kshayarogam

saadhaaranayaayi "micobacterium tuberculosis" (emm. tii. bii) bacteria moolamundaakunna oru pakarchavyaadhiyaanu kshayarogam (tibi). kshayarogam saadhaaranayaayi shwaasakoshathe badhikkunnu, pakshe ithu shareerathinte mattu bhaagangaleyum badhikkum. mikka anubaadhakalum rogalakshanangalonnum kanikkunnilla, eee saahacharyathil ithu olinjirikkunna kshayarogam ennariyappedunnu. olinjirikkunna anubaadhakalil ekadesham 10 sathamaanavum sajeevamaaya rogathilekku purogamikkunnu, ithu chikilsichillenkil, baadhichavaril pakuthiyolam perr marikkunnu. rakthamulla kapham, panii, ratri vearp, sareerabhaaram kurayal ennivayulla vittumaaraatha chumayaanu sajeevamaaya tibi yude saadhaarana lakshanagal. rogavumaayi bandhapetta sareerabhaaram kurayunnathinaal charitraparamaayi ithine upabhogam ennu vilichirunnu. mattu avayavangalude anubadha vaividhyamaarnna lakshanangalkk kaaranamakum.
shwaasakoshathil tii. bii. ulla aalukal chumaykkukayo thuppukayo samsaarikkukayo thummukayo cheyyumbol kshayarogam oru vyakthiyil ninnu mattonnilekku vaayuviloode vyaapikkunnu. olinjirikkunna tii. bii ullavar rogam padartthunnilla. echuaivi/aids ullavarilum pukavalikkunnavarilumaan sajeeva anubadha kooduthalaayi sambhavikkunnath. sajeevamaaya tibi roganirnayam nench ex-reey, athupole microscopic parisodhana, shareera draavakangalude samskaaram ennivaye adisthaanamaakkiyullathaanu. supthamaya tibi roganirnayam tuberculin charmma parisodhana (tii. ezz. tii) allengil rakthaparisodhanaye aasrayichirikkunnu.
uyarnna apakadasaadhyathayullavare parisodhikkuka, kesukal neratthe kandethukayum chikilsikkukayum cheyyuka, basilus kaalmett-guerine (bisiji) vaxine upayogichu prathirodha kuthivayppu nalkuka enniva tibi prathirodhatthil ulppedunnu. uyarnna apakadasaadyathayullavaril sajeevamaaya tibi ulla aalukalude veedu, jolisthalam, saamoohika sanbarkkam enniva ulppedunnu. chikilsaykku deerghakaalathekku onniladhikam antibioticukalude upayogam aavasyamaanu. onniladhikam marunnu prathirodhasheshiyulla kshayarogathinte (emm. dii. aarr-tibi) vardhichuvarunna nirakkukalode antibiotic prathirodham vardhichuvarunna oru prasnamaanu.
2018ll loka janasamkhyayude naalilonn perkkum tii. bii. yude olinjirikkunna anubaadhayundenn karuthappettirunnu. oro varshavum janasamkhyayude oru sathamaanathil puthiya anubadhakal sambhavikkunnu. 2020ll, ekadesham 10 dasalaksham aalukalkk sajeevamaaya tibi vikasichu, ithu 15 laksham maranangalkk kaaranamaayi, ithu ithu sesham pakarchavyaadhi moolamulla maranatthinte randaamathe pradhana kaaranamaayi maari. 2018 leeii kanakkanusarichu, mikka tibi kesukalum thekkukizhakkan eshya (44 sathamaanam), aphrica (24 sathamaanam), padinjaaran pasaphik (18 sathamaanam) ennee pradesangalilaanu, 50 sathamaanathiladhikam kesukalum ezhu raajyangalilaan india (27 sathamaanam), chaina (9 sathamaanam), indoneshya (8 sathamaanam), phillippines (6 sathamaanam), paakistaan (6 sathamaanam), naijeeriya (4 sathamaanam), bangladesh (4 sathamaanam). 2021 aakumbozhekkum oro varshavum puthiya kesukalude ennam prathivarsham ekadesham 2 sathamaanam kurayukayaayirunnu. pala eshyan, aafrikkan rajyangalileyum ekadesham 80 sathamaanam aalukalum positteev aanenkil, yunaittad stetsile 5-10% aalukal tuberculin parishodhanayiloode positteev aanennu parishodhikkunnu. purathana kaalam muthal manushyaril kshayarogam kaanapedunnu.
adayaalangalum lakshanangalum.
kshayarogam shareerathinte eathu bhaagatheyum baadhichekkaam, pakshe saadhaaranayaayi shwaasakoshathilaanu (pulmonary tuberculosis ennariyappedunnu) sambhavikkunnath. shwaasakoshathinu purathu kshayarogam vikasikkumbozhaanu extrapulmonary tibi sambhavikkunnath, ennirunnaalum extrapulmonary tibi pulmonary tibi yumayi sahavarthichekkaam.
panii, thanupp, ratri vearp, vishapp kurayal, sareerabhaaram kurayal, ksheenam ennivayaanu pothuvaaya adayaalangalum lakshanangalum. kaaryamaaya neyil clubbing sambhavikkam.
shwaasakosha.
oru kshayaroga anubadha sajeevamaakukayaanenkil, athu saadhaaranayaayi shwaasakoshathe ulkkollunnu (ekadesham 90 sathamaanam kesukalilum). nenjuvedana neenda cumayum kapham uthppaadippikkunna lakshanangalil ulppedaam. ekadesham 25 sathamaanam aalukalkk rogalakshanangalonnum undakanamennilla (athaayath.iii.avaa rogalakshanangalillathe thudarunnu). idaykkide, aalukal cheria alavil raktham chumachekkaam, valare apoorvamaaya sandarbhangalil, anubadha pulmonary artariyilekko rasmussense anyoorisathilekko shayikkukayum valia rakthasraavathinu kaaranamaakukayum cheyyum. kshayarogam oru vittumaaraatha rogamaayi maarukayum shwaasakoshathinte mukalbhagangalil vyapakamaaya paadukal undaakkukayum cheyyum. shwaasakoshathinte mukalile bhaagangale thaazhathe bhaagangale apekshichu kshayarogam kooduthalaayi badhikkunnu. eee vyathyaasathinte kaaranam vyakthamalla. onnukil mikacha vaayupravaham, allengil mukalile shwaasakoshathinullile mosham lymph drainage enniva moolamaakaam ithu.
extrapulmonary.
sajeevamaaya kesukalil <aii. dii. 1> ll, anubadha shwaasakoshathinu purathu vyaapikkukayum mattu tharatthilulla tbic kaaranamaakukayum cheiyunnu. ivaye koottaayi pulmonaric purameyulla kshayarogam ennu soochippikkunnu. durbalamaaya rogaprathirodha samvidaanamulla aalukalilum cheria kuttikalilum extrapulmonary tibi kooduthalaayi kaanapedunnu. echuaivi ullavaril, ithu 50 sathamaanathiladhikam kesukalilum sambhavikkunnu. pleura (tuberculus plurisiyil), kendra nadiviewham (tuberculus meninchaittisil), lymphatic sisttam (kazhuthile scrofulayil), jenittorinari sisttam (eurogenital kshayarogathil), ellukalum sandhikalum (nattellile pottu rogathil) ennivayaanu sradheyamaaya extrapulmonary anubadha sittukal. tibi yude kooduthal gurutharamaaya, vyapakamaaya roopathe "dispenited tuberculosis" ennu vilikkunnu, ithu milliary tuberculosis ennum ariyappedunnu. nilavil pulmonaric purameyulla kesukalil 10 sathamaanavum milliary tibi aanu.
kaaranagal.
micobacteria.
tii. biyude pradhana kaaranam cheruthum aerobic, nonmottail basilasaaya "micobacterium tuberculasis" (emm. tii. bii) aanu. eee rogakaariyude uyarnna lipid ulladakkam athinte savisheshamaaya klinikkal savisheshathakalkk kaaranamaakunnu. ithu oro 16 muthal 20 manikkoorilum vibhajikkunnu, ithu saadhaaranayaayi oru manikorinullil vibhajikkunna mattu bakteeriyakalumaayi thaarathamyappeduthumbol valare mandagathiyilaanu. micobacteriakalkku oru baahya membran lipid bilayer undu. oru gram qara cheiyukayaanenkil, emm. tii. bii onnukil valare durbalamaaya "gram positteev" karakal undaakkukayo allengil athinte koshabhithi uyarnna lipid, micolic assid ennivayude alavu kaaranam chayam nilanirthaathirikkukayo cheiyunnu. emm. tii. bii. kku durbalamaaya anunaashinikale prathirodhikkanum aazhchakalolam varanda avasthayil nilanilkkaanum kazhiyum. prakrithiyil, bacteriaykku oru aathidheya jeeviyude kosangalkkullil maathrame valaraan kazhiyoo, pakshe "emm. kshayarogam "laboratariyil samskarikkaam.
