Motlholagadi yo Montsho kgatlhanong le Dilo tsa Segokgo sa Borokwa: Go Gagamala ga Mesifa kgatlhanong le Diso tsa Letlalo tse di Bolayang¶

Go ralala Amerika, Australia, Yuropa, le Aforika, go longwa ke digokgo go go botlhokwa mo go tsa kalafi go kgaogana ka matshwao a mabedi a a fapaaneng gotlhelele a kalafi: latrodectism e e botlhole jwa methapo go tswa mo digokgong tsa Widow le Redback (mofuta wa Latrodectus) le loxoscelism e e botlhole jwa disele go tswa mo digokgong tsa Recluse kgotsa tsa Loxosceles (*Loxosceles). Motlholagadi yo Montsho kgotsa Redback wa Australia o tlhaba alpha-latrotoxin, e leng botlhole jwa methapo ya presynaptic jo bo bakang go tlhabiwa ka bonako ka bogale jo bo latelang mo metsotsong e le 30 go ya go e le 90 ke go tlhotlhorega ga mesifa ya marapo e e botlhoko, e e tshwanang le makhubu, **go gagamala ga lebota la mpa go go tshwanang le boto, go etsisa go thubega ga lebota la mpa go fufula ga kgaolo, le kgatelelo e e kwa godimo ya madi, fa e ntse e tlogela mo e ka nnang tshenyo epe ya letlalo mo lefelong le le lomilweng. Go farologana le seo, segokgo sa Brown Recluse se tlhaba sphingomyelinase D (phospholipase D), e leng ensaeme e e senyang dithishu e gantsi e sa utlwiseng botlhoko gotlhelele ka nako ya fa se loma, mme e fetoga mo lobakeng lwa diura di le 6 go ya go di le 72 go nna polaka e e khibidu, e tshweu, le e e pududu ya eschartic e e tlhotlheleditsweng ke letsatsi mo ne1. dikgetsi di tsosa hemolysis e e tseneletseng e e tsenyang botshelo mo kotsing (hemoglobinuria e e borokwa jo bontsho, jaundice, le go sa dire sentle ga diphilo), segolobogolo mo baneng. Se se botlhokwa ke gore, diperesente di feta 80 tsa diso tse di bohibidu tse di botlhoko, tse di rurugileng tse di lemogiwang ke balwetse jaaka go longwa ke segokgo tota ke diso tsa letlalo tse di bonweng mo baaging tse di sa alafegeng ka methicillin Staphylococcus aureus (CA-MRSA). Fa motho yo o lomilweng a nna le ditlhabi tse di masisi mo mpeng kgotsa mo mokwatleng, a nna le bothata jwa go hema, a nna le moroto o o borokwa jo bontsho, kgotsa letlalo le le bohibidu jo bo anamang ka bonako, leletsa . dinomoro tsa tshoganyetso jaanong jaana. Gape sekaseka dikaelo tsa rona tsa bana ba rona mo dikgofa le go longwa ke segokgo, cellulitis, go nna le methalo e mehibidu, le diso tsa letlalo tsa MRSA, le go longwa ke noga.

Selo se se tlang pele mo go wena ka bonako ke go tlhatswa lefelo le le lomilweng ka bonolo ka sesepa le metsi, go dirisa sediriswa se se tsidifetseng kgotsa sephuthelwana sa aese se se phuthetsweng ka letsela (o se ke wa dirisa mogote mo go lomang go go ikemetseng, mme le ka motlha o se ke wa dirisa tourniquet kgotsa Pressure Immobilization Bandage mo go sepe sa segokgo), go ela tlhoko thulaganyo ya mesifa e e tlhatlogang kgotsa ya tshoganyetso ya bookelo. di-opioid tse di tsenngwang mo ditshikaneng le Latrodectus Antivenom mo go longweng thata ga motlholagadi kgotsa go ela tlhoko madi mo go longweng ke batho ba ba sa tlholeng ba le nosi.

