Nzira dzekuziva chirwere chebhakitiriya
Zvirwere zvebhakitiriya zvichiri dambudziko guru pahutano hwevanhu, mhuka, uye zvirimwa. Zvirwere zvebhakitiriya zvinogona kukonzera zviratidzo zvishoma kuzvirwere zvinotyisidzira hupenyu, zvichienderana nerudzi rwebhakitiriya, nzvimbo yehutachiona, mamiriro ekudzivirira kwemuviri wemurwere, uye kumhanya kwekurapwa. Nokudaro, kuziva zvirwere zvebhakitiriya nemazvo uye nekukurumidza kwakakosha kuti kurapwa kubudirire, kunyanya munguva yekuwedzera kwekusagona kurwisa mabhakitiriya. Chinyorwa chino chinokurukura nzira dzakasiyana-siyana dzekuziva zvirwere zvebhakitiriya, kubva panzira dzekurapa kusvika pahunyanzvi hwemazuva ano hwemamorekuru hwakavakirwa pamurabhoritari.
1. Kuzivikanwa Zvichibva Pazviratidzo Zvekiriniki Uye Nhoroondo Yemurwere
Danho rekutanga rekuziva chirwere chebhakitiriya rinowanzo tanga nekuongororwa kwekiriniki. Chiremba kana nyanzvi yehutano vanoongorora zviratidzo zvakaita sefivha, kurwadziwa kwemunzvimbo, kukosora kunobereka, manyoka, maronda anobuda ropa, uye zviratidzo zve sepsis. Uyezve, nhoroondo yemurwere inokosha, kusanganisira nhoroondo yekufamba, kudya zvimwe zvekudya, kusangana nevanhu vane hutachiona, kusangana nenzvimbo yaanogara (mvura, ivhu), kushandisa mishonga inorwisa mabhakitiriya kare, kana nzira dzekurapa dzakadai sekuisa catheter.
Kunyange zvazvo zvichikosha, nzira yekurapa ine miganhu. Zvirwere zvakawanda zvebhakitiriya zvine zviratidzo zvakafanana nehutachiona hwemavhairasi kana hwefungus, saka kuongororwa kwakavakirwa pazviratidzo chete kazhinji hakuwanzo kuve kwakarurama. Nokudaro, mimwe miedzo inodiwa kuti pave nechokwadi chekuti chirwere chacho chinokonzera chirwere chacho.
2. Kuongorora neMicroscopic: Gram Staining nedzimwe nzira
Imwe nzira yekare asi ichiri kubatsira zvikuru ndeyekuongorora nemaikorosikopu. Nzira inonyanya kushandiswa ndeyekudhirowa Gram, iyo inosiyanisa mabhakitiriya kuita Gram-positive (pepuru) uye Gram-negative (pink). Ruzivo urwu runobatsira kufanotaura mhando yebhakitiriya uye kuona sarudzo yekutanga yemishonga inorwisa mabhakitiriya usati wawana mhedzisiro yekurima.
Mienzaniso inogona kuongororwa uchishandisa Gram staining inosanganisira sputum, ropa (mune mamwe mamiriro), cerebrospinal fluid, wound swabs, pleural fluid, kana weti. Pamusoro peGram staining, kunewo mavara akasarudzika akadai seZiehl–Neelsen ebhakitiriya rinokurumidza acid (semuenzaniso, Mycobacterium tuberculosis) uye fluorescent staining mune dzimwe nguva.
Zvakanakira kuongorora nemaikorosikopu ndezvekuti zvinokurumidza uye hazvidhuri zvakanyanya. Zvisinei, kunzwisisa kwaro kunoenderana nehuwandu hwemabhakitiriya ari musampuli uye mhando yesampuli. Uyezve, haasi mabhakitiriya ese anoonekwa nyore nyore kana kusiyanisa nechimiro chawo chete.
3. Tsika dzeMabhakitiriya: Mwero weGoridhe weKuzivikanwa
Tsika inowanzoonekwa se "chiyero chakanaka" chekuongorora zvirwere zvebhakitiriya. Mienzaniso yekiriniki inorimwa pane zvimwe zvinhu kuti mabhakitiriya akure, uye yozoonekwa zvichibva pane hunhu hwekoloni, bvunzo dzemakemikari, uye maitiro ekukura.
