Cov kab mob plab hnyuv yog ib pawg loj ntawm cov kab mob uas ua ke nrog kev puas tsuaj rau cov kab mob hauv plab hnyuv thiab cov yam ntxwv ntawm kev kho mob tshwm sim nyob rau hauv daim ntawv ntawm xeev siab, ntuav, raws plab (nrog mucus thiab ntshav) los yog cem quav. Cov kab mob ua rau mob plab hnyuv tuaj yeem yog kab mob, kab mob, helminths thiab protozoa. Qhov no nyuaj heev rau kev kuaj mob thiab feem ntau cuam tshuam nrog kev kho mob.
Definition
Amebiasis (amebic dysentery) yog kab mob anthroponotic nrog lub plab-qhov ncauj kis tau tus mob. Nws cov tsos mob tseem ceeb tshaj plaws yog: mob colitis ntev thiab cov kab mob hauv plab xws li daim siab abscesses, ulcers thiab lwm yam. Feem ntau, lo lus amoebiasis txhais tau hais tias amoebic dysentery, uas yog tshwm sim los ntawm cov cab Entamoeba histolytica.
Amoebic encephalitis thiab keratitis yog qhov txawv ntawm lwm cov amebiases. Raws li Lub Koom Haum Saib Xyuas Kev Noj Qab Haus Huv Ntiaj Teb, kwv yees li kaum feem pua ntawm cov neeg nyob hauv ntiaj teb tau kis tus kab mob no, thiab nws yog ib qho tseem ceeb ntawm kev tuag los ntawm cov kab mob cab. Extraintestinal manifestations yog qhov nyuaj heev los kuaj xyuas, yog li ntawdNws tsis tuaj yeem kuaj xyuas thiab kho amoebiasis raws sijhawm.
Kab mob kis
Nyob rau hauv txhua lub tebchaws uas muaj huab cua kub thiab av noo, amoebic dysentery yog tshwm sim. Cov tsos mob ntawm tus kab mob no feem ntau pom muaj nyob rau hauv cov neeg uas tsis quav ntsej txog kev huv thiab huv. Cov kab mob rau cov kab mob yog Central thiab South America, tshwj xeeb tshaj yog Mexico, thiab Is Nrias teb.
Qee zaum, qhov tshwm sim loj ntawm cov kab mob plab no tau sau tseg hauv cov tebchaws uas muaj kev vam meej, piv txwv li, xyoo 1933 thaum Lub Ntiaj Teb Exhibition, uas tau tuav hauv Chicago. Tam sim no, cov mob loj heev thiab ntuav ntawm tus kab mob tshwm sim nyob rau hauv qhov chaw ntawm congestion ntawm emigrants los ntawm endemic regions. Feem ntau, tus kab mob tshwm sim nws tus kheej hauv lub caij sov.
Lub hauv paus ntawm tus kab mob yog tus neeg mob lossis tus neeg nqa khoom ntawm protozoa. Kev kis kab mob tsuas yog tshwm sim los ntawm txhais tes qias neeg, zaub mov thiab dej. Tsis tas li ntawd, tus kab mob tuaj yeem kis tau los ntawm kev tiv thaiv kev sib deev uas tsis muaj kev tiv thaiv. Nws paub tias daim ntawv cystic ntawm amoeba tuaj yeem kis tau ntawm ob txhais ceg thiab tis ntawm kab.
Vim li cas amoebic dysentery tshwm sim? Nws tus neeg sawv cev ua rau muaj qhov yooj yim tshaj plaws, uas tuaj yeem muaj nyob hauv peb hom sib txawv:
- daim ntaub (pom tsuas yog hauv cov neeg mob);
- translucent;
- cystic.
Ob qhov kawg tau pom nyob rau hauv cov neeg muaj tus kabmob. Nws yog ib lub xovtooj mus txog 40 micrometers loj, uas muaj cov nucleus thiab ntau lub vacuoles. Nws siv pseudopods mus ncig hauv tib neeg lub cev. Cov kab mob, fungi, cov khoom noj khoom haus yog tsim rau cov khoom noj. Amoebic dysentery yog tshwm sim los ntawm daim ntawv no.
