwa kagaana okuwona. Mu kifo ky’okugonjoola mu wiiki ng’ensiri okuluma, egenda ekula mpola n’efuuka ekiwundu kya sentimita emu ku 5 nga kiriko wakati mu bitundutundu ebiyonjo oba ebifuuse ebikuta n’ensalosalo ya kakobe enzito, egulumivu, enzibu ennyo (elinga ekinnya ky’olusozi oluvuuma)** nga etaliimu bulumi mu ngeri eyeewuunyisa okuggyako nga yasiigibwa mu ngeri ey’okubiri. - Lwaki Incision & Drainage ne Cephalexin Fail: Abasawo batera okuzuula obubi obulwadde bwa cutaneous leishmaniasis nga bacterial staph boil oba spider bite, nga bawandiika cephalexin oba okukola okulongoosa okusala n'okufulumya amazzi, ekintu ekyonoona enkovu z'ebitundu nga tebakwata ku Leishmania amastigotes eziri mu butoffaali. - Obulabe bw’olususu mu nsi empya (Viannia) Ebika: Singa obulwadde buno bwafunibwa mu Central oba South America okuva mu Leishmania (Viannia) braziliensis, L. panamensis, oba L. guyanensis, obuwuka busobola okusaasaana okuva ku ulcer y’olususu okutuuka mu nasal septum, palate, pharynx, ne larynx oluvannyuma lw’emyezi okutuuka ku myaka (mucocutaneous leishmaniasis / espundia), ne busaanyawo eggumba ly’ennyindo ne buleeta okuzibikira kw’emikutu gy’empewo oba okukyukakyuka singa tebujjanjabwa mu nkola. - Enkola y'okuzuula n'okujjanjaba: - Laba omukugu mu by’endwadde ezisiigibwa oba mu bitundu eby’obutiti ku 3- ku 4-mm punch biopsy, dermal scraping, oba fine-needle aspiration okuggyibwa butereevu ku active, raised indurated border of the ulcer (never biopsy only the necrotic center). - Sindika ebitundu by’omubiri ku ebika ebikwata ku Leishmania PCR (ekyetaagisa okwawula ebika by’ensi empya Viannia ebyetaaga obujjanjabi obw’enkola okuva ku bika by’ensi enkadde ebiri mu kitundu), Giemsa histopathology (okunoonya emibiri egy’omu butoffaali Leishman-Donovan [amastigotes] munda mu macrophages), ne Novy-MacNeal-Nicolle (NNN) obuwangwa. - Jjanjaba okusinziira ku bika n’enkula y’ensi n’eddagala lya Miltefosine ey’omu kamwa (Impavido, 50 mg PO emirundi esatu buli lunaku okumala ennaku 28), IV Liposomal Amphotericin B (AmBisome), oba pentavalent antimonials oba obujjanjabi obw’ebbugumu obw’omu kitundu ku Old World L etali nzibu. ebiwundu ebinene.

Ennamba z’embeera ez’amangu mu bitundu n’ebiragiro by’ebitongole¶

• Amerika ne Canada:
• Kuba 911 ku kiro Kissing Bug anaphylaxis, acute myocarditis, oba obulwadde obw’amaanyi obw’omusujja oluvannyuma lw’okutambula.
• Tuukirira CDC Parasitic Diseases Hotline ku +1-404-718-4745 oba CDC Emergency Operations Center ku +1-770-488-7100 okwebuuza ku musawo ku Whole-Blood Trypanosoma cruzi PCR, Leishmania PCR, n’eddagala eritta obuwuka (Eddagala lya Benznidazole, Nifurtimox, Fexinidazole, Suramin, Miltefosine).
• Mu Texas, Arizona, California, Louisiana, ne Gulf of Mexico states, weereza Kissing Bugs ezikwatibwa ng’oyita mu Ekitongole kyo eky’ebyobulamu mu ssaza oba Texas A&M University Kissing Bug Research Lab.
• Latin Amerika (Brazil, Mexico, Argentina, Bolivia, Colombia, Peru):
• Kuba 192 (SAMU) mu Brazil, 911 mu Mexico ne Argentina, 123 mu Colombia, oba 106 mu Peru.
• Goberera ebiragiro bya PAHO ne Ministério da Saúde do Brasil Doença de Chagas Aguda: okuloopa amangu omuntu yenna ateeberezebwa okuba nga alina Chagas ow’amaanyi, okukebera obutereevu omusaayi ogw’okumpi, n’okugaba ennaku 60 Benznidazole ey’omu kamwa ku bwereere.
• United Kingdom: Kuba 999 oba NHS 111, era osindikire abatambuze abakomawo nga bateeberezebwa okuba nga balina Tsetse chancre, akabonero ka Romana, oba amabwa ga Leishmania mu Hospital for Tropical Diseases (London) oba Liverpool School of Tropical Medicine.
• Omukago gwa Bulaaya: Kuba 112. Abatambuze abaddayo bawereze mu bifo eby’eggwanga eby’eddagala ly’omu bitundu eby’obutiti era mukwasaganye ne Ekitebe kya WHO (Geneva) okufulumya Fexinidazole, Suramin, oba NECT mu bwangu.
• Sub-Saharan Africa: Kuba 112 / 999 oba 10177 (South Africa) otuukirire AMREF Flying Doctors (+254 20 699 2299) mu Nairobi oba Minisitule y’ebyobulamu mu ggwanga Trypanosomiasis Control Programs okukakasa amangu omusaayi okusiiga ne Fexinidazole / Suramin.