kafatthil ninnulla (kapham ennum vilikkunnu) kapham puranthallunna saambilukalil hystological paadukal upayogichu shaasthranjarkku microscopinu keezhil emm. tii. bii thirichariyaan kazhiyum. acidity layani upayogichu chikithsichathinusheshavum emm. tii. bii chila paadukal nilanirthunnathinaal, ithine assid-phaast basilus ennu tharamthirikkunnu. neela pashchaathalatthil verittunilkkunna assid-phaast basilly, thilakkamulla chuvapp niratthil chayam pooshunna seal-nielsen steyin, kinyoon steyin ennivayaanu ettavum saadhaaranamaaya assid-phaast staining teknikkukal. auraamain-rodamine staining, fluorescence microscopy ennivayum upayogikkunnu.
emm. kshayarogam undaakkunna mattu naalu micobacteriakal (tibi) kshayarogam sankeernnatha (emm. tii. bii. sii) yill ulppedunnu bovis, "emm. aafrikkaanam, "emm. kaanatti, "umm" emm. micro ". "emm. aafrikkaanam "vyaapakamallengilum aafrikkayude chila bhaagangalil kshayarogathinu ithu oru pradhana kaaranamaan. "emm. oru kaalath kshayarogathinte oru saadhaarana kaaranamaayirunnu bovis, ennaal pasteurise cheytha paal avatharippichathu vikasita rajyangalil oru pothujanaarogya prashnamenna nilayil ithu mikkavarum illaathaakki. "emm. kaanatti "apoorvamaanu, aafrikkayile kombil maathram parimithappeduthunnathaayi thonnunnu, ennirunnaalum aafrikkan kudiyettakkaaril kurachu kesukal kaanappettittund. "emm. micrody apoorvamaanu, rogaprathirodhasheshi kuranja aalukalil maathrame ithu kaanappedunnulloo, ennirunnaalum athinte vyaapanam ganyamaayi kurachukaanaamenkilum.
ariyappedunna mattu rogakarikalaaya micobacteriakalil "m" ulppedunnu. lepre, "emm. eaviyam, "umm" emm. kansasi ". avasaanathe rund enangale "noonn tuberculus micobacteria" (ntm) allengil asaadhaaranamaaya micobacteria ennu tharamthirichittundu. ntm tii. bii. ykko kushtarogatthino kaaranamaakunnillenkilum avaa tii. bii. yumayi saamyamulla shwaasakosha rogangalkk kaaranamaakunnu.
transmission.
sajeevamaaya pulmonary tibi chuma, tummal, samsaarikkal, paadal allengil thuppal ennivayulla aalukal 0.05 muthal 5.0 micrometer vare vyaasamulla pakarchavyaadhi aerosol thullikal puranthallunnu. oru tummalinu 40,000 thullikal vare puratthuvaraan kazhiyum. kshayarogathinte pakarchavyaadhi alavu valare cheruthaanu (10 ll thaazhe bakteeriyakal shwasikkunnathu anubaadhaykk kaaranamakum) ennathinaal eee thullikalil oronnum rogam pakaraan saadhyathayund.
pakarunnathinulla saadhyatha.
22 sathamaanam anubadha nirakkumayi, tii. bii ullavarumayi deerghakaalamo idaykkidayo adutha sanbarkkamo ulla aalukalkk rogam pidipedaanulla saadhyatha valare kooduthalaanu. sajeeva ennaal chikilsikkaathathumaaya shayarogamulla oru vyakthikk prathivarsham <aii. dii. 1> (allengil athil kooduthal) mattu aalukale baadhichekkaam. sajeevamaaya tibi ullavaril ninnu maathrame pakarchavyaadhi undaakoo-olinjirikkunna anubadhayullavar pakarchavyaadhiyaanennu karuthappedunnilla. oru vyakthiyil ninnu mattonnilekku pakaraanulla saadhyatha, vaahakan puranthallunna pakarchavyaadhi thullikalude ennam, vaayusanchaarathinte falaprapti, exposure dairkhyam, emm viralence ennivayulppede niravadhi gadakangale aasrayichirikkunnu. kshayarogam, anubaadhayillaatha vyakthiyile prathirodhasheshi, mattullava. sajeevamaaya ("outtar") tibi ullavare verthirichu aanti-tibi marunnu rejimentukalil idunnathiloode vyakthi-vyakthi vyaapanathinte cascade ozhivakkaam. ekadesham randaazhchathe phalapradamaaya chikilsaykku sesham, prathirodhasheshiyillaatha sajeeva anubaadhakalulla vyakthikal saadhaaranayaayi mattullavarkk pakarchavyaadhiyaayi nilanilkkilla. aarenkilum rogabaadhithanaanenkil, puthuthayi rogabadhithanaaya vyakthikk mattullavarilekku rogam pakaraan kazhiyunna tharatthil pakarchavyaadhi undakaan saadhaaranayaayi moonnu muthal naalu aazhcha vare edukkum.
apakadasaadhyatha gadakangal.
niravadhi gadakangal vyakthikale tibi anubaadhaykkum koodaathe/allengil rogathinum kooduthal vidheyaraakkunnu.
sajeevamaaya rogasadhyatha.
sajeevamaaya tibi vikasippikkunnathinulla aagolathalathile ettavum pradhanappetta apakada gadakamaanu oresamayam echuaivi anubadha; tibi ullavaril 13 sathamaanavum echuaivi rogabaadhitharaanu. echuaivi anubaadhayude nirakk uyarnna sub-saharan aafrikkayile oru prathyeka prashnamaanith. kshayarogam baadhicha echuaivi anubaadhayillaathavaril, ekadesham ekadesham avarude jeevithakaalathu sajeevamaaya rogam vikasippikkunnu; neremarichu, echuaivi saha-rogabaadhitharil 30 sathamaanam sajeevamaaya rogam vikasippikkunnu.
corticosteroidukal, infliximab (oru aanti-tnf monoclonal antibody) thudangiya chila marunnukalude upayogam, prathyekichu vikasita rajyangalil, mattoru pradhana apakada gadakamaanu.
madyapaanam, prameham (apakadasaadhyatha moonniratti vardhichu), silicosis (apakadasaadhyatha 30 madangu vardhichu), pukayila pukavali (apakadasaadhyatha randiratti vardhichu), indor vaayu malineekaranam, poshakaahaarakkurav, cheruppam, aduthide nediya tibi anubadha, vinoda mayakkumarunnu upayogam, gurutharamaaya vrukkarogam, sareerabhaaram kurayuka, avayavamatta sasthrakriya, thalayum kazhuthum cancer, janithaka samvedanakshamatha (janithaka apakadasaadhyatha gadakangalude mothatthilulla praadhaanyam nirvachikkappettitla) ennivayaanu mattu apakada gadakangal.
anubaadhayude saadhyatha.
pukayila pukavali anubaadhaykkulla saadhyatha vardhippikkunnu (sajeevamaaya rogathinum maranathinum saadhyatha vardhippikkunnathinupe). anubaadhayude saadhyatha vardhippikkunna adhika gadakangalil cheruppavum ulppedunnu.
rogakaaranam.
rogabaadhitharil ekadesham 90 sathamaanavum emm. kshayarogathinu lakshanangalillaatha, olinjirikkunna tibi anubadhakal undu (chilappol eltb ennu vilikkunnu), olinjirikkunna anubadha prathyakshavum sajeevavumaaya kshayarogathilekku purogamikkunnathinulla 10 sathamaanam jeevithakalam maathrame ulloo. echuaivi ullavaril, sajeevamaaya tibi vikasippikkanulla saadhyatha prathivarsham ekadesham 10 shathamaanamaayi vardhikkunnu. phalapradamaaya chikitsa nalkiyillengil, sajeevamaaya tibi kesukalude marananirakk 66 sathamaanam vareyaanu.
micobacteriakal shwaasakoshathinte alviolar eyar saakkukalil athumbol tibi anubadha aarambikkunnu, avide avaa alviolar maakrofejukalude endosomukalkkulil akramikkukayum aavarthikkukayum cheiyunnu. macrophageukal bacteria videshamaayi thirichariyukayum phagocytosis vazhi athine illaathaakkaan sramikkukayum cheiyunnu. eee prakriyayil, bacteria macrophage kondu moodappedukayum fagozom ennariyappedunna membran-boundu vesiclil thaalkkaalikamaayi sambharikkukayum cheiyunnu. fagozom pinneedu oru lysosomumaayi samyojippichu oru phagolisosom srishtikkunnu. phagolysosomil, bacteria kollan koshangal reactive ooksijan speesheesukalum assid upayogikkaan shramikkunnu. ennirunnaalum, "emm. kshayarogathinu eee vishavasthukkalil ninnu samrakshikkunna kattiyullathum mezhukullathumaaya micolic assid capsule undu. "emm. kshayarogathinu macrophaginullil punarnirmikkaan kazhiyum, athu oduvil rogaprathirodha koshatthe kollum.
shwaasakoshathile anubaadhayude praadhamika sthalam, ghoon focus ennariyappedunnu, saadhaaranayaayi thaazhathe lobinte mukal bhaagatho mukalile lobinte thaazhathe bhaagatho aanu sthithicheyyunnathu. rakthapravaahathil ninnulla anubaadhayiloodeyum shwaasakoshathile kshayarogam sambhavikkam. ithu saimon focus ennariyappedunnu, ithu saadhaaranayaayi shwaasakoshathinte mukalil kaanapedunnu. eee hematogenous transmission peripheral lymph nodukal, vrukkakal, thalachoru, ellukal thudangiya kooduthal vidoora sthalangalilekku anubadha pakaraan kazhiyum. shareerathinte ellah bhaagangaleyum rogam baadhichekkaam, ennirunnaalum anjjaathamaaya kaaranangalal ithu hridayam, asthikooda peshikal, pancreas allengil thyroid ennivaye apoorvvamaayi maathrame baadhikkunnulloo.