Cyst yog ib puag ncig lossis oval cell ntsuas 30 micrometers. Nws tuaj yeem muaj ob peb cores (los ntawm ob mus rau plaub), nws nyob ntawm theem ntawm kev loj hlob.
Ameba lub neej voj voog
Lub cyst nkag mus rau tib neeg txoj hnyuv los ntawm txhais tes qias neeg, dej lossis zaub ntsuab. Nyob ntawd, lub plhaub cyst raug rhuav tshem, thiab tus niam laus amoeba nkag mus rau hauv lub lumen ntawm lub cev. Daim ntawv no pib faib. Raws li qhov tshwm sim ntawm cov txheej txheem no, yim tshiab ib leeg-nuclear pathogens raug tsim. Dysentery amoebic pib nyob rau lub sijhawm no. Nrog rau kev sib xyaw ua ke ntawm cov xwm txheej zoo ntawm lub cev thiab tus naj npawb txaus ntawm ib leeg-nuclear vegetative forms, amoeba txuas ntxiv mus ntxiv thiab txav mus tob rau hauv txoj hnyuv.
Nyob hauv lawv lub neej, protozoa zais cov tshuaj uas lom neeg thiab ua rau cov tsos mob ntawm cov hnyuv. Nrog rau cov quav, cov ntaub ntawv vegetative thiab cystic nkag mus rau sab nraud ib puag ncig. Lawv tuaj yeem nyob ntawd ntev heev. Tsis tas li ntawd, lawv tiv taus cov tshuaj tua kab mob.
Pathogenesis
Tus kab mob zoo li amoebic dysentery txhim kho li cas? Kab mob pib nrog kev noj zaub mov tsis huv. Yog li amoeba nkag mus rau hauv qhov muag tsis pom kev thiab txoj hnyuv loj, qhov chaw uas lawv yuav tsis tshwm sim rau lawv tus kheej ntev. Tab sis nyob rau hauv unfavorable rau tib neegCov xwm txheej (lub cev qhuav dej, noj zaub mov tsis zoo, dysbacteriosis), cysts plam lawv lub plhaub, thiab daim ntawv translucent ntawm amoebae tshwm.
Nrog kev pab los ntawm nws tus kheej cytolytic thiab proteolytic enzymes, cov kab mob nkag mus rau hauv cov ntaub so ntswg tuab, ua rau mob thiab tsim cov kab mob thiab necrosis ntawm thaj chaw me. Qee zaum, amoebas nkag mus rau hauv cov hlab ntsha thiab nrog cov kua dej nkag mus rau lwm lub cev, tsim cov abscesses.
Nyob rau hauv txoj hnyuv ntawm tus kab mob, qhov mob kis mus rau hauv nqes mus, los ntawm caecum mus rau lub qhov quav. Lub mucosa ntawm lub cev yog edematous, tawm tsam keeb kwm ntawm hyperemia, me nodules thiab ulcers yog pom, uas muaj necrotic detritus thiab vegetative daim ntawv ntawm amoebae. Thaum lub sij hawm, cov nodules raug puas tsuaj, tawm hauv lawv qhov chaw tshiab rwj mus txog ob thiab ib nrab centimeters nyob rau hauv txoj kab uas hla. Sib sib zog nqus tsis xws luag nyob rau hauv qab yog them nrog kua paug. Yog tias koj tshuaj xyuas qhov biopsy ntawm phab ntsa ntawm qhov txhab, koj tuaj yeem pom amoeba.
Chronization ntawm tus kab mob yog nrog los ntawm kev tsim cov hlwv, polyps thiab amoeba. Cov no yog cov qog zoo li cov qog uas muaj cov ntaub so ntswg granulation, eosinophils thiab fibroblasts.
Extraintestinal form
Amebic dysentery muaj ob qho tib si dyspeptic thiab somatic tshwm sim. Thaum cov ntaub ntawv cog qoob loo ntawm amoebae nkag mus rau lub thickness ntawm lub plab hnyuv phab ntsa, lawv tuaj yeem nkag mus rau hauv lub cev. Qhov no ua rau kev sib kis ntawm cov kab mob thoob plaws hauv lub cev. Los ntawm cov hlab ntsha portal, amoeba nkag mus rau lub siab parenchyma.
