Book Inf PDF

a. xoWava, m.
xoWava
bavSvTa
infeqtologia
damtkicebulia saqarTvelos ganaTlebis

saministros mier,rogorc saxelmZRvanelo
umaRlesi samedicino saswavleblis
studentebisa da eqimebisaTvis.
Tbilisi
2000 weli
1
recenzentebi:
medicinis mecnierebaTa doqtori, profesori,

saqarTvelos mediko-biologiuri mecnierebaTa
akademiis akademikosi
T. boWoriSvili
medicinis mecnierebaTa doqtori, profesori
e. vaSakiZe
medicinis mecnierebaTa doqtori, profesori
m. Jvania
2
aleqsi xoWava
medicinis mecnierebaTa doqtori, profesori,
mecnierebaTa damsaxurebuli moRvawe, saqarTvelos
mediko-biologiuri akademiis akademikosi
manana xoWava
medicinis mecnierebaTa kandidati, docenti, Tbilisis
saxelmwifo samedicino universitetis bavSvTa
infeqciur-sneulebaTa kaTedris gamge
3
wignis momzadebaSi gaweuli daxmarebisaTvis
did madlobas vuxdiT:
kaTedris TanamSromlebs _
i. xabazs,
l. jimSitaSvilsa da
b. eliaZes
SviliSvils
Tamar SukakiZesa da
mis meuRles giorgi demurias
qalbaton m. xaxaleiSvils
4
sarCevi
winasityvaoba (a. xoWava, m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
I. zogadi nawili . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
mokle istoriuli cnobebi. (a. xoWava, m. xoWava) . . . . . . . . . . . . . . . . . . . . . 10
infeqciur daavadebaTa epidemiologiis zogierTi kanonzomierebani
(a. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
infeqciuri paTologiis zogierTi terminologiuri ganmarteba
(a. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
infeqciuri daavadebis paTogenezis da klinikuri gamovlinebis
kanonzomierebaTa zogierTi mxare (a. xoWava) . . . . . . . . . . . . . . . . . . . . . . 18
nozokomialuri infeqciebi da maTi Taviseburebani
(a. xoWava, m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
makroorganizmis damcvelobiTi meqanizmebi infeqciuri procesis dros
(a. xoWava, m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
infeqciur
infeqciuri i avadmyofebis mkurnalobis pr inci pebi da maTi r
princi eal
real izaciis
ealizaciis
Tanamedrove saSualebebi (a. xoWava, m. xoWava) . . . . . . . . . . . . . . . . . . . . . . 29
infeqciuri daavadebebis specifikuri profilaqtika
(m. xoWava, a. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
II. kerZo nawili . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51

mwvave respiraciul-virusuli infeqciebi (m. xoWava, a. xoWava) . . . . . . . 51
gr
gri i pi (m. xoWava, a. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
paragr
paragri i pi (a. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
adenovirusuli infeqcia (m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
respiraciul-sincitiuri infeqcia ((RS-infeqcia) -infeqcia) (m. xoWava) . . . . . . . . . . 65
rinovirusuli infeqcia (a. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
reovirusuli infeqcia (a. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
Tandayolili virusuli respiraciuli infeqciebi (a. xoWava) . . . . . . . . 72
wiTela (a. xoWava, m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
wiTura (m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
parotituli infeqcia (m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
herpesis ojaxis virusebiT gamowveuli daavadebebi . . . . . . . . . . . . . . . 90

martivi herpesi (m. xoWava, a. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90
Cutyvavila (a. xoWava, m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
sartyliseburi herpesi (m. xoWava, a. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . 102
citomegalovirusuli infeqcia (m. xoWava, a. xoWava) . . . . . . . . . . . . . . . . . 104
infeqciuri mononukleozi (m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
uecari egzanTema anu meeqvse daavadeba (m. xoWava) . . . . . . . . . . . . . . . . . . 116
infeqciuri eriTema anu mexuTe daavadeba (m. xoWava) . . . . . . . . . . . . . . . 117
5
enterovirusuli infeqciebi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
poliomieliti (a. xoWava, m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120
arapoliomielituri enterovirusuli infeqciebi
(m. xoWava, a. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128
virusuli hepatitebi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135

hepatiti A (a. xoWava, m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138
hepatiti B (a. xoWava, m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149
hepatiti C (a. xoWava, m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167
hepatiti D (a. xoWava, m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170
hepatiti E (a. xoWava, m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173
arc A__E hepatitebi (a. xoWava, m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . 175
rotavirusuli da sxva diareagenuli virusuli infeqciebi

(m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176
tki pismier
pismierii encefaliti (m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180
hemoragiuli cxelebebi (a. xoWava, m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . 185

hemoragiuli cxeleba Tirkmlis sindromiT (a. xoWava, m. xoWava) . . . . . 186
omskis hemoragiuli cxeleba (a. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . 190
yirim -kongos hemoragiuli cxeleba (a. xoWava, m. xoWava) . . . . . . . . . . . . 192
denges da degnesmagvari cxeleba (m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . 194
marburgis cxeleba (m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
ebolas cxeleba (m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199
cofi (m. xoWava, a. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201
aiv/Sidsi (a. xoWava, m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207
mikoplazmuri infeqcia (a. xoWava, m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . 218
qlamidiuri infeqciebi (m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221

qlamidiozi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 222
orniTozi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 225
pnevmoqlamidiozi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 228
leptospirozi (a. xoWava, m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229
tki pismier
pismierii laim-boreli
laim-bor ozi (a. xoWava, m. xoWava) . . . . . . . . . . . . . . . . . 234
eliozi
katis nakawris daavadeba (m. xoWava, a. xoWava) . . . . . . . . . . . . . . . . . . . . . 239
listeriozi (a. xoWava, m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 242
kavasakis daavadeba (m. xoWava, a. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . 248
difTeria (a. xoWava, m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253
6
meningokokuri infeqcia (a. xoWava, m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . 272
hemofiluri infeqcia (m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 286
streptokokuri infeqcia ((GAS, GBS)) (m. xoWava, a. xoWava) . . . . . . . . . . . . 290

qunTruSa (a. xoWava, m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 296
wiTeli qari (a. xoWava, m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 305
stafilokokuri infeqcia (a. xoWava, m. xoWava) . . . . . . . . . . . . . . . . . . . . . . 309
sefsisi (a. xoWava, m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 318
yivanaxvela (m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 329
parayivanaxvela (m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 337
botulizmi (a. xoWava, m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 338
gaSeSeba (a. xoWava, m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 344
brucelozi (a. xoWava, m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 349
legionelozi (a. xoWava, m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 355
muclis tifi da paratifebi A,, B,, C (a. xoWava, m. xoWava) . . . . . . . . . . . . . . 359
iersiniuli infeqcia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 371

fsevdotuberkulozi (a. xoWava, m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . 371
nawlavTa iersiniozi (a. xoWava, m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . 379
baqteriuli dizenteria (m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 384
salmonelozi (m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 393
eSerixiozi (m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 402
qolera (a. xoWava, m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 410
zogierTi araqoleragenuli vibrionebiT gamowveuli infeqciebi

(m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 419
zogierTi pirobiTpaTogenuri floriT gamowveuli mwvave infeqcia

(m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 420
kampilobaqteriozi (m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 420
klebsielebiT gamowveuli nawlavTa mwvave infeqcia (a. xoWava) . . . . . . 423
proteusiT gamowveuli nawlavTa infeqcia (m. xoWava) . . . . . . . . . . . . . . . 425
nawlavTa mwvave citrobaqteriuli infeqcia (m. xoWava) . . . . . . . . . . . . . . 427
nawlavTa mwvave fsevdomonuri infeqcia (m. xoWava) . . . . . . . . . . . . . . . . . 428
7
nawlavTa anaerobuli infeqciebi . . . . . . . . . . . . . . . . . . . . . . . . . 430
klostridium perfringensiT gamowveuli infeqcia (m. xoWava) . . . . . . . 430
klostridium dificileTi gamowveuli nawlavTa infeqcia
(a. xoWava, m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 431
nawlavTa disbaqteriozi (a. xoWava, m. xoWava) . . . . . . . . . . . . . . . . . . . . . 435

kandidozi (m. xoWava, a. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 441
protozouli infeqciebi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 446

amebiazi (a. xoWava, m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 446
niadagSi mobinadre amebebiT gamowveuli daavadebebi (m. xoWava) . . . . 453
pnevmocistozi (a. xoWava, m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 455
leiSmaniozebi (a. xoWava, m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 456
toqsoplazmozi (m. xoWava, a. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 462
malaria (a. xoWava, m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 472
lambliozi (m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 482
helminTozebi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 485
askaridozi (m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 485
strongiloidozi (a. xoWava, m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 487
triqinelozi (a. xoWava, m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 490
enterobiozi (m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 492
triqocefalozi (m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 494
zogierTi neli infeqcia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 495
danarTi 1
etiotropuli mkurnaloba axalSobilobis periodSi . . . . . . . . . . . . . . 497
danarTi 2
etiotropuli mkurnaloba axalSobilobis periodis Semdeg . . . . . . . 498
sxeulis zedapiris farTobis gamoTvlis nomograma

(mosteleris formula) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 501
masis, sxeulis zedapiris farTobis da mozrdilTa

dozebis gaangariSeba (kraufordis cxrili) . . . . . . . . . . . . . . . . . . . . . 502
danarTi 3
zogierTi laboratoriuli maCvenebeli . . . . . . . . . . . . . . . . . . . . . . . . . 503
sagnobrivi saZiebeli . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 513
8
winasityvaoba
umaRlesi saswavleblebis studenti-medikosebisaTvis SemoTavazebuli saxelmZRvanelo

`bavSvTa infeqtologia” pirvelad gamodis qarTul enaze. masSi sakmaod sruladaa
mocemuli nozologiuri erTeulebis ricxvi, rac amomwuravad pasuxobs axali programis
moTxovnas da saSualebas iZleva, studenti daeuflos ara marto farTod gavrcelebul
daavadebebs, aramed im infeqciebsac, romlebic iSviaTad gvxvdebian, magram mZimed
mimdinareoben.
rac Seexeba SemoTavazebuli saxelmZRvanelos saxelwodebas _ `bavSvTa
infeqtologia”, igi ufro srulad asaxavs Tanamedrove terminologiis mecnierul
ganmartebas, vidre dRemde gamoyenebuli da, Cveni azriT, moZvelebuli saxelwodeba _
infeqciuri sneulebani bavSvebSi.
pirvelad, vinc infeqtologiis, rogorc terminis, SemoRebis aucileblobaze yuradReba
gaamaxvila, iyo didi rusi mecnieri, akademikosi a. bilibini. aseve cnobili infeqcionisti,
akademikosi v. pokrovski wers: termin ìnfeqtologiaSi” dReisaTvis gulisxmoben
mikrobiologiis, infeqciuri imunologiis, epidemiologiis, higienisa da infeqciuri
daavadebebis integracias, romelTa gaerTianeba SesaZleblobas iZleva, SevicnoT maTi
urTierTqmedebisa da urTierTdamokidebulebis kanonebi, rogorc dainficirebuli
individumis organizmis, aseve dainficirebuli populaciis masStabiT” (1991).
am srulfasovan ganmartebaSi dasabuTebulia Cvens mier mowodebuli saxelmZRvanelos
saxelwodeba `bavSvTa infeqtologia”.
studentebi, bavSvTa infeqcionistebi, pediatrebi, agreTve sxva dargis specialistebi,
romelTac urTierToba aqvT infeqciur avadmyofebTan, mowodebuli saxelmZRvanelos
saSualebiT, Tanamedrove medicinis miRwevebis doneze, miiReben saTanado codnas, Tumca
movlenebi ise swrafad icvleba infeqtologiis codnis gaRrmavebis TvalsazrisiT,
rom saWiroa sistematuri Tvalyuris devneba da muSaoba mimdinare literaturaze.
wigni pirvelad gamodis qarTul enaze da masSi SeiZleba SevxvdeT ama Tu im
xarvezs, risi aRmofxvrac gagviadvildeba pediatr-infeqcionistebis, zogadi pediatrebis,
sxva kolegebisa da studentebis mier mocemuli SeniSvnebis saSualebiT, rasac didi
madlierebiT miviRebT da saWiro SemTxvevaSi gaviTvaliswinebT Semdegi gamocemebis
dros.
a. xoWava, m. xoWava.
9
zogadi nawili mokle istoriuli cnobebi
zogadi nawili
mokle istoriuli cnobebi
infeqciuri sneulebani uZvelesi droidanaa cnobili. amas mowmobs hi pokrates

Sromebi (460-377 w.w. C.w.aR-mde), sadac aRwerilia iseTi daavadebebi, rogoricaa
muclisa da SebrunebiTi tifi, dizenteria, cimbiris wyluli, wiTela da sxv. ZvelberZnul
papirusebSi (2-4 sauk. C.w.aR-mde) aris cnobebi Sav Wirze, poliomielitze, malariaze
da sxv. kidev ufro adre, Cinur xelnawerebSi, naxsenebia naturaluri yvavili.
kacobriobis xangrZlivi arsebobis manZilze msoflios TiTqmis yvela kontinentze
araerTxel mZvinvarebda infeqciuri daavadebebis epidemiebi Tu pandemiebi, romelTa
msxverplic xdeboda mosaxleobis didi nawili, xolo didi qalaqebi zogjer mTlianad
nadgurdeboda.
miuxedavad imisa, rom cnobebs infeqciuri daavadebebis gavrcelebis kanonzomierebebis
Sesaxeb SeiZleba SevxvdeT Zvel berZen da romael mecnierTa SromebSi (hi pokrate,
lukreciusi, celsiusi, plinius-ufrosi da sxv.), mxolod aRorZinebis epoqaSi italielma
mecnierma d. frokasterom (1546w.) Cauyara safuZveli infeqciur sneulebaTa swavlebas
_ epidemiologias da infeqciur sneulebaTa gamomwvev mizezad cocxali arsebebis _
kontagiebis arseboba CaTvala. am mxriv infeqciur sneulebaTa epidemiologiis
CamoyalibebaSi aseve didi roli miuZRvis rus mkvlevars d. samoiloviCs.
infeqciur sneulebaTa etiologiis dadgenas fundamenturi safuZveli Caeyara me-
18 saukunis bolosa da me-19 saukunis damdegs L. Paster–is, R. Koch-is, Ä\ Èâàíîâñêèé
Èâàíîâñêèé-
is aRmoCenebis Semdeg, roca dadginda, rom infeqciuri daavadebebi gamowveulia organizmSi
paTogenuri baqteriebisa da virusebis SeWris Sedegad.
rusi mecnierebis Ä\ Çàáîëîòíûé
Çàáîëîòíûé-is, Ë\ Ãðîìàøåâñêèé
Ãðîìàøåâñêèé-is, Â\ Áåêëåìèøåâ
Áåêëåìèøåâ-is,
Â\ Áàøåíèí
Áàøåíèí-is, Å\ Ïàâëîâñêèé
Ïàâëîâñêèé-isa da sxvaTa Sromebma mecnieruli safuZveli Cauyara
infeqciur sneulebaTa epidemiologias _ mecnierul disci plinas, romelic aRWurvilia
saTanado TeoriiT, mizandasaxuli amocanebiT, gaaCnia specifikuri obieqti da SemoqmedebiTi
moRvaweobis didi areali.
me-17-19 saukuneebSi intensiurad daiwyo bavSvebSi infeqciur davadebaTa klinikis
aRwera. am daavadebebs (wiTela, wiTura, ybayura, qunTruSa) ganixilavdnen, rogorc
bavSvTa asakisaTvis damaxasiaTebel, damoukidebel infeqciebs.
SemdgomSi epidemiologiurma kvlevebma daadastura, rom bavSvTa asakis 70%-ia
swored mTavari kontingenti infeqciuri daavadebis mimReblobis TvalsazrisiT, rac
dakavSirebulia imunuri statusis TaviseburebebTan.
mozrdilebSi e.w. bavSvTa infeqciebis mimarT imunitetis uqonlobis SemTxvevaSi
xSiria daavadebaTa ara erTeuli SemTxvevebi, aramed epidemiuri afeTqebebi ( mag:
difTeria, ybayura da a.S.).
unda aRiniSnos, rom qarTveli mecnierebisa da infeqcionistebis pleadis
Camoyalibebaze udidesi gavlena moaxdina rusi mecnierebis Í\Ô\ Ãàìàëåÿ Ãàìàëåÿ-s, Ï\Ô\
Çäðîäîâñêèé
Çäðîäîâñêèé-is, Ë\Â\ Ãðîìàøåâñêèé
Ãðîìàøåâñêèé-is, Õ\Õ\ Ïëàíåëüåñ
Ïëàíåëüåñ-is, Ë\À\ Çèëüáåð
Çèëüáåð-is, Ã\Ï\
Ðóäíåâ
Ðóäíåâ-is, À\Ð\ Áèëèáèí
Áèëèáèí-is, Í\È\ Áðàóäå
Áðàóäå-s, Í\È\ Íèñåâè÷
Íèñåâè÷-is da sxvaTa ara marto
fundamenturma Sromebma, aramed maTTan mWidro kontaqtma da TanamSromlobam.
10
zogadi nawili. infeqciur daavadebaTa ... kanonzomierebani
Tavis mxriv, infeqtologiis ganviTarebaSi didi wvlili Seitanes qarTvelma

mecnierebma. maT ricxvs miekuTvnebian a. kandelaki, g. maruaSvili, k. kacitaZe, g. kvitaiSvili,
a. sayvareliZe, v. boWoriSvili, v. baxutaSvili, e. bocvaZe, a. xoWava, n. maxvilaZe, T.
boWoriSvili, e. vaSakiZe, b. korsantia da mravali sxva.
saqarTveloSi bavSvTa infeqciur sneulebaTa kaTedra daarsda Tbilisis saxelmwifo
samedicino institutis (amJamad universiteti) pediatriul fakultetze 1943 w.,
kaTedras xelmZRvanelobda profesori v. nemsaZe, Semdgom doc. v. mWedliSvili, ukanaskneli
2 aTeuli wlis ganmavlobaSi _ profesori a. xoWava. saqarTveloSi Camoyalibda
bavSvTa infeqcionistTa skola, romelsac warmoadgenen: v. nemsaZe, a. xoWava, v. mWedliSvili,
m. xoWava, i. kvitaiSvili, b. didebuliZe, l. nebieriZe, i. SalamberiZe, m. SilakaZe, m.
SublaZe, d. petriaSvili, T. yuraSvili, g.kavilaZe, T. sefiskveraZe, d. demetraSvili, k.
petriaSvili, T. joxTaberiZe, i. xabazi, l. jimSitaSvili, Bb. eliaZe da sxv.
ukanaskneli 10-15 wlis manZilze, pirvelad bavSvTa infeqtologiaSi, Tssu-s bavSvTa
infeqciuri sneulebebis kaTedris TanamSromlebi mizandasaxulad da dawvrilebiT
ikvleven kritikul mdgomareobaSi myof mcire asakis bavSvebSi mwvave respiraciuli
virusuli, nawlavTa da sxva mwvave infeqciebis dros etiologiis, paTogenezis, klinikisa
da mkurnalobis problemebs, rac aisaxa 15 sakandidato sadisertacio SromaSi, periodul
samedicino literaturaSi, maT Soris, ucxour presaSi.
praqtikaSi danergilia mkurnalobis axali meTodebi, romlebic gaSuqebulia calkeuli
nozologiuri erTeulebis aRweris dros.
infeqciur daavadebaTa epidemiologiis

zogierTi kanonzomierebani
Tu infeqciur process warmovidgenT, rogorc infeqciuri agentisa da makroorganizmis

urTierTmoqmedebas garemoSi, epidemiuri procesi SeiZleba ganvmartoT, rogorc daavadebis
gavrceleba garkveul teritoriaze, garkveul mosaxleobaze, asakze, sqesze, romelsac
axasiaTebs sezonuroba, jgufuri da sporaduli SemTxvevebis garkveuli Sefardeba da
sxv.
epidemiuri procesis meqanizmis ganviTarebis swori gageba eyrdnoba sam did Teoriul
ganzogadebas: Â\Ä\ Áåëÿêîâ
Áåëÿêîâ-is epidemiuri procesis TviTregulacias, Ë\Â\
Ãðîìàøåâñêèé
Ãðîìàøåâñêèé-is infeqciuri agentis gadacemis meqanizmisa da Å\Í\ Ïàâëîâñêèé
Ïàâëîâñêèé–
is swavlebas kerovani transmisiuli infeqciis Sesaxeb.
epidemiuri procesis ganviTarebisa da misi uwyveti mimdinareobisaTvis aucilebelia
3 Semadgeneli nawilis urTierTmoqmedeba. esenia _ gamomwvevi infeqciuri agentebis
wyaro, infeqciis gadacemis meqanizmi da organizmis mimRebloba infeqciisadmi.
rac Seexeba epidemiuri procesis pirvel rgols, igi warmoadgens infeqciuri
agentis bunebriv wyaros, sadac xdeba am agentis gamravleba, dagroveba, ris Sedegadac
SeiZleba dasnebovndes janmrTeli adamiani an cxoveli (saTanado gadacemis meqanizmis
arsebobisas). amasTan mTeli rigi gamomwvevi agentebis sapronozuli buneba gvaZlevs
sababs, infeqciis wyarod miviCnioT garemos abioturi obieqtebi _ wyali, niadagi da
sxv. aqedan gamomdinare, infeqciis wyaros cneba unda niSnavdes cocxal an abiotur
obieqts, romelic warmoadgens paTogenuri mikrobebis bunebrivi cxovelqmedebis niadags.
aRniSnulidan gamomdinareobs, rom infeqciis wyaro SeiZleba iyos adamianis organizmi
(anTroponozebi), cxovelebis organizmi (zoonozebi) da abioturi obieqtebi (sapronozebi).
gansakuTrebul yuradRebas imsaxurebs infeqciuri agentis gadacemis meqanizmi, romelic
11
SeiZleba warmovidginoT Semdegi Tanmimdevruli stadiebis ganxorcielebiT: 1) avadmyofi

organizmidan an mtareblidan infeqciuri agentis gamoyofa; 2) misi moxvedra biotur
an abiotur obieqtSi, sadac infeqciuri agenti Tavisi cxovelmyofelobisaTvis saTanado
pirobebs naxulobs; 3) gamomwvevis SeWra janmrTel organizmSi.
infeqciuri agentis specifikuri lokalizacia makroorganizmSi, misi gadacemis
meqanizmis gaTvaliswinebiT, Seadgens l. gromaSevskis epidemiologiuri klasifikaciis
mTavar arss.
infeqciuri agentis pirveladi lokalizaciis Sesabamisad arCeven infeqtis gadacemis
5 tips: haer-wveTovans, fekalur-oralurs, sayofacxovrebo-kontaqturs, transmisiulsa
da me-5 ti ps, rodesac daavadebis gamomwvevis (infeqtis) gadacema xdeba sxvadasxva
gziT.
haer-wveTovani (aerozoluri an mtvris meSveobiT)gza infeqciis gadacemis yvelaze
ufro gavrcelebuli da yvelaze ufro swrafi gzaa. gadacemis intensivoba damokidebulia
iseT fiziologiur aqtebze, rogoricaa laparaki, xvela, cxvircemineba da ase Semdeg,
romlis drosac aerozolis saxiT gamoyofili inficirebuli sekreti wveTebis sididis
mixedviT sxvadasxva manZilze vrceldeba. mag., msxvili aerozolebi (100-200 mkm)
swrafad ileqeba 2-3 m-is, zogjer ki ufro nakleb (epidemiuri parotiti, yivanaxvela
da sxv.) manZilze, maSin, rodesac 1-10 mkm sididis dros ufro didxans rCeba haerSi da
brunvis, moZraobisa da eleqtruli damuxtvis Sedegad did manZilze vrceldeba. aseT
infeqciebs miekuTvneba wiTela, gri pi, Cutyvavila da sxv. amave dros, unda aRiniSnos,
rom kontagiozuri indeqsi am infeqciebis dros sxvadasxva intensivobisaa, rac
dakavSirebulia infeqciis gavrcelebis meqanizmTan da dasainficirebeli organizmis
rezistentobasTan. infeqciis gadacema SesaZlebelia rogorc damtverianebis, aseve
aerogenuli gziTac (difTeria, qunTruSa, salmonelozi, tuberkulozi da sxva infeqciebi).
fekalur-oraluri an alimenturi gziT infeqciis gadacema damaxasiaTebelia
nawlavTa rogorc baqteriuli, aseve virusuli bunebis infeqciebisaTvis. maT miekuTvneba
Sigelozi, salmonelozi, muclis tifi, qolera, rotavirusuli da sxva diareagenuli
virusuli infeqciebi. am dros infeqciis gadacemis faqtorebia kvebiTi produqtebi,
wyali, gaWuWyianebuli xelebi, buzebi, sxvadasxva inficirebuli sayofacxovrebo sagnebi
da sxv. aseTi gziT infeqciis gadacema SeiZleba qunTruSis, difTeriis, tuberkulozis
dros, magram naklebad dasaSvebia wiTelas, mwvave respiraciuli virusuli infeqciebisas
garemoSi maTi gamomwvevebis aramdgradobis gamo.
niadags, rogorc infeqciis gadacemis faqtors, mniSvneloba eniWeba Wrilobis
anaerobuli infeqciiT dasnebovnebis dros (gazovani gangrena, gaSeSeba). am SemTxvevaSi
mikrobebi niadagSi xvdebian adamianis an cxovelebis fekaliebiT, warmoqmnian sporebs
da mravali wlis manZilze inarCuneben sicocxles. adamiani avaddeba Wrilobis zedapirze
an sakvebi produqtebiT per os (botulizmi) mikrobebis an maTi toqsinebis moxvedris
dros.
sayofacxovrebo-kontaqturi gza. am SemTxvevaSi infeqciuri agentis specifikuri
lokalizacia upiratesad aRiniSneba kanze, lorwovan garsebze (garda kuW-nawlavis
traqtisa), romlebic garemosTan uSualo SexebaSia. janmrTeli adamiani inficirdeba
avadmyofTan SexebiTac (kontaqtis dros). dainficireba SeiZleba moxdes pirdapiri an
arapirdapiri kontaqtiT. inficirebul adamianTan pirdapiri kontaqtis gziT infeqciis
gadacema SesaZlebelia difTeriis, qunTruSis, tuberkulozis, herpes-infeqciis (kocniT),
aiv-infeqciis (umTavresad sqesobrivi gziT), wiTeli qaris, munisa da a.S. dros. arapirdapiri
kontaqtisas infeqciis gadacemis faqtorebia sxvadasxva sayofacxovrebo sagnebi, nawlavTa
infeqciebis dros _ WuWyiani xelebi (xSiria bavSvebSi) da nivTebi.
transmisiuli gza xorcieldeba cocxali mwerebiT, xSirad specifikuri gadamcemebiT
12
(tki pa, tili, koRo, rwyili, moskiti), romlebic infeqts gadascemen mxolod mkacrad
gansazRvruli infeciebis dros. maT mier infeqtis gadacema xdeba kbenis an mis
adgilas Sezelvis Sedegad. aRniSnuli mwerebis organizmSi infeqti mravldeba an
gadis sqesobrivi ganviTarebis cikls. araspecifikur biologiur gadamtanebad iTvlebian
buzebi, romlebsac infeqciis gamomwvevi agenti meqanikurad gadaaqvT nawlavTa infeqciebis
dros (Sigelozi, muclis tifi, hepatiti A da sxv.). unda aRiniSnos, rom gadamtanis
aseT faqtors sul ufro da ufro naklebi mniSvneloba eniWeba, gansakuTrebiT
ganviTarebul qveynebSi, rac sanhigienuri pirobebis gaumjobesebaze metyvelebs.
l. gromaSevskis mier mowodebulia infeqciis gadacemis 4 ZiriTadi meqanizmi erTi
saxeobis individumebs Soris (“horizontuli gadacema”). ukanasknel periodSi ki didi
yuradReba miiqcia infeqciis vertikaluri gadacemis meqanizmma. am mxriv, gansakuTrebiT
aqtualuria transplacenturi gziT dedidan nayofze iseTi infeqciebis gadacema,
rogoricaa virusuli (citomegalia, wiTura, Cutyvavila, epidemiuri parotiti da sxv.),
baqteriuli (stafilokokuri, streptokokuri, disbaqteriozi), protozouli (leiSmaniozi,
malaria, toqsoplazmozi) bunebis infeqciebi. aRniSnuli infeqciebi orsulobis sxvadasxva
periodSi iwveven nayofis mZime daavadebebs, sikvdils (mkvdradSobadoba) da (an)
axalSobilTa Tandayolil infeqciebs.
aRniSnul jgufSi Semaval infeqciebs l. gromaSevski da b. vasilevi (1972)
ganixilavdnen, rogorc sisxlis infeqciebs specifikuri gadamtanis gareSe.
epidemiuri procesis ganviTarebisaTvis, misi uwyveti mimdinareobisaTvis
aucilebelia mesame rgolis _ infeqciisadmi mosaxleobis mimReblobis arseboba. amasTan
dakavSirebiT, saWiroa xazi gaesvas im garemoebas, rom imuniteti SeiZleba iyos bunebrivi,
saxeobrivi, Tandayolili anu genetikurad fiqsirebuli. aseTi imunitetiT aixsneba is
faqti, rom adamiani ar avaddeba cxovelebisaTvis damaxasiaTebeli zogierTi infeqciiT
da, piriqiT, cxoveli ar avaddeba, mag. wiTelaTi, qunTruSiT, meningokokuri infeqciiT da
sxv. infeqciis saxeobrivi miuRebloba determinirebulia alelis wyvili geniT. ase,
mag: afrikis zogierT raionSi, sadac farTodaa gavrcelebuli malaria, nanaxia
gansakuTrebuli geni, romelic iwvevs adamianebSi anomaluri, namgliseburujredovani
hemoglobinis sinTezs. aRniSnuli genis heterogenul pirebSi malaria ar viTardeba.
bunebrivi imunitetis Sesustebas xels uwyobs mTeli rigi faqtorebi _ organizmis
fiziologiuri Tvisebebisa da kvebis darRvevebi, organizmis gadaciveba da sxv.
SeZenili imuniteti SeiZleba iyos infeqciis gadatanis an specifikuri acrebis
Catarebis Sedegi. ukanaskneli saxis imunitets didi mniSvneloba eniWeba aramarto
infeqciebisadmi mosaxleobis miuReblobis CamoyalibebaSi, aramed infeqciis srul
likvidaciasa an mis mkveTr SemcirebaSi msoflios masStabiT Catarebuli imunizaciis
gziT. saerTaSoriso da nacionaluri janmrTelobis dacvis sistemebis RonisZiebaTa
Sedegad naturaluri yvavili mTel msoflioSi iqna likvidirebuli da 1980 wlis
maisSi Catarebul msoflios janmrTelobis dacvis XXXIII sesiaze xelmowerili iqna
sertifikati dedamiwaze yvavilis likvidaciis Sesaxeb. aqve unda aRiniSnos sabWoTa
medicinis epidemiologiis fuZemdeblis l. gromaSevskis mier mowodebuli infeqciis
likvidaciis brwyinvale ganmarteba, sadac man pirvelma ganacxada, rom infeqciis likvidacia
niSnavs TviT gamomwvevi agentis likvidacias. yvavilis virusi mxolod samuzeumo
kulturis saxiT inaxeba parizSi l. pasteris saxelobis institutSi.
yvavilis likvidaciis saerTaSoriso programaSi aqtiurad monawileobda
saqarTvelodan Cveni Tanamemamule akad. Tamaz kereseliZe, romelic dajildovda am
movlenisadmi miZRvnili specialuri `bifurkaciuli nemsis~ ordeniT.
mosaxleobis mimRebloba sxvadasxva infeqciebisadmi gansxvavebulia, rac kontagiozuri
indeqsis saxeliTaa cnobili, misi konstanta ganisazRvreba 100 kontaqtirebulidan
13
daavadebulTa procentiT anda gamoisaxeba aTwiladebiT 1,0-mde.

GgansakuTrebiT maRalia wiTelas kontagiozuroba, romelic udris TiTqmis 100%-
s anu 1,0-s, difTeriis kontagiozuri indeqsi Seadgens 20%-s anu 0,2-s, A hepatitisa
_ 40-60% anu 0,4-0,6 da sxv.
unda aRiniSnos, rom anTroponozuli infeqciebis dros infeqciis wyaroa adamiani.
l. gromaSevskis epidemiologiuri klasifikaciis saTaveebSi Cadebulia gamomwvevi
agentisa da adamianis organizmis urTierTkavSiri (lokalizacia). gansxvavebuli suraTia
zoonozuri infeqciebis dros, romelTa rezervuaria ara admiani, aramed cxovelebi.
aseT SemTxvevaSi gamomwvevi infeqciis gadacemis meqanizmi anTroponozul infeqciasTan
SedarebiT sruliad gansxvavebulia. saxeldobr, ar aRiniSneba sruli da aucilebeli
Sesabamisoba mikrobis lokalizaciasa da mis gadacemis meqanizms Soris. zoonozuri
infeqciiT Sepyrobili adamiani ar gadascems infeqcias janmrTel adamians.
adamianisa da cxovelebis infeqciis gamomwvevi zogierTi mikroorganizmi TveobiT
da wlobiT ara marto inarCunebs sicocxlisunarianobas, aramed mravldeba kidec
garemoSi. am SemTxvevaSi wyali, niadagi da zogierTi mcenare SeiZleba ganvsazRvroT,
rogorc infeqciis wyaro.
maSasadame, arsebobs infeqciis sami ZiriTadi wyaro: 1) adamianis organizmi an
populacia, 2) cxovelTa organizmi, 3) abioturi garemo (niadagi, wyalsatevebi, zogierTi
mcenareuloba da sxva). Sesabamisad yvela infeqcia SeiZleba daiyos: 1) anTroponozebad
(mwvave respiraciuli daavadebebi, muclis tifi, wiTela, difTeria da sxva), 2) zoonozebad
(salmonelozi, cofi, tkipismieri encefaliti da sxva), 3) sapronozebad (legionelozi,
melioidozi, qolera, klostridiozi da sxva).
msoflio jandacvis organizaciis eqspertebi gamoyofen sapronozuli
mikroorganizmebis binadrobis 2 wyaros _ cxovelebis organizms da garemos. zogierTi
avtori amjobinebs, sapronozebs uwodos zoofiluri saprozoonozebi. am jgufs akuTvneben
cimbiris wyluls, fsevdomonur infeqcias, leptospirozebs, nawlavTa iersiniozs,
fsevdotuberkulozs, listeriozs da sxv.
amJamad mowodebulia zoonozebis ekoepidemiologiuri klasifikacia, romlis Tanaxmad
zoonozuri daavadebebi dayofilia 2 jgufad:
1. Sinauri cxovelebis (soflis meurneobis, bewviani, binis pirobebSi mcxovrebi da
sinanTropuli _ (mRrRneli cxovelebi) daavadebebi.
2. gareuli (qsenanTropuli) cxovelebis daavadebebi (bunebriv-kerovani).
aseTi klasifikacia klinicists pirvel rigSi exmareba epidanamnezis SegrovebaSi.
bavSvebi gareuli cxovelebisagan xSirad avaddebian fexsaxsriani mwerebis (tki pa,
koRo) saSualebiT, an kontaqtiT mkvdar mRrRnelebTan da inficirebul xorcTan an
wyalTan.
zoonozuri infeqciiT daavadebuli adamiani infeqciis wyaros ar warmoadgens,
maSasadame igi biologiuri Cixia am daavadebis gamomwvevebisaTvis.
infeqciuri daavadebebis gansakuTrebul jgufs warmoadgenen protozoonozebi (ma-
laria, leiSmaniozi, toqsoplazmozi), romlis drosac infeqciis wyaros warmoadgenen
cxovelebi da mwerebi.
rogorc Cans, l. gromaSevskis klasifikacia ver itevs epidemiologiis, infeqtologiis,
saxeldobr infeqciebis paTogenezis axal miRwevebs. es gansakuTrebiT kargad Cans im
infeqciebis magaliTze, roca infeqciis gamomwvevs aqvs organizmSi SeWris ramdenime
meqanizmi. mag., transmisiuli da alimenturi gza Savi Wiris, tularemiis, arbovirusuli
infeqciebis _ virusuli encefalitebis, hemoragiuli cxelebebis dros da sxva; difTeria,
qunTruSa gadaicema ara marto aerogenuli, aramed kontaqturi gziTac,
amasTan dakavSirebiT infeqciuri daavadebebis klasifikacia logikuria daeyrdnos
14
etiologiur princi ps da dayofil iqnas Semdegnairad _ baqteriozi (baqteriuli

infeqcia), baqteriuli toqsinebiT mowamvla, virusuli daavadebebi, riketsiozebi,
qlamidiozebi, mikoplazmozebi, protozouli daavadebebi, mikozebi da helminTozebi.
amave dros yoveli jgufidan SeiZleba maTi SeerTeba daavadebis paTogenezis princi piT,
gamomwvevi agentis gadacemis meqanizmis tropulobis gaTvaliswinebiT.
aseT princi pebzea agebuli infeqciur daavadebaTa klasifikacia saxelmZRvaneloebSi
Ðóêjâîäñòâî ïî èíôåêöèîííûì áîëåçíÿì
_ “Ðóêjâîäñòâî áîëåçíÿì” Þ\Â\ Ëîáçèí-
Ëîáçèí-is== À\Ï\ Êàçàíöåâ
Êàçàíöåâ-
is saerTo redaqciiT (1996), “Èíôåêöèîííûå áîëåçíè ó äåòåé” Â\Ô\ Ó÷àéêèí Ó÷àéêèí-is
saerTo redaqciiT (1998).
meores mxriv, pediatriuli infeqtologiis praqtikaSi miRebulia infeqciuri
daavadebebis klasifikacia ti pis, simZimisa da mimdinareobis mixedviT (a. kolti pini),
rac gaTvaliswinebulia nozologiuri erTeulebis garCevisas.
daavadebis ti pur
purii forma niSnavs nozologiuri erTeulisaTvis damaxasiaTebeli
forma
simptomis an sindromis arsebobas, mag: Sigelozis dros _ kolituri sindromi, qunTruSas
dros-alisebri xaxa da wvrilwinwklovani gamonayari kanis hi peremiul fonze da sxva.
ati puri forma xasiaTdeba daavadebis waSlili an subklinikuri mimdinareobiT, am
SemTxvevaSi daavadeba SeiZleba dadasturdes mxolod laboratoriuli kvlevebiT, maT
Soris serokonversiis dadgeniT. arsebobs mikroorganizmebis janmrTeli mtarebloba,
rasac ufro epidemiologiuri mniSvneloba eniWeba. am dros SeiZleba dadgindes
mikrobis saxe, magram mtareblebis organizmSi raime imunologiur Zvrebs adgili ara
aqvs.
infeqciur
infeqciuri i daavadebis ati pur
puri i mimdinar eobis dros damaxasiaTebeli sindromi
mimdinareobis
SeiZleba nivelirebuli iyos da adgili hqondes agravirebul simptomatikas mZime
mimdinareobiT (hi pertoqsikuri, hemoragiuli formebi).
daavadebis simZimis mixedviT ti puri mimdinareobis dros arCeven msubuq, saSualo
da mZime formebs. aq saWiroa, xazi gaesvas imas, rom simZimis Sefaseba unda moxdes
klinikuri suraTis maqsimaluri gaSlis, Camoyalibebis gaTvaliswinebiT. didi yuradReba
eqceva ara marto saerTo intoqsikaciis movlenebs, aramed adgilobriv movlenebsac,
romlebic rigi infeqciebis dros gansazRvraven daavadebis simZimesac. (mag., xaxis
difTeriis dros nadebebis gavrceleba, kisris kanqveSa qsovilebis SeSupeba da a.S.).
daavadeba SeiZleba sadad mimdinareobdes gamwvavebebisa da recidivebis gareSe, rac
umetes SemTxvevaSi damaxasiaTebelia procesis cikluri mimdinareobisaTvis. xangrZlivobis
mixedviT arCeven procesis mwvave mimdinareobas, roca daavadeba eteva 1-3 Tvis CarCoebSi;
gaxangrZlivebul mimdinareobad iTvleba 4-6 Tvemde, xolo 6 Tvis zeviT ki iTvleba
qronikul formad.
garTulebad iTvleba iseTi mdgomareoba, roca erT SemTxvevaSi misi arseboba
dakavSirebulia nozologiis etiologiasa da paTogenezTan (mag., muclis tifis dros
nawlavis perforacia an sisxldena); meores mxriv garTuleba gamowveulia sxva floriT,
maT Soris egzo- da endogenuri genezis; mag: pnevmoniebi, otiti, piuria da a.S.)
endogenuri disbaqteriozi da amis Sedegad garTuleba sefsisis CaTvliTac. SeiZleba
ganviTardes gamwvavebebi, recidivebi, rac xels uwyobs daavadebis gaxangrZlivebas an
qronikuli formis ganviTarebas. dawvrilebiTi klinikuri klasifikacia mocemulia
nozologiuri erTeulebis ganxilvis dros.
15
zogadi nawili. infeqciuri paTologiis ... ganmarteba
infeqciuri paTologiis zogierTi

terminologiuri ganmarteba
infeqciuri paTologiis zogierTi terminologiuri ganmarteba unda eyrdnobodes

infeqciuri procesis swor warmodgenas da, SeZlebisdagvarad, unda iyos misi arsis
amsaxveli.
xSirad termini ìnfeqcia” (laT.: infectio _ vasnebovneb) bevri avtoris mier
zedmetad Tavisufali midgomiT gaigivebulia infeqciur agentTan, maSin, rodesac
infeqcia farTo gagebiT gulisxmobs infeqciuri procesis mimdinareobas, rasac ganapirobebs
makroorganizmisa da mikroorganizmis (agreTve parazitebis) urTierTmoqmedeba (brZola)
garkveul garemo pirobebSi. organizmSi am dros dinamikurad viTardeba damcvelobiT-
SeguebiTi, kompensaciuri an alteraciuli reaqciebi.
infeqciuri daavadeba ki gulisxmobs infeqciuri procesis ukiduresi gamovlinebis
klinikur manifestacias. xazgasmiT aRvniSnavT, rom daavadebis klinikuri suraTi
SeiZleba meryeobdes didi diapazoniT _ mimdinareobdes ati purad, dawyebuli waSlili,
umsubuqesi (es ki xSirad qmnis diagnostikis siZneleebs), an piriqiT, umZimesi mimdinareobiT,
xSirad agravirebuli formiT. am SemTxvevebSi, subieqturi movlenebis araswori Sefasebis,
daavadebis mZime gamovlinebis Sedegad procesi SeiZleba letaluri gamosavliT
damTavrdes inkubaciuri periodis damTavrebidan ramodenime saaTSi (elviseburi formebi).
daavadeba SeiZleba mimdinareobdes inaparantulad (Sarl nikoli), subklinikurad,
ujredul, qsovilis, organos, organoebis doneze, rac dasturdeba bioqimiuri, imunologiuri,
tropuli organoebis morfologiuri cvlilebebiT da sxva. meores mxriv, makroorganizmisa
da mikroorganizmis Sexvedram SeiZleba miiRos ase Tu ise “indiferentuli”
urTierTkavSiris saxe da ganviTardes e.w. janmrTeli mtarebloba, Tumca es movlena
Tanamedrove imunologiuri gagebiT SeiZleba ganpirobebuli iyos imunodeficitiT.
daavadebis mwvave periodis CamTavrebis Semdeg, e.w. rekonvalescenciis periodSi SeiZleba
ganviTardes “janmrTeli” mtarebloba, magram es ar unda gavaigivoT janmrTeli
mtareblobis farTo mcnebasTan. mwvave mtarebloba, rogorc wesi, xanmoklea da, albaT,
aseve dakavSirebulia am periodSi jer kidev arasrul imunologiur gardaqmnebTan.
cnobilia, rom proteqciuli imuniteti (IgG IgM-isagan gansxvavebiT) yalibdeba
ufro mogvianebiT periodSi. arasruli imunitetis arseboba ki ganapirobebs qronikul
baqteriamtareblobas, rac SeiZleba dakavSirebuli iyos genetikur imunodeficitTanac.
makro- da mikroorganizmebis urTierTmoqmedebis Sedegad SesaZlebelia ganviTardes
infeqciuri procesis SenarCunebuli _ persistuli forma ( laT. sityvidan persistens
_ mdgradi, mudmivi, SenarCunebuli). misi ZiriTadi arsi SeiZleba ganmartebul iqnas,
rogorc infeqciuri procesis qronikuli, latenturi, SesaZlebeli talRiseburi
mimdinareoba, zogjer ki klinikuri gamovlinebis gamwvavebiTac. am rTuli procesis
mimdinareoba aseve dakavSirebulia humoruli da ujreduli imunodeficitis
mdgomareobasTan, virusebTan da mikrobebis L-ti pis SesaZlo ganviTarebasTan, raSic
didi roli miekuTvneba organizmis imunokompetenturi sistemis gavlenas, gansakuTrebiT
ki antibiotikebis moqmedebas. dadasturebulia L-formebis gadasvla ti pur, sawyis
baqteriul formebSi, rasac daavadebis gavrcelebaSi epidemiologiuri mniSvneloba
aqvs. aRsaniSnavia, rom daavadebis persistuli forma umTavresad keTilmimdinareobiT
xasiaTdeba ( mag., qronikuli araaqtiuri B hepatiti, herpesuli infeqcia, citomegalia,
enterovirusuli, adenovirusuli da mravali sxva infeqcia).
infeqciuri procesi SesaZlebelia, ganpirobebuli iyos saprofituli floris
aqtivaciiT _ nawlavTa an sxva sistemis pirobiTpaTogenuri mikrobebiT gamowveuli
16
zogadi nawili. infeqciuri paTologiis ... ganmarteba
endogenuri autoinfeqciebi, romlebic viTardebian mcire asakis bavSvebSi sxvadasxva

infeqciebis antibiotikebiTa da citostatikebiT mkurnalobis Sedegad (stafilokokuri,
kandiduri, proteusuli, fsevdomona-aeruginozuli, klebsieluri infeqciebi da sxv.).
calke unda iqnas ganxiluli neli infeqciebis dros makro- da mikroorganizmebis
Taviseburi urTierTmoqmedeba, risTvisac damaxasiaTebelia daavadebis progresireba,
ramodenime wlis xangrZlivobis mimdinareoba. am ti pis mimdinareobiT xasiaTdeba
iseTi infeqciebi, rogoricaa Tandayolili wiTura, qvemwvave masklerozebeli panencefaliti,
qronikuli aqtiuri hepatiti cirozis ganviTarebiT, kuru da sxv.
Tumca jer ar aris dadgenili am daavadebaTa paTogenezi, magram savaraudoa
autoimunuri procesebis meqanizmis arseboba, rac xorcieldeba antigentropuli
organizmis zemgrZnobelobis Senelebuli pasuxis saxiT.
infeqciuri procesis mimdinareobisas mxedvelobaSia misaRebi daavadebis remisiis
an rekonvalescenciis dros procesis gamwvaveba an recidivis ganviTareba. es movlena
SeiZleba, ganpirobebuli iyos aRniSnul periodebSi organizmis xelmeore inficirebiT
(i. SalamberiZe, 1989 w) an identuri saxis mikroorganizmebiT, rac cnobilia reinfeqciis
saxelwodebiT.
garkveuli infeqciuri daavadebebis fonze sxva saxis mikrobebiT inficireba cnobilia,
rogorc superinfeqcia, aseTma procesma daavadebis mimdinareoba umZimesi SeiZleba
gaxados (mag: B-hepatitis dros D virusiT inficireba, ramac SeiZleba gamoiwvios
iseTi garTulebebi, rogoricaa RviZlis mwvave, qvemwvave distrofia, daavadebis qronizacia
da sxv).
ori sxvadasxva mikrobuli faqtoriT inficirebisas viTardeba e.w. ko-infeqcia
(Co-laTinuri sityvaa da niSnavs “erTad”). ko-infeqcia, albaT, ufro naklebad iwvevs
mZime mimdinareobas. virusuli infeqciebisas SesaZlebelia, interferenciis movlenebic
gamovlindes (virusebis urTierTmoqmedebisa da konkurenciis Sedegad virusis moqmedeba
organizmze sasikeTo xdeba). Cveni dakvirvebiT, virusul hepatitebze wiTelas darTva
iwvevda daavadebis klinikis ukuganviTarebasa da rekonvalescenciis daCqarebas (a.
xoWava).
Tu infeqciuri daavadeba monopaTogeniT (erTi saxeobis mikrobebiT) aris gamowveuli,
am SemTxvevaSi laparakoben monoinfeqciaze. amasTan, xazi unda gaesvas paTogenuri
mikrobis specifikurobas, rac ganapirobebs daavadebul organizmSi mxolod specifikur
process. ase mag.: muclis tifs iwvevs mxolod muclis tifis Cxiri, virusul gri ps
_ gri pis virusebi, dizenterias _ dizenteriis Cxiri, salmonelozs _ salmonelas
Cxiri da a.S. Tumca, amave dros, sxvadasxva paTogenurma mikrobma SeiZleba SedarebiT
msgavsi klinikuri suraTi Seqmnas. mag.: eSerixiis 0124 StamiT gamowveuli daavadeba
zogjer mimdinareobs baqteriuli dizenteriis msgavsad, rac aixsneba dizenteriuli
baqteriisa da eSerixiis 0124 mikrobis antigenTa zogierTi fraqciis identuri
struqturiT.
meores mxriv, umTavresad axalSobilebSi, mcire asakisa da, gansakuTrebiT,
imunodeficitis mqone bavSvebSi infeqciuri daavadeba xSirad SeiZleba gamowveuli
iyos ori an meti paTogeniT (miqst-infeqcia, polimiqst-infeqcia). aseTi daavadebis
ganviTarebaSi mniSvnelovania rogorc saTanado epidemiologiuri situacia _
Sidahospitaluri StamebiT inficireba (nozokomialuri infeqciebi; nosocomialis –
hospitaluri daavadeba, infeqcia), aseve makroorganizmis advili mimRebloba
pirobiTpaTogenuri floris mimarT.
miqstinfeqciebis dros daavadeba xSirad gamoirCeva klinikuri polimorfizmiT,
mZime mimdinareobiT. es movlenebi ki qmnis diagnostikur siZneleebs da ganapirobebs
cud prognozul gamosavals. am SemTxvevaSi didi mniSvneloba aqvs polietiologiuri
17
infeqciuri paTologiis ... ganmarteba
zogadi nawili. infeqciuri daavadebis paTogenezisa da klinikuri ... mxare
struqturis gaSifvras, saTanado etiotropuli da paTogenezuri ( sakmaod rTuli )

Terapiis Catarebas keTili prognozis misaRwevad.
infeqciuri daavadebis paTogenezisa da klinikuri

gamovlinebebis kanonzomierebaTa zogierTi mxare
infeqciuri daavadebebis mimdinareobaSi arCeven inkubaciur anu farul periods,

prodromul anu winamorbed klinikur gamovlinebebs, klinikuri suraTis sruli gaSlisa
da, bolos, gamojansaRebis periods. inkubaciuri periodi mTeli rigi infeqciebis dros
(gansakuTrebiT, cikluri mimdinareobisas) gamoirCeva limitirebuli drois faqtoriT,
romelsac didi praqtikuli mniSvneloba aqvs profilaqtikuri RonisZiebebis
gansaxorcieleblad _ karantinis dawyeba e.w. konvenciuri daavadebebis (qolera, Savi
Wiri, yviTeli cxeleba) da sxva dros, zogjer profilaqtikuri acrebisa da
qimioprofilaqtikis Catarebis TvalsazrisiTac.
infeqciuri periodis xangrZlivoba damokidebulia makroorganizmis rezistentobaze,
paTogenis virulentobaze, SeWris adgilsa da sxva faqtorebze. aRniSnul periodSi
infeqciuri agenti iwyebs gamravlebas (reproduqcias), endo- da egzotoqsinebis dagrovebas,
viTardeba organizmis sensibilizacia. ukve am periodSi zogierTi infeqciis dros
xdeba organizmis imunologiuri gardaqmna, rasac adasturebs serokonversiis arseboba,
mag., virusuli hepatitebis, aiv-infeqciisa da sxva infeqciaTa SemTxvevaSi.
adgilobrivi da zogadi barierebis garRvevisas rigi infeqciebis dros infeqciis
SeWris adgilas viTardeba adgilobrivi anTebadi kera _ pirveladi afeqti ( mag. xaxis,
xorxis, cxviris, sasqeso organoebisa da a.S., difTeriis klinikuri formebis
Camoyalibebisas).
cnobili mecnieris g. rudnevis xatovani gamoTqmiT, infeqciis SeWris WiSkari
ganapirobebs daavadebis klinikur formebs.
baqteriemiis, toqsemiis Sedegad viTardeba zogadi intoqsikaciis movlenebi, cxeleba
da a.S., ris Sedegadac SeiZleba Camoyalibdes status typhosus da sxva romelime
statusi.
rogorc klinikuri gamocdileba gviCvenebs, am bolo dros infeqciuri daavadebis
dawyebisas TiTqmis Tanabar procentSi registrirdeba daavadebis dawyeba uecrad an
TandaTanobiT.
infeqciurma daavadebam SeiZleba Tavidanve miiRos pirveladad qronikuli
mimdinareobis xasiaTi, rac aZnelebs daavadebis dasawyisis Tundac miaxloebiT dadgenas.
daavadebis mwvave dawyebisas SesaZlebelia, gamoiyos e.w. prodromuli periodi
(prodrome _ winamimdinareoba), romliTac mravali infeqciuri daavadeba xasiaTdeba
(muclis tifi, hepatitebi, wiTela, yivanaxvela da sxv.). am periodSi iSviaTad, magram
mainc SeiZleba gamovlindes nozologiuri erTeulisaTvis damaxasiaTebeli specifikuri
paTognomuri simptomebi (wiTelas dros belski-filatov-koplikis simptomi, gaSeSebis
dros _ trizmi da sxv.), rasac klinikur diagnostikaSi gadamwyveti Rirebuleba aqvs.
garkveuli TvalsazrisiT specifikurobis elfers atarebs daavadebis prodromul
periodSi zogierTi simptomis gamovlineba mag. egzanTemis saxiT, misi swrafi metamorfoza
(wiTela, wiTura, Cutyvavila, meningokokcemia da sxv.)
aranaklebi diagnostikuri mniSvneloba aqvs e.w. mimaniSnebel simptomatikas daavadebis
pirvelsave dReebSi misi TandaTanobiT dawyebisas, xolo fiqsirebul droSi am
simptomatikas mag., egzanTemis arsebobas, ufro meti sadiagnostiko Rirebuleba eniWeba.
18
infeqciuri daavadebis paTogenezisa da klinikuri ... mxare
zogadi nawili. nozokomialuri infeqciebi da maTi Taviseburebani
klinikur suraTSi gamoyofen, agreTve, daavadebis sruli simptomatikis gaSlas, rac,

rogorc wesi, emTxveva mZime mimdinareobas (maRali intoqsikacia, cxeleba hi perTermiiT,
ama Tu im organosa Tu sistemis, gansakuTrebiT cns-is upiratesi dazianeba, cns-is
mxriv cvlilebebi gonebis dabindviT, komuri mdgomareobiT da a.S.).
daavadeba SesaZlebelia talRiseburad mimdinareobdes _ gamwvavebebisa da remisiis
monacvleobiT.
mniSvnelovani imunologiuri gardaqmnis Sedegad viTardeba gamojanmrTelebis periodi,
romelic SeiZleba daiyos adreul da mogvianebiT rekonvalescenciur fazebad, mwvave
da SemdgomSi qronikuli baqteriamtareblobis SesaZlo ganviTarebiT, rasac didi
mniSvneloba eniWeba nozologiis epidemiologiur SefasebaSi. xazgasmiT aRvniSnavT,
rom infeqciuri periodis, gansakuTrebiT, klinikuri manifestaciis dros paralelurad
viTardeba saTanado bioqimiuri, hematologiuri da imunologiuri Zvrebi, morfologiuri
cvlilebebi. maTi diagnostikuri mniSvneloba dgindeba Tanamedrove paraklinikuri
gamokvlevis Sedegad (mag.: sisxlSi alat-is momateba virusuli hepatitisas _
“transaminazuli daavadeba”; antisxeulebis dadgena ifa-Ti aiv-infeqciis dros da
sxv.).
bavSvebSi infeqciuri daavadebis klinikuri gamovlinebani xSirad garkveul daRs
asvams avadmyofis saerTo habituss, riTac SesaZlebelia, eWvi iqnas mitanili ama Tu im
daavadebis arsebobaze ukve ad oculus, ase vTqvaT, manZilzec ki. am mxriv interess araa
moklebuli gauwyloebis sindromis konstatacia qolerisa da nawlavTa sxva infeqciebis
dros. saTanado pozis arseboba Cirqovani meningitebis dros ( meZebari ZaRlis poza
da a.S.); saxis hi peremia, gaZnelebuli, mtkivneuli, kisris mobruneba gri pis dros ki
aris simpaTikuri gangliebis dazianebis Sedegi da a.S.
amrigad, infeqciuri daavadebis gamomwvevi agentis specifikuroba, cxelebisa da
intoqsikaciis klinikuri gamovlinebani xSirad centraluri nervuli sistemis dazianeba
gonebis dabindviT, komiT da a.S., mkveTrad ganasxvavebs infeqciuri avadmyofis cnebas
somaturi avadmyofebisagan, Tumca unda aRvniSnoT, rom somatur daavadebaTa nusxa sul
ufro klebulobs Tanamedrove infeqtologiis miRwevebis Sedegad.
da bolos, is garemoeba, rom infeqciuri avadmyofebi xSirad, gansakuTrebiT ki
mwvave kontagiozuri infeqciebis dros, warmoadgenen infeqciis saSiS wyaros kontaqtSi
myof pirTaTvis, xazs usvams maT epidemiologiur mniSvnelobas.
maSasadame, infeqciuri avadmyofis arsis ganmartebisas kriteriumebs warmoadgenen
1)etiologiuri, 2)klinikuri da 3) epidemiologiuri kriteriumebi, riTac is gansxvavdeba
somaturi avadmyofebisagan (Ã\Ï\
Ã\Ï\ Ðóäíåâ
Ðóäíåâ).
nozokomialuri infeqciebi
da maTi Taviseburebani
nozokomialuri infeqcia SeZenili paTologiaa. am infeqciiT dasnebovneba SeiZleba

moxdes, rogorc mSobiarobis procesSi, aseve ufro mogvianebiTac.
aRniSnuli paTologia, ZiriTadad, axalSobilebsa da 1 wlamde asakis bavSvebSia,
Tumca afeTqebebi gvxvdeba mozrdilTa stacionaris pirobebSic.
nozokomialuri infeqciebis xvedriTi wili damokidebulia imaze, Tu rogori
movlis, kvebisa da masis axalSobilTan gvaqvs saqme.
dReisaTvis es infeqcia seriozul problemas warmoadgens mTeli msoflios (maT
Soris saqarTvelos) bevri samkurnalo-profilaqtikuri dawesebulebisaTvis.
19
problemis sirTule mdgomareobs imaSi, rom Tanamedrove pirobebSi arsebiTad

Seicvala ara marto epidemiologiuri procesis ganviTareba da xasiaTi, aramed gamomwvevis
biologiuri Tviseba, klinikuri mimdinareoba da infeqciuri procesis gamovlinebis
formebi. garda amisa, nozokomialuri infeqciebi aucilebels xdis samkurnalo
dawesebulebebSi ZviradRirebuli RonisZiebebis Catarebas.
aRmoCnda, rom es problema mxolod ganviTarebadi qveynebis xvedri ar yofila, da
es rom namdvilad asea, miuTiTebs Semdegi monacemebi: germaniaSi saavadmyofosSida
infeqcia varirebs 3,6-6,3%-s Soris, espaneTSi _ 3,9-9,9%, safrangeTSi _ 6,7%, norvegiaSi
_ 6,3%, aSS-Si _ 5,7%.
aRniSnuli paTologia ufro xSirad gvxvdeba intensiuri Terapiisa da reanimaciis
ganyofilebebSi, fsiqo-nevrologiur stacionarSi, Cvil bavSvTa saxlebSi.
roca nozokomialur infeqciaze vsaubrobT, aucileblad unda aRiniSnos misi
polietiologiuroba, gamomwvevTa farTo diapazoni _ baqteriebi, virusebi, sokoebi da
umartivesebi.
am mikroorganizmTa moqmedebas ganapirobebs mTeli rigi faqtorebi: stacionaris
profili, paTologiuri procesis lokalizacia, laboratoriuli da instrumentuli
gamokvlevebis xasiaTi da done.
nozokomialur infeqcias, Cveulebriv, iwvevs hospitaluri Stamebi, romelTac gaaCniaT
wamlismieri rezistentoba, isini aseve mdgradni arian sxvadasxva faqtorebis mimarT
(gamoSroba, ultraiisferi sxivebis moqmedeba, sadezinfeqcio xsnarebi).
nozokomialuri infeqciis gamomwvevTagan msoflioSi dReisaTvis wamyvani adgili
ukavia: S. aureus (MRSA - meticilinrezistentuli S. aureus), E.coli, Salmonella,
Rotavirus, Herpes simplex virus, Neisseria gonorrhoeae, C.trachomatis, B jgufis
Streptococcus, Listeria monocytogenes, Pseudomona aeruginosa-s.
garda amisa, amerikelma mkvlevarebma gamohyves Malassezia pachydermatis kanidan,
xelebidan da igi miakuTvnes nozokomialuri infeqciis gamomwvevTa jgufs.
ruseTSi da yofili sabWoTa kavSiris qveynebSi did mniSvnelobas aniWeben _ S.
aureus da Salmonella typhimurium-s.
ZiriTad mizezebs Soris, romelTac 90-ian wlebSi nozokomialuri infeqciebis
afeTqeba mohyva, bevri avtori asaxelebs or mizezs:
1) rezistentuli Stamebis gaCena (agresiuli antibiotikTerapiis gamo).
2) avadmyofTa maRali riskis gjufis zrda.
aRniSnuli infeqciis wyaro SeiZleba iyos:
deda (mSobiarobis periodSi), samedicino personali, sxva inficirebuli pacienti,
TeTreuli, sadezinfeqcio xsnarebi, samedicino aparatura, aRWurviloba, WurWeli,
movlisTvis gankuTvnili sxva sagnebi.
nozokomialuri infeqciis epidemiologiis gagebisaTvis didi mniSvneloba aqvs
gadacemis gzis codnas:
1) kontaqtur-sayofacxovrebo (palatebSi sxvadasxva sagnebi, personalis
WuWyiani xelebi, WurWeli).
2) haer-mtvrismieri (igi ukanasknel periodamde sadiskusio sakiTxs
warmoadgenda mravali mkvlevarisaTvis, Tumca, amJamad nozokomialuri infeqciis
keris epidemiologiurma gamokvlevebma saSualeba mogvca, Tamamad gveTqva, rom
arsebobs amgvari gadacemis gzac).
3) garda bunebrivi gadacemis meqanizmebisa, did mniSvnelobas iZens e.w.
xelovnuri, artificiuli gadacemis gza (is dakavSirebulia diagnostikur da
samkurnalo invaziur procedurebTan. msoflio jandacvis organizaciis monacemebiT,
invaziuri Carevebis 30% dausabuTebeli da gaumarTlebelia. bolo wlebSi saqme
20
gvaqvs diagnostikuri da samkurnalo procedurebis namdvil agresiasTan).

rac Seexeba gramdadebiT mikrobebs, maT Soris stafilokokebs, isini yovelTvis
xasiaTdebodnen rezistentobis formirebis unariT axali antibiotikebis mimarT. ase,
mag., 40-ian wlebSi praqtikaSi penicilinis danergvis Sedegad gaCnda S. aureus-is
penicilinrezistentuli Stamebi. ukve 1948 wels aseTi Stamebi hospitaluri Stamebis
60%-s Seadgenda. TiTqos 60-ian wlebSi es problema gadaiWra, radgan es periodi
xasiaTdeboda naxevradsinTezuri penicilinebis (meticilini, oqsacilini) maRali
efeqturobiT. Tumca, am ukanasknelTa mimarT rezistentulobis gaCeniT (pirobiTad maT
uwodeben meticilinrezistentul stafilokokebs MRSA) daiwyo msoflioSi
nozokomialuri infeqciis axali era.
MRSA gamoyofis maRal sixSireze da dReisaTvis paTologiaSi maT rolze miuTiTebs
mravalricxovani publikaciebi.
amJamad, evropaSi, intensiuri Terapiis ganyofilebebSi arsebuli yvela infeqciis
1/3 nawili modis stafilokokebze (kerZod MRSA-ze). iaponiaSi situacia ufro
dramatulia, sadac stafilokokuri infeqciis SemTxvevebi oTxjer ufro xSiria, vidre
evropaSi. SesaZlebelia, vifiqroT, rom “iaponuri” krizisis ZiriTadi mizezia III
generaciis cefalosporinebis Zalze farTo gamoyeneba.
ungrel avtorTa azriT, MRSA-iT gamowveuli infeqciebis 80% hospitaluria.
sainteresoa, rom mikroorganizmebs meticilinisadmi rezistentobis sxvadasxva
meqanizmebi axasiaTebs. yvelaze kargadaa Seswavlili rezistentoba, romelic
dakavSirebulia mecAgene-Tan. es geni nanaxi iqna S.aureus-is yvela amoTesil
StamSi. mas unari aqvs, warmoSos penicilinis SemboWavi proteini PBP (penicillin
bind protein) da igi xSirad dakavSirebulia dnm-is did fragmentTan, romelsac
mecregion hqvia. am nawils mniSvnelovani adgili ukavia rezistentobis CamoyalibebaSi
qinolonebisadmi, klindamicinisadmi, eriTromicinisadmi, trimetoprimisa da
gentamicinisadmi. igi aRiniSneba MRSA StamebSi. ase, rom MRSA aqvs tendencia, gaxdes
multirezistentuli.
specialistebi aRniSnaven aseTi infeqciebis Terapiis sirTules, rac dakavSirebulia
MRSA multirezistentobasTan mravali Tanamedrove antibiotikis mimarT. Tumca yvela
gamoyofili stafilokoki inarCunebda mgrZnobelobas glikopeptid-vankomicinis mimarT.
aRniSnulidan gamomdinare, SeiZleba iTqvas:
a) antibiotikebis daniSvna unda xdebodes Cvenebisa da SesaZleblobis mixedviT
miRebuli kulturis antibiotikogramis Sesabamisad.
b) aucilebelia yvela samedicini dawesebulebaSi momuSave personalis specialuri
swavlebis organizeba, Tu rogor SeiZleba awarmoon kontroli saavadmyofoebSi am
baqteriebis gavrcelebaze. profilaqtikisaTvis aucilebelia palatebis, aparaturis
xSiri damuSaveba-gawmenda. infeqciis gadacemis ZiriTad meqanizmebze moqmedebisas yuradReba
unda mieqces sadezinfeqcio RonisZiebebis swor organizacias klinikur-diagnostikur
ganyofilebebSi. erT-erTi umTavresi amocanaa samedicino personalis swori moqmedeba
zondebis, TeTreulis, WurWlisa da movlisTvis saWiro sxva nivTebis damuSavebisa da
dezinfeqciisas. aucilebelia, samedicino personalma daicvas piradi higiena da
epidsawinaaRmdego reJimi, aseve, is rekomendaciebi, romlebic miRebulia nozokomialuri
infeqciebis SemcirebisaTvis, sadac umTavresia xelis dabana bavSvebTan misvlamde.
rac Seexeba S.aureus-is matarebelTa sanacias, Tanamedrove etapze miRebulia
gadawyvetileba, mTlianad Sewydes samedicino personalis gegmiuri gamokvleva S.aureus-
is mtareblobaze, e.i. personalisagan masalis kulturis rutinulad aReba rekomendebuli
ar aris. mikrobilologiuri gamokvleva unda awarmoon mxolod maSin, Tu ganyofilebaSi
aRiniSneba am infeqciis afeTqeba. yovelive es ki saSualebas mogvcems, davzogoT Zala
21
nozokomialuri infeqciebi da maTi Taviseburebani
zogadi nawili. makroorganizmis damcvelobiTi ... dros
da Tanxebi.
g) nozokomialur infeqciaze saubrisas saWiroa aqcentis gakeTeba profilaqtikasa
da epidsawinaaRmdego RonisZiebebis Catarebaze (unda gvaxsovdes, rom maTi gatareba
sakmaod rTuli da Sromatevadia organizaciuli, epidemiologiuri da ekonomiuri
TvalsazrisiT), aseve epidzedamxedvelobis sistemis gaumjobesebaze (es aucilebelia
rogorc epidsituaciis obieqturad Sefasebisa da prognozirebis TvalsazrisiT, aseve
am infeqciasTan brZolisaTvis mecnierulad dasabuTebuli RonisZiebebiT).
aseTi zomebi Seamcirebs daavadebis cud gamosavalsac da mkurnalobis Rirebulebasac.
yvela saavadmyofos strategia am princi pze unda iyos agebuli.
makroorganizmis damcvelobiTi
meqanizmebi infeqciuri procesis dros
dadgenilia, rom mozrdilisa da bavSvis organizmis sapasuxo reaqciebi infeqciuri

agentis mimarT princi pulad gansxvavdeba erTmaneTisagan, rac ganpirobebulia bavSvTa
organizmis araspecifikuri da specifikuri damcvelobiTi meqanizmebis fiziologiuri
moumwifeblobiT _ imunuri reaqciebis arasrulyofilebiT. es ki sruliad Seesabameba
gundobinis gonebamaxvilur SeniSvnas, rom bavSvi ar aris mozrdili miniaturaSi.
Tanamedrove ganmartebiT, imunologia Seiswavlis genetikuri, molekuluri da
ujredovani meqanizmebis reagirebas ucxo cocxali sxeulebis da/an nivTierebebis
sawinaaRmdegod.
infeqciuri daavadebebis dros imunitets gadamwyveti mniSvneloba aqvs. igi exmareba
organizms infeqciasTan zogjer sasicocxlo brZolaSi. im SemTxvevaSi, roca aRiniSneba
imunitetis deficiti, roca igi arasrulyofilia, infeqciuri procesis mimdinareoba
gaxangrZlivebuli, qronikuli xdeba, viTardeba baqteriamtarebloba, virusmtarebloba
(mag: virusuli hepatitebis dros, CMV (citomegalovirusuli infeqciis), EBV-infeqciis,
muclis tifisa da sxva daavadebebis dros), an viTardeba elviseburi formebi (mag:
meningokokcemia, B hepatitis dros RviZlis mwvave distrofia da sxv.).
organizmis dacvaSi infeqciuri procesis dros didi mniSvneloba eniWeba
araspecifikuri dacvis faqtorebs. cnobili rusi mecnieris Â\Ô\ Èîôôå
Èîôôå–s ganmartebiT,
mxolod am ukanasknelis fonzea SesaZlebeli srulfasovani imunitetis Camoyalibeba.
araspecifikuri damcvelobiTi faqtorebidan mniSvnelovania fagocitoz, komplementis
(komplementis sistemis moqmedebis princi pi mocemulia “sefsisSi”), properdinis
sistemebis, lizocimis, interferonul sistema da a.S.
fagocituri sistema. ZiriTad fagocitebs miekuTvneba neitrofilebi da monocitebi.
pirvels upiratesoba aqvs mikrobebis likvidaciaSi mwvave anTebiTi reaqciebis, meores
ki qronikuli anTebiTi procesis dros.
eozinofilebs aseve SeuZliaT mikrobebis fagocitozi da maTi likvidacia. isini
alergiul da parazitul infeqciebze sapasuxo reaqciebSi monawileoben.
RviZlis, elenTis, filtvisa da Zvlis tvinis qsovilebis fiqsirebuli makrofagebis
amoqmedeba T-limfocitebis citokinebis meSveobiT xdeba, rac gamiznulia cirkulaciidan
imunuri kompleqsebis, antisxeulebis, sisxlis komplementmgrZnobiare ujredebis,
mikrobebisa da sxva mavne “narCenebis” moSorebisaTvis.
neitrofilebi, eozinofilebi da monocitebi warmoiSoba Zvlis tvinSi Rerovani
pluri potenciuri (aradiferencirebuli) ujredisagan, romelic SemdgomSi ganicdis
specifikur diferencirebas da gavlenas axdens limfocitebisa da monocitebis
22
citokinebze.
pluri potenciuri aradiferencirebuli hemopoezuri ujredis proliferaciisaTvis
saWiroa misi kostimulacia sxvadasxva citokinebiT (Rerovani ujredis faqtori,
i n t e r l e i k i n e b i IL-3, IL-1, IL-6, IL-12 d a g r a n u l o c i t - m a k r o f a g -
koloniamastimulirebeli faqtori _ GM-CSF-granulocyte-macrophage-colony
stimulating factor). mieloiduri eriTroiduli ujredebis Semdgomi ganviTarebisaTvis
saWiroa damatebiTi hemopoezuri faqtorebis CarTva (iseTi regulatorebi, rogoricaa
eriTropoetini eriTrocitebisaTvis, IL-5 eozinofilebis ganviTarebisaTvis, IL-9 da
IL-11 _ megakariocitebis ganviTarebisaTvis, makrofag-kolonia-mastimulirebeli faqtori
_ M-CSF (macrophage-colony stimulating factor-monocit-makrofagebisaTvis) da
granulocitkolonia-mastimulirebeli faqtori – G-CSF ( Granulocyte-colony-stimu-
lating factor-leikocitebisTvis).
mieloblasti gardaiqmneba promielocitad, Semdeg mielocitidan yalibdeba
metamielocitad, sabolood ki polimorfulnuklearul neitrofilebad PMN (poly-
morphonuclear neutrophils).
PMN ujredebis gadasvlas Zvlis tvinidan cirkulaciaSi xels uwyobs iseTi
mediatorebi, rogoricaa: endotoqsini, tumormanekrozebeli faqtori, IL-I da gaaqtivebuli
komplementi.
anTebad keraSi zemoT aRniSnuli fagocitebis migracias safuZvlad udevs ujredidan
da plazmidan gamoyofili zogierTi qemotaqsisuri faqtori. anTebiT keraSi aRiniSneba
komplementis aqtivacia, Trombinis warmoSoba, Trombocitebis migracia, makrofagebis da
limfocitebis aqtivacia, interleikin-8-s gamoyofa, polimorfulnuklearebis gaaqtiveba
da maT mier leikotrien B4-is warmoSoba. ameboiduri moZraobiT fagociti miiltvis
anTebis kerisaken da anadgurebs ofsonizirebul mikrobs.
leikocitebis gaaqtiveba maT receptorebze qemogamaRizianebeli molekulebis
zegavleniT xdeba, mikrobebis ofsonizacia (momzadeba gadamuSavebisaTvis) ki xorcieldeba
Termostabiluri da Termolabiluri faqtorebiT (IgG da C3).
neitrofilebis fagocituri funqciis Camoyalibeba iwyeba mucladyofnis periodSi
15-25 kviris nayofSi. bavSvis dabadebisas polinuklearebs aqvT sakmaod aqtiuri
funqcia, rac gamoixateba qemotaqsisSi, moZraobasa da STanTqmis funqciaSi (fagocitozis
mesame faza), antigenis monelebis funqcia (meoTxe faza) jer kidev mniSvnelovnad
dabalia da mozrdilis Sesabamis dones aRwevs mxolod 6-12 Tvis asakSi. meores mxriv,
mxedvelobaSia misaRebi, rom iseTi mikroorganizmebi, rogoricaa hemofiluri Cxirebi,
klebsielebi, pnevmokokebi, saerTod ar eqvemdebarebian dasrulebul fagocitozs. aqedan
gamomdinare, advili SesaZlebelia, rom axalSobilobis periodSi infeqcia mZimed
mimdinareobdes, ganviTardes destruqciuli procesebi, Camoyalibdes sefsisi.
komplementis sistemis aqtivoba axalSobilobis periodSi dabalia da mxolod 6
Tvis asakSi utoldeba mozrdilis dones. komplementi xels uwyobs fagocitozs,
uzrunvelyofs baqteriebisa da virusebis eliminacias organizmidan.
properdini warmoadgens sisxlis Sratis cilas, romelic komplementTan erTad
xels uwyobs fagocitozs. axalSobilebSi properdinis Semcveloba aseve dabalia,
magram pirvelsave kviraSi misi done swrafad matulobs da Semdgom periodSic maRali
rCeba.
lizocimi (muramidaza) warmoadgens ferments, romliTac mdidaria organizmis
yvela ujredi. igi xels uwyobs baqteriebis garsis garRvevas da amiT antibaqteriuli
barieris Seqmnas.
interferoni umniSvnelovanesi virussawinaaRmdego cilaa, romelsac gamoimuSavebs
virusiT inficirebuli organizmi. interferoni praqtikulad yvela virusze moqmedebs.
23
interferonis produqciis yvelaze didi unari aqvT leikocitebs.

interferonis produqciis SesaZlebloba genetikurad determinebulia da organizms
gadaecema memkvidreobiT. axalSobilebSi interferonis aqtivoba dabalia da maqsimums
aRwevs mxolod 12-14 wlis asakSi. igi aZlierebs fagocitozs, Trgunavs malariis,
qlamidiebis, riketsiebis ujredSida gamravlebas. dadgenilia, rom interferoni xels
uwyobs ujredis gamZleobas egzo- da endotoqsinebis mimarT. misi virussawinaaRmdego
moqmedeba vlindeba virusis ujredSida reproduqciis dros.
interferoni aZlierebs fagocitozs, Trgunavs onkogenuri ujredebis transformacias,
Tu es ukanaskneli virusebiTaa gamowveuli, amuxruWebs simsivnuri ujredebis zrdas,
aZlierebs limfocitebis citotoqsikurobas.
sicocxlis pirvel TveebSi interferonis dabali aqtivoba xels uwyobs virusuli
infeqciebis (mag: mwvave respiraciuli virusuli infeqciebis) mimReblobas da maT mZime
mimdinareobas.
interferons, rogorc faqtors, didi mniSvneloba eniWeba adreuli asakis bavSvis
organizmis adaptaciaSi.
axalSobilebSi, gansakuTrebiT ki dRenaklebSi sicocxlis pirvel TveebSi aRiniSneba
interferonis dabali Semcveloba da misi swrafi gamofitva, rac infeqciuri daavadebis
mZimed mimdinareobas ganapirobebs.
araspecifikuri damcvelobiTi faqtorebidan organizmis rezistentobisaTvis aseve
didi mniSvneloba aqvs kanisa da lorwovani garsebis safarvels, epiTelur-ciliarul
ujredebs, normalur mikrobul, maT Soris, nawlavTa floras da a.S.
garemoSi adaptaciasa da, miT umetes, infeqciur daavadebasTan brZolaSi
gadamwyveti mniSvneloba eniWeba makroorganizmis specifikur imunur reaqciebs, romlebic,
pirvel rigSi, dakavSirebulia imunitetis T da B sistemasTan.
T, B da NK ujreduli sistema. organizmis damcvelobiTi funqcia infeqciuri
agentis sawinaaRmdego moqmedebaSi gamoixateba, rac ramdenime fizikuri agentisa da T,
B, NK limfocitebis, fagocituri ujredebisa da komplementis cilebis kombinaciiT
xorcieldeba.
fizikur faqtorebs, romlebsac infeqciuri agenti pirvel rigSi xvdeba, miekuTvneba
kani, lorwovani garsi, lorwo, wamwamovani epiTeliumis ujredebi.
imunur sistemas warmoadgens T, B, NK ujredebi, fagocituri ujredebi da
komplementis sistema. imunuri sistema organizms icavs autoimunuri da avTvisebiani
daavadebebisaganac.
nayofis limfopoezi gestaciis pirvelive kvirebidan iwyeba. imunuri sistema
viTardeba nawlavis milidan. me-2,5-3 kviridan yviTris parkSi arsebobs
aradiferencirebuli hemopoezuri ujredebi, romelTa Semdgomi migracia xdeba RviZlSi,
me-8 kviridan ki _ mkerdis ZvalSi, TimusSi, elenTaSi. me-10 kviridan am ujredebs
naxuloben nayofis lulovan ZvlebSi, me-14 kviridan ki- tonzilebSi, apendiqssa da
limfur qsovilebSi.
amrigad, pirveladi limfoiduri organoebi warmodgenilia TimusiTa da Zvlis
tviniT, meoradi ki _ elenTiT, limfuri kvanZebiT, tonzilebiT, peieris folaqebiT,
Lamina propria-Ti.
T, B, NK- ujredebis diferenciacia meorad limfoidur organoebSi mTeli sicocxlis
manZilze grZeldeba. es diferenciacia, saboloo jamSi, SeiZleba warmovidginoT, rogorc
limfocitebis mTeli armiis da maTive zedapiruli molekulebis, aseve maT mier
gamoyofili cilebis urTierTqmedebis Sedegi.
T da B limfocitebi imunuri sistemis erTaderTi komponentebia, romlebic
pasuxismgebelni arian antigenis gamocnobasa da e.w. adaptaciur imunitetze. NK
24
ujredebic aradiferencirebuli hemopoezuri ujredebisagan warmoiqnebian da garkveul

rols TamaSoben imunuri sistemis regulaciaSi, virusebisa da avTvisebiani procesebis
winaaRmdeg brZolaSi.
rogorc zemoT iTqva, yvela limfocits aqvs uamravi zedapiruli markeri, romlis
mixedviTac SeiZleba, vimsjeloT limfocitebis funqciaze, maTi momwifebis xarisxze.
am funqciebis dasazusteblad limfocitebis zedapiruli molekula _ antigenebis
(markerebis) mixedviT Seqmnilia saerTaSoriso klasifikacia, romelsac diferenciaciis
mtevans (Clusters of Differentiation - CD) uwodeben.
am klasifikaciis Tanaxmad SeiZleba iTqvas, rom:
CD-nomeri sxva saxelwodeba funqcia

es markeri gaaCnia yvela T-limfocits.
mis zedapirze markeri Cndeba TCR
CD3 T3, Leu 4 receptoris momwifebisas da
uzrunvelhyofs am receptoridan
signalebis gadacemas.
es markeri T-helperebis zedapirzea.

CD4 T4, Leu 3a CD4 warmoadgens receptorebs HLA
antigenebis II klasisaTvis.
citotoqsikuri limfocitebi da NK-

ujredebis 30%, romlebis
CD8 T8, Leu 2a axorcieleben CD8-cilebis eqspresias.
CD8 warmoadgens receptorebs HLA
antigenebis I klasisaTvis.
SesaZlebelia am klasifikaciis sruli saxiT warmodgenac, sadac T da B limfocitebs

gaaCniaT ara marto zemoTCamoTvlili antigenebi _ molekuluri markerebi, aramed
mTeli rigi sxva, damatebiTi markerebic, magram infeqtologiaSi klasifikaciis sruli
saxiT moyvanam SeiZleba mxolod gagvirTulos imunologiis elementaruli safuZvlebis
gageba.
am klasifikaciaSi B limfocitebi sakuTari markerebiTaa warmodgenili. ase, mag:
CD19 _ aqvs B4-limfocits (CD19 aregulirebs B ujredebis aqtivacias).
CD20 _ aqvs B1-limfocits (iwvevs ujredebis aqtivacias).
CD21 _ aqvs B2-limfocits (warmoadgens C3d/EBV-s receptors).
arsebobs sxva CD markerebic da agreTve, saerTo markerebi _ CD 11a - T, B, NK
ujredebisaTvis.
citokinebi
citokinebi warmoadgenen T, B, NK ujredebis anda maTTan moqmedi sxva ujredebis
mier sinTezirebul cilebs. citokinebis zogierT warmomadgenels interleikinebsac
uwodeben.
arsebobs klasifikacia, sadac citokinebi ganawilebulia maTi funqciebis Sesabamisad:
1. citokinebi, romlebic monawileobas iReben bunebriv imunur pasuxSi: TNF-α α
(tumormanekrozebeli faqtori), IL- 1 - α da - β, IL-6, qemokinebi, IFN (interferoni)
25
- α da - β da sxv.
2. maregulirebeli-citokinebi:
a)imunomastimulireblebi: IL-1, IL-2, IL-4…...IFN.
b)imunosupresori-citokinebi:…IL-1Ra, IL-10...
3. hemopoezis maregulirebeli citokinebi:
eriTropoetini, IL-3, IL-4, IL-5...
4. proinflamatoruli (proanTebiTi) citokinebi: IL-1, IL-6...
5. antiinflamatoruli (anTebis sawinaaRmdego) citokinebi: IL-4, IL -6, IL-10,
IL-13.
zogierTi citokini, magaliTad, α- IFN, gamoiyeneba ama Tu im virusuli daavadebis
samkurnalod (qronikuli hepatiti B da C). limfocitebis zedapiris molekula-
markerebis peizaJiT SeiZleba vimsjeloT limfocitebis kuTvnilebaze imunitetis ama
Tu im sistemis mimarT (T, B, NK), maT funqciebsa da momwifebaze. ase mag: CD4-is
monopozitiuroba gviCvenebs, rom es momwifebuli helperia, CD8-is monopozituroba
ki laparakobs T-citotoqsikuri limfocitis an, SesaZloa, NK-ujredis (30%) arsebobaze.
im SemTxvevaSi, Tu T–limfocits gaaCnia, rogorc CD4, CD8 aseve arasrulyofili
TCR–receptori (bolomde ar aris misi γ, δ, ε, jaWvi awyobili), maSin T–limfocits
jer ar gauvlia ganviTarebis yvela stadia da ar Camoyalibebula romelime garkveuli
funqciis (citotoqsikuri an helperis) matarebel momwifebul limfocitad.
sabolood, srulyofili momwifebis misaRwevad unda ganxorcieldes T–limfocitis
jer dadebiTi
dadebiTi, Semdeg ki uaryofiTi seleqcia. dadebiTi seleqciis arsi mdgomareobs
imaSi, rom, rogorc ki moumwifebel kortikalur Timocitebs gauCndebaT TCR-receptorebi
(T cell receptor, Tavidan mcire raodenobiT), isini urTierTobas iwyeben, histoSeTavsebis
mTavari kompleqsis antigenebTan, romlebic ganlagebulia epiTelur kortikalur
ujredebze.
histoSeTavsebis mTavari kompleqsis MHC (Major histocompatibility complex)
molekulebi _ transmembranuli glikoproteinebia anu ujredis membranidan nawilobriv
“gamoweuli” glikoproteinebi. isini ucxo cilebis (mag: virusebis an baqteriebis)
antigenebs organizmisaTvis advilad gamosacnob antigenebad aqceven.
HLA ko mp l e qs i
MHC
II III I
kl as i
DPα DPβ DQα DQβ DRα DRβ C2 FB C4A C4B B C A genebi
genebis
H LA -D P H LA -D Q H LA -D R C D FB C4A C 4 B H LA - B H LA - C H LA -A
pr o duqt e
MHC-molekulebze es ucxo antigenebi T–limfocitebisaTvis kargi antigenuri

gamRizianebel-stimulatorebi arian da xels uwyoben maT Semdgom momwifebas.
limfocitebis nawili iRupeba, darCenili nawili ki CD4 an CD8 monopozitiuri
xdeba da iZens diferencirebul funqcias (helperebi, citotoqsikuri limfocitebi)
da TCR–receptorebs.
uaryofiTi seleqcia mdgomareobs imaSi, rom daRupvas gadarCenili da kargad
26
ganviTarebuli TCR–receptorebis mqone CD4 da CD8 reagireben adamianis HLA-I da

HLA II (Human leucocyte antigen - adamianis leikocituri antigeni) antigen-
peptidebTan, romlebic producirdebian sakuTari Zvlis tviniT da imyofebian Timusis
makrofagebze an dendritul ujredebsa da B–limfocitebze.
sainteresoa is faqti, rom uaryofiTi seleqciis procesSi daprogramebulia
autoreaqtiuli Timocitebis daRupva da am process ewodeba apoftoziapoftozi. seleqciis
Sedegad iRupeba kortikuli limfocitebis 97%, darCenili limfocitebi monopozitiuria
da ganicdian migracias Timusis nivTierebaSi.
T-limfocitebis saboloo funqcia mxolod TimusSi moxvedrisas yalibdeba. erTi
Rerovani ujredidan daaxloebiT 3.000 meduluri (timusis tvinovan nivTierebaSi)
momwifebuli limfociti warmoiqmneba. Timusidan T–ujredebi xvdebian sisxlSi, Semdeg
ki sisxlis mimoqcevis gziT migrireben elenTaSi, limfur kvanZebSi, tonzilebSi.
organizmSi aris plant-leqtinis (fitohemaglutinini, konkanavalin A) msgavsi cilebi,
romlebic T –ujredebis proliferacias uwyoben xels.
T-ujredebis momwifebisa da diferenciaciis paralelurad nayofis RviZlSi gestaciis
me-7 kviridan iwyeba B –limfocitebis ganviTareba. nayofis RviZlis Rerovani ujredi
gestaciis me-10 kviras aRwevs laviwis Zvlis, Semdeg ki _ lulovani Zvlebis tvins.
B limfocitebis ganviTarebaSi arCeven 2 stadias
stadias: 1) antigendamoukidebels, roca
ujredSi imunoglobulinebis genisa da molekulaTa zedapiruli peizaJis organizaciis
doneze yalibdeba Tanmimdevruli cvlilebebi. Sedegad pre-pre-B, pre-B da umwifari
B-limfocitis safexuris gavlis Semdeg pro-B ujredi momwifebul B-limfocitad
gardaiqmneba. am ukanasknels ukve SeuZlia IgM da IgD-s produqcia. aseTi B–
limfocitebi cirkulireben sisxlSi dabadebis Semdegac. 2) B–limfocitis ganviTarebis
antigendamokidebuli stadia iwyeba momwifebuli B–limfocitis SIg–receptorze
romelime antigenis zemoqmedebiT, Sedegad B–limfociti gadaiqceva ujredad, romelsac
damaxsovrebuli aqvs es antigeni. aseTi B–limfociti gardaiqmneba plazmur ujredad.
am ukanasknels ukve SeuZlia aRniSnuli konkretuli antigenis sawinaaRmdego specifikuri
imunoglobulin-antisxeulebis sinTezi.
arsebobs imunoglobulinebis 5 izoti pi: IgM, IgG, IgA, IgD da IgE. amasTan
erTaderTi komplementSemboWavi antisxeulebia IgG da IgM. isini imyofebian
sisxlZarRvebSi (IgM, IgG) da sxeulis siTxeebSi (IgG). es antisxeulebi infeqciuri
agentis winaaRmdeg brZolaSi proteqciul rols TamaSoben. is faqti, rom IgM
sisxlZarRvebSi imyofeba, aixsneba am imunoglobulinis maRali molekuluri masiT.
IgG-s ufro mcire masa aqvs, ris gamoc SeuZlia, sxeulis yvela siTxeSi SeaRwios. IgA
sekreciuli proteqciuli cilaa da arsebobs iseT sekretebSi, rogoricaa rZe, kuW-
nawlavis SigTavsi, respiraciuli traqtis lorwo da naxveli, urogenitaluri traqtis
sekreti. es imunoglobulini gansazRvravs e.w. adgilobriv imunitets, Tumca misi
naxva mocirkulire sisxlSic SeiZleba.
IgE warmoadgens dauyovnebeli ti pis alergiuli reaqciebis ZiriTad, Tu ara
erTaderT, mediators. poxieri ujredebisa da bazofilebis receptorebs maRali
afinogenoba (IgE–sTan SekavSirebis unari) axasiaTebs.
IgD-s roli dResdReobiT bolomde naTeli ar aris.
zogierT imunoglobulins Tavisi qveklasi gaaCnia: IgA: IgA1, IgA2; IgG: IgG1,
IgG2, IgG3, IgG4.
TiToeuli qveklasi garkveul biologiur rols asrulebs. cnobilia, rom IgG2
polisaqariduli antigenebis (rogoric, magaliTad, gaaCnia b ti pis H. influenzae-s)
winaaRmdeg brZolazea pasuxismgebeli, amitom am imunoglobulinis nakleboba pfeiferis
Cxirebis mimarT organizmis mimReblobas zrdis. dediseuli IgG2 SedarebiT cudad
27
gadis placentur bariers, sakuTari IgG-is gamomuSaveba ki 6 Tvis asakamde Zalian

dabalia (IgG2-is produqcia 2 Tvis asakamde TiTqmis ar aRiniSneba. bavSvis sisxlSi
misi done normas daaxloebiT 12 wlis asakSi aRwevs).
imunoglobulinebis warmomSob plazmur ujredad B-limfocitis gardaqmnis unari
gestaciis me-20 kviramde ar aRiniSneba, rac saSvilosnos SigTavsis sterilobiT
aixsneba, Tumca ramdenime nanogramis raodenobis IgA, IgD da IgE-s naxva Wi plaris
sisxlSi mainc SeiZleba. es, albaT, im faqtis damamtkicebelia, rom zogierTi antigeni
mainc gadis placentur bariers da nayofSi imunur pasuxs iwvevs. axalSobilis
Wi plaris sisxlSi IgM-is koncentracia mozrdilis sisxlis analogiuri maCveneblis
10%-s Seadgens. droul axalSobilSi dediseuli IgG-s done aRwevs, zogjer ki
aWarbebs dedis IgG-s dones.
sxvadaxva infeqciis (gansakuTrebiT, gramuaryofiTi florisa da virusebis) mimRebloba
axalSobilebSi SeiZleba maT sakuTari imunuri sistemis arasrulyofilebiT aixsnas
da ara, albaT, marto dedisagan gadacemuli pasiuri imunitetis arasruli proteqciuli
moqmedebiT.
NK-ujredebis CamoyalibebisaTvis ganviTarebis stadiis gavla TimusSi aucilebeli
ar aris. am ujredebis aqtiuroba nayofis RviZlSi gestaciis me-8-11 kviridan iwyeba.
pirvel rigSi, isini Zvlis tvins aRweven, Zvlis tvinidan gaTavisuflebis Semdeg ki
xvdebian cirkulaciaSi an elenTaSi migrireben. limfur kvanZebSi es ujredebi cotaa.
normaSi NK-ujredebis raodenoba limfocitebis saerTo raodenobis 10%-s Seadgens.
rogorc zemoT iTqva, receptorebis saSualebiT B-limfocitebs ucxo antigenis
gamocnoba SeuZliaT. T-limfocitma rom igive antigeni gamoicnos, saWiroa T–ujredis
“damuSaveba” makrofagebiTa da B–limfocitebiT (am ukanasknelebs APC (Antigen
Presenting Cells)-ujredebs, antigenwarmdgenel, antigenmaprezentebel ujredebs
uwodeben). “damuSavebuli” antigeni ukve icnoba T–limfocitis TCR–receptoris
mier, rac damokidebulia imaze, Tu MHC romeli, (I Tu II) klasiTaa warmodgenili
aRniSnuli ucxo antigeni, Sedis urTierTqmedebaSi CD4 an CD8-Tan.
T-limfocitebis 2 mTavari funqcia mdgomareobs SemdegSi:
1) antisxeulebis produqciis dasawyebad B-ujredebTan signalebis gadacema
citokinebis meSveobiT.
2) inficirebuli an simsivnuri ujredebis uSualo ganadgureba.
imisaTvis, rom T-limfocitis funqciebi `CairTos”, CD4-molekuliani T-helperi
unda miemagros plazmur ujreds an B-limfocitebs (MHC II klasis ucxo antigenebiT
{baqteriuli antigenebi, vaqcinebi} `damamuSavebel” ujredebs), ris Sedegad iwyeba
antisxeulebis produqcia. antigenis gasanadgureblad CD8-molekulia mqone T-
citotoqsikuri limfociti ki unda miemagros I klasis antigenis (virusuli peptidebi)
matarebel samizne ujreds.
miwebeba-mimagrebis es procesi xorcieldeba I (virusuli peptidebi) da II (baqteriebi,
vaqcinebi) klasis antigenebis e.w. `CaRrmavebebis” saSualebiT, romlebsac, klitisa da
gasaRebis Sesabamisobis analogiurad, Seesabameba _ CD4-T-helperis an CD8-T-
citotoqsikuri limfocitis molekulebi, rac uzrunvelyofs mizanTan mWidro
SekavSirebas.
yvela es procesi regulirdeba sxvadasxva interleikinebiT.
pirveladi imunuri pasuxis dros (manamde ucnob antigenTan Sexvedra) B-limfocitis
S
Ig-receptoris SekavSirebis unari (afiniteti
afiniteti) Tuki dabalia an T-limfociti B-
afiniteti
limfocits adekvatur signals ar ugzavnis, aseTi B-limfociti saboloo jamSi
SeiZleba daiRupos. am process apoftozi ewodeba. Tu kavSiris simtkice da signalebi
normulia, iwyeba IgM- produqcia. Cveulebriv IgM-s susti afiniteti axasiaTebs.
28
makroorganizmis damcvelobiTi ... dros
zogadi nawili. infeqciuri avadmyofebis mkurnalobis ... saSualebebi
zogierTi B-ujredi yalibdeba “maxsovrobis” ujredad. aseTi “maxsovroba” genebis

saSualebiT nawilobriv gadaecema IgA, IgE, IgG-s.
meoradi imunuri pasuxis dros (roca antigenTan Sexvedra meordeba “maxsovrobis”
mqone B-limfocitebi swrafad iwyeben IgG, IgA da IgE-s sinTezs. amasTan unda
aRiniSnos, rom meoradi imunuri pasuxisas genuri gardaqmna-gadacemebi mxolod zrdian
antisxeulebis afinitets.
gansakuTrebiT mniSvnelovania NK-ujredebis mier samizne ujredebis lizisi. samizne
ujredze NK-ujredebis adhezia (miwebeba) molekulur doneze xorcieldeba. am dros
NK-ukredebis receptorebi IgG-s mimarT ufro mgrZnobiare xdeba. damatebiT IgG-
sTan mimagrebis Semdeg, am antisxeulTan kombinaciaSi NK-ujredi ukeTesad klavs
samizne ujreds.
dabadebisas bavSvis imunur sistemaSi garkveuli raodenobrivi da Tvisebrivi
cvlilebebi iwyeba. ase magaliTad, axalSobilebSi CD4/CD8 Sefardeba, romelic 3,5-
4 : 1-is tolia, asakTan erTad icvleba da mozrdilebSi 1,5-2 : 1 xdeba. dabadebis Semdeg
dominirebs T-limfocitebis moumwifebeli izoformebi, 2-3 wlis Semdeg ki maT
urTierTSefardeba icvleba. T-helperebis xazic asakTan erTad iyofa sxvadasxva
citokinebis produqciis unaris Sesabamisad.
dediseuli IgG (Termostabiluri ofsoninebi) uzrunvelyofen janmrTeli
axalSobilis sakmaod karg imunitets gramdadebiTi florisa da virusTa umetesobis
winaaRmdeg. magram dabadebisas sakuTari IgM-is nakleboba (isini ki, ZiriTadad,
gramuaryofiTi floris sawinaaRmdegod moqmedeben) zrdis axalSobilebisa da,
gansakuTrebiT, dRenaklebis mimReblobas aRniSnuli baqteriebis mimarT.
sainteresoa, rom dabadebis Semdeg bavSvi ufro da ufro intensiurad gamoimuSavebs
sakuTar IgM-s. rac Seexeba sakuTari IgG-is sinTezs, igi ZiriTadad daaxloebiT 6-
7 Tvis asakSi iwyeba, rodesac dediseuli IgG-is koncentracia klebulobs (isini
garkveulwilad amuxruWeben bavSvis sakuTari IgG-is gamomuSavebas). amitom bavSvebis
mimRebloba zogierTi infeqciis, mag: wiTelas, hepatitisa da sxvaTa mimarT am asakSi
matulobs. H. influenza b-ti piT gamowveuli infeqciisagan bavSvis dasacavad Seqmnilia
vaqcinebi, sadac baqteriis kafsulis polisaqariduli antigeni SekavSirebulia garkveul
cilasTan, rac aseT baqteriul antigens organizmis mier advilad “aRmosaCenad” aqcevs
da ukve adreul asakSi specifikuri proteqciuli IgG2-is gamomuSavebas iwvevs.
dabadebis Semdeg limfoiduri organoebi swrafad viTardeba da 1 wlis asakSi
histologiur simwifes aRwevs, 6 wlisaTvis ki, ganicdis ra garkveul involucias,
moculobiT mozrdilis Sesabamis maCvenebels uaxlovdeba. mxolod elenTa aRwevs
Tavis normalur masas mogvianebiT, gardatexis asakSi.
infeqciuri avadmyofebis mkurnalobis

inci pebi da maTi r
princi
pr ealizaciis
realizaciis
Tanamedrove saSualebebi
mkurnalobis mTavar princi ps warmoadgens kompleqsuri Terapiis Catareba infeqciuri

avadmyofis daavadebis simZimis, mimdinareobis, fazisa da organizmis individualuri
Taviseburebebis gaTvaliswinebiT. amisaTvis Tanamedrove medicinas gaaCnia etiotropuli
da paTogenezuri Terapiis didi arsenali, romlis gamoyeneba xSirad uzrunvelyofs
avadmyofTa srul gamojanmrTelebas, da, amasTan, letaluri gamosavlis mkveTr Semcirebas.
29
mniSvnelovania isic, rom mTel rig SemTxvevaSi infeqciiT Sepyrobil bavSvTa

mkurnaloba saxlis pirobebSi garkveuli upiratesobiT gamoirCeva, rac ganpirobebulia
imiTac, rom am dros praqtikulad gamoricxulia avadmyofis damatebiTi inficireba
e.w. hospitaluri StamebiT (superinfeqcia). hospitaluri Stamebi, rogorc cnobilia,
xasiaTdebian antibiotikebisadmi polirezistentobiT, iwveven daavadebis mZime mimdinareobas
da mkveTrad aferxeben etiologiuri Terapiis SesaZleblobas. amitom Tanamedrove
medicinam Secvala azri yvela infeqciuri avadmyofis aucilebeli hispitalizaciis
Sesaxeb, Tundac daavadebis maRali kontagiozurobis dros (rasakvirvelia, saTanado
epidreJimis dacvis SesaZleblobis SemTxvevaSi).
hospitalizacias eqvemdebarebian, ZiriTadad, mZime avadmyofebi, romlebic saWiroeben
intensiuri Terapiis Catarebas stacionaris pirobebSi saTanado aparaturis gamoyenebiT.
etiotropuli Terapia gulisxmobs medikamentur RonisZiebebs, rac miznad isaxavs
uSualod gamomwvevi mizezis daTrgunvas, baqteriacidul moqmedebas.
etiologiuri Terapiis did arsenals warmoadgens qimiopreparatebi, maT Soris,
antibiotikebi, romelTa rocxvi 2000-s aWarbebs, maTgan detalurad Seswavlilia 200-
mde preparatis meqanizmi, maTgan mxolod 50 preparati ixmareba praqtikaSi zogadi
profilisa da stacionaris eqimebis mier. aqedan gamomdinare, “mozRvavebuli” preparatebis
codna, maTi amorCeva avadmyofis samkurnalod unda moxdes saTanado cnobarebis gacnobis
Semdeg, Tundac pacientis TandaswrebiT. aseTi midgoma aucilebelia imisaTvis, rom
aramarto gafarTovdes wamlis amorCevis SesaZlebloba, aramed imisTvisac, rom Tavidan
aviciloT erTidaigive wamlis gamoyeneba sxvadasxva sinonimis saxiT, ramac SeiZleba,
gamoiwvios gverdiTi movlenebis zrda.
antibiotikebi Tavisi moqmedebiT SeiZleba daiyos baqteriastatur da baqteriacidul
jgufebad.
molekuluri moqmedebis mixedviT ki iyofa antibiotikebad:
romlebic iwveven: 1) baqteriuli ujredebis garsis cilis sinTezis darRvevas
(penicilini, vankomicini, ristomicini, novobiocini da sxv.).
2) baqteriuli ujredis cilis sinTezis darRvevas (tetraciklini, makrolidebi,
qloramfenikoli da sxv.).
3) baqteriul ujredSi cilis sinTezis daTrgunvas, erTdroulad genetikuri
kodis darRvevas translaciis procesSi.
4) nukleinis mJavebis daTrgunvas ujredebSi (rifampicini da sxv.), rac iwvevs
citoplazmuri membranebis mTlianobis darRvevas.
klinikur praqtikaSi, rogorc binis, aseve stacionaris pirobebSi, xSirad gvixdeba,
gansakuTrebiT, mZime mdgomareobis dros, avadmyofis samkurnalod davniSnoT esa Tu is
antibaqteriuli preparati, raSic gvexmareba aRniSnul regionSi infeqciuri agentebis
antibiotikogramis monacemebi, Tumca am monacemebis mniSvneloba SedarebiTia. amasTan
dakavSirebiT, etiotropuli preparatebi SeZlebisdagvarad unda iniSnebodes maT miRebamde
saTanado paTologiuri masalis aRebisa da daTesvis Semdeg.
meoce saukunis 30-iani wlebidan daiwyo infeqciuri daavadebebis qimioTerapiis
era, rac dakavSirebulia sulfanilamiduri preparatebis sinTezTan, praqtikul medicinaSi
maTma danergvam ganapiroba mTeli rigi infeqciiT (stafilokokuri, streptokokuri,
meningokokuri da sxv.) Sepyrobil avadmyofTa efeqturi mkurnaloba, letaluri gamosavlis
mkveTri Semcireba. magram, samwuxarod, sul 2-3 aTeuli weli dasWirda sulfanilamidebis
efeqturobis mkveTr daqveiTebas, rac ganpirobebuli iyo maT mimarT mikrobebis
rezistentuli Stamebis CamoyalibebiT (ufro metic, eqsperimentSi naCvenebia
sulfanilamiddamokidebuli Stamebis arseboba), rac plazmiduri rezistentobis faqtTanaa
dakavSirebuli. unda aRiniSnos, rom bolo xanebSi kvlav gaizarda aRniSnuli mikrobebis
30
mgrZnobeloba sulfanilamidebis mimarT, rac didi xnis ganmavlobaSi am preparatebis

SedarebiT iSviaTi gamoyenebiT unda aixsnas. amJamad didi efeqturobiT gamoiyeneba
sulfanilamidebi, gansakuTrebiT kombinirebuli, mag: trimetoprimi + sulfametoqsazoli
(biseptoli, ori primi, sxva komerciuli dasaxelebiT).
40-iani wlebidan iwyeba antibiotikebis axali era, rac dakavSirebuli iyo jer
bunebrivi penicilinis
penicilinis, xolo Semdeg _ naxevradsinTezuri penicilinebis miRebasTan,
aman ki ufro masStaburi gaxada infeqciur avadmyofTa mkurnalobis SesaZleblobani.
aqac, sulfanilamiduri preparatebis analogiurad, aRiniSna mkurnalobis efeqturobis
jer aRmavlobis, Semdeg ki moqmedebis ramdenadme Sesustebis periodi, rac, aseve, mikrobTa
rezistentobiTaa ganpirobebuli. mikrobTa rezistentobis (penicilinaziT gamowveuli
rezistentoba) daZleva moxda rogorc naxevradsinTezuri penicilinebiT (ampicilini,
oqsacilini, meticilini, amoqsicilini, amoqsicilinis klavulanati (augmetini), unazini
(ampicilini+sulbaqtami) da sxva, aseve penicilinis masiuri dozebis gamoyenebiTac _
(mag: meningokokuri infeqciebisas _ meningiti, meningokokcemia da sxv.).
infeqciur avadmyofTa mkurnalobaSi revoluciuri Zvrebis tolia iseTi
antibiotikebis Seqmna da praqtikaSi danergva, rogoricaa streptomicini (manamde
tuberkulozuri meningitiT avadmyofTa 100% iRupeboda), qloramfenikoli (levomicetini,
levomicetinis suqcinati). es ukanaskneli iTvleba rogorc tifur-paratifuri, aseve
gramuaryofiTi baqteriebiT gamowveuli rigi infeqciuri daavadebebis samkurnalo
asarCev preparatad.
cefalosporinebis jgufis bunebrivi da sinTezuri antibiotikebis ramdenime
Taobam kidev ufro gaafarTova gramdadebiTi da gramuaryofiTi mikrobebiT, maT Soris
penicilinrezistentuli stafilokokebiT, spiroqetebiT, leptospirebiT, cimbiris wylulis
CxiriT da sxva mikrobebiT gamowveuli daavadebebis mkurnalobis SesaZlebloba. amJamad
klinikur praqtikas gaaCnia 4 Taobis cefalosporinebi: cefadroqsili, cefazolini,
cefaleqsini (I Taoba), cefazoli, cefamandoli (II Taoba), cefotaqsimi, cefoperazoni,
ceftriaqsoni (III Taoba), cefpirami, cefepimi, cefklidimi (IV Taoba). aRniSnuli
antibiotikebi efeqturi aRmoCnda Cirqovani meningitis, mZime pnevmoniebis, sefsisis,
hemofiluri CxiriT, klebsielaTi, proteusiT, mwvave Cirqmbadi CxirebiT gamowveuli
infeqciebis dros da sxv.
aminoglikozidebis jgufis antibiotikebma kidev ufro gaafarTova moqmedebis
areali mTeli rigi gramdadebiTi, gansakuTrebiT ki gramuaryofiTi mikrobebis winaaRmdeg.
es antibiotikebi farTod gamoiyeneba iersiniozis, tifur-paratifuri, saSarde gzebisa
da sxva infeqciebis dros.
aminoglikozidebisa da cefalosporinebis erTdrouli gamoyenebis Sedegad
SesaZlebeli gaxda iseTi umZimesi infeqciuri daavadebebis mkurnaloba, rogoricaa
sefsisi, mZime pnevmoniebi, Cirqovani meningitebi da sxv. aranakleb efeqturia
aminoglikozidebis jgufis preparatebis gamoyeneba naxevradsinTezur penicilinebTan
erTad sefsisis, septikur-Cirqovani daavadebebisa da sxvaTa dros.
makrolidebis jgufis antibiotikebi (eriTromicini, roqsitromicini (rulidi),
azitromicini (sumamedi), oleandomicini, vilprafeni da sxv.) didi efeqtiT gamoiyeneba
aerobuli da anaerobuli gramdedebiTi kokebiT, enterokokebis garda, gamowveuli
infeqciebis dros.
poli peptidebi (polimiqsini, kolistini, bacitracini da sxv.) iniSneba, ZiriTadad,
gramuaryofiTi mikrobebiT ganpirobebuli infeqciebisas.
qimioTerapiis efeqturi gamoyenebis aucilebel pirobas warmoadgens preparatebis
daniSvna ama Tu im mikrobis mgrZnobelobis gaTvaliswinebiT.
rac Seexeba antibaqteriul preparatebs ftorqinolonebis jgufidan, isini
31
xasiaTdebian baqteriaciduli TvisebebiT. stafilokokebis (rogorc penicilinazas

produqciiT, ise mis gareSe), streptokokebis, mwvane Cirqmbadi, hemofiluri baqteriebis,
salmonelebis, Sigelebis, legionelebis winaaRmdeg. pediatriul praqtikaSi (18 wlamde
bavSvebSi) maTi gamoyeneba ar aris sasurveli, Tumca iSviaTad pediatrebic iyeneben maT.
am SemTxvevaSi unda ganisazRvros, SesaZlo gverdiTi movlenebis ugulebelyofa ufro
saWiroa Tu preparatze uaris Tqma. es preparati unda ganixilebodes, rogorc sarezervo
saSualeba zogierTi infeqciis mZime mimdinareobis dros.
qvemoTmoyvanil cxrilSi warmodgenilia farTo xmarebis sxvadasxva antimikrobuli
preparatis rekomendebuli dozebi da igi dayofilia 2 nawilad. erTSi mocemulia
preparatebis dozebi axalSobilTaTvis. Tavis mxriv, axalSobilobis periodi
iTvaliswinebs wamlebis Seyvanas organizmSi 7 dRis asakamde da 7-dan 28 dRemde.
axalSobilis organizmis Taviseburebebidan gamomdinare, aseTi dayofa aucilebelia.
wamlebis eqskrecia da dezintoqsikaciuri SesaZleblobani am periodSi Semcirebulia
da dozebis SerCevac aRniSnuli garemoebis gaTvaliswinebiT xdeba; amasTan, axalSobilobis
periodis yvela daavadeba ganisazRvreba, rogorc mZime. yvela pediatriuli doza
warmodgenilia mg/kg sxeulis masaze dReSi. mozrdilTaTvis sadReRamiso doza aseve
Seyvanil unda iqnas intervalebis gaTvaliswinebiT. unda aRvniSnoT, rom rekomendebuli
dozebi absoluturi ar aris da misi daniSvna saWiroa individualuri midgomiT,
organizmis mdgomareobis gaTvaliswinebiT (mag., Tirkmlebis funqciis darRveva, organizmis
pasuxi mkurnalobaze, laboratoriuli monacemebi).
aucilebelia imis gaTvaliswinebac, Tu rogor da raSia preparati gaxsnili, saWiroa
Tu ara misi ganzaveba, yuradReba eqceva sxva preparatebTan urTierTmoqmedebas da a.S.
etiotropuli preparatebi asakisa da dozis gaTvaliswinebiT ix. danarTi #1.
antimikrobul preparatebs miekuTvnebian baqteriofagebi, romlebic pediatriul
praqtikaSi gamoiyeneba calke an antibiotikebTan da sulfanilamidebTan erTad sxvadasxva
infeqciebis dros. yvelaze ufro xSirad baqteriofagebi iniSneba nawlavTa mwvave
infeqciebis, furunkulozis, anginisa da sxva paTologiebis mkurnalobisas.
Tbilisis eliavas sax. Sratisa da vaqcinebis saxelmwifo kvleviTi instituti
amzadebs da uSvebs stafilokokur, Sigelur, salmonelur da sxva fagebs liofilizebuli
fxvnilisa da siTxis saxiT, romlebic garkveuli warmatebiT gamoiyeneba Sesabamisi
avadmyofebis mkurnalobaSi, daavadebis rogorc mwvave periodSi, aseve, gansakuTrebiT,
gaxangrZlivebuli procesebisa da baqteriamtareblobis dros.
am bolo dros baqteriofagebi kvlav did yuradRebis centrSia. kerZod, aSS-Si
tardeba intensiuri kvlevebi tuberkulozuri infeqciis dros baqteriofagebis gamoyenebis
mizniT, radgan faqtia, rom mxolod antituberkulozuri preparatebiT mkurnaloba
problemas ver wyvets da letalobiT III adgili ukavia respiraciuli da nawlavTa
infeqciebis Semdeg msoflioSi.
moskovis g. taraseviCis saxelobis epidemiologiisa da mikrobiologiis kvleviTi
institutis mier mowodebulia e.w. kompleqsuri imunoglobulinuri preparati (ki p),
romelic warmoadgens adamianis Sratis imunologiurad aqtiuri cilebis fraqciebs
da maRali koncentraciiT Seicavs Sigelebis, salmonelebis, eSerixiebis, rotavirusebis
sawinaaRmdego antisxeulebs.
preparati gamoiyeneba nawlavTa disbaqteriozis, sxvadasxva infeqciuri agentebiT
gamowveuli daavadebebis dros. ki p-i xmarebis win ganzavdeba anaduRari wyliT da
avadmyofebs eZleva per os Wamamde 30 wT-iT adre, 1 doza 1-2 –jer dReSi, 5 dRis
ganmavlobaSi. miRebulia garkveuli dadebiTi Sedegi daavadebis rogorc adreul mwvave
periodSi, aseve baqteriamtareblobis dros.
paTogenezuri Terapia gulisxmobs paTologiuri procesebis meqanizmebze
32
zemoqmedebas da mimarTulia damcvelobiTi, kompensaciuri da aRdgeniTi procesebis

gaumjobesebisaken. am mxriv, Tanamedrove medicinas gaaCnia saTanado saSualebebi, romlebic
zogjer mkurnalobis mTavari dasayrdenia.
mTeli rigi infeqciebis dros, gansakuTrebiT ki mcire asakis bavSvebSi, paTogenezis
wamyvan rgols warmoadgens intoqsikaciiTa da eleqtrolitebisa da siTxeebis disbalansiT
ganpirobebuli darRvevebi.
saerTo intoqsikaciis asalageblad, gansakuTrebiT, etiotropuli mkurnalobis naklebi
efeqturobis an uefeqtobis dros, didi mniSvneloba eniWeba universalur
sadezintoqsikacio saSualebebs: ringeris laqtats, glukozis 10%-ian xsnars,
reopoliglukins, albumins da sxv.
adamianis intravenuri imunoglobulinebis miRebis Sedegad mniSvnelovnad mcirdeba
an sruliad ixsneba intoqsikaciis movlenebi. aseTi efeqti imunologiuri moqmedebis
meqanizmiTaa gamowveuli da etiotropuli Terapiis erT-erT saxes warmoadgens.
eleqtrolitebisa da wylis cvlis darRvevis kontrolisa da masze drouli
zemoqmedebis TvalsazrisiT gadamwyveti roli eniWeba droulad warmarTul RonisZiebebs.
eleqtrolitebisa da siTxis fiziologiuri maxasiaTeblebis codna aucilebelia
imisaTvis, rom maTi cvlis darRvevis SemTxvevaSi mkurnaloba sworad warimarTos.
amasTan dakavSirebiT mizanSewonilia, jer mokled SevCerdeT wylisa da
eleqtrolitebis cvlaze janmrTel organizmSiorganizmSi.
siTxis saerTo raodenoba adreul, postnatalur periodSi axalSobilebSi (pirveli
2-3 dRe) swrafad klebulobs da Seadgens sxeulis masis daaxloebiT 80%-s an odnav
mets. 1 wlis asakis Semdeg ki misi moculoba stabiluri rCeba, Tumca mozrdilebSi
sqesTan dakavSirebiT icvleba da mamakacebSi Seadgens 60, xolo qalebSi 50%-s.
adamianis organizmSi arCeven siTxis 3 moculobas: 1) ujredSida anu intracelulurs
2) ujredgare anu eqstracelulurs, romelic Tavis mxriv iyofa plazmur (sisxlZarRvTa
Sida) da intersticiul siTxeebad 3) transujreduls; ukanasknels miakuTvneben
siTxis moculobas, romelsac aqvs specifikuri lokalizacia mis transportirebasTan
dakavSirebiT (mag: Tav-zurgtvinis siTxe) da mas agreTve uwodeben eqstrakorporul
siTxes.
eqstraceluluri da saerTo siTxis raodenobis cvlilebebi mimdinareoben
paralelurad.
dadgenilia, rom plazmuri siTxis raodenoba axalSobilebSi saSualod Seadgens
80 ml/kg da klebulobs 65-70 ml/kg-mde ufro mozrdil asakSi.
fiziologiur pirobebSi eleqtrolitebis Semcveloba ujredSida da ujredgare
siTxeebSi mniSvnelovnad gansxvavdeba erTmaneTisagan. kaliums, ZiriTadad, ujredSida
siTxe Seicavs, Tumca misi raodenoba izomeba sisxlis plazmaSi da Seadgens kaliumis
saerTo raodenobis 2%-ze naklebs. rigi avtorebis monacemebiT, kaliumis raodenoba
saSualod Seadgens 4,0-4,5 mmols 1 kg sxeulis masaze. miuxedavad ujredgare da
ujredSida siTxeSi kaliumis koncentraciis didi gansxvavebisa, orive sivrce mWidrodaa
dakavSirebuli da imyofeba sxvadasxva faqtorebis zegavlenis qveS. kaliumis
koncentraciaze moqmedebs metaboluri cvlis darRvevis Sedegad ganviTarebuli acidozi
da alkalozi, kuW-nawlavisa da Tirkmlis paTologia, romlis drosac xdeba kaliumis
gaZlierebuli gamoyofa organizmidan, agreTve kaliumiT mdidari preparatebis Seyvana
organizmSi sxvadasxva eqstremaluri situaciebis dros.
natriumisa da qloridebis umetesi nawili imyofeba eqstracelulur sivrceSi.
isini praqtikulad mTlianadaa gandevnili ujredSida siTxidan, xolo kaliumi da
fosfatebi Sekavebulia masSi. wyali Tavisuflad cirkulirebs am or sivrces Soris.
metad mniSvnelovania, aRiniSnos, rom wylis gadaadgileba or sivrces Soris (in-
33
tra-eqstraceluluri) xorcieldeba mxolod osmosuri gradientis gaCenis pasuxad.

organizmi cdilobs, rom SedarebiT mudmiv doneze SeinarCunos natriumi
eqstracelulur sivrceSi.sxva sityvebiT rom vTqvaT, natriumis koncentraciisa da
siTxis raodenobis cvlilebebi mimdinareobs paralelurad. amitom paTologiur pirobebSi
hi pervolemiis an SeSupebis dros natriumis raodenoba organizmSi momatebulia da
piriqiT, hi povolemiis dros ufro xSirad daqveiTebuli.
siTxis raodenobis yoveldRiuri moTxovnileba mWidrodaa dakavSirebuli organizmis
energetikul xarjvasTan. es energia warmoiSoba rogorc endogenuri, ise egzogenuri
naxSirwylebis, cilebis, cximebis oqsidaciis Sedegad, romelic saWiroa saTanado
nivTierebaTa cvlis SesanarCuneblad.
mozrdilebisagan gansxvavebiT, Cvil bavSvebSi siTxeze moTxovnileba (1 kg sxeulis
masaze) ufro metia. es gansxvaveba mWidrod korelirebs energiis moTxovnilebasTan 1
kg sxeulis masaze.
siTxisa da eleqtrolitebis gansazRvrisaTvis gamoiyeneba Holliday da Segar-is
yvelaze ufro gamartivebuli sqema, romelSic asaxulia janmrTeli da avadmyofi
organizmis kaloriis raodenobis gansazRvra 1kg sxeulis masaze dReSi.
energiis da siTxis yoveldRiuri moTxovnileba

janmrTeli da avadmyofi bavSvebisaTvis (Holliday, Segar)
sxeulis masa aucilebeli aucilebeli siTxe

(kg) energia kkal/kg ml/kg
0-10 100 100
1000 kkal+50kkal yovel 1000 ml+50 ml yovel kg-ze
11-20
kg-ze, 10 kg-s zeviT 10 kg-s zeviT
1500 kkal+20 kkal/kg
1500 ml+20 ml/kg yovel kg-
20 da meti yovel kg-ze 20 kg-is
ze 20 kg-is zeviT
zeviT
aRniSnul sqemaSi yuradReba eqceva ara siTxisa da eleqtrolitebis moTxovnilebas,

aramed kkal-is moTxovnilebas. aseTi midgoma ki kritikul aucileblobas warmoadgens
Zlieri katabolizmis mqone bavSvebSi da bavSvebSi, romlebsac sWirdebaT xangrZlivi
gadasxmebi.
fekaliebiT siTxis dakargva, Cveulebriv, fiziologiur pirobebSi umniSvneloa,
magram matulobs danakargi diareis, Rebinebis an nawlavze stomis dadebis dros da
sxva mdgomareobebisas.
organizmidan siTxis gamodevnis ZiriTadi saSualebaa Sardi. igi cxovelqmedebis
erTaderTi saboloo produqtia, romlis meSveobiTac organizmi kontrols uwevs
siTxis cvlasa da eleqtrolitebis raodenobis regulacias.
Tu organizms siTxe saerTod ar miewodeba, maSin, ukeTes SemTxvevaSi, Tirkmlebi
warmoSoben Sardis minimaluri raodenobas maqsimaluri koncentraciiT. 2 Tvis asakis
zeviT bavSvebSi Sardis koncentracia Seadgens 1400mosm/l-ze, xolo 2 Tvis asakSi igi
aRwevs 700 mosm/l-ze.
SardiT siTxis danakargis aRsadgenad saWiroa dReSi 100ml/100kkal kg-ze, siTxis
am raodenobidan 1/3 saWiroa `faruli” danakargis dasafaravad, xolo 2/3 _ SardiT
34
dehidrataciis xarisxis Sefaseba

klinikuri niSnebis mixedviT
msubuqi xarisxis saS. xarisxis

simptomebi mZime gauwyloeba
gauwyloeba gauwyloeba
masis deficiti % 3-5 6-9 10 da >
leTargiulia, civi
zogadi mdgomareoba wyurvili, agznebuli
wyurvili, fxizeli, kidurebi, ofli civi,
wyurvili mcire an leTargiuli, magram
mousvenari, gaRizianebuli cianozi, SeiZleba iyos
asakis bavSvebSi Sexebisas iRviZebs
komuri mdgomareoba
Cveulebriv grZnobazea,
civi, ofliani, cianozuri
ufro mozrdil wyurvili, fxizeli, wyurvili, agzneba,
kidurebiT, kanis naoWebiT
bavSvebSi agzneba mivardniloba
xelis TiTebze, aqvs
kunTebis krunCxvebi
normaluri ritmis da Cqari, Zafisebri, zogjer

radialuri pulsi Cqari, susti
avsebis ar isinjeba
Rrma, SesaZloa
sunTqva normaluri Rrma, Cqari
taqipnoe
yiflibandi normaluri Cavardnili Zalian Cavardnili
normaluri an dabali,
dabali, zogjer ar
arteriuli wneva normaluri orTostatuli
isinjeba
hipotenzia
xelovnuri naoWi naoWi swordeba Zalian
kanis elastiuroba naoWi swordeba nela
swordeba swrafad nela
Tvalebi normaluri Cacvenili Zalian Cacvenili
cremli aqvs Semcirebuli an ar aqvs ar aqvs
lorwovani svelia mSrali Zalian mSrali
Semcirebulia, Sardi
diurezi kargi anuria/mZime oliguria
muqi
kapilaruli Sevseba normaluri ≈ 2 wami 3 wamze >
siTxis deficiti
30-50 60-90 100 da meti
organizmSi (ml/kg)
35
dakarguli siTxis aRsadgenad. siTxis `faruli” dakargva xdeba sunTqvis dros, kanidan
aorTqlebisas, siTbos gamoyofisas. siTxis `faruli” dakargva fizikuri aqtivobis
momatebis dros matulobs da aRwevs 30%-mde da mets, cxelebis dros danakargi
matulobs 12%-mde yovel 1°C-ze. aseve maRalia danakargi haeris dabali tenianobisas,
xolo organizmis dabali aqtivobis dros, piriqiT, danakargi mcirea (komuri mdgomareobebi,
hi poTermia da a.S.), mcirdeba danakargi maRali tenianobis drosac. gansakuTrebiT
maRalia wylis kargva sxeulis mcire masis mqone bavSvebSi. maTSi sadReRamiso danakargi
aRwevs 100-200ml/kg-ze.
wylis kargva izrdeba hiperbilirubinemiis mqone avadmyofebSi dasxivebiT mkurnalobis
dros, uSaqro diabetian avadmyofebSi, Sardmdenebis gamoyenebisas da a.S. amitom wylis
gaZlierebuli dakargvisas aucilebelia koreqciis CatarebisaTvis ara mxolod SardiT
gamoyofili siTxis, aramed “faruli” danakargis gaTvaliswinebac.
zogierT avadmyofSi aucilebelia Na-is, K-is, Cl-is da wylis koreqcia, rogorc es
naCvenebia cxrilSi.
H20, Na, K, Cl deficitis kalkulacia saSualo simZimis dehidrataciis dros
deficitis
H20 ml Na (mEq) K∧ (mEq) Cl (mEq)
gamomwvevi mizezi
SimSili (kvebis
100-120* 5-7 1-2 4-6
naklovaneba), wyurvili
diarea izonatriemiuli 100-120 8-10 8-10 8-10
‡
diarea hiponatriemiuli 100-120 2-4 0-4 _2-dan_6-mde
diarea hipernatriemiuli 100-120 10-12 8-10 10-12
pilorostenozi 100-120 8-10 10-12 10-12
diabeturi acidozi 100-120 8-10 5-7 6-8
* _ mTlianad deficiti warmodgenilia masis 1 kg-ze

∧
_ kaliumi
‡ _ qloridebis uaryofiTi balansi migvaniSnebs imaze, rom marilovani xsnarebiT
mkurnaloba mizanSewonili ar aris.
dehidrat aciis ti pebi sisxlis Srat

dehidrataciis Si
SratSi Na-is maCveneblebis mixedviT
s is xlis SratSi
d ehid rataciis tipebi
natriumis Semcveloba
hipotonuri anu hiponatriemiuli Na < 130 mEq/l
izotonuri anu izonatriemiuli Na 130_150 mEq/l
hipertonuli anu hipernatriemiuli Na > 150 mEq/l
zemoT aRniSnuli gauwyloebis sxvadasxva ti pis klinikuri gamovlineba SeiZleba

iyos sxvadasxvanairi, mag: hi potonuri ti pi xSirad vlindeba Sokuri mdgomareobiT,
36
romelic dakavSirebulia siTxisa da eleqtrolitebis Zlier dakargvasTan. hipertonuli

gauwyloebis SemTxvevaSi siTxis igive raodenobis dakargvisas dehidrataciis simptomebi
naklebadaa gamoxatuli: kani Tbilia, SeSupebuli, comiseburi, avadmyofi leTargiis
mdgomareobaSia, magram Sexebisas igzneba, vlindeba kunTTa hi pertonusi, hi perrefleqsia,
Zlieri acidozis SemTxvevaSi bikarbonatebis dakargvis Sedegad vlindeba kusmaulis
ti pis xmauriani sunTqva, hi pokaliemia xasiaTdeba sisustiT, mucelSi diskomfortiT,
meteorizmiT, ileusiT, aritmiiT. hi pokalciemiisa da hi pomagniemiis dros ki viTardeba
tetania da cvlilebebi ekg-ze.
RviZlis, Tirkmlebisa da gulis paTologiis SemTxvevaSi Na-ze moTxovnileba
klebulobs, gansakuTrebiT arteriuli wnevis momatebisas, xolo anuriis dros marilis
Seyvana saerTod unda gamoiricxos. kaliumze SeiZleba iyos maRali moTxovna kuW-
nawlavisa da RviZlis daavadebebis dros, Cveulebriv, es danakargi mimdinareobs Na-is
dakargvis paralelurad da SeiZleba gamowveuli iyos Tirkmelzeda jirkvlis tvinovani
Sris dazianebiT an nawlavTa drenirebiT (qirurgiuli paTologiis dros), safaRaraToebis
da diuretikebis qronikuli miRebiT. mZime hi peramoniemia viTardeba anuriis dros da
Tirkmelzeda jirkvlebis ukmarisobis Sedegad.
situaciisas, roca adgili aqvs ujredgareSe siTxis gadmosvlas mag: nawlavSi an
transujredul sivrceSi, SeiZleba saWiro gaxdes damatebiTi siTxisa da eleqtrolitebis
Seyvana. am deficitis gamoangariSeba Znelia, magram misi anazRaureba SesaZlebelia
eleqtrolitebis damatebiT SeyvaniT. eleqtrolitebi da siTxeebi paralelurad
dasalevad eZlevaT, xolo urgentul mdgomareobaSi, rodesac venaSi Seyvana gaZnelebulia,
gadasxma SeiZleba gakeTdes Zvlis tvinSi. am gziT iolia wylis, Na-is da K-is aRdgena,
magram pozitiuri azoturi balansis uzrunvelyofa arasakmaod efeqturia. Cveulebriv,
5%-iani glukoza sakmarisia kaloriebis deficitis aRsadgenad.
glikogenisa da cximis depos Semcirebisas, iseve, rogorc maRali kataboluri
procesebis dros, kaliumis aRdgena aseTi gziT uefeqtoa. aseT avadmyofebs esaWiroebaT
5%-iani da ufro maRalprocentuli deqstrozis Seyvana parenterulad ramodenime
dRis manZilze. avadmyofebi gadahyavT aminomJavebiT damatebiT an mTlian kvebaze,
romelic xorcieldeba Rrma venebis kaTeterizaciiT da infuziiT.
parenteruli kveba venebis kaTeterizaciiT potenciurad toqsikuria. mas SeuZlia,
gamoiwvios Na-is, K-is, Mg-is da osmosuri wnevis momateba Tirkmlebis funqciis
darRvevis dros.
laboratoriuli meTodebi saSualebas gvaZlevs, davazustoT dehidrataciis xarisxi
da xasiaTi, magram avadmyofis gasinjvis gareSe marto laboratoriul monacemebze
dayrdnoba ar SeiZleba. mZime xarisxis dehidrataciisas saWiroa, dauyovnebliv daviwyoT
rehidratacia da ar davelodoT laboratoriul pasuxs.
laboratoriuli monacemebidan dehidrataciis dadgenaSi gvexmareba:
1)hemokoncentraciis gansazRvra, romelic xdeba hemoglobinis (Hb), hematokritis
(HT) da sisxlis plazmaSi cilebis gansazRvriT. maSin, roca Hb da HT mZime gauwyloebis
fonze normis farglebSia, avadmyofs aqvs anemia, xSirad rkinis deficitis gamo.
2) eleqtrolitebis gansazRvra SratSi an plazmaSi.
hi pernatr iemia dakavSirebulia msubuqi an saSualo simZimis dehidrataciasTan
pernatriemia
da ar saWiroebs siTxeebis gadasxmas.
Cveulebriv, hi pokal iemia asaxavs kaliumis dakargvas mTel organizmSi da ara
pokaliemia
marto ujredSida siTxeSi. saWiroa gulmodgine monitoruli dakvirveba ekg-s CaTvliT.
bikarbonatebis gansazRvra gvexmareba alkalozis an acidozis dadgenaSi. acidozi
xSirad viTardeba diareis dros qsovilovani katabolizmisas anionebis gamodevniT da
Tirkmlebis funqciis daqveiTebiT.
37
alkalozi vlindeba Zlieri Rebinebis an nazogastraluri zondiT drenirebisas.

sisxlis ionebi gvexmareba pH-is gansazRvraSi.
qloridebi ikargeba Na-is paralelurad an maTi koncentracia erTdroulad
matulobs. gansxvaveba kaTionebsa (Na+,K+) da anionebs (Cl-, bikarbonatebi) Soris
jamSi Seadgens normaSi 12±4 mEq/l., rasac uwodeben anionur “garRvevas”. “garRveva”
momatebulia Tirkmlebis funqciis darRvevis dros, sulfatebis, fosfatebis da sxva
daudgeneli anionebis dayovnebisas; agreTve ketozis da rZemJava acidozis dros.
anionuri garRvevis ararsebobisas SeiZleba vilaparakoT laboratoriis Secdomaze.
3) Sardovana-azotis da Sratismieri kreatininis donem SeiZleba moimatos mZime
gauwyloebis dros Tirkmlebis filtraciis daqveiTebis Sedegad. TirkmlebSi sisxlis
mimoqcevis daqveiTebis dros izrdeba Sardovanas ukuSewova proqsimaluri milakebidan
da oliguriis mqone avadmyofebSi kreatininis donis normis farglebSi SenarCunebisas
aRiniSneba azotis momateba.
Sardovana-azoti SeiZleba dabali iyos maRali anabolizmis mqone bavSvebSi; amave
dros, SeiZleba gamogvrCes maRali kreatininis done, Tu ar viciT, rom mcire asakis
bavSvebSi normaSi, mozrdilebTan SedarebiT, kreatinini dabalia. mag.: Sratis kreatinini
_ 1 mg/dRe mozrdilebSi metyvelebs glomerulebis normalur filtraciaze, maSin,
rodesac 2 Tvis bavSvSi es maCvenebeli mowmobs, rom glomeruluri filtracia Seadgens
mxolod normis 25%-s. amave dros mZime dehidrataciisas es maCveneblebi (kreatinini,
Sardovana-azoti) SeiZleba iyos normaSi, vinaidan daSlis produqtebis akumulacia
Tirkmlebis funqciis daqveiTebis gamo vlindeba mogvianebiT periodSi.
4) Sardis saerTo analizi gvexmareba, avadmyofis mdgomareobis SefasebaSi. Cveulebriv,
xvedriTi wona am dros matulobs, maSinac ki, roca bavSvi ramdenime kvirisaa.
roca xvedriTi wona < 1020, es mowmobs, rom qronikuli daavadebis an uSaqro
diabetis gamo daqveiTebulia Tirkmlebis koncentraciuli unari. dehidrataciis dros
SardSi aRiniSneba hialinuri da granuluri cilindrebi, erTeuli leikocitebi an
eriTrocitebi da proteinuria _ 30-100 mg/dR. es cvlilebebi male qreba rehidrataciis
Semdeg da ar mowmobs Tirkmlebis Zlier dazianebas.
dehidrataciis mkurnalobis pr inci pebi. zogierTi avadmyofi (gansakuTrebiT,
princi
Sokur da komur mdgomareobaSi) saWiroebs xsnarebis dauyovnebliv gadasxmas.
dasazustebelia gadasasxmeli siTxis raodenoba da ti pi (maCveneblad warmodgenilia
Na, K da ionebis balansi _ Tu samedicino dawesebulebas amis saSualeba gaaCnia).
gauwyloebis msubuqi an saSualo simZimis dros saWiroa Catardes oraluri
rehidratacia.
gauwyloebasTan brZola dawyebuli unda iqnas jer kidev saxlis pirobebSi, rac,
umravles SemTxvevaSi, iZleva SesaZleblobas, Tavidan aviciloT ara marto dehidrataciis
gaRrmaveba, aramed mivaRwioT sruli gankurnebasac ki. es ki SesaZlebelia, Tu mSoblebis
mier Sesrulebuli iqneba msoflio janmrTelobis dacvis organizaciis mier
rekomendebuli sami moTxovna:
1)bavSvs unda mieces peroralurad siTxe ufro didi raodenobiT, vidre is iRebda
daavadebamde, 2)mieces sakmarisi raodenobiT, asakis Sesaferisi, srulfasovani, kaloriuli
sakvebi, 3) Tu bavSvis mdgomareoba ar gaumjobesda 2-3 dReSi, maSin dauyovnebliv unda
mimarTon eqims.
peroraluri rehidrataciisaTvis mowodebulia glukoza-marilovani xsnarebi,
romlebic warmodgenilia cxrilSi.
38
ramodenime eroraluri xsnaris Semadgenloba
xsnari glukoza (g) Na (mEq/l) K (mEq/l) Cl (mEq/l) fuZe (mEq/l)
30 bikarbonati,
ORS* 20 90 20 80
citrati
Rehydralyte 2,5 75 20 65 30 citrati

Pedialyte 2,5 45 20 35 30 citrati
Litren 2,0 50 25 45 30 citrati
Ricelyte 3,0 50 25 45 34 citrati
Naturalyte 2,5 45 20 35 48 citrati
* _ msoflio jandacvis organizaciis mier mowodebuli oraluri xsnari

P.S. ‘rehidroni~ ORS-Tan
-Tan gansxvavebiT Seicavs 10 g glukozas
aqedan yvelaze ufro efeqturad gamoiyeneba ORS-i, agreTve am mizniT SeiZleba

gamoyenebul iqnas saxlis pirobebSi sakveb produqtebze damzadebuli siTxeebi, rogoricaa
Txeli sufi (wvniani, damzadebuli bostneulze, mWle xorcze), brinjis naxarSi (“brinjis
wyali”), sasmeli damzadebuli kefirze, iogurtze, mawonze, sufTa wyali. Tu bavSvi
imyofeba ZuZuTi kvebaze saWiroa igi gagrZeldes ufro meti sixSiriT, vidre uwin.
siTxis saerTo raodenoba unda iyos meti, vidre mas Rebulobda bavSvi diareamde. 2
wlis asakamde siTxe msubuqi rehidrataciisaTvis eniSneba 50-100 ml yoveli defekaciis
Semdeg, 2-dan 10 wlamde ki 100-200 ml.
bavSvebma siTxe unda miiRon Cais kovziT yovel 1-2 wuTSi, xolo Tu aRiniSna
Rebineba, 10-wuTiani dasvenebis Semdeg saWiroa isev gavagrZeloT redidratacia. xazi
unda gaesvas imas, rom saxlis pirobebSi damzadebuli siTxeebi ver Secvlian kvebas.
diareis dros kvebis gagrZeleba aucilebelia, rac xels uwyobs zrdis process da
Tavidan gvacilebs kvebis moSlas _ malnutricias.
xelovnur kvebaze myof Cvilebs eZlevaT rZe, rZis narevi, xolo 6 Tvis asakidan,
rodesac ukve unda Rebulobdnen damatebiT sakvebs, racionSi unda iyos SenarCunebuli
marcvleulis an saxameblis Semcveli produqtebi, parkosnebi, bostneuli, xorci da
Tevzi. sakvebi unda iyos advilad mosanelebeli, meqanikurad da Termulad damuSavebuli,
mieces mcire ulufebiT, daematos erTi an ori Cais kovzi mcenareuli zeTi yovel
ulufaSi, energetikuli srulfasovnebisaTvis.
diareis Sewyvetis Semdeg ki saWiroa, daeniSnos damatebiTi kveba 2 kviris ganmavlobaSi
mainc. rZis produqtebi da kvercxi, agreTve, naCvenebia diareiT gamowveuli
dehidratirebuli bavSvis kvebisas. axali xilis wvenebi da banani Zalian sasargebloa,
vinaidan isini Seicaven kaliums. amave dros, unda veridoT uxeSi ujredisis Semcvel
da mZime produqtebs, iseTebs, rogoricaa zogierTi bostneuli da xili, maT kans,
mTlian marcvlebs, romlebic Znelad moineleba da aZliereben diareas.
bavSvebi unda wavaxalisoT, raTa miiRon sakvebi imdeni, ramdenic maT surT. kveba
SeTavazebuli unda iyos yovel 3-4 saaTSi, aranakleb 6-jer dReSi. yvelaze ufro
ukeTesia xSiri kveba mcire ulufebiT, rasac organizmi ufro kargad iTvisebs. Zlieri
39
bavSvi advilad umklavdeba daavadebas.

parenteruli siTxeebi iniSneba mZime dehidrataciis dros da maSin, rodesac avadmyofi
siTxes ver Rebulobs per os (aqvs Seupovari Rebineba, ileusi an sxva mizezis gamo).
intravenuri infuziis SeuZleblobis SemTxvevaSi gadasxma unda gakeTdes Zvlis
tvinSi. Tavdapirvelad saWiroa siTxis deficitis anazRaureba da TirkmlebSi sisxlis
mimoqcevis aRdgena. Semdgomi mkurnaloba mimarTulia siTxis mimdinare dakargvis
aRsadgenad. damamTavrebeli mkurnaloba ki gamoixateba srulfasovani kvebiTa da amiT,
zogierT SemTxvevaSi, kaliumis danakargis aRdgeniT.
Sokis acilebas an mis mkurnalobas axdenen plazmis moculobis aRdgeniT. am
mizniT gamoiyeneba 0,9%-iani natriumis qloridis xsnari glukozis damatebiT 5g/kg
dReSi, gansakuTrebiT metaboluri alkalozis dros. mZime metaboluri acidozis
dros avadmyofis saerTo mdgomareoba SeiZleba gauaresdes qloridebiT gadatvirTvis
Sedegad, rasac mohyveba bikarbonatebis ganzaveba SratSi. am SemTxvevaSi 0,9%-iani
natriumis qloridi unda Seicvalos ringeris laqtatis xsnariT, romelSic aris
damatebiTi buferi, magram es xsnari rZemJava acidozis dros an laqtatis bikarbonatSi
gardaqmnis darRvevisas unda gamoviyenoT frTxilad.
rehidrataciis dawyeba unda moxdes fiziologiuri xsnaris (0,9% NaCl) SeyvaniT
venaSi 20-30 ml/kg sxeulis masaze, sanam ar moxdeba hemodinamikis stabilizacia (20-
30 wuTi) da Semdeg, rac cnobili iqneba laboratoriuli monacemebi, SesaZlebelia
dehidrataciis sxvadasxva variantTan ufro racionaluri brZola.
mxedvelobaSi aucileblad unda miviRoT, rom hi potonuri xsnaris gadasxma
akrZalulia, radgan man SeiZleba gamoiwvios hi perhidratacia da tvinis SeSupeba.
kaliumis donis aRdgena saWiroa mxolod Zlier mZime hi pokalemiis dros da isic
Tirkmlis Senaxuli funqciis fonze. ringeris laqtati Seicavs kaliumis minimalur
raodenobas da amitom misi gadasxma uaryofiT gavlenas ar axdens mZime gauwyloebis
drosac. Tu sakmarisi ar aRmoCnda eleqtrolitebis gadasxma, maSin SeiZleba avadmyofs
gadaesxas gawmendili plazma.
dehidratacia, romelsac axlavs mZime anemia, saWiroebs sisxlis gadasxmas, 10 ml/kg
sxeulis masaze. am dros aucileblad unda gaviTvaliswinoT SesaZlo riski
(SeuTavsebloba, Trombozi, infeqciuri daavadebebis gadacema da sxv.). SesaZlebelia,
rom avadmyofs gadavusxaT 5%-iani albumini, magram mTlianad masze dayrdnoba moculobis
Sevsebis mxriv ar SeiZleba.
SemanarCunebeli Terapia mimarTulia wylis, eleqtrolitebisa da kaliumis mimdinare
deficitis aRsadgenad. rehidrataciis swori warmarTvisaTvis saWiroa individualuri
midgoma. aucilebelia, yovel 8 saaTSi zustad gamovTvaloT Sesayvani siTxis raodenoba,
winaaRmdeg SemTxvevaSi SesaZloa seriozuli garTuleba hi perhidrataciis saxiT.
aRniSnuli gadasxmebis Semdeg kaliumis deficitis aRdgena xdeba TandaTan, magram
misi sruli aRdgena SeiZleba mxolod srulfasovani kvebis Sedegad.
didi raodenobiT gadasxmulma kaliumma SeiZleba gamoiwvios hi perkaliemia da
seriozuli garTulebebi. amasTan dakavSirebiT, rigi avtorebisa gvirCevs, rom mkurnalobis
dawyebidan 10-16 sT-is ganmavlobaSi kaliumi organizmSi ar SeviyanoT. maSin, roca
saqme gvaqvs gaxangrZlivebul diareasTan, hi pokaliemiur alkalozTan an diabetur
ketoacidozTan, sadac kaliumis raodenoba mkveTrad ecema, saWiroa misi damatebiTi
Seyvana.
deqstrozaSemcveli xsnaris gadasxma kaliumis gareSe ar unda xdebodes, radgan
SeiZleba gaaRrmavos misi deficiti da aman gamoiwvios sicocxlisaTvis saSiSi
mdgomareoba. Cveulebriv, gamoiyeneba xsnarebi, romlebic Seicaven 40mEq/l /l kaliums.
mxolod gansakuTrebul SemTxvevaSi, rodesac saqme gvaqvs kritikul situaciasTan
40
msoflio janmrTelobis organizaciis mier mowodebuli

dehidrataciis mkurnalobis sqemebi
à~- gegma (msubuqi xarisxis dehidrataciis mkurnaloba)
ORS xsnari (ml-Si) ORS xsnaris (ml-Si)

asaki dasalevad yoveli moculoba 1 dRe-
defekaciis Semdeg RameSi
< 24 Tvis 50-100 500

2-10 wlis 100-200 1 000
10 weli da meti ramdensac svams 2 000
`b~-gegma (saSualo xarisxis dehidrataciis mkurnaloba)
asaki < 4Tvis 4-11 Tvis 12-23 Tvis 2-4 wlis 5-14 wlis 15 wlis da meti
masa < 5kg 5-7,9 kg 8-10,9 kg 11-15,9 kg 16-29,9 kg 30 kg da meti
ORS (ml) 200-400 400-600 600-800 800-1200 1200-2200 2200-4000
* `b~ gegma sruldeba 4-6 saaTis ganmavlobaSi. am periodis Semdeg, Tu avadmyofis

dehidrataciis xarisxi Semcirda, gadadian à~ gegmaze. Tu mdgomareoba igivea _ meordeba
`b~ gegmis mixedviT mkurnaloba. xolo Tu mdgomareoba gauaresda da gamoixata mZime
gawyloeba gadadian `g~ gegmaze
`g~- gegma (mZime dehidrataciis mkurnaloba)

(iniSneba 0,9% NaCl an ringeris laqtatis xsnari infuziis saxiT)
Tavdapirvelad 30
grZeldeba 70 ml/kg drois Semdeg
asaki ml/kg Semdegi periodis
periodSi:
ganmavlobaSi
12 Tvemde 1 saaTi 5 saaTi
12 Tvis
30 wuTi 2,5 saaTi
zemoT asaki
1. `g~-gegma gameordes, Tu pulsi ar isazRvreba

2. mdgomareoba Sefasdes yovel 1-2 saaTSi da Tu igi ar umjobesdeba siTxis Seyvana
daCqardes
3. rogorc ki avadmyofi dalevas SeZlebs, mieces ORS-i
-i 5 ml/kg/saaTSi
4. gegmis Sesrulebi Semdeg dehidrataciis xarisxi Sefasdes Tavidan da airCios à~, `b~
an isev `g~ gegma.
41
mZime hi pokaliemiiT, kaliumi SeiZleba gamoviyenoT ufro koncentrirebul xsnarebSi

SratSi misi koncentraciis kontroliT.
mZime da mdgradi hi pokaliemiis dros kaliumis xsnaris infuziis saxiT gamoyeneba
ix. eSerixiozis mkurnalobaSi.
siTxis deficitis koreqcia. izonatriemiuli gauwyloebis dros klinikuri
gamovlinebani ganpirobebulia ujredgare (eqstraceluluri) siTxis cvlilebasTan _
am dros Na didi raodenobiT Sedis ujredSi da ikavebs K-is adgils.
saSualo da mZime gauwyloebis dros siTxis deficitis aRdgena unda moxdes
mkurnalobis dawyebidan pirvel 6-8 sT-Si (ix. `b” da `g” gegma). avadmyofze meTvalyureoba
unda xdebodes xSirad (8 sT-ze adre).
hi ponatriemiuli gauwyloebis dros, Tu stacionarSi keTdeba eleqtrolitebis
gansazRvra, SeiZleba vixelmZRvaneloT Semdegi formuliT.
Na-is deficitis gamosaangariSeblad mowodebulia Semdegi formula
Na deficiti [mEq]=(135-SNa)X(0,6Xmkg);
sadac SNa- warmoadgens avadmyofis SratSi Na-is dones, mkg-avadmyofis sxeulis
masas kg-Si.
(0,6Xmkg) _ organizmSi wylis saerTo raodenoba litrebSi.
135 _ Na-is koncentraciis qveda zRvari sisxlis SratSi.
hi ponatr iemiul
iemiuli
ponatriemiul i gauwyloebis dros mkurnaloba igivea, rac izonatriemiuli
gauwyloebis SemTxvevaSi, mxolod im gansxvavebiT, rom saWiroebis SemTxvevaSi SeiZleba
natriumis damatebiTi Seyvana. Sesayvani Na-is raodenoba unda ganawildes 24-48
saaTSi. miuRebelia Na-is donis swrafi awevisaTvis hi pertonuli xsnarebis Seyvana.
(gamonakliss warmoadgens mxolod hi ponatriemiiT gamowveuli krunCxvebi, rac xdeba,
rodesac Na-is done sisxlis SratSi 120mEq/l-ze dabalia. simptomuri (krunCxvebi)
hi ponatriemiis mkurnaloba tardeba 3% NaCl xsnaris venaSi SeyvaniT 1ml/wuTSi
siCqariT, maqsimum 12 ml/kg sxeulis masaze).
hi pernatr iemiul
pernatriemiul
iemiulii dehidrataciis dros mkurnaloba sakmaod rTulia, vinaidan
hiperosmolarobis mZime mdgomareobam SeiZleba gamoiwvios tvinis dazianeba sisxlCaqcevis,
Trombozis, subaraqnoidul sivrceebSi siTxis gamoJonvis saxiT. cns-is meoradi dazianebis
diagnozi am SemTxvevaSi eyrdnoba Tav-zurgtvinis siTxeSi cilis momatebas. Trombozebi
SeiZleba sxva organoebSic ganviTardes, mag., Tirkmlis venebis Trombozi.
krunCxvebis ganviTareba SesaZloa mkurnalobisas natriumis normaluri maCveneblis
miRwevis drosac. es dakavSirebulia imasTan, rom gauwyloebisas natriumis raodenoba
tvinis ujredSi momatebulia da iseTi osmolari, rogoricaa taurini, warmoiSoba
didi raodenobiT. osmolarobis swrafi davardnis dros ujredgareSe siTxeSi ecema,
agreTve, sxva osmolarebis donec _ mag., glukozis, rac iwvevs tvinis ujredebSi wylis
SeRwevas da maT SeSupebas. es movlena SeiZleba moxdes hi pernatriemiis ènergiuli~
koreqciisas an araizotonuri siTxeebis gamoyenebisas. aseTi garTulebebis SeiZleba
avicdinoT gauwyloebisa da hipernatriemiis mxolod TandaTanobiTi koreqciiT ramodenime
dRis ganmavlobaSi. am dros unda vecadoT, rom Na-is daweva SratSi ar mimdinareobdes
10mEq/l 24 sT-Si ufro swrafad.
hi pernatriemiuli gauwyloebis SemTxvevaSi saWiroa siTxisa da Na-is ufro naklebi
raodenoba, vidre hi ponatriemiuli da izonatriemiuli gauwyloebis dros. karg efeqts
eleqtrolitebTan erTad iZleva 5%-iani deqstroza, romelic Seicavs 28mEq/l Na—
s, bikarbonetebisa da qloridebis kombinacias. gadasxmisaTvis sxva gamosayenebeli
xsnarebi Seicaven 40mEq/l Na-s da 40mEq/l K-s. SeiZleba gadaisxas xsnari, romelic
Seicavs SedarebiT didi raodenobiT natriums, rac aixsneba imiT, rom masSi mis Semcveloba
aferxebs Na-is swraf daklebas sisxlis SratSi da amiT Tavidan gvacilebs
42
infeqciuri avadmyofebis mkurnalobis ... saSualebebi
zogadi nawili. infeqciuri daavadebebis specifikuri profilaqtika
zemoTaRniSnul garTulebebs.
krunCxvisas niSnaven antikonvulsantebs, 3% NaCl 3-5 ml/kg, xolo qalasSida
wnevis dasawevad manitols an hi perventilacias.
hi pernatriemiuli gauwyloebisas didi raodenobiT Seyvanili siTxe xSirad iwvevs
ujredgare siTxis momatebas jer kidev acidozisa da eleqtrolitebis koreqciamde,
ramac SeiZleba migviyvanos gulis ukmarisobamde da tvinis SeSupebamde.
gamoxatuli hi pokalciemis dros saWiroa kalciumis Seyvana venaSi. aseve SeiZleba
ganviTardes anemia da Tirkmlebis koncentraciuli unaris daqveiTeba.
zemoTaRniSnuli skrupulozuri koreqcia mTel rig pirobebSi Znelad
ganxorcielebadia, amitom urgentul SemTxvevaSi, rodesac gvaqvs siZneleebi
laboratoriasTan, umjobesia, vixelmZRvaneloT msoflio janmrTelobis dacvis
organizaciis rekomendaciebiT da gamoviyenoT “a”, “b” an “g” gegma, miTumetes, rogorc
es ukve aRiniSna, mZime gauwyloebis dros, miuxedavad gauwyloebis ti pisa (hi po-, izo-
an hi pernatriemiuli), saukeTeso xsnarebad iTvleba 0,9% NaCl da ringeris laqtati.
infeqciuri daavadebebis specifikuri

profilaqtika
infeqciur daavadebaTa profilaqtika warmoadgens saxelmwifos upirveles amocanas

da eyrdnoba mravalricxovani kompleqsuri RonisZiebebis Catarebas. igi unda
xorcieldebodes sistematurad da uwyvetad, maSinac ki, rodesac qveyanaSi
epidemiologiurad mSvidi situaciaa. es ganpirobebulia imiT, rom msoflios ama Tu im
regionSi epidemiuri kerebisa da, gansakuTrebiT, maRalkontagiozuri infeqciebis
arsebobisas infeqciaTa gavrceleba xdeba swrafad, gadaadgilebis Tanamedrove saSualebebiT
inkubaciur periodSi myofi pirovnebis mier.
RonisZiebebi infeqciuri da parazituli daavadebebisas SeiZleba iyos profilaqtikuri
da epidsawinaaRmdego. pirvelis dros RonisZiebebi mimarTulia epidemiuri procesis
Tavidan acilebisaken, xolo meores dros ki iTvaliswinebs ukve arsebuli epidemiuri
procesis likvidacias.
infeqciuri daavadebebis profilaqtikis safuZvels warmoadgens farTomasStabiani,
e.w. saerTo-saxelmwifoebrivi RonisZiebebi, romlebSic Sedis iseTi faqtorebi, rogoricaa
mosaxleobis materialuri keTildReoba, keTilmowyobili sacxovrebeli binebi, maRali
kulturuli done, saTanado samuSao pirobebiT uzrunvelyofa, sanitarul-
epidemiologiuri zedamxedveloba da sxv.
Tanamedrove mediko-biologiuri da momijnave mecnierebebis ganviTarebis miRwevebis
safuZvelze SesaZlebeli gaxda, Seqmniliyo sxvadasxva kategoriis antigenebisa da maTi
nawilakebisagan damzadebuli vaqcinebi, romlebic didi efeqtiT gamoiyeneba infeqciur
sneulebaTa sawinaaRmdego vaqcinaciisaTvis.
1796w. ingliseli eqimis e.jeneris mier pirvelad iqna warmatebiT Catarebuli
Zroxis yvavilis vaqciniT (vezikuluri SigTavsiT) adamianis vaqcinacia naturaluri
yvavilis sawinaaRmdegod. SemdgomSi yvavilis sawinaaRmdego vaqcina bevrad gaumjobesda
da warmatebiT iqna gamoyenebuli mTel rig qveynebSi, sadac, faqtiurad, moxda naturaluri
yvaviliT daavadebaTa mkveTrad kleba an likvidacia. 1958 wlidan msoflios jandacvis
organizaciis mier miRebuli iqna programa, romelic iTvaliswinebda am infeqciis
srul likvidacias msoflioSi. 1980 wels ki am organizaciis XXXIII sesiaze xelmoweril
43
iqna sertifikati, romliTac gamocxadda msoflio masStabiT naturaluri yvavilis

sruli likvidaciis faqti. amJamad naturaluri yvavilis virusi, rogorc etalonuri
Stami, pasteris institutSi (safrangeTSi) inaxeba.
unda aRiniSnos, rom 1977 wlidan msoflios jandacvis organizaciis mier
SemuSavebulia imunizaciis gafarToebuli programa, romelic iTvaliswinebs mTeli
rigi marTvadi infeqciebis mkveTr Semcirebas an zogierTi maTganis likvidacias. am
mxriv, yofili sabWoTa kavSiris mTel teritoriaze miRweul iqna rigi infeqciebis
mkveTri dakleba, xolo iseTi saSiSi infeqcia, rogoricaa poliomieliti da misi
paralizuri formebi, TiTqmis aRar aRiniSneboda. aSS-Si poliomielitis SemTxvevebi
ar aRiniSneba 1991 wlidan, likvidirebulia difTeria, wiTela, epidemiuri parotiti,
yivanaxvela, wiTura, gaSeSeba, Haemophilus influenzae b tipiT gamowveuli infeqciebi.
imasTan dakavSirebiT, rom msoflios sxvadasxva qveyanaSi jer kidev gvxvdeba CamoTvlili
infeqciebi, zogjer ki maTi epidemiuri afeTqebebi, farTomasStabiani imunizaciis Catarebis
aucilebloba aqtualur amocanad rCeba.
unda aRiniSnos, rom profilaqtikuri acrebi garkveulwilad iZulebiT RonisZiebebad
iTvleba, radgan acris Semdeg organizmSi garkveul procentSi viTardeba gverdiTi
movlenebi, romlebic minimumade unda iqnas dayvanili. iSviaTi gamonaklisis garda,
praqtikulad yvela vaqcinur preparats gaaCnia garkveuli reaqtogenuli Tvisebebi.
aseTi reaqciebis arsebobis realoba aucilebels xdis, dawvrilebiT iqnas Seswavlili
maTi gamovlinebis mizezi da miRebul iqnas RonisZiebebi reaqtogenuli Tvisebebis
Sesamcireblad. sakiTxisadmi aseTi midgoma aucilebelia imitomac, rom umravlesi
vaqcinuri preparatebis efeqturoba dakavSirebuli ar aris reaqtogenul TvisebebTan.
SedarebiT erTnairi epidemiologiuri efeqturobisa da imunogenurobis vaqcinuri
preparatebi sxvadasxva reaqtogenobiT xasiaTdeba. es viTareba dakavSirebulia ara
imdenad TviT mikroorganizmebis StamebTan, ramdenadac, saubedurod, calkeuli preparatebis
seriaTa arastandartulobasTan.
amJamad Tanamedrove medicina SeiaraRebulia ramdenime aTeuli cocxali da mkvdari
profilaqtikuri vaqciniT.
imunizaciis masStabi farTovdeba, profilaqtikuri vaqcinebi ki mudmivad umjobesdeba
_ iqmneba axali asocirebuli, qimiuri da sxva vaqcinebi. bunebrivia, rom eqimebma
saWiroa, icodnen uaxlesi specifikuri vaqcinebis, maTi usafrTxoebisa da rekomendaciebis
Sesaxeb. vaqcinaciis dadebiT efeqtebze, aseve mis gverdiT movlenebze informirebuli
unda iyvnen bavSvebis mSoblebi da mozrdili pacientebi.
aqtiuri imunizacia iTvaliswinebs mikrobebis an maTi produqtebis moqmedebas
makroorganizmze, raTa masSi gamoiwvios imunuri reaqciebi daavadebis provocirebis
gareSe. am mizniT gamoiyeneba gawmendili anda genuri inJineriiT miRebuli antigeni.
vaqcinis efeqturoba ganisazRvreba imiT, Tu ramdenad da ramdeni xnis ganmavlobaSi
icavs igi organizms daavadebisagan.
imunizaciis Sedegad organizmi gamoimuSavebs antitoqsikur, antiinvaziur an
maneitralizebel aqtivobas humoruli an ujreduli pasuxis saxiT.
zogi vaqcina organizmSi erTjeradi SeyvaniT uzrunvelyofs proteqciul imunitets
mTeli sicocxlis manZilze, zogi _ garkveuli droiT, zogierTi ki saWiroebs organizmSi
meored Seyvanas _ revaqcinacias garkveuli periodis Semdeg.
interess ar aris moklebuli, gavecnoT aSS-Si amJamad miRebul vaqcinaTa nusxas,
vinaidan am qveyanas profilaqtikaSi udidesi warmatebebi aqvs miRweuli, vaqcinebi ki
maRalgawmendili da maRalefeqturia.
44
aSS -Si miRebuli vaqcinebi da maTi daxasiaTeba (ix. danarT 2-Si)

acrebis kalendari saqarTveloSi (ix. danarTi 2-Si)
vaqcinebis umravlesobis gamoyeneba SeiZleba erTsa da imave dros, erToblivad,

saamiso ukuCveneba arc erTi asakis bavSvs ar aqvs, xolo sxvadasxva vaqciniT gamowveuli
imunuri pasuxi ki erTmaneTs xels ar uSlis (gamonakliss warmoadgens OPV- oraluri
poliovirusuli vaqcinis, qolerisa da yviTeli cxelebis vaqcinebis erTad Seyvana).
MMR_ parotitis, wiTalasa da wiTuras sawinaaRmdego vaqcina ixmareba erTjeradad,
Tu piri endemur adgilebSi miemgzavreba.
im SemTxvevaSi, Tu bavSvis imunizaciaze informacia cnobili ar aris, maSin mas
vaqcinacia utardeba Tavidan. vaqcinaciis Semdeg, axlo periodSi Tavi unda SevikavoT
imunoglobulinebis Seyvanisagan, radgan SesaZloa maT SeboWon vaqcinis antigenebi da
xeli SeuSalon imunitetis gamomuSavebas.
saWiroa, vicodeT, rom tuberkulozis sinjis dros wiTelas sawinaaRmdego vaqcinis
Seyvana mizanSewonili ar aris _ igi tuberkulinis aqtivobas amcirebs.
aucilebelia, rom imunizaciis Catarebis Sesaxeb cnobebi SevitanoT pacientis
pirad samedicino baraTSi, gansakuTrebiT, Tu bavSvis ojaxi xSirad mogzaurobs da
icvlis sacxovrebel adgils.
gverdiT movlenebs absoluturad moklebulni arc licenzirebuli vaqcinebi arian,
Tumca maTi gverdiTi movlenebi, rogorc wesi, Zalian msubuqia an saSualodaa gamoxatuli
da adgilobrivi movlenebiT Semoifargleba. Zalze iSviaTad SeiZleba ganviTardes
OPV acris dros poliomielitis paralizuri forma da sikvdilic ki. aseT SemTxvevaSi
saWiroa, avadmyofisagan gamoyofil iqnas autoStami da Sedarebul iqnas vaqcinur
StamTan etiologiis dazustebis mizniT.
yvela saeWvo SemTxvevisas saWiroa janmrTelobis dacvis zemdgomi organoebis,
daavadebaTa kontrolis centris informireba.
dabali cxeleba per se (TavisTavad) imunizaciisaTvis ukuCvenebas ar warmoadgens,
magram Tu sxva niSnebi mZime daavadebaze migviTiTebs, saWiroa vaqcinaciisagan Tavi
SevikavoT gamojanmrTelebamde. respiraciuli, kuW-nawlavisa da sxva sistemebis msubuqi
daavadebis dros SesaZlebelia, bavSvs Cautardes vaqcinacia zogierTi cocxali vaqciniT:
MMR, Varicella vaccine, OPV, aseve SeiZleba vaqcinaciis Catareba DTaP an DTP-Ti
(ix. aiv-infeqcia, sadac ukuCvenebebi SedarebiT metia).
mniSvnelovania, rom:
1. antimikrobuli Terapia da rekonvalescencia imunizaciisaTvis ukuCvenebas ar
warmoadgens.
2. Tu DTP-Ti wina vaqcinaciis dros aRiniSneboda mxolod adgilobrivi movlenebi,
tkivili, siwiTle, SeSupeba, Tundac temperaturis aweva 40,5°C-mde, SesaZlebelia, Catardes
Semdgomi kalendaruli acra.
3. infeqciur avadmyofTan kontaqti vaqcinaciisaTvis ukuCvenebas ar warmoadgens.
vaqcinaciisaTvis winaaRmdegCvenebebi ar aris, agreTve:
4. alergia penicilinze, neomicinze, streptomicinze, garda im SemTxvevebisa, roca
anamnezSi aRiniSneboda maT mier ganpirobebuli anafilaqsiuri Soki (vaqcinebi, SesaZlebelia
damzadebuli iyos zemoxsenebul antibiotikebze).
5. alergia batis xorcze an mis produqtebze, Tu vaqcina ar Seicavs batis
antigenebs.
6. Tu ojaxis romelime wevrs anamnezSi vaqcinaciis Semdgom hqonda krunCxvebi.
7. cudi kveba (malnutricia) bavSvebSi.
8. dRenakloba.
45
9. ZuZuTi kveba.
10. araspecifikuri alergia.
orsulebSi cocxali vaqcinebi ar gamoiyeneba.
msoflio jandacvis organizaciis rekomendaciiT vaqcinaciis ukuCvenebebi minimumamdea
dayvanili.
pasiuri imunizacia
pasiur imunizaciaSi igulisxmeba pacientis mier mza antisxeulebis miReba daavadebis

profilaqtikisa da mkurnalobis mizniT. aseT preparatebs miekuTvneba adamianis
hi perimunuri plazma da specifikuri imunoglobulinebi. zogierTi specifikuri
imunoglobulini mzaddeba cxenis organizmis imunizaciis Sedegad.
pasiuri imunizacia naCvenebia: imunodeficituri mdgomareobis dros, kontaqtirebul
pirebSi, roca didia mZime daavadebis ganviTarebis riski (wiTela, cofi, B hepatiti da
sxv), zogierTi daavadebis samkurnalod (botulizmi, difTeria, tetanusi, Kawasaki-s
sindromi).
adamianis hi perimunuri plazmidan sxvadasxva infeqciisa da paTologiebisas,
stafilokokuri, koliinfeqciis, fsevdomonuri sefsisis dros venaSi Sesayvanad gamoiyeneba
intravenuri imunoglobulinebi, maT Soris RSV-IGIV (specifikuri hi perimunuri
intravenuri imunoglobulini respiraciul-sincitiur virusuli cxelebis
sawinaaRmdegod), hi perimunuri specifikuri imunoglobulini B hepatitis dros kunTebSi
pasiuri imunizaciis mizniT.
imunoglobulinebi gamoiyeneba iseTi arainfeqciuri paTologiis mkurnalobis drosac,
rogoricaa Guillian-Barre-s sindromi, Trombocitopeniuri purpura da sxv.
cxenis organizmis imunizaciiT miiReba Sratismieri antisxeulebi, romlebsac
miekuTvneba: 1)botulizmis antitoqsini A,B da E ti pis; 2)difTeriis; 3)tetanusis
antitoqsini; 4)cofis sawinaaRmdego imunoglobulini. yvela heterogenuri antisxeulis
mimarT saWiroa, winaswar ganisazRvros adamianis organizmis mgrZnobeloba, raTa Tavidan
aviciloT anafilaqsiuri Sokis SesaZlo ganviTareba.
Sratis Seyvanisas SeiZleba ganviTardes Semdegi ti pis r eaqciebi:
reaqciebi:
1. febriluri reaqcia _ temperaturis momateba, rodesac saWiroa mkurnaloba
mxolod anti piretulebiT, Tbili wyliT sxeulis nazi dazelviT.
2. Sratismieri daavadeba _ aRiniSneba temperaturis momateba, urtikaria, arTriti,
arTralgiebi, limfadenopaTia. daavadeba iwyeba Sratis Seyvanidan 7-16 dRis, (zogjer 2-
3 kviris) Semdeg. SesaZloa, ganviTardes SeSupeba ineqciis adgilze, glomerulonefriti,
Guillian-Barre-s sindromi, periferiuli nevritebi, miokarditi. daavadeba zogjer
spontanurad ikurneba 2 kviris ganmavlobaSi. daavadebis mkurnalobisaTvis simZimis
mixedviT gamoiyeneba antihistaminuri preparatebi, aspirini, sxvadasxva arasteroiduli
anTebissawinaaRmdego preparatebi, kortikosteroidebi ki mxolod mZime gamovlinebis
dros (prednizoloni 1,5-2 mg/kg dReSi, 5-7 dRis ganmavlobaSi).
3. anafilaqsia. misi umTavresi niSnebia: a)kanis gawiTleba, qavili, angionevrozuli
SeSupeba; b)respiraciuli darRvevebi tkivilebiT gulmkerdis areSi, xmis SecvliT,
stridoris CamoyalibebiT, dispnoe da cianozi; g)kardiovaskuluri darRvevebi _ Cqari,
susti pulsi, wnevis dacema, aritmia. es mdgomareoba gadaudebel Carevas saWiroebs.
kanis sinjis Catarebac SeiZleba damTavrdes sikvdiliT, amitom mowodebulia ufro
damzogavi da SedarebiT usafrTxo, e.w. kanis nakawris an naCxvletis sinji. am drosac,
Tumca ufro iSviaTad, ar aris gamoricxuli anafilaqsiuri Sokis ganviTareba. saWiroa,
eqimi mzadyofnaSi iyos Sesabamisi medikamentebiTa da aparaturiT.
46
alergiuli sinjebi cxoveluri Sratis

mgrZnobelobis dasadgenad
nakawris an naCxvletis sinji xorcieldeba Semdegnairad: winamxris medialur

zedapirze keTdeba nakawri an naCxvleti, romelzedac ewveTeba 1:100 ganzavebis, cxenis
saTanado Sratis 1 wveTi. erTdroulad keTdeba sakontrolo sinjebi _ dadebiTi
(histaminuri) da uaryofiTi (fiziologiuri xsnariT). histaminuri testi keTdeba 1%
histaminis fosfatis erTi wveTis dawveTebiT an kanSi SeyvaniT. dadebiTi reaqciis
arsi mdgomareobs Seyvanili histaminisa da SesaZlo arsebul IgE antisxeulebs Soris
reaqciaSi (histaminis moqmedeba xorcieldeba kapilarebis histaminuri receptorebis
doneze). klinikurad testi gamoixateba hi peremiuli da SeSupebuli papulis warmoqmniT.
dadebiTi reaqcia SeiZleba ganviTardes dauyovnebliv (15-20 wuTSi) an 6-7 sT-idan 24
sT-mde drois ganmavlobaSi (Senelebuli ti pis reaqcia). dadebiTi histaminuri reaqcia
am dros 5 mm diametrsa da mets aRwevs. papulis adgilas SeigrZnoba wva, qavili,
temperaturis momateba. Senelebuli ti pis reaqciisas infiltratSi histologiurad
aRiniSneba mononuklearebi, eozinofilebi da neitrofilebi.
dauyovnebeli reaqciis dros (15-30 wT-Si) papulis saxiT gamoxatuli kanis
reaqcia miuTiTebs, rom specifikur IgE antisxeulebs Seicaven qsovilTa poxieri
ujredebi, Tumca es ar niSnavs, rom maTi Sexvedra alergenebTan klinikurad yovelTvis
alergiiT unda gamovlindes.
histaminuri kontrolis gakeTebis mizania is, rom davrwmundeT, kans SeuZlia Tu
ara endogenuri histaminis gamoyofa.
Sratis Seyvanis Semdeg sinji iTvleba dadebiTad, Tu warmoSobili eriTema 3 mm-iT
mainc didia kontrolTan (fiziologiuri xsnaris Seyvanis adgilas) SedarebiT, Seyvanidan
15-20wT-is Semdeg. histaminuri kontroli am dros aseve dadebiTi unda iyos, raTa
moxdes Sedegebis swori interpretacia. Tu nakawris testi uaryofiTia, saWiroa,
Catardes kanis testi.
kanis testi mgrZnobelobaze. am testisaTvis gamoiyeneba fiziologiur xsnarSi
1:1000-ze ganzavebuli Srati, romlis 0,02 ml SehyavT kanSi. am dros aucilebelia
dadebiTi da uaryofiTi kontrolis Sedareba (rogorc zemoT iyo aRwerili). Tu
aseTi ganzavebiTac uaryofiTi Sedegi miviReT, saWiroa, testi gavimeoroT 15-20 wT-is
Semdeg 1:100ganzavebis 0,02 ml SratiT. interpretacia nakawris testiT miRebuli
Sedegebis analogiuria.
kanis dadebiTi testis dros an Tu anamnezSi avadmyofs aReniSneboda odesme
anafilaqsiuri reaqcia Sratis Seyvanaze da, amave dros, misTvis Sratis Seyvana sasicocxlo
Cvenebas warmoadgens, Seyvana xorcieldeba mxolod desensibilizaciis meTodiT.
Tu testi uaryofiTia, Sratis Seyvana Tavidanve SeiZleba moxdes kunTSi, 30 wT-is
Semdeg ki _ venaSi (am dros Sratis ganzaveba xdeba Semdegnairad _ 0,5 ml Srati +
10ml NaCl-is 0,9%-iani an 5%-iani glukozis xsnari). Tu am drosac aranairi reaqcia
ar gamoixata, danarCeni doza 1:20 ganzavebiT venaSi gadaisxmeba 1ml/wT-Si siCqariT.
desensibilizaciisa da ganviTarebuli anafilaqsiis mkurnalobis sqemebi mocemulia
Semdeg cxrilebSi:
47
desensibilizaciis intravenuri meTodi
doza mimdevrobiT ganzaveba raodenoba 1 ml

anafilaqsiis
1 1 : 1 000 0.1 epinefriniT (adrenaliniT)
mkurnalobis meTodika (Tu
2 1 : 1 000 0.3
saWiroa, amave dros unda
3 1 : 1 000 0.6 moxdes intubacia da
4 1 : 100 0.1 Jangbadis mowodeba).
5 1 : 100 0.3
kanqveS da kunTebSi
6 1 : 100 0.6
Seyvana
7 1 : 10 0.1 Epinephrine 1 : 1 0 0 0
8 1 : 10 0.3 ganzaveba: 0,01 ml/kg 1
9 1 : 10 0.6 Seyvanaze Tu saWiroa, yovel
15-20 wT-Si ganmeorebiTi
10 ganuzavebeli 0.1
Seyvana igive doziT.
11 ganuzavebeli 0.3 Tu anafilaqsia
12 ganuzavebeli 0.6 gamowveulia alergiuli
13 ganuzavebeli 1.0 agentis adgilobrivi SeyvaniT,
epinefrinis Seyvana SeiZleba
14 ganuzavebeli i.v imave adgilSi daviwyoT, raTa
darCenili doza alergenis absorbcia
Zalian nela Seneldes.
intervali dozebs Soris 15 wT. e p i n e f r i n i s

erTjeradi Cveulebrivi
dozebi asakobriv
desensibilizaciis
aspeqtSi
kanSiga, kanqveSa da intramuskuluri meTodi
Epinephrine 1:1000
dozebis wlamde asakSi 0,05-0,1ml
Seyvanis gza ganzaveba raodenoba
mimdevroba
ufrosi asakis bavSvebSi
1 kanSi 1 : 1 000 0.1 0,1-0,3ml
2 kanSi 1 : 1 000 0.3 mozardebSi 0,3-0,5ml
3 kanqveS 1 : 1 000 0.6
4 kanqveS 1 : 100 0.1 intravenuri Seyvana
5 kanqveS 1 : 100 0.3 Epinephrine 1:1000 0,1
6 kanqveS 1 : 100 0.6 ml/kg ganzavebuli 1:10000
7 kanqveS 1 : 10 0.1 NaCl 0,9%-Si
8 kanqveS 1 : 10 0.3 dozis gameoreba SeiZleba
9 kanqveS 1 : 10 0.6 yovel 10-20 wT-Si an
10 kanqveS ganuzavebeli 0.1 SeiZleba xangrZlivi
11 kanqveS ganuzavebeli 0.3 gadasxmis Catareba, Tu
12 kunTebSi ganuzavebeli 0.6 saWiroa dozebis ganmeorebaa.
13 kunTebSi ganuzavebeli 0.1 1m g (1 ml) 1:1000
14 kunTebSi ganuzavebeli darCenili doza epinefrini+250ml 5%
deqstroza, anu 4 µ g/ml
48
koncentracia. infuziis siCqarea 0,1 µg/kg/wT wnevis asamaRleblad. doza SeiZleba

01,5 µg/kg/wT-Si gaizardos TandaTan.
Tu intravenuri Seyvana SeuZlebelia, maSin kunTis doza saWiroa Seyvanil iqnas
enis qveS.
meoradi moxmarebis preparatebi anafilaqsiis dros
preparati doz a
H 1 - blokatorebi (antihistaminurebi)
Diphenhydramine (dimedroli) per os, i.m, i.v: 1 - 2 mg/kg yovel 4 - 6 sT-Si (100 mg - erTjeradi
Hydrozyne (Hydroxyzine) Per os, i.m: 0.5 - 1 mg/kg yovel 4 - 6 sT-Si (100 mg - erTjeradi
H 2 - blokatorebi) (antihistaminurebi)
Cimetidine i.v: 5 mg/kg neli Seyvana 15 wT-is ganmavlobaSi yovel 6 - 8 sT-Si
(300 mg maqsimaluri erTjeradi doza)
Ranitidine i.v: 1 mg/kg neli Seyvana 15 wT-is ganmavlobaSi yovel 6 - 8 sT-Si
(50 kortikosteroidebi )
Hydrocortisone i.v: 100 - 200 mg yovel 4 - 6 sT-Si
Methylprednisolone i.v: 1.5 - 2 mg/kg yovel 4 - 6 sT-Si (40 mg maqsimaluri erTjeradi
Prednisone (Prednisolone) ) 1.5 - 2 mg/kg 1-jer diliT 5 dRis ganmavlobaSi (60 mg
Per os:
erTjeradi maqsimaluri doza)
β 2 _ agonistebi
Albuterol aerozoli : 0.5% (mg/ml), 0.05 - 0.15 mg/kg dozaze 0.9% N aCl 2 - 3
ml-ze, maqsimum 2.5 mg dozaze yovel 20 wT-Si, 1 - 2 sT-s
ganmavlobaSi an 0.5 mg/kg sT-Si - xangrZlivi miwodeba (15 mg/sT-Si
maqsimaluri doza)
sxva
Dopamine i.v : 5 - 20 mg/kg wuTSi. 150 mg Dop. + 250 ml 0.9% NaCl an 5%
deqstroza. gadasxmis siCqare 1 ml/kg/sT = 10 mg/kg wT. (bikarbonati
ar ixmareba am dros - boWavs dopamins)
Aminophylline i.v : 4 - 6 mg/kg 0.9% NaCl 20 ml-Si Cqari SeyvaniT, yovel 6 sT-Si
an 0.9 - 1.1 mg/kg/sT xangrZlivi infuziiT
Cvens klinikaSi ramodenime welia, danergilia Kaplan-is skolis desensibilizaciis

meTodi (Mary Ann Jackson), romelic gamoiyeneboda difTeriuli antitoqsinis Seyvanis
dros. unda aRiniSnos, rom anafilaqsiur reaqcias adgili ar hqonia. amitom vTvliT,
saWirod eqimebisaTvis am meTodis gacnobas. igi Sesasruleblad ufro martivia da
did dros ar ikavebs.
Tavdapirvelad kanSi SehyavT antitoqsinis 0,1 ml 1:100 ganzavebiT, Tu ganviTarebuli
siwiTle 1 sm-ze meti diametrisaa (15-20 wuTSi), maSin keTdeba desensibilizacia.
49
difTeriuli antitoqsinis Seyvana desensibilizaciis meTodiT

(Kaplan, Mary Anne Jackson)
ganzaveba raodenoba
doza # Seyvanis gza
0,9%-ian NaCl ml-Si
1* kanqveS 1:20 0,5
2 kanqveS 1:10 0,1
3 kanqveS 1:10 0,3
4 kanqveS ganuzavebeli 0,1
5 kunTebSi ganuzavebeli 0,2
7~ venaSi ganuzavebeli 0,1
* _ dozebi Seiyvaneba yoveli 15 wuTis intervaliT

~ _ Tu me-7 dozis Seyvana kargad aitana, maSin danarceni doza gadaisxmeba venaSi Zalian
nela, (60 - 80 wT-is ganmavlobaSi)
50
kerZo nawili. gr
grii pi
kerZo nawili
gr
grii pi
(GRIPPE, GRIPPUS, INFLUENZA)
gri pi warmoadgens maRalkontagiozur virusul infeqcias, romelic xasiaTdeba

sasunTqi gzebis mTeli rigi dazianebiT, organizmis saerTo intoqsikaciiT da mravali
garTulebebiT. gri ps bavSvebSi da xanSi SesulebSi aqvs avadobisa da sikvdilianobis
maRali maCveneblebi.
daavadebis saxelwodeba dakavSirebulia frangul sityvasTan _ gripper, rac
Tavdasxmas niSnavs. ufro adre daavadeba cnobili iyo terminiT _ influenca (laT.
sityvidan _ influre _ SeWra). es saxelwodeba inglisurenovan samedicino terminologiaSi
dRemde prevalirebs. daavadebas didxans ukavSirebdnen pfeiferis hemolizur
(Haemophilus influenzae) Cxirebs.
etiologia. 1933w. ingliseli avtorebis:
Smith, Andrewes, Leidlaw-s mier dadgenili iqna
daavadebis virusuli buneba. gri pis virusebi
miekuTvnebian orTomiqsovirusebis klass da
Seicaven rnm-s. dadgenilia sami damoukidebeli
antigenuri ti pi_A,B,C, TiToeuli erTma-
neTisagan gansxvavdeba ribonukleinproteinuli,
komplementSemboWveli komponentis (antigenis)
TvisebebiT. virusis gareTa zedapiri
(glikoproteini) dafarulia wvetiseburi
warmonaqmnebiT (hemaglutinini, neiraminidaza),
romlebic pasuxismgebelni arian antigenurobaze
da gansazRvraven ama Tu im qveti pis kuTvnilebas.
amJamad cnobilia hemaglutininis 13 (H1 _ H13)
da neiraminidazas 10 qveti pi (N1 _ _N10 ).
a n t i g e n e b i s c v l i l e b e b i m i m d i n a r e o b s gr
grii pis viru sis sqematur
virusis sqematurii struqtura:
erTmaneTisagan damoukideblad; ufro xSirad HA - hemaglutinini
icvleba hemaglutininebi. gamoxatuli antigenuri NA - neiraminidaza
cvalebadoba gansakuTrebiT axasiaTebs A viruss, Lipid bilayer - li pidur pidurii o rmagi Sr
ormagi Sree
rac vlindeba hemaglutininis an neiraminidazas S i g n i T - n u k l e o p r o t e i n e b i , r n m
mTliani (Shift) an nawilobrivi SecvliT (Drift). (Compano RW, Choppino PW)
orive antigenis Secvlisas warmoiSoba axali
qveti pebi (A1, A2), romlebTanac dakavSirebulia pandemiis ganviTareba. antigenuri
formulebi Semdegnairad aRiniSneba: H1 N1 (A/pekini/262/95), H2 N1, H3 N2 (A/sidnei/5/
97) da a.S. mag.: gri pis pandemia 1918 wels gamowveuli iyo A virusiT, antigenuri
formula iyo H1N1; 1957 wlis pandemiis dros _ H2N2, xolo 1968w. _ H3 N2.
Semdgom wlebSi registrirebuli iyo A virusis mcire cvlilebebi: A /inglisi/ 172; A
/viqtoria/ 175; A /texasi/ 177; A /bangkoki/ 179. saxelwodebebi dakavSirebulia epidemiis
dawyebis adgilebTan.
1977 w. virusis antigenur struqturaSi SemCneuli iyo mosalodneli cvlilebebi,
51
kerZo nawili. gr
grii pi
romlebmac warmoSva seroti pebi H1 N1. amave dros H3 N2 ar gaqra cirkulaciidan da

orive ti pis mier xdeboda epidemiuri afeTqebebi.
gri pis B virusi aRmoCenili iyo 1940w. erTdroulad T. Francis -is (aSS) da T.
Magill -is (inglisi) mier. igi xasiaTdeba ufro naklebi antigenuri cvalebadobiT.
gri pis C virusi aRwerilia 1947w. Taylor-is mier. igi ar iwvevs epidemiebs da
pandemiebs da aris sporaduli SemTxvevebis mizezi, gansakuTrebiT bavSvebSi.
epidemi
epidemio ologia. infeqciis wyaros warmoadgens gri piT daavadebuli adamiani,
romlis klinikuri gamovlinebebi varirebs waSlili da msubuqi formidan dawyebuli
elviseburi mimdinareobis CaTvliT. zogierTi cxoveli da frinveli virusisaTvis
warmoadgens rezervuars da Sesabamisad, adamianisaTvis infeqciis potenciur wyaros.
virusis genomis segmenturi buneba SesaZlebels xdis, koinfeqciis SemTxvevaSi vilaparakoT
cxoveluri rezervuaria damnaSave Tu adamiani infeqciis afeTqebebSi. 13
hemaglutininisagan da 9 neiraminidazidan nebismieri SeiZleba darCes cxovelebis
rezervuarSi da SemdgomSi daavadeba gamoiwvios adamianebSi. B viruss antigenuri
cvalebadoba naklebad axasiaTebs, mas ar aqvs cxoveluri rezervuari. bavSvebisaTvis es
daavadeba gansakuTrebiT saSiSia, vinaidan maTi imuniteti am dros gansazRvrulia
mxolod dedisagan miRebuli pasiuri imunoglobulinebiT. isini infeqcias sakmaod
kargad avrceleben. virusis gadacema janmrTel adamianebze xdeba haer-wveTovani gziT.
avadmyofis sasunTqi gzebis lorwovanebidan gamoyofili sekreti (laparakis, xvelebis,
cxvirceminebis dros) garemoSi ramodenime wuTis ganmavlobaSi imyofeba aerozolis
saxiT. amasTan dakavSirebiT janmrTelebis dainficirebisaTvis saWiroa SedarebiT axlo
kontaqti. agreTve SesaZloa, virusis gadacema sawovaris, saTamaSoebis, WurWlis da
sxva sagnebis meSveobiT. yvelaze ufro didi raodenobiT virusi imyofeba bronqul
sekretSi. infeqciis gadacemis saSiSroeba iwyeba inkubaciuri periodis damTavrebidan
da grZeldeba cxelebis mTel periodSi (praqtikulad, daavadebis pirveli 5-7 dRe),
virusi persistirebs organizmSi 40-45 dRis ganmavlobaSi, rodesac avadmyofs aReniSneba
garTuleba pnevmoniis saxiT, magram qronikuli mtarebloba naklebad SesaZlebelia
(ufro xSirad nazalur sekretSi virusi 7 dRis Semdeg aRar aris).
gri piT daavadeba TiTqmis sayovelTaoa yvela asakisaTvis, Tumca pirveli Tveebis
Cvil bavSvebs daavadeba ufro iSviaTad emarTebaT, rac aixsneba dedisagan miRebuli
imunitetisa da cxviris lorwoSi sekretuli IgA-s arsebobiT.
gri pis pandemiebi ganpirobebulia A virusis antigenuri struqturis sruli SecvliT
da adgili aqvs yovel 10-40 weliwadSi erTxel. antigenuri struqturis nawilobrivi
Secvlisas epidemiebi yovel 2-3 weliwadSi aRiniSneba. A virusis axali qveti pi
iZleva daavadebis yvelaze maRal maCvenebels _ TiTqmis 50%-s, gansakuTrebiT, 5-14
wlamde asakis bavSvebSi. amave ti pis virusis antigenis dreifuli Secvla iwvevs
epidemias da avaddeba bavSvTa 15%.
B ti pis virusis dros epidemiebi aRiniSneba 4-7 weliwadSi erTxel.
C virusis epidemiuri roli jer kidev gaurkveveli rCeba, Tumca serologiuri
gamokvlevebiT dadgenilia, rom 10 wlamde bavSvTa umetesoba inficirebulia am virusiT.
did qalaqebSi yovel wels aRiniSneba am virusiT gamowveuli sporaduli SemTxvevebi.
sezonuroba. zomieri klimatis mqone qveynebSi daavadeba viTardeba zamTarsa da
gazafxulze. tropikul qveynebSi upiratesad vrceldeba sezonuri wvimebis dros.
paTmorfologia da paTogenezi. virusis SeWra da misi reproduqcia xdeba
zemo sasunTqi gzebis epiTeliumSi, sadac warmoiSoba Sidaplazmuri CanarTebi
ribonukleinmJavis saxiT. inficirebuli ujredebi, umetes SemTxvevaSi, ganicdian
degeneracias, danekrozebasa da desqvamacias. amasTanave warmoiSoba autoantigenebi,
romlebic virusul antigenebTan erTad T _ limfocitebis meSveobiT iZlevian
52
kerZo nawili. gr
grii pi
citotoqsikur reaqciebs, rac mimarTulia anTebiTi procesis organizaciis, dazianebuli

ujredebisa da virusTa antigenebis eliminaciisaken. morfologiurad yvelaferi es
gamoixateba adgilobrivi procesis ganviTarebaSi, xolo klinikurad _ zemo sasunTqi
gzebis katarul movlenebSi. daavadebis pirvelsave dRes aRiniSneba traqeis epiTeliumis
desqvamacia, lorwovani garsebis infiltracia limfocitebiT, histiocitebiT,
eozinofilebiT, plazmuri ujredebiTa da ufro naklebad, polimorfulbirTviani
leikocitebiT.
daavadebidan me-3, me-5 dRes xdeba darCenili cilindruli epiTeliumis proliferacia
da metaplazia 8-Sriani aradiferencirebuli epiTeliumis saxiT. es cvlilebebi maqsimums
aRwevs daavadebis me- 9-15 dRes. wamwamovani epiTeliumis struqturisa da bronquli
sekreciis aRdgena xdeba daavadebidan 15 dReSi. Tu daerTo meoradi infeqcia, maSin
adgili aqvs anTebadi procesebis gaRrmavebas _ bazaluri da ujreduli membranebis
uxv infiltracias, rac iwvevs wamwamovani epiTeliumis reparaciis Seferxebas.
pirveladi anTebiTi kerebidan qsovilebis daSlis Sedegad warmoSobili produqtebi
da virusebi xvdebian sisxlSi _ viTardeba viremia, rac ganapirobebs intoqsikaciis
saerTo movlenebs. intoqsikacia, pirvel rigSi mimarTulia centraluri da vegetatiuri
nervuli sistemis dazianebisaken, rac gamoixateba kapilarebisa da prekapilarebis
pareziT; sisxlZarRvebis ganvladobis gaZlierebis Sedegad SeiZleba ganviTardes SeSupeba
da gajirjveba, distrofiuli cvlilebebi da sxva. xdeba kapilaruli sisxlCaqcevebi
serozul da lorwovan garsebSi, Tirkmelzeda jirkvlebSi, Trombozuli procesebi
venur sistemaSi, distrofiuli cvlilebebi parenqimul organoebSi da sxva.
mikrocirkulaciis darRvevis Sedegad viTardeba hemodinamikis darRveva sxvadasxva
organoebsa da sistemebSi, rac wamyvania paTogenezur rgolSi mZime formebis dros.
mZime cirkulaciuri dazianeba qmnis encefalopaTiis suraTs, xolo filtvebSi _
segmentur an gavrcelebul hemoragiul SeSupebas. nawlavTa jorjlis SeSupeba
ganapirobebs abdominur sindroms da ase Semdeg.
gri pozuli pnevmoniebi bavSvebSi xSirad atareben desqvamaciur xasiaTs. eqsudatSi
araiSviaTad naxuloben Camofcqvnil alveolur epiTeliums. adreuli dazianeba filtvebSi,
albaT, sufTa virusuli bunebisaa, xolo SemdgomSi anTebiTi procesis ganviTareba
meoradi baqteriuli floriT xdeba. yalibdeba virusul-baqteriuli an baqteriuli
xasiaTis pnevmoniebi.
kl inika. inkubaciuri periodi A gri pis dros aris 1-2 dRe, zogjer ki ramodenime
klinika.
saaTi; B gri pis dros _ 3-4 dRe. gri pi, gamowveuli A da B virusebis mier, princi pSi,
mimdinareobs erTgvarovnad. klinikuri mimdinareobis Taviseburebani arsebiTad
ganisazRvreba asakiT. mozardebsa da mozrdilebSi daavadeba mimdinareobs klasikuri
formiT, xolo mcire asakSi klinika sakmaod varirebs.
0
daavadeba iwyeba mwvaved, uecrad, temperaturis momatebiT 39-40 C, SemcivnebiT,
xaxis hiperemiiT, TavbrusxveviT, sisustiT, kunTebis tkiviliT, damtvreulobis SegrZnebiT.
aRiniSneba ukudamokidebuleba sxeulis temperaturasa da asaks Soris da piriqiT,
saerTo darRvevebisas simZime korelirebs asakTan. yelis tkivili dakavSirebulia
katarul faringitTan; erTdoulad viTardeba cremldena, sinaTlis SiSi, wvisa da
tkivilis SegrZneba Tvalis kaklis moZraobisas. epidemiuri afeTqebisas bavSvebisa da
mozrdilebis 1/3-s aReniSneba diarea. klinika mZafrdeba 2 dReSi, temperatura aRwevs
maqsimums da grZeldeba 2-5 dRis ganmavlobaSi.
garTulebis gareSe mimdinareobisas, iSviaTad, ufro met xans avadmyofebi uCivian
Tavis tkivils, gansakuTrebiT safeTqlis areSi, Sublis, Tvalis orbitis, Tvalis kaklis,
kisris midamoebSi. zogjer kisris moZraoba SezRudulia, rac avadmyofs iZulebuls
xdis saWiroebisas mobrundes mTeli sxeulis korpusiT, mkveTrad ecema mada, irRveva
53
kerZo nawili. gr
grii pi
Zili, xSirad uviTardebaT Rebineba, ufro metad saWmlis an wamlis miRebasTan dakavSirebiT.
mZime SemTxvevebSi adgili aqvs halucinaciebs, kisris kunTebis rigidobas, sustad
gamoxatul kernigis simptoms, cnobierebis dakargvas, krunCxvebs.
daavadebis 20-30%-Si zemo sasunTqi gzebis katari pirvel dReebSi SeiZleba
mkveTrad ar iyos gamoxatuli, sustad gamoxatuli ki nivelirdeba saerTo intoqsikaciis
movlenebis fonze. me-2-3 dRes yvelas aqvs kataruli movlenebi, romelic gamovlindeba
cxviriT sunTqvis gaZnelebiT, surdoTi, yelis simSraliT da fxaWnis SegrZnebiT.
viTardeba mSrali xvela, zogjer xmis CaxleCa, qoSini, gaZlierebuli oflianoba.
temperaturis xangrZlivoba gaurTulebeli gri pis dros 2-3, iSviaTad 5 dRe, xolo
temperaturis axali momateba ufro garTulebasTanaa dakavSirebuli. me-3, me-4 dRisaTvis
saerTo intoqsikaciuri movlenebi cxreba da pirvel adgilze rCeba movlenebi sasunTqi
organoebis mxriv: mSrali xvela rCeba 4-10 dRe, zogjer 2 kviramde. saerTo intoqsikaciis
movlenebi SedarebiT ufro xSirad aRiniSneba A gripis dros, maSin, rodesac cvlilebebi
cxvir-xaxis mxriv ufro damaxasiaTebelia B gri pisaTvis.
mcirewlovan bavSvebSi gri pi mimdinareobs ati purad da faqtiurad, Zneli gasarCevia
paragri pis, adenovirusuli, rinovirusuli da sincitiuri ccxelebisagan. am asakis
bavSvebs xSirad uviTardebaT laringotraqeiti, bronqiti, bronqioliti, pnevmoniebi, A
virusiT gamowveuli laringotraqeiti mimdinareobs ufro mZimed _ uxvi, sqeli da
webovani naxveliT, rasac araiSviaTad erTvis krupi da zogjer saWiro xdeba intubaciis
an traqeotomiis gakeTeba. mcirewlovan bavSvebSi daavadeba iwyeba mwvaved, saerTo
intoqsikaciis movlenebiT, swrafad viTardeba maRali temperatura, umravles SemTxvevaSi
aRiniSneba krunCxvebi da Rebineba; diarea gvxvdeba 15% SemTxvevaSi, Sua yuris anTeba
25%-Si. xSirad gvxvdeba eriTemuli, laqovani an laqovan-papuluri gamonayari, romelic
male qreba.
B gri pi xSirad mimdinareobs miozitiT (umetesad, kanWis tyupi kunTis), romelic
araiSviaTad viTardeba daavadebidan 1 kviris Semdeg, roca aRiniSneba mdgomareobis
gaumjobeseba.
C virusiT gamowveuli daavadeba bavSvebSi iSviaTad gvxvdeba. igi xasiaTdeba
temperaturis momatebiT, cxviridan gaxangrZlivebuli gamonadeniT, surdoTi da xveliT.
klasifikacia. simZimis mixedviT arCeven msubuq, saSualo da mZime formebs (toqsikuri
da hi pertoqsikuri). mZime
formebis dros aRiniSneba
mkveTri saerTo intoqsikacia,
hi perTermia, nevrologiuri
simptomebi, Trombohemoragiuli
sindromi, gulsisxlZarRvTa,
sunTqvisa da sxva sistemebis
mwvave ukmarisoba.
hi pertoqsikuri gri pis dros
damaxasiaTebelia encefaluri,
hemoragiuli, hi perTermiuli
sindromebi, daavadebis
elviseburi mimdinareoba da
sikvdiliT damTavreba. saSualo
simZimisas aRiniSneba
intoqsikaciuri movlenebis yvela
gr
grii pi. hemo ragiuli fo
hemoragiuli rma (sisxliani Rebineba _ Cans
forma niSani, mxolod maTi simZime
TeTreulze), tvinis SeSupeba, filtvebis mZime anTeba. naklebadaa gamoxatuli.
(sakuTari masala)
54
kerZo nawili. gr
grii pi
0
temperatura 38-39,5 C, SesaZloa krupisa da abdominuri sindromis ganviTareba.
msubuqi formis dros temperatura subfebriluria an umniSvnelodaa momatebuli,
intoqsikaciis niSnebi sustadaa gamoxatuli. amave kategorias miekuTvneba waSlili
formebi, romelebic viTardeba normaluri temperaturis fonze, zemo sasunTqi gzebis
katariT _ surdo, mcire gamonadeni cxviridan, wamoxveleba.
gri pi SeiZleba mimdinareobdes inaparantul formebSi klinikis gareSe, rac dgindeba
avadmyofTan kontaqtirebulebSi gri pis virusis sawinaaRmdego antisxeulebis titris
gazrdiT.
gr
grii pis mimdinar eoba axalSobilebsa da 1 wlamde asakis bavSvebSi. xSirad
mimdinareoba
daavadeba iwyeba TandaTanobiT, temperaturis umniSvnelo matebiT. intoqsikaciis niSnebi
sustadaa gamoxatuli. damaxasiaTebelia kanis sifermkrTale, axalSobilebSi _ sakvebze
uaris Tqma. SeiZleba iyos sustad gamoxatuli xvela, cxviris gagudva; xSirad adgili
aqvs ganmeorebiT Rebinebas, krupis sindromi iSviaTia, filtvebis segmentebis dazianeba
ar aris damaxasiaTebeli. miuxedavad dasawyisSi aseTi susti intoqsikaciisa, 1 wlamde
asakis bavSvebSi daavadeba Semdgom mimdinareobs mZimed, rac ganpirobebulia baqteriuli
infeqciis darTviTa da Cirqovani garTulebebis ganviTarebiT (otiti, bronqiti, pnevmonia
da sxva). mozrdil bavSvebTan SedarebiT am asakis bavSvebSi letaloba 3-jer ufro
metia.
gr
grii pis mimdinar eoba 1-dan 3 wlamde asakis bavSvebSi. am asakSi gri pi xSirad
mimdinareoba
mimdinareobs gansakuTrebiT mZimed gamoxatuli intoqsikaciiT, cns-s dazianebiT da
meningoencefaluri sindromiT; kataruli movlenebi ki sustadaa gamoxatuli. SeiZleba
gvqondes asTmuri da krupis sindromi, filtvebis segmenturi dazianeba. garTulebebia:
otiti, sinusiti, kerovani pnevmoniebi.
grii pi. neirotoqsikozi. n. facialis - is par

gr ezi.
parezi. mwvave respiraciuli virusuli
marcxniv, `Cognis~ simptomi, Tvalis napralis infeqcia. neirotoqsikozi. (sakuTari
parezi. (sakuTari masala) masala)
laboratoriuli diagnostika. virusologiuri diagnozi SeiZleba dadasturdes

72 sT-is ganmavlobaSi standartuli meTodis gamoyenebiT. eqspres-diagnostika efuZneba
antigenis aRmoCenas zemo sasunTqi gzebis epiTeliumSi imunofluorescenciis meTodiT,
niSandebuli imunuri antisxeulebis (izocianidis fluorescinis) gamoyenebiT. specifikur
55
kerZo nawili. gr
grii pi
antigen-antisxeulis kompleqss citoplazmaSi naTeli gamosxiveba axasiaTebs. virusis

kultivireba xdeba qaTmis kvercxze. virusis arseboba kulturaSi dasturdeba
hemadsorbciiT, rac ganpirobebulia hemaglutininis unariT, SeboWos eriTrocitebi.
swrafi diagnostika emyareba A virusis antigenis aRmoCenas enzimniSandebuli
imunosorbentuli analiziT.
virusis identifikacia warmoebs hemaglutinaciis reaqciis SeCerebis an komplementis
SeboWvis reaqciis saSualebiT. virusis gamosayofad iyeneben adamianis embrionis ujredovan
kulturasac (Tirkmlebi, filtvebi) da maimunis Tirkmlebs. serologiuri da
virusologiuri meTodebi gamoiyeneba ufro retrospeqtuli diagnozisaTvis.
serologiuri diagnostika emyareba dinamikaSi antisxeulebis titris 4-jer momatebas
SratSi. I gamokvleva xdeba daavadebidan ara ugvianes 6 dRisa, xolo II _ ara uadres
12-14 dRisa.
diagnostikisaTvis agreTve iyeneben radioimunologiur analizs.
difer enciul
diferenciul
enciuli i diagnozi. sporaduli SemTxvevebis dros gri pis etiologiuri
diagnostika gaZnelebuli, xolo epidemiuri afeTqebebisas _ advilia. gripis diferenciacia
gvixdeba mwvave respiraciul infeqciebTan, rac, zog SemTxvevaSi, rTul saqmes warmoadgens.
gri pisaTvis damaxasiaTebelia daavadebis mwvaved dawyeba, zomieri kataruli movlenebi,
pirvel dResve intoqsikaciis simptomatika, temperaturis kritikuli davardna, daavadebis
SedarebiT xanmokle mimdinareoba. adenovirusuli infeqciisas daavadeba iwyeba TandaTan
_ faringitiT, koniunqtivitiT, kisris, ybisqveSa limfuri kvanZebis da elenTis gadidebiT.
respiraciul-sincitiuri infeqciisas xSirad procesSi erTveba sasunTqi gzebis qveda
nawilebi _ bronqebi, bronqiolebi, xolo paragri pis dros laringits ufro xSirad
aqvs adgili, araiSviaTad krupis sindromis ganviTarebiT, gamoxatuli intoqsikaciis
gareSe. zogjer saWiroa, mxedvelobaSi viqonioT iseTi daavadebebi, rogoricaa wiTela,
muclis tifi, meningokokuri infeqcia prodromul periodSi. wiTelasaTvis
damaxasiaTebelia koniunqtiviti, piris Rrus lorwovanze belski-filatov-koplikis
laqebi, skleriti, mniSvneloba eniWeba epidanamnezs. muclis tifis dros daavadeba
TandaTanobiT iwyeba, ar aRiniSneba zemo sasunTqi gzebis katari, damaxasiaTebelia
mSrali kani, RviZlisa da elenTis gadideba. meningokokuri infeqciis dros daavadeba
gri pisagan gansxvavebiT umwvaves xasiaTs Rebulobs, mimdinareobs zemo sasunTqi gzebis
kataris gareSe. meningitisas pirvelsave dRes mkveTradaa gamoxatuli meningealuri
movlenebi, xolo sefsisuri formis dros pirvelsave 6-12-24 saaTSi damaxasiaTebelia
e.w. varskvlaviseburi gamonayari an sisxlCaqcevebi, periferiul sisxlSi maRali
leikocitozia.
mkurnaloba. avadmyofis hospitalizacia saWiroa, Tu gri pi mimdinareobs mZimed
- toqsikuri da hi pertoqsikuri an garTulebuli formiT; sxva SemTxvevebSi avadmyofebi
imyofebian saxlis pirobebSi. saavadmyofoSi avadmyofebi Tavsdebian boqsebSi an
naxevradboqsebSi, sadac xdeba oTaxis xSiri ganiaveba. niSnaven kaloriul sakvebs: rZe
da rZis produqtebi, bostneuli, xilis wvenebi, uxvi siTxe, Cai, tutovani mineraluri
wylebi (borjomi rZiT). avadmyofi unda Rebulobdes askorbinis mJavasa da B jgufis
vitaminebs. hi perTermiis, Tavisa da kunTebis tkivilis mosaxsnelad saWiroa siTxis
uxvad miReba, maRali temperaturis dros _ paracetamolis daniSvna. unda gvaxsovdes
gverdiTi movlenebis SesaZlo ganviTareba acetilsalicilis mJavas miRebisas, rasac
SeiZleba mohyves reis sindromi (mwvave encefalopaTia, RviZlis cximovani distrofia).
yoveli preparati iniSneba asakis gaTvaliswinebiT Sesabamis dozebSi. agznebisa da
krunCxviTi sindromis dros iniSneba sedaciuri saSualebebi (diazepami). baqteriuli
floriT garTulebisas iniSneba antibiotiki.
gri pis sawinaaRmdego sinTezur preparats _ amantadinis hidroqlorids aqvs
56
kerZo nawili. gr
grii pi
garkveuli unari daTrgunos A virusis aqtivacia da efeqturia daavadebis pirvel

dReebSi (48 saaTSi). igi ar aris efeqturi B virusis SemTxvevaSi.
ribavirini moqmedebs A da B virusze in vitro. misi daniSvna aerozolis saxiT
TiTqos amcirebs daavadebis xangrZlivobas. magram misi gamoyenebis efeqti gri pis
dros mainc saeWvoa. rimantadini iniSneba 1 wlis zemoT asakSi, daavadebis pirvel
dReebSi.
amantadinisa da rimantadinis rekomendebuli dozebi
(aSS-is pediatriis akademiis rekomendaciis mixedviT)
rimantadini asaki
≥ 10 weli
1 - 9 weli
amantadini masa < 40 kg ≥ 40 kg
5 mg/kg/ dRe-RameSi,
5 mg/kg/dRe-RameSi, 200 mg/dRe-RameSi
mkurnaloba maqsimum 50 mg/dReSi
1 an 2 miRebaze 1 an 2 miRebaze
1 an 2 miRebaze
profilaqtika igive dozebia, rac mkurnalobisTvis.
SeniSvna: 1. amantadini da rimantadini ar gamoiyeneba 1 wlamde asakis bavSvebisaTvis.

2. rimantadini gamoiyeneba mxolod profilaqtikisaTvis.
3. saWiroa mkurnalobis periodSi Tirkmlis funqciis kontroli.
fizioTerapiuli procedu-
rebi naCvenebia otitis, pnevmoniis
dros (eleqtroforezi kalci-
umiT, ultramokle sxivebiT da
sxva).
krupiT garTulebisas
avadmyofi bavSvi Tavsdeba
orTqliani Jangbadis karavSi an
oTaxSi, sadac mudmivad aris
teniani (100%) mikroklimati;
haeri Seicavs 40-45% Jangbads.
am procedurebisas bavSvebi
wynardebian, Zili xdeba ufro
mSvidi, exsnebaT laringospazmi,
SeSupeba, Jangbadis naklovaneba;
klebulobs metaboluri
xorxisa da traqeis sqematuri mdgomareoba normalur acidozi da umjobesdeba sisxlis
mdgomareobaSi da virusuli krupis dros (Emmanuel gazovani Semadgenloba.
B. Walter, Paul A. Shurn). stacionarSi keTdeba epinefrinis
Epiglottis - xorxsarqveli
inhalaciebi saWiroebis
False cords - cru iogebi
SemTxvevaSi keTdeba intubacia
True cords - WeSmariti iogebi
subglottic tissue - subglotikuri qsovili an traqeostomia.
Trachea - traqea
Normal - normaluri mdgomareoba
Croup - krupis dros
57
kerZo nawili. gr
grii pi
inhalacia adrenaliniT (epinefriniT)

virusuli krupis dros
avadmyofis sxeulis 2, 25% epinefrinis fiz . xsnaris

saerTo raodenoba
masa (kg) raodenoba ml-Si raodenoba ml-Si
5 0.25 2.75 3.0
10 0.50 2.50 3.0
15 0.75 2.25 3.0
20 1.0 2.00 3.0
25 1.25 1.75 3.0
>25 1.50 1.50 3.0
SeniSvna: 1. proceduris (inhalacia) xangrZlivoba 15 wuTia.
inhalacia saWiroebisas SeiZleba Catardes yovel 30 wuTSi. Tu krupis sindromi

ar ixsneba, SeiZleba mkurnalobaSi kortikosteroidebis damateba (deqsametazoni - 1
mg/kg masaze, 24sT-Si 1-jer, an prednizoloni saTanado doziT). magram Tu epinefrinis
fonze krupis movlenebi ar mcirdeba an progresirebs, saWiroa avadmyofis mkurnalobis
marTva epiglotitis diagnoziT: antibiotikebis daniSvna 7 dRis kursiT (mesame generaciis
cefalosporinebi, ampicilini sulbaqtamiT), narkozis fonze laringoskopiis (am dros
Cans hi peremiuli SeSupebuli xorxsarqveli) da Tu saWiroa, intubaciis Catareba.
rentgenologiuri monacemebi zogjer gvexmareba epiglotitis diagnozis dazustebaSi:
am dros gverdiT proeqciaSi Cans gadidebuli, SeSupebuli xorxsarqveli, xolo pirdapir
rentgenogramaSi xorxsarqvelis qvemoT xorxis konuseburi Seviwroeba (zemoT
Seviwroebuli da qvemoT gafarToebuli nawiliT). epiglotiti sicocxlisaTvis saSiSi
daavadebaa da mkurnalobis gareSe (antibiotikebi, intubacia-traqeotomia) letaloba
6%-s aRwevs. am dros kortikosteroidebis gamoyeneba ukunaCvenebia, vinaidan SemTxvevaTa
50%-Si aRiniSneba baqteriemia. epiglotitis gamomwvevi SeiZleba iyos: Haemophillus
influenzae b ti pis, Streptococcus pyogenes,, Staphilococcus aureus, Myco-
krupis sindromi. (subglotikuri sivrcis epiglotiti. gverdiTi rentgenograma.

Seviwroveba, romelic Zneli gasarCevia SeSupebuli xorxsarqveli. (W.Nelson)
epiglititisagan, sadac damatebiT informaciulia
gverdiTi proeqciis rentgenogramebi) (W.Nelson)
58
gr
grii pi
kerZo nawili. paragri
paragr i pi
plasma pneumoniae da sxva, magram pirvel maTgans wamyvani adgili uWiravs Tu

bavSvi am infeqciisadmi acrili ar aris. mwvave respiraciuli infeqciebis (rinosinusitebis,
faringitebis, larimgitebis, traqeitebis, bronqitebis) SemTxvevaSi aerozolis saxiT
gamoiyeneba franguli preparati `bioparoqsi~ - lokaluri moqmedebis erTaderTi
antibiotiki da anTebis sawinaaRmdego saSualeba.
prognozi. umetes SemTxvevaSi prognozi keTilsaimedoa. bavSvebSi, romelTac anamnezSi
prognozi
aqvT datvirTuli premorbiduli foni, daavadebis garTulebisas prognozi seriozulia.
profilaqtika. didi mniSvneloba aqvs adreul diagnostikasa da avadmyofis
movlas. oTaxi xSirad unda niavdebodes da lagdebodes sveli wesiT _ sadezinfeqcio
xsnarebis gamoyenebiT, amave xsnarebiT muSavdeba avadmyofis nivTebi. momvlels unda
hqondes dolbandis 4-6 Sriani niRabi. aucilebelia xelis xSiri dabana. naxveli da
respiraciuli gzebis sekreti - infeqciis wyaroa.
epidemiis dros avadmyofi bavSvebi skolebsa da organizebul koleqtivebSi ar
miiRebian, saavadmyofoSi oTaxebis dezinfeqcia xdeba ultraiisferi sxivebiT.
sust bavSvebSi SeiZleba gamoyenebul iqnas gri pis sawinaaRmdego imunoglobulini
0,1-0,2ml/kg-ze kunTebSi.
Tumca gri pis sawinaaRmdego Tanamedrove inaqtivirebuli polivalenturi split-
vaqcina sakmaod efeqturia, vaqcinacia rekomendebulia mxolod mosalodneli Stamebis
sawinaaRmdegod riskis jgufis pirebSi, Semdeg SemTxvevebSi:
1. asTma, filtvis qronikuli daavadebebi;
2. gulis qronikuli daavadebebi;
3. imunosupresoruli Terapia;
4. aiv-infeqcia;
5. sisxlis daavadebebi;
6. aspirinis xangrZlivi miReba (reis sindromis asacileblad, sadac virusi
maprovocirebel faqtorad iTvleba);
7. Saqriani diabeti;
8. Tirkmlis qronikuli daavadebebi;
9. qronikuli metaboluri darRvevebi (organizmis cvlis moSla);
10. mcire asaki;
11. orsuloba (Tu fexmZimes aqvs saSiSi Tanmxlebi daavadebebi) da vaqcinacia
tardeba plit-vaqciniT;
12. xanSi Sesuloba.
vaqcina SehyavT kanqveS, kanSi an kunTebSi (damokidebulia vaqcinaze). rac Seexeba
cocxal vaqcinas Tumca imsaxurebs dadebiT Sefasebas, magram saWiroa misi ufro
xangrZlivi Seswavla. igi SehyavT intranazalurad an per os.
unda aRiniSnos, rom efeqturi standartuli gri pis vaqcinis miReba Znelia, vinaidan
virusi eqvemdebareba xSir antigenur cvlilebebs. imuniteti xanmoklea, araumetes 1
wlisa. 6 Tvemde asakSi vaqcinis efeqturoba saeWvoa.
paragr
paragrii pi
(PARAGRIPPUS, PARAINFLUENZA)
paragri pis virusi bavSvTa da mozrdilTa respiraciuli daavadebis gamomwvevi

xSiri mizezia, magram gansakuTrebul yuradRebas pediatrebis mxridan imsaxurebs
krupis sindromis araiSviaTi ganviTarebis gamo.
59
kerZo nawili. paragr
paragrii pi
virusi Tavisi TvisebebiT axlos dgas gri pis virusTan da miekuTvneba miqsovirusebis
ojaxs (Myxovirusis parainfluenzae) igi pirvelad gamoyofili iyo iaponiaSi 1952
w. Kuroya, Insida, Sheatory--is mier pnevmoniiT gardacvlili axalSobili bavSvis
filtvebidan. 1956-58 w.w. R. Chanock--ma gri pismagvari infeqciiT daavadebuli bavSvebis
cxvir-xaxis CamonarecxiT inficirebuli maimunis Tirkmlis ujreduli kulturidan
gamohyo virusi, romelmac miiRo paragri pis virusis saxelwodeba. cnobilia virusis
4 serologiuri tipi: 1, 2, 3, 4. virusis nawilakebs aqvT ovaluri forma da zomiT 50-
250 nm-ia. SeswevT unari moaxdinon adamianis, zRvis goWis, qaTmisa da zogierTi
cxovelis eriTrocitebis aglutinacia. garemoSi male iRupebian.
epidemiologia. inficireba xdeba avadmyofisagan haer-wveTovani gziT. virusis
gansakuTrebuli mimRebloba damaxasiaTebelia adreuli asakis bavSvebisaTvis. infeqcias
axasiaTebs sporaduli SemTxvevebi da afeTqebebi organizebul bavSvTa koleqtivebSi.
mwvave respiraciuli virusuli daavadebebis struqturaSi paragri pi Seadgens 10-
30%-s. daavadeba gvxvdeba mTeli wlis ganmavlobaSi sporaduli SemTxvevebis, xolo
zamTarSi_afeTqebebis saxiT. avadmyofi saSiSia daavadebis me-7 me-10 dRemde. 1, 2, 3,
ti pebiT gamowveuli daavadeba xasiaTdeba gamoxatuli klinikuri simptomatologiiT,
xolo me-4 ti piT gamowveuli mimdinareobs ufro xSirad usimptomod.
1 ti piT gamowveuli epidemia, meordeba yovel 2 weliwadSi; me-2 ti piT ufro
sporaduli SemTxvevebi mimdinareobs; me-3 ti pi epidemiebs ar iwvevs da daavadeba
gvxvdeba erTeuli SemTxvevebis saxiT. 1 ti pis paragri pis virusi iwvevs krupis mZime
formebs da biWebSi ufro xSirad gvxvdeba, vidre gogonebSi. 3 ti pis virusi xasiaTdeba
qvemo respiraciuli traqtis upiratesi dazianebiT.
paTmo rfo
paTmorfo logia. tipuria laringotraqeobronqitis gamoxatuli anTebiTi procesi.
logia
rfologia
pnevmoniiT mkvdar bavSvebSi gamoxatulia bronqebis, bronqiolebis limfocituri
infiltracia, bronqebis epiTeliumi danekrozebulia, alveolebis kedlebi da filtvebis
intersticia leikocitebiTaa infiltrirebuli.
virusis SeWra organizmSi xdeba zemo sasunTqi gzebis lorwovani garsebidan,
umTavresad ziandeba cxvirisa da xorxis epiTeliumi, viTardeba maTi distrofia da
nekrozi, romelic albaT nawilobriv imunologiuri destruqciiTac unda iyos
ganpirobebuli. adgilobrivad viTardeba anTebiTi procesi, lorwovanis eqsudacia,
SeSupeba, es cvlilebebi gansakuTrebiT gamoxatulia xorxSi, riTac ganpirobebulia
krupis sindromis ganviTareba.
pirveladi anTebiTi kerebidan paragri pis virusi vrceldeba sisxlSi da iwvevs
virusemias, saerTo intoqsikaciur movlenebs: temperaturis momatebas, Tavis tkivils,
saerTo sisustes, xSiria meoradi infeqciis darTva.
imuniteti xanmoklea da ecema rekonvalescenciis periodSi, rac ver aferxebs
ganmeorebiT daavadebas. amiT aixsneba 1 wlis ganmavlobaSi daavadebis ramodenimejer
ganmeoreba. xanmokle imunitetis periodSi gamomuSavdeba A, M, G imunoglobulinebi,
Tumca seriozuli T-ujreduli imunodeficitebis dros bavSvebs uWirT virusis
eliminacia (gandevna), rac paTogenezSi ujreduli imunitetis mniSvnelovan rolze
laparakobs.
klinika. inkubaciuri periodi ganisazRvreba 2-7, saSualod 3-4 dRiT. umravles
klinika
SemTxvevaSi daavadeba iwyeba mwvaved, temperaturis momatebiT, romelic 2-3 dReSi
aRwevs maqsimums _ 400 C, Tumca maRali sicxe daavadebas ar axasiaTebs. miuxedavad
amisa, intoqsikaciis saerTo movlenebi gamoxatulia zomierad an ar aris. temperaturuli
reaqciis xangrZlivoba SeiZleba iyos ufro didi (7 dRemde), vidre gri pis dros.
paragri pis diagnoziT stacionarSi Semosuli bavSvebis 50%-s aqvs laringotraqeiti,
xolo 15%-s _ bronqiti, bronqioliti da pnevmonia. 1 ti pis virusi ufro xSirad
60
kerZo nawili. paragr
paragrii pi
iwvevs laringotraqeits, xolo me-3 ti pi _ upiratesad bronqitebs, bronqiolitebs da

pnevmoniebs.
bavSvebi SeiZleba uCiodnen saerTo sisustes, madis daqveiTebas, Zilis darRvevas.
iSviaTad aRiniSneba Tavis tkivili da Rebineba. pirveladi daavadebis dros, daavadebis
dasawyisSi adgili aqvs temperaturis momatebas SemTxvevaTa 20%-Si, mcirewlovan
bavSvebSi damaxasiaTebelia ufro maRali temperatura. daavadebis pirvel dReebSi
bavSvebs aqvT uxeSi, mSrali xvela, yelis tkivili, surdo, cxviridan gamonadeni, romelic
Tavidan lorwos Seicavs, xolo Semdeg lorwovan-Cirqovania. rinoskopiiT dgindeba
lorwovanis hi peremia da SeSupeba. yeli zomierad hi peremiulia. rbili sasa, sasis
rkalebi, saylapavis ukana kedeli mkveTrad hi peremiulia. araiSviaTad paragri pis
oridan xuT wlamde asakis bavSvebSi pirveli gamovlineba SeiZleba iyos krupis
sindromi. Seteva, ZiriTadad, viTardeba RamiT, uecrad da iwyeba uxeSi, myefavi xveliT;
mas erTvis xmis CaxleCa, xmauriani, stridoruli sunTqvas. stenozi, umTavresad, I
xarisxisaa da iSviaTad aRwevs II, III xarisxs. paragripuli krupisaTvis, umetes SemTxvevaSi
damaxasiaTebelia saerTo movlenebis ukuganviTarebisas krupis sindromis swrafad
gaqroba.
klasifikacia. arCeven daavadebis msubuq, saSualo da mZime formebs. msubuqi
klasifikacia
formis dros intoqsikaciis movlenebi TiTqmis ar gvxvdeba. temperatura normaluria
an subfebriluri; gamoxatulia surdo. saSualo simZimis dros temperatura aRwevs
38-390 C. adgili aqvs zomier intoqsikacias. mZime formebi paragri pis dros iSviaTia.
periferiul sisxlSi daavadebis dasawyisSi gvaqvs zomieri leikocitozi, Semdgom
ki leikopenia da eds-is umniSvnelo momateba. krupis sindromi umetes SemTxvevebSi
vlindeba bavSvis datvirTvisas: moZraobis, sicilis, tirilis, gaRizianebis dros da
stridoruli sunTqva mkafiodaa gamoxatuli. krupi `mSvid mdgomareobaSi~
sicocxlisaTvis saSiS daavadebas warmoadgens. am dros stridoruli sunTqva gamoxatulia
mudmivad da saTanado mkurnalobis gareSe SeiZleba sasunTqi gzebis obstruqcia
ganviTardes.
garTulebebi ganpirobebulia meoradi infeqciis darTviT. ufro xSirad viTardeba
angina, sinusiti, otiti, pnevmonia; rogorc wesi, es movlenebi viTardeba adreuli asakis
bavSvebSi. krupis garTuleba ganpirobebulia meoradi infeqciiT da viTardeba daavadebis
dawyebidan me-3, me-5 dRes. igi xasiaTdeba mZime, gaxangrZlivebuli, periodulad
gaZlierebuli da Sesustebuli stenoziT. am dros aucilebelia gamoiricxos epiglotiti,
difTeria.
diagnozi. daavadebaze eWvis mitana SeiZleba im SemTxvevaSi, roca gamoxatulia
diagnozi
kataruli movlenebi krupis sindromiT. 1,2 seroti piT gamowveul daavadebaze SeiZleba
fiqri, Tu adgili aqvs laringotraqeitis epidemias.
eqspres-diagnostika tardeba imunofluorescenciis meTodiT - niSandebuli
SratebiT, romlebic Seicaven yvela ti pis antisxeulebs da aseve enzimimunologiuri
analiziT. retrospeqtulad diagnozis dasma SeiZleba serologiuri meTodebis
saSualebiT - komplementis SeboWvis reaqcia, hemaglutinaciis reaqcia, antisxeulebis
neitralizaciis reaqcia.
diferenciuli diagnozi. diferenciuli diagnozis gatarebisas mxedvelobaSi
unda viqonioT gripi, RSV-infeqcia, adenovirusuli infeqcia; krupis sindromis gamovlineba
da zemo sasunTqi gzebis katari saSualebas gvaZlevs eWvi mivitanoT paragri pze,
magram diagnostika mainc eyrdnoba laboratoriul kvlevas, radgan msgavsi klinika
SeiZleba Segvxvdes gri pisa da sxva mwvave respiraciuli virusuli infeqciis dros.
diferenciuli diagnostikisas unda gamovricxoT mwvave epiglotiti, uveiti (naqis
SeSupeba), angionevrozuli SeSupeba (qvinkes sindromi), ucxo sxeulis aspiracia.
61
paragr
paragrii pi
kerZo nawili. adenovirusuli infeqcia
krupis xSir gamomwvev agentebad epiglotitis dros iTvleba H. influenzae b

ti pis, gri pis B virusi, naklebad Staphilococcus aureus da Streptococcus
pneumoniae. Cveulebriv, es daavadeba gvxvdeba 2-7 wlamde bavSvebSi. epiglotiti
qmnis krupis an xaxis ukana abscesis suraTs. rigi klinikuri niSnebi, rogoricaa
uecari dawyeba, nerwyvis dena, sunTqvis ukmarisoba, afonia, maRali temperatura da
intoqsikacia mowmobs epiglotitze. kisris gverdiT poziciaSi rentgenogramaze Cans
gadidebuli xorxsarqveli laringologiuri gamokvleva tardeba samani pulacioSi
narkozis qveS (ix. kupis sindromis diagnostika da mkurnaloba `gri pSi~).
mkurnaloba simptomuria. krupis sindromis dros warmatebiT gamoiyeneba epinefrinis
ihalacia. (ix. `gri pSi~) garTulebis dros niSnaven antibiotikebs. pnevmoniebi ufro
xSirad gamowveulia H. influenzae-Ti, pnevmokokebiT, stafilokokebiT, Cirqmbadi
streptokokebiT, amitom garTulebis dros antibiotikebis gamoyeneba efeqturia. mZime
krupis dros damatebiT iniSneba deqsametazoni 1-2 mg/kg 1-jer 24 saaTSi, an prednizoloni
saTanado doziT.
paragri pis dros perspeqtiuli aRmoCnda ribavirinis moqmedeba, romelic eniSnebaT
dispersiuli aerozolis saxiT. krupis dros aucilebelia oqsigenacia, grili orTqliT
inhalacia. saWiroebisas keTdeba intubacia.
prognozi, ZiriTadad keTilsaimedoa. laringotraqeitiT da pnevmoniiT mimdinare
prognozi
mZime formebi iwveven mwvave hi poqsias, ramac SeiZleba gamoiwvios tvinis SeSupeba.
obstruqciiT gamowveuli letaluri gamosavali ganpirobebulia gulsisxlZarRvTa
sistemis mwvave ukmarisobiT.
profilaqtika. efeqturi vaqcina Seqmnili ar aris. saerTo profilaqtikuri
profilaqtika
zomebi iseTivea, rogorc gri pis dros.
adenovirusuli infeqcia
adenovirusuli infeqcia warmoadgens mwvave respiraciul-virusul daavadebas,

romelic mimdinareobs temperaturis momatebiT, zemo sasunTqi gzebis dazianebiT,
koniunqtivitiT, periferiuli limfuri kvanZebis gadidebiT. infeqciam SeiZleba gamoiwvios
epidemiuri keratokoniunqtiviti, mwvave diarea da encefalomieliti. daavadebis damTavreba
sikvdiliT Zalze iSviaTia da ganpirobebulia virusis me-7 seroti piT
imunokomprometirebuli pirebis inficirebisas.
dadgenilia, rom zemo sasunTqi gzebis yvela mwvave daavadebidan adenovirusuli
infeqciis wili bavSvebSi Seadgens 12-21%-s.
etiologia: virusi pirvelad gamoyofili iyo 1953 w. (Rowe, Hubner)
praqtikulad janmrTeli bavSvis amokveTili nuSuridan. virusma miiRo adenoantigenis
anu adenovirusis saxelwodeba. amJamad cnobilia 90-ze meti seroti pi, magram adamianSi
paTologiur process mxolod 47-i iwvevs. ramodenime wlis win aRmoaCines enteruli
(31, 40 da 41 seroti pis) adenovirusebi, romlebic ganapirobeben bavSvebSi mZimed
mimdinare diareas 4%-Si. adenovirusebi miekuTneba dnm-Semcvel virusTa jgufs; maTi
zomaa 70-90nm. xasiaTdebian ujredSida lokalizaciiT. sxva virusebTan SedarebiT
ufro gamZlea garemo pirobebisadmi. virions aqvs 3 antigeni: A-antigeni warmoadgens
saerTo specifikur antigens yvela adamianis virusebisaTvis, B-antigeni toqsikuri
Tvisebebis matarebelia, xolo C-antigeni virusis ti puri specifikurobis maxasiaTebelia.
viruss aqvs A-dan G-mde qvegvarebi, 1-39 seroti pi A-dan E-mde qveojaxs ekuTvnis,
seroti pi 40 _ E-s, xolo 41 _ G-s qveojaxs. yvela adenovirusi garda seroti p 40
da 41-sa kargad izrdeba adamianis embrionuli Tirkmlis ujredebze. seroti pebi 1, 2
62
da 5 gvxvdeba tonzilebSi qronikuli infeqciebis saxiT.

epidemiologia: infeqciis wyaros warmoadgens avadmyofi an virusmtarebeli
adamiani. virusis aRmoCena SeiZleba yelidan aRebul nacxSi daavadebis 25 dRemde.
viruss SeuZlia, gamravldes nawlavebSi, es garemoeba ki ar gamoricxavs infeqciis
alimenturi gziT gadacemas. adenovirusis 1,2,3, da 5 ti pebi xSirad aavadeben mcire
asakis bavSvebs. me-3 ti pi xSirad iwvevs faringokoniunqtivur cxelebas. 1,3,4 da 5
ti pebi SeiZleba CaiTvalos folikuluri koniunqtivitis mizezad. araiSviaTad
adenovirusebi iwveven pnevmonias Cvil bavSvebSi. maTve miiCneven etiologiur an
maprovocirebel faqtorad yivanaxvelas msgavsi sindromis, mwvave hemoragiuli cistitis,
mezenteriuli limfadenitis, nawlavTa invaginaciis da sxva sindromTa ganviTarebaSi.
paTogenezi da paTmorfologia. virusis SeWra xdeba zemo sasunTqi gzebis,
koniunqtivisa da nawlavebis lorwovani garsebidan. virusebi pinocitozis gziT SeiWrebian
citoplazmaSi, xolo Semdeg birTvebSi, regionul limfur kvanZebSi. epiTeluri ujredis
birTvSi yalibdeba acidofiluri, xolo citoplazmaSi bazofiluri CanarTebi rozetebis
saxiT. lorwovani jirkvlebi ganicdian eozinofiluri ujredebiT infiltrirebasa da
danekrozebas. virusis gamravleba epiTeliumis ujredebsa da regionul limfur kvanZebSi
Seesabameba inkubaciur periods. paTogenezSi garkveuli roli eniWeba virusemias.
paTologiur procesSi erTveba traqea, bronqebi da filtvebi. seqciaze xSirad dgindeba
gigantujredovani, desqvamaciuri pnevmonia, kerovani da Serwymuli, polisegmenturi
pnevmoniebi.
bronqopulmonuri dazianebis procesSi virusTan erTad didi roli eniWeba meoradi
infeqciis darTvas. adgili aqvs parenqimuli organoebis dazianebas, rac SeiZleba
gamoixatos klinikurad, mag: siyviTliT mimdinare hepatiti da sxva.
klinika. inkubaciuri periodi ganisazRvreba respiraciuli infeqciisaTvis 2-14
dRiT, xolo gastroenteritebis dros ki 3-4 dRiT, saSualod 2-7 dRe. daavadeba
iwyeba mwvaved, magram sxvadasxva simptomebi SeiZleba ganviTardes ara erTbaSad, aramed
TanmimdevrobiT. temperatura 2-3 dRis ganmavlobaSi aRwevs 38-390C, iSviaTad 400C da
mets. am dros zomieradaa gamoxatuli intoqsikaciis saerTo movlenebi: sisuste, madis
dakargva, Tavis tkivili, muclis tkivili, gulis reva, Rebineba; iSviaTad uCivian
kunTebisa da saxsrebis tkivils. metnaklebad gamoxatulia sxvadasxva intensivobis
cvlilebebi zemo sasunTq gzebSi, yelSi, nuSurebSi, koniuqtivaSi, ufro iSviaTad _
kuWnawlavis traqtSi. pirvelsave dRidan daavadebisaTvis damaxasiaTebeli uxvi serozuli
gamonadeni cxviridan, romelmac SeiZleba SemdgomSi serozul-Cirqovani xasiaTi miiRos.
cxviridan sunTqva gaZnelebulia. yelis gasinjvisas aRiniSneba nuSurebis, sasis rkalebis
zomieri hi peremia da SeSupeba. am dros damaxasiaTebelia xaxis ukana kedlis hi peremiul
fonze hi perplazirebuli folikulebis gamoCena. adgili aqvs folikulur, granulur
faringits. anTebiTi eqsudaciuri komponentis intensiuri gamoxatvisas hi perplaziur
kedlebze Cndeba moTeTro nadebi da Sesqelebuli lorwo. xvela daavadebis pirvelsave
dRidan Rebulobs produqciul xasiaTs da gansakuTrebiT Semawuxebelia adreuli
asakis bavSvebisaTvis. filtvebSi moismineba gafantuli mSrali an sveli xixini.
yvelaze ufro damaxasiaTebelia Tvalis lorwovani garsis dazianeba _ koniunqtiviti,
romelic gamoxatulia daavadebis I dRidan an ufro mogvianebiT me-3-5 dRes erTvis.
procesSi erTveba jer erTi , xolo Semdgom meore Tvali. bavSvebi uCivian Tvalis wvas,
ucxo sxeulis SegrZnebas. Tvalis quTuTo hiperemiuli da SeSupebulia, Tvali naxevrad
Riaa; zogjer koniunqtivaze Cndeba mkvrivi, moruxo-moTeTro apkisebri nadebi sklerebSi
sisxlCaqcevebiT. difTeriisgan gansxvavebiT apki arasdros ar scildeba koniunqtivis
sazRvrebs. adenovirusuli infeqciis dros xSiri da damaxasiaTebeli simptomia
koniunqtiviti. mas uwodeben adenovirusuli infeqciis `savizito baraTs~. saxis
63
pastozuroba, quTuTos SeSupeba, serozul-Cirqovani

gamonadeni Tvalidan, uxvi gamonadeni cxviridan
dasayrdeni klinikuri simptomebia daavadebis
diagnostikisaTvis.
miuxedavad imisa, rom adenovirusuli infeqciis
klinika Zlier polimorfulia, SesaZloa misi
klasifikacia sindromuli gamovlinebebis mixedviT.
arCeven Semdeg klinikur sindromebs:
faringokoniunqtiviti, zemo sasunTqi gzebis katari,
keratokoniunqtiviti, tonzilofaringiti,
mezenteriuli limfadeniti da sxva.
faringokoniunqtivuri sindromis dros
adenovirusuli koniunqtiviti yuradRebas iqcevs gamoxatuli faringiti da
(Å.È. Êîí÷àëîâñêèé) koniunqtiviti apkisebri nadebiT koniunqtivaze. am
formis dros maRali temperatura aRiniSneba 4-5
dRis ganmavlobaSi 90% avadmyofebSi, xolo
temperaturis gaxangrZliveba aReniSneba avadmyofTa
75%-s. kataruli koniunqtiviti Tvalis kaklis
lorwovanis dazianebiT gvxvdeba 75%-Si. faringitis
damaxasiaTebeli niSnebi _ xaxis ukana kedlis hiperemia-
hi perplazia mkveTradaa gamoxatuli, diddeba kisris
ukana limfuri kvanZebi. gadidebuli limfuri kvanZebi
rCeba ramodenime kvira mwvave periodis CamTavrebis
Semdeg. koniunqtiviti aRiniSneba temperaturis
normalizaciis Semdegac. Tavis tkivili, saerTo sisuste,
damtvreuloba, apaTia grZeldeba daavadebis gadatanis
Semdeg didxans.
tonzilofaringiti. adenovirusuli infeqciis yvela
adenovirusuli apkovani
koniunqtiviti
formis dros gamoxatulia met-naklebad cvlilebebi
(Í.È. Íèñåâè÷, Â.Ô. Ó÷àéêèí) pirxaxis mxriv, magram tonzilofaringitisas dominirebs
gansakuTrebiT gamoxatuli anTebiTi movlenebi. bavSvebi
uCivian yelis tkivils, nuSurebze viTardeba nadebebi. regionuli limfuri kvanZebi
gadidebulia, romlis genezi virusuli da meoradi floriT aixsneba.
mezenteriuli limfadeniti. am sindromisaTvis damaxasiaTebelia SeteviTi xasiaTis
tkivilebi mucelSi Wipis midamoSi. SeiZleba adgili hqondes muclis faris gaRizianebis
simptomebs. qirurgiuli Carevisas naxuloben gadidebul, hi peremiul da SeSupebul
limfur kvanZebs. periferiul sisxlSi leikocitebis raodenoba normis farglebSia.
zemo sasunTqi gzebis katari yvelaze ufro xSirad vlindeba adenovirusuli
infeqciis dros, igi iwyeba temperaturiT 3-4 dRis ganmavlobaSi, susti an zomieri
intoqsikaciiT da gamoxatuli kataruli movlenebiT - rinitis, traqeobronqitis
saxiT. damaxasiaTebelia kataruli faringiti; kisris limfuri kvanZebi gadidebulia.
zogjer SesaZloa ganviTardes krupis sindromi.
pnevmonia. aSS-Si pnevmoniiT hospitalizebul bavSvTa Soris adenovirusuli
genezis pnevmonia Seadgens 7-10%-s, romelic araiSviaTad SeiZleba damTavrdes sikvdiliT.
am dros paTanatomur masalaze naxuloben sasunTqi gzebis epiTeliumis ujredTa
birTvebSi damaxasiaTebel CanarTebs.
diarea. epidemiuri afeTqebisas enteruli adenovirusebis aRmoCena adasturebs
maT rols am paTologiaSi.
64
adenovirusuli infeqcia
kerZo nawili. respiraciul-sincitiuri infeqcia
hemoragiuli cistiti. es sindromi vlindeba uecrad, hematuriiT, dizuriiT,

gaxSirebuli SardviT, moSardvis cru survilis grZnobiT, romelic SeiZleba gagrZeldes
1-2 kvira. avadmyofebSi am dros dadgenili iyo adenovirusebis 11 da 21 seroti pebi.
diagnozi. darwmunebiT diagnozis dasmaze laparaki SeiZleba mxolod gamoxatuli
diagnozi
klinikuri formebis dros, rac ufro exeba faringokoniunqtivitisa da
keratokoniunqtivitis epidemiur afeTqebebs, sxva SemTxvevebSi adenovirusebis gamoyofis
pnevmokokur
pnevmokokurii koniunqtiviti (Å.È. Êîí÷àëîâñêèé)
gareSe diagnostika gaZnelebulia. virusis gamoyofa xdeba ujredul kulturebSi

(masalas iReben xaxidan, Tvalidan da ganavlidan). infeqciis axal mimdinareobaze
laparakobs xaxidan miRebuli masala, xolo ganavlidan miRebuli ki, SesaZloa
gaxangrZlivebul formaze metyvelebdes. diagnostikisaTvis gamoiyeneba imunuri analizi,
rac gansakuTrebiT mniSvnelovania 40, 41 seroti pebiT gamowveuli diareuli daavadebis
mimdinareobis SemTxvevaSi. aRniSnuli seroti pebi kulturaSi ver miiReba da saWiroa
ganavlis eleqtronuli mikroskopia. farTod gamoiyeneba komplement-fiqsaciis, ifa
meTodebi antisxeulebis dasadgenad.
mkurnaloba. iniSneba Sesabamisi reJimi; hospitalizacia ki mZime formebis dros.
mkurnaloba simptomuria; saWiroa srulfasovani kveba, polivitaminebi. rekomendebulia
TvalSi 0,05%-iani dezoqsiribonukleazis xsnaris 3-4 wveTis 3sT-Si erTxel CawveTeba
2-3 dRis ganmavlobaSi. antibiotikebi naCvenebia meoradi floriT garTulebisas _
pnevmonia, sinusiti, streptokokuri angina da sxva. vaqcinacia araefeqturia.
respiraciul-sincitiuri infeqcia
respiraciul-sincitiuri virusuli infeqcia (RSV-infeqcia) warmoadgens mwvave

virusul daavadebas, romelic mimdinareobs organizmis zomieri intoqsikaciiT, qvemo
sasunTqi gzebis anTebiT da xSirad, bronqiolitis suraTiT. bavSvebSi mwvave respiraciuli
virusuli infeqciebis 15-25% modis respiraciul-sincitiur infeqciaze; es infeqcia
erT wlamde asakis bavSvebSi iTvleba bronqiolitebisa da pnevmoniebis ZiriTad mizezad.
virusi pirvelad gamoyofil iqna respiraciuli infeqciiT avadmyofi maimunidan
1956 wels j. morisisa da Tanaavtorebis mier, xolo 1957w. a. Cenokma da misma
Tanaavtorebma analogiuri virusi gamohyves bavSvebidan. respiraciul-sincitiuri virusis
saxelwodeba dakavSirebulia sincitiebis da simplastis arsebobasTan, romlebic
warmoiqmnebian ujredul kulturebze virusis toqsigenuri moqmedebisas. ujredebis
65
SeerTebis Sedegad warmoiSoba giganturi da mravalbirTviani ujredebi. virusi aris

90-120nm zomis; Seicavs rnm-s, miekuTvneba Paramyxoviridae-s ojaxs rogorc pa-
rotitis, parainfluencas da wiTelas gamomwvevi, magram gamoyofilia calke
gansakuTrebul Pnevmovirus -is saxeobaSi ribonukleinis fermentis mcire zomis
gamo. paTologiuri masalidan virusis gamoyofa gaZnelebulia. virusebi ar izrdebian
qaTmis embrionze da miqso - da umravlesi paramiqsovirusebisagan gansxvavebiT, maTSi
ar aris hemaglutinini da neiraminidaza. virusi kargad izrdeba HELA, HEP-2 -2 da sxva
ujredul kulturebze. garemo pirobebisadmi sustad gamZlea. avadmyofebidan aRebuli
paTologiuri masala 00C-mde unda gaiyinos da dauyovnebliv gaigzavnos laboratoriaSi.
dReisaTvis cnobilia RS-virusis ori seroti pi - A da B, romlebic gansxvavdebian
zedapiruli glikoproteinebiT.
epidemiologia.. infeqciis wyaroa daavadebuli an virusmtarebeli adamiani. gadacema
epidemiologia
xdeba haerwveTovani gziT, magram stacionaris pirobebSi SeiZleba adgili hqondes
inficirebas kanidan maTze sekretis moxvedris Sedegad da Semdeg sasunTq gzebSi misi
moxvedrisas. zomieri klimatis qveynebSi epidemiur afeTqebebs adgili aqvs zamTris
periodSi da grZeldeba 4-5 Tve. daavadebis piki aRiniSneba ianvar-Teberval-martSi,
zogjer dekembridan ivnisis CaTvliT. sxva dros aRiniSneba sporaduli SemTxvevebi.
umTavresad avaddebian 3 wlamde asakis bavSvebi, gansakuTrebiT ki axalSobilebi da
Cvilebi, romelTa hospitalizacia bronqiolitis da pnevmoniis diagnoziT zamTris
periodSi matulobs. ZuZumwovar bavSvebs pasiuri antisxeulebi miRebuli aqvT dedisgan
transplacentulad, rac maT organizms icavs daavadebis mZime formisagan sicocxlis
pirvel 4-5 kviras, xolo infeqciisagan xangrZliv dacvas antisxeulebi ver
uzrunvelyofen. dawesebulebebSi avadmyofTan kontaqtis SemTxvevaSi mcirewlovani
bavSvebis inficireba 100%-Si xdeba, xolo ufrosi asakisa 60-80%-Si.
paTmorfologia da paTogenezi: virusis reproduqcia xdeba zemo da qvemo
sasunTqi gzebis epiTeliumSi, rac iwvevs maT dazianebas; maqsimaluri cvlilebebi
aRiniSneba wvril da saSualo kalibris bronqebsa da bronqiolebSi. am dros xdeba
maTi epiTeliumis hi perplazia, simplastebisa da fsevdogiganturi ujredebis warmoSoba;
bronqiolebis epiTeliumi ganicidis nekrozs; xdeba lorwos hi persekrecia, SeSupeba
da lorwqveSa Sris mravalujredovani infiltracia. yovelive es iwvevs bronqiolebis
sivrcis daxSobas, maT gadaWimvas da gadidebas, xolo Semdgom filtvebis distaluri
nawilebis dazianebas. intersticiuli pnevmonia mimdinareobs ufro metad gavrcelebuli
infiltraciiT. zemoaRniSnuli movlenebi iwvevs bronqebis drenaJuli funqciis darRvevas,
viTardeba wvrili ateleqtazebi, sqeldeba alveolaTaSorisi Zgideebi, rac ganapirobebs
Jangbadis cvlis darRvevas da organizmis hi poqsias. aris azri imis Sesaxeb, rom
bronqiolitis ganviTarebaSi SeiZleba mniSvneloba hqondes imunopaTologiur meqanizms,
ris damadasturebel faqtadac SeiZleba CaiTvalos morfologiuri, virusologiuri,
klinikuri da imunologiuri monacemebi.
klinika.. inkubaciuri periodi Seadgens 2-8, saSualod 4-6 dRes. klinikuri suraTi
klinika
damokidebulia asakze. erT wlamde asakis bavSvebSi daavadeba SeiZleba daiwyos rogorc
mwvaved, ise TandaTanobiT - temperaturis momatebiT. pirvelsave dRes viTardeba
rinorea da faringiti, cxvircemineba da mSrali xvela. intoqsikaciis movlenebi
sustadaa gamoxatuli. xvela SeiZleba iyos pirvel dResve, magram ufro 1-3 dRis
Semdeg. am dros surdo xdeba ufro intensiuri da temperatura ramdenadme matulobs,
rasac erTvis xmauriani, gaZnelebuli sunTqva, asTmuri (obstruqciuli) sindromi.
filtvebSi, moismineba mSrali da sveli xixini. msubuqi mimdinareobisas infeqcia
Semoifargleba aRniSnuli simptomatikiT. procesis gaZlierebisas adgili aqvs xvelis
da xixinis momatebas. hipoqsia Zlierdeba, gulmkerdis gafarToebis gamo neknebi Rebuloben
66
horizontul mdebareobas, gamoxatulia qoSini, cianozi Rebulobs difuzur xasiaTs,

aRiniSneba taqi pnoe - sunTqva 70-80 wuTSi. periodulad sunTqvis gaCerebiT _ apnoe.
auskultaciiT sunTqva Sesustebulia, zog adgilas saerTod ar moismineba (`munji~
zonebi). avadmyofTa 50-80%-Si rentgenogramaze aRiniSneba intersticiuli pnevmoniis
da peribronquli Crdilebis suraTi, 10-25%-Si _ segmenturi dazianebis suraTi,
erTeul SemTxvevebSi _ sveli plevriti. zogjer daavadeba iwyeba pnevmoniis msgavsad,
xveliT da qoSiniT; am dros perkusiiT filtvebis emfizemuri cvlilebebi ar Cans,
magram viTardeba xmauriani, asTmuri, mstvenavi sunTqva; filtvebSi moismineba erTeuli
xixini. rentgenogramaze Cans filtvis emfizemuri nawilebi. mcire asakis bavSvebSi
xvelis Setevebi
SeiZleba iyos
spazmuri xasiaTis
(rogorc yivanaxvelas
dros). perioduli
sunTqva da xanmokle
apnoe gansakuTrebiT
xSiria dRenaklebSi.
araiSviaTad aseT
movlenebs adgili
SeiZleba hqondes
msubuqad mimdinare
bronqiolitis
SemTxvevebSi. zogjer
viTardeba uecari tuberkulozuri procesi, romelic mimdinareobda RSV-- s
sikvdilis sindromi. mimikriiT ((tbc - sTvis damaxasiaTebeli ganleuli mdgomareoba).
mozrdil bavSveb- (sakuTari masala)
Si daavadeba, Cveu-
lebriv, mimdinareobs, rogorc zemo sasunTqi gzebis katari. subfebriluri an nor-
maluri temperaturis fonze aRi-niSneba Semcivneba, mSrali, magram xangrZlivi, Semawux-
ebeli xvela, sunTqva gaZnelebulia amosunTqvis fazaSi. obieqturad saerTo mdgomar-
eoba damakmayofilebelia. aRiniSneba saxis sifermkrTale da pastozuroba, inicirebu-
li sklerebi, yeli odnav hi peremiuli an normaluria, filtvebSi mkvrivi sunTqva,
gafantuli mSrali da sveli xixini. RviZli iSviaTadaa gadidebuli. daavadeba zogjer
SeiZleba gagrZeldes 2-3 kvira.
periferiul sisxlSi leikocitebis raodenoba normis farglebSia an odnav
momatebuli marcxniv gadaxriT. aRiniSneba monocitebisa da ati puri limfocitebis
(5%-mde) momateba, eds odnav momatebulia.
arCeven daavadebis msubuq, saSualo da mZime formebs.msubuqi formebis dros
aRiniSneba subfebriluri an normaluri temperatura, susti intoqsikaciis movlenebi;
daavadeba mimdinareobs rogorc zemo sasunTqi gzebis katari. saSualo simZimis dros
temperatura aRwevs 38-390C, gamoxatulia intoqsikaciis zomieri movlenebi. bronqioliti
mimdinareobs I-II xarisxis sunTqvis ukmarisobiT. mZime formebis dros intoqsikacia
Zlieraa gamoxatuli, adgili SeiZleba hqondes krunCxvebs, II-III xarisxis sunTqvis
ukmarisobas.
diagnozi da diferenciuli diagnozi. gamoxatuli bronqiolitis dros epidemiuri
situaciis gaTvaliswinebiT (daavadebis sezonuroba, afeTqebebi bavSvTa dawesebulebebSi,
ojaxebSi) diagnozis dadgena gaadvilebulia. mxedvelobaSia misaRebi, rom msgavsi
mimdinareoba SeiZleba paragri pis dros. pirveli Tveebis asakis bavSvebSi ufro Znelia,
67
gamoiricxos qlamidiozi da paTogenuri floriT gamowveuli daavadeba, sustad

gamoxatuli bronqioliti da rentgenogramaze infiltrirebuli kerebis ararseboba
gamoricxavs baqteriuli xasiaTis process, xolo qlamidiozis dros 1-4 Tvis asakSi
xSirad dgindeba intersticiuli pnevmoniis suraTi. daavadeba iwyeba qvemwvaved; anamnezSi
aRiniSneba koniunqtiviti, temperatura normaluria. RSV-Tvis mTavari damaxasiaTebeli
simptomebi Semawuxebeli xvela da gaZnelebuli sunTqva am SemTxvevaSi gamoxatuli ar
aris. RSV-sagan gansxvavebiT adenovirusuli infeqciis dros saxezea Tvalis dazianebis
simptomebi. yivanaxvela gansxvavdeba imiT, rom misTvis ar aris damaxasiaTebeli zemo
sasunTqi gzebis katari, temperatura subfebriluri an normaluria, ufro xSirad
gamoxatulia spazmuri xvela da reprizebi. diagnozi emyareba respiraciul sekretSi
virusuli antigenis aRmoCenas (enzimimunofermentuli analizi); meTodis mgrZnobeloba
80-90%-ia.
virusis kulturis miRebas sWirdeba 3-5 dRe, magram gamokvlevis Sedegi da
mgrZnobeloba imazea damokidebuli, Tu ramdenad sworadaa aRebuli da Senaxuli
masala(virusi metad Termolabiluria da oTaxis temperaturaze swrafad iRupeba).
infeqciis dasadastureblad gamoiyeneba serologiuri gamokvlevebi dinamikaSi, Tumca
mcire asakis bavSvebSi serokonversia SeiZleba ar iyos gamoxatuli.
garTulebebi. ZiriTadi garTulebebi ganpirobebulia meoradi baqteriuli infeqciis
garTulebebi
darTviT - otiti, sinusiti, pnevmonia da sxva. RSV gansakuTrebiT saSiSia im pirTaTvis,
romlebsac aReniSnebaT iseTi Tanmxlebi daavadebani, rogoricaa gul-sisxlZarRvTa,
sunTqvis, nervuli da imunuri sistemebis daavadebebi. am SemTxvevebSi sikvdilianobis
maCvenebeli SeiZleba aiwios 2%-mde. mxedvelobaSia misaRebi, rom RSV SeiZleba iyos
erT-erTi faqtori, romelic xels uwyobs bronquli asTmis ganviTarebas.
mkurnaloba. msubuqi mimdinareobis dros, iseve, rogorc sxva virusuli infeqciebisas
mkurnaloba
mkurnaloba utardebaT binaze simptomuri saSualebebiT. mZime formisas avadmyofi
Tavsdeba stacionarSi. obstruqciuli sindromis dros xmaroben salbutamols,
albuterols; hi poqsiis dros _ Jangbadis inhalacias; dehidrataciisas awarmoeben
siTxeebis miwodebas, gadasxmas ki _ garkveuli sifrTxiliT. meoradi infeqciisas
xmaroben antibiotikebs. zogjer iniSneba ribavirini, rac ukve eqimis prerogativiT
xdeba: unda Sefasdes misi potenciuri efeqti, gverdiTi movlenebi, medikamentis fasi.
rekomendebulia ribavirinis daniSvna aerozolis saxiT JangbadTan erTad (12-20
saaTis ganmavlobaSi 1-7 dRe) Semdeg situaciebSi (rodesac RSV-infeqcia bavSvisaTvis
seriozul risks warmoadgens):
1. aRiniSneba gulis seriozuli daavadebebi, mankis CaTvliT.
2. bavSvi imyofeba imunosupresiul Terapiaze.
3. aRiniSneba mZime daavadeba da/an imyofeba meqanikur ventilaciaze.
4. 6 kviramde asakis bavSvebi, sadac mosalodnelia RSV-infeqciis
progresireba mZime formebamde da kortikosteroidebi, rogorc wesi
efeqturi ar aris.
profilaqtika. avadmyofis izolacia binaze an stacionarSi tardeba saerTo
epidsawinaaRmdego RonisZiebebiT. saWiroa oTaxis sveli wesiT, sadezinfeqcio xsnarebiT
damuSaveba, misi dasxiveba ultraiisferi sxivebiT. vaqcinaprofilaqtika ar arsebobs.
dedis rZe Seicavs antisxeulebs RSV-is winaaRmdeg, magram xSirad sakmarisi ar aris
daavadebis Tavidan asacileblad. ixmareba RSV-sawinaaRmdego intravenuri
imunoglobulini (RSV-IGIV). iniSneba 2 wlamde bronqopulmonuri displaziis, an
dRenaklulobis dros (gestacia 35 kviramde). doza 15 ml/kg (750 mg/kg) - 1 jer
TveSi.
68
kerZo nawili. rinovirusuli infeqcia
rinovirusuli infeqcia
(RINOVIRUSIS)
rinovirusuli infeqcia anu mwvave kontagiozuri surdo (common cold-- ingl.)

warmoadgens zemo sasunTqi gzebis mwvave daavadebas, romelic mimdinareobs cxvirisa
da cxvir-xaxis lorwovani garsebis upiratesi dazianebiT.
pirvelad kontagiozuri surdos virusuli buneba dadgenil iqna 1914 w. W.
Kruse-s mier, avadmyofebis cxviris sekretis intranazalurad SeyvaniT. analogiuri
klinikuri suraTi miiRes moxaliseebSic. virusis pirveli Stamebi gamoyofil iqna
1960 w. D. Tyrrell-is da misi Tanaavtorebis mier. maT SeimuSaves virusis kultivirebis
meTodi adamianis embrionze, xolo Õîëüêîâ-ma _ Tirkmelebis ujredul kulturebze.
virusi miqsovirusia da miekuTvneba pikornavirusebis jgufs (pico - patara, rna -
ribonukleinis mJava); igi Seicavs rnm-s da zomiT 20-30 nm-is tolia. amJamad cnobilia
rinovirusebis 113 serologiuri antigenuri varianti. isini kargad mravldebian adamianis
embrionis traqeis epiTeliumisa da filtvebis fibroblastebis ujredul kulturebze.
calkeul serovarebs Soris vlindeba jvaredini serologiuri reaqcia.
epidemiologia. rinovirusebi gavrcelebulia yvelgan. ufro xSirad gvxvdeba
zomieri da civi klimaturi sartylis qveynebSi, gansakuTrebiT, did qalaqebSi.
epidafeTqebebi xdeba organizebul koleqtivebSi (bavSvTa baRi, baga, skola da sxva).
SesaZloa erT koleqtivSi cirkulirebdes virusis sxvadasxva serovari. sporadul
SemTxvevebs adgili aqvs mTeli wlis ganmavlobaSi. daavadeba gadadis haer-wveTovani
gziT. infeqciis wyaroa avadmyofi an virusmtarebeli adamiani. SedarebiT naklebad
avaddebian 6 Tvemde asakis bavSvebi, dedisagan miRebuli pasiuri imunitetis gamo.
daavadebis gadatanis Semdeg viTardeba tipurspecifikuri Seuvaloba, magram ara xangrZlivi
droiT. fiqroben, rom infeqciisadmi rezistentobas gansazRvravs ara Sratismieri
imunoglobulinebi, aramed cxvir-xaxis specifikuri A-imunoglobulinebi. Tu virusi
gavrcelda im adgilas, sadac uwin ar cirkulirebda, asakis miuxedavad yvela kontaqtur
pirSi iwvevs daavadebas.
paTogenezi. rinovirusuli infeqcia anTroponozuli daavadebaa. infeqciis SeWris
paTogenezi
kars warmoadgens cxviris lorwovani. eqsperimentSi yvelaze metad daavadebis gamowveva
xdeba cxviris lorwovansa da koniunqtivaSi virusSemcveli masalis inhalaciiT.
gadacemis meqanizmi haer-wveTovania, magram arsebobs monacemebi imis Sesaxeb, rom cxviridan
gamonadeniT gaWuWyianebuli xelebi xSirad xdeba infeqciis gadacemis wyaro.
klinika. inkubaciuri periodi Seadgens 1-5, ufro xSirad 2-3 dRes. daavadebis
klinika
pirveli gamovlineba sxva mwvave respiraciuli virusuli infeqciebis msgavsia. daavadeba
iwyeba uecrad, saerTo sisustiT, SemcivnebiTa da damtvreulobis SegrZnebiT, rasac
SeiZleba daerTos subfebriluri temperatura. pirvelsave dRes aRiniSneba cxviris
gagudva (surdo), cxvircemineba, ucxo sxeulis an fxaWnis SegrZneba yelSi. wamoxveleba,
xvela da xmis CaxleCa gvxvdeba 30-40%-Si. avadmyofebi uCivian cremldenas, Tavis
tkivils, ynosvis dakargvas, simZimis SegrZnebas cxvirSi. 1-2 dRes cxviridan gamonadeni
wylisebur-serozuli xasiaTisaa, xolo me-2-3 dRes sqeldeba da Rebulobs serozul-
Cirqovan saxes. Warbi anTebadi sekretis gamoyofisa da cxvirsaxocis xSiri xmarebis
gamo kani cxviris SesasvlelTan macerirebulia. amave adgilas an tuCebze zogjer
herpesuli gamonayari gvxvdeba. cxviris lorwovani hi peremiuli da SeSupebulia,
nuSurebi, misi wina rkalebi, xaxis ukana kedeli zomieradaa hi peremiuli. avadmyofs
saxe odnav pastozuri aqvs, Tvalebis sklerebi inicirebuli. zogjer xvela Zlierdeba
da gamoixateba traqeitisa da traqeobronqitis suraTi. gri pisTvis damaxasiaTebel
69
kerZo nawili. rinovirusuli infeqcia
intoqsikaciis movlenebs adgili ara aqvs, maRali temperaturuli reaqcia, rac

damaxasiaTebelia gri pis, paragri pisa da sincitiur-respiraciuli cxelebisaTvis, am
dros ar gvxvdeba. daavadeba grZeldeba 1 kvira, xolo narCeni movlenebi 2 kvira da
gvxvdeba ufro metad mcire asakis bavSvTa 35%-Si.
rinovirusuli infeqcia axalSobilebsa da 1 wlamde asakis bavSvebSi.
axalSobilebi avaddebian im SemTxvevaSi, roca dedas ar gaaCnia imuniteti mocirkulire
seroti pis mimarT. klinikuri suraTi xasiaTdeba surdoTi, cxviridan uxvi serozuli
gamonadeniT, saerTo mousvenrobiT, Zilis darRveviT, madis daqveiTebiT (cxviridan
sunTqvis gaZnelebis gamo).
mozrdilebSi traqeitisa da traqeobronqitis suraTi ganpirobebulia meoradi
baqteriuli floris darTviT.
diagnozi da diferenciuli diagnostika. iseTi klinikuri gamovlinebani,
rogoricaa surdo uxvi wylisebr-serozuli gamonadeniT, macerirebuli kani cxviris
SesavalTan (saerTo intoqsikaciis gareSe), epidsituacia saSualebas gvaZlevs, vifiqroT
rinovirusul infeqciaze. amave dros, mxedvelobidan ar unda gamogvrCes diferenciuli
diagnozi sxva mwvave respiraciul virusul infeqciebTan, difTeriasTan, meningokokur
nazofaringitTan da hemolizuri streptokokebiT gamowveul surdosTan. zogjer
baqteriuli xasiaTis infeqciis gamosaricxad saWiroa, Catardes saTanado
baqteriologiuri gamokvlevebi.
rinovirusuli infeqciis dasadgenad tardeba virusologiuri gamokvlevebi saTanado
ujredul kulturebze. eqspresdiagnostikisaTvis xdeba cxviridan gamonadenis gamokvleva
mafluorescirebeli antisxeulebis gamoyenebiT.
diferenciuli diagnozisTvis mxedvelobaSi unda viqonioT alergiuli riniti,
romlisTvisac damaxasiaTebelia sezonuroba (mcenareTa yvavilobis periodSi),
antihistaminuri preparatebis gamoyenebis efeqturoba. saWiroebis mixedviT, unda
gamoiricxos ucxo sxeulis arseboba cxviris RruSi, rac xorcieldeba rinoskopiiT
mozrdil bavSvebSi zogjer saWiroa narkotikuli nivTierebiT (kokaini, marixuana,
toqsikuri nivTierebis SesunTqva) gamowveuli rinitis arsebobis gamoricxva.
mkurnaloba tardeba simptomuri saSualebebiT. cxviridan sunTqvisas saWiroa
cxvirSi fiziologiuri xsnaris CawveTeba da SemdgomSi baloniT lorwos evakuacia.
aSS-i ixmareba phenylephrine (0,125 - 0,25%) cxvirSi CasawveTeblad. sxva nazaluri
wveTebi, rogorc wesi, aRizianebs cxviris lorwovans rasac moaqvs damatebiTi problemebi.
cxvirSi CawveTeba xdeba kvebamde 15-20 wuTiT adre. Tavidan awveTeben 1-2 wveTs TiTo
nestoSi, 10 wuTis Semdeg kidev 1-2-s, raTa daiSalos ufro Rrmad mdebare sqeli
lorwo. fiziologiuri xsnari CasawveTeblad ixmareba 4-5 dRis manZilze, sxva
medikamentebis CawveTeba am dros ar aris rekomendebuli. ukeTesia sanaciisaTvis
CawveTebis Semdeg bavSvi cota xniT (Tu es xels ar uSlis sunTqvaSi) unda davawvinoT
zurgze.
mozrdili bavSvebisTvis iyeneben fsevdoefedrins. zogierTi gvTavazobs
antihistaminuri saSualebebisa da adrenerguli agonistebis kombinacias. saWiroa
Tbili siTxeebis xSiri miwodeba (Tbili Cai, kompoti, rZe da a.S.).
profilaqtika. tardeba saerTo epidsawinaaRmdego RonisZiebebi. xdeba avadmyofis
profilaqtika
adreuli izolacia.
70
kerZo nawili. reovirusuli infeqcia
reovirusuli infeqcia
reovirusuli infeqcia mwvave daavadebaa, romelic xasiaTdeba zemo sasunTqi gzebis

katariT da araiSviaTad wvril nawlavTa dazianebiT. amasTanaa dakavSirebuli virusis
saxelwodeba REO - respiratory enteric orphan viruses _ adamianis respiraciul-
nawlavTa oboli virusebi.
adre am daavadebis gamomwvevs SecdomiT miakuTvnebdnen enterovirusebs (ECHO-
10). reovirusebi pirvelad gamoyofil iqna mwvave respiraciuli infeqciiT, pnevmoniiT,
encefalitiT, cxelebiT da mwvave diareiT daavadebuli avadmyofebidan.
eti logia. reovirusebis ojaxSi gaerTianebulia 3 tipi. praqtikuli mniSvneloba
ologia
etio
aqvs or ti ps: e.w. sakuTriv reovirusebs da rotavirusebs. maTi zomaa 70-80 nm,
Seicaven rnm-s. isini gamoirCevian sakmao gamZleobiT temperaturis, ultraiisferi
sxivebisa da sadezinfeqcio xsnarebis mimarT. cnobilia adamianis reovirusebis 3
serotipi 1, 2, 3. maT aqvT saerTo komplementSemboWavi da tipur-specifikuri antigenebi.
epidemiologia. daavadeba gvxvdeba msoflios yvela regionSi. infeqcia vrceldeba
epidemiologia
rogorc sporaduli SemTxvevebis, aseve epidafeTqebebis saxiT. avaddebian umTavresad
bavSvebi 6 Tvidan 3-5 wlis asakamde.
infeqciis wyaros warmoadgens rogorc manifesturi klinikis mqone, aseve usimptomo
formiT daavadebuli adamiani. infeqciis gadacemis meqanizmi haer-wveTovania, gadacema
xdeba fekalur-oraluri gziTac.
paTogenezi zustad ar aris cnobili, magram dadgenilia, rom virusi mravldeba
cxvir-xaxisa da nawlavebis lorwovani garsebis epiTeliumSi da iwvevs maT katarul
anTebas. SemdegSi igi xvdeba limfur folikulebsa da limfur kvanZebSi, saidanac
gadadis sisxlSi - viTardeba viremia.
klinika. inkubaciuri periodi ganisazRvreba 1-7 dRiT. daavadeba iwyeba mwvaved
klinika
da vlindeba zemo sasunTqi gzebis katariT an, amave dros, nawlavTa aSlilobiT. katars
Tan erTvis subfebriluri temperatura, surdo, xvela, kataruli koniunqtiviti.
avadmyofebi uCivian Tavis tkivils, madis daqveiTebas, zogjer gulis revis SegrZnebas
an Rebinebas. nuSurebi, xaxis rkalebi, cxvir-xaxis ukana kedlis lorwovani garsebi
hi peremiulia, kisris limfuri kvanZebi, RviZli da elenTa gadidebulia. nawlavuri
sindromis dros bavSvebi uCivian muclis tkivils, nawlavTa yuryurs, defekaciis
gaxSirebas. ganavali Txelia, mZafrsuniani.
adreuli asakis bavSvebSi SeiZleba ganviTardes pnevmonia, serozuli meningiti,
miokarditi. ufrosi asakis bavSvebs xSirad aReniSnebaT infeqciis usimptomo forma.
periferiul sisxlSi damaxasiaTebeli cvlilebebi ar aris.
diagnozis dadgena klinikuri monacemebiT Znelia. cxvir-xaxis lorwos, ganavals
an zurgis tvinis siTxes ikvleven specialur ujredul kulturebze da gamoyofen
viruss. dinamikaSi xdeba specifikuri antisxeulebis titris zrda da hemaglutinaciis
reaqciis daTrgunva.
diferenciuli diagnozi tardeba sxva etiologiis mwvave respiraciul virusul
infeqciebTan, enterovirusul da mikoplazmur infeqciebTan.
mkurnaloba simptomuria, garTulebebis SemTxvevaSi gamoiyeneba antibiotikebi.
profilaqtika. specifikuri profilaqtika SemuSavebuli ar aris da eyrdnoba
profilaqtika
mwvave respiraciuli virusuli daavadebebis dros saerTod miRebul epidsawinaaRmdego
saSualebebs.
71
Tandayolili virusuli respiraciuli infeqciebi
kerZo nawili. wiTela
Tandayolili virusuli
respiraciuli infeqciebi
muclad yofnis periodSi nayofis dazianeba SeiZleba gamoiwvios aramarto virusis

pirdapirma moqmedebam, aramed am dros arsebulma toqsikozmac, romlis drosac viTardeba
mTeli rigi paTologiuri cvlilebebi: metaboluri cvlis moSla, hi poqsia, wyal-
marilovani cvlis, mJava-tutovani wonasworobis darRveva da sxva.
cnobilia, rom mwvave respiraciuli virusuli infeqciiT daavadeba orsulobis I
trimestrSi zrdis 3-5-jer TviTneburi abortis sixSires. Tu nayofis dainficireba
moxda uSualod mSobiarobis periodSi, SeiZleba axalSobili daibados dasnebovnebuli
mwvave respiraciuli virusuli infeqciiT. SemTxvevebis 50% modis Tandayolil gri pze,
xolo naklebi procenti sxva mwvave respiraciul virusul infeqciebze.
Tandayolili gri pi bevrad ar gansxvavdeba axalSobilTa gri pisagan. am dros
temperatura subfebriluri an normis farglebSia. zomieradaa gamoxatuli zemo
sasunTqi gzebis katari, aRiniSneba Tandayolili pnevmonia, hemoragiuli sindromi;
prognozs amZimebs pnevmoniiT garTuleba meoradi infeqciis darTvis Sedegad.
etiologiis dasadgenad mimarTaven virusis gamoyofas axalSobilisa da dedis
cxvir-xaxis Camonarecxidan, sanayofe wylebidan.
Tandayolili adenovirusuli infeqciis mizezad miiCneven me-3 da me-7 ti pis
adenovirusebs. daavadeba mimdinareobs zemo sasunTqi gzebis katariT an pnevmoniiT.
pnevmoniis dros aRiniSneba qoSini, kanis cianozi da sifermkrTale. perkusiiT filtvis
xma kolofiseburi an moyruebulia. auskultaciiT - wvrilbuStukovani xixini, krepitacia.
generalizebuli formisas procesSi erTveba mTeli rigi organoebi.
diagnostikaSi gvexmareba dedis daavadebis klinikuri suraTi, virusis gamoyofa
Wi plaris venidan, sanayofe wylebidan, axalSobilis cxvir-xaxis Camonarecxidan.
wiTela
(MORBILLI)
wiTela mwvave virusuli daavadebaa, romlisTvisac damaxasiaTebelia organizmis

saerTo intoqsikacia, temperaturis momateba, Tvalis, yelis, sasunTqi gzebis dazianeba,
laqovan-papuluri gamonayari da sasunTqi organoebis mxriv xSiri garTulebebi.
daavadeba pirvelad aRweres IX saukuneSi. XVII saukuneSi T. Sydenham-ma da R.
Morton-ma dawvrilebiT daaxasiaTes infeqcia, magram misi diferenciacia gamonayriT
mimdinare sxva daavadebebisagan didxans ar xdeboda. XVIII saukuneSi wiTela gamoyofil
iqna, rogorc calke nozologiuri erTeuli. infeqciis sixSirisa da maRali letalobis
gamo igi iTvleboda mZime daavadebad. XX saukunis dasawyisSi dadgenil iqna wiTelas
virusuli buneba. 1916 wels mowodebuli iyo daavadebis profilaqtika rekonvalescentis
SratiT. 1920w. Degimitz-ma profilaqtikis mizniT inkubaciur periodSi myof bavSvebSi
Seiyvana janmrTeli adamianis Srati, ramac didi roli iTamaSa letalobis SemcirebaSi.
etiologia da epidemiologia. Cveni saukunis 50-ian wlebSi Enders-ma da
Peebles-ma gamoyves wiTelas virusi (Polinosa morbillarum).. igi miekuTvneba
Paramyxoviridae-s ojaxsa da Morbillivirus-is saxeobas. cnobilia mxolod erTi
antigenis ti pi, romelic struqturiT emsgavseba parotitisa da paragri pis virusebs.
igi eleqtronul mikroskopSi ovaluri formisa da 120-250nm zomisaa. igi Seicavs
rnm-s da sxva paramiqsovirusebisagan gansxvavebiT ar Seicavs neiraminidazas. aqvs
72
hemaglutinaciis, hemolizuri da simplasturi aqtivobis Tviseba, adamianis garda

paTogenuria maimunebisaTvis. virusis kultivirebas axdenen adamianis embrionis an
maimunis (makakus rezus) Tirkmelebis epiTelur qsovilebze. dainficirebidan me-5-10
dRes aRiniSneba citopaTogenuri efeqti, rac gamoixateba birTvSida CanarTebisa da
mitoqondriebis giganturi ujredebis warmoqmnaSi. virusi aramdgradia garemo pirobebis
mimarT. oTaxis temperaturaze 34sT-is ganmavlobaSi inarCunebs aqtivobas. xSirad
iRupeba mzisa da ultraiisferi sxivebis moqmedebiT. lorwos gamSral wveTebSi Zlebs
ramodenime dRe, Tu temperatura 12-150 C-ia. virusis gamoyofa SeiZleba sisxlidan,
Sratidan, cxvir-xaxis lorwovanidan.
infeqciis wyaros warmoadgens sxvadasxva formiT daavadebuli piri, maT Soris
isini, visac klinikis susti gamovlineba qvs pasiuri imunizaciis gamo (mitigirebuli
forma). virusi organizmidan gamoiyofa inkubaciuri periodis bolo 1-2 dRes, prodromul
periodSi (kataruli periodi) da 3-4 dRe gamonayris periodSi; me-5 dRidan gamoyofa
wydeba.
infeqcia gadadis haer-wveTovani gziT. laparakis, xvelisa da cxvirceminebis dros
wveTovan aerozolSi myofi virusebi haeris nakadiT vrceldebian daxurul SenobebSi
did manZilze, derefnisa da ventilaciis saSualebiT SesaZloa, virusi gavrceldes
mezobel sadarbazoebsa da sxva sarTulebze. mesame piriT infeqciis gadatana iSviaTia,
radgan adamianis organizmis gareSe virusi swrafad iRupeba.
kontagiozuroba aRwevs TiTqmis 100%, rac dasturdeba epidemiuri afeTqebebiT im
regionebSi, sadac am daavadebas didi xania ar hqonia adgili. am mxriv aRsaniSnavia
panumomis mier aRwerili foreris kunZulebis epidemia, sadac wiTelas infeqcia 65
wlis ganmavlobaSi ar aRniSnula. wiTelas SemotaniT kunZulebze gavrcelda mZime
epidemia, romlis drosac daavadda mosaxleoba ZuZumwovar bavSvTa asakidan 60 wlis
CaTvliT. ar daavaddnen mxolod is pirebi, romelTac wiTela gadatanili hqondaT 65
wlis win. literaturaSi aRwerilia mravali aseTi epidemia.
am infeqciis mimarT mimRebloba narCundeba Rrma moxucebulobamde. dedisagan
miRebuli pasiuri imunitetis gamo bavSvebi 4-6 Tvemde ar avaddebian (Tu dedas
gadatanili aqvs wiTela). 9 Tvidan pasiuri imuniteti bavSvebSi ikargeba. daavadebis
yvelaze maRali maCvenebeli aqvs 1-dan 5 wlamde asaks. infeqcias axasiaTebs sezonuroba:
zamTar-gazafxuli (dekemberi - maisi), maRali maCveneblebi yovel 3-4 weliwadSi.
aqtiur vaqcinaciasTan dakavSirebiT epidsituacia mkveTrad icvleba; daavadeba iRebs
sporadul xasiaTs da aRniSnuli epidemiuri kanonzomiereba irRveva.
paTogenezi. virusi iWreba zemo sasunTqi gzebis lorwovan garsebSi (ar aris
paTogenezi
gamoricxuli koniunqtivac). lorwqveSa Sreebsa da limfur gzebSi xdeba virusis
reproduqcia. amis Semdeg virusi gadadis sisxlSi _ virusemia. dadgenilia, rom es
procesi viTardeba inkubaciis pirvel dReebSi, titris maqsimaluri momatebiT prodromis
periodSi.
wiTelas paTogenezSi didi roli eniWeba virusis Tvisebas, gamoiwvios organizmis
anergia (pirkes dadebiTi reaqciis gaqroba), saerTo da adgilobrivi imunitetis daqveiTeba
(Sikis uaryofiTi reaqciis gadasvla dadebiTSi) sisxlis koplementuri unarianobis
daqveiTeba da sxva).
organizmis saerTo rezistentobis daqveiTeba, vitaminuri cvlis moSla da sxva
movlenebi xels uwyoben paTogenuri da pirobiTpaTogenuri floris gaaqtiurebas da
garTulebebis formirebas.
wiTelas viruss axasiaTebs gansakuTrebuli tropizmi cns-is, sasunTqi da saWmlis
momnelebeli sistemebis mimarT. wiTelas gamonayari iwvevs araspecifikur, kerovan
anTebiT process dermis zeda fenebSi. epiTeliumi ganicdis araswor, gaZlierebul
73
garqovanebas Semdgomi aqercvliT.

