iindaba

Kwiminyaka elikhulu eyadlulayo, indoda eneminyaka engama-24 ubudala yangeniswa kwisibhedlele iMassachusetts General Hospital (MGH) inomkhuhlane, ukukhohlela, kwaye kunzima nokuphefumla.
Isigulana sasisempilweni kangangeentsuku ezintathu ngaphambi kokungeniswa, emva koko saqala ukuziva singonwabanga, ngokudinwa ngokubanzi, intloko ebuhlungu kunye neentlungu zangasemva. Imeko yakhe yaba mandundu kwiintsuku ezimbini ezalandelayo kwaye ixesha elininzi wayelichitha ebhedini. Ngenye imini ngaphambi kokuba amkelwe, waba nomkhuhlane omkhulu, ukukhohlela okomileyo kunye nokugodola, nto leyo isigulana esiyichaze “njengegobile” kwaye asikwazi kwaphela ukuphuma ebhedini. Wathatha i-648 mg ye-aspirin rhoqo kwiiyure ezine kwaye wafumana isiqabu esincinci kwiintloko kunye neentlungu ezibuhlungu. Nangona kunjalo, ngomhla wokungeniswa kwakhe, wafika esibhedlele emva kokuvuka ekuseni ene-dyspnea, ehamba nentlungu yesifuba se-subxiphoid, eyandiswa kukuphefumla kunye nokukhohlela.
Ekungeneni, ukushisa kwe-rectal kwakuyi-39.5 ° C ukuya kwi-40.8 ° C, isantya senhliziyo sasiyi-92 ukuya kwi-145 beats / min, kwaye izinga lokuphefumula laliyi-28 ukuya kwi-58 beats / min. Isigulane sinoloyiko kunye nembonakalo ebukhali. Nangona esongelwe ngeengubo ezininzi, ukubanda kwaqhubeka. Ukuphefumula okufutshane, kukhatshwa yi-paroxysms yokukhohlela okukhulu, okukhokelela kwiintlungu ezibuhlungu ngaphantsi kwe-sternum, ukukhohlela i-phlegm pink, i-viscous, i-purulent kancinane.
I-apical pulsation yayivakala kwisithuba sesihlanu se-intercostal kwicala lasekhohlo le-sternum, kwaye akukho ukwanda kwentliziyo kubonwe kwi-percussion. I-Auscultation ibonakalise ukubetha kwentliziyo ekhawulezayo, isingqi sentliziyo esingaguqukiyo, esivakalayo kwincopho yentliziyo, kunye nokumbombozela okuncinci kwe-systolic. Ukunciphisa izandi zokuphefumla kwicala lasekunene ngasemva ukusuka kwisinye kwisithathu ngaphantsi kwamagxa egxalaba, kodwa akukho rales okanye i-pleural fricatives yavakala. Ubomvu obuncinci kunye nokuvuvukala emqaleni, iitoni zisusiwe. Isiva sotyando lokulungisa i-inguinal hernia ekhohlo sibonakala kwisisu, kwaye akukho ukudumba okanye ukuthamba kwisisu. Ulusu olomileyo, ubushushu obuphezulu bolusu. Ubalo lweeseli ezimhlophe zegazi lwaluphakathi kwe-3700 kunye ne-14500 / ul, kwaye i-neutrophils yenza i-79%. Akukho kukhula kwebhaktheriya kwabonwa kwinkcubeko yegazi.
I-radiograph yesifuba ibonisa izithunzi ezimhlophe kumacala omabini emiphunga, ngakumbi kwilobe ephezulu yasekunene kunye nelobe esezantsi esekhohlo, ebonisa inyumoniya. Ukwandiswa kwe-hilum yasekhohlo yomphunga kubonisa ukuba kunokwenzeka ukwandiswa kwe-lymph node, ngaphandle kwe-pleural effusion ekhohlo.

Ngosuku lwesibini lwesibhedlele, isigulane sasine-dyspnea kunye neentlungu zesifuba eziqhubekayo, kwaye i-sputum yayiyi-purulent kunye negazi. Uvavanyo lomzimba lubonise ukuba kukho ukumbombozela kwe-systolic kwi-pex ye-lung, kwaye i-percussion emazantsi e-right lung yachithwa. Iipapule ezincinci, ezixineneyo zivela kwisandla sasekhohlo kunye nesalathisi sokunene. Oogqirha bayichaza imeko yesigulana “njengembi”. Ngosuku lwesithathu, i-sputum ye-purulent yabonakala ngakumbi. Ubuthuntu bomqolo osezantsi osekhohlo bongeziwe ngelixa inyikima ebambekayo ibisenziwa mandundu. Izandi zokuphefumla kwebronchi kunye neerales ezimbalwa zinokuviwa ngasekhohlo ngasemva isinye kwisithathu sendlela ezantsi ukusuka kwincakuba yegxalaba. I-Percussion kumqolo wasekunene iba buthuntu kancinci, izandi zokuphefumla zikude, kwaye iirales zamaxesha athile ziyavakala.
Ngosuku lwesine, imeko yesigulana yaba mandundu ngakumbi waza wafa ngobo busuku.