Zvinoshandiswa pakukura kwemhuka zvinogona kuva zvakasiyana-siyana (semuenzaniso, ropa risingagayike, zvinovaka muviri zvinovaka muviri) kana kusarudza-kusiyanisa (semuenzaniso, MacConkey agar yebhakitiriya reGram-negative remukati). Kana mabhakitiriya akura, rabhoritari inogona kuita bvunzo dzebiochemical dzakadai secatalase, coagulase, oxidase, kuviriswa kweshuga, nezvimwewo.
Chinhu chakanaka chekurimwa kwembeu ndechekuti kugona kwayo kusimbisa mabhakitiriya mapenyu sechikonzero chehutachiona uye inobvumira kuongororwa kwakawanda, senge kuyedzwa kwehutachiona hwemaantibiotic. Zvakaipa zvinosanganisira nguva inodiwa (kazhinji maawa 24-72, kunyange kupfuura kune mamwe mabhakitiriya), uye haasi mabhakitiriya ese anorimwa nyore nyore (anokurumidza kukura) kana kuti anoda mamiriro chaiwo ehutano.
4. Kuedzwa kweKubatwa neAntibiotic
Kuziva zvirwere zvebhakitiriya hakugumiri pakungotumidza mabhakitiriya mazita. Kazhinji, kuziva kuti maantibiotics api anoshanda ndiko kwakakosha. Kuongororwa kwehutachiona hwemaantibiotic kunoitwa mushure mekunge mabhakitiriya awanikwa kuburikidza nekumera.
Dzimwe nzira dzinowanzoshandiswa:
– Kupararira kweDisk (Kirby-Bauer): inotarisa nzvimbo inodzivisa hutachiona yakatenderedza disk reantibiotic.
– MIC (Minimum Inhibitory Concentration): inosarudza huwandu hwakaderera hwemishonga inorwisa mabhakitiriya inodzivirira kukura kwebhakitiriya, kazhinji kuburikidza nenzira yekudilution kana E-test.
- Kuongororwa kwekuzvigadzirira kwehutachiona: kushandisa maturusi anoshanda otomatiki anokurumidza uye akarongeka.
Mhedzisiro yebvunzo idzi inobatsira vanachiremba kusarudza mushonga wakakodzera, kuderedza kushandiswa kwemishonga inorwisa mabhakitiriya isina kufanira, uye kuderedza njodzi yekusagona kurapwa nemishonga.
5. Nzira dzeSerological: Kuona MaAntibodies kana MaAntigens
Mune zvimwe zvirwere, nzira dzekuongorora ropa dzinoshandiswa kuona masoja emuviri anogadzira kurwisa mabhakitiriya kana kuona maantigen ebhakitiriya. Mienzaniso yekushandiswa uku inosanganisira typhoid fever (mimwe miedzo), Helicobacter pylori (miedzo yakati wandei), kana hutachiona hwakaoma kuhugadzira.
Chinhu chakanaka che serology ndechekuti inogona kuona mhinduro yemuviri kunyangwe huwandu hwebhakitiriya hwakaderera kana kuti hwakaoma kusiyanisa. Zvisinei, serology inogona kuoma kududzira nekuti ma antibodies anogona kuramba aripo kwenguva yakareba mushure mekunge hutachiona hwapera, saka haawanzo kuratidza hutachiona huripo. Saka, serology inowanzo shandiswa sekuwedzera kune data rekiriniki nedzimwe bvunzo.
6. Kuongororwa Kwekukurumidza
Kufambira mberi kwetekinoroji kwakapa mhando dzakasiyana-siyana dzebvunzo dzinokurumidza dzinogona kuitwa munzvimbo dzehutano nemhedzisiro pfupi. Bvunzo dzinokurumidza dzinowanzo shandiswa pakuongorora immunochromatography (yakafanana nebvunzo) kuti dzione maantigen ebhakitiriya kana zvimwe zvikamu.
Mienzaniso yekuyedzwa nekukurumidza inosanganisira kuona streptococci muhuro kana maantigen chaiwo mumienzaniso yekiriniki. Chinhu chikuru chakanakira kukurumidza, zvichiita kuti sarudzo dzekurapa dziitike nekukurumidza. Zvisinei, kunzwisisa kwavo uye kujeka kwavo zvinogona kusiyana zvichienderana nerudzi rwechishandiso, mhando yemuenzaniso, uye danho rechirwere.