damaxasiaTebeli cvlilebebi aRiniSneba cxvir-xaxaSi, bronqebSi, nawlavebSi,
koniunqtivaSi. sisxlis kapilarebis irgvliv warmoiSoba eqsudati proliferirebuli
erTbirTviani ujredebiT. limfuri kvanZebi hiperplaziulia; kerZod, apendiqsSi viTardeba
giganturi mravalbirTviani ujredebi, romelTa diametria 100 mkm (Warthin-Finkeldey
retikuler-endoTeluri ujredebi). kanis cximovani jirkvlebisa da Tmiani folikulebis
irgvliv es movlenebi ufro mZafradaa gamoxatuli. kanis gamonayris msgavsad belski-
filatov-koplikis laqebi piris RruSi Sedgeba serozuli eqsudatisa da
proliferirebuli endoTeluri ujredebisagan. piris Rrusa da saylapavSi viTardeba
kataruli movlenebi, romelic vrceldeba traqeisa da bronqebis limfur qsovilebze.
intersticiuli pnevmoniti zogjer gadadis giganturujredovan pnevmoniaSi.
dadgenilia, rom wiTelas virusi xangrZlivad persistirebs tvinSi da SeiZleba
gamoiwvios qronikuli an qvemwvave infeqcia, ris Sedegadac yalibdeba qvemwvave
masklerozebeli encefaliti romelic azianebs tvinis ruxsa da TeTr nivTierebas
maTi Semdgomi degeneraciiT. morfologiurad nervuli ujredebis birTvsa da
citoplazmaSi CanarTebia.
kuW-nawlavis traqtis mxriv adgili aqvs katarul an wylulovan anTebas, romelic
gamoixateba stomatitis, kolitis saxiT. es procesi, ufro xSirad, ganpirobebulia
meoradi infeqciis darTviT (Sigelebi, stafilokokebi, eSerixiebi).
klinika. inkubaciuri periodi Seadgens 9-10, zogjer 6-12 dRes; iSviaTad grZeldeba
klinika
17 dRemde. bavSvebs, romlebmac inkubaciur periodSi profilaqtikis mizniT miiRes
imunoglobulini, sisxlis an plazmis gadasxmebi, inkubaciuri periodi ugrZeldebaT 21
dRemde.
klinikur mimdinareobaSi arCeven prodromul, gamonayris da pigmentaciis periodebs.
prodromuli periodi grZeldeba 3-5 dRe. daavadeba iwyeba temperaturis momatebiT
38,5 - 390 C-mde, zemo sasunTqi gzebis katariT, koniunqtivitiT, mSrali xasiaTis
Semawuxebeli xveliT, gulmkerdis areSi fxaWnis SegrZnebiT, cxvirceminebiT, rinitiT.
kataruli movlenebi TandaTan mZafrdeba da gamonayris dawyebisas aRwevs piks.
cxviridan aRiniSneba uxvi gamonadeni, dasawyisSi serozuli, xolo Semdgom serozul-
Cirqovani. avadmyofebi uCivian saerTo sisustes, uZlurebas, madis daqveiTebas, uZilobas,
cremldenas. zogjer prodromuli periodi mimdinareobs Zalian mZimed: temperaturis
uecari momatebiT, krunCxviT, pnevmoniiT, krupis sindromiT. kanze gamoyramde 1-2 dRiT
adre aRiniSneba wiTeli, araswori formis laqebis arseboba rbil da magar sasaze. es
aris wiTelas sadiagnostiko mniSvnelovani niSani (enanTema). laqebi 1-2 dRis Semdeg
erTmaneTs erwymis da ikargeba hi peremiuli lorwovani garsis fonze. TiTqmis
erTdroulad an zogjer ufro adre Cndeba wiTelasTvis paTognomuri belski-filatov-
koplikis simptomi, romlisTvisac damaxasiaTebelia ZiriTadi kbilebis, tuCebisa da
RrZilebis lorwovanze monacrisfro-moTeTro feris warmonaqmnebis gaCena. isini
daaxloebiT cercvis marcvlis zomisaa, Semofarglulia anTebadi wiTeli zoliT da
lorwovans ar scildeba tamponiT. amasTanave lorwovani garsi xdeba hi peremiuli,
rbildeba da faSrdeba. mkafiod Semofargluli koniunqtiviti (quToTos kidis gaswvriv)
SeiZleba CaiTvalos damatebiT sadiagnostiko simptomad prodromul periodSi.
koniunqtivaze anTebiTi procesis gavrcelebisas es niSani qreba.
zogjer, katarul fonze gamoCndeba xolme wvrilwertilovani, qunTruSasebri an
WinWris nasusxiseburi gamonayari. aRniSnuli prodromuli gamonayari sustadaa
gamoxatuli, mcire raiodenobisaa da swrafad qreba jer kidev wiTelas gamonayris
gaCenamde.
gamonayris periodi iwyeba daavadebis me-4-5 dRes, temperaturis xelaxali momatebiT
74
da saerTo intoqsikaciis gaZlierebiT,

koniunqtivitisa da zemo sasunTqi
gzebis kataris maqsimaluri
gamovlinebiT. pirveli elementebi
aRiniSneba yuris ukan, niJarasTan
axlos, cxviris zurgze, loyebze. 24sT-
s ganmavlobaSi gamonayari swrafad
vrceldeba mTel saxeze (cxvir-tuCis
samkuTxedis CaTvliT), kiserze, gul-
mkerdis zemo nawilze, xelebze.
gamonayari ukve Rebulobs laqovan-
papulur xasiaTs. Semdegi 24sT-s
ganmavlobaSi gamonayari Cndeba zurgze,
mucelsa da kidurebze, me-3 dRes _
terfebze; amave dros iwyeba maTi
gafermkrTaleba saxeze. gamonayari
fermkrTaldeba da qreba imave
TanmimdevrobiT, rogorc daiwyo. rac
ufro mZimed mimdinareobs daavadeba,
gamonayari miT ufro xSiri da
Serwymuli xasiaTisaa. msubuqi wiTela. gamonayari daavadebis me-3 dReze.
formebis dros gamonayari erTmaneTTan (Í.È. Íèñåâè÷, Â.Ô. Ó÷àéêèí)
ar aris Serwymuli da erTeulebis
saxiTaa warmodgenili. SeiZleba adgili hqondes peteqiur gamonayars an eqkimozebs.
hemoragiiT mimdinare (`Savi wiTela~) formisas SesaZloa sisxldena piris Rrudan,
cxviridan, nawlavebidan. hemoragiuli xasiaTis gamonayari gvxvdeba daavadebis msubuqad
mimdinareobis drosac _ im adgilebze, sadac xdeba zewola, Cndebian peteqiebi an
sisxlCaqcevebi. wiTelas gamonayari xasiaTdeba mcire qaviliT. pigmentaciis periodi
grZeldeba 1-2 kviris ganmavlobaSi; igi iwyeba gamoyridan me-3 dRes. elementebi
kargaven mkafiobas, brtyeldebian, xdebian molurjo feris, bolos Rebuloben naTel-
molurjo feris laqebis saxes, 1 kviris manZilze ganicdian qatosebur aqercvlas.
wiTeliT daavadebuls aqvs sakmaod ti puri saxe: quTuToebi, cxviri da zemo tuCi
SeSupebulia, gamoxatulia koniunqtiviti Cirqovani gamonadeniT, gaZlierebuli eqsudacia
aRiniSneba cxviridan.
temperaturuli mrudi katarul periodSi dabal donezea. gamoyramde 1-2 dRiT
adre ufro dabla iwevs da maRal cifrebze adis gamoyris pirvelsave dRes, rac mruds
orkuzian saxes aZlevs. temperatura maRal cifrebzea gamonayris periodSi da Tu
daavadeba warimarTa garTulebis gareSe 3-4 dReSi xdeba normaluri. gamoyris dros
intoqsikaciis saerTo movlenebi ufro mkafiodaa gamoxatuli _ aRiniSneba mousvenroba,
bodva, zogjer Zilianoba, Tavis tkivili, madis daqveiTeba, xSirad sisxldena cxviridan,
mZafrdeba kataruli movlenebi, blefarospazmi sinaTlisadmi.
ybisqveSa da kisris ukana limfuri kvanZebi gadidebulia; umniSvnelodaa gadidebuli
elenTa. prodromul periodSi SeiZleba gvqondes tkivilebi muclis areSi, romelic
xSirad gamovlindeba apendicitis simptomkompleqsiT, rac ganpirobebulia apendiqsis
limfuri warmonaqmnebis Taviseburi morfologiuri cvlilebebiT. belski-filatov-
koplikis simptomis alagebisas qreba aRniSnuli suraTic. cudi kvebis bavSvebSi
araiSviaTia Sua yuris anTeba, bronqopnevmonia, kuW-nawlavis traqtis dazianeba, diarea,
Rebineba. mozrdilebSi SeiZleba daziandes RviZli, rac iwvevs sisxlSi transaminazis
75
momatebas, siyviTles. ganviTarebad qveynebSi 1 wlamde asakis bavSvebSi wiTela mimdinareobs

mZimed, rac gamowveulia hi potrofiiT; araiSviaTia am dros letaluri gamosavali.
klasifikacia. arCeven tipurad da ati purad mimdinare wiTelas. ti pur SemTxvevebSi
saxezea yvela simptomkompleqsi. ati puri formebis dros ZiriTadi simptomebi waSlilia
an ar arsebobs; irRveva klinikuri periodebis xangrZlivoba, mokldeba gamonayris
periodi da misi etapuroba.
inkubaciur periodSi myof bavSvebSi, romelTac miiRes sisxli, plazma an
imunoglobulinebi, wiTela mimdinareobs waSlili formiT Sesustebuli (mitigirebuli)
saxiT. Tu organizms ara aqvs gamomuSavebuli wiTelas sawinaaRmdego antisxeulebi,
daavadeba mimdinareobs misTvis damaxasiaTebeli simptomkompleqsiT, magram mcireodeni
antisxeulebis arsebobisas SesaZloa waSlili formebis ganviTareba.
garTulebebi. sasunTqi sistemis mxriv garTulebebia: krupi (laringiti,
laringotraqeiti) da pnevmonia. laringiti an laringotraqeiti, romlebic prodromul
periodSi gamovlindeba, gamowveulia virusiT, kataruli xasiaTisaa da gamonayris
gamovlinebisas qreba. pigmentaciis periodSi viTardeba nekrozuli da fibrozul-
nekrozuli xasiaTis laringiti da laringotraqeiti, rac ganpirobebulia virusul-
baqteriuli asociaciiT da xasiaTdeba mZime mimdinareobiT _ afoniiT, xorxis stenoziT.
prodromul periodSi ganviTarebuli pnevmonia zogjer Znelad gamoirCeva filtvebis
im cvlilebebisagan, romlebic dakavSirebulia limfisa da sisxlis mimoqcevis darRvevebTan
da ganpirobebulia virusiT.
adreul periodSi ganviTarebuli pnevmonia gamoirCeva mZime mimdinareobiT; misi
formireba xdeba organizmis saerTo intoqsikaciis fonze cns da gul-sisxlZarRvTa
sistemis saerTo dazianebiT. filtvis mxriv fizikaluri monacemebi am dros SeiZleba
ar gvqondes da pnevmonia mimdinareobdes bronqopnevmoniis ti piT. unda aRiniSnos, rom
aseTi pnevmoniebi gvxvdeba ufro naklebad, vidre pigmentaciis periodSi ganviTarebuli
pnevmoniebi, romelTa etiologiaSi wamyvani roli ekuTvnis pnevmo-strepto- stafilokokebs
da influenciis Cxirebs. Tanamedrove pirobebSi daavadebis mimdinareoba keTilgamosavliani
gaxda. letalobis didi procenti modis 2 wlamde asakis bavSvebze.
wiTelas xSiri garTulebaa kataruli otiti, kataruli da afTozuri stomatiti,
romlebic gvxvdebian pigmentaciis periodSi. nekrozuli da wylulovani stomatiti
viTardeba hi potroful bavSvebSi. rac Seexeba gangrenul stomatits (nomas),
antibiotikTerapiis keraSi igi TiTqmis aRar gvxvdeba. pigmentaciis periodis garTulebebs
miekuTvneba koliti da enterokoliti, romlebic TandarTul infeqciebs warmoadgenen
da ganpirobebulni arian SigelebiT, eSerixiebiT, pirobiTpaTogenuri floriT _
stafilokokebiT, TeTri kandidaTi, enterokokebiT da sxv.
wiTelas seriozul garTulebas warmoadgens encefaliti, romlis sixSire 1000
avadmyofze Seadgens 1-2 SemTxvevas, xolo letaloba 10-15%-ia. encefalitis ganviTarebas
adreul periodSi ukavSireben wiTelas viruss, Tumca unda aRiniSnos, rom tvinidan
misi gamoyofa iSviaTad xdeba.
wiTelas xSiri garTulebaa qvemwvave masklerozebeli encefaliti. varaudoben,
rom wiTelas virusma SeiZleba gamoiwvios gafantuli sklerozi, magram es faqti jer
dadasturebuli ar aris.
sxva infeqciebis TandarTvisas adgili aqvs garTulebebis sixSirisa da letalobis
zrdas.
qunTruSasa da wiTelas erTdrouli mimdinareobisas ukanasknelis inkubaciuri
periodi xangrZlivdeba; viTardeba filtvebis mxriv garTulebebi (abscesi, empiema da
sxva), xolo qunTruSa rTuldeba sefsisuri procesebiTa da recidivebiT.
wiTelasa da yivanaxvelas Serwymisas advilad viTardeba garTulebebi sasunTqi
76
sistemis mxriv (qronikuli pnevmonia, bronqoeqtazia da sxva).

diagnozis dadgena mTlianad eyrdnoba klinikur da epidemiologiur monacemebs.
virusis izolacia sekretidan warmoadgens Znelad gansaxorcielebel proceduras, rac
bolo wlebSi gaxda SesaZlebeli, virusis dnm-is pjr-Si aRmoCeniT. aucileblobis
dros gamoiyeneba serologiuri kvleva, romelic warmoadgens hemaglutinaciis
damuxruWebis reaqcias wiTelas antigenTan. daavadebis me-5-7 dRes avadmyofis sisxlis
SratSi izrdeba antisxeulebis titri 4-jer. Tumca zogierTi mkvlevari eyrdnoba
sisxlSi IgM antisxeulebis erTjerad gamokvlevas (gamonayris 3 dRidan 30-60
dRemde periodSi).
difer enciul
diferenciul
enciulii diagnozi. wiTelas ti puri mimdinareobisas diagnozis dasma iolia
da eyrdnoba epidanamnezsa da misTvis damaxasiaTebel klinikur gamovlinebebs. daavadebis
mwvaved dawyeba, koniunqtivisa da zemo sasunTqi gzebis kataris gaZliereba, prodromul
periodSi enanTemisa da belski-filatov-koplikis laqebis naxva, laqovan-papuluri
gamonayris etapuroba advilad gamoarCevs mas zemo sasunTqi gzebis katariT mimdinare
daavadebebisagan. diagnozis saeWvo SemTxvevebSi saWiroa avadmyofis izolireba da
dakvirveba 1-2 dRis manZilze ZiriTadi simptomebis gamovlinebamde.
mwvave respiraciuli infeqciebis dros loyis lorwovani garsi sufTaa, brWyviala,
gamonayris gareSe. adenovirusuli infeqciisTvis damaxasiaTebelia koniunqtiviti
apkiseburi nadebiT, poliadenopaTia. zusti diagnostikisTvis saWiroa luminescenciuri
eqspres-meTodi.
wiTelasagan gansxvavebiT qunTruSas ar axasiaTebs zemo sasunTqi gzebis katari.
gamonayari viTardeba daavadebis pirvelsave dRes, wvrilwinwklovania da vrceldeba
mTel tanze (hi peremiul fonze). aRsaniSnavia mkafiod gamoxatuli alisferi angina.
wiTuras, wiTelasagan gansxvavebiT, ar axasiaTebs organizmis saerTo intoqsikacia,
zemo sasunTqi gzebis katari sustadaa gamoxatuli. daavadebis pirvelsave dRes Cndeba
wvrilwinwklovani gamonayari, romelsac ara aqvs tendencia Serwymisaken: enanTema
aRiniSneba normaluri lorwovanis fonze, temperatura subfebriluri an normaluria.
kefisa da kisris limfuri kvanZebi gadidebulia da mtkivneuli. periferiul sisxlSi
aRiniSneba leikopenia limfocitoziT, didi raodenobiT plazmuri ujredebi.
zogjer saWiroa wiTelas diferenciacia Sratismier daavadebasa da medikamentur
alergiasTan. am dros, garda anamnezisa, wamyvania egzanTemis gamovlineba fiqsirebul
droSi, wamlis miRebidan me-7-10 dRes. egzanTema polimorfulia, Serwymulia,
lokalizebulia saxsrebis irgvliv da avadmyofs awuxebs qavili.
wiTelasagan gansxvavebiT, enterovirusuli infeqciis gamonayriT mimdinare formis
dros belski-filatov-koplikis simptomi ar aris, gamonayars etapuroba ar axasiaTebs
da rbil sasaze SeiZleba iyos herpesuli gamonayari. avadmyofs aqvs Tavis tkivili,
Rebineba, meningealuri niSnebi. gamonayari vlindeba temperaturis normalizaciis Semdeg.
wiTela wlamde asakis bavSvebSi. 3 Tvemde asakis bavSvebSi wiTelaTi ar avaddebian,
rac ganpirobebulia dedisagan SeZenili pasiuri imunitetiT. orsulobis dros nayofis
adreul stadiaSi inficirebam SeiZleba gamoiwvios qvemwvave masklerozebeli encefaliti.
Tu dainficireba moxda orsulobis ukanasknel kviraSi, maSin SeiZleba daibados wiTelaTi
daavadebuli bavSvi an daavadeba gamovlindes pirvel dReebSive.
wlamde asakis bavSvebSi wiTelas klinika mozrdilebis klinikis identuria, magram
ufro xSirad gvxvdeba ati puri mimdinareoba waSlilidan agravirebul formamde. mag:
naklebadaa gamoxatuli kataruli periodi, SeiZleba ar iyos paTognomuri simptomi,
xSiria garTulebebi meoradi infeqciebis darTvis Sedegad da maRalia letaloba.
axalSobilebSi, diagnozis dadgenaSi, didi mniSvneloba aqvs anamnezs ( dedis daavadeba
orsulobis dros). axalSobilebSi imunologiuri tolerantobis gamo serologiuri
77
gamokvlevebi moklebulia diagnostikur mniSvnelobas.

mkurnaloba. avadmyofebi, umTavresad rCebian binis pirobebSi. hospitalizacia
warmoebs mxolod daavadebis mZime mimdinareobisas an epidCvenebiT (saerTo sacxovrebeli,
aradamakmayofilebeli pirobebi da sxva). stacionarSi avadmyofis izolireba xdeba
boqsebSi an saTanado, izolirebul palatebSi. didi mniSvneloba aqvs woliTi reJimis
dacvas, romelic grZeldeba temperaturis normalizaciidan 1-2 dRis Semdegac. avadmyofis
oTaxi saWiroa xSirad niavdebodes, daculi iyos tenianoba, ganaTeba, Tumca avadmyofs
Tvalebze mkafio sinaTle ar unda ecemodes. meoradi infeqciebis Tavidan acilebis
mizniT samedicino personalis raodenoba izRudeba. es exeba mcireasakovan bavSvebs,
romelTa Soris strepto- da stafilokokuri infeqciebis ganviTarebis saSiSroeba
didia. yuradReba eqceva piradi higienis dacvas: kanis xiluli lorwovani garsebis
tualeti, piris, xelebis dabana, abazanis miReba. keratitis profilaqtikis mizniT
Cirqsa da fufxs acileben Tbili wyliT an 2% sodis xsnariT, ris Semdegac TvalSi
awveTeben retinolacetatis 1-2 wveTs 3-4-jer dReSi.
cxviridan fufxis mocilebis Semdeg kargad moqmedebs fiziologiuri xsnaris,
vazelinis CawveTeba, xolo damskdar tuCebze vazelinis an sxva malamoebis wasma.
avadmyofma piris Rrus gasufTavebis mizniT unda miiRos siTxe, rac aadvilebs mis
gasinjvas. saWiroebisas iyeneben sedacias, anti piretikebs. gamoiyeneba A vitamini (6
Tvidan 1 wlamde asakSi 100.000 IU per os, ufro mozrdilebSi - 200.000 IU per os,
erTjeradad) 2 dRe zedized da 4 kviris Semdeg (Tu aris ofTalmologiuri problema).
dadgenilia, rom A vitaminis deficiti iwvevs avadobisa da sikvdilianobis zrdas
wiTelas dros.
dieta. ar unda SeizRudos vitaminebiT mdidari, srulfasovani, advilad asaTvisebeli
sakvebi. umTavresad iniSneba rZisa da mcenareulobis nawarmi Txier da naxevradTxier
mdgomareobaSi. avadmyofma yoveldRiurad unda miiRos 300-500mg askorbinis mJava.
mZime intoqsikaciis dros unda Catardes saTanado intensiuri Terapia
sadezintoqsikacio xsnarebiT _ ringeris laqtati, glukoza, reopoliglukini, albumini,
da sxva.
mZime laringitis dros SeiZleba saWiro gaxdes xorxis intubacia. traqeobronqitis,
otitis pnevmoniebis da agreTve sxva garTulebebis dros, romlebic ganpirobebulia
meoradi infeqciebiT, mkurnalobaSi erTveba farTo speqtris antibiotikebi Sesabamisi
dozebis mixedviT (asakisa da sxeulis masis gaTvaliswinebiT).
wiTelas virusze virussawinaaRmdego preparatebi ar moqmedeben.
profilaqtika. wiTelas sawinaaRmdego aqtiuri profilaqtika tardeba cocxali,
Sesustebuli vaqciniT, ris Sedegadac organizmi gamoimuSavebs aqtiur imunitets.
iSviaTad, daaxloebiT 2-5%-Si vaqcinaciis Semdeg bavSvebi SeiZleba daavaddnen wiTelas
ti puri mimdinareobiT, rac aixsneba antisxeulebis ararsebobiT. vaqcina keTdeba kanqveS
9-12 Tvis asakidan, zogierT qveynebSi meoradi revaqcinaciiT 4-6 wlis asakSi) da 90-
95% bavSvebis vaqcinaciiT xdeba daavadebis masiuri likvidacia (ifargleba erTeuli
SemTxvevebiT). bolo wlebSi mowodebulia vaqcina MMR wiTelas, wiTurasa da pa-
rotitis sawinaaRmdegod.
vaqcinaciidan me-7-15 dRes xdeba antisxeulebis gamomuSaveba, titri maRal cifrebs
aRwevs 1-2 TveSi, xolo me-4-6 Tvidan klebulobs, imunitetis xangrZlivoba sabolood
dadgenili ar aris; dakvirveba moicavs mxolod 20 wels.
10-11%-Si SeiZleba adgili hqondes e.w. vaqcinur process, romelic mimdinareobs
ZiriTadi paTogenezuri kanonzomierebiT, magram iol formebSi. SeiZleba gamomJRavndes
zemo sasunTqi gzebis sustad gamoxatuli katariT (xvela, surdo), koniunqtivitiT,
wvrillaqovani an papuluri gamonayriT. arCeven reaqciis msubuq, saSualo da mZime
78
wiTela
kerZo nawili. wiTura
formebs.
msubuqi mimdinareobisas temperatura 37,2-37,50 C-ia. saSualos dros 37,5-380 C,
mimdinareobs Tavis tkiviliT, anoreqsiiT, modunebiT. aRniSnuli movlenebi 2-3 dReSi
qreba.
vaqcinacia SeiZleba gaukeTdes infeqciis keraSi myof bavSvebs, rac zRudavs infeqciis
gavrcelebas. am dros vaqcinaze reaqcia ar Zlierdeba.
keraSi vaqcinacia efeqturia im SemTxvevaSi, roca igi tardeba kontaqtamde an
araugvianes 3 dRisa kontaqtidan.
pasiuri imunizacia xorcieldeba imunoglobulinis SeyvaniT kunTebSi (2,25 ml/
kg) - maqsimum 15 ml, ris Sedegadac SeiZleba Tavidan aviciloT daavadeba an mivaRwioT
mis msubuqad mimdinareobas. aseTive koncentraciiT eZlevaT specifikuri IgG intravenuri
imunoglobulinis saxiT. pasiuri imunizacia. pirvel rigSi utardebaT qronikulad
daavadebul mcire asakis bavSvebs, romelTac kontaqti hqondaT wiTelasTan stacionarebSi
an organizebul bavSvTa koleqtivebSi.
wiTura
(RUBEOLLA)
wiTura mwvave virusuli daavadebaa, romelic mimdinareobs organizmis susti

intoqsikaciiT, zemo sasunTqi gzebis msubuqad gamoxatuli katariT, koniunqtivitiT,
wiTelas msgavsi gamonayriT, periferiuli limfuri kvanZebis gadidebiTa da mtkivneulobiT,
gansakuTrebiT - kefis areSi. metsaxelad mas 3 dRian wiTelas an germanul wiTelas
eZaxdnen (germanuli wiTela - German measles,, Rubella (ingl)).
uwin wiTura iTvleboda msubuq infeqciad, romelic interess wiTelasTan
diferenciaciis gamo iwvevda. mas Semdeg, rac dadgenil iqna misi roli Tandayolili
mankebis da simaxinjeebis CamoyalibebaSi, misadmi interesi gaizarda. Tandayolili
wiTuras sindromi ganimarteba, rogorc mwvave kontagiozuri infeqcia rigi organoebis
dazianebiT, farTo speqtris klinikuri gamovlinebiT, xangrZlivi postnataluri periodiT
da virusis gamoyofiT.
1881w. londonSi gamarTul saerTaSoriso kongresze wiTura damtkicebul iqna
calke nozologiur erTeulad. 1938w. Hiro-s da Tasaka-s mier dadgenil iqna misi
virusuli etiologia. 1962w. Weller, Neva da Parkman-is mier virusi gamoyofil
iqna qsovilovan kulturebze. virusologiuri kvlevebiT dadginda, rom e.w. wiTuras
afeTqebebi, romlebic mimdinareobda msgavsi gamonayriT, ganpirobebuli iyo ECHO-s,
kerZod me-9 ti pis virusiT.
wiTuras virusi miekuTvneba Rubivirus-is gvars, Togaviridae-s ojaxs. aqvs sferuli
forma, diametriT 60-70nm-ia. Seicavs rnm-s, aqvs mxolod 1 antigeni. izrdeba qsovilovan
kulturebze. kargad izrdeba afrikuli nacrisferi maimunebis Tirkmlis epiTelur
ujredebze.
epidemiologia. infeqciis wyaroa avadmyofi an virusmtarebeli adamiani. gadacemis
epidemiologia
meqanizmi haer-wveTovania. virusis gamoyofa cxvir-xaxidan iwyeba gamoyramde 7-10
dRiT adre da grZeldeba 7 dRe da meti mis Semdeg.
nayofis dainficireba xdeba transplacenturad. Tandayolili wiTuras dros virusis
gamoyofa grZeldeba 1,5 _ 2 Tvemde. perioduli afeTqebebi aRiniSneba 3-5 weliwadSi
erTxel, xolo epidemiebi 6-9 weliwadSi erTxel. kontagiozuroba mWidro koleqtivebSi
Seadgens 100%-s, ojaxis pirobebSi 50-60%-s. dadgenilia, rom infeqciis kerebSi 1
79
avadmyofze modis 2 subklinikuri forma. dedisagan miRebuli imuniteti 6 Tvis

manZilze icavs bavSvs daavadebisagan. ZiriTadad avaddebian 5-dan 14 wlamde asakis
bavSvebi. daavadebas axasiaTebs sezonuroba da gvxvdeba, ufro xSirad, gazafxulze.
paTogenezi. virusi iWreba zemo sasunTqi gzebis lorwovan garsebSi, gadadis
limfur kvanZebSi, sadac mravldeba da gamoyramde 7-9 dRiT adre gadadis sisxlSi
(virusemia). am dros virusis gamoyofa xdeba cxvir-xaxidan, sisxlidan. gamoyrisas
virusi Cndeba SardSi, ganavalSi. virusi sisxlidan qreba gamoyridan 1 kviris Semdeg.
sisxlSi virusis cirkulaciis pasuxad Cndeba virusmaneitralizebeli antisxeulebi.
klinika. postnatalurad SeZenili wiTuras inkubaciuri periodi ganisazRvreba
klinika
15-24 dRiT, ufro xSirad Seadgens 16-18 dRes. xSirad prodromuli periodi ar aris
an SeumCneveli rCeba. zogjer aRiniSneba zemo sasunTqi gzebis sustad gamoxatuli
katari, surdo, xvela, koniunqtivebis hi peremia. aRniSnuli movlenebi qreba ramodenime
saaTidan _ 2 dReSi. sxeulis temperatura normaluria an subfebriluri _ 37,3-37,50
C, iSviaTad aRwevs 380 C-s da rCeba 2-3 dRe. ufro mozrdilebi SeiZleba uCiodnen
Tavis tkivils. pirveli simptomi, romelic
vlindeba, aris gamonayari; igi Cndeba saxeze,
kiserze da ramdenime saaTSi vrceldeba mTel
sxeulze; umTavresad gvxvdeba zemo kidurebis
gamSlel zedapirebze, dundulebze, zurgze.
gulmkerdze, mucelze da saxeze gamonayari
naklebadaa warmodgenili; igi laqovan-kvanZovani,
mkrTali mowiTalo ferisaa da zogjer aqvs
kanidan aweuli zedapiri. wiTelas
gamonayrisagan gansxvavebiT, ar axasiaTebs
Serwymisaken tendencia. zogjer aRiniSneba ufro
didi elementebi, magram isinic gamoirCevian
erTgvarovani sididiT da aqvT mrgvali an
ovaluri forma. Cveulebriv, wiTuras gamonayari
uxvad warmodgenili ar aris. wiTuras ti pur
simptomad iTvleba kefis, kisris ukana da sxva
limfuri kvanZebis gadideba, romelsac adgili
aqvs gamoyramde 1-3 dRiT adre da rCeba 10-14
dRe gamoyris Semdeg. gadidebuli kvanZebi
zogjer vizualuradac SeimCneva. gamonayramde
wiTuras gamonayari. (Korting G.W) rbil sasaze da loyis lorwovan garsebze
gvaqvs enanTema, magram arasodes ar aris belski-
filatov-koplikis laqebi. daavadebis dasawyisSi sisxlSi Cndeba umniSvnelo leikocitozi
neitrofiloziT, xolo gamoyris periodSi aRiniSneba leikopenia, SedarebiTi limfocitozi
da plazmuri ujredebis momateba 10-30%-mde.
gogonebsa da qalebSi xSirad gvxvdeba poliarTritis niSnebi, arTralgia, saxsrebis
SeSupeba da gadideba, magram aRniSnuli movlenebi qreba 10-14 dRis ganmavlobaSi.
Tandayolili wiTura. araiSviaTad nayofSi wiTura inaparantulad mimdinareobs,
rasac adasturebs garegnulad janmrTeli bavSvebis cxvir-xaxidan da Sardidan virusis
gamoyofa, sisxlSi specifiuri IgM dadgena. aseTi bavSvebi infeqciis wyaros warmoadgenen.
zogierT maTgans Semdgom TveebSi unviTardeba mZime mdgomareoba, romelic vlindeba
intersticiuli pnevmoniiT, gamonayriT, hi pogamaglobulinemiiT, T da B ujredebis
funqciis darRveviT, sxvadasxva nevrologiuri simptomatikiT da mTavrdeba sikvdiliT.
Tandayolili wiTuras sindromi gamoirCeva formirebuli mankis suraTiT dabadebisas;
80
misTvis damaxasiaTebelia triada

kataraqta (an retinopaTia), siyrue
(Surditae) da gulis mankebi (ductus
arteriosus, da filtvis arteriis
stenozi). aseve gamoxatulia
nevrologiuri darRvevebi (qcevis anu
bihevioraluri darRvevebi),
meningoencefaliti, mikrocefalia,
gonebrivi ganviTarebis CamorCena), aseve
fizikuri CamorCena, hepatosplenomegalia,
Trombocitopenia da kanis àlisferi~
dazianeba. triada pirvelad aRwerili
iqna avstralieli ofTalmologis
Cregg-is mier 1942 wels. aRniSnuli
sindromis dadgena dakavSirebulia
garkveul siZneleebTan (mag. siyruis
dadgena axalSobilebSi). Tvlian, rom Tandayolili wiTura. generalizebuli
nayofis inficireba xdeba virusemiis gamonayari (3 dRis asakis bavSvi).
dros, romelic grZeldeba daavadebidan (Kenneth Schiffer, Albert Einstein)
7-10 dRe. virusi azianebs qorionis
xaoebs, epiTeliums da placentis kapilarebis endoTeliums, saidanac wvrili embolebi
xvdebian sisxlSi da Semdeg vrceldebian qsovilebSi, viTardeba qronikuli infeqcia,
romelic Tandayolili mankebis mizezia.
mniSvnelovania, rom orsulobis ukve pirveli 3 Tvis manZilze unda gadaiWras
sakiTxi misi SenarCunebis Sesaxeb. usimptomo infeqciis dasadgenad tardeba ganmeorebiTi
serologiuri gamokvleva 10-20 dRis intervaliT.
diagnozi da diferenciuli diagnostika. diagnozi emyareba klinikur
simptomatikas: damaxasiaTebel gamonayars, romelic TiTqmis erTdroulad vrceldeba
mTel tanze, zemo sasunTqi gzebis sustad gamovlenil katarsa da koniunqtivits,
kefisa da kisris ukana limfuri kvanZebis adreul gadidebas (gamonayris gamoCenamde).
diferenciuli diagnozi unda gatardes Semdeg daavadebebTan: wiTela, qunTruSa,
medikamenturi egzanTema, mononukleozi, enterovirusuli infeqcia. wiTela gamoirCeva
wiTurasgan, pirvel rigSi, mkafiod gamoxatuli zemo sasunTqi gzebis katariT, prodromis
bolos laqovan-papuluri gamonayris etapobrivi gavrcelebiTa da misi metamorfoziT,
xolo gamoyramde 1-2 dRiT adre belski-filatov-koplikis paTognomuri simptomiT.
mxedvelobaSia misaRebi, rom periferiuli limfuri kvanZebis gamoxatuli gadideba,
gansakuTrebiT kefisa da kisris ukana areSi, wiTelasTvis damaxasiaTebeli ar aris.
wiTuras gansxvaveba mitigirebuli wiTelasgan qmnis erTgvar siZneles. aq
mniSvnelovania epidanamnezi da pasiuri imunizaciis mizniT imunoglobulinis Seyvana.
qunTruSis dros saxezea angina alisferi hiperemiiT, hiperemiul fonze Semofargluli,
wvrilwinwklovani gamonayari, rac araa damaxasiaTebeli wiTurasaTvis, kanis foni
normaluria da gamonayris Serwymis tendencia ar aRiniSneba. mniSvnelovania sisxlSi
sxvadasxva cvlilebebi.
egzanTemiT mimdinare enterovirusuli infeqcia wiTurasgan gansxvavebiT xasiaTdeba
mokle inkubaciuri periodiT da misTvis damaxasiaTebeli ara aris periferiuli
limfuri kvanZebis gadideba.
infeqciuri mononukleozi araiSviaTad mimdinareobs wiTuras msgavsi egzanTemiTa
da limfuri kvanZebis gadidebiT. am dros sadiagnostiko mniSvnelobisaa cvlilebebi
81
sisxlSi.
wiTuras msgavsi egzanTemiT mimdinareobs medikamenturi alergia. diferenciuli
diagnozisTvis gadamwyveti mniSvneloba aqvs limfuri kvanZebis gadidebas, anamnezs
(gamonayars medikamentebis miRebasTan dakavSirebiT) da wiTurasaTvis damaxasiaTebel
cvlilebebs sisxlSi.
laboratoriuli diagnostika xorcieldeba qsovilovan kulturebze nazaluri
sekretidan virusis gamoyofiT da serologiuri meTodebiT. Tandayolili infeqciis
dros virusis gamoyofa SesaZlebelia agreTve sisxlidan, Sardidan, Tavzurgtvinis
siTxidan. imuniteti wiTuras mimarT ganisazRvreba hemaglutininSemboWavi antisxeulebiT.
virusis diagnostikisTvis SemuSavebulia ramodenime iseTi axali meTodi, rogoricaa
gelSi hemolizi, lateqs-aglutinacia, imunofermentuli analizi, pasiuri hemaglutinacia,
imunofluorescenciis meTodi. Tandayolili wiTuras dros diagnozis dadastureba
SeiZleba ramodenime TveSi IgG-is specifikuri titris SenarCunebiT an misi zrdiT.
Tumca 1 wlamde asakSi, serologiuri gamokvlevis dadebiTi Sedegebi xSirad kargi
maCvenebeli ar aris.
prognozi. garTulebebi zogjer gvxvdeba nevritebis, arTritebis
garTulebebi da prognozi
saxiT; encefaliti iSviaTia (1 SemTxveva 6000 avadmyofze).
prognozi mozrdil bavSvebSi keTilsaimedoa, magram Tandayolili wiTuras dros
damokidebulia daavadebis simZimeze. encefalitis mkurnalobis Semdeg bavSvTa mxolod
30%-s ar rCeba motoruli funqciisa da fsiqikis gamoxatuli cvlilebebi.
mkurnaloba. rekomendebulia woliTi reJimi gamoyris periodSi. medikamentur
mkurnaloba
Terapias ar saWiroebs. erTeul SemTxvevebSi tardeba simptomuri an paTogenezuri
mkurnaloba.
profilaqtika. imunoglobulinis Seyvana 0,55 ml/kg orsulisaTvis xdeba ukidures
profilaqtika
SemTxvevaSi, roca orsulobis Sewyveta SeuZlebelia (igi garantias ar iZleva, rom
nayofs Tandayolili wiTura ar ganuviTardeba). sxva SemTxvevaSi imunoglobulinis
rutinuli gamoyeneba mizanSewonili ar aris.
aqtiuri imunizaciis mizniT amJamad gamoiyeneba RA 27/3 (adamianis embrionis
filtvebis fibroblastebSi gazrdili cocxali vaqcinis Stami (W11 _ 38 38) (aSS). sxva
vaqcinebTan (maT Soris HPV - 77 77) SedarebiT dadgenilia misi upiratesoba. igi
moqmedebiT axlos dgas bunebrivi infeqciis Sedegad ganpirobebul imunitetTan. vaqcina
keTdeba kanqveS, erTxel. profilaqtikis dros gansakuTrebuli mniSvneloba aqvs nayofis
daavadebis Tavidan acilebas. acras eqvemdebareba yvela bavSvi (gogonebi, biWebi) 15
Tvis asakidan, mozrdilebi, prepubertuli asakis gogonebi da hemaglutinaciis
damuxruWebis uaryofiTi reaqciis mqone qalebi.
aSS-s vaqcinaciis programiT gaTvaliswinebulia wiTuras sawinaaRmdego acrebi.
patara bavSvebis, mozardi biWunebisa da mamakacebis vaqcinacia mizanSewonilia im
TvalsazrisiT, rom isini wiTuras virusis gamavrceleblebi arian da orsuli qalisaTvis
potenciur saSiSroebas warmoadgenen. bolo dros wiTuras sawinaaRmdego vaqcinacia
SesaZlebeli gaxda kombinirebuli MMR-vaqciniT (wiTelas, parotitisa da wiTuras
sawinaaRmdego). am vaqcinis ganmeorebiT Seyvana wiTelas (Tu aseTi vaqcinaciaa kalendarSi)
asacrelad usafrTxoa.
82
kerZo nawili. parotituli infeqcia, epidemiuri parotiti
parotituli infeqcia, epidemiuri parotiti

(PAROTITIS EPIDEMICA)
parotituli infeqcia warmoadgens mwvave virusul, kontagiozur infeqcias,

romlisTvisac damaxasiaTebelia jirkvlovani organoebis, ufro xSirad, sanerwyve
jirkvlebis, gansakuTrebiT ybayuris, naklebad kuWqveSa, saTesle, sakvercxe da sarZeve
jirkvlis, agreTve, centraluri nervuli sistemis dazianeba (meningiti,
meningoencefaliti).
epidemiuri parotiti, rogorc nozologiuri erTeuli, gamohyo jer kidev hipokratem.
daavadebis Seswavla daiwyo XVIII saukunidan, rodesac Seicvala azri epidemiur
parotitze, rogorc adgilobriv daavadebaze. 1894w. À\Ä\ Ðîìàíîâñêèé-m aRniSna, rom
daavadeba SeiZleba mimdinareobdes centraluri nervuli sistemis dazianebiT, xolo
Í\Ô\ Ôèëàòîâ-ma miuTiTa, rom daavadeba azianebs ara marto sanerwyve jirkvlebs,
aramed saTesle jirkvlebsac. epidemiuri parotitis SeswavlaSi didi wvlili miuZRviT
rus mecnierebs: Ì\À\ Ñåëèìîâ-s, À\À\ Ñìîðîäèíöåâ-s, À\Ê\ Øóáëàäçå-s.
epidemiuri parotitis virusuli buneba daadgines Johnson-ma da Goodpasture-m
1934 wels. virusi ekuTvnis paramiqsovirusebis jgufs, cnobilia mxolod misi erTi
ti pi (Paramyxovirus Parotitis), Seicavs rnm-s, 120-300 nm zomisaa, brtyeli an
ovaluri formis. mravldeba sxvadasxva qsovilovan kulturaze, romelSic zogjer
aRiniSneba citopaTogenuri efeqti, magram ufro mgrZnobiare indikatorad iTvleba
hemadsorbcia. viruss naxuloben sisxlSi, Tav-zurgtvinis siTxeSi da sxva qsovilebSi.
organizmidan gamoiyofa nerwyviT da SardiT. mgrZnobiarea praqtikaSi miRebuli
sadezinfeqcio xsnarebis mimarT, gamZlea dabal temperaturaze(-20°C _ Zlebs 6-8 Tves,
xolo +18-20°C-ze _ 4-7 dRes). antibiotikebis mimarT mgrZnobiare ar aris.
epidemiologia. infeqciis wyarod iTvleba nebismieri formiT daavadebuli adamiani.
infeqciis gadacemis meqanizmi haer-wveTovania da wiTelasa da wiTurasagan gansxvavebiT
dainficirebisaTvis saWiroa axlo kontaqti. dadgenilia, rom virusi nerwyviT gamoiyofa
sanerwyve jirkvlebis gadidebamde 6 dRiT adre da grZeldeba 9 dRe mis Semdeg.
virusis gadacema ki intensiuri xdeba sanerwyve jirkvlebis gasivebamde 24 saaTiT
adre da wydeba ara ugvianes procesis Cacxrobidan 3 dRis Semdeg. SardiT gamoiyofa
1-dan 14 dRemde. avadmyofi maqsimalur saSiSroebas warmoadgens inkubaciis bolo da
daavadebis pirvel 3-5 dRes. gamoricxuli ar aris infeqciis gadacema nerwyviT
daWuWyianebuli saTamaSoebiT da sxva sagnebiT, Tumca am meqanizms did praqtikul
mniSvnelobas ar aniWeben. infeqcia gavrcelebulia mTels msoflioSi, magram am bolo
xanebSi aqtiuri imunizaciis gamo daavadebis maCveneblebi mkveTrad Semcirda. epidemiuri
afeTqebebi SesaZloa weliwadis nebismier dros, magram sezonuroba vlindeba zamTarSi
da gazafxulze. umTavresad avaddebian 1-dan 15 wlamde asakis bavSvebi; daavadebis
afeTqeba xdeba bavSvTa koleqtivebSi, yazarmul reJimSi myof axalwveulebSi da a.S.,
rac ganpirobebulia daavadebulTan mWidro kontaqtiT. wlamde asakis bavSvebSi daavadeba
iSviaTia, rac dedisagan miRebuli pasiuri imunitetis Sedegia. Tu orsulma mSobiarobamde
1 kviriT adre gadaitana epidemiuri parotiti, maSin axalSobils SeiZleba, hqondes
daavadebis klinikuri niSnebi an es niSnebi gamoixatos postnatalur periodSi. gadatanili
infeqcia tovebs mdgrad imunitets. daavadebis me-7-9 dRes organizms ukve gaaCnia
sruli imuniteti. ganmeorebiTi daavadeba Zalian iSviaTia.
daavadebis sikvdiliT damTavreba Zalze iSviaTia da aRwerilia 19 wlis zemoT.
orsulobis I trimestrSi virusma SeiZleba ganapirobos spontanuri aborti, Tumca
placentis gadalaxvis Sedegad Tandayolili simaxinjeebi damaxasiaTebeli ar aris.
83
e.w. `postvaqcinuri parotitis” klinika ara acriT, aramed sxva mizezebis damTxveviTaa
ufro gamowveuli.
paTogenezi. organizmSi virusis SeWra xorcieldeba sasunTqi gzebisa da piris
Rrus lorwovanidan, ar aris gamoricxuli koniunqtivac. epiTeliumSi gamravlebis
Semdeg virusi hematogenuri gziT vrceldeba mTels organizmSi da lokalizdeba
Sinagan organoebSi, pirvel rigSi azianebs jirkvlovan organoebs (ybayura, ybisqveSa,
enisqveSa, sanerwyve, saTesle jirkvlebi, sakvercxeebi, pankreasi) da centralur nervul
sistemas. sanerwyve jirkvlebSi xdeba virusis adaptacia, misi replikacia da dagroveba,
saidanac xorcieldeba meoradi viremia. daavadebis paTogenezSi didi roli eniWeba
nervuli sistemis dazianebas. amaze mowmobs Tundac is faqti, rom epidemiuri paroti-
tis umravles SemTxvevaSi adgili aqvs nervuli sistemis sxvadasxva xarisxis dazianebas.
Tav-zurgtvinis siTxeSi citozis momatebiT, raime gamoxatuli meningealuri movlenebis
gareSe da a.S.
zogierTi avtorebis monacemebiT dadgenilia, rom parotitis dros virurias adgili
aqvs 75%-Si. Tumca Tirkmlebis dazianeba bavSvebSi iSviaTia. amave dros aRwerilia
fataluri nefriti parotitis gadatanidan 10-14 dRis Semdeg. SesaZlebelia, Zalze
iSviaTad Trombocituri purpuris ganviTareba.
morfologiuri cvlilebebi parotituli infeqciis dros, ZiriTadad, eyrdnoba
sanerwyve jirkvlebis biofsirebul da maimunebze eqsperimentuli infeqciis monacemebs.
daavadebis dawyebidan 70 saaTis Semdeg biofsirebuli ybayura jirkvlis qsovilSi,
saidanac gamohyves virusi, aRiniSneboda acinozuri struqturis SenarCuneba, magram
sanerwyve sadinarebis irgvliv adgili hqonda SeSupebasa da limfocitur infiltracias,
romelic vrceldeboda SemaerTebel qsovilebze. ZiriTadi cvlilebebi naxuli iyo
sadinrebSi da meryeobda epiTeliumis umniSvnelo SeSupebidan erTeuli polimorfuli
ujredebis SemcvelobiT mis mTlian desqvamaciamde da sadinarebis obstruqciamde
ujreduli detritebiT. citoplazmis SeSupeba SemCneuli iyo erTeul SemTxvevebSi da
masSi iSviaTad naxulobdnen didi zomis bazofilur CanarTebs. parotituli orqitis
dros 1-2 dRis tkivilis Semdeg biofsirebul substratSi aRiniSneboda cvlilebebi
dawyebuli umniSvnelo intersticiuli SeSupebiT, spermatogenezis darRvevis gareSe,
damTavrebuli epiTeliumis mTliani daRupviT, perivaskulur nawilebze limfocituri
infiltraciiT. mZime SemTxvevaSi SesaZloa saTesle jirkvlis atrofia da amis Sedegad
sterilobis ganviTarebas.
kuWqveSa jirkvalSi mZime mimdinareobisas naxuloben nekrozuli xasiaTis
cvlilebebs, ziandeba rogorc endokrinuli, ise egzokrinuli sekreciis qsovilebi
pankreasSi.
parotitul
parotituli i meningitis dros adgili aqvs tvinis SeSupebas, hi peremias, serozul-
fibrinul eqsudacias. SeiZleba aRiniSnos kerovani da difuzuri encefalitis suraTi.
klinika. inkubaciuri periodi meryeobs 11-dan 24 dRemde, zogjer 26 dRemde,
klinika
saSualod Seadgens 17-18 dRes. iSviaTadaa gamoxatuli prodromuli periodi, romelic
mimdinareobs ybayura jirkvlis gadidebamde 1-2 dRiT adre saerTo sisustiT, temperaturis
momatebiT, Tavisa da kunTebis tkiviliT, gansakuTrebiT kisris midamoSi. ufro xSirad
daavadeba iwyeba mZafrad, temperaturis uecari momatebiT 39°C-mde, ybayura jirkvlis
calmxrivi an ormxrivi SeSupebiT da mtkivneulobiT. umTavresad gvxvdeba ybayura
jirkvlis calmxrivi gadideba, 1-3 dRis Semdeg amas SeiZleba daerTos meore jirkvlis
gadideba, Tumca daavadeba arcTu iSviaTad iwyeba orive jirkvlis gadidebiT. mogrZo
an ovaluri formis jirkvali SeigrZnoba qveda ybis gareTa kidis SigniT. es midamo
SeSupebuli, elastiuri da daWimulia, inarCunebs normalur fers. mtkivneuloba Zlierdeba
ReWvisa da ylapvis dros, agreTve mJave siTxeebis miRebisas nerwyvdenis gaZlierebis
84
gamo. SeSupeba aZnelebs ybayura jirkvlis

sazRvrebis dadgenas, romelic avsebs qvedaybis
kuTxes. yuris bibilo SeSupebis gamo win aris
wamoweuli. SeSupeba TandaTan cxreba da 3-7 dRis
Semdeg qreba, iSviaTad 2-3- dRis Semdeg an grZeldeba
ufro met xans. meore ybayura an sxva romelime
jirkvlis dazianeba iwvevs temperaturis axal
momatebas. ybayurisaTvis damaxasiaTebelia Semdegi
mtkivneuli wertilebi: gareTa sasmeni xvrelis
Sesasvlelis qveda kide, dvrilisebr morCsa da
qvedaybis tots Soris arsebuli ormo. am
wertilebis mtkivneuloba saSualebas iZleva
jirkvlebis umniSvnelo an saeWvo gadidebisas
daisvas parotituli infeqciis diagnozi. (Tumca
saeWvo SemTxveva saWiroa dadasturdes parotituli infeqcia. yurTan
serologiuri meTodebiT). ganlagebuli sanerwyve jirkvlis
piris RruSi ybayuris, ybisqveSa da enisqveSa dazianeba.
sadinrebis gamosvlis adgilis irgvliv lorwovani (Í.È. Íèñåâè÷, Â.Ô. Ó÷àéêèí)
garsi SeSupebulia da hi peremiuli. erTdroulad
SeiZleba adgili hqondes xorxisa da rbili sasis SeSupebas, nuSurebis cdomas;
aRwerilia xorxis mwvave SeSupebis suraTic. SeSupeba SeiZleba gavrceldes qveviT,
gulmkerdis zemo nawilis CaTreviT, rac gamowveulia limfostaziT da saWiroebs
toqsikuri difteriisagan diferenciacias.
parotituli infeqcia xSirad mimdinareobs talRiseburad, temperaturis ganmeorebiTi
matebiT, rac ganpirobebulia axali jirkvlovani organos an centraluri nervuli
sistemis procesSi CarTviT; SesaZlebelia daavadebis abortuli mimdinareobac. jirkvlebis
daCirqebas adgili ara aqvs.
klasifikacia. arCeven ti pur da ati pur formebs.
ti purs ekuTvnis: 1) yvela forma, romelic mimdinareobs nebismieri jirkvlovani
organos dazianebiT izolirebulad an kombinaciaSi, erTdroulad an TandaTanobiT
procesSi CarTviT.
2) cns-is da jirkvlovani organos an organoebis erTdroulad an TanmimdevrobiT
dazianeba.
ati purs ekuTvnis: 1) waSlili da 2)usimptomo formebi. ati puri formis dros
temperatura normaluria, ybayura jirkvlis Sesieba umniSvneloa, rac iwvevs diagnozis
daudgenlobas da epidemiur saSiSroebas. usimptomo formis dadgena SeiZleba mxolod
serologiuri gamokvlevebiT (antihemaglutininisa da komplementSemboWavi antisxeulebis
titri izrdeba). sxvadasxva avtorebis monacemebiT ati puri formebi gvxvdeba 20-40%
SemTxvevaSi.
ti pur
purii fo rma organoebis dazianebisa da intoqsikaciis xarisxis mixedviT iyofa:
forma
msubuq, saSualo da mZime mimdinareobad.
ybayura (parotiti) parotituli infeqciis yvelaze ufro xSiri gamovlinebaa.
10-15%-Si SeiZleba ganviTardes ybisqveSa jirkvlis gadideba (submaqsiliti). am dros
jirkvali Rebulobs ovalur an kvercxisebr formas da SeSupeba vrceldeba qveda ybis
win da qveviT. mtkivneuloba naklebadaa gamoxatuli, xolo involucia mimdinareobs
ufro nela, vidre ybayuris dros. submaqsiliti ufro xSirad ormxrivia da viTardeba
izolirebulad an ybayurasTan erTad.
enisqveSa sanerwyve jirkvlebis dazianeba izolirebulad iSviaTia da gvxvdeba
85
ybayurasTan erTad. misTvis damaxasiaTebelia mtkivneuloba nikapqveSa midamoSi da

enisqveSa qsovilebis SeSupeba, romelic vrceldeba kisris zeda nawilze.
sanerwyve jirkvlebis dazianebas Tan sdevs maTi sekreciuli funqciis darRveva.
fermentebis gamoyofa klebulobs 2-3-jer da funqciis aRdgena warmoebs Semdegi 3-4
kvira.
kuWqveSa jirkvlis CaTrevis dros saxezea pankreatitisaTvis damaxasiaTebeli
suraTi: temperaturis momateba, muclis SeteviTi xasiaTis tkivilebi Semosartyluli
zoniT, Rebineba, yabzoba, zogjer faRaraTi. sisxlSi da SardSi gvaqvs amilazis maRali
done, rac izolirebuli dazianebis dros warmoadgens diagnostikur siZneles. kuWqveSa
jirkvlis dazianeba SeiZleba ganviTardes meningitTan erTad, sanerwyve jirkvlebis
dazianebasTan erTdroulad, manamde an mis Semdeg.
sasqeso jirkvlebis dazianeba xSirad gvxvdeba ufrosi asakis bavSvebsa da
mozrdilebSi orqitisa da epididimitis saxiT. Cveulebrivad mimdinareobs sanerwyve
jirkvlebis an cns-is dazianebasTan erTad, izolirebulad Zalian iSviaTia. epidemiuri
afeTqebebisas xSirad (10-40%-Si) gvxvdeba orqoepididimitis SemTxvevebi. ybayura
jirkvlis gadidebidan 7-8 dRis Semdeg viTardeba orqiti, romelic 30%-Si ormxrivia.
misTvis damaxasiaTebelia uecari dawyeba
temperaturis momatebiT, SemcivnebiT,
Tavis tkiviliT. saTesle jirkvlebi
Supdeba da mkvrivdeba; kani SeSupebuli
da hi peremiulia, xolo jirkvlebi
mtkivneuli. anTebadi movlenebi 3-5
dReSi qreba, magram zogjer irRveva
spermatogenezi; sruli steriloba
iSviaTia. dadgenilia, rom
spermatogenezis darRveva SeiZleba
moxdes maSinac, roca infeqcia
mimdinareobs orqitis gareSe (Ã\À\
Òèìîôååâà).
prostatiti SeiZleba, ganviTardes
mozrdilebSi. misTvis damaxasiaTebelia
parotituli infeqcia. ormxrivi orqiti tkivilebi Sorisis midamoSi, swor
(Í.È. Íèñåâè÷, Â.Ô. Ó÷àéêèí) nawlavSi, gansakuTrebiT defekaciisa da
Sardvisas. TiTiT gasinjvisas dgindeba
gadidebuli da mtkivneuli prostata.
mastiti, ooforiti, barToliniti gogonebsa da mozrdil qalebSi, iseve, rogorc
mastiti kacebSi gvxvdeba iSviaTad da isic, sqesobrivi momwifebisas. ooforiti uecari
ganviTarebiT, maRali temperaturiT, mkveTri tkivilebiT emsgavseba mwvave apendicits.
daavadeba 1 kviraSi ukuganviTardeba, magram SeiZleba gamoiwvios steriloba.
Tireoiditi aseve iSviaTia da ybayura jirkvlis gadidebidan viTardeba 1 kviris
Semdeg. mimdinareobs maRali temperaturiT, kisris difuzuri gadidebiTa da tkiviliT,
taqikardiiT, oflianobiT, Tvalebis gadmokarkvliT.
siyrue. smenis nervis dazianeba umTavresad calmxrivia da 1500 avadmyofze modis
1 SemTxveva. siyrue SeiZleba iyos gardamavali an mudmivi.
Tvalis mxriv SeiZleba ganviTardes dakrioadeniti, optikuri nervis anTeba (papiliti),
mxedvelobis droebiTi (10-20 dRe) an mTliani dakargva da sxva.
miokarditi mZimed mimdinare iSviaTia, magram 13%-Si mozrdilebSi naxuloben ST-
segmentis daqveiTebas ekg-ze, riTac xsnian gulis midamoSi tkivilebs, bradikardias,
86
daRlilobas da sxva.
yvela aRniSnul dazianebas Tan erTvis infeqciis saerTo gamovlineba (temperaturis
momateba, tkivilebi da sxva). nebismieri izolirebuli formisas diagnozis dasma
Zlier gaZnelebulia. am dros didi mniSvneloba eniWeba laboratoriul kvlevas _
hemaglutinaciis damuxruWebis da komplementSemboWveli reaqciebiT antisxeulebis
titris dadgenas.
centraluri nervuli sistemis dazianeba ama Tu im formiT parotituli infeqciis
dros xSiria. serozuli meningitis sixSire meryeobs erTeuli SemTxvevidan 50-65%-
mde. zogjer, infeqciis erTaderT gamovlinebad iTvleba serozuli meningiti, romlis,
aseve SesaZloa erTaderTi gamovlineba iyos pleocitozi romelic limfocituri
xasiaTisaa da meryeobs 500-2000-mde 1ml-Si, Saqris normaluri da cilis umniSvnelo
matebiT. meningitis da meningoencefalitis klinika identuria imisa, rasac adgili
aqvs sxva serozuli meningitebisas. parotitis virusi arRvevs Tavzurgtvinis siTxis
cirkulacias da iTvleba hidrocefaliis ganviTarebis erT-erT mizezad. serozuli
meningitis gamosavali keTilsaimedoa, magram misi gadatanis Semdeg SeiZleba didxans
gagrZeldes postinfeqciuri asTenia. Tumca meningoencefaliti parotituli infeqciis
dros iSviaTia, magram misi mimdinareoba ufro mZimea da gadatanis Semdeg SeiZleba
darCes hi pertenziul-hidrocefaluri sindromi, epilefsia, siyrue, simsuqne da sxv.
axalSobilebSi da wlamde asakis bavSvebSi parotituli infeqcia mimdinareobs
ufro msubuqad da vlindeba parotitis an submaqsilitis saxiT. sxva jirkvlebis an
nervuli sistemis dazianeba ar gvxvdeba. parotituli infeqciis gadatanis Semdeg
orsulebSi SesaZloa abortis ganviTareba an nayofis dazianeba (Tumca Zalze iSviaTad).
fiqroben, rom zogjer endokrinuli fibroelastozi SeiZleba ganpirobebuli iyos
nayofis dainficirebiT muclad yofnisas.
diagnozi. ybayuris an masTan erTad sxva jirkvlovani organoebisa an cns-is
dazianebisas diagnozi mTlianad eyrdnoba klinikur suraTs. Tu daavadeba mimdinareobs
izolirebulad an kombinirebulad ybayura jirkvlis dazianebis gareSe, diagnostika
gaZnelebulia da moiTxovs epidsituaciis Seswavlas, kontaqtis dadgenas avadmyofTan.
laboratoriulad periferiul sisxlSi leikopenia da limfocitozia; zogjer
sisxlSi imatebs amilaza, rac dakavSirebulia sanerwyve jirkvlebis SeSupebasTan.
etiologiuri diagnozi xorcieldeba virusis gamoyofiT sisxlidan, nerwyvidan,
Sardidan, magram es dakavSirebulia siZneleebTan da daavadebis adreuli diagnostikisaTvis
ar gamodgeba. ufro xelmisawvdomi da martivia serologiuri reaqciebi _
komplementSemboWveli da hemaglutinaciis damuxruWebis, ifa. antisxeulebis aRmoCena
SeiZleba me-2-3 dRidan, xolo me-7-10 dRidan xdeba antisxeulebis zrdis konstatacia
4-jer da metad titrSi, rac udavod adasturebs parotituli infeqciis arsebobas da
vaqcinuri imunitetis diferenciacias. diagnostikuri mniSvneloba aqvs agreTve dadgenil
erTjerad 1:80 titrs. dadgenilia, rom klinikis mwvave periodSi SardSi aRiniSneba
S antigenisadmi antisxeulebis piki 75% SemTxvevaSi, romlebic 6-12 Tvis manZilze
TandaTan klebulobs. antisxeulebi V antigenis mimarT piks aRweven daavadebis 1 Tvis
bolos, klebuloben 2 wlis manZilze dabal donemde da rCebian didxans. antisxeulebis
aseTi dinamika gvexmareba, magaliTad parotituli meningoencefalitis dros etiologiuri
diagnozis dazustebaSi.
diferenciuli diagnozis gatareba saWiroa meoradi infeqciiT ganpirobebul mwvave
parotitebTan. am dros isini mimdinareoben baqteriuli daavadebis fonze (sefsisi,
pnevmonia, tifebi da sxva) garTulebis saxiT. xasiaTdebian Zlieri mtkivneulobiT,
kanis hi peremiiT, daCirqebiT, sisxlSi maRali neitrofiloziTa da lekocitoziT, edsi-
is momatebiT. ybisqveSa sanerwyve jirkvlebis dazianebisas, romelic kanqveSa qsovilebis
87
SeSupebiT mimdinareobs, saWiroa diferenciacia xaxis difTeriasTan. saSiSroeba iqmneba

maSin, roca difTerias Rebuloben parotitul infeqciad (ix. difTeria).
mwvave da qronikuli mowamvlisas (vercxliswyliT, tyviiT, foladiT) parotitis
garda saxezea sxva dazianebebic ( mag. RrZilebis, kbilebis). es ufro profesiuli
daavadebaa, iSviaTia da gvxvdeba mozrdilebSi.
citomegalovirusiT ganpirobebuli parotiti damaxasiaTebelia bavSvebisaTvis,
romelTac aqvT imunitetis mkveTri darRveva.
did siZneleebTanaa dakavSirebuli parotituli infeqciis dros ganviTarebuli
pirveladi serozuli meningitis garCeva sxva virusuli etiologiis serozuli
meningitebisagan (enterovirusuli infeqcia, poliomieliti). am dros saWiroa kontaqtis
dadgena parotitiT daavadebulTan da serologiuri reaqciebis Catareba
(komplementSemboWveli, hemaglutinaciis).
tuberkulozuri meningiti parotitulisagan gansxvavebiT viTardeba TandaTan da
ufro da ufro mZimdeba. Tav-zurgtvinis siTxeSi mkveTri cvlilebebia. citozi ufro
maRalia, Seicavs didi raodenobiT cilas, Saqari da qloridebi ikleben, araiSviaTad,
SeimCneva nazi fibrinis gamoyofa liqvoris Senaxvisas macivarSi.
garTuleba. 2 wlamde asakis bavSvebSi SeiZleba ganviTardes otiti, pnevmonia,
garTuleba
rac mwvave respiraciuli infeqciis darTvis Sedegia. prognozi keTilsaimedoa. orqitis
an ooforitis gadatanis Semdeg SesaZloa sterilobis ganviTareba. arsebobs monacemebi
mozrdilebSi parotitul pankreatitsa da diabets Soris kavSiris Sesaxeb.
mkurnaloba. mZime mimdinareobisas saWiroa hospitalizacia. mwvave periodSi
mkurnaloba
naCvenebia woliTi reJimi, siTxis uxvi miReba, piris Rrus higiena _ yoveli Wamis
Semdeg 2%-iani natriumis hidrokarbonatis an boris mJavas xsnaris gamovleba.
hi perTermiis dros saWiroa anti piretuli saSualebebi (paracetamoli) asakobrivi
dozis gaTvaliswinebiT, dazianebul jirkvalze mSrali siTbo. saWiroa Txieri dieta
cilisa da cximis SezRudviT pankreatitis dros; venaSi uniSnaven kontrikals, trasilols
an proteolizuri fermentebis sxva inhibitorebs, epigastriumis midamoSi sicives.
meningitis dros naCvenebia lumbaluri punqcia, rac, garda diagnostikuri mniSvnelobisa,
amcirebs qalasSida wnevas, Tavis tkivils, Rebinebas. utardebaT dehidrataciuli Terapia
_ venaSi 20-40% glukozis xsnari, laziqsi, eZlevaT diakarbi da sxva, vitamini C da
B1. aris monacemebi, rom interferoniT (kunTebSi SeyvaniT) mkurnalobisas nevrologiuri
statusi umjobesdeba da xdeba liqvoris sanacia.
orqitis dros uniSnaven suspenzoriebs, antianTebiT preparatebs, iSviaTad
antihistaminur preparatebs da prednizolons 2 mg/kg dRe-RameSi 3-5 dRe, radgan
Tvlian, rom orqitis paTogenezSi didi mniSvneloba eniWeba autoimunur procesebs.
virussawinaaRmdegod iyeneben ribonukleazas 0,5 mg/kg 4-jer dReSi 5-10 dRis ganmavlobaSi
(zogierTi avtoris rCeviT). preparati moqmedebs, rogorc virusis replikaciis
damrTgunveli, anTebadi procesis SemzRudveli da, amave dros, imunogenezis stimulatori.
Tumca am mkurnalobisas aRweven uSualo efeqts, magram mZime formebis dros Soreul
periodSi (1-3 wlis Semdeg) SeiZleba ganviTardes saTesleebis atrofia.
profilaqtika. avadmyofi koleqtividan unda iyos izolirebuli 9 dRiT, klinikuri
suraTis moxsnamde, xolo Tu dawesebulebebSi imyofebian aucreli pirebi saWiroa
maTi dauyovnebliv acra da SemdgomSi SeiZleba maTi dabruneba koleqtivSi. Tu acras
raime ukuCveneba aqvs, aseTi piris koleqtivSi daSveba ar SeiZleba 26 dRis ganmavlobaSi.
aqtiuri imunizacia tardeba atenuirebuli cocxali vaqciniT raime gverdiTi
movlenebis gareSe. vaqcinirebulT ar aReniSnebaT virusis gamoyofa da ar arian
saSiSi sxvisTvis; iSviaTad vaqcinaciidan 10-17 dRis Semdeg viTardeba parotiti.
vaqcinis efeqturoba aRiniSneba 97%-Si.
88
bolo wlebSi saqarTveloSi xelmisawvdomi gaxda vaqcina MMR (parotitis, wiTelas

da wiTuras sawinaaRmdego kombinirebuli vaqcina merkSarp da doiumis (aSS) firmisa.
SesaZlebelia am vaqciniT epidCvenebis mixedviT mozrdilebisa da mozardebis, iseve,
rogorc mcire asakis bavSvTa vaqcinacia. imuniteti praqtikulad mTeli sicocxlis
manZilze grZeldeba. ukuCvenebas ar warmoadgens romelime zemoaRniSnuli daavadebis
gadatana an anamnezSi maTi sawinaaRmdego acrebis faqti.
kalendaruli gegmiT ki imunizacia utardebaT 15-18 Tvis asakSi erTjeradi
SeyvaniT.
dezinfeqcia avadmyofis hospitalizaciis Semdeg ar tardeba.
89
kerZo nawili. herpesis ojaxis
virusebiT gamowveuli daavadebebi. martivi (ubralo) herpesi
herpesis ojaxis virusebiT

gamowveuli daavadebebi
martivi (ubralo) herpesi

(HERPES SIMPLEX)
martivi herpesuli infeqcia klinikurad vlindeba mTeli rigi organoebisa da

qsovilebis dazianebiT (lorwovani, kani sasqeso organoebi, cns), jgufuri buStukovani
gamonayriT kansa da lorwovan garsebze da axasiaTebs latenturi mimdinareoba perioduli
recidivebiT.
virusi, 1912 w. gamohyo V. Grüter-ma. man rqovanis buStukovani SigTavsis SeyvaniT
daavadeba gamoiwvia jer bocvrebSi, Semdeg adamianebSi. 1921 w. Lipschütz-ma aRmoaCina
virusuli infeqciis paTognomuri niSani - acidofiluri CanarTebi dazianebuli
qsovilebis birTvebSi. aRniSnuli infeqciis SeswavlaSi didi roli miuZRviT rus
mecnierebs _ À\Ê\ Øóáëàäçå
Øóáëàäçå-s, Ò\Ì\ Ìàåâñêàÿ
Ìàåâñêàÿ-s, È\Ô\ Áàðèíñêèé
Áàðèíñêèé-s.
martivi herpesis gamomwvevi virusi - Herpesvirus hominis (HSV) Tavisi
biologiuri da antigenuri TvisebebiT iyofa or Stamad _ HSV-1 da HSV-2. pirveli
azianebs kansa da lorwovans, SeiZleba daazianos genitaliebic, xolo meore - sasqeso
organoebs da iwvevs daavadebebs axalSobilebSi.
virusi Seicavs dnm-s. kargad izrdeba qaTmis embrionis alantoisur membranebze.
inficirebul ujredebSi warmoqmnis birTvSida CanarTebs da gigantur ujredebs. HSV-
s garsi warmodgenilia glikoproteinebiT (mag. B1 C1 D1)_ isini imunuri pasuxis
samiznes warmoadgenen.
arCeven infeqciis 2 formas. pirveladsa da morecidives.
1. pirveladi infeqcia yalibdeba adamianis pirveladi kontaqtiT avadmyofTan ar
virusmtarebelTan. umravles SemTxvevaSi raime klinikuri suraTi ar aRiniSneba; erTeul
SemTxvevaSi adgili aqvs saerTo mdgomareobis darRvevasa da zedapirul adgilobriv
cvlilebebs. axalSobilebsa da hi potroful bavSvebSi viTardeba mZime mdgomareoba,
xSirad adgilobrivi cvlilebebis gareSe, magram daavadeba SeiZleba damTavrdes sikvdiliT.
pirveladi infeqciis gadatanis Semdeg sisxlSi vlindeba specifikuri antisxeulebi
virusis mimarT.
2. morecidive forma persistirebuli infeqciis, garkveuli antisxeulebis raodenobis
mqone organizmSi, gaaqtivebis Sedegia. recidivebi dakavSirebulia organizmis
rezistentobis daqveiTebasTan arasfecifikuri faqtorebis zemoqmedebiT (ultraiisferi
sxivebi, menstruacia, cxeleba, emociuri stresi). dazianebas, rogorc wesi, lokaluri
xasiaTi aqvs da generalizacias ar ganicdis.
epidemiologia. infeqcia farTodaa gavrcelebuli adamianebSi. infeqciis wyaros
epidemiologia
warmoadgens avadmyofi an virusmtarebeli. infeqciis gadacema warmoebs kontaqturi,
sqesobrivi da haerwveTovani gziT. zogjer igi nayofisaTvis aRmaval infeqcias
warmoadgens. am dros virusi nayofSi aRwevs TiTqos sruliad intaqturi garsebidan.
axalSobilebis herpesuli infeqcia umetes SemTxvevaSi HSV-2 2-iTaa gamowveuli, HSV--
1-iT ki _ mxolod 15-20%-iT. Tandayolil simaxinjeebs virusi iSviaTad iwvevs.
90
vaginaluri gziT mSobiarobis dros dedisagan pirveladi infeqciis arsebobis SemTxvevaSi,

axalSobils infeqti gadaecema 33-50%-Si. morecidive infeqciis SemTxvevaSi ki _ 3-
5%-Si. aSS-Si mSobiarebSi HSV aRiniSneba 0,01-0,39% SemTxvevaSi. xSirad anamnezSi
dedebi mwvave infeqcias ar aRniSnaven.
dadgenilia, rom mxolod 6 Tvemde asakis bavSvebs gaaCniaT dedisagan transplacenturi
gziT SeZenili antisxeulebi. 4 wlamde asakis bavSvebSi antisxeulebis titri HSV-
is mimarT SesamCnevad matulobs da 14 wlisTvis mniSvnelovnad iklebs. 14 wlis
asakidanve aRiniSneba maRali titri HSV-2-is mimarT.
pirveladi infeqciis gadatanis Semdeg adamiani xdeba virusmtarebeli TiTqmis
yovelTvis maRali titris antisxeulebiT; titris daklebisas viTardeba recidivebi,
romelic xSirad usimptomod mimdinareobs. recidivebi meordeba manam, sanam ar iqneba
miRweuli antisxeulebis stabilizacia maRal doneze.
Cveulebriv. gvxvdeba sporaduli SemTxvevebi, Tumca mWidro koleqtivSi, stacionarebSi
SesaZloa infeqciis afeTqeba, gansakuTrebiT zamTarSi.
paTogenezi: virusi organizmSi iWreba kanidan da lorwovani garsebidan. virusi
paTogenezi
umTavresad mravldeba SeWris adgilas herpesuli gamonayris warmoSobiT. gamonayari
xasiaTdeba epidermisis eqsudaciuri anTebiT da epiTuliumis degeneraciuli movlenebiT.
herpesuli infeqciisTvis damaxasiaTebel specifikur morfologiur niSans miekuTvneba
citologiuri reaqcia, romelic vlindeba ujredTa birTvSi homogenuri qromatuli
nivTierebis CarTviT. vezikulur siTxeSi aRiniSneba epiTeluri mravalbirTviani giganturi
ujredebi da leikocitebi. buStukebis gaskdomis Semdeg Rru ivseba fibriniTa da
buStukebis narCeni kanis feniT, rac xels uwyobs nacrisferi apkis ganviTarebas.
hematogenuri diseminacia xdeba axalSobilebSi, distrofiul pirebSi, egzemis dros,
ujreduli imunitetis darRvevisas da sxva. viremiis gamo ziandeba Sinagani organoebi;
maTSi virusis gamravlebis Sedegad xdeba meoradi viremia. encefaliti mozrdilebSi
ganpirobebulia HSV-1 virusis SeWriT tvinSi nervuli boWkoebis saSualebiT, xolo
HSV-2-isa ki hematoencefaluri barieris gavlis gziT. sisxlSi Cndeba
virusmaneitralebeli da komplementSemboWavi antisxeulebi, magram virusis susti
interferonogenuri moqmedebis gamo dnm ar inaqtivirdeba, riTac unda aixsnas virusis
xangrZlivi persistencia organizmSi.
klinika. inkubaciuri periodi meryeobs 2-dan 14 dRemde (saSualod 4-5 dRe),
klinika
axalSobilebSi daavadeba gamoxatulia dabadebisTanave an gamovlindeba 4-6 kviris
Semdeg. infeqciis gamovlineba mravalferovania da damokidebulia dazianebis
HSV - meningoencefaliti. rekonvalescenciis HSV - vezikuluri gamonayari tuCebze.

periodi. marjvena kiduris dambla. (Herpes labialis)
(sakuTari masala) (Í.È. Íèñåâè÷, Â.Ô. Ó÷àéêèí)
91
lokalizaciaze. rogorc zemoT iyo naxsenebi, iSviaTia viremiis Sedegad procesis

generalizacia da amiT ganpirobebuli Sinagani organoebis, maT Soris nervuli sistemis
dazianeba.
arCeven Semdeg klinikur formebs.
1. kanis dazianeba (tuCebis, cxviris, saxis, xelebis da a.S.), egzema herpetikum
(kapoSis variceliformuli dazianeba);
2. lorwovani garsebis dazianeba (stomatiti, gingiviti, tonziliti da sxva);
3. Tvalis dazianeba (koniunqtiviti, blefariti, keratiti, keratoiridocikliti,
qorioretiniti, uveiti, Tvalis baduris perivaskuliti, mxedvelobis nervis anTeba);
4. genitaluri forma (asos lorwovanis dazianeba, vulvis, saSos, Sorisis, ureTris,
endometriumis dazianeba da sxva);
5. nervuli sistemis dazianeba (encefaliti, meningoencefaliti, nevriti da sxva).
6. visceruli forma (pnevmonia, hepatiti da sxva)
herpesuli keratiti. wertilovani herpesuli keratiti

(Å.È. Êîâàëåâñêèé) autsisxli koniunqtivis qveS, rqovanaSi
`Cazrdilia~ sisxlis ZarRvebi.
(Å.È. Êîâàëåâñêèé)
metaherpesuli keratiti. 6-Tvis bavSvi. kaklis

mwvave ineqcia, anevrizmatulad gafarToebuli kontagiozuri moluski.
sisxlZarRvebi rqovanas sxvadasxva SreSi. (Å.È. Êîâàëåâñêèé)
(Å.È. Êîâàëåâñêèé)
92
kanis herpesuli 1 2
gamonayari. xSirad
gamonayari
gamonayari viTardeba
piris irgvliv, tuCebze
(herpes labialis),
cxvirze (herpes nasa-
lis), yuris niJaraze
(herpes oticum) da a.S.
SeiZleba iyos misi
nebismieri lokalizacia,
magram igi ufro metad
viTardeba kanisa da 3 4
lorwovanis sazRvarze.
damaxasia-Tebeli
morecidive gamonayaric
ufro xSirad am
adgilebze gvxvdeba.
zogjer, gamoyramde 1-2
dRiT adre, iq, sadac
SesaZloa gamovlindes
herpesi, avadmyofi uCivis
wvis da Cxvletis herpesuli infeqcia (HSV)
SegrZnebas, qavils, mcire 5 1. pirveladi HSV -
tkivilsa da daWimvas. gingivostomatiti bavSvebSi
2. pirveladi HSV -
elementebi 0,1-0,3 sm gingivostomatiti mozrdilebSi
zomisaa buStukebi 3. pirveladi HSV -I
Txelkedliania, maT vulvovaginiti wlamde asakSi
irgvliv kani 4. pirveladi HSV -
keratokoniunqtiviti
SeSupebulia da 5. herpesuli vezikulis
hi peremiuli, SigTavsi bioftati. eozinofiluri
gamWvirvale serozuli birTvSida CanarTebi da
siTxea, romelic giganturi ujredebi.
(Blanck H, Rake G)
SeiZleba aimRvres an
hemoragiuli gaxdes.
ramdenime dReSi buStukebi skdeba da saerTo fufxis gakeTebis Semdeg unawiburod
qreba, SeiZleba darCes xanmokled susti pigmentacia. meoradi infeqciiT garTulebisas
saWiroa kontagiozuri diferenciacia impetigosTan. erTeul SemTxvevebSi SeiZleba
gamovlindes generalizebuli buStukovani gamonayris saxiT, am dros diferenciacia
tardeba CutyvavilasTan. kanis travmuli dazianeba xels uwyobs imave adgilze herpesuli
gamonayris ganviTarebas; magaliTad, xelis an fexis Wrilobisas meore-mesame dRes
vlindeba herpesi. zogjer gamonayari vrceldeba limfuri gziT (limfadenitis
ganviTarebiT) janmrTel kanze, rac msgavsebas qmnis sartylisebr herpesTan, gansakuTrebiT
maSin, roca am adgilSi gamoxatulia nevralgia. travmis adgilas xSiria gamonayris
recidivebi, rac zogjer bulozuri formis ganviTarebas iwvevs.
gakawrul kanSi virusis SeWra samedicino personalsa da moWidaveebSi araiSviaTad
ganapirobebs herpesul gamonayars (`gladiatorebis herpesi~), gansakuTrebiT mtkivneulia
da Rrma dazianebiT gamoirCeva herpesuli infeqcia frCxilebTan kanis gakawvrisas.
Sexorceba spontanurad mimdinareobs 2-3 kviraSi da qirurgiul Carevas ar saWiroebs.
93
arCeven herpesuli infeqciiT kanis lokalur da gavrcelebul dazianebas. pirvel

SemTxvevaSi zogadi mdgomareoba umTavresad ar irRveva, temperatura rCeba normis
farglebSi. meore formisas temperaturam SeiZleba miaRwios 39-400C. zogjer aRiniSneba
Tavis tkivili, saerTo sisuste, kunTebis tkivili, maRali intoqsikaciis fonze SesaZloa
Rebineba, krunCxvebi. daavadebis pirvel sam dRes erTdroulad sxvadasxva adgilebSi
tanze, saxeze, xelebze viTardeba buStukovani gamonayari regionuli limfadenitiT,
RviZlis gadidebiT, daavadeba grZeldeba 2-3 kvira.
mwvave herpesuli gingivo-stomatiti (mwvave infeqciuri stomatiti) SeiZleba
iyos pirveladi herpesuli infeqciis gamovlineba, rac ufro xSiria 1-3 wlis asakis
bavSvebSi, ufro mozrdilebSi ki _ iSviaTi. avadmyofebi uCivian tkivilebs piris
RruSi, nerwyvdenas, temperatura iwevs 400C-mde, gaZnelebulia saWmlis miReba. loyebisa
da RrZilebis lorwovan garsebze viTardeba buStukovani gamonayari, romelic male
skdeba da warmoSobs 1-10 mm-mde zomis erozias an wyluls, romelic ifareba
monacrisfro-moyviTalo nadebiT; aRiniSneba ybisqveSa limfadeniti da procesSi SeiZleba
CaerTos nuSurebi. am dros saWiroa diferenciacia vulgarul anginebTan.
morecidive stomatiti SeiZleba mimdinareobdes lokalurad - rbil sasaze an
tuCebTan axlos, temperaturuli reaqciiT. zogierT avadmyofSi tuCebze an kanis sxva
adgilebSi recidividan 7-10 dRis Semdeg regularulad viTardeba herpesuli gamonayari,
SeiZleba daerTos polimorfuli gamonayari eriTemis saxiT, gavrcelebuli stomatiti.
Tvalis dazianeba SeiZleba ganapirobos, rogorc pirveladma herpesulma infeqciam,
aseve morecidive formam. pirvel SemTxvevaSi Tvali ziandeba izolirebulad, xolo
meoris dros Tvalis dazianeba Serwymulia kanisa da lorwovani garsebis dazianebasTan.
ofTalmoherpesi infeqciis mZime gamovlinebaa da mimdinareobs folikuluri, kataruli
an vezikulur-wylulovani koniunqtivitiT. am dros koniunqtiva SeSupebulia da
hiperemiulia, aRiniSneba Cirqdena da blefarospazmi, pirveladi infeqciis dros saxezea
regionuli limfadeniti. herpesuli procesis gaRrmavebisas viTardeba
keratokoniunqtiviti, uveiti, kataraqta, qorioretiniti, ramac SeiZleba ganapirobos
mxedvelobis dakargva, gansakuTrebiT axalSobilebSi.
genitaluri herpesi. mcire asakis bavSvebSi genitaliebis inficireba xdeba
meoradad, sxva organoebis dazianebasTan erTad. infeqciis gadatana xdeba WuWyiani
xelebiT, xelsaxociT, sacvlebiT, mSobiarobisas axalSobilebis dainficireba avadmyof
mSoblebTan kontaqtis Sedegia. genitaluri herpesuli infeqcia SeiZleba mimdinareobdes
qronikulad da recidivebiT. genitaluri herpesi ufro mozrdilebis daavadebaa, romelic
sqesobrivi kontaqtis dros gadaecema da rigi ojaxebisaTvis problemas warmoadges.
dadgenilia, rom mcire asakis bavSvebSi 5-10%-Si inficireba gamowveulia HSV-1
StamiT. mozrdilebSi genitaliebis dainficireba gamowveulia HSV-2 StamiT. daavadeba
iwyeba im SemTxvevaSi, roca sisxlSi virussawinaaRmdego antisxeulebi ar aris. avadmyofis
saerTo mdgomareoba irRveva, temperatura imatebs, diddeba regionuli limfuri kvanZebi,
viTardeba dizuriuli gamovlinebebi. hi peremiuli da SeSupebuli genitaliis kansa da
lorwovanze herpesuli gamonayari vlindeba eroziuli da wylulovani elementebis
saxiT. gogonebSi gamonayari SeiZleba iyos did da mcire bageebze, Sorisze, barZayebis
medialur napirebze, saSos lorwovanze, klitorze, anusze. qalebSi procesSi SeiZleba
CaerTos saSo da vulvac, magram pirveladi infeqcia lokalizdeba saSvilosnos yelze,
misTvis damaxasiaTebelia recidivebi, romelic mimdinareobs raime klinikuri simptomatikis
gareSe; swored es adgili warmoadgens infeqciis wyaros axalSobilebisaTvis
mSobiarobisas. varaudoben, rom HSV-2 Stami SeiZleba iyos saSvilosnos yelis karcinomis
mizezi. biWebSi herpesuli gamonayari lokalizdeba asos Tavze, saTesle parkis kanze
da SeiZleba gavrceldes Sardis buStzec.
94
nervuli sistemis dazianeba ufro xSiria axalSobilebsa da mcire asakis

bavSvebSi da Cveulebriv, viremiis Sedegia. imunitetisa da cilovani cvlis mkveTri
darRvevisas lokalurma herpesulma infeqciam SeiZleba miiRos virusis hematogenuri
diseminaciis xasiaTi da ganapirobos nervuli sistemis iseTi dazianeba, rogoricaa:
encefaliti, meningiti, meningoencefaliti, meningoencefaloradikuliti. letaluri
gamosavlisas seqciaze naxuloben tvinis qerqis mwvave hemoragiul dazianebas umTavresad
Sublis, safeTqlis da kefis wilebSi, rasac Tan axlavs perivaskuluri limfohistocituri
da leikocituri infiltracia oqsifilurbirTviani CanarTebiT. klinikuri suraTi ar
gamoirCeva raime TaviseburebiT sxva virusuli etiologiis nervuli sistemis
dazianebisagan, letaloba aRwevs 40%-s, xolo infeqciis gadatanis Semdeg, miuxedavad
swori mkurnalobisa, aRiniSneba gamoxatuli nevrologiuri defeqtebi.
generalizebuli, sistemuri herpesuli infeqcia. daavadeba axalSobilebis
xvedria. maTi dainficireba xdeba HSV-2 StamiT mSobiarobis dros samSobiaro gzebis
gavlisas an sanayofe wylebis daRvrisas. orsulebi, romlebic dainficirebulni arian
herpesuli infeqciiT, zogjer ar uCivian herpesul gamonayars, aseve axalSobilsac
SeiZleba gamonayari ar hqondes, magram iyos sxva gamovlineba, rogoricaa hialinuri
membranebis daavadeba, pnevmonia da sxva. am SemTxvevaSi diagnozi dgindeba laboratoriuli
kvlevebiT. generalizebuli formisas zogjer saxezea gavrcelebuli gamonayari kanze,
xaxis lorwovanze, saylapavze; procesSi erTveba Sinagani organoebi - filtvebi,
Tirkmelzeda jirkvlebSi, RviZli da sxva. daavadeba Rebulobs sefsisur mimdinareobas.
dRenaklul axalSobilebSi meningoencefaliti mosalodnelia dabadebidan 11-20 dRis
manZilze.
generalizebuli herpesuli infeqciis erT-erT formas warmoadgens kapoSis
herpetiformuli egzema (pirvelad aRwera ungrelma dermatologma 1887w.). es daavadeba
literaturaSi cnobilia sxvadasxva saxelwodebiT - vaqcinoformuli pustulozi,
kapoSi-iulsbergis mwvave varioloformuli pustulozi. umTavresad avaddebian egzemiT
da neirodermitebiT Sepyrobilni. am formis inkubaciuri periodi xanmoklea da
Seadgens 3-5 dRes. iwyeba uecrad, temperatura matulobs 39-400-mde, toqsikozi
progresirebs swrafad, viTardeba krunCxvebi, gonebis dakargva da a.S. gamonayari Cndeba
pirvel 3 dRes da perioduli xasiaTisaa 2-3 kviris manZilze. gamonayarma SeiZleba
miiRos Wi pis msgavsi forma, xSirad warmoiSoba farTo fufxiseburi zedapiri,
mosalodnelia nawiburebis ganviTareba. mZime mimdinareobisas adgili aqvs Sinagani
organoebisa da centraluri nervuli sistemis dazianebas.
visceruli formebisas SeiZleba ganviTardes hepatiti, pnevmonia, nefriti da
sxva. hepatiti viTardeba axalSobilebSi da warmoadgens generalizebuli formiT
gamowveul dazianebas. klinikurad vlindeba organizmis zogadi intoqsikaciiT, RviZlis
gadidebiT, siyviTliT, RviZlis fermentebis aqtivobiT da a.S. pnevmonia da nefriti
raime klinikuri TaviseburebebiT ar gamoirCeva sxva etiologiiT gamowveuli
dazianebisagan.
diagnozis dadgena ZiriTadad eyrdnoba: 1. klinikur simptomatikas; 2. dazianebuli
adgilebidan saTanadod fiqsirebuli da SeRebili nacxebis mikroskopiiT mravalbirTviani
ujredebis birTvSida CanarTebis aRmoCena adasturebs herpesul infeqcias; 3. daavadebis
dinamikaSi antisxeulebis titris zrdis dadgena ELISA da mafluorescencirebuli
antisxeulebis gamoyenebiT; 4. virusuli gamokvleva embrionuli qsovilebis kulturaze
buStukovani SigTavsis, cxvir-xaxis Camonarecxis, zurgis tvinis siTxis daTesvis
Sedegad virusis gamoyofa an ti puri birTvSida CanarTebis dadgena (li pSutcis
nawilakebi); 5. virusis antigenebis dadgena da dnm-is aRmoCena masalaSi polimerazuli
jaWvuri reaqciiT.
95
prognozi damokidebulia klinikur formaze. pirvelad herpesul infeqcias

umTavresad axasiaTebs spontanuri klinikuri gajansaReba. generalizebuli herpesuli
infeqciisas prognozi seriozulia, axalSobilebSi aRiniSneba letaloba, ufro
mozrdilebSi distrofiul egzemas an neirodermits arakeTilsaimedo mimdinareoba
aqvs. maRali letalobiT gamoirCeva infeqcia sefsisuri mimdinareobisas, encefalitisa
da meningoencefalitis dros.
ofTalmoherpesuli infeqciisas SeiZleba Tvalis rqovanaze nawiburebis ganviTareba
da mxedvelobis dakargva.
mkurnaloba. im orsulebSi, romlebmac mSobiarobamde cota xniT adre gadaitanes
mkurnaloba
martivi herpesi an mSobiarobis dros aqvT aqtiuri procesi, xolo wylebis daRvris
Semdeg gavida 4-6 saaTze naklebi, amave dros axalSobilis filtvi momwifebulia
sasurvelia Catardes sakeisro kveTa, rom ar moxdes axalSobilis inficireba. sanayofe
wylebis daRvridan 4 sT-is Semdeg am operacias azri ara aqvs, radgan SesaZloa
ganviTardes aRmavali infeqcia.
kanisa da lorwovanis dazianebisas adgilobrivad gamoiyeneba sxvadasxva malamoebi:
0,5% acikloviri, 0,5% florenalis, 0,25-0,5% Tebrofenis, 0,25-0,5% riodoqsalis
da sxva.
efeqturi aRmoCnda interferonis 50%-iani malamo safenebis, gamovlebis da
instilaciis saxiT. antiseptikuri saSualebebidan iyeneben briliantis mwvanis 1-2%-
ian da meTilenis lurjis 1-3%-ian spirtxsnarebs. piris Rrusa da RrZilebis
dasamuSaveblad 3%-iani wyalbadis zeJangis xsnari. keratitebis dros rekomendebulia
virussawinaaRmdego preparatebi: trifluoroTimidinis, vidarabinis, idoqsuridinis
malamoebi, magram isini ar gvacilebs recidivebs. kortikosteroidebs ki SeuZliaT
ufro daazianon kera, 5-iod-2-dezoqsiuridinis (idu) xsnari an malamo. idu-s an
adenin aribinozidis adgilobrivi gamoyeneba iZleva garkveul efeqts, magram recidivis
sixSires ar amcirebs. mZime formebisas per os iniSneba bonaftoni 0,025gr. 2-4 jer
dReSi asakis gaTvaliswinebiT 5-7 dRe, erTdroulad xmaroben 0,5%-ian bonaftonis
malamos 10-15 dRis manZilze. karg efeqts iZleva idu-s venaSi Seyvana 0,05gr/kg-ze
50ml. acikloviris (acikloguanozini; 9-2-{hidroqsimetoqsimeTil}guanini; zoviraqsi;
viroleqsi) adgilobrivi gamoyenebiT SesaZloa Tavidan aviciloT infeqciis gavrceleba,
Tumca es daavadebis saerTo gamovlinebaze ar moqmedebs. genitaluri herpesis dros
acikloviriT mkurnaloba xels uwyobs tkivilebis, qavilis Semcirebas, amoklebs virusis
gamoyofis xangrZlivobas, magram recidivebs ver lagmavs.
virusuli encefalitisas adenin-arabinozidis venaSi Seyvana (10mg/kg-ze 21 dRis
ganmavlobaSi) efeqturi aRmoCnda. igi wyvets herpesis progresirebasa da infeqciis
diseminacias. mkurnaloba unda iyos dawyebuli adre, komis stadiaSi mkurnaloba
araefeqturia.
adenin-arabinozidis msgavs efeqts iZleva acikloviri (gadasxma 1 saaTis ganmavlobaSi
10mg/kg-ze, yovel 8 saaTSi 14-21 dRis ganmavlobaSi) axalSobilTa herpesuli infeqciebisas.
virusis zogierTi Stami am preparatebis mimarT rezistentuli aRmoCnda, ris gamoc
sisxlSi ar Cndeba antisxeulebi; amiTaa ganpirobebuli, rom zogierT avadmyofSi kanis
formis mkurnalobis Semdeg ar aris gamoricxuli encefalitis ganviTareba.
daavadebis morecidive mimdinareobisas rekomendebulia vitaminoTerapia: B1, B2,
B12-iT, aseve adamianis imunoglobulini. pirogenali (kursze 20 ineqcia). maRal Terapiul
efeqts iZleva specifikuri, herpesis sawinaaRmdego imunoglobulini; vaqcinis efeqti
jer damtkicebuli ar aris. didi mniSvneloba aqvs simptomur mkurnalobas. bavSvebSi
herpesulma stomatitma da egzemam SeiZleba, gamoiwvios dehidratacia, hi poproteinemia
da Soki - aqedan didi yuradReba eTmoba homeostazis normalizacias. regularulad
96
kerZo nawili. herpesis ojaxis martivi (ubralo) herpesi
virusebiT gamowveuli daavadebebi. Cutyvavila
unda xdebodes piris Rrus gamovleba aragamaRizianebeli, steriluri ci prinis 1:4

000 an zefiranis 1:1 000 xsnarebiT. adgilobrivad gamayuCebel saSualebebs mag.:
webovan lidokains, anesTezias da sxva aRar iyeneben. avadmyofis kveba unda iyos
wiladuri, survilis mixedviT, Txeli, fafiseburi sakvebiT. aucilebelia stres-faqtorebis
acileba.
Cutyvavila
(VARICELLA)
Cutyvavila mwvave virusuli infeqciaa, romelic mimdinareobs sustad gamoxatuli

intoqsikaciiT, zomieri temperaturiT, kansa da lorwovanze Tanmimdevruli, ti puri
wvrili laqovan-buStukovani gamonayriT.
pirvelad, rogorc calkeuli daavadeba, aRwerili iyo italieli eqimebis V.Vidius-
is da F. Ingrassia-s mier XVI saukuneSi, magram mis Semdegac didxans Tvlidnen
naturaluri yvavilis erT-erT klinikur variantad. saxelwodeba Varicella mowodebulia
1872 w. Vogel-is mier. 1911 w. Aragao-m Cutyvavilas buStukovan siTxeSi aRmoaCina
virusis elementuri nawilakebi. 1953 w. T.H.Weller-ma moaxdina virusis kultivireba
qsovilovan kulturebze. Cutyvavilas SeswavlaSi didi wvlili miuZRviT rus mecnierebs:
Í\Ô\ Ôèëàòîâ
Ôèëàòîâ-s, Â\Í\ Âåðöíåð
Âåðöíåð-s, Ã\Ò\ Ñòóêñ
Ñòóêñ-s, Ì\À\ Ñêâîðöîâ
Ñêâîðöîâ-s da sxvebs.
etiologia Tanamedrove taqsonomiisa da klasifikaciis mixedviT virusi
dasaxelebulia, rogorc Cutyvavila-zosteris virusi (VZV - Varicella -Zoster vi-
rus). VZV adamianis herpes virusia. igi klasificirebulia, rogorc α-herpesvirusi.
mas aqvs msgavseba im jgufis virusebTan, romlebsac miekuTvneba martivi herpesvirusi
HSV. VZV-s aqvs garsi, 2-jaWviani dnm. virusis genomSi 70-ze meti cilaa, maTSi aseve
Sedian cilebi, romlebzedac moqmedebs acikloviri da sxva antivirusuli agentebi.
VZV-s pirveladi infeqcia iwvevs Cutyvavilas suraTs, xolo virusis latenturi
arseboba zurgis tvinis ukana rqebis gangliebSi da misi reaqtivacia iwvevs sartyliseburi
liqenis suraTs (Zoster-infeqcias).
epidemiologia. infeqciis wyaros warmoadgens CutyvaviliT an zosteriT (erTeul
epidemiologia
SemTxvevaSi) avadmyofi adamiani. infeqcia gadaecema haer-wveTovani da kontaqturi
gziT. axasiaTebs maRali kontagiozuroba; 90%-Si daavadeba gadaaqvT 10 wlamde asakis
bavSvebs, xolo mosaxleobis 96% praqtikulad imunuria am infeqciis mimarT. 2-3 Tvis
asakis bavSvebi iSviaTad avaddebian CutyvavilaTi dedisagan miRebuli pasiuri imunitetis
arsebobis gamo, ukanasknelis ar arsebobisas nayofis dainficireba xdeba transplacenturi
gziT. SesaZloa axalSobilebis daavadeba orsulobis ukanasknel periodSi dedis
avadmyofobis gamo. Cutyvavilas axasiaTebs sezonuroba, ufro Semodgoma-zamTris periodSi.
bavSvTa koleqtivebSi xSiria epidemiuri afeTqebebi. gadatanili infeqcia tovebs
mdgrad imunitets. ganmeorebiT daavadebis albaToba ar aRemateba 2-3%-s. avadmyofi,
rogorc infeqciis wyaro saSiSia gamoyramde 1-2 dRe-RamiT adre da 3-7 dRe mis
Semdeg. rekonvalescenti praqtikulad araa saSiSi ukanaskneli gamonayris fufxis
warmoSobidan. naturaluri yvavilisgan gansxvavebiT fufxi ar Seicavs viruss.
paTogenezi. virusi organizmSi iWreba zemo sasunTqi gzebis lorwovanidan, sadac
paTogenezi
isini pirvelad mravldebian da limfuri gziT gadadian kansa da lorwovan garsebze,
Sinagan organoebSi, centralur nervul sistemaSi. pirvel rigSi, virusi gamoirCeva
dermatotropizmiT, Semdgom ki nervuli sistemis dazianebiT.
ZiriTadi morfologiuri cvlilebebi gvaqvs kansa da lorwovanze. buStukovani
elementebis formirebis dasawyiss Seadgens epidermisis wanazardovani Sris epiTeliuri
97
ujredebis dazianeba. epiTeliumis hi perplaziis Sedegad warmoiSoba birTvSida da

citoplazmaSida oqsifiluri CanarTebi, ris Semdegac xdeba maTi balonuri distrofia
da nekrozi. anTebadi keris adgilas xdeba limfis dagroveba, rac warmoqmnis
CutyvavilasTvis damaxasiaTebel buStukovan gamonayars. buStukebis Rru umTavresad
erTkameriania mis irgvliv anTebadi reaqciis gareSe. procesis ukuganviTarebisas
xdeba limfis Sewova, SeSroba da fufxis warmoqmna. fufxis movardnis Semdeg nawiburebi
ar viTardeba da rCeba pigmentacia 2-3 kviris ganmavlobaSi. lorwovanze buStukebis
gamonayris meqanizmi kanze gamoyris analogiuria, mxolod piris RruSi buStukebi
Cqara macerirdebian da warmoSoben eroziul an wylulovan zedapirebs maT irgvliv
anTebadi reaqciis gareSe. dazianebuli adgilebi gamonayridan 5-7 dReSi ganicdian
srul epiTelizacias.
generalizebuli formebisas adgili aqvs organizmis sistemur dazianebas. vezikuluri
gamonayari eroziebisa da wylulebis saxiT aRiniSneba kuW-nawlavis traqtSi, traqeaze,
sasunTq da saSarde organoebSi, cns-Si. Sinagan organoebSi naxuloben wvril nekrozebs
sisxlCaqceviT. nervuli sistemis dazianebisas cvlilebebi aRiniSneba Tavis tvinis
qerqze, qerqqveS da gansakuTrebiT, Txemis qerqovan nawilSi. unda aRiniSnos, rom
Cutyvavilas generalizebuli formebis ganviTareba iSviaTia da ZiriTadad, mosalodnelia,
darRveuli imunuri sistemis mqone bavSvebSi.
klinika. inkubaciuri periodi ganisazRvreba 10-21 dRiT, saSualod Seadgens 14
klinika
dRes. xSirad prodromuli periodi ar aris an sustadaa gamoxatuli. temperatura am
dros normaluri an subfebriluria, gamonayramde 1-2 dRe adgili aqvs umniSvnelo
sisustes. prodromul periodSi zogierT
avadmyofs SeiZleba, gamoexatos qunTruSas an
wiTelasmagvari gamonayari. dasawyisSi gamonayari
gamoiyureba laqis an papulas saxiT, romelic
Zalian Cqara, ramodenime saaTSi gadaiqceva
gamWvirvale, ovaluri an mrgvali formis buStukad
eriTemul fonze. buStukebis SigTavsi pirvelsave
dReebSi xdeba mRvrie, advilad skdeba siTxis
daRvriT da ifareba fufxiT. Cveulebriv, gamonayari
uxvia da gamoyra grZeldeba 3-4 dRe. pirvelad
gamonayari Cndeba tanze, Semdeg saxeze da Tavis
Tmian adgilebSi, kidurebis distalur nawilebze.
vezikula erTkameriania da Cxvletis Semdeg
iCuteba SigTavsis daRvriT. vezikulebi 1-2 dReSi
Cutyvavilas gamonayari piris RruSi.
qrebian da maT adgilas Cndeba muqi feris brtyeli
(Í.È. Íèñåâè÷, Â.Ô. Ó÷àéêèí)
fufxi, risi mocilebis Semdegac nawiburebi ar
viTardeba. maT adgilas 2-3 Tvis manZilze rCeba
muqi pigmentacia, romelic TandaTan fermkrTaldeba.
lorwovan garsebze (piris RruSi, Tvalis
koniunqtivaze, xorxSi _ am SemTxvevaSi viTardeba
krupis sindromi, sasqeso organoebze) gamonayari
male ganicdis maceracias zedapiruli eroziebisa
da wylulebis gaCeniT, romlebic 5-7 dRis Semdeg
srulad epiTelizdeba. gamoyras aqvs biZgiseburi
xasiaTi 1-2 dRis intervaliT. am dros saxezea
Cutyvavilas gamonayari sxvadasxva
rogorc laqovan-papuluri, vezikuluri, aseve
stadiaSi (makula, papula, vezikula).
(PF Luechesi) fufxiani gamonayari, rac mas `polimorfuls~ xdis.
98
msubuqi formebisas gamonayari erTeulia. yoveli axali gamoyra mimdinareobs

temperaturuli reaqciiT. gamonayris maqsimaluri gamovlinebisas bavSvebi uCivian
saerTo sisustes, madis daqveiTebas, Zilis darRvevas, kanis qavilsa da intoqsikaciis
sxva gamovlinebebs. periferiul sisxlSi arsebiTi cvlilebebi ar aRiniSneba. zogjer
SesaZloa leikopenia, SedarebiTi limfocitozi.
klasifikacia. arCeven ti pur da ati pur formebs. ti puri iyofa msubuq, saSualo
klasifikacia
da mZime formebad. ti puri mimdinareobisas buStukovani gamonayari Seicavs gamWvirvale
SigTavss. msubuqi forma mimdinareobs normaluri temperaturiT an igi aRemateba 37,5-
380 C-s. saerTo mdgomareoba damakmayofilebelia. saSualo simZimis dros temperatura
aRwevs 390 C-s, saerTo mdgomareoba zomierad daTrgunulia; mZime formisas t-400 C da
metia, neirotoqsikozi mkveTradaa gamoxatuli da mimdinareobs krunCxvebiT,
meningoencefalitis suraTiT. gamonayari am dros ufro didi zomisaa da TiTqos
gaCerebulia ganviTarebis erT-erT stadiaSi.
ati pur mimdinareobas miekuTvneba rudimentuli, hemoragiuli, gangrenuli da
generalizebuli formebi.
rudimentuli formisaTvis damaxasiaTebelia rozeolur-papuluri, erTeuli,
ganuviTarebeli, sustad gamoxatuli buStukovani elementebi. saerTo mdgomareoba
damakmayofilebelia, temperatura _ normaluri.
hemoragiuli forma iSviaTia da SeiZleba ganviTardes im bavSvebSi, romelTac,
aReniSnebaT kortikosteroidebis an citostatikebis miRebis fonze hemoblastozi an
hemoragiuli diaTezi.
gangrenuli forma xasiaTdeba hemoragiuli buStukovani gamonayris danekrozebiT,
Rrma wylulebis ganviTarebiT; mimdinareoba xangrZlivia da araiSviaTad, Rebulobs
sefsisur xasiaTs.
generalizebuli formebi gvxvdeba axalSobilebSi da ufro mozrdilebSi, romelTac
aReniSnebaT mZime Tanmxlebi daavadeba da xangrZlivad arian namkurnalebi steroiduli
hormonebiT.
Cutyvavila. orsulobis pirvel sam Tvemde dasaSvebia virusis
Tandayolili Cutyvavila
teratogenuli moqmedeba, magram iSviaTia embrio- da fetopaTiebis SemTxvevebi.
Tandayolili infeqciisas inkubaciuri periodi Seadgens 6-16 dRes. daavadeba
mimdinareobs saSualo an mZime formebiT, araiSviaTia generalizebuli mimdinareoba
Cutyvavilas Tandayolili sindromi. marcxena Cutyvavilas Tandayolili sindromi

barZayis nawibur
nawiburii da kidur is hi potrofia.
kiduris axalSobilebSi. qvemo kidurebis mZime
(Srabstein JC) dazianeba, muclis kedelze marcxniv
nawiburi.
(Charles Grose-s
s mixedviT
mixedviT)
99
Sinagani organoebis dazianebiTa da letaluri

gamosavliT. gamosaricxia rudimentuli formebic. simZime
damokidebulia nayofis dainficirebis droze. mSobiarobis
win orsulebis dainficirebisas, axalSobilebSi
Cutyvavila vlindeba sicocxlis me-5-10 dRes da
mimdinareobs mZimed, araiSviaTad letaluri gamosavliT.
mSobiarobamde 5-10 dRiT adre orsulis dainficirebisas,
axalSobils dabadebisTanave aReniSneba Cutyvavila,
romelic mimdinareobs msubuqad, letaluri SemTxvevebis
gareSe. orsulis VZV-Ti pirvel an adreul meore
trimestrSi dainficireba nayofSi iwvevs embriopaTiis
suraTs kidurebis atrofiiTa da kanis deformaciuli
cvlilebebiT (Tandayolili Cutyvavilas sindromi,
mSobiarobamde 5 dRiT adre an mSobiarobis Semdeg 2
dReSi). am dros letalobis maCvenebeli 30%-s aRwevs.
axalSobilis encefaliti,
axalSobilebSi da wlamde asakis bavSvebSi
gamowveuli Cutyvavilas Cutyvavilas axasiaTebs Taviseburi klinikuri
Tandayolili infeqciiT: mimdinareoba, rac gamoixateba saerTo intoqsikaciis
hemisferoebis nevrozi; A-- siTxe mkveTri gamovlinebiT: moduneba da agzneba, Rebineba,
kefis areSi (suraTi gadaRebulia anoreqsia, defekaciis gaxSireba, temperatura SeiZleba
mwoliare mdgomareobaSi), C - iyos normaluri an subfebriluri. gamonayari viTardeba
hidrocefalia, D-- kalcifikatebi ufro gvian, me-2-5 dRes, uxvia, polimorfuli: papula,
bazalur gangliebSi, B - vezikula, pustula, romelTa maqsimaluri gamovlinebisas
kranialuri artifaqti, gamowveuli
temperatura iwevs maRal ricxvebamde, progresirebs
venis nemsiT. (magnituri
magnituri
rezonansi. Charles Grose)
neirotoqsikozi krunCxvebiTa da meningoencefalitis
suraTiT. gamonayari Rebulobs hemoragiul xasiaTs.
aRniSnul asakSi daavadeba SeiZleba mimdinareobdes rudimentuli an msubuqi formiT,
rac ganpirobebulia dedisagan miRebuli narCeni pasiuri imunitetiT, imunoglobulinis
miRebiT an Sratis da sisxlis gadasxmiT.
garTuleba SeiZleba gamoiwvios meoradma infeqciam da ganviTardes abscesi,
flegmona, wiTeli qari, bronqopnevmonia. mZime mimdinareobisas adgili aqvs
Trombocitopenias, sisxlCaqcevebs kanSi, lorwovanSi, Tirkmelzeda jirkvlebSi letaluri
gamosavliT.
elviseburi purpura mZime formebisas yvelaze xSiri garTulebaa da araiSviaTad
ganapirobebs gangrenas, rasac safuZvlad udevs Svarcmanis ti pis reaqcia.
virusuli pnevmonia iSviaTia mcire asakis bavSvebSi da mozrdilTa xvedria. 20-
30%-Si aRiniSneba klinikur-rentgenologiuri suraTi intersticiuli da kerovani
procesiT. miuxedavad adreuli klinikuri gajansaRebisa, rentgenologiurad narCeni
movlenebi rCeba 6-12 kviris ganmavlobaSi.
sunTqvis mwvave ukmarisoba SeiZleba gamoiwvios buStukovani elementebis
warmoqmnam xorxze (krupis sindromiT mimdinare).
10%-Si aRniSnaven Reye sindroms. aRwerilia iseTi garTulebebi, rogoricaa
mioperiendokarditebi, glomerulonefriti.
ti pur
puri i garTulebaa virusul
virusuli i encefal iti da cer
encefaliti ebrul
cerebrul
ebrulii ataqsia
ataqsia, rac,
albaT, imunuri reaqciebiTaa ganpirobebuli; magram aRsaniSnavia, rom sartyliseburi
herpesisagan gansxvavebiT, virusis gamoyofa nervuli sistemidan, maT Soris tvinidan, ar
xerxdeba. ufro xSirad encefaliti vlindeba fufxis stadiaSi da ar aris dakavSirebuli
daavadebis simZimesTan. encefalitis suraTisaTvis ufro damaxasiaTebelia naTxemis
100
dazianeba - ataqsiuri sindromi. daavadeba mimdinareobs msubuqad da 48-72 saaTSi

xdeba simptomebis TiTqmis mTliani alageba. 15%-Si SeiZleba adgili hqondes narCen
movlenebs krunCxvebisa da fsiqomotoruli funqciebis darRvevis saxiT nevrologiuri
movlenebi viTardeba ufro salicilatebis miRebis fonze (Reye sindromi). sxva
garTulebebidan mosalodnelia gien-bares sindromi, mieliti, saxis nervis dambla,
mxedvelobis nervis anTeba periodulad mxedvelobis dakargviT, hi poTalamuri simsuqnis
sindromi da hemolizur-uremiuli sindromi, arTriti, miokarditi, pankreatiti, orqiti.
diagnozi eyrdnoba kansa da lorwovanze ti pur gamonayars, mis polimorfizmsa
da evolucias.
laboratoriuli meTodebidan iyeneben morozovis meTods - vercxliT SeRebili
buStukis SigTavsidan gakeTebuli nacxis mikroskopiiT naxuloben aragaos sxeulakebs
(virusTa grova _ Tzanck nacxi), keTdeba komplementis SeboWvis reaqcia (Tumca
naklebmgrZnobiarea). gamoiyeneba imunofluorescenciis meTodi monoklonuri
antisxeulebis daxmarebiT. virusis gamoyofa warmoebs adamianis embrionuli qsovilebis
kulturebze. gamoiyeneba serologiuri gamokvlevebi dinamikaSi VZV-s antisxeulebis
dadgeniT (enzimimunofermentuli analizi, lateqs aglutinacia, arapirdapiri
mafluorescirebeli antisxeulebi ifa-Si, mafluorescirebeli antisxeulebi membranuli
antigenisadmi). lateqs aglutinaciisaTvis saWiroa mxolod 15 wuTi, igi keTdeba
specialuri mowyobilobebis gareSe da xasiaTdeba maRali mgrZnobelobiTa da
specifikurobiT. imunokomprometirebulebSi serologiuri meTodebi naklebad
informaciulia. bolo wlebSi gamoiyeneba enzimniSandebuli imunosorbentuli analizi
VZV glikoproteinebis dasadgenad _ varicella vaqcinis imunologiuri Tvisebebis
sakontrolod, magram es meTodi jer komerciul struqturebSi danergili ar aris.
diferenciuli diagnozi tardeba mZimed mimdinare Cutyvavilasa da naturaluri
yvavilis (Tumca daavadebis sayovelTao vaqcinaciis Sedegad igi aRar gvxvdeba mTels
msoflioSi) msubuq formebs Soris. mxedvelobaSi unda miviRoT, rom Cutyvavilas
prodromuli periodi moklea da sustadaa gamoxatuli, kanis dazianeba zerelea, buStukebi
erTkameriania, Wi piseburi Cazneqvebi iSviaTia. saxezea buStukebis ganviTarebis yvela
stadia da bolos, Cutyvavilas virusi morfologiurad mkveTrad gansxvavdeba yvavilis
virusisagan.
impetigo xasiaTdeba gamonayris upiratesi lokalizaciiT saxesa da xelebze.
elementebis SigTavsi moyviTalo-Cirqovania da ikeTeben sqel fufxs.
diseminirebuli martivi herpesi Cutyvavilasagan gamoirCeva jgufuri
buStukovani gamonayriTa da masiuri qerqis warmoSobiT, RviZlisa da elenTis gadidebiT.
qunTruSasaTvis damaxasiaTebelia kardinaluri simptomebi: alisferi angina,
limfadeniti, cxvir-tuCis fermkrTali samkuTxedi, Jolosebri ena da sxva.
Cutvavilas dros wiTelasebri gamonayrisas unda gaviTvaliswinoT, rom etapuri
gamoyra CutyvavilasTvis ar aris damaxasiaTebeli iseve, rogorc zemo sasunTqi gzebisa
da koniunqtivis katari.
prognozi. ti pur SemTxvevebSi gamosavali keTilsaimedoa; garTulebebiT
prognozi
mimdinareobisas (generalizebuli, hemoragiuli, gangrenuli) letalobis procenti didia.
mkurnaloba. aucilebelia higienuri pirobebis dacva, raTa Tavidan aviciloT
mkurnaloba
meoradi infeqciis darTvis saSiSroeba. yoveldRiurad saWiroa tansacmlisa da TeTreulis
gamocvla, abazanis miReba antiseptikuri xsnarebiT, piris Rrus gamovleba yoveli Wamis
Semdeg. qavilis dasawynareblad eniSnebaT sedaciuri saSualebebi, patara bavSvebs
acmeven xelTaTmanebs, aWrian frCxilebs. baqteriuli infeqciis darTvisas iniSneba
antibiotikebi. mZime intoqsikaciisas xmaroben sadezintoqsikacio xsnarebs. hormonebisagan
Tavs ikaveben, Tumca encefalitis dros xmaroben garkveuli efeqtiT. vezikulebs
101
kerZo nawili. herpesis ojaxis Cutyvavila
virusebiT gamowveuli daavadebebi. sartyliseburi herpesi
adgilobrivad amuSaveben briliantis mwvanis 1% spirtxsnariT an 1-2%-ian kaliumis

permanganatiT. antivirusuli preparatebidan mZime SemTxvevaSi iyeneben interferons,
citozars, imunoglobulins. efeqturi aRmoCnda acikloviri, Tu igi iniSneba daavadebis
pirvel 24 saaTSi. misi gamoyeneba yovelTvis saWiro da efeqturi ar aris (preparati
Zviria, 24 saaTSi misi daniSvna iSviaTad xdeba, Tu bavSvs aqvs msubuqi an saSualo
simZimis Cutyvavila, preparatis daniSvna saWiro ar aris). generalizebuli VZV
infeqciis dros (pnevmonia, hepatiti, Trombocitopenia, encefaliti) acikloviri
intravenuri formiT 7 dRis manZilze mainc ixmareba. acikloviri imunitetis
Camoyalibebaze ar moqmedebs.
profilaqtika. aqtiuri profilaqtikisTvis gamoiyeneba atenuirebuli cocxali
profilaqtika
vaqcina (veluri Oka Stamisagan), romelic iwvevs antisxeulebis warmoqmnis karg
efeqts da Tavidan gvacilebs daavadebas, Tu vaqcina Seyvanilia avadmyofTan kontaqtamde
an kontaqtis Semdeg maSinve. rekomendebuli dozaa 0,5 ml kanqveS an kunTebSi, vaqcinacia
tardeba 12 Tvidan. vaqcinaciis efeqturoba 95%-s Seadgens. imuniteti 8-20 weli
grZeldeba. vaqcinis Seyvana cal-calke SpricebiT SeiZleba sxva vaqcinebTan erTad.
donorebisagan miRebuli specifikuri imunoglobulini moqmedebs, rogorc Cutyvavilas,
ise zosteris virusebis winaaRmdeg. preparatis dozireba ganisazRvreba 125 erTeuliT
10kg masaze da efeqturia kontaqtidan araugvianes 72sT-isa. imunoglobulini kunTebSi
SehyavT 2-5 ml raodenobiT. pasiuri imunizacia naCvenebia bavSvebSi neoplazuri
daavadebisas, imunodeficituri mdgomareobisas, leikozebisa da sxva daavadebebis dros,
axalSobilebSi, romelTa dedebs aReniSnebodaT daavadeba mSobiarobisas an mSobiarobidan
5 dRis ganmavlobaSi. imunoglobulinprofilaqtika SeiZleba iyos rekomendebuli
orsulebisaTvis, romelTac ar gadautaniaT Cutyvavila.
avadmyofis hospitalizacia tardeba calke palatebSi, sadac gaTvaliswinebulia
sahaero ventilacia da hermetuloba infeqciis gavrcelebis Tavidan asacileblad.
sartyliseburi herpesi
(HERPES ZOSTER)
sartyliseburi herpesi virusuli infeqciaa, romelic gamowveulia Cutyvavila-

zosteris virusiT (VZV- Varicella-Zoster virus). igi xasiaTdeba kanze jgufuri
buStukovani gamonayriT da mgrZnobiare nervebis gaswvriv nevralgiiT.
zosteriT daavadebuli avadmyofebis anamnezSi, Cveulebriv, aris miTiTeba Cutyvavilas
gadatanis Sesaxeb, misi uaryofisas ar aris gamoricxuli msubuqi, ati purad gadatanili
infeqcia mcire asakSi, axalSobilobis periodSi da nayofis muclad yofnisas.
Cutyvavilas ganixilaven, rogorc hematogenur infeqcias araimunur organizmSi;
zosteri ki gamowveulia imunur organizmSi persistuli Cutyvavilas virusis aqtivaciiT
da gavrcelebis neirogenuli gziT. dadgenilia, rom Cutyvavilas gadatanis Semdeg
virusi didxans rCeba malaTaSoris nervul kvanZebSi latenturi infeqciis saxiT da
ar xdeba misi eliminacia organizmidan. imunoreaqtiulobis mkveTri darRvevis gamo
SeiZleba moxdes virusis aqtivacia da herpesuli infeqciis gamovlineba lokaluri
procesiT, romelic dakavSirebulia sensoruli gangliebis inervaciis zonebTan.
epidemiologia. daavadeba iSviaTia 10 wlamde asakis bavSvebSi da ufro xSiria
mozrdilebSi. gansakuTrebiT maRalia daavadebis done avTvisebiani simsivneebiT, leikozebiT,
darRveuli imunuri statusis mqone da xangrZlivad steroiduli hormonebiTa da
citostatikebiT namkurnaleb avadmyofebSi. zosteriT daavadebul avadmyofTan kontaqtis
102
virusebiT gamowveuli daavadebebi. sartyliseburi herpesi
Semdeg bavSvi SeiZleba daavaddes CutyvaviliT. jer kidev 1888w. ungreli eqimis U\\
Bokay mier naCvenebi iyo saerTo epidemiologiuri msgavseba Cutyvavilasa da
zosters Soris.
klinika. arCeven daavadebis mimdinareobis or fazas _ gamoyramde da gamoyris
Semdeg. daavadeba iwyeba mwvaved, temperaturis
momatebiT, saerTo sisustiT, damtvreulobiT. amave
dros kanze, erT-erTi segmenturi nerviT inervirebul
adgilas avadmyofs uCndeba wvis, qavilis, Cxvletis
SegrZneba da gamkvriveba. 1-2 dRis Semdeg Cndeba
wiTeli papulebis jgufi erT an or mezobel
segmentze da maT adgilas viTardeba mWidrod
ganlagebuli buStukebi, romelTa diametria 0,3-
0,5sm, maTi SigTavsi gamWvirvale siTxea da aqvT
erTmaneTTan Serwymis tendencia. ramodenime dReSi
SigTavsi imRvreva, xolo eriTemuli foni qreba,
buStukebi Srebian da ikeTeben fufxebs. fufxis
mocilebis Semdeg rCeba msubuqi pigmentacia. rac
Seexeba temperaturas da intoqsikaciis sxva niSnebs,
tkivilsa da gamonayris adgilas kanis gamkvrivebas,
maTi manifestacia rCeba procesis progresirebis Herpes Zoster. ti pur
purii
periodSi. 20 wlis asakamde umravles SemTxvevaSi vezikuluri gamonayari
gamonayari fermkTaldeba da qreba 7-14 dRis Semdeg, (Í.È. Íèñåâè÷, Â.Ô. Ó÷àéêèí)
maSin, roca ufro mozrdilebSi adgili aqvs
ganmeorebiT gamonayars da procesis gaxangrZlivebas 5 da meti kviris ganmavlobaSi.
igive, 20 wlis asakamde, SeimCneva gamonayris lokalizaciis tendencia im nervebis
gaswvriv, romlebic gamodian gulmkerdis II da welis II segmentebidan; gamonayari
gamoirCeva, agreTve, procesis erTmxrivi gamovlinebiT. gava-welis segmentebis dazianebisas
saTanado cvlilebebi SeimCneva fexis kanze da sasqeso organoebis midamoebSi. V
wyvili nervis (samwvera) dazianebisas procesSi CarTulia misi erTi an ramodenime
toti. zemo totis dazianebas Tan sdevs gamonayris lokalizacia Tavis Tmian nawilebze,
Sublze, cxvirze, Tvalebze, Sua totis dazianebisas _ loyebsa da sasaze. qveda totis
dazianebisas gamonayari Cndeba qveda ybaze da enaze. VII wyvili nervis dazianebisas
viTardeba misi dambla, buStukovani gamonayari Cndeba gareTa sasmen milSi (ramzaia-
xantas simptomi). SeiZleba adgili hqondes ufro mZime formebsac _ bulurs (didi
farTo buStukebi), gamonayars hemoragiuli SigTavsiT, gangrenuls _ gamonayarze Savi
fufxebiT da maTi dawylulebiT. gamonayris generalizebuli formisas, garda mgrZnobiare
nervebis gaswvriv lokalizaciisa, adgili aqvs buStukebis gafantvas sxvadasxva midamoSi.
laboratoriuli gamokvleva. axali buStukebidan aRebul nacxSi _ anabeWdSi
an amonafxekSi SeiZleba giganturi ujredebis CanarTebis aRmoCena (Tzanck-is nacxi).
VZV-s sawinaaRmdego antisxeulebis dadgena, SigTavsis imunofluorescenciuli
gamokvleva monoklonuri antisxeulebiT, lateqsaglutinacia da a.S. (ix. Cutyvavila).
diagnozi eyrdnoba jgufur buStukovan gamonayars segmenturi inervaciis zonebSi
da nevralgias.
mkurnaloba, umTavresad, simptomuria. uniSnaven gamosaSrob losionsa da malamoebs.
mkurnaloba
tkivilis dros aZleven analgetikebs.
mZime da gavrcelebuli formebis dros imunitetis darRvevisas garkveuli efeqtiT
gamoiyeneba oraluri an intravenuri acikloviri, famcikloviri da valacikloviri
(bolo 2 _ mozrdilebSi)
103
kerZo nawili. herpesis ojaxis sartyliseburi herpesi
virusebiT gamowveuli daavadebebi. citomegalovirusuli infeqcia
prognozi. daavadeba bavSvebSi mimdinareobs msubuqad. imunuri deficitis mqone

pirebSi procesi Wianurdeba; SesaZloa infeqciis diseminacia kanidan Sinagan organoebSi.
profilaqtika. mxedvelobaSi unda miviRoT, rom sartylisebri herpesiT bavSvi
SeiZleba daavaddes CutyvavilasTan kontaqtis Semdeg da piriqiT, CutyvaviliT daavaddes
sartylisebri herpesiT avadmyofTan kontaqtis Semdeg. amis gamo sartylisebri herpesiT
daavadebuli ar unda iyos hospitalizebuli saerTo palataSi. kontaqtis Semdeg
Zoster-is sawinaaRmdego imunoglobulinis Seyvana amcirebs daavadebis gamovlinebas
an agvacilebs mas. daavadebis gamovlinebis Semdeg misi xmareba efeqturi ar aris.
vaqcinaprofilaqtika ixile `Cutyvavila~-Si.
citomegalovirusuli infeqcia
(citomegalia)
citomegalia virusuli infeqciaa (CMV-infeqcia cytomegalovirus CMV)), igi,

umTavresad, miekuTvneba peri- da postnatalur daavadebebs, mimdinareobs mZimed, maRali
letalobiT. xasiaTdeba polimorfuli klinikuri gamovlenebiT, rac ganpirobebulia
sanerwyve jirkvlebSi, Sinagan organoebSi da centralur nervul sistemaSi citomegaliebis
_ giganturi ujredebis, ti puri birTvSida da citoplazmuri CanarTebis ganviTarebiT.
pirvelad citomegalovirusuli ujredebi aRmoCenili iyo H.Ribbert-is mier
1882w. sanerwyve jirkvlis, saSarde milakebis epiTeliumSi intersticiuli kerovani
nefritis dros, sxvadasxva daavadebiT gardacvlil bavSvebSi. 1921 w. E.Goodpasture
da F.Talbot-ma mogvawodes saxelwodeba citomegalia bavSvebSi, riTac xazi gausves
giganturi ujredebis specifikurobas.
etiologia. morfologiurad citomegalovirusi emsgavseba martiv viruss da
miekuTvneba Herpesviridae-s ojaxs, Seicavs dnm-s, diametriT aris 200nm. virusis
guli 64 nm-ia, igi Semofarglulia izosaxedraluri kafsidiT, romelic Sedgeba 162
kafsomerisagan. virusis guli yalibdeba makroorganizmis ujredebSi. kafsidi
Semofarglulia susti zedapiriT, romelic aseve Semofarglulia li pidSemcveli
garsiT. es li piduri garsi ki warmoiqmneba virusis ujredis birTvidan gamosvlisa da
citoplazmis vakuolebSi SeWris dros. vakuoli ki ukve virusuli garsis cilovan
komponentebs Seicavs. momwifebuli virusebi ujredSi, Sebrunebuli pinocitozis meSveobiT
aRweven. CMV-s genomi kodirebs 35 struqturul cilas, glikoproteinebs da ramodenime
arastuqturul cilas. serologiuri testebi ar gvexmareba specifikuri seroti pebis
gansazRvraSi, samagierod CMV-is dnm-is gansazRvriT SeiZleba gavarCioT, Tu ra StamiTaa
gamowveuli es infeqcia.
virusi kultivirdeba adamianis embrionis fibroblastebis qsovilovan kulturaze.
misi citopaTogenuri efeqti gamoirCeva specifikuri moqmedebiT, romlis Sedegadac
warmoiqmneba giganturi ujredebi birTvisa da citoplazmis gadidebis gamo. virusi
mgrZnobiarea sadezinfeqcio xsnarebis, eTeris mimarT. kargad Zlebs oTaxis temperaturaze.
virusi gamoirCeva maRali specifikurobiT, avaddeba mxolod adamiani, gansakuTrebiT
mgrZnobiarea mis mimarT axalSobilebi da nayofi.
epidemiologia.. daavadebis wyaroa CMV-iT inficirebuli avadmyofi an
epidemiologia
virusmtarebeli. infeqcia gavrcelebulia mTels msoflioSi. gadacema xdeba mWidro
kontaqturi gziT _ mSobiarobisas, ojaxis pirobebSi da a.S. inficirebis Semdeg
daavadeba mimdinareobs latenturad. nayofis inficireba muclad yofnis dros warmoebs
transplacenturad, an intranatalurad _ mSobiarobis II periodSi, saSvilosnos yelis
104
sekretTan kontaqtis Sedegad. axalSobilTa umravlesobas ar aReniSneba infeqciis

manifesturi formebi, daavadeba gadaaqvT latenturad. dadgenilia, rom viruss Seicavs
nerwyvi, bronqebis sekreti, sperma, rZe, leikocitebi, Sardi, ganavali. inficireba SeiZleba
moxdes sisxlisa da misi preparatebis gadasxmiT.
serologiuri gamokvlevebiT aSS-Si axalgazrda gogonebis 20-70%-s daudgindaT
infeqciis gadatanis kvali, xolo iaponiaSi mcire asakis bavSvTa umravlesobas. 4-5%-
Si orsuli qali viruss gamohyofs SardiT, saSvilosnos yelis nacxSi virusi SeiZleba
gamovlindes 10%-Si, dedis rZeSi 5-10%-Si. praqtikulad mozrdilebis 70-80%-Si
xerxdeba virusmaneitralebeli da komplementSemboWavi antisxeulebis dadgena.
paTogenezi. transplacenturi gziT nayofis dazianebisas SeiZleba ganviTardes
nayofis simaxinjeebi, adreuli aborti an mkvdradSobadoba. intranatalurad an
dabadebisTanave dainficirebisas daavadebis gamovlineba xdeba postnatalur periodSi.
axalSobilebSi daavadeba, umTavresad, mimdinareobs latenturad da paTmorfologiuri
cvlilebebi Rebulobs lokalur xasiaTs, kerZod, sanerwyve jirkvlebSi xdeba giganturi
ujredebis warmoSoba, romelTac aqvT SidabirTvuli CanarTebi. generalizebuli formebisas
(rac ujreduli imunitetis darRvevis Sedegia) saxezea Sinagani organoebis dazianebis
suraTi _ intersticiuli pnevmonia, hepatiti, nefriti da sxva. virusi ganapirobebs
intoqsikaciis saerTo movlenebs, hemoragiul sindroms, Tirkmelzeda jirkvlis mwvave
ukmarisobas, diseminirebul sisxlZarRvSida Sededebas. am dros bevri Sinagani organos
epiTeliumSi adgili aqvs ujredebis citomegaliur cvlilebas, Tavis tvinis dazianebisas
kerovan nekrozebsa da kalcifikatebs. sainteresoa, rom organos funqciis dazianeba
da virusis saerTo raodenoba xSirad ar emTxveva ujredSi citomegalovirusuli
cvlilebebis sixSires, romelic zogjer erTeul xasiaTs atarebs.
klinika. inkubaciuri periodi zustad ar aris dadgenili da varaudoben, rom misi
xangrZlivoba meryeobs 5 dRidan 3 Tvemde. inficirebuli sisxlis transfuziisas
inkubaciuri periodi aRwevs 3-12 kviras. xolo qsovilis transplantaciis dros 4
kviridan 4 Tvemdea. umetes SemTxvevaSi, infeqcia subklinikur xasiaTs atarebs
(Tandayolili infeqciis drosac).
arCeven Tandayolil da SeZenil formebs.
Tandayolili formebisas 90%-ze met axalSobilebSi daavadeba mimdinareobs usim-
ptomod, da-narCenebSi aRiniSneba sxvadasxva simZimis klinikuri gamovlinebebi erTeu-
li letaluri gamosa-vliT.
latenturi an mwvave formiT daavadebuli dedisagan hematogenuri gziT xdeba
virusis gadacema placentaze da misi dazianeba; amis Semdeg virusi iWreba nayofis
sisxlSi da sanerw-
yve jirkvlebSi xde-
ba misi lokalizacia
da reproduqcia in-
feqciis general-
izaciiT. nayofis da-
zianebis gamo SeiZle-
ba moxdes adreuli
aborti, mkvdradSoba-
doba an adgili
hqondes hepatosple- Tandayolili CMV
nomegaliur sindroms, hidrocefalia, `Camavali Tandayolili CMV hidrocefalia,
mzis~ simptomi. marazmi. decerebracia. kandiduri sefsisi.
siyviTles, purpuras
(sakuTari masala) (sakuTari masala)
da sxva. virusis ter-
105
atogenuri moqmedebis gamo bavSvebi ibadebian

sxvadasxva mankebiT _ Tavis tvinis arqiteqton-
ikis darRveva, mikrogiria, hidrocefalia, endokar-
diumis elastozi, parkuWSida da winagulTa-
Sorisi Zgideebis Seuxorcebloba, aortis sar-
qvlis ukmarisoba da sxva.
cns-is funqciis darRveva Tandayolili
citomegaliis dros iTvleba erT-erT
damaxasiaTebel niSnad. amasTanave, fsiqomotoruli
darRvevebi dabadebisas da Semdgom wlebSi
Tanabari sixSiriT gvxvdeba.
rac Seexeba Sinagani organoebis dazianebas
(RviZli, Tirkmlebi, filtvebi da sxva) maTSi
xdeba procesis ukuganviTareba funqciis TiTqmis
srul aRdgenamde. iSviaTad xdeba mxedvelobis
dakargva qorioretinitisa da mxedvelobis nervis
Tandayolili CMV.. ganviTarebis defeqti. anTebis gamo. xSirad qveiTdeba smena.
(Í.È. Íèñåâè÷, Â.Ô. Ó÷àéêèí) SeZenili citomegalia. bavSvis inficireba
xdeba mSobiarobis meore periodSi an
dabadebisTanave dedisagan an momvleli personalisagan, romelic virusmtarebelia.
infeqciis gadacema SesaZloa sisxlis gadasxmisas, virusmtarebeli donorisagan. SeZenili
infeqcia Tandayolilis msgavsad, umTavresad, mimdinareobs usimptomod, latenturad.
aseTi mimdinareoba axalSobilis sisxlSi antisxeulebis Semcvelobis Sedegia.
infeqcia SeiZleba mimdinareobdes ori klinikuri formiT: lokaluri da
generalizebuli. pirvel SemTxvevaSi ziandebian sanerwyve jirkvlebi Semdegi
TanmimdevrobiT: ybayura, ybisqveSa, enisqveSa. meore formis dros klinikuri suraTi
warmodgenilia Sinagani organoebis dazianebis simptomatikiT.
filtvis formis dros aRiniSneba mdgradi, araiSviaTad yivanaxvelaseburi xvela;
pnevmonias axlavs qoSini, cianozi, TandaTan viTardeba gulmkerdis emfizema. temperatura
subfebriluria, Tumca SeiZleba avides maRal cifrebzec, rac meoradi infeqciis darTvis
maCvenebelia. rentgenologiurad vlindeba sisxlZarRvTa gaZlierebuli suraTi, iSviaTad
_ filtvebis kista. xSirad pnevmonia Rebulobs gaxangrZlivebul, talRisebur
mimdinareobas.
nervuli sistemis dazianeba SeZenili citomegaliis dros iSviaTia. misi
gamovlinebisas SeiZleba gvqondes meningoencefalitis suraTi ufro krunCxviTi sindromiT,
spastiuri di plegia, epilefsiuri Setevebi.
Tirkmlis forma, umTavresad, usimptomod mimdinareobs da sicocxleSi iSviaTad
dgindeba. SardSi SeiZleba iyos cila, didi raodenobiT epiTeliuri ujredebi, Sardis
naleqSi naxuloben citomegaliur ujredebs.
RviZlis forma vlindeba qvemwvaved mimdinare qolestazuri hepatitis
suraTiT. xazgasasmelia is faqti, rom qronikuli hepatitis, hepatosplenomegaliis,
cirozis dros xSirad avlenen citomegalovirussac, risi axsnac jer-jerobiT Znelia.
infeqciuri mononukleozis msgavsi sindromi, rogorc wesi, msubuqad mimdinareobs
da grZeldeba 2-3 kvira.
diagnozis dadgena mxolod klinikuri suraTiT gaZnelebulia. virusis gamoyofa
xdeba adamianis embrionuli fibroblastebis an adamianis embrionis filtvebis
di ploiduri kulturebis gamoyenebiT. didi mniSvneloba aqvs citomegaliuri ujredebis
gamovlenas SardSi, nerwyvSi, Tavzurgtvinis siTxeSi da sxvadasxva organoebis bioftatebSi
106
imunofermentuli meTodiT an citomegalovirusis M klasis imunoglobulinebis dadgenas.

eleqtronuli mikroskopiis saSualebiT SesaZlebelia virusis gamovlineba
qsovilebSi da SardSi, sadac igi didi raodenobiT aris warmodgenili. virusis
aRmoCena calsaxad laparakobs citomegalovirusul infeqciaze, magram ar gvaZlevs
saSualebas, ganvsazRvroT, procesi mwvavea, qronikuli Tu saqme gvaqvs reinfeqciasTan.
IgG da IgM–is titris 4-jer gazrda dinamikaSi (4-16 kviraSi) mowmobs mwvave
infeqciaze, xolo IgG gxvdeba, rogorc mwvave, ise qronikuli mimdinareobis dros.
Sedegebis interpretacia unda xdebodes sifrTxiliT, vinaidan 1 wlis asakamde bavSvs
SesaZloa hqondes dedisagan miRebuli IgG. reinfeqciis da recidivis gansasazRvravad
mowodebulia virusis dnm-is Seswavla da maTi homogenurobis dadgena.
antisxeulebis dasadgenad gamoiyeneba komplementfiqsaciis, neitralizaciis,
antikomplementimunofluorescenciis, arapirdapiri imunofluorescenciis, radioimunuri
da ELISA meTodebi.
diferenciuli diagnozis gatareba saWiroa toqsoplazmozTan, wiTurasTan, martiv
herpesTan, baqteriul sefsisTan, infeqciur mononukleozTan.
toqsoplazmozisaTvis damaxasiaTebelia, mikrofTalmia, Tavis tvinis qerqSi
gavrcelebuli kalcifikacia, hidrocefalia da qorioretiniti. diagnozs adasturebs
toqsoplazmozis mimarT antisxeulebis maRali titri 6 Tvis zeviT asakis bavSvebSi
an toqsoplazmuri IgM arseboba (ix. toqsoplazmuri infeqcia).
Tandayolili wiTura da citomegalia klinikuri gamovlinebiT Zalian
emsgavsebian erTmaneTs. orive SemTxvevaSi TandarTulia iseTi niSnebi, rogoricaa
mowiTalo feris gamonayari, siyviTle, mikrofTalmia, siyrue. mxedvelobaSia misaRebi,
rom centraluri kataraqta, gansakuTrebiT gulis mankebTan erTad damaxasiaTebelia
mxolod wiTurasaTvis. diagnozis dadastureba xdeba serologiuri kvlevebiT (specifiuri
sinji wiTuras virusze, IgM-antisxeulebi, hemaglutinaciis damuxruWebis reaqciis
dinamika).
martivi herpesi axalSobilebSi vlindeba dabadebidan 5-10 dRis Semdeg. Cveulebriv,
iwyeba meningoencefalitis ganviTarebiT, pnevmoniiT an vezikuluri gamonayriT. buStukovan
SigTavsSi advilad xdeba virusis aRmoCena, igi advilad mravldeba sxvadasxva qsovilovan
kulturaze.
baqteriuli sefsisisaTvis damaxasiaTebelia mZime saerTo mdgomareoba gamonayris
gareSe, Catarebuli energiuli antibiotikoTerapia iZleva swraf Sedegs.
SeZenili citomegaliis mononukleozuri sindromiT mimdinareobisas
diagnozis dadgena SeiZleba mxolod virusis gamoyofiT. serologiuri gamokvlevebis
Sedegebi, rogoricaa, magaliTad, imunomafluorescirebeli MM antisxeulebis 4-jer
momateba an komplementSemboWavi antisxeulebis titris dakleba, unda iyos sifrTxiliT
interpretirebuli, vidre axalSobilobis periodSi. pirvelis dros SesaZlebelia
jvaredini reaqciis arseboba epStein-baris virusis mimarT, xolo meoris dros
mxedvelobaSia misaRebi, rom janmrTelebSi adgili aqvs komplementSemboWavi antisxeulebis
did meryeobas. unda aRiniSnos, rom citomegalovirusuli mononukleozis daavadebulebSi
reaqcia heterofilur antisxeulebze xSirad uaryofiTia. citomegalovirusuli
mononukleozisa da infeqciuri mononukleozis diferenciuli diagnostika awydeba
did sirTules; orive daavadebas adgili aqvs mozardebSi da mimdinareobs ati puri
limfocitoziT, saxezea hepatolienuri sindromi, temperaturuli reaqcia da
intoqsikaciis sxva saerTo movlenebi. mafluorescirebeli antisxeulebis IgM mimarT
sinji SeiZleba iyos dadebiTi. SesaZlebelia aseTi reaqcia dakavSirebuli iyos orive
virusis antigenur msgavsebasTan. mxedvelobaSi misaRebia, rom citomegaliis dros
viruss xSirad naxuloben SardSi, bronqul sekretSi, leikocitebSi. infeqciuri
107
kerZo nawili. herpesis ojaxis citomegalovirusuli infeqcia
virusebiT gamowveuli daavadebebi. infeqciuri mononukleozi
mononukleozis dros antisxeulebis dadgena SeiZleba imunofluorescenciis sxvadasxva

meTodebiT.
citomegalia, mimdinare hepatitiTa da siyviTliT, saWiroebs virusuli
hepatitebis gamoricxvas. SeiZleba klinikuri gamovlineba imdenad identuri iyos, rom
maTi diferenciacia unda eyrdnobodes virusologiur da serologiur gamokvlevebs,
saxeldobr, virusuli hepatitebis gasaSifrad unda ganisazRvros A,B,C,D virusebis
markerebi.
mkurnaloba simptomuria. mZime generalizeburi formis dros imunokomprometirebul
avadmyofebs uniSnaven Ganciclovir-s 10 mg/kg dRe-RameSi 2-3 kvira, zogierTi Tandayolili
CMV-infeqciis dros ki 12 mg/kg dRe-RameSi 6 kvira, vitaminebis kompleqss,
imunostimulatirebs.
gancikloviri da foskarneti citomegalovirusuli infeqciis sxvadasxva
garTulebisas aiv-iT inficirebul avadmyofebSi jer mxolod garkveuli efeqtiT
xasiaTdeba, Tumca am mxriv saWiroa dawvrilebiTi analizi. ganciklovirisa da
citomegalovirusuli imunoglobulinis intravenuri gamoyenebisas pnevmoniis mkurnalobis
dros transplantant-reci pientebSi miRebuli iqna preparatebis sinergistuli efeqti.
prognozi Tandayolili citomegaliis dros seriozulia. mimdinare SeZenili
infeqciis dros mononukleozis msgavsad, umravles SemTxvevaSi keTilsaimedoa.
mxedvelobaSi unda miviRoT, rom generalizebuli formebi SeiZleba Segvxvdes avadmyofebSi,
romlebic gansakuTrebiT mgrZnobiareni arian am infeqciis mimarT _ hojkinis,
limfoleikozis, aiv-infeqciis da sxva daavadebis dros.
profilaqtika.. rekomendebulia standartuli RonisZiebebis Catareba avadmyofis
profilaqtika
izolirebisas, radgan citomegalovirusi vrceldeba avadmyofTan mWidro kontaqtis
dros, mis mier gamoyofili dainficirebuli sekretis saSualebiT. imunoprofilaqtika.
citomegaliis sawinaaRmdego imunuri globulinis intravenuri Seyvana mowodebulia
seronegatiur transplantirebul recipientebSi citomegaliis profilaqtikis mizniT.
sawyisi dozaa 150mg/kg sxeulis masaze. SemdgomSi dozebi mcirdeba da Seiyvaneba 2
kviraSi erTjer. mkurnalobis kursi grZeldeba 16 kvira.
arsebobs CMV-is sawinaaRmdego cocxali atenuirebuli vaqcina, magram vaqcinaciis
Semdeg imuniteti aramyaria da swrafad qreba. es vaqcina ar icavs transplantantis
reci pientebs infeqciisagan, magram CMV-is virulentobas ramdenadme amcirebs. qalebis
vaqcinacia ar icavs nayofs dainficirebisagan. mimdinareobs aqtiuri muSaoba rekombinantul
vaqcinaze, romelic ufro efeqturi unda iyos.
saWiroa donorTa sisxlis kontroli CMV-infeqciaze.
infeqciuri mononukleozi
(MONONUCLEOSIS INFECTIOSA, EBV-infeqcia
infeqcia
infeqcia)
infeqciuri mononukleozi mwvave infeqciuri daavadebaa, romelic mimdinareobs

temperaturiT, periferiuli limfuri kvanZebis (gansakuTrebiT kisris) gadidebiT,
pirxaxis dazianebiT (eqsudaciuri tonzilofaringiti), hepatolienuri sindromiT da
periferiul sisxlSi ati puri mononuklearebis gamovleniT. mononukleozismagvari
sindromi SeiZleba gamoiwvios sxva infeqciamac, mag. citomegalovirusi, T. gondii,
adenovirusi, hepatitis gamomwvevi virusi, listeria, aiv-infeqcia, wiTuras virusi. unda
aRiniSnos, rom umravles SemTxvevaSi EBV-negatiuri mononukleozismagvari gamovlinebis
dros daavadebis zusti mizezis dadgena ver xerxdeba.
108
mokle istoriuli cnobebi. pirvelad infeqciuri mononukleozi aRwerili iyo

1885w. Í\Ô\ Ôèëàòîâ
Ôèëàòîâ-is mier idiopaTiuri limfadenitis saxelwodebiT, xolo 1889w.
daavadebas Pfeifer–ma uwoda jikvlovani cxeleba. mogvianebiT dadgenil iqna periferiuli
sisxlis mxriv damaxasiaTebeli cvlilebebi (Turk-1970;). 1932 wels J.R. Paul-ma da
W.Bunnell-ma mogvawodes heterohemaglutinaciis diagnostikuri testi, xolo 1938w.
J.Davidson-ma _ modificirebuli reaqcia, romelic atarebs paul-bunel-davidsonis
saxels da romelmac moi pova praqtikuli mniSvneloba infeqciuri mononukleozis
laboratoriul diagnostikaSi.
etiologia. 1964 w. M.Epstein-ma da J.Barr-ma virusi gamoyves avTvisebiani
berkitis limfomis ujredovan kulturidan, romelic meuRleebma G.Henle-m da W.Henle-
m scnes infeqciuri mononukleozis gamomwvevad. virusi ekuTvnis herpes virusTa
ojaxs, magram maTgan gansxvavebiT igi qsovilovani kulturis citolizs ki ar iwvevs,
aramed ganapirobebs ujredebis gamravlebas. miuxedavad imisa, rom ati puri limfocitebi
warmoadgenen T–limfocitebs (CD8), virusis replikacia da Semdgom xangrZlivi
persistireba xdeba mxolod B–limfocitebSi. aRsaniSnavia, rom epStein-baris virusi
afrikis tropikul zonebSi iwvevs avTvisebiani berkitis limfomas, CineTSi _ nazofaringul
karcinomas, xolo zomieri klimatis pirobebSi ganapirobebs infeqciur mononukleozs.
epidemiologia. infeqciis wyarod iTvleba avadmyofi adamiani nebismieri klinikuri
gamovlinebiT da SesaZloa, janmrTeli virusmtarebelic. virusiT inficirebulia
msoflios mosaxleobis 95% da infeqciis gadacema xdeba mWidro kontaqtis dros
nerwyviT. aradamakmayofilebel socialur-ekonomikur pirobebSi da ganviTarebad qveynebSi
daavadebis gavrcelebis maCvenebeli ufro didia.
centralur afrikaSi inficirebulia praqtikulad yvela bavSvi 3 wlis asakamde.
Tumca pirveladi EBV-infeqcia mimdinareobs xSirad inaparantulad an zogjer ar
gamoirCeva bavSvTa sxva infeqciebisagan. msoflios ganuviTarebel regionebSi infeqciuri
mononukleozis klinikuri sindromi praqtikulad ar aris cnobili. ganviTarebul
industrialur qveynebSi es diagnozi ismeba, magram daavadeba gvxvdeba ufro mozard
bavSvebsa da axalgazrda mozrdilebSi da daaxloebiT 50%-Si mimdinareobs klasikuri
gamovlinebebiT. 4 wlamde asakis bavSvebSi aseT regionebSi infeqcia aRiniSneba iSviaTad.
aSS-Si TiTqmis yvela mozrdili asakTan erTad xdeba EBV-s mimarT seropozitiuri.
daavadeba gadaecema kontaqturi gziTac (dainficirebuli sakvebisa da wylis miReba,
saTamaSoebis, dabinZurebuli sagnebis gamoyeneba da a.S.), virusi mWidro kontaqtis
dros gadaecema, amiT aixsneba misi dabali kontagiozuroba da ZiriTadad sporaduli
SemTxvevebi, Tumca SeiZleba moxdes epidafeqebebi koleqtivebSi da ojaxebSi. virusi
gamoiyofa nerwyviT da cxviridan gamonadeniT, rogorc prodromuli da mwvave periodis
dros, aseve gamojanmrTelebis 6 Tvis manZilze da ufro met xansac.
infeqciis gadatanis Semdeg organizmi iZens mdgrad imunitets, ganmeorebiTi daavadeba
iSviaTia. dadgenilia, rom gamojanmrTelebisas warmoiqmneba specifikuri maxsovrobis
T-ujredebi, romlebic mudmivad cirkulireben sisxlSi da anadgureben inficirebul
B–ujredebs ganmeorebiTi reaqtivaciis Sedegad. amave dros mimoqcevaSi xangrZlivad
imyofebian virusmaneitralizebeli antisxeulebi, romlebic icaven B–ujredebs
dainficirebisagan.
paTogenezi. organizmSi virusi iWreba zemo sasunTqi gzebisa da piris Rrus
lorwovanis epiTeliumidan, rasac mosdevs B–limfocitebis dainficireba da sasis,
cxvir-xaxis da nuSurebis SeSupeba-hi peremia. SemdgomSi virusi vrceldeba B–
limfocitebis saSualebiT limfogenuri da hematogenuri gziT periferiul limfur
kvanZebSi, RviZlSi, elenTaSi da sxva organoebsa da sistemebSi, sadac iwvevs limfoiduri
da retikulohistiocituri elementebis hi perplazias (poliadeniti, hepatolienuri
109
sindromi da sxva).
paTmorfologiuri suraTi ZiriTadad eyrdnoba biofsirebuli substratebis
da iSviaTi letaluri SemTxvevebis Seswavlis Sedegebs. mononuklearuli ujredebis
proliferacia xdeba ZiriTadad limfur kvanZebSi, nuSurebSi, elenTaSi; zogjer maTSi
aRiniSneba nekrozi. RviZlSi adgili aqvs degeneraciul movlenebs; umTavresad cvlilebebi
gamoxatulia mezenqimis mxriv. sxva organoebSi (filtvebi, guli, Tirkmelebi, cns)
upiratesad aRweren nekrozul kerebs, perivaskulur infiltracias mononuklearuli
ujredebis dagrovebiT. yvela monacemi mowmobs imaze, rom paTologiur procesSi
CarTulia mTeli organizmi. virusis pantropizmi mtkicdeba Tundac imiT, rom zurgis
tvinis siTxeSi imyofeba damaxasiaTebeli mononuklearuli ujredebis elementebi.
unda aRiniSnos, rom am bolo dros infeqciur mononukleozs ganixilaven, rogorc
imunuri sistemis daavadebas, rasac safuZvlad udevs virusiT B–limfocitebis inficireba.
sapasuxod xdeba CD8–limfocitebis, NK bunebrivi kilerebis, ujreduli meqanizmebis
gaaqtiveba. matulobs supresoruli aqtivoba, CD4/CD8 Sefardeba, romelic normaSi
aris 2:1, icvleba piriqiT, rac iwvevs B-limfocitebis diferenciaciisa da proliferaciis
daTrgunvas 1:106 (1 inficirebuli B limfociti 106 janmrTel B limfocitze _
koncentraciamde) da amiT inficirebuli limfocitebis gamravlebis SezRudvas. virusis
integracia ujredis genomSi ar aris damaxasiaTebeli. latenturi infeqciis dros
producirdeba mxolod ramodenime virusis antigeni-cila, romlebSic Sedis EBV-
determinirebuli birTvovani antigenebi EBNA (EBV-determined nuclear antigens).
es antigenebi akontroleben virusul episoms latenciis dros (episomebi ki am dros
ganlagebulia B limfocitebsa da pirxaxis epiTelur ujredebSi). replikacia iwyeba
adreuli antigenebis EA (early antigens) produqciasTan erTad, rac Tavis mxriv
iwvevs dnm-is replikacias da Semdeg kafsiduri antigenis VCA (viral capsid antigen)
produqcias. reaqtivacia xSirad asimptomurad mimdinareobs da klinikuri gamovlinebebi
ar axasiaTebs.
onkogenoba. virusi iwvevs daavadebebis mTel speqtrs _ keTilTvisebiani
virusis onkogenoba
infeqciuri mononukleozidan dawyebuli, damTavrebuli limfoiduri da epiTeluri
ujredebis malignizaciiT. keTilTvisebiani mimdinareobiT aseve gamoirCeva EBV-Ti
gamowveuli piris Rrus Tmiani (hairy) leikoplakia (Sidsis dros). EBV agreTve
iwvevs malignizacias _ nazofaringuli karcinoma, Burkitt-is limfoma, Hodgkin-is
daavadeba, limfoproliferaciuli daavadebebi, leikomiosarkoma imunokomprometirebulebSi
(gansakuTrebiT Sidsis dros).
nazofaringuli karcinoma gavrcelebulia ufro CineTSi (samxreT regionebSi)
mamakacebSi, aseve CrdiloeT afrikasa da CrdiloeT amerikaSi inuitebs Soris. yvela
malignizirebul ujredSi am dros aRiniSneba EBV-s episomebis didi raodenoba, sisxlSi
aRiniSneba diagnostikuri da prognozuli antisxeulebi EBV antigenebis mimarT: IgA-
s didi raodenoba EA-s da VCA-s sawinaaRmdego (asimptomur pirebSic ki) da am
rezultatebze eyrdnoba antitumoruli mkurnalobis taqtika.
karcinomis keratizaciis dros sisxlSi EBV genomis raodenoba 0-mdea dayvanili
da serologiuri pasuxi igivea, rac Cveulebriv mosaxleobaSi.
endemuri (afrikuli) Burkitt-is limfoma xSirad azianebs ybis midamos. es
daavadeba aRmosavleT afrikasa da axal gvineaSi bavSvTa asakis kibos yvelaze xSiri
mizezia. daavadeba gvxvdeba daaxloebiT 5 wlis asakSi P.falciparum-isaTvis malariis
endemur zonebSi. malariis gamomwvevTan kontaqtis Sedegad aqtivirdeba B-limfocitebis
mitogeni. EBV-Ti inficirebuli B-limfociti iwyebs proliferacias. irTveba T
limfocitebiT ganpirobebuli kontroli. Burkitt limfomaSi EBV-s genomi nanaxia
98%-Si (xolo amerikul Burkitt limfomaSi mxolod 20%-Si), rac albaT araendemurobiT
110
aixsneba). daavadebulebSi didi koncentraciiTaa nanaxi VCA-s da EA-s mimarT

antisxeulebi. yvela SemTxvevaSi (EBV (+) Tu EBV (_)), aRiniSneba qromosomuli
translokaciebi imunoglobulinis mZime da msubuq jaWvebSi (monoklonur
imunoglobulinebSi).
Hodgkin-isis daavadeba yvelaze xSirad gavrcelebulia ganviTarebad qveynebSi
adreul asakis bavSvebSi. daavadebis gamovlinebas win uZRvis EBV antisxeulebis
titris zrda. seronegatiuri rCeba mxolod avadmyofTa umciresoba. SesaZloa EBV-s
kontrolis funqcia ikargeba imunologiuri defeqtis gamo (Duncan syndrome _ X-
niSandebuli limfoproliferaciuli sindromi), rac ganpirobebulia X-qromosomasTan
dakavSirebuli recesiuli ti pis imunodeficitTan. Sedegad viTardeba mZime qronikuli,
zogjer fataluri EBV infeqcia. biWebis daaxloebiT 2/3 am dros iRupeba diseminirebuli
fulminanturi limfoproliferaciuli procesebis gamo, romelic aRiniSneba yvela
organoSi. gadarCenil avadmyofebSi aRiniSneba hi pogamaglobulinemia, B-ujreduli
limfoma an orive erTad. avadmyofTa umetesoba 10 wlis asakamde kvdeba.
sxva imunuri paTologiebis dros EBV infeqcia asocirebuli SeiZleba iyos
B-limfocitur limfomasTan cns-Si. am dros T citotoqsikurebis (CD8) nakleboba
saSualebas aZlevs EBV-s gausxltes imunur kontrols. EBV-sadmi mimRebloba izrdeba
iseTi Tandayolili imunodeficitebis dros, rogoricaa ataqsia-teleangieqtazia, Wiskott-
Aldrich da Chediak-Higashi-is sindromebi. fiqroben, rom EBV-infeqciiT aris
gamowveuli sanerwyve jirkvlebis karcinoma da, SesaZloa, bevri sxvac.
infeqciuri mononukleozis klinika . sxvadasxva avtorebis monacemebiT
inkubaciuri periodi meryeobs 5-dan 50 dRemde da ufro meti _ 2 Tvemde. inkubaciuri
periodi bavSvebSi ufro xanmoklea, vidre mozrdilebSi.
umetesad daavadeba iwyeba mwvaved, temperaturis momatebiT 38-39°C-mde, saerTo
mdgomareobis darRveviT, ylapvis dros yelis tkiviliT, cxviridan sunTqvis gaZnelebiT,
rac ganpirobebulia lorwovani garsebisa da limfuri kvanZebis SeSupebiT. daavadebisaTvis
damaxasiaTebeli simptomokompleqsi viTardeba TandaTan erTi kviris ganmavlobaSi.
temperatura, yelis tkivili, cxviriT sunTqvis gaZneleba, kisris limfuri kvanZebis
gadideba miekuTvneba daavadebis adreul gamovlinebas. remisiuli an uwyveti temperaturis
fonze daavadebis ukve me-3-4 dRes maqsimalurad diddeba limfuri kvanZebi kisris,
iRliisqveSa, idayvis, sazardulis da sxva adgilebSi. gansakuTrebiT i pyrobs yuradRebas
kisrisa da kisris ukana limfuri kvanZebi,romlebic Zewkvis msgavsad arian ganlagebuli
infeqciuri mononukleozi. `mSrali surdo~, infeqciuri mononukleozi. igive avadmyofi

Ria piriT sunTqva, kisris limfuri kvanZebis gverdidan. (sakuTari masala)
gadideba. (sakuTari masala)
111
mkerd-laviw-dvriliseburi kunTis ukana

kideze da ybisqveSa midamoSi. xSirad
kisris limfuri kvanZebi Semofarglulni
arian da maTi konturebi TvalnaTliv
Cans (ix. suraTi). isini konsistenciiT
momkvrivo-elastiuri da SexebiT
umtkivneulo arian, erTmaneTs ar erwymian,
kanqveSa cximovani qsovili kvanZebis
irgvliv odnav SeSupebulia, xolo kani
inarCunebs normalur fers. kvanZebis
sidide meryeobs cercvis marcvlis
infeqciuri mononukleozi. Ria piriT sunTqva,
zomidan kaklis an qaTmis kvercxis
kisris limfuri kvanZebis `paketi~. zomamde. kvanZebis daCirqeba ar xdeba.
(sakuTari masala) araiSviaTad limfuri kvanZebis gadideba
warmoadgens daavadebis pirvel simptoms.
xazgasasmelia is, rom kisris limfuri
kvanZebis gadidebisa da nuSurebis
dazianebis procesi erTmaneTis
paralelurad ar mimdinareobs. SeiZleba
kataruli tontilofaringitis dros
mniSvnelovnad gadiddes limfuri kvanZebi
da piriqiT, nuSurebze sxvadasxva zomis
nadebis arsebobisas (Tundac fibrinulis)
SeiZleba, limfuri kvanZebi zomaSi
umniSvnelod Seicvalos.
piris Rrus dazianeba. infeqciuri
infeqciuri mononukleozi. cvlilebebi nuSurebis mononukleozis dros aucilebeli da
mxriv. (Alex J. Steigman) mniSvnelovani simptomia eqsudaciuri
tonzilofaringiti, romelic iTvleba
limforetikuluri qsovilebis dazianebis gamovlinebad. zogjer anTeba imdenad
intensiuria, rom nuSurebi erTmaneTs exebian. cxvir-xaxis nuSurebis dazianebasTanaa
dakavSirebuli cxviridan sunTqvis gaZneleba, cxviris tembris xma (dudRuni) da
zogjer stridori, naxevraddaRebuli piriT mxvrinavi sunTqva. am dros cxviridan
gamonadeni Tavidan praqtikulad ar aris, magram igi SeiZleba ganviTardes sunTqvis
aRdgenis Semdeg, rac gamowveulia cxviris qveda niJaris da cxvir-xaxis Sesasvlelis
lorwovani garsebis SeSupebiT (ukana riniti).
xorkliani da gafxvierebuli xaxis ukana kedeli aseve SeSupebuli da hi peremiulia.
gamoxatulia limfuri warmonaqmnebis hi perplazia (granulaciuri faringiti), dafaruli
sqeli lorwovani nadebiT. sasis rkalebze, naqze da nuSurebze aRiniSneba zomieri
hi peremia da mTliani an sxvadasxva zomis nadebi, romelic xSirad moTeTro-moyviTalo
an monacrisfroa, fxvieria, advilad scildeba lorwovans da ar iwvevs adgilze
sisxldenas; zogjer nadebi nawilobriv fibrinulia, mkvrivia, sasagne minebs Soris
mTlianad ar isriseba. SeiZleba adgili hqondes lakunur an, iSviaTad, nekrozul
anginas.
ukana rinoskopiis Sedegad SeiZleba gamovlindes cxvir-xaxis nuSurebze anTebadi
movlenebi fxvieri nadebis arsebobiT, romelic qoanebs faravs.
nuSurebze nadebebis warmoqmna SesaZlebelia daavadebis pirvelsave dRes, rasac
Tan axlavs temperaturis axali momateba.
112
hepatolienuri sindromi infeqciuri mononukleozis dros TiTqmis yovelTvisaa

saxeze (97-98%-Si), RviZli isinjeba daavadebis pirvelsave dReebSi da maqsimalurad
diddeba me-5 dRes. igi momkvrivo konsistenciisaa da odnav mtkivneuli. zogjer
gamoixateba siyviTle da aRiniSneba RviZlis fermentebis da gansakuTrebiT
alaninaminotransferazis umniSvnelo gaaqtiveba. RviZlis sazRvrebi normas uaxlovdeba
Tvis bolos an meore Tvis dasawyisSi; xandaxan ki es procesi grZeldeba 3 Tves.
elenTa diddeba RviZlis gadidebis paralelurad, misi zomebis normalizacia
xdeba ufro adre _ 3 kviraSi. aRwerilia elenTis sagrZnoblad gadidebis SemTxveva,
rasac mohyva misi gaskdoma da avadmyofis daRupva.
sxva klinikuri monacemebidan yuradRebas i pyrobs quTuToebis SeSupeba da sxvadasxva
xasiaTis gamonayari _ laqovan- papuluri (wiTelas msgavsi), wvrilwinwklovani (qunTruSas
msgavsi), WinWriseburi, hemoragiuli. gamoxatuli klinikuri simptomatika rCeba 2-4
kviris manZilze, ris Semdegac avadmyofis mdgomareoba TandaTanobiT umjobesdeba.
daavadebis gadatanis Semdeg zogjer rCeba saerTo sisuste, Sromis unaris daqveiTeba.
cvlilebebi periferiul sisxlSi. damaxasiaTebelia leikocitozi (10-20 aTasi
_ aqedan 2/3 mainc limfocitebis xarjzea). es cifri zogjer naklebia, zogjer ki
ufro meti. eds zomieradaa aCqarebuli.
damaxasiaTebelia sisxlSi ati puri mononuklearebis arseboba (yvela limfocitis
20-40%). morfologiurad isini warmoadgenen mrgvali an ovaluri formis T ujredebs
(antigeniT aqtivirebulebs), romelTa zoma meryeobs limfocitebis saSualo zomidan
monocitebis did zomamde. ujredis protoplazma did birTvs irgvliv akravs TeTri
sartyeliviT da periferiaze gamoxatulia bazofilia. citoplazmasa da birTvSi
gvxvdeba vakuolebi.
ati purma mononuklearebma struqturis cvlilebebis gamo miiRes `farToplazmuri
limfocitebis” da `monolimfocitebis” saxelwodeba. infeqciuri mononukleozis dros
ati puri mononuklearebi periferiul sisxlSi vlindeba 86,5%-Si, xolo leikocitebis
koncentraciis meTodiT _ 100%-Si.
mkafio kavSiri ati puri mononuklearebis raodenobasa da daavadebis simZimes
Soris ar arsebobs.
klasifikacia. arCeven ti pur da ati pur formebs. ati purs ekuTvnis waSlili da
usimptomo formebi (maTi ricxvi gacilebiT didia), visceruli (izolirebulad mimdinare
hepatiti, tonziliti da sxva). maTi diagnostika SeiZleba mxolod hematologiur da
serologiur monacemebze dayrdnobiT.
ti puri formebi simZimis mixedviT iyofa msubuq, saSualo da mZime formebad. am
dayofas safuZvlad udevs organizmis saerTo intoqsikaciis, limfuri kvanZebis,
hepatolienuri sindromis, piris Rrus dazianebis da hematologiuri cvlilebebis
xarisxi.
garTulebebi umTavresad ganpirobebulia mwvave respiraciuli infeqciis darTviT
(bronqiti, pnevmonia, otiti).
saSiSi garTulebaa elenTis gaskdoma, romelic viTardeba daavadebis pirvel or
kviras da romlis provocireba SeiZleba mcire travmiT iyos ganpirobebuli, maT
Soris palpaciiTac.
zemo sasunTqi gzebis obstruqcia (stridori), SeiZleba ganviTardes cxvir-xaxis
nuSurebis da xaxis lorwovani garsebis SeSupebis gamo. xazgasasmelia, rom am dros
kortikosteroidebiT mkurnaloba Tavidan gvacilebs traqeotomiis aucileblobas.
centraluri nervuli sistemis mxriv SeiZleba ganviTardes meningiti (am dros
Tavzurgtvinis siTxeSi naxuloben mononuklearebs), encefaliti, gien-bares sindromi,
rac ganapirobebs vrcel damblebs da letalobas. zog avadmyofs erRveva sivrcisa da
113
sagnebis zomis aRqma (sindromi àlisa ucnaurobaTa qveyanaSi”’). mogvianebiT SeiZleba

ganviTardes hemolizuri anemia kumbsis dadebiTi sinjiT, aglutinaciis reaqcia siciveze
(dabal temperaturaze) eriTrocitebisadmi specifikur i antigenTan. zogjer viTardeba
Trombocitopeniuri purpura, aplaziuri anemia.
infeqciis mZime formebi an epStein-baris virusiT inducirebuli avTvisebiani
procesi uviTardebaT avadmyofebs, romelTac aqvT ujreduli imunitetis sxvadasxva
defeqtebi.
diagnozi. pirveladi diagnozis dadgena eyrdnoba klinikur gamovlinebebs da
hematologiur kvlevebs (ix. zemoT). Cveulebriv, laboratoriebSi epStein-baris virusis
gamoyofa cxvir-xaxis sekretidan Znelia. amave dros virusis gamoyofa yovelTvis ar
laparakobs mwvave infeqciaze.
serologiuri diagnostika eyrdnoba infeqciuri mononukleoziT daavadebulTa
sisxlis SratSi cxovelebis (cxvari, xari, cxeni) eriTrocitebis mimarT heterofiluri
antisxeulebis dadgenas (Paul-Bunnell-is antisxeulebi IgM klasis) Paul-Bunnel-
Davidson-is reaqciaSi titri 1:28 an 1:40 (rac damokidebulia gamoyenebuli ganzavebis
sistemasTan) iTvleba dadebiTad. es testi pozitiuri rCeba daavadebis gadatanis
Semdeg Tveebis manZilze (2 wlamdec ki Tu testi gakeTebulia cxeni eriTrocitebiT).
J.Tomcsik-is mier (1960w) mowodebuli iqna aglutinaciis reaqcia trifsinizebul
xaris eriTrocitebsa da zRvis goWebis Tirkmlis eqstraqtiT damuSavebuli avadmyofis
Srats Soris. es reaqcia iZleva dadebiT pasuxs 90%-Si, maSin, roca sxva daavadebebis
dros _ 2-3%-Si.
martivi, magram ufro maRali specifiurobiT gamoirCeva G.Hofl–is da S.Bauer-
is(1965w) mier mowodebuli reaqcia minaze – cxenis eriTrocitebsa da avadmyofis
Srats Soris. aglutinaciis reaqciisaTvis sakmarisia avadmyofis sisxlis Sratis 1
wveTi. infeqciuri mononukleozis dros es reaqcia 90%-Si dadebiTia, maSin, roca sxva
daavadebebis dros TiTqmis yovelTvis uaryofiTia. pasuxi miiReba maSinve da Seadgens
infeqciuri mononukleozis eqspres diagnostikis meTods.
Tu heterofiluri testi negatiuria, idgmeba EBV-s specifiur antisxeulebis
testebi. es meTodika gamoiyeneba rogorc diagnozis dazustebisaTvis, aseve pastinfeqciis
(gadatanili infeqciis) da momavalSi infeqciisadmi mimReblobis dasadgenad.gamoiyeneba
zemoT aRwerili EBNA, EA da VCA antigenebis daxmarebiT antisxeulebis gansazRvra.
mwvave fazaSi VCA mimarT aRiniSneba IgM da IgG, xolo EA mimarT IgG. VCA IgM-is
naxva SeiZleba daavadebis daaxloebiT 4 kviris manZilze, maqsimum ki 3 Tvis periodSi.
zogjer miiReba cru dadebiTi rezultati revmatoiduri faqtorebis gaaqtivebis
gamo. IgG piki aRiniSneba mogvianebiT. igi SemdgomSi zomierad ecema da persistirebs
stabilur doneze mTeli sicocxle.
anti- EA-s dadgena SeiZleba ramodenime Tvis manZilze, magram zogjer isini
persistireben wlebis ganmavlobaSi. EA-R da EA-D antisxeulebi aRiniSneba
limfocitebis difuzurad SeRebili komponentebisadmi (mwvave fazaSi) nazofaringuli
karcinomis dros maTi titri maRalia. isini maRal doneze rCeba Burkitt-is limfomis,
imunodepresiisa da virusis replikaciis dros.
anti-EBNA Cndeba sisxlSi daavadebis gadatanis Semdeg 2-3 TveSi da dabali
koncentraciiT persistirebs mTeli cxovrebis manZilze.
unda aRiniSnos, rom IgM VCA yvelaze misawvdomi da specifikuri testia diagnozis
dadasturebisaTvis.
114
EBV-s
s klinikuri gamovlinebisa da serologiuri gamokvlevaTa
Soris korelacia (Sumaya CV., Jenson HB)
serologiuri maCvenebeli
heterofiluri EBV - specifikuri antisxeulebi
klinikuri suraTi
antisxeulebi
IgM-VCA IgG-VCA EA-D EA-R EBNA
(xarisxobrivi testi)
uaryofiTi reaqcia _ < 1:8 < 1:10 < 1:10 < 1:10 < 1:25
mimRebloba aqvs _ _ _ _ _+ _
mwvave pirveladi infeqcia:
+ 1:32-1:256 1:160-1:640 1:40-1:160 _+ _dan 1:2,5 mde
axladgadatanili infeqcia:
+/_ _dan 1:32 mde 1:320-1: 1280 1:40-1:160 _+ 1:5-1:10
adre gadatanili infeqcia _ _ 1:40-1: 160 _ ++ _dan 1:40 mde 1:10-1:40
reaqtivacia: imunosupresiis
_ _ 1:320- 1280 _ ++ 1:80-1:320 _dan 1:160mde
an imunokompromet.
Burkitt limfoma _ _ 1:320-1: 1280 _ ++ 1:80-1:320 1:10-1:80
aqvs
nazofaringuli karcinoma _ _ 1:320-1: 1280 1:40-1:160 umciresobas 1:20-1:160
mxolod
EA_ adreuli antigeni

EBNA _ birTvovani antigeni
VCA_ kafsiduri antigeni
diferenciuli
antisxeulebis warmoqmna EBV- s antigenebisadmi drois diagnostika . wamyvani
gaTvaliswinebiT (Sumaya CV., Jenson HB) klinikuri niSnebi
infeqciuri mononukleozis
dros aris piris Rrus
dazianeba, poliadenopaTia,
hepatolienuri sindromi,
ati puri mononuklearebis
aRmoCena periferiul
sisxlSi; amasTan erTad
dadebiTi reaqcia
heterofilur da/an
specifikur antisxeulebze
naTels xdis infeqciuri
mononukleozis arsebobas.
iseTi daavadebebi,
rogoricaa citomegalo-
virusuli infeqcia,
toqsoplazmozi, romlebic
klinikurad emsgavsebian infeqciur mononukleozs, pirvel rigSi gansxvavdebian misgan
am reaqciebSi uaryofiTi pasuxiT.
adenovirusuli da sxva mwvave respiraciurl virusuli infeqciebisas saxezea
zemo sasunTqi gzebis gamoxatuli kataruli movlenebi, rac ar axasiaTebs infeqciur
mononukleozs; amasTanave diferenciaciaSi gvexmareba serologiuri reaqciebi.
zogjer saWiroa infeqciuri monomukleozis (apkovani formis dros) misi
difTeriasTan diferencireba.
infeqciuri mononukleozis mimdinareobisas ìzolirebulad” hepatitis saxiT, saWiroa
diferenciuli diagnozis gatareba virusul hepatitebTan. ukanasknelni xasiaTdebian
115
kerZo nawili. herpesis ojaxis infeqciuri mononukleozi
virusebiT gamowveuli daavadebebi. uecari egzanTema anu meeqvse daavadeba
ufro gamoxatuli fermentuli aqtivobiT da markeruli maCveneblebiT.

siZneleebTan aris dakavSirebuli diagnozis dazusteba maRali leikocitozis
(30-60 109/l) da limfocitozis (80-90%) dros. am SemTxvevaSi mwvave leikozis
gamosaricxad aucilebelia sternaluri punqtatis Seswavla, rac naTels mohfens
daavadebis arss.
zog SemTxvevaSi saWiroa limfogranulomatozis gamoricxva. am dros klinikuri
Taviseburebebis garda (xangrZlivi talRisebri mimdinareoba, maRali leikocitozi,
neitrofilozi da sxva) diagnozis gadawyvetaSi didi roli eniWeba limfuri kvanZebis
punqtatSi berezovski-Sternbergis ujredebis aRmoCenas.
wlamde asakis bavSvebSi infeqciuri mononukleozi xasiaTdeba igive gamovlinebiT,
rac mozrdilebSi, magram amasTan erTad aRiniSneba zogierTi Tavisebureba. umravles
SemTxvevaSi adgili aqvs surdos, xvelas, mxvrinav sunTqvas, saxis pastozurobas, quTuToebis
SeSupebas. xSiria kanze sxvadasxva xasiaTis gamonayari. daavadebis dasawyisSi periferiul
sisxlSi sWarbobs Cxir- da segmentbirTviani leikocitebis raodenoba. serologiuri
reaqciebi hemofilur antisxeulebze wlamde asakis bavSvebSi iSviaTia da Tu aris,
titri dabalia. literaturaSi aRwerilia. infeqciuri mononukleozi axalSobilebSi.
am dros aRiniSneboda dedis daavadeba orsulobis periodSi.
mkurnaloba. specifikuri mkurnaloba ar aris SemuSavebuli. daavadebis
mimdinareobisas faringealur-tonziluri SeSupebiT da zemo sasunTqi gzebis obstruqciiT,
Zlieri tkivilebiT muclis areSi, gamowveuli elenTis gadidebiT, meningitiT, anemiiT,
limfuri kvanZebis gadidebiT, rekomendebulia kortikosteroidebiT
(prednizoloniT)mkurnaloba mokle kursiT (14 dRemde) _ pirvel 7 dReSi 1mg/kg
dReSi, xolo danarCeni 7 dRe TandaTan SemcirebiT.
profilaqtika ar aris SemuSavebuli. avadmyofebi Tavsdebian boqsirebul
ganyofilebaSi. daavadebis keraSi raime epidsawinaaRmdego RonisZieba ar tardeba.
uecari egzanTema anu meeqvse daavadeba

(EXANTHEMA SUBITUM SEU CRIPTUM; ROSEOLA INFANTUM)
daavadeba ganimarteba, rogorc mwvave virusuli infeqcia, romlisTvisac

damaxasiaTebelia temperaturis uecari momateba 39-410C-mde 3-4-5 dRis ganmavlobaSi
da aseve uecari dacema normamde; erTdroulad Cndeba gamonayari, romelic male
fermkrTaldeba da qreba.
etiologia. 1986w. SidsiT daavadebulTa periferiul sisxlSi aRmoaCines axali
virusi, romelic Tavdapirvelad B-ujredis limfotropuli virusi uwodes, SemdgomSi
gamoirkva rom igi adamianis herpesvirusebs miekuTvneba HHV-6_-6_ Human Herpesvi-
rus - 6
6.
HHV-6 -6 adamianis hepres virusebis 7 warmomadgenlidan erTerTia. igi didi zomisaa
_ 185-200nm diametriT, Seicavs dnm-s. virusis replikacia xdeba T ujredebSi (CD4 4 da
CD88-Si), monocitebSi, megakariocitebSi, NK ujredebSi, gliur epiTeliur da sanerwyve
ujredebSi. citopaTiuri efeqti burTis StabeWdilebas tovebs. Semdeg ki aRiniSneba
ujredis lizisi mitogen-stimulirebul leikocitebSi. ufro xSirad gamoiyofa virusis
A varianti (Sidsisa da limfoproliferaciuli daavadebebis mqone avadmyofebSi). 1
wlamde asakis bavSvebSi ki klinikur suraTs B varianti ganapirobebs. HHV-6 axlos
dgas adamianis citomegalovirusTan, riTac akavSirebs antigenuri struqtura da
jvaredini reaqciebi.
116
kerZo nawili. herpesis ojaxis uecari egzanTema anu meeqvse daavadeba
virusebiT gamowveuli daavadebebi. infeqciuri eriTema anu mexuTe daavadeba
epidemiologiuri gamokvlevebiT dadginda, rom axalSobilTa 70-95%-s aqvs dedisagan

gadacemuli antisxeulebi, xolo 2 wlis asakSi bavSvTa 90%-i seropozitiuria.
seropozitiuria aseve TiTqmis yvela mozrdili. afeTqebebi aRiniSneba daxurul
koleqtivebSi, gansakuTrebiT, obolTa internatebSi.
epidemiologia. inkubaciuri periodi Seadgens 5-15, ufro xSirad ki 9-10 dRes.
epidemiologia
kontagiozurobis xarisxi dadgenili ar aris. umetesad avaddebian mcire (6-18 Tvis)
da 3 wlis zeviT asakis bavSvebi. sporadul SemTxvevebs adgili aqvs mcire asakis
bavSvebSi, xolo epidemiebi, isic iSviaTad, gvxvdeba mozrdilebSi. es garemoeba SeiZleba
ufro infeqciis endemur xasiaTs mowmobdes.
paTogenezi bolomde cnobili ar aris. damtkicebulia virusis horizontuli
gziT oraluri gavceleba. pirvel 4-5 dReSi viremia (rac ufro metadaa igi gamoxatuli,
klinikuri niSnebi miT ufro mZimea). gamoiyofa sxvadasxva citokinebi _ α− da β−
interferoni da a.S. varaudoben, rom ziandeba leikocitebi (ufro makrofagebi), sanerwyve
jirkvlis ujredebi.
klinika. daavadeba iwyeba uecrad, temperaturis mkveTri momatebiT 39-410 C-mde,
klinika
zogjer krunCxviT. me-4 me-5 dRes temperatura kritikulad ecema normamde. temperaturis
normalizaciidan ramodenime saaTSi jer tanze, Semdeg kisersa da xelebze vrceldeba
gamonayari. saxesa da kidurebze gamonayari mcirea an ar aris. egzanTema laqovani an
laqovan-papuluri xasiaTisaa; igi Cqara (1-2 dRis ganmavlobaSi) fermkrTaldeba da
qreba. gamonayari iSviaTad iqercleba da pigmentacias ar tovebs. erTeul SemTxvevebSi
SeiZleba gvqondes kisris limfuri kvanZebis umniSvnelo gadideba. varaudoben, rom
HHV-6 -6
-6-is febriluri krunCxvis SemTxvevaTa 50%-is ganviTarebaSi monawileobs. zogjer
daavadeba infeqciur mononukleozs mogvagonebs. HHV-6 -6 iwvevs Kikuchi-s limfadenits
(mimdinare cxelebiT), sinusur histiokistozs (Rosai Dorfman-is daavadebas). virusi
aaqtivebs aiv-is replikacias, Tumca klinikurad mdgomareobas ar auaresebs.
diferenciuli diagnozi unda gavataroT wiTelasTan, wiTurasTan da denges
cieb-cxelebasTan. wiTurasagan gansxvavebiT uecari egzanTema gamoirCeva temperaturis
mkveTri cvalebadobiT; wiTelasa da denges cieb-cxelebas axasiaTebs gamonayris gamovlena
temperaturis awevamde da sxva klinikuri gamovlinebebi. sxva daavadebebTan diferenciacia
ufro gaadvilebulia.
prognozi keTilsaimedoa. iSviaT SemTxvevebSi daavadeba mimdinareobs mZimed, rac
gamoixateba xangrZlivi maRali temperaturis fonze mimdinare krunCxvebiT, fataluri
hepatitiT, mZime encefalitiT.
mkurnaloba. specifikuri mkurnaloba ar arsebobs. saWiroebisas iyeneben sedaciur
mkurnaloba
da sicxis damwev saSualebebs. arakontrolirebul gamokvlevaSi daadgines, rom HHV--
6 TiTqos mgrZnobiarea ganciklovirisadmi.
infeqciuri eriTema anu mexuTe daavadeba

(ERITHEMA INFECTIOSUM)
daavadeba warmoadgens virusul infeqcias. upiratesad avaddebian bavSvebi. daavadeba

mimdinareobs intoqsikaciis gareSe, damaxasiaTebeli gamonayriT, romelic Rebulobs
badisebur saxes.
etiologia da epidemiologia. daavadebis gamomwvevia Parvovirus B19 19
19. virusi
miekuTvneba Parvoviridae-s ojaxs, dnm-is Semcvelia. parvovirusi replikacias ganicdis
ujredebis gayofis procesSi. infeqcia haer-wveTovani gziT gadadis. ufro xSirad
117
kerZo nawili. infeqciuri eriTema anu mexuTe daavadeba
avad xdebian skolis asakis bavSvebi (5-15 wlis).

ukanaskneli ori epidemiis dros londonSi Catarda gamokvlevebi, ramac bavSvebsa
da mozrdilebSi gamoavlina IgM antisxeulebis arseboba parvovirusis mimarT. daavadeba
gvxvdeba msoflios yvela regionSi. infeqcia xasiaTdeba susti kontagiozurobiT.
kontagiozuroba ufro metad axasiaTebs gamonayris wina periods, rac bavSvis skolaSi
daswrebas SesaZlebels xdis xangrZlivi gamonayris arsebobisa da damakmayofilebeli
saerTo mdgomareobis SemTxvevaSi.
klinika. inkubaciuri periodi meryeobs 7-21 dRemde, saSualod Seadgens 16 dRes.
klinika
daavadeba iwyeba prodromuli periodis gareSe, normaluri an subfebriluri temperaturis
fonze. damaxasiaTebeli gamonayari Cndeba sam etapad. dasawyisSi vlindeba mkafio
eriTema loyebze - àliyuris~ sindromi. amis Semdeg eriTemuli, laqovan-papuluri
gamonayari Cndeba tansa da kidurebze. mcireodeni makulur-papuluri elementebi
diddebian da uerTdebian erTmaneTs. zogjer tanze gamoyra aswrebs saxeze gamoyras.
cxviris wveris, cxvirisa da tuCebis irgvliv kani rCeba fermkrTali. cxviris zurgisa
da loyebis siwiTle qmnis `pepelas frTebis~ suraTs. pirvel an meore dRes gamonayari
gadadis mTel tansa da kidurebze.
gamonayari gafermkrTalebas iwyebs centridan, rac qmnis eriTemisTvis damaxasiaTebel
suraTs da iRebs badisebur saxes, axasiaTebs zomieri qavili. gamonayris xangrZlivoba
varirebs 2-dan 39 dRemde. aqercvlas ar axasiaTebs. periodulad SesaZloa aRiniSnos
gamonayris recidivebi, rac ukavSirdeba organizmis gadaRlas, stresul mdgomareobas,
cxeli abazanis miRebas da sxva.
mozrdilebi uCivian saerTo mdgomareobis gauaresebas, Tavis tkivils, rinits,
faringits, kuW-nawlavis traqtis funqciis moSlas. daavadebam SeiZleba miiRos mZime
xasiaTi.
qronikuli hemolizuri problemebis mqone avadmyofebSi parvovirusi B19 19 iwvevs
eriTrocitebis tranzitul aplaziur kriziss, rac vlindeba hemoglobinis mkveTri
dacemiT. am dros gamoxatulia cxeleba, leTargia, cianozi-sifermkrTale, taqikardia,
taqi pnoe. gamonayari iSviaTia. SesaZlebelia ganviTardes tkiviliT mimdinare
vazokonstriqciuli krizisi.
aseTi movlenebi gvxvdeba namgliseburi anemiis, Talasemiis, memkvidreobiTi
sferocitozisa da piruvatkinazuri deficitebis dros.
arTropaTiebi.. ufro xSirad ziandeba didi saxsrebi, Tumca SeiZleba CaTreuli
arTropaTiebi
iyos yvela saxsari. umetes SemTxvevaSi daavadeba TviTgankurnebadia, zogjer ki grZeldeba
ramodenime Tve da am dros revmatiuli faqtorebic dadebiTia.
imunokomprometirebulebSi daavadebam SeiZleba qronikuli saxe miiRos.
Tandayolili infeqcia 5%-Si iwvevs nayofis wyalmanks, zogjer mis dazianebas,
daRupvas _ gansakuTrebiT orsulobis pirvel naxevarSi, Tu dedas orsulobis dros
hqonda es infeqcia. mankebi aRwerili ar aris.
garTulebebi: aseptiuri meningiti, Trombocitopeniuri purpura iSviaTia da
ufro xSirad gvxvdeba imunokomprometirebul avadmyofebSi.
diferenciuli diagnozi tardeba wiTurasTan, enterovirusul egzanTemasTan,
wiTelas ati pur, msubuq formasTan, wiTel mglurasTan da medikamentur alergiasTan.
yvela SemTxvevaSi mxedvelobaSi unda miviRoT infeqciuri eriTemisTvis damaxasiaTebeli
gamonayari. diagnozis dadastureba rutinul laboratoriebSi SeuZlebelia. gamoiyeneba
19 IgM antisxeulebi, polimerazuli jaWvuri reaqcia _ virusis dnm-is
anti-B19
dadasturebisaTvis.
mkurnaloba. daavadeba specialur mkurnalobas ar saWiroebs.
mkurnaloba
118
kerZo nawili.
enterovirusuli infeqciebi.
enterovirusuli infeqciebi
enterovirusuli infeqciebi
(ENTEROVIROSIS)
enterovirusebis gvari miekuTvneba Picornaviridae-s ojaxs da warmoadgens Zlier

patara zomisa da martivi agebulebis virusebs, ris gamoc miiRes es saxelwodeba
(pico _ metad patara, rna _ ribonukleinis mJava). am ojaxSi Sedis adamianis
poliomielitis virusis 3 ti pi, A jgufis koksaki (Coxsackie) virusebi (23 ti pi),
B jgufis koksaki virusi (6 ti pi), adamianis ECHO virusebi (31 ti pi), A hepatitis
virusi (2 ti pi), cxovelebis enterovirusebi (34 ti pi).
pikornavirusebis ojaxSi, garda enterovirusebisa, Sedian kidev 3 ti pis virusebi
_ rinovirusebi, kardiovirusebi da afTovirusebi.
koksakis, ECHO -s da poliomielitis virusebi iwveven Tavisebur da mZimed
mimdinare daavadebebs adamianebSi.
etiologia. eleqtronul mikroskopSi enterovirusebis virionebs daaxloebiT
etiologia
sferos forma aqvT, romlis diametria 15-35nm. virusis nawilaki Sedgeba Sinagani
komponentisagan, romelic warmodgenilia erTZafiani rnm-iT da cilovani garsiT, aqvs
antigenuri specifikuroba. rnm infeqciurobis matarebelia da warmoadgens virusis
genetiur masalas.
oTaxis temperaturis pirobebSi enterovirusebi stabilurebi arian da aqtiurobas
0
inarCuneben ramodenime dRes, gayinul mdgomareobaSi (-20 C) Zleben didxans. swrafad
0
iRupebian 56 C-ze, formaldehidis, qlorisa da ultraiisferi sxivebis zemoqmedebiT.
isini antibiotikebis mimarT mgrZnobiareni ar arian.
sxvadasxva qsovilovan kulturebze enterovirusebis kulturis misaRebad
SemuSavebulia ramodenime meTodi, romlebzec awarmoeben adamianis organizmidan
gamoyofili biologiuri masalis CaTesvas. am qsovilebSi virusi iwvevs citopaTogenur
efeqts (rac gamoiyeneba maTi herpesvirusebis, adenovirusebisa da reovirusebisagan
diferenciaciisaTvis).
epidemiologia. enterovirusuli infeqciebis erTaderT wyaros warmoadgens
avadmyofi, rekonvalescenti an infeqciis usimptomo formiT Sepyrobili adamiani.
janmrTelis dainficireba xorcieldeba avadmyofTan uSualo kontaqtis dros
respiraciuli an alimenturi gziT. garkveuli mniSvneloba aqvT oTaxis buzebs, romlebsac
SeuZliaT produqtebis dainficireba fekaliebiT. es gansakuTrebiT aRiniSneba dabali
ekonomikuri da kulturuli donis mqone mosaxleobis fenebSi.
miuxedavad etiologiuri, epidemiologiuri da klinikuri Taviseburebebis erTobisa,
zemoT naxsenebi sami jgufis enterovirusebis mier gamowveuli daavadebebis paTogenezi,
klinika da gamosavali mniSvnelovnad gamoirCeva erTmaneTisagan, rac saWiroebs Cox-
sackie, ECHO da poliovirusuli infeqciebis calkeul ganxilvas.
119
kerZo nawili.
enterovirusuli infeqciebi. poliomieliti
poliomieliti
(POLIOMYELITIS)
poliomieliti cnobilia Semdegi saxelwodebebiT _ mwvave epidemiuri poliomieliti

_ Poliomyelitis anterior acuta, heine-medinis daavadeba, bavSvTa spinuri dambla.
daavadebis saxelwodeba Poliomyelitis dakavSirebulia laTinur sityvebTan _ polio
niSnavs ruxs, xolo _ myelon zurgis tvins; Poliomyelitis_zurgis tvinis ruxi
nivTierebis anTeba. klinikurad misTvis damaxasiaTebelia organizmis saerTo intoqsikaciis
movlenebi, nervuli sistemis dazianeba periferiuli ti pis damblebiT.
etiologia. poliomielitis virusi _ poliovirus hominis pirvelad gamohyves
etiologia
1908 wels. Landsteiner - ma da Popper-ma gardacvlili avadmyofis zurgis tvinidan.
virusi, adamianis garda, paTogenuria maimunebisaTvis. cnobilia sami ti pis I, II, III
poliovirusi, romlebic erTmaneTisagan gansxvavdebian pH-iT da jvaredini reaqciiT,
komplementSemboWavi reaqciiT ki aRiniSneba maTi antigenuri msgavseba.
epidemiologia. infeqciis wyaros warmoadgens avadmyofi an virusmtarebeli
epidemiologia
adamiani. avadmyofebisagan daavadebis 1-2 kviris manZilze virusis gamoyofa garemoSi
xdeba cxvir-xaxidan, fekaliebidan (zogjer grZeldeba Tveebis manZilze). amasTan
dakavSirebiT gadacemis meqanizmi aris rogorc haer-wveTovani, ise fekalur-oraluri;
ukanaskneli ki iTvleba infeqciis gadacemis mTavar gzad. garkveuli epidemiologiuri
mniSvneloba eniWeba poliovirusebis gamoyofas wyalSi.
dadgenilia, rom dambliT mimdinare 1 avadmyofze modis 200-mde usimptomo,
virusmtarebeli da abortuli formiT daavadebuli. poliomielitis mimarT yvela
asakia mgrZnobiare, gansakuTrebiT ki 5 wlamde bavSvebi. Semdgomi asakis bavSvebi da
mozrdilebi virusis farTo cirkulaciis gamo iZenen imunitets. 3-4 kviris asakis
bavSvebSi daavadeba praqtikulad ar gvxvdeba, rac aixsneba dedisagan placenturi gziT
gadacemuli pasiuri imunitetiT. samociani wlebidan daiwyo farTomasStabiani vaqcinacia
inaqtivirebuli solkis vaqciniT, xolo Semdgom sebinis cocxali vaqciniT; amis gamo
poliomielitiT daavadeba Semcirda 100-jer da iq, sadac vaqcinacia tardeboda
regularulad, mxolod sporaduli SemTxvevebi aRiniSneba.
sezonuroba. zomieri klimatis mqone qveynebSi daavadeba gvxvdeba seqtember-
sezonuroba
oqtomberSi, zamTarSi ki ufro naklebia. tropikul qveynebSi aseT sezonurobas SeiZleba
ar hqondes adgili.
daavadebis gadatanis Sedegad organizmSi viTardeba mdgradi imuniteti. ganmeorebiTi
daavadeba iSviaTia. imuniteti atarebs ti purspecifikur xasiaTs (homogenuri Stamis
mimarT).
paTmorfologia. Tanamedrove Sexeduleba eyrdnoba adamianebSi,
paTogenezi da paTmorfologia
eqsperimentul cxovelebSi infeqciuri procesis kompleqsur Seswavlas da qsovilovani
kulturebis dasnebovnebis Sedegad miRebul faqtebs. aseTma midgomam Secvala azri
daavadebis ganviTarebaSi nervuli faqtoris dominirebis Sesaxeb da win wamoswia
hematogenuri diseminaciis Teoriis upiratesoba.
virusi organizmSi xvdeba piris Rrus lorwovani garsidan. virusis reproduqcia
warmoebs piris Rrus, saylapavis, kuW-nawlavis lorwovan garsebSi, limfur kvanZebSi,
peieris folaqebSi. SemdgomSi virusi hematogenuri gziT vrceldeba da Sinagan organoebSi
diseminirdeba. igi regularulad mravldeba limfur kvanZebSi, elenTaSi, RviZlSi,
TirkmlebSi, filtvebSi, gulis kunTSi da gansakuTrebiT, yavisfer cximSi, romelic
virusis erTgvar (Tavisebur) depos warmoadgens.
hematoencefaluri barieris gavliT virusis nervul sistemaSi SeWris sakiTxi
120
kerZo nawili.
jerjerobiT sakmarisad ar aris Seswavlili, magram varaudoben, rom neirotropuli da

maT Soris, poliomielitis virusebi gaivlian wvrili sisxlZarRvebis epiTeliums,
qorioidul wnuls, parkuWebis ependimas. meore gzaa periferiuli nervebiT virusis
pasiuri gavrceleba ujredSida sivrceSi an aqsoplazmis gavliT, magram ar gamoiricxeba
virusis replikacia limfocitebsa da fibroblastebSi endoTeliuri da perinervuli
garsiT. zogjer umTavresi roli eniWeba nervul gzas; magaliTad, axalSobilis dazianeba
dedis poliomielitiT daavadebis dros xdeba infeqciis SeWriT nervul sistemaSi
ynosvis nervebis saSualebiT. literaturaSi aRwerilia bulburi formis poliomielitis
ganviTareba tonzileqtomiis Semdeg.
virusis mimarT mgrZnobiarea nervuli sistemis mxolod garkveuli ujredebi da
ubnebi. neironebi ziandeba maTSi virusis gamravlebis Sedegad, magram yvela ujredi ar
kvdeba, bevri maTganis funqcia aRdgeba daavadebis 3-4 kviris Semdeg. ufro xSirad
ziandeba: 1) zurgis tvini, (umTavresad wina rqis neiromotoruli ujredebi); 2)
mogrZo tvini (vestibuluri birTvebi, qalas tvinis nervebis birTvebi, retikuluri
formacia misi sasicocxlo centrebiT; 3) naTxemi (saxuravis birTvebi da naTxemis
Wia); 4) Sua tvini (ZiriTadad, ruxi nivTiereba, iSviaTad Savi nivTiereba da wiTeli
birTvebi); 5) Talamusi da hi poTalamusi; 6) mkrTali sfero (Globus pallidus); 7)
tvinis qerqis motoruli ubnebi.
zurgis tvinSi aRiniSneba paTmorfologiuri cvlilebebi, romelic xasiaTdeba
hi peremiiTa da SeSupebiT, motorul ujredebSi adgili aqvs leikocitur reaqcias,
perifokalur infiltracias, romelic warmodgenilia limfuri da polimorfuli
leikocitebis SereviT, gvxvdeba wvrili sisxlCaqcevebi. did mamoZravebel neironebSi
aRiniSneba SeSupeba, tigroiduli beltebis gaqroba. birTvakebis daRupvis Semdeg iRupebian
ujredebic. ufro xSirad ziandeba zurgis tvinis welis nawili, Semdeg ki mkerdisa da
kisris nawilebi. neironebis 1/3 -1/4 nawilis daRupvisas viTardeba parezi, xolo
ujredebis 3/4 nawilis daRupva iwvevs srul damblas. daavadebis aRdgeniT periodSi
daRupuli ujredebi icvleba gliuri qsoviliT. kunTebSi, romelTa inervacia dazianebulia,
SemdgomSi viTardeba atrofia. rbil garsebSi (ufro zurgis tvinis nawilSi)
paralelurad viTardeba hi peremia da infiltracia.
virusi ar azianebs: 1) tvinis qerqs ( motoruli zonis gamoklebiT ); 2) naTxems
(Wiisa da Rrmad mdebare saSualo birTvebis gamoklebiT); 3) zurgis tvinis TeTr
nivTierebas, amasTan erTad neironebis mTlianobas. nervuli ujredebis aseTi mozaikuri
dazianeba gansazRvravs kunTTa parezis asimetriulobasa da maT uwesrigo lokalizacias,
rac damaxasiaTebelia poliomielitisaTvis.
poliomielitis dros aranervuli xasiaTis paTologias meorexarisxovani mniSvneloba
eniWeba. SeiZleba adgili hqondes bronqits, pnevmonias, ateleqtazs, rac ganpirobebulia
gulmkerdis sunTqviTi moZraobebis SezRudviT, araefeqturi xveliT. gul-sisxlZarRvTa
sistemis dazianebam SeiZleba ganapirobos hi pertenzia gulis ukmarisobiT, filtvebis
SeSupebiT.
klinika. inkubaciuri periodi meryeobs 2-dan 35 dRemde, saSualod 10-12 dRe.
klinika
99%-Si daavadeba mimdinareobs damblebis gareSe, damblebiT mimdinareobas adgili aqvs
mxolod 1%-Si.
sxvadasxva klinikuri formiT mwvave poliomielitis mimdinareoba ganpirobebulia
virusuli procesis mimdinareobi etapurobiT da nebismier etapze procesis Sewyvetis
SesaZleblobiT. magaliTad, Tu virusis gamravleba Sewyda nawlavebSi, viTardeba
inaparantuli forma, rac arsebiTad ganapirobebs virusmtareblobas; am dros xdeba
specifikuri imunitetis formireba. misi diagnostika SesaZlebelia mxolod
laboratoriuli monacemebiT. viremiis stadiaSi viTardeba abortuli anu visceruli
121
kerZo nawili.
forma. virusis SeWra nervul sistemaSi iwvevs meningealur an dambliT mimdinare

formas. dambla Tavis mxriv, SeiZleba iyos spinuri, bulburi, pontinuri da Sereuli
xasiaTis _ bulbur-spinuri, pontinur-spinuri, bulbur-pontinur-spinuri. yvelaze xSiri
gamovlinebaa spinuri forma, romelic xasiaTdeba kidurebis, tanis, kisris, diafragmis
damblebiT.
klinikur mimdinareobaSi arCeven Semdeg periodebs: preparalizurs, paralizurs,
aRdgeniTs da narCeni movlenebis (rezidualuri movlenebi).
klinikuri simptomebis gamovlinebis simZlavriTa da procesis gavrcelebis mixedviT
arCeven msubuq, saSualo simZimisa da mZime formebs.
msubuq mimdinareobas SeiZleba Semdgom Seerwyas mZime, rac iwvevs orfazian talRas.
pirveli talRa cnobilia, rogorc `mcire daavadeba~ da xasiaTdeba temperaturis
umniSvnelo momatebiT, xolo ramodenime dRis Semdeg vlindeba simptomatika nervuli
sistemis mxriv _ `didi daavadeba~.
poliomielitis araparalizuri formebi
abortuli anu visceruli forma mimdinareobs saerTo infeqciuri simptomebiT

0
_ temperaturis momateba, romelic iSviaTad aRemateba 38,5 C, erTdroulad viTardeba
Tavis tkivili, sxeulSi damtvreulobis SegrZneba, umadoba, gulis revis SegrZneba,
yelis fxaWna, nawlavTa aSliloba, vegetatiuri darRvevebi _ oflianoba, paresTeziebi
da hi peresTeziebi, wiTeli dermografizmi. daavadebis am formis dros diagnostika
SeuZlebelia, Tumca iseTma gamovlinebebma, rogoricaa hi peresTeziebi, paresTeziebi da
vegetatiuri simptomatika, unda dabados poliomielitze virusologiuri da
serologiuri gamokvlevebis Catarebis survili.
meningealuri forma. wamyvani xdeba serozuli meningitis gamovlinebani, romlebic
Serwymulia abortuli formis simptomatikasTan. aq ufro mkafiodaa gamoxatuli
iseTi simptomebi, rogoricaa Tavis intensiuri tkivili, ganmeorebiTi Rebineba, krTomebi,
calkeuli kunTebis krunCxvebi, kidurebis tremori, horizontuli nistagmi. erTeul
SemTxvevaSi SeiZleba aRiniSnos daRliloba siarulis dros an kidurebis wuTieri
sisuste. iSviaTia Sardis buStis dambla (araxangrZlivad), ufro xSiria yabzoba.
SemTxvevaTa 3/4-Si daavadeba mimdinareobs orfaziani talRiT, xanmokle intervaliT
pirvel (`mcire daavadeba~) da meore (cns-s dazianeba anu `didi daavadeba~) fazebs
Soris.
meningealuri suraTi viTardeba daavadebis meore-mesame dRes da xSirad mimdinareobs
poliradikulonevrituli sindromiT, rac ganpirobebulia nervuli fesvebisa da Reroebis
daWimviT. Cndeba kisris, zurgis da welis kunTebis mtkivneuloba da rigidoba, e.w.
aqtiuri sinjebis meSveobiT dgindeba kisris kunTebis rigidoba, kernigis, bruZinskis,
`samfexas~ simptomi da daWimvis sxva dadebiTi simptomebi. meningiti atarebs serozuli
anTebis xasiaTs. zurgis tvinis siTxeSi adgili aqvs limfocitur citozs (200-300
mkl-Si), umniSvnelod matulobs cilisa da Saqris raodenoba, romelic daavadebis me-
3 kviras srul normalizacias ganicdis. daavadebis mimdinareoba Cveulebriv, keTilsaimedoa.
acril bavSvebSi poliomielitiT daavadeba iSviaTia. daavadebis SemTxvevebi ki
mimdinareobs msubuqad. zogjer viTardeba qveda kidurebis msubuqi parezi, am dros
bavSvi msubuqad koWlobs, myesTa refleqsebi daqveiTebulia. aseTi movlenebi Cqara
qreba da xSirad rCeba mxedvelobis miRma, magram garkveuli periodis manZilze aRiniSneba
narCeni movlenebi susti hipotoniis saxiT, xolo eleqtromiogramaze SesaZloa, aRiniSnos
amplitudis meryeobis Semcireba.
poliomieliti axalSoblebsa da wlamde asakis bavSvebSi. iseve, rogorc
122
kerZo nawili.
wiTuras viruss, poliomielitis virussac SeuZlia embriopaTiis gamowveva orsulobis

pirveli Tveebis dros, xolo orsulobis gvian periodebSi dainficirebisas axalSobilebi
ibadebian poliomielitis niSnebiT (kunTTa atrofia, kidurebis kontraqtura da sxva).
aris monacemebi, rom daavadeba axalSobilebSi Rebulobs inaparantul formas, rac
dasturdeba specifikuri antisxeulebis titris gazrdiT da amave dros mowmobs
axalSobilis reaqtiulobis SesaZleblobas.
2-3 Tvis bavSvebi transplacenturi imunitetis gamo poliomielitiT ar avaddebian.
daavadeba 1 wlis asakSic iSviaTia; rac Seexeba am asakSi poliomielitis gamovlinebas,
igi mravali formis SeiZleba iyos.
paralizuri poliomielitis mimdinareoba iyofa 4 periodad _ preparalizuri,
paralizuri, aRdgeniTi da narCeni movlenebis periodebi:
preparalizuri periodi xasiaTdeba yvela im saerTo infeqciur-intoqsikaciuri
simptomatikiT, rac axasiaTebs viscerul da meningealur formebs. daavadeba iwyeba
uecrad, temperaturis momatebiT. avadmyofTa naxevars aReniSneba zemo sasunTqi gzebis
katari _ surdo, traqeiti, pir-xaxis lorwovani garsebis hiperemia, nawlavTa disfunqcia,
araiSviaTad muclis tkivili, faRaraTi an yabzoba. xSirad saxezea vegetatiuri darRvevebi
_ oflianoba (gansakuTrebiT Tavis areSi), dabali arteriuli wneva, gaxSirebuli
pulsi, wiTeli demografizmi. tipuria im kunTebis tkivili, romlebSic Semdgom viTardeba
dambla. zogjer viTardeba gonebis dabindva, bodva (gansakuTebiT mcire asakis bavSvebSi),
tonuri da klonuri krunCxvebi. daavadeba mimdinareobs ufro poliradikulonevrituli
formiT, romelic vlindeba kisris, welis kunTebis rigidobiT, mTeli rigi nervuli
fesvebisa da Reroebis daWimvis simptomebis gamovlinebiT (dadebiTi kernigis, bruZinskis,
lesaJis da sxva simptomebi). preparalizur periodSi zogjer SeimCneva daavadebis
ortalRiani mimdinareoba. pirveli talRa mimdinareobs subfebriluri temperaturiT
1-2 dRis ganmavlobaSi, 2-4 dRis apireqsiis periodis Semdeg isev aRiniSneba temperaturis
ukve maRal cifrebamde aweva da swored am talRaze viTardeba yvela is infeqciuri
simptomatika da nervuli sistemis dazianebis gamovlineba, romelic zemoTaa aRniSnuli.
preparalizuri periodi grZeldeba 3-5 dRe, amis Semdeg iwyeba paralizuri periodi.
paralizuri periodi. damblebis ganviTareba xdeba uecrad, umravles SemTxvevaSi
ramodenime saaTSi. zogierT bavSvs dambla uviTardeba
preparalizuri periodis gareSe, daavadebis pirvelsave
dRes, dilis saaTebSi (e.w. `dilis siurprizi~).
paralizuri poliomielitis klinika
damokidebulia nervuli sistemis dazianebis
lokalizaciaze. Tavidan klinikuri suraTi igivea,
rogorc araparalizuri formis dros, Cveulebriv,
damblebi viTardeba normaluri temperaturis dros,
Tumca araiSviaTad meoradi temperaturuli talRis
fonzec. avadmyofTa 20%-s aReniSneba Sardis buStis
atonia 1-3 dRis ganmavlobaSi. araiSviaTia msxvili
nawlavis atonia, romelsac nawlavebi mihyavs paralizur
gauvalobamde. yvelaze xSiria spinuri damblebi, ufro
xSirad qvemo kidurebs, xolo Semdeg zemo kidurebis,
naklebi sixSiriT _ kisris, tanis kunTebis. dazianebul
kunTebSi tonusi daqveiTebulia. sisuste aRiniSneba
poliomieliti. spinuri forma.
erTi an ramodenime jgufis kunTebSi, myesTa refleqsebi
orive fexis da marcxena xelis
daTrgunulia an srulebiT ar iwveva (arefleqsia). dambla. tkivilis sindromi.
damblebi atareben dune, periferiuli dazianebis (Í.È. Íèñåâè÷, Â.Ô. Ó÷àéêèí)
123
kerZo nawili.
xasiaTs. atonia da arefleqsia zogjer win uswrebs damblebis ganviTarebas. SemdgomSi

viTardeba kunTebis atrofia. mgrZnobelobis darRvevas, piramidul niSnebs adgili ara
aqvs. mwvave poliomielitisTvis damaxasiaTebelia parezebis da damblebis uwesrigo,
asimetriuli ganlageba, rac asaxavs motoneironebis sxvadasxva xarisxis dazianebas
SesaZloa erT segmentSic ki. damblebis aseTi mozaikuri ganawileba iwvevs `spazmebs~
im kunTebSi, romlebic paralizebuli kunTebis antagonistebs warmoadgenen. aRniSnuli
mdgomareobis Sedegia jer funqciuri, xolo Semdeg organuli kontraqturebis ganviTareba.
zurgis tvinis motoruli segmentis SezRuduli dazianebisas viTardeba spinuri
SezRuduli monoparezi, xolo gavrcelebuli formis dros ki adgili aqvs vrcel
parezebsa da damblebs. yvelaze ufro mZime formas warmoadgens neknTaSua kunTebisa
da diafragmis dazianeba, romlis drosac saxezea sunTqvis ukmarisobis niSnebi _
cianozi, gul-mkerdis moZraobis SezRudva; SesunTqvisas neknTaSoris SualedSi da
epigastriumis midamoSi SeimCneva Sezneqa.
paralizuri periodi grZeldeba ramodenime dRe, zogjer ki 2 kvira. am periodis
CamTavrebisas ukve Cndeba moZraobis aRdgenis niSnebi, rac mowmobs paralizuri periodis
dasasrulsa da aRdgeniTi periodis dawyebas.
eleqtromiografiiT SeiZleba dadgindes dazianebuli kunTebis agznebadobis
daqveiTebis xarisxi. mZime dazianebisas eleqtromiogramaze aRiniSneba swori xazi,
romelic cnobilia bioeleqtruli dumilis saxelwodebiT, rac mowmobs zurgis tvinis
Sesabamis segmentSi umravlesi motoneironebis daRupvas. aRniSnul periodSi Tav-
zurgtvinis siTxeSi cilebis raodenoba imatebs, xolo citozi klebulobs
(preparalizuri periodisaTvis damaxasiaTebeli ujredul-cilovani disociacia icvleba
cilovan-ujreduli disociaciiT), matulobs Saqris raodenoba.
forma. am dros vlindeba organizmis sasicocxlo funqciebis darRveva.
bulburi forma
daavadeba iwyeba uecrad, mcire preparalizuri periodiT an mis gareSe. avadmyofi
pirvelsave dReebSi mZimdeba, aRiniSneba hi perTermia, Tavis Zlieri tkivili, xSiri
Rebineba. saxezea nevrologiuri simptomatika. ZiriTadi klinikuri niSnebi ganpirobebulia
dazianebis lokalizaciiT, mogrZo tvinis sasicocxlo funqciebis darRveviT. qalas IX
da X wyvili nervebis birTvebis dazianeba iwvevs ylapvis darRvevas _ Txieri saWmlisa
da siTxis gadacdenas, cxviridan gadmosvlas, gulmkerdidan ismis xriali, SeuZlebeli
xdeba saWmlis ylapva, nerwyvisac ki (faringuli dambla), irRveva fonacia (`laringuli
dambla~); lorwos gaZlierebuli sekreciis gamo xdeba zemo sasunTqi gzebis obstruqcia,
viTardeba sunTqvis darRveva (`sveli forma~). avadmyofebs aReniSnebaT qoSini, cianozi,
ismis gulmkerdis xriali.
faringuli dambla SeiZleba ganviTardes laringuli damblis gareSe. izolirebuli
laringuli dambla, XI da XII wyvili nervebis birTvebis izolirebuli dazianeba
poliomielitisTvis damaxasiaTebeli ar aris, Tumca bulburi formis dros ori
ukanaskneli SeiZleba ganviTardes sxva simptomebTan erTad. bulburi formis dros
SesaZloa III, VI da VII wyvili nervebis birTvebis dazianeba, rac iwvevs Tvalis
mamoZravebeli kunTebis funqciis darRvevas da saxis asimetrias saxis mimikuri kunTebis
dazianebis gamo.
sunTqvisa da gul-sisxlZarRvTa mamoZravebeli centrebis dazianebis dros, romlebic
mdebareoben mogrZo tvinSi, adgili aqvs Zlier saSiSi sindromebis gamovlinebas _
sunTqvis normaluri ritmis darRvevas pauzis gaCeniT da paTologiuri ritmis
gamovlinebiT. aRiniSneba vazomotoruli laqebis arseboba, cianozi, taqikardia an
bradikardia. dasawyisSi aRiniSneba arteriuli wnevis momateba, Semdeg ki daqveiTeba:
avadmyofebi xdebian mSfoTvare, agznebuli, rac Semdgom icvleba soporiTa da komiT.
letaloba damaxasiaTebelia daavadebis pirvelsave dReebSi. Tu es ar moxda, maSin
124
kerZo nawili.
uaxloes 2-3 dReSi adgili aqvs procesis stabilizacias, xolo 2-3 kviraSi mdgomareoba
umjobesdeba aRdgeniTi movlenebis gamo.
forma. es forma viTardeba saxis nervis (VII wyvili) birTvis
pontinuri forma
izolirebuli dazianebiT, romelic mdebareobs tvinis xidis midamoSi. aRniSnuli
nervis dazianeba iwvevs mimikuri kunTebis moZraobis calmxriv, nawilobriv am mTlian
parezs. klinikurad es gamoixateba cxvir-tuCis naoWis waSliT, janmrTel mxareze
piris gadaweviT, quTuTuebis arasruli daxurviT (lagofTalmi), piris kuTxe daSvebulia.
Cveulebriv, pontinuri forma nakleb mZimed mimdinareobs; xSirad ar aris preparalizuri
periodisTvis damaxasiaTebeli simptomatika, Tumca mcire asakis bavSvebSi es periodi
SeiZleba gamoxatuli iyos.
am formis drosac SesaZlebelia saxis, tanisa da kidurebis damblebis Serwyma, rac
ganapirobebs klinikisa da prognozis Taviseburebas.
encefalituri forma iwyeba agznebiT, dezorientaciiT, ZilianobiT, cnobierebis
darRveviT; adgili aqvs krunCxvebs, xelis uxeS tremors. erTdroulad viTardeba
meningealuri movlenebi, saxezea kerovani simptomatika. amave dros, unda aRiniSnos, rom
garda encefalituri formisa uwin arCevdnen iSviaTi lokalizaciis _ ataqsiur da
poliradikulonevritul formebs, Tumca avadmyofTa laboratoriuli gamokvlevebiT
ar mtkicdeba am formebis poliomielituri warmoSoba (T\ Y\ Ktobycrfz= 1986).
aRdgeniTi periodi iwyeba msubuqad dazianebuli kunTebis aRdgeniT, romelic
mimdinareobs araTanabrad da nela. msubuqi parezebi aRdgebian 2-4 Tvis ganmavlobaSi.
rac Seexeba kunTebis Rrma dazianebas, maTi aRdgena ar xdeba. daavadebis dawyebidan
ukve 1 TveSi iwyeba atrofiis movlenebi, romlebic SemdgomSi progresirebs. vegetatiuri
darRvevebi vlindeba dazianebuli kidurebis gacivebiT, silurjiTa da oflianobiT.
aRdgeniTi procesi gansakuTrebiT aqtiurad mimdinareobs daavadebis pirveli 3-6
Tvis manZilze, Semdeg TandaTanobiT neldeba, magram grZeldeba kidev 1-1,5 weli.
bulburi formis dros ylapva da fonacia umravles SemTxvevaSi aRdgeba. mimikuri
da Tvalis mamoZravebeli kunTebis, saxis nervis izolirebuli dazianebis dros aRdgena
xdeba nela da aRiniSneba narCeni movlenebi, Tumca saxis nervis izolirebuli dazianebisas
aRdgeniTi procesi, ZiriTadad, iwyeba meore-mesame kviras da mTavrdeba sruli an
nawilobrivi aRdgeniT.
rezidualuri (narCeni movlenebis) periodi iwyeba 1-1,5 wlis Semdeg da
xasiaTdeba kunTebis atrofiiT, kontraqturebiT, Zvlebis deformaciiT, osteoporoziT.
zurgis kunTebis dazianebisas viTardeba xerxemlis sxvadasxva deformacia. SemdgomSi
dazianebuli kidurebi CamorCebian zrdaSi, gansakuTrebiT mcire asakis bavSvebSi.
diagnozi. ti puri poliomielitis dros daavadebis diagnostika eyrdnoba dune
damblebis dadgenas, upiratesad qvemo kidurebis damblas, romelsac adgili aqvs umTavresad
temperaturis normalizaciis Semdeg. vinaidan dune dambla SeiZleba ganviTardes sxva
etiologiis virusuli infeqciebis (koksaki, ECHO da a.S.) drosac, amitom diagnozis
saboloo dadgenisTvis saWiroa laboratoriuli gamokvlevebi. rac Seexeba inaparantul
da abortul formebs maTi dadgena SesaZloa mxolod laboratoriuli meTodebiTa da
epidmonacemebiT.
virusologiuri da serologiuri gamokvlevebigamokvlevebi. virusis gamoyofa xdeba
fekaliebidan, cxvir-xaxis Camonarecxidan, sisxlidan, Sardidan da Tav-zurgtvinis siTxidan.
virusis gamoyofa fekaliebidan ufro SesaZlebelia, Tumca am mizniT iyeneben aseve
reqtalur nacxs. bavSvebs, romlebsac miRebuli hqondaT oraluri poliovirusuli
vaqcina OPV, SeuZliaT vaqcinuri virusis eqskrecia ramodenime kviris ganmavlobaSi.
rodesac janmrTel bavSvTan aRiniSneba virusis eqskrecia unda vifiqroT, rom es OPV-
s imunizaciis Sedegia, Tu klinikuri simptomebi ar gamovlinda an ar aris raime
125
kerZo nawili.
epidemiologiuri monacemebi. virusis kulturis miReba damokidebulia diagnostikis

meTodze. ara fekaliebidan, aramed xaxidan da Tav-zurgtvinis siTxidan gamoyofili
virusi ufro metad laparakobs daavadebis arsebobaze. serologiuri gamokvlevebis
interpretacia zogjer Znelia. poliomielitis dros avadmyofis sisxlSi gamomuSavdeba
topurspecifikuri-komplementSemboWavi, maneitralizebeli da mapreci pitirebeli
antisxeulebi. aRniSnul antisxeulebs mniSvneloba aqvs poliomielitis mwvave formis
dros im SemTxvevaSi, roca maTi titri daavadebis dinamikaSi 4-jer matulobs.
mosaxleobaSi vaqcinuri Stamebis farTe cirkulaciis Sedegad SesaZloa imunuri
Zvrebis dadgena, rac am dros virusmtareblobaze mowmobs. amitom klinikuri da
serologiuri monecemebis Sefasebas didi mniSvneloba eniWeba. mTavari diagnostikuri
simptomis _ dune damblis fonze dadebiT serologiur-laboratoriul monacemebs
gadamwyveti diagnostikuri mniSvneloba aqvT.
diferenciuli diagnozi poliomielitis preparalizur periodSi saWiroa,
gamoiricxos gripi, sxva mwvave respiraciuli virusuli infeqciebi. am dros sadiagnostiko
mniSvneloba aqvs iseTi simptomebis gamovlinebas, rogoricaa hiperesTezia, mtkivneuloba
nervul fesvebze zewolisas, kunTis hi potonia da refleqsebis daqveiTeba. paralizur
periodSi diagnostika ufro gaadvilebulia, vinaidan saxezea dune damblebis arseboba,
magram mxedvelobaSi unda miviRoT iseTi daavadebebi, rogoricaa poliomielitis msgavsi
infeqciebi sxva virusuli etiologiiT (Coxsackie da ECHO). poliomielitisgan
gansxvavebiT koksaki-infeqciis dros SeiZleba adgili hqondes herpesul anginas, sklerebis
sisxlZarRvTa inicirebas, xangrZliv temperaturas, mialgias da sxva. parezebi da
damblebi adre qrebian da ar toveben mZime narCen movlenebs. sxva saxis virusuli
etiologiis nevritis dros da difTeriuli poliradikulonevritis SemTxvevaSi saTanado
anamnezuri da klinikuri simptomatika, laboratoriuli monacemebi SesaZlebels xdis
maT diferenciacias.
poliomielitis meningealuri formis diferencireba saWiroa Coxsackie,, ECHO
da parotituli infeqciebisagan. yvela SemTxvevaSi saWiroa klinikuri, epidemiologiuri
da laboratoriuli monacemebis kompleqsuri Sefaseba.
infeqciuri polinevritiT mimdinare gien-bares sindromis SemTxvevaSi iqmneba
garkveuli siZneleebi poliomielitis diferenciaciaSi. am dros damblebi xasiaTdeba
simetriulobiT, adgili aqvs mgrZnobelobis darRvevas, aRiniSneba piramiduli gzebis
darRvevis simptomebi, rac poliomielitis dros ar gvaqvs, Tav-zurgtvinis siTxeSi
matulobs globulinebis done, magram ar gvaqvs citozi. agreTve saWiroa gamoiricxos
neoplazmebi, isteria (iSviaTia), botulizmi, periferiuli nevriti (HZV-iT gamowveuli),
gamoucnobi travmebi, araspecifikuri sinovitebi, mwvave osteomieliti, revmatiuli
cxeleba, skorbuti (suravandi) _ am dros aRiniSneba Zvlebis paTologia.
mkurnaloba. araparalizuri da sustad gamoxatuli paralizuri poliomielitis
dros mkurnalobis daniSvna SeiZleba binis pirobebSi. sxva formebis dros ki saWiroa
avadmyofis hospitalizacia. yvela SemTxvevaSi naCvenebia mkacri woliTi reJimi, xolo
aqtiuri da pasiuri moZraobebi saWiroa tkivilis gavlis Semdeg. opiatebi da sedacia
dasaSvebia mxolod maSin, Tu ar aRiniSneba ventilaciis darRvevebi. saWiroa yabzobasTan
brZola. Tu viTardeba naRvlis buStis parezi, saWiroa parasimpatikuri mimetikebiT
misi koreqcia (mag. bethanechol (Urecholine)-iT 5-10 mg per os an 2,5-5 mg kanqveS
xSirad iwvevs ganTavisuflebas 15-30wT-Si, Tumca zogierT avadmyofSi aRiniSneba
Rebineba preparatis Seyvanisas); naRvlis buStis parezi mxolod ramodenime dRe
grZeldeba. saWiroa sakvebis adekvaturi miReba. bulburi damblis dros avadmyofis
sawolSi pozicia icvleba _ fexebi Tavze ufro maRal doneze unda ganlagdes, raTa
ar moxdes aspiracia, Tavi ki gverdzea Sebrunebuli. mkurnalobis Sedegi damokidebulia
126
kerZo nawili.
daavadebis periodze, formasa da simZimeze.

kortikosteroidebi naCvenebia mxolod tvinis mwvave SeSupebis dros. ylapvis
darRvevisas saWiroa kuWis zondis Cadgma. lorwos gaZlierebuli sekreciisas
aucilebelia misi mocileba zemo sasunTqi gzebidan. roca filtvis sasicocxlo
moculoba ecema 25%-mde, saWiroa xelovnur sunTqvaze gadayvana, agreTve, roca amonasunTq
haerSi naxSirorJangis Semcveloba 4,5%-ze metia (hi perkapniis da hi poqsemiis dros).
Tavis tkivilis da Rebinebis dros tardeba dehidrataciuli Terapia (diakarbi, naklebad
laziqsi) analgetikebTan erTad. meningo-poli-radikulo-nevrituli formebis dros
damatebiT eniSnebaT B jgufis vitaminebi (gansakuTrebiT B12) da daavadebis meore
kviras Tbili procedurebi (parafini, cxeli SefuTva), fizioTerapia (ultraiisferi
sxivebi, diaTermia, ionoforezi novokainiT), absolutur woliT simSvides Txoulobs
daavadebis pirveli ori kvira. aRdgeniT periodSi didi mniSvneloba aqvs kontrols,
dadamblavebuli kidurebis da tanis swor mdebareobaze, kontraqturebisa da deformaciis
profilaqtikas. paralizuri periodis CamTavrebis Semdeg dazianebuli kunTebis aRdgenis
dawyebidan (mesame-meoTxe kvira) aucilebelia im preparatebis daniSvna, romlebic
xels uwyoben nerv-kunTovani impulsebis gamtareblobas da mamoZravebeli funqciis
aRdgenas. amisaTvis iniSneba prozerini erT welze 0,001g 2-jer dReSi kunTebSi;
galantamini (0,25%-iani xsnari kanqveS an kunTebSi: 0,1 -0,2 ml 2 wlamde, 0,2-0,4 ml
_ 3-5 wlamde, 0,3-0,8 ml 7- 8 wlamde asakis bavSvebSi), dibazoli (0,001 g welze
kunTebSi 2-jer dReSi). aRniSnuli preparatebi erTdroulad ar iniSneba. maT niSnaven
Tanamimdevrulad kursebiT 3-4 kviris xangrZlivobiT.
iyeneben anabolur hormonebs: meTandrostenolons, nerobols, retabolils. mkurnaloba
iwyeba adreul aRdgeniT periodSi. sasunTqi kunTebis dazianebisas avadmyofi Tavsdeba
reanimaciis ganyofilebaSi.
aRdgeniTi periodis mkurnaloba tardeba sanatoriul-kurortul pirobebSi.
prognozi. sxvadasxva avtorebis monacemebiT letaloba meryeobs maRal cifrebamde.
prognozi
bulburi da spinuri formebis dros, romlebic mimdinareoben sunTqvis ukmarisobiT,
sikvdili viTardeba damblis 3-6 dRes, rac ganpirobebulia sasicocxlo organoebis
swrafi dambliT. meoradi baqteriuli infeqciiT garTulebis Sedegad letaloba
ufro mogvianebiT viTardeba.
paralizuri formis dros prognozi damokidebulia parezis siRrmeze. damblebis
aRdgenas adgili aqvs 20-40% SemTxvevebSi. cudi prognozuli niSania soporisa da
komis ganviTareba. pontinuri formis dros prognozi sicocxlisaTvis keTilsaimedoa,
magram SeiZleba adgili hqondes narCen movlenebs. meningealuri forma xasiaTdeba
keTilsaimedo gamosavliT, raime seriozuli movlenebis gareSe.
profilaqtika. specifikuri profilaqtika tardeba OPV _ poliomielitis
profilaqtika
cocxali atenuirebuli vaqciniT (sebinis vaqcina). vaqcinaciis sqema iTvaliswinebs
samvalentiani (I, II, III ti pi) per os acras 2, 3, 4 Tvis asakSi. revaqcinacia tardeba 18
Tvis, 5 wlis asakSi.
organizmSi vaqcinuri Stamis gamravlebis dros SesaZloa virusze mutagenuri
zemoqmedeba, rac ar gamoricxavs misi paTologiuri cvlilebebis aRdgenas calkeuli
klonis virusebSi. aseTi cvlilebebi SesaZlebelia vaqcinuri Stamebis mxrivac, romlebsac
vaqcinirebuli bavSvebi gamoyofen garemoSi (gansakuTrebiT dabali imunitetis mqone
bavSvebis organizmSi cirkulirebisas, rac xels uwyobs am virusis mravaljer pasirebas).
Tumca sityva `vaqcinaasocirebulSi~ igulisxmeba, pirvel rigSi cneba vaqcinaciisa da
daavadebis damTxvevaze, miuxedavad amisa gamonaklis SemTxvevaSi ar aris gamoricxuli
mizezobrivi kavSiri vaqcinaciasa da paralizur poliomielits Soris.
msoflio jandacvis specialuri komitetis monacemebiT riskis xarisxi
127
kerZo nawili. poliomieliti
enterovirusuli infeqciebi. arapoliomielituri enterovirusuli infeqciebi
reci pientisaTvis SesaZlebelia iyos 0,087-dan 2,288 SemTxveva 1 milion vaqcinirebulSi,

xolo 0,135-dan 0,645-mde SemTxvevaSi _ kontaqtirebulTaTvis. am mimarTebaSi
mxedvelobaSi unda gvqondes vaqcinaciis da kontaqtebis vadis dadgena; daavadeba
viTardeba vaqcinaciidan 6-30 dRis da kontaqtidan 6-60 dRis ganmavlobaSi.
zemoaRniSnulTan dakavSirebiT SemoTavazebulia da zogierT qveynebSi (mag: aSS-Si)
gamoiyeneba maimunis Tirkmlebidan an adamianis di ploiduri ujredebidan miRebuli
poliovirusis maRalimunogenuri inaqtivirebuli vaqcina IPV (inactivated poliovi-
rus vaccine), romelic aseve moicavs 3 ti pis viruss. saWiroa vicodeT, rom IPV-Si
aRiniSneba streptomicinis, neomicinis umniSvnelo raodenoba da damatebiT polimiqsin
B-c. IPV-Ti vaqcinaciis dros ar xdeba virusis fekaliebiT gamoyofa da sxvebis
dainficirebis riski praqtikulad ar arsebobs iseve, rogorc vaqcinaasocirebuli
paralizuri poliomielitis riski. vaqcinaciisas iyeneben IPV-s da OPV-s rogorc
erT sqemaSi, aseve cal-calke sqemebiT. mxolod IPV-Ti an OPV-Ti vaqcinaciis dros
virusis eqskrecia Sesabamisad 0-mde an minimumamdea dayvanili. IPV-Ti imunizacia
tardeba Semdegnairad: I doza _ 1-2 Tvis asakSi, II doza _ 4-8 kviraSi da III doza 6-
12 Tvis asakSi. damatebiTi doza Seiyvaneba skolaSi an baRSi Sesvlis win (4-6 wlis
asakSi). IPV-OPV vaqcinacia tardeba Semdegnairad: I doza _ IPV 2 Tvis asakSi, II
doza IPV_ 4 Tvis asakSi, III doza OPV _ 12-18 Tvis asakSi da IV doza OPV_ 4-6
wlis asakSi. mozrdilebisaTvis imunizacia saWiroa Tu isini maRal endemur zonebSi
miemgzavrebian. Cvens qvenayaSi, acrebis kalendarSi miRebulia mxolod OPV-Ti vaqcinacia.
aucilebelia, vaqcinaciam srulad moicvas mosaxleobis saTanado kontingenti, rac
uzrunvelyofs maqsimalur koleqtiur imunitets da saSualebas mogvcems, SeizRudos
vaqcinuri Stamebis farTo cirkulacia da mravaljeradi pasireba araimunur organizmSi.
yvela dune damblis Sesaxeb aucilebeilia daavadebaTa kontrolis centris informireba
da maT laboratoriaSi masalis gamosakvlevad gagzavna.
arapoliomielituri enterovirusuli infeqciebi

(NONPOLIO ENTEROVIRUS INFECTIONS,
POLIOMYELITIS LIKE DISEASE--ingl.
ingl.)
es infeqciebi miekuTvnebian mwvave virusul daavadebaTa jgufs, romelTa Soris

umniSvnelovanesia Coxsackie da ECHO virusebi. maT axasiaTebT mravalferovani
klinikuri gamovlinebani, dawyebuli msubuqi cxelebidan da ubralo virusmtareblobidan
da damTavrebuli cns-is, kunTebis, miokardiumisa da kanis safaris dazianebis CaTvliT.
etiologia. koksaki _ virusi pirvelad avadmyofebidan gamohyves 1948w. aSS-Si
etiologia
q. koksakSi Dalidorf-ma da G. Siekles-ma. mialgiis pirveli epidemiuri afeTqebebi 1856
wlidan aRweres islandiaSi, xolo meoce saukunis dasawyisSi parizsa da skandinaviis
qveynebSi. arCeven ori jgufis koksaki virusebs: A da B. A-s aqvs 23 serologiuri
varianti, B-s ki 6. maTi kultivireba SeiZleba adamianis embrionis, maimunebis Tirkmelebis
kulturebze, romlebSic iwveven citopaTogenur efeqts. ZuZumwovara TeTr TagvebSi
koksaki-virusebi iwveven infeqciis paralizur formebs. infeqciis bunebriv wyaros
warmoadgens adamiani.
1951 w. D. Enders-ma pirvelad gamohyo virusi, romelsac didxans ar miiCnevdnen
adamianisaTvis paTogenurad. virusma miiRo ECHO-s saxelwodeba, rac dakavSirebulia
inglisuri sityvebis pirvel asoebTan _ Enteric Cytopathogenic Human Orphan
(nawlavTa citopaTogenuri adamianis oboli virusi). A coxsackie virusebis 23 jgufi
128
kerZo nawili.
(ti pebi A1-A24, garda A23 ti pisa), 6 jgufi B coxsackie virusebi (ti pebi B1-B6), 31
echovirus-i (ti pebi 1-34, garda 10,28 da 34 ti pebisa) da 4 enterovirusi (ti pebi 68-
71). 68-69 ti pebi iwveven respiraciul da nawlavTa daavadebebs, 70-e ti pi _
hemoragiul koniunqtivits, xolo 71-e tipi gamoyofili iyo meningitian da encefalitian
avadmyofebSi.
epidemiologia. yvelaze ufro xSirad avaddebian 1-dan 10 wlamde bavSvebi. 3
epidemiologia
Tvemde bavSvebi, taransplacenturi imunitetis gamo ar avaddebian. daavadeba gvxvdeba
rogorc sporaduli, ise epidafeTqebebis saxiT, zafxulis bolosa da Semodgomis
dasawyisSi. infeqcia gadaecema haer-wveTovani da fekalur-oraluri gziT.
enterovirusuli infeqciebi Zlier kontagiozuria. afeTqebebi advilad viTardeba
bavSvTa koleqtivebSi. kontaqtis Sedegad inficirdeba da avaddeba koleqtivis 80%.
klinikurad Zalian waagavs mwvave respiraciul infeqciebs _ mwvave dawyebiTa da
talRiseburi mimdinareobiT xasiaTdeba.
paTmorfologia. virusi organizmSi iWreba zemo sasunTqi gzebisa
da kuW-nawlavis traqtis lorwovani garsebidan. virusis replikacias adgili aqvs
maT epiTeliumebSi da limfur warmonaqmnebSi. paTogenezis Semdgom fazas warmoadgens
virusis hematogenuri diseminacia, ris Sedegadac ziandeba mTeli rigi organoebis da
organizmis sistemebi, kerZod viTardeba serozuli meningiti an meningoencefaliti,
mwvave mioziti an mialgia, miokarditi, hepatiti da sxva. dadgenilia, rom erTi da igive
virusma SeiZleba gamoiwvios daavadebis sxvadasxva klinikuri forma, magram
gasaTvaliswinebelia is, rom viruss axasiaTebs tropizmi sxvadasxva sistemebis mimarT.
amis damadasturebelia is faqti, rom enterovirusuli afeTqebebis dros (koksaki da
ECHO infeqciebi) bavSvTa koleqtivebSi xSirad adgili aqvs erTgvarovan klinikur
gamovlinebas serozuli meningitis an meningoencefalitis saxiT an sxva formebs.
enterovirusuli infeqciis paTmorfologia arasruladaa Seswavlili, vinaidan
umravles SemTxvevaSi daavadeba mimdinareobs
msubuqi formebiT. gamonakliss warmoadgenen koksaki
A-7
-7 da ECHO-virusi 71, romlebic ufro metad
ganapirobeben letalur gamosavals. am daavadebebis
dros zurgisa da Tavis tvinSi viTardeba ruxi
nivTierebis mZime dazianeba, romelic
morfologiurad ar gansxvavdeba mwvave
poliomielitisagan.
ECHO-virusi _ 71-iT dasnebovnebuli maimunis
zurgis tvinSi histologiurad dadgenilia
mamoZravebeli nervebis ujredebis dazianeba,
neirofagiuri kvanZebi da perifokaluri
infiltracia.
axalSobilebsa da Cvil bavSvebSi, romelTac
aReniSnebodaT B jgufis koksaki virusiT
gamowveuli encefalo-miokarditis klinika,
sikvdilis dros Tavis tvinSi, gulis kunTSi da
sxva organoebSi aRiniSneboda virusis Semcveloba,
xolo seqciaze dgindeboda gulis kunTis moduneba,
misi Rruebis gadideba, perikarditisa da
enterovirusuli pankarditi revmatizmis
endokarditis movlenebi, meningealuri garsebis
fonze (gadidebuli gulis da RviZlis
SeSupa, SeSupeba da sisxlCaqcevebi Tavis tvinSi, sazRvrebi, mZime gulis ukmarisoba).
nekrozebis kera da sxva distrofiuli movlenebi (sakuTari masala)
129
kerZo nawili.
nervul ujredebSi, sisxlCaqcevebi

filtvebSi, ateleqtazi; RviZlSi,
elenTaSi, TirkmelebSi, kuWukana
jirkvalSi, Tirkmelzeda jirkvlebSi
sisxlCaqcevebi da nekrozis kerebi.
klinika. koksaki da ECHO-
virusebi avlenen tropizms
sxvadasxva organoebisa da
sistemebis mimarT da swored amasTan
aris dakavSirebuli maTi klinikuri
suraTis mravalferovneba.
enterovirusul infeqciaTa 50%
saerTod mimdinareobs klinikuri
enterovirusuli pankarditi revmatizmis fonze gamovlinebis gareSe _ usimptomod.
(igive avadmyofi). (sakuTari masala) miuxedavad klinikuri suraTis
mravalferovnebisa, daavadebis
mimdinareobaSi SeiZleba gamovyoT yvela formisaTvis saerTo simptomatika da daavadebis
mimdinareobisas ama Tu im sindromis upiratesi manifestacia.
inkubaciuri periodi meryeobs 2-dan 10 dRemde, ufro xSirad Seadgens 2-4 dRes.
0
daavadeba iwyeba uecrad, temperaturis momatebiT 39-40 C-mde. aRiniSneba Tavbrusxveva,
Tavis tkivili, umadoba, Zilis daRveva, zogjer tkivilebi muclis areSi. damaxasiaTebelia
tanis zemo nawilis hiperemia, sklerebis inicireba, ena Selesilia, ramdenadme hiperemiulia
nuSurebi, rbili sasa, misi rkalebi, xaxis ukana kedlis marcvlovaneba sakmaod gamoxatulia,
adgili aqvs saerTo poliadenias.
enterovirusuli cxeleba (samdRiani cxeleba, mcire daavadeba) warmoadgens
enterovirusuli infeqciis ufro xSir formas, romelic SeiZleba gamoiwvios koksakis,
ECHO-s virusebis sxvadasxva ti pma. zemoaRniSnuli saerTo intoqsikaciis fonze
temperaturuli reaqcia aRiniSneba 1-3 dRis ganmavlobaSi da zogjer Rebulobs
orfazian xasiaTs, rac, albaT, ganmeorebiTi virusemiis maCvenebelia. erTeul SemTxvevaSi
temperaturuli reaqcia 1-1,5 kviramde grZeldeba, zogjer Rebulobs talRisebur
mimdinareobas. daavadebis diagnozis dadgena, miTumetes sporaduli SemTxvevebis dros,
SeuZlebelia. epidemiuri afeTqebebis dros, roca aRniSnuli cxelebisa da intoqsikaciis
fonze mJRavndeba garkveuli sindromi meningitis, herpesuli anginis da a.S. saxiT,
diagnozi xdeba ufro damajerebeli.
periferiul sisxlSi daavadebis pirvel dReebSi SeiZleba iyos zomieri leikocitozi,
romelic male icvleba normocitoziT an leikopeniiT, xanmokle neitrofilozi marcxniv
gadaxriT, Semdgom viTardeba limfocitozi, SesaZlebelia eozinofilebis raodenobis
gazrda, eds normaluri an ramdenadme momatebulia.
herpesuli angina pirvelad aRwera Zahorsky-m 1924 wels. misi xSiri gamomwvevia
koksaki A, iSviaTad koksaki B da ECHO virusebi. daavadeba iwyeba mwvaved, temperaturis
0
uecari momatebiT 40-41 C -mde, gansakuTrebiT mcire asakis bavSvebSi, ufro mozrdilebi
uCivian Tavisa da welis tkivils, 5 wlamde asakis bavSvebSi 25%-Si aRiniSneba
Rebineba. daavadebis pirvelsave dReebSi sasis rkalebze, naqze, rbil da magar sasaze,
enaze Cndeba wvrili, 1-2 mm zomis wiTeli papulebi, romelic swrafad gardaiqmneba naz
buStukebad. isini warmoSoben zedapirul eroziebs, romlebic dafarulni arian
monacrisfro-TeTri detritiT. aRiniSneba tkivili ylapvis dros, limfuri kvanZebis
gadideba. mravlobiTi buStukovani gamonayrisas viTardeba afTozuri stomatitis
suraTi. garda buStukovani gamonayrisa da saerTo intoqsikaciisa, SeiZleba adgili
130
kerZo nawili.
hqondes egzanTemas, diareas, zemo sasunTqi gzebis katarsa da sxva movlenebs.

buStukebis raodenoba Seadgens erTeulidan 10-20-mde, romlebic swrafad ganicdian
maceracias. vezikula Semofarglulia wiTeli gvirgviniT (qobiT).
serozul
serozuli i (aseptikur
(aseptikuri) i) meningiti yvelaze ufro ti puri gamovlinebaa
enterovirusuli infeqciebis dros da umravles SeTxvevaSi gamowveulia B5 5 da ECHO
virusebis 4,6,9, da 11 ti pebiT.
daavadebis pirvelsave dReebSi klinikuri suraTi da cvlilebebi igivea, rac sxva
virusebiT (parotitis, poliomielitis) ganpirobebuli serozuli meningitis dros.
0
daavadeba iwyeba mwvaved, temperaturis aweviT 39-40 C-mde. avadmyofebi uCivian Tavis
Zlier tkivils, zogjer tkivilebs muclis areSi, ganmeorebiT Rebinebas. adgili aqvs
agznebas, SfoTvas. sxva saerTo infeqciuri simptomatikidan dawyebiTi periodisaTvis
damaxasiaTebelia sasis, pir-xaxis lorwovanis hi peremia. pirvelsave dReebSi viTardeba
meningealuri movlenebi: saxezea kisris kunTebis rigidoba, kernigisa da bruZinskis
simptomebi. lumbaluri punqciis dros siTxe gamodis wneviT, gamWvirvalea; cilis,
Saqris, qloridebis raodenoba momatebuli ar aris. pandis reaqcia sustad dadebiTi an
uaryofiTia. damaxasiaTebelia citozis momateba 200-300 ujredamde 1 mm3-Si. pirvel
dReebSi citozi atarebs neitrofilur-limfocitur xasiaTs, Semdgom dReebSi ki,
rogorc wesi, limfocituria. klinikuri suraTi (temperatura, meningealuri movlenebi)
SeiZleba gagrZeldes 3-7 dRe, Tumca SesaZlebelia mTliani klinikis ganmeoreba, rac am
SemTxvevaSi daavadebas orfazian mimdinareobas aniWebs.
agreTve xazgasasmelia, rom garda zemoaRniSnuli araspecifikuri saerTo gamovlinebisa,
serozuli meningitis dros SesaZloa sxva simptomebis Tanxleba (herpesuli angina,
egzanTema da sxva). zogierT SemTxvevaSi viTardeba cerebruli ataqsia, gien-bares
sindromi, periferiuli nevritebi, fokaluri encefaliti da mwvave hemi plegia.
rac Seexeba cvlilebebs Tav-zurgtvinis siTxeSi, misi normalizacia ufro mogvianebiT
xdeba _ daavadebis me-3-4 kviras. zogjer ki SesaZlebelia liqvoridan virusis
gamoyofa.
daavadebis gadatanis Semdeg SesaZloa ganviTardes narCeni movlenebi asTeniuri,
hi pertenziuli sindromis saxiT, ganmeorebiTi pirRebineba, myesTa refleqsebis momateba.
epidemiuri mialgia (plevrodinia, bornqolmis daavadeba) ekuTvnis epidemiur
daavadebas, romlis ZiriTad etiologiur faqtorad iTvleba koksaki-virusi B3 3 da B55
ti pis, garkveuli epidemiuri mniSvneloba eniWeba agreTve B11, B2 2, ECHO-s 1 da me-6
ti pebs.
0
daavadeba iwyeba mwvaved, temperaturis momatebiT 38-40 C-mde, araiSviaTad
SemcivnebiTa da RebinebiT, enterovirusuli infeqciisaTvis saerTo infeqciuri
simptomatikis fonze (Tavis tkivili, umadoba, Rebineba, umniSvnelo xvela, faRaraTi da
sxva). temperaturis xangrZlivoba Seadgens 1-14, saSualod 3-5 dRes. damaxasiaTebelia
spontanuri tkivilebis arseboba sxvadasxva lokalizaciis kunTebSi _ gulmkerdis,
zurgis, muclis. kidurebis mtkivneuloba da misi simZafre imdenad intensiuria, rom
literaturaSi cnobilia, rogorc èSmakiseuli Seteva~, èSmakiseuli daavadeba~, èSmakis
jojoxeTiseburi gri pi~ da sxva.
upiratesad mtkivneulia gulmkerdis, muclis marjvena wili, Wi pis midamoebi.
mgrZnobeloba zedapirulia, rac mowmobs, rom tkivili momdinareobs kunTebidan da ara
Sinagani organoebidan. rentgenologiuri gamokvlevebi gviCvenebs normas. mtkivneuloba
mdgradia, mas Tan axlavs Zlieri oflianoba, sifermkrTale, sunTqvis gaZneleba (zerele
xasiaTis). avadmyofTa 1/3-Si SeiZleba plevris xaxunis mosmena, romelic Zlierdeba
SesunTqvis, xvelis, cxvirceminebis dros da qreba Setevis damTavrebis Semdeg.
daavadebas xSirad aqvs talRiseburi mimdinareoba, temperaturis normalizaciis
131
kerZo nawili.
Semdeg (1-3 dRe) kvlav SesaZlebelia misi momateba da tkivilebis ganaxleba.

epidemiuri mialgia xSirad mimdinareobs Serwymulad enterovirusuli infeqciis
sxva gamovlinebebTan erTad, serozuli meningitiT, herpesuli anginiT da sxva.
nawlavur formas adgili aqvs adreuli asakis bavSvebSi, upiratesad 2 wlis
0
zeviT. temperaturis momateba xdeba uecrad 38-39 C-mde. gamoxatulia zemo sasunTqi
gzebis katari, pir-xaxis hi peremia. pirvelsave dRes an 2-3 dReSi Cndeba muclis
tkivili, Txieri ganavali (5-10-jer dReSi), ganmeorebiTi Rebineba, viTardeba meteorizmi.
mwvave gastroenteriti, kolituri sindromi ar aRiniSneba. daavadeba mimdinareobs 1-2
kvira, temperatura atarebs 2-fazian xasiaTs.
enterovirusuli egzanTemas (bostonis, epidemiuri, wiTelasmagvari da
wiTurasmagvari egzanTemebi) xSirad iwvevs ECHO virusebi.
egzanTema SeiZleba iyos enterovirusuli infeqciis simptomi, amasTanave epidemiuri
afeTqebebisas egzanTema wamyvani
gamovlinebaa.
daavadeba iwyeba temperaturis
momatebiT, Tavisa da muclis
tkiviliT, skleritiT, zemo sasunTqi
gzebis katariT, zogjer kunTebis
tkiviliT. daavadebis 1-2 dRes
tanze, saxeze, kidurebze, terfebze
normaluri kanis fonze Cndeba
mowiTalo, polimorfuli, laqovani
an laqovan-papuluri gamonayari.
SesaZloa gamonayris sxvadasxva
variantebi: wiTelasebri,
wiTurasebri, naklebad
qunTruSismagvari da peteqiuri.
piris Rrus lorwovanze gamonayari
vezikuluri xasiaTisaa, romelic
Cqara gadadis peteqiur eroziebsa
da wylulebSi. gamonayari gvaqvs
1-8 dRe, saSualod 3-4 dRe, Semdeg
qreba pigmentaciis an raime sxva
enterovirusuli infeqcia. saxis kanze gamonayari.
(sakuTari masala)
kvalis gareSe.
enterovirusuli
daavadebis Tavisebur variantebs warmoadgnen koksaki A16 16, A4
16 4, A55 da A1010
10-iT
gamowveuli egzanTemebi _ HFMK (Hand-Fuss-Mund-Krankheit), romlis drosac
ziandeba xelis mtevnebi, terfebi, piris Rru, aseve dunduloebi. terfebisa da mtevnebis
TiTebze Cndeba hi peremiiT Semofargluli, 1-3 mm zomis vezikulebi. erTdoulad Cndeba
erTeuli afTozuri elementebi enaze, piris Rrus lorwovanze.
koniunqtiviti. 1969-1971 ww. afrikaSi, samxreT-
epidemiuri, hemoragiuli koniunqtiviti
aRmosavleT aziaSi, iaponiasa da indoeTSi aRwerili iyo mwvave hemoragiuli
koniunqtivitis sindromi, gamowveuli ECHO enterovirusi 70-iT. am sindromis ganviTareba
agreTve SesaZlebelia A-24 -24 koksaki virusiT. daavadeba Rebulobs mZime mimdinareobas
subkoniunqtivuri hemoragiis saxiT. avadmyofebs uecarad ewyebaT Tvalis tkivili,
sinaTlis SiSi. pirvelad ziandeba erTi Tvali, Semdeg procesSi erTveba meorec;
adgili aqvs quTuToebis SeSupebas. daavadeba mimdinareobs subkoniunqtivuri hemoragiiT,
iSviaTad poliomielitismagvari damblebiT. prognozi keTilsaimedoa. gamojanmrTeleba
132
kerZo nawili.
xdeba 7-14 dReSi.

enterovirusuli daavadeba, romelic
gamowveulia ECHO da koksaki virusebiT, SeiZleba
mimdinareobdes respiraciuli traqtis dazianebiT
_ rinofaringitiT, faringitiT, tonzilitiT,
laringitiT, krupis sindromiT.
mezadeniti _ wvrili nawlavebis jorjlis
limfuri kvanZebis anTeba iwyeba TandaTanobiT,
subfebriluri temperaturiT, movliTi xasiaTis
herpangina ((A jgufis Coxsackie
muclis tkivilebiT. zogjer dgindeba muclis faris virusiT gamowveuli). gamonayari
gaRizianebis niSnebi _ dadebiTi blumberg _ hgavs HSV-ss simptomebs.
SCotkinis simptomi. diagnozis dadgenaSi mniSvneloba (Edmond’s Color Atlas)
aqvs saxis hi peremias, sklerebis inicirebas, piris
Rrus katarul movlenebs.
enterovirusuli infeqcia axalSobilebSi mimdinareobs fataluri encefalitisa
da miokarditis klinikiT. infeqciis wyaro yvelaze xSirad dedaa. daavadeba xSirad
sicocxlis pirvel or kviras mwvave respiraciuli infeqciis msgavsi klinikiT iwyeba.
gamoxatulia cxeleba, kvebasTan dakavSirebuli problemebi, respiraciuli distresi,
cianozi, leTargia, kardiomegalia, hepatomegalia, ekg-ze cvlilebebi. prognozi cudia.
diagnozis dadgena klinikurad SeiZleba mxolod enterovirusuli infeqciebis
ti puri gamovlinebis SemTxvevaSi (herpesuli angina, epidemiuri mialgia,
encefalomiokarditi axalSobilebSi da sxva) gansakuTrebiT epidemiuri afeTqebebis
dros. diagnozis dadastureba sporaduli SemTxvevebis dros rTul amocanas warmoadgens.
igi saWiroebs laboratoriul gamokvlevebs, romlebic ara marto rTulia, aramed
xSirad uSedegoc.
gamokvlevebi iTvaliswinebs virusis gamoyofas fekaliidan (rac yovelTvis ar
laparakobs mwvave daavadebaze), cxvir-xaxis Camonarecxidan, agreTve sisxlisa da Tav-
zurgtvinis siTxidan, xolo letaluri gamosavlis dros _ tvinidan da Sinagani
organoebidan.
virusis gamoyofisaTvis sargebloben aramarto sxvadasxva qsovilebis kulturebiT,
aramed laboratoriuli cxovelebiTac (axalSobili TeTri Tagvebi, bambis
virTagvebi).daavadebis diagnostikaSi ZiriTadi adgili uWiravs serologiur gamokvlevebs:
komplementSemboWav reaqcias, preci pitaciis reaqcias gelze, wyvili Sratebis
neitralizaciis Seswavlas 10-12 dRis intervaliT. mniSvneloba aqvs mxolod specifikuri
antisxeulebis matebas 4-jer da metad. serologiuri skriningi daavadebaze eWvis
mitanis gareSe ar xdeba. bolo wlebSi iyeneben molekuluri biologiis meTods _
dnm-is dadgenas polimerazuli jaWvuri reaqciiT.
diferenciuli diaganostika. enterovirusuli infeqciebis diferenciaciis
Catarebis diapazoni didad farToa da damokidebulia mis mravalferovan klinikur
gamovlinebaze, rac xSirad saWirod xdis mxedvelobaSi iqnas miRebuli aramarto
infeqciuri, aramed arainfeqciuri daavadebebic.
pirvel rigSi, enterovirusuli infeqcia unda ganvasxvavoT respiraciuli
infeqciebisagan. am dros mxedvelobaSia misaRebi is garemoeba, rom TiTqmis yvela
formis dros ase Tu ise gamoxatulia zemo sasunTqi gzebis katari, romlis fonze
araiSviaTad vlindeba ufro damaxasiaTebeli sindromi, rogoricaa aseptikuri meningiti,
herpesuli angina, plevrodinia, egzanTema. araiSviaTia maTi kombinaciebi. 10-12 dRe
temperaturis xangrZlivobis dros saWiroa, gamoiricxos tifur-paratifuri daavadeba.
unda aRiniSnos, rom enterovirusuli infeqciis mimdinareobisas adgili aqvs Status
133
kerZo nawili.
typhosus-s. diagnozis dadgenas aadvilebs virusologiuri da serologiuri

gamokvlevebi.
epidemiuri mialgia zogjer waagavs mwvave apendicits, qolecistits, pankreatits.
mialgiis dros iSviaTi movlenaa muclis faris gaRizianeba, garda amisa gamoxatulia
sxeulis sxvadasxva regionis kunTebis tkivili; tkivilebis Setevis dros xSiria
plevris xaxunic. aRniSnul movlenebs, Cveulebriv, adgili aqvs zemo sasunTqi gzebis
kataris fonze, rac aadvilebs enterovirusuli infeqciis diagnozs.
enterivirusuli egzanTemebi unda ganvasxvavoT wiTelas, wiTuras, iersiniozis
gamonayrisa da medikamenturi alergiisagan.
enterovirusuli serozuli meningitisagan tuberkulozuri meningiti gamoirCeva
daavadebis TandaTanobiT dawyebiT, simZimis TandaTanobiT ganviTarebiT, liqvorologiuri
cvlilebebiT, tuberkulozuri mikobaqteriebis aRmoCeniT.
ufro gaZnelebulia diferenciuli diagnostika enterivorusuli infeqciis
poliomielitis msgavsi mimdinareobis dros. aseT SemTxvevaSi mxolod poliovirusis
gamoricxvis Sedegad SeiZleba daisvas swori diagnozi, rac saWiroebs virusologiur
gamokvlevebs.
mkurnaloba. enterovirusuli infeqciiT avadmyofis hospitalizacia xdeba
infeqciis mxolod mZime gamovlinebis dros. danarCen SemTxvevaSi mkurnaloba tardeba
binis pirobebSi. etiologiuri mkurnaloba amJamad mowodebuli ar aris da eyrdnoba
mxolod paTogenezur da simptomur saSualebebs.
maRali temperaturisa da tkivilebis dros eniSnebaT paracetamoli, zogjer
efeqts iZleva maRali titris mqone IVIG-imunoglobulinebi.
antibiotikebis CarTva gamarTlebulia mxolod meoradi infeqciebis darTvis
SemTxvevaSi.
prognozi. daavadeba umravles SemTxvevaSi mTavrdeba keTili gamosavliT. mZime
formebis dros prognozi rTulia da daavadeba SeiZleba sikvdiliT damTavrdes.
specifikuri profilaqtika SemuSavebuli ar aris. saWiroa xelis dabana bavSvis
movlis dros.
134
kerZo nawili.
virusuli hepatitebi.
virusuli hepatitebi
virusuli hepatitebi
(HEPATITIS VIROSA)
virusuli hepatitebis cnebaSi igulisxmeba etiologiurad araerTgvarovani _

A,B,C,D,E,F,G da, SesaZloa, sxva hepatotropuli virusebiT gamowveuli infeqcia, romelic
mimdinareobs upiratesad RviZlis morfofunqciuri dazianebiTa da sxvadasxva xarisxis
saerTo intoqsikaciis gamovlinebiT. aRniSnuli virusebi gamoirCevian ara marto
sxvadasxva taqsonomiuri daxasiaTebiT, aramed dasnebovnebis meqanizmiT, gadacemis gzebiT,
daavadebis sxvadasxva paTogeneziT, imunogeneziT, daavadebis mimdinareobiTa da simZimiT,
gamosavliT, mkurnalobisa da profilaqtikis programiT. aqedan gamomdinare, mizanSewonilia,
rom TiToeuli nozologiuri erTeuli calke iqnas ganxiluli, Tumca, rogorc es
qvemore klasifikaciaSi iqneba mocemuli, maT gaaCniaT saerTo, gansakuTrebiT, klinikuri
msgavseba, rac aucilebels xdis hepatitis markerebis gamokvlevas daavadebis dinamikaSi.
cnobebi. siyviTliT mimdinare masiuri gavrcelebis daavadeba
cnobili iyo jer kidev hi pokrates droidan (V saukune C.w. aRricxvemde), magram
pirvelad Ñ\Ï\ Áîòêèí
Áîòêèí–is mier naTlad iyo formirebuli `kataruli siyviTlis”
infeqciuri buneba da daavadebis kavSiri `RviZlis mwvave atrofiasTan” da cirozTan.
azri daavadebis virusul genezze daamkvidra 1937w. Findlay. G., Mc. Collum R.-is
mier mikvleulma cnobebma siyviTliT masiurad daavadebis Sesaxeb, romelic ganviTarda
yviTeli cxelebis sawinaaRmdego acrebis Semdeg (vaqcina Seicavda donoris sisxlis
antibaqteriul filtrats). ruseTSi analogiuri monacemebi miRebul iqna Ï\Ã\ Ñåðãèåâ
Ñåðãèåâ-
isa da Å\Ì\ Òàðååâ
Òàðååâ–is mier 1940 wels. gamokvlevebma gamoavlines kavSiri siyviTliT
daavadebasa da sisxlisa da sisxlis komponentebis gadasxmas Soris, rac SemdgomSi
virusologiuri gamokvlevebiTac damtkicda.
virusuli hepatitebis SeswavlaSi udidesi roli iTamaSa B.Blumberg-is mier
(1964w.) avstraliis aborigenebis sisxlSi manamde ucnobi cilis aRmoCenam, romelmac
avstraliuri antigenis saxelwodeba miiRo. naCvenebi iyo, rom es antigeni ar warmoadgens
sisxlis speqtris eTnografiul Taviseburebas da rom aseTive cila aRwerili iyo
hemofiliiT daavadebulebSi, aseve im pirebSi, romlebsac gaukeTdaT mravaljeradi
hemotransfuzia. aRniSnulma faqtma SesaZlebeli gaxada, aRmoCenili cila miekuTvnebinaT
posttransfuziuli hepatitis virusisaTvis. TviTon virusi ki, eleqtronuli
mikroskopiiT mogvianebiT iqna aRmoCenili sisxlis SratSi da RviZlis qsovilSi D.S.
Dane-sa da C.N. Cameron-is mier (1970w.). Semdgom wlebSi aRmoCenili iyo hepatitebis
sxva virusebi _ 1973 wels Feinstone-s mier hepatitis A virusi, 1977 wels _ D
hepatitis virusi HDV M. Rizetto-s mier, C hepatitis virusi _ M.Haugthon-is
xelmZRvanelobiT, am ukanasknelT SeZles, SeeqmnaT xelovnuri rekombinirebuli virusis
antigeni da amis safuZvelze _ pirveli test-sistema specifikuri antisxeulis
identifikaciisaTvis ifa-s meTodiT (Choo Q.L. et al, 1989; Kuo J et al, 1989 1989). am
gamokvlevebma dasaxa virusis Seswavlis axali gzebi. HCV gaxda pirveli virusi,
romelic identificirebuli iyo nukleotidebis Tanmimdevruli daxasiaTebiT sakmaod
didi xniT adre, vidre moxdeboda misi eleqtronulmikroskopuli vizualizacia.
135
kerZo nawili.
virusuli hepatitebis epidemiologiis, klinikis, paTogenezisa da mkurnalobis

sakiTxebis SeswavlaSi mniSvnelovani wvlili Seitana akademikosma e. bocvaZem da misma
skolam.
hepatitebis virusebis specifikacia

