Mayeso a CMV (Mayeso a Cytomegalovirus): Zimene Amawonetsa, Zimene Sangathe, ndi Momwe Mungawerengere Lipoti Lanu

Njira zazikulu

• Mayeso awiri osiyana, mafunso awiri osiyana: Mayankho a CMV serology akuti "kodi munthuyu wapezeka ndi kachilomboka?"; Mayankho a CMV PCR akuti "kodi kachilomboka kangathe kupezeka tsopano, ndipo kangati?"
• Akuluakulu ambiri ku India ali ndi CMV IgG positive, kotero kukhala ndi IgG yabwino yokha nthawi zambiri kumatanthauza kuti munthu wakhalapo kale, osati matenda omwe alipo panopa.
• Zotsatira zabwino sizimangokhala matenda okha: CMV imatha kupezeka popanda kuyambitsa zizindikiro zilizonse, makamaka kwa anthu athanzi.
• Kusunga nthawi kumasankha chilichonse kwa makanda obadwa kumene: Kuzindikira kwa CMV yobadwa nayo kumatsimikiziridwa bwino ndi PCR ya malovu kapena mkodzo mkati mwa milungu itatu yoyambirira ya moyo.
• Zotsatira zimafuna kutanthauzira kwachipatala ndi dokotala amene adalamula kuti mayesowo achitike, pamodzi ndi zizindikiro, momwe chitetezo chamthupi chilili komanso kafukufuku wina. Zotsatira zake zimasiyana malinga ndi momwe matenda alili.

Pang'onopang'ono

Amadziwikanso monga

• Mayeso a Cytomegalovirus
• Kuyesa kwa CMV IgG ndi IgM; Kuyesa kwa ma antibodies a CMV
• Kuyesa kwa CMV PCR; Kuyesa kwa DNA ya CMV; Kuyesa kuchuluka kwa kachilombo ka CMV; PCR yochuluka ya CMV
• Mayeso a CMV IgG adity
• Ku India, anthu ambiri amafunsa kuti "CMV blood test", "CMV titre" kapena "TORCH CMV" (CMV ndi imodzi mwa ma TORCH panel)

Kodi mayeso a CMV ndi chiyani?

Cytomegalovirus ndi kachilombo ka herpes. Pambuyo pa kachilombo koyamba, CMV imakhalabe m'thupi mobisa kwa moyo wonse ndipo imatha kuyambiranso, makamaka chitetezo cha mthupi chikachepa. Popeza kuchedwa kumakhala kwa moyo wonse komanso kofala, kuyezetsa CMV kumafuna kusiyanitsa mitundu itatu yosiyana: yomwe sinatengepo kachilombo, yomwe yatengapo kachilombo kale komanso yomwe yatsala pang'ono kuonekera, kapena yomwe ikugwira ntchito pakadali pano.

Mayeso a CMV si mayeso amodzi okha. Mafomu akuluakulu ndi awa:

• CMV IgG: Zimasonyeza kuti munthu ali ndi kachilombo ka CMV kale ndipo zimapitirira kwa moyo wake wonse. Zimagwiritsidwa ntchito makamaka podziwa momwe chitetezo chamthupi chilili, mwachitsanzo, kufufuza opereka ndi olandira kachilombo asanaikidwe ziwalo kapena maselo oyambira, kapena kudziwa ngati mayi wapakati anali kale ndi kachilombo ka CMV asanayambe kutenga pakati.
• CMV IgM: Ingachuluke m'matenda atsopano kapena oyambitsidwanso, koma IgM imatha kupitirira kwa miyezi ingapo ndipo singawonekere makamaka m'matenda ena opatsirana. CMV IgM si chizindikiro chodalirika cha matenda atsopano.
• Kuthamanga kwa CMV IgG: Kuchepa kwa chikoka kumatanthauza kuti munthu ali ndi kachilombo mkati mwa miyezi ingapo yapitayo; kuopsa kwambiri kumatanthauza kuti munthu ali ndi kachilombo kakale. Amagwiritsidwa ntchito makamaka pa nthawi ya mimba kuti athandize kuzindikira matenda oyamba omwe akukayikiridwa.
• Kuzindikira DNA (CMV PCR): Imazindikira majini a mavairasi. Kuchuluka kwa PCR kumafotokoza kuchuluka kwa mavairasi m'mayunitsi apadziko lonse lapansi pa mililita imodzi (IU/mL) ndipo ndiyo njira yodziwika bwino yowunikira anthu olandira chithandizo cha opaleshoni ndi odwala ena omwe ali ndi chitetezo chamthupi chofooka.

