Umupfakazi w'Umwirabura n'Igitagangurirwa c'Umukara: Ugukomera kw'Imitsi n'Ibisebe vy'Urukoba¶

Mu bihugu vyose vyo muri Amerika, muri Australiya, mu Buraya no muri Afirika, indwara ziterwa n’ibitagangurirwa zifise akamaro mu vy’ubuvuzi zigabanywamwo indwara zibiri zitandukanye cane: ubumara bw’imitsi buva ku bitagangurirwa vy’abapfakazi n’ivy’ibisiga vy’umutuku (ubwoko bwa Latrodectus) na ubumara bw’imitsi y’ibisiga buva ku bitagangurirwa vy’ubwoko bwa Recluse canke Loxosceles* (ubwoko bwa Loxosceles). Umupfakazi w’Umwirabura canke Redback wo muri Australiya atera alpha-latrotoxin, ubumara bw’imitsi y’imbere y’umubiri butera ububabare buteye akaga ubwo nyene bugakurikirwa mu minota 30 gushika ku 90 n’ugutera ububabare, imitsi y’amagufa imeze nk’umupfunda, **ugukomera nk’urubaho kw’uruhome rw’inda, ivyutsi vyo mu karere, n’umuvuduko w’amaraso mwinshi cane, mu gihe hafi ata n’umwe asiga urukoba rwononekaye aho yarumye. Ku rundi ruhande, igitagangurirwa citwa Brown Recluse gitera sphingomyelinase D (phospholipase D), umuti usenya utugingo ngengabuzima akenshi udatera ububabare na gato iyo umuntu aryoshe, ariko ugahinduka mu masaha 6 gushika ku 72 ukagira **igice c’umubiri gitukura, cera, n’ubururu c’umubiri w’umuntu, n’umubiri w’umuntu. n’ibindi bishobora gutuma umuntu apfa (hémoglobinurie y’umuhondo mwiza, jaunisse, n’indwara y’amafyigo), canecane mu bana. Igihambaye cane, ibice birenga 80 kw’ijana vy’ibivyimba vy’umutuku bibabaza kandi bivyimba bimenyekana n’abarwayi ko ari ibisiga vy’ibisiga, mu vy’ukuri ni ibivyimba vy’urukoba bishobora guhangana n’imiti yitwa methicillin Staphylococcus aureus (CA-MRSA). Iyo umuntu yarumye afise ububabare bukomeye mu nda canke mu mugongo, akagorwa no guhema, akagira amasobe y’inzobe, canke akagira urukoba rwo gutukura rwihuta, hamagara uwo mu karere iwanyu . inomero z'ivyihutirwa ubwo nyene. Suzuma kandi uburongozi bwacu bw’abavukanyi ku ururimi rw'inzoka n'igitagangurirwa, cellulite, imirongo itukura, n’ibisebe vyo ku ruhu vya MRSA, na inzoka irya.

Ico ushaka gukora ni uko woza neza aho urya n’amazi n’isabune, ugatera igikoresho gikonje canke igipande c’urubura kizingiye mu mpuzu (ntiwigere ushirako ubushuhe ku muntu arya, kandi ntukigere ushirako igitagangurirwa canke umugozi wo gukingira umukazo), gukurikirana ko ata mitsi iriko iraduga canke ko idashobora gukora neza, kugira ngo ubone ko ata mitsi iriko iraduga. opioïdes ziterwa mu mitsi na Latrodectus Antivenom mu gihe umupfakazi arya cane canke gukurikirana amaraso mu gihe umuntu arya umuntu yiherereye.

