Bezgak - Malaria

Boshqa maqsadlar uchun qarang Bezgak (disambiguatsiya).
Buni chalkashtirib yubormaslik kerak miyariya.
Bezgak
Odamning qizil qon hujayrasiga bog'langan bezgak paraziti (34034143483) .jpg
A ga bog'langan bezgak paraziti qizil qon tanachasi
Talaffuz
MutaxassisligiYuqumli kasallik
AlomatlarIsitma, qusish, bosh og'rig'i, sariq teri[1]
MurakkabliklarTutqanoq, koma[1]
Odatiy boshlanishTa'sirdan keyingi 10-15 kun[2]
SabablariPlazmodium tomonidan tarqatilgan chivinlar[1]
Diagnostika usuliQonni tekshirish, antijeni aniqlash testlari[1]
Oldini olishChivin to'rlari, hasharotlarga qarshi vosita, chivinlarga qarshi kurash, dorilar[1]
Dori-darmonBezgakka qarshi dori[2]
Chastotani228 million (2018)[3]
O'limlar2018 yilda 405,000[3]

Bezgak a chivin bilan yuqadigan yuqumli kasallik odamlarga va boshqa hayvonlarga ta'sir qiladi.[2] Bezgak sabablari alomatlar odatda o'z ichiga oladi isitma, charchoq, qusish va bosh og'rig'i.[1] Og'ir holatlarda, bu sabab bo'lishi mumkin sariq teri, soqchilik, koma, yoki o'lim.[1] Semptomlar odatda yuqtirgan tomonidan tishlanganidan o'n dan o'n besh kungacha boshlanadi chivin.[2] To'g'ri davolanmasa, odamlarda bir necha oy o'tgach kasallik qaytalanishi mumkin.[2] Yaqinda omon qolganlarda infektsiya, reinfektsiya odatda engil alomatlarni keltirib chiqaradi.[1] Bu qisman qarshilik odamda bezgak kasalligi davom etmasa, u bir necha oydan bir necha yilgacha yo'qoladi.[1]

Bezgak kasalligi sabab bo'ladi bir hujayrali mikroorganizmlar ning Plazmodium guruh.[2] Kasallik ko'pincha yuqtirgan ayol tomonidan tarqaladi Anofellar chivin.[2] Chivin chaqishi bilan tanishtiradi parazitlar chivinlardan tupurik odamning ichiga qon.[2] Parazitlar jigar qaerda ular etuk va ko'payish.[1] Beshta turi Plazmodium yuqtirishi va odamlar tomonidan tarqalishi mumkin.[1] O'limning aksariyati sababdir P. falciparum, aksincha P. vivax, P. ovale va P. bezgak odatda bezgakning engilroq shaklini keltirib chiqaradi.[1][2] Turlar P. knowlesi kamdan-kam odamlarda kasallik keltirib chiqaradi.[2] Bezgakni odatda mikroskopik tekshirish qondan foydalanish qon plyonkalari yoki bilan antigenga asoslangan tezkor diagnostika testlari.[1] Dan foydalanadigan usullar polimeraza zanjiri reaktsiyasi parazitlarni aniqlash uchun DNK ishlab chiqilgan, ammo bezgak bo'lgan joylarda keng qo'llanilmaydi umumiy ularning narxi va murakkabligi tufayli.[4]

Yordamida chivin chaqishi oldini olish orqali kasallik xavfini kamaytirish mumkin chivin to'rlari va hasharotlarga qarshi vositalar yoki bilan chivinlarga qarshi kurash choralari purkash kabi hasharotlar va quritish turgan suv.[1] Bir nechta dorilar mavjud bezgakning oldini olish kasallik tez-tez uchraydigan joylarga sayohatchilarda.[2] Kombinatsiyalangan dorilarning vaqti-vaqti bilan dozalari sulfadoksin / pirimetamin ichida tavsiya etiladi go'daklar va keyin birinchi trimestr ning homiladorlik bezgak darajasi yuqori bo'lgan hududlarda.[2] 2020 yilga kelib, bittasi bor emlash Afrikadagi bolalarda bezgak xavfini 40% ga kamaytirishi ko'rsatilgan.[5][6] Keyinchalik samarali vaktsinalarni yaratish bo'yicha harakatlar davom etmoqda.[6] Bezgakni davolash uchun tavsiya etilgan davolash usuli a kombinatsiya ning bezgakka qarshi dorilar shu jumladan artemisinin.[1][2] Ikkinchi dori ham bo'lishi mumkin meflokin, lumefantrin, yoki sulfadoksin / pirimetamin.[7] Xinin, bilan birga doksisiklin, artemisinin mavjud bo'lmasa ishlatilishi mumkin.[7] Kasallik tez-tez uchrab turadigan joylarda bezovtalikni davolash boshlanishidan oldin iloji bo'lsa, kuchayishi xavfi tufayli tasdiqlash tavsiya etiladi dorilarga qarshilik.[2] Parazitlar orasida qarshilik antimalarial dorilarga nisbatan rivojlangan; masalan, xlorokin - chidamli P. falciparum bezgakning aksariyat hududlariga tarqaldi va artemisinin qarshiligi Janubi-Sharqiy Osiyoning ayrim qismlarida muammoga aylandi.[2]

Kasallik keng tarqalgan tropik va subtropik atrofida keng tarmoqli mavjud bo'lgan mintaqalar ekvator.[1] Bunga ko'p narsalar kiradi Saxaradan Afrikaga, Osiyo va lotin Amerikasi.[2] 2018 yilda butun dunyoda bezgak bilan kasallangan 228 million holat qayd etilgan, natijada 405 ming kishi o'limga olib kelgan.[3] Ushbu holatlarning taxminan 93% va o'limning 94% Afrikada sodir bo'lgan.[3] Kasallik darajasi 2010 yildan 2014 yilgacha pasaygan, ammo 2015 yildan 2017 yilgacha o'sgan, bu davrda 231 million kasal bo'lgan.[3] Bezgak odatda qashshoqlik bilan bog'liq bo'lib, unga salbiy ta'sir ko'rsatmoqda iqtisodiy rivojlanish.[8][9] Afrikada sog'liqni saqlash xarajatlarining oshishi, ish qobiliyatini yo'qotishi va turizmga salbiy ta'sirlari tufayli yiliga 12 milliard AQSh dollar yo'qotishlarga olib kelishi taxmin qilinmoqda.[10]

Video xulosasi (skript)

Belgilari va alomatlari

Bezgakning asosiy belgilari[11]

Bezgak belgilari va alomatlari odatda infektsiyadan 8-25 kun o'tgach boshlanadi,[11] ammo keyinchalik olganlarda paydo bo'lishi mumkin oldini olish sifatida bezgakka qarshi dorilar.[4] Kasallikning boshlang'ich ko'rinishlari - bezgakning barcha turlari uchun umumiy - o'xshashdir grippga o'xshash alomatlar,[12] kabi boshqa shartlarga o'xshash bo'lishi mumkin sepsis, gastroenterit va virusli kasalliklar.[4] Taqdimot o'z ichiga olishi mumkin bosh og'rig'i, isitma, titroq, qo'shma og'riq, qusish, gemolitik anemiya, sariqlik, siydikdagi gemoglobin, retinaning shikastlanishi va konvulsiyalar.[13]

Bezgakning klassik alomati bu paroksism - har ikki kunda sodir bo'lgan to'satdan sovuqlikning davriy ko'rinishi, so'ngra titroq, keyin isitma va terlash (tertiana isitmasi ) ichida P. vivax va P. ovale infektsiyalar va har uch kunda (kvarsan isitmasi ) uchun P. bezgak. P. falciparum infektsiya har 36-48 soat ichida takroriy isitma yoki kamroq aniq va deyarli doimiy isitmani keltirib chiqarishi mumkin.[14]

Kuchli bezgak, odatda, sabab bo'ladi P. falciparum (ko'pincha falciparum bezgak deb ataladi). Falciparum bezgak alomatlari infektsiyadan 9-30 kun o'tgach paydo bo'ladi.[12] Miya bezgakka chalingan shaxslar tez-tez namoyish etadilar nevrologik alomatlar, shu jumladan g'ayritabiiy posturing, nistagmus, konjugat najasi (ko'zlarning bir tomonga burilmasligi), opistotonus, soqchilik, yoki koma.[12]

Murakkabliklar

Bezgak bir necha jiddiy kasalliklarga ega asoratlar. Bular orasida rivojlanish nafas olish qiyinlishuvi, bu kattalarning 25% gacha va og'ir bolalarda 40% da uchraydi P. falciparum bezgak. Mumkin bo'lgan sabablarga nafas olish kompensatsiyasi kiradi metabolik atsidoz, kardiogen bo'lmagan o'pka shishi, birgalikda zotiljam va og'ir anemiya. Og'ir bezgakka chalingan yosh bolalarda kam bo'lsa ham, o'tkir nafas yetishmasligi sindromi kattalarning 5-25% va homilador ayollarning 29% gacha uchraydi.[15] Koinfektsiya ning OIV bezgak bilan o'limni oshiradi.[16] Buyrak etishmovchiligi ning xususiyati qora suv isitmasi, gemoglobin qaerdan liza qilingan qizil qon hujayralari siydikka oqib chiqadi.[12]

Yuqtirish P. falciparum miya bezgagiga olib kelishi mumkin, bu og'ir bezgakning bir shakli ensefalopatiya. Bu bezgakni boshqa isitma sabablaridan ajratishda foydali klinik belgi bo'lishi mumkin bo'lgan retinani oqartirish bilan bog'liq.[17] An kengaygan taloq, kengaygan jigar yoki ikkalasi ham, qattiq bosh og'rig'i, past qon shakar va siydikdagi gemoglobin bilan buyrak etishmovchiligi sodir bo'lishi mumkin.[12] Asoratlar o'z-o'zidan qon ketishini o'z ichiga olishi mumkin, koagulopatiya va zarba.[18]

