Ubururu bwa metilene ku ndwara ya Lyme: ibyavuye muri laboratwari n'ibimenyetso byo mu bushakashatsi ku barwayi

Isahani yororerwamo bagiteri si umurwayi. Iryo tandukaniro risobanura hafi buri cyose kivugwa ku bururu bwa metilene n'indwara ya Lyme.

Tekereza abasomyi babiri babonye interuro imwe: abashakashatsi “baranduye burundu” bagiteri zitera Lyme bakoresheje imiti ivanze. Umusomyi umwe yumva ko nta bagiteri zongeye kugaragara mu isahani y'ikirahure mu gihe cy'ibyumweru bibiri. Undi yumva ko abarwayi bari bafite umunaniro bakize. Ibyo byombi bisa n'ibyumvikana. Icya mbere gusa ni cyo gihuye n'icyapimwe mu igerageza ryo muri laboratwari.

Iyi nyandiko itandukanya ibyo bitekerezo byombi. Isuzuma icyo ubururu bwa metilene bwakoreye Borrelia burgdorferi zororerwa muri laboratwari, ibyabaye igihe bwakoreshwaga mu buvuzi bw'abarwayi bugizwe n'imiti myinshi, n'impamvu nta na kimwe muri ibyo gisubiza ikibazo cy'igihe umuntu yakoresha ubururu bwa metilene ku ndwara ya Lyme.

Lyme iterwa na bagiteri, bityo ibimenyetso ku dukoko tw'ibinyabuzima tudutungwa ntibihita biyireba

Indwara ya Lyme iterwa na Borrelia burgdorferi, bagiteri ifite ishusho yizingiye izenguruka kandi ikwirakwizwa n'uburondwe. Ubuvuzi busanzwe bukoresha imiti yica bagiteri nka doxycycline, amoxicillin, cyangwa cefuroxime, nk'uko bisobanurwa mu mabwiriza yo mu 2020 ku ndwara ya Lyme ya IDSA, AAN, na ACR.

Kuba iterwa na bagiteri ni ingenzi kuko ubururu bwa metilene bufite amateka atandukanye mu kurwanya udukoko tw'ibinyabuzima tudutungwa. Bwakorewe ubushakashatsi ku dukoko dutera malariya, kandi rimwe na rimwe buvugwa ku bijyanye na Babesia, agakoko gatungwa n'ikinyabuzima kanduzwa n'uburondwe kandi gashobora kubana na Lyme. Igisubizo kiboneka ku gakoko gatungwa n'ikinyabuzima nticyemeza ko uburyo bumwe bukora kuri Borrelia. Ibyo binyabuzima bitandukanye mu miterere, mu buryo bihindura ibinyabutabire, mu bice byabyo imiti yibasira, no mu gice cy'umubiri byanduza. Incamake yacu y'uburyo ubururu bwa metilene bukora mu tugingo isobanura icyo gitekerezo muri rusange: ibikorwa byo guhererekanya electron biragutse, ariko igisubizo cy'ibinyabuzima giterwa n'ikinyabuzima ubwacyo n'imiterere gikorerwamo.

Bityo, tandukanya ibibazo bibiri. Icya mbere, ubururu bwa metilene bukorera iki Borrelia mu bworozi bwo muri laboratwari bugenzurwa? Icya kabiri, bigenda bite ku bantu bafite indwara ya Lyme? Ibice bisigaye by'iyi nyandiko bikurikiza urwo rutonde.

Bagiteri zikomeza kubaho ziba ziri mu mimerere runaka, si ubwoko bukomeye kurushaho

Imiti yica bagiteri ikunze kwica vuba igice kinini cya Borrelia, igasigaza umubare muto ushobora kuyihanganira. Iyo abashakashatsi bongeye korora izarokotse, izakomotse kuri zo akenshi zongeraga kwicwa n'iyo miti. Ibyo byerekana imimerere y'imikorere y'umubiri ishobora guhinduka, aho kuba ubushobozi bwo kurwanya imiti buhererekanywa mu ruhererekane. Urugero rubigaragaza neza ruboneka mu bushakashatsi bwa Sharma na bagenzi be ku iyicwa rya bagiteri mu byiciro bibiri no ku kongera kwiyongera kw'izikomeza kubaho.

