Chinyorwa
Methylene blue neBartonella: zvakawanikwa murabhoritari nemiganhu yeuchapupu hwekurapa
Mudziyo wekurera mabhakitiriya nemurwere zvinogoverana shoko rimwe chete, kutapukirwa, asi zvarinoreva hazvina kufanana. Mumudziyo, kutapukirwa kunoreva kuverengwa kwemapoka emabhakitiriya ari paagar. Mumurwere, kunoreva mabhakitiriya ari mukati memasero netsinga dzeropa, mishonga inofamba muropa nematishu, uye masoja emuviri anoitawo rimwe basa. Kana izvi zvikavhiringidzwa, nhamba inoshamisa yemurabhoritari inotanga kuita seinoratidza nzira yekurapa. Kana zvikaramba zvakaparadzaniswa, nhamba iyoyo inoramba iri zvayakaita chaizvo: chikonzero chekuita chiedzo chinotevera.
Kuparadzanisa izvi ndiro basa rose reongororo ino yemethylene blue neBartonella. Tsvakurudzo mbiri dzemurabhoritari dzeboka rimwe chete revatsvakurudzi dzakaedza methylene blue paBartonella henselae iri mumamiriro ekusakura. Dzose dzakashuma kushanda kwayo kwakasimba mumidziyo yegirazi neyepurasitiki. Hapana yakaiedza pamunhu.
Nei vatsvakurudzi vachiedza chikamu chekurega kukura
Kuedzwa kwemishonga inorwisa mabhakitiriya kunonyanya kushandisa masero ari kukura. Muenzaniso iwoyo unosiya mamiriro akaoma zvikuru: masero akamira kupatsanuka uye anokwanisa kutsungirira mishonga inouraya mamwe awo ari kukura.
Bartonella inogona kuramba iri mumuviri, kusanganisira mukati memasero matsvuku eropa nemasero anomonerera mukati metsinga dzeropa. Saka boka iri rakabvunza kuti ndeipi mishonga yakatenderwa inogona kuuraya B. henselae kana yapinda muchikamu chekurega kukura. MIC yakaderera pamasero ari kukura haina kufanotaura kuurayiwa kwemasero asingachakuri. Rifampin yaiva neMIC yakaderera zvikuru asi yaisanyanya kuuraya masero asingachakuri, nepo zvimwe zvinhu zvaiva neMIC yakakwirira zvaiauraya zvakanaka. Vaverengi vanoda nzira yakajairika yekuverenga bepa rakadai vanogona kuiwana mugwara rekuverenga tsvakurudzo yemethylene blue.
Kuongorora kwekutanga: Li nevamwe, 2019
Kuongorora kwe2019 kwechikamu chekurega kukura kwakabudiswa muAntibiotics kwakashandisa rudzi rumwe chete, B. henselae JK53, rwakarerwa mumushonga wekurera weSchneider une 10 percent yeseramu yeropa remhuru isati yaberekwa, pa37 C ine 5 percent CO2. Mabhakitiriya akarerwa kwezuva rimwe ainyanya kuva masero akapararira ari kupatsanuka. Akarerwa kwemazuva mashanu, aine zvikamu zvinoumba mapoka emabhakitiriya zvinosvika 10 kusimba re8 pa mL, akatorwa seari muchikamu chekurega kukura uye aiva nezvisumbu zvaionekwa.
Muyedzo wekuyera wakashandisa SYBR Green I pamwe nepropidium iodide, uchienzaniswa nemisanganiswa yemasero mapenyu neakaurayiwa neisopropanol. Sezvo methylene blue iine ruvara rwakasimba, zvinhu zvakaratidza kushanda zvakasimbiswa nemakorosikopu, zvichizoteverwa nekuverengwa kwemapoka emabhakitiriya paagar ine ropa, iyo yaiva nzira yakasimba zvikuru yekuyera mhedzisiro.
Pamishonga yakatenderwa 1,581 yakaedzwa pa50 micromolar, methylene blue yakasiya 16 percent yemasero ari mapenyu maererano nemuchina wekuverenga mahwendefa uye 25 percent maererano nemakorosikopu. Daptomycin yakasvika pa21 percent, maazole akati wandei akasvika pa22 kusvika 27 percent, gentamicin pa32 percent, erythromycin pa66 percent, uye ciprofloxacin pa74 percent. Pyrvinium pamoate yairatidzika kushanda zvakanyanya pamuchina wekuverenga asi yaisagona kuyerwa nemakorosikopu nekuda kwechiedza chainoburitsa pachayo.
