Okuqukethwe
17.03.2017
I-Enterococcus iyibhaktheriya elincane elimise okweqanda eliyingxenye ye-microflora yamathumbu omuntu evamile (ngaphambilini ama-microorganisms anjalo ayehlukaniswa njenge-group D streptococci).
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Ukuzijwayeza kanye nolwazi lokwelashwa
Uma sibheka phambili kancane, siyaqaphela ukuthi abahleli bazi kahle ukuthi abafundi bafuna ulwazi olwengeziwe mayelana indlela yokwelapha i-enterococcus. Ngenxa yalesi sizathu, siqala ukukunikeza ulwazi mayelana neForamu yethu, lapho kunengxoxo esebenzayo ngesihloko sokwelashwa kwe-enterococcal bacterial infection emadodeni. Nazi izihloko ezimbalwa ezidumile eziqukethe kakhulu ulwazi olusekelwa umkhuba:
I-Enterococcus faecalis – Isihloko esinocwaningo mayelana nemiphumela yokwelashwa I-Enterococcus isifile! Futhi angikakakwazi - Isipiliyoni sokwelashwa Ivelaphi i-flora yamathumbu ku-prostate - Udinga ukwazi lokhu
Simema wonke umuntu ukuthi ajoyine ingxoxo! Lesi sithangami siqale ukusebenza kusukela ngo-2006. Inqolobane yolwazi olusebenzayo emkhakheni wezempilo yabesilisa.
Kodwa-ke, ulwazi olusebenzayo alukukhanseli ukuba wusizo kolwazi lwendlela yokusebenza. Ngakho-ke asiqhubeke...
Izinhlobo ze-enterococci. Izimbangela zokutheleleka
I-Enterococci inezinhlobo ezingaphezu kuka-16, ezinye zazo zingabangela izifo ezithathelwanayo zesistimu ye-genitourinary, i-endocarditis, njll. Ezivame kakhulu yi-Enterococcus faecalis (i-fecal enterococcus) ne-Enterococcus faecium. Nakuba indawo evamile ye-enterococci ingamathumbu, cishe ku-25% wamadoda anempilo, i-Enterococcus faecalis ikhona engxenyeni engaphambili ye-urethra. Kungakho i-enterococci ihlukaniswa njenge-microflora engosomathuba (yesikhashana) yezitho ze-genitourinary. Ngokulandelayo, i-Enterococcus faecium ibhekene neningi lezifo ezimelana ne-vancomycin ze-enterococcal. Ukungazweli kwamagciwane kuma-antibiotic kuyinkinga enkulu yezokwelapha zanamuhla.
I-Enterococci inabo bobabili, ngenxa yesakhiwo esikhethekile, futhi ithole ukumelana nama-antibiotic. Lokhu kunikeza umnikelo obalulekile walawa magciwane ekuthuthukiseni izifo ze-nosocomial futhi kunciphisa ikhono lodokotela maqondana nesici esibalulekile njengokwelashwa kwe-enterococcus.
I-Enterococcus emadodeni (kaningi - i-Enterococcus faecalis) ingabangela izifo zezitho ze-urogenital tract, ikakhulukazi kubantu abaye bahlolwa ngendlela efanele yezinsimbi kanye / noma abaphuza ama-antibiotics:
• i-prostatitis; • i-balanoposthitis; • i-urethritis; • i-epididymitis/orchoepididymitis; • i-cystitis, njll.
Izindlela zokutheleleka:
• ukuthintana ngokocansi (ikakhulukazi ukushintshana kwezitho zangasese kanye nezitho zangasese zangasese); • inhlanzeko engafanele ngemva kokusebenzisa indlu yangasese; • ukudluliselwa kusuka kumama kuya kosanda kuzalwa; • kuyaqabukela - ekufakeleni isitho.
Lapho ingena ezithweni ze-genitourinary, i-enterococci ingahlala kuzo kusukela emahoreni ambalwa kuya emasontweni, ekugcineni ibhujiswe yizinqubo zokuzivikela. Lesi simo sibizwa ngenqola yesikhashana noma ezokuthutha. Kulokhu, umthwali angadlulisela i-pathogen kumlingani wocansi. Ukuxilongwa kwe-enterococcus ngenqola yesikhashana kungenzeka ngezindlela zokunemba okuphezulu (isibonelo, i-PCR).
