Hookworm infektsiyasi - Hookworm infection

Hookworm infektsiyasi
Boshqa ismlarAnkilomit kasalligi
Hookworms.JPG
Hookworms
MutaxassisligiYuqumli kasallik
AlomatlarQichishish, lokalize toshma, qorin og'rig'i, diareya[1]
AsoratlarAnemiya, oqsil etishmovchiligi[2]
SabablariAnkilostoma o'n ikki barmoqli ichak (eski dunyo ankilomati), Nekator amerikan (yangi dunyo ankilomateriyasi)[1]
Xavf omillariYalang oyoq yurish iliq iqlim kambag'allar bilan sanitariya[1]
Diagnostika usuliNajas namunasi[1]
Oldini olishYalang oyoq yurmaslik, to'xtash ochiq havoda defekatsiya[1]
Dori-darmonAlbendazol, mebendazol, temir qo'shimchalari[3]
Chastotani428 million (2015)[4]

Hookworm infektsiyasi turi bilan yuqtirishdir ichak paraziti sifatida tanilgan ankilomit.[1][5] Dastlab infektsiya joyida qichishish va toshma paydo bo'lishi mumkin.[1] Faqat bir nechta qurtlarga ta'sir qilganlar hech qanday alomat ko'rsatmasligi mumkin.[1] Ko'p qurtlarni yuqtirganlar boshdan kechirishi mumkin qorin og'riq, diareya, vazn yo'qotish va charchoq.[1] Bolalarning aqliy va jismoniy rivojlanishi ta'sir qilishi mumkin.[1] Anemiya olib kelishi mumkin.[1]

Odamlarda ankilomateriya bilan kasallanishning ikkita keng tarqalgan yuqumli kasalliklari mavjud ankilostomioz va nekatoriyaz, turlari tomonidan kelib chiqqan Ankilostoma o'n ikki barmoqli ichak va Nekator amerikan navbati bilan.[1] Hookworm tuxumlari yuqtirgan odamlarning najaslariga yotqiziladi.[1] Agar ular atrof-muhitga tushib qolsa, ular kirib borishi mumkin lichinkalar (pishmagan qurtlar), keyinchalik teriga kirib borishi mumkin.[1] Bir turi ifloslangan oziq-ovqat orqali ham tarqalishi mumkin.[1] Xavf omillariga yurish kiradi yalangoyoq iliq iqlim sharoitida, qaerda sanitariya kambag'al.[1] Tashxis a najas namunasi bilan mikroskop.[1]

Kasallik keng tarqalgan joylarda yalangoyoq yurmaslik orqali kasallikni individual darajada oldini olish mumkin.[1] Aholi darajasida kamayish ochiq havoda defekatsiya kabi xom najasni ishlatmaslik o'g'it va ommaviy degelmintizatsiya qilish samarali hisoblanadi.[1] Davolash odatda dorilar bilan amalga oshiriladi albendazol yoki mebendazol bir kundan uch kungacha.[3] Temir qo'shimchalari anemiya bilan kasallanganlarga kerak bo'lishi mumkin.[3]

Hookworms 2015 yilda taxminan 428 million kishini yuqtirgan.[4] Og'ir infektsiyalar bolalarda ham, kattalarda ham bo'lishi mumkin, ammo kattalarda kamroq uchraydi.[2] Ular kamdan-kam hollarda o'limga olib keladi.[6] Hookworm infektsiyasi a tuproqdan yuqadigan gelmintoz va a deb tasniflanadi beparvo qilingan tropik kasallik.[7]

Belgilari va alomatlari

Ankilomit infektsiyasi uchun hech qanday alomatlar yoki belgilar xos emas, ammo ular ichakning kombinatsiyasini keltirib chiqaradi yallig'lanish va progressiv temir tanqisligi anemiyasi va oqsil etishmovchiligi. Yutalish, ko'krak qafasi og'rig'i, xirillash va isitma ba'zida og'ir infektsiyadan kelib chiqadi. Epigastral og'riqlar, oshqozon buzilishi, ko'ngil aynish, qusish, ich qotishi va diareya erta yoki keyingi bosqichlarda ham bo'lishi mumkin, garchi oshqozon-ichak trakti belgilari vaqt o'tishi bilan yaxshilanishga intilsa. Murakkab infektsiyaning belgilari anemiya va oqsil etishmovchiligi, shu jumladan ozish, yurak etishmovchiligi va bilan birga qorin bo'shlig'i kengayishi astsitlar.

Lichinka bosqini teri (asosan Amerikada) deb nomlangan teri kasalligini keltirib chiqarishi mumkin teri lichinkasi migratsiyasi shuningdek, sudraluvchi otilish deb ham ataladi. Ushbu qurtlarning egalari odam emas va lichinkalar faqat terining yuqori besh qatlamiga kirib borishi mumkin, bu erda ular intensiv, mahalliy qichishish, odatda oyoq yoki pastki oyoqlarda, deb nomlanuvchi tuproq qichishi. Ushbu yuqumli kasallik lichinkalarga bog'liq A. braziliense ankilomit. Lichinkalar torlararo tunnellarda ko'chib ketadi qatlam bazali va korneum qatlami terining paydo bo'lishiga olib keladi serpiginous vesikulyar jarohatlar. Lichinkalarning ilgarilab ketishi bilan zararlanishning orqa qismlari quruq va qobiq bo'lib qoladi. Lezyonlar odatda kuchli qichishadi.[8]

Inkubatsiya davri

Kuluçka muddati bir necha haftadan ko'p oylarga qadar o'zgarishi mumkin va asosan, odam yuqtirgan ankilomit parazitlar soniga bog'liq.[9]

Sababi

Ancylostoma braziliense og'iz qismlari

Odamlarda ankilomaterm infektsiyalari kiradi ankilostomioz va nekatoriyaz. Antsilostomioz sabab bo'ladi Ankilostoma o'n ikki barmoqli ichak, da joylashgan eng keng tarqalgan turi Yaqin Sharq, Shimoliy Afrika, Hindiston va (avval) in janubiy Evropa. Nekatorioz sabab bo'ladi Nekator amerikan, ning eng keng tarqalgan turi Amerika qit'asi, Saxaradan Afrikaga, Janubi-sharqiy Osiyo, Xitoy va Indoneziya.[iqtibos kerak ]

Kabi boshqa hayvonlar qushlar, itlar va mushuklar ta'sir qilishi mumkin. A. tubaeforme mushuklarni yuqtiradi, A. kaninum itlarga zarar etkazadi va A. braziliense va Uncinaria stenocephala mushuklarga ham, itlarga ham yuqtirish. Ushbu infektsiyalarning ba'zilari bo'lishi mumkin odamlarga yuqadi.[10]

Morfologiya

A. o'n ikki barmoqli ichak qurtlar kulrang oq yoki pushti rangga ega bo'lib, boshi tananing qolgan qismiga nisbatan bir oz egilgan. Ushbu egilish oldingi uchida aniq tutqich shaklini hosil qiladi, buning uchun antik kurtlar nomlanadi. Ular ikki juft tish bilan yaxshi rivojlangan og'izlarga ega. Erkaklar taxminan bir santimetrni 0,5 millimetrga teng bo'lsa, urg'ochilar ko'pincha uzunroq va qattiqroq. Bundan tashqari, taniqli orqa kopulyatsion bursa borligiga qarab, erkaklarni ayollardan ajratish mumkin.[11]