Chifukwa chiyani mayeso a CMV amachitika

• Kukayikiridwa kuti ndi CMV yobadwa nayo: mwa mwana wakhanda wokhala ndi mutu wochepa, wolemera pang'ono pobereka, chikasu cha m'mimba, chiwindi kapena ndulu yokulirapo, ziphuphu za m'mimba, kujambula zithunzi zosazolowereka za m'mutu, kapena kulephera kwa mayeso a kumva kwa mwana wakhanda.
• Matenda a CMV omwe akukayikiridwa kuti ali nawo pa nthawi ya mimba: nthawi zambiri pambuyo pa matenda okhala ndi malungo ndi kutupa kwa lymph node, kapena pambuyo pa ultrasound zomwe zikusonyeza kuti mwana ali ndi kachilombo.
• Mankhwala opatsirana: Malangizo okhudza momwe munthu amagwiritsira ntchito CMV IgG, wopereka ndi wolandira, amatsogolera ku kugawa kwa chiopsezo ndi kuteteza; malangizo okhudza kuchuluka kwa PCR amatsogolera chithandizo cha mavairasi choyambitsa matenda.
• Kachilombo ka HIV kapena kutsika kwa chitetezo chamthupi m'thupi: pamene mukukayikira kuti muli ndi CMV retinitis, colitis, esophagitis, pneumonitis kapena encephalitis.
• Matenda ofanana ndi mononucleosis: kutentha thupi kwa nthawi yayitali, kutopa, kupweteka pakhosi ndi matenda a lymphadenopathy komwe kuyezetsa matenda opatsirana a mononucleosis (Epstein-Barr virus) kumakhala kopanda.
• Matenda a chiwindi kapena cytopenia osadziwika bwino kumene CMV ndi imodzi mwa njira zingapo zomwe zikuganiziridwa.

Ndani ayenera kuchita mayesowa?

• Obadwa kumene ndi zizindikiro zachipatala za matenda obadwa nawo kapena mayeso osagwira ntchito a kumva, oyesedwa ndi malovu kapena PCR ya mkodzo, makamaka mkati mwa masiku 21 kuchokera pamene mwana wabadwa.
• Azimayi ndi matenda ofanana ndi malungo, kapena ndi zovuta za ultrasound ya mwana wosabadwayo, zomwe zayesedwa potsatira upangiri wa dokotala wa za kubereka.
• Omwe amasamutsira maselo oyambira a ziwalo zolimba ndi magazi, opereka ndi olandira: motsatira ndondomeko ya chipangizo chosinthira.
• Anthu omwe ali ndi kachilombo ka HIV kapena omwe akutenga mankhwala amphamvu oletsa chitetezo chamthupi amene amaonetsa zizindikiro zosonyeza kuti ali ndi vuto, kuphatikizapo maso atsopano oyandama kapena maso osawona bwino, kutsegula m'mimba kosalekeza kapena kutentha thupi kosadziŵika.
• Anthu omwe ali ndi matenda ofanana ndi mononucleosis kwa nthawi yayitali zomwe sizikudziwikabe.

Kuyeza CMV nthawi zonse kwa akuluakulu athanzi, kapena amayi onse apakati, sikuvomerezedwa ndi aliyense ndipo kumakambidwabe. Kuyesa ndi chisankho cha dokotala, osati kusankha komwe kumadzipangira wekha.

Zimene mayeso a CMV sangazizindikire kapena kuzichotsa

• Sizingalekanitse matenda ndi matenda. DNA ya CMV imatha kupezeka m'magazi, mkodzo kapena m'malovu mwa munthu amene alibe matenda okhudzana ndi CMV. Kupezeka kokha sikutsimikizira kuti CMV ndiye imayambitsa zizindikiro.
• Kuyesa magazi kopanda umboni sikuchotsa matenda a CMV m'thupi. Matenda a CMV retinitis, colitis ndi matenda ena a chibayo amatha kuchitika ndi CMV DNA yochepa kapena yosaoneka bwino m'magazi. Kuzindikira matendawa kungafunike kuyezetsa retina mozama, endoscopy ndi biopsy, bronchoalveolar lavage kapena kuyezetsa CSF.
• Kukhala ndi IgM yabwino sikutsimikizira kuti munthu wayamba kudwala matendawa posachedwapa, ndipo IgM yoipa sikutanthauza kuti imachotsedwa, makamaka ngati yayesedwa msanga kwambiri kapena mochedwa kwambiri pa matendawa.
• Kuyezetsa kwa mayi sikukudziwitsani ngati mwana wosabadwayo ali ndi kachilomboka. Zimenezi zimafuna amniocentesis ndi madzi amniotic CMV PCR, nthawi zambiri pambuyo pa nthawi inayake ya mimba, ndipo ngakhale zimenezo zimakhala ndi chiŵerengero chabodza-choipa ngati zitachitika msanga kwambiri.
• PCR yoipa ya madzi amniotic sikutanthauza kuti mwana wosabadwayo wadwala matenda onse, ndipo sichilosera kuti ndi makanda ati omwe ali ndi kachilomboka omwe adzakhale ndi vuto la kumva kapena kukula.
• Mayeso a CMV sanena chilichonse chokhudza kumva kapena zotsatira za kukula kwa mitsempha. Anthu amenewa amafunika kuwunika momwe ana akumvera komanso kutsatira momwe ana akukulira pakapita nthawi.
• Chiwerengero cha mavairasi sichingafanane mwachindunji pakati pa ma laboratories. Ngakhale ndi muyezo wa IU/mL, malire oyambira kugwiritsa ntchito mankhwala oletsa mavairasi ndi a pa pulatifomu ndi protocol. Kuwunika kotsatizana kuyenera kuchitika pa pulatifomu yomweyo.
• Sizizindikira matenda ena a TORCH, kapena kukana mankhwala. Kukana ma virus komwe kukukayikiridwa kumafuna mayeso osiyana a genotypic kukana.