Dira se jaanong¶

1. Tlhatlhoba ka bonako go bona matshwao a thulaganyo a a tshosetsang botshelo mme o letsetse nomoro ya gago ya tshoganyetso ya selegae fa e le teng. Letsa 911 kwa United States le Canada, 000 kwa Australia, 111 kwa New Zealand, 112 go ralala Kopano ya Yuropa, 999 kwa United Kingdom, kgotsa tlhola lenaane la rona la lefatshe lotlhe la dinomoro tsa tshoganyetso fa motho a ka nna le botlhoko jo bo tseneletseng jwa go tshwaratshwara mo mpeng, mo mokwatleng, mo sehubeng, kgotsa mo diropeng, go hema ka bothata, go gagamala ga sehuba, kgatelelo e e kwa godimo thata ya madi, go tsewa ke sedidi, letshoroma le le akaretsang, letshoroma, jaundice (matlho a masetlha), kgotsa motlhapo o o mmala o montsho wa tee kgotsa wa cola.
2. Tsaya segokgo senepe ka pabalesego (kgotsa tlisa sekai se se thubegileng mo nkgong e e tswalegileng) fela fa se le gone foo, kwantle ga go itsenya mo kotsing ya go loma gape. Go supa sentle ga ditshenekegi ga segokgo se sentsho se se phatsimang sa kgolokwe se se nang le galase e khibidu ya ura (Latrodectus) kgatlhanong le segokgo se se mmala o mohibidu se se nang le letshwao le lentsho la ipharang e dipara** (Loxosceles) e kaela ka bonako taolo ya botlhole jwa bookelo.
3. Hlatswa lefelo le le lomilweng ka bonolo ka sesepa se se bonolo le metsi a a tsidifetseng a a elelang, mme o tlose dipalamonwana tsotlhe, ditshupanako, dibaga, kgotsa ditlhako tse di gagametseng mo letsogong le le lomilweng. Le ka motlha o se ke wa sega, wa sega, wa anya, wa fisa, wa dirisa ditlhobolo tsa go tlhobaetsa tsa motlakase, kgotsa wa tlhotlhora ntho e e lomilweng. Fa go loma ga Loxosceles go ka pitlaganngwa kgotsa ga segwa, sphingomyelinase D e patelediwa go tsenelela kwa teng mo mafureng a a ka fa tlase ga letlalo le mo methapong ya letlalo, mme seno se godisa seso se se bolayang ka tsela e e gakgamatsang.
4. Tshasa letsela le le le phepa, le le tsidifetseng le le bongola kgotsa sephuthelwana sa aese se se phuthetsweng ka taulo (metsotso e le 10 go ya go e le 15 e tshubilwe, metsotso e le 15 e timilwe) mo lefelong le le lomilweng, mme O SE KE wa tshasa sethibela se se thuthafatsang kgotsa sethibela se se bothitho mo lefelong le le belaelwang gore le lomilweng ke Brown Recluse. Goreng themperetšha e le botlhokwa: enzyme ya necrona botlhole bo na le di-enzymatic tse di ikaegileng ka themperetšha. Go gotetsa letlalo go potlakisa tiro ya enzyme, go thapiwa ga di-neutrophil, le go swa ga dithishu tsa letlalo, fa go tsidifatsa ka bonolo go dira gore go kgaoga ga enzymatic sphingolipid go nne bonya le go fokotsa botlhoko jwa lefelo leo mo go longweng ga motlholagadi le ga motho yo o ikemetseng ka nosi.
5. O SE KE wa dirisa Sebante sa Kgatelelo ya go Thibela go Tsamaya (PIB) kgotsa tourniquet ya madi mo go longweng ke segokgo sa Black Widow, Redback, kgotsa Brown Recluse. Ka fa tlase ga melao ya Lekgotla la go Tsosolosa la Australia (Kaelo ya ANZCOR 9.4.2) le melao ya botlhole jwa Amerika Bokone, Dibante tsa go Thibela go Tsamaya ga Kgatelelo di **thibelwa (Redback/Widow) le Loxosceles (Recluse) di loma: go tshwara botlhole jwa motlholagadi go oketsa botlhoko jo bo botlhoko jwa selegae, mme go tshwara botlhole jwa recluse go kokoanya diensaeme tse di senyang dithishu mo lefelong le le lengwe, go gakatsa go bola ga letlalo go go tseneletseng. (Ela tlhoko: PIB e dirisediwa Digokgo tsa Australia tsa Funnel-Web [Atrax / Hadronyche] le go longwa ke noga, ga e ise e ko e dirisediwe digokgo tsa Redback, Motlholagadi, kgotsa Recluse.)
6. Tlhola mmala wa motlhapo mo loetong longwe le longwe lwa go ya kwa ntlwaneng diura di le 72 morago ga go longwa ke Brown Cocluse e e belaetsang, segolobogolo mo baneng. Fa motlhapo o fetoga go nna pinki, bohibidu, rusi, kgotsa borokwa jo bontsho jaaka Coca-Cola, botlhole bo tsene mo mading mme bo senya disele tse dikhibidu tsa madi (taculism loxomoga viscetic hemolytic anemia), e e tlhokang gore motho a amogelwe ka bonako kwa ICU ya Bana kgotsa ya Bagolo gore a kgone go tsenngwa metsi mo ditshikaneng le go tshelwa madi ka tsela e e bogale.

Setlhare sa tshwetso: go longwa ke segokgo kgatlhanong le ntho ya MRSA le go tlhaola botlhole jwa methapo kgatlhanong le botlhole jwa disele¶

flowchart TD
    A["Go belaelwa gore o lomilwe ke segokgo kgotsa ntho e e botlhoko mo letlalong"] --> B{"A o bone segokgo se loma letlalo ka nako e se diragetseng ka yone?"}
    B -->|No spider seen; swollen painful red bump draining pus| C["Kgonagalo e kgolo (go feta 80%) ya ntho ya letlalo ya baketeria ya CA-MRSA"]
    B -->|Yes, or classic clinical toxidrome developing| D{"Ke matshwao afe a a laolang mo diureng di le 1 go ya go di le 24?"}
    C --> E["O SE KE wa tlhotlhora; latedisa molelwane ka pene; bona ngaka ya go segwa le go ntsha metsi + dibolayamegare tsa MRSA"]
    D -->|Immediate pinprick, target halo with sweating/goosebumps, then severe muscle cramps in back, abdomen, or chest| F["Latrodectism: Motlholagadi yo Montsho kgotsa Segokgo sa Mokwatla o Mohibidu (botlhole jwa alpha-latro)"]
    D -->|Painless or mild sting initially; at 2 to 24 hr develops Red-White-and-Blue plaque with central pale blister| G["Loxoscelism: Segokgo se se Borokwa / Segokgo sa Sebintšolo (sphingomyelinase D)"]
    D -->|Australia eastern coast: large black spider, immediate severe pain, profuse sweating, drooling, muscle twitching| H["Segokgo sa Webo ya Mosele sa Australia: dirisa PIB ka bonako + leletsa 000 go bona Antivenom ya Webo ya Mosele"]
    F --> I["Tlhapa ka sesepa le metsi; dirisa pakete ya aese e e phuthetsweng; O SE KE wa dirisa PIB; ya kwa ED"]
    I --> J["ED ya Bookelo: Di-opioid tsa IV + di-benzodiazepine + Botlhole jwa Latrodectus jwa Dipitse jwa setlhabi se segolo kgotsa kgatelelo e e kwa godimo ya madi"]
    G --> K["Hlatswa ka bonolo; tsidifatso gatelelo; tsholetsa letsogo; O SE KE wa dirisa mogote, PIB, kgotsa go kgaola karo go sa le gale"]
    K --> L{"Letshoroma, letshoroma, jaundice, moroto o o borokwa jo bontsho, kgotsa ngwana?"}
    L -->|Yes: Systemic Viscerocutaneous Loxoscelism| M["Go amogelwa ka bonako kwa ICU: Dieledi tsa IV, dilaboratori tsa hemoglobin/hemolysis tse di latelanang, tshelo ya RBC"]
    L -->|No: Cutaneous Loxoscelism only| N["Tlhokomelo ya dintho tsa selegae, ntšhwafatso ya tetanus, go diega go ntsha legogo fela morago ga gore eschar e tlhaolwe ka dibeke di le 6 go ya go di le 8"]