N. Amerika morfologiyasiga juda o'xshash A. o'n ikki barmoqli ichak. N. Amerika odatda kichikroq A. o'n ikki barmoqli ichak odatda 5 dan 9 mm gacha bo'lgan erkaklar va 1 sm uzunlikdagi ayollar bilan. Holbuki A. o'n ikki barmoqli ichak ikki juft tishlarga ega, N. Amerika bukkal kapsulada bir juft kesuvchi plastinkaga ega. Bundan tashqari, ilgak shakli ancha aniqlangan Nekator ga qaraganda Antsilostoma.[11]

Hayot davrasi

Hookworm hayot davrasi

Ankilomit harorati 18 ° C dan yuqori bo'lgan iliq tuproqda yaxshi rivojlanadi. Ular birinchi navbatda mavjud qumli yoki loamy tuproq va yashay olmaydi gil yoki muck. Yomg'ir omon qolish uchun o'rtacha yiliga 1000 mm dan (40 dyuym) ko'proq bo'lishi kerak. Faqatgina ushbu shartlar mavjud bo'lsa, tuxum chiqishi mumkin. Ning yuqumli lichinkalari N. Amerika yuqori haroratlarda omon qolishi mumkin, aksincha A. o'n ikki barmoqli ichak salqin iqlim sharoitlariga yaxshiroq moslashgan. Odatda, ular tabiiy sharoitda ko'pi bilan atigi bir necha hafta yashaydilar va to'g'ridan-to'g'ri quyosh nurlari ta'sirida vafot etishadi quritish.[iqtibos kerak ]

Uy egasini yuqtirish tuxum emas, lichinkalar tomonidan sodir bo'ladi. Esa A. o'n ikki barmoqli ichak yutish mumkin, odatdagi yuqtirish usuli teri orqali; bu odatda yurishdan kelib chiqadi yalangoyoq najas moddasi bilan ifloslangan joylar orqali. Lichinkalar oyoq terisiga kirib borishi mumkin va tanaga kirib, ular orqali ko'chib o'tishadi qon tomir tizimi uchun o'pka, va u erdan yuqoriga traxeya va yutib yuboriladi. Keyin ular pastga o'tadilar qizilo'ngach va o'zlarining sayohatlarini tugatib, ovqat hazm qilish tizimiga kiradilar ichak, bu erda lichinkalar kattalar qurtlariga aylanadi.[12][13]

Bir marta mezbon ichakda, Nekator uzoq davom etadigan infektsiyani keltirib chiqaradi, odatda 1 yildan 5 yilgacha (ko'plab qurtlar yuqtirilgandan keyin bir yoki ikki yil ichida nobud bo'ladi), ammo ba'zi kattalar qurtlari 15 yoki undan ortiq yil yashashi qayd etilgan. Antsilostoma kattalar qisqa umr ko'rishadi, o'rtacha 6 oygina omon qoladi. Ammo infektsiyani uzaytirishi mumkin, chunki uxlab yotgan lichinkalarni to'qima "do'konlaridan" ketma-ket "yollash" mumkin (qarang. Patologiya), muddati o'tgan kattalar qurtlarini almashtirish uchun. Bu infektsiyaning tarqalishi va intensivligining mavsumiy tebranishini keltirib chiqarishi mumkin (yuqishdagi normal mavsumiy o'zgarishlarni hisobga olmaganda).

Fuqarolik davlat xizmati ishchilar 2065 yilni qurdilar va o'rnatdilar tashqi uylar ankilomitni yo'q qilish uchun Missisipi va Florida 1943 yildan 1947 yilgacha.

Ular uy egasi bilan uyg'unlashadi, urg'ochilar kuniga 30000 taga qadar, hayot davomida esa 18-44 million tuxum qo'yishadi, ular najas bilan chiqib ketadi. Voyaga etgan qurtlarning etuklashishi, juftlashishi va tuxum ishlab chiqarishi uchun 5-7 hafta kerak bo'lganligi sababli, juda og'ir infektsiyaning dastlabki bosqichida, bemorning axlatida tuxum aniqlanmasdan o'tkir alomatlar paydo bo'lishi mumkin. Bu tashxisni juda qiyinlashtirishi mumkin.

N. Amerika va A. o'n ikki barmoqli ichak tuxumni iliq va nam tuproqda topish mumkin, ular oxir-oqibat birinchi darajali lichinkalar yoki L1 ga aylanadi. Infektsion bo'lmagan rabditoforma bosqichi L1 tuproq mikroblari bilan oziqlanadi va oxir-oqibat rabditoform bosqichida bo'lgan L2 lichinkalariga aylanadi. U taxminan 7 kun davomida oziqlanadi va keyin uchinchi bosqich lichinkalari yoki L3 ga aylanadi. Bu parazitning filariform bosqichi, ya'ni lichinkalarning oziqlanmaydigan yuqumli shakli. L3 lichinkalari nihoyatda harakatchan bo'lib, odam xosti terisiga kirib borish imkoniyatini oshirish uchun yuqori joylarni qidiradi. L3 lichinkalari uy egasini topmasdan 2 haftagacha yashashi mumkin. Esa N. Amerika lichinkalar faqat terining kirib borishi bilan yuqadi, A. o'n ikki barmoqli ichak penetratsiya orqali ham, og'iz orqali ham yuqishi mumkin. L3 lichinkalari uy egasiga muvaffaqiyatli kirgandan so'ng, ular teri osti venulalari va odam xujayrasining limfa tomirlari bo'ylab harakatlanadi. Oxir-oqibat, L3 lichinkalari o'pka kapillyarlari orqali o'pkaga kirib, alveolalarga ajralib chiqadi. Keyin ular uy egasi tomonidan yo'talishi va yutilishi uchun traxeya bo'ylab yurishadi. Yutulduktan so'ng, L3 lichinkalari ingichka ichakda topiladi, u erda ular L4 yoki kattalar qurtlari bosqichida eriydi. Terining kirib kelishidan kattalar rivojlanishigacha bo'lgan butun jarayon taxminan 5-9 hafta davom etadi. Voyaga etgan ayol qurtlar tuxum chiqaradi (N. Amerika kuniga 9000–10000 tuxum va A. o'n ikki barmoqli ichak 25000–30000 tuxum / kun), ular odam xujayrasining najasida o'tadi. Ushbu tuxumlar bir necha kun ichida atrof muhitda paydo bo'ladi va tsikl yangidan boshlanadi.[12][14][15]