Ivyo ubikore ubu¶

1. Uce usuzuma ubwo nyene ibimenyetso vy’ubuzima bishobora gutera ingorane maze uhamagare inomero y’ivyihutirwa yo mu karere kawe nimba iriho. Hamagara 911 muri Leta Zunze Ubumwe za Amerika na Canada, 000 muri Australiya, 111 muri Nouvelle-Zélande, 112 mu Bumwe bw’Uburayi bwose, 999 mu Bwongereza, canke urabe urutonde rwacu rw’isi yose rwo inomero z'ivyihutirwa iyo umuntu afise ububabare bukomeye bwo gutera mu nda, mu mugongo, mu gikiriza canke mu matako, akagira ingorane zo guhema, akagira umuvuduko mwinshi w’amaraso, akagira iseseme, akagira ibisebe muri rusangi, umuriro, umuhondo (amaso y’umuhondo), canke amasobe y’ibara ry’icayi canke ry’ibara ry’umukara.
2. Fotora neza igitagangurirwa (canke uzane igitagangurirwa gijanjaguwe mu gitereko gipfutse) iyo gusa kiri ng’aho nyene, ata ngorane yo kurya ubwa kabiri. Ikimenyetso ciza c’igitagangurirwa c’umupira w’umukara gica ibibatsi gifise ibara ry’isaha ry’umutuku (Latrodectus) n’igitagangurirwa c’umukara gifise ikimenyetso c’amaso y’ibara ryirabura arsi bibiri bibiri (Loxosceles) bica biyobora uburyo bwo gucungera ubumara bw’ibitaro.
3. Wose aho umuntu aryoshe neza n’isabune yoroshe n’amazi akonje, hanyuma ukureho impeta zose, amasaha, imiringa, canke inkweto zikomeye ku gice carumye. Ntukigere ukata, ukata, uyonka, utera umuriro, ukoreshe imbunda zitera umuyagankuba, canke ngo ufyonde igikomere carumye. Iyo umuntu arwaye Loxosceles canke akayica, sphingomyelinase D iragoberwa gushika kure cane mu binure vyo munsi y’urukoba no mu mitsi y’urukoba, bigatuma igisebe c’urukoba gikura cane.
4. Shira igitambaro gisukuye kandi gikonje gitose canke igipapuro c’urubura kizingiye mu gitambaro (iminota 10 gushika kuri 15, iminota 15 uzimye) aho warumye, kandi NTUKIGEZE ushirako igikoresho co gushusha canke igikoresho gishushe ku gipfukisho c’umubiri wikekwa ko carumye. Kubera iki ubushuhe buhambaye: the Brownngo enzyme ubumara burafise ubuhinga bwo gukora bushingiye ku bushuhe. Gushusha urukoba bituma enzyme zikora neza, zigatuma ama neutrophiles zikora neza, n’urupfu rw’imitsi y’urukoba rurapfa, mu gihe gukonjesha neza bituma enzymes sphingolipids zicapura buhoro kandi bikagabanya ububabare bwo mu karere mu gihe c’abapfakazi n’abarwayi b’abanyaruyeri.
5. NTUKIGERE ukoresha umugozi wo gukingira umuvuduko (PIB) canke umugozi wo gukingira umutsi ku gitagangurirwa c’umupfakazi w’umukara, umutukura, canke igitagangurirwa c’umukara. Mu gihe c’Inama y’Ugusubiza Ubuzima muri Australiya (Ingingo ngenderwako ya ANZCOR 9.4.2) n’amategeko agenga ubumara bwa Amerika y’Uburaruko, umugozi wo gukingira umuvuduko w’amaraso **uwubujijwe (Redback/Widow) na Loxosceles (Recluse) ziruma: gufata ubumara bw’umupfakazi birongereza ububabare bubabaje bwo mu karere, kandi gufata ubumara bw’umupfakazi butera intungamubiri zisenya utugingo ngengabuzima ahantu hamwe, bigatuma urukoba rwongerekana cane. (Iciyumviro: PIB ikoreshwa ku ibisiga vy’i Australiya [Atrax / Hadronyche] n’ibisiga vy’inzoka, ntiyigera ikoreshwa ku bisiga vy’umutuku, umupfakazi canke ibisiga vy’umutuku.)
6. Suzuma ibara ry’amasobe ku rugendo rwose rwo kwiyuhagira mu kiringo c’amasaha 72 inyuma y’aho umuntu akekwaho ko aryamye Brown Co Recluse, cane cane ku bana. Iyo amasobe ahindutse ibara ry’agahama, ry’umutuku, ry’umugese, canke ry’umukara nk’urwa Coca-Cola, ubumara bwaba bwinjiye mu maraso kandi buriko burasambura utugingo ngengabuzima dutukura (tacuscem-nexolisme viscega hemolytic anemia), ivyo bikaba bisaba ko umuntu ahita yinjira mu bitaro vy’abana canke abakuze kugira ngo ashobore guhabwa amazi menshi mu mutsi no guterwa amaraso.

Igiti c'ingingo: urumogi rw'igitagangurirwa n'ibisebe vya MRSA n'ubumara bwo mu bwonko n'ubumara bwo mu bwonko¶

flowchart TD
    A["Bikekwako ururimi rw'igitagangurirwa canke igikomere c'urukoba kibabaje"] --> B{"Woba wabonye igisiga kiruma urukoba mu gihe cabaye?"}
    B -->|No spider seen; swollen painful red bump draining pus| C["Ivyiza vyinshi (birenga 80%) vy'ibisebe vy'urukoba biterwa n'imigera ya CA-MRSA"]
    B -->|Yes, or classic clinical toxidrome developing| D{"Ni ibimenyetso ibihe bihambaye mu masaha 1 gushika kuri 24?"}
    C --> E["NTUFINYE; gukurikirana urubibi n’ikaramu; reba umuganga ku bijanye n'uguca no gukura amazi + antibiyotike za MRSA"]
    D -->|Immediate pinprick, target halo with sweating/goosebumps, then severe muscle cramps in back, abdomen, or chest| F["Latrodectisme: Umupfakazi w’Umwirabura canke Igitagangurirwa c’Umutuku (alpha-latrotoxin)"]
    D -->|Painless or mild sting initially; at 2 to 24 hr develops Red-White-and-Blue plaque with central pale blister| G["Ugutahura: Igisiga c'umukara / igitagangurirwa c'inanga (sphingomyelinase D)"]
    D -->|Australia eastern coast: large black spider, immediate severe pain, profuse sweating, drooling, muscle twitching| H["Igitanguriro co muri Australiya: ushireko PIB ubwo nyene + hamagara 000 kugira ngo ubone Antivenom y'urubuga"]
    F --> I["Woze n’amazi n’isabune; guterako ibarafu ryinjijwe; NTUZOKWIGEZE ukoresha PIB; genda kuri ED"]
    I --> J["Ibitaro ED: IV opioïdes + benzodiazepines + Antivenom y’amafarasi Latrodectus ku bubabare bukomeye canke umuvuduko w’amaraso"]
    G --> K["Woze neza; igipfunsi gikonje; gushira hejuru igihimba c’umubiri; NTUKIGERE ukoresha ubushuhe, PIB, canke guca igihimba c’umubiri hakiri kare"]
    K --> L{"Umuriro, ibisebe, umuhondo, amasobe y’inzobe yirabura, canke umwana?"}
    L -->|Yes: Systemic Viscerocutaneous Loxoscelism| M["Ukwinjira mu bitaro vy’abarwayi bikomeye: amazi yo mu maraso, ama laboratwari y’uruhererekane ya hemoglobine/hemolyse, guterwa amaraso y’amaraso"]
    L -->|No: Cutaneous Loxoscelism only| N["Ukwitaho ibikomere vyo mu karere, guhindura ububabare bwa tetanus, gutevya gukuraho ibikomere gusa inyuma y'aho eschar ihereye ku ndwi 6 gushika ku 8"]

