nkhani

Zaka 100 zapitazo, mwamuna wa zaka 24 anagonekedwa ku Massachusetts General Hospital (MGH) akudwala malungo, chifuwa, ndi kupuma movutikira.
Wodwalayo anali wathanzi kwa masiku atatu asanalowe, kenako anayamba kumva kuti sakumva bwino, ndi kutopa kwakukulu, mutu ndi ululu wammbuyo. Mkhalidwe wake unakula kwambiri m’masiku aŵiri otsatira ndipo nthaŵi yake yambiri ankakhala pabedi. Tsiku lina asanagone, adayamba kutentha thupi kwambiri, chifuwa chowuma komanso kuzizira, zomwe wodwalayo adazifotokoza kuti "adagwada" ndikulephera kudzuka pabedi. Anamwa 648 mg ya asipirini maola anayi aliwonse ndipo amapeza mpumulo pang'ono kumutu ndi kupweteka kwa msana. Komabe, pa tsiku lololedwa, iye anabwera ku chipatala atadzuka m`mawa ndi dyspnea, limodzi ndi subxiphoid chifuwa ululu, amene anakulirakulira ndi kupuma kwambiri ndi chifuwa.
Pakulowetsedwa, kutentha kwa rectal kunali 39.5 ° C mpaka 40.8 ° C, kugunda kwa mtima kunali 92 mpaka 145 kugunda / mphindi, ndipo kupuma kunali 28 mpaka 58 kugunda / min. Wodwalayo ali ndi mantha ndi pachimake maonekedwe. Ngakhale atakulungidwa m'mabulangete angapo, kuzizira kunapitilirabe. Kupuma movutikira, limodzi ndi paroxysms wa kwambiri chifuwa, chifukwa mu ululu pansi pa sternum, kutsokomola phlegm pinki, viscous, pang`ono purulent.
Apical pulsation inali yomveka mu danga lachisanu la intercostal kumbali ya kumanzere kwa sternum, ndipo palibe kukulitsa kwa mtima komwe kunawonedwa pakumenya. Auscultation inavumbulutsa kugunda kwa mtima kofulumira, kusinthasintha kwa mtima, kumveka pamwamba pa mtima, ndi kung'ung'udza pang'ono kwa systolic. Kuchepetsa kupuma kumamveka kumbali yakumanja kwa kumbuyo kuchokera ku gawo limodzi mwa magawo atatu pansi pa mapewa, koma palibe ma rales kapena pleural fricatives omwe anamveka. Pang'ono redness ndi kutupa pakhosi, tonsils kuchotsedwa. Chipsera cha kumanzere inguinal chophukacho kukonza opaleshoni amaoneka pamimba, ndipo palibe kutupa kapena mwachifundo pamimba. Khungu louma, kutentha kwapakhungu. Maselo oyera a magazi anali pakati pa 3700 ndi 14500 / ul, ndipo ma neutrophils anali 79%. Palibe kukula kwa bakiteriya komwe kunawonedwa mu chikhalidwe cha magazi.
Radiograph ya pachifuwa imawonetsa mithunzi yowoneka bwino mbali zonse ziwiri za mapapu, makamaka kumtunda kumanja ndi kumunsi kumanzere, zomwe zikuwonetsa chibayo. Kukula kwa chigawo chakumanzere kwa mapapo kumasonyeza kuti node ya m'mapapo ikhoza kukulirakulira, kupatulapo kutuluka kwa pleural kumanzere.

Pa tsiku lachiwiri la kuchipatala, wodwalayo anali ndi dyspnea ndi kupweteka pachifuwa kosalekeza, ndipo sputum inali purulent ndi magazi. Kuwunika kwakuthupi kunawonetsa kuti panali kung'ung'udza kwa systolic pamwamba pa mapapo, ndipo kugunda pansi pa mapapu akumanja kunachepetsedwa. Mapapu ang'onoang'ono, odzazana amawonekera kumanzere kwa kanjedza ndi chala chakumanja. Madokotala adafotokoza momwe wodwalayo alili "yoyipa". Pa tsiku lachitatu, purulent sputum inawonekera kwambiri. Kusasunthika kwa msana wakumanzere kunakulitsidwa pomwe kugwedezeka kwamphamvu kumakulirakulira. Phokoso la kupuma kwa bronchial ndi ma rales angapo amatha kumveka kumanzere kumbuyo gawo limodzi mwa magawo atatu a njira yotsika kuchokera pamapewa. Kumenyedwa kumbuyo kumanja kumakhala kozimiririka pang'ono, mawu opumira amakhala kutali, ndipo nthawi zina amamveka.
Pa tsiku lachinayi, matenda a wodwalayo anakula kwambiri ndipo anamwalira usiku womwewo.

