Kissing Bug (Triatomine) Bite, Romana's Sign Chagas Disease Triage, ne Tsetse Fly anyi Sandfly Leishmaniasis Post-Exposure¶

Mu matunga a mu Amerike, mu Afrike, ku Mputu wa ku Sud, ku Moyen-Orient, ne mu Azia, bishi bisatu bidi bidia mashi bidi bifila bipupu bia protozoa bidi bipatula mputa ya dikoba anyi ya mêsu kumpala kua kubuela mu mutshima, mu buongo anyi mu mifuba: nocturnal Triatomine "Kissing Bugs" (klzzwxh:020 (Leishmania, cutaneous cutaneous comaniasis) udi wenda ukola bitekete bitekete, kayi ne kanyinganyinga. Shi muntu udi na kapia kakole, mutu usama bikole, mpala usama, tshiadi usama, anyi disama dia nshingu kunyima kua dikuma dia nyunyi, ubikile muaba unudi nomba ya tshimpitshimpi diakamue. Tangila kabidi mikanda yetu ya bana betu pa disama dia allergie ne anaphylaxie, nyunyi ne nyuki, ne disuma dia nkutshi ne dia nsese.

Tshia kumpala tshiudi ne bua kuenza diakamue paudi upeta Kissing Bug pa mpala webe, pa bulalu buebe anyi pa dikoba diebe ntshia se: KUENA KUKUATA, Kukosa anyi kutshibula tshipupu etshi ku dikoba diebe, kusukula dikoba diakamue ne sabune ne mâyi a mupuya (anyi kuowa dîsu ne saline wa sterile) bua kuowa Trypanosoma infection yonso idi mua kubuela mu tuishi, tuishi tshipupu tshidi munda mua mulondo wa makala anyi mu tshibombi tshia plastike bua tshibambalu tshia malu a bukola bua mubidi tshia ditunga anyi tshia CDC PCR, ne kutangila tshimanyinu tshia Romana (divulangana dia mêsu kadiyi ne kanyinganyinga ku luseke lumue), tshipupu tshia dikoba, anyi kapepe mu matuku 7 anyi 30 adi alonda bua diondapangana dia kumpala dia antiparasite dituadije.

Enza nunku mpindieu¶

1. KUENA KUKUATA mêsu ebe, kukosa muaba udibu bakusuma, anyi kukuma/kutshibula tshipupu tshia Kissing Bug buludiludi ku dikoba diebe. Trypanosoma cruzi bishi bidi bisombela anu mu tshitupa tshia panyima ne mu tuishi tua mâyi tua Kissing Bug, nansha kakese mu bitupa biende bia mate. Kutshibula tshintu etshi ku mpala anyi kutshibula tshintu tshidi tshikuma kudi kunyangakaja miliyo ya bishi bidi biendakana buludiludi mu tshitupa tshikese tshia tshintu tshidi tshikuma anyi mu bitupa bia mubidi bia dîsu ne mukana muebe.
2. Sukula diakamue muaba udibu basuma ne kikoba tshidi tshinyunguluke bimpe ne nsabanga mupepele ne mâyi mimpe adi apita (anyi ela dîsu ne mâyi a mukele adi kaayi ne disama munkatshi mua minite 10 bikalabi pabuipi ne tshilamba tshia ku mêsu). Ela dikoba bitekete bitekete, kuyi usukula, ne maluvu a isopropyl 70% anyi nsabuni wa antiseptique bua kumbusha ne teta bua kuela mafuta onso pa mutu kumpala kua kuela mafuta a nsongo dermis.
3. Tangila diakamue bua kumanya ni udi ne disama dia Kissing Bug salivary anaphylaxie ne ubikile nimero wa lupitadi lua muaba unudi pikalaku. Ela 911 mu États-Unis, mu Canada ne mu Mexique, 192 mu Brésil, 112 mu Union européenne, anyi tangila tshilaminu tshietu tshia buloba bujima tshia nomba ya tshimpitshimpi. Mu matunga a ku Sud-Ouest ne ku Sud kua États-Unis (Triatoma protracta, Triatoma rubida, Triatoma sanguisuga), Mashi a mbuji adi atamba kufikisha ku tshipupu tshia anaphylactic tshidi tshifumina ku IgE butuku: bantu badibu bashipe batu bajuka butuku ne disama dia nsukadi, disama dia mu mikolo, disama dia nsukadi, ne disama dia nsukadi diakamue intramuscular Epinephrine Auto-Injection (EpiPen).
4. Kuata Kissing Bug bimpe kuyi umulenga ku bianza (kudimuna tshibombi anyi dikopo dia plastique pa mutu patshi, ela dibeji dikole muinshi, ne utshikanga mu tshintu tshidi ne 70% ya maluvu anyi utshiteke mu mashika). Kutengi Kissing Bug anyi milonda yende mifiike idi pa bilamba bia bulalu ne minu kayiyi ne tshintu to. Fila tshilejelu kudi munganga webe anyi kudi tshibambalu tshia malu a bukola bua mubidi tshia muaba unudi bua dimanya dia nyama ne Trypanosoma cruzi diteta dia PCR, ne sukula bilamba bionso bidi ne disama mu mayi a kapia.
5. Tangila muaba udibu basuma dituku dionso munkatshi mua mbingu 4 ne ukebe diakamue diteta dia masama a masama (dipima dia mashi + T. cruzi PCR) wewe mupete tshimanyinu tshia Romana, chagoma, anyi fièvre udi kauyi umvuika. Bikala dîsu dimue dipeta disama dia kuulu ne dia kuinshi didi kadiyi ne kanyinganyinga, dia violet-mutoke ne disama dia tshiadi tshia kumpala kua disu (Tshimanyinu tshia Romana), anyi pikala tshitupa tshikole tshia dikoba tshikunze (chagoma) anyi luya lua matuku a bungi lumueneka matuku 5 too ne ku 30 kunyima kua dipetangana, tuadija Benznidazole anyi Nifurtimox diakamue padi bungi bua diondapangana buenda bufika ku 90 anyi 100 pa lukama.
6. Bikalabu basumibue mu Afrike wa kuinshi kua Sahara kudi nyunyi wa Tsetse anyi mu matunga a mashika/mu Mbuu wa Mediterane kudi nyunyi wa nsenga, wangate foto ne funda dituku dia tshilonda ne utangile bimanyinu bikunze bia vecteur. Tshitupa tshikunze tshidi tshisama (trypanosomal chancre) tshidi tshikola **5 too ne ku 15 matuku kunyima kua dituku dikole dia Tsetse mu Afrike wa ku Est anyi mu Afrike wa pankatshi anyi mujima ku kapia kakole kudi disama dia lukasa dia luondapu (Trypanosoma brucei rhodesiense) didi dilomba bua kuya diakamue mu lupitadi; tshintu tshidi katshiyi tshienza kanyinganyinga tshidi tshienda tshikola bitekete bitekete mu tshitupa tshia kapia tshidi ne mikalu mibandile mbingu 2 too ne ku 8 kunyima kua disuma dia nyunyi wa nsenga tshidi tshikengela biopsie wa dikoba/PCR bua Leishmaniasis.