Papiso ya kalafi ya tlhogo le tlhogo: Motlholagadi yo Montsho (Latrodectism) kgatlhanong le Motlholagadi yo o Borokwa (Loxoscelism) kgatlhanong le MRSA Abscess¶

Ka gonne batho ba ba sa rutegang le dingaka tsa tlhokomelo ya motheo gantsi ba tlhakanya go loma ga motlholagadi go go nang le botlhole jwa methapo, go longwa ga necrotic recluse, le diso tse di tlwaelegileng tsa dibakateria, go farologanya dilo tse di bapileng go botlhokwa thata:

Digokgo tsa Motlholagadi yo Montsho le tsa Mokwatla o Mohibidu (Latrodectus) le Botlhole jwa Methapo¶

Botlhole jwa Alpha-Latrotoxin jwa dimolekhule¶

Digokgo tse di namagadi tsa motlholagadi (Latrodectus mactans [Motlholagadi yo Montsho wa Borwa], Latrodectus hesperus [Motlholagadi yo Montsho wa Bophirima], Latrodectus variolus [Motlholagadi yo Montsho wa Bokone], Latrodectus tredecimguttatus [Motlholagadi yo Montsho wa Mediterranean] dikgeleswa tsa botlhole le meno a a khuti a chitinous a a telele go lekana go tsenelela mo letlalong la motho (fa digokgo tse dinnye tse ditonanyana tsa motlholagadi di sa kgone go phunya letlalo la motho).

1. Go Bopega ga Diphatlha tsa Khalesiamo tsa Pele ga Di-Synaptic: Botlhole jo bogolo jwa ditshedi tsa lerapo la mokwatla mo botlholeng jwa Latrodectus ke alpha-latrotoxin, poroteine ya 130-kDa e e tsamayang ka ditšhanele tsa lymphatic go tsena mo leraleng la mmele mme e golagana ka kamano e e kwa godimo le di-endplate tsa dikoloi le ditheminale tsa methapo e e ikemetseng.
2. Go Latlhelwa ga Di-Neurotransmitter tse di sa Laolweng: Fa di kopana, dimolekhule di le nne tsa alpha-latrotoxin di kopana go nna tetramer mme di tsena mo leraleng le le mabedi la mafura la bofelo jwa methapo, di bopa motšhene wa katione o o kgonang go tsenelela khalesiamo wa leruri. Di-ione tsa khalesiamo tse di kwa ntle ga sele di tshologela mo setlhopheng sa methapo ya pele ga go tshwaragana, mme di dira gore di-vesicle tsa synaptic tse di nang le acetylcholine (kwa dikopanong tsa methapo ya marapo) le norepinephrine le epinephrine (kwa ditheminaleng tse di ikemetseng tsa kutlwelobotlhoko).
3. Ditlhagala tsa tetanic tse di tshwanang le makhubu tse di senang loso lwa leruri lwa methapo: Go farologana le botlhole jwa botulinum, botlhole jwa alpha-latrotoxin ga bo senye axon ya motsamao ruri. Go na le moo, go latlhela acetylcholine go lotlela mesifa ya marapo go nna go ngotlega go go tlhotlheletsang, go go tlhotlhoregang fa go latlhelwa ga norepinephrine e e utlwelang botlhoko go baka go fufulelwa thata mo kgaolong, go tlhotlhorega ga piloerection, le kgatelelo e e kwa godimo ya madi, e e kokobelang mo diureng di le 48 go ya go di le 96 jaaka di-vesicle.

