Carmalada Madow vs Brown Dib-u-Celinta Qaniinyada Caarada: Murqaha Craming Rigidity vs Nabarrada Maqaarka Necrotic¶

Guud ahaan Ameerika, Australia, Yurub, iyo Afrika, qaniinyada caarada caaro ee muhiimka ah waxay u qaybsantaa laba cudur oo isdifaac ah: ** neurotoxic latrodectism ** oo ka yimid carmalka iyo caarada casaanka (* noocyada Latrodectus ) iyo ** loxoscelism cytotoxic ** oo ka yimid caarada Recluse ama Violin ( Loxosceles * noocyada). Carmallada Madow ama Australian Redback waxay isku durisaa ** alpha-latrotoxin , neurotoxin presynaptic oo sababa pinpick fiiqan oo degdeg ah ayaa la raacay 30 ilaa 90 daqiiqo gudahood iyadoo xanuunaysa, muruqyo lafaha lafaha oo kale ah, goobta qaniinyada. Taa bedelkeeda, caarada Brown Recluse waxay ku durisaa ** sphingomyelinase D (phospholipase D), unug baabi'iya enzyme kaas oo inta badan aan xanuun lahayn xilliga qaniinyada, laakiin waxay u koraan in ka badan 6 ilaa 72 saacadood oo ah ** casaan, caddaan iyo buluug ah oo bartilmaameed leh ** oo leh qulqulo necrotic madow ah oo kicinaya boqolkiiba 1 ee nolosha. Hemolysis intravascular hemolysis oo degdeg ah (hemoglobinuria brown brown, cagaarshow, iyo kelyaha oo hawlgab ah), gaar ahaan carruurta. Muhiimad gaar ah, ** in ka badan 80 boqolkiiba boogaha casaanka ah ee xanuunka leh, bararsan ee ay bukaanadu ku ogaadeen qaniinyada caarada ayaa dhab ahaantii bulshada ka heshay methicillin u adkaysta Staphylococcus aureus (CA-MRSA) maqaarka maqaarka*. Haddii dhibbanaha qaniinyada uu yeesho casiraad daran oo caloosha ah ama dhabarka, neefsashada oo ku adkaata, kaadida madow madow, ama maqaarka oo si degdeg ah u faafaya, wac degaankaaga nambarada degdega ah isla markiiba. Sidoo kale dib u eeg hagayaasha walaalahayaga shilinta iyo qaniinyada caarada, cellulitis, guduudasho cas, iyo MRSA maqaar maqaarkaiyo abeesada qaniinyada.

Muhiimadaada dhow waa inaad si tartiib ah ugu dhaqdo qaniinyada saabuun iyo biyo, mari ** cadaadis qabow ama baakad baraf ah oo maro ku duudduubtay** (waligaa kulayl ha saarin qaniinyada dib-u-celinta, waligaa ha marin faashad dalxiis ama Cadaadis Immobilization Bandage labada caarada midkood), la soco qallafsanaanta muruqa ee kor u kacaysa ama dhiigbax habaysan, oo raadso daryeelka degdegga ah ee cusbitaalka ee xididdada dhiigga. la socodka hemolytic ee qaniinyada soo noqnoqda.

