izindaba

Eminyakeni eyikhulu edlule, indoda eneminyaka engu-24 ubudala yangeniswa eMassachusetts General Hospital (MGH) inomkhuhlane, ukukhwehlela, nokuphefumula kanzima.
Isiguli sase siphile kahle izinsuku ezintathu ngaphambi kokuba silaliswe, sabe sesiqala ukuzizwa singaphilile, nokukhathala okuvamile, ikhanda elibuhlungu nobuhlungu beqolo. Isimo sakhe saba sibi kakhulu ezinsukwini ezimbili ezalandela futhi wachitha isikhathi esiningi embhedeni. Ngolunye usuku ngaphambi kokungeniswa, waba nomkhuhlane omkhulu, ukukhwehlela okomile nokugodola, isiguli esikuchaze ngokuthi “ukuqoshama” futhi asikwazi nhlobo ukuvuka embhedeni. Wathatha u-648 mg we-aspirin njalo emahoreni amane futhi wezwa ukukhululeka kancane ekhanda elibuhlungu kanye neqolo. Kodwa-ke, ngosuku lokungeniswa kwakhe, wafika esibhedlela ngemuva kokuvuka ekuseni ephethwe yi-dyspnea, ehambisana nesifuba se-subxiphoid, esibhebhezelwa ukuphefumula nokukhwehlela.
Ekungenweni, izinga lokushisa le-rectal lalingu-39.5 ° C kuya ku-40.8 ° C, izinga lokushaya kwenhliziyo lalingu-92 kuya ku-145 beats / min, futhi izinga lokuphefumula lalingu-28 kuya ku-58 beats / min. Isiguli sinokubukeka okuthuthumela nokubi. Nakuba bezisongwe ngezingubo zokulala eziningi, amakhaza aqhubeka. Ukuphefumula, okuhambisana ne-paroxysms yokukhwehlela okukhulu, okuholela ebuhlungu obukhulu ngaphansi kwe-sternum, ukukhwehlela i-phlegm pink, i-viscous, i-purulent kancane.
I-apical pulsation yayizwakala endaweni yesihlanu ye-intercostal ohlangothini lwesobunxele lwe-sternum, futhi akukho ukukhuliswa kwenhliziyo okubonwe ekushaywayo. I-Auscultation yembula ukushaya kwenhliziyo okusheshayo, isigqi senhliziyo esingaguquki, okuzwakalayo phezulu kwenhliziyo, nokububula kancane kwe-systolic. Imisindo yokuphefumula encishisiwe ohlangothini lwesokudla lomhlane kusukela kokukodwa kokuthathu ngaphansi kwamahlombe ehlombe, kodwa awekho ama-rales noma ama-pleural fricatives azwakalayo. Ububomvu obuncane nokuvuvukala emphinjeni, amathoni asusiwe. Isibazi sokuhlinzwa kokulungiswa kwe-inguinal kwesokunxele sibonakala esiswini, futhi akukho ukuvuvukala noma ububele esiswini. Isikhumba esomile, izinga lokushisa eliphezulu lesikhumba. Isibalo samangqamuzana amhlophe egazi sasiphakathi kuka-3700 no-14500/ul, kanti ama-neutrophils abalelwa ku-79%. Akukho ukukhula kwebhaktheriya okubonwe esikweni legazi.
I-radiograph yesifuba ibonisa izithunzi ezicashile kuzo zombili izinhlangothi zamaphaphu, ikakhulukazi engxenyeni engenhla kwesokudla kanye nelobe engezansi kwesokunxele, okubonisa inyumoniya. Ukwandiswa kwe-hilum yesokunxele yephaphu kusikisela ukukhuliswa kwe-lymph node, ngaphandle kokuphuma kwe-pleural kwesokunxele.

Ngosuku lwesibili lokulaliswa esibhedlela, isiguli sasine-dyspnea kanye nobuhlungu besifuba obuqhubekayo, futhi isikhwehlela sasikhukhumezekile futhi sinegazi. Ukuhlolwa ngokomzimba kwabonisa ukuthi kwakukhona ukububula kwe-systolic phezulu kwephaphu, futhi ukushaywa phansi kwephaphu elingakwesokudla kwakufiphele. Ama-papules amancane, aminyene avela entendeni yesobunxele kanye nomunwe wenkomba wesokudla. Odokotela bachaze isimo sesiguli “njengesimuncu”. Ngosuku lwesithathu, isikhwehlela se-purulent sabonakala kakhulu. Ubuthuntu bengemuva elingezansi kwesokunxele buye bathuthukiswa ngenkathi ukundindizela okuthintekayo kwenziwa kubi. Imisindo yokuphefumula kwe-bronchial kanye nama-rales ambalwa angazwakala ngakwesokunxele emuva ingxenye yesithathu yendlela eya phansi ukusuka ehlombe lehlombe. Ukushaywa kwesokudla emuva kuthuntubeze kancane, imisindo yokuphefumula ikude, futhi ama-rales ayenzeka ngezikhathi ezithile ayazwakala.
Ngosuku lwesine, isimo sesiguli saba sibi nakakhulu futhi sashona ngalobo busuku.