Go lemoga go tswelela pele ga bolwetse jwa Latrodectism¶

1. Kgato 1: The Pinprick and Target Halo (Metsotso e le 0 go ya go e le 30): Go farologana le go longwa ke batho ba ba ikemetseng, diperesente di le 75 go ya go di le 90 tsa batswasetlhabelo ba segokgo sa motlholagadi ba utlwa go longwa ka bonako fela fa se diragala, ka tlwaelo go longwa ke pinprick e e bogale fa ba apere ditlelafo kgotsa diboots, ba tsholetsa fanitšhara ka fa tlase ga patio kgotsa ba tsholetsa dikgong tsa molelo. Mo metsotsong e le 15 go ya go e le 30, go loma go nna le lefelo le lesweu le le sediko le le sediko le le dikologilweng ke halo e khibidu e tshesane, ka marothodi a mannye a mofufutso le di-goosebumps tse di tlhatlogileng gone mo lefelong la go loma.
2. Kgato 2: Go Tlhatloga ga Lymphatic le Difasciculations tsa Mesifa ya Kgaolo (Metsotso e le 30 go ya go e le 90): Di-lymph node tsa kgaolo mo sehubeng kgotsa mo tlhogong di nna bonolo, mme di-fasciculations tsa mesifa tse di bonalang le di-cramps tse di tseneletseng, tse di tshwanang le vise di tlhatlogela kwa godimo ga letsogo le le lomilweng go ya kwa kutu.
3. Kgato 3: Go tlhotlhorega ga ditlhaa ka kakaretso, Mpa e e tshwanang le Boto, le Difatlhego tsa Latrodectus (Diura di le 1 go ya go di le 12):
4. Go loma ga dintlha tse di kwa tlase go phatsima mo diropeng, mo mokwatleng wa lumbar, le leboteng la mpa la kwa pele, go lotlela mesifa ya rectus abdominis mo go gagamala go go tshwanang le ga boto ka makhubu a a botlhoko a 10/10 a go tshwaratshwara.
5. Go loma ga dintlha tse di kwa godimo kgotsa mo molaleng go phatsima mo magetleng, mesifeng ya magareng ga matlhatla, le lebota la sehuba, go baka go gagamala thata ga sehuba le go hema go etsisa go ema ga pelo.
6. Boraro jo bo ikemetseng le go sa iketle: Go na le mokgwa o o sa tlwaelegang go fufulelwa (diphoresis), kgatelelo e e tseneletseng ya madi mo ditshikeng (gantsi e feta 180/110 mmHg), le Latrodectus facies (sefatlhego se se hibidu, se se tshosang se se nang le diphuka tsa matlho tse di rurugileng le phatla). Go farologana le molwetse yo o nang le peritonitis ya mmatota ya go arwa (mametlelelo e e thubegileng) yo o robetseng a sa tshikhinyega mo godimo ga sepalangwa, molwetse wa Black Widow o nna a tlhotlhorega, a tsamaya, le go koba mokwatla wa gagwe a leka go otlolla mesifa e e tlhotlhoregang.

Tsamaiso ya Bookelo ya Botlhole jwa Motlholagadi yo Montsho le Redback¶

1. Ke Eng fa Calcium Gluconate e e Tsenngwang mo Tshikeng e sa tlhole e dirisiwa: Motseletsele wa kalafi o o laolwang o supile gore Calcium gluconate ya IV ga e atlege fa e bapisiwa le di-opioid tse di tsenngwang mo ditshikaneng tse di kopantsweng le di-benzodiazepine.
2. Kalafi ya Mola wa Ntlha (Diopioid tsa IV + Dibenzodiazepine tsa IV): Tsenya morphine ya IV (0.1 mg/kg) kgotsa fentanyl ya IV (1 mcg/kg) ya botlhoko jo bo tseneletseng, e kopantswe le benzodiazepapine ya IV e e jaaka mg to**zepalo (1 go ya go 2 mg IV) go tokafatsa thibelo ya GABA-A ya lerapo la mokwatla, go fokotsa go thunya ga mesifa ya tetanic, le go laola kgatelelo e e kwa godimo ya madi.
3. Pheko e e tlhomameng: Botlhole jwa Dipitse jwa Latrodectus: Kwa Amerika Bokone (Botlhole jwa Segokgo sa CSL Redback), dibotlolo di le 1 go ya go di le 2 tsa botlhole jwa dipitse tse di tsenngwang mo metsotsong e le 15 go ya go e le 30 di tlamela ka tharabololo e e feletseng ya go gagamala ga mesifa. go ya go metsotso e le 60. E supilwe mo botlhokong jo bo tseneletseng jo bo sa kgoneng go alafa di-opioid le benzodiazepines, mathata a kgatelelo e e kwa godimo ya madi, boimana (go thibela pelegi pele ga nako kgotsa go kgaoga ga placenta), le botlhole jo bo tseneletseng mo baneng ba ba botlana kgotsa bagolo ba ba bokoa.

Digokgo tse di Borokwa le tsa Violin (Di-Loxosceles) le Di-Loxoscelism tse di Bolaileng kgotsa tsa Thulaganyo¶

Go kgaphela kwa thoko go longwa ke segokgo ga maaka: Mnemonic ya GO SA ITLHOKE¶

Dingaka gantsi di tlhatlhoba ka tsela e e sa siamang diso tsa CA-MRSA tsa dibakateria, diso tsa bolwetse jwa sukiri, herpes simplex, kgotsa erythema ya Lyme e e fudugang fa Brown Recluse e loma mo dikgaolong tse go se nang digokgo tsa Loxosceles tse di nnang mo go tsone. Baithutabotlhole ba dirisa mnemonic e e netefaditsweng ya NOT RECLUSE go kgaphela kwa thoko go longwa ke recluse le go supa tshwaetsego ya baketeria:

• N (Numerous): Go feta 90% ya go longwa ga mmatota ga Brown Recluse ke lebadi le le lengwe le le nosi (go tswa mo go pitikololeng segokgo se le sengwe se se tshwaregileng mo bolaong kgotsa go apara diaparo). Dintho tse dintsi di supa dintsi, dikhukhwana, kgotsa diso tsa MRSA, e seng recluse.
• O (Tiragalo): Kwa Amerika Bokone, Loxosceles reclusa e tlholegile fela kwa Borwa-Bogare le Bophirimagare jwa US (Nebraska le Iowa go ya kwa tlase go ya kwa Texas, kwa botlhaba go ya kwa bophirima jwa Georgia le borwa jwa Ohio). Kwa ntle ga dikgaolo tsa Loxosceles tse di tlwaelegileng (kgotsa Amerika Borwa go L. laeta), go loma ga motho yo o nosi go batla go sa kgonege.
• T (Nako): Go feta 85% ya go loma ga Loxosceles reclusa go go netefaditsweng go diragala mo dikgweding tse di bothitho (Moranang go fitlha ka Diphalane).
• R (Setheo se Sehibidu): Go loma ga mmatota ga Brown Recluse go nna le setheo sa ischemic se se bosetlha, se se bosetlha, kgotsa se se botala jo bo lefifi jo bo phepole (ka gonne sphingomyelinase D e tlhotlhorega mo methapong ya letlalo). Lebadi le le nang le bohibidu jo bo galotseng, setheo se se mogote ke tshwaetsego ya dibakateria.
• E (Elevated Dome): Lomo lwa mmatota lwa Brown Recluse ke sephaphathi kgotsa lo nweletse ka fa tlase ga letlalo le le di dikologileng (ka fa tlase ga sentimitara e le 1 ka bokima). Dome e e tsholetsegileng, e e rurugileng e e kwa godimo ga sentimitara e le 1 ke ntho ya dibakateria e e tletseng mamina (go bedisa).
• C (E e sa foleng mo dikgweding di le 3): Le diso tse dikgolo tsa necrotic recluse di fola mo lobakeng lwa dibeke di le 8 go ya go di le 12. Dintho tse di tswelelang mo dikgweding di le 3 tse di fetileng di tlhoka go tlhatlhobiwa kankere ya letlalo, pyoderma gangrenosum, kgotsa tshwaetsego ya fankase.
• L (E kgolo go feta 10 cm): Go feta 90% ya dintho tsa recluse di dinnye go feta disentimetara di le 3 go ya go di le 10 (disentimetara di le 1.2 go ya go di le 4).
• U (Ulcerates Too Early, ka fa tlase ga Malatsi a le 7): Mo go lomeng ga mmatota ga Brown Recluse, letlalo la fa gare le le nang le ischemic le bopa legogo le lentsho le le omileng (eschar) mo malatsing a le 5 go ya go a le 14 mme ga le bulege go nna seso sa mogogoro go fitlha ka Letsatsi la 7 go ya go Letsatsi la 14. Lebadi le le thunyang le go ntsha mamina a a serolwana a a metsi ka Letsatsi la 2 kgotsa Letsatsi la 3 ke sebediso sa MRSA sa dibakateria.
• S (E rurugile): Ntle le mo letlhogong kgotsa mo leotong, go loma ga recluse ga go bake go ruruga go gogolo ga letsogo le le motlhaba kwantle ga erythema ya kgogedi.
• E (Mamina a a tswang): Dilo tsa mmatota tsa Borokwa jwa Recluse ke ditlhaselo tsa letlalo le le omileng la ischemic. Bodi jo bo serolwana jo bokima kgotsa bosweu bo kaya tshwaetsego ya dibakateria, e seng botlhole jwa segokgo.

Pathofisioloji ya Loxoscelism ya Letlalo: Bohibidu, Bosweu, le Botala jwa Legodimo le Go Anama ga Kgogedi¶

Fa segokgo sa Loxosceles se gatelelwa mo letlalong mo teng ga diaparo kgotsa dishiti tsa malao, meno a sone a tlhaba sphingomyelinase D (phospholipase D) mmogo le hyaluronidase:

1. Diura 6 go ya go 48 (Letshwao le Lehibidu, le lesweu, le le letala):
2. Setheo sa Botala jwa Legodimo/Phepole: Sphingomyelinase D e kgaoganya sphingomyelin ya endothelial, e dira gore dipolatelete di kopane, go thapiwa ga di-neutrophil, le go tlhotlhorega ga madi mo methapong e mennye. Ka go bolawa ke tlala ya kelelo ya madi, dermis e e fa gare e fetoga botala jwa loapi jo bo bosetlha kgotsa bophepole jo bo fifetseng (gantsi ka letshoroma le le tshologang madi).
3. Palamonwana e Tshweu e e Fa Gare: E e dikologileng konokono ya ischemic e e phepole ke palamonwana e e tshesane, palamonwana e e bosetlha e e bakiwang ke go pitlagana ga ditshika tsa reflex.
4. Halo e Khibidu ya Kwa Ntle: Go dikologa mogala o mosweu go na le halo e e bulegileng ya thurugo ya ditshika tse di bohibidu.
5. Go Anamela kwa Tlase ga Kgogedi le go tlhotlhorega ga Eschar (Malatsi a le 5 go ya go a le 21): Ka gonne botlhole jwa Loxosceles bo na le hyaluronidase (ntlha ya go anama), kgogedi e gogela enzyme kwa tlase ka difofane tsa mafura a a ka fa tlase ga letlalo go nna popego ya marothodi a keledi. Mo diperesenteng di le 10 go ya go di le 30 tsa go loma go go nnang necrotic (bogolo jang mo mafelong a a mafura jaaka dirope, marago, kgotsa mpa), bogare jo bo pududu bo thatafatsa go nna eschar e e nweleng, e e omileng, e ntsho ya letlalo ka Letsatsi la bo 5 go ya go la bo 7, e e kgaoganyang fa gare ga Letsatsi la bo 7 le Letsatsi la bo 21 le ulcer to2a1. dibeke.