Matenda

Mnyamata wazaka 24 anagonekedwa m'chipatala mu March 1923 ndi malungo aakulu, kuzizira, kupweteka kwa minofu, kupuma movutikira, ndi kupweteka pachifuwa cha pleurisy. Zizindikiro ndi zizindikiro zake zimagwirizana kwambiri ndi matenda opatsirana ndi tizilombo toyambitsa matenda, monga fuluwenza, ndi zotheka matenda achiwiri a bakiteriya. Popeza kuti zizindikirozi ndizofanana kwambiri ndi zomwe zikuchitika pa mliri wa chimfine cha 1918, fuluwenza mwina ndiye njira yabwino kwambiri yodziwira matenda.

Ngakhale mawonetseredwe azachipatala ndi zovuta za chimfine chamakono zikufanana kwambiri ndi za mliri wa 1918, gulu la asayansi lachitapo kanthu pazaka makumi angapo zapitazi, kuphatikiza kuzindikira ndi kudzipatula kwa ma virus a chimfine, kupanga njira zodziwira mwachangu, kukhazikitsidwa kwamankhwala othandiza oletsa ma virus, komanso kukhazikitsa njira zowunika ndi katemera. Kuyang'ana mmbuyo pa mliri wa chimfine wa 1918 sikuti umangowonetsa maphunziro a mbiri yakale, komanso umatikonzekeretsa bwino miliri yamtsogolo.
Mliri wa chimfine wa 1918 unayamba ku United States. Mlandu woyamba wotsimikizika unachitika pa Marichi 4, 1918, mu wophika wankhondo ku Fort Riley, Kansas. Kenako Lorrin Miner, dotolo ku Haskell County, Kansas, adalemba milandu 18 ya chimfine chachikulu, kuphatikiza atatu omwe anamwalira. Adanenanso zomwe adapeza ku Unduna wa Zaumoyo ku US, koma sizinatengedwe mozama.
Akatswiri a mbiri yakale amakhulupirira kuti kulephera kwa akuluakulu a zaumoyo panthawiyo kuyankha kuphulika kunali kogwirizana kwambiri ndi zochitika zapadera za nkhondo yoyamba yapadziko lonse. Pofuna kupewa kusokoneza nkhondoyi, boma linakhala chete ponena za kuopsa kwa mliriwu. John Barry, wolemba The Great Flu, adadzudzula zomwe zidachitika mu 2020 kuyankhulana: "Boma likunama, likuchitcha chimfine, ndipo sakuwuza anthu zoona." Mosiyana ndi zimenezi, dziko la Spain, lomwe linali losalowerera ndale panthawiyo, linali loyamba kufotokoza za chimfine m'manyuzipepala, zomwe zinachititsa kuti kachilombo ka HIV katsopano kamatchedwa "Chimfine cha ku Spain," ngakhale kuti milandu yoyambirira inalembedwa ku United States.
Pakati pa September ndi December 1918, pafupifupi anthu 300,000 anafa ndi fuluwenza ku United States, kuŵirikiza ka 10 chiwerengero cha anthu amene anafa ndi zifukwa zonse ku United States m’nyengo imodzimodziyo mu 1915. Chimfine chimafalikira mofulumira chifukwa cha kutumizidwa kwa asilikali ndi magulu a anthu ogwira ntchito. Asilikali sanangosuntha pakati pa malo oyendera mayendedwe kummawa, komanso adanyamula kachilomboka kupita kunkhondo zaku Europe, ndikufalitsa chimfine padziko lonse lapansi. Akuti anthu oposa 500 miliyoni adwala ndipo pafupifupi 100 miliyoni ataya miyoyo yawo.
Chithandizo chamankhwala chinali chochepa kwambiri. Chithandizo chimakhala chochepetsera, kuphatikizapo kugwiritsa ntchito aspirin ndi opiates. Chithandizo chokhacho chomwe chingakhale chothandiza ndi kulowetsedwa kwa plasma ya convalescent - yomwe masiku ano imadziwika kuti convalescent plasma therapy. Komabe, katemera wa chimfine akuchedwa kufika chifukwa asayansi sanazindikire chomwe chimayambitsa chimfine. Kuonjezera apo, madokotala ndi anamwino oposa gawo limodzi mwa magawo atatu aliwonse a ku America achotsedwa chifukwa cholowa nawo m'nkhondo, zomwe zasiya chithandizo chamankhwala chosowa kwambiri. Ngakhale kuti katemera wa kolera, typhoid, miliri, ndi nthomba analipo, kupanga katemera wa chimfine kunalibe.
Kupyolera mu maphunziro opweteka a mliri wa chimfine wa 1918, tinaphunzira kufunikira kwa chidziwitso chowonekera bwino, kupita patsogolo kwa kafukufuku wa sayansi, ndi mgwirizano pa umoyo wapadziko lonse. Zochitika izi zimapereka chidziwitso chofunikira chothandizira kuthana ndi zoopsa zapadziko lonse lapansi m'tsogolomu.