Patofiziologiya

Hookworm infektsiyasi odatda asemptomatik deb hisoblanadi, ammo 1962 yilda Norman Stoll ta'riflaganidek, bu o'ta xavfli infektsiya, chunki uning zarari "jim va hiyla-nayrang".[16] Yuqtirishdan ko'p o'tmay, odam umumiy simptomlarni sezishi mumkin. Parazitik kirish va kirish joyida allergik reaktsiya bo'lgan tuproq-qichishish, yuqtirgan bemorlarda keng tarqalgan N. Amerika.[11] Bundan tashqari, yo'tal va pnevmonit lichinkalar sindira boshlashi mumkin alveolalar va traxeya bo'ylab sayohat qiling. Keyin lichinkalar mezbonning ingichka ichaklariga etib borib, etuklasha boshlagach, yuqtirgan odam diareya va boshqa oshqozon-ichak bezovtaligini boshdan kechiradi.[11] Biroq, Stoll tomonidan aytilgan "jim va hiyla-nayrang" alomatlar surunkali, og'ir intensiv ankilomateriya infektsiyalari bilan bog'liq. Ankilomateriya infektsiyasi bilan bog'liq bo'lgan asosiy kasallanish ichakdagi qon yo'qotish, temir tanqisligi anemiyasi va oqsil etishmovchiligi tufayli yuzaga keladi.[14] Ular, asosan, ingichka ichakdagi kattalar ankilostomniklaridan qon yutish, yorilish natijasida hosil bo'ladi eritrotsitlar va kamsituvchi gemoglobin mezbonda.[12] Ushbu uzoq muddatli qon yo'qotish yuz va periferik orqali o'zini jismonan namoyon qilishi mumkin shish; eozinofiliya va temir tanqisligi anemiyasi natijasida kelib chiqqan pikani ankilomateriya bilan kasallangan ba'zi bemorlar ham boshdan kechirishadi.[11] So'nggi paytlarda aholining sog'lig'ida katta rol o'ynaydigan ankilomateriya infektsiyasining boshqa muhim natijalariga ko'proq e'tibor qaratilmoqda. Surunkali ankilomateriya infektsiyasiga chalingan bolalar o'sishning sustlashishi bilan bir qatorda intellektual va kognitiv nuqsonlardan aziyat chekishi mumkinligi endi keng tarqalgan.[12][17] Bundan tashqari, yaqinda o'tkazilgan tadqiqotlar onaning homiladorlik paytida ankilomitni yuqtirganida onaning va homilaning salbiy natijalari potentsialiga bag'ishlangan.

Kasallik nematod qurtlari bilan bog'liq edi (Ankilostoma duodenalis) ichaklarida uchdan yarim dyuymgacha asosan mehnatlari orqali Teodor Bilxars va Grizinger Misrda (1854).[18]

Belgilari ko'ngil aynishi, qorin og'rig'i va davriy diareya kabi ankilomatermlarni oziqlantirish orqali ichakdagi yallig'lanish va uzoq davom etgan kasallikdagi progressiv anemiya bilan bog'liq bo'lishi mumkin: injiq ishtaha, pika (yoki axloqsizlik bilan yeyish), qaysar konstipatsiya va undan keyin diareya, yurak urishi, puls, terining sovuqligi, shilliq pardalarning oqarishi, charchoq va zaiflik, nafas qisilishi va o'limga olib keladigan holatlarda, dizenteriya, qon ketishlar va shish.[18] Qurtlar so'rishadi qon va zarar etkazish shilliq qavat. Biroq, najasda qon yo'qotilishi ko'rinadigan ko'rinmaydi.

Erta infektsiyadagi qon tekshiruvlari ko'pincha eozinofillar sonining ko'payishini ko'rsatadi, bu oq qon hujayralari turi, bu to'qimalarda qurt infektsiyalari bilan imtiyozli ravishda rag'batlantiriladi (mahalliy yallig'lanish reaktsiyasida ko'p miqdordagi eozinofillar ham mavjud). Qonda gemoglobin darajasining pasayishi anemiya bilan uzoq muddat yuqtirish holatlarida kuzatiladi.

Ko'pgina ichaklardan farqli o'laroq gelmintozlar, eng og'ir parazitik yuklarning bolalarda paydo bo'lishi tendentsiyasida kattalar erkaklar orasida ankilomitning tarqalishi va intensivligi yuqori bo'lishi mumkin. Buning izohi shundaki, ankilomateriya infektsiyasi kasbiy xarakterga ega, shuning uchun hamkasblar va boshqa yaqin guruhlar o'zlarining ish muhitini ifloslantirish orqali o'zaro infektsiyaning yuqori tarqalishini saqlab qolishadi. Ammo aksariyat endemik hududlarda kattalar ayollari anemiyaga juda qattiq ta'sir qiladilar, asosan temirga bo'lgan fiziologik ehtiyojlari ancha yuqori (hayz ko'rish, takroriy homiladorlik) .Buning qiziqarli natijasi Ankilostoma o'n ikki barmoqli ichak infektsiya - bu infektsiyaning transaktatsiya yo'li bilan yuqishi: bu turdagi terining invaziv lichinkalari darhol o'pkadan va ichakka o'tib ketmaydi, balki qon aylanishi orqali tananing atrofida tarqalib, mushak tolalari ichida harakatsiz bo'ladi. Homilador ayolda tug'ruqdan keyin bu lichinkalarning bir qismi yoki barchasi qon aylanishiga qaytadan (ehtimol to'satdan gormonal o'zgarishlar bilan), so'ngra sut bezlariga o'tishi uchun rag'batlantiriladi, shunda yangi tug'ilgan chaqaloq yuqumli lichinkalarni katta dozasini olishi mumkin. onasining suti orqali. Bir oy yoki undan katta yoshdagi bolalarda, masalan, Xitoy, Hindiston va Avstraliyaning shimoliy qismida juda og'ir, hatto o'limga olib keladigan, ankilomateriya infektsiyalarining boshqa tushunarsiz holatlarini hisobga olsak, xuddi shunday hodisa ko'proq uchraydi Ancylostoma caninum itlardagi yuqumli kasalliklar, bu erda yangi tug'ilgan chaqaloq kuchuklari ko'p miqdordagi ankilomateriya tufayli ichakdan qon ketishidan o'lishi mumkin. Bu, shuningdek, odam va itlar parazitlari o'rtasidagi yaqin evolyutsion aloqani aks ettiradi, ehtimol bu odamlar va itlar birinchi marta yaqin yashay boshlagan davrdan boshlangan umumiy ajdodga ega. Filariform lichinkalar parazitning yuqumli bosqichidir: infektsiya tuproqdagi lichinkalar kirib kelganda sodir bo'ladi. teriga yoki ular terining kirib borishi bilan ifloslangan oziq-ovqat va suvga tushganda.