PaB. henselae iri kukura, MIC yemethylene blue yaiva 0.08 kusvika 0.16 micrograms per mL. Pamasero akanga asingachakuri ererwa kwemazuva mashanu, pakashandiswa 5 micrograms per mL, kuverengwa kwemapoka emabhakitiriya kwakadzikira kusvika pakushaya mapoka aikwanisa kuonekwa mushure mezuva rimwe rekusangana nayo, zvichifanana nedaptomycin nepyrvinium pamoate pahuwandu hwazvo hwakaedzwa. Mumwe muyedzo wakasiyana wekuyera kuurayiwa nekufamba kwenguva wakashandisa 10 micrograms per mL. Uhwu huwandu hwakaiswa pamasero murabhoritari, kwete hwemushonga hunopiwa munhu, uye bepa rinohutsanangura saizvozvo. Huwandu hwakanyanya hwemethylene blue muplasma yevanhu hunosvika 3.9 micrograms per mL, hwakataurwa kubva kune imwe tsvakurudzo, hunongowanikwa mubepa seruzivo rwekumashure. Ongororo yemafambiro emethylene blue mumuviri inotsanangura nei nhamba yemuplasma isingagoni kutorwa senhamba yemumatishu.
Miganhu miviri yakataurwa pachena mubepa. Pakanga pasina muenzaniso webiofilm uye hapana kuedzwa kwemisanganiswa ine methylene blue. Zvisumbu zvemazuva mashanu zvaiva mapoka emabhakitiriya asingachakuri mumushonga wekurera, kwete chiedzo chebiofilm chakasimbiswa. Vanyori vakakurudzira tsvakurudzo pamhuka, yemisanganiswa, yebiofilm, uye kuedzwa kune mamwe marudzi eBartonella.
Misanganiswa nemasero anobva mubiofilm: Zheng nevamwe, 2020
Tsvakurudzo yekutevera ye2020 muBMC Microbiology yakachengeta rudzi rumwe chete nemushonga mumwe chete wekurera asi yakashandisa mabhakitiriya ererwa kwemazuva matanhatu asisakuri, ikawedzera zvinhu zviviri zvakanga zvisipo mubepa rekutanga: misanganiswa yemishonga miviri nemuenzaniso wemasero anobva mubiofilm.
Pamishonga imwe neimwe yakashandiswa yakaenzana pa5 micrograms per mL kwemaawa 24, methylene blue yakasiya zvikamu zvinoumba mapoka emabhakitiriya zvinokwana 3.2 kakapetwa ne10 kusimba re4 pa mL, zvichienzaniswa neboka risina kurapwa raiva pedyo ne2.8 kakapetwa ne10 kusimba re10. Ciprofloxacin, gentamicin, nenitrofurantoin zvakasiya mapoka mashoma panguva imwe chete iyoyo. Izvi zvakasiyana nemhedzisiro ye2019, umo huwandu hwakafanana hwakanga hwatarwa hwakaita kuti pasawanikwa mapoka aikwanisa kuonekwa mushure mezuva rimwe. Nguva yekurerwa kwemabhakitiriya, kuwanda kwawo, uye mabatirwo awo zvaiva zvakasiyana, saka kuurayiwa kwakaonekwa zvakare asi mwero wako hauna kufanana chaizvo. Shanduko iyi pakati pemiedzo chimwe chezvikonzero nei kuongororwa kwakajairika kwekuchengeteka nekudyidzana kwemishonga kuchitora simba remurabhoritari sechinhu chakasiyana nezvinoitika pakurapa munhu.
Kuongororwa kwemisanganiswa ndicho chikamu chinonyanya kutaurwa. Chinhu chimwe nechimwe mumusanganiswa chakaiswa pa5 micrograms per mL. Azithromycin pamwe nemethylene blue, uye rifampin pamwe nemethylene blue, zvose zvakaita kuti pasawanikwa mapoka aikwanisa kuonekwa emabhakitiriya asingachakuri pamaawa 24. Misanganiswa miviri ine ciprofloxacin yakaitawo saizvozvo, uye misanganiswa mina iyoyo chete ndiyo yakadaro pakati pemisanganiswa 25 yakaedzwa. Hapana ongororo yakarongeka yekuti mishonga inosimbisana kupfuura zvainogona kuita yakazvimirira yakaitwa, saka mashoko akarurama ndeekuti musanganiswa unoshanda mumamiriro aya, kwete kuti kusimbisana kwemishonga kwakaratidzwa.