Futhi, i-enterococci ngenani elincane ingaba njalo ezithweni ze-genitourinary (inqola eqhubekayo). Ukukhula kwabo kuvinjelwa izindlela ezifanayo zokuzivikela kanye ne-microflora evamile. Ngokuncipha kwenani lama-microorganisms ajwayelekile kanye / noma ukwephulwa kokuvikelwa kwe-enterococci, aqala ukwanda ngokushesha, inqubo yokuvuvukala iqala. Ukuthwala okuphikelelayo ngokuvamile akubonakali, ngaphandle kwenkathi yokwanda, ukutholwa kwe-enterococcus kungenzeka nge-PCR, indlela yocwaningo lwamasiko. Kulokhu, kukhona futhi ithuba lokutheleleka komlingani.
Lapho umzimba uyeka ukuvimbela ukuthuthukiswa kwe-enterococci, ukubonakaliswa kwesifo kwenzeka. Izici ezidala ukuthuthukiswa kokutheleleka kwe-enterococcal:
• ukuba khona kwezifo ezimbi kakhulu; • izifo ezidlule ze-gonococcal/chlamydial; • ukwephulwa kwezinqubo zokuvikela zezitho zangasese (izindlela ezinjalo zihlanganisa indawo engathathi hlangothi/ebuthakathaka ye-alkaline ku-urethra, i-prostate antimicrobial factor, mechanical, local immune protection) i-prostate antimicrobial factor - zinc-peptide complex); • ukwelashwa kwe-antibiotic yesikhathi eside; • ukusetshenziswa kabi kwezinzwa zendawo, okuholela ekushisweni kwe-urethra; • i-catheterization ye-urinary tract noma okunye ukuhlolwa kwezinsimbi, okungabangela ukuhlukumezeka kolwelwesi lwamafinyila; • ukuguga, njll.
Izimpawu zokutheleleka kwe-Enterococcal
Azikho izimpawu ezithile zomonakalo ohlelweni lwe-genitourinary nge-enterococcus. Ngokuthuthukiswa kwenqubo ye-pathological, iziguli ziveza izikhalazo ezinezici zohlobo oluthile lwesifo (kuye ngokuthi indawo yokuvuvukala).
I-urethritis ihambisana nalokhu:
• ukwanda kwemvamisa, ukubonakaliswa okubuhlungu ngesikhathi sokuchama; • ukukhishwa kwe-urethral; • ubomvu, ukucasuka, ukungakhululeki ku-urethra.
I-Prostatitis ibonakala ngezimpawu ezilandelayo:
• i-syndrome ngendlela yobuhlungu nokungahambi kahle ku-perineum, ubuhlungu emasendeni, ama-cramps / ubuhlungu ku-urethra, ukushisa ngemva kokulala ngokocansi; • i-urination disorder syndrome (ukwanda, ukuzwa kokukhipha okungaphelele, ukugeleza okubuthakathaka / okuphakathi); • ukwephulwa kwe-orgasm, ukukhishwa kwesidoda (ubuhlungu, ukugqoka i-orgasm, ukuphuma ngaphambi kwesikhathi noma ukuya ocansini isikhathi eside); • ngokuhambisana ne-urethritis engapheli - ukukhishwa kwe-mucopurulent.
Nge-balanitis / balanoposthitis, iziguli zikhononda ngobuhlungu nokubomvu endaweni ye-glans penis, ubomvu (ukuguguleka, izilonda, imifantu), i-plaque, ukuvuvukala, ukukhishwa. I-Orchiepididymitis iyinhlanganisela yokuvuvukala kwesende (orchitis) kanye ne-epididymis yakamuva (epididymitis). Esifweni esibucayi, ubuhlungu obunzima obunzima ku-scrotum, ukukhulisa / ukuqina kwe-testicle eyodwa noma kokubili, i-hyperemia yesikhumba se-scrotum, ukukhuliswa / ukuqina kwe-epididymis ngobuhlungu obunzima. Ubuhlungu buyancipha ku-scrotum lapho siphakanyiswa. Isifo esingelapheki sibonakala ngezimpawu ezifiphele, ngezinye izikhathi ukubonakala kwegazi esidodeni.
