Ne Hurricanes Harvey, Irma, naMaria vanoparadza Texas, Florida, nePuerto Rico, pamwe chete, 2017 Atlantic mhepo inopisa mhepo ndeimwe yezvakaipa zvikuru munhau yezvino. Mukuwedzera kune mazana emabhiriyoni emadhora mukuparadzwa, madutu aya akabatana akareva mararamiro ehupenyu.
Kunyangwe zviitiko zvinoitika zveChikamu 5 mhepo dzine mhepo dzinotyisa, zvichiita kuti mafashamo emvura atakure zvinotyisa zvakadai semvura inobatwa nemvura.
Kuongororwa kwemashure makumi mashanu nemasere ekuberekwa kubva muna 1900 kwakaratidza kuti 51 kubva muzana yezviputi izvi zvakatangira nemvura zhinji.
Zvirwere zvinotonhorera mvura zvinoparadzirwa nenzira yefecal-oral route. Microscopic fecal mahara inopinda mumvura uye kudya, saka kuparadzira utachiona. Mushure memafashamo anorema, mbeu dzekushambidza kwemvura dzinokundikana uye dzinosunungura zvakawanda zviduku zvisina kuparadzwa.
Ngatinyatsoongororai zvirwere zvishanu zvinokonzerwa nemvura: bhakitiriya chirwere, kemera, enteric fever, hepatitis A , uye leptospirosis .
Bhakitiriya Dysentery
Dhizinesi rinoreva kutapurika, kurwara kwemaropa. Mabhakitiriya anokonzera maronda anosanganisira C. jejuni , E. coli 0157: H7, E. coli kwete 0157: Matanho H7, Salmonella marudzi, uye Shigella marudzi. Zvose E. coli 0157: H7 uye E. coli kwete 0157: Matambudziko eH7 anobudisa Shiga toxin. Shigella ndicho chikonzero chinowanzokonzera chirwere, uye sezvimwe zvipembenene zvinogona kuonekwa kushandiswa kwechigadziko tsika.
Zviratidzo zvinozivikanwa zvehutu zvinosanganisira kusuruvara kunorwadza, kurwadziwa kwepamuviri, uye fivhiri.
Nemhaka yokuti mabhakitiriya anopinda mukoni uye rectum, pus uye ropa zviripowo muhombodo. Iyo bhakitiriya inogona kukonzera maronda ekuonda. Uyezve, bhakitiriya inogona kupararira kune ropa-zvichiita kuti bacteremia, kana utachiona hweropa. Varwere vasina simba rekudzivirira zvirwere zvezvirwere kana vasingakwanisi kugadziriswa vari pangozi yebacteremia.
Dhizinesi yakanyanya kukura kudarika chirwere chepamu -zvikurukuru kuvana vaduku vanopfuura 5 uye vakuru vakwegura kudarika 64. Utachiona hunowanzokonzera kupinda muchipatara uye hunogona kuuraya.
Kana chinokonzera maronda chisina kujeka kana murwere asingakwanisi kuvandudza nemishonga inorwisa maantibiotic therapy, colonoscopy inogona kubatsira nekuongorora. Computerized tomography inogona kushandiswawo kuongorora maronda mumatambudziko akaoma.
Dhizinesi inorapwa nemishonga inorwisa mabhakitiriya uye mumuromo kana mumvura. Muvana, Shigella, Salmonella, kana Campylobacter hutachiona hunobatwa neazithromycin, ciprofloxacin, kana ceftriaxone. Kuvanhu vakuru, maronda inorapwa neAzithromycin kana fluoroquinolones.
Mushonga weShiga-toxin-inobudisa E. coli 0157: H7 uye E.coli kwete-0157: H7 mishonga ine antibiotic inopesana. Pane zvinonetseka kuti mishonga inorwisa mabhakitiriya ichapedza hemolytic-uremic syndrome nekuwedzera Shiga toxin yekugadzirwa. Hemolytic uremic syndrome iyo inouraya iyo inobata ropa uye itsvo.
Cholera
Cholera inoreva kuora kwakanyanya kunokonzerwa nemamwe mishonga yeVibrio cholerae. Cholera toxin yakavanzwa neVibrio cholerae , iyo inobatsira adenylyl cyclase, enzyme iri mune epithelial masero emucheche muduku, zvichidaro inobereka hypersecretion yemvura uye ion chloride mumugero unoita kuti zvirwere zviwedzere.