Ukuxilongwa

Owesilisa oneminyaka engu-24 ubudala walaliswa esibhedlela ngo-March 1923 enomkhuhlane omkhulu, amakhaza, ubuhlungu bemisipha, ukuphelelwa umoya, nobuhlungu besifuba be-pleurisy. Izimpawu nezimpawu zakhe zihambisana kakhulu nokutheleleka ngegciwane lokuphefumula, njengomkhuhlane, okungenzeka kube nokutheleleka kwesibili kwebhaktheriya. Njengoba kunikezwe ukuthi lezi zimpawu zifana kakhulu nezimo phakathi nobhubhane lomkhuhlane we-1918, umkhuhlane cishe uwukuxilongwa okunengqondo kakhulu.

Yize ukubonakaliswa kwemitholampilo kanye nezinkinga zomkhuhlane wesimanje kufana kakhulu nalezo zobhubhane lwango-1918, umphakathi wesayensi wenze impumelelo ebalulekile emashumini ambalwa eminyaka edlule, okuhlanganisa ukuhlonza nokuhlukaniswa kwamagciwane omkhuhlane, ukuthuthukiswa kwamasu okuxilonga ngokushesha, ukwethulwa kokwelashwa okuphumelelayo kwe-antiviral, kanye nokuqaliswa kwezinhlelo zokugada kanye nokugoma. Uma sibheka emuva kubhadane lomkhuhlane wango-1918 akubonisi nje kuphela izifundo zomlando, kodwa futhi kusilungiselela kangcono ubhadane lwesikhathi esizayo.
Ubhubhane lomkhuhlane wango-1918 lwaqala e-United States. Icala lokuqala eliqinisekisiwe lenzeka ngoMashi 4, 1918, kumpheki Wezempi eFort Riley, eKansas. Ngemuva kwalokho uLorrin Miner, udokotela eHaskell County, Kansas, wabhala amacala ayi-18 omkhuhlane onzima, okuhlanganisa nokufa kwabantu abathathu. Ubike lokhu okutholakele eMnyangweni Wezempilo Yomphakathi wase-US, kodwa akuzange kuthathwe ngokungathi sína.
Izazi-mlando zikholelwa ukuthi ukwehluleka kweziphathimandla zezempilo zomphakathi ngaleso sikhathi ukuphendula kulokhu kuqubuka kwakuhlobene kakhulu nomongo okhethekile weMpi Yezwe Yokuqala. Ukuze ugweme ukuthikameza impi, uhulumeni akazange akhulume ngobunzima bokuqubuka kwalesi sifo. UJohn Barry, umbhali weThe Great Flu, ukugxekile lokhu engxoxweni yango-2020: “Uhulumeni unamanga, ubiza umkhuhlane ojwayelekile, futhi abawutsheli umphakathi iqiniso.” Ngokuphambene nalokho, iSpain, izwe elalingathathi hlangothi ngaleso sikhathi, kwaba ngeyokuqala ukubika umkhuhlane kwabezindaba, okuholele ekutheni ukutheleleka ngegciwane kuqanjwe ngokuthi “umkhuhlane waseSpain,” yize amacala okuqala aqoshwa e-United States.
Phakathi kuka-September no-December 1918, abantu abalinganiselwa ku-300,000 babulawa umkhuhlane e-United States, inani eliphindwe ka-10 inani labantu ababulawa yizo zonke izimbangela e-United States ngesikhathi esifanayo ngo-1915. Umkhuhlane usakazeka ngokushesha ngokuthunyelwa kwezempi nokunyakaza kwabasebenzi. Amasosha akahambanga nje kuphela phakathi kwezindawo zokuthutha empumalanga, kodwa futhi athwala leli gciwane ezinkundleni zempi zase-Europe, esakaza umkhuhlane emhlabeni wonke. Kulinganiselwa ukuthi bangaphezu kwezigidi ezingu-500 abantu abangenwe yileli gciwane kanti ababalelwa ezigidini eziyikhulu balahlekelwe izimpilo zabo.
Ukwelashwa kwakulinganiselwe kakhulu. Ukwelashwa ngokuyinhloko kuyadambisa, okuhlanganisa ukusetshenziswa kwe-aspirin nama-opiates. Okuwukuphela kwendlela yokwelapha okungenzeka ukuthi isebenze ukumnika kwe-plasma ye-convalescent - namuhla eyaziwa ngokuthi i-convalescent plasma therapy. Kodwa-ke, imithi yokugomela umkhuhlane ibambezelekile ukufika ngoba ososayensi abakayitholi imbangela yomkhuhlane. Ngaphezu kwalokho, ngaphezu kwengxenye eyodwa kwezintathu yodokotela nabahlengikazi baseMelika baye basuswa ngenxa yokuhileleka kwabo empini, okushiya izinsiza zezokwelapha ziyindlala nakakhulu. Nakuba imishanguzo yokugomela ikholera, i-typhoid, isifo sofuba, ne-smallpox yayitholakala, ukwakhiwa komgomo womkhuhlane kwakungakabibikho.
Ngezifundo ezibuhlungu zobhubhane lomkhuhlane wango-1918, safunda ukubaluleka kokudalulwa kolwazi olusobala, ukuthuthukiswa kocwaningo lwesayensi, nokubambisana kwezempilo yomhlaba wonke. Lokhu kuzizwisa kunikeza imininingwane ebalulekile yokubhekana nezinsongo zezempilo zomhlaba wonke ezifanayo esikhathini esizayo.