Zotsatira zomwe sizikusonyeza CMV zimafotokoza zomwe zinapezeka mu chitsanzocho panthawiyo. Sizofanana ndi CMV yomwe yachotsedwa. Ngati zizindikiro zikupitirirabe ngakhale zotsatira zake zili zabwinobwino kapena zoipa, bwererani kwa dokotala wanu.

Mayeso ofanana koma osiyana

Momwe mungakonzekerere

Kukonzekera sikokwanira, koma tsatanetsatane wa zosonkhanitsira umagwira ntchito ndipo umasiyana malinga ndi ma laboratories ndi zipatala. Malangizo olembedwa a chipinda chanu ndi omwe amaperekedwa patsogolo kuposa malangizo onse apa.

• Kusala kudya: Sikofunikira pa mayeso a CMV serology kapena CMV PCR. Ngati CMV ikutengedwa pamodzi ndi mayeso ena monga shuga kapena mafuta, tsatirani malangizo osala kudya pamayeso amenewo.
• Mankhwala: Pitirizani kumwa mankhwala onse olembedwa pokhapokha ngati dokotala wanu wakuuzani mwanjira ina. Uzani labotale ndi dokotala wanu za mankhwala oletsa mavairasi, mankhwala oletsa chitetezo chamthupi, immunoglobulin kapena magazi omwe angoperekedwa kumene, komanso kugwiritsa ntchito mankhwala azitsamba kapena zowonjezera zina.
• Kuwunika kuchuluka kwa mavairasi m'njira zosiyanasiyana: Funsani ngati zitsanzo ziyenera kusonkhanitsidwa nthawi yofanana, ndipo ngati n'kotheka, ku labotale yomweyo pogwiritsa ntchito nsanja yomweyo.
• Mkodzo ndi malovu: Zidebe ndi malamulo a nthawi zimasiyana malinga ndi labu. Zitsanzo za malovu mwa makanda nthawi zambiri zimasonkhanitsidwa osachepera ola limodzi atayamwa bere kapena botolo, chifukwa mkaka ungasokoneze mayeso.

Pregnancy

Kuyezetsa CMV pa nthawi ya mimba kuyenera kulamulidwa ndi kumasuliridwa ndi dokotala wanu wa za mimba. Ngati mwaganizira za amniocentesis, ndi njira yosiyana yokhala ndi chilolezo chake komanso kukambirana za zoopsa zake. Malinga ndi PC-PNDT Act 1994, ultrasound iliyonse yochitidwa pa nthawi ya mimba ku India iyenera kuchitidwa pamalo olembetsedwa ndipo siyenera kugwiritsidwa ntchito poyesa kugonana.

Makanda ndi ana

Kwa CMV yobadwa nayo yomwe ikuganiziridwa kuti ndi yobadwa nayo, nthawi yake ndi yofunika kwambiri kuposa china chilichonse: PCR ya malovu kapena mkodzo mkati mwa milungu itatu yoyambirira ya moyo imasiyanitsa matenda obadwa nawo ndi matenda omwe amapezeka atabadwa. Pambuyo pa masiku 21, zotsatira zabwino zimakhala zovuta kutanthauzira. Zotsatira zabwino nthawi zambiri zimatsimikiziridwa pa mkodzo.

Anthu olandira chithandizo chamankhwala ochepetsa mphamvu ya chitetezo chamthupi komanso anthu omwe ali ndi mankhwala oletsa kupanikizika kwa thupi

Musasinthe kapena kusiya mankhwala oletsa chitetezo chamthupi kapena mavairasi okha kutengera kuchuluka kwa mavairasi. Kusintha kuyenera kuchokera ku gulu lanu loikamo kapena matenda opatsirana.

Okalamba ndi anthu omwe ali ndi matenda ena

Kuboola m'mimba kungafunike chisamaliro chapadera kwa anthu omwe ali ndi mitsempha yofooka, matenda otuluka magazi kapena omwe amamwa mankhwala oletsa magazi kuundana. Tchulani kugwiritsa ntchito mankhwala oletsa magazi kuundana musanatenge magazi kuti magazi azitha kupanikizika kwa nthawi yayitali.