Mutshi wa dipangadika: Kissing Bug vs Tsetse Fly vs Sandfly bite triage and post-exposure care¶

flowchart TD
    A["Disuma dia tshipupu anyi disama dia ku mêsu dia mu matunga a mashika"] --> B{"Ntshinyi tshivua tshilumbu tshia dimanyisha ne diumvua dia disuma?"}
    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 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) Bite: African Trypanosomiasis (Sleeping Sickness) Risk"]
    B -->|Tropics / Mediterranean / Middle East: Tiny 2-mm hairy golden fly with V-wings at dusk; painless or stinging papule| E["Phlebotomine Sandfly Bite: Leishmaniasis Risk"]
    C --> F{"Udiku ne disama dia lukasa, disama dia mishiku anyi dia nshingu, disama dia mupuya, anyi disama dia mutu paudi ujuka anyi?"}
    F -->|Yes: Nocturnal Triatomine Salivary Anaphylaxis| G["Bikila 911 / nomba wa tshimpitshimpi lelu; ela IM Epinephrine 0.3 mg mu tshiadi"]
    F -->|No: Local bite or bug found in bed| H["KUENA KUKOSA dîsu anyi kukosa; sukula dikoba ne nsabanga ne mayi anyi sukula disu ne saline; kukuata tshipupu mu tshibombi tshikanga"]
    H --> I{"Mu mafuku 5 too ne ku 30: Divula dia tshiadi tshia violet tshidi katshiyi tshisama ku luseke lumue (tshimanyinu tshia Romana), disama dia dikoba, anyi luya?"}
    I -->|Yes: Acute Chagas Disease| J["Diakamue dia lupitadi / ID: Mashi onso a T. cruzi PCR + Dipima dia mashi + ECG -> Tuadija Benznidazole anyi Nifurtimox wa matuku 60"]
    I -->|No symptoms| K["Tuma tshintu tshikuata bua PCR; enza tshibangidilu ne 6-to-8 lumingu lua T. cruzi IgG serology ne PCR pikala tshipupu tshikale tshimpe"]
    D --> L{"Mu mafuku 5 too ne ku 15: Disama dia nsongo mikunze (Tsetse Chancre) + kapia kakole, mutu usama, anyi nshingu ya mu nshingu?"}
    L -->|Yes: Acute Human African Trypanosomiasis| M["DIBUELA DIA LUPITU: Chancre aspirate & Giemsa blood smear + Lumbar puncture -> Oral Fexinidazole or IV Suramin/NECT"]
    E --> N{"Mu mbingu 2 too ne ku 12: Papule udi kayi ne kanyinganyinga udi ukola ulua ulcère crusted udi kayi ukola ne mikalu mibandile ya 'volcanic' anyi?"}
    N -->|Yes: Cutaneous or Mucocutaneous Leishmaniasis| O["KUFINYI anyi kupanda bu mudi tshipupu tshia bactérie to; biopsy/scraping from raised ulcer margin for Leishmania PCR + Miltefosine/Amphotericin"]