Loxoscelism ya Letlalo la Thulaganyo (Hemolysis ya Mo teng ga Methapo: Matshosetsi a Boammaaruri a Botshelo)¶

Mo diperesenteng di le 1 go ya go di le 2 tsa dilome tsa Loxosceles reclusa tsa Amerika Bokone (le go fitlha go diperesente di le 10 go ya go di le 15 tsa dilome tsa Loxosceles laeta tsa Amerika Borwa), segolobogolo mo baneng, sphingomyelinase D e tsena mo mading mme e golagana le disele tse dikhibidu tsa madi tse di dikologang:

• Hemolysis e e Tletseng mo Methapong: Le fa go loma ga letlalo go lebega go le gonnye, sphingomyelinase D e e rulagantsweng e apola di-glycophorins mo dimembraneng tsa disele tse dikhibidu tsa madi mme e dira gore tlaleletso e dire, mme seno se baka go tlhotlhorega ga madi mo methapong mo lobakeng lwa diura di le 24 go ya go di le 72 morago ga go longwa.
• Matshwao a kotsi a o tshwanetseng go a tlhokomela mo diureng tsa ntlha di le 72:
• Letshoroma, go tsidifala, go kgwa, go opa ga malokololo, le letshoroma le lehibidu le le anameng go simolola diura di le 12 go ya go di le 48 morago ga go longwa.
• Motlhapo o o borokwa jo bontsho, wa mmala wa teye, kgotsa wa mmala wa cola (hemoglobinuria) fa disele tse dikhibidu tsa madi tse di lysed di tshololela hemoglobin e e sa duelelweng mo polasemeng le mo diphilong, mme seno se baka kgobalo e e botlhoko ya diphilo (AKI).
• Hemoglobin e e welang tlase ka bonako (go tlhoka madi), go nna mohibidu, go tlhotlhorega ga pelo, le botala jwa mmala (matlho a masetlha) go bapa le DIC.
• Prothokholo ya Bookelo: Ngwana mongwe le mongwe kgotsa mogolo yo o nang le letshoroma, letshoroma, kgotsa motlhapo o montsho morago ga go belaelwa gore o longilwe ke motho yo o ikemetseng o tlhoka go amogelwa kwa bookelong ka bonako, dipalo tsa madi ka tatelano (hemoglobin diura dingwe le dingwe di le 6 go ya go di le 12, LDH, bilirubin e e sa tlhamalalang, **haptocrene go tsenngwa ga metsi ka IV crystalloid ka bogale, le go tshelwa disele tse dikhibidu tsa madi tse di pakilweng tsa hemoglobin e e welang kwa tlase ga 7 go ya go 8 g/dL.

Ntlha e khutshwane ka Digokgo tsa Bobi jwa Difonele tsa Australia (Atrax le Hadronyche): PIB e e sa akarediweng¶

Mo lobopong lo lo kwa botlhaba kgotsa lo lo kwa borwa jwa Australia (Sydney le Motseletsele o Mogolo o o Kgaoganyang go tswa kwa Queensland go ya kwa Tasmania), go longwa ke segokgo se segolo se se phatsimang se sentsho (mofuta wa Atrax robustus kgotsa Hadronyche) go tlhaba botlhole jwa delta-atracote-no-storm, go baka Metsotso e le 10 go ya go e le 60 (botlhoko jo bo tseneletseng jwa selegae, go tlhotlhorega ga molomo, go tlhotlhorega ga leleme, go ntsha mamina a mantsi le go fufula, kgatelelo e e kwa godimo ya madi, go ruruga ga makgwafo, le go ema ga go hema). Go farologana le digokgo tsa Redback/Widow kgotsa Recluse, go loma ga Australian Funnel-Web (kgotsa Segokgo sa Peba) GO TLHOKA Bandage ya go Thibela Kgatelelo ka bonako (PIB) + setlhako se se gagametseng, go thibela go tsamaya gotlhelele, le go tsamaisiwa ka bonako ka ambulense (non Segokgo) sa **Fu.

Dinomoro tsa maemo a tshoganyetso tsa kgaolo le diporothokholo tsa boemedi¶

• United States le Canada: Letsa 911 go gagamala thata ga mesifa, botlhoko mo sehubeng/mo mpeng, bothata jwa go hema, kgotsa matshwao a thulaganyo. Leletsa Taolo ya Botlhole ya Amerika mo go 1-800-222-1222 (kgotsa Senthara ya Botlhole ya Porofense ya Canada) 24/7 go bona kaelo ya ngaka ya botlhole ya kalafi ka ga go ela tlhoko botlhole jwa Latrodectus kgotsa Loxosceles jwa go phatloga ga madi.
• Australia le New Zealand: Letsa 000 kwa Australia kgotsa 111 kwa New Zealand. Latela Kaelo ya ANZCOR 9.4.2 (Botlhole: Go Lomiwa ke Segokgo):
• Go Segokgo sa Redback (Latrodectus hasselti) kgotsa digokgo tse dingwe tsa kakaretso: dirisa segokgo se se tsididi (sephuthelwana sa aese se se phuthetsweng go fitlha go metsotso e le 20); O SE KE wa dirisa Bandage ya go sa Tsamaise ka Kgatelelo. Batla tlhokomelo ya bookelo go bona diokobatsi tsa go okobatsa ditlhabi le CSL Redback Antivenom fa ditlhabi di le botlhoko thata.
• Mo go klzzwxh:062/Hadronychkgotsa Segokgo sa Peba *Missulena*)**: dirisa **Setlhako sa Thibela Kgatelelo (PIB) le setlhako ka bonako** mme o letsetse 000. Leletsa **Lefelo la Tshedimosetso la Botlhole la Australia mo go 1361.
• Bogosi jo bo Kopaneng: Letsa 999 go bona maemo a tshoganyetso kgotsa NHS 111 go bona tlhatlhobo ya kalafi e e potlakileng. Ela tlhoko gore ga se Batlholagadi ba Bantsho ba boammaaruri kgotsa Di-Brown Recluses tse di tlholegileng kwa UK; digokgo tsa naga Noble False Widow (Steatoda nobilis) di baka botlhoko jwa selegae jo bo tshwanang le jwa diboko le go sa ikutlwe sentle go go botlhofo ("steatodism") go go alafiwang ka go tlhatswa ka sesepa/metsi, dikhomphutara tse di tsidifetseng, le dipilisi tsa go okobatsa botlhoko tsa molomo, fa diokobatsi tse di botlhoko tse di bohibidu tse di rurugileng thata tsa "go loma ga digokgo" kwa UK e le diokobatsi tse di bolayang disele tse di bogale kgotsa di-antibiotic tse di batlang di le teng ka metlha.
• Kopano ya Yuropa le Mediterranean: Letsa 112. Kwa Yuropa Borwa (Spain, Italy, Gerika, Fora e e kwa Borwa, Balkans), bobedi Motlholagadi yo Montsho wa Mediterranean (Latrodectus tredecimguttatus) le Motlholagadi wa Mediterranean (Loxosceles rufescens) ka bobedi ke tsa naga; tswelela kwa lephateng la tshoganyetso la bookelo le le gaufi go bona ditlhabi tse di masisi tsa mesifa kgotsa dipolakete tsa necrotic.
• Amerika Borwa (Brazil, Peru, Chile, Argentina) le Aforika Borwa: Letsa 192 / 193 kwa Brazil, 131 kwa Chile, 106 kwa Peru, kgotsa 10177 / 112 kwa Aforika Borwa. Kwa Brazil le Peru, kwa Loxosceles laeta le Loxosceles intermedia tse di maatla di bakang dikelo tse di kwa godimo tsa go phatloga ga madi mo letlalong, **botlhole jo bo rileng jwa dipitse jo bo lwantshang di-arachnid (*bolwetsi jwa dipitse jo bo lwantshang di-arachnid (botlhole jo bo lwantshang di-arachnid jo bo nang le di-arachnid go ya go diura di le 48 tsa loxoscelism e e magareng go ya go e e masisi.

