Ukuhlolwa kwe-CMV (Ukuhlolwa kwe-Cytomegalovirus): Lokho Okukubonisayo, Lokho Okungakwazi, kanye Nendlela Yokufunda Umbiko Wakho

Ukuthatha okhiye

• Ukuhlolwa okubili okuhlukene, imibuzo emibili ehlukene: I-CMV serology iphendula ngokuthi "ingabe lo muntu usevezwe?"; i-CMV PCR iphendula ngokuthi "ingabe igciwane liyatholakala manje, futhi lingakanani?"
• Iningi labantu abadala eNdiya linesifo se-CMV IgG, ngakho-ke i-IgG enhle ngokwayo ivame ukusho ukuthi ike yabonakala esikhathini esidlule, hhayi ukugula kwamanje.
• Umphumela omuhle awusona isifo ngokuzenzakalelayo: I-CMV ingabonakala ngaphandle kokubangela noma yiziphi izimpawu, ikakhulukazi kubantu abaphilile.
• Isikhathi sinquma konke ngezingane ezisanda kuzalwa: I-CMV yokuzalwa iqinisekiswa kangcono nge-PCR yamathe noma yomchamo emavikini amathathu okuqala okuphila.
• Imiphumela idinga ukuchazwa ngokwezokwelapha ngudokotela owayala ukuhlolwa, kanye nezimpawu, isimo somzimba sokuzivikela kanye nolunye uphenyo. Imiphumela iyahlukahluka kuye ngezimo zomtholampilo ngazinye.

Nge-shazi

Obeye aziwe njengo

• Ukuhlolwa kwe-Cytomegalovirus
• Ukuhlolwa kwe-CMV IgG kanye ne-IgM; Ukuhlolwa kwe-antibody ye-CMV
• Ukuhlolwa kwe-CMV PCR; Ukuhlolwa kwe-DNA ye-CMV; Ukuhlolwa komthwalo wegciwane le-CMV; I-CMV quantitative PCR
• Ukuhlolwa kokushisekela kwe-CMV IgG
• Ngokuvamile eNdiya kucelwa "ukuhlolwa kwegazi kwe-CMV", "i-CMV titre" noma "i-TORCH CMV" (i-CMV ingenye yezingxenye zephaneli ye-TORCH)

Kuyini ukuhlolwa kwe-CMV

I-Cytomegalovirus iyigciwane lomndeni we-herpes. Ngemva kokutheleleka kokuqala, i-CMV ihlala emzimbeni isesimweni esicashile impilo yonke futhi ingaphinde ivuseleleke, ikakhulukazi lapho isimiso somzimba sokuzivikela sicindezelwe. Ngenxa yokuthi ukubambezeleka kuyinto evamile futhi engapheli, ukuhlolwa kwe-CMV kumayelana nokuhlukanisa izimo ezintathu ezahlukene: ezingakaze zitheleleke, ezingakaze zitheleleke ngaphambili kanye nezingakatholakali, noma ezisasebenza njengamanje.

Ukuhlolwa kwe-CMV akulona ukuhlolwa okukodwa. Amafomu ayinhloko yilawa:

• I-CMV IgG: kubonisa ukuchayeka esikhathini esidlule futhi kuyaqhubeka impilo yonke. Kusetshenziswa kakhulu ukuthola isimo somzimba sokuzivikela, isibonelo, ukuhlola abanikeli kanye nabamukeli ngaphambi kokufakelwa isitho noma iseli le-stem, noma ukuthola ukuthi owesifazane okhulelwe wayesevele echayeke yini ku-CMV ngaphambi kokukhulelwa.
• I-CMV IgM: Ingakhula ekuthelelekeni kwakamuva noma okuvuselelwa, kodwa i-IgM ingaqhubeka izinyanga futhi ingavela hhayi kwezinye izifo ezibangelwa amagciwane. I-CMV IgM akuyona uphawu oluthembekile lokutheleleka kwakamuva.
• Ukushisekela kwe-CMV IgG: Ukushesha okuncane kubonisa ukutheleleka cishe ezinyangeni ezimbalwa ezedlule; ukushesha okukhulu kubonisa ukutheleleka okudala. Isetshenziswa kakhulu ekukhulelweni ukusiza ekutholeni ukutheleleka okusolwayo kokuqala.
• I-CMV PCR (ukutholwa kwe-DNA): ithola izakhi zofuzo zegciwane. I-PCR elinganiselwe ibika umthwalo wegciwane kumayunithi aphesheya ngemililitha (IU/mL) futhi iyindlela ejwayelekile yokuqapha abantu abafakelwe igciwane kanye nezinye iziguli ezinegciwane elinokukhubazeka kwamasosha omzimba.