kshayarogathe granulomatus koshajwalana rogangalilonnayi tharamthirickunnu. macrophageukal, epithelioid koshangal, tii lymphocyteukal, bii lymphocyteukal, fibroblastukal enniva chernnu graanulomakal roopappedunnu, rogabadhithamaaya macrophageukalkku chuttum lymphocyteukal undu. mattu macrophageukal rogabadhithamaaya macrophage aakramikkumbol, avaa orumichu samyojichu alviolar lumenil oru bheeman multinucleated sell roopeekarikkunnu. granuloma micobacteriayude vyaapanam thadayukayum rogaprathirodha samvidaanathile koshangalude prathipravartthanathinu oru praadeshika anthareeksham nalkukayum cheyyum. ennirunnaalum, aathidheyarude rogaprathirodha samvidaanathinte nasham ozhivakkaan bakteeriyakal graanulomakal upayogikkunnuvennu sameepakaala thelivukal soochippikkunnu. graanulomakalile macrophageukalkkum dendraitik koshangalkkum lymphocytukalkku aantijan nalkaan kazhiyilla; athinaal rogaprathirodha prathikaranam adichamarthappedunnu. granulomayile bakteeriyakal nishkriyamaakukayum olinjirikkunna anubaadhaykk kaaranamaakukayum cheyyum. kizhanguvarggathinte madhyabhaagathu asaadhaaranamaaya koshamaranatthinte (necrosis) vikaasamaan graanulomaasinte mattoru savisheshatha. nagnanethrangal kondu, ithinu mriduvaaya, velutha cheesinte gadanayundu, ithine cases necrosis ennu vilikkunnu.
tii. bii bakteeriyakal kedupaadukal sambhavicha tissue pradeshathu ninnu rakthapravaahathilekk praveshikkukayaanenkil, avaa shareerathiludaneelam vyaapikkukayum anubaadhayude niravadhi kendrangal sthaapikkukayum cheyyum, ivayellaam tissuekalil cheruthum veluthathumaaya tuberclukalaayi kaanapedunnu. cheria kuttikalilum echuaivi ullavarilum ettavum saadhaaranamaaya eee gurutharamaaya roopathilulla tibi rogathe milliary tuberculosis ennu vilikkunnu. eee tii. bii. ulla aalukalkk chikilsayil polum uyarnna marananirakk (ekadesham 30 sathamaanam) undu.
pala aalukalilum anubadha vardhikkukayum kurayukayum cheiyunnu. koshangalude nashavum necrosis palappozhum rogashaanthiyiloodeyum fibrosisiloodeyum santhulithamaakkunnu. badhita tissuek pakaram paadukalum keshyas necrotic metteeriyal niracha arakalum varunnu. sajeevamaaya rogathinte samayat, eee arakalil chilath vaayusanjaarangalumaayi (bronkey) bandhippikkukayum eee padaartham chumaykkukayum cheyyaam. athil jeevanulla bakteeriyakal adangiyittundu, athinaal anubadha pakaraan kazhiyum. uchithamaaya antibioticukal upayogichu chikitsa cheiyunnathu bakteeriyakale kollukayum rogashanti nadatthaan anuvadikkukayum cheiyunnu. rogashanti labhikkumbol, badhita pradeshangal oduvil vadu tissue upayogichu maattisthaapikkappedunnu.
roganirnayam.
sajeevamaaya kshayarogam.
rogaprathirodha sheshi durbalaraayavaril rogam nirnnayikkunnathupole, adayaalangaludeyum lakshanangaludeyum adisthaanathil maathram sajeevamaaya kshayarogam nirnnayikkunnath budhimuttaanu. ennirunnaalum, shwaasakosha rogathinte adayaalangalo randaazhchayil kooduthal neendunilkkunna bharanaghadanaaparamaaya lakshanangalo ullavaril tibi roganirnayam pariganikkanam. assid phaast basillikkaayulla nench ex-reyum onniladhikam kapham samskaarangalum saadhaaranayaayi prarambha vilayiruthalinte bhagamaanu. interferon-jii release asseyukalum (igra) tuberculin charmma parishodhanakalum mikka vikaswara raajyangalilum prayojanappedunnilla. echuaivi ullavaril igraykku samanamaaya parimithikalundu.
emm" thiricharinju kondaanu tibi yude krithyamaaya roganirnayam nadathunnathu. oru klinikkal saambilil kshayarogam (udha.jii., kapham, pazhuppu, allengil tissue biopsy). ennirunnaalum, pathukke valarunna eee jeeviyude budhimuttulla kalchar prakriyaykku rakthathino kapham culturino rund muthal aarr aazhcha vare eduthekkaam. athinaal, samskaarangal sthireekarikkunnathinu munbaayi palappozhum chikitsa aarambikkunnu.
nucleic assid amplification testtukalum adenosine deminase testing tibi vegathil roganirnayam nadatthaan anuvadichekkaam. aantibodikal kandethunnathinulla rakthaparisodhana nirddishtamo sensitiivu allathatho aayathinal avaa shupaarsha cheiyunnilla.
olinjirikkunna kshayarogam.
tibi varaanulla saadhyatha kooduthalulla aalukale parisodhikkaan mantox tuberculin charmma parisodhana palappozhum upayogikkunnu. munbu baasille kaalmett-guerine vaxine upayogichu prathirodha kuthivayppu eduthavarkku thettaaya positteev parisodhanaa phalam undakam. sarcoidosis, hodgekins lymphoma, poshakaahaarakkurav, ettavum shradheyamaayi, sajeevamaaya kshayarogam enniva ullavaril parisodhana thettaaya negatteevu aakam. rakthasaampilil interferon gaama release parisodhanakal, mantox parishodhanaykk positteev aayavaril shupaarsha cheiyunnu. ivaye prathirodha kuthivayppo mikka paaristhithika micobacteriakalo baadikkunnilla, athinaal avaa thettaaya-positteev phalangal srishtikkunnu. ennirunnaalum, avare "emm" badhikkunnu. sulgai, "emm. marinam "," emm. kansasi ". charmma parishodhanaykk purame upayogikkumbol igras samvedanakshamatha vardhippikkumenkilum ottaykku upayogikkumbol charmma parishodhanayekkaal sensitiivu kuravaayirikkaam.
yuu. ezz. preventive sarveesas task fozhsu (yuu. ezz. pii. ezz. tii. eph) supta kshayarogathinu uyarnna apakadasaadyathayulla aalukale tuberculin charmma parishodhanakalo interferon-gaama release parishodhanakalo upayogichu parisodhikkaan shupaarsha cheythittundu. chilar aarogya pravartthakare parisodhikkaan shupaarsha cheythittundenkilum, ithinte nettatthinte thelivukal moshamaan. centers phoor disease kantrol aandu prevention (cdc) 2019 ll aarogya pravartthakare ariyappedaathe vaarshika parisodhana shupaarsha cheiyunnathu nirtthi.
prathirodham.
kshayaroga prathirodhavum niyanthrana sramangalum praadhamikamaayi shishukkalude prathirodha kuthivayppineyum sajeevamaaya kesukal kandethunnathinum uchithamaaya chikitsa aasrayichirikkunnu. mechappetta chikitsa reethikaliloodeyum kesukalude ennathilum cheria kuravundaayathiloodeyum lokaarogya samghadana (aarr) kurachu vijayam kaivarichu. chila rajyangalil kshayarogam undennu samshayikkunnavare manahpoorvamallaathe thadankalil vaykkunnathino parishodhikkunnathino allengil rogabaadhitharaanenkil avare manahpoorvamallaathe chikilsikkunnathino niyamanirmmanam undu.
waxinukal.
labhyamaya eaka vaxine basilus kaalmett-guerine (bisiji) aanu. kuttikalil ithu anubaadhaykkulla saadhyatha 20 sathamaanavum anubadha sajeeva rogamaayi maranullah saadhyatha 60 sathamaanavum kuraykkunnu.