Tashxis

Hookworm tuxumi

Tashxis qo'yish najasni mikroskopik tekshirishda xarakterli qurt tuxumlarini topishga bog'liq, ammo bu erta yuqtirishda mumkin emas. Ko'pgina itlarda yuqtirishning dastlabki belgilari orasida oyoq-qo'llarning oqsoqlanishi va anal qichishish mavjud. Tuxumlar oval yoki elliptik, o'lchamlari 60 dan 40 um gacha, rangsiz, emas safro bo'yalgan va ingichka shaffof bilan gialin qobiq membranasi. Ichakdagi qurt tomonidan chiqarilganda tuxum tarkibida segmentatsiz mavjud tuxumdon. Ichak orqali o'tayotganda tuxumhujayra rivojlanadi va shu tariqa najas bilan yuborilgan tuxumlar segmentlangan tuxumdonga ega, odatda 4 dan 8 gacha blastomerlar.Har ikkalasining ham tuxumlari kabi Antsilostoma va Nekator (va boshqa ko'plab ankilomateriya turlari) bir-biridan farq qilmaydi, ularning jinsini aniqlash uchun ularni laboratoriyada lichinkalar chiqishi uchun etishtirish kerak. Agar najas namunasi tropik sharoitda bir kun yoki undan ko'proq vaqtga qoldirilsa, lichinkalar chiqib ketgan bo'ladi, shuning uchun tuxum endi ko'rinmasligi mumkin. Bunday holatda, ankilomatermlarni ajratib ko'rsatish juda muhimdir Strongiloidlar lichinkalar, chunki ikkinchisiga yuqtirish jiddiy oqibatlarga olib keladi va boshqacha boshqarishni talab qiladi. Ikki ankilomateriya turining lichinkalarini mikroskopik usulda ham ajratish mumkin, ammo bu odatiy holga kelmasa ham, odatda tadqiqot maqsadida. Voyaga etgan qurtlar kamdan-kam uchraydi (endoskopiya, jarrohlik yoki otopsi orqali bundan mustasno), ammo topilsa, turni aniq aniqlashga imkon beradi. Tasniflashni bukkal bo'shlig'ining uzunligi, og'iz teshigi va qizilo'ngach orasidagi bo'shliqqa qarab amalga oshirish mumkin: ankilomid rabditoform lichinkalari uzun bo'yin bo'shliqlariga ega. Strongiloidlar rabditoform lichinkalari bukkalning qisqa bo‘shliqlariga ega.[11]

So'nggi tadqiqotlar infektsiyani tashxislash, ankilomatermni o'ziga xos identifikatsiyasi va ankilomaniya populyatsiyasida genetik o'zgaruvchanlikni tahlil qilish uchun DNKga asoslangan vositalarni ishlab chiqishga qaratilgan.[19] Ankilomit tuxumlarini ko'pincha boshqa parazit tuxumlardan ajratib bo'lmaydigan bo'lgani uchun, PCR tahlillar najasda ankilomateriyani aniq tashxislash uchun molekulyar yondashuv bo'lib xizmat qilishi mumkin.[19][20]

Oldini olish

Qo'shimcha ma'lumotlar: Gelmintioz § Oldini olish

Yuqumli lichinkalar nam axloqsizlik, ayniqsa qumli va qumloq tuproq muhitida rivojlanib, yashaydi. Ular loy yoki muckda omon qololmaydilar. Ehtiyotkorlikning asosiy yo'nalishlari yaxshilik buyurgan narsalardir gigiena xatti-harakatlar:

Moksidektin Qo'shma Shtatlarda (imidakloprid + moksidektin) itlar va mushuklar uchun topikal eritma. U moxidektindan dumaloq qurtlarni, ankilomidlarni, oldini olish va oldini olish uchun foydalanadi. yurak qurtlari va qamchi qurtlari.

Efiopiyalik bolalar shistosoma va ankilomatermlardan davolangan.

Bolalar

Ushbu sog'liqni saqlash muammolarining aksariyati ankilomitni yuqtirgan bolalarga qaratilgan. Bolalarga bo'lgan e'tibor, asosan, ankilomateriya infektsiyasi va o'qitishning buzilishi, maktabga ketmaslikning ko'payishi va kelajakdagi iqtisodiy samaradorlikning pasayishi o'rtasidagi kuchli aloqalarni namoyish etgan ko'plab dalillarga bog'liq.[12] 2001 yilda 54-Butunjahon sog'liqni saqlash assambleyasi a'zo davlatlardan 2010 yilgacha xavf ostida bo'lgan maktab o'quvchilarining kamida 75 foizini muntazam ravishda degelmintizatsiya qilish bo'yicha minimal maqsadga erishishni talab qiladigan rezolyutsiya qabul qildi.[21] Jahon sog'liqni saqlash tashkilotining 2008 yildagi nashrida maktab yoshi xavf ostida bo'lgan bolalarni davolash bo'yicha ushbu harakatlar to'g'risida xabar berilgan. Ba'zi qiziqarli statistikalar quyidagicha edi: 1) endemik 130 mamlakatdan atigi 9 tasi 75% maqsadga erisha oldi; va 2) 77 milliondan kam maktab yoshidagi bolalar (jami 878 million xavf ostida) qamrab olindi, bu xavfli bolalarning atigi 8,78 foizida ankilomateriya infektsiyasi davolanayotganligini anglatadi.[22]

Maktabda olib borilayotgan ommaviy degelmintizatsiya

Maktabga asoslangan ommaviy degelmintizatsiya qilish dasturlar bolalarda ankilomateriya yuqtirish masalasini hal qilishning eng mashhur strategiyasi bo'ldi. Maktabga asoslangan dasturlar juda iqtisodiy jihatdan samaralidir, chunki maktablar allaqachon mavjud, keng va barqaror infratuzilma bilan malakali ishchi kuchiga ega bo'lib, ular hamjamiyat bilan yaqin aloqada.[21] Mahalliy sog'liqni saqlash tizimining ozgina malakasini olgan holda, o'qituvchilar ko'pincha har bir bola uchun yiliga 0,50 AQSh dollaridan kam bo'lgan dori-darmonlarni osonlikcha boshqaradilar.[23]

So'nggi paytlarda ko'p odamlar maktabga asoslangan dasturlarning eng samarali yondashuv ekanligi to'g'risida savol berishni boshladilar. Maktabga asoslangan dasturlarning muhim tashvishi shundaki, ular ko'pincha maktabga bormaydigan bolalarga etib bormaydilar, shuning uchun katta miqdordagi xavf ostida bo'lgan bolalar e'tiborga olinmaydi. Massaning 2008 yildagi tadqiqotlari va boshq. maktabga asoslangan dasturlar haqida bahsni davom ettirdi. Tanzaniyaning Tanga mintaqasidagi jamoaviy davolanish va maktabga asoslangan davolash usullarining ta'sirini o'rganishdi. Asosiy xulosa shundan iboratki, qishloqda davolash usulini qo'llaydigan qishloqlarda ankilomateriya infektsiyasining o'rtacha intensivligi maktabga qaraganda ancha past bo'lgan. Ushbu maxsus tadqiqotda foydalanilgan jamoatchilikka yo'naltirilgan davolash modeli qishloq aholisiga antihelminthic dorilarni boshqarish uchun o'zlarining jamoat dori tarqatuvchilarini tanlash orqali bolani davolashni nazorat qilish imkoniyatini berdi. Bundan tashqari, qishloq aholisi barcha bolalarga giyohvand moddalarni tarqatish usullarini uyushtirdi va amalga oshirdi.[24] Ushbu yangi model bilan bog'liq ijobiy natijalar degelmintizatsiya kampaniyalarida jamoatchilikni keng miqyosda jalb qilish zarurligini ta'kidlamoqda.

