Indlela Yokuthola Izifo Zasezindaweni Ezishisayo
Izifo zasezindaweni ezishisayo ziyiqembu lezifo ezivame ukutholakala ezindaweni ezishisayo nezinomswakama, okuhlanganisa amazwe amaningi aseNingizimu-mpumalanga ye-Asia, e-Afrika, eLatin America naseziQhingini zasePacific. Njengezwe elishisayo, i-Indonesia isengozini enkulu yezifo ezahlukahlukene, kusukela kumkhuhlane we-dengue kanye ne-malaria kuya kumkhuhlane we-typhoid kanye ne-leptospirosis. Inselele enkulu ekuxilongweni kwezifo zasezindaweni ezishisayo ukuthi izimpawu zazo zivame ukufana—isibonelo, umkhuhlane, ubuhlungu bemisipha, ubuthakathaka, isicanucanu, noma ukuqubuka—okudinga indlela ehlelekile yokuqinisekisa ukwelashwa okufanele nokuvimbela izinkinga. Lesi sihloko sixoxa ngezindlela ezisebenzayo zokuxilonga izifo zasezindaweni ezishisayo, kusukela engxoxweni yokuqala kuya ekuhlolweni kwelabhorethri.
1. Qonda umqondo we-"syndrome" ezifweni zasezindaweni ezishisayo
Emtholampilo, odokotela bavame ukuqala ukuxilongwa ngendlela ye-syndromic, behlanganisa izikhalazo zeziguli ngokusekelwe kuphethini yezimpawu eziyinhloko. Izifo zasezindaweni ezishisayo zivame ukuvezwa njengezifo eziphindaphindayo, njenge:
– Umkhuhlane omkhulu ongenawo umgomo ocacile (isib. udenga, umalaleveva, i-typhoid, i-chikungunya).
– Umkhuhlane ohambisana nokuqubuka (umkhuhlane we-dengue, isimungumungwane, i-rubella, i-rickettsiosis).
– Umkhuhlane onezinkinga zesisu (i-typhoid, i-hepatitis A/E, i-amebiasis).
– Umkhuhlane ohambisana ne-jaundice (i-leptospirosis, i-hepatitis, umalaleveva onzima).
– Umkhuhlane onezinkinga zokuphefumula (i-TB, i-influenza, i-COVID-19, i-pneumonia).
– Umkhuhlane ohambisana nokopha (udenga olunzima, ezinye izinkinga zokujiya kwegazi).
Ukusebenzisa indlela ye-syndromic kusiza ekwakheni uhlu lwezifo ezihlukile ngaphambi kokuba kwenziwe ukuhlolwa okwengeziwe.
2. I-Anamnesis: ukhiye wokuqala ovame ukunquma
I-Anamnesis (ingxoxo yezokwelapha) iyisisekelo sokuxilongwa. Ezifweni zasezindaweni ezishisayo, imibuzo eminingana ebalulekile ingaqondisa kakhulu ukuxilongwa:
a) Ubude kanye nephethini yomkhuhlane
– Umkhuhlane izinsuku ezingu-1-3 onekhanda elibuhlungu kanye nobuhlungu kungakhomba udenga noma umkhuhlane.
– Umkhuhlane ohlala izinsuku eziningana ngephethini ethile (isib. ukubanda njalo) ungase uphakamise izinsolo zomalaleveva.
– Umkhuhlane ohlala isikhathi esingaphezu kwesonto elilodwa ohambisana nezinkinga zokugaya ukudla kungaholela ku-typhoid.
b) Umlando wohambo nendawo yokuhlala
Buza ukuthi isiguli:
– Muva nje uye endaweni evame ukuba khona umalaleveva.
– Ukuhlala endaweni enabantu abaningi abanesifo sohudo.
– Ukuba sendaweni ekhungethwe yizikhukhula noma indawo enamagundane amaningi (ingozi ye-leptospirosis).