Igereranyo ry’ubuvuzi ry’umutwe ku mutwe: Umupfakazi w’Umwirabura (Latrodectism) n’Umupfakazi w’Umwirabura (Loxoscelism) n’Ikivyimba ca MRSA¶

Kubera ko abantu b’abanyabwenge n’abaganga ba mbere bakunda gutera urujijo ku ndwara y’umupfakazi, indwara y’umupfakazi, n’ibivyimba vy’imigera isanzwe, gutandukanya ibintu biri ku ruhande ni ikintu gihambaye cane:

Umupfakazi w'Umwirabura n'Ibisiga vy'Umutuku (Latrodectus) n'Ibisiga vy'Umubiri¶

Ivyerekeye indwara z'ibihimba vy'umubiri vy'ubumara bwa Alpha-Latrotoxin¶

Ibisiga vy’abapfakazi b’ingore (Latrodectus mactans [Umupfakazi w’Umwirabura wo mu Bumanuko], Latrodectus hesperus [Umupfakazi w’Umwirabura wo mu Burengero], Latrodectus variolus [Umupfakazi w’Umwirabura wo mu Buraruko], Latrodectus tredecimguttatus [Umupfakazi w’Umwirabura wo mu Bumanuko], na *Umupfakazi w’Umwirabura wo mu Kiyaga Mediterane]) ubumara n’amano y’ibitoke afise imyobo maremare bihagije kugira ngo ashobore kwinjira mu ruhu rw’umuntu (mu gihe utusiga dutoduto tw’igitsina-gabo tw’abapfakazi tudashobora gutobora urukoba rw’umuntu).

1. Uguhingura amazi y’umubiri: Ubumara nyamukuru bw’ibikoko bifise urutirigongoye buri mu bumara bwa Latrodectus ni alpha-latrotoxin, ni poroteyine y’uburemere bwa 130 kDa ica mu nzira z’amaraso ikaja mu nzira y’amaraso kandi igafatanya n’ubumara bukomeye bw’ibikoko bifise urutirigongoye mu bumara bwa Latrodectus na-1. amabara y’iherezo y’imitsi n’iherezo ry’imitsi y’umubiri.
2. Ugutera ivyatsi bitagenzuwe: Iyo bifatanye, ama molecule ane y’ubumara bwa alpha-latrotoxin arakorana mu gice c’umubiri citwa tetramere maze akaja mu gice c’amaraso c’iherezo ry’imitsi, agaca agira umurongo w’ivyatsi bishobora guca muri calcium uhoraho. Ivyo bihimba vy’umubiri bita calcium bica biza mu mpera y’imitsi y’imbere y’umubiri, bikaba bituma habaho exocytose nyinshi z’imitsi y’imbere y’umubiri irimwo acetylcholine (ku nzira y’imitsi y’amagufa) na norepinephrine na epinephrine (ku mpera y’imitsi y’imbere y’umubiri).
3. Imitsi y’umubiri imeze nk’imipfunda ata rupfu rw’imitsi rudahera: Ubumara bwa botulinum butandukanye n’ubumara bwa alpha-latrotoxin ntibushobora gusenyura ubudasiba umutsi w’umubiri. Ahubwo, gutera acetylcholine bifunga imitsi y’amagufa mu gutera imbere, gutera imbere mu gihe gutera norepinephrine bitera icuya kinini mu karere, piloerection, n’umuvuduko w’amaraso mwinshi, bikagabanuka mu kiringo c’amasaha 48 gushika kuri 96 nk’uko ibihimba vy’umubiri bisubira inyuma.

