Methylene blue pachirwere cheLyme: zvakawanikwa murabhoritari nehumbowo hwekiriniki

Mudziyo wekurima utachiona hausi murwere. Musiyano iwoyo unotsanangura zvinenge zvose zvinotaurwa pamusoro pemethylene blue nechirwere cheLyme.

Ngatitii vaverengi vaviri vanoona mutsara mumwe chete: vaongorori “vakapedza zvachose” mabhakitiriya eLyme vachishandisa musanganiswa wemishonga. Mumwe muverengi anonzwisisa kuti mudziyo wegirazi wakaramba usina utachiona hunoonekwa kwemavhiki maviri. Mumwe anonzwisisa kuti varwere vainzwa kuneta vakapora. Kunzwisisa kwose kuri kuviri kunoita sokune musoro. Asi kwekutanga chete ndiko kunoenderana nezvakayerwa nemuyedzo wemurabhoritari.

Chinyorwa chino chinochengeta pfungwa mbiri idzodzo dzakaparadzana. Chinoongorora zvakaitwa nemethylene blue kuBorrelia burgdorferi yakarimwa murabhoritari, zvakaitika payakashandiswa muzvirongwa zvekurapa varwere zvine mishonga yakawanda, uye nei pasina pane izvi chinopindura kuti methylene blue inofanira kushandiswa kwenguva yakareba sei pachirwere cheLyme.

Lyme inokonzerwa nemabhakitiriya, saka humbowo hwezvipukanana zvinorarama pane zvimwe hahungoshandiswi pairi

Chirwere cheLyme chinokonzerwa neBorrelia burgdorferi, bhakitiriya rakaita sechitenderedzwa chinomonereka, rinoparadzirwa nezvikwekwe. Kurapa kwakajairika kunoshandisa mishonga inorwisa mabhakitiriya yakadai sedoxycycline, amoxicillin, kana cefuroxime, sezvinotsanangurwa mugwara ra2020 reLyme kubva kuIDSA, AAN, neACR.

Kuziva kuti utachiona uhwu ibhakitiriya kwakakosha nokuti methylene blue ine nhoroondo yakasiyana pakurwisa zvipukanana zvinorarama pane zvimwe. Yakadzidzwa ichishandiswa pazvipukanana zvinokonzera malaria, uye dzimwe nguva inokurukurwa pamusoro peBabesia, chipukanana chinoparadzirwa nezvikwekwe chinogona kuvapo pamwe chete neLyme. Zvakabuda pakurwisa chipukanana chakadaro hazviratidzi kuti nzira imwe cheteyo inoshanda paBorrelia. Zvipenyu izvi zvinosiyana pamaumbirwo azvo, pamashandisiro azvinoita zvinhu kuti zvirarame, pane zvikamu zvinonangwa nemishonga, uye panhengo dzomuviri zvazvinobata. Tsananguro yedu yemashandiro emethylene blue mumasero inosimbisawo pfungwa iyi: kushanda kwayo kuburikidza neredox kwakafara, asi zvinobuda pazvipenyu zvichiri kutsamira pachipenyu chacho nemamiriro acho.

Saka paradzanisa mibvunzo miviri. Wokutanga ndewekuti methylene blue inoitei kuBorrelia yakarimwa mumamiriro anodzorwa. Wechipiri ndewekuti chii chinoitika kuvanhu vane chirwere cheLyme. Zvasara muchinyorwa chino zvinotevera kurongeka ikoko.

Masero anoramba achirarama anenge ari mumamiriro akati, kwete rudzi rune simba kupfuura mamwe

Mishonga inorwisa mabhakitiriya inowanzouraya Borrelia yakawanda nokukurumidza, yosiyira shure boka diki rinokwanisa kutsungirira mishonga yacho. Vaongorori pavakarima zvakare aya akanga asara ari mapenyu, akabva maari aiwanzobatwa zvakare nemishonga. Maitiro aya anoratidza mamiriro ekushanda kwesero anogona kudzokera paaimbova, kwete kusabatwa nemishonga kunogarwa nhaka. Izvi zvinoratidzwa zvakajeka mubasa raSharma nevamwe pamusoro pekuuraya kunoitika muzvikamu zviviri uye kukura zvakare kwemasero anoramba achirarama.