Homilador ayollarda bezgak ning muhim sababidir o'lik tug'ilish, bolalar o'limi, abort va kam vazn,[19] ayniqsa P. falciparum infektsiya, shuningdek P. vivax.[20]

Sababi

Asosiy maqola: Plazmodium

Bezgak parazitlar turkumga mansub Plazmodium (filum Apikompleksa ). Odamlarda bezgak kasalligi sabab bo'ladi P. falciparum, P. bezgak, P. ovale, P. vivax va P. knowlesi.[21][22] Yuqtirilganlar orasida P. falciparum aniqlangan eng keng tarqalgan tur (~ 75%) va undan keyin P. vivax (~20%).[4] Garchi P. falciparum an'anaviy ravishda o'limning aksariyat qismi,[23] so'nggi dalillar shuni ko'rsatmoqdaki P. vivax bezgak, hayotni xavf ostiga qo'yadigan, tashxis qo'yilgan holatlar bilan bog'liq P. falciparum infektsiya.[24] P. vivax mutanosib ravishda Afrikadan tashqarida keng tarqalgan.[25] Odamlarning bir nechta turlari bilan yuqtirishlari hujjatlashtirilgan Plazmodium dan yuqori maymunlar; ammo, bundan mustasno P. knowlesi- a zoonoz bezgakni keltirib chiqaradigan turlar makakalar[22]- ular asosan sog'liq uchun cheklangan ahamiyatga ega.[26]

Hayot davrasi

Bezgak parazitlarining hayot aylanishi. Chivin tishlash orqali infektsiyani keltirib chiqaradi. Birinchidan, sporozoidlar qon oqimiga kirib, jigarga ko'chib o'tishadi. Ular yuqtirishadi jigar hujayralari, bu erda ular merozoitlarga ko'payib, jigar hujayralarini yorib, qon oqimiga qaytadi. Merozoidlar qizil qon hujayralarini yuqtiradi, u erda ular halqa shakllari, trofozoitlar va shizontlarga aylanib, o'z navbatida keyingi merozoitlarni hosil qiladi. Jinsiy shakllar Bundan tashqari, ular chivin tomonidan olinadigan bo'lsa, hasharotlarni yuqtiradi va hayot aylanish jarayonini davom ettiradi.

In hayot davrasi ning Plazmodium, ayol Anofellar chivin ( aniq xost ) harakatlanuvchi yuqumli shaklni uzatadi ( sporozoit ) inson singari umurtqali xostga (ikkilamchi xost), shunday qilib transmissiya vazifasini bajaradi vektor. Sporozoit qon tomirlari orqali jigar hujayralariga o'tadi (gepatotsitlar ), u qaerda ko'payadi jinssiz (to'qima shizogoniya ), minglab ishlab chiqarish merozoitlar. Ular yangi eritrotsitlarga yuqadi va 8 dan 24 gacha yangi infeksion merozoitlarni hosil qiladigan bir qator jinsiy bo'lmagan ko'payish sikllarini (qon shizogoniyasi) boshlaydi va shu vaqtda hujayralar yorilib, infektsiya tsikli yangidan boshlanadi.[27]

Boshqa merozoitlar etuk bo'lib rivojlanadi gametotsitlar, erkak va ayolning kashshoflari jinsiy hujayralar. Urug'langan chivin yuqtirgan odamni tishlaganida, gametotsitlar qon bilan birga olinadi va chivin ichakchasida pishib yetiladi. Erkak va urg'ochi gametotsitlar birlashib, an hosil qiladi ookinete - urug'lantirilgan, harakatchan zigota. Ookinetalar hasharotlarga ko'chib o'tadigan yangi sporozoitlarga aylanadi tuprik bezlari, yangi umurtqali xostni yuqtirishga tayyor. Sporozoitlar teriga, tupurikka, pashsha keyingi qon ovqatini olganda yuboriladi.[28]

Faqatgina ayol chivinlar qon bilan oziqlanadi; erkak pashsha o'simlik nektaridan oziqlanadi va kasallik yuqtirmaydi. Chivin turkumidagi urg'ochilar Anofellar tunda ovqatlanishni afzal ko'rsating. Odatda ular shom tushganda ovqat qidirishni boshlashadi va muvaffaqiyatga erishguncha tun bo'yi davom etadilar.[29] Bezgak parazitlari ham yuqishi mumkin qon quyish, ammo bu kamdan-kam hollarda.[30]

Takroriy bezgak

Bezgak alomatlari har xil alomatsiz davrlardan keyin qaytalanishi mumkin. Sababiga qarab, takrorlanishni ikkala deb tasniflash mumkin orqaga qaytish, qayt qilish yoki reinfektsiya. Qayta tiklanish - bu simptomlarsiz davrdan keyin alomatlar qaytishi. Parazitlar qonda etarli yoki samarasiz davolanish natijasida omon qolishidan kelib chiqadi.[31] Qayta tiklanish - bu parazitlar qondan chiqarilgandan keyin alomatlar paydo bo'lib, ammo uxlab yotgan holatda saqlanib qoladi gipnozitlar jigar hujayralarida.[32] Qaytish odatda 8-24 xafta orasida bo'ladi va ko'pincha kuzatiladi P. vivax va P. ovale infektsiyalar.[4] Biroq, relapsga o'xshash P. vivax qaytalanishlar, ehtimol, gipnozit faollashishi bilan bog'liq. Ulardan ba'zilari tomirdan tashqari merozoit kelib chiqishiga ega bo'lishi mumkin, shuning uchun bu qaytalanishlar relapslar emas, balki rekuduksiyalarga aylanadi.[33] Yaqinda tanilgan, gipnozoid bo'lmagan, takroriy periferiyaga yordam beradigan manba P. vivax parazitemiya suyak iligidagi eritrositik shakllardir.[34] P. vivax bezgak holatlari mo''tadil sohalar ko'pincha o'z ichiga oladi qishlash chivin chaqgandan keyingi yil boshlangan relaps bilan gipnozitlar tomonidan.[35] Reinfektsiya demak, o'tmishda yuqtirilgan parazit tanadan chiqarib tashlangan, ammo yangi parazit paydo bo'lgan. Reinfektsiyani rekrudetsiyadan osonlikcha ajratib bo'lmaydi, ammo dastlabki infektsiyani davolashdan keyingi ikki hafta ichida infektsiyaning takrorlanishi odatda davolanishning muvaffaqiyatsizligi bilan bog'liq.[36] Odamlar bir oz rivojlanishi mumkin immunitet tez-tez yuqadigan infektsiyalarga duch kelganda.[37]

Iqlim o'zgarishi

Shuningdek qarang: Global isishning inson salomatligiga ta'siri § Bezgak

Global iqlim o'zgarishi bezgak yuqishiga ta'sir qilishi mumkin, ammo ta'sir darajasi va ta'sir doiralari noaniq.[38] Hindistonning ayrim hududlarida va undan keyin an El-Nino hodisa chivinlarning ko'payishi bilan bog'liq.[39]

1900 yildan beri Afrika bo'ylab havo harorati va yog'ingarchilik sezilarli darajada o'zgargan[40]. Biroq, yog'ingarchilik natijasida chivinlarni ko'paytirish uchun suvning paydo bo'lishiga yordam beradigan omillar murakkab bo'lib, u tuproq va o'simliklarga singib ketish darajasi, shuningdek, oqim va bug'lanish tezligini o'z ichiga oladi.[41] Yaqinda o'tkazilgan tadqiqotlar bezgakning iqlimga yaroqliligi modelini va dunyodagi gidrologik jarayonlarni aks ettiruvchi kontinental miqyosdagi modelni birlashtirib, Afrika bo'ylab sharoitlarni yanada chuqurroq tasvirlab berdi.[41]

Patofiziologiya

Qo'shimcha ma'lumotlar: Plazmodium falciparum § Patogenezi
Mikrograf a platsenta dan o'lik tug'ilish onaning bezgagi tufayli. H&E binoni. Qizil qon hujayralari anukleardir; yorqin qizil tuzilmalardagi (qizil qon hujayralari) ko'k / qora binoni parazitlardan begona yadrolarni bildiradi.
Elektron mikrograf Plazmodium falciparum- "tugmachalarni" yopishtiruvchi oqsilni aks ettiruvchi eritrotsit (markaz)

Bezgak infektsiyasi ikki bosqichda rivojlanadi: bir bosqich jigar (ekzoeritrositik faza), va qizil qon hujayralarini o'z ichiga olgan yoki eritrotsitlar (eritrositik faza). Yuqtirilgan chivin qondan ovqat olish uchun odamning terisini teshganda, chivin tupurigidagi sporozoidlar qonga kirib, gepatotsitlarni yuqtirgan jigarga ko'chib o'tib, 8-30 kun davomida jinssiz va asemptomatik tarzda ko'payadi.[42]

Jigarda potentsial harakatsiz davrdan keyin bu organizmlar farqlash ularning mezbon hujayralari yorilib, qonga qochadigan va hayot tsiklining eritrositik bosqichini boshlash uchun qizil qon hujayralarini yuqtirgan minglab merozoitlarni hosil qilish.[42] Parazit jigarga o'ralgan holda aniqlanmagan holda qochib ketadi hujayra membranasi yuqtirilgan mezbon jigar hujayrasi.[43]

Qizil qon hujayralarida parazitlar yana ko'payib, yana jinssiz ravishda ko'payadi va vaqti-vaqti bilan yangi qizil qon hujayralariga kirib borish uchun o'z hujayralaridan ajralib chiqadi. Bir nechta bunday kuchaytirish davrlari sodir bo'ladi. Shunday qilib, isitma to'lqinlarining klassik tavsiflari bir vaqtning o'zida merozoidlarning to'lqinlaridan qochib, qizil qon hujayralarini yuqtirishidan kelib chiqadi.[42]

Biroz P. vivax sporozoitlar darhol ekzoeritrotsitik fazali merozoitlarga aylanib chiqmaydi, aksincha, bir necha oydan (7-10 oyga xos) bir necha yilgacha harakatsiz bo'lgan gipnozoidlarni hosil qiladi.[35] Biroz uyqudan keyin ular qayta faollashadi va merozoitlarni hosil qiladi. Gipnozitlar uzoq inkubatsiya va kech qayt qilish uchun javobgardir P. vivax infektsiyalar,[35] garchi ularning mavjudligi P. ovale noaniq.[44]