90 sathamaanathiladhikam kuttikalkkum prathirodha kuthivayppu nalkunna ithu lokamembaadum ettavum vyaapakamaayi upayogikkunna vaaksinaan. ithu ulavaakkunna prathirodhasheshi ekadesham patthu varshathinu sesham kurayunnu. canada, padinjaaran europe, america ennividangalil kshayarogam asaadhaaranamaayathinaal, uyarnna apakadasaadyathayulla aalukalkk maathrame bisiji nalkoo. vaxine upayogikkunnathinethiraaya nyaayavaadatthinte oru bhagam, ithu tuberculin charmma parisodhanaye thettaaya positteev akkunnu ennathaanu, ithu oru screening upakaranamenna nilayil parisodhanayude prayojanam kuraykkunnu. niravadhi waxinukal vikasippichukondirikku.
bisiji kuthivayppinu purame intradermal mva 85eiii vaxine kshayarogam thadayunnathil falapradamalla.
pothujanaarogyam.
pothujanaarogyam tirakk, pothu thuppuka, pathivayi shuchithvam (kaii kazhukunnathu ulppede) ennivayil shradha kendreekaricha pothujanaarogya prachaaranangal vyaapanathe thadassappeduthaano mandagathiyilaakkaano sahayichu, ithu kondaakt tracing, isolation, chikitsa ennivayumaayi samyojippikkumbol kshayarogathinteyum mattu vaayuviloodeyulla rogangaludeyum vyaapanam naadakeeyamaayi thadayaan sahayichu, ithu mikka vikasita sambadvyavasthakalilum kshayarogathe oru pradhana pothujanaarogya prashnamaayi illaathaakkunnathilekku nayichu. poshakaahaarakkurav polulla tii. bii vyaapanam vashalaakkiya mattu apakada gadakangalum mechappeduthi, ennaal echu. aii. vii. yude aavirbhaavathethudarnnu rogaprathirodhasheshi kuranja vyakthikalude oru puthiya janasamkhya tii. bii. yill anubaadhayundaakkaan labhyamaayirunnu.
lokaarogya samghadana (doubleuecho) 1993-ll tb "aagola aarogya adiyantharaavastha" aayi prakhyaapichu, 2006-ll, stopp tbyude pankaalittham kshayarogam thadayunnathinulla oru aagola padhathi vikasippichu, athu athinte samarambhathinum 2015-num idayil 14 dasalaksham jeevan rakshikkaan lakshyamittu. 2015-oode avar nischayicha niravadhi lakshyangal kaivarikkaan kazhinjilla, kooduthalum echuaiviyumaayi bandhapetta kshayarogathinte vardhanavum onniladhikam marunnu prathirodhasheshiyulla kshayarogathinte aavirbhaavavum kaaranam. american thorassic sosaitti vikasippichedutha oru kshayaroga vargeekarana samvidaanam praadhamikamaayi pothujanaarogya paripaadikalil upayogikkunnu. 2015ll 2015ll munbu maranangal 95 sathamaanavum kesukal 90 sathamaanavum kuraykkunnathinulla end tibi thanthram aarambhichu. drutha parisodhanayude abhavam, hraswavum phalapradavumaaya chikitsa kozhsukal, poornnamaayum phalapradamaaya waxinukal ennivayude abhavam enniva kshayaroga nirmmaarjjanathinte lakshyathe thadassappeduthunnu.
mdr-tibi baadhitharaayavaril aanti-tubercular marunnukal nalkunnathinte gunangalum apakadasaadhyathakalum vyakthamalla. echuaivi positteev vyakthikalkk hart therapy labhyamakkiyaal sajeevamaaya tibi anubaadhayilekkulla saadhyatha 90 sathamaanam vare kuraykkukayum eee janasamkhyayiludaneelam vyaapanam laghookarikkukayum cheyyum.
chikitsa.
tii. bii. yude chikilsayil bakteeriyakale kollan antibioticukal upayogikkunnu. marunnukalude praveshanathe thadassappeduthukayum niravadhi antibioticukal falapradamallaathaakkukayum cheiyunna micobacterial sell vaalile asaadhaaranamaaya ghadanayum raasaghadanayum kaaranam phalapradamaaya tibi chikitsa budhimuttaanu.
antibiotic prathirodham vikasippikkunna bakteeriyakalude apakadasaadhyatha kuraykkunnathinu niravadhi antibioticukalude samyojanam upayogichu sajeevamaaya tibi mikacha reethiyil chikilsikkunnu. shayarogamulla echuaivi positteev aalukalil refampicinu pakaram refabootin pathivayi upayogikkunnathu vyakthamallaatha prayojanamaanu.
olinjirikkunna tii. bii.
olinjirikkunna tibi isoniasid allengil refampin upayogichu maathram chikilsikkunnu, allengil isoniasid refampicin allengil refapentain enniva upayogichu samyojippikkunnu.
upayogikkunna marunnukale aashrayich chikilsaykku moonnu muthal ombathu maasam vare edukkum. olinjirikkunna anubaadhakalulla aalukalkk jeevithathil pinneedu sajeevamaaya tibi rogathilekku neengunnathu thadayunnathinaayi chikilsikkunnu.
vidyaabhyaasamo kaunsilingo olinjirikkunna kshayaroga chikilsayude poorttheekarana nirakk mechappeduthiyekkaam.
puthiya thudakkam.
aadyathe rund maasathekku refampicin, isoniasid, pyrasinamide, ethambutol enniva adangiya antibioticukalude samyojanathinte aarr maasavum kazhinja naalu maasathekku refampicin, isoniasid enniva maathram adangiyathaanu puthuthayi aarambikkunna pulmonary kshayarogathinte shupaarsha cheyyappedunna chikitsa. isoniasidinulla prathirodham kooduthalaanengil, badal aayi kazhinja naalu maasathekku ethambootol cherkkaam. kuranjathu 6 maasamenkilum aanti-tibi marunnukal upayogichulla chikitsa, vyathyasam cheruthaanenkilum, 6 maasathil thaazheyulla chikilsayumaayi thaarathamyappeduthumbol uyarnna vijaya nirakk nalkunnu. paalikkal prashnangalullavarkk hrasvamaaya chikitsa reethi shupaarsha cheyyaam. 6 maasathe chikitsa reethiyumaayi thaarathamyappeduthumbol hrasvamaaya kshayaroga virudha chikitsa reethikale pinthunaykkunnathinu thelivukalonnumilla. ennirunnaalum, aduthide, oru anthaaraashtra, kramarahitavum niyantrithavumaaya klinikkal trialil ninnulla phalangal soochippikkunnathu, moxifloxacin (2phzm/2phm) ulla uyarnna alavil allengil "opttimais cheytha" refapentain adangiya naalu maasathe dainamdina chikitsa reethi, mayakkumarunnu-susseptible tuberculosis (tibi) rogam chikilsikkunnathil nilavilulla aarr maasathe saadhaarana dainamdina reethi pole surakshithavum phalapradavumaanu.
aavarthichulla rogam.
kshayarogam aavarthikkukayaanenkil, chikitsa nirnnayikkunnathin munbu eathu antibioticukalodu sensitiivu aanennu nirnnayikkaan parisodhana pradhaanamaan. onniladhikam marunnu prathirodhasheshiyulla tibi (mdr-tibi) kandethiyaal, 18 muthal 24 maasam vare kuranjathu naalu phalapradamaaya antibioticukal upayogichulla chikitsa shupaarsha cheiyunnu.
marunnu administration.
nerittulla nireekshana chikitsa, i.iii.aaa vyakthi avarude marunnukal kazhikkunnath oru aarogya parirakshaa daataav nireekshikkunnathu, antibioticukal uchithamayi edukkaatha aalukalude ennam kuraykkunnathinulla shramathil lokaarogya samghadana (aarr) shupaarsha cheiyunnu. aalukal avarude marunnukal swathanthramaayi kazhikkunnathinekkurichu eee sanbradaayathe pinthunaykkunnathinulla thelivukal mosham gunanilavaaramullathaan. nerittu nireekshicha therapy rogamuktharaaya aalukalude ennamo marunnu poortthiyaakkunna aalukalude ennamo mechappeduthunnuvennu soochippikkunna sakthamaaya thelivukalonnumilla. aalukale veettil nireekshikkunnathum klinikkil nireekshikkunnathum allengil oru kudumbaamgavum aarogya pravartthakanum thammil vyathyaasamillenn mithamaaya gunanilavaaramulla thelivukal soochippikkunnu. chikilsayudeyum appoyintmentukalum praadhaanyathekkurichu aalukale oormmippikkunnathinulla reethikal cheruthenkilum pradhanappetta mechappeduthalinu kaaranamaayekkam. aazhchayil rando moonno thavana nalkunna intermittant refampicin adangiya therapy pinthunaykkunnathinu mathiyaya thelivukalilla, rogashanti nirakk mechappeduthunnathinum veendum undaakunna nirakk kuraykkunnathinum dainamdina doses rejimen thulya falapraapthiyaanu nalkunnathu. shayarogamulla kuttikale chikilsikkunnathil dainamdina dossing rejimentumaayi thaarathamyappeduthumbol aazhchayil rando moonno thavana idaykkide hraswa kozhs rejimen nalkunnathinte falapraapthiyekkurichu mathiyaya thelivukalilla.
marunnukalude prathirodham.
oru vyakthikk prathirodhasheshiyulla tibi baadhikkumbozhaanu praadhamika prathirodham sambhavikkunnath. aparyapthamaaya chikitsa, nirddishta reethi uchithamayi sweekarikkaathirikkuka (paalikkaathirikkuka), allengil gunanilavaaramillaattha marunnukal upayogikkuka enniva kaaranam poornnamaayum emm. tii. bii. baadhithanaaya oru vyakthikk therapy samayat dvitheeya (nediya) prathirodham vikasippichekkaam. pala vikaswara raajyangalilum mayakkumarunnu prathirodhasheshiyulla tibi gurutharamaaya pothujanaarogya prasnamaanu, kaaranam athinte chikitsa dairkhyameriyathum kooduthal chelaveriyathumaaya marunnukal aavasyamaanu. ettavum phalapradamaaya rund aadya-line tibi marunnukalaaya refampicin, isoniasid ennivaykkethiraaya prathirodhamaayaanu mdr-tibi nirvachichirikkunnathu. randaam nira marunnukalude aarr klaasukalil moonno athiladhikamo ennam vyaapakamaayi mayakkumarunnu prathirodhasheshiyulla tibi prathirodhikkunnu. nilavil upayogikkunna ellah marunnukaleyum poornnamaayum mayakkumarunnu prathirodhasheshiyulla tibi prathirodhikkunnu. 2003ll italiyilaanu ithu aadyamaayi nireekshichathenkilum 2012 vare vyaapakamaayi report cheyyapettilla, iraanilum indiayilum ithu kandethiyittundu. exdr-tibi ullavare chikilsikkaan linesolidinu kurachu falaprapti undengilum paarshwafalangalum marunnukal nirthalaakkunnathum saadhaaranamaayirunnu. onniladhikam marunnu prathirodhasheshiyulla tibi-yill upayogikkunnathinu bedakviline thaalkkaalikamaayi pinthunaykkunnu.