Hadda samee tan¶

1. ** Isla markaaba iska hubi calaamadaha habdhiska nafta-khatarta ah oo wac nambarka deg-degga ah ee degaankaaga haddii uu jiro.** Wac 911 gudaha Mareykanka iyo Kanada, 000 gudaha Australia, 111 gudaha New Zealand, 112 gudaha Midowga Yurub, 999 gudaha Boqortooyada Midowday, ama hubi buuggayaga caalamiga ah ee nambarada degdega ah haddii uu qofka ku dhaco xanuun daran oo caloosha, dhabarka, laabta, ama bowdada ah, neefsashada oo ku adkaata, laabta oo adkaata, dhiig karka, dawakhaad, finan guud, qandho, cagaarshow (indho jaale ah), ama ** kaadi midab shaaha madow ama koolaha ah.
2. ** Si badbaado leh u sawir caarada (ama soo qaad muunada la jajabiyey weel xiran) kaliya haddii ay halkaas taallo, adigoon halis gelin qaniinyada labaad. (* Loxosceles*) waxay isla markiiba hagtaa maaraynta sunta cusbitaalka.
3. ** Meesha qaniinyada si tartiib ah ugu dhaq saabuun khafiif ah iyo biyo qabow oo socda, kana saar dhammaan faraantiyada, saacadaha, jijimooyinka, ama kabaha cidhiidhiga ah ee qaniinyada. Haddii qaniinyada Loxosceles la tuujiyo ama la jaro, sphingomyelinase D waxaa lagu qasbaa in ay sii gasho baruurta hoose ee maqaarka iyo xididdada maqaarka, taasoo si weyn u weyneysa boogta necrotic.
4. ** Codso maro qoyan oo nadiif ah, qabow ama baraf ku duuban tuwaal (10 ilaa 15 daqiiqo, 15 daqiiqo ka baxsan) goobta qaniinyada, oo WALIGAA ha marin suuf kuleyl ah ama cadaadi diiran qaniinyada Brown Recluse ee la tuhunsan yahay. Kululaynta maqaarku waxay dardar gelisaa dhaqdhaqaaqa enzyme, qoritaanka neutrophils, iyo dhimashada unugyada maqaarka, halka qaboojinta jilicsan ay hoos u dhigto jeexitaanka enzymatic sphingolipid waxayna yaraynaysaa xanuunka maxalliga ah ee carmalka iyo qaniinyada labadaba.
5. ** Marna ha marin faashadda Cadaadiska Immobilization-ka (PIB) ama dalxiiska halbowlaha ah ee Carmallada Madow, Dib-u-celinta, ama Qaniinyada Caarada Recluse ee Brown. Loxosceles (Recluse) qaniinyada: dabinka sunta carmalka waxay kordhisaa xanuunka aadka u xun ee deegaanka, iyo dabin celinta sunta waxay ururisaa enzymes nudaha baabi'isa hal meel, taasoo ka sii daraysa necrosis maqaarka qoto dheer. (Fiiro gaar ah: PIB waxa loo isticmaalaa Australian Funnel-Web caarada [Atrax / Hadronyche] iyo qaniinyada masaska, waligoodna dib-u-celinta, carmallada, ama caarada-caarada.)
6. ** Hubi midabka kaadida safar kasta oo musqusha ah 72 saacadood ka dib qaniinyada Brown Recluse ee looga shakisan yahay, gaar ahaan carruurta.** Haddii kaadidu isu beddesho casaan, guduud, daxalaysan, ama maroon madow sida Coca-Cola, suntu waxay gashay dhiigga waxayna burburisaa unugyada dhiigga cas (** systemic viscerocutaneous loxoscelism / Coombs-negative hemotric) Taageerada fuuq-baxa xididada iyo dhiiga.

Geedka go'aanka: qaniinyada caarada vs MRSA naaxinta iyo kala soocida neurotoxic vs cytotoxic¶

flowchart TD
    A["Qaniinyada caarada oo laga shakiyo ama dhaawac maqaarka ah oo xanuun badan"] --> B{"Ma aragtay caaro maqaarka qaniinaysa wakhtiga ay dhacday?"}
    B -->|No spider seen; swollen painful red bump draining pus| C["Itimaalka sare (in ka badan 80%) ee maqaarka maqaarka bakteeriyada CA-MRSA"]
    B -->|Yes, or classic clinical toxidrome developing| D{"Waa maxay calaamadaha ugu badan ee 1 ilaa 24 saacadood?"}
    C --> E["Ha tuujin; soohdin qalin leh; u tag dhakhtarka jeexitaan iyo dheecaan + antibiyootiko MRSA"]
    D -->|Immediate pinprick, target halo with sweating/goosebumps, then severe muscle cramps in back, abdomen, or chest| F["Latrodectism: Carmallada Madow ama Caaro-casaha (alpha-latrotoxin)"]
    D -->|Painless or mild sting initially; at 2 to 24 hr develops Red-White-and-Blue plaque with central pale blister| G["Loxoscelism: Dib-u-soo-celinta Brown / Violin Spider (sphingomyelinase D)"]
    D -->|Australia eastern coast: large black spider, immediate severe pain, profuse sweating, drooling, muscle twitching| H["Australian Funnel-Web Spider: ka codso PIB isla markiiba + wac 000 Funnel-Web Antivenom"]
    F --> I["Ku dhaq saabuun iyo biyo; codso baraf duuban; Waligaa ha codsan PIB; tag ED"]
    I --> J["Isbitaalka ED: IV opioids + benzodiazepines + Equine Latrodectus Antivenom ee xanuunka daran ama dhiig karka"]
    G --> K["Si tartiib ah u dhaq; cadaadis qabow; kor u qaadida addimada; Marna ha marin kuleyl, PIB, ama gooyn hore oo qaliin ah"]
    K --> L{"Qandho, firiiric, cagaarshow, kaadi madow madow, ama ilmo?"}
    L -->|Yes: Systemic Viscerocutaneous Loxoscelism| M["Gelitaanka degdega ah ee ICU: dareerayaasha IV, shaybaarada hemoglobin/hemolysis taxane ah, ku shubid RBC"]
    L -->|No: Cutaneous Loxoscelism only| N["Daryeelka nabarka maxalliga ah, cusboonaysiinta teetanada, nadiifinta daahitaanka kaliya ka dib marka eschar ay go'aamiso 6 ilaa 8 toddobaad"]

Isbarbardhigga caafimaad ee madax-ilaa-madaxa ah: Carmallada Madow (Latrodectism) vs Brown Recluse (Loxoscelism) vs MRSA Abscess¶