Uxilongo

Indoda eneminyaka engama-24 ubudala yalaliswa esibhedlele ngoMatshi ka-1923 inesifo somkhuhlane, ukubanda, ukuqaqamba kwemisipha, ukuphefumula okufutshane, kunye neentlungu zesifuba zepleurisy. Iimpawu zakhe kunye neempawu zihambelana kakhulu nosulelo lwentsholongwane yokuphefumula, njengomkhuhlane, kunye nosulelo lwesibini lwebhaktheriya. Ngenxa yokuba ezi mpawu zifana kakhulu neemeko ngexesha lendyikityha yomkhuhlane we-1918, umkhuhlane mhlawumbi ngowona kuxilongwa okufanelekileyo.

Nangona ukubonakaliswa kweklinikhi kunye neengxaki zomkhuhlane wale mihla zifana ngokusondeleyo nezo zendyikityha ye-1918, uluntu lwezenzululwazi lwenze impumelelo ebalulekileyo kumashumi ambalwa eminyaka adlulileyo, kubandakanya ukuchongwa kunye nokwahlukaniswa kweentsholongwane zomkhuhlane, ukuphuhliswa kobuchule bokuxilonga ngokukhawuleza, ukwaziswa konyango olusebenzayo lwe-antiviral, kunye nokuphunyezwa kweenkqubo zokucupha kunye nogonyo. Xa sijonga emva kwindyikityha yomkhuhlane ka-1918 ayibonisi kuphela izifundo zembali, kodwa ikwasilungiselela ngcono ubhubhane wexesha elizayo.
Ubhubhani womkhuhlane we-1918 waqala eUnited States. Ityala lokuqala eliqinisekisiweyo lenzeka ngoMatshi 4, 1918, kumpheki woMkhosi eFort Riley, eKansas. Emva koko uLorrin Miner, ugqirha eHaskell County, Kansas, wabhala iimeko ezili-18 zomkhuhlane omkhulu, kubandakanya nokufa kwabathathu. Uxele oku kufunyaniswayo kwiSebe lezeMpilo yoLuntu laseMelika, kodwa akuzange kuthathwe ngokungathí sina.
Ababhali-mbali bakholelwa ukuba ukusilela kwabasemagunyeni kwezempilo yoluntu ngelo xesha ukuphendula ngokuqhambuka kwakunxulumene ngokusondeleyo nomxholo okhethekileyo weMfazwe yeHlabathi yokuQala. Ukunqanda ukuchaphazela inkqubo yemfazwe, urhulumente wathi cwaka ngobunzulu bokuqhambuka. UJohn Barry, umbhali weThe Great Flu, wayigxeka le nto kudliwanondlebe ngo-2020: “Urhulumente uyaxoka, bawubiza ngokuba ngumkhuhlane oqhelekileyo, kwaye abaluxeleli inyani eluntwini. Ngokwahlukileyo koko, iSpain, ilizwe elingathathi hlangothi ngelo xesha, yayiyeyokuqala ukuchaza umkhuhlane kumajelo eendaba, nto leyo eyakhokelela ekubeni usulelo olutsha lwentsholongwane lubizwe ngokuba “ngumkhuhlane waseSpain,” nangona iimeko zokuqala zabhalwa eUnited States.
Phakathi kukaSeptemba noDisemba 1918, kuqikelelwa ukuba abantu abangama-300,000 babulawa ngumkhuhlane eUnited States, ngokuphindwe kali-10 inani lokufa kwabo bonke oonobangela eUnited States ngexesha elifanayo ngo-1915. Umkhuhlane usasazeka ngokukhawuleza ngokuthunyelwa emkhosini kunye nokunyakaza kwabasebenzi. Amajoni akahambanga nje phakathi kweendawo zothutho empuma, kodwa aphinde athwala intsholongwane ukuya kumabala edabi aseYurophu, esasaza umkhuhlane kwihlabathi jikelele. Kuqikelelwa ukuba bangaphezu kwezigidi ezingama-500 abantu abaye bosulelwa yaye malunga ne-100 lezigidi baye baphulukana nobomi babo.
Unyango lwamayeza lwalulinganiselwe kakhulu. Unyango lunceda kakhulu, kubandakanywa ukusetyenziswa kwe-aspirin kunye ne-opiates. Olona nyango lunokuthi lusebenze lunyango lwe-convalescent plasma - eyaziwa namhlanje njengonyango lwe-convalescent plasma. Nangona kunjalo, izitofu zokugonya umkhuhlane ziye zacotha ukufika kuba izazinzulu azikachongi unobangela womkhuhlane. Ukongeza, ngaphezulu kwesithathu koogqirha kunye nabongikazi baseMelika baye basuswa ngenxa yokubandakanyeka kwabo emfazweni, beshiya izixhobo zonyango zinqabile. Nangona izitofu zokugonya ikholera, isifo setyphoid, isibetho, kunye nengqakaqha zazikho, ukuphuhliswa kwesitofu sokugonya umkhuhlane kwakungekabikho.
Ngezifundo ezibuhlungu zendyikityha yomkhuhlane we-1918, sifunde ukubaluleka kokuchazwa kolwazi oluselubala, ukuqhubela phambili kophando lwezenzululwazi, kunye nentsebenziswano kwimpilo yehlabathi. La mava abonelela ngeembono ezixabisekileyo zokujongana nezoyikiso ezifanayo zempilo kwihlabathi kwixesha elizayo.