Parazit tananing hujumidan nisbatan himoyalangan immunitet tizimi chunki inson hayotining ko'p davrlarida u jigar va qon hujayralarida yashaydi va immunitet nazorati uchun nisbatan sezilmaydi. Ammo aylanib yuruvchi yuqtirilgan qon hujayralari vayron qilingan taloq. Bunday taqdirni oldini olish uchun P. falciparum parazit yopishqoqlikni namoyish etadi oqsillar yuqtirilgan qon hujayralari yuzasida, qon hujayralarining mayda qon tomirlari devorlariga yopishib qolishiga olib keladi va shu bilan parazitni umumiy qon aylanishi va taloq orqali o'tishdan ajratadi.[45] Mikrovaskulatsiyaning tiqilib qolishi platsenta bezgagi kabi alomatlarni keltirib chiqaradi.[46] Sequestered eritrotsitlar buzilishi mumkin qon-miya to'sig'i va miya bezgagiga sabab bo'ladi.[47]

Genetik qarshilik

Asosiy maqola: Bezgakka qarshi insonning genetik qarshiligi

2005 yilgi sharhga ko'ra, yuqori darajalari tufayli o'lim va kasallanish bezgak tufayli kelib chiqadi - ayniqsa P. falciparum turlar - eng buyuklarini joylashtirdi selektiv bosim ustida inson genomi yaqin tarixda. Bir nechta genetik omillar unga qarshilik ko'rsatadi, shu jumladan o'roqsimon hujayra xususiyati, talassemiya xususiyatlar, glyukoza-6-fosfat dehidrogenaza etishmovchiligi va yo'qligi Duffy antigenlari qizil qon hujayralarida.[48][49][50]

O'roqsimon hujayra xususiyatining bezgakka qarshi immunitetiga ta'siri endemik bezgak tufayli yuzaga kelgan ba'zi evolyutsion kelishuvlarni tasvirlaydi. O'roq hujayralarining xususiyati qondagi gemoglobin molekulasining o'zgarishiga olib keladi. Odatda, qizil qon tanachalari tor doirada harakatlanishiga imkon beradigan juda moslashuvchan, bikonkav shakliga ega mayda tomirlar; ammo, o'zgartirilganda gemoglobin S molekulalar kam miqdordagi kislorodga ta'sir qiladi yoki suvsizlanish tufayli olomon to'planib, hujayralarni egri o'roq shaklida buzilishiga olib keladigan iplarni hosil qiladi. Ushbu iplarda molekula kislorod olish yoki chiqarishda unchalik samarali emas va hujayra erkin aylanishi uchun etarlicha moslashuvchan emas. Bezgakning dastlabki bosqichida parazit yuqtirilgan qizil hujayralarni o'roqqa olib kelishi mumkin va shuning uchun ular qon aylanishidan tezroq olib tashlanadi. Bu bezgak parazitlarining hujayrada hayot aylanish jarayonini tugatish chastotasini pasaytiradi. Shaxslar bir jinsli (anormal gemoglobin beta-ning ikki nusxasi bilan) allel ) bor o'roqsimon hujayrali anemiya, heterozigota bo'lganlar (bitta g'ayritabiiy allel va bitta normal allel bilan) og'ir anemiya holda bezgakka chidamliligini boshdan kechirishadi. Gomozigot holatiga ega bo'lganlar uchun umr ko'rishning qisqarishi bu xususiyatning omon qolishiga salbiy ta'sir ko'rsatishi mumkin bo'lsa-da, bu belgi bezgakka moyil bo'lgan mintaqalarda saqlanib qoladi. imtiyozlar geterozigota shakli bilan ta'minlangan.[50][51]

Jigar disfunktsiyasi

Bezgak natijasida jigar faoliyatining buzilishi kam uchraydi va odatda faqat boshqa jigar kasalligi bo'lganlarda uchraydi virusli gepatit yoki surunkali jigar kasalligi. Ba'zida sindrom deyiladi bezgak gepatiti.[52] Bu kamdan-kam uchraydigan hodisa deb hisoblangan bo'lsa-da, bezgak gepatopatiyasi, ayniqsa, Janubi-Sharqiy Osiyo va Hindistonda ko'paygan. Bezgakka chalingan odamlarda jigar murosasi asoratlar va o'lim ehtimoli katta.[52]

Tashxis

Asosiy maqola: Bezgak tashxisi
Qon plyonkasi oltin standart bezgak tashxisi uchun.
Ring shakllari va gametotsitlar ning Plazmodium falciparum inson qonida

Semptomlar namoyon bo'lishining o'ziga xos bo'lmaganligi sababli, endemik bo'lmagan joylarda bezgak tashxisi yuqori darajadagi shubhalarni talab qiladi, bu quyidagi holatlardan biri bo'lishi mumkin: so'nggi sayohat tarixi, kengaygan taloq, isitma, trombotsitlarning kam miqdori qonda va bilirubinning normal darajasidan yuqori qonda normal daraja bilan birlashtirilgan oq qon hujayralari.[4] 2016 va 2017 yillarda bezgak tez-tez uchraydigan mamlakatlarning hisobotlari laboratoriya tekshiruvlarining etarli emasligi yoki noto'g'ri ekanligi sababli tashxisning yuqori darajasini ko'rsatadi.[53][54][55]

Bezgak odatda mikroskopik tekshiruv bilan tasdiqlanadi qon plyonkalari yoki tomonidan antigen asoslangan tezkor diagnostika testlari (RDT).[56][57] Ba'zi hududlarda RDT bezgak alomatlari sabab bo'lgan yoki yo'qligini ajrata olishi kerak Plazmodium falciparum yoki parazitlarning boshqa turlari bilan bog'liq, chunki davolash strategiyasi boshqalarga nisbatan farq qilishi mumkinP. falciparum infektsiyalar.[58] Bezgak parazitini aniqlashda mikroskopiya eng ko'p qo'llaniladigan usuldir - 2010 yilda bezgakka qarshi 165 million qon plyonkasi tekshirildi.[59] Keng qo'llanilishiga qaramay, mikroskop yordamida tashxis qo'yish ikkita asosiy kamchiliklarga duch keladi: ko'plab sozlamalar (ayniqsa, qishloq) testni o'tkazish uchun jihozlanmagan va natijalarning aniqligi qon plyonkasini tekshirayotgan odamning mahoratiga ham, qondagi parazit. The sezgirlik qon plyonkalari maqbul sharoitda 75 dan 90% gacha, 50% gacha. Savdoga qo'yilgan RDTlar bezgak parazitlari borligini taxmin qilishda ko'pincha qon plyonkalariga qaraganda aniqroq, ammo ular ishlab chiqaruvchiga qarab diagnostika sezgirligi va o'ziga xosligi jihatidan juda o'zgaruvchan bo'lib, qancha parazit mavjudligini aniqlay olmaydilar.[59] Ammo RDTlarni bezgak tashxisiga kiritish antimalarial retseptni kamaytirishi mumkin. RDT bezgak bilan kasallanganlarning sog'lig'i natijalarini yaxshilamasa ham, taxminiy antimalarial davolash bilan taqqoslaganda yomon natijalarga olib kelmaydi.[60]

Laboratoriya tekshiruvlari tayyor bo'lgan hududlarda bezgak kasalligi shubha ostiga olinishi va bezgak tarqalgan hududda bo'lgan har qanday kasal odamda tekshirilishi kerak. Laboratoriya diagnostikasi sinovlarini o'tkaza olmaydigan hududlarda bezgakni davolash uchun ko'rsatma sifatida faqat isitma tarixidan foydalanish odatiy holga aylandi - shuning uchun "isitma, aks holda isbotlanmasa, bezgakka tenglashadi" degan keng tarqalgan ta'limot mavjud. Ushbu amaliyotning kamchiliklari ortiqcha tashxis qo'yish bezgak kasalligi va bezgak bezgagini noto'g'ri boshqarish, bu cheklangan resurslarni isrof qiladi, sog'liqni saqlash tizimiga bo'lgan ishonchni pasaytiradi va giyohvandlikka chidamliligini oshiradi.[61] Garchi polimeraza zanjiri reaktsiyasi - asosli testlar ishlab chiqilgan bo'lib, ular murakkabligi sababli 2012 yildan boshlab bezgak tez-tez uchraydigan joylarda keng qo'llanilmaydi.[4]

Tasnifi

Bezgakni "og'ir" yoki "asoratlanmagan" deb tasniflanadi Jahon Sog'liqni saqlash tashkiloti (JSSV).[4] Qachon og'ir deb hisoblanadi har qanday quyidagi mezonlardan biri mavjud, aks holda bu murakkab bo'lmagan hisoblanadi.[62]

Miya bezgagi og'ir deb ta'riflanadi P. falciparum-malariya, nevrologik simptomlar, shu jumladan koma (a Glazgo koma o'lchovi 11 dan kam yoki a Blantir koma o'lchovi 3 dan kam) yoki tutilishdan keyin 30 daqiqadan ko'proq davom etadigan koma bilan.[63]

Bezgakning har xil turlari quyidagi nomlar bilan atalgan:[64]

IsmPatogenIzohlar
algid bezgakPlazmodium falciparumta'sir qiladigan og'ir bezgak yurak-qon tomir tizimi va sabab titroq va qon aylanish shoki
safro bezgagiPlazmodium falciparumta'sir qiladigan og'ir bezgak jigar va sabab qusish va sariqlik
miya bezgagiPlazmodium falciparumta'sir qiladigan og'ir bezgak miya
tug'ma bezgakturli xil plazmodiyaplazmodium onadan tanishtirildi orqali homila qon aylanishi
falciparum bezgak, Plazmodium falciparum bezgak, zararli bezgakPlazmodium falciparum
ovale bezgak, Plazmodium ovale bezgakPlazmodium ovale
kvartan bezgak, bezgak bezgak, Plazmodium bezgak bezgakPlazmodium bezgakhar to'rtinchi kuni paroksismalar (kvartan ), paydo bo'lgan kunni birinchi kun deb hisoblash
kvidian bezgakPlazmodium falciparum, Plazmodium vivax, Plazmodium bilimlariparoksismlar har kuni (kotidian )
tertian bezgakPlazmodium falciparum, Plazmodium ovale, Plazmodium vivaxparoksizmalar har uchinchi kunda (uchlik ), paydo bo'lgan kunni birinchi deb hisoblash
transfüzyon bezgakturli xil plazmodiyatomonidan kiritilgan plazmodium qon quyish, igna almashish, yoki igna jarohati
vivaks bezgak, Plazmodium vivax bezgakPlazmodium vivax

Oldini olish

An Anopheles stephensi chivin odamdan qon olganidan ko'p o'tmay (qon tomchisi ortiqcha sifatida chiqariladi). Ushbu chivin bezgakning vektori bo'lib, chivin bilan kurashish uning tarqalishini kamaytirishning samarali usuli hisoblanadi.