Sababtoo ah dadka caadiga ah iyo dhakhaatiirta daryeelka aasaasiga ah waxay si joogta ah u jahwareeriyaan qaniinyada carmalka neurotoxic, qaniinyada necrotic-ka, iyo bararka bakteeriyada caadiga ah, kala duwanaansho dhinac-dhinac ah ayaa muhiim ah:

Carmalada Madow iyo Caaro-casaha (Latrodectus) iyo Latrodectism Neurotoxic¶

Cilmi-nafsiga molecular ee Alpha-Latrotoxin¶

Caaro-caarada dheddigga ah (* Latrodectus mactans * [Carmalada Madow ee Koonfureed], * Latrodectus hesperus * [Carmalada Madow ee Galbeedka], * Latrodectus variolus * [Carmalada Madow ee Waqooyiga], * Latrodectus tredecimguttatus * [Carmalada Madow Mediterranean*], iyo Aselback Latrodectus qanjidhada sunta iyo faanyo chitinous godlan oo dheer oo ku filan inay galaan maqaarka bini'aadamka (halka kuwa yaryar ee carmalka ah aysan ka dusin karin maqaarka bini'aadamka).

1. ** Presynaptic Calcium Pore Formation:** neerfaha laf-dhabarta ee ugu weyn * Latrodectus* sunta waa ** alpha-latrotoxin **, borotiinka 130-kDa kaas oo ku socdaalaya kanaalka limfiga ee wareegga nidaamka wuxuuna ku xiran yahay xiriir sare oo u dhexeeya ** neurexin *** iyo ** latrophilin-ka-hortagga matoorka-1 xididada dareemayaasha.
2. ** Tuuritaanka Neurotransmitter-ka aan la koontaroolin:** Marka la isku xiro, afar unugyo alfa-latrotoxin ah ayaa ku urura tetramer-ka waxayna geliyaan xuubka dufanka ee terminalka neerfaha, iyaga oo samaynaya ** kanaalka kaalshiyam-ka-dhaafi kara **. Kaalshiyamka kalsiyumka ka baxsan ayaa ku qulqulaya terminalka neerfaha presynaptic, kicinaya exocytosis weyn oo ah xuubka synaptika oo ka kooban acetylcholine (oo ku yaal isgoysyada neuromuscular lafaha) iyo ** norepinephrine iyo epinephrine ** (oo ku yaal terminal madax-bannaan).
3. Mawjadaha teetanada oo kale ah oo aan lahayn dhimasho joogto ah: Si ka duwan sunta botulinum, alfa-latrotoxin si joogto ah uma baabi'iso matoorka axon. Taa baddalkeeda, daadinta acetylcholine waxay quful murqaha lafaha ** tetanic, qandho casiraad *** halka daadinta norepinephrine ee naxariista leh ay sababto ** dhidid badan oo gobolka ah, tijaabada, iyo dhiig-karka ba'an **, hoos u dhaca 48 ilaa 96 saacadood sida xididdada dib loo warshadeeyay

Aqoonsiga horumarka caafimaad ee Latrodectism¶

1. ** Marxaladda 1: Pinprick iyo Bartilmaameedka Halo (0 ilaa 30 daqiiqo):** Si ka duwan qaniinyada dib-u-celinta, 75 ilaa 90 boqolkiiba dhibbanayaasha carmalka caaro-caaro waxay dareemaan qaniinyada isla markaaba ay dhacdo, sida caadiga ah bisin fiiqan marka la gashanayo galoofyada ama kabaha, kor u qaadida xaabada, ama gaarista alaabta guriga hoostooda. 15 ilaa 30 daqiiqo gudahood, qaniinyadu waxay soo saartaa ** balastar wareeg ah oo cad oo maran oo ay ku wareegsan tahay halo cas oo khafiif ah *, oo leh ** dhibco yaryar oo dhidid ah iyo goosebumps kor u kacay isla markiiba goobta qaniinyada.
2. ** Marxaladda 2: Koritaanka Lymphatic iyo Murqaha Murqaha Gobolka (30 ilaa 90 Daqiiqo):** qanjidhada gobolka ee gumaarka ama kilkilada waxay noqdaan kuwo jilicsan, muruqa la arki karo iyo casiraad qoto dheer, casiraad u eg ayaa kor u fuulaya xubinta qaniinyada xagga jirridda.
3. Wajiga 3: Latrodectism Guud, Guddi-sida Caloosha, iyo Latrodectus Facies (1 ilaa 12 saacadood):
4. ** Qaniinyada hoose ee cirifka *** waxay ka soo iftiimaan bowdada, laf-dhabarta lafaha, iyo ** gidaarka hore ee caloosha ***, iyagoo ku xiraya murqaha caloosha malawadka ** qallafsanaan u eg ** oo leh 10/10 mowjado ciriiri ah.
5. Xagga sare ama qaniinta qoortu waxay ka soo ifbaxdaa ** garbaha, murqaha intercostalka, iyo gidaarka xabadka**, taasoo keenta cidhiidhi daran oo laabta ah iyo dyspnea oo u ekaanaysa wadno-qabad.
6. Saddex-geesood iyo Degenaansho La'aan: Qaab aan caadi ahayn u qaabaysan dhidid (diaphoresis), ** dhiig-karka halbowlaha daran** (badanaa ka sarreeya 180/110 mmHg), iyo *** Latrodectus facies *** (latrodectus) Si ka duwan bukaanka qaba peritonitis-ka qalliinka dhabta ah (lafsan dillaacsan) oo si dhaq-dhaqaaq la'aan ah ugu jiifa sariirta, **Bukaan Carmal Madow ayaa si joogto ah u xanaaqa, dhaqdhaqaajiya, oo dhabarka u qaada dhabarka isaga oo isku dayaya inuu kala bixiyo murqaha casiraad ***.