– Ukuvakashela amahlathi noma izindawo ezisengozini yokulunywa yizimpukane/izinambuzane ezithile.
c) Ukuchayeka
Ukuchayeka kuvame ukuba yinto ehlukanisayo:
– Ukulunywa omiyane (udenga, umalaleveva, i-chikungunya, i-zika).
– Ukudla/ukuphuza ukudla okungahlanzekile (i-typhoid, i-hepatitis A/E).
– Ukuthintana namanzi angcolile/amanzi akhukhula (i-leptospirosis).
– Ukuxhumana eduze nabantu abanesifo sofuba noma abahlala ezindaweni ezinabantu abaningi (isifo sofuba).
– Imisebenzi ethile efana nokulima, ukulima imfuyo, noma ukusebenza ezimayini/emahlathini.
d) Izimpawu ezihambisanayo
Ezinye izimpawu "ezibonisayo":
– Ubuhlungu ngemuva kwamehlo kanye nokuqubuka kuvame kakhulu ku-dengue.
– Ubuhlungu obukhulu bamalunga bungakhomba i-chikungunya.
– Ukuphuzi kwamehlo kanye nobuhlungu bemisipha yethole kungakhomba i-leptospirosis.
– Ukukhwehlela isikhathi eside, ukujuluka ebusuku kanye nokwehla kwesisindo kukhomba isifo sofuba.
– Izinsini eziphuma igazi, ukuphuma kwegazi ekhaleni, noma amabala abomvu kungabonisa izinkinga ezinkulu ze-dengue noma ze-platelet.
3. Ukuhlolwa komzimba: ukufuna izimpawu ezivamile nezimpawu zengozi
Ukuhlolwa ngokomzimba kuhlose ukuhlola ubukhali nokubona indawo okugxilwe kuyo ukutheleleka. Izinto ezilandelayo ziyahlolwa:
– Izimpawu ezibalulekile: izinga lokushisa, umfutho wegazi, ukushaya kwenhliziyo, izinga lokuphefumula, ukugcwala komoya-mpilo.
– Isimo sokumanzisa: umlomo owomile, ukukhukhumala kwesikhumba, ukuphuma komchamo.
– Isikhumba: ukuqubuka, i-petechiae (amabala okopha), i-jaundice.
– Isisu: isibindi/isibende esikhulu, ukuqina, izimpawu ze-peritonitis.
– Amaphaphu nenhliziyo: i-rhonchi, izimpawu zokuphelelwa umoya, imisindo yenhliziyo.
– Isimiso sezinzwa: ukwehla kokuqwasha, ukuxhuzula, intamo eqinile (okusolwa ukuthi i-meningitis/encephalitis).
Izimpawu eziyingozi ezidinga ukunakekelwa okusheshayo
Ezifweni zasezindaweni ezishisayo, ezinye izimpawu zidinga ukudluliselwa noma ukwelashwa ngokushesha:
- Ukuncipha kokuqonda, ukuxhuzula, ubuthakathaka obukhulu.
– Ukuphefumula kanzima, ukugcwala okuncane.
– Ukopha igazi okungazelelwe noma ukuhlanza igazi.
– Ukwehla komfutho wegazi, ukushaya kwenhliziyo okusheshayo (ukushaqeka).
– Ubuhlungu obukhulu besisu, ukuhlanza okungapheli.
– Ukukhiqizwa komchamo kwehla kakhulu.
Lezi zimpawu eziyisixwayiso zivame ukuvela ku-dengue enzima, umalaleveva onzima, i-sepsis, noma ezinye izinkinga zezitho zomzimba.
4. Ukuhlolwa okuyisisekelo kwelebhu: isinyathelo sokuqala esisetshenziswa kakhulu
Ngemva kokuhlolwa kwe-anamnesis nokuhlolwa ngokomzimba, izivivinyo eziyisisekelo zelabhorethri zivame ukwenziwa ukuze kuncishiswe ukuxilongwa:
a) Ukubalwa kwegazi okuphelele
– Ama-platelet anciphile avame ukutholakala ku-dengue, kodwa angatholakala nakwezinye izifo.