Zomwe zimachitika panthawi ya mayeso a CMV

• Chitsanzo cha magazi: Pakani tourniquet, khungu limatsukidwa, ndipo magazi amatengedwa kuchokera mumtsempha womwe uli m'dzanja. Singanoyo imakhala pamalo ake kwa mphindi imodzi yokha. Kuluma kwakanthawi komanso kuvulala nthawi zina ndi zachilendo.
• Chitsanzo cha mkodzo: Amasonkhanitsidwa m'chidebe chopanda tizilombo toyambitsa matenda. Mwa makanda, thumba losonkhanitsira ana kapena njira yotsukira imagwiritsidwa ntchito.
• Chitsanzo cha malovu: Pakanikizani swab mkati mwa tsaya. Palibe ululu.
• Madzi a amniotic, CSF, bronchoalveolar lavage kapena biopsy: yopezeka ngati gawo la njira yosiyana yachipatala yokhala ndi njira yakeyake yovomerezeka, yochitidwa pokhapokha ngati pali chifukwa chovomerezeka chachipatala.

Kodi njirayi imatenga nthawi yayitali bwanji

• Kutulutsa magazi: mphindi zochepa.
• Ulendo wonse wosonkhanitsa zitsanzo: nthawi zambiri zimatenga mphindi 15-30, kutengera ndi mizere yomwe ili pamalo osonkhanitsira zinthu.
• Kukonza za mu labotale: Seroloji ndi PCR zimayendetsedwa ndi gulu, kotero nthawi zoperekera malipoti zimasiyana malinga ndi labotale, mtundu wa chitsanzo komanso ngati mayesowo amatumizidwa ku labotale yowunikira. Kuyesa kwa PCR kochuluka ndi kuyesa kwa avidity nthawi zambiri kumatenga nthawi yayitali kuposa IgG/IgM yachizolowezi. Funsani malo anu osonkhanitsira kuti akuuzeni za nthawi yomwe akupereka malipoti.

Kumvetsetsa lipoti lanu la CMV

Malipoti amasiyana pakati pa ma laboratories m'mayunitsi, m'magawo odulidwa ndi m'mawu. Werengani zotsatira zanu molingana ndi mndandanda wa maumboni omwe adasindikizidwa pa lipoti lanu, osati molingana ndi ziwerengero zochokera ku lab ina kapena tsamba lawebusayiti.

Zotsatira za ma antibodies

• IgG yoipa, IgM yoipa: Palibe umboni wa m'ma laboratories wosonyeza kuti kale anali ndi kachilombo ka CMV. Mwa mayi wapakati izi zikutanthauza kuti ali pachiwopsezo, ndipo njira zodzitetezera ku ukhondo zimakhala zofunikira. Matenda atsopano mwina sanapange ma antibodies.
• IgG yabwino, IgM yoipa: Matenda a CMV akale, omwe ndi ofala kwambiri mwa akuluakulu aku India. Sizitanthauza kuti matendawa amabwereranso pambuyo pake.
• IgG yabwino, IgM yabwino: Matenda oyamba omwe angakhalepo posachedwapa, kuyambiranso kugwira ntchito, kapena IgM yosadziwika bwino. Kuyesa kwa mphamvu ya thupi ndi kubwerezanso kutengera zitsanzo nthawi zambiri kumafunika musanapange chisankho.
• IgG yoipa, IgM yoipa: ikhoza kusonyeza matenda oyamba kwambiri kapena IgM yabodza. Kuyesanso kubwereza pambuyo pa milungu ingapo, kufunafuna IgG seroconversion, nthawi zambiri kumafunika.

Zotsatira za PCR

• Sizinapezeke: DNA ya CMV sinapezeke mu chitsanzocho chomwe chinali pamwamba pa malire a kuyesedwa. Izi sizikutanthauza kuti matenda a ziwalo zogawanika m'magulu osiyanasiyana.
• Zapezeka, pansi pa mulingo woyezera: DNA yotsika kwambiri imapezeka. Nthawi zambiri imatsatiridwa ndi kuyezetsa mobwerezabwereza m'malo molandira chithandizo mwachangu.
• Chiwerengero cha ma virus (IU/mL): tanthauzo makamaka ngati chizolowezi chogwiritsa ntchito zitsanzo zingapo pa nsanja imodzi. Mipata yoyambira chithandizo cha ma virus imakhazikitsidwa ndi gawo lililonse la opaleshoni kapena ID; palibe malire amodzi omwe amaperekedwa kwa onse.

Palibe zotsatira za CMV zomwe ziyenera kutanthauziridwa padera. Dokotala amene anapempha mayesowa adzawerenga pamodzi ndi zizindikiro zanu, momwe chitetezo chanu chamthupi chilili, zithunzi ndi kafukufuku wina.