Cov kab mob sib txawv tuaj yeem tshwm sim hauv lub cev: los ntawm cov protein los yog fatty degeneration mus rau mob siab heev thiab daim siab abscess, uas muajhauv qab lub dome ntawm lub diaphragm. Qee lub sij hawm nws tseem hu ua chocolate cyst vim yog cov xim tshwj xeeb ntawm cov kua qaub. Yog tias qhov mob tsis kho, ces qhov qhib ntawm abscess mus rau hauv lub plab kab noj hniav tshwm sim nrog kev loj hlob ntawm peritonitis. Los yog lub cyst tuaj yeem tawg los ntawm lub diaphragm mus rau hauv lub ntsws, mediastinum, lossis pericardium, ua rau muaj teeb meem. Ntxiv nrog rau daim siab, cov kab mob tuaj yeem cuam tshuam rau lub hlwb, tawv nqaij thiab lwm yam kabmob.
Clinic
Lub sijhawm incubation kav txog ib lub lis piam, tom qab uas amoebic dysentery tshwm. Cov tsos mob pib nrog kev qaug zog, mob hauv cheeb tsam iliac thiab nce hauv lub cev kub. Nyob rau hauv kaum feem pua ntawm cov neeg mob, tus kab mob yuav siv sij hawm fulminant chav kawm. Nws yog tus cwj pwm los ntawm kev mob raws plab, nrog rau cov ntshav thiab hnoos qeev, uas ua rau lub cev qhuav dej thiab tuag. Qee qhov ntawm ib feem peb ntawm cov neeg mob, kub taub hau yog pom nyob rau hauv ua ke nrog lub siab loj. Kev mob tshwm sim thaum pib ntawm tus kab mob yog mob me, yog li tsis muaj cov yam ntxwv hloov pauv hauv kev kuaj ntshav dav dav.
Kab mob plab hnyuv plab yog nrog rau lwm yam tshwm sim. Tsis muaj cov tsos mob uas tuaj yeem hu ua pathognomonic hauv qhov no. Amebiasis xyaum tsis tshwm sim nyob rau hauv lub cev kom txog rau thaum lub loj loj ntawm cov kab mob accumulates.
Yog tias tsis muaj kev cuam tshuam txog kev kho tus kabmob, tom qab ib ntus tus kabmob kis mus ntev. Maj mam tsim anemia thiab kev qaug zog. Qhov qis dua ntawm lub cev tsis kam, qhov nrawm ntawm txoj hnyuv nkag mus rau hauv cov hnyuv ntxiv. Cov kev pheej hmoo suav nrog cov menyuam yaus, cov neeg laus, cov poj niam cev xeeb tub thiab cov neeg mob noj tshuaj tiv thaiv kab mob.
Diagnosis
Los ntawm cov txheej txheem twg yog qhov kev kuaj mob ntawm "dysentery" tsim? Kev kuaj mob thiab kev kho mob ntawm tus kab mob no yog ze ze rau lub neej voj voog ntawm protozoa. Txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau nws, tus kws kho mob, tus kws kho mob yuav tshuaj xyuas cov quav, nws pom cov ntaub so ntswg ntawm amoebas. Yog tias muaj cov hlwv lossis cov kab mob luminal hauv cov quav, qhov no qhia tau hais tias lub xeev muaj tus kabmob thiab tsis tuaj yeem ua qhov kev lees paub ntawm kev kuaj mob.