(J. Rasenack-is
is mixedviT)
hepatiti A B C D E G
ojaxi pikornavirusi hepadnavirusi flavivirusi viroidi kalcivirusi flavivirusi ?
zoma 27 - 32 nm 42 nm ? 36 nm 27 - 32 nm ?
rnm-is
dnm-orZafiani rnm-is rnm-is
rnm-erTZafiani erTZafiani
nukleinis mJava cirkuluri erTZafiani Ria erTZafiani Ria ?
Ria jaWvi cirkuluri
jaWvi jawvi jaWvi
jaWvi
inkubaciuri 14 - 45 dRe ( ≈ 30 - 180 dRe 14 - 180 dRe (≈ 1
14 - 60 dRe (≈
... ?
periodi 30 dRe) (≈ 70 dRe) wlebi) 40 dRe)
fekalur-
ki ara ara ara ki ara
oraluri gza
gadaecema 2
ara ki ki ki ara3
sisxliT
vertikaluri 2 3
ara ki ki ki ara ?
gza
4 4 3
sqesobrivi gza ara ki ki ki ara ?
antigeni HAAg HBsAg, HBeAg ... HDAg HEAg ...
anti-HBs,
anti-HAV, anti-HCV anti-HDV
antisxeulebi anti-HBe, anti-HEV ...
anti-HAV IgM anti-HCV IgM anti-HDV IgM
anti-HBcor
fulminanturi
0.001 - 0.5% 0.5 - 1.0% 0.5 - 1.0% 1 - 3 - 25% 2% (25% - ?) ?
hepatiti
gamojanmrTeleba
mwvave hepatitis > 99% > 90% 10 - 40% 50 - 80% > 95% ?
Semdeg
qronikuli
< 10% 30 - 90%
aqtiuri 0% 20 - 50% ? ( < 5%) ki (% - ?)
(0.5% - ?) ( < 10%)
hepatiti
RviZlis cirozi < 0.1% 1% 5 - 30% 10%? ? ki (% - ?)
aqtiuri
ki ki ara ara ara ara
imunizacia
pasiuri
ki ki ara ara ara ? ara
imunizacia
SeniSvnebi: 1 _ inkubaciuri periodi SeiZleba iyos gaurkveveli, vinaidan es

damokidebulia HBV
HBV-s replikaciaze, monacemebi super-infeqciis
Sesaxeb ar aris mocemuli
2 _ parenteruli gadacema xdeba iSviaTad im SemTxvevaSi, rodesac
donoris sisxli aRebulia HAV prodromis dros
3 _ zusti epidemiologiuri monacemebi ar aris
4 _ zusti monacemebi gadacemis sqesobriv gzaze ar aris, Tumca es gza
gamoricxuli ar aris, vinaidan virusi xSirad aReniSneba partniorebs
(B da C hepatiti)
136
klinikurad manifest uri
subklinikuri formebi inaparant uli for mebi
formebi
kerZo nawili.
m an ife s t ac ia ( g am o v l in e b a)
siyviTliT mimdinare
cit olizur i (t ipur i) forma msubuqi
HA V HBV HCV
usiyviTlo forma hepat it B viru si
saSualo simZimis
hepat it A virusi hepat it C virusi
et iol ogia
hepat it E virusi hepat it D virusi
siyviTliT mimdinare
cit olizur i forma mZime
137
qolest azis komponentiT HNA - EV
HEV HD V
hea ti t non A - E viru sebi
siyviTliT mimdinare
fulminant uri
qolest azuri forma
(gansakuTrebiT mZime)
(at ipur i)
virusuli hepatitebis klasifikacia
m im d in ar e ob a
(kriteriumebi da formebi) (Ñ. Í. Ñîðèíñîí)
ciklur i gamojanmrTeleba
mwvave qronokuli
progredientuli qronizacia
kerZo nawili.
virusuli hepatitebi. virusuli hepatiti A
virusuli hepatiti A
sinonimi: botkinis daavadeba, infeqciuri hepatiti, epidemiuri hepatiti.

hepatiti A mwvave enterovirusuli infeqciaa gadacemis fekalur-oraluri meqanizmiT.
upiratesad avaddebian bavSvebi, iSviaTad mimdinareobs siyviTliT, xasiaTdeba xanmokle
intoqsikaciis movlenebiT, RviZlis morfofunqciuri swrafad warmavali darRvevebiT,
keTilgamosavliani prognoziT.
etiologia. hepatit A-s virusi (HAV) aRmoCenili iqna S.M.Feinstone da
etiologia
Tanaavtorebis mier 1973 w. virusis zoma ar
aRemateba 27-32 nm-s, Seicavs wvril, sigrZivi
formis rnm-s. virusi miekuTvneba
Picornaviridae-s gvars, damoukidebel
Hepatoviridae-s ojaxs.
Hepatoviridae-s ojaxs miekuTvneba, agreTve,
CrdiloeT amerikis babuinebSi, miwis ciyvebsa
da pekinis Sinaur ixvebSi hepatitis gamomwvevi
virusi.
avadmyofi adamianisagan izolirebuli HAV
genomis klonirebisas msoflios sxvadasxva
regionebSi dadgenil iqna diferencirebadi cilis
4 genotipi (I, II, III, VII). xolo kontaminirebuli
maimunebis fekaliebis eqstraqtidan _ kidev 3
genoti pi (IV,V,VI). Svidive genoti ps aqvs
erTidaigive antigeni _ HAAg, rac gansazRvravs
yvela genoti pis erT seroti pSi gaerTianebasa
da jvaredini proteqciuli imunitetis
ganviTarebas. HAV-is mxolod erTaderTi
antigeni ganapirobebs monoklonuri
antisxeulebis _ anti- HAV-is produqcias.
avadmyofis sisxlis SratSi jer Cndeba M klasis
HAV - 27 nm-is nawilaki.
eleqtronuli mikroskopia imunoglobulinebi (IgM), sakmaod mogvianebiT
(Provist P.) ki G klasis imunoglobulinebi (IgG). es
ukanaskneli proteqciuli imunitetis
maCvenebelia da adasturebs HAV –iT meoradi dasnebovnebis SeuZleblobas. virusis
eqskreciis piki modis me-7-10 dReze daavadebis klinikur gamovlinebamde.
virusis arseboba aRiniSneba sisxlis SratSi, naRvelSi, fekaliebSi, hepatocitebis
citoplazmaSi, inficirebul pirebSi inkubaciuri periodis bolos, prodromul periodsa
da daavadebis adreul fazaSi, iSviaTad ki _ ufro mogvianebiT. A hepatitis eqsperimentSi
gamowveva SeiZleba maimunebSi, SimpanzeebSi, virusi kultivirdeba adamianis RviZlis
qsovilSi. garemoSi HAV ufro mdgradia, vidre tipuri enterovirusebi. HAV sicocxles
inarCunebs ramodenime Tvis ganmavlobaSi +4°C-ze, xolo -20°C-ze _ ramodenime wels,
oTaxis temperaturis pirobebSi _ ramodenime kviras, duRili klavs 5 wT-Si, virusebis
nawili wyalSi narCeni qloris 0,5-1,5 mg/l koncentraciisas iRupeba 1 saaTis ganmavlobaSi,
maTi sruli likvidacia ki xdeba 2,0-2,5 mg/l koncentraciis dros. virusebi qloris
moqmedebisas 15 wT-is ganmavlobaSi, xolo ultraiisferi dasxivebiT (1,1 vt) ki 30 wm-
Si iRupebian.
epidemiologia. A hepatiti gavrcelebulia mTel msoflioSi. misi gavrcelebis
epidemiologia
intensivoba mniSvnelovnadaa damokidebuli cxovrebis doneze, mosaxleobis sanitarul
138
kerZo nawili.
kulturaze. ase mag: aziis, afrikis, samxreT amerikis ganviTarebad qveynebSi A hepatitiT
avadoba 100 000 mosaxleze aRwevs 500-1000 avadmyofs weliwadSi. yofil ssrk-s
respublikebSi yvelaze ufro maRali maCvenebeli aRwevda 670 _ Sua aziis respublikebSi,
yvelaze dabali maCvenebeli ki _350-120 100 000 mosaxleze modioda baltiispireTis
qveynebze. gasaTvaliswinebelia isic, rom namdvili maCveneblebi gacilebiT ufro metia,
radgan registrirdeba daavadebis mxolod manifesturi formebi maSin, rodesac daavadebis
udidesi nawili modis usiyviTlo, waSlil da inaparantul formebze, rac daudgeneli
rCeba. amitom daavadebis gavrcelebis dadgenis saimedo kriteriumad rCeba mozrdili
pirebis seroepidemiologiuri gamokvleva anti-HAV _ IgG indikaciiT.
virusuli A hepatitis 70%-s saerTo daavadebis struqturaSi Seadgens 3-dan 7-10
wlamde bavSvebi. erT wlamde bavSvebi praqtikulad ar avaddebian transplacenturi
gziT pasiurad miRebuli antisxeulebis, anti- HAV IgG-is gamo. Tumca antisxeulebi
mTlianad ver gamoricxavs axalSobilebSi A hepatitis ganviTarebas, romelic SeiZleba
mimdinareobdes inaparantulidan subklinikur formamde. ufro adreuli periodis
inficirebis mizezi SeiZleba iyos seronegatiuri deda an axalSobilis Rrma
dRenakluloba, vinaidan antisxeulebis transplacenturi gadacema ZiriTadad xdeba
orsulobis me-8 Tveze.
infeqciis wyaros warmoadgens mxolod avadmyofi, maT Soris yvelaze saSiSia
waSlili, usiyviTlo da inaparantuli formiT daavadebuli pirebi.
Ahepatitis virusis gadacema xdeba, upiratesad, sayofacxovrebo-kontaqturi gziT,
inficirebuli sakvebiTa da wyliT. mniSvneloba aqvs, agreTve, buzebiT sakvebis inficirebas.
aRniSnuli infeqcia samarTlianad SeiZleba miekuTvnos nawlavTa infeqciebs. daavadebis
gadacema transplacenturi gziT ar xdeba. ar aris gamoricxuli infeqciis gadacema
haerwveTovani meqanizmiTac.
is faqti, rom mozrdili mosaxleobis 70-80%-s sisxlSi aReniSneba A hepatitis
virusis sawinaaRmdego antisxeulebis arseboba, mowmobs infeqciis farTo gavrcelebas.
ganmeorebiTi daavadeba Zalian iSviaTia. am SemTxvevaSi gamosaricxia sxva hepatotropuli
virusebi.
sezonuroba. daavadeba upiratesad Semodgoma-zamTarSi vrceldeba, yvelaze dabali
sezonuroba
procenti ki ivlis-agvistos periodze modis. infeqciis mimRebloba Tumca sayovelTaoa,
magram ufro xSirad avaddebian bavSvebi 3-7 wlis asakSi. xelSemwyobi faqtorebidan
didi mniSvneloba aqvs dabal sanitarul-higienur pirobebs, Tanamedrove wyalsadenisa
da kanalizaciis uqonlobas. sadac socialur-ekonomikuri pirobebi maRalia, bavSvebSi
avadoba ufro naklebia. epidafeTqebebi, Cveulebriv, registrirdeba bavSvTa mWidro
koleqtivebSi. epidkerebSi kontagiozuri indeqsi maRalia da aRwevs 80%-s. epidemiuri
procesis perioduloba, romelic 4-5 wlis intervalebiT aRiniSneba, ganpirobebulia
mosaxleobis koleqtiuri imunitetis arsebobiTa da araimunur bavSvTa populaciiT.
saqarTveloSi epidemiur afeTqebebs adgili hqonda 1961 wlidan da maTi ganmeoreba
aRiniSneboda zemoxsenebuli intervalebiT. 1980 wlidan avadobis maCvenebeli mudmivad
maRal doneze rCeba.
paTogenezi. A hepatitis virusi organizmSi xvdeba piris Rrudan inficirebuli
paTogenezi
sakvebisa da wylis meSveobiT.
hepatiti A-s paTogenezi, SeiZleba iTqvas, rom jer kidev ar aris srulyofilad
Seswavlili. rogorc sxva hepatitis virusebs (HBV,HDV,HCV da sxv.), aseve HAV-sac
axasiaTebs hepatotropizmi. magram TiTqosda ukve cnobili, A-virusis mier hepatocitebis
uSualo dazianeba eWvqveS iqna dayenebuli 1993 wels tokioSi Catarebul, virusuli
hepatitebisadmi miZRvnil VIII kongresze (Karayiannis et al., Van Damme P, Kane
M). dadginda, rom qsovilovan kulturebze A virusis xangrZlivi replikaciisas ar
139
kerZo nawili.
aRiniSneba hepatocitebis lizisi, xolo maimunebis inficirebisas HAAg-iT fekaliebSi

virusis Semcveloba aRiniSneboda alat-is momatebamde; meores mxriv, naCvenebia imunuri
proteqciuli reaqciis kanonzomieri ganviTareba hepatocitebSi α–interferonis
dagrovebiTa da T-limfocitebis sensibilizaciiT.
virusis RviZlSi SeRweva, rogorc fiqroben, xdeba hepatocitebis saTanado
receptorebidan, romelTa variabelobiT SeiZleba aixsnas HAV-is mimarT individualuri
mimRebloba.
hepatocitebSi virusis SeRweva iwvevs ujredSida metaboluri procesebis darRvevas
_ xdeba ujredSida SeSupeba (rac gamoixateba RviZlis gadidebiT) ujredSida fermentebis
gamosvliT, rac ganapirobebs fermentemias. hepatocitebis dezintegraciis procesi
vrceldeba, agreTve, ujredSida organelebze, xdeba lizosomuri fermentebisa da
hidrolazebis masiuri gamosvla. aseTi movlenebi ganapirobebs hepatocitebis lizissa
da nekrozs. nekrozuli hepatocitebidan gamonTavisuflebuli cilovani kompleqsebi
asruleben autoantigenis rols da hepatotropul virusTan erTad iwveven imunitetis
T da B sistemis stimulacias. erTis mxriv, adgili aqvs hi persensibilizebuli ujredebis
_ kilerebis aqtivacias, meore mxriv, warmoiSoba RviZlis sawinaaRmdego antisxeulebi,
romlebsac unari aqvT, ieriSi miitanon RviZlis parenqimaze. xazgasmiT aRvniSnavT, rom
A hepatitis dros autoimunuri agresiis meqanizmi srulad ar yalibdeba, amitom mZime
formebis ganviTareba iSviaTia.
A hepatitis viruss gaaCnia maRali imunologiuri Tvisebebi, daavadebis pirvelsave
dReebSi igi iwvevs limfocitebis specifikur sensibilizacias. virusis eliminaciaSi
gadamwyveti mniSvneloba eniWeba inficirebuli hepatocitebis liziss naturaluri
kilerebiT, romelTa mobilizacia xdeba interleikinebis intensiuri sinTeziT. specifikuri
antisxeulebis produqcia IgM klasis saxiT daavadebis adreul periodSive, siyviTlis
ganviTarebamde iwyeba, maqsimums aRwevs siyviTlis gamovlinebisas da daavadebis adreuli
periodis markerad iTvleba, maSin, rodesac IgG-s produqcia SeimCneva mogvianebiT,
daavadebis 3-4 kviridan da, faqtiurad, mTeli sicocxlis ganmavlobaSi proteqciuli
mniSvneloba aqvs. amiT aixsneba ganmeorebiT daavadebis SeuZlebloba.
RviZlSi paTmorfologiuri monacemebi viTardeba klinikuri suraTis ganviTarebamde
ramdenime dRiT adre. aqtiurdeba da mravldeba varskvlavisebri retikuluri
endoTeliocitebi (kupferis ujredebi), aRiniSneba, agreTve, monoklonuri infiltracia,
upiratesad portuli traqtis gaswvriv.
hepatocitebis cvlilebebi aRiniSneba prodromuli periodis bolos. pirvelad
diddeba birTvakebi, viTardeba mravalricxovani mitozi da cilovani distrofiuli
cvlilebebi hepatocitebSi, upiratesad periferiuli acinusis zonebSi. klinikuri
gamovlinebis siZliereze metyvelebs hepatocitebis balonuri distrofia da gafantuli
nekrozi. hepatocitebi ganicdis autolizur daSlas an mumificirdeba da gardaiqmneba
eozinofilur sxeulebad, romlebic kaunsilmenis sxeulakebis msgavsia. hepatocitebis
nekrozis moculoba SezRudulia da SeiZleba klasificirebul iqnas Semdegi dayofiT:
fokaluri (wertilovani), laqovani (spotty necrosis) da iSviaTad, RviZlis zonaluri
nekrozebi. fokaluri da laqovani nekrozebi, upiratesad, aRiniSneba msubuqi, usiyviTlo
da siyviTliT mimdinare formebis dros. zonaluri nekrozi xasiaTdeba ufro farTo
nekrozuli procesiT, qsovilebis ufro farTo CaTreviT. zonaluri nekrozi Seesabameba
daavadebis saSualo simZimiT mimdinareobas da aRiniSneba, ZiriTadad, mozrdilebSi,
SeiZleba, Serwymuli iyos portul limfocitur infiltraciasTan, zog SemTxvevaSi
SemomsazRvreli firfitis dazianebiT.
A hepatitis dros, B hepatitisagan gansxvavebiT, nekrozebi ganlagebulia, upiratesad,
wilakebis periferiebze. aseTi cvlilebebi mowmoben, rom HAV SeaRwevs RviZlis
140
kerZo nawili.
parenqimas portuli sistemidan. meore damaxasiaTebel niSnad A hepatitis dros iTvleba

xidisebri nekrozis ararseboba calkeul nekrozul zonebs Soris.
klinika. A hepatitis dros iseve, rogorc sxva virusuli hepatitebisas, daavadeba
klinika
SeiZleba mimdinareobdes klinikurad manifesturi siyviTliT an siyviTlis gareSe,
subklinikurad an inaparantulad. ukanaskneli forma ufro xSiria axalSobilebSi,
rac damaxasiaTebelia pikornavirusebiT gamowveuli sxva infeqciebisaTvisac (mag.,
poliomieliti).
A hepatitis mimdinareobisas, gansakuTrebiT, siyviTliT mimdinare formis dros,
naTlad Cans daavadebis periodebis Tanmimdevruli gaSla _ dawyebiTi anu prodromuli,
daavadebis gamovlineba siyviTliT (yvelaze ufro ti puri), siyviTlis Semdgomi da
rekonvalescenciis periodebi.
periodi, sxva virusul hepatitebTan SedarebiT, minimaluria da
inkubaciuri periodi
meryeobs 10-dan 56 dRemde, ufro xSirad ki 25-30 dRea. inkubaciuri periodis ukanaskneli
mesamedi virusis eliminaciis yvelaze ufro gamoxatuli periodia, ris gamoc am
periodSi inficirebuli piri epidemiologiurad yvelaze ufro saSiSia. inkubaciuri
periodis bolo dReebSi sisxlSi aRiniSneba RviZlis ujredebis maRalfermentuli
aqtivoba (alat, asat da sxv.).
dawyebiTi (prodromuli) periodi. daavadeba iwyeba mwvaved, infeqciur-toqsikuri
sindromis ganviTarebiT. umravles SemTxvevaSi sxeulis temperatura aRwevs 38-39°C,
zogjer ki ufro maRal cifrebs, temperatura, Cveulebriv, imatebs pirvel 2-3 dRes,
SemdegSi ki xdeba normaluri an subfebriluri, romlis xangrZlivoba ar aRemateba
ramodenime dRes, iSviaTad ufro xangrZlivia. zogadi intoqsikaciis movlenebidan
yuradRebas i pyrobs saerTo sisuste, uZlureba, umadoba, gulisreva, Rebineba, Zilianoba.
avadmyofebi uCivian, agreTve, Tavis tkivils, yru tkivils marjvena ferdqveSa da
epigastriumis midamoSi, nawlavTa disfunqcias _ yabzobas an defekacias Txieri ganavliT.
arcTu iSviaTad, siyviTliswina periodSi adre aRwerili zemo sasunTqi gzebis kataruli
movlenebi ufro Seesabameba TandarTul mwvave respiraciul infeqciebs.
siyviTliswina periodSi, zogjer, yuradRebas i pyrobs Zlieri abdominuri sindromi
_ muclis intensiuri tkivilebi, romelic mogvagonebs mwvave qirurgiul daavadebebs
_ apendicits, nawlavTa gauvalobas, qolecistits an kolits, rac saTanado yuradRebas
moiTxovs. aRniSnuli abdominuri sindromi, Cveulebriv, 1-2-3 dRes grZeldeba da Semdeg
qreba.
A hepatitis dros prodromuli periodi B hepatitTan SedarebiT xanmoklea da ar
aRemateba 4-5 dRes.
daavadebis pirvel dReebSi RviZli diddeba 1-2 sm-iT da zogjer ufro metadac.
igi palpaciiT mgrZnobiarea da mtkivneuli, elastiuri konsistenciis. SemTxvevaTa erT
mesamedSi diddeba elenTa _ palpaciiT xvdeba xels an perkusiiT sazRvrebi momatebulia.
prodromuli periodi, rogorc siyviTliT, ise usiyviTlod mimdinare formebis
dros praqtikulad identuri klinikuri simptomatikiT xasiaTdeba. siyviTle, Cveulebriv,
mJRavndeba prodromis me-3-5 dRes, iSviaTad me-6-7 dRes daavadebis dawyebidan.
daavadebulTa umravlesobas siyviTlis gamomJRavnebamde 1-2 dRiT adre aReniSneba
qoliuria (Sardis gamuqeba), Semdeg ki rbil da magar sasaze, saxesa da sxeulis kanze,
mogvianebiT ki kidurebze Cndeba siyviTle, romlis intensiuroba swrafad matulobs
da umravles SemTxvevaSi erT kviraSi aRwevs maqsimums.
siyviTlis vizualur gamovlinebamde gansakuTrebiT sayuradReboa Sardis Seferiloba,
cota mogvianebiT ki arastabiluri, àWrelebuli” aqolia, es cvlilebebi matulobs
siyviTlis mkafio manifestaciisas. aqoliuri ganavalis da Sardis intensiuri Seferadeba
(gamuqeba, gansakuTrebiT qafis) damokidebulia bilirubinis raodenobaze.
141
kerZo nawili.
daavadebis maqsimaluri gamovlinebis dros Sardis raodenoba Semcirebulia, xSirad

aRiniSneba cilis niSnebi, erTeuli eriTrocitebi, hialinuri da marcvlovani cilindrebi.
amave dros maqsimaluri cvlilebebia RviZlis funqciuri sinjebis mxriv. sisxlSi,
rogorc wesi, TiTqmis mTlianad prevalirebs bilirubinis pirdapiri fraqcia. arapirdapiri
bilirubinis momateba, miT umetes, daavadebis dinamikaSi, SeiZleba iyos simZimis maCvenebeli
(RviZlis glukuroniduli funqciis daqveiTeba). laboratoriuli monacemebi metyvelebs
citolizur, mezenqimur-anTebiT cvlilebebze.
siyviTlis gamovlinebisa da misi intensivobis momatebis fonze, B hepatitisagan
gansxvavebiT, rogorc wesi, avadmyofis saerTo mdgomareoba umjobesdeba. es periodi
Seesabameba infeqciuri procesis, virusis replikaciis intensivobis Semcirebas, rac
mtkicdeba ganavalSi HAAg-is SemcirebiT.
miuxedavad intoqsikaciisa da, SedarebiT, mokle droSi siyviTlis intensivobis
ukuganviTarebisa, RviZli sakmaod gadidebuli rCeba rogorc am, ise mogvianebiT _
rekonvalescenciis periodSi.
elenTa avadmyofTa TiTqmis 50%-Sia gadidebuli, magram misi normalizacia RviZlTan
SedarebiT ufro adre xdeba. elenTa palpaciiT mgrZnobiare da momkvrivo konsistenciisaa.
A hepatitis dros, B hepatitisagan gansxvavebiT, siyviTlis intensivobis aRmaval da
daRmaval fazebs Soris naTeli sazRvris gavleba gaZnelebulia. magram naRvelis
gamoyofis dawyebis procesi Sardis gafermkrTalebiT, dasawyisSi ganavlis `Wreli”,
susti Seferadeba, Semdgom ki stabiluri Seferiloba emTxveva kriziss _ `gardatexis”
wertils (`pigmenturi krizi”) da mowmobs daavadebis mimdinareobis gardatexaze
saerTo mdgomareobis gaumjobesebiT. siyviTle mokle droSi qreba. am fonze intoqsikacia
sagrZnoblad mcirdeba, manamde Semcirebuli Sardis raodenoba matulobs (poliuria).
daavadebis normaluri mimdinareobisas 7-10 dRis ganmavlobaSi klinikuri movlenebi
TandaTan umjobesdeba, Tumca SeiZleba, jer kidev mTlianad ar iyos aRdgenili mada,
Zili, xalisi da a.S., elenTa da RviZli jer kidev gadidebuli rCeba, rCeba RviZlis
funqciuri paTologiuri cvlilebebic.
cvlilebebi sxva organoebis mxriv daavadebis umaRlesi gamovlinebis periodSi
sustadaa gamoxatuli. SeiZleba, aRiniSnos taqikardia, ufro mozrdilebSi – zomieri
bradikardia, ramdenadme dabali arteriuli wneva, gulis tonebis Sesusteba, àrasufTa”
pirveli toni an nazi sistoluri Suili mwvervalze, II tonis aqcenti filtvis
arteriaze, SesaZlebelia xanmokle droiT eqstrasistolebis ganviTarebac.
hematologiuri gadaxrebi periferiuli sisxlis mxriv araarsebiTia, SesaZlebelia
normocitozi da zomieri leikopenia SedarebiTi neitropeniiT, monocitoziTa da
limfocitoziT. eds yovelTvis normis farglebSia, Tu ar aris garTulebebi. intoqsikaciis
stadiaSi SeiZleba momatebul iqnas plazmuri ujredebi.
aRdgenis anu rekonvalescenciis periodSi grZeldeba praqtikulad sruli klinikuri
gamojanmrTeleba, magram gadidebuli RviZli avadmyofTa TiTqmis naxevars rCeba, maTve
aReniSnebaT sxvadasxva intensivobiT gamoxatuli RviZlis funqciuri darRvevebi
(periodulad vlindeba citolizis sindromi, gansakuTrebiT momatebulia alat), rac,
Cveulebriv, araumetes 5-6 Tves grZeldeba. daavadebisaTvis qronikuli mimdinareoba
damaxasiaTebeli ar aris.
klasifikacia. yvelaze ufro misaRebia A hepatitis klasifikacia daavadebis ti pis,
klasifikacia
simZimis da mimdinareobis gaTvaliswinebiT.
ti pur formas miekuTvneba siyviTliT mimdinare yvela SemTxveva.
msubuqi formis dros sustadaa gamoxatuli intoqsikaciis movlenebi, temperatura
ufro xSirad subfebriluria, subieqturi Civilebi _ minimaluri. RviZli pirveli
dReebidanve gadidebulia da neknTa rkalidan 2-3 sm-iT gamodis. sisxlSi bilirubinis
142
kerZo nawili.
saerTo raodenoba 85 mkmol/l aRwevs (norma _ 17mkm/l-mde), Tavisufali fraqcia

(arapirdapiri) ki 25 mkmol/l-s Seadgens (norma _ 15 mkmol/l-mde).
saSualo simZimiT mimdinareobisas saerTo intoqsikaciuri movlenebi zomieradaa
gamoxatuli, temperatura 38-39°C-s aRwevs. siyviTlis 2-3 dRis manifestaciis Semdeg
intoqsikaciis gamovlinebani sustdeba, magram isev rCeba madis daqveiTeba, xSiria
gulisrevis SegrZneba, erTjeradi Rebineba. bilirubinis saerTo raodenoba aRwevs 85-
200 mkmol/l, Tavisufali fraqcia (arapirdapiri) aRwevs 50 mkmol/l-mde. proTrombinis
indeqsi Seadgens 60-70%-s, alat-is aqtivoba ufro maRalia, mniSvnelovnad maRalia
Timolis sinjis maCvenebeli.
bavSvebSi A hepatitis mZime formebi iSviaTia. am dros saerTo intoqsikaciis
movlenebi ufro didxans rCeba, maT Soris siyviTlis intensivobis Semcirebis Semdegac.
maRalia RviZlis ujredebis fermentuli aqtivobac, aRiniSneba hi perbilirubinemia _
170-200 mkmol/l, Tavisufali bilirubinis fraqcia _ 50 mkmol/l-ze metia, proTrombinis
indeqsi iklebs 40%-mde, Timolis sinjis maCvenebeli maRal cifrebzea, RviZlis ujredebis
fermentuli aqtivoba _ mkveTrad momatebuli. unda aRiniSnos, rom bilirubinemiis
done ar gansazRvravs daavadebis simZimes. misi Sefaseba ufro obieqturia klinikuri
suraTisa da RviZlis bioqimiuri sinjebis erToblivi analizis mixedviT.
kidev ufro met iSviaTobas warmoadgens A hepatitis dros daavadebis fulminanturi
forma, romelic klinikurad ar gansxvavdeba B hepatitis dros ganviTarebuli
fulminanturi formisagan. A hepatitis fulminanturi formis SemTxvevaSi unda
gamoiricxos SesaZlebeli miqst-infeqciebi (HDV, HCV, herpes-infeqcia), imunodeficituri
mdgomareoba da sxv.
A hepatitis fulminanturi forma SeiZleba damTavrdes letalurad. letaloba am
formis dros ar aRemateba 0,05-0,1%-s, maSin, rodesac B hepatitisas gacilebiT maRalia
_ 0,3%.
A hepatitis ati puri, usiyviTlo mimdinareobisas saerTo intoqsikaciuri movlenebi
SeiZleba gamoxatuli iyos maRali intensivobiT da Seesabamebodes mZime formas. am
SemTxvevaSi misi diagnostireba gaZnelebulia da kompleqsur gamokvlevebs saWiroebs,
maT Soris HAV-sawinaaRmdego IgM gansazRvras sisxlis SratSi.
waSlili formebis dros saerTo intoqsikacia sustadaa gamoxatuli, siyviTle
vlindeba minimalurad, magram RviZli gadidebulia, zogjer diddeba elenTac, sisxlis
SratSi aRiniSneba fermentebis maRali aqtivoba, IgM-is Semcveloba.
A hepatitebis subklinikuri formebis diagnostika kontaqtirebulebSi SesaZlebelia
mxolod IgM-antisxeulebis dadgeniT.
mimdinareoba da gamosavali. A hepatiti umravles SemTxvevaSi mimdinareobs
mwvaved da daavadebis dawyebidan 2-3 kviris Semdeg klinikuri gamojanmrTelebiTa da
bioqimiuri maCveneblebis normalizaciiT mTavrdeba. gaxangrZlivebuli mimdinareobis
dros klinikuri da bioqimiuri reaqciebis normalizacia ferxdeba da gamojanmrTeleba
aRiniSneba me-2-3 Tves, iSviaTad ki me-6 Tves. fermentuli aqtivoba aRniSnul periodSi
maRalia, maRali rCeba, agreTve, Timolis sinjis, β-li poproteidebis done, grZeldeba
disproteinemiis suraTi.
klinikuri simptomatikis Cacxrobis Semdeg, zogjer, viTardeba daavadebis recidivi
_ mwvavdeba zogadi infeqciur-intoqsikaciuri movlenebi, RviZli da elenTa ufro
diddeba, aqtiurdeba bioqimiuri reaqciebi, maT Soris fermentuli _alat.
unda aRiniSnos, rom A hepatits qronikuli mimdinareoba ar axasiaTebs.
diagnostika emyareba epidemiologiur, klinikur-bioqimiur, serologiur da
virusologiur gamokvlevebs. virusologiuri gamokvlevebi moklebulia praqtikul
interesebs.
143
kerZo nawili.
daavadebis ti puri mimdinareobisas diagnostireba advilia da eyrdnoba infeqciur-

intoqsikaciuri movlenebis Tanmimdevrul gaSlas, mis ukuganviTarebas, rogorc siyviTliT,
aseve mis gareSe mimdinareobis CaTvliT, rogorc wesi, gadidebuli RviZlisa da arcTu
iSviaTad gadidebuli elenTis fonze.
didi mniSvneloba eniWeba epidanamnezs _ daavadebis kerebis (bavSvTa koleqtivi,
ojaxi) arsebobas, A hepatitisaTvis damaxasiaTebeli inkubaciuri periodis dadgenas
kontaqtirebulebSi da sxv.
araspecifikuri laboratoriuli meTodebidan mniSvnelovania sisxlis SratSi
aminotransferazebis aqtivobis dadgena: alaninaminotransferaza (alat anu
glutamatpiruvattransaminaza) RviZlismieri fermentia, xolo aspartataminotransferaza
(asat anu glutamoqsaloaceturi transaminaza) gamoiyofa sxva organoebiTac. umetes
SermTxvevaSi hepatitis dros alat-sa da asat-s Soris arsebobs paraleluri cvlilebebi.
am fermentebis aqtivoba SeimCneva RviZlis ujredis dazianebis dros (virusuli
hepatiti, hipoqsia, hi poperfuzia, Reye sindromis dros toqsikuri dazianeba). qronikuli
daavadebebis dros fermentebis aqtivoba naklebadaa gamoxatuli. mwvave hepatitebis
dros alat-i aWarbebs asat-is maCveneblebs, xolo metaboluri procesebis darRvevis
dros, alkoholuri da Echovirus-iT gamowveuli fulminanturi infeqciis dros ki _
asat-i.
sxva sinjebidan yuradReba SeiZleba miiqcios hi poglikemiam, hi perazotemiam,
eleqtrolitebis balansis darRvevam, hi poalbuminemiam, proTrombinuli drois
gaxangrZlivebam. damaxasiaTebelia agreTve Timolis sinjis, β-li poproteidebis mateba
MMklasis imunoglobulinebis gaCena sisxlSi. specifikuri meTodebidan diagnostikisaTvis
saimedo meTods warmoadgens A virusis sawinaaRmdego antisxeulebis _ anti-HAV
IgM-is dadgena, romelic infeqciuri procesis mwvave periods asaxavs. daavadebis
mogvianebiT periodSi producirdeba anti- HAV IgG, romelic ganmeorebiTi daavadebis
gamoricxvis proteqciul antisxeulebs warmoadgens.
saerTo anti-HAVHgansazRvra,
virusuli hepatit A -s specifikuri markerebi
miT umetes, erTjeradad,
diagnostikur mniSvnelobas
moklebulia, garkveul mniSvnelobas
iZens mxolod daavadebis dinamikaSi
misi titris 4-jer da metad gazrda.
fekaliebSi HAV-is indikacias
naklebi mniSvneloba aqvs, vinaidan
virusis eqskrecia umTavresad
inkubaciur periods emTxveva.
maRalmgrZnobiare meTodis _ pjr-
is (polimerazuli jaWvuri reaqcia)
gamoyenebiT SesaZlebeli gaxda
sisxlSi HAV-is rnm-is aRmoCena.
gamokvlevebiT dadginda, rom A hepa-
titis dros virusemia, B
hepatitisagan gansxvavebiT,
umTavresad tranzituli xasiaTisaa
da, ZiriTadad, infeqciuri procesis dasawyisSi aRiniSneba. calkeul SemTxvevebSi virusemia
SeiZleba, ufro xangrZlivi iyos _ 2-3 kvira. es ki SesaZlebels xdis parenteruli
gziT virusis gadacemas (mag: narkomanebSi).
diferenciuli diagnozis gatareba daavadebis dawyebiT fazaSi, prodromul
144
kerZo nawili.
periodSi Zalian Znelia. am dros igi xSirad eSlebaT mwvave respiraciul virusul
daavadebaSi. mxedvelobaSia misaRebi, rom A hepatits arc prodromul da arc mogvianebiT
periodSi ar axasiaTebs zemo sasunTqi gzebis katari, Tumca adgili aqvs dispefsiur
movlenebs, RviZlisa da, xSirad, elenTis gadidebas. arc Tu iSviaTad muqdeba Sardi,
ganavali ki fermkrTaldeba, rac arsebiTad aadvilebs diagnostikis problemas.
abdominuri sindromis mimdinareobisas gamosaricxia apendiciti. hepatitis dros
muceli rbilia, gansakuTrebiT intaqturia muclis qveda nawilis midamo, mcire tkivilebi
RviZlis areSi palpaciisas midis muclis faris gaRizianebis simptomatikis gareSe,
periferiul sisxlSi leikopeniaa. RviZli gadidebulia, arcTu iSviaTad elenTac, rac
saSualebas gvaZlevs, gamovricxoT apendiciti da davsvaT hepatitis dignozi.
zogjer, prodromul periodSi saWiroa, gamoiricxos helminTebiT gamowveuli
intoqsikacia. am SemTxvevaSi yuradRebas i pyrobs anamnezSi xangrZlivi Civilebis
arseboba, romelic didad sWarbobs hepatitis prodromul periods, periferiul sisxlSi
aRiniSneba eozinofilia koprologiuri gamokvlevebi ki xSirad adasturebs WiebiT
invazias.
infeqciuri mononukleoziT ganpirobebuli siyviTle xasiaTdeba poliadenopaTiiT,
gansakuTrebiT, kisris limfuri kvanZebis gadidebiT, ifa-Ti dgindeba epStein-baris
antigenis arseboba.
siyviTlis periodSi xSirad SeiZleba wamoiWras siyviTlis ti pis dadgenis problema
RviZliszeda, RviZlismieri Tu RviZlisqveda genezis Sesaxeb.
RviZliszeda genezis siyviTlis dros eriTrocitebis hemolizis Sedegad aRiniSneba
Tavisufali bilirubinis siWarbe. yuradRebas i pyrobs avadmyofis saerTo sifermkrTale,
mniSvnelovnad gadidebuli elenTa (RviZlis zomebi normis farglebSia), sisxlSi
hemoglobinisa da eriTrocitebis raodenoba daklebulia, ar icvleba proTrombinis
indeqsi.
RviZlismieri siyviTle SeiZleba ganpirobebuli iyos hepatocitebis funqciebis
darRveviT. bilirubinis SeboWvis darRveva xasiaTdeba Jilberis sindromiT _ daavadeba
vlindeba Tavisufali (arapirdapiri) fraqciis hiperbilirubinemiiT, romelic, Cveulebriv,
viTardeba sqesobrivi momwifebis periodSi da keTilTvisebiani mimdinareobisaa.
memkvidreobiT SeZenil hepatozebs miekuTvneba dabin-jonsonisa da rotoris sindromi,
roca irRveva pigmentebis cvla hepatocitebis mier bilirubinis eqskreciis etapze. am
dros sisxlis SratSi upiratesad pirdapiri bilirubini Warbobs, Tumca RviZlis sxva
funqciebi darRveuli ar aris, arc fermentebis aqtivoba imatebs.
gamosaricxi SeiZleba gaxdes citomegalovirusiT, listeriebiT, sxvadasxva etiologiis
sefsisiT gamowveuli siyviTle. aseT SemTxvevaSi klinikuri monacemebis garda
aucilebelia, Catardes ufro Rrma laboratoriuli gamokvlevebi garkveuli
sadiagnostiko meTodebiT, pirvel rigSi unda ganisazRvros anti- HAV IgM.
RviZlisqveda siyviTle, ganpirobebuli meqanikuri dabrkolebebiT (simsivniT, kenWovani
daavadebebiT da sxv.) araiSviaTad saWiroebs kompiuterul tomografias.
zogjer saWiroa diferenciuli diagnozis gatareba angioqolecistitTan,
romlisaTvisac damaxasiaTebelia gulisreviTa da RebinebiT mimdinare SeteviTi xasiaTis
tkivilebi marjvena ferdqveSa midamoSi. aRiniSneba cximovani sakvebis miuRebloba,
subfebriluri temperatura, neitrofiluri leikocitozi, momatebuli eds RviZlis
ujredebis fermentebis aqtivaciis gareSe.
mkurnaloba. daavadebis msubuqi da saSualo simZimiT mimdinareobisas seriozuli
mkurnaloba
premorbiduli fonis gareSe dasaSvebia avadmyofis mkurnaloba saxlis pirobebSi, ra
Tqma unda, saTanado sanitarul-higienuri reJimis dacviT. daavadebis simZimis miuxedavad,
mwvave periodSi, saerTo intoqsikaciis gaqrobamde (saerTo mdgomareobis gaumjobeseba,
145
kerZo nawili.
siyviTlis dakleba, madis gaumjobeseba, RviZlis funqciebis gaumjobeseba da sxv.) unda

daicvan SezRuduli an woliTi reJimi, rac zogavs energetikul danaxarjebs, aumjobesebs
RviZlis sisxlis mimoqcevas, aCqarebs reparaciul process. reJimi Zalian mkacri ar
unda iyos _ aramZime mdgomareobis dros avadmyofs eZleva sawolze dajdomis, magidasTan
Wamis, tualetiT sargeblobis ufleba. reJimis gafarToeba unda moxdes TandaTanobiT.
didi mniSvneloba eniWeba avadmyofis movlas, srulfasovan kvebas, sakvebi unda iyos
advilad asaTvisebeli, SeZlebisdagvarad fiziologiuri, cilebis, cximebisa da
naxSirwylebis raodenobis Sefardeba Sesabamisad 1:1:4-5-ze.
saerTo intoqsikaciis dros cilebis udidesi nawili unda modiodes rZisa da
mcenareul nawarmze. 3 wlamde asakis bavSvebs eniSneba 50-100g xaWo, ufro did asaks
_ 200-300 g-mde. intoqsikaciis Semcirebis Semdeg dieta unda Seesabamebodes asaks.
racionSi Sedis Zroxis, bocveris mWle xorci, ucximo Tevzeuli (virTevza da sxv.),
SeiZleba kvercxis micema, mwvave periodSi saWiroa gamoiricxos eqstraqtuli nivTierebebi,
Sebolili xorci, marinadi, Zneladdnobadi cximebi, cxare sawebeli. madis mosagvrelad
dasaSvebia mcire raodenobiT tyemlis wvenis micema sufris mariliT, mJave kombosto,
kitri, mwvane xaxvi (moxarSuli), wiTeli an Savi xizilala. patara bavSvebSi mwvave
periodSi ramdenadme izRudeba cximi ( mdgomareobis gaumjobesebamde), SemdgomSi ki
eZleva asakis Sesabamisad. SeiZleba, mieces karaqi, mzesumziris, zeiTunis zeTi da a.S.
avadmyofebs eniSnebaT B (B1,B2,B6), C, PP jgufis vitaminebi.
mZime formis hepatitebis dros, arcTu iSviaTi anoreqsiis pirobebSi, roca avadmyofebs
awuxebT gulisreva, Rebineba da a.S. da zogjer saWmlis danaxva an sunic ki iwvevs
refleqsur Rebinebas, iniSneba maqsimalurad damzogavi sakvebi. am SemTxvevaSi standartuli
dieta, rasakvirvelia, ar miesadageba aRniSnul mdgomareobas. am dros gamoiricxeba
xorciani produqtebi, iniSneba mxolod Txieri da naxevradTxieri saWmeli (xilis
wvenebi, tkbili Cai, Cai limniT, xili, Jele da a.S.). saWiroa sitkbos didi raodenobiT
miwodeba, yabzobisas ki _ gamwmendi oyna, laqtulozas micema.
daavadebis msubuqi da saSualo simZimiT mimdinareobisas mkurnaloba, umetesad,
Semoifargleba saTanado reJimiTa da dietiT. saSualo simZimisas mxolod erTeul
SemTxvevaSi da mZime formebis dros iqmneba medikamenturi mkurnalobis Catarebis
aucilebloba. unda aRiniSnos, rom hepatitis dros avadmyofi cudad itans preparatebis
usistemo micemas _ poli pragmazias, romelic isedac darRveul dezintoqsikaciur
funqciebs ufro metad auaresebs. amitom, medikamenturi Terapia yovelTvis maqsimalurad
SezRuduli unda iyos.
Zlieri intoqsikaciis dros venaSi gadasasxmelad ixmareba sxvadasxva xsnari.
gamoiyeneba reopoliglukini, glukozis 5-10%-iani xsnari, ringeris laqtati, albumini,
aminomJavebi. mkurnalobisa da kvebis reJimis princi pebi igivea sxva hepatitebisaTvisac.
metaboluri Terapiis saSualebani. zogjer nivTierebaTa cvlis koreqciis
mizniT, garda vitaminebis kompleqsisa, eZlevaT riboqsini, citoqromi, kaliumis orotati,
legaloni, hepatofalk-planta 20-30 dRis ganmavlobaSi ( gansakuTrebiT gaxangrZlivebuli
formebis dros). am bolo dros Cvens klinikaSi aprobirebulia preparat lazegriniT
monoTerapia, romlis SemadgenlobaSic Sedis danaleqi gogirdi (Sulfur praecipitatum),
aRdgenili rkina (Ferrum reductum), WinWris foTlebi (Folia Urtica dioica), negos
balaxi (Herba Helichrysi arenarii), gvirilis yvavilebi (Flores Chamomillae),
mravalZarRvas foTlebi (Folia Plantaginis majoris), laqtoza (Lactosae). mas
axasiaTebs hepatoproteqciuli, dezintoqsikaciuri, anTebissawinaaRmdego da
imunomakoregirebeli Tvisebebi. miiReba 1 kafsula Wamis win dReSi 3-jer, 2-3 kviris
ganmavlobaSi. saWiroebisas SesaZloa mkurnalobis kursis gagrZeleba 6 kviramde.
lazegriniT Terapia sxva medikamentebis gamoyenebis aucileblobas amcirebs da
146
kerZo nawili.
maRal efeqtsac iZleva, gansakuTrebiT A hepatitis dros. kortikosteroidebi ar

iniSneba.
hepatitgadatanil rekonvalescentis pirveli dispanseruli gasinjva tardeba
gaweridan 15-30 dRis ganmavlobaSi, meore ki _ 3 Tveze. narCeni movlenebis ararsebobis
SemTxvevaSi pirebi ixsnebian aRricxvidan.
profilaqtika. vinaidan, avadmyofi infeqciis wyaros warmoadgens, saWiroa daavadebis
dasawyis periodSive adreuli diagnostireba, izolacia da dakvirveba 2kviriT mainc.
profilaqtikis mizniT iyeneben imunoglobulinebs. imunoglobulinis Seyvana 80-90%
SemTxvevaSi iZleva efeqts.
hepatit A-Ti
-Ti daavadebulTan kontaqtis Semdeg SeerTebul StatebSi miRebulia
profilaqtikis aseTi sqemebi:
h ep atit A -s s aw inaaRmdeg o p r o f il aqtikur i Ro nis Ziebebi

(mo g z aur ebisaTvis)
kont aqt is dr os x angr Zlivoba
asaki (weli) (koleqt ivebSi an endemur r ekomendebuli R onisZieba
ker aS i) (T ve)
< 2 < 3 IG 0,02 ml/kg
3-5 IG 0,06 ml/kg
IG 0,06 ml/kg gamgzavrebisas da
ufro xangrZlivi mogzauroba
yovel 5 TveSi gameoreba
≥ 2 < 3 vaqcina HAV (umjobesia)
an
IG 0,02 ml/kg
3-5 vaqcina HAV
an
IG 0,06 ml/kg
ufro xangrZlivi mogzauroba vaqcina HAV
IG _ imunoglobulini keTdeba Rrmad kunTebSi, Tu siTxis raodenoba didia gakeTdes

sxvadasxva adgilas (did kunTebSi Rrmad)
hepatit A-s
s sawinaaRmdego profilaqtika ojaxSi
an sxva xanmokle kontaqtis dros
kontaqtidan gasuli mosalodnelia rekomendebuli

asaki (weli)
dro (kvira) Semdgomi kontaqti profilaqtika
≤ 2 ara yvela asaki IG (0.02 ml/kg)*
ki ≥ 2 IG (0.02 ml/kg)*
da HAV-vaqcina
> 2 ara yvela asaki profilaqtika ar aris
saWiro
ki ≥ 2 HAV-vaqcina
* IG keTdeba Rrmad
147
kerZo nawili.
unda aRiniSnos, rom adamianis imunoglobulinis Seyvana inficirebamde da mis

Semdeg, iZleva droebiT efeqts da arsebiTad ver axdens gavlenas avadobis doneze.
ZiriTad profilaqtikur RonisZiebas warmoadgens wyalsadenisa da kanalizaciis
Tanamedrove doneze gamarTva, xarisxiani sakvebi produqtebiT sargebloba.
sxvadasxva jgufis mosaxleobaSi epidCvenebiT profilaqtikuri vaqcinacia tardeba
inaqtivirebuli an cocxali atenuirebuli vaqciniT, (mag., Havrix an Vaqta). vaqcinacia
Havrix-is vaqciniT ganapirobebs 15 dRis Semdeg 88%-Si, xolo 1 Tvis Semdeg 99%-Si
proteqciul moqmedebas.
HAV- s sawinaaRmdego inaqtivirebuli

vaqcinebis dozebi da kalendari
asaki (weli) vaqcina* antigenis doza ml/doza dozis r-ba sqema

Havrix † ‡
pirveli Seyvana 1 da
360 EL.U 0,5 3
(SKB) 6-12 Tvis Semdeg
Havrix
720 EL.U 0,5 2 `_"
2-18 (SKB)
Vaqta ¥
25 0,5 2 `_~
(Merck)
Havrix
1440 EL.U 1,0 2 `_~
(SKB)
19 da meti
Vaqta
¥
50 U 1,0 2 `_~
(Merck)
* - SKB - SmithKline Beecham kompania

† - bavSvebSi, vinc miiRo 360 EL.U pirveli doziT, saWiroa gakeTdes 2 damaTebiTi doza
(360 EL.U an 720 EL.U)) sqemis dasamTavreblad
‡ - EL.U - enzyme-linked immunoassay units _ enzimniSandebuli imunuri analizis
erTeulebi
¥ - antigenis erTeulebi (yoveli erTeuli _ 1mg virusuli cilis eqvivalentia)
hepatit A-s sawinaaRmdego vaqcinacia saWiroa Catardes Semdeg jgufebSi:

1. 2 wlis da meti asakis bavSvebsa da mozrdilebSi maRal endemur zonebSi an
HAV-is perioduli afeTqebebis regionebSi cxovrebisas.
2. RviZlis daavadebis mqone pirebSi.
3. homo- da biseqsualebSi.
4. narkomanebSi.
5. laboratoriis muSakebSi, sadac inficirebis riski maRalia.
sasurvelia:
1. bavSvTa organizaciebis (baga-baRi, skola) personalisaTvis.
2. cixeSi myofi pirebisaTvis (rogorc personali, aseve tusaRebi).
3. saavadmyofoebis samedicino personalisaTvis.
4. kvebiT obieqtebSi momuSave pirTaTvis.
5. hemofiliiT daavadebulTaTvis (evropasa da aSS-Si aRwerilia HA-s afeTqebebi
solvent-detergentuli gawmendili sisxlis koncentratebis gadasxmis Semdeg).
6. skolaSi kontaqti bavSvebisaTvis did risks ar warmoadgens, magram SesaZleblobis
Sesabamisad (bavSvebi imyofebian cud sanitarul pirobebSi an aqvT mWidro kontaqti),
saWiroa Ig-is da vaqcina HAV-is Seyvana (ix. sqemaSi).
148
kerZo nawili.
virusuli hepatitebi. virusuli hepatiti B
virusuli hepatiti B
daavadebis sinonimebia: Sratismieri hepatiti, parenteruli hepatiti, inokuluri

hepatiti, artificiuli hepatiti da sxv.
hepatiti B, iseve, rogorc C da D hepatitebi, miekuTvneba sisxlis anTroponozul
infeqcias transmisiuli (magram gadacemaSi mwerebi ar monawileoben), bunebrivi da
xelovnuri gadacemis gzebis mravalricxovani meqanizmebiT da xasiaTdeba virusemiuli
procesiT, RviZlis upiratesi dazianebiT, rogorc elviseburi aseve xangrZlivi
mimdinareobiT, qronikuli hepatitis SesaZlebeli CamoyalibebiT, ciroziTa da zogjer
hepatokarcinomis ganviTarebiT.
etiologia. B hepatitis gamomwvevi virusi (HBV) sxva hepatitis virusebisagan
gansxvavebiT, Seicavs dnm-s. amave dros igi ultrastruqturiT ar Seesabameba arc erT
sxva dnm-is Semcvel taqsonomiur viruss (poliovirusi, adenovirusi, papovavirusi da
sxva).
W.S. Robinson-is winadadebiT
(1975w.) HBV gamoiyo axal damoukidebel
Hepadnaviridae-s ojaxad, (hepar-
RviZli, dna- dnm-is Semcveli virusi).
amave ojaxs miekuTvneba is virusebic,
romlebic hepatitebs iwveven zogierT
gareul mRrRnelebsa da frinvelebSi
(CrdiloeT-amerikuli tyis virTagva, miwis
ciyvi, pekinis Sinauri ixvi da sxv.)
hepatitiT daavadebuli aRniSnuli
cxovelebi da frinvelebi farTod
gamoiyenebian eqsperimentebSi B hepati-
tis Seswavlis dros.
B hepatitis virusi anu `deinis
nawilaki” sferuli formisaa da aqvs 42-
45 nm-is diametri. mis struqturaSi
gamoirCeva sferosebri da sxvadasxva
zomis tubuluri nawilakebiT
Semofargluli eleqtronuli mkvrivi
warmonaqmnebi, aqvs garegani
lipoproteinuli garsi da orZafiani dnm-
is Semcveli nukleokafsidi. erTi maTgani
_ `plus” jaWvi 30%-iT moklea meoreze
_ `minus” jaWvze.
43 nm-is Dane-s
-s nawilaki (HBV) da
`plus” jaWvi mudmivad ganicdis
sferosebri da filamenturi (tubuluri)
nawilakebi 20 nm-is diametriT (HBSAg). daSenebas ferment dnm-polimerazas
(Provist P.) meSveobiT da ganapirobebs virusis
replikacias. Sedegad iqmneba sruli an
defeqturi virionebi. populaciis nawils aReniSneba `carieli” nawilakebi, romlebsac
ar axasiaTebT polimerazuli aqtivoba. `dauSenebeli” virusebi arasrulfasovania,
maTi replikacia SeuZlebelia. HBV replikaciis Tavisebureba permanentuli xasiaTis
gamo iwvevs maTi sinTezis Secdomebs, mutaciebs da amiT ganapirobebs virusis
heterogenobas.
149
kerZo nawili.
HBV sqematuri struqtura.

B hepatitis virusiT
(Â.Ô. Ó÷àéêèí) inficirebul organizmSi
infeqciuri procesis
sxvadasxva etapze
sxvadasxva sixSiriT
SeiZleba gamovlindes
virusis antigenebi:
zedapiruli antigeni _ HBS
Ag, gulovani _ HBcAg
(HBcorAg) d a m a s T a n
axlomdebare HBeAg (HB
precorAg). u S v e b e n a m
antigenis ori variantis
arsebobas _ HBeAg-1 da
HBeAg-2, r o m l e b i c
gansxvavdebian HBcAg-Tan
dakavSirebis xarisxiT.
HBxAg g a n l a g e b u l i a
virusis SuagulSi. misi
mniSvneloba jer kidev
gaurkvevelia.
HBcAg- i s a g a n
gansxvavebiT, romelic
mxolod RviZlis
bioftatSi _ hepatocitebis birTvebSi mdebareobs, HBeAg cirkulirebs sisxlSi da
arapirdapiri gziT adasturebs HBcAg-is RviZlis qsovilSi arsebobas. HBeAg-s
didi mniSvneloba aqvs virusis replikaciaSi, igi imyofeba sisxlSi da mwvave hepati-
tis dros HBSAg-is maRal titrTan korelirebs.
HBSAg-i sisxlSi cirkulirebs dawyebuli mcire raodenobidan (1-10 ng/ml-ze),
damTavrebuli didi koncentraciiT (500 mkg/ml-ze). ukanaskneli ki Seesabameba virusis
birTvuli komponentebisa da misi garsovani struqturebis arabalansirebul sinTezs,
rasac SeiZleba adgili hqondes hepatitis mwvave periodSi da daavadebis qronikuli
mimdinareobis dros.
HBSAg antigenuri struqturiT araerTgvarovania da Seicavs saerTo jgufisaTvis
specifikur a da oTxidan or subti pur determinants (d an y da w an r). amitom
gamoyofen HBSAg-is 4 ZiriTad subti ps _ HBSAg adw, adr, ayw, ayr. HBSAg
ganisazRvreba sxva subtipuri determinantebiTac _ g,x,f. msoflios sxvadasxva regionSi
dadgenilia araerTgvarovani subti pebi, rasac ufro epidemiologiuri mniSvneloba
eniWeba. S antigenis winamdebare zonaSi ganlagebulia (preS1, da preS2) cilebi,
romlebic mniSvnelovan rols TamaSoben HBV-is da RviZlis ujredebis
urTierTmoqmedebis meqanizmze.
B hepatitis dros avadmyofis organizmSi yvela CamoTvlili antigenuri fraqciis
mimarT gamomuSavdeba saTanado antisxeulebi _ anti--HBc, anti--HBe, anti-HBS, anti-
pre-S1, anti-pre-S2, anti-HBx, anti-HBpol (HBpol, dnm-is polimerazas sinTezis markeria).
anti- HBx da anti-HBpol indikaciis Sedegebis Sefaseba jer kidev arasakmarisadaa
Seswavlili.
B hepatitis virusi gamoirCeva garemoSi maRali mdgradobiT. ase, magaliTad, oTaxis
temperaturaze sicocxlisunariania 3 Tve, macivarSi _ 6 Tve, gayinul mdgomareobaSi
150
kerZo nawili.
15-20 weli, gamomSral plazmaSi _ 25 weli. duRili 30 wT-is ganmavlobaSi iwvevs

virusis inaqtivacias, autoklavireba 120°C-ze 5 wuTSi, xolo mSrali sicxis moqmedeba
(160°C) virusis inaqtivacias 2 saaTis Semdeg iwvevs. virusi mdgradia eTeris,
ultraiisferi sxivebis moqmedebis mimarT.
epidemiologia. B virusuli hepatiti mTels msoflioSi gavrcelebuli infeqciaa,
epidemiologia
rasac xels uwyobs imunologiuri, socialuri da ekonomikuri faqtorebis erToblivi
moqmedeba.
infeqciis wyaros warmoadgens avadmyofi da virusmtarebeli adamiani. xSirad
mxedvelobaSi Rebuloben mxolod mwvave formebs, Tumca avadmyofebis didi nawili
daavadebulia qronikuli, waSlili da inaparantuli formebiTac.
msoflio jandacvis organizaciis monacemebiT yovel wels xdeba 50 mln adamianis
pirveladi inficireba, aqedan 5-10%-Si daavadeba gadadis qronikul formaSi. am formas
didi mniSvneloba eniWeba, rogorc infeqciis wyaros. Ë\È\ Øëÿõòåíêî–s da Tanaavtorebis
azriT, inaparantuli, usiyvaTlo, qronikuli formiT daavadebul gamouvlinebel hepatitebs
infeqciis gavrcelebaSi eniWebaT mTavari roli. TiTqmis janmrTeli adamianis sisxlSi
HBV-s dnm-is gamovlineba metyvelebs infeqciis arsebobaze, Tumca bevr aseT pirs
araviTari Civili ara aqvs.
HBV virusis xangrZlivi, xSirad mTeli sicocxlis ganmavlobaSi adamianis organizmSi
persistireba ganisazRvreba, rogorc misi arsebobis ekologiuri forma.
virusis sisxlSi Semcveloba aRiniSneba daavadebis klinikur gamovlinebamde didi
xniT adre da grZeldeba siyviTlis gamovlinebidan mwvave periodis 3-4 kviris
ganmavlobaSi. viruss naxuloben nerwyvSi, SardSi, menstrualur gamonadenSi infeqciis
qronikuli da latenturi mimdinareobis drosac ki, roca dgindeba virusis dabali
koncentracia (1 ng/ml, ifa-s meTodiT). aRniSnuli raodenoba Seesabameba 100 mainficirebel
dozas.
infeqciis gavrcelebis kriteriumad miRebulia HBSAg-is gamovlinebis maCvenebeli
donoris sisxlSi, e.i. mosaxleobis janmrTel fenebSi. keTilsaimedo maCveneblad iTvleba,
roca virusmtarebloba ar aRemateba 2%-s. aseT regionebs miekuTvneba evropis udidesi
nawili (CrdiloeTi, dasavleTi da centraluri evropa) da CrdiloeT amerika. HBV-
s saSualo intensivobis cirkulaciis maCvenebelia 2-7% da mas miekuTvneba samxreTi
da aRmosavleTi evropa, samxreTi da centraluri amerikis regionebi. ufro maRali
virusmtarebloba aRiniSneba aRmosavleT da samxreT-aRmosavleT aziis qveynebSi,
ekvatorul da CrdiloeT afrikaSi. aseTi zonebi hi perendemiuria (mtareblobis 55%
da meti).
daavadeba, ZiriTadad, mozard mosaxleobaSi da aseve erT wlamde bavSvebSi gvxvdeba
(hi perendemiur regionebSi perinataluri gziT inficirebis upiratesobis gamo).
inficirebuli dedisagan nayofs virusi gadaecema placentiT an mSobiarobis dros.
yvela SemTxvevaSi inficireba xorcieldeba parenteruli gziT. xSirad inficireba
xdeba sisxlisa da sisxlis komponentebis gadasxmis Sedegad (fibrinogeni, plazma,
eriTrocituli masa, iSviaTad imunoglobulini da sxv.), cudad sterilizebuli
instrumentebis xmarebis dros (nemsi, Spricebi, qirurgiuli, stomatologiuri
instrumentebi da a.S.). inficireba SesaZloa sqesobrivi an sayofacxovrebo-kontaqturi
gziTac, rac dazianebul kansa da lorwovan garsze virusSemcveli masalis moxvedris
dros xorcieldeba (mWidro kontaqti ojaxebSi, bavSvTa koleqtivebSi). mTlianobaSi
B hepatitiT daavadebis 15% modis bavSvTa asakze, romelTa Soris daavadeba xSiria
wlamde asakis bavSvebSi. 85%-Si dasnebovneba xdeba sisxlisa da misi komponentebis
gadasxmiT, xolo danarCen SemTxvevebSi ineqciebiT, mSobiarobis dros an transfuziuli
gziT. 3 wlis asakis zeviT bavSvebi B hepatitiT SedarebiT iSviaTad avaddebian, rac
151
kerZo nawili.
imiT unda aixsnas, rom am asakSi sisxlsa da mis komponentebs samkurnalod naklebad
iyeneben.
donorebis SerCevaSi HBsAg garda kidev erT damatebiT kriteriumad aRebulia
anti-HBcIgM-is Semowmeba, rac HBV-Ti sisxlis kontaminacias TiTqmis gamoricxavs.
daavadebis gadatanis Semdeg viTardeba myari imuniteti. ganmeorebiTi daavadeba
unda Sefasdes, rogorc qronikuli an sxva etiologiis hepatitis gamovlineba. daavadeba
gvxvdeba mTeli wlis ganmavlobaSi, sezonurobas adgili ara aqvs.
paTogenezi. virusis organizmSi SeWra yvela SemTxvevaSi xdeba parenteruli
paTogenezi
gziT _ kanidan da lorwovani garsebidan, ris Semdegac viTardeba viremia, xolo
inficirebuli sisxlisa da misi komponentebis uSualod sisxlSi gadasxma ganapirobebs
infeqciuri procesis dawyebas viremiiT.
HBV-is replikacia, ZiriTadad, xorcieldeba hepatocitebSi. virusis
hepatotropulobas gansazRvravs misi garegani garsebis pre-S zonis cilebi.
hepatocitebis membranebze imyofeba polimerizebuli cilis zonebi, romlebic Seesabamebian
pre-S-is saTanado receptorebs. hepatocitebis zedapirze moxvedrili virusidan
proteolizuri fermentebis meSveobiT gamoTavisuflebuli dnm, uSualod aRwevs
hepatocitebis birTvs da CaeSeneba ujredis genomSi. xdeba sruli antigenis _ deinis
nawilakis awyoba, romelic mTavrdeba nukleokafsiduri antigenebis – HBcAg-sa da
HBeAg-is wardgeniT (eqspresiiT) hepatocitebis membranebze, sadac xdeba maTi amocnoba
imunocitebis mier. Seqmnili virusis SenarCunebasa da dacvaSi didi roli eniWeba
HBeAg-is sekrecias sisxlSi.
eqsperimentuli gamokvlevebiT dadgenilia, rom mocirkulire HBeAg Trgunavs
imunitetis orive rgols _ ujredulsa da humoruls. ujreduls _ γ-interferonis
produqciis daklebiT, rac T-limfocitebs xels uSlis (asustebs) virusis àmocnobaSi”,
humoruls _ B-limfocitebis mier antisxeulebis produqciis daTrgunvis Sedegad. am
SemTvevebSi TiTqosda adgili aqvs HBeAg-is mimarT imunotolerantobas, rac xels
uSlis organizmidan virusis eliminacias. HBeAg-sgan gansxvavebiT sisxlSi mocirkulire
HBSAg aseT imunotolerantobas ar iwvevs.
daavadebis paTogenezSi didi roli miekuTvneba virusis RviZlgareTa replikacias
_ Zvlis tvinSi, sisxlSi, limfur kvanZebSi, elenTaSi; gansakuTrebiT, mocirkulire
makrofagebSi _ monocitebSi, sadac maTze kontroli imunocitebis mxridan ar xdeba.
es kidev erTi gzaa, rom virusi “gausxltes” imunur zedamxedvelobas. swored es
meqanizmebi ganapirobeben preparat interferonis uefeqtobas, xolo fulminanturi B
hepatitis dros RviZlis transplantantis reinficirebas. qronikuli hepatitis
interferoniT mkurnalobis dros uefeqtoba zogjer aixsneba HBV mutantebis warmoSobiT
(HBV _ minus HBeAg –mutanti (HBVe-), anu HBV-m dakarga HBeAg sinTezis unari).
HBeAg–s dakargva ki niSnavs, rom imunuri sistema ar akontrolebs (ar cnobs) HBV-
s. HBeAg Semcveli ujredebi imunuri sistemisaTvis erTaderTi amocnobadi ucxo
cilaa, HBsAg imunuri sistemisaTvis amosacnob ucxo cilas ar warmoadgens.
mniSvnelovania, rom Tu mutacia moxda HBsAg a-determinantSi (pre-S-S zonaSi),
vaqcina-inducirebuli antisxeulebi anti- HBs aseT mutant HB-viruss ar cnoben da
miuxedavad Catarebuli specifikuri imunizaciisa SesaZloa arsebobdes `vaccine
escape mutant” anu `vaqcinas `gasxletili” mutanti”.
hepatocitebSi HBV-is didi xnis ganmavlobaSi arseboba, maTi SeRweva _ integracia
RviZlis ujredebis genomur aparatSi aseve iwvevs imunuri kontrolidan gamosvlas,
rac xels uwyobs procesis qronizacias da malignizaciis saSiSroebas qmnis.
hepatitis paTogenezSi mniSvnelovani roli ukavia T-citotoqsikuri limfocitebiT
ganpirobebul citolizis sindroms. dadgenilia, rom HBV-is maRali aqtivobis
152
kerZo nawili.
SemTxvevaSic RviZlis mxriv morfologiuri cvlilebebi dasawyisSi minimaluria, es ki

mowmobs virusis arapirdapir citopaTiur moqmedebas. amave dros Tvlian, rom virusis
maRali virulentobis dros adgili SeiZleba hqondes mis pirdapir citopaTiur
efeqtsac.
B hepatitis progresuli mimdinareobis dros arCeven citolizis or, Tanmimdevrulad
SesaZlo stadias _ premorfologiurs anu bioqimiurs, roca morfologiuri cvlilebebi
jer kidev ar aris warmodgenili da ganisazRvreba ujreduli enzimebis dezorganizaciiT,
ris adekvatur reaqciadac iTvleba hepatocitebis membranebis ganvladobis gaZliereba
da sisxlis SratSi alat-is, asat-is, ldg-4,5 momateba.
SesaZloa naRvlis sadinaris fermentebis aqtivobis mateba _ tute fosfataza,
leicinaminopeptidaza, gama-glutamiltranspeptidaza, 5-nukleotidaza. hepatitis
qolestazuri formis dros aRniSnuli maCveneblebi gansakuTrebiT maRal dones aRweven.
citolizis meore stadia warmodgenilia RviZlis qsovilis bioftatis
morfologiuri cvlilebebiT da dasawyisSi xasiaTdeba hidropuli (balonuri)
distrofiiT, xolo SemdgomSi ki hepatocitebis nekrobioziT.
hepatitis simZimes, mimdinareobis xarisxsa da prognozs, gansazRvravs citolizis
xarisxi, nekrozuli procesis gavrcelebis masStabi.
RviZlis hepatocitebis funqciuri da struqturuli cvlilebebis Sedegad ecema
JangviTi fosforilirebis intensivoba, ferxdeba atf-is, cilebis sinTezi, viTardeba
hi poproteinemia ( klebulobs albuminebis raodenoba, matulobs γ- da β- globulinebis
fraqciebi). daavadebis simZimis proporciulad mcirdeba proTrombinis indeqsi,
prokonvertinis, proaqcelerinis da sisxlis sxva Semdedebeli faqtorebis raodenoba.
hepatitis mZime formebis dros aRiniSneba midrekileba paTologiuri
hi perkoagulaciisadmi, romelmac SeiZleba gamoiwvios sisxlZarRvSida sisxlis Sededeba
(moxmarebis koagulopaTia).
RviZlis ujredebis dazianebis meqanizmS
meqanizmSi, rogorc ukve iTqva, mTavar rols TamaSoben
imunuri reaqciebi, romlebic atareben ara imunoproteqciul, aramed imunopaTologiur
xasiaTs.
yvelaze ufro gavrcelebuli virusimunogenetikuri koncefciis Tanaxmad (À\Ô\ À\Ô\
Áëþãåð
Áëþãåð; 1978) RviZlis qsovilebis dazianeba ganpirobebulia umTavresad imunuri
reaqciebis rTuli urTierTqmedebiT, riTac SeiZleba aixsnas hepatitis farTo klinikur-
morfologiuri variabeloba _ Zlier mZime, fulminanturi mimdinareoba masiuri da
submasiuri nekroziT, qronikuli procesis formirebiT, cirozis CamoyalibebiT, msubuqi,
inaparantuli, `janmrTeli” virusmtareblobiT.
imunuri pasuxi HBV-infeqciis dros gamoixateba T limfocitebis mxriv kanonzomier
reaqciaSi, romelic mimarTulia virusis amocnobasa da misi daTrgunvisaken. adgili
aqvs T helperuli da T citotoqsikuri funqciebis sxvadasxva intensivobiT gamovlinebas
hepatit B-s mimdinareobis Sesabamisad.
1. imunuri sistemis gadametebuli pasuxis dros (antisxeulebis hi perproduqcia,
hepatocitebis citolizis maRali aqtivoba) viTardeba daavadebis mZime da zogjer
fulminanturi forma. RviZli xdeba autoimunuri procesebis msxverpli.
2. adekvaturi pasuxis dros (adekvaturi antisxeulebis produqcia, hepatocitebis
imunuri citolizi) viTardeba saSualo da mZime formebi sruli gamojansaRebiT
(cikluri forma).
3. Senelebuli pasuxis dros (adekvaturi antisxeulebis produqcia, imunuri
citolizis daqveiTeba) viTardeba siyviTliT mimdinare msubuqi cikluri forma sruli
gamojanmrTelebiT.
4. Sesustebuli pasuxis dros (antisxeulebis produqcia dabal donezea, imunuri
153
kerZo nawili.
citolizi dabali aqtivobiT) viTardeba waSlili, siyviTliT mimdinare an usiyviTlo

formebi. mimdinareoba gaxangrZlivebulia, mosalodnelia qronizacia.
5. imunuri pasuxi ar
aris (citotoqsikuri T
1 limfocitebi da kilerebi HBV-
sadmi tolerantobiT
gamoirCevian). infeqcia
subklinikuri an inaparantuli
formiT mimdinareobs. yalibdeba
HBSAg qronikuli mtarebloba.
klinikur praqtikaSi
aucilebelia HBV infeqciis
antigenuri markerebisa da maT
sawinaaRmdegod organizmSi
warmoqmnili antisxeulebis
gansazRvra da Semdgomi
2 interpretacia.
qvemoT mocemulia markerebis
dinamika hepatit B-s sxvadasxva
variantiT mimdinareobis dros:
1. HBV-s-s markerebi hepatit B--

s mwvave cikluri mimdinareobis
dros. ((Ñ.Ñîðèíñîí)
2. HBV-s-s markerebi hepatit B--
s mwvave progredientuli (gaxan-
grZlivebuli) mimdinareobis
3 3. HBV-s-s markerebi qronikuli
hepatit B-s-s r eplikaciur
eplikaciurii ti pis
replikaciur
4. HBV-s
-s markerebi qronikuli
hepatit B-s
-s integraciuli ti pis
dros ((HBeAg ar cirkulirebs da
Tu alat normis farglebSia,
mowmobs virusis hepatocitis
genomSi integracias).
(Ñ.Ñîðèíñîí)
zemoT moyvanili sqemebidan

4 Cans, rom markerebis dinamika HBV
infeqciis sxvadasxva mimdinareo-
bis dros gansaxvavdeba da gva-
Zlevs diagnozis dazustebis sa-
Sualebas. amave dros sayuradRe-
boa, rom zogjer saWiroa HBV
dnm-is gansazRvra polimerazu-
li jaWvuri reaqciis meSveobiT,
154
kerZo nawili.
rac adasturebs virusis arsebobas.

polimerazuli jaWvuri reaqciis meTodi agebulia virusis in virto aRwarmoebaze.
substratSi (sisxli, qsovili) SehyavT e.w. praimeri (virusis nukleotidebis patara
jaWvi). Tu substratSi aRiniSna dnm-polimeraza, xdeba patara jaWvis daSeneba bolom-
de orive mxriv.
amplifikaciis (gamravlebis) meTodi saSualebas gvaZlevs miviRoT 1 virusidan
100 miliard aslamde 1 dReSi. aseTi meTodis gamoyenebiT SesaZlebeli gaxda, aRmova-
CinoT virusis minimaluri koncentracia (Tundac igi 1 molekulas warmoadgendes).
HBV dnm-is aRmoCenisaTvis pjr-is meTodiT sakmarisia sisxlis 0,08 ml-is gamokvl-
eva. es meTodi SeiZleba gamoviyenoT praqtikulad yvela infeqciis dros.
autoimunuri procesis rolis Sefaseba SesaZlebeli gaxda RviZlis specifikuri
li poproteidis (autoantigenis) gamoyofis Semdeg, romelic janmrTeli adamianis
hepatocitebis membranebisa da mikrosomebis Semadgenlobis komponentia. imunologiuri
gardaqmnis Sedegad organizmSi iqmneba imunuri kompleqsebi, romlebic Sedgebian antigenebis,
antisxeulebis da C3 komplementis komponentebisagan. Seqmnili imunuri kompleqsebi
fagocitirebas ganicdian ZiriTadad makrofagebiT da toveben organizms. amasTanave,
sisxlSi nawilobriv grZeldeba maTi cirkulacia, rac arasasikeTo imunuri reaqciebiT
xasiaTdeba.
autoimunuri procesebi aRrmaveben da iwveven RviZlis ujredebis nekrozs da
Zlier mZime, fulminanturi mimdinareobis dros fatalur gamosavals ganapirobeben, am
procesebis stabilizacia SeiZleba mniSvnelovani faqtori iyos HBV infeqciis qronikuli
aqtiuri procesis CamoyalibebaSi.
Tanamedrove SexedulebiT, imunuri procesis madeterminirebeli geni (immune
response gen) dakavSirebulia histoSeTavsebis _ HLA genTan. T ujredul
citotoqsikur aqtivobis determinacia gansazRvravs HLA klasis HLA-1 lokusi,
helperul aqtivobas _ HLA –II lokusi. swored HLA-I ganapirobebs T limfocitebis
mier HBV-s àmocnobas” da SemdgomSi maT mier ganpirobebul citotoqsikur efeqts
_ virusis daRupvas inficirebul hepatocitebSi. amave dros, HLA-I garkveulad
kidevac zRudavs T limfocitebis citotoqsikur efeqts, rac mniSvnelovnad uwyobs
xels HBV infeqciis persistencias da qronikuli hepatitis formirebas.
virussawinaaRmdego srulfasovani pasuxi mniSvnelovnadaa damokidebuli interferonis
sakmaris produqciaze.
imunuri, autoimunuri da citolizuri virusuli procesebisa da maTi ganxorcielebis
xarisxis Tanafardoba gansazRvravs RviZlis morfologiur cvlilebebs da daavadebis
klinikur mimdinareobas.
organizmSi zedmeti Tavisufali (toqsikuri) radikalebis dagroveba da lizosomuri
hidrolazebis aqtiuroba xels uwyobs RviZlis parenqimis autolizs, autoimunuri
procesis Camoyalibebas.
Catarebuli klinikur-laboratoriuli da eqsperimentuli kvlevebiT dadgenilia,
agreTve, virusuli hepatitebis dros imunitetis araspecifikuri faqtorebis (sisxlis
Sratis baqteriociduri Tvisebebi, lizocimuri aqtivoba, nawlavTa floris darRvevis
xarisxi, Tirkmelzeda jirkvlis sekreciuli mdgomareoba, serotoninis cvla da sxv.)
mniSvneloba daavadebis paTogenezis, simZimisa da klinikuri variantebis mimdinareobis
formirebaSi (À\È\ Õî÷àâà 1975).
paTmorfologia. mwvave, arafulminanturi B hepatits dros paTmorfologiuri
cvlilebebi ZiriTadad atareben SezRudul xasiaTs, aseTi cvlilebebi aRiniSneba
ufro mwvave hepatitis cikluri mimdinareobis dros.
cikluri hepatitis ganviTarebis SemTxvevaSi P.J. Scheuer-is (1994) morfologiuri
155
kerZo nawili.
klasifikaciis Tanaxmad RviZlis mxriv yvelaze xSiria laqovani nekrozi (spotty

necrosis), romlis nekrozuli kerebic erTmaneTTan SeerTebuli ar aris da atarebs
nekrobiozul xasiaTs. aseTi cvlilebebi Seesabameba hepatitis msubuqad mimdinareobis
variants.
ufro xSirad saSualo simZimiT da, naklebad, msubuqi mimdinareobis dros formirdeba
xiduri nekrozi (bridging necrosis), rac RviZlis nawilakebis erTeuli zonebis
nekrobiozuli cvlilebebiT da maTi nawilobrivi SeerTebiT ganisazRvreba.
nekrobiozuli cvlilebebis gavrceleba mTel nawilakze xasiaTdeba lobaluri an
panacinuri nekroziT (panacinar necrosis) da ZiriTadad B hepatitis saSualo simZimis
formiT mimdinareobas Seesabameba.
mwvave hepatitis progredientuli mimdinareobisas aRiniSneba peri portuli hepa-
titis niSnebi, nekrozuli procesis gavrceleba aRiniSneba SemzRudav firfitaze,
magram procesis gansxvaveba qronikuli mimdinareobisagan xdeba RviZlis bioftatis
dinamikaSi SeswavliTa da hepatitis keTilgamosavlianobis gaTvaliswinebiT.
B hepatitis fulminanturi mimdinareobisas xdeba RviZlis masiuri da submasiuri
nekrozi. masiuri nekrozi xasiaTdeba RviZlis nawilakis TiTqmis vrceli nekroziT,
SenarCunebulia mxolod periferiuli zonis ujredebi. submasiuri nekrozis dros
nekrozi Semoifargleba nawilakis centriT, gvxvdeba intaqturi zonebic.
unda aRiniSnos, rom B hepatitis fulminanturi mimdinareobis dros paTmorfologiuri
cvlilebebi SeiZleba Semoifarglos xiduri nekroziT nekrozebis Serwymis gareSec.
am SemTxvevaSi biofsirebuli masalis safuZvelze Sefasebam SeiZleba SecdomaSi
Segviyvanos.
mxedvelobaSia misaRebi, rom fulminanturi B hepatitis letaluri gamosavliT
mimdinareoba RviZlis mxriv zogierT SemTxvevaSi morfologiurad minimaluri
cvlilebebiT xasiaTdeba, rasac xsnian energetikuli balansis darRveviT, hepatocitebis
membranebis dezorganizaciiT, maTi ganvladobis gaZlierebiTa da eleqtrolitebis
mudmivobis darRveviT. zogierTi avtori am mdgomareobas gansazRvravs, rogorc citolizis
premorfologiur fazas. mwvave nekrozis dros RviZli moculobaSi klebulobs TiTqmis
orjer, dune konsistenciisaa, SeWmuxnuli kafsuliT. qsovili advilad ixeva. RviZlis
ganakveTze naxuloben Jangisfer-mowiTalo an moSavo-wiTel ubnebs, rac naRveliT
RviZlis qsovilis gaJRenTvisa da sisxlis mimoqcevis moSlis Sedegia. aRiniSneba,
agreTve gamocarielebuli adgilebi stromis CavardniT. RviZlis mxriv regeneraciuli
procesebi ar aRiniSneba, anda sustadaa gamoxatuli, stroma Cveulebriv, nekrozs ar
eqvemdebareba.
qvemwvave nekrozis mimdinareobisas RviZli momkvrivo konsistenciisaa da asakis
normasTan SedarebiT naklebD mcirdeba. amasTanave nekrozul ubnebTan erTad xdeba
hepatocitebis regeneraciac, portuli traqtis CaTreviT, SemaerTebeli qsovilebis
ganviTarebiT, RviZlis arqiteqtonikis darRveviT.
RviZlis nekrozis dros viTardeba RviZlis venebis flebiti, distrofiuli movlenebi
TirkmlebSi, miokardiumSi, kuWqveSa jirkvalSi. adgili aqvs toqsikuri encefalopaTiis
movlenebs, nervuli ujredebis distrofiul darRvevebs.
B hepatitis qolestazuri forma xasiaTdeba RviZlSida sadinrebis procesSi
CaTreviT, maTSi naRvlovani Trombebis ganviTarebiT, hepatocitebSi bilirubinis
dagrovebiT.
qronikuli hepatitebis morfologiuri klasifikaciis mixedviT arCeven qronikul
aqtiur, qronikul persistul da qronikul lobulur hepatitebs.
qronikuli aqtiuri hepatitisaTvis damaxasiaTebelia periportuli anTebiTi procesi,
limfocitur-histocituri infiltracia, wvrilkerovani kibisebri nekrozi, mosazRvre
156
kerZo nawili.
firfitis garRveva, RviZlis nawilakebis arqiteqtonikis cvlilebebi, fibrozis movlenebi

damatebiTi septebis warmoqmniT.
qronikuli persistuli hepatitisaTvis damaxasiaTebelia portuli traqtis anTebiTi
infiltracia. am dros ar aRiniSneba mosazRvre firfitis destruqcia da kibisebri
nekrozi. RviZlis wilakebis struqtura ar irRveva, distrofia da nekrobiozi
hepatocitebSi gamoxatulia sustad.
qronikuli lobuluri hepatitisTvis (mimdinare 6 Tvis Semdeg, rogorc qvemwvave
daumTavrebebli hepatiti) damaxasiaTebelia infiltracia RviZlis wilakebis SigniT.
qronikuli hepatitis dros process arCeven virusis maRali da dabali replikaciuri
aqtivobis mixedviT. kriteriumad am SemTxvevaSi miRebulia HBeAg indikacia. am antigenis
sisxlSi cirkulacia daavadebis dawyebidan 6 Tvis Semdeg, laparakobs virusis replikaciis
maRal aqtivobaze, xolo HBeAg-is cirkulaciis am droisaTvis Sewyveta da anti-HBe
gamovlineba HBsAg-enemiis fonze _ dabal replikaciur aqtivobaze (HBeAg-negatiuri
qronikuli hepatiti). misaRebia mxedvelobaSi alat maCveneblebic (dabali alat-I
mowmobs virusis integraciaze hepatocitis genomTan, xolo maRali _ saWiroebs sxva
hepatitebis darTvaze HBV+HCV, HBV+HDV, HBV+HAV da a.S.gamokvlvas).
arsebobs HBV pirveladqronikuli formebic, rac ufro Seesabameba perinatalur
periodSi SeZenil infeqcias dainficirebuli dedisagan (samSobiaro gzebis gavlis
dros an transplacenturad). am SemTxvevaSi pirveladqronikuli hepatiti uviTardeba
axalSobilTa 90%-s da mxolod 5-10%-Si mimdinareobs igi manifesturi formiT.
RviZlSi aqtiuri procesis mogvianebiT stadiaSi vlindeba RviZlis kvanZovani
dezintegracia, romelic cirozis damaxasiaTebel niSans warmoadgens.
klinika. A hepatitisagan gansxavebiT B hepatiti gamoirCeva xangrZlivi inkubaciuri
klinika
periodiT, romelic 45 dRidan 180 dRemde meryeobs, saSualod ki 2-3 Tves Seadgens.
iSviaTad es periodi ganisazRvreba 30-45 dRiT, rac gvxvdeba transfuziuli inficirebisas
da pirveli Tveebis asakis bavSvebSi.
aRsaniSnavia, rom B hepatitis inkubaciur periodSi sisxlSi kanonzomierad dgindeba
HBSAg-is da HBeAg-is Semcveloba, rac mowmobs aseTi kontingentis, rogorc infeqciis
wyaros, epidsaSiSroebaze.
yvelaze ufro xSir, manifestur formas warmoadgens daavadebis mwvave, cikluri
mimdinareoba, romlis drosac kargadaa gamoxatuli 4 periodi. inkubaciuri periodi,
prodromuli anu siyviTliswina periodi, siyviTlisa da intoqsikaciis sruli
simptomatikis gaSlis da daavadebis ukuganviTarebis anu rekonvalescenciis periodi.
daavadeba iwyeba TandaTanobiT da xasiaTdeba siyviTliswina da siyviTlis periodebiT;
misi dawyebis dro xSirad ver fiqsirdeba. dasawyisSi temperatura normaluria, Semdgom
dReebSi ki Rebulobs subfebrilur xasiaTs. avadmyofebi uCivian saerTo sisustes,
advilad daRlas. aRniSnuli movlenebi xSirad sustadaa gamoxatuli, rac maT mimarT
yuradRebis ugulebelyofis mizezia da eqimTan mimarTva zogjer siyviTlis gamomJRavnebis
Semdeg xdeba. sxva SemTxvevebSi siyviTliswina prodromuli periodi mkveTradaa
gamoxatuli. avadmyofebi aRniSnaven gulis revas, Rebinebas, Tavbrusxvevas, Zilianobas,
Tavis tkivils, meteorizms, yabzobas, naklebad faRaraTs. prodromis periodi saSualod
5-7 dRes Seadgens da meryeobs 2-dan 12 dRemde. prodromuli periodi mTavrdeba
siyviTlis ganviTarebiT. am droisaTvis A hepatitisas saerTo intoqsikaciuri movlenebi
cxreba an mkveTrad mcirdeba, xolo B hepatitis dros ki, piriqiT, intoqsikacia
matulobs da xdeba ufro intensiuri. temperatura febrilur xasiaTs Rebulobs,
gamoxatulia saerTo sisuste, madis daqveiTeba an sruli umadoba, xSirad aRniSnaven
mware gemos, myral suns piridan, tkivilebs marjvena ferdqveSa midamoSi, epigastriumis
areSi an gaurkveveli lokalizaciis muclis tkivils. SeteviTi xasiaTis muclis
157
kerZo nawili.
tkivils naklebad aRniSnaven. igi dakavSirebulia naRvlis sadinrebis

dazianebasTan, perihepatitTan, zogjer RviZlis kafsulaSi
sisxlCaqcevasTan an momaswavebel hepatodistrofiasTan. mozrdili
asakis bavSvebs araiSviaTad axasiaTebT msxvili saxsrebis tkivili.
B hepatitis dros poliarTralgias ganixilaven, rogorc
toqsikur-alergiul, e.w. Sratismier sindroms da ukavSireben sisxlSi
mocirkulire imunuri kompleqsebis dagrovebas. igive genezisaa
siyviTliswina periodSi kanze gamonayari, romelic SeiZleba iyos
wiTelas, qunTruSas an WinWris ciebis msgavsi. ufro xSiria gamonayari,
romelic vlindeba papuluri dermatitiT (janoto-kristis sindromi).
gamonayari simetriuladaa ganlagebuli kidurebze, tanze, dundulebze.
daavadebis mZime mimdinareobisas SeiZleba ganviTardes hemoragiuli
diaTezic.
hepatiti B..
siyviTlis gamovlinebis win avadmyofTa umetesoba amCnevs Sardis
Sardis muqi
Seferiloba. gamuqebas, rac Seesabameba bilirubinuriis ganviTarebas. misi
(sakuTari masala) progresireba ganapirobebs qoliurias da aqolias. aqolia SeiZleba
iyos arasruli, Senacvlebadi. iseve, rogorc A hepatitis dros,
siyviTle am SemTxvevaSic daavadebis dasawyisSi piris Rrus lorwovanze (sasa, enis
lagami) da sklerebze vlindeba, xolo Semdeg swrafad vrceldeba saxeze, tansa da
kidurebze. RviZlis gadideba aRiniSneba ufro metad bavSvebSi, vidre mozrdilebSi.
msubuqi mimdina-reobisas RviZli neknTa rkalidan gamodis 2-3 sm-iT, saSualo simZimis
dros _ 3-5 sm-iT, magram xazgasas-melia, rom siy-viTlis mkveTri intensivobisa da
organizmis saerTo intoqsikaciis gamo-xatulebisas (gansa-kuTrebiT avTvi-sebiani mimdina-
reobis dros) RviZ-li naklebadaa gadidebuli, rac SeiZleba cudi prognozis momas-
wavebeli iyos.
elenTa diddeba 30-
40%-Si, igi zomi-
eri simkvrivisa da
mtkivneulobisaa.
Tu daavadebis
mimdinareobisas
misi zomebi ar
mcirdeba, es ufro
procesis gaxang-
hepatiti B.. piris lorwovanis rZlivebaze mety-
(enis qveS) da xaxis
velebs.
iqteriuloba. (sakuTari masala)
siyviTle da
misi elferi xSi-
rad varirebs, rac
daavadebis sim-
ZimesTan da xangr-
ZlivobasTanaa da-
kavSirebuli. daa-
vadeba SeiZleba mim-
dinareobdes sus-
tad gamoxatuli
siyviTliT, rogorc
hepatiti B.. siyviTle, hepatiti B.. siyviTle kansa da
hepatosplenomegalia. (sakuTari masala) sklerebze. (sakuTari masala) dasawyisSi, aseve
158
kerZo nawili.
Semdgomac, magram, xSirad, avadmyofs aqvs zafranis mom-wvano-limonis an Jangis feri.

es feri miuTiTebs daavadebis simZimeze, qolestazis sind-romis ganviTarebaze.
pikis miRwevis Semdeg (5-10 dRis ganmavlobaSi) xdeba siyviTlis stabilizacia. igi
SeiZleba gagrZeldes 5-6 da meti kvirac, saSualod ki 2-3 kviras Seadgens. xangrZlivi
siyviTle, Cveulebriv, mowmobs qolestazuri (qolangiolizuri) formis ganviTarebaze.
RviZlis funqciur-morfologiur dazianebis intensivobis xarisxi ganapirobebs
cvlilebebs sxva organoebis mxriv, rac ufro gamoxatulia daavadebis mwvave periodSi.
pirvel rigSi es exeba simptomatikas centraluri nervuli sistemis mxriv _ viTardeba
adinamia, aqtivobis Semcireba, uZiloba da sxva, zogierT SemTxvevaSi ki mdgomareoba
mZimdeba encefalopaTiamde, rac mJRavndeba cerebruli darRvevebiT, gansakuTrebiT,
daavadebis avTvisebiani mimdinareobisas komis sxvadasxva xarisxis gamovlinebis CaTvliT.
gulsisxlZarRvTa sistemis mxriv aRiniSneba bradikardia, arteriuli wnevis daqveiTeba.
ekg-ze vlindeba T kbilis horizontuli an dabali done. QRS-is umniSvnelo gafarToeba,
zogjer S-T intervalis inversia. es cvlilebebi SeiZleba Sefasdes, rogorc infeqciuri
gulis gamovlinebebi, xolo mZime intoqsikaciis dros, rogorc nivTierebaTa cvlis
toqsikuri produqtebis uSualo moqmedeba gulis kunTze.
periferiuli sisxlis cvlilebebi aseve damokidebulia daavadebis stadiaze,
garTulebaze, asakze da a.S. prodromuli periodis dros adgili SeiZleba hqondes
eriTrocitozs, hemoglobinis maCveneblis momatebas, mogvianebiT mwvave periodSi ki
maT daqveiTebas _ viTardeba anemia, zogjer ki panmieloftizi marcxniv gadaxriT.
mZimed mimdinare daavadebis pikis dros aRiniSneba leikocitozi. rekonvalescencia
xasiaTdeba limfoplazmuri ujredebis reaqciiT. avadmyofTa daaxloebiT 1/3-s aReniSneba
monocitozi, eds, Cveulebriv, normis farglebSia, xolo misi simcire (1-2 mm) ufro
arasaxarbieloa. momatebuli eds moaswavebs SesaZlo garTulebas (meoradi infeqciis
darTva an RviZlis distofia).
daavadebis dasawyisSi, gansakuTrebiT ki prodromul periodSi imatebs RviZlis
ujredebis sxvadasxva lokalizaciis fermentebis aqtivoba _ alat, asat, ldg da misi
izofermentebi γ-glutamiltranspeptidaza, sdg da sxva, romlebic rekonvalescenciis
periodSi TandaTan ganicdian normalizacias.
daavadebis ganviTarebis simaRleze aRiniSneba koniugirebuli bilirubinis momateba,
rac gamowveulia hepatocitebis mier eqskreciis darRveviT. mZime formebis dros
adgili aqvs arapirdapiri bilirubinis zrdas gansakuTrebiT RviZlis masiuri nekrozis
dros (hepatocitebis mier bilirubinis “mitacebis” da koniugaciis Sesustebis gamo).
SratSi, umravles SemTxvevaSi, mcirdeba saerTo cilis raodenoba albuminis sinTezis
daklebis xarjze. zogierT SemTxvevaSi α- da β- globulinebis raodenoba matulobs,
matulobs γ–globulinebic. yvela es cvlilebebi metyvelebs disproteinemiaze da
daavadebis simZimis maCvenebelia.
Timolis sinji, xSirad, normis farglebSia an odnav momatebuli, sulemis sinjs ki
axasiaTebs daklebisaken tendencia, misi sagrZnobi Semcireba mZime mimdinareobisas,
gansakuTrebiT ki masiuri nekrozisa da cirozis dros xdeba. gamoxatuli cvlilebebia
koagulogramaSic _ rekalcifikaciisa da sisxlis Sededebis drois Semcireba, heparinis
mimarT Sratis tolerantobis daqveiTeba, proTrombinis indeqsis 40%-mde da ufro
metad dakleba, fibrinogenis Semcireba (2,93mkmol/l-ze naklebi), Trombocitebis Semcireba
(100X109/l-ze naklebi). li poproteidebi mwvave periodSi 2-3-jeraa momatebuli, xolo
rekonvalescenciis dros sxva bioqimiur maCveneblebTan erTad normalizacias ganicdis.
β–li poproteidebis mkveTri dakleba cudi prognozis maCvenebelia.
klasifikacia. B da A hepatitebis klinikuri klasifikacia identuria, mxolod im
gansxvavebiT, rom 1 wlamde asakis bavSvebSi gvxvdeba B hepatitis gansakuTrebiT avTvisebiani
159
kerZo nawili.
mimdinareoba, rac 2-3 wlis bavSvebSi ufro iSviaTia.

daavadebis msubuqi formis mimdinareoba xasiaTdeba sustad gamoxatuli klinikuri
simptomatikiT an SeiZleba es ukanaskneli srulebiTac ar aRiniSnos. siyviTlis
intensivoba da xangrZlivoba xanmoklea. sisxlis Sratis cilebis formula, proTrombinis
indeqsi, sulemis sinji arsebiTad ar scildeba normis farglebs. adgili aqvs alat-
is momatebas.
saSualo simZimis dros gamoxatulia intoqsikaciis saerTo movlenebi _ saerTo
sisuste, zogjer Tavis tkivili, mada daqveiTebulia, xSirad aRiniSneba gulisreva
Rebinebis gareSe. siyviTle ufro xangrZlivia. bioqimiuri cvlilebebi zomieradaa
warmodgenili.
mZime mimdinareobis dros intoqsikacia Rebulobs progresirebad xasiaTs. vlindeba
iseTi simptomebi, rogoricaa anoreqsia, apaTia, gulisreva. viTardeba sisxldena RrZilebidan,
cxviridan, adgili aqvs sisxlCaqcevebs tanze. siyviTle progresulad matulobs,
proTrombinis indeqsi iklebs. sisxlSi aRiniSneba neitrofiluri leikocitozi.
avTvisebiani mimdinareoba (sinonimebi _ hepatodistofia, RviZlis mwvave yviTeli
atrofia, toqsikuri distrofia) xSirad viTardeba inficirebuli sisxlis masiuri
gadasxmis Sedegad da gvxvdeba, rogorc wesi, wlamde asakis bavSvebSi, iSviaTad 2-3
wlis asakSi. daavadeba xasiaTdeba mokle (1,5-3 Tve) inkubaciuri periodiT, Cveulebriv,
mwvave dawyebiT. SeiZleba dasawyisSive iyos maRali temperatura, romelic terminalur
stadiaSi Rebulobs mdgradi hi perTermiis xasiaTs, ar eqvemdebareba sicxis damwev
saSualebebs. pirveli gamovlinebani xasiaTdebian anoreqsiiT, apaTiiT, ZilianobiT, romelic
ramodenime saaTSi an 1-1.5 dReSi icvleba
SeteviTi xasiaTis mousvenrobiT. adgili
aqvs TiTqosda umizezo tirils,
wamokivlebas, romelic ukve intensiuri
siyviTlis fonze gadadis Zlier
fsiqomotorul agznebaSi, iwyeba gonebis
dabindva (RviZlismieri encefalopaTia),
bodvebi, halucinaciebi, krunCxvebi.
hepatiti B erT wlamde asakis bavSvebSi. avadmyofs piridan amosdis
hepatodistrofia. ekqimozebi. (sakuTari masala) damaxasiaTebeli umi RviZlis suni,
hepatiti B erT wlamde asakis bavSvebSi. hepatiti B. RviZlismieri koma. yavisferi masebiT
hepatodistrofia. mravlobiTi hemoragiebi Rebineba. (Í.È. Íèñåâè÷, Â.Ô. Ó÷àéêèí)
kanze. (sakuTari masala)
160
kerZo nawili.
romelic gansakuTrebiT SeigrZnoba sunTqvis dros (Foeter hepatica), aseTive suni

aqvs Sardsac. Tvlian, rom suni am SemTxvevaSi ganpirobebulia meTioninis cvlis
darRveviT _ sisxlSi grovdeba meTilmerkaptani.
Cveulebriv, mZime, progresirebadi intoqsikaciis, temperaturis da intensiuri siyviTlis
fonze viTardeba RviZlis mkveTri Semcireba (zogjer ramodenime saaTSi an 1-1,5 dRe-
RameSi).
B hepatitis mZime formebi, romlebic mimdinareoben aramwvave, araqvemwvave
hepatodistrofiiT, arsebiTad gansxvavdebian fulminanturi, mwvave hepatodistrofiisagan
Tavisi klinikur-bioqimiuri TaviseburebebiTa da prognoziT. Tu mZime formisas
mkurnaloba warmarTuli iqna Tavis droze sworad, prognozi xasiaTdeba SedarebiT
keTilsaimedo gamosavliT, mwvave hepatodistrofiis dros ki, umravles SemTxvevaSi,
daavadeba letalurad mTavrdeba.
Tumca mZime da fulminanturi hepatitis mimdinareobisas adgili aqvs msgavs saerTo
simptomatikas _ nervul-fsiqikur darRvevebs (mamoZravebeli, mgrZnobelobis da
refleqsebis moSlas), xazi unda gaesvas avTvisebiani mimdinareobisaTvis damaxasaiTebel
gonebis siRrmiseul dakargvas _ komas. avadmyofs reaqcia am dros ara aqvs Sinagan da
garegan gaRizianebaze. Tanamedrove SexedulebiT fulminanturi hepatitis aucilebel
kriteriumad iTvleba prekoma an koma.
bavSvebSi. literaturaSi gamoyofen komis
komis Tanmimdevroba mcire asakis bavSvebSi
3 stadias _ prekoma-1, prekoma-2 da koma-3 anu sakuTriv koma.
komis pirveli stadia xasiaTdeba orientaciis daqveiTebiT, Zilis inversiiT,
aRiniSneba agzneba, eiforia, naRvlianoba, gonebis xanmokle dabindva, xSirad xelebis
tremori, oflianoba da a.S.
meore stadiis dros cnobiereba sul ufro irRveva, damaxasiaTebelia mexsierebis
Cavardna fsiqomotoruli SenacvlebiT, agzneba aRwevs delirias. avadmyofi kargavs
droSi da garemoSi, orientacias, SeiniSneba xelis `damkvrelobiTi” tremori,
eleqtroencefalogramaze aris delta-talRebis aqtivoba.
mesame stadiis anu sakuTriv komis dros adgili aqvs gonebis srul dabindvas
da refleqsebis gaqrobas (jer myesTa, Semdeg rqovanas da bolos gugis).
eleqtroencefalogramaze upiratesad Warbobs hi persinqronuli delta-talRebi.
xazi unda gaesvas imas, rom komis Tanmimdevrul gaSlas nakleb an srulebiT ara
aqvs adgili mcire asakis bavSvebSi da ufro SeiniSneba komis erTi stadiidan Semdgom
stadiebSi swrafi gadasvla.
komis drouli diagnostikisaTvis cns-is dazianebis simptomatikis garda didi
mniSvneloba eniWeba siyviTlis intensivobas, Trombohemoragiuli sindromis ganviTarebas,
temperaturis momatebas, diurezis daklebas, interkurentuli daavadebebis darTvas,
umi RviZlis sunis gaCenas, taqikardias da sxva saerTo simptomebis arsebobas.
avTvisebiani mimdinareobis dros RviZli saerTod ar isinjeba an Znelad isinjeba
neknTa rkalis doneze (marjvena ferdqveSa `sicariele”), RviZlis SesaZlo palpacia
adgens mis comisebr konsistencias. xazi unda gaesvas imas, rom RviZlis Semcirebis
tempi asaxavs nekrozul procesTa simZafres. RviZlis submasiuri nekrozis ganviTarebis
SemTxvevaSi xdeba misi TandaTanobiTi, biZgisebri dakleba. amasTanave organos yovel
Semdgom Semcirebas Tan axlavs saerTo intoqsikaciuri simptomatikis gaZliereba.
RviZlis masiuri nekrozisagan gansxvavebiT klinikuri gamovlinebani TiTqosda gawelilia
da finaluri stadia dgeba daavadebis me-5-10 dRes.
fulminanturi formis dros damaxasiaTebelia taqikardia, dabali arteriuli wneva,
viTardeba kolafsi, Cndeba xmauriani, toqsikuri sunTqva, romelic komis gaZlierebis
paralelurad terminalur stadiaSi gadadis kusmaulis an Cein-stoqsis tipis sunTqvaSi,
161
kerZo nawili.
viTardeba filtvebis SeSupeba. Tirkmelebis parenqimis nekrozis Sedegad (hepatorenuli

nekrozi) adgili aqvs anurias; sapirispiro simptomi, diurezis momateba daavadebis
keTilgamosavlianobis niSania.
periferiul sisxlSi am dros saxezea neitofiluri leikocitozi marcxniv gadaxriT,
limfopeniiT, eds dabalia, Tumca male iRebs aCqarebul xasiaTs.
bioqimiuri maCveneblebidan yuradRebas ipyrobs bilirubin _ fermentuli dissociacia
_ bilirubinis Semcveloba matulobs (150 mkmol/l), xolo fermentebi (alat), klebulobs.
iklebs sulemis sinjis maCvenebelic, adgili aqvs proteolizis inhibitorebis daqveiTebas
(α1- proteazuli inhibitori, α2-makroglobulini da sxva). RviZlis mwvave distrofiis
dros sisxlSi HBSAg qreba maSin, rodesac imatebs anti-HBS, anti-HBc, anti- HBe rac
mZafri imunuri reaqciebis maCveneblad unda CaiTvalos. proTrombinis indeqsi 15%-ze
ufro metad qveiTdeba. aRniSnuli maCveneblebis dakleba cud prognozze metyvelebs.
mcire asakis bavSvebSi mwvave hepatodistrofia ganapirobebs maRal letalobas _ 90%
(mozrdilebTan SedarebiT 20-jer xSiria).
B hepatiti 85%-Si mimdinareobs mwvaved da umetes SemTxvevaSi intoqsikaciis
movlenebi, siyviTle qreba me-3, me-4 kviras, RviZlis sazRvrebi normalurs ubrundeba
me-6, me-8 kviras. calkeul SemTxvevebSi RviZlis funqciuri mdgomareoba normalizdeba
daavadebis me-3, me-4 kviras.
gaxangrZlivebuli mimdinareoba aReniSneba avadmyofTa 10%-s da 5-6 Tves grZeldeba.
qronikuli hepatitis sixSire ganisazRvreba 3-5%-iT, igi xSirad yalibdeba usiyviTlo
da subklinikuri mimdinareobisas da grZeldeba 6 Tvis Semdeg. amave dros xazgasasmelia,
rom qronikuli hepatitis dasadgenad erT-erT pirobas warmoadgens paTmorfologiuri
suraTi punqtatis Seswavlis Semdeg.
RviZlis qronikuli daavadebebis dros laboratoriuli

gamokvlevebi da maTi klinikuri mniSvneloba
maCvenebeli klinikuri interpretacia
koniugirebuli bilirubini hepatocitebis nekrozi, qolestazi

alat, asat hepatocitebis nekrozi
alat, asat N aqtiuri procesi ar aris an minimaluria
tf + qolesterini + γ-gtp qolestazi RviZlSida da RviZlgare sadinrebSi (pirveladi
biliaruli cirozi, meqanikuri siyviTle)
tf + γ-gtp qolestazi parenqimul dazianebasTan erTad (hepatiti,
+ qolesterini an N cirozi)
tf + qolesterini N RviZlis toqsikuri dazianeba
γ-gtp
proTr ombinis dr o hepatoceluluri ukmarisoba
albuminebi
gamaglobulinemia autoimunuri darRvevebi

Sratis mieri rkina RviZlis alkoholuri dazianeba, HCV, cirozi, hemaqromatozi
feritini (nekrozi hepatocitebSi)
B hepatiti wlamde asakis bavSvebSi xSirad iwyeba mwvaved, temperaturis 39-40°C-

mde momatebiT, prodromuli periodi, Cveulebriv, moklea (3-5 dRe). bavSvebs xSirad
aReniSnebaT uZlureba, Zilianoba, sakvebs ar Rebuloben, xSiria Rebineba (50%), wamoqafeba,
zogjer faRaraTi, araiSviaTia Sardis gamuqeba (rac erT-erT simptomad iTvleba).
adgili aqvs daavadebis simZimisa da siyviTlis Seusabamobas. bilirubinis done
162
kerZo nawili.
mozrdilebTan SedarebiT ufro naklebia. hepatosplenomegalia metadaa gamoxatuli,

xSiria hemoragiuli sindromi (gansakuTrebiT dRenakl bavSvebSi).
Tandayolili hepatiti. nayofis inficireba xdeba transplacenturad, amave dros
B hepatitis sixSire pirdapir damokidebulebaSia orsulobis mesame trimestrSi dedis
sisxlSi HBSAg-is koncentraciasTan. inficirebis riski didia mSobiarobis dros,
rodesac HBSAg-is da HBeAg-is koncentracia maRalia.
Tandayolili manifesturi B hepatitis dros adgili aqvs RviZlis dazianebis
simptomebs _ siyviTles, hemoragiul sindroms da a.S. aseve fermentebisa da bioqimiuri
maCveneblebis aqtivobis zrdas axalSobilebSi.
B hepatitis mwvave mimdinareobisas, siyviTle, intoqsikaciis movlenebi Cveulebriv,
3-4 kviris ganmavlobaSi qreba, RviZlis sazRvrebi ufro gvian me-6, me-8 kviraSi
normalizdeba. funqciuri mdgomareobis normalizeba aseve me-3 TvisaTvis xdeba.
gasaTvaliswinebelia, rom saerTo damamSvidebel subieqtur fonze adgili SeiZleba
hqondes fermentebis maRal aqtivobas.
stacionaridan rekonvalescentis pirveli sakontrolo Semowmeba xdeba gaweridan
15-30 dReSi. SemdgomSi, Tu subieqturi da obieqturi monacemebi damakmayofilebelia,
rekonvalescenti meTvalyureobis qveS gadaecema infeqciur kabinets (umjobesia iyos
stacionaris eqimis meTvalyureobis qveS 12 Tvis ganmavlobaSi).
qalebs rekomendacia eZlevaT, rom 1 wlis ganmavlobaSi Tavi Seikavon orsulobisagan.
diferenciuli diagnozi pirvel rigSi unda gatardes sxva virusul hepatitebTan;
Tumca klinikuri, epidemiologiuri da rutinuli laboratoriuli monacemebi saSualebas
iZleva, umetes SemTxvevebSi davadginoT ama Tu im virusuli hepatitis etiologiuri
mxare, magram diagnozis sabolood dadastureba markeruli kvlevis gareSe SeuZlebelia;
es ukanaskneli gvexmareba ara mxolod etiologiuri, aramed infeqciuri procesis
dinamikis Taviseburebebis gamovlinebaSi, rac mniSvnelovania swori mkurnalobis Catarebisa
da prognozisaTvis.
bavSvebSi, zogjer, saWiro xdeba mononukleozis gamoricxva. am
mozrdili asakis bavSvebSi
SemTxvevaSi, garda klinikuri simptomatikisa (angina, polilimfadenopaTia, hepatolienuri
sindromi, ati puri limfocitebi da sxva), mxedvelobaSia misaRebi ifa-s meTodiT
epStein-baris antigenis da mis mimarT antisxeulebis dadgenas.
iersini ozis dros yuradRebas i pyrobs ufro xangrZlivi temperaturuli reaqcia,
iersiniozis
gamonayris lokalizacia, periferiuli sisxlis mxriv leikocitozi neitrofiloziT
da, bolos, diagnozis dadasturebas xels uwyobs iersiniebis gamoyofa da antisxeulebis
dadgena sisxlis SratSi.
leptospirozi iwyeba uecrad maRali temperaturiT, saxis hi peremiiTa da
pastozurobiT, kunTebis, gansakuTrebiT, kanWis kunTebisa mkveTrad gamoxatuli tkiviliT.
xdeba Tirkmlebis dazianeba, sisxlSi leikocitozi neitrofiloziT, diagnozis dasmisas
gasaTvaliswinebelia epidemiuri winapiroba (kontaqti mRrRnelebTan, banaoba dagubebul
wyalsatevebSi da sxva), magram diagnozisaTvis gadamwyveti mniSvneloba aqvs
laboratoriul kvlevebs _ baqteriologiurs (sisxlSi leptospirebis aRmoCena pirdapiri
mikroskopiiT), mikroaglutinaciis reaqcias daavadebis meore kviridan da a.S.
sanaRvle gzebis atreziis dros siyviTle xSirad viTardeba sicocxlis pirvelsave
kviras; nawilobrivi atreziis dros _ me-3-4 kviras. daavadebisaTvis damaxasiaTebelia
siyviTlis progresuli mateba da kanis safarveli Rebulobs zafranis, xolo SemdgomSi
_ momwvano-WuWyis fers (bilirubinis biliverdinad gardaqmnis gamo), ganavali mudmivad
aqoliuria. RviZli TandaTan diddeba da mkvrivdeba, sisxlSi bilirubini xasiaTdeba
pirdapiri reaqciiT. daavadeba TandaTan progresirebs, terminalur stadiaSi Cndeba
hemoragiuli sindromi. operaciuli Carevis gareSe sicocxlis me-5-7 Tveze daavadeba
163
kerZo nawili.
yovelTvis letalobiT mTavrdeba.

siyviTlis sindromi SeiZleba ganviTardes bavSvebSi naRvlis Sededebisas,
gaxangrZlivebuli fiziologiuri an hemolizuri siyviTlis dros, agreTve gadidebuli
limfuri kvanZebiT an simsivniT saerTo sanaRvle gzebis daxSobis Sedegad.. hemolizuri
siyviTlis dros sisxlSi gvaqvs arapirdapiri bilirubini. meqanikuri siyviTlis
dadgenaSi gansakuTrebuli mniSvneloba aqvs ultrabgeriT da scintigrafiul gamokvlevebs,
agreTve kompiuterul tomografias.
RviZlis toqsikuri dazianebis dros didi mniSvneloba eniWeba anamnezs
(hepatotoqsikuri preparatebis _ aminazinis, meTiltestosteronis, paracetamolis,
tuberkulozis sawinaaRmdego preparatebisa da sxvaTa miRebas), am dros siyviTle
viTardeba gamoxatuli fermentemiis gareSe; gansakuTrebiT mniSvnelovania siyviTlis
gaqroba medikamentebis moxsnis Semdeg. RviZlis bioftatSi am dros aRiniSneba cximovani
hepatozis suraTi.
Tandayolili toqsoplazmozis, citomegaliis, listeriozis mier ganpirobebuli
siyviTlis dros umravles SemTxvevaSi bavSvebi hi potrofiulni, dRenaklni arian,
xSirad aReniSnebaT hepatolienuri sindromi. maRalinformaciul cnobebs iZleva
antisxeulebisa da antigenebis dadgena.
karotinuli siyviTle, Cveulebriv, gamowveulia stafilos, mandarinis, gogris da
sxva yviTeli xilisa da bostneulis xangrZlivi, gadaWarbebuli miRebiT. am dros
saerTo mdgomareoba damakmayofilebelia da sklerebis siyviTle ar aRiniSneba.
yvela saeWvo SemTxvevaSi saWiroa gatardes markeruli diagnostika.
mkurnaloba. B hepatitiT avadmyofebi, rogorc mwvave, aseve qronikuli formebis
mkurnaloba
gamwvavebis dros, eqvemdebarebian hospitalizacias stacionarebSi. am SemTxvevaSi
aucilebelia woliTi reJimisa da saTanado dietis dacva, romelic A hepatitis dros
rekomendebuli dietis analogiuria.
msubuqi da saSualo simZimiT mimdinareobisas avadmyofebs utardebaT e.w. bazisuri
Terapia (igivea, rac A hepatits dros).
gansakuTrebul yuradRebas moiTxoven mZime formiT daavadebulni. am SemTxvevaSi
aucilebel pirobas warmoadgens intensiuri Terapiis Catareba, glukozis 10%-iani
xsnaris, ringeris laqtatis, aminomJavebis an albuminis (SezRudulia encefalopaTiis
dros) gadasxma, pirvelsave dRes gantvirTvis dietis daniSvna (xilis da wvenebis
miReba). kortikosteroidebi rekomendebuli ar aris.
hepatitis avTvisebiani mimdinareobisas intensiuri, kompleqsuri Terapiis Catareba
unda daiwyos maSinve da gagrZeldes sanam Sewydeba daavadebis progresirebadi mimdinareoba,
Tumca xazgasasmelia, rom prognozi umetesad, uimedoa.
wlamde asakis bavSvebSi intensiuri Terapiis Catarebis mizniT saWiroa msxvili
venebis kaTeterizacia, vinaidan wvrili venebis venapunqcia TiTqmis SeuZlebelia.
dezintoqsikaciis mizniT avadmyofebs eniSnebaT ringeris laqtati, reopoliglukini,
sisxlis plazma, aminomJavebi (kreatininis klirensis gaTvaliswinebiT), 10%-iani glukozis
xsnari. dRe-RameSi saWiroa 100-150ml siTxe 1kg sxeulis masaze (siTxis Seyvana xdeba
4-6 saaTis intervaliT Tanabari raodenobiT dRe-Ramis ganmavlobSi).
acidozis dros iniSneba 4,5%-iani natriumis bikarbonatis an sxva tutovani
xsnari, alkalozis dros SehyavT askorbinis mJava, ukeTdebaT kuWis amorecxva da
gamwmendi, maRali oynebi 2%-iani sodis xsnariT, eZlevaT laqtuloza. mizanSewonilia,
rom mikrobuli metabolituri intoqsikaciis Sesamcireblad avadmyofebs daeniSnoT
farTo speqtris antibiotikebi (neomicini, cefalosporinebi, ampicilini da sxva).
aRniSnuli RonisZiebebis uefeqtobis SemTxvevaSi mizanSewonilia, rom avadmyofebs
dezintoqsikaciis mizniT CautardeT SenacvlebiTi sisxlis gadasxma (250-500 ml 1-2-
164
kerZo nawili.
jer dRe-RameSi), plazmaferezi, hemosorbcia, limfabsorbcia.

mwvave da qronikuli virusuli hepatitebis mkurnalobisas, rogorc msubuqi, aseve
saSualo da mZime mimdinareobis dros, Cvens klinikaSi miRebulia dadebiTi efeqti
lazegrinis gamoyenebisas. dadgenilia preparatis dezintoqsikaciuri efeqti, daavadebis
ukuganviTarebis daCqareba, dadebiTi imunologiuri Zvrebi (a. xoWava, m, xoWava, b.
eliaZe).
daavadebis Semsubuqebis aucilebel pirobad gvesaxeba lazegrinis daniSvna daavadebis
adreul etapze. es mniSvnelovania maSinac ki, roca daavadeba msubuqad mimdinareobs,
radgan cnobilia, rom B hepatitis msubuqi formis dros xSiria qronikuli hepatitis
Camoyalibeba.
rac Seexeba interferonTerapias bavSvTa asakSi, jerjerobiT damuSavebis procesSia
misi gamoyeneba. am mxriv, imedismomcemia intron A-s (rekombinirebuli α-2b interferoni)
gamoyeneba ribavirinTan erTad qronikuli hepatitiebis dros, bolo monacemebiT
interferoni gamnoiyeneba mwvave hepatitebis samkurnalodac.
profilaqtika. daavadebis iatrogenuli xasiaTis Tavidan acilebis mizniT didi
profilaqtika
mniSvneloba aqvs donorebis guldasmiT gamokvlevas HBV–ze maRali mgrZnobelobis
meTodiT (ifa, pjr da sxv.).
saWiroa, aikrZalos mgrZnobiare meTodebiT gamoukvleveli sisxlisa da misi
preparatebis gadasxma, Tu misi gamoyeneba sasicocxlo Cvenebas ar warmoadgens.
infeqciis yvelaze ufro arsebiT saprofilaqtiko saSualebas warmoadgens vaqcina,
romlis gamoyeneba sul ufro realuri xdeba praqtikaSi. acrebi pirvel rigSi unda
Cautardes riskis jgufSi Semaval pirebs (mesamedicino personali _laborantebi,
qirurgebi, sisxlis gadasxmis kabinetebsa da hemodializSi momuSaveebi da sxva).
B hepatitis virusiT SesaZlo inficirebis SemTxvevaSi rekomendebulia, Catardes
imunoprofilaqtika specifikuri imunoglobuliniT _ HBIG da vaqciniT (mag: Engerix-
B, Recombivax HB da sxv.).
aSS-is pediatriis akademiis infeqciur daavadebaTa komiteti gvTavazobs
imunoprofilaqtikis sqemebs.
hepatitis infeqciis imunoprofilaqtika kontaqtirebul pirebSi
kontaqtis tipi imunoprofilaqtikis saxe

kanis an lorwovanis mTlianobis SemTxveviTi
vaqcinacia + HBIG
darRveva manipulaciis Sesrulebisas
sayofacxovrebo kontaqti inficirebulTan an
vaqcinacia
qronikul mtarebelTan
kanze an lorwovanze inficirebuli sisxlis
moxvedra da sisxliT dabinZurebul sagnebTan vaqcinacia + HBIG
kontaqti
perinataluri inficireba vaqcinacia + HBIG
sqesobrivi kontaqti mwvave hepatitiT
vaqcinacia + HBIG
daavadebulTan
sqesobrivi kontaqti qronikul mtarebelTan vaqcinacia
P.S. HBIG - B hepatitis sawinaaRmdego imunoglobulini
165
kerZo nawili.
axalSobilTa profilaqtika, roca dedas HBSAg--ze

skriningi Catarebuli ar hqonda
vaqcinacia asaki
vaqcinis I doza dabadebidan 12 sT-Si
Tu deda aRmoCnda HBSAg(+), HBIG Seyvanili iqnas 0.5 ml rac
HBIG
SeiZleba adre, magram dabadabidan araugvianes 1 kviris Semdeg
vaqcinis II doza 1-2 Tve
6-18 Tve (Tu deda aRmoCnda HBSAg+, vaqcinacia gakeTdes ukve
vaqcinis III doza
6 Tvis asakSi)
B hepatitis sawinaaRmdegod vaqcinaciis saerTo princi pebi ixileT `saerTo nawilis~ -

princi
ìmunizaciaSi~
axalSobilTa profilaqtika perinataluri infeqciis dros
HBsAg d ad ebiTi d ed is agan d abad ebuli

as aki
axalSobilebi
vaqcinis I doza + HBIG dabadebidan 12 sT-Si
vaqcinis II doza 1-2 Tvis asakSi
vaqcinis III doza 6 Tvis asakSi
qvemoT mocemulia HBV-s markerebis peizaJi

infeqciuri procesis dros da acrilebSi
HBV-infeqciis ganviTarebis fazebi

HBV-s markerebi Stamebis replikacia acrilebSi
integraciis gamojanmrTelebis
`veluris~ `mutantebis~
I. Sratismieri
HBsAg + + + _ _
HBeAg + _ _ _ _
HBV dnm + + _ _ _
anti _ HBeIgM + + _ _ _
anti _ HBcIgG ± ± + + _
anti _ HBs _ _ _ + +
anti _ HBe _ + + ± _
II. qsovilovani
HBcAg + + _ _ _
HBsAg + + + _ _
HBV dnm + + _ _ _
166
kerZo nawili.
virusuli hepatitebi. virusuli hepatiti C
virusuli hepatiti C
(HEPATITIS C)
sinonimebi: arc A da arc B virusuli hepatiti parenteruli inficirebis meqanizmiT,

posttransfuziuli hepatiti.
1989w. M. Houghton-ma da Tanaavtorebma SesZles SeeqmnaT C virusis xelovnuri
rekombinantuli antigeni da amis safuZvelze SeemuSavebinaT C virusis antisxeulebiT
identifikaciis pirveli test-sistema ifa-s meTodiT.
etiologia.HHCV warmoadgens wvril viruss (30-50 nm) erTZafiani sigrZivi rnm-
etiologia.
iT.
C virusis genomis organizacia.
virusis genomi kodirebs struqturul da arastruqturul cilebs, romlebic

cirkulireben sisxlSi. maTi Sefardebebis variabeloba gansazRvravs sxvadasxva serotipis
arsebobas. HCV-s mniSvnelovan Taviseburebas warmoadgens misi genetikuri
araerTgvarovneba, rac ganpirobebulia nukleotidebis swrafi SenacvlebiT. C virusi
miekuTvneba Flaviviridae-s ojaxs; dRemde dadgenilia 30-mde sxvadasxva ti pi, magram
varaudoben, rom klinikuri praqtikisaTvis sakmarisia 5 subti pis gansazRvra _ 1a,
1b, 2a, 2b, 3a.
epidemiologia. infeqciis wyaros warmoadgens C virusiT inficirebuli adamiani
(rogorc mwvave, aseve qronikuli hepatitiT). dadgenilia, rom sxvadasxva qveyanaSi
adgili aqvs gansxvavebuli genoti pebis gavrcelebas. ase mag: iaponiasa da taivanSi,
nawilobriv CineTSi, upiratesad dgindeba genoti pi 1a, 2a, 2b; aSS-Si _ 1a, ruseTSi
_ 1a.
C virusiT inficirebis meqanizmi parenterulia, gadacemis gzebi mravalricxovani
_ xelovnuri da bunebrivi. am mxriv, C hepatiti, B da D hepatitebTan saerTo
167
kerZo nawili.
epidemiologiuri monacemebiT xasiaTdeba. amave dros adgili aqvs metnaklebad inficirebis

intensivobis sxvadasxva xarisxs. ase mag: B hepatitisagan gansxvavebiT sqesobrivi gziT
virusis gadacema naklebad xdeba; aqedan gamomdinare, gadacemis vertikaluri gza
(dedisagan nayofze) naklebi sixSiriT gvxvdeba. HCV pozitiuri SemTxvevebi
posttransfuziuli hepatitebis dros 60-90%-s aRwevs.
C hepatitis virusi gamoyofilia nerwyvidan, Sardidan. daavadebis gavrcelebis
kontrolireba Znelia virusis heterogenobis gamo. rogorc sxva flavivirusebs, HCV-
sac aqvs Tavisi `Wirveulobani~. antigenebis Secvla ar eqvemdebareba makroorganizmis
imunur sistemas, igi permanentulad icvlis antigenur struqturas, es ki, Tavis mxriv
ganapirobebs did siZneleebs vaqcinis SemuSavebaSi.
paTogenezi. C virusi hepatotropulia. misi replikacia xdeba hepatocitebsa da
sisxlis mononuklearebSi.
iTvleba, rom HCV HBV-sagan gansxvavebiT xasiaTdeba hepatocitebze pirdapiri
citopaTuri moqmedebiT, Tumca dabali imunogenoba xels ar uwyobs imunopaTologiuri
reaqciebis mkafio gamovlinebas. daavadebis dasawyisSi paTmorfologiuri cvlilebebi
mudmivi ar aris; cvlilebebs adgili SeiZleba hqondes adre, jer kidev antisxeulebis
gamoCenamde an saerTod ar aRiniSnebodes. SeiZleba cvlilebebi umniSvnelo iyos,
amitom gadamwyveti mniSvneloba aqvs hepatocitebSi HCV-s aRmoCenas (Sherlok Sh;
1993). amave dros alat-is aqtivoba ar gansazRvravs paTmorfologiuri suraTis
simZimes. RviZlis paThistologiuri cvlilebebi moicavs qronikuli persistuli da
qronikuli aqtiuri hepatitis suraTs.
klinika. inkubaciuri periodi meryeobs 2 kviridan 5 Tvemde, saSualod Seadgens 2
Tves. daavadeba xasiaTdeba mravalwliani torpiduli, latenturi mimdinareobiT,
gamwvavebebiT, mogvianebiT ki cirozis an pirveladi hepatoceluluri karcinomis
CamoyalibebiT.
daavadebis mravalwliani mimdinareoba SeiZleba daiyos 3 fazad _ mwvave, latenturi
da reaqtivaciis. umravles SemTxvevaSi mwvave fazis amocnoba gaZnelebulia, rac
aixsneba daavadebis msubuqi mimdinareobiT, damakmayofilebeli saerTo mdgomareobiT;
siyviTle gamoxatuli ar aris, an aRiniSneba sklerebis subiqteruloba, RviZli gadidebulia,
elenTa normis farglebSia. daavadebis dinamikaSi SeiZleba dadgindes alat-is momatebis
pikebi. mwvave hepatiti ufro xSirad dgindeba posttransfuzuli hepatitis
mimdinareobisas (10-30%-mde).
mwvave hepatitis gamovlinebisas avadmyofebi SeiZleba uCiodnen saerTo sisustes,
madis daqveiTebas, simZimis SegrZnebas marjvena ferdqveSa midamoSi. obieqturad kanis
siyviTle naklebadaa gamoxatuli, ufro vlindeba sklerebis subiqteruloba. aRiniSneba
alat-is pikebi, mudmiv momatebas naklebad aqvs adgili.
latentur fazas ar axasiaTebs raime gansakuTrebuli simptomebi. avadmyofebi
praqtikulad ar xvdebian eqimis meTvalyureobis qveS.
daavadebis mimdinareoba SeiZleba damTavrdes gamojanmrTelebiT _ virusis eliminaciiT.
saWiroa, xazi gaesvas im faqts, rom alat-is normalizacia ar mowmobs viremiis
damTavrebas.
fulminanturi formebi iSviaTia; is aRwerilia iaponiaSi, taivanSi, rac miuTiTebs
am regionebSi genoti pebis Taviseburebaze.
reaqtivaciis faza Seesabameba klinikurad daavadebis gamwvavebas, qronikuli hepa-
titis Camoyalibebas, cirozis, hepatokarcinomis ganviTarebas.
qronikuli mimdinareobis sixSire C hepatitis dros aRwevs 70-80%-s, cirozi
viTardeba 20-25%-Si, hepatoceluluri karcinoma _ 75%-Si; iaponiaSi, yofil ssrk-Si
19%-mde, Tumca bavSvebSi es maCvenebli mniSvnelovnad dabalia.
168
kerZo nawili.
HCV - s mimdinareobis fazebi. (Â.Ô. Ó÷àéêèí)
C hepatitiT avadmyofebSi aRwerilia iseTi RviZlgareSe movlenebi, rogoricaa

vaskulitebi, membranuli, proliferaciuli glomerulonefriti, kriogamaglobulinemia,
polimioziti, Segrenis sindromi, uveiti, keratiti da sxva.
diagnostika. aRsaniSnavia, rom ifas meTodiT SesaZlebelia sisxlSi mxolod C-
virusis sawinaaRmdego antisxeulebis gansazRvra. antigenebis raodenoba sisxlSi
imdenad mcirea, rom maTi gamovlineba am meTodiT praqtikulad SeuZlebelia (mxolod
RviZlis bioptatis imunohistoqimiuri gamokvleviT).
anti-HCV arseboba ar metyvelebs procesis simwvaveze da mxolod gvexmareba
anti-HCV speqtris dinamika mwvave C hepatitis dros.

anti-
(À.Þ. Àôàíàñüåâ, Í.Ì. Òðàâèíà)
101 102 101

78
76
30 21 79 68
102 101
23 68
30 23 21
17
8
1-2 kvira 3-4 kvira 5-6 kvira 6 kvira da meti
anti - HCV core IgM anti - HCV NS 4

anti - HCV core IgG
169
kerZo nawili. virusuli hepatiti C
virusuli hepatitebi. virusuli hepatiti D
daavadebis etiologiis dazustebaSi. es antisxeulebi, SesaZloa vnaxoT, rogorc

pastinfeqciis (ingl. past- gadatanili infeqciis), aseve mwvave da qronikuli C-
virusuli hepatitis drosac.
procesis daxasiaTebaSi SeiZleba dagvexmaros anti-HCV-speqtris. gansazRvra ifa-
Ti da imunoblotiT misi dadastureba. rogorc dadgenilia, speqtri daavadebis
simwvavesTan erTad icvleba, ris safuZvelzec xdeba diagnozis da prognozis dazusteba.
sqemidan gamomdinare Cans, rom anti-HCV core Ig M da G aRiniSneba ukve daavadebis
dasawyisSi. mogvianebiT izrdeba antisxeulebis G-klasis titri, xolo M klasis ki
mcirdeba. mkveTrad izrdeba anti-HCV NS4-is raodenoba daavadebis 6 kviris Tavze.
mTavar gadamwyvet mniSvnelobas aniWeben HCV rnm-is RviZlSi da sisxlSi gansazRvras
pjr-is meTodiT. igi òqros standartad~ iTvleba daavadebis sxvadasxva variantebis
da mimdinareobis diagnostikisaTvis.
diferenciuli diagnozi unda gatardes virusul hepatitebTan (ix. saTanado
Tavebi), autoimunur hepatitebTan, vinaidan ukanasknelT adgili aqvT C hepatitis
drosac da RviZlis sxva daavadebebTan.
sruli gamojanmrTeleba da virusisagan ganTavisufleba emyareba klinikur monacemebs,
magram im pirobiT, Tu organizmSi adgili ara aqvs virusis replikacias (pjr uaryofiTia).
mkurnaloba. gamwvavebis dros, zogjer saWiroa avadmyofis hospitalizacia da
iseTive Terapiuli RonisZiebebis Catareba, rogorc sxva hepatitebis dros,
interferoni gamoiyeneba qronikuli fprmebis dros (mag: rekombinantuli α–2b-
interferoni, limfoblasturi velferoni). interferons iyeneben kombinaciaSi ribavirinTan
da urodezoqsiqolis mJavasTan. mkurnalobis efeqti damokidebulia mTel rig faqtorebze
(asaki, daavadebis siaxle da sxv.).
profilaqtika igivea, rac sxva parenteruli hepatitebis dros.
vinaidan C virusi xasiaTdeba xSiri antigenuri cvalebadobiT, vaqcinis Seqmna 2003
wlamde (rogorc es aRiniSna falkis saerTaSoriso simpoziumze TbilisSi 1998)
iqneba gaZnelebuli.
hepatiti D
(DELTA _ infeqcia)
hepatiti D virusuli infeqciaa, romelsac axasiaTebs rogorc mwvave, aseve qronikuli

mimdinareoba. masze modis daavadebis yvelaze xSiri, fulminanturi formebi, rac
ganapirobebs letalobis maRal procents sxva virusul hepatitebTan SedarebiT.
etiologia. 1977w. M.Rizzetto-m qronikuli hepatitiT daavadebuli adamianis
biofsirebuli RviZlis hepatocitebis birTvSi aRmoaCina virusi. misi etiologiuri
specifikuroba dadgenilia Simpanzes dasnebovnebiT da RviZlSi HDV-s (hepatit D
virusi) dadasturebiT. msoflio jandacvis organizaciis winadadebiT, am virusiT
gamowveulma hepatitma miiRo D hepatitis saxelwodeba.
delta virusi zomiT 30-35 nm-ia. virusis struqtura Sedgeba genomisa (rnm) da
cilisagan (antigeni). HDV-s ara aqvs arc Sinagani, arc garegani garsi. genomi warmoadgens
wriul erTZafian rnm-s. virusi gamZlea temperaturis mimarT, ultraiisferi sxivi
viruss infeqciurobas ar ukargavs. arsebobs virusis 3 genoti pi _ I, II, III.
HDV-s umniSvnelovanes Taviseburebad iTvleba misi obligaturi damokidebuleba
damxmare virusis arsebobaze (Helper virus). am pirobebis arsebobis SemTxvevaSi
SesaZlebelia HDV-s replikacia. am mxriv damxmare virusis rols asrulebs HBV,
romlis garegan garsSi (HBSAg) CaeSeneba HDV.
170
kerZo nawili.
im SemTxvevaSi, roca erTdroulad xdeba organizmis dainficireba HDV da HBV

virusebiT, infeqcia cnobilia, rogorc ko-infeqcia. rodesac ukve HBV-Ti inficirebul
organizmSi garkveuli periodis Semdeg HDV SeiWreba, mas superinfeqcias uwodeben.
dadgenilia, agreTve, infeqciis mesame gzac, RviZlis transplantaciis Sedegad D
hepatitis ganviTareba. am SemTxvevaSi daavadeba mimdinareobs latenturad. am dros B
virusis markerebi nanaxi ar aris.
B hepatiti da D hepatiti TavianTi mravalferovani gadacemis meqanizmebiT xasiaTdebian
identurobiT, magram garkveuli gansxvavebac arsebobs, rac Semdgomi gamokvlevebis
SedegebSi unda veZeboT.
infeqciis wyaros warmoadgens avadmyofi, rogorc mwvave, ise qronikuli infeqciis
mimdinareobiT, magram ZiriTad wyarod iTvleba qronikuli hepatitiT daavadebuli,
vinaidan am dros organizmi virusis xangrZliv rezervuars warmoadgens, sadac xdeba
misi, rogorc biologiuri saxis SenarCuneba.
infeqciis gadacema, umetesad, xdeba inficirebuli sisxlisa da misi preparatebis
gadasxmis dros. SesaZlebelia inficirebis sayofacxovrebo-kontaqturi gzac ojaxur
kerebSi, bavSvTa mWidro koleqtivebSi (baRi, baga da sxva), mikrotravmaSi inficirebuli
sisxlis moxvedris Sedegad.
paTogenezi.. D hepatitis ZiriTad Taviseburebas warmoadgens miqst-infeqciis
paTogenezi
ganviTareba. xdeba ara erTi, aramed ori hepatotropuli virusiT _ HDV da HBV
infeqciis Camoyalibeba, hepatocitebSi xdeba orive virusis SeWra; amasTan, ueWvelia
pirveladi damxmare virusis (HBV) roli hepatitis genezSi, magram aris yvela
monacemi imis Sesaxeb, rom HDV-s wamyvani roli eniWeba daavadebis paTogenezis
ganviTarebaSi (M.Rizzetto; A.Ponsetto, 1995). eqsperimentuli monacemebi mowmoben,
agreTve, imas, rom D viruss SeuZlia, damoukideblad gamoiwvios hepatiti. HDV
hepatocitebze pirdapiri citopaTogenuri moqmedebiT xasiaTdeba B virusisagan
gansxvavebiT, romelic azianebs hepatocitebs arapirdapiri imunuri meqanizmebiT. amave
dros HDV drosac garkveuli roli hepatocitebis imunuri meqanizmebiT (Hepatitis
D) dazianebaSi eniWebaT.
B da D hepatitebis dros paTmorfologiuri cvlilebebi identuria. Tumca HD-s
dros RviZlis bioftatSi naxuloben hepatocitebis eozinofilur degeneracias
gamoxatuli anTebadi infiltraciis gareSe, rasac D hepatitis damaxasiaTebel suraTad
Tvlian. D hepatitis dros qronikuli daavadebis formireba ufro xSiria, vidre B
hepatitis dros.
rogorc ko-, ise superinfeqciis mimdinareobis variantebi xasiaTdebian nebismieri
klinikuri formiT _ inaparantuli, msubuqi, mZime gamovlinebiT. amave dros, superinfeqciis
dros xSirad SesaZlebelia umZimesi _ fulminanturi formis Camoyalibeba letaluri
gamosavliT.
klinika. Sereuli B da D infeqciis dros inkubaciuri periodi 1,5-dan 6 Tvemde
meryeobs. avadmyofTa sisxlSi virusi Cndeba 3-9 kviriT adre daavadebis ganviTarebamde
da SeiZleba aRmoCenili iyos qronikuli D infeqciis dros daavadebis mTel periodSi.
mwvave B+D hepatitis dros klinikuri suraTi, ZiriTadad, Seesabameba B hepatitis
gamovlinebas, magram zogjer mimdinareobiT A hepatitis suraTs mogvagonebs. Tumca
siyviTlis gamovlinebis Semdeg saerTo mdgomareoba ar umjobesdeba, intoqsikaciis
movlenebi matulobs da sxva.
superinfeqciis dros mwvave D hepatiti viTardeba qronikuli hepatitis fonze.
damaxasiaTebelia daavadebis ufro mZime mimdinareoba fulminanturi hepatitis
ganviTarebiT, letaluri gamosavliT. qronikuli hepatitis sixSire HBV/HDV
superinfeqciis dros 70-80%-s Seadgens, xSiria cirozis ganviTareba.
171
kerZo nawili.
diagnostika. aucilebelia virusebis HDV/HBV markerebis dinamikaSi gansazRvra

daavadebis mimdinareobis tipis dasazusteblad. AgD-s (antigen D anu HDAg) naxuloben
hepatocitebSi, xolo am virusisadmi specifikur G da M klasis imunoglobulinebs ki
_ sisxlis SratSi. koinfeqciis dros sisxlis SratSi gamovlindeba mwvave hepatitis
markerebi: HBSAg, HBeAg, HBV-s dnm, anti- HBCIgM) da delta virusis markerebi:
AgD, anti-D IgM. rekonvalescenciis dros qreba HBsAg, HBV-dnm, AgD, magram SesaZlo
xdeba anti- HBe, anti- HBS, anti-HBC IgG, anti-D IgG gamovlineba.
superinfeqciis dros D virusis replikaciis stadiaSi sisxlis SratSi zogjer
aRiniSneba AgD, anti-D IgM, B virusis markerebi: HBSAg, HBeAg. qronizaciis dros
ki aris anti- D IgM, IgG da amave dros HBSAg. HDV dnm-isa da rnm-is polimerazuli
jaWvuri reaqciiT sisxlisa da RviZlis bioftatis gamokvleva gvexmareba virusis
HBV/HDV koinfeqcia. specifikuri markerebi.

( Â.Ô. Ó÷àéêèí)
replikaciis intensivobis dadgenaSi.

mkurnaloba igivea, rac B hepatitis dros.
profilaqtika. HBV da HDV inficirebis parenteruli meqanizmis identurobis
gaTvaliswinebiT profilaqtikis RonisZiebebi erTidaigivea B hepatitis sawinaaRmdego
vaqcinaprofilaqtikis CaTvliT.
172
kerZo nawili. virusuli hepatiti D
virusuli hepatitebi. virusuli hepatiti E
HDV mimdinareobis variantebi specifikuri markerebis mixedviT.

virusuli hepatiti E
(HEPATITIS E)
E hepatiti enterovirusuli infeqciaa fekalur-oraluri gziT gadacemis meqanizmiT.

daavadeba, upiratesad, mimdinareobs msubuqi da saSualo simZimiT da keTilsaimedo
prognoziT; gamonakliss warmoadgenen orsuli qalebi, romlebSic xSiria infeqciis
fulminanturi forma letalobis maRali maCvenebliT.
ori aTeuli wlis win, virusis identifikaciamde klinikur-epidemiologiuri da
imunologiuri Taviseburebebis gaTvaliswinebiT dauSves arc A da arc B virusis
arseboba, romelsac axasiaTebda enteruli gziT dasnebovneba.
1990w. molekuluri hibridizaciis meTodiT SeZles, mieRoT virusspecifikuri
kloni, romelic msgavsi iyo aziis regionebSi avadmyofebis fekaliebidan gamoyofili
virusisa.
virusi Sedgeba rnm-isagan da ar gaaCnia garsi. misi klasifikacia sabolood
SemuSavebuli ar aris, magram igi arsebiTad gansxvavdeba HAV-isa da pikornavirusebis
173
kerZo nawili.
virusuli hepatitebi. virusuli hepatiti E
ojaxisagan.
arCeven E virusis 3 ZiriTad genoti ps _ meqsikurs da 2 aziurs. yvela genoti pi
miekuTvneba erT seroti ps, rac gansazRvravs maT Soris jvaredini serologiuri
reaqciis SesaZleblobas.
epidemiologia. infeqciis wyaroa mwvave formiT daavadebuli adamiani. infeqcia
gadaecema pirvel rigSi, wyliT. amasTan dakavSirebiT HEV-s (hepatit E virus) uwodeben
Water born hepatitis virus _ wylismieri hepatitis virusi, Tumca SesaZlebelia
alimenturi gziT dasnebovnebac.
daavadebis endemuri kerebia centraluri da samxreT azia, dasavleT da CrdiloeT
afrika da sxva ganviTarebadi qveynebi.
ganviTarebul qveynebSi (evropa, aSS da sxv) daavadebis SemTxvevebi ganpirobebulia
infeqciis “importuli” SemotaniT. daavadeba cnobilia, agreTve, `mogzaurebis” hepati-
tis saxelwodebiT.
paTogenezi da paTmorfologiuri suraTi. d a d g e n i l i a v i r u s i s
hepatotropuloba da misi pirdapiri citopaTuri moqmedeba hepatocitebze.
paTmorfologiuri suraTi identuria imisa, rasac adgili aqvs HA-s (hepatit A) dros
_ fokaluri da laqovani nekrozi. mZime, fulminanturi mimdinareobisas RviZlis
biofsiuri gamokvlevebi adgenen vrceli, xiduri nekrozebis arsebobas. daavadebis
gadatanis Semdeg gamomuSavdeba xangrZlivi, magram ara sicocxlis bolomde, imuniteti.
droTa ganmavlobaSi anti-HEV IgG titri ecema. zogjer es antisxeulebi ukve ar
aris daavadebis gadatanis Semdeg 10 weliwadSi.
klinika identuria A hepatitis mimdinareobisa, magram amave dros axasiaTebs
sakuTari simptomatikac. A hepatitisagan gansxvavebiT E hepatitis dros adgili aqvs
gamoxatul dispefsiur movlenebs, zogjer arTralgiasac; siyviTlis ganviTarebis
Semdeg avadmyofis subieqturi mdgomareoba ar umjobesdeba.
E hepatiti gansakuTrebul saSiSroebas warmoadgens orsulTaTvis, romlebSic
xSirad adgili aqvs fulminantur formebs, letaluri gamosavlis, mkvdradSobadobis,
abortebis maRal maCveneblebs.
diagnozis zusti dadgena SesaZloa daavadebis mwvave periodSi specifiuri anti
_HEV IgM-is da pjr-is meSveobiT, xolo rekonvalescenciis dros dadebiTi _ IgG-
is konstataciiT.
diagnozi.. ix. A da B hepatitebis diferenciuli diagnozi
diferenciuli diagnozi
mkurnaloba. avadmyofebis hospitalizacia naCvenebia saSualo da mZime formebis
dros.
mZime formebis dros, albaT, gamarTlebulia interferonTerapiis gamoyeneba, Tumca
es sakiTxi diskusias moiTxovs.
profilaqtika. mTavari amocanaa iseTi saerTo sanitarul-higienuri RonisZiebebis
ganxorcieleba, romlebic gamoricxaven wylis dabinZurebasa da alimenturi gziT
daavadebis gadacemas.
rekombinirebuli vaqciniT endemur regionebSi mosaxleobis vaqcinacia xels Seuwyobs
daavadebis mkveTr Semcirebas momavalSi.
174
kerZo nawili.
virusuli hepatitebi. arc A - E hepatitebi
arc A - E hepatitebi
(NON A - E HEPATITIS)
aRniSnuli dasaxeleba miuTiTebs, rom am diagnozis dasma SeiZleba A, B, C, D, E

hepatitebis gamoricxvis Semdeg, Tumca ifa-s meTodi yovelTvis ar gvaZvels saSualebas
zustad davadginoT virusuli hepatitis etiologia. diagnozis dazustebaSi didi
mniSvneloba eniWeba RviZlis bioftatis gamokvlevas polimerazuli jaWvuri reaqciisa
da sxva meTodebis gamoyenebiT.
sainteresoa is faqti, rom axali virusis aRmoCena SesaZlebeli gaxda Zveli
sisxlis masalaSi, kerZod qirurgis sisxlSi, romelmac 25 wlis win gadaitana virusuli
hepatiti (G..B.. _ qirurqis incialebia da axal viruss GB virusi uwodes). virusebis
klonirebis Sedegad aRweres 3 subpopulacia: GB-A, GB-B da GB-C. aRmoCnda, rom
pirveli 2 virusi iwvevs hepatits cxovelebSi, xolo GB-C ki _ adamianebSi. SemdgomSi
aRweres kidev 1 agenti (virusi G, anu HGV), romelic gamoyofili iyo qronikuli
hepatitiT Sepyrobili avadmyofisgan. aRmoCnda, rom SesaZlebelia inficireba HCV da
HGV, aseve HGV da GB-C virusebiT erTdroulad. orive GB-C da HGV virusi rnm-
is Semcvelia, maTi genuri struqtura uaxlovndeba HCV-s da Flavivirus-ebis sxva
virusebs. HGV da HCV virusis aminomJavebis 29% homologiuria (aqedan gamomdinare
igi HCV seroti ps ar warmoadgens); GBV--A da HGV-s _ 48%, xolo GBV-B da HGV-
s _ 28%.
HGV-is diagnozi ismeba pjr-iT sxvadasxva substratebis gamokvlevis Semdeg (sisxli,
organizmis siTxeebi da qsovilebi). am virusebis roli hepatocitebis dazianebaSi
sakamaToa. aRsaniSnavia, rom HGV-virusi hemofilikebSi 18%-Si, xolo narkomanebSi _
33%-Si gvxvdeba. misi rnm-i xSirad naxulia qronikuli HBV infeqciis (≈10%), qronikuli
HCV (≈20%), autoimunuri hepatitebis (≈10%), alkoholuri hepatitebis (≈10%)
dros.
cnobili gaxda, rom HGV ar unda replicirebdes RviZlSi. igi TiTqos ar iwvevs
mwvave da qronikuli RviZlis daavadebebs da mxolod maTi Tanamgzavria. amitom is ar
kvalificirdeba, rogorc RviZlismieri virusi, Tumca sxva avtorebi am azrs ar eTanxmebian
da Tvlian, rom izolirebuli HGV mimdinareobs daaxloebiT mwvave C hepatitis
simZimiT an ufro msubuqad. Serwymuli mimdinareoba imdenad xSiria, rom izolirebul
HGV-ze msjeloba rTulia.
zogierTi mkvlevaris azriT GB-C virusiT dainficirebulia mosaxleobis 1-1,5%
da igi Tan sdevs hepatitis fulminantur formebsac. zogjer HGV-sa da GB-C-s
ganixilaven, rogorc erTi da igive virusis izolatebs, radgan maTi nukleotidebis da
aminomJavebis msgavseba 95%-s aRwevs.
zemoT aRniSnuli virusebi gadaecema transmisiuli gziT.
axlaxan iaponeli avadmyofis ( TT)) sisxlisagan, romelmac gadaitana
posttransfuziuli hepatiti, gamoyves dnm-is 500 ZiriTadi fragmeti. varaudoben, rom
es aris hepatotropuli virusi TTV. igi aRmoCenil iqna posttransfuziuli hepati-
tis dros kidev ramodenime avadmyofSi.
bolo wlebSi literaturaSi gamoCnda informacia axali enteruli virusis Sesaxeb.
frangebma aRmoaCines 27-37 nm-is zomis virusis magvari nawilakebi. maimunebSi pjr-iT
dadginda misi dnm-i. virusma F dasaxeleba miiRo rogorc frangebis sapativcemulod
(French origin virus), aseve anbanis mixedviT. Tumca frang avtorTa meore jgufi am
virusis arsebobas uaryofs.
mwvave da qronikuli arc A-E hepatitebis dros aucilebelia gamoiricxos CMV,
EBV da parvovirus B19, romelic iwvevs erythema infectiozum-s.
175
kerZo nawili. rotavirusuli da sxva diareagenuli virusuli infeqciebi
rotavirusuli da sxva diareagenuli

virusuli infeqciebi
rotavirusuli daDsxva virusuli diareagenuli infeqciebi bavSvebSi yvelaze ufro

xSirad ganapirobeben letalur gamosavals (msoflioSi aRiniSneba yovelwliurad
letaluri 5-10 mln SemTxveva).
mokle istoriuli cnobebicnobebi.. diareis virusuli etiologiis gaSifrvaSi didi
wvlili miuZRviT avstriel mecnierebs _ R.F. Bishop-s da Tanaavtorebs (1973w),
romlebmac gastroenteritiT daavadebulTa 12-goja nawlavis biofsirebul masalaSi
eleqtronuli mikroskopiiT aRmoaCines virusi. 1974w. T. Flewett-ma da Tanaavtorebma
mogvawodes saxelwodeba “rotavirusi”, rac dakavSirebuli iyo virusis formis
borbalTan msgavsebasTan (rota _ borbali).
etiologia.. rotavirusebi miekuTvnebian rotavirusTa ojaxs. virusis zomaa 70-
etiologia
80nm, Seicavs orZafian rnm-s da aqvs ormagi garsi.
rotavirusebi iyofa jgufebad (A, B, C, D, E), qvejgufebad (I da II) da serotipebad.
jgufebad dayofa eyrdnoba vp6 cilebis Sida kafsulebis antigenur struqturas,
xolo seroti pebad _ garegani kafsidis vp7 glikoproteinebs.
A jgufis antigenuri struqtura gansxvavdeba sxva jgufebis antigenebisagan da
iwvevs daavadebas adamianebsa da cxovelebSi; B jgufi daavadebas iwvevs, mxolod
CineTSi, rogorc mozrdilebSi, aseve bavSvebSi. C jgufic ganapirobebs adamianebSi
epidemiur afeTqebebs. sxva jgufebi ki cxovelebSi iwveven diareuli daavadebis SezRudul
afeTqebebs.
antigenuri TvisebebiT rotavirusi iyofa 9 serologiur ti pad, romelTa Soris
adamianebSi gvxvdeba 1-4 da 8-9 ti pebi, me-5 da me-7 gamoiyofa cxovelebidan. cxovelTa
( ZaRli, kata, bocveri, Tagvebi, frinvelebi) rotavirusebi adamianTaTvis arapaTogenuria.
adamianTa rotavirusebi kultivirdebian mwvane maimunebis Tirkmlebis ujredebze.
virusuli diarea da gastroenteriti SeiZleba gamoiwvion sxvadasxva virusebmac:
1. Norwolk da maTi monaTesave virusebi.
2. Astroviruses (astrovirusebi).
3. Caliciviruses (kalicivirusebi).
4. sxva wvrili mrgvali virusebi (Wollan, Ditchling, Cocke), romelTa kultivireba,
jerjerobiT, SemuSavebuli ar aris.
astrovirusebiT gamowveuli gastroenteritebi, romlebic bavSvebSi viTardeba,
sixSiriT meore adgilzea. virusis diametria 30nm da mis centrSi aris 5 an 6
varskvlavisebri figura, Seicavs erTZafian rnm-s, kafsidi Sedgeba 3 sruqturuli
cilisagan.
virusi Norwolk anu Norwolk agentNgastroenteritebis xSiri mizezia mozrdil
bavSvebsa da ufrosebSi. virusis zomaa 27-35nm. gaaCnia erTaderTi struqturuli
cila da erTZafiani rnm. mWidro kavSirSia kalicivirusebTan.
kalicivirusebis saxelwodeba dakavSirebulia epidafeTqebebis adgilebTan _
Snow Mountain, Montgomery Coundy, Sapporo da a.S.
nawlavTa adenovirusebi gastroenteritebis yvelaze xSiri mizezia ZuZumwovar
bavSvebSi. daavadebas iwvevs 40-41 serotipi, respiraciuli simptomebis gareSe. virusebis
zoma Seadgens 80 nm-s; genomi Sedgeba erTZafiani dnm-sagan.
garda aRniSnuli virusebisa, diarea SeiZleba gamoiwvion koronavirusebma,
176
enterovirusebma da a.S. maT mier gamowveuli daavadebebi gamoirCevian xanmokle da

msubuqi mimdinareobiT. aseTi etiologiis diareaze eWvis mitana SeiZleba nawlavTa
baqteriebiT gamowveuli infeqciebis gamoricxvis Semdeg (Sigelozi, eSerixiozi,
kampilobaqteriozi da a.S.).
epidemiologia.. rotavirusuli infeqcia msoflioSi farTodaa gavrcelebuli.
epidemiologia
bevr ganviTarebad da ganviTarebul qveyanaSi 2 wlamde asakis bavSvebSi igi Seadgens
nawlavTa aSlilobis SemTxvevaTa TiTqmis naxevars. aSS-Si rotavirusuli infeqciiT
yovelwliurad avaddeba 1 mln-mde bavSvi, aqedan letaluri SemTxvevebi aRwevs 150.
bavSvebsa da mozrdilebSi daavadeba SeiZleba mimdinareobdes inaparantulad. yvelaze
xSirad avaddebian axalSobilebi da 6-dan 24 Tvis asakis bavSvebi.
infeqciis wyaros warmoadgens nebismieri klinikuri formiT daavadebuli adamiani.
virusis garemoSi gamoyofa xdeba ganavliT. daavadebis pirvel 8-9 dRes 1 g ganavalSi
virusis raodenoba Seadgens 1010-1011. virusis gamoyofa grZeldeba daavadebis 3 kviramde.
infeqciis gadacemis meqanizmi fekalur-oraluria. gadacemis yvelaze mniSvnelovani
faqtorebia wyali da sakvebi (rZis produqtebi).
gansakuTrebiT did saSiSroebas warmoadgens wylis rezervuarebis dainficireba,
rac iwvevs wylismieri afeTqebebis ganviTarebas epidemiebis saxiT. sayofacxovrebo-
kontaqturi gziT infeqciis gavrceleba ganapirobebs afeTqebebs ojaxis pirobebSi.
mosaxleobis mcire migraciis pirobebSi calkeul raionebsa da dasaxlebul punqtebSi
SesaZloa daavadebulebma 70%-s miaRwios. es imiTaa ganpirobebuli, rom mimRebloba am
virusis mimarT araimunur kontingentSi maRalia. infeqciis gadatanis Semdeg organizmSi
viTardeba imuniteti, romelic 7-9 Tves grZeldeba, amitom SesaZlebelia ganmeorebiTi
daavadeba. virusis mimRebloba ganpirobebulia aramarto humoruli imunitetiT, aramed
sekreciuli antisxeulebiTac.
ganviTarebad qveynebSi arabaqteriul gastroenteritTa 30%-s ukavSireben Norwolk-
viruss. kalicivirusebiT gamowveuli diarea bavSvebSi aRwevs SemTxvevaTa 0,2-0,6%-s.
garda klinikurad gamoxatuli formebisa, xSiria, agreTve, kalicivirusebis usimptomod
mimdinare daavadebaTa formebic.
ase, magaliTad, hiustonSi 4-dan 11 Tvis asakis bavSvTa 23%-s aRmoaCnda antisxeulebi
am virusis mimarT. astrovirusebTan dakavSirebulia 8%-mde gastroenteritebisa da
2%-mde diareuli daavadebebis SemTxvevebi gastroenteritis gareSe. am virusebis
mimarT antisxeulebi dadgenili iyo 4 wlamde bavSvebSi 64% SemTxvevaSi, xolo 10
wlamde bavSvebSi _ 87%-Si.
40 da 41 ti pis nawlavTa adenovirusebi SedarebiT iSviaTad iwveven gastroenterits
(2,6%).
sxva wvrili virusebi da koronavirusebi arasakmarisadaa Seswavlili. aRwerilia
rotavirusebiT da sxva CamoTvlili virusebiT gamowveuli nozokomialuri infeqciebi.
paTogenezi.. diareagenuli virusebi seleqciurad iwveven wvrili nawlavebis zemo
paTogenezi
nawilis enterocitebis epiTeliumis dazianebas. inficirebidan 30 wuTis Semdeg iwyeba
virusis SeWra upiratesad funqciurad momwifebul apikalur ujredebSi. 24-72 saaTis
ganmavlobaSi xdeba maTi maqsimaluri dazianeba distrofiuli da desqvamaciuri
movlenebiT.
Tormetgoja nawlavis biofsiuri masalis monacemebi mowmoben, rom diareagenuli
virusebiT dazianebisas adgili aqvs sxvadasxva xarisxis process da infiltracias
lamina propria-Si. paTologiuri gamovlinebani ar korelireben klinikuri simptomebis
simZimesTan da cvlilebebi qreba klinikur gamojansaRebamde.
rogorc cnobilia, momwifebuli enterocitebi asruleben saWmlis monelebis funqcias
(disaqaridebis hidrolizi), aseve absorbciul funqcias (glukozisa da damxmare
177
aminomJavebis meSveobiT wylisa da eleqtrolitebis transporti).

enterocitebis kri ptebi aradiferencirebuli ujredebia, romlebic ganicdian
kedlismieri, gamwmendi, hidrolizuri fermentebis ukmarisobas. hidrolizuri fermentebi
ki warmoadgenen wylisa da eleqtrolitebis sekretul qsels. virusuli infeqcia
iwvevs xaoebis dazianebas (villus type cells), romelic ganapirobebs: 1)absorbciisa da
wylis sekreciis disbalanss ujredSi; 2) karbohidratebis kompleqsis gansakuTrebiT
ki laqtozis malabsorbcias. dazianebis Sedegad adgili aqvs arahidrolizebuli
disaqaridebisa da Seuwovi martivi saqaridebis dagrovebas wvrili nawlavis sanaTurSi,
saidanac maTi mzardi raodenoba msxvil nawlavSi xvdeba. es ki iwvevs wylis mozidvas
da misi Sewovis SezRudvas. Seuwoveli naxSirwylebis daSla nawlavTa baqteriebiT
ganapirobebs organuli marilebis Seqmnas, rac kidev ufro aZlierebs nawlavTa SigTavsis
hi perosmolarobas. yovelive es ganapirobebs diareuli sindromis ganviTarebas, ris
gamoc organizmSi viTardeba sxvadasxva xarisxis gauwyloeba. SesaZlebelia mZime
cvlilebebi sxvadasxva organoebis mxrivac, magram isini ar gamoirCevian mkacri
specifikurobiT.
xazgasasmelia,, rom termini `gastroenteriti” ar asaxavs procesis srul arss
xazgasasmelia
kuWSi, Tumca Norwolk infeqciis dros adgili aqvs SigTavsis ramdenadme dayovnebas.
klinika.. rotavirusuli infeqcia iwyeba 1-5 dRiani inkubaciis periodis Semdeg
klinika
mwvaved an mZafrad temperaturis momatebiT 37,5-38°C-mde (ufro iSviaTad 39°C-mde),
RebinebiT da Semdgomi wylisebri FfaRaraTiT. dasawyisSi Rebineba produqciulia da
Seicavs saWmlis minarevebs, Semdeg xdeba wyliseburi da Seicavs lorwos mcuravi
fifqebis saxiT. Rebineba, umetesad, daavadebis pirvel dReebSi wydeba. xangrZlivad
qveiTdeba mada da avadmyofs aqvs gulisrevis SegrZneba. temperatura normalizacias
ganicdis meore dResve, faRaraTi grZeldeba 5-7 dRe, ganavali sisxls (eriTrocitebs)
da leikocitebs ar Seicavs. igi uxvia, wylisebri, moyviTalo an momwvano ferisaa,
qafiania da aqvs mkveTri suni, zogjer ganavali mRvrie TeTri ferisaa da mogvagonebs
qoleris ganavals. mozrdili bavSvebi zogjer epigastriumisa da Wi pis midamoSi
uCivian tkivils. SesaZloa movliTi xasiaTis Zlieri muclis tkivili, damaxasiaTebelia
defekaciis imperatiuli
survili, romelic uecrad
warmoiSoba da Tan sdevs
xmauriani yuryuri da airis
xmauriani gamoSveba Sxefiani
ganavliT. defekaciis Semdeg
avadmyofebi Svebas grZnoben.
defekaciis cru survili
damaxasiaTebeli ar aris.
mcire asakis bavSvebSi
swrafad viTardeba da
progresirebs gauwyloebis
niSnebi (75-85%-Si). Cvil,
kvebadaqveiTebul, imunode-
ficitis mqone bavSvebSi
daavadeba Rebulobs mZime da
gaxangrZlivebul mimdinareobas,
rotavirusuli infeqcia. mZime dehidrotacia. kanis naoWi
swordeba Zalian nela zogjer faRaraTi grZeldeba
(sakuTari masala) 10-15 dRe da metic. daavadebis
mZime formebis dros SeiZleba
178
ganviTardes krunCxvebi, gonebis dabindva, gul-sisxlZarRvTa mwvave ukmarisoba.

rotavirusiT inficirebul axalSobilebSi daavadeba, upiratesad, usimptomod mimdinareobs,
magram infeqciis zogierTi afeTqebis dros SeiZleba aRiniSnos nekrozuli enterokolitis
suraTi, rasac ukavSireben axalSobilTa ganyofilebaSi axali Stamis gaCenas.
avadmyofebs aReniSnebaT rbili sasis, naqis, nuSurebis rkalebis nawilobrivi hiperemia
odnavi SeSupebiT. RviZli da elenTa gadidebuli ar aris.
daavadebis dasawyisSi periferiul sisxlSi SeiZleba iyos umniSvnelo leikocitozi
neitrofiloziT, Semdgomi neitropeniiT, limfocitoziT, eds Secvlili ar aris.
astrovirusuli infeqciis klinikuri gamovlineba Znelad gansxvavdeba
rotavirusuli infeqciisagan. daavadeba ramdenadme keTilmimdinarea, naklebadaa gamoxatuli
dehidratacia.
adenovirusuli infeqcia iwvevs ufro xangrZliv diareas 10-14 dRe.
Norwolk _ virusul infeqcias aqvs xanmokle inkubaciuri periodi da klinikur
suraTSi dominirebs Rebineba da gulisreva, xangrZlivoba ar aRemateba 1-3 dRes.
klinika mogvagonebs S. aureus-iT da Bacillus cereus-iT ganpirobebul e.w. `kvebiT
mowamvlas”.
diagnozi.. virusis aRmoCenas daavadebis 1-5 dRes awarmoeben eleqtronuli
diagnozi
mikroskopiiT, imunofermentuli analiziT, arapirdapiri hemaglutinaciiT, lateqs-
aglutinaciiT, Semxvedri imunoeleqtroforeziT, koaglutinaciiT.
praqtikuli mniSvneloba aqvs imunofermentul analizs, romlis mgrZnobeloba da
specifikuroba aRwevs 90%-s. A-jgufis rotavirusebisaTvis ufro detaluri gamokvleva
xdeba jaWvuri polimerizaciis reaqciiT.
diferenciuli diagnozi unda gatardes im daavadebebTan, romelTaTvisac
damaxasiaTebelia diarea; pirvel rigSi, unda gamoiricxos Sigelozi, eSerixiozi,
salmonelozi, qolera da a.S.
mkurnaloba. mTavari amocanaa, rom daavadebis mimdinareobisas Tavidan aviciloT
dehidrataciis gaRrmaveba.
mkurnalobis dros antibiotikebi ar unda gamoviyenoT maTi uefeqtobis gamo.
imunokomprometirebuli avadmyofebisaTvis per os imunoglobulinebis SesaZlo
gamoyeneba dResdReobiT sadiskusioa da jer kidev eqsperimentul xasiaTs atarebs.
179
kerZo nawili. tki pismier
pismierii encefaliti
encefaliti
tki pismier
pismierii encefali ti
encefaliti
(ENCEPHALITIS IXODICA, ENCEPHALITIS ACARINA)
sinonimebi: taigis encefaliti, rusuli encefaliti, aRmosavleTis encefaliti,

sinonimebi
Sua evropis encefaliti, gazafxul-zafxulis encefaliti, tkipismieri encefalomieliti
da sxva.
tki pismieri encefaliti (Encephalitis acarina) warmoadgens bunebriv-kerovan,
transmisiul arbovirusul infeqcias, romelic mimdinareobs centraluri nervuli
sistemis upiratesi dazianebiT da vlindeba zogadtvinovani, meningealuri da kerovani
simptomatikiT.
cnobebi. 1936-40ww. dawvrilebiT iqna aRwerili daavadebis
klinika rusi mecnierebis mier (À\Ã\ Ïàíîâ, À\Ê\ Øàïîâàë= Ì\Á\ Êðîëü= È\Ñ\ Ãëàçóíîâ).
1937w. aRmoCenil iqna daavadebis gamomwvevi virusi (Ë\À\ Çèëüáåð= Å\Í\ Ëåâêîâè÷=
À\Ê\ Øóáëàäçå= Ì\ Ï\ ×óìàêîâ= Â\Ä\ Ñîëîâüåâ= À\Ä\ Øåáàëäàåâà).
etiologia. virusi miekuTvneba Flaviviridae-s ojaxs, Flavivirus-is gvars; igi
etiologia
sferuli formisaa, 25-50nm diametris, misi Sinagani komponenti _ nukleokafsidi
Semofarglulia lipoproteiduli kafsuliT, romelSic Caflulia glikoproteidisagan
Semdgari wvetebi da romelsac gaaCnia hemaglutinaciis unari. nukleokafsidi Seicavs
rnm-s. virusis kultivireba xdeba qaTmis embrionze da sxvadasxva qsovilovan kulturaze.
laboratoriuli cxovelebidan virusis mimarT yvelaze ufro mgrZnobiareni arian
TeTri Tagvebi, zazunebi da sxva.
garemoSi virusi iCens mdgradobas temperaturul meryeobaze –150-dan +30°C-mde.
optimalur temperaturad iTvleba –60°C da qveviT. oTaxis temperaturaze xdeba misi
swrafi inaqtivacia, duRili klavs 2 sT-Si, cxel rZeSi 60°C-ze iRupeba 20 wT-Si.
Zlier mgrZnobiarea Cveulebrivi sadezinfeqcio xsnarebis da ultraiisferi sxivebis
mimarT. tki pismieri encefalitis virusis antigenuri Tvisebebi gansxvavdebian sxva
arbovirusebisagan, rac gamoiyeneba daavadebis serologiuri diagnostikisaTvis.
epidemiologia. daavadebas axasiaTebs gamoxatuli bunebrivi kerebi da
epidemiologia
gavrcelebulia wynari okeanis regionebidan dawyebuli aRmosavleT da dasavleT
evropis qveynebSi, aziis qveynebis CaTvliT. daavadeba gvxvdeba aramarto ruseTSi,
aramed Cvens mezobel qveynebSic mag., azerbaijanSi.
virusis rezervuarad da gadamcemad iTvlebian tki pebi Ixodes persulcatus _,
romlebic umTavresad binadroben ruseTis aRmosavleT raionebSi da Ixodes ricinus
_ ruseTis dasavleT regionebSi da evropis rig qveynebSi.
arCeven daavadebis kerebis sam ti ps: pirveladi _ bunebrivi kerebi velur pirobebSi,
meoradi _ gardamavali kerebi, ganpirobebuli biocenozis komponentebis SecvliT,
dakavSirebuli adamianis sameurneo saqmesTan da anTropurguli (meoradi kerebi)
adamianis sacxovrebel teritoriasTan axlos, sadac tki pebis gamosakvebad mRrRnelebis
garda gvevlinebian Sinauri cxovelebi.
inficirebul tki pebSi virusi rCeba mudmivad da transovariulad gadaecema maT
Semdgom modgmas.
inficirebis ZiriTad gzad iTvleba transmisiuli gza. daavadebis gadacema xdeba
tkipis kbenis dros nerwyviT an misi gaWyletisa da kanSi Sezelvis Sedegad. SesaZlebelia,
agreTve, alimenturi gziT gadacema inficirebuli Txis, Zroxis umi rZis miRebis
Sedegad da, bolos, haer-wveTovani gziTac, rasac SesaZloa adgili hqondes laboratoriul
180
encefaliti
pirobebSi gaTvaliswinebuli pirobebis darRvevis SemTxvevaSi.

daavadeba gvxvdeba yvela asakSi, maT Soris axalSoblebSic. daavadebis 60-80%
modis pirebze, romlebic tyis samuSaoebTan uSualod ar arian dakavSirebuli, magram
uxdebaT tyeSi yofna (mag.: seirnobis dros da a.S.).
daavadebas axasiaTebs gamokveTili sezonuroba gazafxul-zafxulis periodSi, rac
dakavSirebulia am periodSi tki pebis gansakuTrebul aqtiurobasTan.
paTogenezi. pirveladi lokalizaciis adgilze virusis replikaciis Semdeg
paTogenezi
limfuri da hematogenuri gziT xdeba misi gavrceleba limfur kvanZebSi, Sinagan
organoebsa da centralur nervul sistemaSi.
alimenturi inficirebis dros dasawyisSi adgili aqvs paTogenezis viscerul
fazas virusemiiT, Sinagan organoebSi replikaciiT, xolo SemdgomSi ki meorad virusemias
centraluri nervuli sistemis dazianebiT (ortalRiani meningoencefaliti).
aRniSnuli virusuli infeqciis dros SesaZlebelia, ganviTardes virusmtarebloba
sxvadasxva gamovlinebiTa da SedegebiT: latenturi infeqcia (am SemTxvevaSi SesaZlebelia
virusis integracia organizmis ujredSi an defeqturi formiT arseboba), persistuli
infeqcia (adgili aqvs virusis replikacias, magram klinikuri gamovlineba ar xdeba),
qronikuli infeqcia (adgili aqvs virusis replikaciasa da klinikur gamovlinebas
recidiuli, progresirebadi an regresirebadi mimdinarobiT), neli infeqcia (virusis
reproduqcia xdeba xangrZlivi inkubaciuri periodis Semdeg, procesis ganuxreli
progresirebiTa da letaluri gamosavliT).
yvelaze ufro gamoxatuli cvlilebebi aRiniSneba nervuli sistemis mxriv, Tumca
tki pismieri encefalitis dros mniSvnelovnad ziandeba yvela organo da qsovili
(Tirkmelzeda jirkvlebi, elenTa, gul-sisxlZarRvTa sistema da a.S.)
morfologiurad daavadeba xasiaTdeba mwvave anTebiTi movlenebiT, sisxlZarRvTa
upiratesi dazianebiT. Tavis tvinis qerqSi naxuloben hemoragiebs, eriTro- da
leikostazebs, didi raodenobiT perivaskulur infiltratebs, perivaskulur da
pericelulur SeSupebebs. paTologiur procesSi CarTulia Tavisa da zurgis tvinis
ruxi nivTiereba, gansakuTrebiT, zurgis tvinis motoneironebi da mogrZo tvini. adgili
aqvs Sua tvinis, Talamusisa da hi poTalamusis midamoebis dazianebas. periferiul
nervul sistemaSi viTardeba intersticiuli nevritis suraTi. kanonzomierad ziandeba
tvinis rbili garsebi. morfologiurad gamoxatulia meningoencefalitis suraTi.
procesis mwvave mimdinareobis dros adgili aqvs dazianebis nel reparacias da
mdgradi imunitetis formirebas. imunuri statusis darRveva ki ganapirobebs mdgradi
Seuqcevadi parezebisa da damblebis ganviTarebas virusis xangrZlivi persistenciis
gamo. am SemTxvevaSi SesaZlebelia virusis gamoyofa tvinis qsovilidan da Tav-
zurgtvinis siTxidan, magram es arc ise xSirad xdeba. siTxeSi zogjer naxuloben
antisxeulebs.
kl inika. tki pismieri encefalitiT daavadebis SemTxvevaTa 20-40% bavSvTa asakze,
inika
klinika
maT Soris axalSobilebze modis. unda aRiniSnos, rom ZiriTadi klinikuri suraTi
mozrdilTa klinikuri suraTis identuria.
inkubaciuri periodi transmisiuli inficirebisas 3-dan 60 dRemde meryeobs, saSualod
ki 7-15 dRes Seadgens.
arCeven daavadebis klinikuri mimdinareobis sam _ cxelebis, meningealursa da
kerovan anu paralizur formas.
cxelebis formas xSirad waSlil formasac uwodeben da endemur kerebSi SemTxvevaTa
40-50%-Si gvxvdeba. am formis wamyvan simptomad iTvleba temperatura da iwyeba
prodromis gareSe, temperaturis uecari momatebiT 38-39°C-mde. amave dros saxezea
intoqsikaciis movlenebi. avadmyofebi uCivian Tavis Zlier tkivils, Semcivnebas an
181
encefaliti
sicxis SegrZnebas, gulisrevas, Rebinebas, Zilis darRvevas. pirveli dReebidanve aRiniSneba

saxis hi peremia, romelic xSirad tanzec vrceldeba, sklerebis sisxlZarRvTa inicireba,
sinaTlis SiSi. zogadi fsiqomotoruli agzneba iSviaTia, avadmyofebi ufro metad
SeboWilni arian. xSiria krunCxviTi sindromi. ena xSirad Selesilia TeTri nadebiT,
pulsi Seesabameba temperaturas. temperatura iklebs me-8-10 dRes, SesaZloa, gagrZeldes
2 kvira da metic. SemTxvevaTa 40%-Si aRiniSneba ortalRiani temperaturuli mrudi
(Ñ\È\ Äàâèäåíêîâ= À\À\ Ñìîðîäèíöåâ). am formas ufro xSirad adgili aqvs rZiT
inficirebisas; gvxvdeba ojaxur-jgufuri SemTxvevebi. inkubaciuri periodi ar aRemateba
4-7 dRes. upiratesad avaddebian bavSvebi. es forma registrirdeba belorusiis calkeul
raionebSi, sankt-peterburgis olqSi, udmurtiaSi, norvegiaSi, fineTSi, SveciaSi, CexeTSi,
slovakiaSi. pirveli temperaturuli talRa grZeldeba 2-dan 10 dRemde, meore _ 7
dRemde, iSviaTad aRiniSneba erTfaziani temperatura 5-10 dRis xangrZlivobiT. pirveli
temperaturuli talRis dros vlindeba zogadtoqsikuri sindromi da zogad-tvinovani
niSnebi, meore talRis dros ki temperatura xanmoklea da gamojanmrTeleba mimdinareobs
raime narCeni movlenebis gareSe.
saerTod, cxelebiTi forma Zalian iSviaTad Rebulobs qronikul (progredientul)
mimdinareobas da prognozulad ufro metad kargi gamosavliT xasiaTdeba.
meningealuri forma Seadgens daavadebis 20-40%-s da xasiaTdeba meningealuri
sindromiT zogadi intoqsikaciis fonze, amave dros, aRiniSneba umniSvnelod gamoxatuli
gafantuli nevrologiuli simptomatika. Tav-zurgtvinis siTxis mxriv cvlilebebi
pirvel dReebSi xasiaTdeba neitrofiluri citoziT, kviris bolosaTvis ki limfocitur
xasiaTs iRebs. citozis raodenoba meryeobs 30-dan 600 ujredamde 1 mkl-Si, cilis
Semcveloba ki 1-2 g/l-s aRwevs. aRniSnul cvlilebebs SeiZleba adgili hqondes
maSinac ki, roca meningealuri movlenebi ar aris saxeze. 40% SemTxvevaSi klinikuri
gamojansaRebis Semdegac adgili aqvs asTenias.
nervuli sistemis kerovani cvlilebebi viTardeba meningealuri formis fonze da
vlindeba daavadebis 1-4 dRes erTtalRiani da 1-3 dRes ortalRiani mimdinarobis
dros.
encefalituri forma viTardeba daavadebis meore-mesame dRes meningealuri
movlenebis fonze da difuzur an kerovan xasiaTs atarebs. difuzuri encefalitis
dros aRiniSneba gonebis dakargva (msubuqi Seferxebidan Rrma soporamde da komamde).
mwvave periodSi avadmyofTa nawils aReniSneba bodvebi, halucinaciebi, fsiqomotoruli
agzneba, orientaciis dakargva drosa da sivrceSi. pirvel dReebSi aRiniSneba moZraobiTi
darRvevebi nawilobrivi da generalizebuli, erTeuli an mravaljeradi epileptiformuli
SetevebiT, xSirad viTardeba saxisa da kidurebis fibrilaciuri tokva, xelebis tremori,
refleqsebis daTrgunva, kunTTa tonusis daqveiTeba.
kerovani encefalitis klinikuri gamovlineba xasiaTdeba centraluri nervuli
sistemis gansazRvruli ubnis dazianebiT. tki pismieri encefalitis dros gansakuTrebiT
damaxasiaTebelia mogrZo tvinis qveda nawilebis dazianeba, procesSi IX,X,XIda XII
wyvili nervebis birTvebis CarTviTa da bulburi darRvevebis simptomatikiT (afonia,
ylapvis darRveva, rbili sasis dambla, hi persalivacia) sunTqvis ritmis Semdgomi
darRveva da gul-sisxlZarRvTa tonusis daqveiTeba. kerovani dazianebis gamovlinebas
warmoadgenen hi perkinezebi, romelic ganpirobebulia erT-erTi naxevarsferos TeTri
nivTierebis gaRizianebiT masSi nawiburis ganviTarebis gamo. hiperkinezebi ufro xSirad
mosalodnelia mwvave periodis CaTavebisas da lokaluri jgufis klonuri krunCxvis
xasiaTs atarebs.
po
poll i omiel itur
omielitur
iturii sindromi . tki pismieri encefalitis dros ufro
damaxasiaTebelia zurgis tvinis wina rqebis, kisrisa da gulmkerdis zeda nawilebis
182
encefaliti
arCeviTi dazianeba da warmodgenilia myesTa da periostaluri refleqsebis darRveviT

an mTliani gamovardniT, adre dawyebuli da mkveTrad gamoxatuli kunTTa atrofiiT.
poliradikulonevrituli forma xasiaTdeba spinuri nervuli fesvebis tkivilebiT.
avadmyofebs aReniSnebaT mtkivneuloba nervebis gaswvriv, paraparezebi (WianWvelis
xoxvis, Cxvletis SegrZneba), poliomielitis ti pis darRvevebi kidurebis distalur
nawilebSi. tkipismieri encefaliti, rogorc sxva neiroinfeqciebi, SeiZleba mimdinareobdes
aRmavali spinuri, landris ti pis dambliT. am SemTxvevaSi rbili dambla SeiZleba
daiwyos qvemo kidurebidan da gavrceldes xelebisa da sxeulis kunTebze. dambla
SeiZleba daiwyos mxris sartyelis kunTebidan, CaiTrios kisris kunTebis, mogrZo
tvinis birTvebis kaudaluri jgufi.
tki pismieri encefaliti xasiaTdeba ti puri da ati puri mimdinareobiT. ti purs
miekuTvneba nervuli sistemis dazianebiT mimdinare yvela SemTxveva, ati purs _ waSlili
da subklinikuri forma, agreTve _ elviseburi, romelic SeiZleba letaluri gamosavliT
damTavredes 1-2 dReSi, ZiriTadi niSnebis klinikur gamovlinebamde. letaluri gamosavali
ganpirobebulia sisxlZarRvTa da sunTqvis centrebis dambliT an Zlieri zogadi
toqsikoziT, romelic mimdinareobs tvinis SeSupebiTa da gajirjvebiT.
keTilsaimedo gamosavlis SemTxvevaSi zogadi mdgomareobis gaumjobeseba xdeba
TandaTanobiT. temperatura klebulobs da normas ubrundeba, centraluri nervuli
sistemis mxriv darRvevebi qreba. daavadebam SeiZleba miiRos xangrZlivi, TandaTan
progresuli mimdinareoba centraluri nervuli sistemis mxriv simptomebis gaZlierebiT
an axali kerebis gaCeniT, mdgradi lokaluri hi perkinezebiT, koJevnikovis ti pis
epileptiformuli SetevebiT. SesaZlebelia, agreTve, ganviTardes mdgradi fsiqikuri
darRvevebi, damblebi, kontraqturebi, deformaciebi da sxva.
diagnozi da difer enciul
diferenciul
enciuli diagnozi. tki pismieri encefalitis diagnozi eyrdnoba
i diagnozi
klinikur suraTs (mwvave dawyeba, zogadi intoqsikaciis fonze adre dawyebuli Tavis
tvinis difuzuri an kerovani dazianeba, rbili damblebi, hi perkinezebi da sxva),
epidemiologiur monacemebs (avadmyofis yofna endemur kerebSi, gazafxul-zafxulis
sezonis, tki pis nakbenis dadgena kanze) da specifikur laboratoriul monacemebs.
virusologiuri gamokvlevebi iTvaliswineben virusis dadgenas sisxlis, Tav-
zurgtvinis siTxis da, letalobis SemTxvevaSi, Tavis tvinis masalis SetaniT qsovilovan
kulturebze (qaTmis fibroblastebi) da axalSobili TeTri Tagvebis tvinze.
serologiuri meTodebidan gamoiyeneba IgM antisxeulebis gamovlena ifas meTodiT.
diferenciuli diagnozi tardeba, pirvel rigSi, virusul encefalitebTan, meningokokur
da tuberkulozur meningitebTan, poliomielitTan, laim-boreliozTan da sxva.
prognozi keTilsaimedoa meningealuri da cxelebiTi formis dros, xolo
meningoencefalituri, poliomielituri, poliradikulonevrituli formis dros
seriozulia. mZime SemTxvevebis dros letaloba 25-30%-s aRwevs.
rekonvalescentebs xangrZlivad (1-2 weli, zogjer mTeli sicocxle) aReniSnebaT
centraluri nervuli sistemis mxriv gamoxatuli darRvevebi (krunCxviTi sindromi,
kunTTa atrofia, demenciis niSnebi da sxva.).
mkurnaloba. miuxedavad daavadebis simZimisa, maT Soris, msubuqi formis CaTvliT,
mkurnaloba
daavadebis mwvave periodSi aucilebelia woliTi reJimis dacva zogadi intoqsikaciis
moxsnamde. moZraobis SezRudva, damzogveli transportireba TiTqmis nulamde amcirebs
tkivilis SegrZnebas da garkveulad aumjobesebs daavadebis prognozs.
etiotropul
etiotropul
otropuli i mkurnaloba iTvaliswinebs tki pismieri encefalitis virusis
sawinaaRmdego adamianis imunoglobulinis (damzadebuli adgilobrivi macxovrebeli
donorebis sisxlidan) daniSvnas. preparati iwvevs mkafio efeqts, gansakuTrebiT saSualo
da mZime mimdinareobis dros, daavadebis adreul periodSi. adamianis imunoglobulini,
183
encefaliti
titriT aranakleb 1:80 eniSnebaT kunTebSi, doziT 0,1-0,2 ml/kg sxeulis masaze dRe-
RameSi 2-3 dRis ganmavlobaSi. Terapiuli efeqti aRiniSneba ukve 12-24 saaTis Semdeg
da gamoixateba temperaturis normamde daqveiTebiT, umjobesdeba zogadi mdgomareoba
_ Tavis tkivili da meningealuri movlenebi mcirdeba, zogjer ki mTlianad qreba.
specifikur mkurnalobaSi gamoiyeneba, agreTve, ribonukleaza (rnm-aza) _ fermentuli
preparati (2,5-3 mg/kg dRe-RameSi kunTebSi, miRebuli msxvili rqosani cxovelebis
kuWqveSa jirkvlisagan), romelsac unari aqvs, gadalaxos hematoencefaluri barieri
da nervul ujredebSi SeaCeros virusis gamravleba. gamoiyeneba, agreTve, interferonis
preparatebi (reoferoni, leikinferoni da sxva).
erTdroulad tardeba mkurnaloba dezintoqsikaciuri da dehidrataciuli
preparatebiT. sunTqvis darRvevis SemTxvevaSi avadmyofi gadahyavT xelovnur sunTqvaze
barokameraSi.
rekonvalescenciis periodSi gamoiyeneba masaJi, fizioTerapiuli procedurebi.
profilaqtika. tki pismieri encefalitis endemur kerebSi, gansakuTrebiT saSiS
profilaqtika
adgilebSi tardeba RonisZiebebi tki pebis mosaspobad inseqticidebis saSualebiT. tkipis
mokidebisas, saswrafod, profilaqtikis mizniT eniSnebaT tki pismieri encefalitis
sawinaaRmdego imunoglobulini kunTebSi 1,5ml 12 wlamde, 2ml 12-dan 16 wlamde da 3
ml 16 wlisa da meti asakis bavSvebs.
Tu aRiniSneba tki pis mokideba sxeulze, xorcieldeba pasiuri imunizacia adamianis
imunoglobuliniT ara ugvianes 4 dRisa. agreTve, endemur regionebSi unda aikrZalos
Zroxisa da Txis rZis miReba.
aqtiuri imunizaciis mizniT gamoiyeneba inaqtivirebuli vaqcina, romelic keTdeba
samjeradad da Semdeg revaqcinacia 6-12 Tvis Semdeg. pirveli ori acra 14-30 dRis
intervaliT, mesame ki 3 Tvis Semdeg da araugvianes 2 kvirisa keraSi Casvlamde.
individualur RonisZiebebSi Sedis repelentebis (perme thrin) xmareba, Catanebuli
grZeli Sarvlisa da grZelsaxeloebiani zeda tansacmlis xmareba tyeSi gasvlis
dros.
184
kerZo nawili.
hemoragiuli cxelebebi.
hemoragiuli cxelebebi
(FEBRES HAEMORRHAGICA)
hemoragiuli cxelebis cnebaSi igulisxmeba bunebriv-kerovani virusuli infeqciebis

jgufi, romelTa paTogenezSi wamyvan rols TamaSobs sisxlZarRvTa dazianeba, klinikur
suraTSi ki mwvave cxelebisa da intoqsikaciis fonze mimdinare Trombohemoragiuli
sindromi.
infeqciis rezervuarad iTvleba ZuZumwovari cxovelebi, ZiriTadad, mRrRnelebi,
adamianze infeqciis gadacemis xasiaTis mixedviT iyofa transmisiul ( gadaecema
tki pis, koRos meSveobiT) da kontagiozur infeqciebad (Ì\Ï\ ×óìàêîâ 1977)\
dReisaTvis aRwerilia hemoragiuli cxelebis 12 damoukidebeli nozologiuri
forma adamianSi: yviTeli cxeleba, denges cxeleba, hemoragiuli cxeleba Tirkmlis
sindromiT, omskis hemoragiuli cxeleba, kiasanuris cxeleba, yirim-kongos hemoragiuli
cxeleba, lasas cxeleba, marburgis cxeleba, ebolas cxeleba, argentinis hemoragiuli
cxeleba, boliviuri hemoragiuli cxeleba, Rift Valley-cxeleba.
hemoragiuli cxelebebi gadacemis

mixedviT iyofa Semdegnairad:
gadacemis meqanizmi daavadeba virusi
yirim-kongos cxeleba Congo - virus

tkipismieri kiasanuris tyis cxeleba kiasanuris tyis daavadebis
omskis cxeleba virusi omskis virusi
denges hemoragiuli Dengue denges virusi (4tipi)-
cxeleba Rift-Valley is Rift-Valley-s cxelebis
moskitebis mieri
cxeleba yviTeli virusi yviTeli cxelebis
cxeleba virusi
argentinis cxeleba;
Junin-virusi
boliviuri cxeleba;
inficirebuli cxoveliT Machupo-virusi
lasas cxeleba;
an masaliT Lassa-virusi
marburgis cxeleba;
ganpirobebuli Marburg-virusi
ebolas cxeleba;
gadamdebloba Ebola-virusi
hemoragiuli cxeleba
Hantaan-virusi
Tirkmlis sindromi;
185
kerZo nawili.
hemoragiuli cxelebebi. hemoragiuli cxeleba Tirkmlis sindromiT
hemoragiuli cxeleba
Tirkmlis sindromiT
sinonimebi: hemoragiuli nefrozonefriti, epidemiuri nefrozonefriti, Soreuli

aRmosavleTis cxeleba, koreis hemoragiuli cxeleba, skandinaviis hemoragiuli cxeleba
da sxva.
etiologia. 1976 w. samxreTkoreeli mecnieris H.W. Lee da P. Lee-is mier
mRrRnelis Apodemus argarius coreae-s filtvebidan gamoyofil iqna virusi
Hantaan, romlis saxelic mdinare xantaanTan aris dakavSirebuli. igive avtorebma
1978w. analogiuri virusi gamoyves avadmyofi adamianidan. SemdgomSi msgavsi virusi
gamoyofil iqna fili pinebze, aSS-Si, ruseTSi da sxva qveynebSi.
Tirkmlis sindromiT mimdinare hemoragiuli cxelebis virusi miekuTvneba
buniavirusebis (Bunyaviridae) ojaxs da gamoyofilia calke gvarad, romelic moicavs
Hantaan (koreis hemoragiuli cxeleba _ mZime daavadebaa) da Puumala (epidemiuri
nefrozonefriti _ SedarebiT keTilTvisebiani mimdinareobis) virusebs da or viruss
_ Prospect Hill da Tchoupitoulast, romlebic adamianisaTvis paTogenuri ar arian.
xantaan-virusi cirkulirebs Soreuli aRmosavleTis, ruseTis, samxreT koreis, CineTis,
iaponiis bunebriv kerebSi. infeqciis ZiriTad rezervuarad iTvleba mindvris Tagvi.
meore virusi _ evropuli ( dasavleTis) puumala-virusi aRmoCenilia fili pinebze,
SveciaSi, ruseTSi, safrangeTSi, bulgareTSi.
xantaan da puumala sferuli, rnm-is Semcveli virusebia, romelTa diametri 80-110
nm-s Seadgens. maTi inaqtivacia xdeba 50°C temperaturis pirobebSi 30 wT-is ganmavlobaSi,
xolo 0-4°C temperaturaze igi 12 saaTis ganmavlobaSi rCeba stabiluri.
epidemi
epidemio logia.. hemoragiuli cxeleba Tirkmlis sindromiT (hcTs) ti puri
ologia
zoonozuri daavadebaa. infeqciis rezervuaria memindvria, tyis Tagvebi, virTagva da
sxva Tagvisebri mRrRnelebi. mRrRnelTa Soris infeqciis gadacema xdeba tki pebis,
rwyilebis mier, romlebSic adgili aqvs latentur virusmtareblobas. virusis gamoyofa,
Cveulebriv, xdeba ganavliT da SardiT. adamianze infeqciis gadacema SesaZlebelia
bunebriv da laboratoriul pirobebSi, umTavresad ki xorcieldeba haer-wveTovani
gziT dabinZurebul masalasTan muSaobisas (ganavliT da SardiT dabinZurebuli fiCxi,
Cala, Tiva), agreTve SesaZloa dazianebul kanze ( macerirebuli da gafxaWnili)
infeqciis moxvedrisas. SesaZlebelia inficireba alimenturi gziTac (inficirebuli
puri, xili da a.S.), gadacemis transmisiuli gza, romelic uwin wamyvan meqanizmad
iTvleboda, dReisaTvis sadaoa. infeqcia avadmyofi adamianidan janmrTelze ar gadadis.
7 wlamde asakis bavSvebi iSviaTad avaddebian bunebasTan SedarebiT SezRuduli
kontaqtis gamo. daavadeba umTavresad sporadul xasiaTs atarebs, magram SesaZlebelia
afeTqebebic mWidro koleqtivebSi (baga, sanatoriumi, banaki da sxva), romelTa
dawesebulebebi tyesTan axlos aris ganlagebuli. ufro xSirad avaddebian axalgazrda
mamakacebi.
infeqciis sezonuroba gamoxatulia zafxul-Semodgomaze ( maisi-noemberi). Soreul
aRmosavleTSi daavadeba xasiaTdeba ortalRiani mimdinareobiT _ mais-ivnissa da,
gansakuTrebiT, oqtomber-noemberSi, rac ganpirobebulia mRrRnelebis migraciiT adamianTa
dasaxlebul adgilebSi da sameurneo nagebobebSi. am dros xSiria adamianis kontaqti
tyesTan, soflis meurneobis obieqtebTan da sxva.
imuniteti daavadebis gadatanis Semdeg sakmaod mdgradia. daavadebis ganmeorebiTi
SemTxvevebi iSviaTia.
paTogenezi. kanidan da lorwovani garsebidan virusis SeWrisa da makrofaguli
sistemis ujredebSi misi replikaciis Semdeg viTardeba virusemiis faza, rac ganapirobebs
186
kerZo nawili.
daavadebis klinikur gamovlinebas organizmis zogadi intoqsikaciis simptomatikiT.

daavadebis paTogenezSi mTavar rols TamaSobs arteriolebisa da venulebis dazianeba,
rac gamowveulia, rogorc uSualod virusis moqmedebiT, aseve hialuronidazas aqtivobiT,
sisxlZarRvTa kedlis ZiriTadi nivTierebebis depolarizaciiT, histaminisa da
histaminismagvari nivTierebebis, kalikrein-kininuri kompleqsis moqmedebiT. viTardeba
hcTs-Tvis paTognomuri plazmorea mosazRvre qsovilebis irgvliv, sisxlis Sededeba.
sisxlis Semdedebel sistemaSi Trombohemoragiuli ti pis cvlilebebi mZime SemTxvevebSi
sisxlZarRvTaSida diseminirebuli sindromis xasiaTs Rebulobs. iSemiuri kerebis
ganviTareba ki iwvevs qsovilovani elementebis masiur destruqcias da cilovani
struqturebis Seqmnas, romlebsac autoantigenis Tviseba gaaCnia da mniSvnelovani
adgili ukavia kapilarotoqsikozis ganviTarebaSi. aRniSnuli cvlilebebi yvelaze
metad TirkmlebSia gamoxatuli. maTi zomebi mkveTradaa gadidebuli, kafsula daWimulia,
zogjer mravalricxovani sisxlCaqcevebiT. qerqovani Sre ganakveTze moyviTalo-
monacrisfro ferisaa, adgili aqvs sisxlCaqcevebs da nekrozebs. tvinovan nivTierebaSi
SeimCneva serozul-hemoragiuli sisxlCaqcevebi.
mikroskopulad TirkmlebSi adgili aqvs sisxlCaqcevebs, sisxlZarRvTa kedlebis
kerovan SeSupebiT-destruqciul cvlilebebs, saSarde milakebis destruqcias, Suamdebare
qsovilebis SeSupebas, maTi sanaTuri avsebulia hialinuri da marcvlovani cilindrebiT,
SemaerTebeli milakebi miWyletilia. maTi sanaTuri daxurulia, epiTeliumi gadagvarebuli
da desqvamirebulia. aRniSnuli paTologiuri cvlilebebis Sedegad mcirdeba
glomeruluri filtracia, irRveva milakebis reabsorbcia, rac ganapirobebs oligurias,
masiur proteinurias, azotemias, eleqtrolitebis balansis darRvevasa da mJava-tutovani
wonasworobis acidozur gadaxras. sxva organoebis mxriv aRiniSneba farTod
gavrcelebuli distrofiuli movlenebi hi pofizis, Tirkmelzeda jirkvlebis da
vegetatiuri gangliebis ujredTa mxriv.
daavadebis gadatanis Semdeg viTardeba mdgradi imuniteti.
klinika. inkubaciuri periodis xangrZlivoba 7-dan 46 dRemde meryeobs, saSualod
3-4 kviras Seadgens.
daavadebisaTvis damaxasiaTebelia mkafiod gamoxatuli cikluri mimdinareoba. amasTan
dakavSirebiT gamoyofen 4 stadias: 1. dawyebiT anu cxelebis, 2. oliguriul, 3. poliuriul
da 4. rekonvalescenciis stadiebs.
daavadeba iwyeba mwvaved, temperaturis momatebiT 39-40°C-mde, zogjer SemcivnebiT,
organizmis zogadi intoqsikaciiT, (gulisreva, Rebineba, Zilis darRveva, dauZlureba,
daTrgunva, anoreqsia). pirveli dRidanve avadmyofebi aRniSnaven Tavis Zlier tkivils,
upiratesad Sublisa da safeTqlis areSi. Tvalis kaklis mtkivneulobas moZraobis
dros, gansakuTrebiT aRniSnaven mtkivneulobas muxlis saxsrebSi. damaxasiaTebelia
muclis Zlieri tkivilebi, tkivilebi welis areSi, daavadebis meore-mesame dRes
klinikuri simptomebi maqsimums aRwevs, bavSvis zogadi mdgomareoba mZimea an Zlier
mZime, temperatura rCeba maRali. aRiniSneba enis, xelis TiTebis tremori, SesaZloa
halucinaciebi, bodvebi, krunCxvebi. mozrdili bavSvebi xSirad uCivian Tvalwin nisls,
TvalSi Savi wertilebis SegrZnebas, mxedvelobis daqveiTebas, sagnebis xedvas wiTel
ferSi. obieqturad aRiniSneba sklerebisa da koniunqtivis sisxlZarRvTa inicireba,
saxis, kisris, gulmkerdis zemo nawilis hiperemia (kapiuSonis simptomi), saxis pastozuroba,
xaxis hi peremia da mtkivneuloba, enanTema rbil sasaze, peteqiebi gulmkerdze, iRliis
qveS. SesaZloa, ganviTardes sisxldena cxviridan, saSvilosnodan, nawlavebidan,
gansakuTrebiT ineqciis adgilebSi. pulsi dasawyisSi aCqarebulia, Semdeg xdeba
bradikardiuli. gulis tonebi moyruebulia, mwvervalze ismis sistoluri Suili.
arteriuli wneva daqveiTebulia, zogjer viTardeba kerovani miokarditi. muclis
187
kerZo nawili.
palpaciis dros SeimCneva mtkivneuloba, Cveulebriv, muclis zemo naxevarSi, zogjer ki

aRiniSneba muclis faris gaRizianeba, RviZli gadidebulia 50%-Si, elenTa ki _ iSviaTad.
xSirad adgili aqvs yabzobas, SesaZlebelia gamoixatos faRaraTic sisxlis SemcvelobiT.
oliguriis periodi bavSvebSi daavadebis mesame-meoTxe dRes, ufro iSviaTad _
me-6-8 dRes iwyeba. am dros tkivilebi welis areSi Zlierdeba da zogjer analgetikebis
daniSvnas saWiroebs. diurezi mcirdeba, temperatura SeiZleba daqveiTdes da gaxdes
normaluri an subfebriluri, magram zogadi mdgomareoba ufro mZimdeba. Tumca calkeul
avadmyofebs temperatura SeiZleba isev aewioT subfebrilur cifrebamde (ortalRiani
temperatura). ufro metic, am stadiaze SeiZleba ganviTardes mZime, Tirkmlis ukmarisobis
sindromi. erTdroulad an cota mogvianebiT viTardeba xSiri Rebineba, romelic araa
dakavSirebuli medikamentis an sakvebis miRebasTan, mdgomareoba ufro mZimdeba. Zlierdeba
sisxlCaqcevebi sklerebSi, hemoragiuli gamonayari quTuToebsa da kanis sxvadasxva
nawilebze. gamoixateba wyurvili, Cndeba mtanjveli slokini. muclisa da welis areSi
Zlieri tkivilebis gamo avadmyofi mousvenaria, cdilobs, miiRos nakleb mtkivneuli
poza. tkivilebi imdenad damaxasiaTebelia hcTs-is dros, rom misi ararseboba daavadebis
pirvel 5 dRes diagnostikur eWvs badebs. mxedvelobaSi unda viqonioT, rom pasternackis
simptomis dasadgenad saWiroa damzogavi biZgiseburi dartymebi welis areSi Tirkmlebis
SesaZlo gaskdomis Tavidan acilebis mizniT. aseve mniSvnelovania hospitalizaciisas
avadmyofis damzogavi transportireba (sakaceze leibis dageba, unda aRikveTos
transportis uxeSad marTva). oliguriis periodSi adgili aqvs gamoxatul izostenurias.
xvedriTi simkvrive meryeobs 1001-dan 1006-mde. matulobs cilis raodenoba. Sardis
saerTo analizSi vlindeba hematuria, hialinuri, fibrinuli cilindrebi, Tirkmlis
epiTeliumis mrgvali vakuolizebuli ujredebi. daavadebis am stadiaSi periferiuli
sisxlis mxriv dawyebiTi periodisagan gansxvavebiT, sadac cvlilebebi umniSvneloa
(leikopenia an normocitozi), kanonzomierad gamoixateba neitrofiluri leikocitozi,
plazmuri ujredebis momateba, Trombocitopenia, eds momateba, sisxldenis Sedegad
viTardeba anemia.
poliuriuli stadia daaxloebiT daavadebis me-7-12 dRes iwyeba. pirvel rigSi,
wydeba Rebineba, tkivilebi muclisa da welis areSi klebulobs da Semdeg qreba,
umjobesdeba Zili, mada, Sardis raodenoba aRwevs 3-5-6 litrs dRe-RameSi, magram
mdgradi hi poizostenuria jer kidev didxans rCeba. xangrZlivad rCeba, agreTve, zogadi
sisuste, piris Rrus simSrale.
garda daavadebis aRwerili ciklurobisa hcTs-is dros adgili SeiZleba hqondes
calkeuli sistemebis da organoebis dazianebas, rac diagnozis dasmas arTulebs.
iSviaT variantad iTvleba meningoencefalitismagvari forma, roca daavadebis me-3-4
dRes viTardeba soporozul-komaturi mdgomareoba. aRniSnuli movlenebi dakavSirebulia
tvinis gajirjvebas da SeSupebasTan, romelic, Cveulebriv, mosdevs uremiul intoqsikacias
da mravalricxovan sisxlCaqcevebs tvinsa da tvinis garsebSi. swored aseTi SemTxvevebi
gamoirCevian gansakuTrebiT mZime mimdinareobiT da yovelTvis cud prognozs ganapirobeben.
garda aRniSnuli formebisa gvxvdeba, agreTve, hcTs-s waSlili da subklinikuri
mimdinareoba.
waSlili formebi, Cveulebriv, xasiaTdeba umniSvnelo intoqsikaciiT. am dros
sklerebi sustadaa inicirebuli, pasternackis simptomi odnavaa gamoxatuli. hemoragiuli
sindromi ar aRiniSneba, diurezi ar aris mniSvnelovnad darRveuli, narCeni azoti
normis farglebSia.
diagnozis dasmisas didi mniSvneloba eniWeba epidemiologiur anamnezs, daavadebis
dinamikas.
msubuqi formebis dros temperatura ar aRemateba 38-38,5°C, hemoragiuli movlenebi
188
kerZo nawili.
sustadaa gamoxatuli, oliguria zomieria, narCeni azoti normis farglebSia, aRiniSneba

leikopenia an normocitozi.
saSualo simZimiT mimdinare hcTs xasiaTdeba zomieri intoqsikaciiT ( Tavis tkivili,
Rebineba, sklerebis umniSvnelo hi peremia, peteqiuri gamonayari, ineqciis adgilebSi
hematomebi). oliguria aRwevs 300-900ml dReRameSi narCeni azoti _ 0,9g/l-ze meti
ar aris, Sardovana 19 mmol/l, kreatinini 300mkmol/l. sisxlSi _ zomieri leikocitozi
14X109/l-mde.
mZime formebis dros avadmyofebs aReniSnebaT Tavis Zlieri tkivili, xSiri Rebineba,
temperatura 39,5°C-mde, hemoragiuli sindromi mkveTradaa gamoxatuli (farTo
subskleruli hematomebi, hemoragiuli gamonayari, sixldena cxviridan), oliguria Sardis
raodenobis SemcirebiT, 300ml-ze naklebi dRe-RameSi, narCeni azoti aRemateba 0,9
g/l-ze, Sardovana _ 19 mmol/l-ze da kreatinini 300 mkmol/l-ze metia. sisxlSi
aRiniSneba maRali leikocitozi ( 20-30.109/l).
Zlier mZime formis dros anuria viTardeba 2-4 dReSi, cxeleba mkveTradaa gamoxatuli,
aRiniSneba sisxlCaqcevebi Sinagan organoebSi (masiuri sisxldena, sisxlCaqcevebi
Tirkmelzeda jirkvlebSi, hi pofizSi), sopori, Soki, koma da sxva.
mimdinareoba. hcTs yovelTvis mwvaved mimdinareobs. msubuqi da saSualo simZimiT
mimdinareobis dros prognozi yovelTvis keTilsaimedoa, maSin, rodesac mZime formebis
dros SesaZlebelia letaluri gamosavali, romelic ganpirobebulia sisxlCaqcevebiT
Sinagani sekreciis organoebSi, filtvebis hemoragiuli SeSupebiT, gul-sisxlZarRvTa
mwvave ukmarisobiT, uremiiT da sxva.
aRsaniSnavia, rom Soreul aRmosavleTSi letaloba Seadgens saSualod 6-8%-s,
ruseTis evropul regionebSi ki 3,5%-s ar aRemateba.
diagnozi.. hcTs-is diagnostika umTavresad eyrdnoba klinikur suraTs cikluri
diagnozi
stadiebis gaTvaliswinebiT, saxis, kisris, gulmkerdis hi peremias, kapiuSonis sindroms,
hemoragiul gamonayars, Tirkmlebis dazianebis simptomatikas, sisxlSi leikocitozs
marcxniv gadaxriT, plazmuri ujredebis momatebiT, anamnezSi _ avadmyofTa endemur
zonaSi yofnas, sezonurobis dadgenas. diagnozis dadastureba SeiZleba antisxeulebis
IgM klasis gansazRvriT imunofermentuli analiziT an 4-jeradi titris gazrdiT
imunuri adhezia-hemaglutinaciis reaqciaSi. gamoiyeneba agreTve, komplementSemboWavi
neitralizaciis reaqcia da imunomafluorescirebeli antisxeulebis testebi, pjr.
mkurnaloba avadmyofis hospitalizacia xdeba stacionarSi maqsimalurad damzogavi
transportirebiT. oliguriis periodSi saWiroa mkacri woliTi reJimi, naxevradTxieri
da advilad asaTvisebeli produqtebi, marilis SezRudvis gareSe. mZime mimdinareobis
dros droebiT izRudeba cila, kaliumis Semcveli produqtebi (qiSmiSi, atami, qliavi,
gargaris Ciri da sxv.). saWiroebisas tardeba antiSokuri Terapia, hemodializi Tirkmlis
ukmarisobis dros, dehidratacia, cilisa da eleqtrolitebis koreqcia. hemoragiuli
sindromis mkurnaloba yovelTvis individualurad wydeba. xSirad ixmareba sisxlisa
da Trombocituli masis gadasxma, kloting-faqtorebis gamoyeneba. steroidebi iseve,
rogorc presoruli aminebi da α–adrenoblokatorebi ar iZleva efeqts.,sedacia unda
xdebodes didi sifrTxiliT, Tirkmlis da RviZlis dazianebis xarisxis gaTvaliswinebiT.
etiotropuli mkurnaloba jerjerobiT ar aris srulad SemuSavebuli. magram
aris monacemebi, romlebic mowmoben dadebiT Sedegebs virussawinaaRmdego preparatebis
gamoyenebis dros dadebiT rezultatebze. ribavirini eZlevaT intravenurad. igi pirvel
4 dReSi efeqturia Tirkmlis disfunqciis dros, amcirebs sisxlZarRvTa dazianebasa
da sikvdilianobas.
Catarebuli mkurnalobis araefeqturobisa da zogadi mdgomareobis gauaresebis
SemTxvevaSi _ Tirkmlebis mwvave ukmarisobis dros, roca Sardovana aRemateba 30
189
kerZo nawili. hemoragiuli cxeleba Tirkmlis sindromiT
hemoragiuli cxelebebi. omskis hemoragiuli cxeleba
mmol/l-s, kreatinini 800 mkmol/l, kaliumi 5,5 mmol/l naCvenebia eqstrakorporuli

hemodializi. hemodializis absolutur Cvenebas warmoadgens Tirkmlismieri eklamfsia,
meningoencefalituri sindromi.
rekonvalescentis binaze gawera SeiZleba klinikuri gamojanmrTelebis Semdeg,
magram mZime SemTxvevebSi daavadebis dawyebidan arauadres 3-4 kvirisa.
dispanseruli dakvirveba hcTs-is msubuqi formis gadatanis Semdeg grZeldeba
3 Tvemde, mZime formebis dros _ 12 Tvemde. yovel 3 TveSi erTxel Sardis analizis,
arteriuli wnevis kontroliT, nefrologisa da okulistis konsultaciiT.
Tumca HhcTs-s ar axasiaTebs qvemwvave da qronikuli mimdinareoba, avadmyofTa
mniSvnelovan nawils SeiZleba aReniSnos narCeni movlenebi _ postinfeqciuri asTenia,
nevrologiuri da endokrinuli darRvevebi. rezidualuri sindromebis xangrZlivoba,
rogorc wesi, ar aRemeteba 3-6 Tves. 6 Tveze xangrZlivi mdgradi poliuria, wyurvili
da piris Rrus simSrale, gamoxatuli hi poizostenuria gvafiqrebinebs qronikul
tubulointersticiul nefropaTiaze (qtin). qtin-is diagnozi ismeba radionukliduri
meTodiT, romelic avlens Tirkmlis milakebis sekreciul-eqskreciul darRvevebs, aseve
gasaTvaliswinebelia natriumisa da kaliumis gaZlierebuli eqskrecia. zogierT
SemTxvevaSi gamosaricxia uSaqro diabetic.
profilaqtika.. specifikuri profilaqtika SemuSavebuli ar aris. saerTo
profilaqtika
RonisZiebebi mimarTulia infeqciis rezervuaris _ mRrRnelebis likvidaciisa da
mRrRnelebiT dabinZurebul sagnebTan kontaqtis Tavidan acilebisaken. koreaSi
SemoTavazebulia inaqtivirebuli vaqcina, xolo CineTSi ki _ cocxali atenuirebuli
vaqcina, Tumca maTi gamoyenebis sakiTxi jer gadawyvetili ar aris.
omskis hemoragiuli cxeleba

(FEBRIS HAEMORRHAGICA SIBIRICA)
omskis hemoragiuli cxeleba warmoadgens bunebriv-kerovan virusul infeqcias,

romelic adamians mRrRnelebidan tki piT an rwyiliT gadaecema da xasiaTdeba cxelebiT,
hemoragiuli sindromiT, nervuli sistemis dazianebiT.
cnobebi. daavadeba pirvelad aRweril iqna 1940-45ww. omskisa
da novosibirskis olqebSi daavadebis epidemiuri afeTqebis dros adgilobrivi eqimebis
mier(D\G\ Gthdeiby= T\D\ Ytecnhjtd= B\<\ <jhbcjd), xolo Semdeg daavadebis
etiologiis, epidemiologiisa da klinikis SeswavlaSi didi wvlili Seitanes rusma
mecnierebma _ V\G\ Xevfrjd= F\A\ <bkb,by= H\V\ F[htv _ F[htvjdbx.
etiologia. gamomwvevi miekuTvneba arbovirusebis jgufs, Flavivirus-is gvars,
etiologia
Togaviridae-s ojaxs. igi rnm-s Semcveli virusia, 35-40nm diametriT. paTogenuria
waulis, TeTri Tagvis, zRvis goWisa da sxva laboratoriuli cxovelebisaTvis. virusis
aRmoCena adamianis sisxlSi SeiZleba daavadebis mwvave periodSi da tki pebis organizmSi.
epidemi
epidemio logia. daavadebis gadamtani da infeqciis ZiriTadi rezervuaria tki pa
ologia
_ Dermatocentor pictus, Dermatocentor marginatus, SesaZlebelia sxva tki pi _
gamazidebi, rwyilebi. adamiani SeiZleba dasnebovndes, agreTve wyliT, saWmliT da
aspiraciuli gziT, daavadebul mRrRnelebTan kontaqtis Semdeg an laboratoriul
masalasTan muSaobis dros.
daavadebas axasiaTebs sezonuroba gazafxul-zafxulis periodSi (aprili, ivnisi),
1958 wlidan gadamtani mwerebis depresiis (daTrgunvis) Sedegad daavadeba praqtikulad
ar gvxvdeba.
190
kerZo nawili.
hemoragiuli cxelebebi. omskis hemoragiuli cxeleba
paTogenezi. organizmSi virusis SeWra xorcieldeba kanidan tki pis kbenis adgilze
paTogenezi
an dazianebuli kanis dainficirebiT avadmyof mRrRnelebTan kontaqtis dros. amasTan,
virusis SeWris adgilas pirveladi afeqti ar yalibdeba. paTogenezSi mTavari roli
eniWeba virusemias da masTan dakavSirebul wvrili sisxlZarRvebis endoTeliumis
dazianebas. Sinagani organoebis mxriv (Tirkmlebi, filtvebi, kuW-nawlavis traqti da
sxva) aRiniSneba sisxlsavseoba da sisxlCaqcevebi. didi mniSvneloba aqvs virusiT
centraluri da vegetatiuri nervuli sistemis, Tirkmelzeda jirkvlebis, sisxlmbadi
organoebis dazianebas. paTmorfologiuri cvlilebebi msgavsia imisa, rac viTardeba
sxva hemoragiuli cxelebebis dros, magram xSirad aRiniSneba bronqopnevmoniis suraTi.
klinika. inkubaciuri periodis xangrZlivoba meryeobs 2-dan 10 dRemde, saSualod
klinika
2-4 dRes Seadgens. daavadeba, Cveulebriv, xasiaTdeba mwvave dasawyisiT, temperaturis
momatebiT 39-400 C-mde, SemcivnebiT, Tavisa da kunTebis tkiviliT. rogorc sxva
hemoragiuli cxelebebis dros, omskis cxelebis drosac saxe, kiseri da gulmkerdis
zemo nawili hi peremiulia, saxe pastozuri, sklerebi da koniunqtiva inicirebuli.
rbil da magar sasaze aRiniSneba wvrili hemoragiebi. hemoragiuli egzanTema viTardeba
gulmkerdis wina da gverdiT zedapirebze, aqve SesaZlebelia farTo nekrozebis gaCenac.
unda aRiniSnos, rom hemoragiuli sindromi SedarebiT naklebadaa gamoxatuli (20-
25%). iSviaTia, agreTve, masiuri sisxldena kuW-nawlavis traqtidan da sxva organoebidan.
daavadebis mZime formebis dros centraluri nervuli sistemis mxriv SeiZleba
ganviTardes meningitis, meningoencefalitis suraTi.
gul-sisxlZarRvTa sistemis mxriv cvlilebebi warmodgenilia gulis tonebis
moyruebiT, bradikardiiT, hi potenziiT, SesaZlebelia difuzuri miokarditis ganviTareba,
sasunTqi sistemis mxriv _ pnevmonia. mudmivi cvlilebebia Tirkmlebis mxriv, rac
gamoixateba Sardis SemcirebiT, albuminuriiT, hematuriiT, cilindruriiT.
temperatura maRal cifrebze rCeba 3-4 dRe, iSviaTad grZeldeba 7-10 dRe. avadmyofTa
TiTqmis naxevars uviTardeba temperaturis ganmeorebiTi talRa (recidivi), ufro
daavadebis meore _ mesame kviras da grZeldeba 4-dan 14 dRemde. daavadebis saerTo
xangrZlivoba 3-5 kviras Seadgens.
daavadebis dasawyisSi periferiul sisxlSi aRiniSneba leikopenia neitrofiloziT,
marcxniv gadaxriT, Trombocitopenia, aneozinofilia.
simZimis mixedviT arCeven msubuq, saSualo da mZime mimdinareobas. SesaZlebelia,
agreTve, waSlili da subklinikuri formebic.
diagnozi eyrdnoba damaxasiaTebel klinikur suraTs, Sardisa da sisxlis cvlilebebs,
epidanamnezs. specialuri gamokvlevebidan keTdeba virusologiuri gamokvlevebi (virusis
sisxlidan gamoyofa). daavadebis dinamikaSi antisxeulebis titris zrdis dadgena
xdeba komplementis SeboWvis, hemaglutinaciis Senelebis reaqciiT, agaris gelze difuzuri
preci pitaciis reaqciiT an neitralizaciis reaqciiT.
diferenciuli diagnozi tardeba hemoragiul cxelebebTan, leptospirozTan,
tki pismier virusul encefalitTan, gri pTan, kapilarotoqsikozTan da sxva.
mkurnaloba mxolod paTogenezuria, mZime SemTxvevebSi gamoiyeneba
kortikosteroidebi. meoradi infeqciiT ganpirobebuli garTulebebi eqvemdebareba
antibiotikTerapias.
profilaqtika mimarTulia tki pisagan Tavis dacvisken. aqtiuri imunizacia tardeba
daxocili vaqciniT, romelic damzadebulia omskis cxelebis virusiT TeTri Tagvebis
inficirebuli tvinidan. vaqcinacia tardeba mxolod mkacri epidemiuri Cvenebis mixedviT.
profiliqtikisaTvis aseve gamoiyeneba tki pismieri encefalitis sawinaaRmdego
vaqcina, vinaidan gamomwvevebs antigenuri msgavseba axasiaTebs.
191
kerZo nawili.
hemoragiuli cxelebebi. yirim-kongos cxeleba
yirim-kongos cxeleba
(FEBRIS HAEMORHAHICA CRIMIANA)
sinonimebi: yirim-kongo-xazeris hemoragiuli cxeleba, Sua aziis hemoragiuli cxeleba,

karaxalaki da sxva. daavadeba warmoadgens mwvave, bunebriv-kerovan arbovirusul infeqcias
da xasiaTdeba mwvave dasawyisiT, mZime intoqsikaciiTa da hemoragiuli movlenebiT.
mokle istoriuli cnobebicnobebi. daavadebis gamomwvevi virusi pirvelad aRweril
iqna afrikis mcxovreblebSi, xolo V\G\ Xevfrjd-is da TanaavtorTa mier 1945w. -
yirimis dasavleTis velebSi. SemdgomSi msgavsi daavadeba gamovlenil iqna ruseTis
sxvadasxva olqSi, maT Soris dunais, rostovis raionebSi, krasnodaris, stavropolisa
da sxva regionebSi. daavadebas adgili aqvs Sua aziis respublikebSi, yazaxeTSi, aRmosavleT
da dasavleT afrikaSi, indoeTSi, eraySi, iranSi, pakistanSi. SavizRvispireTis qveynebidan
- bulgareTSi, rumineTSi. Cvens mezobel qveyanaSi _ azerbaijanSi. saqarTveloSi tki pebis
virusis antigeni napovnia gardabnis raionSi, azerbaijanTan mosazRvre teritoriaze
(1984-87 wlebSi Catarebuli gamokvlevebi). 1999wlis ivlisSi daavadebis afeTqebas
adgili hqonda rostovis olqSi, sadac stanica ilovskaiaSi aRiniSneba bunebrivi kera.
avad gaxda 80-ze meti adamiani, maT Soris 6 gardaicvala.
etiologia. infeqciis gamomwvevia virusi Congo buniavirusebidan. infeqciis wyarod
etiologia
iTvleba gareuli wvrili ZuZumwovrebi _ tyis Tagvi, patara Tria, kurdReli, zRarbi.
infeqciis rezervuari da gadamtania tki pebi, upiratesad Hyaloma-s gvaridan. yirimSi
da yofili sabWoTa kavSiris teritoriaze infeqciis gadamtani tki pebia Hyaloma
plumbeum da Hyaloma marginata, Sua aziasa da afrikaSi _ Hyaloma anatolicum.
tki pebis sakveb da infeqciis wyarod iTvlebian Txa, cxvari, Zroxa da sxva.
mniSvnelovan epidemiologiur Taviseburebas warmoadgens avadmyofi adamianisagan
janmrTeli adamianis dasnebovnebis SesaZlebloba pirnaReb masasTan, sisxlTan kontaqtis
Sedegad (saavadmyofosSida infeqciebi). SesaZlebelia aerogenuli dasnebovneba
(laboratoriul pirobebSi). endemur kerebSi daavadebas axasiaTebs sezonuroba gazafxul-
zafxulis periodSi, rac dakavSirebulia tki pebis gaaqtiurebasTan. ZiriTadad avaddebian
20-60 wlis asakis adamianebi, soflis meurneobis muSakebi.
paTanatomia. virusis SeWra xdeba kanidan, tki pis kbenis Sedegad
paTogenezi da paTanatomia
anda kanis travmuli dazianebisas inficirebul masalasTan kontaqtis dros (pirnaRebi
masa, sisxli). amasTan, raime adgilobrivi cvlilebebi kanSi virusis SeWris dros ar
SeimCneva. virusi aRwevs sisxls, viTardeba virusemia, Semdeg grovdeba retikulur-
endoTelur sistemaSi da meored viTardeba ufro intensiuri virusemia. aRniSnul
masiur virusemiasTanaa dakavSirebuli organizmis zogadi intoqsikaciis movlenebi da
sisxlis Semdedebeli sistemis darRvevis Sedegad sisxlZarRvSida Sededebis da
Trombohemoragiuli cvlilebebi. virusi ise, rogorc sxva hemoragiuli cxelebis
dros, gamoirCeva wvrili sisxlZarRvebis endoTeliumis upiratesi dazianebiT, rac
ganapirobebs Tirkmlebis, RviZlis, centraluri nervuli sistemisa da sxva organoebis
dazianebebs.
paTanatomiurad cvlilebebi xasiaTdebian mravalricxovani hemoragiebiT, kuWis,
nawlavis lorwovanebSi sisxlCaqcevebiT, Tavis tvini da misi garsebi hi peremiulia,
sisxlCaqcevebiT, Trombohemoragiul movlenebs adgili aqvs sxva organoebis mxrivac.
RviZlSi viTardeba xiduri nekrozebi, distrofiuli cvlilebebia miokardiumSi,
Tirkmelzeda jirkvlebSi.
unda aRiniSnos, rom daavadebis paTogenezis bevri sakiTxi jerjerobiT srulad
damuSavebuli ar aris.
192
kerZo nawili.
hemoragiuli cxelebebi. yirim-kongos cxeleba
suraTi. inkubaciuri periodi 1-dan 14 dRemde meryeobs, saSualod ki

klinikuri suraTi
3-5 dRes Seadgens. garda inkubaciuri periodisa, daavadebis mimdinareobaSi arCeven 2
periods _ dasawyiss, romelic 3 dRemde grZeldeba, maqsimaluri gamovlinebisa da
damTavrebis periodebs. simZimis mixedviT - msubuq, saSualo da mZime mimdinareobas.
daavadeba iwyeba mwvaved, SeiZleba uecradac, temperaturis momatebiT 39-400 C-mde,
SemcivnebiT, Tavis Zlieri tkiviliT, zogadi damtvreulobis SegrZnebiT, zogadi sisustiT.
avadmyofebi uCivian tkivilebs muclisa da welis areSi, damaxasiaTebelia gulis
reva, Rebineba.
daTvalierebisas aRiniSneba saxis, kisris, gulmkerdis zemo nawilis, xaxis da
koniunqtivis hi peremia, sklerebisa da koniunqtivis sisxlZarRvTa inicireba. aRniSnuli
gamovlinebani grZeldeba 3-6 dRe. es periodi cnobilia, rogorc infeqciis dasawyisi
periodi. SemdegSi temperatura qveiTdeba, magram adgili aqvs hemoragiuli movlenebis
ganviTarebas da amave dros, zogadi mdgomareobis gauaresebas. kanze, piris Rrus
lorwovan garsebze viTardeba hemoragiuli gamonayari, viTardeba sisxldena cxviridan,
ineqciis adgilebze Cndeba hematomebi. mZime mdgomareobis dros viTardeba infeqciur-
toqsikuri Soki, intensiuri sisxldena kuW-nawlavis traqtidan, saSvilosnodan da a.S.
avadmyofebi xdebian apaTiurni, uZlurni, SeiZleba ganviTardes meningoencefalitis
suraTi, kanis, sklerebis subiqteruloba. gulis tonebi, Cveulebriv, moyruebulia, aRiniSneba
taqikardia, arteriuli wneva daqveiTebulia. pasternackis simptomi dadebiTia, magram
Tirkmlebis funqcia ar irRveva, Tumca adgili aqvs albuminurias, mikrohematurias.
daavadebis dasawyis periodSi periferiul sisxlSi viTardeba leikopenia, neitrofilozi
marcxniv gadaxriT, eozinopenia.
daavadebis keTilsaimedo gamosavlis SemTxvevaSi hemoragiuli movlenebi qreba 5-
7 dRis ganmavlobaSi. recidivebi da meoradi Trombohemoragiuli diaTezi damaxasiaTebeli
ar aris. daavadeba mTavrdeba 3-4 kviris ganmavlobaSi. SesaZlebelia gamojansaRebis
periodis gaxangrZliveba garTulebis darTvis Sedegad (pnevmonia, Tirkmlebis ukmarisoba,
filtvebis SeSupeba da sxva).
diagnostika eyrdnoba zogadi toqskozis fonze hemoragiuli diaTezis ganviTarebas,
sisxlisa da Sardis mxriv cvlilebebs, epidanamnezs. laboratoriuli meTodebidan
diagnozis dasadastureblad iyeneben virusisa da mis sawinaaRmdego antisxeulebis
dadgenas daavadebis dinamikaSi komplementis SeboWvis reaqciis, arapirdapiri
hemaglutinaciis reaqciis, IgM da IgG antisxeulebis gansazRvriT.
difer enciul
diferenciul
enciuli i diagnostika tardeba gripTan, partaxtian tifTan, leptospirozTan,
sxva hemoragiul cxelebebTan.
mkurnaloba igivea, rac Tirkmlis sindromiT mimdinare hemoragiuli cxelebisa
da omskis hemoragiuli cxelebis dros. aris monacemebi ribavirinis intravenuri
gamoyenebis Sesaxeb, magram kontrolirebuli gamokvleva ar aris Catarebuli. yvela
avadmyofs unda Cautardes individualuri antisindromuli mkurnaloba (sisxlis,
Trombocituli masis, sisxlis Semdedebeli faqtorebis gadasxma). steroiduli hormonebis,
aminokapronis mJavis, presoruli aminebis an ∝-adrenoblokatorebis efeqturoba
damtkicebuli ar aris.
prognozi seriozulia. letalobis maCvenebeli meryeobs 6-30%-mde.
profilaqtika igivea, rac sxva hemoragiuli cxelebebis dros aris miRebuli.
aqtiuri imunizacia ar aris damuSavebuli. mxolod bulgareTSi imunizaciis mizniT
iyeneben Tagvebis tvinis qsovilebidan miRebul inaqtivirebul vaqcinas.
saWiroa Sinauri cxovelebis datki pianebis winaaRmdeg brZola da tki pebisagan
Tavdasacavi individualuri saSualebebis _ grZelsaxeloebiani Ria feris Casacmelis,
windebSi Catanebuli Sarvlis gamoyeneba, kanis damuSaveba repelentebiT
193
kerZo nawili. yirim-kongos cxeleba
hemoragiuli cxelebebi. denges da dengesmagvari cxelebebi
(dieTiltoluamidis Semcveli) an Sarvlis totebisa da saxeloebis _ permeTriniT.

tki pebis SesaZlo gavrcelebis areSi (mindori, veli) muSaobisas an dasvenebisas yovel
3-4 saaTSi sxeulis daTvaliereba da mikruli tki pebis frTxili moSoreba (maTi
sxeulis mTlianobis dazianebis gareSe) pincetiT.
denges da dengesmagvari cxelebebi

(DENGUE)
denges cxeleba warmoadgens bunebriv-kerovan arbovirusul infeqcias, romelic

xasiaTdeba orfaziani temperaturuli reaqciiT, intoqsikaciiT, mialgiiT, arTralgiiT,
gamonayriT, leikopeniiT, limfadenopaTiiT da hemoragiuli sindromiT, xSirad axasiaTebs
Sokis ganviTareba.
mokle istoriuli cnobebi. daavadebis epidemia pirvelad aRwera D. Bylon-ma
iavis kunZulebze, xolo erTi wlis Semdeg _ filadelfiaSi B. Rush-ma. meoce saukunis
dawyebamde epidemiebi aRiniSneboda amerikis sxvadasxva regionSi, evropaSi, avstraliaSi
da aziaSi. amJamad denges da dengesmagvari cxelebebi gvxvdeba endemurad, tropikul
afrikaSi, centralur da samxreT amerikaSi. xSirad am infeqciiT avaddebian mogzaurebi
bunebrivi kerebis regionebSi Casvlisas.
eti
etio logia. jerjerobiT cnobilia denges cxelebis gamomwvevi virusebis 4 ti pi
ologia
(Togaviridae-s ojaxidan, Flavivirus-is gvaridan), romlebic gansxvavdebian erTmaneTisagan
antigenuri SemadgenlobiT, miekuTvnebian B antigenuri jgufis arbovirusebs, Seicaven
rnm-s, aqvT fosfoli pidebisa da qolesterinisagan Sedgenili orSriani li piduri
garsi. virionis diametria 40-45 nm, mravldebian maimunis Tirkmelebis qsovilovan
ujredebze. virusi inaqtivirdeba proteolizuri fermentebiT damuSavebisas da 600C-
mde gacxelebisas. garda aRniSnulisa, aris kidev 3 arbovirusi, romlebic iwveven
denges msgavs daavadebebs _ Cikungunias, o’ niong-niong da dasavleT nilosis cxelebas.
epidemi
epidemio logia. denges cxelebis virusis gadacema xdeba tki pebiT Stegomia-s
ologia
ojaxidan, mTavar gadamtanad ki iTvleba Aedes aegypti, romelic kbens adamians
dRisiT. denges yvela cnobili 4 ti pis virusi gamoyofil iqna aRniSnuli koRodan.
Aedes aegypti farTodaa gavrcelebuli umravles tropikul adgilebSi, qalaqis
pirobebSi da mravldeba damdgar sasmel, sabanao da wvimis wylebSi. virusi koRos
organizmSi mravldeba mxolod haeris teperaturaze, araumetes 220C-is pirobebSi.
denges virusi agreTve nanaxia Aedes albopictus, xolo okeaniis raionebSi _ Aedes
scutellaris-Si.
infeqciis wyarod iTvleba avadmyofi adamiani da maimuni, SesaZlebelia _ Ramurebi.
mWidrod dasaxlebul adgilebSi daavadeba epidemiur xasiaTs Rebulobs.
dengesmagvari daavadebebi SeiZleba epidemiur xasiaTsac atarebdnen. Chikungunya-
s virusi farTodaa gavrcelebuli msoflios mraval regionSi. aziaSi mis gadamtanad
iTvleba Aegypti, afrikaSi ki SeiZleba iyos sxva koRoebic. samxreT-aRmosavleT
aziaSi denges da Cikungunias epidemiebi SeiZleba mimdinareobdes erTdroulad. o’
niong-niong da dasavleT nilosis cxelebebis epidemiebi, Cveulebriv, aRiniSneba soflebsa
da mcire qalaqebSi maSin, rodesac denges da Cikungunias epidemiebi ufro xSirad
gvxvdeba qalaqebSi.
paTogenezi. virusis SeWra organizmSi xdeba kanidan koRos kbenis dros. 3-4-7
paTogenezi
dRis inkubaciuri periodis Semdeg adgilobrivad viTardeba Semofargluli anTeba,
sadac xdeba virusis gamravleba da dagroveba. inkubaciuri periodis ukanaskneli 12
194
kerZo nawili.
saaTidan viTardeba viremia, romelic grZeldeba cxelebis 3-5 dRemde. denges cxeleba
SeiZleba mimdinareobdes klasikuri da hemoragiuli formebiT. mkacri damokidebuleba
ti psa da klinikur gamovlinebas Soris ar aRiniSneba. ase, magaliTad, fili pinis
hemoragiuli cxelebisas daavadeba SeiZleba gamowveuli iyos 2, 3 da 4 ti pebiT maSin,
rodesac singapurSi _ yvela 4 ti piT.
amJamad dadgenilia, rom denges hemoragiuli forma SeiZleba gamowveuli iyos
virusis oTxive tipiT. daavadebis paTogenezSi gansakuTrebul rols TamaSobs organizmSi
1, 3 da 4 ti pis pirveladi SeWra da infeqciis gadatanidan ramdenime wlis Semdeg,
seroti p 2-iT ganmeorebiTi inficireba.
hemoragiuli cxelebis ganviTarebaSi gansakuTrebuli roli eniWeba imunur faqtorebs.
dadgenilia, rom virusis me-2 ti pis gaZlierebul zrdas adgili hqonda imunizirebuli
donorebisagan miRebul mononuklearebSi, denge virusis e.w. gamaaqtivebeli antisxeulebi
virusemias mxolod xels uwyoben. warmoqmnili antigen-antisxeulis kompleqsis SeRweva
mononuklearebSi xdeba Fc receptorebis meSveobiT.
virusis aqtiuri replikacia, Tavis mxriv, ganapirobebs mTeli rigi meoradi reaqciebis
serias _ komplementis, kininisa da sxva sistemebis aqtivacias, rac Trombohemoragiuli
sindromis ganviTarebaSi wamyvan rols TamaSobs. e.i. hemoragiuli formebis warmoSobaSi
wamyvania adgilobrivi sensibilizebuli mosaxleobis ganmeorebiTi inficireba, an Tu
axalSobils pirveladi inficirebis dros dedisagan ukve aqvs miRebuli gamaaqtivebeli
antisxeulebi. pirveladi da meoradi inficirebis Soris intervali 3 Tvidan 5
wlamde meryeobs. pirveladi infeqciis dros viTardeba denges klasikuri forma
(CamosulebSi), xolo hemoragiuli varianti ki adgilobriv mosaxleobaSi. SesaZlebelia
ganmeorebiTi dasnebovneba igive sezonis dros (2-3 TveSi) sxva ti pis virusiT
inficirebisas. am dros maneitralebeli antisxeulebis dabali donec ki icavs
axalSobilsa da bavSvebs hemoragiuli formis ganviTarebisagan. Sokis dros sisxlis
Sededebisa da fibrinolizis sistemebi aqtiurdeba, xolo XII (hagemanis) faqtori
daTrgunulia. sisxlZarRvSida diseminirebuli Sededeba, RviZlis dazianeba da
Trombocitopenia moqmedeben sinergistulad da iwveven hemoragiebs. kapilarebis dazianeba
ki ujredgareTa sivrceSi siTxis, eleqtrolitebis, cilis da zogjer eriTrocitebis
gamosvlis SesaZleblobas qmnis, rac Rebinebis da umadobis gamo zrdis hemokoncentracias.
viTardeba hi povolemia, iwyeba gulis gaZlierebuli muSaoba, izrdeba qsovilovani
hi poqsia, metaboluri acidozi, hi ponatriemia.
klinika. inkubaciuri periodi meryeobs 3-dan 15 dRemde, xSirad Seadgens 5-7
klinika
dRes. daavadebis mimdinareoba damokidebulia ara marto asakze, aramed individis
Taviseburebebze. daavadeba yovelTvis iwyeba mwvaved, iSviaTad, erTeul SemTxvevebSi
aRiniSneba prodromi, romelic vlindeba saerTo damtvreulobiTa da Tavis tkivilebiT.
rogorc iTqva, arCeven daavadebis mimdinareobis klasikur da hemoragiul formebs.
daavadeba iwyeba mwvaved, maRali temperaturiT 39-400C-de, rac 3-5 dRe grZeldeba.
temperaturis kritikuli dacemis Semdeg dgeba normaluri temperaturis 1-4 dRiani
periodi.
intoqsikaciis movlenebidan Tavidanve aRsaniSnavia Tavis tkivilebi Sublis wina
da Tvalis orbitis ukana nawilSi, welis midamoSi. rogorc wesi, daavadebis pirvel
24-48 saaTSi aRiniSneba makuluri gamonayari, romelic kanis daWimvisas fermkrTaldeba.
pulsi SedarebiT bradikardiulia. avadmyofis saerTo mdgomareobas auaresebs mialgia
da arTralgia (siaruli SezRudulia `dendis~ an `Jirafis~ siaruli), gansakuTrebiT,
Cikungunias da o’niong-niongiT daavadebebis dros. cxelebis me-2-6 dRidan aRniSnul
simptomatikas emateba gulisreva, Rebineba da generalizebuli limfadenopaTia; avadmyofs
awuxebs hi peresTezia, hiperalgia, anoreqsia, gemovnebis gaukuRmarTeba, romelic atarebs
195
kerZo nawili.
`SimSilobis gamocxadebis~ xasiaTs.

saerTo mdgomareobis gaumjobesebidan 1-2 dRis Semdeg Cndeba wiTelasmagvari
gavrcelebuli gamonayari. xelebze da fexis terfebze gamonayari ar aRiniSneba, Tumca
iSviaTad SeiZleba adgili hqondes maT SeSupebas. gamonayari grZeldeba 1-5 dRe da
SesaZlo desqvamaciiT mTavrdeba. kanze meoradi gamonayris dros temperaturam SeiZleba
moimatos ramodenime dRe, rac hqmnis daavadebis orfaziani temperaturis mruds.
virusis moqmedebis Sedegad ziandeba sisxlZarRvebi (vazotropuli virusi), rac
ganapirobebs hemoragiebs, peteqiebs daavadebis nebismier stadiaSi.
zogjer adgili aqvs sisxldenas kuW-nawlavis traqtidan gansakuTrebiT hemoragiul
diaTezian bavSvebSi (denges cxeleba hemoragiuli sindromiT). maRali temperaturis
fonze araiSviaTad viTardeba krunCxvebi.
febriluri stadiis CamTavrebis Semdeg adgili aqvs xangrZliv asTenias, gonebriv
depresias, bradikardias, parkuWovan eqstrasistolias.
hemoragiuli formebis dros maRali temperaturis fonze me-3 me-4 dRes viTardeba
gamoxatuli hemoragiuli sindromi. am dros SeiZleba ganviTardes infeqciur-toqsikuri
Soki. hemoragiuli movlenebi gvxvdeba avadmyofTa 1-2%-Si.
garTulebebidan SeiZleba ganviTardes encefaliti, polinevriti, pnevmonia. periferiul
sisxlSi daavadebis me-3-4 dRes SeiZleba gamovlindes pancitopenia, neitropenia grZeldeba
an isev Cndeba daavadebis mogvianebiT stadiaSi, zogjer ki _ gamojanmrTelebis periodSi.
leikocitebi 2000 1mkl-Si, Trombocitebi 100 000 mm3. acidozi zomieradaa gamoxatuli,
odnav momatebulia transaminazebis done, adgili aqvs hi poproteinemias.
klasikuri hemoragiuli cxeleba Sokis sindromiT SeiZleba gamovlindes bavSvebSic,
romlebic daibadnen denge-imunuri dedebisagan (aqvT gamaaqtivebeli antisxeulebi).
bavSvebSi am dros aRiniSneba sinusuri bradikardia, eqtopiuri parkuWovani fokusebi,
T kbilis gafarToeba, PR intervalis gadideba.
diagnozi da diferenciuli diagnozi. daavadebis diagnostikaSi didi mniSvneloba
aqvs endemuri kerebis dadgenas, koRoebis arsebobas, rac saTanado klinikuri gamovlinebis
SemTxvevaSi (orfaziani cxeleba, egzanTema, mialgia, hemoragiuli gamovlinebani da sxva)
ufro aadvilebs diagnozis dasmas. epidemiuri afeTqebis dros ki klinikuri diagnostika
siZneles ar warmoadgens.
diferenciuli diagnozi tardeba mwvave respiraciul infeqciebTan, malariis adreul
stadiasTan, partaxtian tifTan, leptospirozebTan, hepatitebTan.
abortuli, namkurnalebi da vaqcinirebuli SemTxvevebis dros daavadeba SeiZleba
ar mivides dengesaTvis damaxasiaTebel mZime mdgomareobamde.
arbovirusuli daavadebebi SeiZleba mimdinareobdes denges suraTiT, magram gamonayaris
gareSe qvemoTCamoTvlili _ kolorados cxeleba, sendflais cxeleba, Rift-Valley-s
cxeleba, Ross-River-is cxeleba.
radgan aRniSnuli daavadebebis klinikuri gamovlinebani variabiluria, termini
`denges daavadeba~ ar unda iyos gamoyenebuli specifikuri faqtoris gamovlinebamde.
etiologia SeiZleba dadasturdes serologiurad an virusis sisxlidan gamoyofiT
(leikocitebidan, Sratidan) (anti-denge IgM pirveladi da meoradi inficirebis drosac
tranzitulia), xolo IgG- ufro aRiniSneba meoradi inficirebis dros: titri 1 - 640
da meti hemaglutinaciis damuxruWebis reaqciaSi wyvil SratebSi. virusis kvleva
warmoebs rogorc temperaturis, ise rekonvalescenciis periodSi.
pirvel Srats iReben daavadebis dawyebidan arauadres me-5 dRisa, xolo meores _
dawyebidan araugvianes me-6 kvirisa.
mkurnaloba. woliTi reJimi sicxis dros. maRali temperaturis dros gamoiyeneba
anti piretuli saSualebebi, analgetikebi, zomieri sedacia, eleqtrolitebis koreqcia,
196
kerZo nawili. denges da dengesmagvari cxelebebi
hemoragiuli cxelebebi. marburgis cxeleba
sadezintoqsikacio saSualebebi da sxva.

prognozi damokidebulia paTogenezuri mkurnalobis swor warmarTvaze. prognozi,
Cveulebriv, cudia, Tu adgili aqvs maneitralebeli antisxeulebis sust matebas da
sxva virusuli infeqciebis darTvas.
hemoragiuli formis mZimed mimdinareobis dros mkurnalobaSi ZiriTadia
cirkularuli kolafsisa da Sokis koreqcia (5% glukoza, ringeris laqtati,
kortikosteroidebi mizanSewonili ar aris uefeqtobis gamo).
prognozi klasikuri formis dros keTilsaimedoa, xolo hemoragiuli formis
dros letaloba Seadgens 40_50%-s, Tumca adekvaturi Terapiis dros 2%-ia.
profilaqtika. efeqturad iTvleba mkvdari vaqcina _ Chikungunya-s mimarT
(Tumca farTod ar gamoiyeneba). denges vaqcinas SeuZlia sensibilizaciis gamowveva da
daavadebis warmarTva hemoragiuli variantiT.
endemur adgilebSi gadamtani koRoebis sawinaaRmdegod ixmareba repelentebi da
damcveli badeebi.
Senobebi muSavdeba inseqticidebiT.
marburgis cxeleba
(FEBRIS MARBURG)
(cerkopitikuri cxeleba)
marburgis cxeleba cnobilia kidev ori saxelwodebiT _ marburgis hemoragiuli

cxeleba, marburgis daavadeba.
daavadeba warmoadgens zoonozur _ anTroponozul mwvave virusul infeqcias,
romelic xasiaTdeba mZime mimdinareobiT, hemoragiuli sindromiT, RviZlis, kuW-nawlavis
traqtisa da centraluri nervuli sistemis dazianebiT, maRali letalobiT. miekuTvneba
gansakuTrebiT saSiS infeqciaTa jgufs.
etiologia. marburgis cxelebis gamomwvevi virusebi miekuTvnebian Filoviridae-
s ojaxs, Lyssaviridae-s gvars. zusti taqsonomiuri mdgomareoba jerjerobiT
gansazRvruli ar aris. morfologiurad, es da ebolas virusi ar gansxvavdebian
erTmaneTisagan da SeiZleba iyvnen Wiisebri, spiralisebri da momrgvalo formis. maTi
sigrZe meryeobs 665nm-dan 1200nm-mde, 70-80nm ganivi diametriT. erTmaneTisagan
gansxvavdebian antigenuri SemadgenlobiT, ultrastruqturiT da antigenuri SemcvelobiT
ki _ yvela cnobili virusisagan _ Seicaven rnm-s, li poproteins. virusis pasireba
xdeba zRvis goWebze da mwvane maimunis Tirkmelebis (vero) ujredebis kulturebze.
qsovilovan kulturaze iwveven arasrul citopaTur efeqts, an zogjer saerTod ar
iwveven. inficirebul masalaSi virusi mdgradia gacxelebis mimarT, mgrZnobiarea eTeris,
qloroformis, dezoqsiqolatis, formaldehidis, acetonis mimarT.
epidemiologia. daavadebis pirveli afeTqeba aRiniSna 1967 wels, marburgsa da
mainis frankfurtSi (germania) erTdroulad, biologiuri laboratoriis TanamSromelTa
Soris, romlebsac hqondaT kontaqti ugandidan Semoyvanili mwvane maimunebis
(Ceropithecus aethiops) qsovilebTan. daavadda 31 adamiani, aqedan gardaicvala 7, 6
SemTxvevaSi inficireba moxda avadmyof adamianTan kontaqtis Sedegad. SemdgomSi msgavsi
daavadebis afeTqebas adgili hqonda iugoslaviaSi (1967), sudanSi (sofel maridSi,
daavadebam miiRo saxelwodeba _ maridis cxeleba), keniaSi (1980, 1988) samxreT
afrikis respublikaSi (1983) da afrikis sxva qveynebSi.
197
kerZo nawili.
hemoragiuli cxelebebi. marburgis cxeleba
infeqciis wyaro da rezervuari bunebriv pirobebSi yvela am afeTqebebis dros

iyvnen mwvane maimunebi, romlebSic infeqcia mimdinareobs inaparantulad. maimunze
infeqciis gadacemis gza jerjerobiT Seswavlili ar aris.
avadmyofi adamiani saSiSia irgvliv myofTaTvis. virusis garemoSi gamoyofa xdeba
cxvir-xaxis gamonadenTan, SardTan erTad, gadamdebia agreTve sisxli.
adamianis inficireba SesaZlebelia haer-wveTovani gziT virusis moxvedrisas
koniunqtivaze, kanze (SemTxveviT nemsis Cxvleta, gaWra). ar aris gamoricxuli sqesobrivi
gziT gadacemac (virusi nanaxia saTesle siTxeSi).
paTogenezi. infeqciis SeWra xdeba kanidan, piris Rrusa da Tvalebis lorwovani
garsebidan. damaxasiaTebelia virusis diseminacia sisxlSi, Sinagan organoebSi.
paTanatomiur cvlilebebs naxuloben RviZlSi ujredebis cximovani gadagvarebis,
calkeuli ujredebis nekrobiozis ujreduli infiltraciis, TirkmelebSi milakebis
epiTeliumis dazianebis saxiT. nanaxia mravalricxovani wvrili sisxlCaqcevebi Tavis
tvinsa da sxvadasxva organoebSi.
klinika. marburgis da maridis daavadebebi klinikuri gamovlinebiT, simZimisa da
gamosavlis mixedviT erTmaneTisagan ar gansxvavdebian. daavadeba iwyeba uecrad, prodromis
gareSe 2-16 dRis inkubaciuri periodis Semdeg, temperaturis mkveTri momatebiT maRal
cifrebamde. aRiniSneba Tavis Zlieri tkivili, gansakuTrebiT, Sublis areSi, welis
kunTebis tkivili, damtvreuloba, saxsrebis tkivili. me-3-4 dRes erTvis kuW-nawlavis
traqtis dazianeba SeteviTi xasiaTis muclis tkiviliT, ganavali xdeba Txeli, wylisebri,
sisxlis minarevebiT, zogjer sisxli Sededebulia an adgili aqvs sisxldenas (melena).
defekaciis sixSire dRe-RameSi 10-15-s aRwevs. faRaraTi aReniSneba TiTqmis yvela
avadmyofs (83%), grZeldeba 1 kviras, Rebineba (68%) 4-5 dRes naRvlis Semcveli
masebiT. gulmkerdis areSi SeiZleba iyos mCxvletavi xasiaTis tkivilebi, romelic
Zlierdeba sunTqvis dros. zogjer aRiniSneba mSrali xvela, simSralis SegrZneba da
tkivili yelSi. xaxa, enis wveri da gverdebi hi peremiulia, magar da rbil sasaze, enaze
Cndeba vezikulebi Semdgomi eroziebiT. lasas cxelebisgan gansxvavebiT gamoxatuli
nekrozi ar Cndeba. kunTebis tonusi gansakuTrebiT momatebulia, daWimuli da palpaciiT
mtkivneulia zurgis, kisris, saReWi kunTebi.
avadmyofTa naxevars daavadebis me-4-5 dRes tanze uCndebaT makulur-papuluri
gamonayari, SesaZlebelia aRiniSnos vezikuluri elementebic. gamonayari gamoxatulia
zemo kidurebze, kiserze, saxeze, zogjer Tan sdevs kanis qavili. kanSi sisxlCaqcevebis
SemTxvevebi 62%-mde aRwevs. sisxlCaqcevebi SeiZleba iyos koniunqtivaSi, piris Rrus
lorwovan garsze; adgili aqvs sisxldenas saSvilosnodan da kuW-nawlavidan. gamonayari
aseve vrceldeba sasqeso organoebze, aRiniSneba maTi SeSupeba.
pirvel, zogjer meore kviras, toqsikozi maqsimalur gamovlinebas aRwevs; Cndeba
dehidrataciis niSnebi, viTardeba infeqciur-toqsikuri Soki. SesaZlebelia krunCxvebi,
gonebis dakargva. am SemTxvevaSi avadmyofoba xSirad mTavrdeba sikvdiliT.
periferiul sisxlSi aRiniSneba leikopenia, Trombocitopenia, anizocitozi,
poikilocitozi, eriTrocitebis bazofiluri marcvlovaneba. meningizmis dros Tav-
zurgtvinis siTxe cvlilebebis gareSea.
rekonvalescenciis stadia 3-4 kvira grZeldeba. am periodSi SeiZleba aRiniSnos
gameloteba, paresTeziebi, muclis SeteviTi xasiaTis tkivilebi, madis gauareseba, xangrZlivi
fsiqikuri darRvevebi. mogvianebiT garTulebebs miekuTvneba mieliti da uveiti.
diagnozi. eyrdnoba epidanamnezs (marburgis virusis bunebriv-kerovan adgilebSi
yofna, muSaoba afrikis mwvane maimunebis qsovilebze), klinikur si ptomatikas _ daavadebis
uecari dawyeba, mZime mimdinareoba, hemoragiuli sindromi, egzanTema, dehidrataciis
movlenebi da a.S. sisxlSi _ leikopenia, Trombocitopenia, garkveuli mniSvneloba
198
kerZo nawili. marburgis cxeleba
hemoragiuli cxelebebi. ebolas cxeleba
eniWeba antibiotikebis araefeqturobas, baqteriologiuri da parazitologiuri

gamokvlevis uaryofiT Sedegebs.
virusis gamoyofa SeiZleba sisxlidan, cxvir-xaxis gamonadenidan, Sardidan, axalSobili
Tagvebis inficirebuli tvinidan an vero-E6 6 qsovilovan kulturebze.
serologiuri meTodebidan sargebloben Sratis gamokvleviT daavadebis dinamikaSi
radioimunuri, imunofermentuli analiziT da a.S.
mkurnaloba. paTogenezuria da mimarTulia organizmis dezintoqsikaciisa da
wyal-marilovani cvlis koreqciisaken. gamoiyeneba kortikosteroiebi, hemotransfuzia,
vitaminoTerapia.
dieta iTvaliswinebs mcenareuli da rZis produqtebis daniSvnas.
prognozi. yovelTvis seriozulia. saerTo letaloba 25%-s aRwevs. sikvdili
viTardeba daavadebis me 8-10 dRes.
profilaqtika. profilaqtikuri RonisZiebebi gamoixateba saTanado wesebis dacvaSi
mwvane maimunebis qsovilebTan muSaobis dros (respiratoris, xelTaTmanebisa da damcveli
saTvaleebis xmareba). saerTaSoriso karantinis reJimis dacva.
imunoprofilaqtika SemuSavebuli ar aris.
ebolas cxeleba
(FEBRIS EBOLA)
ebolas cxeleba warmoadgens maRalkontagiozur virusul infeqcias, romelic

mimdinareobs maRali temperaturiT, mZime intoqsikaciiT, egzanTemiT, diareiT, hemoragiuli
sindromiT da xasiaTdeba maRali letalobiT.
etiologia, epidemiologia da paTogenezi. 1976w. samxreT sudansa da CrdiloeT
zairSi adgili hqonda hemoragiuli cxelebis epidemiur afeTqebas maRali letalobiT
(Sesabamisad 50,3 da 59%). infeqciis afeTqebas Tavdapirvelad nozokomialuri xasiaTi
hqonda. zairSi mdinare ebolas axlos gamoyofil iqna daavadebis gamomwvevi virusi,
rasac ukavSirdeba cxelebis saxelwodeba. marburgis cxelebisa da ebolas cxelebis
virusi morfologiurad erTmaneTisagan ar gansxvavdeba, magram axasiaTebT sxvadasxva
antigenuri Tvisebebi. ebolas cxelebis virusi miekuTvneba rabdovirusebis
(Rabdoviridae) ojaxs da lisavirusebis (Lyssaviridae) gvars. bunebaSi infeqciis
rezervuarad iTvlebian mRrRnelebi, romlebic adamianis sacxovrebel adgilebTan axlos
binadroben. avadmyofi adamiani saSiSroebas warmoadgens janmrTeli pirebisaTvis.
gansakuTrebiT maRali kontagiozuroba dadgenilia saavadmyofos pirobebSi kontaqtis
Sedegad. avadmyofi adamiani viruss gamoyofs daavadebis pirvel sam kviras. infeqciis
gadacema SesaZlebelia inficirebuli nemsebiTa da sxva instumentebiT.
paTogenezi da imuniteti naklebadaa Seswavlili. virusis SeWris adgils warmoadgens
respiraciuli traqtis lorwovani garsebi da kanis mikrotravmebis adgilebi. pirveladi
afeqti ar viTardeba. damaxasiaTebelia infeqciis swrafi generalizacia zogadi
intoqsikaciisa da Trombohemoragiuli sindromis ganviTarebiT. endemur adgilebSi
adamianebSi (7%-mde) dadgenilia virusis mimarT antisxeulebis arseboba, rac saSualebas
gvaZlevs, vifiqroT daavadebis msubuq an usimptomo mimdinareobazec.
klinika. inkubaciuri periodi 1-dan 15 dRemde meryeobs. klinika marburgis
cxelebis msgavsia. daavadeba iwyeba mwvaved, maRali temperaturiT 39-400 C-mde. avadmyofebi
uCivian Tavisa da kunTebis Zlier tkivils, faRaraTs, muclis tkivils. SesaZlebelia
mSrali xvela da mCxvletavi xasiaTis tkivili gulmkerdis areSi. aRiniSneba
199
kerZo nawili.
hemoragiuli cxelebebi. ebolas cxeleba
dehidrataciis movlenebi. daavadebis me-5-7 dRes Cndeba makulur-papuluri gamonayari,

romelic kanis aqercvliT mTavrdeba. hemoragiuli sindromi gamoixateba sisxlCaqcevebiT
koniunqtivaSi, piris Rrus lorwovan garsebSi. sisxldena aRiniSneba sxvadasxva
organoebidan _ cxviridan, saSvilosnodan, kuWidan (sisxliani Rebineba), orsulebSi
xSiria aborti. cxelebis periodi 5-7 dRe grZeldeba, mis bolos 50%-Si Cndeba
wiTelasmagvari gamonayari kidurebze. intoqsikaciis simaRleze viTardeba oliguria.
SesaZlebelia infeqciur-toqsikuri Sokis ganviTareba. avadmyofi kvdeba, Cveulebriv,
daavadebis meore kviras sisxldenisa da Sokis fonze. periferiul sisxlSi aRiniSneba
neirtrofiluri leikocitozi, Trombocitopenia, anemia.
gamojanmrTeleba iwyeba me-9-10 dRes.
diagnozi da diferenciuli diagnozi. diagnozi eyrdnoba klinikur,
epidemiologiur da laboratoriul monacemebs. laboratoriuli gamokvlevebidan
sargebloben virusologiuri da serologiuri meTodebiT, romlebic tardeba mxolod
specialur laboratoriebSi.
diferenciuli diagnostika tardeba hemoragiul cxelebebTan.
mkurnaloba igivea, rac marburgisa da sxva cxelebebis dros.
prognozi mZimea da letaloba Seadgens 30-90%-s.
profilaqtika. avadmyofebi Tavsdebian boqsebSi. momvleli personali muSaobs
Savi Wiris dros gaTvaliswinebuli spectansacmliT. rekonvalescentis gawera dasaSvebia
daavadebis 21-e dRidan.
200
kerZo nawili. cofi
cofi
(RABIES)
sinonimebi: wylis SiSi (Hydrophobia, Lyssa), haeris SiSi (Aerophobia).

cofi mwvave neiroinfeqciuri daavadebaa nerwyv-nevraluri gadacemis meqanizmiT.
miekuTvneba zoonozur daavadebebs gansakuTrebiT saSiSi infeqciebis jgufidan,
mimdinareobs centraluri nervuli sistemis dazianebiT (encefaliti), romelic yovelTvis
mTavrdeba letalobiT.
cnobebi.. cofi uZvelesi droidan aris cnobili. pirveli
klinikuri aRwera ekuTvnis korneli celsiuss (I saukune Cv.w.aR-mde), romelmac
daavadebas misca saxelwodeba _ wylis SiSi (Hydrophobia). 1884w. lui pasteris
mier mowodebuli iqna cofis sawinaaRmdego vaqcina, romelmac daavadebis profilaqtikaSi
udidesi gardatexa moaxdina.
etiologia.. cofis virusi (Neuroryctes rabies) miekuTvneba miqsovirusebis jgufs,
etiologia
Lyssaviridae-s gvars, Rabdoviridae-s ojaxs. aRmoCenilia 1903w. ramlenJes mier.
misi nawilakebi zolian cilindrs mogvagoneben, romlis SigniTac imyofeba erTZafiani
rnm-is Semcveli nukleokafsidi. ukanasknelis mimarT antisxeulebi SeiZleba gamovlenili
iqnes avadmyofi cxovelis sisxlSi, magram proteqciuli moqmedebis unari gaaCnia
mxolod antisxeulebs zedapiruli glikoproteinebis mimarT. virusis zedapiri
dafarulia glikoproteiduli warmonaqmnebiT, romlebic amJRavneben hemaglutinaciur
aqtivobas, magram mxolod virusTan maTi kavSiris SemTxvevaSi. viruss rusuli SaSxanis
tyviis forma aqvs, romlis zoma 90-170nm-dan 100-200 nm-mde aRwevs. virusi swrafad
iRupeba duRilisas, 2-3%-ian lizolis an 0,1%-ian qloraminis da sulemis xsnarSi.
kargad itans dabal temperaturas, gayinvas. neironis citoplazmaSi virusis gamravlebisas
warmoiqmneba specifikuri ovaluri CanarTebi 0,5-2,5 nm zomis _ babeS-negris sxeulakebi,
romlebic warmoadgenen virusebis koloniaTa grovas.
arCeven `velur” anu `quCis” da fiqsirebul, pasteris mier bocveris organizmSi
adaptirebul virusebs.
bunebriv pirobebSi `veluri~ virusi cirkulirebs cxovelebSi. fiqsirebuli virusis
Senaxva xdeba laboratoriul pirobebSi da is gamoiyeneba cofis sawinaaRmdego
vaqcinisaTvis. vaqcinuri Stamebi iwveven srulyofil imunitets veluri Stamebis
mimarT, rac maT saerTo antigenur erTobliobas mowmobs. garda aRniSnuli Stamebisa,
arCeven, agreTve, bunebriv biovarebs _ ùcnaurobis” da `SeSlili” ZaRlis virusebs.
epidemiologia.. cofi enzooturi infeqciaa da praqtikulad msoflios yvela
epidemiologia
kontinentze gvxvdeba, avstraliisa da antarqtidis garda. cofi praqtikulad ar
gvxvdeba iq, sadac Semoyvanil cxovelebze (ZaRli, kata da sxv.) mkacri karantinuli
reJimi tardeba, (didi britaneTi, malta, axali zelandia, iaponia da sxva). saqarTveloSi
am bolo wlebSi adgili hqonda cofis SemTxvevebs. msoflioSi yovel wels cofiT
25000-100000-mde adamiani da milionze meti cxoveli avaddeba. garemoSi virusis
gamoyofa xdeba inficirebuli cxovelisa da adamianis nerwyvidan inkubaciuri periodis
ukanaskneli 7-10 dRidan da grZeldeba daavadebis mTel manZilze. adamianis dasnebovneba
xorcieldeba inficirebuli cxovelebis kbenis, dazianebuli kanis, lorwovani garsebis
dadorbvlis Sedegad. virusis Semcveloba sxvadasxva cxovelis nerwyvSi araTanabari
intensivobisaa. nerwyvSi virusis yvelaze maRali Semcveloba aReniSneba myralas.
ZaRlis nerwyvSi virusis Semcveloba gacilebiT adre dgindeba, vidre ganviTardeba
201
kerZo nawili. cofi
daavadebis klinika. amitom adamianis dasnebovneba garegnulad janmrTeli ZaRlisagan