Kwemera iterambere ry'ubuvuzi bw'ubumuga bwa Latrodectisme¶

1. Iciciro ca 1: Igitero c’Ikigereranyo n’Iciyumviro (Iminota 0 gushika ku 30): Bitandukanye n’ibirenge vy’abantu biherereye, 75 gushika ku 90 kw’ijana vy’abapfakazi bafatwa n’ibitagangurirwa bumva iyo ndwara igihe nyene bishika, kenshi na kenshi igitero gikomeye iyo bambaye amaganzu canke inkweto, baterura ibikoresho vyo mu nzu canke inkwi zo mu nzu, bariko baraterura inkwi. Mu minota 15 gushika kuri 30, iyo nkoko iragira igice c’uruziga cera gikikujwe n’umuco w’umutuku mutoyi, ikaba igira utudodo dutoduto tw’icuya n’ibisebe vy’inzoka biduze aho nyene irya.
2. Iciciro ca 2: Uguduga kw’imitsi n’imitsi y’akarere (Iminota 30 gushika kuri 90): Imitsi y’akarere iri mu rubavu canke mu gikiriza iragira ububabare, maze imitsi iboneka n’imitsi ikomeye imeze nk’ivy’amavuta y’umubiri iraduga ku gice c’umubiri carumwe kija ku ntugu.
3. Iciciro ca 3: Ugutera imbere muri rusangi, Inda imeze nk'urubaho, n'Ugusenyuka kw'Inda (Amasaha 1 gushika kuri 12):*
4. Imitsi yo mu mpera zo hasi irashika mu matako, mu mugongo wo mu rubavu, no mu uruhome rw’imbere rw’inda, igafunga imitsi y’inda igororotse mu uburemere bumeze nk’ubw’urubaho n’imipfunda ibabaza 10/10 y’ugukomera.
5. Ukuruma kw’ibihimba vyo hejuru canke kw’izosi guca mu bitugu, mu mitsi iri hagati y’ibihimba vy’umubiri, no mu ruhome rw’igikiriza, bigatuma igifu gifatanya cane n’uguhema nabi nk’uko umuntu arwaye umutima.
6. Ubutatu bwigenga no kutagira aho uhagaze: Ubutatu buteye ubwoba ugucuya (diaphoresis), ugutera umuvuduko w’amaraso mwinshi (kenshi birenze 180/110 mmHg), na Latrodectus facies (mu maso hatukura, harimwo ivyutsi vy’amaso n’imbere). Mu buryo butandukanye n’umurwayi afise ububabare bw’umubiri nyakuri (appendice ruptured) aryamye ataco akora ku ntambamyi, umurwayi w’umupfakazi w’umukara aguma azunguruka, agendagenda, kandi apfukama umugongo agerageza kurambura imitsi ipfutse.

Ubuyobozi bw'ibitaro vy'umupfakazi w'umwirabura n'ubumara bw'umutuku¶

1. Igituma Gluconate ya Calcium iterwa mu mutsi idakoreshwa: Urutonde rw’ubuvuzi rwagenzuwe rwerekanye ko Imiti ya calcium gluconate mu mutsi idakora neza ugereranyije n’imiti y’ibiyobyabwenge iterwa mu mutsi ifatanijwe n’imiti yitwa benzodiazepines**.
2. Ubuvuzi bw’umurongo wa mbere (Imiti y’ibitera ububabare + Imiti y’ibitera ububabare): Gutanga morphine (0,1 mg/kg) canke fentanyl (1 mcg/kg) ku bubabare bukomeye, ifatanijwe n’imiti y’ibitera ububabare** nk’iyitwa mg to**m00 (1 gushika kuri 2 mg IV) kugira ngo umuntu ashobore guhagarika GABA-A yo mu mugongo, arekure imitsi y’umutima, no kugenzura umuvuduko w’amaraso.
3. Umuti nyawo: Ubumara bw'amafarasi Latrodectus: Muri Amerika y'Uburaruko (Ubumara Latrodectus mactans) no muri Ostraliya (CSL Redback Spider Antivenom), Ibikombe 1 gushika kuri 2 vy'ubumara bw'amafarasi bushizwe mu minota 15 gushika kuri 30 bitanga ugukira kw'imitsi n'ugukira kw'imitsi kugeza ku minota 60. Igaragazwa ku bubabare bukomeye budakira imiti y’ibitera ububabare n’imiti y’ibitera ububabare, ingorane y’umuvuduko w’amaraso, ugusama (kugira ngo umuntu ntavyare imbere y’igihe canke gukuraho igihimba c’irondoka), n’ubumara bukomeye mu bana bato canke abakuze bafise intege nke.

Ibisiga vy'umukara n'ivy'inanga (Loxosceles) n'ibisiga vy'umubiri bipfuye canke bifise ubumuga bwo mu mutwe¶

Gukuraho ibisiga vy'ibinyoma: Mnemonic¶

Abaganga kenshi barafata nabi ibisebe vy’imigera CA-MRSA, ibisebe vy’indwara y’igisukari, herpès simplex, canke Lyme erythema migrans nk’uko Brown Recluse irya mu turere ata bitagangurirwa Loxosceles biba. Abahinga mu vy’ubumara bakoresha NOT RECLUSE mnemonic yemejwe kugira ngo bakuremwo ururimi rw’umuntu yiherereye no kumenya indwara y’imigera:

• N (Numerous): Ivyiyumviro birenga 90% vy’ibikoko vy’ukuri vyitwa Brown Recluse ni ibikomere bimwe bimwe (kuva ku kwikubita hejuru y’igitagangurirwa kimwe gifise umutego mu gitanda canke kwambara impuzu). Ibisebe vyinshi vyerekana ibiguruka, ibikoko vyo mu gitanda canke ibivyimba vya MRSA, atari umuntu yiherereye.
• O (Igihugu): Muri Amerika y’Uburaruko, Loxosceles reclusa ivuka mu Bumanuko-Hagati n’Uburengero Hagati bwa Amerika gusa (Nebraska na Iowa bimanuka gushika i Texas, mu buseruko gushika mu burengero bwa Georgia no mu Bumanuko bwa Ohio). Hanze y’ibice vy’ibidukikije Loxosceles (canke Amerika y’Epfo ku L. laeta), ururimi rw’inyamaswa yiherereye ntabwo rushoboka.
• T (Igihe): Ivyiyumviro birenga 85% vyemejwe ko Loxosceles reclusa irwaye bishika mu mezi ashushe (Kuva muri Ndamukiza gushika mu Gitugutu).
• R (Ikibanza Gitukura): Ururimi rw’ukuri rw’Ikinyamasyo c’Umutuku rutera igice c’umubiri gifise ibara ry’umuhondo ry’umuhondo, ry’umweru canke ry’ubururu bwijimye (kubera ko sphingomyelinase D ifata imitsi y’urukoba). Igisebe gifise umutuku ukeye, gishushe hagati ni indwara y’imigera.
• E (Elevated Dome): Igikoko nyaco c’Ikinyamasyo c’Ibara ry’agahama ni igipfukisho canke gipfutse munsi y’urukoba rukikuje (gifise uburebure buri munsi ya sentimetero 1). Igikoko giteye hejuru, kivyimvye, gifise uburebure burenga sentimetero 1 ni igisebe c’imigera cuzuye ibisebe (ibivyimba).
• C (Idakira mu mezi 3): Mbere n’ibisebe binini vy’umubiri bikira mu ndwi 8 gushika kuri 12. Ibisebe bigumaho mu mezi 3 aheze bisaba gupima kanseri y’urukoba, pyoderma gangrenosum, canke indwara y’ibiherere ku mubiri.
• L (Inini irenga cm 10): Ibikomere birenga 90% vy’ibihimba vy’irondoka bifise uburebure butoyi kuruta santimetero 3 gushika kuri 10 (1,2 gushika kuri 4 inches).
• U (Ulcerates Too Early, munsi y’imisi 7): Mu gihe umuntu arwaye Brown Recluse, urukoba rwo hagati rugira igisebe c’umwirabura (eschar) mu misi 5 gushika kuri 14 kandi ntirufunguka ngo rube igisebe c’umukara gushika ku musi wa 7 gushika ku musi wa 14. Igisebe gituritse kigasohoka amazi y’umuhondo ku musi wa 2 canke ku musi wa 3 ni ibivyimba vya MRSA vy’imigera.
• S (Ivyimvye): Uretse ku gipfukisho c’amaso canke ku kirenge, iyo umuntu aryoshe n’ibikoko ntibituma amaguru n’amaboko bivyimba cane ata n’imwe igira erytheme y’uburemere bw’isi.
• E (Exudative Pus): Ivy’ukuri vy’urukoba rw’umukara ni indwara z’urukoba rwumye. Ivyimba vy'umuhondo canke vyera bisigura indwara y'imigera, si ubumara bw'ibitagangurirwa.

Ivyerekeye indwara z’urukoba: Umutuku, Umweru, n’Ubururu n’Ugukwiragira kw’Inguvu¶

Iyo igitagangurirwa Loxosceles gifatanye n’urukoba imbere mu mpuzu canke mu bitanda, amano yaco aratera sphingomyelinase D (phospholipase D) hamwe n’umuti witwa hyaluronidase:

1. Amasaha 6 gushika 48 (Ikimenyetso c'Umutuku, Umweru, n'Ubururu):
2. Ikibanza c’ubururu/Ibara ry’umuyugubwe: Sphingomyelinase D icagura sphingomyeline y’imbere mu mubiri, igatuma utugingo ngengabuzima dukorana, utugingo ngengabuzima dukorana, n’ugutera amaraso mu mitsi mito mito. Inzara y’amaraso, urukoba rwo hagati ruhinduka ubururu-butukura canke umutuku w’agahama (kenshi rugira igisebe c’amaraso).
3. Impeta yo hagati yera: Ikikuje umurongo w’amaraso w’umutuku ni igice gitoya, impeta y’umutuku w’agahama iterwa n’ugucika kw’imitsi y’umubiri.
4. Red Outer Halo: Ikikuje impeta yera hari umuco wagutse w’umururumba w’imitsi y’umubiri.
5. Ugukwiragira kw’isi n’ugusenyuka kwa Eschar (Imisi ya 5 gushika ku ya 21): Kubera ko ubumara bwa Loxosceles burimwo hyaluronidase (ikintu gikwiragira), uburemere bw’isi burakwegera iyo enzyme hasi biciye mu ndege z’ibinure ziri munsi y’urukoba zigaca zigira ishusho y’amarira. Mu bice 10 gushika ku bice 30 kw’ijana vy’ibirungo bica bipfa (na cane cane ku bice vy’ibinure nk’amatako, amatako canke inda), igice c’ubururu kiri hagati kirakomera kikaba eschar y’urukoba rwinjiye, rwumye, rwirabura ku musi wa 5 gushika ku wa 7, ivyo bikaba bitandukanya hagati ya Umusi wa 7 n’Umusi wa 21 he ulcer to2a1. amayinga.

Loxoscelisme systémique viscerocutanée (Hemolyse intravasculaire: Ingeramizi y’ukuri y’ubuzima)¶

Mu 1 gushika ku 2 kw’ijana vy’ibikoko Loxosceles reclusa vyo muri Amerika y’Uburaruko (kandi 10 gushika ku 15 kw’ijana vy’ibikoko Loxosceles laeta vyo muri Amerika y’Epfo), cane cane mu bana, sphingomyelinase D yinjira mu maraso maze igafatanya n’utugingo ngengabuzima dutukura tugendagenda**:

• Igitero c’amaraso mu mitsi: N’igihe urukoba rwarumye rusa n’uruto, sphingomyelinase D irakura glycophorins mu turemangingo tw’amaraso dutukura maze igatuma complément ikora, igatuma ugusenyuka kw’amaraso mu mitsi mu masaha 24 gushika kuri 72 inyuma y’aho urukoba rurumye.
• Ibimenyetso vy'akaga vyo kwirinda mu masaha 72 ya mbere:
• Umuriro, ububabare, gukorora, kubabara mu ngingo, n’ibisebe vy’umutuku bikwiragiye bitangura amasaha 12 gushika kuri 48 umuntu amaze kurya.
• Amasozi y’inzobe, y’ibara ry’icayi canke y’ibara ry’ikola (hemoglobinuria) nk’uko utugingo ngengabuzima dutukura dusesagura hemoglobine y’ubuntu mu maraso no mu mafyigo, bikaba bitera ugukomeretswa kw’amafyigo (AKI).
• Hemoglobine igabanuka vuba (anemie), ububabare bw’umuhondo, umutima utera cane, n’ububabare bw’umuhondo (amaso y’umuhondo) iruhande ya DIC.
• Itegeko ry’ibitaro: Umwana wese canke umuntu mukuru afise umuriro, ibisebe, canke amasobe y’umwirabura inyuma y’aho akekwaho kurya umuntu yiherereye, bisaba kwinjira mu bitaro ubwo nyene, gupima amaraso (hemoglobine buri masaha 6 gushika kuri 12, LDH, bilirubine indirecte, **haptocrene ugutera amazi mu maraso y’amaraso, na ugutera amaraso y’utugingo ngengabuzima dutukura kubera hemoglobine igabanutse munsi ya 7 gushika kuri 8 g/dL.

Iciyumviro kigufi ku bitagangurirwa vyo muri Ostraliya (Atrax & Hadronyche): Ivyo bita PIB bidasanzwe¶

Ku inkengera y’ubusereko canke y’amajepfo ya Australiya (Sydney n’Ikigobe Kinini Gicapura kuva i Queensland gushika i Tasmania), iyo umuntu aryoshe igitagangurirwa kinini kandi kikayangana (ubwoko bwa Atrax robustus canke Hadronyche), kigatera ubumara bw’imitsi y’umubiri, kigatuma umuntu agira ubumara bw’imitsi n’ubumara bw’imitsi Iminota 10 gushika kuri 60 (ububabare bukomeye bwo mu karere, ugucika intege mu kanwa, ugucika intege kw’ururimi, gusohora amazi menshi n’icuya, umuvuduko w’amaraso, ukuvyimba kw’amahaha, n’uguhagarara kw’impwemu). Bitandukanye n’ibitagangurirwa vy’umukara/umupfakazi canke vy’umukaraba, igisiga c’i Australiya (canke igitagangurirwa c’imbeba) gikeneye guhita gifata umugozi wo guhagarika umuvuduko (PIB) + umugozi ukomeye, guhagarara neza, no gutwara umugozi w’abagwayi (000

Inomero z'ivyihutirwa zo mu karere n'amategeko y'ibigo¶

• Leta Zunze Ubumwe za Amerika na Canada: Hamagara 911 iyo ufise ububabare bukomeye bw’imitsi, ububabare bwo mu gikiriza/mu nda, ububabare bwo guhema, canke ibimenyetso vy’indwara. Hamagara Ikigo kijejwe kugenzura ubumara muri Amerika kuri 1-800-222-1222 (canke ikigo c’ubumara co mu ntara ya Canada) 24/7 kugira ngo ubone ubuyobozi bw’abaganga b’ubumara ku bijanye n’ugukurikirana ubumara bwa Latrodectus canke Loxosceles.
• Ostraliya na Nouvelle-Zélande: Hamagara kuri 000 muri Australiya canke 111 muri Nouvelle-Zélande. Kurikiza Ingingo ngenderwako ya ANZCOR 9.4.2 (Ubumara: Uruma rw'igitagangurirwa):
• Ku Igitagangurirwa c’umutuku (Latrodectus hasselti) canke ibindi bitagangurirwa rusangi: ushireko igitagangurirwa gikonje (igipapuro c’urubura kizingiwe gushika ku minota 20); NTUKORERE umugozi wo gukingira umuvuduko. Rondera ubuvuzi bwo mu bitaro kugira ngo ubone imiti igabanya ububabare n’imiti igabanya ububabare yitwa CSL Redback Antivenom iyo ububabare bukomeye cane.
• Ku bitagangurirwa binini vyirabura (Atrax*/Hadronyche canke igitagangurirwa c'imbeba Missulena)**: ushireko Umugozi wo gukingira umukazo (PIB) n'igiti co gukingira ubwo nyene hanyuma uhamagare 000. Hamagara **Ikigo c'amakuru y'ubumara co muri Australiya ku 1311.
• Ubwongereza: Hamagara 999 ku bibazo vyihutirwa canke NHS 111 ku bibazo vyihutirwa. Zirikana ko ata bapfakazi b’Abirabura b’ukuri canke aba Brown Recluses bavukiye mu Bwongereza; native Ibitagangurirwa vy'ikinyoma (Steatoda nobilis) bitera ububabare bumeze nk'ubw'ibisiga n'ububabare bukeyi ("steatodism") buvuwe n'ugukaraba n'isabune/amazi, n'amazi akonje, n'imiti yo mu kanwa, mu gihe "ibisiga vy'ibisiga" vy'umutuku bikomeye mu Bwongereza bitera ububabare bw'ibisiga canke ububabare bw'ibisiga.
• Ubumwe bw'Uburayi n'Ikiyaga Mediterane: Hamagara 112. Mu Buraya bwo mu Bumanuko (Esipanye, Ubutaliyano, Ubugiriki, Ubufaransa bwo mu Bumanuko, ibihugu vya Balkans), Igikoko c’Umupfakazi w’Ikiyaga Mediterane (Latrodectus tredecimguttatus) n’Igikoko c’Ikiyaga Mediterane (Loxosceles rufescens)** vyose ni ivy’imvukira; n’ugendere mu bitaro biri hafi cane iyo ufise ububabare bukomeye bw’imitsi canke ububabare bukomeye bw’imitsi.
• Amerika y’Epfo (Brésil, Peru, Shili, Argentine) na Afirika y’Epfo: Hamagara 192 / 193 muri Brezil, 131 muri Shili, 106 muri Peru, canke 10177 / 112 muri Afirika y’Epfo. Muri Brezile na Peru, aho Loxosceles laeta na Loxosceles intermedia bikomeye bitera ibiharuro vyinshi vy’ugusenyuka kw’amaraso mu bihimba vy’umubiri, ubumara bw’amafarasi bufise ubushobozi bwinshi canke bwihariye bwo kurwanya amaraso / ubumara bw’amafarasi (soro antiaracnídico / antiracnídico / antiracnídico n’ubuvuzi bwa Minisitere) ni ububiko bw’ibitaro vya Minisitere kugeza ku masaha 48 y’ubumuga bwo mu mutwe buringaniye canke bukomeye.