Mukushanda kwacho, Borrelia ichangotanga kurimwa iri muchikamu chekuwanda nokukurumidza inenge iine zvikuru mabhakitiriya akamonereka anokwanisa kufamba, uye inobatwa nyore nemishonga yakajairika. Borrelia yarimwa kwenguva yakareba iri muchikamu chekurega kuwanda inenge iine masero akawanda akaita denderedzwa nemapoka madiki akaungana, uye inokwanisa kutsungirira mishonga imwe cheteyo zviri nani. Mashoko iwayo anotsanangura maumbirwo nemamiriro ekukura mumudziyo. Haasi humbowo hwokuti maumbirwo iwayo ndiwo anotsanangura zviratidzo zvinoramba zviripo mushure mekurapwa kwechirwere cheLyme.

Pfungwa inobatsira kunzwisisa izvi iri nyore. Kukura kuri kuitika kunoita kuti zvinhu zvakadai sekuumbwa kwemadziro esero zvive nyore kunangwa nemishonga. Kukura kunononoka kana kuchinja kunovanza zvinhu izvozvo. Chinhu chinobatsira pamamiriro echipiri chingasava chakakosha pamamiriro ekutanga, uye zvinogonawo kuva zvakapesana.

Zvakanyatsowanikwa nechidzidzo chekusefa mishonga cha2015

Chidzidzo chinonyanya kutaurwa panyaya iyi ndechekusefa mishonga iri muunganidzwa weFDA kwakaitwa naFeng nevamwe muna2015. Chakaedza zvinhu paBorrelia yakanga yarimwa kwemazuva manomwe iri muchikamu chekurega kuwanda, kweamwe mazuva manomwe, chinhu chimwe nechimwe chichishandiswa pa50 micromolar.

Methylene blue yakashanda zvakakwana kuti itariswe, asi haina kubvisa utachiona hwose. Pakuongorora nemaikorosikopu, anenge 40 muzana emasero akaramba ari mapenyu mushure memethylene blue, zvichienzaniswa ne93 muzana muboka risina kurapwa, 75 muzana mushure medoxycycline, 76 muzana mushure meamoxicillin, 49 muzana mushure mecefuroxime, uye 35 muzana mushure medaptomycin yakashandiswa pakuenzanisa. Zvakayerwa nemuchina wekuverenga mahwendefa emiyedzo pamethylene blue hazvina kukwanisa kushandiswa nokuti ruvara rwayo rwakasimba rwakakanganisa muyedzo wefluorescence, saka mhedziso yakavakirwa pakuongorora zvakananga nemaikorosikopu.

Ichi chiratidzo chinobuda pakusefa mishonga, kwete kupedzwa zvachose kweutachiona. Borrelia yakarimwa ichirapwa nemethylene blue haina kuratidzwa kuti yakaramba isina utachiona pakurimwa zvakare kwenguva refu pasina mushonga. Vanyori vakakurudzira kuti pave nezvidzidzo zvinotevera zvemusanganiswa wemishonga uye zvemhuka, zvinova ndizvo zvinofanira kunzwisiswa kubva pakusefa muunganidzwa wemishonga.

Nei zvabuda pamusanganiswa wemishonga zviri nyore kududzirwa zvisizvo

Chimwe chidzidzo cha2015 chine chokuita neizvi chinowanzosanganisirwa muchirevo chimwe chetecho. Muchidzidzo chaFeng, Auwaerter, naZhang pamusoro pemisanganiswa yemishonga paBorrelia iri muchikamu chekurega kuwanda, mhedzisiro yakasimba zvikuru yemurabhoritari yakabva padaptomycin yakasanganiswa nedoxycycline necefoperazone, mumwe nomumwe uri pa10 micrograms per milliliter kwemazuva manomwe. Mushure mekurapa, mishonga yakaderedzwa kusimba kwayo nokuiswa mune zvinovaka utachiona zvitsva, uye utachiona hwakarimwa hwakatariswa kuti hwaizokura zvakare here.

Musanganiswa iwoyo wemishonga mitatu chete ndiwo wakaramba usina zvipenyu zvinokwanisa kuonekwa mushure memazuva 15 ekurimwa zvakare. Muganhu wakataurwa wekukwanisa kuona nemaikorosikopu waiva pasi pezvipenyu 100,000, saka “kupedzwa zvachose” kwaireva kuti hapana kukura zvakare kwaikwanisa kuonekwa nemaikorosikopu pasi penzira iyoyo yemuyedzo. Zvaisareva kuratidzwa kwokuti hapana kana chipenyu chimwe chakasara, kusvika kwemushonga mumatishu emhuka, kana kupora kwomunhu. Chinyorwa chacho pachacho chakayambira kuti zvabuda izvi zvisangoendeswa zvakananga mukurapa.

