IMethylene blue kwisifo seLyme: iziphumo zaselabhoratri nobungqina beklinikhi

Isitya sokukhulisela iintsholongwane asisosigulana. Lo mahluko uchaza phantse onke amabango ngemethylene blue nesifo seLyme.

Masithi abafundi ababini babona isivakalisi esinye: abaphandi “bazitshabalalise ngokupheleleyo” iibhaktheriya zeLyme ngendibaniselwano yamayeza. Omnye umfundi uqonda ukuba isitya seglasi sahlala singenazo iintsholongwane ezibonakalayo kangangeeveki ezimbini. Omnye uqonda ukuba izigulana ezazidiniwe zachacha. Zombini ezi ndlela zokuqonda zivakala zisengqiqweni. Yeyokuqala kuphela engqinelana noko kwakulinganiswa luvavanyo lwaselabhoratri.

Eli nqaku lizigcina zahlukene ezi ngcamango zimbini. Lihlolisisa oko kwenziwa yimethylene blue kwi-Borrelia burgdorferi kwizikhuliso zaselabhoratri, oko kwenzekayo xa yayiqukwa kwiinkqubo zonyango ezintsonkothileyo zezigulana, nokuba kutheni kungekho nasinye kwezo ziphumo esiphendula umbuzo wokuba imele ithathwe ixesha elingakanani imethylene blue xa umntu eneLyme.

ILyme ibangelwa yibhaktheriya, ngoko ubungqina obungezifunxi-gazi abunakusetyenziswa kuyo

Isifo seLyme sibangelwa yi-Borrelia burgdorferi, ibhaktheriya emile okwejiko edluliselwa ngamakhalane. Unyango oluqhelekileyo lusebenzisa amayeza alwa neebhaktheriya afana nedoxycycline, iamoxicillin, okanye icefuroxime, njengoko kuchaziwe kwisikhokelo seLyme sowama-2020 se-IDSA, AAN, ne-ACR.

Ukuba esi sifo sibangelwa yibhaktheriya kubalulekile kuba imethylene blue inembali eyahlukileyo yokusetyenziswa kwizifunxi-gazi. Iphandiwe kwizifunxi-gazi zemalariya yaye maxa wambi iyaxoxwa ngokuphathelele iBabesia, isifunxi-gazi esidluliselwa ngamakhalane esinokubakho ngaxeshanye neLyme. Isiphumo esifunyenwe kwisifunxi-gazi asiqinisekisi ukuba indlela efanayo yokusebenza iyasebenza kwiBorrelia. Ezi zinto ziphilayo zahlukile ngobume, ngemetabolism, ngezinto ekujoliswa kuzo ngamayeza, nangamalungu omzimba eziwasulelayo. Isishwankathelo sethu sendlela imethylene blue esebenza ngayo kwiiseli senza ingongoma efanayo ngokubanzi: umsebenzi weredox ubanzi, kodwa isiphumo sebhayoloji sisaxhomekeke kwinto ephilayo nakwiimeko.

Ngoko gcina imibuzo emibini yahlukene. Okokuqala, yenza ntoni imethylene blue kwiBorrelia kwisikhuliso esiphantsi kweemeko ezilawulwayo. Okwesibini, kwenzeka ntoni kubantu abanesifo seLyme. Inxalenye eseleyo yeli nqaku ilandela olo landelelwano.

Iiseli eziqhubeka ziphila zikwimeko ethile, azilohlobo olunamandla ngakumbi

Amayeza okubulala iibhaktheriya adla ngokubulala uninzi lweBorrelia ngokukhawuleza aze ashiye iqela elincinane elikwaziyo ukumelana nawo. Xa abaphandi baphinda bakhulisa ezo zazisindile, inzala yazo yayidla ngokuphinda ibe sesichengeni sala mayeza. Le pateni ibonisa imeko yokusebenza kweeseli enokubuyiselwa umva kunokuxhathisa okuzuzwa njengelifa. Umzekelo ocacileyo uvela kuphando lukaSharma noogxa bakhe ngokubulawa okunamanqanaba amabini nokukhula kwakhona kweeseli eziqhubeka ziphila.