Intsholongwane

Kwiminyaka emininzi, i-ejenti ye-causative ye-"flu yaseSpain" yayicingelwa ukuba yi-bacterium Pfeiffer (ngoku eyaziwa ngokuba yi-Haemophilus influenzae), efunyenwe kwi-sputum yabaninzi, kodwa kungekhona zonke, izigulane. Nangona kunjalo, le bhaktheriya ithathwa njengobunzima kwinkcubeko ngenxa yeemeko zayo eziphezulu zenkcubeko, kwaye ngenxa yokuba ayizange ibonwe kuzo zonke iimeko, uluntu lwezenzululwazi luye lwahlala lubuza indima yalo njenge-pathogen. Uphononongo olulandelayo lubonise ukuba i-Haemophilus influenzae ngenene yintsholongwane yosulelo oluphindwe kabini lwebhaktiriya oluxhaphakileyo kumkhuhlane, kunentsholongwane ebangela ngqo umkhuhlane.
Ngowe-1933, uWilson Smith neqela lakhe benza inkqubela. Bathathe iisampulu kwi-pharyngeal flusher kwizigulana zomkhuhlane, baziqhubela ngesihluzo sebhaktiriya ukuphelisa ibhaktheriya, emva koko bazama ukuhluza okungenantsholongwane kwii-ferrets. Emva kwexesha lokufukamela leentsuku ezimbini, i-ferrets eveziweyo yaqala ukubonisa iimpawu ezifana nomkhuhlane womntu. Uphononongo lolokuqala ukuqinisekisa ukuba umkhuhlane ubangelwa ziintsholongwane kunebhaktheriya. Ekunikeni ingxelo ngezi ziphumo, abaphandi baye baqaphela ukuba usulelo lwangaphambili lwentsholongwane lunokuthintela ngokufanelekileyo ukosuleleka kwakhona kwentsholongwane enye, ebeka isiseko sethiyori sophuhliso lwesitofu sokugonya.
Kwiminyaka embalwa kamva, umlingane kaSmith uCharles Stuart-Harris, ngelixa wayejonge i-ferret eyosulelwe ngumkhuhlane, wosulelwa ngengozi le ntsholongwane ukusuka ekuvezweni kufutshane nokuthimla kwe-ferret. Intsholongwane ebekwe yedwa eHarris emva koko yosulela ngempumelelo i-ferret engosulelwanga, iqinisekisa amandla entsholongwane yomkhuhlane ukusasazeka phakathi kwabantu nezilwanyana. Kwingxelo enxibeleleneyo, ababhali baphawule ukuba “kuyabonakala ukuba usulelo lwaselabhoratri lunokuba sisiqalo sobhubhani.”