Mashoko akazouya pamusoro pemisanganiswa ine methylene blue akabva pamwero wakasiyana uye usina kusimba zvakanyanya wehumbowo. Tsvakurudzo yaMegan Weitner yedhigirii remasters kuJohns Hopkins ya2016 yakaedza methylene blue pa4 micrograms per milliliter, mwero wakasarudzwa pachifungwa kuti ingasvika pachiyero chakadii muplasma yeropa, ichisanganiswa nemishonga yakadai secefuroxime, doxycycline, azithromycin, rifabutin, rifaximin, nitrofurantoin, nepyrimethamine. Utachiona hwakarimwa hwakaiswa mumishonga kwemazuva manomwe, hwobva hwaongororwa nokuiswa mavara uye nemaikorosikopu. Misanganiswa yaiva nechiyero chakasara chemasero mapenyu, chakagadziridzwa kuti chienzaniswe, chiri pasi pe0.90 yakanzi yaishanda. Somuenzaniso, methylene blue yakasanganiswa neazithromycin yakasvika pa0.88, ikavandudzika kusvika pa0.64 pakawedzerwa cefuroxime, nepo mimwe misanganiswa yakawanda yemishonga mitatu yakasvika pakati pe0.69 ne0.82.

Izvozvo kuderera kwechiratidzo chemavara, kwete kubviswa kweutachiona hwose hwakarimwa. Tsvakurudzo iyi haina kuratidza kuti utachiona hwakarimwa hwakaramba husingaonekwi kwenguva refu pamisanganiswa ine methylene blue, sezvakaitika pamusanganiswa wedaptomycin nemimwe mishonga miviri. Uyewo itsvakurudzo yedhigirii, kwete chinyorwa chemujenari chakaongororwa nedzimwe nyanzvi. Inogona kuburitsa pfungwa dzinoda kuedzwa. Haigoni kuva nehuremu hwakaenzana nehumbowo hwekiriniki hunobva mumiyedzo ine mapoka ekuenzanisa.

Ndokusaka “chirongwa chemethylene blue cheLyme” chisingagoni kungotorwa muzvinyorwa izvi. Kuisa zvipenyu mumushonga murabhoritari zvisingamiri kwemazuva manomwe hakutsananguri chipimo chomunhu, nzira yokushandisa, nguva yokushandisa, chiyero chinofanira kuva mumatishu, kana mwero unogamuchirika wokukuvadza. Hakuedziwo methylene blue yoga pazvinhu zvinokosha kuvarwere, zvakadai sekurwadziwa, kuneta, kuzvimba kwemajoini, zviratidzo zvetsinga, kana kudzoka kwechirwere. Kuti ubatsirwe kusiyanisa mwero iyi yehumbowo, ona gwara redu rekuverenga zvinotaurwa mutsvakurudzo yemethylene blue.

Kubva mumidziyo kuenda kuvarwere: danho rekiriniki risipo

Pakunyora chinyorwa chino, hapana muyedzo unogovera varwere mumapoka zvisina kusarudzwa kana unotevera varwere mberi nenguva uine boka rekuenzanisa, unoratidza kuti methylene blue inorapa chirwere cheLyme. Zviripo muvanhu imishumo isina mapoka ekuenzanisa umo methylene blue yaiva chimwe chikamu chechirongwa chine mishonga yakawanda.

Muenzaniso wakajeka zvikuru ibasa raHorowitz, Fallon, nevamwe rakaongorora zvakanga zvatoitika pakurapa nemusanganiswa une dapsone, kusanganisira mushumo wa2023 pamusoro pevarwere 25 vakanga vamborapwa kakawanda. Zvakataurwa kuti vasere pavari 25 vakanga vasisina zviratidzo zveLyme yaishanda kweinenge mwedzi mitatu. Asi varwere vakapiwawo dapsone, tetracyclines, rifampin kana rifabutin, macrolides, uye dzimwe nguva mimwe mishonga. Pakanga pasina boka raishandisa methylene blue yoga uye pasina boka rekuenzanisa rakagoverwa zvisina kusarudzwa. Mishumo midiki yakazotevera yenyaya dzevarwere ine chimiro chimwe chetecho.