Enyanisweni, izikhuliso eziselula ezikwinqanaba lokukhula ngokukhawuleza ziqulethe ubukhulu becala iispirochete ezikwaziyo ukuhamba yaye zisabela lula ngakumbi kumayeza aqhelekileyo. Izikhuliso ezindala ezikwinqanaba lokungakhuli ziqulethe imizimba engqukuva engakumbi kunye neendidi ezidityanisiweyo zamaqela amancinane eebhaktheriya, yaye ziyakwazi ukumelana ngakumbi naloo mayeza. La magama achaza iimilo neemeko zokukhula kwisitya. Akabobungqina bokuba ezo milo zichaza iimpawu eziqhubekayo emva kokunyangwa kwesifo seLyme.

Indlela eluncedo yokukuqonda oku ilula. Ukukhula okusebenzayo kuveza izinto ekujoliswa kuzo, ezifana nokwenziwa kodonga lweseli. Ukukhula okucothayo okanye okutshintshileyo kuzifihla ezo zinto. Ikhompawundi encedayo kwimeko yesibini isenokungabaluleki kweyokuqala, yaye kusenokuba njalo nangokuchaseneyo.

Oko kwafunyanwa ngokwenene luphando lovavanyo lokuqala lowama-2015

Umthombo odla ngokucatshulwa kakhulu kulo mba luvavanyo lowama-2015 lukaFeng noogxa bakhe kusetyenziswa ingqokelela yeekhompawundi ze-FDA. Bavavanya iikhompawundi kwizikhuliso zeBorrelia ezineentsuku ezisixhenxe nezikwinqanaba lokungakhuli kangangezinye iintsuku ezisixhenxe, ikhompawundi nganye yovavanyo ikwi-50 micromolar.

IMethylene blue yayinomsebenzi owaneleyo ukuba itsale ingqalelo, kodwa ayizange isuse zonke iintsholongwane kwisikhuliso. Ngokujonga ngemikroskopu, malunga nama-40 ekhulwini eeseli zazisakwazi ukuphila emva kwemethylene blue, xa kuthelekiswa nama-93 ekhulwini kwiqela lolawulo elinganyangwanga, ama-75 ekhulwini emva kwedoxycycline, ama-76 ekhulwini emva kweamoxicillin, ama-49 ekhulwini emva kwecefuroxime, nama-35 ekhulwini emva kwedaptomycin eyayisetyenziselwa uthelekiso. Isiphumo somatshini wokufunda iipleyiti semethylene blue sasingenakusetyenziswa kuba umbala wayo onamandla wawuphazamisa uvavanyo lwefluorescence, ngoko isigqibo sasixhomekeke ekujongeni ngqo ngemikroskopu.

Loo nto ngumqondiso ofunyenwe kuvavanyo lokuqala, ayikokutshatyalaliswa ngokupheleleyo. Akuzange kuboniswe ukuba izikhuliso zemethylene blue zahlala zingenazo zonke iintsholongwane xa ziphinda zikhuliswa ixesha elide kungekho mayeza. Ababhali bacela ukuba kamva kwenziwe uphando ngeendibaniselwano nangemifuniselo yezilwanyana, nto leyo eyindlela efanelekileyo yokuqonda uvavanyo lwengqokelela yeekhompawundi.

Isizathu sokuba kube lula ukungaziqondi kakuhle iziphumo zeendibaniselwano

Olunye uphando olunxulumeneyo lowama-2015 ludla ngokudityaniswa kweli bango. Kuphando lukaFeng, Auwaerter, noZhang ngeendibaniselwano zamayeza ezichasene neBorrelia ekwinqanaba lokungakhuli, esona siphumo sinamandla saselabhoratri savela kwidaptomycin kunye nedoxycycline kunye necefoperazone, nganye ikwi-10 micrograms per milliliter kangangeentsuku ezisixhenxe. Emva konyango, amayeza axutywa nesondlo esitsha sokukhulisela ukuze ancitshiswe ukuxinana kwawo, kwaza kwajongwa ukuba izikhuliso ziyakhula kwakhona na.

Yiloo ndibaniselwano yamayeza amathathu kuphela eyahlala ingenazo iintsholongwane ezibonakalayo emva kweentsuku ezili-15 zokuphinda kukhuliswe. Umda ochaziweyo wokubonwa ngemikroskopu wawungaphantsi kwe-100,000 yezinto eziphilayo, ngoko “ukutshatyalaliswa ngokupheleleyo” kwakuthetha ukuba akukho kukhula kwakhona kwakunokubonwa ngemikroskopu phantsi kwaloo nkqubo. Kwakungathethi ukuqinisekiswa kokungabikho kwanto iphila nokuba ibe nye, ukungena kwizicubu zesilwanyana, okanye ukuphiliswa komntu. Iphepha ngokwalo lalilumkisa ngokusebenzisa ezi ziphumo ngokuthe ngqo kunyango.