Iyo yehuta inogona kusvika 15 L pazuva! Kurasikirwa kwakanyanya kwemvura kunokurumidza kukonzera kushushikana kwe hypovolemic, nengozi uye yakaipa mamiriro ezvinhu.
Mvura yakachena yekororera ihodzi, ine makore, uye isina kunhuhwirira, pus, kana ropa. Ichi chigaro dzimwe nguva chinonzi "rice-mvura chigaro."
Stool tsika uye kuongorora ropa zvinoratidza uchapupu hwehutachiona hwehutachiona.
Kunyange munzvimbo dzekufashamo, kora haigone kuwanikwa muUnited States. Mazuva ano kushambidzika kwetsvina uye kurapa kwemvura kunopedza kora yakawanda muUnited States. Zvose zvenguva ichangopfuura yekodera muUnited States inogona kunyorerwa kumashure enyika dzose.
Chorera inoparadza nyika dzichiri kusimukira dzine urombo husina kunaka uye kurapa kwemvura, uye ndiyo dambudziko rekushaya nzara, kuputika, uye hondo. Ikupedzisira kubuda kukuru kwekorira kuWestern hemisphere kwakaitika mushure mekudengenyeka kwenyika muna 2010 kuHaiti. Iko kuHaiti kuputika kwakauraya zviuru zvevanhu.
Nheyo yekona yekurapa kwekodera inoshandiswa mvura. Muzviitiko zvinyoro kana zvishoma, kushandiswa kwemvura kunogona kuva muromo. Kushandiswa kwemvura kushandiswa kunoshandiswa nehosha yakaoma zvikuru.
Mishonga inorwisa mabhakitiriya inogona kushandiswa kuderedza nguva yehutera chirwere. Aya maantibayoti anosanganisira azithromycin, ampicillin, chloramphenicol, trimethoprim-sulfamethoxazole, fluoroquinolones, uye tetracycline. Nyaya, maitiro akawanda asingakwaniki nemishonga yekolera aripo.
Kunyange zvazvo kune chirwere chokumera, inodhura, kwete iyo inoshanda, uye kwete iyo inobatsira pakugadzirisa matambudziko. Kubva pane zvehutano hwehutano, nzira yakanakisisa yekubata nekodera kubuda ndeyekugadzirisa kurasa kwakachena uye kupa zvokudya zvakachena nemvura.
Enteric Fever
Inic fever inokonzerwa neSalmonella rudzi rwebhakitiriya. Dutu remhepo rine dutu rinonyanya kureva chinonzi enteric fever chinokonzerwa nechisimba Salmonella typhi. Salmonella inopinda mumuviri kuburikidza nemukomana muduku uye inopinda muropa. Iyo bhakitiriya inogona kupararira kubva mumatumbi kuenda kune dzimwe zvirongwa zvehutano, kusanganisira mapapu, inso, gallbladder, uye central central nerve system.
Muzviitiko zvisingaverengeki, enteric fever inoratidzira semusoro, kukohwa, malaise, uye chirwere chepamuviri uye kurwadziwa kwepamuviri, kubvongodza, uye kuvimbiswa. Fever inokwira mumafambiro akafanana, uye munguva yekudzikinura, kutonhora kwemuviri kunodzokera kunowanzoitika.
Pasina zvinetso, fivha ichaputsa uye munhu ane enteric fever achapora muvhiki kana maviri. Zvisinei, kunyange mushure mokunge fivhiri inoputsa, murwere anogona kudzoka zvakare uye anorwara ne enteric fever zvakare.
Zvinetso zvinouraya uye zvinosanganisira kubuda ropa, mumatumbo, uye kushamiswa. Vanenge makumi matatu kubva muzana yevanhu vane enteric fever vasingagamuchiri kurapwa vanokurudzira matambudziko, uye vanhu ava vanoverenga 75 muzana yevakafa nekuda kwekupinda kwemhepo. Muvanhu vanorapwa nemishonga inorwisa mabhakitiriya, chirwere chekufa chinenge 2 muzana.
Nzira dzeropa dzinogona kushandiswa kuti dziongorore zvinonzi enteric fever. Leukopenia, kana kudonha mumasero machena eropa, iriwo kuongororwa.
Nemhaka yekuwedzera mishonga inorwisa mabhakitiriya, fluoroquinolones ndiyo antibiotic inosarudzwa pakurapa fefiidhi fever. Ceftriaxone, cephalosporin, inoshandawo.