Mu bikorwa, ibyororero bikiri bishya biri mu cyiciro cyo kwiyongera ku muvuduko birimo ahanini bagiteri zizingiye kandi zigenda, kandi byitabira imiti isanzwe ku buryo bworoshye kurushaho. Ibyororero bimaze igihe biri mu cyiciro cyo guhagarika kwiyongera birimo byinshi bifite ishusho y'uruziga n'ibiteranyirijwe mu matsinda mato, kandi bihanganira iyo miti kurushaho. Ayo magambo asobanura imiterere n'uburyo bagiteri zikura mu isahani. Ntabwo ari ikimenyetso cy'uko izo miterere zisobanura ibimenyetso bikomeza kugaragara nyuma yo kuvurwa indwara ya Lyme.

Uburyo bworoshye bwo kubyumva ni ubu. Gukura no kwiyongera bigaragaza ibyo imiti yibasira, nko kubaka urukuta rw'akagingo. Gukura buhoro cyangwa mu buryo bwahindutse bihisha ibyo imiti yibasira. Ikintu gifasha kurwanya imimerere ya kabiri gishobora kutagira akamaro kanini ku ya mbere, kandi n'ibinyuranye na byo bishobora kuba ukuri.

Icyo ubushakashatsi bwo mu 2015 bwo gushakisha imiti ikora bwabonye koko

Inyandiko yifashishwa kenshi kurusha izindi kuri iyi ngingo ni ubushakashatsi bwo mu 2015 bwa Feng na bagenzi be bwagerageje icyegeranyo cy'imiti ya FDA. Bwagerageje ibinyabutabire kuri Borrelia zari zimaze iminsi irindwi mu byororero ziri mu cyiciro cyo guhagarika kwiyongera, bukabikoresha indi minsi irindwi, buri kinyabutabire kigeragezwa ku gipimo cya 50 micromolar.

Ubururu bwa metilene bwagaragaje ibikorwa bihagije byo gutuma bwitabwaho, ariko ntibwagaragaje ko bwica bagiteri zose. Hakoreshejwe mikorosikopi, hafi 40 ku ijana by'utugingo twari tugishobora kubaho nyuma yo gukoresha ubururu bwa metilene, ugereranyije na 93 ku ijana mu byororero byo kugereranya bitahawe umuti, 75 ku ijana nyuma ya doxycycline, 76 ku ijana nyuma ya amoxicillin, 49 ku ijana nyuma ya cefuroxime, na 35 ku ijana nyuma ya daptomycin yakoreshejwe mu kugereranya. Igisubizo cy'igikoresho gisoma amasahani ku bururu bwa metilene nticyashoboye gukoreshwa kuko ibara ryabwo rikomeye ryabangamiraga ipimwa rikoresha urumuri rwa fluorescence. Bityo, umwanzuro washingiye ku kureba utugingo muri mikorosikopi.

Icyo ni ikimenyetso cyo mu bushakashatsi bwo gushakisha ibikora, si ukurandura burundu. Ntibyerekanywe ko ibyororero byahawe ubururu bwa metilene byakomeje kutagira bagiteri nzima igihe byimurirwaga mu bindi byororero bitarimo umuti bikamara igihe kirekire. Abanditsi basabye ko hakurikiraho ubushakashatsi ku miti ivanze no ku nyamaswa, ari na ko gusobanura neza ibisubizo by'igeragezwa ry'icyegeranyo cy'imiti.

Impamvu ibisubizo by'imiti ivanze byumvikana nabi ku buryo bworoshye

Ubundi bushakashatsi bufitanye isano n'ubu bwo mu 2015 akenshi buvangwa na bwo mu kuvuga ikintu kimwe. Mu bushakashatsi bwa Feng, Auwaerter, na Zhang ku miti ivanze irwanya Borrelia ziri mu cyiciro cyo guhagarika kwiyongera, igisubizo gikomeye kurusha ibindi muri laboratwari cyavuye kuri daptomycin ivanze na doxycycline na cefoperazone, buri muti ku gipimo cya 10 micrograms per milliliter mu gihe cy'iminsi irindwi. Nyuma yo gukoresha imiti, yagabanyijwe ubukana ishyirwa mu kinyabutabire gishya gifasha bagiteri gukura, maze ibyororero bikurikiranwa harebwa niba bagiteri zongera kwiyongera.

Iyo miti itatu ivanze ni yo yonyine yakomeje kutagaragaramo ibinyabuzima nyuma y'iminsi 15 yo kongera kubyorora. Urugabano rwavuzwe rw'ibishobora kubonwa na mikorosikopi rwari munsi y'ibinyabuzima 100,000, bityo “kurandura burundu” byasobanuraga ko nta kongera kwiyongera kwabonwaga na mikorosikopi muri ubwo buryo bw'igerageza. Ntibyasobanuraga ko byemejwe ko nta kinyabuzima na kimwe cyasigaye, ko imiti yinjira mu ngirangingo z'inyamaswa, cyangwa ko ikiza umuntu. Inyandiko ubwayo yaburiye abantu kudahita bafata ibyo bisubizo nk'ibireba ubuvuzi.