Idatha yeendibaniselwano zemethylene blue eyalandelayo yavela kwinqanaba lobungqina elahlukileyo nelibuthathaka ngakumbi. Ithisisi yesidanga seemasters yowama-2016 kaMegan Weitner waseJohns Hopkins yavavanya imethylene blue kwi-4 micrograms per milliliter, eyakhethwa kuqwalaselwa amanqanaba anokufumaneka kwiplasma, kunye namayeza afana necefuroxime, idoxycycline, iazithromycin, irifabutin, irifaximin, initrofurantoin, nepyrimethamine. Izikhuliso zazichanabeke kula mayeza kangangeentsuku ezisixhenxe zaza zavavanywa ngokudaywa nangokujongwa ngemikroskopu. Iindibaniselwano ezazinexabiso elihlengahlengisiweyo lokukwazi ukuphila kweeseli eziseleyo elingaphantsi kwe-0.90 zabizwa ngokuba ziyasebenza. Ngokomzekelo, imethylene blue kunye neazithromycin zafikelela kwi-0.88, yaza loo nto yaphucuka yaya kwi-0.64 xa kongezwa icefuroxime, ngoxa ezinye iindibaniselwano ezininzi zamayeza amathathu zafikelela malunga ne-0.69 ukuya kwi-0.82.

Ezo zinto kukuncipha komqondiso ovela ekudayweni, asikokususwa kwazo zonke iintsholongwane kwizikhuliso. Ithisisi ayizange ibonise ukuba izikhuliso ezineendibaniselwano zemethylene blue zahlala zingenazo iintsholongwane ixesha elide ngendlela ethelekiseka nesiphumo sendibaniselwano yamayeza amathathu equka idaptomycin. Kwakhona yithisisi, ayilophepha lejenali elihlolwe ngabanye iingcali. Inokuvelisa iingcamango eziza kuvavanywa. Ayinako ukuba nobunzima obufanayo nobobungqina beklinikhi obuqokelelwe phantsi kweemeko ezilawulwayo.

Yiyo loo nto “inkqubo yemethylene blue yeLyme” ingenakuthathwa kula maphepha. Ukuvezwa kwaselabhoratri apho iintsholongwane zisemayezeni ngokuqhubekayo kangangeentsuku ezisixhenxe akuchazi idosi yomntu, indlela yokuyinika, ixesha lokuyisebenzisa, uxinaniso kwizicubu, okanye inqanaba lomonakalo elamkelekileyo. Kananjalo akuvavanyi imethylene blue iyodwa ngokubhekisele kwiziphumo zeklinikhi ezibalulekileyo kwizigulana, ezifana neentlungu, ukudinwa, ukudumba kwamalungu, iimpawu zenkqubo yemithambo-luvo, okanye ukubuya kwesifo. Ukuze ufumane uncedo lokwahlula la manqanaba obungqina, jonga isikhokelo sethu sokufunda amabango ophando ngemethylene blue.

Ukusuka kwizitya ukuya kwizigulana: inyathelo leklinikhi elingekhoyo

Ngexesha lokubhalwa kweli nqaku, akukho lingo elabela abantu kumaqela ngokungakhethiyo okanye elilawulwayo nelilandela abantu ukuya phambili elibonisa ukuba imethylene blue inyanga isifo seLyme. Okukhoyo ebantwini ziingxelo ezingalawulwayo apho imethylene blue yayiyinxalenye enye yenkqubo yonyango enamayeza amaninzi.

Owona mzekelo ucacileyo luphando lukaHorowitz, Fallon, noogxa babo olujonga emva kunyango ngendibaniselwano equka idapsone, kuquka ingxelo yowama-2023 ngezigulana ezingama-25 ezazisele zifumene unyango oluninzi. Kwaxelwa ukuba ezisibhozo kwezingama-25 zazingenazo iimpawu zeLyme esebenzayo kangangeenyanga ezintathu ubuncinane. Kodwa izigulana zanikwa nedapsone, iitetracycline, irifampin okanye irifabutin, iimacrolide, yaye ngamanye amaxesha namanye amayeza. Kwakungekho qela lifumana imethylene blue kuphela yaye kwakungekho qela lolawulo elenziwe ngokwabela abantu ngokungakhethiyo. Iingxelo ezincinane zamatyala ezalandelayo zinoyilo olufanayo.