Maareynta Cusbitaalka Carmallada Madow iyo Baqashada Dib-u-celinta¶

1. Waa maxay sababta Calcium Gluconate-ka-xididka uu u gaboobay: Taxanayaal caafimaad oo la kontaroolay ayaa caddeeyey in IV calcium gluconate aanu waxtar lahayn marka la barbar dhigo ** xididada opioids-ka oo ay weheliso benzodiazepines**.
2. ** Dawaynta Farmaajo ee Khadka Koowaad (IV Opioids + IV Benzodiazepines):** Maamule titrated ** IV morphine** (0.1 mg/kg) ama ** IV fentanyl** (1 mcg/kg) xanuunka daran, oo ay weheliso ** IV benzodiazepine*** sida ** 5 to diazepam** (1 mg) ilaa 2 mg IV) si kor loogu qaado xannibaadda laf-dhabarta ee GABA-A, nasiyo murqaha teetanada, oo loo xakameeyo dhiig-karka.
3. ** Daawo qeexan: Equine Latrodectus Antivenom:** Waqooyiga Ameerika (** Antivenin Latrodectus mactans) iyo Australia ( CSL Redback Spider Antivenom**), 1 ilaa 2 fijaan oo antivenom equine ah oo lagu shubay 15 ilaa 30 daqiiqo gudahood daqiiqo. Waxaa lagu tilmaamaa xanuunka daran ee u diida opioids iyo benzodiazepines, qalalaasaha hypertensive, ** uur *** (si looga hortago foosha dhicis ama naaxinta mandheerta), iyo barar daran ** carruurta yaryar ama dadka waaweyn ee jilicsan **.

Recluse Brown iyo Caarada Violin (* Loxosceles*) iyo Necrotic ama Nidaamka Loxoscelism¶

Xakamaynta qaniinyada caaro-caaro ee beenta ah: Mnemonic-ka AAN dib loo dhigin¶

Dhakhaatiirtu waxay had iyo jeer si khaldan u baadhayaan bakteeriyada CA-MRSA mansabyada, boogaha macaanka, herpes simplex, ama soogalootiga Lyme erythema sida Brown Recluse ay ku qaniinto gobolada aysan ku noolayn Loxosceles caaro. Dhakhaatiirta sunta ah waxay adeegsadaan aaladda la ansixiyay MA DIBSAN mnemonic si ay meesha uga saaraan qaniinyada soo-noqoshada oo ay u aqoonsadaan caabuqa bakteeriyada:

• ** N (Tiro badan):** In ka badan 90% qaniinyada dhabta ah ee Brown Recluse waa ** nabar keligiis ah** (laga bilaabo ku rogidda hal caaro ku xanniban sariirta ama xidhashada dharka). Nabaro badan ayaa tilmaamaya boodada, dhiqlaha, ama bararka MRSA, ma aha kuwo soo celin kara.
• **O (Dhacdo) Meelaha ka baxsan Loxosceles (ama Koonfurta Ameerika ee L. laeta), qaniinyada dib-u-celinta waa wax aan macquul ahayn.
• T (Waqtiga): In ka badan 85% ee la xaqiijiyay Loxosceles reclusa qaniinyada waxay dhacaan bilaha diiran (** Abriil ilaa Oktoobar**).
• R (Xarunta Cas): Qaniinyada Dib-u-celinta Brown ee dhabta ah waxay soo saartaa ** cirro, guduudan, ama xarun ischemic buluug-guduud ah** (maxaa yeelay sphingomyelinase D waxay xinjirtaa weelasha maqaarka). Nabar leh ** casaan dhalaalaya, xarun kulul ** waa caabuq bakteeriya ah.
• E (Dome Sarreysa): Qaniinyada Dib-u-celinta Brown ee dhabta ah waxay ka hooseysaa maqaarka ku hareereysan ** (wax ka hooseeya 1 sentimitir). A ** kor u kacay, qubbad bararsan oo ka sarreeya 1 sentimitir *** waa malax-bakteeriyo kabuuxsan tahay (karin).
• C (Ragga 3 bilood ka badan): Xataa boogaha necrotic-ga ee waaweyn waxay ku bogsadaan 8 ilaa 12 toddobaad gudahood. Nabaro sii jiraya 3 bilood ee la soo dhaafay waxay u baahan yihiin biopsy kansarka maqaarka, pyoderma gangrenosum, ama caabuq fangas.
• ** L (Ka weyn 10 cm):** In ka badan 90% nabarrada soo laabashada waxay ka yar yihiin 3 ilaa 10 sentimitir (1.2 ilaa 4 inji).
• U (Ulcerates Too Early, Under 7 days): Qaniinyada dhabta ah ee Brown Recluse, maqaarka dhexe ee ischaemic wuxuu sameeyaa qolof madow qalalan (** eschar**) in ka badan 5 ilaa 14 maalmood ** kamana furna boogaha godka ilaa maalinta 7 ilaa maalinta 14. Nabarka dilaaca oo soo daa malax jaale ah oo dareere ah maalinta 2 ama maalinta 3 waa ** bakteeriya MRSA.
• S (Bara): Marka laga reebo daboolka isha ama cagta, qaniinyada dib-u-noqoshada ma keenaan barar aad u weyn oo addin ah oo aan lahayn cunfis-jiidadka.
• E (Malax-baxsan): Qaniinyada Recluse Recluse ee dhabta ah waa ** qallayl maqaarka ischaemic ah**. Malax jaalle ah ama caddaan ah oo dhumucdeedu waa bakteeriya, ee maaha sun caaro.

Pathophysiology ee Loxoscelism Cutaneous: Casaan, Cadaan, iyo Buluug iyo Faafinta Cufisjiidka¶

Marka Loxosceles caaro lagu cadaadiyo maqaarka gudaha dharka ama gogosha sariiraha, faashadeeda waxay ku durtaa ** spingomyelinase D (phospholipase D)** oo ay weheliso hyaluronidase:

1. ** Saacadaha 6 ilaa 48 (Calaamadda Cas, Caddaan iyo Buluugga):**
2. Xarunta buluuga ah: Sphingomyelinase D waxay jeexjeexdaa sphingomyelin endothelial, kicinta isu geynta platelet, qorista neutrophils, iyo ** xinjirowga xididdada yar yar**. Gaajo socodka dhiigga, maqaarka dhexe wuxuu isu rogaa ** buluug-cawr ama guduud mugdi ah** (badanaa leh finan dhiigbax ah).
3. ** Giraanta dhexe ee cad:** Hareeraha xudunta ischaemic guduudan waa cidhiidhi, ** giraan cad oo cirro leh** oo uu keeno vasoconstriction reflex.
4. Halo-ka-baxsan ee cas: Ku hareeraysan giraanta cad waa halo balaadhan oo ah ** caabuq vasodilatory erythematous**.
5. ** Cufisjiidhka Hoos u Fida iyo Sloughing Eschar (Maalmaha 5 ilaa 21):** Sababtoo ah * Loxosceles* suntu waxa ay ka kooban tahay ** hyaluronidase** (faafinta cunsur), cufisjiidku waxa uu hoos u soo jiidaa ensaymka iyada oo loo sii marayo diyaaradaha dufanka hoose ee jirka ka samaysan si uu u noqdo qaab ilmada. 10 ilaa 30 boqolkiiba qaniinyada noqda necrotic (gaar ahaan meelaha dufanka leh sida bowdyaha, barida, ama caloosha), xarunta buluuga ah waxay ku adkaataa maqaarka qallalan, qalalan, maqaar madow ** 5 ilaa 7, kaas oo u dhexeeya ** Maalinta 7 iyo Maalinta 21 **, taasoo ka tagaysa boog qotodheer oo bogsiinaya toddobaadyo ** 4 ilaa 12.

Loxoscelism Systemic Viscerocutaneous (Hemolysis Intravascular: Khatarta Nolosha Dhabta ah)¶

In 1 ilaa 2 boqolkiiba Waqooyiga Ameerika Loxosceles reclusa qaniinyada (iyo ilaa 10 ilaa 15 boqolkiiba Koonfurta Ameerika Loxosceles laeta qaniinyada), gaar ahaan carruurta, sphingomyelinase D waxay gashaa dhiigga waxayna xidhaa wareegga unugyada dhiigga cas:

• Xataa marka qaniinyada maqaarku ay u muuqato mid yar, nidaamka sphingomyelinase D waxay ka saartaa glycophorins xuubabka unugyada cas ee dhiigga waxayna hawlgelisaa dhamaystirka, taasoo keenta ** hemolysis xiniinyaha dhiigga oo ba'an *** gudaha **24 ilaa 72 saacadood qaniinyada ***.
• Calaamadaha halista ah ee la daawado 72-da saacadood ee ugu horreeya:
• Xummad, qarqaryo, matag, kalagoysyo xanuun, iyo finan casaan ah oo fidsan oo bilaabmaya 12 ilaa 48 saacadood ka dib qaniinyada.
• Kaadi madow,midab shaaha ah,ama koolaha leh (hemoglobinuria) sida unugyada dhiiga cas ee lysed ay ku daadiyaan haemoglobin bilaasha ah balaasmaha iyo kelyaha, taasoo keenta ** dhaawac kelyo ah oo degdeg ah (AKI)**.
• ** Hemoglobin si degdeg ah hoos ugu dhacaya (anemia), pallor, tachycardia, iyo ** cagaarshow (indhaha jaalaha ah) oo ay weheliso DIC.
• Bartakoolka Isbitaalka: Ilmo kasta ama qaangaar ah oo leh qandho, finan, ama kaadi madow ka dib qaniinyada laga shakiyo waxay u baahan tahay ** isbitaal seexasho degdeg ah , tirinta dhiigga ee taxanaha ah ( hemoglobin 6 ilaa 12 saacadood**, ** LDH**, ** bilirubin aan toos ahayn, haptoglobin, **haptoglobin fuuqbaxa ***, iyo **ku shubidda unugyada dhiigga cas

Qoraal kooban oo ku saabsan Funnel-Web Spiders-ka Australiyaanka ah (Atrax & Hadronyche): Ka Reebka PIB¶

Dhinaca ** bari ama xeebta koonfureed ee Australia *** (Sydney iyo Rajada Qaybinta Weyn ee Queensland ilaa Tasmania), qaniinyada ** weyn, caaro madow oo dhalaalaysa (Atrax robustus ama Hadronyche noocyada) xanuun, xiirid xuubka, carrabka oo gariir, dhidid badan, dhiig karka, bararka sambabada, iyo neefsashada oo xirma). ** Si ka duwan Caarada Dib-u-celinta/Carmalka ama Dib-u-celinta, Qaniinyada Funnel-Web-ka Australia (ama Mouse Spider) waxay u baahan tahay faashad degdeg ah oo ka-hortagga cadaadiska

Lambarada degdega ah ee gobolka iyo borotokoolka wakaalada¶

• Mareykanka iyo Kanada: garaac 911 muruq adkaanshiyaha daran, xabadka/caloosha, neefsashada oo ku adkaata, ama calaamadaha nidaamka. Wac ** Xakamaynta Sunta Maraykanka 1-800-222-1222** (ama Xarunta Sunta Gobolka Kanada) 24/7 si aad u hesho hagitaanka dhakhtarka sunta caafimaadka ee Latrodectus antivenom ama Loxosceles la socodka hemolysis.
• Australia iyo New Zealand: Wac 000 gudaha Australia ama 111 gudaha New Zealand. Raac ** Tilmaamaha ANZCOR 9.4.2 (Xiriir: Caaro Caaro)*
• Loogu talagalay ** Caaro-casaan (Latrodectus hasselti)** ama caarada guud ee kale: mari ** cadaadis qabow *** ( baraf duuban ilaa 20 daqiiqo); ** Ha isticmaalin faashadda Cadaadiska ka saarista**. U raadso daryeelka cisbitaalka xanuunka xanuunka iyo CSL Redback Antivenom haddii xanuunku daran yahay.
• Wixii ** Caaro Madow Weyn (Funnel-Web Atrax/Hadronyche ama Mouse Spider Missulena): mari Faashad Ka-hortagga Cadaadiska (PIB) oo isla markiiba kabid wac 000. Wac ** Xarunta Macluumaadka Sunta Australiyaanka ah 13 11 26*.
• United Kingdom: Wac 999 xaaladaha degdega ah ama NHS 111 qiimayn caafimaad oo degdeg ah. Ogsoonow in Carmallada Madow ee runta ah ama Dib-u-celinta Brown aysan u dhalan UK; hooyo Noble Been Carmalada Caaro-caaro (Steatoda nobilis) waxay keentaa xanuujin u eg xanuunka maxaliga ah iyo xanuunka fudud ("steatodism") oo lagu daaweeyay saabuun/biyo dhaqid, cadaadis qabow, iyo xanuunka afka, halka barar daran oo casaanka ah "qaniinyada caarada" ee UK ay tahay had iyo jeer bakteeriyada bakteeriyada cellulitis ama nabarka antibiyootiga.
• Midowga Yurub iyo Mediterranean: garaac 112. Koonfurta Yurub (Spain, Italy, Greece, Southern France, Balkans), labadaba ** Carmalka Madoow ee Mediterranean (* Latrodectus tredecimguttatus*)** iyo ** Recluse Mediterranean (* Loxosceles rufescens*)** waa asal; U sii gudub qaybta degdega ah ee cusbitaalka kuugu dhow si aad u hesho murqo xanuun daran ama lakabyo necrotic ah.
• South America (Brazil, Peru, Chile, Argentina) iyo South Africa: Wac 192/193 gudaha Brazil, 131 gudaha Chile, 106 gudaha Peru, ama 10177/112 ee Koonfur Afrika. Brazil iyo Peru, halkaas oo * Loxosceles laeta * iyo * Loxosceles intermedia * waxay keenaan heerar sare oo ah hemolysis systemic viscerocutaneous hemolysis, ** polyvalent ama gaar ah equine anti-loxoscelic / anti-arachnid antivenom (soro antiaracnídico / antiloxoscélico) waxaa lagu kaydiyaa wasaarada caafimaadka ee ugu horeysa. saacadaha dhexdhexaad-ilaa-daran loxoscelism.