Bezgakning oldini olish uchun dori-darmonlarni qabul qilish, chivinlarni yo'q qilish va chaqishning oldini olish usullari qo'llaniladi. 2020 yilga kelib, bittasi bor bezgakka qarshi emlash (nomi bilan tanilgan RTS, S ) foydalanish uchun litsenziyalangan.[6][5] Bezgakning borligi odamlarning yuqori zichligi, anofellarning chivinlari sonining zichligi va odamlardan chivinlarga va chivinlardan odamga yuqish tezligini birlashtirishni talab qiladi. Agar ulardan birortasi etarlicha tushirilsa, Shimoliy Amerika, Evropa va Yaqin Sharqning ba'zi joylarida bo'lgani kabi, parazit bu hududdan yo'q bo'lib ketadi. Ammo, agar parazit butun dunyodan yo'q qilinmasa, shartlar parazitning ko'payishini ma'qullaydigan kombinatsiyaga qaytsa, u qayta tiklanishi mumkin. Bundan tashqari, anofel chivinlarini yo'q qilish uchun bir kishiga xarajatlar aholi zichligi pasayishi bilan ortib boradi va bu ba'zi joylarda iqtisodiy jihatdan maqsadga muvofiq emas.[65]

Bezgakning oldini olish uzoq muddatda kasallikni davolashdan ko'ra iqtisodiy jihatdan samaraliroq bo'lishi mumkin, ammo dastlabki xarajatlar talab qilinadigan narsa dunyodagi eng qashshoq odamlarning qo'lidan kelmaydi. Mamlakatlar o'rtasida nazorat qilish (ya'ni past darajadagi endemiklikni saqlash) va yo'q qilish dasturlari bo'yicha xarajatlar juda katta farq qiladi. Masalan, Xitoyda - uning hukumati 2010 yilda bezgakni yo'q qilish bo'yicha strategiyasini e'lon qildi Xitoy viloyatlari - talab qilinadigan sarmoyalar sog'liqni saqlashga sarflanadigan davlat xarajatlarining ozgina qismidir. Aksincha, Tanzaniyadagi shunga o'xshash dastur sog'liqni saqlash byudjetining taxminan beshdan bir qismiga to'g'ri keladi.[66]

Bezgak tez-tez uchraydigan joylarda besh yoshgacha bo'lgan bolalar tez-tez uchraydi anemiya, bu ba'zida bezgak bilan bog'liq. Ushbu sohalarda anemiya bilan kasallangan bolalarni bezgakka qarshi profilaktik dori berish qizil qon hujayralari darajasini biroz yaxshilaydi, ammo o'lim xavfiga yoki kasalxonaga yotqizilishga ta'sir qilmaydi.[67]

Chivinlarga qarshi kurash

Qo'shimcha ma'lumotlar: Chivinlarga qarshi kurash
Odam kerosin moyini turgan suvga sepmoqda, Panama kanali zonasi, 1912

Vektorli boshqaruv chivin bilan yuqish darajasini pasaytirish orqali bezgakni kamaytirish uchun ishlatiladigan usullarni nazarda tutadi. Shaxsiy himoya qilish uchun eng samarali hasharotlarga qarshi vositalar asoslanadi DEET yoki picaridin.[68] Biroq, chivinlarga qarshi vositalar bezgak infektsiyasini oldini olishga qodir ekanligi to'g'risida etarli dalillar mavjud emas.[69] Insektitsid bilan davolash chivin to'rlari (ITN) va yopiq qoldiq purkash (IRS) samarali, odatda bezgakni oldini olish uchun ishlatilgan va ulardan foydalanish 21-asrda bezgakning pasayishiga katta hissa qo'shgan.[70][71][72] ITN va IRS kasallikni to'liq bartaraf etish uchun etarli bo'lmasligi mumkin, chunki bu aralashuvlar qancha odam to'r ishlatganiga, insektitsidda qancha bo'shliq mavjudligiga (kam qamrab olinadigan joylar), agar odamlar uydan tashqarida bo'lmaganida himoya qilinmasa va ko'payish hasharotlarga chidamli chivinlarda.[70] Chivinlarning yuqishini oldini olish uchun odamlarning uylarini o'zgartirishlar uzoq muddatli profilaktika choralari bo'lishi mumkin.[70]

Ichkarida DDT qoldiq purkash qo'llanilgan devorlar. Chivinlar polda o'lik holda yiqilib tushguncha devorda qoladi.

Insektitsid bilan ishlangan to'rlar

Amaldagi chivin tarmog'i.

Chivinli tarmoqlar chivinlarni odamlardan uzoqroq tutishga yordam beradi va bezgak yuqtirish darajasi va yuqishini kamaytiradi. To'rlar mukammal to'siq emas va ko'pincha chivinni o'ldirish uchun mo'ljallangan insektitsid bilan davolanadi, to'rdan o'tib ketishga vaqt topmasdan. Hasharotlarga qarshi vositalar bilan ishlov berilgan to'rlar, ishlov berilmagan to'rlardan ikki baravar ko'proq samaraliroq va hech qanday to'r bilan taqqoslaganda 70% dan yuqori himoyani ta'minlaydi.[73] 2000-2008 yillarda ITN-lardan foydalanish Afrikaning Sahroi Sahroda taxminan 250 000 go'dakning hayotini saqlab qoldi.[74] Sahro osti mamlakatlaridagi uy xo'jaliklarining taxminan 13 foizi 2007 yilda ITN-larga ega edi[75] va 2008 yilda afrikalik uy xo'jaliklarining 31 foizida kamida bitta ITN borligi taxmin qilingan. 2000 yilda dunyoda bezgak tez-tez uchrab turadigan 1,7 million (1,8 foiz) afrikalik bolalar ITN tomonidan himoya qilingan. 2007 yilda ITN-lardan foydalanadigan bu raqam 20,3 millionga (18,5%) o'sdi va 89,6 million bola himoyasiz qoldi[76] 2015 yilda chivinli tarmoqlardan foydalanadigan afrikalik bolalarning 68%.[77] Ko'pgina to'rlar singdirilgan piretroidlar, past bo'lgan hasharotlar klassi toksiklik. Ular shomdan to tonggacha foydalanilganda eng samarali hisoblanadi.[78] To'shakning markazidan kattaroq "to'shak to'rini" osib qo'yish yoki qirralarini matras ostiga tiqish yoki uning erga tegib turadigan darajada katta ekanligiga ishonch hosil qilish tavsiya etiladi.[79] ITN Afrikadagi bezgak-endemik mintaqalarda homiladorlik natijalari uchun foydalidir, ammo Osiyo va Lotin Amerikasida ko'proq ma'lumotlarga ehtiyoj bor.[80]

Bezgakka chidamliligi yuqori bo'lgan joylarda, ITN tarkibidagi piretroidlar bilan birlashtirilgan piperonil butoksid bezgak infektsiyasini kamaytirishda samarali hisoblanadi.[81]

Yopiq qoldiq purkash

Yopiq qoldiq purkash - bu uy ichidagi devorlarga hasharotlar sepishdir. Ovqatlantirilgandan so'ng, ko'plab chivinlar qon po'stini hazm qilish paytida yaqin atrofda dam olishadi, shuning uchun agar uylarning devorlari hasharotlar bilan qoplangan bo'lsa, qolgan chivinlar boshqa odamni tishlamasdan va bezgak parazitini yuqtirishdan oldin o'ldirilishi mumkin.[82] 2006 yildan boshlab Jahon Sog'liqni saqlash tashkiloti IRS operatsiyalarida 12 ta hasharotlarni, shu jumladan tavsiya qiladi DDT va piretroidlar sflutrin va deltametrin.[83] Kam miqdordagi DDT dan sog'liqni saqlashga ushbu foydalanishga ruxsat berilgan Stokgolm konventsiyasi, bu uning qishloq xo'jaligida foydalanishni taqiqlaydi.[84] IRSning barcha shakllarida bitta muammo mavjud insektisidlarga qarshilik. IRS ta'sirlangan chivinlar yopiq joylarda dam olishga va yashashga moyil bo'lib, purkagandan kelib chiqqan tirnash xususiyati tufayli ularning avlodlari ochiq havoda dam olishga va yashashga intilishadi, ya'ni ularga IRS kamroq ta'sir qiladi.[85] ITN bilan birgalikda IRSdan foydalanish bezgak kasalligini kamaytirishda, bezgak tarqalishining keng geografik xilma-xilligi, bezgak yuqishi va insektitsidga chidamliligi sababli samarali bo'ladimi, aniq emas.[86]

