Documentos de Académico
Documentos de Profesional
Documentos de Cultura
xoWava
bavSvTa
infeqtologia
Tbilisi
2000 weli
1
recenzentebi:
T. boWoriSvili
e. vaSakiZe
m. Jvania
2
aleqsi xoWava
medicinis mecnierebaTa doqtori, profesori,
mecnierebaTa damsaxurebuli moRvawe, saqarTvelos
mediko-biologiuri akademiis akademikosi
manana xoWava
medicinis mecnierebaTa kandidati, docenti, Tbilisis
saxelmwifo samedicino universitetis bavSvTa
infeqciur-sneulebaTa kaTedris gamge
3
wignis momzadebaSi gaweuli daxmarebisaTvis
did madlobas vuxdiT:
kaTedris TanamSromlebs _
i. xabazs,
l. jimSitaSvilsa da
b. eliaZes
SviliSvils
Tamar SukakiZesa da
mis meuRles giorgi demurias
qalbaton m. xaxaleiSvils
4
sarCevi
I. zogadi nawili . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
mokle istoriuli cnobebi. (a. xoWava, m. xoWava) . . . . . . . . . . . . . . . . . . . . . 10
infeqciur daavadebaTa epidemiologiis zogierTi kanonzomierebani
(a. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
infeqciuri paTologiis zogierTi terminologiuri ganmarteba
(a. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
infeqciuri daavadebis paTogenezis da klinikuri gamovlinebis
kanonzomierebaTa zogierTi mxare (a. xoWava) . . . . . . . . . . . . . . . . . . . . . . 18
nozokomialuri infeqciebi da maTi Taviseburebani
(a. xoWava, m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
makroorganizmis damcvelobiTi meqanizmebi infeqciuri procesis dros
(a. xoWava, m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
infeqciur
infeqciuri i avadmyofebis mkurnalobis pr inci pebi da maTi r
princi eal
real izaciis
ealizaciis
Tanamedrove saSualebebi (a. xoWava, m. xoWava) . . . . . . . . . . . . . . . . . . . . . . 29
infeqciuri daavadebebis specifikuri profilaqtika
(m. xoWava, a. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
5
enterovirusuli infeqciebi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
poliomieliti (a. xoWava, m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120
arapoliomielituri enterovirusuli infeqciebi
(m. xoWava, a. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128
tki pismier
pismierii encefaliti (m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180
tki pismier
pismierii laim-boreli
laim-bor ozi (a. xoWava, m. xoWava) . . . . . . . . . . . . . . . . . 234
eliozi
6
meningokokuri infeqcia (a. xoWava, m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . 272
7
nawlavTa anaerobuli infeqciebi . . . . . . . . . . . . . . . . . . . . . . . . . 430
klostridium perfringensiT gamowveuli infeqcia (m. xoWava) . . . . . . . 430
klostridium dificileTi gamowveuli nawlavTa infeqcia
(a. xoWava, m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 431
helminTozebi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 485
askaridozi (m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 485
strongiloidozi (a. xoWava, m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 487
triqinelozi (a. xoWava, m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 490
enterobiozi (m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 492
triqocefalozi (m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 494
danarTi 1
etiotropuli mkurnaloba axalSobilobis periodSi . . . . . . . . . . . . . . 497
danarTi 2
etiotropuli mkurnaloba axalSobilobis periodis Semdeg . . . . . . . 498
danarTi 3
zogierTi laboratoriuli maCvenebeli . . . . . . . . . . . . . . . . . . . . . . . . . 503
8
winasityvaoba
a. xoWava, m. xoWava.
9
zogadi nawili mokle istoriuli cnobebi
zogadi nawili
10
mokle istoriuli cnobebi
zogadi nawili. infeqciur daavadebaTa ... kanonzomierebani
11
zogadi nawili. infeqciur daavadebaTa ... kanonzomierebani
12
zogadi nawili. infeqciur daavadebaTa ... kanonzomierebani
(tki pa, tili, koRo, rwyili, moskiti), romlebic infeqts gadascemen mxolod mkacrad
gansazRvruli infeciebis dros. maT mier infeqtis gadacema xdeba kbenis an mis
adgilas Sezelvis Sedegad. aRniSnuli mwerebis organizmSi infeqti mravldeba an
gadis sqesobrivi ganviTarebis cikls. araspecifikur biologiur gadamtanebad iTvlebian
buzebi, romlebsac infeqciis gamomwvevi agenti meqanikurad gadaaqvT nawlavTa infeqciebis
dros (Sigelozi, muclis tifi, hepatiti A da sxv.). unda aRiniSnos, rom gadamtanis
aseT faqtors sul ufro da ufro naklebi mniSvneloba eniWeba, gansakuTrebiT
ganviTarebul qveynebSi, rac sanhigienuri pirobebis gaumjobesebaze metyvelebs.
l. gromaSevskis mier mowodebulia infeqciis gadacemis 4 ZiriTadi meqanizmi erTi
saxeobis individumebs Soris (“horizontuli gadacema”). ukanasknel periodSi ki didi
yuradReba miiqcia infeqciis vertikaluri gadacemis meqanizmma. am mxriv, gansakuTrebiT
aqtualuria transplacenturi gziT dedidan nayofze iseTi infeqciebis gadacema,
rogoricaa virusuli (citomegalia, wiTura, Cutyvavila, epidemiuri parotiti da sxv.),
baqteriuli (stafilokokuri, streptokokuri, disbaqteriozi), protozouli (leiSmaniozi,
malaria, toqsoplazmozi) bunebis infeqciebi. aRniSnuli infeqciebi orsulobis sxvadasxva
periodSi iwveven nayofis mZime daavadebebs, sikvdils (mkvdradSobadoba) da (an)
axalSobilTa Tandayolil infeqciebs.
aRniSnul jgufSi Semaval infeqciebs l. gromaSevski da b. vasilevi (1972)
ganixilavdnen, rogorc sisxlis infeqciebs specifikuri gadamtanis gareSe.
epidemiuri procesis ganviTarebisaTvis, misi uwyveti mimdinareobisaTvis
aucilebelia mesame rgolis _ infeqciisadmi mosaxleobis mimReblobis arseboba. amasTan
dakavSirebiT, saWiroa xazi gaesvas im garemoebas, rom imuniteti SeiZleba iyos bunebrivi,
saxeobrivi, Tandayolili anu genetikurad fiqsirebuli. aseTi imunitetiT aixsneba is
faqti, rom adamiani ar avaddeba cxovelebisaTvis damaxasiaTebeli zogierTi infeqciiT
da, piriqiT, cxoveli ar avaddeba, mag. wiTelaTi, qunTruSiT, meningokokuri infeqciiT da
sxv. infeqciis saxeobrivi miuRebloba determinirebulia alelis wyvili geniT. ase,
mag: afrikis zogierT raionSi, sadac farTodaa gavrcelebuli malaria, nanaxia
gansakuTrebuli geni, romelic iwvevs adamianebSi anomaluri, namgliseburujredovani
hemoglobinis sinTezs. aRniSnuli genis heterogenul pirebSi malaria ar viTardeba.
bunebrivi imunitetis Sesustebas xels uwyobs mTeli rigi faqtorebi _ organizmis
fiziologiuri Tvisebebisa da kvebis darRvevebi, organizmis gadaciveba da sxv.
SeZenili imuniteti SeiZleba iyos infeqciis gadatanis an specifikuri acrebis
Catarebis Sedegi. ukanaskneli saxis imunitets didi mniSvneloba eniWeba aramarto
infeqciebisadmi mosaxleobis miuReblobis CamoyalibebaSi, aramed infeqciis srul
likvidaciasa an mis mkveTr SemcirebaSi msoflios masStabiT Catarebuli imunizaciis
gziT. saerTaSoriso da nacionaluri janmrTelobis dacvis sistemebis RonisZiebaTa
Sedegad naturaluri yvavili mTel msoflioSi iqna likvidirebuli da 1980 wlis
maisSi Catarebul msoflios janmrTelobis dacvis XXXIII sesiaze xelmowerili iqna
sertifikati dedamiwaze yvavilis likvidaciis Sesaxeb. aqve unda aRiniSnos sabWoTa
medicinis epidemiologiis fuZemdeblis l. gromaSevskis mier mowodebuli infeqciis
likvidaciis brwyinvale ganmarteba, sadac man pirvelma ganacxada, rom infeqciis likvidacia
niSnavs TviT gamomwvevi agentis likvidacias. yvavilis virusi mxolod samuzeumo
kulturis saxiT inaxeba parizSi l. pasteris saxelobis institutSi.
yvavilis likvidaciis saerTaSoriso programaSi aqtiurad monawileobda
saqarTvelodan Cveni Tanamemamule akad. Tamaz kereseliZe, romelic dajildovda am
movlenisadmi miZRvnili specialuri `bifurkaciuli nemsis~ ordeniT.
mosaxleobis mimRebloba sxvadasxva infeqciebisadmi gansxvavebulia, rac kontagiozuri
indeqsis saxeliTaa cnobili, misi konstanta ganisazRvreba 100 kontaqtirebulidan
13
zogadi nawili. infeqciur daavadebaTa ... kanonzomierebani
14
zogadi nawili. infeqciur daavadebaTa ... kanonzomierebani
15
zogadi nawili. infeqciuri paTologiis ... ganmarteba
16
zogadi nawili. infeqciuri paTologiis ... ganmarteba
17
infeqciuri paTologiis ... ganmarteba
zogadi nawili. infeqciuri daavadebis paTogenezisa da klinikuri ... mxare
18
infeqciuri daavadebis paTogenezisa da klinikuri ... mxare
zogadi nawili. nozokomialuri infeqciebi da maTi Taviseburebani
nozokomialuri infeqciebi
da maTi Taviseburebani
19
zogadi nawili. nozokomialuri infeqciebi da maTi Taviseburebani
20
zogadi nawili. nozokomialuri infeqciebi da maTi Taviseburebani
21
nozokomialuri infeqciebi da maTi Taviseburebani
zogadi nawili. makroorganizmis damcvelobiTi ... dros
da Tanxebi.
g) nozokomialur infeqciaze saubrisas saWiroa aqcentis gakeTeba profilaqtikasa
da epidsawinaaRmdego RonisZiebebis Catarebaze (unda gvaxsovdes, rom maTi gatareba
sakmaod rTuli da Sromatevadia organizaciuli, epidemiologiuri da ekonomiuri
TvalsazrisiT), aseve epidzedamxedvelobis sistemis gaumjobesebaze (es aucilebelia
rogorc epidsituaciis obieqturad Sefasebisa da prognozirebis TvalsazrisiT, aseve
am infeqciasTan brZolisaTvis mecnierulad dasabuTebuli RonisZiebebiT).
aseTi zomebi Seamcirebs daavadebis cud gamosavalsac da mkurnalobis Rirebulebasac.
yvela saavadmyofos strategia am princi pze unda iyos agebuli.
makroorganizmis damcvelobiTi
meqanizmebi infeqciuri procesis dros
22
zogadi nawili. makroorganizmis damcvelobiTi ... dros
citokinebze.
pluri potenciuri aradiferencirebuli hemopoezuri ujredis proliferaciisaTvis
saWiroa misi kostimulacia sxvadasxva citokinebiT (Rerovani ujredis faqtori,
i n t e r l e i k i n e b i IL-3, IL-1, IL-6, IL-12 d a g r a n u l o c i t - m a k r o f a g -
koloniamastimulirebeli faqtori _ GM-CSF-granulocyte-macrophage-colony
stimulating factor). mieloiduri eriTroiduli ujredebis Semdgomi ganviTarebisaTvis
saWiroa damatebiTi hemopoezuri faqtorebis CarTva (iseTi regulatorebi, rogoricaa
eriTropoetini eriTrocitebisaTvis, IL-5 eozinofilebis ganviTarebisaTvis, IL-9 da
IL-11 _ megakariocitebis ganviTarebisaTvis, makrofag-kolonia-mastimulirebeli faqtori
_ M-CSF (macrophage-colony stimulating factor-monocit-makrofagebisaTvis) da
granulocitkolonia-mastimulirebeli faqtori – G-CSF ( Granulocyte-colony-stimu-
lating factor-leikocitebisTvis).
mieloblasti gardaiqmneba promielocitad, Semdeg mielocitidan yalibdeba
metamielocitad, sabolood ki polimorfulnuklearul neitrofilebad PMN (poly-
morphonuclear neutrophils).
PMN ujredebis gadasvlas Zvlis tvinidan cirkulaciaSi xels uwyobs iseTi
mediatorebi, rogoricaa: endotoqsini, tumormanekrozebeli faqtori, IL-I da gaaqtivebuli
komplementi.
anTebad keraSi zemoT aRniSnuli fagocitebis migracias safuZvlad udevs ujredidan
da plazmidan gamoyofili zogierTi qemotaqsisuri faqtori. anTebiT keraSi aRiniSneba
komplementis aqtivacia, Trombinis warmoSoba, Trombocitebis migracia, makrofagebis da
limfocitebis aqtivacia, interleikin-8-s gamoyofa, polimorfulnuklearebis gaaqtiveba
da maT mier leikotrien B4-is warmoSoba. ameboiduri moZraobiT fagociti miiltvis
anTebis kerisaken da anadgurebs ofsonizirebul mikrobs.
leikocitebis gaaqtiveba maT receptorebze qemogamaRizianebeli molekulebis
zegavleniT xdeba, mikrobebis ofsonizacia (momzadeba gadamuSavebisaTvis) ki xorcieldeba
Termostabiluri da Termolabiluri faqtorebiT (IgG da C3).
neitrofilebis fagocituri funqciis Camoyalibeba iwyeba mucladyofnis periodSi
15-25 kviris nayofSi. bavSvis dabadebisas polinuklearebs aqvT sakmaod aqtiuri
funqcia, rac gamoixateba qemotaqsisSi, moZraobasa da STanTqmis funqciaSi (fagocitozis
mesame faza), antigenis monelebis funqcia (meoTxe faza) jer kidev mniSvnelovnad
dabalia da mozrdilis Sesabamis dones aRwevs mxolod 6-12 Tvis asakSi. meores mxriv,
mxedvelobaSia misaRebi, rom iseTi mikroorganizmebi, rogoricaa hemofiluri Cxirebi,
klebsielebi, pnevmokokebi, saerTod ar eqvemdebarebian dasrulebul fagocitozs. aqedan
gamomdinare, advili SesaZlebelia, rom axalSobilobis periodSi infeqcia mZimed
mimdinareobdes, ganviTardes destruqciuli procesebi, Camoyalibdes sefsisi.
komplementis sistemis aqtivoba axalSobilobis periodSi dabalia da mxolod 6
Tvis asakSi utoldeba mozrdilis dones. komplementi xels uwyobs fagocitozs,
uzrunvelyofs baqteriebisa da virusebis eliminacias organizmidan.
properdini warmoadgens sisxlis Sratis cilas, romelic komplementTan erTad
xels uwyobs fagocitozs. axalSobilebSi properdinis Semcveloba aseve dabalia,
magram pirvelsave kviraSi misi done swrafad matulobs da Semdgom periodSic maRali
rCeba.
lizocimi (muramidaza) warmoadgens ferments, romliTac mdidaria organizmis
yvela ujredi. igi xels uwyobs baqteriebis garsis garRvevas da amiT antibaqteriuli
barieris Seqmnas.
interferoni umniSvnelovanesi virussawinaaRmdego cilaa, romelsac gamoimuSavebs
virusiT inficirebuli organizmi. interferoni praqtikulad yvela virusze moqmedebs.
23
zogadi nawili. makroorganizmis damcvelobiTi ... dros
24
zogadi nawili. makroorganizmis damcvelobiTi ... dros
citokinebi
citokinebi warmoadgenen T, B, NK ujredebis anda maTTan moqmedi sxva ujredebis
mier sinTezirebul cilebs. citokinebis zogierT warmomadgenels interleikinebsac
uwodeben.
arsebobs klasifikacia, sadac citokinebi ganawilebulia maTi funqciebis Sesabamisad:
1. citokinebi, romlebic monawileobas iReben bunebriv imunur pasuxSi: TNF-α α
(tumormanekrozebeli faqtori), IL- 1 - α da - β, IL-6, qemokinebi, IFN (interferoni)
25
zogadi nawili. makroorganizmis damcvelobiTi ... dros
- α da - β da sxv.
2. maregulirebeli-citokinebi:
a)imunomastimulireblebi: IL-1, IL-2, IL-4…...IFN.
b)imunosupresori-citokinebi:…IL-1Ra, IL-10...
3. hemopoezis maregulirebeli citokinebi:
eriTropoetini, IL-3, IL-4, IL-5...
4. proinflamatoruli (proanTebiTi) citokinebi: IL-1, IL-6...
5. antiinflamatoruli (anTebis sawinaaRmdego) citokinebi: IL-4, IL -6, IL-10,
IL-13.
zogierTi citokini, magaliTad, α- IFN, gamoiyeneba ama Tu im virusuli daavadebis
samkurnalod (qronikuli hepatiti B da C). limfocitebis zedapiris molekula-
markerebis peizaJiT SeiZleba vimsjeloT limfocitebis kuTvnilebaze imunitetis ama
Tu im sistemis mimarT (T, B, NK), maT funqciebsa da momwifebaze. ase mag: CD4-is
monopozitiuroba gviCvenebs, rom es momwifebuli helperia, CD8-is monopozituroba
ki laparakobs T-citotoqsikuri limfocitis an, SesaZloa, NK-ujredis (30%) arsebobaze.
im SemTxvevaSi, Tu T–limfocits gaaCnia, rogorc CD4, CD8 aseve arasrulyofili
TCR–receptori (bolomde ar aris misi γ, δ, ε, jaWvi awyobili), maSin T–limfocits
jer ar gauvlia ganviTarebis yvela stadia da ar Camoyalibebula romelime garkveuli
funqciis (citotoqsikuri an helperis) matarebel momwifebul limfocitad.
sabolood, srulyofili momwifebis misaRwevad unda ganxorcieldes T–limfocitis
jer dadebiTi
dadebiTi, Semdeg ki uaryofiTi seleqcia. dadebiTi seleqciis arsi mdgomareobs
imaSi, rom, rogorc ki moumwifebel kortikalur Timocitebs gauCndebaT TCR-receptorebi
(T cell receptor, Tavidan mcire raodenobiT), isini urTierTobas iwyeben, histoSeTavsebis
mTavari kompleqsis antigenebTan, romlebic ganlagebulia epiTelur kortikalur
ujredebze.
histoSeTavsebis mTavari kompleqsis MHC (Major histocompatibility complex)
molekulebi _ transmembranuli glikoproteinebia anu ujredis membranidan nawilobriv
“gamoweuli” glikoproteinebi. isini ucxo cilebis (mag: virusebis an baqteriebis)
antigenebs organizmisaTvis advilad gamosacnob antigenebad aqceven.
HLA ko mp l e qs i
MHC
II III I
kl as i
genebis
H LA -D P H LA -D Q H LA -D R C D FB C4A C 4 B H LA - B H LA - C H LA -A
pr o duqt e
26
zogadi nawili. makroorganizmis damcvelobiTi ... dros
27
zogadi nawili. makroorganizmis damcvelobiTi ... dros
28
makroorganizmis damcvelobiTi ... dros
zogadi nawili. infeqciuri avadmyofebis mkurnalobis ... saSualebebi
29
zogadi nawili. infeqciuri avadmyofebis mkurnalobis ... saSualebebi
30
zogadi nawili. infeqciuri avadmyofebis mkurnalobis ... saSualebebi
31
zogadi nawili. infeqciuri avadmyofebis mkurnalobis ... saSualebebi
32
zogadi nawili. infeqciuri avadmyofebis mkurnalobis ... saSualebebi
33
zogadi nawili. infeqciuri avadmyofebis mkurnalobis ... saSualebebi
34
zogadi nawili. infeqciuri avadmyofebis mkurnalobis ... saSualebebi
Cveulebriv grZnobazea,
civi, ofliani, cianozuri
ufro mozrdil wyurvili, fxizeli, wyurvili, agzneba,
kidurebiT, kanis naoWebiT
bavSvebSi agzneba mivardniloba
xelis TiTebze, aqvs
kunTebis krunCxvebi
35
zogadi nawili. infeqciuri avadmyofebis mkurnalobis ... saSualebebi
dakarguli siTxis aRsadgenad. siTxis `faruli” dakargva xdeba sunTqvis dros, kanidan
aorTqlebisas, siTbos gamoyofisas. siTxis `faruli” dakargva fizikuri aqtivobis
momatebis dros matulobs da aRwevs 30%-mde da mets, cxelebis dros danakargi
matulobs 12%-mde yovel 1°C-ze. aseve maRalia danakargi haeris dabali tenianobisas,
xolo organizmis dabali aqtivobis dros, piriqiT, danakargi mcirea (komuri mdgomareobebi,
hi poTermia da a.S.), mcirdeba danakargi maRali tenianobis drosac. gansakuTrebiT
maRalia wylis kargva sxeulis mcire masis mqone bavSvebSi. maTSi sadReRamiso danakargi
aRwevs 100-200ml/kg-ze.
wylis kargva izrdeba hiperbilirubinemiis mqone avadmyofebSi dasxivebiT mkurnalobis
dros, uSaqro diabetian avadmyofebSi, Sardmdenebis gamoyenebisas da a.S. amitom wylis
gaZlierebuli dakargvisas aucilebelia koreqciis CatarebisaTvis ara mxolod SardiT
gamoyofili siTxis, aramed “faruli” danakargis gaTvaliswinebac.
zogierT avadmyofSi aucilebelia Na-is, K-is, Cl-is da wylis koreqcia, rogorc es
naCvenebia cxrilSi.
deficitis
H20 ml Na (mEq) K∧ (mEq) Cl (mEq)
gamomwvevi mizezi
SimSili (kvebis
100-120* 5-7 1-2 4-6
naklovaneba), wyurvili
diarea izonatriemiuli 100-120 8-10 8-10 8-10
‡
diarea hiponatriemiuli 100-120 2-4 0-4 _2-dan_6-mde
diarea hipernatriemiuli 100-120 10-12 8-10 10-12
pilorostenozi 100-120 8-10 10-12 10-12
diabeturi acidozi 100-120 8-10 5-7 6-8
s is xlis SratSi
d ehid rataciis tipebi
natriumis Semcveloba
hipotonuri anu hiponatriemiuli Na < 130 mEq/l
izotonuri anu izonatriemiuli Na 130_150 mEq/l
hipertonuli anu hipernatriemiuli Na > 150 mEq/l
36
zogadi nawili. infeqciuri avadmyofebis mkurnalobis ... saSualebebi
37
zogadi nawili. infeqciuri avadmyofebis mkurnalobis ... saSualebebi
38
zogadi nawili. infeqciuri avadmyofebis mkurnalobis ... saSualebebi
30 bikarbonati,
ORS* 20 90 20 80
citrati
39
zogadi nawili. infeqciuri avadmyofebis mkurnalobis ... saSualebebi
40
zogadi nawili. infeqciuri avadmyofebis mkurnalobis ... saSualebebi
asaki < 4Tvis 4-11 Tvis 12-23 Tvis 2-4 wlis 5-14 wlis 15 wlis da meti
masa < 5kg 5-7,9 kg 8-10,9 kg 11-15,9 kg 16-29,9 kg 30 kg da meti
ORS (ml) 200-400 400-600 600-800 800-1200 1200-2200 2200-4000
Tavdapirvelad 30
grZeldeba 70 ml/kg drois Semdeg
asaki ml/kg Semdegi periodis
periodSi:
ganmavlobaSi
12 Tvemde 1 saaTi 5 saaTi
12 Tvis
30 wuTi 2,5 saaTi
zemoT asaki
41
zogadi nawili. infeqciuri avadmyofebis mkurnalobis ... saSualebebi
42
infeqciuri avadmyofebis mkurnalobis ... saSualebebi
zogadi nawili. infeqciuri daavadebebis specifikuri profilaqtika
zemoTaRniSnul garTulebebs.
krunCxvisas niSnaven antikonvulsantebs, 3% NaCl 3-5 ml/kg, xolo qalasSida
wnevis dasawevad manitols an hi perventilacias.
hi pernatriemiuli gauwyloebisas didi raodenobiT Seyvanili siTxe xSirad iwvevs
ujredgare siTxis momatebas jer kidev acidozisa da eleqtrolitebis koreqciamde,
ramac SeiZleba migviyvanos gulis ukmarisobamde da tvinis SeSupebamde.
gamoxatuli hi pokalciemis dros saWiroa kalciumis Seyvana venaSi. aseve SeiZleba
ganviTardes anemia da Tirkmlebis koncentraciuli unaris daqveiTeba.
zemoTaRniSnuli skrupulozuri koreqcia mTel rig pirobebSi Znelad
ganxorcielebadia, amitom urgentul SemTxvevaSi, rodesac gvaqvs siZneleebi
laboratoriasTan, umjobesia, vixelmZRvaneloT msoflio janmrTelobis dacvis
organizaciis rekomendaciebiT da gamoviyenoT “a”, “b” an “g” gegma, miTumetes, rogorc
es ukve aRiniSna, mZime gauwyloebis dros, miuxedavad gauwyloebis ti pisa (hi po-, izo-
an hi pernatriemiuli), saukeTeso xsnarebad iTvleba 0,9% NaCl da ringeris laqtati.
43
zogadi nawili. infeqciuri daavadebebis specifikuri profilaqtika
44
zogadi nawili. infeqciuri daavadebebis specifikuri profilaqtika
45
zogadi nawili. infeqciuri daavadebebis specifikuri profilaqtika
9. ZuZuTi kveba.
10. araspecifikuri alergia.
orsulebSi cocxali vaqcinebi ar gamoiyeneba.
msoflio jandacvis organizaciis rekomendaciiT vaqcinaciis ukuCvenebebi minimumamdea
dayvanili.
pasiuri imunizacia
46
zogadi nawili. infeqciuri daavadebebis specifikuri profilaqtika
47
zogadi nawili. infeqciuri daavadebebis specifikuri profilaqtika
48
zogadi nawili. infeqciuri daavadebebis specifikuri profilaqtika
preparati doz a
H 1 - blokatorebi (antihistaminurebi)
Diphenhydramine (dimedroli) per os, i.m, i.v: 1 - 2 mg/kg yovel 4 - 6 sT-Si (100 mg - erTjeradi
Hydrozyne (Hydroxyzine) Per os, i.m: 0.5 - 1 mg/kg yovel 4 - 6 sT-Si (100 mg - erTjeradi
H 2 - blokatorebi) (antihistaminurebi)
Cimetidine i.v: 5 mg/kg neli Seyvana 15 wT-is ganmavlobaSi yovel 6 - 8 sT-Si
(300 mg maqsimaluri erTjeradi doza)
Ranitidine i.v: 1 mg/kg neli Seyvana 15 wT-is ganmavlobaSi yovel 6 - 8 sT-Si
(50 kortikosteroidebi )
Hydrocortisone i.v: 100 - 200 mg yovel 4 - 6 sT-Si
Methylprednisolone i.v: 1.5 - 2 mg/kg yovel 4 - 6 sT-Si (40 mg maqsimaluri erTjeradi
Prednisone (Prednisolone) ) 1.5 - 2 mg/kg 1-jer diliT 5 dRis ganmavlobaSi (60 mg
Per os:
erTjeradi maqsimaluri doza)
β 2 _ agonistebi
Albuterol aerozoli : 0.5% (mg/ml), 0.05 - 0.15 mg/kg dozaze 0.9% N aCl 2 - 3
ml-ze, maqsimum 2.5 mg dozaze yovel 20 wT-Si, 1 - 2 sT-s
ganmavlobaSi an 0.5 mg/kg sT-Si - xangrZlivi miwodeba (15 mg/sT-Si
maqsimaluri doza)
sxva
Dopamine i.v : 5 - 20 mg/kg wuTSi. 150 mg Dop. + 250 ml 0.9% NaCl an 5%
deqstroza. gadasxmis siCqare 1 ml/kg/sT = 10 mg/kg wT. (bikarbonati
ar ixmareba am dros - boWavs dopamins)
Aminophylline i.v : 4 - 6 mg/kg 0.9% NaCl 20 ml-Si Cqari SeyvaniT, yovel 6 sT-Si
an 0.9 - 1.1 mg/kg/sT xangrZlivi infuziiT
49
zogadi nawili. infeqciuri daavadebebis specifikuri profilaqtika
ganzaveba raodenoba
doza # Seyvanis gza
0,9%-ian NaCl ml-Si
1* kanqveS 1:20 0,5
2 kanqveS 1:10 0,1
3 kanqveS 1:10 0,3
4 kanqveS ganuzavebeli 0,1
5 kunTebSi ganuzavebeli 0,2
6 kunTebSi ganuzavebeli 0,5
7~ venaSi ganuzavebeli 0,1
50
kerZo nawili. gr
grii pi
kerZo nawili
gr
grii pi
(GRIPPE, GRIPPUS, INFLUENZA)
51
kerZo nawili. gr
grii pi
52
kerZo nawili. gr
grii pi
53
kerZo nawili. gr
grii pi
Zili, xSirad uviTardebaT Rebineba, ufro metad saWmlis an wamlis miRebasTan dakavSirebiT.
mZime SemTxvevebSi adgili aqvs halucinaciebs, kisris kunTebis rigidobas, sustad
gamoxatul kernigis simptoms, cnobierebis dakargvas, krunCxvebs.
daavadebis 20-30%-Si zemo sasunTqi gzebis katari pirvel dReebSi SeiZleba
mkveTrad ar iyos gamoxatuli, sustad gamoxatuli ki nivelirdeba saerTo intoqsikaciis
movlenebis fonze. me-2-3 dRes yvelas aqvs kataruli movlenebi, romelic gamovlindeba
cxviriT sunTqvis gaZnelebiT, surdoTi, yelis simSraliT da fxaWnis SegrZnebiT.
viTardeba mSrali xvela, zogjer xmis CaxleCa, qoSini, gaZlierebuli oflianoba.
temperaturis xangrZlivoba gaurTulebeli gri pis dros 2-3, iSviaTad 5 dRe, xolo
temperaturis axali momateba ufro garTulebasTanaa dakavSirebuli. me-3, me-4 dRisaTvis
saerTo intoqsikaciuri movlenebi cxreba da pirvel adgilze rCeba movlenebi sasunTqi
organoebis mxriv: mSrali xvela rCeba 4-10 dRe, zogjer 2 kviramde. saerTo intoqsikaciis
movlenebi SedarebiT ufro xSirad aRiniSneba A gripis dros, maSin, rodesac cvlilebebi
cxvir-xaxis mxriv ufro damaxasiaTebelia B gri pisaTvis.
mcirewlovan bavSvebSi gri pi mimdinareobs ati purad da faqtiurad, Zneli gasarCevia
paragri pis, adenovirusuli, rinovirusuli da sincitiuri ccxelebisagan. am asakis
bavSvebs xSirad uviTardebaT laringotraqeiti, bronqiti, bronqioliti, pnevmoniebi, A
virusiT gamowveuli laringotraqeiti mimdinareobs ufro mZimed _ uxvi, sqeli da
webovani naxveliT, rasac araiSviaTad erTvis krupi da zogjer saWiro xdeba intubaciis
an traqeotomiis gakeTeba. mcirewlovan bavSvebSi daavadeba iwyeba mwvaved, saerTo
intoqsikaciis movlenebiT, swrafad viTardeba maRali temperatura, umravles SemTxvevaSi
aRiniSneba krunCxvebi da Rebineba; diarea gvxvdeba 15% SemTxvevaSi, Sua yuris anTeba
25%-Si. xSirad gvxvdeba eriTemuli, laqovani an laqovan-papuluri gamonayari, romelic
male qreba.
B gri pi xSirad mimdinareobs miozitiT (umetesad, kanWis tyupi kunTis), romelic
araiSviaTad viTardeba daavadebidan 1 kviris Semdeg, roca aRiniSneba mdgomareobis
gaumjobeseba.
C virusiT gamowveuli daavadeba bavSvebSi iSviaTad gvxvdeba. igi xasiaTdeba
temperaturis momatebiT, cxviridan gaxangrZlivebuli gamonadeniT, surdoTi da xveliT.
klasifikacia. simZimis mixedviT arCeven msubuq, saSualo da mZime formebs (toqsikuri
da hi pertoqsikuri). mZime
formebis dros aRiniSneba
mkveTri saerTo intoqsikacia,
hi perTermia, nevrologiuri
simptomebi, Trombohemoragiuli
sindromi, gulsisxlZarRvTa,
sunTqvisa da sxva sistemebis
mwvave ukmarisoba.
hi pertoqsikuri gri pis dros
damaxasiaTebelia encefaluri,
hemoragiuli, hi perTermiuli
sindromebi, daavadebis
elviseburi mimdinareoba da
sikvdiliT damTavreba. saSualo
simZimisas aRiniSneba
intoqsikaciuri movlenebis yvela
gr
grii pi. hemo ragiuli fo
hemoragiuli rma (sisxliani Rebineba _ Cans
forma niSani, mxolod maTi simZime
TeTreulze), tvinis SeSupeba, filtvebis mZime anTeba. naklebadaa gamoxatuli.
(sakuTari masala)
54
kerZo nawili. gr
grii pi
0
temperatura 38-39,5 C, SesaZloa krupisa da abdominuri sindromis ganviTareba.
msubuqi formis dros temperatura subfebriluria an umniSvnelodaa momatebuli,
intoqsikaciis niSnebi sustadaa gamoxatuli. amave kategorias miekuTvneba waSlili
formebi, romelebic viTardeba normaluri temperaturis fonze, zemo sasunTqi gzebis
katariT _ surdo, mcire gamonadeni cxviridan, wamoxveleba.
gri pi SeiZleba mimdinareobdes inaparantul formebSi klinikis gareSe, rac dgindeba
avadmyofTan kontaqtirebulebSi gri pis virusis sawinaaRmdego antisxeulebis titris
gazrdiT.
gr
grii pis mimdinar eoba axalSobilebsa da 1 wlamde asakis bavSvebSi. xSirad
mimdinareoba
daavadeba iwyeba TandaTanobiT, temperaturis umniSvnelo matebiT. intoqsikaciis niSnebi
sustadaa gamoxatuli. damaxasiaTebelia kanis sifermkrTale, axalSobilebSi _ sakvebze
uaris Tqma. SeiZleba iyos sustad gamoxatuli xvela, cxviris gagudva; xSirad adgili
aqvs ganmeorebiT Rebinebas, krupis sindromi iSviaTia, filtvebis segmentebis dazianeba
ar aris damaxasiaTebeli. miuxedavad dasawyisSi aseTi susti intoqsikaciisa, 1 wlamde
asakis bavSvebSi daavadeba Semdgom mimdinareobs mZimed, rac ganpirobebulia baqteriuli
infeqciis darTviTa da Cirqovani garTulebebis ganviTarebiT (otiti, bronqiti, pnevmonia
da sxva). mozrdil bavSvebTan SedarebiT am asakis bavSvebSi letaloba 3-jer ufro
metia.
gr
grii pis mimdinar eoba 1-dan 3 wlamde asakis bavSvebSi. am asakSi gri pi xSirad
mimdinareoba
mimdinareobs gansakuTrebiT mZimed gamoxatuli intoqsikaciiT, cns-s dazianebiT da
meningoencefaluri sindromiT; kataruli movlenebi ki sustadaa gamoxatuli. SeiZleba
gvqondes asTmuri da krupis sindromi, filtvebis segmenturi dazianeba. garTulebebia:
otiti, sinusiti, kerovani pnevmoniebi.
55
kerZo nawili. gr
grii pi
56
kerZo nawili. gr
grii pi
rimantadini asaki
≥ 10 weli
1 - 9 weli
amantadini masa < 40 kg ≥ 40 kg
5 mg/kg/ dRe-RameSi,
5 mg/kg/dRe-RameSi, 200 mg/dRe-RameSi
mkurnaloba maqsimum 50 mg/dReSi
1 an 2 miRebaze 1 an 2 miRebaze
1 an 2 miRebaze
profilaqtika igive dozebia, rac mkurnalobisTvis.
fizioTerapiuli procedu-
rebi naCvenebia otitis, pnevmoniis
dros (eleqtroforezi kalci-
umiT, ultramokle sxivebiT da
sxva).
krupiT garTulebisas
avadmyofi bavSvi Tavsdeba
orTqliani Jangbadis karavSi an
oTaxSi, sadac mudmivad aris
teniani (100%) mikroklimati;
haeri Seicavs 40-45% Jangbads.
am procedurebisas bavSvebi
wynardebian, Zili xdeba ufro
mSvidi, exsnebaT laringospazmi,
SeSupeba, Jangbadis naklovaneba;
klebulobs metaboluri
xorxisa da traqeis sqematuri mdgomareoba normalur acidozi da umjobesdeba sisxlis
mdgomareobaSi da virusuli krupis dros (Emmanuel gazovani Semadgenloba.
B. Walter, Paul A. Shurn). stacionarSi keTdeba epinefrinis
Epiglottis - xorxsarqveli
inhalaciebi saWiroebis
False cords - cru iogebi
SemTxvevaSi keTdeba intubacia
True cords - WeSmariti iogebi
subglottic tissue - subglotikuri qsovili an traqeostomia.
Trachea - traqea
Normal - normaluri mdgomareoba
Croup - krupis dros
57
kerZo nawili. gr
grii pi
58
gr
grii pi
kerZo nawili. paragri
paragr i pi
paragr
paragrii pi
(PARAGRIPPUS, PARAINFLUENZA)
59
kerZo nawili. paragr
paragrii pi
virusi Tavisi TvisebebiT axlos dgas gri pis virusTan da miekuTvneba miqsovirusebis
ojaxs (Myxovirusis parainfluenzae) igi pirvelad gamoyofili iyo iaponiaSi 1952
w. Kuroya, Insida, Sheatory--is mier pnevmoniiT gardacvlili axalSobili bavSvis
filtvebidan. 1956-58 w.w. R. Chanock--ma gri pismagvari infeqciiT daavadebuli bavSvebis
cxvir-xaxis CamonarecxiT inficirebuli maimunis Tirkmlis ujreduli kulturidan
gamohyo virusi, romelmac miiRo paragri pis virusis saxelwodeba. cnobilia virusis
4 serologiuri tipi: 1, 2, 3, 4. virusis nawilakebs aqvT ovaluri forma da zomiT 50-
250 nm-ia. SeswevT unari moaxdinon adamianis, zRvis goWis, qaTmisa da zogierTi
cxovelis eriTrocitebis aglutinacia. garemoSi male iRupebian.
epidemiologia. inficireba xdeba avadmyofisagan haer-wveTovani gziT. virusis
gansakuTrebuli mimRebloba damaxasiaTebelia adreuli asakis bavSvebisaTvis. infeqcias
axasiaTebs sporaduli SemTxvevebi da afeTqebebi organizebul bavSvTa koleqtivebSi.
mwvave respiraciuli virusuli daavadebebis struqturaSi paragri pi Seadgens 10-
30%-s. daavadeba gvxvdeba mTeli wlis ganmavlobaSi sporaduli SemTxvevebis, xolo
zamTarSi_afeTqebebis saxiT. avadmyofi saSiSia daavadebis me-7 me-10 dRemde. 1, 2, 3,
ti pebiT gamowveuli daavadeba xasiaTdeba gamoxatuli klinikuri simptomatologiiT,
xolo me-4 ti piT gamowveuli mimdinareobs ufro xSirad usimptomod.
1 ti piT gamowveuli epidemia, meordeba yovel 2 weliwadSi; me-2 ti piT ufro
sporaduli SemTxvevebi mimdinareobs; me-3 ti pi epidemiebs ar iwvevs da daavadeba
gvxvdeba erTeuli SemTxvevebis saxiT. 1 ti pis paragri pis virusi iwvevs krupis mZime
formebs da biWebSi ufro xSirad gvxvdeba, vidre gogonebSi. 3 ti pis virusi xasiaTdeba
qvemo respiraciuli traqtis upiratesi dazianebiT.
paTmo rfo
paTmorfo logia. tipuria laringotraqeobronqitis gamoxatuli anTebiTi procesi.
logia
rfologia
pnevmoniiT mkvdar bavSvebSi gamoxatulia bronqebis, bronqiolebis limfocituri
infiltracia, bronqebis epiTeliumi danekrozebulia, alveolebis kedlebi da filtvebis
intersticia leikocitebiTaa infiltrirebuli.
virusis SeWra organizmSi xdeba zemo sasunTqi gzebis lorwovani garsebidan,
umTavresad ziandeba cxvirisa da xorxis epiTeliumi, viTardeba maTi distrofia da
nekrozi, romelic albaT nawilobriv imunologiuri destruqciiTac unda iyos
ganpirobebuli. adgilobrivad viTardeba anTebiTi procesi, lorwovanis eqsudacia,
SeSupeba, es cvlilebebi gansakuTrebiT gamoxatulia xorxSi, riTac ganpirobebulia
krupis sindromis ganviTareba.
pirveladi anTebiTi kerebidan paragri pis virusi vrceldeba sisxlSi da iwvevs
virusemias, saerTo intoqsikaciur movlenebs: temperaturis momatebas, Tavis tkivils,
saerTo sisustes, xSiria meoradi infeqciis darTva.
imuniteti xanmoklea da ecema rekonvalescenciis periodSi, rac ver aferxebs
ganmeorebiT daavadebas. amiT aixsneba 1 wlis ganmavlobaSi daavadebis ramodenimejer
ganmeoreba. xanmokle imunitetis periodSi gamomuSavdeba A, M, G imunoglobulinebi,
Tumca seriozuli T-ujreduli imunodeficitebis dros bavSvebs uWirT virusis
eliminacia (gandevna), rac paTogenezSi ujreduli imunitetis mniSvnelovan rolze
laparakobs.
klinika. inkubaciuri periodi ganisazRvreba 2-7, saSualod 3-4 dRiT. umravles
klinika
SemTxvevaSi daavadeba iwyeba mwvaved, temperaturis momatebiT, romelic 2-3 dReSi
aRwevs maqsimums _ 400 C, Tumca maRali sicxe daavadebas ar axasiaTebs. miuxedavad
amisa, intoqsikaciis saerTo movlenebi gamoxatulia zomierad an ar aris. temperaturuli
reaqciis xangrZlivoba SeiZleba iyos ufro didi (7 dRemde), vidre gri pis dros.
paragri pis diagnoziT stacionarSi Semosuli bavSvebis 50%-s aqvs laringotraqeiti,
xolo 15%-s _ bronqiti, bronqioliti da pnevmonia. 1 ti pis virusi ufro xSirad
60
kerZo nawili. paragr
paragrii pi
61
paragr
paragrii pi
kerZo nawili. adenovirusuli infeqcia
adenovirusuli infeqcia
62
kerZo nawili. adenovirusuli infeqcia
63
kerZo nawili. adenovirusuli infeqcia
64
adenovirusuli infeqcia
kerZo nawili. respiraciul-sincitiuri infeqcia
pnevmokokur
pnevmokokurii koniunqtiviti (Å.È. Êîí÷àëîâñêèé)
respiraciul-sincitiuri infeqcia
65
kerZo nawili. respiraciul-sincitiuri infeqcia
66
kerZo nawili. respiraciul-sincitiuri infeqcia
67
kerZo nawili. respiraciul-sincitiuri infeqcia
68
kerZo nawili. rinovirusuli infeqcia
rinovirusuli infeqcia
(RINOVIRUSIS)
69
kerZo nawili. rinovirusuli infeqcia
70
kerZo nawili. reovirusuli infeqcia
reovirusuli infeqcia
71
Tandayolili virusuli respiraciuli infeqciebi
kerZo nawili. wiTela
Tandayolili virusuli
respiraciuli infeqciebi
wiTela
(MORBILLI)
72
kerZo nawili. wiTela
73
kerZo nawili. wiTela
74
kerZo nawili. wiTela
75
kerZo nawili. wiTela
76
kerZo nawili. wiTela
77
kerZo nawili. wiTela
78
wiTela
kerZo nawili. wiTura
formebs.
msubuqi mimdinareobisas temperatura 37,2-37,50 C-ia. saSualos dros 37,5-380 C,
mimdinareobs Tavis tkiviliT, anoreqsiiT, modunebiT. aRniSnuli movlenebi 2-3 dReSi
qreba.
vaqcinacia SeiZleba gaukeTdes infeqciis keraSi myof bavSvebs, rac zRudavs infeqciis
gavrcelebas. am dros vaqcinaze reaqcia ar Zlierdeba.
keraSi vaqcinacia efeqturia im SemTxvevaSi, roca igi tardeba kontaqtamde an
araugvianes 3 dRisa kontaqtidan.
pasiuri imunizacia xorcieldeba imunoglobulinis SeyvaniT kunTebSi (2,25 ml/
kg) - maqsimum 15 ml, ris Sedegadac SeiZleba Tavidan aviciloT daavadeba an mivaRwioT
mis msubuqad mimdinareobas. aseTive koncentraciiT eZlevaT specifikuri IgG intravenuri
imunoglobulinis saxiT. pasiuri imunizacia. pirvel rigSi utardebaT qronikulad
daavadebul mcire asakis bavSvebs, romelTac kontaqti hqondaT wiTelasTan stacionarebSi
an organizebul bavSvTa koleqtivebSi.
wiTura
(RUBEOLLA)
79
kerZo nawili. wiTura
80
kerZo nawili. wiTura
81
kerZo nawili. wiTura
sisxlSi.
wiTuras msgavsi egzanTemiT mimdinareobs medikamenturi alergia. diferenciuli
diagnozisTvis gadamwyveti mniSvneloba aqvs limfuri kvanZebis gadidebas, anamnezs
(gamonayars medikamentebis miRebasTan dakavSirebiT) da wiTurasaTvis damaxasiaTebel
cvlilebebs sisxlSi.
laboratoriuli diagnostika xorcieldeba qsovilovan kulturebze nazaluri
sekretidan virusis gamoyofiT da serologiuri meTodebiT. Tandayolili infeqciis
dros virusis gamoyofa SesaZlebelia agreTve sisxlidan, Sardidan, Tavzurgtvinis
siTxidan. imuniteti wiTuras mimarT ganisazRvreba hemaglutininSemboWavi antisxeulebiT.
virusis diagnostikisTvis SemuSavebulia ramodenime iseTi axali meTodi, rogoricaa
gelSi hemolizi, lateqs-aglutinacia, imunofermentuli analizi, pasiuri hemaglutinacia,
imunofluorescenciis meTodi. Tandayolili wiTuras dros diagnozis dadastureba
SeiZleba ramodenime TveSi IgG-is specifikuri titris SenarCunebiT an misi zrdiT.