Kungani kwenziwa ukuhlolwa kwe-CMV

• Okusolwa ukuthi yi-CMV yokuzalwa: kumntwana osanda kuzalwa onekhanda elincane, onesisindo esincane sokukhulelwa, i-jaundice, isibindi noma i-spleen ekhuphukile, ukuqubuka kwe-petechial, ukuthathwa kwezithombe zekhanda okungavamile, noma ukuhlolwa kokuzwa kosana olusanda kuzalwa okungasebenzi kahle.
• Ukutheleleka okusolwayo kwe-CMV ngesikhathi sokukhulelwa: ngokuvamile ngemva kokugula okunomkhuhlane kanye nokuvuvukala kwama-lymph node, noma ngemva kokutholakele kwe-ultrasound okubonisa ukutheleleka kombungu.
• Umuthi wokufakelwa: Iziqondiso zesimo se-CMV IgG somnikeli kanye nomemukeli ukuhlukaniswa kwengozi kanye nokuvimbela; iziqondiso ze-PCR yokulinganisa elandelanayo yokwelashwa ngamagciwane ngaphambi kokusebenzisa umuthi.
• I-HIV ethuthukisiwe noma okunye ukucindezelwa okukhulu kwamasosha omzimba: uma kusolwa ukuthi i-CMV retinitis, i-colitis, i-oesophagitis, i-pneumonia noma i-encephalitis.
• Isifo esifana ne-mononucleosis: umkhuhlane ohlala isikhathi eside, ukukhathala, umphimbo obuhlungu kanye ne-lymphadenopathy lapho ukuhlolwa kwe-infectious mononucleosis (igciwane le-Epstein-Barr) kungabi naso.
• I-hepatitis noma i-cytopenia engachazeki lapho i-CMV ingenye yamathuba amaningana acatshangelwayo.

Ubani okufanele athole lolu vivinyo

• Izinsana ngezici zomtholampilo zokutheleleka kokuzalwa noma ukuhlolwa kokuzwa okuhlulekile, okuhlolwe nge-PCR yamathe noma yomchamo, okungcono kakhulu zingakapheli izinsuku ezingu-21 zokuzalwa.
• abesifazane abakhulelwe uma unesifo somkhuhlane esihambisanayo, noma uma unezinkinga ze-ultrasound yengane esanda kuzalwa, kuhlolwe ngeseluleko sikadokotela wokubelethisa owelaphayo.
• Abantu abazofakelwa amaseli e-stem-cell aqinile kanye nalawo angena egazini, abanikeli kanye nabamukeli: ngokwenqubo yeyunithi yokufakelwa.
• Abantu abane-HIV eseyithuthukile noma abasebenzisa ukwelashwa okunamandla okucindezela amasosha omzimba abathola izimpawu ezibonisa ukucasuka, okuhlanganisa ukubona okusha okuntantayo noma ukubona okufiphele, uhudo oluqhubekayo noma umkhuhlane ongachazeki.
• Abantu abanesifo esifana ne-mononucleosis isikhathi eside lokho akukatholakali.

Ukuhlolwa kwe-CMV okuvamile kwabantu abadala abanempilo, noma bonke abesifazane abakhulelwe, akukhuthazwa yibo bonke abantu futhi kusaxoxwa ngakho. Ukuthi ukuhlolwa kuyisinqumo sikadokotela okwelaphayo, akuyona into ozikhethela yona.

Lokho ukuhlolwa kwe-CMV okungenakukuthola noma okungakubandakanyi

• Ayikwazi ukuhlukanisa ukutheleleka nesifo. I-CMV DNA ingatholakala egazini, emchameni noma ematheni kumuntu ongenaso nhlobo isifo esihlobene ne-CMV. Ukutholwa kukodwa akubonisi ukuthi i-CMV ibangela izimpawu.
• I-PCR yegazi engemihle ayikususi isifo se-CMV esithinta izitho ezithile zomzimba. I-CMV retinitis, i-colitis kanye nezinye izimo ze-pneumonitis kungenzeka nge-CMV DNA ephansi noma engabonakali egazini. Ukuxilongwa kungadinga ukuhlolwa kwe-retinal okuvulekile, i-endoscopy nge-biopsy, i-bronchoalveolar lavage noma ukuhlolwa kwe-CSF.
• I-IgM enhle ayiqinisekisi ukutheleleka kokuqala kwamuva, futhi i-IgM engemihle ayikukhiphi ngaphandle, ikakhulukazi uma ihlolwe kusenesikhathi noma sekwephuzile kakhulu ekuguleni.
• Ukuhlolwa kukamama okunegciwane akukutsheli ukuthi ingane ithelelekile yini. Lokho kudinga i-amniocentesis nge-amniotic fluid CMV PCR, ngokuvamile ngemva kwefasitela elithile lokukhulelwa, futhi ngisho nalokho kuhambisana nesilinganiso esingalungile uma kwenziwa kusenesikhathi kakhulu.
• I-PCR ye-amniotic fluid engemihle ayikuvimbeli ngokuphelele ukutheleleka kwengane, futhi ayibikezeli ukuthi yiziphi izingane ezinegciwane ezizoba nezinkinga zokungezwa noma zokukhula.
• Ukuhlolwa kwe-CMV akusho lutho ngokuzwa noma umphumela wokuthuthukiswa kwemizwa. Labo badinga ukuhlolwa kwe-audiological kanye nokulandelwa kokukhula kwezingane ngokuhamba kwesikhathi.
• Izinombolo zomthwalo wegciwane aziqhathaniseki ngqo phakathi kwama-laboratory. Ngisho noma kubekwe amazinga e-IU/mL, imikhawulo yokuqala imithi yokulwa namagciwane iqondene neplatifomu kanye neprotokholi. Ukuqapha ngokulandelana kufanele kwenziwe endaweni efanayo.
• Ayiboni ezinye izifo ze-TORCH, noma ukumelana nemithi. Ukumelana namagciwane okusolwayo kudinga ukuhlolwa okuhlukile kokumelana nofuzo.

