Kurapa kwechirwere cheCasgas kunobva pane iyo chirwere chinowanikwa . Vanhu vanoongororwa panguva yechikamu chechirwere chechirwere vanobatwa zvakasiyana kune avo vanoongororwa panguva yechigarire chisingaperi.
Kurapa Acute-Phase Disease
Mukana wakanaka chete wokurapa chirwere cheChagas-kureva, kubvisa zvachose Testpanosoma cruzi (T.
cruzi) parasite kubva mumuviri-kana kana kurapwa kunogona kutangiswa pakutanga kwechirwere ichi, panguva yechikamu chakaoma.
Mumunhu chero upi zvake anorwara ane utachiona hweA. T. cruzi, kana kana mucheche anowanikwa ane hutachiona hwepabonde, kurapwa kunofanira kupiwa nemishonga inoparadzanpanosomal. Iyo mishonga miviri iyo yakaratidzwa kuti inoshanda neT. cruzi ndiyo benznidazole uye nifurtimox. Vakadzi vane pamuviri havafaniri kugamuchira mishonga iyi.
Kana nzira yakakwana yekurapwa ine imwe yemishonga iyi yakapedzwa, kuparadzwa kweT. cruzi kunopedzerwa kusvika kuzana 85 muzana yenguva.
Benznidazole
Benznidazole kazhinji ine zvishoma uye zvinowanzotorwa kurapa. Uyu mushonga unofanirwa kutorwa kwemazuva 60. Iyo yakawanda yakasvibiswa nayo yechirwere ndeyekukurumidza kweganda.
Nifurtimox
Nifurtimox (iyo isingagamuchirwi muUnited States) inowanzokonzera zviratidzo zvepamuviri. Inogonawo kubereka kusuruvara, kuora mwoyo, uye kuparara kweuropathy .
Izvi zvinokonzerwa nemigumisiro inogadzirisa kubatsira kwayo. Uyu mushonga unofanirwa kutorwa kwemazuva makumi mapfumbamwe.
Kurapa Utachiona Husingaperi
Ne chirwere chisingagumi chaChagas, kupedza chirwere cheT. cruzi ne antitrypanosomal therapy chakaoma zvikuru kupfuura icho chiri mukati mechikamu chakaoma, uye chingave chisingaiti.
Kunyange zvakadaro, nyanzvi dzakawanda dzinokurudzira kubata pamwe nebenzidazole kana nifurtimox kana munhu ane utachiona ari muchikamu chisingagumi chechirwere chisingaperi chine Chagas (kureva kuti, haina chirwere chepfungwa kana maviri kuratidzwa kwechirwere cheCagas), uye iri pasi pemakore makumi mashanu.
Vanhu vanopfuura makore makumi mashanu vane huwandu hwemigumisiro yakawanda kubva kune antitrypanosomal mishonga, asi kurapwa kuchiri kungofungidzirwa.
Antitrypanosomal therapy haina kukurudzirwa kana Chagas chirwere chemwoyo chave chiripo, kana chirwere chakanyanya chaCasgas chiripo (zvakadai se megacolon ), kana kana chiropa chakakura kana chirwere chepfungwa chiripo. Muvanhu ava mikana yokudzora utachiona hweT. cruzi yakanyanya kuderera, uye njodzi yemigumisiro yakakwirira.
Kurapa Chagas Cardiac Disease
Kurapa nemishonga inoparadzanpanosomal hazvibatsiri pakugadzirisa chirwere chinonzi Chagas. Pane kudaro, kurapwa kunofanira kunge kwakanyatsotarisirwa kugadzirisa chirwere chemwoyo pachako.
Chagas chirwere chemoyo chimiro chechirwere chemoyo chinowanzoita kuti mwoyo usakundikana , uye vanhu vane chirwere ichi vanofanira kugamuchira mishonga yepamusoro yekuderedza cardiomyopathy .
Kurapa Mwoyo Kusakundikana
Kurapa kwechiremba kazhinji kunosanganisira kurapa ne beta blockers , ACE inhibitors , uye spironolactone. Diuretic therapy inoshandiswa kubatsira kubatsira kuderedza edema uye dyspnea.
Cardiac resynchronization therapy (CRT) inoratidzika seinobatsira mune chirwere chemwoyo cheChagas sezvinongoita chero chimwe chimiro chekushaya mwoyo. Zvisinei, kukosha kweRCT mukurapa mwoyo kusakundikana kunowanikwa kune vanhu vakasiya bundle branch block , pasinei nokuti vane chirwere cheChagas kana chimwe chechimwe chechirwere chechirwere chinokonzera.
Uye, zvinosuruvarisa, muChagas chirwere chakarurama chebato rebazi rinowanzoshamisa kupfuura rakasara bundle branch block-saka CRT yakakodzera vanhu vashomanana vane Chagas kusakatika kwemoyo kupfuura kune mamwe marudzi ekushaya simba kwemoyo.