Difuanyikija dia mutu ne mutu: Kissing Bug (Chagas) ne Tsetse Fly (Sleeping Sickness) ne Sandfly (Leishmaniasis)¶

Bualu bena ngendu, bena mu misoko, ne baminganga batu misangu ya bungi bapetangana ne masama asatu aa a protozoa vector syndromes, dishilangana dia ku luseke ne ku luseke didi ne mushinga wa bungi:

Kissing Bugs (Triatomines), Romana's Sign, ne Acute Chagas Disease¶

1. Bua tshinyi mushindu udi Kissing Bug udia ne upatuka mu tshina udi ufila disama¶

Bipupu bia triatomine (Triatoma infestans, Rhodnius prolixus, Panstrongylus megistus, Triatoma dimidiata mu Latin America; ne Triatoma sanguisuga, Triatoma gerstaeckeri, Triatoma protracta, ne Triatoma rubida mu États-Unis) mu bimanu mu munya, nzubu ya bisonsa, nzubu ya mbua, mitshi ya nkunyi, ne muinshi mua matela, idi ipatuka butuku mikokibue kudi kapepe ka karbone (CO2) ne kapia ka mubidi. - Bua tshinyi badi bababikila ne: "Barbeiros mu Brésil, Vinchucas mu Andes, Chinches Besuconas mu Mexique):* Bu mudi muntu mulale utamba kulama mubidi wende ne maulu ende muinshi mua tshilamba, tshipupu etshi tshidi tshienda tshibuela pa mpala, pa matama, pa mishiku ne pa mêsu. - Didia dia mashi dia minite 15 too ne ku 30 didi kadiyi ne kanyinganyinga: Tshipupu tshidi tshiunzulula tshitupa tshiatshi tshilulame, tshia bitupa bisatu (proboscis) ne tshiela mate adi ne nitrophorins (biodi bidi bivudija mishipa), apyrases (bipangisha plakete), ne anesthesie ya muaba udibu basombele. Bu mudi disuma kadiyi dienza kanyinganyinga, muntu udi mulale katu ujuka padi tshipupu tshienda tshikola mu minite 15 anyi 30 to. - Buteyi bua ditangalaka dia bintu bia munda: Padi tshifu tshia tshipupu tshienda tshikola (nangananga mu bintu bidi bipatuka lukasa bu mudi Triatoma infestans ne Rhodnius prolixus), tshidi tshiela tshintu tshifiike tshia bintu bia munda buludiludi pa ditama dia muntu anyi pa tshilamba tshia mêsu kumpala kua kunyema. - Bualu bua mushinga mukole bua disama: Dikoba dia muntu didi kadiyi dinyanguke ne kadiyi ditshibuka didi tshibumba tshidi Trypanosoma cruzi metacyclic trypomastigotes kayi mua kubuela nkayatshi. Disama didi dienzeka anu padi muntu udi mulale kayi mumanye ukosa anyi ukosa muaba udibu bamusume (usukula ditontolola dia tuishi mu mputa mukese wa dibunda anyi dikoba didibu bapatule) NANSHA usukula ditontolola dia tuishi mu tshilonda tshia mêsu (disu) anyi tshia mukana (mishiku).

================================================================================
   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. Kujingulula tshimanyishilu tshia Romana kumpala kua tshipupu tshia bactérie anyi tshia selulitis wa ku mpala¶