Umphumela ongabonisi i-CMV uchaza lokho okutholakale kuleyo sampula ngaleso sikhathi. Akufani nokuthi i-CMV ayitholakali. Uma izimpawu ziqhubeka naphezu komphumela ojwayelekile noma omubi, buyela kudokotela wakho.

Ukuhlolwa okuhlobene kodwa okuhlukile

Ungalungiselela kanjani

Ukulungiselela kuncane kakhulu, kodwa imininingwane yokuqoqa iyasebenza futhi iyahlukahluka phakathi kwama-laboratory nezibhedlela. Imiyalelo ebhaliwe yeyunithi yakho iza kuqala kunanoma yisiphi isiqondiso esijwayelekile lapha.

• Ukuzila ukudla: Akudingeki ku-CMV serology noma i-CMV PCR. Uma i-CMV idonswa kanye nezinye izivivinyo ezifana ne-glucose noma ama-lipid, landela imiyalelo yokuzila ukudla yalezo zivivinyo.
• Imithi: qhubeka nayo yonke imithi oyinikezwe udokotela ngaphandle kokuthi udokotela wakho akutshele ngokuqondile okuhlukile. Tshela ilabhorethri kanye nodokotela wakho ngemithi yokulwa namagciwane, imithi yokucindezela amasosha omzimba, i-immunoglobulin noma ukumpontshelwa igazi kwakamuva, kanye nanoma yikuphi ukusetshenziswa kwemithi noma izithasiselo.
• Ukuqapha umthamo wegciwane ngokulandelana: Buza ukuthi amasampula kufanele aqoqwe ngesikhathi esifanayo futhi, lapho kungenzeka, elabhorethri efanayo kusetshenziswa ipulatifomu efanayo.
• Umchamo namathe: Izitsha kanye nemithetho yesikhathi kuyahluka ngokwelabhorethri. Amasampula amathe ezinganeni ngokuvamile aqoqwa okungenani ihora ngemva kokudla ibele noma ibhodlela, ngoba ubisi lungaphazamisa ukuhlolwa.

ukukhulelwa

Ukuhlolwa kwe-CMV ngesikhathi sokukhulelwa kufanele ku-odwe futhi kuhunyushwe ngudokotela wakho wokubelethisa. I-Amniocentesis, uma icatshangelwe, inqubo ehlukile enemvume yayo kanye nengxoxo ngengozi. Ngaphansi koMthetho we-PC-PNDT ka-1994, noma iyiphi i-ultrasound eyenziwa ngesikhathi sokukhulelwa eNdiya kumele yenziwe esikhungweni esibhalisiwe futhi akumele isetshenziswe ukunquma ubulili.

Izinsana nezingane

Ku-CMV yokuzalwa okusolwayo, isikhathi sibaluleke kakhulu kunanoma yini enye: i-PCR yamathe noma yomchamo emavikini amathathu okuqala okuphila ihlukanisa ukutheleleka kokuzalwa nokutheleleka okutholakale ngemva kokuzalwa. Ngemva kwezinsuku ezingu-21, umphumela omuhle uba nzima ukuwuchaza. Umphumela omuhle wamathe uvame ukuqinisekiswa emchameni.

Abantu abathola izitho zokufakelwa kanye nabantu abasebenzisa imithi yokucindezela amasosha omzimba

Ungalokothi ulungise noma uyeke imithi yokucindezela amasosha omzimba noma imithi yokulwa namagciwane ngokwakho ngokusekelwe kwinani legciwane. Izinguquko kumele zivela eqenjini lakho lokufakelwa noma lezifo ezithathelwanayo.

Abantu abadala kanye nabantu abanezinye izifo

Ukubhoboza igazi kungadinga ukunakekelwa okwengeziwe kubantu abanemithambo ebuthakathaka, izinkinga zokopha noma abasebenzisa imithi yokuvimbela ukugabha kwegazi. Khuluma ngokusetshenziswa kwemithi yokuvimbela ukugabha kwegazi ngaphambi kokukhipha igazi ukuze kusetshenziswe ingcindezi isikhathi eside.