Chiedzo chebiofilm chakaedza masero akatorwa mubiofilm diki yakanga yaputswa, kwete kupinda kwemushonga mubiofilm yakura uye isina kuputswa. Mabhakitiriya akarerwa kwemazuva mashanu, akazoderedzwa kuwanda kwawo akaiswa mumahwendefa ane tumatsime kwemamwe mazuva mashanu, akasimbiswa nekudhayiwa necrystal violet, achibva akwenywa asati asangana nemishonga. Pa5 micrograms per mL, methylene blue yoga yakaderedza nhamba kusvika pa2.3 kakapetwa ne10 kusimba re2 pazuva 6, iri pakati pemishonga yakazvimirira yakaita zvakanakisisa, asi isina kusvika pazero. Misanganiswa miviri ine methylene blue yakasvika pazero pazuva 6, sezvakaitawo misanganiswa miviri ine ciprofloxacin.
Vanyori vakaratidza miganhu imwe chete yaizoonekwa nemuverengi anonyatsoongorora: biofilm diki yakakwenywa panzvimbo peyakare isina kuputswa, huwandu humwe chete hwakasarudzwa kuti hurerutse kuedza mishonga yose panzvimbo pekushandisa mushonga mumwe nemumwe pahuwandu hwawo hwepamusoro hunogona kunyatsoitika mumuviri, misanganiswa yakasarudzwa chete yakavakirwa paazithromycin kana rifampin, rudzi rumwe chete, pasina mhuka, pasina varwere. Tsvakurudzo yaizotevera yemisanganiswa yemishonga mitatu yakakurudzirwa, asi haina kushumwa seyakaitwa.
Kuenzanisa magadzirirwo etsvakurudzo
| Chinhu mukugadzirwa kwetsvakurudzo | Li 2019 | Zheng 2020 | Zvinonzi uchapupu hwekurapa |
|---|---|---|---|
| Chisikwa chakaedzwa | B. henselae JK53 chete | B. henselae JK53 chete | Varwere vane bartonellosis yakasimbiswa, nezvinoyerwa zvakatsanangurwa |
| MIC yemethylene blue pamasero ari kukura | 0.08 kusvika 0.16 micrograms per mL | Zvakafanana, 0.08 kusvika 0.16 | Hazvishandi pano |
| Muenzaniso wekurega kukura | Mabhakitiriya ererwa kwemazuva 5, mishonga yakazvimirira | Mabhakitiriya ererwa kwemazuva 6, mishonga yakazvimirira pamwe nemisanganiswa 25 | Kushanda mumatishu nemukati memasero, mafambiro emushonga mumuviri |
| Muenzaniso webiofilm | Hapana, zvisumbu hazvisi biofilm | Masero akakwenywa achibva mubiofilm yemazuva 5 | Biofilm isina kuputswa kana ruzivo rwekuramba kwemabhakitiriya ari mumuviri |
| Mhedzisiro huru yemethylene blue | 5 micrograms per mL, hapana mapoka pazuva 1 | Huwandu humwe chete, 3.2 kakapetwa ne10 kusimba re4 pamaawa 24; misanganiswa ine azithromycin kana rifampin iri pazero | Mwero wevanoratidza shanduko, mwero wekudzoka kwechirwere, zviitiko zvinokuvadza |
| Muyedzo wakarongeka wekusimbisana kwemishonga | Hauna kuitwa | Hauna kuitwa | Kutsvaga huwandu hwemushonga hunopiwa uye kuenzanisa kunodzorwa |
Tafura iyi ndiyo pfungwa huru yechinyorwa chino muchidimbu. Zvose zviri kuruboshwe rwechikamu chekupedzisira ibasa rekurera mabhakitiriya. Hapana chiri mune rimwe remapepa aya chinopinda muchikamu chekupedzisira.