Kachilombo

Kwa zaka zambiri, woyambitsa matenda a "Chimfine cha ku Spain" ankaganiza kuti ndi bakiteriya Pfeiffer (yomwe tsopano imadziwika kuti Haemophilus influenzae), yomwe inapezeka mu sputum ya odwala ambiri, koma osati onse. Komabe, mabakiteriyawa amaonedwa kuti ndi ovuta ku chikhalidwe chifukwa cha chikhalidwe chake chapamwamba, ndipo chifukwa sichinawonekere nthawi zonse, gulu la sayansi lakhala likukayikira udindo wake monga tizilombo toyambitsa matenda. Kafukufuku wotsatira wasonyeza kuti Haemophilus influenzae kwenikweni ndi tizilombo toyambitsa matenda a bakiteriya awiri omwe amapezeka mu fuluwenza, osati kachilombo kamene kamayambitsa fuluwenza.
Mu 1933, Wilson Smith ndi gulu lake adachita bwino. Adatenga zitsanzo kuchokera ku pharyngeal flusher kuchokera kwa odwala chimfine, adawathamangitsa kudzera musefa ya bakiteriya kuti athetse mabakiteriya, kenako adayesa ndi wosabala filtrate pa ferrets. Pambuyo pa makulitsidwe masiku awiri, ferrets poyera anayamba kusonyeza zizindikiro zofanana ndi fuluwenza munthu. Kafukufukuyu ndi woyamba kutsimikizira kuti chimfine chimayambitsidwa ndi ma virus osati mabakiteriya. Pofotokoza zomwe apezazi, ofufuzawo adawonanso kuti matenda am'mbuyomu omwe ali ndi kachilomboka amatha kuletsa kufalikira kwa kachilombo komweko, komwe kumakhazikitsa maziko opangira katemera.
Zaka zingapo pambuyo pake, mnzake wa Smith a Charles Stuart-Harris, akuwona ferret yemwe ali ndi fuluwenza, adatenga kachilomboka mwangozi chifukwa choyandikira kuyetsemula kwa ferret. Kachilombo kamene kanalekanitsidwa ndi Harris kenaka kachilombo kamene kalibe kachilomboka, ndikutsimikiziranso kuthekera kwa ma virus a chimfine kufalikira pakati pa anthu ndi nyama. Mu lipoti lofananalo, olembawo ananena kuti “ndikoyenera kuti matenda a m’ma laboratories angakhale poyambira miliri.”