Pamene zotsatira za CMV zingakhale zosokeretsa

Zotsatira zomwe zingatchulidwe molakwika kapena zabwino molakwika

• IgM yosadziwika bwino m'matenda ena opatsirana ndi mavairasi, kuphatikizapo EBV, komanso pamaso pa rheumatoid factor kapena ma autoantibodies enaake.
• IgM yopitilira kwa miyezi yambiri pambuyo pa matenda omwe salinso ofunika kuchipatala.
• Zitsanzo zodetsedwa, makamaka malovu a makanda omwe amatengedwa nthawi yomweyo atangoyamwitsa, kapena mkodzo womwe umatengedwa popanda kutsukidwa bwino.
• Antibody yomwe imapezedwa mwangozi: Chithandizo chaposachedwa cha immunoglobulin kapena kuikidwa magazi kungapangitse kuti IgG ikhale ndi IgG yomwe imasonyeza woperekayo, osati wodwalayo. IgG ya mwana wakhanda imawonetsa kwambiri ma antibodies a amayi omwe amadutsa mu placenta, kotero IgG ya mwana wakhanda singathe kuzindikira CMV yobadwa nayo.
• DNA yopezeka koma yosafunikira: Ana aang'ono athanzi nthawi zambiri amataya CMV mu mkodzo ndi malovu kwa miyezi ingapo. Kupezeka kwa PCR yabwino mkodzo mwa mwana nthawi zambiri kumatanthauza kutaya magazi, osati matenda.

Zotsatira zomwe zingachepetsedwe molakwika kapena molakwika

• Kuyesa msanga kwambiri, ma antibodies asanapangidwe (nthawi yowonekera).
• Kuyankha kwa ma antibodies kofooka kapena kosakhalapo Kwa anthu omwe ali ndi vuto lalikulu la chitetezo chamthupi, agammaglobulinemia kapena omwe amalandira chithandizo chochepetsa maselo a B, mwa odwala awa, serology si yodalirika ndipo PCR ndi yomwe imakondedwa.
• Mankhwala oletsa mavairasi ayamba kale, zomwe zingachepetse kuchuluka kwa mavairasi osapezeka pamene matenda a ziwalo akupitirira.
• Matenda ophatikizidwa m'zipinda: Matenda a retinitis, colitis ndi matenda a CNS amatha kuchitika ndi PCR yoipa m'magazi.
• Kuchedwa kunyamula kapena kusungira kosayenera nucleic acid yomwe imawononga mu chitsanzocho.
• Kuyesa mwana wakhanda akakwanitsa milungu itatu, zomwe sizingasiyanitse matenda obadwa nawo ndi matenda obadwa nawo pambuyo pobereka.

Zoopsa ndi chitetezo

Kuyesa magazi, mkodzo ndi malovu

Kuboola mbolo ndi njira yochepetsera chiopsezo. Zotsatira zake zimaphatikizapo kupweteka kwakanthawi, kuvulala komanso kufooka mutu nthawi zina. Nthawi zambiri, kutuluka magazi pang'ono kapena matenda am'deralo pamalo oboola mbolo kumatha kuchitika. Kusonkhanitsa mkodzo ndi malovu sikubweretsa chiopsezo chakuthupi.

Kusanthula kwa CMV m'njira yosadziwika

Kuyeza magazi m'thupi (amniocentesis), kupunthwa kwa lumbar, bronchoscopy ndi endoscopic biopsy) chilichonse chimakhala ndi zoopsa zake, zomwe zimasiyana kwambiri ndi zomwe zimachitika poyesa magazi mosavuta. Njirazi zimachitika pokhapokha ngati funso lachipatala likutsimikizira kuti ndi lolondola, ndipo dokotala wochita izi adzafotokoza zoopsa zake ndikutenga chilolezo chosiyana.

Zinsinsi zachinsinsi

Zotsatira za CMV zimakhala gawo la mbiri yanu yaumoyo. Kusamalira deta yaumoyo waumwini ku India kumayendetsedwa ndi Digital Personal Data Protection Act 2023, ndipo mutha kufunsa labotale momwe deta yanu imasungidwira ndikugawidwa.

Zinthu zapadera

Pregnancy

Nkhawa yaikulu pa nthawi ya mimba ndi matenda oyamba a CMV, omwe ali ndi chiopsezo chachikulu chofalikira kwa mwana wosabadwayo kuposa kubwezeretsanso, ngakhale kubwezeretsanso kachilomboka kungayambitsenso CMV yobadwa nayo. Kusiyanitsa matenda oyamba ndi akale nthawi zambiri kumafuna serology yogwirizana, kuyezetsa kwa chipiriro komanso nthawi zina kusungidwa zitsanzo zoyambirira. Madzi a amniotic PCR ndiye mayeso omwe amathetsa matenda a mwana wosabadwayo, ndipo ali ndi malamulo ake a nthawi. Njira zoyezera ukhondo, kusamba m'manja mokwanira mutasintha matewera, kusagawana chakudya, ziwiya kapena ziwiya zakumwa ndi ana aang'ono, komanso kupewa kukhudzana ndi malovu a mwana wakhanda, ndi njira zothandiza zomwe nthawi zambiri zimalangizidwa.