Kwenzekani ngesikhathi sokuhlolwa kwe-CMV

• Isampula yegazi: Kufakwa i-tourniquet, isikhumba siyahlanzwa, bese kukhishwa igazi emthanjeni osengalweni. Inaliti ihlala endaweni yayo isikhathi esingaphansi komzuzu. Ukuhlaba okufushane kanye nokulunywa ngezikhathi ezithile kuvamile.
• Isampula yomchamo: kuqoqwe esitsheni esingenamagciwane. Ezinsaneni, kusetshenziswa isikhwama sokuqoqa izingane noma indlela yokubamba ehlanzekile.
• Isampula yamathe: Kuhlikihlwa i-swab ngaphakathi esihlathini. Akubuhlungu.
• Uketshezi lwe-amniotic, i-CSF, ukuhlanza i-bronchoalveolar noma i-biopsy: etholwe njengengxenye yenqubo yomtholampilo ehlukile enenqubo yayo yemvume, eyenziwa kuphela lapho kufaneleke khona ngokwezokwelapha.

Inqubo ithatha isikhathi esingakanani

• Ukudonswa kwegazi: imizuzu embalwa.
• Ukuvakasha okuphelele kokuqoqwa kwesampula: ngokuvamile imizuzu eyi-15-30, kuye ngokuthi imigqa ikuphi esikhungweni sokuqoqa.
• Ukucutshungulwa kwelebhu: I-serology kanye ne-PCR ziqhutshwa ngeqoqo, ngakho-ke izikhawu zokubika ziyahlukahluka kuye ngelebhu, uhlobo lwesampula kanye nokuthi ukuhlolwa kuthunyelwa yini elebhu yokubhekisela. Ukuhlolwa kwe-PCR yobuningi kanye nokuhlolwa kwe-avidity ngokuvamile kuthatha isikhathi eside kune-IgG/IgM evamile. Cela isikhungo sakho sokuqoqa imibiko ngeshejuli yaso yamanje yokubika.

Ukuqonda umbiko wakho we-CMV

Imibiko iyahluka phakathi kwama-laboratory ngamayunithi, iziqephu kanye namagama. Funda umphumela wakho uqhathaniswe nohlu lwezinkomba oluphrintiwe embikweni wakho, hhayi uqhathaniswe nezibalo ezivela kwenye i-laboratory noma iwebhusayithi.

Imiphumela ye-antibody

• I-IgG negative, i-IgM negative: akukho bufakazi belebhu bokutheleleka kwe-CMV kwangaphambilini. Kowesifazane okhulelwe lokhu kusho ukuthi usesichengeni, futhi izinyathelo zokuphepha ziyaba yinto ebalulekile. Ukutheleleka kwakamuva kungenzeka ukuthi akukakhiqizi ama-antibodies.
• I-IgG enhle, i-IgM embi: ukutheleleka kwe-CMV okwedlule, okuyiphethini evame kakhulu kubantu abadala baseNdiya. Akukuvimbeli ukuvuselelwa kamuva.
• I-IgG enhle, i-IgM enhle: ukutheleleka okuyinhloko okungenzeka muva nje, ukuvuselelwa, noma i-IgM engaqondile. Ukuhlolwa kokuqina komzimba kanye nokuthatha amasampula okuphindaphindiwe kuvame ukudingeka ngaphambi kokufinyelela iziphetho.
• I-IgG negative, i-IgM enhle: kungase kubonise ukutheleleka kokuqala kwasekuqaleni noma i-IgM engalungile. Isampula ephindaphindwayo ngemva kwamasonto ambalwa, ifuna i-IgG seroconversion, ivame ukudingeka.

Imiphumela ye-PCR

• Akutholakalanga: I-CMV DNA ayitholakalanga kuleyo sampula engaphezu komkhawulo wokuhlolwa. Lokhu akukhiphi izifo zezitho ezihlukaniswe ngezigaba.
• Kutholwe, ngaphansi kobubanzi obungalinganiswa: i-DNA esezingeni eliphansi ikhona. Ngokuvamile ilandelwa ukuhlolwa okuphindaphindiwe kunokwelashwa okusheshayo.
• Umthamo wegciwane olinganiselwe (IU/mL): okubalulekile ikakhulukazi njengomkhuba wokusebenzisa amasampula alandelanayo epulatifomu efanayo. Izithiyo zokuqala ukwelashwa ngamagciwane zibekwa yiyunithi ngayinye yokufakelwa noma i-ID; akukho ukunqunywa okukodwa okujwayelekile.

Akukho mphumela we-CMV okufanele uhunyushwe wodwa. Udokotela ocele ukuhlolwa uzokufunda kanye nezimpawu zakho, isimo somzimba wakho wokuzivikela, izithombe kanye nolunye uphenyo.