Vanhu vane chirwere chaChagas vanoita sevari kuita pamwe nekushanda kwepachiviri sevarwere vane mamwe marudzi ekushaya simba kwemoyo. Chimwe chinonetsa mukuita chirwere chekuchera muChagas moyo wechirwere chave chiri chokuti kurapa kwemumunosuppressive inoda kuti mushure mokunge kuwedzerwa kunogona kukonzera chirwere cheT. cruzi kuti chigadzirise zvakare. Zvisinei, zvidzidzo zvekuchipatara zvakaratidza kuti kushandiswazve kwehutachiona mushure mekugadziriswa hakuratiki sechinhu chinowanzoitika muChagas moyo wechirwere.
Ngozi ye thromboembolism (mamiriro ezvinhu anowanzobereka hutachiona hwakakomba , kuputika kwemapapu , kana kurohwa ) inowedzera kune munhu ane mwoyo wekukundikana, asi inoratidzika kunge yengozi yevanhu vane chirwere chemwoyo chaChagas. Vanhu vazhinji vane chirwere chemwoyo chaChagas vanofanira kuiswa pane anticoagulant therapy ( neCoumadin kana chirongwa cheNoAC ), kana prophylactic aspirin kuderedza dambudziko guru re thromboembolism.
Kurapa Cardiac Arrhythmias uye Kudzivirira Kuerekana Kufa Rufu
Chirwere chekudzivirira kana kubata chirwere chakakomba chemwoyo chinowanzodiwa kuvanhu vane chirwere chemwoyo chaChagas nokuti vari mungozi yakawanda yeviri bradycardias (slow slow heart rhythms) uye tachycardias (fast heart rhythms).
Bradycardias inowanzoitika mune dzimwe nguva muvanhu vane chirwere chaChagas. Iyo bradycardias inokonzerwa zvose nehosha ye node ye sinus uye nemoyo block . Kana iyo inononoka mwoyo rhythm iri kubudisa zviratidzo, kana kana ichiita sokuti inogona kuita zviratidzo zvakaoma zvakadai se syncope , kurapwa ne pacemaker kunokosha.
Icho chinonyanya kukonzera kukanganisa nemaridyrita emwoyo mukati mevanhu vane chirwere chemwoyo chaChagas, zvisinei, rufu rwakangoerekana rwakonzerwa ne ventricular tachycardia kana ventricular fibrillation . Mungozi yekuita zvirongwa izvi zvinopisa upenyu zvinokonzerwa nekuoma kwemarwadzo emwoyo akange aitwa naChagas.
Kana chirwere chemwoyo chikaderera kusvika pakuguma kwekuti zvirongwa izvi zvine ngozi zvingangoerekana zvaitika, kuiswa kwechigadziriswa chinogadziriswa kunofanira kunyatsoongororwa. Zvisinei, kunyanya muLatin America, iyo inogadziriswa inorable defibrillator therapy inowanzosawanika nyore nyore, varwere vane chirwere cheChagas vanogona kunyatsobatwa ne antiarrhythmic drug amiodarone pane, mukuedza kuderedza ngozi yavo yekufa kamwe kamwe.
Kurapa Utachiona Hwezvirwere
Antitrypanosomal therapy haina kukonzera chirwere chepakumbo chinokonzerwa neChagas. Mishonga inotarirwa kuderedza zviratidzo nekuderedza zviratidzo zvekudzivirira kwepamuviri uye kuronga kunyorera uye kubatwa nemishonga uye kudya. Kupindira kwokuvhiya kunogona kudiwa kana megacolon kana megaesophagus aripo.
Kudzivirira
Mumakumi emakore achangopfuura nyika dzakawanda dzeLatin America dzakaedza zvikuru kuedza kuparadza kana kuti kuderedza zvikuru chirwere cheCagas.
Kazhinji, kuedza uku kwakaisa pakubvisa vector ye chirwere-kureva, "mhombwe dzinotsvoda" dzinoparadzira chirwere cheT. cruzi kubva kuvanhu kusvika kuvanhu. Kuparadzaniswa kwemakumbo ekutsvoda kwave kuedza kuburikidza nekushandisa zvipembenene zvemazuva mazhinji mumisha yevanhu. Aya maitiro akabatsira zvikuru asi haana kubvisa dambudziko-uye chirwere cheChagas chinoramba chiripo munzvimbo dzakawanda dzekumaruwa muLatin America.
Kuongorora kwepabonde kweT. cruzi kwakabatsira kubatsira kuderedza kufema kwehutachiona hwechirwere. Vakadzi havagoni kurapwa nemishonga ye antitrypanosomal pavanenge vasikana, asi kurapwa musati mimba inowanzobudirira. Vakadzi vari kutapukirwa naT. cruzi vanorayirwawo kuti vasayamwa, kunyange kutapurirwa kwechirwere kuburikidza nemukaka wechipfuva hazvina kuonekwa.
> Sources:
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> Martí-Carvajal AJ, Kwong JS. Kupindira Kwemishonga Kuporesa Kushaya Mwoyo Muvarwere NeChagas Cardiomyopathy. Cochrane Database Database Rev 2016; 7: Cd009077.
> Pinazo MJ, Cañas E, Elizalde JI, et al. Kuongororwa, Kutarisira Uye Kuchengetedzwa Kwechigarire Chagas 'Zvirwere Zvepachiviri Munzvimbo Iyo nzvimbo yaTerpanosoma Cruzi Infection Haisi Dambudziko. Gastroenterol Hepatol 2010; 33: 191.
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