Su'aalaha soo noqnoqda¶

Sideen ku garan karaa faraqa u dhexeeya qaniinyada Carmallada Madow iyo Qaniinyada Dib-u-celinta Brown?¶

Waxay soo saaraan astaamo gebi ahaanba iska soo horjeeda. Qaniinyada Carmalka Madow waxay isla markiiba dareentaa sida bini-fiiqan fiiqan, waxay ka baxdaa ku dhawaad ​​​​wax dhaawac ah oo maqaarka ah (kaliya giraan yar oo cirro leh oo leh dhibco dhididka ah iyo goosebumps), iyo 30 ilaa 90 daqiiqo gudahood waxay keentaa xanuun, mawjad u eg muruq muruq oo ku yaal bowdyaha, dhabarka hoose, laabta, iyo caloosha (rogrogista muruqyada caloosha - adag) oo ay weheliso dhiig karka iyo dhididka. Qaniinyada Recluse Brown caadi ahaan xanuun ma laha marka hore, waligeed ma keento qallafsanaanta muruqa, iyo in ka badan 6 ilaa 48 saacadood waxay soo saartaa huurada bartilmaameedka ah ee casaanka, caddaanka iyo buluugga ah ee maqaarka taasoo isu rogi karta qolof madow oo go'day (eschar) iyo boog si tartiib ah u bogsata.

Waa maxay sababta ugu xanuun badan, barar cas "qaniinyada caarada" dhab ahaantii MRSA caabuq maqaarka bakteeriyada?¶

Haddii aanad dhab ahaantii arkin caaro-caaro isla markiiba ay dhacday, daraasado lagu sameeyay waaxaha xaaladaha degdega ah ayaa muujinaya in in ka badan 80 boqolkiiba nabarrada bukaanada ay aaminsan yihiin in qaniinyada caarada ay dhab ahaantii yihiin nabarrada maqaarka (kabaxyada) ee ay keento methicillin-adkeysiga Staphylococcus aureus (MRSA). Qaniinyada dhabta ah ee Brown Recluse waa fidsan ama la quustay oo leh cirro ama xarun buluug-buluug ah oo madow iyo dhimasho unug qalalan, halka nabarka ka soo baxa sida qubbad bararay, kulul iyo casaan dhalaalaya oo dhexe ah, oo dareere dareeraha jaalaha ah ama caddaanka ah dhowr maalmood gudahood waa caabuq bakteeriya ah oo u baahan dheecaan caafimaad iyo antibiyootik.

Waa maxay sababta qaniinyada carmalka madow ay calooshaada u dareento inay adag tahay sida looxa alwaax ah, sida lifaaq dillaacsan?¶

Sunta carmalka madow waxay ka kooban tahay alfa-latrotoxin, neurotoxin oo ka soo kacda marinnada lymfatic ka qaniinyada lugta ama cagta oo feedha daloolada kaalshiyamka ee xididada dareemayaasha ee siiya muruqyada waaweyn ee bowdada, dhabarka hoose, iyo gidaarka caloosha. Daadinta ballaaran ee neurotransmitter acetylcholine waxay quful muruqyada derbiga caloosha si joogto ah, foosha teetanada ee aan ikhtiyaarka lahayn. Dhakhaatiirtu waxay ka soocaan xanuunka loo yaqaan 'appendicitis' sababtoo ah bukaanku waa nasasho la'aan oo wuu xanaaqaa halkii uu been sheegi lahaa, ma jiraan wax jilicsan oo dib-u-soo-kabashada peritoneal gudaha ah, xanuunkuna si dhakhso ah ayuu u xalliyaa opioids-ka xididdada, benzodiazepines, ama Latrodectus antivenum.