Ebibuuzo ebitera okubuuzibwa¶

Kissing Bug ekuba empiso obulwadde bwa Chagas butereevu ng’ayita mu kuluma kwayo ng’ensiri bw’ekuba empiso y’omusujja?¶

Nedda Okwawukanako n’ensiri oba enseenene za tsetse, ekiwuka kya Trypanosoma cruzi ekivaako obulwadde bwa Chagas tekibeera mu nnywanto z’amalusu za Kissing Bug era tekufukibwako kuluma kwennyini. Wabula, ekiwuka kino kibeera mu byenda eby’emabega eby’ekiwuka ne kiyisibwa mu musulo ogw’amazzi ekiwuka kye kifulumya omusulo ku lususu ng’olya ekiro oba nga wayise akaseera katono. Ofuna akawuka singa osiiga oba okukunya mu butamanya ekiluma ekisiiwa, ekisiimuula omusulo gw’ekiwuka ogulina akawuka butereevu mu kafo akatono akaluma oba okubuna obuwuka obunnyogovu obw’eriiso lyo (conjunctiva) oba mu kamwa.

Akabonero ka Romana kye ki, era nnyinza ntya okukayawula ku pinkeye oba ekiwuka ekiluma bulijjo ku kikoola ky’eriiso?¶

Akabonero ka Romana ke kabonero akamanyiddwa nga classic early warning disease of acute Chagas disease akalabika nga wayise ennaku 5 ku 14 nga omusulo gwa Kissing Bug ogulina Trypanosoma cruzi gusiigiddwa mu liiso erimu. Okwawukanako n’ensiri okuluma ku kikoola ky’eriiso (ekizimba amangu, ekisiiwa ennyo, ne kizikira mu nnaku 2 ku 3) oba bacterial pinkeye (ekikosa amaaso gombi nga galina amasira aga kyenvu), akabonero ka Romana kalina strictly one-sided, kakula wiiki 1 ku 2 oluvannyuma lw’okukwatibwa, kaleeta okuzimba okunywevu, okutaliimu bulumi, okwa purple-pink ku bitundu byombi ebya waggulu n’ebya wansi ebikowe by’eriiso erimu nga tebirina masira ga kyenvu, era nga biwerekerwako ennywanto ezizimba mu maaso g’okutu n’omusujja ogumala wiiki eziwera.

Nkole ntya singa nsanga ekiwuka ekiyitibwa Kissing Bug mu kitanda kyange oba ku lususu lwange?¶

Okusooka, tosiiga maaso go oba okukunya ekiluma, era amangu ago onaabe olususu ne ssabbuuni n’amazzi agakulukuta (oba okunaaza eriiso n’omunnyo ogutaliimu buwuka) okuggyawo amatondo gonna ag’omusulo agatonotono ng’obuwuka tebunnayingira mu lususu. Ekirala, tobetenta kiwuka n’omukono gwo ogw’obwereere; mutege wansi w’ekibbo oba ekikopo eky’endabirwamu, ogisibe mu kibbo, era onaabe ebitanda byonna mu mazzi agookya. N’ekisembayo, tuukirira ekitongole ky’ebyobulamu mu ssaza lyo oba omusawo okukeberebwa ekiwuka kino mu PCR okuzuula oba kirimu Trypanosoma cruzi era weekenneenye okumala ennaku 30 okulaba oba olina omusujja, okuzimba ebikowe by’amaaso, oba olususu olunywevu.

Obulwadde bwa Chagas busobola okuwona ddala singa bukwatibwa nga bukyali oluvannyuma lw’okulumwa Kissing Bug?¶

Yee. Obulwadde bwa Chagas bwe buzuulibwa mu kiseera kya Acute Phase (wiiki 2 ku 8 ezisooka oluvannyuma lw’okukwatibwa, ng’obuwuka butambula mu musaayi era nga busobola okuzuulibwa mu musaayi gwonna PCR oba okusiiga omusaayi), empeke ezilwanyisa obuwuka eziweebwa mu kamwa (Benznidazole oba Nifurtimox) okumala ennaku 60 zituuka ku kuwona mu bujjuvu ebitundu 80 ku 99 ku buli 100 (era kumpi ebitundu 100 ku 100 mu abaana abawere n’abaana), okuziyiza omutima okulemererwa obutawona, obutatambula bulungi, n’okwonooneka kw’emmere y’emmere ebikula oluvannyuma lw’emyaka 10 ku 30.