Kunyange zvazvo chirwere chetachidiidhi fever chiripo, haisi nguva dzose inoshanda. Nzira yakanakisisa yekudzivirira furuidhi fever ndeyekugadzirisa kurasa zvakakwana uye kushandiswa kwemvura yakachena nemvura.
Dhiyabhorosi fivha inogona kupararira kubva kumunhu kusvika kumunhu; saka, vanhu vane chirwere ichi havafaniri kutora zvokudya. Vanhu vashomanana vane utachiona hweSalmonella typhi vanogara vasingagumi, vasingakwanisi kutakura zvirwere uye vanogona kuparadzira zvirwere kana vasati varapwa kwevhiki dzinoverengeka nemishonga inorwisa mabhakitiriya. Vanotakura zvinotakura vanogonawo kurapwa necholecystectomy kana kuti kubvisa gorosi.
Hepatitis A
Kunyange zvazvo chirwere cheApatitis A chinowanzopera uye hachisi chakaipa, zviratidzo zvehutachiona izvi hazvina kunaka. Vanenge makumi mapfumbamwe kubva muzana vevanhu vakuru vane utachiona hwehupatitis A vane ruzivo rwemafivha, kurwadziwa kwepamuviri, kurasikirwa kwechido, kurutsira, kushungurudza, uye gare gare panguva yekurwara, jaundice.
Rufu nekuda kwehepatitis A isingawanzoitiki uye kazhinji inowanikwa kune vanhu vakwegura kana avo vane chirwere chisingaperi chechiropa, chakadai sehepatitis B kana hepatitis C.
Zviratidzo zvehepatitis A zvinowanzopedza mashoma masere masere. Vachidiki vevarwere vanogona kutora mwedzi mitanhatu kuti vadzoke.
Hepatitis A inowanikwa pamwe nekubatsirwa kweropa rekuongorora ropa rinoona hutachiona hunokwana.
Hapana mishonga chaiyo ye hepatitis A iripo, uye varwere vanokurudzirwa kuti vagone kuzorora zvakawanda uye kudya kwakakwana.
Nenzira yakanaka, chirwere cheHepatitis A chinoda kusvika zana muzana, uye kubva pakusikwa kwayo muna 1995, kuwandisa kwehutachiwana muUnited States kwakaderera zvinopfuura 90 muzana. Chirwere cheHepatitis A chinokurudzirwa kuvana vane makore gumi nemaviri nekure uye pamwe chete nevakuru vezvikwata zvepamusoro-soro sevaya vanogara munzvimbo dzine hepatitis A inowanzopararira.
Nokuti hutachiona ne hepatitis A inotora masvondo mashoma kuti abate, nguva pfupi mushure mekubuda, zviratidzo zvehutachiona zvinogona kudzivirirwa nemushonga kana immune globulin administration.
Kunyange zvazvo isingabatanidzi njodzi dzinongoitika dzoga uye mafashamo, muna 2003 uye muna 2017, zviputi zviviri zvakakura zvehepatitis A zvakaitika. Yokutanga yakaitika kuBeverver County, Pennsylvania, uye yakadzoserwa kumashure anonyadzisira yakasvibirira yakashanda muresitorendi yeMexico. Chechipiri chakaitika muSan Diego uye-nemhaka yehutsanana hwehutsanana-dambudziko racho raitaurirwa pakati pevanhu vasina musha. Pamwe chete kubuda uku kwakaunza mazana ezvipatara uye kufa kwevakawanda.
Leptospirosis
Mumakore achangobva kupfuura, leptospirosis yakadzokorora zvakare sechirwere chepathogen chakakosha nemitambo inowanika kune imwe nyika. Leptospirosis chirwere chezoonotic, zvinoreva kuti inoparidzirwa kuvanhu nemhuka. Zvinoratidzika kuti leptospirosis inogona kuparadzirwa pakati pevanhu vaviri.
Leptospires inonda, yakabikwa, bhakitiriya yepamusoro inoparidzirwa kuvanhu nemakonzo, mhuka dzemhuka, uye mhuka dzepurazi. Kubviswa kwevanhu kunowanzoitika kuburikidza nehutachiona hwekuchengetedzwa kwemhepo asi kunogonawo kuitika kune wechipiri kutaurirana zvakananga nemuviri wemhuka, feces, ropa, kana tissue.
Leptospirosis inoparidzirwa pasi rose; zvisinei, iyo inowanzosvika munzvimbo dzinotyisa uye dzepasi. Zvinofungidzirwa kuti leptospirosis inokanganisa vanhu vane mamiriyoni rimwe pagore, uye vane 10 muzana yevanhu vane utachiona vanofa nehutachiona.