10 dRisa da metis gavlis Semdeg realobaa. Tu amave dros cxoveli, romelmac dakbina
adamiani, 10 dRis ganmavlobaSi ar mokvda, maSin adamianis daavadebis riski didi araa,
vinaidan cxoveli iSviaTad ganikurneba cofisagan.
Ramurebi didi xniT rCebian infeqciis wyarod, amave dros maTSi daavadeba klinikurad
ar vlindeba. Ramurebi viruss didi raodenobiT gamoyofen eqskrementiT, es ki iseT
adgilebSi rogorc gamoqvabulebi, mtvriT, aerogenuli gziT inficirebis saSiSroebas
qmnis.
vinaidan adamianis inficireba, ZiriTadad, ZaRlisagan xdeba, interess moklebuli ar
aris maTSi daavadebis mimdinareobis ZiriTadi gamovlinebebis aRwera, romelic mocemulia
Blauter-is mier:
cofian ZaRlebSi `mZvinvareba”, `mrisxaneba” ganpirobebulia centraluri nervuli
sistemis agznebiT, cxelebiTi mdgomareobiT, hiperesTeziiTa da umadobiT. aseTi gamovlineba
bevradaa damokidebuli ZaRlis xasiaTze da gawafulobaze. agresiuli ZaRlebi daavadebis
adreul stadiaSive ikbinebian, alersiani cxovelebi nerwyvisagan iclebian, arafers ar
Wamen an agznebulni xdebian, mogvianebiT ki avlenen agresiulobas ara marto ucnobi
pirebis mimarT, cdiloben daiWiron da ukbinon warmosaxviT, moCvenebiT sagnebs, devnian
da kbenen sxva cxovelebs. bolos garbian saxlidan Sors, kbenen Semxvedrebs gzaze,
iRupebian dambliT; Tumca aseTi klinika yovelTvis ar aris gamoxatuli.
inficirebis aRniSnuli meqanizmis garda dasnebovneba SesaZlebelia, agreTve, alimenturi
da transplacenturi gziTac. ar aris gamoricxuli adamianidan adamianze infeqciis
gadacema. aRwerilia Tvalis rqovanas gadanergvis Semdeg cofiT inficirebis ramdenime
SemTxveva.
yvelaze met saSiSroebas warmoadgens kbena Tavisa da saxis midamoebSi (Tavis
tvinTan axlos), gansakuTrebiT, Rrma Wrilobebis dros. sqeli tansacmeli da fexsacmeli
mniSvnelovnad icavs adamians inficirebisagan.
mimRebloba cofisadmi, albaT, absoluturi araa. amaze metyvelebs is faqti, rom
cofiT daavadebuli cxovelis kbenis Semdeg adamianebSi daavadeba viTardeba mxolod
3-dan 50% SemTxvevaSi. amave dros, xazgasasmelia, rom cofiani mglis kbenisas daavadebas
adgili aqvs 16-dan 100%-mde. daavadebis sixSire damokidebulia kbenis lokalizaciaze.
amaze mowmoben Semdegi monacemebi: saxeze kbenis Semdeg daavadeba viTardeba 90%-Si,
xelis mtevnebze _ 63%-Si, xolo xelebisa da fexebis proqsimalur nawilebze kbenisas
mxolod 23%-Si. yvelaze nakleb procentSi cofiT dasnebovnebas adgili aqvs terfis
dazianebis dros.
daavadeba praqtikulad gvxvdeba zafxul-Semodgomis periodSi, rac gamowveulia am
dros adamianis kontaqtis gaaqtiurebiT velur cxovelebTan da moxetiale ZaRlebTan.
upiratesad avaddebian 7-12 wlis asakis bavSvebi.
paTogenezi.. damtkicebulia, rom cofis virusi mravldeba uSualod kunTebSi,
paTogenezi
nakbenis irgvliv, nervul daboloebebSi SeRwevis Semdeg vrceldeba centriskenuli
nervebiT da aRwevs mamoZravebel neironebs. varaudoben, rom antisxeulebi, interferoni
da makroorganizmebis damcveli sxva faqtorebi damRupvelad moqmedeben kunTebis
ujredebidan gamosul virusebze. arasakmarisi damcvelobiTi meqanizmis dros advilad
xdeba virusis SeRweva nervul sistemaSi. amasTan virusis gavrceleba da tvinis
dazianebis siCqare damokidebulia kbenis adgilze. virusis replikacia xdeba mogrZo
tvinis, hi pokampis (amonis rqis), Tavis tvinis fuZisa da zurgis tvinis welis midamos
neironebSi. iwvevs refleqsuli agznebadobis gaZlierebas, sunTqvisa da saylapavis
kunTebis SekumSvas, hipersalivacias, gaZlierebul oflianobas, gul-sisxlZarRvTa, sunTqvis
sistemis funqciis darRvevas, damblas.
202
kerZo nawili. cofi
centraluri nervuli sistemidan virusi centridanuli gziT isev nervuli ReroebiT

aRwevs sxvadasxva organoebs _ Tirkmelzeda jirkvlebs, Tirkmelebs, filtvebs, RviZls,
ConCxis kunTebs, kans, guls, jirkvlebs. garemoSi virusis gamoyofa xdeba nerwyvis
saSualebiT.
ar SeiZleba, agreTve, uarvyoT organizmSi limfogenuri da hematogenuri gziT
virusis gavrceleba. interess iwvevs is faqti, rom cofis virusis glikoproteinis
aminomJavebis Tanmimdevroba gvelis Sxamis neirotoqsinis analogiuria, romelic arCeviTad
ukavSirdeba acetilqolinis receptorebs. es SesaZlebelia, ganapirobebdes, cofis virusis
neirotropulobas, xolo misi SeerTeba specifikur neirotransmiterul receptorebTan
an neironis sxva molekulebTan iwvevs autoimunur reaqciebs da zogierTi sxva
jgufis seleqciur dazianebas.
cofiT gardacvlilebSi naxuloben tvinis hemisferoebis qerqis da Txemis, mxedvelobis
borcvebis, Savi substanciis neironebis daSlas, qala-tvinis nervebis birTvebis bazaluri
gliebis da tvinis xidis daSlas, magram maqsimaluri cvlilebebi vlindeba mogrZo
tvinSi, gansakuTrebiT IV parkuWis fuZeze. dazianebuli ujredebis irgvliv viTardeba
oqsifiluri CanarTebi (babeS-negris sxeulakebi), romlebic warmoadgenen virionebis
koloniebis grovas da gadamwyveti diagnostikuri mniSvneloba aqvT daavadebis
diagnostikaSi.
klinika.. daavadebis mimdinareobaSi arCeven inkubaciur periods, dawyebiT anu
klinika
prodromuls (depresiuls), gaSlils (agznebis) da terminalur anu paralizur periodebs.
inkubaciuri periodi 5 dRidan 1 wlamde meryeobs, saSualod 30-60 dRe. iSviaTad
SeiZleba gaxangrZlivdes 2 wlamde.
masiuri inficirebis dros, rasac adgili aqvs Tavisa da saxis vrceli Wrilobis
SemTxvevaSi, inkubaciuri periodi yvelaze xanmoklea _ 5-9 dRe, bavSvebSi inkubaciuri
periodi ufro xanmoklea.
prodromuli periodi SeiZleba 2-dan 10 dRemde gagrZeldes. daavadeba iwyeba
nakben adgilze wvis SegrZnebiT, yru an gabmuli xasiaTis tkiviliT, qaviliT, kanis
hi peresTeziiT. zogjer ukve Sexorcebuli nakbeni Wrilobis Semdegac adgili aqvs
nawiburis hi peremias da SeSupebas. araspecifikuri intoqsikaciis movlenebidan viTardeba
organizmis zogadi dauZlureba, Tavis tkivili, dispefsiuri movlenebi _ madis daqveiTeba,
gulisreva, Rebineba. temperatura Rebulobs subfebrilur xasiaTs, erTdroulad aRiniSneba
fsiqikis darRvevis simptomatika _ autaneli SiSi, sevda, mRelvareba, depresia, gaZlierebuli
gaRizianeba. avadmyofs awuxebs koSmaruli sizmrebi, “Caketilia”, saxeze miyenebuli
dazianebis dros aRiniSneba ynosviTi da mxedvelobiTi halucinaciebi.
periodi.. depresiul periods cvlis agznebis periodi, romelic gamoixateba
agznebis periodi
zogadi mousvenrobiT, Zlieri refleqsuli agznebadobiTa da mkveTri simptomatikiT.
adgili aqvs pulsis da sunTqvis gaxSirebas; avadmyofebs awuxebT gulmkerdSis moWeriTi
tkivilis SegrZneba, sunTqvisa da ylapvis darRveva progresirebs. uviTardebaT cofisaTvis
yvelaze metad damaxasiaTebeli simptomatika, romelic pirvel rigSi gamoixateba
wylisadmi SiSSi (hidrofobia), wylis dalevis cdisas, male ki misi danaxvisas, wylis
Cxrialis xmis gagonebisas da a.S. avadmyofs uviTardeba saylapavisa da xorxis kunTebis
spazmi. aseTi paroqsizmebi SeiZleba gamowveuli iyos haeris moZraobiTac (aerofobia),
mkveTri sinaTliT (fotofobia), xmauriT, xmamaRla laparakiT (akustikofobia). Setevebi
iwyeba mousvenrobiT, SiSiT, Semdeg erTvis moZraobiTi agzneba, krTomebi, sunTqva Zlier
gaZnelebulia, rac vlindeba sunTqvaSi gulmkerdis damxmare kunTebis monawileobaSi.
sunTqva xdeba xmauriani, wyvetili, amosunTqva gaZlierebulia. adgili aqvs haeris
mkveTrad gamoxatul ukmarisobas. paroqsizmebis dros saxis gamometyveleba Zlier
damaxasiaTebelia. avadmyofebi kivian, Tavi da gulmkerdi ukanaa gadazneqili. zogjer
203
kerZo nawili. cofi
aRiniSneba opistotonusi, win agdeben akankalebul xelebs, Tavidan iSoreben, isvrian

wyliT avsebul WurWels. awuxebT mtkivneuli krunCxvebi, romelic dakavSirebulia
hi poqsiasTan Serwymul hi perventilaciasTan. aseTi krunCxvebi amaxinjeben avadmyofis
saxes, igi Rebulobs cianozur elfers, gamoxatavs SiSs, gugebi farTovdeba. avadmyofis
mzera mimarTulia erTi wertilisaken, kiseri wamoweulia, qoSini inspiraciul xasiaTs
Rebulobs, xdeba mstvinavi. avadmyofi iTxovs Svelas, Tvalebi gadmokarkluli aqvs.
paroqsizmebis dros SeiZleba moxdes gulisa da sunTqvis gaCereba. Setevis xangrZlivoba
ramdenime wams Seadgens, Tu igi ukanaskneli ar aRmoCnda; Setevebi SemdegSi meordeba.
avdmyofis qceva daavadebis saxelwodebis adekvaturia; Rrmavdeba fsiqikuri moSliloba:
avlens agresiulobas _ amtvrevs nivTebs, ixevs tansacmels, ikbineba, yviris, aslokinebs.
drodadro avadmyofi grZnobs Tavis gamouval mdgomareobas, iTxovs daxmarebas.
agznebis periodSi adgili aqvs simpatikuri nervuli sistemis tonusis momatebas,
ris gamoc avadmyofs aReniSneba gaZlierebuli salivacia (sialorea), romelic Rrmavdeba
nerwyvis ylapvis SeuZleblobiT xaxis kunTebis spazmis gamo, avadmyofi ganuwyvetliv
ifurTxeba. adekvaturi mkurnalobis gareSe viTardeba gauwyloeba, saxis kunTebi xdeba
wawvetebuli, sxeulis masa klebulobs, temperatura matulobs maRal cifrebamde.
agznebis periodi grZeldeba 2-3 dRe, iSviaTad 4-5 dRe. erT-erTi Setevis dros
avadmyofi SeiZleba mokvdes. SedarebiT iSviaTad avadmyofebi inarCuneben sicocxles
daavadebis mesame kviramde. Tu Setevis periodSi avadmyofi ar daiRupa, daavadeba
gadadis paralizur stadiaSi.
periodi.. am periodisaTvis damaxasiaTebelia bavSvis fsiqikuri
paralizuri periodi
damSvideba, qreba SiSisa da gangaSis grZnoba, wydeba hidro- da aerofobiis Setevebi.
Cndeba Wamisa da smis SesaZlebloba. iqmneba gamojansaRebis STabeWdileba (es ki
“avismomaswavebeli simSvidea”). amave dros matulobs moduneba, apaTia, salivacia, viTardeba
kidurebisa da qalas nervebis sxvadasxva lokalizaciis damblebi. damblebi atarebs
landris ti pis aRmaval xasiaTs. viTardeba menjis Rrus organoebis disfunqcia,
temperatura aRwevs 42°C-mde. avadmyofi kvdeba agoniis gareSe, uecrad, gulisa da
sunTqvis centris dambliT.
cnobilia cofis paralizuri forma e.w. “miwynarebuli cofi”, romelic viTardeba
iSviaTad da xasiaTdeba progresuli dambliT (landris ti pis), naTxemis funqciis
darRveviT, agznebis stadiis gareSe. sikvdili dgeba bulburi damblebis zrdis fonze.
cofis klinikis stadiurobas SeiZleba yovelTvis adgili ar hqondes. prodromuli
periodi da agzneba SesaZlebelia ar iyos gamoxatuli, iseve, rogorc hidrofobia an
fobiebis simptomatika.
ati pur fo rmebs miekuTvneba bulburi, naTxemis, meningoencefalituri formebi da
formebs
sxva.
meningealuri formebis dros Tav-zurgtvinis siTxe xasiaTdeba limfocituri
citoziT.
cofis dros periferiul sisxlSi vlindeba neitrofiluri leikocitozi,
hemoglobinis, eriTrocitebis, hematokritis momateba.
diagnozi. daavadebis diagnozi eyrdnoba epidemiologiur anamnezs (cofze saeWvo
cxovelebiT dakbena da dadorblva), klinikur gamovlinebebs _ nakbenis adgilas
paresTeziebis ganviTareba; saerTo intoqsikaciis fonze damaxasiaTebeli simptomatikis
ganviTarebas (hidrofobia, bodvebi, halucinaciebi da sxv.), laboratoriul monacemebs.
diferenciuli diagnostika tardeba yvela daavadebasTan, romelic mimdinareobs
encefalitiT da gamowveulia arbo-, entero- da martivi virusebiT. am dros yvela
sxva daavadebis uaryofa SeiZleba, Tu avadmyofs aqvs mxolod mogrZo tvinis (Reros)
dazianebis simptomebi cnobierebis SenaxviT da Tu gamoricxulia Tavis tvinis moculobiTi
204
kerZo nawili. cofi
procesi (simsivne).
tetanusis dros gamowveuli kunTebis spazmi zogjer siZneles qmnis cofis
diagnostikaSi, magram cofis dros adgili ara aqvs trizms, tetanusis dros ki –
hidrofobias.
kvebiTi da Wrilobismieri botulizmi mimdinareobs agreTve damblebiT, magram ar
aRiniSneba sensoruli darRvevebi.
diferenciuli diagnostikis TvalsazrisiT ZiriTadi siZneleebi warmoiSoba cru
cofis suraTis dadgenisas isterionevrozul avadmyofebSi, romlebic TavianT Tavs
cofiT dasnebovnebulad Tvlian. aseT SemTxvevebSi anamnezi zogjer gaurkvevelia
(xSirad damkbeni cxoveli janmrTelia). avadmyofebs axasiaTebT subieqturi Civilebis
siuxve, ara aqvT sunTqvis darRveva, taqikardia, gugebis gafarToeba, daavadeba gamoirCeva
xangrZlivi mimdinareobiT.
zogjer cru cofis klinikis msgavsi suraTi aRiniSneba agreTve atropiniT, striqniniT
mowamvlis dros, magram aq didi mniSvneloba eniWeba cofisaTvis damaxasiaTebel
kardinalur simptomebs da anamnezs.
laboratoriuli diagnostika. diagnostika SesaZlebelia avadmyofis sicocxleSi.
virusis aRmoCena SeiZleba mafluorescirebeli antisxeulebis meSveobiT rqovanidan
aRebul nacxSi an kisris midamos kanis anaTalSi Tmis zrdis doneze. aRniSnuli
sinjebis dadebiTi Sedegebi aixsneba virusis gavrcelebiT Tavis tvinidan nervul
boWkoebSi, romeliTac mdidaria rqovana da Tmis folikulebi. virusis gamoyofa
SeiZleba nerwyvidan, cremlidan, Tav-zurgtvinis siTxidan, axalSobili Tagvebidan maTi
intracerebruli dasnebovnebis dros.
cofis diagnostikaSi zusti Sedegebis miRweva SeiZleba gardacvlili adamianis,
cxovelis histologiuri gamokvlevebis Sedegad Tavis tvinis hi pokampis midamoSi
aRebuli nacxis specialuri SeRebvis Semdeg, Cveulebrivi sinaTlis mikroskopiiT
babeS-negris sxeulakebis aRmoCeniT.
serologiuri gamokvlevebidan iyeneben neitralizaciis, komplementSemboWav (kSr),
pasiuri hemaglutinaciis reaqciebs, radioimunur meTods aravaqcinirebul pirebSi.
mkurnaloba.. etiotropuli mkurnaloba amJamad ar arsebobs. gansakuTrebuli
mkurnaloba
mniSvneloba aqvs Wrilobis pirvelad damuSavebas. am mizniT axdenen Wrilobis gamorecxvas
didi raodenobiT sapniani wyliT. Semdeg Wrilobas amuSaveben 70%-iani spirtiT an
koncentrirebuli iodis spirtiani xsnariT. qirurgiuli Careva (napirebis amokveTa da
misi gakerva) mkacradaa akrZaluli inkubaciuri periodis SesaZlebeli Semcirebis
gamo. Wrilobis damuSavebis Semdeg aucilebelia bavSvis gagzavna asacrel punqtSi,
sadac utardeba pasiur-aqtiuri imunizacia, rogorc cofis, aseve tetanusis sawinaaRmdegod.
antirabiuli imunoglobulini eniSnebaT imunizaciasTan (vaqcinasTan) erTdroulad,
rac SeiZleba male (umjobesia kbenis Semdeg 24 saaTSi).
zogjer mkurnalobis mizniT SehyavT interferoni did dozebSi, magram misi efeqturoba,
iseve, rogorc antirabiuli Sratis, umniSvneloa. simptomuri saSualebebidan avadmyofebis
tanjvis Sesamcireblad iyeneben analgetikebs, maT Soris morfins, krunCxvis sawinaaRmdego
preparatebs. tardeba RonisZiebebi wyal-marilovani balansis aRsadgenad. eniSnebaT
gul-sisxlZarRvTa, sunTqvis mastimulirebeli medikamentebi. Cvenebisas avadmyofi gadahyavT
xelovnur sunTqvaze. yvela Catarebuli RonisZieba mxolod mcireoden gaumjobesebas
iZleva da rogorc wesi, daavadeba letaluri gamosavliT mTavrdeba.
cofis sawinaaRmdego pasiur-aqtiuri imunizacia utardeba yvela dazaralebuls
Sesabamis punqtSi.
pasiuri imunizaciis mizania, uzrunvelhyos dazaralebulis dacva antisxeulebiT,
aqtiuri vaqcinaciiT gamowveuli antisxeulebis gamomuSavebamde. antisxeulebis Seyvana
205
kerZo nawili. cofi
wyvets virusis fiqsacias da mis adgils ikavebs vaqciniT ganpirobebuli aqtiuri

antisxeulebi.
pasiuri imunizaciis mizniT zogierT qveyanaSi gamoiyeneba: a) cxenis antirabiuli
Srati, magram misi Seyvanis Semdeg 5%-Si viTardeba alergiuli reaqcia, b) adamianis
antirabiuli imunoglobulini, romelic praqtikulad ar iZleva alergiul reaqciebs.
ukanasknelis doza ganisazRvreba 20 saerTaSoriso erTeuliT 1 kg sxeulis masaze,
romlis naxevari SehyavT kbenis adgilis irgvliv, xolo meore naxevari ki kunTebSi.
cxenis antirabiuli Sratic SehyavT organizmSi wignis zogad nawilSi aRwerili
meTodiT. kortikosteroidebis gamoyeneba ukunaCvenebia, radgan isini cofis virusze
mastimulirebel moqmedebas iwveven.
arCeven antirabiuli vaqcinis sam ti ps: 1) miRebuli mozrdili an axalSobili
ZuZumwovara cxovelis nervuli qsovilebidan (gamoiyeneboda adre). 2) frinvelis
qsovilebidan da 3) adamianis di ploiduri ujreduli vaqcina _ HDCV _ human
diploidcell vaccine (yvelaze efeqturi da uvnebeli) an makaka rezus maimunis
di ploiduri (Ðàáèâàê- âíóêîâî-32) vaqcina.
nervuli qsovilisagan damzadebuli vaqcina gamoirCeva maRali reaqtiulobiT da
xSiri alergiuli reaqciebiT, encefalitis ganviTarebiT.
msoflioSi yvelaze aqtiur da amave dros naklebad mkveTri movlenebis mqone
vaqcinad iTvleba adamianis diploiduri antirabiuli vaqcina (aSS). antigenuri TvisebebiT
igi sxva vaqcinebze 10-jer ufro Zlieria da misi Seyvana organizmSi Semoifargleba
5-jeradi SeyvaniT. vaqcina SehyavT deltisebr kunTSi (zustad!). dadgenilia, rom
dundula kunTebSi Seyvanis SemTxvevaSi ( mozrdilebSi! ) vaqcinis imunuri efeqti
naklebia.
vaqcina keTdeba 1 ml raodenobiT xuTjeradad _ 1,3,7,14,28 dRes kbenis Semdeg.
zogierT evropul qveyanaSi rekomendebulia meeqvse dozis Seyvana, Tumca 5 doza,
Cveulebriv, ukve uzrunvelhyofs imunitets. bavSvebSi dozebs ar amcireben !
qvemoT warmodgenilia mkurnalobis Catarebis orientirebi kbenis Semdeg.
cxovelze dakvirveba an misi kbenis S emTxvevaS i

cxovelis saxe
mdg omareo bis Sefaseba sarekomendacio Ro nisZiebebi
janmrTeli kbenis momentSi da Tu
profilaqtika iwyeba, Tu cxovels
SesaZlebelia cxovelze dakvirveba 10
ganuviTarda daavadebis niSnebi*
dRis manZilze
ZaRli, kata
cofiT daavadebuli an eWvmitanili ∼ saswrafo vaqcinacia da RIG Seyvana
‡
mimarTeT specialur samsaxurs

Tu cnobili ar aris
konsultaciisaTvis
ivaraudeT, rom cxoveli

myrala, enoti,
inficirebulia, Tu cnobili ar aris,
Ramura, melia da
saswrafo vaqcinacia da RIG Seyvana
‡
rom geografiuli zona cofisgan
sxva xorcismWameli
Tavisufalia, sanam ar iqneba miRebuli
nadirebi; kodala
laboratoriuli monacemebi ∼
mimarTeT specialur samsaxurs

konsultaciisaTvis. rogorc weri, ciyvis,
saqoneli, qrcvini,
burundukis, zRvis goWis, zazunas,
mRrRnelebi, gadasawyvetia individualurad
virTxis, Tagvis da sxva mRrRnelebis,
bocveri, kurdReli
bocveris, kurdRlis nakbenebi ar
saWiroebs antirabiul mkurnalobas
206
cofi
kerZo nawili. aiv/Sidsi
* _ 10 dRis dakvirvebis periodSi, Tu cxovels aRmoaCnda daavadebis pirveli niSnebi,

saWiroa antirabiuli imunoglobulinis (adamianis) _ RIG ((Rabies Immune Globulin)
Seyvana vaqcinasTan erTad. daavadebis simptomebis mqone avadmyofi cxoveli unda daiklas
da gamoikvlios laboratoriulad.
∼ _ saWiroa cxovelis dauyovnebeli dakvla da laboratoriuli gamokvleva.
dakvirveba rekomendebuli ar aris. vaqcinacia Sewydes, Tu imunofluorescenciuli testi
uaryofiTia.
‡ _ ixile teqstSi.
arsebobs winaswari profilaqtikuri acrebi riskis jgufis adamianebisaTvis

(veterinarebi, laboratoriis muSakebi da sxv.).vaqcina risk-jgufebSi keTdeba Semdegi
cxrilis mixedviT: 1, 7, 21 an 28 dRe (sul 3-jer).
vaqcinis Semdeg sruli imunitetis dadgenis mizniT serologiuri kontroli saWiro
ar aris.
vinaidan sxvadasxva meTodiT damzadebuli vaqcinis efeqturoba sxvadasxvaa da
ineqciebis sixSirec gamsxvavdeba, saWiroa yovel konkretul SemTxvevaSi aqtiuri
imunizacia Catardes TandarTuli saTanado instruqciis Tanaxmad.
antibiotikebis daniSvna mizanSewonilia Wrilobis gabinZurebis SemTxvevaSi.
cofis profilaqtika gamoixateba daavadebuli cxovelis gamovlinebaSi da maT
likvidaciaSi. ama Tu im raionSi epizooturi viTareba damokidebulia daavadebis
gavrcelebaze gareul cxovelebSi, pirvel rigSi gareuli ZaRlis ojaxis saxeobebis
warmomadgenlebze. aucilebelia mudmivi kontroli da regulacia maT ricxobriv
Semadgenlobaze.
germaniaSi da SveicariaSi Catarebulma farTomasStabianma oralurma vaqcinaciam
cocxali vaqciniT ganapiroba daavadebis mkveTri Semcireba aRniSnuli qveynebis bunebriv
kerebSi.
Sinauri cxovelebis epizootiis winaaRmdeg brZola mdgomareobs moxetiale ZaRlebisa
da katebis daWeraSi, aucilebel vaqcinaciaSi, Sinaur da sameurneo cxovelebSi daavadebis
kerebis gamovlinebaSi.
daavadebis profilaqtikaSi mniSvnelovani adgili ukavia sanitarul-veterinarul
propagandas.
cofis yvela SemTxvevis Sesaxeb saWiroa, zemdgom organoebsa da daavadebaTa kontrolis
centrs acnobon.
aiv/Sidsi
(adamianis imunodeficitis virusi
/SeZenili imunodeficitis sindromi)
HIV/AIDS (HUMAN IMMUNODEFICIENCY VIRUS/
AQUIRED IMMUNODEFICIENCY SYNDROME)
aiv-infeqcia _ nelaprogresirebadi anTroponozuli daavadebaa, romelic mimdinareobs

specifikuri imunodeficituri sindromiT, ris fonzec xdeba avTvisebiani simsivneebis,
oportunistuli infeqciebisa da autoimunuri daavadebebis Camoyalibeba.
cnobebi. aiv-infeqcia pirvelad aRweres aSS-Si 1981 wels.
avadmyofebi iyvnen homoseqsualisti mamakacebi, romlebic imyofebodnen daavadebis finalur
207
stadiaSi, maT aReniSnebodaT pnevmocisturi pnevmonia (m.s. gotlibi da i. pozalski) da

kapoSis sindromi (a. fridmani). imasTan dakavSirebiT, rom aRniSnul avadmyofebSi
xdeboda imunuri sistemis moSla, axalma daavadebam miiRo saxelwodeba AIDS (Aquired
immunodeficiency syndrome) anu Sidsi (SeZenili imunodeficitis sindromi).
pirveli cnobebi daavadebis gamomwvevze mowodebuli iyo 1983 wels frangi mecnieris
montanies mier, romelmac homoseqsualisti mamakacis limfur kvanZSi aRmoaCina virusi
da uwoda mas LAV (Lymphoadenopathy associated virus). erTi wlis Semdeg, 1984
w. analogiuri virusi aRmoaCina r. halom da uwoda mas HTLV-III (Human T-
Limphotropic virus type III). SemdgomSi orive virusis identuroba damtkicda da
1987 wels saerTaSoriso komisiis mier mieca saxelwodeba adamianis imunodeficitis
virusi _ HIV ( Human immunodeficiency virus).
unda aRiniSnos, rom daavadebis aRricxvamde 5-10 wliT adre aRebulsa da Senaxul
SratebSi naxul iqna Sidsis virusis sawinaaRmdego antisxeulebi, rac miuTiTebs, rom
imunodeficitis virusi adrec cirkulirebda adamianebSi, centraluri afrikis regionSi,
saidanac sxva kontinentebzec gavrcelda.
amJamad Sidsi registrirebulia msoflios xuTive kontinentis 206 qveyanaSi. aiv-
iT inficirebulTa 90% ganviTarebad qveynebze modis: 3/5 afrikis kontinentis mcxovrebia,
1/5 _ aziis. yvelaze didi procenti modis karibis zRvis auzis qveynebze, centralur
afrikaze, amerikasa da dasavleT evropaze. yofili sabWoTa kavSiris teritoriaze aiv-
infeqcia registrirebuli iyo 1985 w, xolo 1989-94 wlebSi ruseTis federaciaSi
inficirebul moqalaqeTa ricxvi 47-dan gaizarda 825-mde, rac safuZvels iZleva,
ivaraudon, rom inficirebulTa ricxvi SeiZleba aRwevdes ramodenime aTass, rac qmnis
epidemiis ganviTarebis SesaZleblobas. amJamad ki msoflioSi imunodeficitis virusiT
yoveldRe inficirdeba 8500 adamiani, maT Soris 1000-mde _ 15 wlis asakamde bavSvi.
Tbilisis Sidsis respublikuri centris monacemebiT 2000 wlis 20 maisisTvis
saqarTveloSi registrirebulia aiv-infeqciis 123 (70% - i.-v. narkomani, 25% -
heteroseqsuali, 3% - homo da biseqsuali, 1% - sisxlis reci pienti) SemTxveva, maT
Soris 34 adamiani daavadebulia SidsiT (mokvda 22). varaudoben, rom dReisaTvis
inficirebulTa ricxvi 2000-ze metia.
etiologia. aiv miekuTvneba rnm-is Semcvel retrovirusebis (Retrovirus) ojaxs,
etiologia
neli mimdinareobis virusuli infeqciebis _ lentivirusebis (Lentivirus) qvejgufs.
virusis momwifebuli nawilakis diametria 100-140 nm. maT struqturaSi arCeven
tyviismsgavs nukleokafsidsa da garss _ subkafsids. nukleokafsidSi imyofeba genomi
orspiraliani rnm-is saxiT da ukutranskri ptaza anu revertaza. aiv-i genetikurad da
antigenurad araerTgvarovania. aRwerilia 2 ti pis virusi _ aiv-1 da aiv-2. aiv-is
genomi 3 ZiriTadi genisagan Sedgeba: 1) gag, romelic kodirebs Sinagani cilebis
warmoqmnas (P17/18, 24/26, 55/56), 2) env kodirebs _ garsis cilebis warmoqmnas (gp
41/36, 120/105, 150/140) da 3) pol kodirebs _ fermentuli sistemebis, maT Soris
ukutranskri ptazis sinTezs (p31,55,66/68). virionis garsi Sedgeba fosfoli pidebisa
da glikoproteidebisagan. ukanasknelis struqtura gansazRvravs virusis tropizms
patronis organizmis sxvadasxva ujredis mimarT. aiv-i tropulia im ujredebis mimarT,
romelTa membranebze imyofeba gansakuTrebuli cilovani struqturebi _ CD4 anti-
gen-receptorebi. virusi kargad mravldeba aqtivirebul T4 limfocitebSi, monocitebSi,
adamianis limfomis ujredebSi. virusis struqturul komponentebs aqvT antigenurobis
unari, romelic ganapirobebs specifikuri imunoglobulinebis sinTezs, maTi gansazRvra
ki gamoiyeneba infeqciis diagnostikisa da virusis tipis dasadgenad. virusis struqtura
mocemulia sqemaSi.
208
adamianis imunodeficitis virusis struqtura
virusi garemoSi aramdgradia. 56°C tempereturaze kvdeba 30 wuTis ganmavlobaSi,

70-80°C-ze _ 10 wuTSi, xolo duRili klavs 1-2 wuTSi. swrafad kvdeba eTilis
spirtSi, acetonSi, 0,2% natriumis hi poqloridis xsnarSi da sxva sadezinfeqcio
xsnarebSi. SedarebiT mdgradia maionizebeli radiaciis mimarT, ultraiisferi dasxivebis
mimarT, - 70°C gayinvisas.
virusis kultivireba SeiZleba adamianis T limfocitebze, eqsperimentuli infeqciis
gamowveva ki xorcieldeba SimpanzeebSi.
epidemiologia
epidemiologia. infeqciis wyaros warmoadgens adamiani, romelic imyofeba
infeqciuri procesis nebismier stadiaSi. inficirebuli adamianis organizmSi virusi
sxvadasxva substratSi imyofeba, yvelaze didi raodenobiTaa sisxlSi, spermaSi, saSos
gamonadenSi, dedis rZeSi, Tav-zurgtvinis siTxeSi, limfur kvanZebSi, Tavis tvinSi,
naklebi koncentraciiT ki _ cremlSi, nerwyvSi, oflSi.
virusis gadacemis meqanizmi, upiratesad, perkutaneulia, rogorc bunebrivi, aseve
xelovnuri gziT kanisa da lorwovani garsebis dazianebis Sedegad. amasTan yvelaze
mniSvnelovania virusis gavrceleba bunebrivi sqesobrivi gziT, rogorc heteroseqsualuri,
aseve, gansakuTrebiT, homoseqsualuri kontaqtebis dros sqesobrivi perversiisa da
promiskuitetis (mravlobiTi sqesobrivi partnioris yolis) SemTxvevebSi. aRniSnulTan
dakavSirebiT, aiv-infeqcias miakuTvneben sqesobrivi gziT gadamcem daavadebas (Sexu-
ally transmited disiases).
virusis gadacema SesaZlebelia inficirebuli sisxlis an sisxlis komponentebis
gadasxmiTac, inficirebuli organos transplantaciisas da mTeli rigi situaciebis
dros.
bavSvebis inficireba xSirad transplacenturi gziT xdeba. xazgasmiT aRvniSnavT,
rom adamianis imunodeficitis virusi, sxva retrovirusebisagan gansxvavebiT, ar gadaecema
STamomavlobiT genomSi CarTvis saxiT, aramed nayofSi aRwevs uSualod dedis sisxlidan
orsulobisa da mSobiarobis procesSi.
bavSvebSi serokonversiuli dedebisagan aiv-is gadacemis riski aRwevs 15-20%-s,
209
zogierTi monacemiT ki _ 50%-s. virusis gadacemis sixSire damokidebulia daavadebis

stadiaze da matulobs ZuZuTi kvebis dros.
virusis gadacema sayofacxovrebo, Cveulebrivi urTierTobebis dros ar aris
dadgenili. haeriT, sakvebiTa da wyliT ar gadaecema. transmisiuli gadacema, praqtikulad,
SeuZlebelia, vinaidan sisxlismwoveli mwerebis sisxlSi virusebi ar mravldeba.
paTogenezi da paTanatomiuri suraTi. virusis SeWra sisxlSi yvela SemTxvevaSi
parenteruli gziT xdeba (kanidan da lorwovani garsebidan), saidanac makrofagebis
meSveobiT xdeba maTi diseminireba organizmis sxvadasxva sistemaSi, maT Soris,
hematoencefaluri barieris gavliT Tavis tvinSi. virusebi im ujredebSi aRweven
endocitozis gziT, romelTac aqvT CD4-antigeni-receptorebi (T4 (CD4)) limfocitebi,
zogierTi B-limfociti, sisxlis monocitebi, alveoluri, koloreqtaluri da sxva
qsovilovani makrofagebi, farisebri jirkvlisa da Zvlis tvinis ujredebi, nawlavTa
lorwovani garsebis M-ujredebi, placentis ujredebi da sxva).
citoplazmaSi virusis genomis SeWris Semdeg informacia virusuli rnm-dan
ukutranskri ptazas meSveobiT ujredis dnm-ze gadaiwereba, dnm-is warmoqmnil erTZafian
struqturas igive fermentis meSveobiT daaSendeba rnm-is meore Zafi, xolo dnm-is
sigrZivi Sualeduri forma transformirdeba birTvSi, sadac Rebulobs beWdisebur
formas da gadaiqceva provirusad. aseT àraaqtiur” mdgomareobaSi, virusis axali
nawilakebis araintensiuri replikaciiT, virusi SeiZleba persistirebdes didxans (8-
10 weli da SesaZlebelia, metic), raime SesamCnevi gamovlinebis gareSe, magram antisxeulebis
gamomuSavebiT, pirvel rigSi ki, nukleokafsidisP P24 cilis winaaRmdeg. latenturi
mdgomareoba grZeldeba
aiv - is tropizmi organoebis da qsovilebis mixedviT manam, vidre romelime
( Â.Ô. Ó÷àéêèí) darTuli infeqciis
mizeziT ar daiwyeba T-
limfocitebis stimu-
lacia, rac, Tavis mxriv,
iwvevs virusis aqtivobis
mZafr zrdas, CD4-is
dazianebasa da mis daRu-
pvas, es ki ganpirobebulia
gamonTavisuflebuli
virusis masiuri
SekavSirebiT CD4-is
zedapirze ganlagebul
gp120 fragmentTan. CD4
limfocitebis popu-
laciis SemcirebaSi didi
roli miekuTvneba
s e n s i b i l i z e b u l T8
(CD8) limfocitebsa da
kilerul ujredebs.
inficirebul ujredebSi
virusis aqtiuri
replikaciis Sedegad
xdeba ujredebis des-
truqcia da citolizi.
swored aiv-citopaTo-
210
genuri efeqti ujredis danekrozebisa da daRupvis saxiT warmoadgens erT-erT wamyvan

fenomens. citopaTogenuri moqmedebis meore komponents warmoadgens sincitiebis warmoSoba
arainficirebul da inficirebul ujredebSi, virusis zogierTi cilis (P120) paTogenuri
efeqti, ujredebis qronikuli infeqcia (langerhansis ujredebi, monociti, makrofagi,
neironebi).
amave dros aRiniSneba B-limfocitebis poliklonuri aqtivacia, matulobs yvela
klasis globulinebi, mocirkulire imunuri kompleqsebi, klebulobs interferonis
gamomuSaveba, bunebrivi kilerebis ricxvi, qveiTdeba interleikin-2-is produqcia, T-
helperebis - CD4 mier interleikin-1-is adsorbciis unari da sxva.
amrigad, CD4-ze virusis parazitireba ganapirobebs imunuri procesebis darRvevasa
da imunodeficitis ganviTarebas. gansakuTrebiT ki, CD4-is 400-mde daqveiTebisas 1
mkl sisxlSi aiv-is replikacia arakontrolirebadi xdeba.
am fonze advilad qveiTdeba organizmis saerTo rezistentoba _ igi uZluri xdeba
garkveuli mikroorganizmebis, maT Soris, pirobiTpaTogenurebis mimarTac. pirvel rigSi,
mxedvelobaSi misaRebia iseTi mikroorganizmebi, rogoricaa virusebi (herpesvirusebi,
gansakuTrebiT ki me-6 ti pis HHV, romelic alogenuri spermiT mravalricxovan
sqesobriv partniorebSi masensibilizebel efeqts iwvevs, papovavirusebi da sxva), baqteriebi
(atipuri mikobaqteriebi, legionelebi da sxva), sokoebi (kandida, kriptokoki, histoplazmebi
da sxva), umartivesebi (pnevmocista, kri ptosporidiebi da sxva) da helminTebi
(strongiloidebi da sxva). SesaZlebelia avTvisebiani simsivneebis (kapoSis sarkoma,
tvinis limfoma da sxva), autoimunuri procesebis ganviTareba (vaskulitebi, nevropaTia
da sxva). aRniSnuli paTologiebis TandarTvisas Sids-is suraTi srulad gaiSleba,
rasac organizmi mihyavs gardauval letalur gamosavlamde. dadgenilia, rom
dainficirebulTa 30% avaddeba pirvel 5 wels, 20%-s aReniSneba daavadebis susti
gamovlinebani, 50%-Si ki aranairi simptomatika ar vlindeba, Tumca maTi sisxlis
formul elementebsa da Tavisufal cirkulaciaSi yovelTvis SeiZleba virusis aRmoCena.
mZime mdgomareobis formirebaSi didi mniSvneloba eniWeba adamianis saerTo
imunoreaqtiulobas, virusiT masiur inficirebas maSin, rodesac savaraudo sayofacxovrebo
inficirebis dros xSirad viTardeba latenturi formebi da virusmtarebloba.
aiv-i mxolod imunotropul viruss ar warmoadgens, igi azianebs, agreTve, nervul
sistemas da sxva sistemebs. nervuli sistemis ujredebis dazianeba uSualod virusis
moqmedebiT xdeba, saxeldobr, ganpirobebulia xsenebuli gp120 Tu sxva cilebiT.
mniSvnelovania tvinis dazianeba oportunistuli infeqciebiTa da simsivneebiTac.
yuradsaRebia pirovnebis reaqcia inficirebasa da daavadebaze, vinaidan TviTon es faqti
warmoadgens gamoxatul paTologiur stress.
morfologiuri cvlilebebidan aRsaniSnavia limfuri kvanZebis gadideba, folikuluri
hi perplazia an maTi qsovilis involucia. virusis uSualo moqmedebis Sedegia gliuri
ujredebis anomaluri hi perplazia neironebis irgvliv, neironebis demielinizacia.
Zvlis tvinis mxriv aRiniSneba aplazia, vlindeba vaskulitis, nevropaTiis suraTi da
sxva. garda aRniSnulisa, meoradi infeqciis darTvisas naxuloben Sesabamis cvlilebebs
an simsivnur dazianebas.
klinika. aiv-infeqciis mimdinareobaSi arCeven 4 periods: inkubaciurs, daavadebis
pirveladi gamovlinebis, daavadebis meoradi gamovlinebis da dazianebis periods, calkeul
organoTa an sistemaTa upiratesobiT.
inkubaciuri periodi grZeldeba 3 dRidan ramdenime Tvemde, zogi monacemebiT ki 5
wels da met xansac.
pirveladi gamovlinebis mwvave fazaSi avadmyofTa nawils (20-30%-mde) aReniSneba
zogadintoqsikaciuri movlenebi (am mxriv principuli gansxvaveba bavSvebsa da mozrdilebs
211
Soris ar arsebobs, Tumca bavSvebs axasiaTebT Taviseburebani). daavadeba iwyeba

TandaTanobiT, saerTo sisustiT, temperaturis TiTqosda aramotivirebuli momatebiT,
limfuri kvanZebis gadidebiT, persistuli diareiT, sxeulis masis daklebiT. kanze
viTardeba sxvadasxva xasiaTis gamonayari _ eriTemuli, herpesuli, sokovani dazianebis
saxiT da sxv. SesaZlebelia maTi sxvadasxva kombinacia, raime specifikurobis gareSe.
wamyvan simptomebad iTvleba limfadenopaTiis movlenebi, limfuri kvanZebis gadideba
xSirad generalizebul xasiaTs Rebulobs, SesaZlebelia 2-3 jgufis _ kisris ukana da
wina, kefis ukana, iRliisqveSa da idayvis midamos kvanZebis gadideba; sazardulis
midamos limfuri kvanZebis gadideba damaxasiaTebeli ar aris. palpaciiT kvanZebi
umtkivneulo da moZravia. damaxasiaTebelia temperaturuli reaqciis fonze gaZlierebuli
oflianoba. temperaturuli reaqciis sixSire bavSvebSi 3-jer metia, mozrdilebTan
SedarebiT da Rebulobs mudmiv an intermisiul xasiaTs. diarea xdeba mdgradi. daavadebis
mwvave gamovlinebis xangrZlivoba ramdenime saaTidan 1-1,5 Tvemdea, SesaZlebelia
recidivebis ganviTareba. am periodSi periferiul sisxlSi aRiniSneba limfocitozi,
neitropenia, zogjer limfopenia.
serologiuri an virusologiuri gamokvlevebiT SesaZlebelia virusis an mis
mimarT antisxeulebis aRmoCena inficirebidan 2 kviris Semdeg.
meoradi gamovlinebis periodi aiv-infeqciisas SeiZleba grZeldebodes ramdenime
Tvidan wlobiT. damaxasiaTebeli simptomebidan aRsaniSnavia limfuri kvanZebis gadidebis
konstatacia 2-3 Tvis ganmavlobaSi.
am dros diddeba 2-3 jgufis limfuri kvanZebi, sazardulis limfuri kvanZebis
gamoklebiT. xSirad viTardeba
A B qvemwvaved mimdinare difuzuri
encefalitis suraTi. am dros
sisxlSi ganisazRvreba aiv-
sawinaaRmdego antisxeulebi,
imatebs imunoglobulinebi, amave
d r o s m c i r d e b a CD4 (T-
helperebis) absoluturi
raodenoba. iklebs kanis
alergiuli sinjebi, aRiniSneba
imunuri homeokinezis
toqsoplazmozi. toqsoplazmuri encefaliti Sidsi-s dros p r o g r e s u l i darRveva,
), sadac nevrozi gansakuTrebiT ki 1 mkl sisxlSi
mkurnalobamde ((A)) da mkurnalobis Semdeg ((B),
da anTebis didi kerebi qreba. CD4-is 400 ujredamde daklebis
SemTxvevaSi, rac xels uwyobs
daavadebis meoradi gamovlinebis stadiaSi gadasvlas da gamoixateba oportunistuli
infeqciebis gaaqtivebiT, avTvisebiani simsivneebisa da autoimunuri procesebis ganviTarebiT.
am periodSi ukve Warbobs anergiis niSnebi kanisa da lorwovani garsebis mxriv,
seboreuli dermatitis, piodermiis, lorwovani garsebis kandidozis saxiT, aRiniSneba
martivi herpesiT gamowveuli morecidive xasiaTis gamonayari da a.S. daavadeba
TandaTanobiT progresirebs.
Sids-is ukidures gamovlinebad iTvleba pnevmocisturi pnevmoniis, generalizebuli
toqsoplazmozis, kri ptosporidiozis, avTvisebiani simsivneebidan kapoSis sarkomis, B-
ujreduli limfomebisa da autoimunuri efeqtebis gamomJRavneba. es periodi ki
calkeuli organoebis an sistemebis dazianebis periods Seesabameba.
wamyvani klinikuri simptomebis upiratesi gamovlinebiT arCeven filtvis, nervuli
sistemis, kuW-nawlavis traqtis, limfadenopaTiur da sxva formebs.
212
yvelaze ufro xSir da saSiS oportunistul-invaziur daavadebas warmoadgens

pnevmocistozi, gamowveuli Pneumocystis carinii-iT, es gamomwvevi farTodaa
gavrcelebuli, rogorc Sinaur da gareul cxovelebs Soris, aseve adamianebSic. masiuri
serologiuri gamokvlevebis Sedegad amerikasa da holandiaSi antisxeulebi aRniSnuli
parazitis mimarT 4 wlamde asakis bavSvTa 75%-Si iqna nanaxi. aiv-inficirebuli
avadmyofebis P.carinii-iT invazirebisas pnevmonia mimdinareobs mZimed da xSirad
ganapirobebs letalur gamosavals. imunodeficitisa da alveoluri makrofagebis
funqciuri darRvevebis fonze parazitebi intensiurad mravldebian filtvebSi, iwveven
bronqiolebisa da alveolebis anTebas, es ukanasknelni ivseba mwebavi, qafiani eqsudatiT,
rac mkveTrad amcirebs gazTa cvlas. daavadebis 1-2 kviras filtvebis mxriv Raribi
fizikaluri monacemebi aRiniSneba, romlis fonzec saerTo mdgomareoba mZimea. daavadeba
iwyeba mSrali, Semawuxebeli xveliT, tkivilis SegrZnebiT mkerdis ukan, rasac Tan
axlavs temperaturis mateba da oflianoba, saerTo sisuste. procesi mimdinareobs
duned. antibiotikoTerapia efeqts ar iZleva. 13 wlamde asakis bavSvebisaTvis
damaxasiaTebelia limfoiduri intersticiuli pnevmonia anu pulmonuri limfoiduri
hi perplazia. sxva SemTxvevebSi aRiniSneba filtvis ormxrivi, difuzuri anTebadi
kerebi. naxvelSi an dazianebuli keris biofsirebul masalaSi naxuloben P.carinii-s.
forma. nevrologiuri simptomebi SeiZleba, ganpirobebuli iyos aiv-
cerebruli forma
iT Tavis tvinis specifikuri dazianebis Sedegad (kerovani leikoencefalopaTia),
meoradi infeqciiT (CMV _ citomegalovirusiT), herpesvirusiT, kri ptokokebiTa da
sxva). Tavis tvinis dazianebis informaciuli monacemebi SesaZlebelia, miRebul iqnas
avadmyofebis instrumentuli gamokvlevebiTY (birTvul-magnituri rezonansi,
kompiuteruli tomografia da sxva).
kuW-nawlavis forma. mimdinareobs enteritis, enterokolitis suraTiT, rac
gamowveulia sokoebiT an umartivesebiT (kandida, ameba, lambliebi, kri ptosporidiebi
da sxva). damaxasiaTebelia sxeulis masis mniSvnelovani kleba, saylapavi milis sokovani
dazianeba da a.S.
aRniSnuli infeqciis garda e.w. dazianebis periodSi viTardeba zogierTi procesi,
gansakuTrebiT kapoSis sindromi da limfomebi.
kapoSis sindromi aRwerili iyo 1982 wels ungreli mecnieris m. kapoSis mier.
sindromi warmoadgens avTvisebian simsivnes, retikulur-histiocituri sistemis daavadebas
(kapoSis angiomatozi). daavadebis sporaduli SemTxvevebi gvxvdeba xandazmulebsa da
moxucebSi. procesi lokalizdeba qvemo kidurebis distalur nawilSi. aiv-infeqciis
dros ki daavadeba ufro xSirad aRiniSneba da lokalizdeba kidurebis proqsimalur
nawilSi, sxeulze, saxeze, piris Rrusa da sasqeso organoebis lorwovan garsebze.
perianalur midamoSi vlindeba muqi feris, sxvadasxva zomis, usworo formis laqebi.
mogvianebiT stadiaSi sarkoma iZens generalizebul mimdinareobas Sinagani organoebis,
Tavis tvinis, Tvalis dazianebiT.
avadmyofebs uviTardeba Tavis tvinis B-ujreduli pirveladi an meoradi dazianeba
limfomebis saxiT (SesaZlebelia koinfeqciis monawileoba sxva retrovirusul _
HTLV-I, HTLV-II-Tan, romlebic iwveven limfoproliferaciul procesebs).
autoimunuri procesebi SeiZleba, mravali saxiT gamovlindes (dermatitebi, vaskulitebi,
Tireoiditi, endomiokarditi, orqiti saTesle jirkvlebis Semdgomi fibroziTa da
spermatogenezis darRveviT da sxv.).
mZime mimdinareobis dros finalur stadiaSi periferiul sisxlSi gamoixateba
leikopeniisaken kanonzomieri tendencia, Trombocitopenia, hemoragiuli sindromi, romelic
SesaZlebelia, sikvdilis mizezic gaxdes, anemia, romlis intensivoba gansazRvravs daavadebis
simZimesa da mimdinareobis stadias.
213
hemoragiuli cxelebebi
bavSvebSi. mucladyofnisas inficirebuli nayofi xSirad

Sidsi mcire asakis bavSvebSi
hi potrofulia, gamoxatuli aqvs sxvadasxva nevrologiuri darRvevebi, yvela limfuri
kvanZis gadideba, hepatosplenomegaliuri sindromi. postnatalur periodSi aseT bavSvebs
xSirad aReniSnebaT daudgeneli genezis temperaturuli reaqciebi, persistuli diarea.
aiv-infeqciaze eWvs badebs kanisa da lorwovani garsebis sokovani dazianebebi, sxeulis
masis dakleba, pnevmocisturi pnevmoniis arseboba. kanze laqovan-papuluri, arcTu
iSviaTad, hemoragiuli gamonayari. letaluri gamosavali viTardeba daavadebis SedarebiT
adreul periodSi, rac gamowveulia generalizebuli citomegaliiT, gramuaryofiTi da
gramdadebiTi mikrobebiT gamowveuli sefsisiT da sxva daavadebebiT, romelTa mizezs
warmoadgens, umTavresad, pirobiTpaTogenuri mikroorganizmebi.
diagnostika. aiv-infeqciis diagnostika eyrdnoba anamnezur, klinikur da
diagnostika
laboratoriul gamokvlevaTa kompleqss. anamnezuri monacemebidan didi mniSvneloba
aqvs riskis jgufis bavSvebis dadgenas, orsulobis periodSi dedis inficirebis
SesaZleblobas, sisxliTa da sisxlis komponentebiT bavSvebis SesaZlo inficirebas. am
mxriv idealuria niu-iorkis mecnierebis mier yvela bavSvis Semowmeba aiv-inficirebaze.
aiv-infeqciis dawyebiTi klinikuri gamovlinebebidan gansakuTrebuli yuradReba eqceva
aiv-infeqciis specifikuri markerebi

ori da meti jgufis limfuri kvanZebis gadidebas, rac ramodenime kviras grZeldeba,
mudmivi an intermisiuli xasiaTis xangrZliv temperaturas, xangrZliv diareas, sxeulis
masis daklebas. ufro mogvianebiT iklebs CD4 limfocitebi, CD4/CD8 limfocitebis
SefardebiTi koeficienti, qveiTdeba limfocitebis blastgenuri reaqcia mitogenebze,
214
aiv/Sidsi
kanis anergia sxvadasxva antigenis mimarT, imunuri kompleqsebis cirkulireba da sxva.

Sidsis klinikis indikatorad iTvleba mudmivi, morecidive infeqciebis arseboba,
romelTac pirvel rigSi miekuTvneba kanisa da lorwovani garsebis, saylapavis kandidozi,
pnevmocisturi pnevmonia, pnevmonia, romelic cudad eqvemdebareba mkurnalobas,
kri ptosporidiozi diareiT, romelic Tveze metxans grZeldeba, RviZlis, elenTis an
limfuri kvanZebis dazianeba 1 Tveze meti asakis bavSvebSi, martivi virusiT gamowveuli
kanisa da lorwovani garsebis dawylulebiT mimdinare infeqcia, limfocituri
intersticiuli pnevmonia, filtvebis limfoiduri hi perplazia 13 wlamde asakis
bavSvebSi, Tavis tvinis toqsoplazmozi 1 Tvis asakis zeviT, kapoSis sarkoma, Tavis
tvinis limfoma da sxv. aRniSnuli ìndikatori” daavadebebi Sidsis diagnozis dasmis
safuZvels iZleva im SemTxvevaSi, roca daavadebebis gamovlinebis pirvel sam Tves
imunodeficitis sxva mizezebi ar aris. aiv-iT ganpirobebuli imunuri darRvevebis
maCvenebelTa, pirvel rigSi, CD4 saerTo raodenobis daqveiTeba, ase, mag: CD4 daqveiTeba
1 mkl sisxlSi 500 ujredamde da qveviT iTvleba antiretrovirusuli Terapiis
dawyebis, xolo misi daqveiTeba 200-mde da qveviT _ oportunistuli infeqciis
profilaqtikuri Terapiis Catarebis standartad.
aiv-infeqciis klinikis gamovlinebidan gamokvleul unda iqnas sisxli virusis
mimarT antisxeulebze (antisxeulebi, Cveulebriv, inficirebidan 2 kvira-3 Tvemde
droSi vlindeba). imunofermentuli analizi warmoadgens ZiriTad da farTod gamoyenebul
meTods, romelic gansazRvravs saerTo antisxeulebs virusis mimarT. sisxlis pozitiuri
Sratebis dadgenis SemTxvevaSi Sratis imave ulufidan imeoreben analizs 2-jer.
reaqciis erTi dadebiTi pasuxis SemTxvevaSi gamokvlevas agrZeleben ufro specifikuri
meTodiT _ imunoblotingiT, romelic saSualebas iZleva, gamovlenil iqnas antisxeulebi
virusis calkeuli cilebis mimarT (imunoblotingiT dadgenili Sedegi dadebiTad
iTvleba, Tu avadmyofis sisxlSi gamovlindeba antisxeulebi 4 an meti virusuli
cilis mimarT _ gp120, gp41, p24, p18 da sxv.). gamoiyeneba polimerazuli jaWvuri
reaqcia da aseve virusis kultivireba.
mkurnaloba. aiv-infeqciis klinikuri gamovlinebisa da dadebiTi laboratoriuli
mkurnaloba
monacemebis SemTxvevaSi avadmyofi eqvemdebareba aucilebel hospitalizacias specialur
stacionarSi, sadac xdeba daavadebis fazisa da formis dadgena, amasTan avadmyofi
daculi unda iyos reinfeqciebisa da superinfeqciebisagan. mkurnalobis mizania virusis
moqmedebis SezRudva.
mkurnaloba aiv-infeqciis dros iTvaliwinebs, rom qimiopreparatebiT mivaRwioT
viremiis donis Semcirebas da organizmis imunuri maCveneblebis gaumjobesebas.
amJamad aiv-infeqciis samkurnalod mowodebulia nukleozidis analogebi, preparatebi
_ zidovudini (Zidovudine-(ZDV)), didanozini (Didanosine-(ddI)-Dideoxinosine)
da sxva, romlebic damTrgunvelad moqmedeben aiv-virusis ukutranskri ptazaze da
virusis proteazas inhibitorebi _ saqvinviri (saquinvir), indinaviri(indinavir) da
sxv. maTi kombinirebuli daniSvnis Sedegad miRebulia ukeTesi Sedegebi, vidre calkeuli
preparatebiT mkurnalobis SemTxvevebSi.
iTvleba, rom antivirusuli Terapia aiv-inficirebul avadmyofebSi unda Catardes
miuxedavad imisa, maRalia riski infeqciis persistirebisa Tu ara. mkurnaloba unda
ganxorcieldes kombinirebulad _ 2 nukleozidis analogiTa da proteazas inhibitoris
preparatiT.
amave dros, unda aRiniSnos, rom virusi am preparatebis mimarT xSirad xdeba
rezistentuli, rac ganpirobebulia misi damaxasiaTebeli mutagenuri TvisebebiT. es
garemoeba ki qmnis did siZneleebs saTanado vaqcinis SemuSavebaSi.
aSS-is pediatriis akademiis infeqciuri komitetis mocemulia mkurnalobis sqema
bavSvebSi aiv-infeqciis dros.
215
antiretrovirusuli preparatebis dozireba bavSvebisaTvis
preparatebis
dasaxeleba asaki rekomendebuli dozebi
(komerciuli)
0-6 kvira 2 mg/kg/doza yovel 6 sT-Si
Zidovudine (ZDV, AZT 4 kvira _ 13w. 2
90-180 mg/m /doza yovel 6 sT-Si
Azidothymidine) [Retrovir] 100 mg/doza 5-jer dReSi an 200 mg/doza
≥ _ 13w.
yovel 8 sT-Si
2
< 13w. 90-135 mg/m /doza yovel 12 sT-Si
Didanozine (ddl,
< 60kg: tabl. 125 mg yovel 12 sT-Si,
dideoxynosine) [Videx]
buferuli fxvnili 167 mg yovel 12 sT-Si
≥ 13w.
≥ 60kg: tabl. 200 mg yovel 12 sT-Si.
buferuli fxvnili 250 mg yovel 12 sT-
Si.
Zalcitabine (ddC, < 13w. 0,01 mg/kg/doza yovel 8 sT-Si
dideoxycytidine) [Hivid] ≥ 13w. 0,75 mg/kg/doza yovel 8 sT-Si
< 13w. 1 mg/kg/ doza yovel 12 sT-Si
Stavudine (d4T) [Zerix]
≥ 13w. 30-40 mg yovel 12 sT-Si
3 Tve _ 12 weli 4 mg/kg/doza yovel 12 sT-Si
Lamivudine (3TC) [Epivir]
≥ 12w. 150 mg/doza yovel 12 sT-Si
< 13w. dozebi gansazRvruli ar aris
Saquinavir (SQV)
< 13w. doza gansazRvruli ar aris
Indinavir (IDV) [Crixivan]
2
< 13w. 350 mg/m /doza yovel 12 sT-Si
Ritonavir (RTV) [Norvir]
idovudinis gamoyeneba aiv-inficirebul dedebsa da

zidovudinis
maT axalSobilebSi infeqciis gadacemis Sesamcireblad.
(aSS-s pediatriis akademia, infeqciuri komitetis rekomendacia)
Seyvanis
gamoyenebis dro doza
meTodi
orsulebSi 14-34 kviris
per os 100 mg 5-jer dReSi
gestaciis dros
2mg/kg mSobiarobis 1 saaTSi, Semdeg

mSobiarobis dros intravenurad
1 mg/kg/saaTSi mSobiarobis bolomde
axalSobili 8-12 saaTis

per os 2 mg/kg 4-jer dReSi
dabadebidan 6 kviris manZilze
216
antivirusuli preparatebis daniSvnis gadawyvetileba emyareba virusologiur,

imunologiur da klinikur kriteriumebs. ase mag: qimioTerapia utardebaT saSualo da
mZime imunosupresiis da klinikuri gamovlinebis saSualo da mZime formebis dros.
asimptomuri an mcired gamoxatuli simptomatikis dros (imunosupresiis gareSe)
gadawyvetileba, daeniSnos Tu ara antivirusuli preparatebi, efuZneba individualur
midgomas.
Tu inficirebuli orsulis mkurnaloba daiwyo gestaciis 14 kviridan mSobiarobis
CaTvliT, maSin mniSvnelovnad mcirdeba axalSobilze infeqciis gadacema. amave dros
axalSobils 6 kviris ganmavlobaSi unda Cautardes qimioTerapia.
Seswavlis procesSia IGIV (intravenuri imunoglobulini). misi daniSvna
rekomendebulia antivirusul preparatebTan kombinaciaSi da eZlevaT im SemTxvevaSi,
roca adgili aqvs 1) hi pogamaglobulinemias(IgG<250mg/DL; 2) baqteriuli
infeqciebis darTvis Sedegad ganpirobebuli morecidive mimdinareobisas; 3). bavSvebs,
romlebsac darRveuli aqvT antisxeulebis warmoqmnis unari Cveulebrivi antigenebis
mimarT; 4) bavSvebs, romlebic cxovroben wiTelas endemur regionebSi da romlebsac
ar ganuviTardaT antisxeulebis gamomuSaveba 2-jer wiTelas sawinaaRmdego acris
Semdeg IGIV eniSnebaT 400mg/kg yovel 4 kviraSi.
aiv-infeqciis dros imunizaciis Catarebis rekomendaciebi: 1)aiv-infeqciis klinikuri
gamovlinebis mqone avadmyofebs ar unda daeniSnos cocxali vaqcinebi, mag.: poliomielitis
oraluri vaqcina, Cutyvavilas vaqcina, BCG. gamonakliss warmoadgens MMR (wiTela,
parotiti, wiTura) avadmyofebisaTvis, romelTac aReniSnebaT aramZime imunosupresia.
imunizacia rekomendirebulia Catardes mxolod vaqcinebiT _ DTP; Hepatitis B-s
sawinaaRmdego, Haemophilus influenzae b ti pis koniugirebuli vaqciniT,
inaqtivirebuli poliovirusuli vaqciniT _ IPV (inactivated poliovirus), aseve
gamosayenebelia pnevmokokuri vaqcina 2 wlis asakSi da yovelwliuri gripis sawinaaRmdego
vaqcinacia 6 Tvis asakidan zedapiruli gawmendili antigenis vaqciniT _ split-virus
vaccine. 2) arasimptomuri aiv-infeqciis dros: gamoiyeneba yvela zemoT aRniSnuli
vaqcina da BCG ganviTarebul qveynebSi.
Tu aiv-inficirebuls aReniSneba kontaqti CutyvaviliT an zosteriT avadmyofTan,
maSin Cutyvavila-zosteris sawinaaRmdego imunoglobulinis an IGIV-is Seyvanaa
aucilebeli.
saTanado Cvenebisas eniSnebaT agreTve tetanusis da wiTelas sawinaaRmdego
imunoglobulinebi. aiv-iT inficirebuli dedebis mier ZuZuTi kveba maRalganviTarebul
qveynebSi araa rekomendebuli.
rTul amocanas warmoadgens meoradi pirobiTpaTogenuri mikrobebiT gamowveuli
daavadebebis mkurnaloba da profilaqtika.
am mizniT farTod gamoiyeneba antibiotikebi, sulfanilamidebi, virusis sawinaaRmdego
preparatebi. yvela calkeul SemTxvevaSi saWiroa garkveuli nozologiuri erTeulebis
gaTvaliswinebiT Catardes saTanado preparatebiT mkurnaloba.
avadmyofebs esaWiroebaT fsiqo-socialuri reabilitacia.
prognozi. prognozi arakeTilsaimedoa, Tumca daavadebis adreul stadiaSi dawyebuli
prognozi
mkurnalobiT SesaZlebelia sicocxlis gaxangrZliveba, amis SesaZleblobas iZleva
axali Terapiuli meTodebis gamoyeneba.
profilaqtika. aiv-infeqciis specifikuri profilaqtika mowodebuli ar aris.
profilaqtika
daavadebis gavrcelebis SezRudvis mizniT saWiroa avadmyofTa adre gamovlineba, donoris
sisxlis, misi preparatebisa da transplantantebis mkacri gakontroleba. pediatriaSi
profilaqtikuri sistemis RonisZiebebi unda daeyrdnos imis analizs, rom bavSvebis
aiv-iT inficireba xdeba maRali riskis mqone ojaxebSi (SidsiT daavadebulebi, narkomanebi,
217
aiv/Sidsi
kerZo nawili. mikoplazmuri infeqcia
biseqsualebi da sxva). zemoaRniSnulidan gamomdinare, aiv-infeqciis profilaqtikis

mTavar meTods warmoadgens mosaxleobis swori sqesobrivi qceva skolis asakidanve,
sqesobrivi partniorebis SezRudva da prezervativis gamoyeneba.
avadmyofebSi sisxlisa da sxva biologiuri masalis aReba unda xdebodes mxolod
xelTaTmanebiT.
mikoplazmuri infeqcia
mikoplazmuri infeqcia warmoadgens adamianebisa da cxovelebis mwvave daavadebas,

ganpirobebuls Taviseburi mikroorganizmebiT, romlebic Tavisi kulturaluri TvisebebiT
ikaveben Sualedur adgils virusebsa da mikrobebs Soris.
adamianis paTologiaSi Mycoplasma pneumoniae-s ukavia mniSvnelovani adgili.
igi Mycoplasmataceae-s ojaxs miekuTvneba, upiratesad azianebs bronqebs, filtvebsa
da zemo sasunTq gzebs, mikoplazmebis 40 saxeobidan M. hominis, M. formentans, T-
Stamebi (Ureaplasma urealyticum) da sxvebi iwveven Sard-sasqeso, Tvalis, saxsrebis
da sxva sistemebis daavadebebs.
etiologia. gamomwvevi pirvelad aRmoCenil iqna 1944 w. M.D. Eatonis da
etiologia
Tanaavtorebis mier ati puri pnevmoniiT daavadebuli adamianis naxvelSi. 1962 wlamde
mikroorganizmebs Tvlidnen virusebad da uwodebdnen ati puri pnevmoniis gamomwvev
itonis faqtors.
1962 w. R. Chanock-is da Tanaavtorebis mier mikroorganizmi kultivirebuli
iqna xelovnur niadagze da CaiTvala mikoplazmuri ojaxis erT-erT saxeobad. mikoplazmebs
aqvT 3-firfitiani gareTa membrana. P11-genis mixedviT M. pneumoniae dayofilia I da
II jgufebad. anti-P1 antisxeulebis gamoyeneba saeqsperimento cxovelebSi amcirebs
daavadebis simptomebs. M. pneumoniae iSviaTad arRvevs ujredis membranas. igi
ujredSida paraziti ar aris. M. pneumoniae izrdeba agarze sokos eqstraqtisa da
cxenis Sratis damatebiT, qaTmis embrionis epiTeliur ujredebze, adamianisa da cxovelebis
ujredul kulturebze. isini Zafiseburi formisa (gvelismagvari) da erT-erT boloze
aqvT specialuri warmonaqmni, risi meSveobiTac iWrebian sasunTqi gzebis cilindruli
epiTeliumis ujredebSi. maTi kultivirebis meTodebi Tumca kargadaa Seswavlili,
magram teqnikurad rTulia da yvela laboratoriaSi ar keTdeba.
epidemiologia. infeqciis wyaroa avadmyofi an mtarebeli adamiani. daavadeba
epidemiologia
gadaecema haer-wveTovnad, SesaZleblad iTvleba transplacenturi gadacemis gza dedidan
nayofze. 5 wlamde asakSi es infeqcia iSviaTia.
skolisa da mozrdili asakis bavSvebSi yvelaze ufro xSirad mwvave respiraciuli
daavadebis gamomwvev mizezad iTvleba M. pneumoniae. epidemiis dros am asakze
modis SemTxvevaTa 40-60%. mikoplazmuri infeqciis epidemiebi ufro mdgradi da
xangrZlivad mimdinarea, vidre sxva mwvave respiraciuli virusuli infeqciebis epidemiebi.
daavadeba aRwerilia TiTqmis yvela qveyanaSi. yvelaze meti SemTxveva aRiniSneba wlis
civ periodSi oqtombridan Tebervlamde, magram organizebul koleqtivebSi epidafeTqebebs
SeiZleba adgili hqondes zafxulSic.
mikoplazmuri infeqcia ar miekuTvneba maRalkontagiozur daavadebas, rasac adasturebs
is, rom ojaxSi avadmyofTan kontaqtirebuli yvela piri ar avaddeba, magram epidemiis
dros ramodenime kviraSi an TveSi isini, visac ar gaaCndaT imuniteti, inficirebulni
xdebian.
paTmorfologia. traqeisa da bronqebis lorwovani garsebis
epiTeliums mikoplazma emagreba specialuri daniSnulebis daboloebiT. igi burRiviT
218
iWreba epiTeliumis kedelTaSoris ZgideebSi da amiT iwvevs qsovilTa arqiteqtonikis

dezorganizacias. procesSi TandaTanobiT erTveba bronqiolebisa da alveolebis nawilebi,
viTardeba intersticiuli pnevmonia. makroskopulad traqeisa da bronqebis lorwovani
garsebi hiperemiulia, aRiniSneba hemoragiuli diaTezis movlenebi, zogjer dawyluleba,
alag-alag filtvebis ateleqtazi da emfizemuri adgilebi.
mZime SemTxvevebSi adgili aqvs pirveladi anTebiTi kerebidan mikoplazmebis
hematogenur diseminacias, ris gamoc xdeba sxvadasxva organoebisa da sistemebis
(RviZli, elenTa, Tirkmlebi, cns da sxva) dazianeba. viTardeba meoradi hepatiti, nefriti,
meningiti da sxva klinikuri gamovlinebani, romelic ganpirobebuli unda iyos
autoimunuri darRvevebiT (maT Soris namgliseburi anemia). bronqopulmonuri sistemis
dazianebaSi didi roli ekuTvnis meoradi infeqciis darTvas. mikroskopulad dgindeba
peribronquli infiltratebi, romlebic Sedgebian erTbirTviani da plazmuri
ujredebisagan. bronqebis sanaTurebi gavsebulia polinuklearebiT da desqvamirebuli
epiTeliumiT. icvleba organizmis imunologiuri statusi. yvelaze ufro adre vlindeba
da adreve qreba araspecifikuri hemaglutinaciis reaqcia dabali temperaturis pirobebSi.
zogjer es reaqcia saerTod uaryofiTia mTeli daavadebis mimdinareobisas. reaqciis
gamovlinebis sixSire da antisxeulebis titri pirdapir damokidebulebaSia daavadebis
xangrZlivobasa da simZimesTan. zazunebSi Catarebulma eqsperimentma gviCvena, rom
mikoplazmuri pnevmoniis dros peribronquli erTbirTviani ujredebi datvirTuli
iyo antisxeulebiT. antiTimocituri Sratis Seyvana iwvevda T-ujredebis gantvirTvas
antisxeulebisagan da mTlianad uzrunvelyofda organizmis dacvas pnevmoniisagan.
aRniSnuli monacemebi mowmoben, rom mikoplazmiT gamowveul daavadebas aqvs rTuli
imunologiuri sarCuli da makroorganizmi Tavad gansazRvravs, ganviTardeba Tu ara
pnevmonia.
klinika. inkubaciuri periodi Seadgens 1-3 kviras, zogjer 4-5 kviras. daavadeba
klinika
SeiZleba gamovlindes zemo sasunTqi gzebis kataridan dawyebuli mZime Serwymuli
pnevmoniiT damTavrebuli.
daavadeba iwyeba saerTo sisustiT, madis daqveiTebiT, Tavis tkiviliT, temperaturis
momatebiT, surdoTi, xveliT. Semdgom dReebSi temperaturam SeiZleba miaRwios 38-
390C. avadmyofis saxe am dros fermkrTalia, zogjer aRiniSneba koniunqtivis hi peremia,
sklerebis inicireba, Tvalis kaklebis tkivili, Tavbrusxveva, zogjer muclis tkivili.
yuradRebas iqcevs is, rom maRali da xangrZlivi temperaturis fonze saerTo
intoqsikaciis movlenebi sustadaa gamoxatuli an zomieria. mTavar simptomebs
warmoadgenen xvela da yelis tkivili. im SemTxvevaSi, roca gvaqvs zemo sasunTqi
gzebis katari, saxezea faringiti, traqeiti, bronqioliti, otiti an krupi. filtvebSi
moismineba mSrali xixini, perkusiiT alag-alag mokle xma.
mikoplazmuri pnevmonia SeiZleba iyos kerovani an wilobrivi. igi SeiZleba ganviTardes
daavadebis me-3-5 dRes, magram ar aris gamoricxuli misi dawyeba pirvelsave dRes.
temperatura am dros aRwevs 39-400C. Zalian iSviaTad procesi mimdinareobs
bronqopulmonuri sistemis dazianebis gareSe da xasiaTdeba kanis, gul-sisxlZarRvTa
sistemis, saxsrebis paTologiiT. kanze gvxvdeba laqovan-papuluri gamonayari, kvanZovani
eriTema, stivens-jonsonis sindromi.
aRwerilia specifikuri meningoencefaliti da gien-bares sindromi.
periferiul sisxlSi adgili aqvs zomier leikocitozs, leikocituri formulis
marcxniv gadaxras, limfopenias, monocitopenias, hemolizur anemias, eds momatebulia
30-40mm-mde/sT-Si.
garTuleba dakavSirebulia meoradi floris darTvasTan. iSviaTad gvxvdeba
specifikuri meningoencefaliti, Tvalis lorwovani garsis dazianeba, sikvdili.
219
diagnozi. klinikuri, epidemiologiuri da laboratoriuli meTodebi daavadebis

diagnozi
dasawyisSi saSualebas ar gvaZlevs, rom davsvaT mikoplazmuri infeqciis diagnozi.
mniSvnelovan klinikur simptomad unda CaiTvalos xvela, gansakuTrebiT skolisa da
mozardTa asakSi. mxedvelobaSi unda miviRoT daavadebisTvis damaxasiaTebeli
TandaTanobiTi dawyeba, xangrZlivi temperatura, sustad gamoxatuli saerTo intoqsikacia,
bronqopulmonuri sistemis ufro mogvianebiTi dazianeba (pnevmoniis ganviTareba me-3-
5 dRes), xangrZlivi mimdinareoba. diagnostikuri mniSvneloba aqvs temperaturis
dabal maCveneblebs. didi mniSvneloba aqvs hemaglutininebisa (1:64) da komplementSemboWavi
antisxeulebis dinamikaSi zrdas (titris matebas dinamikaSi aranakleb 4-jer). xaxis
lorwos, naxvelis, Cirqisa da sxva substratis daTesva xdeba sakveb niadagebze da
Semdeg gamoyofen gamomwvevs. mikoplazmis gamoyofa zogjer xdeba janmrTeli mtarebelidan,
amitom saWiroa daavadebis dadastureba serologiuri meTodiT. sakvebi niadagiT
mikroorganizmis kultivireba Znelia da arapraqtikuli.
diferenciuli diagnozi tardeba, pirvel rigSi, mwvave respiraciul virusul
infeqciebTan, gansakuTrebiT adenovirusul infeqciasTan, RS-infeqciasTan, Q-cxelebasTan,
krupozul pnevmoniasTan. Q-cxelebisTvis damaxasiaTebelia daavadebis uecari dawyeba,
Zlieri intoqsikacia, zemo sasunTqi gzebis kataris ararseboba, RviZlisa da elenTis
gadideba, leikopenia an normocitozi eds momatebiT.
krupozuli pnevmoniis dros saxezea mZime toqsikozi, mniSvnelovani klinikuri da
rentgenologiuri monacemebi, maRali leikocitozi neitrofiloziT, maRali eds, Cqari
daqvemdebareba antibiotikebis mimarT, rasac adgili ara aqvs mikoplazmuri pnevmoniis
dros.
prognozi. Tu garTuleba seriozuli ar aris, gamosavali keTilsaimedoa.
prognozi
mkurnaloba. msubuqi formebis dros mkurnaloba simptomuria da SeiZleba Catardes
mkurnaloba
binis pirobebSi. saSualo simZimisa da mZime formebis dros mkurnaloba tardeba
stacionarSi simptomuri saSualebebiT da intensiuri TerapiiT (sadezintoqsikacio
xsnarebis venaSi Seyvana, maril- da wyaldeficituri mdgomareobis koreqcia, Sardmdeni
saSualebebi da sxva). paralelurad xdeba antibiotikebis CarTva (eriTromicini,
qloramfenikoli, linkomicini, klaritromicini, tetraciklinis jgufis preparatebi
da sxva) saTanado dozebiT 5-7 dRis ganmavlobaSi. saWiroa, xazi gaesvas im garemoebas,
rom tetraciklinis jgufis preparatebi iniSneba 8 welze ufrosi asakis bavSvebSi.
profilaqtika. vaqcina SemuSavebuli ar aris. profilaqtikisTvis saWiroa
profilaqtika
avadmyofis izolacia da daavadebis kerebSi saerTo profilaqtikuri RonisZiebebis
gatareba.
220
kerZo nawili.
qlamidiuri infeqciebi.
qlamidiuri infeqciebi
qlamidiuri infeqciebis cnebaSi igulisxmeba adamianisa da cxovelis rigi daavadebebi,

romelTa gamomwvevia ujredSida ganviTarebis unaris mqone obligaturi paraziti.
qlamidiur infeqciebs miekuTvnebian: orniTozi, traqoma, sazardulis anu veneriuli
limfogranulomatozi, reiteris sindromi, ureTritebi, cervicitebi, koniunqtivitebi,
mravalricxovani perinataluri infeqcia, pnevmonia.
cnobebi. jer kidev 15 saukuniT adre Cvens welTaRricxvamde
aRwerili iyo Tvalis daavadeba traqomis saxelwodebiT, 1908 wels ki aRweres
mSobiaris sasqeso organoebidan inficirebis Sedegad ganviTarebuli axalSobilTa
koniunqtiviti.
etiologia. qlamidiebi miekuTvnebian gramuaryofiT kokebs, 0,2-0,4 mkm diametriT.
etiologia
virusebis msgavsad qlamidiebi ujredSida obligaturi parazitebia, romlebsac gamravlebis
unari SeswevT mxolod cocxal ujredSi, magram maTgan gansxvavebiT Seicaven rogorc
dnm-s, ise rnm-s, xolo kedlis garsis agebulebiT emsgavsebian baqteriebs.
arsebobs adamianisaTvis paTogenuri 3 saxis Chlamydiaceae _ 1) Chlamydia
psittaci, romlebic parazitoben frinvelebis, cxovelebis da adamianis ujredebSi da
iwveven maTSi daavadeba _ orniTozs, anu psitakozs, 2) Chlamydia trachomatis
paTogenuria adamianisaTvis, maT SeswevT sicocxlis unari nebismier ujredSi, upiratesad
ki lokalizdebian epiTeliur qsovilSi; sisxlSi isini parazitoben polimorful
leikocitebSi, masiuri invaziis dros SeiZleba iyos dazianebuli eriTrocitebi, rasac
adgili aqvs generalizebuli procesis dros. Chlamydia trachomatis-s gaaCia 15
serologiuri varianti, romelic Tavad gayofilia 2 biologiur variantad (biovarebad):
okulurgenitaluri (A-K serovarebi) da LGV- Lymphogranulomatosis venereum
- veneriuli limfogranulomatozis (anu nikola-favris daavadeba) (L1-L3 serovarebi)
gamomwvevebi. traqoma, Cveulebriv, gamowveulia A,C serovarebiT, xolo genitaluri da
perinataluri infeqciebi ki _ B, D-K serovarebiT. 3) Chlamydia pneumoniae sxva
qlamidiebisagan gamoirCeva gansxvavebuli antigenuri struqturiT da iwvevs asimptomuri
mtareblobidan dawyebuli respiraciuli traqtis daavadebebs: bronqits bronqospazmiT,
pnevmonias, mZime faringits cxelebiT.
qlamidiebs aqvT ganviTarebis damaxasiaTebeli cikli, romelic Sedgeba ujredgare
da ujredSida fazebisgan. elementuri sxeulakebi, SeiWrebian ra adamianis cilindrul
an gardamaval epiTeliumSi, iq gardaiqmnebian vegetaciur-retikulur anu provaCekis
sxeulakebad da inficirebidan 36-48 saaTSi ganicdian 8-12 jer masiur dayofas.
Svileuli retikuluri ujredebi gardaiqmnebian elementur anu axali Taobis infeqciur
formebad. cikli mTavrdeba patroni ujredis gaskdomiT da rogorc daRupuli, ise
axali sxeulakebis ganTavisuflebiT. aseTi unikaluri ciklis safuZvelze, riketsiebi
da qlamidiebi gamoyofilia ujredTa obligaturi parazitebis calke jgufSi.
TavianTi ganviTarebis procesSi qlamidiebi citoplazmaSi gamoyofen toqsinebsa
da fermentebs, Tumca maTi virulentoba SedarebiT dabalia.
epidemiologia. C. psittaci-iT gamowveuli qlamidiuri infeqcia gavrcelebulia
mTel msoflioSi; infeqciis wyaros warmoadgens: wvrili da msxvilfexa rqosani
pirutyvi, ufro metad gareuli da Sinauri frinvelebi, maTSi viTardeba daavadebis
221
kerZo nawili.
qlamidiuri infeqciebi. qlamidiozi
waSlili, usimptomo da generalizebul-manifesturi formebi. daavadeba mimdinareobs

Sinagani organoebis, kerZod - saSarde sistemis, saxsrebis, Tvalis dazianebiT da sxva.
frinvelebi da cxovelebi gamomwvevs garemoSi gamoyofen ganavliT, SardiT, sasqeso
sekretiT, abortuli nayofiT da sxva. adamianis dasnebovneba xdeba ZiriTadad daavadebuli
frinvelis an cxovelis movlis, maTi dakvlisa da damuSavebis dros. daavadebulTa
umravlesobas Seadgenen fermerebi da mwyemsebi. miuxedavad imisa, rom infeqciis gadacemis
gzebi srulyofilad ar aris Seswavlili, epidemiologiuri dakvirvebebi iZleva safuZvels,
vivaraudoT, rom dasnebovneba SesaZlebelia moxdes alimenturi gziT. aRwerilia daavadebis
afeTqebebi adamianTa Sorisac (mefrinveleebSi). orsul qalebSi daavadeba SeiZleba
abortiT damTavrdes.
qlamidiozi
bolo dros gamovlinebulia 20-mde klinikuri sindromi, romelic dakavSirebulia

qlamidiur infeqciasTan. C. trachomotis aSS-Si da evropul qveynebSi sqesobrivi
gziT gadamdebi daavadebebis erT-erTi yvelaze wamyvani mizezia. orsulebSi misi
gavrcelebis sixSire StatebSi 6-12%, zogierT regionebSi ki 37% aRwevs.
okulurgenitaluri serovarebi dedis genitaluri traqtidan asnebovneben axalSobilebs.
1987 wlis monacemebiT aSS-Si sqesobrivi gziT gadamdebi qlamidiuri infeqcia
aRmoaCines 3 milion adamianSi, maT Soris 350 000 adamians daudginda mcire menjis
Rrus daavadeba, 3,600-s aRmoaCnda orsulTa paTologia, 1 milions _ ureTriti, 150
000 - epididimiti. qlamidiebiT inficirebas adgili aqvs ufro cervikalur areSi.
saSos inficireba ganxilulia genitaluri organoebis sawyis paTologiad da, rogorc
wesi, SemdgomSi iwvevs Cirqovan-serozul cervicits, hipertrofiul erozias, saSvilosnos
yelis dazianebas. qronikuli procesi sabolood sakvercxe milis lorwovani garsis
SeSupebis, milebis gauvalobisa da uSvilobis mizezi xdeba. amJamad qlamidiuri
infeqcia gonokokur infeqciasTan SedarebiT 2-3-jer ufro xSiria.
bavSvTa asakSi qlamidiuri infeqcia farTo speqtris dazianebiT xasiaTdeba, viTardeba
axalSobilTa koniunqtiviti, iSviaTad mxedvelobis dakargviT, faringiti, respiraciuli
traqtis paTologia, otiti pnevmoniis CaTvliT, proqtiti, ureTriti, vulviti. nayofi
dasnebovndeba samSobiaro gzebSi gavlisas an sakeisro kveTis dros. qlamidiebis
aRmoCena SeiZleba Tvalis koniunqtivaSi, xaxis nacxSi, saylapav milSi, swor nawlavSi,
ureTraSi, vulvaSi da a.S.
dadgenilia, rom qlamidiuri infeqciiT daavadebuli dedis mier Sobil bavSvTa 40-
50%-s aReniSnebaT Semdegi klinikuri gamovlinebani: koniunqtiviti (35-90%), pnevmonia
(11-20%), infeqciis zogadi niSnebi (60-70%). sxva monacemebiT, 6-Tvemde asakis bavSvebSi
pnevmoniis 30%, xolo obstruqciuli bronqitis 1/3 ganpirobebulia qlamidiuri
infeqciis arsebobiT.
klinika. axalSobilTa qlamidiuri koniunqtivitis inkubaciuri periodi 5-14
klinika
dRes Seadgens. zogierT SemTxvevaSi daavadeba SeiZleba gamovlindes me-4 dRes. am
dros temperatura, Cveulebriv, normis farglebSia, magram aRiniSneba bavSvis Wirveuloba.
daavadebis dawyebidan me-4 dRes, adgili aqvs quTuToebis SeSupebas, Tvalidan Cirqovan
gamonadens, romelSic cru fibrinuli warmonaqmnebia, koniunqtiva mkveTrad hiperemiulia,
aseT SemTxvevaSi sxva baqteriuli flora rogorc wesi ar dgindeba, zogjer koniunqtiviti
ganicdis ukuganviTarebas da procesi mkurnalobis gareSec qreba.
222
kerZo nawili.
qlamidiuri infeqciebi. qlamidiozi
qlamidiozi SeiZleba Taviseburi pnevmoniuri sindromis mizezi gaxdes. mas adgili

aqvs daavadebis dawyebidan me-3-16 kviras. am dros temperatura SeiZleba normis
farglebSi iyos, habitusic TiTqos normaluri rCeba, magram aRiniSneba Semawuxebeli
xvela, taqi pnoe, cianozi, hepatolienuri sindromi, limfadenopaTia, sunTqvis darRveva.
xvela SeteviTi xasiaTisaa, Tumca yivanaxvelasgan gansxvavdeba reprizebis ararsebobiT.
filtvebis auskultaciiT moismineba mSrali xixini, iSviaTad krepitacia.
rentgenologiurad intersticiuli an SemosazRvruli infiltraciuli kerebi. sisxlSi
momatebulia eozinofilebi, iSviaTad leikocitozi, neitrofilozi, hiporegeneraciuli
ti pis gadaxriT. cxeleba da asTmuri sunTqva damaxasiaTebeli ar aris. xSiria anemia.
am dros SesaZlebelia arapirdapiri bilirubinisa da gamaglobulinis fraqciis momateba,
∝ - globulinis fraqciis Semcireba. pnevmonia dabadebidan 2-19 kviraSi viTardeba.
mZime mimdinareobiT igi gvxvdeba imunokompromentirebul bavSvebSi. axalSobilis sxva
daavadebebi moicavs aseve swori nawlavisa da vaginis dazianebas. perinatalur periodSi
SeZenili qlamidiuri infeqcia zogjer 3 wlamde persistirebs. diagnozis dasma
SeiZleba gaZneldes, Tu bavSvi aseve inficirebulia C. pneumoniae-Ti.
SedarebiT mozrdil asakSi daavadeba ufro mZimed mimdinareobs, kerZod, reiteris
an urookulur-sinoviuri sindromiT, romelsac, ZiriTadad, axasiaTebs msxvili saxsrebis
dazianeba, iSviaTad ziandeba distalurad mdebare falangTaSorisi saxsrebi. aRniSnul
paTologias Tan erTvis Cirqovani ureTriti, ormxrivi koniunqtiviti. genitaluri
qlamidiozis garTulebaa - perihepatiti (Fitz-Hugh-Curtis-sindromi), salpingiti.
araiSviaTad qlamidiuri infeqcia asocirebulia gonoreasTan; mozardebSi salpingiti
ufro xSiria vidre mozrdil qalebSi.
veneriuli limfogranuloma. daavadeba warmoadgens generalizebul infeqcias.
pirveladi dazianeba warmodgenilia genitaliebze umtkivneulo tranzituli papulis
gaCeniT. meore stadiaSi viTardeba limfadeniti sazardulis limfuri kvanZis gadidebiT,
romelsac axasiaTebs mtkivneuloba. mamakacebSi aseTi kvanZi - buboni SesaZlebelia
TviTneburad gaixsnas da moxdes SigTavsis drenireba. process Tan axlavs cxeleba,
mialgia, Tavis tkivili, SesaZloa Camoyalibdes retrovaginuri fistula, swori nawlavis
Seviwroveba, ureTris destruqcia.
diagnozi da difer enciul
diferenciul
enciuli diagnozi: qlamidiebis kultivireba SeiZleba McCoy-
i diagnozi
is an Hela xazis zazunebis Tirkmlis qsovilovan ujredebSi. qlamidiebis sawinaaRmdego
antisxeulebis aRmoCena sisxlSi xorcieldeba komplementis SeboWvis reaqciiT,
imunomafluorescirebeli antisxeulebis sinjiT. swrafi diagnostikis mizniT iyeneben
imunofermentul meTods monoklonuri antisxeulebis gamoyenebiT. amJamad kultivirebaze
ufro mgrZnobiare meTodad iTvleba dnm-s aRmoCena polimerazuli jaWvuri reaqciis
daxmarebiT.
qlamidiuri koniunqtiviti saWiroa ganvasxvavoT koniunqtivis dazianebisgan,
gamowveuli vercxlis nitratis zemoqmedebiT, romelic vlindeba axalSobilis samSobiaro
saxlSi yofnis dros. baqteriuli xasiaTis koniunqtivitebi SeiZleba dadgenil iqnas
gamosakvlevi nacxis gramis wesiT SeRebvis Sedegad, an misi daTesvisas sakveb niadagze.
qlamidiur infeqciaze eWvis mitana SeiZleba im SemTxvevaSi, rodesac anamnezSi
dedas aReniSneba xSiri TviTneburi aborti, saSvilosnos milis daxSobis Sedegad
ganviTarebuli uSviloba, duned mimdinare salpingoooforiti da a.S.
sasqeso organoebis eqskretidan damzadebul nacxSi aRiniSneba leikocitebis momateba,
xSiria citoplazmuri CanarTebisa da elementuri sxeulakebis aRmoCena organoebidan
aRebul nacxSi.
mxedvelobaSia misaRebi axalSobilTa qlamidiuri koniunqtivitisaTvis
damaxasiaTebeli suraTi, kerZod, misi ganviTareba dabadebidan meoTxe dRes, duned
223
kerZo nawili. qlamidiozi
qlamidiuri infeqciebi. orniTozi
mimdinareoba, webovani gamonadeni, koniunqtivis gamoxatuli hi peremia, sxva mikrobze

mimarTuli Catarebuli mkurnalobis araefeqturoba.
qlamidiuri infeqciisas ganviTarebuli pnevmoniis dros aRiniSneba
hepatosplenomegalia, limfadenopaTia, dabadebidan 4-12 saaTis Semdeg sunTqvis darRvevis
sindromi, aRiniSneba disociacia gamoxatul qoSinsa da SedarebiT Rarib fizikalur
da rentgenologiur monacemebs Soris. saboloo diagnozis dasma SeiZleba mxolod
gamomwvevi mizezis dadgenis SemTxvevaSi. serologiuri diagnostika gansakuTrebiT
mniSvnelovania axalSobilebSi; dinamikaSi dgindeba antisxeulebis raodenobis momateba
aranakleb 2 da metjer. veneriuli limfogranulomis diferenciuli diagnozi tardeba
SankroidTan, herpes-simpleqs virusul (HSV) infeqciasTan, sifilisTan, rac bubonis
aspiratis kultivirebiTa da serologiuri gamokvlevebiT xerxdeba.
mkurnaloba. qlamidiuri infeqciis mkurnaloba sakmaod rTulia parazitebis
mkurnaloba
ujredSida _ retikulur formebze antibiotikebis arasruli zemoqmedebis gamo.
aRniSnuli ki ganapirobebs antibiotikebis xangrZliv da zogjer, maT kombinirebul
gamoyenebas, maqsimalur Terapiul dozebSi. etiotropuli mkurnalobis mizniT gamoiyeneba
antibiotikebi qlamidiebze mimarTuli moqmedebiT, kerZod eriTromicini, gansakuTrebiT,
eriTromicin-askorbinati, rulidi (makrolidebi). eriTromicini eniSnebaT 40mg/kg masaze,
xolo rulidi 5-8mg/kg sxeulis masaze 14 dRis ganmavlobaSi. cefalosporinebidan _
klaforani, longocefi, maTi efeqti naklebadaa gamoxatuli. Tumca tetraciklinis
jgufis antibiotikebi yvelaze efeqturia, maTi gamoyeneba mozrdilebSi dasaSvebia,
isini axalSobilebSi ar gamoiyeneba. mkurnalobis mizniT am SemTxvevaSi maT xmaroben
adgilobrivad, malamoebis saxiT. traqomis dros kursi 40 dRes Seadgens (eriTromicini
an doqsiciklini per os).
koniunqtivuri formis dros adgilobrivad iyeneben eriTromicinis an tetraciklinis
5%-ian malamos (koniunqtivaSi SezelviT) dReSi ramdenjerme, 14 dRis ganmavlobaSi, an
per os 40mg/kg (sadReRamiso doza), aseve 14 dRis ganmavlobaSi. analogiuri peroraluri
mkurnaloba tardeba pnevmoniuri formis drosac. saerTo mdgomareobis gaumjobeseba
aRiniSneba preparatis miRebidan me-5-7 dRes, amave dros adgili aqvs cxvir-xaxis
sanacias qlamidiebisgan.
gaurTulebeli genitaluri qlamidiozis dros doqsiciklinis kursi 7 dRes
Seadgens; aseve gamoiyeneba azitromicini - 2g 1 dRe.
qlamidiuri pnevmoniis mZime formis dros gamoiyeneba kompleqsuri mkurnaloba _
oqsigenoTerapia, sadezintoqsikacio saSualebebi; fizikuri meTodebidan: masaJi, samkurnalo
fizkultura da fizioTerapiuli procedurebi. organizmis imunoreaqtiulobis
gasaumjobeseblad xmaroben interferonis induqtorebs.
vinaidan bavSvis inficireba xdeba samSobiaro gzebis gavlis dros, brZola qlamidiebTan
da misi profilaqtika mdgomareobs avadmyofi qalis mkurnalobaSi. am mizniT maT
orsulobis mesame trimestrSi eniSnebaT eriTromicini 1 g dReSi 2 kviris ganmavlobaSi.
analogiur mkurnalobas saWiroebs misi partnioric.
qlamidiuri da amave dros gonoreuli koniunqtivitebis Tavidan acilebis mizniT,
axalSobilebSi, erT-erT efeqtur saSualebas warmoadgens eriTromicinis, vercxlis
nitratis an tetraciklinis malamos adgilobrivi gamoyeneba.
224
kerZo nawili.
orniTozi
(ORNITHOSIS)
orniTozi (fsitakozi) qlamidiebis jgufis warmomadgenlis mier gamowveuli,

infeqciuri daavadebaa, romelic adamians gadaecema inficirebuli frinvelidan, upiratesad,
respiraciuli gziT. daavadeba mimdinareobs filtvebis dazianebiTa da organizmis
saerTo intoqsikaciiT.
1875 wels T. Jurgensen-ma pirvelad aRwera atipuri pnevmonia adamianebSi, romelic
ganuviTardaT maT avadmyof TuTiyuSebTan kontaqtis Sedegad. 1892 wels parizSi
adgili hqonda mZime pnevmoniis epidemias, romlis infeqciis wyaro iyo buenos-airesidan
importirebuli TuTiyuSebi (psittacos _ TuTiyuSi), swored maTTan aris dakavSirebuli
daavadebis saxelwodeba _ fsitakozi.
Semdeg gamoirkva, rom pnevmoniis epidemiuri afeTqebebis wyaros warmoadegnen: gareuli
da Sinauri frinvelebi (mtredi, xoxobi, qaTami, bati, ixvi, indauri da sxva). 1942 wels
K. F. Meyer-is winadadebiT, daavadebam miiRo saxelwodeba orniTozi (laT. ornithos
_ frinveli).
daavadebis gamomwvevi agenti gamoyofil iqna 1930 wels, S.P. Bedson-is, G.T.
Westen-isa da S.Sympos-is mier. arsebobs misi sul mcire 5 biovari.
epidemiologia. infeqciis wyaros bunebaSi ZiriTadad warmoadgnen frinvelebi,
epidemiologia
romelTa saxeoba 132 aRwevs. dadgenilia, rom garda farTod cnobili orniTozis
rezervuarebisa, Psittacidae (TuTiyuSebi) da Columbidae (mtredebi), arsebiTi
epidemiologiuri mniSvneloba eniWeba wylis an wylis kompleqsTan kavSiris mqone
frinvelebs (ixvi, bati, Tolia da sxva), oTaxis dekoraciul frinvelebs, gansakuTrebiT
TuTiyuSebs, kanaris Citebs. frinvelebSi daavadeba SeiZleba mimdinareobdes mwvaved,
qronikulad an latenturi formiT. klinikuri formis dros adgili aqvs procesis
generalizacias, romelic mimdinareobs parenqimuli organoebis, nawlavebis dazianebiT.
garemoSi infeqcia eqskrementebisa da sasunTqi gzebidan sekretis gamoyofis gziT
xvdeba. infeqciis gadacemis ZiriTadi meqanizmi haer-wveTovania, Tumca gadacema
SesaZlebelia dabinZurebuli da damtverianebuli haeriTac ganxorcieldes. yvelaze
xSirad avaddebian mefrinveleebi, xolo bavSvebi inficirdebian oTaxis dekoraciuli
frinvelebTan (kanaris Citebi, TuTiyuSebi, stveniebi da sxva) kontaqtis Sedegad.
daavadeba, Cveulebriv, gvxvdeba sporaduli SemTxvevebis saxiT, magram SesaZlebelia
epidemiuri afeTqebebic organizebul koleqtivebSi. infeqciis wyaros warmoadgenen
aseve cxvari, rqosani pirutyvi, kata.
organizmis mimRebloba orniTozisadmi maRalia. magram misi zusti diagnostika _
gaZnelebulia.
paTogenezi. infeqciis organizmSi SeWris ZiriTad WiSkrad iTvleba zemo sasunTqi
paTogenezi
gzebis lorwovani garsi. qlamidiebis gamravleba xorcieldeba traqeis, bronqebis,
bronqiolebis epiTeliumSi, alveolur epiTeliumSi, rac ganapirobebs filtvis
intersticiuli da parenqimuli qsovilebis dazianebas.
inficirebuli ujredebis daRupvis Semdeg xdeba parazitebisa da maTi toqsinebis
ganTavisufleba, ris safuZvelzedac viTardeba virusemia, toqsemia da sensibilizacia.
klinikurad yovelive es vlindeba saerTo intoqsikaciis simptomatikiTa da filtvebis
dazianebiT. daavadebis mZime mimdinareobis SemTxvevaSi aRiniSneba qlamidiebis hematogenuri
diseminacia da parenqimul organoebSi, centralur nervul sistemaSi, miokardiumSi,
Tirkmelzeda jirkvlebSi maTi ganTesva. organizmis reaqtiulobis daqveiTebisas adgili
aqvs parazitebis eliminaciis Seferxebas, maT xangrZliv yofnas makrofaguli sistemis
225
kerZo nawili.
ujredebSi, romelmac SesaZlebelia Semdgom gamoiwvios daavadebis recidivebi.

orniTozis paTogenezSi mniSvneloba eniWeba, agreTve, meoradi floris rolsac, rac
mas aZlevs virusul-baqteriuli infeqciisaTvis damaxasiaTebel mimdinareobas.
paTmorfologiuri cvlilebebidan aRsaniSnavia traqeobronqitis suraTi,
peribronquli limfuri kvanZebis hi perplazia, filtvebis intersticiuli qsovilis
anTeba, ateleqtazi. meoradi infeqciis darTvis SemTxvevaSi, viTardeba pnevmonia, romelic
SeiZleba iyos wvrilkerovani, segmenturi an Serwymuli (mTeli wilis dazianebiT)
xasiaTis. alveoluri eqsudati Seicavs mononuklearebsa da desqvamaciur epiTeliur
ujredbs. intersticiul da alveolur qsovilSi Warbi raodenobiT aRiniSneba
erTbirTviani elementebi, meoradi infeqciis darTvis dros ki anTebad kerebSi
neitrofiluri infiltraciaa.
sxva organoebis mxriv prevalirebs sisxlsavseoba, SeSupeba, distrofiuli movlenebi,
makrofaguri sistemis ujredebis proliferacia, SeiZleba adgili hqondes fokalur
nekrozs.
klinika. inkubaciuri periodi saSualod 7-14 dRes Seadgens da SeiZleba meryeobdes
klinika
5-dan _ 21 dRemde. daavadeba, Cveulebriv iwyeba SemcivnebiT, temperaturis momatebiT
390 C-mde, zogjer 400 C-mde. subieqturi Civilebidan aRsaniSnavia Tavisa da kunTebis
tkivili, yelis tkivili, mSrali xvela, saerTo sisuste, gulisreva, zogjer ki Rebineba.
yuradRebas ipyrobs saxis hi peremia, sklerisa da koniunqtivis sisxlZarRvebis inicireba.
temperatura atarebs remisiul, mZime mimdinareobisas ki - mudmivi ti pis xasiaTs.
kanze zogjer SeiZleba iyos alergiuli xasiaTis laqovan-papuluri gamonayari.
daavadebis dasawyisSi wina planze wamoweulia traqeobronqitis movlenebi, mSrali
xvela, tkivili gulmkerdis areSi, filtvebSi auskultaciiT _ gafantuli mSrali
xixini, rentgenologiurad ki difuzur-intersticiuli pnevmoniisTvis damaxasiaTebeli
cvlilebebi. daavadebis me-4-5, zogjer ki me-7 dRidan meoradi floris darTvisas
viTardeba qoSini, xolo rentgenologiuri monacemebi avlenen wvrilkerovani, segmenturi
an wilovan-Serwymuli anTebis suraTs, upiratesad filtvebis qvemo wilebSi
lokalizaciiT. am SemTxvevaSi fizikaluri monacemebi ufro mdidaria, vidre daavadebis
pirvel dReebSi.
gul-sisxlZarRvTa sistemis mxriv vlindeba gulis tonebis moyrueba, bradikardia,
mZime SemTxvevaSi taqikardia, dabali arteriuli wneva, SesaZlebelia toqsikuri
miokarditis suraTic.
sistema. enaze aRiniSneba nacrisferi, sqeli, mSrali nadebi,
saWmlis momnelebeli sistema
enis gverdebi hiperemiulia, aRiniSneba kbilebis CanaWdevebi. RviZli umravles SemTxvevaSi
gadidebulia, zogjer viTardeba parenqimuli hepatiti. elenTa ufro naklebadaa
gadidebuli; SeiZleba aRiniSnos faRaraTi.
periferiul sisxlSi gaurTulebeli formis dros aRiniSneba: leikopenia an
normocitozi, aneozinofilia, limfocitozi, eds zomieri momateba; meoradi infeqciiT
garTulebebisas viTardeba leikocitozi, procesis ukuganviTarebis periods limfocitozi
axasiaTebs.
yvela formis daavadebas Tan axlavs nervuli sistemis dazianebis niSnebi; saerTo
intoqsikaciis movlenebidan aRsaniSnavia: Tavis tkivili, sisuste, uZiloba; mZime
mimdinareobis dros ki _ SesaZloa gonebis dabindva, fsiqomotoruli agzneba da
depresia. meningealuri movlenebis dros vlindeba serozuli meningiti, xanmokle
mimdinareobiTa da keTilsaimedo gamosavliT. daavadebis gadatanis Semdeg zogjer
rCeba vegetodistoniuri darRvevebi.
orniTozis saerTod miRebuli klasifikacia ar arsebobs, magram iseve, rogorc
sxva infeqciebis dros, arCeven (orniTozis) ti pur da ati pur formebs. ti purs
226
kerZo nawili.
miekuTvneba daavadeba, romelic mimdinareobs filtvebis dazianebiT, xolo ati purs _

waSlili formebi (mwvave respiraciuli virusuli infeqciis msgavsad), subklinikuri
(raime klinikuri gamovlinebis gareSe) da meningoencefalituri. ti puri forma
mimdinareobis mixedviT SeiZleba iyos msubuqi, saSualo simZimis da mZime, xangrZlivobis
TvalsazrisiT ki _ mwvave (1 _ 1 1/2 Tve), qvemwvave (3 Tvemde) da qronikuli (3 Tve
da meti).
mwvave formis dros temperaturuli reaqciis xangrZlivoba ar aRemateba 1-2
kviras, xolo pnevmoniisTvis damaxasiaTebeli niSnebi 3-4 kviramde rCeba. gamojanmrTelebis
periodSi SesaZlebelia gamwvavebisa da recidivebis arseboba, es ukanaskneli xasiaTdeba
sasunTq sistemaSi qronikuli cvlilebebis niSnebis arsebobiT. daavadebis qronikuli
mimdinareobisas SesaZlebelia pnevmosklerozis Camoyalibeba. aRwerilia agreTve,
qronikuli hepatitebi da arTritebi.
diagnozi. vinaidan orniTozis klinikas ar axasiaTebs paTognomuri simptomatika,
diagnozi
diagnozis dasmaSi didi roli eniWeba ati puri pnevmoniis mimdinareobas, romelic
iRebs dune xasiaTs. epidemiologiuri anamnezidan ki sayuradReboa kontaqtis dadgena
mkvdar an avadmyof frinvelebTan.
laboratoriuli meTodebidan didi mniSvneloba eniWeba komplementis SeboWvis
reaqcias jgufur-specifikuri orniTozuli antigeniT. antisxeulebis gamovlinebas
adgili aqvs daavadebis me-7-10 dRidan, sadiagnostikod iTvleba antisxeulebis titri
1:8 _ 1:16, maTi dinamikaSi 4-jer momatebiT. dadasturebul SemTxvevad iTvleba C.
psittaci-s aRmoCena da Tav-zurgtvinis siTxeSi antisxeulebis 4-jer zrda.
perspeqtiul da mgrZnobiare meTodad iTvleba humorul-jgufuri da
ti purspecifikuri orniTozuli antisxeulebis aRmoCena arapirdapiri
imunofluorescenciis meTodiT.
bolo dros gamoiyeneba arapirdapiri hemaglutinaciis reaqcia ti purspecifikuri
eriTrocituli diagnostikumebiT zoonozuri da ofTalmogenitaluri
(okulurgenitaluri) qlamidiozebis diferenciaciis mizniT.
etiologiuri diagnostikis yvelaze ufro saimedo meTods warmoadgens qlamidiebis
gamoyofa sisxlidan da naxvelidan an sxva substratidan. swored substratiT xdeba
xerxemliani cxovelebis an qsovilovani kulturebis ujredebis (ganviTarebadi qaTmis
embrioni da sxva) inficireba, TeTr TagvebSi ki aRniSnuli substrati SehyavT kunTebSi
an tvinSi, an mimarTaven mis CawveTebas cxvirSi. SemdegSi awarmoeben qlamidiebis
indikacias dazianebul ujredebSi pirdapiri an arapirdapiri imunofluorescenciis
reaqciis an imunoenzimuri meTodis gamoyenebiT.
diagnostika. diferenciuli diagnostika tardeba orniTozis
diferenciuli diagnostika
dros mwvave respiraciul-virusul infeqciasTan, mikoplazmur pnevmoniasTan,
leptospirozTan, muclis tifTan, filtvebis tuberkulozTan, xolo meningealuri
formis dros sxva etiologiis serozul meningitebTan.
mkurnaloba: etiotropuli preparatebidan yvelaze efeqtur saSualebad iTvleba
mkurnaloba
tetraciklinis jgufis antibiotikebi, magram maTi gamoyeneba SeiZleba mxolod mozrdil
bavSvebSi 8 wlis zemoT, amitom orniTozis samkurnalod ixmareba eriTromicini 40 mg/
kg sadReRamiso doziT, 10 -14 dRis ganmavlobaSi. garkveul efeqts iZleva tetraciklinis,
qloramfenikolis, ampicilinis miReba asakis Sesabamis dozebSi. meoradi infeqciis
darTvisas xmaroben aminoglikozidebis jgufis antibiotikebs.
mZime mimdinareobis dros iniSneba kortikosteroidebi, sadezintoqsikacio saSualebebi
_ ringeris laqtati, reopoliglukini, glukoza; vitaminebi, mastimulirebeli preparatebi.
prognozi. keTilsaimedoa, letaluri gamosavali gvxvdeba gamonaklis SemTxvevebSi.
prognozi
profilaqtika. profilaqtikuri RonisZiebebi mimarTulia avadmyofi frinvelebis
profilaqtika
227
kerZo nawili. orniTozi
qlamidiuri infeqciebi. pnevmoqlamidiozi
(Sinauri frinvelebi, oTaxis dekoraciuli Citebi) gamovlinebaSi. aucilebelia

sanitaruli dakvirveba frinvelTa meurneobaSi, sadac adgili hqonda orniToziT daavadebis
SemTxvevebs; saWiroa qveyanaSi ucxoeTidan Semoyvanili frinvelebis veterinaruli
Semowmeba, dakvirveba maT momvlel personalze da im bavSvebze, romlebsac mudmivi
kontaqti aqvT frinvelebTan. unda xdebodes sanitarul-higienuri normebis swori
SemuSaveba, gansakuTrebiT frinvelebis daavadebis SemTxvevebSi.
avadmyofis eqskrementi da naxveli unda damuSavdes 5%-iani lizoliT, an qloraminiT
3 saaTis ganmavlobaSi, an 2%-iani mduRare sodiani xsnariT 30 wuTis ganmavlobaSi.
specifikuri profilaqtikis mizniT im personalisTvis, romelic warmoadgens riskis
jgufs, maT Soris laboratoriis TanamSromlebisTvis, naCvenebia aerozoluri vaqcinacia
inaqtivirebuli qsovilovani orniTozuli vaqciniT (Bkdbycrbq Y\ F\ 1974+ Nthcrb[
B\B\ 1979).
pnevmoqlamidiozi
(PNEUMOCHLAMIDIOSIS)__ daavadeba,
gamowveuli C. PNEUMONIAE
daavadeba anTroponozul xasiaTs atarebs. upiratesad ziandeba sasunTqi gzebis

organoebi. daavadebas axasiaTebs mwvave dasawyisi, cxeleba.
Chlamydia pneumoniae sxva qlamidiebisagan gansxvavdeba antigenuri, genetikuri
da morfologiuri struqturiT.
epidemiologia. infeqcia gadaecema adamianidan adamianze respiraciuli traqtis
epidemiologia
sekretis meSveobiT haer-wveTovani gziT. frinvelebis an cxovelebis rezervuari
cnobili ar aris, daavadeba gavrcelebulia mTel msoflioSi, magram tropikul da
ekonomikurad cudad ganviTarebul qveynebSi igi ufro xSiria adreul asakSi
mozrdilebTan SedarebiT.
aSS-Si C. pneumoniae-s sawinaaRmdego antisxeulebi aReniSneba mozrdilebis
umetesobas. infeqciis piki modis 5-dan 15 wlamde asakSi. xSiria recidivebi, gansakuTrebiT
mozrdilebSi.
klinika. inkubaciuri periodi saSualod 21 dRea. xSirad infeqcia asimptomurad,
klinika
msubuqad an saSualo simZimiT mimdinareobs. mZime faringiti, obstruqcia _ asTmuri
sunTqviT, produqtiuli xvela, cxeleba, kisris limfadenopaTia ufro iSviaTia. yelis
tkivili zogjer win uswrebs xveliTi xasiaTis Setevas. fizikaluri monacemebiT
vlindeba araeqsudaciuri (unadebo) faringiti, bronqospazmi xixinis gareSe.
rentgenogramaze xSiria infiltratis suraTi. daavadebas axasiaTebs bifazuri
mimdinareoba.
diagnozi emyareba klinikur monacemebs, cxvirxaxaSi da C. pneumoniae-s aRmoCenas
(qsovilebis ujredebze kultivirebiT). diagnostikisaTvis xmaroben mafluorescirebel
monoklonur antisxeulebs, polimerazul jaWvur reaqcias, mikroimunofluorescenciis
meTods. SratSi antisxeulebis 4-jeradi zrda (IgM 1:16 da meti an IgG - specifiuri
titri 1:512 da meti) axal infeqciaze laparakobs.
mkurnaloba. iniSneba eriTromicini an tetraciklini asakis da masis
gaTvaliswinebiT. kursi 5-14 dRe, zogjer 21 dRemdec ki.
228
kerZo nawili. leptospirozi
leptospirozi
(LEPTOSPIROSIS)
sinonimi: vasilev-veilis daavadeba, wylismieri cxeleba, iaponuri 7-dRiani cxeleba

da sxv.
leptospirozi warmoadgens generalizebul mwvave zoonozur infeqcias, romelic
gamowveulia leptospirebis gvaris sxvadasxva serotipiT. xasiaTdeba organizmis saerTo
intoqsikaciiT, cxelebiT, mkveTrad gamoxatuli mialgiebiT, RviZlis, Tirkmlebis, nervuli
da sisxlZarRvovani sistemis dazianebiT, mZime mimdinareobis dros ki _ siyviTliT,
hemoragiuli sindromiT, Tirkmlebis mwvave ukmarisobiTa da meningitiT.
cnobebi. daavadebis klinikuri suraTi 1886 w. pirvelad
aRwera germanelma mecnierma a. veilma, xolo 1888w. rusma mecnierma n. vasilevma.
1914_15 ww. iaponelma mecnierebma a. inadom da Tanaavtorebma avadmyofebisagan gamohyves
leptospira - L.. icterohaemorrhagiae, romelic spiroqetebs miekuTvneba.
etiologia. daavadebis gamomwvevi miekuTvneba Leptospira-s gvars (laT.
etiologia
Lepto_wvrili, spira_ xveuli) da Spirochaetaceae ojaxs. leptospira Seicavs
mxolod erT saxeobas, romelic, Tavis mxriv, iyofa or nawilad: paTogenur _Interrogans
da saprofituli _Biflexa. amJamad cnobilia 200-mde paTogenuri da 60-mde saprofituli
seroti pi. leptospirebs axasiaTebs sworxazovani da rotaciuli (mbrunavi) moZraoba.
morfologiurad xasiaTdebian mravalricxovani (15_20-mde) wvrili xveulebiT,
sigrZiT 6_20 mkm, siganiT 0,1_0,15 mkm zomisaa, gramuaryofiTi arian, gimza-romanovskiT
iRebebian vardisfrad, xolo vercxlSi _ muqi yavisfrad. maTi kultivireba xdeba
anaerobul pirobebSi specialur niadagze, romelic Seicavs sisxlis Srats, 25_350C-
ze, PH__7,2-7,4-ze. ZiriTad paTogenebad iTvlebian serojgufebi _ L. grippothyphosa,
L. pomona, L. tarassovi, L. hebdomadis, L. icterohaemorrhagiae, L. canicola.
leptospirebi warmoadgenen hidrobiontebs, garemoSi sicocxlis SenarCunebisaTvis
mniSvnelovan pirobad iTvleba maRali tenianoba da PH 7,0_7,4. zrdis optimaluri
temperaturaa 20_280. paTogenuri seroti pebisagan gansxvavebiT saprofituli Stamebis
optimalur temperaturad iTvleba 130C. didxans inarCuneben sicocxles wyalSi.
56_580C-ze iRupebian 25_ 30 wuTSi. duRili hklavs swrafad. mikrobis daRupvisas
gamoiyofa fermentebi: hemolizini, fibrinolizini, plazmokoagulaza, li paza da
endotoqsinebi.
daavadebis paTogenezSi mniSvnelovan faqtorad iTvleba leptospirebis adheziuri
aqtivoba kapilaruli ujredebisa da eriTrocitebis mimarT.
epidemiologia. leptospirozi gavrcelebulia mTel msoflioSi, garda
epidemiologia
antarqtidisa, gansakuTrebiT xSirad gvxvdeba tropikul qveynebSi. saqarTveloSi
leptospirozi ganpirobebulia upiratesad L. grippothyphosa-Ti.
adamianisaTvis infeqciis wyaros warmoadgens daavadebuli da infeqciagadatanili
da mxolod mtarebeli _ gareuli (tyis memindvria, Tagvi, nacrisferi virTagva, zRarbi
da sxva) da Sinauri cxovelebi (Zroxa, Rori, ZaRli da sxva), romlebic SardiT
ainficireben wyals, niadags, sakveb produqtebs, garemo sagnebs. ZaRli da Tagvi
adamianisaTvis infeqciis ZiriTadi wyaroa.
leptospirozuli bunebrivi kerebia upiratesad tyis, tye-velis, tye-tundris, tyis
daWaobebuli balaxovani niadagi, xolo anTropurguli (sameurneo) kerebi gvxvdeba
rogorc soflis, ise qalaqis pirobebSi (msxvili rqosani cxovelebi, Rorebi, ZaRlebi,
katebi, virTagva da sxva). arCeven Sereul kerebs _ bunebrivsa da anTropurguls.
bunebriv kerebSi adamianis inficireba xdeba sasoflo-sameurneo samuSaoebis
229
Sesrulebis (mosavlis aReba da sxva), banaobis, nadirobis, fexSiSveli muSaobis, SemTxveviTi

wyalsatevebidan wylis dalevis, piris dabanis dros da a.S.
bunebriv kerebSi dgindeba garkveuli kavSiri leptospirebis gamoyofasa da cxovelis
saxes Soris, mag. L. icterohaemorrhagiae-s mtarebeli ufro xSirad aris nacrisferi
virTagva _ Ratus norvegicus, xolo L. grippothyphosa-si _ memindvria.
leptospiroziT inficirebis ZiriTad gzad iTvleba alimenturi da kontaqturi
meqanizmi.
avadoba ufro maRalia zafxulSi, banaobis sezonis dros, xolo sporadulad
SemTxvevebi SeiZleba gxvdebodes mTeli wlis ganmavlobaSi.
daavadeba adamianidan adamianze ar gadadis.
paTogenezi: infeqciis SeWra organizmSi, ZiriTadad, xdeba kanidan, misi umniSvnelo
paTogenezi
dazianebis pirobebSic ki. amasTan, leptospirebis SeWra SesaZlebelia wyalTan mcire
kontaqtis drosac. inficireba SesaZlebelia agreTve, piris Rrus, koniunqtivis lorwovani
garsebidan. raime adgilobrivi movlenebi (pirveladi afeqtebi) am dros kanisa da
lorwovani garsebis mxriv ar aRiniSneba. ufro metic, anTebiTi procesi limfuri
ZarRvebis, regionuli limfuri kvanZebis mxriv an srulebiT ar aris gamoxatuli an
susti reaqciiTaa warmodgenili. limfuri barieris advilad gadalaxvis Semdeg
leptospirebi aseve advilad xvdebian sisxlSi. viTardeba e.w. pirveladi leptospiremia
(drois mixedviT es periodi Seesabameba inkubaciur periods 2-dan _ 26 (saSualod 7-
dan 12) dRemde xangrZlivobiT da maTi upiratesi parenqimuli ganTesva aRiniSneba
RviZlSi, elenTaSi, TirkmelebSi, Tirkmelzeda jirkvlebSi da a.S. aq xdeba maTi gamravleba
da dagroveba. leptospirebs aqvT unari, zogjer gadalaxon hematoencefaluri barieri,
gamravldnen liqvorSi, tvinis qsovilSi. xangrZlivobiT es periodi Seesabameba inkubaciur
periods da iTvleba infeqciuri procesis pirvel fazad. SemdegSi aRniSnuli kerebidan
viTardeba masiuri leptospiremia (meoradi leptospiremia anu septicemia), rac klinikurad
vlindeba daavadebis mwvaved dawyebiT. mikroskopiT am dros sisxlSi aTeulobiT
leptospirebs naxuloben. masiuri leptospiremia da maT mier egzotoqsinismagvari
nivTierebebisa da daRupvis Sedegad endotoqsinis ganTavisufleba ganapirobebs paTogenezis
sesisur-intoqsikaciur rgols. momdevno periodi xasiaTdeba saerTo mdgomareobis
xanmokle gaumjobesebiT, ris Semdegac iwyeba daavadebis e.w. imunuri stadia. am droisaTvis
organizmSi warmoiqmneba specifikuri antisxeulebi, rasac Tan sdevs sisxlidan, Tav-
zurgtvinis siTxidan da sxva organoebidan leptospirebis gaqroba, Tumca maTi kerebi
jer kidev SenarCunebulia Tirkmlebsa da sxva organoebSi da SardiT. parazitis
gamoyofac grZeldeba.
leptospirebisa da maTi toqsinebis erT-erTi umTavresi paTogenuri moqmedeba
mimarTulia sisxlZarRvTa kapilarebis universaluri dazianebisaken. garda amisa,
leptospirebis toqsini aZlierebs Trombocitebis agregaciul aqtivobas. gansakuTrebiT
mZime mimdinareobis dros irRveva hemostazis yvela rgoli (sisxlZarRvovan-
Trombocituli da plazmuri), rac ganapirobebs hemoragiul sindroms. aseT SemTxvevebSi
seqciaze naxuloben mravalkerovan sisxlCaqcevebs, romelTa intensivoba gansakuTrebiT
didia ConCxis kunTebSi, TirkmelebSi, RviZlSi, Tirkmelzeda jirkvlebSi, kuWSi, filtvebSi
da sxva organoebSi. RviZlSi aRiniSneba calkeuli hepatocitebis degeneraciuli da
nekrozuli cvlilebebi. gavrcelebul nekrozebs, B hepatitisagan gansxvavebiT,
leptospirozis dros adgili ara aqvs, an viTardeba iSviaTad.
daavadebis paTogenezSi gansakuTrebuli adgili uWiravs Tirkmlebis dazianebas,
rac umravles SemTxvevaSi letaluri gamosavlis mizezi xdeba mwvave ukmarisobis
(uremiuli komis) ganviTarebis gamo. leptospirebi da maTi toqsinebi uSualod
azianeben Tirkmlebis sisxlis kapilarebs, qerqovan, qerqqveSa Sris nivTierebebs, rac
230
iwvevs Sardis warmoqmnis darRvevas, oliguriasa da uremias.

leptospirebi 10-35%-Si arRveven hematoencefalur bariers da ganapirobeben nervuli
sistemis dazianebas meningitis saxiT. gansakuTrebiT xSiria sisxlCaqcevebi wvivis
kunTebSi ti puri fokaluri nekrozuli da nekrobiozuli cvlilebebi aRiniSneba.
zogjer hematogenuri gziT moxvedrili leptospirebi ganapirobeben specifikur pnevmonias,
irits, iridociklits da sxva.
antibiotikoTerapiasTan dakavSirebiT imunuri sxeulebis gamomuSaveba xdeba
mogvianebiT fazaSi da ufro naklebi titriT, vidre etiotropul mkurnalobis dawyebamde,
rodesac antisxeulebis titri maRalia (1:1000, 1:100000).
imuniteti leptospirozis dros ti pur-specifikuri da xangrZlivia, rac ar
gamoricxavs meored daavadebas sxva seroti pebiT.
rekonvalescenciis periodSi (5-10 dRiani apireqsia) SesaZlebelia daavadebis
recidivi, rac ufro araadekvaturi antibiotikTerapiis Sedegia.
klinika. inkubaciuri periodi 2-dan 26 dRemde meryeobs da xSirad 7-12 dRes
klinika
Seadgens. leptospirozi, gansakuTrebiT endemur kerebSi, umTavresad subklinikurad
(usimptomod) mimdinareobs da gvxvdeba, ufro metad fermerebSi, nagvis gamtanebSi,
maTi ojaxis wevrebSi.
manifesturi formebis dros arCeven siyviTliTa da siyviTlisgareSe mimdinare
daavadebas.
usiyviTlo forma, rogorc wesi, iwyeba uecrad, raime prodromuli movlenebis
gareSe Zlieri SemcivnebiT da maRali temperaturiT 39-400C-mde (70%-Si), meningitiT
(20%-Si), hepatorenuli disfunqciiT (10%-Si). avadmyofebi uCivian Tavis Zlier tkivils,
uZilobas, madis dakargvas, wyurvils, kunTebis, gansakuTrebiT wvivis kunTebis tkivils.
aRiniSneba agreTve barZayis, welis da sxva kunTebis tkivilic, rac siaruls Zlier
zRudavs, an SeuZlebels xdis. zogierT avadmyofSi muclis swor kunTebSi
sisxlCaqcevebTan dakavSirebiT aRiniSneba muclis kunTebis Zlieri tkivili, ris gamoc
saWiro xdeba mwvave muclis gamoricxva.
damaxasiaTebelia avadmyofis habitusi _ saxe hi peremiuli da pastozuria, sklerebi
inicirebuli, magram koniunqtiviti gamonadenis gareSea, avadmyofebs TvalSi ucxo
sxeulis SegrZneba ara aqvT. zogjer adgili aqvs kisrisa da gulmkerdis zemo
nawilis hi peremias (`kapiuSonis simptomi~). temperatura rCeba maRal cifrebze 5-7
dRe, mudmiv an remisiul xasiaTs atarebs da klebulobs kritikulad an daCqarebuli
lizisiT.
bavSvebSi, SemTxvevaTa 50%-Si kanze cvlilebebi atarebs laqovan, laqovan-papulur,
dasqvamaciul, zogjer ki peteqiur, hemoragiul xasiaTs. daavadeba SedarebiT msubuqad
mimdinareobs L. autumnalis- infeqciis dros, romelmac pretibialuri cxelebis
saxelwodeba miiRo (fort-bregis cxeleba).
sasunTqi sistemis mxriv zogjer adgili aqvs rinofaringitis movlenebs,
iSviaTad_leptospirozul pnevmonias.
gul-sisxlZarRvTa sistemis mxriv aRiniSneba bradikardia, gulis tonebis moyrueba,
ekg-ze _ difuzuri miokarditis niSnebi.
RviZli, daavadebis me-4-5 dRidan TiTqmis yvela avadmyofSi gadidebulia, palpaciiT
mtkivneulia marjvena ferdqveSa are, avadmyofi uCivis simZimis SegrZnebas, elenTa
gadidebulia TiTqmis 50%-Si.
Tirkmlebis dazianeba pirvelsave dRes iwvevs oligurias, avadmyofTa umravlesobas
uvlindeba pasternackis simptomi.
bolo dros gaxSirda dazianebebi centraluri nervuli sistemis mxriv, rac
leptospirozis bavSvTa SemTxvevebis TiTqmis 50%-Si gvxvdeba da vlindeba meningizmis
231
an meningitis saxiT _gamoxatulia kisris kunTebis rigidoba, kernigis, bruZinskis,

nerisa da sxva simptomebi. TiTqmis 80%-Si imatebs Tav-zurgtvinis siTxis wneva,
aRiniSneba mononuklearuli citozi, romelic ar aRemateba 400-500 1/mkl-Si,
zemoaRniSuli movlenebi SeiZleba erT kviraSi alagdes, SesaZloa ganviTardes Cirqovani
meningiti. encefalitis movlenebi leptospirozisaTvis damaxasiaTebeli ar aris.
leptospirozi iSviaTad xdeba mxedvelobis daqveiTebis mizezi. SesaZlebelia
ganviTardes calmxrivi an ormxrivi uveiti.
leptospirozi bavSvebTa 10%-Si mimdinareobs siyviTliT (vasilev-veilis (Weil-
is) daavadeba). adre Tvlidnen, rom aseTi formebi gamowveulia L. icterohaemorrhagiae-
Ti, magram Semdeg dadginda, rom msgavsi formebi SeiZleba sxvadasxva seroti pebiTac
iyos ganpirobebuli. siyviTliT mimdinare leptospirozis dasawyisi periodi arafriT
gansxvavdeba usiyviTlod mimdinare formebisagan. daavadebis meore talRa RviZlisa da
Tirkmelebis disfunqciiT xasiaTdeba. RviZli am dros gadidebuli da mtkivneulia,
viTardeba sxvadasxva intensivobis siyviTle. romelic, Cveulebriv, kargadaa gamoxatuli
da ramodenime dRidan ramodenime kviramde xangrZlivobiT xasiaTdeba. sisxlSi adgili
aqvs rogorc pirdapiri, aseve arapirdapiri bilirubinis momatebas, aRiniSneba alat-isa
da asat-is zomieri momateba, albuminebis raodenoba ramdenadme klebulobs, momatebulia
alfa-1,-2- da gama- globulinebi. ukanaskneli cvlilebebi SeiZleba ganviTardes rogorc
siyviTliT mimdinare, ise usiyviTlo formebis dros.
umravles SemTxvevaSi daavadebis mZime mimdinareobisas klinikur suraTSi dominirebs
Tirkmlebis dazianebis simptomatika, kritikul SemTxvevebSi maTi mwvave ukmarisoba da
letaluri gamosavali. arCeven mwvave ukmarisobis 3 stadias: pirveli xasiaTdeba
diurezis SemcirebiT, meore _ mdgradi oliguriiT. sisxlSi matulobs Sardovanas,
kreatininisa da kaliumis Semcveloba, mcirdeba Sardis xvedriTi wona, viTardeba
proteinuria da aRwevs 1-3 g/l. Sardis naleqSi aRiniSneba eriTrocitebi, sxvadasxva
saxis cilindrebi, epiTeliuri ujredebi. xanmokle anuriis SemTxvevaSi (3-4 dRe)
prognozi keTilsaimedoa. 4 dReze meti anuria prognozs yovelTvis seriozuls xdis.
mesame stadia xasiaTdeba poliuriiT, romelic SeiZleba 2 kviramde gagrZeldes.
leptospirozis mZime formis dros Tirkmlis mwvave ukmarisobasTan erTad
SesaZlebelia ganviTardes RviZlis ukmarisobac.
simZimis gaTvaliswinebiT leptospirozi SeiZleba mimdinareobdes msubuqi, saSualo
da mZime formiT.
msubuqi formisas zogadi intoqsikacia sustadaa gamoxatuli, temperatura ar
aRemateba 38-38,50C. RviZlisa da elenTis dazianeba umniSvneloa, hemoragiuli diaTezi
ar aRiniSneba.
saSualo simZimis SemTxvevaSi temperatura 38,5-390C-s aRwevs, kunTebis tkivili
zomieria, SeiZleba adgili hqondes siyviTles, Tirkmlebis dazianebis simptomatikas.
hemoragiuli sindromi zomieradaa gamoxatuli.
mZime formebi hiperTermiiT, kunTebis Zlieri mtkivneulobiT, hemoragiuli sindromiT,
formebi
siyviTliT, Tirkmelebis dazianebiT, meningitiTa da a.S. xasiaTdeba.
daavadebis xangrZlivoba, SeiZleba 4-5 da meti kvira gagrZeldes. recidivebi (3-4
talRa) araadekvaturi antibiotikTerapiiTaa gamowveuli.
leptospirozis gaurTulebeli mimdinareobis dros rekonvalescenciis periodi
iwyeba meore kviris bolos da gamoixateba saerTo mdgomareobis TandaTanobiTi
gaumjobesebiT _ kunTebis tkivili, meningealuri movlenebi qreba, siyviTle klebulobs,
temperatura normas ubrundeba, ar meordeba sisxldena, izrdeba Sardis gamoyofa,
normalizacias ganicdis dazianebuli organoebis funqciebi.
garTulebebi leptospirozis dros dakavSirebulia TviT leptospirebTan. pirvel
232
rigSi maT miekuTvneba Tirkmlebis mwvave ukmarisoba, infeqciur-toqsikuri Soki, miokarditi,

pnevmonia. mogvianebiT _ Tvalis dazianeba: iriti, iridocikliti. meoradi floriT
gamowveul garTulebebs miekuTvneba pnevmonia, otiti, parotiti, qolecistiti, pieliti
da a.S.
diagnozi. leptospirozze eWvis mitana SesaZlebelia klinikuri niSnebis safuZvelze
diagnozi
_ daavadebis uecari dawyeba maRali temperaturiT, kunTebis Zlieri mtkivneuloba,
damaxasiaTebeli saxe `myvinTavis Casisxlianebuli Tvalebi~, RviZlisa da elenTis
mtkivneuli gadideba, hemoragiuli gamonayari, meningealuri movlenebi da sxva. epidanamnezis
gaTvaliswinebiT _ daavadebis dawyeba zafxulSi banaobis an fexSiSvela siarulis
Semdeg.
daavadebis pirvel 7-10 dRes sisxlidan da Tav-zurgtvinis siTxidan, Sardidan ki
pirvel rigSi daavadebis meore kviras da rekonvalescenciis periodSi SeiZleba
specialur niadagze miRebul iqnas leptospirebis kultura.
vercxliT impregnaciisa da mafluorescirebeli antisxeulebis meTodiT SesaZlebelia
leptospirebis identificireba inficirebuli organizmis qsovilebsa da siTxeebSi.
leptospirebis aRmoCena SesaZlebelia slaid-aglutinaciiT sisxlSi da SardSi
mikroskopiiT mxedvelobis bnel areSi. muq fonze naxuloben aqtiurad moZrav moTeTro-
monacrisfro spiralebs. maTi aRmoCena SesaZlebelia agreTve fazur-kontrastuli
mikroskopiiT, magram, es meTodi did gamocdilebas saWiroebs da xSirad iZleva Secdomebs.
daavadebis meore kviridan sisxlSi SeiZleba antisxeulebis aRmoCenac.
praqtikaSi leptospirozis diagnostikisaTvis gamoiyeneba serologiuri meTodi.
antisxeulebis titri 1:100 da meti dadgenil SeiZleba iqnas daavadebis dawyebidan
arauadres 8-10 dReSi. maqsimaluri titri ki me-14-17 dRes vlindeba. daavadebis
dinamikaSi sisxlis Sratis aranakleb 2 gamokvleva gviCvenebs antisxeulebis titris
4-jer zrdas, rac leptospirozis diagnozs sarwmunos xdis.
mwvave da gatanili infeqciis gansasxvaveblad iyeneben calkeuli klasis M da G
imunoglobulinebis gansazRvras. mwvave leptospirozis dros sisxlSi M klasis
imunoglobulinebi matulobs, G imunoglobulinebi ki gadatanil infeqciaze mowmobs.
sadiagnostikod gamoiyeneba enzimniSandebuli imunosorbentuli analizic.
leptospirozze eWvis mitanis SemTxvevaSi diferenciuli diagnozi saWiroa gatardes
aseptiur meningitTan, mwvave brucelozTan, hemolizur-uremiul sindromTan, virusul
hepatitebTan, daavadebebTan, romlebsac Tan axlavT hemoragiuli diaTezi, maT Soris
meningokokcemiasTan, gri pTan, siyviTliT mimdinare mononukleozTan, iersiniozTan,
listeriozTan da sxva.
mkurnaloba tardeba stacionarSi. iniSneba saTanado dieta (rZisa da mcenareuli
produqtebi). mkurnaloba tardeba RviZlisa da Tirkmelebis dazianebis gaTvaliswinebiT.
Terapiis ZiriTadi meTodia antibiotikebiT mkurnaloba.
yvelaze efeqturia penicilinTerapia, gansakuTrebiT Tu dawyebulia daavadebis
dawyebidan araugvianes 4 dReSi. iniSnebaT 50-100000 erT/kg sxeulis masaze dRe-
RameSi. daavadebis mZime formebisa da meningitiT mimdinareobis dros preparati iniSneba
ufro maRal dozebSi. am SemTxvevaSi penicilinis ineqciis Semdeg pirvelsave saaTebSi
SeiZleba ganviTardes iariS-herqsmeieris sindromi (endotoqsikuri Soki). penicilini
SeiZleba tetracikliniT Seicvalos, romelic, Cveulebriv, iniSneba 12 wlis asakis
zeviT. tetraciklinis preparatebidan yvelaze efeqturia doqsiciklini 0,1_0,2g 2-
jer dReSi _ 7 dRe.
ruseTSi leptospirozis sawinaaRmdego imunoglobulini (gamaglobulini)
saWiroebisas SehyavT winaswari desensibilizaciis Semdeg.
avadmyofebs eniSnebaT vitaminebis kompleqsi. infeqciur-toqsikuri Sokis, Tirkmlebisa
233
leptospirozi
kerZo nawili. tki pismieri laim - bo
pismieri borreliozi
eliozi
da RviZlis mwvave ukmarisobis dros mkurnaloba tardeba Sesabamisad.

2-3 dRis anuriis, sisxlSi Sardovanas, kreatininis, kaliumis momatebis SemTxvevaSi
naCvenebia hemodializi, hiperbaruli oqsigenacia, hemabsorbcia da intensiuri mkurnalobis
sxva meTodebi.
profilaqtika. saWiroa wylis rezervuarebisa da produqtebis dacva
profilaqtika
mRrRnelebisagan, cxovelebisagan adamianebisaTvis wylis smis akrZalva. avadmyofi
cxovelebis xorcis xmareba sakvebad sakmarisi Termuli damuSavebis gareSe.
aucilebelia avadmyofi cxovelebis izolacia da mkurnaloba.
mozrdilebSi daavadebis riskis dros profilaqtika tardeba doqsicikliniT _
200mg 1-jer kviraSi.
kontaqtis Tavidan asacileblad arsebobs specialuri tansacmeli.
adamianTa vaqcinacia SemuSavebuli ar aris. cxovelTa vaqcinacia uzrunvelyofs
mxolod maTi daavadebis Tavidan acilebas da ara baqteriebis gamoyofas SardiT.
tki pismier
pismierii laim - bo
borreliozi
eliozi
(LYME DISEASE - ingl.
ingl.)
laim-boreliozi (sinonimi laimis daavadeba, tki pismieri sistemuri boreliozi,

tki pismieri eriTema da sxva) warmoadgens bunebriv-kerovan infeqciur daavadebas,
romelic xSirad Rebulobs recidivul da qronikul mimdinareobas organizmis sxvadasxva
sistemis dazianebiT.
daavadeba pirvelad aRwerili iyo 1975 wels q. laimSi, koneqtikutis StatSi (aSS),
mimdinareobda arTritiT, hqonda lokaluri afeTqebis xasiaTi da dakavSirebuli iyo
tki pis kbenasTan. SemdgomSi gamoirkva, rom daavadebis gavrcelebis geografiuli areali
gacilebiT farToa da gvxvdeba evropasa da aziaSic.
daavadeba, rogorc calke nozologiuri erTeuli, gamoyofil iqna 1984w. mas Semdeg,
rac dadginda, rom 1981w. boreliebiT inficirebuli tki pis nawlavidan W. Burgdorfer-
is mier gamoyofili iyo spiroqeta. dadginda, rom laimis daavadebis gamomwvevia
analogiuri mikroorganizmi Borrelia Burgdorferi.
ruseTSi laim-boreliozi serologiurad verificirebuli iyo 1985w., xolo 1991w.
Sevida infeqciuri nozologiuri erTeulebis oficialur CamonaTvalSi. saqarTveloSi
daavadeba serologiurad 1997 wels aris verificirebuli (T. cercvaZe da n.
goCitaSvili.).
gamomwvevi miekuTvneba spiroqetebis ojaxs, boreliebis gvars. spiroqeta Borrelia
Burgdorferi formiT deziseburad daklaknil spirals mogvagonebs da, rogorc yvela
sxva spiroqetas, gaaCnia protoplazmuri cilindri. Semofarglulia ujreduli da
garegani membraniT. miekuTvnebian gramuaryofiT baqteriebs 0,2-0,3 X 20-30mkm zomiT.
maTi zoma cvalebadobs kultivirebisa da sxvadasxva patronis organizmSi yofnis
dros. axasiaTebs brunviTi moZraoba, aqvT zedapiruli OSPA, OSPB da OSPC antigenebi,
romlebic gansazRvraven calkeul Stamebs. maTi kultivireba xdeba Kelly modificirebul
niadagze (niadagi BSK, seleqciuri niadagi BSK-K5). kulturaSi boreliebi kargaven
paTogenurobas da 10-15 pasaJis Semdeg arapaTogenurebi xdebian.
boreliebi gamoiyofa gadamtani tki pebidan, xolo daavadebuli adamianebidan _
eriTemis zonidan, romelic tkipis mokidebis gamo viTardeba; agreTve gamoiyofa sisxlidan,
Tav-zurgtvinis siTxidan, arTrituli siTxidan.
ukanasknel dros, garda Borrelia Burgdorferi sensu stricto, gamoyofilia ori
234
pismierii laim - bo
borreli ozi
eliozi
axali saxis Borrelia garinii sp. nov da VS461 group, romelmac praqtikulad ukve
miiRo saxelwodeba Borrelia afzelii sp. nov dadginda, rom dRemde gamoyofili amerikuli
Stamebi miekuTvnebian mxolod B. Burgdorferi-is Stamebs, evropaSi ki aRiniSneba yvela,
samive saxis borelia. varaudoben, rom revmatologiuri gamovlineba ufro xSirad
dakavSirebulia B.Burgdorferi-is StamTan. nevrologiuri _ B. garinii, xolo mogvianebiT
kanis forma _ B. afzelii-sTan.
aris winaswari monacemebi axali paTologiuri boreliebis arsebobis Sesaxeb, romlebic
dakavSirebulia Ixodidea-s (Bijaponica) saxeobis tki pebTan.
maSasadame, iqsoduri boreliozebi warmoadgenen etiologiurad axlos myof, magram
damoukidebel nozologiur jgufebs, Tumca yvela maTgans jer kidev ara aqvT TavianTi
saxelwodeba.
amJamindeli boreliozis epidemiologiuri Taviseburebebis, paTogenezisa da klinikuri
gamovlinebis gaTvaliswinebiT sruliad misaRebia maTi gaerTianeba saerTo saxelwodebiT
tki pismieri laimis daavadeba an laimis daavadeba, tki pismieri boreliozis pirvelad
aRmweris pativsacemad.
epidemiologia. bunebrivi kerebi, ZiriTadad, dakavSirebulia zomieri klimaturi
zonis tyian landSaftTan. amerikaSi ZiriTad gadamtanebs miekuTvneba saZovris tki pebi
_ Ixodes scapularis (Zveli saxelwodeba I.dammini), evraziaSi taigis
(I.persulcatus) da tyis (I. ricinus) tki pebi.
ruseTSi ZiriTadi epidemiologiuri da epizooturi mniSvneloba aqvs taigis tkipebs.
tki pebis Wupri xSirad parazitobs wvril mRrRnelebze, xolo nimfa da momwifebuli
saxe _ xerxemlianebze, ZiriTadad _ tyis cxovelebze. garkveuli mniSvneloba eniWeba
ZaRlebs. dadgenilia boreliebis ramdenime Stamis simbiozi erT tki paSi. aqedan,
SesaZlebelia encefalitiTa da laimis daavadebiT erTdrouli inficireba, rac arTulebs
klinikur diferenciacias miqst-infeqciis SemTxvevaSi.
adamianis inficireba xdeba transmisiuli gziT, tki pis kbenisas gamomwvevis nerwyviT
inokulaciis gziT. ar aris gamoricxuli daavadebis gadacema orsulobis SemTxvevaSi
transplacenturad, riTac SesaZlebelia aixsnas daavadebis sakmaod maRali procenti
skolamdel da umcrosi saskolo asakis bavSvebSi.
daavadebuli adamianidan janmrTelze infeqcia ar gadadis.
laimis daavadebisaTvis damaxasiaTebelia gazafxul-zafxulis sezonuroba. ruseTSi
bunebriv-kerovani zoonozebidan laimis daavadebas erT-erTi pirveli adgili ukavia.Tumca
aSS-Si da sxva qveynebSic medicinaSi am daavadebis gamo aRiniSneboda didi mRelvareba
ufro albaT hi perdiagnostikis gamo (Eugene D.Shapiro; 1997).
paTogenezi. organizmis inficireba xdeba tkipis kbenis adgilidan nerwyviT, romlis
sapasuxod, umravles SemTxvevaSi, viTardeba pirveladi afeqti anTebad-alergiuli
cvlilebebiT. histologiurad dermaSi sisxlis kapilarebis irgvliv adgili aqvs
infiltracias limfocitebiTa da plazmuri ujredebiT.
boreliebis lokaluri persistenciis SemTxvevaSi (eriTema) avadmyofebis zogadi
mdgomareoba SedarebiT damakmayofilebelia _ intoqsikaciis movlenebi sustadaa
gamoxatuli, ar aRiniSneba laimis daavadebisaTvis damaxasiaTebeli gamovlinebani, gviandeba
organizmis imunuri pasuxi. procesis progresirebisas (an lokaluri fazis gareSe
mimdinareobisas) simptomkompleqsis ganviTarebaSi mniSvneloba eniWeba boreliebis
hematogenur, SesaZloa, limfuri gziTac gavrcelebas, SeWris adgilidan Sinagan organoebSi,
saxsrebSi, perinevrulad, SemdgomSi rostralurad (niskartiseburad) tvinis garsebis
procesSi CaTreviT.
imasTan dakavSirebiT, rom boreliebi organizmSi SeiZleba didxans persistirebdnen,
klinikuri manifestacia zogjer mogvianebiT viTardeba.
235
pismieri borreliozi
eliozi
boreliebis flageluri (wamwamovani) antigenis 41 kd masiT gaRizianebis Sedegad

(ufro evropuli Stamebis dros) organizmSi adgili aqvs zogad da adgilobriv
humorul da ujredul hi perimunur pasuxs. specifikuri IgM-is gamovlinebas adgili
aqvs daavadebis me-3-6 kviras, magram SeiZleba ufro didxansac darCes. Semdeg vlindeba
specifikuri IgG. arTritebis paTogenezSi wamyvani roli eniWeba interleikinsa da
sxva limfokinebs. dadgenilia, rom avadmyofebi, romlebsac aReniSnebaT aloti pebi
HLA-DR2, DR3 da DR4, genetikurad ganwyobilni arian qronikuli arTritebisadmi.
limfokinebis stimulacia ganpirobebulia boreliebis li popolisaqariduli antigeniT
monocituri makrofagocitebis rigis da zogierTi T limfocitebis, B limfocitebisa
da sxvaTa gaaqtiurebiT. interleikin-1, Tavis mxriv, iwvevs prostaglandinebis da
kolagenazas sekrecias sinovialur qsovilebSi, amiT anTebadi procesis gaaqtiurebas,
rac iwvevs Zvlis rezorbcias, xrtilebis destruqciasa da panusis (rqovanas SemRvrevis)
warmoqmnas.
SedarebiT gvian da sustad gamoxatul boreliemiasTan dakavSirebuli, Senelebuli
imunuri pasuxi genetikurad midrekil avadmyofebSi, autoimunuri procesebiTa da
ujredSida persistenciiT warmoadgens infeqciis qronizaciis ZiriTad mizezs.
klinika. klinikur mimdinarobaSi arCeven sam periods _ adreul lokalizebul,
adreul diseminirebul da mogvianebiTi gamovlinebis periodebs, (amerikaSi ixmareba
sityva “daavadeba” periodis magier).
adreuli lokalizaciis periodSi pirveladi afeqti 70%-Si warmodgenilia
ti puri gamonayriT, romelic xSirad Cndeba inficirebidan 7-14 dRis, iSviaTad _ 3-32
dRis ganmavlobaSi.
tkipis kbenis adgilebia iRliis are, Wipis irgvlivi are, barZayebi, Tumca SesaZlebelia,
nakbeni sxeulis nebismier adgilas iyos. avadmyofTa nawils kbenis adgilas aReniSneba
wvis SegrZneba, tkivili, kanis mgrZnobelobis darRveva. kbenis adgilze Cndeba eriTema
mowiTalo papulis an makulis saxiT, romelic ramdenime dReSi uniformuli xdeba
(rgolisebri), Tumca SesaZlebelia sxva formisac iyos. axasiaTebs gadideba ramdenime
dRis an kviris ganmavlobaSi, misi diametri SeiZleba varirebdes 3sm-dan 15sm-mde da
metad. zomis aseTi cvalebadobis gamo man miiRo saxelwodeba Erythema migrans.
eriTemis gareTa sazRvari, Cveulebriv, intensiurad wiTelia da, rogorc wesi, misi done
ar scildeba mosazRvre kanis dones. eriTemis centraluri nawili ufro mkrTalia da
SeiZleba aRiniSnos vezikula da nekrozi (pirveladi afeqti). daavadebis simZime ar
aris dakavSirebuli eriTemis sidideze. zogierT SemTxvevaSi daavadebis mwvave periodi
SeiZleba Semoifarglos mxolod kanis dazianebiT. ufro xSirad ki eriTemas Tan
axlavs organizmis zogadi intoqsikaciis movlenebi _ maRali temperatura (39-40°C-
mde) 2-7 dRis ganmavlobaSi, Semcivnebebi, zogadi sisuste, Tavis tkivili, zogjer
kisris kunTebis rigidoba, arTralgiebi. aranamkurnaleb avadmyofebSi aseTi gamovlineba
ama Tu im intensivobiT SeiZleba gagrZeldes ramdenime kvira. normamde daklebis
Semdeg temperatura subfebriluria ramdenime dRis ganmavlobaSi.
adreuli diseminaciis periodis yvelaze xSir gamovlinebad iTvleba
mravalricxovani eriTema, romelic tki pis kbenidan 3-5 kviris ganmavlobaSi Cndeba,
rogorc meoradi genezis eriTemebi. pirveladi eriTemisagan (pirveladi afeqti)
gansxvavebiT, meoradi eriTemebi gamoirCevian mcire zomiT, ar arian dakavSirebuli
kbenis adgilTan, maTi lokalizacia SeiZleba iyos mravlobiTi da sxeulis nebismier
adgilas, ar aReniSnebaT pirveladi afeqtisaTvis damaxasiaTebeli eriTemis centris
danekrozeba. meoradi eriTemis genezi dakavSirebulia dermaSi spiroqetebis
diseminaciasTan. laim-boreliozis mwvave periodSi nevrologiuri gamovlinebani,
Cveulebriv, daavadebis meoTxe kviras Cndeba, Tumca SesaZlebelia, adgili hqondes jer
236
pismierii laim - bo
borreli ozi
eliozi
kidev pirveladi eriTemis periodSi.

yvelaze xSiria sami ZiriTadi saxis cvlileba _ serozuli meningiti, kranialuri
nervebis dambla da radikulonevritebi.
bavSvebSi mozrdilebTan SedarebiT sxva nevrologiuri darRvevebze metad
meningealuri movlenebi dominireben.
serozuli meningitis dros Tav-zurgtvinis siTxe xasiaTdeba limfocituri
pleocitoziT, cilebis momatebiT, wneva da Saqris Semcveloba, Cveulebriv, normis
farglebSia. liqvorSi xSirad naxuloben monoklonur IgG da IgM-s.
kranialuri nervebis dazianebidan gansakuTrebiT aRsaniSnavia qalas VII wyvili
nervis (n. facialis) parezi, romelic xSirad 2-3 kviris ganmavlobaSi srulad aRdgeba.
sayuradReboa, rom aseTi dambla gamonayris gareSec ki SeiZleba gamovlindes. SesaZlebelia
Tvalis mamoZravebeli, mxedvelobisa da smenis (III,IV,VI) nervTa dazianeba. iSviaTad
gvxvdeba gadaxrebi IX-X wyvili nervebis mxriv.
periferiuli nervuli sistemis mxriv avadmyofTa 30%-s aReniSneba kisris,
gulmkerdis, welis dazianeba xerxemlis nervTa fesvebis mgrZnobelobis darRveviT.
SeiZleba adgili hqondes mono- da poliradikulonevritebs erTi an ramdenime kiduris
moZraobisa da mgrZnobelobis darRveviT. pirveladi eriTemis gaCenidan daaxloebiT 5
kviris Semdeg SeiZleba gamovlindes karditi, iSviaTad gamtareblobis darRveviT.
mogvianebiTi periodi. daavadebis dawyebidan daaxloebiT 6 Tvis Semdeg SeiZleba
ganviTardes laimis daavadebis gviani gamovlineba. tipuria msxvili saxsrebis morecidive
arTritebi (muxlis (90%), idayvis), Tumca wvrili saxsrebic ziandeba. saxsrebis
anTebiTi procesi SeiZleba TveobiT gagrZeldes saxsrebis monacvleobiT. aRsaniSnavia,
rom aseTi morecidive arTritebi SeiZleba iyos laimis daavadebis gamovlineba raime
sxva adreuli simptomatikis gareSe, eriTema migransis CaTvliT. adreul periodSi
Catarebuli antibiotikTerapiis Sedegad qronikuli arTritebi ar viTardeba.
daavadebis periodebi zogjer Tanmimdevrulad ar vlindeba da ifargleba mxolod
adreuli stadiiT, zogjer ki SeiZleba warmodgenili iyos nebismieri nevrologiuri
darRveviT, magG.: meningitiT, meningoencefalitiT.
laimis daavadebis dros periferiul sisxlSi leikocitebis raodenoba normis
farglebSia an odnav momatebuli. eds ramdenadme momatebulia, sinovialur siTxeSi
leikocitebis ricxvi 1 mkl-Si 25000-125000-mde aRwevs.
diagnozi da diferenciuli diagnostika. laimis daavadebis diagnostika, pirvel
rigSi, eyrdnoba ti pur (beWdisebr) eriTemul gamonayars _ pirvelad afeqts (mTavari
markeri), epidemiologiur gamokiTxvas (kontaqtis dadgena tki pasTan). ama Tu im
periodisaTvis damaxasiaTebel klinikur suraTs _ nevrologiuri, kardiuli da saxsrovani
dazianebis saxiT. mniSvnelovania, mxedvelobaSi miviRoT daavadebis SesaZlo mimdinareoba
pirveladi afeqtis gareSe (20-30%), an avadmyofs SeiZleba ar axsovdes tki pis
mokidebs dro da pirveladi eriTemis arseboba an Tu daavadebis meoradi gamovlinebis
droisaTvis pirveladi afeqti spontanurad gaqra. aseT SemTxvevebSi diagnozis
dadastureba unda moxdes baqteriologiuri da serologiuri meTodebis saSualebiT.
boreliebis gamoyofa SeiZleba sisxlidan, Tav-zurgtvinisa da sinovialuri siTxeebidan,
biofsirebuli pirveladi afeqtidan, miokardiumidan da sxva dazianebuli organoebidan
da qsovilebidan. avadmyofebidan boreliebis kulturis miReba gaZnelebulia, misi
zrdisaTvis saWiroa 4 kvira, gamokvleva ZviradRirebulia, pasuxi ki xSirad _ uaryofiTi.
dazianebul organoebsa da qsovilebSi boreliebis gamovlena SesaZloa bioftatSi
eleqtronuli mikroskopiiT, vercxlis SeRebviT (Wartrhin-Starry an Dieteile
modifikaciiT) da monoklonuri antiboreliuri niSandebuli antisxeulebiT. IgM-is
piki daavadebis dawyebidan 3-6 kviraSia, IgG-s ki nela izrdeba da Tveebis Semdeg aqvs
237
pismieri borreliozi
eliozi
adgili _ persistencia grZeldeba wlebis manZilze. magram es mkurnalobis dasaniSnad

ar aris sakmarisi. gamoiyeneba enzimimunosorbentuli analizi, magram SeiZleba jvaredini
reaqciebi leptospirebTan, T. pallidum, Varicella-virus, imunuri daavadebebis dros
dasamtkiceblad sasurvelia, daidgas imunoblotis testi. es testi adasturebs ifas
da enzimimunuri testebis pasuxs. Western immunoblot-is reaqcia saWiroa mxolod
ifas da enzimimunuri testis dadebiTi pasuxis dros, xolo maTi uaryofiTi pasuxi
imunoblotiT dadasturebas ar saWiroebs. Tu daavadeba 1 Tveze meti xangrZlivobisaa,
ar aris saWiro IgM-is Zebna. Tu ki adreul periodSi (1 Tvemde) pasuxi uaryofiTia,
saWiroa wyvili Sratis gamokvleva. adreuli diseminerebuli da mogvianebiTi
diseminirebuli daavadebebis dros IgG dadebiTia.
antisxeulebis aRmoCena Tav-zurgtvinis siTxeSi Znelia da saWiroa momzadebuli
personali Sedegis interpretaciisaTvis.
zogjer arTralgiiTa da asTeniiT mimdinare daavadebebis drosac SeiZleba miviRoT
dadebiTi serologiuri pasuxi, magram maTgan TiTqmis umravlesoba cru-dadebiTia.
saWiroa am pasuxebis Sefardeba klinikur gamovlinebebTan.
gamoiyeneba serologiuri meTodi antisxeulebis dasadgenad _ ifa da imunoenzimuri
meTodi. perspeqtiulia polimerazuli jaWvuri reaqcia (Polymerase chain reac-
tion), romelic iZleva diagnozis dadasturebis saSualebas organizmSi mikrobTa
mcire raodenobis SemTxvevaSic.
diferenciuli diagnozis gatarebisas, pirvel rigSi, mxedvelobaSia misaRebi
tkipismieri encefaliti, rigi serozuli meningitebi da meningoencefalitebi, reaqtiuli
da revmatoiduli arTritebi, revmatizmi. kanis dazianebis periodSi streptokokuri
celulitebi, erizi peloidi da sxva. sadiferenciacio areali ganisazRvreba imisda
mixedviT, Tu ra periodSi xdeba avadmyofis gamokvleva (adreuli Tu mogvianebiTi
gamovlinebis dros).
mkurnaloba. etiotropuli preparatebidan avadmyofebs eniSneba penicilini,
amoqsicilini, doqsiciklini 9 wlis asakis zemoT, eriTromicini, qloramfenikoli da
sxva.
amerikis pediatriis akademiis mier laimis
daavadebis mkurnalobis rekomendaciebi
daavadebis gamovlineba preparati da doza

adreuli lokalizaciis daavadeba
≥ 8 weli Doxycycline per os
100 mg 2-jer dReSi 14-21 dRis ganmavlobaSi
yvela asaki Amoxicillin per os
25-50 mg/kg dRe-RameSi gayofili 3 miRebaze
(maqsimum 2 g/dRe-RameSi) 14-21 dRe
adreuli diseminaciis an mogvianebiTi daavadebis
dros
igive, rac adreuli lokalizaciis dros, magram 21
mravalricxovani meoradi erythema migrans
dRe
izolirebuli n. facialis-is dambla igive, rac zemoT aRniSnuli, oRond 21-28 dRe
arTritebi igive, magram 28 dRe
Ceftriaxone (rocefini) 75-100 mg/kg I.V an I.M 1-
morecidive arTritebi
jer dReSi 14-21 dRe
an penicillin-i 300 000 erT/kg I.V : 4 Seyvanaze
(maqim. 20 mln) 14 - 21 dRe)
Ceftriaxone an penicillin-i igive dozebiT da
karditi
xangrZlivobiT
Ceftriaxone an penicillin-i igive dozebiT da
meningiti an encefaliti
xangrZlivobiT
238
tki pismieri laim - bo
pismieri borreli ozi
eliozi
kerZo nawili. katis nakawris daavadeba
aRniSnuli preparatebis miuReblobis SemTxvevaSi (alergiuli da sxva gverdiTi

movlenebi) mkurnaloba utardebaT per os eriTromiciniT 30-50 mg/kg sxeulis masaze,
4 miRebaze 21 dRis ganmavlobaSi.
Cvenebis mixedviT tardeba sadezintoqsikacio mkurnaloba.
prognozi. adreul stadiaSi Catarebuli mkurnalobisas prognozi keTilsaimedoa.
igi keTilsaimedo SeiZleba iyos diagnozis mogvianebiT (1,5 wlis) dasmis Semdegac.
mkurnalobis uefeqtoba ufro metad dakavSirebulia diagnostikur SecdomasTan
(klinikurad laim-borelozis msgavsi sxva daavadeba). SesaZloa daavadebis qronikuli
mimdinareoba. aRwerilia letaluri gamosavlis SemTxvevebic.
profilaqtika analogiuria imisa, rac gaTvaliswinebulia tkipismieri encefalitis
dros. vaqcinacia da seroprofilaqtika dReisaTvis SemuSavebuli ar aris, Tumca am
mizniT muSaoba grZeldeba.
laim-borelioziT daavadebulebi ar SeiZleba iyvnen sisxlis donorebi.
katis nakawris daavadeba
sinonimi: felinozi (laT. Felis _ katis gvareobiTi saxelwodeba), keTilTvisebiani

limforetikulozi, Lymphoreticulosis benigna, regionuli arabaqteriuli
limfadeniti.
katis nakawris daavadeba warmoadgens mwvave infeqciur daavadebas, romelic adamians
gadaecema inficirebuli katisagan gakawvris, kbenis an lokvis Sedegad da xasiaTdeba
regionuli limfadenitiT, cxelebiT, zogjer egzanTemiT, hepatolienuri sindromiT da
zomieri intoqsikaciiT.
cnobebi. calke nozologiur erTeulad daavadeba saxelwodebiT
`katis brWyalebis daavadeba~ gamoyofil iqna 1950w. frangi mecnieris _ debres da
Tanaavtorebis mier.
etiologia. daavadebis gamomwvevi agenti Bartonella henselae, adre cnobili
saxelwodebiT Rochalimaea aRmoCenili iqna 1983 w. amerikeli mecnierebis mier (D.
Wear et al; 1983w) da warmoadgens wvril, gramuaryofiT Cxirs, romelic zrdisaTvis
saWiroebs specialur niadags. 1991w. Brenner da Tanaavtorebma aRmoaCines mikrobis
6 ti pi, naxes misi dnm Semcveloba da daarqves am gvars Afipia (AFIP _ Armed Forces
Institute of Pathology- institutis dasaxelebisgan modis). yvela 6 ti pi gram-
uaryofiTia, moZravi da Soltis mqone mikroorganizmia. izrdebian naxSir-sokoian
eqstraqtebze (BCYE) - agarze. antigenuri TvisebebiT igi gansxvavdeba riketsiebisagan,
barTonelebisa da brucelebisagan. igi axlos dgas sangris daavadebis gamomwvevTan -
Bartonella (Rochalimaea) quintana -sTan. es infeqcia aiv-infeqciis drosac gvxvdeba
imunokoprometirebulebSi.
epidemiologia. infeqciis wyaros warmoadgenen mxolod katebi. TviTon katebi
am dros janmrTelni rCebian. iTvleba, rom mikrobebi maTi piris Rrus normalur
floras warmoadgenen, romelTa aRmoCena SeiZleba nerwyvSi, SardSi, TaTebze. daavadeba
adamianidan adamianze ar gadadis. daavadeba upiratesad gvxvdeba bavSvebSi. umniSvnelovanes
epidemiologiur faqtors warmoadgens katebTan kontaqti da mikrobebis gadacema
kanis gakawvriT, kbeniT an lokviT. daavadeba ufro sporaduli SemTxvevebis saxiT
gvxvdeba, Tumca SeiZleba adgili hqondes ojaxur afeTqebebsac.
paTogenezi. mikrobebis organizmSi SeWra xdeba kanidan, zemo sasunTqi gzebis
lorwovani garsebidan, koniunqtividan, kuW-nawlavis traqtidan. katasTan kontaqtis
239
dros inficireba SeiZleba moxdes kanis mikrotravmebis drosac. inficirebis ZiriTad

gzas warmoadgens dazianebuli kani. yvelaze xSirad ziandeba xelis mtevnebi, winamxris
qveda nawilebi. ramdenime dReSi mikrobis SeWris adgilas viTardeba anTebadi reaqcia
_ pirveladi afeqti mkvrivi papulis saxiT, romelic SeiZleba dawyluldes da daifaros
fufxiT. aRniSnuli keridan mikrobebi limfuri gzebiT aRweven regionul limfur
kvanZebs, da mravldebian kidec maTSi. nawili iRupeba da gamoiyofa endotoqsini,
romelic iwvevs limfuri kvanZis an kvanZebis anTebas. limfur kvanZebSi aRiniSneba
anTebadi procesis sami stadia _ adreul stadiaSi viTardeba retikulur-endoTeluri
hi perplazia, Semdeg warmoiqmneba granulomebi, mogvianebiT stadiaSi ki _ mikroabscesebi.
aRniSnuli cvlilebebi ar warmoadgenen mxolod felinozisaTvis damaxasiaTebel
paTognomur suraTs, aramed msgavs cvlilebebs SeiZleba adgili hqondes brucelozis,
tularemiis, sarkoidozis, veneriuli limfogranulomebis da limfogranulomatozis
drosac. abscedirebuli retikuluri limfadeniti irRveva, rac iwvevs Cirqisagan mis
Semdgom sanacias an Tavdeba sklerozirebiT. iSviaT SemTxvevaSi adgili aqvs infeqciis
hematogenur diseminacias da mTeli rigi organoebisa da sistemebis dazianebas RviZlis,
elenTis, centraluri nervuli sistemis CaTreviT da sxva.
regionuli limfuri kvanZebidan procesSi SeiZleba CarTuli iyos pirvelad afeqtTan
uSualod axlos mdebare erTi an ramdenime limfuri kvanZi, romlebic mtkivneulia,
zomieradaa gamkvrivebuli da mWidrodaa erTmaneTTan Serwymuli. maT ganakveTze SeimCneva
moSavo-mowiTalo feris homogenuri an nekrozuli ubnebi. adreul stadiaSi ki Warbobs
retikuluri ujredebis hi perplazia granulomatozur procesSi TandaTanobiT
transformaciiT, romlebic warmodgenilni arian epiTeluri ujredebiT. mikroabscesebi
SeiZleba SeerTdnen da procesSi mTlianad CaerTos limfuri kvanZi. anTebiT kerebSi
SeiZleba adgili hqondes gigantur, mravalbirTvian, berezovski-Stenbergis ti pis
ujredebis warmoSobas. generalizebuli procesis SemTxvevaSi cvlilebebi viTardeba
tvinSi (encefaliti), filtvebSi (pnevmonia), RviZlSi (hepatiti), Zvlis tvinSi
(osteomieliti), jorjalSi (adeniti) da sxva.
klinika. inkubaciuri periodi 3-dan 61 dRemde meryeobs, ufro xSirad ki 1-2
kviras Seadgens. daavadebis ti puri gamovlineba 90%-Si xasiaTdeba pirveladi afeqtis
_ mikrobis SeWris adgilas anTebadi papulis, misi metamorfozis ganviTarebiT, xolo
mogvianebiT _ regionuli limfadenitis CamoyalibebiT. sxva SemTxvevebSi viTardeba
daavadebis atipuri formebi, romlebic moicaven: a) Tvalis formas (okulurglanduluri
Pirinaud-is sindromi koniunqtivis da preaurikuluri limfuri kvanZis dazianebiT.
b) centraluri nervuli sistemis dazianebas, g) sxva organoebis dazianebas, d) katis
nakawris daavadebas aiv-iT inficirebulebSi. mimdinareobis mixedviT iyofa mwvave da
qronikul mimdinareobad, xolo simZimis mixedviT arCeven msubuq, saSualo da mZime
formebs.
yvelaze xSir formas warmoadgens kan-jirkvlovani forma, romelic vlindeba kanis
an lorwovani garsis pirveladi anTebiTi reaqciiT, umravles SemTxvevaSi infeqciis
SeWris adgilas kanze Cndeba wiTeli feris laqa an papula, romelic gadadis vezikulaSi,
Semdeg ki wylulSi. mTavrdeba SexorcebiT nawiburis gareSe. pirveladi afeqti SeiZleba
ganviTardes infeqciis SeWridan ramdenime dRis Semdeg, magram SeiZleba gaCndes an
gamwvavdes ramdenime kviris Semdeg, roca infeqcia SeiWreba limfur kvanZebSi. limfadeniti
ufro xSirad viTardeba iRliisqveS (45%), kisris midamoSi (25%) da sazardulis
regionSi (20%). zogierT SemTxvevaSi adgili aqvs generalizebul limfadenits.
limfuri kvanZebi palpaciiT mtkivneulia, momkvrivo konsistenciis, Cveulebriv
mimdinareobs periadenitiT. gadidebuli limfuri kvanZebis sidide zog SemTxvevaSi 8-
10 sm aRwevs. 30-50%-Si kvanZebi ganicdian daCirqebas da galRobas momwvano feris
240
Cirqovani gamonadeniT. limfadenitma SeiZleba gaxangrZlivebuli, persistuli xasiaTi

miiRos (TveobiTac). am dros procesi mTavrdeba sklerozirebiT. sxva SemTxvevaSi ki
4-5 kviris ganmavlobaSi kvanZebis moculoba TandaTan mcirdeba, xdeba naklebad mkvrivi
da bolos ubrundeba sawyis mdgomareobas. zogadi intoqsikaciis movlenebs, rogorc
wesi, adgili aqvs limfadenitis Camoyalibebis periodSi, romelic gamoixateba daRlilobaSi,
dauZlurebaSi, Semcivnebasa da temperaturis momatebaSi. temperatura matulobs uecrad,
39-400 C-mde da 7-10 dRe grZeldeba, Semdeg ki ubrundeba normas an grZeldeba kidev
5-10 dRe subfebrilur doneze. msubuqi formis dros intoqsikaciis movlenebi saerTod
ar aRiniSneba, anda gamoxatulia sustad. temperatura ar aRemateba 370 C-s.
zog SemTxvevaSi erT-erT wamyvan simptoms warmoadgens pirveladi afeqti SeWris
adgilas da limfadeniti. zogjer ki aRiniSneba mxolod limfadeniti.
periferiul sisxlSi cvlilebebi dakavSirebulia paTologiuri procesis stadiasTan.
dawyebiTi procesisaTvis damaxasiaTebelia zomieri leikocitozi limfocitoziTa da
monocitoziT. eds normis farglebSia. limfuri kvanZebis daCirqebis periodSi aRiniSneba
maRali leikocitozi 15-20.103/l, neitrofilozi marcxniv gadaxriT, momatebuli eds.
atipuri mimdinareobisas 4-5%-Si SeiZleba adgili hqondes Tvalis formas. varaudoben,
rom am SemTxvevaSi agentis SeWris adgilia koniunqtiva. rogorc wesi, ziandeba
mxolod erTi Tvali koniunqtivis mkveTri hi peremiiTa da SeSupebiT. am dros yuris
bibilos win mdebare limfuri kvanZi gadidebuli da mtkivneulia. zogjer procesSi
SeiZleba CarTuli iyos ybayuris da ybisqveSa limfuri kvanZebi. mZime SemTxvevaSi
koniunqtiva wyluldeba, regionuli limfuri kvanZebi Cirqdeba. aRniSnul adgilobriv
movlenebTan erTad viTardeba zogadi intoqsikaciis movlenebi temperaturuli reaqciiT,
romelic SeiZleba ramodenime kviras gaxangrZlivdes.
felinozis sxva klinikuri formebidan iSviaTia, magram mZime mimdinareobiT gamoirCeva
nervuli sistemis dazianeba. klinikuri suraTi xasiaTdeba simptomTa nairsaxeobiT _
saxis nervis parezi, meningiti, encefaliti da sxva. aseTi formebis dros klinikuri
gamojanmrTelebis periodi xangrZlivia da ramodenime Tves moicavs.
sxva formebidan an garTulebebidan aRsaniSnavia filtvebis dazianeba, romelic
umravles SemTxvevaSi intersticiul xasiaTs atarebs da zogadi mdgomareobis gauaresebiT
mimdinareobs: xveliT, gaZlierebuli oflianobiT. rentgenogramaze aRiniSneba filtvebis
sisxlZarRvovani suraTis gaZliereba. zogjer ki pnevmonia mimdinareobs, rogorc
damoukidebeli daavadeba. aRwerilia agreTve felinozis abdominuri forma mezenteriuli
limfuri kvanZebis dazianebiT. SesaZlebelia ganviTardes Trombocitopeniuri purpura,
elenTis abscesi, miokarditi da sxva.
aiv-inficirebul pirebSi felinozi mimdinareobs sisxlZarRvebis Taviseburi
dazianebiT, romelic mogvagonebs kapoSis sindroms (baciluri angiomatozi da baciluri
peliozi), rac ganpirobebulia kanqveSa da kanSida sisxlZarRvebis cvlilebebiT.
klinikurad am dros aRiniSneba sxvadasxva saxis angiomebis suraTi an sisxlCaqcevebi
kanze.
diagnozis dadgena epidemiologiuri da klasikuri klinikuri mimdinareobis
SemTxvevaTa 95%-Si ar warmoadgens siZneles. diagnozis dadastureba SeiZleba
biofsirebuli limfuri kvanZebis histologiuri gamokvlevis dros wvrili Cxirebis
(afi piebis) aRmoCeniT, magram araumetes 40%-Si. yvelaze ufro damajerebelia dadebiTi
kanis sinji, romliTac avadmyofTa 95%-Si SeiZleba diagnozis dadgena. imunodeficitis
mqone avadmyofebSi 1-2%-Si SesaZebelia miviRoT uaryofiTi Sedegic. gamoiyeneba kanis
sinji PPD-T an PPD-Battey (gawmendili cilovani derivati - 0,1 ml kanqveS. Sedegi
72-96 saaTis Semdeg (5mm da > diametri papula-dadebiTi pasuxi) daxmarebiT da
daCirqebuli limfuri kvanZis substratis gamokvleva.
241
katis nakawris daavadeba
kerZo nawili. listeriozi
diferenciuli diagnozis gatareba aucilebelia iseT infeqciur daavadebebTan,

romelTaTvisac damaxasiaTebelia periferiuli limfuri kvanZebis gadideba. maT ricxvs
miekuTvneba: brucelozi, Savi Wiri, tularemia, veneriuli granuloma, cxeleba virTxis
kbenis Sedegad (sodoku), agreTve Cirqovani, sokovani, tuberkulozuri etiologiis
limfadenitebi da sxva.
mkurnaloba da prognozi. mxolod limfuri kvanZebis mniSvnelovani gadideba,
maTi daCirqeba warmoadgens punqciis da antiseptikebiT, analgetikebiT SigTavsis drenaJis
Cvenebas. mkurnaloba ZiriTadad simptomuria. gamoiyeneba fizioTerapiuli meTodebi,
rogoricaa ultramokle sxivebi, diaTermia. mkveTrad gamoxatuli limfadenitis dros
iniSneba kortikosteroidebi. aris monacemebi auromicinis dadebiT moqmedebaze, romelic
aCqarebs gamojansaRebas. generalizebuli infeqciis dros ixmareba trimetoprim-
sulfametoqsazoli, ci profloqsacini (asakis gaTvaliswinebiT). in vitro dadebiTi
efeqti aqvs gentamicins, amikacins, imi penems (tienams), cefalosporinebs.
prognozi, rogorc wesi, keTilsaimedoa, letaluri SemTxvevebi ar aRiniSneba.
profilaqtika. saWiroa katebTan kontaqtis SezRudva. specifikuri profilaqtika
SemuSavebuli ar aris.
listeriozi
LISTERIOSIS
listeriozi mwvave infeqciuri daavadebaa, romlis ZiriTadi gamomwvevia Listeria

monocytogenes (sul aris 7 saxeoba). daavadeba, upiratesad, aReniSneba orsul qalebsa
da axalSobilebs. klinikuri suraTi xasiaTdeba cxelebiT, organizmis zogadi
intoqsikaciiT, saylapavi rgolis limfuri kvanZebis xSiri gadidebiT, centraluri
nervuli sistemis, RviZlisa da elenTis dazianebiT. infeqcia xSirad mimdinareobs
sefsisis saxiT da araiSviaTad Rebulobs gaxangrZlivebul da qronikul formas.
cxovelebisagan gansxvavebiT, adamianebSi daavadebas Tan axlavs sisxlSi, Tav-zurgtvinis
siTxesa da sxva qsovilebSi polimorful-birTviani ujredebis reaqcia.
cnobebi.. 1926 wels ingliselma avtorebma _(E.S.Murray,
R.Webb, M.Swann) zRvis goWebsa da bocvrebSi aRweres sefsisuri daavadeba da
gamohyves agenti, romelsac daarqves saxelwodeba B. monocytogenes, sisxlSi
monocitebis maRali procentuli maCveneblis gamo (30-40%-mde). infeqciis Seswavlis
mniSvnelovan etapad iTvleba daavadebis aRwera melogineebsa da axalSobilebSi. 1940w.
listeris pativsacemad mikrobma miiRo saxelwodeba _ Listeria monocytogenes
(J.H. Pirie).
etiologia.. Listeria monocytogenes miekuTvneba Corinebacteriaceae-s ojaxs.
etiologia
igi gramdadebiTi Cxiria, zomiT (0,5-2)X(0,4-0,5)mkm. sporebs ar warmoSobs. listerias
7 saxeoba iyofa 2 sxvadasxva jgufad genomis mixedviT (dnm-is Seswavlis safuZvelze).
I jgufSi Sedis L. murrayi da L. grayi _ maT adre arapaTogenur mikrobebad Tvlidnen.
II jgufSi Sedis 5 saxeoba arahemolizuri L. innocua da L.welshimeri da hemolizuri
L. monocytogenes, L seeligeri, L. ivanovii (bolo paTogenuria ufro cxovelebisaTvis),
magram daavadebas yvelaze xSirad ganapirobebs L. monocytogenes. mas oTaxis
temperaturaze moZraobis unari aqvs, magram 37°C-ze kargavs am Tvisebas. sisxlian
agarze gamravlebisas iwvevs β-hemolizs, magram araiSviaTad α-hemolizsac. organoebidan
gakeTebul nacxSi mikrobebi erTmaneTis mimarT kuTxiT Tavsdebian da mogvagoneben
romaul cifrs – V. kargad izrdebian 37°C-ze Cveulebriv niadagebze, romelTac
242
glukoza da Srati aqvT damatebuli. listeriebs aqvT O da H antigenebi. mikrobis

daRupvisas gamoiyofa endotoqsini.
epidemi
epidemioologia. listeriozi warmoadgens ti pur bunebriv-kerovan zoonozur
infeqcias, dakavSirebulia epizootiebTan da Sinauri da gareuli cxovelebis infeqciis
mtareblobasTan. L. monocytogenes gavrcelebulia mTel msoflioSi. infeqciis ZiriTad
rezervuarebad iTvlebian mRrRnelebi (mindvris Tagvebi, virTxa, miwis kurdReli, bocveri
da sxva), Sinauri cxovelebi (msxvili rqosani saqoneli, cxvari, Txa, Rori da sxva),
frinvelebi, tki pebi da sxva. adamianis inficireba, ZiriTadad, xdeba cxovelebTan
kontaqtisas (momvleli personali, xorckombinatis muSebi da sxva).
inficirebis ZiriTadi gzaa alimenturi, sakvebi produqtebis arasakmarisi Termuli
damuSavebis gamo. am mxriv sainteresoa À\Ï\ Êàçàíöåâ
Êàçàíöåâ–is mier moyvanili monacemebi,
romelic aRniSnavs, rom listerioziT inficirebuli 123 saxeobis macivarSi Senaxuli
sxvadasxva produqtis 2013 nimuSidan mikrobiologiuri gamokvlevebis Sedegad
inficirebuli aRmoCnda 226 nimuSi (11%), aqedan 36% iyo Zroxis xorci, 31% _
frinvelis, 27% _ Roris, 11% _ bostneuli. araiSviaTad adamiani inficirdeba wyliTac;
SesaZlebelia infeqciis gadacema haeriTa da mtvriT.
cxovelebisagan inficireba mxolod erTaderTi meqanizmi rom ar aris, amaze is
faqtic mowmobs, rom daavadebulTa gansazRvruli raodenoba qalaqis macxovrebelia,
romelTac ara aqvT kontaqti cxovelebTan. am SemTxvevaSi infeqciis rezervuars
warmoadgenen, ZiriTadad, ginekologiuri paTologiiT daavadebulni, romelTac aqvT
ucnobi etiologiis cxeleba an daavadeba “usimptomod” mimdinareobs. dadgenilia, rom
1-5%-Si adamianis fekaliebidan SesaZlebelia listeriebis gamoyofa. aRwerilia daavadebis
perkutaneuli gziT gadacemac.
adamianidan adamianze listeriozis gadacemis yvelaze xSir meqanizmad iTvleba
nayofis an axalSobilis inficireba avadmyofi an baqteriamtarebeli dedisagan.
listerioziT daavadebis umetesi SemTxvevebi gazafxul-zafxulis periodSia. adgili
aqvs sporadul SemTxvevebs, magram SesaZlebelia epidemiuri afeTqebebic.
avaddebian nebismieri asakis adamianebi, magram yuradReba unda gavamaxviloT mcire
asakis bavSvebze, romlebSic letaluri gamosavali yvelaze didia.
paTogenezi. organizmSi listeriebis SeWra xorcieldeba kuW-nawlavis traqtidan,
xaxis, sasunTqi gzebisa da Tvalis lorwovani garsebidan, dazianebuli kanidan,
transplacenturi gziT, mSobiarobisas axalSobilis kontaqtiT dedis inficirebul
sekretTan. arsebiTi klinikur-paTogenezuri mniSvneloba aqvs infeqciis SeWris adgils.
ase mag: saylapavis limfuri rgolis gziT SeWrisas viTardeba anginuri forma, kuW-
nawlavis traqtidan _ tifoiduri (pirveladi anTebiTi procesi peieris folaqebsa da
solitarul folikulebSi), koniunqtividan _ Tval-jirkvlovani, transplacenturi
gziT _ sefsisuri forma.
mikrobis SeWris adgilidan maTi Semdgomi gavrceleba xdeba limfagenuri da
hematogenuri gziT, rac ganapirobebs Sinagan organoebSi diseminaciasa da mTeli
organizmis dazianebas (cns, nuSurebi, RviZli, elenTa, Tirkmelzeda jirkvlebi, Tirkmlebi,
placenta da sxv.).
aRwerilia paTogenezis 4 stadia: 1) mikrobis moTesva organoebSi SeRweviT 2)
fagocituri vakuolidan misi gasxltoma. 3) mikrobis sxivisebur wanazardebSi birTvebis
warmoSoba da ujredidan ujredze maTi gavrceleba. cnobilia genebi, romlebic am
stadiebze pasuxismgebelni arian. izogenur mutantebs ki naklebi virulentoba gaaCnia.
listeriolizini Tavisi bunebiT hemolizinia da saukeTesod asaxavs baqteriis
virulentobas. igi ganapirobebs vakuolis liziss. ujredidan ujredSi baqteriis
gadasvla xdeba citoxalazin-mgrZnobiare sxiviseburi fsevdopodiebis polimerizaciis
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meqanizmis ganxorcielebiT. fsevdopodiebi eqvemdebarebian axlomdebare ujredis

fagocitozs, Semdeg ki kvlav xdeba am ujredis vakuolis daSla da listeriebis
iqidan gamoTavisufleba. aseTi ujredSida parazitizmi icavs listerias humoruli (B
_ ujreduli) imunitetisagan. maofsonizebeli antisxeulebis roli garkveuli ar
aris. am infeqciis dros imunuri reaqciebi ujreduli meqanizmebiT xorcieldeba,
amitom nebismieri Tandayolili an SeZenili ujreduli T-limfocitebis funqciuri
darRveva xels uwyobs listeriozis ganviTarebas.
daavadeba, upiratesad, mcire asakis bavSvebisa da 55 wels gadacilebulTa xvedria,
gansakuTrebiT ki im avadmyofebisa, romelTac CautardaT xangrZlivi mkurnaloba
depresantebiT, kortikosteroidebiT an avadoben Saqriani diabetiT, avTvisebiani simsivneebiT,
aiv-infeqciiT da sxva.
Tumca L. monocytogenes-s axasiaTebs garemoSi ubikvaturi gavrceleba, magram
xSirad daudgeneli rCeba adamianebisa da cxovelebis inficirebis gza. 70%-ze meti
baqteriulad dadasturebuli SemTxvevebis dros adgili aqvs meningits. amasTanave,
unda aRiniSnos, rom am dros meningiti ar gamoirCeva sxva etiologiis meningitebisagan.
infeqciis perinataluri (transplacenturi gza) gadacema ganapirobebs nayofis
generalizebuli formiT daavadebas _ sefsiss, daavadebas, Cveulebriv, adgili aqvs
orsulobis me-3 trimestrSi inficirebisas.
axalSobilis inficireba mSobiarobis dros, albaT, inficirebuli dedis sekretTan
kontaqtis Sedegia.
morfologiuri cvlilebebidan yvelaze ufro damaxasiaTebelia granulomebis arseboba.
granulomebi Sedgeba epiTeluri ujredebisagan, makrofagebisagan, limfocitebisagan da
sxva ucnauri formis birTvebis mqone ujredebisagan. procesis progresirebis SemTxvevaSi
listeriebis gamravlebis gamo xdeba granulomebis centris danekrozeba. specifikuri
granulomebi warmoiqmnebian yvela organoSi (elenTa, filtvebi, Tirkmlebi, Tirkmelzeda
jirkvlebi, cns da sxva), magram gansakuTrebiT ki RviZlSi.
Tandayolili listeriozis dros granulomatozuri procesi Rebulobs
generalizebul xasiaTs da ganisazRvreba, rogorc granulomatozuri sefsisi. misi
paTmorfologiuri suraTi emsgavseba listerioziT daavadebul mRrRnelTa
paTmorfologiur cvlilebebs _ farTo diseminacia da mcire zomis abscesebi an
granulomebi.
kuW-nawlavis traqtis dazianebisas didi raodenobiT listeriebi SeiZleba vnaxoT
mekoniumidan gakeTebul nacxSi.
klinika.. infeqciis klinikuri gamovlinebani meryeobs avadmyofis asakTan dakavSirebiT.
klinika
inkubaciuri periodi meryeobs 3-dan 45 dRemde, sakvebismieri ki _ 21-30 dRe. ti puri
mimdinareobisas arCeven Semdeg klinikur formebs : 1) anginuri, anginur-sefsisuri, 2)
tifoiduri, 3)Tval-jirkvlovani, 4)nervuli, 5)nayofisa da axalSobilTa sefsisur-
granulomatozuri. araiSviaTad aRiniSneba Sereuli formebi. listeriozi SeiZleba
mimdinareobdes ati purad, subklinikuri an gri pismagvari formiT (orsulebSi) da sxv.
ufro xSirad adgili aqvs anginur, anginur-sefsisur mimdinareobas, romelsac
axasiaTebs daavadebis mwvave dawyeba, temperaturis momateba 39-40°C-mde, intoqsikaciis
movlenebi _ saerTo sisuste, madis daqveiTeba, Tavis tkivili; araiSviaTad xvela,
surdo, yelisa da kunTebis tkivili, saxis hiperemia, sklerebis sisxlZarRvebis inicireba.
xaxaSi SeiZleba procesi SemoizRudos kataruli movlenebiT, folikuluri anginiT,
nuSurebis dawyluleba-danekrozebiT an apkisebri nadebis arsebobiT. kisris, zogjer
iRliisqveSa limfuri kvanZebi gadidebulia da mtkivneuli, isinjeba gadidebuli RviZli
da elenTa. periferiul sisxlSi izrdeba leikocitebis raodenoba, gansakuTrebiT ki
mononuklearebis, eds momatebulia.
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daavadebis pikis dros SesaZloa polimorfuli gamonayari. arCeven daavadebis

msubuq, saSualo da mZime formebs. temperaturisa da sxva gamovlinebis ukuganviTareba
5-7 dRis an, iSviaTad, 2 kviris periodSi eteva, ris Semdegac iwyeba rekonvalescenciis
stadia. mZime SemTxvevebSi SeiZleba ganviTardes sefsisi, meningiti, meningoencefaliti;
aRwerilia listeriuli endokarditi, osteomieliti da sxva. orsulebSi daavadeba
gri pismagvari klinikiT mimdinareobs, iwvevs abortebs an naadrev mSobiarobas,
mkvdradSobadobas placentis dazianebis gamo. nayofis naadrevi dabadeba 50-90%-Si
sikvdiliT mTavrdeba. dedebs ki aReniSnebaT zogjer inficirebuli loxiebi, mSobiarobis
Semdeg cxeleba, Tumca infeqcia ufro xSirad maTSi spontanur gamojanmrTelebas
ganicdis.
Tval-jirkvlovani forma iSviaTia da, Cveulebriv, viTardeba inficirebul
cxovelebTan kontaqtis Sedegad, rodesac infeqtis SeWra xdeba koniunqtivis
lorwovanidan. daavadeba iwyeba temperaturis zomieri momatebiT, saerTo sisustiT,
Tavis tkiviliT, koniunqtivitiT (Cirqovani gamonadeniT).
koniunqtivis nakecebze naTlad moCans xasxasa folikulebis grova. aRsaniSnavia,
rom rqovanas dazianebas adgili ara aqvs, magram SeiZleba ganviTardes mxedvelobis
daqveiTeba. yurisqveSa, ybisqveSa da, zogjer, kefis ukana limfuri kvanZebi gadidebuli
da mtkivneulia. periferiul sisxlSi igive cvlilebebia, rac anginuri formis dros
iyo xsenebuli. daavadebis xangrZlivoba SeiZleba meryeobdes 1-dan 3 Tvemde.
tifoiduri formis dros temperatura ufro xangrZlivia da zogadi intoqsikaciis
movlenebi mkveTradaa gamoxatuli, amasTan, raime arsebiTi paTologiuri procesis
lokalizacia ar dgindeba. RviZli da elenTa gadidebulia, araiSviaTia Sardis gamuqeba,
siyviTle, aqoliuri ganavali. SesaZloa poliserozitis movlenebi perikarditiT da
plevritiT. procesSi SeiZleba CaerTos cns, filtvebi, kuW-nawlavis traqti da sxva.
periferiul sisxlSi aRiniSneba anemia, Trombocitopenia, Sededebis unaris daqveiTeba;
aRwerili klinikuri mimdinareoba ufro gvxvdeba dasustebul, axalSobil da wlamde
asakis bavSvebSi. tifoidur formas angina ar axasiaTebs. SesaZlebelia daavadeba
sikvdiliT damTavrdes.
nervuli forma, Cveulebriv, mcire asakis bavSvebSi gvxvdeba da axasiaTebs menin-
gitis, meningoencefalitis da encefalitis suraTis ganviTareba. daavadeba SeiZleba
daiwyos rogorc mwvaved, aseve TandaTanobiT. am dros Tav-zurgtvinis siTxe gamWvirvalea,
gamodis wneviT, cilis Semcveloba momatebulia, citozma SeiZleba umniSvnelod moimatos
limfocitebis xarjze; mZime formebis dros siTxe mRvriea, citozi maRalia da atarebs
neitrofilur xasiaTs.
periferiuli nervuli sistemis dazianebisas SeiZleba ganviTardes kunTebis calkeuli
jgufebis dambla; zogjer viTardeba poliradikulonevritis suraTi. daavadebis
paTogenezSi mniSvneloba eniWeba meorad imunodeficitur mdgomareobas, sxvadasxva
Tanmxleb daavadebebs, depresantebiT mkurnalobas da sxva.
Tandayolili listeriozis sefsisur-granulomatozur formas adgili aqvs
avadmyofi an mtarebeli dedisagan axalSobilis an nayofis inficirebisas. inficireba
xdeba orsulobis adreul stadiaSi, Tumca igi kargad Seswavlil ar aris ukanasknel
TveebSi (transplacenturi inficireba) an mSobiarobisas sanayofe wylebis aspiraciis
da Caylapvis Sedegad. orsulobis adreul periodSi inficirebisas SeiZleba ganviTardes
aborti an bavSvi daibados Camoyalibebuli mankiT. orsulobis meore naxevarSi
inficirebisas bavSvi ibadeba Tandayolili listeriozis niSnebiT _ sunTqvisa da
sisxlis mimoqcevis darRveviT (dispnoe, cianozi, gulis tonebis moyrueba). adgili
aqvs Rebinebas, enterokolitis suraTs, kanze aRiniSneba kvanZovani, papuluri, rozeoluri,
naklebad _ hemoragiuli gamonayari, romelic Zalian emsgavseba meningokokcemiisaTvis
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damaxasiaTebel gamonayars. gamonayars adgili aqvs agreTve piris RruSi, gansakuTrebiT

nuSurebze. yovelTvis aRiniSneba hepato-lienuri sindromi, araiSviaTad siyviTle, cns-
is dazianebis simptomatika meningitis, meningoencefalitis saxiT; periferiul sisxlSi
leikocitozia neitrofiloziT, momatebulia eds. aRniSnuli forma xasiaTdeba maRali
letaluri gamosavliT.
arsebobs axalSobilTa listeriozis adreuli da mogvianebiTi gamovlinebebi:
ad reuli gamovlinebis d ros mogvianebiTi gamovlinebis d ros

naadrevi mSobiaroba drouli mSobiaroba
dabadebis dros masa mcirea dabadebis dros masa normaluria
axalSobilTa sefsisi axalSobilTa meningiti
daavadebis dawyeba dabadebidan ≈ 1,5 dReSi daavadebis dawyeba dabadebidan ≈ 14 dReSi
sikvdilianoba >30% sikvdilianoba <10%
sameano garTulebebi orsuloba da mSobiaroba garTulebis gareSe
dedas aqvs Listeria infeqcia nozokomialuri xasiaTisaa
ZuZumwovar bavSvebSi daavadeba mimdinareobs mwvave respiraciuli virusuli

infeqciis klinikiT (surdo, xvela, maRali temperatura), xSirad viTardeba bronqopnevmonia,
SesaZlebelia Cirqovani plevritis Camoyalibebac, gamonayari kanze, piris RruSi
mravalricxovani granulomebi, araiSviaTia meningitisa da meningoencefalitis suraTi.
gamojanmrTelebis SemTxvevaSi adgili aqvs nervuli sistemis dazianebis narCen movlenebs.
daavadeba xSirad mTavrdeba letalurad.
listeriozi SeiZleba mimdinareobdes mwvaved, qvemwvaved da qronikulad. mwvave
formis xangrZlivobisa da gamojanmrTelebis periodebi 1,5-dan 3 Tvemdea. qronikuli
formisas listeriebi didxans imyofebian organizmSi da SesamCnev klinikur gamovlinebebs
ar iwveven; zogjer ki procesi mwvavdeba msubuqi mwvave respiraciuli daavadebis
niSnebiT an pielitis gamwvavebis saxiT; organizmis dauZlurebisas, romelic
ganpirobebulia sxvadasxva Tanmxlebi daavadebiT (avTvisebiani simsivne, leikozi, mkurnaloba
citostatikebiT, kortikosteroidebiT da sxva), xdeba procesis gamwvaveba, maT Soris
infeqciis generalizaciac, es ki orsulobis SemTxvevaSi SesaZlebels xdis nayofis
inficirebas.
diagnozi. listeriozi raime specifikuri simptomatikiT ar xasiaTdeba, magram am
daavadebaze eWvis mitana SeiZleba yvela SemTxvevaSi, roca axalSobilebsa da mcire
asakis bavSvebSi daavadeba mimdinareobs sefsisiT, meningitiT, meningoencefalitiT, pnevmoniiT
da sxva. didi mniSvneloba eniWeba anamnezs _ perinataluri infeqciis niSnebs (spontanuri
aborti, memkvidreoba, dRenakli bavSvi), mZime Tanmxlebi daavadebis gamo miRebul
imunodepresantebsa da kortikosteroidebs da a.S.
listeriozis anginur-jirkvlovani da Tval-jirkvlovani formebi, romlebic
mimdinareoben limfuri kvanZebis gadidebiT, saWiroeben diferenciuli diagnozis gatarebas
infeqciur mononukleozTan, infeqciur eriTemasTan, mwvave toqsoplazmozTan, sisxlis
daavadebebTan da sxva; nervuli formebis dros diferenciuli diagnozi tardeba
meningitebTan (meningokokuri, pnevmokokuri, stafilokokuri).
vinaidan listeriozis klinikuri diagnostika siZneleebTanaa dakavSirebuli,
gadamwyveti mniSvneloba aqvs etiologiur diagnostikas, romelic xorcieldeba
baqteriologiuri da serologiuri gamokvlevebiT. unda aRiniSnos, rom sakvebi niadagebis
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aradamakmayofilebeli gamdidrebis gamo inficirebuli biologiuri substratebidan

listeriebis gamoyofa sakmaod rTulia.
axalSobilTa gamokvlevisas sargebloben dedis cervikaluri vaginuri sekretiT,
axalSobilis Wi pis venidan aRebuli sisxliT, mekoniumiT, Tav-zurgtvinis siTxiT, kanis
gamonayris SigTavsiT, kuWis amonarecxiT, placentidan miRebuli kulturidan damzadebuli
nacxis mikroskopiis dros mxedvelobaSia misaRebi is faqti, rom difTeroidebi an sxva
morfologiurad msgavsi mikrobebi SeiZleba SecdomiT miCneul iqnas listeriebad.
listeriebis saorientacio daxasiaTebisaTvis SeiZleba gamoviyenoT luminescenciuri
mikroskopia.
listeriebis arsebobis dasadgenad zogjer mimarTaven biologiur sinjebs TeTr
Tagvebze (gamosakvlevi masalis SeyvaniT), magram es meTodi sakmaod rTulia.
serologiuri meTodebidan sargebloben aglutinaciis, arapirdapiri hemaglutinaciis
da komplementis SeboWvis reaqciebiT. serologiuri diagnostika cru dadebiTi reaqciebis
Sedegad nakleb efeqturia, rac ganpirobebulia e.w. xSiri bunebrivi antisxeulebiT,
amitom diagnostikuri mniSvneloba am reaqciebs eniWeba daavadebis mimdinareobisas
titris dinamiuri zrdis dros. listeriozis dros titri diddeba daavadebis me-3,
me-4 kviras. Tumca unda aRiniSnos, rom serologiuri testebi didad ar gvexmareba
diagnozis dazustebaSi. bolo xanebSi iyeneben polimerazul jaWvur reaqcias.
mkurnaloba. listeriebi, pirvel rigSi, mgrZnobiareni arian penicilinis, ampicilinis,
eriTromicinis da gentamicinis mimarT. penicilinisa da gentamicinis an ampicilinisa
da gentamicinis kombinacias gaaCnia sinergistuli efeqti. cefalosporinebs, maT Soris,
III generaciis preparatebs mikrobi ar emorCileba.
axalSobilTa listeriozis SemTxvevebSi venaSi penicilini SehyavT Semdegi doziT
240.000-320.000e/kg sxeulis masaze 6 Seyvanaze, yovel 4 sT-Si, 2 kviris ganmavlobaSi.
listeriuli endokarditis dros _ 4-6 kvira, yvela sxva formis dros _ 2 kvira;
gamonaklisia cns-is dazianeba, roca antibiotikebi ufro xangrZlivad ixmareba. daavadebis
Tvalis formis dros avadmyofebs eniSneba penicilini 320000-480000 erT/kg 6 Seyvanaze,
4 sT-is intervaliT, aranakleb 1 kviris ganmavlobaSi. penicilinis mimarT alergiul
avadmyofebSi gamoiyeneba trimetoprim-sulfametoqsazoli.
listeriuli limfadenitisa da kanis formis dros iniSneba eriTromicini _ 30-40
mg/kg sxeulis masaze.
zogierT L. monocytogenes axasiaTebs plazmiduri rezistentoba qloramfenikolis,
eriTromicinis da tetraciklinis mimarT.
prognozi damokidebulia klinikur formaze. anginuri, Tval-jirkvlovani da
tifoiduri formis dros keTilsaimedoa. axalSobilTa cns-is dazianebiT mimdinare
listeriozi, saTanado mkurnalobis Catarebis gareSe, xasiaTdeba maRali letalobiT.
profilaqtika. specifikuri profilaqtika SemuSavebuli ar aris. didi mniSvneloba
eniWeba sanitarul-veterinaruli RonisZiebebis maRal doneze Catarebas mecxoveleobis
meurneobebsa da sasaklaoebze. saWiroa saTanado kontrolis gaZliereba sakveb
produqtebze. listeriozis gavrcelebisaTvis saSiS zonebSi rZe mxolod aduRebis
Semdeg unda gamoviyenoT. mniSvneloba aqvs agreTve, moxetiale katebze, ZaRlebze,
mRrRnelebze kontrols.
axalSobilTa profilaqtikisaTvis saWiroa, droulad gamovavlinoT daavadebuli
dedebi da droulad CavutaroT saTanado mkurnaloba (antimikrobuli mkurnaloba
orsulobis dros zogjer icavs axalSobilsa da nayofs inficirebisagan).
247
kerZo nawili. kavasakis daavadeba
kavasakis daavadeba
kavasakis daavadeba anu limfur-kvanZovani mukokutaneuri sindromi multisistemuri

daavadebaa, romelic upiratesad gvxvdeba 4 wlamde asakis bavSvebSi da xasiaTdeba
mwvave cxelebiT, Tvalis, piris Rrus lorwovani garsebis dazianebiT, polimorfuli
makulur-papuluri gamonayriT, angio-nevrozuli SeSupebiT, mtevnisa da quslebis eriTemiT,
kisris limfuri kvanZebis gadidebiT, xSirad TandarTuli koronaruli Trombangitis
ti pis cvlilebebiT, Semdgomi mikroinfarqtebisa da nekrozebis ganviTarebiT.
cnobebi.. pirvelad limfur-kvanZovani muko-kutaneuri sindromi
aRwera Tomisaku Kawasaki-m 1967w. iaponiaSi.
etiologia. eleqtronuli mikroskopiiT kanis limfuri kvanZebisa da periferiuli
sisxlis elementebSi nanaxi iqna riketsiis msgavsi sxeulakebi (Homashima et
al.1973 da Odom P. et al 1977), rac ar gamoricxavs daavadebis riketsiul bunebas.
amasTan erTad zogierTi mkvlevaris varaudiT es sindromi SesaZloa retrovirusiTac
iyos gamowveuli. araa agreTve gamoricxuli streptokokis Epstein Barr virusisa da
HSV-6-is roli, dRemde sindromis gamomwvevi zustad cnobili ar aris.
epidemiologia.. iaponiaSi pirvel 50 SemTxvevaze cnobebi moxsenebuli iyo
epidemiologia
Kawasaki-is mier, xolo 70-iani wlebis Sua ricxvebSi SemTxvevaTa ricxvma ukve
1000-s miaRwia. daavadeba registrirebulia msoflios yvela kontinentze (korea,
kanada, safrangeTi, Svecia, germania, aSS) da endemuri da epidemiuri afeTqebebis xasiaTs
Rebulobs, SemTxvevaTa ZiriTadi ricxvi zamTar-zafxulis sezons emTxveva.
amJamad aSS-Si yovel wels kavasakis daavadebis 2-4 aTasi SemTxvevis registrireba
xdeba. ruseTSi aRwerilia daavadebis ramdenime SemTxveva. 1999w. q. Tbilisis bavSvTa
klinikur infeqciur savadmyofoSi diagnostirebul iqna 4 Tvis asakis bavSvis kavasakis
daavadebis pirveli SemTxveva, romelzec eWvi iqna mitanili 5, minimaluri klinikuri
kriteriumis damTxvevis Sedegad (cxeleba, koniunqtiviti, piris Rrus lorwovani
garsis dazianeba, kisris limfuri kvanZebis calmxrivi gadideba, egzanTema (a. xoWava,
m.xoWava)), rac aucilebeli iyo diagnostikisaTvis. daavadeba SedarebiT msubuqi
mimdinareobisa iyo da keTili gamosavliT damTavrda.
paTmorfologia da zogierTi imunologiuri aspeqti. autofsiis dros
gardacvlilebSi nanaxi iqna multisistemuri vaskulitis suraTi. ZiriTadad cvlilebebi
exeboda mcire, saSualo da msxvili kalibris arteriebis dazianebas. imasTan dakavSirebiT,
rom kavasakis daaavadebisa da kvanZovani periarteriitis dros morfologiuri suraTi
identuria, mkvlevarTa jgufi Tvlis, rom kavasakis sindroms ewodos kvanZovani
periarteriitis msgavsi daavadeba. Timusis mxriv adgili aqvs masis Semcirebas hasalis
sxeulakebis hipoplaziis xarjze (mesame ti pis hipoplazia di-duoTi). limfur kvanZebSi
aRiniSneba folikulebis hipoplazia, mravlobiTi nekrozebi, sisxlZarRvebis Trombozi,
imunoblasturi reaqcia, gansakuTrebiT postkapilaruli venebis irgvliv.
sistemuri vaskulitebis dros yuradRebas gansakuTrebiT i pyrobs koronaruli
arteriebis dazianeba. SemTxvevaTa 80%-Si sikvdili ganpirobebuli iyo koronaruli
arteriebis TromboziT. zog SemTxvevaSi (daavadebidan 2 kviris periodSi) viTardeboda
pankarditi da fataluri aritmia. vaskuluri dazianebis xarisxi dakavSirebulia
daavadebis periodTan da sikvdilis drosTan. mogvianebiT (wlebis gasvlis Semdeg)
sikvdili SesaZlebelia koronaruli stenozis da qronikuli iSemiis gamo.
adreuli dazianebisas aRiniSneboda koronaruli arteriebis intimis anTebadi procesi,
perivaskuluri infiltracia, xSirad _ anevrizmuli gafarToebebi.
daavadebis meore kviridan meeqvse kviramde anTebiTi cvlilebebis intensivoba
progresulad iklebs. polimorfulnuklearuli infiltracia icvleba plazmuri
248
ujredebiT da limfocituri infiltraciiT. sisxlZarRvTa kedlebSi aRiniSneba

destruqciuli procesebi, ris Sedegadac viTardeba anevrizmebi. am etapze sikvdili
xSirad gamowveulia koronaruli TrombozebiT da miokardiumis masiuri infarqtiT.
daavadebis dawyebidan 2 Tvis Semdeg gardacvlilebis sisxlZarRvTa kedlebSi da
gulis qsovilebSi anTebiTi procesi gamoxatuli iyo mcired an saerTod aRar iyo,
samagierod, vlindeboda miokardiumis infarqtis suraTi.
arteriebis dazianeba aRiniSneboda kuWSi, elenTaSi, nawlavebSi, barZayis da aqsilarul
arteriebSi, Tumca dazianebis xarisxi SedarebiT naklebad iyo gamoxatuli. agreTve
aRiniSneboda limfuri kvanZebis mikroTrombebis warmoSobis gamo fokaluri nekrozi
_ T-zonis hi perplaziiT, xolo B-zonis mononuklearuli ujredebis infiltraciiT.
kavasakis sindromis zogierTi imunologiuri aspeqtis Seswavlis Sedegad dadginda,
rom daavadebis mwvave periodSi adgili hqonda yvela ti pis imunoglobulinis donis
momatebas, rekonvalescenciis periodSi ki _ maT mkveTr daqveiTebas. mocirkulire B
ujredebis ricxvi mkveTrad izrdeboda da isini spontanurad aproducirebdnen
poliklonur imunoglobulinebs. B ujredebis aqtivacia ki TavisTavad iwvevda T
supresorebis (CD4) absolutur depresias da mwvave periodSi CD4/CD8 maCveneblis
awevas. CD8 supresia daavadebis 2-3 kvirisaTvis TandaTan klebulobs da citotoqsikuri
supresorebis ricxvi normaSi modis. amave dros aRmoCenilia mocirkulire imunuri
kompleqsebi daavadebis adreul stadiaSi, xolo daavadebis 4 kviris Semdeg maTi
raodenoba piks aRwevs. rekonvalescenciis periodSi maTi aRmoCena praqtikulad
SeuZlebelia. mocirkulire imunuri kompleqsebis raodenoba kavasakis sindromis dros
naklebia, vidre sistemuri wiTeli mgluras dros. daavadebis I, II, III kviras momatebulia
C3-is done, amave dros C4 mTeli daavadebis periodSi normis farglebSi rCeba. imunuri
kompleqsebis momateba normaluri an aweuli komplementis maCvenebliT gansxavdeba
klasikuri imunur-kompleqsuri daavadebebisagan imiT, rom ukanasknelSi prevalirebs
Tirkmlis dazianebis gamovlinebani, rac kavasakis sindromis dros iSviaTia. vazoaqtiur
faqtorTa aqtivacia dakavSirebulia imunur kompleqsebTan da Trombocitebis
agregaciasTan. SesaZlebelia, imunuri kompleqsebi pirdapir ukavSirdebian sisxlZarRvovan
epiTeliums da iwveven anTebiT process. periferiuli sisxlis mononuklearebis mier
izrdeba IL-1, TNF, γ-IFN, IL-2 produqcia.
endoTeliumis dazianeba SeiZleba aixsnas rogorc citokinebis gaZlierebuli
produqciiT (isini iwveven endoTeliur ujredze antigenebis dagrovebas), aseve mavnebeli
IgM da IgG zedmeti produqciiT. am axalwarmoqmnili antigenebis sawinaaRmdegod
zemoT aRniSnuli cvlilebebi sisxlZarvTa epiTeliumSi iwveven anTebiT process.
aseTi anTebiTi cvlilebebi sabolood sisxlZarRvTa anevrizmas iwveven. daavadebis
dawyebidan 13-29-e dRidan izrdeba Leukotriene B4-is produqcia, romelsac gamohyofen
polinuklearuli ujredebi anTebiTi procesis dros. es ki ufro aZlierebs da
axangrZlivebs anTebiT cvlilebebs.
kavasakis sindromis dros imunologiuri faqtorebis mniSvnelovan rols amtkicebs
is, rom mkurnalobaSi did efeqts iZleva maRali dozebiT daniSnuli intravenuri
imunoglobulini (IVIG), rogorc mwvave periodSi, aseve koronaruli anevrizmebis
dros. imunoglobulinTerapiis Semdeg mkveTrad qveiTdeba B ujredebis aqtivacia da
citokinebis sekrecia, xolo T citotoqsikuri ujredebis ricxvi ubrundeba normas.
SesaZlebelia, rom koronaruli arteriebis endoTeliuri ujredebi aaqtiveben mTavari
histoSeTavsebis kompleqsis HLA II klasis antigenebs. savaraudoa, IVIG-is maRali
dozebi iwvevs citokinebis donis Semcirebas da amiT endoTeluri ujredis funqciaze
moqmedebs. zemoaRniSnuli ki amcirebs antigenis produqcias. sxva moqmedebis meqanizmi
aixsneba IVIG-is imunoglobulinebis zedmet produqciaze SesaZlo gavleniT, citokinebisa
249
da gamomwvevi agentis an toqsinis neitralizaciiT, imunuri kompleqsebis da

autoantisxeulebis araspecifikuri blokadiT.
klinika.. kavasakis sindromisaTvis damaxasiaTebelia klinikuri gamovlinebebis
klinika
polimorfizmi da amave dros specifikis gareSe, rac ganapirobebs diagnostikis did
siZneleebs. amitom daavadebis diagnostika emyareba simp-tomTa erTobliobas (kom-
pleqss):
1) erT-erT wamyvan simp-tomad iTvleba cxeleba, romelic mwvaved iwyeba da remi-
siul xasiaTs atarebs 2-4 pikiT dReSi. Tu avadmyofi aspiriniTa da imunoglobuliniT
namkurnalebi ar aris, cxele-
ba 5-35 dRemde grZeldeba, sa-
Sualod ki 10 dRe. intrave-
nuri imunoglobulinis gada-
sxmis Semdeg 80%-Si temper-
atura normas ubrundeba 24
saaTSi.
2) koniunqtiviti. bulbur
koniunqtivaze aRiniSneba
sisxl-Caqcevebi. zogierT pa-
cientSi dgindeba foliku-
luri palpeb-raluri koniun-
qtiviti. koniunqtivitis dros
naklebadaa gamoxatuli eqsu-
dacia, SeSupeba da dawylule-
ba. zog SemTxvevaSi viTarde-
ba saSualo simZimis mwvave
iridocikliti an wina uvei-
ti. avadmyofebi iSviaTad uCiv-
ian Tvalis tkivils, foto-
fobias.
3) piris Rrus mxriv
cvlilebebi variabeluria.
SesaZloa gamoxatuli iyos
tuCebis dazianeba, Jolosebri
ena, pirxaxis eriTema.
daavadebis dawyebidan 2-5
Kawasaki -s daavadeba. koniunqtiviti, gamonayari, SeSupeba, d R e S i tuCebi odnav
kanis aqercvla frCxilebTan, limfuri kvanZis gadideba. hi peremiuli da SeSupebulia,
(S. Krugman) ramdenime dReSi tuCebis
lorwovani skdeba da xdeba
sisxlmdeni. tonzilebze nadebi iSviaTia, misi arsebobisas saWiroa sxva daavadebebis
gamoricxva.
4) kidurebis dazianeba. xSirad, adgili aqvs xelisgulebsa da terfebze muqi
mowiTali feris difuzur gamonayars (angionevrozuli SeSupeba), rac iwvevs siarulis
gaZnelebas, uWirT xeliT sagnebis fiqsacia, mag., makratelis da a.S. daavadebis qvemwvave
stadiaSi damaxasiaTebelia xelisa da terfebis desqvamacia. xelebze da terfebze
Cndeba damaxasiaTebeli zolebi _ Beaus lines (Rarisebri ganivi CaRrmavebebi), romlebic
daavadebis dawyebidan me-6-8 kviraze viTardeba da Tan mohyveba frCxilis zrdas.
qunTruSis dros desqvamacia gamoxatulia ufro wvrili qatoseburi aqercvliT, xolo
250
kavasakis sindromis dros ki aqerclili firfitebi gamoirCeva sisqiT.

5) gamonayari kavasakis sindromis dros eriTemuli xasiaTisaa, igi ar aris vezikuluri
an buluri, magram mas axasiaTebs polimorfizmi. elementebis diametri 2-10 mm-s
Sedgens, mosdevs qavili. gamonayari Erithema multiforme-s an Erithema urticaria-
s waagavs. SeiZleba iyos mravalricxovani papuluri gamonayari, romelic, rogorc
gafantuli, aseve Serwymuli xasiaTisaa. wiTelasagan gansxvavebiT saxeze da sxeulze
gamonayari Zalian iSviaTia. qunTruSismagvari gamonayari gvxvdeba daaxloebiT 10%-Si.
iSviaT gamonayars miekuTvneba Erithema marginatum (brtyeli eriTemuli gamonayari),
romelic aRwerilia wlamde asakis bavSvebSi. gamonayris gavrceleba individualuria,
magram ufro xSirad igi muclis qveda nawiliT an perianaluri ariT Semoifargleba.
6) limfuri kvanZebis gadidebis sixSire 50%-s aRwevs. rogorc wesi, procesSi
calmxrivad erTveba kisris limfuri kvanZebi da maTi zoma 1,5-7 sm-mde aRwevs, palpaciiT
metad mgrZnobirea. kvanZebis irgvliv qsovilebi SeSupebulia. zog SemTxvevaSi avadmyofebs
periodulad aReniSnebaT tkivili ylapvis dros. limfuri kvanZebis gadideba iwyeba
gamonayris gamovlinebasTan erTad da qreba temperaturis normalizaciisas.
sxva gamovlinebebi. 1/3 SemTxvevaSi avadmyofebs aReniSnebaT steriluri piuria
ureTritis movlenebiT. SeiZleba adgili hqondes wvrili saxsrebis anTebas, sinovits,
saxsris siTxeSi aRiniSneba sqeli Cirqovani gamonaJoni (leikocitebis raodenoba
aseul aTass aRwevs 1 mkl-Si). rogorc wesi, eqsudati steriluria. arTritis
gamovlinebani iwyeba daavadebis me-10 dRemde, xolo Tu igi mogvianebiT ganviTarda,
ziandeba msxvili (muxlis da wvivis) saxsrebi.
kuW-nawlavis mxriv SemTxvevaTa daaxloebiT 1/3-Si aRsaniSnavia muclis tkivili,
mZime diarea, gulisreva, cns-is dazianeba SeiZleba gamovlindes leTargiiT, prekomiT.
SemTxvevaTa ¼1/4-Si avadmyofebs uviTardebaT aseptiuri meningiti, 5%-Si _ Soki.
mosalodnelia obstruqciuli siyviTlis ganviTareba, naRvlis buStis mwvave anTeba,
wyalmankis Camoyalibeba (Hydrops).
gulis dazianeba, romelic 20% SeiZleba
ganviTardes, xasiaTdeba perikardiumSi siTxis
dagrovebiT, tranzituli miokardiopaTiiT,
gulis ukmarisobiT da/an aritmiebiT
anevrizmebis CamoyalibebiT, miokardiumis
infarqtiT da sxv.
laboratoriuli monacemebi a r
xasaiTdebian specifikurobiT. mwvave fazaSi
aRiniSneba leikocitozi neitrofiloziT, eds
momatebulia. C reaqtiuli cila dadebiTia,
momatebulia α1- antitrifsinis maCveneblebi
mwvave da qvemwvave fazaSi, xolo 8-12 kviris
Semdeg isini uaxlovdebian normas. Trombocitebi
momatebulia (450 000-mde) daavadebis me-7-10
dRidan da piks aRwevs me-15-20 dReze. 3 Tvis
Semdeg maTi ricxvi rCeba odnav momatebuli.
diagnozze eWvis mitana SeiZleba, rodesac
6 kriteriumidan 5 mainc saxezea da Catarebulia
diferenciuli diagnostika egzanTemur
gamonayrebTan: wiTela, strepto-stafilokokuri
infeqcia, infeqciuri mononukleozi, mZime alergiuli dermatiti.
fsevdotuberkulozi, kvanZovani periarteriiti (sakuTari masala)
251
da sxva.
kvanZovani periarteriitis dros kavasakis sindromisagan gansxvavebiT swrafad
viTardeba kanis, cns-is da periferiuli nervuli sistemis, Sinagani organoebis
mravalricxovani dazianebebi (guli, RviZli, Tikmeli, kuW-nawlavis traqti). kanis
dazianebis mxriv ufro damaxasiaTebelia kvanZebi, hemoragiebi, nekrozebi, kidurebis
distaluri nawilebis gangrenis CaTvliT. mkvrivi angionevrozuli SeSupeba aramarto
xelisa da fexis gulebzea, aramed gavrcelebul xasiaTs Rebulobs. ti puria mialgia,
polineiromioziti, poliradikulonevriti, agreTve abdominuri sindromi mwvave muclis
klinikis ganviTarebiT.
mkurnaloba.. kavasakis daavadebaze eWvis mitanisTanave dauyovnebliv unda Catardes
mkurnaloba
Sesabamisi mkurnaloba. daavadebis dawyebidan sul mcire 10 dRis ganmavlobaSi saWiroa
dainiSnos intravenuri imunoglobulini maRali dozebiT aspirinTan erTad, rac
mniSvnelovnad ganapirobebs koronaruli arteriebis dilatacias da anevrizmebis
Camoyalibebis Seferxebas. daavadebis dawyebidan ufro xangrZlivi drois gasvlis
SemTxvevaSi IGIV avadmyofs eniSneba rodesac adgili aqvs klinikur simptomebs (mag.,
temperaturis momateba da a.S.) IGIV optimaluri dozebi jerjerobiT dadgenili ar
aris, magram miRebulia 400 mg/kg erTjeradi xangrZlivi Seyvana 4 dRe zedized. aseTi
reJimiT Seyvanis dros garTulebebi iSviaTia. zogierTi klinicistis monacemebiT, am
SemTxvevaSi igive efeqts iZleva erTjeradi, xangrZlivi infuzia (0,08ml/kg/wT) preparatis
jamuri doziT 2 g/kg masaze 10-12 saaTis ganmavlobaSi.
aspirinis sadReRamiso doza 80-100 mg/kg eniSnebaT gayofili 4 miRebaze, daaxloebiT
daavadebis me-14 dRemde, rac iwvevs cxelebis periodis Semcirebas, Tu mkurnaloba
dawyebulia daavadebis dawyebidan 1 kviris ganmavlobaSi. mas Semdeg, rac cxeleba xdeba
kontrolirebadi aspirinis doza mcirdeba 5-10 mg/kg dReSi erT miRebaze (40-80mg) da
misi miReba grZeldeba daaxloebiT 3 Tve, preparatis Trombocitebze mainhibirebeli
moqmedebis gamo da
IVIG -s (intravenuri imunoglobulinis) da aspirinis efeqti eds normaliza-
Kawasaki-s
-s daavadebis dros ciamde. iaponeli
( Marian E. Melish) mecnierebi ki aspi-
rins aZleven doziT
3-50mg/kg dReSi. ase
rom, dozis SerCeva
avtorebis mier
individualuria.
naCvenebia, rom aseT
Terapias SeuZlia
minimumamde daiyvanos
spontanuri korona-
ruli Trombozebis
da anevrizmebis
ganviTareba. mkur-
nalobis efeqtiuroba mkveTrad mcirdeba, Tu igi daiwyo daavadebis dawyebidan 10 dRis
Semdeg an anevrizmis Camoyalibebisas. saWiroa yuradRebis gamaxvileba mosalodneli
Reye-s sindromze aspiriniT mkurnalobis gamo. koronaruli arteriebis mxriv
cvlilebebis arsebobisas aspirinTan erTad iniSneba dipyridamole 4mg/kg dReSi. Tu
Camoyalibda didi koronaruli arteriebis anevrizma Trombozis profilaqtikisaTvis
mkurnalobaSi irTveba antikoagulantebi _ streptokinaza, urokinaza,qsovilovani
plazminogenis aqtivatori, zogierTi avtori iyenebs arasteroidul preparatebs
252
kavasakis daavadeba
kerZo nawili. difTeria
(tolmetins da a.S.).
kortikosteroidebi rekomendebulia mxolod mZime formebis dros da eniSnebaT 2
mg/kg dReSi 4 miRebaze (meTilprednizoloni 25mg/kg venaSi). mwvave periodis dros,
Semdeg ramodenime Tvis ganmavlobaSi damxmare dozebiT. zogjer aRiniSneba kidurebis
distaluri nawilebis gaxangrZlivebuli vazokonstriqcia. Tu aseTi mdgomareoba
sicocxlisaTvis saSiSroebas qmnis, iniSneba prostaglandinis E1 infuziebi (0,007-
0,03 mg/kg/wuTSi), ramdenime dRis ganmavlobaSi stabiluri hemodinamikis miRebamde;
aseve gamoiyeneba heparinizacia.
daavadebis gadatanis Semdeg yvela bavSvi unda imyofebodes dispanseruli dakvirvebis
qveS. pirveli gamokvleva unda CautardeT daavadebidan 2 Tvis Tavze, an saWiroebis
mixedviT, aritmiis, miokarditis, gulis ukmarisobis gamosavlenad. Semdgomi dakvirvebebi
damokidebulia paTologiuri cvlilebebis arsebobaze, mizanSewonilia kardiologis
meTvalyureoba, romelic kargad flobs eqokardiografiul gamokvlevebs.
saWiroebisas avadmyofebs periodulad utardebaT arsebuli qronikuli anTebadi
kerebis sanacia. eniSnebaT vitaminebi, antikoagulantebi, sisxlZarRvTa gamafarToebeli
preparatebi, unda gamovikvlioT sisxlis Semdedebeli sistema.
saWiroa eqimma icodes, rom maRali doziT IGIV-s miRebis Semdeg wiTelas
sawinaaRmdego vaqcinacia unda gadaidos 11 TviT. maT Soris, gaTvaliswinebuli saWiro
revaqcinaciac (mza antisxeulebi uSlian bunebrivi antisxeulebis warmoSobas).
Cutyvavilas vaqcina ki keTdeba IGIV Seyvanidan arauadres 5 Tvisa. gri pis
sawinaaRmdego vaqcina SeiZleba gamoviyenoT ufro adre 6-18 Tvis asakis pacientebSi.
profilaqtika ar aris SemuSavebuli.
DdifTeria
(DIPHTHERIA)
difTeria mwvave baqteriuli infeqciaa, romelic xasiaTdeba baqteriis SeWris

adgilas (lorwovan garsebsa da kanze) egzotoqsinis gamomuSavebis pasuxad fibrinuli
nadebis ganviTarebiT, toqsinebis Semdgomi gavrcelebiT adgilze da mTel organizmSi.
difTeriuli mikrobebis zogierTi Stami gamoyofs toqsin-proteins, romelic ganapirobebs
miokarditis, polinevritis ganviTarebas da sxva sistemebis toqsikur dazianebas.
difTeriis respiraciuli forma, Cveulebriv, ganpirobebulia toqsigenuri StamebiT
(tox+), xolo kanis difTeria, umTavresad, aratoqsigenuri StamebiT (tox-).
mokle istoriuli monacemebi. difTeriaze, rogorc saSiS daavadebaze miuTiTebdnen
jer kidev hi pokrate da gomeri. Cvens welTaRricxvamde I-II saukuneebSi aRiwera
daavadebis klinikuri suraTi “xaxis sasikvdilo wylulis”, “siriisa da egvi ptes
wylulis” saxelwodebiT.
daavadebis klinikuri da anatomiuri formebi pirvelad klasikurad aRwera P.
Bretonneau-m 1826w. manve mogvawoda saxelwodeba `difTeriti” (Diphtherion _
berZnulad niSnavs apks, pergaments), riTac xazi gaesva mTavar wamyvan simptoms _
xaxaSi fibrinuli nadebis arsebobas. XIX saukunis bolos A. Trousseau-m termini
“difTeriti” Secvala sityviT _ difTeria.
etiologia. difTeriis gamomwvevi mikrobi aRmoCenili iyo 1883-84 w.w. T. Klebs
da F. Löffler-is mier. 1889 w. Roux-ma da Jersen-ma gamoyves difTeriuli egzotoqsini,
xolo 1894 w. Behring-ma moamzada antitoqsini da mogvawoda difTeriis sawinaaRmdego
Srati. unda aRiniSnos, rom praqtikaSi am Sratis danergvamde daavadebis toqsikuri da
253
xorxis formebis dros letaloba Seadgenda TiTqmis 100%-s.

difTeriuli toqsinis formaliniT dasustebis Sedegad Ramon-ma 1923 w. miiRo
anatoqsini, romelsac SenarCunebuli hqonda antigenuri Tvisebebi. Semdgom wlebSi
faqtiurad xdeboda anatoqsinis ufro sufTa Semcvelobis miRweva. swored ramonis
aRmoCenasTanaa dakavSirebuli difTeriis sawinaaRmdego acrebis epoqa, ramac mkveTrad
Seamcira daavadebis maCveneblebi.
difTeriis gamomwvevi Cxirebi miekuTvnebian Corynebacterium-is gvars (laTinurad
corine _ qinZisTavi). CxirisaTvis damaxasiaTebelia nacxSi Taviseburi ganlageba _
erTmaneTis mimarT kuTxiT mdebareoba, rac mogvagonebs romaul cifrs _ V-s. igi
gramdadebiTi mikrobia, uZravia, polimorfuli. xSirad boloebi kolbisebri aqvs, ris
gamoc iRebs Tofizis (qinZisTavis) formas. kolbiseburi amoburculoba ar warmoadgens
Cxiris namdvil morfologiur niSans, aramed asaxavs difTeriis kultivirebis Sedegs
araadekvatur sakveb niadagze (lefleris niadagze). Cxiris boloebze moTavsebulia
volutinis marcvlebi, romlebic advilad vlindebian preparatis intensiurad SeRebvisas
lefleris an neiseris meTodebiT. saRebavis intensiurad miRebis gamo isini iRebebian
rux an moSavo ferad da mkveTrad Canan muq-wiTeli da cisferi mikrobebis fonze.
difTeriis Cxirebis zoma meryeobs sigrZeSi 1-6 mkm, xolo siganeSi 0,3-0,8mkm farglebSi.
axal kulturaSi ufro sWarbobs saSualo zomis Cxirebi _ sigrZiT 3-mkm, xolo
siganiT 0.3_0,5 mkm-mde.
paTologiur masalas Tesaven cxenisa da msxvilfexa rqosani pirutyvis Sededebul
Sratze (lefleris niadagi) an klaubergis niadagze (telurit-sisxliani agari),
buCinis an tindalis niadagebze. damaxasiaTebelia, rom klaubergis niadagze mikrobebi
izrdebian Sav-monacrisfro koloniebad, xolo lefleris niadagze monacrisfro-rZisfrad
an kremisfrad.
difTeriis Cxirebi gamohyofen egzotoqsins, kulturaluri da bioqimiuri ( saxameblis
fermentireba) TvisebebiT arCeven difTeriis sami ti pis Cxirebs _ gravis, mitis,
intermedius. am bolo xans evropaSi aRwerilia toqsigenuri Cxiri C. diphtheriae
belfanti, romelsac aseve SeuZlia gamoiwvios miokarditi. Gravis ti pis Cxirebi
xasiaTdebian ufro gamoxatuli invaziurobiTa da Cveulebriv, maRali toqsikurobiT.
calkeul kulturalur variantSi SeiZleba iyos rogorc toqsigenuri, ise aratoqsigenuri
Stamebi. yvela toqsigenuri Stami gamohyofs identur toqsins. Cxirebis mier toqsinis
produqciis SesaZlebloba determinirebulia masSi profagis arsebobiT, romelsac
uwodeben tox+ da SeiZleba gamowveuli iyos fagis tox+ _is lizogenizaciiT.**
difTeriis Cxirebi sakmaod rezistentulni arian garemo faqtorebis mimarT.
difTeriis apkSi, nerwyvis wveTebiT gaWuWyianebuli Wiqis kideebze da saTamaSoebze
mikrobebi inarCuneben sicocxlisunarianobas 15 dRemde; wyalsa da rZeSi Zleben 6-20
dRes, gvamSi _ 2 kviras; Semodgoma-zamTris pirobebSi garemoSi sicocxlis unars
inarCuneben 5-5,5 Tvemde. duRilisas iRupebian 1 wuTSi, 10% Jangbadis zeJangSi _ 3
wT-Si. 1% sulemis xsnarSi, 5% karbolis mJavaSi da 50-60% alkoholSi _ 1 wuTSi.
epidemiologia. daavadeba gvxvdeba mTel msoflioSi. aqtiuri imunizaciis Sedegad
ukanaskneli 30 wlis manZilze daavadebis maCvenebeli 100-jer da metad Semcirda.
Seicvala zogierTi epidemiologiuri kanonzomierebac. Tu uwin epidemiur afeTqebebs
adgili hqonda yovel 8-10-15 weliwadSi, amJamad daavadebam miiRo sporaduli xasiaTi.
difTeriis avadobis maCvenebeli 100 000 mosaxleze yofil ssrk-Si 1968 wels
* aratoqsigenuri Stamebis toqsigenurad gardaqmnis fenomeni virusuli infeqciis

moqmedebis Sedegia da mas uwodeben lizogenur an fagur konversias.
254
63,5-jer dabali iyo 1958 welTan SedarebiT, xolo 1913 welTan SedarebiT ki 370-
jer. sikvdilianobis maCvenebeli Semcirda 300-jer 1967 wels 1913 welTan SedarebiT;
1972 wels ki 3,9-jer 1968 welTan SedarebiT.
ruseTis teritoriaze avadoba 1975 wels Seadgenda 0,003-s 100000 mosaxleze,
magram 1976 wels avadobam moimata 0,001-dan 1,8-mde 100000 mosaxleze.
saqarTveloSi avadobis maCvenebeli 90-ian wlebSi gansakuTrebiT gaizarda
mozrdilebSi, rac aixsneboda am asakis mosaxleobaSi imunuri fonis naklebobiT.
saqarTveloSi difTeriis SemTxvevebi aRiniSneboda 1980 wlidan (2 SemTxveva), xolo
1993w-dan infeqciam epidemiis xasiaTi miiRo (28 SemTxveva 1993w, 312 SemTxveva 1994w,
425 SemTxveva 1995w). amJamad daavadebas sporaduli xasiaTi aqvs.
avadobis maCveneblis piki emTxveva Semodgoma-zamTars (seqtember-Tebervali).
daavadebulTa 80%-ze meti modis 15 wlamde araimunizirebul bavSvebze. ar aris
gansazRvruli antitoqsinis raodenoba, romelic uzrunvelhyofs infeqciisagan organizmis
absolutur dacvas. dadginda, rom im pirebSi, romelTac aReniSnebaT 1ml sisxlSi
>0,01 erTeulze antitoqsini, avadobis da sikvdilianobis maCvenebeli ufro naklebia.
aRniSnuli antitoqsinis maCvenebeli xSirad ixmareba epidemiologiur gamokvlevebSi
da cnobilia, rogorc imunitetis indeqsi.
infeqciis wyaros warmoadgens avadmyofi difTeriis nebismieri klinikuri formiT
da baqteriamtarebeli.
dasnebovnebis meqanizmis realizacia difTeriis respiraciuli formebis dros,
ZiriTadad, xorcieldeba haer-wveTovani gziT. mikrobis SeWra xdeba xaxis, cxviris,
zemo sasunTqi gzebis lorwovani garsebidan. infeqciis gadacema SeiZleba kontaqturi
gziTac saojaxo nivTebis, saTamaSoebis, produqtebis saSualebiT (rZe, rZis produqti,
kremi da sxva), agreTve mesame piris meSveobiT. organizmidan baqteria gamoiyofa xaxis
da cxviris lorwoTi. avadmyofi saSiSia inkubaciis ukanaskneli dRidan. saSualod
75%-Si organizmis ganTavisufleba baqteriebisagan mTavrdeba daavadebis me-20-25
dRes.iSviaTad baqteriamtarebloba grZeldeba ramodenime Tves, rasac xels uwyobs
cxvir-xaxis paTologiuri mdgomareoba, imunoreaqtiulobis daqveiTeba da sxva. Zlier
epidemiur saSiSroebas warmoadgens daavadebis ati puri formebi, romlebic mimdinareoben
kataruli, lakunuri tonzilitiT da kataruli rinitis saxiT.
praqtikaSi difTeriis sawinaaRmdego masiuri acrebis danergvamde avadobis mimReblobis
maCvenebeli (kontagiozuri indeqsi) ganisazRvreboda 0,15-0,2-iT, rac niSnavs imas, rom
100 kontaqtirebulidan avaddeboda 15-20 individi. amJamad ki infeqciis mimRebloba,
misi intensiuri gavrceleba damokidebulia organizmSi difTeriis sawinaaRmdego
antisxeulebis _ antitoqsinebis sisxlSi Semcvelobasa da araspecifikuri damcvelobiTi
meqanizmis doneze. difTeriis sawinaaRmdego antitoqsikuri damcvelobiTi done Seesabameba
Sikis uaryofiT reaqcias, arsebobs korelacia klinikur damcvelobiT reaqciasa da
SratSi arsebuli antitoqsinis titrs Soris. gadatanili daavadebis an imunizaciis
Sedegad SeZenili imunitetis dros antitoqsinis koncentracia 0,001-dan _ 0,09-mde
saerTaSoriso erTeulia, rac uzrunvelyofs ZiriTad imunitets da ganapirobebs daavadebis
dabal maCvenebelsa da dabal sikvdilianobas. antisxeulebis ufro maRali done
gansazRvravs srul imunitets. aRniSnuli done epidemiologiur gamokvlevebSi cnobilia,
rogorc imunitetis indeqsis maCvenebeli.
aqtiuri imunizaciis danergvamde difTeriis sawinaaRmdego antitoqsikuri imunitetis
gamomuSaveba xdeboda ori gziT _ daavadebis gadatanis Sedegad da xangrZlivi
baqteriamtareblobiT. umTavresad avaddebodnen 14 wlamde bavSvebi (80%-ze meti iyo
araimunuri) da iSviaTad mozrdilebi. amJamad bavSvebis masiurma imunizaciam difTeriis
avadobis maCveneblebi sagrZnoblad Seamcira am kontingentSi da daavadeba gadaadgilda
255
ufro mozrdil asakSi, rac aixsneba am jgufSi imunitetis uqonlobiT. ukanasknelma

garemoebam gamoiwvia aqtiuri imunizaciis aucilebloba mozrdilebSic.
paTogenezi. infeqciis SeWris adgilebi da daavadebis mimdinareobis simZime
gansazRvravs difTeriis klinikur formas. yvelaze ufro xSiri lokalizacia aRiniSneba
nuSurebze, sasis rkalebze, naqze; ufro naklebad ziandeba cxviri, xorxi, bronqebi. rac
Seexeba kans, Tvalebsa da sasqeso organoebs, isini miekuTvnebian iSviaTi lokalizaciis
adgilebs. aRwerilia kuWis difTeriis SemTxvevac.
unda aRiniSnos, rom respiraciuli daavadebis formebi, rogorc wesi gamowveulia
mikrobebis toqsigenuri StamebiT (tox+), magram kanis formebi SeiZleba gamoiwvios
rogorc toqsigenurma, aseve aratoqsigenurma Stamebma (tox-). difTeriuli toqsini
warmoadgens eqstracelulur poli peptids, romlis xvedriTi wonaa 62,000.
proteolizuri fermentebis moqmedebis Sedegad toqsini iSleba or fragmentad _A da
B, romlebic erTmaneTTan dakavSirebulia disulfiduri xidiT. fragmenti B aucilebelia
ujredis receptorebis SeboWvis da ujredSi SeRwevisaTvis. A fragmenti ganapirobebs
toqsikurobas da aZlierebs ujredSi cilis fermentebis daSlas, riTac sabolood
iwvevs ujredis daRupvas.
fragmenti B boWavs plazmuri ujredebis membranaze specifikur receptorebs da
aseTi toqsini endocitozis saSualebiT SeiWreba citoplazmaSi, sadac iwvevs nikotin-
amidnukleotidin adenozintrifosfatribozis gadatanas kataliziT histidinur narCenze
(diftamidze), elongaciur faqtor – 2-ze (EF-2) da iwvevs EF-2-is inaqtivacias da
proteinis inhibicias. A fragmentis 1 molekula iwvevs citoplazmis ujredis daRupvas.
intoqsicirebul ujredSi sxva metaboluri cvlilebebi meoradia proteinis
inhibirebasTan mimarTebaSi. intoqsikaciis Sedegad gulis kunTSi xdeba karnitinis
ganleva, rac difTeriuli miokarditis ganviTarebas xels uwyobs. difTeriul da P.
aeruginosa-s egzotoqsinebs aqvT erTi da igive enzimuri aqtivoba. miuxedavad amisa,
maTi biologiuri efeqti gansxvavdeba erTmaneTisagan, vinaidan isini moqmedeben ujredis
sxvadasxva receptorze da xasiaTdebian sxvadasxva ujreduli tropizmiT.
egzotoqsinis Zala ganisazRvreba erTeuliT _ Dosis Letalis Minima (DLM).
garda cnobili letaluri egzotoqsinisa, mikrobebi gamohyofen uamrav adgilobrivad
moqmed faqtorebs _ hialuronidazas, neiraminidazas da sxvebs, romlebic xels uwyoben
ujreduli barieris ganvladobis gaZlierebas da baqteriebisa da egzotoqsinis
gavrcelebas qsovilebSi. aranaklebi roli ekuTvnis dazianebul ujredebSi kokebis
SeWras, maT mier gamoyofil nivTierebebs, romlebic xels uwyoben egzotoqsinis masiur
difuzias. yovelive amis gamo mikrobebis cirkulaciis zonaSi viTardeba TiTqmis
mTeli qsovilebis dazianeba _hiperemia, sisxldinebis Seneleba, sisxlZarRvTa ganvladobis
mkveTri momateba da qsovilTa dazianebis zonaSi fibrinuli nadebis ganviTareba.
miuxedavad amisa, lofleris Cxirebi (difTeriuli Cxirebi) dazianebul zonas ar
toveben da ar xvdebian sisxlis cirkulaciaSi, garda iSviaTi SemTxvevebisa Spricis
momxmarebel narkomanebSi, sadac aRwerilia difTeriuli endokarditis SemTxvevebi.
difTeriis avTvisebiani formebis paTogenezSi, gansakuTrebiT hemoragiuli da
hi pertoqsikuri mimdinareobisas, specifikur intoqsikaciasTan erTad didi roli eniWeba
avadmyofis premorbidul fons _ 3-4-kviriT adre gadatanil daavadebebs, rac xazs
usvams hi perergiul mdgomareobas araspecifikuri sensibilizaciis Sedegad.
toqsinis adgilobrivi moqmedebiT warmoSobili eqsudati mdidaria ciliT,
gansakuTrebiT ki fibrinogeniT. epiTeliumis nekrozis Sedegad gamoiyofa fermenti
Trombokinaza da xdeba lorwovan garsebze eqsudatis Sededeba, rac warmoSobs fibrinul
apks. imisda mixedviT, Tu ra xasiaTis epiTeliumiTaa dafaruli anTebadi adgili,
viTardeba krupozuli an difTeriuli anTeba.
256
krupozuli anTebis dros nadebi ufri zedapirulia da advilad scildeba dazianebul

kerebs, rac aixsneba lorwovan garsebze (xorxi, traqea) cilindruli epiTeliumis
aramWidro kavSiriT. brtyeli, mravalSriani epiTeliumi (xaxis) ufro mWidrodaa
dakavSirebuli lorwovan da lorwqveSa qsovilebTan, rac ganapirobebs difteriuli
anTebis dros mWidro, organizebuli fibrinuli nadebis ganviTarebas. misi mocileba
iwvevs zedapiris erozirebas da sisxldenas.
adgilobrivi anTebadi kerebidan toqsini limfuri gziT vrceldeba qsovilebis
siRrmeSi, rac ganapirobebs lorwqveSa qsovilebisa da limfuri kvanZebis SeSupebas.
aqedan toqsini vrceldeba sisxlSi da moqmedebs nervul simpatikoadrenuli da
gulsisxlZarRvTa sistemebze.
xaxis difTeriis dros nuSurebi SeSupebuli da gadidebulia moculobaSi. maT
zedapirze aRiniSneba fibrinuli nadebi, romlis feri varirebs mowiTalo-Savidan
moSavo- movercxlisferomde, rac ganpirobebulia masSi sisxlis SemcvelobiT. nuSurebis
ganakveTze agreTve gvxvdeba nekrozuli kerebic. regionul limfur kvanZebSi viTardeba
toqsikuri limfadeniti, romelsac Tan axlavs mis irgvliv mdebare qsovilebis SeSupeba.
SeSupebis gavrceleba damokidebulia daavadebis simZimeze da misi sazRvrebi toqsikuri
formis dros varirebs limfuri kvanZebidan da mis irgvliv mdebare qsovilebidan
gulmkerdis CaTvliT. hemoragiuli formebis dros fibrinuli nadebi gaJRenTilia
sisxliT da moSavo feris xdeba. sisxlCaqcevebi viTardeba regionul limfur kvanZebSi,
kanqveSa cximovan qsovilebSi, kanSi, Tirkmelzeda jirkvlebSi, filtvebSi, endoTeliumis
qveS, gulis parkuWebSi, kuWis lorwovanze da sxva.
Tavis tvinis mxriv adgili aqvs SeSupebas, raime anTebadi an distrofiuli movlenebis
gareSe. difTeriis mZime formebi, romlebic mimdinareoben hemoragiuli sindromiT,
zogjer rTuldeba centraluri dambliT. am dros seqciaze naxuloben embols a. fossa
sylvii-s an misi erT-erTi fesvis Sida kafsulis midamoSi. embolia SesaZloa ganviTardes
sxva organoebSic (Tirkmlebi, elenTa). emboliis wyarod am dros iTvleba gulis
Trombi. ufro damaxasiaTebelia periferiuli nervuli sistemis dazianeba. bevr
periferiul nervSi mimdinareobs cvlilebebi toqsikuri nevritis saxiT. magaliTad
xaxis difTeriis dros ziandeba ena-xaxis nervi _ n. glossopharingeus. misi dazianeba
iwvevs rbili sasis damblas ( damaxasiaTebelia cxviris tembris xma, saWmlis gadacdena
cxvir-xaxaSi). mZime SemTxvevaSi viTardeba poliradikulonevriti sasunTqi kunTebis
dambliT.
specifikuria anTebadi movlenebi gulis kunTSi _ toqsikuri miokarditis saxiT,
romelic, Cveulebriv, vlindeba daavadebidan 10-15 dRis Semdeg. ganakveTze Cans
gafarToebuli, mrgvali formis guli, romelic rbilkedliania da zogjer tomaras
gvagonebs. Tu avadmyofma gadaitana mwvave da qvemwvave periodi, mogvianebiT SeiZleba
ganviTardes kardiosklerozi, miofibrozi. es paTologia SemdgomSi SeiZleba gaxdes
gulis dekompensaciis an damblis mizezi da sikvdiliT damTavrdes difTeriis gadatanidan
3-4 Tvis Semdegac. umetes SemTxvevaSi miokarditi keTilTvisebianad mimdinareobs.
cvlilebebi mkveTrad aris gamoxatuli Tirkmelzeda jirkvlebSi. difTeriis toqsiuri
formebis dros masSi aRiniSneba mkveTri distrofiuli cvlilebebi ujredebis nekroziT,
hemoragiuli formisas _ sisxlCaqcevebiT. distrofiul movlenebs adgili aqvs
TirkmlebSi – nefritis saxiT, elenTaSi aRiniSneba folikuluri aparatis hiperplazia.
garTulebebi traqeostomiisa da intubaciis dros dakavSirebulia nawolebis gaCenasTan
traqeostomiis milis Seyvanis Sedegad im adgilas, sadac saintubacio milis bolo
nawili zewolas axdens sasuleze, aseve mosalodnelia meoradi floriT garTuleba.
klinika. difTeriis klinikuri gamovlineba imdenad mravalferovania, rom XIX
saukunemde misi calkeuli formebi iTvleboda sxvadasxva daavadebad. Bretonneau-m
257
pirvelma gaaerTiana yvela forma erT nozologiur erTeulSi da mogvawoda klasifikacia

procesis lokalizaciis gaTvaliswinebiT. difTeriis SeswavlaSi didi roli ekuTvnis
rus mecnierebs (F\F\ Rjknsgby= V\U\ Lfybktdbx= D\B\ Vjkxfyjd da sxvebi). ase mag:
D\B\ Vtxybrjd-ma pirvelma gamohyo toqsikuri difTeriis kardinaluri simptomi _
kanqveSa SeSupeba, xolo Rjknsgby-ma Tavis klasifikacias safuZvlad daudo daavadebis
tipuroba, simZime da procesis toqsikuroba. SemdgomSi <\U\ Ibhdfyln-is, C\Y\ Hjpfyjd-
is da V\U\ Lfybktdbx-is mier toqsikuri difTeria dayofil iqna sam xarisxad
_I,II,III, gamoyofil iqna subtoqsikuri forma. C\Y\ Hjpfyjd-ma mogvawoda da SemdgomSi
damtkicebul iqna erToblivi samuSao klasifikacia (1944w.), romelsac dRemde ar
daukargavs mniSvneloba. daavadebis klinikuri gamovlineba ganisazRvreba procesis
lokalizaciiTa da simZimiT. yvelaze ufro xSirad ziandeba nuSurebi, sasis rkalebi
da naqis lorwovani garsebi, ufro naklebad _ cxviri, xorxi, traqea da bronqebi.
sasqeso organoebis, Tvalisa da kanis dazianeba ganekuTvneba difTeriis iSviaTi
lokalizaciis adgilebs.
inkubaciuri periodi Seadgens 2-dan 10 dRemde.
daavadebis mimdinareoba damokidebulia procesis lokalizaciaze, gavrcelebaze,
simZimesa ada organizmis
imunologiur statusze.
yvelaze ufro xSiri
lokalizaciisaa xaxis
difTeria da amJamad
gvxvdeba SemTxvevaTa 90-
95%-Si. nebismieri
lokalizaciis dros
difTeriis kardinalur
simptomad iTvleba
mikrobebis SeWris adgilas
fibrinuli nadebis arseboba
daavadebis pirvelsave
saaTebSi, romelic TandaTan
fibrinuli nadebi marcxena tonzilaze (lokaluri forma) ganicdis metamorfozas.
(Í.È. Íèñåâè÷, Â.Ô. Ó÷àéêèí) dasawyisSi `SegubebiTi”
hiperemiis fonze viTardeba
obobas qselis msgavsi
nadebi, romelic jer kidev
iolad scildeba anTebiT
keras, magram ramodenime
saaTSi, ufro ki meore dRes
xdeba organizebuli, Znelad
mosacilebeli. mocilebis
SemTxvevaSi aRiniSneba
sisxldena da amave adgilas
ramodenime saaTSi
organizdeba axali nadebi.
daavadebis pirvel dReebSi
xaxis difTeria, difTeria. nuSurebze
fibrinuli apki. nadebi moruxo-moTeTro
gavrcelebuli forma
(nadebi scildeba (Franklin H. Top) ferisaa, sadafisebri
tonzilas). elferiT, xolo Semdeg
258
iRebs moruxo-WuWyis fers. fibrinuli nadebi lorwovan garsebze mdebareobs zedapirulad

(plus qsovili) da sadaa. mocilebuli apkis nawili ar isriseba or sasagne minas
Soris, elastiuria da zambarasaviT, reziniviT drekadia. toqsikuri formebisas aRiniSneba
nadebis gavrcelebisa da misi gamsxvilebis tendencia.
xaxis difTeria yvelaze ufro gavrcelebuli formaa. praqtikaSi imunizaciis
danergvamde igi Seadgenda 40-70%-s, xolo amJamad dominirebs da aRwevs daavadebis
yvela formis 90-95%-s.
arCeven xaxis difTeriis lokalur, gavrcelebul da toqsikur formebs. toqsikuri
formebi Tavis mxriv iyofa I, II, III xarisxad. hemoragiuli forma xasiaTdeba toqsikuri
formis II da III xarisxis klinikiT, romelsac erTvis diseminirebuli sisxlZarRvTa
Sida Sededebis sindromis ganviTareba da fibrinuli nadebiT gaJRenTva hemoragiuli
eqsudatiT. klinikurad yvelaze mZime hi pertoqsikur-elviseburi forma, romelic
TiTqmis yovelTvis sikvdiliT mTavrdeba.
xaxis lokaluri forma xasiaTdeba adgilobrivi procesis SemofargvliT, nuSurebze
fibrinuli nadebiT, xolo nadebis sidide da zoma gansazRvravs _ katarul, wertilovan,
kunZulovan da apkovan klinikur formas.
kataruli formis dros kardinaluri simptomis _ fibrinuli nadebis arsebobas
adgili ara aqvs da saerTo mdgomareoba damakmayofilebelia. temperatura normaluria
an subfebriluri. avadmyofi uCivis yelis umniSvnelo tkivils. am dros nuSurebi
gadidebulia, odnav hi peremiuli da SeSupebuli. praqtikulad misi diagnostika
SeuZlebelia toqsigenuri Csirebis gamoyofis gareSe.
xaxis difTeriis lokaluri formis dros daavadeba iwyeba uecrad, magram
aramZafri simptomebiT: sisustiT, anoreqsiiT, faringitiT, temperaturis momatebiT
37,5-38°C-mde, yelis tkiviliT. wertilovani da kunZulovani formis dros intoqsikacia
sustadaa gamoxatuli, xolo apkovani nadebisas zomierad. aRiniSneba aCqarebuli pulsi,
nuSurebis zomieri hi peremia da SeSupeba. fibrinuli nadebi viTardeba ufro xSirad
meore dRes. igi SeiZleba ganviTardes erT an orive mxares, mag.: erTi nuSura dafaros
mTlianad, xolo meore ki kunZulebisamebr da a.S. daavadebis pirvel dRes nadebi
Txelia, monacrisfro da mogvagonebs obobas qsels, xolo Semdgom dReebSi xdeba sqeli,
monacrisfro-WuWyiani. yvela SemTxvevaSi difTeriis am formis dros nadebi ar scildeba
nuSurebsa da mis rkalebs. adgili aqvs regionuli limfuri kvanZebis gadidebas,
palpaciisas umniSvnelo tkivils. am dros difTeriis sawinaaRmdego Sratis Seyvanis
Semdeg ukve meore dRes saerTo mdgomareoba umjobesdeba, temperatura xdeba normaluri
da nadebi qreba 1-2 dReSi. mkurnalobis gareSe procesma SeiZleba miiRis gavrcelebuli
xasiaTi da garTuldes miokarditis saxiT.
xaxis gavrcelebuli difTeriis dros dros, romelic iSviaTad gvxvdeba (1-2%-Si),
daavadeba iwyeba uecrad, temperaturis momatebiT 38-39°C-mde. avadmyofebi uCivian
yelis tkivils, umadobas, saerTo sisustes. gamoxatulia saerTo intoqsikacia. fibrinuli
nadebi gvxvdeba ara marto nuSurebze, aramed nuSurebis rkalebze, naqze, xaxis ukana
kedelze. nuSurebi, misi rkalebi, naqi da rbili sasa zomieradaa hi peremiuli da
SeSupebuli. kisris regionuli limfuri kvanZebi gadidebulia da palpaciiT mtkivneuli.
fibrinul nadebs aqvs gavrcelebisadmi tendencia, igi sqeldeba, feriT moWuWyo-
monacrisfro an moyviTalo-monacrisfroa. regionuli limfuri kvanZebi gadidebuli
da mtkivneulia. difTeriis sawinaaRmdego Sratis drouli Seyvana iZleva karg efeqts,
rac gamoixateba ramodenime dReSi (3-4 dRe) intoqsikacia ixsneba da adgilobrivi
simptomebi qreba. zog SemTxvevaSi Sratis Seyvana ar iZleva srul efeqts. mkurnalobis
gareSe SesaZlebelia intoqsikaciis gaZliereba, nadebebis Semdgomi gavrceleba, kisris
midamoSi kanqveSa qsovilebis SeSupeba da daavadeba iRebs toqsikuri difTeriisaTvis
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damaxasiaTebel mimdinareobas.
difTeria, rogorc pirveladi toqsikuri forma, umravles
xaxis toqsikuri difTeria
SemTxvevaSi daavadebis pirvelsave dReebSi yalibdeba. iSviaTad ki aranamkurnalebi,
xaxis gavrcelebuli an sxva formis difTeriis Sedegia. daavadeba iwyeba uecrad,
temperaturis aweviT 39-40°C-mde , intoqsikaciiT _uZlurebiT, saerTo sisustiT,
zogjer ki agznebiT, pirRebinebiT, umadobiT. avadmyofi uCivis yelis, Tavisa da muclis
tkivils; yuradRebas i pyrobs kanis mkveTri sifermkrTale. xaxis daTvalierebisas
SeigrZnoba motkbo-dampali suni. daavadebis pirvelsave saaTebSi pir-xaxis lorwovani
mkafiod hi peremiulia. nuSurebi, misi rkalebi, naqi, rbili sasis lorwovani garsi
SeSupebulia. zogjer SeSupeba imdenad didia, rom SeiZleba nuSurebi erTmaneTs Seexon
da xaxis ukana kedeli aRar Candes. piriT sunTqva gaZnelebulia da atarebs cxviris
tembrs. daavadebis dawyebidan 12-15 saaTSi viTardeba nadebi, romelic Tavdapirvelad
hgavs obobas qsels an Jeleseburia da advilad scildeba adgils, magram 24 saaTSi
sqeldeba da scdeba nuSuras farglebs, ufro mogvianebiT ki, 3-4 dReSi nadebi msxvildeba,
xdeba xorkliani, monacrisfro da mTlianad faravs nuSurebs, rbil sasas, sasis rkalebs,
naqs. zogjer, mZime mdgomareobisas nadebi aRiniSneba magar sasazec. am dros mkafio
hi peremia Rebulobs cianozur elfers.
toqsikuri formisaTvis xaxaSi procesis ganviTarebasTan erTad an 1-2 dRis Semdeg
damaxasiaTebelia umniSvnelovanesi niSani –kiserze kanqveSa qsovilebis SeSupeba, romlis
gavrcelebis intensivoba safuZvlad udevs difTeriis toqsikuri formebis xarisxebad
dayofas. SeSupebuli qsovilebi rbili (comiseburi) konsistenciisaa, xelis SexebiT
Tbili da umtkivneuloa; TiTis daWeriT CaRrmavebas ar tovebs. biZgiseburi dartymisas
SeSupebuli qsovilebi labasaviT iryevian. am adgilebSi kans normaluri feri aqvs.
subtoqsikuri formis dros xaxaSi fibrinuli nadebi da SeSupeba naklebad gvxvdeba.
SeSupeba kiserze izRudeba regionuli limfuri kvanZebis irgvliv da xSirad calmxrivia.
I xarisxis toqsikuri difTeriis dros SeSupeba vrceldeba kisris Sua donemde, II
xarisxis dros aRwevs laviwamde, III xarisxis dros vrceldeba gulmkerdis zemo
nawilze da zogjer aRwevs processus xiphoideus-s. II da III xarisxis toqsikuri
difTeriis dros ufro mkveTrad, vidre I xarisxisa da subtoqsikuri formis, gamoxatulia
Semdegi simptomebi: kanis sifermkrTale cianozuri elferiT, pastozuri saxe, naxevrad
Ria piri, daxeTqili da mSrali tuCebi, gaurkveveli xma cxviris tembriT. toqsikuri
difTeriis dros procesSi xSirad erTveba cxvirxaxa da cxviris nestoebi. cxviridan
SeimCneva uxvi, serozul-sisxlnarevi gamonadeni. cxviris nestoebis SesasvlelTan da
zemo tuCze kani eqskorirebulia (dawylulebuli). periferiul sisxlSi aRiniSneba
leikocitozi neitrofiloziT, eds momatebulia, SardSi SeiZleba iyos cila da hialinuri
cilindrebi.
toqsikuri difTeriis yvelaze mZime formebad iTvleba hemoragiuli da
hi pertoqsikur
pertoqsikuri i (elvisebur
(elviseburi)i) fo rmebi.
formebi.
hemoragiuli formis dros klinikuri suraTi igivea, rac II da III xarisxis
SemTxvevaSi, mxolod im gansxvavebiT, rom daavadebis II, III dRes viTardeba sisxlZarRvTa
Sida diseminirebuli Sededeba, romlis pirveli gamovlinebaa sisxlCaqceva ineqciis
adgilas; xolo mogvianebiT viTardeba sisxlCaqcevebi kanze, lorwovanze; adgili aqvs
sisxlian pirRebinebas, hematurias, sisxliani ganavlis arsebobas.
hipertoqsikuri (elviseburi) formis dros pirvelive saaTebSi aRiniSneba organizmis
Zlieri intoqsikacia, temperatura aRwevs 40-41°C, Rebineba xSiria, zogjer Seuwyveteli,
goneba dabindulia, aRiniSneba krunCxvebi; swrafad viTardeba gulsisxlZarRvTa ukmarisoba.
am formis dros xdeba xaxis SeSupeba, xolo rac Seexeba fibrinul nadebs, SeiZleba
arc ganviTardes, radgan adgilobrivi procesi gaSlas ver aswrebs. kanqveSa qsovilis
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SeSupeba vrceldeba laviwqveSa midamomde. progresuli intoqsikacia ganapirobebs

letalur gamosavals daavadebis uaxloes dReebSi. aRniSnuli formebi cudad an
saerTod ar eqvemdebarebian antitoqsikuri Sratis moqmedebas. letaloba aRwevs maRal
procents.
mimdinareoba. xaxis toqsikuri difTeriis yvela SemTxvevisas prognozi seriozulia.
hemoragiuli da gansakuTrebiT, elviseburi mimdinareobisas, miuxedavad pirvelsave
dReebSi dawyebuli specifikuri da antisindromuli mkurnalobisa, gamosavali TiTqmis
yovelTvis letaluria. sxva toqsikuri formebisas prognozi bevradaa damokidebuli
daavadebis pirvel dReebSi antitoqsikuri Sratis Seyvanasa da kompleqsuri mkurnalobis
Catarebaze.
xorxis difTeria anu difTeriuli krupi amJamad iSviaTad gvxvdeba da ar
aRemateba 1-2%-s, maSin, rodesac uwin misi xvedriTi wili 20-40%-s Seadgenda. am
formiT, Cveulebriv, avaddebian 1-dan 3-4 wlamde asakis bavSvebi. umravles SemTxvevaSi
aRiniSneba izolirebuli, pirveladi xorxis difTeria, xolo iSviaTad _ meoradi,
romelic ganpirobebulia xaxisa da cxvir-xaxis difTeriuli nadebis xorxze gavrcelebiT,
rac organizmis gamoxatuli intoqsikaciiT mimdinareobs. procesis gavrcelebis mixedviT
arCeven xorxis izolirebul difTerias, roca nadebi gavrcelebulia mxolod xorxze
da gavrcelebuls, roca procesSi CarTulia traqea da SesaZlebelia, bronqebic
(difTeriuli laringo-traqeo-bronqiti).
xorxis difTeriis kardinaluri simptomia e.w. krupis sindromi, romelsac SeiZleba
adgili hqondes mTeli rigi mwvave respiraciuli virusuli da baqteriuli infeqciebis
drosac (gri pi, paragri pi, adenovirusuli infeqcia, RS infeqcia, wiTela, qunTruSa da
sxva). amave dros difTeriuli krupisaTvis damaxasiaTebelia Taviseburi klinika da
daavadebis dinamika, rac SesaZlebels xdis mis diferenciacias sxva daavadebebisagan.
izolirebuli anu xorxis pirveladi difTeria iwyeba subfebriluri temperaturiT
an erTeul SemTxvevebSi 38-38,5°C –mde momatebiT, sustad gamoxatuli intoqsikaciis
movlenebiT _ madis daqveiTeba, uZlureba. xma xdeba CaxleCili, erTdroulad adgili
aqvs xvelas, romelic dasawyisSi mSrali, uxeSi da “myefavi” xasiaTisaa. xmis CaxleCis
paralelurad xvela kargavs JReradobas. laringoskopiiT xorxis lorwovani garsebi
hi peremiuli da SeSupebulia (es procedura keTdeba medikamenturi Zilis qveS da
mZime krupis dros).
disfoniisas xorxis lorwovanze difTeriuli nadebi SeiZleba ar gvqondes. aRniSnuli
klinikuri da laringoskopiuli suraTi, krupozuli xvela, kataruli disfoniuri
stadia Seesabameba krupis I stadias, romelic SeiZleba gagrZeldes ramodenime saaTidan
2-3 dRemde. SemdgomSi krupis yvela simptomi mkurnalobis gareSe iRebs progresul
xasiaTs da daavadeba gadadis meore _ stenozur stadiaSi, romelic xasiaTdeba gaZnelebuli,
xmauriani sunTqviT; sunTqvas aqvs mstvenavi xasiaTi, gansakuTrebiT inspiraciuli
fazis dros da mogvagonebs sveli xis xerxvis xmas. stenozuri sunTqvis Setevebi
xSirdeba, romelic mTlianad Zilis drosac ar ixsneba.
stenozis erT-erT simptoms warmoadgens gulmkerdis rbili nawilebis inspiraciuli
Sezneqva, romelic viTardeba forsirebuli SesunTqvisas da ganpirobebulia gulmkerdis
RruSi uaryofiTi wneviT. Seizniqeba neknTaSorisi adgilebi, gulmkerdis qveda nawili,
laviwzeda da laviwqveSa fosoebi, sauRle foso. sunTqvis gaZnelebasTan erTad izrdeba
rbili adgilebis Sezneqvis intensivoba. stenozis niSania SesunTqvis dros damxmare
sasunTqi kunTebis daWimva, rac SeigrZnoba mkerd-laviw-dvrilisebr kunTze TiTis
dadebiT, xolo gamxdrebSi SeimCneva aRniSnuli kunTebis ritmuli SekumSva (beios
simptomi). stenozis dros SesaZloa sxva kunTebic daiWimos (gulmkerdis didi kunTebi,
trapeciuli da kibisebri kunTebi). amosunTqvisas adgili aqvs muclis faris daWimvas,
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rac xels uwyobs diafragmis awevas. am dros narkoziT Catarebuli laringoskopiiT

nadebi Cans xorxis SesasvlelTan, saxmo iogebze da zogjer iogqveSa sivrceSic.
stenozis I da II stadiis dasawyisSi avadmyofi jer kidev kargad grZnobs Tavs _ iCens
interess garemosadmi. xvela rCeba myefavi, uxeSi, magram TandaTan kargavs Tavis
JReradobas. SemdgomSi saerTo mdgomareoba uaresdeba, TandaTan viTardeba III xarisxis
stenozi, romelic xasiaTdeba Jangbadis mkveTri ukmarisobis suraTiT. hi poqsemiis
Sedegad adgili aqvs sifermkrTales, perioralur cianozs, pulsi aCqarebulia, paradoqsuli
(SesunTvis dros pulsis gamovardna). gulsisxlZarRvTa sistemis mxriv viTardeba
dekompensaciis niSnebi _ taqikardia, gulis sazRvrebis gadideba. dgindeba SegubebiTi
movlenebi mcire wreSi, filtvebSi sunTqva tardeba sustad. bavSvi agznebulia ver
poulobs adgils, Txoulobs xelSi ayvanas, oflianobs, gansakuTrebiT Tavis midamoSi.
stenozis am periods uwodeben gardamaval periods stenozis stadiidan asfiqsiis
stadiaSi. mesame xarisxis stenozis periodi moicavs 2-dan 5 saaTamde da Tu am xnis
ganmavlobaSi ar gakeTda intubacia an traqeostomia, maSin daavadeba gadadis meoTxe _
asfiqsiis stadiaSi. am stadiisaTvis damaxasiaTebelia Taviseburi klinikuri suraTi:
avadmyofis agzneba icvleba uZlurebiT, adinamiiT. sunTqva gaxSirebuli, aritmuli da
zerelea, TiTqmis uxmauro; mniSvnelovnad klebulobs gulmkerdis drekadi nawilebis
Sezneqva. “damSvidebis” suraTis fonze aRiniSneba mkveTri saerTo cianozi, kunTebis
hi potonia, drodadro krunCxvebi, rac tvinis SeSupebis Sedegia, pulsi TandaTan
bradikardiuli xdeba, rac win uZRvis gulis gaCerebas. I stadiaSi, stenozuri sunTqva
ismis mxolod fizikuri datvirTvisas an tirilis dros, xolo II stadiidan ki ukve
mSvidi mdgomareobisas da ZilSic.
kataruli, krupozuli periodis dros difTeriis sawinaaRmdego Sratis Seyvana
klinikur efeqts gvaZlevs 12-18 saaTSi, rac gamoixateba stenozis TandaTanobiT
Sesustebasa da Semdgom mis srul moxsnaSi. afoniis aRdgena xdeba TandaTan 4-5 dRis
ganmavlobaSi. zogjer SeiZleba ganviTardes xorxis sanaTuris uecari daxSoba
naxevradmowyvetili fibrinuli apkiT, ramac SeiZleba asfiqsiis Sedegad uecari sikvdili
gamoiwvios. SesaZlo garTulebebidan unda aRiniSnos aspiraciuli pnevmoniis ganviTareba.
daRmavali, gavrcelebuli xorxis difTeriis dros (laringotraqeobronqiti) daavadeba
gamoirCeva uecari dawyebiT da procesis mZafri progresirebiT. saxezea gazTa cvlis
swrafi darRvevis suraTi; vlindeba ara cianozi, aramed mkvdriseburi sifermkrTale
_ TeTri asfiqsia. klinikuri suraTi mogvagonebs mZime pnevmonias, romelic xSirad Tan
erTvis am periods. avadmyofi kvdeba daavadebis meore, mesame dRes. difTeriis sawinaaRmdego
Sratis droulad Seyvanam da saTanado energiuli Terapiis Catarebam SeiZleba
keTilsaimedo gamosavali mogvces.
xorxis kombinirebuli difTeriis dros (xaxis difTeriasTan erTad) SeiZleba
ganviTardes iseTi garTulebebi, rogoricaa miokarditi, poloradikulonevriti da
sxva.
cxviris difTeria umTavresad gvxvdeba mcire asakis bavSvebSi, gansakuTerebiT, 1
wlamde. bolo dros cxviris difTeriis SemTxvevaTa sixSirem sagrZnoblad daiklo,
adre ki Seadgenda difTeriis SemTxvevaTa 4-12%-s. arCeven pirvelad, cxviris izolirebul
difTerias da Serwymuls, roca aRiniSneba sxva lokalizaciis procesic _ xaxis,
xorxis difTeria da a.S.
pirveladi, cxviris izolirebuli difTeriis dros daavadeba iwyeba TandaTanobiT,
normaluri an subfebriluri temperaturiT. daavadebis dasawyisi mogvagonebs Cveulebriv
surdos, susti serozuli gamonadeniT, saerTo mdgomareobis darRvevis gareSe. Tumca
unda aRiniSnos, rom cxviridan sunTqvis gaZnelebis gamo ZuZuze myofi bavSvebi ZuZus
ver woven, ramac SeiZleba gamoiwvios kvebis moSliT ganpirobebuli meoradi movlenebi,
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(viTardeba saerTo sisuste, adinamia da a.S.). serozul-sisxliani gamonadeni SeimCneva

jer erTi, xolo 2-3 dRis Semdeg meore nestodan; mogvianebiT gamonadeni xdeba
serozul-Cirqovani. zemo tuCze, nestos SesasvlelebTan Cndeba kanis eroziuli ubnebi,
maceracia da Cirqovani gamonayari. cxviridan SeimCneva arasasiamovno suni. cxviris
daTvalierebisas aRiniSneba nestoebisa da cxviris Zgidis lorwovnis SeSupeba. cxviris
Zgideze xSirad gvxvdeba eroziebi, wylulebi da sisxliani fufxebi (katarul-wylulovani
forma). zog SemTxvevaSi fibrinuli nadebebi mWidrodaa dakavSirebuli Zgidis
lorwovanTan (apkovani, fibrinuli forma). iSviaTad procesi cxviris danamat Rruebze
(sinusebSi) vrceldeba da SeiZleba sinusebis Sesabamis saproeqcio areSi SeSupdes
kanqveSa qsovilebi. SeSupebas SeiZleba adgili hqondes Tvalebis upeebSi, loyebze,
cxviris zurgze, rac cxviris difTeriis toqsikur formas axasiaTebs. am formis
garda cxviris difTerias ar axlavs toqsikuri procesisaTvis damaxasiaTebeli
garTulebebi (miokarditi, poliradikulonevriti da sxva). miuxedavad daavadebis
gaxangrZlivebisa, igi kargad eqvemdebareba specifikuri Sratis moqmedebas da sruli
klinikuri gamojanmrTelebiT mTavrdeba.
Tvalis difTeria gvxvdeba ufro adreuli asakis bavSvebSi. arCeven daavadebis 1)
krupozul, 2) difteriul da 3) katarul formebs. pirveli xasiaTdeba daavadebis
uecari dawyebiT, magram temperatura ufro xSirad subfebriluria, Tumca SeiZleba
normaluric iyos. saerTo intoqsikacia ar aris an sustadaa gamoxatuli. koniunqtiva
zomierad hi peremiulia da masze aRiniSneba moTeTro-nacrisferi, zereled mdebare,
advilad mosacilebeli fibrinuli apki. iolad SeiZleba SeSupebuli quTuToebis
gadabruneba da daTvaliereba; SeSupeba ufro metad gamoxatulia zeda quTuToze.
pirvel dReebSi Tvalidan aRiniSneba mcireodeni Cirqovan-sisxliani gamonadeni. Tvalis
SemaerTebeli qsovili mkveTradaa SeSupebuli (qemozi), rqovana dazianebuli ar aris.
specifikuri mkurnaloba 3-5 dReSi iwvevs yvela movlenis dacxrobas. mxedvelobis
darRveva ar aRiniSneba. difteriuli formis dros daavadeba iwyeba maRali
temperaturiT(38-39°C), zomieri intoqsikaciiT. koniunqtivaze aRiniSneba fibrinuli
apki, romelic masTan mWidrodaa dakavSirebuli da SeiZleba gavrceldes Tvalis
kakalzec. fibrinuli apki moruxo-WuWyisferi an moyviTaloa, misi zedapiri ki xorkliania.
quTuToebis Zlieri SeSupebis gamo Tvali daxuWulia. SeSupeba mkvrivia, rac aZnelebs
quTuToebis Sebrunebas. gamonadeni Tvalidan ufro uxvia da Cirqovan-sisxliani. quTuTos
kani mkveTrad SeSupebulia da mogvagonebs mwife qliavis fers. SeiZleba daziandes
rqovana (wylulovani keratiti). zog SemTxvevaSi viTardeba panofTalmiti, romelmac
SeiZleba gamoiwvios mxedvelobis dakargva. ara iSviaTad viTardeba quTuTos kideebis
Sexorceba da amis Sedegad gamowveuli kosmetikuri defeqti _ quTuToebi srulad ar
faraven Tvals. specifikuri Sratis Seyvana da adgilobrivi mkurnalobis Catareba
iZleva karg gamosavals, mxedveloba ar qveiTdeba. kataruli forma miekuTvneba daavadebis
ati pur mimdinareobas, romlis drosac adgili aqvs quTuToebis lorwovani garsebis
hi peremias, raime nadebis gareSe, misi diagnostika eyrdnoba mxolod baqteriologiur
gamokvlevebs _ toqsikuri difTeriuli Cxirebis aRmoCenas.
gareTa sasqeso organoebis difTeria daavadebis iSviaTi formaa da Cveulebriv,
meoradi inficirebis genezisaa, dakavSirebulia xaxis an cxviris difTeriasTan an maT
kombinirebul formebTan. daavadebas xSirad win uZRvis lorwovanis garsebis eqskoriacia
biWebSi praeputium-ze, xolo gogonebSi did da mcire sasircxo bageebze. lorwovan
garsebze aRiniSneba zomieri hi peremia cianozuri elferiT, SeSupeba da fibrinuli
nadebebi. nadebebi xSirad naklebad ti puria, ufro faSari xasiaTisaa. sazardulis
limfuri kvanZebi gadidebulia. zogierT SemTxvevaSi fibrinuli nadebebi vrceldeba,
Rebulobs organizebul xasiaTs: mkvrivia, Znelad scildeba adgils da gadadis mcire
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bageebis lorwovan garsebze, saSosa da kanze. SeiZleba adgili hqondes boqvenis

midamos, sazardulis nakecebisa da barZayis kanqveSa qsovilebis SeSupebas. amave dros
SeimCneva organizmis saerTo intoqsikaciis movlenebi da mosalodnelia toqsikuri
difTeriisaTvis damaxasiaTebeli garTulebebi.
specifikuri Sratis droulad (pirvel dRes) Seyvana ganapirobebs adgilobrivi da
saerTo movlenebis moxsnas da srul klinikur gamojanmrTelebas.
kanisa da Wrilobis difTeria viTardeba pirveladad (afrikis qveynebSi) an
meoradad sxva lokalizaciebis paralelurad, kanis epiTeliumis dazianebis _ gamoyelvis,
naxeTqebis, Wrilobebisa da ganakawrebis midamoebSi. kani SeSupebuli da hi peremiulia,
warmoiSoba moWuWyo-monacrisfro fibrinuli nadebi, romlis lokalizacia SeiZleba
iyos yuris ukan, kiserze, sazardulis nakecebze, axalSobilebSi da 3-6 Tvis asakis
bavSvebSi Wi pis midamoSi. Tu procesi lokalizebulia, maSin fibrinuli nadebi mcire
raodenobisaa. iSviaTad SeiZleba ganviTardes kanqveSa cximovani qsovilis SeSupeba. Tu
fibrinuli nadebi vrcelia, daavadeba Rebulobs toqsikuri formis saxes da mosalodnelia
misTvis damaxasiaTebeli garTulebebis Camoyalibeba. specifikuri Sratis drouli
Seyvana gvaZlevs daavadebis keTil gamosavals.
kanis difTeria SeiZleba mimdinareobdes ati purad _ nadebebis gareSe, romelic
vlindeba impetiguri formiT. am dros sisxliani fufxebi aRiniSneba kanis infiltrirebul
fuZeze. daavadeba gamoirCeva xangrZlivi mimdinareobiT. specifikuri Sratis moqmedeba,
miuxedavad daavadebis xangrZlivobisa, iZleva karg klinikur efeqts, rac aixsneba imiT,
rom process gamoxatuli intoqsikacia ar axlavs.
unda aRiniSnos, rom am formis difTeria ufro xSirad gvxvdeba cxeli klimatis
qveynebSi, rac epidemiur saSiSroebas ganapirobebs.
iSviaTi lokalizaciis adgilebs warmoadgenen piris Rrus lorwovanis, Sua yurisa
da axalSobilebSi Wi pis dafTeria; aRwerilia agreTve kuWis difTeriis SemTxvevebi.
garTulebebi, Cveulebriv, dakavSirebulia organizmis specifikur intoqsikaciasTan,
gansakuTrebiT II da III xarisxis xaxis toqsikuri difTeriis dros, roca SemTxvevaTa
100%-Si viTardeba mZime miokarditi. swored es garTuleba ganapirobebs letalobis
maRal procents (50-60%). III xarisxis toqsikuri difTeria xasiaTdeba rogorc
hi pertoqsikuri forma Trombohemoragiuli sindromiT. isini gamoirCevian mZafri
toqsemiiT da miuxedavad droulad dawyebuli mkurnalobisa (specifikuri SratiT),
daavadeba, rogorc wesi, mTavrdeba letalurad. sikvdilis umTavres mizezad aseTi
formebis dros iTvleba masiuri sisxlCaqcevebi Tirkmelzeda jirkvlebSi, ris gamoc
viTardeba periferiul sisxlZarRvTa mwvave ukmarisoba kolafsis saxiT.
miokarditis suraTi vlindeba daavadebis II kviris dasawyisidan.
miokarditi SeiZleba ganviTardes difTeriis aramZime mimdinareobis drosac, magram
rogorc wesi, es garTuleba xaxis toqsikuri formis xvedria.
miokarditis gamovlinebebs miekuTvneba saerTo mdgomareobis gauareseba, Tumca am
dros specifikuri mkurnalobis Sedegad adgilobrivi movlenebi da intoqsikaciis
saerTo suraTi TiTqmis qreba. Tu miokarditi TandaTanobiT Camoyalibda, prognozi
ufro saimedoa. gulis mZime ukmarisobisas saxeze gvaqvs mzardi sifermkrTale, tuCebis
cianozi, saerTo mousvenroba an adinamia. avadmyofi uCivis muclis tkivils, Rebinebas,
romlis sixSire damokidebulia daavadebis simZimeze. avadmyofi wevs kedlisaken
pirmibrunebuli da ara aqvs kontaqtSi Sesvlis survili. erTdroulad diddeba
gulis sazRvrebi, tonebi moyruebulia, ritmi darRveuli, Cndeba eqstrasistolebi,
Wenebis ritmi. pulsi aCqarebulia, susti avsebisa da daWimulobis; arteriuli wneva
mkveTradaa daqveiTebuli. eleqtrokardiograma gvaZlevs miokarditis adreuli
diagnostikis saSualebas; dgindeba hisis konis an atrioventrikuluri blokada. sikvdili
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mosalodnelia aramarto miokarditis mwvave periodSi (me-12, me-17 dRe daavadebis

dawyebidan), aramed misi ganviTarebidan 1,5-3 Tvis Semdegac, rac ganpirobebulia
miokardiumis difuzuri skleroziT. umravles SemTxvevaSi gadatanili miokarditi
mTavrdeba raime seriozuli narCeni movlenebis gareSe. msubuqi da saSualo simZimis
miokarditis dros gulis mwvave ukmarisobis suraTi ar aRiniSneba da klinikuri
gamojanmrTeleba xdeba daavadebis 25-30-e dRisaTvis, Tumca ekg-ze mosalodnelia
kbilebis voltaJis daqveiTeba, S--T intervalis cdomileba izoxazis qveviT, uaryofiTi
T kbili da sistoluri maCveneblis gadideba. aRniSnuli monacemebi mowmoben miokardiumis
dazianebas gamtarebeli sistemis procesSi CarTvis gareSe.
nefrozi viTardeba daavadebis mwvave periodSi, maRali intoqsikaciis fonze.
SardSi matulobs leikocitebi, cila da hialinuri cilindrebi zomieri raodenobiT.
nefrozisaTvis damaxasiaTebeli sxva raime suraTi saxeze ar aris. aRniSnuli movlenebi
eqvemdebarebian srul ukuganviTarebas da prognozi keTilsaimedoa.
nervuli sistema ziandeba, rogorc adreul, ise mogvianebiT periodSi da igi
toqsikuri genezisaa. gamojanmrTelebis SemTxvevaSi narCeni movlenebi ar gvaqvs da
xdeba motoruli funqciis sruli aRdgena.
xaxis difTeriis toqsikuri formisas pirveli kviris bolos, ufro adre, an ufro
mogvianebiT (5-6 kviris Semdegac) SeiZleba ganviTardes Tavis tvinis nervebis dazianeba.
SedarebiT adre viTardeba rbili sasis dambla (IX da X wyvili nervebis _
nn.glossopharyngeus et vagus). misTvis damaxasiaTebelia sasuleSi saWmlis gadacdena,
cxviridan Txieri masis gadmodineba, xma iRebs cxviris tembrs, sasis rkali Camoweulia
erT an orive mxares, fonaciaze sustad an saerTod ar reagirebs. calmxrivi dazianebisas
naqi gadaweulia janmrTel mxareze. sixSiris mxriv meore adgilzea akomodaciis
nervis dambla (n.ciliaris) _ avadmyofi axlo manZilidan ver arCevs wvril sagnebs, ver
kiTxulobs. erTdroulad SesaZloa ganviTardes garegani ofTalmoplegia _ sielme
(n.abducens), ftozi (n.oculomotorius), saxis nervis dambla (n.facialis). daavadebis
me-5-6 kviras SeiZleba ganviTardes kidurebis dambla (poliradikulonevriti). damblebi
atareben periferiul, dune xasiaTs (hi porefleqsia, arefleqsia). n.laringeus-is da
n.phrenicus-is dazianebisas prognozi atarebs mZime xasiaTs. mZime formebis dros,
gansakuTrebiT, miokarditis fonze, daavadebis me-2-3 kviras SeiZleba ganviTardes krunCxvebi,
gonebis dakargva, marjvena hemi plegia (ufro xSirad), rac ganapirobebulia art.fossae
sylvii-s emboliiT. emboliis wyaros warmoadgens gulis mwvervalis Trombi. seqciaze
emboliebi dgindeba sxva organoebSic.
daavadebis mimdinareobis Taviseburebani wlamde asakis bavSvebSi bavSvebSi.. am asakis
bavSvebi, gansakuTrebiT 6 Tvemde da axalSobilebi avaddebian iSviaTad.ufro xSirad
gvxvdeba cxviris, kanis, xorxis difTeria, naklebia xaxis dazianebis SemTxvevebi, rac
aixsneba nuSurebis susti ganviTarebiT. mozrdilebisagan gansxvavebiT, cxviris difTeriis
dros aRiniSneba katarul-wylulovani procesi, intoqsikaciis niSnebi sustadaa
gamoxatuli. miuxedavad amisa, ar aris gamoricxuli miokarditisa da
poliradikulonevritis formireba.
axalSobilebsa da 3 Tvemde asakis bavSvebSi xorxis difTeria gansxvavdeba
mozrdilebis daavadebis suraTisagan. kerZod, sustadaa gamoxatuli myefavi xvela,
naklebi intensivobisaa gulmkerdis drekadi nawilebis Sezneqva, afonia ki atarebs
mdgrad xasiaTs. aRniSnuli klinikuri Taviseburebani dakavSirebulia nervul-kunTovani
sistemis nakleb ganviTarebasTan. 3 Tvis asakis zeviT krupis sindromi atarebs ti pur
xasiaTs, Tumca misi xangrZlivoba ufro moklea da ganisazRvreba 1-1,5 dRe-RamiT,
romlis drosac swrafad viTardeba asfiqsia. 6 Tvemde asakis bavSvebSi xaxis toqsikuri
formebi ar gvxvdeba. iSviaTia igi 12 Tvemde bavSvebSic, Tumca mimdinareobs ti purad.
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wlamde asakis bavSvebSi letaloba ufro maRalia, vidre mozrdilebSi, rac ganpirobebulia
pnevmoniis ganviTarebiT krupis dros, xolo toqsikuri mimdinareobisas _ miokarditiTa
da pnevmoniiT.
diagnozis dasma, pirvel rigSi, eyrdnoba klinikur suraTs, sadac wamyvania fibrinuli
nadebebis arsebobis dadgena. difTeriul nadebs axasiaTebs anTebad keraze TiTqosda
zedapiruli ganlageba, romelic moruxo-WuWyisferia. apkis mocilebas sWirdeba
Zaldataneba da gaSiSvlebuli adgili sisxlmdenia; mocilebidan ramdenime saaTSi
SeimCneva fibrinuli apkis axali organizacia. apki mkvrivia, reziniseburi da or
sasagne minas Soris ar isriseba. xaxis difTeriisaTvis damaxasiaTebelia aramkveTri
hiperemia, romelsac gadahkravs cianozuri elferi, TiTqos gvagonebs moxarSuli xorcis
fers. gavrcelebuli da toqsikuri formis dros yuradRebas i pyrobs nuSurebis, sasis
rkalebis, naqis da a.S. mkveTri SeSupeba, romlis fonze ufro xSirad orive mxares
viTardeba sakmaod sqeli, uxeSi, WuWyis feri fibrinuli nadebebi. difTeriuli anginis
dros ylapva zomierad an sustadaa mtkivneuli, rac miuTiTebs toqsinis anesTeziur
moqmedebaze. zog SemTxvevaSi SeimCneva xaxis mkveTri hi peremia, romelic aixsneba
streptokokuri infeqciis aqtivaciiT da am dros adgili aqvs Sereul difTeriul-
streptokokul infeqcias.
xaxis toqsikuri difTeriis kardinaluri simptomia fibrinuli nadebebis arsebobasTan
erTad, regionuli limfuri kvanZebis irgvliv da mTels kiserze kanqveSa cximovani
qsovilis SeSupebis gamovlineba. difTeriis sxvadasxva lokalizaciisas adgilobrivi
procesis intensivoba, SeSupebiTi simptomis CaTvliT gansazRvravs organizmis
intoqsikaciis xarisxs, rac unda dadgindes daavadebis pirvelsave dRes, vinaidan erTaderTi
efeqturi ukuganviTareba mxolod antitoqsinis mieraa SesaZlebeli.
Zalze iSviaTad, acril bavSvebSi, imuniteti ar yalibdeba, rac ar gamoricxavs
toqsikuri difTeriis ganviTarebas. daavadeba SeiZleba ganviTardes imunitetis arsebobis
drosac, magram am fonze daavadeba mimdinareobs lokaluri formiT, ufro metad xaxaSi,
(iSviaTad cxvirSi). nadebebi nuSurebze gamoirCevian kunZulovani ganlagebiTa da
lorwovans scildebian advilad, sisxldenis gareSe. am dros Zalian iSviaTia seriozuli
garTulebebi da procesi xSirad ganicdis ukuganviTarebas specifikuri mkurnalobis
gareSec. iSviaTad SeiZleba ganviTardes subtoqsikuri, toqsikuri I da II xarisxis
xaxis difTeria.
difTeriis yvela formisas (saeWvo SemTxvevebis CaTvliT) da gansakuTrebiT,
difTeriuli krupis dros organizmSi dauyovnebliv unda SeviyvanoT antitoqsini
(antidifTeriuli Srati). prognozi mTlianadaa damokidebuli Sratis adreul Seyvanaze.
laboratoriuli gamokvlevebi. nacxis pirdapiri SeRebva da mafluorescirebeli
antisxeulebis kvleva ara saimedoa. baqteriologiuri kvleviT difTeriis Cxiris
gamoyofa SeiZleba 90%-Si. gamokvlevis Sedegi damokidebulia masalis swor aRebaze.
dasaTes masalas iReben steriluri bambis tamponiT nadebis kedlidan; cal-calke
iReben xaxidan, cxviridan da a.S., Wamamde an Wamidan 2-sT-is Semdeg. masalas (lorwos,
fibrinul nadebs, tampons) aTavseben sterilur sinjaraSi da swrafad (ara ugvianes 3
saaTisa) agzavnian laboratoriaSi, sadac iTeseba specialur niadagebze (sisxliani,
teluritiani tinsdalis agari, klaubergis niadagi). laboratoriidan winaswari pasuxi
SeiZleba gaices 24 saaTSi, xolo saboloo 48-72 sT-Si (toqsigenurobisa da
antibiotikogramis gaTvaliswinebiT). uaryofiTi pasuxi ar gamoricxavs difTeriis
arsebobas, xolo dadebiTi adasturebs mas. Tu transportirebas 3 saaTze meti dro
sWirdeba, saWiroa masalis satransporto niadagSi moTavseba (teluritiT gamdidrebuli
niadagi an gel-silikonur sinjarebSi, ukanasknel SemTxvevaSi masalis aRebis win
saWiroa tamponis datenianeba peptonuri bulioniT). masala igzavneba daavadebaTa
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kontrolis centrSi.
Tu avadmyofis anamnezSi aRiniSneba gadatanili angina, xolo mogvianebiT ganviTarda
iseTi garTulebebi, rogoricaa rbili sasis dambla, miokarditi, poliradikulonevriti,
savaraudoa, rom man gadaitana difTeria specifikuri mkurnalobis gareSe.
periferiul sisxlSi gvaqvs zomieri leikocitozi, poliradikulonevritis dros
Tav-zurgtvinis siTxeSi mcired imatebs cilisa da ujredebis raodenoba, toqsikuri
mimdinareobisas (RviZlis dazianebiT) aRiniSneba hipoglikemia da glukozuria. Tirkmlis
milakebis nekrozuli dazianebisas sisxlSi imatebs Sardovana da narCeni azoti.
miokarditis dros ekg-ze aRiniSneba aritmiis movlenebi, T kbilis, S-T segmentis
cvlilebebi.
diferenciuli diagnozis gatarebis aucilebloba ganpirobebulia procesis
lokalizaciiT da misi formiT.
xaxis difTeriis dros, romelic xasiaTdeba sxvadasxva sididis fibrinuli nadebiT
(dawyebuli wertilovanidan, damTavrebuli nuSurebis zedapiris mTliani dafarviT),
gasaTvaliswinebelia lakunuri da folikuluri anginebi, romlebic xasiaTdebian daavadebis
uecari dawyebiT, SemcivnebiT, maRali temperaturiT, ylapvis dros mkveTri tkiviliT,
saerTo intoqsikaciis suraTiT. xaxis daTvalierebisas aRiniSneba mkveTri hi peremia,
dgindeba Cirqovani folikulebi, romlebic moTavsebulia lorwovanis SigniT. lakunebSi
Cirqovani nadebebia. aRniSnul SemTxvevaSi nadebi Cirqovani xasiaTisaa, maSin, roca
difTeriis dros fibrinulia. adgilobrivi procesi ki xasiaTdeba naklebad gamoxatuli
hi peremiiT, es ukanaskneli ufro cianozuri elferisaa da intoqsikacia zomier xasiaTs
atarebs. toqsikuri difTeriis dros fibrinuli nadebebis garda pirvelsave dReebSi
regionuli limfuri kvanZebis irgvliv an mTel kiserze aRiniSneba kanqveSa cximovani
qsovilis SeSupeba.
nekrozuli angina, romelic mimdinareobs nuSurebze borcviani, xorkliani nadebebis
ganviTarebebiT, SeiZleba miRebuli iqnas xaxis difTeriad. misTvis damaxasiaTebelia
nuSurebis lorwovani garsebis mkveTri hi peremia, regionuli limfuri kvanZebis Zlieri
mtkivneuloba, nadebebi advilad scildeba anTebad keras da isriseba or sasagne minas
Soris, rac ganasxvavebs difTeriisagan.
simanovski-plaut-vensanis angina ifargleba adgilobrivi procesiT, nekrozuli
kera gamoirCeva Rrma mdebareobiT. nadebi iSviaTadaa zedapiruli da xorkliani. 3-4
dReSi nekrozis adgilas warmoiSoba kraterismagvari wyluli, romlis epiTelizacia
sruldeba 10-12 dReSi. daavadebis etiologiis dadgenas aadvilebs anTebadi keridan
aRebuli nacxis pirdapiri mikroskopia, romelSic aRiniSneba simbionturi saprofitebi
_ spirilebi da TiTistarismagvari Cxirebi (fuzospirilebi).
sokovani anginis dros zogjer saWiroa diferencireba xaxis difTeriasTan.
aRniSnuli dazianeba umTavresad gvxvdeba 2 wlis asakamde. sokovani anginis dros
nadebi TeTri an moyviTalo ferisaa da advilad scildeba adgils, igi xaWoseburia da
Tavisuflad ifSvneba. regionuli limfuri kvanZebi ar aris gadidebuli, sxeulis
temperatura normis farglebSia. damaxasiaTebelia nadebebis xangrZlivi arseboba raime
dinamikis gareSe. anTebadi adgilidan aRebuli nacxis pirdapiri mikroskopiiT dgindeba
Candida albicans-is aqtivoba.
paratonzilits (flegmonur anginas) SecdomiT miiCneven xaxis toqsikuri formis
difTeriad. misTvis damaxasiaTebelia calmxrivi dazianeba, nuSurebis zemdebare qsovilebis
mwvave anTeba da umTavresad im bavSvebis xvedria, romlebic qronikuli tonzilitiT
arian Sepyrobili. hi peremiulia xaxis ukana da wina TaRebi, naqi; swrafad viTardeba
infiltraciuli anTebiTi procesi, rac iwvevs nuSurebis cdomas Sua xazidan an, ufro
metic, janmrTeli nuSurisaken. saerTo mdgomareoba Zlier mZimea, temperatura aRwevs
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40°C da mets, romelic iklebs mxolod flegmonis gaskdomis an gakveTis Semdeg.

daavadebis pirvelsave dRes avadmyofi uCivis tkivils, romelic TandaTan mZafrdeba. am
dros avadmyofi ver ylapavs, ver ReWavs, zogjer gaZnelebulia piris daxurva-gaReba,
aRiniSneba gaZlierebuli nerwyvdena, trizmi. gamoxatulia regionuli limfadeniti
mZafri tkivilebiT. difTeriis dros gamoxatuli tkivilebi ar gvaqvs miuxedavad
nuSurebze arsebuli fibrinuli nadebisa an toqsikuri formis dros arsebuli
kanqveSa qsovilebis SeSupebisa. difTeriis dros avadmyofi fermkrTali da adinamiuria,
roca paratonzilitis dros xSirad aRiniSneba agzneba.
infeqciuri mononukleozi xSirad saWiroebs garCevas xaxis toqsikuri
difTeriisagan, rac dakavSirebulia xaxis cvlilebebTan, kisris konfiguraciis SecvlasTan
limfuri kvanZebis gadidebis gamo. difTeriisagan gansxvavebiT mononukleozs axasiaTebs
daavadebis TandaTan dawyeba, nuSurebze nadebi advilad scildeba lorwovans, fxvieria,
araTanabari sisqisa da moyviTalo-moTeTro ferisaa, xorkliania. damaxasiaTebelia
kisris ukana limfuri kvanZebis gadideba, hepatolienuri sindromi. diagnozs adasturebs
ati puri mononuklearebis momateba periferiul sisxlSi, agreTve heterofiluri
intisxeulebis arseboba.
epidemiuri parotitis gansxvaveba xaxis difTeriis toqsikuri formisagan siZneles
ar warmoadgens, Tu kargad iqna daTvalierebuli piris Rru; kerZod, difTerias gamoricxavs
nadebebis ararseboba.
difTeriuli krupi xSirad saWiroa ganvasxvavoT sxva etiologiis krupis
sindromisagan, romelic ganpirobebulia mwvave respiraciuli infeqciebiT (gripi, paragripi,
adenovirusuli infeqcia, RS-infeqcia). xorxis difTeriisaTvis damaxasiaTebelia krupis
sindromis dinamikuri gaSla, sadac gansakuTrebuli mniSvneloba aqvs afoniis TandaTanobiT
ganviTarebas, mwvave respiraciuli virusuli infeqciebis dros aRniSnuli sindromi
viTardeba uecrad da daavadeba vlindeba stenozuri movlenebiT, romlis drosac
srul afonias adgili ar aqvs, aRiniSneba xmis maRali tembri, agreTve gamoxatulia
zemo sasunTqi gzebis katari.
xorxSi an traqeaSi ucxo sxeulis arsebobisas viTardeba uecari stenozis
suraTi. am dros anamnezSi aRniSnaven, rom mdgomareoba ganviTarda saWmlis miRebis an
wvril sagnebTan TamaSis dros. difTeriuli krupisagan gansxvavebiT aseTi movlenebi
uviTardebaT janmrTel bavSvebs normaluri temperaturis fonze da xma rCeba ucvleli.
diagnozis dazustebas xels uwyobs laringobronqoskopia da rentgenologiuri kvleva
(aspirirebuli sxeulebis dasadgenad).
mZime krupis sindromis ganviTarebis yvela SemTxvevaSi pirdapiri laringoskopia
xels uwyobs diagnozis dazustebas, xolo asfiqsiis acilebis mizniT xdeba traqeotomiis
an intubaciis Catareba.
mkurnaloba. yvela formis difTeriis dros da agreTve saeWvo SemTxvevebSi
aucilibelia avadmyofis hospitalizacia specialur ganyofilebebSi, boqsebSi, xolo
xorxis difTeriis dros intensiuri Terapiis ganyofilebaSi. avadmyofs unda Cautardes
kompleqsuri mkurnaloba daavadebis pirvelsave dRes, mZime SemTxvevebSi binis pirobebSic
(Tu hospitalizacia gviandeba an SeuZlebelia saavadmyofos siSoris gamo) ki saWiroa
Seyvanil iqnas difTeriis sawinaaRmdego antitoqsikuri Srati _ antitoqsini, romelic
miiReba anatoqsiniT cxenis organizmis hi perimunizaciis Sedegad. Tumca Tanamedrove
antitoqsini gawmendilia balasturi cilisagan dializisa da fermentaciis meTodebiT.
avadmyofis organizmSi misma ganmeorebiTma Seyvanam SeiZleba gamoiwvios Sratismieri
daavadeba an anafilaqsiuri Soki.
daavadebis prognozi damokidebulia antitoqsinis adreul Seyvanaze; umjobesia es
moxdes erTjeradad venaSi saTanado meTodikis dacviT, raTa Tavidan aviciloT cxenis
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SratiT organizmis sensibilizacia, rasac adgili aqvs misi ganmeorebiTi Seyvanisas.

saWiroa sakmarisi dozis Seyvana sisxlSi mocirkulire toqsinis gasaneitraleblad.
agreTve mniSvnelovania, avadmyofis imunuri statusi, asaki da a.S.
specifikuri mkurnalobis dawyebamde aucilebelia organizmis mgrZnobelobis
gansazRvra cxenis cilis mimarT (ix. zogad nawilSi `pasiuri imunizacia~).
Tu stacionarSi Semosuli avadmyofi saeWvoa difTeriul krupze da Catarebuli
damxmare Terapia (epinefrinis inhalacia) 1-1,5 sT-is ganmavlobaSi efeqts ar iZleva
(stenozuri sunTqvis SesamCnevi Semcireba, avadmyofis damSvideba da sxva), xolo
gamoricxulia epiglotiti da ucxo sxeuli, aucilebelia difTeriis sawinaaRmdego
Sratis Seyvana, saWiroebisas laringoskopia narkoziT da intubacia.
specifikuri mkurnalobis efeqtis maCvenebelia adgilobrivi procesis _ nadebebis
mkveTri Semcireba an alageba da saerTo mdgomareobis gaumjobeseba, krupis sindromis
dros ki stenozuri sunTqvis sruli an xangrZlivi moxsna. rac Seexeba afonias da
myefavi xasiaTis xvelas, maT SeiZleba ufro didxans gastanon da amitom Sratis
moxsnisaTvis ar aris winaaRmdegCveneba.
amerikis pediatriis akademiis infeqciuri komitetis mier

rekomendebulia difTeriis antitoqsinis Semdegi dozebi:
antitoqsinis doza
difTeriis forma
(saerTaSoriso erTeulebSi)
mxolod kanis dazianebiT mimdinare 20 000 _ 40 000
xaxis, xorxis difTeria (daavadebis
dasawyisidan gavida 48sT-ze naklebi 20 000 _ 40 000
dro)
cxvir-xaxis difTeria 40 000 _ 60 000
daavadebis dawyebidan gavida 72 saaTi
80 000 _ 100 000
an meti
toqsikuri difTeria kisris
80 000 _ 100 000
SeSupebiT
P.S. saqarTveloSi toqsikuri difTeriis dros gamoiyeneboda

80 000 - 120 000 - 150 000 erT.
Cvens klinikaSi difTeriis mkurnaloba xdeboda am sqemis mixedviT venaSi wveTovnad

(90 wuTis ganmavlobaSi) mTeli dozis SeyvaniT. Sratis samkurnalo doza ixsneboda
0,9%-iani NaCl _ 500 ml-Si. sikvdilis SemTxvevebi aRiniSneboda mxolod dagvianebuli
(7-8 dRe) hospitalizaciis dros. saWiroebisas keTdeboda desensibilizacia Kaplan-
is mixedviT.
kanis dadebiTi sinjis miRebis Semdeg (1:100 ganzavebis 0,1 ml antitoqsinis Seyvana
winamxris medialur zedapirze 20 wuTis Semdeg iZleoda 1sm-ze meti diametris
papulas) Segvyavda antitoqsini, desensibilizaciis mizniT, yovel 15 wuTSi Semdegnairad:
269
difTeriuli antitoqsinis Seyvana desensibilizaciis meTodiT
(Kaplan, Mary Anne Jackson)
ganzaveba 0,9%-
doza # Seyvanis gza raodenoba ml-Si
ian NaCl
1* kanqveS 1:20 0,5
2 kanqveS 1:10 0,1
3 kanqveS 1:10 0,3
4 kanqveS ganuzavebeli 0,1
7~ venaSi ganuzavebeli 0,1
* yoveli dozis 15 wuTis intervaliT Seyvana.