Izindlela zokuxilonga
Ukuxilongwa kwe-enterococcus ezithweni ze-urogenital tract kuhilela:
• ukuhlolwa nguchwepheshe; • ukuhlolwa komchamo jikelele kanye negazi; • i-polymerase chain reaction (ivumela ukukhomba i-microorganism ngisho ne-asymptomatic carriage); • izifundo zamasiko (ngaphandle kwalokho i-bacteriological inoculation) ngokunqunywa kokuzwela kwama-antibiotic; • enye ilabhorethri, efana ne-RIF, ELISA, smear microscopy, njll., kanye nezifundo zezinsimbi (i-ultrasound, urethroscopy, MRI, CT) ukuze zikhiphe ezinye izimbangela zesifo (ukutheleleka okungezona i-enterococcal genital, izinqubo zesimila, njll.) Amasampula omchamo ahlolwa elabhorethri, isidoda, ukukhishwa kwe-prostate, ukukhishwa kwe-urethral.
Lapho kukhona ukubonakaliswa okungalungile okuvela emgudwini we-urogenital, kubalulekile ukuqonda ukuthi i-enterococcus ayiyona imbangela yezinkinga ezinjalo. Uma ukuhlolwa kungazange kubonise ukuba khona kwamanye amagciwane, kungase kudingeke ukuthi kuhlolwe kabusha (ngezinye izikhathi ngisho naselabhorethri ehlukile). Kuphela ngemva kokukhishwa kwamanye amagciwane angenzeka (i-Trichomonas, i-gonococci, i-chlamydia, njll.) kuyinkambo yokwelapha yomuntu ngamunye enqunywe ukuqeda i-enterococci.
Izindlela zokwelapha i-Enterococcus
Uma kwenzeka kutholakala ngengozi i-enterococcus ngesikhathi sokuhlolwa okujwayelekile, ukwelashwa kunconywa kuphela uma kunezikhalazo ezinezici, ukuhlela ukungenelela kokuhlinzwa ezithweni ze-genitourinary tract (kwezinye izimo, udokotela angancoma ukwelashwa okufanele lapho uhlela ukukhulelwa). Lokhu kungenxa yokuthi i-microorganism enjalo ingatholakala ngokujwayelekile emadodeni anempilo ngokuphelele.
I-Enterococcus titers ye-oda ye-1 * 10 ku-6th degree ibhekwa njengokubalulekile kokuxilonga (uma kungekho ukubonakaliswa komtholampilo). Ngasikhathi sinye, i-bacteriuria ye-asymptomatic (ukutholwa kwe-enterococcus emchameni) ingadinga kuphela ukuqondiswa kukadokotela futhi, uma kunesidingo, ukuhlolwa ngezikhathi ezithile: izitshalo eziphindaphindiwe. Ebafaneni abangenazo izimpawu zokutheleleka kwe-urinary tract, ukutholwa kwelebhu evamile ye-enterococcus akunconywa.
Uma i-enterococcus isolwa njengembangela yodwa yezinkinga kumuntu ovela emgudwini we-urogenital (urethritis, prostatitis pyelonephritis, cystitis, njll.), ukwelashwa okwanele kwama-antibiotic kuyadingeka. Njengoba kunikezwe ukumelana okukhulayo kwama-microorganisms anjalo esenzweni semithi elwa namagciwane, kufiseleka kakhulu ukucacisa ukuzwela okufanele ngaphambi kokuqala ukwelashwa (ngeshwa, lokhu kuwumsebenzi odla isikhathi futhi akwenzeki ngaso sonke isikhathi ukuhlehlisa ukuqala kokwelashwa).
Ezimweni eziningi zezifo ezivuthayo zesistimu ye-genitourinary emadodeni, imbangela yokutheleleka yi-enterococcus ye-fecal (Enterococcus faecalis). Lolu hlobo lwe-enterococcus ngokuvamile:
• ukuzwela ku-rifaximin, i-levofloxacin, i-nifuratel, ezinye izinhlobo - ku-doxycycline; • ukuzwela ngokumaphakathi ku-ciprofloxacin; • ukuzwela kancane (ezinhlobonhlobo eziningi) ku-tetracycline; • ayizwani ne-lincomycin.