Sog'liqni saqlash bo'yicha ta'lim

Ko'plab ommaviy degelmintizatsiya dasturlari, shuningdek, o'zlarining sa'y-harakatlarini xalq salomatligi ta'limi bilan birlashtiradi. Ushbu sog'liqni saqlash dasturlari ko'pincha muhim profilaktika usullarini ta'kidlaydi, masalan: ovqatdan oldin qo'lingizni yuvish va odamning najasi bilan ifloslangan suv / joylardan uzoqroq turish. Ushbu dasturlarda, shuningdek, poyabzal kiyish kerakligi ta'kidlanishi mumkin, ammo ular sog'liq uchun o'zlari uchun xavf tug'diradi va samarali bo'lmasligi mumkin.[25] Butun dunyo bo'ylab shahar va qishloqlarda poyabzal kiyish madaniy e'tiqodlar va ushbu jamiyatdagi ta'lim darajasi bilan belgilanadi. Oyoq kiyimlarini kiyish ankilomateriya infektsiyasini atrofdagi tuproqlardan terining mayin mintaqalariga kirib qolishining oldini oladi; oyoq barmoqlari orasidagi joylar kabi.[26]

Sanitariya

1943 yildan 1947 yilgacha bo'lgan Missisipi va Florida shtatlaridagi ankilomateriya kampaniyalari kabi tarixiy misollar shuni ko'rsatdiki, ankilomateriya yuqtirishning asosiy sababi yomon sanitariya holati bo'lib, uni qurish va saqlash orqali hal qilish mumkin. hojatxonalar. Ammo bu oddiy vazifalar bo'lib tuyulsa-da, ular sog'liqni saqlash uchun muhim muammolarni keltirib chiqaradi. Yuqtirilgan aholining aksariyati sanitariya holati juda yomon bo'lgan qashshoqlikka uchragan hududlardan. Shunday qilib, xavf ostida bo'lgan bolalar kirish imkoniyatiga ega emasligi ehtimoli katta toza suv ga qo'llarini yuving va tegishli sanitariya infratuzilmasi bo'lmagan muhitda yashash. Shuning uchun sog'liqni saqlash ta'limi profilaktika choralarini resurslar bilan cheklangan sharoitlarda ham amalga oshiriladigan, ham barqaror usullar bilan hal qilishi kerak.

Integratsiyalashgan yondashuvlar

Ko'plab sog'liqni saqlash tadbirlarini baholash, odatda, qashshoqlik bilan bog'liq bo'lgan har bir alohida komponentning yaxshilanishi (masalan, sanitariya, sog'liqni saqlash ta'limi va asosiy ovqatlanish holati) ko'pincha yuqtirishga minimal ta'sir ko'rsatadi. Masalan, bitta tadqiqot shuni ko'rsatdiki, manba cheklangan jamoaga hojatxonalarni kiritish ankilomid infektsiyasining tarqalishini to'rt foizga kamaytirgan.[27] Biroq, Braziliyaning Salvador shahrida o'tkazilgan yana bir tadqiqot shuni ko'rsatdiki, yaxshilandi drenaj va kanalizatsiya bor edi muhim ta'sir ankilomateriya infektsiyasining tarqalishiga, ammo ankilomaniya infektsiyasining intensivligiga umuman ta'sir ko'rsatmaydi.[28] Bu shuni ko'rsatadiki, ekologik nazoratning o'zi ankilomateriya yuqishiga cheklangan, ammo to'liq bo'lmagan ta'sir ko'rsatadi. Shu sababli, ta'lim, sanitariya va davolanishni o'z ichiga olgan ko'plab profilaktika usullarini birlashtirgan integral dasturlarning samaradorligi va barqarorligini tushunish uchun ko'proq tadqiqotlar olib borish zarur.

Davolash

Qo'shimcha ma'lumotlar: Gelmintioz § davolash

Anthelmintic dorilar

Ankilomitni davolashning eng keng tarqalgan usuli bu benzimidazollar, xususan albendazol va mebendazol. BZAlar kattalar qurtlarini nematodaning β- ga bog'lab o'ldiradi.tubulin va keyinchalik inhibe qiladi mikrotubula parazit ichida polimerlanish.[14] Muayyan sharoitlarda, levamizol va pirantel pamate ishlatilishi mumkin.[12] 2008 yilgi tadqiqotlar shuni ko'rsatdiki, ankilomateriya infektsiyasini bir martalik davolash samaradorligi quyidagicha: albendazol uchun 72%, mebendazol uchun 15% va pirantel pamat uchun 31%.[29] Albendazol ankilomaterm infektsiyalari uchun mebendazolga qaraganda ancha samaraliroq degan ilgari da'volarni tasdiqlaydi. Shuni ham ta'kidlash joizki, Jahon sog'liqni saqlash tashkiloti homilador ayollarda birinchi trimestrdan keyin anthelmintic davolashni tavsiya qiladi.[14] Agar bemorda ham anemiya bo'lsa, tavsiya etiladi temir sulfat (200 mg) anthelmintic davolash bilan bir vaqtda kuniga uch marta yuboriladi; bu gemoglobin ko'rsatkichlari normal holatga kelguncha davom etishi kerak, bu 3 oygacha davom etishi mumkin.[11]

Hookworm infektsiyasini mahalliy davolash mumkin kriyoterapiya ankilomit hali ham terida bo'lganida.[30]

Albendazol ichak bosqichida ham, bosqichda ham parazit hanuzgacha teri ostida ko'chib yuradi.[30]

Anemiya bo'lsa, temir qo'shimchalarning yengillik alomatlarini keltirib chiqarishi mumkin temir tanqisligi anemiyasi. Ammo, qizil qon hujayralari darajasi tiklangani kabi, boshqa zarur moddalarning etishmasligi foliy kislotasi yoki vitamin B12 rivojlanishi mumkin, shuning uchun ular ham to'ldirilishi mumkin.