Makanda ndi makanda

Matenda a CMV obadwa nawo ndi omwe amachititsa kuti munthu asamve bwino popanda kugwiritsa ntchito majini. Matenda a kumva amatha kuchitika munthu akangobadwa kapena akamakula, choncho mayeso amodzi okha a kumva sathetsa vutoli; kutsatira nthawi yokwanira kwa dokotala wodziwa bwino za matendawa kumafunika. Zisankho za chithandizo cha matenda a CMV obadwa nawo zimapangidwa ndi akatswiri a matenda opatsirana a ana, ndipo chithandizo cha mavairasi chimafuna kuyang'aniridwa mosamala kuti adziwe zotsatira zake.

Olandira kusintha

Chiwopsezo chimadalira kwambiri kuphatikiza kwa CMV IgG kwa wopereka ndi wolandira, chiwalo chomwe chaikidwa komanso mphamvu ya chitetezo chamthupi. Mayunitsi amagwiritsa ntchito njira zopewera mavairasi kapena njira zochizira matenda motsogozedwa ndi PCR. Njira zonsezi ndi zovomerezeka ndipo njira zimasiyana pakati pa zipatala.

Anthu omwe ali ndi kachilombo ka HIV

Chiwopsezo chachikulu chili pa kuchuluka kwa ma CD4 ochepa. CMV retinitis imatha kupitirira mpaka kutayika kosatha kwa maso, kotero chizindikiro chilichonse chatsopano cha maso chimafunika kufufuzidwa maso mwachangu osati kuyezetsa magazi kokha. Mankhwala othandiza ochepetsa ma ARV amachepetsa kwambiri chiopsezo cha matenda a CMV m'ziŵalo zamkati.

Anthu omwe ali ndi matenda a mtima, kulephera kwa mtima kapena kumwa mankhwala osiyanasiyana

Mankhwala oletsa mavairasi a CMV monga ganciclovir ndi valganciclovir amafunika kusintha mlingo wa mankhwala kuti impso zisamagwire bwino ntchito ndipo amatha kuchepetsa kuchuluka kwa magazi m'magazi. Kusankha mankhwala, mlingo ndi kuyang'anira ndi zisankho za gulu lopereka mankhwala.

Kuyesa kwa CMV ku India

• Kuchuluka kwa maselo m'thupi (seroprevalence) m'mbuyo: Kuchuluka kwa CMV IgG pakati pa akuluakulu aku India, kuphatikizapo akazi a msinkhu wobereka, n'kokwera. Izi zili ndi zotsatira zake: lipoti la IgG lokha lomwe lili ndi kachilomboka limayambitsa nkhawa zambiri zosafunikira ndipo nthawi zambiri silimasintha kasamalidwe kokha.
• Mapanelo a TORC akonzedwa modzidzimutsa: Ma profiles a TORCH nthawi zambiri amakonzedwa kumayambiriro kwa mimba kapena pambuyo pa kutaya mimba popanda chizindikiro china chachipatala. Izi nthawi zambiri zimapangitsa kuti IgG kapena IgM ikhale ndi zotsatira zabwino zomwe zimakhala zovuta kuchitapo kanthu. Funsani dokotala wa za mimba kuti ndi funso liti lachipatala lomwe mayesowa akuyenera kuyankha.
• Kukula kwa kuchuluka kwa zomera zobzala M'malo onse aku India, kuyang'anira kuchuluka kwa mavairasi a CMV kukhala gawo la chisamaliro chapadera mukangobereka mwana, ndipo njira zoyendetsera ntchito zimakhazikitsidwa m'deralo ndi chipinda chilichonse.
• Matenda a malungo ophatikizana: Ku India, kutentha thupi kwa nthawi yayitali komwe kumayenderana ndi hepatosplenomegaly ndi ma enzymes a chiwindi osazolowereka (SGPT/ALT, SGOT/AST) kungakhale chifukwa cha dengue, enteric fever, hepatitis A kapena E, chifuwa chachikulu, malungo kapena EBV. CMV iyenera kuganiziridwa pamodzi ndi izi, osati m'malo mwake.
• Kusiyanasiyana kwa Laboratory: Mapulatifomu ndi malire amasiyana kwambiri pakati pa ma laboratories aku India, zomwe ndizofunikira kwambiri poyerekeza kuchuluka kwa ma virus m'magawo osiyanasiyana. Kupitiliza kwa ma laboratories ndikofunikira kupempha.
• Kuwunika makutu a ana akhanda ikupezeka m'zipatala zambiri zaku India, ngakhale kuti si zonse. Kumene matenda a CMV obadwa nawo apezeka, funsani makamaka za nthawi yoti muwerengerenso kumva.