vipulamaaya prathirodhasheshiyulla" tibi nirvachikkaan chilappol upayogikkunna oru padamaanu exdr-tibi, ithu mdr-tibi yude patthil onnu kesukalaanu. 90 sathamaanathiladhikam rajyangalil ex. dii. aarr. tibi kesukal kandethiyittundu.
ariyappedunna refampicin allengil mdr-tibi ullavarkku, genotype mtbdrsl asse (kalchar aisolettukalil allengil smear positteev saambilukalil nadathunnathu) polulla tanmatra parisodhanakal randaam nira aanti-tubercular drugg resistans kandethaan upayogapradamaakum.
pravachanam.
rogaprathirodha samvidaanathinte prathirodhatthe marikadannu basilli perukaan thudangumbozhaanu tibi anubaadhayil ninnu outtar tibi rogathilekkulla purogathi sambhavikkunnath. praadhamika tibi rogathil (chila kesukalil 1-5%), ithu prarambha anubaadhaykk thottupinnaleyaanu sambhavikkunnath. ennirunnaalum, bhooribhaagam kesukalilum, vyakthamaaya lakshanangalonnumillathe oru olinjirikkunna anubadha sambhavikkunnu. eee nishkriyamaaya baasillikal eee olinjirikkunna kesukalil <aii. dii. 1> ll sajeevamaaya kshayarogam srishtikkunnu, palappozhum anubaadhaykk niravadhi varshangalkk sesham.
echuaivi anubadha moolamundaakunnathupole rogaprathirodhasheshi kurayumbol veendum sajeevamakaanulla saadhyatha vardhikkunnu. emm" ennathumaayi sanbarkkam pulartthunna aalukalil. kshayarogam, echuaivi enniva veendum sajeevamakaanulla saadhyatha prathivarsham 10 shathamaanamaayi vardhikkunnu. emm"-nte dna viraladayaalam upayogichulla padanangal. kshayarogathinte vakabhedangal munbu chinthichathilum kooduthal aavarthichulla tbic reinfection sambhavana cheiyunnuvennu kaanikkunnu, tibi saadhaaranamaaya pradeshangalil veendum sajeevamaaya kesukalil 50 sathamaanathiladhikam ithu kaaranamaakumenn kanakkaakkappedunnu. 1995ll kshayarogam moolam maranappedaanulla saadhyatha 8 shathamaanamaayirunnappol ithu ekadesham 4 sathamaanamaanu.
smear positteev pulmonary tibi (echuaivi qoo-infection illaathe) ullavaril, chikilsayillaathe 5 varshathinu sesham, 50-60% marikkumbol 20-25% svayamprerithamaaya resolution (chikitsa) nedunnu. chikilsikkaattha echuaivi qoo-infection ullavaril tibi mikkavarum ellaayppozhum maarakamaan, koodaathe echuaivi yude antiretroviral chikilsayiloode polum marananirakk vardhikkunnu.
epidemiology.
loka janasamkhyayude ekadesham naalilonn perkku 'emm' rogam baadhichittundu. kshayarogam, "oro varshavum janasamkhyayude ekadesham 1 sathamaanathil puthiya anubadhakal sambhavikkunnu. ennirunnaalum, mikka anubaadhakalum "emm" aanu. kshayarogam "rogathinu kaaranamakunnilla, koodaathe anubaadhakalude <aii. dii. 1> lakshanangalillathathaayi thudarunnu. 2012ll 86 laksham vittumaaraatha kesukal sajeevamaayirunnu. 2010ll 8.8 dasalaksham puthiya kshayaroga kesukal kandethukayum <aii. dii. 1> dasalaksham maranangal sambhavikkukayum cheythu (ivayil bhooribhaagavum vikaswara rajyangalilaanu sambhavikkunnath). ithil ekadesham 0.35 dasalaksham echuaivi baadhichavarilaanu sambhavikkunnath. 2018ll, kshayarogam lokamembaadumulla oru pakarchavyaadhi ejantil ninnulla maranatthinte pradhana kaaranamaayirunnu. 2005 muthal motham kshayaroga kesukalude ennam kurayunnu, athesamayam 2002 muthal puthiya kesukal kuranju.
ellah vasanthakaalathum venalkkaalathum ettavum uyarnna thothil undaakunna kshayarogam kaalaanusrithamaanu. ithinte kaaranagal vyakthamallengilum shaithyakaalath vitaamin diyude kuravumaayi bandhappettirikkam. kuranja thaapanila, kuranja eerppam, kuranja mazha thudangiya vividha kaalaavasthakalumaayi kshayarogathe bandhippikkunna padanangalum undu. kshayarogam undaakunna nirakk kalavastha vyathiyanavumaayi bandhappettirikkamenn abhipraayappettittund.
apakadasaadyathayulla grouppukal.
kshayarogam tirakkum poshakaahaarakkuravum thammil adutha bandhamullathinal ithu daaridryathinte pradhana rogangalilonnaan. uyarnna apakadasaadyathayullavaril iva ulppedunnu anadhikritha mayakkumarunnu kuthivaykkunna aalukal, nivaasikal, durbalaraaya aalukal othukoodunna pradeshangalile jeevanakkar (udha.jii.jayilukal, bhavanarahitharude abhayakendrangal), vaidyashaasthraparamaayi pinnakkam nilkkunnavarum vibhavangal illaathavarumaaya samoohangal, uyarnna apakadasaadyathayulla vamseeya nyoonapakshangal, uyarnna apakadasaadyathayulla vibhaagathilulla rogikalumaayi adutha sanbarkkam pulartthunna kuttikal, eee rogikale sevikkunna aarogya parirakshaa daathaakkal.
kshayarogathinte nirakk praayathinanusarichu vyathyaasappedunnu. aafrikkayil ithu pradhaanamaayum kaumaarakkaareyum cheruppakkaareyum badhikkunnu. ennirunnaalum, rogavyaapana nirakk ganyamaayi kuranja rajyangalil (america polullava), kshayarogam pradhaanamaayum praayamaayavarudeyum rogaprathirodhasheshi kuranjavarudeyum rogamaanu (apakadasaadhyatha gadakangal mukalil pattikappedutthiyirikku). lokamembaadumulla 22 "uyarnna bharam" ulla samsthaanangalo raajyangalo orumichu 80 sathamaanam kesukalum 83 sathamaanam maranangalum anubavikkunnu.
canadayilum australiyayilum thaddesheeyarkkidayil, prathyekichu vidoora pradeshangalil kshayarogam palamadangu kooduthalaanu. munkootty kaanapedunna aarogyasthithikaludeyum perumaattangaludeyum uyarnna vyaapanam, tirakkum daaridryavum enniva ithinu kaaranamakunna gadakangalil ulppedunnu. chila canadian thaddesheeya grouppukalil, janithaka samvedanakshamatha oru punk vahichekkaam.
saamoohika saambathika nila (ezz. iii. ezz) tii. bii apakadasaadhyathaye shakthamayi badhikkunnu. thaazhnna sess ullavarkku tibi pidipedaanum rogam kooduthal gurutharamaayi badhikkaanum saadhyathayund. kuranja sess ullavare tibi (udha.jii.poshakaahaarakkurav, akathe vaayu malineekaranam, echuaivi qoo-infection muthalaayava.), koodaathe thirakkeriyathum mosham vaayusanchaaramullathumaaya edangalilekku thurannukattaanulla saadhyatha kooduthalaanu. aparyapthamaaya aarogya pariraksha ennathinartham, vyaapanam sugamamakkunna sajeeva rogangalulla aalukalkk vegathil roganirnayam nadathukayum chikilsikkukayum cheiyunnilla; athinaal rogikalaaya aalukal pakarchavyaadhiyude avasthayil thudarukayum (thudaruka) anubadha vyaapikkukayum cheiyunnu.
bhoomishaasthraparamaaya epidemiology.
lokamembaadum kshayarogathinte vitharanam orupoleyalla; pala aafrikkan, caribean, dakshineshyan, kizhakkan europian rajyangalileyum janasamkhyayude 80 sathamaanavum tuberculin parisodhanakalil positteev aanenkil, yuu. esile <aii. dii. 1> maathramaan.ezz. janasamkhya positteev aayi. phalapradamaaya oru vaxine vikasippikkunnathinulla budhimuttu, chelaveriyathum samayamedukkunnathumaaya roganirnaya prakriya, niravadhi maasathe chikilsayude aavasyakatha, echuaiviyumaayi bandhapetta kshayarogathinte vardhanavu, 1980-kalil mayakkumarunnu prathirodhasheshiyulla kesukalude aavirbhavam thudangi niravadhi gadakangal kaaranam rogam poornnamaayum niyantrikkaanulla prathekshakal naadakeeyamaayi kuranjittundu.
vikasita rajyangalil kshayarogam saadhaaranamallaathathum pradhaanamaayum nagarapradeshangalil kaanapedunnathumaanu. europil, 1850ll 1,00,000ll 500 ayirunna tibi maranangal maranangal 1,00,000ll 50 aayi kuranju. pothujanaarogyathile mechappeduthalukal antibioticukalude varavinu munbuthanne kshayarogam kurachukondirunnu, ennirunnaalum eee rogam pothujanaarogyathinu kaaryamaaya bheeshaniyaayi thudarnnu, 1913ll brittanil medical research kaunsil roopeekarichappol athinte prarambha shradha kshayaroga gaveshanathilaayirunnu.