– I-hematocrit ephezulu ingabonisa ukuvuza kwe-plasma ku-dengue.
– I-Leukopenia (amangqamuzana amhlophe egazi aphansi) ivame kakhulu ezifweni ze-dengue/viral.
– I-Leukocytosis (amangqamuzana amhlophe egazi aphezulu) ingaholela ekuthelelekeni ngamagciwane/i-sepsis.
– I-anemia ingatholakala kumalariya noma ezimweni ezingamahlalakhona.
b) Umsebenzi wesibindi nezinso
– Ukwanda kwe-AST/ALT kungenzeka ku-dengue, i-hepatitis, noma i-leptospirosis.
– Ukwanda kwe-creatinine/urea kubonisa izinkinga zezinso, okubalulekile ku-leptospirosis noma i-sepsis.
c) I-CRP noma i-procalcitonin (uma ikhona)
Kusiza ukuhlukanisa ukuthambekela kokutheleleka ngamagciwane namagciwane, yize kungacacisiwe.
d) Ukuhlolwa komchamo
Bheka izimpawu zokutheleleka komgudu womchamo, ukuphelelwa amanzi emzimbeni, noma izinkinga zezinso. Ezinye izinkinga, nakuba zingacaci ngaso sonke isikhathi, zingatholakala ku-leptospirosis.
5. Ukuhlolwa okuqondile okusekelwe ekusolweni kwezokwelapha
Ukuhlolwa okuqondile kukhethwa ngokusekelwe ekuxilongweni okunamandla kakhulu kokwehluka.
a) UDengue
– I-antigen ye-NS1: inhle esigabeni sokuqala (izinsuku 1-5 zomkhuhlane).
– I-IgM/IgG dengue: iwusizo ngemva kwezinsuku ezimbalwa, ukubona ukutheleleka okusha noma ukutheleleka kabusha.
– Ukuqapha ama-platelet kanye ne-hematocrit ngokulandelana kubalulekile ukuze kuhlolwe ukuthi awekho yini ama-protein.
b) Umalaleveva
– Ama-smear egazi aqinile futhi amancane: indinganiso yokubuka izimuncagazi.
– Ukuhlolwa okusheshayo kokuxilonga (RDT): kuyasiza uma kungekho microscopy, kodwa imiphumela isadinga ukuhunyushwa ngokomongo wezokwelapha.
c) I-Typhoid
– Ukuhlolwa kwegazi (uma kutholakala) kungenye yezindlela ezinhle kakhulu, ikakhulukazi ekuqaleni kwesifo.
– Kukhona ukuhlolwa okuthile kwe-serological, kodwa ukunemba kwakho kungahluka futhi kufanele kuhunyushwe ngokucophelela.
d) I-Leptospirosis
– I-Leptospira serology noma ezinye izivivinyo ngokwezikhungo zasendaweni.
– Ukusola kuyanda uma kunomlando wezikhukhula/amanzi angcolile kanye nezinkinga zesibindi nezinso.
e) Isifo Sofuba
– Ukuhlolwa kwesikhwehlela (ukuhlolwa kwama-microscopic, ukuhlolwa okusheshayo kwama-molecule, ukukhuliswa).
– I-X-ray yesifuba njengokusekelwa.
f) Ezinye izifo ezibangelwa amagciwane
Ku-chikungunya, i-zika, i-hepatitis, noma izifo ezithile ezibangelwa amagciwane, ukuhlolwa kwe-serology noma kwe-PCR kungakhethwa kuye ngesigaba sesifo kanye nokutholakala kwaso.