~ Tu me-7 doza avadmyofma kargad aitana, darCenili doza ganzavdes 0,9%-ian
NaCl 400-500 ml-Si da Seyvanil iqnas 90 wuTis ganmavlobaSi.
antibiotikTerapia iTvaliswinebs difTeriul Cxirebze pirdapir moqmedebas, rac

xels uwyobs egzotoqsinis produqciis Sewyvetas da meoradi infeqciis (streptokokuris,
romelic 30%-Si Tan axlavs xaxis toqsikur difTerias) daTrgunvas.
mikrobebis sanaciisaTvis, pirvel rigSi iniSneba: parenterulad penicillin G kunTebSi
an venaSi, 100 000-150 000 erT/kg dRe-RameSi 4 Seyvanaze an procain penicillin 25
000-50 000 erT/kg dRe-RameSi 2 Seyvanaze 14 dRis ganmavlobaSi.
alternatiul preparats warmoadgens eriTromicini: per os an parenterulad 40-
50 mg/kg dRe-RameSi, maqsimum 2 g dReSi 14 dRis ganmavlobaSi.
kanis difTeriis dros saWiroa wylulis damuSaveba sufTa wyliT da sapniT da
antimikrobuli preparatebis 10 dRis ganmavlobaSi miReba.
garTulebebis mkurnaloba. miokarditis dros icaven mkacr woliT reJims (2-
3 kvira). pirvel kviras kveba Txieria da maRalkaloriuli, SemdegSi _ ufro Tavisufali.
dezintoqsikaciis mizniT venaSi ukeTdebaT albumini, reopoliglukini, ringeris laqtati
da a.S. difTeriuli miokarditis mkurnaloba moicavs mkacr woliT reJims, digitalisis
preparatebi eZlevaT mxolod gulis mZime ukmarisobis dros, magram Zalian frTxilad,
vinaidan es preparati zrdis miokardiumis mgrZnobelobas da aritmias. saWiroa misi
dozis xSiri kontroli. kardiogenuli Sokis dros gamoiyeneba saTanado preparatebi
periferiuli perfuziis da gulidan gandevnili sisxlis moculobis aRsadgenad da
wnevis asawevad (mag.: nitroprusside, dopamine-Tan kombinaciaSi). Sardmdeni preparatebis
gamoyeneba aseve sifrTxiliT aris saWiro. mZime miokarditis dros iniSneba steroidebi,
Tumca maTi efeqti zogierTi avtorebis mier ar mtkicdeba.
poliradikulonevritis dros ixmareba B jgufis vitaminebi, xolo sasunTqi kunTebis
dazianebisas avadmyofi gadahyavT marTviT sunTqvaze da aZleven farTo speqtris
antibiotikebs, Jangbads.
mZime difTeriuli krupis dros Cvenebis mixedviT keTdeba intubacia an traqeostomia,
eleqtroSemwoviT lorwosa da nadebis moSoreba xorxidan.
msubuqi formisas avadmyofebs dafTeriis sawinaaRmdego Sratis da antibiotikis
garda medikamentebi ar eniSnebaT.
270
saavadmyofodan gaweris dro. garTulebis gareSe mimdinare lokaluri formisas

avadmyofi iwereba me-12-14 dRes, xaxis gavrcelebuli formisas me-20-25 dRes. xaxis
subtoqsikuri da I xarisxis toqsikuri difTeriis dros woliTi reJimi avadmyofebs
eniSnebaT 25-30 dRis manZilze, xolo gawera xdeba 35-40-e dRes, II da III xarisxis
SemTxvevaSi woliTi reJimis xangrZlivobaa 4-6 kvira, xolo gawera xdeba 2 Tvis
Semdeg. yvela SemTxvevaSi gaweris aucilebeli pirobaa 2 uaryofiTi pasuxi difTeriis
Cxirze baqteriologiuri kvlevisas. antibiotikTerapiidan minimum 24 saaTis Semdeg
keTdeba ganmeorebiTi gamokvleva mtareblobaze.
prognozi, upirveles yovlisa, damokidebulia specifikuri, antidifTeriuli Sratis
adreul Seyvanaze (kargi Sedegebia Seyvanidan pirvel sam dReSi), radgan daavadebis
paToganezSi gadamwyveti roli eniWeba egzotoqsiniT gamowveul intoqsikacias.
antitoqsini (Srati) aneitralebs sisxlSi Tavisuflad mocirkulire toqsins, xolo
qsovilebze fiqsirebuls ki (romelic daavadebis 3 dRis mere Cndeba) ver aneitralebs.
mniSvnelovania saTanado antibiotikebis gamoyeneba, vinaidan mwvave periodSi grZeldeba
toqsinebis produqcia Cxirebis mier. difTeriis lokaluri formebis dros prognozi
keTilsaimedoa; rac ufro intensiuria fibrinuli nadebis gavrceleba da toqsikuri
mimdinareobis formireba, miT ufro mZimdeba prognozi. xaxis II da III xarisxis
mimdinareobisas xSirad viTardeba Trombohemoragiuli sindromi an hi pertoqsikuri
formis dros antitoqsinis Seyvana xSirad Sedegs ar gvaZlevs da procesi mTavrdeba
letaluri gamosavliT. 4 wlamde asakis bavSvebSi letaloba ufro maRalia, vidre
mozrdilebSi. aucrel bavSvebSi daavadeba umZimesad mimdinareobs da letalobam SeiZleba
miaRwios 40-50%-s.
prognozis gansazRvrisas mxedvelobaSi unda miviRoT mTeli rigi faqtorebi: gamomwvevi
agentis virulentoba (gravis ti pi iwvevs mZime mimdinareobas), procesis lokalizacia
(xorxis difTeriis dros SeiZleba ganviTardes uecari sikvdili, romelic gamowveulia
apkis aSrevebis Sedegad sanaTuris daxSobiT), fibrinuli nadebebis gavrcelebis intensivoba
(xaxis difTeriis toqsikuri formebi rTuldeba miokarditiT, poliradikulonevritiT,
centraluri dambliT, romlebic umTavresad ganapirobeben maRal letalobas). mniSvneloba
aqvs organizmis imunologiur statuss da bolos umniSvnelovanesia specifikuri
antidifTeriuli SratiT adre dawyebuli mkurnaloba, antibiotikTerapia, paTogenezuri
Terapiis warmarTva da avadmyofis movla.
profilaqtikis mTavar safuZvels warmoadgens aqtiuri imunizacia, romelic
tardeba difTeriuli anatoqsinis saSualebiT. imunizaciisaTvis iyeneben vaqcinebs
DTP,, DTaP,, Td,, DT (dawvrilebiT ix. àcrebis kalendari~, saerTo nawilSi).
axali kalendris Tanaxmad difTeriis sawinaaRmdego acra iwyeba 2 Tvis asakidan
DTP-is 0,5 ml vaqcinis kunTebSi SeyvaniT samjeradad, erTi Tvis intervaliT;
erTdroulad igive intervaliT tardeba poliomielitis sawinaRmdego vaqcinacia.
difTeriis sawinaaRmdego revaqcinacia DTP-is vaqciniT ukeTdebaT 1 wlis da 6 Tvis
asakSi, xolo DT-Ti 5-6 da Td-Ti 14-15 wlis asakSi.
samamulo da ucxoeTis janmrTelobis dacvis gamocdileba gviCvenebs, rom Tu
bavSvebis 97-98% acrilia, maSin difTeriiT daavadeba an ar gvxvdeba an adgili aqvs
erTeul SemTxvevebs.
kontaqtirebulTaTvis profilaqtikis taqtika Semdegnairia:
1. aucilebelia epidjaWvis kontroli;
2. axlo kontaqtis SemTxvevaSi saWiroa dakvirveba 7 dRis ganmavlobaSi, kulturis
aReba xaxidan, cxviridan. eriTromicinis micema (40-50 mg/kg dRe-RameSi 7 dRis
ganmavlobaSi), an bicilin_1-is gakeTeba (30kg-mde masis mqone bavSvebSi 600 000
erTeuli, xolo mozrdil bavSvebsa da mozrdilebSi 1 200 000 erTeuli);
271
difTeria
kerZo nawili. meningokokuri infeqcia
* imunizaciaCatarebul bavSvebSi, Tu bolo vaqcinis miRebidan gavida 5 welze meti,

saWiroa buster-dozis gakeTeba. Tu bavSvs ar hqonda Catarebuli vaqcinis me-4 acra,
saWiroa misi dauyovnebeli Seyvana (Td an DT asakis mixedviT);
* Tu acrebze informacia ar aris an aqvs miRebuli 3 dozaze naklebi vaqcina,
gasakeTebelia Td an DT asakis mixedviT.
meningokokuri infeqcia
meningokokuri infeqcia, meningokok- Neisseria meningitidis - iT gamowveuli

mwvave infeqciuri daavadebaa, romelic xasiaTdeba klinikuri polimorfizmiT, rogorc
calke nazofaringitis, meningitis, sefsisis, arTritis, pnevmoniis saxiT, agreTve maTi
Serwymuli formebiTac.
daavadebis mZime formebi vlindeba meningitisa da SokiT mimdinare elviseburi
meningokokuri sefsisis saxiT.
cnobebi. daavadeba uZvelesi droidanaa cnobili. amaze mowmobs
jer kidev Cvens welTaRricxvamde II saukuneSi areTeosis SromebSi moxsenebuli
faqtebi meningitis epidafeTqebebis Sesaxeb.
Jenevis epidafeTqebis Semdeg 1805 wels m. biesis mier daavadeba gamoyofili iyo
epidemiuri cerebrospinuri meningitis saxelwodebiT, magram misi etiologiis saboloo
dadastureba moxda 1887 w. Weichselbaum-is mier Tav-zurgtvinis siTxidan
gramuaryofiTi di plokokis gamoyofis Semdeg. SemdgomSi dadgenil iqna, rom garda
meningitisa, meningokoki iwvevs meningokokur sefsiss, nazofaringits, sxva organoebisa
da sistemebis dazianebas. amasTan dakavSirebiT 1965 w. jandacvis saerTaSoriso
organizaciis mier yvela klinikuri formisaTvis rekomendebulia saxelwodeba
`meningokokuri infeqcia~.
etiologia. meningokokuri infeqciis gamomwvevi Neisseria meningitidis
etiologia
gramuaryofiTi, momrgvalo an ovaluri formis 0,6 - 0,8 mkm zomis uZravi di plokokia.
zurgis tvinis siTxeSi da sisxlSi
meningokokebi vlindeba yavis an lobios
marcvlis msgavsad, ti pur SemTxvevaSi
ganlagebulni arian wyvilad gamodrekili gare
kideebiT, ujredSiga ganlagebiT an ujredgare
mdebareobiT.
antigenuri struqturiT meningokokebi
iyofa rig serologiur jgufebad, romlebic
erTmaneTisagan gamoirCevian specifikuri
kafsuluri polisaqaridebis sxvadasxva
SemadgenlobiT. 13 jgufida yvelaze cnobilia
A, B, C, X, Y, Z, W-135
-135 da L serologiuri
jgufebi. yvelaze maRali virulentobiT
gamoirCeva A seroti pi, romelsac
gansakuTrebuli invaziurobis unari aqvs da
gavrcelebulia mTel msoflioSi. aSS-Si ki
ujredSida meningokokebis ganlageba prevalirebs B da C jgufis seroti pebi (45%-
lumbalur punqtatSi meningokokuri mde). dadasturebulia meningokokebis L
meningitis dros.
formebis warmoSoba, romlebic SeiZleba iyos
(Í.È. Íèñåâè÷, Â.Ô. Ó÷àéêèí)
272
meningokokuri meningitis gaxangrZlivebuli formebis mizezi.

meningokokebis kultivireba xorcieldeba niadagebze, romlebic Seicaven adamianis
an cxovelis cilebs an aminomJavebis specialur Semadgenlobas. kultivirebisTvis
gamoiyeneba Sokoladis agari, Mueller-Hinton-is agari, sisxliani agari, tri ptaza-
soios agari. mikrobebs daSlisas aqvT polisaqariduli endotoqsinis ganTavisuflebis
unari (egzotoqsins ar gamoyofen). zrdis optimaluri temperaturaa 370C. meningokoki
aerobi an fakultaturi anaerobia. xasiaTdeba garemoSi dabali rezistentobiT: +560C
iRupeba 5 wT-Si, 1000C-ze 30 wamSi, naklebad mdgradia dabal temperaturazec: _100C
iRupeba 2 sT-Si, ultraiisferi sxivebis moqmedebiT iRupeba maSinve. Zlier mgrZnobiarea
yvela sadezinfeqcio xsnaris mimarT.
epidemiologia. infeqciis wyaros da rezervuars warmoadgens mxolod adamiani
epidemiologia
(meningokokuri infeqcia anTroponozuri infeqciaa), romelsac aReniSneba daavadebis
generalizebuli forma, nazofaringiti an meningokokis mtarebloba. avadmyofi yvelaze
metad gadamcemia daavadebis dasawyisSi, gansakuTrebiT, roca aRiniSneba gamoxatuli
kataruli movlenebi pir-xaxis mxriv (nazofaringitis dros). dadgenilia, rom aseTi
formiT daavadebuli 6-jer metad iwvevs daavadebas kontaqtirebul pirebSi, vidre
janmrTeli mtarebeli. magram imasTan dakavSirebiT, rom mtarebloba ufro gavrcelebulia,
misi mniSvneloba infeqciis gadacemaSi gacilebiT metia. ase magaliTad, D\B\ Gjrhjdcrbq
da Tanaavtorebis monacemebiT (1972) mtareblobis sixSiris gamovlineba 2000-jer
aRemateba daavadebis SemTxvevebs.
infeqciis gadacemis meqanizmi haer-wveTovania da xorcieldeba amosunTqvis, laparakis,
ceminebis da a.S. dros. didi mniSvneloba aqvs avadmyofTan axlo kontaqts. gadacemis
meqanizmis intensiuroba ufro izrdeba, Tu meningokokur infeqcias Tan erTvis mwvave
respiraciuli daavadebebi. daavadebis SemTxvevaTa 80% modis bavSvebze. 3 Tvemde
asakis bavSvebi iSviaTad avaddebian, Tumca aRwerilia misi SemTxvevebi axalSobilebSic.
SesaZlebelia nayofis inficirebac. 3-8 Tvis asakidan sisxlSi ukve aRar aRiniSneba
meningokokebis sawinaaRmdego, pasiurad miRebuli antisxeulebi, xolo SemdgomSi, TandaTan
xdeba maTi momateba.
organizmis mimRebloba meningokokuri infeqciisadmi ar aris maRali da kontagiozuri
indeqsi 10-15%-iT Semoifargleba.
daavadebis ganviTarebaSi didi mniSvneloba eniWeba mTel rig faqtorebs, maT Soris,
mWidro kontaqts daxurul dawesebulebebSi (baga, baRi da a.S.), maRal temperaturas,
tenianobas. Tumca daavadebis afeTqebis mizezi srulad ar aris Seswavlili, magram
SesaZlo faqtorebidan mniSvneloba eniWeba meningokokebis saxeobis Secvlas. ukanasknel
periodSi meningokokuri infeqcia xSirad ganpirobebulia B da C meningokokebiT. B
jgufis meningokokis kafsula warmoadgens sialis mJavas homopolimers, romelic
komplementis aqtivaciis klasikur gzaSi antisxeulebis monawileobiT ganapirobebs
alternatiuli gzis inhibicias. specifikuri antisxeulebis nakleboba, da alternatiuli
gzis inhibicia xsnis bavSvebSi B meningokokuri infeqciisadmi gansakuTrebul mimReblobas
da daavadebis ganviTarebas.
riskis jgufSi Sedian pirebi, romlebsac aReniSnebaT komplementis bolo komponentebis
deficiti (C5-9), properdinisa da D faqtoris maragis gamoleva. aRniSnul pirebSi
adgili aqvs meningokokebis invaziurobis gaZlierebas, daavadebis recidivebs.
daavadebis didi procenti modis qalaqis macxovreblebze. soflis mosaxleoba
naklebad avaddeba, magram maTi moxvedrisas maRali mtareblobis koleqtivebSi daavadeba
viTardeba swrafad da mZime formebSi.
meningokokuri infeqciis perioduli afeTqebebi aRiniSneba 10-15 wlis intervalebiT.
daavadebas axasiaTebs sezonuroba - zamTrisa da gazafxulis periodSi, SemTxvevebis
273
maqsimumi modis Teberval-aprilis TveSi.

dadgenilia, rom Tu meningokokuri mtarebloba mosaxleobaSi 20 da met procents
aRemateba, adgili aqvs manifesturi formebis ganviTarebas.
paTogenezi. meningokokebis SeWra organizmSi xorcieldeba cxvir-xaxisa da pir-
xaxis lorwovani garsebidan. amasTan, mxolod 10-15%-Si viTardeba adgilobrivi anTebadi
procesi nazofaringitisa da tonzilitis saxiT. kidev ufro nakleb SemTxvevaSi
meningokokebi gadalaxaven adgilobriv damcvelobiT bariers (IgA-s, maT Soris) da
fagocitirebuli leikocitebiT xvdebian sisxlSi, romelic SeiZleba damTavrdes
tranzituli baqteriemiiT an ganviTardes meningokokcemia (meningokokuri sefsisi). am
SemTxvevaSi adgili aqvs meningokokebis ganTesvas mTel organizmSi (kanSi, saxsrebSi,
Tirkmelzeda jirkvlebSi, Tvalis sisxlZarRvebSi, TirkmelebSi, filtvebSi da a.S.).
aris monacemebi imis Sesaxeb, rom meningokokuri infeqciis generalizacia viTardeba
specifikuri da araspecifikuri imunoreaqtiulobis daqveiTebis fonze. didi mniSvneloba
aqvs adre gadatanil daavadebebs, organizmis reaqtiulobis Secvlas stresreaqciis
saxiT. maT miekuTvneba virusuli, xSirad gripuli, herpes-infeqcia; klimaturi pirobebis
mkveTri cvlileba, travma, herpesi, infeqciis ganviTarebas xels uwyobs aseve wiTeli
mglura, nefrozuli sindromi, mieloma, RviZlis ukmarisoba.
hi pertoqsikuri (elviseburi) meningokokcemiis paTogenezSi endotoqsinemiasTan
erTad didi mniSvneloba eniWeba organizmis hi persensibilizacias da misi reaqtiulobis
cvlilebas (autoalergiuli procesebi).
meningokokcemias Tan sdevs meningokokebis masiuri daSla da mZime toqsikuri
procesis Camoyalibeba, gansakuTrebiT, elviseburi formis dros, romelic infeqciur-
toqsikuri Sokis sindromiT mimdinareobs (am dros gansakuTrebiT damaxasiaTebelia
sisxlCaqcevebi Tirkmelzeda jirkvlebSi, nekrozebi).
meningokokuri endotoqsini warmoadgens Zlier toqsins, romelic mkveTrad azianebs
sisxlZarRvebis endoTeliums da, pirvel rigSi, ganapirobebs mikrocirkulaciis moSlas.
endotoqsini da komplementis sistema paTogenezSi wamyvan rols asruleben. endotoqsemia
korelirebs mocirkulire citokinebTan, romelic gamoiyofa endotoqsinmastimulirebeli
monocitebiTa da makrofagebiT. sainteresoa, rom tumormanekrozebel faqtor - ∝ -s da
interleikinebis koncentracia pirdapir SefardebaSia meningokokuri infeqciis fatalur
gamosavalTan.
viTardeba diseminirebuli sisxlZarRvSida Sededebis sindromi (wvril venebsa da
arteriolebSi viTardeba Trombebi). es ki ganapirobebs Rrma metabolur darRvevebs -
hi poqsias, acidozs, hi pokaliemias da sxvas. dasawyisSi adgili aqvs hi perkoagulacias
(fibrinogenisa da sxva Semadedebeli faqtorebis momatebiT), ramac SeiZleba SemdgomSi
ganapirobos wvril sisxlZarRvebSi fibrinis daleqva da Trombebis ganviTareba. msxvili
sisxlZarRvebis Trombozis dros SeiZleba ganviTardes TiTebis, kidurebis gangrena.
Semdegi faza hi pokoagulaciiT mimdinareobs, ris Sedegadac adgili aqvs fibrinis
Semcvelobis daqveiTebas sisxlSi (moxmarebis koagulopaTia), rac xSirad sxvadasxva
qsovilebsa da organoebSi sisxldenis da sisxlCaqcevebis mizezia.
rig SemTxvevaSi meningokokcemia mimdinareobs septikopiemiis saxiT, meoradi
metastazuri kerebis CamoyalibebiT (meningokokuri endokarditi, arTriti, iridocikliti
da sxva).
meningokokebis SeWra Tav-zurgtvinis garsebsa da tvinis nivTierebaSi xdeba
hematoencefaluri barieris garRvevis Sedegad. dasawyisSi viTardeba anTebiTi procesi
rbil da qselisebur garsebSi, rac vlindeba meningitis sindromis saxiT, xolo Semdeg
perivaskulurad vrceldeba tvinis nivTierebebze da iwvevs encefalits. anTebiTi
procesi xSirad lokalizdeba didi hemisferoebis zedapirsa da Tavis tvinis fuZeze,
274
magram araiSviaTad vrceldeba zurgis

tvinzec. SesaZlebelia moxdes parkuWebis
CaTreva paTologiur procesSi da
ganviTardes ependimatiti. makroskopulad
tvini am SemTxvevaSi gamoiyureba Cirqovani
CaCis magvarad.
Zlieri toqsikozis Sedegad SeiZleba
ganviTardes tvinis mwvave SeSupeba, rac
zrdis mis moculobas da ganapirobebs tvinis
cdomas kefis did xvrelSi naTxemis
danamatebis gaWedviT, iwvevs zewolas mogrZo
tvinze, mogrZo tvinze zewolis Sedegad ki
viTardeba am ukanasknelis sasicocxlo
centrebis - sunTqvisa da sisxlZarRvTa meningokokuri meningiti. Cirqovani
mamoZravebeli centris dambla. gamonaJoni Tavis tvinis hemisferoebze.
zogjer, mZime formebis dros, (Í.È. Íèñåâè÷, Â.Ô. Ó÷àéêèí)
gansakuTrebiT mcire asakis bavSvebSi
viTardeba ara hi pertenzia, aramed cerebruli hi potenzia (cerebruli kolafsi).
am sindromis genezSi wamyvani roli ekuTvnis wyal-marilovani balansis darRvevas.
Tavis mxriv, cerebruli kolafsi xels uwyobs subaraqnoidul sivrceSi eqsudatis
gaJonvas. Cirqovani eqsudatis ukuganviTarebisas araxelsayrel pirobebSi (meningitis
gaxangrZlivebuli SemTxvevebi, arasrulfasovani mkurnaloba) SesaZlebelia SemaerTebeli
qsoviliT Cirqis konsolidacia, ris Sedegadac SeiZleba ganviTardes maJandis, luSkes,
keas, retciusis xvrelebis, Sua tvinis wyalsadenis (silviis wyalsadeni) daxSoba,
qselqveSa sivrceebis kerovani an totaluri gamocarieleba, perivaskuluri gzebis
obliteracia. aRniSnuli, Tavis mxriv, warmoadgens hidroceles warmoSobis safuZvels.
siTxe grovdeba parkuWebSi, iwvevs maT gawelvas da, bolos, Tavis tvinis nivTierebis
atrofias. garda tvinis garsebisa, cvlilebebi SeiZleba gamovlindes Tavis tvinis
nervebis dazianebis saxiT (III, V, XII, VI, VII, VIII wyvili nervebi).
warsulSi sulfanilamidebiTa da antibiotikebiT mkurnalobamde meningokokuri
meningiti mdgradi siyruis erT-erTi ZiriTadi mizezi iyo. mwvave labirinTiti da
smenis nervis retrobulburi dazianeba axlac gvxvdeba antibiotikebis didi dozebis
gamoyenebisas.
periferiuli sisxlis mxriv adgili aqvs ufro metad leikocitozs neitrofiloziT,
marcxniv gadaxriT, eds momatebiT. meningokokuri meningiti SeiZleba mimdinareobdes
sisxlis normaluri suraTiT, rac msubuqi formebisaTvisaa damaxasiaTebeli.
axalSobilebSi meningokokuri meningiti aRiniSneba iSviaTad, Tumca SeiZleba adgili
hqondes epidafeTqebebs samSobiaro saxlebSi momvleli personalis baqteriamtareblobis
dros. orsulobis periodSi meningokokurma infeqciam SeiZleba gamoiwvios nayofis
dazianeba.
klinika. inkubaciuri periodi saSualod udris 6-7 dRes. minimaluri dro
klinika
ganisazRvreba saaTebiT, maqsimaluri ki aRwevs 20 dRemde (iSviaTad).
arCeven meningokokuri infeqciis Semdeg klinikur formebs: 1) pirveladi
lokalizebuli formebi _ a) meningokokebis mtarebloba, b) mwvave nazofaringiti g)
pnevmonia.
2) hematogenurad diseminirebuli generalizebuli formebi: a) meningokokemia
(meningokokcemia) - ti puri, elviseburi (mwvave meningokokuri sefsisi), b) meningiti, g)
meningoencefaliti, d) Sereuli (meningokokemia+meningiti) e) iSviaTi formebi
275
(endokarditi, arTriti, poliarTriti, pnevmonia, iridocikliti).

meningokokuri infeqciis mimdinareobis calkeuli formebi SeiZleba iyos msubuqi,
saSualo simZimis, mZime da Zlier mZime. meningokokebis mtareblobis dros ar aRiniSneba
araviTari klinika.
mwvave nazofaringiti SeiZleba mimdinareobdes rogorc meningokokuri infeqciis
calke forma an 30-40%-Si iyos Cirqovani meningitis, meningokokemiis prodromuli
stadia. nazofaringiti meningokokuri infeqciis yvelaze xSiri formaa da gvxvdeba
80%-Si. daavadeba iwyeba mwvaved, temperaturis momatebiT 37,5-38 0 C-mde. avadmyofebi
uCivian Tavis tkivils upiratesad safeTqlis midamoSi, yelis tkivils ylapvis dros,
xaxaSi fxaWnis SegrZnebas, cxviris gaWedvas, zogad sisustes, Zilis darRvevas. aReniSnebaT
sifermkrTale, koniunqtivebisa da sklerebis inicireba. zog SemTxvevaSi adgili aqvs
Rebinebas, sisxlZarRvebis vegetodistonias. piris Rrus daTvalierebisas naxuloben
xaxis ukana kedlis mkafio hi peremias da SeSupebas folikulebis hi perplaziiT -
faringiti, romelic nawilobriv dafarulia lorwovani nadebiT. aRniSnuli anTebadi
movlenebi qreba 5-7 dReSi limfuri hi perplaziis garda, romelic ufro xangrZlivia
da SeiZleba 2 kviras gagrZeldes. nazofaringitis dros temperaturuli reaqcia
grZeldeba 1-3 dRes, iSviaTad 5-7 dRe.
periferiul sisxlSi vlindeba tendencia leikocitozisaken, marcxniv gadaxriT an
normaluri sisxlis suraTiT. eds zomieradaa momatebuli.
pnevmonia, rogorc pirveladi, viTardeba izolirebulad sxvadasxva formebis
pnevmonia
gareSe, xSirad axasiaTebs plevriti, mimdinareobs xangrZlivad da mZimed.
meningokokuri meningiti SeiZleba ganviTardes erTdroulad meningokokemiis
dros, magram xSirad viTardeba rogorc meningokokuri infeqciis calke klinikuri
forma. zogjer prodromis saxiT mas win uZRvis nazofaringitis movlenebi.
wlamde asakis bavSvebSi daavadeba iwyeba TandaTanobiT, mozrdilebSi ki
damaxasiaTebelia ufro uecari dawyeba. mSoblebi am SemTxvevaSi xSirad aRniSnaven
daavadebis dasawyiss drois zusti miTiTebiT. Zlieri Semcivnebis Semdeg temperatura
mkveTrad matulobs 39-400 C-mde, xSiria mdgradi ganmeorebiTi Rebineba, romelsac
Sveba ar moaqvs. Rebinebas win ar uZRvis gulisrevis SegrZneba, igi viTardeba uecrad,
sakvebis miRebasTan ar aris dakavSirebuli da Sadrevniseburi xasiaTisaa. Rebineba
meningitis damaxasiaTebel niSnad iTvleba . avadmyofebi uCivian Tavis Zlier, Seupovar
tkivils, romelic umetes SemTxvevaSi difuzur xasiaTs atarebs. Tumca SeiZleba
sxvadasxva lokalizaciisac iyos - Sublis, safeTqlis, kefis areSi da a.S. amasTan
tkivilebi Zlierdeba avadmyofis umniSvnelo moZraobis drosac ki (Tavis moZraoba,
gasinjva da sxva). aReniSnebaT SiSi da tkivilebis gaZliereba mkveTri sinaTlis,
xmamaRali laparakis dros (hi peresTezia, hi perakuzia, fotofobia da sxva) da
saerTod, gare gamRizianeblebisadmi.
adreuli asakis bavSvebSi xSiria krunCxvebi, Cveulebriv, klonuri xasiaTis.
mozrdilebSi krunCxvebs adgili aqvs daavadebis mZime mimdinareobis dros.
Tumca daavadebis pirvelsave dRes SeiZleba gamovlindes meningealuri movlenebi,
magram simptomatika ufro metad meore-mesame dResaa gamoxatuli. cnobilia Tav-
zurgtvinis garsebis 30-mde simptomi, magram yvelaze ufro xSiria da naTladaa
gamoxatuli kisris, zurgis kunTebis rigidoba, kernigis, bruZinskis (zeda, Sua da qveda)
simptomebi. xSirad gamoxatulia myesTa refleqsebis gaZliereba, magram mZime formebis
dros adgili aqvs muclis, periostaluri da myesTa refleqsebis daqveiTebas an
anizorefleqsias. meningokokuri meningitis suraTSi didi adgili uWiravs gonebis
daTrgunvas (sopori, koma). xSirad gonebis dakargva Tan sdevs fsiqomotorul agznebas.
daavadebis mZime formebis dros gonebis dakargva daavadebis pirvel saaTebSi prognozulad
276
cudi maCvenebelia.
damaxasiaTebelia avadmyofis
iZulebiTi poza - wevs gverdze,
ukan gadaweuli TaviT, qveda
kidurebi ki muxlisa da menj-
barZayis saxsrebSia moxrili
(e.w. meZebari ZaRlis poza,
Seyenebuli Caxmaxis poza -
`Chien en Fusil~).
Tavis tvinis nervebis
dazianeba (VI, VII, VIII wyvili)
daavadebis pirvel dReebSi
iSviaTad aRiniSneba.
sulfanilamidebisa d a meningokokuri meningiti. damaxasiaTebeli `Caxmaxis~, `meZebari
antibiotikebis eramde ki smenis ZaRlis~ poza. (sakuTari masala)
daqveiTeba meningokokuri menin-
gitis dros arc Tu ise iSviaTi garTuleba iyo.
sxva zogadi simptomatikidan yuradRebas i pyrobs gamoxatuli sifermkrTale, wiTeli
dermografizmi, saxis tanjuli gamometyveleba, inicirebuli sklerebi. pulsi aCqarebulia,
gulis tonebi moyruebuli. pirvel xanebSi adgili aqvs taqikardias, rac mogvianebiT
bradikardiiT icvleba. arteriul wnevas aqvs tendencia daqveiTebisaken. sunTqva
gaxSirebulia da zerele. filtvebis perkusiiT moismineba kolofiseburi xmianoba,
auskultaciiT - mkvrivi sunTqva.
wlamde asakis bavSvebSi meningiti mimdinareobs ati purad. daavadeba iwyeba
TandaTanobiT. meningealuri movlenebi naklebadaa gamoxatuli, saxezea ufro zogadi
intoqsikaciis niSnebi - tremori, umizezo tirili, krunCxvebi, amoburculi, daWimuli
da pulsirebadi yiflibandi. hi potroful bavSvebSi yiflibandi SeiZleba Cavardnili
iyos, rac sxvadasxva mizeziTaa gamowveuli. erT SemTxvevaSi mis genezSi benzilpenicilinis
kaliumis marilis mkurnalobaSi masiuri dozebiT gamoyenebas aqvs adgili. meore
SemTxvevaSi ki igi intensiuri dehidrataciis Sedegia. meningitis mimdinareobaSi mcire
asakis bavSvebSi mniSvneloba aqvs, agreTve, gamoxatuli diareuli komponentis arsebobas.
faRaraTi iwvevs gauwyloebis simptomatikas - avadmyofebs
aReniSnebaT wyurvili, piris Rrus simSrale, kanis turgoris
daqveiTeba, Cavardnili Tvalebi, Tvalebis irgvliv Savi rgolebi,
Tav-zurgtvinis siTxis wnevis daqveiTeba. lumbaluri punqciis
dros liqvori gamodis iSviaTi wveTebiT. meningealuri simptomebi
am dros zogjer qreba an sustad gamoxatuli xdeba, qreba myesTa
refleqsebic, viTardeba kunTebis hi potonia.
bevr bavSvs daavadebis me-3-4 dRes aReniSneba herpesuli
gamonayari kanis sxvadasxva nawilebze an lorwovan garsebze,
terfebze. gamonayari zogjer uxvadaa warmodgenili, rac
mniSvnelovnad auaresebs zogad mdgomareobas. saWiroa aRiniSnos,
rom herpesi gvxvdeba sxva etiologiis meningitebis drosac.
daavadebis pirvel saaTebSi Tav-zurgtvinis siTxe gamWvirvalea
an opalescirebs, xolo Semdgom dReebSi ki mRvriea da Cirqovani.
meningokokuri
citozi, Cveulebriv, maRalia (12-13 aTasi 1 mkl-Si, zogjer
meningiti. Cirqovani
dauTvleli xdeba), mkveTradaa momatebuli cilebis Semcveloba lumbaluri punqtati.
(0,6-3,0-6,0 g/l), Sida wneva matulobs da aRwevs 300-500mm-de (sakuTari masala)
277
wylis svetisa, SeiZleba iyos normaluric. zogjer, maRali wnevis miuxedavad, liqvori
SeiZleba gamodiodes wveTebiT, rac miuTiTebs mis maRal webovnebaze, liqvoris gzebis
nawilobriv blokze.
cilis maRali Semcveloba xSirad gvxvdeba meningokokuri meningitis mZime formebis
dros, romelic mimdinareobs ependimatitis sindromiT. ependimatitis sindromi xasiaTdeba
simptomebis ramdenadme specifikuri TaviseburebebiT da ganpirobebulia procesis
lokalizaciiT (Zilianoba, cnobierebis mdgradi da progresirebadi darRveva, sopori,
koma, opistotonusi, krunCxvebi). viTardeba, agreTve, simptomebi, romlebic mowmoben
qalasSida wnevis momatebaze - Tavis tkivili, yiflibandis amoburcva da daWimuloba
qalas nakerebis daSorebiT (hidrocefalia), arteriuli wnevis momateba, mxedvelobis
nervis dvrilis SeSupebiT. cilis swrafi da mniSvnelovani momateba liqvorSi adasturebs
ependimatitis diagnozs. amave dros, xazgasmulia, rom ependimatitis zusti diagnozis
dasma SesaZlebelia mxolod kompiuteruli tomografiiT an paTanatomiur seqciaze.
damaxasiaTebelia aseve, avadmyofis poza - opistotonusi, gaSlili qveda kidurebi,
`balerinas terfebiT~, xSirad fexebi gadajvaredinebulia. xelebi moxrilia idayvis
saxsarSi, TiTebi muStebad aris Sekruli. SemdgomSi viTardeba kaxeqsia, fsiqomotoruli
darRvevebi da aseTi avadmyofebi kvdebian superinfeqciiT an sxva zeddarTuli garTulebiT.
qalasSida garTulebebi SeiZleba ganviTardes rekonvalescenciis periodSic (liqvoris
mimoqcevis gzebis bloki, abscesi, subaraqnoidul sivrceSi eqsudatis gaJonva). liqvorSi
SesaZlebelia, iyos sisxlic, rac ganpirobebulia sisxlCaqceviT garsqveSa sivrceSi
(SesaZlebelia diapedezuri sisxldena, mravalricxovani sisxlCaqcevebi tvinSi).
daavadebis pirvel dReebSi antibiotikTerapiis dawyebamde aRebuli liqvoris
neitrofilebSi da ujredgareT naxuloben gramuaryofiT di plokokebs (meningokokebs,
rac etiologiuri faqtoris dadasturebaa).
meningokokuri meningoencefaliti. daavadebis es forma upiratesad mcire
asakis bavSvebSi gvxvdeba. am dros daavadebis pirvel dReebSi dominirebs encefalituri
movlenebi, motoruli agzneba, adre viTardeba kidurebis, Tavis qalas nervebis parezi
da damblebi, naTxemuri ataqsia, Tvalis moZraobis darRveva da sxva. amasTan, meningealuri
movlenebi sustadaa gamoxatuli. meningoencefaliti xSirad mimdinareobs zogadtvinovani
movlenebis gareSe. naTxemis funqciuri darRveva viTardeba ukve daavadebis pirvel
dReebSi, saxezea kunTTa tonusis mkveTri daqveiTeba staturi da lokomotoruli
ataqsiis SerwymiT. bavSvebi ver ikaveben Tavs, ver jdebian, ver dgebian, ver dadian,
moZraoba uxerxulia, disimetriulia da Tan axlavs intensiuri tremori.
meningoencefealitis dros sisxlsa da cerebrul siTxeSi cvlilebebi igivea, rac
meningitis dros.
meningoencefalitis rig SemTxvevaSi, `sufTa~ meningitis TanatogenezSi mniSvnelovani
roli miekuTvneba tvinis SeSupebas, romelic gamowveulia neirotoqsikoziT, hemodinamikuri
da metaboluri darRvevebiT, agreTve imunoreaqtiulobis darRveviT (Vfxthtn K\ F\
da sxva, 1985).
meningokokemia - meningokokcemia, meningokokuri sefsisi, Cveulebriv, mimdinareobs
mZafrad intoqsikaciis mkveTri gamovlinebiT da meoradi metastazuri kerebis
ganviTarebiT. meningokokemia meningitis gareSe iSviaTia. meningokokuri infeqciis es
forma gvxvdeba yvela asakSi.
meningokokemia iwyeba temperaturis uecari momatebiT 39-400C-mde, xolo Semdeg
SeiZleba iyos mudmivi, intermisiuli, heqtiuri, talRiseburi xasiaTis. SesaZlebelia
daavadeba temperaturis momatebis gareSec mimdinareobs. infeqciur-toqsikuri Sokis
dros temperatura, Cveulebriv, subfebrilur, normalur donemde ecema, an adgili aqvs
hi poTermias.
278
hiperTermias erTvis Semcivneba, ganmeorebiT Rebineba, Tavis Zlieri tkivili. adreuli

asakis bavSvebisaTvis damaxasiaTebelia tirili gamkinavi xmiT. adgili aqvs gonebis
dakargvas, krunCxvebs. garda aRniSnulisa gamoxatulia intoqsikaciis sxva movlenebi -
madis daqveiTeba, zogadi sisuste, kunTebis tkivili, wyurvilis SegrZneba, piris Rrus
simSrale, sifermkrTale, qoSini, cianozi pirvelsave
6-12 saaTSi an ufro gvian. meore dRes mTel
tanze Cndeba gamonayari; igi gansakuTrebiT
gamoxatulia qveda kidurebze, dundulebze, barZayis
ukana da wvivebis zedapirze, quTuToebze, sklerebze,
iSviaTad saxeze. mZime formebis dros klasikuri
mimdinareobis SemTxvevaSi gamonayari, rogorc wesi,
hemoragiul xasiaTs atarebs, romelic SeiZleba
iyos sxvadasxva zomisa da formis _
wvrilwertilovani peteqiidan dawyebuli,
damTavrebuli msxvili sisxlCaqcevebiT. ufro
ti puria araswori formis `varskvlaviseburi~
gamonayari centraluri nekroziT, romelic kanis
meningokokcemia. sisxlCaqceva sklerebSi.
donidan wamoweulia da xelis SexebiT mkvrivi. (sakuTari masala)
hemoragiul gamonayars xSirad SeiZleba win
uZRodes rozeoluri an rozeolur-papuluri
elementebi. am SemTxvevaSi meningokokemiaze eWvis
mitana SesaZlebelia aRniSnul elementebs Soris
erTeuli hemoragiuli xasiaTis gamonayris
dadgenisas.
vinaidan meningokokemiis dros gamonayari
araerTdroulad viTardeba, erTidaigive avadmyofs
gansxvavebuli Seferilobis sxvadasxva elementebi
aReniSneba.
hemoragiuli gamonayris ukuganviTareba
damokidebulia kanis dazianebis sidideze.
rozeolur-papuluri elementebi, Cveulebriv meningokokcemia. mravlobiTi hemoragiuli
swrafad qreba da ar tovebs raime kvals, maSin, gamonayari Rrma nekroziT marjvena
rodesac mniSvnelovani sisxlCaqcevebi xSirad terfze. (sakuTari masala)
iwvevs nekrozebs mkvdari qsovilebis Semdgomi
mocilebiT, ris Sedegadac adgili aqvs xangrZlivad
mimdinare Sexorcebebs. mZime mimdinareobisas
SeiZleba ganviTardes TiTebis, terfis, yuris
bibilos, cxviris gangrena; SesaZlebelia, agreTve,
zemo da qvemo kidurebis gangrenac. meningokokemiis
dros SeiZleba aRiniSnos Tvalis sisxlZarRvebis
anTeba-iridocikliti. am SemTxvevaSi feradi garsi
Jangisebur elfers Rebulobs, viTardeba
koniunqtiviti. dazianeba, xSirad calmxrivia.
simZimis mixedviT arCeven meningokokemiis
msubuq, saSualo da mZime formebs.
msubuqi, abortuli f o r m i s d r o s
meningokokcemia. erTeuli hemoragiuli
meningealuri niSnebi sustadaa gamoxatuli, am gamonayari qvemo kidurebze. (sakuTari
SemTxvevaSi diagnozs wyvets liqvoris masala)
279
laboratoriuli monacemebi.
elviseburi meningokokemia
meningokokuri infeqciis yvelaze
rTuli formaa da umZimesi
prognoziT xasiaTdeba. am formas
xSirad uwodeben zemwvave
meningokokur sefsiss, fulminantur
meningokokemias, hemoragiul
adrenalits an uoterhaus-
frideriqsenis sindroms. misTvis
damaxasiaTebelia daavadebis
dawyebidan ramdenime saaTSi
meningokokcemia. mravlobiTi hemoragiuli gamonayari infeqciur-toqsikuri Sokis
ti pur
purii lokalizaciiT. (sakuTar
(sakuTarii masala)
ganviTareba, romelic
ganpirobebulia endotoqsinemiis
Sedegad sisxlZarRvTa
mikrocirkulaciis darRveviT.
klinikurad xasiaTdeba uecari
dawyebiT da mZafri mimdinareobiT,
SemcivnebiT, temperatura swrafad
matulobs 40-41 0C-mde, magram
ramdenime saaTSi SeiZleba
Seicvalos hi poTermiiT. aRiniSneba
progresirebadi qoSini, kani
fermkrTalia, magram
generalizebuli cianoziT
meningokokur
meningokokurii infeqcia. meningokokcemia ti pur
purii gamonayr iT. kidurebze, xolo Semdeg tanze
gamonayriT.
(sakuTari masala) viTardeba mowiTalo cianozuri
laqebi, romlebic sxeulis
mdebareobis Secvlis dros
ganicdian gadaadgilebas (cnobilia
`gvamuri laqebis~ saxelwodebiT
_ Livors mortalis). aRniSnul
movlenebs win uZRvis gulis wasvla,
motoruli agzneba, krunCxvebi,
Semdeg progresirebadi prostracia
da gonebis dakargva. toqsikozis,
gul-sisxlZarRvTa da sunTqvis
mwvave ukmarisobis Sedegad
meningokokcemia. Tirkmelzeda jirkvalSi sisxlCaqcevebi daavadeba SeiZleba garTuldes
uoterhau-frideriqsenis sindromis dros. tvinis SeSupebiT, misi Semdgomi
(Í.È. Íèñåâè÷, Â.Ô. Ó÷àéêèí) dislokaciiT (mogrZo tvinis
CaWedva), gansakuTrebiT terminalur
stadiaSi.
mkveTr cvlilebebs adgili aqvs sisxlis Semadedebeli sistemis mxriv. daavadebis
dasawyisSi aRiniSneba hi perkoagulaciis faza, Semdeg, Sokis intensivobis momatebisas,
viTardeba hi po - an afibrinogenemia, gamoxatulia Trombocitopenia.
meningokokemiis dros SeiZleba ganviTardes iseTi garTulebebi, rogoricaa plevriti,
280
pieliti, Tromboflebiti, RviZlis Cirqovani anTeba, endo-, mio- perikarditi. gulis

dazianebisas aRiniSneba qoSini, cianozi, gulis tonebis moyrueba, sazRvrebis gadideba.
Tirkmelebis mxriv SeiZleba ganviTardes kerovani glomerulonefriti, mwvave
ukmarisobis CaTvliT (Sokuri Tirkmeli).
meningokokemiis dros mcire asakis bavSvebSi 1-3%-Si SeiZleba ganviTardes saxsrebis,
upiratesad wvrili saxsrebis anTeba (poliarTritis saxiT). mtevnis dazianebisas
aRiniSneba misi gadaxra TiTebis gafarCxviT, aqtiuri moZraobis SezRudviT. sxva
saxsrebis dazianebisas avadmyofebi fexze ver dgebian. saxsrebis irgvliv aRiniSneba
kanis hiperemia da SeSupeba. avadmyofebis gamojanmrTelebis SemTxvevaSi xdeba dazianebuli
saxsrebis funqciis sruli aRdgena.
ise, rogorc meningitebis dros, periferiuli sisxlis suraTi xasiaTdeba
hi perleikocitoziT (30X109 - 40X109), neitrofiluri gadaxriT mielocitebis
CaTvliT, aneozinofiliiT, aCqarebuli eds, leikopenia prognozulad cud maCveneblad
iTvleba.
mimdinareoba. meningokokuri infeqcia etiotropuli mkurnalobis gareSe
mimdinareobs mZimed da xangrZlivad 4-6 kvira _ 2-3 Tve. daavadeba xasiaTdeba
talRiseburi mimdinareobiT (gaumjobeseba-gauaresebis suraTiT). amave dros, yvela
periodSi daavadeba SeiZleba sikvdiliT damTavrdes.
meningokokemiis, naklebad meningokokuri meningitis dros sikvdilis mizezi SeiZleba
iyos Tavis tvinis SeSupeba, rac ganpirobebulia lokaluri procesiT, aseve
neirotoqsikoziT, hemodinamikuri da metaboluri procesebis darRvevebiT.
Tavis tvinis SeSupebis pirvel simptomad iTvleba Tavis mkveTri tkivilebi,
ganmeorebiTi Rebineba. avadmyofi gabruebulia, dezorientirebulia garemoSi. aReniSneba
motoruli agzneba, Zilianoba, procesis progresirebisas avadmyofi kargavs gonebas,
viTardeba klonur-tonuri krunCxvebi. dasawyisSi gugebi Seviwroebulia, SemdegSi -
gafarToebuli. xSirad adgili aqvs anizikorias, gare sielmes, vertikalur nistagms.
kunTTa tonusi SeiZleba iyos momatebuli decerebraciuli rigidobis gamo. gamoxatulia
meningealuri simtomebi. iSviaTad viTardeba hiperTermia; Sardva, rogorc wesi Sekavebulia.
kefis did xvrelSi mogrZo tvinis CaWedvisas aRiniSneba iSviaTi pulsi, aritmia,
Cein-stoqsis sunTqva, xSirad hiperTermia, saxis hiperemia, cianozi, oflianoba. sikvdili
ganpirobebulia filtvebis SeSupebiTa da sunTqvis gaCerebiT. sikvdili SeiZleba
ganviTardes daavadebis pirvel saaTebSi, magram zogjer me-2-3 an SesaZlebelia me-5-7
dResac.
cerebruli hi potenziiT mimdinare meningiti warmoadgens iSviaT variants da
gvxvdeba, upiratesad, mcire asakis bavSvebSi. daavadeba mimdinareobs mkveTri toqsikoziT
da eqsikoziT, swrafad viTardeba gaSeSeba, SesaZlebelia krunCxvebi, meningealuri niSnebi
gamoxatuli ar aris, rac aZnelebs diagnostikas. qalasSida wneva mkveTrad ecema,
mcirdeba parkuWebSi siTxis raodenoba, viTardeba ventrikuluri kolafsi, ZuZuTa
asakis bavSvebs yiflibandi Cavardnili aqvT. SedarebiT mozrdilebsa da ufrosi
asakis bavSvebs aReniSnebaT gauwyloebis sxva simptomebi, rogoricaa Tav-zurgtvinis
siTxis dabali wneva lumbaluri punqciis dros. meningitis dros cerebruli wnevis
dacemisas SeiZleba ganviTardes ukiduresad mZime garTuleba - subaraqnoiduli he-
matoma.
meningiti ependimatitiT (ventrikuliti) amJamad iSviaTi SemTxvevaa, romelic
viTardeba dagvianebuli an araadekvaturi mkurnalobis dros. gansakuTrebuli simZime
ganpirobebulia anTebis gavrcelebiT parkuWTa garsebze (ependimaze) agreTve Tavis
tvinis procesSi CarTviT, subependimuri encefalitiT.
diagnozi. meningokokuri infeqciis diagnostika eyrdnoba kompleqsur klinikur-
281
laboratoriul da epidemiologiur monacemebs. meningitisa da meningokokemiisaTvis

damaxasiaTebeli simptomatikis swrafi ganviTarebis gamo klinikurad maTi diagnostika
SesaZlebelia daavadebis pirvelsave dReebSi da saaTebSi. meningokokemiis dros optimalur
sadiagnostiko drod iTvleba daavadebis dawyebidan 12 saaTi, rac etiotropuli da
paTogenezuri mkurnalobis sruli efeqturobis sawindaria, sruli gamojanmrTelebis
miRweviT. meningokokuri meningitis, meningokokemiis meningitiT mimdinareobisas,
diagnostikaSi gadamwyveti roli eniWeba lumbalur punqcias, liqvoris laboratoriul
gamokvlevebs. am dros neitrofilebSi xSirad aRiniSneba intracelulurad ganlagebuli
gramuaryofiTi diplokokebi (meningokokebi), xolo iseTi bioqimiuri monacemebi, rogoricaa
ujredul-cilovani disociacia, globulinuri fraqciebi, mkveTrad dadebiTi none-
apeltis, pandi-s reaqciebi, Saqrisa da qloridebis daqveiTeba, adasturebs maT Cirqovan
bunebas.
saWiroa, agreTve, liqvoris, sisxlis, gamonayridan, xaxidan aRebuli nacxis mikroskopuli
da baqteriologiuri gamokvleva. saWiroa xazi gaesvas imas, rom uaryofiTi Sedegebi
araviTar SemTxvevaSi ar gamoricxaven meningokokur infeqcias, Tu daavadeba klinikurad
tipur formebSi mimdinareobs. epidemiuri afeTqebis dros SesaZlebelia, agreTve, msubuqi
formis meningitis dadgenac.
serologiuri gamokvlevebidan gamoiyeneba daavadebis dinamikaSi specifikuri
antisxeulebis dadgena imunofermentuli, lateqs-aglutinaciis, pasiuri hemaglutinaciis,
Semxvedri imunoeleqtroforezis, radioimunuri reaqciebiT. bolo dros cdiloben
polimerazuli jaWvuri reaqciis danergvas.
diagnostika, garda tuberkulozuri meningitisa, tardeba sxvadasxva
baqteriologiuri floriT gamowveul meningitebTan (pnevmokokuri, hemofiluri,
stafilokokuri, streptokokuri, sokovani xasiaTis).
meningokokemiis dros arsebuli peteqiuri gamonayari msgavsia nebismieri hemoragiuli
vaskulitis dros arsebuli gamonayrisa (gramdadebiTi da gramuaryofiTi baqteriebiT
gamowveuli sefsisi, ECHO-virusebis 6, 9, 16 serovarebiT, A2, A4, 9, da A16 koqsakis
ti pis virusebiT gamowveuli infeqcia, Sonlain-henoxis sindromi, kavasakis daavadeba
da sxva).
diferenciuli diagnostikis gatarebis aucilebloba iqmneba wiTelas, qunTruSas,
iersiniozis, mZimed mimdinare gri pis, Trombocitopeniuri purpurisa da sxva
SemTxvevebTan.
wiTelas dros gamoxatulia kataruli movlenebi - koniunqtiviti, skleriti,
xvela, enanTema, filatov-koplikis laqebi, kanze gamonayari Cndeba etapurad da papulur-
laqovania. sisxlSi aRiniSneba leikopenia, limfocitozi.
qunTruSa xasiaTdeba nuSurebis mkveTrad gamoxatuli hi peremiiT, kanze gamonayari
wvrilwertilovania, kanis bunebriv nakecebSi damaxasiaTebelia gamonayris gajereba
muq ferebSi.
iersiniozis dros gamonayari umTavresad saxsrebis irgvlivaa ganlagebuli. vlindeba
`kapiuSonis~, `xelTaTmanis~, `windebis~ simptomebi.
Trombocitopeniuri purpuris dros gamonayari warmodgenilia ufro advilad
travmirebad adgilebSi, temperaturis momateba damaxasiaTebeli ar aris. periferiul
sisxlSi adgili aqvs Trombocitebis raodenobis daqveiTebas.
gr
grii pis toqsikuri formis dros, romelsac Tan axlavs meningealuri da encefaluri
movlenebi, gadamwyveti mniSvneloba eniWeba liqvoris cvlilebebs. aseT SemTxvevaSi
Tav-zurgtvinis siTxe normaluria.
rac Seexeba tuberkulozur meningits, igi gansxvavdeba daavadebis TandaTanobiTi
dasawyisiT da meningealuri movlenebis gaZlierebiT daavadebis SedarebiT mogvianebiT
282
periodSi, Tumca Cvil bavSvebSi meningealuri movlenebi ufro zogadi infeqciur-

intoqsikaciuri simptomebiT da meningealur simptomTa eqvivalentebiT xasiaTdeba.
sabolood, yvela SemTxvevaSi, meningitis etiologiis dadgena SesaZlebelia liqvoris
bioqimiuri baqteriologiuri, serologiuri gamokvlevebis Sedegad.
Henoch-Schönlein-- is Rocky Mountain Spotted fever-- kldovani mTebis

purpura (anafilaqtoiduri laqovani cxeleba, gamowveuli Rickettsia -Ti.
Ti.
purpura). (Debra Karp Skopicki)
(Korting GW)
mkurnaloba. g e n e r a l i z e b u l i
meningokokuri infeqciiT daavadebuli yvela
avadmyofi eqvemdebareba hospitalizacias
specializebul ganyofilebebsa da
sadiagnostiko boqsebSi. nazofaringitiT
daavadebulebs mkurnaloba SeiZleba
Cautardes saxlis pirobebSi.
antibiotikTerapia tardeba saSualo toqsikomania. mZime mowamvla narkotikuli
dozebiT, romlis xangrZlivoba 2 dRes balaxis mowevis Sedegad. sisxlCaqcevebi
Seadgens (rifampicini, mozrdilebSi - sklerebSi Rebinebis dros. (sakuTari masala)
ci profloqsacinic) gamoiyeneba agreTve sulfanilamidebi.
meningokokuri infeqciis generalizebuli formebis dros mkurnaloba unda
iyos etiotropuli, paTogenezuri da kompleqsuri klinikuri formebis, simZimis,
garTulebebisa da premorbiduli fonis gaTvaliswinebiT. asarCev etiotropul
preparatebad iTvleba penicilini da qloramfenikoli. gamoiyeneba agreTve cefotaqsimi
(cefazolini) da ceftriaqsini (rocefini).
benzilpenicilinis natriumis an kaliumis marili iniSneba venaSi 200 000-400
000 _ 500,000 erT/kg sxeulis masaze sadReRemiso doziT 4 saaTis intervaliT
Tanabar dozebSi SeyvaniT. intervalis gaxangrZlivebisas antibiotikis koncentracia
sisxlSi da liqvorSi ecema, ramac SeiZleba daavadebis gamwvaveba gamoiwvios. peniciliniT
mkurnalobis xangrZlivoba Seadgens 5-8 dRes, zogjer mets.
meningitis Sorswasul SemTxvevebSi (ugono mdgomareoba, agreTve ependimatiti -
ventrikuliti) penicilinis doza izrdeba 800 000 erT/kg sxeulis masaze. Tumca
zogierTi avtoris monacemebiT 500.000 erT/kg-ze meti doza ar iwvevs ufro karg
klinikur efeqts. am dros venaSi SehyavT mxolod benzilpenicilinis natriumis da
283
ara kaliumis marili hi perkaliemiis Tavidan acilebis mizniT. penicilinis

endolumbaluri Seyvana ar aris rekomendebuli.
maRali efeqturobiT xasiaTdebian agreTve penicilinis naxevradsinTezuri preparatebi
- ampicilini, oqsacilini. gansakuTrebiT saimedo da asarCev `sastarto~ preparatad
Cirqovani meningitis diagnozis dadgenamde SeiZleba CaiTvalos ampicilini, romelic
eniSnebaT 200-300 mg/kg sxeulis masaze gayofili Tanabar dozebad, 6 saaTis intervaliT
venaSi SeyvaniT.
elviseburi meningokokemiis da mZime meningitis (meningoencefalitis) SokiT
mimdinareobisas ki asarCev preparatad iTvleba qloramfenikoli (levomicetinis
suqcinati), romelic avadmyofebs eniSnebaT 100 mg/kg dRe-RameSi Tanabari dozebiT, 6
saaTis intervaliT venaSi. dadgenilia, rom qloramfenikoli 2-3-jer ufro iSviaTad
iZleva iariS-herqsheimeris (Jarisch-Herxheimer) fenomens - Terapiul Soks meningokokebis
masiuri daSlis Sedegad, vidre amas adgili aqvs peniciliniT mkurnalobis dros. amave
dros unda aRiniSnos, rom Sokidan gamosvlis Semdeg saWiroa baqteriastatuli moqmedebis
qloramfenikoli Seicvalos baqteriaciduli moqmedebis peniciliniT.
antibiotikebis dozis Semcireba mkurnalobis periodSi ar SeiZleba. mkurnalobis
xangrZlivoba saSualod 7 dRiT ganisazRvreba.
Terapiuli RonisZiebebis sistemaSi gansakuTrebuli mniSvneloba aqvs paTogenezur
mkurnalobas, romelic etiotropul TerapiasTan erTad mimarTulia toqsikozis winaaRmdeg,
sasicocxlo mniSvnelobis funqciebis aRsadgenad nivTierebaTa cvlis normalizaciisaken.
am mizniT etiotropuli Terapiis fonze avadmyofebs eZlevaT siTxis optimaluri
raodenoba eleqtrolituri xsnarebis CaTvliT, asakobrivi moTxovnilebis, perspiraciis,
momatebuli temperaturis gaTvaliswinebiT. siTxeebi eniSnebaT rogorc per os, aseve
venaSi. intravenurad eniSnebaT reopoliglukini, albumini, glukozis 5-10%-iani xsnari,
ringeris laqtati.
Zlier mZime meningokokuri infeqciis dros zogjer 2-3 dRis ganmavlobaSi eniSnebaT
kortikosteroidebi - prednizoloni 5-10 mg/kg sxeulis masaze, deqsametazoni. kveba,
Tu saWiroa, parenterulad an zondiT mimdinareobs.
hemodinamikisa (wneva) da organoebis sisxlis mimoqcevis stabilizaciis mizniT
venaSi SeiZleba Seyvanili iqnas seleqtiuri moqmedebis preparati dopamini 2-dan 15
mg/kg sxeulis masaze 1 wuTSi ( preparatis swrafi Seyvana akrZalulia gverdiTi
movlenebis gamo).
metaboluri acidozis koreqciisaTvis iyeneben 4% sodis xsnars an natiriumis
acetats. metaboluri alkalozis SemTxvevaSi naCvenebia askorbinis mJava.
mwvave meningokokuri sefsisis dros gamarTlebulia heparinis daniSvna sisxlZarRvTa
Sida Sededebis sindromis aRsakveTad dozebSi 150-200 erT/kg sxeulis masaze venaSi
(asakis gaTvaliswinebiT) 4-6 da met gakeTebaze, heparinis daniSvna umjobesia krioplazmis
fonze. gamoiyeneba gordoqsi, kontrikali, trasiloli, romlebic fibrinolizis
aqtivatorebs warmoadgenen. avadmyofis zogadi mdgomareobis gauaresebis SemTxvevaSi
heparinrezistentuli SemTxvevebis dros rekomendebulia antiTrombin III -is
koncentratis venaSi Seyvana.
hi perhidrataciis profilaqtikisa da tvinis SeSupebis dros gamoiyeneba Sardmdeni
saSualebebi laziqsi 3-5 mg/kg sxeulis masaze, manitoli 10-15 %_ 0,5-1 g/kg mSrali
nivTierebisa sxeulis masaze.
krunCxvebis SemTxvevaSi eniSnebaT diazepami 20-40 mg dRe - RameSi, natriumis
oqsibutirati 70-120 mg/kg sxeulis masaze erT Seyvanaze 4-6 saaTis intervaliT,
ganmeorebiTi saWiroebis SemTxvevaSi iniSneba agreTve fenobarbitali, qloralhidrati
oyniT da sxva.
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Tirkmelebis mwvave ukmarisobis dros avadmyofebi gadahyavT hemodializze, sunTqvis

ukmarisobisas, tvinis SeSupebisa da Sokis dros naCvenebia - oqsigenoTerapia, hiperbaruli
oqsigenacia, xelovnuri sunTqvis aparatze gadayvana.
gulis mwvave ukmarisobis dros eniSnebaT digoqsini gamajerebel dozebSi.
uoterhauz-frideriqsenis sindromis dros, garda kortikosteroidebisa da dopaminisa
gamarTlebulia venaSi epinefrinis (0,1%-iani 0,1-0,2 ml) Seyvana.
prognozi. antibiotikebis eramde letaloba 60-70%-s Seadgenda, amJamad kompleqsuri
prognozi
mkurnalobis Sedegad ufro keTilsaimedo mimdinareoba miiRo, magram saSualod 12%-
s aRwevs.
meningitis gadatanis Semdeg xSiria asTeniuri sindromi. 3%-Si SeiZleba adgili
hqondes siyrues. iSviaTad SeiZleba aRiniSnebodes parezebi da damblebi. hidrocefalias
adgili aqvs dagvianebuli mkurnalobis SemTxvevebSi.
profilaqtika meningokokuri infeqciiT daavadebuli, (msubuqi nazofaringitis
garda), saswrafod unda iqnas hospitalizebuli. daavadebis yvela SemTxveva saswrafod
unda ecnobos sanepidsamsaxurs. koleqtivSi, sadac aRiniSneba SemTxveva, 10 dRis
ganmavlobaSi ar miiReba axali wevri da akrZalulia bavSvebis gadayvana erTi jgufidan
meoreSi. kontaqtirebul pirebs utardebaT baqteriologiuri gamokvleva orjeradi, 3-
7 dRis intervaliT. riskis jgufs ekuTvnian baRis bavSvebi, skolis moswavleebi da
a.S. aRniSnul koleqtivebSi daavadebis SesaZlebloba 300-jer metia, vidre araorganizebul
bavSvebSi.
generalizebuli meningokokuri infeqciis gadatanis Semdeg rekonvalescentis gawera
binaze xdeba cxvir-xaxidan aRebuli nacxis orjeradi uaryofiTi baqteriologiuri
gamokvlevis Semdeg, romelic xorcieldeba antibiotikis Sewyvetidan araugvianes 3
dRisa. nazofaringitis dros aseve antibiotikoTerapiis 3 dRis mere keTdeba gamokvleva,
mxolod erTjeradad.
asarCev profilaqtikur preparatad iTvleba rifampicini - 10mg/kg sxeulis masaze,
maqsimum 600 mg yovel 12 saaTSi, sul 2 dRe.
profilaqtikis mizniT rekomendebulia gamoyenebul iqnas ceftriaqsoni - 125 mg
erTjer 12 wlamde, 250 mg 12 wlis da meti asakis bavSvebSi. meningokokebis mtareblobis
dros aRniSnuli preparati ufro efeqturia, vidre oraluri rifampiciniT profilaqtika,
magram rutinulad misi micema ar SeiZleba, vinaidan efeqturia mxolod seroti p A-Ti
gamowveuli mtareblobis dros. gamoiyeneba, agreTve, preparatebi: benzilpenicilini,
qloramfenikoli da sxva. mniSvnelovan profilaqtikur RonisZiebad iTvleba saerTo
higienuri reJimis dacva.
amJamad SemuSavebulia ramdenime vaqcina, saxeldobr, kvadrivalenturi polisaqariduli
vaqcinebi A, C, Y, W-135
-135 2 wlidan da ufro mozrdilebSi. 24 Tvemde C vaqcina imunogenobiT
ar xasiaTdeba. B jgufebis meningokokebisaTvis vaqcina SemuSavebuli jer ar aris -
igi cudi imunogenobiT xasiaTdeba. Tu bavSvi 4 wlamde iyo vaqcinirebuli, sisxlSi
antisxeulebis ricxvi momdevno 3 wlis ganmavlobaSi mkveTrad iklebs. amitom Tu
didia dasnebovnebis riski, C jgufis sawinaaRmdego imunizaciis Catareba SeiZleba
vaqcinaciidan 1 wlis mere.
Tu vaqcinacia 5 wlis asakis merea Catarebuli, revaqcinacia tardeba 5 wlis
Semdeg.
mozrdilTa revaqcinacia 5 welze adre saWiro ar aris.
A jgufis meningokokur vaqcinas kargi imunuri Tvisebebi aqvs me-3 Tvis asakidan.
18 Tveze mcire asakis bavSvebs epidemiuri saSiSroebisas eZlevaT vaqcinis 2 doza 3
Tvis intervaliT.
285
kerZo nawili. hemofiluri infeqcia
hemofiluri infeqcia
(HAEMOPHILUS INFLUENZAE)
hemofiluri infeqcia warmoadgens mwvave infeqciur daavadebas, romelic gamowveulia

influenciis CxirebiT da mimdinareobs sunTqvis organoebis, centraluri nervuli
sistemis dazianebiTa da Cirqovani kerebis ganviTarebiT sxvadasxva organoebSi.
etiologia. hemofiluri infeqciis gamomwvevia Haemophilus influenzae
etiologia
(pfeiferis Cxiri), romelic 1892w. gamoyo pfeiferma sakveb niadagze hemoglobinis
damatebiT, rasTanac dakavSirebulia misi saxelwodeba (Haemophilus berZnuli sityvaa
da haima niSnavs sisxls, xolo philos _ mosiyvarules).
mikrobebi patara, gramuaryofiTi, polimorfuli Cxirebi an kokobacilebia, zomiT
0,2 - 0,3 X 0,5 - 2 mkm, uZravia, sporebs ar warmoSobs. gamoirCevian sakvebi niadagis
mimarT gansakuTrebuli moTxovniT _ zrdisTvis saWiroeben eriTrocitebSi Semcvel
Termolabilur V faqtors (fosfoli pidinis nukleotidi) da X faqtors
(Termostabiluri hematini). kulturaluri TvisebebiT ( indolis produqcia, uralazis
aqtivoba da sxva) iyofa 7 biotipad (I-dan _ VII-mde). lorwovani garsebidan gamoyofili
Cxirebis nawils aReniSneba kafsula, romlis antigenebi polisaqariduli xsnadi
substanciis gansxvavebiT klasificirdebian a-dan f-mde (a, b, c, d, e, f). wamyvani roli
paTologiuri procesis ganviTarebaSi ekuTvnis b ti pis mikrobebs. arakafsulirebadi
Cxirebi (arati pirebadi) warmoadgenen mniSvnelovan etiologiur faqtors zemo sasunTqi
gzebis, sinusitebis, Sua yuris qronikuli anTebis gamowvevaSi.
epidemiologia. infeqciis wyaros warmoadgens mxolod adamiani, manifesturi an
epidemiologia
waSlili formiT, an janmrTeli mtarebeli. gadacemis meqanizmi haer-wveTovania, xolo
gadacemis faqtorebad iTvlebian inficirebuli saTamaSoebi, tansacmeli da sxva. miuxedavad
imisa, rom influenciis Cxirebi miekuTvnebian pirobiTpaTogenur mikrobebs, maTi endemuri
kerebis arsebobis garda SeiZleba, adgili hqondes epidafeTqebebs mcire asakis bavSvebSi,
samSobiaro saxlebSi, qronikuli avadmyofebisaTvis gankuTvnil ganyofilebebSi da
avadmyofebSi, romelTac mkurnaloba CautardaT citostatikebiTa da kortikosteroidebiT.
kontagiozuri indeqsi damokidebulia asakze; wlamde asakSi igi Seadgens 3-5%, 5
wlamde 1-2%-s. daavadebas ufro xSirad adgili aqvs zamTris bolosa da gazafxulis
TveebSi. H.influenzae-s b ti pis mikrobis kolonizacia aucrel bavSvebSi 2-5%-s
Seadgens; igi 3 Tvidan 3 wlis bavSvebSi baqteriuli meningitis wamyvani mizezia. Hib
(Haemofilus influenzae b ti pis) - koniugirebuli vaqcinis gamoyenebis Sedegad (im
qveynebSi, sadac es vaqcina xelmisawvdomia) baqteriuli epiglotitis da baqteriuli
meningitis ricxvma iklo.
paTogenezi. infeqciis SeWris adgilia zemo sasunTqi gzebis lorwovani garsebi,
sadac infeqcia xangrZlivad da usimptomod (latenturad) SeiZleba persistirebdes.
daavadebis manifesturi formebis ganviTarebaSi didi mniSvneloba eniWeba bavSvis
adreul asaksa da organizmis imunur statuss. mniSvnelovania, agreTve, gamomwvevi
agentis virulentoba da misi epidemiuri klonuri ganwyoba, agreTve sxvadasxva
mikroorganizmebis arseboba, rac xels uwyobs miqst-infeqciis formirebas.
influenciis Cxirebi xasiaTdebian rogorc ujredSida, aseve ujredgare
lokalizaciiT. daavadeba SeiZleba ganviTardes endogenuri gziT, romlis paTogenezSi
gadamwyveti mniSvneloba eniWeba ujreduli da humoruli imunitetis Zlier daqveiTebas
da am SemTxvevaSi, Cveulebriv, warmoadgens mwvave respiraciul virusuli infeqciis an
meoradi baqteriuli infeqciis garTulebas. egzogenuri inficirebisas H. influenzae
SeiWreba lorwovani garsebidan, sadac viTardeba anTebiTi procesi anginis, pnevmoniis
286
an ufro generalizebuli paTologiebis, meningitis, epiglotitisa da sefsisis saxiT.

aseTi mimdinareoba, rogorc wesi, gamowveulia b tipis influenciis CxirebiT, romelTac
gaaCniaT fagocitozis Zlieri daTrgunvis unari. dadgenilia, rom b tipis polisaqariduli
antigenebis mimarT antisxeulebi did rols TamaSoben makroorganizmis damcvelobiT
reaqciebSi. Hib-kafsuluri polisaqaridis (poliribozilribotolfosfati) mimarT
warmoSobili antisxeulebi monawileobas Rebuloben Sratis ofsonizaciis aqtivaciaSi,
maTi titri 2 wlamde TiTqmis ar aRiniSneba, xolo 12 wlamde dabalia. did rols
TamaSoben komplementis klasikuri da alternatiuli aqtivobis gzebi. mniSvnelovania
agreTve, retikulur-endoTeliuri sistemis makrofagebis roli H. influenzae-s
eliminaciis procesSi. 2,4 da 6 (an 2 da 4) Tvis asakSi Hib-koniugirebuli vaqciniT
Catarebuli imunizacia mniSvnelovnad zrdis Hib-is mimarT imunitets.
klinika. inkubaciuri periodis xangrZlivobis dadgena gaZnelebulia, rac xSirad
klinika
dakavSirebulia infeqciis latenturi formis manifesturSi gadasvlasTan.
procesis lokalizaciis mixedviT arCeven Semdeg klinikur formebs: pnevmonias,
meningits, otits, epiglotits, osteomielits, celulits, empiemas, Cirqovan perikardits,
endokardits, koniunqtivits, epididimo-orqits, glosits, sefsisur Tromboflebits da
sxva. axalSobilebSi xSirad vlindeba septicemiis saxiT, koniunqtivitiT, Cirqovani
arTritiTa da sxva. daavadeba mimdinareobs mwvaved, Tumca, SesaZlebelia, gaxangrZlivebuli
formebic Segvxvdes.
zogi avtoris monacemebiT 3-4 wlamde asakis bavSvebSi Cirqovani meningitis xSiri
mizezia H. influenzae-s b ti pi. klinikurad Cirqovani meningiti ar gamoirCeva
meningokokuri, pnevmokokuri an sxva etiologiis baqteriuli meningitebisagan. am
SemTxvevaSi didi mniSvneloba aqvs baqteriologiur gamokvlevebs. mag: Tav-zurgtvinis
siTxidan H. influenzae-s gamoyofas. daavadeba iwyeba mwvaved, zogjer mwvave
respiraciuli daavadebis simptomatikiT, Semdgom ki swrafad viTardeba mwvave baqteriuli
meningitisaTvis damaxasiaTebeli meningealuri sindromi an maTi eqvivalentebi,
gansakuTrebiT, axalSobilebSi (didi yiflibandis daWimuloba, amoburcva, pulsacia)
mkveTrad gamoxatuli saerTo intoqsikaciiT. daavadeba, rogorc wesi, xasiaTdeba mZime
mimdinareobiT da araiSviaTia letaluri gamosavalic. aqve davZenT, rom hemofiluri
meningiti xSirad Serwymulia sxva klinikur gamovlinebebTan, rogoricaa Cirqovani
arTriti, mwvave epiglotiti, celuliti da sxva. gamojanmrTelebis SemTxvevaSi, xSiria
mniSvnelovani narCeni movlenebi, damblebis, krunCxviTi sindromis, inteleqtis darRvevis,
smenis daqveiTebis, metyvelebis dakargvisa da sxvaTa saxiT. Tumca H. influenzae-Ti
gamowveuli pnevmoniis sixSire zustad ar aris dadgenili, magram 4 wlamde asakis
bavSvebSi daavadeba xSirad maT mieraa ganpirobebuli. hemofiluri pnevmoniis klinika
xasiaTdeba sxva baqteriuli pnevmoniebis msgavsi klinikuri suraTiT.
periferiul sisxlSi am SemTxvevaSi ufro maRali leikocitozi da neitrofilozia
mosalodneli, Tumca vrceli pnevmoniuri kerebis arsebobisas, SesaZlebelia normaluri
an zomieri neitrofiluri leikocitozi.
mwvave epiglotiti (xorxsarqvelis mwvave anTeba) hemofiluri infeqciis erT-
erTi umZimesi gamovlinebaa da gvxvdeba ufro xSirad 2-dan 7-wlamde asakis bavSvebSi.
igi, rogorc wesi, mimdinareobs baqteriemiiT (90%-Si). damaxasiaTebelia daavadebis
dawyeba mwvaved, stridoriT, maRali temperaturiT, yelis mkveTri tkiviliT, ylapvis
gaZnelebiT an misi SeuZleblobiT, zogjer afoniiT, adgili aqvs mZime intoqsikaciis
movlenebs (t 39-400C), kanis mkveTr sifermkrTales, qoSins, rac ganpirobebulia
xorxsarqvelis mwvave SeSupebiT. mcire asakis bavSvebisTvis am dros damaxasiaTebelia
Tavis ukan gadaqindvra raime meningealuri movlenis gareSe. ufro mozrdilebSi enis
fuZeze SpateliT daWerisas SeiZleba inaxos mkveTrad SeSupebuli muqi-alublisferi
287
xorxsarqveli, xolo laringoskopiT naxuloben lorwqveSa sivrcis SeSupebasac (es

mani pulaciebi saWiroa xdebodes samani pulacio oTaxSi, sadac SesaZlebelia intubaciis
gakeTeba narkozis fonze); krupis sindromis swrafi progresirebis Sedegad SeiZleba
ganviTardes asfiqsia da letaluri gamosavali, rac saWiroebs swraf intubacias an
traqeostomias. rentgenologiuri monacemebiT epiglotitis dros SesaZlebelia
xorxsarqvlis qvemoT pirdapir proeqciaSi konusiseburi Seviwroebis, xolo gverdiTi
proeqciiT ki SeSupebuli gadidebuli xorxsarqvelis naxva.
H. influenzae-Ti gamowveuli hemofiluri sefsisisadmi ganwyoba, xSiria 6-12
Tvis asakSi. daavadeba Rebulobs mZafr mimdinareobas, araiSviaTad elviseburi Sokis
ganviTarebiT, raime meoradi floris gareSe da xSirad mTavrdeba sikvdiliT.
axalSobilebSi xSiria septicemia, pnevmonia, respiraciuli distresi, SokiT mimdinare
Cirqovani meningiti, kanis vezikuluri dazianeba da sxva, rac SeiZleba gamowveuli
iyos H. influenzae-s arati pirebadi StamebiTac.
panikuliti (celuliti-cximovani qsovilis anTeba) xSiri formaa wlamde asakis
bavSvebSi. klinikurad xasiaTdeba lurji, wiTeli an iisferi mkvrivi mtkivneuli
ubnebiT, diametriT 1-dan 10sm-mde, rogorc wesi, igi lokalizdeba Tavis, kisris, loyebisa
da Tvalis axlos. anTebadi ubnebis sazRvrebi mkafiod ar aris gamoxatuli. zemoaRniSnuli
ferebi ar warmoadgenen raime specifikurs b ti pis influencas CxirebiT gamowveuli
infeqciisaTvis. loyaze panikulitis dros, araiSviaTad, infeqciis pirvel kerad gvevlineba
Sua yuris anTeba, (infeqciis gavrceleba xdeba limfogenuri gziT), erTdroulad
SeiZleba gamoxatuli iyos meningiti an Cirqovani arTriti da sxva.
gamomwvevi agenti SeiZleba gamoyofil iqnas kanis anTebadi kerebis aspiratidan,
romelsac win uZRvis 0,1 ml fiziologiuri xsnaris Seyvana.
Cirqovani arTriti vlindeba menj-barZayis, muxlis, mxrisa da sxva msxvili
saxsrebis dazianebiT da ar gansxvavdeba sxva etiologiuri faqtoriT ganpirobebuli
arTritisagan.
osteomieliti. upiratesad ziandeba msxvili lulovani Zvlebi _ barZayis, didi
wvivis, mxris Zvali da sxva. klinikuri suraTi sxva etiologiuri faqtoriT
ganpirobebuli dazianebis identuria.
endo- da per ikarditi. H. influenzae-s b ti piT gamowveuli peri- da
ikarditi
perikarditi
endokarditebi yvela endokarditis 15%-s Seadgenen; igi gvxvdeba 2-dan 4 wlamde
asakis bavSvebSi. klinikuri suraTi ar xasiaTdeba raime gansxvavebebiT sxva etiologiis
perikarditebTan SedarebiT. perikarditebis ganviTarebas xSirad win uZRvis zemo
sasunTqi gzebis dazianeba; perikardiuli eqsudatiT an sisxliT SesaZlebelia daavadebis
baqteriuli bunebis dadastureba.
mkurnaloba. kompleqsur mkurnalobaSi wamyvani roli ukavia antibiotikebis
adreul gamoyenebas, maT Soris, mZime formebis dros, ampicilinis da qloramfenikolis
kombinacias, TumcaRa bolo dros adgili aqvs ampicilinis mimarT rezistentuli
Stamebis warmoSobasac.
ampicilini SehyavT 200-400 mg/kg sxeulis masaze, bavSvebs da mozrdilebs eniSnebaT
venaSi igive doziT. qloramfenikoli 100 mg/kg. ukanasknel xans naCvenebia iseTi
preparatebi, rogoricaa ceftriaqsoni (rocefini _ cefalosporinebis jgufi) doziT
50-100 mg/kg-ze, 24sT-Si erTxel, venaSi an kunTSi, agreTve imi penemi (tienamicinebis
jgufi) da sxv. antibiotikogramis dadgenis SemTxvevaSi tardeba saTanado etiotropuli
mkurnaloba. mkurnalobis kursi ganisazRvreba klinikuri efeqtiT da saSualod Seadgens
2-3 kviras. droze adre mkurnalobis Sewyvetam, SeiZleba, gamoiwvios recidivi (saxeldobr
meningitis dros da sxva).
msubuqi formebis mkurnalobaSi SeiZleba gamoyenebul iqnas eriTromicini,
288
(trimetoprim-sulfametoqsazoli) biseptoli 10-14 dRe. didi mniSvneloba aqvs

organizmis saerTo reaqtiulobis gaZlierebas, simptomur Terapias. gansakuTrebiT
mniSvnelovania Cirqovani kerebis gaxsna, drenireba da a.S..
epiglotitis mkurnalobaSi Tavidanve saWiroa krupis sindromis mkurnalobis
swori taqtikis arCeva: Tu krupi Tavidan eWvs ar badebs epiglotitis arsebobaSi, an
im SemTxvevaSi, rodesac misi mkurnaloba ar eqvemdebareba epinefrinis inhalaciebs (ix.
krupis mkurnaloba `gri pSi~), saWiroa diagnozis gadaxedva da mkurnalobis warmarTva
epiglotitis Sesabamisad. narkozis qveS intubaciis gakeTeba, manamde ki mani pulaciebis
maqsimaluri SezRudva (ineqciebi, yelis gasinjva da a.S.), mSoblis yofna bavSvTan da
mkurnalobaSi CarTva, sanam gakeTdeba intravenuri narkozi (niRbis narkozs bavSvis
zedmeti agznebis Tavidan acilebis gamo aZlevs mSobeli). Semdeg saWiroa antibiotikebis
(III Taobis cefalosporinebiT an ampicilinis sulbaqtamiT) 7 dRiani kursis Catareba.
profilaqtika da RonisZiebebi daavadebis keraSi. zogierTi avtori Tvlis,
rom b ti pis influenciis Cxirebis mtareblebs da riskis jgufebs hemofiluri
infeqciiT daavadebulTan kontaqtisas saWiroa, CautardeT rifampicinis 4 dRiani
kursi. amave dros, mcire asakis bavSvebSi farTo masStabiT aseTi midgoma, albaT,
mizanSewonili ar aris.
H. influenzae-s
-s b ti pis aqtiuri imunizacia SesaZlebelia polisaqariduli
koniugirebuli vaqciniT, igi aqtiurad gamoiyeneba zogierT qveyanaSi, magram misi
efeqturoba dabalia wlamde asakis bavSvebSi. amJamad mcire asakis bavSvebSi gadamwyveti
mniSvneloba eniWeba araspecifikuri profilaqtikis iseT meTodebs, rogoricaa
axalSobilis izolacia, adreuli asakis bavSvebis gancalkeveba, kanis higienuri movla,
saerTo reaqtiulobis aweva da mastimulirebeli Terapia.
289
kerZo nawili.
streptokokuri infeqciebi. GAS ,GBS
streptokokuri infeqcia
streptokokur infeqciaSi anu streptokokozSi (D\ L\ <tkzrjd) igulisxmeba

farTo speqtris klinikuri gamovlinebani, romlis etiologiur momentad iTvleba
streptokoki, gansakuTrebiT A jgufis β-hemolizuri streptokoki. klinikuri suraTi
moicavs formebs kanis, kanqveSa qsovilebis msubuqi dazianebidan dawyebuli, mZime
generalizebuli mimdinareobiT _ septicemiiT, septikopiemiiT damTavrebuli.
streptokokur infeqcias agreTve miekuTvneba qunTruSa, wiTeli qari, revmatizmi,
mwvave glomerulonefriti, osteomieliti. yvela aRniSnuli klinikuri forma xasiaTdeba
ara marto saerTo etiologiuri, aramed epidemiologiuri, paTogenezuri da
morfologiuri monacemebiTac.
etiologia. streptokoki formiT sferosebri an ovaluri kokia, zomiT 0,5-1 mkm,
etiologia
qmnian sxvadasxva zomis jaWvebs, gramdadebiTi fakultaturi anaerobia, aqvs kafsula,
romelic ZiriTadad hialuronis mJavisagan Sedgeba; zrdis optimaluri temperaturaa
370 C-i. amJamad cnobilia 21 serologiuri jgufi, romlebic aRiniSneba laTinuri
anbanis didi asoebiT (A, B, C, D da a.S), romelTagan bevri aRmoCenilia cxovelebSi.
hemolizis unaris mixedviT arCeven sam jgufs _ β (sruli hemolizi), µα α (nawilobrivi
hemolizi) da γ (hemolizis gareSe) streptokokebs. ujredis garsis cilebs yofen M,
T, da R proteinebad, sadac M proteini warmoadgens virulentobis mTavar faqtors,
romelic uzrunvelyofs gamomwvevis fiqsacias SeRwevis adgilas da gansazRvravs
antifagocitur aqtivobas. cnobilia streptokokebis 80 serologiuri varianti
(serovari), romlebic ganisazRvreba aglutinaciis reaqciiT saTanado imunizirebuli
cxovelis Sratis saSualebiT.
A jgufis streptokokebi gamoimuSaveben zogadi moqmedebisa da lokaluri moqmedebis,
`kerZo morgebis~ toqsinebs. zogadi moqmedebis toqsinebidan yvelaze didi mniSvneloba
eniWeba eriTrogenul toqsinebs (A (ganapirobebs toqsikuri Sokis sindroms), B, C),
romlebic cnobilia, rogorc dikis, pirogenuli egzotoqsini, gamonayris, qunTruSis
toqsini. maT gaaCnia citotoqsikuri moqmedebis unari, kerZod, azianeben qsovilebs,
Trgunaven fagocitozs, ganapirobeben imunosupresias (maT sawinaaRmdegod organizmi
gamoimuSavebs antitoqsinebs (antisxeulebs)). streptolizinebi (O da S) xels uwyoben
streptokokebis hemolizis unars sakveb niadagze. streptolizinebis sawinaaRmdego
antisxeulebis gamomuSaveba da maTi dadgena aadvilebs infeqciis diagnostikas.
hialuronidaza iwvevs membranis ganvladobis gaZlierebasa da streptokokebis gavrcelebas.
A jgufis β -hemolizuri streptokokebi _ Streptococcus pyogenes anu GAS
(GAS - Group A Streptococcus)), Tavis mxriv, SeiZleba daiyos 80-ze met ti pad M-
proteinis sxvaobasTan dakavSirebiT. streptokokuri toqsini Sedgeba Termolabiluri
da Termostabiluri fraqciisagan. pirveli maTgani warmoadgens WeSmarit toqsins,
meore ki xasiaTdeba alergiuli TvisebebiT.
`kerZo morgebis~ toqsinebs miekuTvneba streptolizinnukleazebi (O da S),
hialuronidaza, streptokinaza, proteinaza, li poproteinaza da baqteriolizinebi.
yvela toqsini da fermenti xels uwyobs streptokokebis SeRwevas qsovilebSi,
streptokokebis baqteriuli komponentebi ki ganapirobeben maT invaziasa da agresiulobas.
maT mimarT gamomuSavdeba ti pur-specifikuri antisxeulebi, rogoricaa aglutininebi,
precipitinebi, baqteriatropinebi, komplementSemboWavi da damcvelobiTi antisxeulebi.
antitoqsikuri imuniteti, rogorc wesi, mdgradia, xolo antibaqteriuli mimarTulia
290
kerZo nawili.
mxolod erTi gansazRvruli ti pis an ti pebis winaaRmdeg.

dadgenilia, rom β- hemolizuri streptokokis nebismier serovars SeuZlia, gamoiwvios
infeqciis mravalferovani klinikuri suraTi, maT Soris qunTruSa da wiTeli qari.
streptokokebis klasifikacia mowodebulia Lancefield-is mier. maTi hemolizis
unarianoba da klinikuri formebis kavSiris gamovlineba warmodgenilia cxrilSi.
Lancefield-is
-is mier streptokokebis klasifikacia jgufebad, misi
hemolizisunarianoba da kavSiri daavadebis klinikur formebTan
h emol i z i
Lancefield-i s
cx v ri s k ol on i z a ci i s
a n t i g en u ri saxe d a a v a d ebi s k l i n i k u ri for ma
sisxlis adgili
jg u fi
a g a rz e
faringiti , tonzi l i ti , w iTel i qari , i mpeti go,
septi cemi a, Wri l obi s i nfeqci a, manek rozebel i
xaxa, k ani , sw ori
A S. pyogenes β fasci l i ti , cel u l i ti , meni ngi ti, pnevmonia,
naw l avi
qu nTru Sa, toqsi k u ri Sok ismagvari si nd romi,
revmatiu l i cxel eba, mw vave gl omeru l onefriti .
axal Sobi l Ta sefsi si , qori oamni oni ti ,
B S. agalactiae β xaxa, saSo end ok ard iti , meni ngi ti , osteomi el i ti, pnevmoni a,
mel ogi nes sefsi si
W ri l obis i nfeqci a, mel ogi nes sefsi si , cel u l i ti ,
piri s Rru , xaxa, end ok ard iti , tvi ni s abscesi , sefsi si ,
C-H, K-O sxvad asxva β, α
saSo, k ani nozok omi al u ri i nfeqciebi, oportu ni stu l i
i nfeqciebi
arati pirebu l i S. viridans α xaxa end ok ard iti
arati pirebu l i S. mutans α xaxa end ok ard iti
Enterococcu end ok ard iti , saSard e gzebi s infeqci ebi ,
s faecalis
bil iaru l i traqti s infeqci ebi , naw l avTa
arati pirebu l i (enterococcu α, β , γ naw l a vi s Si gTa vsi
i nfeqciebi, peri toni ti , baqteriemia su perinfeqci i s
s), E.
faecium saxi T.
α _ nawilobrivi hemolizi, β _ mTliani hemolizi

hemolizi,, γ _ ar aris hemolizi
sxva jgufis streptokokebi umTavresad cirkulireben cxovelebSi, magram am bolo

dros zogierTi maTgani adamianSic iwvevs paTologias.
streptokokebi Zlier mgrZnobiareni arian antibiotikebis, gansakuTrebiT penicilinis,
eriTromicinis, oleandomicinis mimarT, swrafad iRupebian sadezinfeqcio nivTierebebis
moqmedebiT, rezistentulni arian dabali temperaturis mimarT, gamomSral CirqSi an
sisxlSi sicocxlisunarianobas inarCuneben kviraobiTa da TveobiT.
gansakuTrebul yuradrebas iqcevs B jgufis streptokoki S. agalactiae anu GBS
(GBS- Group B Streptococcus), romelic axalSobilebSi adgilobriv infeqciasa da
mZime generalizebul daavadebas iwvevs.
S. agalactiae garmdadebiTi β-hemolizuri streptokokia (zogierTi saxeoba
gramuaryofiTia. misi klasifikacia xdeba kafsuluri polisaqariduli da cilovani
antigenebis mixedviT da moicavs Ia, Ib, Ia/c, II, III da IV ti ps. arsebos V ti pic.
daavadebis adreuli gamovlinebebi SeiZleba nebismierma ti pma gamoiwvios, mogvianebiTi
ki _ III ti pma (90%). IV da V ti pi axalSoblTa daavadebebs iSviaTad iwvevs). GBS
gamoimuSaveben sxvadasxva ujredgareSe substancias, maT Soris hemolizins, nukleazas,
proteazas, neiraminidazas, li poteiqois mJavas da a.S. ukanaskneli ori faqtori
gansazRvravs GBS-is gansakuTrebul virulentobas.
epidemiologia. daavadeba gvxvdeba mTel msoflioSi. infeqciis wyaros warmoadgens
avadmyofi nebismieri klinikuri gamovlinebiT, maT Soris baqteriamtarebeli.
GAS infeqciis gadacemis meqanizmi haerwveTovania da xorcieldeba xvelis, ceminebis,
laparakis dros. gamoyofili respiraciuli sekreti gamoSxefebisas ereva mtverSi da
291
kerZo nawili.
cirkulirebs haerSi. aRniSnuli meqanizmi da mWidro kavSiri daavadebis aRmocenebas

ganapirobebs upiratesad mWidro TavSeyris adgilebSi (skola-internatebSi, baga-baRebSi,
yazarmebsa da a.S).
xelebis Cirqovani dazianebis Sedegad SesaZloa, streptokokebiT dabinZurdes rZis,
labas, kremis produqtebi, sadac xdeba maTi gamravleba, rac ganapirobebs kvebiTi
toqsikoinfeqciebis (anu sakvebismieri intoqsikaciis) SemTxvevebs. ar aris gamoricxuli
infeqciis gadacema dainficirebuli nivTebiT, `mesame piriT~, magram daavadebis gavrcelebis
TvalsazrisiT es gza naklebmniSvnelovania.
streptokokuri infeqciis mimarT midrekileba yvela asakisa da rasis adamians
axasiaTebs. daavadebaTa yvelaze meti ricxvi modis bavSvebze. yelis infeqcia faringitis
saxiT aRiniSneba 6-dan 12 wlamde, xolo kanis infeqcia _ skolamdeli asakis bavSvebSi.
damaxasiaTebelia sezonurobac _ faringitisaTvis weliwadis civi periodi, xolo
kanis daavadebebisaTvis _ gviani zafxuli da adre Semodgoma.
gadatanili infeqciis Sedegad organizmi gamoimuSavebs antibaqteriul da
antitoqsikur imunitets. antibaqteriuli imuniteti ti pur-specifikuria.
adamiani mTeli sicocxlis ganmavlobaSi Teoriulad SeiZleba Sexvdes 40-ze met
streptokokur infeqcias. zogierTi maTgani mimdinareobs inaparantulad, zogi ki
klinikuri gamovlinebiT. dadgenilia, rom bavSvebis sisxlis SratSi arsebobs
baqteriastaturi antisxeulebis SezRuduli ricxvi, romelic asakis matebasTan erTad
matulobs, rac mowmobs infeqciasTan ganmeorebiT Sexvedras. SesaZlebelia, organizms
meored Sexvdes erTi da igive ti piT gamowveuli infeqcia. adre Catarebuli
penicilinTerapia iwvevs antigenuri Tvisebebis daqveiTebas, ramac SeiZleba, SemdgomSi
ar gamoricxos igive ti piT daavadeba.
antitoqsikuri imuniteti yalibdeba eriTrogenuri toqsinebiT organizmis
stimulaciis Sedegad. dedisagan nayofze misi gadacema xdeba rogorc pasiurad, ise
aqtiurad. pirvel SemTxvevaSi saxezea antisxeulebis transplacenturi gadacema, romelsac
bavSvi sicocxlis pirveli wlis bolosaTvis kargavs. aqtiuri imuniteti ki viTardeba
infeqciis gadatanis Sedegad da rCeba mudmivad. antitoqsiuri imuniteti, umravles
SemTxvevaSi, jgufuri tipur-specifikuri xasiaTisaa. saerTod, adamianis imunuri statusi
gansazRvravs ama Tu im infeqciis klinikur formas (cxrili).
adamianis imunuri statusis gavlena

infeqciis klinikur manifestaciaze
A jgufis I da IV tipis streptokoki + eriTrogenuri toqsini
antibaqteriuli antibaqteriuli antibaqteriuli antibaqteriuli

imuniteti + imuniteti + imuniteti _ imuniteti _
antitoqsikuri antitoqsikuri antitoqsikuri antitoqsikuri
imuniteti + imuniteti _ imuniteti + imuniteti _
klinika ar streptokokuri
qunTruSa
aRiniSneba faringiti
292
kerZo nawili.
rac Seexeba GBS-s, es mikroorganizmi qalebis Sard-sasqeso da kuW-nawlavis

traqtis binadaria. misi kolonizacia aRniSnuli lokalizaciiT orsul qalebSi
daaxloebiT 20% (4_40%)-s aRwevs. orsulebSi, infeqcia Cveulebriv, usimptomod
mimdinareobs, magram SeiZleba gamoiwvios Sard-sasqeso sistemis anTebiTi cvlilebebi,
qorioamnioniti, endometriti. GBS-is mniSvnelovani kolonizaciis mqone qalebi, rogorc
wesi, inficirebul bavSvebs Soben. axalSobilebi infeqcias Rebuloben vertikaluri
(aRmavali gziT an dainficirebul samSobiaro gzebSi gavlisas) da maTSi GBS-
kolonizaciis done 40-70%-s aRwevs. nayofis dainficireba SesaZlebelia sanayofe
garsebis mTlianobis pirobebSic ki. infeqcia gadaecema horizontuli gziTac: meore
axalSobilidan, sxva dedebidan, samedicino personalidan.
infeqciis adreuli niSnebi sicocxlis pirvel 5 dReSi vlindeba, rac Cveulebriv,
aRiniSneba nayofis saSvilosnosSida dainficirebisa, gansakuTrebiT ki dRenaklebSi an
dabadebisas mcire masis mqone bavSvebSi.
mogvianebiTi niSnebi sicocxlis 1 kviris mere vlindeba da mSobiarobis Semdgom
SeZenil infeqciaze metyvelebs.
paTogenezi. GAS-is SeWris adgils warmoadgens nuSurebi da zemo sasunTqi
gzebis lorwovani garsebi, ufro iSviaTad dazianebuli kani (Wriloba, maceracia,
damwvroba), axalSobilebSi ki Wi pis Wriloba. SeWris adgilas xdeba mikrobebis
gamravleba. Tumca leikocitebis mobilizacia anTebad kerebSi swrafad viTardeba,
magram maT fagocitur unarianobas yovelTvis ar mosdevs mikrobebis likvidacia.
zogjer, adgili aqvs daumTavrebel fagocitozs. mikrobebisa da qsovilebis daSlis
Sedegad yalibdeba pirveladi anTebadi kera. procesi vlindeba hi peremiiT, SeSupebiTa
da polimorfuli nuklearebis ujreduli infiltraciiT. mikrobebisa da qsovilebis
daSlis Sedegad warmoSobili toqsikuri produqcia iwvevs procesis Semdgom
gavrcelebasa da gaRrmavebas. arCeven am paTologiuri procesis sam paTogenezur xazs
_ infeqciurs an sefsisurs, toqsikursa da alergiuls.
infeqciuri sindromis gamomxatvelia kataruli anTebiTi kera, romelic SeiZleba
gadavides Cirqovan an nekrozul procesSi. Semdeg procesi grZeldeba regionul
limfur kvanZebSi, viTardeba limfadeniti (D. L. Wbpthkbyu-is mixedviT yalibdeba
pirveladi kompleqsi). SesaZloa ganviTardes periadeniti da flegmona. streptokokebis
gavrceleba intrakanikulurad evstaqis milis gavliT iwvevs Sua yuris anTebas, anTrits,
mastoidits, xolo cxvir-xaxidan ki _ sinusits, eTmoidits; aRniSnuli kerebidan
SesaZlebelia streptokokebis hematogenuri diseminacia da Cirqovani metastazis
warmoSoba sxvadasxva organoebSi (septikokiemia). aRsaniSnavia, rom adre dawyebul
etiotropul Terapias SeuZlia procesis kupireba.
toqsikuri sindromi ganpirobebulia organizmSi β-hemolizuri streptokokebis
eriTrogenuli toqsinis generalizaciiT. am dros aRiniSneba temperatura, saerTo
mdgomareobis gauareseba, Rebineba, taqikardia. intoqsikaciis simZime damokidebulia
organizmis imunur statusze, infeqtis masiurobasa da maT agresiulobaze.
alergiuli sindromi ganpirobebulia mikrobis daSlis cilovani komponentebiTa
da toqsinis Termostabiluri fraqciiT, romlebic Seiwoveba organizmSi mTeli daavadebis
ganmavlobaSi. misi klinikuri gamovlinebebia: revmatizmi, nefriti, kolagenozi.
GBS-ma SeiZleba gamoiwvios amnionuri garsebis anTeba da maTi gaskdomac ki.
amnionur siTxeSi mcire raodenobiTaa tipur-specifikuri GBS-antisxeulebi, komplementi,
fagocituri ujredebi, amitom igi kargi garemoa GBS-Tvis. aseTi wylebis aspiraciam
axalSobilebSi SeiZleba gamoiwvios pnevmonia, baqteriemia da sefsisuri Soki. axalSobilTa
ofsonofagocituri defeqti zrdis infeqciisadmi maT ganwyobas, rasac xels uwyobs
dediseuli ti pur-specifikuri antisxeulebis deficitic.
293
kerZo nawili.
daavadebis adreuli gamovlinebaa pnevmonia baqteriemiiT, romelic rTuldeba filtvis

hi pertenziiT.
mogvianebiTi GBS-infeqciis paTogenezi dakavSirebulia mikrobis pirveladi
kolonizaciis adgilTan, mikrobis mier lorwovani barieris gadalaxvis unarTan, rasac
xSirad respiraciuli virusuli infeqcia uswrebs win. mniSvnelovan rols TamaSobs
GBS-III
-III ti pis kafsuluri polisaqaridis didi raodenoba, dediseuli antisxeulebis
simcire. mag.: osteomieliti viTardeba baqteriemiis Sedegad.
klinika. GAS xasiaTdeba mravalsaxovani gamovlinebebiT _ dawyebuli Zlier
msubuqi formidan, damTavrebuli mZime sefsisur mimdinareobamde. misi gamovlineba bevr
faqtorzea damokidebuli, maT Soris yvelaze mniSvnelovania bavSvTa asaki, imunuri
statusi, premorbiduli foni, pirveladi anTebiTi kerebis lokalizacia, hemolizuri
streptokokebis specifikuri Tvisebebi da maTi mainficirebeli dozebis sidide. rac
ufro mZimed mimdinareobs daavadeba, miT ufro advili xdeba misi diagnostika maSin,
rodesac procesis dacxromis stadiasa da msubuqi manifestaciis dros misi dadgena
gaZnelebulia.
inkubaciuri periodi ganisazRvreba ramodenime saaTidan 7 dRemde, saSualod
Seadgens 4-5 dRes.
streptokokuri infeqciis gamovlineba pirobiTad SeiZleba daiyos lokalizebul
da generalizebul formebad. lokalizebul formebs miekuTvneba angina, riniti, faringiti,
otiti, sinusiti, adenoiditi da sxva, romlebic viTardebian respiraciuli virusuli
infeqciebis fonze da iTvleba maT garTulebad iseve, rogorc laringiti, bronqiti,
pnevmonia, pieliti, nefriti da sxva.
yvela klinikuri formisaTvis damaxasiaTebelia daavadebis swrafi manifestacia
pirveladi anTebiTi kerebis lokalizaciiT, regionuli limfuri kvanZebis reaqciiTa
da maTi midrekilebiT daCirqebisadmi, sxvadasxva intensivobis temperaturuli reaqciiT.
periferiul sisxlSi, Cveulebriv, dgindeba sxvadasxva xarisxis leikocitozi
neitrofiloziT, marcxniv gadaxriTa da eds mkveTri matebiT.
streptokokuri infeqcia 6 Tvemde asakis bavSvebSi Cveulebriv, vlindeba
nazofaringitis saxiT. am dros aRiniSneba cxviridan Cirqovani gamonadeni, kanis eqskoriacia
nestoebis irgvliv. temperatura SeiZleba gamoxatuli iyos araregularulad. mwvave
periodi grZeldeba erT kviramde, magram cxviris gaRizianebam da misma gagudvam
SeiZleba, 6 kviramdec gastanos. klinikurad misi bunebis dadgena mxolod streptokokebis
gamoyofiT xdeba.
streptokokuri infeqciis mimdinareoba 3-dan 12 wlamde (piki 6 wlidan).
daavadebis dasawyisSi temperatura subfebrilur xasiaTs Rebulobs. saerTo intoqsikaciis
movlenebi gamoxatulia saSualod, zogjer aRiniSneba nazofaringiti, Cirqovani gamonadeni
cxviridan, kisris limfuri kvanZebi gadidebulia, rbili konsistenciis. nuSurebze
moTeTro nadebi alisferi xaxis fonze, rac paTognomur niSnad iTvleba streptokokuri
tonzilofaringitisaTvis. SesaZlebelia, garTulebis saxiT ganviTardes sinusiti, otiti
da sxva. daavadeba grZeldeba 4-dan 8 kviramde, zogjer aqvs morecidive xasiaTi.
impetigo (impetigo _ Cirqovani gamonayari) xasiaTdeba kanis zedapiruli Cirqovani
dazianebiT, fufxis organizaciiT. SeiZleba, gamowveuli iyos hemolizuri streptokokiTa
da stafilokokebiT. SesaZlebelia 1-2 mm diametris gardamavali vezikuluri gamonayris
gaCena, kanis hi peremiul fonze mrgvali formiT, mwebavi qarviseburi fufxiT, xSirad
aRiniSneba adgilobrivi limfadeniti. bulur impetigos, Cveulebriv, iwvevs stafilokoki,
paralelurad aRiniSneba vezikuluri dazianebac 1-2 mm diametriT, gaaCnia fufxi,
limfadeniti ki ar axasiaTebs.
GBS-infeqciis klinika asimptomuri baqteriemiidan sefsisur Sokamde varirebs.
294
kerZo nawili.
daavadebis adreuli gamovlinebis pirveli niSnebi dabadebidan 6 saaTSi Cndeba. nayofis

saSvilosnosSida inficirebisas viTardeba asfiqsia, koma an Soki. respiraciuli simptomebi
vlindeba cianozis, apnoes, taqipnoes, mkvnesare sunTqvis, qoSinis saxiT. rentgenologiurad
filtvebSi aRiniSneba infiltratebi, iSviaTad siTxe plevris RruSi, sisxlZarRvovani
suraTis gaZliereba. 30-40% SemTxvevaSi viTardeba sefsisi romelime organos TvalsaCino
dazianebis gareSe.
axalSobilebSi daavadebis adreuli gamovlinebisas 10% SemTxvevaSi viTardeba
meningiti, romelic manifestirdeba krunCxvebiT, leTargiiT, komiT, yiflibandis
pulsaciiT. SesaZlebelia meningiti yovelgvari simptomis gareSec mimdinareobdes.
GBS infeqciis mogvianebiTi gamovlinebisas (dabadebidan 1 kviris Semdeg) 60%
SemTxvevaSi daavadeba mimdinareobs meningitis saxiT.
iSviaTad GBS infeqciam SeiZleba gamoiwvios Tirkmelzeda jirkvlebis abscesi,
naRvlis buStis wyalmanki, hi perbilirubinemia (SekavSirebuli bilirubinis), tvinis
abscesi, endo-, mio- da perikarditi, koniunqtiviti, ofTalmiti, arTriti, osteomieliti,
otiti, mastoiditi, filtvis empiema, sarZeve jirkvlis abscesi, fasciliti, impetigo,
omfaliti, Tavis qalas abscesi, saSarde traqtis infeqcia da sxva).
diagnozi. yelis streptokokuri infeqciis mqone bavSvTa mxolod 30%-s
diagnozi
baqteriologiuri gamokvlevis Sedegad eTeseba GAS-infeqti da mxolod 50%-s aReniSneba
antisxeulebis produqcia. amitom, Tu 5 wlis asakze ufros bavSvs aReniSneba yelis
siwiTle, SesaZloa TeTri eqsudatic, kisris limfuri kvanZebis gadideba, eWvi unda
mivitanoT streptokokuri etiologiis daavadebaze da daviwyoT etiotropuli
mkurnalobis 10 dRiani kursi. imavdroulad, saWiroebis mixedviT gamovricxoT difTeria,
infeqciuri mononukleozi da sxva daavadebebi.
baqteriologiuri gamokvlevisaTvis gamoiyeneba sisxliani agari (cxvris sisxliT),
seleqciuri niadagebi, Tumca cxvir-xaxidan mikroorganizmis gamoyofa daavadebis
etiologiis sasargeblod yovelTvis ar laparakobs.
kisris gadidebuli limfuri kvanZebiTa da zogjer, rbil sasaze peteqiebis arsebobiT
mimdinare streptokokuri eqsudaciuri (TeTri nadebiT) faringitis saSualo simZimisa
da mZime formebi ufro metad yelidan aRebuli kulturis baqteriologiuri monacemebiT
dasturdeba.
imunologiuri gamokvlevebisaTvis mimarTaven titrSi antistreptolizin - O-s
anu ASO-s (Antistreptolisin O) gansazRvras. aranamkurnaleb avadmyofTa 80%-Si
daavadebis pirvels 3-6 kviras aReniSneba 166 erT.-ze meti titri Todd-is mixedviT.
antibiotikis fonze titri mcirdeba. revmatizmis dros es maCvenebeli Zalian maRalia,
streptokokuri piodermiisas ki dabalia. impetigos dros sisxlSi anti-DNase B
(antidezoqsiribonukleaza) 6-8 kviris Semdeg matulobs, igi saukeTeso serologiuri
testia am SemTxvevaSi. streptokokuri faringitiT avadmyofTa umravlesobas titri
am fermentis mimarT maRali aqvs. aRiniSneba antihialuronidazis matebac.
ukanasknel dros iyeneben iaf, 2-wuTian slaid - Streptozyme tests (Wampole
Laboratories,, Granbury,, NJ) eqstraceluluri, ujredgare antigenebis sawinaaRmdego
antisxeulebis gansazRvrisaTvis. magram SesaZlebelia, rogorc crudadebiTi, aseve
cruuaryofiTi Sedegebis miReba.
periferiul sisxlSi SeiZleba arc leikocitozi da arc eds momatebuli ar iyos.
GBS-infeqciisas saWiroa sisxlis, lumbaluri punqtatis, plevruli siTxis, iSviaTad
Sardis, abscesis, Zvlisa da saxsris aspiratebis baqteriologiuri gamokvleva. kuWis
SigTavssa da kans ar SeuZlia daavadebis etiologiis asaxva.
mowodebulia GBS-antigenis gamokvleva lateqs-aglutinaciiT (kulturasTan
SedarebiT naklebad gamomsaxvelia), romelic adasturebs da ara amtkicebs diagnozs.
295
kerZo nawili. GAS ,GBS
streptokokuri infeqciebi. qunTruSa
es meTodi gamoiyeneba, rogorc orsulebis skriningi mSobiarobis momentisaTvis (dadebiTi

Sedegebi mxolod 40% SemTxvevaSia) kolonizaciis gamovlenis mizniT.
mkurnaloba. GAS streptokokuri infeqciis dros efeqtur etiotropul
mkurnaloba
saSualebas warmoadgens penicilini. msubuqi formis dros iniSneba per os 40 000
erT/kg, xolo mZime mimdinareobisas _ 50 000 _ 100 000 erT/kg dReRameSi 2
gakeTebaze kunTebSi. mkurnalobis xangrZlivoba 10 dRea. aseve iniSneba eriTromicini
da cefalosporinebi, amoqsicilini 10 dRis ganmavlobaSi (10 dRe saWiroa streptokokis
sruli ganadgurebisaTvis da kursi ar unda Sewydes miuxedavad klinikuri gaumjobesebisa,
raTa ar moxdes recidivi da revmatizmis Camoyalibeba). qirurgiuli Careva SeiZleba
piodermiuli kerebis dros agreTve iniSneba vitaminoTerapia, srulfasovani kveba.
GBS mgrZnobiarea penicilin G-s mimarT, romelic arCevis preparats warmoadgens.
sinergizmiT xasiaTdeba gentamicini (Tumca GBS aminoglikozidebis mimarT
rezistentulia). zogierTi gvTavazobs mkurnalobas ampicilinisa da gentamicinis
kombinaciiT kargi klinikuri efeqtis an Tav-zurgtvinis siTxis sterilobis miRwevamde.
GBS aseve mgrZnobiarea vankomicinis, cefalosporinebis (cefotaqsimi, ceftriaqsoni
{rocefini}), naxevradsinTezuri penicilinebis, imi penemis (tienami) mimarT.
penicilini iniSneba doziT 300 000 erT/kg dRe-RameSi, ampicilini ki _ 300 mg/kg
dRe-RameSi. meningitebis dros gentamicinTan erTad mkurnalobas agrZeleben 2-3 kvira.
iniSneba paTogenezuri mkurnaloba. intravenuri imunoglobulini Seicavs proteqciuli
antisxeulebis dabal titrs da misi efeqti arc Tu iseTi mniSvnelovania.
profilaqtika. gadamwyveti mniSvneloba eniWeba epidemiologiur zedamxedvelobas,
profilaqtika
adreul diagnostikas, avadmyofis hospitalizacias da sanitarul-higienur RonisZiebebs.
riskis jgufis orsulebSi GBS kolonizaciis SemTxvevaSi, naadrevi mSobiarobis,
sanayofe garsebis garRvevis da qorioamnionitis dros, axalSobilebSi infeqciis
profilaqtikis mizniT, mSobiares eniSneba ampicilini. mxedvelobaSia misaRebi orsulis
skriningis rezultati. inficirebuli dedisagan dabadebul bavSvs ukeTeben specifikur
imunoglobulins.
dReisaTvis streptokokuri infeqciis vaqcinoprofilaqtika ar arsebobs.
qunTruSa
(SCARLATINA)
qunTruSa warmoadgens streptokokuri infeqciis erT-erT klinikur formas, romelsac

aqvs sakmaod mkafiod gamoxatuli, damaxasiaTebeli klinikuri suraTi, mimdinare organizmis
saerTo intoqsikaciiT, mkafiod gamoxatuli anginiT, regionuli limfadenitiT, kanis
wvrilwinwklovani gamonayriTa da firfitisebri aqercvliT.
qunTruSa pirvelad gamoyofil iqna wiTelasagan 1554w. sicilieli eqimis Ingrassias-
mier saxelwodebiT `rossania~. 1675w. daavadeba ufro dawvrilebiT aRwera ingliselma
eqimma T. Sidenham-ma da uwoda `scarlet fever~ (alisferi cxeleba).
qunTruSis streptokokuri etiologiis mowodebis fuZemdeblebad iTvlebian rusi
mecnierebi U. B. Uf,hbxtdcrbq da B. U. Cfdxtyrj (1905 - 1906ww), romelTagan
pirvelma aRniSnuli mikrobis etiologiuri rolidan gamomdinare, mogvawoda qunTruSis
sawinaaRmdego imunizaciis meTodi, meorem ki daamtkica, rom qunTruSis streptokoki
gamoyofs egzotoqsins. es ukanaskneli ki man antitoqsikuri Sratis misaRebad gamoiyena.
SemdgomSi amerikelma mecnierebma _ dikebma ganamtkices streptokokuri Teoria da
gamoyves daavadebis kardinaluri simptomebi, rogoricaa temperaturuli reaqcia, gamonayari;
296
kerZo nawili.
Rebineba daukavSires egzotoqsinis moqmedebas. maT mier mowodebul iqna mkurnalobisTvis

antitoqsikuri Sratic, aqtiuri imunizaciisTvis _ streptokokuri toqsini, imunitetis
gansazRvrisaTvis ki _ kanis sinji (dikis reaqcia).
dikis reaqcia xorcieldeba winamxris medialur nawilSi kanSi ganzavebuli toqsinis
erTi dozis SeyvaniT, rac imunitetis armqone bavSvebSi iwvevs 1sm-mde diametris kanis
hi peremias. dadebiTi reaqciis mqone bavSvebSi qunTruSiT daavadebis maCvenebeli ufro
maRalia.
amJamad dadgenilia, rom A jgufis hemolizuri streptokokis (GAS) yvela 80
ti ps SeuZlia eriTrogenuli toqsinebis producireba da qunTruSis gamowveva. amasTan
erTad unda aRiniSnos, rom streptokokebis roli qunTruSis gamowvevaSi SezRudulia
da ifargleba 1-2 e.w. wamyvani ti piT, romlebic ufro virulentuli da toqsigenuri
arian. mxedvelobaSia misaRebi isic, rom sxvadasxva qveynebSi es ti pebi SeiZleba
sxvadasxva iyos.
paTogenezis arsi qunTruSis ganviTarebaSi Semdegia: Tu dainficirebis momentSi
organizms streptokokebis mimarT antitoqsikuri imuniteti ar gaaCnia, SesaZlebelia
qunTruSis ganviTareba da piriqiT, antitoqsikuri imunitetis arsebobisas, antibaqteriuli
imunitetis uqonlobis fonze viTardeba ara qunTruSa, aramed sxva klinikuri formebi.
epidemiologia. qunTruSis dros infeqciis wyaros warmoadgens streptokokuri
epidemiologia
infeqciis sxvadasxva klinikuri gamovlinebis mqone pirebi, maT Soris wamyvani roli
eniWeba qunTruSiT daavadebulT. epidemiologiurad gansakuTrebul saSiSroebas ki
waSlili klinikuri formis mqoneni warmoadgenen.
janmrTelebSi streptokokebis mtareblis rolis dadgena rTulia, Tumca D. B.
Bjaat -s monacemebiT xaxaSi mikrobebis ganTesvis maCvenebeli qunTruSis mwvave
periodTan SedarebiT naklebia.
streptokokebis gamoyofa garemoSi xdeba lorwovani garsebis sekretiT xaxidan,
cxviridan, agreTve sxvadasxva Ria Cirqovani kerebidan otitis, sinusitis, limfadenitisa
da sxva lokalizaciis paTologiebis dros.
gamomwvevi agentis gadacemis mTavari meqanizmi haerwveTovani gzaa. avadmyofi
kontagiozuri xdeba daavadebis pirvelsave dReebSi. peniciliniT namkurnalebi avadmyofebi
klinikur efeqtTan erTad Tavisufldebian streptokokebisagan da rekonvalescenti,
rogorc wesi, bavSvTa koleqtivisaTvis saSiSi aRaraa. im SemTxvevaSi ki, roca
rekonvalescents aqvs qronikuli anTebadi kera qronikuli tonzilitis, rinofaringitis
an sxva saxiT, aRiniSneba xangrZlivi mtarebloba da aseTi pirebi warmoadgenen infeqciis
wyaros. gadacemis meqanizmSi prevalirebs wveTovani gza, rasac adasturebs daavadebis
gadacema mcire manZilze mWidro kontaqtiT. did manZilze, kerZod, mezobel binebSi
daavadeba ar vrceldeba, rogorc es xdeba wiTelasa da Cutyvavilas dros.
infeqciis gadacema SesaZlebelia dainficirebuli nivTebiT (saTamaSoebi, WurWeli
da sxva), Tumca es gza epidemiur saSiSroebas ar qmnis. infeqcia gadaecema saWmlis
dainficirebisasac, ZiriTadad rZisa da rZis produqtebiT (nayini, kremi da sxva). es
gza Tumca iSviaTia, magram am SemTxvevaSic ar aris gamoricxuli daavadebis mniSvnelovani
epidafeTqebebi.
kontagiozuri indeqsi qunTruSis dros Seadgens 0,4 anu 100 kontaqtirebulidan
daavadeba emarTeba 40 adamians.
imuniteti. qunTruSis gadatanis Semdeg organizms uviTardeba mdgradi imuniteti.
imuniteti
recidivi aRiniSneba 1,5-4%-mde, rac gamowveulia antibiotikebiT mikrobebis imunogenuri
Tvisebebis daqveiTebiTa da, aqedan gamomdinare, organizmis imunologiuri reaqtiulobis
arasrulyofiT, Tumca qunTruSismagvar daavadebas iwveven enterovirusebi, stafilokokebi,
iersiniebi da saWiroa maT Soris diferenciuli diagnozis Catareba.
297
kerZo nawili.
amJamad umTavresad gvxvdeba msubuqi da saSualo simZimiT mimdinare qunTruSa, rac

ganpirobebulia susti da saSualo toqsigenuri kulturebiTa da SesaZlebelia
mosaxleobis e.w. `Cqari~ bunebrivi imunizaciiT.
daavadebaTa ricxvi umTavresad 3-dan 8 wlamde modis. 15 wlis zemoT da mozrdil
asakSi daavadeba iSviaTia, rac gadatanili infeqciisa da maT Soris msubuqi ati puri
formebiTa da mikrobebis mtareblobiT mosaxleobis faruli bunebrivi imunizaciis
Sedegia.
wlamde asakis bavSvebi avaddebian iSviaTad, es gansakuTrebiT exeba 6 Tvemde
asaks, rac aixsneba dedidan imunitetis trasplacenturi gziT gadacemiTa da am asakSi
TviTon bavSvTa fiziologiuri areaqtiulobiT streptokokuri toqsinis mimarT.
sezonuroba, msgavsad haerwveTovani infeqciebisa, damaxasiaTebelia zamTris periodSi
sezonuroba
(seqtemberi-ianvari), gansakuTrebiT ufro civi, nestiani klimatis mqone qveynebSi.
cxel da mSral adgilebSi avadoba dabalia, xolo tropikul qveynebSi _ TiTqmis ar
gvxdeba. periodulad yovel 4-5 weliwadSi, aRiniSneba avadobis maCvenebelTa zrda da
kleba.
paTogenezi da paTmorfologia qunTruSasa da streptokokuri infeqciis sxva
formebis dros princi pulad erTi da igivea. Tumca qunTruSas paTogenezis ganviTarebaSi
zogierTi Tavisebureba gaaCnia. F. F. Rjknsgby-isa da misi mowafeebis mier SemuSavebuli
da dasabuTebulia qunTruSas paTogenezis sami xazi _ toqsikuri, infeqciuri da
alergiuli, romlebic erTi paTologiuri procesis Sedegs warmoadgens da maTi
manifestacia TanmimdevrobiT SeiZleba moxdes, an samive komponenti mwvave periodSive
gaiSalos sxvadasxva xarisxiT.
hemolizuri streptokokuri toqsemiis Sedegad pirvel rigSi adgili aqvs toqsinis
tropizms vegetatiur, endokrinul, nervul, sisxlZarRvTa aparatis mimarT, rac klinikurad
saerTo intoqsikaciis suraTiT gamoixateba; kerZod, maRali temeraturiT, kanze gamonayriT,
centraluri da vegetatiuri nervuli sistemisa da gul-sisxlZarRvTa aparatis
dazianebiT.
qunTruSis mwvave periodSi yovelTvis aRiniSneba specifikuri intoqsikaciis esa
Tu is gamovlineba. toqsikuri sindromis modelireba SeiZleba gamowveuli iyos
toqsinis SeyvaniT (aqtiuri imunizaciis dros) da misi alagmva moxdes antitoqsinis
Seyvanis saSualebiT.
toqsemiis zogierTi sawyisi gamovlinebis msgavseba anafilaqsur reaqciasTan
gvafiqrebinebs, rom mis ganviTarebaSi monawileobas Rebulobs alergiuli meqanizmi
(F. F. Rjknsgby). daavadebis pirveli kviris bolosa da meore kvirisaTvis organizmi
gamoimuSavebs antitoqsikur imunitets. amasTan erTad, mikrobis cirkulaciisa da misi
daSlis Semdeg mikrobuli alergenis mimarT yalibdeba Secvlili mgrZnobeloba _
infeqciuri alergia, romelic klinikurad mJRavndeba daavadebis meore-mesame kviras
da xasiaTdeba talRiseburi mimdinareobiT. misi klinikuri niSnebia sxeulis temperaturis
momateba, sxvadasxva saxis gamonayari mogvagonebs Sratismier daavadebas. viTardeba
fsevdorecidivi, arTralgia, arTriti, nefriti da sxva.
qunTruSis mZime formebis ganviTarebaSi didi mniSvneloba eniWeba organizmis
winamorbed sensibilizacias sxvadasxva infeqciis gadatanis saxiT. aseT bavSvebSi
daavadebis pirvelsave dReebSi viTardeba sxvadasxva saxis gamonayari, saxisa da
Tvalebis SeSupeba, rbili konsistenciis limfuri kvanZebis gadideba. organizmis
Secvlili reaqtiuloba iwvevs qunTruSis hi pertoqsikuri formebis Camoyalibebas.
paTogenezis alergiuli xazis ganviTarebas didi mniSvneloba eniWeba imunitetis
daTrgunvasa da misi barieruli funqciis moSlaSi. mkveTrad izrdeba sisxlZarRvTa
ganvladobac. es yvelaferi ki xels uwyobs mikrobul invaziasa da paTogenezis sefsisuri
298
kerZo nawili.
xazis formirebas.
paTogenezis sefsisuri xazis ganviTareba SeiZleba, daiwyos pirveladi anTebiTi
keris adgilze da miiRos nekrozul-anTebadi xasiaTi xaxaSi, cxvirxaxaSi, xorxSi da
a.S. aseTi mZime formebi ufro damaxasiaTebelia adreuli asakis bavSvebisaTvis, romelTa
organizmis barieruli funqcia daTrgunulia da advilad xdeba infeqciis generalizacia.
Cirqovani kerebi, Cveulebriv, yalibdeba daavadebis me-3-5 dRes, roca intoqsikaciis
movlenebi sustdeba. anTebadi kerebidan limfuri da sisxlZarRvebis gziT regionul
limfur kvanZebSi viTardeba limfadeniti da sxva (pirveladi kompleqsi), saidanac
sisxlSi Seiwoveba toqsinebi, mikrobis daSlis produqtebi _ alergenebi, rac, Tavis
mxriv, xels uwyobs SemdgomSi mikrobuli invaziis realizacias. viTardeba Cirqovani
angina da sxva Cirqovani garTulebebi. aseTi sefsisuri movlenebi SeiZleba, ganviTardes
mogvianebiT, alergiuli talRis fonze (meore, mesame, meoTxe kviras) glomerulonefritis,
arTritis, sinovitisa da sxva gamovlinebaTa paralelurad.
F. F. Rjknsgby-isa da misi TanamSromlebis mier dadgenil iqna vegetatiuri
nervuli sistemis cvlilebebi daavadebis dinamikis fonze. am cvlilebebTan mWidrodaa
dakavSirebuli gul-sisxlZarRvTa sistemis dazianeba. daavadebis dawyebiT fazaSi
umravles SemTxvevaSi imatebs simpatikuri sistemis tonusi, romelic Semdgom
parasimpatikuri tonusis momatebiT icvleba, xolo gamojanmrTelebis periodisaTvis
xdeba simpatikuri sistemis normalizacia. es kanonzomiereba SeiniSneba mravali sxva
infeqciis drosac. ase, rom qunTruSis mimdinareobis dadgenili kanonzomiereba SeiZleba
CaiTvalos sxva nozologiebisaTvis analogiuri procesebis prototi pad.
klinika. inkubaciuri periodi ganisazRvreba 2-7 dRiT, ufro xSirad moicavs 3-
klinika
4 dRes, Tumca zogjer ramodenime saaTs an iSviaTad, 12 dRemde grZeldeba.
daavadeba iwyeba uecrad, temperaturis momatebiT, pirRebinebiT, yelis tkiviliT,
saerTo intoq-sikaciis movlenebiT _ SemcivnebiT, Tavis tkiviliT, uZilobiT, madis
daqveiTebiT. gamonayari viTardeba ramodenime saaTSi an meore dRes, iSviaTad - meoTxe
dRes. mas axasiaTebs swrafi gavrceleba sa-xeze, kiserze, tanze, kidurebze. gamonayari
wvrilwinwklovania da ganviTarebulia kanis hi peremiul fonze, mogvagonebs mziT
damwvrobas. gamonayari aRiniSneba saxezec, Subli da loyebi ga-wiTlebulia, sadaa,
ìwvis~, mogizgizea, winwklebi ar aqvs. piris irgvliv kani gamonayris gareSea mkrTali
samkuTxediT. gamonayari
ufro intensiuria
tanis gverdiT zeda-
pirebze, muclis qveda
nawilSi, kidurebis me-
dialur midamoebze, gan-
sakuTrebiT ki kanis
bunebriv naoWebSi:
iRliisqveSa, sazardu-
lis, idayvis, muxlis
ukana fosoebSi. nakece-
bis adgilas aRiniSne-
ba hi perpigmentacia,
Cveulebriv, msubuqi
peteqiebiT. mas raime
qunTruSa. gamonayris uxvi qunTruSa. TeTri
prognozuli mniS-
xasiaTi idayvis saxsris Sida dermografizmi.
vneloba ar gaaCnia, ma- pirze. (Í.È. Íèñåâè÷,
gram warmoadgens sak- (Í.È. Íèñåâè÷, Â.Ô. Ó÷àéêèí) Â.Ô. Ó÷àéêèí)
299
kerZo nawili.
mao diagnostikur maCvenebels (pastas simptomi _ da-

Werisas siwiTle ar qreba). aseTi gamonayris xangr-
Zlivoba SeiZleba erTi dRe iyos, an gastanos saerTo
gamonayris gaqrobamde. intensiuri gamonayris SemTx-
vevaSi SeiZleba, Camoyalibdes miliarul-buStukovani
forma (Miliary-Sydomina), sididiT wvrili qinZisTavi-
sodena, Txieri, gamWvirvale an mRvrie SigTavsiT, rac
zogjer Rebulobs Serwymul xasiaTs, gansakuTrebiT ki
xelis mtevnebze. papuluri xasiaTis gamonayrisas kani
iRebs Sagrenis tyavis elfers. mZime, toqsikuri qunT-
ruSis dros gamonayari cianozuri elferisaa. misTvis
damaxasiaTebelia sustad gamoxatuli dermografizmi,
misi wyvetili gamovlineba. saerTod, ki qunTruSas, TeTri
dermografizmi imdenad Zlier axasiaTebs, rom avadmyo-
fis kanze SeiZleba gakeTdes warwera. kani mSralia,
avadmyofebi zogjer uCivian qavils.
mZime formebis dros kanze zogjer viTardeba
hemoragiuli gamonayari, kansa da lorwovan garsebSi _
sisxlCaqcevebi (hemoragiuli forma). msubuqi
mimdinareobisas gamonayari aRiniSneba 2-3 dRes, xolo
Zlier msubuqi formisas _ ramodenime saaTs. gamonayris
qunTruSa. wvrilwinwklovani ukuganviTareba xdeba TandaTanobiT: pirvelad kargavs
gamonayari, `TeTri~ cxvir-tuCis sikaSkaSes, Semdeg Rebulobs muq fers, zogjer naoWebSi
samkuTxedi, `Jolosebri~ ena. Cndeba pigmenturi zolebi. daavadebisaTvis
(S. Krugman) damaxasiaTebelia kanis desqvamacia, romlis intensivobac
pirdapirproporciulia gamonayris intensivobisa.
aqercvla iwyeba saxeze, kidurebze da ufro mkveTrad gamoixateba daavadebis mesame
kvirisaTvis. aqercvla tansa da kidurebze firfitisebri xasiaTisaa. kani am dros
SiSvldeba. mZime mimdinareobis dros aqercvlam SeiZleba, 8 kviramde gastanos. am
simptomebiT diagnozis retrospeqtuli dasma ioldeba, rasac xels uwyobs anamnezSi
yelis tkivilis arseboba maSin, rodesac mwvave periodSi gamonayari SeiZleba arc
yofiliyo SemCneuli.
angina aucilebeli da amave dros, damaxasiaTebelia qunTruSisaTvis. anginis gareSe
mimdinareobas ewodeba eqstrabukaluri qunTruSa. infeqciis SeWra xdeba kanis Wrilobis
an damwvrobisas. anginisaTvis damaxasiaTebelia pirxaxis lorwovani garsebis kaSkaSa
hi peremia (nuSurebis, naqis, sasis rkalebis) _ aalebuli xaxa. daavadebis pirvel
dReebSi xSiria rbili sasis ara mTliani hi peremia, aramed wertilovani enanTema,
xolo zogjer - wertilovani sisxlCaqcevebi. angina SeiZleba iyos kataruli an
nadebiT dafaruli, rogorc lakunuri anginis dros, nadebi advilad scildeba lorwovans,
moyviTalo an WuWyisferi - moTeTro ferisaa. nekrozuli angina gansakuTrebiT ti puria
sefsisuri qunTruSisaTvis. aseTi cvlilebebi vrceldeba nuSurebze lakunebs gareTac,
aqvs midrekileba mTels nuSuraze gavrcelebisaken, mZime SemTxvevebSi ki gadadis sasis
rkalebze, naqze, rbil sasaze, xaxis kedelze, odnav zedapiruli mdebareobisaa, magram
male, Cirqovani gadagvarebis Semdeg, ukve arazedapiruli mdebareobis saxe aqvs, aramed
TiTqos imyofeba ramdenadme siRrmeSi. nadebebis zedapiri gamoiyureba, rogorc `gamdnari
qoni~, maT qveS mdebare lorwovani garsebi ki hi peremiuli da SeSupebulia. daavadebis
2-3 dRidan enis dvrilebis SiSvldeba da gamovlindeba `Jolosebri~ enis simptomi _
ena mkveTrad gawiTlebulia 2 kviris manZilze.
300
kerZo nawili.
gulsisxlZarRvTa sistemis mxriv daavadebis dasawyis periodSi pulsi

aCqarebulia, arteriuli wneva momatebuli, me-4-5 an mogvianebiT dReebSi ki pulsi
Rebulobs Senelebul xasiaTs, xSirad aritmiuli xdeba, wneva ecema normamde an normis
qvemoT, gulis sazRvrebi gadidebulia, moismineba sistoluri Suili, meore tonis
aqcenti filtvis arteriaze. ekg-ze vlindeba bradikardia da aritmia.
gulis mxriv cvlilebebi pirvelad aRwera Í\ Ô\ Ôèëàòîâ-ma saxelwodebiT
`qunTruSiseburi guli~. SemdgomSi dadginda, rom aRniSnul cvlilebebs safuZvlad
udevs eqstrakardiuli darRvevebi da mxolod erTeul SemTxvevebSi viTardeba
miokardiumis dazianeba. aseTi cvlilebebi gulis mxriv grZeldeba 1 Tvidan an 2-3
Tvemde da bolos mTlianad qreba.
saWmlis momnelebeli traqtis mxriv, garda ukve aRniSnuli cvlilebebisa (Rebineba,
nadebiani ena da sxva), adgili aqvs RviZlisa da elenTis gadidebas. RviZli zomieradaa
gadidebuli da mgrZnobiarea palpaciis dros. igi aRiniSneba umetesad daavadebis me-
5-6 dRes da dakavSirebulia intoqsikaciasTan, aseve gulsisxlZarRvTa sistemis funqciur
cvlilebebTan. RviZlis gadidebis dros kanis safarvels gadahkravs odnav moyviTalo
elferi, sisxlSi bilirubini mcired momatebulia, agreTve mcired momatebulia RviZlis
fermentebi, SardSi - urobilini. elenTis gadidebac dakavSirebulia daavadebis simZimesTan
- toqsikur-sefsisur movlenebTan.
damaxasiaTebeli cvlilebebi gvxvdeba periferiul sisxlSi sisxlSi. pirvelsave
dReebSi aRiniSneba leikocitozi neitrofiloziT, marcxniv gadaxriT, zogjer
mielocitebamde. cvlilebebis intensivoba, agreTve damokidebulia toqsikur-sefsisur
procesebze. SeiZleba iyos xarisxobrivi cvlilebebi leikocitebis mxriv, rac gamoixateba
maT vakuolizaciasa da toqsikur marcvlovanebaSi. eds momatebulia. daavadebis me-3
dRidan SeimCneva eozinofilia, romelic aRwevs 15-20%-s, mZime periodSi SeiZleba
eozinofilebi mTlianad gaqres da mxolod gamojanmrTelebis periodSi daubrundes
normis farglebs.
Sardis mxriv xSirad vlindeba cila (kvalis saxiT), Seucvleli eriTrocitebi.
klasifikacia eyrdnoba daavadebis ti pur gamovlinebasa da mis mimdinareobas.
qunTruSis klasifikacia
(À\ À\ Êîëòûïèí)
tipi simZime mimdinareoba

1. msubuqi formebi, saSualo 1. alergiuli talRebisa da
I. tipuri formebi simZimeSi gardamavali. garTulebis gareSe
2. saSualo simZimis formebi,
2. alergiuli talRebiT
mZimeSi gardamavali
3. mZime formebi 3. garTulebebiT
a) toqsikuri a) alergiuli xasiaTis
(nefriti, sinoviti, reaqtiuli
limfadeniti).
b) sefsisuri b) Cirqovani
g) toqsikur-sefsisuri g) septikokiemiiT.
4. abortuli mimdinareoba
II. atipuri formebi:
1. waSlili
2. formebi agravirebuli
simptomebiT (hipertoqsikuri,
hemoragiuli).
III. gviani Semosvla
301
kerZo nawili.
ti puri formebi Tavis mxriv iyofa msubuq, saSualo da mZime mimdinareobis formebad.
msubuqi forma SeiZleba gadavides saSualo simZimeSi, xolo ukanaskneli - mZimeSi.
daavadebis simZimis Sefaseba eyrdnoba adgilobrivi da zogadi movlenebis maCveneblebs.
msubuqi mimdinareobis dros saerTo intoqsikacia gamoxatuli ar aris, sxeulis
temperatura ar aRemateba 38,50 C, saerTo mdgomareoba sustadaa darRveuli, angina
kataruli xasiaTisaa. gamonayari kanze Tumca ti puria, magram mkrTali da iSviaTia
(mwiria). temperaturuli reaqcia da saerTo movlenebi 4-5 dReSi qreba. bolo aTeuli
wlebis ganmavlobaSi Tanamedrove qunTruSa swored aseTi formiTaa cnobili, rac
mniSvnelovnadaa ganpirobebuli antibiotikebis epoqiTa da gansakuTrebiT penicilinis
preparatebis gamoyenebiT.
saSualo simZimis dros temperatura aRwevs 390 C da mets, gamoxatulia zogadi
intoqsikaciis movlenebi - saerTo sisuste, Tavis tkivili, ganmeorebiTi Rebineba. aseTi
mimdinareobisas toqsikuri da sefsisuri simptomebis xangrZlivoba ar aRemateba erT
kviras. Tumca sxvadasxva saxis garTulebebi ufro xSiria, vidre msubuqi formebis
dros.
mZime mimdinareobisas arCeven sam formas formas: 1) toqsikurs, roca gamoxatulia
saerTo intoqsikaciis suraTi, 2) sefsisurs, roca saxezea sefsisuri kerebi da 3)
toqsikur-sefsisurs, sadac Serwymulia toqsikuri da sefsisuri simptomatika.
mZime toqsikuri mimdinareobisas daavadeba iwyeba uecrad, mZafrad, temperatura
aRwevs 40-410 C, ganmeorebiTi Rebineba grZeldeba 2-3 dRes. avadmyofi agznebulia an
piriqiT, daTrgunuli, bodavs, goneba dabindulia, aqvs krunCxvebi, saxezea meningealuri
movlenebi. viTardeba sisxlZarRvTa mwvave ukmarisoba, rac simpatikuri nervuli sistemis
pareziTaa ganpirobebuli. gamonayris feri ufro mkrTalia, gadakravs cianozuri elferi,
TeTri dermografizmi ar iwveva an sustadaa gamoxatuli.
mZime sefsisuri forma xasiaTdeba saerTo sefsisuri suraTiT, kerovani Cirqovani
anTebiT, intoqsikaciis movlenebi ki ukana planze iwevs. mkveTradaa gamoxatuli nekrozuli
angina. nekrozuli procesi SeiZleba gavrceldes piris RruSi, cxviris danamat RruebSi.
viTardeba iseTi sefsisuri gamovlinebani, rogorociaa regionuli limfuri kvanZebis
Cirqovani anTeba, Cirqovani angina da sxva regionebSi mZime sefsisuri kerebis Camoyalibeba
saTanado saerTo sefsisuri suraTiT.
daavadebis mZime toqsikur-sefsisuri mimdinareobisas pirvel 3-5 dRes wina
planze wamoweulia organizmis mZimed mimdinare saerTo intoqsikacia, xolo Semdgom
vlindeba sefsisuri kerebi, rac, Tavis mxriv, ganapirobebs Sesabamis klinikur suraTs.
iSviaT formebs miekuTvneba qunTruSis mimdinareoba agravirebuli simptomebiT -
hipertoqsikuri (SeiZleba ganviTardes toqsikuri Sokis sindromi _ sklerebis inicirebiT,
diareiT, saerTo mZime mdgomareobiT da daavadeba sikvdiliT damTavrdes) da hemoragiuli
forma, romelTa drosac procesi imdenad mZafrad da elviseburad yalibdeba, rom
sikvdili viTardeba daavadebis damaxasiaTebeli ti puri simptomebis gamovlinebamde.
daavadebis pirvelsave dRes avadmyofebi xvdebian saavadmyofoSi meningitis,
meningoencefalitis, toqsikoinfeqciisa da sxva mZime klinikuri formebis suraTiT.
Semosvla. am dros kardinaluri simptomebi ar gamoixateba, rac
dagvianebuli Semosvla
daavadebis bunebis dadgenas aZnelebs. SesaZlebelia, ganviTardes mogvianebiTi periodisaTvis
damaxasiaTebeli rogorc alergiuli, ise sefsisuri genezis garTulebani. didi mniSvneloba
eniWeba anamnezur monacemebs (Cveneba anginaze, gamonayarsa da a.S.). am SemTxvevaSi
garkveuli mniSvneloba aqvs gansakuTrebul dasayrden sadiagnostiko simptoms - kanis
firfitisebr aqercvlas.
garTulebebi sefsisuri an alergiuli xasiaTisaa. pirveli dakavSirebulia
uSualod streptokokebTan, meore ki maT antigenur TvisebebTan. garTuleba SeiZleba
302
kerZo nawili.
Camoyalibdes daavadebis rogorc adreul, ise mogvianebiT periodSi. adreuli

garTulebebidan xSiria limfadeniti, otiti, nekrozuli angina da sxva. kataruli
angina regionul limfadenitTan erTad warmoadgens qunTruSis aucilebel atributs.
limfadeniti reaqtiuli genezisaa da anginis CamTavrebasTan erTad cxreba. Tumca
anTebiTma procesma SeiZleba ganicados progresireba da miiRos Cirqovani, nekrozuli
mimdinareoba. limfuri kvanZebi daCirqebisas mniSvnelovnad diddeba, zogjer viTardeba
periadeniti. nekrozuli procesis dros xdeba mTeli limfuri kvanZebisa da kanqveSa
qsovilis procesSi CaTreva, xolo mZime mimdinareobisas mkvrivi, merqniseburi flegmonis
Camoyalibeba, romelsac axasiaTebs danekrozebuli adgilebis Camocileba, Sesabamisi
kunTebisa da sisxlZarRvebis gaSiSvleba. nekrozuli angina, Cveulebriv, lokalizdeba
simetriulad nuSurebsa da naqis fuZeze. xSirad gadadis rbil sasaze, saylapavis ukana
kedelze, xorxze da zogjer, saylapavzec. Rrma nekrozebis mocilebis adgilas rCeba
qsovilebis defeqti.
xSirad mcire asakis bavSvebSi garTulebebis saxiT gvxvdeba mastoiditi, meningiti,
otiti, venuri sinusis Trombozi, tvinis abscesi. nekrozuli anginis procesis gavrcelebam
zogjer SeiZleba ganapirobos cxviris Rrus danamatebis anTebiTi movlenebi, kerZod,
pansinusiti. yvela am Cirqovan-nekrozul process SeuZlia, gamoiwvios iseTi garTulebebi,
rogoricaa septicemia, septikopiemiuri kerebis Camoyalibeba, maTi metastazebiT saxsrebSi,
nebismier Sinagan organoSi.
alergiuli garTulebebi zogjer daavadebis adreul periodSive (10-11 dReSi)
viTardeba, ufro mogvianebiT ki me-2-3 kviras. maT miekuTvneba limfadeniti, sinusiti,
nefriti. am bolo dros nefriti iSviaTad viTardeba, xolo ganviTarebisas, misi
prognozi Cveulebriv, keTilsaimedoa.
recidivis sixSire sxvadasxva avtorTa monacemebiT meryeobs 0,4%-4%-mde, rac
aixsneba recidivebis gamovlinebis araerTgvarovani SefasebiT. recidivSi saWiroa
vigulisxmoT qunTruSisaTvis damaxasiaTebeli ZiriTadi dawyebiTi simptomebis sruli
gamovlineba da ara calkeuli niSani, rogoricaa angina an limfadeniti. recidivebi
dakavSirebulia streptokokebis re- an superinfeqciasTan. didi mniSvneloba eniWeba
agreTve organizmis alergiul mdgomareobas, imunur statussa da sxva iseTi infeqciebis
darTvas, rogoricaa mwvave respiraciuli virusuli infeqciebi, Cutyvavila da sxva.
amave dros saWiroa gamoiricxos `qunTruSismagvari~ daavadebebi: stafilokokuri,
enterovirusuli, iersiniozuli da sxva infeqciebi.
gamosavali. Tanamedrove qunTruSa 90%-Si ioli formebiT mimdinareobs, Cirqovani
garTulebebis gareSe. Tanmxlebi daavadebebis arsebobisas, rogoricaa qronikuli
tonziliti, revmatizmi qunTruSis rekonvalescenciis periodSi bavSvebs xSirad
aReniSnebaT subfebriluri temperatura, revmatizmis gaaqtiveba da sxva garTulebebi.
letaloba qunTruSis dros TiTqmis nulamdea dayvanili (misi maCvenebeli procentis
measedebs Seadgens).
qunTruSa wlamde asakis bavSvebSi. axalSobilebSi daavadeba iSviaTia, rac
ganpirobebulia dedisagan transplacenturad gadacemuli imunitetiT, magram wlis
meore naxevarSi imuniteti ecema. wlamde asakis bavSvebSi daavadebisaTvis damaxasiaTebelia
toqsikuri sindromis susti gamovlineba, angina, Cveulebriv, kataruli xasiaTisaa, gamonayari
kanze sustadaa gamovlenili, TviTon kanic sustad hi peremiulia, iSviaTia `Jolosebri~
ena, kanis aqercvla yovelTvis ar xdeba. miuxedavad susti klinikuri gamovlinebebisa,
axalSobilebs xSirad aReniSnebaT sefsisuri garTulebebi (Cirqovani otiti, limfadeniti,
sefsisuri kerebi Sinagan organoebSi), mwvave respiraciuli virusuli infeqciis fonze
xSiria garTulebebi pnevmoniis saxiT, rac mniSvnelovanwilad gansazRvravs daavadebis
gamosavals.
303
kerZo nawili.
diagnozi qunTruSis klinikuri suraTis mTlianad gaSlis dros ar warmoadgens

raime siZneles, rac ar iTqmis, kardinaluri simptomebis sustad gamoxatvis dros. am
ukanasknel SemTxvevaSi yuradReba maxvildeba simptomebis kvalis aRmoCenaze, rogoricaa
kanis naoWebis `najeroba~, gamuqeba, romelic ufro didxans narCundeba, vidre gamonayari.
yuradReba eqceva, agreTve, sxva adgilebSi (kiserze, iRliis midamoSi) peteqiebis arsebobas,
`Jolosebr~ enas, kanis simSrales, yuris bibiloebisa da kisris midamos adreul
aqercvlas, mogvianebiT periodSi ki (2-3 kviris Semdeg) kidurebze Cndeba firfitisebri
aqercvla da bolos, mniSvnelovania daavadebis anamnezisa da epidsituaciis Sefaseba.
gamoiyeneba laboratoriuli meTodebi, romelic aRwerilia streptokokuri infeqciis
diagnostikis nawilSi.
diferenciuli diagnozi tardeba iseT daavadebebTan, rogoricaa wiTela, wiTura,
stafilokokuri infeqcia, iersiniozi (fsevdotuberkulozi da nawlavTa iersiniozi),
medikamenturi alergia, `nasicxi~ axalSobilebSi.
wiTela qunTruSisagan gansxvavdeba misTvis damaxasiaTebeli zemo sasunTqi gzebis
katariT, gamonayris etapuri ganviTarebiT, piris RruSi prodromul periodsa da
gamonayris pirvel dReebSi belski-filatov-koplikis leqebis arsebobiT. kanze gamonayari
Tavidan wvrilia, SemdgomSi ki msxvil makulur-papulur xasiaTs Rebulobs, araswori
formisaa, aqvs Serwymisadmi midrekileba, kani gamonayar elementebs Soris normaluri
ferisaa. Semdgom gamonayris gaqrobis kanze rCeba laqovani pigmentacia da iwyeba
qatosebri aqercvla. periferiul sisxlSi aRiniSneba leikopenia, neitropenia.
wiTuras dros gamonayari viTardeba daavadebis gamovlinebis pirvelsave dRes, igi
wiTeli ferisaa, wvrillaqovania, upiratesad ganlagebulia kidurebis gamSlel mxareebze.
damaxasiaTebelia mikropoliadeniti, gansakuTrebiT gadidebuli da mtkivneulia kefisa
da kisris ukana limfuri kvanZebi. periferiul sisxlSi naxuloben leikopenias,
neitropenias, plazmuri ujredebis momatebas.
stafilokokuri infeqciis dros yuradReba unda gamaxvildes qunTruSisebur
gamonayarTan erTad Cirqovani kerebis arsebobaze (limfadeniti, osteomieliti da
sxva).
iersiniozuli infeqciis dros piris RruSi qunTruSisaTvis damaxasiaTebeli
mkveTri hi peremia, Semofargluli angina, kanze ki naoWebis `gajereba~ ar aRiniSneba.
gamonayari fsevdotuberkulozis dros polimorfulia da Cndeba Cveulebrivi
kanis fonze. avadmyofebs aReniSnebaT e.w kapiuSonis, windebis, xelTaTmanebis simptomebi,
uCivian muclis tkivils, viTardeba hepatolienuri sindromi. nawlavTa iersiniozis
dros damaxasiaTebelia klinikis polimorfizmi, sefsisuri suraTi, kuW-nawlavis mxriv
_ xSiri defekacia, ganavali Seicavs lorwos, zogjer sisxls, momwvano ferisaa.
gamonayari wiTuris an qunTruSis msgavsia, magram xSirad lokalizdeba saxsrebis
irgvliv da aqvs laqovan-papuluri xasiaTi. hepatolienuri sindromis dros viTardeba
siyviTle arapirdapiri bilirubinemiis xarjze. mxedvelobaSia misaRebi daavadebis
jgufobrivi SemTxvevebi, dgindeba saerTo sargebloba wyliTa da sakvebi faqtorebiT.
daavadebis diagnozis dadgenaSi gadamwyveti roli eniWeba sisxlisa da piris Rrus
gamonarecxis baqteriul gamokvlevasa da serologiur reaqciebs (aglutinaciis,
preci pitaciis, komplementis SeboWvis, pasiuri aglutinaciis, hemaglutinaciis
damuxruWuebis reaqciebs).
toqsikuri qunTruSis dros aucilebelia Cirqovani meningitis arsebobis
mxedvelobaSi miReba, rac moiTxovs liqvorologiuri gamokvlevebis Catarebas.
ZuZumwovar bavSvebSi diagnozis SeSlis mizezi xSirad xdeba nasicxi gamonayari.
qunTruSisgan gansxvavebiT kani am dros naklebad hi peremiulia, gamonayari kvanZovani
xasiaTisaa da misi intensivoba organizmis gaTbobis Sesabamisad matulobs, gacivebisas
304
kerZo nawili. qunTruSa
streptokokuri infeqciebi. wiTeli qari
ki iRebs mkrTal fers. qunTruSisaTvis damaxasiaTebeli xaxisa da enis cvlilebebi am

dros ar aRiniSneba. kanis hi peremiis mizezi zogjer medikamenturi malamoebis xmareba
xdeba, rac anamneziT advili dasadgenia.
mkurnaloba. penicilini streptokokuri infeqciis mkurnalobaSi asarCev prepats
warmoadgens, radgan mis mimarT hemolizuri streptokokebis mgrZnobeloba maRalia.
penicilinTerapiiT SeiZleba Tavidan aviciloT rogorc sefsisuri garTulebebi, aseve
revmatuli mimdinareoba da glomerulonefriti. mkurnalobis xangrZlivoba 10 dRes
Seadgens.
mZime SemTxvevaSi mizanSewonilia penicilinis gamoyeneba ineqciebis saxiT kunTebSi.
msubuqi da saSualo simZimis dros preparati rekomendebulia 30 000-50 000 erT/kg
or gakeTebaze 10 dRe an bicilinis erTi ineqcia kursze. rac Seexeba sefsisur
formebs, penicilini iniSneba aranakleb 100 000-200 000 erT/kg (dRe-Ramis doza) 4
Seyvanaze, ufro xangrZlivad Tu saWiroa.
toqsikuri formebis dros saWiro xdeba dezintoqsikaciuri Terapiis Catareba
_ ringeris laqtatis, reopoliglukinis, glukozis 5-10%-iani xsnaris, vitaminebisa
intravenuri gadasxma, Cvenebis mixedviT sagule glikozidebis (digoqsinis) gamajerebeli
dozebiT Seyvana da dopaminis gamoyeneba.
saxlis pirobebSi ufro mosaxerxebelia fenoqsimeTilpenicilinis (penicilini V)
per os daniSvna, magram am SemTxvevaSi sasurvelia dozis gaormageba saineqcio penicilinTan
SedarebiT dReSi 3-4 miRebaze dozis gaTvaliswinebiT.
penicilinis garda gamoiyeneba sxva antibaqteriuli preparatebic, maT Soris -
farTo speqtris. rac Seexeba sulfanilamidebs, maTi gamoyeneba naklebad sasurvelia,
radgan isini naklebad efeqturia.
profilaqtika. specifikuri profilaqtika qunTruSis sawinaaRmdegod SemuSavebuli
ar aris.
avadmyofis saavadmyofodan gawera xdeba klinikuri Cvenebis da garTulebis mixedviT.
avadmyofi infeqciis gadamdebi aRar aris antibiotikis daniSvnis Semdeg ukve 24
saaTSi.
daavadebis keraSi daskvniTi dezinfeqcia ar tardeba.
wiTeli qari
(ERYSIPELAS)
wiTeli qari streptokokuri infeqciis erT-erT klinikur formas warmoadgens,

xasiaTdeba kanisa da kanqveSa cximovani qsovilebis serozul-eqsudaciuri anTebiT,
cxelebiT, organizmis saerTo intoqsikaciiT.
laTinuri saxelwodeba Erysipelas warmoiSva ori berZnuli sityvisagan: Erythes
_ wiTeli da pelas _ kani _ wiTeli kani.
wiTeli qari antibiotikebis eramde Zlier gavrcelebul infeqcias warmoadgenda,
mimdinareobda mZime sefsisuri garTulebebiT da, Cveulebriv, miekuTvneboda qirurgiul
daavadebebs. penicilinis praqtikaSi danergvis Semdeg daavadebis gavrceleba ufro
Semofargluli gaxda da naklebadac xasiaTdeba Cirqovani garTulebebiT. mkveTrad
daeca letalobis maCvenebeli, Tumca jer kidev mZime mimdinareobiT xasiaTdeba,
gansakuTrebiT axalSobilebSi, roca kanis dazianebis procesi progresirebs. am dros
daavadebis mimdinareoba iseTi mZafri xdeba, rom Seyvanili penicilini verc ki aswrebs
Terapiul zemoqmedebas, ise viTardeba letaluri gamosavali.
305
etiologiur momentad iTvleba A jgufis hemolizuri streptokokis nebismieri

serologiuri varianti. daavadebis ganviTarebaSi did mniSvnelobas aniWeben organizmis
Tavisebur midrekilebas, ganwyobas. yvelaze metad es exeba axalSobilebsa da kvebis
darRveva-daqveiTebis an eqsudaciuri diaTezis mqone bavSvebs.
epidemiologia. infeqciis wyarod iTvleba streptokokuri infeqciiT daavadebuli
epidemiologia
nebismieri avadmyofi da streptokokebis mtarebeli.
paTmorfologia. daavadebis paTogenezi arasakmarisadaa
Seswavlili. arsebobs streptokokebis kanSi SeWris egzogenuri da endogenuri Teoria.
pirvelis Tanaxmad, kanSi gamomwvevi agentis SeWra xdeba garedan, xolo meore Teoriis
mixedviT _ endogenuri kerebidan, romlebic ukve arseboben organizmSi. Tumca orive
SemTxvevaSi wamyvan rols TamaSobs organizmis daavadebisadmi Taviseburi midrekileba.
miRebulia Sexeduleba, rom streptokoki SeiWreba kanis limfur ZarRvebSi da
iwvevs serozul anTebiT process, viTardeba SeSupeba, hi peremia da wvrilkerovani
infiltracia. streptokokuri toqsini iwvevs arteriits, flebits, SesaZloa limfuri
ZarRvebis daTrombva, SemaerTebeli qsovilis ganviTareba da limfostazis warmoSoba.
wiTeli qaris centralur nawilSi eqsudati steriluria, xolo mis periferiebsa,
sasazRvro lilvaksa da janmrTel kanzec streptokokebs didi raodenobiT naxuloben,
isini xSirad ujredSigniTac imyofebian.
limfuri kvanZebis barieris garRvevis dros streptokokebi iWrebian kanis Rrma
qsovilebSi, rac iwvevs kanqveSa abscesebs, baqteriemiis ganviTarebas, organizmSi metastazuri
Cirqovani kerebis Camoyalibebas.
cnobili rusi mecnieri B\ D\ Lfdsljdcrbq wiTel qars gansazRvravs, rogorc
organizmis Tavisebur reaqcias streptokokuri agentis mimarT, amave dros mTeli rigi
mecnierebisa _ V\ U\ Hfcrjdfkjd= D\ F\ Ghjcrehjd da sxvebi daavadebis etiologiur
rols aniWeben stafilokokur infeqcias, ris sasargeblodac laparakobs sisxlidan da
anTebiTi kerebidan stafilokokebis, maT Soris L- formebis xSiri gamoyofa, ∝-
antitoqsinis dadgena sisxlSi. gasaTvaliswinebelia travma, qronikuli kerebis gaaqtiureba,
medikamentebis gverdiTi moqmedeba, mzis radiacia da sxva organizmis saerTo da
adgilobrivi sensebilizaciis pirobebSi.
klinika. inkubaciuri periodi SeiZleba gagrZeldes ramodenime saaTi an dRe.
klinika
adgilobrivi anTebadi procesi viTardeba sxeulis
nebismier adgilas, maT Soris lorwovan garsebze,
rac bolo wlebSi ar gvxvdeba. yvelaze xSirad ki
viTardeba saxesa da wvivebze.
klasifikacia. arCeven anTebadi procesis
klasifikacia
pirvelad, meorad da morecidive formebs. anTebadi
procesis xasiaTis mixedviT ki _ eriTemul da
bulur formebs. buluri forma bolo dros TiTqmis
aRar gvxvdeba.
pirveladi wiTeli qari qari. daavadebisaTvis
damaxasiaTebelia uecari dawyeba, sxeulis
temperaturis momateba 39-400 C-mde. procesis
lokalizaciis adgilas Cndeba kaSkaSa hi peremia
pirveladi laqis saxiT, romelic swrafad diddeba,
misi kideebi kuwubiseburia, mkvrivi, TiTqos gamijnavs
wiTeli qari, eriTemuli forma
Sexorcebis stadiaSi, centrSi anTebad qsovils janmrTeli kanisagan (sasazRvro
aqercvla. lilvaki). anTebad keraSi kani mkvrivia da
(Í.È. Íèñåâè÷, Â.Ô. Ó÷àéêèí) mtkivneulia, mgrZnobeloba matulobs centridan
306
periferiisaken, regionuli limfuri kvanZebi gadidebuli, elastiuri da mtkivneulia,

gamoxatulia saerTo intoqsikaciis suraTi _ mousvenroba, bodvebi, Rebineba, pulsi
aCqarebulia, gulis tonebi moyruebuli. antibiotikiT mkurnalobis gareSe SesaZlebelia
saerTo mdgomareobis simZimisa da adgilobrivi procesis progresireba. Tumca umravles
SemTxvevaSi procesi regresirebs, temperatura xdeba normaluri da adgilobrivi
procesic ukuviTardeba _ SeSupebisa da hi peremiis gaqrobis Semdeg lokalizaciis
adgilze iwyeba kanis aqercvla. antibiotikebis daniSvnidan ramodenime saaTSi saerTo
mdgomareoba sagrZnoblad umjobesdeba, siwiTle mkrTaldeba, sasazRvro lilvaki qreba.
mTliani simptomatikis alageba xdeba 2-3 dReSi.
zog SemTxvevaSi mkurnalobis gareSe daavadeba progresirebs, viTardeba mcocavi,
metastazuri formebi, garTulebebi atarebs sesisur xasiaTs.
buluri forma xasiaTdeba dazianebul kanze buStukebis gaCeniT, romlebic serozul-
moyviTalo an, ufro mZime mimdinareobisas, hemoragiul SigTavss Seicavs. saerTo
intoqsikacia ufro gamoxatulia, vidre eriTemuli mimdinareobis dros.
recidivebis erTi da igive adgilas ganviTarebis SemTxvevebSi infeqciis qronikuli
xasiaTis miRebisas viTardeba kidurebis spilovneba (Elephantiasis). es garTuleba,
romelic antibiotikebis eramde xSirad gvxvdeboda, Tanamedrove pirobebSi iSviaTia,
rac sworad warmarTuli penicilinTerapiis Sedegia. xangrZlivi penicilinTerapiis
daxmarebiT SesaZlebeli xdeba streptokokebisagan kanis sruli sanacia, Tumca
gamoricxuli ar aris meoradi daavadeba streptokokuri reinfeqciis an superinfeqciis
xarjze.
periferiul sisxlSi wiTeli qaris ti pur cvlilebebs warmoadgens leikocitozi
neitrofiloziT da maRali eds.
difer enciul
diferenciul
enciuli diagnostika. emyareba ti pur simptomebs _ eriTemis swraf
i diagnostika
ganviTarebas, romelsac axasiaTebs sasazRvro lilvakis Camoyalibeba kuwubebiT,
limfadeniti da saerTo intoqsikaciis suraTi.
furunkulozis dros zogjer aRiniSneba maT irgvliv alisferi hi peremia, magram
am dros Semofargluli sasazRvro lilvaki ar yalibdeba.
sartyl isebur
sartylisebur
iseburiil iqenis dros (Herpes Zoster) yuradRebas i pyrobs jgufuri
liqenis
vezikuluri gamonayari calkeuli mgrZnobiare nervebis gaswvriv da sasazRvro lilvaki
amave dros ar aRiniSneba. periferiul sisxlSi damaxasiaTebelia leikopenia limfopeniiT.
wiTeli qari axalSobilebsa da wlamde asakis bavSvebSi bavSvebSi. axalSobilebSi
streptokokebis SeWrisa da wiTeli qaris lokalizaciis adgilia Wi pi. damaxasiaTebelia
procesis swrafi gavrceleba (1-2 dReSi) sasqeso organoebze, qvemo kidurebze, dundulebze,
zurgsa da mTels tanze. kanis hi peremia gamoxatuli ar aris, rogorc es SedarebiT
mozrdilebSi xdeba, naklebad reliefuria sasazRvro lilvaki. axalSobilebSi
damaxasiaTebelia mkveTrad gamoxatuli intoqsikacia, hi perTermia, krunCxviTi sindromi,
septikopiemiuri kerebi, peritoniti maRali letaluri maCvenebliT.
wlamde asakis bavSvebSic wiTeli qari mZimed mimdinareobs. pirveladi kera xSirad
lokalizdeba kanis gamoyelvis adgilas an saxeze. procesi swrafad vrceldeba (mcocavi
forma). SeiZleba ganviTardes flegmonuri forma sefsisis CamoyalibebiT an meningiti.
literaturaSi aRwerilia orsulobis periodis wiTeli qari, romlis drosac viTardeba
nayofis sefsisuri dazianeba.
mkurnaloba wiTeli qaris dros iseTivea, rogorc sxva streptokokuri klinikuri
formebisas. asarCev samkurnalo preparats warmoadgens penicilini Cveulebriv dozebSi
5-7-10 dRis ganmavlobaSi.
Terapiis Sedegad xanmokle droSi (2-3 dRe) qreba rogorc adgilobrivi, ise
307
saerTo movlenebi. organizmis mier penicilinis miuReblobis SemTxvevaSi SeiZleba

gamoviyenoT sxva preparatebi (ampicilini, oqsacilini) asakobrivi dozebis
gaTvaliswinebiT.
arsebobs monacemebi, rom kargi efeqtiT gamoirCeva antibiotikebisa da krioTerapiis
kombinirebuli gamoyeneba (anTebadi zedapiris qloreTiliT xanmokle gayinva hi peremiis
gafermkrTalebiT).
buluri formebis drosdros, roca intoqsikacia maRalia, saWiroa dezintoqsikaciuri
paTogenezuri Terapiis Catareba.
morecidive mimdinareobisas antibiotikis ramodenime kursTan erTad mimarTaven
fizioTerapiul saSualebebs _ ultraiisfer sxivebs, kvarcs.
profilaqtika. iseve, rogorc nebismieri streptokokuri infeqciis dros ar
profilaqtika
aris SemuSavebuli.
308
kerZo nawili. stafilokokuri infeqcia
stafilokokuri infeqcia
stafilokokuri infeqcia warmoadgens seriozul problemas bavSvebSi, gansakuTrebiT

ki wlamde asakisaTvis da aseve uxSires mizezs Sida infeqciebis ganviTarebaSi. iseTi
stafilokokuri infeqciebi, rogoricaa impetigo, furunkuli, Wrilobis infeqcia da
sxva SeiZleba gadaizardos generalizebul formaSi septicemiis saxiT da gaxdes
Zvlis tvinis, gulis, filtvebis, Tirkmlebis dazianebis mizezi.
bavSvebSi erT-erT mZime da seriozul mimdinareobad iTvleba septicemia da pnevmonia
(emfizemuri wyalmanki), empiema, pioToraqsi, iSviaTad gvxvdeba stafilokokuri sefsisi,
romelic klinikurad Zalian waagavs meningokokur sefsiss. stafilokokebis umravlesoba
mdgradia antibiotikebis mimarT, ufro metic, Tavisi biologiuri TvisebebiT gansxvavdebian
sxva gramdadebiTi kokebisagan. swrafad eguebian Secvlil situacias, swrafad vrceldebian,
ganicdian generalizacias. S. aureus-s pirdapiri mutaciis moqmedebisas mniSvnelovani
adaptogenurobis unari aqvs. SeuZlia genetikuri masalis transduqciuri gadacema
(genetikuri masalis gadacema baqteriofagiT erTi baqteriidan meoreze).
etiologia.. Staphylococcus berZnulad yurZnis mtevans niSnavs. mikrobi
etiologia
gramdadebiTia. arCeven stafilokokebis 3 ti ps _ S. aureus, S. epidermidis da S.
saprophiticus. S. aureus pasuxismgebelia adamianebSi daavadebis gamowvevaze, magram
SeiZleba Cveulebriv binadrobdes kansa da lorwovan garsebze. S. aureus-is Stamebis
identifikacia xdeba baqteriofagebiT ti pirebis meSveobiT (sul fagebis 5 jgufi). S.
epidermidis naklebad paTogenuria adamianisaTvis, vidre S. aureus, Tumca ukanasknel
dros izrdeba misgan gamowveul daavadebaTa raodenoba _ baqteriemia, endokarditi,
gansakuTrebiT dauZlurebul, dasustebul bavSvebsa da Tandayolili gulis mankis
mqone pirebSi. patara bavSvebSi aRiniSneba meningitis ganviTarebis maRali riski
Spina bifida-Ti, meningomioceleTi, hidroceleTi daavadebul bavSvebSi da sxvadasxva
saxeobis cerebrospinuri Suntebis dros. ati puri S. epidermidis iwvevs axalgazrda
qalebis Sardsadenebis anTebas. bolo wlebSi es ati puri stafilokoki
reklasificirebul iqna, rogorc S. saprophyticus.
S. aureus-is baqteriis kedeli Seicavs peptidoglikans (igi iwvevs IL-1 produqcias
monocitebiT da ganapirobebs cxelebis gamovlinebas), teiqois mJavasa da A proteins.
protein A-s didi msgavseba aqvs imunoglobulinebis Fc fragmentTan, romlis meSveobiTac
igi IgG–sTan reagirebs. Sedegad xdeba IgG aglutinacia da komplementiT fiqsacia.
stafilokokebis zogierTi ti pi warmoSobs kafsulas, iwvevs fagocitozis Senelebas
da did rols TamaSobs daavadebis generalizaciaSi.
mZime avadmyofebSi didi mniSvneloba eniWeba antisxeulebis titris dadgenas
teiqois mJavis mimarT, romelic baqteriuli ujredis umniSvnelovanesi komponentia.
koagulacia.. S. aureus-is ti pebi paTogenuria adamianisaTvis, kargad izrdeba
koagulacia
sisxlian niadagze, afermenteben manits, gamoimuSaveben ramdenime ferments, toqsinsa da
hemolizinebs, aqedan fermenti koagulaza yvelaze ufro damaxasiaTebelia oqrosferi
stafilokokisaTvis., rac ar aReniSneba epidermul stafilokoks. koagulazas unari
aqvs, gamoiwvios plazmis Sededeba. koagulacia ganpirobebulia Semdegi faqtorebis
kombinirebuli moqmedebiT: 1) koagulaziT, romelsac warmoqmnis stafilokoki, 2)
koagulaza-mastimulirebeli substanciiT, romelic gaaCnia adamiansa da bevr cxovels.
am ori faqtoris urTierTqmedeba iwvevs Trombinis msgavsi nivTierebis produqcias da
amiT fibrinogenis fibrinad gardaqmnas.
eqsperimentul cxovelebs, romlebsac ar gaaCndaT plazmis koagulaza-mastimulirebeli
309
faqtori, koagulazapozitiuri stafilokokiT dasnebovneba iSviaTad iwvevda maTSi

procesis Camoyalibebas abscesad. koagulaciis roli daavadebis paTogenezSi naTeli
ar aris.
toqsinebi.. stafilokokebi gamoimuSaveben sxvadasxva toqsins. zogs aqvs, agreTve,
toqsinebi
substanciebi _ teiqois mJavis peptidoglikanuri kompleqsi ujredis kedlebSi, romelsac
axasiaTebs endotoqsinis Tvisebebi da did rols TamaSobs infeqciis klinikur
mimdinareobaSi.
aRwerilia 6 enterotoqsini (A-dan F-mde), romlebic aRmoCnda dainficirebul
sakvebSi. dadasturebulia maTi roli mwvave gastroenteritebis ganviTarebaSi.
enterotoqsin F-s aseve SeulZlia toqsikuri Sokis sindromis gamowveva. aRwerili
iyo eqsfoliaciuri toqsini (1973 Melish da Tanaavtorebi) romelic gamomuSavdeba
koagulomaproducirebeli stafilokokebis meore jgufis fagiT. am toqsins SeuZlia
gamoiwvios daavadebebi, romlebic xasiaTdeba Semdegi niSnebiT: 1) e.w. “daTuTquli”
kanis, damwvrobis sindromi _ generalizebuli eqsfoliaciuri dermatiti mcire asakis
bavSvebSi (Ritter-is daavadeba), 2) toqsikuri epidermuli nekrozi (Lyell-is daavadeba),
3) lokaluri buluri impetigo, 4) stafilokokuri qunTruSasmagvari daavadeba. toqsini
arCeviTad moqmedebs epidermisis marcvlovani Sreebis ujredebze, maSin, rodesac kanis
sxva ujredebi procesSi ar aris CarTuli.
sxva fermentebi. stafilokokebi warmoSoben sxva ujredgare fermentebsac.
leikocidini producirdeba yvela paTogenuri oqrosferi stafilokokis mier. igi
moqmedebs fagocitis membranaze da iwvevs cilis destruqcias. stafilokinaza
(fibrinolizini) yvelaze ufro paTogenuri, koagulaciis unaris mqone
stafilikokebisaTvisaa damaxasiaTebeli. streptokinaza uzrunvelyofs Sededebuli
plazmis daSlis process. @@@@
egzotoqsinebSi _ hemolizinebSi arCeven 4 ti ps _ alfa, beta, gama da delta,
romlebsac warmoqmnian sxvadasxva ti pis stafilokokebi. yvelaze ufro mniSvnelovania
alfa _ hemolizini, romelic Tavisi moqmedebiT nekrozuli toqsinis _ hialuronidazas
identuria. am toqsins uwodeben gamavrcelebel faqtorsac, mas gamoyofen stafilokokebis
90%.
kargad aris cnobili, rom stafilokokebis rezistentobas penicilinis mimarT
iwvevs penicilinaza, romelic axdens penicilinis inhibirebas hidrolizis meSveobiT.
baqter iafagoti pir
baqteriafagoti eba. stafilokokebis identifikacia gadawyvetili iyo
pireba.
baqteriati pirebiT. meTodi mdgomareobs agarze staflokokebis daTesvaSi. agaris
zedapirze Tavsdeba mcire raodenobis fagi da xdeba aRniSnuli nimuSebis inkubacia,
ris Semdegac Sexebis adgilas aRiniSneba stafilokokebis lizisi. stafilokokebis
ti pirebisaTvis rekomendebuli iyo 19 ZiriTadi fagi, romlebic dayofili iqna 5
ti pad _ I, II, III, IV da Sereuli. yovel maTgans gaaCnda Taviseburebani, ase, mag., II
jgufis stfilokokebis kultura ar iSleboda sxva jgufis fagebiT. mxolod
koagulazamaproducirebel stafilokoks SeuZlia fagebis ti pireba.
paTogenezi da paTanatomia. stafilokoki yvelgan gavrcelebuli mikrobia. igi
adamianis normaluri mikrofloris, kanis, respiraciuli da kuW-nawlavis traqtis
mobinadrea. janmrTel adamianTa 15%-s cxvir-xaxaSi aReniSnebaT mikrobis arseboba.
Stamebis paTogenuroba damokidebulia toqsinebisa da fermentebis kombinirebul efeqtsa
da maT individualobaze. mag., SesaZlebelia abscesis ganviTareba kanSi mikrobis SeWris
adgilas. stafilokokebi am dros mravldebian adgilobrivad da gamoyofen toqsins,
romelic zrdis dazianebuli qsovilebis ganvladobas da amiT xels uwyobs mikrobis
gavrcelebas. SeWris adgilas aRiniSneba plazmis eqsudacia da didi raodenobiT
granulocitebis migracia. mikrobis invaziis Sedegad swrafad viTardeba qsovilebis
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nekrozi da destruqcia, sisxlZarRvTa Trombozi fibrinis warmoSobiT. dazianebis

adgilas aRiniSneba didi raodenobiT plazmis dagroveba da fagocitebis Tavmoyra.
adgilobrivi procesis centrSi ki yalibdeba nekrozuli zona, romelic Sevsebulia
mkvdari da momakvdavi leikocitebiTa da mikrobebiT da sxva qsovilebisagan
gancalkevebulia demarkaciuli xaziT _ fibroblasturi kedliT, romelzec naxuloben
sicocxliunarian leikocitebsa da baqteriebs. mkurnalobis gareSe abscesi SeiZleba
TviTon gaixsnas, moxdes misi drenireba da ganikurnos.
fibroblastebis barieri icavs organizms infeqciis gavrcelebisagan. yovelgvarma
travmam, romelic daarRvevs am bariers da agreTve furunkulis adreulma gakveTam
SeiZleba xeli Seuwyos baqteriemias. mkvlevarebis mier dadgenili iyo, rom stafilokokebs
SeuZliaT SeinarCunon sicocxle adamianis da bocvris leikocitebisa da monocitebis
citoplazmaSi fagocitirebis Semdeg, riTac SeiZleba nawilobriv aixsnas stfilokokebis
rezistentoba antibiotikebis mimarT; am meqanizms SeuZlia, xeli SeuSalos makroorganizms
mikrobebis ganadgurebaSi. damtkicebulia, rom ti puri, Semofargluli, Raribi
sisxlZarRvovani qselis mqone dazianeba xasiaTdeba: 1) antisxeulebis raodenobis
simciriT, 2) infeqciis persistenciiT, 3) antimikrobuli saSualebebis uefeqtobiT in
vivo, Tumca in vitro maT maRali aqtivoba aReniSnebaT. Cans, rom antimikrobuli preparatebi
gadian bariers qsovilovani siTxis meSveobiT da maSin aRweven stafilokokebs.
Sratis cilebs da sxva qsovilovan substanciebs antimikrobul agentze SeuZliaT
moaxdinin mniSvnelovani gavlena da Seaferxon antimikrobuli preparatis efeqti.
aRmoCnda. rom adgilobrivi anTebadi procesis zonaSi adgili aqvs rZis mJavas
koncentraciis zrdas. glukozis done mkveTrad ecema da didi raodenobiT ixarjeba
Jangbadi, gamoiyofa CO2, pH klebulobs. SeiZleba vivaraudoT, rom aseTi Zlieri
fiziologiuri cvlilebebi dazianebis adgilas antimikrobul-parazituli kavSirebis
Sedegia. abscesSi SesaZlebelia antimikrobuli preparatebis inaqtivacia, garda amisa,
abscesis SigniT stafilokokebi rezistentuli xdebian. baqteriebma abscesSi SeiZleba
Sewyviton zrda mikroorganizmebis didi raodenobisa da metaboluri procesebis
Sedegad. antimikrobuli preparatebi, romlebsac SeuZliaT ujredis sinTezze zemoqmedeba
am SemTxvevaSi naklebad efeqturia. isini mcire efeqts iCenen im mikrobebze, romlebic
ar mravldebian.
maspinZlis (makroorganizmis) faqtorifaqtori.. cnobilia stafilokokuri infeqciis
mimarT winaswarganwyobis zogierTi faqtori. magaliTad, SeiZleba iTqvas, rom diabeti
da stafilokokuri infeqcia mxardamxar arseboben.
kvebis mZime darRveva, kanis barieruli funqciis moSla ganapirobebs stafilokokuri
infeqciis ganviTarebas. kaTeterebi, ucxo sxeulis arseboba, instrumentuli Careva
xels uwyoben stafilokokur baqteriemias. stafilokokuri infeqcia virusuli infeqciis
fonze SeiZleba meorad xasiaTs atarebdes (mag., Cutyvavilas dros). kortikosteroidebis
miReba, agreTve iseTi daavadebebi, rogoricaa qronikul granulomatozi da leikocitebis
sxva funqciuri defeqtebi aseve ganawyobs organizms am infeqciisadmi.
imuniteti. Tumca janmrTel adamianTa umravlesobas sisxlis SratSi aReniSneba
antisxeulebi stafilokokebis sxvadasxva antigenuri komponentebis _ toqsinebisa da
fermentebis mimarT, vlindeba arasakmarisi koreqcia antisxeulebsa da imunitets
Soris.
antisxeulebi nakleb rols TamaSoben, vidre organizmis dacvis nebismieri sxva
faqtori. mikrobebis zemoqmedebas kontrols uwevs araspecifikuri fagocitozi
polinuklearuli leikocitebiT. avadmyofebi, romlebsac ara aqvT dasrulebuli
fagocitozis unari mag., granulomatozis dros, warmoadgenen riskis jgufs.
asakTan dakavSirebiT stafilokokuri infeqciis klinikuri suraTi icvleba. mag.,
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lokalizebuli abscesebi ufro

xSirad gvxvdeba mozrdilebSi,
xolo iseTi seriozuli formebi,
rogoricaa stafilokokuri
pnevmonia, empiema, septicemia, ufro
xSiria bavSvebSi.
preantibiotikur periodSi
stafilokokuri pnevmonia iSviaTi
iyo mozrdilebSi da Cveulebrv
viTardeboda gri pis Semdeg.
klinikuri suraTi
damokidebulia dazianebis
adgilze (stafilokokis SeWris
stafilodermia. adgilze). erTi da igive
marcxena orbitaluri aris
(sakuTari masala) stafilokokuri etiologiis stafilokoks SeuZlia, gamoiwvios
celuliti. marcxena Tvalis rogorc furunkuli,
proftozi (gamoweva) da Rrma o s t e o m i e l i t i , aseve
qsovilebis dazianeba (komp.
fulminanturi septicemia.
tomogr.)
(Dennis A. Clement) stafilokokuri pnevmonia.
Cveulebriv, viTardeba, rogorc
pirveladi pnevmoniis, aseve
garTulebis saxiT, mag., wiTalas,
Cutyvavilas, gri pis dros, aseve
virusuli infeqciis Sedegad,
mwvave baqteriuli endokarditis
an sefsisuri Tromboflebitis
dros. daavadeba, Cveulebriv, iwyeba,
rogorc zemo sasunTqi gzebis
stafilokokuri infeqcia.
stafilodermia.
infeqcia cxelebiT, cxviris
(Í.È. Íèñåâè÷, gaWedvis SegrZnebiT, xveliT,
Â.Ô. Ó÷àéêèí) qveda quTuTos flegmona u m a d o b i T SesaZlebelia
(Å.È. Êîâàëåâñêèé) simptomebis swrafi an
TandaTanobiTi progresireba,
xvela matulobs, aRiniSneba taqikardia, sunTqvis gaZneleba. sunTqvis aqtSi aqtiur
monawileobas Rebulobs gulmkerdis drekadi nawilebi, mZime pnevmoniis dros ki _
ufro ferdqveSa nawili. patara bavSvebSi mZime mdgomareoba xasiaTdeba sunTqvis
ukmarisobiT, diskomfortiT muclis areSi, sifermkrTaliT, cianoziT, prostraciiT, rac
SeiZleba sikvdiliT damTavrdes. fizikaluri monacemebi varireben imisda mixedviT, Tu
ramdenadaa procesSi CarTuli filtvebi. SeiZleba ganviTardes abscesi, pnevmocele,
empiema, pnevmoToraqsi an piopnevmoToraqsi. rentgenogramaze aRiniSneba pnevmoceles
Sedegad Camoyalibebuli kistebi. mozrdilebSi ki adgili aqvs kerovan anTebebs, romlebic
SemdgomSi ganapirobeben filtvebis abscesisa da Rrus Camoyalibebas. pnevmoceles
ganviTareba stafilokokuri pnevmoniis Sedegia. es aris filtvebis intersticiuli
qsovilis emfizemuri gafarToebebi _ “buStukebi”-s saxiT, romlebic viTardeba
Semdegnairad: stafilokoki iWreba bronqebis kedelSi, peribronqur qsovilSi Semdgomi
anTebisa da mikroabscesebis ganviTarebiT, romlebic spontanurad ixsneba da ganapirobebs
“buStukebis” suraTs rentgenogramaze.
bronquli kedlis abscesis garRveva ar iwvevs haeris Sesvlas filtvis qsovilSi.
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iqmneba e.w. “maxiseburi burTis” situacia , rodesac adgili aqvs haeris evakuaciis
darRvevas, ris Sedagadac viTardeba kista an pnevmocele. ase, rom aRniSnuli haerovani
“buStuki” warmoadgens bronquli an peribronquli infeqciis meorad gamovlinebas. 4
dRidan 4 Tvemde periodSi pnevmocele TavisTavad sufTavdeba. pnevmoToraqsi viTardeba
pnevmoceles gaskdomis Sedegad. uecari dispnoes, cianozis, prostraciisa da Sokis
ganviTareba pnevmoToraqsis ganviTarebaze metyvelebs. empiema ki warmoiSoba abscesis
gaskdomiTa da misi CaRvriT plevris RruSi. piopnevmoToraqsi viTardeba maSin, Tu
abscess kavSiri aqvs bronqTan. piopnevmoToraqsi, pnevmoToraqsi, empiema SeiZleba iyos
izolirebuli an kombinirebuli. 50%-ze met SemTxvevaSi sisxlis suraTSi aRiniSneba
polimorfuli leikocitebis siWarbe, Tumca SeiZleba adgili hqondes normocitozs an
leikopenias. rentgenogramaze pnevmoceles, pnevmoToraqsis, empiemis an piopnevmoToraqsis
SemTxvevaSi aRiniSneba damaxasiaTebeli cvlilebebi, infiltratebi.
garTuleba.. stafilokokuri pnevmonia SeiZleba garTuldes: 1) gulis
pnevmoniis garTuleba
ukmarisobiT (filtvis qsovilebis mniSvnelovani dazianebis Sedegad), rac gamovlindeba
taqikardiiT, gulis sazRvrebis gadidebiT, sulis xuTviT, 2) empiemis araadekvaturma
drenirebam SeiZleba gamoiwvios fibroToraqsiT garTuleba.
diagnozi stafilokokur infeqciaze eWvis mitana saWiroa Semdegi mdgomareobebeis
dros: 1) mwvave respiraciuli distresis (mwvave sunTqvis ukmarisoba) ganviTareba
ZuZumwovar bavSvebSi. 2) anamnezSi aRiniSneba dabadebis Semdgomi omfaliti an dedis
mastiti, 3) rentgenologiuri monacemebiT vlindeba pnevmocele, empiema an piopnevmoToraqsi.
stafilokokuri etiologia mtkicdeba dadebiTi hemokulturiT - empiemidan da
dazianebis sxva adgilebidan miRebuli masalidan mikrobis amoTesviT.
xaxidan amoTesili dadebiTi kultura ar TamaSobs did rols, vinaidan axalSobilebis
60%-s aReniSneba stafilokokebi cxvirxaxaSi, diagnozi SeiZleba daadasturos kulturam,
Tu iTeseba koagulazamaproducirebeli oqrosferi stafilokokebi.
diferenciuli diagnozi. saWiroa diferenciacia Catardes Semdeg daavadebebTan:
1)pnevmokokur pnevmoniasTan. stafilokokuri pnevmonia adreul stadiaSi SeiZleba
daemsgavsos pnevmokokur pnevmonias, magram ukanasknelisaTvis ara aris damaxasiaTebeli
antibiotikTerapiis uefeqtoba da zemoTaRniSnuli rentgenologiuri cvlilebebi. 2)
pnevmoniasTan, romelic gamowveulia E.coli, enterobaqteria, klebsiela an Pseudomonas
aeruginosa-Ti. klinikurad es pnevmoniebi SeiZleba iyos stafilokokuri pnevmoniis
msgavsi. am SemTxvevaSi dRenaklebSi rentgenologiuri monacemebi stafilokokuri
pnevmoniis msgavsia, magram yelidan, sisxlidan iTeseba nawlavis Cxiri da sxva.
mwvave bronqiti. obstruqciuli sunTqva dakavSirebulia mwvave respiraciul
stafilokokur infeqciasTan. taqi pnoe da rentgenologiuri monacemebi amtkicebs
emfizemiT mimdinare obstruqciul bronqits.
mukoviscidozi. stafilokokuri pnevmonia SeiZleba gaarTulos mukoviscidozma.
oflSi natriumisa da naxvelSi qloridebis maRali Semcveloba gvexmareba mukoviscidozis,
fibrinul-kistozur degeneraciis diagnozis dadgenaSi.
ucxo sxeulis moxvedra sasunTq gzebSi SeiZleba garTuldes stafilokokuri
pnevmoniiT.
prognozi. antibiotikebis eramde stafilokokuri pnevmonia xSirad iwvevda
letalur gamosavals, magram antibiotikebma mniSvnelovnad Seamcires es maCvenbeli.
rac ufro pataraa bavSvi, miT ufro maRalia letaloba da piriqiT, gamojanmrTelebis
Sansi matulobs mozrdilebisaTvis optimaluri antibaqteriuli mkurnalobis Catarebis
dros. prognozi damokidebulia Tanmxleb daavadebebzec. gamojanmrTelebulebSi aris
narCeni movlenebi. Cveulebriv, pnevmocele mTlianad rCeba. filtvebis qronikuli
abscesi gvxvdeba iSviaTad. lokaluri procesis dros SesaZlebelia bronqoeqtaziebis
313
ganviTareba.
mkurnaloba. stafilokokuri pnevmonia Cvil bavSvebSi saWiroebs gadaudebel
Terapias. adreuli optimaluri Terapia zrdis gamojanmrTelebis Sanss. adreuli
Terapia gansakuTrebiT mniSvnelovania, radgan stafilokokuri pnevmoniis dros xSirad
adgili aqvs qsovilebis fokalur nekrozebs. mkurnaloba araefeqturia, Tu procesi
Sorsaa wasuli. optimaluri mkurnaloba moicavs _ antibiotikebis Seyvanas saTanado
dozebiT da xangrZlivad (SerCeviTi antibiotiki), Cirqovani Rruebis drenirebas Tu
aRiniSneba empiema, pnevmoToraqsis mkurnalobas.
mZime stafilokokur infeqcias iwvevs penicilinrezistentuli koagulazapozitiuri
stafilokoki. am SemTxvevaSi Terapia unda Catarades penicilinazarezistentuli
peniciliniT. am bolo dros gaizarda meticilinrezistentuli stafilokokebis (MRSA))
ricxvi, gansakuTrebiT maTi hospitaluri Stamebi, romelTa samkurnalod iyeneben
vankomicins. stafilokokebi aseve rezistentulia klindamicinis mimarT. tolerantuli
stafilokokuri mikrobebiT inficirebul pacients unda Cautardes mkurnaloba ori
antibiotikiT, gansakuTrebiT maSin, rodesac antibiotikiT Catarebuli pirveli cikli
uefeqto iyo. TiToeuli avadmyofisaTvis antibiotikTerapia sxvadasxva xangrZlivobisa
unda iyos. SesaZloa mkurnaloba gagrZeldes 2 kviridan 2 Tvemde da damokidebuli
iyos mikrobis mgrZnobelobaze, filtvis qsovilis dazianebis xarisxze da xasiaTze,
da aseve garTulebebze. SesaZlebelia recidivis ganviTareba. antisxeulebis gansazRvra
teiqois mJavas mimarT gvexmareba antobiotikebis moxsnis gadawyvetilebis miRebaSi.
antisxeulebis Semcveloba antibiotikis kursis CamTavrebis Semdeg laparakobs daavadebis
gagarZlebasa da abscesis metastazirebaze. am antisxeulebis gansazRvra informaciulia,
agreTve, sisxlis baqteriologiuri uaryofiTi pasuxis SemTxvevaSi da Rrma qsovilebis
dazianebis (osteomieliti) dros, roca SeuZlebelia dazianebuli organodan masalis
aReba kulturis misaRebad.
Terapia.. mZime avadmyofs aTavseben Jangbadis karavSi, zogierTi saWiroebs
damxmare Terapia
xelovnur sunTqvas, hidratacias oraluri da parenteruli gziT, xolo ganviTarebuli
anemia koregirebuli unda iyos sisxlis preparatebis gadasxmiT.
mkurnaloba.. stafilokokuri pnevmoniis dros: pnevmoceles
garTulebebis mkurnaloba
SemTxvevaSi mosalodnelia misi spontanuri gaqroba da, rogorc wesi, ar aris saWiro
qirurgiuli Careva. buStukebi (bulebi) qrebian ramdenime kviris an Tveebis ganmavlobaSi.
Tu bula iwvevs traqeis an mTavari bronqis kompresias, SesaZlebelia misi aspiracia an
gakveTa.
piopnevmoToraqsi.. am SemTxvevaSi mkurnalobis arCevani Cerdeba
empiema da piopnevmoToraqsi
kaTeteriT drenirebaze adgilobrivi anesTeziis qveS. aseTi procedura ufro misaRebia,
vidre Cirqis aspiracia. es amcirebs respiraciuli distresis movlenebs. pnevmoToraqsis
an masiuri empiemis dros Rrudan Cirqis evakuacia uzrunvelyofs filtvis kompresiis
ganviTarebis Tavidan acilebas.
fibroToraqsi. am dros iSviaTad aris saWiro qirurgiuli Careva. rogorc wesi,
is spontanurad ikurneba gansazRvruli drois ganmavlobaSi. saeWvo SemTxvevaSi ukeTesia
movicadoT procesis srul organizaciamde, Tumca es ukanaskneli iSviaTia.
SeiZleba davaskvnaT, rom avadmyofebi mwvave stafilokokuri pnevmoniiT saWiroeben
gadaudebel da, SesaZloa, qirurgiul daxmarebas. optimaluri antibiotikoTerapia saWiroa
dainiSnos rac SeiZleba adre. drenireba gamoiyeneba kompresiuli pnevmoToraqsis
dros da igi sicocxlis gadamrCen proceduras warmoadgens.
mwvave stafilokokuri osteomieliti. ukanasknel wlebSi osteomielitis
sixSire Cvil bavSvebSi mniSvnelovnad Semcirda. klinikur gamovlinebas adgili aqvs
travmis Semdeg, swrafad viTardeba kanis Cirqovani anTeba, Cutyvavilas an sxva winmswrebi
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infeqciis Semdeg. klinika

damokidebulia daavadebis simZimeze,
procesis lokalizaciasa da
adgilobriv mkurnalobaze.
SesaZlebelia procesSi nebismieri
Zvlis CaTreva, magram yvelaze ufro
xSirad ziandeba barZayisa da laviwis
Zvlebi. erT wlamde asakis bavSvebSi
osteomielits, Cveulebriv, Tan axlavs
Cirqovani arTriti. mkurnaloba
tardeba antibiotikiTa da
drenirebiT. parenteruli
antibiotikTerapiis Semdeg zogierTi
avadmyofi SeiZleba gadayvanili iqnas
oralur preparatze.
stafilokokuri enteroko-
liti (fsevdomembranuli koliti,
postantibiotikuri diarea). koliti
cnobili iyo antibiotikTerapiis stafilokokuri infeqcia axalSobilebSi. marcxena
e p o q a m d e c . f a r T o s p e q t r i s fexis multifokaluri osteomieliti, gamowveuli
antibiotikebis moqmedebis Sedegad S. aureus-iT. -iT. barZayis ZvalSi mZime destruqciuli
mniSvnelovnad gaizarda aRniSnuli procesi, Cirqovani arTriti muxlis saxsarSi.
daavadebis sixSire. cnobila, rom igi (Nandini Narasimban, Melvin Marks)
SeiZleba gamowveuli iyos ara marto
stafilokokiT, aramed C. difficile-Ti.
stafilokoki, Cvulebriv, kuW-nawlavis traqtis mobinadrea. antimikrobuli preparatebi
qmnian xelsayrel pirobebs maTi gamravlebisaTvis (rezistentuli Stamebis warmoqmna).
enteriti, albaT, ori faqtoriT iwveva: 1) antibiotik-rezistentuli enterotoqsigenuri
hemolizuri S. aureus-is zemoqmedebiT da 2) nawlavTa traqtSi normaluri floris
daTrgunviT, Tumca enteritis ganviTarebisaTvis ar aris aucilebeli am orive faqtoris
arseboba.
klinikurad gamovlindeba mZime daavadebis saxiT, romelic warmodgenilia
sisxliani diareiT, xSirad gonebis dabindviT, SokiT da mZime SemTxvevebSi SesaZloa
letaluri gamosavliT, magram SeiZleba daavadeba TviTkupirebiTac damTavrdes.
garTuleba gvxvdeba peritonitis saxiT.
diagnozi efuZneba ganavalSi didi raodemobiT S. aureus-is dadgenas, serologiur
reaqciebs, biofsiur masalas.
diferenciuli diagnozidiagnozi.. postantibiotikuri diarea SeiZleba gamowveuli iyos,
agreTve, C. difficile-Ti, romlis drosac ganavalSi naxuloben uSualod gamomwvevs an
mis toqsins.
prognozi.. adreuli diagnostika da swori mkurnaloba uzrunvelyofs ukeTes
prognozi
prognozs. mZime SemTxvevaSi SesaZlebelia Soki da sikvdili.
mkurnaloba. stafilokokuri fsevdomembranuli enterokolitis diagnozis dasmisas
saWiroa, maSinve Sewydes farTo speqtris antibiotikebis miReba. msubuq SemTxvevebSi
xdeba normaluri floris aRdgena da simptomebi TviTkupirebas ganicdian. mZime
SemTxvevebSi saWiroa, dehidrataciis koreqcia da specialuri antibiotikis (vankomicinis)
daniSvna, romelic gamoiyeneba rogorc stafilokokuri, ise klostridiuli
enterokolitis dros.
315
stafilokokuri kvebiTi toqsikoinfeqcia (msoflio jandacvis nomenklaturis

mixedviT _ kvebiTi intoqsikacia) gavrcelebulia farTod da igi gamoirCeva Tavisi
epidemiuri monacemebiT. stafilokokuri enterotoqsini am SemTxvevaSi organizmSi
xvdeba inficirebul sakvebTan erTad. mikrobebi TviTon kuW-nawlavis traqtSi ar
gamoimuSaveben toqsins. sakvebis momzadebis wesis darRvevisa da araswori Senaxvis
SemTxvevaSi, (gansakuTrebiT, sakonditro nawarmi, romelic dabinZurebulia da datovebulia
oTaxis temperaturaze ramdenime saaTis ganmavlobaSi), produqtSi iqmneba
stafilokokebisaTvis xelSemwyobi pirobebi, xdeba maTi gamravleba da enterotoqsinis
warmoqmna.
gamovlinebani.. inkubaciuri periodi 1-dan 6sT-mdea, mZime SemTxvevaSi
klinikuri gamovlinebani
aRiniSneba gulisreva, Rebineba, muclis tkivili, FfaRaraTi, prostracia,Soki. daavadeba
ufro xSirad mimdinareobs saSualo simZimiT. temperatura, Cveulebriv, normaluria an
subfebriluri. rehidrataciis fonze avadmyofi grZnobs ukeTesobas 8-24 saaTis Semdeg,
Tumca SemdegSi rCeba sisuste ramdenime dRis ganmavlobaSi.
diagnozze eWvis mitana martivdeba jgufuri mowamvlis SemTxvevebis dros, rodesac
baqteriuli kvlevis Sedegad sakvebidanac Rebuloben stafilokoks.
mkurnaloba.. mZime SemTxvevebSi iTvaliswinebs siTxis parenterul Seyvanas, msubuqi
mkurnaloba
da saSualo simZimis dros ki _ oralur rehidratacia-dezintoqsikacias.
stafilokokuri `daTuTquli” kanis sindromi. es sindromi aRwerili iyo
1970 w. Melish-is da Glasgow-s mier. igi moicavs daavadebis mTel speqtrs, romelic
gamowveulia I-II ti pis koagulazadadebiTi
stafilokokebiT.
axalSobilebSi stafilokokuri infeqcia
xSirad iwvevs kanis generalizebul eriTemas,
rac kanis naoWebze ufroa gamoxatuli.
ramdenime dRis an, SesaZlebelia, saaTis
ganmavlobaSi epidermisis zemo fenaze xelis
msubuqad gadasmisas an Sexebisas kani iWmuWneba
(nikolskis simptomi), ramdenime xnis Semdeg Cndeba
bulebi gamWvirvale SigTavsiT, epidermisi
iqercleba did fenebad, SiSvldeba sveli, wiTeli,
elvare zedapiri. 24 saaTis ganmavlobaSi
eqsfoliaciuri adgilebi cotaTi Sreba da
ifareba seboreuli nadebiT, romelic xSirad
lokalizdeba dazianebul adgilebze da piris
irgvliv. meoradi desqvamacia grZeldeba 3-5 dRe.
stafilokokuri infeqciis
stafilokokuri infeqcia. qunTruSasmagvari mimdinareobisas
`daTuTquli kanis~- Ritter -is aRiniSneba gavrcelebuli generalizebuli eriTema
sindromi (eqsfoliaciuri dermatiti). r e l i e f u r i s u r a T i T a d a d i f u z u r i
mgrZnobelobiT. qunTruSaseburi gamonayari
daavadebis adreul stadiaSi ar gamoirCeva
eqsudaciuri dermatitis dros ganviTarebuli gamonayarisagan. magram qunTruSaseburi
gamonayris dros eqsfoliacia ar aris. SemdegSi kani ifareba seboreuli nadebiT.
seboreuli desqvamacia grZeleba 3-5 dRe. Tumca adreul stadiaSi kanis cvlilebebi
waagavs qunTruSas, aRiniSneba sxva mniSvnelovani gansxvavebebic: ar aris Jolosebri ena,
enanTema, yelidan streptokokebis kultura uaryofiTia. sxvagvaria aqercvla. qunTruSas
dros kanis desqvamacia xdeba wvril fenebad.
316
stafilokokuri toqsikuri Sokis sindromi (tSs) (Toxic shock syndrome_

TSS). es sindromi dawvrilebiT aRwerili iyo Todd da Tanaavtorebis mier 1978w.
daavadeba xasiaTdeba uecari dawyebiT, maRali temperaturiT, Tavis tkiviliT, cnobierebis
dabindviT, qunTruSaseburi gamonayriT, sklerebis inicirebiT. sxva gamovlinebebia yelis
tkivili, Rebineba, wylisebri faRaraTi, Sardis Semcireba, RviZlis funqciuri sinjebis
darRveva, diseminirebuli sisxlZarRvSida Sededebis sindromi da Soki. yvela garTuleba
dakavSirebulia I jgufis fagis oqrosfer stafilokokTan, romelic iTeseba lorwovani
garsebidan an abscesidan. aRwerili toqsini mniSvnelovnad gamoirCeva II jgufis fagis
stafilokokebisagan, romelic iwvevs `daTuTquli” kanis sindroms.
dadgenilia, rom simptomatikas iwvevs stafilokokis enterotoqsini (adre uwodebdnen
pirogenul egzotoqsin C-s). jer-jerobiT ucnobia, es toqsini TviTon moqmedebs
qsovilebze Tu aZlierebs endotoqsinis efeqts.
tSs-iT mimdinare stafilokouri infeqcia SeiZleba alagdes TavisTavad. biofsirebuli
kani toqsikuri Sokisa da `daTuTquli” kanis sindromis dros sxadasxva suraTs
iZleva. tSs-s dros epidermisi ziandeba bazaluri Sris doneze, xolo `daTuTquli”
kanis dros _ epidermisis saSualo Sris doneze.
eqsfoliaciuri sindromi epidermuli nekroziT xSirad viTardeba medikamenturi
mkurnalobisa da virusuli infeqciebis fonze. tSs SesaZlebelia, ganviTardes qalebSi,
romlebic xmaroben tamponebs menstruaciis dros. aseTi qalebi warmoadgenen tSs-s
riskis jgufs, maT aReniSnebaT Sard-sasqeso sistemaSi stafilokokebis kolonizacia.
antibiotikebi daavadebis mimdinareobaze ar moqmedeben, damaxasiaTebelia antisxeulebis
nakleboba enterotoqsin F-is mimarT, amitom saWiroa vaqcinis SemuSaveba da specifikuri
SratebiT mkurnaloba.
endokarditebi.. mZime baqteriuli endokarditebi warmoadgenen elvisebur, xSirad
endokarditebi
letalurad mimdinare daavadebas, gansakuTrebiT mozrdilebSi, narkomanebSi narkotikebis
parenteruli xmarebis SemTxvevaSi. am dros SesaZlebeli garTulebebia filtvebis,
Tirkmlebis, saxsrebisa da Tavis tvinis garsebis sefsisuri emboliebi.
meningikokcemiis msgavsi daavadeba. zogierT stafilokoks SeuZlia sisxlis
Semdedebeli sistemis aqtivacia.
baqteriemias sisxlis Semdedebeli sistemis aqtivaciis Sedegad SeuZlia gamoiwvios
meningokokcemiis msgavsad mimdinare daavadeba romelic xasiaTdeba hemoragiuli
gamonayriT, sisxlCaqcevebiT, amitom avadmyofebs, romlebsac aqvT sefsisuri Sokis
simptomebi mkurnalobisaTvis aucileblad unda daeniSnoT penicilinazarezistentuli
antibiotikebi.
traqeiti. es daavadeba iwvevs zemo sasunTqi gzebis obstruqcias, romelic SecdomiT
SeiZleba virusul krupad an epiglotitad iqnas miCneuli. traqeitisaTvis damaxasiaTeblia
SeSupeba da Cirqovani naxveli, maRali temperatura. saWiroa rentgenologiuri gamokvleva.
mkurnalobaSi mniSvnelovania sasunTqi gzebis ganTavisufleba, antibiotikis roli am
dros mTlianad dadasturebuli ar aris, magram fiqroben, rom misi daniSvna aucilebelia.
diagnozi. saWiroa stafilokokuri kulturis gamokvleva, maT Soris morfologiuri
Seswavla, SeRebviT, rac laringoskopiis an bronqoskopiis dros masalis aRebiTaa
SesaZlebeli. amave dros procedura (laringoskopia) gvexmareba epiglotitis
difdiagnostikaSi.
prognozi umravles avadmyofTaTvis keTilsaimedoa.
rogorc aRvniSneT, antisxeulebis gansazRvra teiqois mJavis mimarT gansakuTrebiT
saWiroa baqteriemiis dros da Rrma anTebadi kerebis (mag., osteomielitis) arsebobisas.
gansakuTrebiT ki, imis gadasawyvetad, Tu rodisaa antibiotikTerapiis Sewyveta
mizanSewonili. antisxeulebis gansazRvra xdeba gelze eleqtroforezis meTodiT.
317
stafilokokuri infeqcia
kerZo nawili. sefsisi
epidfaqtorebi. stafolokokuri mtarebloba adamianebSi Cveulebrivi movlenaa,

magram daavadeba iSviaTad gvxvdeba mozrdilebSi. koagulazapozitiuri stafilokokebi
umravles SemTxvevaSi binadroben kansa da lorwovan garsebze. maTi gavrceleba xdeba
dainficirebuli sacvlebiT, mtvriT, saoperacioSi, samedicino personalis mier saavadmyofos
palataSi. aseTi mtarebloba saSiSia Ria Wrilobis mqone avadmyofebis da im pirebisaTvis,
romlebsac aqvT daqveiTubuli imuniteti. meores mxriv, infeqciis yvelaze ufro saSiS
wyaros warmoadgenen mwvave stafilokokuri infeqciiT Sepyrobili avadmyofebi, janmrTel
baqteriamtreblebTan SedarebiT, Cirqovani procesis mqone momvlelebs unda aekrZlos
axalSobilebTan kontaqti, vinaidan axalSobilebs SeiZleba ganuviTardes seriozuli
stafilokokuri daavadeba. advili SesaZlebelia axalSobili pirdapir dainficirdes
wveTovani gziTac. saavadmyofo warmoadgens stafilokokuri infeqciis seriozul
gamavrcelebel adgils, sadac aRiniSneba penicilinrezistentuli Stamebi. ambulatoriul
avadmyofTa Soris ufro penicilimgrZnobiare Stamebi aRiniSneba.
profilaqtika stafilokokebi advilad vrceldebian da binadroben adamianebSi,
rac masTan brZolaSi did siZneleebs qmnis. vinaidan cnobilia, rom baqteriamtareblebi
ar gadascemen infeqcias wveTovani gziT, niRbis gakeTebas ara aqvs didi mniSvneloba.
yvelasaTvis rekomendebulia kontaqtamde da kontaqtis Semdeg xelis dabana sapniT da
meticilinrezistentuli Stamis amoTesvis SemTxvevaSi specialuri steriluri xalaTebis,
samedicino qudebis, niRbis, xelTaTmanebis erTjeradi xmareba.
radgan infeqciis gadacema SeiZleba axalSobilebzec aerogenuli gziT, saWiroa
Semdegi RonisZiebebis Catareba:
1. yvela bavSvis sawoli hospitalizaciis win damuSavebul iqnas sadezinfeqcio
xsnarebiT.
2. oTaxis dalageba moxdes sveli wesiT dezinfeqtantebiT.
3. antimikrobuli qimioprofilaqtika ar aris rekomendebuli.
4. aparaturis dezinfeqcia.
5. kvebiTi mowamvlis Tavidan acileba xdeba kvebis win sakvebis Termuli damuSavebiT.
6. qirurgiuli Carevis SemTxvevaSi profilaqtikis mizniT iyenebn vankomicins.
sefsisi
(SEPSIS)
sefsisis yvelaze ufro xSir gamomwvev mizezad jer kidev iTvleba gramdadebiTi,
pirobiTpaTogenuri mikrobebi, rogoricaa Staphylococcus aureus da Staphylococ-
cus epidermidis. ukanaskneli 10-15 wlis ganmavlobaSi yuradRebis centrSia, agreTve,
gramuaryofiTi mikrobebi _ Escherichia coli, Klebsiella, Proteus mirabilis, Pro-
teus vulgaris, Enterobacter, Serratia, Pseudomonas aeruginosa, H. influenzae
da sxv.
maRalia, rogorc gramdadebiTi, aseve gramuaryofiTi mikrobebiT gamowveuli
nozokomialuri infeqciebisadmi midrekileba, rogorc axalSobilebSi, aseve
imunokomprometirebul pirebSi (sxvadasxva paTologiiT Sepyrobilni _ avTvisebiani
simsivne, hematologiuri daavadebebi, anemia, kortikosteroidebiTa da sxivuri TerapiiT
xangrZlivad namkurnalebi avadmyofebi da a.S.) amasTan, araiSviaTia polimikrobuli
kombinaciiT gamowveuli sefsisi, risTvisac xelSemwyob faqtorebad iTvleba sxvadasxva
saxis qirurgiuli Carevebi, gansakuTrebiT, kuW-nawlavis traqtsa da saSarde gzebze,
318
invaziuri meTodebis gamoyeneba _ centraluri venebis kaTeterizacia da sxv. sefsisis

gamomwvevi mizezi SeiZleba gaxdes dabinZurebuli intravenuri infuzati, medikamentebi
da instrumentebi. am SemTxvevaSi xSirad iTeseba ara marto Cveulebrivi flora,
aramed iseTi mikrobebic, romlebic, rogorc wesi, binadroben wyalSi (Pseudomonas,
Serratia da sxv.).
ufro nakleb SemTxvevaSi imunokomprometirebul pirebSi sefsisis mizezi paTogenuri
floraa _ N. meningitidis, S. pneumoniae, H. influenzae b ti pis, Salmonella da
sxv.
sefsisi SeiZleba gamowveuli iyos virusebiT, sokoebiT, umartivesebiT, riketsiebiTac.
sefsisis arsis swori warmodgenisaTvis, saWiroa, pirvel rigSi, ganisazRvros baqteriemiisa
da septicemiis cneba. baqteriemia, rogorc wesi, xanmokle, tranzituli, mikrobebis
dabali koncentraciiTaa warmodgenili da igi 1 mkl sisxlSi ar aRemateba koloniis
formirebis 100 erTeuls. infeqtis xanmokle diseminacia SeiZleba ganviTardes
osteomielitis, wiTeli qarisa da mravali sxva daavadebis dros. aseTi xasiaTis
baqteriemia SeiZleba mimdinareobdes asimptomurad, anda xanmokle simptomatikiT. sefsisis
ganviTarebisaTvis ki aucilebelia septicemiuri procesi, romelic xasiaTdeba mWidro,
mdgradi da xangrZlivi hematogenuri diseminaciiT _ aranakleb 100-dan 1000-mde da
meti koloniis formirebiT 1 mkl sisxlSi.
sefsisis racionalur ganmartebad unda CaiTvalos akademikos v. boWoriSvilis
mier mowodebuli ganmarteba: `mwvave sefsisi aris nebismieri infeqciuri daavadebis
klinikur-paTogenezuri forma, romlis drosac mZime premorbidul fonze (diabeti,
raqiti, paTologiuri mSobiaroba, damwvroba da sxv.), mikrobTa didi raodenobis an maTi
maRali virulentobisa da arabunebrivi gziT SeWris gamo, organizmis rezistentoba
imdenad daTrgunulia, rom mikrobuli anTebiTi kerebi gamomwvevis ganadgurebis,
daTrgunvisa da lokalizaciis nacvlad maTi SeuCerebeli gamravlebisa da ganmeorebiTi
generalizaciis wyarod iqcevian. amis gamo procesi hkargavs ciklurobas da gamomwvevis
xelovnuri daTrgunvis an/da organizmis rezistentobis xelovnuri amaRlebis gareSe
adamiani mihyavs sikvdilamde.”
es vrceli ganmarteba moicavs ara marto infeqciuri procesis klinikur-paTogenezur
mxareebs, aramed Tanamedrove saSualebebis aucilebel Sinaarsobriv gamoyenebas letalobis
mkveTri Semcirebis mizniT.
unda aRiniSnos, rom klinikuri monacemebis safuZvelze baqteriemiasa da septicemias
Soris mkafiod iqna gavlebuli zRvari. dadginda, rom organizms (misi nebismieri
maRali rezistentobis SemTxvevaSi) pirobiTpaTogenuri mikrobebis generalizacia SeuZlia,
aRkveTos mxolod meoTxe dRemde. amis Semdeg baqteriemia (TviT infeqciuri procesi)
spontanurad (mkurnalobis gareSe) Seuqcevadi xdeba da, maSasadame, formirdeba sefsisi,
baqteriemia iqceva septicemiad. aRniSnuli koncefcia eqsperimentSic brwyinvaled iqna
dadasturebuli (g. dumbaZe; v. boWoriSvili; m. moiswrafiSvili; 1996). es ki didi
Teoriuli da klinikuri mniSvnelobis aRmoCenaa.
sazRvargareT ki farTod gavrcelebulia sefsisis ganmarteba, romelic ganixileba,
rogorc sistemuri anTebadi procesis sindromi, gamowveuli dadasturebuli
mikroorganizmebis kulturiT.
sefsisisa da Sokis paTogenezi. xSirad, infeqciis generalizacia swrafad xdeba,
pirveladi fokusis naxva ki ar xerxdeba. anTebadi procesi SeiZleba ganviTardes
nebismier organoSi an sxeulis nawilSi da gamovlindes meningitis, pnevmoniis, perito-
nitis, otitis, osteomielitis, Cirqovani arTritis an rbil qsivilebSi miliaruli
abscesis saxiT.
319
b a q t e r i a
fokaluri baqteriemia
kerZo nawili.
klinikuri gamovlineba plus:
sefsisi * hiper/hipoTermia
* cvlilebebi leikocitebis raod.
sefsisi plus erT-erTi mainc:
mxriv
* mwvave darRveva cns-is mxriv * taqikardia
* taqipnoe
* hipoqsemia
sefsisis sindromi * leikocitebis r-bis Secvla
* plazmaSi rZemJava
* oliguria
(Saez-Llorens-is
320
sefsisis sindromi plus hipotenzia an
adreuli sefsisuri kapilarebis sisxlis mimoqcevis
Soki daqveiTeba, romelic koregirdeba
sefsisi da Soki
siTxeebiTa da medikamentebiT.
-is mixedviT)
sefsisis sindromi plus hipotenzia

an cudi kapilaruli mimoqceva I sT- refraqteruli
ze meti xangrZlivobis periodSi
sefsisuri Soki nebismieri kombinacia:
miuxedavad siTxeebiTa da
* diseminirebuli sisxlZarRvTaSida
vazopresorebiT saTanado
Sededebis sindromi
mkurnalobisa
multiorganuli * respiraciuli distresi
dazianeba * Tirkmlebis mwvave ukmarisoba
* RviZlis mwvave ukmarisoba
*cns mwvave disfunqcia
sikvdili
sefsisi
dadgenili iyo, rom sefsisis dros organizmis sistemuri anTebadi pasuxis sindromi
(diseminirebuli anTebadi procesi organoebisa da sistemebis dazianebiT) warmoadgens
qsovilebze gramdadebiTi baqteriebis lipoteiqo _ acidur-peptido-glikanuri kompleqsis
an gramuaryofiTi mikrobebis endotoqsinis moqmedebis Sedegs.
gamovlenilia isic, rom sefsisis dros gramuaryofiTi mikrobebis mier gamowveuli
cvlilebebi gulisa da filtvebis mxriv mogvagonebs eqsperimentSi endotoqsinisa da
tumormanekrozebeli faqtoris (TNF) moqmedebas. am faqtorebis sawinaaRmdego
monoklonuri antisxeulebiT inhibicia mkveTrad amcirebs Sokis movlenebs.
baqteriuli metabolitebis sisxlSi moxvedris Semdeg aqtiurdebian citokinebi,
romlebic SemdgomSi rig fiziologiur gardaqmnebs iwveven. anTebad procesTan
dakavSirebuli citokinebis ricxvi matulobs, rac, Tavis mxriv, aaqtivebs TNF-s, IL-1 -1
-1,
IL-6 –8-s, TAF-s (Trombocitaqtivaciis faqtors), γ-IFN (γ-interferons).
-6-s da IL–8
-6 –8
baqteriuli produqtebisa da citokinebis zemoqmedebis Sedegad irTveba
fiziologiuri meqanizmebi, romlebic moicaven: 1)komplementis sistemis aqtivacias; 2)
hagemani (XII) faqtoris aqtivacias, rac ganapirobebs koagulaciur kaskads; 3)
adrenokortikotropuli hormonisa da β-endorfinebis gamoTavisuflebas; 4)
polimorfulnuklearuli leikocitebis aqtivacias da 5) kalikrein-kininuri sistemis
stimulacias. TNF da sxva anTebadi mediatorebi zrdian sisxlZrRvTa ganvladobas
kapilarebSi sisxlis mimoqcevis darRveviT, iwveven sisxlZarRvebis tonusis daqveiTebas;
ganapirobeben disbalanss perfuziasa da qsovilebSi mimdinare gaZlierebul metabolur
process Soris. anTebis gamomwvevi mediatorebis aqtivacia an makroorganizmis zedmeti
pasuxi ayalibebs sefsisis paTogenezs.
Soki. sefsisuri procesis ukidures gamovlinebas warmoadgens Soki, rac sikvdilis
mizezi xdeba. Soki ganixileba, rogorc civi kidurebi, periferiuli perfuziis Semcireba.
mogvianebiT aRiniSneba arteriuli wnevis dacemac. periferiuli sisxlZarRvebis
rezistentobis daqveiTeba aRiniSneba `Tbili Sokis” adreul periodSi da mkveTrad
matulobs `civi Sokis” stadiaSi.
sefsisuri Sokis dros Jangbadze qsovilebis moTxovnileba Zalian izrdeba. disbalansi
Rrmavdeba periferiuli vazodilataciis, mogvianebiT vazokonstriqciis, miokardiumis
depresiis, ventilaciuri problemebisa da anemiis Sedegad.
sefsisuri Sokis dros gulis sistoluri SekumSvis periodSi sisxlis gandevna
parkuWebidan gaZnelebulia, rac xels uwyobs qsovilovan hi poqsiasa da rZemJava
acidozis ganviTarebas.
filtvebis funqcia xSirad irRveva da viTardeba “Sokuri filtvi” anu respiraciuli
distresi, rac cudi prognozis maCvenebelia. viTardeba Tirkmlebis, RviZlis mwvave
ukmarisoba, centraluri nervuli sistemis mwvave darRvevebi. Soks Tan axlavs
diseminirebuli sisxlZarRvTaSida Sededeba.
m. maCabelis, n. maxvilaZisa da Tanaavtorebis ganmartebiT sefsisuri Sokis sindromi
Tanamedrove doneze ganixileba, rogorc sisxlis mimoqcevis sistemis darRveva mimdinare
ujredebisa da qsovilebis araadekvaturi perfuziiT, saerTo paTologiis eleqtronuli
SimSilis fonze.
sefsisuri procesis paTfiziologiis mTavari mxareebi warmodgenilia cxrilSi
(sefsisuri procesis paTfiziologia), romelic naTels xdis sefsisisa da Sokis
ganviTarebis Tanmimdevrul Camoyalibebas.
321
infeqciis fokusi
baqteriuli ujredebis
produqtebi
kerZo nawili.
akth, endorfinebis gamoTavisufleba
pirveladi mediatorebi
(TNF, IL-1, IFN da sxva)
koagulaciis sistemis aqtivoba komplementis sistemis aqtivacia
endoTeliuri ujredebisa
da leikocitebis aqtivacia
molekulur doneze
(Saez-Llorens-is
322
kalikrein-kininuri sistemis
aqtivoba meoradi mediatorebi
polimorfuli leikocitebis
(Trombocitebis aqtivaciis
aqtivacia
faqtori, interleikinebi)
-is mixedviT)
kapilarebSi sisxlis mimoqcevis

vazodilatacia da endoTeliumis
Soki daqveiTeba da endoTeliumis
sefsisuri procesis paTfiziologiis mTavari mxareebi
dazianeba
dazianeba
multisistemuri dazianeba
sikvdili
sefsisi
klinika. infeqciis SeWris kari sefsisis dros SeiZleba iyos kani, piris Rru, kuW-
nawlavis traqti, sasunTqi gzebi da a.S. igi SeiZleba ganviTardes meanginekologiuri
da qirurugiuli Carevebis Sedegad. im SemTxvevaSi, roca SeWris adgilis dadgena ver
xerxdeba, sefsiss uwodeben kri ptogenurs. ukanaskneli forma SedarebiT iSviaTad
gvxvdeba.
daavadebis mimdinareobis mixedviT sefsisi iyofa elvisebur, mwvave, qvemwvave da
qronikul formebad.
elviseburi formisaTvis damaxasiaTebelia umZimesi klinikuri suraTis ramodenime
saaTSi Camoyalibeba. amasTan, misi mimdinareobis Tavisebureba zogjer mkafiod gamoirCeva
imisda mixedviT, Tu romeli baqteriebiTaa ganpirobebuli sefsisi. gramdadebiTi
sefsisisaTvis damaxasiaTebelia mZafri dawyeba hi perTermiiT (ufro xSirad) an
hi poTermiiT (iSviaTad), mkveTri zogadi intoqsikaciiT, gulis mwvave ukmarisobis
suraTiT, maSin, rodesac gramuaryofiTi sefsisis elviseburi formis klinikuri
mimdinareoba gamoirCeva periferiul sisxlZarRvTa ukmarisobis suraTiT. orive
SemTxvevaSi diagnostika Tu pirvel saaTebSi ar moxda da ar Catarda intensiuri
etiologiuri da paTogenezuri mkurnaloba, daavadeba, rogorc wesi, pirvel dReebSive
letaluri gamosavaliT mTavrdeba.
baqteriemiis progresireba sefsisSi da Sokis ganviTarebis klinikuri aspeqtebi _
sefsisisa da Sokis klinikuri gamovlinebis sindromebis, maTi ganviTarebisa da
diagnostirebis kriteriumebi mocemulia cxrilSi (sefsisi da Soki).
mwvave sefsisis xangrZlivoba ar aRemateba sam Tves. aqve unda aRiniSnos, rom
mwvave simptomatikis suraTi klinikurad SeiZleba gamovlindes daavadebis ramdenadme
mogvianebiT stadiaSi, magram procesis dawyebidan ara ugvianes sami Tvisa. aRsaniSnavia,
rom mozrdilebSi daavadebis mwvave dawyeba gamoxatuli temperaturuli reaqciiTa da
Zlieri SemcivnebiT mxolod 16%-Sia aRniSnuli. temperaturuli mrudi am dros
mravalferovania (heqtiuri, remisiuli, intermisiuli, subfebriluri ). sxva SemTxvevebSi
daavadeba TiTqosda mimdinareobs gamoxatuli temperaturuli reaqciis gareSe, ufro
xSirad aRiniSneba e.w. `temperaturuli pikebi”, romlebic icvleba 7-10 dRiani remisiiT.
daavadeba SeiZleba mimdinareobdes talRiseburi temperaturiT, saerTo simptomatikis
gamovlinebiT _ saerTo sisuste, oflianoba, hepatolienuri sindromi, periferiul
sisxlSi _ leikocitozi neitrofiloziT, momatebuli eds. zogjer, mZime mdgomareobis
dros aRiniSneba neitropenia, rac prognozulad cudi gamosavlis maCvenebelia.
qvemwvave sefsisi grZeldeba 3-dan 6 Tvemde. am formis drosac daavadeba talRisebur
mimdinareobas Rebulobs. maRali temperaturis fonze saerTo intoqsikaciis movlenebi
zomieradaa gamoxatuli.
qronikuli sefsisi xasiaTdeba xangrZlivi dune mimdinareobiT, gamwvavebebiTa da
sxvadasxva xangrZlivobis remisiiT. temperaturuli mrudi mravalferovania.
polimorfuli klinikuri suraTi igivea, rac sxva xangrZlivobis sefsisis dros.
xSirad viTardeba hepatolienuri sindromi, periferiuli sisxlis cvlilebebi xasiaTdeba
zomieri, zogjer maRali leikocitoziT, zogjer ki SesaZlebelia, cvlilebebi umniSvnelo
iyos.
adreuli asakis bavSvebSi xSiria sefsisis gaxangrZlivebuli forma, romlisaTvisac
Semdegi parametrebia damaxasiaTebeli: gamoiyurebian kargad, fizikuri da fsiqikuri
ganviTareba asakis Sesabamisia, magram aRiniSneba sxvadasxva ti pis temperaturuli
reaqcia, romelic ufro xSirad atarebs subfebrilur xasiaTs, zogjer maRalia, magram
ar aris continua-s ti pis. araiSviaTad viTardeba hepatolienuri sindromi. sisxlidan
iTeseba stafilokokebi, streptokokebi, sxva gramdadebiTi an gramuaryofiTi mikrobebi,
sisxlSive vlindeba stafilokokuri α-toqsinis an aRniSnuli mikrobebis sawinaaRmdego
323
antisxeulebis arseboba. antibiotikebi xSirad

araviTar efeqts ar iZlevian. ufro efeqturia
imunoTerapia (antistafilokokuri an
antikoli-hi perimunuri plazma, adamianis
intravenuri imunoglobulinebi). aRsaniSnavia,
rom stafilokokuri sefsisi, umravles
SemTxvevaSi, adreuli asakis bavSvebSi
spontanurad ikurneba daavadebis dawyebidan
1-2 wlis Semdeg.
stafilokokur
stafilokokurii sefsisi (Wi pismier i).
pismieri). axalSobilebSi sefsisi sxva asakis
hepatolienuri sindromi, mikrocirkulaciis
bavSvebTan SedarebiT yvelaze ufro xSirad
darRveva. (sakuTari masala)
gvxvdeba.
sxvadasxva saavadmyofoebSi
(samSobiaro saxlebSi) sefsisiT
avadobis maCveneblebi
sxvadasxvanairia da meryeobs 1-dan
4 SemTxvevamde 1000 cocxal
axalSobilze. es maCvenebeli
damokidebulia mSobiarobis vadebze,
personalis mier avadmyofis movlaze
(saavadmyofosSida infeqciebi),
mSobiarobis taqtikaze, sanayofe
wylebis naadrev daRvrasa da mis
stafilokokuri sefsisi, mikrocirkulaciis darRveva.
Soki. marmariloseburi kani. ganleva.
xangrZlivobaze, qorioamnionitis
(sakuTari masala) arsebobaze, mSobiarobis periodSi
mSobiaris cxelebis arsebobaze.
rac ufro dRenaklia axalSobili, miT ufro xSiria infeqciis generalizacia.
dabadebidan, sicocxlis pirvel kviraSi (rogorc wesi, pirvel 72 sT-Si) vlindeba
sefsisis klinika (adreuli sefsisi).
neonataluri sefsisi SeiZleba daiwyos nayofis mucladyofnis dros hematogenuri
gziT dasnebovnebisas, yvelaze ufro xSirad qorioamnionitis Sedegad, infeqciis dedidan
nayofze gadacemiT. inficirebuli amnionuri siTxe SesaZloa iqces infeqciis wyarod,
Tu nayofi aseT siTxes ylapavs. am SemTxvevaSi klinikuri suraTi gamoixateba nayofis
distres-sindromiT an axalSobilis asfiqsiiT.
unda aRiniSnos, rom B-jgufis streptokokiT (GBS) gamowveuli adreuli sefsisi
mZime mimdinareobiT xasiaTdeba. am dros aRniSnuli mikrobebi SeiZleba nanaxi iqnas
yvela qsovilSi, dawyebuli cns-idan, damTavrebuli filtvis, RviZlis, elenTis qsovilebis
CaTvliT. aseTi xasiaTis sefsisis yvelaze ufro xSir gamovlinebas warmoadgens
meningiti.
dadgenilia, rom qalebis 50%-s aReniSneba stafilokokebis vaginaluri kolonizacia,
maTgan 21%-Si infeqciis gadacema nayofze xdeba qorioamnionitis mqone qalebidan.
nayofis autofsiiT dadgenilia, rom jer kidev vaginalur kolonizaciamde placentidan,
filtvebidan, RviZlidan da sxva organoebidan iTeseba stafilokokebi, rac mowmobs,
umetesad, amnionitis Sedegad procesis generalizaciiT ganpirobebul neonatalur
sefsiss. 75% SemTxvevaSi adreuli sefsisi ganpirobebulia B-jgufis streptokokebiT,
E. coli-iT, H. influenzae-Ti (ara b ti pis).
mogvianebiTi periodis sefsisi dRenaklebSi an avadmyof axalSobilebSi umTavresad
intensiuri Terapiis ganyofilebebSi an maTi binaze gaweris Semdeg (hospitaluri
324
infeqcia) vlindeba.
mniSvnelovania, rom janmrTel axalSobilebSi gamomwvevi faqtorebidan prevalirebs
virulenturi mikroorganizmebi. aqve unda aRiniSnos, rom sefsisis gamomwvev iseT
virulentur mikrobebs, rogoricaa E. coli K-1, yvela seroti pis B jgufis streptokoki,
pnevmokokebi da H. influenzae, aqvT saerTo kafsuluri antigeni, romelic xels
uSlis komplementis alternativuli gziT aqtivacias da amiT xels uwyobs fagocitozis
daTrgunvas, vinaidan am SemTxvevaSi antisxeulebis warmoqmna darRveulia da mikrobebis
ofsonizacia ar xdeba.
neonataluri sefsisis dros mniSvnelovan rols asrulebs humoruli imunitetis
funqciis darRveva.
dedisagan nayofi transplacenturi gziT garkveuli speqtris G klasis antisxeulebs
Rebulobs, magram ver Rebulobs A da M-klasis antisxeulebs, vinaidan mucladyofnis
periodSi fiziologiuri pirobebis dros nayofi antigens praqtikulad ver xvdeba,
ris gamoc ukanaskneli antisxeulebis gamomuSaveba nayofis mier ar xdeba. Tumca
cnobilia, rom nayofs aqvs IgM antisxeulebis gamomuSavebis unari, rac dasturdeba
aseTi klasis antisxeulebis aRmoCeniT Wi plaridan aRebul sisxlSi sifilisiT,
toqsoplazmoziTa da wiTuriT inficirebisas.
gramuaryofiTi baqteriebis sawinaaRmdego specifikuri baqteriaciduri da
maofsonizebeli antisxeulebis umravlesoba IgM klass miekuTvneba, amitom axalSobils
nawlavTa mikroorganizmebisadmi naklebi humoruli dacva aqvs.
mozrdil qalebs, umravles SemTxvevaSi, aReniSnebaT B-jgufis streptokokebis
ti purspecifikuri kafsuluri polisaqaridisadmi gamomuSavebuli IgG-s titris dabali
an umniSvnelo done, amitom es proteqciuli antisxeulebi inficirebul axalSobilebSi
praqtikulad ar aris, rac ganapirobebs am infeqciisadmi maRal mimReblobas.
IgG–is done drouli axalSobilis Wi plaris sisxlSi uTanabrdeba an odnav
aWarbebs dedis sisxlis analogiur maCvenebels. dRenakl bavSvebSi ki misi done miT
ufro naklebia, rac ufro Rrmaa dRenakloba.
komplementis sistema. am sistemas makroorganizmis infeqciissawinaaRmdego
brZolaSi maintegrirebeli roli akisria.
komplementis proteqciuli funqcia gansakuTrebiT mimarTulia eqstraceluluri
mikrobebis sawinaaRmdegod (gramdadebiTi paTogenuri baqteriebisa da nawlavTa
gramuaryofiTi mikrobebis CaTvliT). am mikroorganizmebs unari aqvT, ar daeqvemdebaron
fagocitozs. antisxeulebi ar gamomuSavdeba iseTi mniSvnelovani gamomwvevebis winaaRmdeg,
rogoricaa B jgufis streptokokebi da E.coli K1, romelTa kafsula Seicavs sialis
mJavas, (mas ki mainhibirebeli efeqti SemboWav C3b-s mimarT gaaCnia). Cveulebriv,
antisxeulebi saWiroa, erTis mxriv, mikrobebis ofsonizaciisaTvis, meores mxriv ki _
mikrobebis sawinaaRmdego brZolaSi fagocitozis CarTvisaTvis.
komplementi antisxeulebTan erTad an damoukideblad monawileobs baqteriebis
ofsonizaciaSi, ris Sedegadac procesSi erTveba fagocitozi. klasikurad komplementi
antigen-antisxeulis urTierTqmedebis Sedegad aqtivirdeba. komplementis komponentebis
fiqsirebuli, kaskaduri CarTva xdeba Semdegi TanmimdevrobiT: 1-4-2-3-5-6-7-8-9.
meore, alternativuli gza ki C-3 komplementis mTavar fragmentze _ C-3b-zea
damokidebulia. C-3b-s done organizmSi, Cveulebriv, dabalia (zemoaRniSnuli infeqciebis
dros kidev ufro ecema axsnili meqanizmebis gamo).
baqteriebis ofsonizacia xdeba rogorc klasikuri, ise alternatiuli gziT, Semdeg
ki erTveba fagocitozi (infeqciis dros axalSobilebSi aRiniSneba rogorc antisxeulebis,
aseve C3b-nakleboba da procesi mZimed mimdinareobs).
mocirkulire komplementis gadacema dedisagan nayofze, rogorc wesi, ar xdeba.
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fetaluri komplementis sinTezi iwyeba orsulobis I trimestrSi da droul

axalSobilebSi klasikuri gziT mimdinareobs. komplementis klasikuri gziT
axalSobilebSi aqtivacia xasiaTdeba upiratesobiT alternatiuli gziT aqtivaciaze,
romelic sakmaod daqveiTebulia. dRenaklebSi aseTi procesebi gamoxatulia ufro
mkafiod. fibroneqtini plazmisa da qsovilebis glikoproteins warmoadgens, igi xels
uwyobs neitrofilebisa da monocitebis adhezias da urTierTobas baqteriebTan mag:
B jgufis streptokokebTan, miuxedavad imisa, am procesSi CarTulia Tu ara antisxeulebi
da komplementi.
axalSobilebSi da, gansakuTrebiT, dRenakl bavSvebSi asfiqsiisa da respiraciuli
distresis dros fibroneqtinis done plazmaSi Sesabamisad daqveiTebulia.
monocit-makrofaguri sistema. es sistema warmodgenilia rogorc mocirkulire
monocitebiT, aseve retikulur-endoTeliuri sistemis qsovilovani makrofagebiT.
axalSobilebis sisxlSi mocirkulire monocitebis ricxvi normaluria, magram
daqveiTebulia (gansakuTrebiT ki dRenaklebSi) retikulur-endoTeliur sistemaSi
makrofagebis raodenoba da funqcia.
rogorc droul, aseve dRenakl axalSobilebSi darRveulia monocitebis qemotaqsisi,
rac gamoixateba qsovilebSi gaukuRmarTebuli anTebiTi procesiTa da kanis
hi permgrZnobelobis testis darRveviT.
axalSobilis monocitebs kargad aqvT gamoxatuli fagocitozis _ moZraobisa da
STanTqmis funqcia, xolo antigenis monelebis funqcia jer kidev mniSvnelovnad
dabalia. interferoni da tumormanekrozebeli faqtorebi sinTezirdeba rogorc
axalSobilebSi, iseve mozrdilebSi.
dabadebis Semdeg dRenaklebSic da droul axalSobilebSic neitrofilebis raodenoba
momatebulia. piki grZeldeba 12 sT-is manZilze, xolo 72-sT-Si uaxlovdeba mozrdilTa
neitrofilebis ricxvs.
axalgazrda neitrofilebis mateba aRiniSneba axalSobilebSi sefsisis, asfiqsiis
da sxva situaciebis dros. zogierT SemTxvevaSi sefsisis dros gamoxatulia neitropenia,
rac SeiZleba gamowveuli iyos depoSi (Zvlis tvinSi) neitrofilebis ricxvis daqveiTebiT.
neitrofilebis daqveiTeba am dros xSirad fatalur gamosavalze metyvelebs.
avadmyof axalSobilebSi sefsisis, respiraciuli distresis, hi perbilirubinemiis,
hi perglikemiis dros mikrobociduri aqtivoba darRveulia.
klinika. sefsisis gamovlineba axalSobilebSi saSualo simZimidan mZime
mdgomareobamde varirebs. saerTo gamovlinebidan aRsaniSnavia cxeleba (38°C da meti)
an dabali temperatura _ 35,5-37°C. aRiniSneba sisxlis sisxlZarRvTaSida diseminirebuli
Sededebis sindromi sisxldeniT, oliguriiT. respiraciuli traqtis darRvevebi
gamoixateba apnoes, taqi pnoes, saerTo cianozis saxiT. cirkulaciuri darRvevebidan
viTardeba taqikardia, bradikardia, hi potenzia, sifermkrTale. kidurebi civia, cudia
kapilaruli mimoqceva. nervuli sistemis dazianebis simptomatika vlindeba gonebis
dabindviTa da komiT.
laboratoriuli monacemebiT _ leikocitozi an neitropenia, Trombocitopenia,
metaboluri acidozi, hipoqsia, hiperTrombogenemia, hipoalbuminemia, RviZlis fermentebis
momateba.
kuW-nawlavis mxriv damaxasiaTebelia madis daqveiTeba, Rebineba, diareis movlenebi,
meteorizmi. sefsisis dros siyviTle axalSobilebSi Cveuli movlenaa (arapirdapiri
bilirubinis xarjze). zogjer SeiZleba gamovlindes nekrozuli enteritis, kolitis,
peritonitisa da sxva movlenebis suraTi.
cns dazianeba. meningiti da cerebruli vaskuliti xSirad Tan sdevs masiur
baqteriemias da axalSobilTa sefsisis 1/3 SemTxvevaSi vlindeba meningitis niSnebi.
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mozrdil bavSevbSi aRiniSneba kisris kunTebis rigidoba, hiperrefleqsia. kisris kunTebis

rigidoba da bruZinskis simptomebi axalSobilebSi aramyaria, risi mizezic xSirad
axalSobilTa daTrgunuli an agznebuli mdgomareobaa. yiflibandi zogierT SemTxvevaSi
daWimulia, aRiniSneba krunCxvebi an fokaluri nervuli gamovlinebani. am simptomebidan
zogierTi gamowveulia hi poqsiiT, intrakranialuri sisxlCaqceviT, hi poglikemiiT,
hi pokalciemiiT, narkomani dedebis SemTxvevebisas kokainisa da sxva prepartebis
axalSobilis cns-ze moqmedebiT.
klinikuri kriteriumebis analizi adreuli da mogvianebiTi neonataluri sefsisis
dros aranozokomialuri da nozokomialuri sefsisis gaTvaliswinebiT warmodgenilia
cxrilSi `sefsisis klinikuri niSnebis kriteriumebi”.
neonataluri sefsisis kriteriumebi

(Samuel P. Gotoff))
sefsisis mogvianebiTi gamovlinebebi
maCvenebeli sefsisi adreuli gamovlinebebi aranozokomialuri
sefsisi nozokomialuri sefsisi
1. gamovlinebis drodabadebidan 1 kviramde (rogorc wesi, 72 1 kviridan 1 Tvemde 1 kviraSi gaweridan (Tu gawera
sT-Si) dabadebidan sam dReSi xdeba)
2. gestacia 50 % dRenaklebSi Cveulebriv droul rogorc wesi, dRenaklebSi
axalSobilebSi
3. risk-faqtorebi amnioniti, sanayofe wylebis naadrevi ar aris endotraqeuli intubacia,
daRvra kaTeterizacia, sisxldena,
qirurgiuli Carevebi
4. gadacemis gza vertikaluri horizontuli da vertikaluri horizontuli
5. uxSiresi B jgufis streptokokebi (yvela), B jgufis streptokokebis III koagulazanegatiuri

gamomwvevebi Eseherichia coli, Klebsiella, Listeria tipi, E. coli stafilokokebi, S. aureus,
monocytogenes, Enterococus, Streptococcus K1, L. monocytogenes, HSV, Candida albicans, Pseudomonas
pneumoniae, Haemophylus influenzae Enterovirus aeruginosa, Klebsiella, Serratia,
(aratipirebuli) E. coli.
6. klinikuri gamonayari (gamowveuli listeriiT) vezikuluri gamonayari (HSV), rZiana, kandiduri dermatiti,
gamovlinebani baqteriuli meningiti Cirqovani gamonayari ecthyma
gangrenosum, abscesebi
kanisa da lorwovani garsebis dazianeba sefsisis dros SedarebiT iSviaTia.

infeqciis fokusi SeiZleba iyos impetigo, celuliti an kanqveSa abscesi, mastiti,
omfaliti, koniunqtiviti. Listeria monocytogenes-iT gamowveul sefsiss axasiaTebs
narinjisfer-movardisfro patara papulebis gaCena. vezikuluri gamonayari SeiZleba
gamowveuli iyos Herpes simplex virus (HSV)-iT. mravlobiTi muko-kutanuri
gamovlinebebi C. albicans-iT gamowveuli infeqciis dros zog SemTxvevaSi lokaluri
xasiaTisaa, zogjer ki generalizebuli infeqciis suraTs iZleva.
kanis gangrenuli dazineba fsevdomonur sefsisze miuTiTebs. sxva garTulebebidan
aRsaniSnavia Sua yuris anTeba, sklerebis, saxsrebis, Sardis gamomyofi gzebis, RviZlisa
da peritoneumis Rrus anTebebi.
sefsisis diagnostika emyareba klinikur-laboratoriul monacemebs. rogorc zemoT
iyo naCvenebi, elviseburi sefsisi imdenad reliefurad gamoxatuli klinikuri
gamovlinebiT xasiaTdeba, rom SesaZlebelia ara marto diagnozis dasma daavadebis
pirvelsave dReebSi, aramed etiologiuri momentis gansazRvrac _ gramdadebiTia Tu
gramuaryofiTi igi. miRebuli hemokultura zogjer ki adgilobrivi kerebidan aRebuli
masalac naTels xdis sefsisis etiologiur mxares. rac Seexeba mwvave, qvemwvave da
qroniosefsiss, diagnostikisas saWiroa, mxedvelobaSi miviRoT tuberkulozi,
hematologiuri, onkologiuri da kolagenuri daavadebebi, romelTa diferenciacia
327
moiTxovs gamokvlevebis arealis gafarToebas Tanamedrove moTxovnaTa gaTvaliswinebiT.