Magadzirirwo echidzidzo iwayo anogona kutsanangura zvakaitika. Haagoni kuti methylene blue ndiyo yakazvikonzera. Kuvandudzika kungabva kune mumwe mushonga, kumusanganiswa, pakufamba kwechirwere pachacho, pazvinokonzerwa neplacebo, pakunyatsoteverwa kwevarwere, kana pakusarudzwa kwevarwere vaingangovandudzika. Tafura inoratidza mukaha uyu pachena.

Saka humbowo huripo hunotevedzana sezvizvi: kusefa mishonga, misanganiswa mutsvakurudzo yedhigirii, nemishumo yemishonga yakawanda isina mapoka ekuenzanisa. Kutevedzana ikoko hakuna kusimba sekuratidzwa kwekushanda kwekurapa mumuyedzo wekiriniki.

Hapana mhinduro yakavakirwa pahumbowo yekuti inofanira kushandiswa kwenguva yakareba sei

Kufarira kutsvaga kuti “methylene blue inofanira kushandiswa kwenguva yakareba sei paLyme” kunonzwisisika. Zviratidzo zvinoramba zviripo zvinoita kuti munhu anzwe achifanira kutora danho. Asi kutaura nguva yokushandisa kunofungidzira kuti pane chipimo chinoshanda chakatosimbiswa, uye hapana muyedzo wakasimbisa chimwe cheLyme.

Methylene blue mushonga unoshanda mumuviri wose uye une zvipingamupinyi chaizvo. Gwaro remushonga unopiwa netsamba yachiremba muU.S. pakurapa methemoglobinemia yakawanikwa rinotsanangura 1 mg per kg inopinzwa mutsinga kwemaminitsi 5 kusvika 30, asi ichi chirwere chakasiyana, nzira yakasiyana yokupa mushonga, nechinangwa chakasiyana, saka hazvigoni kushandurwa kuva chipimo cheLyme. Gwaro remushonga rine yambiro iri mubhokisi pamusoro peserotonin syndrome kana methylene blue yasanganiswa nemishonga inowedzera kushanda kweserotonin, kunyanya SSRIs, SNRIs, nemishonga inodzivisa MAO, uye rinorambidza kushandiswa kana paine kushomeka kweG6PD nokuda kwengozi yeanemia inokonzerwa nekuparara kwemasero matsvuku eropa. Ani naani ari kufunga kuishandisa anoda kuti nyanzvi yezvokurapa iongorore mishonga yaari kushandisa, mamiriro eG6PD, pamuviri, kushanda kweitsvo, uye kupindirana kwemishonga. Pfupiso yedu yekuchengeteka nemabatiro inotsanangura nei kuchena kwemushonga nokutarisirwa nachiremba zvakakosha usati waushandisa nenzira inoita kuti ushande mumuviri wose.

Kana zviratidzo zvichiramba zviripo mushure mekurapa Lyme sezvakakurudzirwa, pasina humbowo hunoyerwa hwokubatwa neutachiona zvakare kana kutadza kwekurapa, gwara reIDSA rinokurudzira kusawedzera kurapa nemishonga inorwisa utachiona. Rinotiwo hapana humbowo hwekiriniki hunotsigira zvirongwa zvinonanga chaizvo masero anoramba achirarama kana utachiona hune maumbirwo akasiyana. Izvi hazvirambi kuti masero anotsungirira mishonga aripo mumidziyo. Zvinoreva kuti danho rinobatanidza izvi nekurapa varwere harisati rasimbiswa.

Nzira inobatsira pakuverenga chirevo chinotevera chaunosangana nacho ndeyekubvunza mibvunzo mitatu. Zvakabuda izvi zvakawanikwa muutachiona hwakarimwa mumvura ine zvinovaka muviri, mumhuka, kana muvarwere here? Methylene blue yakaedzwa yoga here kana kuti yaingova mumusanganiswa wemishonga yakawanda? Chiyero chemhedzisiro chaiva kukura zvakare mumudziyo here kana kupora kwevanhu? Kana mhinduro dziri mudziyo, musanganiswa, uye kukura zvakare, chidzidzo chacho chinoburitsa pfungwa dzinoda kuedzwa. Hachisi chirongwa chekurapa.