Uy-joy modifikatsiyalari

Uy-joy bezgak uchun xavf omilidir va uyni profilaktika chorasi sifatida o'zgartirish barqaror strategiya bo'lishi mumkin, bu insektitsidlar samaradorligiga ishonmaydi. piretroidlar.[70][87] Chivinlarning zichligini yaxshilashi mumkin bo'lgan uy ichidagi va tashqarisidagi jismoniy muhit e'tiborga olinadi. Uyning chivinlarni ko'paytirish joylari, drenaj va suv ta'minoti, chivinlar uchun dam olish joylari (uy atrofidagi o'simliklar) mavjudligi, jonli zaxiralarga va uy hayvonlariga yaqinligi va jismoniy yaxshilanishlar yoki o'zgartirishlar chivinlarning kirib kelishini oldini olish uchun uyning dizayni.[70]

Boshqa chivinlarga qarshi kurash usullari

Odamlar chivin chaqishini kamaytirish va bezgak tarqalishini sekinlashtirish uchun bir qator boshqa usullarni sinab ko'rishdi. Chivin lichinkalarini, ular rivojlanadigan joylarda ochiq suv mavjudligini kamaytirish yoki ularning rivojlanishini kamaytirish uchun moddalar qo'shib kamaytirish orqali ba'zi joylarda samarali bo'ladi.[88] Ayol chivinlarni uzoqlashtirishi kerak bo'lgan juda yuqori chastotali tovushlarni chiqaradigan elektron chivinlarga qarshi vositalarda samaradorlikning tasdiqlovchi dalillari yo'q.[89] Bunga past aniq dalillar mavjud tumanlash bezgak yuqishiga ta'sir qilishi mumkin.[90] Kimyoviy yoki mikrobial insektitsidlarni qo'lda etkazib berish yo'li bilan larvitsidlanish, lichinkalari kam tarqalishini o'z ichiga olgan suv havzalariga bezgak yuqishini kamaytirishi mumkin.[91] Yirtqich baliqlar bu hududda chivin zichligi va yuqishini kamaytirishi mumkinligini aniqlash uchun etarli dalillar yo'q.[92]

Dori vositalari

Asosiy maqola: Bezgak profilaktikasi

Infektsiya tez-tez uchraydigan joylarga sayohatchilarda bezgakning oldini olish yoki uni to'xtatishga yordam beradigan bir qator dorilar mavjud. Ushbu dorilarning aksariyati davolashda ham qo'llaniladi. Qaerda Plazmodium bir yoki bir nechta dorilarga, uchta dorilarga chidamli -meflokin, doksisiklin yoki birikmasi atovaquone / proguanil (Bezgak) - profilaktika maqsadida tez-tez ishlatiladi.[93] Doksitsiklin va atovakuon / proguanil yaxshi muhosaba qilinadi, meflokin esa haftada bir marta olinadi.[93] Dunyo mintaqalari xlorokin - sezgir bezgak kam uchraydi.[94] Bir vaqtning o'zida butun aholiga bezgakka qarshi ommaviy dori yuborish aholi bezgak bilan kasallanish xavfini kamaytirishi mumkin.[95]

Himoya ta'siri darhol boshlamaydi va bezgak mavjud bo'lgan hududlarga tashrif buyuradigan odamlar odatda giyohvand moddalarni kelishdan bir-ikki hafta oldin ichishni boshlaydilar va ularni tark etgandan keyin to'rt hafta davomida davom etadilar (faqat boshlash kerak bo'lgan atovakuone / proguanildan tashqari) ikki kun oldin va keyin etti kun davom etdi).[96] Profilaktik preparatlarni qo'llash ko'pincha bezgak mavjud bo'lgan joylarda yashovchilar uchun amaliy emas va ulardan foydalanish odatda faqat homilador ayollar va qisqa muddatli tashrif buyuruvchilarga beriladi. Bu dorilarning narxiga bog'liq, yon effektlar uzoq muddatli foydalanishdan va antimalarial dorilarni boy davlatlardan tashqarida olish qiyinligidan.[97] Homiladorlik paytida bezgakni oldini olish uchun dori tug'ilganda bolaning vaznini yaxshilaydi va uning xavfini kamaytiradi anemiya onada.[98] Bezgak chivinlari mavjud bo'lgan profilaktika vositalaridan foydalanish qisman qarshilik rivojlanishini rag'batlantirishi mumkin.[99]

Vaqti-vaqti bilan profilaktika terapiyasi orqali chaqaloqlarga antimalarial dorilarni berish bezgak yuqtirish, kasalxonaga yotqizish va anemiya xavfini kamaytirishi mumkin.[100]

Meflokin sulfadoksin-pirimetamindan samaraliroq, OIV yuqtirgan homilador ayollar bezgakning oldini oladi. Kotrimoksazol bezgak infektsiyasini oldini olish va OIV bilan kasallangan ayollarda kamqonlik xavfini kamaytirishda samarali hisoblanadi.[101] Uch yoki undan ortiq dozada sulfadoksin-pirimetaminni vaqti-vaqti bilan profilaktik davo sifatida berish bezgak-endemik hududlarda yashovchi OIV bilan kasallangan ayollar uchun ikki dozadan ustundir.[102]

Tasdiqlangan holatlarni artemisininga asoslangan kombinatsiyalangan davolash (ACT) bilan tezkor davolash ham yuqtirishni kamaytirishi mumkin.[103]

Boshqalar

Jamiyat ishtiroki va sog'liqni saqlash ta'limi rivojlanayotgan dunyoning ayrim hududlarida bezgak bilan kasallanishni kamaytirish uchun bezgak to'g'risida xabardorlikni targ'ib qiluvchi strategiyalar va nazorat choralarining ahamiyati muvaffaqiyatli qo'llanilmoqda.[104] Dastlabki bosqichda kasallikni tanib olish uning o'limiga olib kelishi mumkin. Ta'lim, shuningdek, odamlarga parazit va chivin uchun ideal sharoit yaratadigan suv omborlari kabi turg'un, to'xtab turadigan suvlarni qamrab olishi haqida xabar berishi mumkin, shu bilan odamlar o'rtasida yuqish xavfini kamaytiradi. Bu, odatda, cheklangan makonda aholining katta markazlari mavjud bo'lgan shahar joylarida qo'llaniladi va ushbu hududlarda yuqish ehtimoli katta bo'ladi.[105] Vaqti-vaqti bilan profilaktik terapiya homilador ayollar va chaqaloqlarda bezgakni nazorat qilish uchun muvaffaqiyatli qo'llanilgan yana bir aralashuv,[106] va yuqtirish mavsumiy bo'lgan maktabgacha yoshdagi bolalarda.[107]

Davolash

Uchun reklama xinin 1927 yildan bezgakni davolash sifatida.

Bezgak bilan davolash qilinadi bezgakka qarshi dorilar; ishlatilganlar kasallikning turiga va og'irligiga bog'liq. Esa isitma qarshi dorilar odatda ishlatiladi, ularning natijalarga ta'siri aniq emas.[108] Uy xo'jaliklarini bezgakka qarshi bepul dori-darmon bilan ta'minlash, tegishli ravishda ishlatilganda bolalar o'limini kamaytirishi mumkin. Isitmaning barcha sabablarini antimalarial dorilar bilan taxminiy davolash dasturlari bezgakka qarshi vositalarni haddan tashqari iste'mol qilishga va boshqa isitma sabablarini davolashga olib kelishi mumkin. Shunga qaramay, bezgakning tezkor diagnostikasi vositalaridan foydalanish bezgakka qarshi vositalardan ortiqcha foydalanishni kamaytirishga yordam beradi.[109]

Asoratlanmagan bezgak

Oddiy yoki asoratsiz bezgakni og'iz orqali qabul qilingan dorilar yordamida davolash mumkin. Arteminisin preparatlari asoratsiz bezgakni davolashda samarali va xavfsizdir.[110] Arteminisim boshqa antimalarial vositalar bilan birgalikda (ma'lum artemisinin kombinatsiyalangan davolash, yoki ACT) asoratsiz bezgakni davolash uchun ishlatilganda taxminan 90% samarali bo'ladi.[74] Uchun eng samarali davolash P. falciparum infektsiya - bu ACT-dan foydalanish, bu preparatning har qanday tarkibiy qismiga qarshilikni pasaytiradi.[111] Artemeter-lumefantrin (olti dozali rejim) artemeter-lumefantrin (to'rt dozali rejim) yoki falciparum bezgakni davolashda artemisinin hosilalarini o'z ichiga olmaydigan boshqa rejimlarga qaraganda samaraliroq.[112][113] Yana bir tavsiya etilgan kombinatsiya dihidroartemisinin va piperakvin.[114][115][116] Artemisinin-naftokin kombinatsiyasi terapiyasi falciparum bezgakni davolashda istiqbolli natijalarni ko'rsatdi. Shu bilan birga, ko'proq tadqiqotlar samaradorligini ishonchli davolash sifatida aniqlashi kerak.[117] Artesunate plus mefloquine faqatgina yuqumli sharoitda asoratlanmagan falciparum bezgakni davolashda meflokinga qaraganda yaxshiroq ishlaydi.[118] Atovakuon-proguanilning xlorokin, amodiakvin va meflokinga qaraganda falciparum bezgakni davolashda samaraliroq ekanligini ko'rsatadigan ma'lumotlar cheklangan.[119] Azitromitsin monoterapiyasi yoki kombinatsiyalangan davolash plazmodium yoki vivax bezgakni davolashda samaradorligini ko'rsatmadi.[120] Amodiakvin va sulfadoksin-pirimetamin asoratlanmagan falciparum bezgakda faqat sulfadoksin-pirimetamin bilan taqqoslaganda, davolanishning kam natijalariga erishishi mumkin.[121] Asoratlanmagan falciparum bezgakni davolashda xlorproguanil-dapson haqida ma'lumot etarli emas.[122] Falsiparum bezgak uchun artemisinin asosidagi kombinatsiyalashgan terapiya bilan primakvin qo'shilishi uning yuqishining 3-4-kunida va 8-kunida kamayishini kamaytiradi.[123] Sulfadoksin-pirimetamin va artesunat sulfadoksin-pirimetamin va amodiakuindan 28-kun davolashning muvaffaqiyatsizligini nazorat qilishda yaxshiroqdir. Ammo ikkinchisi 7-kun qonda gametotsitlarni kamaytirishda birinchisiga qaraganda yaxshiroqdir.[124]