Isitofu sokugonya

Nje ukuba intsholongwane yomkhuhlane ibekwe yodwa kwaye ichongiwe, uluntu lwenzululwazi lwaqalisa ngokukhawuleza ukwenza isitofu sokugonya. Ngo-1936, uFrank Macfarlane Burnet waqala wabonisa ukuba iintsholongwane zomkhuhlane zingakhula ngokufanelekileyo kumaqanda achumileyo, ukufumanisa okubonelele ngeteknoloji yempumelelo yokuveliswa kwesitofu sokugonya esasetyenziswa ngokubanzi namhlanje. Ngowe-1940, uThomas Francis noJonas Salk baphuhlisa ngempumelelo isitofu sokuqala somkhuhlane.
Isidingo sesitofu sokugonya sasicinezela ngokukodwa umkhosi wase-US, ngenxa yempembelelo eyingozi yomkhuhlane kumajoni ase-US ngexesha leMfazwe Yehlabathi I. Ekuqaleni kwee-1940, amajoni oMkhosi wase-US ayephakathi kwabokuqala ukufumana isitofu sokugonya. Ngo-1942, amaphononongo aqinisekisa ukuba isitofu sokugonya siyasebenza ekuboneleleni ngokhuseleko, kwaye abantu abagonyiweyo babengenakufane basulelwe ngumkhuhlane. Ngo-1946, isitofu sokugonya sokuqala somkhuhlane samkelwa ukuba sisetyenziswe ngabantu, sivula isahluko esitsha kuthintelo nolawulo lomkhuhlane.
Kuyavela ukuba ukufumana isitofu sokugonya umkhuhlane kunempembelelo ebalulekileyo: abantu abangagonywanga banethuba eli-10 ukuya kuma-25 amathuba okuba bafumane umkhuhlane kunabo bawenzayo.

Ukubek' esweni

Uphononongo loMkhuhlane kunye neentlobo ezithile zentsholongwane zibalulekile ekukhokeleni iimpendulo zempilo yoluntu kunye nokuphuhlisa iishedyuli zogonyo. Ngenxa yobume behlabathi bomkhuhlane, iinkqubo zokucupha zelizwe kunye nezamazwe ngamazwe ziyimfuneko ngakumbi.
AmaZiko oLawulo lweSifo kunye noThintelo (CDC) yasungulwa kwi-1946 kwaye ekuqaleni igxininise kuphando malunga nokuqhambuka kwezifo ezifana ne-malaria, i-typhus kunye ne-smallpox. Kwisithuba seminyaka emihlanu yokudalwa kwayo, i-CDC yenza iNkonzo yobuNgqondo be-Epidemic ukuba ibonelele ngoqeqesho olukhethekileyo lokuphanda ukuqhambuka kwezifo. Kwi-1954, i-CDC yaseka inkqubo yokuqala yokujonga umkhuhlane kwaye yaqala ukukhupha iingxelo rhoqo malunga nomsebenzi womkhuhlane, ibeka isiseko sokuthintela nokulawula umkhuhlane.
Kwinqanaba lamazwe ngamazwe, uMbutho wezeMpilo weHlabathi (i-WHO) waseka i-Global Influenza Surveillance and Response System ngo-1952, usebenza ngokusondeleyo ne-Global Sharing of Influenza Data Initiative (GISAID) ukwenza inkqubo yokujonga umkhuhlane wehlabathi. Ngo-1956, i-WHO yaphinda yatyumba i-CDC njengeziko layo elisebenzisanayo kwinkalo yokucupha umkhuhlane, i-epidemiology kunye nokulawula, ukubonelela ngenkxaso yobugcisa kunye nesikhokelo sezenzululwazi sothintelo kunye nokulawula umkhuhlane wehlabathi. Ukusekwa kunye nokusebenza okuqhubekayo kwezi nkqubo zokucupha kubonelela ngokhuseleko olubalulekileyo kwimpendulo yehlabathi kubhubhane womkhuhlane kunye nobhubhane.

Okwangoku, i-CDC iseke uthungelwano olubanzi lokucupha umkhuhlane wasekhaya. Amacandelo amane angundoqo ophononongo lomkhuhlane abandakanya uvavanyo lwaselebhu, ukucupha iimeko zezigulane ezingalaliswayo, ucupho kwimeko yesigulane esingaphakathi, kunye nokucupha ukusweleka. Le nkqubo yokucupha edibeneyo ibonelela ngenkxaso ebalulekileyo ukukhokela ukuthathwa kwezigqibo zempilo yoluntu kunye nokusabela kubhubhani womkhuhlane..

IGlobal Influenza Surveillance and Response System ibandakanya amazwe ali-114 kwaye inamaziko esizwe omkhuhlane ali-144, anoxanduva lokucupha umkhuhlane ngokuqhubekayo unyaka wonke. I-CDC, njengelungu, isebenza kunye neebhubhoratri kwamanye amazwe ukuthumela i-virus ye-influenza yodwa kwi-WHO ye-antigenic kunye ne-genetic profiling, efana nenkqubo apho iilebhu zase-US zihambisa zodwa kwi-CDC. Intsebenziswano phakathi kwe-United States ne-China kule minyaka ingama-40 idlulileyo ibe yinxalenye ebalulekileyo yokhuseleko lwezempilo lwehlabathi kunye nediplomacy.