Miyaan ku shubaa baraf ama kulaylka Recluse Brown ama qaniinyada carmalka madow?¶

Had iyo jeer isticmaal baraf qabow ama baraf lagu duudduubay maro nadiif ah (10 ilaa 15 daqiiqo markiiba), marna ha marin suuf kulul ama biyo kulul qaniinyada Brown Recluse ee looga shakisan yahay. Enzym-ka nudaha burburiya ee ku jira sunta Brown Recluse (sphingomyelinase D) waxay si degdeg ah ugu shaqeysaa heerkul sare; kulaylka codsanaya waxa ay dedejisaa necrosis maqaarka, halka qaboojin debecsan ay hoos u dhigto ensaymka iyo kabuubyo xanuunka maxaliga ah ee labadaba Brown Recluse iyo Carmalka Madow qaniinyada.

Maxay muhiim u tahay in la eego midabka kaadida ilmaha 3 maalmood ka dib qaniinyada Brown Recluse ee la tuhunsan yahay?¶

1 ilaa 10 boqolkiiba Brown Recluse qaniinyada, iyo si aan u dhigmin carruurta, enzyme venom sphingomyelinase D waxay gashaa dhiigga waxayna weerartaa xuubka sare ee unugyada dhiigga cas, taasoo keenta inay furmaan gudaha xididdada dhiigga (hemolysis systemic intravascular hemolysis) inta u dhaxaysa 24 iyo 72 saacadood ka dib qaniinyada. Xitaa haddii qaniinyada maqaarku ay u muuqato mid yar, unugyada dhiigga cas ee dilaaca waxay u beddelaan kaadida madow madow, midab miridh ah, ama koola-midab leh (hemoglobinuria) waxayna keeni kartaa dhiig-yaraan nafta halis gelisa iyo kelyaha oo hawlgab ah oo u baahan fuuqbax degdeg ah ICU iyo dhiig ku shubid.

Waligaa ma ku duubi kartaa faashad adag oo ka saarista cadaadiska ama dalxiiska agagaarka carmallada Madow ama qaniinyada Brown?¶

Maya. Marna ha ku dabin dalxiiska ama faashad ka saarista cadaadiska laastikada ah carmallada Madow, dib-u-celinta, ama qaniinyada dib u celinta Brown. Ku dabin sunta Brown Recluse hal meel waxa ay xooga saartaa enzyme-ka nudaha nudaha waxayna sababtaa necrosis maqaarka oo qoto dheer, halka faashadda carmalka ama qaniinyada casaanka ay ka sii darayso xanuunka maxalliga ah iyada oo aan natiijooyin wanagsanayn. (Faashadaha ka saarista cadaadiska waxaa loo isticmaalaa Australian Funnel-Web caarada iyo masaska sunta ah, marna loogu talagalay carmalka ama caarada dib u celinta.)

Ilaha iyo hanuuninta rasmiga ah¶

• ** Ururka Maraykanka ee Xarumaha Xakamaynta Sunta (AAPCC) & Kulliyadda Maraykanka ee Sunta Caafimaadka (ACMT, United States):** * Tilmaamaha Dhaqanka Kiliinikada iyo Dib-u-eegga Sunta ee Latrodectus (Carmallada) iyo Loxosceles (Recluse) Envenomations * iyo * MA NOQOTO Diagnostic Mnemonic * (Vetter) et *).
• ** Golaha Dib-u-soo-nooleynta Australiya (ANZCOR, Australia iyo New Zealand):** * Tilmaamaha ANZCOR 9.4.2: Deegaanka, Qaniinyada Caaro-caarada*
• ** Xarumaha Xakamaynta iyo Kahortagga Cudurrada (CDC / NIOSH, Mareykanka):** * Caaro-caaro (Carmalada Madow iyo Dib-u-celinta Brown): Aqoonsiga, Gargaarka Degdegga ah, iyo Maareynta Caafimaadka, oo lagu daray Kala Duwanaanta Caabuqyada Maqaarka ee CA-MRSA*.
• Ururka Caafimaadka Adduunka (WHO) & Ururka Caafimaadka ee Pan American (PAHO): Maareynta Kiliinikada ee Loxoscelism (Cutaneous and Viscerocutaneous Hemolytic Syndromes) iyo Latrodectism ee Ameerika.
• ** Adeegga Caafimaadka Qaranka (NHS, Boqortooyada Midowday) & Adeegga Macluumaadka Sumowga Qaranka (NPIS):** * Qaniinyada Caarada: Gargaarka Degdegga ah, Maareynta Steatoda (Carmalada Beenta ah), iyo Caabuqa bakteeriyada Calamada Cas.

Tilmaamaha la xidhiidha¶

• Sax iyo caaro ayaa qaniinta gargaarka degdegga ah
• Faafinta cellulitis, xariijimaha lymphangitis-ka cas, iyo maqaar maqaarka MRSA
• Qaniinyada abeesada iyo xaaladaha degdega ah ee xamaaratada sunta ah
• Dhaawac kelyo oo ba'an, rhabdomyolysis, iyo kala soocida kaadida mugdiga ah
• Nambarada degdega ah wadan ahaan