2010ll lokathinte vividha bhaagangalil 100,000 peril 178 perr, aphrica 332 perr, america 36 perr, kizhakkan medittareniyan 173 perr, europe 63 perr, thekkukizhakkan eshya 278 perr, padinjaaran pasaphik 139 perr ennivaraayirunnu nirakk.
russia.
1965ll 100,000 perkku 61.9 shathamaanamaayirunna russiayude marananirakk 1993ll 100,000 perkku 2.7 shathamaanamaayi kuranju; ennirunnaalum, 2005ll marananirakk 100,000 perkku 24 aayi uyarnnu, uyarnnu athu 100,000 perkku 11 aayi.
chaina.
chaina 1990num idayil chainayude tibi marananirakkil 80 sathamaanam kuravundaayi. kuravundaayi 2004num idayil puthiya kesukalude ennam 17 sathamaanam kuranju.
aphrica.
2007ll, 100,000 perkku 1,200 kesukal ulla eswathini aayirunnu ettavum kooduthal tibi baadhitharulla raajyam. 2017ll, janasamkhyayude oru shathamaanamenna nilayil ettavum kooduthal kesukal kanakkaakkappedunna raajyam lesotho aayirunnu, 100,000 aalukalkk 665 kesukal.
india.
2017 leeii kanakkanusarichu, indiayil ettavum kooduthal kesukal report cheyyappettathu, athaayath 2,740,000 kesukal. lokaarogya samghadanayude (huu) kanakkanusarichu, 2015ll 480,000 perr kshayarogam baadhichu marichathode indiayile marananirakk prathivarsham 100,000 janasamkhyayil 55ll ninnu 36 aayi kuranju. indiayil kshayaroga rogikalil valiyoru vibhaagam swakaarya pankaalikalum swakaarya aashupathrikalum chikilsikkunnu. indiayile swakaarya klinikkukalum aashupathrikalum kandethukayum rekhappeduthukayum cheiyunna kesukalude ennathe kshayaroga deseeya sarway prathinidheekarikkunnille thelivukal soochippikkunnu.
vadakke america.
amerikkayil thaddesheeya amerikkakkaarkk tibi moolamulla marananirakk anjirattiyaanu, report cheyyappetta tibi kesukalil 84 sathamaanavum vamseeya, vamseeya nyoonapakshangalaanu.
2017ll amerikkayil mothatthilulla kshayaroga nirakk 100,000 peril 3 aayirunnu. kaanadayil, chila graamapradesangalil ippozhum kshayarogam thaddesheeyamaanu.
padinjaaran europe.
2017ll, yunaittad kingdatthil, deseeya sharashari 100,000-ll 9 aayirunnu, padinjaaran europile ettavum uyarnna rogavyaapana nirakk portugalil 100,000-ll 20 aayirunnu.
charithram.
purathana kaalam muthal kshayarogam nilavilundu. ettavum pazhakkam chennath vyakthathayillathe kandethiya "m. ekadesham 17,000 varshangalkk munbulla yomingile kaattukutthiyude avashishtangalil kshayarogam undennathinu thelivukal nalkunnu. ennirunnaalum, kshayarogam uthbhavichath kannukaalikalil ninnaano atho pinneedu manushyarilekku kaimaattam cheyyappettathaano atho kannukaalikalum manushyarilum kshayarogam oru pothu poorvvikanil ninnu verpirinjathaano ennathu vyakthamalla. m" nte jeenukalude thaarathamyam. manushyaril kshayaroga sankeernnatha (emm. tii. bii. sii) mrugangalil emm. tii. bii. sii. mrugangale valarthumbol mrugangalil ninnu manushyarkk emm. tii. bii. sii labhichillennu gaveshakar munbu vishwasichirunnu. kshayaroga bacteriayude rund vakabhedangalum oru pothu poorvvikane pankidunnu, ithu puthiya shilayuga viplavathinu munbuthanne manushyare baadhichekkaam. chila charitraatheethakaala manushyarkk (bisi 4000) tibi undayirunnathaayi asthikooda avashishtangal kaanikkunnu, bisi 3000 muthal 2400 vareyulla eejipshyan mammikalude nattellukalil kshayarogam undayathaayi gaveshakar kandethi. janithaka padanangal soochippikkunnathu ekadesham eiii. dii 100 muthal amerikkayil tibi saannidhyam undaayirunnu ennaanu.
vyaavasaayika viplavathinu munbu, naadodikkadhakal palappozhum kshayarogathe vaambayarukalumaayi bandhappettirunnu. oru kudumbatthile oru amgam rogam baadhichu marikkumbol, rogabadhitharaaya mattu amgangalkku pathukke aarogyam nashtappedum. tii. bii. ulla yadhaartha vyakthi mattu kudumbamgangalil ninnu jeevan vattikkunnath moolamaanu ithu sambhavichathenn aalukal vishwasichu.
richard morttan 1689-ll kshayarogavumaayi bandhapetta pulmonary roopam oru paatholajiyaayi sthaapichenkilum, athinte lakshanangalude vaividhyam kaaranam, 1820 vare tibi orotta rogamaayi thiricharinjirunnilla. parasparam aduthu thamasikkunna aalukal pakaruna sookshumaanukkal moolamaanu upabhogam undaakunnathenn 1720-ll benchamin marten anumaanichu. 1819-ll, shwaasakosha kshayarogathinu kaaranam kshayarogangalaanennu rene lenneck avakashappettu. jeey. ell. 1832-ll skonleen aadyamaayi "kshayarogam" (jarmman "tuberculose") enna peru prasidheekarichu. 1838 num 1845 num idayil, 1839 muthal kentakkiyile mamath guhayude udamayaaya joonn crogan, guhayile vaayuvinte sthiramaaya thapanilayum shudhathayum upayogichu rogam bhedamakkamenna pratheekshayil shayarogamulla niravadhi aalukale guhayilekk konduvannu; oororutharum oru varshathinullil marichu. herman brehmer 1859-ll saileshyayile gorbezhsdorfil (ippol sokolovsko) aadyathe tibi saanitoriyam thurannu. 1865-ll jeane aantoyin villemin manushyaril ninnu mrugangalilekkum mrugangalkkidayilum kuthivayppiloode kshayarogam pakaraan kazhiyumennu theliyichu. theliyichu (1867lum joonn burden-saandezhsan villeminte kandethalukal sthireekarichu.)
roobert coach kshayarogathinu kaaranamakunna baasilasine thirichariyukayum vivarikkukayum cheythu. 1882 march march kshayarogam enna eee kandethalinu 1905ll addehathinu shareerashaasthrathino vaidyashaasthrathino ulla nobal sammanam labhichu. kannukaalikalum manushyarile kshayarogangalum samaanamaanenn coach vishwasichilla, ithu rogabadhithamaaya paaline anubaadhayude uravidamaayi thirichariyunnathu vaikippichu. 1900-kalude aadya pakuthiyil, paashcharaiseshan prakriya prayogichathinushesham eee srothassil ninnulla pakarchavyaadhiyude apakadasaadhyatha naadakeeyamaayi kuranju. 1890-ll kshayarogathinulla oru "prathividhi" aayi tuberkle basilliyude oru glycerine sathinte sathil coach athine "tuberculin" ennu vilichu. ithu phalapradamallengilum, rogalakshanangalkk munbulla kshayarogathinte saannidhyathinulla oru screening testaayi ithu pinneedu vijayakaramaayi sweekarichu. ellah varshavum march 24 nuu kochinte yadhaartha shaasthreeya prakhyaapanatthinte vaarshikamaanu loka kshayaroga dinam.