Ibibazo bikunda kubazwa¶

Nomenya gute itandukaniro riri hagati y’ururimi rw’Umupfakazi w’Umuzungu n’ururimi rw’Umupfakazi w’Umukara?¶

Bitera ibimenyetso bihushanye rwose n’ivyo. Umupfakazi w’Umwirabura ahita yumva nk’aho ari urusenga rusongoye, nta co asiga ku ruhu (agace k’urukoba gusa gafise amatonyanga y’icuya n’ibisebe), kandi mu minota 30 gushika ku 90 bitera ububabare bubabaje, bumeze nk’umupfunda mu mitsi y’amatako, mu mugongo wo hasi, mu gikiriza, hamwe n’umuvuduko munini w’amaraso n’icuya. Ubusanzwe, iyo Brown Recluse irya umuntu, ntiyigera ibabaza mu ntango, ntiyigera itera imitsi gukomera, kandi mu masaha arenga 6 gushika kuri 48, urukoba ruca rugira igisebe c’umutuku, cera n’ubururu gishobora guhinduka igisebe c’umwirabura (eschar) gishobora guhinduka igisebe c’umwirabura (eschar) n’igisebe gikira buhoro buhoro.

Ni kuki "ibirenge vy'ibitagangurirwa" vyinshi bibabaza, bivyimba bitukura mu vy'ukuri ari indwara z'urukoba ziterwa n'imigera ya MRSA?¶

Keretse mu vy’ukuri wabonye igisiga kikuruma igihe nyaco cabereye, inyigisho zakozwe mu bigo vy’ubuvuzi vyihutirwa vyerekana ko ibisebe birenga 80 kw’ijana abarwayi bemera ko ari igisiga mu vy’ukuri ari ibisebe vyo ku ruhu (ibivyimba) bitewe n’umugera wa Staphylococcus aureus (MRSA) udashobora gufatwa n’imiti yitwa methicillin. Igikoko nyaco c’umuhondo w’umuhondo (Brown Recluse bite) gica gipfutse canke gipfutse gifise hagati igihimba c’ubururu buzize canke bwijimye n’urupfu rw’imitsi yumye, mu gihe igisebe kivyuka nk’igisenge c’umubiri kivyimvye, gishushe kandi gitukura cane hagati, kigasohora amazi y’umuhondo canke yera mu misi mikeyi ni indwara y’imigera ikeneye imiti irwanya indwara.

Ni kuki igisiga c’Umupfakazi w’Umwirabura kigutuma inda yawe yumva ikomeye nk’urubaho rw’ibiti, nk’umugereka wacitse?¶

Ubumara bwa Black Widow burimwo ubumara bwa alpha-latrotoxin, ubumara bwo mu bwonko buja hejuru mu mitsi y’amaraso buva ku muntu aryaye ku kuguru canke ku kirenge, bugatera ibipfunsi vy’imitsi y’umubiri bita calcium mu mpera z’imitsi y’umubiri itanga imitsi minini y’amatako, yo mu mugongo wo hasi no mu ruhome rw’inda. Gutera cane umuti witwa acetylcholine bituma imitsi y’uruhome rw’inda iguma ikora, ata co ishaka. Abaganga bayitandukanya n’indwara y’ibihaha kubera ko umurwayi adaruhuka kandi akavyimba aho kuryama ataco akora, nta n’ububabare nyakuri bwo gusubira mu nda bubaho, kandi ububabare burahera ningoga iyo umuntu akoresheje imiti y’ibitera ububabare, benzodiazepines canke Latrodectus antivenom.

Noba noshira barafu canke ubushuhe ku gitagangurirwa c’Igikoko citwa Brown Recluse canke Black Widow?¶

Imisi yose ukoreshe igikoresho gikonje canke igikoresho co gupfuka barafu kizingiye mu mpuzu isukuye (mu minota 10 gushika ku 15 ku gihe), kandi ntukigere ukoresha igikoresho co gushusha canke amazi ashushe ku muntu wikekwa ko ariwe Brown Recluse. Igitera gusenya utugingo ngengabuzima kiri mu bumara bw’inyamaswa yitwa Brown Recluse (sphingomyelinase D) gikora ningoga cane iyo ubushuhe buri hejuru; gukoresha ubushuhe bituma urukoba rwihuta gusenyuka, mu gihe gukonjesha buhoro buhoro bigabanya iyo enzyme kandi bikagabanya ububabare bwo mu karere mu bikoko vyose bibiri, Brown Recluse na Black Widow.