Uma imiphumela ye-CMV ingadukisa

Imiphumela engaphakanyiswa ngokungeyikho noma ibe mihle ngokungeyikho

• I-IgM engacacile kwezinye izifo ezibangelwa amagciwane eziyingozi, okuhlanganisa i-EBV, kanye nokuba khona kwe-rheumatoid factor noma ama-autoantibodies athile.
• I-IgM eqhubekayo izinyanga eziningi ngemva kokutheleleka okungasabalulekile emtholampilo.
• Amasampula angcolile, ikakhulukazi amathe ezingane aqoqwa ngokushesha ngemva kokudla, noma umchamo uqoqwa ngaphandle kokuhlanzwa okufanele.
• I-antibody etholakale ngokungahleliwe: Ukwelashwa kwamuva kwe-immunoglobulin noma ukumpontshelwa igazi kungaveza i-IgG enhle ekhombisa umnikeli, hhayi isiguli. I-IgG yosana olusanda kuzalwa ibonisa kakhulu i-antibody kamama ewela i-placenta, ngakho-ke i-IgG yosana olusanda kuzalwa ayikwazi ukuthola i-CMV yokuzalwa.
• I-DNA etholakele kodwa engabalulekile: Izingane ezincane ezinempilo zivame ukulahla i-CMV emchameni nasematheni izinyanga eziningi. I-PCR yomchamo etholakala kahle enganeni encane ivame ukusho ukulahla, hhayi isifo.

Imiphumela engehliswa ngokungeyikho noma engemihle ngokungeyikho

• Ukuhlolwa kusenesikhathi kakhulu, ngaphambi kokuba ama-antibodies avele (isikhathi sokulinda).
• Impendulo ye-antibody ebuthakathaka noma engekho kubantu abanokucindezelwa okukhulu kwamasosha omzimba, i-agammaglobulinemia noma abasebenzisa ukwelashwa okuqeda amaseli e-B, kulaba ziguli i-serology ayithembekile futhi i-PCR iyathandwa.
• Ukwelashwa ngama-antiviral sekuqalile kakade, okunganciphisa umthwalo wegciwane ngaphansi kokutholakala ngenkathi isifo sezitho siqhubeka.
• Isifo esihlukaniswe ngamagumbi: I-retinitis, i-colitis kanye nesifo se-CNS kungenzeka nge-negative blood PCR.
• Ukuthutha okulibazisekile noma isitoreji esingafanele i-nucleic acid ewohlokayo kusampula.
• Ukuhlola usana olusanda kuzalwa ngemva kwamasonto amathathu ubudala, okungakwazi ukuhlukanisa ukutheleleka kokuzalwa nokutholwa ngemva kokuzalwa.

Izingozi nokuphepha

Ukuthatha isampula yegazi, umchamo namathe

I-Venepuncture inqubo enobungozi obuphansi. Imiphumela elindelekile ihlanganisa ubuhlungu obufushane, ukuklwebheka kanye nokukhanya kwekhanda ngezikhathi ezithile. Akuvamile ukuthi kube ne-hematoma encane noma ukutheleleka kwendawo endaweni yokubhoboza. Ukuqoqwa komchamo namathe akunangozi engokomzimba.

Isampula ehlaselayo ye-CMV

I-Amniocentesis, ukubhoboza i-lumbar, i-bronchoscopy kanye ne-endoscopic biopsy ngayinye inezingozi zayo ezihlukile, ezihluke kakhulu kulezo zokuhlolwa kwegazi okulula. Lezi zinqubo zenziwa kuphela uma umbuzo wezokwelapha uzithethelela, futhi udokotela osebenzayo uzochaza izingozi ezithile futhi athathe imvume ehlukile.

Ubumfihlo bedatha

Imiphumela ye-CMV iyingxenye yerekhodi lakho lezempilo. Ukuphathwa kwedatha yezempilo yomuntu siqu eNdiya kulawulwa yi-Digital Personal Data Protection Act 2023, futhi ungabuza ilabhorethri ukuthi idatha yakho igcinwa futhi yabelwana ngayo.

Izimo ezikhethekile

ukukhulelwa

Okukhathazayo ekukhulelweni ukutheleleka kwe-CMV okuyinhloko, okuthwala ingozi enkulu yokudluliselwa embungwini kunokuvuselelwa, yize ukuvuselelwa kabusha nokutheleleka kabusha nakho kungabangela i-CMV yokuzalwa. Ukuhlukanisa ukutheleleka okuyinhloko nokwedlule kuvame ukudinga i-serology ehambisanayo, ukuhlolwa kokushesha kanye namasampula agcinwe ngezinye izikhathi. I-PCR yoketshezi lwe-amniotic ukuhlolwa okubhekana nokutheleleka kwe-fetus, futhi inemithetho yayo yesikhathi. Izinyathelo zokuhlanzeka, ukugeza izandla ngokuphelele ngemva kokushintsha amanabukeni, ukungabelani ngokudla, izitsha noma izitsha zokuphuza nezingane ezincane, kanye nokugwema ukuthintana namathe omntwana omncane, yizinyathelo ezisebenzayo ezivame ukwelulekwa.