Bartonella haisi Borrelia
Mapepa ose ari maviri anotaura nezveBorrelia burgdorferi, bhakitiriya rakamonereka rinokonzera chirwere cheLyme, nokuti muyedzo wedhayi wakabva patsvakurudzo yapfuura yeBorrelia isingachakuri murabhoritari imwe cheteyo, umo methylene blue nedaptomycin zvakanga zvaratidzwawo sezvinhu zvinoshanda. Nhoroondo iyoyo inobatsira kunzwisisa zvakaitika uye inowanzokonzerawo kukanganisa.
Hapana chiedzo mune rimwe remapepa eBartonella chinoedza Borrelia pamwe neBartonella zvichienzaniswa zvakananga. Zvisikwa izvi zvakasiyana, mishonga yekuzvirera yakasiyana, huwandu hwemishonga yakashandiswa hwakasiyana, uye pfungwa yekuti methylene blue ingakanganisa membrane yeBartonella yakataurwa sefungidziro inoda imwe tsvakurudzo. Mhedzisiro haifaniri kuendeswa kune mamwe marudzi, uye hapana rimwe remapepa aya rinotsigira zvirevo zvakafara pamusoro pezvipuka zvinorarama pane zvimwe. Kuenzaniswa kwemasero eBorrelia neeBartonella anoramba aripo kunochengeta tsvakurudzo dzezviviri izvi dzakaparadzana nechikonzero ichi.
Nei kurera mabhakitiriya kusingashanduki kuita gwara rekurapa
Kufarira kwevanhu kutsvaga gwara rekurapa Bartonella nemethylene blue kunonzwisisika. Mapepa aya ndiwo chikonzero nei mashoko iwayo achifanira kutorwa sechiratidzo chekungwarira pane kuti ave rondedzero yezvinotengwa.
Chekutanga, 5 micrograms per mL mukatsime kemuyedzo haisi murayiro wemushonga. Haina ruzivo rwakabatana nayo rwekupinzwa kwemushonga mumuviri, kupararira kwawo, kusungana kwawo nemapuroteni, kupinda mukati memasero, kana kukwanisa kwemuviri kuutsungirira. Vanyori vakaisarudza semwero wepakati unofungidzirwa wehuwandu hwepamusoro hwemishonga inorwisa mabhakitiriya, vakati tsvakurudzo dzinotevera dzinofanira kushandisa mushonga mumwe nemumwe pahuwandu hwawo hunogona kunyatsoitika mumuviri.
Chechipiri, mapoka ari pazero zvinoreva kuti hapana mapoka ari pasi pemamiriro iwayo ekuisa mabhakitiriya paagar, kwete kuti matishu haasisina mabhakitiriya. Masero anoramba aripo, mabhakitiriya ari mukati memasero, uye miganhu yekutora masampuli zvose hazvibatanidzwi neagar iri mundiro.
Chechitatu, misanganiswa inobvisa mabhakitiriya ose mukatsime inogona kusashanda kana kukuvadza mumuviri. Azithromycin pamwe nemethylene blue, uye rifampin pamwe nemethylene blue, misanganiswa yemurabhoritari pahuwandu hwemurabhoritari. Pasina ruzivo rwemafambiro emishonga mumuviri wemhuka uye ruzivo rwevanhu kubva mutsvakurudzo dzinodzorwa, hapana huwandu hwemushonga hunopiwa, hapana nguva yekuushandisa, uye hapana chiyero pakati pezvingabatsira nezvingakuvadza. Munhu ari kufunga nezvezvaangasarudza anofanira kuzvikurukura nenyanzvi yezvekurapa uye kuongorora kuti kushandisa methylene blue kunoda kutarisirwa nachiremba riini asati aita mhedziso kubva paruzivo rwemudziyo wekurera mabhakitiriya.
Mhedziso ine miganhu inotsigirwa nemapepa aya ndeiyi: methylene blue ine kushanda kunogona kuonekwa zvakare paB. henselae JK53 isingakuri kunze kwemuviri, kusanganisira mumisanganiswa yemishonga miviri murabhoritari, uye mhedzisiro yakasimba zvikuru yemisanganiswa neyemasero anobva mubiofilm yakabva mutsvakurudzo ye2020. Zvimwe zvose, kusanganisira kuti kushanda ikoko kune basa here pabartonellosis yevanhu, hazvisati zvaedzwa.