Muna 1998, kwaiva neptospirosis kuputika muSpanish, Illinois, pakati pevatambi ve triathlon. Aya maTaathati akawana utachiona mushure mekudonha mumvura yakasvibiswa. Sezviri pachena, mvura inonaya yakawanda yakakonzera kuputika kwekurima mugungwa.
Kudengenyeka kweLeptospirosis kunowanikwa pamakwenzi, ganda rakagadzirwa, uye mucous membrane yemeso nemuromo.
Leptospirosis inopa zviratidzo zvakasiyana-siyana. Mune vamwe vanhu, leptospirosis inokonzera kusava nezviratidzo uye saka haigadziri. Muzvinyoro zvinyoro, zviratidzo zve leptospirosis dzinosanganisira fevha, musoro, uye muscle aches. Severe leptospirosis inokonzera jaundice, kushaya mafungiro, uye kubuda ropa; iyi triad yezviratidzo inotumidzwa sechirwere cheWeil. Severe leptospirosis inogonawo kuunza nemaplummorrhage, kana kubuda pamapapu, izvo zvingave kana zvisingatenderwi ne jaundice.
Vanhu vazhinji vanotapukirwa neptospirosis vanodzoka. Rufu runogona kuitika mumamiriro ehutachiona hwakakura hunosanganisira renal kushaya simba nekubuda ropa. Vakura uye vane pamuviri varwere vanewo mungozi yakawanda yekufa kwechipiri kune leptospirosis.
Zvakakosha kurapa leptospirosis nemishonga inorwisa mabhakitiriya kudzivirira nhengo kusakundikana. Varwere vanofanira kurapwa nokukurumidza sezvinobvira chimiro chisina kuitika chinoitika. Leptospirosis inogona kurapwa nemhando yakawanda yemishonga inorwisa mabhakitiriya, kusanganisira, ceftriaxone, cefotaxime, kana doxycycline.
Mukuwedzera kumishonga inorwisa mabhakitiriya, kuchengetedza kwakatsigira sekushandiswa kwemvura inopisa inokosha zvakare.
Muzviitiko zvehosha yakaoma, kusvibiswa kwepvo kunofanirwa kubatwa ne dialysis kwenguva pfupi. Varwere vane ropa rekumapapu vanogona kudiwa magetsi.
Kune chirwere chinonzi leptospirosis chemhuka. Vamwe vanhu vakuru vanga vachengetwa; zvisinei, iyi inzvimbo inoda kuwedzera kudzidza.
Summing Up
Kunyange zvazvo United States inyika yakafuma ine unhu hwakanaka hwekuchenesa uye zvigadziriswa, njodzi-dzakadai sedutu nemafashamo-zvinoitika. Munguva iyi yezvipingamupinyi, zvirwere zvinowanikwa mumvura zvinogona kupararira.
Pamusana pekuchinja kwemamiriro ekunze uye kusvibiswa kwemafuro emhepo, kuenzanisa kwemamiriro ekunze kunoratidza kuti mugore ra2100, kuchava nekuwedzera kwekuremera kwezviitiko, izvo zvingaita kuti kuwedzerwa kuparadzirwa kwezvirwere zvemvura.
> Sources:
> Mhumbu, Perineum, Anus, uye Rectosigmoid. Mu: LeBlond RF, Brown DD, Suneja M, Szot JF. eds. Kudzidzira Kuongorora kwaDeGowin, 10e New York, NY.
> Bernstein AS. Kuchinja Kwemamiriro Ezemupembenene uye Utachiona hweHIV. Muna: Kasper D, Fauci A, Hauser S, Longo D, Jameson J, Loscalzo J. eds. Harrison's Principles of Internal Medicine, 19e New York, NY: McGraw-Hill; 2014.
> Infectious Diseases. Mu: Iserson KV. eds. Improvised Medicine: Kuchengetedza Munzvimbo Dzakawanda, 2e New York, NY: McGraw-Hill
> Pfeiffer M, DuPont HL, Ochoa TJ. Murwere anopa chirwere chakakomba-chirongwa chekugadzirisa. J Inofadza. 2012; 64 (4): 374-86. dx.doi.org/10.1016/j.jpf 2012.01.006
> Schwartz BS. Mabhakitiriya & Chlamydial Infections. Mu: Papadakis MA, McPhee SJ, Rabow MW. eds. Kurapa Kwazvino Kwemishonga uye Kurapa 2018 New York, NY.