Yuqtirish P. vivax, P. ovale yoki P. bezgak odatda kasalxonaga yotqizishni talab qilmaydi. Davolash P. vivax qon bosqichlarini (xlorokin yoki ACT bilan) davolashni va jigar shakllarini tozalashni talab qiladi primakvin.[125] Arteminisin asosidagi kombinatsiyalangan terapiya asoratsiz davolashda xlorokin kabi samaralidir P. vivax bezgak.[126] Bilan davolash tafenokin tasdiqlanganidan keyin relapslarning oldini oladi P. vivax bezgak.[127] However, for those treated with chloroquine for blood stage infection, 14 days of primaquine treatment is required to prevent relapse. Shorter primaquine regimens may lead to higher relapse rates.[128] There is no difference in effectiveness between primaquine given for seven or 14 days for prevention of relapse in vivax malaria. The shorter regimen may be useful for those with treatment compliance problems.[129]

To treat malaria during pregnancy, the JSSV recommends the use of quinine plus klindamitsin early in the pregnancy (1st trimester), and ACT in later stages (2nd and 3rd trimesters).[130] There is limited safety data on the antimalarial drugs in pregnancy.[131]

Severe and complicated malaria

Cases of severe and complicated malaria are almost always caused by infection with P. falciparum. The other species usually cause only febrile disease.[132] Severe and complicated malaria cases are medical emergencies since mortality rates are high (10% to 50%).[133]

Recommended treatment for severe malaria is the vena ichiga yuborish use of antimalarial drugs. For severe malaria, parenteral artesunate was superior to quinine in both children and adults.[134] In another systematic review, artemisinin derivatives (artemether and arteether) were as efficacious as quinine in the treatment of cerebral malaria in children.[135] Treatment of severe malaria involves supportive measures that are best done in a og'ir tibbiy yordam bo'limi. This includes the management of high fevers and the seizures that may result from it. It also includes monitoring for poor breathing effort, low blood sugar, and past kaliy.[23] Artemisinin derivatives have the same or better efficacy than quinolones in preventing deaths in severe or complicated malaria.[136] Xinin yuklash dozasi helps to shorten the duration of fever and increases parasite clearance from the body.[137] There is no difference in effectiveness when using intrarectal quinine compared to intravenous or intramuscular quinine in treating uncomplicated/complicated falciparum malaria.[138] There is insufficient evidence for intramuscular arteether to treat severe malaria.[139] The provision of rectal artesunate before transfer to hospital may reduce the rate of death for children with severe malaria.[140]

Cerebral malaria is the form of severe and complicated malaria with the worst neurological symptoms.[141] There is insufficient data on whether osmotic agents such as mannitol or urea are effective in treating cerebral malaria.[142] Routine phenobarbitone in cerebral malaria is associated with fewer konvulsiyalar but possibly more deaths.[143] There is no evidence that steroids would bring treatment benefits for cerebral malaria.[144]

There is insufficient evidence to show that blood transfusion is useful in either reducing deaths for children with severe anaemia or in improving their gematokrit bir oy ichida.[145] There is insufficient evidence that iron chelating agents such as deferoxamine and deferiprone improve outcomes of those with malaria falciparum infection.[146]

Qarshilik

Dori-darmonlarga qarshilik poses a growing problem in 21st-century malaria treatment.[147] In the 2000s (decade), malaria with partial resistance to artemisins emerged in Southeast Asia.[148][149] Resistance is now common against all classes of antimalarial drugs apart from artemisinins. Treatment of resistant strains became increasingly dependent on this class of drugs. The cost of artemisinins limits their use in the developing world.[150] Malaria strains found on the Cambodia–Thailand border are resistant to combination therapies that include artemisinins, and may, therefore, be untreatable.[151] Exposure of the parasite population to artemisinin monotherapies in subtherapeutic doses for over 30 years and the availability of substandard artemisinins likely drove the selection of the resistant phenotype.[152] Resistance to artemisinin has been detected in Cambodia, Myanmar, Thailand, and Vietnam,[153] and there has been emerging resistance in Laos.[154][155] Resistance to the combination of artemisinin and piperaquine was first detected in 2013 in Cambodia, and by 2019 had spread across Cambodia and into Laos, Tailand va Vetnam (with up to 80 percent of malaria parasites resistant in some regions).[156]

There is insufficient evidence in unit packaged antimalarial drugs in preventing treatment failures of malaria infection. However, if supported by training of healthcare providers and patient information, there is improvement in compliance of those receiving treatment.[157]

Prognoz

Nogironlik uchun belgilangan hayot yili for malaria per 100,000 inhabitants in 2004
  ma'lumotlar yo'q
   <10
   0–100
   100–500
   500–1000
  1000–1500
  1500–2000
  2000–2500
  2500–2750
  2750–3000
  3000–3250
  3250–3500
   ≥3500

When properly treated, people with malaria can usually expect a complete recovery.[158] However, severe malaria can progress extremely rapidly and cause death within hours or days.[159] In the most severe cases of the disease, fatality rates can reach 20%, even with intensive care and treatment.[4] Over the longer term, developmental impairments have been documented in children who have suffered episodes of severe malaria.[160] Surunkali infection without severe disease can occur in an immune-deficiency syndrome associated with a decreased responsiveness to Salmonella bakteriyalar va Epstein-Barr virusi.[161]

During childhood, malaria causes anaemia during a period of rapid brain development, and also direct brain damage resulting from cerebral malaria.[160] Some survivors of cerebral malaria have an increased risk of neurological and cognitive deficits, xulq-atvori buzilishi va epilepsiya.[162] Malaria prophylaxis was shown to improve cognitive function and school performance in klinik sinovlar bilan solishtirganda platsebo guruhlar.[160]

Epidemiologiya

Distribution of malaria in the world:[163] ♦ Elevated occurrence of chloroquine- or multi-resistant malaria
♦ Occurrence of chloroquine-resistant malaria
♦ Yo'q Plazmodium falciparum or chloroquine-resistance
♦ No malaria
Deaths due to malaria per million persons in 2012
  0–0
  1–2
  3–54
  55–325
  326–679
  680–949
  950–1,358
Past and current malaria prevalence in 2009

The WHO estimates that in 2018 there were 228 million new cases of malaria resulting in 405,000 deaths.[3] Children under 5 years old are the most affected, accounting for 67% (272,000) of malaria deaths worldwide in 2018.[3] About 125 million pregnant women are at risk of infection each year; yilda Afrikaning Sahroi osti qismi, maternal malaria is associated with up to 200,000 estimated infant deaths yearly.[19] There are about 10,000 malaria cases per year in Western Europe, and 1300–1500 in the United States.[15] The United States eradicated malaria in 1951.[164] About 900 people died from the disease in Europe between 1993 and 2003.[68] Both the global incidence of disease and resulting mortality have declined in recent years. According to the WHO and UNICEF, deaths attributable to malaria in 2015 were reduced by 60%[77] from a 2000 estimate of 985,000, largely due to the widespread use of insecticide-treated nets and artemisinin-based combination therapies.[74] In 2012, there were 207 million cases of malaria. That year, the disease is estimated to have killed between 473,000 and 789,000 people, many of whom were children in Africa.[2] Efforts at decreasing the disease in Africa since 2000 have been partially effective, with rates of the disease dropping by an estimated forty percent on the continent.[165]

Malaria is presently endemic in a broad band around the equator, in areas of the Americas, many parts of Asia, and much of Africa; in Sub-Saharan Africa, 85–90% of malaria fatalities occur.[166] An estimate for 2009 reported that countries with the highest death rate per 100,000 of population were Fil suyagi qirg'og'i (86.15), Angola (56.93) and Burkina-Faso (50.66).[167] A 2010 estimate indicated the deadliest countries per population were Burkina Faso, Mozambik va Mali.[168] The Bezgak atlasi loyihasi aims to map global levels of malaria, providing a way to determine the global spatial limits of the disease and to assess kasallik yuki.[169][170] This effort led to the publication of a map of P. falciparum endemicity in 2010 and an update in 2019.[171][172][173] As of 2010, about 100 countries have endemic malaria.[174][175] Every year, 125 million international travellers visit these countries, and more than 30,000 contract the disease.[68]

The geographic distribution of malaria within large regions is complex, and malaria-afflicted and malaria-free areas are often found close to each other.[176] Malaria is prevalent in tropical and subtropical regions because of rainfall, consistent high temperatures and high humidity, along with stagnant waters where mosquito larvae readily mature, providing them with the environment they need for continuous breeding.[177] In drier areas, outbreaks of malaria have been predicted with reasonable accuracy by mapping rainfall.[178] Malaria is more common in rural areas than in cities. For example, several cities in the Katta Mekong Subregion of Southeast Asia are essentially malaria-free, but the disease is prevalent in many rural regions, including along international borders and forest fringes.[179] In contrast, malaria in Africa is present in both rural and urban areas, though the risk is lower in the larger cities.[180]

Tarix

Asosiy maqolalar: Bezgak tarixi va Chivin-bezgak nazariyasi
Ancient malaria oocysts preserved in Dominik amberi

Although the parasite responsible for P. falciparum malaria has been in existence for 50,000–100,000 years, the population size of the parasite did not increase until about 10,000 years ago, concurrently with advances in agriculture[181] and the development of human settlements. Close relatives of the human malaria parasites remain common in chimpanzees. Ba'zi dalillar shuni ko'rsatadiki P. falciparum malaria may have originated in gorillas.[182]

References to the unique periodic fevers of malaria are found throughout history.[183] Hippocrates described periodic fevers, labelling them tertian, quartan, subtertian and quotidian.[184] Rim Kolumella associated the disease with insects from swamps.[184] Malaria may have contributed to the decline of the Rim imperiyasi,[185] and was so pervasive in Rome that it was known as the "Rim isitmasi ".[186] Several regions in ancient Rome were considered at-risk for the disease because of the favourable conditions present for malaria vectors. This included areas such as southern Italy, the island of Sardiniya, Pontin botqoqlari, the lower regions of coastal Etruriya va shahar Rim bo'ylab Tiber. The presence of stagnant water in these places was preferred by mosquitoes for breeding grounds. Irrigated gardens, swamp-like grounds, run-off from agriculture, and drainage problems from road construction led to the increase of standing water.[187] In Medieval G'arbiy Afrika, odamlar Jenne successfully identified the mosquito as the vector and cause of malaria.[188]

Britaniyalik shifokor Ronald Ross oldi Fiziologiya yoki tibbiyot bo'yicha Nobel mukofoti in 1902 for his work on malaria.