Igciwane

Iminyaka eminingi, i-agent ebangela "umkhuhlane waseSpain" kwakucatshangwa ukuthi i-bacterium Pfeiffer (manje eyaziwa ngokuthi i-Haemophilus influenzae), eyatholakala esikhwehlela seziguli eziningi, kodwa hhayi zonke. Kodwa-ke, leli bhaktheriya libhekwa njengobunzima emasikweni ngenxa yezimo zalo eziphakeme zesiko, futhi ngenxa yokuthi alizange libonwe kuzo zonke izimo, umphakathi wesayensi ubulokhu ungabaza indima yawo njenge-pathogen. Ucwaningo olwalandela luye lwabonisa ukuthi i-Haemophilus influenzae empeleni iyigciwane le-bacterial infection eliphindwe kabili elivamile kumkhuhlane, kunegciwane elibangela umkhuhlane ngokuqondile.
Ngo-1933, uWilson Smith nethimba lakhe benza intuthuko. Bathathe amasampula ku-pharyngeal flusher ezigulini zomkhuhlane, bawahambisa ngesihlungi sebhaktheriya ukuze basuse amagciwane, base behlola i-filtrate ebulalayo kuma-ferrets. Ngemva kokufukamela izinsuku ezimbili, ama-ferrets avele aqala ukubonisa izimpawu ezifana nomkhuhlane womuntu. Ucwaningo olokuqala oluqinisekisa ukuthi umkhuhlane ubangelwa amagciwane hhayi amagciwane. Lapho bebika lokhu okutholakele, abacwaningi baphinde baphawula ukuthi ukutheleleka kwangaphambilini ngegciwane kungavimbela ngempumelelo ukuphinda kutheleleke ngegciwane elifanayo, okubeka isisekelo sethiyori sokuthuthukiswa komgomo.
Eminyakeni embalwa kamuva, uzakwabo kaSmith uCharles Stuart-Harris, ngenkathi ebuka i-ferret eyayingenwe umkhuhlane, ngephutha walithola leli gciwane ngokuchayeka eduze kokuthimula kuka-ferret. Igciwane elihlukanisiwe ne-Harris labe selithelela ngempumelelo i-ferret engatheleleki, liqinisekisa ikhono lamagciwane omkhuhlane ukusabalala phakathi kwabantu nezilwane. Embikweni ohlobene nalokhu, ababhali baphawule ukuthi “kungenzeka ukuthi izifo zaselabhorethri zingaba isiqalo sezifo eziwumshayabhuqe.”