Ama-penicillin, amanye ama-cephalosporins, i-fluoroquinolones yakuqala awasebenzi noma awasebenzi kahle ngokumelene ne-enterococcus ye-fecal.
Ukuze ukwelashwa, njengomthetho, umuthi owodwa wanele; uma kungasebenzi, kungase kubekwe enye noma inhlanganisela yezimbalwa. Ngemva kokuphela kwesifundo, ukuxilongwa kwesibili kwe-enterococcus kwenziwa. Ukwelashwa komlingani wezocansi kwenziwa ngokuncoma kukadokotela (ngokuvamile uma kwenzeka ukuhlela ukukhulelwa). Endabeni yokutheleleka okuxubile, izidakamizwa ezisebenzayo ku-pathogen ngayinye zikhethiwe.
Inkambo yokwelashwa ngama-antibiotic ngokuvamile yanele ukwelapha okuphelele. Nokho, kwezinye izimo, udokotela angase futhi anikeze:
• izinqubo ezihlukahlukene ze-physiotherapeutic; • inkambo ye-massage (evame ukusetshenziselwa i-pathologies yokuvuvukala ye-prostate gland); • amalungiselelo e-enzyme; • amavithamini; • ama-immunomodulating agents; • ukwelashwa kwe-homeopathic; • imithi yendabuko (ukugeza kwama-decoctions kanye ne-infusions yamakhambi okwelapha, ukuphuza ijusi le-cranberry, njll.); • ukwelashwa kwendawo (i-infusions, okuthiwa i-instillations, ku-urethra yezixazululo zemithi ehlukahlukene, njenge-antiseptics).
Ukungazinaki izincomo zezokwelapha, ukuzithiba ngokweqile kanye nemithi yabantu akukwazi nje ukuholela ekululameni, kodwa futhi kubi kakhulu isimo sesiguli. Isibonelo, ukusetshenziswa kabi kokufakwa kwezixazululo ze-antiseptic ku-urethra ngokuvamile kuholela ekushiseni kwe-mucosal, okuyinto ngokwayo esebenza njengesici esicasulayo sokuthuthukiswa kokutheleleka kwebhaktheriya.
Izinkinga
Uma kungekho ukwelashwa okwanele kokutheleleka kwe-enterococcal, okulandelayo kungenzeka:
• ukusatshalaliswa kwenqubo yokuvuvukala kwezinye izitho nezicubu; • ukuguqulwa kwesifo kufomu elingapheli; • ukuwohloka kwekhwalithi yesidoda futhi, ngokufanele, ukuthuthukiswa kokungazali kwabesilisa; • ukwephulwa komsebenzi we-erectile, njll.
Prevention
Ukuvimbela ukutheleleka kwe-enterococcal:
• ukuhambisana nemithetho yocansi oluphephile (ukusetshenziswa kwezindlela zokuvimbela ukuvikela, umlingani ohlala njalo); • ukutholakala ngesikhathi kanye nokuqedwa/ukulungiswa kwezifo ezingelapheki; • ukwelashwa okunekhono kwezifo zocansi ezihlonziwe (ikakhulukazi i-gonococcal, trichomonas); • indlela yokuphila enempilo (ukwenziwa okujwayelekile kombuso womsebenzi nokuphumula, ukudla okunomsoco okugcwele kwekhwalithi ephezulu, ukuvivinya umzimba okulinganiselayo, ukunciphisa izimo ezicindezelayo, njll.), njll.
Kulungiswe futhi kwengezwa ngo-14.03.2021/XNUMX/XNUMX.
Imithombo esetshenzisiwe
1. Ukubaluleka kwamagciwane ohlobo lwe-Enterococcus empilweni yomuntu. Ijenali yesayensi ye-elekthronikhi "Izinkinga zanamuhla zesayensi nemfundo". Krasnaya Yu.V., Nesterov AS, Potaturkina-Nesterova NI FSBEI HPE “Ulyanovsk State University”. 2. Imiphumela yocwaningo lwe-multicenter lwe-antibiotic susceptibility ye-enterococci. Sidorenko SV, Rezvan SP, Grudinina SA, Krotova LA, Sterkhova GV State Research Center for Antibiotics, eMoscow