Mtengo ndi inshuwalansi ku India

Mitengo siili yofanana ku India konse ndipo imasintha pakapita nthawi. M'malo motchula chiwerengero, nazi zifukwa zomwe zimayambitsa izi:

• Mtundu wa mayeso: Kuyesa kwa CMV IgG kapena IgM immunoays ndikotsika mtengo kwambiri. Kuchuluka kwa PCR (viral load) ndi IgG avidity zimadula kwambiri chifukwa cha reagent ndi mtengo wa platform.
• Mayeso amodzi motsutsana ndi gulu: Gulu la TORCH limawononga ndalama zoposa mayeso amodzi a CMV, ndipo gawo lalikulu silingafunike kuchipatala.
• Mtundu wa chitsanzo ndi zovuta zake: Kuyesa madzi amniotic, CSF kapena minofu kumafuna kukonza kwina.
• Kuyesa kwamkati poyerekeza ndi kotumizidwa: Zitsanzo zotumizidwa ku labotale yowunikira zimawonjezera ndalama zoyendetsera zinthu ndi nthawi yopereka malipoti.
• Mzinda, gawo ndi kuvomerezeka: Mitengo ya sitima zapamtunda poyerekeza ndi mizinda yaying'ono, mitengo ya boma poyerekeza ndi ya anthu achinsinsi, komanso ma laboratories ovomerezeka ndi NABL akhoza kukhala osiyana.
• Kuthamanga: Kuwunika kuchuluka kwa mavairasi nthawi zonse mukatha kumuika munthu wina ndi ndalama zomwe zimabwerezedwa, nthawi zambiri zimakhala nkhani yaikulu pazachuma.

Inshuwalansi: Mayeso oyezetsa matenda omwe amachitidwa kunja kwa chipatala nthawi zambiri samaphatikizidwa mu inshuwalansi yazaumoyo yoyambira, pomwe kafukufuku wokhudza kulowa m'chipatala kapena pansi pa chisamaliro cha tsiku ndi tsiku kapena phindu loperekedwa pambuyo poika mwana m'thupi angafunike. Kuphimba pansi pa mapulani aboma monga Ayushman Bharat PM-JAY kumadalira phukusi lomwe chithandizocho chili. Tsimikizirani mtengo wapano ndi zofunikira zovomerezeka ndi labotale ndi kampani yanu ya inshuwaransi musanayesere.

Nthano ndi mfundo zenizeni

MAFUNSO OFUNSIDWA KAWIRIKAWIRI

Kodi mayeso a CMV amazindikira chiyani kwenikweni?

Kuyezetsa kwa CMV kumazindikira momwe thupi limayankhira ma antibodies ku cytomegalovirus (IgG, IgM, avidity) kapena DNA ya kachilomboka pogwiritsa ntchito PCR. Ma antibodies amasonyeza kufalikira kwa kachilomboka ndi nthawi yoyerekeza; PCR imasonyeza ngati DNA ya kachilomboka ilipo tsopano ndipo, ikachuluka, imasonyeza kuchuluka kwake. Palibe zotsatira zomwe zimasonyeza kuti CMV ikuyambitsa zizindikiro za munthu.

Ndi mayeso ati a CMV omwe ndiyenera kufunsa?

Zimenezo zimadalira kwambiri funso lachipatala, kotero si chisankho chomwe mungadzipangire nokha. Seroloji ikugwirizana ndi mafunso okhudza momwe chitetezo chamthupi chilili komanso matenda omwe akuganiziridwa kuti ali nawo posachedwapa pa nthawi ya mimba. PCR ikugwirizana ndi kupeza matenda a makanda obadwa kumene komanso kuyang'anira odwala omwe ali ndi chitetezo chamthupi chofooka. Dokotala wanu amasankha mayeso, mtundu wa chitsanzo ndi nthawi kutengera momwe mulili.

Kodi mayeso a CMV amapweteka?

Kutenga magazi kumayambitsa kuluma kwakanthawi ndipo nthawi zina kuvulala pang'ono. Kusonkhanitsa mkodzo ndi malovu sikupweteka. Zitsanzo zolowa m'thupi monga madzi amniotic kapena minofu ya biopsy ndi njira zosiyana zomwe zimakhala ndi kusasangalala kwawo komanso chiopsezo chawo, zomwe zafotokozedwa ndi dokotala amene amachita zimenezi.

Kodi CMV imasiyana bwanji ndi mayeso a monospot kapena EBV?