Amakuru yakurikiyeho ku bururu bwa metilene buvanze n'indi miti yavuye mu rundi rwego rw'ibimenyetso rudakomeye nka rwo. Inyandiko ya Megan Weitner yo mu 2016 y'impamyabumenyi y'icyiciro cya kabiri cya kaminuza muri Johns Hopkins yagerageje ubururu bwa metilene ku gipimo cya 4 micrograms per milliliter, cyatoranyijwe hitawe ku kigero gishobora kugera mu gice cy'amazi y'amaraso, buvanze n'imiti nka cefuroxime, doxycycline, azithromycin, rifabutin, rifaximin, nitrofurantoin, na pyrimethamine. Ibyororero byahawe imiti iminsi irindwi, bisuzumwa hakoreshejwe amabara agaragaza utugingo na mikorosikopi. Imvange zagize igipimo cy'utugingo tugishobora kubaho, cyashyizwe ku rugero rwo kugereranya, kiri munsi ya 0.90 zafatwaga nk'izikora. Urugero, ubururu bwa metilene buvanze na azithromycin bwageze kuri 0.88, icyo gipimo kigabanuka kigera kuri 0.64 hiyongereyemo cefuroxime, mu gihe izindi mvange nyinshi z'imiti itatu zageze hafi kuri 0.69 kugeza kuri 0.82.

Ibyo ni igabanuka ry'ikimenyetso kigaragazwa n'amabara, si ukwica ibinyabuzima byose mu byororero. Iyo nyandiko ntiyerekanye ko ibyororero byahawe ubururu bwa metilene buvanze n'indi miti byamaze igihe kirekire bitagaragaramo bagiteri, ku buryo bwagereranywa n'igisubizo cy'imvange y'imiti itatu irimo daptomycin. Nanone ni inyandiko y'impamyabumenyi, si inyandiko yasohotse mu kinyamakuru cy'ubushakashatsi nyuma yo gusuzumwa n'izindi nzobere. Ishobora gutanga ibitekerezo byo kugerageza. Ntishobora kugira uburemere bungana n'ibimenyetso byo mu bushakashatsi bugenzurwa ku barwayi.

Ni yo mpamvu “amabwiriza yo gukoresha ubururu bwa metilene kuri Lyme” adashobora gukurwa muri izi nyandiko. Gushyira ibinyabuzima mu muti ubikikije ubudahwema iminsi irindwi muri laboratwari ntibigaragaza igipimo cyo guha umuntu, uburyo bwo kuwumuha, igihe yawukoresha, ikigero cyawo mu ngirangingo, cyangwa uburozi bushobora kwemerwa. Nanone ntibigerageza ubururu bwa metilene bwonyine ku bisubizo by'ubuvuzi abarwayi bitaho, nk'ububabare, umunaniro, kubyimba kw'ingingo, ibimenyetso by'imikorere y'imyakura, cyangwa kongera kurwara. Kugira ngo ubashe gutandukanya izi nzego z'ibimenyetso, reba inyandiko yacu iyobora gusoma ibivugwa mu bushakashatsi ku bururu bwa metilene.

Kuva ku masahani kugera ku barwayi: intambwe y'ubushakashatsi ku barwayi ibura

Mu gihe iyi nyandiko yandikwaga, nta gerageza rigabanya abarwayi mu matsinda ku buryo bw'amahirwe cyangwa ubushakashatsi bugenzurwa bukurikirana abarwayi buhereye mu ntangiriro bwari bwarerekanye ko ubururu bwa metilene buvura indwara ya Lyme. Ibihari ku bantu ni raporo zitagenzuwe, aho ubururu bwa metilene bwari kimwe mu bigize ubuvuzi bukoresha imiti myinshi.

Urugero rusobanutse kurusha izindi ni ubushakashatsi busubiza amaso inyuma ku buvuzi bwa dapsone ivanze n'indi miti bwakozwe na Horowitz, Fallon, na bagenzi babo, burimo raporo yo mu 2023 ku barwayi 25 bari barahawe imiti myinshi mbere. Byavuzwe ko umunani muri 25 batongeye kugira ibimenyetso bya Lyme yari ikigaragara nibura mu gihe cy'amezi atatu. Ariko abarwayi bahawe na dapsone, tetracyclines, rifampin cyangwa rifabutin, macrolides, ndetse rimwe na rimwe indi miti. Nta tsinda ryahawe ubururu bwa metilene bwonyine kandi nta tsinda ryo kugereranya ryatoranyijwe ku buryo bw'amahirwe ryari rihari. Raporo nto z'abarwayi zakurikiyeho na zo zifite iyo miterere.