Munkatshi mua matuku 5 ne 14 kunyima kua T. cruzi fecal trypomastigotes contact the conjunctiva of one eye, mubedi udi upeta tshimanyishilu tshia disama dia Chagas, tshimanyinu tshia Romana (tshidi tshileja kudi Cecilio Romaña mu 1935): - Bimanyinu bia disama dia Romana: 1. Strictly Unilateral (One Eye Only): Udi ulenga anu dîsu didi ne disama. 2. Painless, Violaceous (Purple-Pink) Bipalpebral Edema: Bitupa bia kuulu ne bia kuinshi bidi bivula bikole, misangu ya bungi bikanga tshitupa tshia palpebral fissure, ne dikala dikole, kadiyi ne mputa, dishintuluka dia dikala dia violet-mutoke, kadi bishilangane ne disama dia bactérie anyi dia tuzubu tua mu tshiadi, **kadiyi ne kanyinganyinga ne kadiena ne kanyinganyinga to kakuena pus jaune purulent to. 3. Conjunctivitis, Dacryoadenitis, and Preauricular Node: Divulangana dia gland lacrimal (tear) ipsilateral ne preauricular anyi submandibular lymph node mukole udi umueneka ku luseke lumue lua mpala. 4. Bule ne dikola dia mubidi: Tshimanyinu tshia Romana tshidi tshitungunuka munkatshi mua mbingu 2 too ne ku 4 nansha mudibu bafila manga a antibiotique anyi antihistamines, ne kapia kakole anyi kakole, disama dia mubidi, disama dia lymphadenopathie dia mu tshibungi, ne hepatosplenomegaly mukese.

3. Kukuata tshipupu, diteta dia diagnostic, ne diondapa dia matuku 60 dia antiparasite¶

1. Mushindu wa kukuata ne kutuma tshipupu tshia kissing Bug mu bukubi:
2. Koki kulenga tshipupu ne minu patupu to. Vwala bifulu bia mudimu bia musangu umua anyi ubalulule tshibombi tshia dikala pa mutu pa tshipupu, ela karte muinshi, ne ukanga tshibuikidiji.
3. Tangila bimpe mutu ne tshifu: bishi bidi bidia mitshi bidi ne maulu manene a nyima ne tshifu tshile tshinyunguluke, kadi bishi bidi bishipa bantu / bishi bia nkata bidi ne tshifu tshinene tshikosa bu tshia raptor ne kabiena bikuata T to. cruzi; bulelela Triatomine Kissing Bugs badi ne mutu mule, mutekete, muenza bu tshikokedi ne tshifu tshilulame, tshitekete tshisokoka muinshi mua tshiadi ne bimanyinu bia milonda ya orange/mikunze/ya jaune ku muelelu wa difu.
4. Tuma tshipupu etshi ku diambuluisha dia Tshibambalu tshiebe tshia malu a bukola bua mubidi, programe wa dikolesha dia iniversite, anyi Tshibambalu tshia CDC tshia masama a tshipupu ne malaria (DPDM) bua Diteta dia PCR dia Trypanosoma cruzi DNA (mu matunga a ku Sud kua États-Unis, 30 too ne ku 55 pa lukama ya bipupu bia muitu bidi ne T. cruzi).
5. Dimanya dia mu laboratware mu mubedi udibu baleje:
6. Mu tshikondo tshia dikisha dia tshimpitshimpi (mu mbingu 1 to ne ku 8 kunyima kua dipeta dia disama, anyi padi tshimanyinu tshia Romana / tshipepele tshidiku): Serology (anticorps IgG) utu misangu ya bungi anu mubi ku ntuadijilu. Bipimu bia mushinga mukole bidi Mashi onso Trypanosoma cruzi Real-Time PCR NE dikonkonona dia buludiludi dia mashi mapiamapia adi kaayi anyanguka (tshintu tshidi ne mâyi bua trypomastigotes idi yenza mudimu) ne mashi makole ne makese adibu balengeje ne Giemsa.
7. Panyima pa lumingu lua 6 too ne lua 8 (Dikonkonona dia malu adi kaayi malelela): Lomba bibidi bishilangane T. cruzi IgG serologic tests using distinct antigen preparations (ELISA plus immunoblot or IFA) to confirm or out out seroconversion, along a baseline 12-lead ECG (screening for RBBB, LAFB, or prolongation of PR).
8. Diondapangana dia tshishiki (Benznidazole ne Nifurtimox):
9. Bionso bibidi Benznidazole ne Nifurtimox (Lampit) FDA-approved in the United States ne World Health Organization (WHO):
   • Benznidazole (Mulongo wa kumpala): 5 too ne ku 7.5 mg/kg/dituku mu bitupa bibidi bia dituku dionso mu matuku 60 (too ne ku 8 too ne ku 10 mg/kg/dituku kudi babedi ba bana). Tangila bipupu, disama dia mitu ya ku mpenga, ne CBC/enzymes ya tshifu.
   • Nifurtimox: 8 too ne ku 10 mg/kg/dituku mu bitupa bisatu bia dituku dionso ne biakudia mu matuku 60 kudi bantu bakole (10 too ne ku 20 mg/kg/dituku kudi bana).