Dipotso tse di bodiwang kgapetsakgapetsa¶

Nka bona jang pharologanyo fa gare ga go longwa ke Black Widow le go longwa ke Brown Recluse?¶

Di ntsha matshwao a a fapaaneng gotlhelele. Go longwa ke Black Widow go utlwala e kete ke go tlhabiwa ka bogale gone fela foo, ga go tlogele tshenyo epe mo letlalong (ke fela mogala o monnye o o bosetlha o o nang le marothodi a mofufutso a a mo lefelong le le rileng le di-goosebumps), mme mo metsotsong e le 30 go ya go e le 90 go baka go tlhotlhorega ga mesifa e e botlhoko, e e tshwanang le makhubu mo diropeng, mesifa e e kwa tlase ya mokwatla, sehuba, . mmogo le kgatelelo e kgolo ya madi le go fufula. Go longwa ke Brown Recluse gantsi ga go botlhoko kwa tshimologong, ga go ke go baka go gagamala ga mesifa, mme mo diureng di le 6 go ya go di le 48 go nna le polaka e e bohibidu, e tshweu le e e pududu e e tlhomilweng mo letlalong e e ka fetogang go nna legogo le lentsho le le nweletseng (eschar) le seso se se folang ka iketlo.

Ke ka ntlha yang fa bontsi jwa "digomo tsa segokgo" tse di botlhoko, tse di rurugileng tse dikhibidu tota e le ditshwaetso tsa letlalo tsa dibakateria tsa MRSA?¶

Ntle le fa tota o bone segokgo se go loma ka nako e e tshwanang le e se diragetseng ka yone, dipatlisiso tse di dirilweng mo mafapheng a maemo a tshoganyetso di bontsha gore diperesente di feta 80 tsa dintho tse balwetse ba dumelang gore di longilwe ke segokgo tota ke diso tsa letlalo (diso) tse di bakiwang ke Staphylococcus aureus (MRSA) e e sa alafegeng ka methicillin. A sebele Brown Recluse loma ke sephaphathi kapa sunken le bosehla kapa lefifi putsoa-phepole setsi le omileng dinama tse nyenyane tse lefu, athe lesion hore e phahamisitsoeng joaloka ruruha dome, chesang le khanyang khubelu ka bohareng, 'me drains mokedikedi mosehla kapa tšoeu pus ka matsatsi a seng makae ke tshwaetso ea baktheria e hlokang antibiotics draina.

Ke ka ntlha yang fa go longwa ke segokgo sa Black Widow go dira gore mpa ya gago e ikutlwe e le thata jaaka boto ya logong, e kete ke mametlelelo e e thubegileng?¶

Botlhole jwa Black Widow bo na le alpha-latrotoxin, e leng botlhole jwa methapo jo bo tsamayang go tlhatloga ditshika tsa lymphatic go tswa mo go longweng mo leotong kgotsa mo leotong mme bo phunya diphatlha tsa calcium mo diphelelong tsa methapo ya dikoloi tse di tlamelang ka mesifa e megolo ya dirope, karolo e e kwa tlase ya mokwatla le lebota la mpa. Go latlhelwa ga acetylcholine e e fetisang methapo ka bontsi go dira gore mesifa ya lebota la mpa e nne le go ngotlega go go tswelelang pele, go go sa itireleng. Dingaka di e farologanya le bolwetse jwa appendicitis ka gonne molwetse ga a iketle e bile o a tlhotlhorega go na le go rapama a sa tshikinyege, ga go na bonolo jwa mmatota jwa go boela mo mpeng, mme botlhoko bo rarabologa ka bonako fa go tsenngwa di- opioid, di- benzodiazepine kgotsa Latrodectus antivenom.