6. Naka isikhathi sokuthola amasampula
Ukunemba kokuxilongwa kuthonywa kakhulu isikhathi. Ezinye izivivinyo zingcono ezigabeni zokuqala (isb., i-dengue NS1), kanti izivivinyo zama-antibody zibaluleke kakhulu ngemva kwezinsuku eziningana. Ngakho-ke, uma izimpawu zisesencane kakhulu, odokotela ngezinye izikhathi baphinda isivivinyo ngemva kwamahora angu-24-48, ikakhulukazi ezifweni ezishintshashintshayo njenge-dengue.
7. Ukuxilongwa okuhlukile kanye nokutheleleka kanyekanye: ungabanjwa ukuxilongwa okukodwa
Ezindaweni ezishisayo, ukutheleleka ngakunye kungenzeka, isibonelo, lapho isiguli se-dengue siphinde sibe nokutheleleka ngamagciwane, noma lapho izimpawu ezifana ne-dengue empeleni ziwumalaleveva. Ngakho-ke, uma isimo sesiguli siba sibi kakhulu noma uma lesi sifo singalandeli indlela evamile, ukuhlolwa kabusha kuyadingeka. Ukuxilongwa akuyona inqubo yesikhathi esisodwa, kodwa kunalokho ukuhlolwa okuvuselelwa njalo okusekelwe empendulweni yezokwelapha kanye nemiphumela yokuhlolwa.
8. Indima yokuthwebula izithombe kanye nokuhlolwa okwengeziwe
Kwezinye izimo, udokotela anganezela:
– I-ultrasound yesisu ukuze kubhekwe ukukhishwa kwamanzi, ukwandiswa kwezitho zomzimba, noma izimpawu zokuvuza kwe-plasma.
– I-X-ray yesifuba uma kukhona ukukhwehlela/ukuphelelwa umoya noma uma kusolwa ukuthi i-TB/pneumonia.
– I-ECG uma kukhona izikhalo zenhliziyo noma ukuphazamiseka kwe-electrolyte.
9. Kufanele uye nini esikhungweni sezempilo ngokushesha?
Umphakathi udinga ukuqonda ukuthi ukuxilongwa kwezifo zasezindaweni ezishisayo akufanele kusekelwe kuphela ekubikezelweni komuntu siqu, njengoba ezinye izifo ziba zimbi ngokushesha. Bheka udokotela ngokushesha uma uhlangabezana nalokhu:
– Umkhuhlane ophakeme isikhathi esingaphezu kwezinsuku ezingu-2-3, ikakhulukazi ohambisana nobuthakathaka obukhulu.
– Izimpawu zokopha (ukopha ekhaleni, ukuhlanza okumnyama, indle emnyama).
– Ukuphelelwa umoya, ubuhlungu besifuba, ukudideka.
– Ubuhlungu obukhulu besisu, ukuhlanza okungapheli.
– Amehlo aphuzi, umchamo omncane kakhulu, noma ukuquleka.
Isiphetho
Ukuxilonga izifo zasezindaweni ezishisayo kudinga indlela ehlelekile: kusukela ekuqoqweni kwezimpawu ezihambisana nezimpawu, umlando ophelele, ukuhlolwa ngokomzimba kwezimpawu ezijwayelekile nezimpawu eziyisixwayiso, kuya ekuhlolweni kwelebhu okuyisisekelo nokuqondile. Ngenxa yokuthi izifo eziningi zasezindaweni ezishisayo zinezimpawu ezifanayo, ukukhetha ukuhlolwa nesikhathi esifanele kubalulekile. Okubaluleke kakhulu, uma izimpawu eziyisixwayiso zivela noma isimo siba sibi kakhulu, ukunakekelwa kwezokwelapha okusheshayo kungasindisa izimpilo futhi kuvimbele izinkinga zesikhathi eside.
Uma ungathanda, ngingenza lesi sihloko sibe ngokwezifiso ngokwezidingo ezithile (isb., inguqulo yemfundo yomphakathi jikelele, yabafundi bezokwelapha, noma yokuqukethwe kwebhulogi yezempilo okudumile).