Txij li ob peb hom amoebas twb muaj nyob rau hauv tib neeg lub cev raws li kev siv sijhawm, kev kuaj mob tuaj yeem nyuaj me ntsis. Misdiagnosis kuj tuaj yeem ua tau yog tias pom Entamoeba dispar. Qhov no yog ib qho tsis muaj kab mob amoeba, uas tsis muaj kev phom sij rau tib neeg, tab sis morphologically zoo ib yam li dysentery.
txhawm rau txheeb xyuas qhov kev kuaj mob, cov tshuaj tiv thaiv polymerase saw thiab kev kuaj serological kuj tau siv. Txhawm rau kuaj pom cov kab mob hauv plab hnyuv ntawm amebiasis, nws yog ib qho tsim nyog yuav tau kuaj X-ray, ultrasound thiab xam tomography. Sib txawv amoebic kab mob los ntawm shigellosis, salmonellosis thiab ulcerative colitis.
Kev kho mob
Kev kho mob amoebic dysentery pib nrog cytostatics, xws li metronidazole lossis tinidazole. Yog tias tus neeg mob asymptomatic, iodoquinode lossis paromomycin tuaj yeem siv los tshem tawm cov kab mob.
thawj cov tshuaj tiv thaiv amebiasis yog emetine, uas tau mined hauv South America los ntawm ipecac. Tam sim no nws tsis tshua siv, vim nws tsis tshua muaj neeg sivtshuaj lom thiab tsis zoo. Txoj kev kho no tsuas yog siv rau hauv cov chav kawm ntev, nrog cov ntaub ntawv tiv thaiv thiab kev ua xua rau metronidazole.
Rau kev kho mob ntawm cov kab mob hauv plab, metronidazole yog siv ua ke nrog yatren, doidoquine, mexaform thiab lwm yam tshuaj. Qee qhov xwm txheej, lawv siv kev cuam tshuam kev phais.
Kev nyuaj siab
Amebic dysentery nyob rau hauv tib neeg tuaj yeem nyuaj los ntawm perforation ntawm lub plab hnyuv phab ntsa. Qhov no tshwm sim thaum muaj qhov tsis xws luag tob heev. Nrog perforation, plab hnyuv cov ntsiab lus nkag mus rau hauv lub plab kab noj hniav thiab kis nws. Cov teeb meem tom ntej yog peritonitis. Yuav kom cawm tau tus neeg mob txoj sia, nws yog ib qho tsim nyog yuav tsum tau mus rau kev pab cuam phais: ua kom laparotomy nruab nrab thiab ua kev kho mob ntawm lub plab.
Lwm qhov teeb meem loj heev yog txoj hnyuv los ntshav. Nws kuj tsim thaum lub sij hawm tsim ntawm ulcers. Rau nws txoj kev pab, ob qho tib si kev saib xyuas thiab kev phais yuav siv tau. Kho qhov txhab tuaj yeem nqaim lub plab hnyuv lumen vim tsim cov caws pliav, yog li cuam tshuam cov zaub mov.
Kev Tiv Thaiv
Amebic dysentery yog kab mob hauv plab, yog li ntawd, txhawm rau tiv thaiv nws, nws yog ib qho tsim nyog yuav tsum tau tshem tawm cov kab mob hauv lub sijhawm: cov dej tsis zoo, cov dej hauv nruab nrab thiab lwm yam.
Ntxiv rau, nws yuav tsum tau ua cov kev ntsuas txhawm rau txheeb xyuas cov neeg nqa khoom thiab cov tshuaj tua kab mob, nrog rau kho cov neeg mob uas muaj cov ntaub ntawv mob hnyav ua raws li kev tiv thaiv kab mob sib kis. Convalescent neeg thiab cov cab kuj nyob rau hauv ob leegtsis muaj teeb meem koj yuav tsum raug tso cai ua haujlwm hauv cov chaw noj mov rau pej xeem.
Lwm txoj hauv kev los txo tus naj npawb ntawm cov kab mob yog txhawm rau txhawb kev nyiam huv ntawm tus kheej thiab tuav cov zaub mov kom raug ua ntej noj mov. Tom qab kis tus kab mob, tus neeg yuav tsum tsis tu ncua nyob rau hauv lub chaw ua hauj lwm ntawm kis kab mob rau ib xyoos. Thiab tsuas yog tom qab kuaj peb lub hlis yuav tsis pom zoo rau amoebiasis, tus neeg mob yuav raug suav hais tias noj qab nyob zoo.