Ni kuki ari ngombwa cane gusuzuma ibara ry’amasobe y’umwana imisi 3 inyuma y’aho akekwa ko aryamye Brown Recluse?¶

Mu bice 1 gushika ku bice 10 kw’ijana vy’ibikoko bita Brown Recluse, kandi bitari bihuye n’ivyo abana barwaye, ubumara bwitwa sphingomyelinase D bwinjira mu maraso bugatera utugingo ngengabuzima two hanze tw’utugingo ngengabuzima dutukura, tugatuma duturika imbere mu mitsi y’amaraso (systemique intravasculaire hemolyse) inyuma y’imisi itatu n’imisi ibiri. Naho urukoba rwarumye rusa n’uruto, utugingo ngengabuzima dutukura duturika duhindura amasobe akagira ibara ry’umuhondo ryirabura, ibara ry’umugese canke ibara ry’ikola (hemoglobinuria) kandi birashobora gutuma umuntu agira amaraso make bishobora gutuma apfa be n’amafyigo akabura ubushobozi bwo gukora neza, bikaba bisaba ko umuntu ahita afata amazi mu bitaro vy’abarwayi bikomeye kandi akamutera amaraso.

Woba ukwiye kwigera uzingira umugozi ukomeye wo gukingira umukazo canke umugozi wo gukingira umupfakazi w’umukara canke w’umukara w’umukara?¶

Oya, ntukigere ukoresha igipfukisho canke igipfukisho co gukingira umukazo ku gikoko c’umupfakazi w’umukara, c’umutuku w’umutuku canke c’umukara w’umukara. Gufata ubumara bwa Brown Recluse ahantu hamwe bituma enzyme ishobora gusenyura utugingo ngengabuzima yibanda cane kandi bigatuma urukoba rupfa cane, mu gihe gupfuka urukoba rwitwa Widow canke Redback rwarumye bituma ububabare bwo mu karere bukomera cane ataco buhinduye. (Imibande yo gukingira umukazo ikoreshwa ku bitagangurirwa vy’i Australiya vyitwa Funnel-Web n’inzoka zifise ubumara, ntiyigera ikoreshwa ku bitagangurirwa vy’abapfakazi canke vy’ibisiga vy’abapfakazi.)

Amasoko n'ubuyobozi buzwi¶

• Ishirahamwe ry’Abanyamerika ry’Ibigo Bijejwe Gucungera Ubumara (AAPCC) & Ishure ry’Ubuvuzi ry’Amerika (ACMT, Leta Zunze Ubumwe za Amerika): Imirongo ngenderwako y’Ibikorwa vy’Ubuvuzi n’Ivyiyumviro vy’Ubumara ku Bumara bwa Latrodectus (Umupfakazi) n’Ubumara bwa Loxosceles (Recluse) n’Ubumara bwa *NOT RECLUSEJ Diagnostic,*M).
• Inama y’Igihugu yo gusubiza ubuzima mu buzima (ANZCOR, Australiya na Nouvelle-Zélande): Ingingo ngenderwako ya ANZCOR 9.4.2: Ubumara, Uruma rw’igitagangurirwa (Itegeko ry’igitagangurirwa ry’umutuku n’itegeko ry’igitagangurirwa c’uruzitiro rwo gukingira).
• Ibigo bijejwe kugenzura no kwirinda indwara (CDC / NIOSH, Leta Zunze Ubumwe za Amerika): Ibisiga vy’ubumara (Ibisiga vy’Umupfakazi w’Umwirabura n’Ibisiga vy’Ibisiga vy’Ibara ry’agahama): Ibimenyekana, Ubufasha bwa mbere, n’Ubufasha bwo kuvura, hamwe n’Itandukaniro n’Indwara z’Urukoba za CA-MRSA.
• Ishirahamwe mpuzamakungu ry’ubuzima (OMS) & Ishirahamwe ry’ubuzima ryo muri Amerika yose (PAHO): Ubuvuzi bw’indwara y’amaraso y’urukoba n’iy’imbere mu ruhu) n’indwara y’amaraso y’urukoba muri Amerika.
• Ikigo c’Igihugu c’Ubuzima (NHS, Ubwongereza) & Ikigo c’Igihugu c’Amakuru y’Ubumara (NPIS): Igitagangurirwa: Ubutabazi bwa mbere, Gucungera Steatoda (Umupfakazi w’Ikinyoma), n’Ibendera Ritukura ry’Indwara ziterwa n’Imigera.

Inyobora zifitaniye isano¶

• Ubutabazi bwa mbere burumye inzoka n'igitagangurirwa
• Gukwiragiza indwara y’ibihimba vy’irondoka, imirongo y’indwara y’amaraso itukura, n’ibisebe vyo ku ruhu vya MRSA
• Inzoka zirumye n'ibikoko bikwega inda hasi bifise ubumara vyihutirwa
• Igikomerekezo gikomeye c'amafyigo, rhabdomyolyse, n'ugutoranya amasobe y'umwirabura
• Inomero z'ivyihutirwa hakurikijwe igihugu