A ke tshwanetse go tsenya aese kgotsa mogote mo go lomeng ga segokgo sa Brown Recluse kgotsa sa Black Widow?¶

Ka metlha dirisa sediriswa se se tsidifetseng kgotsa sephuthelwana sa aese se se phuthetsweng ka letsela le le phepa (metsotso e le 10 go ya go e le 15 ka nako), mme le ka motlha o se ke wa tshasa sethibela-thuthafatsi kgotsa metsi a a bolelo mo go se se belaelwang gore se lomilwe ke Brown Recluse. Ensaeme e e senyang dithishu mo botlholeng jwa Brown Recluse (sphingomyelinase D) e dira ka bonako mo dithemphoritšhareng tse di kwa godimo; go dirisa mogote go itlhaganedisa go bola ga letlalo, fa go tsidifatsa ka bonolo go fokotsa enzyme le go fokotsa botlhoko jwa selegae mo go longweng ga Brown Recluse le Black Widow ka bobedi.

Ke eng go le botlhokwa go tlhola mmala wa moroto wa ngwana malatsi a le 3 morago ga go longwa ke Brown Recluse e e belaetsang?¶

Mo diperesenteng di le 1 go ya go di le 10 tsa go loma ga Brown Recluse, mme ka tsela e e sa lekalekaneng mo baneng, enzyme ya botlhole ya sphingomyelinase D e tsena mo mading mme e tlhasela dithishu tse di kwa ntle tsa disele tse dikhibidu tsa madi, e dira gore di thunyege mo teng ga ditshika tsa madi (hemolysis ya madi e e mo teng ga ditshika tse pedi) fa gare ga ho7 le 224. Tota le fa go loma ga letlalo go lebega go le gonnye, disele tse dikhibidu tsa madi tse di thubegang di dira gore motlhapo o nne borokwa jo bontsho, mmala wa rusi, kgotsa mmala wa cola (hemoglobinuria) mme di ka baka go tlhoka madi go go ka tsenyang botshelo mo kotsing le go sa dire sentle ga diphilo mo go tlhokang gore motho a tshelwe metsi ka bonako kwa ICU le go tshelwa madi.

A o tshwanetse go tsamaya o phuthela Bandage e e gagametseng ya go sa Tsamaise ka Kgatelelo kgotsa tourniquet go dikologa go loma ga Motlholagadi yo Montsho kgotsa Motho yo o Borokwa?¶

Nnyaa Le ka motlha o se ke wa tshasa tourniquet kgotsa Sebante sa elastic sa go sa kgone go tsamaya mo Motlholagading yo Montsho, Redback, kgotsa Brown Recluse. Go tshwara botlhole jwa Brown Recluse mo lefelong le le lengwe go tsepamisa enzyme e e phatlalatsa dithishu mme go baka go bola ga letlalo go go tseneletseng thata, fa go bofa loma lwa Motlholagadi kgotsa lwa Redback go gakatsa botlhoko jwa lefelo leo kwantle ga go tokafatsa ditlamorago. (Dibante tsa go sa tshikinyege ka ntlha ya kgatelelo di dirisediwa digokgo tsa Australian Funnel-Web le dinoga tse di botlhole, ga di ke di dirisediwa digokgo tsa Widow kgotsa Recluse.)

Metswedi le kaelo ya semmuso¶

• Mokgatlho wa Amerika wa Disenthara tsa Taolo ya Botlhole (AAPCC) & Kholetšhe ya Amerika ya Botlhole jwa Kalafi (ACMT, United States): Dikaelo tsa Tiriso ya Kalafi le Ditshekatsheko tsa Botlhole ka ga Dibotlhole tsa Latrodectus (Motlholagadi) le Loxosceles (Recluse) le *Tlhatlhobo ya NOT RECLUSEJE.
• Lekgotla la Australia la go Tsosolosa (ANZCOR, Australia le New Zealand): Kaelo ya ANZCOR 9.4.2: Go tsenwa ke botlhole, go Lomiwa ke Segokgo (Prothokholo ya go paka serame ya Segokgo sa Redback kgatlhanong le porothokholo ya Segokgo sa Funnel-Web sa go Se Tsamaya).
• Disenthara tsa Taolo le Thibelo ya Malwetse (CDC / NIOSH, United States): Digokgo tse di Botlhole (Motlholagadi yo Montsho le Motho yo o Borokwa): Go Supa, Thuso ya Ntlha, le Taolo ya Kalafi, mmogo le go Pharologanya le Ditshwaetso tsa Letlalo tsa CA-MRSA.
• Mokgatlho wa Lefatshe Lotlhe wa Boitekanelo (WHO) & Mokgatlho wa Boitekanelo wa Pan American (PAHO): Taolo ya Kalafi ya Loxoscelism (Matshwao a go tlhotlhorega ga madi mo letlalong le mo teng ga letlalo) le Latrodectism kwa Amerika.
• Tirelo ya Bosetšhaba ya Boitekanelo (NHS, United Kingdom) & Tirelo ya Bosetšhaba ya Tshedimosetso ya Botlhole (NPIS): Go Lomiwa ke Segokgo: Thuso ya Ntlha, Taolo ya Steatoda (Motlholagadi wa Maaka), le Difolaga tse di Khibidu tsa Tshwaetso ya Dibaketeria.

Dikaedi tse di tsamaelanang¶

• Thuso ya potlako ya go longwa ke dikgofa le segokgo
• Go anama ga bolwetse jwa sele, methalo e mehibidu ya lymphangitis, le diso tsa letlalo tsa MRSA
• Go longwa ke noga le maemo a tshoganyetso a digagabi tse di botlhole
• Kgobalo e e botlhoko ya diphilo, rhabdomyolysis, le go tlhaola motlhapo o montsho
• Dinomoro tsa tshoganyetso go ya ka dinaga