rac Seexeba sefsisis adreul diagnostikas axalSobilebSi, saWiroa potenciurad
inficirebuli dedis gamokvleva meanisa da pediatris mier (sisxli, amnionuri siTxe;
Sardi SeRebili unda iqnas gramis wesiT). im SemTxvevaSi, Tu aRiniSneba sanayofe
garsebis adreuli darRveva an suniani sanayofe wylebi, aucilebelia, yuradReba mieqces
axalSobilis sefsisis SesaZlo klinikur niSnebs da droulad iqnas gamokvleuli
miRebuli kultura. polinuklearuli leikocitebis, kuWis SigTavsis, aspiratisa da
yuridan miRebuli nacxis SeRebva xSirad gvexmareba diagnozis dazustebaSi.
aRsaniSnavia, rom venapunqciiT miRebuli sisxlis dabinZureba naklebadaa SesaZlebeli
Wi plaridan aRebul sisxlTan SedarebiT.
mkurnalobis ZiriTadi princi pebi naTladaa Camoyalibebuli akademikos v.
boWoriSvilis mier, masSi gaTvaliswinebulia mwvave sefsisis klinikur-paTogenezuri
periodizacia. es ukanaskneli iyofa I anu adreul, II anu mogvianebiT da III anu
dagvianebul periodad.
pirveli periodi moicavs daavadebas me-3-4 dRidan 2 Tvemdec ki, roca daavadebis
mimdinareobaSi wamyvani roli miekuTvneba mikrobul intoqsikacias.
meore periodisaTvis damaxasiaTebelia mdgomareoba, roca baqteriul intoqsikacias
Tan erTvis klinikurad SesamCnevi qsovilovani intoqsikacia. am dros an sul aRar
aRiniSneba apireqsiis periodebi, anda apireqsiis drosac rCeba gamoxatuli intoqsikacia.
mesame periodi xasiaTdeba poliorganuli ukmarisobis klinikur-laboratoriuli
suraTiT da, rogorc wesi, Trombohemoragiuli sindromis III xarisxiT. mwvave sefsisis
dros gadamwyvetia mkurnalobis dawyebis dro da swori antibiotikTerapia.
mkurnalobis moculoba (da, ra Tqma unda, Rirebulebac) isazRvreba periodebis
gaTvaliwinebiT.
daavadebis mimdinareobis aseTi periodizacia migviTiTebs, droulad da adekvaturad
CavataroT saTando mkurnaloba sefsisis ara marto mwvave, aramed sxva, vTqvaT, qronikuli
formebis drosac, Tumca xazi unda gaesvas imas, rom sefsisis qvemwvave da, miT umetes,
qronikuli formis dros eqims aqvs SedarebiT meti dro mkurnalobis ama Tu im
meTodis upiratesobis arCevisaTvis.
daavadebis adreul periodSi, gansakuTrebiT, elviseburi sefsisis dros gadamwyvetia,
pirvel rigSi, dauyovnebeli intensiuri antibiotikoTarapiis dawyeba ampicilinisa da
aminoglikozidebis kombinaciiT. SemdgomSi etiologiuri momentisa da misi
antibiotikogramis dadgenisas SesaZlebelia saTanado koreqciis Setana.karg efeqts
iZleva Cveni klinikis monacemebiT, antibiotikTarapiisa da intravenuri imunoglobulinebis
kombinirebuli gamoyeneba. neonataluri sefsisis mkurnalobis sqema ix. zogad nawilSi
axalSobilTa sefsisis antimikrobuli Terapia (danarTi 1).
I periodSi mkurnalobaSi wamyvania qimioTarapia. amasTanave, yvela, gansakuTrebiT II
da III periodSi saWiroa Catardes antibaqteriuli, imunuri, antikoagulaciuri,
antifermentuli, saWiroebisamebr eqstrakorporuli dezintoqsikacia (plazmaferezi).
mizanSewonilia aqve aRiniSnos, rom prof. n. maxvilaZes, didi Rvawli miuZRvis
infeqciuri paTologiis, maT Soris sefsisis dros antikoagulaciuri Terapiis
kardinaluri sakiTxebis SemuSavebaSi.
paTogenezuri Terapia aseve iTvaliswinebs organizmSi siTxeebisa da eleqtrolitebis
aucilebel Seyvanas, hipokaliemiis, hiponatriemiis, hipokalciemiis, metaboluri acidozis,
hi poqsiis, oqsigenaciis, intravenuri kvebis problemebis regulacias maCveneblebis
monitoringiT.
qronikuli sefsisis mkurnalobaSi umTavresi roli eniWeba ara antibiotikebs,
aramed imunoTerapias, pirvel rigSi, specifikuri hi perimunuri sisxlis, plazmis,
328
sefsisi
kerZo nawili. yivanaxvela
imunoglobulinebis saxiT, Cveni dakvirvebiT, sefsisis TiTqmis yvela periodSi dadebiTi

efeqti iqna miRebuli intravenuri imunoglobulinebis gamoyenebis Sedegad.
Sokis mkurnalobis dros aucilebelia iseTi siTxeebis gadasxma venaSi, rogoricaa
eleqtrolitebi, albumini, deqstrani (poliglukini). Tu wnevis aweva am siTxeebis
Seyvanis Sedegad ar moxerxda, iyeneben dopamins da dobutamins. Tu am SemTxvevaSic
arteriuli wnevis koreqcia ar moxerxdeba, SesaZloa intravenuri infuzia gagrZeldes
epinefrinis an norepinefrinis gamoyenebiT, rogorc damoukideblad, aseve natriumis
nitroprusidTan kombinaciaSi. aucilebelia Jangbadis miwodeba. Tu cianozi grZeldeba,
saWiroa filtvis meqanikuri, xelovnuri ventilaciis Catareba. Cveulebriv, efeqturi
oqsigenaciisaTvis sakmarisia eqspiraciuli wneva wylis svetis 5-dan 20sm-mde. magram
SesaZloa aseTma wnevam gamoiwvios venuri sisxlsavseoba da gulidan sisxlis
gaZlierebuli gandevna. optimaluri _ saboloo eqspiraciuli wneva miRebuli unda
iqnas filtvSida marjvnidan-marcxniv umciresi SuntirebiT, gulidan sisxlis gandevnaze
zemoqmedebis gareSe. sisxlZarRvSida Sededebis sindromi qreba, ZiriTadad, daavadebis
mkurnalobis procesSi. sisxlis denis dros saWiroa koagulaciis iseTi faqtorebis
gadasxma, rogorcaa krioplazma, kriopreci pitati da Trombomasa. heparini iniSneba
Trombozisa da periferiuli gangrenis dros. damxmare Terapia SezRudulia da moicavs
intravenur imunoglobulins, monoklonur IgM endotoqsinisadmi da granulocitebis
transfuzias, ukanaskneli ki rekomendebulia neitropeniis mqone avadmyofebisaTvis,
romlebSic aRiniSneba persistiuli baqteriemia da uSedego antimikrobuli Terapia.
Sokis dros arsebul eleqtronul SimSilTan dakavSirebiT, mizanSewonilia
paTogenezur TerapiaSi reanimaciul palatebSi, barokamerebSi da a.S. eleqtronebis
CarTva aeroionizaciis saxiT, . a. CiJevskis `retro”-WaRebis gamoyenebiT, rac sagrZnoblad
amcirebs letalobas (m. maxvilaZe, n. maCabeli da sxv., 1998)
Sokis dros mozrdil avadmyofebSi, aseve distresis drosac kortikosteroidebi
uefeqtoa. savaraudoa maTi efeqti H. influenzae b ti piT gamowveuli meningitis
dros, kortikosteroidebis gamoyeneba efeqturi SeiZleba iyos Waterhouse-
Friderichsen-is sindromis dros.
yivanaxvela
(PERTUSSIS, TUSSIS)
yivanaxvela miekuTvneba mwvave respiraciul infeqciebs. igi vrceldeba haer-wveTovani

gziT. klinikuri mimdinareobisaTvis damaxasiaTebelia nervuli sistemis dazianeba da
Taviseburi, SeteviTi xvela.
mokle istoriuli cnobebi: pirvelad yivanaxvela moxseniebulia jer kidev XV
saukuneSi. am saxelwodebaSi, arc Tu usafuZvlod, gulisxmobdnen temperaturiTa da
xveliT mimdinare sxva daavadebebs. rogorc Semdeg aRmoCnda yivanaxvelas sindromi
SeiZleba gamoiwvios B. parapertussis, Mycoplasma pneumoniae, C. trachomatis,
C. pnemoniae, B. bronchiseptica, SesaZloa, adenovirusma da sxva respiraciulma
infeqciebma. T.Sidenham-ma XVII saukuneSi dawvrilebiT aRwera es daavadeba da
manve SemogvTavaza saxelwodeba Pertussis; termini `Pertussis~~ niSnavs Zlier,
Semawuxebel xvelas “Tussis” xvela.
etiologia: 1906_1908 wlebSi Bordet--is da Jengou--is mier dadgenil iqna
daavadebis gamomwvevi agenti, romelic cnobilia borde - Jangus Cxirebis, agreTve
Bordetella pertussis saxelwodebiT. mikrobi warmoadgens gramuaryofiT, uZrav, mokle,
329
0,5_2 mkm sigrZis hemofilur baqterias (sxva dasaxeleba - Haemophillus pertus-

sis). maTi gamravlebisaTvis klasikur niadags warmoadgens glicerin-kartofil-sisxliani
agari, romelsac emateba penicilini Tanmxlebi mikrobebis dasaTrgunavad. aRniSnul
niadagze mxolod axlad miRebul borde-Jangus Cxirebs aqvT antigenuri unari. maT
miakuTvneben ti ps, romelsac aRniSnaven, rogorc I fazis Stamebs. sakveb niadagze
baqteriebis pasirebis Sedegad warmoiSveba II, III da IV fazebis Stamebi. zrdisaTvis
aseve gamoiyeneben sinTezur niadags nikotinamidis zrdis faqtoris, aminomJavebis
naxSiris an ciklodeqstranis damatebiT.
mxolod pirveli fazis mikrobebi iwveven daavadebas. maTve iyeneben vaqcinis
dasamzadeblad.
yivanaxvelas Cxirebi warmoqmnian Termolabilur egzotoqsinsa (pertusis toqsins
_ PT-s) da Termostabilur endotoqsins. producirebuli B. pertusis sxvadasxva
substanciebs didi roli eniWeba daavadebis paTogenezSi: filamenturi hemaglutinini
FHA, aglutininebi FLM2 2, FLM3 3 da nonfibriluri cila 69KD (pertactin - PRN)
ganapirobeben mimagrebas respiraciuli traqtis ciliarul epiTeliumze. traqeuli
citotoqsini, adenilatciklaza da PT xels uSlian organizmidan baqteriis eliminacias.
traqeuli citotoqsini, dermonekrozuli faqtori da adenilatciklaza ganapirobeben
respiraciuli traqtis epiTeliumis dazianebas da respiraciuli simptomkompleqsis
Camoyalibebas. PT-s absorbcias. PT-s axasiaTebs sxvadasxva biologiuri aqtivoba
(histaminuri, insulinis sekreciis, leikocitebis disfunqciis gamowveva), rac ganapirobebs
daavadebis sistemur gamovlinebas. eqsperimentul cxovelebSi igi iwvevs limfocitebis
gaZlierebul cirkulacias sisxlis baseinSi. Tumca paTogenezi ganpirobebulia ara
mxolod PT-s moqmedebiT.
epidemiologia. infeqciis wyaros warmoadgens avadmyofi, gansakuTrebiT, daavadebis
pirvel dReebSi, Semdgom periodebSi dasnebovnebis intensivoba TandaTan klebulobs.
garemoSi mikrobebis ganTesvis saSiSroeba grZeldeba 4-5 kvira. epidemiologiuri
TvalsazrisiT yvelaze met saSiSroebas qmnian waSlili klinikis mqone avadmyofebi,
romelTa raodenobac sakmaod maRal (50_70%-mde) procents aRwevs. subklinikuri
formebi, romlebsac baqteriamtarebloba miekuTvneba (qronikuli mtarebloba damtkicebuli
ar aris), epidemiologiurad usafrTxoa, radgan avadmyofebs aseTi formebis dros ar
aReniSneba xvela, rac mikrobTa gavrcelebis ganmapirobebelia. dadgenilia, rom sasunTqi
gzebidan xvelebis dros gamofrqveuli wveTebi aerozolebis saxiT sami metris manZilze
vrceldeba. amiT aixsneba inficirebis SesaZlebloba mxolod mWidro kontaqtis dros
da amitomaa naCvenebi aseT avadmyofTa hospitalizacia naxevradboqsebSi.
avadobis maCvenebeli yvelaze maRalia 1-dan 7 wlamde asakis bavSvebSi, Tumca misi
done 1 wlamde, gansakuTrebiT aucrel bavSvebSi didia.
letaloba vaqcinaciis SemoRebis Semdeg dabalia. maRali letaluri maCvenebeli
wlamde asakis bavSvTa wilad modis.
gadatanili infeqciis Semdeg organizmi iZens umTavresad, mdgrad imunitets. acris
Sedegad SeZenili imuniteti yovelTvis ar xasiaTdeba mdgradi SeuvalobiT, SesaZlebelia
meored daavadeba, amitom saWiroa revaqcinaciis gakeTeba buster-vaqcinis SeyvaniT,
gansakuTrebiT acridan 5 wlis Semdeg. amis aucileblobas adasturebs ukanasknel
xanebSi avadobis momateba ufro mozrdili asakis bavSvebsa da samedicino personalSi,
romlebsac yivanaxvelis sawinaaRmdego acrebi Cautarda sicocxlis pirvel 6 wels.
aRniSnulia, agreTve, Sida infeqciebi (nozokomialuri SemTxvevebi).
bolo dros infeqciis wyarod gvevlinebian mozrdilebi. maT Sesustebul imunur
fonze uviTardebaT yivanaxvelis ati puri, waSlili formebi. aseT pirebTan kontaqtis
Sedegad xSirad avaddebian mcire asakis aravaqcinirebuli (aucreli) bavSvebi.
330
paTogenezi. organizmis dainficirebis meqanizmi

paTmorfologia da paTogenezi
haerwveTovania. Cxirebis adhezia xdeba epiTeliumis zedapirze, mis bususebze mimagrebiT.
mikrobebi mravldeba mxolod wamwamovani epiTeliumis ujredebSi da bronqogenuri
gziT vrceldeba wvril bronqebSi, bronqiolebsa da alveolebSi. daavadebis ganviTarebaSi
wamyvani roli egzotoqsin PT-s eniWeba. producirebuli mikrobuli substanciebidan
mniSvnelovania e.w. limfocitozis damxmare faqtori. yivanaxvelasaTvis baqteriemia
damaxasiaTebeli ar aris, amitom Sinagan organoebSi mikrobebis diseminacia ar xdeba.
toqsini, pirvel rigSi, zemo sasunTqi gzebis lorwovani garsebis SeSupebasa da
infiltracias iwvevs. aRsaniSnavia, rom daavadebas ar axasiaTebs neirotoqsikoziT
mimdinareoba. daavadebis jer kidev adreul periodSi xdeba peribronquli sivrcis
limfocituri da leikocituri infiltracia, SemdgomSi ki bronqebis Sualedur Sreebsa
da epiTeliumis bazalur membranaSi viTardeba nekrozuli procesi. wvrili bronqebis
dazianeba iwvevs bronqopnevmoniis ganviTarebas. lorwovani sekretiT (detritiT)
bronqiolebis daxSoba ki _ filtvebis Sesabamisi ubnebis ateleqtazs, Tumca
ateleqtazebis genezi marto amiT ar aixsneba, radgan ateleqtazi zogjer daavadebis
reparaciul periodSi viTardeba, roca avadmyofs xvela ukve aRar awuxebs. savaraudoa,
rom yivanaxvelas dros bronquli spazmis Sedegad ateleqtazis ganviTareba
dakavSirebulia centraluri nervuli sistemis dazianebasTan. klinikuri dakvirveba
gviCvenebs, rom ateleqtazi SeiZleba ganviTardes ama Tu im infeqciis (mag.: Cutyvavilas,
otitis da sxv.) darTvis Sedegad, romlebsac uSualod sasunTqi gzebis dazianeba ar
axasiaTebs. bronqopnevmoniis ganviTarebaSi didi roli miuZRvis meorad mikrofloras,
maT Soris, pirvel rigSi, S. pneumoniae--s, b ti pis H. influenzae--s, A jgufis
streptokokebsa da S. aureus--s.
zemo sasunTqi gzebis lorwovan garsze ganlagebuli cdomili nerviT inervirebuli
neiroreceptorebi ganicdian toqsiniT xangrZliv gaRizianebas, risi pasuxicaa daavadebis
adreul periodSi damcveli xasiaTis xvela. SemdgomSi, procesis progresirebasTan
dakavSirebiT, xvela Rebulobs spazmur xasiaTs, rac inspiraciul-tonuri krunCxvebiTaa
ganpirobebuli da romlis klinikuri gamovlinebacaa xvela repriziT. aRniSnulis
gamo irRveva sunTqvis ritmi da viTardeba apnoe (inspiraciuli apnoe), rac ganapirobebs
filtvebis ventilaciisa da hemodinamikis moSlas (saxis SeSupeba, SegubebiTi movlenebi
Tavis tvinSi, gulis marjvena parkuWis gaganiereba, arteriuli hi pertenzia, sisxlSi
gazTa cvlis moSla—acidozi da sxv.), es ki Tavis mxriv, iwvevs hi poqsiisa da
hi poqsemiis ganviTarebas. hemocirkulaciis darRvevis Sedegia tvinis qerqis dazianeba
sisxlCaqcevebis saxiT. kerovani cvlilebebi SeiZleba mimdinareobdes krunCxviTi
sindromiT. encefalopaTiis suraTs SesaZloa Tan axldes RviZlis qsovilis cximovani
degeneracia_reis sindromi.
aRniSnuli klinikuri, morfologiuri da bioqimiuri Zvrebi xazs usvams yivanaxvelas
paTogenezSi Jangbadis ukmarisobis mniSvnelobas.
meore mxriv, aranakleb mniSvnalovania agznebis mdgradi keris arseboba mogrZo
tvinSi, sadac Tavs iyris zemo sasunTqi gzebis receptoruli aparatidan wamosuli
uwyveti impulsebi.
a. uxtomskis dominantis ti pis agznebis mdgradi keris arsebobam Tavis tvinSi,
masze araspecifikurma, sasunTqi gzebis receptorebTan sruliad daukavSirebelma
gamRizianeblebma SeiZleba gamoiwvios krunCxviTi xasiaTis xvela sunTqvis gaCerebiT
(mag.: nebismieri saxis tkivilma, yelis gasinjvam, Spricis danaxvam da sxv.) amasTan
erTad Zlier gamRizianeblebs sxvadasxva receptoruli ubnebidan (mag.: garemos Secvla,
gasarTobi TamaSebi da sxv.) SeuZliaT, droebiT CaaxSon aRniSnuli dominanta da
Seasuston an Sewyviton SeteviTi xvela.
331
daavadebis ukuganviTarebasTan erTad Tavis

tvinSi arsebuli agznebis kera TandaTan qreba, Tumca
daavadebis damTavrebis Semdeg igi kvlav inarCunebs
spazmuri xvelis gamowvevis unars yovelgvar
araspecifikur gamRizianebelze sapasuxod.
spazmuri xvelis warmoSobaSi garkveuli roli
miekuTvneba borde-Jangus Cxirebis alergiul
moqmedebasac.
yivanaxvelas, rogorc infeqciuri procesis
Sedegad organizmSi xdeba hemaglutininebis,
hemaglutininmainhibirebeli, baqteriaciduli,
komplementSemboWavi da imunomafluorescencirebeli
antisxeulebis gamomuSaveba. amasTan unda aRiniSnos,
rom dRemde dadgenili ar aris imunologiurad
yivanaxvela. spazmuri xvela. reprizi. aqtiuri is faqtori, romelic koreqcias uwevs
(Í.È. Íèñåâè÷, Â.Ô. Ó÷àéêèí) infeqciis miuReblobas.
yivanaxvelas sawinaaRmdego imunitetis mqone
pirebis zemo sasunTqi gzebis sekreti Seicavs
sekreciul IgA-sa da Sratismier IgG-s, romlebsac
gaaCniaT infeqciis winaaRmdeg brZolis unari. IgA
aferxebs mikrobis adhezias, xolo IgG ki pirdapiri
imunitetis xangrZlivobis maCvenebelia.
damcvelobiTi xasiaTis moqmedeba
dakavSirebulia, agreTve, SratSi antitoqsikuri
antisxeulebis arsebobasTan. es ukanasknelebi aferxeben
toqsinis fiqsacias ujredul receptorebze da
yivanaxvela. wyluli enis lagamze. aneitraleben mas.
(Í.È. Íèñåâè÷, Â.Ô. Ó÷àéêèí) eqsperimentSi dadgenilia, rom limfocitebis
mastimulirebel faqtors, romelic axdens limfuri
organoebidan limfocitebis mobilizacias, didi mniSvneloba aqvs daavadebis paTogenezis
ganviTarebaSi. dRemde mTlianad ar aris cnobili, ra kavSiria limfocitebis
mastimulirebel faqtorsa da limfocitozis maCvenebels Soris. limfocitozis damxmare
faqtori ar gaaCnia B. parapertussis-s, magram avadmyofis sisxlSi limfocitozis
maCvenebeli sakmaod matulobs. yivanaxvelas dros adgili aqvs T da B limfocitebis
dazianebas, Tumca es sakiTxi Semdgom gamokvlevebs kidev saWiroebs.
klinika. inkubaciuri periodi meryeobs 6-dan 20 dRemde (saSualod 7-10 dRemde).
arCeven daavadebis mimdinareobas sam _ katarul, spazmuri xvelisa (paroqsizmebi) da
gamojanmrTelebis periods. daavadebis xangrZlivoba Seadgens 6-8 kviras. klinikuri
gamovlineba damokidebulia borde-Jangus Cxiris virulentobasa da organizmis imunur
statusze.
kataruli periodi viTareba TandaTanobiT, umniSvnelo, sustad gamoxatuli mSrali
xveliT, raime specifikuri Tvisebebis gareSe. aRiniSneba surdo, sklerebis inicireba,
temperatura zomierad momatebuli, subfebriluri an, xSirad, normis farglebSia, Tumca
SeiZleba 390C-sa da metsac miaRwios.
yivanaxvelas diagnozi am periodSi, Cveulebriv, iSviaTad ismeba. saerTo mdgomareoba
rCeba damakmayofilebeli da avadmyofebi ganagrZoben baga-baRebsa Tu skolebSi siaruls.
magram Semdgomi 1-2 kviris manZilze xvela xdeba Semawuxebeli, mdgradi, gansakuTrebiT
Ramis saaTebSi da Rebulobs spazmur xasiaTs. kataruli periodis xangrZlivoba
332
meryeobs 3-dan 14 dRemde, mZime SemTxvevebSi ki, gansakuTrebiT wlamde asakis bavSvebSi,
SeiZleba, ufro naklebi iyos.
spazmuri xvela daavadebis gadasvla meore, spazmur periodSi viTardeba TandaTan,
rac gamoixateba spazmuri xvelis mkafio Camoyalibebul SetevebSi, romlis damaxasiaTebel
niSansac warmoadgens swrafi amosunTqvis biZgebis seria maT Soris SesunTqvis intervalis
gareSe. xvelis biZgebis damTavrebisas xdeba mstvinavi xasiaTis Zlieri CasunTqva,
rasac ganapirobebs spazmurad Seviwrovebuli xmovani napralis haeriT forsireba
(reprizi). spazmuri xvelis dros SesaZlebelia, aRiniSnos ramodenime reprizi. rac
ufro mZimed mimdinareobs yivanaxvela, miT ufro xangrZlivia spazmuri xvela da
xSiria reprizebis ricxvi. spazmuri periodis dasawyisSi xveliTi Setevebi ufro
naklebia da Zlierdeba da xSirdeba daavadebis me-2-3 kviras.
spazmuri, konvulsiuri xvelis Seteva iwyeba uecrad, xanmokle winamorbedi simptomebiT,
rogoricaa mousvenroba, bavSvebi eZeben sayrden wertils, uCivian yelSi fxaWnis SegrZnebas,
simZimes gul-mkerdis areSi (aura). avadmyofs spazmuri xvelis Setevis dros aqvs
damaxasiaTebeli saxe, igi gawiTlebuli an cianozuria, Tvalebi gadmokarklulia,
Casisxlianebuli, ena gamoyofilia maqsimalurad, enis wveri ki zemoTaa amozneqili,
gaZlierebulia nerwyvisa da cremlis dena, kisris venebi gaberilia da daWimuli. mZime
xveliTi Seteva grZeldeba manam, vidre bavSvi lorwos ar amoaxvelebs. zogjer Seteva
mTavrdeba RebinebiT. es ukanaskneli miekuTvneba daavadebis ti pur simptoms. spazmuri
xvelis Serwyma RebinebasTan iTvleba imdenad damaxasiaTebel sindromad, rom Tundac
ar hqondes adgili reprizs, eWvi mainc yivanaxvelaze unda iqnas mitanili.
reprizi yvela avadmyofs ar aReniSneba. daavadebis msubuqi da saSualo simZimiT
mimdinareobisas bavSvebi aqtiurni rCebian, TamaSoben. mZime SemTxvevaSi ki spazmuri
xvela iwvevs organizmis dauZlurebas, sxeulis masis Semcirebas. bavSvebi daZabulni
xdebian, aqvT Setevis molodini. xvelis Setevas xels uwyobs sxvadasxva garegani
gaRizianeba, rogoricaa yelis gasinjva, tansacmlis gaxda an Cacma, tirili, ReWva, ylapva,
fizikuri datvirTva da sxva. xvelis xSiri SetevebiT gamowveuli sisxlis mimoqcevis
darRvevasTan dakavSirebiT saxis quTuToebis SeSupeba Rebulobs mudmiv xasiaTs, kansa
da koniunqtivaze SeiZleba ganviTardes sisxlCaqcevebi, rac avadmyofs xvelis Setevis
gareSec Tavisebur habituss uqmnis. Setevis dros gamoyofili enis kbilze xaxunis
gamo enis lagamze Cndeba wylulebi, romlebic male ifareba mWidro TeTri nadebiT.
wyluli qreba TandaTan, xvelis Setevis intensivobis klebis Sesabamisad.
maRali temperaturis arseboba spazmuri xvelis periodSi, Cveulebriv, garTulebaze
metyvelebs, Tumca SeiZleba, iyos garTulebis gareSec.
auskultaciiT filtvebis mxriv zogjer moisimineba mSrali xixini. mZime mimdinareobis
dros aRiniSneba emfizemis movlenebi - perkutoruli xmis timpanuri an kolofiseburi
elferi, rentgenologiurad filtvis saerTo suraTi da hilusebi gaZlierebulia,
zogjer gamoixateba samkuTxedis msgavsi daCrdilva, romlis fuZe diafragmaze, mwvervali
_ ki hilusiskenaa mimarTuli. Tvlian, rom es ukanaskneli ganpirobebulia
limfocirkulaciis moSliT, iSviaTad aris ateleqtazuri kerebi.
gul-sisxlZarRvTa sistemis mxriv spazmuri xvelebis Setevis dros SeimCneva
taqikardia, arteriuli da venuri wnevis momateba; pnevmoniiT garTulebis SemTxvevaSi
xSiria gulis gaganiereba, gansakuTrebiT marjvniv da misi hemodinamikuri funqciis
darRveva.
nervuli sistemis mxriv mZime mimdinareobisas, gansakuTrebiT Cvil bavSvebSi,
yalibdeba hi poqsiuri encefalopaTiis suraTi - Zilis darRveva, mimikuri kunTebis
uneblie moZraoba, krunCxvebi, gonebis dakargva da sxv.
periferul sisxlSi damaxasiaTebelia leikocitozi (15X109_ 40X109), limfocitozi
333
60-80%-mde. eds normis farglebSia. aRniSnuli cvlilebebi ufro aSkaraa daavadebis

mZime mimdinareobis dros konvulsiuri xvelis periodSi, Tumca kataruli periodis
drosac SesaZloa, gvqondes leikocitozisa da limfocitozis suraTi.
rekonvalescenciis periodi grZeldeba 2-4 kvira. daavadebis mTeli simptomatika
TandaTanobiT cxreba - xvelebis Seteva, reprizi da Rebineba xdeba msubuqi da iSviaTi.
ufro mogvianebiT SesaZlebelia, adgili hqondes cru recidivebs borde-Jangus Cxirebis
monawileobis gareSe. aseTi `recidivebi~ viTardeba zemo sasunTqi gzebis infeqciebis
darTvis dros (mwvave respiraciuli infeqciebi, mwvave respiraciul- virusuli infeqciebi,
wiTela da sxva). SeteviTi xasiaTis xvelis recidivebs zogierTi avadmyofis SemTxvevaSi
SeiZleba, adgili hqondes Tveebis, anda wlebis ganmavlobaSic, es recidivebi kvalificirdeba,
rogorc infeqciis darTvis Sedegad ganviTarebuli reaqciebi.
klasifikacia. arCeven yivanaxvelas ti pur da ati pur formebs. ti purs miekuTvneba
klasifikacia
spazmuri xveliT mimdinare yvela SemTxveva. atipurisTvis ki damaxasiaTebelia waSlili
da subklinikuri formebi. waSlili mimdinareobis dros adgili aqvs Cveulebriv
xvelas, reprizebis gareSe. subklinikuri inaparantuli formis dadgena ki xdeba
mxolod maSin, roca sisxlSi Sesabamisi imunologiuri Zvrebi, ufro naklebad ki -
hematologiuri cvlilebebi dgindeba.
Tavis mxriv, ti puri forma SeiZleba, mimdinareobdes msubuqad, saSualo simZimiTa
da mZimed. maT ganmasxvavebel kriteriumad miRebulia spazmuri xvela, reprizebis
raodenoba erTi spazmuri xvelis dros da sunTqvis gaCereba - apnoe.
msubuqi formis dros spazmuri xvelis sixSire dRe-RameSi aRwevs 10-15-s, saSualo
simZimis dros _ Sesabamisad 15-25-s, xolo mZime mimdinareobisas _ spazmuri xvelis
sixSire 40-50 da metia, reprizebis ricxvi ki 10-ze meti. amave dros mkveTradaa
darRveuli avadmyofis saerTo mdgomareoba (uZlureba, umadoba, Zilis darRveva, agzneba
da sxv.).
garTulebebi pnevmoniiT garTuleba sam wlamde asakis bavSvTa 90%-Si xdeba
sikvdilis mizezi. pnevmonia SeiZleba B. pertussis-ma gamoiwvios, magram ufro xSirad
igi ganpirobebulia meoradi infeqciiT, kerZod H. influenzae, S. pneumoniae, A
jgufis streptokokebiT, S. aureus-iT.
garTulebebs miekuTvneba hipoqsiuri encefalopaTiac, romelic yivanaxvelas mxolod
mZime formebis dros gvxvdeba da SeiZleba, mimdinareobdes krunCxvebiT, meningizmiT,
komiT.
mZime formebis dros SegubebiTi movlenebisa da sisxlis kapilarebis rezistentobis
daqveiTebis gamo viTardeba sisxldena cxviridan, sisxlCaqcevebi koniunqtivaSi, zogjer
baduraze, ufro iSviaTad, Tavis tvinSi saTanado centraluri damblebis CamoyalibebebiT.
xSiri spazmuri xvelis Sedegia, agreTve, spontanuri pnevmoToraqsi, Suasayrisa da
kanqveSa qsovilebis emfizema, Wi pisa da sazardulis Tiaqari, filtvSi bronqebis
sanaTuris detritiT daxSobisas SeiZleba, Camoyalibdes segmenturi an wilovani
ateleqtazi, am fonze xSirad viTardeba bronqoeqtazebi, romlebic didxans rCeba
rekonvalescenciis periodSic.
SemTxvevebSi, gansakuTrebiT ki axalSobilebSi aRiniSneba mokle
wlamde asakis SemTxvevebSi
(4-5 dRiani) inkubaciuri periodi, kataruli ki ar aRemateba 1 kviras. daavadeba
zogjer pirdapir spazmuri xveliT iwyeba, saerTo mdgomareoba mZimea, saxezea hipoqsemiisa
da hi poqsiis suraTi - sisxlSi gazTa cvlis moSla. reprizebis nacvlad adgili aqvs
wamokivlebebs, tirils, ceminebas, sunTqvis Sesustebas an gaCerebas, generalizebul
krunCxvebs. Cvens klinikis reanimaciis ganyofilebaSi aRwerilia axalSobilis yivanaxvelis
SemTxveva, romelic mxolod xSiri apnoeTi mimdinareobda. (a. xoWava).
yivanaxvela acrilebSi mimdinareobs waSlili formiT, spazmuri xvelis gareSe.
334
Cveulebrivi xvela grZeldeba 5-7 kviris ganmavlobaSi. garTulebebi ar axasiaTebs.

iSviaTad aRiniSneba damaxasiaTebeli hematologiuri cvlilebebi.
diagnozis dasma spazmuri xvelis dros siZneles ar warmoadgens, xolo yivanaxveliT
sxva avadmyofTan kontaqtis dadgena diagnozs ufro damajerebels xdis. katarul
periodSi diagnostika rTulia, magram am dros yuradReba unda gamaxvildes xvelaze,
romelic sul ufro Semawuxebeli xdeba da bolos SeiZleba, RebinebiT damTavrdes.
filtvebis mxriv, Cveulebriv, raime fizikaluri monacemebi ar aRiniSneba an SesaZloa,
rentgenologiurad hilusebis infiltracia, filtvebis emfizema, ateleqtazi iyos.
periferiul sisxlSi ki - leikocitozi, limfocitozi da eds normis farglebSi.
diagnostika. daavadebis bunebis zusti dadgena eyrdnoba borde-
laboratoriuli diagnostika
Jangus Cxirebis gamoyofas, rac daavadebis dasawyisSi yvelaze adre xerxdeba. cxvir-
xaxidan tamponiT aRebuli masala iTeseba borde-Jangus, Regan-Fowe-s niadagebze.
eqspres-diagnostika tardeba aRebuli nacxis mikroskopuli gamokvleviT
mafluorescirebeli antisxeulebis gamoyenebiT. Tumca mas naklebi diagnostikuri
mniSvneloba aqvs (crudadebiTi an cruuaryofiTi pasuxis gamo). pjr iTvleba
nazofaringeuli ujredis gamokvlevis saukeTeso meTodad (igi kulturis miRebazec
ki ufro mgrZnobiarea).
enzimimunologiuri testis meSveobiT SeiZleba borde-Jangus Cxirebis mimarT
antisxeulebis, M, A, G - imunoglobulinebis dadgena. es sinji dadebiT pasuxs iZleva
im SemTxvevaSic ki, roca ar aRiniSneba mikrobis zrda specifiur niadagze. zogierT
avadmyofSi, Cveulebriv, 3 Tvemde asakis bavSvebSi, es sinji SeiZleba iyos uaryofiTi
dadebiT baqteriologiur fonze. saWiroa testis wyvil SratebSi Catareba.
enzimimunosorbentuli meTodi saSualebas iZleva, aRmoCenil iqnas yivanaxvelas
mikrobisaTvis specifikuri Ig A antisxeulebi. piris Rrus lorwovan sekretSi ki
antisxeulebis gamoyofa xdeba daavadebis me-2-3 kviras da rac aRsaniSnavia, maTi
inducireba ar warmoebs vaqcinaciis Semdeg.
agreTve keTdeba, aglutinaciis, komplementSemboWavi reaqciebi. yvela aRniSnuli
meTodi gamoiyeneba mxolod retrospeqturi diagnostikisaTvis da xSirad iZleva
uaryofiT pasuxs 2 wlamde asakis bavSvebSi.
diagnostika, pirvel rigSi mwvave respiraciul virusul
infeqciebTan (gri pTan, paragri pTan, adenovirusul da respiraciul-sincitiur
infeqciasTan) tardeba. yivanaxvelas mTavari damaxasiaTebeli niSania zemo sasunTqi
gzebis SedarebiT sustad gamoxatuli kataruli movlenebis fonze xvelis TandaTanobiT
gaZliereba - Semawuxebeli, mdgradi xvela, romelic Semdgom Rebulobs spazmur, SeteviT
xasiaTs, Setevis bolos ki zogjer adgili aqvs Rebinebas. spazmur xvelaTa Soris
SualedebSi, TiTqmis yovelTvis, avadmyofis saerTo mdgomareoba damakmayofilebelia.
spazmuri periodis dros periferiul sisxlSi aRiniSneba leikocitozi, limfocitoziT.
mwvave respiraciuli virusuli infeqciebis dasadgenad didi mniSvneloba eniWeba
eqspres-diagnostikas.
did sirTules warmoadgens yivanaxvelasa da parayivanaxvelas erTmaneTisagan garCeva.
garda imisa, rom ukanasknelisaTvis damaxasiaTebelia naklebad xangrZlivi (1-2 kvira)
spazmuri xvela, zogjer diagnozis dadgenisaTvis saWiroa baqteriologiuri gamokvlevis
Catareba B. parapertussis-is aRmosaCenad. igive siZneleebia B. bronchiseptica-Ti
gamowveuli klinikuri suraTis drosac, rac saWiros xdis gamomwvevi agentis dadgenas.
zogjer mxedvelobaSia misaRebi gulmkerdis limfuri kvanZebis, sasunTqi gzebis
ucxo sxeuliT dazianebis SemTxvevebi, romlebic moiTxoven rentgenologiur da sxva
saTanado gamokvlevebs.
mkurnaloba. hospitalizaciis aucileblobas gansazRvravs avadmyofis asaki (3
335
Tvemde) daavadebis simZime, garTulebuli SemTxvevebi. epidCvenebebiT Tavsdebian avadmyofebi,

Tu maT ojaxSi ZuZumwovara bavSvia, an saerTo sacxovreblis mobinadreni, sadac
yivanaxvelaze aucreli bavSvebic cxovroben. hospitalizacias gansazRvravs mZime ojaxuri
pirobebic. avadmyofebi Tavsdebian calke, maTTvis gaTvaliswinebul palatebSi an boqsebSi,
rac, pirvel rigSi, iTvaliswinebs ara marto infeqciis gadacemis saSiSroebis, aramed
superinfeqciis Tavidan acilebasac.
mkurnaloba tardeba daavadebis paTogenezis Taviseburebebis gaTvaliswinebiT
kataruli da spazmuri periodis pirvel dReebSi didi mniSvneloba eniWeba borde-
Jangus Cxirebis daTrgunvas antibiotikebiT, romlebic 3-5 dReSi anTavisufleben
cxvir-xaxas mikrobebisagan.
am mizniT gamoiyeneba eriTromicini 50mg/kg sxeulis masaze dRe-RameSi, ampicilini
100mg/kg dRe-RameSi. yoveli maTgani iniSneba dReSi 4 miRebaze 14 dRis ganmavlobaSi,
antibiotikebs gaaCnia unari, Seamciron xvelis intensivoba, misi sixSire da daavadebis
xangrZlivoba, Tu mieca avadmyofs kataruli periodis pirvel dReebSi, maT didi roli
uZRviT infeqciis gavrcelebis SewyvetaSi. mZime SemTxvevebSi (garTulebis dros)
naCvenebia antibiotikebis kombinireba. spazmur periodSi, gansakuTrebiT mogvianebiT,
antibiotiki uefeqtoa. pnevmoniiT garTulebis dros iniSneba sxvadasxva antibiotiki.
mowodebulia imunoTerapia yivanaxvelas sawinaaRmdego imunoglobulinis saxiT, romelic
eniSneba 2 wlamde asakis bavSvebs daavadebis mZimed mimdinareobisas dozirebiT 1,25 ml
yoveldRe 3-5 dRis ganmavlobaSi kunTebSi, Tumca misi efeqturoba makontrolebeli
gamokvlevebis Sedegad eWvqveSaa dayenebuli.
spazmuri xvelis sixSirisa da simZimis SemcirebisaTvis zogjer gamoiyeneba
kortikosteroidebi, albuteroli, romlebic xsnian bronqospazms, amcireben sunTqvis
centris agznebadobas, xels uwyoben avadmyofis damSvidebas.
hi poqsemiisa da hi poqsiis sawinaaRmdegod uniSnaven Jangbads, umjobesia Jangbadis
mowodeba karavis pirobebSi. apnoes dros amwovi aparatis meSveobiT zemo sasunTq
gzebs frTxilad aTavisufleben sqeli, webovani lorwosagan. sunTqvis gaCerebisas
mimarTaven intubacias, xelovnur sunTqvas. sunTqvis centris gamaRizianebeli preparatebis
daniSvna winaaRmdegnaCvenebia, aRniSnuli centri isedac Zlieri agznebis mdgomareobaSi
imyofeba.
damxmare Terapiis saxiT adekvaturi hidratacia siTxis saxiT, maRalkaloriuli,
vitaminebiT mdidari dieta. didi mniSvneloba aqvs maprovocirebeli faqtebis mocilebas
_ sawovara (amitom zogjer kveba xangrZlivad zondiT xdeba), saTanado reJimis
dacvas. dadgenilia, rom avadmyofebis CarTva saintereso TamaSSi sufTa, civ haerze
(araumetes 100 C-ze qvemoT) yofna amcirebs spazmuri Setevebis sixSires.
prognozi seriozulia, gansakuTrebiT 5 Tvemde asakis bavSvebSi, sadac letaloba
40%-sa da mets aRwevs. letalobas ZiriTadad pnevmonia an filtvebis mxriv sxva
garTulebebi ganapirobebs, iseve rogorc tvinis hi poqsia da krunCxvebi. qronikuli
daavadebebis, gansakuTrebiT, bronqoeqtaziebis Camoyalibeba Znelad eqvemdebareba aRricxvas.
profilaqtika. RonisZiebebi epidkeraSi: avadmyofis izolacia xdeba daavadebis
profilaqtika
adreul periodSi (diagnozis dasma xSirad spazmuri xvelis periodSi xerxdeba).
avadmyofi Tavsdeba saxlis pirobebis dros calke oTaxSi an keTdeba ganmacalkevebeli
Sirma, hospitalizacia ki xdeba Cvenebebis mixedviT (epid-situacia, simZime). avadmyofis
izolacia ganisazRvreba 5 dRiT, Tu mas eZleoda antibiotiki, xolo Tu ar eZleoda _
3 kviriT.
profilaqtika. nayofs imuniteti tansplacenturad ar gadaecema.
specifikuri profilaqtika
miuxedavad imisa, rom axalSobilTa 1/3-is sisxlSi aRiniSneba Cxirebis sawinaaRmdego
antisxeulebi, igi mainc ver uzrunvelyofs daavadebis Tavidan acilebas. specifikuri
336
yivanaxvela
kerZo nawili. parayivanaxvela
profilaqtikuri acrebi tardeba ujreduli an aceluluri vaqciniT (bolo vaqcinas

krunCxvis saxiT naklebi gverdiTi movlenebi axasiaTebs). kontaqtis SemTxvevaSi,
aucilebelia vaqcinacia, Tu igi Catarebuli ar aris.
qimioprofilaqtika. kontaqtSi myof axalSobilebSi warmatebiT gamoiyeneba
qimioprofilaqtika
eriTromicini igive dozebiT, rac mkurnalobis drosaa gaTvaliswinebuli.
kontaqtis SemTxvevaSi, miuxedavad uwin gakeTebuli acrisa, rekomendebulia bavSvebs
Cautardes yivanaxvela-difTeria-tetanusis acra damatebiti dozebiT. acrebi ar keTdeba,
Tu ukanaskneli, damamTavrebeli dozis miRebidan ar gasula 6 Tveze meti, magram aseT
SemTxvevaSi mainc uniSnaven eriTromicins 50 mg/kg sxeulis masaze dRe-RameSi 4
miRebaze, 10 dRis ganmavlobaSi.
yivanaxvelagadatanili 7 wlis asakis bavSvebi da samedicino personali kontaqtis
SemTxvevaSi ar eqvemdebarebian izolireba-gancalkevebas (karantins), Tumca maTze wesdeba
meTvalyureoba 25 dRis ganmavlobaSi. daavadebis keraSi tardeba mxolod saerTo
profilaqtikuri RonisZiebebi.
parayivanaxvela
(PARAPERTUSIS)
parayivanaxvela mwvave infeqciuri daavadebaa, romelic xasiaTdeba yivanaxvelas,

klinikuri simptomatikiT, mxolod im gansxvavebiT, rom misi xangrZlivoba ufro moklea
da ar aRemateba 2-3 kviras, mimdinareobs ioli formiT, garTulebebis gareSe.
parayivanaxelas diagnostika eyrdnoba mxolod kompleqsur gamokvlevas _ klinikur,
baqteriologiur, serologiur, epidemiologiur monacemebs.
etiologia. gamomwvevi agenti Bordetella parapertussis aRmoCenili da aRwerili
etiologia
iqna 1937w. Eldering-is da Rendrick-is mier. igi warmoadgens gramuaryofiT Cxirs,
romelic borde-Jangus niadagze iZleva kaSkaSa koloniebs. mikroorganizmi aseve izrdeba
Regan-Lowe naxSiris agarze 10% cxenis sisxls da 5-40 mkg/ml cefaleqsinis
damatebiT, an Stainer-Seholte-s niadagze ciklodeqstrinis damatebiT. bolo wlebSi
SesaZlebeli gaxda polimerazuli jaWvuri reaqciis meSveobiT ganvasxvavoT mikrobi
yivanaxvelas gamomwvevisagan. igi morfologiurad ar gansxvavdeba yivanaxvelas Cxirebisagan,
magram misgan diferencireba SesaZlebelia specifikuri maaglutinirebeli SratebiT.
epidemiologia. daavadeba gavrcelebulia mTel msoflioSi. yivanaxvelasagan
epidemiologia
gansxvavebiT, ufro xSirad avaddebian 2-dan 10-wlamde, naklebad ki _ wlamde asakis
bavSvebi. daavadebis gadacemis meqanizmi haer-wveTovania. kontagiozobis indeqsi aRwevs
40%-s. infeqciis wyaros warmoadgens avadmyofi an, ufro naklebad, baqteriamtarebeli.
daavadebis afeTqebebi aRiniSneba organizebul bavSvTa koleqtivebSi. SesaZlebelia,
rom afeTqebis didi kera yivanaxvelas sawinaaRmdegod acril bavSvebsac moicavdes,
Tumca yivanaxvelasa da parayivanaxvelas Soris arsebobs jvaredini imuniteti, rac
ganpirobebulia saerTo antigenuri TvisebebiT.
paTogenezi. igivea, rac yivanaxvelas dros. paTanatomiuri suraTi Seswavlili ar
paTogenezi
aris, rac daavadebis msubuqi mimdinareobiTaa ganpirobebuli.
klinika. inkubaciuri periodi moicavs 3-dan 15-mde dRes, ufro xSirad ki 10-11
klinika
dRea. daavadeba, umravles SemTxvevaSi, mimdinareobs temperaturis gareSe, iwyeba xveliT,
romelic TandaTanobiT Zlierdeba. zogjer xvela spazmur, SeteviT xasiaTsac Rebulobs,
aRiniSneba reprizi da Rebineba. aseT SemTxvevaSi parayivanaxvela mogvagonebs yivanaxvelas
_ mkafiodaa gamoxatuli daavadebis samive klinikuri periodi (kataruli, spazmuri
337
parayivanaxvela
kerZo nawili. botulizmi
xvelisa da gamojanmrTelebis stadia), Tumca yivanaxvelasagan gansxvavebiT, spazmuri

xvelis xangrZlivoba da sixSire ufro naklebia da ar aRemateba 5-7 Setevas dRe-
RameSi. aseTi klinikuri mimdinareoba axasiaTebs daavadebis SemTxvevaTa 1/3-s.
hematologiuri cvlilebebic identuria (leikocitozi, limfocitozi), Tumca ufro
sustadaa gamoxatuli. sxva danarCen SemTxvevebSi parayivanaxvela mimdinareobs waSlili
formiT, inaparantulad, spazmuri xvelis gareSe, mwvave respiraciuli virusuli infeqciis
msgavsad bronqitis ti pis xveliT, ris gamoc diagnozis dadgena ufro gaZnelebulia
da SesaZlebeli xdeba mxolod baqteriologiuri, serologiuri da epidemiologiuri
gamokvlevebis meSveobiT. diagnozis dadasturebisaTvis cxvir-xaxis lorwodan mikrobis
gamoyofasTan erTad saWiroa serologiuri _ hemaglutinaciis, komplementSemboWavi
reaqciebis titris zrda daavadebis dinamikaSi da, aucileblad, epidemiologiuri
monacemebis gaTvaliswineba.
mkurnaloba mxolod simptomuria.
profilaqtika. rogorc yivanaxvelas dros, aqac tardeba saerTo profilaqtikuri
profilaqtika
RonisZiebebi. specifikuri acrebi ar tardeba.
1 wlis zeviT bavSvebi da mozrdilebi, maT Soris, bavSvTa koleqtivis momsaxure
personali izolirebas (karantins) ar eqvemdebarebian.
botulizmi
(BOTULINUS)
sinonomi: alantiazisi (Allantiasis), iqtiizmi (ichtyismus)

botulizmi warmoadgens mZime kvebiT toqsikoinfeqcias*, romelic gamowveulia
botulotoqsiniT da TviT CxirebiT, xasiaTdeba nervuli sistemis, gansakuTrebiT, mogrZo
tvinisa da zurgis tvinis mxriv ganpirobebuli ofTalmoplegiuri da bulburi
sindromebis gamovlinebiT.
mokle istoriuli cnobebi cnobebi: daavadebis saxelwodeba dakavSirebulia ZexviT
mowamvlasTan (laT. botulus _ Zexvi; berZn. - allas, antos _ Zexvi). 1820 wels
pirveli klinikur-epidemiologiuri aRwera ganaxorciela i. kernerma. ruseTSi daavadeba
iqTiizmis saxelwodebiT iyo cnobili da ukavSirdeboda damarilebuli da Sebolili
Tevzis miRebas (berZn. ichthus-Tevzi). 1896w. van-ermengma loris narCenebidan, botulizmiT
gardacvlili gvamis elenTidan da msxvili nawlavebidan gamohyo mikrobi, romelsac
Clostridium botulinum uwoda. zogjer neirotoqsins warmoSoben iSviaTi klostridiebi
_ C. butyricum da C. baratii (informacia am Cxirebze mwiria). cnobilia adamianis
botulizmis 3 forma: Cvili bavSvebis botulizmi, sakvebismieri (klasikuri) da Wrilobis
botulizmi.
etiologia. Clostridium botulinum warmoadgens anaerobul mikrobs, romelic
miekuTvneba Clostridium gvarsa da Bacillacea-s ojaxs. cnobilia 7 serologiuri
tipi _A, B, C (Cα da Cβ β), D, E, F, G. maTi ti pebad dayofa ganpirobebulia egzotoqsinis
antigenuri TvisebebiT. TiToeuli ti pis toqsini srul neitralizacias ganicdis
mxolod homologiuri ti pis Sratis moqmedebiT. yvela ti pisaTvis damaxasiaTebelia
toqsinis anaerobul pirobebSi gamomuSaveba. isini morfologiurad erTmaneTisagan ar
gansxvavdebian, moZraoben Soltebis meSveobiT, romelTa raodenoba 4-dan 35-mde meryeobs.
* msoflio jandacvis organizaciis mier miRebuli klasifikaciiT es infeqcia

moixseneba, rogorc kvebiTi intoqsikacia.
338
mikrobebis zoma (4-9) X (0,6-0,9)mkm-ia. axal kulturaSi Cxirebi gramis wesiT

iRebebian dadebiTad, Zvel kulturaSi (4-5 dRis zrdis Semdeg) ki _ gramuaryofiTad.
garemoSi Cxirebi warmoSoben subterminalur da terminalur sporebs da formiT
CogburTis Cogans mogvagoneben. sporebi Termostabiluria, 100°C temperaturas uZleben
ramodenime saaTis, avtoklavirebas 120°C-ze ki _ 30 wT-is ganmavlobaSi. vegetaciuri
formebi garemoSi nakleb rezistentulia da 60°C-ze iRupebian.
botulotoqsins mxolod vegetaciuri formebi gamoimuSaveben. aRniSnuli toqsini
iTvleba yvelaze ufro Zlier bunebriv Sxamad. botulinis Cxirebi kargad mravldeba
sakveb produqtebSi, Tevzis, loris did naWrebSi, ZexvSi, da konservebSi (gansakuTrebiT
saxlis pirobebSi damzadebisas), iSviaTad, TaflSic (ris gamoc 1 wlamde asakis bavSvebis
racionSi Tafli ar unda Sediodes), anaerobul pirobebSi gamomuSavdeba da grovdeba
egzotoqsini (sakvebismieri botulizmis dros toqsini warmoiSoba produqtSi, Wrilobis
botulizmis dros _ anaerobul sivrceSi qsovilebSi, xolo Cvil bavSvTa botulizmis
dros ki, sporebis vegetaciur formaSi gadasvlisas nawlavSi.). igi warmoadgens toqsinur
kompleqss, romelic Sedgeba sakuTriv neirotoqsinisagan
neirotoqsinisagan, hemaglutininisa da ucnobi
biologiuri Tvisebebis mqone aratoqsikuri cilisagan
cilisagan. 1 mg toqsini Seicavs letalur
dozas 100 milioni TeTri TagvisaTvis, mozrdili adamianisaTvis ki letaluria
0,005mg. toqsini Termolabiluria da iSleba 80°C-ze 30 wT-is ganmavlobaSi.
adamianisaTvis paTogenuria A, B, E daEF ti pis toqsinebi, C da D ti pis ki toqsikuria
mxolod cxovelebisaTvis. G ti pis toqsini ar unda iwvevdes daavadebas arc adamianebSi
da arc cxovelebSi.
epidemiologia. sakvebismieri botulizmi miekuTvneba saprozoonozebs. infeqciis
epidemiologia
ZiriTadi wyaroa Tbilsisxliani cxovelebi (cxeni, Zroxa, Txa), naklebad _ civsisxlianebi
(Tevzi, moluski, kibosnairebi da sxva), romelTa nawlavebSic didi raodenobiT grovdeba
C.botulinum da garemoSi ganavliT gamoiyofa, ris Semdegac gardaiqmneba sporebad.
niadagSi sicocxlisunarianobas inarCuneben Tveebisa da wlebis ganmavlobaSi. niadagis
mikrobebiT moTesva gansakuTrebiT intensiuria cxovelTa saZovrebze, sadac organul
substratebSi moxvedrisas (xorci, Zexvi, dakonservebuli produqti) anaerobul pirobebsa
da Sesabamis (gansakuTrebiT 22-37°C-ze) temperaturaze mravldebian da gamoyofen
toqsinebs.
daavadeba, umTavresad, dakavSirebulia saxlis pirobebSi dakonservebuli produqtebis
miRebasTan (barda, badrijani, soko, lobio, wiwaka, Tevzi, Roris qoni da sxva) da
ganpirobebulia toqsinebiTa da cocxali mikrobebiT.
cxovelidan cxovelze infeqciis gadacema xorcieldeba dainficirebuli sakvebiT,
maT Soris, saZovrebzec.
adamianidan adamianze infeqciis gadacema dadasturebuli ar aris, Tumca cnobilia,
rom adamiani botulotoqsinebis mimarT Zlier mgrZnobiarea.
Cvil bavSvTa botulizmi aRwerilia yvela kontinentze afrikis garda. ojaxSi am
daavadebiT avad xdeba mxolod Cvili. gansakuTrebiT 3 kviridan 6 Tvis asakamde, sxvani
ki janmrTelni rCebian.
daavadeba gamoixateba uecari sikvdilis sindromiT. daavadebis diagnostika xSirad
ver xerxdeba. aSS-Si yovelwliurad aRiricxeba 75-dan 100 SemTxvevamde. daavadeba
xSirad ukavSirdeba Taflis miRebas. risk-faqtors warmoadgens, aseve, nawlavTa
gaiSviaTebuli moqmedeba (zogjer dReSi 1 defekaciaze iSviaTi). ZuZuTi kveba garkveulad
icavs botulizmiT ganpirobebuli uecari sikvdilis sindromisagan. daavadebis
ganviTarebaSi garkveuli mniSvneloba, albaT, aqvs nawlavis anatomias, fiziologiasa da
mikrofloras, vinaidan mozrdili bavSvebi da mozrdilebi aseTi infeqciisadmi
miuReblobiT gamoirCevian. Cvil bavSvTa botulizmi ganpirobebulia bavSvis kuW-
339
nawlavSi sporebis vegetaciur formaSi gadasvliT.

Wrilobis botulizmi Zalze iSviaTad gvxvdeba (sul aRwerilia daaxloebiT 100
SemTxvevamde). igi bolo wlebSi gvxvdeba ufro narkomanebSi _ arasteriluri
produqtebis an narkotikebis quCaSi inhalaciis an sxva mizezis gamo.
paTogenezi. botulinis vegetaciuri Cxirebi da toqsinebi adamianis kuW-nawlavis
paTogenezi
traqtSi inficirebuli sakvebis miRebis gziT xvdeba. iSviaT SemTxvevaSi SesaZloa
daavadeba gamoiwvios sporebis Semcveli miwiT Wrilobis gaWuWyianebam (Wrilobis
botulizmi), an xdeba zemo sasunTqi gzebis inficireba toqsinebis haerSi gafrqvevisas.
adamiani avaddeba maSinac, roca mxolod daReWavs inficirebul sakvebs.
daavadebis ZiriTad paTogenur faqtorad iTvleba botulotoqsini, Tumca paTogenezis
ganviTarebaSi infeqciuri faqtoric mniSvnelovan rols TamaSobs, roca vegetaciuri
formebi nawlavSi mravldebian da damatebiT gamoyofen toqsinebs. daavadeba aseTi
meqanizmiT viTardeba im SemTxvevaSi, roca inficirebuli sakvebi toqsinebis mcire
dozebisa da sporebis didi raodenobis Semcvelia. aseT SemTxvevaSi daavadebis inkubaciuri
periodi gaxangrZlivebulia. amrigad, paTogenezis TvalsazrisiT botulizmi SeiZleba
ganvixiloT, rogorc kvebiTi toqsikoinfeqcia.
kuWSi moxvedrili botulotoqsini proteolizuri fermentebis gavleniT 10-100-
jer aqtiurdeba. sisxlSi misi Sewova, ZiriTadad, xdeba kuWis, nawilobriv ki nawlavebis
lorwovani garsebidan. viTardeba toqsemia. toqsini sisxlZarRvTa sistemis Zlieri
Sxamia, iwvevs sisxlZarRvTa Zlier spazms, rac kanis safarvelis sifermkrTaliT,
mxedvelobis darRveviT, TavbrusxveviTa da gulis areSi usiamovno SegrZnebiT gamoixateba.
toqsemiis gavleniT metnaklebad yvela organosa da qsovilis funqcia iSleba, ufro
mgrZnobiarea nervuli sistema, gansakuTrebiT ki zurgisa da mogrZo tvinis motoneironebi,
rac ganapirobebs bulburi da paralizuri sindromis ganviTarebas. xdeba parasimpaTikuri
inervaciis Zlieri daTrgunva, maSin, roca simpaTikuri inervacia TiTqmis intaqturia.
toqsini moqmedebs periferiul motorul nerv-kunTovan sinafsebze da Sesabamisad
iwvevs agznebis gadacemis darRvevas nervebidan kunTebze. qolinerguli nervebis
daboloebebSi toqsini aferxebs acetilqolinis gamoTavisuflebas, Tumca impulsebis
blokireba srulad ar xdeba. garda aRniSnulisa, botulotoqsinis maRali dozebi
iwvevs did hemisferoebSi qsovilovani sunTqvis daTrgunvas. da, mainc, es darRvevebi ar
ganapirobeben sikvdils. dadgenilia, rom botulotoqsini warmoadgens sisxlZarRvTa
Zlier Sxams.
organizmSi hi poqsiis gaRrmaveba xdeba pirnaRebi masebis, nerwyvis an saWmlis
aspiraciiT bronqebis obstruqciisas, rac Tavis mxriv, gamowvulia xorxis, xaxisa da
xorxsarqvelis kunTebis pareziT.
paTmorfologiuri suraTi araspecifikuri cvlilebebis xasiaTs atarebs da
gamowveulia Rrma hi poqsiis movlenebiT. Tavis tvinsa da Sinagan organoebSi viTardeba
Zlieri SeSupeba, hi peremia, didi da mcire zomis mravlobiTi sisxlCaqcevebi, Trombebi.
imuniteti. daavadebis gadatanis Semdeg organizmSi Cndeba antitoqsikuri da
antibaqteriuli antisxeulebi. imuniteti ti purspecifikuria, rac ar gamoricxavs
sxva ti pis mikrobebiT ganmeorebiT daavadebas.
klinika. sakvebismieri botulizmis inkubaciuri periodi ramdenime saaTidan 10
dRemdea. misi xangrZlivoba damokidebulia toqsinis dozaze, sakvebSi cocxali mikrobebis
raodenobasa da organizmis reaqtiulobaze.
daavadeba, umravles SemTxvevaSi, iwyeba mwvaved. imisda mixedviT, Tu ra simptomatika
sWarbobs daavadebis dasawyisSi, klinikuri mimdinareoba pirobiTad SeiZleba daiyos
sam variantad: 1. dispefsiuri movlenebi daavadebis dasawyisSi; 2. mxedvelobis darRveva;
3. sunTqvis sistemis ukmarisoba.
340
dispefsiuri movlenebi aRiniSneba daavadebis dasawyis periodSi. avadmyofebi daavadebis

pirvel stadiaSi uCivian gulisrevas, pirRebinebas, epigastriumis midamoSi SeteviTi
xasiaTis tkivils, piris Rrus simSrales, Zlier wyurvils, muclis Sebervas, zogjer
Txier defekacias, romelic Semdgom yabzobiT icvleba. adreul simptomebs miekuTvneba,
agreTve, mtkivneuloba ylapvis dros, yelSi `gorgalis mowolis” (saWmlis TiTqosda
`gulze dadgomis”) SegrZneba.
sxeulis temperatura rCeba normalur cifrebze, iSviaTad subfebriluria. aRiniSneba
swrafi daRliloba kunTebis progresuli sisustis gamo.
mxedvelobis darRvevis dros avadmyofebi uCivian mxedvelobis daqveiTebas, Tvalis
win nisls, mariambulas salbunis, badis gaCenas. avadmyofebi ver kiTxuloben, gansakuTrebiT,
wvril Srifts, maTi subieqturi SegrZnebiT asoebi TiTqosda moZraoben da erTmaneTs
erwymian. aRniSnuli movlenebi gamowveulia akomodaciis pareziTa da mxedvelobis
gaorebiT. obieqturad aRiniSneba midriazi, anizoqoria, sinaTleze gugis reaqciis
daqveiTeba an sruli ararseboba. SesaZlebelia, ganviTardes Tvalis kaklis moZraobis
SezRudva an, mZime SemTxvevebSi, mxedvelobis aris sruli dambla (sruli ofTalmoplegia,
uZravi Tvalis kakali), orive quTuTos ftozi, strobizmi, xSiria vertikaluri nistagmi,
ufro iSviaTad ki _ msubuqi anizokoria. avadmyofebi xSirad TvalTan dakavSirebuli
Civilebis gamo akiTxaven okulists. am dros mxedvelobis darRvevis garda yuradRebas
i pyrobs iseTi simptomebis arsebobac, rogoricaa piris Rrus Zlieri simSrale, xmis
CaxleCa, Zlieri wyurvili da intoqsikaciis simptomebi _ saerTo sisuste, Tavbrusxveva,
kunTebis moduneba da sxva. aseTi formebis dros, Tundac mogvianebiT, karg efeqts
iZleva specifikuri antitoqsikuri SratiT mkurnaloba (a.xoWava).
Tvalis simptomebTan erTad an mogvianebiT Cndeba Tavis qalas nervebis birTvebis
dazianebis suraTic _ sxvadasxva organos inervaciaTa paralizuri darRvevebi, rac
simetriul xasiaTs atarebs. IX-XII wyvili nervebis dazianeba ganapirobebs iseT
simptomatikas, rogoricaa xmis CaxleCa, gaugebari metyveleba (luRluRi), cxviris
tembris mqone xma, zogjer ki afonia. xaxis, xorxsarqvelisa da sasules kunTebis
parezis gamo avadmyofebs uZneldebaT ylapva, xSiria sasuleSi saWmlis gadacdena,
Txieri saWmlis cxviridan gadmodena.
sunTqvis darRvevis upiratesobiT mimdinareobis dros saerTo mdgomareoba Zlier
mZimea. daavadebis dasawyisSive viTardeba haeris mwvave ukmarisoba. avadmyofebi uCivian
gulmkerdis areSi moWeris grZnobas, zogjer _ tkivilebs. klinikur suraTs ganapirobebs
kisrisa da gulmkerdis didi motoneironebis CarTva: SesunTqvis aqti Zlier Sesustebulia
da did Zaldatanebas saWiroebs. avadmyofi iRebs iZulebiT pozas, rac xels uwyobs
sunTqvis aqtSi damxmare kunTebis CarTvas, sunTqva xdeba zerele, wyvetili, matulobs
cianozi, qreba xvelis refleqsi, viTardeba sasunTqi kunTebis sruli parezi _ mkveTrad
izRudeba neknTaSua kunTebis moZraoba, bolos ki diafragmuli sunTqvac wydeba (diafragmis
nervis damblis gamo), rac xdeba sikvdilis mizezi. aspiraciuli pnevmoniis ganviTareba
xels uwyobs sunTqvis darRvevis gaRrmavebas.
garda aRniSnulisa, botulizmis dros viTardeba yvela organosa da sistemis
funqciis daTrgunva. maT Soris, damaxasiaTebelia kunTovani sistemis moduneba. bavSvebi
xSirad Tavs ver iWeren, fexze ver dgebian. kunTebi rbili, comiseburi konsistenciisaa.
gulis mxriv aRiniSneba sazRvrebis gadideba, yru tonebi, taqikardia, sistoluri
Suili, romelic toqsikuri miokarditiTaa ganpirobebuli. gulis kunTSi gamoxatulia
distrofiuli movlenebi. centraluri nervuli sistemis dazianebisa da encefalitis
miuxedavad avadmyofebs ar uviTardebaT gonebis dabindva, mgrZnobelobis sferoc
SenarCunebulia.
periferiul sisxlSi aRiniSneba zomieri leikocitozi, neitrofilozi marcxniv
341
gadaxriT. eds umniSvnelod momatebulia.

mZime formebis dros sunTqvis ukmarisoba progresirebs, igi mTavrdeba diafragmis
dambliT, rac sikvdilis ZiriTad mizezs warmoadgens.
daavadebis keTili gamosavlis SemTxvevaSi aRdgeniTi periodi sakmaod xangrZlivia
da grZeldeba 3-5 Tves, Tumca merec didxans rCeba saerTo sisuste, advilad daRlilobis
SegrZneba, tkivilebi gulis areSi da guliscemis gaZliereba fizikuri datvirTvisas.
daavadebis ukuganviTarebis procesSi pirvelad qreba nevrologiuri simptomatika _
ixsneba sunTqvis darRveva, Semdeg aRdgeba ylapva da sxva. daavadebis gadatanis Semdeg
gamojanmrTeleba srulia.
garda aRniSnuli klinikuri manifestaciisa, SesaZlebelia Segvxvdes waSlili da
umsubuqesi formebi centraluri nervuli sistemis dazianebis gareSe an sunTqvis
ukmarisobis gareSe, mimdinare mxedvelobisa da ylapvis swrafad gardamavali darRveviT.
botulizmi Cvili asakis bavSvebSi. 1976 w. aSS-Si Pickett-ma da Tanaavtorebma
pirvelad aRweres daavadeba Cvili asakis bavSvebSi, romlis gamomwvevia C.botulinum.
daavadeba gvxvdeboda 1 wlis asakamde bavSvebSi ufro xSirad ki 6 Tvemde, aRiniSneba
“modunebuli bavSvis” simptomi _ igi ver ylapavs, tiris CaxleCili xmiT, xSiria
aspiracia, SesaZloa uecari sikvdilis sindromis ganviTareba.
damaxasiaTebelia Sekruloba, romelic 3 da met dRes grZeldeba, mas mosdevs
leTargia, bavSvebi ver ikaveben Tavs da kisers, sunTqvis parezis gamo viTardeba
sunTqvis ukmarisoba, romelic progresirebis SemTxvevaSi letalur gamosavals
ganapirobebs. SeiZleba, gamovlindes qalatvinis nervebis parezi (ftozi, gugebis dune
reaqcia, mxedvelobis daqveiTeba, Tvalis kaklis moZraobis SezRudva da a.S.). ganavalSi
naxuloben botulinis Termolabilur toqsinebs an Cxirebs. am formis dros antitoqsiniT
an antibiotikebiT mkurnaloba araviTar efeqts ar iZleva, piriqiT: dadgenilia, rom
aminoglikozidebi auareseben daavadebis prognozs, radgan aZliereben nerv-kunTovan
blokadas. mkurnaloba iTvaliswinebs uwyvet dakvirvebas, intensiuri Terapiis Catarebas,
hi perbarul oqsigenacias da a.S.
Wrilobis botulizmi iSviaTi daavadebaa da misi ganviTareba dakavSirebulia
botulinis Cxirebis garemodan moxvedrasTan, ris Semdegac WrilobaSi xdeba toqsinis
producireba, xolo klinikuri suraTi mimdinareobs yvela zemoT aRniSnuli sistemis
dazianebiT.
diagnozi. daavadebis mTavar diagnostikur niSnebs miekuTvneba mxedvelobis, ylapvis,
metyvelebis da sunTqvis darRvevis simptomebi, romlebic ganviTarebulia kunTebis
sisustis, kanis sifermkrTalisa da lorwovani garsebis simSralis fonze.
laboratoriuli diagnostika eyrdnoba botulinuri toqsinebis an Cxirebis
gamovlinebas avadmyofis sisxlSi, pirnaReb masaSi, kuW-nawlavis amonarecx wylebSi,
gvamidan aRebul masalaSi da sxv., agreTve sakveb produqtebSi, romlebmac gamoiwvia
mowamvla. mTavaria ara marto toqsinebisa da mikrobebis aRmoCena, aramed maTi ti pebis
dadgena, rac azustebs nozologiur diagnostikas da saSualebas iZleva, sworad
warimarTos mkurnaloba.
mniSvnelovania, rom sisxli aRebuli unda iyos samkurnalo Sratis organizmSi
Seyvanamde. aRebul gamosakvlev masalebs ar unda daematos makonservebeli nivTiereba,
maTi Senaxva saWiroa mxolod siciveSi, vinaidan botulinuri toqsini oTaxis
temperaturaze nawilobriv iSleba.
laboratoriaSi Semosuli masalis gamokvleva xdeba ori mimarTulebiT. winaswar
momzadebul 2/3 substratis filtrati an centrifugati gankuTvnilia botulotoqsinebis
gamosakvlevad. am mizniT asnebovneben TeTr Tagvebs (biologiuri sinji) da paralelurad
atareben neitralizaciis reaqcias botulotoqsinis sawinaaRmdego Sratebis gamoyenebiT.
342
1/3 ki iTeseba sakveb niadagebze (pefsin-peptonis, kit-tarocis niadagze, xotingeris

bulionze) botulinuri Cxirebis gamoyofis mizniT.
diferenciuli diagnostika tardeba toqsikoinfeqciebTan (stafilokokuri,
salmonelozuri da sxva etiologiis), sokoTi, lencofiT, atropiniT mowamvlasTan,
virusul encefalitTan, poliomielitTan, difTeriul poliradikulonevritTan da
sxva.
sxva toqsikoinfeqciebis dros aRiniSneba maRali temperatura, dispefsiuri
movlenebi, da, rac ZiriTadia, ar aris botulizmisaTvis damaxasiaTebeli parezuli
gamovlinebani.
mowamvla, Cveulebriv, dakavSirebulia arakonservirebul, axaldamzadebul
sokoTi mowamvla
produqtTan (Sxamiani sokoebi, rogoricaa Sxama soko da sxva). am dros aRiniSneba
gastroenterituli movlenebi, muclis tkivili, gaZlierebuli nerwyvdena, oflianoba,
mZime SemTxvevebSi xSiria mxedvelobiTi halucinacia, krunCxvebi.
atropiniTa da lencofaTi mowamvlisas pirveli niSnebi vlindeba 1-5 saaTSi.
klinikuri suraTi xasiaTdeba agznebiT, SesaZlebelia aRiniSnos bodvebi, sopori da
koma, gugebis Zlieri gafarToeba.
poliomielitisa da encefalitis dros arsebuli bulburi movlenebi saWiroa,
gairCes botulizmisagan. am ukanasknelisagan gansxvavebiT poliomielitsa da encefalitebs
axasiaTebT hi persalivacia, uxvi raodenobiT lorwos gamoyofa, temperaturuli reaqcia,
zemo sasunTqi gzebis kataruli movlenebi, meningealuri sindromi, Tav-zurgtvinis
siTxis paTologiuri cvlilebebi.
difTeriuli poliradikulonevritebi viTardeba daavadebis mogvianebiT periodSi
(5-6 kvira), amave dros anamnezSi figurirebs miTiTeba gadatanil ànginaze”.
mkurnaloba. botulizmze eWvis mitanis dros avadmyofebi eqvemdebarebian infeqciur
mkurnaloba
saavadmyofoSi aucilebel hospitalizacias. maT eniSnebaT kuWis amorecxva (Tu ar
aris darRveuli ylapvis refleqsi) da sodiani xsnaris maRali sifonuri oyniT
nawlavebis gamorecxva. zondis gamoyeneba kuWis amosarecxad unda tardebodes frTxilad
imis Semdeg, roca davrwmundebiT, rom igi ar aris sasunTq gzebSi.
sisxlSi mocirkulire toqsinebis gasaneitraleblad aucilebelia rac SeiZleba
adre, pirvelsave dReebSi antitoqsinis Seyvana. toqsinebis sisxlSi yvelaze maRali
koncentracia aRiniSneba daavadebis me-2-3 dRes da drois am periodSi antitoqsinis
Seyvana yvelaze efeqturia. Tumca toqsinebis Sewova sisxlSi mogvianebiTac xdeba,
amitom antitoqsini daavadebis ufro mogvanebiT periodSic gamoiyeneba.
toqsinis ganeitralebis mizniT organizmSi SehyavT polivalenturi (A, B, E ti pis)
specifikuri antitoqsini hi persensibilizaciaze sinjis gakeTebis Semdeg (ix. zogad
nawilSi).
Seiyvaneba A ti pis antitoqsini 10.000, B ti pis _ 5.000, E ti pis _ 10.000 da F
ti pis _ 10.000. aRniSnuli raodenobebi Seadgens erT samkurnalo dozas. mZime
SemTxvevebSi SehyavT 2-3 samkurnalo doza, romelic winaswar 10-jer ganzavdeba
fiziologiuri xsnariT (rusuli warmoebis anatoqsini). winaswar 37°C-mde gamTbari
pirveli doza Seiyvaneba venaSi, neli tempiT, Cvil bavSvTa botulizmis dros antitoqsini
uefeqtoa. kaliforniaSi grZeldeba adamianis `Botulism Immune Globulin”-ze
gamokvlevebi, magram es muSaoba damTavrebuli ar aris.
Wrilobis botulizmis dros antibiotikebi rekomendebulia 7 dRis ganmavlobaSi.
Cvil bavSvebSi antibiotiki uefeqtoa da piriqiT, mdgomareobis gauaresebasac iwvevs
(patara asakis bavSvebSi isini gamoiyeneba mxolod meoradi infeqciis samkurnalod,
raTa C. botulinus-is daSlis Sedegad ar moimatos toqsemiam). gamoiyeneba
sadezintoqsikacio xsnarebi, ringeris laqtati, reopoliglukini, plazma, glukozis 5-
343
botulizmi
kerZo nawili. gaSeSeba
10%-iani xsnari da sxva, sagule glikozidebi urgentul SemTxvevebSi, vitaminebi,

gansakuTrebiT B jgufis.
mniSvnelovani roli eniWeba sunTqvis ukmarisobis, hi poqsiis mkurnalobas. am
mizniT iyeneben hiperbarul oqsigenoTerapias. mZime avadmyofebi, rogorc wesi, Tavsdebian
intensiuri Terapiis palataSi da saWiroebis SemTxvevaSi gadahyavT xelovnur sunTqvaze.
pnevmoniis ganviTarebis dros ixmareba antibiotikebi. saWiroa kvebis gagrZeleba zondiT
da parenteruli gziT.
profilaqtika. gadamwyveti mniSvneloba eniWeba sanitarul-saganmanaTleblo muSaobas
profilaqtika
da, pirvel rigSi, saxlis pirobebSi sakvebi produqtebis sworad dakonservebasa da
Senaxvas. bombaJiani konservirebuli produqtebi eqvemdebareba aucilebel likvidacias.
botulizmiT jgufuri mowamvlis dros daavadebis keraSi myof pirebs, romlebmac
miiRes saeWvo produqti, profilaqtikis mizniT kunTebSi botulizmis sawinaaRmdego
Srati ar ukeTdebaT, vinaidan mosalodnelia xSiri alergiuli reaqciebi Sratismieri
daavadebis da anafilaqsiuri Sokis CaTvliT.
gaSeSeba
(TETANUS)
gaSeSeba warmoadgens mwvave infeqciur daavadebas, romelic vlindeba organizmis

saerTo toqsikoziTa da tonuri krunCxvebiT, rac centraluri nervuli sistemis
mamoZravebeli nervebis egzotoqsiniT (tetanospazminiT) dazianebis Sedegia.
mokle istoriuli cnobebi. daavadeba cnobilia uZvelesi droidan. daavadebis
klinikis mkafio aRwera pirvelad mogvawoda hi pokratem, romelsac Svili tetanusiT
gardaecvala.
1883w. rusi mecnieris Í\ Ä\ Ìîíàñòûðñêèé
Ìîíàñòûðñêèé–s mier aRmoCenil iqna daavadebis
gamomwvevi mikrobi. 1887w. s. kitasotom miiRo mikrobis sufTa kultura, xolo 1890w.
toqsini da e. beringTan erTad mogvawoda gaSeSebis sawinaaRmdego antitoqsiuri
Srati daavadebis samkurnalod. 1923 wels miRebul iqna anatoqsini, romelic SemdgomSi
daavadebis profilaqtikis safuZveli gaxda.
etiologia. gaSeSebis gamomwvevi (Clostridium tetani) gramdadebiTi, wvrili,
moZravi Cxiria. misi zomebia (4-8)X(0,3-0,8)mkm. mikrobs gaaCnia 0-somaturi da H-
ti purspecifikuri antigeni, romlis mixedviTac arCeven 10 serovariants. yvela isini
gamohyofen identur toqsinebs _ tetanospazminsa da tetanohemolizins, romlebic
egzotoqsinebs miekuTvnebian. tetanospazmini pasuxismgebelia daavadebis klinikur
manifestaciaze. botulinis toqsinis Semdeg igi iTvleba yvelaze ufro Zlier Sxamad.
adamianisaTvis misi letaluri dozaa 130 mkg. toqsini swrafad inaqtivirdeba gaTbobis,
mzis sxivebis moqmedebisas. sporebi Zlier mdgradia fizikur-qimiuri faqtorebisa da
antiseptikuri saSualebebis mimarT. xelsayrel pirobebSi sporebi gadadian vegetaciur
formebSi da iwyeben egzotoqsinis produqcias. kuW-nawlavis traqtis fermentebi ar
Slian egzotoqsins, magram is ar Seiwoveba nawlavebis lorwovani garsebidan; amis
gamo toqsinis per os moxvedra saSiSroebas ar warmoadgens.
epidemiologia. balaxismWamel cxovelebSi tetanusis Cxiri nawlavis mudmivi
mobinadrea, xolo adamianebSi gvxvdeba 5-10%-mde. garemoSi maTi ganTesva fekaluri
masebiT xdeba. infeqciis karad iTvleba dazianebuli kani da lorwovani garsebi.
daavadeba iwyeba ganakawris, Wrilobis, damwvrobis, kriminaluri abortis dros
dainficirebiT. daavadeba mTel msoflioSia gavrcelebuli, magram ufro metad gvxvdeba
344
cxeli klimatis mqone qveynebSi, sadac wlis nebismier periodSi SeiZleba moxdes
inficireba. subtropikuli da zomieri klimatis mqone qveynebSi daavadeba, upiratesad,
mais-oqtomberSi gvxvdeba.
avadobis maCvenebeli damokidebulia imunizirebuli mosaxleobis fenaze. ganviTarebad
qveynebSi igi Seadgens 5-dan 50-mde SemTxvevas 100.000 mosaxleze. msoflioSi 80%-Si
daavadeba modis axalSobilebze ( e.w. Wipismieri gaSeSeba), rac ganpirobebulia araimunuri
dedebis higienis dabali doniT, mSobiarobisas higienuri pirobebis darRveviT. bavSvebSi
gaSeSebis 62-65% modis qvemo kidurebis travmaze (fexSiSvela siaruli, Wrilobis
miwiT dabinZureba da a.S.). mSvidobian periodSi daavadebis 80-86% soflis
macxovreblebSi gvxvdeba.
paTogenezi. organizmSi infeqciis SeWra xdeba dazianebuli kanidan da lorwovanidan.
gansakuTrebiT saSiSia naCxvleti Wriloba, romelsac Rrma jibeebi aqvs, saidanac
anaerobul pirobebSi (Jangbadis nakleboba) sporebi gardaiqmnebian vegetaciur formebad
da gamoimuSaveben Zlier biologiur Sxams _ tetanospazmins, romelic ganapirobebs
daavadebis paTogenezis mTavar rgols. toqsinis gavrceleba xdeba mamoZravebeli nervebis
endonervuli da perinervuli boWkoebisa (retrogradulad, zogierT nervSi misi
gadaadgilebis siCqare 3.4mm/sT-Si aRwevs) da sisxlis meSveobiT zurgis tvinsa da
Reros retikulur formaciaSi. toqsini arCeviTad azianebs polisinafsur refleqsur
rkalSi myof neironebs da iwvevs damblas. amasTan dakavSirebiT impulsebi, romlebic
gamomuSavdebian motoneironebSi, uwyvetad da arakoordinirebulad aRweven sxeulis
kunTebs, rac iwvevs maT mudmiv daWimvas, klinikurad es vlindeba krunCxviTi sindromiT.
vinaidan procesSi CarTulia retikuluri formacia, krunCxvebi Rebuloben generalizebul
xasiaTs. araspecifikuri gamRizianeblis moqmedebasTan dakavSirebiT (sinaTle, taqtiluri,
ynosviTi da sxva gamRizianeblebi), aferentuli impulsebiT Zlierdeba kunTebis daWimva.
kunTebis aseTi xangrZlivi daWimva iwvevs hi perTermiasa da energiis did xarjvas, rac
xels uwyobs metaboluri acidozis ganviTarebas. Rrmavdeba sunTqvis ukmarisoba,
romelic gamowveulia filtvis wuT-moculobis SemcirebiT diafragmuli da neknTaSua
kunTebis daWimvis Sedegad.
tetanospazminisa da striqninis moqmedeba erTmaneTis analogiuria. adgili aqvs
parasimpaTikuri nervuli sistemis aqtivacias, rac gamoixateba taqikardiaSi, aramdgrad
hi pertenziaSi, aritmiaSi, profuzul oflianobaSi, hi perkapniasa da kateqolaminebis
SardiT gamoyofaSi. toqsinis moqmedeba fermentuli bunebisaa. endoproteaza-
sinaptobrevini azianebs sinafsur ZarRvs, romelic ukavSirdeba ujredis membranas.
qsovilebSi ukve adsorbirebuli toqsini mWidrodaa dakavSirebuli maTTan da misi
daSla an neitralizacia antitoqsinis moqmedebiT ar xdeba. antitoqsini aseve ar
moqmedebs sporebsa da vegetaciur formebze. igi moqmedebs mxolod mocirkulire
toqsinze.
paTmorfologiuri suraTi avlens minimalur anTebad process. cns-Si aRiniSneba
tvinisa da misi garsebis SeSupeba. yvelaze ufro met cvlilebebs adgili aqvs Zval-
saxsarTa da kunTovan sistemebSi. krunCxviTma sindromma SeiZleba gamoiwvios Zvlebis
motexiloba, xerxemlis kompresiuli motexiloba (tetanus-kifozi), kunTebisa da myesebis
gagleja. kunTebsa da mis ganakveTze aRiniSneba sisxlCaqcevebi. adgili aqvs kunTTa
degeneracias (maT Soris diafragmuli da neknTaSua kunTebis), kunTebis lizissa da
miofibrilebis daRupvas, ramac SeiZleba ganapirobos ventilaciuri ukmarisoba da
miasTenia rekonvalescenciis periodSi.
klinika. inkubaciuri periodi 2 dRidan 2 Tvemde meryeobs, saSualod ki 14 dRea.
damtkicda, rom rac ufro moklea inkubaciis periodi, daavadeba miT ufro mZimed
mimdinareobs.
345
procesis gavrcelebis mixedviT

gaSeSeba iyofa saerTo anu
generalizebul da adgilobriv
formebad.
Cveulebriv, daavadeba xSirad
gvxvdeba generalizebuli formiT,
tetanusi. opistotinusi. xolo adgilobrivi formiT _
(Í.È. Íèñåâè÷, Â.Ô. Ó÷àéêèí) iSviaTad. TiTqmis yvela
SemTxvevaSi daavadeba iwyeba mwvaved.
generalizebuli forma zogjer iwyeba prodromiT, rac gamoixateba madis daqveiTebiT,
mousvenrobiT (Tanmxlebi kiviliT), Wrilobis areSi usiamovno wvis SegrZnebiT, mCxvletavi
xasiaTis tkiviliT, romelic vrceldeba nervuli Reros gaswvriv. miuxedavad daavadebis
aseTi TandaTanobiTi da aramZafri dawyebisa, daavadebulTa 50%-Si dgindeba saReWi
kunTebis daWimuloba (trizmi), romelic daavadebis aSkarad gamoxatuli mwvave dawyebisas,
pirvel sindroms warmoadgens. trizmis dros bavSvi ver wovs, kriWa Sekruli aqvs,
piris gaReba SpateliTac ver xerxdeba. araiSviaTad trizmi Serwymulia kisris
rigidobasTan, ylapva gaZnelebulia. avadmyofi Rebulobs Tavisebur gamometyvelebas _
erTdrouli Rimili da tirili (`risus sardonius” _ tanjviTi Rimili); am dros
Subli danaoWebulia, piris naprali ganzea gaWimuli, xolo tuCis kuTxeebi daweuli,
ylapva gaZnelebulia (disfagia) saylapavis kunTebis spazmis Sedegad. es simptomebi
adreve iCens Tavs da maTi Serwyma damaxasiaTebelia mxolod gaSeSebisaTvis, swrafad
viTardeba kisris kunTebis mtkivneuli rigidoba, xolo Semdeg zurgis swori kunTebis
rigidobac. kunTebis rigidoba daRmavli TanmimdevrobiT vrceldeba: kiseri, zurgi,
qvemo kidurebi. krunCxva, Cveulebriv, ar vrceldeba xelis mtevnisa da fexis terfis
kunTebze. organizmis ganivi kunTebis monawileoba krunCxvebSi proporciulad matulobs.
opistotonusi viTardeba, Tu Warbobs zurgis gamSleli kunTebis tonusi, avadmyofi
Rebulobs rkalisebur formas, sawols eyrdnoba mxolod kefiTa da quslebiT. momxreli
kunTebis hi potonusisas TiTebi ikeceba muStad, mtevani _ majaSi, xolo mxari _
idayvis saxsarSi. muclis swori kunTebis daWimvis SemTxvevaSi muceli mkvrivdeba,
ficariviT xdeba. mZime SemTxvevebis dros SeiZleba ganviTardes tanisa da kidurebis
SeboWiloba.
dasawyisSi spazmi grZeldeba ramdenime wamis ganmavlobaSi da icvleba modunebiT,
magram SemdgomSi igi xdeba ufro intensiuri, Zlieri, xangrZlivi, damRleli. krunCxvebis
progresireba xdeba araspecifikuri gamRizianeblebiT (sinaTle, xmauri, Sexeba). daavadebis
mTeli mimdinareobisas avadmyofi inarCunebs gonebas, ganicdis Zlier tkivils, erTdroulad
gamoxatavs SiSs.
saylapavi da sasunTqi kunTebis spazms SeuZlia, gamoiwvios sasunTqi gzebis Caketva,
cianozi, asfiqsia. Sardis Sekaveba da dizuria viTardeba meoradad, Sardis buStis
sfinqteris spazmis Sedegad. SeiZleba ganviTardes uneblie Sardva da defekacia.
Zlierma krunCxvebma SesaZloa, gamoiwvion xerxemlis kompresiuli motexiloba da
sisxlCaqcevebi kunTebSi. zogjer viTardeba calkeuli kunTebis sisuste da mgrZnobelobis
(Tumca iSviaTad) dakargva, rac gamowveulia periferiuli nevropaTiiT. ziandeba idayvis,
Sua da gareTa muxlqveSa nervebi. eleqtrofiziologiuri meTodiT dasawyisSi vlindeba
nervuli impulsebis gavrcelebis daqveiTeba. darRveuli funqciebis mTliani an
nawilobrivi aRdgena xdeba ramdenime kviris an Tvis ganmavlobaSi.
gaSeSebis dros temperatura umniSvnelod matulobs, magram mZime krunCxvebis
dros is SeiZleba maRal cifrebze avides (40°C da metic), rac ganpirobebulia
intensiuri krunCxvis dros energiis Zlieri xarjviT; avadmyofebs uviTardebaT
346
profuzuli oflianoba, taqikardia, hi pertenzia, aritmia da sxva. pirvel 3-7 dRes da

2 kviris ganmavlobaSi daavadebis simptomatika matulobs. amis Semdeg saerTo mdgomareoba
TandaTan umjobesdeba da sruli gamojansaReba xdeba 2-6 kviris Semdeg.
axalSobilTa gaSeSeba (Tetanus neonatorum). daavadeba iwyeba dabadebidan
3-7 dRis Semdeg. pirvel simptoms miekuTvneba wovis gaZneleba da mudmivi Wirveuloba.
male wova SeuZlebeli xdeba. gamowovis erTi-ori aqtis Semdeg bavSvi RrZilebs
Zlier aWers, lurjdeba da wovas wyvets; es, Tavis mxriv, Zlier tkivils ayenebs dedas,
rac axalSobilTa tetanusis pirveli da mTavari sadiagnostiko niSania. zemoaRniSnuls
uerTdeba saReWi kunTebis trizmi da krunCviTi statusi sxvadasxva variantebiT.
opistotonusi SeiZleba gamoxatuli ar iyos an mkveTrad gamoixatos; am SemTxvevaSi
Tavi TiTqmis wvdeba quslebs. avadmyofs aReniSneba CaxleCili, moguduli xmiT tirili.
kanis feri SeiZleba icvlebodes normaluridan cianozuramde. mZime krunCxva SeiZleba
asfiqsiiT damTavrdes.
temperatura imatebs 38°C-mde, Sublis kani naoWdeba, gamoixateba `sardonikuli
Rimili~, sunTqva zerele da xSiria. TandarTuli pnevmoniis gamo avadmyofi SeiZleba
daiRupos.
Tavis anu bulburi gaSeSeba miekuTvneba aradamaxasiaTebel formas. igi viTardeba
Sua yuris anTebis, saxis Wrilobis, cxvirSi ucxo sxeulis moxvedris Sedegad.
yvelaze damaxasiaTebelia III, IV, VI, VII, IX, X, XI wyvili nervebis dazianeba. maT
Soris yvelaze ufro xSirad procesSi VI wyvili nervi erTveba. qala-tvinis dazianebis
gamo SeiZleba ganviTardes generalizebuli forma. am formis dros, Cveulebriv, ziandeba
mogrZo tvini, kerZod, sunTqvis centri da cdomili nervis birTvebi. sikvdili viTardeba
sasunTqi kunTebis an gulis damblis gamo.
simZimis mixedviT arCeven: elvisebur, mZime, saSualo da msubuqi formis gaSeSebas.
aseTi dayofa eyrdnoba krunCxviTi simptomatikis intensivobas, temperaturas, gul-
sisxlZarRvTa da sunTqvis ukmarisobis dones. mZime formis dros viTardeba
sicocxlisaTvis saSiSi asfiqsia, filtvebis SeSupeba, maSin, rodesac sxva formebis
dros amas adgili ara aqvs.
saSualo simZimis formis dros inkubaciuri periodi 8-15 dReze metia da simptomatika
viTardeba SedarebiT nela (3-4 dReSi), ylapva darRveuli ar aris, asfiqsia ar viTardeba.
msubuqi formisas inkubaciuri periodi 2 kviraze metia, klinika TandaTan viTardeba
7-8 dRis ganmavlobaSi, temperatura normaluri an subfebriluria. aseTi formebi
SeiZleba Segvxvdes imunizirebul bavSvebSi.
mimdinareoba.. daavadeba yvela SemTxvevaSi mwvaved iwyeba, mxolod zogjer aRiniSeneba
mimdinareoba
xanmokle prodromul movlenebi. gamoxatuli klinikuri suraTi 2-4 kvira grZeldeba.
saSiSia, roca wamyvani klinikuri simptomatika intensiurad gamovlindeba pirvelsave
kviras. daavadebis recidivi iSviaTia da isic reinfeqciis Sedegia. Tumca ar SeiZleba
gamovricxoT, rom is gamowveuli iyos inkafsulirebuli CxirebiT, romlebic ganagrZoben
egzotoqsinis gamoyofas.
zogjer, gamojanmrTelebis Semdeg didxans aRiniSneba saxsrebis kontraqturebi da
III, VI, VII wyvili nervebis damblebi.
diagnostika eyrdnoba klinikur simptomatikas, mikrobebis gamoyofa Wrilobidan
SezRudulia.
diferenciuli diagnozi saWiroa, gavataroT iseT daavadebebTan, rogoricaa tetania,
cofi, isteria, paratonziluri abscesi, striqniniT mowamvla, qalas fuZis motexiloba
da sxva. C. tetani-s SeRebva da misi naxva SemTxvevaTa mxolod 1/3-Sia SesaZlebeli.
mkurnaloba tardeba gaSeSebis sawinaaRmdego imunoglobuliniT, romelic bavSvebSi
SehyavT erTjeradi doziT, 3000 erTeuli, xolo mozrdilebSi _ 6000 erTeuli.
347
axalSobilTa gaSeSebis dros _ 500 erT. imunoglobulini nawilobriv SehyavT Wrilobis

irgvliv. venaSi imunoglobulinis Seyvana ar SeiZleba. im qveynebSi, sadac ar xmaroben
imunoglobulins, rekomendebulia gaSeSebis sawinaaRndego antitoqsini saSualo dozebiT:
50000-100000 erTeuli kunTebSi da nawilobriv venaSi (am antitoqsinisadmi organizmis
zemgrZnobelobis gansazRvris Semdeg. (ix. zogad nawilSi). saWiroebisas unda gakeTdes
winaswari desensibilizacia. Tu gaSeSebis sawinaaRmdego imunoglobulini ar aris,
maSin mis magivrad iyeneben venaSi Sesayvan Cveulebriv imunoglobulins. igulisxmeba,
rom is Seicavs gaSeSebis toqsinis sawinaaRmdego antisxeulebs.
per os an venaSi eniSnebaT metronidazoli 30 mg/kg-ze dReSi 4 miRebaze (6
saaTiani intervaliT). igi gaSeSebis Cxirebze baqteriastatulad moqmedebs.
metronidazoli am SemTxvevaSi iTvleba arCeviT preparatad. penicilini iniSneba kunTebSi
100000 erT/kg sxeulis masaze, 4 gakeTebaze (6 sT-iani intervaliT), 10-14 dRis
ganmavlobaSi. am SemTxvevaSi penicilini alternatiuli preparats warmoadgens.
yvela Wriloba eqvemdebareba damuSavebasa da gaxsnas. axalSobilebSi Wi plaris
amokveTa rekomendebuli ar aris.
avadmyofis moTavseba aucilebelia reanimaciis ganyofilebaSi, sadac garda toqsinis
ganeitralebisa, eniSnebaT saTanado paTogenezuri mkurnaloba: krunCxviTi sindromis
moxsna, wyal-marilovani balansis aRdgena, maqsimaluri simSvide da a.S.
prognozi: daavadeba yovelTvis seriozulia da letaloba, gansakuTrebiT
axalSobilebSi, aRwevs 60%-s.
profilaqtika:: aqtiuri imunizaciis mizniT 2 Tvis asakidan yvela bavSvs utardeba
profilaqtika
vaqcinacia gaSeSebis sawinaaRmdego anatoqsiniT (ix. acrebis kalendari). imunizaciis
Semdeg antitoqsikuri proteqciuli imuniteti grZeldeba 10 wels, xolo Tu busteruli
doza aqvs miRebuli _ met xans.
tetanusis profilaqtika Wrilobebis dros

aSS pediatriis akademiis rekomendaciiT
sufTa an patara sxva saxis Wrilobebi

warsulSi miRebuli anatoqsinis
Wriloba ◊
dozebi
Td * TIG ~ Td * TIG ~
Tu ar aris cnobili an miRebuli
+B _ +B _
aqvs 3 dozaze naklebi
Tu ar aqvs miRebuli 3 da meti √
_ _ _∇ _
doza ≈
◊ _ Wrilobebi - dabinZurebuli miwiT, mtvriT, nerwyviT, daglejili, naCxvleti, moyinuli,

damwvroba da sxva.
* _ 7 wlamde asakis bavSvebSi gamoiyeneba DTP (Tu yivanaxvelas vaqcina winaaRmdegnaCvenebia,
keTdeba DT).
). 7 wlis asakis zemoT rekomendebulia Td-s
-s Seyvana, romelic Seicavs tetanusis
da difTeriis anatoqsinebs.
∼ _ TIG - tetanusis sawinaaRmdego adamianis imunoglobulini. Tu igi xelmiuwvdomelia,
ixmareba cxenis antitoqsini.
≈ _ Tu miRebuli aqvs mxolod vaqcinis 3 doza, saWiroa meoTxe dozis gakeTeba.
√ _ saWiroa Td, Tu bolo vaqcinaciidan 10 welze meti gavida.
∇ _ saWiroa Td, Tu bolo vaqcinaciidan 5 welze meti gavida.
348
kerZo nawili. brucelozi
brucelozi
(BRUCELLOSIS)
sinonimebi: maltis, xmelTaSuazRvis, talRisebri cxeleba, brusis septicemia, bangis,

traumis daavadeba da sxv.
brucelozi zoonozuri, infeqciur-alergiuli daavadebaa mwvave, xSirad qronikuli
mimdinareobiT, romelic xasiaTdeba sayrden-mamoZravebeli, retikulur-endoTeliuri,
gul-sisxlZarRvTa, Sard-sasqeso, nervuli da sxva sistemebis dazianebiT.
mokle istoriuli cnobebi. daavadeba didi xania cnobilia, magram, rogorc
damoukidebeli nozologiuri forma gamoyofili iqna 1859w. s. marstonis mier
(Marston). 1886w. brusma maltis cxelebiT gardacvlili adamianis elenTidan gamoyo
Micrococcus melitensis. 1906w. v. bangma da h. striboldma abortirebuli Zroxis
sanayofe wylebidan gamoyves Bact. abortus bovis, xolo 1914w Roris nayofSi aRmoaCines
Bact. abortus suis. 1920 wels yvela zemoTCamoTvlil mikrobebs d. brusis pativsacemad
daerqva brucelebi, daavadebas ki brucelozi. mozrdilebSi brucelozis SeswavlaSi
didi wvlili miuZRviT mecnierebs: g. rudnevs, a. bilibins, a. miasnikovs, xolo bavSvebSi
_ v. bisiarinas, o. sokolova-ponomariovas da sxvebs.
etiologia. amJamad arCeven 6 saxis brucelozis gamomwvev mikrobs _ Brucella
melitensis (azianebs upiratesad wvril rqosan cxovelebs _ Txas, cxvars), B. abortus
bovis (upiratesad msxvil rqosan cxovelebs _ Zroxebs da sxv.), B. abortus suis
(Rorebi, kurdRlebi), B. canis (ZaRlebi). B. ovis da B. neotomae adamianisaTvis ar
arian paTogenuri, aRiniSneba cxvrebSi da virTxebSi. yvela brucela iyofa, agreTve,
bioti pebad.
brucelebs axasiaTebT polimorfizmi _ aqvT Cxirisebri, ovaluri, sferosebri
forma, gramuaryofiTi baqteriebia, mkacri anaerobebi arian, izrdebian Cveulebriv sakveb
niadagebze. pirveli generacia xasiaTdeba neli zrdiT (2-4 kvira), xolo gadaTesvis
Semdeg ufro swrafad izrdebian. egzotoqsins ar gamoimuSaveben. daRupvisas gamoyofen
endotoqsins, fermentebs, kerZod, hialuronidazas. aqvT maRali invaziurobisa da
agresiulobis unari. gadian dauzianebel lorwovan garss, parazitoben ujredSi,
mravldebian limfoidur-makrofagur sistemaSi. aqvT garkveuli rezistentoba garemoSi:
rZeSi sicocxlisunarianobas inarCuneben 10 dRidan 27 dRemde, brinzaSi _ 45, xolo
gayinul xorcSi _ 273 dRe. damarilebul xorcSi Zleben 113 dRemde, niadagSi 46-100
dRemde, damdgar wyalSi 45-90 dRe. Txevad kulturaSi brucelebi 60°C temperaturaze
30 wT-Si iRupebian, xolo duRili klavs maSinve. sadezinfeqcio xsnarebi Cveulebriv
koncentraciebSi damRupvelad moqmedeben. mgrZnobiareni arian eriTromicinis,
tetraciklinis, streptomicinis, rifampicinis mimarT. antibiotikebis moqmedebiT
brucelebSi aRiniSneba L formebad transformacia.
epidemiologia.. brucelozi zoonozuri infeqciaa da msoflios bevr qveyanaSia
epidemiologia
gavrcelebuli, maT Soris, evropaSi, amerikaSi, meqsikaSi, ruseTSi (krasnodarisa da
stavropolis mxareebSi), yazaxeTSi, Sua aziis respublikebSi, CrdiloeT kavkasiaSi.
brucelozi gvxvdeba saqarTveloSic, romelsac iwvevs, ZiriTadad, B. abortus bovis.
Tumca, saxelmwifo xaziT gatarebuli RonisZiebebis Sedegad bevr qveyanaSi brucelozuri
infeqcia cxovelebSi likvidirebul iqna da Sewyda daavadeba adamianebSic, magram jer
kidev SeinarCuna samxareo paTologiis xasiaTi ( aziis qveynebi, afrika, samxreT amerika,
amierkavkasia da sxv.).
infeqciis wyaros da rezervuars, upiratesad, warmoadgenen wvrili da msxvili
rqosani cxovelebi (Txa, cxvari, Zroxa da sxv.), Rorebi.
349
daavadebis paTogenezis mTavar Taviseburebas warmoadgens brucelebis

organotropuloba cxovelTa sasqeso organoebisa da ganviTarebadi nayofisadmi, rac
iwvevs maTSi aborts, mastits, endometrits. brucelebis did raodenobas Seicavs da
garemoSi gamoyofs placenta, sanayofe wylebi, samSobiaro gzebidan gamonadeni, nayofi,
Sardi, ganavali. umravles SemTxvevaSi daavadeba gvxvdeba mwyemsebSi, veterinarebSi,
momvlel personalSi. am mxriv brucelozi kvalificirdeba, rogorc profesiuli
daavadeba.
B. melitensis-iT gamowveuli brucelozi, romelic damaxasiaTebelia wvrili rqosani
cxovelebisaTvis (Txa, cxvari) xSirad Rebulobs epizootiis xasiaTs, adamianebSi ki
iwvevs mZime mimdinareobas. msxvil rqosan cxovelebSi da RorebSi brucelozi
ganpirobebulia Sesabamisad B. abortus bovis da B. abortus suis-iT. unda aRiniSnos,
rom ukanaskneli ti pebi naklebad paTogenuria adamianisaTvis da maTi, rogorc infeqciis
wyaros, epidemiologiuri roli meorexarisxovani mniSvnelobisaa. amave dros yuradsaRebia
is faqti, rom wvrili da msxvili rqosani cxovelebis saerTo sadgomebsa da saerTo
saZovrebze yofnisas SesaZlebelia maT Soris B. melitensis-is migracia, rac ganapirobebs
saTanado daavadebas.
brucelebis SeWra adamianis organizmSi sxvadasxva gziT xorcieldeba.
alimenturi gza. infeqciis SeWra xSirad xdeba umi rZiT, rZis nawarmiT _ yveli,
karaqi, brinza da sxva.
aerogenuli inficireba gulisxmobs zemo sasunTqi gzebiT brucelebis organizmSi
moxvedras bewvis, nakelis, miwis mtvriani nawilakebiT.
intensiur kerebSi, gansakuTrebiT, Txis, cxvris da Rorebis brucelozis dros
inficireba xdeba kontaqturi gziT dazianebuli kanidan da lorwovanebidan (mikrotravmis
CaTvliT), cxovelTa movlis dros, gansakuTrebiT dolis, zvevis, abortirebis periodSi
cxovelTa produqtebis _ bewvis, tyavis, xorcis damzadebisa da damuSavebis dros.
infeqciis gadacema adamianidan adamianze ar xdeba.
paTogenezi. infeqciuri procesis paTogenezis Sesaxeb yvelaze ufro srul
warmodgenas iZleva g. rudnevis mier SemuSavebuli paTogenezis sqema.
adamianis brucelozis paTogenezi
specifikuri
paTogenezi klinika
gamRizianeblebi
I faza. brucelebis limfoiduri
pirveladi gavrceleba da limforeceptorebis inkubacia
gaRizianeba.
II faza. brucelebis hematogenuri
SeWra (pirveladi generalizacia) da
sefsisis ganviTareba
sisxlZarRvTa receptorebis
gaRizianeba.
III faza. mravalkerovani lokalizacia
(metastazuri kerebis formireba).
IV faza. egzogenuri ganTesva (meoradi
meoradi generalizacia. xSirad mravaljer) da gamosavali
reaqtiul-alergiuli cvlilebebi.
Vfaza. saboloo metamorfoziT a)
Sewova b) fibrozi g) mdgradi
cvlilebebis gareSe
350
yvela SemTxvevaSi brucelebis limfuri gziT regionul limfur kvanZebSi SeWris

Semdeg xdeba maTi dagroveba, susti reaqtiuli anTebadi procesiT, infeqtis SeWris
adgilze ki pirveladi afeqtis raime gamovlinebis gareSe (inkubaciuri periodi).
limfur kvanZebSi arasruli fagocitozis Sedegad limfuri barieris garRvevis
Semdeg adgili aqvs brucelebis hematogenur gavrcelebas (daavadebis klinikuri
gamovlineba) da mononuklearuli sistemis ujredebis-fagocitebis meSveobiT maT
ganTesvas Sinagan organoebSi (RviZli, elenTa, Zvlis tvini da sxva) mravalricxovani
metastazuri kerebis CamoyalibebiT. daavadebis mwvave periodSi bruceluri intoqsikacia
ganpirobebulia mikrobebis infeqciur-toqsikuri faqtorebis zemoqmedebiT, rac iwvevs
sisxlZarRvTa kedlebisa da Sinagani organoebis serozul-eqsudaciur da distrofiul
cvlilebebs. SemdgomSi araxelsayreli pirobebis zemoqmedebiT endogenuri kerebidan
xdeba brucelebis meoradi generalizacia (meoradi baqteriemia) an generalizacia
klinikurad vlindeba gamwvavebebisa da recidivebis saxiT. infeqciis hematogenuri
generalizaciidan organizmSi iwyeba alergiuli gardaqmnebi. am periodSi yalibdeba
organizmis Senelebuli ti pis zemgrZnobelobiTi reaqcia (biurnes reaqcia). swored
specifikuri alergiuli procesiTaa ganpirobebuli universaluri vaskulitis arseboba,
sisxlis mimoqcevis moSla; gamoxatuli hi poqsia, SegubebiTi sisxlsavseoba Sinagan
organoebSi, sisxlCaqcevebi kanSi, kunTebSi, centralur nervul sistemaSi, Sinagan
organoebSi.
qvemwvave da qronikuli procesis dros Warbobs produqciuli anTebadi cvlilebebi
specifikuri brucelozuri granulomebis saxiT, upiratesad sayrden-mamoZravebeli,
nervuli da sasqeso organoebis mxriv.
brucelozi xasiaTdeba qronikuli mimdinareobisadmi xSiri midrekilebiT, rac
aixsneba organizmSi brucelebis didi xniT, 2 wlamde arsebobiT. mikrobTa ufro meti
xniT arseboba aixsneba mxolod axali inficirebiT (reinfeqcia, superinfeqcia epizootur
kerebSi), romlebic warmoadgenen damatebiT faqtorebs procesis gamwvavebisa da qronikuli
mimdinareobis genezSi.
inficirebis yvela SemTxvevaSi ar viTardeba daavadeba da misi ganviTareba
damokidebulia organizmis imunuri sistemis mdgomareobaze. erT SemTxvevaSi infeqcia
SeiZleba mimdinareobdes raime klinikuri simptomatikis gareSe ( pirveladi latencia),
sxva SemTxvevaSi aRiniSneba mwvave procesi an dasawyisSi dgindeba pirveladi qronikuli
mimdinareoba. Zlier susti imunuri sistemis mqone pirebSi brucelozuri vaqcinis
moqmedebiT SeiZleba aRiniSnos reaqcia, romelic mogvagonebs brucelozur daavadebas.
brucelozis mZime formebi, Cveulebriv, gamowveulia B. melitensis-iT, maSin, rodesac
sxva saxis brucelebi iwveven ufro msubuq mimdinareobas. amave dros mxedvelobaSia
misaRebi, rom msxvil rqosan cxovelebSi B. melitensis-is SesaZlebeli migracia da
mZime mimdinareoba SeiZleba ganpirobebuli iyos melitenzisis ti pis brucelebiT.
klinika.. cnobilia brucelozis ramdenime klasifikacia, magram klinicistebisTvis
klinika
paTogenezurad yvelaze ufro dasabuTebuli da praqtikulad misaRebia g. rudnevis
mier mowodebuli klasifikacia. arCeven brucelozis mwvave formas (3 Tvemde
xangrZlivobiT), qvemwvave (6 Tvemde), qronikul (6 Tveze meti) da rezidualur brucelozs.
simZimis mixedviT _ msubuq, saSualo da mZime formebs kompensaciis, subkompensaciisa da
dekompensaciis fazebiT.
inkubaciuri periodis xangrZlivoba meryeobs 7-dan 40-50 dRemde da saSualod
2-3 kviras Seadgens. bavSvebSi daavadeba xSirad iwyeba mwvaved, temperaturis momatebiT.
damaxasiaTebelia Civilebi saerTo sisusteze, advilad daRlaze, madis daqveiTebaze.
aRiniSneba Tavis tkivilebi, uZiloba, saxsrebisa da kunTebis tkivilebi. daavadebis
TandaTanobiTi dawyebis SemTxvevaSi aRniSnuli intoqsikaciis movlenebi 3-5 dRis
351
xangrZlivobis prodromiT win uZRvis temperaturis momatebas. brucelozis wamyvan

simptoms warmoadgens temperaturuli reaqcia, romelic SeiZleba iyos mudmivi, remisiuli,
talRiseburi an subfebriluri xasiaTisa. es ukanaskneli ufro bavSvebSi gvxvdeba.
miuxedavad temperaturis xangrZlivobisa da hi perTermiisa, saerTo mdgomareoba
mozrdil bavSvebSi ar irRveva da maT xSirad aReniSnebaT saxisa da kisris aris
SewiTleba, enawylianoba da eiforia. yvela Semcivnebasa da temperaturas Tan axlavs
profuzuli oflianoba da, malariuli Setevebisagan gansxvavebiT, triada _ Semcivneba,
temperatura (cxeleba) da oflianoba ramdenjerme meordeba dRe-Ramis ganmavlobaSi.
yvelaze xSiria kisrisa da sazardulis limfuri kvanZebis gadideba, iSviaTad _
sxva periferiuli kvanZebis gadideba. limfuri kvanZebi umtkivneulo da moZravia,
romelic saSualod ar aRemateba muxudos zomas.
umravles SemTxvevebSi gul-sisxlZarRTa sistemis mxriv dgindeba gulis tonebis
moyrueba, sistoluri Suili mwvervalze, arteriuli hi potonia. mZime mimdinareobis
dros SeiZleba ganviTardes miokarditi, endokarditi, perikarditi. sunTqvis organoTa
sistemis mxriv _ bronqiti, bronqoadeniti, bronqopnevmonia. kuW-nawlavis traqtis
dazianeba vlindeba umadobiT, piris Rrus simSraliT. ena, Cveulebriv, zomieradaa
Selesili. pirvel dReebSi damaxasiaTebelia RviZlisa da elenTis gadideba, romlebic
palpaciiT zomierad mtkivneulia. zogjer avadmyofebi uCivian yru tkivils marjvena
ferdqveSa midamoSi, SesaZlebelia, agreTve, ganviTardes ufro subiqteruli intensivobis
siyviTle.
brucelozis mwvave mimdinareobis dros damaxasiaTebelia sayrden-mamoZravebeli
aparatis mxriv gamoxatuli arTralgiebi raime garegani cvlilebebis gareSe. tkivilebi
kunTebis, Zvlebis, saxsrebis mxriv xasiaTdeba xanmokle mimdinareobiT da amave dros
zogadi intoqsikaciis movlenebis SemcirebasTan erTad qrebian. ufro metad gvxvdeba
qvemo kidurebis saxsrebis dazianeba.
nervuli sistemis mxriv adgili aqvs pleqsits, xerxemlis sxvadasxva segmentis
radikulits, iSiazs, lumbago iSialgias da sxva. mZime formebis dros SesaZlebelia
ganviTardes fsiqikuri darRvevebi, meningiti, meningoencefaliti. meningiti, Cveulebriv,
duned mimdinareobs da serozuli anTebis xasiaTs atarebs.
unda aRiniSnos, rom umravles SemTxvevaSi am bolo dros mwvave brucelozi
msubuqi da saSualo simZimis mimdinareobiT xasiaTdeba, mZime mimdinareoba iSviaTia,
temperaturuli mrudi subfebrilur xasiaTs atarebs. naklebad aRiniSneba araswori
da talRisebri temperaturuli reaqciebi, Semcirda mZime dazianebebi sayrden-mamoZravebeli
aparatis, periferiuli da centraluri nervuli sistemis, Sinagani organoebis,
urogenitaluri da sxva organoebis mxriv.
mwvave brucelozis pirveli talRis CamTavrebis Semdeg apireqsiuli periodis
xangrZlivoba SeiZleba ramdenime kvira gagrZeldes. recidivi apireqsiuli periodis
Semdeg mJRavndeba temperaturuli reaqciiTa da ufro gamoxatuli kerovani cvlilebebiT,
romlebic mowmoben brucelozis sxva formaze, saxeldobr, mwvave recidivul formaze.
recidivTa ricxvi SeiZleba 3-5 talRiT ganisazRvros, romelTa genezSi didi mniSvneloba
eniWeba Tanmxleb daavadebebs, reJimis darRvevas, operaciul Carevebs, orsulobas, nervul
stresebs da sxv.
recidivuli mimdinareobisas infeqciuri simptomatikis gamovlinebis garda saxezea
cvlilebebi, romelTa meqanizmSi wamyvani roli miekuTvneba organizmis alergiul
gardaqmnebs specifikuri sensibilizaciis fonze. saerTod, brucelozis dros da,
gansakuTrebiT ki, qvemwvave da qronikuli mimdinareobis dros SeiZleba ganviTardes
yvela formis alergiul reaqcia _ dauyovnebeli, dayovnebuli, paraalergiuli da
352
autoimunuri reaqciebi. amasTan dakavSirebiT, brucelozi iTvleboda polialergiul

daavadebad.
brucelozis mwvave, morecidive, qvemwvave da qronikuli mimdinareobis periodSi
damaxasiaTebelia aramarto gamoxatuli tkivilebi saxsrebis mxriv, aramed adgili
aqvs maT garegan cvlilebebsac. avadmyofebs uviTardebaT bursitebi, sinovitebi,
tendovaginitebi, romlebic mkveTrad zRudaven sayrden-mamoZravebeli aparatis funqciur
moqmedebas, aReniSnebaT saxsrebis deformacia, kontraqturebi.
xSir kerovan simptomatikas warmoadgens saxsrebis kunTTaSua fasciebSi da kanqveSa
qsovilSi SemaerTebeli qsovilis infiltratebi, romlebic dasawyisSi erTeulia, Semdeg
ki SeiZleba mravlobiTi iyos, zomiT 0,5 sm-idan 5-6 sm-mde, Cveulebriv, Zlier mtkivneuli,
momkvrivo konsistenciis (celulitebi). SemdgomSi isini moculobaSi mcirdebian,
mkvrivdebian da naklebad mtkivneuli xdebian (fibrozitebi).
gamojanmrTeleba xdeba rogorc mwvave, aseve qvemwvave da qronikuli brucelozis
dros, magram daavadebis gadatanis Semdeg SeiZleba ganviTardes narCeni movlenebi
(rezidualuri formebi). am dros daavadebis infeqciuri simptomatika srulebiTac ar
aRiniSneba, magram saxezea organuli da funqciuri darRvevebi sxvadasxva organoebisa
da sistemebis mxriv. avadmyofebis Civilebi mravalferovania _ nevrasTeniuli,
vegetonevrozuli, Tavis, kunTebisa da saxsrebis tkivilebi da sxva. zogierT avadmyofs
aReniSneba saxsrebis deformacia saxsrisirgvlivi qsovilis gamsxvilebis xarjze, rac
zogierT SemTxvevaSi qirurgiul Carevas saWiroebs.
diagnostika.. daavadebis daignostika eyrdnoba epidemiologiuri, klinikuri da
diagnostika
laboratoriuli monacemebis erTobliobas.
brucelozis absolutur damadasturebel meTods warmoadgens baqteriologiuri
gamokvlevebis Sedegad miRebuli brucelebis kultura. am mizniT specialur eleqtiur
niadagze xdeba sisxlis, Sardis, Cirqis, Zvlis tvinis, limfuri kvanZebisa da sxva
substratebis daTesva. brucelebisaTvis damaxasiaTebelia zrdis neli tempi, romelic
3-4 kviras grZeldeba. kulturaze muSaoba xdeba mxolod specialur laboratoriebSi,
sadac yvela pirobaa daculi da romelic gamoricxavs personalis inficirebis SemTxvevebs.
didi diagnostikuri mniSvneloba eniWeba raitis aglutinaciis reaqcias, romelic
tardeba daxocili brucelebis kulturiT. diagnostikur titrad iTvleba 1:200 da
meti ganzaveba. hedelsonis reaqcia _ sasagne minaze aglutinaciis reaqcia xSirad
iZleva cru dadebiT Sedegs, rac ramdenadme dakavSirebulia rigi antigenebis mimarT
jvaredin reaqciasTan (iersiniebi, tularemiis mikrobebi, qoleris vibrionebi da sxva).
dadgenilia, agreTve, B. melitensis da B. abortus Soris analogiuri reaqciis arseboba
maSin, rodesac aseTi reaqcia B. canis mimarT ar aRiniSneba.
brucelozuri antisxeulebis gamovlineba, Cveulebriv, daavadebis meore kviris
bolos xdeba, Semdgom periodSi ki SesaZlebelia titris zrdis mateba. komplementis
SeboWvis, pasiuri hemaglutinaciisa da ofsonofagocituri reaqciebi naklebad
informaciulia raitis reaqciasTan SedarebiT da diagnostikuri mniSvneloba ar aqvT.
kumbsis meTodi zrdis diagnostikur sizustes. imunosorbentuli testi saSualebas
iZleva, aRmoCenil iqnes specifikuri M, G da A klasis imunoglobulinebi.
biurnes kanSiga reaqcia xorcieldeba kanSi brucelinis (3- dRiani brucelebis
kulturis filtrati) 0,1 ml SeyvaniT, romelic brucelozuri antigenis sensibilizaciis
fonze iwvevs kanis hi peremiasa da SeSupebas ineqciis adgilas. reaqciis Sefaseba xdeba
SeSupebis sididis gansazRvriT. Tu SeSupeba 1 sm-ze naklebi diametrisaa, reaqcia
iTvleba saeWvod. 1-3 sm-mde _ sustad dadebiTia, 3 sm _ dadebiTi da 6 sm-ze meti
diametris ki fasdeba, rogorc mkveTrad dadebiTi.
353
kanis uaryofiTi sinji, Cveulebriv, gamoricxavs brucelozis diagnozs, magram am

sinjis Catareba ar aris rekomendebuli, radgan Seyvanili antigeni iwvevs antisxeulebis
sinTezs, rac serologiuri gamokvlevebis Sedegebs saeWvos xdis.
diferenciuli diagnostika tardeba brucelozis mwvave formebis dros muclis
tifTan, iersiniozTan, sefsisTan. qronikuli brucelozis dros saWiroa, gamoiricxos
limfogranulomatozi da sxva neoplazmuri daavadebebi. daavadebis anamnezuri da
serologiuri reaqciebis Sedegebi iZleva saSualebas, sworad daisvas brucelozis
diagnozi.
mkurnaloba. mwvave da qvemwvave brucelozis dros naCvenebia antibiotikTerapia
_ qloramfenikoli, tetraciklini, streptomicini, eriTromicini, rifampicini, imi penemi,
trimetoprim-sulfametoqsazoli da sxv., asakobrivi dozis gaTvaliswinebiT, 7-10 dRiani
kursiT. zog SemTxvevaSi saWiro xdeba 2-3 kursis Catareba. msoflio jandacvis
organizaciis rekomendaciiT miRebulia, rom antibiotikTerapiis kursi 3-4 kvira
gagrZeldes. Tumca antibiotikebs gaaCniaT gamoxatuli antimikrobuli moqmedeba, magram
ver uzrunvelyofen recidivebisa da gamwvavebebis Tavidan acilebas. amasTan dakavSirebiT
rusi avtorebis mier mowodebuli iyo vaqcinaTerapia, gansakuTrebiT, qronikuli
brucelozis dros. am mizniT gamoiyeneba daxocili brucelozuri vaqcina, romelic
SehyavT kanSi, kanqveS, kunTebsa da venaSi.
venaSi Sesayvani vaqcinis dozis dasadgenad xelmZRvanelobdnen biurnes sinjiT
organizmis imunologiuri reaqciis xarisxis dasadgenad da postvaqcinuri reaqciis
simZafris gamosavlenad. yvelaze racionaluria g. rudnevis mier mowodebuli
vaqcinoTerapia venaSi or etapad vaqcinis SeyvaniT. dasawyisSi adgenen pirvel Sesayvan
dozas, dawyebuli minimaluri titriTY 50000-100000 da a.S. mikrobis SemcvelobiT,
1,5-2 saaTis Semdeg ki imeoreben igive dozas an zrdian mas. aRniSnuli meTodi ufro
saimedoa erTmomentian SeyvanasTan SedarebiT da icavs organizms Sokuri reaqciisagan.
dauZlurebul an vaqcinaze mZafri reaqciis mqone avadmyofebSi ufro mizanSewonilia
vaqcinis Seyvana alisovis kanSiga meTodiT, yoveli Semdegi ineqciis dros dozis
momatebiT (specialuri instruqcia).
ukanasknel wlebSi vaqcinis masensibilizebeli Taviseburebebis gamo misi gamoyeneba
SezRudulia.
daavadebis recidivebis aRmosafxvrelad mowodebulia brucelozis sawinaaRmdego
imunoglobulini.
brucelozis mwvave mZime formebis dros avadmyofebs eniSnebaT anTebis sawinaaRmdego
preparatebi, zogjer glukokortikoidebi, mastimulirebeli Terapia imunuri koreqciis
mizniT (sisxlis Sratis, eriTrocituli masis da sxva komponentebis gadasxma)
dauZlurebul avadmyofebSi, fizioTerapiuli procedurebi (ultraiisferi sxivebi,
ozokeriti, masaJi, varjiSi da sxva). qronikuli brucelozis dros naCvenebia sanatoriul-
kurortuli mkurnaloba (rodonis, gogirdmJavas abazanebi da sxva).
profilaqtika. ZiriTadi profilaqtikuri RonisZieba mdgomareobs soflis
meurneobis cxovelebSi infeqciis likvidaciaSi, rac gamoixateba sanitarul-veterinaruli
debulebebis mkacr dacvaSi. aucilebel pirobad iTvleba rZis aduReba da pasterizacia.
janmrTel cxovelebs utardebaT vaqcinacia brucelozis sawinaaRmdegod. infeqciis
kerebSi tardeba dezinfeqcia.
erT-erT mniSvnelovan, magram droebiT profilaqtikur RonisZiebas adre warmoadgenda
profilaqtikuri acrebis Catareba soflis meurneobis cxovelebis momsaxurebis sferosa
da cxoveluri produqtebis damamuSavebel sawarmoebSi momuSave kontingentisaTvis.
354
kerZo nawili. legionelozi
legionelozi
(LEGIONELLOSIS)
sinonimebi: legionerebis daavadeba, pitsburgis pnevmonia, pontiakis cxeleba, legionerTa

infeqcia.
legionelozi warmoadgens mwvave sapronozul infeqciur daavadebas haerwveTovani
gadacemis meqanizmiT, romelic mimdinareobs cxelebiT, pnevmoniiT, araiSviaTad kuW-
nawlavis traqtisa da cns-is dazianebiT.
daavadebis saxelwodeba dakavSirebulia infeqciis afeTqebasTan filadelfiaSi
1976w, sadac amerikeli legionerebis kongresis 320 delegati mwvave pnevmoniiT
daavadda da 34 maTgani gardaicvala. filadelfiis epidemiis dros daRupulTa
filtvebidan 1977w. j.e. makleidma da k.k. Separdma gamohyves gram-uaryofiTi baqteria,
romlis etiologiuri roli dadasturda mikroorganizmis mimarT specifikuri
antisxeulebis arsebobiT.
daavadebis kontrolis centrSi atlantaSi (aSS) sxvadasxva epidafeTqebebis dros
aRebuli Sratebis retrospeqtulma gamokvlevebma daadgina, rom infeqciis gamomwvevi
agentebi miekuTvnebian legionelebis sxvadasxva tipebs. 1978w. saerTaSoriso simpoziumze
axali ti pis mikrobebma miiRes saxelwodeba Legionella pneumophila.
etiologia. Legionella pneumophila miekuTvneba Legionellaceae gvars,
etiologia
Legionella ojaxs; gramuaryofiTi moZravi Cxiria, zomiT (2-3,0)X(0,5-0,7) mkm. maTi
kulturis miReba xangrZlivi da Sromatevadi procesia (saWiroa L-cisteinis, rkinis
ionebis da α-ketomJavebis damateba zrdisaTvis, koloniebi izrdeba BCYE-agarze);
isini Zlier mgrZnobiareni arian sakvebi niadagis pH-is mimarT. kultivirebisaTvis
iyeneben qaTmis embrionsa da zRvis goWebs. legionelebi warmoSoben endotoqsins; aris
monacemebi, romlebic mowmoben Zliermoqmedi egzotoqsinis producirebazedac.
mikroskopiis dros mikroorganizmis naxva SeiZleba Gimenez-meTodiT an vercxlis
SeRebviT (Dieterle an Warthin-Starry). misi morfologia Pseudomonas-s mogvagonebs.
aRwerilia 30-ze meti seroti pi, magram klinikurad gamoxatul infeqcias (90%-Si)
iwvevs ufro L.pneumophila. danarCen SemTxvevaSi daavadebebs iwveven: L. micdadei,
L. bozemanii, L. dumoffii da L. longbeache.
baqteriebi wyalSi sakmaod mdgradia _ mdinaris wyalSi 3 kvira Zlebs, onkanis
wyalSi 1 welze mets, distilirebulSi _ 14 dRe. mgrZnobiareni arian praqtikaSi
gamoyenebuli sadezinfeqcio xsnarebis, eriTromicinis, ampicilinis, qloramfenikolis
da sxvaTa mimarT. mikrobi nanaxi iyo qsovilebis dazianebul ujredebSi da ujredgareTac.
epidemiologia. legionelebi mTel msoflioSia gavrcelebuli da warmoadgenen
bunebrivi da xelovnuri wylis floris ekosistemis nawils. udidesi mniSvneloba
eniWeba mikrobebis arsebobas wylis momaragebis sistemaSi, sastumroebsa da saavadmyofoebSi
haeris kondicirebisas. mikrobebis arsebobis optimalur adgilad iTvleba Tbili, Ria
wyalsatevebi (25-30°C).
infeqciis wyaro dadgenili ar aris, magram infeqciis gadacemis meqanizmia mxolod
aerogenuli gza. gadacemis faqtorebidan mniSvnelovania gadacema kondicirebuli haeriTa
da wyliT. SesaZloa endemur kerebSi garkveuli mniSvneloba hqondes inficirebul
niadagsac. infeqciis gadacema avadmyofi adamianidan janmrTelze nakleb sarwmunoa.
mxedvelobaSi mainc aris misaRebi is faqti, rom garkveul procentSi (9,3%)
legioneloziT daavadebuli kontingentis momvleli personalis sisxlSi naxuloben
mikrobebis sawinaaRmdego antisxeulebis sakmaod maRal titrs (1:128).
bavSvebis inficirebas adgili SeiZleba hqondes skolamdel, skolis moswavleTa da
355
bavSvTa saxlis binadarTa Soris, romlebic aRWurvilni arian gaumarTavi kondicionerebiT.

aRwerilia legionelozis afeTqebebi saavadmyofoebis pirobebSi, rac zogierT avtors
sababs aZlevs, rom infeqcia miakuTvnon nozokomialur infeqciebs.
daavadeba ufro xSirad zafxulis periodSi gvxvdeba. umetesad igi ifargleba
sporaduli SemTxvevebiT. infeqciis epidafeTqebebis dros yuradRebas i pyrobs avadmyofTa
didi raodenoba dasnebovnebis erTi da igive wyarodan. 100000 adamianidan weliwadSi
7-20 avad xdeba am daavadebiT.
paTogenezi. legionelebis organizmSi SeWra sasunTqi gzebis lorwovani garsidan
paTogenezi
xdeba mxolod aerogenuli gziT, inficirebuli wylis aerozolebis SesunTqvis dros,
ultrabgeriTi dafrqvevisas da sxva. imis miuxedavad, rom avadmyofis naxvelSi naxuloben
legionelebs, maTi gadacema janmrTel adamianze ar xdeba. mikrobebis diseminacias Tan
axlavs maTi daRupva da endotoqsinis warmoSoba, rac Tavis mxriv ganapirobebs organizmis
sistemur dazianebas hemoragiuli da nekrozuli anTebadi cvlilebebis saxiT. daavadebis
mZime mimdinareobisas mikrobebis masiuri daSlis gamo SeiZleba ganviTardes infeqciur-
toqsiuri Soki, mwvave poliorganuli, pirvel rigSi, sasunTqi organoebisa da Tirkmelebis
dazianebiT, encefalopaTiiT, sisxlZarRvTaSida diseminirebuli SededebiT, rac xSirad
letaluri gamosavlis mizezia.
legionelozis dros, umravles SemTxvevebSi, viTardeba dazianeba filtvebis mxriv,
rac detaluradaa Seswavlili. am dros filtvebis qsovili mikroskopulad ruxi
ferisaa, mkvrivi anTebadi kerebiTa da araiSviaTad aRiniSneba fibrinuli plevriti.
dazianebul organoebSi histomorfologiurad naxuloben limfoplazmocituri
infiltraciis suraTs, aRiniSneba intersticiuli qsovilis nekrozi. vercxliT
impregnaciisa da fluorescenciis meTodebiT nekrozul kerebSi nanaxia didi raodenobiT
mikrobebis ganlageba ujredSida da ujredgare sivrceebSi. nekrobiozul movlenebs
anTebadi infiltraciisas SeiZleba adgili hqondes sxvadasxva dazianebul organoebSi
_ RviZlSi, elenTaSi, kuW-nawlavis traqtSi, TirkmelebSi da sxva. aRniSnuli
paTomorfologiuri suraTi legionelozis dros raime specifikur xasiaTs ar atarebs.
imuniteti. dacviTi mniSvneloba eniWeba humorul imunitets. rekonvalescentebSi
dadgenilia komplementSemboWavi antisxeulebi, romlebsac gaaCniaT proteqciuli Tvisebebi.
specifikuri antisxeulebis maqsimalur dones adgili aqvs daavadebis me-2-3 kviras,
SemdgomSi TandaTanobiT klebis tendenciiT. varaudoben, rom imuniteti rCeba mTeli
sicocxlis ganmavlobaSi. postinfeqciuri imuniteti ti purspecifikuria. zogierT
rekonvalescentSi SeiZleba ganviTardes recidivi. daavadebis paTogenezi bolomde
axsnili ar aris.
klinika. inkubaciuri periodis xangrZlivoba ganisazRvreba 2-10 dRiT, ufro
xSirad 5-7 dRiT.
daavadeba SeiZleba mimdinareobdes subklinikuridan dawyebuli umZimesi, elviseburi
formis CaTvliT.
gamoyofen Semdeg klinikur formebs _ 1. legionerebis daavadebas, mimdinare
pnevmoniiT (sakuTriv legionerebis daavadeba). 2. mwvave respiraciuli daavadeba
pnevmoniis gareSe _ pontiakis cxeleba (saxelwodeba dakavSirebulia q. pontiakSi
infeqciis afeTqebasTan (aSS). 3. mwvave respiraciuli daavadeba mimdinare cxelebiTa
da kanze gamonayriT (`fort-bragis” cxeleba) 4. sxva SesaZlo formebi.
ti puri klinikuri suraTi yvelaze metad aRiniSneba daavadebis pnevmoniiT mimdinare
formis dros, romelic xSiradaa gamowveuli L.pneumophila-s mier. daavadeba iwyeba
temperaturis momatebiT, Tavisa da kunTebis tkiviliT, arTralgiebiT. daavadebis
pirvelsave dReebSi avadmyofebi uCivian surdos, mSral xvelas, tkivils mkerdis ukana
areSi. aRniSnuli movlenebi 3-5 dReSi maqsimums aRweven – temperatura iwevs 39-40°-
356
mde, xvela xdeba sveli, naxveliT, Zlierdeba qoSini. am dros filtvebSi perkutoruli
xma mokldeba, auskultaciiT ismis krepitaciuli an wvrilbuStukovani xixini.
rentgenologiurad aRiniSneba anTebadi kerebi, romlebsac Serwymisadmi aqvT midrekileba
farTo kerebis warmoqmniT. pnevmonia SeiZleba iyos erTmxrivi an ormxrivi. ufro
xSirad procesSi CaTreulia marjvena filtvi. SesaZloa ganviTardes eqsudaciuri
plevriti, rasac adgili ara aqvs imunodeficitis mqone bavSvebSi, magram maTSi es
procesi destruqciul xasiaTs Rebulobs, Tu specifikuri mkurnaloba droze ar
Catarda. mZime formebisas (15-20%) SesaZlebelia gamoixatos muclis tkivilebi,
ganmeorebiTi Rebineba, faRaraTi, ganviTardes Tirkmlebis mwvave ukmarisoba, sisxldena
kuW-nawlavidan, cns-is dazianebis simptomatika _ Tavbrusxveva, uZiloba, gonebis dakargva,
halucinaciebi, bodvebi, moZraobis koordinaciis darRveva, romelic dakavSirebulia
naTxemis dazianebasTan da sxva.
pirveli kviris ganmavlobaSi pnevmonia progresulad mZimdeba. mkurnalobis fonze
saerTo mdgomareoba TandaTanobiT umjobesdeba, anTebadi kerebi filtvebSi TandaTan
cxreba, magram saerTo sisuste da qoSini SeiZleba grZeldebodes ramdenime Tve.
legionelozuri pnevmoniis dros sxva simptomebidan aRsaniSnavia kanis sifermkrTale,
gadidebuli da palpaciiT mtkivneuli kisris da ybisqveSa limfuri kvanZebi. kuW-
nawlavis traqtis mxriv yuradRebas iqcevs madis daqveiTeba, Selesili mSrali ena,
tkivilebi muclis zemo nawilSi, nawlavTa spazmi, miuxedavad amisa muceli palpaciiT
rbilia, aReniSnebaT faRaraTi, gadidebuli RviZli da elenTa.
periferiul sisxlSi gvaqvs leikocitozi, neitrofilozi marcxniv gadaxriT, mkveTrad
momatebuli eds. SardSi aRiniSneba toqsikuri albuminuria, cilindruria, eriTrocitebi.
sisxlis bioqimiuri kvlevisas SesaZloa gamovlindes alanin- da
aspartataminotransferazebis, Sardovanas, kreatininis momateba, metaboluri da
respiraciuli acidozi.
legionelozuri pnevmoniis mimdinareoba damokidebulia premorbidul fonze,
interkurentuli daavadebebis darTvaze, adekvaturi mkurnalobis Catarebaze.
mwvave r espiraciuli daavadebis ti pis legi
respiraciuli onelozi (pontiakis cxeleba)
legionelozi
praqtikulad ar gamoirCeva sxva etiologiis mwvave respiraciuli infeqciebisagan.
daavadeba mimdinareobs pnevmoniis gareSe rinitis, bronqitisa da saerTo intoqsikaciis
suraTiT. prognozi keTilsaimedoa.
cxelebiTa da egzanTemiT mimdinare legionelozi (fort-bragis daavadeba)
praqtikulad ar gamoirCeva specifikuri klinikuri gamovlinebiT. gamonayari SeiZleba
iyos wiTelasmagvari, msxvillaqovani, peteqiuri, sxvadasxva lokalizaciis. gamonayris
Semdeg aqercvla ar xdeba. am formis dros adgili aqvs bronqitisa da intoqsikaciis
sxvadasxva movlenebs. prognozi yovelTvis keTilsaimedoa.
garTuleba. yvelaze ufro saSiS garTulebas sunTqvis mwvave ukmarisoba, infeqciur-
garTuleba
toqsikuri Soki, meoradi genezis Tirkmelebis ukmarisoba warmoadgens. bavSvebSi letaloba
aRemateba 20%-s.
diagnostika eyrdnoba klinikur, epidemiologiur da laboratoriul monacemebs.
daavadebaze eWvis mitana SeiZleba, roca rentgenogramaze filtvebSi aRiniSneba
daCrdiluli zonebi an laqovan-intersticiuli infiltratebis arseboba xangrZlivi
drois ganmavlobaSi, agreTve, rodesac antibiotikTerapia araefeqturia, saxezea
epidemiologiuri monacemebi (infeqciis kerebSi – sastumroebi, saavadmyofoebi da a.S.),
daavadebebis jgufuri xasiaTi.
legionelozis baqteriologiuri gamokvleva xelmisawvdomia mxolod specialur
laboratoriebSi. amave dros aucilebel pirobad iTvleba transTorakaluri bioftatis
an bronqebidan lavaJis meTodiT miRebuli siTxis daTesva specialur niadagebze, rac
357
gamoricxavs piris Rrudan sxva mikrofloris moxvedras niadagSi, aseve gamoiyeneba

sisxlisa da qsovilovani masalis daTesva.
farTod ixmareba sasagne minaze arapirdapiri fluorescenciis meTodi. am SemTxvevaSi
antigenad gamoiyeneba daxocili legionelebis kulturis suspenzia. antigeniT preparatis
damuSaveba xdeba avadmyofis Sratis mzardi ganzavebiT. antisxeulebis titri ganisazRvreba
luminescenciuri mikroskopiT, reaqciaSi warmoqmnili imunuri kompleqsebis naTebis
intensivobis dadgeniT. avadmyofebis sisxlSi antisxeulebis aRmoCena SeiZleba daavadebis
me-6-7 dRidan, rac maqsimums aRwevs me-5 kviras, ris Semdegac maTi koncentracia
TandaTanobiT klebulobs. diagnostikuri mniSvneloba aqvs wyvil SratebSi titris
momatebas 4 jeradad da metad. amave dros erTjeradi kvlevisas 1:128 titri SeiZleba
CaiTvalos diagnostikur Rirebulebad. aRniSnuli meTodis mgrZnobeloba aRwevs 80%-
mde, magram naklebspecifikuria. ufro naklebmgrZnobiarea mikroaglutinaciis reaqcia,
sadac antigenebad gamoiyeneba daxocili legionelebi. dadebiTi reaqciis dros
warmoiqmneba aglutinirebuli ujredebis rkali. sadiagnostiko testadaa miRebuli
dinamikaSi titris 4 da metjer gazrda an dadebiTi reaqcia 1:4-ze ganzavebisas.
perspeqtiuli meTodebidan yuradRebas ipyrobs arapirdapiri hemaglutinaciis reaqcia,
imunofermentuli meTodi. gamoiyeneba dnm-is gansazRvra, magram kulturis miReba
yvelaze zust maCveneblad iTvleba.
diferenciuli diagnostika. legionelozuri pnevmoniis dros unda gamoiricxos
virusul-baqteriuli asociaciis, qlamidiuri da mikoplazmuri pnevmoniebi. Tu
legionelozi mimdinareobs mwvave respiraciuli daavadebis ti piT, aucilebelia
diferenciaciis gatareba mwvave respiraciul virusul infeqciebTan.
mkurnaloba. efeqtur etiotropul preparatad iTvleba eriTomicini, romelic
bavSvebs eniSnebaT 40 mg/kg sxeulis masaze 4 jeradad 2 kviris manZilze per os an
venaSi (daavadebis dasawyisSi). recidivebi SesaZloa antibiotikis arasruli miRebis
Sedegadac. am SemTxvevaSi saWiroa, Catardes ganmeorebiTi mkurnaloba eriTromiciniT.
eriTromicinis uefeqtobis SemTxvevaSi gamoiyeneba rifampicini 15 mg/kg sadReRamiso
doziT. efeqturia agreTve qloramfenikoli, azitromicini, klaritromicini,
ciprofloqsacini, ofloqsacini, doqsiciklini, trimetoprim-sulfametoqsazoli, romlebic
avadmyofebs eniSnebaT saTanado dozebis gaTvaliswinebiT.
pontiakis cxelebis dros specifikuri mkurnaloba ar tardeba.
mZime pnevmoniebis dros aucilebelia Jangbadis gamoyeneba, avadmyofis xelovnur
sunTqvaze gadayvana. Tirkmlebis mwvave ukmarisobisas saWiroa wyal-marilovani balansis
aRdgena; zogjer ki saWiroa hemodializis Catareba.
sxva paTogenezuri da simptomuri mkurnaloba tardeba saerTo miRebuli meTodebis
gaTvaliswinebiT.
profilaqtika. detalur epidemiologiur analizs saWiroebs mwvave pnevmoniebisa
da respiraciuli daavadebebis analizi zafxul-Semodgomis periodSi. garemo samyaros
kvlevisas gansakuTrebuli yuradReba eqceva legionelebis arsebobis dadgenas wylis
sistemaSi. es, pirvel rigSi, exeba samkurnalo dawesebulebebs.
qimio- da specifikuri profilaqtika SemuSavebuli ar aris. rekomendebulia wylis
hi perqlorireba da 70°C-mde gacxeleba, wylis meqanikuri gawmenda.
358
kerZo nawili. muclis tifi da paratifebi A, B, C
muclis tifi
(TYPHUS ABDOMINALIS)
da paratifebi
A, B, C (PARATYPHUS ABDOMINALIS A, B, C)
muclis tifi warmoadgens nawlavTa mwvave infeqcias da mimdinareobs baqteriemiiT,

upiratesad wvril nawlavTa limfuri aparatis dazianebiT, TandaTanobiT mzardi
temperaturiTa da organizmis saerTo intoqsikaciiT, xSirad tifuri statusiT, kanze
rozeoluri gamonayriT, RviZlisa da elenTis gadidebiT.
mokle istoriuli monacemebi. muclis tifisa da paratifebis klinikuri
mimdinareoba aRwerili iyo jer kidev hi pokrates mier (460-377 ww. C.w. aR-mde). man
mogvca saxelwodeba “tifi” (typhos berZnuli sityvaa da niSnavs buruss, nisls),
riTac xazi gausva am daavadebisaTvis damaxasiaTebel klinikur niSans _ gonebis
dabindvas. XVIII saukunemde am saxelwodebiT aerTianebdnen sxvadasxva daavadebebs,
romlebic temperaturiTa da gonebis dabindviT mimdinareobda.
muclis tifis Cxirebis Sesaxeb pirveli cnobebi mowodebuli iyo t. broviCis
(poloneTi) 1874w da n. sokolovis (ruseTi) mier, romlebmac SeniSnes Cxirismagvari
mikrobebi nawlavis limfur aparatSi. 1880w. aRniSnuli mikrobebi dawvrilebiT Seiswavla
C. Eberth-ma, xolo 1884 wels G. Gaffky-ma miiRo maTi sufTa kultura. 1887 wels
F\ È\ Âèëü÷óð-is mier muclis tifis Cxirebi gamoyofil iqna avadmyofis sisxlidan,
riTac sabolood dadasturda am infeqciis baqteriemiuli xasiaTi.
etiologia. muclis tifisa (Salmonella typhi abdominalis anu Salmonella
typhi) da A, B da C paratifebis (Salmonella paratyphi A, B anu S.schottmuelleri,
C anu S.hirschfeldii) Cxirebi miekuTvneba Salmonella-s ojaxs, aqvT Cxiris forma
momrgvalebuli boloebiT, zomiT (0,5-0,8)X(1,5-3) mkm-ia, gramuaryofiTi aerobebia, aqvT
moZraobis unari, sporebsa da kafsulebs ar warmoqmnian, izrdebian da mravldebian
Cveulebriv sakveb, yvelaze ukeT ki naRvlis Semcvel niadagebze. dadgenilia agreTve
filtrirebadi da L-formis baqteriebis arseboba. mikrobebis daSlisas gamoiyofa
endotoqsini.
muclis tifis Cxiri rTuli antigenuri struqturisaa. praqtikuli mniSvneloba
aqvs H-, O- da Vi- (virulentur) antigenebs, romelTa winaaRmdeg inficirebuli organizmi
gamoimuSavebs saTanado antisxeulebs _ H-, O- da Vi- aglutininebs.
paratifebis mikrobebi, muclis tifis Cxirebisagan gansxvavebiT, Vi-antigens ar
Seicaven.
H-wamwamovani da Vi- zedapirulad mdebare somaturi antigenebi Termolabiluria,
O- _ ufro Rrmad mdebare somaturi antigeni ki _ Termostabiluria.
baqteriofagebisadmi mgrZnobelobis mixedviT dadgenilia muclis tifisa da
paratifebis Cxirebis 70-ze meti fagoti pi, romlebic aRiniSneba laTinuri asoebiT da
A, B, F, E da a.S. fagoti pebis dadgenas praqtikuli mniSvneloba eniWeba, vinaidan
SesaZlebeli xdeba epidemiologiuri kavSiris dadgena daavadebebs Soris da regionebSi
maTi gavrcelebis arealis gansazRvra.
mikrobebs axasiaTebs garemosadmi garkveuli gamZleoba mag.: niadagsa da wyalSi
Zleben 3 Tvemde, rZesa da rZis produqtebSi ( xaWo, araJani), xorcis farSSi, labaSi
ara marto cocxloben, aramed mravldebian kidec, xilsa da bostneulze Zleben 5-10
dRes, purze, karaqze _ 3 Tvemde. dabal temperaturas itanen ramodenime Tvis ganmavlobaSi,
Termul zemoqmedebas ki cudad uZleben; mag: 60°C-mde gacxelebisas iRupebian 30 wT-
359
Si, xolo 100°C-ze ki _ maSinve. Cveulebriv sadezinfeqcio xsnarebSic aseve ramodenime

wuTSi iRupebian.
epidemiologia. muclis tifi, A, B da C paratifebi warmoadgenen klasikur
epidemiologia
fekalur-oralur infeqciebs. infeqciis wyaros warmoadgens avadmyofi, gansakuTrebiT:
1) daavadebidan erTi kviris Semdeg, rodesac infeqti masiurad gamoiyofa ganavliT,
SardiT, nerwyviT; 2) rekonvalescenti, baqteriamtarebeli (3 Tvemde); 3) qronikuli
baqteriamtarebeli, romelic iTvleba daavadebidan 3 Tvis Semdeg da grZeldeba ramodenime
weli, zogjer mTeli sicocxle; 4) janmrTeli baqteriamtarebeli. aseTi mtarebloba
grZeldeba 10-20 dRe.
infeqciis gansakuTrebiT saSiS wyaros warmoadgenen skolamdeli asakisa da dawyebiTi
klasis moswavleebi, romlebic dabali sanitaruli Cvevebis gamo advilad ainficireben
garemos. muclis tifis gadatanis Semdeg baqteriamtareblobis procenti bavSvebSi,
sxvadasxva avtorTa monacemebiT, meryeobs 2-dan 10%-mde (saSualod 4%). muclis
tifi da paratifi A iTvleba anTroponozul infeqciad, maSin, roca paratifi B _
anTropozoonozuri xasiaTisaa. aRwerilia paratif B-Ti Sinauri cxovelebis daavadebis
SemTxvevebi.
infeqciis gadacema xdeba kontaqturi gziT, dainficirebuli wylisa da sakvebi
produqtebis meSveobiT. Tanamedrove pirobebSi daavadebis gavrcelebis ZiriTadi faqtoria
sayofacxovrebo-kontaqturi gza. bavSvebSi avadmyofTan kontaqti SeiZleba iyos pirdapiri
an arapirdapiri _ dainficirebuli sagnebis, saTamaSoebis, WurWlis, sacvlebis xmarebis
saxiT.
am dros aRiniSneba daavadebis erTeuli, sporaduli SemTxvevebi, magram SesaZloa,
ganviTardes epidafeTqebebic, romelsac axasiaTebs neli dawyeba SemTxvevaTa TandaTanobiT
matebiT, aseve neli dakleba _ e.w. epidemiuri kudi.
Tanamedrove muclis tifi ganviTarebul qveynebSi xasiaTdeba sporadulobiT, Tumca
ar aris gamoricxuli daavadebis afeTqeba, rac SesaZlebelia, gamowveuli iyos Camdinare
wyliT sasmeli wylis dabinZurebiT.
epidafeTqebebs adgili aqvs umetesad ganviTarebad qveynebSi, rac ganpirobebulia
cudi sanitaruli zedamxedvelobiTa da gaumarTavi wyalsadenebiT. sakvebi produqtebis
dainficireba, ZiriTadad, ganpirobebulia kvebis blokSi an realizaciis sferoSi
dasaqmebuli baqteriamtareblebiT.
rogorc erTeuli, ise jgufuri SemTxvevebis mizezi SeiZleba gaxdes dabinZurebuli
wyalsatevebis xamanwkebisa da sxva moluskebis saWmelad gamoyeneba maTi saTanado
Termuli damuSavebis gareSe.
wyliTa da kvebiTi produqtebiT gamowveuli afeTqebebi jgufuri daavadebis saxes
atarebs, romelsac axasiaTebs SemTxvevaTa ricxvis swrafi zrda, xolo dainficirebis
gzis mospobis Semdeg _ aseve uecari Sewyveta.
tifur-paratifuri infeqciis gavrcelebaSi garkveuli mniSvneloba eniWeba buzebs.
daavadebebs gamoxatuli sezonuroba axasiaTebT _ ZiriTadad zafxul-Semodgoma,
rodesac infeqciis gadacemis meqanizmisa da faqtorebisaTvis Seqmnilia optimaluri
pirobebi.
daavadebis 75% modis bavSvTa asakze. kontagiozuri indeqsi muclis tifis dros
0,4-ia. daavadebis maCvenebeli amJamad Seadgens 6-8 SemTxvevas 100.000 mosaxleze.
paTogenezi da paTmorfologia. piris RruSi moxvedris Semdeg mikrobebs uxdebaT
saWmlis momnelebeli sistemis zemo nawilis garkveuli barieris gadalaxva, kerZod,
mikrobebi neitrofilebSi iwveven JangviTi procesebis daTrgunvas fagocitozis
damamTavrebel stadiaSi, riTac inarCuneben sicocxlisunarianobas. arc monocitebs
SeswevT infeqciis sawyis periodSi mikrobebis daSlis unari. mniSvnelovania, rom
360
mikroorganizmis virulentobaSi 1
Vi- k o r p u s k u l u r a n t i g e n s
eniWeba wamyvani roli. igi
fagocitozs aferxebs da xels
uSlis C3-is SekavSirebas
baqteriasTan, rac mikrobis
invazias uwyobs xels.
mikroorganizmebi fagocitozis
Semdeg makrofagebSi did xans 2 3
rCebian, rac ganpirobebulia
makrofagis metabolizmze
salmonelas moqmedebiT.
kritikul mdgomareobaSi
myof avadmyofebs aReniSnebaT T-
sistemis maCveneblebis daqveiTeba,
xolo mtareblebSi ki
darRveulia ujreduli
reaqtiuloba Salmonella-s
antigenebisadmi, rac gamoixateba
leikocitebis migraciis testis
4 5 6 7
SeboWvaSi.
infeqtis transporti
grZeldeba wvrili nawlavebis
sanaTurSi (inficirebis faza),
sadac mikrobebi xelsayrel
pirobebs pouloben
gamravlebisaTvis. wvrili
muclis tifi. klinikur-morfologiuri niSnebi.
nawlavebis lorwovani garsis, 1- hepatosplenomegalia; rozeolebi; 2- temperaturuli
limfuri warmonaqmnebis _ mrudi; 3- yavisferi nadebi enaze; 4- limfuri kvanZebis
solitaruli folikulebisa da `tvinovani~ SeSupeba wvril nawlavebSi (1-i kvira); 5-
maTi warmonaqmnebis _ jgufuri peieris folaqebis nekrozi (me-2 kvira); 6- wylulebis
limfuri folikulebis gavliT warmoSoba (me-3 kvira); 7- sufTa wylulebis stadia,
mikrobebi xvdebian regionul Sexorceba (4-5 kvira).
limfur kvanZebSi, sadac
intensiurad mravldebian da iwveven limfangoitisa da limfadenitis ganviTarebas.
upiratesad aRiniSneba jorjlis limfuri kvanZebis anTebiTi procesi.
pirveladi regionuli faza. inficirebis faza da pirveladi regionuli infeqciis
faza Seesabameba inkubaciur periods. am dros viTardeba organizmis, maT Soris wvril
nawlavTa limfuri aparatis zogadi sensibilizacia. sensibilizaciis procesTanaa
dakavSirebuli mTeli Semdgomi paTmorfologiuri suraTi _ limfuri warmonaqmnebis,
limfuri kvanZebis SeSupeba, maTi danekrozeba, wylulebis ganviTareba, rac esoden
damaxasiaTebelia tifur-paratifuri infeqciisaTvis.
inkubaciur periodSive, magram iSviaTad, SesaZlebelia, miRebul iqnas koprokultura,
Tumca ganavliT baqteriebis intensiuri eliminacia aRiniSneba daavadebis mxolod
pirveli kviris bolosaTvis.
limfuri kvanZebis anTebadi procesis Sedegad salmonelebi nawilobriv iSlebian
da gamoTavisufldeba endotoqsinebi, romelTa moqmedebiT xdeba hemato-limfuri barierebis
garRveva da paTogenezis Semdegi fazis _ baqteriemiis ganviTareba, rac emTxveva
361
cxelebis dawyebas _ daavadebis klinikur manifestacias. cxeleba da saerTo intoqsikaciis

genezi uSualod dakavSirebulia salmonelebis endotoqsinTan, romelic mikrobis
polisaqaridul kompleqss warmoadgens. endotoqsin-gamowveuli citokinebis warmoSoba
aseve aZlierebs zemoaRniSnul simptomebs.
sisxlis baqteriaciduli da makrofagebis fagocituri moqmedebis Sedegad baqteriebis
nawili iRupeba, Tavisufldeba endotoqsini, rac ganapirobebs paTogenezis Semdgomi
fazis _ toqsemiis dawyebas, ufro zustad, am dros adgili aqvs baqteriemiuli
toqsemiis ganviTarebas. salmonelebis toqsinebs axasiaTebT centralur nervul
sistemisadmi tropizmi, rac arcTu iSviaTad gamoixateba klinikur mimdinareobaSi
Status typhosus-is ganviTarebiT. toqsinebi moqmedeben nawlavis vegetatikur gangliebze
da ganapirobeben sisxlZarRvovan da trofikis darRvevebs limfur warmonaqmnebSi, ris
gamoc viTardeba maTi nekrozi Semdgomi dawylulebiT. vegetatiuri sistemis dazianebaze
miuTiTebs iseTi simptomebi, rogoricaa vagotonia, meteorizmi, muclis tkivili da a.S.
baqteriebis nawili sicicxlisunarianobas inarCunebs makrofagur sistemaSi, isini
mravldebian kidec da iwveven mikrobebis ganTesvas mTels organizmSi, viTardeba e.w.
parenqimuli diseminacia RviZlis, limfuri kvanZebis, elenTis, Zvlis tvinisa da sxva
organoebis retikulur-endoTelur ujredebSi. yalibdeba tifur-paratifuri
infeqciisaTvis damaxasiaTebeli granulomebi. aRniSnul kerebSi xdeba baqteriebis
nawilobrivi daSla, xolo nawilobriv _ maTi gamoyofa eqskreciuli organoebidan:
RviZlidan _ naRvlis buStSi, Tirkmlebidan _ SardSi, sanerwyve da sarZeve jirkvlebidan
_ Sesabamis eqskretebSi da a.S.
nawlavSi darCenili baqteriebis nawili isev SeiWreba pirveladad ukve sensibilizebul
limfur warmonaqmnebSi da iwvevs maTSi hi perergiuli xasiaTis anTebas ( gamoyofisa
da hi perergiis faza).
alergiuli reaqciis erT-erTi maCvenebelia, agreTve, fiqsirebul droSi ( daavadebis
meore kvira) rozeoluri gamonayari, romelic warmoadgens tifur-paratifuri Cxirebis
mier kanis gafarToebul limfur napralebs da atarebs hi perergiul xasiaTs
sensibilizebul adgilebSi maTi ganmeorebiTi SeWris gamo. rozeolis gakawvrisas
miiReba limfa, misi daTesviT ki _ rozeolokultura (Ñ\B\ Ñ\B\ Ðàòíåð
Ðàòíåð, 1943).
specifikuri antisxeulebis gamomuSaveba, romelic iwyeba infeqciis dawyebisTanave
(ofsoninebi, aglutininebi, baqteriolizinebi, antiendotoqsinebi da sxva), ufro intensiurad
ki _ daavadebis meore kviridan, xels uwyobs mikrobebis gaZlierebul eliminaciasa da
klinikuri simptomatikis ukuganviTarebas.
zog SemTxvevaSi, klinikuri remisiis Semdegac, arsebuli lokalizebuli anTebadi
kerebidan mikrobebi SeiWrebian sisxlSi da ganapirobeben generalizebul infeqciur
process _ baqteriemias recidivebis saxiT. ukanaskneli ki xSirad dakavSirebulia
antibiotikTerapiasTan. garkveul procentSi ki (1-5%) viTardeba qronikuli mtarebloba,
romelsac Tanamedrove monacemebiT Tvlian infeqciis qronikul mimdinareobad, rasac
safuZvlad udevs imunuri sistemis ganuviTarebloba, kerZod, makroglobulinuri 0-
antisxeulebis (IgM) defeqti (maTi defeqti genetikuradaa determinebuli), maSin
rodesac swored am klasis imunoglobulinebs eniWeba mniSvnelovani roli muclis
tifis sawinaaRmdego imunitetis formirebaSi.
cnobilia, agreTve, rom Zvlis tvinis makrofagebSi parazitirebisas mikrobebi gadadian
e.w. L-formebSi, garkveul pirobebSi kvlav ubrundebian TavianT sawyis formas, zog
SemTxvevaSi ki iwveven usimptomo baqteriemias mikrobebis ganavalSi gamoyofiT.
muclis tifisa da paratifebisaTvis damaxasiaTebeli ZiriTadi morfologiuri
suraTia Tanmimdevruli, stadiuri cvlilebebi mliv nawlavSi. maTi kanonzomieri da
cikluri ganviTarebis Sesabamisad pirobiTad arCeven xuT paTomrfologiur periods,
362
Tumca es periodebi yvela SemTxvevaSi mTlianad ar emTxveva klinikur periodebsa da

daavadebis simZimes.
aRsaniSnavia, rom mcire asakis bavSvebSi limfoiduri aparatis ganuviTareblobis
gamo stadiuri morfologiuri suraTi ar gvxvdeba. procesi, Cveulebriv, abortul
xasiaTs Rebulobs, peieris folaqebis tvinovani SeSupebis Semdeg maTi danekrozeba ar
xdeba. granulomebis elementebi TandaTan gaiwoveba, ris gamoc nawlavis perforacia
da sisxldena aRar viTardeba.
pirveli stadia _ tvinovani SeSupeba emTxveva daavadebis pirvel kviras. am dros
peieris folaqebisa da solitaruli folikulebis mxriv viTardeba anTebadi infiltracia
tifuri granulomebis ganviTarebiT, romlebic Sedgebian proliferaciuli retikuluri
ujredebisa da histiocitebisagan. limfuri warmonaqmnebi moculobaSi gadidebulia
da amoburculia lorwovani garsis zedapiridan. amasTan erTad nawlavis garsis mxriv
aRiniSneba zomieri kataruli movlenebi, jorjlis limfuri kvanZebis gadideba, romelTa
qsovilSic aseve viTardeba zemoaRniSnuli granulomebi.
termini `tvinovani” SeSupeba ixmareba bavSvis tvinis zedapirTan anTebadi
folikulebis msgavsebis gamo.
meore stadia (daavadebis meore kvira) xasiaTdeba solituri folikulebisa da
peieris folaqebis granulomebis nekroziT. swored es da Semdgomi stadiebi SeiZleba
ar ganviTardes mcire asakis bavSvebSi da procesi SeizRudos e.w. tvinovani SeSupebiT
an zedapiruli nekroziT maSin, rodesac ufrosi asakis bavSvebsa da mozrdilebSi
adgili aqvs ufro Rrma da gavrcelebul nekrozs.
mesame stadiis (daavadebis me-2-3 kvira) dros xdeba danekrozebuli adgilebis
mocileba da wylulebis ganviTareba.
meoTxe stadia (daavadebis me-3-4 kvira) sufTa wylulebis periodia, romlebic
aRweven kunTovan Sres. swored am drosaa mosalodneli iseTi mZime garTulebebis
ganviTareba, rogoricaa nawlavTa perforacia da sisxldena.
mexuTe stadia (daavadebis me-4-5 kvira) xasiaTdeba wylulebis SexorcebiT. unda
aRiniSnos, rom Sexorceba mimdinareobs nawlavTa sanaTuris stenozis gareSe.
garda aRniSnuli cikluri paTmorfologiuri cvlilebebisa, adgili SeiZleba hqondes
sxvadasxva periodebisaTvis damaxasiaTebeli cvlilebebis Serwymas. paTologiuri procesis
gamomJRavnebis xarisxi damokidebulia etiotropuli mkurnalobis adreul Catarebazec
( daavadebis pirveli kvira), ramac SeiZleba, gamoiwvios paTmorfologiuri suraTis
Semdgomi metamorfoza da abortuli klinikuri suraTis Camoyalibeba. procesis
analogiuri Semobruneba daavadebis mogvinebiT periods ar axasiaTebs, radgan specifikuri
mkurnaloba ukve danekrozebul da dawylulebul limfur aparatze efeqtur gavlenas
ver axdens.
garda nawlavTa limfuri aparatis dazianebisa, damaxasiaTebelia limfuri sistemis
saerTo, zogadi dazianebac, rac gamoixateba elenTis gadidebaSi, bronquli, parabronquli,
mediastinuri da sxva limfuri kvanZebis reaqtiul cvlilebebSi retikuluri ujredebis
hi perplaziiTa da maTi kerovani SejgufebiT _ tifuri kvanZebiT _ granulomebiT. es
ukanasknelni Sedgebian didi zomis e.w. tifuri ujredebisagan, romlebic Seicaven Ria
feris birTvebs.
daavadebis mZime mimdinareobisas garda specifikuri cvlilebebisa tifuri
granulomebis saxiT, Sinagan organoebSi viTardeba cilovani da cximovani distrofia,
kerovani nekrozebi, sisxlsavseoba, sisxlCaqcevebi. SeiZleba, Camoyalibdes muclis
tifisaTvis damaxasiaTebeli encefaliti, ataqsia, cns-is sisxlZarRvTa Trombozi, siyrue,
fsiqozi, gardamavali mieliti, miokarditi, kunTebis nekrozi (gansakuTrebiT, muclis
swor kunTebSi e.w. cvilisebri nekrozi), Tvalis nervis anTeba, pnevmonia, kerovani
363
nefriti. RviZli, Cveulebriv, gadidebulia, ganakveTze mkrTali moyviTalo ferisaa.

mikroskopulad dgindeba specifikuri granulomebi, kerovani nekrozebi, hepatocitebis
cilovani da cximovani degeneracia. elenTa gadidebulia sisxlsavseobisa da anTebadi
proliferaciuli retikuluri ujredebis xarjze, tifuri granulomebis ganviTarebiT.
SesaZlebelia, ganviTardes elenTis infarqti misi Semdgomi daCirqebiT.
pnevmonia muclis tifis dros upiratesad meoradi infeqciiTaa ganpirobebuli,
Tumca gvxvdeba specifikuri tifuri pnevmoniebic maTTvis damaxasiaTebeli granulomebiT
(`pnevmotifi”).
klinika. inkubaciuri periodi saSualod 10-14 dRes Seadgens da meryeobs 3-dan
21 dRemde. misi xangrZlivoba damokidebulia organizmis Taviseburebebze.
daavadebis klasikuri manifestaciisas ufrosi asakis bavSvebSi iseve, rogorc
mozrdilebSi klinikuri mimdinareoba pirobiTad iyofa Semdeg periodebad: klinikuri
simptomatikis TandaTanobiT gaSla da gaZliereba (daavadebis pirveli kvira, stadium
incrementi), misi Semdgomi sruli gaSla da gamZafreba (7-dan 14 dRis CaTvliT,
stadium fastigii et acme), temperaturisa da intoqsikaciis TandaTanobiT dacxroba
_ (stadium decrementi) (14-dan 25 dRemde) da rekonvalescenciis periodi (21-dan
28 dRemde).
daavadebis 1-3 dRes avadmyofebi uCivian msubuq daRlilobas, apaTias, gaRizianebas,
Tavis tkivils, uZilobas (prodromi), Semdeg dReebSi ki xdeba sprcifikuri intoqsikaciis
gaZliereba. temperaturuli reaqcia dasawyisSi subfebriluria, romelic 3-4 dReSi
kibiseburad matulobs dilis saaTebSi sakmaod didi meryeobiT, saRamoobiT ki aRwevs
38,5-39°-s. ukve am periodSi SeiZleba gamovlindes centraluri nervuli sistemis
mxriv tifuri statusi, rac gamoixateba avadmyofis gabruebiT, igi nakleb interess
iCens garemosadmi, kiTxvebze pasuxobs martivad (ho, ara), mogvianebiT SeiZleba aRiniSnos
halucinaciebi, sizmriseuli ltolva wylisadmi, cudad orientireben garemosa da
sivrceSi.
daavadebis pirveli kviris monakveTi SeiZleba, ganimartos, rogorc
temperaturisa da intoqsikaciis mzardi periodi.
ukve am periodSi aRiniSneba gul-sisxlZarRvTa sistemis mxriv cvlilebebi:
midrekileba bradikardiisadmi, pulsi zogjer dikrotulia, filtvebSi sunTqva
vezikuluria, magram axlavs gafantuli mSrali xixini, rac mowmobs difuzur bronqitze.
qveiTdeba arteriuli wneva, gulis tonebi moyruebulia. saWmlis momnelebeli sistema
kanonzomierad CaTreulia paTologiur procesSi. ukve me-3-4 dRes aRiniSneba
monacrisfro-yavisferi mSrali nadebi enaze, Tumca enis wveri da kideebi sufTa da
wiTeli ferisaa, kideebze aRiniSneba kbilebis anabeWdebi enis SeSupebis gamo. muceli
zomierad Seberilia, marjvena TeZos midamoSi moismineba uxeSi, gaZlierebuli,
msxvilkalibriani yuryuri, romelic Zlierdeba muclis Rrma palpaciis dros, xolo
TeZos nawlavis terminalur nawilSi aRiniSneba mtkivneuloba da wvrilkalibriani
yuryuri, rac mowmobs ileitis arsebobaze. meore-mexuTe dRes, Cveulebriv, diddeba
RviZli da elenTa, zogjer viTardeba kataruli angina.
periferiul sisxlSi daavadebis pirvel dReebSi aRiniSneba normocitozi an mciredi
leikocitozi, daavadebis pikis dros ki (5-7 dReE) _ leikopenia, neitropenia,
aneozinofilia, limfocitozi, zomierad momatebuli eds (20-25mm/sT).
daavadebis meore kviras klinikuri simptomatika srulad da mTeli simZafriT
vlindeba (Stadium fastigii et acme). am dros temperatura maRal cifrebze adis da,
SesaZlebelia, miiRos mudmivi xasiaTi (febris continua), e.w. vunderlixis ti pi, an
ganicados talRiseburi cvalebadoba, e.w. botkinis ti pi. centraluri nervuli sistemis
mxriv Rrmavdeba tifuri statusi, avadmyofi soporSi an komaSia, aRiniSneba uneblie
364
Sardva da defekacia, yuradRebas i pyrobs kanis sifermkrTale, daxeTqili tuCebi, ena

mSralia, sqeli, moSavo-yavisferi nadebiT (e.w. fuliginozuri ena, laT. fuliginositas
_ Wvartli). Zlierdeba meteorizmi, yabzoba, romelic zogjer FfaRaraTiT icvleba,
Tumca am ukanasknelis sixSire 3-4-s ar aRemateba.
gul-sisxlZrRvTa sistemis mxriv garda bradikardiuli pulsisa da moyruebuli
gulis tonebisa, SesaZlebelia miokarditis ganviTareba. Sardis gamoyofa Semcirebulia,
SeiZleba, aRiniSnos proteinuria, mikrohematuria, cilindruria, viTardeba baqteriuria,
romelic zogjer Tirkmlis fialebisa da Sardis buStis lorwovani garsis anTebas
ganapirobebs.
daavadebis me-8-10 dRes (SesaZlebelia, ufro adre an mogvianebiT) Cndeba erTeuli
rozeoluri gamonayari, romelic mkrTali kanis fonze wiTeli feris laqas mogvagonebs,
Tumca kanis zedapiridan wamoweulia (papula). rozeola kanis daWimviT fermkrTaldeba,
modunebisas ki umal iRebs wiTel fers. gamonayari, Cveulebriv, mcirericxovania ( 10-
20-30-mde), Tumca iSviaTad uxvic SeiZleba iyos (paratifi B). umTavresad Cndeba
mucelze, mkerdze, zurgze, naklebad kidurebze, zogjer Cndeba damatebiTi, axali gamonayari.
gamonayari SeiZleba, aRiniSnos cxelebis mTeli periodis ganmavlobaSi. rozeolis
diametri ar aRemateba 3-mm-s da 3-4 dRis Semdeg ukvalod qreba. gamonayaris intensivoba
ar gansazRvravs daavadebis simZimes, igi miuTiTebs limfuri sistemis dazianebis
xarisxze, Tumca mZime mimdinareobisas rozeolebi iReben hemoragiul xasiaTs. rozeola,
romelic Cndeba fiqsirebul droSi, warmoadgens erT-erT wamyvan, dasayrden simptoms
tifur-paratifuri infeqciis diagnostirebisaTvis (rozeolokultura).
daavadebis sruli gaSlisa da simptomatikis ayvavebis stadia grZeldeba 1 an 2
kvira, ris Semdegac intensivoba nel-nela iklebs. temperatura lizisiT klebulobs,
xSirad, gansakuTrebiT mZime mimdinareobisas, aRiniSneba dilis Rrma remisiebi, zogjer
zomieri oflianoba. am dros temperaturis dila-saRamos meryeoba aRwevs 1,5-2°-mde.
aseT temperaturas uwodeben amfibolurs (laT. Stadium amphybolicum – gardamavali
mdgomareoba). cnobiereba Cndeba TandaTanobiT, Zili normaluri xdeba, ena sufTavdeba
nadebisagan, matulobs Sardis raodenoba, qreba adinamia, temperatura Rebulobs normalur
xasiaTs _ iwyeba rekonvalescenciis stadia, aRiniSneba fizikuri wonasworobis
TandaTanobiTi aRdgena. SesaZlebelia, 2-3 kviris Semdeg, iSviaTad ki ufro mogvianebiT
(4-5 kvira) ganviTardes recidivi an recidivebi (3-4 recidivi). maTi ganviTarebis
albaToba saSualod aRwevs 7-9%-s.
Tavisi anatomiuri da klinikuri cvlilebebiT recidivi xSirad imeorebs pirveli
daavadebis formiT ZiriTad, Tumca ufro msubuq mimdinareobas. temperaturuli reaqciis
xangrZlivoba sakmaod meryeobs da SeiZleba, grZeldebodes 1-3 dRidan 2-3 kviramde.
recidivis wina periods zogjer axlavs subfebriluri temperatura, romelic Semdgom
swrafad matulobs, RviZli da elenTa rCeba gadidebuli. rozeoluri gamonayari ufro
adre Cndeba, daavadebac ufro msubuqad mimdinareobs, intoqsikacia sustia, garTulebebi
_ naklebi. sruli fizikuri mdgomareoba aRdgeba klinikur gamovlinebaTa Sewyvetidan
4-6 kviris Semdeg. zogjer rCeba xangrZlivi postinfeqciuri asTenia (daRliloba,
madis daqveiTeba, oflianoba da sxv.).
klasifikacia. arCeven daavadebis tipur da atipur mimdinareobas. tipurs miekuTvneba
ZiriTadi klinikuri simptomatikiT mimdinare SemTxvevebi, ati purs ki _ waSlili da
subklinikuri formebi, agreTve is formebi, romlebic mimdinareobs ama Tu im sistemis
upiratesi dazianebiT, rac damaxasiaTebelia mZime mimdinareobisaTvis (meningotifi,
pnevmotifi, nefrotifi). unda aRiniSnos, rom ukanaskneli formebi bavSvTa asakSi
iSviaTia.
waSlili formebi mimdinareobs intoqsikaciis gareSe, subfebriluri temperaturiT,
365
msubuqi dispefsiuri movlenebiT. mimdinareoba iRebs abortul xasiaTs.

subklinikuri formebis diagnostika emyareba mxolod baqteriologiur da
serologiur monacemebs.
simZimis mixedviT arCeven msubuq, saSualo simZimisa da mZime formebs.
msubuqi formebis dros intoqsikacia sustadaa gamoxatuli, temperatura ar
aRemateba 38°C-s damaxasiaTebelia Tavis gardamavali tkivilebi, mada naklebadaa
daqveiTebuli, hepato-lienuri sindromi gamoxatulia sustad.
saSualo simZimis dros temperatura aRwevs 39-40°C-s da grZeldeba 2-4 kvira,
avadmyofs aqvs uZiloba, anoreqsia, Tavis tkivilebi, zogadi daTrgunva, aRiniSneba
hepatolienuri sindromi.
mZime formebis dros gamoxatulia status typhosus, meningoencefalituri
sindromi, hemoragiuli sindromi (peteqiebi, ekqimozebi), miokarditi, pnevmonia, nefriti,
viTardeba garTulebebi recidivebis, nawlavTa perforaciis, sisxldenis, gramuaryofiTi
da anaerobuli sefsisis saxiT.
baqteriamtarebloba. mikrobebis organizmidan eliminacia adreul periodSive
iwyeba, magram maTi didi nawilisagan avadmyofi Tavisufldeba temperaturis
normalizaciidan 2-4 kviris Semdeg. daaxloebiT 4-5%-Si muclis tifis gadatanis
Semdeg yalibdeba baqteriamtarebloba, romelic wlobiT an mTeli sicocxlis ganmavlobaSi
SeiZleba gagrZeldes (qronikuli mtarebloba). es ganpirobebulia mTeli rigi mizezebiT,
romelTa Soris aRsaniSnavia mogvianebiT dawyebuli an araswori mkurnaloba, sxvadasxva
Tanmxlebi daavadebebi, rogoricaa sanaRvle an saSarde sistemebis anTebiTi procesi,
kenWovani daavadeba, genetikurad determinebuli arasrulyofili ujreduli da humoruli
imuniteti, TviTon mikrobTa antigenuri struqturis SesaZlebeli cvlilebebi, maTi
parazitireba makrofagur sistemaSi, gansakuTrebiT _ Zvlis tvinis ujredebSi. dadgenilia,
rom aseT SemTxvevebSi vlindeba qronikuli infeqciis paTmorfologiuri suraTi,
kerZod Zvlis tvinis stromis plazmuri infiltracia, mielogramaSi ki vlindeba
retikulur-endoTeliuri elementebis aqtivacia.
qronikul mtareblebs zogjer aReniSnebaT sanaRvle gzebis hipokineziuri diskinezia,
qolecistiti, qolecistoqolangiti, am dros ar aris gamoricxuli muclis tifis
recidivebis mogvianebiTi ganviTareba.
garTulebebi. saSiS garTulebaTa Soris unda aRiniSnos nawlavTa sisxldena da
perforacia. sisxldena viTardeba wvrili nawlavis distalur nawilSi wylulis
(venis an arteriolis eroziiT dazianebis) gamo, igi, Cveulebriv, iwyeba daavadebis
mesame kviras da damaxasiaTebelia mozrdilebisa da ufrosi asakis bavSvebisaTvis (1-
2%-mde). intensiuri sisxldenisas avadmyofs aReniSneba saerTo sisuste, Tavbrusxveva,
mkveTri sifermkrTale, arteriuli wnevis mkveTri dacema, temperaturis uecari kleba
normalur an subfebrilur cifrebamde. periferiuli pulsi aCqarebuli da susti
avsebisaa, gulis mwvervalze moismineba sistoluri Suili. sisxldenis dawyebidan
ramodenime saaTis Semdeg an meore dRes ganavali xdeba kuprisferi (melaena),
zogjer, aRniSnuli mdgomareobis miuxedavad, avadmyofebs ubrundeba cnobiereba, rac
unda aixsnas sisxlTan erTad toqsikuri produqtebis gamoyofiT. masiuri sisxldenisas
SeiZleba, ganviTardes hemoragiuli Soki, rac prognozs yovelTvis auaresebs.
msubuqi sisxldena SesaZlebelia, gagrZEldes ramodenime dRes, rasac axlavs zogadi
mdgomareobis TandaTanobiTi gauareseba, rac, Tavis mxriv, aZnelebs mis droul diagnostikas.
nawlavTa perforacia viTardeba nekrozebisa da wylulebis gaCenisas (2-3 kvira)
mliv nawlavSi, iSviaTad _ WianawlavSi. garTulebis sixSirea 0,5-1,5% da SeiZleba,
ganviTardes rogorc mZime, ise msubuqi mimdinareobisas, mis ganviTarebas xels uwyobs
Zlieri meteorizmi, intensiuri peristaltika, aqtiuri moZraoba, xvela, muclis uxeSi
366
palpacia, dietis darRveva.

perforaciis wamyvani niSnebia muclis mwvave tkivilebi (Tumca mZime intoqsikaciis
SemTxvevaSi nervuli sistemis daTrgunvis gamo mtkivneulobis simptomi SeiZleba
damaxinjdes da atarebdes naklebad intensiur xasiaTs), avadmyofebs aqvT pirRebineba.
perforaciis pirvelive saaTebSi aRiniSneba muclis Semofargluli daWimva, romelic
ramodenime xanSi mTel mucelze vrceldeba, rogorc wesi, saxezea blumberg-SCotkinis
simptomi. mogvianebiT (6-12 sT-Si) aRiniSneba Zlieri meteorizmi, am dros qreba
RviZlis arisaTvis damaxasiaTebeli perkutoruli siyrue da moismineba timpanitis
elferis xmianoba. peritonitis diagnostika gaZnelebulia im SemTxvevaSi, roca
perforaciuli adgili mdebareobs nawlavis ukana kedelze, TirkmelTan an swor
nawlavTan axlos, badeqonis an nawlavis maryuJis mifarebisas. miuxedavad amisa,
praqtikulad yovelTvis xerxdeba perforaciis sami niSnis _ muclis mwvave tkivilis,
kunTebis daWimvisa da sunTqvis ti pis Secvlis dadgena.
ufro iSviaT garTulebas warmoadgens toqsikuri Soki (romelic mimdinareobs
sisxlZarRvTa kolafsiT), infeqciur-alergiuli miokarditi, Tromboflebiti, tifuri
pnevmonia, pieliti, osteomieliti, agreTve meoradi infeqciiT ganpirobebuli garTulebebi
_ pnevmonia, otiti, stomatiti, parotiti da sxv.
muclis tifi mcire asakis bavSvebSi iwyeba mwvaved, ZiriTadad mZafrad, temperatura
swrafad aRwevs 39-40°C-s, pirvel dResve gamoixateba saerTo intoqsikaciis movlenebi,
damaxasiaTebelia mousvenroba an Zilianoba, Zilis inversia (dRisiT sZinavT, RamiT
awuxebT uZiloba), aRiniSneba Rebineba, krunCxvebi (Tavzurgtvinis siTxidan SeiZleba
amoiTesos muclis tifis Cxiri). daavadeba SesaZlebelia, mimdinareobdes meningitis,
meningoencefalitis suraTiT. xSiria gastriti, gastroenteriti, gasrtoenterokoliti.
defekacia gaxSirebulia, lorwoiani da momwvano ferisaa. SeiZleba, ganviTardes mZime
eqsikozi an distrofiuli cvlilebebi. daavadeba am asakSi xSirad mimdinareobs pnevmoniiT,
rac maRal letalobas ganapirobebs. niSandoblivia isic, rom muclis tifisaTvis
damaxasiaTebeli niSnebi _ bradikardia, leikopenia, rozeolebi anda garTulebebi _
perforacia, sisxldena _ ar gvxvdeba. daavadebis profilaqtikis SemTxvevaSi acril
bavSvebSi muclis tifi waSlili formiT an abortulad mimdinareobs.
paratifi A, B da C (Salmonella paratyphi A, B anu S. schottmuelleri, C anu S.
hirschfeldii). klinikuri gamovlinebiT paratifebi Zlier emsgavseba muclis tifs,
Tumca aqvT zogierTi Taviseburebani. saboloo diagnozi ismeba laboratoriuli meTodebis
saSualebiT.
A da B paratifebis inkubaciuri periodi xanmoklea. daavadeba xSirad mwvaved
iwyeba, tuCebze herpesuli gamonayriT, rac muclis tifisaTvis ar aris damaxasiaTebeli.
bavSvebi xSirad uCivian muclis tkivils, romlis klinika apendicitisa da qolecistitis
suraTs mogvagonebs, sakmaod xSiria, agreTve, saxis hi peremia, koniunqtiviti, surdo,
ganmeorebiTi Semcivneba, oflianoba, uxvia rozeoluri gamonayari, gansakuTrebiT paratifi
B-s dros da gamoirCeva polimorfizmiT. tifuri statusi viTardeba iSviaTad, naklebia
specifikuri garTulebebic.
paratifi C-s-s dros arCeven Semdeg klinikur formebs : 1) tifismagvari mimdinareoba,
romelic praqtikulad ar gansxvavdeba muclis tifisagan, 2) gastrointestinuri,
romelic dakavSirebulia kvebiTi xasiaTis masiur inficirebasTan da mimdinareobs
RebinebiTa da faRaraTiT, 3) sefsisuri forma, romelic, Cveulebriv, uviTardeba dasustebul
da dRenakl bavSvebs, axasiaTebs remisiuli tipis temperatura, mZime zogadi mdgomareoba,
kanze gamonayari, Sinagani organoebis mxriv Cirqovani kerebi _ parenqimuli hepatiti,
Cirqovani meningiti, osteomieliti da sxv.
diagnozi muclis tifisa da paratifebis dros emyareba daavadebis klinikur
367
gamovlinebebs _ temperaturas, TandaTanobiT mzard intoqsikacias, enis damaxasiaTebel

cvlilebebs, rozeoluri gamonayris gaCenas gansazRvrul droSi, hepatolienur sindroms
da sxv., agreTve epidemiologiuri da laboratoriuli gamokvlevebis monacemebs. vinaidan
adreuli klinikuri niSnebidan arc erTi ar aris paTognomuri, kanonzomierad iTvleba
Cveneba imis Sesaxeb, rom yvela daudgeneli diagnozis SemTxvevaSi da 3 dReze meti
xangrZlivobis maRali temperaturis arsebobisas Catardes sisxlis baqteriologiuri
kvleva tifur-paratifur infeqciebze.
diagnozis dasadgenad baqteriologiur da serologiur meTodebs iyeneben infeqciuri
periodebis gaTvaliswinebiT. daavadebis pirvel kviras ufro advilia hemokulturis
miReba, Tumca misi dadebiTi pasuxi SeiZleba miviRoT rogorc cxelebis mTeli periodis
manZilze, aseve rekonvalescenciis dawyebis periodSi. daavadebis meore-mesame kviras
ufro advilia kopro-, urino-, rozeolokulturis, ufro mogvianebiT ki
(rekonvalescenciis periodSi) bilikulturis miReba duodenuri SigTavsis daTesviT.
igive dros an ufro gvian, qronikuli mtareblobisas SesaZlebelia mikrobebis amoTesva
Zvlis tvinidan (mkerdis an TeZos Zvlis punqtati an trepanirebuli TeZos Zvlis
daTesva). igi 85-90%-Si dadebiTia da mis Sedegebze adreuli antibiotikTerapiis
dawyeba imdenad ar moqmedebs. ukanaskneli meTodi SeiZleba gamoviyenoT sxva
laboratoriuli meTodebis uaryofiTi Sedegebis Semdeg. hemokulturisa da
rozeolokulturis dadebiTi pasuxi yovelTvis mowmobs muclis tifis an paratifebis
arsebobaze, maSin, rodesac kopro- da urinokulturis dadebiTi pasuxi SeiZleba, miviRoT,
rogorc mwvave daavadebis dros, aseve baqteriamtareblobis SemTxvevaSic. amitom sisxlis
baqteriologiuri gamokvleva unda Catardes ramdenimejer. igi 40-60% dadebiT pasuxs
iZleva. venidan aRebuli 5-10ml sisxli iTeseba 10-20%-ian 50-100 ml naRvelis
Semcvel bulionSi an rapoportis niadagze. aucilebel pirobas warmoadgens sisxlisa
da niadagis Tanafardobis dacva 1:10-Tan, vinaidan naklebi raodenobis niadagSi sisxlis
baqtericiduli moqmedebis Sedegad xdeba mikrobebis daTrgunva. kopro-, bili- da
urinokulturebis misaRebad iyeneben ploskirevis niadags. sisxlidan da Zvlis tvinidan
L-formebis gamoyofisaTvis sargebloben specialuri penicilin-Sratiani niadagiT.
vinaidan kulturebis miRebas sWirdeba 3 dRe, gamoiyeneba zogierTi eqspres meTodic:
Vi-antigenis gansazRvra SardSi monoklonuri antisxeulebiT. aseve gamoiyeneba
polimerazuli jaWvuri reaqcia sisxlSi S.typhi-s specifikuri genis amplifikacia-
gansazRvrisaTvis, rac diagnozs ramdenime saaTSi adasturebs.
serologiuri gamokvlevebi nakleb informaciulia, magram maTi gamoyeneba SeiZleba
epidemiologiuri kvlevebisaTvis. Widal-is klasikuri testi sazRvravs O-,H- antigenebis
mimarT warmoSobil antisxeulebs, magram es testi SeiZleba iyos, rogorc cru-
dadebiTi, aseve cru-uaryofiTi.
diagnostika. diferenciuli diagnostikis Catareba zog SemTxvevaSi
saWiroa mTel rig daavadebebTan _ gri pTan, enterovirusul infeqciasTan, sefsisTan,
miliarul tuberkulozTan, salmonelur gastroenteritTan, brucelozTan, tularemiasTan,
leptospirozTan, riketsiozebTan, mononukleozTan, sisxlis daavadebebTan.
gr
grii pi, muclis tifisagan gansxvavebiT, xasiaTdeba mokle temperaturuli periodiT,
zemo sasunTqi gzebis katariT, tkivilebiT Tvalis kaklisa da Sublis midamoebSi,
texvis SegrZnebiT saxsrebsa da kunTebSi, hepatolienuri sindromi ar aris.
enterovirusuli infeqcis dros aRiniSneba herpesuli angina, mialgia, ar aris
gamoxatuli intoqsikacia muclis tifisaTvis damaxasaiaTebeli mzardi intensivobiT,
sisxlSi eozinofiliaa.
sefsisi muclis tifisagan gansxvavdeba heqtiuri temperaturis mrudiT, romelsac
Tan axlavs Semcivneba, oflianoba, periferiul sisxlSi ki _ neitrofiluri leikocitozi,
368
maRali eds.
miliaruli tuberkulozi ufro mcire asakis bavSvebSi gvxvdeba. damaxasiaTebelia
saerTo mdgomareobis TandaTanobiT gauareseba, tifuri statusi ar aRiniSneba. kanze
Cndeba tuberkuloidebi, romlebic rozeolebs ar hgvanan, rentgenologiurad vlindeba
miliaruli kerebi, icvleba Tvalis fskeric.
mkurnaloba.. avadmyofebi eqvemdebarebian aucilebel hospitalizacias, sadac iniSneba
mkurnaloba
mkacri woliTi reJimi temperaturis normalizaciidan 6-7 dRis CaTvliT, me-7-8
dRidan nebadarTulia wamojdoma, normaluri temperaturis me-10-11 dRidan ki _
siaruli. Tu avadmyofebs ara aqvT Catarebuli antibiotikTerapia, aRniSnuli vadebi
SeiZleba ufro Semokldes.
didi mniSvneloba eniWeba avadmyofis saTanado movlas, yuradReba eqceva kanisa da
piris Rrus higienas.
daavadebis mwvave periodSi da Semdgom, zomieri temperaturis 7-8 dRis ganmavlobaSi
dieta nawlavebisaTvis maqsimalurad damzogavi unda iyos, avadmyofs eZleva meqanikurad
da qimiurad advilad gadasamuSavebeli sakvebi, rac xels uwyobs duRilisa da lpobiTi
procesebis Semcirebas, Tumca sakvebi unda Seicavdes saTanado kaloriebs. unda moveridoT
nawlavTa gadatvirTvas uxeSi ujredisiT. Cveulebriv kvebaze gadasvla SeiZleba
temperaturis normalizaciidan 15-25 dRis Semdeg.
avadmyofebs eniSneba rZis nawarmi _ mawoni, kefiri, araJani, xaWo, naduRi, agreTve
Toxlo kvercxi an omleti, bulioni, gaxexili supebi, mananis burRulisa da brinjis
fafebi, bostneulis piure, dakepili xorci, orTqlze momzadebuli kotleti, Jele,
tkbili Cai, TeTri orcxobila. kveba tardeba mcire ulufebiT, xSirad, aucilebelia
sakmarisi raodenobis siTxis miReba askilis nayenis an borjomis saxiT.
etiotropuli saSualebebidan ufro miRebulia qloramfenikoli, romelic tifur-
paratifur mikrobebze baqteriacidulad moqmedebs. preparati iniSneba per os, kunTebSi
an venaSi. mcire asakis bavSvebs erT miRebaze eZleva 0,01-0,015 g/kg sxeulis masaze,
skolamdeli da skolis asakis bavSvebs ki _ 0,15-0,25g/kg 4-jer dReSi.
umravles SemTxvevaSi temperatura normaluri xdeba ramodenime dReSi. pirvel
dReebSive mniSvnelovnad mcirdeba saerTo intoqsikaciis movlenebi, magram preparatis
miReba unda gagrZeldes aranakleb 10 dRisa, rac uzrunvelyofs recidivebis mkveTr
Semcirebas. (À\È\ Õî÷àâà= Ì\Ì\ Êóëèåâ= Â\È\ Ïîêðîâñêèé)
Ïîêðîâñêèé). xolo distrofiul
avadmyofebSi an mosalodneli saSiSi garTulebebis dros etiotropuli mkurnaloba
grZeldeba 3 kviramde normaluri temperaturis fonze. unda aRiniSnos, rom
qloramfenikoliT mkurnaloba ver uzrunvelyofs qronikuli mtareblobis ganviTarebis
Tavidan acilebas.
qloramfenikoliT mkurnalobis uefeqtobis SemTxvevaSi an misi miRebis
winaaRmdegCvenebis dros avadmyofebs eniSnebaT ampicilini 50-100 mg/kg sxeulis masaze
4 miRebaze dReSi, Tumca ampicilinTerapia qloramfenikoliT mkurnalobasTan SedarebiT
ufro Senelebuli efeqtiT gamoirCeva, magram recidivebi da qronikuli
baqteriamtarebloba SedarebiT naklebad viTardeba. arsebobs monacemebi imis Sesaxeb,rom
ampicilinis maRali dozebi 4-6 kviris ganmavlobaSi iwvevs baqteriamtareblobis
gankurnebas, maT Soris im pirebSic, visac aReniSneba qolecistiti.
amoqsicilini(100mg/kg 3 miRebaze) klinikuri efeqtiT qloramfenikols ar
Camouvardeba, xolo ampicilinTan SedarebiT ufro ukeTesad moqmedebs. mkurnalobaSi
iyeneben trimetoprim-sulfametoqsazols asakis Sesabamisad, Tumca efeqti
qloramfenikolsa da ampicilinze naklebia.
dezintoqsikaciis mizniT gamoiyeneba reopoliglukinis, glukozis, 0,9% NaCl-is,
ringeris laqtatis, vitaminebis intravenuri Seyvana.
369
mniSvnelovania adekvaturi hidrataciisa da eleqtrolitebis balansis dacva. mZime

formebis dros intoqsikaciis moxsnis TvalsazrisiT iniSneba kortikosteroidebi.
kritikul avadmyofebSi delirias da Sokis dros iniSneba deqsametazoni Tavidan 3 mg/
kg, Semdeg ki 1 mg/kg yovel 6 saaTSi. adekvaturi antibiotikTerapiis fonze
kortikosteroidebis Seyvana garTulebebs ar iwvevs. maTi daniSvna me-8-9 dRemde
(wylulebis gaCenamde) ufro metadaa gamarTlebuli. rekomendebulia proteolizuri
fermentebis inhibitorebis daniSvnac (gordeqsi, kontrikali, trasiloli). infeqciur-
toqsikuri Sokis dros xorcieldeba Sokis sawinaaRmdego RonisZiebebi.
nawlavidan sisxldenis SemTxvevaSi aucilebelia mkacri woliTi reJimis dacva,
siTxis miRebis SezRudva da 10-12 saaTiT kvebis Sewyveta, Semdgom iniSneba Txieri
sakvebi. dietis gamravalferovneba xdeba TandaTanobiT. hemostazuri da SenacvlebiTi
Terapiis mizniT venaSi iniSneba donoris sisxli, 10%-iani kalciumis glukonatis
xsnari, plazma.
nawlavis perforaciis SemTxvevaSi naCvenebia saswrafo qirurgiuli Careva.
letaloba muclis tifis dros Seadgens 0,2-0,3%-s.
rekonvalescentis binaze gawera xdeba temperaturis normalizaciidan arauadres
2 kvirisa, ganavlis baqteriologiuri gamokvlevis samjeradi uaryofiTi pasuxis Semdeg.
bavSvTa dawesebulebebSi ki daiSvebian ganavlis damatebiTi orjeradi uaryofiTi
baqteriologiuri analiziT. rekonvalescenciis periodSi baqteriologiuri gamokvleva
xorcieldeba 5 dRis intervaliT.
profilaqtika mimarTulia, pirvel rigSi, infeqciis wyaros izolaciisaken, amasTan
dakavSirebiT, didi mniSvneloba aqvs daavadebis adreul diagnostikas, avadmyofis
hospitalizacias, mis efeqtur mkurnalobasa da mikrobTa sruli eliminaciis miRwevas.
mniSvnelovania sanitarul-higienuri RonisZiebebis organizaciac, wylis momaragebis
gaumjobeseba, dasaxlebuli adgilebis dasufTaveba, kanalizaciis srulyofa, brZola
buzebTan, sanitarul-saganmanaTleblo muSaoba mosaxleobaSi, sanitaruli higienis saTanado
Cvevebis gamomuSaveba.
aqtiuri imunizacia tardeba epidemiologiuri CvenebiT. tifis sawinaaRmdegod
arsebobs sxvadasxva vaqcinebi:
1. peroraluri cocxali atenuirebuli vaqcina momzadebuli Ty21a S.typhi-s
Stamidan. 6 welze ufrosi bavSvebisaTvis.
2. parenteruli kafsuluri polisaqariduli vaqcina Vi CPS momzadebuli
gawmendili Vi-antigenisagan. 2 welze ufrosi bavSvebisaTvis.
3. parenteruli Termo-fenol-inaqtivirebuli vaqcina. 6 Tveze ufrosi
bavSvebisaTvis.
4. aceton-inaqtivirebuli parenteruli vaqcina. gamoiyeneba mxolod aSS jarisaTvis.
vaqcinis arCeva xdeba asakis, busteruli dozebis saWiroebisa da gverdiTi movlenebis
SesaZlo gamovlinebis mixedviT.
rekomendaciebi vaqcinaciisaTvis aSS-Si:
1. mogzauroba im teritoriebze, sadac SeiZleba S.typhi-T dasnebovneba.
2. axlo kontaqti tifiT daavadebulTan.
3. laboratoriuli muSakebisaTvis, sadac aRiniSneba xSiri kontaqti dabinZurebul
masalasTan.
SesaZlebelia busteruli dozis gakeTeba, Tu mosalodnelia xangrZlivi kontaqti
S.typhi-sTan 2-5 wlis Semdeg (damokidebulia vaqcinaze).
370
kerZo nawili.
iersiniuli infeqcia. fsevdotuberkulozi
iersiniuli infeqcia
iersiniuli infeqciis cnebaSi igulisxmeba nawlavTa ori, mwvave baqteriuli,

anTroponozul-zoonozuri infeqcia _ fsevdotuberkulozi da iersiniozi, gamowveuli
iersinias gvaris mikrobebiT _ Yersinia pseudotuberculosis da Yersinia
enterocolitica. orive gramuaryofiTi, 22°C–ze moZravi Cxirebia, romlebic kargaven
gadaadgilebis unars 37°C-ze. amiT isini gansxvavdebian Y.pestis da enterobaqteriebisagan.
Tavis mxriv, iersiniebi gansxvavdebian erTmaneTisagan bioqimiuri TvisebebiT. specifikuri
antiSratebiT, aglutinaciis reaqciiT da Y. pseudotuberculosis-is specifikuri
baqteriofagis zemoqmedebis mixedviT.
orive infeqcias axasiaTebs organizmis zogadi intoqsikacia, mimdinare, araiSviaTad,
egzanTemiT, RviZlis, elenTis, kuW-nawlavis traqtis, saxsrebis da sxva organoebisa da
sistemebis dazianebiT. garda amisa, xasiaTdebian garkveuli TaviseburebebiT, rogorc
damoukidebeli nozologiuri formebi.
fsevdotuberkulozi
PSEUDOTUBERCULOSIS
daavadebis sinonimebia:P Soreuli aRmosavleTis qunTruSismagvari cxeleba,

pasterelozi, mwvave mezenteriuli limfadeniti da sxva.
fsevdotuberkulozi zoonozuri jgufis infeqciuri daavadebaa, romelsac axasiaTebs
organizmis zogadi intoqsikacia mimdinare cxelebiT, qunTruSismagvari gamonayariT da
sxva organoebis dazianebiT.
istoriuli cnobebi. gamomwvevi agenti aRmoCenili iyo 1883 w. R.Malasses da
W.Vignal-is mier da dawvrilebiT iqna aRwerili 1889w. R.Pfeiffer-is mier. 1895w.
K.Ebert-ma daRupuli cxovelebis Sinagan organoebSi aRmoaCina kvanZovani warmonaqmnebi,
romlebic garegnulad tuberkulozur xorkls hgavdnen da daavadebas
fsevdotuberkulozi uwoda.
fsevdotuberkulozis mikrobis Savi Wiris CxirTan (Y.pestis) garkveuli msgavseba
gaxda sababi, miekuTvnebinaT igi iersiniis gvarisaTvis.
fsevdotuberkulozuri infeqciis sistematuri Seswavla SesaZlebeli gaxda 1953
wlidan Nassoff–is da Dolle-s Sromebis Semdeg, romlebmac SeZles bavSvebsa da
mozrdilebSi aratuberkulozuri etiologiiT dazianebuli limfuri kvanZebidan
gamoecalkevebinaT abscedirebuli limfadeniti (klinikurad apendicitis suraTiT).
swored aseTi avadmyofebidan 1954w. Knapp-ma gamhoyo fsevdotuberkulozis Cxirebi.
am periodidan literaturaSi xSiria monacemebi mezenteriuli limfuri kvanZebis
dazianebisa aRniSnuli mikrobebiT.
adamianebSi fsevdotuberkulozis Seswavlis axal etapad iTvleba 1959w., roca
dagrovda monacemebi am daavadebis epidemiur xasiaTze. Soreul aRmosavleTSi adgili
hqonda daavadebis epidemias, romelmac miiRo saxelwodeba “Soreuli aRmosavleTis
qunTruSismagvari cieb-cxeleba”.
371
kerZo nawili.
1965 w. Â\À\ Çíàìåíñêèé

Çíàìåíñêèé-m da À\Ê\ Âèøíÿêîâ
Âèøíÿêîâ-ma avadmyofebis fekaliebidan
gamohyves fsevdotuberkulozis Cxiri, xolo Â\À\ Çíàìåíñêèé
Çíàìåíñêèé-m TviTdasnebovnebis
gziT daamtkica aRniSnuli mikrobis etiologiuri roli Soreuli aRmosavleTis
QqunTruSismagvar cxelebasTan dakavSirebiT.
etiologia. fsevdotuberkulozis gamomwvevi agenti _ Yersinia pseudotuber-
culosis miekuTvneba Yersinia-s gvars da Enterobacteriaceae-s ojaxs. igi
gramuaryofiTi moZravi Cxiria, kargad izrdeba, rogorc Cveulebriv, ise Rarib sakveb
niadagze. aqvs O da H antigenebi. O antigenis gaTvaliswinebiT gamoyofen
fsevdotuberkulozuri Cxirebis 8 serovariants. adamianebSi daavadebas ufro xSirad
I varianti iwvevs, iSviaTad III da erTeul SemTxvevebSi II, IV da V serovarebi.
varaudoben, rom endotoqsini warmoadgens O antigenis xsnad fraqcias. I da III
serovaris zogierTi Stami avlens egzotoqsinis produqciis unars.
mikrobebi aqtiurad mravldebian mdinaris, onkanis, auduRar wyalSi da inarCuneben
yvela Tvisebas dabal temperaturaze. erT-erT umniSvnelovanes epidemiologiur Tvisebas
warmoadgens fsiqrofiloba e.i. unari SeinarCunos yvela Tviseba da gamravldes dabali
temperaturis pirobebSi. mravldebian macivris temperaturaze +4-8°C-ze, uZleben
mcire gayinvasa da galRobas, didxans inarCuneben sicocxlisunarianobas niadagSi.
amasTan, Zlier mgrZnobiareni arian gamoSrobisadmi, mzis sxivebis moqmedebisadmi. duRili
klavs mas 10-30 wamSi. sadezinfeqcio xsnarebi (qloramini, kalciumis hi poqloridi da
sxv.) klavs ramdenime wuTSi.
epidemiologia. infeqciis wyaros warmoadgens gareuli da Sinauri cxovelebi.
fsevdotuberkulozis Cxiris gamoyofa dadgenilia 60-mde saxis ZuZumwovar cxovelSi
da 29 saxis frinvelSi. miuxedavad amisa, adamianisaTvis infeqciis ZiriTad wyaros
sinanTropuli da gareuli mRrRnelebi warmoadgenen, romlebic Tavisi gamonayofebiT
abinZureben sakveb produqtebs, wyals, sadac mikrobebi ara marto inarCuneben
sicocxlisunarianobas, aramed mravldebian kidec.
infeqciis meore rezervuarad iTvleba niadagi, sadac mikrobebis xSiri arseboba
ganpirobebulia aramarto cxovelebis fekaliebis maTSi xSiri moxvedriT, aramed
fsevdotuberkulozis CxirebSi saprofituli Tvisebebis mqone Stamebis arsebobiTac.
fsevdotuberkuloziT daavadebuli an baqteriamtarebeli ar aris saSiSi, rogorc
infeqciis wyaro.
infeqciis gadacemis mTavar gzas warmoadgens kvebiTi faqtori. haeriT da
mtvriT infeqciis gadacemis meqanizmi dadgenili ar aris (Â\È\ Â\È\ Ïîêðîâñêèé da Ã\Â\
Þùóê
Þùóê).
adamianebSi dasnebovneba, ZiriTadad, xdeba umi bostneulis sacavSi an saTburSi
dayovnebiT, sadac kargad mravldebian mikrobebi. gadacemis faqtorebad iTvleba umi
salaTa, damzadebuli sanitaruli wesebis darRveviT.
daavadebas xSirad aqvs adgili organizebul bavSvTa koleqtivebSi, saerTo kvebiTi
blokiT sargeblobis SemTxvevaSi, rodesac irRveva saTanado sanitaruli wesebi.
upiratesad avaddebian bavSvebi 3-dan 14 wlamde. 6 Tvemde bavSvebi
fsevdotuberkuloziT ar avaddebian, 7 Tvidan 1 wlamde ki _ iSviaTad, rac SeiZleba
kvebis xasiaTiT aixsnas. daavadebis afeTqebebi da sporaduli SemTxvevebi modis gazafxul-
zafxulis periodze. daavadebis sixSirea 1000 bavSvze 8-20 SemTxveva.
paTogenezi. fsevdotuberkulozis Cxirebis SeWra organizmSi xdeba dainficirebuli
sakvebis (salaTa, vinegreti, wyali) moxvedriT piris RruSi (dasnebovnebis faza). piris
Rrus lorwovani garsebis mxriv SeiZleba adgili hqondes iseT anTebiT process,
rogoricaa faringiti, araiSviaTad kisris limfuri kvanZebis anTeba _ limfadeniti.
kuWis barieris gadalaxvis Semdeg mikrobebi xvdebian wvrili nawlavebis lorwovani
372
kerZo nawili.
garsis enterocitebSi an nawlavis kedlis ujredSoris sivrceSi, aqedan regionul

limfur kvanZebSi, kerZod jorjalSi da iwveven maT anTebas. daavadebis paTogenezis
limfagenur-regionuli fazis gamovlinebad unda CaiTvalos pirveladi reaqtiuli
cvlilebebi kuW-nawlavis traqtis limfuri sistemis mxriv, rac baqteriuli
generalizaciis gareSe mimdinareobs da inkubaciur periodSi eteva (paTogenezis es
monakveTi SeiZleba agreTve ganisazRvros, rogorc enteraluri faza).
pirveladi baqteriemiis klinikuri gamovlinebis Sedegad (limfuri barieris garRveva
da baqteriebis hematogenuri generalizacia), yalibdeba iseTi simptomatika, rogoricaa
neirotoqsikozis suraTi, qunTruSismagvari cxeleba. SesaZlebelia amiT infeqciuri
procesi Semoifarglos da damTavrdes sruli gamojanmrTelebiT, anda procesma miiRos
ufro mZafri mimdinareoba, mag.: mZime sefsisis ganviTarebiT da a.S.
procesis hematogenur generalizaciasTan (baqteriemiasTan) erTad adgili aqvs
baqteriebis toqsikuri substanciis daSlas. masTan aris dakavSirebuli organizmis
mzardi intoqsikaciis ganviTareba, alergiuli procesebis Camoyalibeba _ alergiuli
gamonayari, kvanZovani eriTemebi da sxva. alergiuli komponentis monawileobaze mowmobs
sisxlSi histaminisa da serotoninis maRali Semcveloba. fsevdotuberkulozma avadmyofTa
nawilSi SeiZleba biZgi misces imunopaTologiur Zvrebs da gamoiwvios kolagenuri
ti pis sistemuri daavadebis ganviTareba.
fsevdotuberkuloziT gardacvlilTa gvamebSi seqciaze Sinagan organoebSi dgindeba
mwvave generalizebuli infeqciuri retikulozis suraTi, pirvel rigSi, nawlavebis,
RviZlisa da elenTis limfuri sistemis dazianebiT. kerZod, adgili aqvs
fsevdotuberkulozur kerebs _ `granulomebs”, zogjer ki mikroabscesebs. sxva organoebis
mxriv aRiniSneba araspecifikuri, distrofiuli xasiaTis cvlilebebi. damaxasiaTebelia,
agreTve, Sinagani organoebis mxriv hi peremia da sisxlsavseoba, hemoragiuli SeSupeba.
adgili aqvs endo- da perivaskulits, peribronqits, panbronqits, intersticiul da
kerovan pnevmoniebs.
yvelaze ufro mniSvnelovani cvlilebebi aRiniSneba nawlavis terminalur nawilSi.
brma nawlavSi Sesvlis adgilas xdeba gamomwvevi mikrobebis e.w. deponireba da aRiniSneba
terminaluri serozuli cvlilebebi, zogjer eroziul-wylulovani ileitis saxiT,
mwvave apendicitis suraTi limfangoitiT da mezenteriuli adenitiT.
procesis ganviTareba an ukuganviTareba damokidebulia retikulur-endoTeliuri
ujredebis mier mikrobTa fiqsaciaze. upiratesad ki es xdeba RviZlSi, elenTaSi, rac
gamoixateba reaqtiul cvlilebebSi da saTanado funqciis moSlaSi.
SesaZlebelia, organizmSi arsebuli Sinagani kerebidan moxdes infeqciis meoradi
generalizacia, rac ganapirobebs recidivebisa da gamwvavebebis formirebas.
procesis damamTavrebel rgolad iTvleba organizmis ganTavisufleba mikrobebisagan.
klinikuri monacemebi mowmoben, rom fsevdotuberkulozis dros imuniteti viTardeba
TandaTanobiT da yovelTvis ar aris mdgradi, ris gamoc SesaZlebelia gamwvavebebisa
da recidivebis arseboba.
imuniteti. humoruli imunitetis Camoyalibeba xdeba TandaTanobiT, neli tempiT
da SeiZleba xasiaTdebodes susti damcvelobiTi TvisebebiT. zogjer sruli imunitetis
CamoyalibebisaTvis saWiroa recidiuli reaqciebis aucilebloba.
Ã\Ì\ Ñîìîâ
Ñîìîâ-is (1979w) monacemebiT, imunuri sistemis pirveli rgoli xasiaTdeba
fagocitozuri reaqciiT, romelsac xSirad dausrulebeli fagocitozis saxe aqvs.
aseT SemTxvevaSi fsevdotuberkulozi bavSvebSi mZime da xangrZliv mimdinareobas
Rebulobs. sabolood organizmSi warmoebs specifikuri antisxeulebis TandaTanobiT
dagroveba, Zlierdeba dacvis araspecifikuri meqanizmebi da xdeba mikrobebis sruli
eliminacia.
373
kerZo nawili.
daavadebis me-6-8 dRidan SratSi Cndebian A, M da G klasis imunoglobulinebi

(saerTo da imunuri). daavadebis pirvel dReebSi IgM upiratesobiT, romlebic daavadebis
me-2-3 kviras maqsimalur koncentracias aRweven, Semdeg ki xdeba IgG producireba.
klinika. fsevdotuberkulozi xasiaTdeba klinikuri suraTis polimorfizmiT.
dagvianebuli diagnostikis da gvian dawyebuli mkurnalobis dros adgili aqvs procesis
gamwvavebas da recidivebs.
inkubaciuri periodi 4-18 dRea, ufro xSirad ki 1-3
dRes Seadgens. umravles SemTxvevaSi daavadeba iwyeba mwvaved,
prodromis gareSe, iSviaTad _ TandaTanobiT. daavadebis
pirvelsave dReebSi vlindeba organizmis saerTo intoqsikacia:
zogadi sisuste, uZiloba, Tavis tkivili, Tavbrusxveva, zogjer,
Semcivnebis SegrZneba. avadmyofebi uCivian, agreTve, kunTebisa
da saxsrebis tkivils, katarul movlenebs _ cxviridan
sunTqvis gaZnelebas, xvelas, yelSi fxaWnis SegrZnebas, sxeulis
temperatura 38-40°C-mde imatebs. zogjer avadmyofebi uCivian
tkivils marjvena ferdqveSa midamoSi, epigastriumis an
erTeul SemTxvevebSi iliocekalur areSi. am regionis
nawlavebis palpaciis dros vlindeba gadidebuli brma nawlavi,
isinjeba mtkivneuli mezenteriuli limfuri kvanZebi, ris
gamoc Zneldeba misi diferencireba mwvave apendicitisagan.
habitusSi yuradRebas ipyrobs saxis pastozuroba, saxisa
da kisris hi peremia, rac kontrastirebs mkrTal cxvir-
tuCis samkuTxedTan. SesaZlebelia konstatirebuli iqnas
kisris limfadeniti. intoqsikaciis simaRleze calkeul
avadmyofebs uviTardebaT daavadebisaTvis damaxasiaTebeli
saxisa da kisris, xelis mtevnebisa da terfebis mniSvnelovani,
SemosazRvruli hi peremia cianozuri elferiT, romlebic
cnobilia, rogorc kapiuSonis, xelTaTmanis, windebis simptomi.
fsevdotuberkulozi. SesaZloa ganviTardes koniunqtivis hi peremia, Tvalis
ti pur
purii gamonayar TeTrii sklerebis inicireba, zogjer herpesuli gamonayari tuCebze
i, TeTr
gamonayari,
dermografizmi. an cxviris nestoebze. xaxis mxriv yuradRebas i pyrobs
(Í.È. Íèñåâè÷, Â.Ô. nuSurebis gadideba, maTi mkveTri hi peremia. piris Rrus
Ó÷àéêèí) lorwovani garsebi SeSupebulia, zogjer SeimCneva enanTema.
ena pirvelsave dReebSi Sesqelebulia nadebiT,
romelic sufdavdeba daavadebis me-3-4 dRes da
emsgavseba `Jolosebur” enas, gamoxatuli SeSupebuli
dvrilebiT.
fsevdotuberkulozis dros erT-erT kardinalur
simptomad iTvleba egzanTema, romelsac adgili aqvs
avadmyofTa 70-80%-Si. gamonayari Cndeba erTbaSad
mTel sxeulze, daavadebis pirvel kviras,
gansakuTrebiT maRali intoqsikaciis fonze,
wertilovani xasiaTisaa da qunTruSis gamonayars
mogvagonebs, an laqovania, romlis feric meryeobs
fsevdotuberkulozi.
mkrTali wiTelidan kaSkaSa wiTel feramde. kanis
`xelTaTmanis simptomi~ - laqovan-
safarveli am dros sufTaa an SeiZleba hi peremiuli
papuluri wvrili gamonayari zemo
kidurebis distalur nawilze. iyos. aRniSnuli gamonayari umravles SemTxvevaSi
(Í.È. Íèñåâè÷, Â.Ô. Ó÷àéêèí) gvxvdeba da mas Tan axlavs qavilis SegrZneba.
374
kerZo nawili.
gaxangrZlivebuli mimdinareobisa da recidivebis dros gamonayari gvxvdeba ufro

wvivebze, naklebad _ dundulebze, SesaZlebelia kvanZovani gamonayaris arseboba. msgavsad
qunTruSisa, advili gamosawvevia xangrZlivi TeTri dermografizmi. kanis bunebriv
nakecebSi SeimCneva muqi feris zolebi, romelsac ganapirobebs gamonayris gajereba,
gamonayars adgili aqvs, agreTve, saxsrebis irgvliv. dadebiTia laxtis, Cqmetis simptomebi,
rumpel-konCalovski-leedes, mozeris simptomebi. gamonayris xangrZlivoba 3–7 dRes
ar aRemateba, sustad gamoxatuli gamonayari ki efemerul xasiaTs atarebs (Cqara
qreba). gamonayari xSirad simetriuladaa ganlagebuli da sxeulis lateralur adgilebSi
lokalizdeba; iRliis fosoebSi, barZayisa da zemo kidurebis medialur zedapirebze,
muclis qvemo nawilSi. gamonayrisagan Tavisufalia Tavis kani da saxe. mZime SemTxvevebSi
gamonayari hemoragiul xasiaTs atarebs.
daavadebis mwvave periodSi avadmyofTa naxevari uCivis tkivils muxlis, sxiv-majis,
falangTaSoris saxsrebSi, SesaZlebelia adgili hqondes maT SeSupebasac.
saWmlis momnelebeli sistemis mxriv intoqsikaciis movlenebi gamoixateba madis
daqveiTebaSi, RebinebaSi. ena Selesilia, nadebiT, romelic me-4-5 dRisaTvis sufTavdeba
da Rebulobs “Jolosebr” Sesaxedaobas. aRiniSneba faRaraTi ganavlovani masebis
SenarCunebiT. zog SemTxvevaSi viTardeba muclis zomieri Seberva, iliocekalur areSi
moismineba yuryuri, aqvT mtkivneulobis SegrZneba. brma nawlavi Semsxvilebulia,
mtkivneuli. mis saproeqcio midamoSi palpaciiT SesaZlebelia, dadgindes mtkivneuli
limfuri kvanZebi, viTardeba terminaluri ileitis an apendicitis suraTi.
daavadebis mwvave periodSi RviZli gadidebulia, zogjer SeimCneva sklerebis
siyviTle. laboratoriuli monacemebi adgenen bilirubinemias, urobilin- da
bilirubinurias, irRveva cilis masinTezirebeli da qolesterinis warmomSobi funqciebi.
erTeul SemTxvevaSi procesSi SeiZleba CaerTos sanaRvle gzebi.
mZime intoqsikaciis Sedegia Tirkmlis dazianebis da infeqciur-toqsikuri Sokis
suraTi proteinuriis, mikrohematuriis, leikocituriis, oliguriis gamovlinebiT. iSviaTad
ki SeiZleba ganviTardes difuzuri glomerulonefritis suraTi.
gul-sisxlZarRvTa sistemis mxriv aRiniSneba bradikardia, ufro iSviaTad _ taqikardia,
ritmis darRveva, gulis tonebis moyrueba, mwvervalze moismineba sistoluri Suili,
arteriuli wneva zomieradaa daqveiTebuli. ekg-ze _ miokardiumis kumSvadobis unaris
daqveTeba, gamtareblobis darRveva, eqstrasistolebi, dabali T kbili, parkuWovani
kompleqsis gafarToeba.
daavadebis mimdinareobaSi SeiZleba gamovlindes ama Tu im organos an sistemis
dazianebis upiratesoba, rac gansazRvravs mis klinikur formebs. gvian dawyebuli
mkurnalobis SemTxvevaSi mosalodnelia gamwvavebebisa da recidivebis formireba da
axali organoebis procesSi CaTreva.
recidivebis dros SeiZleba adgili hqondes alergiul gamonayars _ WinWrisebur,
medikamentur, nodozur eriTemas, mimdinares saxsrebis dazianebiT.
gansakuTrebiT mZime SemTxvevebSi daavadebis klinikur suraTSi aRiniSneba meningizmis,
serozuli meningitis, meningoencefalitis movlenebi.
periferiul sisxlSi cvlilebebi Seesabameba zomier, an ufro, maRal leikocitozs
marcxniv gadaxriT, monocitoziT, zogierT avadmyofs aReniSneba eozinofilia, eds
momatebulia (20-55 mm/sT).
mwvave periodi iSviaTad grZeldeba 5-7 dReze metxans. aRsaniSnavia, rom recidivebi
da gamwvavebebi xSiria da SesaZlebelia, ganuviTardes avadmyofTa 1/3-s. aRniSnuli
talRebis gamovlineba xasiaTdeba temperaturis axali matebiT da lokaluri dazianebis
simptomatikiT. xSiria muclis tkivili, arTralgiebi, Sardis gamuqeba, egzanTema, upiratesad
alergiuli xasiaTis _ makula-papuluri, WinWrisebri, nodozuri eriTema. recidivebi,
375
kerZo nawili.
Cveulebriv, ufro msubuqad mimdinareoben, vidre mwvave periodi. ufro xSirad adgili
aqvs erT recidivul talRas, naklebad 2-3 da mets. recidivuli mimdinareobisas
gamojansaRebis periodi 2-3 Tvemde aRwevs.
gamojanmrTelebis periodSi temperaturis normalizacia TandaTanobiT xdeba, zogadi
intoqsikaciis movlenebi qreba, Sinagani organoebis funqciebi normalizacias ganicdis.
aqercvla tanze, kiserze burbuSelasebr xasiaTs Rebulobs, ufro uxeSi aqercvla _
Sreebad an foTliseburi, uviTardebaT xelis gulebze da terfebze.
sada (garTulebis gareSe) mimdinareobis dros daavadebis xangrZlivoba 1-1,5 Tves
ar aRemateba.
fsevdotuberkulozis sayovelTaod miRebuli klasifikacia jerjerobiT ar arsebobs,
xolo arsebuli klasifikaciebi efuZneba ama Tu im klinikuri simptomatikis upirates
gamovlinebas.
pediatrebisaTvis misaRebia klasifikacia ti pis, simZimisa da mimdinareobis xasiaTis
gaTvaliswinebiT.
ti pur mimdinareobas miekuTvneba daavadebis is formebi, romlebic srulad an
nawilobriv emTxveva damaxasiaTebel klinikur simptomatikas _ qunTruSiseburi, abdominuri,
generalizebuli, arTralgiuri, Sereuli da sefsisuri ti pebi.
ama Tu im Semofargluli klinikuri sindromebiT daavadebis mimdinareoba iSviaTia,
klinikur praqtikaSi ufro Sereuli formebi gvxvdeba, amasTan aseT gamovlinebebs
adgili aqvT erTdroulad, ufro xSirad ki _ Tanmimdevrulad iSleba klinikuri
suraTi. amasTan dakavSirebiT Sereuli formebis arseboba ufro Seefardeba ti pur
gamovlinebebs.
ati purs miakuTvneben waSlil, subklinikur da katarul formebs.
fsevdotuberkulozis msubuqi formebi xasiaTdebian umniSvnelo intoqsikaciiT _
temperatura 38-38,5°C-s ar aRemateba da ufro xanmoklea, gamonayari zomieradaa
gamoxatuli, RviZli odnav aris gadidebuli, arTritebi da sxva simptomebi sustadaa
warmodgenili.
saSualo simZimiT mimdinareobisas intoqsikacia mniSvnelovania, temperatura 38,5°C-
ze metia. avadmyofebi uCivian gulisrevas, ganmeorebiT Rebinebas, gamonayari uxvia,
Sinagani organoebis mxriv aRiniSneba cvlilebebi.
mZime formis dros saxezea organizmis Zlieri intoqsikacia, maRali da mdgradi
temperatura, ganmeorebiTi Rebineba, Tavbrusxveva, gamonayari intensiuria, xSirad
hemoragiuli xasiaTis. damaxasiaTebelia RviZlis, saxsrebis, kuW-nawlavis traqtis,
gul-sisxlZarRvTa da sxva sistemebis xangrZlivi dazianeba. xSirad aseTi formebi
xasiaTdebian generalizebuli mimdinareobiT. am dros periferiul sisxlSi aRiniSneba
leikocitebis toqsikuri marcvlovaneba, maRali leikocitozi, anemia, Trombocitopenia.
ati puri formebi xasiaTdebian msubuqi mimdinareobiT. rac Seexeba subklinikur
(inaparantul) formas, misi diagnostika emyareba mxolod laboratoriul monacemebs.
garTulebebi. xSir garTulebad iTvleba alergiuli xasiaTis gamonayari,
WinWriseburi, kvinkes SeSupeba, reaqtiuli arTritebi, nodozuri eriTema, reiteris
sindromi. iSviaTia fsevdotuberkulozuri meningiti, meningoencefaliti, Tirkmlebis
mwvave ukmarisoba, miokarditi, pnevmonia.
diagnostika. klinikurad diagnozis dadgena garkveul siZneleebTanaa dakavSirebuli
da, ZiriTadad, daavadebis ti pur gamovlinebebs eyrdnoba _ Sereuli formebis
damaxasiaTebel simptomatikas, rogoricaa organizmis saerTo intoqsikacia, piris Rrus
lorwovani garsebis katari, kuW-nawlavis traqtis, RviZlis mxriv movlenebi, saxsrebis
dazianeba da kanis damaxasiaTebeli egzanTema (“kapiuSonis”, “xelTaTmanis”, “windebis”
simptomebi), mniSvneloba aqvs, agreTve, epidanamnezs, zamTar-gazafxulis sezonurobas,
376
kerZo nawili.
daavadebis jgufur SemTxvevebs, romlebic gamowveulia erTi wyarodan sakvebiTa da

wyliT sargeblobiT.
gadamwyveti roli diagnozis saboloo dadgenaSi baqteriologiur da serologiur
gamokvlevebs eniWeba. daavadebis mwvave mimdinareobisas gamosakvlev masalas warmoadgens
fekaliebi, Sardi, xaxis nacxi, pirnaRebi masa, amokveTili apendiqsi, mezenteriuli limfuri
kvanZebi. baqteriologiuri gamokvlevis mizniT iyeneben petersonisa da kukis meTodikas,
romelic emyareba sakveb masalaSi (steriluri fosfat-marilovani buferi pH-7,4
serovis niadagi da sxva) dabali temperaturis pirobebSi Pfsevdotuberkulozis
gamomwvevebis zrdisunarianobas.
rac Seexeba sisxls, sakveb niadagze misi daTesva ar iZleva hemokulturis miRebis
saSualebas, magram mikrobis gamoyofa xerxdeba cxovelebze.
serologiuri diagnostikisaTvis sargebloben aglutinaciis reaqciiT (ar),
arapirdapiri hemaglutinaciis reaqciiT (aphr). Cveulebriv, mimarTaven wyvili Sratebis
gamokvlevas, romelic tardeba daavadebis dasawyisSi da daavadebis mesame kviras.
reaqcia dadebiTad iTvleba 1:200 da met ganzavebaze, xolo aphr _ 1:100. yvelaze meti
mniSvneloba diagnostikis TvalsazrisiT eniWeba titris zrdas dinamikaSi. amJamad
praqtikaSi gamoiyeneba etalonuri fsevdotuberkulozis cocxali kultura, xolo
autoStamebis SemTxvevaSi mas iyeneben reaqciaSi, rogorc damatebiT antigens. unda
aRiniSnos, rom serologiuri meTodebi ar xasiaTdebian maRali specifikurobiT da
maTi diagnostikuri mniSvneloba ufro daavadebis gvian periodSi vlindeba.
amJamad fsevdotuberkulozuri hi perimunuri Sratebis miRebasTan dakavSirebiT
mowodebulia ramdenime eqspres-meTodika mikrobis antigenis dasadgenad _
imunofluorescenciis arapirdapiri reaqcia (aifr), koaglutinaciis reaqcia (kar),
imunofermentuli analizi (ifa). aRniSnuli reaqciebi iZlevian antigenis dadgenis
saSualebas sxvadasxva biologiur substratSi daavadebis pirvelsave dReebSi.
fsevdotuberkulozis diagnostikaSi aprobirebulia da axlo momavalSi gamoyenebuli
iqneba, agreTve, iseTi Tanamedrove meTodebi, rogoricaa imunoblotingi da polimerazuli
jaWvuri reaqcia (pjr).
diferenciuli diagnostika. diferenciuli diagnostikis gatarebis aucilebloba
damokidebulia fsevdotuberkulozis klinikur formaze. pirvel rigSi saWiroa
gamoiricxos qunTruSa, romlisTvisac damaxasiaTebelia angina mkveTrad hi peremiuli
tonzilebiT, SemosazRvruli hi peremiiT, mTel tanze da kidurebze hi peremiuli kani
wvrilwinwklovani gamonayriT. diferencirebaSi gvexmareba agreTve daavadebis pirvel
periodSi saxsrebis mxriv cvlilebebis ararseboba.
wiTela gansxvavdeba fsevdotuberkulozisagan zemo sasunTqi gzebis mkveTri
kataris arsebobiT rogorc prodromul periodSi, ise gamonayris arsebobis pirvel
dReebSi, agreTve, wiTelas paTognomuri simptomis _ belski-filatov-koplikis laqebis
aRmoCeniT.
revmatiuli infeqciebis dros SedarebiT xSiria miTiTebebi anamnezSi gadatanili
anginebis Sesaxeb, agreTve, cvlilebebi saxsrebis mxriv. periferiul sisxlSi maRali
eds, dadebiTi revmatiuli sinjebi da sxva.
siyviTliT mimdinare fsevdotuberkulozis dros mxedvelobaSi misaRebia virusuli
hepatitisagan misi gansxvavebis aucilebloba. ukanasknelis gamosaricxad mniSvneloba
eniWeba hepatitebis markerebis, momatebuli hepatoceluluri fermentebis dadgenas,
romelic axasiaTebs hepatitebs.
fsevdotuberkulozis mZime mimdinareobis dros saWiroa gamoiricxos sefsisi,
tifur-paratifuri daavadebebi.
sefsisisaTvis damaxasiaTebelia acikluri mimdinareoba, xangrZlivi cxeleba. tifur-
377
kerZo nawili.
paratifuri infeqciebis dros, garda xangrZlivi temperaturuli reaqciisa, yuradRebas

i pyrobs garkveul periodSi rozeolebis arseboba, nervuli sistemis mxriv tifozuri
statusis dadgena da, bolos, baqteriologiuri da serologiuri monacemebi.
siZneleebi iqmneba fsevdotuberkulozis enterovirusul infeqciebTan
diferencirebisas. gamonayari am ukanasknelis dros laqovan-papulur xasiaTs Rebulobs,
romelic xSirad Serwymulia zemo sasunTqi gzebis katarTan, xSirad SesaZlebelia
pirxaxaSi herpesuli gamonayris arseboba, zog SemTxvevaSi adgili aqvs tipur tkivilebs
kunTebSi msxvili nervebis gaswvriv. periferiul sisxlSi aRiniSneba umniSvnelo
cvlilebebi an maT srulebiT ara aqvT adgili.
didi siZneleebi warmoiqmneba apendicitTan fsevdotuberkulozis diferencirebisas,
gansakuTrebiT ki im SemTxvevebSi, roca fsevdotuberkulozuri mezadeniti mimdinareobs
sxva damaxasiaTebeli simptomatikis gareSe. diagnozis dasadgenad saWiroa qirurgis
mier dakvirveba dinamikaSi. zogjer diagnozis dasadgenad mimarTaven laparaskopias.
mkurnaloba. fsevdotuberkulozis mwvave periodis dros aucilebelia woliTi
reJimis dacva temperaturis normalizaciamde da zogadi intoqsikaciis moxsnamde.
raime specialuri dieta naCvenebi ar aris, magram kuW-nawlavis traqtisa da
RviZlis dazianebis SemTxvevaSi saWiroa saTanado koreqciis Setana kvebis reJimSi,
rogorc es gaTvaliswinebulia saerTod.
etiotropuli Terapia. yvelaze kargi Terapiuli efeqti aRiniSneba
qloramfenikolis miRebis dros. karg efeqts iZleva, agreTve, aminoglikozidebi,
cefalosporinebis jgufis antibiotikebi, sulfanilamidebidan _ trimeprim-
sulfametoqsazoli. yvela SemTxvevaSi mkurnalobis xangrZlivoba saSualod 7-10
dRes Seadgens. kursis gaxangrZliveba an meore ciklis daniSvna, sxva antibiotikebiT
Secvla an maTi kombinirebuli miReba araantagonisturi moqmedebis gaTvaliswinebiT
xdeba. etiotropuli preparatebis daniSvna daavadebis 1-2 dRes makupirebel efeqts
iZleva da aCqarebs klinikur gamojanmrTelebas, xolo maTi miReba daavadebis me-4
dRis Semdeg da ufro gvian Tavidan ver gvacilebs recidivebsa da gamwvavebebs.
daavadebis mZime, sefsisuri mimdinareobis dros naCvenebia antibiotikebis daniSvna
kunTebSi an venaSi.
gamoxatuli intoqsikaciis dros naCvenebia dezintoqsikaciuri Terapiis Catareba
_ venaSi reopoliglukini, plazma, albumini, glukozis 10%-iani xsnari, ringeris laqtati,
vitaminebi. yvela avadmyofs eniSneba antihistaminuri preparatebi (dimedroli, suprastini,
diazolini, pi polfeni da sxva). mZime mimdinareobisas iniSneba kortikosteroidebi.
gul-sisxlZarRvTa ukmarisobis dros naCvenebia analefsiuri saSualebebi, sagule
glikozidebi (digitalisis preparatebi _ digoqsini da sxv.). gamoxatuli arTralgiuri
movlenebisas _ indometacini, reopirini.
rekonvalescentis gawera stacionaridan naCvenebia temperaturis normalizebidan
7-10 dRis Semdeg, klinikuri simptomatikis da periferiuli sisxlis maCveneblebis
normalizaciis gaTvaliswinebiT.
fsevdotuberkulozis gadatanis Semdeg bavSvebi organizebul bavSvTa koleqtivebSi
(baRi, skola da sxv.), daiSvebian pediatris meTvalyureobis qveS temperaturis kontroliT,
romelic tardeba 3 kviris ganmavlobaSi gviani recidivebis gamovlenis mizniT. infeqciis
gadatanis Semdeg bavSvebi Tavisufldebian fizikuri datvirTvisagan 3 Tvis ganmavlobaSi.
prognozi keTilsaimedoa.
profilaqtika. profilaqtikuri RonisZiebebidan didi mniSvneloba eniWeba infeqciis
wyarosTan da infeqciis gadamtan faqtorebTan brZolas. upirvelesi mniSvneloba aqvs
mRrRnelebiT, frinvelebiT bostneulisa da xilis inficirebis Tavidan acilebas, arsebiTi
mniSvneloba aqvs deratizaciul RonisZiebebs kvebis obieqtebSi, wyalmomaragebis sistemaSi,
378
kerZo nawili. fsevdotuberkulozi
iersiniuli infeqcia. nawlavTa iersiniozi
mecxoveleobis kompleqsebSi.
kvebiT blokebSi daavadebis afeTqebis dros aucilebelia dezinfeqcia da sanitaruli
damuSaveba.
avadmyofis hospitalizaciis Semdeg tardeba daskvniTi dezinfeqcia.
specifikuri profilaqtika SemuSavebuli ar aris.
nawlavTa iersiniozi
(YERSINIOSIS ENTEROCOLITICA)
iersiniozi warmoadgens mwvave anTroponozul-zoonozur infeqciur daavadebas

alimenturi gadacemis meqanizmiT, romelic mimdinareobs kuW-nawlavis traqtis upiratesi
dazianebiT, procesSi sxvadasxva organoebisa da sistemebis CarTvis tendenciiT da
gamoxatuli toqsikur-alergiuli simptomatikiT.
istoriuli cnobebi. iersiniozis gamomwvevi agentis Sesaxeb pirveli cnobebi
miRebul iqna aSS-Si 1923-1957 wlebSi, rodesac organizmidan gamoyofili iqna baqteriebis
15 Stami, romelic kvalificirebuli iyo, rogorc fsevdotuberkulozis baqteriebis
ati puri formebi. SemdgomSi baqteriebis saxelwodeba icvleboda, sanam ar miiRes
sayovelTaod aRiarebuli saxelwodeba Yersinia enterocolitica. msoflio jandacvis
organizaciis monacemebiT 1966 w. adamianebSi aRwerili iyo mxolod 26 SemTxveva.
amJamad ki daavadeba mudmivad registrirdeba evropis, aziis, amerikisa da afrikis
qveynebSi. iersiniozis SemTxvevebi aRwerilia saqarTveloSic.
etiologia. iersiniozis gamomwvevi _ Y.enterocolitica iseve, rogorc
fsevdotuberkulozisa da Savi Wiris gamomwvevi mikrobebi, miekuTvneba Enterobacte-
riaceae-s ojaxs, iersinias gvars. mikrobi warmoadgens gramuaryofiT Cxirs an
kokobaqterias, romelsac Soltebis aramudmivi ricxvi aqvs. mikrobebi zomiT (1,8-2,7)
X (0,7-0.9) mkm. aqvT moZraobis unari +4 _ +28°C pirobebSi, +37°C-ze ki uZravi
xdebian. mikrobebis kultivireba SeiZleba rogorc Rarib, ise Cveulebriv sakveb niadagebze.
igi fakultaturi aerobia, sporebs da kafsulas ar warmoqmnis.
Y. enterocolitica Seicavs O da H antigenebs. O antigenis agebulebis mixedviT
arCeven 50-ze met serologiur variants. adamianis paTologiaSi mniSvneloba aqvs 0:3,
0:5, 0:8, 0:9 serovariantebs. mikrobebs gaaCniaT nawlavis epiTeliumis zedapirze adheziisa
da kolonizaciis unari Termostabiluri enterotoqsinebis producirebiT. maT aqvT
agreTve invaziisa da ujredSida gamravlebis unari. gamomwvevi ekuTvnis fsiqrofilebs
_ mikrobebi xangrZlivad cocxloben macivris (+4-8°C) pirobebSi, mravldebian
bostneulSi, ZirnayofebSi da sxva sakveb produqtebSi. duRili spobs mikrobebs ramdenime
wamSi, maTze damRupvelad moqmedeben, agreTve, Cveulebrivi sadezinfeqcio xsnarebi in
vitro mikrobebi mgrZnobiareni aRmoCndnen streptomicinis, qloramfenikolis, gentamicinis,
furazolidonis mimarT.
epidemiologia. Y. enterocolitica farTodaa gavrcelebuli bunebaSi. ZiriTad
bunebriv wyaros warmoadgenen mcire zomis mRrRnelebi, romlebic xels uwyoben
infeqciis gavrcelebas cxovelebSi _ msxvil rqosan saqonelSi, RorebSi, ZaRlebSi,
katebSi. rogorc infeqciis wyaro, ufro mniSvnelovania soflis meurneobis cxovelebi,
calkeul SemTxvevebSi _ Sinauri cxovelebi. mikrobebis gamoyofa xdeba rZis
produqtebidan, nayinidan. infeqciis gadacemis umTavres faqtorad iTvleba xorceuli,
bostneuli, rZe da wyali. bavSvebisaTvis am mxriv ufro saSiSia rZe da bostneuli.
iersiniozis dros sakvebis gziT inficireba umTavresi da wamyvania. adgili aqvs,
379
kerZo nawili.
agreTve, sayofacxovrebo gziT inficirebas, romelic xorcieldeba avadmyofTan mWidro

kontaqtisas (inficirebuli xelebi, sayofacxovrebo nivTebi da sxva) ojaxebsa da
stacionarSi. magram avadmyofi da baqteriamtarebeli warmoadgens infeqciis gacilebiT
naklebmniSvnelovan wyaros, vidre dainficirebuli sakvebi.
daavadeba gvxvdeba nebismier asakSi, magram umTavresad avaddebian bavSvebi 3-5
wlamde, maT Soris 2-3 Tvis asakis bavSvebic.
iersiniozs gamoxatuli sezonuroba ar axasiaTebs, magram daavadebis SemTxvevebi
ufro xSiria wlis civ periodSi. infeqcias, upiratesad, sporaduli xasiaTi aqvs,
gansakuTrebiT didi afeTqebebi iSviaTad gvxvdeba.
paTogenezi. iersiniebis SeWra organizmSi xorcieldeba piris Rrudan inficirebuli
sakvebiT, wyliT an kontaqturi gziT. didi mniSvneloba eniWeba infeqtis dozas. kuWis
barieris (pH) gadalaxvis Semdeg mikrobebi xvdebian wvrili nawlavis lorwovan
garsSi, gansakuTrebiT, TeZos nawlavSi, sadac isini mravldebian, SemdgomSi aRiniSneba
destruqciuli movlenebi wvrili nawlavis terminalur nawilSi, apendiqsSi, rac
ganpirobebulia mikrobis enterotoqsigenuri da invaziuri TvisebebiT. iwvevs ra
epiTeliumis daSlas, anTebadi procesi SeiZleba sxvadasxva xarisxiT iyos gamoxatuli
_ dawyebuli kataruli movlenebiT da damTavrebuli wylulovan-nekrozuli procesiT.
infeqciis gavrceleba xdeba regionul limfur kvanZebSi limfuri qsovilis
hi perplaziiT, sadac aRiniSneba nekrozuli kerebi an viTardeba mikroabscesi.
mZime SemTxvevaSi limfuri barieris gadalaxvis Sedegad viTardeba infeqciis
hematogenuri generalizacia anTebadi kerebis CamoyalibebiT sxvadasxva organoSi _
RviZlSi, elenTaSi, filtvebSi, ZvlebSi da a.S.
pirveladi imunuri pasuxi, romelic msgavsia imisa, rac fsevdotuberkulozis dros
leikocitebisa da monocitebis fagocitozis meSveobiT xorcieldeba, SeiZleba damTavrdes
iersiniebis sruli daRupviT (sruli fagocitozi), ramac SeiZleba enterul an regionul
fazaSi daavadebis kupireba gamoiwvios. Tu imunitetis es rgoli damTavrda fagocitozis
arasruli reaqciiT (arasruli fagocitozi), maSin SeiZleba adgili hqondes procesis
gaRrmavebas da infeqciis generalizacias.
zogierTi avtori iersiniozis sxvadasxva infeqciur-alergiul gamovlinebebs,
rogoricaa poli-, monoarTriti, egzanTema, arTralgiebi, reiteris sindromi, gulis
dazianeba da sxva ukavSirebs Y. enterocolitica-s antigenis agebulebis msgavsebas
HLA B27 antigenTan.
operaciuli Carevis Sedegad miRebuli bioftatebisa da autofsiis monacemebis
mixedviT iersiniozis dros morfologiurad dgindeba mezenteriuli limfuri kvanZebis
hi peremia da hi perplazia, wvrili nawlavis distalur nawilSi abscedirebuli
retikulocituri limfadeniti. mZime generalizebuli formis dros adgili aqvs
TeZos nawlavis lorwovani garsis hemoragiul SeSupebas da nekrozs. jorjlis
limfuri kvanZebi gadidebuli da hi perplazirebulia. RviZlsa da elenTaSi gvxvdeba
mravalricxovani wvrili nekrozuli kerebi an abscesebi, saidanac iTeseba iersinia.
imunuri reaqciebis ganviTarebis dadgena xdeba daavadebis me-6-8 dRes, rogorc sxva
infeqciebis dros da gamoixateba sami klasis, rogorc saerTo, ise specifikuri
imunoglobulinebis produqciaSi M klasis imunoglobulinebis upiratesi titriT.
mogvianebiT ki, daavadebis me-2-3 kviras xdeba IgG-ze gadarTva.
gamojansaRebis procesi damokidebulia imunuri pasuxis doneze.
klinika. inkubaciuri periodi 12-15 saaTidan 10 dRemdea, saSualod 7-10 dRes
Seadgens. avtorTa umravlesoba, imisda mixedviT, YTu romeli sindromi Warbobs daavadebis
mimdinareobaSi gamohyofs nawlavTa, abdominur (fsevdoapendikulur) an iliocekaluri
midamos sindroms, iersiniozul hepatits, sefsisur, saxsrovan formas, kvanZovan eriTemas.
380
kerZo nawili.
bavSvebSi yvelaze xSir gamovlinebad iTvleba kuW-nawlavis traqtis dazianeba.

daavadeba iwyeba mwvaved, temperaturis momatebiT 38-39°C-mde. zogjer temperaturis
momatebas adgili aqvs daavadebis me-2-3 dRes. organizmis zogadi intoqsikaciis
movlenebi aRiniSneba daavadebis pirvelsave dReebSi, romelic xasiaTdeba saerTo sisustiT,
modunebiT, madis daqveiTebiT, SemcivnebiT, TavbrusxveviT. avadmyofebs aReniSnebaT Tavis
tkivili, xSirad gulisreva, umravles SemTxvevaSi ganmeorebiTi Rebineba. avadmyofebi
uCivian muclis tkivils marjvena TeZos, Wi pis, epigastriumis midamoSi an mTeli
muclis areSi. mudmiv simptomad iTvleba diarea, romelic daavadebis dawyebidan 6-12
saaTis Semdeg viTardeba. ganavali xdeba Txeli, uxvi, muqi, momwvano feris, qafiani,
myrali sunis, lorwos Semcveli, zogjer naxuloben polimorful leikocitebs, erTeul
eriTrocitebs, nawlavTa fermentaciuli funqciis darRvevis niSnebs.
periferiul sisxlSi adgili aqvs zomier leikocitozs marcxniv gadaxriT, eds
momatebulia. daavadebis xangrZlivoba 5-dan 15 dRemdea.
garda gastroenteritisa da enterokolitis msubuqi formisa, roca faRaraTi
warmoadgens erTaderT simptoms, gvxvdeba agreTve kuW-nawlavis traqtis yvela nawilis
dazianeba, romelic xangrZlivad, (2 kvira da meti) mimdinareobs diareiT, organizmis
gamoxatuli toqsikoz-eqsikoziT, meningealuri movlenebiTa da diareiT. daavadebis
maRali intoqsikaciis fonze muceli zomierad Seberilia. palpaciiT nawlavebis gaswvriv
dgindeba mtkivneuloba da yuryuri, upiratesad TeZosa da brma nawlavis midamoSi.
adgili aqvs RviZlisa da elenTis gadidebas. zog SemTxvevaSi, daavadebis dawyebidan
ramdenime dRis Semdeg enteritis fonze, zogjer ki raime mniSvnelovani dispefsiuri
movlenebis gareSe viTardeba muclis Rrus gaRizianebis simptomebi, “infiltrati”
iliocekalur midamoSi. operaciuli Carevisas, apendicitze eWvis SemTxvevaSi, naxuloben
kataruli, flegmonuri an gangrenuli apendicitis suraTs. zogjer dgindeba mwvave
terminaluri ileiti an ufro vrceli anTebadi procesi TeZos nawlavis da brma
nawlavis nekrozuli movlenebiT.
umravles SemTxvevaSi iersiniozi mimdinareobs msubuqi an saSualo simZimiT. mZime
SemTxvevebSi aRiniSneba tendencia generalizebuli sefsisuri mimdinareobisaken. am
dros zogadi mdgomareoba mZimea. temperatura maRal cifrebs aRwevs. avadmyofebi
aRniSnaven Semcivnebas, Tavisa da saxsrebis tkivils, Rebinebas, gulisrevas, tkivils
ylapvis dros, faRaraTs. daavadebis pirvel kviras (2-7 dRe) Cndeba gamonayari, romelic
qunTruSis an wiTuras gamonayars gavs. gamonayars SeiZleba polimorfuli xasiaTi
hqondes. igi didxans rCeba da xSirad saxsrebis irgvlivaa gamoxatuli. gamonayari
iqercleba da tovebs pigmentacias. xSirad gadidebulia RviZli da elenTa.
gamoxatuli sefsisuri formis dros temperaturis meryeoba 2-3 gradusamdea. es
forma am bolo dros xSirad gvxvdeba, rogorc bavSvebSi, aseve mozrdilebSi, romelTac
aReniSnebaT sxvadasxva mZime Tanmxlebi daavadebis (mag: Saqriani diabeti da sxva)
SemTxvevebi. sefsisur mimdinareobaSi arCeven or formas _ mwvave da qvemwvave. mwvave
mimdinareobis dros aRiniSneba sasunTqi da gul-sisxlZarRvTa sistemebis dazianeba,
RviZli da elenTa gadidebulia. avadmyofTa nawils aqvs kanze gamonayari, arTriti,
diarea. periferiul sisxlis suraTSi _ dabali hemoglobini, maRali neitrofolozi
marcxniv gadaxriT, leikocitozi (20-25 109/l) eds 60-80 mm/sT aRwevs.
sisxlidan, Sardidan, ganavlidan, xaxis lorwovanidan iTeseba Y. enterocolitica.
sefsisis qvemwvave mimdinareobis dros baqteriemia SeiZleba SeumCneveli darCes. es
forma ufro lokaluri dazianebiT xasiaTdeba: RviZlis abscesi, peritoniti, osteomieliti
da a.S. qvemwvave mimdinareoba xSirad cudi gamosavliT mTavrdeba.
fsevdoapendikuluri forma an marjvena TeZos midamos sindromi ufro
xSirad gvxvdeba bavSvebSi wlis asakis zemoT. es forma warmodgenilia apendicitis,
381
kerZo nawili.
mezadenitisa da terminaluri ileitis suraTiT. am dros temperatura 38-40°C-mde

matulobs, avadmyofebi uCivian saerTo sisustes, umadobas, gulisrevas, Rebinebas, Tavis
tkivils, movliTi xasiaTis tkivils mucelSi, romelic ufro Wi pis irgvliv an
iliocekalur midamoSi AaRiniSneba.
moismineba wvrili nawlavebis gaswvriv yuryuri, SesaZloa muclis faris gaRizianebis
simptomatika. am fonze adgili aqvs xanmokle faRaraTs an yabzobas, saxsrebis tkivils,
zemo sasunTqi gzebis katars. sisxlis mxriv damaxasiaTebelia leikocitozi,
neitrofilozi marcxniv gadaxriT, momatebuli eds. apendicitze eWvis dros qirurgiuli
Carevisas adgenen katarul an gangrenul apendicits an ufro xSirad, mezadenits,
agreTve anTebiT process TeZos nawlavis terminalur nawilSi. amokveTili apendiqsidan
xSirad iTeseba Y. enterocolitica.
iersiniozuli hepatiti viTardeba gastroenteritis movlenebTan erTad an nawlavTa
disfunqciidan 2-3 dRis Semdeg, romlis genezic toqsikuria. avadmyofebi uCivian
simZimes an tkivils marjvena ferdqveSa midamoSi, zogjer kanis qavils. viTardeba
sklerebisa da kanis siyviTle, Sardis gamuqeba, aqolia. RviZli gadidebulia da mtkivneuli.
sisxlSi aRiniSneba pirdapiri bilirubinis donis momateba. sayuradReboa, rom
mxedvelobaSi unda iqnas miRebuli hepatoceluluri fermentebis done, virusuli
hepatitis markerebi. zogjer viTardeba RviZlis abscesic.
kvanZovani forma (Erythema nodosa) upiratesad gvxvdeba bavSvebSi 10 wlis
asakis Semdeg. garda organizmis zogadi intoqsikaciisa, damaxasiaTebelia gamonayari
wvivebze, mtkivneuli movardisfro- cianozuri elferis kvanZebi, romelic SeiZleba 4-
22 dRe SeiniSnebodes. revmatiuli etiologiis kvanZebisagan gansxvavebiT igi ufro
adre qreba.
saxsrovani forma daavadebis dasawyiSi vlindeba temperaturis momatebiT, diareiT,
me-5-20 dRes ki viTardeba saxsrebis mxriv movlenebi _ arTriti, poliarTriti.
procesSi ZiriTadad CaTreulia muxlisa da idayvis saxsrebi, amasTan unda aRiniSnos,
rom saxsrebi garegnulad ucvlelia. daavadebis es forma ufro xSirad 10 wlis
Semdgom asakSi gvxvdeba.
iersiniozi mcire asakis bavSvebSi. 3 wlamde asakSi daavadeba ufro kuW-
nawlavis traqtis dazianebiT mimdinareobs _ gastritis, gastoenterokolitis saxiT.
mozrdilebTan SedarebiT intoqsikaciis movlenebi _ xSiri Rebineba, faRaraTi,
dehidratacia mkveTradaa gamoxatuli, gansakuTrebiT wlamde asakis bavSvebSi.
diagnozi eyrdnoba klinikur-epidemiologiur da, gansakuTrebiT, laboratoriul
monacemebs.
klinikuri diagnozis dasmaSi gvexmareba simptomebis erToblioba, pirvel rigSi,
movlenebi kuW-nawlavis traqtis mxriv, SemdgomSi egzanTemebis ganviTareba, romelic
upiratesad ganlagebulia saxsrebis irgvliv, RviZlisa da elenTis gadideba. gvexmareba
agreTve cvlilebebi periferiul sisxlSi.
didi mniSvneloba eniWeba epidanamnezs, gansakuTrebiT daavadebis jgufur SemTxvevebSi.
daavadebis diagnostikaSi gadamwyveti roli ekuTvnis baqteriologiur da
serologiur meTodebs. daTesvas eqvemdebareba ganavali, sisxli, Sardi, Tav-zurgtvinis
siTxe, nacxi xaxis lorwovani garsidan, gamonadeni Tvalebidan da a.S., operaciis dros
amikveTili limfuri kvanZi, Wianawlavi. mikrobebis gamoyofa SeiZleba daavadebis pirvel
2 kviras, zogjer 4 Tvemde. daavadebis saxsrovani da kanis formebis dros baqteriuli
dadastureba iSviaTia.
iersiniozuli antisxeulebis dadgena, Cveulebriv, 7-14 dRis ganmavlobaSi xdeba.
dinamikaSi antisxeulebis titris mateba adasturebs serologiuri monacemebis
specifikurobas.
382
kerZo nawili.
serologiur reaqciebad xmaroben aglutinaciis reaqcias (ar) da arapirdapiri

hemaglutinaciis reaqcias (aphr). pirvelisaTvis diagnostikur titrad iTvleba 1:80
da meti, xolo meores dros _ 1:160 da zeviT ganzaveba. pirveli serologiuri
gamokvleva tardeba daavadebis pirvel, ganmeorebiTi ki _ me-3 kviras. aglutinaciis
maqsimaluri titri klebulobs 2 Tvis ganmavlobaSi, mcire asakSi antisxeulebis
titri ufro naklebia mozrdilebTan SedarebiT, amitom gadamwyveti mniSvneloba aqvs
mis gansazRvras dinamikaSi. eqspres-diagnostikisaTvis iyeneben aphr-s antisxeulebis
diagnostikumebiT, komplementSemboWav reaqcias, imunofermentul analizs, arapirdapiri
imunofluorescenciis reaqcias, antigen-gamomwvevis gamovlinebis meTods. iersiniozis
diagnostikaSi garkveuli mniSvneloba aqvs biofsirebuli limfuri kvanZebisa da sxva
organoebis histologiur gamokvlevas.
diferenciuli diagnostikis Catarebis aucilebloba damokidebulia imaze, Tu
ra klinikur formebTan gvaqvs saqme. pirvel rigSi, saWiroa diferencireba nawlavTa
mwvave infeqciebisagan, fsevdotuberkulozis, qunTruSas, wiTelas, enterovirusuli
infeqciis, revmatizmis, sefsisisagan.
mkurnaloba. daavadebis msubuqi mimdinareobisas mkurnaloba tardeba saxlis
pirobebSi. hospitalizacia aucilebelia mZimed mimdinare formebis SemTxvevaSi. saTanado
dietis dacva saWiroa kuW-nawlavis, abdominuri da hepatitiT mimdinare formebis
dros.
etiologiuri Terapia tardeba, pirvel rigSi, qloramfenikoliT 6-7 dRiani
kursiT asakobrivi dozebis gaTvaliswinebiT. misi uefeqtobis SemTxvevaSi ki eniSneba
gentamicini parenterulad 7-10 dRis ganmavlobaSi asakobrivi dozebiT. sefsisuri
mimdinareobisas rekomendebulia ori antibiotikis kombinirebuli daniSvna
(aminoglikozidebi plus cefalosporinebi, fluoroqinolonebi an iseTi preparatebi,
rogoricaa rifampini (rifampicini), trimetoprim-sulfametoqsazoli).
simptomuri Terapiis mizniT saSualo da mZime mimdinareobisas avadmyofebs
eniSnebaT sadezintoqsikacio da sarehidratacio saSualebebi, antihistaminuri preparatebi,
vitaminebi.
arTritebisa da kvanZovani eriTemis dros antibiotikebi naklebefeqturia, saWiroa
antirevmatiuli da zogjer (SezRudulia) kortikosteroiduli preparatebis daniSvna.
apendicitis, abscesis da osteomielitis dros naCvenebia qirurgiuli Careva.
profilaqtika x o r c i e l d e b a k o m p l e q s u r i s a S u a l e b e b i T , r o g o r c
fsevdotuberkulozis dros. specifikuri profilaqtika SemuSavebuli ar aris.
383
kerZo nawili. baqteriuli dizenteria
baqteriuli dizenteria
dizenteria warmoadgens Sigelas gvaris mikrobebiT gamowveul zogad infeqciur

daavadebas, romelic xasiaTdeba saerTo intoqsikaciiT, temperaturis momatebiT, msxvili
nawlavis, upiratesad, distaluri nawilis dazianebiT, sisxliani diareiT.
termini dysenteria (berZnulad dis - darRveva, aSliloba, enteron - nawlavi)
SemoiRo jer kidev hi pokratem, romelic nawlavTa daavadebebs or ti pad hyofda:
Cveulebrivi faRaraTiT mimdinare da FfaRaraTiTa da muclis tkiviliT mimdinare. am
mxriv sayuradReboa Cv. w. aR-mde pirvel saukuneSi areTeosis mier daavadebis
dawvrilebiTi aRwera @`WinTviTi faRaraTis” saxelwodebiT.
istoriuli cnobebi: dizenteriis mikrobebis pirveli aRwera ekuTvnis F.
Chantemesse da F. Widal-s (1888), F\C\ Hftdcrbq-s (1875) G\Y\ Re,fcjd-s
(1889). 1891 wels F\D\ Uhbujhmtd-ma dizenteriiT daRupuli adamianis organoebidan
gamohyo gramuaryofiTi mikrobi da eqsperimentulad Seiswavla misi morfologiuri
da paTogenuri Tvisebebi. 1898 wels iaponelma mecnierma K. Shiga-m dawvrilebiT
aRwera baqteriis Tvisebebi. SemdgomSi aRwerili iyo sxva dizenteriuli mikrobebi,
romlebic morfologiurad axlos dganan qvemoT naxseneb mikrobebTan, magram gansxvavdebian
fermentuli aqtivobiTa da antigenuri struqturiT. am mikrobebma saxelwodeba TavianTi
aRmomCenelebis mixedviT miiRes - C. Flexner (1906), V\B\ Inewth (1916) K. Schmitz
(1916), C. Sonne (1915) F.H. Clayton da S.H. Warren (1929), I.S. Boydii (1932).
etiologia: dizenteriis gamomwvevi mikrobebi miekuTvnebian Enterobacteriaceae-
s ojaxs, Shigella-s gvars. Tavis mxriv es ukanaskneli bioqimiuri da antigenuri
Tvisebebis gaTvaliswinebiT iyofa 4 jgufad: A (S. disenteriae), B (S. flexneri), C
(S. boydii), D (S. sonnei)..
Sigelebis klasifikacia dawvrilebiT warmodgenilia cxrilSi.
Sigelebis gvaris klasifikacia
Semoklebuli
qvej gufi saxeoba serotipi qveserotipi antigenuri
formula
A S. dysenteriae 1-12 -
B S. flexneri* 1 1a I : 4
1b I : 6 * S. flexneri 5
2 2a II : 3,4... gvxvdeba ori
2b II : 7,8... qveserovaris saxiT: 5a
3 3a III : 6,7,8...
(V:4) d a 5b (V:7).
SeniSvna: serovari da
3b III : 3,4,6...
qveserovari aRiniSneba
3c III : 6…
arabuli cifrebiT, magram
4 4a IV : 3,4...
ukanasknelT emateba
4b IV : 6...
patara laTinuri asoebi
5 * V : 7,8... ( a,b a n c).
). t i p u r i
6 - VI :- antigenebi aRiniSneba
X_variant - - :7,8… romauli cifrebiT ((I_VI
I_VI ),
I_VI),
Y_variant - -:3,4 xolo jgufebis
C S. boydii 1-18 - antigenebi arabuli
D S. sonnei - - cifrebiT (3,4,6,7,8).
384
amJamad cnobilia dizenteriis Cxirebis serologiuri variantebis 50-mde

gansxvavebuli nairsaxeoba. A jgufSi 12 seroti pia, B-Si 6 serotipi da 13 qveserotipi,
C-Si _ 18 seroti pi, D-Si _ 1 seroti pi. saerTaSoriso klasifikaciis Tanaxmad, adre
cnobili grigoriev-Sigas saxeoba miekuTvneba Shigella dysenteriae-s serovar 1-s,
Stutcer-Smitcis - S. dysenteriae-s serovar 2-s, larj-saqsis - S. dysenteriae-s
serovar 3-7. qvesaxeoba niukastli - S. flexneri-s serovar 6-s.
Sigelebi warmoadgens uZrav Cxirebs, romelTa zoma (0,3-0,6)X(1,0-3,0) mkm-ia,
momrgvalebuli boloebiT. igi gramuaryofiTia, kafsulebsa da sporebs ar warmoqmnis.
Sigelebi mravldebian Cveulebriv sakveb niadagebze.
Sigelebis virulentoba gamoixateba nawlavis epiTeliuri ujredebis invazirebis
unarSi. aseTi SesaZleblobebi kodirebulia baqteriis did (120-140 MD) plazmidSi.
plazmidi awarmoebs poli peptidebis sinTezs, romlebic ganapirobeben ujredSi baqteriis
invaziasa da mis ganadgurebas. plazmid-dakarguli baqteria kargavs Tavis virulentobas.
E. coli, romelic Seicavs msgavss plazmids, avlens Sigelas Tvisebebs. Sigelas qromosomuli
faqtorebi avseben baqteriis virulentul Tvisebebs. baqteriis qromosoma pasuxismgebelia
li popolisaqaridebis (endotoqsinebis) sinTesze yvela SigelaSi da agreTve zogierT
SigelaSi _ egzotoqsinis (Sigas toqsinis) sinTezzec. Sigas toqsini iwvevs nawlavis
epiTeliuri ujredis cilis sinTezis inhibirebas, klavs mas da iwvevs sisxlian
diareas, Tumca misi roli bolomde axsnili ar aris.
sainteresoa, rom Shigella Enterotoxin1 ((ShET-1)) kodirebulia qromosomiT, xolo
ShET-2 _ virulentobis plazmidiT. orive zemoaRniSnuli enterotoqsini iwvevs
wylisebr diareas, xolo Sigas toqsinTan erTad _ dizenteriis mTel simptomkompleqss.
dizenteriis mikrobebis rogorc bioqimiuri, ise antigenuri Tvisebebi aramdgradia,
rac vlindeba sxvadasxva pirobebis zegavlenis dros maTi cvlilebebiT. am mxriv
gansakuTrebul yuradRebas i pyrobs im Stamebis zrda, romlebic xasiaTdeba qimiuri
preparatebisa da antibiotikebis mimarT mdgradi rezistentobiT da xSirad
polirezistentobiTac, rac did siZneleebs uqmnis daavadebis specifikur mkurnalobas.
dizenteriis Cxirebi swrafad iRupeba mzis sxivebis pirdapiri moqmedebiT, 600 C-
ze _ 30wT-is ganmavlobaSi, 1000 C-ze ki - maSinve. Cveulebrivi koncentraciebis
sadezinfeqcio xsnarebSi (hi poqloritebi, qloramini, lizoli) Cxirebi iRupebian
ramdenime wuTSi, xolo xelsayreli pirobebis SemTxvevaSi (sibnele, zomieri temperatura,
sinotive da sxva), Ramis sacvlebze, Ramis qoTanze sicocxles inarCuneben kviraobiTa
da TveobiT, sakveb produqtebze - 15-30 dRe, xolo wyalSi - 9 dRemde.
epidemi
epidemio ologia: Sigelozi tipuri fekalur-oraluri infeqciaa. infeqciis wyaros
warmoadgens avadmyofi yovelgvari klinikuri gamovlinebiT, maT Soris baqteriamtarebeli.
Sigelozi msoflioSi gavrcelebuli daavadebaa da mis mimarT mimRebloba yvela
asakSi aRiniSneba. ufro xSirad avaddebian 1 wlidan 6 wlamde asakis bavSvebi. skolamdel
asakze modis daavadebis SemTxvevaTa 1/3.
infeqciis wyaros warmoadgens avadmyofi da baqteriamtarebeli. mwvave mimdinareobisas
daavadebis pirvel sam dRes baqteriebis raodenoba 1g ganavalSi aRwevs 106 mikrobul
erTeuls, maSin roca S. dysenteriae-1 -1 seroti pis dasnebovnebis minimaluri doza
Seadgens 10 baqterias, S. Flexner-iT 102-s, S. sonnei-T 107-s, qoleris gamosawvevad
ki _ saWiroa 108 _1010 mikroorganizmi. amiT aixsneba, rom dizenteriis kontagiozuroba
qoleraze ufro maRalia.
miuxedavad imisa, rom infeqciis gadacemis meqanizmi erTia _ fekalur-oraluri da
yvela SemTxvevaSi adgili aqvs janmrTeli adamianis piris RruSi infeqtis moxvedras,
misi gadacemis gza rTuli da mravalmxrivia. amis dasturia epidemiologiuri gamokvlevebi,
romelTa saSualebiTac dadginda infeqciis gadacemis sami ZiriTadi gza dizenteriuli
385
mikrobebis qvejgufebis Tvisebebis gaTvaliswinebiT. ase mag., S. dysenteriae-sTvis

gavrcelebis ZiriTad gzad iTvleba sayofacxovrebo - kontaqturi gza, rac ufro
xSiria skolamdeli asakis bavSvebSi (avadmyofebma an mtarebelma SeiZleba gaWuWyianebuli
xelebiT daainficiron sxvadasxva nivTebi, WurWeli, saTamaSoebi, karis saxelurebi da
sxva).
es gza upiratesad ganapirobebs sporadul SemTxvevebs, iSviaTad - jgufurs. S.
flexner-iT dasnebovnebaSi xSirad wamyvania wylis faqtori, rac upiratesad daavadebis
epidemiur afeTqebebs iwvevs. S. sonnei ZiriTadad sakvebi produqtebis (araJani, xaWo,
laba, paSteti, bostneuli, xili, wvenebi da sxva) dainficirebis Sedegad vrceldeba.
daavadeba xSirad jgufur xasiaTs iRebs, rasac adgili ufro metad aqvs mWidro
koleqtivebSi, e.w. daxurul dawesebulebebSi (baga-baRi, yazarma da sxva).
epidemiis ganviTarebaSi didi roli eniWeba socialur-sayofacxovrebo da bunebriv
faqtorebsac, aradamakmayofilebel sanitarul mdgomareobas, dabal higienur kulturas.
sezonuroba: daavadeba mTeli wlis ganmavlobaSi gvxvdeba, magram misi maRali
maCveneblebi zafxul-Semodgomis periodze modis, rasac xels uwyobs kvebis xasiaTis
Secvla, infeqciis ganviTarebisaTvis optimaluri pirobebis arseboba (garemos temperatura,
sinotive da sxva) produqtebis damzadebisa da Senaxvis wesebis darRveva.
XX saukunis manZilze mkafiod gamovlinda Sigelozis etiologiuri struqturis
kanonzomieri cvlilebebi: Tu saukunis 20-ian wlebSi gamomwvevi upiratesad grigoriev-
Sigas mikrobi (50-80%) iyo, 40-ianAwlebSi S. Flexneri (evropaSi 60-80%), 60-ian
wlebSi ki rogorc evropaSi, ise sabWoTa respublikebSi - S.sonnei, Tumca mTel rig
respublikebSi, maT Soris saqarTveloSi axlac aRiniSneba S. flexneri-iT gamowveuli
dizenteriis arseboba.
paTogenezi: mikrobis SeWra organizmSi mxolod peroralurad xdeba. daavadebis
ganviTarebaSi didi roli eniWeba mTel rig faqtorebs: mainficirebeli dozis raodenobas,
adgilobriv (kuW-nawlavis traqtis) imunitets, saerTo imunuri statusis mdgomareobas.
kuWSi moxvedril mikrobebs garkveuli winaaRmdegobebi xvdeba: sxvadasxva
proteolizuri fermentebi, mJave are, sekreciuli imunoglobulinebi da antagonisturi
flora. mikrobebis daSla grZeldeba wvril da msxvil nawlavebSi saWmlis momnelebeli
wvenebis moqmedebiT. daavadeba viTardebaPmxolod nawlavis epiTeliumSi mikrobis
SeWris Sedegad. mikrobis daSlis Semdeg warmoqmnili toqsinebi sisxlSiPSeiwoveba
(SesaZloa ganviTardes xanmokle baqteriemia, magram daavadebis paTogenezSi mas raime
mniSvneloba ar eniWeba) da gamoixateba zogadiPintoqsikaciis movlenebi, rac iwvevs
klinikuri niSnebis gamovlinebas. aRsaniSnavia amerikeli avtorebis Sheldon L.
Kaplan, Ralph D. Feigin (1995) azri: isini Tvlian, rom mcire asakis bavSvebSi,
romelTac aReniSnebaT dizenteriis mZime mimdinareoba, sikvdilianobis 50% Sigelur
baqteriemiasTanaa dakavSirebuli. toqsinebis neitralizacia da eliminacia xdeba ara
marto RviZlisa da Tirkmlebis meSveobiT, aramed msxvili nawlavis lorwovani
garsebiTac,Prac iwvevs am ukanasknelSi intramuruli nervuli gangliebis dazianebas,
nawlavis kedlis sisxlZarRvTaPganvladobis momatebas, lorwovanis SeSupebas,
sensibilizacias, anTebadi procesis ganviTarebas. darCenili mikrobebi sakvebTan erTad
kuWidan wvril nawlavebSi xvdeba, sadac ramdenime dRe rCeba da Semdeg msxvil nawlavSi
gadadis da sabolood am ukanasknelis lorwovanis epiTeliumSi SeaRwevs. aq xdeba
maTi invazia, replikacia da didi raodenobiT daSla. Sigelebis gamravleba SeiZleba
erTdroulad xdebodes Lamina propria-s lorwqveSa fenis epiTeliumSi. procesis
Semdgomi aqtiuroba damokidebulia Sigelebis invaziurobaze, fermentebis aqtivobaze,
makrofagebis funqciis daTrgunvaze da sxv. mikrobebis umravlesoba fagocitirdeba
neitrofilebisa da makrofagebis mier ujredebis bazaluri membranis doneze. arsebobs
386
mosazreba imis Sesaxeb, rom Sigelebis ujredSida parazitireba mniSvnelovan paTogenezur

rols TamaSobs SigelebiT gamowveuli yvela infeqciis dros, Tumca am azrs yvela ar
iziarebs.
wvril nawlavSi Sigelebi gamoyofen enterotoqsinebs. egzotoqsinis roli
paTogenezSi mTlianad cnobili ar aris.
Tvlian, rom enterocitebze Sigelebis enterotoqsinebis moqmedebis Sedegia
epiTeliumis membranaSi Semcveli fermentis adenilatciklazis gaaqtiureba, romelic
akatalizebs atf-is daSlas ciklur adenozinmonofosfatamde (c-amf). ujredSi c-
amf-isa da, SesaZloa, prostaglandinebis momateba xels uwyobs wylisa da eleqtrolitebis
gamoZevebas ujredidan, rac nawlavTa yvela mwvave infeqciis dros, maT Soris dizenteriis
drosac, diareuli sindromis ganviTarebaSi wamyvani meqanizmis rols TamaSobs.
dizenteriis mZime mimdinareoba gamomwvevi agentis saxeobiTac ganisazRvreba. yvelaze
ufro toqsikuri formebi ganpirobebulia grigoriev-Sigasa da fleqsneris StamebiT.
rac Seexeba S. sonnei-s, maT mier gamowveuli klinikuri suraTi xSirad mimdinareobs
daavadebis dasawyisSi kvebiTi toqsikoinfeqciisaTvis damaxasiaTebeli manifestaciiT,
Semdeg ki dizenteriisaTvis damaxasiaTebeli klinikiT.
toqsikuri komponentis (egzo-endotoqsinebis) moqmedeba vrceldeba, gul-sisxlZarRvTa
da nervul sistemaze, vegetatiur centrebze, kuW-nawlavis traqtze, viscerul organoebze
- RviZlze, kuWqveSa jirkvalze da a.S., rac iwvevs maTi funqciuri da morfologiuri
suraTis darRvevas.
mcire asakis bavSvebSi dizenteriis mimdinareobis Taviseburi gamovlinebaa
adgilobrivi procesis susti ganviTareba da pirveladi intoqsikaciis mZafri suraTis
manifestacia, rasac Tan axlavs nivTierebaTa cvlis swrafi darRveva. daavadebis
hi pertoqsikuri formebis dros letaluri gamosavali SeiZleba ganviTardes daavadebis
pirvelsave dReebSi, jer kidev maSin, roca lokaluri movlenebi ver aswrebs gamovlinebas.
dasustebul bavSvebSi (umTavresad wlamde asakSi), romelTac aReniSnebaT Tanmxlebi
daavadebebi xSirad viTardeba daavadebis gaxangrZlivebuli persistuli mimdinareoba.
qronikuli mimdinareobis formirebas xels uwyobs re- da superinfeqciebi.
klinikur-imunologiuri gamokvlevebis Sedegad dadgenilia, rom dasustebul bavSvebSi
saSiSi simptomebis Camoyalibeba xdeba TandaTanobiT, rac ganpirobebulia imunuri
reaqtiulobis `dambliT~ (a. xoWava, b. didebuliZe, k. petriaSvili, m. xoWava).
infeqciis SeWris Semdeg ramodenime dReSi an kviraSi aRiniSneba sekreciuli IgA
(i. SalamberiZe) da Sratismieri antisxeulebis produqcia. dadgenilia, rom arsebobs
antili polisaqariduli da antivirulentuli, anti plazmiduri antisxeulebi, Tumca
maTi roli imunitetSi gaurkvevelia. imuniteti xanmoklea da ti purspecifikuri.
paTmorfologiuri suraTi. dizenteriuli procesisaTvis upiratesad
damaxasiaTebelia msxvili nawlavis distaluri nawilis dazianeba. mZime formebis
dros procesSi mTlianad CarTulia msxvili nawlavi da 35% SemTxvevaSi _ mosazRvre
wvrili nawlavi (Cnherjd).
arCeven dazianebis Semdeg saxeebs: kataruls, folikulurs, krupozuls da
difTeriuls.
katarul
kataruli i formis dros lorwovani garsebi hi peremiuli, SeSupebuli da advilad
sisxlmdenia, aRiniSneba wvrilwertilovani sisxlCaqcevebi, zogjer wvrili eroziebi.
morfologiurad vlindeba sisxlZarRvTa ganvladobis momateba, lorwovani garsisa da
lorwqveSa fenis mrgvalujredovani infiltracia (neitrofiluri leikocitebiT,
limfocitebiTa da erTeuli plazmuri ujredebiT), nawlavis sanaTurSi momatebulia
lorwos eqsudacia. eqsudati Sedgeba lorwosagan, desqvamirebuli da danekrozebuli
epiTelisagan, leikocitebisa da erTeuli eriTrocitebisagan, lorwo mRvriea da Cirqovani.
387
iersiniuli infeqcia
folikuluri forma viTardeba kataruli anTebiTi procesis fonze, sadac adgili

aqvs solituri folikulebis anTebad hi perplazias, romelTa garSemo Cans irgvliv -
anTebadi zona. folikulebis da centraluri danekrozebisa da misi desqvamaciis
Sedegia wylulebis warmoSoba.
krupozuli anTebis dros wylulovan cvlilebebs emateba fibrinuli nadebi,
romelic Sedgeba danekrozebuli qsovilisa da fibrinisagan.
difteriul anTebas, krupozulisgan gansxvavebiT, axasiaTebs ufro Rrma gavrceleba,
kerZod serozuli garsebis CaTvliT. am dros nawlavis kedeli gasqelebuli da
gamsxvilebulia, mTeli lorwovani garsi gaJRenTilia sisxliT, vrceli, mkrTali
monacisfro-WuWyisferi fibrinuli nadebiT. SesaZlebelia ganviTardes peritonizmi,
rac gamowveulia anTebadi eqsudatis gaJonviT serozul garsebSi (muclis tifisgan
gansxvavebiT, nawlavis dazianebis dros ar xdeba misi perforacia). procesis
ukuganviTarebis Sedegad Cndeba wylulebi, romlebic ufro xSirad zedapiruli da
mkvrivkideebiania.
kataruli anTebis dros regeneraciuli procesi me-2-3 dRes iwyeba. misi mTliani
morfo-funqciuri aRdgena rogorc msubuqi, ise mZime formebis dros xdeba daavadebidan
me-4-5 kviras. destruqciuli cvlilebebis dros ki regeneracia Zalian nela mimdinareobs,
didxans rCeba anTebiTi cvlilebebi, kri ptebis deformacia da lorwovani garsebis
ubnebis atrofia.
garda nawlavis aRniSnuli damaxasiaTebeli cvlilebebisa, distrofiuli movlenebi
sxva Sinagan organoebSic gvxvdeba.
klinikuri mimdinareoba. dizenteriis inkubaciuri periodi ramodenime saaTidan
7 dRemde grZeldeba (umetesad 2-3 dRe) da damokidebulia inficirebis dozasa da
infeqtis gadatanis faqtorebze. daavadebis klinikuri gamovlineba mravalferovania
da ganpirobebulia mravali faqtoriT: pirvel rigSi organizmis saerTo reaqtiulobiT,
premorbiduli foniT, avadmyofis asakiT, Sigelebis saxeobiT. ZiriTadi klinikuri
suraTi moicavs zogadi intoqsikaciis, dehidrataciis movlenebsa da kolitur sindroms.
sayuradReboa daavadebis gamovlineba mcire asakis bavSvebSi, romlebSic wina planze
dgas intoqsikaciis manifestacia, nivTierebaTa cvlis swrafi moSla, nawlavTa mxriv ki
- simptomatikis ufro susti ganviTareba.
ti pur
puri i dizenteria SeiZleba iyos msubuqi, saSualo simZimisa da mZime formis.
daavadeba, rogorc wesi, iwyeba mwvaved, temperaturis momatebiT subfebriluri
ricxvebidan 39-400 C-mde da zogjer metadac. xSirad aRiniSneba gulisreva an ganmeorebiTi
Rebineba, bavSvebi uars amboben sakvebze, erRvevaT Zili, uCivian Tavis tkivils, SeteviTi
xasiaTis tkivils muclis areSi garkveuli lokalizaciis gareSe.
msubuqi mimdinareobis dros saerTo mdgomareoba damakmayofilebelia. temperatura
normaluri an subfebriluria, iSviaTad aRwevs 380C-s. defekaciis sixSire dReRameSi
3-4-s ar aRemateba, inarCunebs ganavlovan xasiaTs, magram momwvano fers Rebulobs.
paTologiuri minarevebi umniSvneloa, damaxasiaTebelia sfinqteriti.
saSualo simZimis SemTxvevaSi zogadi intoqsikaciis movlenebi zomieradaa
gamoxatuli. temperatura 38-390 C-s, xolo defekaciis sixSire 15-20 aRwevs. ganavali
Seicavs lorwosa da sisxls, romelic warmodgenilia lorwoze Zafiseburi zonrebis
saxiT an Sereulia masSi. me-2-3 dRes ukve garkveulad vlindeba diarea, rac defekaciis
gaxSirebiT gamoixateba. dasawyisSi ganavali Cveulebrivi konsistenciisa, Semdgom saaTebsa
da dReebSi ki xdeba Txeli, raodenobrivad mcire, momwvano feris, lorwosa da xSirad
sisxlis Semcveli. xSirad ganavali mxolod lorwosa da sisxlisagan Sedgeba (sisxlian-
lorwoiani `nafurTxi~). daavadebis am periodSi bavSvebi uCivian muclis uwyvet
araintensiur tkivils, sigmoiduri kolinjisa da anusis midamoSi tkivils. tenezmi
388
baqteriuli dizenteria
dizenteriis damaxasiaTebeli niSania, romelic

viTardeba sigmisa da anusis sfinqteris spazmis
Sedegad.
mZime SemTxvevaSi Zlieri WinTvis dros
SesaZloa ganviTardes swori nawlavis
lorwovani garsis gamovardna (prolapsus recti)
an aRiniSnos swori nawlavis parezi anusis
RiaobiT, rac ganapirobebs uneblie defekacias;
avadmyofs ganavali epareba an xangrZlivad
gamoedineba. yovel defekacias, rogorc wesi,
win uswrebs muclis tkivili, defekacia ar
iwvevs dakmayofilebis grZnobas, avadmyofi
didxans ganagrZobs qoTanze jdomas.
damaxasiaTebeli sisxlian-lorwoiani
muclis Rrus palpaciiT isinjeba tonurad
ganavali
daWimuli, infiltrirebuli, mcired moZravi, (Í.È. Íèñåâè÷, Â.Ô. Ó÷àéêèí)
mkveTrad mtkivneuli sigmoiduri kolinji. mZime
SemTxvevaSi msxvili nawlavis mTel sigrZeze aRiniSneba mtkivneuli daWimuloba, zogjer
muclis faris gaRizianebis niSnebi. muclis palpaciam SeiZleba gamoiwvios defekaciis
survilis provocireba.
Sigeluri baqteriemia viTardeba Zalze iSviaTad da mxolod mZime malnutriiciis
dros.
hi pertoqsikur
pertoqsikuri i fo rmebis dros daavadebis pirvel saaTebSi avadmyofis zogadi
formebis
mdgomareoba mZimea, rasac ZiriTadad ganapirobebs centraluri nervuli sistemis
dazianeba - e.w. meningoencefalituri sindromi mimdinare tvinis SeSupebiT, letaluri
toqsikuri encefalopaTia anu Ekiri-s sindromis paTogenezi srulyofilad axsnili
ar aris. avadmyofebs aReniSnebaT gonebis dabindva an sruli dakargva, seriuli tonur-
klonuri xasiaTis krunCxvebi, gul-sisxlZarRvTa mwvave ukmarisoba, infeqciur-toqsikuri
Soki. kolituri sindromi viTardeba daavadebis meore-mesame dRes. SesaZloa avadmyofi
mokvdes pirvelsave dReebSi, vidre gamovlindeba kolituri sindromi.
adre am klinikis Camoyalibeba miewereboda Sigas toqsiniT gamowveul neirotoqsikozs
mimdinare maRali sicxiT, magram Tanamedrove SexedulebiT (Henry G. Gomez, Tomas
G. Cleary), aseTi axsna swori ar unda iyos. zogjer krunCxva aRiniSneba dabali
temperaturis dros (rac laparakobs imaze, rom febriluri komponenti aq ar figurirebs).
krunCxvas agreTve iwvevs hi pokalciemia da/an hi ponatriemia. Tav-zurgtvinis siTxeSi
SeiZleba vnaxoT minimaluri pleocitozi da cilis umniSvnelo koncentracia. Sigeluri
meningiti Zalze iSviaTia (H.F. Gomez, Tomas. G. Cleary). meningoencefalituri
movlenebi damaxasiaTebelia 7 wlamde, gansakuTrebiT ki 3 wlamde asakis bavSvebSi.
wlamde asakis bavSvebSi dizenterias rigi Taviseburebebi axasiaTebs. Tumca
kolituri sindromis sixSire 80-90%-s aRwevs, igi sustadaa gamoxatuli: ganavali
Txieria, momwvano feris, Seicavs lorwos, sisxls _ naklebad. ufrosi asakisTvis
damaxasiaTebeli tenezmebi icvleba maTi eqvivalentebiT - defekaciis win mousvenrobiT,
tiriliT, saxis SewiTlebiT, anusis sfinqteris modunebiT. amave dros vlindeba zogadi
infeqciuri intoqsikaciis niSnebi. advilad SeiZleba ganviTardes wyal-marilovani
cvlis darRveva, rac gansazRvravs daavadebis mimdinareobis simZimes.
gaxangrZlivebuli formis (persistuli) xasiaTs (14 dReze meti xangrZlivoba)
daavadeba Rebulobs dasustebul bavSvebSi. sxeulis masa cudad an sul ar matulobs.
defekacia Txeli ganavlovania da Seicavs lorwos. drodadro ganavali normaluri
konsistenciisaa, raime paTologiuri minarevebis gareSe. aseTi kategoriis avadmyofebSi
389
ganavalidan xangrZlivad gamoiyofa