Tumca 1 wlamde asakSi, serologiuri gamokvlevis dadebiTi Sedegebi xSirad kargi
maCvenebeli ar aris.
prognozi. garTulebebi zogjer gvxvdeba nevritebis, arTritebis
garTulebebi da prognozi
saxiT; encefaliti iSviaTia (1 SemTxveva 6000 avadmyofze).
prognozi mozrdil bavSvebSi keTilsaimedoa, magram Tandayolili wiTuras dros
damokidebulia daavadebis simZimeze. encefalitis mkurnalobis Semdeg bavSvTa mxolod
30%-s ar rCeba motoruli funqciisa da fsiqikis gamoxatuli cvlilebebi.
mkurnaloba. rekomendebulia woliTi reJimi gamoyris periodSi. medikamentur
mkurnaloba
Terapias ar saWiroebs. erTeul SemTxvevebSi tardeba simptomuri an paTogenezuri
mkurnaloba.
profilaqtika. imunoglobulinis Seyvana 0,55 ml/kg orsulisaTvis xdeba ukidures
profilaqtika
SemTxvevaSi, roca orsulobis Sewyveta SeuZlebelia (igi garantias ar iZleva, rom
nayofs Tandayolili wiTura ar ganuviTardeba). sxva SemTxvevaSi imunoglobulinis
rutinuli gamoyeneba mizanSewonili ar aris.
aqtiuri imunizaciis mizniT amJamad gamoiyeneba RA 27/3 (adamianis embrionis
filtvebis fibroblastebSi gazrdili cocxali vaqcinis Stami (W11 _ 38 38) (aSS). sxva
vaqcinebTan (maT Soris HPV - 77 77) SedarebiT dadgenilia misi upiratesoba. igi
moqmedebiT axlos dgas bunebrivi infeqciis Sedegad ganpirobebul imunitetTan. vaqcina
keTdeba kanqveS, erTxel. profilaqtikis dros gansakuTrebuli mniSvneloba aqvs nayofis
daavadebis Tavidan acilebas. acras eqvemdebareba yvela bavSvi (gogonebi, biWebi) 15
Tvis asakidan, mozrdilebi, prepubertuli asakis gogonebi da hemaglutinaciis
damuxruWebis uaryofiTi reaqciis mqone qalebi.
aSS-s vaqcinaciis programiT gaTvaliswinebulia wiTuras sawinaaRmdego acrebi.
patara bavSvebis, mozardi biWunebisa da mamakacebis vaqcinacia mizanSewonilia im
TvalsazrisiT, rom isini wiTuras virusis gamavrceleblebi arian da orsuli qalisaTvis
potenciur saSiSroebas warmoadgenen. bolo dros wiTuras sawinaaRmdego vaqcinacia
SesaZlebeli gaxda kombinirebuli MMR-vaqciniT (wiTelas, parotitisa da wiTuras
sawinaaRmdego). am vaqcinis ganmeorebiT Seyvana wiTelas (Tu aseTi vaqcinaciaa kalendarSi)
asacrelad usafrTxoa.
82
kerZo nawili. parotituli infeqcia, epidemiuri parotiti
83
kerZo nawili. parotituli infeqcia, epidemiuri parotiti
e.w. `postvaqcinuri parotitis” klinika ara acriT, aramed sxva mizezebis damTxveviTaa
ufro gamowveuli.
paTogenezi. organizmSi virusis SeWra xorcieldeba sasunTqi gzebisa da piris
Rrus lorwovanidan, ar aris gamoricxuli koniunqtivac. epiTeliumSi gamravlebis
Semdeg virusi hematogenuri gziT vrceldeba mTels organizmSi da lokalizdeba
Sinagan organoebSi, pirvel rigSi azianebs jirkvlovan organoebs (ybayura, ybisqveSa,
enisqveSa, sanerwyve, saTesle jirkvlebi, sakvercxeebi, pankreasi) da centralur nervul
sistemas. sanerwyve jirkvlebSi xdeba virusis adaptacia, misi replikacia da dagroveba,
saidanac xorcieldeba meoradi viremia. daavadebis paTogenezSi didi roli eniWeba
nervuli sistemis dazianebas. amaze mowmobs Tundac is faqti, rom epidemiuri paroti-
tis umravles SemTxvevaSi adgili aqvs nervuli sistemis sxvadasxva xarisxis dazianebas.
Tav-zurgtvinis siTxeSi citozis momatebiT, raime gamoxatuli meningealuri movlenebis
gareSe da a.S.
zogierTi avtorebis monacemebiT dadgenilia, rom parotitis dros virurias adgili
aqvs 75%-Si. Tumca Tirkmlebis dazianeba bavSvebSi iSviaTia. amave dros aRwerilia
fataluri nefriti parotitis gadatanidan 10-14 dRis Semdeg. SesaZlebelia, Zalze
iSviaTad Trombocituri purpuris ganviTareba.
morfologiuri cvlilebebi parotituli infeqciis dros, ZiriTadad, eyrdnoba
sanerwyve jirkvlebis biofsirebul da maimunebze eqsperimentuli infeqciis monacemebs.
daavadebis dawyebidan 70 saaTis Semdeg biofsirebuli ybayura jirkvlis qsovilSi,
saidanac gamohyves virusi, aRiniSneboda acinozuri struqturis SenarCuneba, magram
sanerwyve sadinarebis irgvliv adgili hqonda SeSupebasa da limfocitur infiltracias,
romelic vrceldeboda SemaerTebel qsovilebze. ZiriTadi cvlilebebi naxuli iyo
sadinrebSi da meryeobda epiTeliumis umniSvnelo SeSupebidan erTeuli polimorfuli
ujredebis SemcvelobiT mis mTlian desqvamaciamde da sadinarebis obstruqciamde
ujreduli detritebiT. citoplazmis SeSupeba SemCneuli iyo erTeul SemTxvevebSi da
masSi iSviaTad naxulobdnen didi zomis bazofilur CanarTebs. parotituli orqitis
dros 1-2 dRis tkivilis Semdeg biofsirebul substratSi aRiniSneboda cvlilebebi
dawyebuli umniSvnelo intersticiuli SeSupebiT, spermatogenezis darRvevis gareSe,
damTavrebuli epiTeliumis mTliani daRupviT, perivaskulur nawilebze limfocituri
infiltraciiT. mZime SemTxvevaSi SesaZloa saTesle jirkvlis atrofia da amis Sedegad
sterilobis ganviTarebas.
kuWqveSa jirkvalSi mZime mimdinareobisas naxuloben nekrozuli xasiaTis
cvlilebebs, ziandeba rogorc endokrinuli, ise egzokrinuli sekreciis qsovilebi
pankreasSi.
parotitul
parotituli i meningitis dros adgili aqvs tvinis SeSupebas, hi peremias, serozul-
fibrinul eqsudacias. SeiZleba aRiniSnos kerovani da difuzuri encefalitis suraTi.
klinika. inkubaciuri periodi meryeobs 11-dan 24 dRemde, zogjer 26 dRemde,
klinika
saSualod Seadgens 17-18 dRes. iSviaTadaa gamoxatuli prodromuli periodi, romelic
mimdinareobs ybayura jirkvlis gadidebamde 1-2 dRiT adre saerTo sisustiT, temperaturis
momatebiT, Tavisa da kunTebis tkiviliT, gansakuTrebiT kisris midamoSi. ufro xSirad
daavadeba iwyeba mZafrad, temperaturis uecari momatebiT 39°C-mde, ybayura jirkvlis
calmxrivi an ormxrivi SeSupebiT da mtkivneulobiT. umTavresad gvxvdeba ybayura
jirkvlis calmxrivi gadideba, 1-3 dRis Semdeg amas SeiZleba daerTos meore jirkvlis
gadideba, Tumca daavadeba arcTu iSviaTad iwyeba orive jirkvlis gadidebiT. mogrZo
an ovaluri formis jirkvali SeigrZnoba qveda ybis gareTa kidis SigniT. es midamo
SeSupebuli, elastiuri da daWimulia, inarCunebs normalur fers. mtkivneuloba Zlierdeba
ReWvisa da ylapvis dros, agreTve mJave siTxeebis miRebisas nerwyvdenis gaZlierebis
84
kerZo nawili. parotituli infeqcia, epidemiuri parotiti
85
kerZo nawili. parotituli infeqcia, epidemiuri parotiti
86
kerZo nawili. parotituli infeqcia, epidemiuri parotiti
daRlilobas da sxva.
yvela aRniSnul dazianebas Tan erTvis infeqciis saerTo gamovlineba (temperaturis
momateba, tkivilebi da sxva). nebismieri izolirebuli formisas diagnozis dasma
Zlier gaZnelebulia. am dros didi mniSvneloba eniWeba laboratoriul kvlevas _
hemaglutinaciis damuxruWebis da komplementSemboWveli reaqciebiT antisxeulebis
titris dadgenas.
centraluri nervuli sistemis dazianeba ama Tu im formiT parotituli infeqciis
dros xSiria. serozuli meningitis sixSire meryeobs erTeuli SemTxvevidan 50-65%-
mde. zogjer, infeqciis erTaderT gamovlinebad iTvleba serozuli meningiti, romlis,
aseve SesaZloa erTaderTi gamovlineba iyos pleocitozi romelic limfocituri
xasiaTisaa da meryeobs 500-2000-mde 1ml-Si, Saqris normaluri da cilis umniSvnelo
matebiT. meningitis da meningoencefalitis klinika identuria imisa, rasac adgili
aqvs sxva serozuli meningitebisas. parotitis virusi arRvevs Tavzurgtvinis siTxis
cirkulacias da iTvleba hidrocefaliis ganviTarebis erT-erT mizezad. serozuli
meningitis gamosavali keTilsaimedoa, magram misi gadatanis Semdeg SeiZleba didxans
gagrZeldes postinfeqciuri asTenia. Tumca meningoencefaliti parotituli infeqciis
dros iSviaTia, magram misi mimdinareoba ufro mZimea da gadatanis Semdeg SeiZleba
darCes hi pertenziul-hidrocefaluri sindromi, epilefsia, siyrue, simsuqne da sxv.
axalSobilebSi da wlamde asakis bavSvebSi parotituli infeqcia mimdinareobs
ufro msubuqad da vlindeba parotitis an submaqsilitis saxiT. sxva jirkvlebis an
nervuli sistemis dazianeba ar gvxvdeba. parotituli infeqciis gadatanis Semdeg
orsulebSi SesaZloa abortis ganviTareba an nayofis dazianeba (Tumca Zalze iSviaTad).
fiqroben, rom zogjer endokrinuli fibroelastozi SeiZleba ganpirobebuli iyos
nayofis dainficirebiT muclad yofnisas.
diagnozi. ybayuris an masTan erTad sxva jirkvlovani organoebisa an cns-is
dazianebisas diagnozi mTlianad eyrdnoba klinikur suraTs. Tu daavadeba mimdinareobs
izolirebulad an kombinirebulad ybayura jirkvlis dazianebis gareSe, diagnostika
gaZnelebulia da moiTxovs epidsituaciis Seswavlas, kontaqtis dadgenas avadmyofTan.
laboratoriulad periferiul sisxlSi leikopenia da limfocitozia; zogjer
sisxlSi imatebs amilaza, rac dakavSirebulia sanerwyve jirkvlebis SeSupebasTan.
etiologiuri diagnozi xorcieldeba virusis gamoyofiT sisxlidan, nerwyvidan,
Sardidan, magram es dakavSirebulia siZneleebTan da daavadebis adreuli diagnostikisaTvis
ar gamodgeba. ufro xelmisawvdomi da martivia serologiuri reaqciebi _
komplementSemboWveli da hemaglutinaciis damuxruWebis, ifa. antisxeulebis aRmoCena
SeiZleba me-2-3 dRidan, xolo me-7-10 dRidan xdeba antisxeulebis zrdis konstatacia
4-jer da metad titrSi, rac udavod adasturebs parotituli infeqciis arsebobas da
vaqcinuri imunitetis diferenciacias. diagnostikuri mniSvneloba aqvs agreTve dadgenil
erTjerad 1:80 titrs. dadgenilia, rom klinikis mwvave periodSi SardSi aRiniSneba
S antigenisadmi antisxeulebis piki 75% SemTxvevaSi, romlebic 6-12 Tvis manZilze
TandaTan klebulobs. antisxeulebi V antigenis mimarT piks aRweven daavadebis 1 Tvis
bolos, klebuloben 2 wlis manZilze dabal donemde da rCebian didxans. antisxeulebis
aseTi dinamika gvexmareba, magaliTad parotituli meningoencefalitis dros etiologiuri
diagnozis dazustebaSi.
diferenciuli diagnozis gatareba saWiroa meoradi infeqciiT ganpirobebul mwvave
parotitebTan. am dros isini mimdinareoben baqteriuli daavadebis fonze (sefsisi,
pnevmonia, tifebi da sxva) garTulebis saxiT. xasiaTdebian Zlieri mtkivneulobiT,
kanis hi peremiiT, daCirqebiT, sisxlSi maRali neitrofiloziTa da lekocitoziT, edsi-
is momatebiT. ybisqveSa sanerwyve jirkvlebis dazianebisas, romelic kanqveSa qsovilebis
87
kerZo nawili. parotituli infeqcia, epidemiuri parotiti
88
kerZo nawili. parotituli infeqcia, epidemiuri parotiti
89
kerZo nawili. herpesis ojaxis
virusebiT gamowveuli daavadebebi. martivi (ubralo) herpesi
90
kerZo nawili. herpesis ojaxis
virusebiT gamowveuli daavadebebi. martivi (ubralo) herpesi
91
kerZo nawili. herpesis ojaxis
virusebiT gamowveuli daavadebebi. martivi (ubralo) herpesi
92
kerZo nawili. herpesis ojaxis
virusebiT gamowveuli daavadebebi. martivi (ubralo) herpesi
kanis herpesuli 1 2
gamonayari. xSirad
gamonayari
gamonayari viTardeba
piris irgvliv, tuCebze
(herpes labialis),
cxvirze (herpes nasa-
lis), yuris niJaraze
(herpes oticum) da a.S.
SeiZleba iyos misi
nebismieri lokalizacia,
magram igi ufro metad
viTardeba kanisa da 3 4
lorwovanis sazRvarze.
damaxasia-Tebeli
morecidive gamonayaric
ufro xSirad am
adgilebze gvxvdeba.
zogjer, gamoyramde 1-2
dRiT adre, iq, sadac
SesaZloa gamovlindes
herpesi, avadmyofi uCivis
wvis da Cxvletis herpesuli infeqcia (HSV)
SegrZnebas, qavils, mcire 5 1. pirveladi HSV -
tkivilsa da daWimvas. gingivostomatiti bavSvebSi
2. pirveladi HSV -
elementebi 0,1-0,3 sm gingivostomatiti mozrdilebSi
zomisaa buStukebi 3. pirveladi HSV -I
Txelkedliania, maT vulvovaginiti wlamde asakSi
irgvliv kani 4. pirveladi HSV -
keratokoniunqtiviti
SeSupebulia da 5. herpesuli vezikulis
hi peremiuli, SigTavsi bioftati. eozinofiluri
gamWvirvale serozuli birTvSida CanarTebi da
siTxea, romelic giganturi ujredebi.
(Blanck H, Rake G)
SeiZleba aimRvres an
hemoragiuli gaxdes.
ramdenime dReSi buStukebi skdeba da saerTo fufxis gakeTebis Semdeg unawiburod
qreba, SeiZleba darCes xanmokled susti pigmentacia. meoradi infeqciiT garTulebisas
saWiroa kontagiozuri diferenciacia impetigosTan. erTeul SemTxvevebSi SeiZleba
gamovlindes generalizebuli buStukovani gamonayris saxiT, am dros diferenciacia
tardeba CutyvavilasTan. kanis travmuli dazianeba xels uwyobs imave adgilze herpesuli
gamonayris ganviTarebas; magaliTad, xelis an fexis Wrilobisas meore-mesame dRes
vlindeba herpesi. zogjer gamonayari vrceldeba limfuri gziT (limfadenitis
ganviTarebiT) janmrTel kanze, rac msgavsebas qmnis sartylisebr herpesTan, gansakuTrebiT
maSin, roca am adgilSi gamoxatulia nevralgia. travmis adgilas xSiria gamonayris
recidivebi, rac zogjer bulozuri formis ganviTarebas iwvevs.
gakawrul kanSi virusis SeWra samedicino personalsa da moWidaveebSi araiSviaTad
ganapirobebs herpesul gamonayars (`gladiatorebis herpesi~), gansakuTrebiT mtkivneulia
da Rrma dazianebiT gamoirCeva herpesuli infeqcia frCxilebTan kanis gakawvrisas.
Sexorceba spontanurad mimdinareobs 2-3 kviraSi da qirurgiul Carevas ar saWiroebs.
93
kerZo nawili. herpesis ojaxis
virusebiT gamowveuli daavadebebi. martivi (ubralo) herpesi
94
kerZo nawili. herpesis ojaxis
virusebiT gamowveuli daavadebebi. martivi (ubralo) herpesi
95
kerZo nawili. herpesis ojaxis
virusebiT gamowveuli daavadebebi. martivi (ubralo) herpesi
96
kerZo nawili. herpesis ojaxis martivi (ubralo) herpesi
virusebiT gamowveuli daavadebebi. Cutyvavila
Cutyvavila
(VARICELLA)
97
kerZo nawili. herpesis ojaxis
virusebiT gamowveuli daavadebebi. Cutyvavila
98
kerZo nawili. herpesis ojaxis
virusebiT gamowveuli daavadebebi. Cutyvavila
99
kerZo nawili. herpesis ojaxis
virusebiT gamowveuli daavadebebi. Cutyvavila
100
kerZo nawili. herpesis ojaxis
virusebiT gamowveuli daavadebebi. Cutyvavila
101
kerZo nawili. herpesis ojaxis Cutyvavila
virusebiT gamowveuli daavadebebi. sartyliseburi herpesi
sartyliseburi herpesi
(HERPES ZOSTER)
102
kerZo nawili. herpesis ojaxis
virusebiT gamowveuli daavadebebi. sartyliseburi herpesi
Semdeg bavSvi SeiZleba daavaddes CutyvaviliT. jer kidev 1888w. ungreli eqimis U\\
Bokay mier naCvenebi iyo saerTo epidemiologiuri msgavseba Cutyvavilasa da
zosters Soris.
klinika. arCeven daavadebis mimdinareobis or fazas _ gamoyramde da gamoyris
Semdeg. daavadeba iwyeba mwvaved, temperaturis
momatebiT, saerTo sisustiT, damtvreulobiT. amave
dros kanze, erT-erTi segmenturi nerviT inervirebul
adgilas avadmyofs uCndeba wvis, qavilis, Cxvletis
SegrZneba da gamkvriveba. 1-2 dRis Semdeg Cndeba
wiTeli papulebis jgufi erT an or mezobel
segmentze da maT adgilas viTardeba mWidrod
ganlagebuli buStukebi, romelTa diametria 0,3-
0,5sm, maTi SigTavsi gamWvirvale siTxea da aqvT
erTmaneTTan Serwymis tendencia. ramodenime dReSi
SigTavsi imRvreva, xolo eriTemuli foni qreba,
buStukebi Srebian da ikeTeben fufxebs. fufxis
mocilebis Semdeg rCeba msubuqi pigmentacia. rac
Seexeba temperaturas da intoqsikaciis sxva niSnebs,
tkivilsa da gamonayris adgilas kanis gamkvrivebas,
maTi manifestacia rCeba procesis progresirebis Herpes Zoster. ti pur
purii
periodSi. 20 wlis asakamde umravles SemTxvevaSi vezikuluri gamonayari
gamonayari fermkTaldeba da qreba 7-14 dRis Semdeg, (Í.È. Íèñåâè÷, Â.Ô. Ó÷àéêèí)
maSin, roca ufro mozrdilebSi adgili aqvs
ganmeorebiT gamonayars da procesis gaxangrZlivebas 5 da meti kviris ganmavlobaSi.
igive, 20 wlis asakamde, SeimCneva gamonayris lokalizaciis tendencia im nervebis
gaswvriv, romlebic gamodian gulmkerdis II da welis II segmentebidan; gamonayari
gamoirCeva, agreTve, procesis erTmxrivi gamovlinebiT. gava-welis segmentebis dazianebisas
saTanado cvlilebebi SeimCneva fexis kanze da sasqeso organoebis midamoebSi. V
wyvili nervis (samwvera) dazianebisas procesSi CarTulia misi erTi an ramodenime
toti. zemo totis dazianebas Tan sdevs gamonayris lokalizacia Tavis Tmian nawilebze,
Sublze, cxvirze, Tvalebze, Sua totis dazianebisas _ loyebsa da sasaze. qveda totis
dazianebisas gamonayari Cndeba qveda ybaze da enaze. VII wyvili nervis dazianebisas
viTardeba misi dambla, buStukovani gamonayari Cndeba gareTa sasmen milSi (ramzaia-
xantas simptomi). SeiZleba adgili hqondes ufro mZime formebsac _ bulurs (didi
farTo buStukebi), gamonayars hemoragiuli SigTavsiT, gangrenuls _ gamonayarze Savi
fufxebiT da maTi dawylulebiT. gamonayris generalizebuli formisas, garda mgrZnobiare
nervebis gaswvriv lokalizaciisa, adgili aqvs buStukebis gafantvas sxvadasxva midamoSi.
laboratoriuli gamokvleva. axali buStukebidan aRebul nacxSi _ anabeWdSi
an amonafxekSi SeiZleba giganturi ujredebis CanarTebis aRmoCena (Tzanck-is nacxi).
VZV-s sawinaaRmdego antisxeulebis dadgena, SigTavsis imunofluorescenciuli
gamokvleva monoklonuri antisxeulebiT, lateqsaglutinacia da a.S. (ix. Cutyvavila).
diagnozi eyrdnoba jgufur buStukovan gamonayars segmenturi inervaciis zonebSi
da nevralgias.
mkurnaloba, umTavresad, simptomuria. uniSnaven gamosaSrob losionsa da malamoebs.
mkurnaloba
tkivilis dros aZleven analgetikebs.
mZime da gavrcelebuli formebis dros imunitetis darRvevisas garkveuli efeqtiT
gamoiyeneba oraluri an intravenuri acikloviri, famcikloviri da valacikloviri
(bolo 2 _ mozrdilebSi)
103
kerZo nawili. herpesis ojaxis sartyliseburi herpesi
virusebiT gamowveuli daavadebebi. citomegalovirusuli infeqcia
citomegalovirusuli infeqcia
(citomegalia)
104
kerZo nawili. herpesis ojaxis
virusebiT gamowveuli daavadebebi. citomegalovirusuli infeqcia
105
kerZo nawili. herpesis ojaxis
virusebiT gamowveuli daavadebebi. citomegalovirusuli infeqcia
106
kerZo nawili. herpesis ojaxis
virusebiT gamowveuli daavadebebi. citomegalovirusuli infeqcia
107
kerZo nawili. herpesis ojaxis citomegalovirusuli infeqcia
virusebiT gamowveuli daavadebebi. infeqciuri mononukleozi
infeqciuri mononukleozi
(MONONUCLEOSIS INFECTIOSA, EBV-infeqcia
infeqcia
infeqcia)
108
kerZo nawili. herpesis ojaxis
virusebiT gamowveuli daavadebebi. infeqciuri mononukleozi
109
kerZo nawili. herpesis ojaxis
virusebiT gamowveuli daavadebebi. infeqciuri mononukleozi
sindromi da sxva).
paTmorfologiuri suraTi ZiriTadad eyrdnoba biofsirebuli substratebis
da iSviaTi letaluri SemTxvevebis Seswavlis Sedegebs. mononuklearuli ujredebis
proliferacia xdeba ZiriTadad limfur kvanZebSi, nuSurebSi, elenTaSi; zogjer maTSi
aRiniSneba nekrozi. RviZlSi adgili aqvs degeneraciul movlenebs; umTavresad cvlilebebi
gamoxatulia mezenqimis mxriv. sxva organoebSi (filtvebi, guli, Tirkmelebi, cns)
upiratesad aRweren nekrozul kerebs, perivaskulur infiltracias mononuklearuli
ujredebis dagrovebiT. yvela monacemi mowmobs imaze, rom paTologiur procesSi
CarTulia mTeli organizmi. virusis pantropizmi mtkicdeba Tundac imiT, rom zurgis
tvinis siTxeSi imyofeba damaxasiaTebeli mononuklearuli ujredebis elementebi.
unda aRiniSnos, rom am bolo dros infeqciur mononukleozs ganixilaven, rogorc
imunuri sistemis daavadebas, rasac safuZvlad udevs virusiT B–limfocitebis inficireba.
sapasuxod xdeba CD8–limfocitebis, NK bunebrivi kilerebis, ujreduli meqanizmebis
gaaqtiveba. matulobs supresoruli aqtivoba, CD4/CD8 Sefardeba, romelic normaSi
aris 2:1, icvleba piriqiT, rac iwvevs B-limfocitebis diferenciaciisa da proliferaciis
daTrgunvas 1:106 (1 inficirebuli B limfociti 106 janmrTel B limfocitze _
koncentraciamde) da amiT inficirebuli limfocitebis gamravlebis SezRudvas. virusis
integracia ujredis genomSi ar aris damaxasiaTebeli. latenturi infeqciis dros
producirdeba mxolod ramodenime virusis antigeni-cila, romlebSic Sedis EBV-
determinirebuli birTvovani antigenebi EBNA (EBV-determined nuclear antigens).
es antigenebi akontroleben virusul episoms latenciis dros (episomebi ki am dros
ganlagebulia B limfocitebsa da pirxaxis epiTelur ujredebSi). replikacia iwyeba
adreuli antigenebis EA (early antigens) produqciasTan erTad, rac Tavis mxriv
iwvevs dnm-is replikacias da Semdeg kafsiduri antigenis VCA (viral capsid antigen)
produqcias. reaqtivacia xSirad asimptomurad mimdinareobs da klinikuri gamovlinebebi
ar axasiaTebs.
onkogenoba. virusi iwvevs daavadebebis mTel speqtrs _ keTilTvisebiani
virusis onkogenoba
infeqciuri mononukleozidan dawyebuli, damTavrebuli limfoiduri da epiTeluri
ujredebis malignizaciiT. keTilTvisebiani mimdinareobiT aseve gamoirCeva EBV-Ti
gamowveuli piris Rrus Tmiani (hairy) leikoplakia (Sidsis dros). EBV agreTve
iwvevs malignizacias _ nazofaringuli karcinoma, Burkitt-is limfoma, Hodgkin-is
daavadeba, limfoproliferaciuli daavadebebi, leikomiosarkoma imunokomprometirebulebSi
(gansakuTrebiT Sidsis dros).
nazofaringuli karcinoma gavrcelebulia ufro CineTSi (samxreT regionebSi)
mamakacebSi, aseve CrdiloeT afrikasa da CrdiloeT amerikaSi inuitebs Soris. yvela
malignizirebul ujredSi am dros aRiniSneba EBV-s episomebis didi raodenoba, sisxlSi
aRiniSneba diagnostikuri da prognozuli antisxeulebi EBV antigenebis mimarT: IgA-
s didi raodenoba EA-s da VCA-s sawinaaRmdego (asimptomur pirebSic ki) da am
rezultatebze eyrdnoba antitumoruli mkurnalobis taqtika.
karcinomis keratizaciis dros sisxlSi EBV genomis raodenoba 0-mdea dayvanili
da serologiuri pasuxi igivea, rac Cveulebriv mosaxleobaSi.
endemuri (afrikuli) Burkitt-is limfoma xSirad azianebs ybis midamos. es
daavadeba aRmosavleT afrikasa da axal gvineaSi bavSvTa asakis kibos yvelaze xSiri
mizezia. daavadeba gvxvdeba daaxloebiT 5 wlis asakSi P.falciparum-isaTvis malariis
endemur zonebSi. malariis gamomwvevTan kontaqtis Sedegad aqtivirdeba B-limfocitebis
mitogeni. EBV-Ti inficirebuli B-limfociti iwyebs proliferacias. irTveba T
limfocitebiT ganpirobebuli kontroli. Burkitt limfomaSi EBV-s genomi nanaxia
98%-Si (xolo amerikul Burkitt limfomaSi mxolod 20%-Si), rac albaT araendemurobiT
110
kerZo nawili. herpesis ojaxis
virusebiT gamowveuli daavadebebi. infeqciuri mononukleozi
111
kerZo nawili. herpesis ojaxis
virusebiT gamowveuli daavadebebi. infeqciuri mononukleozi
112
kerZo nawili. herpesis ojaxis
virusebiT gamowveuli daavadebebi. infeqciuri mononukleozi
113
kerZo nawili. herpesis ojaxis
virusebiT gamowveuli daavadebebi. infeqciuri mononukleozi
114
kerZo nawili. herpesis ojaxis
virusebiT gamowveuli daavadebebi. infeqciuri mononukleozi
EBV-s
s klinikuri gamovlinebisa da serologiuri gamokvlevaTa
Soris korelacia (Sumaya CV., Jenson HB)
serologiuri maCvenebeli
heterofiluri EBV - specifikuri antisxeulebi
klinikuri suraTi
antisxeulebi
IgM-VCA IgG-VCA EA-D EA-R EBNA
(xarisxobrivi testi)
uaryofiTi reaqcia _ < 1:8 < 1:10 < 1:10 < 1:10 < 1:25
mimRebloba aqvs _ _ _ _ _+ _
mwvave pirveladi infeqcia:
+ 1:32-1:256 1:160-1:640 1:40-1:160 _+ _dan 1:2,5 mde
infeqciuri mononukleozi
axladgadatanili infeqcia:
+/_ _dan 1:32 mde 1:320-1: 1280 1:40-1:160 _+ 1:5-1:10
infeqciuri mononukleozi
adre gadatanili infeqcia _ _ 1:40-1: 160 _ ++ _dan 1:40 mde 1:10-1:40
reaqtivacia: imunosupresiis
_ _ 1:320- 1280 _ ++ 1:80-1:320 _dan 1:160mde
an imunokompromet.
Burkitt limfoma _ _ 1:320-1: 1280 _ ++ 1:80-1:320 1:10-1:80
aqvs
nazofaringuli karcinoma _ _ 1:320-1: 1280 1:40-1:160 umciresobas 1:20-1:160
mxolod
115
kerZo nawili. herpesis ojaxis infeqciuri mononukleozi
virusebiT gamowveuli daavadebebi. uecari egzanTema anu meeqvse daavadeba
116
kerZo nawili. herpesis ojaxis uecari egzanTema anu meeqvse daavadeba
virusebiT gamowveuli daavadebebi. infeqciuri eriTema anu mexuTe daavadeba
117
kerZo nawili. infeqciuri eriTema anu mexuTe daavadeba
118
kerZo nawili.
enterovirusuli infeqciebi.
enterovirusuli infeqciebi
enterovirusuli infeqciebi
(ENTEROVIROSIS)
119
kerZo nawili.
enterovirusuli infeqciebi. poliomieliti
poliomieliti
(POLIOMYELITIS)
120
kerZo nawili.
enterovirusuli infeqciebi. poliomieliti
121
kerZo nawili.
enterovirusuli infeqciebi. poliomieliti
122
kerZo nawili.
enterovirusuli infeqciebi. poliomieliti
123
kerZo nawili.
enterovirusuli infeqciebi. poliomieliti
124
kerZo nawili.
enterovirusuli infeqciebi. poliomieliti
uaxloes 2-3 dReSi adgili aqvs procesis stabilizacias, xolo 2-3 kviraSi mdgomareoba
umjobesdeba aRdgeniTi movlenebis gamo.
forma. es forma viTardeba saxis nervis (VII wyvili) birTvis
pontinuri forma
izolirebuli dazianebiT, romelic mdebareobs tvinis xidis midamoSi. aRniSnuli
nervis dazianeba iwvevs mimikuri kunTebis moZraobis calmxriv, nawilobriv am mTlian
parezs. klinikurad es gamoixateba cxvir-tuCis naoWis waSliT, janmrTel mxareze
piris gadaweviT, quTuTuebis arasruli daxurviT (lagofTalmi), piris kuTxe daSvebulia.
Cveulebriv, pontinuri forma nakleb mZimed mimdinareobs; xSirad ar aris preparalizuri
periodisTvis damaxasiaTebeli simptomatika, Tumca mcire asakis bavSvebSi es periodi
SeiZleba gamoxatuli iyos.
am formis drosac SesaZlebelia saxis, tanisa da kidurebis damblebis Serwyma, rac
ganapirobebs klinikisa da prognozis Taviseburebas.
encefalituri forma iwyeba agznebiT, dezorientaciiT, ZilianobiT, cnobierebis
darRveviT; adgili aqvs krunCxvebs, xelis uxeS tremors. erTdroulad viTardeba
meningealuri movlenebi, saxezea kerovani simptomatika. amave dros, unda aRiniSnos, rom
garda encefalituri formisa uwin arCevdnen iSviaTi lokalizaciis _ ataqsiur da
poliradikulonevritul formebs, Tumca avadmyofTa laboratoriuli gamokvlevebiT
ar mtkicdeba am formebis poliomielituri warmoSoba (T\ Y\ Ktobycrfz= 1986).
aRdgeniTi periodi iwyeba msubuqad dazianebuli kunTebis aRdgeniT, romelic
mimdinareobs araTanabrad da nela. msubuqi parezebi aRdgebian 2-4 Tvis ganmavlobaSi.
rac Seexeba kunTebis Rrma dazianebas, maTi aRdgena ar xdeba. daavadebis dawyebidan
ukve 1 TveSi iwyeba atrofiis movlenebi, romlebic SemdgomSi progresirebs. vegetatiuri
darRvevebi vlindeba dazianebuli kidurebis gacivebiT, silurjiTa da oflianobiT.
aRdgeniTi procesi gansakuTrebiT aqtiurad mimdinareobs daavadebis pirveli 3-6
Tvis manZilze, Semdeg TandaTanobiT neldeba, magram grZeldeba kidev 1-1,5 weli.
bulburi formis dros ylapva da fonacia umravles SemTxvevaSi aRdgeba. mimikuri
da Tvalis mamoZravebeli kunTebis, saxis nervis izolirebuli dazianebis dros aRdgena
xdeba nela da aRiniSneba narCeni movlenebi, Tumca saxis nervis izolirebuli dazianebisas
aRdgeniTi procesi, ZiriTadad, iwyeba meore-mesame kviras da mTavrdeba sruli an
nawilobrivi aRdgeniT.
rezidualuri (narCeni movlenebis) periodi iwyeba 1-1,5 wlis Semdeg da
xasiaTdeba kunTebis atrofiiT, kontraqturebiT, Zvlebis deformaciiT, osteoporoziT.
zurgis kunTebis dazianebisas viTardeba xerxemlis sxvadasxva deformacia. SemdgomSi
dazianebuli kidurebi CamorCebian zrdaSi, gansakuTrebiT mcire asakis bavSvebSi.
diagnozi. ti puri poliomielitis dros daavadebis diagnostika eyrdnoba dune
damblebis dadgenas, upiratesad qvemo kidurebis damblas, romelsac adgili aqvs umTavresad
temperaturis normalizaciis Semdeg. vinaidan dune dambla SeiZleba ganviTardes sxva
etiologiis virusuli infeqciebis (koksaki, ECHO da a.S.) drosac, amitom diagnozis
saboloo dadgenisTvis saWiroa laboratoriuli gamokvlevebi. rac Seexeba inaparantul
da abortul formebs maTi dadgena SesaZloa mxolod laboratoriuli meTodebiTa da
epidmonacemebiT.
virusologiuri da serologiuri gamokvlevebigamokvlevebi. virusis gamoyofa xdeba
fekaliebidan, cxvir-xaxis Camonarecxidan, sisxlidan, Sardidan da Tav-zurgtvinis siTxidan.
virusis gamoyofa fekaliebidan ufro SesaZlebelia, Tumca am mizniT iyeneben aseve
reqtalur nacxs. bavSvebs, romlebsac miRebuli hqondaT oraluri poliovirusuli
vaqcina OPV, SeuZliaT vaqcinuri virusis eqskrecia ramodenime kviris ganmavlobaSi.
rodesac janmrTel bavSvTan aRiniSneba virusis eqskrecia unda vifiqroT, rom es OPV-
s imunizaciis Sedegia, Tu klinikuri simptomebi ar gamovlinda an ar aris raime
125
kerZo nawili.
enterovirusuli infeqciebi. poliomieliti
126
kerZo nawili.
enterovirusuli infeqciebi. poliomieliti
127
kerZo nawili. poliomieliti
enterovirusuli infeqciebi. arapoliomielituri enterovirusuli infeqciebi
128
kerZo nawili.
enterovirusuli infeqciebi. arapoliomielituri enterovirusuli infeqciebi
(ti pebi A1-A24, garda A23 ti pisa), 6 jgufi B coxsackie virusebi (ti pebi B1-B6), 31
echovirus-i (ti pebi 1-34, garda 10,28 da 34 ti pebisa) da 4 enterovirusi (ti pebi 68-
71). 68-69 ti pebi iwveven respiraciul da nawlavTa daavadebebs, 70-e ti pi _
hemoragiul koniunqtivits, xolo 71-e tipi gamoyofili iyo meningitian da encefalitian
avadmyofebSi.
epidemiologia. yvelaze ufro xSirad avaddebian 1-dan 10 wlamde bavSvebi. 3
epidemiologia
Tvemde bavSvebi, taransplacenturi imunitetis gamo ar avaddebian. daavadeba gvxvdeba
rogorc sporaduli, ise epidafeTqebebis saxiT, zafxulis bolosa da Semodgomis
dasawyisSi. infeqcia gadaecema haer-wveTovani da fekalur-oraluri gziT.
enterovirusuli infeqciebi Zlier kontagiozuria. afeTqebebi advilad viTardeba
bavSvTa koleqtivebSi. kontaqtis Sedegad inficirdeba da avaddeba koleqtivis 80%.
klinikurad Zalian waagavs mwvave respiraciul infeqciebs _ mwvave dawyebiTa da
talRiseburi mimdinareobiT xasiaTdeba.
paTmorfologia. virusi organizmSi iWreba zemo sasunTqi gzebisa
paTogenezi da paTmorfologia
da kuW-nawlavis traqtis lorwovani garsebidan. virusis replikacias adgili aqvs
maT epiTeliumebSi da limfur warmonaqmnebSi. paTogenezis Semdgom fazas warmoadgens
virusis hematogenuri diseminacia, ris Sedegadac ziandeba mTeli rigi organoebis da
organizmis sistemebi, kerZod viTardeba serozuli meningiti an meningoencefaliti,
mwvave mioziti an mialgia, miokarditi, hepatiti da sxva. dadgenilia, rom erTi da igive
virusma SeiZleba gamoiwvios daavadebis sxvadasxva klinikuri forma, magram
gasaTvaliswinebelia is, rom viruss axasiaTebs tropizmi sxvadasxva sistemebis mimarT.
amis damadasturebelia is faqti, rom enterovirusuli afeTqebebis dros (koksaki da
ECHO infeqciebi) bavSvTa koleqtivebSi xSirad adgili aqvs erTgvarovan klinikur
gamovlinebas serozuli meningitis an meningoencefalitis saxiT an sxva formebs.
enterovirusuli infeqciis paTmorfologia arasruladaa Seswavlili, vinaidan
umravles SemTxvevaSi daavadeba mimdinareobs
msubuqi formebiT. gamonakliss warmoadgenen koksaki
A-7
-7 da ECHO-virusi 71, romlebic ufro metad
ganapirobeben letalur gamosavals. am daavadebebis
dros zurgisa da Tavis tvinSi viTardeba ruxi
nivTierebis mZime dazianeba, romelic
morfologiurad ar gansxvavdeba mwvave
poliomielitisagan.
ECHO-virusi _ 71-iT dasnebovnebuli maimunis
zurgis tvinSi histologiurad dadgenilia
mamoZravebeli nervebis ujredebis dazianeba,
neirofagiuri kvanZebi da perifokaluri
infiltracia.
axalSobilebsa da Cvil bavSvebSi, romelTac
aReniSnebodaT B jgufis koksaki virusiT
gamowveuli encefalo-miokarditis klinika,
sikvdilis dros Tavis tvinSi, gulis kunTSi da
sxva organoebSi aRiniSneboda virusis Semcveloba,
xolo seqciaze dgindeboda gulis kunTis moduneba,
misi Rruebis gadideba, perikarditisa da
enterovirusuli pankarditi revmatizmis
endokarditis movlenebi, meningealuri garsebis
fonze (gadidebuli gulis da RviZlis
SeSupa, SeSupeba da sisxlCaqcevebi Tavis tvinSi, sazRvrebi, mZime gulis ukmarisoba).
nekrozebis kera da sxva distrofiuli movlenebi (sakuTari masala)
129
kerZo nawili.
enterovirusuli infeqciebi. arapoliomielituri enterovirusuli infeqciebi
130
kerZo nawili.
enterovirusuli infeqciebi. arapoliomielituri enterovirusuli infeqciebi
131
kerZo nawili.
enterovirusuli infeqciebi. arapoliomielituri enterovirusuli infeqciebi
132
kerZo nawili.
enterovirusuli infeqciebi. arapoliomielituri enterovirusuli infeqciebi
133
kerZo nawili.
enterovirusuli infeqciebi. arapoliomielituri enterovirusuli infeqciebi
134
kerZo nawili.
virusuli hepatitebi.
virusuli hepatitebi
virusuli hepatitebi
(HEPATITIS VIROSA)
135
kerZo nawili.
virusuli hepatitebi.
hepatiti A B C D E G
ojaxi pikornavirusi hepadnavirusi flavivirusi viroidi kalcivirusi flavivirusi ?
zoma 27 - 32 nm 42 nm ? 36 nm 27 - 32 nm ?
rnm-is
dnm-orZafiani rnm-is rnm-is
rnm-erTZafiani erTZafiani
nukleinis mJava cirkuluri erTZafiani Ria erTZafiani Ria ?
Ria jaWvi cirkuluri
jaWvi jawvi jaWvi
jaWvi
inkubaciuri 14 - 45 dRe ( ≈ 30 - 180 dRe 14 - 180 dRe (≈ 1
14 - 60 dRe (≈
... ?
periodi 30 dRe) (≈ 70 dRe) wlebi) 40 dRe)
fekalur-
ki ara ara ara ki ara
oraluri gza
gadaecema 2
ara ki ki ki ara3
sisxliT
vertikaluri 2 3
ara ki ki ki ara ?
gza
4 4 3
sqesobrivi gza ara ki ki ki ara ?
antigeni HAAg HBsAg, HBeAg ... HDAg HEAg ...
anti-HBs,
anti-HAV, anti-HCV anti-HDV
antisxeulebi anti-HBe, anti-HEV ...
anti-HAV IgM anti-HCV IgM anti-HDV IgM
anti-HBcor
fulminanturi
0.001 - 0.5% 0.5 - 1.0% 0.5 - 1.0% 1 - 3 - 25% 2% (25% - ?) ?
hepatiti
gamojanmrTeleba
mwvave hepatitis > 99% > 90% 10 - 40% 50 - 80% > 95% ?
Semdeg
qronikuli
< 10% 30 - 90%
aqtiuri 0% 20 - 50% ? ( < 5%) ki (% - ?)
(0.5% - ?) ( < 10%)
hepatiti
aqtiuri
ki ki ara ara ara ara
imunizacia
pasiuri
ki ki ara ara ara ? ara
imunizacia
136
klinikurad manifest uri
subklinikuri formebi inaparant uli for mebi
formebi
kerZo nawili.
m an ife s t ac ia ( g am o v l in e b a)
siyviTliT mimdinare
cit olizur i (t ipur i) forma msubuqi
virusuli hepatitebi.