Izinsana nezinsana

I-CMV yokuzalwa iyimbangela ehamba phambili yokulahlekelwa ukuzwa okungeyona eyezakhi zofuzo. Ukulahlekelwa ukuzwa kungaba khona ekuzalweni noma kuvele kamuva ebuntwaneni, ngakho-ke ukuhlolwa kokuzwa okuvamile okukodwa akuyixazululi le ndaba; kudingeka ukulandelwa kwe-audiological okuhleliwe. Izinqumo zokwelapha i-CMV yesifo sokuzalwa esinezimpawu zenziwa odokotela bezingane ezisanda kuzalwa kanye nochwepheshe bezifo ezithathelwanayo zezingane, kanti ukwelashwa ngamagciwane kudinga ukuqapha eduze imiphumela emibi.

Abamukeli bokufakelwa

Ingozi incike kakhulu ekuhlanganisweni kwe-CMV IgG yomnikeli kanye nowamukelayo, isitho esitshaliwe kanye nobukhulu bokucindezelwa kwamasosha omzimba. Amayunithi asebenzisa i-universal antiviral prophylaxis noma ukwelashwa kwangaphambili okuqondiswa yi-serial PCR. Zombili izindlela zisemthethweni futhi izinqubo ziyahlukahluka phakathi kwezibhedlela.

Abantu abaphila ne-HIV

Ingozi enkulu itholakala ekubalweni kwe-CD4 okuphansi. I-CMV retinitis ingaqhubekela ekulahlekelweni kokubona okungenakuguqulwa, ngakho-ke noma yiluphi uphawu olusha lokubona ludinga ukuhlolwa kwamehlo ngokushesha kunokuhlolwa kwegazi kuphela. Ukwelashwa okuphumelelayo kwe-antiretroviral kunciphisa kakhulu ingozi yesifo se-CMV end-organ.

Abantu abane-CKD, ukwehluleka kwenhliziyo noma abasebenzisa imithi eminingi

Ama-antiviral e-CMV afana ne-ganciclovir kanye ne-valganciclovir adinga ukulungiswa komthamo ekusebenzeni kwezinso okunciphile futhi anganciphisa inani legazi. Ukukhetha umuthi, umthamo kanye nokuqapha kuyisinqumo sethimba elinikeza umuthi.

Ukuhlolwa kwe-CMV kumongo waseNdiya

• Ukwanda kwe-seroprevalence ngemuva okuphezulu: Ukutholakala kwe-CMV IgG kubantu abadala baseNdiya, okuhlanganisa nabesifazane abaseminyakeni yokuzala, kuphakeme. Lokhu kunomphumela osebenzayo: umbiko we-IgG omuhle ohlukile ubangela ukukhathazeka okukhulu okungadingekile futhi akuvamile ukushintsha ukuphathwa ngokwako.
• Amaphaneli e-TOCH ahlelwe ngokubonakalayo: Amaphrofayili e-TOCH abanzi avame ukuhleleka ekuqaleni kokukhulelwa noma ngemva kokulahlekelwa ukukhulelwa ngaphandle kwenkomba ethile yezokwelapha. Lokhu kuvame ukukhiqiza imiphumela emihle ye-IgG noma imiphumela emihle ye-IgM okunzima ukuyenza. Buza udokotela wakho wezifo zokubelethisa ukuthi yimuphi umbuzo wezokwelapha ohloselwe ukuwuphendula.
• Ukukhula komthamo wokufakelwa kuzo zonke izikhungo zaseNdiya zenze ukuqapha i-CMV viral load kwaba yingxenye evamile yokunakekelwa ngemva kokutshalwa kwesitshalo, ngezinqubo ezibekwe endaweni yiyunithi ngayinye.
• Izifo zomkhuhlane ezihambisanayo: eNdiya, umkhuhlane omude one-hepatosplenomegaly kanye nama-enzyme esibindi angajwayelekile (i-SGPT/ALT, i-SGOT/AST) kungenzeka ukuthi ubangelwa yi-dengue, umkhuhlane we-enteric, i-hepatitis A noma i-E, isifo sofuba, umalaleveva noma i-EBV. I-CMV kufanele icatshangelwe kanye nalawa mathuba, hhayi esikhundleni salokho.
• Ukwehlukahluka kwelebhu: Amapulatifomu kanye nokunqunywa kwezindlela kuhluka kakhulu phakathi kwama-laboratories aseNdiya, okubaluleke kakhulu uma kuqhathaniswa imithwalo yegciwane elandelanayo. Ukuqhubeka kwe-laboratories kufanelekile ukucelwa.
• Ukuhlolwa kokuzwa kwezinsana iyatholakala ezibhedlela eziningi zaseNdiya, nakuba kungezona zonke. Lapho kutholakala khona i-CMV yokuzalwa, buza ngokuqondile ngesheduli yokuhlolwa kokuzwa okuphindaphindiwe.