Sigelebi, mdgradia sxvadasxva
xasiaTis nawlavTa disfunqciac.
janmrTeli baqteria-
mtareblobisas raime klinikur,
morfologiur an serologiur
cvlilebebs adgili ara aqvs. igi
tranzituli xasiaTisaa da
xanmokle (araumetes 4 kvirisa).
garTulebebi dakavSire-
bulia dizenteriul procesTan,
mZime, gaxangrZlivebuli Sigelozi. araswori kvebiT da gansakuTrebiT, mcire asakis
mkurnalobiT gamowveuli malnutricia - marazmi (bavSvi bavSvebSi. mZime mimdinareobisas
gamoiyureba rogorc `Zvali da tyavi~) SeiZleba ganviTardes nefriti,
(sakuTari masala) toqsikur-infeqciuri da
hi povolemiuri Soki, swori
nawlavis gamovardna, sisxldena, invaginacia, peritoniti. SesaZlebelia, Camoyalibdes
bronqopnevmonia, stomatiti, piodermia, furunkulozi, osteomieliti, saSarde gzebis
infeqciebi, hemolizur-uremiuli sindromi Tirkmlis mwvave ukmarisobiT, araCirqovani
arTriti da reiteris sindromi, romelic dizenteriis dros, rogorc wesi, dakavSirebulia
HLA B27 antigenis arsebobasTan.
diagnozi. daavadebis tipuri mimdinareobisas diagnozis dasma klinikurad sirTules
ar warmoadgens, Tumca mxedvelobaSia misaRebi, rom msgavsi simptomatika, maT Soris,
kolituri sindromiT mimdinareoba SeiZleba Camoyalibdes salmonelozis, eSerixiozis,
amebiazis mTeli rigi pirobiT paTogenuri mikrobebiT (stafilokoki, klebsiela,
kampilobaqteriebi da sxv.) gamowveuli infeqciebis dros. amitom mZime SemTxvevaSi
zogjer aucilebelia kompleqsuri gamokvlevebis, kerZod, epidemiologiuri (daavadebis
kerebis dadgena), klinikuri (wamyvani sindromebis gaTvaliswineba), laboratoriuli
(baqteriologiuri, maT Soris, eqspres-diagnostika, serologiuri reaqciebi) da ufro
mozrdilebSi instrumentuli (reqtoromanoskopia, kolonoskopia) gamokvlevebis Catareba.
paTologiuri masalis (lorwos, Cirqis) daTesva unda moxdes àvadmyofis sawolTan~
antibaqteriuli preparatebis daniSvnamde da dauyovnebliv gaigzavnos laboratoriaSi.
SesaZlebelia daiTesos kuWidan amonarecxi.
specialuri masala iTeseba Gkjcrbhtd-is, Ktdby-is, MacConkey-s agarze, qsiloza-
lizinis dezoqsixolatis niadagze da sxva seleqciur niadagebze. Sigelebis amoTesvis
maCvenebeli sxvadasxva laboratoriebSi mniSvnelovnad meryeobs da procentulad 22-
80%-s Seadgens.
dizenteriis eqspres-diagnostikisTvis mowodebulia mTeli rigi reaqciebi, romlebic
ramdenime wuTSi an saaTSi avlenen dizenteriul antigens:
1. mafluorescirebeli antisxeulebis meTodi, romlis drosac antigenis gamovlena
natiur fekaliebSi xdeba fluoroqromiT niSandebuli antisxeulebis saSualebiT.
2. naxSirovani aglomeraciis reaqcia. dizenteriuli antigenis dasadgenad iyeneben
antisxeulebis maRali Semcvelobis naxSir-Sratovan narevs. am reaqciis saSualebiT
winaswari dadebiTi pasuxi gaicema 2-3 saaTSi (r. zaldastaniSvili)
4. ahr antisxeulebis gamoyenebiT.
5. imunofermentuli analizi (ifa).
bolo wlebSi gamoiyeneba Sigelis genis diagnostika (pjr).
mxolod serologiur kvlevebze dayrdnobiT diagnozis dasma SeuZlebelia. miuxedavad
390
CamoTvlili meTodebisa, dizenteriis diagnostikaSi baqteriuli meTodi jerjerobiT

mTavar meTods warmoadgens.
martivi, magram xelmisawvdomi meTodia koprologiuri gamokvleva. ganavalSi SedarebiT
mudmivad aRiniSneba lorwo, leikocitebis grovebi neitrofilebis ricxvobrivi
upiratesobiT (30-50 da meti mxedvelobis areSi), eriTrocitebi da Secvlili epiTeluri
ujredebi.
diferenciuli diagnostika, pirvel rigSi, unda gatardes amebiazTan salmonelozTan,
eSerixiozTan, stafilokokur enterokolitTan, meoradi baqteriuli floriT gamowveul
enterokolitebTan. xSiria invaginaciisa da mwvave apendicitis gamoricxvis aucilebloba.
mxedvelobaSi misaRebia iseTi daavadebebi, rogoricaa balantidiazi, lambliozi, nawlavTa
triqomoniazi, kandidozi da sxva, SedarebiT iSviaTi daavadebebi.
ameburi dizenteriis gamoricxva gansakuTrebiT aucilebelia Sua aziasa da
amierkavkasiaSi, sadac aRiniSneba amebiazis endemuri kerebi. baqteriuli dizenteriisagan
gansxvavebiT aRniSnuli daavadeba viTardeba normaluri an subferiluri temperaturis
fonze. defekaciis sixSire aRwevs 5-8-s dRe-RameSi. ufro xSiri defekacia iSviaTia.
ganavali xasiaTdeba sisxlisa da lorwos uxvi SemcvelobiT, Tumca e.w. Jolosebri
Jeles arseboba srulebiT ar aris aucilebeli. palpaciis dros aRiniSneba upiratesad
marjvena kolinjis mtkivneuloba da rezistentoba. diagnostikisaTvis gadamwyvetia
ganavalSi qsovilovani amebis - trofozoitebis aRmoCena.
salmonelozi xasiTdeba ufro xangrZlivi temperaturuli reaqciiT, defekacia
xSiri uxvi, wylisebri, momwvano feris (Waobisferi) lorwos Semcveli ganavliT.
tenezmebi gamoixateba sustad an ar aRiniSneba, palpaciiT vlindeba nawlavis yuryuri
da mtkivneuloba, anusi Sekrulia, xSiria hepatolienuri sindromis arseboba.
enteroinvaziuri eSerixiozisaTvis (0124, 0143, 0151 da a.S.) damaxasiaTebelia
damakmayofilebeli zogadi mdgomareoba, temperatura normaluria an subfebriluri,
ganavali wylisebria, uxvi, didi raodenobiT Seicavs mRvrie lorwos, zogjer sisxls.
daavadeba umravles SemTxvevaSi msubuqad mimdinareobs dizenteria - zones ti piT.
saboloo diagnozi ismeba laboratoriuli gamokvlevebis meSveobiT.
stafilokokuri enterokoliti SesaZloa iyos infeqciis pirveladi gamovlineba
an ganviTardes meoradad sefsisis an sxva gamovlinebis fonze (pnevmonia, meningiti,
omfaliti da sxv.) daavadeba ufro xSiria 6 Tvemde asakis dasustebul dRenakl,
sxvadasxva Tanmxlebi daavadebis mqone bavSvebSi. xasiaTdeba dune mimdinareobiT, xangrZlivi
temperaturiT, sxeulis masis cudi matebiT, Txeli, magram ganavlovani xasiaTis masebiT,
romlebic Seicavs lorwos, zogjer sisxls, mwvane ferisaa. xSiria paTogenuri
stafilokokis amoTesva avadmyofis ganavlidan, sisxlidan.
araspecifikuri wylulovani koliti, dizenteriisgan gansxvavebiT, iSviaTi
daavadebaa da xasiaTdeba xangrZlivi progredientuli mimdinareobiT. igi gvxvdeba
ufro mozrdilebSi. ganavali gaformebulia, masSi aRiniSneba lorwo da axali Seucvleli
sisxli. reqtoromanoskopiiT an kolonoskopiiT vlindeba swori nawlavisa da sigmoiduri
kolinjis wylulovani procesi.
invaginacia viTardeba uecrad an zogjer, rogorc garTuleba nawlavTa mwvave
aSlilobis fonze. axasiaTebs muclis SeteviTi xasiaTis tkivili, ganavlovani masis
Semcireba an sruli ararseboba, ganavali Sedgeba mxolod lorwosa da sisxlisagan,
nawlavTa palpaciiT an swori nawlavis TiTiT reviziisas isinjeba invaginati, TiTze
ki lorwo da sisxli rCeba.
mwvave apendiciti. Wiayelanawlavi retrograduli mdebareobisaa. misi anTebis
dros SeiZleba gaxSirdes defekacia, aRiniSnebodes lorwos minarevebi. am SemTxvevaSi
yuradRebas i pyrobs mudmivi tkivilebi, romelic upiratesad muclis marjvena naxevarSi
391
lokalizdeba. amave adgilas aRiniSneba muclis faris gaRizianebis niSnebi. sisxlSi

SeimCneva gamoxatuli neitrofiluri leikocitozi.
daavadebebi, rogorc balantidiazi, lambliozi, nawlavTa triqomoniazi
parazituli daavadebebi
da zogjer helminTozebi xasiTdeba defekaciis gaxSirebiTa da mtkivneulobiT muclis
areSi. maTi diferenciacia sabolood koprologiur gamokvlevebs eyrdnoba.
mxedvelobaSia misaRebi kandiduri enterokolitic, romelic aseve koprologiuri
gamokvleviT dasturdeba (gamravlebis stadiaSi myofi Candida albicans-is dadgena,
maTi ricxvis 100-ze metad momateba mxedvelobis areSi).
mkurnaloba. avadmyofis hospitalizacia xdeba daavadebis simZimis, sayofacxovrebo
pirobebisa da epidemiologiuri situaciis maCveneblebis gaTvaliswinebiT. aucilebel
hospitalizacias eqvemdebareba mxolod mZime SemTxvevebi. sxva avadmyofebs mkurnaloba
utardeba binis pirobebSi higienis dacvis gaTvaliswinebiT.
antibaqteriuli preparatebi gamoiyeneba Sigelebis mgrZnobelobis gaTvaliswinebiT.
Tu pirvelsave dReebSi ar gvaqvs aseTi monacemebi, sargebloben regionisTvis Sesabamisi
monacemebiT an msoflio jandacvis organizaciis rekomendaciebiT.
preparatebis xmarebis speqtri didia da Seicavs TiTqmis yvela cnobil antibaqteriul
saSualebas - sulfanilamidebs, naftiridins (nevigramoni da sxv.), cefalosporinebs
(ceporini, rocefini da sxv.), naxevradsinTezur penicilinebs (ampicilini da sxv.),
qloramfenikols (levomicetini) - ufro mozrdilebSi, aminogligozidebs (gentamicini,
amikacini, netromicini) da sxva jgufebs, fTorqinolonebs (cipro da sxva) - mozrdilebSi.
amJamad SedarebiT efeqturad gamoiyeneba (maT Soris Cveni regionisaTvis)
trimetoprim-sulfametoqsazoli, nevigramoni, ampicilini. antibiotikebis daniSvna
mizanSewonilia mxolod mZime da saSualo simZimis formebis dros, rodesac ganavalSi
aRiniSneba sisxli. mkurnalobis xangrZlivoba ganisazRvreba 5-7 dRiani cikliT, zogjer
ki Sedgeba 2 ciklisagan. antibiotikis Secvla xdeba, roca 2 dRis ganmavlobaSi ar
SeimCneva mimdinareobis gardatexa gaumjobesebisaken (kvlav aRiniSneba sisxli). meore
antibiotikis uefeqtobis Semdeg diagnozi unda iqnas revizirebuli (SesaZlebelia
ameburi dizenteriis arseboba da sxv.).
antibaqteriuli Terapiis Semdeg zogjer viTardeba nawlavTa disbaqteriozi, rac
saWiroebas qmnis Catardes 1-2 kviriani mkurnaloba eubiotikebiT (bifidumbaqterini,
kolibaqterini, laqtobaqterini, baqtisubtili, lineqsi da sxv.) romlebic aumjobeseben
da xels uwyoben nawlavTa floris fiziologiuri wonasworobis koreqcias.
paTogenezuri Terapia iTvaliswinebs moxsnas krunCxviTi sindromi, saWiroa
dehidrataciis xarisxi da xasiaTis koreqcia, brZola hiperTemiasTan da intoqsikaciasTan.
dieta. sakvebi unda iyos Termulad damuSavebuli, srulfasovani, vitaminizebuli,
Seicavdes xilsa da bostneuls, xorcs. avadmyofs sakvebi eZleva mcire ulufebiT, 5-
7-jer dReSi, raodenoba - asakis gaTvaliswinebiT. ar aris gamarTlebuli e.w. `Caisa da
wylis dieta~. saWiroa erTi damatebiTi kvebis daniSvna diareis Sewyvetis Semdeg 2
kvira mainc, rac aucilebelia sxeulis masis aRsadgenad, gansakuTrebiT distrofiul
bavSvebSi.
profilaqtika. qmediTi specifikuri profilaqtika jerjerobiT SemuSavebuli
ar aris. igi iTvaliswinebs sanitarul-higienur da epidsawinaaRmdego RonisZiebebs.
392
kerZo nawili. salmonelozi
salmonelozi
(SALMONELLOSIS)
salmonelozi (sinonimi _ aratifuri salmonelozi) warmoadgens mwvave infeqciur

daavadebas, romelic gamowveulia sxvadasxva saxeobis salmonelas mikrobebiT. daavadeba
mimdinareobs upiratesad gastrointestinuri traqtis dazianebiT da iSviaTad
generalizebuli formiT.
arCeven salmoneluri daavadebis or jgufs. pirvelSi Sedis muclis tifi, paratifi
A da B, romelTa gamomwvevi warmoadgens adamianisaTvis obligatur parazits. meore
jgufs miekuTvneba sakuTriv salmonelozi, romelic ganpirobebulia rogorc adamianisaTvis,
ise cxovelebisaTvis paTogenuri salmonelebiT. salmonelozis saxelwodeba gamoiyeneba
mxolod meore jgufis daavadebis aRsaniSnavad.
saxelwodeba salmonela, romelic miRebuli iyo 1934w. saerTaSoriso kongresze,
dakavSirebulia D.E. Salmon-Tan, romelmac pirvelad 1885w. T.S. Smith-Tan erTad
daavadebuli Roris organoebidan gamohyo Bacterium Suipestifer e.w. B. Cholerae
suis _ Roris Savi Wiris Cxiri. 1888w. G. Gertner-ma Zroxis xorcidan da adamianis
gvamis elenTidan, romelsac miRebuli hqonda avadmyofi Zroxis xorci, gamohyo B.
enteritidis. aRmoCenili mikrobebi pirvel xanebSi iTvlebodnen kvebiTi toqsikoinfeqciis
mizezad. mimdinare saukunis 40-50-ian wlebSi gamoirkva, rom salmonelozi vrceldeba
kontaqturi gziTac da arsebobs sxva klinikuri formebic. Semdgom periodSi aRmoaCines
morfologiurad da bioqimiurad salmonisa da gertneris mier aRmoCenili Cxirebis
msgavsi mravalricxovani mikrobebi.
etiologia.. gamomwvevi agentebi miekuTvneba salmonelebis gvars, Enterobacteri-
etiologia
aceae-s ojaxs, morfologiurad warmoadgenen Cxirebs momrgvalebuli boloebiT, zomiT
(1,0-3,0)X(0,2-0,8)mkm. isini moZravi, gramuaryofiTi mikrobebia; kafsula ara aqvT,
sporebs ar warmoSoben, rTuli antigenuri struqturisaa. ZiriTadi antigenebia H-
Soltisebri Termolabiluri da O-somaturi Termostabiluri antigenebi. Vi antigeni
O-antigenis erT-erT komponents warmoadgens.
salmonelebis saerTaSoriso serologiur klasifikacias safuZvlad udevs mikrobebis
antigenuri struqtura (kaufman-uaitis sqema). O-antigenis sxvaobis safuZvelze gamoyofen
serologiur jgufebs _ A, B, C, D, E da a.S., xolo H antigenebis sxvaobiT ki yovel
jgufSi arCeven serologiur variantebs, romelTa ricxvi 2200-ze metia, maT Soris
700-ze meti _ adamianebSi. yvelaze ufro xSirad gvxvdeba S. typhimurium, S.
heidelberg, S. enteritidis, S. anatum, S. derby, S. panama. ufro didi klinikuri
mniSvneloba aqvs S. typhimurium-s.
salmonelebi SedarebiT gamZlea garemoSi. ase mag: wyalSi inarCuneben sicocxles 2
Tvemde, miwaSi 4-5 Tvemde, oTaxis mtverSi _ 3 Tve, mSral fekaliebSi _ 3-4 weli.
mikrobebisaTvis karg sakveb niadags warmoadgens rZis produqtebi (araJani, karaqi, rZis
fxvnili da sxv.), xorci, kvercxi, kvercxis fxvnili. kargad itanen gamoSrobas, kviraobiT
inarCuneben sicocxles sxvadaxva farmakologiur preparatebze, ar iRupebian 48-80°C-
ze, gamZle arian antibiotikebis umravlesobis mimarT.
mikrobebis likvidaciisaTvis saWiroa xarisxiani Termuli zemoqmedeba; mag: kvercxis
2-3 wuTiani duRilis Semdeg misi ganadgureba ar xdeba, rac moiTxovs eqspoziciis
gaxangrZlivebas 15-20 wuTamde; 400-gramiani xorcis moxarSva saWiroebs 2,5 saaTs.
amasTanave aRsaniSnavia, rom salmonelebi maRalmgrZnobiareni arian sadezinfeqcio
preparatebis mimarT (Cveulebriv ganzavebaSi).
epidemiologia.. infeqciis ZiriTad wyaros warmoadgenen sxvadasxva cxovelebi:
epidemiologia
393
Rori, Zroxa, kata, ZaRli, frinvelebi da sxva; gansakuTrebiT broileris frinvelebi,

ufro metad ki ixvebi da batebi, romlebic salmonelebis sxvadasxva tipebis rezervuarebi
arian.
mikrobebis ganTesva xorcSi da Sinagan organoebSi ganpirobebulia endogenurad
cxovelebis daavadebiT, xolo egzogenurad _ produqtebis transportirebis, Senaxvis
da kulinaruli damuSavebis wesebis darRveviT.
epidmniSvnelobiT cxoveluri infeqciis wyarosTan SedarebiT meore adgilze dgas
avadmyofi adamiani da baqteriamtarebeli. maTi roli gansakuTrebiT mniSvnelovania
kvebis qselSi momuSave personalSi (xorcis, rZis kombinatebi da sxva). dadgenilia,
rom 1g ganavalSi avadmyofi mwvave periodSi gamohyofs 106-109-mde mikrobs.
baqteriamtareblobis xangrZlivoba erTnairia rogorc simptomuri, ise asimptomuri
formis dros, xolo 1 wlamde asakis bavSvebSi ufro metia, vidre mozrdil bavSvebSi.
aRsaniSnavia, rom antibiotikebiT mkurnalobisas baqteriamtarebloba ufro xangrZlivia.
Tumca mikrobebis gamoyofis xangrZlivoba daavadebis ukuganviTarebasTan erTad klebulobs,
mtarebloba SeiZleba gagrZeldes 10 kviramde da metic.
infeqciis gadacemis meqanizmi fekalur-oraluria, xolo mTavari gadacemis faqtoria
sakvebi; Semdeg mniSvneloba aqvs wylis faqtors da, iSviaTad, inficirebuli oTaxis
mtvris gadaylapvas (saavadmyofoebSi). sayofacxovrebo-kontaqturi gziT inficirebas
umTavresad adgili aqvs mcire asakis bavSvebSi. am mxriv yuradRebas imsaxurebs
saavadmyofoebSi Sida infeqciebis SesaZlebeli ganviTareba, rac ganpirobebulia
antibiotikebis mimarT rezistentuli, rogorc wesi S. typhimurium-is StamebiT,
romlebic gamoirCevian daavadebis mZimed mimdinare formebiT.
salmoneloziT daavadeba gvxvdeba wlis yvela periodSi; mcire sezonuroba axasiaTebs
zafxulSi, rac dakavSirebulia inficirebis xelSemwyob pirobebTan. adgili aqvs rogorc
sporadul, ise jgufur SemTxvevebs.
paTogenezi. salmonelebis SeWra organizmSi inficirebuli kvebis produqtebiTa
Tu sxva faqtorebiT, yvela SemTxvevaSi mxolod peroraluria. am TvalsazrisiT
daavadeba warmoadgens klasikur oralur infeqcias. infeqciuri procesis
ganviTarebisaTvis didi roli eniWeba mainficirebeli dozis sidides, magram gadamwyvetia
organizmis imunologiuri statusis mdgomareoba, misi daqveiTeba, romelic ganpirobebulia
sxvadasxva paTologiuri procesiT. swored amiT aixsneba salmonelozisaTvis
damaxasiaTebeli nozoparazitizmi _ advilad darTva sxva romelime daavadebis fonze.
alimenturi gziT dasnebovnebisas adgili aqvs salmonelebis masiuri doziT
Semcvelobas, rac, Tavis mxriv, garkveul daRs asvams klinikur suraTs, inkubaciur
periods, inicialur periodSi suraTis simZafres da sxva.
kontaqturi gziT dainficirebisas infeqciuri procesi mimdinareobs ufro ciklurad,
romelsac bevri saerTo aqvs nawlavTa sxva mwvave infeqciebis mimdinareobasTan.
paTogenezSi mniSvneloba eniWeba, rogorc endotoqsinebs, ise cocxal mikrobebs.
mikrobebis masiuri SeWris Sedegad (alimenturi gza) kuW-nawlavis traqtis zemo
nawilebSi (kuWi da wvrili nawlavebi) xdeba maTi daSla organizmis araspecifikuri
dacvis faqtorebis meqanizmebiT (kuWis simJave pH-2, lizocimi, komplementi da sxva)
da endotoqsinebis warmoSoba sisxlSi maTi Semdgomi SewoviT. endotoqsinemiis Sedegia
pirveladi intoqsikaciuri movlenebis Camoyalibeba, romlebic daavadebis dasawyis
periodSi Rebulobs toqsikoinfeqciis ti piT mimdinareobis xasiaTs.
Tu baqterializuri procesi susti aRmoCnda da infeqtma gadalaxa fiziologiuri
barierebi, maSin salmonelebi Seuferxeblad Sedian wvril da msxvil nawlavebSi, sadac
intensiurad mravldebian. maTi maRali invaziurobis gamo advilad aRweven enterocitebs
da nawlavebis lorwovani garsebis sakuTriv Sreebs, sadac xdeba maTi fagocitozi
394
neitrofilebisa da makrofagebis meSveobiT, viTardeba anTebiTi procesi. unda aRiniSnos,

rom sxva paTogenuri da saprofituli mikrobebisagan gansxvavebiT, salmonelebi
gamoirCevian ara mxolod makrofagebSi sicocxlisunarianobis SenarCunebiT
(dausrulebeli fagocitozi), aramed mravldebian kidec ujredSi. aRniSnuli mdgomareobiT
aixsneba maTi mniSvneloba daavadebis gamwvavebis, recidivebisa da baqteriamtareblobis
ganviTarebaSi.
organizmis imunur sistemazea damokidebuli, procesi Semoifargleba mxolod kuW-
nawlavis traqtis dazianebiT, Tu ganviTardeba infeqciuri procesis Semdegi etapi _
baqteriemia. unda iTqvas, rom xanmokle baqteriemias SeiZleba adgili hqondes lokaluri
formebis drosac (gastrointestinuri forma). baqteriemia ki Tavis mxriv iwvevs
Sinagani organoebisa da qsovilebis mikrobul diseminacias, sadac aris maTi gamravlebis
da sefsisuri kerebis formirebis SesaZlebloba. varaudoben, rom diarea salmonelozis
dros iseve, rogorc nawlavTa sxva mwvave infeqciis dros, gamowveulia enterocitebze
endotoqsinebisa da mikrobebis erToblivi moqmedebiT, romlebic iwveven ujredSi
fermentuli sistemis _ adenilatciklazas, guanilciklazas gaaqtiurebas, rasac Semdgom
mosdevs camf-is, cgmf-is, prostaglandinebis koncentraciis momateba. aRniSnuli movlenebi
ki ganapirobeben nawlavTa sanaTurSi siTxis sekreciis gaZlierebas, rasac kanonzomierad
mosdevs siTxisa da eleqtrolitebis _ kaliumis, natriumis, qloridebis dakargva.
viTardeba faRaraTi, Rebineba, eqsikozi. daavadebis mZime formebis dros mZime dehidratacia
da demineralizacia organizmSi iwvevs mikrocirkulaciis darRvevas, hipoqsiur movlenebs
da acidozs. viTardeba mZime, kritikuli mdgomareoba _ gul-sisxlZarRvTa da sxva
sistemebis mwvave ukmarisoba (infeqciur-toqsikuri _ hi povolemiuri Soki).
gastrointestinuri formis dros paTanatomiuri cvlilebebi gvxvdeba sxvadasxva
intensivobiT; lorwovani garsi da lorwqveSa Sre ziandeba mTel traqtze. kuWi da
nawlavebi gaganierebulia, Seicaven momwvano, Cirqis sunis mqone lorwos. wvrili
nawlavebis lorwovani garsebi hiperemiuli da SeSupebulia, aRiniSneba wvrilwertilovani
da sxva zomis sisxlCaqcevebi. araiSviaTia erTeuli limfuri folikulebis hiperplazia.
zogjer msxvil nawlavebSic aRiniSneba Rrma anTebiTi procesi, romelic lorwqveSa
fenamde aRwevs. gamoxatulia sisxlis mimoqcevis darRvevis suraTi ujreduli
infiltraciiT, makrofagebis proliferaciuli reaqciebiT. cvlilebebi nawlavebSi
gamoxatulia rogorc msubuqi anTebadi procesiT, aseve uxeSi alteraciuli movlenebiT,
apkisebri an qatosebri nadebiT, eroziebisa da wylulebis CaTvliT.
generalizebuli formebis dros sefsisuri gamovlinebebi kuW-nawlavis mxriv
gamoxatulia sisxlsavseobiTa da sxvadasxva zomis sisxlCaqcevebiT, xolo Sinagani
organoebis mxriv mravlobiTi sefsisuri metastazebi da distrofiuli movlenebia;
difuzuri da kerovani proliferaciaa retikulur-endoTeluri sistemis mxriv.
tifoiduri formebis dros saxezea gadidebuli elenTa da jorjlis limfuri
kvanZebi, nawlavebSi ki aRiniSneba lorwovani garsebis SeSupeba, sxvadasxva zomis
sisxlCaqcevebi, gansakuTrebiT limfuri folikulebis dajgufebebSi.
imuniteti mxolod ti purspecifikuria. infeqciuri procesis adreul stadiaSi
organizmi gamoimuSavebs specifikur antisxeulebs IgM, xolo Semdgom _ IgG da IgA
saxiT. arasruli fagocitozis gamo mikrobebis neitralizacia Seferxebulia, ramac
SeiZleba ganapirobos daavadebis gaxangrZlivebuli mimdinareoba. amiT aixsneba
organizmidan SedarebiT dune eliminacia da sakmaod xSiri baqteriamtarebloba. arasruli
imunitetis Sedegia qronikuli baqteriamtarebloba, SemdgomSi procesis gamwvaveba da
recidivebi. imuniteti mxolod ti pur-specifikuria da grZeldeba 5-6 Tve.
klinikuri mimdinareoba. inkubaciuri periodi meryeobs ramodenime saaTidan 6-
7 dRemde. mokle inkubaciuri periodi (ramodenime saaTidan 1,5 dRemde) araiSviaTad
395
dgindeba kvebiTi produqtebiT inficirebis dros (masiuri doziT inficireba). kontaqturi

gziT inficirebisas (Cveulebriv, mainficirebeli doza pataraa) inkubaciuri periodi
ufro xangrZlivia. garda amisa, gasaTvaliswinebelia, rom inficirebis meqanizmi gavlenas
axdens klinikur mimdinareobaze. pirvel SemTxvevaSi es gamoixateba mZafri simptomebis
gamovlinebiT (daavadeba Rebulobs toqsikoinfeqciis mimdinareobis xasiaTs). xolo
meore SemTxvevaSi mimdinareobs ufro ciklurad (`TandaTanobiT” klinikis gaSla da
sxv.).
klinikuri formebidan yvelaze gavrcelebulia gastrointestinuri forma (90%-
mde), roca paTologiur procesSi CarTulia mTeli traqti, magram daavadeba araiSviaTad
mimdinareobs ama Tu im nawilis upiratesi dazianebiT, rac klinikurad ganapirobebs
garkveuli seqtoris dazianebisaTvis damaxasiaTebel suraTs – gastrits, enterits,
kolits an maT kombinaciebs.
gastrituli da gastroenterituli formebi ufro xSirad gvxvdeba 3 wlis zeviT
asakis bavSvebSi, dakavSirebulia inficirebuli sakvebis miRebasTan da xSirad axasiaTebs
toqsikoinfeqciis ti piT mimdinareoba. daavadeba iwyeba uecrad, temperaturis mkveTri
momatebiT 39-40°C-mde, ganmeorebiTi RebinebiT. avadmyofebi uCivian saerTo sisustes,
YTavis tkivils, Tavbrusxvevas, tkivils epigastriumis midamoSi da mTels mucelSi.
SesaZlebelia msubuqi toqsikozis suraTi; ena Selesilia, mSralia, kani mSrali, muceli
Seberili. daavadeba grZldeba 4-5 dRes (gastrituli forma). ufro xSirad ki am
stadiaSi aRiniSneba FfaRaraTis TandarTva 3-5-jer dRe-RameSi (gastroenteriti).
ganavali Rebulobs fafisebur konsistencias an Txeli, uxvi da qafiania, Seicavs
mcireoden lorwos. saerTo sisuste, kanis sifermkrTale, Tavis tkivili, muclis
Seberva da zomieri intoqsikaciis sxva simptomebi am formisaTvis ufro damaxasiTebelia,
magram zog avadmyofSi SeiZleba ganviTardes neirotoqsikozis movlenebi _ hi perTermia,
gonebis dakargva, klonur-tonuri krunCxvebi, kidurebis gaciveba; ufro iSviaTad SeiZleba
adgili hqondes endotoqsikur Soksac (arteriuli wnevis swrafi daweva, zogadi
ianozi da a.S.).
mZime dehidratacia. kanis naoWis Zalian neli salmonelozi. mZime dehidratacia. komaturi
gasworeba. (msoflio janmrTelobis dacvis mdgomareoba. `Cacvenili Tvalebi~, mSrali tuCebi,
organizaciis masalebi) cremli ar aqvs. (sakuTari masala)
daavadeba ufro iSviaTad mimdinareobs enterituli formiT. am SemTxvevaSi SeimCneva

simptomatikis TandaTanobiTi Camoyalibeba gamZafrebisaken. ramdenime dReSi faRaraTis
sixSire dRe-RameSi aRwevs 5-10-s; ganavali uxvia, akuwuli, Seicavs gadaumuSavebel,
396
TeTr koStebs, mcire lorwos da aqvs mZafri suni; SesaZlebelia dehidrataciis

ganviTareba. daavadeba, Cveulebriv, grZeldeba 5-6 dRe, Tumca zogjer SeiZleba 2-3
kviras da met xans gastanos.
gastroenterokoliti da enterokoliti warmoadgens yvelaze ufro xSir
formebs, romlebic ufro metad mcire asakis bavSvebSi gvxvdeba (gansakuTrebiT 1
wlamde). 2-3 dRiani inkubaciuri periodis Semdeg daavadeba iwyeba maRali temperaturiT
_ 39-40°C da 3-4 dRis ganmavlobaSi an ufro gvian gamoixateba daavadebis simptomatika.
damaxasiaTebelia gaxSirebuli defekacia; ukve pirvelsave dReebSi ganavali paTologiuria,
Rebulobs moSavo-momwvano fers, romelic mogvagonebs Waobs an bayayis qviriTs. iSviaTad
daerTvis distaluri koliti. am dros saxezea sigmoiduri kolinjis spazmi, SeteviTi
xasiaTis tkivilebi, tenezmebi an wlamde asakis bavSvebSi kolitis eqvivalenturi
simptomebi _ WinTvebi, saxis gawiTleba, SeteviTi xasiaTis mousvenroba.
gastrointestinuri salmonelozis yvela formis dros periferiul sisxlSi adgili
aqvs zomier leikocitozs, neitrofilozs marcxniv gadaxriT.
simZimis mixedviT arCeven daavadebis msubuq mimdinareobas, roca saerTo mdgomareoba
daTrgunuli ar aris, temperatura an normaluria, an umniSvnelodaa momatebuli,
Rebineba 1-3-jer, xolo defekacia 5-10-jer dRe-RameSi, umniSvnelo paTologiuri
minarevebiT.
saSualo simZimis dros saerTo intoqsikaciis movlenebi zomieradaa gamoxatuli,
temperatura aRwevs 38-39°C-mde, Rebineba ufro xSiria, defekacia aRwevs 10-15-s dRe-
RameSi lorwosa da sisxlis SemcvelobiT. mZime mdgomareobisas gvaqvs neirotoqsikozis
suraTi, FmZime dehidratacia faRaraTis raodenoba dauTvlelia, SesaZloa sisxlis
dena.
tifoiduri forma xasiaTdeba temperaturis xangrZlivobiT, nervuli sistemis
mxriv gamovlinebebiT _ SeimCneva gonebis dabindva, bodvebi, meningealuri movlenebi
(meningizmi), kanis simSrale, rozeolur-papuluri gamonayari, ena mSralia, sqeli nadebiT,
muceli Seberili, araiSviaTia RviZlisa da elenTis gadideba, am fonze xSiria enterituli
xasiaTis faRaraTi lorwosa da sisxlis SemcvelobiT, myrali suniT. daavadeba ufro
gvxvdeba ufrosi asakis bavSvebSi.
sefsisuri forma mcire asakis bavSvTa da dRenaklTa xvedria, romelTac aReniSnebaT
gadatanili da Tanmxlebi daavadebebi, imyofebian xelovnur kvebaze. daavadeba viTardeba
rogorc kuW-nawlavis daava-debebis fonze, ise pirveladi klinikuri mimdinareobiT.
damaxasiaTebelia mravali
Cirqovani keris arseboba
Sinagani organoebis mxriv
(filtvebi, Tirkmlebi da sxva).
aRniSnul fonze mimdinareobs
sxvadasxva intensivobis ente-
riti. specifikuri anTebadi
procesis damadasturebelia
salmonelebis amoTesva
kerebidan.
waSlili formis dros
diareuli procesebi sustadaa
salmonelozis mZime, sefsisuri forma. gamoxatulia rogorc
gamoxatuli an simptomebi Cqara
lokaluri movlenebi kuW-nawlavis traqtis mxridan
qreba; ganavali ufro
(faRaraToba, momwvano `Waobisferi~ siTxisa da lorwos
formirebulia da paTologiur Semcveli ganavliT), aseve procesis generalizacia -
minarevebs ar Seicavs. diagnozi salmonelozuri sefsisi SokiT. (sakuTari masala)
397
eyrdnoba epidemiologiur da baqteriologiur monacemebs. unda aRiniSnos, rom erTi

da igive ti pis salmonelebs SeuZliaT gamoiwvion daavadebis sxvadasxva klinikuri
forma; amasTanave, adgili aqvs klinikuri mimdinareobis Taviseburebebs, rac gamomwvevis
tipTanaa dakavSirebuli. ase mag.: S. typhymurium ufro xSirad ganapirobebs daavadebis
SedarebiT mZime formas, xangrZlivi baqteriamtarebloba ufro xSirad gvxvdeba S.
heidelberg-is da S. derby-s ti pebis dros. B ti pis salmonelebi ufro xSirad
iwveven enterokolitur formas. salmonelozis tifoiduri da sefsisuri mimdinareobis
SemTxvevaSi xSirad gamoiyofa S. heidelberg, S.kunzendorph da sxva. Cirqovani
meningitis dros _ S. hertner, saxsrebis dazianebisas _ S.kunzendorph.
mimdinareobis xangrZlivoba damokidebulia daavadebis klinikur formaze, asakze,
Tanmxleb daavadebebsa da salmonelebis tipebze. msubuqi daavadebisas misi ukuganviTareba
xdeba ramodenime dReSi, saSualo da mZime formebisas _ 2-3 kviraSi, xolo Zlier mZime,
gansakuTrebiT, tifoiduri da sefsisuri formebi zogjer xangrZlivdeba 1,5 Tvemde;
SesaZlebelia, agreTve, salmonelozis qronikuli mimdinareoba baqteriebis mdgradi
gamoyofiT.
daavadeba, umravles SemTxvevaSi, mimdinareobs garTulebis gareSe, magram arcTu
iSviaTia procesis gamwvaveba, recidivebi. aRniSnuli garTulebebi ki xasiaTdeba mwvave
intoqsikaciisa da faRaraTis SeqcevadobiT. mcire asakis bavSvebSi da, upirvelesad,
dRenaklebSi, romelTac aReniSnebaT anemia, hi potrofia, procesi Rebulobs
gaxangrZlivebul da qronikul mimdinareobas, rasac Tan erTvis sxva garTulebebi
maRali letaluri gamosavliT.
gansakuTrebuli yuradRebis centrSi unda iyos salmoneluri infeqciebis kerebis
arseboba samSobiaro saxlebSi, sadac infeqciis wyaros, ZiriTadad, Seadgenen avadmyofi
an baqteriamtarebeli deda, samedicino personali, romelTac aReniSnebaT hospitaluri,
antibiotikebisadmi polirezistentuli Stamebis mtarebloba. araiSviaTia, agreTve,
samkurnalo preparatebis (tabletebis) inficireba; dasnebovnebis meqanizmi am SemTxvevaSi
atarebs, upiratesad, kontaqtur xasiaTs. nayofis dainficireba SeiZleba moxdes samSobiaro
gzebis gavlis drosac. inficirebuli bavSvebi stacionaridan xSirad ewerebian inkubaciur
periodSi, garegnulad sruliad janmrTelni. maTi daavadebis manifestacia ki xdeba
saxlSi. es epidemiologiuri `kudi” kargad Cans am dros.
axalSobilTa salmoneluri infeqcia, garda gastrointestinuri formisa,
mimdinareobs ufro xSirad sefsisuri gamovlinebiT _ meningitiT, meningoencefalitiT,
osteomielitiT da sxva sefsisuri kerebiT, saidanac araiSviaTad gamoiyofa salmonelebi.
letalobis yvelaze ufro didi procenti modis axalSobilTa kontingentze.
wlamde asakis bavSvebSi daavadeba mimdinareobs ufro enterokolitis suraTiT.
Rebineba iSviaTia, magram mkveTradaa gamoxatuli saerTo intoqsikaciis movlenebi,
Zlieri faRaraTi, ganavali Seicavs didi raodenobiT lorwosa da sisxls. zogjer
sisxlisa da lorwos raodenoba imdenad mniSvnelovania, rom saWiroa diferenciaciis
gatareba invaginaciasTan. damaxasiaTebel gamovlinebas ekuTvnis ufro xangrZlivi
temperaturuli reaqcia da toqsikozis ufro xSiri ganviTareba, vidre mozrdilebSi.
Rebineba ar aris xSiri da wamyvani simptomi.
garTulebebi.. mZime formebis dros SesaZlebelia infeqciur-toqsikur-
garTulebebi
hi povolemiuri Sokis ganviTareba. gul-sisxlZarRvTa, Tirkmlisa da sxva sistemebis
mwvave ukmarisobiT, romlebic saWiroeben gadaudebel reanimaciul daxmarebas.
mxedvelobaSia misaRebi, rom zogierTi klinikuri gamovlinebani, rogoricaa miokarditi,
hepatiti, meningiti, tvinis, elenTis, RviZlis, Tirkmlebis abscesi, cistiti, pieliti da
sxva, SesaZlebelia ganimartos, rogorc salmoneloziT ganpirobebuli garTulebebi,
magram didi mniSvneloba eniWeba meorad infeqciasac, romelsac iwveven stafilokokebi,
398
mwvane Cirqmbadi mikrobebi da sxva.

xazgasasmelia isic, rom daavadebis gaxangrZliveba, recidivuli mimdinareoba SeiZleba
ganpirobebuli iyos mwvave respiraciuli infeqciis TandarTviT.
diagnozi eyrdnoba epidemiologiur, klinikur da laboratoriul gamokvlevebs.
klinikur diagnostikaSi ZiriTad simptomad iTvleba daavadebis mwvave dawyeba, SedarebiT
xangrZlivi temperatura, mdgradi pirRebineba, ganavlis enterituli xasiaTi mwvane
lorwosa da sisxlis SemcvelobiT, myrali suniT, meteorizmi. saSualo da mZime
mimdinareobisas araiSviaTia RviZlisa da elenTis gadideba. periferiul sisxlSi
leikocitozi, neitrofilozi marcxniv gadaxriT, zomierad momatebuli eds. vinaidan
msgavsi klinikuri simptomatika gvxvdeba nawlavTa sxva mwvave infeqciebis drosac
(mag: pirobiTpaTogenuri mikrobebi), gadamwyveti roli nozologiis dadgenaSi eniWeba
laboratoriul gamokvlevebs da, gansakuTrebiT, baqteriologiurs. salmonelebis gamoyofa
SeiZleba ganavlidan, piranaRebi masidan, kuWis amonarecxidan, Sardidan, sisxlidan, Tav-
zurgtvinis siTxidan da a.S. masalis daTesva, iseve, rogorc dizenteriis dros, xdeba
pirvelsave dReebSi ploskirevis da bismut-sulfatis agarze da gamdidrebul niadagze.
dadebiTi pasuxi meryeobs didi diapazoniT da sxvadasxva laboratoriebSi Seadgens
40-80%-mde. diagnostikuri mniSvneloba eniWeba serologiur reaqciebs, roca titri
aRwevs 1:200 da mets. dadebiTi reaqciis sixSire aRwevs 80%-mde. bolo wlebSi
SeimuSaves ufro mgrZnobiare laboratoriuli meTodebi: radioimunuri, imunofermentuli,
romelTa meSveobiT SesaZlebelia salmonelebis antigenebis da antisxeulebis mcire
titrebis dadgena.
diferenciuli diagnostika. salmonelozis gastrointestinuri formis dros
zogjer gvixdeba diferenciacia iseT daavadebebTan, rogoricaa mwvave dizenteria,
eSerixiozi, stafilokokuri enterokoliti, pirobiTpaTogenuri mikrobebiT ganpirobebuli
enterokolitebi, rotavirusuli infeqcia, adeno- da enterovirusuli infeqciebi, invaginacia,
apendiciti.
dizenteria salmonelozisagan gamoirCeva TiTqmis yovelTvis kargad Semofargluli
kolituri sindromiT (tenezmebi, sigmoiduri kolinjis spazmi, anusis moduneba,
sfinqteriti da sxva), defekacia mcire ulufebiT lorwosa da sisxlis Semcveli
ganavliT, temperatura xangrZlivdeba ramodenime dRe.
eSerixiozis diferenciacia xSirad awydeba siZneleebs, amitom didi mniSvneloba
eniWeba baqteriologiur da serologiur gamokvlevebs (aglutinaciis reaqcia,
arapirdapiri hemaglutinacia).
stafilokokuri enterokoliti, salmonelozisagan gansxavavebiT, TiTqmis
yovelTvis viTardeba Cirqovani kerebis fonze (omfaliti, dedis mastiti, endometriti,
panariciumi); samSobiaro saxlSi registrirdeba toqsikur-sefsisuri daavadebebis
afeTqeba.
rotavirusuli infeqcia iwyeba uecriv, ganmeorebiTi RebinebiT, or-samdRiani
temperaturiT, ganavali pirvelsave dReebSi xdeba wylisebri; igi SadrevaniviT mSxefavi
da qafiania, Seicavs mcire lorwos, sisxlis minarevebis gareSe. damaxasiaTebelia
muclis Seberva. daavadeba, umravles SemTxvevaSi Semoifargleba erTi kviriT, Tumca
arsebobs mZime formebi gaxangrZlivebuli mimdinareobiT, toqsikoziTa da mZime
garTulebebiT. diagnozs naTels xdis virusologiuri gamokvlevebi (ganavalSi
rotavirusebis aRmoCena eleqtronuli mikroskopiT an antisxeulebis komplementSemboWavi
reaqciiT, hemaglutinaciis damuxruWebis reaqciiT, imunofermentuli analiziT da
sxva).
adenovirusuli da enterovirusuli infeqciebi zogjer mimdinareobs diareuli
sindromiT, magram salmonelozisagan gansxvavebiT maTTvis damaxasiaTebelia zemo sasunTqi
399
gzebis katari, adenovirusuli infeqciisas faRaraTi ganpirobebulia ufro me-40 da

41-e StamebiT, gadidebulia RviZli, elenTa, limfuri kvanZebi. enterovirusuli daavadeba
SeiZleba mimdinareobdes kunTebis tkiviliT, meningealuri movlenebiT, sxvadasxva xasiaTis
gamonayriT, herpesuli anginiT.
invaginaciis dros, rogorc wesi, dgindeba invaginati.
apendicitisaTvis damaxasiaTebelia tkivili marjvena TeZos midamoSi da muclis
faris gaRizianeba, leikocitozi da sxva.
salmonelozis tifoiduri da sefsisuri formebis dros zogjer saWiroa
tifur-paratifuri daavadebebis gamoricxva; gansakuTrebiT rodesac saerTo intoqsikaciis
fonze adgili aqvs enteritis movlenebs, xangrZliv temperaturas, rozeoluri elementebis
arsebobas da a.S. salmonelozisagan gansxvavebiT tifur-paratifuri infeqciisaTvis
damaxasiaTebelia toqsikur-infeqciuri simptomatikis TandaTanobiTi mateba tifuri
statusis CaTvliT, fiqsirebul dros (8-9-11 dRes) rozeolebis warmoSoba da sxva.
amave dros gvexmareba drouli baqteriologiuri da serologiuri gamokvlevebi, romlebic
sabolood iZleva tifur-paratifuri daavadebis diagnostikis saSualebas.
salmoneluri sefsisi gamoirCeva sxva sefsisuri procesisagan gastroenteritisa
da enterokolitis arsebobiT. gaZnelebulia misi diagnostika da gadamwyveti roli
ekuTvnis baqteriologiur da serologiur monacemebs (mikrobis amoTesva Cirqovani
kerebidan, sisxlidan, Sardidan da a.S.).
mkurnaloba.. msubuqi da saSualo simZimiT mimdinareobisas avadmyofebi rCebian
mkurnaloba
binaze, sadac utardebaT eqimis mier daniSnuli Terapiuli RonisZiebebi, romelic,
ZiriTadad, gamoixateba peroraluri rehidrataciis Sesrulebasa da kvebis swor
warmarTvaSi. am dros umTavresi amocanaa rehidronis, ORS-is an sxva siTxeebis
miwodeba saTanado dozebiT. amasTanave saWiroa srulfasovani kveba da dauSvebelia
mSieri dieta (ix. rehidrataciis princi pebi).
mZime dehidrataciis an sxva garTulebebis dros avadmyofebi eqvemdebarebian aucilebel,
swraf hospitalizacias. am dros avadmyofebi, rogorc wesi, Tavsdebian intensiuri
Terapiis an reanimaciis ganyofilebebSi.
daavadebis paTogenezis sirTule da mravalferovani klinikuri gamovlinebani (pirvel
rigSi, gastrointestinuri formis dros), miznad isaxavs Semdeg umTavres amocanebs:
1)wyal-marilovani cvlis swrafi normalizacia, 2)organizmis dezintoqsikacia, 3)brZola
hipoqsemiasTan, hipoqsiasTan, metabolur acidozTan, 4)hemodinamikis, gul-sisxlZarRvTa,
Tirkmlebisa da sxva sistemebis fiziologiur doneze SenarCuneba.
mZime formebis dros, gansakuTrebiT, III xarisxis gauwyloebis SemTxvevaSi (miTumetes,
Tu mimdinareobs infeqciur-toqsikuri, hi povolemiuri SokiT) aucilebelia: 1)venaSi
intensiuri infuzuri Terapiis gadaudebeli Catareba. amisaTvis saukeTeso xsnarad
iTvleba ringeris laqtatis xsnari, romlis Seyvanis intensivoba damokidebulia gul-
sisxlZarRvTa sistemis mdgomareobaze. periferiuli pulsis uqonlobisas xsnari
SehyavT TiTqmis nakadurad, sanam ar aRdgeba pulsi (15-30 wT-is ganmavlobaSi).
Semdgom ki atareben wveTovan gadasxmebs saTanadod gaangariSebuli dozebiT da Tvalyurs
adevneben, rom ar gadaitvirTos gulis marjvena nawili, ar ganviTardes SeSupebiTi
movlenebi. 2) dezintoqsikaciisaTvis venaSi saWiroebisas SehyavT albumini, plazma,
reopoliglukini; tvinis SeSupebisa da gajirjvebis Tavidan acilebis mizniT uniSnaven
oqsigenoTerapias, krunCxvis dros _ diazepams. Cvenebisas SehyavT sagule glikozidebi,
rogorc wesi, mxolod dehidrataciuli movlenebis moxsnis Semdeg.
acidozis mosaxsnelad venaSi SehyavT natriumis bikarbonatis 4%-iani xsnari, pH-
is gaTvaliswinebiT. mkveTri anemiis dros xdeba eriTrocitebis masis gadasxma, JangbadiT
inhalacia.
400
etiotropuli Terapia. gastrointestinuri formis dros antibiotikebi uefeqtoa

da amitom ar eniSnebaT maT iyeneben mxolod maSin, Tu adgili aqvs sxva baqteriuli
floriT ganpirobebul raime garTulebas. am SemTxvevaSi gamoiyeneba ampicilini,
qloramfenikoli, gentamicini, cefalosporinebis jgufi, 5-7 dRe. generalizebuli
salmoneluri infeqciis dros iniSneba farTo speqtris antibiotikebi da maTi kombinacia
(ampicilini + gentamicini da sxv.). gaxangrZlivebuli da qronikuli formebis dros
zogjer karg efeqts iZleva intravenuri imunoglobulinebi da sxva. msubuqi da
saSualo simZimis salmonelozis dros zogjer SeiZleba gamoviyenoT polivalenturi
baqteriofagi.
prognozi. umravles SemTxvevaSi daavadeba mTavrdeba keTili gamosavliT. letalur
gamosavals SeiZleba adgili hqondes sefsisuri formis dros, mcire asakis bavSvebSi,
gansakuTrebiT interkurentuli daavadebis TandarTvis SemTxvevebSi (baqteriuli,
baqteriul-virusuli infeqciis darTvisas).
profilaqtika. salmonelozis profilaqtika iTvaliswinebs kompleqsur RonisZiebebs
da isaxavs sam ZiriTad amocanas: 1)veterinarul-sanitarul, 2)sanitarul-higienur da
3)epidsawinaaRmdego zomebis ganxorcielebas.
veterinarul-sanitaruli zomebi iTvaliswinebs Sinauri cxovelebisa da
frinvelebis daavadebis gavrcelebis Tavidan acilebas,sanitaruli reJimis organizacias
xorcis, rZis kombinatebSi.
sanitarul-higienuri reJimis amocanaa mikrobebis ganTesvisa da Senaxvis aRkveTa
kvebiTi produqtebis damuSavebis, realizaciisa da Senaxvis qselSi. gansakuTrebuli
yuradReba eqceva xorcis, kvercxisa da sxva produqtebis Termul damuSavebas. sanitarul-
higienuri RonisZiebebi mimarTuli unda iyos bavSvebisa da mozrdilebis sanitaruli
kulturis amaRlebaze.
epidsawinaaRmdego brZola iTvaliswinebs daavadebis gavrcelebis aRkveTas, pirvel
rigSi, organizebul koleqtivebSi (baga, baRi, kvebis blokebi da a.S.).
gadamwyveti mniSvneloba eniWeba infeqciis wyaros gamovlinebas, avadmyofebis
izolirebas da infeqciis gadacemis gzis Sewyvetas. avadmyofis izolaciis Semdeg
xdeba saboloo dezinfeqcia. karantini ar iniSneba. diareis mqone yvela kontaqtirebul
pirs utardeba gamokvleva salmonelozze. baqteriul kvlevas saWiroebs, agreTve,
avadmyofis mier 1-2 dRiT adre miRebuli produqtebi.
salmonelozze erTjradi baqteriologiuli kvleva gaTvaliswinebulia im bavSvTaTvis,
romlebic Sedian baga-baRSi, bavSvTa saxlSi, mozrdili personalisaTvis, romelTac
aReniSnebaT kuW-nawlavis disfunqcia da emsaxurebian bavSvebs.
avadmyofis izolacia wydeba mxolod sruli gamojanmrTelebisas da erTjeradi
baqteriologiuri gamokvlevis uaryofiTi pasuxis SemTxvevaSi, roca kvleva xdeba
araumetes 3 dRis etiotropuli mkurnalobis Sewyvetis Semdeg.
baqteriamtarebeli ar daiSveba bagaSi, baRSi. maTi daSveba gaTvaliswinebulia mxolod
3-jeradi baqteriologiuri gamokvlevisas uaryofiTi pasuxis Semdeg. Sidahospitaluri
salmonelozis afeTqebis SemTxvevaSi moqmedebs specialuri instruqciiT
reglamentirebuli reJimi.
salmonelozis specifikuri profilaqtika ar arsebobs.
401
kerZo nawili. eSerixiozi
eSerixiozi
(ESCHERICHIOSIS)
sinonimi _ nawlavTa koliinfeqcia.

eSerixiozi warmoadgens nawlavTa mwvave infeqcias, romelic mimdinareobs gastro-
enteritis, gastroenterokolitis simptomebiT, zogjer infeqciis generalizaciiT da
gamowveulia diareagenuli nawlavTa CxirebiT. daavadeba, upiratesad, mcire asakis
bavSvebSi aRiniSneba.
saxelwodeba eSerixiozi dakavSirebulia avstralieli mecnieris T. Escherich-is
saxelTan, romelmac pirvelad aRwera nawlavis Cxiri _ B. Coli Commune da romelmac
azri gamoTqva bavSvTa diareis ganviTarebaSi am mikrobis SesaZlo rolze.
1922w. A.Adam-ma daadgina, rom saprofitul nawlavTa Cxirebs Soris arseboben
enteropaTogenuri Stamebic. am Stamebis detaluri Seswavla SesaZlebeli gaxda mxolod
50-ian wlebSi, rodesac F. Kauffman-ma daamuSava maTi serologiuri diagnostika.
termini “enteropaTogenuri” gamoxatavs mTavar ganmasxvavebel niSans sxva mravalricxovani
nawlavis Cxirebisagan, romlebic binadroben nawlavebSi normaluri floris saxiT.
etiologia. gamomwvevi mikrobebi miekuTvnebian Escherichia-s gvars, Enterobac-
teriaceae-s ojaxs da gramuaryofiTni arian, zomiT (0,4-0,6) X (2-3)mkm. kultura
kargad izrdeba Cveulebriv sakveb niadagebze. Tavisi morfologiuri TvisebebiT paTogenuri
da arapaTogenuri nawlavis Cxirebi erTmaneTisagan ar gamoirCevian, magram paTogenur
Stamebs gaaCniaT agresiulobis garkveuli faqtorebi (toqsinebi, hemolizinebi,
kolonizaciis unari), romlebic imyofebian plazmidebis kontrolis qveS.
mikrobebs gaaCnia rTuli antigenuri struqtura; Seicaven O-somatur Termostabilur,
K-zedapirul somatur Termolabilur da H-Soltisebur antigenebs.
amJamad Seswavlilia E. coli-is 170 sxvadasxva somaturi antigeni, maT Soris, 80
gamoyofilia adamianisaTvis paTogenuri Stamebidan. gamovlenilia 50-ze meti Soltiseburi
antigeni.
O an OK antigenis mixedviT aRniSnuli Cxirebi iyofian serologiur jgufebad,
xolo OKH an OH antigenis mixedviT seroti pebad. maTi gansazRvra xorcieldeba
specifikuri Sratebis meSveobiT.
imisda mixedviT, Tu ra faqtorebiTaa warmodgenili mikrobebi (kolonizaciis,
invaziurobis an enterotoqsinebis warmoSobis unari), yvela serovarianti pirobiTad
SeiZleba daiyos 5 jgufad:
eSerixiebis klasifikacia
eSerixiebis
# yvelaze xSiri serotipebi
kategoria
1 enteropaTogenuri klasi I plazmid(+). 055, 086, 0111, 0119, 0125, 0126, 0127,
0128ab, 0142
EPEC (epnC) klasi II plazmid(-) , 018, 044, 0112, 0114
2 enteroinvaziuri plazmid(+) 028ac, 029, 0124, 0136, 0143, 0144, 0152, 0164,
0167 da zogierTi aratipirebadi Stami
EIEC (einC)
3 enterotoqsigenuri plazmid(+) 06, 08, 015, 020, 025, 027, 063, 073, 080, 085,
ETEC (etnC) 0115, 0128ac (da ara 0125ab an 0128ad)

4 enterohemoragiuli 0157:H7, 026:H11 da sxva
EHEC (ehnC)
5 enteroagregaciuli
EAggEC (eanC) plazmid(+)
402
enteropaTogenur nawlavis Cxirebs (epnC-s) miekuTvneba 30-mde serologiuri

varianti, romelTa Soris wamyvania cxrilSi moyvanili seroti pebi. aRniSnuli
variantebiT gamowveuli daavadeba, rogorc wesi, ZuZumwovar bavSvebSi gvxvdeba. am
jgufis nawlavis Cxirebs gaaCniaT antigenuri msgavseba salmonelebTan da maT msgavsad
kargad mravldebian lorwovan garsebze, iWrebian masSi da iwveven anTebad procesebs
(upiratesad wvril nawlavebSi). ufro metad gavrcelebulia 0111 da 055 seroti pebiT
gamowveuli daavadeba danarCeni seroti pebi ki, ZiriTadad, sporaduli SemTxvevebis
saxiT gvxvdeba.
enteroinvaziur nawlavis Cxirebs (einC-s) miekuTvneba, umTavresad 13 serovarianti;
maT Soris, wamyvan Stamebad iTvlebian 0124 da 0151. am jgufis seroti pebi Seicaven
Sigelebis msgavs 0-antigens da Sigelebis msgavsad axasiaTebT nawlavebis EepiTeliumSi
invazirebisa da gamravlebis unari. isini eqsperimentSi zRvis goWebze iwveven
keratokoniunqtivits, xolo klinikurad ganapirobeben baqteriuli dizenteriis msgavs
mimdinareobas. daavadeba, umTavresad, gvxvdeba ufrosi asakis bavSvebsa da mozrdilebSi.
enterotoqsigenuri nawlavis Cxirebis (etnC-is) SemadgenlobaSi Semavali 0-
somaturi antigenis mqone mikrobebs Soris ganasxvaveben egzotoqsins. eSerixiebis
enterotoqsigenoba dakavSirebulia 2 toqsinTan: Termolabilur da Termostabilur
toqsinTan. etnC-s umravlesoba (70%) gamoimuSavebs orive toqsins, danarCenebi ki
mxolod Termolabilur an mxolod Termostabilur egzotoqsins.
damtkicebulia, rom Termolabiluri egzotoqsini _ cilaa, romelic hgavs qolerogens
da iwvevs nawlavTa maryuJebis gafarToebas sanaTurSi siTxis dagrovebis xarjze.
daavadeba ufro xSirad gvxvdeba bavSvebsa da mozrdilebSi, umTavresad, ganviTarebad
qveynebSi (brazilia, meqsika, fili pinebi da sxva). am infeqciiT iolad avaddebian
ganviTarebuli qveynebidan Casuli mgzavrebi, rasTanac dakavSirebulia saxelwodeba
“mogzaurTa diarea”.
enterohemoragiuli nawlavis Cxirebi (ehnC) (ehnC).. 1982w. amerikaSi (miCiganisa da
oregonis StatSi) nawlavTa mwvave diareis 2 afeTqebis dros pirvelad iqna
dadasturebuli 0157: 0157:H7 nawlavis Cxiris etiologiuri roli hemoragiuli
enterokolitebis ganviTarebaSi. am jgufSi Semavali sxva paTogenuri seroti pebic
ganapirobeben msgavs klinikur gamovlinebas (hemoragiul kolits).
dadgenilia, rom es serovarebi gamoyofen Sigelas msgavs 2 ti pis toqsins anu e.w.
“vero-toxin”-s. am ukanasknelis saxelwodeba ki dakavSirebulia mwvane maimunis Tirkmlis
(vero-Tirkmeli) qsovilovan ujredebze toqsinis citopaTogenur efeqtTan. 0157: H7
serovaris toqsini Tavisi paTogenezuri mniSvnelobiT da klinikuri gamovlinebiT
gansxvavdeba epnC-is, einC-is, etnC-is toqsinebisagan, Tumca misi moqmedeba srulad jer
kidev ar aris Seswavlili.
enteroagregaciuli nawlavis Cxiri Enteroaggregative E.coli, romelic
ganapirobebs HEp-2 ujredebTan adhezias qsovilovan kulturaSi. mas aseve uwodeben
automaaglutirebel da enteroadheziur-agregaciul E.coli-s. zogierTi am Stamebidan
arapaTogenuria, magram zogierTs aqvs Termostabiluri toqsini, romelic msgavsia
etnC-is toqsinisa. aseve gaaCnia Termolabiluri toqsini-cila, romelic Sedis Bordetella
pertussis adenilatciklazas hemolizinSi da iwvevs ujredSida Ca-is koncentraciis
matebas. zemoTaRniSnuli toqsinebis roli paTogenezSi jer srulad Seswavlili ar
aris. es Cxiri, rogorc Cans, kolonizirebs nawlavSi.
epidemiologia.. eSerixiozebi warmoadgenen anTroponozul daavadebas; aris
epidemiologia
monacemebi, rom eSerixiebi cirkulireben cxovelebsa da frinvelebSi.
epnC-is, einC-is da etnC-is infeqciis mTavar wyaros warmoadgens, pirvel rigSi,
avadmyofi adamiani daavadebis mwvave periodSi, roca ganavlidan SesaZloa TiTqmis
403
sufTa kulturis gamoyofa. epidemiologiurad ufro did saSiSroebas warmoadgenen

pirebi, romlebSic daavadeba gamowveulia enteroinvaziuri da enteropaTogenuri
eSerixiebiT. am mxriv yvelaze kontagiozuria serovari 0111. dasnebovneba xSirad
xorcieldeba egzogenurad, fekalur-oraluri gziT. rekonvalescentebSi
baqteriamtarebloba xanmoklea da ar aRemateba 2-3%-s. janmrTeli baqteriamtarebloba
xanmoklea da epidemiologiuri TvalsazrisiT mas didi mniSvneloba ara aqvs. eSerixiebiT
dasnebovneba, pirvel rigSi, xorcieldeba sayofacxovrebo gziT an sakvebis meSveobiT
(dedis, momvleli personalis mier gaWuWyianebuli xelebiT, sakvebi produqtebis, saojaxo
nivTebis, saTamaSoebis da sxva nivTebis dainficirebiT). Tavisi mniSvnelobiT meore
adgilzea wyliT inficireba.
epnC-iT upiratesad avaddebian 2 wlamde asakis bavSvebi. 2 Tvemde asakis bavSvebi
epnC
bunebrivi imunitetis gamo iSviaTad avaddebian. dRenakli bavSvebi ki am infeqciis
mimarT maRali mimReblobiT gamoirCevian. infeqciis gavrceleba SeiZleba rogorc
sporadulad, aseve epidafeTqebebis saxiT. ukanaskneli ki xSirad gvxvdeba somatur
stacionarebSi, baga-baRebSi, samSobiaro saxlebSi, gansakuTrebiT, dRenaklTa ganyofilebebSi.
daavadeba gvxvdeba wlis yvela periodSi.
einC-iT daavadebas upiratesad adgili aqvs alimenturi faqtorebiT dainficirebis
einC
Sedegad. amasTanave, epidafeTqeba viTardeba mokle drois monakveTSi (2-3 dRe) da
Rebulobs lokalur xasiaTs. infeqciis SemTxvevebi damaxasiaTebelia, ufro, zafxulsa
da Semodgomaze. avaddebian, upiratesad, ufrosi asakis bavSvebi. am daavadebis gadatanis
Semdeg araiSviaTia baqteriamtareblobis formireba.
etnC-iT dainficirebis wamyvani faqtorebia sakvebi produqtebi da wyali. daavadebis
etnC
ganviTarebisaTvis didi mniSvneloba aqvs organizmSi enterobaqteriebis didi doziT
arsebobas.
rigi mkvlevarebis azriT (W. Robson et al., 1993; B.Bell et al., 1994)
enterohemoragiuli (epnC) eSerixiozis dros, romelic gamowveulia E.coli 0157:H7-
iT, infeqciis wyarod iTvlebian inficirebuli msxvilfexa rqosani cxovelebi. infeqtis
gadacema xdeba mxolod inficirebuli xorciT, rZiT. daavadebis ganviTarebisaTvis
sakmarisia mikrobebisa da toqsinebis mcire dozebi. dadgenilia, rom daavadeba viTardeboda
axali, magram Termulad arasakmarisad damuSavebuli xorcis miRebis Sedegad. aRniSnuli
seroti piT 0157:H7 saSiSi afeTqebebi aRiniSna kanadaSi, aSS-Si. iaponiaSi daadgines,
rom inficirebis mniSvnelovani faqtori iyo arasakmarisad damuSavebuli hamburgerebi.
aRniSnulTan dakavSirebiT ismeba sakiTxi eSerixiozebis, rogorc anTropozoonozuri
daavadebis kvalifikaciis Sesaxeb.
eanC-is Sesaxeb cnobilia, rom igi kolonizirebs nawlavSi da zogierTi misi Stami
arapaTogenuria.
paTogenezi da paTmorfologia. yvela jgufis paTogenuri nawlavis CxiriT
dasnebovneba xorcieldeba mxolod peroralurad. maTTvis metnaklebad damaxasiaTebelia
organizmSi intoqsikaciis movlenebis Camoyalibebis saerTo meqanizmi, rac ganpirobebulia
mikrobTa mier gamomuSavebuli cilebis, fermentebis da enterotoqsinebis warmoSobiT
anTebadi procesis dros wvril nawlavebSi. mZime SemTxvevebis dros procesSi SeiZleba
CaerTos msxvili nawlavebic, daziandes regionuli limfuri kvanZebi da Sinagani
organoebi mikrobuli diseminaciis Sedegad. intoqsikacias xels uwyobs nawlavidan
sisxlSi Sewovili toqsikuri metabolitebi. toqsemiis Sedegia sisxlZrRvTa epiTeliumis
dazianeba, refleqsogenur zonaze da uSualod nervul sistemaze toqsinis moqmedeba,
sisxlZarRvTa kedlis ganvladobis gaZliereba.
I klasis epnC-iT gamomuSavebuli endotoqsinebi, gansakuTrebiT 0111, moqmedeben
enterocitebze qolerogenuli TvisebebiT, rac iwvevs wvrili nawlavis epiTeliumSi
404
ferment adenilatciklazas gaaqtiurebas. ukanaskneli ki iwvevs, Tavis mxriv, cikluri

3′-5′-adenozinmonofosfatis (camf) momatebas, xolo camf-is done ki gansazRvravs
nawlavis sekreciis moculobis gazrdas _ nawlavis sanaTurSi didi raodenobiT
siTxis, kaliumisa da natriumis marilebis dagrovebas. amave dros, nawlavebSi dagrovebuli
siTxis ukan Sewova ferxdeba da yovelive amis Sedegad viTardeba Zlieri faRaraTi.
ukanasknelTanaa dakavSirebuli organizmSi dehidrataciis ganviTareba, ris gamoc
mkveTrad iklebs cirkulirebadi siTxis raodenoba. hi poqsiis movlenebis Sedegad
viTardeba dauJangavi metabolitebis momateba, acidozi. mZime dehidrataciis SemTxvevebSi
SeiZleba ganviTardes gulsisxlZarRvTa, Tirkmlebis, RviZlisa da sxva organoebisa da
sistemebis mwvave ukmarisoba.
einC-iT enterocitebis daSlis gamo nawlavTa koliinfeqcia xasiaTdeba, rogorc
einC
saerTo intoqsikaciuri gamovlinebiT, ise enterokolitis simptomatikiT, rac araiSviaTad
ganapirobebs dizenteriis msgavs suraTs. etnC etnC-iT gamowveuli koliinfeqciis dros
adgili aqvs wvrili nawlavebis lorwovani mikrobebis adhezias garsebze, xolo
intoqsikacia ganpirobebulia Termostabiluri enterotoqsinebiT da mimdinareobs camf-
is an cgmf-is (cikluri guanidin monofosfati) aqtivaciiT. orive endotoqsiniT (Ts,
Tl) intoqsikaciis SemTxvevaSi aqtivacia xdeba, rogorc camf-is, aseve cgmf-is, romlebic
mniSvnelovnad iwveven eleqtrolitebisa da wylis gaZlierebul sekrecias da ganapirobeben
organizmis gauwyloebas.
ehnC-iT gamowveuli enterohemoragiuli eSerixiozebis dros mikrobebis adhezias
ehnC
adgili aqvs distaluri msxvili nawlavebis lorwovani garsis epiTeliumSi. am jgufis
wamyvan paTogenur faqtors warmoadgens citotoqsini anu vero-toqsini. ukanasknelis
cirkulacia sisxlSi lipopolisaqaridebTan erTad iwvevs intoqsikacias, poliorganul
ukmarisobas da ganapirobebs hemoragiul enterokolits araiSviaTad mZime garTulebiT
(hemolizur-uremiuli sindromi (hus), Trombocitopeniuri purpura, toqsikuri Soki
da a.S.), rasac aqvs prognozulad mZime gamosavali.
wvril nawlavebSi eSerixiozebis dros aRiniSneba paTmorfologiuri cvlilebebi.
aris siTxis didi raodenobiT Semcveloba maTi sanaTurebis gafarToebis xarjze.
nawlavebis kedlebSi aRiniSneba sisxlsavseoba zomieri SeSupebiT, erTeuli sisxlCaqcevebis
kerebiT. enterocitebi ganicdian distrofiuli xasiaTis cvlilebebs, aris jirkvlebis
hi persekrecia da folikulebis hiperplazia nekrozuli movlenebiT, lorwqveSa garsis
stromis anTebadi infiltraciiT. enteriti atarebs katarul-desqvamaciur, iSviaTad
hemoragiul xasiaTs. SeiZleba adgili hqondes hemoragiul suraTs, iSviaTad, nekrozuli
enteritis saxiT, rac ganpirobebulia nawlavebisa da jorjlis sisxlCaqcevebiT
Trombozis Sedegad. damaxasiaTebelia lorwqveSa, iSviaTad ki serozuli garsqveSa
pnevmocistozis movlenebi, rac mowmobs eSerixiebis unarze, gamohyon airi.
Sinagan organoebSi xdeba sxvadaxva cirkulaciuri da distrofiuli movlenebi.
SesaZloa, agreTve, gamoixatos ehnC-iT gamowveuli kerovani pnevmoniis suraTi. kuW-
nawlavis sisxlZarRvebis ganvladobis gaZlierebis gamo SesaZloa meoradi infeqciiT
gamowveuli sxvadasxva saxis garTulebebis Camoyalibeba.
sikvdilis mizezi SeiZleba iyos Rrma dehidrataciis movlenebi, toqsikozi, nivTierebaTa
cvlis moSla da meoradi infeqciis darTva.
klinika.. eSerixiozis dros inkubaciuri periodis xangrZlivoba, klinikuri
klinika
gamovlinebis mravalferovneba, misi simZime damokidebulia bavSvis asakze, mis imunur
statusze, premorbidul fonze, Tanmxleb daavadebebze, eSerixiebis jgufze, serologiur
variantze, infeqtis dozaze da mTel rig sxva faqtorebze.
epnC, I klasis eSerixiebi daavadebas iwveven ufro wlamde asakis bavSvebSi, rasac
adre toqsiur dispefsiad Tvlidnen. inkubaciuri periodis xangrZlivoba mcire asakis
405
bavSvebSi ganisazRvreba 5-8 dRiT; maSin, roca sust bavSvebsa da axalSobilebSi

SeiZleba 1-2 dRe an piriqiT 2-3 kvira iyos. ukanasknels adgili aqvs infeqtiT mcire
doziT dasnebovnebis dros.
epnC, II klasis eSer ixiebi iwveven salmonelozis ti pis klinikur suraTs, rogorc
eSerixiebi
bavSvebSi, aseve mozrdilebSi.
eSerixiozis saerTo klasifikacia amJamad miRebuli ar aris, magram praqtikaSi
mizanSewonilia klinikurad mimdinare variantebisa da daavadebis simZimis gaTvaliswineba.
(mag.: gastriti, enterokoliti, gastroenterokoliti).
yvela jgufis eSerixiozisaTvis klinikuri mimdinareoba SeiZleba warmodgenili
iyos, rogorc saerTo toqsikur-infeqciuri sindromiT, aseve calkeuli jgufebisa da
serovarebisaTvis, maTTvis damaxasiaTebeli klinikuri suraTiT. umravles SemTxvevaSi
daavadeba iwyeba mwvaved, temperaturis gareSe, defekaciis gaxSirebiT, ganavali wylisebria,
saWmlis mounelebeli nawilebiT, zogjer TiTqosda dakepil kvercxs hgavs, moyviTalo-
narinjis an oqrosferisaa.
msubuqi formis dros temperatura ufro xSirad normaluria, zogadi intoqsikaciis
movlenebi ar aRiniSneba, mada ar irRveva, defekaciis sixSire ar aRemateba 3-5-s dRe-
RameSi, klinikuri gamovlinebani dispefsiuri sindromis msgavsia. sxeulis masa ar
qveiTdeba. daavadebis xangrZlivoba 1 kviras ar aRemateba.
saSualo simZimis dros ki temperatura aRwevs 39-40°C, saxezea organizmis
intoqsikaciis simptomebi _ saerTo sisuste, adinamia, uZiloba. kanis safari da xiluli
lorwovani garsebi fermkrTalia, Rebinebis sixSire aRwevs 2-3-s dRe-RameSi, xangrZlivia
da aqvs mdgradi xasiaTi. defekacia aris 10-15-jer dRe-RameSi, ganavali wylisebria,
qafiani, mcire ganavlovani masebiT, sxeulis masa zomierad klebulobs. daavadebis
mimdinareoba damokidebulia saTanado mkurnalobis Catarebaze. daavadebis xangrZlivoba
xSirad grZeldeba 2-3 kvira.
mZime forma _ xSirad ganpirobebulia ara marto organizmis reaqtiulobis
daqveiTebiT da asakobrivi TaviseburebebiT, aramed epnC-is serovariTac (055, 0111). am
SemTxvevebSi daavadeba iwyeba temperaturis 39-40°C-mde momatebiT. defekacia xSirdeba
dRe-RameSi 15-20-mde, Rebineba ki 4-5 jeraa, gamoxatulia meteorizmi nawlavTa parezis
gamo, sxeulis masa mniSvnelovnad iklebs, ecema arteriuli wneva, gulis tonebi
moyruebulia, sunTqva gaxSirebulia, aRiniSneba taqikardia. Zlier mZime formebis dros
gamoxatulia mkveTri neirotoqsikozi. pirvelsave dRes vlindeba nervuli sistemis
dazianeba _ mkveTri agzneba, adgili aqvs tonuri xasiaTis krunCxvebs, gonebis dakargvas,
xSir Rebinebas, saxezea meningealuri movlenebi, kisris kunTebis rigidoba, didi yiflibandi
amoburculia da pulsirebs. aseT dros sisxlSi dgindeba natriumis da kaliumis
Semcvelobis momateba.
koliinfeqciis dros sisxlSi aRiniSneba zomieri leikocitozi neitrofiloziT,
momatebulia eds.
koliinfeqciis xangrZlivi da talRiseburi mimdinareoba temperaturis ganmeorebiTi
momatebiT, diareis gamwvavebiT xSirad ganpirobebulia Tanmxlebi daavadebebiT,
superinfeqciebiT, mwvave respiraciuli virusuli da nawlavTa mwvave infeqciebiT
(Serwymuli dizenteriasTan, salmonelozTan da a.S.), nawlavTa disbaqterioziT, meoradi
baqteriuli floriT.
mozrdili asakis bavSvebSi zogjer SeiZleba adgili hqondes dizenteriis msgavs
koliinfeqcias, einC-is 0124 serovariT gamowveuls, romlis epidemiologiuri (epidkerebis
formireba, daavadebis sezonuroba, ZuZumwovar bavSvebSi SemTxvevaTa iSviaToba, mozrdil
asakSi ki sixSiris upiratesoba) da klinikuri ( mokle inkubaciuri periodi: saSualod
2-3 dRe, kolituri sindromi) Taviseburebani dizenteriis msgavsia.
406
0124 serovariT gamowveuli daavadeba dizenteriisagan

gansxvavdeba WinTvebisa da anusis Riaobis ararsebobiT,
xolo iseTi simptomebi, rogoricaa xanmokle intoqsikacia,
kolituri simptomebi – SeteviTi xasiaTis muclis
tkivilebi, spazmuri sigmoiduri nawlavi, ganavalSi didi
raodenobiT lorwo da sisxlis Zafiseburi minarevi Zlier
waagavs dizenterias. aRniSnulTan dakavSirebiT, diagnozis
dadgena ufro eyrdnoba baqteriologiur gamokvlevebs.
etnC-iT gamowveul eSerixiozul infeqcias, anu
rogorc mas uwodeben qoleris msgavs diareas, upiratesad
adgili aqvs ufro mozrdilebSi. daavadeba iwyeba mwvaved,
saerTo sisustiT, gulisrevis SegrZnebiT da RebinebiT.
avadmyofebi uCivian SeteviTi xasiaTis muclis tkivils,
defekaciis sixSirea 10-15 dRe-RameSi. ganavali Rebulobs
brinjis naxarSis Sesaxedaobas. ufro xSirad viTardeba
agznebuli mdgomareoba,
II xarisxis gauwyloeba, iSviaTad ki III xarisxisa. daavadeba
gamowveuli dehidrataciiT da
grZeldeba 3-5 dRe. toqsikoziT (Tanmxlebi
enterotoqsigenuri eSerixiebi ganviTarebad daavadebebi - malnutricia, mZime
qveynebSi(azia, afrika, laTinuri amerika) mogzaurTaTvis raqiti). (sakuTari masala)
diareis mizezs warmoadgenen 60-70%-Si. isini
inficirdebian keraSi Casvlidan araumetes 4 dRis Semdeg. daavadeba iwyeba mwvaved,
mucelSi Wris SegrZnebiT, gulisreviTa da RebinebiT, profuzuli faRaraTiT, rac zog
avadmyofSi iwvevs gauwyloebas; es ki gansakuTrebiT saSiSia tropikul qveynebSi
oflis saxiT siTxis didi raodenobiT dakargvis gamo. daavadeba grZeldeba 4-5 dRe.
ehnC-iT gamowveuli eSerixiozis inkubaciuri periodi ganisazRvreba 1-7 dRiT.
ehnC
daavadeba SeiZleba mimdinareobdes sxvadasxva klinikuri variantiT – dawyebuli waSlili
formidan, damTavrebuli mZime formiT. gansakuTrebiT mZimed mimdinareobs 0157:H7-
iT gamowveuli infeqcia. daavadeba iwyeba mwvaved, muclis tkivilebiT, gulisreviT,
ganmeorebiTi (3-4-jer) RebinebiT, faRaraTiT (5-10-jer dRe-RameSi). daavadebis me-2
dRes aRiniSneba saerTo mdgomareobis gauareseba, Zlierdeba muclis tkivili, defekaciis
sixSire izrdeba, ganavali sisxliania da ganavlovan masebs TiTqmis ar Seicavs. maRali
temperatura damaxasiaTebeli ar aris; gulisreva aReniSneba TiTqmis yvela avadmyofs,
faRaraTi ki mxolod 1/3-s. kolonoskopiiT dgindeba katarul-hemoragiuli an fibrinul-
wylulovani koliti. paTmorfologiuri cvlilebebi aRiniSneba brma nawlavis ubanze,
reqtosigmoidur monakveTSi ki _ naklebad.
yvelaze saSiS garTulebad iTvleba hemolizur-uremiuli sindromi (hus) – gaseris
sindromi, romlisTvisac damaxasiaTebelia klinikurad gamoxatuli simptomatika _
hemolizuri anemia, Trombocitopenia, Tirkmlis mwvave ukmarisoba. xSirad am triadas
Tan erTvis cerebronevrologiuri darRvevebi: kidurebis kunTebis krunCxvebi,
decerebraciuli rigidoba, hemi parezi, sopori, koma.
epnC-iT gamowveuli eSerixiozisaTvis damaxsiaTebelia siTxis didi raodenobiT
epnC
dakargva, xolo pirRebiniba da sisxliani ganavali iSviaTia.
daavadebis toqskoziTa da eqsikoziT mimdinareobisas, rac ufro mcire asakis
bavSvebSi gvxvdeba, klinikurad saxezea, rogorc nervuli, aseve gul-sisxlZarRvTa
sistemis dazianeba, rac ganpirobebulia xSiri defekaciiT, siTxisa da eleqtrolitebis
Tanabari (izotonuri) an siTxis an eleqtrolitebis upiratesi dakargviT.
garTuleba ufro dakavSirebulia mwvave respiraciuli virusuli infeqciis
darTvasTan da pirobiTpaTogenuri mikrobuli floris gaaqtivebasTan. ufro xSiria
407
iseTi garTulebebi, rogoricaa otiti, pnevmonia, piodermia, pielonefriti da sxva.

imunokomprometirebulebSi daavadebam SeiZleba miiRos sefsisuri xasiaTi.
prognozi. letalur SemTxvevebs adgili aqvs ufro axalSobilebSi, gansakuTrebiT,
miqst-infeqciebis dros da procesis generalizaciisas.
diagnozi, ZiriTadad, eyrdnoba laboratoriul gamokvlevebs. daavadebaze eWvis
mitana gaadvilebulia diareis uecari afeTqebebis dros, gansakuTrebiT, bavSvTa
koleqtivebSi mZimed mimdinare SemTxvevebisas. am mxriv aRsaniSnavia mcire asakis
bavSvebSi faRaraTis fonze toqsikozisa da eqsikozis mzardi mateba, sxeulis masis
dakleba, damaxasiaTebeli enterituli an enterokolituri ganavali da sxva.
baqteriologiuri meTodi mTavaria laboratoriuli diagnostikisaTvis. masalas
iReben ganavlidan, iSviaTad, xaxis lorwovanidan, pirnaRebi masidan, kuWis amonarecxidan,
sisxlidan; seqciaze iReben sisxls gulidan, qsovils _ filtvebidan, RviZlidan, elenTidan,
wvrili da msxvili nawlavebis lorwovani garsebidan da Tesaven endosa da levinis
niadagebze. 50-60%-Si SesaZlebelia miviRoT nawlavis Cxirebis paTologiuri serotipebis
amoTesvis dadebiTi pasuxi, maTi mgrZnobelobis Semdgomi gansazRvriT ki generalizebuli
formis dros avirCioT antibiotikebi da qimiopreparatebi. 0157:H7 koliinfeqciisaTvis
saWiroa specialuri niadagebi da laboratoriuli kvlevebi toqsinis gamosavlenad,
rac SeuZlebelia ganxorcieldes Cveulebrivi laboratoriis pirobebSi.
serologiuri gamokvlevebidan iyeneben aglutinaciis reaqcias, arapirdapiri
hemaglutinaciis reaqcias, daavadebis dinamikaSi diagnostikur titrad iTvleba 1:80,
1:100 ganzaveba; magram xazgasasmelia, rom 3 Tvemde da, gansakuTrebiT, dRenakl bavSvebSi
antisxeulebis titri dabalia da aRiniSneba iSviaTad.
diferenciuli diagnostikis Catareba zogjer saWiroa mcire asakis bavSvebSi,
pirvel rigSi, martivi dispefsiis dros. diferenciuli diagnozi tardeba agreTve
salmonelozTan, stafilokokuri da virusuli genezis diareebTan.
e.w.martivi dispefsiis dros irkveva asakTan SedarebiT zedmeti sakvebis miReba an
araswori kveba. bavSvs aReniSneba wamoqafeba, ganavali Txelia, gadaumuSavebeli, mwvane
feris, raime paTologiuri minarevebis gareSe, aqvs mJave suni. faRaraTis sixSirea 5-6
dRe-RameSi, zogjer awuxebs muclis Seberva, magram saerTo mdgomareoba ar irRveva.
kvebis koreqciis Semdeg nawlavis funqciis aRdgena swrafad xdeba.
stafilokokuri etiologiis diareis dros dedebSi anamneziT dgindeba mastitis,
anginis, kanis Cirqovani procesis arseboba, xolo bavSvebSi ( axalSobilebSi) _ omfaliti,
piodermia, pnevmonia da sxva. saerTo mdgomareoba SeiZleba didxans iyos damakmayofilebeli,
magram am fonze ganavali Seicavs paTologiur minarevebs, maT Soris lorwosa da
sisxls.
mkurnaloba. daavadebis msubuqi da saSualo simZimis dros sakmarisia oraluri
rehidrataciis Catareba _ ORS-iT rehidroniT da sxva siTxeebiT datvirTva (Cai,
brinjis naxarSi, wvenebi, borjomi da sxva). mZime gauwyloebis da Sokis SemTxvevebSi
avadmyofi Tavsdeba stacionaris intensiuri Terapiis palataSi da venaSi dauyovnebliv
utardeba eleqtrolituri xsnarebis Seyvana;
klinikuri da laboratoriuli testebis meSveobiT ganisazRvreba gadasasxmeli
siTxis raodenoba, infuziis tempi. aseT maCveneblad iTvleba pulsis mdgomareoba (misi
aRdgena, savseoba, arteriuli wnevis aRdgena, gulis tonebis simZlavre, hematokritis,
natriumisa da kaliumis koncentraciis gansazRvra, sxeulis masis gansazRvra daavadebis
dinamikaSi, siTxis mimdinare danakargis gansazRvra, rac mniSvnelovania rehidrataciis
swori CatarebisaTvis, maT Soris marjvena gulis gadatvirTvis Tavidan acilebis
mizniTac (mkurnalobis princi pebi ix. zogad nawilSi).
kaliumis deficitis dros organizmSi damatebiT unda SeviyvanoT kaliumis qloridi,
408
romlis gamoangariSeba SeiZleba formuliT:
kaliumis(K)deficiti(mmol)=(K norm.- K avadm.) X sxeulis masa

3
normaSi kaliumis raodenoba Seadgens 4,5mmol/l.
dadgenili K-s raodenoba unda SeviyvanoT venaSi wveTovnad neli tempiT dRe-
Ramis monakveTSi (2-3 gadasxma) glukozis 10%-ian xsnarTan erTad insulinis damatebiT.
xsnaris Seyvana Catardes ise, rom kaliumis koncentracia ar aRematebodes 0,5-1%-s.
SemdgomSi kaliumi unda SeviyvanoT sisxlSi misi gansazRvris gaTvaliswinebiT.
Tu avadmyofs ar aReniSneba hi pokaliemia, kaliumis aucilebeli raodenobis
miwodeba organizmisaTvis xdeba per os sakvebTan erTad.
metaboluri acidozis koreqciisaTvis venaSi SehyavT 4%-iani sodis xsnari, romlis
raodenobasac angariSoben formuliT:
4%-iani hidrokarbonatis xsnaris r-ba (ml)=sx.masa(kg) X BE X 0.5
sadac BE aris fuZis deficiti astrupis mikromeTodis mixedviT.

Tu acidozis dadgena mikromeTodiT ver moxerxda, SeiZleba gamoviyenoT klinikuri
maCveneblebi (`marmarilosebri” kani, oliguria, qoSini, adinamia, hi perTermia,
mikrocirkulaciis moSla). am SemTxvevebSi sodis 4%-iani xsnaris saWiro raodenobaTa
gansazRvra xdeba gamoangariSebiT : 4 ml X sxeulis masaze (kg).
daavadebis mZime mimdinareobisas kortikosteroidebis daniSvna paTogenezurad ar
aris gamarTlebuli. hi povolemiisa da hipovolemiuri Sokis dros mTavaria dakarguli
siTxis Semcvelobis aRdgena. eniSnebaT maRalkaloriuli vitaminebiT mdidari kveba.
rac Seexeba sagule glikozidebs, misi daniSvna SesaZlebelia, Tu venuri auzis Sevsebis
Semdeg gulis ukmarisoba ar moixsna. didi mniSvneloba eniWeba Jangbadis miwodebas.
mkurnalobis aucilebel princi ps warmoadgens srulfasovani kvebis uzrunvelyofa.
rogorc mwvave diareis dros, aseve mis Semdeg periodSi. ar arsebobs fiziologiuri
safuZveli nawlavebis sakvebisagan `dasvenebisaTvis”.
etiotropuli mkurnaloba ganisazRvreba infeqciuri procesis generalizaciiT
(sefsisi, meningiti). am dros aucilebelia mkurnalobaSi antibiotikebis CarTva _
ampicilini + aminoglikozidebi an ampicilini + cefalosporinebi (cefotaqsimi,
ceftazidimi da sxv.). meoradi infeqciiT garTulebuli eSerixiozis SemTxvevebSi
mkurnaloba sxva antibiotikebiTac tardeba. eSerixiozis lokaluri formis dros
antibiotikebi iniSneba mxolod ganavalSi sisxlis arsebobis SemTxvevaSi.
unda aRiniSnos rom antibiotikebis daniSvna 0157:H7 koliinfeqciis dros xels
uwyobs endotoqsemias (baqteriebis daSlis Sedegad), ris gamoc sisxliani faRaraTi,
Sokuri mdgomareoba da hemolizur-uremiuli sindromi SesaZloa sikvdiliTac damTavrdes.
profilaqtika. vinaidan eSerixiozebiT, ZiriTadad, avaddebian mcire asakis bavSvebi,
koliinfeqciis Tavidan acilebis mizniT profilaqtikuri RonisZiebebi mimarTuli
unda iyos sanhigienuri normebis dacvisaken stacionarebSi, samSobiaro saxlebSi, dRenaklTa
ganyofilebebSi. 0157:H7 koliinfeqciis profilaqtikisaTvis aucilebelia xorcisa
da sxva produqtebis swori Senaxva, miwiT dabinZurebisagan dacva, xorcis kargi
Termuli damuSaveba. didi mniSvneloba aqvs avadmyofebis adreul gamovlinebasa da
mkurnalobas.
409
kerZo nawili. qolera
qolera
(CHOLERA)
qolera nawlavTa mwvave infeqciaa fekalur-oraluri gziT gadacemis meqanizmiT,

romlis gamomwvevia enterotoqsinis gamomuSavebis unaris mqone vibrioni Vibrio cholerae
01. daavadeba mimdinareobs dawyebuli usimptomo formidan, damTavrebuli ukiduresad
mZime gastroenteritiT _ faRaraTiTa da RebinebiT, siTxisa da eleqtrolitebis
katastrofuli dakargviT. mkurnalobis gareSe aseTi SemTxvevebi letalurad mTavrdeba.
jandacvis saerTaSoriso organizaciis mediko-sanitaruli normiT qolera sakarantino
(sakonvencio) daavadebebs miekuTvneba.
mokle istoriuli cnobebi da etiologia. qolera, romelsac saxelwodeba
hi pokratem misca, uZvelesi droidan iyo cnobili. istoriulad mis endemur kerad
samxreT-aRmosavleT aziis qveynebi iTvleboda, kerZod, mdinare gangisa da brahmaputras
auzebi (indoeTi, pakistani, bangladeSi). V.cholerae 01 gramuaryofiTi moZravi (aqvs
Solti) mikroorganizmia, romelic sporebs ar warmoSobs, zomiT (1,5-3,0)X0,5mkm-ia.
serojgufebis (serovarebi) dayofa xdeba somaturi an 0 antigenis mixedviT.
V.cholerae 01-s gaaCnia 2 ZiriTadi antigenuri ti pi (Ogawa, Inaba) da 1
arastabiluri Sualeduri (Hikojima) ti pi. axali epidemiuri Stami V.cholerae-
0139(Bengal) 01-antiSratiTan ar aglutinirebs, magram igi El-Tor-is bioti pTan
axlos dgas. Non-01 V.cholerae (araaglutinirebuli V.cholerae anu NAG) aRmoCenili
iyo aSS-Si. igi V.cholerae 0139-sagan gansxvavebiT epidemiebs ar iwvevs.
arCeven qoleris gamomwvevi vibrionebis or sxvadasxva biovariants (bioti ps) _
koxis klasikurs da El-Tor-s. pirveli aRwerili iyo 1883-1885ww. robert koxis mier
(egvi pte), rogorc qoleris erTaderTi gamomwvevi agenti. 1906w. sakarantino sadgur
El-Tor-Si (sinai) f. gotSlixma aRwera bioti pi, romelmac El Tor–is vibrionis
saxelwodeba miiRo da 1962 w. msoflio jandacvis organizaciis mier aRiarebuli iqna,
rogorc qoleris gamomwvevi.
1817 wlamde qolera faqtiurad ar gascilebia indo-pakistanis epidemiur keras,
rasac xels uwyobda geografiuli (Tbili klimati), dabali socialuri da sanitarul-
higienuri pirobebi. 1817 wlidan 1926 wlamde tradiciuli endemiuri kerebidan qoleram
6-jer miiRo pandemiuri gavrcelebis saxe TiTqmis yvela kontinentze, rasac milionobiT
adamianis sicocxle Seewira. 1926-1960ww. qolera upiratesad isev endemur kerebSi
lokalizdeba.
Tu 1960 wlamde klasikuri qoleris gamomwvev agentad koxis vibrioni iTvleboda,
razec mowmobda SemTxvevaTa 80%-Si avadmyofebis fekaliebdan misi gamoyofa, ukve
1970w. iseT klasikur endemur keraSi, rogorc indoeTia, ar iyo registrirebuli
klasikuri (koxis) vibrioniT gamowveuli qoleris SemTxvevebi. 1961 wels El-Tor
vibrioniT gamowveuli me-7 pandemia gascilda msoflioSi arsebul mxolod erTaderT
endemur keras _ kunZul sulavess (indonezia). daavadebam SeaRwia sxva regionebSi,
sadac uwin klasikuri qolera batonobda.
60-iani wlebis Sua ricxvebSi qolera El-Tor praqtikulad gavrcelda samxreT-
aziis yvela qveyanaSi, xolo 1970-77ww. ukve msoflios 86 qveyanaSi aRniSnuli iyo
qoleris SemTxvevebi, maT Soris evropis, avstraliis, axali zelandiis, aSS, kanadis
qveynebSi. SedarebiT maRali sixSiriT aRiniSna daavadebis kerebi yofil sabWoTa
kavSiris respublikebis teritoriebze (astraxanis olqi, Savi zRvis sanapiros regionebi)
erTeuli SemTxvevebi registrirebuli iyo saqarTveloSic.
infeqciis wyaros warmodgens mxolod adamiani _ ti puri an waSlili formiT
410
daavadebuli, rekonvalescenti da janmrTeli vibrion mtarebeli. Tu klasikuri qoleris

vibrionis garemoSi arseboba mxolod maSin aris SesaZlebeli, rodesac mis axlos
qoleriT daavadebuli an vibrionmtarebeli imyofeba, El-Tor-is vibrionis mimarT aseT
damajerebel faqtebs naklebad aqvs adgili. ukanasknelisaTvis damaxasiaTebelia
subklinikuri formebi, maRali vibrionmtarebloba da garemoSi vibrionis maRali
ganTesva, damaxasiaTebeli didxans SenarCuneba wyalSi, hidrobiontebSi _kiborCxala,
xamanwka, Tevzi da a.S.). vibrioni didxans Zlebs garemoSi Tundac maSin, rodesac
aRniSnul garemosaTan avadmyofi axlos ar aris. miuxedavad aRniSnulisa, mkvlevarebis
umravlesoba fiqrobs, rom adamianis gareSe infeqciis wyaro ar arsebobs.
daavadebis ti puri mimdinareobis dros, gansakuTrebiT pirvel 4-5 dRes intensiurad
xdeba ganavliT maRalvirulenturi variantebis gamoyofa (1 ml ganavali Seicavs 106-
109-mde vibrions. inkubaciur periodSi avadmyofi agreTve warmoadgens infeqciis ueWvel
wyaros, Tumca mas am dros didi epidemiologiuri mniSvneloba ar aqvs.
El-Tor afeTqebis epidsaSiSroebas warmoadgens rekonvalescentebi, janmrTeli
(tranzituli) mtareblebi, romlebic 1-2 kviris ganmavlobaSi, zogjer ki ufro metxans
gamoyofen vibrionebs), Tumca nakleb intensiurad. yvela SemTxvevaSi inficireba
xorcieldeba fekalur-oraluri gziT, magram didi mniSvneloba aqvs misi gadacemis
gzebs _ wyliT, sayofacxovrebo kontaqtiT, kvebis produqtebiT Tu Serwymul variantebs.
El-Tor-iT gamowveuli qoleris dros wamyvan gadamcem faqtorad iTvleba Ria
wylis auzi dabinZurebuli CanadeniT da sakanalizacio wyliT, sadac aRniSnuli
vibrionebi sicocxlisunarianobas 2 wels da metxans inarCuneben. adamianis inficireba
xdeba wylis sasmelad gamoyenebisas. xelis dabanis, banaobis, xilisa da bostneulis
garecxvis dros, sxva sayofaxcovrebo-sameurneo mizniT wylis xmarebis Sedegad.
daavadebulTa ricxvi damokidebulia rogorc wylis dabinZurebis xarisxze, agreTve
inficirebul pirTa raodenobaze. wyliT ganpirobebuli epidafeTqebisaTvis
damaxasiaTebelia avadobis maRali maCveneblebi ramdenime dRis ganmavlobaSi. rac
Seexeba epidprocess da mis Semdgom mimdinareobas, igi damokidebulia epidRonisZiebebze,
romlebic mimarTulia gadacemis meqanizmis Sesawyvetad.
El-Tor qoleris gavrcelebaSi didi mniSvneloba eniWeba inficirebuli produqtebis
miRebas (rZe, bostneuli, Tevzi da sxva). maTSi qoleris vibrionebis sicocxlisunarianoba
3-5 dRes aRwevs. aRwerilia SemTxvevebi, roca daavadeba gamowveuli iyo Termulad
damuSavebuli hidrobiontuli sakvebi produqtebis miRebis Semdeg. hidrobiontebSi
(xamanwka, kiborCxala, kibo, bayayi da sxv.) adgili aqvs vibrionebis gamravlebas, rac maT
infeqciis droebiT rezervuarad xdis.
kvebiTi epidafeTqebebi, Cveulebriv, SezRuduli kontingents moicavs da dakavSirebulia
inficirebuli produqtebis miRebasTan.
sayofacxovrebo-kontaqturi gziT infeqciis gadacemas naklebi mniSvneloba aqvs,
rac ganpirobebulia avadmyofebisa da vibrionmtareblebis swrafi hospitalizaciiT.
sayuradReboa, rom kuW-nawlavis traqtSi infeqtis moxvedra SeiZleba dabinZurebuli
xelebiT, inficirebuli saTamaSoebiT, tansacmliT da sxva sagnebiT.
zomieri klimatis mqone qveynebSi daavadebis sezonuroba zafxul-Semodgomis periodSi
dakavSirebulia gadacemis gzisa da gadacemis faqtoris inficirebasTan (wylis, bostneulis
da xilis uxvi raodenobiT miReba, banaoba, buzebis faqtori da sxv.).
upiratesad avaddebian mozrdili bavSvebi. aris monacemebi imis Sesaxebac, rom
endemur kerebSi 2 wlamde bavSvebi iSviaTad avaddebian (msoflio jandacvis organizaciis
monacemebiT).
paTogenezi da paTanatomia
paTanatomia.. infeqtis SeWra xorcieldeba piris Rrudan, saidanac
inficirebul wyalTan an sakvebTan erTad vibrionebi kuWSi xvdebian. piris RruSi am
411
dros raime dabrkolebas vibrionebi ar ganicdian. didi mniSvneloba eniWeba kuWis

funqciur mdgomareobas. aRsaniSnavia, rom qoleris vibrionebi Zlier mgrZnobiareni
arian marilmJavas mimarT, ase mag., maTi daRupva 1:10000 ganzavebaze ramdenime wamSi
xorcieldeba. aqedan gamomdinare, aqiliis da hi poaciduri gastritis dros xelsayreli
pirobebi iqmneba vibrionebis Semdgomi gavrcelebisaTvis. zafxulis pirobebSi, rodesac
adamians wylis didi raodenobiT miReba uxdeba, adgili aqvs kuWis wvenis ganzavebas,
gansakuTrebiT tutovani da maRalmineralizebuli wylis miRebis Sedegad. meores
mxriv ki xil-bostneulis uxvi raodenobiT miReba ganapirobebs kuWis SigTavsis
gaZlierebul evakuacias. aRniSnuli situacia ki xels uwyobs organizmis rezistentobis
daqveiTebas da qoleris vibrionis gadasvlas wvril nawlavebSi.
dadgenilia, rom Tu mainficirebeli doza 105-107-ze naklebia 1 ml substratSi,
mosalodnelia vibrionebis sruli daRupva, maSin rodesac qoleris ganviTarebis
SesaZlebloba miT ufro izrdeba, rac ufro maRalia vibrionis Semcveloba wyalSi da
sakvebSi. kuWis barieris gadalaxvis Semdeg vibrionebi aRweven wvrili nawlavebis
sanaTurs sicocxlisunariT, sadac intensiurad mravldebian tute aresa da peptonis
maRali Semcvelobis gamo.
lorwovani garsi Seicavs faqtorebs, romelTac vibrionisaTvis qemotaqsisuri
mniSvneloba aqvT. vibrionebi gamoimuSaveben proteolizur enzimebs, maT Soris mucinazas.
vibrionebis virulentobis maCvenebeli maTi moZraobisunarianobaa. 12-goja da Wia
nawlavebis vibrionebiT kolonizacias Tan axlavs enterotoqsinebis gamonTavisufleba,
rac iwvevs siTxis sekrecias nawlavis sanaTurSi. nawlavis lorwovani am dros ar
ziandeba, Tumca aRiniSneba intersticiuli sivrcis SeSupeba da kapilarebisa da limfuri
ZarRvebis dilatacia. anTeba moicavs ujredebis umniSvnelo raodenobas. gamoyofili
siTxe Tavisi SemadgenlobiT waagavs plazmas da Seicavs didi raodenobiT natriums,
bikarbonatebs, kaliums. aRiniSneba wvril nawlavebSi disaqaridebis, maT Soris laqtozis
daSla, glukozis absorbcia SenarCunebulia. enterotoqsinebis produqcia virionebis
`virulentobis kasetazea” kodirebuli. toqsinebs Soris gansakuTrebiT mniSvnelovania
qoleris toqsini _ e.w. `qolerogeni” _ msxvili cila, romlis genebia ctxA da ctxB,
arsebobs enzim_ aqtiuri A-suberTeuli da ujredSemboWavi B–suberTeuli, riTac
vibrionis toqsini emagreba ujredis kedels, qoleris klasikur Stamebs gaaCniaT
Tavisufali ctxAB–s 2 asli, xolo El-Tor-is Stamebs gaaCniaT, Cvulebriv, 1 asli.
B–suberTeulis receptori aris enterocitebis GM1- gangliozidi. A–suberTeulis
nawili A1 warmoadgens adf–riboziltransferazas, romelic aaqtivebs adenilatciklazas,
rac Tavis mxriv ganapirobebs camf-is donis xangrZliv momatebas. camf-is maRali
koncentracia ganapirobebs natriumisa da qloridebis absorbciis Seferxebas nawlavis
xaoebis mier, xolo kri ptebis mier ujredebiT qloridebis aqtiur sekrecias.
V.cholerae–s meore toqsinis roli dadginda genuri-inJineriis saSualebiT
specifikuri vaqcinis miRebis dros. aRmoCnda, rom e.w. zot–toqsini (zonula occludens
toxin) moqmedebs nawlavis lorwovanze, iwvevs ra misi ganvladobis gazrdas, sanaTurSi
wylisa da eleqtrolitebis gamosvlas. hidrostaturi wnevis Sedegad Zlierdeba
diarea.
mesame potenciuri damatebiTi ace–enterotoqsinis (accesory cholerae entero-
toxin) gens aqvs eukariotuli msgavseba iontransportul atf-azebTan da mukoviscidozis
transmembranul gamyol genTan.
genebi ctx, zot da ace warmoadgens V.cholerae `virulentobis kasetas” da
ganapirobeben diareis klinikas qoleris dros.
Non-01 da Non-0139 Stamebi V.cholerae(NAG) aproducireben qoleris
toqsinebisagan gansxvavebul enterotoqsinebs.
412
daavadebis mZime mimdinareobis dros mcire monakveTSi SesaZlebelia siTxisa da

eleqtrolitebis Semcvelobis katastrofuli dakargva RebinebiTa da faRaraTiT.
dakarguli siTxis saerTo raodenobam SeiZleba gadaaWarbos sxeulis masas 2-jer da
metad. eleqtrolitebis, gansakuTrebiT ki kaliumis deficiti SeiZleba davides 1/3-
mde normasTan SedarebiT. dehidrataciisa da demineralizaciis faqtorebi da maTi
xarisxi ganapirobebs qoleris mTavar paTogenezur meqanizms, maSin, rodesac intoqsikaciasa
da alergiul faqtorebs daavadebis paTogenezSi meorexarisxovani roli eniWeba.
hi povolemia, romelsac safuZvlad udevs ujredgare (eqstraceluluri) _
izoosmosuri dehidratacia, eleqtrolitebis mkveTr dakargvasTan erTad ganapirobebs
mTel rig paTfiziologiur mdgomareobas, romelic gamoixateba mocirkulire siTxis
daklebaSi, sisxlis SededebaSi, mikrocirkulaciis moSlaSi. hi pokaliemiis Sedegad
aRiniSneba kunTebis tonusis daqveiTeba, miokardiumis funqciis moSla, nawlavTa parezi,
Tirkmlis milakebis dazianeba da a.S.
Â\È\ Ïîêðîâñêèé gamoyofs dehidrataciis 4 xarisxs. I xarisxis dros mocirkulire
siTxis dakargva ar aRemateba sxeulis masis 1-3%-s. II _ 4-6%-s, III _ 7-9%-s da IV
xarisxi ki Seadgens sxeulis masis 10% da mets. I xarisxis dehidrataciis dros
raime SesamCnevi fiziologiuri darRvevebi ar viTardeba. II xarisxis dros adgili
aqvs mocirkulire sisxlis umniSvnelod daklebas. III xarisxis dehidrataciis dros
ukve aRiniSneba mocirkulire sisxlis moculobis dacema, pulsuri wnevis dakleba,
Tirkmlebis sisxlis mimoqcevis, periferiuli sisxlis mimoqcevis moSla, romelic
mimdinareobs gardamavali metaboluri acidoziT.
IV xarisxis gauwyloebis dros (Seefardeba algidur mdgomareobas) daavadeba
mimdinareobs dehidrataciuli SokiT, mocirkulire sisxlis mkveTri daklebiT, venuri
mimoqcevisa da sistoluri moculobis darRveviT, hematokritis momatebiT, qsovilovani
hi poqsiiT, dekompensirebuli metaboluri acidoziT, respiraciuli alkaloziT.
msoflio janmrTelobis dacvis organizacia 5 wlamde asakis bavSvebisaTvis gvTavazobs
dehidrataciis aseT klasifikacias ( yvela diareiT mimdinare nawlavuri infeqciisaTvis).
I. diarea mimdinare gauwyloebis gareSe (msubuqi gauwyloebiT)(masis dakargva
4-5%-mdea, avadmyofebs ar aReniSnebaT Tvalebis Cacvena, kanis naoWi swordeba swrafad,
gaZlierebuli wyurvili ara aqvT, saerTo mdgomareoba damakmayofilebelia, tirilis
dros bavSvs aqvs cremli, ena da piris lorwovani svelia).
II. diarea gamoxatuli gauwyloebiT (masis dakargva 4-5%-ze metia). SesaZloa
iyos iseTi niSnebi, rogoricaa agzneba, Zlieri wyurvili, kanis naoWi nela swordeba,
piris Rru da ena mSrali, tirilis dros cremli ar aris, Tvalebi Cacvenilia).
III. diarea mZime gauwyloebiT (masis dakargva 9-10% da mets Seadgens). gamoxatulia
hi povolemiuri Sokis movlenebi, algidi. am dros goneba dabindulia an bavSvi ugono
mdgomareobaSia, siTxis daleva mZime saerTo mdgomareobis gamo gaZnelebulia, Tvalebi
Zlier Cacvenili, kanis naoWis gasworebas 2′′-ze meti sWirdeba).
I-II xarisxis dros mdgomareoba SesaZlebelia daeqvemdebaros peroralur
rehidratacias ORS-is xsnaris da sxva siTxeebis gamoyenebiT, xolo III xarisxis
dehidratacia saWiroebs venaSi wyalmarilovani siTxeebis dauyovnebliv gadasxmas,
letaluri gamosavlis asacileblad.
qoleris algidisagan gardacvlil gvamebs mkveTri dehidrataciis da demineralizaciis
gamo aReniSnebaT damaxasiaTebeli saxe: mkveTri sigamxdre, kanis safaris mniSvnelovani
silurje, hi pokrates saxe _ Cavardnili TvalebiT, wawvetebuli saxis nakvTebiT; kani
danaoWebulia, gansakuTrebiT, xelis mtevnis areSi, romelmac mrecxavis xelis saxelwodeba
miiRo; kanze aris didi muqi mowiTalo feris laqebi da, araiSviaTad, reliefurad
gamoxatuli kidurebis kunTebis krunCxviTi SekumSvis gamo avadmyofi mokrivis, meomris,
413
morbenalis pozaSi wevs. mkveTradaa gamoxatuli gvamuri gaSeSeba, romlis drosac

aRwerilia krunCxviTi tokva klinikuri sikvdilis Semdegac.
gvamis seqciaze yvelaze met cvlilebebs adgili aqvs kuW-nawlavis traqtis mxriv:
kuWisa da nawlavebis SigTavsi uferulia da brinjis naxarSs mogvagonebs. raime sunis
gareSe, wvrili nawlavebis lorwovani garsi SeSupebulia (intersticiuli SeSupeba),
moyviTalo feris, mravalricxovani sisxlCaqcevebiT. limfuri warmonaqmnebi _peieris
folaqebi, SeSupebulia, jorjlis limfuri kvanZebi hi perplaziuria da SeSupebuli.
wvrili nawlavebis maryuJi mowiTalo ferisaa, inicirebuli sisxlZarRvebiT. serozul
garsebze vlindeba mwebavi xasiaTis lorwovani masa. sicocxleSi biofsirebuli masalis
paTmorfologiuri gamokvlevebis Sedegad dadgenilia, rom saWmlis momnelebeli traqtis
mxriv adgili aqvs gamoxatul eqsudaciur process, magram xaoebis epiTeliumis desqvamacia
ar aRiniSneba, maTi struqtura da funqcia darRveuli ar aris.
sxva Sinagani organoebis mxriv aRiniSneba kapilaruli sisxlZarRvovani qselis
sicariele, msxvil venebSi Segubeba da iSemiuri kerebi filtvebSi. RviZlSi SesaZlebelia
distrofiuli movlenebi, zogjer nekrozuli kerebis arseboba, TirkmelebSi klaknili
milakebis epiTeliumi ganicdis distrofiul cvlilebebs, zogjer proqsimaluri milakebis
epiTeliuri ujredebis nekroziT. gulis kunTi nacrisferia, dune konsistenciis, adgili
aqvs kunTTa boWkoebis cximovan-cilovan degeneracias. Tavis tvinSi vlindeba venuri
Segubebebi, diapedezuri sisxlCaqcevebi, nervuli ujredebis degeneraciuli movlenebi.
klinika.. inkubaciuri periodi ramdenime saaTidan 5 dRemde meryeobs, saSualod ki
klinika
48 saaTs Seadgens.
klinikuri suraTi gamowveuli koxis klasikuri da El-Tor vibrioniT, mimdinareobs
erTmaneTis msgavsad.
prodromuli periodi ar aris damaxasiaTebeli da aReniSnebaT mxolod avadmyofTa
mcire nawils (umTavresad miqst-infeqciis dros).
ti puri mimdinareobisas daavadeba iwyeba mwvaved. avadmyofebi grZnoben imperatiuli
xasiaTis defekaciis survils, magram tkivilisa da WinTvebis gareSe. xSirad adgili
aqvs diskomforts, yuryurisa da Sxefis xmas Wi pis irgvliv an muclis qvemo nawilSi.
sxvadasxva monacemebiT, maT Soris ukanaskneli epidemiis CaTvliT, SeteviTi xasiaTis
muclis tkivils Wi pis areSi adgili hqonda avadmyofTa 50%-Si, rac, SesaZloa,
dakavSirebuli iyo nawlavTa parezTan, hi pokaliemiis arasakmarisi koreqciis, acidozis,
krunCxvasa da agreTve kuW-nawlavis Tanmxleb paTologiasTan.
avadmyofebi uCivian saerTo sisustes, msubuq Semcivnebas, zogjer Tavbrusxvevas da
temperaturis umniSvnelo momatebas subfebrilur ricxvebamde. umravles SemTxvevaSi
igi SeiZleba normaze dabali iyos. ganavali Tavidanve wylisebria, an 1-2 defekaciis
Semdeg xdeba Ria feris da brinjis naxarSis saxes Rebulobs, usunoa an Tevzis an
gaxexili kartofilis suniT, ganavali didi raodenobiT vibrionebs Seicavs, araiSviaTad
avadmyofi amoanTxevs kuWis SigTavss Sadrevaniseburad. zogjer ganavali mcire raodenobiT
lorwos an sisxlis minarevebs Seicavs (`xorcis narecxis” feri). ti pur SemTxvevaSi
ganavali warmoadgens transudats, identurs izotonuri xsnarisa. ufro iSviaTad
SeiZleba iyos ganavlovani, magram swrafad xdeba wylisebri.
defekaciis sixSire, Cveulebriv, gansazRvravs daavadebis simZimes da 3-dan 10-mde
aRwevs, mZime mdgomareobisas ki 30-sac, anda daTvla SeuZlebeli xdeba. nawlavebis
peristaltikis mimarTulebiT ismis yuryuri an siTxis tylaSuni. Rebineba, Cveulebriv,
faRaraTis Semdeg iwyeba, avadmyofi mokle xanSi kargavs didi raodenobiT siTxesa da
qloridebs, rac iwvevs organizmis gauwyloebas. amis gamo mkveTrad ecema qsovilebis
turgori, kani advilad iWmuxneba da didxans ar swordeba. am dros damaxasiaTebelia
e.w. “hi pokrates saxe” _ Cavardnili Tvalebi, wawvetebuli saxis nakvTebi, Tvalebis
414
irgvliv aRiniSneba silurje (“Savi saTvalis” simptomi), sklera kargavs sikriales,

cremli qreba, piris Rrus lorwovani mSralia, avadmyofis saxe gamoxatavs tanjvas
(facies cholerica), rac pirvelad hi pokrates mieraa mowodebuli, aRiniSneba afonia
(vox cholerica) periferiuli pulsi ar isinjeba an Zafiseburia. mZime formebis
dros adgili aqvs oligurias an anurias, sxvadasxva jgufis kunTebis krunCxviT
tokvas. diafragmuli krunCxvebis dros avadmyofs aqvs mtanjveli slokini.
mimdinar eoba.. arCeven ti pur da ati pur qoleras. ti puri forma, imisda mixedviT,
eoba
mimdinareoba
Tu ra xarisxis gauwyloebiT mimdinareobs, iyofa msubuq, saSualo da mZime formebad,
rac Seesabameba zemoT aRniSnul msoflio jandacvis organizaciis klasifikacias.
msubuqi forma gauwyloebis gareSe (I xarisxis), 1-5% sxeulis masis daklebiT. am
dros daavadeba iwyeba TandaTanobiT, defekacia 3-5-jer dRe-RameSi, ganavali fafiseburia,
ar aris uxvi, Rebineba ar aRematebba 2-3-s. klinikurad hemodinamikuri darRvevebis
gamovlinebas adgili ara aqvs.
saSualo simZimis (gamoxatuli gauwyloebiT) SemTxvevebSi dakarguli siTxis
raodenoba 7-8%-mde aRwevs. daavadeba iwyeba mwvaved, ganavali swrafad Rebulobs
ti pur xasiaTs, mRvrie-moTeTro ferisaa mcuravi fifqebiT, romelic brinjis naxarSs
mogvagonebs, defekaciis sixSire 5-15-s Seadgens, zogjer metsac, Rebineba 5-8-jer da
metad. viTardeba kunTebis sisuste, Tavbrusxveva, krunCxviTi tokva, lorwovani garsebis
simSrale, kanis turgori daqveiTebulia,
avadmyofi agznebulia, kanis naoWi swordeba
nela, aqvs Zlieri wyurvili.
mZime formis dros (III-IV xarisxis
gauwyloeba) sxeulis masis dakargva 10%-s
aRemateba. daavadeba vlindeba Zlieri
faRaraTiT, mdgradi, xSiri RebinebiT,
gamoxatulia krunCxva da Seunelebeli
kunTebis tkivili, siTxes, mZime mdgomareobis
gamo, ver svams, kanis naoWi didxans ar swordeba,
arteriuli wneva daqveiTebulia an ar isinjeba,
sunTqvis ukmarisobis gamo avadmyofebi xSirad
Ria piriT sunTqaven. sunTqvaSi aqtiurad mZime dehidratacia. Sokuri mdgomareoba.
monawileobs gulmkerdis kunTebi. tonuri Tvalebi Zlier `Cacvenilia~, tuCebi Zlier
mSrali, cremli ar aqvs. (msoflio
krunCxvebi yvela jgufis kunTebSi vrceldeba,
janmrTelobis dacvis organizaciis masalebi)
maT Soris diafragmaze, rac mtkivneul slokins
iwvevs. xSirad viTardeba algiduri suraTi
(laT. algus-civi), risTvisac damaxasiaTebelia
soporozuli an komatozuri mdgomareoba,
sxeulis temperatura ecema 35-34°C-mde.
periferiul sisxlSi mZime formebis dros
adgili aqvs gamoxatul cvlilebebs; kerZod
eriTrocitozi, romelic aRwevs 7-8 1012/l,
leikocitozi 15-20 109/l marcxniv gadaxriT,
hematokritis indeqsi 60-70%-s Seadgens.
viTardeba hi pokaliemia, gansakuTrebiT 7
wlamde asakis bavSvebSi, rasac
epileftiformul Setevamde mivyavarT.
mZime gauwyloeba. kanis naoWi swordeba
aRiniSneba hi poqloremia, dekompensirebuli Zalian nela. (msoflio janmrTelobis dacvis
metaboluri acidozi, Trombocitopenia, maRali organizaciis masalebi)
415
fibrinolizi. saTanado mkurnalobis gareSe aseTi formebi umravles SemTxvevaSi

letaluri gamosavliT mTavrdeba.
ati pur fo rmebs ekuTvnis hi pertoqsikuri da e.w. mSrali qolera, romelTaTvisac
formebs
damaxasiaTebelia daavadebis umZafresi dawyeba da letaluri gamosavali jer kidev
faRaraTis da Rebinebis dawyebamde, rac ganpirobebulia maRali intoqsikaciiT.
waSlili formis dros kuW-nawlavis disfunqcia umniSvneloa da xasiaTdeba abortuli
mimdinareobiT subklinikuri formebis dros. klinikuri suraTi ar viTardeba, magram
sisxlSi adgili aqvs vibriociduli, maaglutinirebeli da toqsinSemboWavi antisxeulebis
zrdas (retrospeqtuli kvlevis dros).
organizmis vibrionebisagan ganTavisufleba umTavresad daavadebis 7-10 dRis periodSi
xdeba, iSviaTad grZeldeba 3-4 Tve.
axalSobilebSi da 2 wlamde asakis bavSvebSi qolera iSviaTia, magram mZimed
mimdinareobs da letaluri gamosavalis maCvenebeli SeiZleba iyos maRali _ 15-20%-
mde da metic, rac aixsneba organizmis gansakuTrebuli mgrZnobelobiT wyal-marilovani
cvlilebebis mimarT. daavadeba xSirad iwyeba temperaturuli reaqciiT _ subfebriluri
an zomierad momatebuli temperaturiT. damaxasiaTebelia intoqsikaciis swrafi
ganviTareba, centraluri nervuli sistemis dazianeba _ krunCxvebi soporiT an komiT.
hi pokaliemiis Sedegad SeiZleba ganviTardes paralizuri ileusi, aritmiebi da a.S.,
xSirad Tan erTvis meoradi infeqciebi baqteriuli an baqteriul-virusuli xasiaTis
pnevmoniis ganviTarebiT.
siTxisa da eleqtrolitebis racionaluri, swrafi da sruli koreqciis Catarebamde
adre xSirad adgili hqonda milakebis nekroziT ganpirobebul Tirkmlebis ukmarisobas,
rac amJamad Tavis droze Catarebuli mkurnalobis Sedegad ar gvxvdeba. unda aRiniSnos,
agreTve, rom zedmeti, swrafi, didi raodenobiT siTxis gadasxmam SeiZleba gamoiwvios
filtvebis SeSupeba.
eqsikozis xarisxis dadgena unda eyrdnobodes klinikur gamokvlevebs da (Tu
xelmisawvdomia) sxeulis masis gansazRvras.
SemCneulia, rom epidkerebSi bavSvebisaTvis damaxasiaTebeli klinkuri Taviseburebani
_ temperaturis xSiri momateba, centraluri nervuli sistemis dazianeba,
hi pokaliemiisaken midrekileba ganapirobebs epileftiformuli Setevebis suraTs.
miqst-infeqciebis erTdrouli mimdinareobisas (dizenteria, muclis tifi, amebiazi
da sxv.) qolera vlindeba prodromuli movlenebiT, magram swrafad iRebs misTvis
damaxasiaTebel suraTs, amave dros ufro metadaa gamoxatuli muclis yuryuri, SeteviTi
tkivilebi, subfebriluri da maRaltemperaturuli reaqciebi.
diagnostika da diferenciuli diagnostika. qoleris diagnostika eyrdnoba
anamnezur, epidemiologiur, klinikur da laboratoriul monacemebs. ti puri
mimdinareobisas klinikuri diagnostika ar warmoadgens siZneles, magram oficialuri
registracia SeuZlebelia vibrionis gamoyofamde da mis srul identifikaciamde.
gamokvlevis pirvel etapze tardeba ganavlisa da pirnaRebi masis nacxis mikroskopia
fiqsirebuli eTanoliT, nikiforovis xsnariT da SeRebili gramis wesiT an ganzavebuli
karbolis fuqsiniT. mikroskopiis dros vlindeba vibrionebis grovebad mdebareoba,
rasac “patara Tevzebis” grovas adareben.
baqteriuli gamokvlevisaTvis masalis (pirnaRebi masa, duodenuri SigTavsi, gvamuri
wvrili nawlavis monakveTi, saWmlis narCenebi da sxv.) aRebidan araugvianes 3 saaTisa
Tesaven Txier tute sakveb niadagebze (1%-iani peptoniani wyali an 1%-iani peptoniani
taurolatteluritiani wyali vibrionis dagrovebis mizniT), Semdgomi gadaTesviT
magar sakveb niadagze (diedonis, xotingeris agari, TCBS _ Thiosulfate-Citrate-Bile-
Sucrose, TTGA _ Tellurite-Traurocholate-Gelatin Agar), saeWvo koloniebs amowmeben
416
specifikuri SratiT.
eqspres--diagnostikisaTvis gamoiyeneba luminescenciuri-serologiuri meTodi.
eqspres
arapirdapiri hemaglutinaciis reaqcia, vibrionebis imobilizacia qoleris sawinaaRmdego
01 SratiT, aglutinaciis reaqcia fazur-kontrastuli mikroskopiiT da sxva. aRwerili
meTodebiT dadebiTi Sedegebis miReba SeiZleba ramdenime saaTSi. aseve gamoiyeneba
enzimniSandebuli imunosorbentuli, poliklonuri da monoklonuri antisxeulebi da
pjr.
diagnostika.. I da II xarisxis dehidrataciis dros saWiroa
gamoiricxos iseTi infeqciebi, rogoricaa kvebiTi toqsikoinfeqciebi, eSerixiozi,
salmonelozi, rotavirusuli gastroenteriti, sokoTi da SxamqimikatebiT mowamvla.
kvebiTi toqsikoinfeqciebis dros dgindeba daavadebis ganviTareba inficirebuli
sakvebi produqtebis miRebasTan dakavSirebiT. daavadebis pirvel saaTebSi mkveTradaa
gamoxatuli gastrituli gamovlinebebi, iSviaTia enteritis suraTi.
eSerixiozis dros aRiniSneba xangrZlivi temperaturuli reaqcia. defekacia
ganavlovani masebiT, TandaTanobiTi toqsikozisa da eqsikozis ganviTareba.
salmonelozis dros, garda gamoxatuli, zogjer xangrZlivi temperaturisa, aris
momwvano feris myrali ganavali.
rotavirusuli infeqciis dros ganavali wylisebria, xSirad aRiniSneba zemo
respiraciuli gzebis katari, adgili aqvs daavadebis epidkerebs, sezonurobas Semodgoma-
zamTarSi.
sokoTi da SxamqimikatebiT mowamvlisas klinikur suraTSi dominirebs muclis
Zlieri tkivilebi SemdgomSi faRaraTis darTviT. saxezea RviZlis dazianeba siyviTlis
ganviTarebiT, RviZlis funqciuri sinjebis darRveviT. didi mniSvneloba aqvs anamnezSi
miRebuli produqtebis dadgenas.
prognozi.. Tavis droze diagnostirebuli da adekvaturi mkurnalobis Catarebisas
prognozi
El-Tor qoleris dros letaloba 1-3%-s ar aRemateba, mcire asakis bavSvebSi ki es
maCvenebeli gacilebiT metia.
mkurnaloba.. qoleriT daavadebulebi, miuxedavad daavadebis simZimisa, eqvemdebarebian
mkurnaloba
aucilebel hospitalizacias specialurad maTTvis mowyobil ganyofilebebSi an boqsebSi.
daavadebis paTogenezis, ZiriTadi sindromebis gaTvaliswinebiT pirvel rigSi, saWiroa
wyal-marilovani balansis saswrafod aRdgena, misma Seferxebam ki SeiZleba sabediswero
gamosavali gamoiwvios.
araswori mkurnaloba an misi arCatareba iwvevs Tirkmlebis mwvave ukmarisobas,
hi pokaliemias, es ukanaskneli ki, Tavis mxriv, ganapirobebs nawlavTa atonias,
hi potonias, aritmias, cvlilebebs miokardiumSi, viTardeba anuria, azotemia, sisxlis
mimoqcevis darRveva tvinSi, acidozi da uremia cns-is dazianebiT, gonebis dakargviT,
soporiT, komiT.
wyal-marilovani xsnarebiT rehidratacia or etapad xorcieldeba – pirveladi
rehidratacia iTvaliswinebs, dauyovnebliv iqnes aRdgenili siTxisa da eleqtrolitebis
deficiti, meoradi rehidrataciis mizania eleqtrolitebisa da siTxis mimdinare
dakargvis koreqcia.
avadmyofebs, romlebsac aReniSnebaT I, II xarisxis dehidratacia utardebaT oraluri
rehidratacia glukoza-marilovani xsnarebiT; mag. ORS romelic Seicavs 3,5 g natriumis
qlorids, 2,9 g natriumis citrats, 1,5 g kaliumis qlorids, 20 g mSral glukozas da
unda gaixsnas 1 l sasmel wyalSi). analogiuri Semadgenlobisaa citraglukosolani.
III xarisxis dehidrataciis drosac parenterul rehidrataciasTan erTad iniSneba
oraluri rehidrataciac (Tu ar aris Seupovari Rebineba) zemoaRniSnuli xsnarebiT.
(rehidrataciis sqemebi “a”, “b”, “g” ix. –`mkurnalobis saerTo princi pebi~).
417
rehidrataciis swori CatarebisaTvis saWiroa dRe-Ramis periodSi dakarguli siTxis

zusti aRricxva, rac moicavs ganavlis, pirnaRebi masis da avadmyofis sxeulis masis
gansazRvras yovel 4-8 saaTSi erTxel.
oraluri rehidratacia tardeba faRaraTis srul Sewyvetamde, rac umravles
SemTxvevaSi 1-2 dRe grZeldeba. aRsaniSnavia, rom droulad Catarebuli oraluri
rehidratacia mniSvnelovnad amcirebs infuzuri rehidrataciis aucileblobas da
SesaZlo garTulebebs (gulis marjvena naxevris gadatvirTvas, filtvis da tvinis
SeSupebas ).
mZime formebis dros infuzuri Terapiis dawyebamde, Tu es SesaZlebelia, saWiroa
venidan sisxlis aReba laboratoriuli gamokvlevebisaTvis (plazmis xvedriTi wonis,
eleqtrolitebis gansazRvra da sxv.) venaSi infuzuri TerapiisaTvis gamoiyeneba pirvel
rigSi ringeris laqtati, fiziologiuri xsnari (hi pokaliemiis mkurnaloba saWiroa,
roca misi Semcveloba sisxlSi 2 mmol/l-ze naklebia. (gamosaTvleli formula ix.
eSerixiozis mkurnalobaSi).
Tavdapirvelad venaSi siTxis Seyvana mZime SemTxvevebSi mozrdil bavSvebSi xdeba
nakaduri wesiT. siTxis Semdgomi Seyvana xdeba klinikur-laboratoriuli monacemebis
gaTvaliswinebiT, siTxis danakargis gansazRvriT. Rebinebis Sewyvetis Semdeg aucilebelia
avadmyofs per os mieces ORS, kaliumiT gamdidrebuli sxva siTxeebi (kompoti, nayeni da
a.S.).
qoleriT daavadebuli avadmyofebis mkurnalobaSi gamoiyeneba trimetoprim-
sulfametoqsazoli, furazolidoni 3 dRis ganmavlobaSi. tetraciklini SeiZleba
dainiSnos 3 dRis ganmavlobaSi 6-9 kg masis bavSvebSic ki. doqsiciklini 300mg sul 1-
jer (1 dRe) iniSneba 12 wlis zemoT asakis bavSvebSi.
specialuri dieta ar aris saWiro, dieta iseTivea, rogoric nawlavTa mwvave
infeqciebis dros (kaloriuli, meqanikurad da Termulad damuSavebuli, asakis Sesabamisi,
srulfasovani). bunebriv kvebaze myofma bavSvebma aucileblad xSirad unda miiRon
dedis rZe.
avadmyofis gawera stacionaridan xdeba klinikuri gamojanmrTelebidan me-8-10
dReze ganavlis samjeradi baqteriologiuri gamokvlevis Semdeg. baqteriologiuri
gamokvleva grZeldeba etiotropuli Terapiis damTavrebidan 24-36 saaTis Semdeg da
tardeba zedized 3 dRe.
profilaqtikaSi yvelaze ufro mniSvnelovania garemos dacva, pirvel rigSi
mosaxleobis uzrunvelyofa sufTa sasmeli wyliT, Camonadeni wylebis gauvnebelyofa.
mkacrad unda iqnas daculi sanitarul-higienuri normebi kvebis mrewvelobis dargSi,
savaWro da kvebis obieqtebSi.
gansakuTrebuli yuradReba unda mieqces qoleris epidkerebidan Camosul pirebs. 5
dRis ganmavlobaSi maT da maTi ojaxis wevrebs unda utardebodeT meTvalyureoba
eqimis mier. nawlavTa infeqciis simptomebis pirvelive gamovlinebisas saWiroa
hospitalizacia.
specifikuri profilaqtikis mizniT iyenebdnen qoleris korpuskulur vaqcinas da
qolerogen-anatoqsins. vaqcinacias eqvemdebarebodnen bavSvebi 7 wlidan. (imuniteti
yalibdeba 50% da mxolod 3-6 TviT). unda aRiniSnos, rom zogierTi avtoris mier
mowodebulia peroraluri vaqcina, igi TiTqosda ufro efeqturia da aqvs naklebi
gverdiTi movlenebi.
dadgenilia, rom qoleris sawinaaRmdego vaqcinacia ver uzrunvelyofs inaparantul
infeqciis aRkveTas da masTan dakavSirebuli vibrionis eqskrecias. amitom msoflio
jandacvis organizacia ar aZlevs vaqcinaciisaTvis rekomendacias rogorc keridan
gamosul, aseve keraSi mimavali pirebisaTvis. amasTan dakavSirebiT arc erTi qveyana ar
418
qolera
kerZo nawili. zogierTi araqoleragenuli vibrionebiT ... infeqciebi
moiTxovs qoleris sawinaaRmdego vaqcinaciis kalendarSi Setanas.

informacia qoleraze saeWvo yvela SemTxvevaze aucileblad unda miewodos
daavadebaTa kontrolis centrsa da zemdgom organoebs.
zogierTi araqoleragenuli vibrionebiT

gamowveuli infeqciebi
etiologia. aseT vibrionebs miakuTvneben gramuaryofiT, moZrav, fakultatur

anaerobebs, romlebic marilovan xsnarebSi iCenen mdgradobas.
yvelaze ufro mniSvnelovan, diareis gamomwvev vibrionebs warmoadgenen _
V.parahaemolyticus, V.cholerae non-01, V.mimicus, V.hollisae, V.fluvialis,
V.furnissii. Vibrio vulnificus iwvevs septicemiasa da Wrilobis infeqcias
imunokomprometirebul avadmyofebSi, gansakuTrebiT, roca maT aReniSnebaT RviZlis
daavadebebi. V.parahaemolyticus, V.damsela, V.alginolyticus aseve iwvevs Wrilobis
infeqcias. V.alginolyticus SeuZlia gamoiwvios otitis externa.
epidemiologia. araqoleragenul vibrionebs ZiriTadad naxuloben zRvis wyalSi
zafxulSi. daavadebas axasiaTebs sezonuroba, aRiniSneba zafxulsa da Semodgomaze.
adamianis inficireba xdeba umi da Termulad daumuSavebeli zRvis produqtebiT
(kiborCxala, xamanwka, niJarovanebi).
daavadeba adamianidan adamianze ar gadadis.
Wrilobis infeqcia SeiZleba gamowveuli iyos dabinZurebuli wyliT, moluskis
niJariT, Wrilobis miyenebisas zRvaSi banaobis dros.
gansakuTrebiT am infeqciebiT avaddebian pirebi, romlebsac aReniSnebaT RviZlis
daavadebebi, kuWis dabali mJavianoba, imunodeficituri mdgomareoba (aiv-infeqciis CaTvliT).
klinika.. araqoleragenuli vibrionebiT gamowveuli daavadebis klinika ZiriTadad
klinika
vlindeba diareiT, septicemiiT da Wrilobis infeqciiT.
yvelaze ufro xSirad gvxvdeba diarea, romelic iwyeba mwvaved mWreli xasiaTis
tkivilebiT da wylisebri faRaraTiT. avadmyofTa naxevars aqvs umniSvnelod momatebuli
temperatura; uCivian Tavis tkivils, Semcivnebas, Rebinebas (30%-Si). spontanuri
gamojanmrTeleba xdeba 2-5 dReSi. imunokomprometirebul pirebSi Wrilobis infeqcia
SeiZleba mimdinareobdes mZimed, qsovilebis danekrozebiT, buluri dazianebiT, ganviTardes
Soki da ganapirobos sikvdili.
diagnozi.. vibrionebs naxuloben pirnaReb masaSi, ganavalSi, sisxlSi, Wrilobis
diagnozi
eqsudatSi. vibrionebis identifikacia xdeba saTanado meTodiT, momzadebuli person-
alis mier.
mkurnaloba. diareis dros mkurnaloba tardeba peroraluri rehidrataciiT.
antibiotikoTerapia gamoiyeneba Wrilobis infeqciis mZime mimdinareobisa da sefsisis
dros. rekomendebulia tetraciklini (8 wlis zemoT asakSi), cefotaqsimi, gentamicini,
qloramfenikoli.
profilaqtika. zRvis produqtebis miReba unda tardebodes Termuli damuSavebis
Semdeg, gansakuTrebiT imunodeficituri statusis mqone pirebSi.
zRvaSi banaobis dros miRebuli Wrilobis dabana saWiroa xdebodes sufTa wyliT.
419
kerZo nawili.
zogierTi pirobiTpaTogenuri ... infeqciebi. kampilobaqteriozi
zogierTi pirobiTpaTogenuri floriT

gamowveuli mwvave infeqciebi
kampilobaqteriozi
(CAMPYLOBACTERIOSIS)
sinonimi _ vibriozi
vibriozi.
nawlavTa kampilobaqteriozi warmoadgens mwvave infeqciur-zoonozur daavadebas
gadacemis fekalur-oraluri meqanizmiT, gamowveulia pirobiTpaTogenuri mikrobebiT
Campylobacter-is gvaridan da xasiaTdeba gastroenteritis an enterokolitis suraTiT,
iSviaTad Rebulobs generalizebul mimdinareobas (axalSobilebsa da
imunokomprometirebul avadmyofebSi).
cnobebi. mikrobebi miekuTvnebian Campylobacter-is gvars (Campylo
istoriuli cnobebi
berZnulad niSnavs daklaknils, xveuls, bacter _ Cxirs), identificirebulia 1909wels.
cnobili iyo, rogorc Sinaur cxovelebSi abortiTa da diareiT mimdinare daavadeba.
adamianTa Soris daavadebis pirveli SemTxvevebi aRweril iqna 1947w. R.Vinzent-isa da
Tanaavtorebis mier, bavSvebSi ki _ 1972w. ukanasknel wlebSi adamianTa Soris, gansakuTrebiT
ki bavSvTa asakSi diareis gamowvevaSi kampilobaqteriebs mniSvnelovan rols miakuTvneben.
etiologia. kampilobaqteriaTa gvarSi arCeven 14 Stams, aqedan 8 paTogenuria
etiologia
adamianisaTvis: C. jejuni, C. fetus, C. coli, C. hypointestinalis, C. laridis, C. cinaedi,
C. fennelliae da C. upsaliensis. C. jejuni-s 90-ze meti serotipi gaaCnia. Helycobacter
pylori (adre cnobili dasaxelebiT C. pylori) warmoadgens axal ojaxs, romelic
Campylobacter-isagan rnm-is wyobiT gamoirCeva. klinikuri gamovlinebebi (nawlavTa
daavadebebi) umetes SemTxvevaSi gamowveulia C. jejuni-iT, xolo nawlavTagare da
generalizebuli infeqcia ki ufro C. fetus-iT. nakleb xSirad diareas (enterits)
iwveven C. coli, C. laridis an C. fetus, xolo C. jejuni da C. coli-s naklebad axasiaTebs
procesis generalizacia. es baqteriebi gramuaryofiTi moZravi Cxirebia 0,5-1 mm zomiT,
sporebs ar warmoqmnian, aqvT 1 an 2 Solti (erT an orive polusze), formiT mogvagonebs
mZimes (vibrions), SeiZleba Zafisebri formisac iyos, aqvs Termostabiluri 0- da
Termolabiluri H-antigeni. kampilobaqteriebs aqvT saerTo antigeni iersiniozisa da
botulizmis gamomwvev mikrobebTan. zogierT Stams Seswevs enterotoqsinis produqciis
unari. mikrobebi mikroaurofilebia da zrdisaTvis saWiroeben Jangbads.
mikrobebi mravldebian agarian niadagze 1%-iani glicerinis damatebiT, sadac wvrili
koloniebis saxes Rebuloben. zrdis optimalur temperaturad iTvleba 37°C, pH-7,0.
kampilobaqteriebs garemoSi garkveuli gamZleoba axasiaTebs. ase mag., 4°C-ze
inarCuneben sicocxles; niadagSi, wyalSi, rZeSi arseboben ramodenime kviris ganmavlobaSi,
gayinul xorcSi _ ramodenime Tves. mgrZnobiareni arian gamoSrobisa da mzis sxivebis
mimarT. wylis duRili da daqlorva mikrobebs mTlianad Slis. rZisa da rZis produqtebis
pasterizacia friad efeqturad iTvleba.
mikrobebi mgrZnobiareni arian eriTromicinis, qloramfenikolis, streptomicinis,
kanamicinis, tetraciklinis, gentamicinis, nakleb mgrZnobiare ki _ penicilinis mimarT.
mikrobebs mgrZnobeloba ara aqvT sulfanilamiduri preparatebis mimarT.
420
kerZo nawili.
epidemiologia. infeqcia gavrcelebulia mTel msoflioSi da yvela diareuli

epidemiologia
daavadebis 5-10%-s Seadgens, xolo ganviTarebul qveynebSi mas Shigella da Salmo-
nella –infeqciebTan SedarebiT pirveli adgili uWiravs gastroenteritebis saxiT.
daavadeba xSirad gvxvdeba zafxul-Semodgomaze. subtropikul zonebSi misi piki modis
wvimis sezonze. asakobriv WrilSi kampilobaqteriozis piki 2-jer aris gamoxatuli.
I _ 4 welze naklebi asakis bavSvebSi (gansakuTrebiT 1 wlamde), II _ ki mozardsa da
mozrdilebSi. infeqcia xSirad, (gansakuTrebiT bavSvebSi) mimdinareobs usimptomod.
janmrTel adamianebSi mikrobebis arseboba aRiniSneba 1-15%-Si. adamianisaTvis infeqciis
ZiriTad wyarod iTvleba gareuli da upiratesad Sinauri cxovelebi (Zroxa, cxvari,
Txa, ZaRli, kata da sxva) da frinvelebi. mniSvnelovania yvavis, beRuras roli sakveb
produqtebTan advilad SesaZlebeli kontaqtis gamo.
adamiani mxolod droebiTi rezervuaria da infeqciis gadacemis erT-erT rgols
warmoadgens. adamianisaTvis infeqtis gadacema SesaZlebelia inficirebul cxovelebTan
an adamianTan kontaqtis dros. cxovelebis inficirebam SesaZloa maTi daRupva gamoiwvios,
Tumca, upiratesad, baqteriamtareblobiT Semoifargleba. aseT cxovelTa dakvlisas
xdeba nawlavis SigTavsiT xorcis dainficireba. rZis inficireba ki SeiZleba Zroxebis
kampilobaqteriuli mastitebis mizeziT moxdes.
mniSvnelovan epidfaqtorad iTvleba dainficirebuli saWmeli, wyali, rZe, xorci
(axali da gayinuli). sakmaod xSiria am dros frinvelebisa da adamianisagan gamoyofili
serovarebis identurobis damTxveva.
adamianis dainficireba, upiratesad, alimenturi gziT xdeba.
kampilobaqteriuli infeqciis 70%-mde SemTxvevebi 2 wlamde asakis bavSvebis
wilad modis. gansakuTrebiT maRali mimReblobiT gamoirCevian dRenakli da premorbiduli
an Tanmxlebi daavadebebiT dauZlurebuli bavSvebi.
sporaduli SemTxvevebi, upiratesad, miqst-infeqciis saxiT gvxvdeba. aRwerilia
inficirebuli wyliT, rZiTa da sxva produqtebiT gamowveuli epidafeTqebebi, es
ukanaskneli SeiZleba moxdes samSobiaro saxlebSi, dRenaklTa ganyofilebebSi. adamianidan
adamianze gadacema iSviaTad xdeba. qronikuli mtarebloba ar axasiaTebs.
paTogenezi srulad Seswavlili ar aris. eqsperimentuli monacemebisa da
moxaliseebze miRebuli Sedegebis mixedviT dadgenilia, rom daavadebis formirebaSi
mniSvnelovani roli eniWeba mainficirebeli dozis sididesa da organizmis mgrZnobelobas
baqteriebis mimarT. gamokveTilia mikrobebis invaziuri (kerZod, proteinebTan maTi
membranebis dakavSirebis) Tvisebebis roli da anTebiTi diareis gamowveva. infeqciis
dasawyisSi kampilobaqteria emagreba enterocitis zedapirs, Semdeg ki Soltebis daxmarebiT
ujredSic aRwevs. anTebadi procesis ganviTareba SesaZlebelia kuW-nawlavis traqtis
sxvadasxva doneze _ kuWSi, wvril da msxvil nawlavebSi. Semdgom mikrobebi zogjer
sakmaod swrafad gadadian sisxlSi (generalizacia) – viTardeba baqteriemia, intoqsikacia.
xdeba mikrobebis ganTesva Sinagan organoebsa da qsovilebSi, dauZlurebul pirebSi
anTebadi sefsisuri kerebis ganviTareba (meningiti, encefaliti, peritoniti, endokarditi
da a.S.). daavadebis mZime mimdinareobisas xSiri Rebinebisa da faRaraTis gamo SesaZlebelia,
ganviTardes saSiSi dehidratacia da hi povolemiuri Soki.
transplacenturi gziT infeqciis gavrcelebisas SeiZleba daziandes nayofi da
ganviTardes aborti.
paTmorfologiuri suraTi kuW-nawlavis traqtSi xasiaTdeba nawlavebis distaluri
nawilis kataruli anTebiT, neitrofiluri infiltraciiT, kri ptebis abscesebiTa da
danekrozebiT, lorwovani garsis sisxlCaqcevebiTa da dawylulebiT (viTardeba
wylulovani koliti), romelic friad mogvagonebs kronis daavadebas an Sigelozs.
zogjer adgili aqvs wylisebr diareas, radgan C. jejuni-s zogierT seroti ps SeuZlia
421
kerZo nawili.
qoleragenulismagvari enterotoqsinis produqcia.

infeqciis gadatanis Semdeg sisxlSi vlindeba antisxeulebi imunoglobulinebis
saxiT (IgM, IgG,IgA). imuniteti aramyaria da grZeldeba araumetes erTi wlisa.
klinika. inkubaciuri periodi 1-6 dRea, saSualod 2-3 dRe, SeiZleba gagrZeldes
10 dRemde. daavadeba, umetesad, gastrointestinuri formiT mimdinareobs. daavadeba
iwyeba mwvaved, temperaturis momatebiT 38-39°C-mde, zogjer 40°C-mde. Rebineba xSiri
ar aris, magram ganmeorebiTia, aRiniSneba anoreqsia. mcire asakis bavSvebi xdebian
modunebuli, Wirveuloben, ufro mozrdilebi ki uCivian Tavis, kunTebis, saxsrebis,
muclis tkivils. daavadebis pirvelsave dRes ewyebaT faRaraTi, romlis sixSire dRe-
RameSi 2-dan 20-mde meryeobs, ganavali wylisebri, qafiani da myralsuniania, mogvagonebs
virusul gastroenterits, xolo zogjer ki daavadebis me-2-3 dRes SeteviTi xasiaTis
tkivilebis fonze vlindeba kolituri movlenebi – ganavalSi Cndeba lorwosa da
sisxlis minarevebi. tkivili ZiriTadad Wi pis areSi lokalizdeba, defekaciis win
intensiuria, defekaciis Semdeg ki klebulobs. zogjer aRiniSneba swori kunTebis
daWimva, rac qirurgiuli yuradRebis aucileblobas hqmnis. wlamde asakis bavSvebSi
daavadeba SeiZleba mZimed mimdinareobdes, organizmis saerTo intoqsikacia mkveTria.
xSiri da uxvi, wylisSemcveli defekacia ki iwvevs gauwyloebas _ kanis simSrales,
turgoris mkveTr daqveiTebas, demineralizaciasa da acidozs, krunCxviT sindroms,
hopovolemiur Soks anuriiT. daavadeba Rebulobs qoleris msgavs mimdinareobas mZime
gamosavliT.
daavadeba, Cveulebriv, mwvaved mimdinareobs (Tumca hi pogamaglobulinemiis da
Sidsis dros ki axasiaTebs persistencia da recidivebi), misi xangrZlivoba damokidebulia
procesis simZimeze. simZimis kriteriumebi igivea, rac nawlavTa sxva mwvave infeqciebis
drosaa miRebuli _ organizmis saerTo intoqsikacia da dehidratacia. msubuqi formis
dros temperatura 2-3 dReSi normalizdeba. saSualo da mZime formebis SemTxvevaSi
faRaraTi SeiZleba 2-3 kviras gagrZeldes. defekaciis normalizaciis Semdeg bevr
avadmyofs rCeba muclis tkivili, romelic zogjer intensiur xasiaTs iRebs.
gamojansaRebis periodi, saSualod, 10-14 dRes ar aRemateba. recidivebis ganviTareba
mosalodnelia daavadebis me-2-3 kviras.
baqteriemiis dros (C. fetus-iT gamowveuli infeqcia) diareas SesaZloa adgili
ar hqondes. daavadebas axasiaTebs cxeleba, Tavis tkivili, damtvreuloba, Semcivneba,
RamiT oflianoba, masis dakleba Tu daavadebam miiRo gaxangrZlivebuli xasiaTi. amave
dros xSirad gamoxatulia muclis tkivili. diarea, siyviTle da meningiti xSirad ar
aris. fizikaluri monacemebi, rogorc wesi, sustia. aRwerilia spontanuri gamojanmrTeleba,
magram dauZlurebulebSi daavadeba sikvdiliT mTavrdeba saTanado mkurnalobis gareSe.
fokaluri formebi moicaven pankreatits, meningits, qolecistits, saSarde gzebis
infeqcias, filtvebis abscess, arTrits, peritonits. es daavadebebi axalSobilebsa da
imunokomprometirebulebSi gvxvdeba. mikroorganizmebs gaaCnia sisxlZarRvTa
epiTeliumisadmi tropizmi, rac iwvevs endokardits, perikardits, Tromboflebits,
anevrizmebs.
perinataluri infeqcia (gamowveuli C. fetus da C. jejuni-iT) mimdinareobs
Zalze mZimed da iwvevs spontanur aborts, naadrev mSobiarobas, axalSobilTa sefsissa
da meningits, sisxlian diareas (ufro C. jejuni).
garTulebebi. aRwerilia daavadebis gadatanis 1-3 kviris Semdeg Guillain-Barre
sindromi, reaqtiuli arTriti, Reiter-is sindromi, nefropaTia, glomerulonefriti,
gamowveuli imunuri kompleqsebiT, hemolizuri anemia, sisxldena swori nawlavidan.
diagnozi, diferenciuli diagnozi. kampilobaqteriozi saWiroebs diferencirebas
nawlavTa mwvave infeqciebTan (eSerixiozi, salmonelozi, kvebiTi toqsikoinfeqciebi,
422
kerZo nawili. kampilobaqteriozi
zogierTi pirobiTpaTogenuri ... infeqciebi. klebsielebiT gamowveuli...
dizenteria, qolera), muclis Rrus qirurgiul daavadebebTan, generalizebuli forma

ki _ pnevmoniasTan, meningitTan, sxvadasxva etiologiis sefsisTan, nawlavTa iersiniozTan,
fsevdotuberkulozTan, brucelozTan, toqsoplazmozTan.
baqteriuli gamokvlevisaTvis mimarTaven ganavlis daTesvas specialur seleqciur
niadagebze. maT ricxvs upirvelesad baclerisa (Batzler) da skirous (Skirrow)
niadagebi miekuTvneba, romlebic ramodenime antibiotikdamatebuli sisxliani agaris
sxvadasxva modifikacias warmoadgens. iyeneben prestonis magar niadagsac, romelic
sisxls ar Seicavs. kampilobaqteriebis gamravlebis aucilebel pirobad iTvleba
Jangbadis dabali parcialuri wneva (naxSiroJangis winaswari damatebiT). zogierT
laboratoriaSi gamoiyeneba swrafi winaswari gamokvleva _ ganavlis gasinjva mikroskopis
Sav velSi. bolo xanebSi gamoiyeneba pjr.
mikrobisaTvis damaxasiaTebeli ti puri moZraobis danaxva SesaZlebelia
fazokontrastuli mikroskopis meSveobiT.
serologiuri diagnostikisaTvis gamoiyeneba a g l u t i n a c i i s a d a
komplementSemboWavi reaqciebi, arapirdapiri hemaglutinacia, imunofermentuli analizi,
radioimunuri analizi, imunobloti da sxva. gamokvleva tardeba wyvil SratebSi, 10-
14 dRis intervaliT. keTdeba antisxeulebis IgA, IgM da IgG gansazRvra enzimniSandebuli
meTodiT, romelic saSualebas gvaZlevs, gavarCioT daavadebis mwvave mimdinareoba
qronikulisagan.
mkurnaloba. mkurnalobis intensivoba da misi saxe damokidebulia daavadebis
mkurnaloba
simZimeze. antibiotikiT mkurnalobas saWiroebs mxolod sisxliani diareiT an infeqciis
generalizaciiT mimdinare saSualo da mZime formebi. avadmyofebs asakobrivi dozis
gaTvaliswinebiT 7-10 dRis ganmavlobaSi eniSnebaT iseTi etiotropuli saSualebebi,
rogoricaa aminoglikozidebi, eriTromicini (50 mg/kg dRe-RameSi 5 dRe), tetraciklini,
qloramfenikoli, nitrofuranis preparatebi, ci profloqsacini. Cvenebis mixedviT
tardeba saTanado paTogenezuri da simptomuri Terapia (rehidratacia, dezintoqsikacia,
organizmis reaqtiulobis gaZliereba, imunomakoregirebeli preparatebis gamoyeneba da
sxva).
prognozi gastrointestinuri formis dros kargia. antibiotikTerapiis fonze
swrafad xdeba sisxliani diareis kupireba. rac Seexeba sefsisur formas, gansakuTrebiT
axalSobilebsa da imunodefeqtur bavSvebSi, igi sikvdilianobis maRali maCvenebliT
xasiaTdeba. swored am SemTxvevebSi Catarebuli drouli da swori antibaqteriuli
da paTogenezuri Terapia xels uwyobs prognozis mniSvnelovnad gaumjobesebas.
profilaqtika. ZiriTad profilaqtikur RonisZiebas warmoadgens sanitarul-
higienuri RonisZiebebis Catareba mecxoveleobisa da mefrinveleobis meurneobebSi,
dakvlisa da kulinaruli gadamuSavebis teqnologiis dacva, kvebis produqtebis swori
realizacia.
klebsielebiT gamowveuli nawlavTa

mwvave infeqcia
klebsielebiT gamowveuli nawlavTa mwvave infeqcia upiratesad kuW-nawlavis

traqtis dazianebiT mimdinareobs da vlindeba gastritis, enterokolitis an
gastroenterokolitis suraTiT.
etiologia. klebsielebi miekuTvnebian Enterobacteriaceae-s ojaxs, klebsielebis
423
kerZo nawili.
zogierTi pirobiTpaTogenuri ... infeqciebi. klebsielebiT gamowveuli...
gvars; gramuaryofiTi, uZravi, kafsulis mqone Cxirebia. O-somaturi antigenis mixedviT

arCeven 11 jgufs, xolo kafsulis mixedviT _ 80-mde serologiur variants. adamianebSi
daavadebas ZiriTadad iwvevs K.pneumoniae, K. riniscleromatis, K. ozenae, K.
oxytoca. zogierTi Stami gamohyofs egzotoqsins, danarCeni ki endotoqsins warmoqmnis.
garemoSi mikrobebi garkveul mdgradobas iCenen, aqvT gamravlebis unari macivris
pirobebSi. san-higienuri reJimis darRvevis dros advilad xdeba samedicino perso
nalis xelebis inficireba, iTeseba wylidan, rZidan, xorcidan. bevri antibiotikis
mimarT mdgradia.
epidemiologia. infeqciis wyaros warmoadgens avadmyofi adamiani an cxoveli,
agreTve baqteriamtareblebi, romlebic garemoSi didi raodenobiT mikrobebs gamoyofen.
axalSobili SeiZleba dainficirdes mSobiarobis dros, magram umTavresad inficireba
xdeba dabadebis Semdeg, sxvadasxva nivTebiT (tansacmeli, instrumentebi da a.S.). infeqtis
gadacema SesaZlebelia, agreTve, haer-wveTovani gziT. klebsieloziT pirvel rigSi
avaddebian dRenakli, dasustebuli bavSvebi. zogjer adgili aqvs Sida infeqciebis
saxiT mis gavrcelebas infeqciur da somatur saavadmyofoebSi.
daavadebas sezonuroba ar axasiaTebs. imuniteti aramyaria, rogorc nawlavTa sxva
mwvave infeqciebis dros.
paTogenezi. infeqciis SeWris gzas warmoadgens kuW-nawlavis traqti. daavadebis
ganviTareba xdeba egzogenurad da endogenurad. masiuri inficirebis SemTxvevaSi
Warbobs intoqsikaciis movlenebi, rac gamowveulia rogorc toqsinemiiT, aseve mikrobTa
uSualo moqmedebiT. masiuri baqteriemiis mizezad iTvleba mikrobisaTvis damaxasiaTebeli
maRali invaziuri Tvisebebi, limfagenuri da hematogenuri gavrcelebis unari. masiuri
baqteriemiis dros yalibdeba meoradi kerebi _ Cirqovani meningiti, pielonefriti,
cistiti da sxva.
procesis generalizebuli (sefsisuri) mimdinareoba ufro xSirad SeimCneva Rrma
dRenakl bavSvebSi, romelTac aqvT imunodeficiti da xSirad moavadeni arian.
paTmorfologiuri suraTi, ZiriTadad, gamoxatulia kataruli cvlilebebiT
kuW-nawlavis mxriv da xasiaTdeba wvrili sisxlCaqcevebiTa da zogjer mikroabscesebiT.
mZime mimdinareobisas procesi msxvili nawlavebis distaluri nawilis lorwovan
garsSia lokalizebuli, sadac viTardeba vrceli sisxlCaqcevebi nekrozuli ubnebiT,
maTi dawylulebiT, Cirqovan-fibrinuli nadebebis CamoyalibebiT, peritonitis movlenebiT.
aRniSnuli procesi xSirad stafilokokebisa da mwvane Cirqmbadi mikrobebis asociaciiTaa
ganpirobebuli. sefsisuri mimdinareobis dros SeiZleba ganviTardes abscesi filtvebSi,
RviZlSi, TirkmlebSi, Tavis tvinSi da sxva organoebSi. xSiria Trombohemoragiuli
sindromi.
klinika. masiuri inficirebisas inkubaciuri periodi 3-5 saaTs ar aRemateba,
sayofacxovrebo-kontaqturi gziT inficirebis SemTxvevaSi ki 3-6 dRes Seadgens.
daavadeba iwyeba mwvaved, temperatura 38-39°C-s aRwevs, zogjer 40°C. mcire asakis
bavSvebs aReniSnebaT wamoqafeba, ganmeorebiTi Rebineba, enterituli xasiaTis faRaraTi,
wylis Semcveli, qafiani ganavliT. mZime mimdinareobisas aRiniSneba enterokolituri,
lorwosa da sisxlis Semcveli ganavali. defekaciis sixSire dRe-RameSi 15-20 da
mets aRwevs. msubuqi formis dros defekaciis sixSire ar aRemateba 3-5-s dRe-RameSi,
ganavlovani masebiT. daavadebis xangrZlivoba 3-5 dRea.
mozrdilebSi daavadeba mimdinareobs toqsikoinfeqciisaTvis damaxasiaTebeli suraTiT
(gastritiT, gastroenteritiT).
diagnozis dadgena gaZnelebulia sxva pirobiT-paTogenuri mikrobebiT gamowveuli
infeqciebis msgavsi klinikuri mimdinareobis gamo, amitom mniSvneloba eniWeba klebsielebis
masiur da ganmeorebiT amoTesvas ganavlidan, pirnaRebi masidan. didi mniSvneloba aqvs
424
kerZo nawili. klebsielebiT gamowveuli...
zogierTi pirobiTpaTogenuri ... infeqciebi. proteusiT gamowveuli...
specifikuri antisxeulebis dadgenas, gansakuTrebiT sarwmunoa misi momateba daavadebis

dinamikaSi.
mkurnaloba. generalizebuli klebsielozis dros antibiotikebis daniSvna
mizanSewonilia klebsielebis mimarT antibiotikogramis mgrZnobelobis gaTvaliswinebiT.
antibaqteriuli preparatebidan efeqturia aminoglikozidebis jgufis antibiotikebi
ampicilinTan erTad, qloramfenikoli, nitrofuranis preparatebi. meningitis dros
antibiotikebiT mkurnaloba SeiZleba gagrZeldes minimum 21 dRe, xolo garTulebuli
septicemiis dros ki 10-14 dRe. rac Seexeba paTogenezur da simptomur Terapias, maTi
Catareba xorcieldeba iseve, rogorc nawlavTa sxva infeqciebis dros. amasTan,
imunoreaqtiulobis daqveiTebis dros iniSneba imunomakoregirebeli saSualebebi _
imunoglobulinebi da sxva. nawlavTa floris normalizaciis mizniT mizanSewonilia
eubiotikebis daniSvna (bifidumbaqterini, kolibaqterini, bifikoli, laqtobaqterini da
sxva).
profilaqtika. ZiriTadi mniSvneloba aqvs sanepidreJimis dacvas, gansakuTrebiT
samSobiaro saxlebSi, dRenaklTa ganyofilebebSi, infeqciur da somatur bavSvTa
saavadmyofoebSi, radgan sanepidreJimis daucvelobis SemTxvevaSi klebsielebi didi
raodenobiT iTesebian personalis xelebidan, samedicino instrumentebidan, sayofacxovrebo
nivTebidan, dedis da donoris rZidan da a.S.
proteusiT gamowveuli
nawlavTa infeqcia
proteusuli etiologiis nawlavTa infeqcia xasiaTdeba kuW-nawlavis traqtis

dazianebiT gastroenteritis an enterokolitis saxiT.
etiologia. arCeven proteusis 5 saxeobas _ P. mirabilis, P. morganii, P.
vulgaris, P. vettgeri, P. incostans. miekuTvnebian proteusis gvars, Enterobacteri-
aceae-s ojaxs, moZravi, gramuaryofiTi mikrobebia, fakultaturi anaerobebi, sporebs
da kafsulas ar warmoSoben.
adamianis paTologiaSi upiratesi mniSvneloba eniWeba P. mirabilis, P.morganii
da P.vulgaris. arCeven 2 aTasze met serovariants. mikrobebs aqvT somaturi O0-
Termostabiluri da H-Soltiseburi Termolabiluri antigenebi.
mikrobebi garemoSisakmaod gamZleni arian, sadezinfeqcio xsnarebis mimarT (fenoli,
rivanoli, furacilini) nakleb mgrZnobiareni arian. zogierTi antibiotikis (eriTromicini,
oleandomicini, polimiqsini da sxva) mimarT ki mgrZnobiare ar arian.
epidemiologia. mikrobebi farTodaa gavrcelebuli bunebaSi, iq sadac aris
cxoveluri warmoSobis lpobadi nivTierebebi, ganavali, gaxrwnili xorci da sxva.
infeqciis wyaros warmoadgens proteusiT daavadebuli adamiani, ufro naklebad _
janmrTeli mtarebeli. infeqciis gadamcemi faqtorebia inficirebuli wyali, saWmeli
(xorci, Tevzi, frinvelis xorci, Zexvi da sxva). inficirebul produqtSi proteusi
swrafad mravldeba da gamoyofs endotoqsins, amasTan produqtis organolepturi
Tvisebebi ar icvleba.
daavadeba gvxvdeba afeTqebebisa da sporaduli SemTxvevebis saxiT, ufro metad
zafxulis periodSi.
infeqcia ufro xSirad gvxvdeba mcire asakis bavSvebSi damZimebuli premorbiduli
foniT da Tanmxlebi daavadebebiT. masiuri inficirebisas SesaZlebelia janmrTelTa
425
kerZo nawili.
zogierTi pirobiTpaTogenuri ... infeqciebi. proteusiT gamowveuli ...
daavadebac.
paTogenezi . sakvebiT masiuri inficirebis SemTxvevaSi daavadeba iwyeba
toqsikoinfeqciisaTvis damaxasiaTebeli suraTiT, rac ganpirobebulia proteusisa da
misi endotoqsinebis dagrovebiT. endogenuri warmoSobis proteusuli infeqcia ki
viTardeba disbaqteriozis fonze antibiotikebiT xangrZlivi mkurnalobisa da
imunoreaqtiulobis daqveiTebis Sedegad.
proteusuli endotoqsinebi (hemolizini, leikocidini, hialuronidaza, fibrinolizini,
lecitinaza) iwveven kuW-nawlavis traqtis lorwovani garsis dazianebas da organizmis
zogad intoqsikacias.
sayofacxovrebo-kontaqturi gziT inficirebisa da endogenuri warmoSobis infeqciis
dros paTologiuri procesi viTardeba TandaTanobiT, wvrili da msxvili nawlavebis
upiratesi dazianebiT. mikrobebis maRali invaziurobis Sedegad mikrobTa nawili
nawlavis kedelSi xvdeba, saidanac limfagenuri da hematogenuri gziT xvdebian sxvadasxva
Sinagan organoebSi, iq isini kidevac mravldebian, gansakuTrebiT, TirkmlebSi da limfur
kvanZebSi. organizmis zogadi imunoreaqtiulobis daqveiTebis Sedegad xdeba meoradi
kerebis formireba _ pnevmonia, pielonefriti, Cirqovani meningiti da sxva an viTardeba
sefsisi. kuW-nawlavis mxriv adgili aqvs zedapiruli da jirkvlovani epiTeliumis
anTebiT infiltracias, zogjer wylulebis warmoSobas, lorwos hi persekrecias. mZime
SemTxvevebSi SesaZloa ganviTardes eroziul-kolituri proqtosigmoiditi.
klinikuri suraTi vlindeba gastroenteritis, enteritis an enterokolitis
saxiT. mozrdili asakis bavSvebSi adgili aqvs ufro toqsikoinfeqciis suraTs.
inkubaciuri periodi 2-5 saaTia. daavadeba iwyeba mwvaved, SemcivnebiT, temperatura
SeiZleba normaluri iyos an zogjer momatebulia 38-39°C-mde. ramdenime dRe daavadeba
mimdinareobs SeteviTi xasiaTis muclis tkiviliT epigastriumis an mTeli muclis
areSi. erTdroulad viTardeba faRaraTi. ganavali wylisebria, raime paTologiuri
minarevebis gareSe, zogjer lorwosa da sisxlis minarevebiT. aRiniSneba meteorizmi.
mZime SemTxvevaSi SeiZleba ganviTardes kolaftoiduri mdgomareoba letaluri
gamosavliT. umravles SemTxvevaSi daavadeba msubuqi da saSualo simZimiT mimdinareobs,
xangrZlivoba 2-7 dRes ar aRemateba da mTavrdeba sruli gamojanmrTelebiT.
axalSobilebsa da dauZlurebul bavSvebSi daavadeba xSirad enteritisa da
enterokolitis saxiT mimdinareobs. inkubaciuri periodis xangrZlivoba 2-5 dRea.
aRiniSneba zogadi intoqsikacia, wamoqafeba, Rebineba, adinamia, faRaraTi, mousvenroba,
muclis perioduli tkivili. faRaraTi xasiaTdeba Txeli, momwvano feris, myrali
sunis mqone uxvi ganavliT, lorwosa da sisxlis minarevebiT, anusis Zlieri gaRizianebiT,
Tumca anusis Riaoba ar aRiniSneba.
daavadeba SeiZleba mimdinareobdes mwvaved (1 Tve), gaxangrZlivebulad (1-3 Tve)
an miiRos qronikuli mimdinareoba (3 Tveze meti).
reqtoromanoskopiiT aRiniSneba kataruli, hemoragiuli, iSviaTad eroziuli
proqtosigmoiditi. periferiul sisxlSi cvlilebebi ifargleba leikopeniiT an
normocitoziT mcire neitrofiluri gadaxriT marcxniv, SedarebiTi limfocitoziT,
eds momatebulia 15-20 mm/sT-mde.
diagnozi sabolood ismeba baqteriologiuri da serologiuri monacemebis
safuZvelze. gamokvleuli unda iyos ganavali, pirnaRebi masa, kuWis amonarecxi, sakvebi
produqtebi, dedis rZe. vinaidan proteusi pirobiTpaTogenur floras miekuTvneba,
diagnostikisaTvis mniSvneloba eniWeba mis masiur da mravaljerad amoTesvas. sxvadasxva
wyarodan gamoyofili StamebiT aglutinaciisa da arapirdapiri hemaglutinaciis reaqciaSi
specifikuri antisxeulebis titris zrda 4-jer da metjer dinamikaSi adasturebs
proteusiT gamowveul infeqcias.
426
kerZo nawili. proteusiT gamowveuli ...
zogierTi pirobiTpaTogenuri ... infeqciebi. nawlavTa ... citrobaqteriuli ...
mkurnaloba. hospitalizacias eqvemdebareba daavadebis saSualo da mZime

mimdinareobis formebi. gastroenteritiT mimdinareobis dros saWiroa rehidratacia-
dezintoqsikacia. mZime generalizebuli infeqciis SemTxvevebSi eniSneba antibiotikebi
SeZlebisdagvarad mgrZnobelobis gaTvaliswinebiT. etiotropuli saSualebebidan iniSneba
qloramfenikoli, nevigramoni, gentamicini, cefalosporinebi da sxv.
profilaqtika. daavadebis Tavidan acilebis mizniT aucilebelia, dacul iqnas
mkacri sanitarul-higienuri reJimi. saWiroa daavadebis adreuli gamovlena, organizmis
zogadi reaqtiulobis amaRleba.
aqtiuri profilaqtika SemuSavebuli ar aris.
nawlavTa mwvave citrobaqteriuli

infeqcia
nawlavTa mwvave citrobaqteriuli infeqcia klinkurad vlindeba sakvebismieri

toqsikoinfeqciis an enterokolitis saxiT.
etiologia. mikrobi miekuTvneba Enterobacteriaceae-s ojaxs, Citrobacter-is
etiologia
gvars, gramuaryofiTi Cxiria. cnobilia mikrobis 2 saxeoba da ramodenime aTeuli
serovari. warmoSobs endotoqsins, umravles SemTxvevaSi Stamebi gamoyofen
kolinocinogenebs.
epidemiologia. infeqciis wyaroa avadmyofi an baqteriamtarebeli adamiani, agreTve,
epidemiologia
SesaZloa, Sinauri cxovelebi. infeqcia SeiZleba SeiWras inficirebuli sakvebiT
(xorci, rZe), kontaqturi gziT (inficirebuli saTamaSoebi, sawovara). umTavresad
avaddebian mcire asakis bavSvebi, iSviaTad _ mozrdilebi. ufrosi asakis bavSvebSi
daavadeba toqsikoinfeqciis suraTiT mimdinareobs. infeqciis sezonuroba gamoxatulia
zafxul- Semodgomaze.
paTogenezi Seswavlili ar aris.
klinika. kvebiTi toqsikoinfeqciis suraTiT mimdinareobisas daavadeba iwyeba
klinika
inficirebuli produqtebis miRebidan 3-5 saaTSi, muclis tkiviliT epigastriumis
areSi, gulis reviT, ganmeorebiTi RebinebiT, saerTo sisustiT, faRaraTiT 2-3-jer
dReSi. temperatura matulobs subfebrilur donemde. obieqturad saxezea TeTrad
Selesili ena. palpaciiT SeigrZnoba da manZilze ismis yuryuri nawlavis gaswvriv,
defekacia Txeli ganavlovani masebis SenarCunebiT, raime paTologiuri minarevebis
gareSe. daavadebis xangrZlivoba ar aRemateba 3-5 dRes da gamojanmrTelebiT mTavrdeba.
dauZlurebul bavSvebSi daavadeba Rebulobs enterokolitur xasiaTs, viTardeba toqsikozi,
temperatura matulobs, damaxasiaTebelia nawlavTa zomieri disfunqcia. ganavali
enterituli an enterokolituria, Seicavs lorwos da iSviaTad _ sisxls. daavadebis
Semdgomi mimdinareoba damokidebulia bavSvis premorbidul fonze da Tanmxlebi
daavadebebis arsebobaze.
diagnozi ismeba mxolod baqteriologiuri da serologiuri monacemebis safuZvelze.
generalizebuli formebis dros antibaqteriuli preparatebidan eniSnebaT farTo
speqtris antibiotikebi da qimiopreparatebi antibiotikogramis gaTvaliswinebiT. tardeba
saTanado paTogenezuri da simptomuri Terapia.
profilaqtika tardeba ise, rogorc sxva mwvave nawlavuri infeqciebis dros.
specifikuri profilaqtika ar aris SemuSavebuli.
427
kerZo nawili.
zogierTi pirobiTpaTogenuri ... infeqciebi. nawlavTa ... fsevdomonuri ...
nawlavTa mwvave fsevdomonuri

infeqcia
fsevdomonuri etiologiis nawlavTa mwvave infeqcia gvxvdeba, upiratesad, mcire

asakis, susti imunuri statusis, gansakuTrebiT, dRenakl bavSvebSi da mimdinarobs
organizmis saerTo intoqsikaciiT, Cirqovan-nekrozuli enterokolitiT, sefsisiT,
nozokomialuri infeqciis saxiT, SedarebiT mozrdil bavSvebSi ki _ toqsikoinfeqciis
suraTiT.
etiologia. mwvane Cirqmbadi Cxiri _ Pseudomonas aeruginosa gramuaryofiTi,
etiologia
moZravi, obligaturi anaerobia. mikrobi miekuTvneba Pseudomonadaceae-s ojaxs,
Pseudomonas-s gvars, warmoqnmis egzotoqsins _ A,B,C, agreTve proteinazebs
(hemolizini, leikocidini, enterotoqsini, kolagenaza, elastaza da sxva), glikokaliqss
(lorwovani kafsula), gamoimuSavebs mwvane da lurj pigments. somaturi 0-antigenis
meSveobiT arCeven 13 serologiur jgufs, xolo H antigenis mixedviT _ 80-mde
serologiur variants. sxva paTogenuri fsevdomonebia: P.cepacia, P. maltophilia, P.
fluorescens, P. putrifaciens, p. mallei.
epidemiologia
pidemiologia. mwvane Cirqmbadi mikrobebi farTodaa gavrcelebuli garemoSi.
misi aRmoCena SeiZleba niadagSi, wyalSi, agreTve, adamianisa da cxovelebis kuW-nawlavis
traqtSi. mikrobebi, gansakuTrebiT advilad vrceldeba samSobiaro saxlebSi, reanimaciisa
da intensiuri Terapiis ganyofilebebSi, sadac momvleli personalis xelebidan, samedicino
instrumentebidan Tu sxva obieqtebidan xSirad xdeba maTi amoTesva.
fsevdomonuri infeqciis mimarT gansakuTrebiT mgrZnobiareni arian pirveli sami
Tvis asakis bavSvebi, maT Soris _ axalSobilebi. aRniSnul kontingentSi arcTu
iSviaTia hospitaluri StamebiT gamowveuli epidafeTqebebi, ufro xSirad ki gvxvdeba
sporaduli SemTxvevebi. mozrdili bavSvebi avaddebian Sesustebuli imunoreaqtiulobis
SemTxvevaSi, romelTac aReniSnebaT anamnezSi imunodepresantebiT mkurnaloba.
infeqciis wyaros warmoadgens avadmyofi adamiani, gansakuTrebiT, Ria Cirqovani
kerebiT, pnevmoniiT, nawlavTa disfunqciiT, agreTve janmrTeli baqteriamtarebeli.
infeqcia gadaecema sayofacxovrebo-kontaqturi gziT, inficirebuli sakvebi
produqtebiT.
paTogenezi. piris RruSi fsevdomonebis moxvedra pirveladad azianebs kuW-
nawlavis traqts, rac klinikurad xSirad gastroenteritis, enterokolitis suraTiT
gamoixateba. disbaqteriozis fonze ganviTarebuli fsevdomoniazi ki meoradi genezisaa.
nawlavTa traqtis meoradi dazianeba ganpirobebulia meoradi anTebadi kerebidan
(pnevmonia, sefsisi da sxva) mwvane Cirqmbadi mikrobebis gavrcelebiT.
egzogenuri infeqciis dros organizmis saerTo intoqsikacia da adgilobrivi
cvlilebebi gamowveulia egzotoqsinebis A,B,C da sxva mikrobuli metabolitebis
(hemolizini, endotoqsini da sxva) moqmedebiT.
endogenuri anu nawlavTa meoradi genezis dazianeba, romelic viTardeba imunuri
statusis daqveiTebis Sedegad, rogorc wesi, dRenakli axalSobilebisa da pirveli
Tvis asakis bavSvebis xvedria. am formis paTogenezSi wamyveni roli miekuTvneba,
agreTve, mikrobis invaziur da baqteriemiis swrafad ganviTarebis unarsac.
nawlavTa fsevdomonuri infeqcia xSirad mimdinareobs stafilokokebiT, klebsielebiT,
salmonelebiTa da sxva, pirobiT paTogenuri mikrobebiT gamowveuli Sereuli infeqciebis
saxiT.
nawlavTa fsevdomonuri infeqciis paTmorfologiuri suraTi xasiaTdeba sxvadasxva
anTebadi procesiT _ lorwovani garsis kataruli movlenebidan fibrinul-nekrozul
428
kerZo nawili.
zogierTi pirobiTpaTogenuri ... infeqciebi. nawlavTa ... fsevdomonuri ...
procesamde. adgilobrivi procesis intensivoba bevradaa damokidebuli organizmis

imunobiologiur reaqtiulobasa da mikrobTa asociaciaze da SeiZleba atarebdes
wylulovan-nekrozul xasiaTsac.
klinika. adreuli asakis bavSvebSi klinikuri suraTi mimdinareobs enteritis an
enterokolitis saxiT. ufro mozrdil bavSvebSi SeiZleba atarebdes toqsikoinfeqciis
xasiaTs. aRniSnulTan dakavSirebiT, pirveli formis dros inkubaciuri periodi Seadgens
2-5 dRes, xolo meore formis dros SeiZleba ganisazRvros ramdenime saaTiTac ki,
saSualod _ 1-2 dRiT.
enterokolituri formis dros daavadeba iwyeba TandaTan, saerTo mdgomareobis
gauaresebiT, temperatura, umetesad subfebrilur xasiaTs atarebs, aRiniSneba wamoqafebebi,
Txieri defekacia. pirvel dReebSi toqsikozis suraTi zomieradaa gamoxatuli, magram
SemdgomSi SeiZleba TandaTan ganviTardes eqsikozi xSiri faRaraTis gamo. am ukanasknelis
sixSirem 5-20-sa da mets SeiZleba miaRwios dRe-RameSi. ganavali Txieri konsistenciisaa,
axasiaTebs myrali suni, mwvane feri. didi raodenobiT Seicavs lorwos, zogjer
sisxlsac. SesaZlebelia, ganviTardes sisxldena nawlavebidan, daavadebam miiRos
gaxangrZlivebuli, talRiseburi xasiaTi. am dros aRiniSneba subfebriluri an zomierad
momatebuli temperatura, umadoba, sxeulis masis dakleba, meteorizmi, yuryuri, anusisa
da dundulebis areSi gaRizianeba da sxva. saerTo intoqsikaciis movlenebi daavadebis
dawyebidan saSualod 10-12 dRes grZeldeba, gamojanrTelebis periodi _ ki 2-3
kviras.
gastroenteruli forma iSviaTia da, rogorc wesi, mxolod mozrdil bavSvebSi
gvxvdeba, rac inficirebuli sakvebis miRebasTanaa dakavSirebuli. inkubaciuri periodi
am dros ramodenime saaTs Seadgens. daavadeba iwyeba mwvaved, gulisreviT, ganmeorebiTi
RebinebiT, avadmyofebi xSirad uCivian tkivilebs epigastriumis midamoSi. temperatura,
umetesad, normaluria, Tumca zogjer subfebrilur ricxvebs aRwevs, defekaciis sixSire
dRe-RameSi 5-6-s ar aRemateba. ganavali fafisebria, Seicavs mcire raodenobiT lorwos,
momwvano ferisaa. ufro mZime SemTxvevebSi gamoxatulia saerTo intoqsikacia, nawlavTa
disfunqcia ki klinikur suraTSi ar dominirebs.
simZimis mixedviT arCeven msubuq, saSualo da mZime formebs. Sefasebis kriteriumebi
igivea, rac sxva nawlavTa mwvave infeqciebis dros.
diagnozi ismeba klinikuri, epidemiologiuri da laboratoriuli monacemebis
meSveobiT. gadamwyveti mniSvneloba aqvs ganavlidan, kuWis amonarecxidan, sisxlidan,
naxvelidan, Cirqidan da sxva substratebidan sufTa kulturis miRebas. diagnostikuri
mniSvneloba eniWeba daavadebis dinamikaSi antisxeulebis titris zrdas, rac dgindeba
antisxeulebis aglutinaciisa da pasiuri hemaglutinaciis reaqciiT.
mkurnaloba. etiologiuri mkurnalobis Catareba gaZnelebulia bevri antibiotikis
mkurnaloba
mimarT mikrobebis rezistentobis gamo. amJamad asarCev preparatad iTvleba
aminoglikozidebis jgufis antibiotikebi (gentamicini, amikacini, netromicini da sxva),
sulfati, karbenicilini, agreTve. antibaqteriuli preparatebis gamoyeneba mizanSewonilia
daavadebis mZime generalizebuli formebis dros.
koreqciisaTvis imunokomprometirebul avadmyofebs eniSnebaT imunoglobulinebi,
itaminebi da sxva paTogenezuri Terapia.
profilaqtika analogiuria im profilaqtikuri RonisZiebebisa, rac sxva
pirobiTpaTogenuri floriT gamowveuli nawlavTa mwvave infeqciebis drosaa
gaTvaliswinebuli.
429
kerZo nawili.
nawlavTa anaerobuli infeqcia klostridium perfringensiT ...
nawlavTa anaerobuli infeqcia

(klostridiozebi)
enterotoqsigenuri StamebiT gamowveuli nawlavTa klostridiuli etiologiis

diareuli daavadebebi klinikurad xasiaTdeba toqsikoinfeqciis ti pis mimdinareobiT
da nekrozuli anu fsevdomembranuli kolitis suraTiT. ufro xSirad daavadebas
iwvevs A da C ti pis C. perfringens da C. difficile. maT mier gamowveuli klinikuri
formebi erTmaneTisagan gansxvavdebian rogorc daavadebis ganviTarebis meqanizmiT,
aseve klinikuri gamovlinebiTac, rac aucilebels xdis, yvela forma ganxiluli
iqnas cal-calke.
sxva klostridiebidan, romlebic iwveven daavadebas adamianebSi unda aRiniSnos
C.sordelii, C.hystolyticum, C.septicum, C.tertium, C.novyi, C.butyricum,
C.bifermantans, C.paraputrificum, C.botulinum, C.tetani.
klostridium perfringensiT gamowveuli infeqcia

perfringens klostridiozi
etiologia: C. perfringens warmoadgens adamianisa da cxovelis normalur

mobinadres, gramuaryofiTi mikrobebia, zomiT (4-8) X (0,8-1) mkm, warmoSoben sporebs,
mravldebian da uxvad gamoyofen gazebs yvela sakveb niadagze; gamoyofen Zlier
egzotoqsins, romelsac aqvs enterotoqsikuri, nekrozuli, neirotoqsikuri,
hematotoqsikuri da sxva Tvisebebi. antigenuri da serologiuri Tvisebebis mixedviT
iyofa A,B,C,D,E,F ti pebad. sakvebismieri mowamvla xSirad ganpirobebulia C ti pis C.
perfringens-iT.
epidemiologia. mikrobebi farTodaa gavrcelebuli garemoSi _ niadagSi, wyalSi,
adamianebisa da cxovelebis ganavalSi. Termostabiluri sporebi advilad mravldebian
da intensiurad abinZureben sakveb produqtebs _ xorcs, rZes, xaWos, rZis narevebs da
sxvas, rasac damatebiT xels uwyobs sakvebis damzadebis, Senaxvisa da realizaciis
darRveva, aradamakmayofilebeli san-higienuri pirobebi.
literaturaSi aRwerilia infeqciis afeTqeba didi nadimis dros, rac iyo
dakavSirebuli Rorebis dakvlasTan (axali gvinea). daavadeba, umTavresad, atarebs
sporadul xasiaTs. gazafxul-Semodgomaze infeqcias axasiaTebs sezonuroba.
paTogenezi. kuW-nawlavis traqtSi infeqciis SeWra xdeba sakvebTan erTad, sadac,
upiratesad wvril nawlavSi mimdinareobs mikrobTa gamravleba. maT mier gamoyofili
toqsinebi sisxlSi iwoveba da mZime SemTxvevebSi iwvevs sisxlis kapilarebis toqsikur
da nekrozul dazianebas. am dros nawlavebSi xdeba lorwovani garsebis mkveTri
SeSupeba, hi peremia, mravalricxovani sisxlCaqcevebi, Rrma nekrozebi, dawylulebebi,
SesaZloa nawlavis perforaciac. Sinagan organoebSi gvaqvs distrofiuli da nekrozuli
movlenebi, mravalricxovani sisxlCaqcevebiT.
klinika. inficirebuli sakvebis miRebidan 6-24 saaTis Semdeg daavadeba vlindeba
mwvaved, araiSviaTad temperaturis momatebiT 38-39°C-mde, RebinebiT, faRaraTiT,
430
kerZo nawili. klostridium perfringensiT ...
nawlavTa anaerobuli infeqcia klostridium dificileTi ...
epigastriumis areSi SeteviTi xasiaTis tkiviliT. am dros palpaciiT xSirad vlindeba

mtkivneuloba nawlavebis gaswvriv, SesaZloa adgili hqondes sigmis spazms, sfinqterits,
anusis Riaobas. daavadebis enterituli mimdinareobisas ganavali Seicavs didi raodenobiT
siTxes. xolo enterokolitis SemTxvevaSi aRiniSneba aseve didi raodenobiT lorwo
da sisxlic.
daavadebis msubuqi mimdinareobisas intoqsikaciis saerTo movlenebi ar grZeldeba
2 dReze metxans, Tumca nawlavTa disfunqcia rCeba 5-7 dRis ganmavlobaSi. mZime
klostridiozis dros toqsikozisa da eqsikozis movlenebi mkveTradaa gamoxatuli;
am dros SeiZleba ganviTardes toqsikur-hi povolemiuri Soki da procesi letaluri
gamosavliT damTavrdes.
diagnozi emyareba klinikur, laboratoriul da epidemiologiur monacemebs. vinaidan
klinikuri simptomatika araspecifikur xasiaTs atarebs, amitom gadamwyveti mniSvneloba
laboratoriul monacemebs emyareba, romlebic mimarTulia fekaliebSi toqsinis
aRmoCenisaken. iyeneben eqspres-meTods, imunoeleqtroforezs, agreTve gamoyofili A da
C ti pis C. perfrigens-is toqsigenobis dadgenas.
mkurnaloba. antibaqteriuli preparatebidan iyeneben penicilins, cefalosporinebis,
aminoglikozidebis jgufis antibiotikebs da sxvas saTanado dozebiT, asakis da simZimis
gaTvaliswinebiT. Tumca, aSS-Si am dros antibiotikebs ar xmaroben.
rusi avtorebis mier daavadebis mZimed mimdinareobisas rekomendebulia antitoqsikuri
Sratebis daniSvna 5000-10000 a.e. raodenobiT kunTebSi bezredkas wesiT. avadmyofebs
utardebaT saTanado paTogenezuri da simptomuri mkurnaloba, rogorc es mowodebulia
nawlavTa infeqciebis dros.
profilaqtika. gadamwyveti mniSvneloba eniWeba sanitarul-higienuri reJimis da
sakvebi produqtebis infeqciisagan dacvas da mis gacxelebas miRebis win, kvebis blokSi
momuSave personalis gamokvlevas klostridiebze da mtareblebisa da avadmyofebis
izolacia-mkurnalobas.
didi yuradReba unda eqceodes sanitarul-higienur propagandas, bavSvis swor
movlas da maT saTanado kvebas.
klostridium dificileTi gamowveuli infeqcia

dificile klostridiozi
Tanamedrove TvalsazrisiT, antibiotikebiT namkurnaleb avadmyofebSi nawlavTa

normaluri floris daTrgunvis fonze xdeba Clostridium difficile-s Seukavebeli
zrda, rac fsevdomembranuli kolitis Camoyalibebas iwvevs.
etiologia. C. difficile pirvelad, rogorc komensali gamoyofil iqna 1935 wels,
J. Hall da F.O. Toole-s mier, janmrTeli axalSobilis ganavlidan.
mikrobs Tavisi originaluri saxelwodeba mieca inglisuri sityvidan difficult
(rTuli). pirvel xanebSi mikrobi ar iqna miCneuli paTogenad, Tumca bulionis kulturaSi
igi toqsikur Tvisebebs avlenda. misi ganmeorebiTi aRmoCena moxda 70-ian wlebSi,
roca klinikur praqtikaSi farTo speqtris antibiotikebis gamoyenebasTan erTad wina
planze wamovida antibiotikebTan asocirebuli fsevdomembranuli koliti.
1978 wels dadginda, rom fsevdomembranuli kolitis mqone avadmyofTa ganavalSi
arsebuli toqsinis wyaroa C. difficile.
C. difficile warmoadgens (5-10) X (1,5-2)mkm zomis Cxirs, igi mkacri anaerobuli
mikrobia, romelsac aqvs ovaluri formis sporebi. mikrobebi warmoSoben orive saxis,
431
kerZo nawili.
erTmaneTisagan gansxvavebul toqsinebs _ A-enterotoqsinsa da B-citotoqsins.

enterotoqsini bocvrebis izolirebul nawlavebSi iwvevs hemoragiuli siTxis dagrovebas,
citotoqsini ki _ qsovilovani kulturis citopaTogenur efeqts.
epidemiologia. C. difficile SedarebiT xSirad gvxvdeba garemoSi _ niadagSi,
wyalSi, cxovelTa ganavalSi. mozrdil adamianebSi normaluri mdgomareobis dros
maTi aRmoCena SesaZloa 5-10%-Si, wlamde asakis bavSvebSi ki es maCvenebeli 30-40%-
s aRwevs. dadgenilia, rom C. difficile ainficirebs avadmyofTa 20%-ze mets da amJamad
msoflioSi yvelaze xSir nozokomialur infeqciadaa miCneuli. aSS-Si yovel wels
stacionarul pirobebSi diareisa da kolitis 3 mln SemTxveva registrirdeba maSin,
rodesac ambulatoriul avadmyofebSi es maCvenebeli Seadgens mxolod 20.000 SemTxvevas
weliwadSi.
xazgasasmelia, rom stacionarSi yofnis dros avadmyofTa mxolod 1/3-s aReniSneba
diarea, SemTxvevaTa 2/3-Si ki adgili aqvs asimptomur mtareblobas. swored es ukanaskneli
warmoadgens infeqciis rezervuars stacionarSi. infeqciis gadacema, umTavresad,
xorcieldeba sayofacxovrebo-kontaqturi gziT (inficirebuli WurWeli, saTamaSoebi,
sagnebi). gadacemis meqanizmi fekalur-oraluria. gadacema SesaZlebelia inficirebuli
sakvebis meSveobiT. nozokomialuri afeTqebebi gansakuTrebiT xSiria dRenakl da
dasustebul bavSvebSi.
paTogenezi. C. difficile-s paTogenuri Stamebi warmoSoben or Zlier toqsins _
A-enterotoqsinsa da B-citotoqsins. es toqsinebi warmoadgenen maRalmolekulur
proteinebs, romlebic ukavSirdebian msxvili nawlavis lorwovanis epiTeliumze arsebul
receptorebs da Semdeg vrceldebian ujredis citoplazmaSi da axdenen xilis specifikur
dazianebas. antibiotikebiT mkurnalobis fonze toqsinebis mier lorwovani garsis
dazianebiT viTardeba fsevdomembranuli koliti, nekrozuli koliti an diareiT mimdinare
daavadeba. am mxriv, gansakuTrebiT didi mniSvneloba aqvs farTo speqtris antibiotikebs,
rogoricaa cefalosporinebi, ampicilini, linkomicini, klindamicini da sxv. maT mier
gamowveuli disbaqtriozis fonze Cndeba xelsayreli pirobebi C. difficile-s Seukavebeli
zrdisaTvis, romlis toqsinebic iwveven nawlavis lorwovani garsis mkveTr dazianebas
da organizmis saerTo intoqsikacias.
miuxedavad imisa, rom axalSobilTa ganavalSi xSirad vlindeba C. difficile-s
toqsinebis maRali koncentracia, am mikrobiT gamowveuli diarea da koliti maTSi
ukiduresad iSviaTad gvxvdeba, iseve, rogorc wlamde asakSi. eqsperimentulad dadgenilia,
rom axalSobil bocvrebs ar gaaCniaT am toqsinisadmi specifikuri receptorebi. es
ukanasknelni uyalibdebaT sqesobrivi momwifebis dros. axalSobili bavSvebi moklebulni
arian Tu ara toqsinis receptorebs da aris Tu ara es imis mizezi, rom maT Soris
iSviaTia C. difficile-Ti gamowveuli diarea da koliti, jerjerobiT cnobili ar aris.
sigmoskopiiT, kolonoskopiiT da reqtaluri biofsiiT dgindeba anTebiTi procesi,
romelic warmodgenilia fibrinuli, moyviTalo-moTeTro, 2mm-dan 2 sm-mde zomis nadebebis
an fokaluri wylulovani, hemoragiuli enterokolitis suraTis saxiT.
imuniteti. C. difficile infeqtisagan dacvaSi ZiriTadi mniSvneloba eniWeba nawlavTa
normalur mikrofloras, romelic Trgunavs am paTogenis in vitro da in vivo kolonizacias.
meore damcvel faqtors warmoadgens kuWis normaluri mJavianoba, romlis drosac
mcirdeba sicocxlisunariani sporebis ricxvi, inaqtivirdeba ganTavisuflebuli toqsinebi.
mniSvnelovan rols TamaSobs nawlavTa normaluri peristaltika, aqedan gamomdinare,
antiperistaltikuri moqmedebis mqone antidiareuli preparatebis daniSvna rekomendebuli
ar aris.
iTvleba, rom adamianis organizmis humoruli pasuxi C. difficile-s kolitis simZimisa
da xangrZlivobis mniSvnelovani ganmsazRvreli faqtoria.
432
kerZo nawili.
eqsperimentulad naCvenebia, rom A-toqsinisadmi cxovelTa imunizacia icavs maT C.

difficile-s kolitis ganviTarebisagan. interess iwvevs is faqti, rom mozrdili adamianebis
populaciis sisxlis SratSi nanaxia A da B-toqsinebis sawinaaRmdego antisxeulebi,
msxvili nawlavis sekretSi ki A klasis sekreciuli imunoglobulinebi, romlebic
warmoadgenen antitoqsins da SeuZliaT A-toqsinisa da receptorebis SekavSirebis
inhibireba, rac, SesaZloa, C. difficile-sagan dacvis erT-erTi meqanizmi iyos.
klinika. daavadeba viTardeba antibiotikebiT 7-10 dRis mkurnalobis Semdeg (Tumca
SesaZloa ufro swrafadac ki). igi iwyeba mwvaved, temperaturis momatebiT, ganmeorebiTi
RebinebiT, muclis tkiviliT, faRaraTiT. am fonze swrafad viTardeba organizmis
saerTo intoqsikacia, sxeulis masis dakleba, ganavali xdeba wylisebri, Seicavs lorwos.
nekrozuli enteriti xasiaTdeba umZafresi mwvave dasawyisiT, muclis Zlieri tkiviliT,
mravaljeradi RebinebiT, Zlieri faRaraTiT, SokiT. aseTi formebi xSirad letaluri
gamosavliT mTavrdeba.
fsevdomembranuli kolitis dros, garda aRniSnuli simptomkompleqsisa, ganavali
Seicavs didi raodenobiT lorwos, fibrinul nafleTebs, sisxlsa da Cirqs. zogjer
xdeba nawlavis perforacia. aRsaniSnavia, rom antibiotikebis miRebis Sewyvetis Semdeg
saerTo mdgomareoba umjobesdeba. es ki am daavadebis genezSi antibiotikebis mniSvnelovan
rolze miuTiTebs.
daavadeba gansakuTrebiT mZimed mimdinareobs dRenakl bavSvebSi, romlebSic nawlavTa
dawylulebisas viTardeba perforacia da yalibdeba ganavlovani peritoniti mZime
prognozuli gamosavliT. amave dros, gvxvdeba msubuqi formebic, romlebic sustad
gamoxatuli enteritisa da enterokolitis suraTiT xasiaTdeba.
fsevdomembranuli koliti SeiZleba ganviTardes antibiotikebiT aranamkurnaleb
bavSvebSic. am dros ganavalSi dgindeba rogorc C. difficile-s, ise misi toqsinebis
arsebobac. fsevdomembranuli koliti C. difficile-infeqciis dros SemTxvevaTa 3%-Si
gvxvdeba. es klinikuri forma xSirad ganapirobebs iseT seriozul garTulebebs,
rogoricaa gauvaloba, toqsikuri megakoloni da rac SemdgomSi sikvdilis mizezi
xdeba.
morecidive infeqcia. C. difficile-s diareis pirveli epizodis mkurnalobis
warmatebiT CaTavebis Semdeg daavadebis recidivi SeiZleba ganviTardes 15-20%-Si. jer
araa dadgenili, ra udevs safuZvlad recidivis ganviTarebas _ mikrobis persistencia
Tu reinfeqcia. metronidazoliTa da vankomiciniT mkurnalobam SeiZleba TviTon
ganapirobos da gaaxangrZlivos nawlavTa normaluri floris darRveva da amiT xeli
Seuwyos C. difficile-s reinfeqcias.
amgvarad, reinfeqciis SesaZlo meqanizmia: C. difficile-s garemodan reinfeqcia;
nawlavebSi mikrobebis kolonizaciisaTvis xelSemwyobi pirobebi, metronidazolis,
vankomicinis, klindamicinisa da farTo speqtris sxva antibiotikebiT mkurnaloba da
organizmis susti imunuri pasuxi C. difficile-s infeqciasa da mis toqsinebze.
garTuleba.. fulminanturi kolitis dros zogierT SemTxvevaSi SeiZleba
garTuleba
ganviTardes toqsiuri megakoloni. am diagnozis dasma SeiZleba msxvili nawlavis
diametris 7 sm-ze metad dilataciisas. SesaZlebelia, gaganierdes wvrili nawlavic
siTxis horizontuli doniT da Seiqmnas nawlavTa obstruqciisa da iSemiis suraTi.
nawlavTa perforaciisas viTardeba ganavlovani peritoniti. am dros rentgenogramaze
vlindeba Tavisufali airis arseboba muclis RruSi.
diagnozi ismeba klinikuri, laboratoriuli da epidemiologiuri monacemebis
meSveobiT. diagnostikis ZiriTadi testia enzim-imunuri analizi A da B toqsinebis
arsebobis gamosavlenad. sxva infeqciuri diareebisagan gansxvavebiT ganavlidan C.
difficile-s amoTesvas klinikaSi iSviaTad mimarTaven, igi, ZiriTadad, epidemiologiur
433
kerZo nawili.
kvlevebSi gamoiyeneba. saukeTeso standartuli diagnostikuri testia citotoqsikuri

testi qsovilovan kulturaze. misi arsi fibroblastebis kulturaSi toqsinis
citopaTogenuri efeqtis dadgenaSi mdgomareobs. testi gamoirCeva maRali specifikurobiT
(100%), Tumca unda aRiniSnos misi SedarebiTi siZvire da xangrZlivi drois saWiroeba
(Cveulebriv, 2-3 dRe).
PCR (polymerase chain reaction _ polimerazuli jaWvuri reaqcia) SemuSavebulia,
magram farTod jer ar gamoiyeneba.
fsevdomembranuli kolitis diagnozis swrafi dasmis mizniT mizanSewonilia
urgentuli endoskopia. reqtaluri fsevdomembranebis aRmoCena paTognomuria C. difficile-
s kolitisaTvis. abdominuri kompiuteruli tomografiiT vlindeba msxvili nawlavis
kedlis mniSvnelovani gasqeleba, romelic SeiZleba moicavdes mTel msxvil nawlavs.
mkurnaloba.. daavadebis mZime mimdinareobisas naCvenebia mkurnalobis stacionarSi
mkurnaloba
Catareba. pirvel rigSi, aucilebelia antibiotikebis moxsna, romelTa fonzec ganviTarda
daavadeba.
C. difficile-ze zemoqmedebis mizniT avadmyofs eniSneba metronidazoli, vankomicini
an bacitracini 7-10 dRe.
metronidazoli iniSneba asakobrivi dozebis gaTvaliswinebiT, 40mg/kg dRe-RameSi, 4
miRebaze. nawlavidan metronidazoli eqskretirdeba da gamoiyofa anTebiTi msxvili
nawlavis eqsudatTan erTad. mkurnalobis efeqturoba aRemateba 95%-s. mdgomereoba
umjobesdeba me-2-3 dReSi. sruli gamojansaReba xdeba me-7-10 dRes.
vankomicini per os miRebisas ar Seiwoveba, ris gamoc nawlavis sanaTurSi misi
maRali koncentracia iqmneba, gverdiTi movlenebis saerTo gamovlineba ki umniSvneloa.
mozrdilebs vankomicini intravenurad eZlevaT 1-2 grami dRe-RameSi, axalSobilebSi
iniSneba 15 mg/kg sxeulis masaze yovel 12 saaTSi, 1 Tvis asakSi _ igive doziT 8 saaTSi
erTxel, erTi Tvis asakis zemoT ki _ 40 mg/ kg-ze. preparati SehyavT venaSi wveTovnad,
araumetes 10 mg/wT-Si, infuziis xangrZlivoba ar unda iyos 60 wuTze naklebi. swrafi
Seyvanisas viTardeba red man syndrome (‘wiTeli kacis sindromi~).
bacitracini gamoiyeneba asakobriv dozebSi. aRwerilia morecidive kolitis
warmatebuli mkurnaloba imunoglobuliniT. akrZalulia nawlavTa motorikis
damTrgunveli preparatebis gamoyeneba.
vankomicini metronidazolTan SedarebiT ufro Zlieria, magram vankomicinis oraluri
miReba ganapirobebs nozokomialuri vankomicinrezistentuli baqteriebis warmoSobas.
amitom vankomicinis per os miReba naCvenebia mxolod im avadmyofebSi, romelTac aReniSnebaT
metronidazolis autanloba, naCvenebia, agreTve, metronidazolis araefeqturobisas da
mZime fsevdomembranuli kolitis dros.
unda aRiiSnos, rom upiratesad antibiotikTerapiiT ganpirobebuli diareis
samkurnalod mowodebulia cocxali sokos Saccharomyces boulardii–is
liofilizebuli forma (Enterol-i). am sokos moqmedeba emyareba mis mier gamoyofil
ferment-proteinazas msgavsi cilis gamoyofas, romelic amcirebs C. difficile–s toqsinis
moqmedebas nawlavis garsze.
profilaqtika. vinaidan C. difficile-s enterokolitis ZiriTadi mizezi xdeba
antibiotikTerapia, aucilebelia antibiotikebis, gansakuTrebiT farTo speqtris
antibiotikebis kontroliT gamoyeneba.
434
kerZo nawili. nawlavTa disbaqteriozi
nawlavTa disbaqteriozi
nawlavTa disbaqteriozi ganimarteba, rogorc mdgomareoba, ganpirobebuli

polietiologiuri faqtorebiT, nawlavis floris raodenobrivi da xarisxobrivi
darRveviT, nawlavTa ZiriTadi funqciis moSliT da amis Sedegad kuW-nawlavis traqtis
mxriv rigi simptomkompleqsis ganviTarebiT, araiSviaTad organizmis saerTo intoqsikaciis
movlenebiT.
1916 w. A. Nissle-m pirvelad mogvawoda termini disbaqteriozi, romlis arsSi
igulisxmeba mikrofloris raodenobrivi da xarisxobrivi cvlilebebi, ganpirobebuli
nawlavis mikroekologiis dinamiuri darRveviT, damcvelobiTi da kompensaciuli
adaptaciuri meqanizmebis CavardniT. dadgenilia, rom janmrTeli adamianis nawlavTa
mikroflora ZiriTadad Sedgeba anaerobebisagan _ bifidobaqteriebisa da baqteroidebisagan,
romlebic Seadgenen yvela saxis mikrobebis 90%-s; Tanmxleb floras miekuTvnebian
laqtobaqteriebi, eSerixiebi, enterokokebi (mikrobTa saerTo raodenobis 10%-mde) da
danarCeni flora _ stafilokokebi, proteusi, klebsielebi, citrobaqteriebi, klostridiebi,
sokoebi, aerobuli bacilebi da sxva ( mikrobTa saerTo raodenobis 1 %).
normaluri flora SeiZleba, agreTve, davyoT obligatur (mudmiv) da fakultatur
(iSviaTad gvxvdeba) mikrobebad.
nawlavTa ekologiuri homeokinezis mudmivobis SenarCunebaSi nawlavTa normaluri
mikroflora asrulebs sxvadasxva damcvelobiT funqcias, romelTa Soris, ZiriTadad,
gamoiyofa faqtorTa 4 jgufi: pirvel jgufs miekuTvnebian specifikuri
imunoglobulinebi; pirvel rigSi, sekreciuli A imunoglobulinebi, romelic warmoadgens
nawlavebis lorwovani garsebis bariers sxvadasxva alergenis mimarT da araspecifikuri
(komplementi, interferoni, lizocimi, transferini, laqtobaqterini da sxva) humoruli
dacvis faqtorebi. meore jgufs Seadgens nawlavTa lorwovani garsebis epiTeliumi,
romelic ganaxlebas ganicdis yovel 6-8 dReSi, makro- da mikroxaoebi, romlebic
dafarulni arian sqeli glikokaliqsiT, peristaltikuri moZraobebi, iliocekaluri
sarqveli. mesame jgufi warmodgenilia iseTi qimiuri faqtorebiT, rogoricaa kuWis
wveni, nerwyvi, pankreasis da nawlavTa sekretebi, naRveli, cximovani mJavebi.
bifidumbaqteriebi warmoSoben rZis, Zmris, WianWvelis, qarvis mJavebs, rac iwvevs nawlavebSi
pH-is daklebas 4,0-3,8-mde da ganapirobebs lpobisa da paTogenuri mikrobebis
gamravlebisa da zrdis Seferxebas. meoTxe jgufi cnobilia biologiuri faqtorebiT
da warmoadgens nawlavTa normalur mikrofloras, pirvel rigSi anaerobul
bifidumbaqteriebs da umniSvnelo SefardebiT aerobul floras.
bifidoflora, gansakuTrebiT, wlamde asakis bavSvebSi Rebulobs monawileobas
nawlavebSi rkinis, kalciumis, vitamin D-s absorbciaSi da, maSasadame, mas aqvs antianemiuri
da antiraqituli unari. bifidumbaqteriebi monawileoben aminonJavebis, cilebis, K
vitaminis, Tiaminis, riboflavinis, B jgufis vitaminebis, folis, nikotinis, pantoTenis
mJavebis SeqmnaSi, moqmedeben damcveli peristaltikis agznebaze da sxva.
nawlavis Cxirebis antibaqteriuli aqtivoba ganisazRvreba maTi unariT, gamoimuSavon
kolicinebi da mikrocinebi _ specifikuri cilebi, romlebic iwveven enteropaTogenuri
eSerixiebis, praqtikulad yvela saxis enterobaqteriebis, fsevdomonebis, streptokokebis,
sokoebis gamravlebis daTrgunvas da sxva. normaluri mikroflora xels uwyobs
limfuri sistemis stimulacias.
kuW-nawlavis traqtis mikroflora erTmaneTisagan gansxvavdeba kolonizaciis
adgiliT; arCeven nawlavis garsSi mobinadre (mukozur) da mis gareSe mobinadre _
sanaTuris mikrofloras. mukozur floras didi roli eniWeba nawlavis rezistentobaSi,
igi meqanikurad abrkolebs paTogenur da pirobiTpaTogenur mikrobebs.
435
advili Sesaswavlia sanaTuris mikroflora, rac ganavlis mikrofloris identuria.

dadgenilia, rom axalSobili ibadeba steriluri nawlavebiT, mxolod meore dRes
xdeba mikrobebis Casaxleba. nawlavebSi upirvelesad saxldeba saSos gramdadebiTi
dederleinis Cxirebi, romlebic miekuTvnebian rZemJavian floras. me-5-7 dRes bunebriv
kvebaze myof bavSvebSi ZiriTad floras warmoadgens bifidoflora, romlis zrdasac
xels uwyobs dedis rZis β-laqtoza.
bavSvebs, romlebic bunebriv kvebaze imyofebian, sicocxlis pirvel wels bifidoflora
ufro swrafad uyalibdebaT, vidre xelovnur kvebaze myof bavSvebs. es aixsneba dedis
rZeSi bifidogenuri faqtorebis da sxva komponentebis (imunoglobulinebi, gansakuTrebiT
ki sekreciuli Ig A, makrofagebi, T da B limfocitebi, komplementi da misi komponentebi,
lizocimi, interferoni da sxva) SemcvelobiT.
3 Tvis asakis zeviT, praqtikulad janmrTel bavSvTa 5-15%-is nawlavTa SigTavsSi
vlindeba proteusis gvaris mikrobebi (<103), sxva pirobiTpaTogenuri enterobaqteriebi
(<104), saprofituli da epidermuli stafilokokebi (104-106), safuari sokoebi (104).
amave asakis, magram xelovnur kvebaze myof bavSvebSi, garda laqto- da bifidobaqteriebis
daTrgunvisa, aRiniSneba baqteroidebis, nawlavTa Cxirebis raodenobis, upiratesad
pirobiTpaTogenuri floris zrda. pirobiTpaTogenuri baqteriebis, sokoebis,
klostridiebis eliminaciis sixSire meryeobs did farglebSi.
gansazRvrulia, rom 1g fekaliebSi bunebrivi kvebis dros bifidobaqteriebis raodenoba
Seadgens 109-1011, xolo Sereuli kvebis dros adgili aqvs bifidobaqteriebisa da
laqtobaqteriebis deficits. amave dros izrdeba eSerixiebis, klebsielebis, proteusis,
enterokokebis, stafilokokebis, sokoebis da sxvaTa raodenoba, ganavali Rebulobs
myral suns. wlis asakis bavSvebSi bifidobaqteriebis raodenoba ramdenadme mcirdeba
(106-mde), sWarbobs nawlavis da acidofiluri Cxirebi, enterokokebi. bifidobaqteriebisa
da rZemJavas Cxirebis simbiozs aqvs princi puli mniSvneloba nawlavis normaluri
biocenozis formirebisaTvis.
mikrobTa cvlilebebis saerTo tendencia asakis matebasTan dakavSirebiT mdgomareobs
mTavari floris _ bifidobaqteriebis stabilizaciaSi (1g fekaliebSi _ 108-1011-mde).
erTdroulad xdeba mcire asakisaTvis damaxasiaTebeli ramdenime saxeobis
bifidobaqteriebis (B. bifidum, B. brove, B. infantis da sxva) siWarbis Secvla ufro
mozrdilebSi gavrcelebuli saxeobebiT _ B. longum, B. odalescentis da sxva.
aerobuli flora, ZiriTadad, warmodgenilia normaluri nawlavis CxirebiT da
Seadgens 1-4 %-s, fakultaturi (narCeni) flora (stafilokoki, enterokoki, proteusi,
sarcinebi, kandidas gvaris sokoebi, eSerixiebi dabali fermentuli TvisebebiT, hemolizuri
Cxirebi, klostridiebi, umartivesebi da sxva pirobiT-paTogenuri mikrobebi) 0,01-
0,001%-ze naklebia mikrobebis saerTo raodenobasTan SedarebiT. ase, rom mozrdil
bavSvebSi 1 mln bifidobaqteriebze modis 1 mln nawlavis Cxiri da 10-dan 1000-mde
pirobiTpaTogenuri mikroflora.
yvelaze ufro xSirad da advilad nawlavTa disbaqteriozi viTardeba mcire
asakis bavSvebSi, aseve orsulobisa da mSobiarobis paTologiebisas, cns-is dazianebisas
(perinatalur periodSi xelovnur kvebaze myof bavSvebSi ), alergiuli daavadebebis
dros, antibiotikebis miRebis Semdeg, sxvadasxva infeqciuri daavadebebis gadatanis da
Tanmxlebi daavadebebis Semdeg. aRniSnuli kategoriis bavSvebi miekuTvnebian riskis
jgufs nawlavTa disbaqteriozis ganviTarebis TvalsazrisiT.
nawlavTa disbaqteriozis etiologiuri faqtorebi mravalricxovania _ infeqciuri
da arainfeqciuri bunebis agentebi, maT Soris alimenturi darRvevebi, wamlismieri
genezis, imunologiuri darRvevebi, klimatur-geografiuli pirobebi, radiacia da sxva.
daavadebis paTogenezi damokidebulia CamoTvlili faqtorebis moqmedebaze; disbaqteriozs
436
ar gaaCnia calke `specifikuri” paTogenezi da paTmorfologiuri suraTi. disbaqteriozi

aRrmavebs calkeuli nozologiisaTvis damaxasiaTebel paTologiur procesebs, zog
SemTxvevaSi ki xels uwyobs daavadebis letalur gamosavals.
infeqciuri faqtorebidan pirvel rigSi nawlavTa disbaqteriozis ganviTarebaSi
didi roli eniWeba iseT infeqciur daavadebebs, rogoricaa Sigelozi, salmonelozi,
eSerixiozi, iersiniozi da sxva; Tumca nawlavTa disbaqteriozis gamowveva SeuZlia
nebismier infeqciur daavadebas, maT Soris virusuli bunebisasac, mag: virusuli hepatitebis
À\È\ Õî÷àâà= Ñ\Á\ Þøêåâè÷= 1975)\
dros (À\È\
ali
alimenturi
menturi darRvevebis dros nawlavTa disbaqteriozi ganpirobebulia
erTgvarovani an xangrZlivi parenteruli kvebiT. am mxriv, gansakuTrebiT, yuradsaRebia
Cvens klinikaSi Catarebuli dakvirveba kritikul mdgomareobaSi myof nawlavTa mwvave
infeqciebiT daavadebuli mcire asakis bavSvebze, romelTac nazogastraluri zondiT
kvebis Semdeg ganuviTardaT nawlavTa disbaqteriozi.
wamlismieri darRvevebi iTvaliswinebs farTo speqtris antibiotikebis,
steroiduli hormonebis, fsiqotropuli da sxva wamlebis moqmedebas.
antibiotikTerapia iwvevs ara marto paTogenuri mikrobebis daTrgunvas, aramed
toqsikurad moqmedebs nawlavis epiTeliumze, Trgunavs kuW-nawlavis traqtis jirkvlebis
aqtivobas, uaryofiTad moqmedebs imunitetze da sxva.
imunuri darRvevebidan aRsanisnavia γ-globulinebisa da imunoglobulinebis
kleba sisxlSi.
pirveladi an meoradi genezis fermentopaTiebi ganapirobeben sxvadasxva
produqtis autanlobas, rac xels uwyobs nawlavTa disbaqteriozis Camoyalibebas.
magaliTad, rZis miRebisas (laqtazis ukmarisoba), marcvleulis (gluteinuri ukmarisoba),
sokoebis (trigalazuri ukmarisoba) da sxva.
klimatur-geografiuli pirobebi (radiaciuli foni, adgilsamyofelis Secvla da
a.S.) garkveul rols TamaSobs disbaqteriozis CamoyalibebaSi.
disbaqteriozis dasadgenad praqtikul muSaobaSi gamoiyeneba normebi nawlavTa
mikrofloris Sesafaseblad.
nawlavTa mikrofloris normis kriteriumebi
Á. Åïøòåéí-Ëèòâàê-is da Ô.Á. Âèëüøàíñêàÿ-s monacemebiT
kriteriumebi
mikroflora axalSobilebSi mozrdilebSi da
1 wlis asakis bavSvebSi
paTogenuri mikrobebi nawlavTa ojaxidan _ _
nawlavTa Cxirebis saerTo raodenoba 100 - 700 mln/1g 300 - 400 mln/1g
nawlavTa Cxirebi susti fermentuli TvisebebiT araumetes 10 %-sa araumetes 10 %-sa
laqtonegatiuri enterobaqteriebi >> >> 5 % >> >> 5 %
hemolizuri nawlavTa Cxirebi _ _
kokuri formebi saerTo mikrobebidan araumetes 25 %-sa araumetes 5 %-sa
hemolizuri stafilokokebis procentuli _ _
Semadgenloba yvela kokebTan SedarebiT
bifiduobaqteriebi 9
10 da meti
8
10 da meti
proteusis gvaris mikrobebi _ _
kandidas gvaris mikrobebi _ _
M-17 nawlavis Cxiris raodenoba (%) _ _
kolibaqteriniT, bifikoliT mkurnalobamde
rZemJavis baqteriebi 10 - 100 mln/g 1 - 10 mln/g
enterokokebi 1 - 20 mln/g 1 mln/g
sxva mikroorganizmebi _ _
437
klinikuri gamovlinebani. nawlavTa disbaqteriozi vlindeba araspecifikuri,

polimorfuli simptomatikiT _ dawyebuli diskineziis ti pis nawlavTa tkiviliT,
yabzobiT, damTavrebuli Zlieri FfaRaraTiT da nivTierebaTa cvlis moSliT.
mcire asakis bavSvebSi daavadeba mimdinareobs dispefsiuri movlenebiT. ganavali
xasiaTdeba didi moculobiT, TeTri an aWrelebulia, fafisebria, aqvs mJave suni.
bavSvebs xSirad aReniSnebaT wamoqafeba, meteorizmi, yuryuri nawlavebis sxvadasxva
midamoSi; sxeulis masa arasakmarisad matulobs nawlavTa SewoviTi funqciis darRvevis
gamo. disbaqteriozis suraTSi SeiZleba dominirebdes faRaraTi myrali suniT, ganviTardes
polihi povitaminozis simptomebi, toqsikur-distrofiuli movlenebi.
disbaqteriozis klinikur suraTSi aseve SeiZleba sWarbobdes yabzoba, romelic
Cveni dakvirvebiT gaxSirda kidec am bolo dros, rasac vukavSirebT kvebis darRvevas
(erTgvarovani, arasrulfasovani kveba socialur-ekonomikuri pirobebis gauaresebasTan
dakavSirebiT). Cveni klinikis TanamSromlebis monacemebiT hi potrofiul bavSvebSi,
romelTac aReniSnaT nawlavTa mwvave infeqciebi, araspecifikuri dacvis faqtorebis
maCveneblebi, ZiriTadad, interferoni, xasiaTdeba normasTan SedarebiT mkveTri daklebiT
(T. joxTaberiZe, m. xoWava, i. xabazi, 1998).
mozrdil bavSvebSi nawlavTa disbaqteriozi SeiZleba gamovlindes boyiniT, yabzobiT,
muclis SeberviT; mada, Cveulebriv, ar irRveva an ramdenadme daqveiTebulia. aseTi
formebi miekuTvnebian disbaqteriozis kompensirebul formebs, rac yvela asakSi gvxdeba
da aRwevs 70-80%-s. unda aRiniSnos, rom nawlavTa kompensirebuli formis dros
adgili ara aqvs mkafiod Semofarglul suraTs da am SemTxvevaSi misi diagnozi
eyrdnoba klinikur-laboratoriul monacemebs.
praqtikul muSaobaSi mniSvnelovania, rom mxedvelobaSi miviRoT biocenozis
gamomJRavnebis xarisxi. amisaTvis mizanSewonilia gamoyenebuli iqnas È\Í\ Áëîõèíà
Áëîõèíà-
s rekomendaciebi da gamoiyos biocenozis darRvevis 3 xarisxi.
I xarisxi (sustad gamoxatuli disbaqteriozi). am dros anaerobuli flora
Warbobs. bifido- da laqtobaqteriebi vlindeba ganzavebaSi _ 108-107 an erT-erTi am
formidan 1010-109 ganzavebaSi dgindeba. pirobiT-paTogenuri baqteriebi (ara umetes
ori saxisa)gamoiyofa 104-102 ganzavebaSi.
II xarisxi. aRiniSneba anaerobuli baqteriebis daTrgunva, maTi jami daaxloebiT
tolia aerobuli mikrofloris raodenobisa. pirobiT-paTogenuri baqteriebi gamoyofen
asociaciebs 106-107 ganzavebaSi, srulyofili nawlavTa Cxirebi icvlebian maTi ati puri
variantebiT (laqtozonegatiuri, hemolizuri).
III xarisxi (gamoxatuli disbaqteriozi) Warbobs aerobuli flora, zogjer bifido-
da laqtobaqteriebis TiTqmis gaqrobiT. mkveTrad matulobs pirobiTpaTogenuri mikrobebi,
gansakuTrebiT xSirad gvxvdeba paTogenuri stafilokoki, proteusi, Candida-s msgavsi
safuara sokoebi, klebsielebi, iSviaTad mwvane Cirqmbadi Cxirebi, klostridiebi da sxv.
mesame xarisxis disbaqteriozis dros pirobiT-paTogenuri mikrobebi SeiZleba aRiniSnos
sxvadasxva organoebsa da qsovilebSi, am dros Zlierdeba maTi toqsiuri, invaziuri da
sxva paTogenuri Tvisebebi.
disbaqteriozis klinikuri suraTi ganisazRvreba ZiriTadi daavadebis simptomatikiT.
subkompensirebuli disbaqteriozis dros nawlavTa mxriv simptomatika zomieradaa
gamoxatuli, magram bavSvi mivardnilia, cudad Rebulobs sakvebs, sxeulis masa arasakmarisad
matulobs, magram miuxedavad amisa saerTo mdgomareoba mainc damakmayofilebeli rCeba.
aseTi formebis procentuli raodenoba aRwevs 15-20%-s. am dros nawlavTa mikrofloris
darRveva iwvevs misi damcvelobiTi funqciis daqveiTebas. irRveva saWmlis momnelebeli,
vitaminuri da fermentSemqmneli funqciebi, antigenuri funqcia, romlis fonzec swrafad
mravldebian enterobaqteriebi.
438
rogorc kompensirebul, aseve subkompensirebul nawlavTa disbaqteriozs mkveTrad

gamoxatuli ‘specifikuri~ klinikuri suraTi ar gaaCnia. disbaqteriozis uaryofiTi
moqmedeba organizmis rezistentobaze, saxeldobr, mwvave respiraciuli virusuli infeqciis
darTvisas gamoixateba am infeqciis gaxangrZlivebul mimdinareobaSi, gamwvavebaSi da
iseT baqteriul garTulebebSi, rogoricaa otiti, piuria, piodermia, stomatiti, angina
da sxva.
nawlavTa mikrofloris cvlilebebi subkompensirebuli disbaqteriozis dros meryeobs
did farglebSi: III xarisxis aRiniSneba 50%-Si, II xarisxis _ 30%-Si, I _ 20%-Si.
dekompensirebuli disbaqteriozis pirobebSi gamoxatulia mZime intoqsikacia.
SeiZleba adgili hqondes Rebinebas, xSir faRaraTs, madis dakargvas, mis daqveiTebas,
avitaminozs. am fonze irRveva organizmis damcvelobiTi meqanizmi, advilad viTardeba
mwvave egzogenuri an endogenuri nawlavTa infeqciebi, gamowveuli pirobiTpaTogenuri
floriT. SeiZleba ganviTardes mZime enterokoliti, romelic SeiZleba mimdinareobdes
baqteriemiiT da specifikuri procesiTac. am SemTxvevaSi ZiriTadi daavadebebic mwvavdebian.
maSin, roca viTardeba dekompensirebuli disbaqteriozi, nawlavTa mikrofloris III
xarisxis cvlilebebi aRiniSneba mxolod 55-60%-Si, I-II xarisxisa _ 40-45%-Si. es
faqti ki imaze mowmobs, rom klinikuri simptomatika ganpirobebulia ara marto
mikrofloris xarisxis darRveviT, aramed sxva faqtorebiTac _ pirobiTpaTogenuri
floris paTogenobis gaZlierebiT, imunobiologiuri reaqciebis daqveiTebiT, fermentuli
darRvevebiT da sxva.
nawlavis mikrofloris gadaxra normidan unda ganixilebodes, rogorc nawlavTa
biocenozis darRveva, maSin, roca adgili aqvs ricxobriv da raodenobriv Serwymul
cvlilebebs normaluri mikrofloris ZiriTad, Tanmxleb an narCen jgufebSi.
diagnostika. disbaqteriozis diagnostika, pirvel rigSi, iTvaliswinebs nawlavTa
mwvave infeqciebis gamoricxvas. disbaqteriozi yvela SemTxvevaSi saWiroebs nawlavTa
floris baqteriologiur gamokvlevas, romlis mizania, gamoavlinos baqteriebis
ricxobrivi da xarisxobrivi cvlilebebi, mTavari floris daTrgunvisa da
pirobiTpaTogenuri floris aqtivoba, xarisxi.
nawlavTa disbaqteriozis dasadgenad saWiroa ganavlis baqteriologiuri kvleva.
amisaTvis ganavali unda aiRon sterilur WurWelSi da 1:10 ganzavebis Semdeg unda
daTeson saTanado niadagebze _ endos (laqtozanegatiuri koloniebis dasaangariSeblad),
ploskirevis, levinis, selenitur bulionSi, bismut-sulfatze (anaerobuli mikrobebisaTvis),
blaurokis niadagze (bifidumbaqteriebis ricxobrivi dadgenisaTvis), tomatianze
(rZemJavabaqteriebisaTvis), seleqciuri niadagi natriumis azidoTi _ enterokokebisaTvis,
saburos niadagi sokoebisaTvis. universalur niadagad iTvleba sisxliani agari, sadac
xorcieldeba hemolizuri baqteriebisa da kokebis raodenobrivi Tanafardobis dadgena.
laboratoriuli meTodebi dRemde ZviradRirebulia da rTulad iTvleba niadagebis
didi raodenobis gamoyenebisa da baqteriebis gansakuTrebul pirobebSi kultivirebis
gamo. amasTan dakavSirebiT mowodebulia sxvadasxva arapirdapiri testebi. sazRvraven
nawlavis mikrofloris metabolitebs da fermentebs sxvadasxva substratebSi,
antagonistur da Q–aspartilpeptidazur aqtivobas, fakultatur-anaerobuli mikrobebis
mier egzonukleazis Seqmnis unars, interferonis antibaqteriuli Semadgenlobis
inaqtivaciis unars. am meTodebs SeuZliaT ganaxorcielon praqtikulad saorientacio
nawlavis mikrofloris biocenozis darRvevis diagnostireba sruli baqteriologiuri
analizis Catarebis gareSe.
mkurnaloba. racionaluri mkurnalobis Catareba, pirvel rigSi, iTvaliswinebs
gamomwvevi faqtorebis moxsnas. didi yuradReba eniWeba srulfasovan kvebas, rac
uzrunvelyofs ara marto energetikuli da plastiuri nivTierebebis organizmisaTvis
439
miwodebas, aramed nawlavTa motoruli funqciis, pH-is stabilizacias, rac friad

mniSvnelovania nawlavis normaluri florisaTvis. am mxriv aucilebelia, rom bavSvi
imyofebodes bunebriv kvebaze. didi yuradReba unda mieqces ama Tu im produqtis
tolerantobis da autanlobis SemTxvevaSi saTanado koreqcias. mkurnalobis mTavar
meTodad iTvleba biologiuri, baqteriologiuri preparatebis gamoyeneba. am mizniT
eniSnebaT bifidumSemcveli preparatebi da kvebis produqtebi (bifidumbaqterini,
kolibaqterini, bifikoli, bifilaqti, bifilini, bifidokefiri da sxva). mxedvelobaSia
misaRebi, rom iseTi preparatebis daniSvna, rogoricaa kolibaqterini da bifikoli, ar
aris sasurveli, vinaidan didi raodenobiT eSerixiebi aZliereben disbaqteriozs wlamde
asakis bavSvebSi da xels uwyoben autoantisxeulebis gamomuSavebas.
amJamad disbaqteriozis mkurnalobaSi gamoiyeneba cocxali liofilizebuli
bifidobaqteriebis preparatebis fxvnili flakonebSi an rZis komponentebTan erTad.
bifidumbaqterini gamodis flakonebSi liofilizebuli cocxali mikrobebis
saxiT (Stami I), dafasoebulia 1-dan 50dozamde. erTi doza Seicavs mikrobebis 108
raodenobas.
bifilini bavSvebisaTvis _ rZemJava narevi momzadebuli b. adalescentis -MC–
42-sagan. pirobiTpaTogenuri da paTogenuri baqteriebis mimarT aqvs kargi mJavaSemqmneli
da antibiotikuri aqtivoba. rZis ZiriTad fuZed aRebulia narevi “Ìàëþòêà Ìàëþòêà
Ìàëþòêà”.
bifidumbaqteriebis raodenoba mza produqtis 1 ml-Si Seadgens 2-5X109.
bifidumbaqterini rZiani, orvalentiani mcire asakis bavSvebisaTvis sufTa rZe
an cximgaclili steriluri, Sededebuli b.bifidumiT, b. longumiT, romelTa raodenobaa
109 1 ml produqtSi.
bifidumbaqterini rZiani, samvalentiani mozrdili bavSvebisa da didebisaTvis.
sufTa an cximgaclili rZe, Sededebuli b. ifidumiT, b. longumiT da b. adalescentiT.
aqtiuri mikrobebis raodenoba 1 ml produqtSi aRwevs 109 xarisxs.
bifidokefiri “bifidoki” _ rZemJavas produqti, romlis 1 ml Seicavs 106
mikrobTa cocxal Stams (N1 A “Ïàðòíåð
Ïàðòíåð
Ïàðòíåð”).
mSrali laqtobaqterini _ liofilizebuli, cocxali, antagonisturad
aqtivirebuli laqtobaqteriebi.
acilaqti _ warmoadgens mikrobul masas (niadagze kultivirebul acidofilur
laqtobaqteriebs).
aci po
polli _ Seicavs aqtiur acidofilur laqtobaqteriebsa da kefiris sokos
polisaqarids. tabletSi 5 dozaa.
enteroli (Enterol) warmoadgens aqtiur, loifilizebul _ Saccharomycetes
boulardi-s, romelsac gaaCnia antimikrobuli moqmedeba, ganpirobebuli antagonisturi
efeqtiT paTogenuri da pirobiTpaTogenuri mikroorganizmebis mimarT, romlebic iwveven
diareas.
lineqsi _ rZemJava baqteriebis lizati (Lactobacillus-10 acidophilis, Lacto-
bacillus bifidus da Streptococcus faecium) mdgradi antibiotikebisa da
qimiopreparatebis mimarT.
biologiuri baqteriuli preparatebi (bbp). mSrali bbp amJamad gamodis ampulebSi,
flakonebsa da tabletebSi.
ampula Seicavs _ 1-3 dozas
flakoni _ 5,10,20 dozas
tableti _ 1-dan 5 dozamde.
bbp-s daniSvna xdeba disbaqteriozis formisa da avadmyofis asakis gaTvaliswinebiT.
mravali avtoris azriT kompensirebuli formis dros misi daniSvna mizanSewonili ar
aris. im SemTxvevaSi, roca klinikuri niSnebi saxezea da gaxangrZlivebulia,
440
nawlavTa disbaqteriozi
kerZo nawili. kandidozi
laboratoriuli monacemebi daavadebis dinamikaSi mowmoben disbaqteriozze, iniSneba

bbp. 1 wlamde asakis bavSvebs, romlebic imyofebian xelovnur kvebaze, aqvT raqiti,
dRenakloba, baqteriuli da virusuli infeqciebi, eniSnebaT laqtobaqterinis Semcveli
prepartebi (acilaqti, aci poli, lineqsi, laqtobaqterini) an bifidumbaqterini (mSrali
an rZiani bifidumbaqterini, bifilini, bifidokefiri asakobriv dozebSi).
subkompensirebuli da dekompensirebuli formis dros ZuZus asakis bavSvebSi
naCvenebia erToblivi bifidolaqtobaqterinis daniSvna. amasTanave dekompensirebuli
formis dros biopreparatebis doza ormagdeba da miecema 2-3 kviris ganmavlobaSi, 2-
3 kviris SesvenebiT SeiZleba dainiSnos mkurnalobis meore kursi, Tumca amisaTvis
saWiroa klinikur-laboratoriuli monacemebi.
dekompensirebuli formis dros mcire asakis bavSvebs biopreparatebi eZlevaT
igive sqemiT, dozis gaormagebiT. 3 wlis asakis zeviT mkurnaloba princi pulad
analogiuria da atarebs kombinirebul xasiaTs _ bifidumbaqterini da laqtobaqterini
erTad eniSnebaT.
mkurnalobis efeqturi Sedegis sawindaria mxolod kompleqsuri paTogenezuri
Terapia, rac iTvaliswinebs dietis, fermentebis, vitaminebis gamoyenebas.
im SemTxvevaSi, rodesac dadgenilia disbaqteriozis koliproteusuli, stafilokokuri,
klebsieluri, fsevdomonuri da a.S. buneba, avadmyofebs zogjer eniSnebaT Sesabamisi
fagebi.
profilaqtika. disbaqteriozis profilaqtikisaTvis didi roli eniWeba
antibiotikebis racionalur xmarebas, srulfasovan kvebas, rafinirebuli sakvebis SezRudvas
nawlavTa infeqciebisas, gansakuTrebiT adreuli asakis bavSvebSi, romlebSic disbaqteriozi
iolad viTardeba.
kandidozi
CANDIDOSIS
sinonimi: kandidomikozi, moniliazi, kandiduri infeqcia.

kandidozis gamomwvevia kandidas ojaxis sokoebis mravalricxovani ti pebi, romlebic
cnobilia saerTo saxelwodebiT Fungi Imperfecti (arasrulyofili soko) anu
Deutermycetes.
kandidozi SedarebiT msubuqad mimdinareobs kanisa da lorwovani garsebis dazianebisas,
Tumca SesaZlebelia mZime mimdinareobac. gansakuTrebiT mZime mimdinareobiT xasiaTdeba
kandidozis generalizebuli visceruli forma, romlis drosac ziandeba kuW-nawlavis
traqti (ufro xSirad), sasunTqi gzebi da sxva, gansakuTrebiT aiv-infeqciis SemTxvevebSi.
kandidozi Zlier mZimed mimdinareobs sefsisis saxiT.
etiologia. kandidozis gamomwvevi sokoebidan yvelaze ufro xSir etiologiur
faqtorad iTvleba Candida albicans, aseve C. tropicalis, C. parapsilosis, C.
guilliermonidii, C. crusei, C. husitaniae. bolo dros kandidas ojaxs miakuTvneben
Torulopsis glabrata-sac.
yvela CamoTvlili gamomwvevi miekuTvneba safuar sokoebs da namdvili safuarebisagan
miceliumis warmoqmniTa da sqesobrivi gziT gamravlebis uunarobiT gansxvavdeba. maT
axasiaTebT antigenuri Semcveloba, aqvT alergiuli da antigenuri Tvisebebi. xazgasmiT
aRvniSnavT, rom kandidozis mxolod visceruli formebis dros yalibdeba antisxeulebis
maRali titri. amJamad dadgenilia kandidas 150-ze meti Stami.
arsebobs kandidas sami morfologiuri forma _ ovaluri anu mrgvali blastspora
441
anu safuari ujredebi 3-6mkm diametriT, orkedliani qlamidospora (7-14 mm diametriT)

da fsevdomiceliebi, qsovilovani forma.
uwin kandidas ojaxs uwodebdnen Monilia-s, xolo kanisa da lorwovani garsebis
dazianebiT mimdinare daavadebebs _ Moniliasis.
epidemiologia. kandidebi bunebaSi farTodaa gavrcelebuli, gvxvdeba bostneulze,
xilze da a. S.
normalur, fiziologiur mdgomareobaSi binadroben adamianis kanze, lorwovan garsebze,
kuW-nawlavis traqtSi.
paTogenezi. daavadeba ganpirobebulia qsovilebSi Candida-s SeRweviT (qsovilovani
forma). parazitul mdgomareobaSi mis gadasvlas xels uwyobs disbaqteriozi, romlis
xSiri mizezicaa farTo speqtris antibiotikebis xangrZlivi gamoyeneba.
sokovani daavadebebi gansakuTrebiT xSiria aiv/Sids-is dros (aspergilozi da
kandidozi xSirad oportunistuli daavadebebia).
imunokoprometirebul pirebSi kandiduri infeqciis yvelaze ufro xSiri gamovlinebaa
rZiana da mwvave dermatiti da avadmyofTa 50-80%-Si gvxvdeba.
piris Rrus lorwovani garsebis dazianeba C. albicans-iT cnobilia, moniliazis
saxelwodebiT. igi muko-kutanur infeqcias warmoadgens da vlindeba TeTri nadebebis
an izolirebuli kerebis saxiT piris Rrus lorwovan garsebze, loyis, xaxis ukana
kedelze, enaze, RrZilebze da a.S..
uxvi nadebebiT dazianebuli adgilebis daxeTqva iwvevs piris Rrus mtkivneulobas.
rogorc rZianas dros, anTebadi kerebis sxeulis sxva adgilebSi lokalizaciisasac,
aRiniSneba saerTo infeqciur-toqsikuri movlenebi _ zogadi uZlureba, depresia, anoreqsia,
diareuli movlenebi, romlebic varireben Sekrulobidan sisxlian faRaraTamde, Tavis
tkivili, yuradRebis koncentraciis unarianobis darRveva. es mdgomareoba cnobilia,
rogorc ‘safuariani~ (sokovani) sindromi. es ganmarteba samarTliania, Tu aRniSnuli
sindromi kandidas gamoyofiT dasturdeba. amave dros sworad unda iqnas Sefasebuli
aRniSnuli agentis mniSvneloba, daudasturebel SemTxvevebSi fungiciduri preparatebis
daniSvna swori ar aris.
Tandayolili kandidozis dros kanis dazianeba gavrcelebuli formisaa da
xasiaTdeba kanis naoWebis gamoyelviT, anTebad kerebze TeTri nadebebis arsebobiT,
aRiniSneba makulur-papuluri, zogjer ki vezikulur-pustuluri gamonayari. am SemTxvevaSi
kandiduri pnevmoniis darTva mkveTrad amZimebs prognozs. Tandayolili kandidozi
dedisagan nayofis masiuri inficirebis Sedegia.
axalSobilis dainficireba xdeba samSobiaro gzebSi nayofis gavlis dros,
daavadeba ki dabadebidan me-7-10 dRes vlindeba.
wlamde asakis bavSvebSi, rZianasagan gansxvavebiT,
SesaZlebelia, kandiduri kerebi gavrceldes
tuCebze, lorwovan garsebze, nuSurebis
rkalebze, rbil da magar sasaze. nadebebis
mocileba iwvevs adgilobriv sisxldenas.
bavSvebs awuxebT piris Rrus tkivili, rac
xels uSlis sakvebis miRebas. aRniSnul
kontingentSi daavadeba SeiZleba
mimdinareobdes susti gamovlinebebiT
(àsimptomuri~ mimdinareoba).
kandiduri infeqcia. eriTemuli
neonatalur periodSi kandiduri
gamonayari gavrcelebuli satelituri
(Svileuli) dazianebiT. infeqcia vlindeba Sorisis gamoyelvis, sto-
(W. E. Nelson) matitis, rZianas an piris Rrus lorwovani
442
kandiduri infeqcia. loyis Sida mxris rZiana _ kandiduri infeqcia. xaWosebri

dazianeba. nadebi enaze.
(Í.È. Íèñåâè÷, Â.Ô. Ó÷àéêèí) (Í.È. Íèñåâè÷, Â.Ô. Ó÷àéêèí)
garsebis fsevdomembranuli kandidozis saxiT. axalSobilebSi kandidoziT daavadeba

2-5%-s aRwevs. aiv-inficirebul ZuZumwovar bavSvebSi, arainficirebulebTan SedarebiT,
rZianas suraTi 2-jer ufro xSirad gvxvdeba. janmrTel bavSvebSi rZiana raime problemas
ar warmoadgens da SeiZleba dakavSirebuli iyos mxolod antibiotikebis miRebasTan.
antibiotikebis miRebis gareSe ganviTarebuli persistuli, morecidive rZiana xSirad
mowmobs, rom aseT SemTxvevaSi saWiroa, gamoiricxos diabetes melitus an
imunodeficituri mdgomareoba.
kandidam SeiZleba gamoiwvios paroniqiebi, oniqomikozebi, Tumca ufro xSirad maTi
mizezi Trichophyton an Epidermophyton-ia.
dermatomikozebisagan (dermatofitiebi) gansxvavebiT oniqomikozebi xasiaTdebian
xelis frCxilebis dazianebiTa da paroniqiebiT.
Tu ismeba, dermatomikozis (dermatofitia) diagnozi, mkurnaloba unda daiwyos
grizeofulviniT, maSin, rodesac xelis kandidozi saWiroebs dazianebuli adgilis
simSrales da mkurnaloba tardeba adgilobrivad antifunginuri preparatebiT, SesaZloa
dasWirdes per os azole-ebiT mkurnaloba.
vulvovaginiti xSiria prepubertatuli da pubertatuli asakis gogonebSi.
SemTxvevaTa 75%-Si es daavadeba qalebSi gvxvdeba. mis xelSemwyob faqtorebad iTvleba
orsuloba, oraluri kontraceptivebis xmareba, cudi higienuri pirobebi da antibiotikebis
oraluri miReba. aseT SemTxvevebSic aucilebelia Saqriani diabetis gamoricxva.
klinikurad vulvovaginiti qaviliT, dizuriiT, hi peremiiT, TeTri xaWosebri
nadebiT, anTebiTi fifqebiT xasiaTdeba. es forma warmatebiT ikurneba vaginaluri
malamoebiT, an, Cveulebriv, nistatiniT, klotrimazoliT.
qronikuli kandidozis dros simptomebi ufro mdgradia. anTebadi adgilebidan
nadebis moSoreba Zneldeba, viTardeba xeiliti. mkurnaloba am SemTxvevaSic tardeba
nistatiniT an klotrimazoliT, saTanado efeqtiT, Tumca aucilebelia, gamoyenebul
iqnas gencianvioleti. sakvebis miRebis gaZneleba mowmobs procesis progresirebas,
ezofagitis ganviTarebas, rac saWiroebs mkurnalobas ketokonazoliT an flukonazoliT.
kandiduri dermatiti an onixomikozebi aseve xSiria aiv/Sids-iT avadmyofebSi,
xasiaTdebian agresiuli mimdinareobiT da saWiroeben xangrZliv mkurnalobas. dRenaklebSi
(sxeulis masa 1 500-ze naklebi) SemTxvevaTa 2-5%-Si kandidozi Rebulobs diseminirebul
xasiaTs, risi xelSemwyobi risk-faqtorebia: xangrZlivi antibiotikTerapia, sisxlZarRvebis
kaTeterizacia, intravenuri hi peralimentacia. generalizebuli kandidozi emsgavseba
443
sefsisur mdgomareobebs da vlindeba

respiraciuli distresiT, apnoeTi,
bradikardiiT. temperatura Rebulobs
meryev xasiaTs, aRiniSneba glukozis
intolerantoba. avadmyofTa naxevars
kanze uCndeba sxvadasxva saxis, difuzuri
vezikulur-pustuluri gamonayari,
saidanac SesaZlebelia, gamoyofil iqnas
kandidas kultura. SemTxvevaTa 50%-Si
procesSi erTveba Tirkmlebi.
ultrasonografia an kompiuteruli
tomografia avlens Tirkmlebis, RviZlis,
elenTis parenqimis kerovani dazianebis
suraTs.
nervuli sistemis dazianeba xdeba
generalizebuli kandidozis dros
avadmyofTa 1/3-Si da gamoixateba Tav-
zurgtvinis siTxis raodenobis
momatebiT. meningoencefaliti
diseminirebuli (sefsisuri) kandidozis
dros avadmyofTa 20-30%-s uviTardeba.
osteoarTriti, rogorc garTuleba, 20%-
Si gvxvdeba. aiv/SidsiT daavadebis dros
mniSvnelovani simptomia ezofagiti,
kandiduri sefsisi, rogorc super-infeqcia romlis dadgenis saSualebas gvaZlevs
Tandayolili CMV-s -s dros. bariumiT gamokvleva. diseminirebuli
(sakuTari masala) kandidozis dros autofsiuri masalis
mixedviT pnevmonia 70%-Si iqna
aRmoCenili, Tumca rentgenologiuri kvlevebiT procenti bevrad dabalia.
diagnostika. etiologiuri diagnozi eyrdnoba mikroskopul gamokvlevebs. SeRebva
gramis wesiT avlens gramdadebiT sokoebsa da fsevdomiceliums. mxedvelobis areSi
100-ze meti kandida an kandidas dakvirtva adasturebs kandidur etiologias (Rfirby
G\ Y). mikroskopuli daTvalierebisaTvis saWiroa Camonafxekis ganzaveba KCL 10%-
xsnarSi. daTesva saburos niadagze saSualebas iZleva daisvas kandidozis sefsisuri
formis diagnozi, Tuki kulturis gamoyofa xerxdeba sisxlidan, Zvlis tvinidan,
biofsirebuli masalidan, Tav-zurgtvinis siTxidan. sisxlidan kandidas gamoyofa xdeba,
agreTve, bifazuri an liziscentrifugaciuli sistemiT. Sardidan an sxva kontaminirebuli
masalidan miRebuli gamokvlevebis Sedegebis interpretacia SedarebiT Znelia. testebi
antisxeulebsa da antigenebze amJamad damuSavebis procesSia. dResdReobiT arsebuli
arcerTi xelmisawvdomi komerciuli testi ar xasiaTdeba sizustiT.
mkurnaloba. oraluri kandidozi _ rZiana normaluri imunuri statusis mqone
bavSvebSi ikurneba nistatinis suspenziiT, klotrimazoliT. klotrimazolis efeqturoba
3 wlamde asakis bavSvebSi srulad ar aris dasabuTebuli. imunokomprometirebul
avadmyofebSi orofaringeuli kandidozis dros ketokonazoli da flukonazoli
ramdenadme avlens Terapiul efeqts, Tumca organizmi kandidebisagan ar Tavisufldeba.
2 wlamde asakis bavSvebSi ketokonazolis, 6 Tvemde asakisas ki flukonazolis moqmedebis
sando efeqturoba dadasturebuli ar aris, Tumca hospitalizebul avadmyofebs orive
preparati eniSnebaT.
444
kanismieri gamovlinebis dros atareben adgilobriv mkurnalobas nistatiniT,

mikonazoliT, klotrimazoliT, amfotericin B-Ti, ekonazoliT an ciklopiroqsiT.
vulvovaginiti warmatebiT ikurneba bevri preparatiT: klotrimazoliT,
butakonazoliT, terkonazoliT, tiokonazoliT da sxva.
flukonazoli rogorc mozardebs, aseve mozrdil avadmyofebs eZleva erTjeradad
per os 150 mg dReSi 4 miRebaze. qronikuli muko-kutanuri kandidozis dros iniSneba
ketokonazoli, flukonazoli, amfotericin B venaSi, plus per os flucitozini mZime
SemTxvevaSi. sistemuri generalizebuli kandidozis dros arCevis preparatad rCeba
amfotericin B, Tumca gamoiyeneba flukonazolic.
prognozi piris Rrus lorwovani garsebis kandidozis dros keTilgamosavliania,
hematogenuri diseminaciis (sefsisi) SemTxvevaSi _ seriozuli.
445
kerZo nawili.
protozouli infeqciebi. amebiazi
protozouli infeqciebi
amebiazi
(AMEBIASIS)
amebiazi warmoadgens protozoul infeqcias, romlisTvisac damaxasiaTebelia daavadebis

TandaTanobiT dawyeba, diarea lorwosa da sisxlis Semcveli minarevebiT, ZiriTadad,
normaluri an subfebriluri temperaturis fonze, msxvili nawlavis dazianeba upiratesad
marjvena kolitiT, axasiaTebs morecidive da qronikuli mimdinareoba, abscesebis SesaZlo
ganviTareba Sinagan organoebSi.
etiologia. ameburi dizenteriis gamomwvevi agenti pirvelad aRmoaCina rusma
etiologia
mecnierma Ô\À\ Ëåø-ma 1875 w., dizenteriis klinikiT mimdinare avadmyofis ganavalSi.
man SeZlo ZaRlebSi analogiuri daavadebis gamowveva: cxovelebi daainficira avadmyofi
adamianis ganavliT, Semdgom ki SeZlo amebis gamoyofa, riTac sabolood daadastura
etiologiuri momenti.
1903w. ameba dawvrilebiT Seiswavla f. Saudinma, romelmac mogvawoda saxelwodeba
Entamoeba histolytica.. es daavadeba ameburi dizenteriis saxelwodebiT damoukidebel
nozologiur formad gamoyves kaunsilmenma da leflerma 1891 wels. saqarTveloSi
amebiazis klinikis, diferenciuli diagnostikisa da mkurnalobis dawvrilebiT SeswavlaSi
didi wvlili Seitana cnobilma mecnierma profesorma d. svaniZem.
amJamad amebur dizenteriaSi igulisxmeba nawlavTa dazianebiT mimdinare forma,
xolo amebiazSi ki nebismieri
organos dazianeba Entamoeba
histolytica-s mier.
amebiazis gamomwvevi Entam-
oeba histolytica miekuTvneba En-
tamoeba-s ojaxs, Sarcodinae-s
(fsevdopodiebis) klass, Protozoa-
s tips. adamianSi daavadeba SeiZleba
gamoiwvios 2 jgufis, erTmaneTisagan
Zlier gansxvavebulma amebebma.
amebebis I jgufi, Entamoeba
histolytica-s CaTvliT, warmoadgens
obligatur parazitebs, romlebic
binadroben nawlavebSi, rogorc
komensalebi _ maT mitoqondriebi
ar gaaCniaT. trofozoiti Entam-
oeba histolytica zogjer iWreba
qsovilebSi, sadac aqtiurdeba da
icvlis Tavis saxes. arsebobs, aseve,
arapaTogenuri amebebi: E.dispar
Entamoeba histolytica. (morfologiurad Entamoeba
(trofozoiti - eriTrofagi) histolytica-sagan ar gansxvavdeba),
446
kerZo nawili.
E.coli da E.hartmanni,, romlebic ar arian trofozoitebi (anu ar Seicaven

eriTrocitebs).
II jgufs, niadagis amebas _ Naegleria fowleri, Acanthamoeba da Balamuthia-
s SeuZlia adamianis qsovilebSi, rqovanaSi da gansakuTrebiT, tvinis garsebSi invazireba
da mZime daavadebis gamowveva letaluri gamosavliT. 1958 w. pirvelad iyo aRmoCenili,
rom aRniSnul amebebs SeuZlia ZuZumwovarTa organizmis ujredebis dazianeba.
amebis ganviTarebis cikli moicavs or stadias _ vegetaciursa (trofozoiti) da
uZraobis _ cistis stadias, romlebsac SeuZlia organizmSi binadrobis pirobebis
Secvlis mixedviT erTi formidan meoreSi gadasvla.
vegetaciuri ciklis ganviTarebis stadia Seicavs 4 formas: qsovilovans, did
vegetaciur, sanaTurisa da cistis wina formas. qsovilovan formas, sigrZiT 20-25mkm,
aqvs moZraobisa da invazirebis didi unari. moZraoba xorcieldeba biZgiseburad
fsevdopodirebis meSveobiT, amasTan mxolod dazianebul organoebSi, mwvave periodis
dros, iSviaTad ki avadmyofi adamianis ganavalSi.
didi vegetaciuri forma (forma magna) 30-40-dan 60-80-mkm-mde zomiT, moZraobs
fsevdopodiebiT, aqvs eriTrocitebis fagocitirebis (eriTrofagi) unari. es forma
gvxvdeba mxolod nawlavTa amebiazis dros axalgamoyofil ganavalSi.
sanaTuris forma (forma minuta) 15-20 mkm sigrZiT, mcired moZravi, binadrobs
msxvili nawlavis sanaTurSi, ganavalSi Cndeba mwvave dizenteriis rekonvalescenciis,
qronikuli, morecidive mimdinareobis SemTxvevaSi an amebis mtareblebSi (naxuloben
safaRaraTo saSualebebis miRebis Semdeg).
cistiswina forma (precysta)) 12-20mkm, mcired moZravia, naxuloben ganavalSi
mwvave dizenteriis rekonvalescenciis periodSi an amebis mtareblobis dros (aseve
safaRaraTos miRebis Semdeg).
amebis vegetaciuri forma garemoSi aramdgradia da fekalur masaSi gvxvdeba 30
wuTis Semdeg.
uZraobis stadiaSi dizenteriuli amebebi arseboben sxvadasxva xarisxis
momwifebuli cistebis saxiT, zomiT aRweven 9-14 mkm, gvxvdebian daavadebis mwvave da
rekonvalescenciis periodSi, qronikuli, morecidive mimdinareobis dros da mtareblebSi.
epidemiologia. infeqciis wyaros warmoadgens adamiani, romlis ganavali Seicavs
epidemiologia
amebebis cistur formas. vegetaciuri formis garemoSi gamoyofas raime epidemiologiuri
mniSvneloba ara aqvs. infeqciis gadacemis meqanizmi fekalur-oraluria. gansakuTrebuli
epidemiologiuri mniSvneloba eniWeba pirebs, romelTac aReniSnebaT asimptomuri
mimdinareoba, magram cistebis eqskrecia grZeldeba didi xnis ganmavlobaSi, zogjer
wlobiTac.
adamianis dasnebovneba xdeba produqtebis (gansakuTrebiT _ xil-bostneulis),
ufro naklebad _ wylis miRebis Sedegad. garkveul rols TamaSobs WurWlis, saTamaSoebis,
oynis, karis saxelurebis dainficireba, antisanitariul pirobebSi uSualo kontaqti
cistis mtarebelTan. amebis ganTesvas xels uwyobs buzebi da taraknebi, romelTa
nawlavSi amebis sicocxlisunarianoba aRwevs 48-72 saaTs.
daavadebis mimRebloba axasiaTebs yvela asaks, gvxvdeba msoflios yvela qveyanaSi,
gansakuTrebiT, cxelsa da subtropikul qveynebSi, maT Soris Sua aziasa da amierkavkasiaSi.
iTvleba, rom msoflios mosaxleobis 10%-ze meti inficirebulia amebiT _ tropikul
qveynebSi 20-50%-mde, zomieri klimatis qveynebSi 5%-mde, xolo aSS-Si ki 4%-mde.
amebebi gansakuTrebiT mdgradia dabali temperaturisa da wylis sadezinfeqcio
qloris koncentraciis mimarT. parazitebi iRupebian 55°C temperaturaze. emetinis
susti xsnari (1:5 000 000) moqmedebs damRupvelad. cistebi inarCuneben sicocxles
svel ganavalsa da gamdinare wyalSi 1 kvira, sakveb produqtebze an sayofacxovrebo
447
kerZo nawili.
nivTebze _ 3-5 dRe.