1906ll albert kaalmettum kaamili guerinum kshayathinethiraaya prathirodha kuthivayppil aadyathe yadhaartha vijayam kaivarichu, attenuated bovin-strain kshayarogam upayogichu. baasille kaalmett-guerine (bisiji) ennaanu ithine vilichirunnathu. 1921ll fraansilaanu bisiji vaxine aadyamaayi manushyaril upayogichathenkilum randaam lokamahaayudhathinushesham maathramaan amerikkayilum grettu brittanilum germmaniyilum ithu vyapakamaaya sveekaaryatha nediyathu.
nagaratthile paavappettavarkkidayil eee rogam saadhaaranamaayitheernathinaal 19-aamm noottaandilum 20-aamm noottaandinte thudakkathilum kshayarogam vyapakamaaya pothujana aashanka srishtichu. 1815ll englandile naalil onnu maranangalum upabhogam moolamaayirunnu. 1918 aayappozhekkum fraansil aarilonn maranangalkkum tibi kaaranamaayi. tii. bii. pakarchavyaadhiyaanennu nirnnayichathinushesham, 1880-kalil, ithu brittanil ariyikkavunna rogangalude pattikayil ulppeduthi; pothusthalangalil thuppunnath thadayaan prachaaranangal aarambhichu, rogabadhitharaaya pavappettavare jayilukalkk samanamaaya saanittoriyayilekk praveshikkaan "prothsaahippichu" (madhyavargathinum uyarnnavargakkaarkkumulla saanitoriya mikacha paricharanavum nirantharamaaya vaidyasahaayavum nalki). shudhavaayu" yum saanittoriyayile thozhilum enthutharam gunangal nalkiyaalum, ettavum mikacha saahacharyangalil polum, praveshichavaril 50 sathamaanavum anchu varshathinullil (1916) marichu. 1913ll brittanil medical research kaunsil roopeekarichappol athu thudakkathil kshayaroga gaveshanathil shradha kendreekarichu.
europil, kshayarogathinte nirakk 1600-kalude thudakkathil 1800-kalil ettavum uyarnna nilayilekku uyaran thudangi, athu motham maranangalil 25 shathamaanatholam kaaranamaayi. 18-aamm noottaandilum 19-aamm noottaandilum europil kshayarogam oru seasonal paatten kaanikkunna pakarchavyaadhiyaayi maari. maari europile marananirakk 90 sathamaanam kuranju. shuchithvam, prathirodha kuthivayppu, mattu pothujanaarogya nadapadikal ennivayile mechappeduthalukal streptomycin, mattu antibioticukal ennivayude varavinu munbuthanne kshayarogathinte nirakk ganyamaayi kuraykkaan thudangi, ennirunnaalum rogam oru pradhana bheeshaniyaayi thudarnnu. 1946ll antibiotic streptomycin vikasippichathode tbic phalapradamaaya chikitsa chikitsa yaadhaarthyamaayi. eee marunnu avatharippikkunnathin munbu, rogabadhithamaaya shwaasakoshathe "vishramikkaan" thakarkkukayum kshayarogam bhedamaakkaan anuvadikkukayum cheiyunna "pneumothorax technic" ulppedeyulla shasthrakriyaathmaka edapedal mathramaayirunnu eaka chikitsa.
multidrug-resistant tuberculosis (mdr-tibi) uyarnnuvannathinaal, tibi anubaadhayude chila kesukalkku sasthrakriya veendum avatharippichu. bakteeriyakalude ennam kuraykkunnathinum sheshikkunna bakteeriyakal rakthapravaahathile antibioticukalilekka exposure cheiyunnathinum shwaasakoshathile rogabadhithamaaya nench arakal ("bullah") neekkam cheiyunnathu ithil ulppedunnu. ulppedunnu mayakkumarunnu prathirodhasheshiyulla vakabhedangalude vardhanayode tibi illaathaakkaanulla prathekshakal avasaanichu. kshayarogathinte thudarnnulla punarujjeevanatthinte falamaayi 1993ll lokaarogya samghadana (aarr) aagola aarogya adiyantharaavastha prakhyaapichu.
samoohavum samskaaravum.
perukal.
saankethikam muthal parichitham vare niravadhi perukalil kshayarogam ariyappedunnu. () ennathu upabhogathinulla oru greak padamaanu, pulmonary tuberculosis enna pazhaya padam; bisi 460 oode, hippocratus fthisisine varanda kaalaavasthayile rogamaayi visheshippichu. tibi" enna churukkezhuthu "tuberkle basilus" ennathinte churukkamaanu. "pathonpathaam noottaandil eee rogathe soochippikkunna ettavum saadhaaranamaaya engleesh padamaayirunnu "upabhogam", irupathaam noottaand vare ithu nannayi upayogichirunnu. poornnamaayum' ennartham varunna laattin root 'thaazhe ninnu edukkuka' ennarthavumaayi bandhappettirikkunnu. joonn bunyan ezhuthiya "misttar baadmaante jeevithavum maranavum" enna pusthakatthil, rachayithaav upabhogathe "eee maranapurushanmaarude kyapttan" ennu vilikkunnu."grettu vaitt playg" enna wack upayogichittundu.
kalayum saahityavum.
noottaandukalaayi rogabaadhitharaayavaril kavyathmakavum kalaparavumaaya gunangalumayi bandhappettirunna kshayarogam "romaantik rogam" ennum ariyappettirunnu. kavikalaaya joonn keats, persey baishe shelle, edger alaan poow, samgeethasamvidhaayakan frederic choppin, naadakakrithaaya aantan chekov, novalistukalaaya france kaafka, catherine mansfield, charlot bronde, feoder dastayevsky, thomas maan, dablyu. somerset mougaam, jorjju oorvel, roobert luis steevansan, kalakaaranmaaraaya alis neel, jeane-aantoyin vaattyoo, elisabath siddal, maari bashkirtseff, edward manchu, abri bardsley, amedio modigliani ennivarkku onnukil rogam undaayirunnu allengil angane cheytha aalukalaal chuttappettavaraayirunnu. kalaparamaaya kazhivukale kshayarogam sahaayichuvenn vyapakamaaya vishwaasam undaayirunnu. eee phalathinaayi nirddeshikkappetta shaareerika samvidaanangalil athu undaakkunna neriya paniyum toximia ulppedunnu, ithu jeevithathe kooduthal vyakthamaayi kaananum nirnnaayakamaayi pravartthikkaanum avare sahaayichuvenn aaropikkappedunnu.
thomas maaninte "maanthrikaparvvatham" enna gaanathil oru aarogyakendrathil sajjeekarichirikkunnathu, vaan morisante "tii" enna gaanatthilennapole samgeethathilum saahithyathil palappozhum veendum upayogikkappedunna oru prameyamaayirunnu kshayarogam.bii. sheettukal; oopparayil, pukkiniyude laa bohemilum verdiyude laa traviatayilum ullathupole; kalayil, monattinte aadya bhaarya kaamilinte maranasayyayil varacha paintingilum; 1945 leeii 'dhii bells oof sent' polulla sinimakalilum. shayarogamulla oru kanyaasthreeyaayi ingrid bergman abhinayicha merris.
pothujanaarogya sramangal.
2014ll, 2014ll tibi kesukal 80 sathamaanavum tibi maranangal 90 sathamaanavum kuraykkaan lakshyamitulla "end tibi" thanthram sweekarichavar. ennirunnaalum tibi kesukal 20 sathamaanavum tibi maranangal 35 sathamaanavum kuraykkunnathinulla oru naazhikakkall eee thanthrathil ulppedunnu. ennirunnaalum, ennirunnaalum aagolathalathil oro janasamkhyayilum 9 sathamaanam kuravu maathramaan kaivarichathu, europian mekhala 19 sathamaanavum aafrikkan mekhala 16 sathamaanavum kuranju. athupole, maranasamkhya 14 sathamaanam maathram kuranju, 2020 leeii 35 sathamaanam kuravinte naazhikakkall nashtappettu, chila pradeshangal mikacha purogathi kaivarichu (europil 31 sathamaanavum aafrikkayil 19 sathamaanavum). athinanusarichu, 2020-ll chikitsa, prathirodham, dhanasahayam enniva nashtappettu, udaaharanathinu, 3 kodi enna lakshyathekkaal kurravulla 63 laksham aalukal maathramaan tii. bii. prathirodhatthil aarambhichath.
lokaarogya samghadana (aarr), bill aandu melinda gates foundeshan, yuu.ezz. 2012 leeii kanakkanusarichu thaazhnna, idatharam varumaanamulla rajyangalil upayogikkunnathinaayi sarkkar athivegam pravartthikkunna diagnostic kshayaroga parishodhanaykk subsidy nalkunnu. athivegam pravarthikkunnathinu purame, antibiotic refampicin prathirodhamundo ennu nirnnayikkaan eee parishodhanaykk kazhiyum, ithu multy-drugg resistant kshayarogathe soochippikkukayum echuaivi baadhichavaril krithyatha pulartthukayum cheyyum. vibhavangal illaatha pala sthalangalilum spoottam microscopy maathrame labhyamaakoo.