Disuma dia nyunyi wa Tsetse wa mu Afrike (Glossina) ne disama dia Trypanosomiasis dia mu Afrike dia bantu (disama dia tulu)¶

1. Kujingulula Tsetse Fly ne Trypanosomal Chancre¶

Bantu badi benza ngendu mu matunga a ku Est ne ku Sud kua Afrike (Serengeti, Ngorongoro, Masai Mara, Luangwa Valley, Zambezi, Okavango) anyi benza mudimu mu bitupa bia ku misulu bia mu Afrike wa pankatshi ne wa ku Ouest (Republique démocratique du Congo, République centrale africaine, Angola, Sud-Soudan) batu misangu mivule batuilangana ne Tsetse fly (Glossina). - Bua tshinyi DEET nkayende kena mua kuimanyika nyunyi ya Tsetse: Nsese ya Tsetse itu minene (8 too ne ku 15 mm), itu isuma lukasa mu munya ne mapuapua adi ne tshiseba idi ikokibua kudi mashinyi a safari adi enda, nsese ya lupuishi, ne bilamba bia bule anyi bifiike, ne itu kayiyi ne bukole bua kuimanyika DEET to. Nsongo yabu idi bu ya bayonete idi itobola bilamba bia khaki, mashosette, ne jean ya denim, ifila disama dikole ne disama didi dikoka ditontolola dia mashi. - Trypanosomal Chancre (Matuku 5 to ne 15 kunyima kua disuma): - Nansha mudi nyunyi ya tsetse mipite pa 99% kayiyi ne masama, disuma dia nyunyi udi ne Trypanosoma brucei rhodesiense (wa mu Afrike wa ku Est), ne misangu mikese Trypanosoma brucei gambiense (wa mu Afrike wa ku Ouest/wa pankatshi), udi ufila tshipupu tshia **Trypanosoma T 5 muaba wa bipizome too ne matuku 15 pashishe: - Tshimuenekelu: Tshintu tshikole, tshikole, tshitekete, tshinyunguluka tshitupa tshikunze too ne ku tshitoke tshidi ne bule bua santimetre 2 too ne ku 5 mu bule bua santimetre 2 too ne ku 5, tshibuikila kudi tshipupu tshia munkatshi anyi eschar mufike ne tshinyunguluka kudi tshitupa tshia nsongo tshidi tshitoka, tshidi tshilonda kudi tuzubu tua lymphe tudi tukola. - Bua tshinyi T. b. rhodesiense udi lutatu lua lukasa lua luondapu: - Mu mbingu 1 to ne ku 3 ya disuma, mubedi udi utuadija ne kapia kakole, disama dia mutu, disama dia mubidi, disama dia mubidi (trypanides), disama dia tshiadi, disama dia mutshima, ne dibuela dia CNS, bidi 100% bia lufu mu mbingu mikese too ne ku ngondo mikese pikalabu bamumanyishe bibi bu disama dia selile anyi dia bactérie. - Mukenji wa lupitadi wa lukasa: Muena ngendu yonso udi upingana ufumina mu Afrike wa kuinshi kua Sahara ne disama dia dikoba dikunze (chancre) ne kapia udi dijinga ne dibuela mu lupitadi dituku dimue dimue, dikonkonona dia buludiludi dia mâyi adibu bumbusha ku muelelu wa tshitupa tshia mubidi ne tshikebelu tshia mashi makole ne makese adibu balengeje ne Giemsa, dikonkonona dia dikoba dia mu tshiadi (CSF) dibuela, ne diondapa dia lukasa ne Fexinidazole wa ku mishiku anyi IV Suramin / Melarsoprol / Pentamidine / NECT.