Ntegeera ntya ennyonyi ekika kya Tsetse fly bite chancre oluvannyuma lwa safari mu Africa, era lwaki kya mangu?¶

Obutafaananako Kissing Bug eluma ekiro mu nnyumba nga tewali bulumi, enseenene ya African Tsetse (Glossina) eluma nnyo emisana mu ppaaka z’ebisolo oba mu nsiko. Singa ensekere yali etisse Trypanosoma brucei rhodesiense (obulwadde bw’okwebaka mu Buvanjuba bwa Afirika), ekifo we kirumye kifuna ekizimba ekiruma, eky’ebbugumu, nga kya kapiira ekimyufu-ekimyufu (obugazi bwa sentimita 2 ku 5) ekiyitibwa trypanosomal chancre oluvannyuma lw’ennaku 5 ku 15 ng’olumye, ne kigobererwa amangu omusujja ogw’amaanyi, okulumwa ennyo omutwe, n’okutabulwa. Olw’okuba obulwadde bw’okwebaka mu buvanjuba bwa Afrika busobola okulumba obwongo ne buleeta okulemererwa kw’omutima n’ebitundu ebingi mu wiiki 3 ku 6, omutambuze yenna mu safaali ng’alina ebizimba by’olususu ebiruma n’omusujja yeetaaga okusiigibwa omusaayi mu ddwaaliro ku lunaku lwe lumu n’okujjanjabibwa n’eddagala lya Fexinidazole oba Suramin.

Lwaki akatono akalumwa enseenene z'omusenyu kaafuuka amabwa aga "volcanic crater" agataliimu bulumi nga wayise wiiki n'olugendo lwange?¶

Enseenene entonotono eziyitibwa Phlebotomine sandflies eziweza milimita 2 mu Latin America, Mediterranean, Middle East, Africa ne Asia zitambuza obuwuka bwa Leishmania butereevu mu lususu nga ziluma. Oluvannyuma lw’ekiseera ky’okufumbiza wiiki 2 ku 8, akatundu akatono aka pinki kakula ne kagguka ne kafuuka amabwa agatawona, agataliimu bulumi, agatawona nga galina ensalosalo ya kakobe enzito, ewanvuye, eyeekulukuunya ng’elinga ekituli ky’olusozi oluvuuma (cutaneous leishmaniasis). Olw’okuba kiva ku kiwuka ekiyitibwa intracellular protozoan okusinga bacteria, ebizigo ebitta obuwuka n’eddagala eritta obuwuka erya staph eriweebwa mu kamwa tebikola; omusawo alina okukwata akapimo akatono oba okusenya okuva ku nsalo esituddwa ku Leishmania PCR n’awandiika eddagala erigendereddwamu eriweweeza ku bulwadde bwa leishmanial nga miltefosine ow’omu kamwa.

Ensonda n’obulagirizi obutongole¶

• Ebifo ebifuga n’okuziyiza endwadde (CDC, Amerika): Obulwadde bwa Chagas (Trypanosoma cruzi): Okuzuula obuwuka bwa Triatomine, Okuzuula obulwadde bwa Acute Phase PCR, Akabonero ka Romana, n’enkola z’obujjanjabi bwa Benznidazole / Nifurtimox.
• Ekitongole ky’ebyobulamu mu nsi yonna (WHO) & Pan American Health Organization (PAHO): Ebiragiro ku kuzuula n’okujjanjaba obulwadde bwa Chagas; Ebiragiro by’ekitongole ky’ebyobulamu eky’ensi yonna ku bujjanjabi bw’obulwadde bwa Human African Trypanosomiasis (Fexinidazole); ne Okufuga ensolo za Leishmaniases.
• Ekibiina ky’endwadde ezisiigibwa ekya Amerika (IDSA) & ASTMH: Endagiriro y’enkola y’obujjanjabi ku kuzuula n’okuddukanya obulwadde bwa Leishmaniasis (Aronson et al., Endwadde ezisiigibwa mu bujjanjabi).
• American Heart Association (AHA): Okuzuula n’okuddukanya abalwadde abalina emisuwa gy’omutima mu bulwadde bwa Chagas (Nunes et al., Circulation).
• Journal of Allergy and Clinical Immunology (JACI): Obulwadde bwa Triatomine (Kissing Bug) Obulwadde bwa Procalin mu malusu mu bugwanjuba bw’amaserengeta ga Amerika (Klotz et al.).

Ebiragiro ebikwatagana nabyo¶

• Allergic reactions ne anaphylaxis okulabirira okw‟amangu
• Enjuki, enseenene, n’ensowera ziluma obujjanjabi obusookerwako
• Enkwale n’enjuki ziluma obujjanjabi obusookerwako
• Leech attachment mu liiso, emimiro oba olususu, tick granuloma, n’okuggya botfly
• Ennamba z’amangu okusinziira ku nsi