Reinfektsiya va dorilarga qarshilik

Ankilomitni davolash bilan bog'liq boshqa muhim masalalar reinfektsiya va dori-darmonlarga chidamlilikdir. Davolanishdan keyin reinfektsiya juda yuqori bo'lishi mumkinligi ko'rsatilgan. Ba'zi tadkikotlar shuni ko'rsatadiki, ankilomateriya infektsiyasini oldindan davolashning 80% davolash qilingan jamoalarda 30-36 oy ichida ko'rish mumkin.[14] Reinfektsiya sodir bo'lishi mumkin bo'lsa-da, doimiy davolanishni o'tkazish tavsiya etiladi, chunki bu surunkali natijalar paydo bo'lishini minimallashtiradi. Shuningdek, giyohvand moddalarga qarshilik ko'rsatish masalasida xavotirlar kuchaymoqda. Chorvachilik nematodalari uchun ishlatiladigan anthelmintics dorilarida giyohvandlikka qarshilik paydo bo'ldi. Umuman olganda inson nematodlari ko'payish muddatlari, kamroq davolanish va maqsadli davolanish tufayli qarshilikka duch kelmaydi. Shunga qaramay, global hamjamiyat hozirgi anthelmintic samaradorligini saqlab qolish uchun ehtiyot bo'lishlari kerak, chunki yangi anthelmintic dorilar rivojlanish bosqichida yo'q.[14]

Epidemiologiya

Qo'shimcha ma'lumotlar: Gelmintioz § Epidemiologiya
Nogironlik uchun belgilangan hayot yili uchun ankilomit kasalligi 2002 yilda 100000 aholiga.
  ma'lumotlar yo'q
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  55–60
  60 dan ortiq

Ma'lumotlarga ko'ra, 576 dan 740 milliongacha odam ankilomid bilan kasallangan.[31][14] Ushbu yuqtirilgan odamlarning taxminan 80 millioni jiddiy ta'sir ko'rsatadi.[19] Ankilomitni yuqtirishning asosiy sababi bu N. Amerika bu Amerika, Sahroi Afrikada va Osiyoda joylashgan.[12] A. o'n ikki barmoqli ichak ko'proq tarqalgan fokusli muhitda, ya'ni Evropa va O'rta dengizda joylashgan. Yuqtirilgan odamlarning aksariyati Saxaradan janubiy Afrikada va Sharqiy Osiyo / Tinch okean orollarida to'plangan bo'lib, ularning har bir mintaqasida, tegishlicha 198 va 149 million yuqtirganlar bor. Boshqa ta'sirlangan hududlarga quyidagilar kiradi: Janubiy Osiyo (50 million), Lotin Amerikasi va Karib havzasi (50 million), Janubiy Osiyo (59 million), Yaqin Sharq / Shimoliy Afrika (10 million).[14] Ushbu yuqtirilgan odamlarning aksariyati kambag'allik sharoitida, sanitariya sharoitlari yomon bo'lgan joylarda yashaydilar. Ankilomit infektsiyasi dunyodagi eng kambag'al odamlar orasida eng ko'p to'plangan, kuniga 2 dollardan kam pul ishlashadi.[12]

Ankilomit infektsiyasi to'g'ridan-to'g'ri o'limga olib kelmasligi mumkin bo'lsa-da, uning kasallikka ta'siri darhol e'tibor talab qiladi. Ko'rib chiqayotganda nogironlik bo'yicha tuzatilgan hayot yillari (DALY), e'tiborsiz qoldirilgan tropik kasalliklar, shu jumladan ankilomateriya infektsiyasi, diareya kasalliklari orasida, yurak ishemik kasalligi, bezgak va sil kasalligi rivojlanayotgan dunyo sog'lig'ining eng muhim muammolaridan biri sifatida.

Taxminan 22,1 mln DALY ankilomit infektsiyasi tufayli yo'qolgan. So'nggi paytlarda ankilomateriya infektsiyasi bilan bog'liq sog'liqni saqlash muammolarini hal qilishga qiziqish kuchaymoqda. Masalan, Bill va Melinda Geyts jamg'armasi Yaqinda beparvo qilingan tropik kasalliklarga qarshi kurashish uchun 34 million AQSh dollari miqdorida xayriya yordami, shu jumladan ankilomaniya infektsiyasi.[32] AQShning sobiq prezidenti Klinton ham Klinton Global Initiative (CGI) 2008 yillik yig'ilishida 10 million bolani gelmintlardan tozalash bo'yicha mega majburiyatini e'lon qildi.[33]

Ankilomateriya infektsiyasining tarqalishi bilan bog'liq ko'plab raqamlar taxminlarga ko'ra, hozirgi kunda tarqalishi va global tarqalishini aniqlash uchun xalqaro kuzatuv mexanizmi mavjud emas.[12] Ba'zi tarqalish darajasi dunyodagi endemik mintaqalarda o'tkazilgan so'rov ma'lumotlari orqali o'lchandi. Quyida ankilomateriya bilan kasallangan mintaqalarda tarqalish darajasi bo'yicha so'nggi topilmalar keltirilgan.

Darjeeling, Xogli tumani, G'arbiy Bengal, Hindiston (Pal va boshq. 2007)[34]

  • Infektsiya darajasi 43% ni tashkil qiladi N. Amerika ba'zilari bilan bo'lsa ham A. o'n ikki barmoqli ichak infektsiya
  • Ikkala ankilomaterm infektsiyasining yuki va anemiya darajasi engil diapazonda

Syulongkan Qishloq, Xaynan viloyati, Xitoy (Gandi va boshq. 2001)[35]

  • 60% yuqtirish darajasi N. Amerika
  • Belgilangan muhim tendentsiyalar shuni ko'rsatdiki, tarqalish yoshga qarab ko'paygan (taxminan 41 yoshdagi plato) va ayollarda erkaklarnikiga nisbatan tarqalish darajasi yuqori

Hòa Bìhh, Shimoliy G'arbiy Vetnam (Verle.) va boshq. 2003)[36]

  • Jami 526 ta tekshirilgan uy xo'jaliklarining 52% yuqtirgan
  • Turlarni aniqlay olmadi, ammo Shimoliy Vetnamda o'tkazilgan avvalgi tadqiqotlar haqida xabar berilgan N. Amerika ankilomateriya lichinkalarining 95% dan ortig'ida

Minas Gerais, Braziliya (Fleming va boshq. 2006)[37]

  • Infektsiya darajasi asosan 63% ni tashkil qiladi N. Amerika

KwaZulu-Natal, Janubiy Afrika (Mabaso.) va boshq. 2004)[38]

  • Ichki hududlarning tarqalish darajasi 9% ni tashkil etdi N. Amerika
  • Sohil bo'yidagi tekisliklarning tarqalish darajasi 63% ni tashkil etdi N. Amerika

Labdes okrugi, Alabama, Qo'shma Shtatlar [39][40]

  • Infektsiya darajasi 35% ni tashkil qiladi N. Amerika

Bundan tashqari, ankilomateriya tarqalishini xaritasini aniqroq aniqlashga yordam beradigan texnologik o'zgarishlar ham bo'lgan. Ba'zi tadqiqotchilar gelmint ekologiyasi va epidemiologiyasini tekshirish uchun geografik axborot tizimlari (GIS) va masofadan zondlash (RS) dan foydalanishni boshladilar. Bruker va boshq. ushbu texnologiyadan Afrikaning Sahroi osti qismlarining gelmint tarqatish xaritalarini yaratish uchun foydalangan. Sun'iy yo'ldoshdan olingan atrof-muhit ma'lumotlarini maktabda o'tkazilgan so'rovnomalarning tarqalish ma'lumotlari bilan taqqoslab, ular keng tarqalish xaritalarini yaratishga muvaffaq bo'lishdi. Tadqiqotda ko'plab gelmintlarga e'tibor qaratildi, ammo ankilostomnik haqida qiziqarli xulosalar topildi. Boshqa gelmintlar bilan taqqoslaganda, ankilomid juda issiq sharoitda omon qolishga qodir va termal diapazonning yuqori qismida juda keng tarqalgan.[41]