Phlebotomine Sandfly Bites and Cutaneous or Mucocutaneous Leishmaniasis¶

1. Kujingulula tshipupu tshia "Volcanic Crater" tshidi katshiyi tshienza mudimu ne manga a antibiotique a bactérie¶

Mu matunga a mu Amerike wa ku Sud, mu tshitupa tshia Mbuu wa Mediterane, mu Moyen-Orient, mu Afrike wa ku Nord/Est, ne mu Asie wa ku Sud/wa pankatshi, tuishi tukese tua butuku tua Phlebotomine sandflies (Lutzomyia ne Phlebotomus species, anu bule bua milimetre 2) tudi tufila Leishmaniarosite munda mua selile: -he Classic Clinical ap: Pabuipi ne **mbingu 2 too nku 8 kunyima kua dipingana ku luendu lua muitu, ku mudimu wa busalayi, anyi ku dikisha dia ku Mbuu wa Mediterane, tshintu tshikese tshia nsenga tshikunze tshidi tshisuma ku dikasdia kuinshi, ku diboko, ku ditshi anyi ku mpala tshidi tshibenga kuondopibua* Pamutu pa kujika mu lumingu lumue bu mudibu basuma kudi nsese, udi wenda ukola bitekete bitekete ulua tshitupa tshia 1- too ne ku 5-centimetre tshidi ne tshitupa tshia munda tshikezuke anyi tinyanguke ne muelelu munene, mubandile, mubumbakane (mufuanangane ne tshina tshia mukuna wa kapia) udi **kayi ne kanyinganyinga kakole** pa kumbusha padiye ne disama diamusangu muibii. -*Bua tshinyi dipanda ne dipatula dia mash ne Cepalexin kabna bikumbane:** Baminganga batu misangu ya bungi bamona disama dia lemaniasis dia ku dikoba bu disama iastaph anyi diuma diambua, bafundaphalexin anyi benza mudimu wa dipanda ne dipatula dia mashi, bidi bivuija mputa ya mu mubidi kayi ulenga tshitupa tshia munda mua lile Leishmaniates. - **Njiwya mu dikoba mu buloba bupiabuia (*Viaa*) Mishipa:** Shi disama edi difumina mu Amerike wa pankatshi anyi wa ku Sud kudi **Leishmania (Viannia) braziliensis, L. panamensis, anyi . guyanensis***, bipupu bidi mua kutanlaka ku tshilonda tshia dikoba too ne ku **tshitupa tshia mu mishiku, mu tshiadi, mu tshiadi, ne mtshiadi** ngondo anyi bidimu pashishe (mucocutaneous leishmaniasis / espundia), binyanga tshitupa tshia mu mhiku ne bifikisha ku dikanga dia njila wa luya anyi ku dinyanguka dia mubidi padibu kabi babiondapa bimp. - **Mukeji wdikonkonona ne wa diondapa:** - Tangila mumanyiwa masaa a masama anyi wa malu a dikoba dia mu matunga a mashika bua kuenza **3- to 4-mm punch biopsy, dermal scrapg, anyi fine-needle airation miangatshila budiludi ku muelelu wa ulcère**kuenza biopsie anu ku tshita tshia necse to). - Tuma tstupa tshia mubidi bua species-specific *Leishmania* PCR** (tshidi tshikengela bua kusunguluja mishindu yaVianniaya mu buloba bupiabupia idi ikengela lndapu lua mubidi ne mishindu ya mu buloba bua kale idi mimanyike), Giemsa histopathology**udi ukeba mibidi ya *Leishman-Donovan[amastigotes]** idi munda mua selile), ne MacrophagesNevic (NNN) culture**. - Udi mua kuondopa bilondeshile mishindu ne muaba udibu basombele ne Miltefosine wa ku mishiku (Impavido, 50 mg PO misangu isatu ku dituku mu matuku 28), IV Liposomal Amphotericin B (AmBisome), anyi pentavalent antimonials anyi thermotherapy wa muaba udibu basombele bua Old World udi kayi ne lutatu L. bilonda binene.

Nomba ya tshimpitshimpi ya mu tshijengu ne mikenji ya bibambalu¶

• Etats-Unis ne Canada:
• Ela 911 bua disama dia Kissing Bug dia butuku, disama dia mutshima dikole, anyi disama dikole dia luya panyima pa luendu.
• Bikila CDC Parasitic Diseases Hotline ku +1-404-718-4745 anyi CDC Emergency Operations Center ku +1-770-488-7100 bua kupeta diyukidilangana dia munganga pa bidi bitangila Whole-Blood Trypanosoma cruzi PCR, Leish, ne manga a diluisha parasite (Benznidazole, Nifurtimox, Fexinidazole, Suramin, Miltefosine).
• Mu Texas, Arizona, California, Louisiana, ne Gulf of Mexico states, batuma Kissing Bugs bakuate ku diambuluisha dia State Department of Health anyi Texas A&M University Kissing Bug Research Lab.
• Latin America (Brésil, Mexique, Argentine, Bolivie, Colombie, Pérou):
• Ela 192 (SAMU) mu Brésil, 911 mu Mexique ne mu Argentine, 123 mu Colombie, anyi 106 mu Pérou.
• Londa mikenji ya PAHO ne ya Ministério da Saúde do Brasil Doença de Chagas Aguda: kumanyisha diakamue muntu yonso udibu bela meji ne: udi ne disama dia Chagas, dipima dia mashi a mubidi, ne difila dia tshianana dia Benznidazole wa mukana wa matuku 60.
• Royaume-Uni: Ela 999 anyi NHS 111, ne utume benyi badi bapingana ne Tsetse chancre, tshimanyinu tshia Romana, anyi ulcer wa Leishmania ku Lupitadi lua masama a mu matunga a mashika (London) anyi ku Tshilongelu tshia buanga tshia mu matunga a mashika a mu Liverpool.
• Buobumue bua matunga a ku Mputu: Ela 112. Tuma benyi badi bapingana ku nzubu ya luondapu ya mu matunga a mashika ne yukila ne Bilo bia WHO (Geneve) bua kupatula Fexinidazole, Suramin, anyi NECT mu tshimpitshimpi.
• Sub-Saharan Africa: Ela 112 / 999 anyi 10177 (South Africa) ne yukila ne AMREF Flying Doctors (+254 20 699 2299) mu Nairobi anyi national Ministry of Health Trypanosomiasis Control Programs bua kujadika diakamue mashi ne zole Suramin.