Izindleko kanye nomshuwalense eNdiya

Izindleko azilinganiswa kulo lonke elaseNdiya futhi ziyashintsha ngokuhamba kwesikhathi. Esikhundleni sokucaphuna isibalo, nazi izici ezisibangela lokhu:

• Uhlobo lokuhlolwa: Ukuhlolwa kwamasosha omzimba kwe-CMV IgG noma i-IgM kubiza kancane. I-Quantitative PCR (viral load) kanye ne-IgG avidity kubiza kakhulu ngenxa yezindleko ze-reagent kanye ne-platform.
• Ukuhlolwa okukodwa uma kuqhathaniswa nephaneli: Iphaneli ye-TORCH ibiza okungaphezu kokuhlolwa okukodwa kwe-CMV, futhi ingxenye enkulu yephaneli ingase ingadingeki ngokwezokwelapha.
• Uhlobo lwesampula kanye nobunzima: Ukuhlola uketshezi lwe-amniotic, i-CSF noma izicubu kuhilela ukucubungula okwengeziwe.
• Ukuhlolwa kwangaphakathi uma kuqhathaniswa nokuhlolwa okudluliselwe kwabanye: amasampula athunyelwe elabhorethri yokubhekisela engeza izindleko zezokuthutha kanye nesikhathi sokubika.
• Idolobha, umkhakha kanye nokugunyazwa: Intengo yesitimela esingaphansi komhlaba uma iqhathaniswa neyasemadolobheni amancane, uhulumeni uma iqhathaniswa neyangasese, kanye nezindawo zokucwaninga ezigunyazwe yi-NABL zingase zibe nentengo ehlukile.
• Ukuvama: Ukuqapha inani legciwane elilandelanayo ngemva kokufakelwa kuyindleko ephindaphindayo, ngokuvamile kuyindleko enkulu ngokwezimali.

Umshwalense: izivivinyo zokuxilonga ezenziwa esibhedlela ngaphandle zivame ukukhishwa kumshuwalense wezempilo oyisisekelo, kuyilapho uphenyo ngesikhathi sokwamukelwa noma ngaphansi kwesibonelelo esithile sokunakekelwa kwasemini noma sokufakelwa isitshalo lungambozwa. Ukumbozwa ngaphansi kwezinhlelo zikahulumeni ezifana ne-Ayushman Bharat PM-JAY kuncike ephaketheni lokwelashwa eliwela ngaphansi kwalo. Qinisekisa intengo yamanje kanye nezidingo zokugunyazwa kusengaphambili nelabhorethri kanye nomshwalense wakho ngaphambi kokuhlolwa.

Izinganekwane namaqiniso

Imibuzo ejwayelekile ukubuzwa

Yini ngempela etholwa ukuhlolwa kwe-CMV?

Ukuhlolwa kwe-CMV kuthola impendulo yomzimba ye-antibody ku-cytomegalovirus (IgG, IgM, avidity) noma i-DNA yegciwane uqobo nge-PCR. Ama-antibodies abonisa ukuchayeka kanye nesikhathi esilinganiselwe; i-PCR ikhombisa ukuthi i-DNA yegciwane ikhona yini manje nokuthi, uma ilinganiswa, ingakanani. Akukho miphumela yodwa efakazela ukuthi i-CMV ibangela izimpawu zomuntu.

Yikuphi ukuhlolwa kwe-CMV okufanele ngikucele?

Lokho kuncike ngokuphelele embuzweni wezokwelapha, ngakho-ke akuyona into ongayenza wena ngokwakho. I-Serology ifanelana nemibuzo yesimo somzimba kanye nokutheleleka okusolwayo kwakamuva ngesikhathi sokukhulelwa. I-PCR ifanelana nokuxilongwa kwezinsana kanye nokuqapha iziguli ezine-immune ebuthakathaka. Udokotela wakho ukhetha isivivinyo, uhlobo lwesampula kanye nesikhathi ngokusekelwe esimweni sakho.

Ingabe ukuhlolwa kwe-CMV kubuhlungu?

Ukudonswa kwegazi kubangela ukuhlaba isikhashana futhi ngezinye izikhathi kube nokuklwebheka okuncane. Ukuqoqwa komchamo namathe akubuhlungu. Amasampula ahlaselayo njenge-amniotic fluid noma izicubu ze-biopsy yizinqubo ezihlukene ezinokungakhululeki kwazo kanye nephrofayili yazo yengozi, echazwa udokotela owenza lokho.

Ihluke kanjani i-CMV ku-monospot noma i-EBV test?

Kokubili igciwane le-CMV ne-Epstein-Barr kungabangela isifo esifana ne-mononucleosis esinomkhuhlane, umphimbo obuhlungu, ukukhathala kanye nezindlala ezivuvukele. I-Monospot ne-EBV serology zifuna i-EBV; Ukuhlolwa kwe-CMV kubheka i-CMV. Ukuhlolwa kwe-EBV okungenayo i-negative akukukhiphi i-CMV, yingakho lokhu kokubili kuvame ukucelwa ndawonye.