2010ll swakaarya, pothujanaarogya mekhalayile mosham roganirvahanam kaaranam lokamembaadumulla ettavum kooduthal tibi kesukal indiayilaayirunnu. pothujanaarogya pariraksha labhikkuna aalukalkkidayil kshayarogathinte alavu kuraykkunnathinu puthukkiya deseeya kshayaroga niyanthrana paripadi polulla paripaadikal pravartthikkunnu.
pravartthikkunnu oru iii. aii. yuu-health cair report kaanikkunnath nissamgatha pariharikkendathinte aavasyavum vardhicha dhanasahaayathinulla abhyarthanakalumaanu. lucica dittui [tii. bii] oru anaadhayeppoleyaanennu report udharikkunnu. uyarnna bharamullah rajyangalil polum ithu avaganikkappedukayum palappozhum daathaakkalum aarogya edapedalukalil nikshepikkunnavarum ithu marakkukayum cheiyunnu."
mandagathiyilulla purogathi niraashayilekku nayichu, aids, kshayarogam, malaria ennivaykkethire pooraadunnathinulla aagola fundinte executive director prakadippichu-maarkk daibul "tb oru pakarchavyaadhiyaayum pothujanaarogya bheeshaniyaayum avasaanippikkanulla upakaranangal njangalude pakkalund, pakshe njangal athu cheiyunnilla."niravadhi anthaaraashtra samghadanakal chikilsayil kooduthal suthaaryathaykkaayi shramikkunnu, koodaathe 2014 leeii kanakkanusarichu kooduthal rajyangal kesukal sarkkaarin nirbandhithamaayi report cheiyunnathu nadappaakkunnu, ennirunnaalum ithu paalikkunnath palappozhum vyathyaasappettirikkunnu. vaanijya chikitsa daathaakkal chilappol randaam nira marunnukalum anubandha chikitsa amithamaayi nirddeshikkukayum kooduthal niyanthranangalkkulla aavasyangal prolsaahippikkukayum cheythekkaam. brazeel sarkkar saarvathrika tibi paricharanam nalkunnu, ithu eee prashnam kuraykkunnu. neremarichu, tibi anubaadhayude nirakk kurayunnathu anubadha nirakk kuraykkunnathinulla paripaadikalude ennavumaayi bandhappettirikkilla, pakshe janasamkhyayude vardhicha vidyaabhyaasa nilavaaram, varumanam, aarogyam ennivayumaayi bandhappettirikkam. 2009ll locabank kanakkukoottiyathanusarichu, uyarnna bharamullah rajyangalil rogathinte chelavu prathivarsham 150 bilyan dollar kaviyunnu. chainayile 250 dasalaksham grameena kudiyettakkaaril rogiyude fooloo-appinte abhavam rogathe unmoolanam cheiyunna purogathiyude abhavam kaaranamaayirikkam.
kshayarogam kandethanulla nirakk mechappeduthaan sajeevamaaya kondaakt tracing sahaayikkunnuvenn kaanikkan mathiyaya dattayilla. veeduthorumulla sandarshanangal, vidyaabhyaasa laghulekhakal, bahujana maadyama thanthrangal, vidyaabhyaasa sessionukal thudangiya edapedalukal hraswakaalathekku kshayarogam kandethanulla nirakk vardhippikkum. soshyal network vishakalanam polulla kondaakt tracinginte puthiya reethikale nilavilulla kondaakt tracing reethikalumaayi thaarathamyam cheiyunna oru padanavumilla.
kalankam.
rogam thadayunnathile mandagathiyilulla purogathi bhaagikamaayi tibi-yumayi bandhapetta kalankam moolamaakaam. badhita vyakthikalil ninnu pakarumenna bhayam moolamaanu kalankam undaakunnath. tb daaridryavum thammilulla bandhavum aafrikkayil aids kaaranam eee kalankam uyarnnuvannekkaam. atharam kalankam yadhaarthavum bodhapoorvavumaayirikkaam; udaaharanathinu, ghaanayil, tii. bii ulla vyakthikale pothusammelanagalil pankedukkunnathil ninnu vilakkiyittundu.
tibi-ykkethiraaya kalankam chikitsa thedunnathil kaalathamasam varuthaanum kuranja chikitsa palikkalinum kudumbamgangal maranakaaranam rahasyamaayi sookshikkaanum kaaranamaayekkam-ithu rogam kooduthal padaraan anuvadikkunnu. ithinu vipareethamaayi, russiayil vardhichuvarunna chikitsa paalikkalumaayi kalankam bandhappettirikkunnu. tii. bii. kalankam saamoohikamaayi paarshwalkkarikkappetta vyakthikaleyum kooduthal baadikkukayum pradeshangalkkanusarichu vyathyaasappedukayum cheiyunnu.
tii. bii. klabbukalude" prachaaranatthiloodeyo rogabaadhitharkk anubavangal pankidaanum pinthuna nalkaanum allengil kaunsiling vazhiyo aakam kalankam kuraykkunnathinulla oru maargam. chila padanangal kaanikkunnath tii. bii vidyaabhyaasa paripaadikal kalankam kuraykkunnathinu phalapradamaanennum athinaal chikilsayude anusaranm vardhippikkunnathinu falapradamaakumennum. ennirunnaalum, kuranja kalankavum marananirakkum thammilulla bandhathekkurichulla padanangal kuravaanu, koodaathe sahaayangalkk chuttumulla kalankam kuraykkunnathinulla samanamaaya sramangal valare kuranja falapradamaanu. chilar eee kalankam rogathekkaal moshamaanenn avakaashappedunnu, aarogya parirakshaa daathaakkal manappoorvvam kalankam shakthippeduthiyekkaam, kaaranam tibi ullavar palappozhum budhimuttullavaro allengil abhikaamyamallaathavaro aayi kanakkaakkappedunnu. kshayarogathinte saamoohikavum saamskaarikavumaaya maanangalekkurichu kooduthal manassilaakkunnath kalankam kuraykkunnathinu sahaayichekkam.
gaveshanam.
bisiji vaaksinukalkk parimithikalundu, puthiya tibi waxinukal vikasippikkunnathinulla gaveshanam nadakkunnu. saadhyathayulla niravadhi udyogaarthikal nilavil onnaam ghattathilum randaam ghattathilumaanu. labhyamaya vaaksinukalude falaprapti mechappeduthaan rund pradhana sameepanagal upayogikkunnu. oru sameepanathil bcjiyil oru subunit vaxine cherkkunnath ulppedunnu, athesamayam mattoru thanthram puthiyathum mikachathumaaya sajeeva waxinukal srishtikkaan shramikkunnu. 2006 leeii kanakkanusarichu dakshinaafrikkayil pareekshanatthilirikkunna oru subunit vaaksinukalude udaaharanamaaya udaaharanamaaya, janithakamattam varuthiya vaxinia vairasine adisthaanamaakkiyullathaanu. olinjirikkunna, sajeevamaaya rogangalude chikilsayil waxinukal oru pradhana punk vahikkumennu prathekshikkunnu.
kooduthal kandethalukal prolsaahippikkunnathi, puraskaarangal, nikuthi aanukoolyangal, munkoor vipani prathibaddhathakal ennivayulppede 2006 leeii vaxine vikasanathinte puthiya saambathika modalukal gaveshakarum nayaroopeekaranakkaarum prothsaahippikkunnu. stopp tibi pankaalittham, dakshinaafrikkan kshayaroga vaxine samrambham, earaas global tibi vaxine foundeshan ennivayulppede niravadhi grouppukal gaveshanathil earppettirikkunnu. ivayil, uyarnna bharamullah rajyangalil kshayarogathinethire mechappetta vaxine vikasippikkunnathinum licenses nalkunnathinumaayi beal aandu melinda gates foundeshanil ninnu airus global tibi vaxine foundeshanu 280 dasalaksham dollariladhikam (us) sammaanamaayi labhichu.
bedakvilin, delamanid ennivayulppede multidrug-resistant kshayarogathinaayi 2012 vare niravadhi marunnukal padichuvarikayaanu. bedakviline yuu sweekarichu.ezz. 2012 avasaanathode phudu aandu drugg administration (eph. dii. eiii) amgeekaaram. thaarathamyena cheria padanangalude phalangale adisthaanamaakkiyullathinaal eee puthiya ejantumaarude surakshyum falapraptiyum 2012 vare anishchithathvathilaanu. ennirunnaalum, staanderd tibi therapic purame bedakvilin edukkunna rogikal puthiya marunnine apekshichu marikkanulla saadhyatha anjirattiyaanennu nilavilulla daatta soochippikkunnu, ithu medical jenal lekhanangalil fda enthukondaanu marunnu amgeekarichathennathinekkurum bedakvilin nirmmikkunna kambaniyumaayulla saambathika bandhangal athinte upayogathinu doctormaarude pinthunaye swaadheenichittundo ennathinekkurichum aarogya naya chodyangal uyarthaan kaaranamaayi.
sajeevamaaya pulmonary tuberculosis anubaadhaykk stiroyidukal aadu-oonn therapy oru gunavum kaanichittilla.
mattu mrugangal.
pakshikal, malsyangal, elikal, uragangal ennivayulppede niravadhi mrugangale micobacteria badhikkunnu. micobacterium tuberculosis" enna upajaathikal vanyamrugangalil apoorvvamaayi maathrame kaanappedunnulloo. nyoosilandile kannukaalikaludeyum maanukaludeyum koottangalil ninnu "micobacterium bovis" moolamundaakunna bowine kshayarogam unmoolanam cheyyaanulla sramam thaarathamyena vijayichu. grettu brittanile sramangal vijayichilla.
amerikkayil bandikalaaya aanakalkkidayil kshayarogam vyaapakamaanennu thonnunnu. mrugangalkku yadhaarthathil manushyaril ninnaan rogam labhichathennu vishwasikkappedunnu, ithu reverse sunosis ennu vilikkunna oru prakriyayaan. manushyareyum mattu mrugangaleyum badhikkaan eee rogam vaayuviloode padarunnathinaal, ithu sarkkasukaleyum mrgashaalakaleyum badhikkunna pothujanaarogya aashankayaan.