The term malaria originates from O'rta asr Italyancha: mala aria—"bad air "; the disease was formerly called ague yoki botqoq isitmasi due to its association with swamps and marshland.[189] The term first appeared in the English literature about 1829.[184] Malaria was once common in most of Europe and North America,[190] where it is no longer endemic,[191] though imported cases do occur.[192]

Scientific studies on malaria made their first significant advance in 1880, when Charlz Lui Alphonse Laveran —a French army doctor working in the military hospital of Konstantin yilda Jazoir —observed parasites inside the red blood cells of infected people for the first time. He, therefore, proposed that malaria is caused by this organism, the first time a protist was identified as causing disease.[193] For this and later discoveries, he was awarded the 1907 Fiziologiya yoki tibbiyot bo'yicha Nobel mukofoti. Bir yil o'tgach, Karlos Finlay, a Cuban doctor treating people with sariq isitma yilda Gavana, provided strong evidence that mosquitoes were transmitting disease to and from humans.[194] This work followed earlier suggestions by Josiah C. Nott,[195] va ishlash Ser Patrik Menson, the "father of tropical medicine", on the transmission of filariaz.[196]

Xitoy an'anaviy xitoy tibbiyoti tadqiqotchi Sen sen oldi Fiziologiya yoki tibbiyot bo'yicha Nobel mukofoti in 2015 for her work on the antimalarial drug artemisinin.

In April 1894, a Scottish physician, Ser Ronald Ross, visited Sir Patrick Manson at his house on Queen Anne Street, London. This visit was the start of four years of collaboration and fervent research that culminated in 1897 when Ross, who was working in the Presidency General Hospital yilda Kalkutta, proved the complete life-cycle of the malaria parasite in mosquitoes.[197] He thus proved that the mosquito was the vector for malaria in humans by showing that certain mosquito species transmit malaria to birds. He isolated malaria parasites from the salivary glands of mosquitoes that had fed on infected birds.[197] For this work, Ross received the 1902 Nobel Prize in Medicine. After resigning from the Hindiston tibbiy xizmati, Ross worked at the newly established "Liverpul" tropik tibbiyot maktabi and directed malaria-control efforts in Misr, Panama, Gretsiya va Mavrikiy.[198] The findings of Finlay and Ross were later confirmed by a medical board headed by Uolter Rid in 1900. Its recommendations were implemented by Uilyam C. Gorgas yilda the health measures undertaken qurish paytida Panama kanali. This public-health work saved the lives of thousands of workers and helped develop the methods used in future public-health campaigns against the disease.[199]

1896 yilda, Amico Bignami discussed the role of mosquitoes in malaria.[200] 1898 yilda Bignami, Giovanni Battista Grassi va Juzeppe Bastianelli succeeded in showing experimentally the transmission of malaria in humans, using infected mosquitoes to contract malaria themselves which they presented in November 1898 to the Accademia dei Lincei.[197]

Artemisia annua, source of the antimalarial drug artemisinin

The first effective treatment for malaria came from the bark of cinchona daraxti o'z ichiga oladi xinin. This tree grows on the slopes of the And, asosan Peru. The indigenous peoples of Peru qildi damlamasi of cinchona to control fever. Its effectiveness against malaria was found and the Iezuitlar introduced the treatment to Europe around 1640; by 1677, it was included in the London farmakopeyasi as an antimalarial treatment.[201] It was not until 1820 that the active ingredient, quinine, was extracted from the bark, isolated and named by the French chemists Per Jozef Pelletier va Jozef Biename Kventu.[202][203]

Quinine was the predominant malarial medication until the 1920s when other medications began to appear. In the 1940s, chloroquine replaced quinine as the treatment of both uncomplicated and severe malaria until resistance supervened, first in Southeast Asia and South America in the 1950s and then globally in the 1980s.[204]

The medicinal value of Artemisia annua has been used by Chinese herbalists in an'anaviy xitoylik dorilar for 2,000 years. In 1596, Li Shizhen recommended tea made from qinghao specifically to treat malaria symptoms in his "Materia Medica kompendiumi ". Artemisinins, discovered by Chinese scientist Sen sen and colleagues in the 1970s from the plant Artemisia annua, became the recommended treatment for P. falciparum malaria, administered in severe cases in combination with other antimalarials.[205] Tu unga a ta'sir qilganini aytadi an'anaviy xitoy o'simlik dorilari source, Favqulodda yordam uchun retseptlar bo'yicha qo'llanma, 340 yilda yozilgan Ge Xong.[206] For her work on malaria, Sen sen 2015 yilni oldi Fiziologiya yoki tibbiyot bo'yicha Nobel mukofoti.[207]

Plazmodium vivax was used between 1917 and the 1940s for malariotherapy —deliberate injection of malaria parasites to induce a fever to combat certain diseases such as tertiary sifiliz. In 1927, the inventor of this technique, Julius Vagner-Jauregg, kashfiyotlari uchun fiziologiya yoki tibbiyot bo'yicha Nobel mukofotini oldi. The technique was dangerous, killing about 15% of patients, so it is no longer in use.[208]

U.S. Marines with malaria in a field hospital on Gvadalkanal, 1942 yil oktyabr

The first pesticide used for indoor residual spraying was DDT.[209] Although it was initially used exclusively to combat malaria, its use quickly spread to qishloq xo'jaligi. In time, pest control, rather than disease control, came to dominate DDT use, and this large-scale agricultural use led to the evolution of pestitsidga chidamli mosquitoes in many regions. The DDT resistance shown by Anofellar mosquitoes can be compared to antibiotiklarga qarshilik shown by bacteria. During the 1960s, awareness of the negative consequences of its indiscriminate use increased, ultimately leading to bans on agricultural applications of DDT in many countries in the 1970s.[84] Before DDT, malaria was successfully eliminated or controlled in tropical areas like Brazil and Egypt by removing or poisoning the breeding grounds of the mosquitoes or the aquatic habitats of the larval stages, for example by applying the highly toxic arsenic compound Parij Yashil to places with standing water.[210]

Malaria vaccines have been an elusive goal of research. The first promising studies demonstrating the potential for a malaria vaccine were performed in 1967 by immunising mice with live, radiation-zaiflashgan sporozoites, which provided significant protection to the mice upon subsequent injection with normal, viable sporozoites. Since the 1970s, there has been a considerable effort to develop similar vaccination strategies for humans.[211] The first vaccine, called RTS, S, was approved by European regulators in 2015.[212]

Jamiyat va madaniyat

Shuningdek qarang: Butunjahon bezgakka qarshi kurash kuni

Iqtisodiy ta'sir

Malaria clinic in Tanzania

Malaria is not just a disease commonly associated with qashshoqlik: some evidence suggests that it is also a cause of poverty and a major hindrance to iqtisodiy rivojlanish.[8][9] Garchi tropical regions are most affected, malaria's furthest influence reaches into some temperate zones that have extreme seasonal changes. The disease has been associated with major negative economic effects on regions where it is widespread. During the late 19th and early 20th centuries, it was a major factor in the slow economic development of the American southern states.[213]

A comparison of average per capita YaIM in 1995, adjusted for parity of purchasing power, between countries with malaria and countries without malaria gives a fivefold difference (US$1,526 versus US$8,268). In the period 1965 to 1990, countries where malaria was common had an average per capita GDP that increased only 0.4% per year, compared to 2.4% per year in other countries.[214]

Poverty can increase the risk of malaria since those in poverty do not have the financial capacities to prevent or treat the disease. In its entirety, the economic impact of malaria has been estimated to cost Africa US$12 billion every year. The economic impact includes costs of health care, working days lost due to sickness, days lost in education, decreased productivity due to brain damage from cerebral malaria, and loss of investment and tourism.[10] The disease has a heavy burden in some countries, where it may be responsible for 30–50% of hospital admissions, up to 50% of ambulatoriya visits, and up to 40% of public health spending.[215]

Child with malaria in Efiopiya

Cerebral malaria is one of the leading causes of neurological disabilities in African children.[162] Studies comparing cognitive functions before and after treatment for severe malarial illness continued to show significantly impaired school performance and cognitive abilities even after recovery.[160] Consequently, severe and cerebral malaria have far-reaching ijtimoiy-iqtisodiy consequences that extend beyond the immediate effects of the disease.[216]

Counterfeit and substandard drugs

Murakkab counterfeits have been found in several Asian countries such as Kambodja,[217] Xitoy,[218] Indoneziya, Laos, Tailand va Vetnam, and are an important cause of avoidable death in those countries.[219] The WHO said that studies indicate that up to 40% of artesunate-based malaria medications are counterfeit, especially in the Greater Mekong mintaqa. They have established a rapid alert system to rapidly report information about counterfeit drugs to relevant authorities in participating countries.[220] There is no reliable way for doctors or lay people to detect counterfeit drugs without help from a laboratory. Companies are attempting to combat the persistence of counterfeit drugs by using new technology to provide security from source to distribution.[221]

Another clinical and public health concern is the proliferation of substandard antimalarial medicines resulting from inappropriate concentration of ingredients, contamination with other drugs or toxic impurities, poor quality ingredients, poor stability and inadequate packaging.[222] A 2012 study demonstrated that roughly one-third of antimalarial medications in Southeast Asia and Sub-Saharan Africa failed chemical analysis, packaging analysis, or were falsified.[223]