Nkonko itubu bela misangu ya bungi¶

Tshipupu tshia Kissing Bug tshidi tshibueja disama dia Chagas buludiludi ku diambuluisha dia disuma diatshi anu bu mudi tshisuku tshibueja malaria anyi?¶

Tòo. Bishilangane na mbua anyi nyunyi ya tsetse, tshipupu tshia Trypanosoma cruzi tshidi tshikebesha disama dia Chagas katshiena tshisombela mu tuishi tua Kissing Bug to, ne katshiena tshibuela nansha kakese ku disuma nkayadi to. Pamutu pa nanku, tshipupu etshi tshidi tshisombela mu tshifu tshia panyima tshia tshipupu ne tshidi tshipita mu tuishi tua mâyi tudi tshipupu etshi tshiela pa dikoba paditshi anyi matuku makese panyima pa didia butuku. Udi upeta disama anu wewe mudisuike anyi mukose tshitupa tshidi tshikuma, tshidi tshikupula tuishi tua tshipupu tshidi ne disama buludiludi mu tshitupa tshikese tshia disuma anyi mu bitupa bia mubidi bidi ne mâyi bia dîsu diebe (conjunctiva) anyi mukana.

Tshimanyinu tshia Romana ntshinyi, ne mmunyi mundi mua kutshimanya ne disuma dia dîsu dia pa tshibidilu anyi dia nsese ya dîba?¶

Tshimanyinu tshia Romana ntshimanyinu tshia kumpala tshia disama dia Chagas didi dimueneka matuku 5 too ne ku 14 kunyima kua bamane kuela tuishi tua Kissing Bug tudi ne disama dia Trypanosoma cruzi mu dîsu dimue. Bishilangane na disuma dia mbuji ku tshilamba tshia ku mêsu (didi dikola diakamue, dikola bikole, ne dijika mu matuku 2 anyi 3) anyi disu dia nsese dia bactérie (didi dikuata mêsu onso abidi ne pus wa jaune), tshimanyinu tshia Romana tshidi anu tshia ku luseke lumue, tshidi tshipatuka mbingu 1 anyi 2 kunyima kua dipetangana, tshidi tshikebesha dikola dikole, kadiyi ne kanyinganyinga-difuka dia kuinshi ne dia kuulu bipese bia dîsu dimue kabiyi ne pus wa jaune, ne bidi bienda pamue ne tshitupa tshia lymphe tshidi tshiuwule kumpala kua ditshi ne luya ludi lupita mbingu ya bungi.

Ntshinyi tshindi mua kuenza meme mupeta tshipupu tshia Kissing Bug mu bulalu buanyi anyi pa dikoba dianyi?¶

Tshia kumpala, kuedi meso eba anyi kukosa muaba udi muntu mukusuma to, ne diakamue sukula dikoba ne nsabanga ne mayi a kunua (anyi sukula dîsu ne mâyi a mukele adi kaayi ne disama) bua kumbusha tutoyi tukese tua mu tshisuku kumpala kua bipupu kubuela mu dikoba. Tshibidi, kutshinyi tshintu nansha tshimue ne tshianza tshiebe tshia patupu to; uyikuate muinshi mua tshibombi anyi dikopo dia dikala, uyisuike mu tshintu, ne usukule bilamba bionso bia bulalu mu mayi a kapia. Ku ndekelu, yukila ne tshibambalu tshia malu a bukola bua mubidi anyi munganga bua kuenza mateta a tshipupu etshi ku diambuluisha dia PCR bua Trypanosoma cruzi ne uditangile matuku 30 bua kumanya ni udi ne kapia, disama dia mêsu anyi disama dia dikoba dikole.

Disama dia Chagas didi mua kuondopibua bimpe menemene padibu badikuata kumpala kua dîba kunyima kua dikuma dia Kissing Bug anyi?¶

Eyowa. Padibu bapeta disama dia Chagas mu tshikondo tshia Acute Phase (mbingu 2 too ne ku 8 ya kumpala kunyima kua dipetangana, padi bishi biendakana mu mashi ne bidi mua kumanyibua ku diambuluisha dia PCR anyi dipima dia mashi), dienza dia matuku 60 dia manga a diluisha bishi (Benznidazole anyi Nifurtimox) didi dikumbaja 80 too ne ku 90 pa lukama (pabuipi ne 1900 pa lukama mu bana batyetye ne bana), kupangisha disama dia mutshima dia kashidi, disama dia tshiadi, ne dinyanguka dia tshiadi tshidi mua kuenzeka kunyima kua bidimu 10 too ne ku 30.