Ingabe umphumela we-CMV ongemuhle usho ukuthi anginayo i-CMV?

Cha. Umphumela ongemuhle usho ukuthi i-CMV ayitholakalanga kuleyo sampula ngaleyo ndlela ngaleso sikhathi. Ukuhlolwa kusenesikhathi, ukucindezelwa kwamasosha omzimba, ukwelashwa kwangaphambilini ngamagciwane, noma isifo esivalelwe esithweni esisodwa konke kungaveza umphumela ongemuhle. Uma izimpawu ziqhubeka, buyela kudokotela wakho ukuze ahlolwe kabusha.

Kungani ukuhlolwa kwezinsana kufanele kwenzeke zingakapheli amasonto amathathu?

Ngaphambi kwezinsuku ezingu-21 ubudala, i-PCR yamathe noma yomchamo etholakele ikhombisa ukutheleleka okutholakale ngaphambi noma eduze kokuzalwa. Ngemva kwalokho, i-CMV ethathwe obisini lwebele noma ukuxhumana okuseduze ayikwazi ukuhlukaniswa nokutheleleka kokuzalwa, okushintsha lonke uhlelo lokuphatha nokulandelela.

Ingabe i-CMV ingelapheka ngemithi?

I-CMV ayikwazi ukususwa emzimbeni, ihlala ifihliwe impilo yonke. Ama-antiviral afana ne-ganciclovir kanye ne-valganciclovir angalawula ukuphindaphinda okusebenzayo futhi anciphise ukulimala kwezitho ezigulini ezikhethiwe. Ukwelashwa kugcinelwe izimo ezithile, kudinga ukubhekwa kwemiphumela emibi, futhi kunqunywa uchwepheshe wezokwelapha.

Nginganciphisa kanjani amathuba okuthola i-CMV ngesikhathi sokukhulelwa?

Izinyathelo ezisebenzayo zigxile ekuhlanzekeni okuzungezile izingane ezincane: geza izandla kahle ngensipho ngemva kokushintsha amanabukeni, ukusula impumulo nokuphatha amathoyizi; gwema ukwabelana ngokudla, izipuni, izinkomishi noma amabhulashi amazinyo; futhi gwema ukuqabula izingane ezincane emlonyeni. Imiphumela iyahlukahluka phakathi kwabantu, futhi akukho silinganiso esisusa ingozi ngokuphelele.

Yini okufanele ngiyenze ngombiko we-CMV engiwuthathele mina?

Yiyise kudokotela ngaphambi kokufinyelela esiphethweni. I-serology ye-CMV ezihlelele yona ivame ukubuyisa i-IgG enhle, okulindeleke kubantu abadala abaningi baseNdiya futhi akuvamile ukushintsha lutho. Ukuchazwa kuncike ezimpawini zakho, isimo sokukhulelwa kanye nesimo somzimba wakho wokuzivikela, okungekho umbiko ongakwazi ukukunikeza.

Imithombo

• Izikhungo Zokulawula Nokuvimbela Izifo, i-Cytomegalovirus (CMV) kanye Nokutheleleka Kwe-CMV Yokuzalwa: ukubuka konke kwezokwelapha kanye nesiqondiso sokuhlolwa kwelebhu.
• URawlinson WD, uBoppana SB, uFowler KB, nabanye. Ukutheleleka kwe-cytomegalovirus okuzelwe ngesikhathi sokukhulelwa kanye nosana: izincomo ezivumelanayo zokuvimbela, ukuxilongwa, kanye nokwelashwa. Izifo ezithathelwanayo zeLancet, 2017.
• UKotton CN, uKumar D, uCaliendo AM, nabanye. Iziqondiso Zesivumelwano Sesithathu Samazwe Ngamazwe Zokuphathwa Kwegciwane Le-Cytomegalovirus Ekutshalweni Kwezitho Eziqinile. Ukufakelwa kwezitshalo, 2018.
• Iphaneli Yeziqondiso Zokuvimbela Nokwelapha Izifo Ezingena Ngengozi Kubantu Abadala Nentsha Ene-HIV (NIH/CDC/IDSA), isigaba sesifo se-Cytomegalovirus.
• I-World Health Organisation International Standard for human cytomegalovirus DNA nucleic acid amplification techniques (isisekelo sokubika i-IU/mL).
• Umthetho Wokuvimbela Ukukhetha Ubulili Ngaphambi Kokukhulelwa kanye Nezindlela Zokuxilonga Ngaphambi Kokuzalwa, 1994, Uhulumeni waseNdiya.
• Umthetho Wokuvikelwa Kwedatha Yomuntu Siqu Yedijithali, 2023, Uhulumeni waseNdiya.