Yaxshilangan molekulyar diagnostika vositalari - mavjud tarqalish statistikasini yaxshilashga yordam beradigan yana bir texnologik yutuq. Yaqinda o'tkazilgan tadqiqotlar DNKga asoslangan vositani ishlab chiqishga qaratilgan bo'lib, u infektsiyani aniqlash, ankilomateriyaning o'ziga xos identifikatsiyasi va ankilomateriya populyatsiyasida genetik o'zgaruvchanlikni tahlil qilish uchun ishlatilishi mumkin. Shunga qaramay, bu ankilomateriya infektsiyasiga qarshi turli xil sog'liqni saqlash choralari uchun asosiy vosita bo'lishi mumkin. Diagnostika vositalari bilan bog'liq ko'plab tadqiqotlar hozirgi vaqtda ankilomateriya infektsiyasining o'ziga xos diagnostikasi uchun tezkor va tejamkor tahlilni yaratishga qaratilgan. Ko'pchilik uning rivojlanishiga yaqin besh yil ichida erishish mumkinligiga umid qilmoqda.[qachon? ][19]

Tarix

Kashfiyot

Endi ankilomitga tegishli alomatlar paydo bo'ladi papirus qadimiy qog'ozlar Misr (miloddan avvalgi 1500 y.), anemiya bilan tavsiflangan buzilish deb ta'riflangan. Avitsena, XI asrning fors shifokori, kasallarning bir nechtasida qurtni topdi va ularni ularning kasalligi bilan bog'ladi. Keyingi paytlarda bu holat tog'-kon sanoati sohasida keng tarqalgan Angliya, Frantsiya, Germaniya, Belgiya, Shimoliy Kvinslend va boshqa joylarda.[18]

Italiya shifokori Anjelo Dubini 1838 yilda qurtlarni zamonaviy kashf etgan otopsi dehqon ayolining. Dubini 1843 yilda tafsilotlarni e'lon qildi va turlarni aniqladi A. o'n ikki barmoqli ichak. Misr tibbiyot tizimida 1852 yilda nemis shifokori ishlagan Teodor Bilxars, hamkasbining ishiga asoslanib Vilgelm Grizinger, ushbu qurtlarni otopsi paytida topdi va ularni mahalliy endemik hodisalar bilan bog'lashda yana bir qadam tashladi xloroz, ehtimol bu deyilishi mumkin temir tanqisligi anemiyasi Bugun.

25 yildan so'ng, a dan keyin bir yutuq paydo bo'ldi diareya va anemiya orasida sodir bo'lgan epidemiya Italyancha bo'yicha ishchilar Gotthard temir yo'l tunnel.[18] 1880 yilgi maqolada shifokorlar Camillo Bozzolo, Edoardo Perroncito va Luidji Palliani ankilomateriya ishchilarning 15 km uzunlikdagi tunnel ichida najas olishlari kerakligi va ko'plari eskirgan poyabzal kiyib olishlari bilan bog'liqligi to'g'risida to'g'ri faraz qildi.[42] 1897 yilda terining infektsiyaning asosiy yo'li ekanligi aniqlandi biologik hayot aylanishi ankilomitga aniqlik kiritildi.

Yo'q qilish dasturlari

1899 yilda amerikalik zoolog Charlz Vardell Staylz progressiv aniqlangan xavfli anemiya Qo'shma Shtatlarning janubida ankilomit sabab bo'lgan deb ko'rilgan A. o'n ikki barmoqli ichak. 1900-yillarda o'tkazilgan sinovlar maktab yoshidagi bolalarda juda og'ir yuqumli kasalliklarni aniqladi. Yilda Puerto-Riko, Doktor Beyli K.Eshford, AQSh armiyasining shifokori parazitlarni davolash kampaniyasini tashkil qildi va o'tkazdi, bu taxminan 300,000 odamni (Puerto-Riko aholisining uchdan bir qismini) davoladi va yillar davomida ushbu anemiyadan o'limni 90 foizga kamaytirdi. 1903-04.

Shifokor bolani ankilomateriya belgilari uchun tekshirmoqda Coab County, Alabama, 1939.

1909 yil 26-oktabrda Rokfellerning ankilomaterm kasalligini yo'q qilish bo'yicha sanitariya komissiyasi tomonidan 1 million AQSh dollari miqdoridagi sovg'a natijasida tashkil etildi. Jon D. Rokfeller, Sr. Besh yillik dastur o'n bir janubiy shtatda xalq ta'limi, dori-darmon vositalari, dala ishlari va zamonaviy hukumat sog'liqni saqlash bo'limlarini tarbiyalashda Qo'shma Shtatlarning sog'lig'ini saqlashga ulkan hissa qo'shdi.[43]Ankilostomitlar ko'rgazmasi 1910 yilgi Missisipi shtati ko'rgazmasining muhim qismi bo'lgan.

Komissiya maktab yoshidagi bolalarning o'rtacha 40 foizida ankilomurt yuqtirganligini aniqladi. Yo'q qilish dasturidan oldin ankilomateriya yuqtirish darajasi yuqori bo'lgan joylarda aralashuvdan so'ng maktabga qabul qilish, davomat va savodxonlik darajasi oshgan. Ekonometrik tadqiqotlar shuni ko'rsatdiki, bu ta'sirni turli xil alternativ omillar, jumladan, hududlar bo'yicha differentsial tendentsiyalar, ekinlar narxlarining o'zgarishi, ta'lim va sog'liqni saqlash sohasidagi ayrim siyosatning o'zgarishi va bezgakni yo'q qilish ta'siri bilan izohlash mumkin emas.[44] Infektsiya darajasi ancha past (oldingi) bo'lganligi sababli aralashuvdan kamroq foyda ko'rishi kerak bo'lgan kattalar uchun biron bir muhim natijalar topilmadi. Dastur ankilomitni deyarli yo'q qildi va keyinchalik yangi mablag 'bilan rivojlanib bordi Rokfeller jamg'armasi Xalqaro sog'liqni saqlash bo'limi.[45]

RFning Meksikadagi ankilomateriya kampaniyasi fan va siyosat sog'liqni saqlash siyosatini ishlab chiqishda qanday rol o'ynashini ko'rsatdi. Unda hukumat amaldorlari, sog'liqni saqlash xodimlari, sog'liqni saqlash xodimlari, Rokfeller amaldorlari va jamoat birlashdi. Ushbu aksiya Meksikada ankilomitlarni yo'q qilish uchun boshlangan. Although the campaign did not focus on long-term treatments, it did set the terms of the relationship between Mexico and the Rockefeller Foundation. The scientific knowledge behind this campaign helped shape public health policies, improved public health and built a strong relationship between US and Mexico.[46]

In the 1920s, hookworm eradication reached the Caribbean and Latin America, where great mortality was reported among people in the G'arbiy Hindiston towards the end of the 18th century, as well as through descriptions sent from Braziliya and various other tropical and sub-tropical regions.[18]

Muolajalar

Early treatment relied on the use of Epsom salt to reduce protective mucus, followed by thymol to kill the worms.[47] Keyinchalik tetrakloretilen was the leading method. It was not until later in the mid-20th century when new organic drug compounds were developed.[48]