7. Nzira dzeMolecular: PCR neVariants dzayo
Nzira dzemamorekuru dziri kuramba dzichikosha nekuti dzinogona kuona zvinhu zvemajini ebhakitiriya (DNA/RNA) zvine hunhu hwakanyanya. Nzira inonyanya kufarirwa ndeyePCR (Polymerase Chain Reaction), kusanganisira real-time PCR, iyo inogona kupa mhedzisiro nekukurumidza uye inobvumira huwandu hwehuwandu.
PCR inobatsira pakurapa mabhakitiriya akaoma kumera, zviitiko zvinoda kuongororwa nekukurumidza, uye mamiriro ezvinhu apo murwere atogamuchira mishonga inorwisa mabhakitiriya, izvo zvinogona kukonzera kukura kwechirwere chisina kunaka. Kuwedzera kune imwe chete PCR, multiplex PCR inowanikwawo, iyo inogona kuona hutachiona hwakawanda panguva imwe chete, semuenzaniso mumapaneru ekufema kana emudumbu.
Zvakaipa zvekushandisa nzira dzemamorekuru imitengo yakakwira, kudiwa kwemidziyo nevashandi vakadzidziswa, uye chokwadi chekuti PCR inogona kuona DNA yebhakitiriya yakafa, saka inofanira kutsanangurwa nekungwarira mukiriniki.
8. Kuzivikanwa kwakavakirwa paMALDI-TOF MS
MALDI-TOF (Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry) itekinoroji yemazuva ano inoona mabhakitiriya zvichibva pa "fingerprints" dzeprotein. Kana bhakitiriya rawanikwa kubva mumiti, MALDI-TOF inogona kuratidza mabhakitiriya mukati memaminitsi.
Zvakanakira zvayo zvinosanganisira kumhanya, kururama kwebhakitiriya dzakasiyana-siyana, uye kushanda zvakanaka kwema laboratori ane huwandu hwakawanda hwesampuro. Zvisinei, michina yacho inodhura uye ichiri kuda danho rekutanga rekukudziridza maitiro mazhinji, kunyangwe zvimwe zvigadzirwa zvichibvumira kushandiswa zvakananga kwesampuro dzakati.
9. Kutevedzana kwemajini nemetagenomic
Panyaya dzakaoma, kunyanya kana utachiona hwacho hwakaoma kuziva, nzira dzekuongorora hutachiona dzakadai se16S rRNA sequencing kana whole-genome sequencing dzinogona kushandiswa. Nzira idzi dzinobvumira kuzivikanwa kwebhakitiriya kusvika pamhando uye kunyange padanho remhando, pamwe nekuona majini ekudzivirira chirwere.
Metagenomics (semuenzaniso, kutevedzana kwechizvarwa chinotevera zvakananga kubva mumienzaniso yekiriniki) inogona kuona tupukanana twakawanda pasina chikonzero chekurimwa. Nzira iyi ine vimbiso huru yehutachiona hwakakomba husina kuongororwa, sepsis isina culture, kana hutachiona hwakasanganiswa. Matambudziko anosanganisira kudhura kwakanyanya, zvinodiwa nebioinformatics, uye njodzi yekusvibiswa, izvo zvinogona kukanganisa kududzirwa.
Mhedziso
Nzira dzekuziva zvirwere zvebhakitiriya dziri kuramba dzichichinja, kubva panzira dzechinyakare dzakadai seGram staining uye culture kusvika panzira dzemazuva ano dzakadai sePCR, MALDI-TOF, uye sequencing. Hapana nzira imwe chete inogara yakanakira mamiriro ese ezvinhu. Sarudzo yenzira inoenderana nerudzi rwehutachiona, mienzaniso iripo, kukurumidza, zviwanikwa zvemurabhoritari, uye zvinangwa zvekiriniki (semuenzaniso, kuzivikanwa kuri nyore kana kuyedzwa kwekurapwa panguva imwe chete). Kubatanidzwa kwekuongorora kwakanaka kwekiriniki uye nzira dzakakodzera dzemurabhoritari kuchaita kuti pave nekuongororwa kwakarurama, kutsigira kushandiswa kwemishonga inorwisa mabhakitiriya zvine musoro, uye pakupedzisira kuvandudza kuchengetedzeka kwemurwere uye mhando yehutano.