Urush

World War II poster

Throughout history, the contraction of malaria has played a prominent role in the fates of government rulers, nation-states, military personnel, and military actions.[224] 1910 yilda, Tibbiyot bo'yicha Nobel mukofoti -winner Ronald Ross (himself a malaria survivor), published a book titled The Prevention of Malaria that included a chapter titled "The Prevention of Malaria in War." The chapter's author, Colonel C. H. Melville, Professor of Hygiene at Qirollik armiyasi tibbiyot kolleji in London, addressed the prominent role that malaria has historically played during wars: "The history of malaria in war might almost be taken to be the history of war itself, certainly the history of war in the Christian era. ... It is probably the case that many of the so-called camp fevers, and probably also a considerable proportion of the camp dysentery, of the wars of the sixteenth, seventeenth and eighteenth centuries were malarial in origin."[225] In British-occupied India the cocktail jin va tonik may have come about as a way of taking quinine, known for its antimalarial properties.[226]

Malaria was the most significant health hazard encountered by U.S. troops in the South Pacific during Ikkinchi jahon urushi, where about 500,000 men were infected.[227] According to Joseph Patrick Byrne, "Sixty thousand American soldiers died of malaria during the African and South Pacific campaigns."[228]

Significant financial investments have been made to procure existing and create new antimalarial agents. Davomida Birinchi jahon urushi and World War II, inconsistent supplies of the natural antimalaria drugs cinchona bark and quinine prompted substantial funding into tadqiqot va rivojlantirish of other drugs and vaccines. American military organisations conducting such research initiatives include the Navy Medical Research Center, Valter Rid armiyasi tadqiqot instituti, va AQSh armiyasi yuqumli kasalliklar tibbiyot ilmiy-tadqiqot instituti AQSh qurolli kuchlari.[229]

Additionally, initiatives have been founded such as Malaria Control in War Areas (MCWA), established in 1942, and its successor, the Communicable Disease Center (now known as the Kasalliklarni nazorat qilish va oldini olish markazlari, or CDC) established in 1946. According to the CDC, MCWA "was established to control malaria around military training bases in the southern United States and its territories, where malaria was still problematic".[230]

Yo'q qilish harakatlari

Members of the Malaria Commission of the Millatlar Ligasi collecting larvae on the Dunay deltasi, 1929

Several notable attempts are being made to eliminate the parasite from sections of the world or eradicate it worldwide. In 2006, the organization Endi bezgak yo'q set a public goal of eliminating malaria from Africa by 2015, and the organization claimed they planned to dissolve if that goal was accomplished. 2007 yilda, Butunjahon bezgakka qarshi kurash kuni was established by the 60th session of the World Health Assembly. As of 2018, they are still functioning.[231] Faqat bitta bezgakka qarshi emlash is licensed for use, while several others are in clinical trials [6], which are intended to provide protection for children in endemic areas and reduce the speed of transmission of the disease. 2012 yildan boshlab, The Global Fund to Fight AIDS, Tuberculosis, and Malaria has distributed 230 million insecticide-treated nets intended to stop mosquito-borne transmission of malaria.[232] AQShda joylashgan Klinton jamg'armasi has worked to manage demand and stabilize prices in the artemisinin market.[233] Other efforts, such as the Malaria Atlas Project, focus on analysing climate and weather information required to accurately predict malaria spread based on the availability of habitat of malaria-carrying parasites[169]. The Malaria Policy Advisory Committee (MPAC) of the Jahon Sog'liqni saqlash tashkiloti (WHO) was formed in 2012, "to provide strategic advice and technical input to WHO on all aspects of malaria control and elimination".[234] In November 2013, WHO and the malaria vaccine funders group set a goal to develop vaccines designed to interrupt malaria transmission with malaria eradication's long-term goal.[235]

Malaria has been successfully eliminated or significantly reduced in certain areas. Malaria was once common in the United States and southern Europe, but vector control programs, combined with the monitoring and treatment of infected humans, eliminated it from those regions. Several factors contributed, such as the draining of botqoqlik breeding grounds for agriculture and other changes in suvni boshqarish practices, and advances in sanitation, including greater use of glass windows and screens in dwellings.[236] Malaria was eliminated from most parts of the United States in the early 20th century by such methods. Dan foydalanish pestitsid DDT and other means eliminated it from the South's remaining pockets in the 1950s as part of the Bezgakni yo'q qilish milliy dasturi.[237]

One of the targets of Maqsad 3 ning BMT "s Barqaror rivojlanish maqsadlari is to end the malaria epidemic in all countries by 2030.

In 2015 the WHO targeted a 90% reduction in malaria deaths by 2030[238]va Bill Geyts said in 2016 that he thought global eradication would be possible by 2040.[239]

In 2018, WHO announced that Paraguay was free of malaria, after an eradication effort that began in 1950.[240]

As of 2019, the eradication process is ongoing, but it will be tough to achieve a world free of malaria with the current approaches and tools. Approaches may require investing more in research and greater universal health care.[241] Continuing surveillance will also be important to prevent the return of malaria in countries where the disease has been eliminated.[242]

Tadqiqot

The Malaria Eradication Research Agenda (malERA) initiative was a consultative process to identify which areas of research and development (R&D) must be addressed for worldwide eradication of malaria.[243][244]

Vaktsina

Shuningdek qarang: Bezgakka qarshi emlash

A vaccine against malaria called RTS,S/AS01 (RTS,S) was approved by European regulators in 2015.[212] As of 2019 it is undergoing pilot trials in 3 sub-Saharan African countries – Ghana, Kenya and Malawi – as part of the WHO's Malaria Vaccine Implementation Programme (MVIP).[245]

Immunity (or, more accurately, bag'rikenglik ) ga P. falciparum malaria does occur naturally, but only in response to years of repeated infection.[37] An individual can be protected from a P. falciparum infection if they receive about a thousand bites from mosquitoes that carry a version of the parasite rendered non-infective by a dose of Rentgen nurlanish.[246] Juda yuqori polimorfik nature of many P. falciparum proteins results in significant challenges to vaccine design. Vaccine candidates that target antigens on gametes, zygotes, or ookinetes in the mosquito midgut aim to block the transmission of malaria. These transmission-blocking vaccines induce antikorlar in the human blood; when a mosquito takes a blood meal from a protected individual, these antibodies prevent the parasite from completing its development in the mosquito.[247] Other vaccine candidates, targeting the blood-stage of the parasite's life cycle, have been inadequate on their own.[248] Masalan, SPf66 was tested extensively in areas where the disease was common in the 1990s, but trials showed it to be insufficiently effective.[249]

Dori vositalari

Malaria parasites contain apikoplastlar, organelles usually found in plants, complete with their own genomlar. These apicoplasts are thought to have originated through the endosymbiosis of algae and play a crucial role in various aspects of parasite metabolizm, kabi fatty acid biosynthesis. Over 400 proteins have been found to be produced by apicoplasts and these are now being investigated as possible targets for novel antimalarial drugs.[250]

With the onset of drug-resistant Plazmodium parasites, new strategies are being developed to combat the widespread disease. One such approach lies in the introduction of synthetic pyridoxal -amino acid qo'shimchalar, which are taken up by the parasite and ultimately interfere with its ability to create several essential B vitaminlari.[251][252] Antimalarial drugs using synthetic metal-based komplekslar are attracting research interest.[253][254]

  • (+)-SJ733: Part of a wider class of experimental drugs called spiroindolone. It inhibits the ATP4 protein of infected red blood cells that cause the cells to shrink and become rigid like the aging cells. This triggers the immune system to eliminate the infected cells from the system as demonstrated in a mouse model. 2014 yildan boshlab, a 1-bosqich klinik sinov to assess the safety profile in human is planned by the Xovard Xyuz tibbiyot instituti.[255]
  • NITD246 and NITD609: Also belonged to the class of spiroindolone and target the ATP4 protein.[255]

Boshqalar

A non-chemical vector control strategy involves genetic manipulation of malaria mosquitoes. Avanslar gen muhandisligi technologies make it possible to introduce foreign DNA into the mosquito genome and either decrease the lifespan of the mosquito, or make it more resistant to the malaria parasite. Steril hasharotlar texnikasi is a genetic control method whereby large numbers of sterile male mosquitoes are reared and released. Mating with wild females reduces the wild population in the subsequent generation; repeated releases eventually eliminate the target population.[73]

Genomika is central to malaria research. Bilan ketma-ketlik ning P. falciparum, one of its vectors Anopheles gambiae, va inson genomi, the genetics of all three organisms in the malaria life cycle can be studied.[256] Another new application of genetic technology is the ability to produce genetik jihatdan o'zgartirilgan mosquitoes that do not transmit malaria, potentially allowing biologik nazorat of malaria transmission.[257]

In one study, a genetically-modified strain of Anopheles stephensi was created that no longer supported malaria transmission, and this resistance was passed down to mosquito offspring.[258]

Gen haydovchisi is a technique for changing wild populations, for instance to combat or eliminate insects so they cannot transmit diseases (in particular mosquitoes in the cases of malaria, zika,[259] dengue and yellow fever).[238]

Boshqa hayvonlar

Nearly 200 parasitic Plazmodium species have been identified that infect qushlar, sudralib yuruvchilar va boshqa sutemizuvchilar,[260] and about 30 species naturally infect non-human primates.[261] Some malaria parasites that affect non-human primates (NHP) serve as model organizmlar for human malarial parasites, such as P. coatneyi (a model for P. falciparum) va P. cynomolgi (P. vivax). Diagnostic techniques used to detect parasites in NHP are similar to those employed for humans.[262] Malaria parasites that infect rodents are widely used as models in research, such as P. Berghei.[263] Qushlar bezgagi primarily affects species of the order Passeriformes, and poses a substantial threat to birds of Gavayi, Galapagos va boshqalar arxipelaklar. Parazit P. relictum is known to play a role in limiting the distribution and abundance of endemic Hawaiian birds. Global isish is expected to increase the prevalence and global distribution of parranda bezgagi, as elevated temperatures provide optimal conditions for parasite reproduction.[264]

Adabiyotlar

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