HA V HBV HCV
usiyviTlo forma hepat it B viru si
saSualo simZimis
hepat it A virusi hepat it C virusi
et iol ogia
hepat it E virusi hepat it D virusi
siyviTliT mimdinare
cit olizur i forma mZime
137
qolest azis komponentiT HNA - EV
HEV HD V
hea ti t non A - E viru sebi
siyviTliT mimdinare
fulminant uri
qolest azuri forma
(gansakuTrebiT mZime)
(at ipur i)
virusuli hepatitebis klasifikacia
m im d in ar e ob a
(kriteriumebi da formebi) (Ñ. Í. Ñîðèíñîí)
ciklur i gamojanmrTeleba
mwvave qronokuli
progredientuli qronizacia
kerZo nawili.
virusuli hepatitebi. virusuli hepatiti A
virusuli hepatiti A
138
kerZo nawili.
virusuli hepatitebi. virusuli hepatiti A
kulturaze. ase mag: aziis, afrikis, samxreT amerikis ganviTarebad qveynebSi A hepatitiT
avadoba 100 000 mosaxleze aRwevs 500-1000 avadmyofs weliwadSi. yofil ssrk-s
respublikebSi yvelaze ufro maRali maCvenebeli aRwevda 670 _ Sua aziis respublikebSi,
yvelaze dabali maCvenebeli ki _350-120 100 000 mosaxleze modioda baltiispireTis
qveynebze. gasaTvaliswinebelia isic, rom namdvili maCveneblebi gacilebiT ufro metia,
radgan registrirdeba daavadebis mxolod manifesturi formebi maSin, rodesac daavadebis
udidesi nawili modis usiyviTlo, waSlil da inaparantul formebze, rac daudgeneli
rCeba. amitom daavadebis gavrcelebis dadgenis saimedo kriteriumad rCeba mozrdili
pirebis seroepidemiologiuri gamokvleva anti-HAV _ IgG indikaciiT.
virusuli A hepatitis 70%-s saerTo daavadebis struqturaSi Seadgens 3-dan 7-10
wlamde bavSvebi. erT wlamde bavSvebi praqtikulad ar avaddebian transplacenturi
gziT pasiurad miRebuli antisxeulebis, anti- HAV IgG-is gamo. Tumca antisxeulebi
mTlianad ver gamoricxavs axalSobilebSi A hepatitis ganviTarebas, romelic SeiZleba
mimdinareobdes inaparantulidan subklinikur formamde. ufro adreuli periodis
inficirebis mizezi SeiZleba iyos seronegatiuri deda an axalSobilis Rrma
dRenakluloba, vinaidan antisxeulebis transplacenturi gadacema ZiriTadad xdeba
orsulobis me-8 Tveze.
infeqciis wyaros warmoadgens mxolod avadmyofi, maT Soris yvelaze saSiSia
waSlili, usiyviTlo da inaparantuli formiT daavadebuli pirebi.
Ahepatitis virusis gadacema xdeba, upiratesad, sayofacxovrebo-kontaqturi gziT,
inficirebuli sakvebiTa da wyliT. mniSvneloba aqvs, agreTve, buzebiT sakvebis inficirebas.
aRniSnuli infeqcia samarTlianad SeiZleba miekuTvnos nawlavTa infeqciebs. daavadebis
gadacema transplacenturi gziT ar xdeba. ar aris gamoricxuli infeqciis gadacema
haerwveTovani meqanizmiTac.
is faqti, rom mozrdili mosaxleobis 70-80%-s sisxlSi aReniSneba A hepatitis
virusis sawinaaRmdego antisxeulebis arseboba, mowmobs infeqciis farTo gavrcelebas.
ganmeorebiTi daavadeba Zalian iSviaTia. am SemTxvevaSi gamosaricxia sxva hepatotropuli
virusebi.
sezonuroba. daavadeba upiratesad Semodgoma-zamTarSi vrceldeba, yvelaze dabali
sezonuroba
procenti ki ivlis-agvistos periodze modis. infeqciis mimRebloba Tumca sayovelTaoa,
magram ufro xSirad avaddebian bavSvebi 3-7 wlis asakSi. xelSemwyobi faqtorebidan
didi mniSvneloba aqvs dabal sanitarul-higienur pirobebs, Tanamedrove wyalsadenisa
da kanalizaciis uqonlobas. sadac socialur-ekonomikuri pirobebi maRalia, bavSvebSi
avadoba ufro naklebia. epidafeTqebebi, Cveulebriv, registrirdeba bavSvTa mWidro
koleqtivebSi. epidkerebSi kontagiozuri indeqsi maRalia da aRwevs 80%-s. epidemiuri
procesis perioduloba, romelic 4-5 wlis intervalebiT aRiniSneba, ganpirobebulia
mosaxleobis koleqtiuri imunitetis arsebobiTa da araimunur bavSvTa populaciiT.
saqarTveloSi epidemiur afeTqebebs adgili hqonda 1961 wlidan da maTi ganmeoreba
aRiniSneboda zemoxsenebuli intervalebiT. 1980 wlidan avadobis maCvenebeli mudmivad
maRal doneze rCeba.
paTogenezi. A hepatitis virusi organizmSi xvdeba piris Rrudan inficirebuli
paTogenezi
sakvebisa da wylis meSveobiT.
hepatiti A-s paTogenezi, SeiZleba iTqvas, rom jer kidev ar aris srulyofilad
Seswavlili. rogorc sxva hepatitis virusebs (HBV,HDV,HCV da sxv.), aseve HAV-sac
axasiaTebs hepatotropizmi. magram TiTqosda ukve cnobili, A-virusis mier hepatocitebis
uSualo dazianeba eWvqveS iqna dayenebuli 1993 wels tokioSi Catarebul, virusuli
hepatitebisadmi miZRvnil VIII kongresze (Karayiannis et al., Van Damme P, Kane
M). dadginda, rom qsovilovan kulturebze A virusis xangrZlivi replikaciisas ar
139
kerZo nawili.
virusuli hepatitebi. virusuli hepatiti A
140
kerZo nawili.
virusuli hepatitebi. virusuli hepatiti A
141
kerZo nawili.
virusuli hepatitebi. virusuli hepatiti A
142
kerZo nawili.
virusuli hepatitebi. virusuli hepatiti A
143
kerZo nawili.
virusuli hepatitebi. virusuli hepatiti A
144
kerZo nawili.
virusuli hepatitebi. virusuli hepatiti A
periodSi Zalian Znelia. am dros igi xSirad eSlebaT mwvave respiraciul virusul
daavadebaSi. mxedvelobaSia misaRebi, rom A hepatits arc prodromul da arc mogvianebiT
periodSi ar axasiaTebs zemo sasunTqi gzebis katari, Tumca adgili aqvs dispefsiur
movlenebs, RviZlisa da, xSirad, elenTis gadidebas. arc Tu iSviaTad muqdeba Sardi,
ganavali ki fermkrTaldeba, rac arsebiTad aadvilebs diagnostikis problemas.
abdominuri sindromis mimdinareobisas gamosaricxia apendiciti. hepatitis dros
muceli rbilia, gansakuTrebiT intaqturia muclis qveda nawilis midamo, mcire tkivilebi
RviZlis areSi palpaciisas midis muclis faris gaRizianebis simptomatikis gareSe,
periferiul sisxlSi leikopeniaa. RviZli gadidebulia, arcTu iSviaTad elenTac, rac
saSualebas gvaZlevs, gamovricxoT apendiciti da davsvaT hepatitis dignozi.
zogjer, prodromul periodSi saWiroa, gamoiricxos helminTebiT gamowveuli
intoqsikacia. am SemTxvevaSi yuradRebas i pyrobs anamnezSi xangrZlivi Civilebis
arseboba, romelic didad sWarbobs hepatitis prodromul periods, periferiul sisxlSi
aRiniSneba eozinofilia koprologiuri gamokvlevebi ki xSirad adasturebs WiebiT
invazias.
infeqciuri mononukleoziT ganpirobebuli siyviTle xasiaTdeba poliadenopaTiiT,
gansakuTrebiT, kisris limfuri kvanZebis gadidebiT, ifa-Ti dgindeba epStein-baris
antigenis arseboba.
siyviTlis periodSi xSirad SeiZleba wamoiWras siyviTlis ti pis dadgenis problema
RviZliszeda, RviZlismieri Tu RviZlisqveda genezis Sesaxeb.
RviZliszeda genezis siyviTlis dros eriTrocitebis hemolizis Sedegad aRiniSneba
Tavisufali bilirubinis siWarbe. yuradRebas i pyrobs avadmyofis saerTo sifermkrTale,
mniSvnelovnad gadidebuli elenTa (RviZlis zomebi normis farglebSia), sisxlSi
hemoglobinisa da eriTrocitebis raodenoba daklebulia, ar icvleba proTrombinis
indeqsi.
RviZlismieri siyviTle SeiZleba ganpirobebuli iyos hepatocitebis funqciebis
darRveviT. bilirubinis SeboWvis darRveva xasiaTdeba Jilberis sindromiT _ daavadeba
vlindeba Tavisufali (arapirdapiri) fraqciis hiperbilirubinemiiT, romelic, Cveulebriv,
viTardeba sqesobrivi momwifebis periodSi da keTilTvisebiani mimdinareobisaa.
memkvidreobiT SeZenil hepatozebs miekuTvneba dabin-jonsonisa da rotoris sindromi,
roca irRveva pigmentebis cvla hepatocitebis mier bilirubinis eqskreciis etapze. am
dros sisxlis SratSi upiratesad pirdapiri bilirubini Warbobs, Tumca RviZlis sxva
funqciebi darRveuli ar aris, arc fermentebis aqtivoba imatebs.
gamosaricxi SeiZleba gaxdes citomegalovirusiT, listeriebiT, sxvadasxva etiologiis
sefsisiT gamowveuli siyviTle. aseT SemTxvevaSi klinikuri monacemebis garda
aucilebelia, Catardes ufro Rrma laboratoriuli gamokvlevebi garkveuli
sadiagnostiko meTodebiT, pirvel rigSi unda ganisazRvros anti- HAV IgM.
RviZlisqveda siyviTle, ganpirobebuli meqanikuri dabrkolebebiT (simsivniT, kenWovani
daavadebebiT da sxv.) araiSviaTad saWiroebs kompiuterul tomografias.
zogjer saWiroa diferenciuli diagnozis gatareba angioqolecistitTan,
romlisaTvisac damaxasiaTebelia gulisreviTa da RebinebiT mimdinare SeteviTi xasiaTis
tkivilebi marjvena ferdqveSa midamoSi. aRiniSneba cximovani sakvebis miuRebloba,
subfebriluri temperatura, neitrofiluri leikocitozi, momatebuli eds RviZlis
ujredebis fermentebis aqtivaciis gareSe.
mkurnaloba. daavadebis msubuqi da saSualo simZimiT mimdinareobisas seriozuli
mkurnaloba
premorbiduli fonis gareSe dasaSvebia avadmyofis mkurnaloba saxlis pirobebSi, ra
Tqma unda, saTanado sanitarul-higienuri reJimis dacviT. daavadebis simZimis miuxedavad,
mwvave periodSi, saerTo intoqsikaciis gaqrobamde (saerTo mdgomareobis gaumjobeseba,
145
kerZo nawili.
virusuli hepatitebi. virusuli hepatiti A
146
kerZo nawili.
virusuli hepatitebi. virusuli hepatiti A
hepatit A-Ti
-Ti daavadebulTan kontaqtis Semdeg SeerTebul StatebSi miRebulia
profilaqtikis aseTi sqemebi:
hepatit A-s
s sawinaaRmdego profilaqtika ojaxSi
an sxva xanmokle kontaqtis dros
* IG keTdeba Rrmad
147
kerZo nawili.
virusuli hepatitebi. virusuli hepatiti A
Havrix
1440 EL.U 1,0 2 `_~
(SKB)
19 da meti
Vaqta
¥
50 U 1,0 2 `_~
(Merck)
148
kerZo nawili.
virusuli hepatitebi. virusuli hepatiti B
virusuli hepatiti B
149
kerZo nawili.
virusuli hepatitebi. virusuli hepatiti B
150
kerZo nawili.
virusuli hepatitebi. virusuli hepatiti B
151
kerZo nawili.
virusuli hepatitebi. virusuli hepatiti B
imiT unda aixsnas, rom am asakSi sisxlsa da mis komponentebs samkurnalod naklebad
iyeneben.
donorebis SerCevaSi HBsAg garda kidev erT damatebiT kriteriumad aRebulia
anti-HBcIgM-is Semowmeba, rac HBV-Ti sisxlis kontaminacias TiTqmis gamoricxavs.
daavadebis gadatanis Semdeg viTardeba myari imuniteti. ganmeorebiTi daavadeba
unda Sefasdes, rogorc qronikuli an sxva etiologiis hepatitis gamovlineba. daavadeba
gvxvdeba mTeli wlis ganmavlobaSi, sezonurobas adgili ara aqvs.
paTogenezi. virusis organizmSi SeWra yvela SemTxvevaSi xdeba parenteruli
paTogenezi
gziT _ kanidan da lorwovani garsebidan, ris Semdegac viTardeba viremia, xolo
inficirebuli sisxlisa da misi komponentebis uSualod sisxlSi gadasxma ganapirobebs
infeqciuri procesis dawyebas viremiiT.
HBV-is replikacia, ZiriTadad, xorcieldeba hepatocitebSi. virusis
hepatotropulobas gansazRvravs misi garegani garsebis pre-S zonis cilebi.
hepatocitebis membranebze imyofeba polimerizebuli cilis zonebi, romlebic Seesabamebian
pre-S-is saTanado receptorebs. hepatocitebis zedapirze moxvedrili virusidan
proteolizuri fermentebis meSveobiT gamoTavisuflebuli dnm, uSualod aRwevs
hepatocitebis birTvs da CaeSeneba ujredis genomSi. xdeba sruli antigenis _ deinis
nawilakis awyoba, romelic mTavrdeba nukleokafsiduri antigenebis – HBcAg-sa da
HBeAg-is wardgeniT (eqspresiiT) hepatocitebis membranebze, sadac xdeba maTi amocnoba
imunocitebis mier. Seqmnili virusis SenarCunebasa da dacvaSi didi roli eniWeba
HBeAg-is sekrecias sisxlSi.
eqsperimentuli gamokvlevebiT dadgenilia, rom mocirkulire HBeAg Trgunavs
imunitetis orive rgols _ ujredulsa da humoruls. ujreduls _ γ-interferonis
produqciis daklebiT, rac T-limfocitebs xels uSlis (asustebs) virusis `amocnobaSi”,
humoruls _ B-limfocitebis mier antisxeulebis produqciis daTrgunvis Sedegad. am
SemTvevebSi TiTqosda adgili aqvs HBeAg-is mimarT imunotolerantobas, rac xels
uSlis organizmidan virusis eliminacias. HBeAg-sgan gansxvavebiT sisxlSi mocirkulire
HBSAg aseT imunotolerantobas ar iwvevs.
daavadebis paTogenezSi didi roli miekuTvneba virusis RviZlgareTa replikacias
_ Zvlis tvinSi, sisxlSi, limfur kvanZebSi, elenTaSi; gansakuTrebiT, mocirkulire
makrofagebSi _ monocitebSi, sadac maTze kontroli imunocitebis mxridan ar xdeba.
es kidev erTi gzaa, rom virusi “gausxltes” imunur zedamxedvelobas. swored es
meqanizmebi ganapirobeben preparat interferonis uefeqtobas, xolo fulminanturi B
hepatitis dros RviZlis transplantantis reinficirebas. qronikuli hepatitis
interferoniT mkurnalobis dros uefeqtoba zogjer aixsneba HBV mutantebis warmoSobiT
(HBV _ minus HBeAg –mutanti (HBVe-), anu HBV-m dakarga HBeAg sinTezis unari).
HBeAg–s dakargva ki niSnavs, rom imunuri sistema ar akontrolebs (ar cnobs) HBV-
s. HBeAg Semcveli ujredebi imunuri sistemisaTvis erTaderTi amocnobadi ucxo
cilaa, HBsAg imunuri sistemisaTvis amosacnob ucxo cilas ar warmoadgens.
mniSvnelovania, rom Tu mutacia moxda HBsAg a-determinantSi (pre-S-S zonaSi),
vaqcina-inducirebuli antisxeulebi anti- HBs aseT mutant HB-viruss ar cnoben da
miuxedavad Catarebuli specifikuri imunizaciisa SesaZloa arsebobdes `vaccine
escape mutant” anu `vaqcinas `gasxletili” mutanti”.
hepatocitebSi HBV-is didi xnis ganmavlobaSi arseboba, maTi SeRweva _ integracia
RviZlis ujredebis genomur aparatSi aseve iwvevs imunuri kontrolidan gamosvlas,
rac xels uwyobs procesis qronizacias da malignizaciis saSiSroebas qmnis.
hepatitis paTogenezSi mniSvnelovani roli ukavia T-citotoqsikuri limfocitebiT
ganpirobebul citolizis sindroms. dadgenilia, rom HBV-is maRali aqtivobis
152
kerZo nawili.
virusuli hepatitebi. virusuli hepatiti B
153
kerZo nawili.
virusuli hepatitebi. virusuli hepatiti B
154
kerZo nawili.
virusuli hepatitebi. virusuli hepatiti B
155
kerZo nawili.
virusuli hepatitebi. virusuli hepatiti B
156
kerZo nawili.
virusuli hepatitebi. virusuli hepatiti B
157
kerZo nawili.
virusuli hepatitebi. virusuli hepatiti B
158
kerZo nawili.
virusuli hepatitebi. virusuli hepatiti B
159
kerZo nawili.
virusuli hepatitebi. virusuli hepatiti B
hepatiti B erT wlamde asakis bavSvebSi. hepatiti B. RviZlismieri koma. yavisferi masebiT
hepatodistrofia. mravlobiTi hemoragiebi Rebineba. (Í.È. Íèñåâè÷, Â.Ô. Ó÷àéêèí)
kanze. (sakuTari masala)
160
kerZo nawili.
virusuli hepatitebi. virusuli hepatiti B
161
kerZo nawili.
virusuli hepatitebi. virusuli hepatiti B
162
kerZo nawili.
virusuli hepatitebi. virusuli hepatiti B
163
kerZo nawili.
virusuli hepatitebi. virusuli hepatiti B
164
kerZo nawili.
virusuli hepatitebi. virusuli hepatiti B
165
kerZo nawili.
virusuli hepatitebi. virusuli hepatiti B
vaqcinacia asaki
vaqcinis I doza dabadebidan 12 sT-Si
Tu deda aRmoCnda HBSAg(+), HBIG Seyvanili iqnas 0.5 ml rac
HBIG
SeiZleba adre, magram dabadabidan araugvianes 1 kviris Semdeg
vaqcinis II doza 1-2 Tve
6-18 Tve (Tu deda aRmoCnda HBSAg+, vaqcinacia gakeTdes ukve
vaqcinis III doza
6 Tvis asakSi)
anti _ HBcIgG ± ± + + _
anti _ HBs _ _ _ + +
anti _ HBe _ + + ± _
II. qsovilovani
HBcAg + + _ _ _
HBsAg + + + _ _
HBV dnm + + _ _ _
166
kerZo nawili.
virusuli hepatitebi. virusuli hepatiti C
virusuli hepatiti C
(HEPATITIS C)
167
kerZo nawili.
virusuli hepatitebi. virusuli hepatiti C
168
kerZo nawili.
virusuli hepatitebi. virusuli hepatiti C
169
kerZo nawili. virusuli hepatiti C
virusuli hepatitebi. virusuli hepatiti D
hepatiti D
(DELTA _ infeqcia)
170
kerZo nawili.
virusuli hepatitebi. virusuli hepatiti D
171
kerZo nawili.
virusuli hepatitebi. virusuli hepatiti D
172
kerZo nawili. virusuli hepatiti D
virusuli hepatitebi. virusuli hepatiti E
virusuli hepatiti E
(HEPATITIS E)
173
kerZo nawili.
virusuli hepatitebi. virusuli hepatiti E
ojaxisagan.
arCeven E virusis 3 ZiriTad genoti ps _ meqsikurs da 2 aziurs. yvela genoti pi
miekuTvneba erT seroti ps, rac gansazRvravs maT Soris jvaredini serologiuri
reaqciis SesaZleblobas.
epidemiologia. infeqciis wyaroa mwvave formiT daavadebuli adamiani. infeqcia
gadaecema pirvel rigSi, wyliT. amasTan dakavSirebiT HEV-s (hepatit E virus) uwodeben
Water born hepatitis virus _ wylismieri hepatitis virusi, Tumca SesaZlebelia
alimenturi gziT dasnebovnebac.
daavadebis endemuri kerebia centraluri da samxreT azia, dasavleT da CrdiloeT
afrika da sxva ganviTarebadi qveynebi.
ganviTarebul qveynebSi (evropa, aSS da sxv) daavadebis SemTxvevebi ganpirobebulia
infeqciis “importuli” SemotaniT. daavadeba cnobilia, agreTve, `mogzaurebis” hepati-
tis saxelwodebiT.
paTogenezi da paTmorfologiuri suraTi. d a d g e n i l i a v i r u s i s
hepatotropuloba da misi pirdapiri citopaTuri moqmedeba hepatocitebze.
paTmorfologiuri suraTi identuria imisa, rasac adgili aqvs HA-s (hepatit A) dros
_ fokaluri da laqovani nekrozi. mZime, fulminanturi mimdinareobisas RviZlis
biofsiuri gamokvlevebi adgenen vrceli, xiduri nekrozebis arsebobas. daavadebis
gadatanis Semdeg gamomuSavdeba xangrZlivi, magram ara sicocxlis bolomde, imuniteti.
droTa ganmavlobaSi anti-HEV IgG titri ecema. zogjer es antisxeulebi ukve ar
aris daavadebis gadatanis Semdeg 10 weliwadSi.
klinika identuria A hepatitis mimdinareobisa, magram amave dros axasiaTebs
sakuTari simptomatikac. A hepatitisagan gansxvavebiT E hepatitis dros adgili aqvs
gamoxatul dispefsiur movlenebs, zogjer arTralgiasac; siyviTlis ganviTarebis
Semdeg avadmyofis subieqturi mdgomareoba ar umjobesdeba.
E hepatiti gansakuTrebul saSiSroebas warmoadgens orsulTaTvis, romlebSic
xSirad adgili aqvs fulminantur formebs, letaluri gamosavlis, mkvdradSobadobis,
abortebis maRal maCveneblebs.
diagnozis zusti dadgena SesaZloa daavadebis mwvave periodSi specifiuri anti
_HEV IgM-is da pjr-is meSveobiT, xolo rekonvalescenciis dros dadebiTi _ IgG-
is konstataciiT.
diagnozi.. ix. A da B hepatitebis diferenciuli diagnozi
diferenciuli diagnozi
mkurnaloba. avadmyofebis hospitalizacia naCvenebia saSualo da mZime formebis
dros.
mZime formebis dros, albaT, gamarTlebulia interferonTerapiis gamoyeneba, Tumca
es sakiTxi diskusias moiTxovs.
profilaqtika. mTavari amocanaa iseTi saerTo sanitarul-higienuri RonisZiebebis
ganxorcieleba, romlebic gamoricxaven wylis dabinZurebasa da alimenturi gziT
daavadebis gadacemas.
rekombinirebuli vaqciniT endemur regionebSi mosaxleobis vaqcinacia xels Seuwyobs
daavadebis mkveTr Semcirebas momavalSi.
174
kerZo nawili.
virusuli hepatitebi. arc A - E hepatitebi
arc A - E hepatitebi
(NON A - E HEPATITIS)
175
kerZo nawili. rotavirusuli da sxva diareagenuli virusuli infeqciebi
176
kerZo nawili. rotavirusuli da sxva diareagenuli virusuli infeqciebi
177
kerZo nawili. rotavirusuli da sxva diareagenuli virusuli infeqciebi
178
kerZo nawili. rotavirusuli da sxva diareagenuli virusuli infeqciebi
179
kerZo nawili. tki pismier
pismierii encefaliti
encefaliti
tki pismier
pismierii encefali ti
encefaliti
(ENCEPHALITIS IXODICA, ENCEPHALITIS ACARINA)
180
kerZo nawili. tki pismier
pismierii encefaliti
encefaliti
181
kerZo nawili. tki pismier
pismierii encefaliti
encefaliti
182
kerZo nawili. tki pismier
pismierii encefaliti
encefaliti
183
kerZo nawili. tki pismier
pismierii encefaliti
encefaliti
titriT aranakleb 1:80 eniSnebaT kunTebSi, doziT 0,1-0,2 ml/kg sxeulis masaze dRe-
RameSi 2-3 dRis ganmavlobaSi. Terapiuli efeqti aRiniSneba ukve 12-24 saaTis Semdeg
da gamoixateba temperaturis normamde daqveiTebiT, umjobesdeba zogadi mdgomareoba
_ Tavis tkivili da meningealuri movlenebi mcirdeba, zogjer ki mTlianad qreba.
specifikur mkurnalobaSi gamoiyeneba, agreTve, ribonukleaza (rnm-aza) _ fermentuli
preparati (2,5-3 mg/kg dRe-RameSi kunTebSi, miRebuli msxvili rqosani cxovelebis
kuWqveSa jirkvlisagan), romelsac unari aqvs, gadalaxos hematoencefaluri barieri
da nervul ujredebSi SeaCeros virusis gamravleba. gamoiyeneba, agreTve, interferonis
preparatebi (reoferoni, leikinferoni da sxva).
erTdroulad tardeba mkurnaloba dezintoqsikaciuri da dehidrataciuli
preparatebiT. sunTqvis darRvevis SemTxvevaSi avadmyofi gadahyavT xelovnur sunTqvaze
barokameraSi.
rekonvalescenciis periodSi gamoiyeneba masaJi, fizioTerapiuli procedurebi.
profilaqtika. tki pismieri encefalitis endemur kerebSi, gansakuTrebiT saSiS
profilaqtika
adgilebSi tardeba RonisZiebebi tki pebis mosaspobad inseqticidebis saSualebiT. tkipis
mokidebisas, saswrafod, profilaqtikis mizniT eniSnebaT tki pismieri encefalitis
sawinaaRmdego imunoglobulini kunTebSi 1,5ml 12 wlamde, 2ml 12-dan 16 wlamde da 3
ml 16 wlisa da meti asakis bavSvebs.
Tu aRiniSneba tki pis mokideba sxeulze, xorcieldeba pasiuri imunizacia adamianis
imunoglobuliniT ara ugvianes 4 dRisa. agreTve, endemur regionebSi unda aikrZalos
Zroxisa da Txis rZis miReba.
aqtiuri imunizaciis mizniT gamoiyeneba inaqtivirebuli vaqcina, romelic keTdeba
samjeradad da Semdeg revaqcinacia 6-12 Tvis Semdeg. pirveli ori acra 14-30 dRis
intervaliT, mesame ki 3 Tvis Semdeg da araugvianes 2 kvirisa keraSi Casvlamde.
individualur RonisZiebebSi Sedis repelentebis (perme thrin) xmareba, Catanebuli
grZeli Sarvlisa da grZelsaxeloebiani zeda tansacmlis xmareba tyeSi gasvlis
dros.
184
kerZo nawili.
hemoragiuli cxelebebi.
hemoragiuli cxelebebi
(FEBRES HAEMORRHAGICA)
argentinis cxeleba;
Junin-virusi
boliviuri cxeleba;
inficirebuli cxoveliT Machupo-virusi
lasas cxeleba;
an masaliT Lassa-virusi
marburgis cxeleba;
ganpirobebuli Marburg-virusi
ebolas cxeleba;
gadamdebloba Ebola-virusi
hemoragiuli cxeleba
Hantaan-virusi
Tirkmlis sindromi;
185
kerZo nawili.
hemoragiuli cxelebebi. hemoragiuli cxeleba Tirkmlis sindromiT
hemoragiuli cxeleba
Tirkmlis sindromiT
186
kerZo nawili.
hemoragiuli cxelebebi. hemoragiuli cxeleba Tirkmlis sindromiT
187
kerZo nawili.
hemoragiuli cxelebebi. hemoragiuli cxeleba Tirkmlis sindromiT
188
kerZo nawili.
hemoragiuli cxelebebi. hemoragiuli cxeleba Tirkmlis sindromiT
189
kerZo nawili. hemoragiuli cxeleba Tirkmlis sindromiT
hemoragiuli cxelebebi. omskis hemoragiuli cxeleba
190
kerZo nawili.
hemoragiuli cxelebebi. omskis hemoragiuli cxeleba
paTogenezi. organizmSi virusis SeWra xorcieldeba kanidan tki pis kbenis adgilze
paTogenezi
an dazianebuli kanis dainficirebiT avadmyof mRrRnelebTan kontaqtis dros. amasTan,
virusis SeWris adgilas pirveladi afeqti ar yalibdeba. paTogenezSi mTavari roli
eniWeba virusemias da masTan dakavSirebul wvrili sisxlZarRvebis endoTeliumis
dazianebas. Sinagani organoebis mxriv (Tirkmlebi, filtvebi, kuW-nawlavis traqti da
sxva) aRiniSneba sisxlsavseoba da sisxlCaqcevebi. didi mniSvneloba aqvs virusiT
centraluri da vegetatiuri nervuli sistemis, Tirkmelzeda jirkvlebis, sisxlmbadi
organoebis dazianebas. paTmorfologiuri cvlilebebi msgavsia imisa, rac viTardeba
sxva hemoragiuli cxelebebis dros, magram xSirad aRiniSneba bronqopnevmoniis suraTi.
klinika. inkubaciuri periodis xangrZlivoba meryeobs 2-dan 10 dRemde, saSualod
klinika
2-4 dRes Seadgens. daavadeba, Cveulebriv, xasiaTdeba mwvave dasawyisiT, temperaturis
momatebiT 39-400 C-mde, SemcivnebiT, Tavisa da kunTebis tkiviliT. rogorc sxva
hemoragiuli cxelebebis dros, omskis cxelebis drosac saxe, kiseri da gulmkerdis
zemo nawili hi peremiulia, saxe pastozuri, sklerebi da koniunqtiva inicirebuli.
rbil da magar sasaze aRiniSneba wvrili hemoragiebi. hemoragiuli egzanTema viTardeba
gulmkerdis wina da gverdiT zedapirebze, aqve SesaZlebelia farTo nekrozebis gaCenac.
unda aRiniSnos, rom hemoragiuli sindromi SedarebiT naklebadaa gamoxatuli (20-
25%). iSviaTia, agreTve, masiuri sisxldena kuW-nawlavis traqtidan da sxva organoebidan.
daavadebis mZime formebis dros centraluri nervuli sistemis mxriv SeiZleba
ganviTardes meningitis, meningoencefalitis suraTi.
gul-sisxlZarRvTa sistemis mxriv cvlilebebi warmodgenilia gulis tonebis
moyruebiT, bradikardiiT, hi potenziiT, SesaZlebelia difuzuri miokarditis ganviTareba,
sasunTqi sistemis mxriv _ pnevmonia. mudmivi cvlilebebia Tirkmlebis mxriv, rac
gamoixateba Sardis SemcirebiT, albuminuriiT, hematuriiT, cilindruriiT.
temperatura maRal cifrebze rCeba 3-4 dRe, iSviaTad grZeldeba 7-10 dRe. avadmyofTa
TiTqmis naxevars uviTardeba temperaturis ganmeorebiTi talRa (recidivi), ufro
daavadebis meore _ mesame kviras da grZeldeba 4-dan 14 dRemde. daavadebis saerTo
xangrZlivoba 3-5 kviras Seadgens.
daavadebis dasawyisSi periferiul sisxlSi aRiniSneba leikopenia neitrofiloziT,
marcxniv gadaxriT, Trombocitopenia, aneozinofilia.
simZimis mixedviT arCeven msubuq, saSualo da mZime mimdinareobas. SesaZlebelia,
agreTve, waSlili da subklinikuri formebic.
diagnozi eyrdnoba damaxasiaTebel klinikur suraTs, Sardisa da sisxlis cvlilebebs,
epidanamnezs. specialuri gamokvlevebidan keTdeba virusologiuri gamokvlevebi (virusis
sisxlidan gamoyofa). daavadebis dinamikaSi antisxeulebis titris zrdis dadgena
xdeba komplementis SeboWvis, hemaglutinaciis Senelebis reaqciiT, agaris gelze difuzuri
preci pitaciis reaqciiT an neitralizaciis reaqciiT.
diferenciuli diagnozi tardeba hemoragiul cxelebebTan, leptospirozTan,
tki pismier virusul encefalitTan, gri pTan, kapilarotoqsikozTan da sxva.
mkurnaloba mxolod paTogenezuria, mZime SemTxvevebSi gamoiyeneba
kortikosteroidebi. meoradi infeqciiT ganpirobebuli garTulebebi eqvemdebareba
antibiotikTerapias.
profilaqtika mimarTulia tki pisagan Tavis dacvisken. aqtiuri imunizacia tardeba
daxocili vaqciniT, romelic damzadebulia omskis cxelebis virusiT TeTri Tagvebis
inficirebuli tvinidan. vaqcinacia tardeba mxolod mkacri epidemiuri Cvenebis mixedviT.
profiliqtikisaTvis aseve gamoiyeneba tki pismieri encefalitis sawinaaRmdego
vaqcina, vinaidan gamomwvevebs antigenuri msgavseba axasiaTebs.
191
kerZo nawili.
hemoragiuli cxelebebi. yirim-kongos cxeleba
yirim-kongos cxeleba
(FEBRIS HAEMORHAHICA CRIMIANA)
192
kerZo nawili.
hemoragiuli cxelebebi. yirim-kongos cxeleba
193
kerZo nawili. yirim-kongos cxeleba
hemoragiuli cxelebebi. denges da dengesmagvari cxelebebi
194
kerZo nawili.
hemoragiuli cxelebebi. denges da dengesmagvari cxelebebi
saaTidan viTardeba viremia, romelic grZeldeba cxelebis 3-5 dRemde. denges cxeleba
SeiZleba mimdinareobdes klasikuri da hemoragiuli formebiT. mkacri damokidebuleba
ti psa da klinikur gamovlinebas Soris ar aRiniSneba. ase, magaliTad, fili pinis
hemoragiuli cxelebisas daavadeba SeiZleba gamowveuli iyos 2, 3 da 4 ti pebiT maSin,
rodesac singapurSi _ yvela 4 ti piT.
amJamad dadgenilia, rom denges hemoragiuli forma SeiZleba gamowveuli iyos
virusis oTxive tipiT. daavadebis paTogenezSi gansakuTrebul rols TamaSobs organizmSi
1, 3 da 4 ti pis pirveladi SeWra da infeqciis gadatanidan ramdenime wlis Semdeg,
seroti p 2-iT ganmeorebiTi inficireba.
hemoragiuli cxelebis ganviTarebaSi gansakuTrebuli roli eniWeba imunur faqtorebs.
dadgenilia, rom virusis me-2 ti pis gaZlierebul zrdas adgili hqonda imunizirebuli
donorebisagan miRebul mononuklearebSi, denge virusis e.w. gamaaqtivebeli antisxeulebi
virusemias mxolod xels uwyoben. warmoqmnili antigen-antisxeulis kompleqsis SeRweva
mononuklearebSi xdeba Fc receptorebis meSveobiT.
virusis aqtiuri replikacia, Tavis mxriv, ganapirobebs mTeli rigi meoradi reaqciebis
serias _ komplementis, kininisa da sxva sistemebis aqtivacias, rac Trombohemoragiuli
sindromis ganviTarebaSi wamyvan rols TamaSobs. e.i. hemoragiuli formebis warmoSobaSi
wamyvania adgilobrivi sensibilizebuli mosaxleobis ganmeorebiTi inficireba, an Tu
axalSobils pirveladi inficirebis dros dedisagan ukve aqvs miRebuli gamaaqtivebeli
antisxeulebi. pirveladi da meoradi inficirebis Soris intervali 3 Tvidan 5
wlamde meryeobs. pirveladi infeqciis dros viTardeba denges klasikuri forma
(CamosulebSi), xolo hemoragiuli varianti ki adgilobriv mosaxleobaSi. SesaZlebelia
ganmeorebiTi dasnebovneba igive sezonis dros (2-3 TveSi) sxva ti pis virusiT
inficirebisas. am dros maneitralebeli antisxeulebis dabali donec ki icavs
axalSobilsa da bavSvebs hemoragiuli formis ganviTarebisagan. Sokis dros sisxlis
Sededebisa da fibrinolizis sistemebi aqtiurdeba, xolo XII (hagemanis) faqtori
daTrgunulia. sisxlZarRvSida diseminirebuli Sededeba, RviZlis dazianeba da
Trombocitopenia moqmedeben sinergistulad da iwveven hemoragiebs. kapilarebis dazianeba
ki ujredgareTa sivrceSi siTxis, eleqtrolitebis, cilis da zogjer eriTrocitebis
gamosvlis SesaZleblobas qmnis, rac Rebinebis da umadobis gamo zrdis hemokoncentracias.
viTardeba hi povolemia, iwyeba gulis gaZlierebuli muSaoba, izrdeba qsovilovani
hi poqsia, metaboluri acidozi, hi ponatriemia.
klinika. inkubaciuri periodi meryeobs 3-dan 15 dRemde, xSirad Seadgens 5-7
klinika
dRes. daavadebis mimdinareoba damokidebulia ara marto asakze, aramed individis
Taviseburebebze. daavadeba yovelTvis iwyeba mwvaved, iSviaTad, erTeul SemTxvevebSi
aRiniSneba prodromi, romelic vlindeba saerTo damtvreulobiTa da Tavis tkivilebiT.
rogorc iTqva, arCeven daavadebis mimdinareobis klasikur da hemoragiul formebs.
daavadeba iwyeba mwvaved, maRali temperaturiT 39-400C-de, rac 3-5 dRe grZeldeba.
temperaturis kritikuli dacemis Semdeg dgeba normaluri temperaturis 1-4 dRiani
periodi.
intoqsikaciis movlenebidan Tavidanve aRsaniSnavia Tavis tkivilebi Sublis wina
da Tvalis orbitis ukana nawilSi, welis midamoSi. rogorc wesi, daavadebis pirvel
24-48 saaTSi aRiniSneba makuluri gamonayari, romelic kanis daWimvisas fermkrTaldeba.
pulsi SedarebiT bradikardiulia. avadmyofis saerTo mdgomareobas auaresebs mialgia
da arTralgia (siaruli SezRudulia `dendis~ an `Jirafis~ siaruli), gansakuTrebiT,
Cikungunias da o’niong-niongiT daavadebebis dros. cxelebis me-2-6 dRidan aRniSnul
simptomatikas emateba gulisreva, Rebineba da generalizebuli limfadenopaTia; avadmyofs
awuxebs hi peresTezia, hiperalgia, anoreqsia, gemovnebis gaukuRmarTeba, romelic atarebs
195
kerZo nawili.
hemoragiuli cxelebebi. denges da dengesmagvari cxelebebi
196
kerZo nawili. denges da dengesmagvari cxelebebi
hemoragiuli cxelebebi. marburgis cxeleba
marburgis cxeleba
(FEBRIS MARBURG)
(cerkopitikuri cxeleba)
197
kerZo nawili.
hemoragiuli cxelebebi. marburgis cxeleba
198
kerZo nawili. marburgis cxeleba
hemoragiuli cxelebebi. ebolas cxeleba
ebolas cxeleba
(FEBRIS EBOLA)
199
kerZo nawili.
hemoragiuli cxelebebi. ebolas cxeleba
200
kerZo nawili. cofi
cofi
(RABIES)
201
kerZo nawili. cofi
202
kerZo nawili. cofi
203
kerZo nawili. cofi
204
kerZo nawili. cofi
procesi (simsivne).
tetanusis dros gamowveuli kunTebis spazmi zogjer siZneles qmnis cofis
diagnostikaSi, magram cofis dros adgili ara aqvs trizms, tetanusis dros ki –
hidrofobias.
kvebiTi da Wrilobismieri botulizmi mimdinareobs agreTve damblebiT, magram ar
aRiniSneba sensoruli darRvevebi.
diferenciuli diagnostikis TvalsazrisiT ZiriTadi siZneleebi warmoiSoba cru
cofis suraTis dadgenisas isterionevrozul avadmyofebSi, romlebic TavianT Tavs
cofiT dasnebovnebulad Tvlian. aseT SemTxvevebSi anamnezi zogjer gaurkvevelia
(xSirad damkbeni cxoveli janmrTelia). avadmyofebs axasiaTebT subieqturi Civilebis
siuxve, ara aqvT sunTqvis darRveva, taqikardia, gugebis gafarToeba, daavadeba gamoirCeva
xangrZlivi mimdinareobiT.
zogjer cru cofis klinikis msgavsi suraTi aRiniSneba agreTve atropiniT, striqniniT
mowamvlis dros, magram aq didi mniSvneloba eniWeba cofisaTvis damaxasiaTebel
kardinalur simptomebs da anamnezs.
laboratoriuli diagnostika. diagnostika SesaZlebelia avadmyofis sicocxleSi.
virusis aRmoCena SeiZleba mafluorescirebeli antisxeulebis meSveobiT rqovanidan
aRebul nacxSi an kisris midamos kanis anaTalSi Tmis zrdis doneze. aRniSnuli
sinjebis dadebiTi Sedegebi aixsneba virusis gavrcelebiT Tavis tvinidan nervul
boWkoebSi, romeliTac mdidaria rqovana da Tmis folikulebi. virusis gamoyofa
SeiZleba nerwyvidan, cremlidan, Tav-zurgtvinis siTxidan, axalSobili Tagvebidan maTi
intracerebruli dasnebovnebis dros.
cofis diagnostikaSi zusti Sedegebis miRweva SeiZleba gardacvlili adamianis,
cxovelis histologiuri gamokvlevebis Sedegad Tavis tvinis hi pokampis midamoSi
aRebuli nacxis specialuri SeRebvis Semdeg, Cveulebrivi sinaTlis mikroskopiiT
babeS-negris sxeulakebis aRmoCeniT.
serologiuri gamokvlevebidan iyeneben neitralizaciis, komplementSemboWav (kSr),
pasiuri hemaglutinaciis reaqciebs, radioimunur meTods aravaqcinirebul pirebSi.
mkurnaloba.. etiotropuli mkurnaloba amJamad ar arsebobs. gansakuTrebuli
mkurnaloba
mniSvneloba aqvs Wrilobis pirvelad damuSavebas. am mizniT axdenen Wrilobis gamorecxvas
didi raodenobiT sapniani wyliT. Semdeg Wrilobas amuSaveben 70%-iani spirtiT an
koncentrirebuli iodis spirtiani xsnariT. qirurgiuli Careva (napirebis amokveTa da
misi gakerva) mkacradaa akrZaluli inkubaciuri periodis SesaZlebeli Semcirebis
gamo. Wrilobis damuSavebis Semdeg aucilebelia bavSvis gagzavna asacrel punqtSi,
sadac utardeba pasiur-aqtiuri imunizacia, rogorc cofis, aseve tetanusis sawinaaRmdegod.
antirabiuli imunoglobulini eniSnebaT imunizaciasTan (vaqcinasTan) erTdroulad,
rac SeiZleba male (umjobesia kbenis Semdeg 24 saaTSi).
zogjer mkurnalobis mizniT SehyavT interferoni did dozebSi, magram misi efeqturoba,
iseve, rogorc antirabiuli Sratis, umniSvneloa. simptomuri saSualebebidan avadmyofebis
tanjvis Sesamcireblad iyeneben analgetikebs, maT Soris morfins, krunCxvis sawinaaRmdego
preparatebs. tardeba RonisZiebebi wyal-marilovani balansis aRsadgenad. eniSnebaT
gul-sisxlZarRvTa, sunTqvis mastimulirebeli medikamentebi. Cvenebisas avadmyofi gadahyavT
xelovnur sunTqvaze. yvela Catarebuli RonisZieba mxolod mcireoden gaumjobesebas
iZleva da rogorc wesi, daavadeba letaluri gamosavliT mTavrdeba.
cofis sawinaaRmdego pasiur-aqtiuri imunizacia utardeba yvela dazaralebuls
Sesabamis punqtSi.
pasiuri imunizaciis mizania, uzrunvelhyos dazaralebulis dacva antisxeulebiT,
aqtiuri vaqcinaciiT gamowveuli antisxeulebis gamomuSavebamde. antisxeulebis Seyvana
205
kerZo nawili. cofi
206
cofi
kerZo nawili. aiv/Sidsi
aiv/Sidsi
(adamianis imunodeficitis virusi
/SeZenili imunodeficitis sindromi)
HIV/AIDS (HUMAN IMMUNODEFICIENCY VIRUS/
AQUIRED IMMUNODEFICIENCY SYNDROME)
207
kerZo nawili. aiv/Sidsi
208
kerZo nawili. aiv/Sidsi
209
kerZo nawili. aiv/Sidsi
210
kerZo nawili. aiv/Sidsi
211
kerZo nawili. aiv/Sidsi
212
kerZo nawili. aiv/Sidsi
213
hemoragiuli cxelebebi
ori da meti jgufis limfuri kvanZebis gadidebas, rac ramodenime kviras grZeldeba,
mudmivi an intermisiuli xasiaTis xangrZliv temperaturas, xangrZliv diareas, sxeulis
masis daklebas. ufro mogvianebiT iklebs CD4 limfocitebi, CD4/CD8 limfocitebis
SefardebiTi koeficienti, qveiTdeba limfocitebis blastgenuri reaqcia mitogenebze,
214
aiv/Sidsi
215
kerZo nawili. aiv/Sidsi
preparatebis
dasaxeleba asaki rekomendebuli dozebi
(komerciuli)
0-6 kvira 2 mg/kg/doza yovel 6 sT-Si
Zidovudine (ZDV, AZT 4 kvira _ 13w. 2
90-180 mg/m /doza yovel 6 sT-Si
Azidothymidine) [Retrovir] 100 mg/doza 5-jer dReSi an 200 mg/doza
≥ _ 13w.
yovel 8 sT-Si
2
< 13w. 90-135 mg/m /doza yovel 12 sT-Si
Didanozine (ddl,
< 60kg: tabl. 125 mg yovel 12 sT-Si,
dideoxynosine) [Videx]
buferuli fxvnili 167 mg yovel 12 sT-Si
≥ 13w.