Katemera

Kachilombo kachimfine kakadziwika ndikudziwika, asayansi anayamba kupanga katemera mwamsanga. Mu 1936, Frank Macfarlane Burnet adawonetsa koyamba kuti ma virus a chimfine amatha kukula bwino m'mazira obereketsa, kutulukira komwe kunapereka luso lopanga katemera lomwe likugwiritsidwabe ntchito masiku ano. Mu 1940, Thomas Francis ndi Jonas Salk anapanga bwino katemera woyamba wa chimfine.
Kufunika kwa katemera kunali kofunika kwambiri kwa asilikali a US, chifukwa cha zotsatira zoopsa za fuluwenza pa asilikali a US pa nthawi ya nkhondo yoyamba ya padziko lonse. Kumayambiriro kwa zaka za m'ma 1940, asilikali a US Army anali m'gulu la oyamba kulandira katemera wa chimfine. Pofika m’chaka cha 1942, kafukufuku anatsimikizira kuti katemerayu anali wothandiza popereka chitetezo, ndipo anthu otemerawo sankadwala chimfine. Mu 1946, katemera woyamba wa chimfine adavomerezedwa kuti agwiritsidwe ntchito ndi anthu wamba, ndikutsegula mutu watsopano wa kupewa ndi kuwongolera chimfine.
Zikuoneka kuti kupeza katemera wa chimfine kumakhudza kwambiri: anthu omwe alibe katemera amakhala ndi mwayi wopezeka ndi chimfine nthawi 10 mpaka 25 kuposa omwe amachita.

Kuyang'anira

Kuyang'anira chimfine ndi ma virus ake enieni ndikofunikira kutsogolera mayankho azaumoyo wa anthu ndikupanga ndandanda ya katemera. Poganizira momwe chimfine chilili padziko lonse lapansi, njira zowunikira dziko lonse lapansi komanso zapadziko lonse lapansi ndizofunikira kwambiri.
Centers for Disease Control and Prevention (CDC) idakhazikitsidwa mchaka cha 1946 ndipo poyambilira idayang'ana kwambiri kafukufuku wokhudza miliri ya matenda monga malungo, typhus ndi nthomba. Pasanathe zaka zisanu chiyambireni kukhazikitsidwa, CDC idapanga Epidemic Intelligence Service kuti ipereke maphunziro apadera kuti athe kufufuza matenda omwe abuka. Mu 1954, CDC idakhazikitsa njira yoyamba yowunikira chimfine ndipo idayamba kupereka malipoti okhazikika pazochitika za fuluwenza, ndikuyika maziko opewera ndi kuwongolera chimfine.
Padziko lonse lapansi, World Health Organisation (WHO) idakhazikitsa Global Influenza Surveillance and Response System mu 1952, ikugwira ntchito limodzi ndi Global Sharing of Influenza Data Initiative (GISAID) kuti ipange dongosolo loyang'anira chimfine padziko lonse lapansi. Mu 1956, bungwe la WHO linasankhanso CDC kukhala malo ake ogwirira ntchito poyang'anira chimfine, miliri ndi kulamulira, kupereka chithandizo chaukadaulo ndi chitsogozo cha sayansi cha kupewa ndi kuwongolera fuluwenza padziko lonse lapansi. Kukhazikitsidwa ndi kupitiliza kugwira ntchito kwa machitidwe owunikirawa kumapereka chitetezo chofunikira pakuyankha kwapadziko lonse ku miliri ya chimfine ndi miliri.

Pakadali pano, CDC yakhazikitsa gulu lalikulu loyang'anira chimfine. Zigawo zinayi zazikuluzikulu zowunikira chimfine ndi monga kuyezetsa ma labotale, kuyang'anira odwala omwe ali kunja, kuyang'anira odwala omwe ali m'chipatala, komanso kuyang'anira imfa. Dongosolo loyang'anira lophatikizikali limapereka chithandizo chofunikira kuwongolera zisankho zaumoyo wa anthu komanso kuthana ndi mliri wa chimfine..

Global Influenza Surveillance and Response System imakhudza mayiko 114 ndipo ili ndi malo 144 amtundu wa chimfine, omwe amayang'anira kuyang'anira chimfine mosalekeza chaka chonse. CDC, monga membala, amagwira ntchito ndi ma laboratories m'mayiko ena kutumiza tizilombo toyambitsa matenda a chimfine ku WHO kuti awonetsere ma antigenic ndi majini, mofanana ndi njira yomwe ma laboratories aku US amapereka zodzipatula ku CDC. Mgwirizano wapakati pa United States ndi China pazaka 40 zapitazi wakhala gawo lofunikira pachitetezo chaumoyo padziko lonse lapansi komanso zokambirana.