Olo yilo lunokuchaza iziphumo. Alunako ukunika imethylene blue iwonga lokuba ngunobangela wazo. Ukuphucuka kusenokuba kubangelwe lelinye iyeza, yindibaniselwano, yindlela yendalo yesifo, ziziphumo zeplacebo, kukubekwa esweni ngokusondeleyo ngakumbi, okanye kukukhethwa kwezigulana ezazinokuphucuka. Itheyibhile ibonisa lo msantsa ngokucacileyo.

Ngoko ipateni luvavanyo lokuqala kunye neendibaniselwano zethisisi kunye neengxelo ezingalawulwayo zamayeza amaninzi. Olo landelelwano lubuthathaka kunesiphumo sonyango esiboniswe kwilingo leklinikhi.

Akukho mpendulo isekelwe kubungqina yokuba imele ithathwe ixesha elingakanani

Umdla wokukhangela “ixesha lokuthatha imethylene blue xa uneLyme” uyaqondakala. Iimpawu eziqhubekayo zibangela uxinzelelo lokwenza okuthile. Kodwa ukumisela ixesha kuthetha ukuba sele ikhona idosi esebenzayo eqinisekisiweyo, yaye akukho lingo liyiqinisekisileyo kwiLyme.

IMethylene blue liyeza elisebenza emzimbeni wonke yaye linezithintelo zokwenene. Ileyibhile yeyeza elimiselwayo laseU.S. lemethemoglobinemia efunyenweyo ichaza 1 mg per kg ngokufakwa emthanjeni kangangemizuzu emi-5 ukuya kwengama-30, nto leyo ephathelele isifo, indlela yokulisebenzisa, nenjongo eyahlukileyo engenakuguqulwa ibe yidosi yeLyme. Ileyibhile inesilumkiso esikwibhokisi ngeserotonin syndrome xa imethylene blue idityaniswa namayeza achaphazela iserotonin, ingakumbi ii-SSRI, ii-SNRI, nezithinteli ze-MAO, yaye iyakwalela ukusetyenziswa kwayo xa kukho ukusilela kwe-G6PD ngenxa yomngcipheko weanemia ebangelwa kukutshatyalaliswa kweeseli ezibomvu zegazi. Nabani na ocinga ngokuyisebenzisa kufuneka ahlolwe yingcali yezonyango ngokuphathelele amayeza awasebenzisayo, imeko ye-G6PD, ukukhulelwa, ukusebenza kwezintso, nokusebenzisana kwamayeza. Isishwankathelo sethu sokhuseleko nokuphathwa sichaza ukuba kutheni ukucoceka nokubekwa esweni kwezonyango kubalulekile ngaphambi kokusetyenziswa kwayo emzimbeni wonke.

Kwiimpawu eziqhubekayo emva konyango lweLyme olucetyiswayo, kungekho bungqina bunokuqinisekiswa bokosuleleka kwakhona okanye bokungaphumeleli konyango, isikhokelo se-IDSA sicebisa ukuba kunganikwa unyango olongezelelweyo olulwa neentsholongwane yaye sichaza ukuba akukho bungqina beklinikhi buxhasa iinkqubo ezijolise ngokukhethekileyo kwiiseli eziqhubeka ziphila okanye kwiintlobo ezahlukeneyo ngokwemilo. Oko akukhanyeli ukuba iiseli ezikwaziyo ukumelana namayeza zikhona kwizitya. Kuthetha ukuba ikhonkco eliya kubungqina beklinikhi alikakhiwa.

Indlela esebenzayo yokufunda ibango elilandelayo odibana nalo kukubuza imibuzo emithathu. Ngaba isiphumo safunyanwa kwisikhuliso esikwisondlo esilulwelo, kwisilwanyana, okanye kwizigulana. Ngaba imethylene blue yavavanywa iyodwa okanye kuphela njengengxenye yomxube wamayeza amaninzi. Ngaba isiphumo esasilinganiswa yayikukukhula kwakhona kwisitya okanye ukuchacha kwabantu. Ukuba iimpendulo sisitya, ngumxube, nokukhula kwakhona, olo phando luvelisa iingcamango eziza kuvavanywa. Aluyonkqubo yonyango.