≥ 60kg: tabl. 200 mg yovel 12 sT-Si.
buferuli fxvnili 250 mg yovel 12 sT-
Si.
Zalcitabine (ddC, < 13w. 0,01 mg/kg/doza yovel 8 sT-Si
dideoxycytidine) [Hivid] ≥ 13w. 0,75 mg/kg/doza yovel 8 sT-Si
< 13w. 1 mg/kg/ doza yovel 12 sT-Si
Stavudine (d4T) [Zerix]
≥ 13w. 30-40 mg yovel 12 sT-Si
3 Tve _ 12 weli 4 mg/kg/doza yovel 12 sT-Si
Lamivudine (3TC) [Epivir]
≥ 12w. 150 mg/doza yovel 12 sT-Si
< 13w. dozebi gansazRvruli ar aris
Saquinavir (SQV)
≥ 13w. 600 mg/doza yovel 8 sT-Si
< 13w. doza gansazRvruli ar aris
Indinavir (IDV) [Crixivan]
≥ 13w. 800 mg/doza yovel 8 sT-Si
2
< 13w. 350 mg/m /doza yovel 12 sT-Si
Ritonavir (RTV) [Norvir]
≥ 13w. 600 mg/doza yovel 12 sT-Si
Seyvanis
gamoyenebis dro doza
meTodi
orsulebSi 14-34 kviris
per os 100 mg 5-jer dReSi
gestaciis dros
216
kerZo nawili. aiv/Sidsi
217
aiv/Sidsi
kerZo nawili. mikoplazmuri infeqcia
mikoplazmuri infeqcia
218
kerZo nawili. mikoplazmuri infeqcia
219
kerZo nawili. mikoplazmuri infeqcia
220
kerZo nawili.
qlamidiuri infeqciebi.
qlamidiuri infeqciebi
221
kerZo nawili.
qlamidiuri infeqciebi. qlamidiozi
qlamidiozi
222
kerZo nawili.
qlamidiuri infeqciebi. qlamidiozi
223
kerZo nawili. qlamidiozi
qlamidiuri infeqciebi. orniTozi
224
kerZo nawili.
qlamidiuri infeqciebi. orniTozi
orniTozi
(ORNITHOSIS)
225
kerZo nawili.
qlamidiuri infeqciebi. orniTozi
226
kerZo nawili.
qlamidiuri infeqciebi. orniTozi
227
kerZo nawili. orniTozi
qlamidiuri infeqciebi. pnevmoqlamidiozi
pnevmoqlamidiozi
(PNEUMOCHLAMIDIOSIS)__ daavadeba,
gamowveuli C. PNEUMONIAE
228
kerZo nawili. leptospirozi
leptospirozi
(LEPTOSPIROSIS)
229
kerZo nawili. leptospirozi
230
kerZo nawili. leptospirozi
231
kerZo nawili. leptospirozi
232
kerZo nawili. leptospirozi
233
leptospirozi
kerZo nawili. tki pismieri laim - bo
pismieri borreliozi
eliozi
tki pismier
pismierii laim - bo
borreliozi
eliozi
(LYME DISEASE - ingl.
ingl.)
234
kerZo nawili. tki pismier
pismierii laim - bo
borreli ozi
eliozi
axali saxis Borrelia garinii sp. nov da VS461 group, romelmac praqtikulad ukve
miiRo saxelwodeba Borrelia afzelii sp. nov dadginda, rom dRemde gamoyofili amerikuli
Stamebi miekuTvnebian mxolod B. Burgdorferi-is Stamebs, evropaSi ki aRiniSneba yvela,
samive saxis borelia. varaudoben, rom revmatologiuri gamovlineba ufro xSirad
dakavSirebulia B.Burgdorferi-is StamTan. nevrologiuri _ B. garinii, xolo mogvianebiT
kanis forma _ B. afzelii-sTan.
aris winaswari monacemebi axali paTologiuri boreliebis arsebobis Sesaxeb, romlebic
dakavSirebulia Ixodidea-s (Bijaponica) saxeobis tki pebTan.
maSasadame, iqsoduri boreliozebi warmoadgenen etiologiurad axlos myof, magram
damoukidebel nozologiur jgufebs, Tumca yvela maTgans jer kidev ara aqvT TavianTi
saxelwodeba.
amJamindeli boreliozis epidemiologiuri Taviseburebebis, paTogenezisa da klinikuri
gamovlinebis gaTvaliswinebiT sruliad misaRebia maTi gaerTianeba saerTo saxelwodebiT
tki pismieri laimis daavadeba an laimis daavadeba, tki pismieri boreliozis pirvelad
aRmweris pativsacemad.
epidemiologia. bunebrivi kerebi, ZiriTadad, dakavSirebulia zomieri klimaturi
zonis tyian landSaftTan. amerikaSi ZiriTad gadamtanebs miekuTvneba saZovris tki pebi
_ Ixodes scapularis (Zveli saxelwodeba I.dammini), evraziaSi taigis
(I.persulcatus) da tyis (I. ricinus) tki pebi.
ruseTSi ZiriTadi epidemiologiuri da epizooturi mniSvneloba aqvs taigis tkipebs.
tki pebis Wupri xSirad parazitobs wvril mRrRnelebze, xolo nimfa da momwifebuli
saxe _ xerxemlianebze, ZiriTadad _ tyis cxovelebze. garkveuli mniSvneloba eniWeba
ZaRlebs. dadgenilia boreliebis ramdenime Stamis simbiozi erT tki paSi. aqedan,
SesaZlebelia encefalitiTa da laimis daavadebiT erTdrouli inficireba, rac arTulebs
klinikur diferenciacias miqst-infeqciis SemTxvevaSi.
adamianis inficireba xdeba transmisiuli gziT, tki pis kbenisas gamomwvevis nerwyviT
inokulaciis gziT. ar aris gamoricxuli daavadebis gadacema orsulobis SemTxvevaSi
transplacenturad, riTac SesaZlebelia aixsnas daavadebis sakmaod maRali procenti
skolamdel da umcrosi saskolo asakis bavSvebSi.
daavadebuli adamianidan janmrTelze infeqcia ar gadadis.
laimis daavadebisaTvis damaxasiaTebelia gazafxul-zafxulis sezonuroba. ruseTSi
bunebriv-kerovani zoonozebidan laimis daavadebas erT-erTi pirveli adgili ukavia.Tumca
aSS-Si da sxva qveynebSic medicinaSi am daavadebis gamo aRiniSneboda didi mRelvareba
ufro albaT hi perdiagnostikis gamo (Eugene D.Shapiro; 1997).
paTogenezi. organizmis inficireba xdeba tkipis kbenis adgilidan nerwyviT, romlis
sapasuxod, umravles SemTxvevaSi, viTardeba pirveladi afeqti anTebad-alergiuli
cvlilebebiT. histologiurad dermaSi sisxlis kapilarebis irgvliv adgili aqvs
infiltracias limfocitebiTa da plazmuri ujredebiT.
boreliebis lokaluri persistenciis SemTxvevaSi (eriTema) avadmyofebis zogadi
mdgomareoba SedarebiT damakmayofilebelia _ intoqsikaciis movlenebi sustadaa
gamoxatuli, ar aRiniSneba laimis daavadebisaTvis damaxasiaTebeli gamovlinebani, gviandeba
organizmis imunuri pasuxi. procesis progresirebisas (an lokaluri fazis gareSe
mimdinareobisas) simptomkompleqsis ganviTarebaSi mniSvneloba eniWeba boreliebis
hematogenur, SesaZloa, limfuri gziTac gavrcelebas, SeWris adgilidan Sinagan organoebSi,
saxsrebSi, perinevrulad, SemdgomSi rostralurad (niskartiseburad) tvinis garsebis
procesSi CaTreviT.
imasTan dakavSirebiT, rom boreliebi organizmSi SeiZleba didxans persistirebdnen,
klinikuri manifestacia zogjer mogvianebiT viTardeba.
235
kerZo nawili. tki pismieri laim - bo
pismieri borreliozi
eliozi
236
kerZo nawili. tki pismier
pismierii laim - bo
borreli ozi
eliozi
237
kerZo nawili. tki pismieri laim - bo
pismieri borreliozi
eliozi
238
tki pismieri laim - bo
pismieri borreli ozi
eliozi
kerZo nawili. katis nakawris daavadeba
239
kerZo nawili. katis nakawris daavadeba
240
kerZo nawili. katis nakawris daavadeba
241
katis nakawris daavadeba
kerZo nawili. listeriozi
listeriozi
LISTERIOSIS
242
kerZo nawili. listeriozi
243
kerZo nawili. listeriozi
244
kerZo nawili. listeriozi
245
kerZo nawili. listeriozi
246
kerZo nawili. listeriozi
247
kerZo nawili. kavasakis daavadeba
kavasakis daavadeba
248
kerZo nawili. kavasakis daavadeba
249
kerZo nawili. kavasakis daavadeba
250
kerZo nawili. kavasakis daavadeba
251
kerZo nawili. kavasakis daavadeba
da sxva.
kvanZovani periarteriitis dros kavasakis sindromisagan gansxvavebiT swrafad
viTardeba kanis, cns-is da periferiuli nervuli sistemis, Sinagani organoebis
mravalricxovani dazianebebi (guli, RviZli, Tikmeli, kuW-nawlavis traqti). kanis
dazianebis mxriv ufro damaxasiaTebelia kvanZebi, hemoragiebi, nekrozebi, kidurebis
distaluri nawilebis gangrenis CaTvliT. mkvrivi angionevrozuli SeSupeba aramarto
xelisa da fexis gulebzea, aramed gavrcelebul xasiaTs Rebulobs. ti puria mialgia,
polineiromioziti, poliradikulonevriti, agreTve abdominuri sindromi mwvave muclis
klinikis ganviTarebiT.
mkurnaloba.. kavasakis daavadebaze eWvis mitanisTanave dauyovnebliv unda Catardes
mkurnaloba
Sesabamisi mkurnaloba. daavadebis dawyebidan sul mcire 10 dRis ganmavlobaSi saWiroa
dainiSnos intravenuri imunoglobulini maRali dozebiT aspirinTan erTad, rac
mniSvnelovnad ganapirobebs koronaruli arteriebis dilatacias da anevrizmebis
Camoyalibebis Seferxebas. daavadebis dawyebidan ufro xangrZlivi drois gasvlis
SemTxvevaSi IGIV avadmyofs eniSneba rodesac adgili aqvs klinikur simptomebs (mag.,
temperaturis momateba da a.S.) IGIV optimaluri dozebi jerjerobiT dadgenili ar
aris, magram miRebulia 400 mg/kg erTjeradi xangrZlivi Seyvana 4 dRe zedized. aseTi
reJimiT Seyvanis dros garTulebebi iSviaTia. zogierTi klinicistis monacemebiT, am
SemTxvevaSi igive efeqts iZleva erTjeradi, xangrZlivi infuzia (0,08ml/kg/wT) preparatis
jamuri doziT 2 g/kg masaze 10-12 saaTis ganmavlobaSi.
aspirinis sadReRamiso doza 80-100 mg/kg eniSnebaT gayofili 4 miRebaze, daaxloebiT
daavadebis me-14 dRemde, rac iwvevs cxelebis periodis Semcirebas, Tu mkurnaloba
dawyebulia daavadebis dawyebidan 1 kviris ganmavlobaSi. mas Semdeg, rac cxeleba xdeba
kontrolirebadi aspirinis doza mcirdeba 5-10 mg/kg dReSi erT miRebaze (40-80mg) da
misi miReba grZeldeba daaxloebiT 3 Tve, preparatis Trombocitebze mainhibirebeli
moqmedebis gamo da
IVIG -s (intravenuri imunoglobulinis) da aspirinis efeqti eds normaliza-
Kawasaki-s
-s daavadebis dros ciamde. iaponeli
( Marian E. Melish) mecnierebi ki aspi-
rins aZleven doziT
3-50mg/kg dReSi. ase
rom, dozis SerCeva
avtorebis mier
individualuria.
naCvenebia, rom aseT
Terapias SeuZlia
minimumamde daiyvanos
spontanuri korona-
ruli Trombozebis
da anevrizmebis
ganviTareba. mkur-
nalobis efeqtiuroba mkveTrad mcirdeba, Tu igi daiwyo daavadebis dawyebidan 10 dRis
Semdeg an anevrizmis Camoyalibebisas. saWiroa yuradRebis gamaxvileba mosalodneli
Reye-s sindromze aspiriniT mkurnalobis gamo. koronaruli arteriebis mxriv
cvlilebebis arsebobisas aspirinTan erTad iniSneba dipyridamole 4mg/kg dReSi. Tu
Camoyalibda didi koronaruli arteriebis anevrizma Trombozis profilaqtikisaTvis
mkurnalobaSi irTveba antikoagulantebi _ streptokinaza, urokinaza,qsovilovani
plazminogenis aqtivatori, zogierTi avtori iyenebs arasteroidul preparatebs
252
kavasakis daavadeba
kerZo nawili. difTeria
(tolmetins da a.S.).
kortikosteroidebi rekomendebulia mxolod mZime formebis dros da eniSnebaT 2
mg/kg dReSi 4 miRebaze (meTilprednizoloni 25mg/kg venaSi). mwvave periodis dros,
Semdeg ramodenime Tvis ganmavlobaSi damxmare dozebiT. zogjer aRiniSneba kidurebis
distaluri nawilebis gaxangrZlivebuli vazokonstriqcia. Tu aseTi mdgomareoba
sicocxlisaTvis saSiSroebas qmnis, iniSneba prostaglandinis E1 infuziebi (0,007-
0,03 mg/kg/wuTSi), ramdenime dRis ganmavlobaSi stabiluri hemodinamikis miRebamde;
aseve gamoiyeneba heparinizacia.
daavadebis gadatanis Semdeg yvela bavSvi unda imyofebodes dispanseruli dakvirvebis
qveS. pirveli gamokvleva unda CautardeT daavadebidan 2 Tvis Tavze, an saWiroebis
mixedviT, aritmiis, miokarditis, gulis ukmarisobis gamosavlenad. Semdgomi dakvirvebebi
damokidebulia paTologiuri cvlilebebis arsebobaze, mizanSewonilia kardiologis
meTvalyureoba, romelic kargad flobs eqokardiografiul gamokvlevebs.
saWiroebisas avadmyofebs periodulad utardebaT arsebuli qronikuli anTebadi
kerebis sanacia. eniSnebaT vitaminebi, antikoagulantebi, sisxlZarRvTa gamafarToebeli
preparatebi, unda gamovikvlioT sisxlis Semdedebeli sistema.
saWiroa eqimma icodes, rom maRali doziT IGIV-s miRebis Semdeg wiTelas
sawinaaRmdego vaqcinacia unda gadaidos 11 TviT. maT Soris, gaTvaliswinebuli saWiro
revaqcinaciac (mza antisxeulebi uSlian bunebrivi antisxeulebis warmoSobas).
Cutyvavilas vaqcina ki keTdeba IGIV Seyvanidan arauadres 5 Tvisa. gri pis
sawinaaRmdego vaqcina SeiZleba gamoviyenoT ufro adre 6-18 Tvis asakis pacientebSi.
profilaqtika ar aris SemuSavebuli.
DdifTeria
(DIPHTHERIA)
253
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254
kerZo nawili. difTeria
63,5-jer dabali iyo 1958 welTan SedarebiT, xolo 1913 welTan SedarebiT ki 370-
jer. sikvdilianobis maCvenebeli Semcirda 300-jer 1967 wels 1913 welTan SedarebiT;
1972 wels ki 3,9-jer 1968 welTan SedarebiT.
ruseTis teritoriaze avadoba 1975 wels Seadgenda 0,003-s 100000 mosaxleze,
magram 1976 wels avadobam moimata 0,001-dan 1,8-mde 100000 mosaxleze.
saqarTveloSi avadobis maCvenebeli 90-ian wlebSi gansakuTrebiT gaizarda
mozrdilebSi, rac aixsneboda am asakis mosaxleobaSi imunuri fonis naklebobiT.
saqarTveloSi difTeriis SemTxvevebi aRiniSneboda 1980 wlidan (2 SemTxveva), xolo
1993w-dan infeqciam epidemiis xasiaTi miiRo (28 SemTxveva 1993w, 312 SemTxveva 1994w,
425 SemTxveva 1995w). amJamad daavadebas sporaduli xasiaTi aqvs.
avadobis maCveneblis piki emTxveva Semodgoma-zamTars (seqtember-Tebervali).
daavadebulTa 80%-ze meti modis 15 wlamde araimunizirebul bavSvebze. ar aris
gansazRvruli antitoqsinis raodenoba, romelic uzrunvelhyofs infeqciisagan organizmis
absolutur dacvas. dadginda, rom im pirebSi, romelTac aReniSnebaT 1ml sisxlSi
>0,01 erTeulze antitoqsini, avadobis da sikvdilianobis maCvenebeli ufro naklebia.
aRniSnuli antitoqsinis maCvenebeli xSirad ixmareba epidemiologiur gamokvlevebSi
da cnobilia, rogorc imunitetis indeqsi.
infeqciis wyaros warmoadgens avadmyofi difTeriis nebismieri klinikuri formiT
da baqteriamtarebeli.
dasnebovnebis meqanizmis realizacia difTeriis respiraciuli formebis dros,
ZiriTadad, xorcieldeba haer-wveTovani gziT. mikrobis SeWra xdeba xaxis, cxviris,
zemo sasunTqi gzebis lorwovani garsebidan. infeqciis gadacema SeiZleba kontaqturi
gziTac saojaxo nivTebis, saTamaSoebis, produqtebis saSualebiT (rZe, rZis produqti,
kremi da sxva), agreTve mesame piris meSveobiT. organizmidan baqteria gamoiyofa xaxis
da cxviris lorwoTi. avadmyofi saSiSia inkubaciis ukanaskneli dRidan. saSualod
75%-Si organizmis ganTavisufleba baqteriebisagan mTavrdeba daavadebis me-20-25
dRes.iSviaTad baqteriamtarebloba grZeldeba ramodenime Tves, rasac xels uwyobs
cxvir-xaxis paTologiuri mdgomareoba, imunoreaqtiulobis daqveiTeba da sxva. Zlier
epidemiur saSiSroebas warmoadgens daavadebis ati puri formebi, romlebic mimdinareoben
kataruli, lakunuri tonzilitiT da kataruli rinitis saxiT.
praqtikaSi difTeriis sawinaaRmdego masiuri acrebis danergvamde avadobis mimReblobis
maCvenebeli (kontagiozuri indeqsi) ganisazRvreboda 0,15-0,2-iT, rac niSnavs imas, rom
100 kontaqtirebulidan avaddeboda 15-20 individi. amJamad ki infeqciis mimRebloba,
misi intensiuri gavrceleba damokidebulia organizmSi difTeriis sawinaaRmdego
antisxeulebis _ antitoqsinebis sisxlSi Semcvelobasa da araspecifikuri damcvelobiTi
meqanizmis doneze. difTeriis sawinaaRmdego antitoqsikuri damcvelobiTi done Seesabameba
Sikis uaryofiT reaqcias, arsebobs korelacia klinikur damcvelobiT reaqciasa da
SratSi arsebuli antitoqsinis titrs Soris. gadatanili daavadebis an imunizaciis
Sedegad SeZenili imunitetis dros antitoqsinis koncentracia 0,001-dan _ 0,09-mde
saerTaSoriso erTeulia, rac uzrunvelyofs ZiriTad imunitets da ganapirobebs daavadebis
dabal maCvenebelsa da dabal sikvdilianobas. antisxeulebis ufro maRali done
gansazRvravs srul imunitets. aRniSnuli done epidemiologiur gamokvlevebSi cnobilia,
rogorc imunitetis indeqsis maCvenebeli.
aqtiuri imunizaciis danergvamde difTeriis sawinaaRmdego antitoqsikuri imunitetis
gamomuSaveba xdeboda ori gziT _ daavadebis gadatanis Sedegad da xangrZlivi
baqteriamtareblobiT. umTavresad avaddebodnen 14 wlamde bavSvebi (80%-ze meti iyo
araimunuri) da iSviaTad mozrdilebi. amJamad bavSvebis masiurma imunizaciam difTeriis
avadobis maCveneblebi sagrZnoblad Seamcira am kontingentSi da daavadeba gadaadgilda
255
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kerZo nawili. difTeria
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kerZo nawili. difTeria
damaxasiaTebel mimdinareobas.
difTeria, rogorc pirveladi toqsikuri forma, umravles
xaxis toqsikuri difTeria
SemTxvevaSi daavadebis pirvelsave dReebSi yalibdeba. iSviaTad ki aranamkurnalebi,
xaxis gavrcelebuli an sxva formis difTeriis Sedegia. daavadeba iwyeba uecrad,
temperaturis aweviT 39-40°C-mde , intoqsikaciiT _uZlurebiT, saerTo sisustiT,
zogjer ki agznebiT, pirRebinebiT, umadobiT. avadmyofi uCivis yelis, Tavisa da muclis
tkivils; yuradRebas i pyrobs kanis mkveTri sifermkrTale. xaxis daTvalierebisas
SeigrZnoba motkbo-dampali suni. daavadebis pirvelsave saaTebSi pir-xaxis lorwovani
mkafiod hi peremiulia. nuSurebi, misi rkalebi, naqi, rbili sasis lorwovani garsi
SeSupebulia. zogjer SeSupeba imdenad didia, rom SeiZleba nuSurebi erTmaneTs Seexon
da xaxis ukana kedeli aRar Candes. piriT sunTqva gaZnelebulia da atarebs cxviris
tembrs. daavadebis dawyebidan 12-15 saaTSi viTardeba nadebi, romelic Tavdapirvelad
hgavs obobas qsels an Jeleseburia da advilad scildeba adgils, magram 24 saaTSi
sqeldeba da scdeba nuSuras farglebs, ufro mogvianebiT ki, 3-4 dReSi nadebi msxvildeba,
xdeba xorkliani, monacrisfro da mTlianad faravs nuSurebs, rbil sasas, sasis rkalebs,
naqs. zogjer, mZime mdgomareobisas nadebi aRiniSneba magar sasazec. am dros mkafio
hi peremia Rebulobs cianozur elfers.
toqsikuri formisaTvis xaxaSi procesis ganviTarebasTan erTad an 1-2 dRis Semdeg
damaxasiaTebelia umniSvnelovanesi niSani –kiserze kanqveSa qsovilebis SeSupeba, romlis
gavrcelebis intensivoba safuZvlad udevs difTeriis toqsikuri formebis xarisxebad
dayofas. SeSupebuli qsovilebi rbili (comiseburi) konsistenciisaa, xelis SexebiT
Tbili da umtkivneuloa; TiTis daWeriT CaRrmavebas ar tovebs. biZgiseburi dartymisas
SeSupebuli qsovilebi labasaviT iryevian. am adgilebSi kans normaluri feri aqvs.
subtoqsikuri formis dros xaxaSi fibrinuli nadebi da SeSupeba naklebad gvxvdeba.
SeSupeba kiserze izRudeba regionuli limfuri kvanZebis irgvliv da xSirad calmxrivia.
I xarisxis toqsikuri difTeriis dros SeSupeba vrceldeba kisris Sua donemde, II
xarisxis dros aRwevs laviwamde, III xarisxis dros vrceldeba gulmkerdis zemo
nawilze da zogjer aRwevs processus xiphoideus-s. II da III xarisxis toqsikuri
difTeriis dros ufro mkveTrad, vidre I xarisxisa da subtoqsikuri formis, gamoxatulia
Semdegi simptomebi: kanis sifermkrTale cianozuri elferiT, pastozuri saxe, naxevrad
Ria piri, daxeTqili da mSrali tuCebi, gaurkveveli xma cxviris tembriT. toqsikuri
difTeriis dros procesSi xSirad erTveba cxvirxaxa da cxviris nestoebi. cxviridan
SeimCneva uxvi, serozul-sisxlnarevi gamonadeni. cxviris nestoebis SesasvlelTan da
zemo tuCze kani eqskorirebulia (dawylulebuli). periferiul sisxlSi aRiniSneba
leikocitozi neitrofiloziT, eds momatebulia, SardSi SeiZleba iyos cila da hialinuri
cilindrebi.
toqsikuri difTeriis yvelaze mZime formebad iTvleba hemoragiuli da
hi pertoqsikur
pertoqsikuri i (elvisebur
(elviseburi)i) fo rmebi.
formebi.
hemoragiuli formis dros klinikuri suraTi igivea, rac II da III xarisxis
SemTxvevaSi, mxolod im gansxvavebiT, rom daavadebis II, III dRes viTardeba sisxlZarRvTa
Sida diseminirebuli Sededeba, romlis pirveli gamovlinebaa sisxlCaqceva ineqciis
adgilas; xolo mogvianebiT viTardeba sisxlCaqcevebi kanze, lorwovanze; adgili aqvs
sisxlian pirRebinebas, hematurias, sisxliani ganavlis arsebobas.
hipertoqsikuri (elviseburi) formis dros pirvelive saaTebSi aRiniSneba organizmis
Zlieri intoqsikacia, temperatura aRwevs 40-41°C, Rebineba xSiria, zogjer Seuwyveteli,
goneba dabindulia, aRiniSneba krunCxvebi; swrafad viTardeba gulsisxlZarRvTa ukmarisoba.
am formis dros xdeba xaxis SeSupeba, xolo rac Seexeba fibrinul nadebs, SeiZleba
arc ganviTardes, radgan adgilobrivi procesi gaSlas ver aswrebs. kanqveSa qsovilis
260
kerZo nawili. difTeria
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kerZo nawili. difTeria
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kerZo nawili. difTeria
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kerZo nawili. difTeria
wlamde asakis bavSvebSi letaloba ufro maRalia, vidre mozrdilebSi, rac ganpirobebulia
pnevmoniis ganviTarebiT krupis dros, xolo toqsikuri mimdinareobisas _ miokarditiTa
da pnevmoniiT.
diagnozis dasma, pirvel rigSi, eyrdnoba klinikur suraTs, sadac wamyvania fibrinuli
nadebebis arsebobis dadgena. difTeriul nadebs axasiaTebs anTebad keraze TiTqosda
zedapiruli ganlageba, romelic moruxo-WuWyisferia. apkis mocilebas sWirdeba
Zaldataneba da gaSiSvlebuli adgili sisxlmdenia; mocilebidan ramdenime saaTSi
SeimCneva fibrinuli apkis axali organizacia. apki mkvrivia, reziniseburi da or
sasagne minas Soris ar isriseba. xaxis difTeriisaTvis damaxasiaTebelia aramkveTri
hiperemia, romelsac gadahkravs cianozuri elferi, TiTqos gvagonebs moxarSuli xorcis
fers. gavrcelebuli da toqsikuri formis dros yuradRebas i pyrobs nuSurebis, sasis
rkalebis, naqis da a.S. mkveTri SeSupeba, romlis fonze ufro xSirad orive mxares
viTardeba sakmaod sqeli, uxeSi, WuWyis feri fibrinuli nadebebi. difTeriuli anginis
dros ylapva zomierad an sustadaa mtkivneuli, rac miuTiTebs toqsinis anesTeziur
moqmedebaze. zog SemTxvevaSi SeimCneva xaxis mkveTri hi peremia, romelic aixsneba
streptokokuri infeqciis aqtivaciiT da am dros adgili aqvs Sereul difTeriul-
streptokokul infeqcias.
xaxis toqsikuri difTeriis kardinaluri simptomia fibrinuli nadebebis arsebobasTan
erTad, regionuli limfuri kvanZebis irgvliv da mTels kiserze kanqveSa cximovani
qsovilis SeSupebis gamovlineba. difTeriis sxvadasxva lokalizaciisas adgilobrivi
procesis intensivoba, SeSupebiTi simptomis CaTvliT gansazRvravs organizmis
intoqsikaciis xarisxs, rac unda dadgindes daavadebis pirvelsave dRes, vinaidan erTaderTi
efeqturi ukuganviTareba mxolod antitoqsinis mieraa SesaZlebeli.
Zalze iSviaTad, acril bavSvebSi, imuniteti ar yalibdeba, rac ar gamoricxavs
toqsikuri difTeriis ganviTarebas. daavadeba SeiZleba ganviTardes imunitetis arsebobis
drosac, magram am fonze daavadeba mimdinareobs lokaluri formiT, ufro metad xaxaSi,
(iSviaTad cxvirSi). nadebebi nuSurebze gamoirCevian kunZulovani ganlagebiTa da
lorwovans scildebian advilad, sisxldenis gareSe. am dros Zalian iSviaTia seriozuli
garTulebebi da procesi xSirad ganicdis ukuganviTarebas specifikuri mkurnalobis
gareSec. iSviaTad SeiZleba ganviTardes subtoqsikuri, toqsikuri I da II xarisxis
xaxis difTeria.
difTeriis yvela formisas (saeWvo SemTxvevebis CaTvliT) da gansakuTrebiT,
difTeriuli krupis dros organizmSi dauyovnebliv unda SeviyvanoT antitoqsini
(antidifTeriuli Srati). prognozi mTlianadaa damokidebuli Sratis adreul Seyvanaze.
laboratoriuli gamokvlevebi. nacxis pirdapiri SeRebva da mafluorescirebeli
antisxeulebis kvleva ara saimedoa. baqteriologiuri kvleviT difTeriis Cxiris
gamoyofa SeiZleba 90%-Si. gamokvlevis Sedegi damokidebulia masalis swor aRebaze.
dasaTes masalas iReben steriluri bambis tamponiT nadebis kedlidan; cal-calke
iReben xaxidan, cxviridan da a.S., Wamamde an Wamidan 2-sT-is Semdeg. masalas (lorwos,
fibrinul nadebs, tampons) aTavseben sterilur sinjaraSi da swrafad (ara ugvianes 3
saaTisa) agzavnian laboratoriaSi, sadac iTeseba specialur niadagebze (sisxliani,
teluritiani tinsdalis agari, klaubergis niadagi). laboratoriidan winaswari pasuxi
SeiZleba gaices 24 saaTSi, xolo saboloo 48-72 sT-Si (toqsigenurobisa da
antibiotikogramis gaTvaliswinebiT). uaryofiTi pasuxi ar gamoricxavs difTeriis
arsebobas, xolo dadebiTi adasturebs mas. Tu transportirebas 3 saaTze meti dro
sWirdeba, saWiroa masalis satransporto niadagSi moTavseba (teluritiT gamdidrebuli
niadagi an gel-silikonur sinjarebSi, ukanasknel SemTxvevaSi masalis aRebis win
saWiroa tamponis datenianeba peptonuri bulioniT). masala igzavneba daavadebaTa
266
kerZo nawili. difTeria
kontrolis centrSi.
Tu avadmyofis anamnezSi aRiniSneba gadatanili angina, xolo mogvianebiT ganviTarda
iseTi garTulebebi, rogoricaa rbili sasis dambla, miokarditi, poliradikulonevriti,
savaraudoa, rom man gadaitana difTeria specifikuri mkurnalobis gareSe.
periferiul sisxlSi gvaqvs zomieri leikocitozi, poliradikulonevritis dros
Tav-zurgtvinis siTxeSi mcired imatebs cilisa da ujredebis raodenoba, toqsikuri
mimdinareobisas (RviZlis dazianebiT) aRiniSneba hipoglikemia da glukozuria. Tirkmlis
milakebis nekrozuli dazianebisas sisxlSi imatebs Sardovana da narCeni azoti.
miokarditis dros ekg-ze aRiniSneba aritmiis movlenebi, T kbilis, S-T segmentis
cvlilebebi.
diferenciuli diagnozis gatarebis aucilebloba ganpirobebulia procesis
lokalizaciiT da misi formiT.
xaxis difTeriis dros, romelic xasiaTdeba sxvadasxva sididis fibrinuli nadebiT
(dawyebuli wertilovanidan, damTavrebuli nuSurebis zedapiris mTliani dafarviT),
gasaTvaliswinebelia lakunuri da folikuluri anginebi, romlebic xasiaTdebian daavadebis
uecari dawyebiT, SemcivnebiT, maRali temperaturiT, ylapvis dros mkveTri tkiviliT,
saerTo intoqsikaciis suraTiT. xaxis daTvalierebisas aRiniSneba mkveTri hi peremia,
dgindeba Cirqovani folikulebi, romlebic moTavsebulia lorwovanis SigniT. lakunebSi
Cirqovani nadebebia. aRniSnul SemTxvevaSi nadebi Cirqovani xasiaTisaa, maSin, roca
difTeriis dros fibrinulia. adgilobrivi procesi ki xasiaTdeba naklebad gamoxatuli
hi peremiiT, es ukanaskneli ufro cianozuri elferisaa da intoqsikacia zomier xasiaTs
atarebs. toqsikuri difTeriis dros fibrinuli nadebebis garda pirvelsave dReebSi
regionuli limfuri kvanZebis irgvliv an mTel kiserze aRiniSneba kanqveSa cximovani
qsovilis SeSupeba.
nekrozuli angina, romelic mimdinareobs nuSurebze borcviani, xorkliani nadebebis
ganviTarebebiT, SeiZleba miRebuli iqnas xaxis difTeriad. misTvis damaxasiaTebelia
nuSurebis lorwovani garsebis mkveTri hi peremia, regionuli limfuri kvanZebis Zlieri
mtkivneuloba, nadebebi advilad scildeba anTebad keras da isriseba or sasagne minas
Soris, rac ganasxvavebs difTeriisagan.
simanovski-plaut-vensanis angina ifargleba adgilobrivi procesiT, nekrozuli
kera gamoirCeva Rrma mdebareobiT. nadebi iSviaTadaa zedapiruli da xorkliani. 3-4
dReSi nekrozis adgilas warmoiSoba kraterismagvari wyluli, romlis epiTelizacia
sruldeba 10-12 dReSi. daavadebis etiologiis dadgenas aadvilebs anTebadi keridan
aRebuli nacxis pirdapiri mikroskopia, romelSic aRiniSneba simbionturi saprofitebi
_ spirilebi da TiTistarismagvari Cxirebi (fuzospirilebi).
sokovani anginis dros zogjer saWiroa diferencireba xaxis difTeriasTan.
aRniSnuli dazianeba umTavresad gvxvdeba 2 wlis asakamde. sokovani anginis dros
nadebi TeTri an moyviTalo ferisaa da advilad scildeba adgils, igi xaWoseburia da
Tavisuflad ifSvneba. regionuli limfuri kvanZebi ar aris gadidebuli, sxeulis
temperatura normis farglebSia. damaxasiaTebelia nadebebis xangrZlivi arseboba raime
dinamikis gareSe. anTebadi adgilidan aRebuli nacxis pirdapiri mikroskopiiT dgindeba
Candida albicans-is aqtivoba.
paratonzilits (flegmonur anginas) SecdomiT miiCneven xaxis toqsikuri formis
difTeriad. misTvis damaxasiaTebelia calmxrivi dazianeba, nuSurebis zemdebare qsovilebis
mwvave anTeba da umTavresad im bavSvebis xvedria, romlebic qronikuli tonzilitiT
arian Sepyrobili. hi peremiulia xaxis ukana da wina TaRebi, naqi; swrafad viTardeba
infiltraciuli anTebiTi procesi, rac iwvevs nuSurebis cdomas Sua xazidan an, ufro
metic, janmrTeli nuSurisaken. saerTo mdgomareoba Zlier mZimea, temperatura aRwevs
267
kerZo nawili. difTeria
268
kerZo nawili. difTeria
antitoqsinis doza
difTeriis forma
(saerTaSoriso erTeulebSi)
mxolod kanis dazianebiT mimdinare 20 000 _ 40 000
xaxis, xorxis difTeria (daavadebis
dasawyisidan gavida 48sT-ze naklebi 20 000 _ 40 000
dro)
cxvir-xaxis difTeria 40 000 _ 60 000
daavadebis dawyebidan gavida 72 saaTi
80 000 _ 100 000
an meti
toqsikuri difTeria kisris
80 000 _ 100 000
SeSupebiT
269
kerZo nawili. difTeria
ganzaveba 0,9%-
doza # Seyvanis gza raodenoba ml-Si
ian NaCl
1* kanqveS 1:20 0,5
2 kanqveS 1:10 0,1
3 kanqveS 1:10 0,3
4 kanqveS ganuzavebeli 0,1
5 kunTebSi ganuzavebeli 0,2
6 kunTebSi ganuzavebeli 0,5
7~ venaSi ganuzavebeli 0,1
270
kerZo nawili. difTeria
271
difTeria
kerZo nawili. meningokokuri infeqcia
meningokokuri infeqcia
272
kerZo nawili. meningokokuri infeqcia
273
kerZo nawili. meningokokuri infeqcia
274
kerZo nawili. meningokokuri infeqcia
275
kerZo nawili. meningokokuri infeqcia
276
kerZo nawili. meningokokuri infeqcia
cudi maCvenebelia.
damaxasiaTebelia avadmyofis
iZulebiTi poza - wevs gverdze,
ukan gadaweuli TaviT, qveda
kidurebi ki muxlisa da menj-
barZayis saxsrebSia moxrili
(e.w. meZebari ZaRlis poza,
Seyenebuli Caxmaxis poza -
`Chien en Fusil~).
Tavis tvinis nervebis
dazianeba (VI, VII, VIII wyvili)
daavadebis pirvel dReebSi
iSviaTad aRiniSneba.
sulfanilamidebisa d a meningokokuri meningiti. damaxasiaTebeli `Caxmaxis~, `meZebari
antibiotikebis eramde ki smenis ZaRlis~ poza. (sakuTari masala)
daqveiTeba meningokokuri menin-
gitis dros arc Tu ise iSviaTi garTuleba iyo.
sxva zogadi simptomatikidan yuradRebas i pyrobs gamoxatuli sifermkrTale, wiTeli
dermografizmi, saxis tanjuli gamometyveleba, inicirebuli sklerebi. pulsi aCqarebulia,
gulis tonebi moyruebuli. pirvel xanebSi adgili aqvs taqikardias, rac mogvianebiT
bradikardiiT icvleba. arteriul wnevas aqvs tendencia daqveiTebisaken. sunTqva
gaxSirebulia da zerele. filtvebis perkusiiT moismineba kolofiseburi xmianoba,
auskultaciiT - mkvrivi sunTqva.
wlamde asakis bavSvebSi meningiti mimdinareobs ati purad. daavadeba iwyeba
TandaTanobiT. meningealuri movlenebi naklebadaa gamoxatuli, saxezea ufro zogadi
intoqsikaciis niSnebi - tremori, umizezo tirili, krunCxvebi, amoburculi, daWimuli
da pulsirebadi yiflibandi. hi potroful bavSvebSi yiflibandi SeiZleba Cavardnili
iyos, rac sxvadasxva mizeziTaa gamowveuli. erT SemTxvevaSi mis genezSi benzilpenicilinis
kaliumis marilis mkurnalobaSi masiuri dozebiT gamoyenebas aqvs adgili. meore
SemTxvevaSi ki igi intensiuri dehidrataciis Sedegia. meningitis mimdinareobaSi mcire
asakis bavSvebSi mniSvneloba aqvs, agreTve, gamoxatuli diareuli komponentis arsebobas.
faRaraTi iwvevs gauwyloebis simptomatikas - avadmyofebs
aReniSnebaT wyurvili, piris Rrus simSrale, kanis turgoris
daqveiTeba, Cavardnili Tvalebi, Tvalebis irgvliv Savi rgolebi,
Tav-zurgtvinis siTxis wnevis daqveiTeba. lumbaluri punqciis
dros liqvori gamodis iSviaTi wveTebiT. meningealuri simptomebi
am dros zogjer qreba an sustad gamoxatuli xdeba, qreba myesTa
refleqsebic, viTardeba kunTebis hi potonia.
bevr bavSvs daavadebis me-3-4 dRes aReniSneba herpesuli
gamonayari kanis sxvadasxva nawilebze an lorwovan garsebze,
terfebze. gamonayari zogjer uxvadaa warmodgenili, rac
mniSvnelovnad auaresebs zogad mdgomareobas. saWiroa aRiniSnos,
rom herpesi gvxvdeba sxva etiologiis meningitebis drosac.
daavadebis pirvel saaTebSi Tav-zurgtvinis siTxe gamWvirvalea
an opalescirebs, xolo Semdgom dReebSi ki mRvriea da Cirqovani.
meningokokuri
citozi, Cveulebriv, maRalia (12-13 aTasi 1 mkl-Si, zogjer
meningiti. Cirqovani
dauTvleli xdeba), mkveTradaa momatebuli cilebis Semcveloba lumbaluri punqtati.
(0,6-3,0-6,0 g/l), Sida wneva matulobs da aRwevs 300-500mm-de (sakuTari masala)
277
kerZo nawili. meningokokuri infeqcia
wylis svetisa, SeiZleba iyos normaluric. zogjer, maRali wnevis miuxedavad, liqvori
SeiZleba gamodiodes wveTebiT, rac miuTiTebs mis maRal webovnebaze, liqvoris gzebis
nawilobriv blokze.
cilis maRali Semcveloba xSirad gvxvdeba meningokokuri meningitis mZime formebis
dros, romelic mimdinareobs ependimatitis sindromiT. ependimatitis sindromi xasiaTdeba
simptomebis ramdenadme specifikuri TaviseburebebiT da ganpirobebulia procesis
lokalizaciiT (Zilianoba, cnobierebis mdgradi da progresirebadi darRveva, sopori,
koma, opistotonusi, krunCxvebi). viTardeba, agreTve, simptomebi, romlebic mowmoben
qalasSida wnevis momatebaze - Tavis tkivili, yiflibandis amoburcva da daWimuloba
qalas nakerebis daSorebiT (hidrocefalia), arteriuli wnevis momateba, mxedvelobis
nervis dvrilis SeSupebiT. cilis swrafi da mniSvnelovani momateba liqvorSi adasturebs
ependimatitis diagnozs. amave dros, xazgasmulia, rom ependimatitis zusti diagnozis
dasma SesaZlebelia mxolod kompiuteruli tomografiiT an paTanatomiur seqciaze.
damaxasiaTebelia aseve, avadmyofis poza - opistotonusi, gaSlili qveda kidurebi,
`balerinas terfebiT~, xSirad fexebi gadajvaredinebulia. xelebi moxrilia idayvis
saxsarSi, TiTebi muStebad aris Sekruli. SemdgomSi viTardeba kaxeqsia, fsiqomotoruli
darRvevebi da aseTi avadmyofebi kvdebian superinfeqciiT an sxva zeddarTuli garTulebiT.
qalasSida garTulebebi SeiZleba ganviTardes rekonvalescenciis periodSic (liqvoris
mimoqcevis gzebis bloki, abscesi, subaraqnoidul sivrceSi eqsudatis gaJonva). liqvorSi
SesaZlebelia, iyos sisxlic, rac ganpirobebulia sisxlCaqceviT garsqveSa sivrceSi
(SesaZlebelia diapedezuri sisxldena, mravalricxovani sisxlCaqcevebi tvinSi).
daavadebis pirvel dReebSi antibiotikTerapiis dawyebamde aRebuli liqvoris
neitrofilebSi da ujredgareT naxuloben gramuaryofiT di plokokebs (meningokokebs,
rac etiologiuri faqtoris dadasturebaa).
meningokokuri meningoencefaliti. daavadebis es forma upiratesad mcire
asakis bavSvebSi gvxvdeba. am dros daavadebis pirvel dReebSi dominirebs encefalituri
movlenebi, motoruli agzneba, adre viTardeba kidurebis, Tavis qalas nervebis parezi
da damblebi, naTxemuri ataqsia, Tvalis moZraobis darRveva da sxva. amasTan, meningealuri
movlenebi sustadaa gamoxatuli. meningoencefaliti xSirad mimdinareobs zogadtvinovani
movlenebis gareSe. naTxemis funqciuri darRveva viTardeba ukve daavadebis pirvel
dReebSi, saxezea kunTTa tonusis mkveTri daqveiTeba staturi da lokomotoruli
ataqsiis SerwymiT. bavSvebi ver ikaveben Tavs, ver jdebian, ver dgebian, ver dadian,
moZraoba uxerxulia, disimetriulia da Tan axlavs intensiuri tremori.
meningoencefealitis dros sisxlsa da cerebrul siTxeSi cvlilebebi igivea, rac
meningitis dros.
meningoencefalitis rig SemTxvevaSi, `sufTa~ meningitis TanatogenezSi mniSvnelovani
roli miekuTvneba tvinis SeSupebas, romelic gamowveulia neirotoqsikoziT, hemodinamikuri
da metaboluri darRvevebiT, agreTve imunoreaqtiulobis darRveviT (Vfxthtn K\ F\
da sxva, 1985).
meningokokemia - meningokokcemia, meningokokuri sefsisi, Cveulebriv, mimdinareobs
mZafrad intoqsikaciis mkveTri gamovlinebiT da meoradi metastazuri kerebis
ganviTarebiT. meningokokemia meningitis gareSe iSviaTia. meningokokuri infeqciis es
forma gvxvdeba yvela asakSi.
meningokokemia iwyeba temperaturis uecari momatebiT 39-400C-mde, xolo Semdeg
SeiZleba iyos mudmivi, intermisiuli, heqtiuri, talRiseburi xasiaTis. SesaZlebelia
daavadeba temperaturis momatebis gareSec mimdinareobs. infeqciur-toqsikuri Sokis
dros temperatura, Cveulebriv, subfebrilur, normalur donemde ecema, an adgili aqvs
hi poTermias.