Tadqiqot

Anemia in pregnancy

It is estimated that a third of all pregnant women in developing countries are infected with hookworm, 56% of all pregnant women in developing countries suffer from anemia, 20% of all maternal deaths are either directly or indirectly related to anemia. Numbers like this have led to an increased interest in the topic of hookworm-related anemia during pregnancy.[49] With the understanding that chronic hookworm infection can often lead to anemia, many people are now questioning if the treatment of hookworm could effect change in severe anemia rates and thus also on maternal and child health as well. Most evidence suggests that the contribution of hookworm to maternal anemia merits that all women of child-bearing age living in endemic areas be subject to periodic anthelmintic treatment. The World Health Organization even recommends that infected pregnant women be treated after their first trimester.[14] Regardless of these suggestions, only Madagascar, Nepal and Sri Lanka have added deworming to their antenatal care programs.[50]

This lack of deworming of pregnant women is explained by the fact that most individuals still fear that anthelmintic treatment will result in adverse birth outcomes. But a 2006 study by Gyorkos et al. found that when comparing a group of pregnant women treated with mebendazole with a control placebo group, both illustrated rather similar rates in adverse birth outcomes. The treated group demonstrated 5.6% adverse birth outcomes, while the control group had 6.25% adverse birth outcomes.[49] Furthermore, Larocque et al. illustrated that treatment for hookworm infection actually led to positive health results in the infant. This study concluded that treatment with mebendazole plus iron supplements during antenatal care significantly reduced the proportion of very low birth weight infants when compared to a placebo control group.[51] Studies so far have validated recommendations to treat infected pregnant women for hookworm infection during pregnancy.

A review of effects of antihelminthics (anti-worm drugs) given in pregnancy found that there was not enough evidence to support treating pregnant women in their second or third trimesters.[52] The women who were treated in the second trimester and the women who had no treatment showed no difference in numbers of maternal anemia, low birth weight, preterm birth or deaths of babies.[52]

The intensity of hookworm infection as well as the species of hookworm have yet to be studied as they relate to hookworm-related anemia during pregnancy. Additionally, more research must be done in different regions of the world to see if trends noted in completed studies persist.

Malaria co-infection

Co-infection with hookworm and Plazmodium falciparum is common in Africa.[53] Although exact numbers are unknown, preliminary analyses estimate that as many as a quarter of African schoolchildren (17.8–32.1 million children aged 5–14 years) may be coincidentally at-risk of both P. falciparum and hookworm.[54] While original hypotheses stated that co-infection with multiple parasites would impair the host's immune response to a single parasite and increase susceptibility to clinical disease, studies have yielded contrasting results. For example, one study in Senegal showed that the risk of clinical malaria infection was increased in helminth-infected children in comparison to helminth-free children while other studies have failed to reproduce such results,[55] and even among laboratory mouse experiments the effect of helminths on malaria is variable.[56]

Some hypotheses and studies suggest that helminth infections may protect against cerebral malaria due to the possible modulation of pro-inflammatory and anti-inflammatory cytokines responses.[57] Furthermore, the mechanisms underlying this supposed increased susceptibility to disease are unknown. For example, helminth infections cause potent and highly polarized immune response characterized by increased T-helper cell type 2 (Th2) sitokin va Immunoglobulin E (IgE) production.[58] However, the effect of such responses on the human immune response is unknown. Additionally, both malaria and helminth infection can cause anemia, but the effect of co-infection and possible enhancement of anemia is poorly understood.[48]

Hygiene hypothesis and hookworm as therapy

Asosiy maqola: Helminthic therapy

The gigiena gipotezasi states that infants and children who lack exposure to infectious agents are more susceptible to allergic diseases via modulation of immune system development. The theory was first proposed by David P. Strachan who noted that gul changiga allergiya va ekzema were less common in children who belonged to large families.[59] Since then, studies have noted the effect of gastrointestinal worms on the development of allergies in the developing world. For example, a study in Gambia found that eradication of worms in some villages led to increased skin reactions to allergies among children.[60]

Vaksinalar

Asosiy maqola: Hookwormga qarshi emlash

While annual or semi-annual mass antihelminthic administration is a critical aspect of any public health intervention, many have begun to realize how unsustainable it is due to aspects such as poverty, high rates of re-infection, and diminished efficacy of drugs with repeated use. Current research, therefore, has focused on the development of a vaccine that could be integrated into existing control programs. The goal of vaccine development is not necessarily to create a vaccine with sterilizing immunity or complete protection against immunity. A vaccine that reduces the likelihood of vaccinated individuals developing severe infections and thus reduced blood and nutrient levels could still have a significant impact on the high burden of disease throughout the world.

Current research focuses on targeting two stages in the development of the worm: the larval stage and the adult stage. Research on larval antigens has focused on proteins that are members of the pathogenesis-related protein superfamily, Ancylostoma Secreted Proteins.[61] Although they were first described in Anyclostoma, these proteins have also been successfully isolated from the secreted product of N. Amerika. N. Amerika ASP-2 (Na-ASP-2) is currently the leading larval-stage hookworm vaccine candidate. A randomized, double-blind, placebo-controlled study has already been performed; 36 healthy adults without a history of hookworm infection were given three intramuscular injections of three different concentrations of Na-ASP-2 and observed for six months after the final vaccination.[62] The vaccine induced significant anti-Na-ASP-2 IgG and cellular immune responses. In addition, it was safe and produced no debilitating side effects. The vaccine is now in a phase one trial; healthy adult volunteers with documented evidence of previous infection in Brazil are being given the same dose concentration on the same schedule used in the initial study.[61] If this study is successful, the next step would be to conduct a phase two trial to assess the rate and intensity of hookworm infection among vaccinated persons. Because the Na-ASP-2 vaccine only targets the larval stage, it is critical that all subjects enrolled in the study be treated with antihelminthic drugs to eliminate adult worms prior to vaccination.

Adult hookworm antigens have also been identified as potential candidates for vaccines. When adult worms attach to the intestinal mucosa of the human host, erythrocytes are ruptured in the worm's digestive tract which causes the release of free hemoglobin which is subsequently degraded by a proteolytic cascade. Several of these proteins that are responsible for this proteolytic cascade are also essential for the worm's nutrition and survival.[63] Therefore, a vaccine that could induce antibodies for these antigens could interfere with the hookworm's digestive pathway and impair the worm's survival. Three proteins have been identified: the aspartic protease-hemoglobinase APR-1, the cysteine protease-hemoglobinase CP-2, and a glutathione S-transferase.[64][65][66] Vaccination with APR-1 and CP-2 led to reduced host blood loss and fecal egg counts in dogs.[64][65] With APR-1, vaccination even led to reduced worm burden.[64] Research is currently stymied at the development of at least one of these antigens as a recombinant protein for testing in clinical trials.

Terminologiya

The term "hookworm" is sometimes used to refer to hookworm infection.[12] A hookworm is a type of parasitic worm (helminth ).

Shuningdek qarang

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