Kachilombo ka CMV ndi Epstein-Barr kangayambitse matenda ofanana ndi a mononucleosis omwe ali ndi malungo, kupweteka pakhosi, kutopa ndi kutupa kwa glands. Mayeso a monospot ndi EBV amafufuza EBV; mayeso a CMV amafufuza CMV. Kuyesa kopanda EBV sikuchotsa CMV, ndichifukwa chake nthawi zambiri awiriwa amapemphedwa pamodzi.

Kodi zotsatira za CMV zomwe zili zoipa zikutanthauza kuti ndilibe CMV?

Ayi. Zotsatira zoyipa zikutanthauza kuti CMV sinapezeke mu chitsanzo chimenecho pogwiritsa ntchito njira imeneyo panthawiyo. Kuyezetsa msanga kwambiri, kuletsa chitetezo chamthupi, mankhwala oletsa mavairasi, kapena matenda omwe ali m'chiwalo chimodzi chonsecho chingabweretse zotsatira zoyipa. Ngati zizindikiro zikupitirira, bwererani kwa dokotala kuti akawunikenso.

N’chifukwa chiyani kuyezetsa ana akhanda kuyenera kuchitika mkati mwa masabata atatu?

Asanafike masiku 21, mayeso a PCR a malovu kapena mkodzo amasonyeza kuti munthu ali ndi kachilombo ka HIV asanabadwe kapena pafupi ndi kubadwa. Pambuyo pake, CMV yomwe yatengedwa kuchokera ku mkaka wa m'mawere kapena kukhudzana kwambiri ndi matendawa sikungasiyanitsidwe ndi matenda obadwa nawo, zomwe zimasintha dongosolo lonse loyang'anira ndi kutsatira.

Kodi CMV ingachiritsidwe ndi mankhwala?

CMV singathe kuchotsedwa m'thupi, imakhalabe yobisika kwa moyo wonse. Mankhwala oletsa mavairasi monga ganciclovir ndi valganciclovir amatha kuwongolera kufalikira kwa kachilomboka ndikuchepetsa kuwonongeka kwa ziwalo mwa odwala osankhidwa. Chithandizo chimasungidwa pazochitika zinazake, chimafuna kuyang'aniridwa kuti adziwe zotsatira zake, ndipo chimasankhidwa ndi katswiri wochizira.

Kodi ndingachepetse bwanji mwayi wopeza CMV panthawi ya mimba?

Njira zothandiza zimayang'ana kwambiri pa ukhondo wozungulira ana aang'ono: kusamba m'manja bwino ndi sopo mutasintha matewera, kupukuta mphuno ndi kugwira zoseweretsa; kupewa kugawana chakudya, supuni, makapu kapena burashi ya mano; komanso kupewa kupsompsona ana aang'ono pakamwa. Zotsatira zake zimasiyana pakati pa anthu, ndipo palibe njira yochotseratu chiopsezocho.

Kodi ndiyenera kuchita chiyani ndi lipoti la CMV lomwe ndatenga ndekha?

Pitani kwa dokotala musanaganize. CMV serology yodziyimira payokha nthawi zambiri imabweretsa IgG yabwino, yomwe imayembekezeredwa mwa akuluakulu ambiri aku India ndipo nthawi zambiri siimasintha chilichonse. Kutanthauzira kumadalira zizindikiro zanu, momwe mulili ndi pakati komanso momwe chitetezo chanu chamthupi chilili, zomwe lipoti silingathe kupereka.

magwero

• Malo Oyang'anira ndi Kuteteza Matenda, Cytomegalovirus (CMV) ndi Congenital CMV Infection: chidule cha zachipatala ndi malangizo oyesera a labotale.
• Rawlinson WD, Boppana SB, Fowler KB, ndi ena. Matenda a cytomegalovirus obadwa nawo m'mimba ndi makanda: malingaliro ogwirizana popewa, kuzindikira, ndi kuchiza. Matenda Opatsirana a Lancet, 2017.
• Kotton CN, Kumar D, Caliendo AM, ndi ena. Malangizo Achitatu Ogwirizana Padziko Lonse Okhudza Kusamalira Cytomegalovirus mu Kuika Ziwalo Zolimba. Kusindikizidwa, 2018.
• Gulu Lotsogolera pa Malangizo Opewera ndi Kuchiza Matenda Opatsirana Mwayi mwa Akuluakulu ndi Achinyamata Omwe Ali ndi HIV (NIH/CDC/IDSA), gawo la matenda a Cytomegalovirus.
• Bungwe la World Health Organization International Standard for human cytomegalovirus DNA nucleic acid amplification techniques (maziko a IU/mL reporting).
• Lamulo Loletsa Kusankha Amuna ndi Akazi Asanatenge Mimba, 1994, Boma la India.
• Lamulo la Chitetezo cha Deta Yaumwini pa Intaneti, 2023, Boma la India.