278
kerZo nawili. meningokokuri infeqcia
279
kerZo nawili. meningokokuri infeqcia
laboratoriuli monacemebi.
elviseburi meningokokemia
meningokokuri infeqciis yvelaze
rTuli formaa da umZimesi
prognoziT xasiaTdeba. am formas
xSirad uwodeben zemwvave
meningokokur sefsiss, fulminantur
meningokokemias, hemoragiul
adrenalits an uoterhaus-
frideriqsenis sindroms. misTvis
damaxasiaTebelia daavadebis
dawyebidan ramdenime saaTSi
meningokokcemia. mravlobiTi hemoragiuli gamonayari infeqciur-toqsikuri Sokis
ti pur
purii lokalizaciiT. (sakuTar
(sakuTarii masala)
ganviTareba, romelic
ganpirobebulia endotoqsinemiis
Sedegad sisxlZarRvTa
mikrocirkulaciis darRveviT.
klinikurad xasiaTdeba uecari
dawyebiT da mZafri mimdinareobiT,
SemcivnebiT, temperatura swrafad
matulobs 40-41 0C-mde, magram
ramdenime saaTSi SeiZleba
Seicvalos hi poTermiiT. aRiniSneba
progresirebadi qoSini, kani
fermkrTalia, magram
generalizebuli cianoziT
meningokokur
meningokokurii infeqcia. meningokokcemia ti pur
purii gamonayr iT. kidurebze, xolo Semdeg tanze
gamonayriT.
(sakuTari masala) viTardeba mowiTalo cianozuri
laqebi, romlebic sxeulis
mdebareobis Secvlis dros
ganicdian gadaadgilebas (cnobilia
`gvamuri laqebis~ saxelwodebiT
_ Livors mortalis). aRniSnul
movlenebs win uZRvis gulis wasvla,
motoruli agzneba, krunCxvebi,
Semdeg progresirebadi prostracia
da gonebis dakargva. toqsikozis,
gul-sisxlZarRvTa da sunTqvis
mwvave ukmarisobis Sedegad
meningokokcemia. Tirkmelzeda jirkvalSi sisxlCaqcevebi daavadeba SeiZleba garTuldes
uoterhau-frideriqsenis sindromis dros. tvinis SeSupebiT, misi Semdgomi
(Í.È. Íèñåâè÷, Â.Ô. Ó÷àéêèí) dislokaciiT (mogrZo tvinis
CaWedva), gansakuTrebiT terminalur
stadiaSi.
mkveTr cvlilebebs adgili aqvs sisxlis Semadedebeli sistemis mxriv. daavadebis
dasawyisSi aRiniSneba hi perkoagulaciis faza, Semdeg, Sokis intensivobis momatebisas,
viTardeba hi po - an afibrinogenemia, gamoxatulia Trombocitopenia.
meningokokemiis dros SeiZleba ganviTardes iseTi garTulebebi, rogoricaa plevriti,
280
kerZo nawili. meningokokuri infeqcia
281
kerZo nawili. meningokokuri infeqcia
282
kerZo nawili. meningokokuri infeqcia
mkurnaloba. g e n e r a l i z e b u l i
meningokokuri infeqciiT daavadebuli yvela
avadmyofi eqvemdebareba hospitalizacias
specializebul ganyofilebebsa da
sadiagnostiko boqsebSi. nazofaringitiT
daavadebulebs mkurnaloba SeiZleba
Cautardes saxlis pirobebSi.
antibiotikTerapia tardeba saSualo toqsikomania. mZime mowamvla narkotikuli
dozebiT, romlis xangrZlivoba 2 dRes balaxis mowevis Sedegad. sisxlCaqcevebi
Seadgens (rifampicini, mozrdilebSi - sklerebSi Rebinebis dros. (sakuTari masala)
ci profloqsacinic) gamoiyeneba agreTve sulfanilamidebi.
meningokokuri infeqciis generalizebuli formebis dros mkurnaloba unda
iyos etiotropuli, paTogenezuri da kompleqsuri klinikuri formebis, simZimis,
garTulebebisa da premorbiduli fonis gaTvaliswinebiT. asarCev etiotropul
preparatebad iTvleba penicilini da qloramfenikoli. gamoiyeneba agreTve cefotaqsimi
(cefazolini) da ceftriaqsini (rocefini).
benzilpenicilinis natriumis an kaliumis marili iniSneba venaSi 200 000-400
000 _ 500,000 erT/kg sxeulis masaze sadReRemiso doziT 4 saaTis intervaliT
Tanabar dozebSi SeyvaniT. intervalis gaxangrZlivebisas antibiotikis koncentracia
sisxlSi da liqvorSi ecema, ramac SeiZleba daavadebis gamwvaveba gamoiwvios. peniciliniT
mkurnalobis xangrZlivoba Seadgens 5-8 dRes, zogjer mets.
meningitis Sorswasul SemTxvevebSi (ugono mdgomareoba, agreTve ependimatiti -
ventrikuliti) penicilinis doza izrdeba 800 000 erT/kg sxeulis masaze. Tumca
zogierTi avtoris monacemebiT 500.000 erT/kg-ze meti doza ar iwvevs ufro karg
klinikur efeqts. am dros venaSi SehyavT mxolod benzilpenicilinis natriumis da
283
kerZo nawili. meningokokuri infeqcia
284
kerZo nawili. meningokokuri infeqcia
285
kerZo nawili. hemofiluri infeqcia
hemofiluri infeqcia
(HAEMOPHILUS INFLUENZAE)
286
kerZo nawili. hemofiluri infeqcia
287
kerZo nawili. hemofiluri infeqcia
288
kerZo nawili. hemofiluri infeqcia
289
kerZo nawili.
streptokokuri infeqciebi. GAS ,GBS
streptokokuri infeqcia
290
kerZo nawili.
streptokokuri infeqciebi. GAS ,GBS
h emol i z i
Lancefield-i s
cx v ri s k ol on i z a ci i s
a n t i g en u ri saxe d a a v a d ebi s k l i n i k u ri for ma
sisxlis adgili
jg u fi
a g a rz e
faringiti , tonzi l i ti , w iTel i qari , i mpeti go,
septi cemi a, Wri l obi s i nfeqci a, manek rozebel i
xaxa, k ani , sw ori
A S. pyogenes β fasci l i ti , cel u l i ti , meni ngi ti, pnevmonia,
naw l avi
qu nTru Sa, toqsi k u ri Sok ismagvari si nd romi,
revmatiu l i cxel eba, mw vave gl omeru l onefriti .
axal Sobi l Ta sefsi si , qori oamni oni ti ,
B S. agalactiae β xaxa, saSo end ok ard iti , meni ngi ti , osteomi el i ti, pnevmoni a,
mel ogi nes sefsi si
W ri l obis i nfeqci a, mel ogi nes sefsi si , cel u l i ti ,
piri s Rru , xaxa, end ok ard iti , tvi ni s abscesi , sefsi si ,
C-H, K-O sxvad asxva β, α
saSo, k ani nozok omi al u ri i nfeqciebi, oportu ni stu l i
i nfeqciebi
arati pirebu l i S. viridans α xaxa end ok ard iti
arati pirebu l i S. mutans α xaxa end ok ard iti
Enterococcu end ok ard iti , saSard e gzebi s infeqci ebi ,
s faecalis
bil iaru l i traqti s infeqci ebi , naw l avTa
arati pirebu l i (enterococcu α, β , γ naw l a vi s Si gTa vsi
i nfeqciebi, peri toni ti , baqteriemia su perinfeqci i s
s), E.
faecium saxi T.
291
kerZo nawili.
streptokokuri infeqciebi. GAS ,GBS
klinika ar streptokokuri
qunTruSa
aRiniSneba faringiti
292
kerZo nawili.
streptokokuri infeqciebi. GAS ,GBS
293
kerZo nawili.
streptokokuri infeqciebi. GAS ,GBS
294
kerZo nawili.
streptokokuri infeqciebi. GAS ,GBS
295
kerZo nawili. GAS ,GBS
streptokokuri infeqciebi. qunTruSa
qunTruSa
(SCARLATINA)
296
kerZo nawili.
streptokokuri infeqciebi. qunTruSa
297
kerZo nawili.
streptokokuri infeqciebi. qunTruSa
298
kerZo nawili.
streptokokuri infeqciebi. qunTruSa
xazis formirebas.
paTogenezis sefsisuri xazis ganviTareba SeiZleba, daiwyos pirveladi anTebiTi
keris adgilze da miiRos nekrozul-anTebadi xasiaTi xaxaSi, cxvirxaxaSi, xorxSi da
a.S. aseTi mZime formebi ufro damaxasiaTebelia adreuli asakis bavSvebisaTvis, romelTa
organizmis barieruli funqcia daTrgunulia da advilad xdeba infeqciis generalizacia.
Cirqovani kerebi, Cveulebriv, yalibdeba daavadebis me-3-5 dRes, roca intoqsikaciis
movlenebi sustdeba. anTebadi kerebidan limfuri da sisxlZarRvebis gziT regionul
limfur kvanZebSi viTardeba limfadeniti da sxva (pirveladi kompleqsi), saidanac
sisxlSi Seiwoveba toqsinebi, mikrobis daSlis produqtebi _ alergenebi, rac, Tavis
mxriv, xels uwyobs SemdgomSi mikrobuli invaziis realizacias. viTardeba Cirqovani
angina da sxva Cirqovani garTulebebi. aseTi sefsisuri movlenebi SeiZleba, ganviTardes
mogvianebiT, alergiuli talRis fonze (meore, mesame, meoTxe kviras) glomerulonefritis,
arTritis, sinovitisa da sxva gamovlinebaTa paralelurad.
F. F. Rjknsgby-isa da misi TanamSromlebis mier dadgenil iqna vegetatiuri
nervuli sistemis cvlilebebi daavadebis dinamikis fonze. am cvlilebebTan mWidrodaa
dakavSirebuli gul-sisxlZarRvTa sistemis dazianeba. daavadebis dawyebiT fazaSi
umravles SemTxvevaSi imatebs simpatikuri sistemis tonusi, romelic Semdgom
parasimpatikuri tonusis momatebiT icvleba, xolo gamojanmrTelebis periodisaTvis
xdeba simpatikuri sistemis normalizacia. es kanonzomiereba SeiniSneba mravali sxva
infeqciis drosac. ase, rom qunTruSis mimdinareobis dadgenili kanonzomiereba SeiZleba
CaiTvalos sxva nozologiebisaTvis analogiuri procesebis prototi pad.
klinika. inkubaciuri periodi ganisazRvreba 2-7 dRiT, ufro xSirad moicavs 3-
klinika
4 dRes, Tumca zogjer ramodenime saaTs an iSviaTad, 12 dRemde grZeldeba.
daavadeba iwyeba uecrad, temperaturis momatebiT, pirRebinebiT, yelis tkiviliT,
saerTo intoq-sikaciis movlenebiT _ SemcivnebiT, Tavis tkiviliT, uZilobiT, madis
daqveiTebiT. gamonayari viTardeba ramodenime saaTSi an meore dRes, iSviaTad - meoTxe
dRes. mas axasiaTebs swrafi gavrceleba sa-xeze, kiserze, tanze, kidurebze. gamonayari
wvrilwinwklovania da ganviTarebulia kanis hi peremiul fonze, mogvagonebs mziT
damwvrobas. gamonayari aRiniSneba saxezec, Subli da loyebi ga-wiTlebulia, sadaa,
`iwvis~, mogizgizea, winwklebi ar aqvs. piris irgvliv kani gamonayris gareSea mkrTali
samkuTxediT. gamonayari
ufro intensiuria
tanis gverdiT zeda-
pirebze, muclis qveda
nawilSi, kidurebis me-
dialur midamoebze, gan-
sakuTrebiT ki kanis
bunebriv naoWebSi:
iRliisqveSa, sazardu-
lis, idayvis, muxlis
ukana fosoebSi. nakece-
bis adgilas aRiniSne-
ba hi perpigmentacia,
Cveulebriv, msubuqi
peteqiebiT. mas raime
qunTruSa. gamonayris uxvi qunTruSa. TeTri
prognozuli mniS-
xasiaTi idayvis saxsris Sida dermografizmi.
vneloba ar gaaCnia, ma- pirze. (Í.È. Íèñåâè÷,
gram warmoadgens sak- (Í.È. Íèñåâè÷, Â.Ô. Ó÷àéêèí) Â.Ô. Ó÷àéêèí)
299
kerZo nawili.
streptokokuri infeqciebi. qunTruSa
300
kerZo nawili.
streptokokuri infeqciebi. qunTruSa
qunTruSis klasifikacia
(À\ À\ Êîëòûïèí)
301
kerZo nawili.
streptokokuri infeqciebi. qunTruSa
ti puri formebi Tavis mxriv iyofa msubuq, saSualo da mZime mimdinareobis formebad.
msubuqi forma SeiZleba gadavides saSualo simZimeSi, xolo ukanaskneli - mZimeSi.
daavadebis simZimis Sefaseba eyrdnoba adgilobrivi da zogadi movlenebis maCveneblebs.
msubuqi mimdinareobis dros saerTo intoqsikacia gamoxatuli ar aris, sxeulis
temperatura ar aRemateba 38,50 C, saerTo mdgomareoba sustadaa darRveuli, angina
kataruli xasiaTisaa. gamonayari kanze Tumca ti puria, magram mkrTali da iSviaTia
(mwiria). temperaturuli reaqcia da saerTo movlenebi 4-5 dReSi qreba. bolo aTeuli
wlebis ganmavlobaSi Tanamedrove qunTruSa swored aseTi formiTaa cnobili, rac
mniSvnelovnadaa ganpirobebuli antibiotikebis epoqiTa da gansakuTrebiT penicilinis
preparatebis gamoyenebiT.
saSualo simZimis dros temperatura aRwevs 390 C da mets, gamoxatulia zogadi
intoqsikaciis movlenebi - saerTo sisuste, Tavis tkivili, ganmeorebiTi Rebineba. aseTi
mimdinareobisas toqsikuri da sefsisuri simptomebis xangrZlivoba ar aRemateba erT
kviras. Tumca sxvadasxva saxis garTulebebi ufro xSiria, vidre msubuqi formebis
dros.
mZime mimdinareobisas arCeven sam formas formas: 1) toqsikurs, roca gamoxatulia
saerTo intoqsikaciis suraTi, 2) sefsisurs, roca saxezea sefsisuri kerebi da 3)
toqsikur-sefsisurs, sadac Serwymulia toqsikuri da sefsisuri simptomatika.
mZime toqsikuri mimdinareobisas daavadeba iwyeba uecrad, mZafrad, temperatura
aRwevs 40-410 C, ganmeorebiTi Rebineba grZeldeba 2-3 dRes. avadmyofi agznebulia an
piriqiT, daTrgunuli, bodavs, goneba dabindulia, aqvs krunCxvebi, saxezea meningealuri
movlenebi. viTardeba sisxlZarRvTa mwvave ukmarisoba, rac simpatikuri nervuli sistemis
pareziTaa ganpirobebuli. gamonayris feri ufro mkrTalia, gadakravs cianozuri elferi,
TeTri dermografizmi ar iwveva an sustadaa gamoxatuli.
mZime sefsisuri forma xasiaTdeba saerTo sefsisuri suraTiT, kerovani Cirqovani
anTebiT, intoqsikaciis movlenebi ki ukana planze iwevs. mkveTradaa gamoxatuli nekrozuli
angina. nekrozuli procesi SeiZleba gavrceldes piris RruSi, cxviris danamat RruebSi.
viTardeba iseTi sefsisuri gamovlinebani, rogorociaa regionuli limfuri kvanZebis
Cirqovani anTeba, Cirqovani angina da sxva regionebSi mZime sefsisuri kerebis Camoyalibeba
saTanado saerTo sefsisuri suraTiT.
daavadebis mZime toqsikur-sefsisuri mimdinareobisas pirvel 3-5 dRes wina
planze wamoweulia organizmis mZimed mimdinare saerTo intoqsikacia, xolo Semdgom
vlindeba sefsisuri kerebi, rac, Tavis mxriv, ganapirobebs Sesabamis klinikur suraTs.
iSviaT formebs miekuTvneba qunTruSis mimdinareoba agravirebuli simptomebiT -
hipertoqsikuri (SeiZleba ganviTardes toqsikuri Sokis sindromi _ sklerebis inicirebiT,
diareiT, saerTo mZime mdgomareobiT da daavadeba sikvdiliT damTavrdes) da hemoragiuli
forma, romelTa drosac procesi imdenad mZafrad da elviseburad yalibdeba, rom
sikvdili viTardeba daavadebis damaxasiaTebeli ti puri simptomebis gamovlinebamde.
daavadebis pirvelsave dRes avadmyofebi xvdebian saavadmyofoSi meningitis,
meningoencefalitis, toqsikoinfeqciisa da sxva mZime klinikuri formebis suraTiT.
Semosvla. am dros kardinaluri simptomebi ar gamoixateba, rac
dagvianebuli Semosvla
daavadebis bunebis dadgenas aZnelebs. SesaZlebelia, ganviTardes mogvianebiTi periodisaTvis
damaxasiaTebeli rogorc alergiuli, ise sefsisuri genezis garTulebani. didi mniSvneloba
eniWeba anamnezur monacemebs (Cveneba anginaze, gamonayarsa da a.S.). am SemTxvevaSi
garkveuli mniSvneloba aqvs gansakuTrebul dasayrden sadiagnostiko simptoms - kanis
firfitisebr aqercvlas.
garTulebebi sefsisuri an alergiuli xasiaTisaa. pirveli dakavSirebulia
uSualod streptokokebTan, meore ki maT antigenur TvisebebTan. garTuleba SeiZleba
302
kerZo nawili.
streptokokuri infeqciebi. qunTruSa
303
kerZo nawili.
streptokokuri infeqciebi. qunTruSa
304
kerZo nawili. qunTruSa
streptokokuri infeqciebi. wiTeli qari
wiTeli qari
(ERYSIPELAS)
305
kerZo nawili. qunTruSa
streptokokuri infeqciebi. wiTeli qari
306
kerZo nawili. qunTruSa
streptokokuri infeqciebi. wiTeli qari
307
kerZo nawili. qunTruSa
streptokokuri infeqciebi. wiTeli qari
308
kerZo nawili. stafilokokuri infeqcia
stafilokokuri infeqcia
309
kerZo nawili. stafilokokuri infeqcia
310
kerZo nawili. stafilokokuri infeqcia
311
kerZo nawili. stafilokokuri infeqcia
312
kerZo nawili. stafilokokuri infeqcia
iqmneba e.w. “maxiseburi burTis” situacia , rodesac adgili aqvs haeris evakuaciis
darRvevas, ris Sedagadac viTardeba kista an pnevmocele. ase, rom aRniSnuli haerovani
“buStuki” warmoadgens bronquli an peribronquli infeqciis meorad gamovlinebas. 4
dRidan 4 Tvemde periodSi pnevmocele TavisTavad sufTavdeba. pnevmoToraqsi viTardeba
pnevmoceles gaskdomis Sedegad. uecari dispnoes, cianozis, prostraciisa da Sokis
ganviTareba pnevmoToraqsis ganviTarebaze metyvelebs. empiema ki warmoiSoba abscesis
gaskdomiTa da misi CaRvriT plevris RruSi. piopnevmoToraqsi viTardeba maSin, Tu
abscess kavSiri aqvs bronqTan. piopnevmoToraqsi, pnevmoToraqsi, empiema SeiZleba iyos
izolirebuli an kombinirebuli. 50%-ze met SemTxvevaSi sisxlis suraTSi aRiniSneba
polimorfuli leikocitebis siWarbe, Tumca SeiZleba adgili hqondes normocitozs an
leikopenias. rentgenogramaze pnevmoceles, pnevmoToraqsis, empiemis an piopnevmoToraqsis
SemTxvevaSi aRiniSneba damaxasiaTebeli cvlilebebi, infiltratebi.
garTuleba.. stafilokokuri pnevmonia SeiZleba garTuldes: 1) gulis
pnevmoniis garTuleba
ukmarisobiT (filtvis qsovilebis mniSvnelovani dazianebis Sedegad), rac gamovlindeba
taqikardiiT, gulis sazRvrebis gadidebiT, sulis xuTviT, 2) empiemis araadekvaturma
drenirebam SeiZleba gamoiwvios fibroToraqsiT garTuleba.
diagnozi stafilokokur infeqciaze eWvis mitana saWiroa Semdegi mdgomareobebeis
dros: 1) mwvave respiraciuli distresis (mwvave sunTqvis ukmarisoba) ganviTareba
ZuZumwovar bavSvebSi. 2) anamnezSi aRiniSneba dabadebis Semdgomi omfaliti an dedis
mastiti, 3) rentgenologiuri monacemebiT vlindeba pnevmocele, empiema an piopnevmoToraqsi.
stafilokokuri etiologia mtkicdeba dadebiTi hemokulturiT - empiemidan da
dazianebis sxva adgilebidan miRebuli masalidan mikrobis amoTesviT.
xaxidan amoTesili dadebiTi kultura ar TamaSobs did rols, vinaidan axalSobilebis
60%-s aReniSneba stafilokokebi cxvirxaxaSi, diagnozi SeiZleba daadasturos kulturam,
Tu iTeseba koagulazamaproducirebeli oqrosferi stafilokokebi.
diferenciuli diagnozi. saWiroa diferenciacia Catardes Semdeg daavadebebTan:
1)pnevmokokur pnevmoniasTan. stafilokokuri pnevmonia adreul stadiaSi SeiZleba
daemsgavsos pnevmokokur pnevmonias, magram ukanasknelisaTvis ara aris damaxasiaTebeli
antibiotikTerapiis uefeqtoba da zemoTaRniSnuli rentgenologiuri cvlilebebi. 2)
pnevmoniasTan, romelic gamowveulia E.coli, enterobaqteria, klebsiela an Pseudomonas
aeruginosa-Ti. klinikurad es pnevmoniebi SeiZleba iyos stafilokokuri pnevmoniis
msgavsi. am SemTxvevaSi dRenaklebSi rentgenologiuri monacemebi stafilokokuri
pnevmoniis msgavsia, magram yelidan, sisxlidan iTeseba nawlavis Cxiri da sxva.
mwvave bronqiti. obstruqciuli sunTqva dakavSirebulia mwvave respiraciul
stafilokokur infeqciasTan. taqi pnoe da rentgenologiuri monacemebi amtkicebs
emfizemiT mimdinare obstruqciul bronqits.
mukoviscidozi. stafilokokuri pnevmonia SeiZleba gaarTulos mukoviscidozma.
oflSi natriumisa da naxvelSi qloridebis maRali Semcveloba gvexmareba mukoviscidozis,
fibrinul-kistozur degeneraciis diagnozis dadgenaSi.
ucxo sxeulis moxvedra sasunTq gzebSi SeiZleba garTuldes stafilokokuri
pnevmoniiT.
prognozi. antibiotikebis eramde stafilokokuri pnevmonia xSirad iwvevda
letalur gamosavals, magram antibiotikebma mniSvnelovnad Seamcires es maCvenbeli.
rac ufro pataraa bavSvi, miT ufro maRalia letaloba da piriqiT, gamojanmrTelebis
Sansi matulobs mozrdilebisaTvis optimaluri antibaqteriuli mkurnalobis Catarebis
dros. prognozi damokidebulia Tanmxleb daavadebebzec. gamojanmrTelebulebSi aris
narCeni movlenebi. Cveulebriv, pnevmocele mTlianad rCeba. filtvebis qronikuli
abscesi gvxvdeba iSviaTad. lokaluri procesis dros SesaZlebelia bronqoeqtaziebis
313
kerZo nawili. stafilokokuri infeqcia
ganviTareba.
mkurnaloba. stafilokokuri pnevmonia Cvil bavSvebSi saWiroebs gadaudebel
Terapias. adreuli optimaluri Terapia zrdis gamojanmrTelebis Sanss. adreuli
Terapia gansakuTrebiT mniSvnelovania, radgan stafilokokuri pnevmoniis dros xSirad
adgili aqvs qsovilebis fokalur nekrozebs. mkurnaloba araefeqturia, Tu procesi
Sorsaa wasuli. optimaluri mkurnaloba moicavs _ antibiotikebis Seyvanas saTanado
dozebiT da xangrZlivad (SerCeviTi antibiotiki), Cirqovani Rruebis drenirebas Tu
aRiniSneba empiema, pnevmoToraqsis mkurnalobas.
mZime stafilokokur infeqcias iwvevs penicilinrezistentuli koagulazapozitiuri
stafilokoki. am SemTxvevaSi Terapia unda Catarades penicilinazarezistentuli
peniciliniT. am bolo dros gaizarda meticilinrezistentuli stafilokokebis (MRSA))
ricxvi, gansakuTrebiT maTi hospitaluri Stamebi, romelTa samkurnalod iyeneben
vankomicins. stafilokokebi aseve rezistentulia klindamicinis mimarT. tolerantuli
stafilokokuri mikrobebiT inficirebul pacients unda Cautardes mkurnaloba ori
antibiotikiT, gansakuTrebiT maSin, rodesac antibiotikiT Catarebuli pirveli cikli
uefeqto iyo. TiToeuli avadmyofisaTvis antibiotikTerapia sxvadasxva xangrZlivobisa
unda iyos. SesaZloa mkurnaloba gagrZeldes 2 kviridan 2 Tvemde da damokidebuli
iyos mikrobis mgrZnobelobaze, filtvis qsovilis dazianebis xarisxze da xasiaTze,
da aseve garTulebebze. SesaZlebelia recidivis ganviTareba. antisxeulebis gansazRvra
teiqois mJavas mimarT gvexmareba antobiotikebis moxsnis gadawyvetilebis miRebaSi.
antisxeulebis Semcveloba antibiotikis kursis CamTavrebis Semdeg laparakobs daavadebis
gagarZlebasa da abscesis metastazirebaze. am antisxeulebis gansazRvra informaciulia,
agreTve, sisxlis baqteriologiuri uaryofiTi pasuxis SemTxvevaSi da Rrma qsovilebis
dazianebis (osteomieliti) dros, roca SeuZlebelia dazianebuli organodan masalis
aReba kulturis misaRebad.
Terapia.. mZime avadmyofs aTavseben Jangbadis karavSi, zogierTi saWiroebs
damxmare Terapia
xelovnur sunTqvas, hidratacias oraluri da parenteruli gziT, xolo ganviTarebuli
anemia koregirebuli unda iyos sisxlis preparatebis gadasxmiT.
mkurnaloba.. stafilokokuri pnevmoniis dros: pnevmoceles
garTulebebis mkurnaloba
SemTxvevaSi mosalodnelia misi spontanuri gaqroba da, rogorc wesi, ar aris saWiro
qirurgiuli Careva. buStukebi (bulebi) qrebian ramdenime kviris an Tveebis ganmavlobaSi.
Tu bula iwvevs traqeis an mTavari bronqis kompresias, SesaZlebelia misi aspiracia an
gakveTa.
piopnevmoToraqsi.. am SemTxvevaSi mkurnalobis arCevani Cerdeba
empiema da piopnevmoToraqsi
kaTeteriT drenirebaze adgilobrivi anesTeziis qveS. aseTi procedura ufro misaRebia,
vidre Cirqis aspiracia. es amcirebs respiraciuli distresis movlenebs. pnevmoToraqsis
an masiuri empiemis dros Rrudan Cirqis evakuacia uzrunvelyofs filtvis kompresiis
ganviTarebis Tavidan acilebas.
fibroToraqsi. am dros iSviaTad aris saWiro qirurgiuli Careva. rogorc wesi,
is spontanurad ikurneba gansazRvruli drois ganmavlobaSi. saeWvo SemTxvevaSi ukeTesia
movicadoT procesis srul organizaciamde, Tumca es ukanaskneli iSviaTia.
SeiZleba davaskvnaT, rom avadmyofebi mwvave stafilokokuri pnevmoniiT saWiroeben
gadaudebel da, SesaZloa, qirurgiul daxmarebas. optimaluri antibiotikoTerapia saWiroa
dainiSnos rac SeiZleba adre. drenireba gamoiyeneba kompresiuli pnevmoToraqsis
dros da igi sicocxlis gadamrCen proceduras warmoadgens.
mwvave stafilokokuri osteomieliti. ukanasknel wlebSi osteomielitis
sixSire Cvil bavSvebSi mniSvnelovnad Semcirda. klinikur gamovlinebas adgili aqvs
travmis Semdeg, swrafad viTardeba kanis Cirqovani anTeba, Cutyvavilas an sxva winmswrebi
314
kerZo nawili. stafilokokuri infeqcia
315
kerZo nawili. stafilokokuri infeqcia
316
kerZo nawili. stafilokokuri infeqcia
317
stafilokokuri infeqcia
kerZo nawili. sefsisi
sefsisi
(SEPSIS)
sefsisis yvelaze ufro xSir gamomwvev mizezad jer kidev iTvleba gramdadebiTi,
pirobiTpaTogenuri mikrobebi, rogoricaa Staphylococcus aureus da Staphylococ-
cus epidermidis. ukanaskneli 10-15 wlis ganmavlobaSi yuradRebis centrSia, agreTve,
gramuaryofiTi mikrobebi _ Escherichia coli, Klebsiella, Proteus mirabilis, Pro-
teus vulgaris, Enterobacter, Serratia, Pseudomonas aeruginosa, H. influenzae
da sxv.
maRalia, rogorc gramdadebiTi, aseve gramuaryofiTi mikrobebiT gamowveuli
nozokomialuri infeqciebisadmi midrekileba, rogorc axalSobilebSi, aseve
imunokomprometirebul pirebSi (sxvadasxva paTologiiT Sepyrobilni _ avTvisebiani
simsivne, hematologiuri daavadebebi, anemia, kortikosteroidebiTa da sxivuri TerapiiT
xangrZlivad namkurnalebi avadmyofebi da a.S.) amasTan, araiSviaTia polimikrobuli
kombinaciiT gamowveuli sefsisi, risTvisac xelSemwyob faqtorebad iTvleba sxvadasxva
saxis qirurgiuli Carevebi, gansakuTrebiT, kuW-nawlavis traqtsa da saSarde gzebze,
318
kerZo nawili. sefsisi
319
b a q t e r i a
fokaluri baqteriemia
kerZo nawili.
sefsisi * hiper/hipoTermia
* cvlilebebi leikocitebis raod.
sefsisi plus erT-erTi mainc:
mxriv
* mwvave darRveva cns-is mxriv * taqikardia
* taqipnoe
* hipoqsemia
sefsisis sindromi * leikocitebis r-bis Secvla
* plazmaSi rZemJava
* oliguria
(Saez-Llorens-is
320
sefsisis sindromi plus hipotenzia an
adreuli sefsisuri kapilarebis sisxlis mimoqcevis
Soki daqveiTeba, romelic koregirdeba
sefsisi da Soki
siTxeebiTa da medikamentebiT.
-is mixedviT)
sikvdili
sefsisi
kerZo nawili. sefsisi
dadgenili iyo, rom sefsisis dros organizmis sistemuri anTebadi pasuxis sindromi
(diseminirebuli anTebadi procesi organoebisa da sistemebis dazianebiT) warmoadgens
qsovilebze gramdadebiTi baqteriebis lipoteiqo _ acidur-peptido-glikanuri kompleqsis
an gramuaryofiTi mikrobebis endotoqsinis moqmedebis Sedegs.
gamovlenilia isic, rom sefsisis dros gramuaryofiTi mikrobebis mier gamowveuli
cvlilebebi gulisa da filtvebis mxriv mogvagonebs eqsperimentSi endotoqsinisa da
tumormanekrozebeli faqtoris (TNF) moqmedebas. am faqtorebis sawinaaRmdego
monoklonuri antisxeulebiT inhibicia mkveTrad amcirebs Sokis movlenebs.
baqteriuli metabolitebis sisxlSi moxvedris Semdeg aqtiurdebian citokinebi,
romlebic SemdgomSi rig fiziologiur gardaqmnebs iwveven. anTebad procesTan
dakavSirebuli citokinebis ricxvi matulobs, rac, Tavis mxriv, aaqtivebs TNF-s, IL-1 -1
-1,
IL-6 –8-s, TAF-s (Trombocitaqtivaciis faqtors), γ-IFN (γ-interferons).
-6-s da IL–8
-6 –8
baqteriuli produqtebisa da citokinebis zemoqmedebis Sedegad irTveba
fiziologiuri meqanizmebi, romlebic moicaven: 1)komplementis sistemis aqtivacias; 2)
hagemani (XII) faqtoris aqtivacias, rac ganapirobebs koagulaciur kaskads; 3)
adrenokortikotropuli hormonisa da β-endorfinebis gamoTavisuflebas; 4)
polimorfulnuklearuli leikocitebis aqtivacias da 5) kalikrein-kininuri sistemis
stimulacias. TNF da sxva anTebadi mediatorebi zrdian sisxlZrRvTa ganvladobas
kapilarebSi sisxlis mimoqcevis darRveviT, iwveven sisxlZarRvebis tonusis daqveiTebas;
ganapirobeben disbalanss perfuziasa da qsovilebSi mimdinare gaZlierebul metabolur
process Soris. anTebis gamomwvevi mediatorebis aqtivacia an makroorganizmis zedmeti
pasuxi ayalibebs sefsisis paTogenezs.
Soki. sefsisuri procesis ukidures gamovlinebas warmoadgens Soki, rac sikvdilis
mizezi xdeba. Soki ganixileba, rogorc civi kidurebi, periferiuli perfuziis Semcireba.
mogvianebiT aRiniSneba arteriuli wnevis dacemac. periferiuli sisxlZarRvebis
rezistentobis daqveiTeba aRiniSneba `Tbili Sokis” adreul periodSi da mkveTrad
matulobs `civi Sokis” stadiaSi.
sefsisuri Sokis dros Jangbadze qsovilebis moTxovnileba Zalian izrdeba. disbalansi
Rrmavdeba periferiuli vazodilataciis, mogvianebiT vazokonstriqciis, miokardiumis
depresiis, ventilaciuri problemebisa da anemiis Sedegad.
sefsisuri Sokis dros gulis sistoluri SekumSvis periodSi sisxlis gandevna
parkuWebidan gaZnelebulia, rac xels uwyobs qsovilovan hi poqsiasa da rZemJava
acidozis ganviTarebas.
filtvebis funqcia xSirad irRveva da viTardeba “Sokuri filtvi” anu respiraciuli
distresi, rac cudi prognozis maCvenebelia. viTardeba Tirkmlebis, RviZlis mwvave
ukmarisoba, centraluri nervuli sistemis mwvave darRvevebi. Soks Tan axlavs
diseminirebuli sisxlZarRvTaSida Sededeba.
m. maCabelis, n. maxvilaZisa da Tanaavtorebis ganmartebiT sefsisuri Sokis sindromi
Tanamedrove doneze ganixileba, rogorc sisxlis mimoqcevis sistemis darRveva mimdinare
ujredebisa da qsovilebis araadekvaturi perfuziiT, saerTo paTologiis eleqtronuli
SimSilis fonze.
sefsisuri procesis paTfiziologiis mTavari mxareebi warmodgenilia cxrilSi
(sefsisuri procesis paTfiziologia), romelic naTels xdis sefsisisa da Sokis
ganviTarebis Tanmimdevrul Camoyalibebas.
321
infeqciis fokusi
baqteriuli ujredebis
produqtebi
kerZo nawili.
pirveladi mediatorebi
(TNF, IL-1, IFN da sxva)
endoTeliuri ujredebisa
da leikocitebis aqtivacia
molekulur doneze
(Saez-Llorens-is
322
kalikrein-kininuri sistemis
aqtivoba meoradi mediatorebi
polimorfuli leikocitebis
(Trombocitebis aqtivaciis
aqtivacia
faqtori, interleikinebi)
-is mixedviT)
dazianeba
dazianeba
multisistemuri dazianeba
sikvdili
sefsisi
kerZo nawili. sefsisi
klinika. infeqciis SeWris kari sefsisis dros SeiZleba iyos kani, piris Rru, kuW-
nawlavis traqti, sasunTqi gzebi da a.S. igi SeiZleba ganviTardes meanginekologiuri
da qirurugiuli Carevebis Sedegad. im SemTxvevaSi, roca SeWris adgilis dadgena ver
xerxdeba, sefsiss uwodeben kri ptogenurs. ukanaskneli forma SedarebiT iSviaTad
gvxvdeba.
daavadebis mimdinareobis mixedviT sefsisi iyofa elvisebur, mwvave, qvemwvave da
qronikul formebad.
elviseburi formisaTvis damaxasiaTebelia umZimesi klinikuri suraTis ramodenime
saaTSi Camoyalibeba. amasTan, misi mimdinareobis Tavisebureba zogjer mkafiod gamoirCeva
imisda mixedviT, Tu romeli baqteriebiTaa ganpirobebuli sefsisi. gramdadebiTi
sefsisisaTvis damaxasiaTebelia mZafri dawyeba hi perTermiiT (ufro xSirad) an
hi poTermiiT (iSviaTad), mkveTri zogadi intoqsikaciiT, gulis mwvave ukmarisobis
suraTiT, maSin, rodesac gramuaryofiTi sefsisis elviseburi formis klinikuri
mimdinareoba gamoirCeva periferiul sisxlZarRvTa ukmarisobis suraTiT. orive
SemTxvevaSi diagnostika Tu pirvel saaTebSi ar moxda da ar Catarda intensiuri
etiologiuri da paTogenezuri mkurnaloba, daavadeba, rogorc wesi, pirvel dReebSive
letaluri gamosavaliT mTavrdeba.
baqteriemiis progresireba sefsisSi da Sokis ganviTarebis klinikuri aspeqtebi _
sefsisisa da Sokis klinikuri gamovlinebis sindromebis, maTi ganviTarebisa da
diagnostirebis kriteriumebi mocemulia cxrilSi (sefsisi da Soki).
mwvave sefsisis xangrZlivoba ar aRemateba sam Tves. aqve unda aRiniSnos, rom
mwvave simptomatikis suraTi klinikurad SeiZleba gamovlindes daavadebis ramdenadme
mogvianebiT stadiaSi, magram procesis dawyebidan ara ugvianes sami Tvisa. aRsaniSnavia,
rom mozrdilebSi daavadebis mwvave dawyeba gamoxatuli temperaturuli reaqciiTa da
Zlieri SemcivnebiT mxolod 16%-Sia aRniSnuli. temperaturuli mrudi am dros
mravalferovania (heqtiuri, remisiuli, intermisiuli, subfebriluri ). sxva SemTxvevebSi
daavadeba TiTqosda mimdinareobs gamoxatuli temperaturuli reaqciis gareSe, ufro
xSirad aRiniSneba e.w. `temperaturuli pikebi”, romlebic icvleba 7-10 dRiani remisiiT.
daavadeba SeiZleba mimdinareobdes talRiseburi temperaturiT, saerTo simptomatikis
gamovlinebiT _ saerTo sisuste, oflianoba, hepatolienuri sindromi, periferiul
sisxlSi _ leikocitozi neitrofiloziT, momatebuli eds. zogjer, mZime mdgomareobis
dros aRiniSneba neitropenia, rac prognozulad cudi gamosavlis maCvenebelia.
qvemwvave sefsisi grZeldeba 3-dan 6 Tvemde. am formis drosac daavadeba talRisebur
mimdinareobas Rebulobs. maRali temperaturis fonze saerTo intoqsikaciis movlenebi
zomieradaa gamoxatuli.
qronikuli sefsisi xasiaTdeba xangrZlivi dune mimdinareobiT, gamwvavebebiTa da
sxvadasxva xangrZlivobis remisiiT. temperaturuli mrudi mravalferovania.
polimorfuli klinikuri suraTi igivea, rac sxva xangrZlivobis sefsisis dros.
xSirad viTardeba hepatolienuri sindromi, periferiuli sisxlis cvlilebebi xasiaTdeba
zomieri, zogjer maRali leikocitoziT, zogjer ki SesaZlebelia, cvlilebebi umniSvnelo
iyos.
adreuli asakis bavSvebSi xSiria sefsisis gaxangrZlivebuli forma, romlisaTvisac
Semdegi parametrebia damaxasiaTebeli: gamoiyurebian kargad, fizikuri da fsiqikuri
ganviTareba asakis Sesabamisia, magram aRiniSneba sxvadasxva ti pis temperaturuli
reaqcia, romelic ufro xSirad atarebs subfebrilur xasiaTs, zogjer maRalia, magram
ar aris continua-s ti pis. araiSviaTad viTardeba hepatolienuri sindromi. sisxlidan
iTeseba stafilokokebi, streptokokebi, sxva gramdadebiTi an gramuaryofiTi mikrobebi,
sisxlSive vlindeba stafilokokuri α-toqsinis an aRniSnuli mikrobebis sawinaaRmdego
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kerZo nawili. sefsisi
infeqcia) vlindeba.
mniSvnelovania, rom janmrTel axalSobilebSi gamomwvevi faqtorebidan prevalirebs
virulenturi mikroorganizmebi. aqve unda aRiniSnos, rom sefsisis gamomwvev iseT
virulentur mikrobebs, rogoricaa E. coli K-1, yvela seroti pis B jgufis streptokoki,
pnevmokokebi da H. influenzae, aqvT saerTo kafsuluri antigeni, romelic xels
uSlis komplementis alternativuli gziT aqtivacias da amiT xels uwyobs fagocitozis
daTrgunvas, vinaidan am SemTxvevaSi antisxeulebis warmoqmna darRveulia da mikrobebis
ofsonizacia ar xdeba.
neonataluri sefsisis dros mniSvnelovan rols asrulebs humoruli imunitetis
funqciis darRveva.
dedisagan nayofi transplacenturi gziT garkveuli speqtris G klasis antisxeulebs
Rebulobs, magram ver Rebulobs A da M-klasis antisxeulebs, vinaidan mucladyofnis
periodSi fiziologiuri pirobebis dros nayofi antigens praqtikulad ver xvdeba,
ris gamoc ukanaskneli antisxeulebis gamomuSaveba nayofis mier ar xdeba. Tumca
cnobilia, rom nayofs aqvs IgM antisxeulebis gamomuSavebis unari, rac dasturdeba
aseTi klasis antisxeulebis aRmoCeniT Wi plaridan aRebul sisxlSi sifilisiT,
toqsoplazmoziTa da wiTuriT inficirebisas.
gramuaryofiTi baqteriebis sawinaaRmdego specifikuri baqteriaciduri da
maofsonizebeli antisxeulebis umravlesoba IgM klass miekuTvneba, amitom axalSobils
nawlavTa mikroorganizmebisadmi naklebi humoruli dacva aqvs.
mozrdil qalebs, umravles SemTxvevaSi, aReniSnebaT B-jgufis streptokokebis
ti purspecifikuri kafsuluri polisaqaridisadmi gamomuSavebuli IgG-s titris dabali
an umniSvnelo done, amitom es proteqciuli antisxeulebi inficirebul axalSobilebSi
praqtikulad ar aris, rac ganapirobebs am infeqciisadmi maRal mimReblobas.