Mmunyi mundi mua kumanya tshipupu tshia nyunyi wa Tsetse kunyima kua luendu lua mu Afrike, ne bua tshinyi mbualu bua lukasa?¶

Bishilangane na Kissing Bug udi uluma butuku mu nzubu kakuyi kanyinganyinga, nyunyi wa Tsetse wa mu Afrike (Glossina) utu uluma bikole mu munya mu madimi a nyama anyi muitu. Shi nyunyi uvua ne disama dia Trypanosoma brucei rhodesiense (disama dia tulu dia mu Afrike wa ku Est), muaba uvuabu bamulume udi upeta tshitupa tshikole, tshia kapia, tshia nsongo tshikunze ne tshikunze (tshia santimetre 2 too ne ku 5) tshidibu babikila ne: trypanosomal chancre matuku 5 anyi 15 kunyima kua disuma, ne pashishe kudi luya lukole lua lukasa, disama dia mu mutu ne disama dia mutu. Bualu disama dia tulu dia mu Afrike wa ku Est didi mua kubuela mu buongo ne kufikisha mutshima ne bitupa bia mubidi bia bungi mu mbingu 3 anyi 6, muntu yonso udi wenza ngendu mu safari udi ne disama dia dikoba ne kapia udi dijinga ne dipima dia mashi mu lupitadi dituku dimue ne diondapibua ne Fexinidazole anyi Suramin.

Bua tshinyi disuma dikese dia nyunyi wa nsenga diakalua tshilonda tshia "tshibandabanda tshia kapia" tshidi katshiyi ne kanyinganyinga mbingu mikese kunyima kua luendu luanyi?¶

Tuishi tukese tua 2-millimetre tua Phlebotomine mu Amerike wa ku Sud, mu Mbuu wa Mediterane, mu Moyen-Orient, mu Afrike ne mu Azia tudi tufila bipupu bia Leishmania buludiludi mu dikoba padibu baluma. Kunyima kua tshikondo tshia mbingu 2 too ne ku 8, tshitupa tshikese tshia rose tshidi tshivula ne tshiunzuluka tshilua tshilonda tshidi katshiyi tshisama, katshiyi tshiondapa ne muelelu munene, mubandile, mubumbakane udi umueneka bu tshina tshia mukuna wa kapia (leishmaniasis cutanée). Bu mudibi bifumina ku protozoa udi munda mua selile pamutu pa bactérie, mafuta a antibiotique ne manga a staph a mukana kaena ambuluisha to; munganga udi ne tshia kuangata biopsie mukese anyi kukosa ku muelelu mubandile bua Leishmania PCR ne kumufundila buanga bua diluisha leishmania bu mudi miltefosine wa ku mishiku.

Miaba ne buludiki bua mbulamatadi¶

• Centres for Disease Control and Prevention (CDC, United States): Chagas Disease (Trypanosoma cruzi): Triatomine Vector Identification, Acute Phase PCR Diagnosis, Romana's Sign, and Benznidazole / Nifurtimox Treatment Protocols.
• Bulongolodi bua bukola bua mubidi pa buloba bujima (OMS) ne Bulongolodi bua bukola bua mubidi bua mu Amerike (PAHO): Mibelu ya dimanya ne diondapa dia disama dia Chagas; Mibelu ya OMS idi itangila diondapa dia disama dia tshiadi tshia mu Afrike (Fexinidazole); ne Dikokesha dia Leishmaniases.
• Infectious Diseases Society of America (IDSA) & ASTMH: Clinical Practice Guidelines on Diagnosis and Management of Leishmaniasis (Aronson et al., Clinical Infectious Diseases).
• Tshisumbu tshia muoyo tshia mu Amerike (AHA): Dimanya ne dilama dia babedi badi ne disama dia mutshima mu disama dia Chagas (Nunes et al., Circulation).
• *Triatomine (Kissing Bug) Salivary Procalin Anaphylaxis in the Southwestern United States (Klotz et al.).

Malu adi apetangana¶

• Disama dia allergie ne anaphylaxie diambuluisha dia lukasa
• Diambuluisha dia kumpala dia nyuki, mbua, ne mbua
• Diambuluisha dia kumpala dia disuma dia nkutshi ne dia nsese
• Dilamakaja dia nkutshi mu dîsu, mu nshingu, anyi mu dikoba, disama dia nkutshi, ne diumusha dia botfly
• Nomba ya njiwu bilondeshile ditunga