Ubwo buryo bw'ubushakashatsi bushobora gusobanura ibyabaye. Ntibushobora kwemeza ko byatewe n'ubururu bwa metilene. Kumererwa neza bishobora guterwa n'undi muti, imvange y'imiti, uko indwara isanzwe igenda, ingaruka zo kwitega ko ubuvuzi bufasha, gukurikiranwa hafi kurushaho, cyangwa gutoranya abarwayi bari bafite amahirwe yo kumererwa neza. Imbonerahamwe igaragaza neza icyo cyuho.

Bityo, uruhererekane rw'ibimenyetso ni igeragezwa ryo gushakisha ibikora, rukurikirwa n'imvange z'imiti mu nyandiko y'impamyabumenyi, hanyuma raporo zitagenzuwe ku miti myinshi. Urwo ruhererekane ntirukomeye nk'ingaruka z'ubuvuzi zagaragajwe mu igerageza ku barwayi.

Igihe cyo kubukoresha nta gisubizo gishingiye ku bimenyetso gifite

Kuba abantu bashakisha “igihe cyo gukoresha ubururu bwa metilene kuri Lyme” birumvikana. Ibimenyetso bikomeza kubaho bituma umuntu yumva ko agomba kugira icyo akora. Ariko kuvuga igihe cyo gukoresha umuti bishingira ku kuba haramaze kwemezwa igipimo cyawo gikora, kandi nta gerageza ryigeze ryemeza icyo gipimo kuri Lyme.

Ubururu bwa metilene ni umuti ukorera mu mubiri wose kandi ufite imbogamizi nyakuri. Amabwiriza y'umuti wandikwa na muganga muri Amerika ku ndwara ya methemoglobinemia umuntu agira atari iyo avukana asobanura 1 mg per kg itangwa mu mutsi mu gihe cy'iminota 5 kugeza kuri 30. Ibyo bireba indi ndwara, ubundi buryo bwo gutanga umuti, n'indi ntego; ntibishobora guhindurwa igipimo cyo kuvura Lyme. Amabwiriza arimo umuburo ukomeye uri mu gasanduku ku byago bya sindorome ya serotonine iyo ubururu bwa metilene buvanze n'imiti igira ingaruka kuri serotonine, cyane cyane SSRIs, SNRIs, n'imiti ibuza MAO gukora. Anabuza kubukoresha ku bafite ibura rya G6PD kubera ibyago byo kubura amaraso bitewe no gusenyuka kw'utugingo dutukura tw'amaraso. Umuntu wese utekereza kubukoresha akeneye ko umuganga asuzuma imiti afata, uko G6PD ye ihagaze, inda, imikorere y'impyiko, n'imikoranire y'imiti. Incamake yacu y'umutekano n'uburyo bwo kubukoresha isobanura impamvu ubuziranenge no gukurikiranwa na muganga ari ingenzi mbere yo kubukoresha mu buryo bugera mu mubiri wose.

Ku bimenyetso bikomeza kubaho nyuma y'ubuvuzi bwa Lyme busabwa, hatari ibimenyetso bifatika by'uko umuntu yongeye kwandura cyangwa ko ubuvuzi bwananiwe, amabwiriza ya IDSA asaba kudatanga ubundi buvuzi bwica mikorobe. Avuga kandi ko nta bimenyetso byo mu bushakashatsi ku barwayi bishyigikira ubuvuzi bwibasira by'umwihariko utugingo dukomeza kubaho cyangwa utugingo twahinduye imiterere. Ibyo ntibihakana ko utugingo twihanganira imiti tubaho mu masahani ya laboratwari. Bivuga ko isano yo kubihindura ubuvuzi bwemejwe ku barwayi itarubakwa.

Uburyo bufatika bwo gusoma ikindi kintu uzabona kivugwa ni ukwibaza ibibazo bitatu. Igisubizo cyabonetse mu byororero birimo amazi y'intungamubiri, mu nyamaswa, cyangwa ku barwayi? Ubururu bwa metilene bwageragejwe bwonyine cyangwa gusa mu mvange y'imiti myinshi? Igisubizo cyapimwe cyari ukongera kwiyongera mu isahani cyangwa gukira kw'abantu? Niba ibisubizo ari isahani, imvange, no kongera kwiyongera, ubwo ubushakashatsi butanga ibitekerezo byo kugerageza. Ntabwo ari amabwiriza y'ubuvuzi.