IgG–is done drouli axalSobilis Wi plaris sisxlSi uTanabrdeba an odnav
aWarbebs dedis sisxlis analogiur maCvenebels. dRenakl bavSvebSi ki misi done miT
ufro naklebia, rac ufro Rrmaa dRenakloba.
komplementis sistema. am sistemas makroorganizmis infeqciissawinaaRmdego
brZolaSi maintegrirebeli roli akisria.
komplementis proteqciuli funqcia gansakuTrebiT mimarTulia eqstraceluluri
mikrobebis sawinaaRmdegod (gramdadebiTi paTogenuri baqteriebisa da nawlavTa
gramuaryofiTi mikrobebis CaTvliT). am mikroorganizmebs unari aqvT, ar daeqvemdebaron
fagocitozs. antisxeulebi ar gamomuSavdeba iseTi mniSvnelovani gamomwvevebis winaaRmdeg,
rogoricaa B jgufis streptokokebi da E.coli K1, romelTa kafsula Seicavs sialis
mJavas, (mas ki mainhibirebeli efeqti SemboWav C3b-s mimarT gaaCnia). Cveulebriv,
antisxeulebi saWiroa, erTis mxriv, mikrobebis ofsonizaciisaTvis, meores mxriv ki _
mikrobebis sawinaaRmdego brZolaSi fagocitozis CarTvisaTvis.
komplementi antisxeulebTan erTad an damoukideblad monawileobs baqteriebis
ofsonizaciaSi, ris Sedegadac procesSi erTveba fagocitozi. klasikurad komplementi
antigen-antisxeulis urTierTqmedebis Sedegad aqtivirdeba. komplementis komponentebis
fiqsirebuli, kaskaduri CarTva xdeba Semdegi TanmimdevrobiT: 1-4-2-3-5-6-7-8-9.
meore, alternativuli gza ki C-3 komplementis mTavar fragmentze _ C-3b-zea
damokidebulia. C-3b-s done organizmSi, Cveulebriv, dabalia (zemoaRniSnuli infeqciebis
dros kidev ufro ecema axsnili meqanizmebis gamo).
baqteriebis ofsonizacia xdeba rogorc klasikuri, ise alternatiuli gziT, Semdeg
ki erTveba fagocitozi (infeqciis dros axalSobilebSi aRiniSneba rogorc antisxeulebis,
aseve C3b-nakleboba da procesi mZimed mimdinareobs).
mocirkulire komplementis gadacema dedisagan nayofze, rogorc wesi, ar xdeba.
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1. gamovlinebis drodabadebidan 1 kviramde (rogorc wesi, 72 1 kviridan 1 Tvemde 1 kviraSi gaweridan (Tu gawera
sT-Si) dabadebidan sam dReSi xdeba)
2. gestacia 50 % dRenaklebSi Cveulebriv droul rogorc wesi, dRenaklebSi
axalSobilebSi
3. risk-faqtorebi amnioniti, sanayofe wylebis naadrevi ar aris endotraqeuli intubacia,
daRvra kaTeterizacia, sisxldena,
qirurgiuli Carevebi
4. gadacemis gza vertikaluri horizontuli da vertikaluri horizontuli
327
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328
sefsisi
kerZo nawili. yivanaxvela
yivanaxvela
(PERTUSSIS, TUSSIS)
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330
kerZo nawili. yivanaxvela
331
kerZo nawili. yivanaxvela
332
kerZo nawili. yivanaxvela
meryeobs 3-dan 14 dRemde, mZime SemTxvevebSi ki, gansakuTrebiT wlamde asakis bavSvebSi,
SeiZleba, ufro naklebi iyos.
spazmuri xvela daavadebis gadasvla meore, spazmur periodSi viTardeba TandaTan,
rac gamoixateba spazmuri xvelis mkafio Camoyalibebul SetevebSi, romlis damaxasiaTebel
niSansac warmoadgens swrafi amosunTqvis biZgebis seria maT Soris SesunTqvis intervalis
gareSe. xvelis biZgebis damTavrebisas xdeba mstvinavi xasiaTis Zlieri CasunTqva,
rasac ganapirobebs spazmurad Seviwrovebuli xmovani napralis haeriT forsireba
(reprizi). spazmuri xvelis dros SesaZlebelia, aRiniSnos ramodenime reprizi. rac
ufro mZimed mimdinareobs yivanaxvela, miT ufro xangrZlivia spazmuri xvela da
xSiria reprizebis ricxvi. spazmuri periodis dasawyisSi xveliTi Setevebi ufro
naklebia da Zlierdeba da xSirdeba daavadebis me-2-3 kviras.
spazmuri, konvulsiuri xvelis Seteva iwyeba uecrad, xanmokle winamorbedi simptomebiT,
rogoricaa mousvenroba, bavSvebi eZeben sayrden wertils, uCivian yelSi fxaWnis SegrZnebas,
simZimes gul-mkerdis areSi (aura). avadmyofs spazmuri xvelis Setevis dros aqvs
damaxasiaTebeli saxe, igi gawiTlebuli an cianozuria, Tvalebi gadmokarklulia,
Casisxlianebuli, ena gamoyofilia maqsimalurad, enis wveri ki zemoTaa amozneqili,
gaZlierebulia nerwyvisa da cremlis dena, kisris venebi gaberilia da daWimuli. mZime
xveliTi Seteva grZeldeba manam, vidre bavSvi lorwos ar amoaxvelebs. zogjer Seteva
mTavrdeba RebinebiT. es ukanaskneli miekuTvneba daavadebis ti pur simptoms. spazmuri
xvelis Serwyma RebinebasTan iTvleba imdenad damaxasiaTebel sindromad, rom Tundac
ar hqondes adgili reprizs, eWvi mainc yivanaxvelaze unda iqnas mitanili.
reprizi yvela avadmyofs ar aReniSneba. daavadebis msubuqi da saSualo simZimiT
mimdinareobisas bavSvebi aqtiurni rCebian, TamaSoben. mZime SemTxvevaSi ki spazmuri
xvela iwvevs organizmis dauZlurebas, sxeulis masis Semcirebas. bavSvebi daZabulni
xdebian, aqvT Setevis molodini. xvelis Setevas xels uwyobs sxvadasxva garegani
gaRizianeba, rogoricaa yelis gasinjva, tansacmlis gaxda an Cacma, tirili, ReWva, ylapva,
fizikuri datvirTva da sxva. xvelis xSiri SetevebiT gamowveuli sisxlis mimoqcevis
darRvevasTan dakavSirebiT saxis quTuToebis SeSupeba Rebulobs mudmiv xasiaTs, kansa
da koniunqtivaze SeiZleba ganviTardes sisxlCaqcevebi, rac avadmyofs xvelis Setevis
gareSec Tavisebur habituss uqmnis. Setevis dros gamoyofili enis kbilze xaxunis
gamo enis lagamze Cndeba wylulebi, romlebic male ifareba mWidro TeTri nadebiT.
wyluli qreba TandaTan, xvelis Setevis intensivobis klebis Sesabamisad.
maRali temperaturis arseboba spazmuri xvelis periodSi, Cveulebriv, garTulebaze
metyvelebs, Tumca SeiZleba, iyos garTulebis gareSec.
auskultaciiT filtvebis mxriv zogjer moisimineba mSrali xixini. mZime mimdinareobis
dros aRiniSneba emfizemis movlenebi - perkutoruli xmis timpanuri an kolofiseburi
elferi, rentgenologiurad filtvis saerTo suraTi da hilusebi gaZlierebulia,
zogjer gamoixateba samkuTxedis msgavsi daCrdilva, romlis fuZe diafragmaze, mwvervali
_ ki hilusiskenaa mimarTuli. Tvlian, rom es ukanaskneli ganpirobebulia
limfocirkulaciis moSliT, iSviaTad aris ateleqtazuri kerebi.
gul-sisxlZarRvTa sistemis mxriv spazmuri xvelebis Setevis dros SeimCneva
taqikardia, arteriuli da venuri wnevis momateba; pnevmoniiT garTulebis SemTxvevaSi
xSiria gulis gaganiereba, gansakuTrebiT marjvniv da misi hemodinamikuri funqciis
darRveva.
nervuli sistemis mxriv mZime mimdinareobisas, gansakuTrebiT Cvil bavSvebSi,
yalibdeba hi poqsiuri encefalopaTiis suraTi - Zilis darRveva, mimikuri kunTebis
uneblie moZraoba, krunCxvebi, gonebis dakargva da sxv.
periferul sisxlSi damaxasiaTebelia leikocitozi (15X109_ 40X109), limfocitozi
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336
yivanaxvela
kerZo nawili. parayivanaxvela
parayivanaxvela
(PARAPERTUSIS)
337
parayivanaxvela
kerZo nawili. botulizmi
botulizmi
(BOTULINUS)
338
kerZo nawili. botulizmi
339
kerZo nawili. botulizmi
340
kerZo nawili. botulizmi
341
kerZo nawili. botulizmi
342
kerZo nawili. botulizmi
343
botulizmi
kerZo nawili. gaSeSeba
gaSeSeba
(TETANUS)
344
kerZo nawili. gaSeSeba
cxeli klimatis mqone qveynebSi, sadac wlis nebismier periodSi SeiZleba moxdes
inficireba. subtropikuli da zomieri klimatis mqone qveynebSi daavadeba, upiratesad,
mais-oqtomberSi gvxvdeba.
avadobis maCvenebeli damokidebulia imunizirebuli mosaxleobis fenaze. ganviTarebad
qveynebSi igi Seadgens 5-dan 50-mde SemTxvevas 100.000 mosaxleze. msoflioSi 80%-Si
daavadeba modis axalSobilebze ( e.w. Wipismieri gaSeSeba), rac ganpirobebulia araimunuri
dedebis higienis dabali doniT, mSobiarobisas higienuri pirobebis darRveviT. bavSvebSi
gaSeSebis 62-65% modis qvemo kidurebis travmaze (fexSiSvela siaruli, Wrilobis
miwiT dabinZureba da a.S.). mSvidobian periodSi daavadebis 80-86% soflis
macxovreblebSi gvxvdeba.
paTogenezi. organizmSi infeqciis SeWra xdeba dazianebuli kanidan da lorwovanidan.
gansakuTrebiT saSiSia naCxvleti Wriloba, romelsac Rrma jibeebi aqvs, saidanac
anaerobul pirobebSi (Jangbadis nakleboba) sporebi gardaiqmnebian vegetaciur formebad
da gamoimuSaveben Zlier biologiur Sxams _ tetanospazmins, romelic ganapirobebs
daavadebis paTogenezis mTavar rgols. toqsinis gavrceleba xdeba mamoZravebeli nervebis
endonervuli da perinervuli boWkoebisa (retrogradulad, zogierT nervSi misi
gadaadgilebis siCqare 3.4mm/sT-Si aRwevs) da sisxlis meSveobiT zurgis tvinsa da
Reros retikulur formaciaSi. toqsini arCeviTad azianebs polisinafsur refleqsur
rkalSi myof neironebs da iwvevs damblas. amasTan dakavSirebiT impulsebi, romlebic
gamomuSavdebian motoneironebSi, uwyvetad da arakoordinirebulad aRweven sxeulis
kunTebs, rac iwvevs maT mudmiv daWimvas, klinikurad es vlindeba krunCxviTi sindromiT.
vinaidan procesSi CarTulia retikuluri formacia, krunCxvebi Rebuloben generalizebul
xasiaTs. araspecifikuri gamRizianeblis moqmedebasTan dakavSirebiT (sinaTle, taqtiluri,
ynosviTi da sxva gamRizianeblebi), aferentuli impulsebiT Zlierdeba kunTebis daWimva.
kunTebis aseTi xangrZlivi daWimva iwvevs hi perTermiasa da energiis did xarjvas, rac
xels uwyobs metaboluri acidozis ganviTarebas. Rrmavdeba sunTqvis ukmarisoba,
romelic gamowveulia filtvis wuT-moculobis SemcirebiT diafragmuli da neknTaSua
kunTebis daWimvis Sedegad.
tetanospazminisa da striqninis moqmedeba erTmaneTis analogiuria. adgili aqvs
parasimpaTikuri nervuli sistemis aqtivacias, rac gamoixateba taqikardiaSi, aramdgrad
hi pertenziaSi, aritmiaSi, profuzul oflianobaSi, hi perkapniasa da kateqolaminebis
SardiT gamoyofaSi. toqsinis moqmedeba fermentuli bunebisaa. endoproteaza-
sinaptobrevini azianebs sinafsur ZarRvs, romelic ukavSirdeba ujredis membranas.
qsovilebSi ukve adsorbirebuli toqsini mWidrodaa dakavSirebuli maTTan da misi
daSla an neitralizacia antitoqsinis moqmedebiT ar xdeba. antitoqsini aseve ar
moqmedebs sporebsa da vegetaciur formebze. igi moqmedebs mxolod mocirkulire
toqsinze.
paTmorfologiuri suraTi avlens minimalur anTebad process. cns-Si aRiniSneba
tvinisa da misi garsebis SeSupeba. yvelaze ufro met cvlilebebs adgili aqvs Zval-
saxsarTa da kunTovan sistemebSi. krunCxviTma sindromma SeiZleba gamoiwvios Zvlebis
motexiloba, xerxemlis kompresiuli motexiloba (tetanus-kifozi), kunTebisa da myesebis
gagleja. kunTebsa da mis ganakveTze aRiniSneba sisxlCaqcevebi. adgili aqvs kunTTa
degeneracias (maT Soris diafragmuli da neknTaSua kunTebis), kunTebis lizissa da
miofibrilebis daRupvas, ramac SeiZleba ganapirobos ventilaciuri ukmarisoba da
miasTenia rekonvalescenciis periodSi.
klinika. inkubaciuri periodi 2 dRidan 2 Tvemde meryeobs, saSualod ki 14 dRea.
damtkicda, rom rac ufro moklea inkubaciis periodi, daavadeba miT ufro mZimed
mimdinareobs.
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kerZo nawili. gaSeSeba
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kerZo nawili. gaSeSeba
348
kerZo nawili. brucelozi
brucelozi
(BRUCELLOSIS)
349
kerZo nawili. brucelozi
specifikuri
paTogenezi klinika
gamRizianeblebi
I faza. brucelebis limfoiduri
pirveladi gavrceleba da limforeceptorebis inkubacia
gaRizianeba.
II faza. brucelebis hematogenuri
SeWra (pirveladi generalizacia) da
sefsisis ganviTareba
sisxlZarRvTa receptorebis
gaRizianeba.
III faza. mravalkerovani lokalizacia
(metastazuri kerebis formireba).
IV faza. egzogenuri ganTesva (meoradi
meoradi generalizacia. xSirad mravaljer) da gamosavali
reaqtiul-alergiuli cvlilebebi.
Vfaza. saboloo metamorfoziT a)
Sewova b) fibrozi g) mdgradi
cvlilebebis gareSe
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kerZo nawili. brucelozi
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353
kerZo nawili. brucelozi
354
kerZo nawili. legionelozi
legionelozi
(LEGIONELLOSIS)
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kerZo nawili. legionelozi
mde, xvela xdeba sveli, naxveliT, Zlierdeba qoSini. am dros filtvebSi perkutoruli
xma mokldeba, auskultaciiT ismis krepitaciuli an wvrilbuStukovani xixini.
rentgenologiurad aRiniSneba anTebadi kerebi, romlebsac Serwymisadmi aqvT midrekileba
farTo kerebis warmoqmniT. pnevmonia SeiZleba iyos erTmxrivi an ormxrivi. ufro
xSirad procesSi CaTreulia marjvena filtvi. SesaZloa ganviTardes eqsudaciuri
plevriti, rasac adgili ara aqvs imunodeficitis mqone bavSvebSi, magram maTSi es
procesi destruqciul xasiaTs Rebulobs, Tu specifikuri mkurnaloba droze ar
Catarda. mZime formebisas (15-20%) SesaZlebelia gamoixatos muclis tkivilebi,
ganmeorebiTi Rebineba, faRaraTi, ganviTardes Tirkmlebis mwvave ukmarisoba, sisxldena
kuW-nawlavidan, cns-is dazianebis simptomatika _ Tavbrusxveva, uZiloba, gonebis dakargva,
halucinaciebi, bodvebi, moZraobis koordinaciis darRveva, romelic dakavSirebulia
naTxemis dazianebasTan da sxva.
pirveli kviris ganmavlobaSi pnevmonia progresulad mZimdeba. mkurnalobis fonze
saerTo mdgomareoba TandaTanobiT umjobesdeba, anTebadi kerebi filtvebSi TandaTan
cxreba, magram saerTo sisuste da qoSini SeiZleba grZeldebodes ramdenime Tve.
legionelozuri pnevmoniis dros sxva simptomebidan aRsaniSnavia kanis sifermkrTale,
gadidebuli da palpaciiT mtkivneuli kisris da ybisqveSa limfuri kvanZebi. kuW-
nawlavis traqtis mxriv yuradRebas iqcevs madis daqveiTeba, Selesili mSrali ena,
tkivilebi muclis zemo nawilSi, nawlavTa spazmi, miuxedavad amisa muceli palpaciiT
rbilia, aReniSnebaT faRaraTi, gadidebuli RviZli da elenTa.
periferiul sisxlSi gvaqvs leikocitozi, neitrofilozi marcxniv gadaxriT, mkveTrad
momatebuli eds. SardSi aRiniSneba toqsikuri albuminuria, cilindruria, eriTrocitebi.
sisxlis bioqimiuri kvlevisas SesaZloa gamovlindes alanin- da
aspartataminotransferazebis, Sardovanas, kreatininis momateba, metaboluri da
respiraciuli acidozi.
legionelozuri pnevmoniis mimdinareoba damokidebulia premorbidul fonze,
interkurentuli daavadebebis darTvaze, adekvaturi mkurnalobis Catarebaze.
mwvave r espiraciuli daavadebis ti pis legi
respiraciuli onelozi (pontiakis cxeleba)
legionelozi
praqtikulad ar gamoirCeva sxva etiologiis mwvave respiraciuli infeqciebisagan.
daavadeba mimdinareobs pnevmoniis gareSe rinitis, bronqitisa da saerTo intoqsikaciis
suraTiT. prognozi keTilsaimedoa.
cxelebiTa da egzanTemiT mimdinare legionelozi (fort-bragis daavadeba)
praqtikulad ar gamoirCeva specifikuri klinikuri gamovlinebiT. gamonayari SeiZleba
iyos wiTelasmagvari, msxvillaqovani, peteqiuri, sxvadasxva lokalizaciis. gamonayris
Semdeg aqercvla ar xdeba. am formis dros adgili aqvs bronqitisa da intoqsikaciis
sxvadasxva movlenebs. prognozi yovelTvis keTilsaimedoa.
garTuleba. yvelaze ufro saSiS garTulebas sunTqvis mwvave ukmarisoba, infeqciur-
garTuleba
toqsikuri Soki, meoradi genezis Tirkmelebis ukmarisoba warmoadgens. bavSvebSi letaloba
aRemateba 20%-s.
diagnostika eyrdnoba klinikur, epidemiologiur da laboratoriul monacemebs.
daavadebaze eWvis mitana SeiZleba, roca rentgenogramaze filtvebSi aRiniSneba
daCrdiluli zonebi an laqovan-intersticiuli infiltratebis arseboba xangrZlivi
drois ganmavlobaSi, agreTve, rodesac antibiotikTerapia araefeqturia, saxezea
epidemiologiuri monacemebi (infeqciis kerebSi – sastumroebi, saavadmyofoebi da a.S.),
daavadebebis jgufuri xasiaTi.
legionelozis baqteriologiuri gamokvleva xelmisawvdomia mxolod specialur
laboratoriebSi. amave dros aucilebel pirobad iTvleba transTorakaluri bioftatis
an bronqebidan lavaJis meTodiT miRebuli siTxis daTesva specialur niadagebze, rac
357
kerZo nawili. legionelozi
358
kerZo nawili. muclis tifi da paratifebi A, B, C
muclis tifi
(TYPHUS ABDOMINALIS)
da paratifebi
A, B, C (PARATYPHUS ABDOMINALIS A, B, C)
359
kerZo nawili. muclis tifi da paratifebi A, B, C
360
kerZo nawili. muclis tifi da paratifebi A, B, C
mikroorganizmis virulentobaSi 1
Vi- k o r p u s k u l u r a n t i g e n s
eniWeba wamyvani roli. igi
fagocitozs aferxebs da xels
uSlis C3-is SekavSirebas
baqteriasTan, rac mikrobis
invazias uwyobs xels.
mikroorganizmebi fagocitozis
Semdeg makrofagebSi did xans 2 3
rCebian, rac ganpirobebulia
makrofagis metabolizmze
salmonelas moqmedebiT.
kritikul mdgomareobaSi
myof avadmyofebs aReniSnebaT T-
sistemis maCveneblebis daqveiTeba,
xolo mtareblebSi ki
darRveulia ujreduli
reaqtiuloba Salmonella-s
antigenebisadmi, rac gamoixateba
leikocitebis migraciis testis
4 5 6 7
SeboWvaSi.
infeqtis transporti
grZeldeba wvrili nawlavebis
sanaTurSi (inficirebis faza),
sadac mikrobebi xelsayrel
pirobebs pouloben
gamravlebisaTvis. wvrili
muclis tifi. klinikur-morfologiuri niSnebi.
nawlavebis lorwovani garsis, 1- hepatosplenomegalia; rozeolebi; 2- temperaturuli
limfuri warmonaqmnebis _ mrudi; 3- yavisferi nadebi enaze; 4- limfuri kvanZebis
solitaruli folikulebisa da `tvinovani~ SeSupeba wvril nawlavebSi (1-i kvira); 5-
maTi warmonaqmnebis _ jgufuri peieris folaqebis nekrozi (me-2 kvira); 6- wylulebis
limfuri folikulebis gavliT warmoSoba (me-3 kvira); 7- sufTa wylulebis stadia,
mikrobebi xvdebian regionul Sexorceba (4-5 kvira).
limfur kvanZebSi, sadac
intensiurad mravldebian da iwveven limfangoitisa da limfadenitis ganviTarebas.
upiratesad aRiniSneba jorjlis limfuri kvanZebis anTebiTi procesi.
pirveladi regionuli faza. inficirebis faza da pirveladi regionuli infeqciis
faza Seesabameba inkubaciur periods. am dros viTardeba organizmis, maT Soris wvril
nawlavTa limfuri aparatis zogadi sensibilizacia. sensibilizaciis procesTanaa
dakavSirebuli mTeli Semdgomi paTmorfologiuri suraTi _ limfuri warmonaqmnebis,
limfuri kvanZebis SeSupeba, maTi danekrozeba, wylulebis ganviTareba, rac esoden
damaxasiaTebelia tifur-paratifuri infeqciisaTvis.
inkubaciur periodSive, magram iSviaTad, SesaZlebelia, miRebul iqnas koprokultura,
Tumca ganavliT baqteriebis intensiuri eliminacia aRiniSneba daavadebis mxolod
pirveli kviris bolosaTvis.
limfuri kvanZebis anTebadi procesis Sedegad salmonelebi nawilobriv iSlebian
da gamoTavisufldeba endotoqsinebi, romelTa moqmedebiT xdeba hemato-limfuri barierebis
garRveva da paTogenezis Semdegi fazis _ baqteriemiis ganviTareba, rac emTxveva
361
kerZo nawili. muclis tifi da paratifebi A, B, C
362
kerZo nawili. muclis tifi da paratifebi A, B, C
363
kerZo nawili. muclis tifi da paratifebi A, B, C
364
kerZo nawili. muclis tifi da paratifebi A, B, C
365
kerZo nawili. muclis tifi da paratifebi A, B, C
366
kerZo nawili. muclis tifi da paratifebi A, B, C
367
kerZo nawili. muclis tifi da paratifebi A, B, C
368
kerZo nawili. muclis tifi da paratifebi A, B, C
maRali eds.
miliaruli tuberkulozi ufro mcire asakis bavSvebSi gvxvdeba. damaxasiaTebelia
saerTo mdgomareobis TandaTanobiT gauareseba, tifuri statusi ar aRiniSneba. kanze
Cndeba tuberkuloidebi, romlebic rozeolebs ar hgvanan, rentgenologiurad vlindeba
miliaruli kerebi, icvleba Tvalis fskeric.
mkurnaloba.. avadmyofebi eqvemdebarebian aucilebel hospitalizacias, sadac iniSneba
mkurnaloba
mkacri woliTi reJimi temperaturis normalizaciidan 6-7 dRis CaTvliT, me-7-8
dRidan nebadarTulia wamojdoma, normaluri temperaturis me-10-11 dRidan ki _
siaruli. Tu avadmyofebs ara aqvT Catarebuli antibiotikTerapia, aRniSnuli vadebi
SeiZleba ufro Semokldes.
didi mniSvneloba eniWeba avadmyofis saTanado movlas, yuradReba eqceva kanisa da
piris Rrus higienas.
daavadebis mwvave periodSi da Semdgom, zomieri temperaturis 7-8 dRis ganmavlobaSi
dieta nawlavebisaTvis maqsimalurad damzogavi unda iyos, avadmyofs eZleva meqanikurad
da qimiurad advilad gadasamuSavebeli sakvebi, rac xels uwyobs duRilisa da lpobiTi
procesebis Semcirebas, Tumca sakvebi unda Seicavdes saTanado kaloriebs. unda moveridoT
nawlavTa gadatvirTvas uxeSi ujredisiT. Cveulebriv kvebaze gadasvla SeiZleba
temperaturis normalizaciidan 15-25 dRis Semdeg.
avadmyofebs eniSneba rZis nawarmi _ mawoni, kefiri, araJani, xaWo, naduRi, agreTve
Toxlo kvercxi an omleti, bulioni, gaxexili supebi, mananis burRulisa da brinjis
fafebi, bostneulis piure, dakepili xorci, orTqlze momzadebuli kotleti, Jele,
tkbili Cai, TeTri orcxobila. kveba tardeba mcire ulufebiT, xSirad, aucilebelia
sakmarisi raodenobis siTxis miReba askilis nayenis an borjomis saxiT.
etiotropuli saSualebebidan ufro miRebulia qloramfenikoli, romelic tifur-
paratifur mikrobebze baqteriacidulad moqmedebs. preparati iniSneba per os, kunTebSi
an venaSi. mcire asakis bavSvebs erT miRebaze eZleva 0,01-0,015 g/kg sxeulis masaze,
skolamdeli da skolis asakis bavSvebs ki _ 0,15-0,25g/kg 4-jer dReSi.
umravles SemTxvevaSi temperatura normaluri xdeba ramodenime dReSi. pirvel
dReebSive mniSvnelovnad mcirdeba saerTo intoqsikaciis movlenebi, magram preparatis
miReba unda gagrZeldes aranakleb 10 dRisa, rac uzrunvelyofs recidivebis mkveTr
Semcirebas. (À\È\ Õî÷àâà= Ì\Ì\ Êóëèåâ= Â\È\ Ïîêðîâñêèé)
Ïîêðîâñêèé). xolo distrofiul
avadmyofebSi an mosalodneli saSiSi garTulebebis dros etiotropuli mkurnaloba
grZeldeba 3 kviramde normaluri temperaturis fonze. unda aRiniSnos, rom
qloramfenikoliT mkurnaloba ver uzrunvelyofs qronikuli mtareblobis ganviTarebis
Tavidan acilebas.
qloramfenikoliT mkurnalobis uefeqtobis SemTxvevaSi an misi miRebis
winaaRmdegCvenebis dros avadmyofebs eniSnebaT ampicilini 50-100 mg/kg sxeulis masaze
4 miRebaze dReSi, Tumca ampicilinTerapia qloramfenikoliT mkurnalobasTan SedarebiT
ufro Senelebuli efeqtiT gamoirCeva, magram recidivebi da qronikuli
baqteriamtarebloba SedarebiT naklebad viTardeba. arsebobs monacemebi imis Sesaxeb,rom
ampicilinis maRali dozebi 4-6 kviris ganmavlobaSi iwvevs baqteriamtareblobis
gankurnebas, maT Soris im pirebSic, visac aReniSneba qolecistiti.
amoqsicilini(100mg/kg 3 miRebaze) klinikuri efeqtiT qloramfenikols ar
Camouvardeba, xolo ampicilinTan SedarebiT ufro ukeTesad moqmedebs. mkurnalobaSi
iyeneben trimetoprim-sulfametoqsazols asakis Sesabamisad, Tumca efeqti
qloramfenikolsa da ampicilinze naklebia.
dezintoqsikaciis mizniT gamoiyeneba reopoliglukinis, glukozis, 0,9% NaCl-is,
ringeris laqtatis, vitaminebis intravenuri Seyvana.
369
kerZo nawili. muclis tifi da paratifebi A, B, C
370
kerZo nawili.
iersiniuli infeqcia. fsevdotuberkulozi
iersiniuli infeqcia
fsevdotuberkulozi
PSEUDOTUBERCULOSIS
371
kerZo nawili.
iersiniuli infeqcia. fsevdotuberkulozi
372
kerZo nawili.
iersiniuli infeqcia. fsevdotuberkulozi
373
kerZo nawili.
iersiniuli infeqcia. fsevdotuberkulozi
374
kerZo nawili.
iersiniuli infeqcia. fsevdotuberkulozi
375
kerZo nawili.
iersiniuli infeqcia. fsevdotuberkulozi
Cveulebriv, ufro msubuqad mimdinareoben, vidre mwvave periodi. ufro xSirad adgili
aqvs erT recidivul talRas, naklebad 2-3 da mets. recidivuli mimdinareobisas
gamojansaRebis periodi 2-3 Tvemde aRwevs.
gamojanmrTelebis periodSi temperaturis normalizacia TandaTanobiT xdeba, zogadi
intoqsikaciis movlenebi qreba, Sinagani organoebis funqciebi normalizacias ganicdis.
aqercvla tanze, kiserze burbuSelasebr xasiaTs Rebulobs, ufro uxeSi aqercvla _
Sreebad an foTliseburi, uviTardebaT xelis gulebze da terfebze.
sada (garTulebis gareSe) mimdinareobis dros daavadebis xangrZlivoba 1-1,5 Tves
ar aRemateba.
fsevdotuberkulozis sayovelTaod miRebuli klasifikacia jerjerobiT ar arsebobs,
xolo arsebuli klasifikaciebi efuZneba ama Tu im klinikuri simptomatikis upirates
gamovlinebas.
pediatrebisaTvis misaRebia klasifikacia ti pis, simZimisa da mimdinareobis xasiaTis
gaTvaliswinebiT.
ti pur mimdinareobas miekuTvneba daavadebis is formebi, romlebic srulad an
nawilobriv emTxveva damaxasiaTebel klinikur simptomatikas _ qunTruSiseburi, abdominuri,
generalizebuli, arTralgiuri, Sereuli da sefsisuri ti pebi.
ama Tu im Semofargluli klinikuri sindromebiT daavadebis mimdinareoba iSviaTia,
klinikur praqtikaSi ufro Sereuli formebi gvxvdeba, amasTan aseT gamovlinebebs
adgili aqvT erTdroulad, ufro xSirad ki _ Tanmimdevrulad iSleba klinikuri
suraTi. amasTan dakavSirebiT Sereuli formebis arseboba ufro Seefardeba ti pur
gamovlinebebs.
ati purs miakuTvneben waSlil, subklinikur da katarul formebs.
fsevdotuberkulozis msubuqi formebi xasiaTdebian umniSvnelo intoqsikaciiT _
temperatura 38-38,5°C-s ar aRemateba da ufro xanmoklea, gamonayari zomieradaa
gamoxatuli, RviZli odnav aris gadidebuli, arTritebi da sxva simptomebi sustadaa
warmodgenili.
saSualo simZimiT mimdinareobisas intoqsikacia mniSvnelovania, temperatura 38,5°C-
ze metia. avadmyofebi uCivian gulisrevas, ganmeorebiT Rebinebas, gamonayari uxvia,
Sinagani organoebis mxriv aRiniSneba cvlilebebi.
mZime formis dros saxezea organizmis Zlieri intoqsikacia, maRali da mdgradi
temperatura, ganmeorebiTi Rebineba, Tavbrusxveva, gamonayari intensiuria, xSirad
hemoragiuli xasiaTis. damaxasiaTebelia RviZlis, saxsrebis, kuW-nawlavis traqtis,
gul-sisxlZarRvTa da sxva sistemebis xangrZlivi dazianeba. xSirad aseTi formebi
xasiaTdebian generalizebuli mimdinareobiT. am dros periferiul sisxlSi aRiniSneba
leikocitebis toqsikuri marcvlovaneba, maRali leikocitozi, anemia, Trombocitopenia.
ati puri formebi xasiaTdebian msubuqi mimdinareobiT. rac Seexeba subklinikur
(inaparantul) formas, misi diagnostika emyareba mxolod laboratoriul monacemebs.
garTulebebi. xSir garTulebad iTvleba alergiuli xasiaTis gamonayari,
WinWriseburi, kvinkes SeSupeba, reaqtiuli arTritebi, nodozuri eriTema, reiteris
sindromi. iSviaTia fsevdotuberkulozuri meningiti, meningoencefaliti, Tirkmlebis
mwvave ukmarisoba, miokarditi, pnevmonia.
diagnostika. klinikurad diagnozis dadgena garkveul siZneleebTanaa dakavSirebuli
da, ZiriTadad, daavadebis ti pur gamovlinebebs eyrdnoba _ Sereuli formebis
damaxasiaTebel simptomatikas, rogoricaa organizmis saerTo intoqsikacia, piris Rrus
lorwovani garsebis katari, kuW-nawlavis traqtis, RviZlis mxriv movlenebi, saxsrebis
dazianeba da kanis damaxasiaTebeli egzanTema (“kapiuSonis”, “xelTaTmanis”, “windebis”
simptomebi), mniSvneloba aqvs, agreTve, epidanamnezs, zamTar-gazafxulis sezonurobas,
376
kerZo nawili.
iersiniuli infeqcia. fsevdotuberkulozi
377
kerZo nawili.
iersiniuli infeqcia. fsevdotuberkulozi
378
kerZo nawili. fsevdotuberkulozi
iersiniuli infeqcia. nawlavTa iersiniozi
mecxoveleobis kompleqsebSi.
kvebiT blokebSi daavadebis afeTqebis dros aucilebelia dezinfeqcia da sanitaruli
damuSaveba.
avadmyofis hospitalizaciis Semdeg tardeba daskvniTi dezinfeqcia.
specifikuri profilaqtika SemuSavebuli ar aris.
nawlavTa iersiniozi
(YERSINIOSIS ENTEROCOLITICA)
379
kerZo nawili.
iersiniuli infeqcia. nawlavTa iersiniozi
380
kerZo nawili.
iersiniuli infeqcia. nawlavTa iersiniozi
381
kerZo nawili.
iersiniuli infeqcia. nawlavTa iersiniozi
382
kerZo nawili.
iersiniuli infeqcia. nawlavTa iersiniozi
383
kerZo nawili. baqteriuli dizenteria
baqteriuli dizenteria
Semoklebuli
qvej gufi saxeoba serotipi qveserotipi antigenuri
formula
A S. dysenteriae 1-12 -
B S. flexneri* 1 1a I : 4
1b I : 6 * S. flexneri 5
2 2a II : 3,4... gvxvdeba ori
2b II : 7,8... qveserovaris saxiT: 5a
3 3a III : 6,7,8...
(V:4) d a 5b (V:7).
SeniSvna: serovari da
3b III : 3,4,6...
qveserovari aRiniSneba
3c III : 6…
arabuli cifrebiT, magram
4 4a IV : 3,4...
ukanasknelT emateba
4b IV : 6...
patara laTinuri asoebi
5 * V : 7,8... ( a,b a n c).
). t i p u r i
6 - VI :- antigenebi aRiniSneba
X_variant - - :7,8… romauli cifrebiT ((I_VI
I_VI ),
I_VI),
Y_variant - -:3,4 xolo jgufebis
C S. boydii 1-18 - antigenebi arabuli
D S. sonnei - - cifrebiT (3,4,6,7,8).
384
kerZo nawili. baqteriuli dizenteria
385
kerZo nawili. baqteriuli dizenteria
386
kerZo nawili. baqteriuli dizenteria
387
iersiniuli infeqcia
388
baqteriuli dizenteria
389
kerZo nawili. baqteriuli dizenteria
390
kerZo nawili. baqteriuli dizenteria
391
kerZo nawili. baqteriuli dizenteria
392
kerZo nawili. salmonelozi
salmonelozi
(SALMONELLOSIS)
393
kerZo nawili. salmonelozi
394
kerZo nawili. salmonelozi
395
kerZo nawili. salmonelozi
mZime dehidratacia. kanis naoWis Zalian neli salmonelozi. mZime dehidratacia. komaturi
gasworeba. (msoflio janmrTelobis dacvis mdgomareoba. `Cacvenili Tvalebi~, mSrali tuCebi,
organizaciis masalebi) cremli ar aqvs. (sakuTari masala)
396
kerZo nawili. salmonelozi
397
kerZo nawili. salmonelozi
398
kerZo nawili. salmonelozi
399
kerZo nawili. salmonelozi
400
kerZo nawili. salmonelozi
401
kerZo nawili. eSerixiozi
eSerixiozi
(ESCHERICHIOSIS)
eSerixiebis klasifikacia
eSerixiebis
# yvelaze xSiri serotipebi
kategoria
1 enteropaTogenuri klasi I plazmid(+). 055, 086, 0111, 0119, 0125, 0126, 0127,
0128ab, 0142
EPEC (epnC) klasi II plazmid(-) , 018, 044, 0112, 0114
2 enteroinvaziuri plazmid(+) 028ac, 029, 0124, 0136, 0143, 0144, 0152, 0164,
0167 da zogierTi aratipirebadi Stami
EIEC (einC)
3 enterotoqsigenuri plazmid(+) 06, 08, 015, 020, 025, 027, 063, 073, 080, 085,
402
kerZo nawili. eSerixiozi
403
kerZo nawili. eSerixiozi
404
kerZo nawili. eSerixiozi
405
kerZo nawili. eSerixiozi
406
kerZo nawili. eSerixiozi
407
kerZo nawili. eSerixiozi
408
kerZo nawili. eSerixiozi
409
kerZo nawili. qolera
qolera
(CHOLERA)
410
kerZo nawili. qolera
411
kerZo nawili. qolera
412
kerZo nawili. qolera
413
kerZo nawili. qolera
414
kerZo nawili. qolera
415
kerZo nawili. qolera
416
kerZo nawili. qolera
specifikuri SratiT.
eqspres--diagnostikisaTvis gamoiyeneba luminescenciuri-serologiuri meTodi.
eqspres
arapirdapiri hemaglutinaciis reaqcia, vibrionebis imobilizacia qoleris sawinaaRmdego
01 SratiT, aglutinaciis reaqcia fazur-kontrastuli mikroskopiiT da sxva. aRwerili
meTodebiT dadebiTi Sedegebis miReba SeiZleba ramdenime saaTSi. aseve gamoiyeneba
enzimniSandebuli imunosorbentuli, poliklonuri da monoklonuri antisxeulebi da
pjr.
diagnostika.. I da II xarisxis dehidrataciis dros saWiroa
diferenciuli diagnostika
gamoiricxos iseTi infeqciebi, rogoricaa kvebiTi toqsikoinfeqciebi, eSerixiozi,
salmonelozi, rotavirusuli gastroenteriti, sokoTi da SxamqimikatebiT mowamvla.
kvebiTi toqsikoinfeqciebis dros dgindeba daavadebis ganviTareba inficirebuli
sakvebi produqtebis miRebasTan dakavSirebiT. daavadebis pirvel saaTebSi mkveTradaa
gamoxatuli gastrituli gamovlinebebi, iSviaTia enteritis suraTi.
eSerixiozis dros aRiniSneba xangrZlivi temperaturuli reaqcia. defekacia
ganavlovani masebiT, TandaTanobiTi toqsikozisa da eqsikozis ganviTareba.
salmonelozis dros, garda gamoxatuli, zogjer xangrZlivi temperaturisa, aris
momwvano feris myrali ganavali.
rotavirusuli infeqciis dros ganavali wylisebria, xSirad aRiniSneba zemo
respiraciuli gzebis katari, adgili aqvs daavadebis epidkerebs, sezonurobas Semodgoma-
zamTarSi.
sokoTi da SxamqimikatebiT mowamvlisas klinikur suraTSi dominirebs muclis
Zlieri tkivilebi SemdgomSi faRaraTis darTviT. saxezea RviZlis dazianeba siyviTlis
ganviTarebiT, RviZlis funqciuri sinjebis darRveviT. didi mniSvneloba aqvs anamnezSi
miRebuli produqtebis dadgenas.
prognozi.. Tavis droze diagnostirebuli da adekvaturi mkurnalobis Catarebisas
prognozi
El-Tor qoleris dros letaloba 1-3%-s ar aRemateba, mcire asakis bavSvebSi ki es
maCvenebeli gacilebiT metia.
mkurnaloba.. qoleriT daavadebulebi, miuxedavad daavadebis simZimisa, eqvemdebarebian
mkurnaloba
aucilebel hospitalizacias specialurad maTTvis mowyobil ganyofilebebSi an boqsebSi.
daavadebis paTogenezis, ZiriTadi sindromebis gaTvaliswinebiT pirvel rigSi, saWiroa
wyal-marilovani balansis saswrafod aRdgena, misma Seferxebam ki SeiZleba sabediswero
gamosavali gamoiwvios.
araswori mkurnaloba an misi arCatareba iwvevs Tirkmlebis mwvave ukmarisobas,
hi pokaliemias, es ukanaskneli ki, Tavis mxriv, ganapirobebs nawlavTa atonias,
hi potonias, aritmias, cvlilebebs miokardiumSi, viTardeba anuria, azotemia, sisxlis
mimoqcevis darRveva tvinSi, acidozi da uremia cns-is dazianebiT, gonebis dakargviT,
soporiT, komiT.
wyal-marilovani xsnarebiT rehidratacia or etapad xorcieldeba – pirveladi
rehidratacia iTvaliswinebs, dauyovnebliv iqnes aRdgenili siTxisa da eleqtrolitebis
deficiti, meoradi rehidrataciis mizania eleqtrolitebisa da siTxis mimdinare
dakargvis koreqcia.
avadmyofebs, romlebsac aReniSnebaT I, II xarisxis dehidratacia utardebaT oraluri
rehidratacia glukoza-marilovani xsnarebiT; mag. ORS romelic Seicavs 3,5 g natriumis
qlorids, 2,9 g natriumis citrats, 1,5 g kaliumis qlorids, 20 g mSral glukozas da
unda gaixsnas 1 l sasmel wyalSi). analogiuri Semadgenlobisaa citraglukosolani.
III xarisxis dehidrataciis drosac parenterul rehidrataciasTan erTad iniSneba
oraluri rehidrataciac (Tu ar aris Seupovari Rebineba) zemoaRniSnuli xsnarebiT.
(rehidrataciis sqemebi “a”, “b”, “g” ix. –`mkurnalobis saerTo princi pebi~).
417
kerZo nawili. qolera
418
qolera
kerZo nawili. zogierTi araqoleragenuli vibrionebiT ... infeqciebi
419
kerZo nawili.
zogierTi pirobiTpaTogenuri ... infeqciebi. kampilobaqteriozi
kampilobaqteriozi
(CAMPYLOBACTERIOSIS)
sinonimi _ vibriozi
vibriozi.
nawlavTa kampilobaqteriozi warmoadgens mwvave infeqciur-zoonozur daavadebas
gadacemis fekalur-oraluri meqanizmiT, gamowveulia pirobiTpaTogenuri mikrobebiT
Campylobacter-is gvaridan da xasiaTdeba gastroenteritis an enterokolitis suraTiT,
iSviaTad Rebulobs generalizebul mimdinareobas (axalSobilebsa da
imunokomprometirebul avadmyofebSi).
cnobebi. mikrobebi miekuTvnebian Campylobacter-is gvars (Campylo
istoriuli cnobebi
berZnulad niSnavs daklaknils, xveuls, bacter _ Cxirs), identificirebulia 1909wels.
cnobili iyo, rogorc Sinaur cxovelebSi abortiTa da diareiT mimdinare daavadeba.
adamianTa Soris daavadebis pirveli SemTxvevebi aRweril iqna 1947w. R.Vinzent-isa da
Tanaavtorebis mier, bavSvebSi ki _ 1972w. ukanasknel wlebSi adamianTa Soris, gansakuTrebiT
ki bavSvTa asakSi diareis gamowvevaSi kampilobaqteriebs mniSvnelovan rols miakuTvneben.
etiologia. kampilobaqteriaTa gvarSi arCeven 14 Stams, aqedan 8 paTogenuria
etiologia
adamianisaTvis: C. jejuni, C. fetus, C. coli, C. hypointestinalis, C. laridis, C. cinaedi,
C. fennelliae da C. upsaliensis. C. jejuni-s 90-ze meti serotipi gaaCnia. Helycobacter
pylori (adre cnobili dasaxelebiT C. pylori) warmoadgens axal ojaxs, romelic
Campylobacter-isagan rnm-is wyobiT gamoirCeva. klinikuri gamovlinebebi (nawlavTa
daavadebebi) umetes SemTxvevaSi gamowveulia C. jejuni-iT, xolo nawlavTagare da
generalizebuli infeqcia ki ufro C. fetus-iT. nakleb xSirad diareas (enterits)
iwveven C. coli, C. laridis an C. fetus, xolo C. jejuni da C. coli-s naklebad axasiaTebs
procesis generalizacia. es baqteriebi gramuaryofiTi moZravi Cxirebia 0,5-1 mm zomiT,
sporebs ar warmoqmnian, aqvT 1 an 2 Solti (erT an orive polusze), formiT mogvagonebs
mZimes (vibrions), SeiZleba Zafisebri formisac iyos, aqvs Termostabiluri 0- da
Termolabiluri H-antigeni. kampilobaqteriebs aqvT saerTo antigeni iersiniozisa da
botulizmis gamomwvev mikrobebTan. zogierT Stams Seswevs enterotoqsinis produqciis
unari. mikrobebi mikroaurofilebia da zrdisaTvis saWiroeben Jangbads.
mikrobebi mravldebian agarian niadagze 1%-iani glicerinis damatebiT, sadac wvrili
koloniebis saxes Rebuloben. zrdis optimalur temperaturad iTvleba 37°C, pH-7,0.
kampilobaqteriebs garemoSi garkveuli gamZleoba axasiaTebs. ase mag., 4°C-ze
inarCuneben sicocxles; niadagSi, wyalSi, rZeSi arseboben ramodenime kviris ganmavlobaSi,
gayinul xorcSi _ ramodenime Tves. mgrZnobiareni arian gamoSrobisa da mzis sxivebis
mimarT. wylis duRili da daqlorva mikrobebs mTlianad Slis. rZisa da rZis produqtebis
pasterizacia friad efeqturad iTvleba.
mikrobebi mgrZnobiareni arian eriTromicinis, qloramfenikolis, streptomicinis,
kanamicinis, tetraciklinis, gentamicinis, nakleb mgrZnobiare ki _ penicilinis mimarT.
mikrobebs mgrZnobeloba ara aqvT sulfanilamiduri preparatebis mimarT.