Umuthi wokugoma

Lapho igciwane lomkhuhlane selihlukanisiwe futhi selihlonziwe, umphakathi wesayensi ngokushesha waqala ukwenza umuthi wokugoma. Ngo-1936, uFrank Macfarlane Burnet wabonisa okokuqala ukuthi amagciwane omkhuhlane angakhula kahle emaqandeni avundisiwe, ukutholakala okwanikeza ubuchwepheshe obusha bokukhiqiza umgomo osasetshenziswa kabanzi namuhla. Ngo-1940, uThomas Francis noJonas Salk basungula ngempumelelo umuthi wokuqala wokugomela umkhuhlane.
Isidingo somuthi wokugoma sasicindezela kakhulu amasosha ase-US, uma kubhekwa umthelela omubi womkhuhlane emasosheni ase-US phakathi neMpi Yezwe I. Ekuqaleni kwawo-1940, amasosha e-US Army ayephakathi kwabokuqala ukuthola umuthi wokugomela umkhuhlane. Ngo-1942, ucwaningo lwaqinisekisa ukuthi umgomo wawusebenza ngempumelelo ekunikezeni isivikelo, futhi abantu abagonyiwe babemancane kakhulu amathuba okuba bathole umkhuhlane. Ngo-1946, umuthi wokugomela umkhuhlane wokuqala wagunyazwa ukuthi usetshenziswe ngabantu, kwavula isahluko esisha ekuvimbeleni nasekulawuleni umkhuhlane.
Kuvele ukuthi ukuthola umuthi wokugomela umkhuhlane kunomphumela obalulekile: abantu abangagonyiwe banamathuba aphindwe ka-10 kuye kwangama-25 okuthola umkhuhlane kunalabo abawutholayo.

Ukugadwa

Ukubhekwa komkhuhlane kanye nezinhlobo zawo ezithile zegciwane kubalulekile ukuze kuqondiswe izimpendulo zezempilo zomphakathi kanye nokuthuthukisa izinhlelo zokugoma. Uma kubhekwa isimo somhlaba wonke somkhuhlane, izinhlelo zokugada zikazwelonke nezamazwe ngamazwe zidingeka kakhulu.
I-Centers for Disease Control and Prevention (CDC) yasungulwa ngo-1946 futhi ekuqaleni yayigxile ocwaningweni lokuqubuka kwezifo ezifana nomalaleveva, isifo sofuba kanye ne-smallpox. Phakathi neminyaka emihlanu yasungulwa, i-CDC idale i-Epidemic Intelligence Service ukuze inikeze ukuqeqeshwa okukhethekile ukuze iphenye ukuqubuka kwezifo. Ngo-1954, i-CDC yasungula uhlelo lwayo lokuqala lokuhlola umkhuhlane futhi yaqala ukukhipha imibiko evamile ngomsebenzi womkhuhlane, yabeka isisekelo sokuvimbela nokulawula umkhuhlane.
Ezingeni lamazwe ngamazwe, iNhlangano Yezempilo Yomhlaba (i-WHO) yasungula i-Global Influenza Surveillance and Response System ngo-1952, isebenzisana eduze neGlobal Sharing of Influenza Data Initiative (GISAID) ukwakha uhlelo lokuhlola umkhuhlane womhlaba wonke. Ngo-1956, i-WHO yaphinde yaqoka i-CDC njengesikhungo sayo esisebenzisanayo emkhakheni wokubhekwa komkhuhlane, isifo esiwumshayabhuqe kanye nokulawula, ihlinzeka ngosizo lobuchwepheshe kanye nesiqondiso sesayensi sokuvimbela nokulawula umkhuhlane womhlaba. Ukusungulwa nokusebenza okuqhubekayo kwalezi zinhlelo zokugada kunikeza isivikelo esibalulekile ekuphenduleni umhlaba wonke ezikhundleni eziwubhubhane zomkhuhlane kanye nezifo eziwubhadane.

Njengamanje, i-CDC isungule inethiwekhi ebanzi yokuhlola umkhuhlane wasekhaya. Izingxenye ezine eziyinhloko zokubhekwa komkhuhlane zihlanganisa ukuhlolwa kwaselabhorethri, ukubhekwa kwecala lesiguli esingaphandle, ukubhekwa kwecala elingaphakathi kwesiguli, kanye nokubhekwa kokufa. Lolu hlelo lokugada oludidiyelwe luhlinzeka ukwesekwa okubalulekile ukuqondisa izinqumo zezempilo zomphakathi kanye nokubhekana nobhubhane lomkhuhlane..

IGlobal Influenza Surveillance and Response System ihlanganisa amazwe ayi-114 futhi inezikhungo zomkhuhlane zikazwelonke eziyi-144, ezibhekele ukugadwa komkhuhlane unyaka wonke. I-CDC, njengelungu, isebenzisana namalabhorethri akwamanye amazwe ukuthumela igciwane lomkhuhlane lodwa ku-WHO ukuze kufakwe iphrofayili ye-antigenic kanye nezakhi zofuzo, okufana nenqubo lapho amalabhorethri ase-US athumela khona iziqephu zodwa ku-CDC. Ukubambisana phakathi kwe-United States ne-China kule minyaka engu-40 edlule kube yingxenye ebalulekile yokuphepha kwezempilo emhlabeni wonke kanye nokukhulumisana.