420
kerZo nawili.
zogierTi pirobiTpaTogenuri ... infeqciebi. kampilobaqteriozi
421
kerZo nawili.
zogierTi pirobiTpaTogenuri ... infeqciebi. kampilobaqteriozi
422
kerZo nawili. kampilobaqteriozi
zogierTi pirobiTpaTogenuri ... infeqciebi. klebsielebiT gamowveuli...
423
kerZo nawili.
zogierTi pirobiTpaTogenuri ... infeqciebi. klebsielebiT gamowveuli...
424
kerZo nawili. klebsielebiT gamowveuli...
zogierTi pirobiTpaTogenuri ... infeqciebi. proteusiT gamowveuli...
proteusiT gamowveuli
nawlavTa infeqcia
425
kerZo nawili.
zogierTi pirobiTpaTogenuri ... infeqciebi. proteusiT gamowveuli ...
daavadebac.
paTogenezi . sakvebiT masiuri inficirebis SemTxvevaSi daavadeba iwyeba
toqsikoinfeqciisaTvis damaxasiaTebeli suraTiT, rac ganpirobebulia proteusisa da
misi endotoqsinebis dagrovebiT. endogenuri warmoSobis proteusuli infeqcia ki
viTardeba disbaqteriozis fonze antibiotikebiT xangrZlivi mkurnalobisa da
imunoreaqtiulobis daqveiTebis Sedegad.
proteusuli endotoqsinebi (hemolizini, leikocidini, hialuronidaza, fibrinolizini,
lecitinaza) iwveven kuW-nawlavis traqtis lorwovani garsis dazianebas da organizmis
zogad intoqsikacias.
sayofacxovrebo-kontaqturi gziT inficirebisa da endogenuri warmoSobis infeqciis
dros paTologiuri procesi viTardeba TandaTanobiT, wvrili da msxvili nawlavebis
upiratesi dazianebiT. mikrobebis maRali invaziurobis Sedegad mikrobTa nawili
nawlavis kedelSi xvdeba, saidanac limfagenuri da hematogenuri gziT xvdebian sxvadasxva
Sinagan organoebSi, iq isini kidevac mravldebian, gansakuTrebiT, TirkmlebSi da limfur
kvanZebSi. organizmis zogadi imunoreaqtiulobis daqveiTebis Sedegad xdeba meoradi
kerebis formireba _ pnevmonia, pielonefriti, Cirqovani meningiti da sxva an viTardeba
sefsisi. kuW-nawlavis mxriv adgili aqvs zedapiruli da jirkvlovani epiTeliumis
anTebiT infiltracias, zogjer wylulebis warmoSobas, lorwos hi persekrecias. mZime
SemTxvevebSi SesaZloa ganviTardes eroziul-kolituri proqtosigmoiditi.
klinikuri suraTi vlindeba gastroenteritis, enteritis an enterokolitis
saxiT. mozrdili asakis bavSvebSi adgili aqvs ufro toqsikoinfeqciis suraTs.
inkubaciuri periodi 2-5 saaTia. daavadeba iwyeba mwvaved, SemcivnebiT, temperatura
SeiZleba normaluri iyos an zogjer momatebulia 38-39°C-mde. ramdenime dRe daavadeba
mimdinareobs SeteviTi xasiaTis muclis tkiviliT epigastriumis an mTeli muclis
areSi. erTdroulad viTardeba faRaraTi. ganavali wylisebria, raime paTologiuri
minarevebis gareSe, zogjer lorwosa da sisxlis minarevebiT. aRiniSneba meteorizmi.
mZime SemTxvevaSi SeiZleba ganviTardes kolaftoiduri mdgomareoba letaluri
gamosavliT. umravles SemTxvevaSi daavadeba msubuqi da saSualo simZimiT mimdinareobs,
xangrZlivoba 2-7 dRes ar aRemateba da mTavrdeba sruli gamojanmrTelebiT.
axalSobilebsa da dauZlurebul bavSvebSi daavadeba xSirad enteritisa da
enterokolitis saxiT mimdinareobs. inkubaciuri periodis xangrZlivoba 2-5 dRea.
aRiniSneba zogadi intoqsikacia, wamoqafeba, Rebineba, adinamia, faRaraTi, mousvenroba,
muclis perioduli tkivili. faRaraTi xasiaTdeba Txeli, momwvano feris, myrali
sunis mqone uxvi ganavliT, lorwosa da sisxlis minarevebiT, anusis Zlieri gaRizianebiT,
Tumca anusis Riaoba ar aRiniSneba.
daavadeba SeiZleba mimdinareobdes mwvaved (1 Tve), gaxangrZlivebulad (1-3 Tve)
an miiRos qronikuli mimdinareoba (3 Tveze meti).
reqtoromanoskopiiT aRiniSneba kataruli, hemoragiuli, iSviaTad eroziuli
proqtosigmoiditi. periferiul sisxlSi cvlilebebi ifargleba leikopeniiT an
normocitoziT mcire neitrofiluri gadaxriT marcxniv, SedarebiTi limfocitoziT,
eds momatebulia 15-20 mm/sT-mde.
diagnozi sabolood ismeba baqteriologiuri da serologiuri monacemebis
safuZvelze. gamokvleuli unda iyos ganavali, pirnaRebi masa, kuWis amonarecxi, sakvebi
produqtebi, dedis rZe. vinaidan proteusi pirobiTpaTogenur floras miekuTvneba,
diagnostikisaTvis mniSvneloba eniWeba mis masiur da mravaljerad amoTesvas. sxvadasxva
wyarodan gamoyofili StamebiT aglutinaciisa da arapirdapiri hemaglutinaciis reaqciaSi
specifikuri antisxeulebis titris zrda 4-jer da metjer dinamikaSi adasturebs
proteusiT gamowveul infeqcias.
426
kerZo nawili. proteusiT gamowveuli ...
zogierTi pirobiTpaTogenuri ... infeqciebi. nawlavTa ... citrobaqteriuli ...
427
kerZo nawili.
zogierTi pirobiTpaTogenuri ... infeqciebi. nawlavTa ... fsevdomonuri ...
428
kerZo nawili.
zogierTi pirobiTpaTogenuri ... infeqciebi. nawlavTa ... fsevdomonuri ...
429
kerZo nawili.
nawlavTa anaerobuli infeqcia klostridium perfringensiT ...
430
kerZo nawili. klostridium perfringensiT ...
nawlavTa anaerobuli infeqcia klostridium dificileTi ...
431
kerZo nawili.
nawlavTa anaerobuli infeqcia klostridium dificileTi ...
432
kerZo nawili.
nawlavTa anaerobuli infeqcia klostridium dificileTi ...
433
kerZo nawili.
nawlavTa anaerobuli infeqcia klostridium dificileTi ...
434
kerZo nawili. nawlavTa disbaqteriozi
nawlavTa disbaqteriozi
435
kerZo nawili. nawlavTa disbaqteriozi
436
kerZo nawili. nawlavTa disbaqteriozi
kriteriumebi
mikroflora axalSobilebSi mozrdilebSi da
1 wlis asakis bavSvebSi
paTogenuri mikrobebi nawlavTa ojaxidan _ _
nawlavTa Cxirebis saerTo raodenoba 100 - 700 mln/1g 300 - 400 mln/1g
nawlavTa Cxirebi susti fermentuli TvisebebiT araumetes 10 %-sa araumetes 10 %-sa
laqtonegatiuri enterobaqteriebi >> >> 5 % >> >> 5 %
hemolizuri nawlavTa Cxirebi _ _
kokuri formebi saerTo mikrobebidan araumetes 25 %-sa araumetes 5 %-sa
hemolizuri stafilokokebis procentuli _ _
Semadgenloba yvela kokebTan SedarebiT
bifiduobaqteriebi 9
10 da meti
8
10 da meti
proteusis gvaris mikrobebi _ _
kandidas gvaris mikrobebi _ _
M-17 nawlavis Cxiris raodenoba (%) _ _
kolibaqteriniT, bifikoliT mkurnalobamde
rZemJavis baqteriebi 10 - 100 mln/g 1 - 10 mln/g
enterokokebi 1 - 20 mln/g 1 mln/g
sxva mikroorganizmebi _ _
437
kerZo nawili. nawlavTa disbaqteriozi
438
kerZo nawili. nawlavTa disbaqteriozi
439
kerZo nawili. nawlavTa disbaqteriozi
440
nawlavTa disbaqteriozi
kerZo nawili. kandidozi
kandidozi
CANDIDOSIS
441
kerZo nawili. kandidozi
442
kerZo nawili. kandidozi
443
kerZo nawili. kandidozi
444
kerZo nawili. kandidozi
445
kerZo nawili.
protozouli infeqciebi. amebiazi
protozouli infeqciebi
amebiazi
(AMEBIASIS)
446
kerZo nawili.
protozouli infeqciebi. amebiazi
447
kerZo nawili.
protozouli infeqciebi. amebiazi
448
kerZo nawili.
protozouli infeqciebi. amebiazi
tkivilebi.
kardinalur simptomad
iTvleba faRaraTi, romelic
dasawyisSi uxvganavlovani da
mkveTrsuniania da Seicavs
gamWvirvale lorwos, Semdeg igi
TandaTanobiT kargavs ganavlovan
xasiaTs, izrdeba masSi lorwos
raodenoba, romelic gamWvirvale
da miniseburia da advilad
ekvreba qoTans. mogvianebiT
ganavalSi Cndeba sisxli, romlis
lorwoSi SereviT zogjer es
ukanaskneli Rebulobs
`Jolosebri Jeles saxes” da
axasiaTebs `labisebri
TrTolva”. daavadebis simZimes
gansazRvravs defekaciis sixSire,
romelic dRe-RameSi zogjer 20- amebiazi. nawlavis wylulovani procesi.
30 aRwevs, rac, Sesabamisad, Rrma
dehidrataciis mizezi xdeba. procesSi swori nawlavis CarTvisas avadmyofebi uCivian
Znelad asatan, SeteviTi xasiaTis tenezmebs, SesaZlebelia, ganviTardes anusis Riaoba an
swori nawlavis gamovardna (aRniSnuli mdgomareoba saWiroebs baqteriuli dizenteriis
gamoricxvas), muceli odnav Seberilia, sigmoiduri kolinji ki palpaciiT mtkivneuli.
xazgasasmelia, rom nawlavTa amebiazi araiSviaTad mimdinareobs asimptomurad, dizenteriis
ti pis simptomebis gareSe, waSlili formiT, yabzobiTac ki.
msxvili nawlavis lorwovan garsze endoskopiiT naxuloben 2-dan 10-20 mm-mde
diametris mqone wylulebs, romelTa lokalizaciis adgili ufro metad lorwovani
naoWis zemo nawilia. wylulebis kideebi SeSupebuli da CaTxrilia, fuZe ki serozul
garss aRwevs, rac mZime garTulebis _ perforaciisa da peritonitis mizezi xdeba.
wylulebis fuZeebi, Cveulebriv, gavsebulia CirqiTa da danekrozebuli masiT, TviTon
wylulebi ki Semofarglulia hiperemiuli zoniT, rac maT lorwovani garsis normaluri
an odnav hi peremiuli da SeSupebuli ubnebisagan gamohyofs.
mwvave diareuli movlenebi SeiZleba, ramdenime kviras gagrZeldes, Sewydes spontanurad,
specifikuri mkurnalobis gareSe, xangrZlivi remisiis ganviTarebiT, magram Semdeg
kvlav aRiniSnos mwvave simptomatika da a.S., rac iRebs qronikuli mimdinareobis
xasiaTs, grZeldeba TveobiT da, SesaZloa, wlobiTac. qronikuli baqteriuli dizenteriis
analogiurad, daavadebam SeiZleba miiRos morecidive an uwyveti mimdinareoba. morecidive
forma gamwvavebis fazaSi vlindeba mwvave diareuli simptomatikiTa da saerTo
mdgomareobis gauaresebiT, remisiis dros ganavali gaformebulia, saerTo mdgomareoba
ki _ damakmayofilebeli. uwyveti mimdinareoba xasiaTdeba simptomatikis SedarebiT
SesustebiT an piriqiT, aSkara gamwvavebiT.
ameburi dizenteriis qronikuli mimdinareobisas organizmis reaqtiuloba mkveTrad
qveiTdeba, iSleba kveba, viTardeba avitaminozi, asTeniuri sindromi da a.S.
ameburi dizenteriis momdevno mudmiv simptomad iTvleba tkivilebi muclis
areSi, romelTa intensivobas gansazRvravs daavadebis simZime. msubuqi formis dros
tkivilebi ufro lokaluri xasiaTisaa da upiratesad epigastriumis, ileocekalur an
marcxena ferdqveS midamoSi aRiniSneba. mZime mimdinareobisas tkivilebi difuzurad
449
kerZo nawili.
protozouli infeqciebi. amebiazi
450
kerZo nawili.
protozouli infeqciebi. amebiazi
451
kerZo nawili.
protozouli infeqciebi. amebiazi
452
kerZo nawili. amebiazi
protozouli infeqciebi. niadagSi mobinadre amebebiT gamowveuli daavadeba
453
kerZo nawili.
protozouli infeqciebi. niadagSi mobinadre amebebiT gamowveuli daavadeba
454
kerZo nawili.
protozouli infeqciebi. pnevmocistozi
pnevmocistozi
(PNEUMOCYSTOSIS)
(intersticiuli plazmurujredovani pnevmoniti)
455
kerZo nawili. pnevmocistozi
protozouli infeqciebi. leiSmaniozebi
vlindeba.
daavadebis paTogenezSi didi roli eniWeba ujredul imunitets. CD4-is maCveneblis
daqveiTeba pnevmocisturi pnevmoniis dawyebis indikatorad iTvleba da profilaqtikuri
qimioTerapiis aucileblobaze miuTiTebs.
klinika. epidafeTqebis dros viTardeba intersticiuli plazmurujredovani
klinika
pnevmonia. Cvili da mcire asakis bavSvebSi daavadeba qvemwvaved mimdinareobs. gamoxatulia
sunTqvis gaxSireba normaluri temperaturis fonze, neknTaSorisi da epigastriumis
areebis Cazneqa, cianozi.
sporaduli SemTxvevebis dros ki pnevmocisturi pnevmonia imunodeficitis
gamovlinebaa. daavadeba iwyeba mwvaved, xveliT, sunTqvis uecari gaxSirebiT, cianoziT,
dispnoeTi. sunTqvis aqtSi monawileobs damxmare kunTebi, aRiniSneba cxviris nestoebis
berva, Tumca zogjer simptomebi varirebs. rogorc wesi, fizikaluri monacemebi sustia.
zogierT SemTxvevaSi pnevmocistozi vlindeba eqstrapulmonuri simptomebiTac: retinitiT,
elenTisa da Zvlis tvinis dazianebiT. rentgenologiurad aRiniSnebafiltvis orive
mxares alveolebis granuluri dazianeba. Tavidan Crdili Cndeba filtvis karis
irgvliv, Semdeg progresirebs periferiisken da bolos, apeqsisken.
diagnozi ismeba daavadebis ti puri mimdinareobiT, parazitis aRmoCeniT filtvebSi
filtvis lavaJiT, traqeis SigTavsis aspiraciiT, transbronquli bioftatiT, perkutanuli
transTorakaluri aspiraciiT an ,,Ria filtvis” dros. cistebze masala iRebeba
Grocott-Gomori-s wesiT an toludinis lurjiT. trofozoitebisa da sporozoitebis
aRmosaCenad gamoiyeneba Giemsa-s wesi an poliqromiT SeRebva. mafluorescirebeli
niSandebuli antisxeulebi gamoiyeneba parazitis orive formis gamosakvlevad.
mkurnalobis gareSe daavadeba 3-4 kviraSi sikvdiliT mTavrdeba. asarCev preparatia
trimetoprim (15-20mg/kg/24saaTSi) _ sulfametoqsazoli (75-100mg/kg/24saaTSi). Sidsis
dros mkurnalobis kursi 3 kviraa, sxva SemTxvevaSi ki - 2 kvira. alternatiul
preparats warmoadgens pentamidinis izeTionati 4mg/kg dRe-RameSi 1-jer. zogierTi
mkvlevaris azriT, mZime pnevmoniis dros mizanSewonilia kortikosteroidebis gamoyenebac
(sasicocxlo CvenebiT ).
profilaqtikis mizniT trimetoprim (5mg/kg/24saaTSi) _sulfametoqsazoli (25mg/
kg/24saaTSi) iniSneba yoveldRe, an kviraSi 3 dRe, xolo misi xangrZlivoba damokidebulia
imunokomprometaciaze.
leiSmaniozebi
(LEISHMANIOSES)
456
kerZo nawili.
protozouli infeqciebi. leiSmaniozebi
eti
etio logia. leiSmaniozis gamomwvevi parazitebi miekuTvnebian Protozoa-s ti ps,
ologia
Sarcomastigophora-s qveti ps, Mastigophora-s zeklass, Flagellata-s klass,
Kinetoplastida-s razms, Trypanosomidae-s ojaxs, Leishmania-s gvars.
visceruli leiSmaniozis gamomwvevebi Leishmania donovani iyofa 4 saxeobad:
1) L. d. donovani (induri varianti); 2) L.d. infantum (xmelTaSua zRva-Suaaziuri
varianti); 3) L.d. archibaldi (aRmosavleT-afrikuli varianti); 4) L.d. chagasi
(samxreT-amerikuli varianti). es qvesaxeobebi gansxvavdebian mxolod antigenuri da
bioqimiuri TvisebebiT da ara morfologiurad.
Leishmania tropica (L.tropica minor), L. major (l. tropica major), L. aethiopica
Zveli samyaros kanis leiSmaniozis gamomwvevebia; L. mexicana, L. braziliensis; L.
peruviana, L. amazonensis, L. panamensis, L. guanensis ki _ axali samyaros
kanis leiSmaniozis gamomwvevebi.
leiSmaniebis ganviTarebis cikli mimdinareobs patronis SecvliT da ori stadiisagan
Sedgeba: 1. wamwamovani forma _ promastigotebi _ kargad mravldebian ujredgareSe
gadamtani moskitis organizmSi da qsovilebis kulturebze. 2. uwamwamo forma _
amastigotebi _ obligaturi ujredSiga parazitebia, romlebic parazitoben xerxemliani
cxovelebis mononuklearul ujredebSi.
parazitebis gadamtanebi _ mdedri moskitebi (Phlebotomus (L. donovani-s
gadamtania) Lutzomygia, Psychdopygus) inficirdebian avadmyofi cxovelebis sisxlis
wovis dros. infeqciis gadamtani moskitebis zoma ar aRemateba 1,5-2 mm.
leiSmaniebs amastigotur stadiaSi aqvT ovaluri forma, 3-5 mkm sigrZis da 1-3 mkm
siganis. isini, Cveulebriv, mononuklearul ujredebSi imyofebian da maTi SeRebvisas
advilad naxuloben homogenur an vakuolizebul, lurji feris citoplazmas,
centralurad mdebare birTvsa da lalisfer-wiTel kinetoplasts. promastigotur
stadiaSi leiSmaniebs TiTistariseburi forma aqvT. parazitis sigrZe 10-20 mkm-ia,
sigane 4-5 mkm. SeRebvisas garda citoplazmisa, birTvisa da kinetoplastisa wina
nawilis boloSi SeiniSneba wamwami, romlis saSualebiTac paraziti moZraobs. aRniSnuli
formebis dadgena SesaZlebelia moskitis organizmSi da NNN niadagze kultivirebis
Sedegad.
epidemiologia . visceruli leiSmaniozi (Leishmaniosis visceralis)
gavrcelebulia tropikul da subtropikul qveynebSi. yvelaze ufro aqtiuri kerebia
CineTSi, indoeTSi, bangladeSSi, iranSi, TurqeTSi, centralur da samxreT amerikaSi, Sua
aziaSi, xmelTaSua zRvis qveynebSi, amierkavkasiaSi da sxva.
visceruli leiSmaniozis wyarosa da rezervuars warmoadgenen ZaRlebi da maTi
msgavsi gareuli cxovelebi (tura, mela), SesaZlebelia avadmyofi adamianic; kanis
qalaqis ti pis leiSmaniozis dros avadmyofi adamiani da SesaZlebelia ZaRlebi.
soflis ti pis leiSmaniozis dros ki sxvadasxva mRrRnelebi ( didi meqviSia, qudwiTela
meqviSia, wvrilTaviani Tria, firfitisebrkbiliani virTxa da sxva).
parazitebi mravldebian sacxovrebeli saxlis sardafebSi, gamoqvabulebSi, frinvelTa
budeebSi, kldis napralebSi da sxva. tropikul qveynebSi moskitebi gvxvdeba mTeli
wlis ganmavlobaSi.
mdedri moskitebis inficireba xdeba xorTumiT dazianebuli kanis Cxvletis an
avadmyofi adamianis an cxovelebis sisxlis wovis dros.
kanis soflis ti pis leiSmaniozi gvxvdeba Sua aziis qveynebSi.
LleiSmanioziT daavadebis sezonuroba dakavSirebulia moskitis biologiur
TvisebebTan. gansakuTrebiT didia avadoba im pirebSi, romlebic Camodian endemur
kerebSi.
paTogenezi. leiSmaniebis SeWris adgils warmoadgens kani. moskitis kbenis adgilas
paTogenezi
457
kerZo nawili.
protozouli infeqciebi. leiSmaniozebi
458
kerZo nawili.
protozouli infeqciebi. leiSmaniozebi
459
kerZo nawili.
protozouli infeqciebi. leiSmaniozebi
460
kerZo nawili.
protozouli infeqciebi. leiSmaniozebi
461
kerZo nawili. leiSmaniozebi
protozouli infeqciebi. toqsoplazmozi
toqsoplazmozi
(TOXOPLASMOSIS)
462
kerZo nawili.
protozouli infeqciebi. toqsoplazmozi
463
kerZo nawili.
protozouli infeqciebi. toqsoplazmozi
embrionSi.
epidemiologia. toqsolazmozi ubikvitaruli zoo-anTroponozuli bunebrivi
keris mqone infeqciaa da warmoadgens yvelaze ufro gavrcelebul latentur infeqcias.
iTvleba, rom msoflioSi inficirebul adamianTa ricxvi aRwevs 500 mln-dan 1 mlrd-
mde; did britaneTSi inficirebulTa ricxvi aRwevs 20-40%-s, aSS-Si _ 50-60%,
safrangeTSi _ 90% (Barkar da sxv. 1992), dsT-s qveynebSi _ mosaxleobis 30%-s.
kata da katisebrTa ojaxis warmomadgenlebi (focxveri, bengaliuri kata, iaguari
da sxva), romelTa ganavalSi gamoiyofa toqsoplazmebis oocisturi forma, ganapirobeben
ramodenime aseuli saxis cxovelisa da frinvelis dainficirebas.
katisebrTa ojaxis garda danarCeni cxovelebi da adamiani iTvleba Sualedur
patronad. adamianis inficireba xdeba, umTavresad, umi xorcis an farSis miRebis
Sedegad, gansakuTrebiT ki Roris, cxvris xorcis arasakmarisi Termuli damuSavebis
dros, SesaZlebelia kontaqturi gziT (katasTan kontaqti) anda, iSviaTad, dazianebuli
kanidan (veterinarebi) inficireba. damtkicebulia sisxlis transfuziisa da, gansakuTrebiT,
organoebis transplantaciis roli daavadebis gavrcelebaSi.
avadmyofi adamiani garemoSi parazitebs ar gamoyofs da araviTar saSiSroebas ar
warmoadgens garSemomyofTaTvis. orsulobis pirvel trimestrSi inficireba 15-20%-
Si iwvevs axalSobilTa toqsoplazmozs, romelic mimdinareobs mZimed, orsulobis III
trimestrSi ki axalSobilTa inficirebis procenti aRwevs 65-s, Tumca zogjer daavadeba
mimdinareobs klinikurad gamoxatuli suraTis gareSe. aseTi gansxvaveba dakavSirebulia
placentaSi sisxlis mimoqcevis momatebiT, parazitis virulentobiTa da misi raodenobrivi
maCvenebliT. Tu qalis inficireba moxda orsulobamde 6 TviT da metiT adre, nayofis
inficireba ar xdeba, vinaidan qals uyalibdeba imuniteti, xolo Tu qalis dainficirebasa
da orsulobas Soris dro ufro naklebia, SesaZlebelia, moxdes nayofis inficirebac,
Tumca riskis procenti dabalia. axalSobilTa daavadebis sixSire 1000 axalSobilze
3-8 SemTxvevas aRwevs.
qalebis qronikuli toqsoplazmozis dros orsulebSi nayofis inficireba Zlier
iSviaTad xdeba, zogierTi avtoris azriT ki gamoricxulia dedis garkveuli imunitetis
gamo.
bavSvTa asaki toqsoplazmozis mimarT gansakuTrebuli mimReblobiT gamoirCeva da
warmoadgens latenturi infeqciis yvelaze ufro gavrcelebul mizezs.
paTogenezi: toqsoplazmozi arsebiTad polisistemur daavadebas warmoadgens.
parazitebis SeWra, Cveulebriv, xdeba kuW-nawlavis traqtidan, Tumca literaturaSi
aRwerilia Sidalaboratoriuli maRali virulentobis mqone toqsoplazmebiT kanidan
inficirebis SemTxvevebic. ar aris gamoricxuli samedicino personalis, umTavresad,
meanginekologebis inficireba qalebis vaginaluri gamokvlevisas an mSobiarobis miRebis
dros, amitom SemTxveviTi ar aris aRniSnul pirebSi toqsoplazmozze sakmaod maRali
serologiuri reaqciebis arseboba. toqsoplazmebi nanaxia sanayofe wylebSi, menstrualur
da vaginalur gamonadenSi (loqiaSi).
parazitebi umTavresad wvrili nawlavebis qvemo nawilSi SeWris Semdeg aRweven
regionul limfur kvanZebs, sadac mravldebian kidec da iwveven anTebad-granulomatozur
cvlilebebs (mezadenitsa da sxv.). aRniSnuli granulomebi Tavisi ujreduli
SemadgenlobiT emsgavsebian tuberkulozur- da brucelozur- infeqciuri genezis
granulomebs. momdevno stadias warmoadgens parazitemia da diseminacia Sinagani
organoebis makrofagur-fagocitur sistemaSi fiqsaciiT. pirvel rigSi ziandeba RviZli,
elenTa, limfuri kvanZebi, centraluri nervuli sistema, ConCxis kunTebi, miokardiumi,
Tvali, filtvebi, agreTve endokrinuli sistema, qalebSi saSvilosno da misi danamatebi.
parazitebis aqtiur gamravlebas Tan sdevs sxvadasxva toqsinebisa da alergenebis
464
kerZo nawili.
protozouli infeqciebi. toqsoplazmozi
465
kerZo nawili.
protozouli infeqciebi. toqsoplazmozi
466
kerZo nawili.
protozouli infeqciebi. toqsoplazmozi
centraluri toqsoplaz-
B muri qorioretiniti.
Tandayolili centraluri
toqsoplazmuri
Tandayolili toqsoplaz- makulur da paramakulur qorioretiniti. fskerze
mozi. qoreoretiniti. zonebSi ori msxvili kera. makulur areSi uxeSad
A - mwvave aqtiuri procesi, marjvniv ufro axali, pigmentirebuli kera.
B - Zveli procesi. xolo marcxniv ufro (Å.È. Êîâàëåâñêèé)
(Desmonts G, Zveli, mkafio konturebiT.
Remington J) (Å.È. Êîâàëåâñêèé)
467
kerZo nawili.
protozouli infeqciebi. toqsoplazmozi
laqovan-papuluri an
hemoragiuli xasiaTis
gamonayari. sisxl-
Caqcevebi SeiZleba
iyos sklerebze da
lorwovan garsebSi.
RviZli da elenTa
gadidebulia, xSirad
gamoixateba siyviTle.
damaxasiaTebelia yve-
la jgufis limfuri
Tandayolili
kvanZebis gadideba. toqsoplazmozi da
klinikur suraTSi hidrocefalia.
arc Tu iSviaTia (kompiuteruli
dispefsiuri darR- tomografia)
vevebi, pnevmonia, (Rima Mc LEOD)
miokarditi. Zlier
mZime formebis dros aRiniSneba encefaliti,
meningoencefaliti (Rebineba, krunCxvebi, parezebi
da damblebi, Tavis qalas nervebis dazianeba da
sxv.). Tav-zurgtvinis siTxeSi cilis raodenoba
momatebulia, siTxe qsantoqromulia, citozi
limfocituri xasiaTisaa. qronikuli
toqsoplazmozis progresirebis SemTxvevaSi
daavadeba mTavrdeba letaluri gamosavliT, sxva
SemTxvevaSi procesi gaxangrZlivebuli
mimdinareobis xdeba _ xangrZlivi
subfebriliteti, hepatolie-nuri sindromi,
siyviTle. centraluri nervuli sistemis mxriv
aRiniSneba progresirebadi darRvevebi _
fizikuri da gonebrivi sisuste, metyvelebisa
da motoruli funqciis moSla, kunTTa
hi pertonusi, paTologiuri refleqsebi.
viTardeba hidrocefalia an mikrofTalmia Tandayolili toqsoplazmozi. A-- suraTi
oligofreniiT. mZime Seuqcevadi xasiaTisaa dabadebisas, saSualod dilatirebuli parkuWebi,
patara kalcifikatebi, B-- igive avadmyofi 1 wlis
cvlilebebi Tvalis mxriv _ qorioretiniti,
asakSi antimikrobuli mkurnalobis Semdeg suraTi
mxedvelobis nervis atrofia. iSviaTia smenis TiTqmis normaluria garda 2 patara kalcifikatisa.
daqveiTeba an sruli siyrue. C-- TiTqos janmrTeli dabadebuli bavSvis suraTi
Tandayolili toqsoplazmozi SeiZleba 1 wlis asakSi, sadac ukve Cans gadatanili
mimdinareobdes msubuqi, waSlili an latenturi meningoencefalitis niSnebi (ar iyo
formiT. am dros SesaZlebelia, ganviTardes diagnostirebuli droze) da bavSvi ar mkurnalobda
duned mimdinare encefaliti, rac mogvianebiT, pirveli 3 Tvis manZilze, rodesac ukve gamoixata
6-7 wlis asakSi (swavlis periodSi) bavSvebSi hidrocefalia; Cans rezidualuri atrofia da
iwvevs swraf daRlas, Tavis tkivils, krunCxviT kalcifikatebi; avadmyofs hqonda ganviTarebis
Seferxeba (motoruli da mxedveloba). D-- suraTi
epizodebs, qorioretinitis suraTs. daavadeba
mikrocefaliis dros, mravlobiTi kalcifikatebi.
grZeldeba wlobiT da avadmyofi mihyavs
E-- hidrocefalia aqvaduqturi stenozis gamo. F--
invalidobamde. Tavis qalas rentgenogramaze igive avadmyofi Suntirebis Semdeg. (komp. tomog.)
an kompiuterul tomogramaze am dros SeiZleba (Mc Auleya, Boyer K, Patel D et al)
468
kerZo nawili.
protozouli infeqciebi. toqsoplazmozi
469
kerZo nawili.
protozouli infeqciebi. toqsoplazmozi
C =antisxeulebis
antisxeulebis titri organizmis romelime siTxeSi X
antisxeulebis titri SratSi
X gamaglobulinis koncentracia SratSi
gamaglobulinis konc. romelime igive siTxeSi
470
kerZo nawili.
protozouli infeqciebi. toqsoplazmozi
471
kerZo nawili.
protozouli infeqciebi. malaria
malaria
(MALARIA)
472
kerZo nawili.
protozouli infeqciebi. malaria
473
kerZo nawili.
protozouli infeqciebi. malaria
474
kerZo nawili.
protozouli infeqciebi. malaria
475
kerZo nawili.
protozouli infeqciebi. malaria
476
kerZo nawili.
protozouli infeqciebi. malaria
477
kerZo nawili.
protozouli infeqciebi. malaria
478
kerZo nawili.
protozouli infeqciebi. malaria
479
kerZo nawili.
protozouli infeqciebi. malaria
peroraluri:
parenteruli preparati
qinidinis glukonati igive, rogorc zemoT igive, rogorc zemoT
an
qininis dihidroqloridi igive, rogorc zemoT igive, rogorc zemoT
plus
wlamde asakSi erTjeradi
erTjerad miRebaze 3 dozaa 1/4 tableti; 1-dan 3
tableti qininiT wlamde asakSi tabletis
pirimeTamin sulfadioqsini
mkurnalobis bolo dRes (an 1/2; 4-dan 8 wlamde 1
(fanzidari)
7,5ml kunTebSi tableti; 9-14 wlamde 2
erTjeradad) tableti; 14 wlis zemoT 3
tableti
an xsnaris saxiT 5-10kg masaze _ 1-1,5ml
11-20kg-ze _ 2,5ml
21-30kg-ze _ 3,5ml
31-45kg-ze _ 5ml
erTjeradi doza 15-25mg/kg 15-25 mg/kg erTjeradad
mefloqsinhidroqloridi
(maqsimum 1250mg) maqsimum 1250mg.
480
kerZo nawili.
protozouli infeqciebi. malaria
cieb-cxeleba.
paTogenezuri TerapiisaTvis gamoiyeneba sisxlis SenacvlebiTi transfuzia,
eleqtrolitebi, glukoza, albumini, imunoglobulini, rkinis preparatebi, B jgufis
vitaminebi, saWiroebisamebr keTdeba dializi.
prognozi. droulad Catarebuli mkurnalobis umravles SemTxvevaSi malaria
keTili mimdinareobiT, swrafi da sruli gamojanmrTelebiT xasiaTdeba. letaloba 1%-
s Seadgens, ZiriTadad, tropikuli malariis avTvisebiani mimdianreobis dros. bavSvebSi
letaloba ufro maRalia (5%-mde).
malariagadatanili pirebi stacionaridan saxlSi ewerebian mkurnalobis kursis
Catarebisa da klinikuri gamojanmrTelebis Semdeg, sisxlis nacxis SeRebvis uaryofiTi
pasuxis, sisxlisa da Sardis saerTo analizebis normalizebis Semdeg.
temperaturis momatebis yvela SemTxvevaSi rekonvalecentebs utardebaT sisxlis
sqeli wveTis gamokvleva malariis plazmodiumze (1,5-2,5 wlis ganmavlobaSi).
profilaqtika iTvaliswinebs RonisZiebebis ganxorcielebas, romelic mimarTulia
epidemiuri procesis ZiriTadi rgolebisaken: 1) malariiT daavadebulebis, parazitis
mtareblebis aqtiuri drouli gamovlineba da maTi mkurnaloba. 2) anofelesis gvaris
koRoebis mospoba da 3) mosaxleobis malariisadmi mimReblobis daqveiTeba. ukanasknelis
mizniT endemur kerebSi gamgzavrebis win bavSvebs wasvlamde 2 kviriT adre da keridan
gamosvlis Semdeg 8 kviris ganmavlobaSi saWiroa, Cautardes malariis qimioprofilaqtika.
qimioprofilaqtikis mizniT gamoiyeneba qlorguanidini (proguanili) 2 wlamde
asakis bavSvebSi 50mg; 2-6 wlamde _ 100mg; 6 wlis zemoT _ 200mg dReSi. preparati
cota mware gemosia. naklebad mwarea, magram ufro toqsikuria pirimeTamini, romelic
2 wlamde bavSvebSi miiReba 1-jer kviraSi _ 6,25mg; 2-6 wlamde 12,5mg; xolo ufro
mozrdilebSi _ 25mg kviraSi.
qloroqini 1 wlamde asakSi miiReba kviraSi erTxel, fuZis 37,5mg, 1-2 wlamde _
fuZis 75mg; 2-6 wlamde _ fuZis 112,5mg; 6-12 wlamde _ fuZis 150mg da ufro zemo
asakSi _ fuZis 300mg kviraSi 1-jer. preparatis mware gemo SeiZleba SevamciroT
jemiT an sqel sirofSi ganzavebiT, Tumca maTi Senaxvis vada moklea.
unda aRiniSnos, rom P. falciparum–is da qlorguanidinisadmi rezistentoba
farTodaa gavrcelebuli, amitom qloroqini iTvleba profilaqtikis saukeTeso
preparatad. amerikaSi ki am preparatisadmic aRiniSneba rezistentoba. amitom
qlorguanidinis dapsonTan (dapson) erTad yoveldRiuri an pirimeTanis dapsonTan
erTad yovelkvireuli gamoyenebaa saWiro. maTi xmareba 6 Tveze meti xangrZlivobiT ar
aris mizanSewonili gverdiTi movlenebis gamo (antifoliuri moqmedeba).
pirimeTaminis ganmeorebiTi xmareba xangrZlivi moqmedebis sulfanilamidebTan
kombinaciaSi (sulfatoqsini, sulfaleni) mizanSewonili ar aris.
8 wlis asakze ufros bavSvebs SeiZleba mokle kursiT daeniSnos doqsiciklini 2
mg/kg dReSi, magram gasaTvaliswinebelia fotosensibilizaciis ganviTareba. im teritoriaze,
sadac aRiniSneba multirezistentuli P. falciparum, zogierT qveyanaSi gamoiyeneba
mefloqini.
arsebobs malariis sawinaaRmdego sami ti pis vaqcina: 1) sporozoituli vaqcina _
icavs malariiT dasnebovnebisagan, vinaidan sporozoitebi kbenis Semdeg dauyovnebliv
ixocebian, 2) merozoituli vaqcina, xels uwyobs usqeso formis parazitebis daxocvas.
aseTi acra ar icavs dasnebovnebisagan. egzoeriTrocituli Sizogonia viTardeba
Cveulebrivi gziT, magram RviZlidan gamosuli merozoitebi ixoceba da daavadebis
klinikuri gamovlineba ar viTardeba, 3) gametcituri vaqcina ar icavs daavadebisagan,
magram koRoebi aseTi sisxlis wovis Semdeg ar inficirdebian.
481
kerZo nawili.
protozouli infeqciebi. lambliozi
lambliozi
(LAMBLIOSIS, GIARDIASIS)
482
kerZo nawili.
protozouli infeqciebi. lambliozi
483
kerZo nawili.
protozouli infeqciebi. lambliozi
mkurnalobis
sadReRamiso doza
xangrZlivoba
mozrdilebi da bavSvebi
35 kg-mde masiT bavSvebi
masiT 35kg-ze meti
(tab. 500 mg) 3 tableti 40 mg/kg sxeulis masaze
1-2 dRe
erT miRebaze saRamos erT miRebaze
484
kerZo nawili.
helminTozebi. askaridozi
helminTozebi
askaridozi
(ASCARIDOSIS)
485
kerZo nawili.
helminTozebi. askaridozi
486
kerZo nawili. askaridozi
helminTozebi. strongiloidozi
strongiloidozi
(STRONGYLOIDOSIS)
487
kerZo nawili.
helminTozebi. strongiloidozi
matlebs.
epidemiologia. daavadeba, ZiriTadad, gavrcelebulia tropikuli da subtropikuli
sartylis qveynebSi.
infeqciis wyaros warmoadgens strongiloidoziT daavadebuli adamiani. igi parazitis
ZiriTadi wyaroa. infeqciis rezervuari SeiZleba iyos ZaRli, kata da sxva.
inficirebuli adamiani, cxoveli ganavalTan erTad gamohyofs parazitis rabditoidul
formebs. isini niadagSi saTanado pirobebis SemTxvevaSi (miwisa da haeris maRali
tenianoba, Jangbadi, miwis neitraluri da tute reaqcia, sakvebis arseboba) arseboben
ganusazRvreli drois ganmavlobaSi. Sesabamis pirobebSi, rabditoiduli forma gadaiqceva
filariad da adamianisaTvis invaziuri xdeba. adamianis invazia SesaZlebelia inficirebul
niadagTan kontaqtis Semdeg. parazitis mier invazia xorcieldeba, Cveulebriv, qvemo
kidurebis kanidan, agreTve SesaZloa piris RruSi moxvedra gabinZurebuli wyliT an
saWmliT. iSviaTia dainficireba dasnebovnebulis kanTan mWidro kontaqtiT.
piradi higienis dabali done xels uwyobs inficirebas.
paTmorfologia. momwifebis stadiaSi (filarias) parazitebs
paTogenezi da paTmorfologia
gaaCniaT unari, aqtiurad SeaRwion kanSi (fexSiSvela siaruli, xelebiT niadagis
damuSaveba an piris RruSi moxvedra gabinZurebuli wyliTa da sakvebiT). Semdeg isini
hematogenurad xvdebian filtvis alveolebSi da askaridebisa da ankilostomebis
analogiurad migrireben bronqul sistemaSi, saidanac nerwyvis gadaylapvis Semdeg
aRweven adgilsamyofels _ wvril nawlavebs. parazituli Taobis sqesobrivad momwifebuli
mdedrebi lokalizdebian wvrili nawlavis lorwovan garsSi, ZiriTadad, 12-goja nawlavis
liberkiunis jirkvlebSi, sadac deben kvercxebs SemdgomSi matlis gamoCekviT. matlebi
garemoSi gamoiyofa fekaliiT, sadac isini gardaiqmnebian filarias msgavs matlebad
(homogenia) an Tavisuflad mcxovreb sqesobrivad momwifebul mdedrebad da mamrebad
(heterogenia), romlebsac gaaCniaT kvercxis produqciis unari.
filarias msgavs Wiebs SeuZliaT adamianis invazireba saTanado SeWris adgilidan,
autoinvazirebis CaTvliT.
aseTi unikaluri ganviTarebis sasicocxlo cikli parazits saSualebas aZlevs,
wlebis ganmavlobaSi imyofebodes erTi da igive organizmSi da gamoiwvios daavadebis
seriozuli klinikuri suraTi.
kanidan matlis SeWris adgilze pirveladi afeqti ar aRiniSneba an SeiZleba
adgili hqondes umniSvnelo cvlilebebs. mxolod reinvaziisas SeiZleba iyos derma-
titis movlenebi an eroziuli procesi.
matlis migracia iwvevs e.w. Löffler-is sindroms (intersticiuli pnevmoniti da
eozinofilia, romelic ufro intensiuri xdeba parazitis nawlavis lorwovan garsSi
SeRwevis dros).
diseminirebuli strongiloidozi warmoadgens rTul process Sinagan organoebSi
ganTesviT, meoradi infeqciis TandarTviT.
parazitis nivTierebaTa cvlisa da sxeulis daSlis produqtebis moqmedeba iwvevs
sensibilizacias, alergias da distrofiul cvlilebebs organizmSi.
klinika. strongiloidozis klinikuri simptomatika vlindeba mxolod erTeul
klinika
avadmyofebSi, xSirad ki mimdinareobs SeumCnevlad.
klinikuri gamovlineba zogjer xasiaTdeba papulur-eriTemuli gamonayriT.
Larve currens mdgomareoba viTardeba parazitis mier kanis meoradi invaziis
dros da xasiaTdeba farTo eriTemul-WinWrisebri gamonayariT, misi swrafi gavrcelebiT,
mcocavi kideebiT. Cveulebriv, misi zoma aRwevs 30 sm-mde, mrgvali formisaa, Cndeba
perianalur midamoSi dundulebze da aris xSirad morecidive.
strongiloidozis kuW-nawlavis formisaTvis damaxasiaTebelia temperatura,
488
kerZo nawili.
helminTozebi. strongiloidozi
muclis tkivilebi, Rebineba, diarea, rac gamowveulia mozrdili matlebis mier wvrili
nawlavis zemo nawilis dazianebiT. aRniSnuli simptomebis sixSire gansazRvruli ar
aris. maT SeiZleba hqondeT mwvave dasawyisi, morecidive mimdinareoba. muclis tkivilebi
xSirad aRiniSneba epigastriumis midamoSi da vlindeba wvis SegrZnebiT, SeteviTi an
yru tkivilebiT. ganavali Txelia, afuebuli, uxvi lorwos minareviT (‘koxinxinis
diarea”), defekaciis sixSire aRwevs 10-15-s dRe-RameSi.
obieqturad avadmyofs aReniSneba Selesili ena, meteorizmi, madis dakargva, palpaciiT
difuzurad mtkivneuli muceli, taqikardia, gulis tonebi moyruebulia.
qronikulma strongiloidozma SeiZleba gamoiwvios malabsorbciis movlenebi _
cilovani enteropaTia sxeulis masis dakargviT.
periferiul sisxlSi aRiniSneba maRali eozinofilia. 70-80%-Si viTardeba anemia.
diseminirebuli strongiloidozi bavSvebSi dakavSirebulia ganwyobis iseT
faqtorebTan, rogoricaa SimSiloba an ujreduli imunitetis defeqti (limfoma, hojkinis
daavadeba, SeZenili imunodeficiti). am SemTxvevebSi daavadeba iwyeba mwvaved, cxelebiT,
mucelSi tkivilebiT viTardeba Soki diseminirebuli septicemiis (diseminirebuli
strongiloidozis) Sedegad. am dros adgili aqvs matlebiT Sinagani organoebis
masiur invazias, isini iwveven organoTa qsovilebis destruqcias. sisxlSi gvaqvs
leikocitozi eozinofiliis gareSe.
diagnozi. nawlavTa strongiloidozi dgindeba fekaliebis mravaljeradi
diagnozi
gamokvleviT an duodenur SigTavsSi parazitebis matlebis aRmoCeniT. gamokvleva
xdeba ganavlis nacxis rogorc pirdapiri, aseve bermanis koncentraciuli meTodiT.
alternatiul meTods warmoadgens Enterotest-iT duodenuri aspiratis gamokvleva.
bavSvebSi ‘hi perinfeqciuri sindromis~ dros matlebi SeiZleba inaxos nerwyvSi,
kuWis SigTavsSi an, iSviaTad, wvrili nawlavis bioftatSi.
strongiloidozi unda gamoiricxos imunodeficitis mqone avadmyofebSi,
romelTac daavadeba daewyoT uecrad, infeqciuri procesis diseminaciiT.
axlaxans mogvawodes serologiuri testi strongiloidebis sawinaaRmdego
antisxeulebis dasadgenad, romelic mgrZnobiare aRmoCnda nawlavTa formis dros,
maSin, rodesac ‘hi perinfeqciuri sindromis~ SemTxvevaSi igi naklebmgrZnobiarea.
mkurnaloba. yvelaze ufro xSirad gamoiyeneba Tiabendazoli (Thiabendazolum),
migraciuli formis dros dozebSi 25 mg/kg 2-jer dReSi, 2 dRis ganmavlobaSi.
hi perinvaziis dros mkurnaloba grZeldeba aranakleb 2 kvirisa. es preparati
winaaRmdegnaCvenebia orsulebSi.
Ivermectin-i erTjerad dozebSi TiTqosda efeqturia, magram misi efeqturoba
generalizebuli formis dros ar aris damtkicebuli.
Tu avadmyofi raRac mizezis gamo saWiroebs imunosupresiul Terapias, saWiroa
antistrongiloiduri Terapiis daniSvna.
profilaqtika. yvelaze ufro racionaluria sanitaruli RonisZiebebis Catareba
niadagis inficirebisa da bavSvidan bavSvze invazirebis Tavidan acilebis mizniT. yvela
gamovlenili bavSvi eqvemdebareba mkurnalobas. pirebs, romelTac utardeba
imunosupresiuli mkurnaloba, mizanSewonilad unda Cautardes fekaliebis gamokvleva
strongiloidebis Wiis kvercxebze.
489
kerZo nawili.
helminTozebi. triqinelozi
triqinelozi
(TRICHINELLOSIS)
490
kerZo nawili.
helminTozebi. triqinelozi
491
kerZo nawili. triqinelozi
helminTozebi. enterobiozi
enterobiozi
(ENTEROBIOSIS)
492
kerZo nawili.
helminTozebi. enterobiozi
intoqsikaciis movlenebi da, rac mTavaria, iwvevs ukana tanis Zlier Semawuxebel
qavils, rac ganapirobebs fsiqasTeniuri da nevrozuli mdgomareobis Camoyalibebas.
eti
etio logia.. enterobiozis gamomwvevi Wia _ Enterobius vermicularis (Oxyuris
ologia
vermicularis _ bavSvTa maxvila) nematodebis klasidanaa, zomiT 1 sm, TeTri ferisaa,
kvercxebi mogrZo, ovaluri, orkonturiani garsiT, romlis zoma 50X30 mkm-ia, formiT
asimetriulia, rac sxva Wiebis kvercxebisagan ganmasxvavebeli ZiriTadi niSania. momwifebul
kvercxSi ukve eqvsi saaTis Semdeg Cndeba larva, romelic garemoSi sicocxlisunarianobas
inarCunebs 20 dRemde.
maxvila parazitobs wvrili nawlavis qvemo nawilSi. mdedri maxvila 10-17 aTasamde
kvercxs Seicavs. igi Camodis swor nawlavSi, analuri napralis garSemo, debs kvercxebs
da kvdeba.
epidemiologia. daavadeba farTodaa gavrcelebuli msoflioSi, invazia
gansakuTrebiT maRalia bavSvebSi. Tvlian, rom enterobiozi ufro socialuri problemaa,
vidre samedicino. infeqciis erTaderTi wyaroa inficirebuli adamiani. dasnebovneba
xdeba fekalur-oraluri gziT. perianalur kanze mdedri maxvilas mier dadebuli
kvercxi 6 saaTSi mwifdeba da iZens invazirebis unars. mdedrebis gadaadgilebiT
gamowveuli qavilis Sedegad, mofxanisas xdeba frCxilebis dainficireba, sxvadasxva
sagnebis, (saTamaSoebis, loginis, tansacmlis, TeTreulis) dabinZureba. Zalian xSiria
autoinficireba xelis TiTebiT perianaluri midamos qavilis Semdeg.
infeqtis gadatanaSi garkveuli roli miekuTvneba buzebs.
paTogenezi. adamianis inficireba xdeba momwifebuli kvercxebis kuW-nawlavis
traqtSi moxvedriT. kuWSi kvercxebi gardaiqmnebian matlebad, migrireben brma nawlavSi,
sadac mwifdebian mozrdil stadiamde. maxvila nawlavis lorwovans meqanikurad azianebs,
mas naxuloben CaWedils lorwovanis Rrma SreSi, zogjer ki kunTovan Sresac aRwevs.
Wiebis nivTierebaTa cvlis Sedegad viTardeba organizmis sensibilizacia da
gamovlindeba alergiuli reaqcia. ganmeorebiTi intensiuri invaziisas mdedrma maxvilam
zogjer SeiZleba SeaRwios qalis sasqeso organoebSi, peritoneumis RruSi. maT, amave
dros, Tan SeaqvT nawlavTa baqteriebi, rac SemdgomSi iwvevs anTebiT procesebs.
klinika. enterobiozisaTvis specifikuri simptomebi damaxasiaTebeli ar aris.
mcire asakis bavSvebSi daavadeba mimdinareobs msubuqad, Zilis win da Rame aqvT ukana
tanis msubuqi qavili, romelic grZeldeba 1-3 dRe da Semdeg qreba. qavili xSirad
meordeba ori kviris Semdeg. qavilis aseTi perioduloba dakavSirebulia reinvaziis
Sedegad maxvilas Taobis cvlasTan. aseT SemTxvevaSi ( ganmeorebiTi invaziisas )
qavili mudmivi da intensiuria, xdeba mtanjveli. kanis meqanikuri dazianeba iwvevs
dermatits. avadmyofebs uviTardebaT fizikuri da fsiqikuri sisuste _ fsiqasTenia
da nevrasTenia.
SesaZlebelia, aRiniSnos diarea ara marto fafiseburi, lorwos Semcveli ganavliT,
aramed tenezmebiTac, rac dakavSirebulia swor nawlavSi wertilovani sisxlCaqcevebis
arsebobasTan da anusis gaRizianebasTan. eozinofilia, Cveulebriv, ar axasiaTebs.
SesaZlebelia, ganviTardes apendiciti, vaginiti da sxva.
diagnozi. diagnozis swori dasma SeiZleba ganavalSi kvercxebis an Wiis aRmoCeniT.
kvercxebis naxva advilad SeiZleba perianalur midamoSi, diliT, specialuri mwebavi
firfitis gamoyenebiT (dabanamde 3-jer, diliT), an perianaluri aris daTvalierebiT
daZinebidan 2-3 saaTis Semdeg. Tu nanaxi iqna Wia, ukeTesia, igi Senaxuli iqnas 75%-ian
eTilis spirtSi Semdgomi mikroskopuli gamokvlevisaTvis. Wiebsa da kvercxebze
gamokvleva aucilebelia inficirebuli avadmyofis ojaxis yvela wevrisaTvis.
mkurnaloba. mkurnaloba utardeba inficirebuli piris ojaxis yvela wevrs
miuxedavad imisa, aqvT Tu ara raime klinikuri gamovlineba. iniSneba pirantelis
493
kerZo nawili. enterobiozi
helminTozebi. triqocefalozi
triqocefalozi
494
kerZo nawili. zogierTi neli infeqcia
495
kerZo nawili. zogierTi neli infeqcia
496
danarTebi
497
danarTi #2 etiotropuli mkurnaloba axalSobilobis periodis Semdeg
498
danarTi #2 (gagrZeleba) etiotropuli mkurnaloba axalSobilobis
periodis Semdeg
499
danarTi #2 (gagrZeleba) etiotropuli mkurnaloba axalSobilobis
periodis Semdeg
500
zogjer preparatis dozireba moiTxovs sxeulis zedapiris
farTobis codnas, risTvisac mogvyavs Mosteller -is farTo
praqtikaSi miRebuli formula
Nomogram - nomograma
Height - simaRle
cm - sm
in - diuimi
For children of normal height for weight - normaluri simaRlisa da masis Sefardeba
S.A. - zedapiris farTobi
M2 - m 2
Weight - masa
lb - funtebSi
kg - kg-Si
Weight in pounds - masa funtebSi
Surface area in square meters - zedapiris farTobi m2-Si
501
Crawford and associates
masisa (funtebSi), sxeulis zedapiris farTobisa da mozrdilTa dozebis gaangariSeba
502
danarTi #3 specifikuri profilaqtika
503
danarTi #3 (gagrZeleba) specifikuri profilaqtika
504
zogierTi laboratoriuli maCvenebeli (gagrZeleba)
si sx l i
si sx l i e r T eu l i S i e r T eu l i
3 3 9
l e ikoc it e bi s isx l S i dab ad eb isas 9 .0 - 30 .0 X 10 /m m ( m kl ) 9 .0 - 30 .0 X 10 /l
3 3 9
< 1 dRe 9 .4 - 34 .0 X 10 /m m ( m kl ) 9 .4 - 34 .0 X 10 /l
3 3 9
1 T ve 5.0 - 19 .5X 10 /m m ( m kl ) 5.0 - 19 .5X 10 /l
3 3
3 wel i 6.0 - 17 .5X 10 /m m ( m kl ) 6.0 - 17 .5X 10 9 /l
3 3
4 - 7 wel i 5.5 - 15.5X 10 /m m ( m kl ) 5.5 - 15.5X 10 9 /l
3 3 9
8 - 13 wel i 4 .5 - 13.5X 10 /m m ( m kl ) 4 .5 - 13.5X 10 /l
3 3 9
> 13 we l i 4 .5 - 11.0 X 10 /m m ( m kl ) 4 .5 - 11.0 X 10 /l
difer en c ir e b u l i
l e ikoc it e bi:
m ie l oc it e bi 0 0
9
n eit r ofil e b i se g m e nt . 54 - 62% 0 .54 - 0 .62X 10 /l
9
n eit r ofil e b i Cx ir b ir T . 3 - 5% 0 .0 3 - 0 .0 5X 10 /l
l im foc it e bis sae r T o d a
s u b popu l ac ieb is r aod en ob a
asakis m ix e dv iT
9 9
s ae r T o l im foc it eb i 2 - 3 T ve 2,9 2 - 8,84 X 10 /l 2,9 2 - 8,84 X 10 /l
55 - 7 8% 0 ,55 - 0 ,7 8
9 9
4 - 8 T ve 3,61 - 8,84 X 10 /l 3,61 - 8,84 X 10 /l
45 - 79 % 0 ,4 5 - 0 ,7 9
12 - 23 T v e 2,18 - 8,27 X 10 9 /l 2,18 - 8,27 X 10 9 /l
4 4 - 7 2% 0 ,4 4 - 0 ,7 2
9 9
24 - 59 T ve 2,4 0 - 5,81 X 10 /l 2,4 0 - 5,81 X 10 /l
38 - 64 % 0 ,38 - 0 ,64
9 9
m oz r dil e b i 1,50 - 3,0 0 X 10 /l 1,50 - 3,0 0 X 10 /l
25 - 33% 0 ,25 - 0 ,33
CD 3 (T u j re d e bis 2 - 3 Tv e 2 , 0 7 - 6 , 54 X 1 0 9 /l 2 , 0 7 - 6 , 54 X 1 0 9 /l
s a e rT o r -b a ) 60 - 87% 0 ,60 - 0 ,84
4 - 8 Tv e 2 , 2 8 - 6 , 45 X 1 0 9 /l 2 , 2 8 - 6 , 45 X 1 0 9 /l
57 - 8 4% 0 , 57 - 0 , 84
1 2 - 2 3 Tv e 1 , 46 - 5, 44 X 1 0 9 /l 1 , 46 - 5, 44 X 1 0 9 /l
53 - 81 % 0 , 53 - 0 , 81
2 - 6 we l i 1 , 6 1 - 4, 23 X 1 0 9 /l 1 , 6 1 - 4, 23 X 1 0 9 /l
62 - 80 % 0 62 - 0 , 80
m oz rd il eb i 0 56 - 1 , 95 X 1 0 9 /l 0 56 - 1 , 95 X 1 0 9 /l
59 - 8 1 % 0 , 59 - 0 , 81
CD 4 (T he l p e re bi) 2 - 3 Tv e 1 , 46 - 5, 1 1 X 1 0 9 /l 1 , 46 - 5, 1 1 X 1 0 9 /l
41 - 6 4% 0 , 6 0 - 0 , 84
4 - 8 Tv e 1 , 6 9 - 4, 60 X 1 0 9 /l 1 , 6 9 - 4, 60 X 1 0 9 /l
36 - 6 1 % 0 , 36 - 0 , 61
1 2 - 2 3 Tv e 1 , 0 2 - 3, 60 X 1 0 9 /l 1 , 0 2 - 3, 60 X 1 0 9 /l
31 - 54% 0 , 31 - 0 , 54
2 - 6 we l i 0 , 9 0 - 2 , 86 X 1 0 9 /l 0 , 9 0 - 2 , 8 6 X 1 0 9 /l
35 - 51 % 0 , 35 - 0 , 51
m oz rd il eb i 0 , 35 - 1 , 33 X 1 0 9 /l 0 , 35 - 1 , 33 X 1 0 9 /l
31 - 35% 0 , 31 - 0 , 55
505
zogierTi laboratoriuli maCvenebeli (gagrZeleba)
sisxli
sisxli erTeuli S ierTeuli
CD 8 (T citotoqsikurisuper- 2 - 3 Tve 0,65 -2,45 X 10 9 /l 0,65 -2,45 X 10 9 /l
sorebi) 16 - 35% 0,16 - ,35
4 - 8 Tve 0,72 - 2,49 X 10 9 /l 0,72 - 2,49 X 10 9 /l
16 - 34% 0,16 - 0 ,34
12 - 23 Tve 0,57 - 2,23 X 10 9 /l 0,57 - 2,23 X 10 9 /l
16 - 38% 0,16 - 0 ,38
2 - 6 weli 0,63 - 1,91 X 10 9 /l 0,63 - 1,91 X 10 9 /l
22 - 38% 0,22 - 0,38
mozrdilebi 0,15 - 0,81 X 10 9 /l 0,15 - 0,81 X 10 9 /l
17 - 38% 0,17 - 0 ,38
CD 4/CD 8 2 - 3 Tve 1,32 - 3,47
4 - 8 Tve 1,20 - 3,48
12 - 23 Tve 0,95 - 2,95
2 - 6 weli 1,0 5 - 2,0 7
mozrdilebi 0,84 -3,0 5
CD 9 (B limfocitebi) 2 - 6 Tve 1,30 -2,50 X 10 9 /l 1,30 -2,50 X 10 9 /l
21 - 35% 0,21 - 0 ,35
7 - 18 Tve 0,80 - 1,60 X 10 9 /l 0,80 - 1,60 X 10 9 /l
21 - 32% 0,21 - 0 ,32
19 - 36 Tve 0,60 - 0,90 X 10 9 /l 0,60 - 0,90 X 10 9 /l
21 - 26% 0,21 - 0 ,26
37 - 48 Tve 0,40 - 0,60 X 10 9 /l 0,40 - 0,60 X 10 9 /l
15 - 23% 0,15 - 0,23
49 - 60 Tve 0,30 - 0,90 X 10 9 /l 0,30 - 0,90 X 10 9 /l
14 - 23% 0,14 - 0 ,23
mozrdilebi 7 - 23% 0,00 7 - 0 ,23
monocitebi 3 - 7% 0.03 - 0.07X10 9 /l
eozinofilebi 1 - 3% 0.01 - 0 .03X10 9 /l
bazofilebi 0 - 0 .75 % 0 - 0 .0075X10 9 /l
alanin-aminotransferaza 0-5 dRe 6-50 erT/l 6-50 erT/ l raitman-frenkelis wesiT.
(alat, glutamatpiruvat- 1-19 weli 5-45 erT/l 5-45 erT/l 0.1-0 68 mkmol/(sT.ml.)
transaminaza) SratSi mozrdilebi 7-53 erT/l 7-53 erT/l 28-190 nmol/(wm.l.)
aspartat-aminotransferaz a 0-5 dRe 35-140 erT/l 35-140 erT/ l raitman-frenkelis wesiT.
(asat, glutamoqsaloacetu- 1-19 weli 5-55 erT/l 5-55 erT/ l 0.1-0 45 mkmol/(sT.ml.)
ri transaminaza) SratSi mozardebi 11-47 erT/l 11-47 erT/ l 28-190 nmol/(wm.l.)
albumini plaz maSi dRenakl. axalSob.
< 1 dRe 1.8 - 3.0 g% (g/dl) 18 - 30 g/l
dResruli axalSob.
< 6 dRe 2.5 - 3.4 g% (g/dl) 25 - 34 g/l
5 w. 3.9 - 5.0 g% (g/dl) 39 - 50 g/l
5-19 w. 4.0 - 5.3 g% (g/dl) 40 - 53 g/l
mozrdilebi 3.6 - 5.0 g% (g/dl) 36 - 50 g/l
acetoni SratSi, 0.3 - 2.0 mg% (mg/dl) 0.05 - 0.34 mmol/l
plaz maSi (raodenobrivi)
bilirubini saerTo Wiplari < 2.0 mg% (mg/dl) < 34 mkmol/l
SratSi dRenakl. axalSob:
0.1 dRe < 8.0 mg% (mg/dl) < 137 mkmol/l
1-2 dRe < 12.0 mg% (mg/dl) < 205 mkmol/l
2-5 dRe < 16.0 mg% (mg/dl) < 274 mkmol/l
> 5 dReze meti < 2.0 mg% (mg/dl) < 34 mkmol/l
dResruli axalSob:
0-1 dRe < 6.0 mg% (mg/dl) < 103 mkmol/l
1-2 dRe < 8.0 mg% (mg/dl) < 137 mkmol/l
2-5 dRe < 12.0 mg% (mg/dl) < 205 mkmol/l
> 5 dReze meti 0.2 - 1.0 mg% (mg/dl) 3.4 - 17.1 mkmol/l
mozrdilebi 0.2 - 1.3 mg% (mg/dl) 3.4 - 22.2 mkmol/l
506
zogierTi laboratoriuli maCvenebeli (gagrZeleba)
sisxli
sisxli erTeuli S ierTeuli
bilirubini koniugirebuli 0 - 0 .2 mg% (mg/dl) 0 - 3.4 mkmol/l
SratSi
γ-glutamiltranspep- Wiplari 37 - 193 erT/l 37 - 193 erT/l
tidaza (γ-glutamil-, 0 - 1 Tve 12 - 123 erT/l 12 - 123 erT/l
transferaza, ggtp) 2 - 4 Tve 8 - 90 erT/l 8 - 90 erT/l
4 Tve - 10 weli 5 - 32 erT/l 5 - 32 erT/l
10 - 15 weli 5 - 24 erT/l 5 - 24 erT/l
glukoza SratSi Wiplari 45 - 96 mg% (mg/dl) 2.5 - 5.3 mmol/l
ax alSob. 1 dRis 40 - 60 mg% (mg/dl) 2.2 - 3.3 mmol/l
> 1 dReze 50 - 90 mg% (mg/dl) 2.8 - 5.0 mmol/l
bavSvebi 60 - 10 0 mg% (mg/dl) 3.3. - 5.5 mmol/l
mozrdilebi 70 - 10 5 mg% (mg/dl) 3.9 - 5.8 mmol/l
2 sT Wamis Semdeg < 120 mg% (mg/dl) < 6.7 mmol/l
Trombinuli dro dRenakl. axalSob. 11 - 17 wm 11 - 17 wm
(sisx lSi) dResrul. axalSob. 10 - 16 wm 10 - 16 wm
mozrdilebi 11.3 - 18.8 wm 11.3 - 18.8 wm
Tromboplastinuri dro
_ aqtivirebuli 1 wlamde asakSi < 90 wm < 90 wm
Semdgomi 25 - 35 wm 25 - 35 wm
_ araqtivirebuli 60 - 85 wm 60 - 85 wm
Trombocitebi < 1 kviraze 84-478X10 3 /mm 3 (mkl) 84 - 478X10 9 /l
(sisx lSi) SemdgomSi 150 -40 0 X10 3 /mm 3 (mkl) 150 - 40 0 X10 9 /l
proTrombinuli dro dRenakl. axalSob. 14.6 - 1 6.9 wm 14.6 - 1 6.9 wm
(sisx lSi) dResrul. axalSob. 10 .1 - 15.9 wm 10 .1 - 15.9 wm
bavSvebi/mozrdilebi 10 .8 - 1 3.9 wm 10 .8 - 1 3.9 wm
kaliumi < 2 Tve 3.0 - 7.0 mmol/l 3.0 - 7.0 mmol/l
(SratSi) 2 - 12 Tve 3.5 - 6.0 mmol/l 3.5 - 6.0 mmol/l
> 12 Tve 3.5 - 5.0 mmol/l 3.5 - 5.0 mmol/l
kalciumi saerTo Wiplari 9.0 - 11.5 mg% (mg/dl) 2.25 - 2.88 mmol/l
SratSi ax alSobili:
umwifari < 1 kvira 6 - 10 mg% (mg/dl) 1.5 - 2.5 mmol/l
dResruli:
3 - 24 sT 9.0 - 10 .6 mg% (mg/dl) 2.3 - 2.65 mmol/l
24 - 48 sT 7.0 - 12.0 mg% (mg/dl) 1.75 - 3.0 mmol/l
4 - 7 dRe 9.0 - 10 .9 mg% (mg/dl) 2.25 - 2.73 mmol/l
bavSvebi 8.0 - 10 .5 mg% (mg/dl) 2.0 - 2.6 mmol/l
mozrdilebi 8.5 - 10 .5 mg% (mg/dl) 2.1 - 2.6 mmol/l
kalciumi ioniozirebuli Wiplari 5.0 - 6.0 mg% (mg/dl) 1.25 - 1.50 mmol/l
(SratSi, plazmaSi) 0 - 1 dRe 4.3 - 5.1 mg% (mg/dl) 1.0 7 - 1.27 mmol/l
1 - 2 dRe 4.0 - 4.7 mg% (mg/dl) 1.0 0 - 1.17 mmol/l
SemdgomSi 4.8 - 4.92 mg% (mg/dl) 1.12 - 1.23 mmol/l
an 2.24 - 2.46 meqv/l
ketonuri sx eulebi 0 .5 - 3.0 mg% (mg/dl) 5 - 30 mg/l
(raodenobrrivi)
ketonuri sx eulebi 0 0
(xarisxobrivi)
507
zogierTi laboratoriuli maCvenebeli (gagrZeleba)
sisxli
sisxli erTeuli S ierTeuli
kreatinini Wiplari 06. - 1.2 mg% (mg/dl) 53 - 10 6 mkmol/l
axalSobili 0.3 - 1.0 mg% (mg/dl) 27 - 88 mkmol/l
Cvilebi 0.2 - 0 .4 mg% (mg/dl) 18 - 35 mkmol/l
bavSvebi 0.3 - 0 .7 mg% (mg/dl) 27 - 62 mkmol/l
mozardebi 0.5 - 1.0 mg% (mg/dl) 44 - 88 mkmol/l
mozrdilebi:
qalebi 0.5 - 1.1 mg% (mg/dl) 44 - 97 mkmol/l
mamakacebi 0.6 - 1.2 mg% (mg/dl) 53 - 10 6 mkmol/l
magniumi 0 - 6 dRe 1.2 - 2.6 mg% (mg/dl) 0.48 - 1.05 mmol/l
7 dRe - 2 weli 1.6 - 2.7 mg% (mg/dl) 0.65 - 1.10 mmol/l
2 - 14 weli 1.5 - 2.3 mg% (mg/dl) 0.60 - 0.95 mmol/l
mozrdilebi 1.6 - 2.7 mg% (mg/dl) 0.65 - 1.10 mmol/l
natriumi axalSobilebi:
(SratSi, plazmaSi) dResruli, 134 - 146 mmol/l 134 - 146 mmol/l
dRenakli 130 - 140 mmol/l 130 - 140 mmol/l
Cvilebi 139 - 146 mmol/l 139 - 146 mmol/l
bavSvebi 138 - 145 mmol/l 138 - 145 mmol/l
mozrdilebi 136 - 148 mmol/l 136 - 148 mmol/l
C _ reaqtiuli cila Wiplari 52 - 1330 ng/ml 52 - 1330 mkg/l
(SratSi) 2 - 12 weli 67 - 1800 ng/ml 67 - 1800 mkg/l
rkina axalSobilebi 100 - 250 mkg% 17.9 - 44.75 mkmol/l
(SratSi) Cvilebi 40 - 10 0 mkg% 7.16 - 17.90 mkmol/l
bavSvebi 50 - 120 mkg% 8.95 - 21.48 mkmol/l
mozrdilebi:
mamakacebi 50 - 160 mkg% 8.95 - 28.64 mkmol/l
qalebi 40 - 150 mkg% 7.16 - 26.85 mkmol/l
rkinis SeboWvis < 1 weli 100 - 400 mkg% 17, 90 - 71.60 mkmol/l
unari SemdgomSi 250 - 400 mkg% 44.75 - 71.60 mkmol/l
sisxldenis dro normaluri 2 - 7 wT. 120 - 420 wm.
mosazRvre 7 - 11 wT. 420 - 660 wm.
sisxlis raodenoba mamakacebi 52 - 83 ml/kg 0.0 52 - 0.083 l/kg
qalebi 50 75 ml/kg 0.0 50 - 0.057 l/kg
folis mJava
eriTrocituli 150 - 450 ng/ml.eriTr. 340 - 1020 nmol/l ujredi
plazmis axalSobilebi 7.0 - 32 ng/ml 15.9 - 72.4 nmol/l
SemdgomSi 1.8 - 9.0 ng/ml 4.1 - 20 .4 nmol/l
qlori Wiplari 96 - 10 4 mmol/l 96 - 10 4 mmol/l
(CL-) axalSobili 97 - 110 mmol/l 97 - 110 mmol/l
Semdgom 98 - 10 6 mmol/l 98 - 10 6 mmol/l
qolesterini < 3 weli 45 - 182 mg% (mg/dl) 1.15 - 4.70 mmol/l
(saerTo) 4 - 6 weli 109 - 189 mg% (mg/dl) 2.80 - 4.80 mmol/l
bavSvebi <170 mg% (mg/dl) (sasurv.) < 4.3 mmol/l
mozrdilebi <200 mg% (mg/dl) (sasurv.) < 5.1 mmol/l
SardmJava 1 - 5 weli 1.7 - 5.8 mg% (mg/dl) 100 - 350 mkmol/l
6 - 11 weli 2.2 - 6.6 mg% (mg/dl) 130 - 390 mkmol/l
12 - 19 weli:
vaJebi 3.0 - 7.7 mg% (mg/dl) 180 - 460 mkmol/l
gogonebi 2.7 - 5.7 mg% (mg/dl) 160 - 340 mkmol/l
mozrdilebi 3.0 - 8.0 mg% (mg/dl) 179 - 476 mkmol/l
508
zogierTi laboratoriuli maCvenebeli (gagrZeleba)
sisxli
sisxli erTeuli S ierTeuli
Sardovana Wiplari 21 - 40 mg% (mg/dl) 7.5 - 14.3 mmol/l
axalSobilebi:
dRenakli 3 - 25 mg% (mg/dl) 1.1 - 9.0 mmol/l
dResruli 3 - 12 mg% (mg/dl) 1.1 - 4.3 mmol/l
bavSvebi 5 - 18 mg% (mg/dl) 1.8 - 6.4 mmol/l
mozrdilebi 7 - 18 mg% (mg/dl) 2.5 - 6.4 mmol/l
Sededebis dro 5 - 8 wT. minis sinjaraSi 5 - 8 wT.
cila saerTo axalSobilebi:
dRenakli 4.3 - 7.6 g% (g/dl) 43 - 76 g/l
dResruli 4.6 - 7.4 g% (g/dl) 46 - 74 g/l
1 - 7 weli 6.1 - 7.9 g% (g/dl) 61 - 79 g/l
8 - 12 weli 6.4 - 8.1 g% (g/dl) 64 - 81 g/l
13 - 19 weli 6.6 - 8.2 g% (g/dl) 66 - 82 g/l
mozrdilebi 6.2 - 8.2 g% (g/dl) 62 - 82 g/l
eleqtroforeziT axalSobilebi:
albumini dRenakli 3.0 - 4.2 g% (g/dl) 30 - 42 g/l
dResruli 3.6 - 5.4 g% (g/dl) 36 - 54 g/l
< 1 wlis 4.0 - 5.0 g% (g/dl) 40 - 50 g/l
SemdgomSi 3.5 - 5.0 g% (g/dl) 35 - 50 g/l
α1 _ globulini axalSobilebi:
dRenakli 0.1 - 0.5 g% (g/dl) 1 - 5 g/l
dResruli 0.1 - 0.3 g% (g/dl) 1 - 3 g/l
< 1 wlis 0.2 - 0.4 g% (g/dl) 2 - 4 g/l
SemdgomSi 0.2 - 0.3 g% (g/dl) 2 - 3 g/l
α2 _ globulini axalSobilebi:
dRenakli 0.3 - 0 .7 g% (g/dl) 3 - 7 g/l
dResruli 0.3 - 0 .5 g% (g/dl) 3 - 5 g/l
< 1 wlis 0.5 - 0 .8 g% (g/dl) 5 - 8 g/l
SemdgomSi 0.4 - 1.0 g% (g/dl) 4 - 10 g/l
β _ globulini axalSobilebi:
dRenakli 0.3 - 1.2 g% (g/dl) 3 - 12 g/l
dResruli 0.2 - 0.6 g% (g/dl) 2 - 6 g/l
< 1 wlis 0.5 - 0 .8 g% (g/dl) 5 - 8 g/l
SemdgomSi 0.5 - 1.1 g% (g/dl) 5 - 11 g/l
γ _ globulini axalSobilebi:
dRenakli 0.3 - 0 .4 g% (g/dl) 3 - 4 g/l
dResruli 0.2 - 1.0 g% (g/dl) 2 - 10 g/l
< 1 wlis 0.3 - 1.2 g% (g/dl) 3 - 12 g/l
SemdgomSi 0.7 - 1.2 g% (g/dl) 7 - 12 g/l
imunoglobulini A Wiplari 1,4 - 3,6 mg/dl 14 - 36 mg/l
(IgA) 1 - 3 Tve 1,3 - 53 mg/dl 13 - 530 mg/l
4 - 6 Tve 4,4 - 84 mg/dl 44 - 840 mg/l
7 Tve - 1 weli 11 - 106 mg/dl 110 - 1,0 60 mg/l
2 - 5 weli 14 - 159 mg/dl 140 - 1,590 mg/l
6 - 10 weli 33 - 236 mg/dl 330 - 2,360 mg/l
mozrdilebi 70 - 320 mg/dl 700 - 3,120 mg/l
509
zogierTi laboratoriuli maCvenebeli (gagrZeleba)
sisxli
sisxli erTeuli S ierTeuli
imunoglobulini D axalSobili ar isinjeba ar isinjeba
(IgD) SemdgomSi 0 - 8 mg/dRe 0 - 80 mg/l
imunoglobulini E mamakacebSi 0 - 230 IU/ml 0 - 230 k IU/l
(IgE) qalebSi 0 - 170 IU/ml 0 - 170 k IU/l
imunoglobulini G WilrarSi 6,36 - 1,606 mg/dRe 6,39 - 16,06 g/l
(IgG) 1 Tve 251 - 960 mg/dRe 2,51 - 9,06 g/l
2 - 4 Tve 176 - 601 mg/dRe 1,76 - 6,01 g/l
5 - 12 Tve 152 - 1,0 6 mg/dRe 1,72 - 10,69 g/l
1 - 5 weli 345 - 1,236 mg/dRe 3,45 - 12,36 g/l
6 - 10 weli 608 - 1,572 mg/dRe 6,08 - 15,72 g/l
mozrdili 639 - 1,349 mg/dRe 6,39 - 13,49 g/l
hematokriti 1 dRe 48 - 69 % 0.48 - 0 .69
(HT) 2 dRe 48 - 75 % 0.48 - 0 .75
(sxeulis mocirkulire 3 dRe 44 - 72 % 0.44 - 0.72
siTxis saSualo raoden. 2 Tve 28 - 42 % 0.28 - 0 .42
da eriTrocitebis raode- 6 - 12 weli 35 - 45 % 0.35 - 0.45
nobidan) 12 - 18 weli:
vaJebi 37 - 49 % 0.37 - 0 .49
gogonebi 36 - 46 % 0.36 - 0 .46
18 - 49 weli:
mamakacebi 41 - 53 % 0.41 - 0.53
qalebi 36 - 46 % 0.36 - 0 46
g an aval i
g an aval i er T eu l i S ie r T e u l i
ka l c iu m i 2 .1 - 2 .7 m e q v/l 1 .0 5 - 1 .3 5 m m o l /l
a n 4 .2 - 5.4 m g %
a n 0 .6 4 g 2 4 s T -S i an 1 6 mmol 24 sT -S i
na Rvl is mJa vebi 1 2 0 - 2 2 5 m g /2 4 s T 1 2 0 - 2 2 5 m g /2 4 s T
f a r u l i s is x l i u a r y o f iT i
(< 2 m l /2 4 s T
1 0 0 - 2 0 0 g g a n a v a l S i)
pH 7 .0 - 7 .5 3 1 - 1 0 0 n m o l /l
c x im i ax al S ob. bu nebriv kvebaz e < 1 g /2 4 s T < 1 g /2 4 s T
0 - 6 weli < 2 g /2 4 s T < 2 g /2 4 s T
mo z r d il ebi:
no rmal u r i d iet a < 7 g /2 4 s T < 7 g /2 4 s T
u c x imo d iet a < 4 g /2 4 s T < 4 g /2 4 s T
510
zogierTi laboratoriuli maCvenebeli (gagrZeleba)
Sardi
Sardi erTeuli S ierTeuli
acetoni 0.0 N 0.0N
bilirubini 0.0 N 0.0N
glukoza (raodenobrivi) < 0.5 g/24sT < 2.8 mmol/l/24sT
glukoza (xarisxobrivi) 0 0
kalciumi bavS vebi:
ukalc iumo dieta 5 - 40 mg/24sT 0.13 - 1.0 mmol/l/24sT
dieta Ca-is mc ire Semcv. 50 - 150 mg/24sT 1.25 - 3.80 mmol/l/24sT
dieta Ca-is saSualo Semcv. 100 - 300 mg/24sT 2.5 - 7.5 mmol/l/24sT
(20 mmol/l/24sT)
mozrdilebi 0 - 250 mg/24sT 0 - 6.25 mmol/l/24sT
kreatinini dRenakl. axalSob. 8.1 - 15.0 mg/kg/24sT 72 - 133 mkmol/kg/24sT
dResrul. ax alS ob. 10.4 - 19.7 mg/kg/24sT 92 - 174 mkmol/kg/24sT
1.5 - 7 weli 10 - 15 mg/kg/24sT 88 - 133 mkmol/kg/24sT
7 - 15 weli 5.2 - 41 mg/kg/24sT 46 - 362 mkmol/kg/24sT
leikocitebi mamakacebi 0 - 3 /mx. areSi 0 - 3 /mx. areSi
(naleqSi) qalebi/bavSvebi 0 - 5 /mx. areSi 0 - 5 /mx. areSi
Sardis r-ba dRe-RameS i axalSobilebi 50 - 300 ml/24sT 0.050 - 0 .30 0 l/24sT
Cvilebi 350 - 550 ml/24sT 0.350 - 0.550 l/24sT
bavS vebi 500 - 1000 ml/24sT 0.5 - 1 l/24sT
mozardebi 70 0 - 1400 ml/24sT 0.7 - 1.4 l/24sT
SemdgomSi:
mamakacebi 800 - 1800 ml/24sT 0.8 - 1.8 l/24sT
qalebi 60 0 - 1600 ml/24sT 0.6 - 1.6 l/24sT
cila saerTo 24 sT-Si SardS i 1 - 14 mg/dl 10 - 140 mg/l
mosvenebul mdgomareobaSi 50 - 80 mg 24 sT-Si 50 - 80 mg 24 sT-Si
fizikuri datvirTvisas < 250 mg 24 sT-S i < 250 mg 24 sT-S i
xvedriTi wona mozrdilebSi 1.00 2 - 1.030 1002 - 1030
siTxis 12 sT-iT Sewyvetis > 1.025 > 1.025
Semdeg
24 saaTiani 1.015 - 1.0 25 1.015 - 1.0 25
511
zogierTi laboratoriuli maCvenebeli (gagrZeleba)
Tavzurgtvinis siTxe
Tavzurgtvinis erTeuli S ierTeuli
siTxe
leikocitebi
mononuklearebi < 24 sT
dRenakli 0 - 25 ujredi/mkl 0 - 25X10 6 /l
dResruli 0 - 20 ufredi/mkl 0 - 20X10 6 /l
axalSobilebi 0 - 5 ujredi/mkl 0 - 5X10 6 /l
SemdgomSi 0 - 5 ujredi/mkl 0 - 5X10 6 /l
polimorfonuklearebi axalSobilebi 0 - 10 ujredi/mkl 0 - 10X10 6 /l
eriTrocitebi < 24 sT
dRenakli 0 - 1.00 0 erT/mkl 0 - 1.00 0X10 6 /l
dResruli 0 - 800 erT/mkl 0 - 800X10 6 /l
axalSobilebi 0 -50 erT/mkl 0 -50X10 6 /l
diferencirebuli
leikocitebi:
eozinofilebi 0 ujredi 0 ujredi
limfocitebi 62% ± 34% 0.62 ± 0.34
monocitebi 36% ± 20% 0.36 ± 0.20
neitrofilebi 2% ± 5% 0.02 ± 0.05
histiocitebi 0 ufredi 0 ujredi
albumini 10 - 30 mg% (mg/dl) 100 - 30 0 mg/l
glukoza axalSobilebi:
dRenakli 24 - 63 mg% (mg/dl) 1.3 - 3.5 mmol/l
dResruli 34 - 119 mg% (mg/dl) 1.9 - 6.5 mmol/l
bavSvebi 40 - 80 mg% (mg/dl) 2.2 - 4.4 mmol/l
mozrdilebi 40 - 70 mg% (mg/dl) 2.2 - 3.9 mmol/l
kalciumi 2.1 - 2.7 meqv/l
an 4.2 - 5.7 mg% (mg/dl) 1.05 - 1.35 mmol/l
qlori 118 - 132 mmol/l 118 - 132 mmol/l
cila saerTo (arxSi) lumbaluri 8 - 32 mg% (mg/dl) 80 - 320 mg/l
turbidimetriiT lumbaluri:
dRenakli 40 - 300 mg% (mg/dl) 400 - 3.000 mg/l
dResruli 45 - 120 mg% (mg/dl) 450 - 1.200 mg/l
bavSvebi 10 - 20 mg% (mg/dl) 100 - 200 mg/l
mozardebi 15 - 20 mg% (mg/dl) 150 - 200 mg/l
mozrdilebi 15 - 45mg% (mg/dl) 150 - 450 mg/l
eleqtroforeziT
prealbumini 2 - 7% 0.02 - 0 .07
albumini 56 - 76% 0.56 - 0 .76
alfa1-globulini 2 - 7% 0.02 - 0 .07
alfa2-globulini 4 - 12% 0.04 - 0 .12
beta-globulini 8 - 18% 0.08 - 0.18
gam m a-globulini 3 - 12% 0.03 - 0.12
wneva gaxsnisas 70 - 180 mm H2O 70 - 180 mm H2O
512
sagnobrivi saZiebeli. a - d
sagnobrivi saZiebeli
abioturi garemo 11, 12 diagnozi 390
adenovirusuli infeqcia 62 diferenciuli diagnozi 391
epidemiologia 63 epidemiologia 385
etiologia 62 etiologia 384
zemo sasunTqi gzebis katari 64 klinika 388
klinika 63 mkurnaloba 392
mezenteriuli limfadeniti 64 paTogenezi 386
paTogenezi da paTmorfologia 63 paTmorfologia 387
tonzilo-faringiti 64 profilaqtika 392
faringokoniunqtivuri sindromi 64 wlamde asakis bavSvebSi 389
aiv-Sidsi 207 janmrTeli baqteriamtarebeli 390
diagnozi 214 botulizmi 338
epidemiologia 209 diagnozi 342
etiologia 208 diferenciuli diagnozi 343
imunizaciis Catarebis rekomendaciebi 217 epidemiologia 339
kapoSis sarkoma 211 etiologia 338
klinika 211 klinika 340
kuW-nawlavis forma 213 mkurnaloba 343
mkurnaloba 215 paTogenezi 340
paTogenezi da paTanatomuri suraTi 210 profilaqtika 344
prognozi 217 Cvil bavSvTa 342
profilaqtika 217 brucelozi 349
Sidsi mcire asakis bavSvebSi 214 biurnes kanSiga reaqcia 353
cerebruli forma 213 diagnostika 353
amebiazi 446 diferenciuli diagnostika 354
abscesi tvinis 451 epidemiologia 349
abscesi filtvis 451 etiologia 349
abscesi RviZlis 450 klinika 351
diagnostika 452 mkurnaloba 354
epidemiologia 447 paTogenezi 350
etiologia 446 profilaqtika 354
kanis 451 raitis reaqcia 353
klinika 448 garTuleba 15
mkurnaloba 452 gri pi 51
gri
paTogenezi da paTanatomuri suraTi 448 axalSobilebSi da wlamde asakis
prognozi 452 bavSvebSi 55
profilaqtika 453 diferenciuli diagnozi 56
fulminanturi 451 epidemiologia 52
anaerobuli nawlavTa mwvave infeqcia 1-dan 3 wlamde asakSi 55
(klostridiozebi) 430 etiologia 51
anafilaqsia 46 klasifikacia 54
antibiotikebi 30 klinika 53
baqteriostaturi 30 labratoriuli diagnostika 55
baqteriociduri 30 mkurnaloba 56
askaridozi 485 paTmorfologia da paTogenezi 52
diagnozi 486 prognozi 59
epidemiologia 485 profilaqtika 59
etiologia 485 deinis nawilaki 149
klinika 486 denge da dengesmagvari cxelebebi 194
mkurnaloba 487 diagnozi da diferenciuli diagnozi 196
nawlavTa obstruqcia 486 epidemiologia 194
paTogenezi 485 etiologia 194
profilaqtika 487 klinika 195
filtvis 486 mkurnaloba 196
RviZlis 486 paTogenezi 194
baqteriuli dizenteria 384 profilaqtika 197
garTulebebi 390 hemoragiuli forma 196
gaxangrZlivebuli 389 dehidratacia 35, 36
513
sagnobrivi saZiebeli. d - e
514
sagnobrivi saZiebeli. e - k
515
sagnobrivi saZiebeli. k - m
516
sagnobrivi saZiebeli. m - p
517
sagnobrivi saZiebeli. p - s
518
sagnobrivi saZiebeli. s - t
519
sagnobrivi saZiebeli. t - q
520
sagnobrivi saZiebeli. y - h
521
sagnobrivi saZiebeli. h - h
522