paTogenezi da paTanatomiuri suraTisuraTi. organizmis dasnebovneba xdeba momwifebuli
cistebis moxvedriT kuW-nawlavis traqtSi sakvebis, wylis da sxva saSualebebiT.
kuWis wveni cistebze arsebiT gavlenas ar axdens. misi garsis darRvevis Sedegad
xdeba eqscistireba da amebis metacisturi formebis warmoSoba. aRniSnuli formebi
gamravlebisunariania. isini mravldebian mliv nawlavSi, sabolood ki xvdebian brma
nawlavSi, sadac maTi sicocxlisaTvis yvelaze ufro xelsayreli pirobebia (Txieri
garemo, baqteriuli floris siuxve, optimaluri pH _ tute reaqcia).
umravles SemTxvevaSi, kerZod, nawlavTa garsisa da mTeli organizmis fiziologiur
wonasworobaSi yofnis dros, adamianis organizms aqvs unari, daTrgunos amebis
virulenturi da invaziuri Tvisebebi. inficirebul pirTa mxolod 2-8%-Si viTardeba
paTologiuri procesi nawlavebSi, rac ganpirobebulia organizmis saerTo rezistentobis
daqveiTebiT, disbaqterioziT, gamomwvevi Stamis virulentobiTa da sxva faqtorebiT.
lorwovani garsis gadalaxvis Semdeg amebebi aRweven lorwqveSa Sres, sadac
optimaluri pirobebia maTi kvebisa da gamravlebisaTvis. proteolizuri fermentebis
moqmedebis Sedegad isini iwveven qsovilTa ujredebis danekrozebas, viTardeba mcire
zomis abscesi, romlis fuZe Rrmavdeba qvemdebare qsovilebis mimarTulebiT, izrdeba
diametrSi da uerTdeba mezobel danekrozebul ujredebs. kvebamoSlili lorwovani
garsis Sesabamisi ubanic nekrozdeba, ris Semdegac abscesis SigTavsi icleba nawlavis
sanaTurSi, abscesis adgilas ki viTardeba wyluli Rrma fuZiTa da araswori, Camokidebuli
kideebiT, fuZe gavsebulia detritiT, ujreduli eqsudatiT, amebebiTa da baqteriebiT.
wylulis diametris zoma meryeobs 2-2,5 sm-mde, aqvs kolbisebri forma da SeSupebuli,
dakbiluli kideebi, romlebic Semofarglulia da janmrTeli qsovilebis ubnisagan
gamocalkevebulia hi peremiuli zoniT. wylulebi umetesad gvxvdeba brma nawlavSi,
aswvriv kolinjSi, SesaZlebelia swori nawlavisa da sxva nawilebis dazianeba. nawlavTa
dazianeba zogjer ufro mZime xasiaTs Rebulobs, rac qsovilebis daSlaSi gamoixateba.
am dros lorwqveSa garsSi viTardeba sinusebi, romelTa gaerTianebiT arasworkideebiani
farTo wylulebi warmoiqmneba. es ukanasknelni zogjer kunTovansa da serozul
garsebs aRweven da SeiZleba, nawlavis perforacia da Semofargluli an difuzuri
peritonitic gamoiwvion.
amebis hematogenuri diseminacia iwvevs Sinagan organoebSi (RviZlSi, filtvebSi,
Tavis tvinsa da sxva) abscesebis ganviTarebas.
klinika. msoflio jandacvis eqspartTa komitetis daskvnis Tanaxmad (1970)
klinika
arCeven amebiazis 3 ZiriTad klinikur formas:
1) nawlavTa amebiazs;
2) nawlavgareSe amebiazs;
3) kanis amebiazs;
nawlavTa amebiazi anu ameburi dizenteria warmoadgens daavadebis ZiriTad da
yvelaze ufro xSir klinikur gamovlinebas.
histolitikuri entamebis mtareblobis arsebobis gamo gaZnelebulia inkubaciuri
periodis zusti dadgena. dasnebovnebis drois gaTvaliswinebiT dadgenilia inkubaciuri
periodis xangrZlivoba, romelic meryeobs erTi-sami kviridan sam Tvemde da metic.
umravles SemTxvevaSi inficirebas ar axlavs simptomatika, amitom misi diagnostika
SesaZlebelia mxolod ganavalSi parazitebis aRmoCeniT. nawlavTa mwvave amebiazis
dros avadmyofis saerTo mdgomareoba didxans rCeba damakmayofilebeli, intoqsikacia
ar aris gamoxatuli, sxeulis temperatura normaluri an subfebriluria. avadmyofTa
mxolod mcire nawili aRniSnavs iseT Civilebs, rogoricaa saerTo sisuste, uZlureba,
madis daqveiTeba, Tavis tkivili, simZimis SegrZneba epigastriumis areSi, muclis xanmokle
448
kerZo nawili.
tkivilebi.
kardinalur simptomad
iTvleba faRaraTi, romelic
dasawyisSi uxvganavlovani da
mkveTrsuniania da Seicavs
gamWvirvale lorwos, Semdeg igi
TandaTanobiT kargavs ganavlovan
xasiaTs, izrdeba masSi lorwos
raodenoba, romelic gamWvirvale
da miniseburia da advilad
ekvreba qoTans. mogvianebiT
ganavalSi Cndeba sisxli, romlis
lorwoSi SereviT zogjer es
ukanaskneli Rebulobs
`Jolosebri Jeles saxes” da
axasiaTebs `labisebri
TrTolva”. daavadebis simZimes
gansazRvravs defekaciis sixSire,
romelic dRe-RameSi zogjer 20- amebiazi. nawlavis wylulovani procesi.
30 aRwevs, rac, Sesabamisad, Rrma
dehidrataciis mizezi xdeba. procesSi swori nawlavis CarTvisas avadmyofebi uCivian
Znelad asatan, SeteviTi xasiaTis tenezmebs, SesaZlebelia, ganviTardes anusis Riaoba an
swori nawlavis gamovardna (aRniSnuli mdgomareoba saWiroebs baqteriuli dizenteriis
gamoricxvas), muceli odnav Seberilia, sigmoiduri kolinji ki palpaciiT mtkivneuli.
xazgasasmelia, rom nawlavTa amebiazi araiSviaTad mimdinareobs asimptomurad, dizenteriis
ti pis simptomebis gareSe, waSlili formiT, yabzobiTac ki.
msxvili nawlavis lorwovan garsze endoskopiiT naxuloben 2-dan 10-20 mm-mde
diametris mqone wylulebs, romelTa lokalizaciis adgili ufro metad lorwovani
naoWis zemo nawilia. wylulebis kideebi SeSupebuli da CaTxrilia, fuZe ki serozul
garss aRwevs, rac mZime garTulebis _ perforaciisa da peritonitis mizezi xdeba.
wylulebis fuZeebi, Cveulebriv, gavsebulia CirqiTa da danekrozebuli masiT, TviTon
wylulebi ki Semofarglulia hiperemiuli zoniT, rac maT lorwovani garsis normaluri
an odnav hi peremiuli da SeSupebuli ubnebisagan gamohyofs.
mwvave diareuli movlenebi SeiZleba, ramdenime kviras gagrZeldes, Sewydes spontanurad,
specifikuri mkurnalobis gareSe, xangrZlivi remisiis ganviTarebiT, magram Semdeg
kvlav aRiniSnos mwvave simptomatika da a.S., rac iRebs qronikuli mimdinareobis
xasiaTs, grZeldeba TveobiT da, SesaZloa, wlobiTac. qronikuli baqteriuli dizenteriis
analogiurad, daavadebam SeiZleba miiRos morecidive an uwyveti mimdinareoba. morecidive
forma gamwvavebis fazaSi vlindeba mwvave diareuli simptomatikiTa da saerTo
mdgomareobis gauaresebiT, remisiis dros ganavali gaformebulia, saerTo mdgomareoba
ki _ damakmayofilebeli. uwyveti mimdinareoba xasiaTdeba simptomatikis SedarebiT
SesustebiT an piriqiT, aSkara gamwvavebiT.
ameburi dizenteriis qronikuli mimdinareobisas organizmis reaqtiuloba mkveTrad
qveiTdeba, iSleba kveba, viTardeba avitaminozi, asTeniuri sindromi da a.S.
ameburi dizenteriis momdevno mudmiv simptomad iTvleba tkivilebi muclis
areSi, romelTa intensivobas gansazRvravs daavadebis simZime. msubuqi formis dros
tkivilebi ufro lokaluri xasiaTisaa da upiratesad epigastriumis, ileocekalur an
marcxena ferdqveS midamoSi aRiniSneba. mZime mimdinareobisas tkivilebi difuzurad
449
kerZo nawili.
mTel mucelSi vrceldeba, ufro intensiuria, Setevebi viTardeba zedized, cxreba

defekaciis Semdeg, xolo xanmokle drois Semdeg SeiZleba axlidan ganmeordes.
msxvil nawlavebSi paTologiuri procesis dacxrobis Semdeg tkivilebi naklebad
SeigrZnoba, naklebintensiuri da xanmokle xdeba, Semdeg qreba. mudmivi tkivilebi
aRiniSneba Sexorcebebisa da nawiburebis ganviTarebis dros.
tenezmebi ameburi dizenteriis dros ganpirobebulia swori nawlavis wylulovani
dazianebiT, gansakuTrebiT maSin, roca wylulebi anusTan axlos mdebareobs. tenezmebi
am dros mudmivi da Semawuxebelia. aseTi SemTxvevebis dros upirvelesad saWiroa
baqteriuli dizenteriis erTdroulad mimdinareobis gamoricxva.
temperatura, miT umetes maRali ricxvebi, ameburi dizenteriisaTvis damaxasiaTebeli
ar aris. temperaturis arsebobisaTvis saWiroa namdvili mizezis dadgena. am dros
saWiroa, gamoiricxos abscesi RviZlis an sxva organoebis mxriv da sxva garTulebebi.
saWmlis momnelebeli sistema sistema. daavadebis dasawyisSive ena TeTri nadebiTaa
Selesili, salivacia Semcirebulia. avadmyofi uCivis piris simSralesa da cud suns
pirSi, madis daqveiTebas an umadobas, mogvianebiT _enis wvas, tkivils, muclis yuryurs.
muceli Seberilia, Rrma palpaciiT vlindeba mtkivneuli da Semsxvilebuli brma
nawlavi da spazmurad SekumSuli sigmoiduri kolinji. RviZlisa da elenTis gadideba
damaxasiaTebeli ar aris. RviZli nawlavTa amebiazis dros normis farglebSia, zogjer
mcired gadidebuli da palpaciiT mgrZnobiare, SesaZlebelia mwvave hepatitis ganviTareba
daCirqebis gareSe.
gul-sisxlZarRvTa sistemis mxriv aRiniSneba pulsis labiloba, taqikardia,
gulis tonebis moyrueba, sazRvrebis gadideba. daavadebis mZime mimdinareobisas
SesaZlebelia, ganviTardes gul-sisxlZarRvTa mwvave ukmarisoba, mkveTri hi potenzia.
filtvebis mxriv garTulebebi meoradi infeqciis xasiaTs atarebs.
periferiul sisxlSi leikocitebi mcired momatebulia marcxniv gadaxriT an
normis farglebSia. limfocitozi, monocitozi, eozinofilia gamoxatulia qronikuli
recidivebis Semdgom periodSi. avadmyofobis Sorswasuli formebis dros viTardeba
kaxeqsia, rac kidec ganapirobebs letalur gamosavals.
nawlavTa amebiazis yvelaze ufro xSiri garTulebaa perikoliti, nawlavTa perforacia
peritonitis Semdgomi ganviTarebiT, swori nawlavis gamovardna, specifikuri apendiciti,
zogierTi avtori nawlavTa amebiazis garTulebad Tvlis misi mimdinareobis dros
nawlavgareE yovelgvari amebiazis gamovlinebas.
amebiazis nawlavgareSe forma forma. RviZlis amebiazi SeiZleba ganviTardes nawlavTa
mwvave amebiazis fonze an misi gadatanidan ramdenime Tvis an wlis Semdeg, zogjer ki
nawlavuri epizodis
gareSec. arCeven mis mwvave,
qvemwvave da qronikul
mimdinareobas, igi gvxvdeba
RviZlis abscesis saxiT.
RviZlis dazianeba,
umetesad, nawlavTa
amebiazTanaa dakavSi-
rebuli. am dros RviZli
Tanabrad diddeba,
avadmyofebi uCivian
tkivils marjvena
ferdqveSa midamoSi,
amebiazi. RviZlis abscesi. siyviTle viTardeba
450
kerZo nawili.
iSviaTad. RviZli ramdenadme gamkvrivebuli da zomierad mtkivneulia, SesaZlebelia

axldes subfebriluri an maRali temperaturuli reaqciebi. sisxlSi zomieri
leikocitozia.
RviZlis abscesis mudmivi simptomia RviZlis gadideba, tkivilebi paTologiuri
procesis lokalizaciis areSi, temperaturis momateba. arapirdapir maCveneblad miiCneven
diafragmis marjvena TaRis awevas da amiT ganpirobebul filtvis qsovilis Sesabamisi
ubnis CafuSvas. laboratoriuli monacemebidan aRsaniSnavia leikocitebis umniSvnelo
momateba, zomieri anemia, RviZlis fermentebis umniSvnelo mateba.
RviZlis abscesis 50%-ze met SemTxvevaSi ganavalSi amebis aRmoCena ar xerxdeba.
diagnostikaSi gvexmareba ultrabgeriTi da izotopebiT skanireba, roca TiTqmis yovelTvis
zustad dgindeba abscesis lokalizacia da xasiaTi (upiratesad marjvenawilovani da
erTeuli). diagnozis dasmis dayovneba da dagvianebuli mkurnaloba ganapirobebs iseT
mZime garTulebebs, rogoricaa abscesis gaxsna muclis an plevris RruSi, agreTve kanis
zedapirze.
ameba filtvis qsovilSi SeiZleba moxvdes hematogenuri gziT an plevris RruSi
RviZlis abscesis gaxsnis Semdeg. am dros mimdinare klinikuri suraTi Seesabameba
plevropnevmonias an abscess. pnevmonias axlavs iseTi Civilebi, rogoricaa tkivili
gulmkerdis areSi, mSrali xvela an xvela mcire naxveliT, romelic zogjer sisxlnarevia,
temperatura normaluri an subfebriluri ti pisaa. periferiul sisxlSi aRiniSneba
umniSvnelo leikocitozi neitrofiloziT. eds momatebulia. daavadeba duned
momdinareobs, mkurnalobis gareSe rTuldeba da yalibdeba filtvis abscesi, rasac
axlavs upiratesad heqtiuri xasiaTis temperaturuli reaqcia, xvela didi raodenobis
naxveliT, romelic SeiZleba sisxlnarevi iyos. am dros naxveli Rebulobs Sokoladisfers
_ `Sokoladiseburi” naxveli an ànCousis sousis” saxes, romelSic SeiZleba amebebis
aRmoCena.
amebebi hematogenuri gziT SeiZleba gavrceldes tvinis qsovilSi da ganviTardes
tvinis abscesi, rasac axlavs Tavis tvinis saerTo da kerovani dazianebis simptomatika.
zogadi simptomebidan aRsaniSnavia Tavis Zlieri tkivili, Rebineba, gulisreva, normaluri
an subfebriluri temperatura.
kanis amebiazi warmoadgens meorad process da umTavresad lokalizdeba anusis
irgvliv, dundula kunTebze, Sorisis midamoSi eroziebisa da wylulebis saxiT.
damaxasiaTebelia Rrma, gaSavebulkideebiani da usiamovno sunis mqone wylulebi. ameburi
wylulebi SeiZleba ganviTardes Cirqovani fistulebis irgvliv, operaciuli nakerebis
axlos. ameburi abscesis gaxsnis Semdeg advilia wylulis SigTavsidan aRebul nacxSi
amebebis aRmoCena.
1996w. Cvens mier diagnostirebul iqna amebiazi, romelmac Semdgom wlebSi (1996-
98) miiRo epidafeTqebis tendencia. aRsaniSnavia, rom rodesac bavSvebSi viTardeboda
amebiazis nawlavTa formebi, mozrdilebSi 300-mde RviZlis abscesiT garTulebas
hqonda adgili. maTi umravlesoba daavadebis anamnezSi an ar aRniSnavdnen faRaraTs an
diarea waSlili formiT ufro xasiaTdeboda.
150-ze meti mcire asakis bavSvis klinikis detalurma Seswavlam gviCvena, rom kuW-
nawlavis mxriv daavadebis gamovlineba xSirad waagavda Sigelozs, salmonelozs,
eSerixiozs klinikuri suraTiT. ganavali iyo uxvi, Txeli an wylisebri, didi raodenobiT
lorwos Semcveli, sisxlis minarevebiT. klasikuri `Jolosebri” ganavali ufro iSviaT
movlenas warmoadgenda. xazgasasmelia, rom nawlavTa amebiazi mcire asakis bavSvebSi
40%-Si miqst-infeqciebiT mimdinareobda (Sigelozi, salmonelozi da sxv.), ramac daRi
daasva klinikur Taviseburebebs.
yvelaze ufro mZime formas warmoadgens, e.w. fulminanturi forma, romelsac
451
kerZo nawili.
SeiZleba adgili hqondes 5 % SemTxvevaSi. am dros aRiniSneba maRali temperatura,

mkveTri saerTo intoqsikacia, dehidratacia, kolaftoiduri mdgomareoba. aseTi formebis
ganviTarebas ukavSireben imunodeficitur mdgomareobas, distrofias, miqst-infeqcias
Cveulebriv wlamde asakis bavSvebSi.
prognozi nawlavTa amebiazis adreuli diagnostikisa da mkurnalobis Catarebis
SemTxvevaSi keTilsaimedoa, xolo nawlavgareSe formebis _ RviZlis, filtvis, tvinis
an sxva organoTa dazianebis dros seriozulia da xSirad moaswavebs letalur
gamosavals.
diagnostika. efuZneba epidemiologiur, klinikur da laboratoriul gamokvlevebs,
diagnostika
mis dazustebaSi ki gvexmareba endoskopiuri, rentgenologiuri, ultrabgeriTi, izotopuri
da serologiuri kvlevebi. gadamwyveti mniSvneloba aqvs ganavalSi, naxvelSi, biofsiur
masalaSi, wylulidan aRebul nacxSi da a.S. amebis vegetaciuri formebis
(trofozoitebis)aRmoCenas. axladgamoyofil ganavals mikroskopulad ikvleven
ganmeorebiT, ramdenime nacxSi, misi natiuri praparatebi gamokvleul unda iqnas
defekaciidan araugvianes 10-15 wuTSi. am mizniT amebiazis mwvave periodSi safaRaraTo
saSualebebi ar gamoiyeneba, maTi gamoyeneba koprologiuri kvlevis xelSewyobis mizniT
(amebis advilad aRmoCenisaTvis) rekomendebulia nawlavTa amebiazis qronikuli
mimdinareobisas remisiis periodSi.
amebiazze eWvis mitanis dros Seiswavleba, agreTve, specialurad damzadebuli
nacxi, romelsac winaswar afiqsireben polivinilis spirtiT, Semdeg ki Rebaven m.
heidenhainis meTodiT lugolis xsnariT an rkinis hematoqsiliniT. aseTi nacxi inaxeba
didxans. mowodebulia amebebis koncentrirebisa da permanentuli SeRebvisaTvis
specialuri reaqtivebi.
amebis kultivireba SesaZlebelia baqteriebian xelovnur niadagze (robinsonis
niadagi).
diagnostikisaTvis mniSvnelovan monacemebs iZleva damxmare imunuri reaqciebi
nawlavTa amebiazis dros SemTxvevaTa 60-70%-Si, xolo RviZlis ameburi abscesis
dros _ aranakleb 95%-Si (ifa, Semxvedri imunoeleqtroforezi). yvelaze ufro
mgrZnobiare imunuri reaqciebis gamovlineba xorcieldeba specialuri `kiti” reaqtivebis
meSveobiT (aSS, CDC-is centri); ameburi dizenteriis asimptomuri infeqciis dros,
cistebis naklebi eqskreciis SemTxvevaSi serokonversias naklebad aqvs adgili.
serokonversia uaryofiTia, Tu adamiani inficirebulia arapaTogenuri Entamoeba
dispar-iT.
SesaZlebelia laboratoriuli cxovelebis amebiT dasnebovneba.
diferenciuli diagnozis gatareba aucilebelia protozoul daavadebebTan,
baqteriul dizenteriasTan, araspecifikur wylulovan kolitTan.
mkurnaloba amJamad arsebuli efeqturi specifikuri preparatebi amebaze moqmedebis
Tvisebebis gaTvaliswinebiT iyofa 3 jgufad:
1. cistebis asimptomuri eqskreciis dros iniSneba iodoqinoli, alternativulad
ki paromomycin an diloxanide furoate _ sanaTuris amebocidebi.
2. ameburi diarea, mimdinare dizenteriis klinikis gareSe _ iniSneba metronidazoli
(an tinidazoli).
3. dizenteriis saxiT mimdinare diareisa da, aseve, abscesebis dros _ metronidazoli
an tinidazoli, xolo sanaTuris amebocidebi iniSneba Semdgom.
Cvens mier nawlavuri formis amebiazis dros mcire asakis bavSvebSi warmatebiT
gamoyenebul iqna firma `roS~-is mier mowodebuli mkurnalobis sqema tiberaliT.
452
kerZo nawili. amebiazi
protozouli infeqciebi. niadagSi mobinadre amebebiT gamowveuli daavadeba
tiberaliT amebiazis mkurnaloba
mkurnalobis sadReRamiso doza

mozrdilebisTvis da bavSvebisaTvis
xangrZlivoba bavSvebisaTvis >35kg masiT < 35 kg masiT
3 dRe dReSi 3 tableti erT miRebaze 40 mg/kg-ze erT miRebaze dReSi
saRamos.
60 kg-ze zeviT dReSi 4 tableti
(2 dilas - 2 saRamos)
5 - 10 dRe 2 tableti dReSi 25 mg/kg-ze erT miRebaze dReSi
(1 dilas - 1 saRamos)
amebiazis mZime mimdinareobisas da rodesac aRiniSneba gverdiTi movlenebi Rebinebis

saxiT tiberali iniSneba venaSi 1-2 dRis ganmavlobaSi da Semdeg gadadian peroralur
miRebaze.
msoflio jandacvis organizaciis rekomendaciiT ameburi dizenteriis mkurnaloba
iwyeba rogorc trofozoitis (eriTrofagis) ganavalSi naxvis Semdeg, aseve empiriulad
Tu klinikurad gamoxatuli dizenteriis dros antibiotikebiT mkurnaloba efeqts ar
iSleva da ganavalSi isev aRiniSneba sisxli. aseT SemTxvevaSi iniSneba metronidazoli
40 mg/kg-ze 5-10 dRis ganmavlobaSi.
amebiazis, iseve, rogorc nawlavTa sxva infeqciebis profilaqtika emyareba
sanitaruli normebis guldasmiT Sesrulebas. saWiroa, regularuli gamokvlevebi
Cautardes mTel personals, vinc dasaqmebulia produqciis damzadebasa da realizaciaSi,
gansakuTrebiT _ diareis arsebobisas.
niadagSi mobinadre amebebiT

gamowveuli daavadeba
adamianebSi niadagis amebebiT gamowveuli daavadeba pirvelad aRwerili iyo

avstraliaSi 1965 w. da mas Semdeg registrirebulia msoflios mraval qveyanaSi. aSS-
Si, Cveulebriv, daavadeba gvxvdeba zafxulSi da aRiniSneba bavSvebsa da mozrdilebSi.
amebebi, ZiriTadad, binadroben wyalSi (sicocxles inarCuneben qlorirebul wyalSic),
iolad mravldebian Tbil wyalSi, maT naxuloben kondicirebiT datenianebul haerSic.
adamianebSi daavadebas iwvevs morfologiurad gansxvavebuli ori saxis ameba.
infeqcia xasiaTdeba klinikuri da epidemiologiuri TaviseburebebiT. Naegleria fowleri-
s SeuZlia gamoiwvios meningoencefaliti, romelic TiTqmis yovelTvis fatalurad
mTavrdeba.
daavadeba iwyeba Tbil, dabinZurebul wyalsatevSi banaobis Semdeg. paraziti iWreba
kanidan an respiraciuli traqtidan _ cxviris epiTeliumSi, xolo Semdeg n. olfactorius-
isa da Lamina cribriformis-idan aRwevs tvins. daavadebis inkubaciuri periodi
ganisaZRvreba ramdenime dRidan erT kviramde.
adreul klinikur gamovlinebas warmoadgens: cxeleba, Tavis tkivilebi, zogjer
gemovnebisa da ynosvis dakargva. daavadeba Rebulobs progresirebad xasiaTs mkafiod
gamoxatuli simptomebiT _ kisris kunTebis rigidoba, cnobierebis darRveva; xSirad
adgili aqvs krunCxvebs da swrafad viTardeba sikvdili. sxva fulminanturi
453
kerZo nawili.
protozouli infeqciebi. niadagSi mobinadre amebebiT gamowveuli daavadeba
meningitebisagan raime klinikuri simptomatikiT ar gamoirCeva, garda imisa, rom daavadebas

win uswrebda Ria Tbil wyalSi banaoba.
Acanthamoeba. Acanthamoeba culbertsoni-T da masTan axlos mdgomi amebebiT
gamowveuli daavadebis klinikuri gamovlineba gamoirCeva mniSvnelovani sxvaobiT.
cistebis mcire masa da maTi sqeli kedeli xels uwyobs mikroorganizmebis aerogenul
gavrcelebas. amasTan dakavSirebiT, aRniSnul amebebs xSirad naxuloben cxvir-xaxidan
aRebul nacxSi da janmrTeli adamianebis fekaliebSi. SesaZloa, rom amebebi
incistirebulad gaivlian kuW-nawlavis traqts, misi dazianebis gareSe.
Acanthamoeba-Ti da Balamuthia-Ti dasnebovneba igive meqanizmiT xdeba, rac
Naegleria fowleri-is dros.
Acanthamoeba-saTvis inkubaciuri periodi zustad ar aris dadgenili.
Acanthamoeba-Ti da Balamuthia-Ti gamowveuli granulomatozuri encefaliti
viTardeba TandaTanobiT da progresirebs ufro nela, vidre Naegleria fowleri-is
dros.
daavadeba iwyeba inficirebidan erTi kviris an ramdenime Tvis Semdeg. infeqcias,
Cveulebriv, adgili aqvs imunokomprometirebul pirebSi. klinikur gamovlinebaSi aRiniSneba
krunCxvebi, Tavis tkivili, kisris kunTebis rigidoba, ataqsia, qalas nervebis dazianeba,
hemi parezi da sxva fokaluri defeqtebi. temperatura Cveulebriv, maRali ar aris,
SeiZleba iyos intermisiuli. kani zogjer wyluldeba. daavadeba mogvagonebs tvinis
abscesis an tvinis simsivnis suraTs.
ameburi keratiti SeiZleba ganviTardes avadmyofebSi, romlebic atareben kontaqtur
linzebs da mogvagonebs herpes simplex-iT da sokoTi ganpirobebul keratits;
SeiZleba ganviTardes meoradi uveitic.
granulomatozebs tvinis garda naxuloben kanze, filtvebSi, Sua yurSi, kuWis
lorwovanze.
diagnostikuri testebi. Naegleria-s dadgena SeiZleba centrifugirebul Tav-
zurgtvinis siTxeSi mikroskopiiT, sadac aRiniSneba moZravi trofozoitebi. parazitis
kultivireba SeiZleba 1,5%-ian aranoyier agarSi nawlavis CxirebiT an Page-s xsnarSi;
diagnostikisaTvis gamoiyeneba imunofluorescenciis meTodi.
daavadebas, gamowveuls Naegleria-Ti da Acanthamoeba-Ti araiSviaTad adastureben
histologiuri kvlevebiT. amebebis identifikacia SeRebil preparatebSi Znelia, ujredis
centrSi msxvili endosomis aRmoCena diagnostikur niSans warmoadgens.
zogierT SemTxvevaSi warmatebiT gamoiyeneba diagnozis retrospeqtuli dazusteba.
amisaTvis saWiroa, rom histologiuri anaTali damuSavdes specifikuri antiSratiT
da Semdeg SeiRebos antitipurspecifikuri SratiT, romelic niSandebulia izoTiocianatis
fluoresciniT.
axlaxans dadginda, rom zemoT aRniSnuli ori gvaris amebebi arian alergiuli
alveolitebis mizezi.
mkurnaloba. Naegleria fowleri-T gamowveuli meningoencefalitis dros
mkurnalobisaTvis arCevis preparatad iTvleba amfotericini B. amfotericini SeiZleba
dainiSnos mikonazolTan an rifampicinTan erTad. daavadebis adreuli diagnostika da
maRal dozebSi maTi gamoyeneba gansazRvravs mkurnalobis efeqts.
efeqturi mkurnaloba nervuli sistemis dazianebis dros gamowveuli
Acanthamoeba-Ti zemoaRniSnuli preparatebiT ar aris dadasturebuli. mxolod
erT avadmyofSi miRebuli iqna gaumjobeseba sulfametaziniT mkurnalobis dros.
keratitis mkurnalobisaTvis gamoiyeneba adgilobrivad propamidini, neomicini,
oligeqsameTilenis biguanidinis preparatebi, sxvadasxva azolebi, mag., mikonazoli,
klotrimazoli.
454
kerZo nawili.
protozouli infeqciebi. pnevmocistozi
pnevmocistozi
(PNEUMOCYSTOSIS)
(intersticiuli plazmurujredovani pnevmoniti)
imunokomprometirebul avadmyofTaTvis pnevmocistozi warmoadgens protozoul,

sicocxlisTvis saSiS infeqcias. daavadeba viTardeba Pneumocystis carinii-T
inficirebul, magram manamde usimptomo pirebSi.
etiologia. P. carinii imyofeba filtvebis ujredgare sivrceSi ZuZumwovar
etiologia
cxovelebSi da inficirebul adamianebSi. Tumca parazitis taqsonomia Seswavlili
mTlianad ar aris, magram mas aqvs rogorc sokoebis, aseve parazitis Tvisebebi.
paraziti gamoirCeva mkveTri tropizmiT filtvis qsovilis mimarT. sporozoitebidan
vegetaciur formad _ trofozoitad paraziti gardaiqmneba filtvis qsovilSi _
alveolebSi. igi warmoadgens erTujredian warmonaqmns zomiT 2×4µ. trofozoiti
drodadro gardaiqmneba precistad, romelic mravldeba sqesobrivad. cistebi diametrSi
5-8 mkm-s aRweven da 8 pleomorful sporozoits Seicaven.
epidemiologia. P. carinii farTodaa gavrcelebuli Sinaur da gareul cxovelebSi
da adamianebSi.
eqsperimentuli gamokvlevebiT dadginda, rom cxovelidan cxovelze infeqcia gadadis
haeriT, magram cxovelidan adamianze gadadebis es gza ar unda iyos damaxasiaTebeli.
amave dros ar aris dadasturebuli adamianidan adamianze infeqciis gadacema. serologiuri
gamokvlevebi mowmoben, rom bavSvi iZens am parazits 4 wlamde. janmrTeli adamianis
organizmSi paraziti imyofeba usimptomod. infeqciis gamwvaveba xdeba mZime formis
simsivnuri procesis dros, organotransplantirebul pacientebSi, Tandayolili
imunodeficitis SemTxvevaSi. Sids-is dros, saTanado profilaqtikis Catarebis gareSe,
es infeqcia wlamde asakis bavSvTa 40%-Si gvxdeba, mozrdili bavSvebis 70%-Si, leikemiiT
daavadebulebis 12%-Si da organotransplantirebuli bavSvebis 10%-Si. sainteresoa,
rom II msoflio omis dros aRiniSna bavSvebSi intersticiuli pnevmoniis SemTxvevebi,
rasac arasrulfasovan kvebas(SimSils) ukavSirebdnen.
paTogenezi. daavadeba viTardeba pirveladi an meoradi imunodeficitis dros.
paTogenezi
filtvebSi SeiZleba nanaxi iqnas P. carinii-s 2 forma: cista, romelic Seicavs 8-
mde polimorful sporozoits da trofozoiti _ eqstracistuli forma.
P. carinii ekvreba alveolas protein _ fibroneqtinis da manozadamokidebuli
SenaerTis meSveobiT. ofsonizirebuli paraziti SemdgomSi ganicdis fagocitirebas
makrofagiT da ganadgurdeba tumormanekrozebeli faqtoriT. makrofagebi srulad ver
uweven winaaRmdegobas parazitebs, ris gamoc pnevmocistebi TandaTanobiT avseben
alveolebis Rrus.
histologiurad aRiniSneba qafiani vakuolizebuli alveoluri eqsudati, romelic
Seicavs parazitebs.
gamoxatulia 2 ti pis histologiuri cvlilebebi.
pirveli ti pi ganpirobebulia cistebiT. adgili aqvs infantilur(sustad gamoxatul)
intersticiul plazmurujredovan anTebas. aRwerilia aseTi ti piT mimdinare infeqciis
afeTqebebi 3-dan 6 Tvemde ganleul bavSvebSi. am dros aRiniSneba alveoluri septebis
gasqeleba da plazmurujredovani infiltracia.
imunokomprometirebulebSi meo re ti pis cvlilebebi gamoxatulia alveolebis
meor
desqvamaciuri procesiT. am dros, alveolebSi P. carinii-s didi raodenoba aRiniSneba,
xolo eqsudatSi _ makrofagebi fagocitozis fazaSi, ujredSigniT myofi parazitiT.
alveolebis septebi gasqelebuli ar aris da, rogorc wesi, plazmuri ujredebic ar
455
kerZo nawili. pnevmocistozi
protozouli infeqciebi. leiSmaniozebi
vlindeba.
daavadebis paTogenezSi didi roli eniWeba ujredul imunitets. CD4-is maCveneblis
daqveiTeba pnevmocisturi pnevmoniis dawyebis indikatorad iTvleba da profilaqtikuri
qimioTerapiis aucileblobaze miuTiTebs.
klinika. epidafeTqebis dros viTardeba intersticiuli plazmurujredovani
klinika
pnevmonia. Cvili da mcire asakis bavSvebSi daavadeba qvemwvaved mimdinareobs. gamoxatulia
sunTqvis gaxSireba normaluri temperaturis fonze, neknTaSorisi da epigastriumis
areebis Cazneqa, cianozi.
sporaduli SemTxvevebis dros ki pnevmocisturi pnevmonia imunodeficitis
gamovlinebaa. daavadeba iwyeba mwvaved, xveliT, sunTqvis uecari gaxSirebiT, cianoziT,
dispnoeTi. sunTqvis aqtSi monawileobs damxmare kunTebi, aRiniSneba cxviris nestoebis
berva, Tumca zogjer simptomebi varirebs. rogorc wesi, fizikaluri monacemebi sustia.
zogierT SemTxvevaSi pnevmocistozi vlindeba eqstrapulmonuri simptomebiTac: retinitiT,
elenTisa da Zvlis tvinis dazianebiT. rentgenologiurad aRiniSnebafiltvis orive
mxares alveolebis granuluri dazianeba. Tavidan Crdili Cndeba filtvis karis
irgvliv, Semdeg progresirebs periferiisken da bolos, apeqsisken.
diagnozi ismeba daavadebis ti puri mimdinareobiT, parazitis aRmoCeniT filtvebSi
filtvis lavaJiT, traqeis SigTavsis aspiraciiT, transbronquli bioftatiT, perkutanuli
transTorakaluri aspiraciiT an ,,Ria filtvis” dros. cistebze masala iRebeba
Grocott-Gomori-s wesiT an toludinis lurjiT. trofozoitebisa da sporozoitebis
aRmosaCenad gamoiyeneba Giemsa-s wesi an poliqromiT SeRebva. mafluorescirebeli
niSandebuli antisxeulebi gamoiyeneba parazitis orive formis gamosakvlevad.
mkurnalobis gareSe daavadeba 3-4 kviraSi sikvdiliT mTavrdeba. asarCev preparatia
trimetoprim (15-20mg/kg/24saaTSi) _ sulfametoqsazoli (75-100mg/kg/24saaTSi). Sidsis
dros mkurnalobis kursi 3 kviraa, sxva SemTxvevaSi ki - 2 kvira. alternatiul
preparats warmoadgens pentamidinis izeTionati 4mg/kg dRe-RameSi 1-jer. zogierTi
mkvlevaris azriT, mZime pnevmoniis dros mizanSewonilia kortikosteroidebis gamoyenebac
(sasicocxlo CvenebiT ).
profilaqtikis mizniT trimetoprim (5mg/kg/24saaTSi) _sulfametoqsazoli (25mg/
kg/24saaTSi) iniSneba yoveldRe, an kviraSi 3 dRe, xolo misi xangrZlivoba damokidebulia
imunokomprometaciaze.
leiSmaniozebi
(LEISHMANIOSES)
leiSmaniozebi miekuTvnebian adamianisa da cxovelebis protozoul transmisiul

daavadebaTa jgufs, romelTa gadamtania moskitebi. klinikurad daavadeba xasiaTdeba
Sinagani organoebis dazianebiT, cxelebiT, hepatosplenomegaliiT, anemiiT, leikopeniiT
(visceruli leiSmaniozi _ Leishmaniosis visceralis), kanisa da lorwovani garsebis
Semofargluli dazianebiT, maTi dawylulebiTa da nawiburebis ganviTarebiT (kanis
leiSmaniozi _ Leishmaniosis cutanea, kan-lorwovanis leiSmaniozi _ Leishmani-
osis mucocutanea).
mokle istoriuli cnobebi. kanis leiSmaniozis gamomwvevi aRmoCenili iyo 1897w.
Ï\Ô\ Áîðîâñêèé–s mier pendinis wylulis nawiburebSi, xolo 1900w. W. Leishman-
ma da 1903 w Ch. Donovan-ma visceruli leiSmaniozis gamomwvevi paraziti aRmoaCines
kala-azariT daavadebuli adamianis elenTaSi.
456
kerZo nawili.
eti
etio logia. leiSmaniozis gamomwvevi parazitebi miekuTvnebian Protozoa-s ti ps,
ologia
Sarcomastigophora-s qveti ps, Mastigophora-s zeklass, Flagellata-s klass,
Kinetoplastida-s razms, Trypanosomidae-s ojaxs, Leishmania-s gvars.
visceruli leiSmaniozis gamomwvevebi Leishmania donovani iyofa 4 saxeobad:
1) L. d. donovani (induri varianti); 2) L.d. infantum (xmelTaSua zRva-Suaaziuri
varianti); 3) L.d. archibaldi (aRmosavleT-afrikuli varianti); 4) L.d. chagasi
(samxreT-amerikuli varianti). es qvesaxeobebi gansxvavdebian mxolod antigenuri da
bioqimiuri TvisebebiT da ara morfologiurad.
Leishmania tropica (L.tropica minor), L. major (l. tropica major), L. aethiopica
Zveli samyaros kanis leiSmaniozis gamomwvevebia; L. mexicana, L. braziliensis; L.
peruviana, L. amazonensis, L. panamensis, L. guanensis ki _ axali samyaros
kanis leiSmaniozis gamomwvevebi.
leiSmaniebis ganviTarebis cikli mimdinareobs patronis SecvliT da ori stadiisagan
Sedgeba: 1. wamwamovani forma _ promastigotebi _ kargad mravldebian ujredgareSe
gadamtani moskitis organizmSi da qsovilebis kulturebze. 2. uwamwamo forma _
amastigotebi _ obligaturi ujredSiga parazitebia, romlebic parazitoben xerxemliani
cxovelebis mononuklearul ujredebSi.
parazitebis gadamtanebi _ mdedri moskitebi (Phlebotomus (L. donovani-s
gadamtania) Lutzomygia, Psychdopygus) inficirdebian avadmyofi cxovelebis sisxlis
wovis dros. infeqciis gadamtani moskitebis zoma ar aRemateba 1,5-2 mm.
leiSmaniebs amastigotur stadiaSi aqvT ovaluri forma, 3-5 mkm sigrZis da 1-3 mkm
siganis. isini, Cveulebriv, mononuklearul ujredebSi imyofebian da maTi SeRebvisas
advilad naxuloben homogenur an vakuolizebul, lurji feris citoplazmas,
centralurad mdebare birTvsa da lalisfer-wiTel kinetoplasts. promastigotur
stadiaSi leiSmaniebs TiTistariseburi forma aqvT. parazitis sigrZe 10-20 mkm-ia,
sigane 4-5 mkm. SeRebvisas garda citoplazmisa, birTvisa da kinetoplastisa wina
nawilis boloSi SeiniSneba wamwami, romlis saSualebiTac paraziti moZraobs. aRniSnuli
formebis dadgena SesaZlebelia moskitis organizmSi da NNN niadagze kultivirebis
Sedegad.
epidemiologia . visceruli leiSmaniozi (Leishmaniosis visceralis)
gavrcelebulia tropikul da subtropikul qveynebSi. yvelaze ufro aqtiuri kerebia
CineTSi, indoeTSi, bangladeSSi, iranSi, TurqeTSi, centralur da samxreT amerikaSi, Sua
aziaSi, xmelTaSua zRvis qveynebSi, amierkavkasiaSi da sxva.
visceruli leiSmaniozis wyarosa da rezervuars warmoadgenen ZaRlebi da maTi
msgavsi gareuli cxovelebi (tura, mela), SesaZlebelia avadmyofi adamianic; kanis
qalaqis ti pis leiSmaniozis dros avadmyofi adamiani da SesaZlebelia ZaRlebi.
soflis ti pis leiSmaniozis dros ki sxvadasxva mRrRnelebi ( didi meqviSia, qudwiTela
meqviSia, wvrilTaviani Tria, firfitisebrkbiliani virTxa da sxva).
parazitebi mravldebian sacxovrebeli saxlis sardafebSi, gamoqvabulebSi, frinvelTa
budeebSi, kldis napralebSi da sxva. tropikul qveynebSi moskitebi gvxvdeba mTeli
wlis ganmavlobaSi.
mdedri moskitebis inficireba xdeba xorTumiT dazianebuli kanis Cxvletis an
avadmyofi adamianis an cxovelebis sisxlis wovis dros.
kanis soflis ti pis leiSmaniozi gvxvdeba Sua aziis qveynebSi.
LleiSmanioziT daavadebis sezonuroba dakavSirebulia moskitis biologiur
TvisebebTan. gansakuTrebiT didia avadoba im pirebSi, romlebic Camodian endemur
kerebSi.
paTogenezi. leiSmaniebis SeWris adgils warmoadgens kani. moskitis kbenis adgilas
paTogenezi
457
kerZo nawili.
ramdenime dRis an kviris Semdeg viTardeba pirveladi afeqti _ umniSvnelo papula an

wyluli qavilis SegrZnebiT, romelic zogjer fufxiT ifareba. pirveladi afeqti
damaxasiaTebelia kanis leiSmaniozisaTvis, viscerulis dros ki adgilobrivi kera
sustadaa gamoxatuli an srulebiT ar aRiniSneba. kanis formis dros parazitis
gamravleba xdeba adgilobrivad _ dazianebul qsovilebSi, magram SesaZlebelia limfur
kvanZebSic hematogenuri diseminaciis gareSe.
visceruli (gamomwvevi L. donovani) da kan-lorwovani (espundia _ kanis
leiSmaniozis garTuleba gamomwvevi L. braziliensis) leiSmaniozebis dros aRiniSneba
leiSmaniebis hematogenuri diseminacia Sinagani organoebis dazianebiT. visceruli
leiSmaniozis dros organizmSi SeWrili promastigotebi fagocitirdebian makrofagebiT
da gardaiqmnebian amastigotebad, mravldebian elenTis, RviZlis, Zvlis tvinis, limfuri
kvanZebis, nawlavebisa da sxva Sinagani organoebis mononuklearul-fagocituri sistemis
ujredebSi. aRniSnuli cvlilebebi ganapirobeben degeneraciul da nekrozul procesebs,
gansakuTrebiT _ elenTaSi. sisxlmbadi organoebis dazianeba iwvevs leikopenias
granulocitebis xarjze da progresirebad hi poqromul anemias. espundias dros paraziti
hematogenuri gziT aRwevs pirisa da cxviris lorwovans kanis Tavdapirveli dazianebis
1 Tvis _ 24 wlis (iSviaTad) Semdeg da iwvevs tuCebis, enis, rbili sasis, cxviris
Zgidis, xaxis, xorxisa da traqeis destruqcias. cxviris deformacia Rebulobs
damaxasiaTebel konfiguracias _ brtyeldeba da mas uwodeben “tapiris cxvirs”
(cxovel tapirTan msgavsebis gamo). zemoaRniSnuli deformaciebi iwvevs disfagias da,
iSviaTad, asfiqsiasac, aspiraciul pnevmonias, Wrilobis meorad infeqciebs, baqteriul
meningits da sxva garTulebebs. am dros saWiroa diferenciuli diagnozi sifilisTan,
histoplazmozTan, sarkoidozTan, karcinomasTan da a.S. ujreduli imunitetis
daTrgunvasTan erTad adgili aqvs araspecifikuri antisxeulebis, upiratesad IgG
hi pergamaglobulinemias da hi poalbuminemias. hi pergamaglobulinemia, rogorc wesi, ar
atarebs damcvelobiT xasiaTs da xSirad ganapirobebs imunopaTologiur process.
umravles SemTxvevaSi imunuri pasuxis Sedegad, pirvel rigSi, Senelebuli ti pis
zemgrZnobelobis reaqciis dros, adgili aqvs invazirebuli ujredebis daSlas, rac
ganapirobebs daavadebis subklinikur an latentur mimdinareobas. ukanasknel SemTxvevaSi
infeqciis gadacema SesaZlebelia hemotransfuziis gziT.
morfologiuri cvlilebebidan RviZlSi aRniSnaven degeneraciul da nekrobiozul
movlenebs, elenTaSi _ hemoragiul infiltratebs, kafsulisa da malpigis sxeulakebis
atrofias, Zvlis tvinSi retikulur da eriTroblastur hi perplazias da sxva.
klinika. rogorc ukve aRvniSneT, arCeven leiSmaniozis or ZiriTad formas _
klinika
viscerulsa da kanis leiSmaniozs.
visceruli leiSmaniozis ZiriTadi klinikuri gamovlinebani miuxedavad induri
(kala-azari), xmelTaSua zRvis, Sua aziis (bavSvTa) da aRmosavleT afrikis variantebisa,
yvelgan erTgvarovani rCeba.
inkubaciuri periodi grZeldeba moskitis kbenis Semdeg 20 dRidan wlamde da
metic, ufro xSirad ki Seadgens 3-6 Tves.
daavadebis mimdinareobaSi gamoyofen sam periods _ daavadebis dasawyis, klinikis
mTliani gaSlisa da kaxeqsiur stadias. moskitis kbenis Sedegad viTardeba pirveladi
afeqti papulis saxiT, romelsac avadmyofis pirveli momarTvis dros iSviaTad naxuloben
SemdegSi, eqimis mier dawvrilebiTi anamnezis Seswavlisas mSoblebi ixseneben, rom
zogadi mdgomareobis gauaresebamde didi xniT adre kanze, ZiriTadad, gaSiSvlebul
adgilze aRiniSneboda umniSvnelo papuluri gamonayari, romelic Semdeg gaqra an
amJamadac aRniSnaven mis sustad gamoxatul kvals. pirvelad afeqts upiratesad
adgili aqvs 1-1,5 wlis asakis bavSvebSi da ufro iSviaTad _ mozrdilebSi. mniSvnelovania,
458
kerZo nawili.
rom sworad Sefasdes moskitis kbenis Sedegad

gaCenili pirveladi afeqti, romelic Cndeba organizmis
zogadi intoqsikaciis dawyebamde didi xniT adre.
mozrdil bavSvebSi pirveli periodi umravles
SemTxvevaSi iwyeba TandaTan, maSin, rodesac mcire
asakis bavSvebSi adgili aqvs ufro mwvave dasawyiss.
daavadebis TandaTanobiTi dawyebisas saxezea
Civilebi zogad sisusteze, umadobaze, aRniSnaven
subfebrilur temperaturas. am periodSi, zogjer,
aRiniSneba elenTis gadideba. SemdgomSi simptomebi
progresirebad xasiaTs Rebulobs, sxeulis
temperatura matulobs da xdeba talRiseburi,
intermisiuli.
meore periodis anu klinikuri gamovlinebis
mTliani gaSlis dros temperatura maRalia,
xangrZlivi, dRe-RameSi SesaZlebelia 2-3 pikis (39-
40°C-mde) dadgena ( 2-3 saaTiani Sualedis
TermometriiT), romelsac Tan axlavs Zlieri visceruli leiSmaniozi. didi muceli,
Semcivneba da oflianoba. miuxedavad amisa, hepatosplenomegalia.
leiSmaniozisaTvis aseTi temperatura ar warmoadgens (sakuTari masala)
sakmaris sayrden simptoms. cxelebis periodi
grZeldeba 2 kviridan 1-2 Tvemde da icvleba sxvadasxva xangrZlivobis apireqsiuli
periodiT. SemdegSi temperatura SeiZleba gaxdes normaluri, magram zogadi sisuste
matulobs, Cndeba elenTis gadidebasTan dakavSirebuli simptomebi – diskomforti
mucelSi, swrafad danayrebis SegrZneba. fizikaluri monacemebiT yovelTvis dgindeba
RviZlisa da elenTis gadideba, gansakuTrebiT _ elenTisa, romlis zomebi aRwevs mcire
menjs da ikavebs muclis Rrus did nawils. gadidebuli RviZli da elenTa mkvrivi
konsistenciisa da sada zedapirisaa. limfuri kvanZebi diddeba naklebad. Tmebi TandaTan
Txeldeba da advilad msxvrevadi xdeba. avadmyofebs uviTardebaT anemia.
xmelTaSua zRvis, Sua aziis visceruli formiT ( bavSvTa leiSmaniozi ) daavadebuli
avadmyofebis kani Rebulobs cvilisfers miwis elferiT, xolo induri leiSmaniozis
dros aRiniSneba kanis gamuqeba, rasTanac dakavSirebulia daavadebis saxelwodeba _
kala-azari (“Savi daavadeba”) da ganpirobebulia Tirkmelzeda jirkvlebis hi pofunqciiT.
kala-azaris dros SeiZleba adgili hqondes generalizebul gamonayars, romelic Sedgeba
kvanZebisagan ( leiSmanoidebi ) _ mcire zomis laqebisa da papilomebisagan. SesaZlebelia,
agreTve, meoradi infeqciiT TandarTuli Cirqovani garTulebebi (mravalricxovani
pustulebi, furunkulebi, abscesebi). leiSmaniozis am formis dros limfuri kvanZebis
gadideba damaxasiaTebeli ar aris.
Tu leiSmaniozis meore periodSi ar iqna Catarebuli etiotropuli mkurnaloba,
daavadeba progresirebs, avadmyofebs uviTardebaT anoreqsia. daavadeba gadadis kaxeqsiis
stadiaSi, romlis damaxasiaTebel niSnad iTvleba mkveTri gaxdoma da SeSupeba.
SesaZlebelia RviZlis cirozis Camoyalibeba, asciti, sisxlCaqcevebi kanSi, sisxldena
kuW-nawlavis traqtidan. gul-sisxlZarRvTa sistemis dazianeba, viTardeba taqikardia,
arteriuli wneva ecema.
periferiul sisxlSi leiSmaniozis progresirebasTan dakavSirebiT eriTocitebisa
da hemoglobinis done qveiTeba, viTardeba leikopenia (granulocitopenia), Trombocitopenia,
eds mkveTrad imatebs. hi pergamaglobulinemiis, hi poalbuminemiis, agranulocitopeniis
fonze Cndeba xaxis, piris Rrus wylulovan-nekrozuli cvlilebebi.
459
kerZo nawili.
Cveni klinikis masalis analizis safuZvelze dadginda, rom visceruli leiSmaniozis

letaluri gamosavali, rogorc wesi, ganpirobebuli iyo Tanmxlebi poli-miqst-infeqciebiT
(stafilokokuri sefsisi, Sigelozi, salmonelozi) da meoradi imunodeficitiT. aseT
SemTxveveSi mxolod kompleqsurma mkurnalobam (antimonialuri, paTogenezuriantibiotiki
da imunoTerapa) ganapiroba mZime prognozis Tavidan acileba (a.xoWava, m. xoWava, 1997).
indoeTisa da aRmosavleT afrikis leiSmanioziT daavadebul avadmyofebSi
gamojansaRebis Semdeg zogjer rCeba kanis leiSmanioma, romelic warmoadgens kvanZovan
an laqovan gamonayars, Seicavs leiSmaniebs da amitomac rekonvalescenti SesaZloa
infeqciis wyaro da rezervuari iyos.
simZimis mixedviT arCeven leiSmaniozis msubuq, saSualo da mZime formas. mimdinarebis
xangrZlivobis gaTvaliswinebiT _ mwvave, qvemwvave da qronikuls. pirveli ori mimdinareoba,
ZiriTadad, damaxasiaTebelia mcire asakis bavSvebisaTvis da xasiaTdeba organizmis
zogadi intoqsikaciiT, progresirebadi hepatosplenomegaliiT, anemiiT, zogadi
disrtofiuli movlenebiT da a.S. Tu Tavis droze ar iqna Catarebuli saTanado
etiotropuli da paTogenezuri Terapia, letaluri gamosavali viTardeba 3-5 TveSi.
qronikuli mimdinareoba ki grZeldeba 1,5-3 weli.
mozrdil bavSvebSi gvxvdeba daavadebis waSlili formebi, romelic mimdinareobs
temperaturis momatebis gareSe, RviZli da elenTa umniSvnelodaa gadidebuli, sisxlSi
raime arsebiTi cvlilebebi ar aRiniSneba. garTulebebidan, garda zemoT aRniSnulisa,
iSviaT SemTxvevaSi SesaZlebelia elenTis gaskdoma.
anTroponozuli kanis leiSmaniozi cnobilia sxvadasxva saxelwodebiT,
rogoricaa pirveli ti pis borovskis daavadeba, gvian dawylulebuli variantiT mimdinare,
qalaqis tipis, aSxabadis, aRmosavleTis wylulis saxelwodebiT. daavadeba gavrcelebulia
xmelTaSua zRvis, axlo da Sua aRmosavleTis, indoeTis naxevarkunZulis qalaqebSi.
zoonozuri (udabno-soflis) kanis leiSmaniozi xasiaTdeba ufro mwvave
nekrozirebadi mimdinareobiT, vidre anTroponozuli genezis leiSmaniozi. misi sinonimebia:
meore ti pis borovskis daavadeba, murgabis, pendinis wyluli.
kanis orive formis leiSmaniozis gamomwvevia Leishmania tropica minor-i.
anToponozuli kanis leiSmaniozis dros inkubaciuri periodi meryeobs 2-4
Tvidan 1-2 wlamde, SesaZlebelia 4-5 wlamde.
daavadeba iwyeba kanze avadmyofisaTvis naklebad SesamCnevi 2-3mm zomis papulis,
xorklis gaCeniT, romelic odnav scildeba mis irgvliv Semofarglul janmrTel kans.
papulis feri odnav muqia. xorklis centrSi SeimCneva mcire zomis foso, romelic
amovsebulia mSrali qercliani liqeniT. aRniSnuli pirveladi afeqti TandaTan matulobs
da 3-6 TveSi SeiZleba 5-10 sm-s miaRwios. kani moruxo-mowiTalo fers Rebulobs.
wylulis fuZe sadaa an SeWmuxnuli, wylulis irgvliv aRiniSneba infiltracia.
wyluls aqvs araswori kideebi, gamonadeni umniSvneloa. wylulis Sexorceba mTavrdeba
1-2 weliwadSi nawiburis organizaciiT. nawiburi dasawyisSi vardisferia, Semdeg xdeba
mSrali da bolos atrofiuli.
zoonozuri kanis leiSmaniozis inkubaciuri periodi ganisazRvreba 1 kviridan
1-1,5 Tvemde da saSualod 10-20 dRes Seadgens. pirveladi afeqti _ leiSmanioma
konusis msgavsi formisaa, swrafad diddeba zomaSi da imavdroulad mis irgvliv
infiltrirdebakani. leiSmaniomis danekrozebis Sedegad viTardeba 2-4 mm diametris
mqone wyluli, SeiZleba adgili hqondes erTeul 10-15 sm diametris da mravlobiTi, 2-
4mm diametris wylulebis gaCenas. wylulebi xasiaTdeba uxvi serozul-Cirqovani
gamonadeniT. 2-3 Tvis Semdeg wyluli sufTavdeba da viTardeba misi granulacia.
bolos anTebadi procesi cxreba da mTavrdeba wylulis SexorcebiT.
rogorc anTroponozuli, ise zoonozuri kanis leiSmaniozis dros gvxvdeba daavadebis
460
kerZo nawili.
Semdegi klinikuri formebi: 1) pirveladi leiSmanioma _ a) xorklis stadia; b)

dawylulebis stadia; Gg) Sexorcebis stadia; 2) momdevno leiSmanioma; 3) difuzurad
infiltrirebuli leiSmanioma; 4) kanis tuberkuloiduri leiSmaniozi. ukanaskneli
ori forma xSirad viTardeba anTroponozuli ti pis leiSmaniozis dros. axali
samyaros kanis leiSmaniozebi xasiaTdebian lorwovani garsebis procesSi CaTreviT da
zemoT aRwerili garTulebebiT (kan-lorwovani leiSmaniozi) kanze wylulis ganviTarebis
1-2 wlis Semdeg
diagnostika da diferenciuli diagnozi. visceruli leiSmaniozis diagnostika
eyrdnoba damaxasiaTebel klinikur suraTs, epidemiologiur monacemebs (ukanaskneli 1-
2 wlis ganmavlobaSi endemur kerebSi yofna). saboloo diagnozis dasma xdeba leiSmaniebis
aRmoCeniT pirvel rigSi elenTaSi, Zvlis tvinis punqtatsa da Semdeg RviZlisa da
limfuri kvanZebis biofsirebuli masalis romanovski-gimzas meTodiT SeRebvisa da
misi mikroskopiis Sedegad, kanis leiSmaniozis dros ikvleven dazianebuli adgilis
bioftats. 95-100%-Si naxuloben leiSmaniebs. zogjer ikvleven sisxlsac. leiSmaniebis
kulturis misaRebad awarmoeben Zvlis tvinis punqtatis daTesvas specialur NNN
niadagze (saWiroa 4 kvira), sadac naxuloben promastigotebs. SesaZlebelia, gamoyenebul
iqnas biologiuri sinji oqrosfer zazunebze leiSmaniebis inficirebiT. damxmare
meTodebidan iyeneben serologiur reaqciebs _ komplementis SeboWvis reaqcias,
imunofermerntul analizs, lateqs-aglutinacias, imunofluorescenciis reaqcias da
sxva, magram isini SeiZleba iyos, rogorc cru-uaryofiTi, aseve cru-dadebiTi (rogorc
tri panosomiazis dros). bolo xanebSi cdiloben polimerazuli jaWvuri reaqciis
gamoyenebas. rekonvalescentebSi kanis dadebiTi sinji dgindeba leiSmaninis meSveobiT
(montegros reaqcia). misi arsi mdgomareobs leiSmaniebis mimarT Senelebuli ti pis
zemgrZnobelobis gamovlinebaSi, romelic dadebiTi xdeba mxolod 6-8 kviris Sedegiani
mkurnalobis Semdeg. leiSmaninis miReba SeiZleba msoflios janmrTelobis organizaciis
leiSmaniozis referentuli centridan.
saWiroa visceruli leiSmaniozis diferenciacia sefsisis, leikozis, qronikuli
aqtiuri hepatitis, infeqciuri mononukleozis, malariis, brucelozisa da sxva
infeqciebisagan. mxedvelobaSia misaRebi, rom aseTi mkveTri hepatosplenomegalia da
mis fonze mimdinare progresirebadi anemia da kaxeqsia intermisiuli cxelebiT arcerTi
zemoxsenebuli infeqciebisaTvis damaxasiaTebeli ara aris. diagnozis dasmis gaZnelebisas
gadamwyveti mniSvneloba eniWeba specialur laboratoriul monacemebs.
prognozi visceruli leiSmaniozis dros yovelTvis seriozulia da mkurnalobis
gareSe xSirad mTavrdeba letaluri gamosavliT. Tavis droze Catarebuli etiotropuli
da paTogenezuri mkurnalobis Semdeg ki aRiniSneba sruli gamojanmrTeleba, Tumca
aris monacemebi etiotropuli preparatebisadmi rezistentul leiSmaniebze.
mkurnaloba. etiotropuli saSualebebidan yvelaze efeqturia xuTvalentiani
mkurnaloba
surmis preparatebi _ sodium stibogluconate (pentostam) da meglumine
antimonate (glukantim).
pentostami gamoiyeneba leiSmaniozis yvela formis dros (visceruli, kanis, samxreT
amerikis mukokutaneuri (kan-lorwovani) formebis, recidivebisa da axali samyaros
difuzuri leiSmaniozis dros).
L.aethiopica-Ti gamowveuli kanisa da difuzuri leiSmaniozebis mkurnalobis
dros susti efeqtis miRebisas saWiroa samkurnalo dozebis gadideba.
preparatis moqmedebis meqanizmi naklebadaa Seswavlili, magram dadgenilia, rom
pentostami in vitro aferxebs parazitis dnm-is, agreTve rnm-is, cilis purinuli
glukozidebis trifosfatebis sinTezs. pentostami pacientebs ukeTdebaT venaSi an
kunTebSi, asakis miuxedavad 10-20 mg/kg sxeulis masaze (0,1-0,2 ml), erTjeradad,
461
kerZo nawili. leiSmaniozebi
protozouli infeqciebi. toqsoplazmozi
minimum 15-20 dRe.

mkurnalobidan 2-3 Tvis Semdeg saWiroa rekonvalescentebis gamokvleva daavadebis
SesaZlo recidivebze.
avadmyofebisaTvis, romlebsac aReniSnebaT antimonialuri (surmis) preparatebis
uefeqtoba (rezistentoba), mkurnalobis alternatiul preparatebad iTvleba
amfotericini B, pentamidini, lizosomuri amfotericini. mowodebulia, agreTve,
interferonis kombinacia surmis preparatebTan.
AAamerikis kanis leiSmaniozis mkurnalobisaTvis warmatebiT gamoiyeneba ketokonazoli,
itrakonazoli, alopurinoli, adgilobrivi mowva.
meoradi baqteriuli infeqciisa da zogierT sxva SemTxvevaSi avadmyofebs eniSnebaT
antibiotikebi, saWiroebisamebr utardebaT paTogenezuri Terapia da eniSnebaT
maRalkaloriuli dieta.
profilaqtika. saWiroa avadmyofi adamianis adreuli gamovlena da misi mkurnaloba,
profilaqtika
avadmyof ZaRlebze kontroli. yvela ti pis leiSmaniozis dros tardeba instruqciiT
gaTvaliswinebuli, moskitebTan brZolis RonisZiebebi. repelent-permetriniT sawolis
damuSaveba, moskitebis sawinaaRmdego badis xmareba. tardeba profilaqtikuri acrebi
cocxali leiSmaniebis kulturis SeyvaniT kanis daxurul adgilze. vaqcinis Seyvanis
adgilze viTardeba nawiburi. vaqcina jer-jerobiT farTod ar gamoiyeneba.
toqsoplazmozi
(TOXOPLASMOSIS)
toqsoplazmozi warmoadgens zoo-anTroponozur infeqcias, romlis gamomwvevia

ujredSida paraziti Toxoplasma gondii. arCeven mis SeZenil da Tandayolil formebs,
romlebsac axasiaTebT qronikuli mimdinareoba, nervuli sistemis, ConCxis kunTebis,
miokardiumis, Tvalis, limfuri kvanZebis, RviZlisa da elenTis xSiri dazianeba.
cnobebi:: toqsoplazmozis gamomwvevi pirvelad aRwera
italielma mecnierma a. splendorem, romelmac eqsperimentSi daainficira janmrTeli
cxoveli. TiTqmis erTdroulad, 1908 wels, S. nikolma da l. mansom mRrRnelebis
organizmSi aRmoaCines uZravi erTujrediani paraziti da misces mas saxelwodeba
Toxoplasma gondii(gondii _ TaRi, rkali). 1927 wels Cexma mkvlevarma iankum
toqsoplazma aRmoaCina mkvdari bavSvis TvalSi. amerikelma mecnierma a. sebinma
TanamSromlebTan erTad (1937-1955w.) Seiswavla parazitebis ujredSida ganviTarebis
Taviseburebani da mogvawoda toqsoplazmozis serologiuri diagnostika (komplementis
SeboWvis reaqcia).
etiologia. Toxoplasma gondii miekuTvneba Protozoa-s tips, Sporozoa-s klass,
etio
Coccidia-s rigs, aris ujredSida paraziti (endociti), mravldeba mxolod Tbilsisxliani
cxovelebis cocxal ujredSi, maT Soris, adamianis ujredebSi, upiratesad ConCxis
kunTebSi, miokardiumSi, centralur nervul sistemaSi. mravldeba gaswvrivi dayofiT.
sqesobrivi gziT toqsoplazma mravldeba mxolod katis an katisebrTa ojaxis
warmomadgenelTa wvrili nawlavis epiTelur ujredebSi (saboloo patroni).
Toxoplasma gondii arsebobs sami ZiriTadi formiT _trofozoiti anu taqizoiti
(endociti), cista bradizoitebiT da oocista sporozoiti. trofozoits aqvs
naxevarmTvaris forma, igi kargad iRebeba romanovski-gimzas meTodiT _ citoplazma
cisfrad, birTvi ki wiTel-lalisferSi. toqsoplazmebi moZraoben livliviT. maTi
zoma 4-8X2-4 mkm-ia. taqizoits (trofozoits) SeuZlia ZuZumwovarTa ujredebis
462
kerZo nawili.
invazireba da maTSi gamravleba. parazitis gamravlebis dros iRupeba makroorganizmis

ujredi. es forma mdgradobiT ar gamoirCeva da saTanado pirobebSi swrafad iRupeba.
cistebis formireba xdeba ZuZumwovara cxovelebisa da adamianis (Sualeduri
patroni) sxvadasxva organoebsa da qsovilTa ujredebSi. qsovilovan cistebSi imyofeba
ramodenimedan 10.000-mde bradizoiti. maT iseve, rogorc taqizoitebs, SeuZliaT gamravleba,
magram gacilebiT neli tempiT. gadaylapvis mere cistis kedeli pefsinis an trifsinis
moqmedebiT irRveva, bradizoitebi invazireben saWmlis momnelebeli traqtis lorwovanSi
da Semdeg ganicdian diseminacias mTel sxeulSi, yvela organoSi. cistebi SeiZleba
darCnen moqmedni mTeli sicocxlis manZilze da imunokomprometirebul pirebSi seriozul
daavadebebs iwveven. isini iRupebian –20°C gayinvisas da 60°C-ze gacxelebis dros.
maTi zomebi varirebs. parazitis ujredSida gamravlebisa da dagrovebis Sedegad
warmoiqmneba precista, romelsac garsi ar gaaCnia. precistas gaskdomis Semdeg
toqsoplazmebi Tavisufldeba da invazirdeba janmrTel ujredebSi. precistebi mWidro,
elastiuri garsis SeZenis Semdeg gardaiqmnebian cistebad, romelTa diametri 30-
100mkm-s aRwevs da 3000-dan 15000-mde parazits Seicavs. patronis organizmSi qronikuli
toqsoplazmozis dros cistebi sicocxles inarCuneben aTeulwlobiT, ZiriTadad
lokalizdebian ConCxis kunTebSi, miokardiumsa da centralur nervul sistemaSi.
droTa ganmavlobaSi xdeba cistebis Cakirva an garRveva, am dros gamoTavisuflebuli
trofozoitebi iwveven janmrTeli ujredebis dainficirebas, rasac SeiZleba, mohyves
daavadebis recidivi.
oocitebis Camoyalibeba xdeba saboloo patronis organizmSi (kata, katisebrTa
ojaxis warmomadgenlebi), isini gamoiyofian ganavalTan erTad dainficirebis me-3
dRidan 24 dRemde. eqskrecia grZeldeba 7-20 dRe. katis nawlavebSi maTi povna
SeiZleba ufro pirveladi inficirebis dros, xolo qronikuli infeqciis dros katas
aReniSneb, agreTve, koqcidiebis rigis sxva paraziti _ Isospora. oocistis zoma 10-
12 mkm diametrisaa. igi mdgradia kuWis wvenis mimarT da maT ganadgurebas sWirdeba
TiTqmis duRilis temperatura 5 wuTis ganmavlobaSi. sporozoitebis formaSi gadasvlis
Semdeg maTi invaziuroba izrdeba. oocitebi did rols TamaSoben infeqciis gadacemaSi.
katebis inficireba xdeba inficirebuli xorciT. 2 kviris ganmavlobaSi kata gamohyofs
105-107 oocistas dReSi _ saTanado pirobebSi oocistis sicocxlis xangrZlivoba 1
wels aRwevs. oocista momwifebas ganicdis1-5 dReSi da kata xdeba gadamdebi.
toqsoplazmebis sxvadasxva Stami erTmaneTisagan araerTnairi virulentobiTa da
antigenuri struqturiT gansxvavdeba. zogierTi maTgani (Stami RII) maRalvirulenturia,
zogierTi ki _avirulenturi. mTlianobaSi Toxsoplasma gondii sust paTogenad
iTvleba, Tumca Zlier paTogenobas iCens orsulobis adreul periodSi, rac 40%
SemTxvevaSi gamoixateba gamomwvevi mizezis vertikalur gadacemasa da nayofis Semdgom,
mZime dazianebaSi.
garemoSi toqsoplazmebis gamZleoba damokidebulia parazitis ganviTarebis stadiaze.
vegetaciuri formebi (trofozoitebi) cxovelTa ganavalsa da rZeSi Zleben ramodenime
saaTidan 7-8 dRemde, qaTmis kvercxSi _ 15-20 dRe, konservirebul sisxlSi ki _ 50-60
dRe, swrafad iRupebian 55°C-ze, 5-10 wT-Si _ 50%-ian spirtSi, 1%-fenolSi, 2%-ian
qloraminSi da sxv.
cistebi, gansakuTrebiT ki oocistebi xasiaTdebian Zlieri gamZleobiT xorcSi, +4_
+6°C-ze sicocxles inarCuneben erT Tves, tvinis qsovilSi _ 2 Tves. oocistebi
niadagSi Zleben weliwadze mets.
cistebi da oocistebi mdgradia yvela samkurnalo preparatis (qloridini,
sulfanilamidebi) mimarT. toqsoplazmis kultivireba SeiZleba eqsperimentul
cxovelebSi (TeTri Tagvebi, zRvis goWi, bocveri da sxv.) da qaTmis ganviTarebad
463
kerZo nawili.
embrionSi.
epidemiologia. toqsolazmozi ubikvitaruli zoo-anTroponozuli bunebrivi
keris mqone infeqciaa da warmoadgens yvelaze ufro gavrcelebul latentur infeqcias.
iTvleba, rom msoflioSi inficirebul adamianTa ricxvi aRwevs 500 mln-dan 1 mlrd-
mde; did britaneTSi inficirebulTa ricxvi aRwevs 20-40%-s, aSS-Si _ 50-60%,
safrangeTSi _ 90% (Barkar da sxv. 1992), dsT-s qveynebSi _ mosaxleobis 30%-s.
kata da katisebrTa ojaxis warmomadgenlebi (focxveri, bengaliuri kata, iaguari
da sxva), romelTa ganavalSi gamoiyofa toqsoplazmebis oocisturi forma, ganapirobeben
ramodenime aseuli saxis cxovelisa da frinvelis dainficirebas.
katisebrTa ojaxis garda danarCeni cxovelebi da adamiani iTvleba Sualedur
patronad. adamianis inficireba xdeba, umTavresad, umi xorcis an farSis miRebis
Sedegad, gansakuTrebiT ki Roris, cxvris xorcis arasakmarisi Termuli damuSavebis
dros, SesaZlebelia kontaqturi gziT (katasTan kontaqti) anda, iSviaTad, dazianebuli
kanidan (veterinarebi) inficireba. damtkicebulia sisxlis transfuziisa da, gansakuTrebiT,
organoebis transplantaciis roli daavadebis gavrcelebaSi.
avadmyofi adamiani garemoSi parazitebs ar gamoyofs da araviTar saSiSroebas ar
warmoadgens garSemomyofTaTvis. orsulobis pirvel trimestrSi inficireba 15-20%-
Si iwvevs axalSobilTa toqsoplazmozs, romelic mimdinareobs mZimed, orsulobis III
trimestrSi ki axalSobilTa inficirebis procenti aRwevs 65-s, Tumca zogjer daavadeba
mimdinareobs klinikurad gamoxatuli suraTis gareSe. aseTi gansxvaveba dakavSirebulia
placentaSi sisxlis mimoqcevis momatebiT, parazitis virulentobiTa da misi raodenobrivi
maCvenebliT. Tu qalis inficireba moxda orsulobamde 6 TviT da metiT adre, nayofis
inficireba ar xdeba, vinaidan qals uyalibdeba imuniteti, xolo Tu qalis dainficirebasa
da orsulobas Soris dro ufro naklebia, SesaZlebelia, moxdes nayofis inficirebac,
Tumca riskis procenti dabalia. axalSobilTa daavadebis sixSire 1000 axalSobilze
3-8 SemTxvevas aRwevs.
qalebis qronikuli toqsoplazmozis dros orsulebSi nayofis inficireba Zlier
iSviaTad xdeba, zogierTi avtoris azriT ki gamoricxulia dedis garkveuli imunitetis
gamo.
bavSvTa asaki toqsoplazmozis mimarT gansakuTrebuli mimReblobiT gamoirCeva da
warmoadgens latenturi infeqciis yvelaze ufro gavrcelebul mizezs.
paTogenezi: toqsoplazmozi arsebiTad polisistemur daavadebas warmoadgens.
parazitebis SeWra, Cveulebriv, xdeba kuW-nawlavis traqtidan, Tumca literaturaSi
aRwerilia Sidalaboratoriuli maRali virulentobis mqone toqsoplazmebiT kanidan
inficirebis SemTxvevebic. ar aris gamoricxuli samedicino personalis, umTavresad,
meanginekologebis inficireba qalebis vaginaluri gamokvlevisas an mSobiarobis miRebis
dros, amitom SemTxveviTi ar aris aRniSnul pirebSi toqsoplazmozze sakmaod maRali
serologiuri reaqciebis arseboba. toqsoplazmebi nanaxia sanayofe wylebSi, menstrualur
da vaginalur gamonadenSi (loqiaSi).
parazitebi umTavresad wvrili nawlavebis qvemo nawilSi SeWris Semdeg aRweven
regionul limfur kvanZebs, sadac mravldebian kidec da iwveven anTebad-granulomatozur
cvlilebebs (mezadenitsa da sxv.). aRniSnuli granulomebi Tavisi ujreduli
SemadgenlobiT emsgavsebian tuberkulozur- da brucelozur- infeqciuri genezis
granulomebs. momdevno stadias warmoadgens parazitemia da diseminacia Sinagani
organoebis makrofagur-fagocitur sistemaSi fiqsaciiT. pirvel rigSi ziandeba RviZli,
elenTa, limfuri kvanZebi, centraluri nervuli sistema, ConCxis kunTebi, miokardiumi,
Tvali, filtvebi, agreTve endokrinuli sistema, qalebSi saSvilosno da misi danamatebi.
parazitebis aqtiur gamravlebas Tan sdevs sxvadasxva toqsinebisa da alergenebis
464
kerZo nawili.
gamoyofa, riTac ganpirobebulia organizmis Senelebuli ti pis hi persensibilizacia.

mwvave toqsoplazmozis mimdinareobisas organizmSi didi raodenobiT cirkulireben
endocitebi (trofozoitebi). qvemwvave da qronikuli procesis periodSi ki imunologiuri
reaqciebi TandaTan Zlierdeba, rac ganapirobebs sisxlidan da Sinagani organoebidan
vegetaciuri formis parazitebis gaqrobasa da cisturi formebis warmoSobas. cistebi
gansakuTrebiT didi raodenobiT Tavis tvinsa da kunTebSi grovdeba. danekrozebuli
kerebi rig SemTxvevaSi TandaTan kalcificirdeba (Caikireba), magram cistebi wlobiTa
da aTeulwlobiT inarCuneben sicocxlisunarianobas.
inficirebulTa 99%-Si toqsoplazmozi klinikurad ar vlindeba da mimdinareoba
atarebs latentur, qronikul xasiaTs, Tavidanve viTardeba e.w. pirveladi qronikuli
mimdinareoba, romlis damadasturebelia Senelebuli ti pis hi persensibilizaciisa da
humoruli antisxeulebis reaqciebis dadgena (kanSida alergiuli sinji,
komplementSemboWavi reaqcia da sxv.). aRniSnuli formebisas, dasawyis periodSi
SesaZlebelia, moxdes toqsoplazmebis diseminacia mTels organizmSi. Tu am periods
daemTxva qalis orsuloba, nayofis inficirebis riski mkveTrad izrdeba. am mxriv, didi
mniSvneloba eniWeba iseT interkurentul daavadebebs, rogoricaa gri pi, mwvave
respiraciuli infeqcia, pnevmonia da a.S., romlebic aqveiTeben organizmis damcvelobiT
reaqciebsa da imunuri sistemis aqtiurobas. aRwerilia gamwvavebebis SemTxvevebi mZime
toqsoplazmuri encefalitis ganviTarebiT citostatikebiTa da imunodepresantebiT
mkurnalobis fonze. ukanasknel wlebSi ki mniSvnelovan problemad iqca latenturi
toqsoplazmozis generalizacia aiv-iT inficirebul avadmyofebSi. am ukanasknelTa
Soris daavadeba Rebulobs avTvisebian mimdinareobas lokalizebuli an difuzuri
meningoencefalitis saxiTa da procesSi mTeli rigi organoebis CarTviT.
sayuradReboa is faqti, rom inficirebulebSi mxolod zogjer (1%-mde) aRiniSneba
qronikuli, morecidive mimdinareoba, ufro iSviaTad (0,2-0,5%) _ qronikuli formebis
gamwvaveba procesis mZime mimdinareobiTa da dekompensaciiT.
paTogenezi Tandayolili toqsoplazmozis dros arasakmarisadaa axsnili, magram
dadgenilia, rom toqsoplazmozis vertikaluri gadacema dedidan nayofze mucladyofnis
yvela periodSi xdeba. Tu orsuloba mimdinareobs qronikuli infeqciis saxiT, nayofi
dedisagan transplacenturad Rebulobs IgG klasis antisxeulebs, rac nayofs
daavadebisagan icavs.
mucladyofnisas nayofis inficirebam SeiZleba, gamoiwvios mkvdradSobadoba an
axalSobilis Sinagani organoebis mZime, xSirad sicocxlesTan SeuTavsebeli dazianeba.
rac Seexeba Tandayolili toqsoplazmozis paTmorfologiur suraTs, igi mimdinarobs
Sinagan organoebSi anTebad-granulomatozuri procesis saxiT. granulomebi Sedgebian
epiTeluri ujredebisagan, makrofagebisagan, plazmuri ujredebisagan, limfocitebisa
da eozinofilebisagan. gansakuTrebiT ziandeba centraluri nervuli sistema, Tvalis
badura da qorioiduli garsi. qorioretiniti viTardeba mogvianebiTac, Tu Tandayolili
toqsoplazmozi ar aris namkurnalebi. ukanaskneli lokalizacia SeZenili
toqsoplazmozisaTvis damaxasiaTebeli ar aris . Tavisufali trofozoitebi mxolod
mwvave infeqciis mimdinareobisas gvxvdeba. didi da mcire nekrozuli kerebi da
fibrinuli cvlilebebi aRiniSneba yvela organoSi, ufro xSirad ki kunTebSi, miokardiumSi,
RviZlSi, elenTaSi. Cakiruli kerebi gvxvdeba mxolod Tandayolili formebis dros
Tavis tvinSi, SesaZlebelia, ganviTardes mikrocefaliis suraTi, ependimis dazianeba,
SexorcebiTi procesis ganviTareba hidrocefaliis CamoyalibebiT. bavSvebSi SeZenili
mwvave toqsoplazmozis dros aRiniSneba T supresorebis raodenobis zrda, xolo T
helperebis funqcia qveiTdeba. aseTi suraTi gamoxatulia asimptomur pirebSic. helperebis
populacia daqveiTebulia xSirad limfadenopaTiis drosac, daavadebis dawyebidan 6
465
kerZo nawili.
Tvis merec. Sidsis dros toqsoplazmozs gansakuTrebuli manifestacia axasiaTebs.

klinika. inkubaciis xangrZlivobis zusti dadgena SeuZlebelia, gansakuTrebiT,
daavadebis TandaTanobiT dawyebis, paTognomuri simptomebis ararsebobis SemTxvevaSi,
da e.w. pirveladi qronikuli toqsoplazmozis dros. aseT SemTxvevebSi inficirebidan
klinikur gamovlinebamde inkubaciuri periodi SeiZleba ramdenime Tvesac gagrZeldes.
maRalvirulenturi StamebiT Sidalaboratoriuli inficirebisas inkubaciuri periodi
Seadgens 14 dRes.
organizmis inficirebis meqanizmis gaTvaliswinebiT arCeven SeZenil da Tandayolil
toqsi plazmozs, romlebic SeiZleba, mimdinareobdes msubuqi, saSualo simZimisa da
mZime formebiT da miiRos rogorc mwvave, aseve qronikuli mimdinareoba.
SeZenili toqsoplazmozi iyofa Semdeg klinikur formebad: 1) mwvave; 2) qronikuli;
3) latenturi. es ukanaskneli, Tavis mxriv, atarebs pirvelad qronikul xasiaTs, raime
klinikuri gamovlinebis gareSe da iSviaTad mwvavdeba. am formis diagnostika mxolod
imunologiuri reaqciebis meSveobiT xdeba.
inkubaciuri periodi SeZenili toqsoplazmozis dros 3-dan 21 dRemde grZeldeba,
Tumca SeiZleba, gaxangrZlivdes ramdenime Tvemde, rac damokidebulia organizmis
premorbidul fonze, parazitis virulentobaze, inficirebis masiurobaze. mxolod 0,2-
0,3%-Si iwyeba daavadeba mwvaved, rac vlindeba encefalituri, tifuri an Sereuli
formebis saxiT. mwvave mimdinareobisas zogjer aRiniSneba prodromuli periodi, romelic
saerTo ontoqsikaciis niSnebiT xasiaTdeba _ avadmyofebi uCivian saerTo sisustes,
Tavis tkivils, saxsrebisa da kunTebis tkivils, temperatura aRwevs 38-39°C, zojger
kanze Cndeba laqovan-papuluri gamonayari, romelic Tavis Tmian nawilze, xelis gulebsa
da terfebze ar aRiniSneba. toqsoplazmozisaTvis yvelaze metad damaxasiaTebelia
limfuri kvanZebis generalizebuli gadideba Sinagani organoebis limfuri kvanZebis
CaTvliT (bronquli, mezenteriuli da sxva), gansakuTrebiT ki kisris, iRliisqveSa da
sazardulis midamoSi. limfuri kvanZebi moZravia, dasawyisSi momkvrivo, Semdeg ki
rbili konsistenciis, zomierad mtkivneuli, daCirqeba ar axasiaTebs, adenopaTia ESeiZleba
gagrZeldes erT wlamde da metxans, rac xSirad qmnis siZneleebs diferenciuli
diagnostikis TvalsazrisiT, gansakuTrebiT ki infeqciuri mononukleozis,
limfogranulomatozis dros, vidre ar gakeTdeba serologiuri gamokvlevebi, romelTa
mdgradi uaryofiTi pasuxebiT SesaZlebeli xdeba toqsoplazmuri infeqciis gamoricxva.
daavadebis mwvave periodSi, ukve me-6-7 dRes saxezea hepatolienuri sindromi,
SesaZlebelia ganviTardes miokarditi gamtarebeli sistemis darRveviT, pnevmonia,
encefaliti, meningoencefaliti, encefalomieliti. xSiria sxvadasxva klinikuri
gamovlinebis kombinacia (encefalituri, tifuri suraTis kombinacia). qorioretiniti,
Cveulebriv, calmxrivi procesis xasiaTs atarebs da mxolod 1%-Si gvxvdeba., Tumca
aSS-s monacemebiT am qveyanaSi T. gondii yvela qorioretinitis mizezis 35%-s
warmoadgens.
umravles SemTxvevaSi toqsoplazmozi mTavrdeba spontanuri gamojanmrTelebiT,
magram SesaZlebelia letaluri gamosavalic.
SeZenili qronikuli toqsoplazmozi xSirad mimdinareobs simptomebis gareSe,
subklinikuri formiT, zogjer ki Rebulobs talRisebur mimdinareobas _ gamwvavebisa
da remisiebis monacvleobiT. qronikuli mimdinareobisas SesaZlebelia gamoixatos
saerTo intoqsikaciis simptomebi, rogoricaa saerTo sisuste, uZiloba, swrafi daRla,
avadmyofebi uCivian kunTebisa da saxsrebis tkivils raime garegani cvlilebebis
gareSe. nervuli sistemis mxriv SesaZlebelia, gamoixatos asTeniuri mdgomareoba,
nevrasTeniuri reaqciebi. qronikuli encefalitis mimdinareobisas zogjer aRiniSneba
klonuri da tonuri xasiaTis krunCxvebi, jeksonis tipis epilefsia, mZime diencefaluri
466
kerZo nawili.
paTologia damaxasiaTebelia vegetatiuri nervuli sistemis darRvevebi, rac gamoixateba

akrocianozSi, kanis marmarilosebur aWrelebaSi da sxv. xSir gamovlinebad iTvleba
mxedvelobis progresirebadi daqveiTeba, progresirebadi axlomxedveloba mxedvelobis
nervis atrofiis CaTvliT.
aiv-iT inficirebul avadmyofebSi SeZenili toqsoplazmozi mimdinareobs, rogorc
oportunistuli infeqcia imunodeficitis fonze, romlis drosac viTardeba mwvave
encefaliti letaluri gamosavliT.
imunuri sistemis mkveTri daTrgunva SeiZleba gamoiwvios sxva daavadebebmac, saxeldobr,
limfogranulomatozma, hemolizurma daavadebebma, transplantantis mocilebis aRkveTis
mizniT imunodepresantebis gamoyenebam da a.S. aRniSnuli kategoriis avadmyofebSi
toqsoplazmozi Rebulobs generalizebul mimdinareobas da Tu am dros ar Catarda
saTanado etiotropuli mkurnaloba, daaavadeba swrafad mZimdeba da letaluri gamosavliT
mTavrdeba.
Tandayolili toqsoplaz-mozi iSviaTad gvxvdeba. misi sixSire ar aRemateba 1
SemTxvevas 1000-3500 axalSobilze (aSS-Si 1:1000 an 1:8000). daavadeba SeiZleba,
mimdinareobdes rogorc mwvaved, aseve
qronikuli procesis saxiT.
monozigotur tyupebSi daavadeba
mimdinareobs xSirad msgavsi
simptomatikiT, maSin, rodesac
dizigotur tyupebSi daavadebis
klinika gansxvavdeba da SeiZleba
erTSi mimdinareobdes mZimed, xolo
meoreSi _ subklinikurad.
daavadebis mwvave mimdinareobisas
mkveTradaa gamoxatuli saerTo
intoqsikaciis movlenebi, Tandayolili toqsoplazmozi. meningoencefaliti
temperatura xSirad maRal (ti pur
purii poza). marjvena qvemo kidur is mucladyofnis
kiduris
cifrebamde aRwevs, iSviaTad dros ganviTarebis defeqti (terfis da TiTebis
subfebriluria. kanze viTardeba uxvi deformacia). (sakuTari masala)
centraluri toqsoplaz-
B muri qorioretiniti.
Tandayolili centraluri
toqsoplazmuri
Tandayolili toqsoplaz- makulur da paramakulur qorioretiniti. fskerze
mozi. qoreoretiniti. zonebSi ori msxvili kera. makulur areSi uxeSad
A - mwvave aqtiuri procesi, marjvniv ufro axali, pigmentirebuli kera.
B - Zveli procesi. xolo marcxniv ufro (Å.È. Êîâàëåâñêèé)
(Desmonts G, Zveli, mkafio konturebiT.
Remington J) (Å.È. Êîâàëåâñêèé)
467
kerZo nawili.
laqovan-papuluri an
hemoragiuli xasiaTis
gamonayari. sisxl-
Caqcevebi SeiZleba
iyos sklerebze da
lorwovan garsebSi.
RviZli da elenTa
gadidebulia, xSirad
gamoixateba siyviTle.
damaxasiaTebelia yve-
la jgufis limfuri
Tandayolili
kvanZebis gadideba. toqsoplazmozi da
klinikur suraTSi hidrocefalia.
arc Tu iSviaTia (kompiuteruli
dispefsiuri darR- tomografia)
vevebi, pnevmonia, (Rima Mc LEOD)
miokarditi. Zlier
mZime formebis dros aRiniSneba encefaliti,
meningoencefaliti (Rebineba, krunCxvebi, parezebi
da damblebi, Tavis qalas nervebis dazianeba da
sxv.). Tav-zurgtvinis siTxeSi cilis raodenoba
momatebulia, siTxe qsantoqromulia, citozi
limfocituri xasiaTisaa. qronikuli
toqsoplazmozis progresirebis SemTxvevaSi
daavadeba mTavrdeba letaluri gamosavliT, sxva
SemTxvevaSi procesi gaxangrZlivebuli
mimdinareobis xdeba _ xangrZlivi
subfebriliteti, hepatolie-nuri sindromi,
siyviTle. centraluri nervuli sistemis mxriv
aRiniSneba progresirebadi darRvevebi _
fizikuri da gonebrivi sisuste, metyvelebisa
da motoruli funqciis moSla, kunTTa
hi pertonusi, paTologiuri refleqsebi.
viTardeba hidrocefalia an mikrofTalmia Tandayolili toqsoplazmozi. A-- suraTi
oligofreniiT. mZime Seuqcevadi xasiaTisaa dabadebisas, saSualod dilatirebuli parkuWebi,
patara kalcifikatebi, B-- igive avadmyofi 1 wlis
cvlilebebi Tvalis mxriv _ qorioretiniti,
asakSi antimikrobuli mkurnalobis Semdeg suraTi
mxedvelobis nervis atrofia. iSviaTia smenis TiTqmis normaluria garda 2 patara kalcifikatisa.
daqveiTeba an sruli siyrue. C-- TiTqos janmrTeli dabadebuli bavSvis suraTi
Tandayolili toqsoplazmozi SeiZleba 1 wlis asakSi, sadac ukve Cans gadatanili
mimdinareobdes msubuqi, waSlili an latenturi meningoencefalitis niSnebi (ar iyo
formiT. am dros SesaZlebelia, ganviTardes diagnostirebuli droze) da bavSvi ar mkurnalobda
duned mimdinare encefaliti, rac mogvianebiT, pirveli 3 Tvis manZilze, rodesac ukve gamoixata
6-7 wlis asakSi (swavlis periodSi) bavSvebSi hidrocefalia; Cans rezidualuri atrofia da
iwvevs swraf daRlas, Tavis tkivils, krunCxviT kalcifikatebi; avadmyofs hqonda ganviTarebis
Seferxeba (motoruli da mxedveloba). D-- suraTi
epizodebs, qorioretinitis suraTs. daavadeba
mikrocefaliis dros, mravlobiTi kalcifikatebi.
grZeldeba wlobiT da avadmyofi mihyavs
E-- hidrocefalia aqvaduqturi stenozis gamo. F--
invalidobamde. Tavis qalas rentgenogramaze igive avadmyofi Suntirebis Semdeg. (komp. tomog.)
an kompiuterul tomogramaze am dros SeiZleba (Mc Auleya, Boyer K, Patel D et al)
468
kerZo nawili.
aRiniSnos tvinSi, qalas nakerebze adreuli Cakirva da sxva movlenebi.

diagnostika. qronikuli toqsoplazmozis mimdinareobis dros didi mniSvneloba
aqvs damaxasiaTebeli simptomebis dadgenas(rogoricaa xangrZlivi subfebriliteti,
limfadenopaTia, hepatolienuri sindromi, siyviTle), organoebisa da sistemebis specialur
gamokvlevebs (ekg, Tvalis fskeris gamokvleva, Tavis qalisa da dazianebuli kunTebis
rentgenografia), specifikur serologiur reaqciebs, adre zogjer iyenebdnen kanSida
alergiul sinjs. amave dros gasaTvaliswinebelia, rom janmrTel pirTa 20-30%-Si
aRiniSneba toqsoplazmis dadebiTi serologiuri reaqcia, ris gamoc maTi Sefaseba
unda moxdes mxolod klinikuri simptomebis gaTvaliswinebiT. Sids-iT daavadebul
adamianebSi, romlebsac aReniSnebaT imunodeficituri mdgomareoba. dadebiTi serologiuri
reaqciebi, pirvel rigSi, organizmis inficirebaze laparakobs, daavadebaze ki _ imavdroulad
damaxasiaTebeli simptomebis arseboba.
toqsoplazmozis mwvave mimdinareobis dasadgenad gadamwyveti mniSvneloba aqvs
sisxlis, Tav-zurgtvinis siTxis centrifugatis, limfuri kvanZebis punqtatis an
biofsirebuli anaTlis masalaSi trofozoitebis aRmoCenas. orsulobis Sewyvetis
SemTxvevaSi keTdeba placentis, sanayofe wylebisa da garsebis gamokvleva parazitebze.
serologiuri reaqciebidan iyeneben sebin-feldmanis SeRebvis meTods
mafluorescirebeli antisxeulebis dasadgenad. misi Sedegebi asaxuli unda iqnas
saerTaSoriso standartis mixedviT saerTaSoriso erTeulebSi _ International Units
(IU/ml) _ rac keTdeba standartis kontroliT (msoflio janmrTelobis dacvis
organizaciis mieraa mowodebuli).
ifas meTodiT xdeba mafluorescirebeli IgG-s gansazRvra (igive antisxeulebi,
rac sebinis meTodiT isazRvreba _ titrebis paraleluri cvlilebebia). aseTi
antisxeulebi infeqtis organizmSi moxvedris Semdeg 1-2 kviraSi Cndeba da maRal
titrebs aRwevs 6-8 kviraSi (≥1:1000), Semdeg titri ecema Tveebis an wlebis manZilze
da mTeli sicocxle rCeba dabal doneze (1:4 _1:64). titris gansazRvriT daavadebis
simZimeze ver visaubrebT. SesaZlebelia crudadebiTi da cruuaryofiTi pasuxebic.
aglutinaciis testi (Bio-Merieux, France) iyeneben evropul qveynebSi IgG-s
dasadgenad _ testi advili, zusti da SedarebiT iafia.
ifa-s meTodiT IgG-s -s gansazRvra _ saSualebas gvaZlevs, rom vivaraudoT
mwvave infeqciis arseboba. es antisxeulebi daavadebidan 5 dRis Semdegac Cndeba da
qreba IgG-is titris zrdamde. (titri IgM 1:50 _ 1:1000 dadebiTad iTvleba, igi
ecema 1:10 – 1:20 ramdenime kviraSi an TveSi), Tumca zogjer xdeba am antisxeulebis
xangrZlivi persistencia). Tandayolili infeqciis dros axalSobilTa 25% aReniSeneba
es antisxeulebi.
IgM- ELISA _ ormagi-sendviCis enzimniSandebuli imunosorbentuli analizi ifas
meTodze ufro zusti da mgrZnobiarea. gamoiyeneba IgM dasadgenad. IgM-is 1,7 maCvnebeli
laparakobs mwvave infeqciaze mozrdil bavSvebSi.
IgM imunosorbentuli analizi gamoiyeneba, agreTve, mwvave infeqciis dasadgenad.
maRalmgrZnobiarea IgA- ELISA-s meTodi _ Tandayolili, axalSobilTa da orsulebis
infeqciis diagnostikisaTvis.
IgE- ELISA da IgE imunosorbentuli analizi gamoiyeneba Tandayolili da
mwvave infeqciebis dasadgenad.
arapirdapiri hemaglutinaciis reaqciiT (aphr) antisxeulebis gansazRvra
gansxvavdeba ifa-s meTodisagan. vinaidan aphr-Si gansazRvruli antisxeulebi persistireben
wlebis ganmavlobaSi _ amitom es meTodi ar gamoiyeneba Tandayolil infeqciaze eWvis
mitanis dros da aseve orsulobis dros infeqciaze eWvis mitanisas, vinaidan pasuxi
didi xani SesaZloa uaryofiTi iyos.
469
kerZo nawili.
sainteresoa is faqti, rom antisxeulebis titris formuliT SeiZleba infeqciis

xasiaTze msjeloba:
C =antisxeulebis
antisxeulebis titri organizmis romelime siTxeSi X
antisxeulebis titri SratSi
X gamaglobulinis koncentracia SratSi
gamaglobulinis konc. romelime igive siTxeSi
Tu koeficient C-s mniSvneloba 8 da metia SeiZleba vifiqroT Tvalis infeqciaze;

Tu 4 da metia _ cns-is Tandayolil infeqciaze da Tu 1-ze metia _ cns-is dazianebaze
Sids-is dros.
SesaZlebelia T. gondii-s antigenis dadgena SratSi, amnionur siTxesa da Tav-
zurgtvinis siTxeSi Tandayolil toqsoplazmozis zogierT SemTxvevaSi.
enzimniSandebuli imunofiltraciuli meTodi (antisxeulebis gamokvleva) 85%
SemTxvevaSi saSualebas gvaZlevs, davsvaT Tandayolili infeqciis diagnozi dabadebidan
pirvel dReebSi. bolo xanebSi SesaZlebeli gaxda polimerazuli jaWvuri reaqciis
Catareba parazitis dnm-is amplifikaciis gamoyenebiT.
Western blot analizi saSualebas gvaZlevs, rom dedisa da bavSvis Sratis
antisxeulebis titri SevadaroT da Tandayolili infeqcia davadasturoT an uarvyoT.
aseve gamoiyeneba limfocitebis blastogenezis meTodi T. gondii-s antigenis
dasadgenad Tu sxva meTodebiT miRebuliauaryofiTi pasuxi.
kanSida alergiuli testi mowodebulia organizmis specifikuri alergiuli reaqciis
dasadgenad, magram Tu erTxel maincaa gakeTebuli, igi mTeli sicocxlis manZilze
dadebiTi rCeba, rac mis mniSvnelobas amcirebs. amitom bolo wlebSi igi ar gamoiyeneba.
diferenciuli diagnozi. mwvave toqsoplazmozis dros, roca klinikur
mimdinareobaSi aRiniSneba encefalitis, meningoencefalitis suraTi, etiologiuri
diagnozis dadgenis sakiTxs wyvets organizmis sxvadasxva substratSi trofozoitebis
aRmoCena da serologiuri reaqciebi, pjr-is Sedegebi.
qronikuli an SeZenili toqsoplazmozis diferenciuli diagnozis gatarebisas
gasaTvaliswinebelia infeqciuri mononukleozi, limfogranulomatozi, keTilTvisebiani
limforetikulozi (felinozi), herpesuli infeqcia, revmatizmi, tuberkulozi da sxv.
Tandayolili toqsoplazmozis dros _ wiTura, citomegalia, listeriozi, sifilisi,
Tavis qalasSida travmebi da sxv. am SemTxvevaSi didi mniSvneloba eniWeba saTanado
laboratoriul gamokvlevebs, gansakuTrebiT serologiur reaqciebs, romlebic iZlevian
antisxeulebis an antigenebis dadgenis SesaZleblobas.
toqsoplazmozis mkurnaloba kompleqsur xasiaTs atarebs, rac gulisxmobs
etiotropul, paTogenezur da simptomur mkurnalobas, organizmis imunostimulacias.
mwvave formebi etiotropul Terapias kargad emorCileba, radgan trofozoitebi
mgrZnobiareni arian procistociduri preparatebis mimarT, Tumca ar gamoiricxeba
recidivi.
qronikuli toqsoplazmozis dros, romlis paTogenezSi parazitebis cisturi
formebis rolia wamyvani, etiologiuri mkurnaloba naklebad efeqturi an sruliad
uefeqtoa, rac ganpirobebulia cistebis garsis SeuvalobiT qimiopreparatebis mimarT.
etiologiuri mkurnalobisaTvis mowodebulia parazitociduri preparatebi
_ daraprimi (Daraprimum; syn: Pyrimethamine, cindurini, qloridini)
sulfanilamidur preparatebTan erTad (sulfadimezini, sulfapiridazini,
470
kerZo nawili.
sulfadimetoqsini, trimetoprim-sulfametoqsazoli da sxv.). pirameTaminTan erTad

iniSneba folis mJava (kalciumis leikovorini) Zvlis tvinis supresiis Sesamcireblad.
saWiroa yvela inficirebuli axalSobilis mkurnaloba miuxedavad imisa, aqvs Tu
ara maT infeqciis klinikuri gamovlineba (daavadeba sxva SemTxvevaSi zogjer Tavs
iCens mogvianebiT _ qorioretinitis an encefalitis saxiT). axalSobilebSi mkurnaloba
wyvets infeqciis mwvave mimdinareobas. saWiroa bavSvebis mkurnaloba 1 wlis manZilze.
pirveli 6 Tvis ganmavlobaSi pirimeTamini per os 1-2 mg/kg dReSi 2 dRe, Semdeg 1 mg/
kg dReSi 2 Tve, Semdeg 1 mg/kg dReSi orSabaTs, oTxSabaTs da paraskevs (dedisaTvis
advilad dasamaxsovreblad). amasTan erTad eZlevaT sulfanilamidi mag., sami preparatis
kombinacia 100mg/kg gajerebis doza, Semdeg ki 100mg/kg dReSi 2 miRebaze, folis
mJavasTan erTad (5-10 mg/dRe-RameSi orSabaTs, oTxSabaTs da paraskevs). Semdeg 6 TveSi
preparatebi eZlevaT igive sqemiT an gamoiyeneba alternatiuli preparati spiramy-
cin--i ((50mg/kg-ze 2 jer dReSi). aqtiuri qorioretinitis dros (rqovanas laqis
CaTrevisas) iniSneba prednizoloni 1 mg/kg dRe-RameSi gayofili dozebiT.
limfadenopaTiis, mZime gamovlinebebisa da organoebis dazianebis dros
gamoiyeneba igive preparatebi, magram mkurnalobis xangrZlivoba individualuria. saWiroa,
rom specifikuri simptomebis Caqrobis Semdeg mkurnaloba gagrZeldes 2 kvira mainc (
sul 4-6 kvira saSualod).
mozrdil bavSvebSi aqtiuri qorioretinitis mkurnaloba igive preparatebiT
xdeba daaxloebiT 1 Tvis manZilze. mkurnaloba 60-70%-Si efeqturia. zogjer damatebiT
iniSneba kortikosteroidebi. xandaxan ixmareba fotokoagulacia procesis gaCerebisaTvis.
zogjer saWiroa vitreqtomia da brolis amoReba.
imunokomprometirebulebSi mkurnaloba saWiroa, gagrZeldes sasicocxlo Cvenebis
mixedviT.
mkurnaloba.. Tu maT imunologiuri gamokvlevebi normaSi aqvT,
orsuli qalis mkurnaloba
mkurnaloba ar tardeba. Tu qali dainficirda T. gondii-T orsulobis nebismier
periodSi, daaxloebiT 60%-Si mosalodnelia nayofis dainficirebac. arCevis preparatia
spiramicini da pirimeTamini sulfadiazinTan kombinaciaSi. pirimeTamini teratogenulia,
amitom orsulobis I trimestrSi iniSneba spiramicini: 1mg yovel 8 saaTSi Wamamde.
qronikuli infeqciis dros, orsulebSi imunodeficitis SemTxvevaSi saWiroa mTeli
orsulobis manZilze spiramicinis miReba. Tu amave dros aqvs aiv-infeqcia, saWiroa am
preparatis miReba azidothymydine-Tan erTad.
prognozi Tandayolili toqsoplazmozis dros seriozulia, rasac Sedegis
simZime ganapirobebs. toqsoplazmozi gansakuTrebiT mZimed mimdinareobs SidsiT
daavadebul pirebSi, mwvave imunodeficitis fonze. qronikuli toqsoplazmozis prognozi
ufro keTilsaimedoa, Tumca gasaTvaliswinebelia morecidive mimdinareoba.
profilaqtika gulisxmobs kontaqtis SezRudvas inficirebul katebTan, piradi
higienis dacvas, xorceuli kerZebis saTanado Termul damuSavebas. ar SeiZleba umi
xorcis gasinjva, xmareba, Sinauri katebis kveba umi xorciT. orsul qalebs kategoriulad
ekrZalebaT katebTan kontaqti. (Tu orsuls mainc uwevs aseTi kontaqti, saWiroa am
dros xelTaTmanis tareba, katis eqskrementebis dauyovnebliv ganadgureba _ oocista
1-2 dRes ar aris infeqciozuri). saWiroa, kata ikvebebodes specialuri sakvebiT.
471
kerZo nawili.
protozouli infeqciebi. malaria
malaria
(MALARIA)
malaria warmoadgens protozoul transmisiul daavadebas, romlis gamomwvevis

gadacema adamianze xdeba Anopheles-is gvaris mdedri koRos saSualebiT. klinikurad
mimdinareobs SeteviTi xasiaTis cieb-cxelebiT, progresirebadi anemiiT, RviZlisa da
elenTis gadidebiT, recidivebiT.
mokle istoriuli monacemebi. daavadeba uZvelesi droidan aris cnobili. 1696
wels Jenevelma eqimma mortinma igi calke nozologiur daavadebad gamohyo da daamtkica
samkurnalo mizniT qinaqinis qerqis gamoyeneba. amasTan, unda aRiniSnos, rom aRwerili
saSualeba ufro adrec gamoiyeneboda.
1717 wels lancizim daasabuTa malariisa da Waobiani adgilis urTierTkavSiri
(mala aria italiuri sityvidan niSnavs cud, dampal haers).
1830 wels gamomwvevi paraziti aRwerili iyo frangi eqimis a. laveranis mier,
xolo 1887w. i. meCnikovma miakuTvna protozoas ti ps. amJamad malariis plazmodiums
miakuTvneben erTujredovan mikroorganizmebs,
Protozoa t i p s , Sporozoa k l a s s ,
Haemosporidea razms, Plasmodiidae ojaxs
da Plasmodium gvars.
adamianSi daavadebas iwvevs 4 saxis
plazmodiumi Plasmodium _ 1)PP.vivax
(samdRiani malaria) 2) P. malariae (4 dRiani
malaria) 3) P. falciparum (tropikuli ma-
laria) 4) P. ovale (afrikaSi iwvevs 3
dRianismagvar malarias, ovale-malaria).
romanovski-gimzas meTodiT SeRebili
Plazmodium falciparum 2 preparatebis mikroskopiiT malariul
eriTrocitSi suraTis SuaSi plazmodiumebSi arCeven garss, cisfer
(David J. Wyler, D.H. Hamer) protoplazmas, lalisfer-wiTel birTvs, saWmlis
momnelebel vakuols da ganviTarebis zogierT
stadiaze muq-oqrosfer pigments, romelic hemoglobinis metabolits warmoadgens.
malariis plazmodiumebi Tavis ganviTarebaSi aucileblad gaivlian sqesobriv anu
sporogoniis cikls dedali koRos organizmSi da usqeso anu Sizogoniis cikls _
adamianebSi.
sporogoniis procesSi sisxlis wovis Sedegad moxvedrili sqesobrivi
plazmodiumebidan (gametebi) warmoiSoba invaziuri sporozoitebi (10-50 aTasamde
wyvili gametebidan). es ukanasknelni upiratesad koRos sanerwyve jirkvlebSi grovdebian,
sadac 2-2,5 Tvis ganmavlobaSi rCebian. sporogoniis xangrZlivoba damokidebulia
haeris temperaturaze da 15°C-ze nakleb temperaturaze ar mimdinareobs.
inficirebuli koRo adamianis sisxlis wovis dros nerwyvTan erTad sisxlSi
uSvebs sporozoitebs, romlebic Semdeg xvdebian RviZlis qsovilebSi, sadac usqeso
gamravlebis gziT gardaiqmnebian Sizontebad (egzoeriTrocituli anu qsovilovani
Sizogonia). qsovilovani Sizogonia usimptomod mimdinareobs da xangrZlivobiT Seesabameba
inkubaciur periods. tropikuli da oTxdRiani malariisagan gansxvavebiT, samdRiani da
ovale-malariis dros SesaZlebelia parazitis xangrZlivi (ramdenime Tve an wlebic
ki) yofna RviZlSi dune mdgomareobaSi. cnobilia, rom P.vivax-is `CrdiloeTis”
Stamebis populaciaSi Warbobs daavadebis ganviTareba xangrZlivi inkubaciuri periodis
472
kerZo nawili.
Semdeg, `samxreTis” Stamebis dros ki inkubaciis periodi moklea.

egzoeriTrocituli Sizogoniis procesis dros warmoSobili qsovilovani
merozoitebi aRweven eriTrocitebs da maTSi viTardeba eriTrocituli Sizogonia,
romelic pasuxismgebelia malariis klinikur gamovlinebaze. eriTrocituli Sizogoniis
erTi ciklis xangrZlivoba P. vivax-is, P.ovale-sTvis Seadgens 48 saaTs, P.falciparum-
is _ daaxloebiT 48 saaTs (meryeobs), xolo P.malariae-saTvis _ 72 saaTs.
eriTrocitebis daSlis Sedegad merozoitebi xvdebian plazmaSi. plazmaSi pirogenuli
nivTierebebis _ daSlili eriTrocitebis nawilebis, parazitebis garsis nafleTebis,
mkvdari merozoitebisa da maTi metaboluri produqtebis moxvedraze organizmi pasuxobs
SeteviTi xasiaTis klinikuri suraTiT. eriTrocitebidan gamoTavisuflebuli parazitebi
isev ainficireben axal eriTrocitebs da cikli meordeba ramdenjerme.
eriTrocituli Sizogoniis 3-5 ciklis Semdeg sisxlSi myofi merozoitebidan
warmoiSoba sqesobrivi formebi _ gametocitebi (mdedrobiTi _ makrogamontebi da
mamrobiTi _ mikrogamontebi). gamontebs daavadebis dawyebidan 10-12 dRis Semdeg
SeuZliaT koRos inficireba.
epidemiologia. bunebriv pirobebSi malaria anTroponozuli, transmisiuli
daavadebaa. parazitebis transmisiul gadacemaSi 80-mde anofelesis saxis koRo
monawileobs. (berZn. Anopheles – niSnavs mavnes, saSiSs). maT Soris A. maculipennis,
A. pulcherrimus, A. sacharovi, A. superpictus da sxv.).
infeqciis wyaros warmoadgens adamiani _ parazitmtarebeli, romlis sisxlSic
imyofeba orive sqesis plazmodiumebi _ gametocitebi. koRos kuWSi moxvedris Semdeg
xdeba maTi ganayofiereba da gametebis warmoSoba (sqesobrivi cikli). sqesobrivi
ciklis saboloo formas warmoadgens sporozoitebi, igi koRos hemolimfaSi da Semdeg
sanerwyve jirkvlebSi xvdeba. am momentidan koRo adamianisaTvis infeqciis wyaroa.
parazitmtarebloba farTodaa gavrcelebuli, gansakuTrebiT, bavSvebSi. orsuli qalis
dasnebovnebisas SesaZlebelia nayofze transplacenturad infeqciis gadacema. iSviaT
SemTxvevaSi malaria iatrogenuli daavadebaa, romelic SeiZleba ganpirobebuli iyos
inficirebuli sisxlis gadasxmiT an inficirebuli Spricebisa da instrumentebis
xmarebiT, rodesac sisxlSi adgili aqvs preeriTrocituli formebis moxvedras
(gansakuTrebiT es exeba oTxdRian malarias). am SemTxvevebSi inficirebulT aReniSnebaT
mxolod eriTrocituli Sizogoniis cikli da daavadeba xasiaTdeba mokle inkubaciuri
periodiT.
malariis endemur kerebSi pirTa garkveul raodenobas aReniSneba genetikurad
determinirebuli imuniteti, rac aixsneba maTSi anomaluri hemoglobinis - HbS
(namgliseburi hemoglobini) arsebobiT, romelic malariisadmi miuReblobas ganapirobebs.
aseve miuReblobas uwyobs xels sisxlis jgufis antigenebis Fy a da Fy b ararseboba
(es antigenebi xels uwyoben P. vivax-is eriTrocitebTan mimagrebas) da glukoza-6-
fosfatdehidrogenazas deficiti.
malariis gamomwvevis pirvelad wyaros warmoadgens mdedri koRo anofelesi,
sqesobrivi cikli mxolod maTSi xorcieldeba da yvela saxis plazmodiumisaTvis
erTtipobrivad mimdinareobs mravalricxovani axali sporozoitebis warmoqmniT; amasTan,
haeris temperaturis garkveul sazRvrebSi _ +16-+30°C.
malariisadmi mimRebloba sayovelTaoa yvela asakisaTvis, magram endemur kerebSi,
upiratesad, avaddebian bavSvebi, mozrdil mosaxleobas ki ama Tu im regionSi
registrirebuli Stamebis mimarT gaaCnia imuniteti. Tu deda malariiT avad ar iyo,
maSin adgili aqvs axalSobilis infeqciisadmi mimReblobas (maSinve), pasiuri imunitetis
xangrZlivoba ki 5-8 Tves ar aRemateba, ris Semdegac bavSvi am infeqciisadmi mgrZnobiare
xdeba.
koRodan adamianze parazitis gadacema tropikuli klimatis mqone QqveynebSi mTeli
473
kerZo nawili.
wlis ganmavlobaSi xdeba, zomieri klimatis qveynebSi ki xasiaTdeba gamoxatuli

sezonurobiT gazafxul-Semodgomis periodebSi. malaria ganviTarebad qveynebSi, upiratesad
tropikul afrikaSi, amJamadac sikvdilianobis maRal procents ganapirobebs. yofil
sabWoTa kavSirSi, maT Soris, Cvens respublikaSic 1964 wlidan malaria likvidirebulad
iTvleboda, magram bolo wlebSi aRiniSneba SemTxvevebi azerbaijanis teritoriaze.
arsebobs SemTxvevebis saxiT malariis Semotanis saSiSroeba, rac gvavalebs, ar modundes
yuradReba am infeqciis mimarT.
paTmorfologia. paTogenezis TvalsazrisiT malaria warmoadgens
ciklur process, romelsac midrekileba aqvs morecidive mimdinareobisaken. yvela
paTologiuri cvlileba usqeso ciklis _ Sizogoniis ganviTarebasTan aris dakavSirebuli.
qsovilovani Sizogonia drois mixedviT emTxveva inkubaciur periods eriTrocituli
Sizogoniis dros adgili aqvs klinikurad malariis Setevebis manifestacias, romelic
ganpirobebulia inficirebuli eriTrocitebis daSlis Sedegad merozoitebis, Tavisufali
hemoglobinis, parazitis metabolitebis, eriTrocitebis nafleTebis, pirogenuli
substanciebisa da sxva produqtebis mozRvavebiT sisxlSi. malariuli Setevebis
realizaciisaTvis saWiroa ara marto plazmodiumebis sakmarisi raodenoba, aramed
organizmis sensibilizacia ganmeorebiT antigenur gaRizianebaze, romelic hi perergiuli
reaqciebis ti piT mimdinareobs.
ramodenime saxis plazmodiumiT adamianis inficirebisas malariis klinikuri
gamovlineba mxolod erT-erTi maTganiT ganisazRvreba. ase mag., P. falciparum da P.
vivax erTdrouli inficirebisas dominirebs pirveli maTgani, xolo P. ovale da P.
malariae-Ti erTdrouli inficirebisas _ meore. mxolod dominirebul Stamebze
sakmaod maRali imunitetis ganviTarebis Semdeg Cndeba sxva saxis plazmodiumebiT
ganpirobebuli daavadebis niSnebi.
inficirebuli eriTrocitebis daSlis substanciebi warmoadgens ra organizmisaTvis
ucxo sxeulebs, garda maTi pirogenuli moqmedebisa, iwveven saerTo intoqsikaciasac.
sisxlSi maTi cirkulaciis pasuxad RviZlSi, elenTaSi viTardeba retikulur-
endoTeliuri, limfuri elementebis hiperplazia. adgili aqvs organizmis sensibilizacias.
ganmeorebiT Setevebs Tan axlavs anemiis ganviTareba, periferiuli sisxlZarRvebis
Seviwroeba Semcivnebis dros. aRniSnuli cvlilebebi aZliereben kininebisa da sxva
produqtebis gamomuSavebas, romlebic sabolood iwveven sisxlZarRvTa maRal ganvladobas.
sisxlZarRvebis irgvliv sivrceSi adgili aqvs wylisa da cilebis gaJonvas, sisxlis
webovnebis momatebas da sisxlis dinebis Senelebas. hemolizis procesSi warmoqmnili
Tromboplasturi nivTierebebi ki aZliereben hi perkoagulaciis movlenebs. Tvlian,
rom plazmoidebi warmoqmnian citotoqsikur faqtorebs, romlebic iwveven ujreduli
sunTqvis, fosforilirebis inhibicias. mikrocirkulaciis moSlis Sedegad viTardeba
sisxlis mimoqcevis moSla da Tavis tvinis kvebis darRveva. centraluri nervuli
sistemis mxriv cvlilebebi, ZiriTadad, tropikuli malariis dros aRiniSneba. maRali
parazitemiis dros, romelic damaxasiaTebelia malariisaTvis, viTardeba gamoxatuli
cvlilebebi rogorc adgilobrivi, ise saerTo sisxlis mimoqcevis mxriv. amis gamo
adgili aqvs Tavis tvinis anoqsiasa da SeSupebas, romelic klinikurad vlindeba komiT,
Tirkmelzeda jirkvlebis mwvave ukmarisobiT da sxva. nefrituli sindromi oTxdRiani
malariis dros warmoadgens erT-erT mdgomareobas, dakavSirebuls glomerulebis
bazalur membranaze imunoaqtiuri kompleqsis xsnadi P. malariae-s antigenebis,
imunoglobulin M-is da C3 komplementis arsebobasTan.
mwvave malariuli Setevis dros qsovilovani sunTqvis darRvevis gamo
adenilatciklazas aqtivobasTan dakavSirebiT SeiZleba adgili hqondes enteritis
suraTis gamovlinebasac.
filtvebSi mikrocirkulaciis moSla vlindeba bronqitis simptomebiT, xolo mZime
474
kerZo nawili.
mimdinareobis dros SesaZloa ganviTardes pnevmonia. RviZlSi sisxlis mimoqcevis

moSla xels uwyobs distrofiul-nekrozul movlenebs hepatocitebis mxriv, rac
iwvevs fermentebis _ alaninaminotransferazasa da aspartataminotransferazas donis
momatebas, pigmenturi cvlis moSlas da sxva.
malariisaTvis damaxasiaTebelia bevr organoSi, gansakuTrebiT RviZlSi, elenTaSi,
Zvlis tvinSi muqi pigmentebis dagroveba, rac ganapirobebs maT Sesabamis fers. elenTa
da RviZli mkveTradaa gadidebuli, ganakveTze muqi Sokoladis ferisaa. daavadebis
xangrZlivi mimdinareobisas parenqimul organoebSi viTardeba sklerozuli ubnebi.
klinika. bavSvebSi malariis klinikuri gamovlineba damokidebulia asakze da
organizmis imunur mdgomareobaze.
daavadebis inkubaciur periods gansazRvravs plazmodiebis saxe, ase, mag: samdRiani
malariis P.vivax inkubaciuri periodi 1-dan 3 kviramdea, oTxdRianis _ 3-5 kvira,
xolo tropikuli malariis dros 2 kviras ar aRemateba. amave dros, inkubaciur
periodze gavlenas axdens klimaturi pirobebi. samdRiani malariis dros samxreT
regionebSi inkubaciuri periodi 7-20 dRes Seadgens, maSin, rodesac CrdiloeTisaTvis
6 Tve da metic SeiZleba iyos. mniSvneloba aqvs, agreTve, profilaqtikis mizniT
qinaqinas preparatebis miRebas. araimunur mcire asakis bavSvebSi daavadebis dasawyisi
araspecifikuri zogadi intoqsikaciis movlenebiT gamoixateba. maT miekuTvneba _
bavSvis zogadi agzneba, anoreqsia, Zilad mivardna an uZiloba. sxeulis temperatura
SeiZleba normis farglebSi iyos an TandaTan moimatos 1-2 dRis ganmavlobaSi. zogjer
daavadeba iwyeba uecrad, temperaturis momatebiT 40°C da metad, SemcivnebiT an mis
gareSe. Semdeg temperatura ecema normamde an normis qveviT, rasac axlavs profuzuli
oflianoba. Cvil bavSvebSi adgili aqvs cieb-cxelebis Setevis ati purobas. Semcivnebebi
gamoxatulia sustad. kani fermkrTalia, xdeba cianozuri, Setevis Semdeg uxvi oflianoba
ar aRiniSneba. apireqsiuli periodebi aSkarad gamoxatuli ar aris. sxeulis temperatura
SeiZleba iyos momatebuli, RviZli da elenTa gadidebuli. mZime SemTxvevebSi aRiniSneba
meningoencefalitis simptomebi _ Rebineba, krunCxvebi; gamoxatuli nawlavTa disfunqcia,
infeqciur-toqsikuri Sokis simptomebi.
cieb-cxelebiTi paroqsizmebi SeiZleba sul ar iyos (1 wlamde asakis bavSvebSi),
iyos xanmokle an 2-12 saaTi gagrZeldes. 3 wlamde asakis bavSvebSi Setevebi
araintensiurad, waSlilad mimdinareobs. temperatura meryeobs maRali ricxvebidan
subfebriluramde, SemdgomSi oflianoba ar aris damaxasiaTebeli. avadmyofebi uCivian
Tavis tkivils, gulisrevas, umadobas, Rebinebas, sxeulSi damtvreulobis SegrZnebas,
gansakuTrebiT welis midamoSi, yuradRebas amaxvileben muclis tkivilze, romelic
elenTis swraf gadidebasTan (ikavebs mTeli muclis Rrus) aris dakavSirebuli.
xSiria diarea dehidrataciiT. sam- da oTxdRiani malariis plazmodiumebis erTi
generaciiT ganpirobebuli daavadebis dros paroqsizmebi xasiaTdeba 48-72 saaTis
intervalebiT Sesabamisad.
3 wlis asakis zemoT _ yvela formis malariisaTvis damaxasiTebelia SeteviTi
xasiaTis cieb-cxeleba, romelic pirvel xanebSi araswori temperaturuli mrudiTaa
warmodgenili _ ìnicialuri cieb-cxeleba”. Seteva 3 fazisagan Sedgeba: 1) Semcivneba,
romelic 1-2 saaTs grZeldeba, 2) temperaturuli reaqcia 6-8 saaTis xangrZlivobiT
da 3) oflianoba. amrigad, Setevis xangrZlivoba 1-2 saaTidan 12-14 saaTs Seadgens.
daavadebis gamovlinebis pikze avadmyofis saxe hi peremiulia, sklerebi inicirebuli,
arteriuli wneva _ daqveiTebuli. ena mSrali, sqeli nadebiT. RviZli da elenTa
gadidebulia daavadebis pirveli kviris bolos _ meore kviris dasawyisSi. TiTqmis
yvela avadmyofs aReniSneba muclis zomieri Seberiloba, defekaciis gaxSireba Txeli
ganavliT. tuCebze da cxviris nestoebze xSiria herpesuli gamonayari. paroqsizmebis
gaxSirebasTan erTad vlindeba kanisa da sklerebis subiqteruloba. Tu pirveli
475
kerZo nawili.
paroqsizmebis CamTavrebis Semdeg zogadi mdgomareoba damakmayofilebeli iyo, Setevis

gaxSirebis Semdeg apireqsiuli periodi xasiaTdeba avadmyofis saerTo sisustiT, Tavis
tkivilebiT, mialgiiT, arTralgiiT. saxe xSirad miwisferia, siyviTle ufro metad
gamoxatulia kansa da sklerebze. periferiul sisxlSi dgindeba anemia, eriTrocitebis
poikiloanizocitozi, leikopenia, neitrofilozi marcxniv gadaxriT, momatebuli eds.
avadmyofebi kargaven sxeulis masas.
daavadeba gansakuTrebiT mZimed mimdinareobs avadmyofebSi, romelTac aReniSnebaT
masis deficiti, eqsikozi, sxvadasxva Tanmxlebi daavadebebi (muclis tifi, virusuli
hepatiti, amebiazi da sxva).
garda aRniSnuli saerTo movlenebisa, yvela formis malariis dros calkeul
nozologiur erTeulebs gaaCniaT, agreTve, Taviseburebani. samdRiani malaria (epidemiuri
kerebi aRiniSneba azerbaijanSi, tajikeTSi). Cveulebriv, xangrZlivad, magram
keTilTvisebianad mimdinareobs. inkubaciuri periodi SeiZleba iyos mokle _ 10-21
dRe da xangrZlivi _ 6-14 Tve. umravles SemTxvevaSi ti pur Setevebs win uZRvis
temperaturis 2-3-dRiani momateba 38-39°C-mde, araswori temperaturuli mrudi, SemdegSi
ki paroqsizmebi mkafiod Semoifargleba Tanabari intervalebiT da ufro xSirad dRis
erTsa da imave dros iwyeba (11-15 saaTebs Soris dRisiT). Setevebs Soris Sualedi _
apireqsiuli periodi grZledeba 40-43 saaTamde.
aranamkurnaleb avadmyofebSi daavadebis bunebrivi mimdinareobisas Setevebi grZeldeba
4-5 kvira. adreuli recidivebi viTardeba, Cveulebriv, ‘inicialuri cxelebis” dawyebidan
6-8 kviris Semdeg, paroqsizmuli talRebis Tanabari intervalebis SenacvlebiT. aRsaniSnavia,
rom am dros prodromuli movlenebi ar aris damaxasiaTebeli.
saerTod, samdRiani malaria keTilgamosavliani mimdianreobiT xasiaTdeba. recidivebs
adgili SeiZleba hqondes 3-6-14 Tvis Semdegac, zogjer ki 3-4 wlis intervalis
Semdeg. garTulebebi iSviaTia, magram avadmyofebSi, romelTac aqvT sxeulis masis
deficiti, organizmis `gadaxureba” eqsikozis ganviTarebiT, mosalodnelia endotoqsiuri
Soki. sxva infeqciasTan Serwymis dros daavadeba SeiZleba damTavrdes sikvdiliT.
oTxdRiani malariis P.malariae inkubaciuri periodi 21-40 dRes Seadgens.
sxva formis malariisagan gansxvavebiT paraziti organizmSi SeiZleba imyofebodes
daavadebis gadatanis Semdeg didi xnis ganmavlobaSi (aTeuli wlebiT). prodromi
paroqsizmis win iSviaTad gvxvdeba, xolo Tu eqna adgili, ar gansxvavdeba samdRiani
malariis prodromisagan. damaxasiaTebelia cieb-cxelebis ti puri paroqsizmi 13 saaTis
ganmavlobaSi, SemdgomSi maTi Tanabari SenacvlebiT yovel meoTxe dRes. anemia naklebad
intensiuria, vidre sxva formebis dros, rac parazitemiis dabali doniTaa ganpirobebuli.
bunebrivi mimdinareobisas daavadebis xangrZlivoba TveobiT grZeldeba manam, sanam ar
daiwyeba spontanuri gamojanmrTeleba. ufro xSirad, vidre sxva formis malariis
dros inficirebas SesaZlebelia adgili hqondes hemotransfuziis Sedegad.
posttransfuziuli infeqciis mizezi ki imaSi mdgomareobs, rom daavadebis gadatanis
Semdeg P. malariae rCeba sisxlSi umniSvnelo raodenobiT, rac aZnelebs mis aRmoCenas
mikroskopiis dros, xolo aseTi donoris sisxli saSiSroebas warmoadgens sxvaTaTvis.
bunebrivi inficirebisas inkubaciuri periodi 29-43 dRes Seadgens maSin, rodesac
hemotransfuziis dros 6 dRidan ramodenime Tves moicavs (Sizonturi infeqcia),
rogorc wesi ar axasiaTebs prodromuli periodi, xolo Tuki aRiniSna, samdRiani
malariiis prodromis msgavsia.
ovale-malaria (P.ovale) endemuri daavadebaa da gvxvdeba dasavleT afrikis
qveynebSi. Cvens qveyanaSi SeiZleba iyos mxolod Semotanili SemTxvevebis saxiT.
inkubaciuri periodi 11-16 dRes Seadgens. xasiaTdeba keTilTvisebiani mimdinareobiT
da xSirad spontanuri gamojanmrTelebiT. klinika samdRiani (P. vivax) malariis
msgavsia. paroqsizmul Setevebs adgili aqvs saRamosa da Ramis saaTebSi. daavadebis
476
kerZo nawili.
xangrZlivoba 2 welia, magram SeiZleba aRiniSnos recidivebi 3-4 wlis Semdegac.

tropikuli malaria (P.falciparum) _ temperaturis mrudis mixedviT daaxloebiT
3- an 4-dRiani malariis msgavsia. aqvs sustad gamoxatuli sinqronizacia da Setevebi
meordeba 48 saaTze ufro xSiradac. yvelaze mZime daavadebaa da ufro gavrcelebulia
msoflioSi, araimunur pirebSi maRal letalobas ganapirobebs, gansakuTrebiT, bavSvebSi.
inkubaciuri periodi 8-16 dRes Seadgens. araimunur pirebSi daavadeba xSirad avTvisebianad
mimdinareobs da specifikuri mkurnalobis gareSe pirvelsave dReebSi SeiZleba
letalurad damTavrdes. zogierT avadmyofs aReniSneba prodromuli periodi _ saerTo
sisuste, oflianoba, Tavis tkivili, arTralgia, mialgia, madis daqveiTeba, faRaraTi, or-
samdRiani temperaturis momateba 38-39°C-mde. araimunur avadmyofTa umetesobas daavadeba
ewyeba uecrad, zomieri SemcivnebiT, maRali temperaturiT, agznebiT. pirveli 3-8 dRe
temperatura mudmivi xasiaTisaa, Semdeg Rebulobs mdgrad, mudmiv, SenacvlebiT saxes.
daavadebis gamovlinebis umaRles mwvervalze cieb-cxelebis Setevas Taviseburi
mimdinareoba aqvs, saxeldobr, mkveTri perioduloba ar axasiaTebs. Seteva SeiZleba
daiwyos dRe-Ramis nebismier dros, magram ufro metad dRis meore naxevarSi.
temperaturuli reaqcia 30 sT-mde grZeldeba, apireqsiis periodi ki xSirad moklea
(dRe-Rameze naklebi).
gul-sisxlZarRvTa sistemis mxriv viTardeba taqikardia, arteriuli wnevis
mniSvnelovani daqveiTeba. sasunTqi sistemis mxriv _ mSrali xvela, filtvebSi moismineba
mSrali da sveli xixini. SesaZlebelia, ganviTardes bronqopnevmonia. xSirad viTardeba
toqsikuri hepatiti. 1/4 SemTxvevebSi avadmyofebs uviTardebaT nefrozo-nefriti.
periferiul sisxlSi dgindeba anemia, leikopenia, neitropenia, SedarebiTi limfocitozi
marcxniv gadaxriT, retikulocitozi, eds momatebulia. daavadebis pirvelsave dReebSi
eriTrocitebSi aRniSnaven beWdisebri formis plazmodiebs.
Tandayolili malaria viTardeba mucladyofnis dros transplacenturad.
orsulobis I naxevarSi SesaZloa ganviTardes spontanuri aborti. Tu inficireba
moxda II naxevarSi, nayofi ibadeba dRenakli, susti, anemiuri, hi potrofuli. daavadeba
vlindeba mousvenrobiT, cianoziT, tonur-klonuri krunCxvebiT, temperatura ar aris
momatebuli. gamoxatulia hepatolienuri sindromi.
mSobiarobis dros nayofis dasnebovnebisas daavadeba iwyeba inkubaciuri periodis
Semdeg da klinikuri gamovlinebani igivea, rac 1 wlamde asakis bavSvebSi.
recidivebi. P. vivax-s da P.ovale-Ti gamowveul malarias axasiaTebs recidivebi
(zogjer merozoitebi ainvazireben sxva hepatocitebs da iwyeba meoradi
egzoeriTrocituli cikli). P.vivax-iT gamowveuli recidivi SesaZloa ganviTardes
5 wlis Semdeg. zogjer RviZlismieri cikli mkurnalobas ar eqvemdebareba da saWiroa
8-aminoqinolinis jgufis preparatebis gamoyeneba. P.malarie-s recidivebi gvxvdeba
40 wlis Semdegac. P. falciparum-iT da P.malarie-Ti gamowveuli recidivi aixsneba
eriTrocitebSi latenturi infeqciis aqtivaciiT.
garTulebebi. did saSiSroebas iwvevs malariis avTvisebiani mimdinareoba: cerebruli
forma (malariuli koma), infeqciur-toqsikuri Soki ( malariuli algidi ) da
hemoglobinuri cxeleba.
cerebruli forma (malariuli koma), Cveulebriv, viTardeba tropikuli malariis
dros, upiratesad 5-12 wlis bavSvebSi, xSirad viTardeba daavadebis dawyebidan pirvel
24-43 saaTSi, rasac safuZvlad udevs cerebruli hemodinamikis darRveva inficirebuli
SizontebiT kapilarebis daTrombvis gamo. klinikur suraTSi am dros aRiniSneba
gonebis dakargva, meningealuri movlenebi, hi perkinezebi, klonur-tonuri xasiaTis
krunCxvebi. komis dros jer qreba ylapvis refleqsi, mogvianebiT rqovanasa da gugebis
refleqsebi. adekvaturi mkurnalobis Cautareblobis SemTxvevaSi gardauvalia letaluri
gamosavali.
477
kerZo nawili.
malariuli algidi warmoadgens tropikuli malariis iSviaT garTulebas.

damaxasiaTebelia kolaftoiduri mdgomareoba, romelic gadadis prostraciaSi. am
dros kani nacrisferia, civi ofliT dacvaruli, saxis nakvTebi wawvetebulia, Tvalebi
Cavardnili, irgvliv Calurjebuli, sxeulis temperatura daqveiTebulia, arteriuli
wneva mkveTrad ecema, sunTqva xdeba zerele, gaxSirebuli, Sardva Semcirebulia, myesTa
refleqsebi ar iwveva. damaxasiaTebelia faRaraTi, dehidratacia.
Tirkmlebis mwvave ukmarisoba viTareba qinaqinas an primaqinis miRebis Semdeg
masiuri sisxlZarRvSida eriTrocitebis hemolizis Sedegad. mas SeiZleba sxva
preparatebmac Seuwyos xeli (delagili, sulfanilamidebi). garTuleba viTardeba uecrad
da vlindeba Zlieri SemcivnebiT, hi perTermiiT (40°C-mde da meti), saxsrebis, kunTebis
tkiviliT, Rebineba Savi naRveliT. ZiriTadi simptomia Savi Sardis gamoyofa, rac
ganpirobebulia axalgamoyofil SardSi oqsihemoglobinis da dayovnebul SardSi
methemoglobinis arsebobiT. Sardis dayovnebisas xdeba misi or fenad gayofa _ pirvel,
zemo fenas aqvs gamWvirvale Sav-wiTeli feri, qveda fenas ki Savi feri, mRvriea da
Seicavs detrits. Sardis naleqis mikroskopiiT aRiniSneba amorfuli hemoglobinis
beltebi, Secvlili da Seucvleli eriTrocitebi. sisxlis Srati Rebulobs moSavo-
mowiTalo fers, aRiniSneba Tavisufali bilirubinis, kreatininis, Sardovanas maCveneblebis
momateba.
tvinis SeSupeba. e.w. avTvisebiani, elviseburi forma uwin gvxvdeboda samdRiani
malariis dros skolamdeli asakis bavSvebSi. erT-erTi cieb-cxelebis Setevis dros
viTardeba Tavis Zlieri tkivili, krunCxvebi, gonebis dakargva, piridan qafiani gamonadeni
daSeteva mTavrdeba letalurad. aRniSnuli suraTi ganpirobebulia Tavis tvinis
mwvave SeSupebiT.
diagnozi. diagnozis dadgena eyrdnoba klinikur-epidemiologiur da laboratoriul
monacemebs. ti puri paroqsizmis dros, romlis fonze aRiniSneba RviZlisa da elenTis
kanonzomieri gadideba, diagnozis dasma ar warmoadgens raime siZneles. siZneleebi
iqmneba, gansakuTrebiT, Cvil bavSvebSi, rodesac davadebis pirvel dReebSi cieb-cxelebis
Setevebi mkveTrad gamoxatuli ar aris. am SemTxvevaSi didi mniSvneloba eniWeba
endemuri kerebis arsebobas. daskvniTi diagnozi eyrdnoba laboratoriul monacemebs,
pirvel rigSi ki romanovski- gimzas meTodiT SeRebili sisxlis sqeli wveTis gamokvlevas.
mikroskopiiT SesaZlebelia didi raodenobiT malariis plazmodiumebis aRmoCena. sisxlis
nacxis saSualebiT ki advilad xdeba plazmodiumebis saxeobebis diferenciacia.
erTjeradi uaryofiTi pasuxi ar gamoricxavs malariis diagnozs, saWiroa, gamokvleva
ganmeordes yovel 8-12 saaTSi, 3 dReE zedized. didi mniSvneloba aqvs periferiuli
sisxlis parazitologiuri gamokvlevis ricxobriv da xarisxobriv daxasiaTebas;
intensiuri parazitemia ( 10 da meti parazitis dadgena erT mxedvelobis areSi an 100
X 109 plazmodiumis _ erT litr sisxlSi an 5% eriTrocitebis inficireba) an P.
falciparum-is Sualeduri stadiis aRmoCena, rogorc wesi, mowmobs arakeTilsaimedo
mimdinareobaze, komuri an tropikuli malariis avTvisebian formaze.
zogjer fagocitirebul parazits da mis pigments naxuloben leikocitebSi an
monocitebSi. gimza-s saRebavi saWiroa gamoviyenoT 1:25 wylis ganzavebiT pH 7,0-7,2,
aseve raitis meTodiT: saRebavi 0,75 fxvnilis saxiT + 65 ml methylalcohol + 35ml
gawmendili glicerini (saWiroa 2 dRis ganmavlobaSi xsnaris ganmeorebiTi xSiri
SenjRreva).
serologiuri diagnostikisaTvis gamoiyeneba radioimunofermentuli reaqcia,
arapirdapiri hemaglutinaciis reaqcia, enzimniSandebuli antisxeulebis reaqcia. unda
aRiniSnos, rom serologiuri gamokvlevebi didad informaciuli ar aris da gamoiyeneba
ufro epidemiologiuri kvlevebis dros.
perspeqtiulad isaxeba axali diagnostikuri testebi _ (polimerazuli jaWvuri
478
kerZo nawili.
reaqcia) dnm-is da ribosomuli rnm-is gamokvleviT.

skrining-testad gamoiyeneba raodenobrivi analizi _ quantitive buffy coat analysis
(QBC), magram igi unda dadasturdes parazitis naxviT periferiul sisxlSi.
diferenciuli diagnozis gatarebisas mxedvelobaSi unda miviRoT iseTi daavadebebi,
rogoricaa brucelozi, hemolizuri siyviTle, sefsisi, tuberkulozi, SebrunebiTi tifi
da sxva.
mkurnaloba. malariiT daavadebuli eqvemdebareba aucilebel hospitalizacias
stacionarSi, sadac tardeba radikaluri etiotropuli, paTogenezuri da simptomuri
Terapia.
qimioTerapia parazitis sawinaaRmdego preparatebiT iTvaliswinebs: 1) daavadebis
mwvave gamovlinebis (paroqsizmebis) kupirebas 2) recidivebis Tavidan acilebas da 3)
plazmodiumebis sqesobrivi formebis mospobas, rac ganapirobebs koRos meSveobiT
infeqciis gadacemis SesaZleblobis aRkveTas.
parazitis sawinaaRmdego preparatebi iniSneba dauyovnebliv, malariis mZime formebis
dros da malariaze saeWvo SemTxvevebSic (klinikur-epidemiologiuri monacemebis
safuZvelze) mosalodneli infeqciur-toqsikuri Sokis Tavidan acilebis mizniT.
mkurnalobaSi gamoiyeneba eriTrocitul Sizontebze moqmedi preparatebi, rogoricaa
qloridini, delagili, qingamini da sxva, aseve qsovilovan Sizontebze moqmedi _ primaqini,
qlorocidi. es ukanasknelni moqmedeben plazmodiumis yvela sqesobriv formaze
(gamontebze).
malariis mkurnalobis sqemebi mocemulia cxrilSi.
∗ saWiroa ekg-s da wnevis kontroli.
preparati mozrdilis doza pediatriuli doza

yvela plazmodiumi eqvemdebareba garda, qloroqinrezistentuli Pl. falciparum- isa
peroraluri arCevis
preparati
10mg fuZisa kg-ze (maqsimum
600 mg fuZisa), 6 saaTis
600 mg fuZis (1gr), 6 sT-is Semdeg
qingamini (qloroqinis Semdeg 5mg fuZisa kg-ze
300mg fuZisa (500mg) 24 da Semdeg
fosfati anu delagili) (maqsimum 300 mg fuZisa) da
48 saaTSi
5mg fuZisa kg-ze dReSi 24
da 48 saaTis intervalebiT.
arCevis parenteruli
preparati
10 mg/kg gajerebis doza
intravenurad (maqsimum 600mg) 1-2
saaTis ganmavlobaSi, Semdeg 0,02
qinidinis glukonati * igive, rac mozrdilebSi
mg/kg wuTSi, xangrZlivi infuzia,
sanam ar daiwyeba peroraluri
mkurnaloba.
600mg ganzavebuli 300ml
30 mg/kg-ze dReSi; dRiuri
fiziologiur xsnarSi, venaSi
dozis 1/3 esxmeba 2-4 saaTis
gadasasxmelad 2-4 saaTis
an qininis ganmavlobaSi; ganmeordes
ganmavlobaSi. aseTi doziT gameoreba
dihidroqloridi yovel 8 saaTSi, sanam ar
yovel 8 saaTSi (maqsimum 1800mg
daiwyeba oraluri Terapia
dReSi) sanam ar daiwyeba
(maqsimum 1800mg dReSi).
peroraluri Terapia.
479
kerZo nawili.
qloroqinrezistentuli P. falciparum-is sawinaaRmdego mkurnaloba
arCevis peroraluri preparati
659mg 3-jer dReSi 3-7

qininis sulfati 30 mg/kg dReSi sam miRebaze, 3-7 dRe
dRis ganmavlobaSi
5 mg/kg dReSi 4-jer 7 dRis ganmavlobaSi
plus tetraciklini 250mg 4-jer dReSi 7 dRe
(maqsimum 250 mg 4-jer dReSi
alternatiuli mkurnaloba rezistentuli Pl. falciparum-is dros
peroraluri:
650mg 3-jer dReSi 3-7 30 mg/kg dReSi sam miRebaze

qininis sulfati
dRis ganmavlobaSi 3 dRis ganmavlobaSi
parenteruli preparati
qinidinis glukonati igive, rogorc zemoT igive, rogorc zemoT
an
qininis dihidroqloridi igive, rogorc zemoT igive, rogorc zemoT
plus
wlamde asakSi erTjeradi
erTjerad miRebaze 3 dozaa 1/4 tableti; 1-dan 3
tableti qininiT wlamde asakSi tabletis
pirimeTamin sulfadioqsini
mkurnalobis bolo dRes (an 1/2; 4-dan 8 wlamde 1
(fanzidari)
7,5ml kunTebSi tableti; 9-14 wlamde 2
erTjeradad) tableti; 14 wlis zemoT 3
tableti
an xsnaris saxiT 5-10kg masaze _ 1-1,5ml
11-20kg-ze _ 2,5ml
21-30kg-ze _ 3,5ml
31-45kg-ze _ 5ml
erTjeradi doza 15-25mg/kg 15-25 mg/kg erTjeradad
mefloqsinhidroqloridi
(maqsimum 1250mg) maqsimum 1250mg.
P. vivax da P. ovale-Ti gamowveuli recidivebis profilaqtika
15mg fuZisa (26,3mg)

0,3mg fuZisa/kg dReSi 14
primaqinfosfati 14 dRe an 45mg fuZisa
dRe (maqsimum 26,3mg) dReSi
(79mg)/kviraSi 8 kvira.
grZeldeba rkinis xelatonis (iron chelaton) gamoyenebaze klinikuri gamokvlevebi,

magram farTo xmarebisaTvis es preparati jer ar aris rekomendebuli.
delagili orsulobaze da nayofis ganviTarebaze toqsikur moqmedebas ar axdens.
primaqiniT mkurnalobis dros SeiZleba ganviTardes dispefsiuri movlenebi, hemoglobinuri
480
kerZo nawili.
cieb-cxeleba.
paTogenezuri TerapiisaTvis gamoiyeneba sisxlis SenacvlebiTi transfuzia,
eleqtrolitebi, glukoza, albumini, imunoglobulini, rkinis preparatebi, B jgufis
vitaminebi, saWiroebisamebr keTdeba dializi.
prognozi. droulad Catarebuli mkurnalobis umravles SemTxvevaSi malaria
keTili mimdinareobiT, swrafi da sruli gamojanmrTelebiT xasiaTdeba. letaloba 1%-
s Seadgens, ZiriTadad, tropikuli malariis avTvisebiani mimdianreobis dros. bavSvebSi
letaloba ufro maRalia (5%-mde).
malariagadatanili pirebi stacionaridan saxlSi ewerebian mkurnalobis kursis
Catarebisa da klinikuri gamojanmrTelebis Semdeg, sisxlis nacxis SeRebvis uaryofiTi
pasuxis, sisxlisa da Sardis saerTo analizebis normalizebis Semdeg.
temperaturis momatebis yvela SemTxvevaSi rekonvalecentebs utardebaT sisxlis
sqeli wveTis gamokvleva malariis plazmodiumze (1,5-2,5 wlis ganmavlobaSi).
profilaqtika iTvaliswinebs RonisZiebebis ganxorcielebas, romelic mimarTulia
epidemiuri procesis ZiriTadi rgolebisaken: 1) malariiT daavadebulebis, parazitis
mtareblebis aqtiuri drouli gamovlineba da maTi mkurnaloba. 2) anofelesis gvaris
koRoebis mospoba da 3) mosaxleobis malariisadmi mimReblobis daqveiTeba. ukanasknelis
mizniT endemur kerebSi gamgzavrebis win bavSvebs wasvlamde 2 kviriT adre da keridan
gamosvlis Semdeg 8 kviris ganmavlobaSi saWiroa, Cautardes malariis qimioprofilaqtika.
qimioprofilaqtikis mizniT gamoiyeneba qlorguanidini (proguanili) 2 wlamde
asakis bavSvebSi 50mg; 2-6 wlamde _ 100mg; 6 wlis zemoT _ 200mg dReSi. preparati
cota mware gemosia. naklebad mwarea, magram ufro toqsikuria pirimeTamini, romelic
2 wlamde bavSvebSi miiReba 1-jer kviraSi _ 6,25mg; 2-6 wlamde 12,5mg; xolo ufro
mozrdilebSi _ 25mg kviraSi.
qloroqini 1 wlamde asakSi miiReba kviraSi erTxel, fuZis 37,5mg, 1-2 wlamde _
fuZis 75mg; 2-6 wlamde _ fuZis 112,5mg; 6-12 wlamde _ fuZis 150mg da ufro zemo
asakSi _ fuZis 300mg kviraSi 1-jer. preparatis mware gemo SeiZleba SevamciroT
jemiT an sqel sirofSi ganzavebiT, Tumca maTi Senaxvis vada moklea.
unda aRiniSnos, rom P. falciparum–is da qlorguanidinisadmi rezistentoba
farTodaa gavrcelebuli, amitom qloroqini iTvleba profilaqtikis saukeTeso
preparatad. amerikaSi ki am preparatisadmic aRiniSneba rezistentoba. amitom
qlorguanidinis dapsonTan (dapson) erTad yoveldRiuri an pirimeTanis dapsonTan
erTad yovelkvireuli gamoyenebaa saWiro. maTi xmareba 6 Tveze meti xangrZlivobiT ar
aris mizanSewonili gverdiTi movlenebis gamo (antifoliuri moqmedeba).
pirimeTaminis ganmeorebiTi xmareba xangrZlivi moqmedebis sulfanilamidebTan
kombinaciaSi (sulfatoqsini, sulfaleni) mizanSewonili ar aris.
8 wlis asakze ufros bavSvebs SeiZleba mokle kursiT daeniSnos doqsiciklini 2
mg/kg dReSi, magram gasaTvaliswinebelia fotosensibilizaciis ganviTareba. im teritoriaze,
sadac aRiniSneba multirezistentuli P. falciparum, zogierT qveyanaSi gamoiyeneba
mefloqini.
arsebobs malariis sawinaaRmdego sami ti pis vaqcina: 1) sporozoituli vaqcina _
icavs malariiT dasnebovnebisagan, vinaidan sporozoitebi kbenis Semdeg dauyovnebliv
ixocebian, 2) merozoituli vaqcina, xels uwyobs usqeso formis parazitebis daxocvas.
aseTi acra ar icavs dasnebovnebisagan. egzoeriTrocituli Sizogonia viTardeba
Cveulebrivi gziT, magram RviZlidan gamosuli merozoitebi ixoceba da daavadebis
klinikuri gamovlineba ar viTardeba, 3) gametcituri vaqcina ar icavs daavadebisagan,
magram koRoebi aseTi sisxlis wovis Semdeg ar inficirdebian.
481
kerZo nawili.
protozouli infeqciebi. lambliozi
lambliozi
(LAMBLIOSIS, GIARDIASIS)
Giardia Lamblia anu Lamblia intestinalis farTod gavrcelebuli umartivesi

parazitia.
lambliiT gamowveuli klinikuri suraTi did farglebSi meryeobs _ dawyebuli
maTi kuW-nawlavis traqtSi usimptomo kolonizaciiT da damTavrebuli mwvave da
qronikulad mimdinare diareiT.
etiologia. Giardia Lamblia umartivesebs miekuTneba. arsebobs misi 2 forma _
etiologia
cisturi da vegetaciuri. momwifebuli cistebi 8-10mkm aRweven. maT ovaluri forma
aqvT da aRWurvilni arian sqeli garsiT, Seicaven 4 birTvs. moumwifebeli cista 2
birTviania. cistis garsi mkafiodaa gamoxatuli da metwilad CamorCeba protoplazmas,
rac ganasxvavebs parazits nawlavis sxva umartivesebisagan.
lambliebi gamoirCevian antigenuri struqturiT da sxvadasxva xarisxis
infeqciurobiT. maTSi enterotoqsini nanaxi ar aris.
epidemiologia. msoflios sxvadasxva regionSi adamianTa Soris lambliebis
epidemiologia
gavrceleba meryeobs 0,5%-dan 50%-mde. ganviTarebad qveynebSi lamblia nawlavTa erT-
erTi paTogenia da 10 wlamde bavSvebSi gvxvdeba 15-20%-Si.
infeqciis wyaros warmoadgens adamiani, Tumca am bolo dros gairkva, rom es roli
SeiZleba Seasrulon sxvadasxva cxovelebma (ZaRlebi, katebi, mRrRnelebi da a. S.). aSS
CDC (Centre of Disease Control- daavadebaTa kontrolis centri)- is monacemebiT,
daavadebis umetesi SemTxvevebi gamowveulia wylis dabinZurebiT, xolo dabinZurebuli
produqtebiT inficireba ufro sporaduli SemTxvevebis mizezia.
daavadeba mozrdilebTan SedarebT ufro Warbobs bavSvebSi. lambliozis gavrceleba
damaxasiaTebelia msoflios iseTi endemuri regionebisTvis, sadac sanitaruli done
dabalia. daavadebis maRali maCveneblebi aRiniSneba avadmyofTa movlis centrebSi,
gansakuTrebiT, gonebrivad CamorCenil pirTa Soris. mamakac homoseqsualebSi lambliozi
SeiZleba gadaeces sqesobrivi gziT. fekaliebiT gamoyofili cistebi xasiaTdebian
garemoSi garkveuli rezistentobiT. qloris normaluri koncentraciis dros cistebi
wyalSi sicocxlisunarianobas inarCuneben 2 Tvemde.
paTogenezi. lambliebi organizmSi iWrebian piris Rrudan inficirebuli wyliTa
paTogenezi
da sakvebiT.
invaziis ganviTarebisaTvis sakmarisia lambliebis erTeuli cistebi (1-dan 10-mde).
wvril nawlavSi SeRwevis Semdeg cistebi gardaiqmnebian 4 trofozoitad, romlebic
TormetgoWa nawlavsa da wvrili nawlavis proqsimalur nawilSi pouloben kolonizaciis
adgils. trofozoitebi didi raodenobiT mravldebian epiTeliur ujredebSi gaswvrivi
dayofiT, lorwovani garsis 1sm2-ze maTi raodenoba aRwevs 1 milions da mets, xolo
fekaliebiT garemoSi gamoiyofa 18 mln-mde cista.
lambliozis asimptomuri formis xangrZlivoba ucnobia, magram zogierT bavSvSi
cistebis gamoyofa 6 Tves grZeldeba.
lambliebis vegetaciuri formebi (trofozoitebi) nawlavis lorwovan garsebSi
qmnian meqanikur dabrkolebas da ganapirobeben sakvebis kedlismieri Sewovis darRvevas;
SeiZleba adgili hqondes naxSirwylebis, cximebis, vitaminebis Sewovis darRvevebs.
lambliozis gadatanis Semdeg xSirad SeiZleba gamovlindes intolerantoba laqtozis
mimarT.
lambliebze damRupvelad moqmedebs naRveli. amis gamo maT ar SeuZliaT iyvnen
RviZlis mZime daavadebis mizezi, gamoiwvion qolecistoqolangiti da sxva. maT mier
482
kerZo nawili.
gamowveuli refleqsuri diskinezia ki xels uwyobs meoradi infeqciis darTvas, nervuli

sistemis dazianebas. lambliozis fonze TandarTuli infeqciebi (Sigelozi da sxva)
xels uwyobs diareis gaxangrZlivebas.
bavSvebSi, romelTac aReniSnebaT X-qromosomasTan dakavSirebuli agamaglobulinemia
(X q22
22 qromosomuli defeqti) an Bruton-is agamaglobulinemia, lambliebi zogjer
warmoadgenen qronikuli diareis seriozul mizezs, Tumca lamblia diareis erTaderTi
gamomwvevi TiTqmis arasodes ar aris, igi gvxvdeba sxva nawlavTa infeqciasTan asociaciaSi.
aRsaniSnavia, rom SidsiT daavadebul da IgA-s deficitis mqone ZuZuTkvebaze myof
bavSvebSi daavadeba ar Rebulobs mZime mimdinareobas. es faqti imiT aixsneba, rom dedis
rZeSi arsebuli Tavisufali cximovani mJavebi da IgA iwveven daavadebis sawinaaRmdego
damcvel reaqcias.
klinika. daavadeba vlindeba inficirebidan 1-3 kviraSi. klinikis mimdinareoba
klinika
variabiluria. yvelaze ufro xSir simptomad iTvleba diarea (rac lambliozisaTvis
paTognomuri niSania), romelic SeiZleba iyos uxvi, wyliseburi, Zlier suniani (paTognomuri
niSania), sisxlisa da lorwos Semcvelobis gareSe, muclis SeteviTi xasiaTis tkivilebiT.
daavadeba SeiZleba mimdinareobdes spru-daavadebis magvari suraTiTac, diarea SeiZleba
iyos xangrZlivi, rac ganapirobebs organizmis dasustebas, sxeulis masis dakargvas,
anemiis ganviTarebas.
imunodeficituri mdgomareoba iwvevs qronikul mimdinareobas.
daavadeba SeiZleba daiwyos uecrad an TandaTanobiT subferiluri an normaluri
temperaturiT.
mxedvelobaSia misaRebi, rom malabsorbciiT gamowveuli laqtozis intolerantobis
fonze ganviTarebuli diareis klinika hgavs lambliozis gamwvavebis suraTs.
diagnozi. lambliis trofozoiti an cista SeiZleba vnaxoT inficirebuli
diagnozi
avadmyofis ganavalSi fekaliebis an duodenuri masalis nacxis mikroskopiiT Seswavlis
dros. dadgenilia, rom ganavlis erTjeradi mikroskopiisas lambliis cistebi aRmoCndeba
50-70%-Si, maSin, rodesac 3-jeradi gamokvleva amis SesaZleblobas zrdis 95%-mde.
Entero-Test. Tormergoja nawlavis aspiratis gamokvleva ufro mgrZnobiare testia,
vidre fekaliebis 1-jeradi gamokvleva.
ganavlis gamosakvlevi nakrebi (kit) Sedgeba speckonteinerebisgan, romlebSic
moTavsebulia 10%-iani formalini da polivinilalkohol-fiqsatori da gamoiyeneba
saxlis pirobebSi masalis asaRebad.
gamosakvlevi masalis misaRebad zogjer iyeneben nawlavis zemo nawilis endoskopias
aspiratis an bioftatis miRebis mizniT.
Tu cista ver iqna nanaxi, maSin iyeneben specialur, Zlier mgrZnobiare testebs
antigenis aRmosaCenad, rac gamoiyeneba saWiroebisas epidafeTqebebis mizezis dasadgenad.
mkurnaloba. umravles SemTxvevaSi xdeba daavadebis TviTgankurneba. specifikuri
mkurnaloba
mkurnalobis TvalsazrisiT iyeneben Semdeg preparatebs:
metronidazols (Metronidazolum) 40 mg/kg sxeulis masaze 3-jer dReSi 7-10

dRe. Tumca aSS-Si misi gamoyeneba Food and Drug Administration-is mier (sakvebis
da medikamenturi preparatebis kontrolis departamenti) ar aris rekomendebuli,
vinaidan klinikuri efeqti arc iseTi TvalsaCinoa. bavSvebSi ki preparati garkveul
mutagenur Tvisebebs amJRavnebs. msoflio janmrTelobis organizaciis rekomendaciiT
metronidazoli (40mg/kg/dReSi - 10 dRe) iniSneba persistuli diareis dros (14
dReze meti xangrZlivobis), Tu ganavalSi aRiniSneba lambliis trofozoitebi an
cistebi. igive exeba tinidazols.
tinidazoli (Tinidazolum) 50 mg/kg sxeulis masaze erT miRebaze (efeqts iZleva
483
kerZo nawili.
80%-Si). orsulebSi gamoiyeneba paromomicini daavadebis klinikuri gamovlinebis

dros.
ornidazoli (tiberali) eZleva Semdegi sqemiT:
mkurnalobis
sadReRamiso doza
xangrZlivoba
mozrdilebi da bavSvebi
35 kg-mde masiT bavSvebi
masiT 35kg-ze meti
(tab. 500 mg) 3 tableti 40 mg/kg sxeulis masaze
1-2 dRe
erT miRebaze saRamos erT miRebaze
Quinacrine 2 mg/kg sxeulis masaze 3-jer dReSi - 7 dRe. es preparati ufro

efeqturia, magram naklebad Seswavlilia misi moqmedeba bavSvebze.
im SemTxvevaSi, roca aRiniSneba daavadebis qronizaciis riski, (xangrZlivi daavadeba,
tkivilebi da a.S.) niSnaven furazolidons (Furazolidonum) 2 mg/kg sxeulis masaze
4-jer dReSi 10 dRe. igi aSS-Si lambliozis mkurnalobisaTvis arCevis preparatad
iTvleba.
lambliozis asimptomuri formebis mkurnalobis Catareba damokidebulia imaze, Tu
ramdenad gvaqvs saqme riskis jgufis bavSvebTan (baga-baRis, internatis da a.S.).
avtorTa umravlesoba asimptomuri lambliozis dros mkurnalobis Catarebaze
rekomendacias ar iZleva.
484
kerZo nawili.
helminTozebi. askaridozi
helminTozebi
askaridozi
(ASCARIDOSIS)
Ascaris lumbricoides-iT gamowveuli helminTozi SeiZleba mimdinareobdes

organizmis saerTo intoqsikaciur - alergiuli movlenebiT, seriozuli garTulebebiT
filtvebis, kuW-nawlavis, sanaRvle gzebis mxriv.
etiologia. Ascaris lumbricoides miekuTvneba nematodebis klass, gayofilsqesiania.
helminTozis aqtiur-infeqciuri stadia ganpirobebulia larviT, romelic Seicavs
ovaluri formis momwifebul, sqelgarsian, 40-60mkm diametris mqone kvercxebs.
mdedri askarida 25-35sm X 4mm zomisaa, mamri ki _ 15-20sm X 3mm. cocxali
individi TiTistaris formisaa. nawlavidan axalgamoyofili Wia mowiTalo-moyviTalo,
sikvdilis Semdeg ki _ moTeTro ferisaa. askaridas sicocxlis xangrZlivoba 1-2
weliwads aRwevs, Semdeg igi kvdeba da fekaliebTan erTad gamoiyofa. amitom erTi da
igive pirovnebaSi askaridas ufro xangrZlivi arseboba unda aixsnas reinvaziiT.
kvercxebis raodenoba mdedrSi aRwevs 200 000-s dReSi. momwifebuli kvercxebiT
invazirebis Semdeg Wiebis mier kvercxebis produqcia iwyeba 2 TveSi. Wiis kvercxebi
sicocxlisunarianobas 5-100C temperaturis pirobebSi 2 wlamde inarCunebs.
epidemiologia. Ascaris
lumbricoides m s o f l i o S i
farTod gavcelebuli helminTia.
inficirebis raodenoba
yovelwliurad 1 miliard
SemTxvevas iTvlis. daavadeba
yvelaze ufro gavrcelebulia
skolamdeli da skolis mcire
asakis bavSvebSi. askarida ufro
xSirad gvxvdeba notio klimatis
mqone zomier, Tbil qveynebSi, A B C
SedarebiT iSviaTia mSral Ascaris lumbricoides. A - fertiluri da B, C -
qveynebSi. arafertiluri kvercxebi. (James W. Kazura)
askaridozis gavrceleba
damokidebulia imaze, Tu ramdenadaa gaWuWyianebuli niadagi, rogoria masSi kvercxis
momwifebis pirobebi. inficirebis intensivoba damokidebulia sazogadoebrivi da
individualuri higienis wesebis dacvaze. mniSvnelovania xelebis, sakvebis, maT Soris,
buzebis mier dabinZurebis faqtorebi. tualetis ar gamoyenebiT miwis dabinZureba an
fekaliebiT miwis ganoyiereba askaridis gavrcelebis 2 ZiriTadi mizezia.
paTogenezi. inficirebuli piris mier garemoSi Wiis kvercxebis gamoyofa xdeba
fekaliebiT, ris Semdegac isini 5-10 dRis ganmavlobaSi mwifdebian niadagSi. moumwifebeli
kvercxiT dainficireba ar xdeba. saWmlis momnelebel traqtSi moxvedrili momwifebuli
kvercxebidan wvril nawlavSi Cndebian matlebi (larvebi), romlebic nawlavis garsSi
penetraciis Semdeg hematogenurad, RviZlis gavliT aRweven filtvebis alveolebsa da
485
kerZo nawili.
helminTozebi. askaridozi
bronqiolebs, bronqul traqts, saidanac wamwamovani epiTeliumis meSveobiT naxvelTan

erTad piris RruSi moxvedris Semdeg isev kuWsa da nawlavebSi xvdebian. migracia
grZeldeba 14-15 dRes. nawlavSi moxvedrili larvis sqesobriv momwifebas sWirdeba
70-75 dRe.
RviZlisa da sanaRvle gzebis parazitiT dazianebis paTogenezi jer srulad
Seswavlili ar aris.
matlebis diseminacia SeiZleba moxdes Tavis tvinSi, TvalSi, sxva organoebSi.
matlebi ikvebebian sisxlis SratiT, eriTrocitebiT, rac iwvevs iseT simptomebs,
rogoricaa anemia, Tavbrusxveva da sxva.
daavadebis klinikuri simtomatika, ZiriTadad, ganpirobebulia organizmis alergiuli
movlenebiT, rac gamowveulia matlebis daSliTa da maTi metabolitebis organizmis
sensibilizaciiT. nawlavisa da filtvis qsovilebSi viTardeba eozinofiluri
infiltratebi. toqsikur-alergiuli reaqciebi vlindeba mozrdili askaridebis nawlavSi
lokalizaciis drosac. nawlavSi xdeba askaridebis ara mimagreba, aramed Sekaveba, rac
xorcieldeba nawlavis kedelze parazitis boloebis mibjeniT. aseTi mdgomareobiT
aixsneba askaridebis mobiluroba daswvrivi da aswvrivi mimarTulebiT, maTi migracia
kuWSi, saylapavSi, xaxaSi, sasunTq gzebsa da danamat RruebSi.
rogorc matlebis, aseve mozrdili askaridebis aqtiuri migraciis Sedegia, agreTve
sxvadasxva meqanikuri dazianeba - sisxlCaqcevebi filtvebSi, sisxliani naxveli, risi
mizezicaa matlebis mier kapilarebis perforacia.
askaridozis dros zogjer aRiniSneba zogadi intoqsikaciis movlenebi - saerTo
sisuste, madis dakargva, subfebriluri, zogjer ki ufro maRali temperatura, Tumca am
SemTxvevaSi saWiroa gamoiricxos sxva infeqciuri daavadebis foni, meoradi floriT
gamowveuli garTulebebi da sxva. zogierT avadmyofs aReniSneba steatorea, A-vitaminis
absorbciis daqveiTeba.
klinika. klinikuri gamovlinebani bevradaa damokidebuli mosaxleobis invaziis
intensivobaze. daavadebis simptomatikas gansazRvravs klinikuri forma.
filtvis askaridozi, Cveulebriv, viTardeba masiuri invaziis pirobebSi, rac
gasaTvaliswinebelia diagnostikis TvalsazrisiT maSin, rodesac saqme gvaqvs pnevmoniis
sezonur xasiaTTan. yvelaze ufro damaxasiaTebel sindroms warmoadgens sisxliani
naxveli da eozinofilia e.w. Löffler-is sindromis simptomatika, romelic dakavSirebulia
filtvebis tranzitul eozinofilur infiltraciasTan.
bavSvebSi am sindromis etiologiuri arsis dadgena visceruli Larva migrans-is
dros Znelia, magram mxedvelobaSia misaRebi, rom filtvebis askaridozis dros abdominuri
simptomebi iSviaTia da klinika pnevmoniis saxiT vlindeba.
RviZlis askaridozis paTogenezi srulad axsnili ar aris. klinikurad garda
organizmis zemgrZnobelobisa (alergiuli simptomatika), naRvlis buStsa da sadinarebSi
askaridebis migraciis Sedegad viTardeba SeteviTi xasiTis Zlieri tkivilebi, SesaZlebelia,
ganviTardes siyviTle. askaridebis migracia naRvlis buStSi ufro xSirad CineTsa da
fili pinebSi gvxvdeba, Tumca siyviTlis sixSire maRali ar aris.
daavadebis diagnostikisaTvis mniSvneloba aqvs eozonofilias da askaridebis an
misi Wiis kvercxebis gamovlenas.
nawlavTa obstruqcia ufro xSiria bavSvebSi, risi mizezic mozrdilebTan
SedarebiT nawlavis diametris simcirea. klinikuri suraTis simZime damokidebulia
askaridebis raodenobaze, romelic erTeuli egzemplaridan ramdenime aTeulamde an
aTasamdec bavSvebSi ufro metadac ki meryeobs.
diagnozi. nawlavis stadiis askaridozis dadgenis ZiriTad meTods warmoadgens
fekaliebis Cato-s meTodiT (msxvili nacxis) mikroskopuli gamokvleva.
486
kerZo nawili. askaridozi
helminTozebi. strongiloidozi
didi mniSvneloba aqvs kvercxebis morfologiis dawvrilebiT Seswavlas.

ganayofierebul kvercxebs naxuloben mdedri da mamri askaridebis nawlavSi
parazitirebisas. gaunayofierebeli kvercxebi gamoiyofa mxolod mdedri askaridebiT.
kvercxebis aRmoCena duodenuri SigTavsis nacxSi SeiZleba mowmobdes naRvlisa da
pankreasis sadinrebSi parazitis arsebobas.
askaridebis migraciis periodSi sarwmuno diagnozis dadgena emyareba Wiis matlebis
aRmoCenas naxvelSi da specifikuri antisxeulebis dadgenas sisxlSi.
mkurnaloba. arsebobs mkurnalobis mravali qiomioTerapiuli saSualeba, magram
arcerTi maTgani ar gamoiyeneba askaridozis filtvis formis dros.
askaridozis dros yvelaze ufro efeqturia mebendazoli (vermoqsi), romelic
WiaSi iwvevs glukozis utilizaciis Seuqcevad darRvevas da aferxebs atf-is sinTezss.
bavSvebs mebendazoli eZlevaT 100 mg 2-jer dReSi 3 dRe. rekomendebulia, mkurnaloba
ganmeordes 2-4 kviris Semdeg, radgad ganmeorebiTi invazia sakmaod xSiria. gamoiyeneba
pi perazinis marilebi (citrati, adi pati, fostati) 50-75 mg/kg dReSi, 2 dRis
ganmavlobaSi, Tumca zogjer erTjeradi miReba ufro karg efeqts iZleva (Tu doza
metia). pi perazini parazitis neiromuskulur damblas iwvevs da aqedan gamomdinare,
ganapirobebs mis swraf gandevnas, mas biliaruli da nawlavuri obstruqciis dros
iyeneben. vinaidan pi perazinisadmi aRwerilia hi permgrZnobelobisa da neirotoqsikuri
reaqciebi. SeiZleba agreTve gamoviyenoT pirantelis pamoati (kombantrini) dozebSi
10mg/kg erTjeradad suspenziis an abis saxiT. pi perazini pirantelis antagonistia,
amitom isini erTad ar iniSneba.
mZime SemTxvevaSi, qirurgiuli Carevisas, umjobesia ki ar gaiWras TviT nawlavi,
aramed parazitis konglomerati daiSalos intensiuri masaJis saSualebiT.
profilaqtika. didi mniSvneloba aqvs dasaxelebuli adgilebis sanitarul
keTilmowyobas, avadmyofebisa da mtareblebis gamovlinebasa da maT mkurnalobas, sakvebisa
da wylis epidstandartebis Sesabamisad dacvas, sapirfareSoebis mowyobis da niadagis
dacvas adamianis ganavliT dabinZurebisagan. intensiur kerebSi askaridozis Tundac
erTi SemTxvevis dadgenisas saWiroa, yvela pirs Cautardes mkurnaloba. roca inficireba
40%-s da mets aRwevs, mkurnaloba utardeba keraSi myof yvela pirs, araintensiur
keraSi erTeuli SemTxvevis dadgenis dros mkurnalobas eqvemdebareba mxolod
inficirebuli. niadagis ganoyiereba dasaSvebia mxolod kompostirebuli fekaliebiT.
strongiloidozi
(STRONGYLOIDOSIS)
strongiloidozi, masiuri invaziis Sedegad SeiZleba gaxdes sicoclisaTvis saSiSi

mdgomareobis an uecari sikvdilis mizezi, gansakuTrebiT moSimSile da
imunokomprometirebul bavSvebSi.
daavadebis adreul stadiaSi aRiniSneba upiratesad alergiuli xasiaTis simptomatika,
movlenebi filtvebis mxriv, xolo mogvianebiT stadiaSi ki sWarbobs kuW-nawlavis
traqtis dazianeba.
mokle istoriuli cnobebi. strongiloidozi saxelwodebiT ‘koxinxinis diarea~
aRwerili iyo normanis mier 1816 wels.
etiologia. daavadebis gamomwvevia Strongyloidosis - wvrili filaris msgavsi
etiologia
(Zafiseburi) nematoda, romlis zomaa 2,2mm X (0,03 _ 0,07mm). Wiis kvercxis zomaa
0,05-0,3 mm, romlebic Seicaven sruliad formirebul rabdis msgavs (zolismagvar)
487
kerZo nawili.
matlebs.
epidemiologia. daavadeba, ZiriTadad, gavrcelebulia tropikuli da subtropikuli
sartylis qveynebSi.
infeqciis wyaros warmoadgens strongiloidoziT daavadebuli adamiani. igi parazitis
ZiriTadi wyaroa. infeqciis rezervuari SeiZleba iyos ZaRli, kata da sxva.
inficirebuli adamiani, cxoveli ganavalTan erTad gamohyofs parazitis rabditoidul
formebs. isini niadagSi saTanado pirobebis SemTxvevaSi (miwisa da haeris maRali
tenianoba, Jangbadi, miwis neitraluri da tute reaqcia, sakvebis arseboba) arseboben
ganusazRvreli drois ganmavlobaSi. Sesabamis pirobebSi, rabditoiduli forma gadaiqceva
filariad da adamianisaTvis invaziuri xdeba. adamianis invazia SesaZlebelia inficirebul
niadagTan kontaqtis Semdeg. parazitis mier invazia xorcieldeba, Cveulebriv, qvemo
kidurebis kanidan, agreTve SesaZloa piris RruSi moxvedra gabinZurebuli wyliT an
saWmliT. iSviaTia dainficireba dasnebovnebulis kanTan mWidro kontaqtiT.
piradi higienis dabali done xels uwyobs inficirebas.
paTmorfologia. momwifebis stadiaSi (filarias) parazitebs
gaaCniaT unari, aqtiurad SeaRwion kanSi (fexSiSvela siaruli, xelebiT niadagis
damuSaveba an piris RruSi moxvedra gabinZurebuli wyliTa da sakvebiT). Semdeg isini
hematogenurad xvdebian filtvis alveolebSi da askaridebisa da ankilostomebis
analogiurad migrireben bronqul sistemaSi, saidanac nerwyvis gadaylapvis Semdeg
aRweven adgilsamyofels _ wvril nawlavebs. parazituli Taobis sqesobrivad momwifebuli
mdedrebi lokalizdebian wvrili nawlavis lorwovan garsSi, ZiriTadad, 12-goja nawlavis
liberkiunis jirkvlebSi, sadac deben kvercxebs SemdgomSi matlis gamoCekviT. matlebi
garemoSi gamoiyofa fekaliiT, sadac isini gardaiqmnebian filarias msgavs matlebad
(homogenia) an Tavisuflad mcxovreb sqesobrivad momwifebul mdedrebad da mamrebad
(heterogenia), romlebsac gaaCniaT kvercxis produqciis unari.
filarias msgavs Wiebs SeuZliaT adamianis invazireba saTanado SeWris adgilidan,
autoinvazirebis CaTvliT.
aseTi unikaluri ganviTarebis sasicocxlo cikli parazits saSualebas aZlevs,
wlebis ganmavlobaSi imyofebodes erTi da igive organizmSi da gamoiwvios daavadebis
seriozuli klinikuri suraTi.
kanidan matlis SeWris adgilze pirveladi afeqti ar aRiniSneba an SeiZleba
adgili hqondes umniSvnelo cvlilebebs. mxolod reinvaziisas SeiZleba iyos derma-
titis movlenebi an eroziuli procesi.
matlis migracia iwvevs e.w. Löffler-is sindroms (intersticiuli pnevmoniti da
eozinofilia, romelic ufro intensiuri xdeba parazitis nawlavis lorwovan garsSi
SeRwevis dros).
diseminirebuli strongiloidozi warmoadgens rTul process Sinagan organoebSi
ganTesviT, meoradi infeqciis TandarTviT.
parazitis nivTierebaTa cvlisa da sxeulis daSlis produqtebis moqmedeba iwvevs
sensibilizacias, alergias da distrofiul cvlilebebs organizmSi.
klinika. strongiloidozis klinikuri simptomatika vlindeba mxolod erTeul
klinika
avadmyofebSi, xSirad ki mimdinareobs SeumCnevlad.
klinikuri gamovlineba zogjer xasiaTdeba papulur-eriTemuli gamonayriT.
Larve currens mdgomareoba viTardeba parazitis mier kanis meoradi invaziis
dros da xasiaTdeba farTo eriTemul-WinWrisebri gamonayariT, misi swrafi gavrcelebiT,
mcocavi kideebiT. Cveulebriv, misi zoma aRwevs 30 sm-mde, mrgvali formisaa, Cndeba
perianalur midamoSi dundulebze da aris xSirad morecidive.
strongiloidozis kuW-nawlavis formisaTvis damaxasiaTebelia temperatura,
488
kerZo nawili.
muclis tkivilebi, Rebineba, diarea, rac gamowveulia mozrdili matlebis mier wvrili
nawlavis zemo nawilis dazianebiT. aRniSnuli simptomebis sixSire gansazRvruli ar
aris. maT SeiZleba hqondeT mwvave dasawyisi, morecidive mimdinareoba. muclis tkivilebi
xSirad aRiniSneba epigastriumis midamoSi da vlindeba wvis SegrZnebiT, SeteviTi an
yru tkivilebiT. ganavali Txelia, afuebuli, uxvi lorwos minareviT (‘koxinxinis
diarea”), defekaciis sixSire aRwevs 10-15-s dRe-RameSi.
obieqturad avadmyofs aReniSneba Selesili ena, meteorizmi, madis dakargva, palpaciiT
difuzurad mtkivneuli muceli, taqikardia, gulis tonebi moyruebulia.
qronikulma strongiloidozma SeiZleba gamoiwvios malabsorbciis movlenebi _
cilovani enteropaTia sxeulis masis dakargviT.
periferiul sisxlSi aRiniSneba maRali eozinofilia. 70-80%-Si viTardeba anemia.
diseminirebuli strongiloidozi bavSvebSi dakavSirebulia ganwyobis iseT
faqtorebTan, rogoricaa SimSiloba an ujreduli imunitetis defeqti (limfoma, hojkinis
daavadeba, SeZenili imunodeficiti). am SemTxvevebSi daavadeba iwyeba mwvaved, cxelebiT,
mucelSi tkivilebiT viTardeba Soki diseminirebuli septicemiis (diseminirebuli
strongiloidozis) Sedegad. am dros adgili aqvs matlebiT Sinagani organoebis
masiur invazias, isini iwveven organoTa qsovilebis destruqcias. sisxlSi gvaqvs
leikocitozi eozinofiliis gareSe.
diagnozi. nawlavTa strongiloidozi dgindeba fekaliebis mravaljeradi
diagnozi
gamokvleviT an duodenur SigTavsSi parazitebis matlebis aRmoCeniT. gamokvleva
xdeba ganavlis nacxis rogorc pirdapiri, aseve bermanis koncentraciuli meTodiT.
alternatiul meTods warmoadgens Enterotest-iT duodenuri aspiratis gamokvleva.
bavSvebSi ‘hi perinfeqciuri sindromis~ dros matlebi SeiZleba inaxos nerwyvSi,
kuWis SigTavsSi an, iSviaTad, wvrili nawlavis bioftatSi.
strongiloidozi unda gamoiricxos imunodeficitis mqone avadmyofebSi,
romelTac daavadeba daewyoT uecrad, infeqciuri procesis diseminaciiT.
axlaxans mogvawodes serologiuri testi strongiloidebis sawinaaRmdego
antisxeulebis dasadgenad, romelic mgrZnobiare aRmoCnda nawlavTa formis dros,
maSin, rodesac ‘hi perinfeqciuri sindromis~ SemTxvevaSi igi naklebmgrZnobiarea.
mkurnaloba. yvelaze ufro xSirad gamoiyeneba Tiabendazoli (Thiabendazolum),
migraciuli formis dros dozebSi 25 mg/kg 2-jer dReSi, 2 dRis ganmavlobaSi.
hi perinvaziis dros mkurnaloba grZeldeba aranakleb 2 kvirisa. es preparati
winaaRmdegnaCvenebia orsulebSi.
Ivermectin-i erTjerad dozebSi TiTqosda efeqturia, magram misi efeqturoba
generalizebuli formis dros ar aris damtkicebuli.
Tu avadmyofi raRac mizezis gamo saWiroebs imunosupresiul Terapias, saWiroa
antistrongiloiduri Terapiis daniSvna.
profilaqtika. yvelaze ufro racionaluria sanitaruli RonisZiebebis Catareba
niadagis inficirebisa da bavSvidan bavSvze invazirebis Tavidan acilebis mizniT. yvela
gamovlenili bavSvi eqvemdebareba mkurnalobas. pirebs, romelTac utardeba
imunosupresiuli mkurnaloba, mizanSewonilad unda Cautardes fekaliebis gamokvleva
strongiloidebis Wiis kvercxebze.
489
kerZo nawili.
helminTozebi. triqinelozi
triqinelozi
(TRICHINELLOSIS)
triqinelozi invaziuri (nematodozi) daavadebaa, romelic mimdinareobs gamoxatuli

alergiuli gamovlinebiT, hi pereozinofiliiT. mZime formebis dros adgili aqvs
miokardiumis kerovan anTebas, meningoencefalits.
adamianis ConCxis kunTebSi triqinelebi aRmoaCina ingliselma medikosma-studentma
pejetma 1835 wels gvamis preparirebis dros. r. oJenma paraziti aRwera da uwoda
Trichina spiralis. Tanamedrove saxelwodeba _ Trichinella spiralis uwoda raliem.
msoflioSi aRwerilia adamianisaTvis paTogenuri 3 helminTi _ Trichinella spiralis,
Trichinella nativa da Trichinella nelsoni. sqesobrivad momwifebuli dedali 1-3 mm
zomisaa, mamali 1-2 mm. ganayofierebuli dedali 2-3 dRis Semdeg Sobs Wuprebs.
dedlebis ganayofierebis Semdeg mamlebi kvdebian.
epidemiologia. triqinela peroraluri biohelminTozia, igi zoonozia. daavadeba
gavrcelebulia mTel msoflioSi, garda avstraliisa da wynari okeanis ramodenime
kunZulisa.
Trichinella spiralis cirkulirebs sinantropul cxovelebSi _ Rori, kata, ZaRli
da sxva. romlebic inficirdebian sakvebi produqtebis narCenebiT, mZoriT da a.S.
bunebriv kerebSi invaziis wyaroa gareuli cxovelebi _ daTvi, taxi, mgeli, enotiseburi
ZaRli, maCvi da sxv., romlebic inficirdebian, ZiriTadad, mtaceblebis da invazirebuli
mZoris SeWmis Sedegad.
Wuprebi iRupebian +55°C da ufro met temperaturaze an –15°C-ze gayinvisas 3
kviris ganmavlobaSi.
adamianis mimRebloba triqinelebis mimarT maRalia. triqinelebiT inficireba xdeba
Termulad arasakmarisad damuSavebuli xorcis (Rori, daTvi, selapi da sxv.) miRebis
Sedegad.
Cvens respublikaSi araiSviaTad gvxvdeba triqinelozis jgufuri, ojaxuri afeTqebebi.
Rorebi, ufro xSirad, inficirdebian mkvdari virTxebis SeWmis Sedegad.
paTogenezi. triqinelebi kuWSi xvdebian invazirebul xorcTan erTad, sadac
kuWis wvenis gavleniT kunTovani (invaziuri) triqinelebi swrafad Tavisufldebian
kafsulebisagan. isini 1-1.5 sT-is ganmavlobaSi aRweven wvrili nawlavis zemo nawils
da iWrebian lorwovanSi. iq sqesobrivad 1 dRe-RameSi mwifdebian da nayofierdebian
nawlavis sanaTurSi, ganayofierebidan me-3-4 dRes da Semdeg, 10-30-50 dReebSi ki
yoveli maTgani Sobs 100-dan 2000-mde triqinelas (larvas).
Tumca dawvrilebiT ar aris Seswavlili triqinelebis gavrcelebis gza organizmSi,
varaudoben, rom matlebi nawlavTa kedlebidan xvdebian mezenteriul limfur kvanZebSi,
mkerdis limfur sadinarSi, Rru venaSi. SesaZlebelia matlebis nawilobrivi migracia
sisxlZarRvTa sistemiT ganivzolian kunTebSi, sadac isini rCebian, diddebian, spiralurad
ixvevian da ganicdian inkafsulacias. ConCxis muskulaturaSi ujreduli infiltratebi
warmoadgenen kafsulis formirebis safuZvels.
endemur, invaziis kerebSi arsebul triqinelebs gaaCniaT maRali imunogenuri Tvisebebi,
romlebic ganapirobeben parazitis swraf inkafsulacias, proteqciuli IgG-s produqcias,
magram, amasTanave, xdeba IgE-s produqciac inficirebidan maqsimum me-2,3 kviras. masiuri
inficirebisas didi paTogenezuri mniSvneloba aqvs anTebis endogenur faqtorebs _
prostaglandinebs, kininebs, leikotrienebs, biogenur aminebs.
inkafsulirebuli triqinelebi cxovroben didxans, magram garkveul etapze arauadres
5-7 wlisa xdeba maTi TandaTanobiTi kalcifikacia,. zogierTi avtoris monacemiT
490
kerZo nawili.
helminTozebi. triqinelozi
triqinelebi yvelaze meti raodenobiT aRiniSneba enisa da diafragmis kunTebSi.

paTmorfologia. wvrili nawlavebis zemo nawilis lorwovanSi vlindeba
infiltracia monocitebiT, eozinofilebiT, leikocitebiT. mcirdeba Sefardeba qaoebsa
da kri ptebs Soris. aRniSnuli unda CaiTvalos procesis nawlavur stadiad. igi
mimdinareobs klinikuri manifestaciis gareSe.
paTologiuri procesis simZimis SefasebaSi didi mniSvneloba eniWeba invaziis
intensivobas. saSualo simZimiT invazirebisas nawlavebidan triqinelebis eliminacia
xdeba daavadebidan meoTxe kviras. fibrinuli kafsulis formireba kunTovani
(invazirebuli) triqinelebis irgvliv mkveTrad amcirebs antigenebis gavrcelebas
organizmSi, rac ganapirobebs temperaturis daklebas organizmSi, mwvave, saerTo movlenebis
Semcirebas. triqinelebis masiuri warmoSoba ganapirobebs Zlier, intensiur, ujredul-
proliferaciul reaqciebs kunTovan qsovilSi da, Sesabamisad, iwvevs klinikuri
gamovlinebis gaxangrZlivebas.
alergiuli reaqciebi ganapirobeben koniunqtivits, blefarits, respiraciul da
dizuriul movlenebs. granulomatozuri procesebi iwveven miokardits, pnevmonias,
meningoencefalits, SesaZloa hepatitsac. mZime mimdinareobis SemTxvevaSi adgili aqvs
eozinofilur miokardits, pnevmonias, sistemur vaskulits. daavadebis mimdinareoba,
zogjer, gamoirCeva saerTo SeSupebiT, romlis genezi SeiZleba iyos alergiuli,
hi poproteinuli, gul-sisxlZarRvTa da sunTqvis ukmarisobis dros ki _ hi postazuri.
Sinagani organoebis mxriv ( RviZli, miokardiumi, Sinagani sekreciis jirkvlebi)
distrofiulma movlenebma SeiZleba ganapirobos alopecia, kanis Rrma distrofiuli
cvlilebebi.
klinika. inkubaciuri periodi grZeldeba 5-dan 30 dRemde. misi xangrZlivoba
damokidebulia parazitis invaziurobis intensivobaze. rac ufro intensiuria igi, miT
ufro xanmoklea inkubacia da daavadeba Rebulobs mZime mimdinareobas. piriqiT, susti
invazia ganapirobebs waSlil da msubuq mimdinareobas.
mcire asakis bavSvebSi daavadebis iseTi wamyvani simptomebi, rogoricaa temperatura,
Tavis tkivili, saxis SeSupeba, alergiuli gamonayari, koniunqtiviti, ufro naklebadaa
gamoxatuli, vidre mozrdilebSi, sadac adgili aqvs poliadenopaTias, temperaturuli
reaqcia pirvel 7-10 dRes SeiZleba iyos mudmivi ti pis an remisiuli, Semdeg ki miiRos
subfebriluri xasiaTi, rasac SesaZloa daerTos yelis tkivili, elenTis gadideba,
kanze mkafio, eqsudaciuri an eriTemuli xasiaTis gamonayari.
waSlili da msubuqi formebis dros klinikuri suraTi izRudeba limfadenopaTiiT,
kanze gamonayriT, subfebriluri temperaturiT, eozinofiliiT 7-12%-mde, leikocitozis
gareSe.
saSualo simZimis dros temperatura maRali rCeba ufro didxans (2 kvira da
meti), Semdeg ecema subfebriluramde da SeiZleba darCes ramdenime kvira. gamoxatulia
saxisa da periorbituli aris SeSupeba, koniunqtiviti, kanze polimorfuli gamonayari.
eozinofilia aRwevs 35-40%-s, leikocitozi 12-14 109/l. mZime triqinelozis dros,
garda aRniSnuli simptomatikisa, gamoxatulia intoqsikaciis saerTo movlenebi _
cudi ganwyoba, gulisreva, Rebineba, saerTo sisuste, mkveTrad gamoxatuli kunTebis
tkivili. yvelaze ufro gamoxatulia tkivilebi diafragmis, neknTaSoris da saReW
kunTebSi, klinikuri suraTis maqsimaluri gaSla aRiniSneba ukve daavadebis pirvelive
kviris bolos da meore kviras. SeSupebas SeiZleba hqondes gavrcelebuli xasiaTi.
avTvisebiani mimdinareobis dros saerTo mdgomareoba uaresdeba da mas erTveba gul-
sisxlZarRvTa sistemis ukmarisoba _ arteriuli wnevis dacema, taqikardia, sistoluri
Suili, ekg-ze miokardiumis difuzuri dazianeba, kanze gamonayari xdeba hemoragiuli,
sxeulis SeSupeba Rebulobs universalur xasiaTs. SeiZleba ganviTardes nefritis,
491
kerZo nawili. triqinelozi
helminTozebi. enterobiozi
hepatitis, meningoencefalitis, pnevmoniis suraTi da am SemTxvevaSi aRiniSneba letalobis

maRali procenti.
abdominuri sindromi SeiZleba gamovlindes daavadebis pirvel dReebSi enteritis
saxiT. ganavali Txelia, raime paTologiuri minarevebis gareSe, sixSire ar aRemateba 3-
5-s dReSi.
prognozi mZimea da avTvisebiani mimdinareobis dros eyrdnoba periorbituli
SeSupebis xarisxs, mialgiebs, cxelebas, eozinofilias, epidanamnezis monacemebs (Termulad
cudad damuSavebuli xorcis didi raodenobiT miReba, amave produqtis miRebis Semdeg
msgavsi mZime simptomatikis ganviTareba sxva pirebSi da a.S.).
saeWvo xorcs laboratoriulad ikvleven mikroskopiiT. saeWvo SemTxvevebSi
mimarTaven deltiseburi kunTis, zurgis ganieri kunTis, kanWis kunTebis biofsirebuli
masalis gamokvlevas da kunTebis monelebis meTodiT matlebis aRmoCenas.
arsebiT daxmarebas gviwevs serologiuri reaqciebi _ kSr, aphr, ifa, isini dadebiTi
xdeba daavadebis III kviridan. diagnozs adasturebs bentoniT flokulaciis (1:5 da
meti) reaqcia. avadmyofTa 50%-is kunTebSi dgindeba fermentebis _
kreatininfosfokinazasa da laqtatdehidrogenazas momateba.
mkurnaloba.. gamoiyeneba mebendazoli _ 200 mg 3-jer dReSi 3 dRe, Semdeg 400 mg
mkurnaloba
3-jer dReSi 10 dRe, rac xels uwyobs nawlavebidan mozrdili triqinelebis matlebis
eliminacias. mizanSewonilia, rom preparati avadmyofs daeniSnos daavadebis dawyebidan
I-III kviras. rac Seexeba kunTovan (invaziur) triqinelebs, maTze moqmedeba eWvqveSaa
dayenebuli. Tiabendazoli _ alternatiuli preparatia da iniSneba 7 dRis ganmavlobaSi.
avadmyofebs kortikosteroidebs uniSnaven kritikuli mdgomareobis dros _
miokarditis, cns-is dazianebis SemTxvevaSi, magram maTi efeqturoba sakmarisad
dadasturebuli ar aris, xolo gverdiTi movlenebis SesaZlebeli ganviTarebis gamo
kortikosteroidebis xmareba unda tardebodes sifrTxiliT.
simptomuri mkurnalobidan ixmareba madesensibilizebeli, anti piretuli
(paracetamoli), anTebis sawinaaRmdego preparatebi (indometacini, voltareni) zomier
dozebSi, 10-14 dRe.
rekonvalescentebi imyofebian meTvalyureobis qveS aranakleb 2 weli, am dros
saWiroa gakeTdes ekg, sisxlis analizi (eozinofiliis dasadgenad); aucilebelia
srulyofili kveba. profilaqtika iTvaliswinebs moxetiale ZaRlebisa da katebis
populaciis kontrols, saxlebSi da maT axlos cxovelebis sadgomis deratizacias,
akrZaluli unda iqnes Rorebis kveba gareuli cxovelebis narCenebiT.
Tu saSualeba ar aris, rom xorci Semowmdes triqinelebze, maSin igi unda moixarSos
ara umetes 2-3 sm diametris zomis naWrebad 3 saaTis ganmavlobaSi.
xorcis gayinva _ 23,3°C-mde 10 dRis ganmavlobaSi klavs triqinelas Wuprs, Tumca
es profilaqtikuri zoma yovelTvis ar aris sakmarisi (arqtikis cxovelebSi triqinela
rCeba didxans). profilaqtikisaTvis, dainficirebuli xorcis miRebis SemTxvevaSi,
rekomendebulia mebendazolis da Tiabendazolis miReba.
enterobiozi
(ENTEROBIOSIS)
enterobiozi msoflioSi sayovelTaod gavrcelebuli helminTozia. adamiani,

gansakuTrebiT bavSvTa asakSi, 2-dan 14 wlamde, gamoirCeva didi mimReblobiT. daavadeba
umravles SemTxvevaSi klinikurad msubuqad mimdinareobs, iSviaTad ki axlavs saerTo
492
kerZo nawili.
helminTozebi. enterobiozi
intoqsikaciis movlenebi da, rac mTavaria, iwvevs ukana tanis Zlier Semawuxebel
qavils, rac ganapirobebs fsiqasTeniuri da nevrozuli mdgomareobis Camoyalibebas.
eti
etio logia.. enterobiozis gamomwvevi Wia _ Enterobius vermicularis (Oxyuris
ologia
vermicularis _ bavSvTa maxvila) nematodebis klasidanaa, zomiT 1 sm, TeTri ferisaa,
kvercxebi mogrZo, ovaluri, orkonturiani garsiT, romlis zoma 50X30 mkm-ia, formiT
asimetriulia, rac sxva Wiebis kvercxebisagan ganmasxvavebeli ZiriTadi niSania. momwifebul
kvercxSi ukve eqvsi saaTis Semdeg Cndeba larva, romelic garemoSi sicocxlisunarianobas
inarCunebs 20 dRemde.
maxvila parazitobs wvrili nawlavis qvemo nawilSi. mdedri maxvila 10-17 aTasamde
kvercxs Seicavs. igi Camodis swor nawlavSi, analuri napralis garSemo, debs kvercxebs
da kvdeba.
epidemiologia. daavadeba farTodaa gavrcelebuli msoflioSi, invazia
gansakuTrebiT maRalia bavSvebSi. Tvlian, rom enterobiozi ufro socialuri problemaa,
vidre samedicino. infeqciis erTaderTi wyaroa inficirebuli adamiani. dasnebovneba
xdeba fekalur-oraluri gziT. perianalur kanze mdedri maxvilas mier dadebuli
kvercxi 6 saaTSi mwifdeba da iZens invazirebis unars. mdedrebis gadaadgilebiT
gamowveuli qavilis Sedegad, mofxanisas xdeba frCxilebis dainficireba, sxvadasxva
sagnebis, (saTamaSoebis, loginis, tansacmlis, TeTreulis) dabinZureba. Zalian xSiria
autoinficireba xelis TiTebiT perianaluri midamos qavilis Semdeg.
infeqtis gadatanaSi garkveuli roli miekuTvneba buzebs.
paTogenezi. adamianis inficireba xdeba momwifebuli kvercxebis kuW-nawlavis
traqtSi moxvedriT. kuWSi kvercxebi gardaiqmnebian matlebad, migrireben brma nawlavSi,
sadac mwifdebian mozrdil stadiamde. maxvila nawlavis lorwovans meqanikurad azianebs,
mas naxuloben CaWedils lorwovanis Rrma SreSi, zogjer ki kunTovan Sresac aRwevs.
Wiebis nivTierebaTa cvlis Sedegad viTardeba organizmis sensibilizacia da
gamovlindeba alergiuli reaqcia. ganmeorebiTi intensiuri invaziisas mdedrma maxvilam
zogjer SeiZleba SeaRwios qalis sasqeso organoebSi, peritoneumis RruSi. maT, amave
dros, Tan SeaqvT nawlavTa baqteriebi, rac SemdgomSi iwvevs anTebiT procesebs.
klinika. enterobiozisaTvis specifikuri simptomebi damaxasiaTebeli ar aris.
mcire asakis bavSvebSi daavadeba mimdinareobs msubuqad, Zilis win da Rame aqvT ukana
tanis msubuqi qavili, romelic grZeldeba 1-3 dRe da Semdeg qreba. qavili xSirad
meordeba ori kviris Semdeg. qavilis aseTi perioduloba dakavSirebulia reinvaziis
Sedegad maxvilas Taobis cvlasTan. aseT SemTxvevaSi ( ganmeorebiTi invaziisas )
qavili mudmivi da intensiuria, xdeba mtanjveli. kanis meqanikuri dazianeba iwvevs
dermatits. avadmyofebs uviTardebaT fizikuri da fsiqikuri sisuste _ fsiqasTenia
da nevrasTenia.
SesaZlebelia, aRiniSnos diarea ara marto fafiseburi, lorwos Semcveli ganavliT,
aramed tenezmebiTac, rac dakavSirebulia swor nawlavSi wertilovani sisxlCaqcevebis
arsebobasTan da anusis gaRizianebasTan. eozinofilia, Cveulebriv, ar axasiaTebs.
SesaZlebelia, ganviTardes apendiciti, vaginiti da sxva.
diagnozi. diagnozis swori dasma SeiZleba ganavalSi kvercxebis an Wiis aRmoCeniT.
kvercxebis naxva advilad SeiZleba perianalur midamoSi, diliT, specialuri mwebavi
firfitis gamoyenebiT (dabanamde 3-jer, diliT), an perianaluri aris daTvalierebiT
daZinebidan 2-3 saaTis Semdeg. Tu nanaxi iqna Wia, ukeTesia, igi Senaxuli iqnas 75%-ian
eTilis spirtSi Semdgomi mikroskopuli gamokvlevisaTvis. Wiebsa da kvercxebze
gamokvleva aucilebelia inficirebuli avadmyofis ojaxis yvela wevrisaTvis.
mkurnaloba. mkurnaloba utardeba inficirebuli piris ojaxis yvela wevrs
miuxedavad imisa, aqvT Tu ara raime klinikuri gamovlineba. iniSneba pirantelis
493
kerZo nawili. enterobiozi
helminTozebi. triqocefalozi
pamoati (Pyrantel pamoate), 11 mg/kg sxeulis masaze (maqsimaluri doza 1 gramia

erTjeradad). igive doza ganmeorebiT iniSneba 2 kviris Semdeg. alternatiuli preparatia
mebendazoli (Mebendazolum - vermoqsi) 100 mg erTjeradad. reinfeqciis SemTxvevaSi
mkurnaloba SeiZleba saWiro gaxdes yoveli 3-4 Tvis Semdeg.
triqocefalozi
Trichiuris trichiura triqocefalozis gamomwvevia. igi farTodaa gavrcelebuli

mTel msoflioSi(0,5mlrd adamianSi) da anTroponozur helminTozs warmoadgens. infeqcia
ufro metad gvxdeba Tbili qveynebis mqone qveynebSi.
etiologia. infeqcia gadaecema parazitis kvercxiT, romelmac gaivlis kuW-nawlavis
traqts da gamoiyofa fekaliebiT. 2-4 kviris Semdeg, igi niadagSi mwifdeba Tu
amisTvis aris saTanado pirobebi(sinotive da Tbili temperatura). nawlavebSi Trichiuris
trichiura-s kvercxebidan gamodis
larva, romelic invazirebs wvrili
nawlavis xaoebSi, sadac 3-10 dRis
ganmavlobaSi rCeba, Semdeg ki nela
Camodis nawlavis gayolebiT da
TandaTan mozrdil WiaSi gardaiqmneba.
Trichiuris trichiura-s binadrobis
ZiriTad adgils brma nawlavi da
aswvrivi kolinji warmoadgens. Wiis
sxeuli gayofilia wina
wagrZelebul(Soltisebr) da ukana
gamsxvilebul nawilebad. misi sigrZe
Trichiuris trichiura -s kvercxi. daaxloebiT 40 mm-s warmoadgens.
(James W. Kazura) nawlavSi Wia lorwovanze miemagreba
Soltisebri nawiliT. dainficirebidan
1-3 TveSi mdedri Wia gamoyofs kvercxebs.
epidemiologia. triqocefalozi gavrcelebulia cudi higienur-sanitaruli
epidemiologia
pirobebis mqone raionebSi. umetesad avaddebian bavSvebi. embrionuli kvercxis gadacema
xdeba dabinZurebuli xelis, sakvebis da sasmeli wylis meSveobiT. aseve gavrcelebaSi
garkveuli roli mieniWeba buzebs da sxva mwerebs.
gamovlinebani. inficirebulTa umetesobaSi infeqcia mimdinareobs
klinikuri gamovlinebani
asimptomurad. zogjer uCivian muclis tkivils, kolikas, Sebervas. 1 mozrdili Wia
dReSi daaxloebiT 0,005ml sisxls wovs, ase, rom mZime anemia viTardeba mxolod
masiuri invaziis dros; aseve am SemTxvevaSi SeiZleba gamoixatos sisxliani diarea,
swori nawlavis gamovardna. rogorc wesi am dros saqme gvaqvs miqst-Sigelur an
protozoul infeqciasTan.
diagnozi emyareba Wiis kvercxis ganavalSi aRmoCenas.
mkurnalobaSi gamoiyeneba mebendazoli 100mg 2 jer dReSi 3 dRe, rac 70-90%-
Si srul gankurnebas uzrunvelyofs, xolo Wiis eqskrecias amcirebs 90-99%-iT.
494
kerZo nawili. zogierTi neli infeqcia
zogierTi neli infeqcia
neli infeqciebi miekuTvnebian arakonvenciuri (uCveulo) virusebiT gamowveul

infeqciur daavadebebs, romlebic mimdinareoben qvemwvave spongioformuli encefalopaTiiT.
am daavadebebs, romlebic gvxvdebian adamianebSic _ miekuTvneba kuru da CJD
(Cruetzfeldt-Jakob-desease) da misi varianti _ Gerstman-Strusser-Schinker
(GS).
cxovelebSi daavadeba cnobilia cxvris scapie da Zroxis spongiformuli
encefalopaTiis saxelwodebiT. yvela spongiformuli encefalopaTia xasiaTdeba msgavsi
klinikuri simptomatikiT, histologiuri gamovlinebiT da miekuTvneba nel infeqciebs.
yvelaze ufro mkafio neiropaTologiur gamovlinebad aRniSnuli daavadebisaTvis
iTvleba Tavis tvinis ruxi nivTierebis qerqovani Sris Rrubliseburi degeneracia.
daavadeba kurus afeTqebebi aRwerilia bavSvTa da mozrdilTa Soris papua axali
gvineas zogierT raionSi. aRsaniSnavia, rom daavadebis SemTxvevebi Sewyda daaxloebiT
35 wlis win da amJamad igi gvxvdeba mxolod mozrdilebSi. am asakobriv jgufSi
yvelaze xSirad fiqsirdeba CJD-is SemTxvevebi.
iatrogenuli gziT daavadebis gadacema aRiniSna, rogorc mozrdilebSi, aseve bavSvebSi.
GSS sindromi _ ojaxuri spongiloformuli encefalopaTia xasiaTdeba amiloiduri
folaqisebri firfitebis warmoSobiT, naTxemisebri ataqsiiT da ufro xangrZlivi
mimdinareobiT, vidre CJD, amitom SeiZleba iTvlebodes mis erT-erT variantad.
etiologia da epidemiologia. spongiformuli encefalopaTia gadaicema zogierTi
cxovelis dainficirebuli qsovilebidan.
gamomwvevi agentis kultivireba SeiZleba tvinis qsovilebSi, Tumca dabali titriT
da agreTve ar xasiaTdeba citopaTogenuri efeqtiT. cxvris scapie-is an GJD-is
dros in vivo gamokvlevebSi cxovelebSi dadginda agentis arseboba da raime reaqtiuli
cvlilebebis gareSe. dRemde avtorebis umravlesoba spongiformuli encefalopaTiis
gamomwvevebs miakuTvneben virusebs. agenti xasiaTdeba rezistentobiT qimio preparatebis
da temperaturis dasxivebis mimarT. varaudoben, rom igi SesaZloa iyos unikaluri
infeqciuri agenti da warmoadgendes subvirusul nawilaks, romelic Sedgeba cilisa
da nukleinis mJavis nawilakisagan. aseTi kategoriis gamomwvevebs mieca ganmarteba
`prioni”, Tumca hi poTezas prionebze yvela ar iziarebs.
am infeqciuri agentis zoma da struqtura jer kidev ar aris dadgenili. Tu
dadasturda, rom spongiformuli encefalopaTiis gamomwvevi Seicavs genomur nukleinis
mJavebs, maSin SeiZleba vivaraudoT, rom es ati puri virusia. amitom sanam ar aris
cnobili paTogenis struqtura, umjobesia vixmaroT termini _ agenti.
Scapie-s dros nervuli qsovilebi Seicavs fibrilebs, rac nanaxi iyo spongiformuli
encefalopaTiiT daavadebul adamianebsa da cxovelebSi, magram janmrTel qsovilebSi
cvlilebebi ver naxes. es fibrilebi amiloidur fibrilebs hgvanan, romlebic gvxvdeba
Alzheimer-is daavadebis dros.
dabali molekuluri wonisa da antigenmsgavsebis cilebis jgufi ganmartebuli
iyo, rogorc `prionproteini” _ PzP27-30. es komponentebi naxes amiloidur folaqebSi
(avadmyofi adamianebisa da cxovelebis tvinSi). jer kidev ara aris naTeli, SeiZleba
Tu ara am antigen-specifikur warmonaqmnebiT gadacema-dasnebovneba da rogor aris es
dakavSirebuli reci pientis genetikasTan masalasTan.
asea Tu ise, gamomwvevi agenti mniSvnelovan rols TamaSobs spongiformuli
encefalopaTiis CamoyalibebaSi.
is faqti, rom kurus SemTxvevebi TandaTan iSviaTdeba, laparakobs imaze, rom papua
axal gvineaSi daavadebis SemTxvevebi dakavSirebuli iyo kanibalizmTan.
msoflioSi 1 mln mosaxleze weliwadSi gvxvdeba CJD-is daavadeba 0,25 SemTxveva;
495
kerZo nawili. zogierTi neli infeqcia
ufro xSirad ki israelSi libiel ebraelebSi, slovakeTis zogierT sofelSi da a.S.

varaudoben, rom avadmyofs. infeqcia gadaecema xorcis produqtebiTa da iatrogenuli
gziT.
adamianisaTvis cxvris xorci SeiZleba iyos infeqciis wyaro. zooparkis cxovelebSi
daavadebis afeTqeba daakavSires Zvlis tviniT mdidari sakvebis miRebasTan. Tumca
spongiformuli encefalopaTiis gadacema cxovelebidan adamianebze dadasturebuli
ar aris, magram mainc iTvleba, rom bavSvebs daavadebuli cxovelebis xorci ar unda
mieces.
aRwerilia CJD-is iatrogenuli gadacema neiroqirurgiuli instrumentiT, rqovanas
transplantatiT, epilefsiis qirurgiuli mkurnalobisas inficirebuli instrumentebiT,
pituitrinis ineqciis Semdeg da sxv. ase, rom dasaSvebia gamokvleuli donorebisagan
transplantaciis dros dasnebovaneba.
sayofacxovrebo kontaqtiT dasnebovneba minimaluria, (Tumca aRwerilia 2 SemTxveva).
samedicino personali imyofeba garkveuli riskis qveS. aRwerilia neiroqirurgis,
paTanatomis, histologiuri laboratoriis TanamSromlis inficirebis SemTxvevebi.
paTologiuri cvlilebebi gamoixateba neironis vakuolizaciasa da daRupvaSi,
hialinuri ujredebis hi pertrofiaSi. daavadebis dasawyisSi cvlilebebi ufro
gamoxatulia tvinis rux nivTierebaSi. demielinizacia meoradia neironebis degeneraciis
Sedegad. Cveulebriv, anTebadi movlenebi gamoxatuli ar aris, magram aRiniSneba
astrocitebis zomebSi momateba. amiloidur folaqebs GSS-is dros daaxloebiT
70%-Si, xolo kurus dros ufro iSviaTad naxuloben. aRniSnuli folaqebi ufro
meti raodenobiTaa naTxemSi. isini reagireben Scapie-s antiSratTan.
paTogenezi. varaudoben, rom kuru-s agenti organizmSi vrceldeba dazianebuli
paTogenezi
nervidan. ucnobia kuW-nawlavis traqtidan SeRwevis meqanizmi. pirveladi fokusi
imyofeba retikulur-endoTeliur sistemaSi.
CJD-agenti naxes sisxlSi, magram ucnobia, Tu ramdenad ganapirobebs `viremia”
agentis gavrcelebas cns-Si. varaudoben, rom Scapie - agenti gadaecema cns-Si periferiuli
nervebiT. kurus dros infeqciis wyaro iyo adamianis xorci kanibalizmis SemTxvevaSi.
iatrogenul wyarod iTvleba avadmyofi adamianis tvini, Tvali. paTologiur agents
Seicaven, agreTve, Tirkmlebi, RviZli, filtvebi, limfuri kvanZebi, elenTa, Tav-zurgtvinis
siTxe.
klinika. kuru warmoadgens naTxemisa da tvinis Reros progresirebad, degeneraciul
daavadebas. pirvel niSnad iTvleba naTxemismieri ataqsia, progresuli diskoordinacia.
mzardi tremori, Tavis qalas nervebis disfunqcia, xSiria akomodaciisa da ylapvis
darRveva.
avadmyofebi iRupebian sigamxdrisa da pnevmoniis gamo. maTi sicocxlis xangrZlivoba
1 wels ar aRemateba. demencia komaSi progresirebiT gvxvdeba CJD-is dros, Tumca ar
aris encefalitis niSnebi (cxeleba, Tavis tkivili, krunCxvebi).
CJD gvxvdeba mTels msoflioSi. dasawyisSi avadmyofebs uviTardebaT sensoruli
darRvevebi an darRvevebi qcevaSi, SemdgomSi vlindeba progresirebadi demencia da koma
ramdenime kviraSi an TveSi. zogjer daavadebis dasawyisSi gvaqvs naTxemisebri ataqsia
da mioklonuri krunCxvebi.
GSS warmoadgens ojaxur daavadebas sadac naTxemisebri ataqsia ufro naTladaa
gamoxatuli, sicocxlis xangrZlivoba 1 welze naklebia, Tumca 10%-Si cxovroben 2
wlamde.
laboratoriuli kvlevebi adgenen cvlilebebs eleqtroencefalogramaSi.
kompiuteruli tomograma gviCvenebs tvinis atrofias. Tav-zurgtvinis siTxeSi SeiZleba
iyos cila, zogjer icvleba RviZlis funqciuri sinjebi.
mkurnaloba uefeqtoa.
496
danarTebi
danarTi #1. etiotropuli mkurnaloba axalSobilobis periodSi
preparatis Seyvanis sadReRamiso doza 1 kg-ze

dasaxeleba gza < 7 dRis asakis 7 dRidan - 28 dRemde
Penicillin G (K an Na marili) i.v, i.m 100 000 erT: 2 Seyvanaze 225 000 erT: 3 Seyvanaze
penicilinaza-rezistentuli
penicilinebi
Oxacillinum (Prostaphlin, Bactocill) i.v, i.m 50 - 100 mg: 3 Seyvanaze 100 - 150 mg: 4 Seyvanaze
Nafcillin (Unipen) i.v, i.m 50 mg: 2 Seyvanaze 75 mg: 3 Seyvanaze
farTo speqtris penicilinebi
Ampicillinum i.v, i.m 150 mg: 3 Seyvanaze 200 mg: 4 Seyvanaze
Mezlocillin (Mezlin) i.v 150 mg: 3 Seyvanaze masa<2kg 225mg: 3 Seyvanaze
masa>2kg 300mg: 4 Seyvanaze
Ticarcillin (Ticar) i.v, i.m 225 mg: 3 Seyvanaze 300 mg: 4 Seyvanaze
aminoglikozidebi
Gentamycin (sxvadasxva) i.v*, i.m 5 mg : 2 Seyvanaze 7.5 mg : 3 Seyvanaze
Tobramicin (Nebcin) i.v*, i.m 5 mg : 2 Seyvanaze 7.5 mg : 3 Seyvanaze
Amikacinum (Amikin) i.v*, i.m 20 mg : 2 Seyvanaze 30 mg : 3 Seyvanaze
Chloramphenicolum - i.v dRenakli 25 mg : 2 Seyvanaze dRenakli 25 mg : 1 Seyvanaze
(Chloromicetinum)¤ drouli 25 : 1 Seyvanaze drouli 50 mg : 2 Seyvanaze
cefalosporinebi
Cephalothin (Keflin) i.v 60 mg : 3 Seyvanaze 80 mg : 4 Seyvanaze
Cefazolin (Kefzol, Ancef) i.v, i.m 40 mg : 2 Seyvanaze 60 mg : 3 Seyvanaze
Cefotaxim (Claforan) i.v, i.m 100 mg : 2 Seyvanaze 150 mg : 3 Seyvanaze
Ceftazidim (Fortaz, Tazidim, i.v, i.m 100 mg : 2 Seyvanaze 150 mg : 3 Seyvanaze
Tazicef)
Ceftriaxon (Rocephin) i.v, i.m 50 mg : 1 Seyvanaze 75 mg : 1 Seyvanaze
sxva preparatebi
tienamicinis preparati
Imipenem/cilastatin (Primaxin, i.v 40 mg : 2 Seyvanaze 40 mg : 2 Seyvanaze
Tienam)
monobaqtami
Aztreonam (Azactam) i.v, i.m 90 mg : 3 Seyvanaze 120 mg : 4 Seyvanaze
linkomicinis jgufi
Clindamycin (Cleocin) i.v, i.m drouli 15 mg : 3 Seyvanaze dRenakli < 28 dReze
Per os an/da < 3.5 kg-ze
15 mg : 3 Seyvanaze
dRenakli > 28 dReze
an/da > 3.5 kg-ze
20 mg : 4 Seyvanaze
drouli 20 mg : 4 Seyvanaze
Metronidazole (Flagyl) i.v 15 mg : 2 Seyvanaze 30 mg : 3 Seyvanaze
Per os
Vancomycin (Vancocin) i.v* 30 mg : 2 Seyvanaze 45 mg : 3 Seyvanaze
antifunginuri preparatebi
Nystatinum (Mycostatin) Per os 200000-400000 erT:4 miR. 200000-400000 erT:4 miR.
Amphotericin B (Fungizone) i.v ø 0.25 - 1 mg : 1 Seyvanaze 0.25 - 1 mg : 1 Seyvanaze
antivirusuli preparati
Acyclovir (Zovirax) i.v 30 mg : 3 Seyvanaze 30 mg : 3 Seyv. HSV-s dros
* _ intravenuri Seyvana 30 - 60 wuTis ganmavlobaSi.

¤ _ iniSneba didi sifrTxiliT, saWiroa preparatis koncentraciis sisxlSi kontroli.
ø _ saWiroa Zalian neli Seyvana, wveTovnad. sxva preparatebTan Seyvana ar SeiZleba, vinaidan
preparati warmoadgens naz koloids.
497
danarTi #2 etiotropuli mkurnaloba axalSobilobis periodis Semdeg

SeniSvnebi
dasaxeleba gza saSualo simSimis mZime infeqcia
Penicillin G (K an Na marili) i.v, i.m 50000-100000erT:4 Seyv 100000-250000erT: 4 an 6 Seyv. i.v didi dozebisTvis
ixmare Na marili
Penicillin G, procaine i.m 250000-50000erT:1 an 2 Seyv. ar gamoiyeneba ukunaCvenebia prokainze
alergiis dros
Penicillin G, benzathine i.m 14kg-mde 600 000 erT ar gamoiyeneba gamoiyeneba revmatizmis
(Bicillinum, Permapen) 14 - 28kg 1 200 000 erT profilaqtikisTvis.
> 28 kg 2 400 000 erT da strept. inf. dros
Penicillin V Per os 25 - 50 mg : 3 an 4 miRebaze ar gamoiyeneba 1600 erT = 1 mg
(Phenoxymethylpenicillinum)
penicilinaza - rezistentuli
penicilinebi, naxevrad sinTezuri
Oxacillin (Prostaphlin, Bactocill) i.v, i.m 50 - 100 mg : 4 Seyvanaze 100 - 200 mg:4 an 6 Seyvanaze
(mozrdilebisTvis dRiuri (mozrdilebisTvis dRiuri
doza 2 - 4g) doza 4 - 12g)
Nafcillin (Unipen, Nafcil) i.v, i.m 50 - 100 mg : 4 Seyvanaze 100 - 200 mg:4 an 6 Seyvanaze
doza 2 - 4g) doza 4 - 12g)
Cloxacillin (Tegopen) Per os 50 - 100 mg : 4 miRebaze ar gamoiyeneba
(mozrdilebisTvis dRiuri
doza 2 - 4g) doza 2 - 4g)
Dicloxacillin (Dynapen, Pathocill, Per os 25 - 50 mg : 4 miRebaze ar gamoiyeneba
(Veracillin) (mozrdilebisTvis dRiuri
doza 2 - 4g)
farTo speqtris penicilinebi,
naxevrad sinTezuri
Ampicillin i.v, i.m 50 - 100 mg : 4 Seyvanaze 200-400mg: 4 an 6 Seyvanaze ar aris efeqturi
(mozrdilebisTvis dRiuri (mozrdilebisTvis dRiuri penicilin-rezistent.
doza 2 - 4g) doza 8 - 12 mg) stafilokokisadmi
Per os 50 - 100 mg : 4 miRebaze ar gamoiyeneba mononukleozis dros
(mozrdilebisTvis dRiuri xSirad iZleva gamonayars
doza 2 - 4g)
Amoxicillin (Amoxcil, Larotid, Per os 20 - 40 mg : 3 miRebaze ar gamoiyeneba
Polymox) (mozrdilebisTvis dRiuri
doza 750 mg - 1.5 g)
Amoxicillin Clavulanate potassium Per os 40 mg per Amoxicillin ar gamoiyeneba xSiria gulisreva,
(Augmentin) component Rebineba, diarea.
Mezlocillin (Mezlin) i.v, i.m 200-300mg: 4 an 6 Seyvanaze 200-300mg: 4 an 6 Seyvanaze
doza 16 - 24 g) doza 16 - 24 g)
Piperacillin (Piperacil) i.v, i.m 200-300mg: 4 an 6 Seyvanaze 200-300mg: 4 an 6 Seyvanaze
doza 16 - 24 g) doza 16 - 24 g)
Ticarcillin (Ticar) i.v 50 - 100 mg : 4 Seyvanaze 200-300mg: 4 an 6 Seyvanaze Seicavs 5.2 mEq Na/g
doza 4 - 8 g) doza 12 - 24 g)
Ticarcillin Clavulanate potassium i.v 200-300mg tikarcilinis : 4
(Timentin) an 6 Seyvanaze
cepalosporinebi
cepalosporinebi
Cephalothin (Keflin)
Cephalothin (Keflin) i.v
i.v 40 -- 80
40 80 mg
mg :: 4
4 Seyvanaze
Seyvanaze 100-150mg
10 0 -150 mg :: 4
4 an
an 6
6 Seyvanaze
Seyvanaz e
(moz rdilebisTvis dRiuri (moz rdilebisTvis dRiuri
doza 2 - 4g) doza 8 - 12 mg)
doz a 2 - 4g) doz a 8 - 12 mg)
Cefazolin (Kefzol, Ancef) i.v, i.m 50 mg : 4 Seyvanaze 100 mg: 4 Seyvanaze
Cefazolin (Kefzol, Ancef) i.v, i.m 50 mg : 4 Seyvanaz
(mozrdilebisTvis e
dRiuri 10 0 mg: 4 Seyvanaz
(mozrdilebisTvis e
dRiuri
(moz rdilebisTvis
doza 2 g) dRiuri (moz rdilebisTvis
doza 4 - 6 g) dRiuri
doz a 2 g) doz a 4 - 6 g)
Cephalexin (Keflex) Per os 25 - 50 mg : 4 miRebaze ar gamoiyeneba
(moz rdilebisTvis dRiuri
doz a 1 - 2 g)
Cefoxitin sodium (Mefoxin) i.v, i.m 80 - 160 mg : 4 Seyva naze 80 - 160 mg : 4 Seyva naze
Cefuroxim (Zinacef, Kefurox) i.v, i.m 50 - 10 0 mg : 3 Seyva naze ar gamoiyeneba
(moz rdilebisTvis dRiuri cns infeqciis dros
doz a 1 - 2 g)
Cefuroxime axetil (Ceftin) i.v, i.m 30 - 40 mg : 2 Seyvanaze ar gamoiyeneba
(250 - 500 mg dReSi)
498
danarTi #2 (gagrZeleba) etiotropuli mkurnaloba axalSobilobis
periodis Semdeg
preparatis eyvani sadReRamiso doza 1 kg-ze

SeniSvnebi
Cefaclor (Ceclor) Per os 40 - 60 mg : 2 an 3 miRebaze ar gamoiyeneba
Cefadroxil monohydrate Per os 30 mg : 2 miRebaze ar gamoiyeneba
(Duracef, Ultracet)
(Cefixim (Suprax) Per os 8 mg : 1 an 2 miRebaze ar gamoiyeneba suspenz ia mxolod
Sua yuris anTebisTvis;
axasiaTebs diarea
Cefprozil (Cefzil) Per os 30 C19mg : 2 miRebaz e ar gamoiyeneba
Cefoperazon (Cefobid) i.v 100 mg : 2 an 3 S eyvanaz e 150 mg : 3 Seyvanaze
(mozrdilebisTvis dRiuri (mozrdilebisaTvis dRiuri
doza 2 - 4 g) doza 8 - 12 g)
Cefotaxim (Claforan) i.v, i.m 100-150 mg : 4 S eyvanaz e 20 0 mg : 4 an 6 S eyvanaz e
(mozrdilebisTvis dRiuri (mozrdilebisaTvis dRiuri
doza 4 g) doza 8 g)
Ceftazidim (Fortaz, Tazicef, i.v, i.m 100 mg : 3 Seyvanaze 150 mg : 3 Seyvanaze
Tazidime)
Ceftriaxon (Rocephin) i.v, i.m 50-10 0 mg : 1 an 2 S eyvanaz e 100 mg : 2 Seyvanaze
monobaq tami
Aztreonam (Azactam) i.v, i.m 90 mg : 3 S eyvanaz e 120 mg : 4 Seyvanaze
karb apenemi
Imipenem-Cilastatin i.v,m 60 mg : 4 S eyvanaz e 100 mg : 4 Seyvanaze Tirkmlis ukmarisobis
(Primaxin, Tienam) dros doz a SesarCevia;
SeiZleba gamoiw. krunCxva
makrolid eb i
Erythromycin Per os 20 - 50 mg : 3 an 4 S eyvanaz e ar gamoiyeneba
doza 1 - 2 g)
i.v ar gamoiyeneba 20 - 40 mg : 3 an 4 S eyvanaz e
doza 1 - 4 g)
Clarithromycin (Biaxin) Per os 15 mg : 2 miRebaze
aminoglikozidebi
Gentamycin (Garamycin) i.v, i.m ar gamoiyeneba 3 - 7.5 mg : 3 S eyvanaz e aminoglikoz idebi cudad
(mozrdilebisTvis dRiuri aRweven Tavzurgtvinis
doza 3 - 7 mg/kg dReS i) siTxes; i.v Seyvana
saWiroa gagrZeldes
30-60 wT-is ganmavlobaSi;
mukoviscidozis dros
SeiZleba dasWirdes ufro
maRali doz ebi
Tobramycin (Nebcin) i.v, i.m ar gamoiyeneba 7.5 mg: 3 Seyvanaze
doza 3 - 7 mg/kg dReS i)
Amikacin (Amikin) i.v, i.m ar gamoiyeneba 15-20 mg : 2 an 3 Seyvanaze
doza 15 mg/kg dReSi)
Neomycin (Mycifradin) Per os 100 mg : 4 Seyvanaze
linkozamid eb i
Clindamycin (Cleocin) Per os 10 - 25 mg : 4 Seyvanaze 25 - 40 mg : 4 Seyvanaze
i.v, i.m (mozrdilebisTvis dRiuri (mozrdilebisTvis dRiuri
doza 600 - 120 0 mg) doza 120 0 - 2700 mg)
nitroimidazoleb i i.v i.v 30 mg : 4 S eyvanaz e i.v 30 mg : 4 S eyvanaz e
Metronidazol (Flagyl) (mozrdilebisTvis dajerebis (mozrdilebisTvis dajerebis
doza 15 mg/kg, S emdeg doza 15 mg/kg, S emdeg
30mg/kg : 4 Seyvanaze) 30mg/kg : 4 Seyvanaze)
Per os Per os 15 - 35 mg : 3 miRebaze Per os 15 - 35 mg : 3 miRebaze
doza 200 0 mg) doza 200 0 mg)
glikop ep tidebi i.v i.v 40 mg : 4 S eyvanaz e i.v 40 - 60 mg : 4 Seyvanaze
Vancomycin (Vancocin) (mozrdilebisTvis dRiuri (mozrdilebisTvis dRiuri
doza 2 g) doza 2 g)
Per os Per os 10 - 50 mg:L4 miRebaz e Per os 10 - 50 mg:L4 miRebaz e dasalevad mxolod
(mozrdilebisTvis dRiuri (mozrdilebisTvis dRiuri C. difficile - s kolitis
doza 500 mg) doza 500 mg) dros
tetraciklinebi
Doxycycline hyclate (Vibramycin, i.v ar gamoiyeneba 2 - 4 mg : 1 Seyvanaze i.v infuzia 2 sT-s ganmavl.
s xva) Per os 2 - 4 mg : 1 an 2 miRebaze ar gamoiyeneba damax asiaTebelia kbilis
(mozrdilebisTvis dRiuri SeRebva, gamoiyeneba
doza 100 mg 2-jer) mxolod 8 wlis z emoT da
gansakuTrebul S emTx vevaSi
499
danarTi #2 (gagrZeleba) etiotropuli mkurnaloba axalSobilobis
periodis Semdeg

SeniSvnebi
Chloramphenicol
suqcinati i.v ar gamoiyeneba 50 - 100mg : 3 an 4 Seyvanaze ar aris rekomendebuli
(mozrdilebisTvis dRiuri kunTebS i S eyvana;
doza 2 - 4 mg)
palmitati Per os ar gamoiyeneba 50 - 75 mg: 3 an 4 miRebaze
doza 2 - 4 g)
sulfanilamidebi
Sulfadiazin i.v, sc 120 mg : 4 Seyvanaze 120-150 mg : 4 Seyvanaze sulfanilamidebis
pirveli doza ormagdeba;
mozrdilebisTvis dRiuri
doza Per os 2- 4 g;
da i.v da sc igivea rac
bavSvebisaTvis
Sulfisoxazole (Gantrisin) i.v, sc 120 mg : 4 Seyvanaze 120-150 mg : 4 Seyvanaze
Per os 120 mg : 4 miRebaze ar gamoiyeneba
Trimethoprim-sulfamethoxazole Per os 8 mg Trimethoprim-i, 40 mg 20 mg Trimethoprim-i,
(Bactrim, Septra) i.v sulfamethoxazole-i : 2 miRebaze 100 mg sulfamethoxazole-i
: 4 Seyvanaze
saSarde gzebis antiseptikuri
saSualebebi
Methanamine mandelate Per os 50 - 70 mg: 3 an 4 miRebaze ar gamoiyeneba 1 wlamde asakSi ar
(mandelamine) (mozrdilebisTvis dRiuri ixmareba, pH unda iyo 5-5.5
doza 2 - 4 g)
Nitrofurantoin (Furadantin, Per os 5 - 7 mg: 4 miRebaze ar gamoiyeneba 1 wlamde asakSi ar
Macrodantin) (mozrdilebisTvis dRiuri gamoiyeneba.
doza 200 - 400 mg)
antifunginuri preparatebi
Nystatin (Mycostatin, Nilstat) Per os 600.000-2.000.000erT:3an4 miReb.
Amphotericin B (Fungizone) i.v 0.25 - 1 mg : 1 Seyvanaze 0.5 - 1 mg : 1 Seyvanaze Zalian neli infuzia
ar SeurioT sxva
preparatTan, (preparati
warmoadgens naz koloids).
Flucytozine (Ancobon) Per os 50 - 150 mg : 4 miRebaze 50 - 150 mg : 4 miRebaze rogorc monoTerapia
(mozrdilebisTvis dRiuri (mozrdilebisTvis dRiuri iSviaTad gamoiyeneba,
doza 50 - 150 mg/kg: 4 miRebaze) doza 50 - 150 mg/kg: 4 miRebaze) vinaidan misadmi male
viTardeba rezistentoba
Fluconazole (Diflucan) Per os 3 - 6 mg/kg : 1 miRebaze
i.v doza 100 - 200 1: miRebaze
Grizeofulvin Per os 15 mg : 1 miRebaze 15 mg : 1 miRebaze
doza 250 - 500 mg) doza 250 - 500 mg)
Ketoconazole (Nizoral) Per os 5 -10 mg: 1 an 2 miRebaze 5 -10 mg: 1 an 2 miRebaze
(mozrdilTaTvis dRiuri (mozrdilTaTvis dRiuri
doza 200 - 400 mg : 1 miRebaze doza 200 - 400 mg : 1 miRebaze
sx va preparatebi
Pendamidine (Pentam 300) i.v, i.m 4 mg : 1 Seyvanaze infuzia 1 - 3 sT-s ganmavlobaSi
wnevis kontroliT
Ciprofloxacin (Cipro) Per os 20 - 30 mg :L2 miRebaze ar gamoiyeneba ar unda ixmarebodes
(mozrdilTaTvis dRiuri 18-21 wlamde
doza 500 : 2 miRebaze)
inhalacia 300 mg mTliani doza mukoviscidozis dros
antivirusuli preparatebi
Acyclovir (Zovirax)
Acyclovir (Zovirax) i.v
i.v 750 mg/m2/dReSi
750 mg/m2/dReSi :: 33 Seyvanaze
Seyvanaze 1.5 g/m2
1.5 g/m2 :: 33 Seyvanaze
Seyvanaze Tirkmlis funqciis
Tirkmlis funqciis
kontroli; ufro maRali
kontroli; ufro maRali
dozebi. VZV-s dros
dozebi. VZV-s dros
riskis jgufis pacientebSi
riskis jgufis pacientebSi
Per os 1 g : 5 miRebaze ar gamoiyeneba 2 wlamde genitaruli HSV-isTvis
Per os 1 g : 5 miRebaze ar gamoiyeneba 2 wlamde genitaruli HSV-isTvis
80 mg : 4 miRebaze ar gamoiyeneba janmrTeli bavSvebisTvis
80 mg : 4 miRebaze ar gamoiyeneba janmrTeli bavSvebisTvis
Cutyvavilas dros
Cutyvavilas dros
i.v 30 mg : 3 Seyvanaze HSV encefalitis dros
i.v 30 mg : 3 Seyvanaze HSV encefalitis dros
Amantadine (Symmetrel) Per os 5 - 8 mg : 2 miRebaze ar gamoiyeneba
Amantadine (Symmetrel) Per os 5 - 8 mg : 2 miRebaze ar gamoiyeneba
(maqsimaluri dRiuri doza
(maqsimaluri dRiuri doza
200 mg)
200 mg)
Didioxyinosine (Videx) i.v, Per os 180 mg/m2 : 3 Seyvanaze
Didioxyinosine (Videx) i.v, Per os 180 mg/m2 : 3 Seyvanaze
Ganciclovir (Cytovene) i.v 10 mg : 2 Seyvanaze
Ganciclovir (Cytovene) i.v 10 mg : 2 Seyvanaze
Ribavirin (Virazole) inhalacia 6 g boTli SPAC-2 aerozolis xsnari Seicavs 20 mg/ml
Ribavirin (Virazole) inhalacia 6 g boTli SPAC-2 aerozolis xsnari Seicavs 20 mg/ml
generatoris dax marebiT
1 : 12-18 sT-Si
Zidovudine (Retrovir) Per os 720 mg/m2 : 4 miRebaze
i.v 480 mg/m2 : 4 Seyvanaze
SeniSvna: i.v _ venaSi Sesayvanad. Per os _ dasalevad.

i.m _ kunTebSi Sesayvanad. sc _ kanqveS.
500
zogjer preparatis dozireba moiTxovs sxeulis zedapiris
farTobis codnas, risTvisac mogvyavs Mosteller -is farTo
praqtikaSi miRebuli formula
Mosteller -is formula:
sxeulis zedapiris farTobi (m2) =

√ simaRle (sm) X masa (kg)
3600
sxeulis zedapiris farTobis gamoTvlis nomograma:
Nomogram - nomograma
Height - simaRle
cm - sm
in - diuimi
For children of normal height for weight - normaluri simaRlisa da masis Sefardeba
S.A. - zedapiris farTobi
M2 - m 2
Weight - masa
lb - funtebSi
kg - kg-Si
Weight in pounds - masa funtebSi
Surface area in square meters - zedapiris farTobi m2-Si
501
Crawford and associates
masisa (funtebSi), sxeulis zedapiris farTobisa da mozrdilTa dozebis gaangariSeba
Surface Area - sxeulis zedapiris farTobi m2-Si

Percent Adult Dos - mozrdilTa dozis %
pounds to SQ meter (m2) - funtebSi - kvadratul metrze
Body Weight-Pounds - sxeulis masa - funtebi
funti - girvanqa _ 454g
diuimi - 2,54sm
502
danarTi #3 specifikuri profilaqtika
aSS-Si miRebu li vaqcin ebi da maTi daxasiaTeba

vaqcinebi vaqcinis tipi Seyvanis gza
Adenovirus _ adenovirusis sawinaaRmdego cocxali virusi per os
Anthrax _ cimbiris wylulis sawinaaR mdego inaqtivirebuli baqteriebi kanqveS
BCG _ tuber kulozis sawinaaRmdego cocxali baqteriebi kanSi, kanqveS
kanqveS, kunTebSi,
Cholera _ qoleris sawinaaRmdego inaqtivirebuli baqteriebi
kanSi
DTP _ difT er ia, tetanusisa da yivanaxvelas
anatoqsini da inaqtivirebuli baqteriebi kunTebSi
sawinaaR mdego
DTaP _ difT er ia, tetanusi, acelulur i
anatoqsini da inaqtivirebuli baqteriebi kunTebSi
yivanaxvelas sawinaaR mdego
Hepatitis A _ A hepatitis sawinaaRmdego inaqtivirebuli virusi kunTebSi
Hepatitis B_ B hepatitis sawinaaRmdego inaqtivirebuli virusuli antigeni kunTebSi
Hib Conjugates _ H. influenzae b tipis
polisaqariduli cilovani koniugati kunTebSi
koniugirebuli vaqcina
Hib Conjugates - DTaP _ H. influenzae b tipis polisaqariduli cilovani koniugati,
koniugati, difTeria-tetanus acelulur i difTeria-tetanusis anatoqsini da kunTebSi
yivanaxvelas sawinaaR mdego inaqtivirebuli baqteriuli komponentebi
Hib polisaqariduli koniugati, difTeria-
Hib Conjugates DTP _ H. influenzae b tipis, DTP tetanusis anatoqsini da inaqtivirebuli kunTebSi
baqteria
Hib Conjugate (PRP _ OMP) - hepatitis B _ H. polisaqariduli Hib koniugati,
kunTebSi
influenzae b tipis, hepatit B-s sawinaaRmdego inaqtivirebuli B virusi
inaqtivirebuli mTliani virusi, virusuli
Influenzae _vir usuli gripis sawinaaRmdego kunTebSi
komponentebi
Japanese encephalitis _ iaponuri encefalitis
inaqtivirebuli virusi kanqveS
sawinaaR mdego
Measles _ wiTelas sawinaaR mdego cocxali virusi kanqveS
Meningococcal _ meningokokuri vaqcina polisaqariduli kanqveS
MMR (Measles, Mumps, rubella) _ wiTela, ybayur a,
cocxali virusebi kanqveS
wiTur a
Measles - Rubella _ wiTela-wiT ura cocxali virusebi kanqveS
Mumps _ epid. par otiti cocxali virusi kanqveS
Pertussis _ yivanaxvela inaqtivirebuli baqteriebi kunTebSi
Plaque _ Savi Wiri inaqtivirebuli baqteriebi kunTebSi
Pneumococcal _ pnevmokokuri polisaqariduli kunTebSi an kanqveS
Poliovirus (poliovirusi):
OPV cocxali virusi per os
IPV inaqtivirebuli virusi kanqveS
Rabies _ cofi inaqtivirebuli virusi kunTebSi, kanSi
Rubella _ wiTura cocxali virusi kanqveS
Tetanus _ tetanusi anatoqsini kunTebSi
Tetanus-diphtheria (Td, DT) _ tetanusi-difTeria anatoqsinebi kunTebSi
Typhoid _ muclis tifi
parenteruli inaqtivirebuli baqteria kanqveS
kanqveS (busteruli
parenteruli kafsuluri polisaqaridi
doza SeiZleba kanSi)
oraluri cocxali baqteria per os
Varicella _ Cutyvavila cocxali virusi kanqveS
Yellow fever _ yviTeli cxeleba cocxali virusi kanqveS
503
danarTi #3 (gagrZeleba) specifikuri profilaqtika
acrebis kalendari saqarTveloSi

vaqcina asaki
0-5 dRe 2 Tve 3 Tve 4 Tve 8 Tve 12 Tve 18 Tve 5 weli 14 weli
BCG (tuberk.) BCG 1 BCG 2
DTP (difTeria,
DTP 1 DTP 2 DTP 3 DTP 4
tetanusi, yivanaxvela)
OPV (oraluri
OPV 1 OPV 2 OPV 3 OPV 4 OPV 5
poliovaqcina)
wiTela wiTela 1 wiTela 2
ybayura ybayura 1
DT (difTeria, tetanusi) DT
Td (tetanusi, difTeria) Td
hepatiti B (HB) HB 1 HB 2 HB 3
zogierTi laboratoriuli maCvenebeli

sisxli
sisxli erTeuli S i erTeuli
6 3 12
eriTrocitebi Wiplari 3.9 - 5.5X10 mm (mkl) 3.9 - 5.5X10 /l
6 3 12
1 - 3 dRis (kapilarSi) 4.0 - 6.6X10 mm (mkl) 4.0 - 6.6X10 /l
6 3 12
1 kviris 3.9 - 6.3X10 mm (mkl) 3.9 - 6.3X10 /l
6 3 12
2 kviris 3.6 - 6.2X10 mm (mkl) 3.6 - 6.2X10 /l
6 3 12
1 Tvis 3.0 - 5.4X10 mm (mkl) 3.0 - 5.4X10 /l
6 3 12
2 Tvis 2.7 - 4.9X10 mm (mkl) 2.7 - 4.9X10 /l
6 3 12
3 - 6 Tvis 3.1 - 4.5X10 mm (mkl) 3.1 - 4.5X10 /l
6 3 12
6 Tvis - 2 wlis 3.7 - 5.3X10 mm (mkl) 3.7 - 5.3X10 /l
6 3 12
2 - 6 wlis 3.9 - 5.3X10 mm (mkl) 3.9 - 5.3X10 /l
6 3 12
6 - 12 wlis 4.0 - 5.2X10 mm (mkl) 4.0 - 5.2X10 /l
12 - 18 wlis:
6 3 12
vaJebi 4.5 - 5.3X10 mm (mkl) 4.5 - 5.3X10 /l
6 3 12
gogonebi 4.1 - 5.1X10 mm (mkl) 4.1 - 5.1X10 /l
mozrdilebi:
6 3 12
mamakacebi 4.5 - 5.9X10 mm (mkl) 4.5 - 5.9X10 /l
6 3 12
qalebi 4.0 - 5.2X10 mm (mkl) 4.0 - 5.2X10 /l
eriTrocitebis bavSvebi 0 - 10 mm/sT 0 - 10 mm/sT
daleqvis siCqare mozrdilebi < 50 weli:
(Westergren-iT) mamakacebi 0 - 15 mm/sT 0 - 15 mm/sT
qalebi 0 - 20 mm/sT 0 - 20 mm/sT
mozrdilebi >50 weli:
mamakacebi 0 - 20 mm/sT 0 - 20 mm/sT
qalebi 0 - 30 mm/sT 0 - 30 mm/sT
retikulocitebi < 1 dRe 0.4 - 6.0% 0.004 - 0.060
< 1 kvira < 0.1 - 1.3% < 0.001 - 0.013
1 - 4 kvira < 1.0 - 1.2% < 0.001 - 0.012
5 - 6 kvira 0.1 - 2.4% 0.001 - 0.024
eriTrocitebis saerTo 7 - 8 kvira 0.1 - 2.9% 0.001 - 0.029
raodenobis % 9 - 10 kvira < 0.1 - 2.6% < 0.01 - 0.026
11 - 12 kvira 0.1 - 1.3% 0.001 - 0.013
SemdgomSi 0.5 - 1.5% 0.005 - 0.015
3
an 25000 - 75000/mm (mkl)
504
zogierTi laboratoriuli maCvenebeli (gagrZeleba)
si sx l i
si sx l i e r T eu l i S i e r T eu l i
3 3 9
l e ikoc it e bi s isx l S i dab ad eb isas 9 .0 - 30 .0 X 10 /m m ( m kl ) 9 .0 - 30 .0 X 10 /l
3 3 9
< 1 dRe 9 .4 - 34 .0 X 10 /m m ( m kl ) 9 .4 - 34 .0 X 10 /l
3 3 9
1 T ve 5.0 - 19 .5X 10 /m m ( m kl ) 5.0 - 19 .5X 10 /l
3 3
3 wel i 6.0 - 17 .5X 10 /m m ( m kl ) 6.0 - 17 .5X 10 9 /l
3 3
4 - 7 wel i 5.5 - 15.5X 10 /m m ( m kl ) 5.5 - 15.5X 10 9 /l
3 3 9
8 - 13 wel i 4 .5 - 13.5X 10 /m m ( m kl ) 4 .5 - 13.5X 10 /l
3 3 9
> 13 we l i 4 .5 - 11.0 X 10 /m m ( m kl ) 4 .5 - 11.0 X 10 /l
difer en c ir e b u l i
l e ikoc it e bi:
m ie l oc it e bi 0 0
9
n eit r ofil e b i se g m e nt . 54 - 62% 0 .54 - 0 .62X 10 /l
9
n eit r ofil e b i Cx ir b ir T . 3 - 5% 0 .0 3 - 0 .0 5X 10 /l
l im foc it e bis sae r T o d a
s u b popu l ac ieb is r aod en ob a
asakis m ix e dv iT
9 9
s ae r T o l im foc it eb i 2 - 3 T ve 2,9 2 - 8,84 X 10 /l 2,9 2 - 8,84 X 10 /l
55 - 7 8% 0 ,55 - 0 ,7 8
9 9
4 - 8 T ve 3,61 - 8,84 X 10 /l 3,61 - 8,84 X 10 /l
45 - 79 % 0 ,4 5 - 0 ,7 9
12 - 23 T v e 2,18 - 8,27 X 10 9 /l 2,18 - 8,27 X 10 9 /l
4 4 - 7 2% 0 ,4 4 - 0 ,7 2
9 9
24 - 59 T ve 2,4 0 - 5,81 X 10 /l 2,4 0 - 5,81 X 10 /l
38 - 64 % 0 ,38 - 0 ,64
9 9
m oz r dil e b i 1,50 - 3,0 0 X 10 /l 1,50 - 3,0 0 X 10 /l
25 - 33% 0 ,25 - 0 ,33
CD 3 (T u j re d e bis 2 - 3 Tv e 2 , 0 7 - 6 , 54 X 1 0 9 /l 2 , 0 7 - 6 , 54 X 1 0 9 /l
s a e rT o r -b a ) 60 - 87% 0 ,60 - 0 ,84
4 - 8 Tv e 2 , 2 8 - 6 , 45 X 1 0 9 /l 2 , 2 8 - 6 , 45 X 1 0 9 /l
57 - 8 4% 0 , 57 - 0 , 84
1 2 - 2 3 Tv e 1 , 46 - 5, 44 X 1 0 9 /l 1 , 46 - 5, 44 X 1 0 9 /l
53 - 81 % 0 , 53 - 0 , 81
2 - 6 we l i 1 , 6 1 - 4, 23 X 1 0 9 /l 1 , 6 1 - 4, 23 X 1 0 9 /l
62 - 80 % 0 62 - 0 , 80
m oz rd il eb i 0 56 - 1 , 95 X 1 0 9 /l 0 56 - 1 , 95 X 1 0 9 /l
59 - 8 1 % 0 , 59 - 0 , 81
CD 4 (T he l p e re bi) 2 - 3 Tv e 1 , 46 - 5, 1 1 X 1 0 9 /l 1 , 46 - 5, 1 1 X 1 0 9 /l
41 - 6 4% 0 , 6 0 - 0 , 84
4 - 8 Tv e 1 , 6 9 - 4, 60 X 1 0 9 /l 1 , 6 9 - 4, 60 X 1 0 9 /l
36 - 6 1 % 0 , 36 - 0 , 61
1 2 - 2 3 Tv e 1 , 0 2 - 3, 60 X 1 0 9 /l 1 , 0 2 - 3, 60 X 1 0 9 /l
31 - 54% 0 , 31 - 0 , 54
2 - 6 we l i 0 , 9 0 - 2 , 86 X 1 0 9 /l 0 , 9 0 - 2 , 8 6 X 1 0 9 /l
35 - 51 % 0 , 35 - 0 , 51
m oz rd il eb i 0 , 35 - 1 , 33 X 1 0 9 /l 0 , 35 - 1 , 33 X 1 0 9 /l
31 - 35% 0 , 31 - 0 , 55
505
sisxli
sisxli erTeuli S ierTeuli
CD 8 (T citotoqsikurisuper- 2 - 3 Tve 0,65 -2,45 X 10 9 /l 0,65 -2,45 X 10 9 /l
sorebi) 16 - 35% 0,16 - ,35
4 - 8 Tve 0,72 - 2,49 X 10 9 /l 0,72 - 2,49 X 10 9 /l
16 - 34% 0,16 - 0 ,34
12 - 23 Tve 0,57 - 2,23 X 10 9 /l 0,57 - 2,23 X 10 9 /l
16 - 38% 0,16 - 0 ,38
2 - 6 weli 0,63 - 1,91 X 10 9 /l 0,63 - 1,91 X 10 9 /l
22 - 38% 0,22 - 0,38
mozrdilebi 0,15 - 0,81 X 10 9 /l 0,15 - 0,81 X 10 9 /l
17 - 38% 0,17 - 0 ,38
CD 4/CD 8 2 - 3 Tve 1,32 - 3,47
4 - 8 Tve 1,20 - 3,48
12 - 23 Tve 0,95 - 2,95
2 - 6 weli 1,0 5 - 2,0 7
mozrdilebi 0,84 -3,0 5
CD 9 (B limfocitebi) 2 - 6 Tve 1,30 -2,50 X 10 9 /l 1,30 -2,50 X 10 9 /l
21 - 35% 0,21 - 0 ,35
7 - 18 Tve 0,80 - 1,60 X 10 9 /l 0,80 - 1,60 X 10 9 /l
21 - 32% 0,21 - 0 ,32
19 - 36 Tve 0,60 - 0,90 X 10 9 /l 0,60 - 0,90 X 10 9 /l
21 - 26% 0,21 - 0 ,26
37 - 48 Tve 0,40 - 0,60 X 10 9 /l 0,40 - 0,60 X 10 9 /l
15 - 23% 0,15 - 0,23
49 - 60 Tve 0,30 - 0,90 X 10 9 /l 0,30 - 0,90 X 10 9 /l
14 - 23% 0,14 - 0 ,23
mozrdilebi 7 - 23% 0,00 7 - 0 ,23
monocitebi 3 - 7% 0.03 - 0.07X10 9 /l
eozinofilebi 1 - 3% 0.01 - 0 .03X10 9 /l
bazofilebi 0 - 0 .75 % 0 - 0 .0075X10 9 /l
alanin-aminotransferaza 0-5 dRe 6-50 erT/l 6-50 erT/ l raitman-frenkelis wesiT.
(alat, glutamatpiruvat- 1-19 weli 5-45 erT/l 5-45 erT/l 0.1-0 68 mkmol/(sT.ml.)
transaminaza) SratSi mozrdilebi 7-53 erT/l 7-53 erT/l 28-190 nmol/(wm.l.)
aspartat-aminotransferaz a 0-5 dRe 35-140 erT/l 35-140 erT/ l raitman-frenkelis wesiT.
(asat, glutamoqsaloacetu- 1-19 weli 5-55 erT/l 5-55 erT/ l 0.1-0 45 mkmol/(sT.ml.)
ri transaminaza) SratSi mozardebi 11-47 erT/l 11-47 erT/ l 28-190 nmol/(wm.l.)
albumini plaz maSi dRenakl. axalSob.
< 1 dRe 1.8 - 3.0 g% (g/dl) 18 - 30 g/l
dResruli axalSob.
< 6 dRe 2.5 - 3.4 g% (g/dl) 25 - 34 g/l
5 w. 3.9 - 5.0 g% (g/dl) 39 - 50 g/l
5-19 w. 4.0 - 5.3 g% (g/dl) 40 - 53 g/l
mozrdilebi 3.6 - 5.0 g% (g/dl) 36 - 50 g/l
acetoni SratSi, 0.3 - 2.0 mg% (mg/dl) 0.05 - 0.34 mmol/l
plaz maSi (raodenobrivi)
bilirubini saerTo Wiplari < 2.0 mg% (mg/dl) < 34 mkmol/l
SratSi dRenakl. axalSob:
0.1 dRe < 8.0 mg% (mg/dl) < 137 mkmol/l
1-2 dRe < 12.0 mg% (mg/dl) < 205 mkmol/l
> 5 dReze meti < 2.0 mg% (mg/dl) < 34 mkmol/l
dResruli axalSob:
> 5 dReze meti 0.2 - 1.0 mg% (mg/dl) 3.4 - 17.1 mkmol/l
mozrdilebi 0.2 - 1.3 mg% (mg/dl) 3.4 - 22.2 mkmol/l
506
sisxli
bilirubini koniugirebuli 0 - 0 .2 mg% (mg/dl) 0 - 3.4 mkmol/l
SratSi
γ-glutamiltranspep- Wiplari 37 - 193 erT/l 37 - 193 erT/l
tidaza (γ-glutamil-, 0 - 1 Tve 12 - 123 erT/l 12 - 123 erT/l
transferaza, ggtp) 2 - 4 Tve 8 - 90 erT/l 8 - 90 erT/l
4 Tve - 10 weli 5 - 32 erT/l 5 - 32 erT/l
10 - 15 weli 5 - 24 erT/l 5 - 24 erT/l
glukoza SratSi Wiplari 45 - 96 mg% (mg/dl) 2.5 - 5.3 mmol/l
ax alSob. 1 dRis 40 - 60 mg% (mg/dl) 2.2 - 3.3 mmol/l
> 1 dReze 50 - 90 mg% (mg/dl) 2.8 - 5.0 mmol/l
bavSvebi 60 - 10 0 mg% (mg/dl) 3.3. - 5.5 mmol/l
mozrdilebi 70 - 10 5 mg% (mg/dl) 3.9 - 5.8 mmol/l
2 sT Wamis Semdeg < 120 mg% (mg/dl) < 6.7 mmol/l
Trombinuli dro dRenakl. axalSob. 11 - 17 wm 11 - 17 wm
(sisx lSi) dResrul. axalSob. 10 - 16 wm 10 - 16 wm
mozrdilebi 11.3 - 18.8 wm 11.3 - 18.8 wm
Tromboplastinuri dro
_ aqtivirebuli 1 wlamde asakSi < 90 wm < 90 wm
Semdgomi 25 - 35 wm 25 - 35 wm
_ araqtivirebuli 60 - 85 wm 60 - 85 wm
Trombocitebi < 1 kviraze 84-478X10 3 /mm 3 (mkl) 84 - 478X10 9 /l
(sisx lSi) SemdgomSi 150 -40 0 X10 3 /mm 3 (mkl) 150 - 40 0 X10 9 /l
proTrombinuli dro dRenakl. axalSob. 14.6 - 1 6.9 wm 14.6 - 1 6.9 wm
(sisx lSi) dResrul. axalSob. 10 .1 - 15.9 wm 10 .1 - 15.9 wm
bavSvebi/mozrdilebi 10 .8 - 1 3.9 wm 10 .8 - 1 3.9 wm
kaliumi < 2 Tve 3.0 - 7.0 mmol/l 3.0 - 7.0 mmol/l
(SratSi) 2 - 12 Tve 3.5 - 6.0 mmol/l 3.5 - 6.0 mmol/l
> 12 Tve 3.5 - 5.0 mmol/l 3.5 - 5.0 mmol/l
kalciumi saerTo Wiplari 9.0 - 11.5 mg% (mg/dl) 2.25 - 2.88 mmol/l
SratSi ax alSobili:
umwifari < 1 kvira 6 - 10 mg% (mg/dl) 1.5 - 2.5 mmol/l
dResruli:
3 - 24 sT 9.0 - 10 .6 mg% (mg/dl) 2.3 - 2.65 mmol/l
24 - 48 sT 7.0 - 12.0 mg% (mg/dl) 1.75 - 3.0 mmol/l
4 - 7 dRe 9.0 - 10 .9 mg% (mg/dl) 2.25 - 2.73 mmol/l
bavSvebi 8.0 - 10 .5 mg% (mg/dl) 2.0 - 2.6 mmol/l
mozrdilebi 8.5 - 10 .5 mg% (mg/dl) 2.1 - 2.6 mmol/l
kalciumi ioniozirebuli Wiplari 5.0 - 6.0 mg% (mg/dl) 1.25 - 1.50 mmol/l
(SratSi, plazmaSi) 0 - 1 dRe 4.3 - 5.1 mg% (mg/dl) 1.0 7 - 1.27 mmol/l
1 - 2 dRe 4.0 - 4.7 mg% (mg/dl) 1.0 0 - 1.17 mmol/l
SemdgomSi 4.8 - 4.92 mg% (mg/dl) 1.12 - 1.23 mmol/l
an 2.24 - 2.46 meqv/l
ketonuri sx eulebi 0 .5 - 3.0 mg% (mg/dl) 5 - 30 mg/l
(raodenobrrivi)
ketonuri sx eulebi 0 0
(xarisxobrivi)
507
sisxli
kreatinini Wiplari 06. - 1.2 mg% (mg/dl) 53 - 10 6 mkmol/l
axalSobili 0.3 - 1.0 mg% (mg/dl) 27 - 88 mkmol/l
Cvilebi 0.2 - 0 .4 mg% (mg/dl) 18 - 35 mkmol/l
bavSvebi 0.3 - 0 .7 mg% (mg/dl) 27 - 62 mkmol/l
mozardebi 0.5 - 1.0 mg% (mg/dl) 44 - 88 mkmol/l
mozrdilebi:
qalebi 0.5 - 1.1 mg% (mg/dl) 44 - 97 mkmol/l
mamakacebi 0.6 - 1.2 mg% (mg/dl) 53 - 10 6 mkmol/l
magniumi 0 - 6 dRe 1.2 - 2.6 mg% (mg/dl) 0.48 - 1.05 mmol/l
7 dRe - 2 weli 1.6 - 2.7 mg% (mg/dl) 0.65 - 1.10 mmol/l
2 - 14 weli 1.5 - 2.3 mg% (mg/dl) 0.60 - 0.95 mmol/l
mozrdilebi 1.6 - 2.7 mg% (mg/dl) 0.65 - 1.10 mmol/l
natriumi axalSobilebi:
(SratSi, plazmaSi) dResruli, 134 - 146 mmol/l 134 - 146 mmol/l
dRenakli 130 - 140 mmol/l 130 - 140 mmol/l
Cvilebi 139 - 146 mmol/l 139 - 146 mmol/l
bavSvebi 138 - 145 mmol/l 138 - 145 mmol/l
mozrdilebi 136 - 148 mmol/l 136 - 148 mmol/l
C _ reaqtiuli cila Wiplari 52 - 1330 ng/ml 52 - 1330 mkg/l
(SratSi) 2 - 12 weli 67 - 1800 ng/ml 67 - 1800 mkg/l
rkina axalSobilebi 100 - 250 mkg% 17.9 - 44.75 mkmol/l
(SratSi) Cvilebi 40 - 10 0 mkg% 7.16 - 17.90 mkmol/l
bavSvebi 50 - 120 mkg% 8.95 - 21.48 mkmol/l
mozrdilebi:
mamakacebi 50 - 160 mkg% 8.95 - 28.64 mkmol/l
qalebi 40 - 150 mkg% 7.16 - 26.85 mkmol/l
rkinis SeboWvis < 1 weli 100 - 400 mkg% 17, 90 - 71.60 mkmol/l
unari SemdgomSi 250 - 400 mkg% 44.75 - 71.60 mkmol/l
sisxldenis dro normaluri 2 - 7 wT. 120 - 420 wm.
mosazRvre 7 - 11 wT. 420 - 660 wm.
sisxlis raodenoba mamakacebi 52 - 83 ml/kg 0.0 52 - 0.083 l/kg
qalebi 50 75 ml/kg 0.0 50 - 0.057 l/kg
folis mJava
eriTrocituli 150 - 450 ng/ml.eriTr. 340 - 1020 nmol/l ujredi
plazmis axalSobilebi 7.0 - 32 ng/ml 15.9 - 72.4 nmol/l
SemdgomSi 1.8 - 9.0 ng/ml 4.1 - 20 .4 nmol/l
qlori Wiplari 96 - 10 4 mmol/l 96 - 10 4 mmol/l
(CL-) axalSobili 97 - 110 mmol/l 97 - 110 mmol/l
Semdgom 98 - 10 6 mmol/l 98 - 10 6 mmol/l
qolesterini < 3 weli 45 - 182 mg% (mg/dl) 1.15 - 4.70 mmol/l
(saerTo) 4 - 6 weli 109 - 189 mg% (mg/dl) 2.80 - 4.80 mmol/l
bavSvebi <170 mg% (mg/dl) (sasurv.) < 4.3 mmol/l
mozrdilebi <200 mg% (mg/dl) (sasurv.) < 5.1 mmol/l
SardmJava 1 - 5 weli 1.7 - 5.8 mg% (mg/dl) 100 - 350 mkmol/l
6 - 11 weli 2.2 - 6.6 mg% (mg/dl) 130 - 390 mkmol/l
12 - 19 weli:
vaJebi 3.0 - 7.7 mg% (mg/dl) 180 - 460 mkmol/l
gogonebi 2.7 - 5.7 mg% (mg/dl) 160 - 340 mkmol/l
mozrdilebi 3.0 - 8.0 mg% (mg/dl) 179 - 476 mkmol/l
508
sisxli
Sardovana Wiplari 21 - 40 mg% (mg/dl) 7.5 - 14.3 mmol/l
axalSobilebi:
dRenakli 3 - 25 mg% (mg/dl) 1.1 - 9.0 mmol/l
dResruli 3 - 12 mg% (mg/dl) 1.1 - 4.3 mmol/l
bavSvebi 5 - 18 mg% (mg/dl) 1.8 - 6.4 mmol/l
mozrdilebi 7 - 18 mg% (mg/dl) 2.5 - 6.4 mmol/l
Sededebis dro 5 - 8 wT. minis sinjaraSi 5 - 8 wT.
cila saerTo axalSobilebi:
dRenakli 4.3 - 7.6 g% (g/dl) 43 - 76 g/l
dResruli 4.6 - 7.4 g% (g/dl) 46 - 74 g/l
1 - 7 weli 6.1 - 7.9 g% (g/dl) 61 - 79 g/l
8 - 12 weli 6.4 - 8.1 g% (g/dl) 64 - 81 g/l
13 - 19 weli 6.6 - 8.2 g% (g/dl) 66 - 82 g/l
mozrdilebi 6.2 - 8.2 g% (g/dl) 62 - 82 g/l
eleqtroforeziT axalSobilebi:
albumini dRenakli 3.0 - 4.2 g% (g/dl) 30 - 42 g/l
dResruli 3.6 - 5.4 g% (g/dl) 36 - 54 g/l
< 1 wlis 4.0 - 5.0 g% (g/dl) 40 - 50 g/l
SemdgomSi 3.5 - 5.0 g% (g/dl) 35 - 50 g/l
α1 _ globulini axalSobilebi:
dRenakli 0.1 - 0.5 g% (g/dl) 1 - 5 g/l
dResruli 0.1 - 0.3 g% (g/dl) 1 - 3 g/l
< 1 wlis 0.2 - 0.4 g% (g/dl) 2 - 4 g/l
α2 _ globulini axalSobilebi:
dRenakli 0.3 - 0 .7 g% (g/dl) 3 - 7 g/l
dResruli 0.3 - 0 .5 g% (g/dl) 3 - 5 g/l
< 1 wlis 0.5 - 0 .8 g% (g/dl) 5 - 8 g/l
β _ globulini axalSobilebi:
dRenakli 0.3 - 1.2 g% (g/dl) 3 - 12 g/l
dResruli 0.2 - 0.6 g% (g/dl) 2 - 6 g/l
< 1 wlis 0.5 - 0 .8 g% (g/dl) 5 - 8 g/l
γ _ globulini axalSobilebi:
dRenakli 0.3 - 0 .4 g% (g/dl) 3 - 4 g/l
dResruli 0.2 - 1.0 g% (g/dl) 2 - 10 g/l
< 1 wlis 0.3 - 1.2 g% (g/dl) 3 - 12 g/l
imunoglobulini A Wiplari 1,4 - 3,6 mg/dl 14 - 36 mg/l
(IgA) 1 - 3 Tve 1,3 - 53 mg/dl 13 - 530 mg/l
4 - 6 Tve 4,4 - 84 mg/dl 44 - 840 mg/l
7 Tve - 1 weli 11 - 106 mg/dl 110 - 1,0 60 mg/l
2 - 5 weli 14 - 159 mg/dl 140 - 1,590 mg/l
6 - 10 weli 33 - 236 mg/dl 330 - 2,360 mg/l
mozrdilebi 70 - 320 mg/dl 700 - 3,120 mg/l
509
sisxli
imunoglobulini D axalSobili ar isinjeba ar isinjeba
(IgD) SemdgomSi 0 - 8 mg/dRe 0 - 80 mg/l
imunoglobulini E mamakacebSi 0 - 230 IU/ml 0 - 230 k IU/l
(IgE) qalebSi 0 - 170 IU/ml 0 - 170 k IU/l
imunoglobulini G WilrarSi 6,36 - 1,606 mg/dRe 6,39 - 16,06 g/l
(IgG) 1 Tve 251 - 960 mg/dRe 2,51 - 9,06 g/l
2 - 4 Tve 176 - 601 mg/dRe 1,76 - 6,01 g/l
5 - 12 Tve 152 - 1,0 6 mg/dRe 1,72 - 10,69 g/l
1 - 5 weli 345 - 1,236 mg/dRe 3,45 - 12,36 g/l
6 - 10 weli 608 - 1,572 mg/dRe 6,08 - 15,72 g/l
mozrdili 639 - 1,349 mg/dRe 6,39 - 13,49 g/l
hematokriti 1 dRe 48 - 69 % 0.48 - 0 .69
(HT) 2 dRe 48 - 75 % 0.48 - 0 .75
(sxeulis mocirkulire 3 dRe 44 - 72 % 0.44 - 0.72
siTxis saSualo raoden. 2 Tve 28 - 42 % 0.28 - 0 .42
da eriTrocitebis raode- 6 - 12 weli 35 - 45 % 0.35 - 0.45
nobidan) 12 - 18 weli:
vaJebi 37 - 49 % 0.37 - 0 .49
gogonebi 36 - 46 % 0.36 - 0 .46
18 - 49 weli:
mamakacebi 41 - 53 % 0.41 - 0.53
qalebi 36 - 46 % 0.36 - 0 46
g an aval i
g an aval i er T eu l i S ie r T e u l i
ka l c iu m i 2 .1 - 2 .7 m e q v/l 1 .0 5 - 1 .3 5 m m o l /l
a n 4 .2 - 5.4 m g %
a n 0 .6 4 g 2 4 s T -S i an 1 6 mmol 24 sT -S i
na Rvl is mJa vebi 1 2 0 - 2 2 5 m g /2 4 s T 1 2 0 - 2 2 5 m g /2 4 s T
f a r u l i s is x l i u a r y o f iT i
(< 2 m l /2 4 s T
1 0 0 - 2 0 0 g g a n a v a l S i)
pH 7 .0 - 7 .5 3 1 - 1 0 0 n m o l /l
c x im i ax al S ob. bu nebriv kvebaz e < 1 g /2 4 s T < 1 g /2 4 s T
0 - 6 weli < 2 g /2 4 s T < 2 g /2 4 s T
mo z r d il ebi:
no rmal u r i d iet a < 7 g /2 4 s T < 7 g /2 4 s T
u c x imo d iet a < 4 g /2 4 s T < 4 g /2 4 s T
510
Sardi
Sardi erTeuli S ierTeuli
acetoni 0.0 N 0.0N
bilirubini 0.0 N 0.0N
glukoza (raodenobrivi) < 0.5 g/24sT < 2.8 mmol/l/24sT
glukoza (xarisxobrivi) 0 0
kalciumi bavS vebi:
ukalc iumo dieta 5 - 40 mg/24sT 0.13 - 1.0 mmol/l/24sT
dieta Ca-is mc ire Semcv. 50 - 150 mg/24sT 1.25 - 3.80 mmol/l/24sT
dieta Ca-is saSualo Semcv. 100 - 300 mg/24sT 2.5 - 7.5 mmol/l/24sT
(20 mmol/l/24sT)
mozrdilebi 0 - 250 mg/24sT 0 - 6.25 mmol/l/24sT
kreatinini dRenakl. axalSob. 8.1 - 15.0 mg/kg/24sT 72 - 133 mkmol/kg/24sT
dResrul. ax alS ob. 10.4 - 19.7 mg/kg/24sT 92 - 174 mkmol/kg/24sT
1.5 - 7 weli 10 - 15 mg/kg/24sT 88 - 133 mkmol/kg/24sT
7 - 15 weli 5.2 - 41 mg/kg/24sT 46 - 362 mkmol/kg/24sT
leikocitebi mamakacebi 0 - 3 /mx. areSi 0 - 3 /mx. areSi
(naleqSi) qalebi/bavSvebi 0 - 5 /mx. areSi 0 - 5 /mx. areSi
Sardis r-ba dRe-RameS i axalSobilebi 50 - 300 ml/24sT 0.050 - 0 .30 0 l/24sT
Cvilebi 350 - 550 ml/24sT 0.350 - 0.550 l/24sT
bavS vebi 500 - 1000 ml/24sT 0.5 - 1 l/24sT
mozardebi 70 0 - 1400 ml/24sT 0.7 - 1.4 l/24sT
SemdgomSi:
mamakacebi 800 - 1800 ml/24sT 0.8 - 1.8 l/24sT
qalebi 60 0 - 1600 ml/24sT 0.6 - 1.6 l/24sT
cila saerTo 24 sT-Si SardS i 1 - 14 mg/dl 10 - 140 mg/l
mosvenebul mdgomareobaSi 50 - 80 mg 24 sT-Si 50 - 80 mg 24 sT-Si
fizikuri datvirTvisas < 250 mg 24 sT-S i < 250 mg 24 sT-S i
xvedriTi wona mozrdilebSi 1.00 2 - 1.030 1002 - 1030
siTxis 12 sT-iT Sewyvetis > 1.025 > 1.025
Semdeg
24 saaTiani 1.015 - 1.0 25 1.015 - 1.0 25
511
Tavzurgtvinis siTxe
Tavzurgtvinis erTeuli S ierTeuli
siTxe
leikocitebi
mononuklearebi < 24 sT
dRenakli 0 - 25 ujredi/mkl 0 - 25X10 6 /l
dResruli 0 - 20 ufredi/mkl 0 - 20X10 6 /l
axalSobilebi 0 - 5 ujredi/mkl 0 - 5X10 6 /l
SemdgomSi 0 - 5 ujredi/mkl 0 - 5X10 6 /l
polimorfonuklearebi axalSobilebi 0 - 10 ujredi/mkl 0 - 10X10 6 /l
eriTrocitebi < 24 sT
dRenakli 0 - 1.00 0 erT/mkl 0 - 1.00 0X10 6 /l
dResruli 0 - 800 erT/mkl 0 - 800X10 6 /l
axalSobilebi 0 -50 erT/mkl 0 -50X10 6 /l
diferencirebuli
leikocitebi:
eozinofilebi 0 ujredi 0 ujredi
limfocitebi 62% ± 34% 0.62 ± 0.34
monocitebi 36% ± 20% 0.36 ± 0.20
neitrofilebi 2% ± 5% 0.02 ± 0.05
histiocitebi 0 ufredi 0 ujredi
albumini 10 - 30 mg% (mg/dl) 100 - 30 0 mg/l
glukoza axalSobilebi:
dRenakli 24 - 63 mg% (mg/dl) 1.3 - 3.5 mmol/l
dResruli 34 - 119 mg% (mg/dl) 1.9 - 6.5 mmol/l
bavSvebi 40 - 80 mg% (mg/dl) 2.2 - 4.4 mmol/l
mozrdilebi 40 - 70 mg% (mg/dl) 2.2 - 3.9 mmol/l
kalciumi 2.1 - 2.7 meqv/l
an 4.2 - 5.7 mg% (mg/dl) 1.05 - 1.35 mmol/l
qlori 118 - 132 mmol/l 118 - 132 mmol/l
cila saerTo (arxSi) lumbaluri 8 - 32 mg% (mg/dl) 80 - 320 mg/l
turbidimetriiT lumbaluri:
dRenakli 40 - 300 mg% (mg/dl) 400 - 3.000 mg/l
dResruli 45 - 120 mg% (mg/dl) 450 - 1.200 mg/l
bavSvebi 10 - 20 mg% (mg/dl) 100 - 200 mg/l
mozardebi 15 - 20 mg% (mg/dl) 150 - 200 mg/l
mozrdilebi 15 - 45mg% (mg/dl) 150 - 450 mg/l
eleqtroforeziT
prealbumini 2 - 7% 0.02 - 0 .07
albumini 56 - 76% 0.56 - 0 .76
alfa1-globulini 2 - 7% 0.02 - 0 .07
alfa2-globulini 4 - 12% 0.04 - 0 .12
beta-globulini 8 - 18% 0.08 - 0.18
gam m a-globulini 3 - 12% 0.03 - 0.12
wneva gaxsnisas 70 - 180 mm H2O 70 - 180 mm H2O
512
sagnobrivi saZiebeli. a - d
sagnobrivi saZiebeli
abioturi garemo 11, 12 diagnozi 390
adenovirusuli infeqcia 62 diferenciuli diagnozi 391
epidemiologia 63 epidemiologia 385
etiologia 62 etiologia 384
zemo sasunTqi gzebis katari 64 klinika 388
klinika 63 mkurnaloba 392
mezenteriuli limfadeniti 64 paTogenezi 386
paTogenezi da paTmorfologia 63 paTmorfologia 387
tonzilo-faringiti 64 profilaqtika 392
faringokoniunqtivuri sindromi 64 wlamde asakis bavSvebSi 389
aiv-Sidsi 207 janmrTeli baqteriamtarebeli 390
diagnozi 214 botulizmi 338
epidemiologia 209 diagnozi 342
etiologia 208 diferenciuli diagnozi 343
imunizaciis Catarebis rekomendaciebi 217 epidemiologia 339
kapoSis sarkoma 211 etiologia 338
klinika 211 klinika 340
kuW-nawlavis forma 213 mkurnaloba 343
mkurnaloba 215 paTogenezi 340
paTogenezi da paTanatomuri suraTi 210 profilaqtika 344
prognozi 217 Cvil bavSvTa 342
profilaqtika 217 brucelozi 349
Sidsi mcire asakis bavSvebSi 214 biurnes kanSiga reaqcia 353
cerebruli forma 213 diagnostika 353
amebiazi 446 diferenciuli diagnostika 354
abscesi tvinis 451 epidemiologia 349
abscesi filtvis 451 etiologia 349
abscesi RviZlis 450 klinika 351
diagnostika 452 mkurnaloba 354
epidemiologia 447 paTogenezi 350
etiologia 446 profilaqtika 354
kanis 451 raitis reaqcia 353
klinika 448 garTuleba 15
mkurnaloba 452 gri pi 51
gri
paTogenezi da paTanatomuri suraTi 448 axalSobilebSi da wlamde asakis
prognozi 452 bavSvebSi 55
profilaqtika 453 diferenciuli diagnozi 56
fulminanturi 451 epidemiologia 52
anaerobuli nawlavTa mwvave infeqcia 1-dan 3 wlamde asakSi 55
(klostridiozebi) 430 etiologia 51
anafilaqsia 46 klasifikacia 54
antibiotikebi 30 klinika 53
baqteriostaturi 30 labratoriuli diagnostika 55
baqteriociduri 30 mkurnaloba 56
askaridozi 485 paTmorfologia da paTogenezi 52
diagnozi 486 prognozi 59
epidemiologia 485 profilaqtika 59
etiologia 485 deinis nawilaki 149
klinika 486 denge da dengesmagvari cxelebebi 194
mkurnaloba 487 diagnozi da diferenciuli diagnozi 196
nawlavTa obstruqcia 486 epidemiologia 194
paTogenezi 485 etiologia 194
profilaqtika 487 klinika 195
filtvis 486 mkurnaloba 196
RviZlis 486 paTogenezi 194
baqteriuli dizenteria 384 profilaqtika 197
garTulebebi 390 hemoragiuli forma 196
gaxangrZlivebuli 389 dehidratacia 35, 36
513
sagnobrivi saZiebeli. d - e
disbaqteriozi nawlavTa 435 profilaqtika 200

acilaqti 440 enterobiozi 492
aci po
polli 440 diagnozi 493
bbp (biologiuri baqteriuli epidemiologia 493
preparati) 440 etiologia 493
bifidokefiri 440 klinika 493
bifidumbaqterini 440 mkurnaloba 493
bifidumbaqterini rZiani orvalentiani 440 enterovirusuli arapoliomielituri
bifidumbaqterini rZiani samvalentiani 440 infeqciebi 128
bifilini (bavSvebisaTvis) 440 diagnozi 133
diagnostika 439 diferenciuli diagnozi 133
enteroli 440 enterovirusuli daavadeba 133
klinikuri gamovlinebani 438 enterovirusuli egzanTema 132
laqtobaqterini (mSrali) 440 enterovirusuli infeqcia
lineqsi 440 axalSobilebSi 133
mkurnaloba 439 enterovirusuli cxeleba 130
nawlavis mikrofloris Semadgenloba 437 epidemiologia 129
profilaqtika 441 epidemiuri, hemoragiuli
difTeria 253 koniunqtiviti 132
antibiotikoTerapia 270 epidemiuri mialgia (plevrodinia,
gareTa sasqeso organoebis 263 bornholmis daavadeba) 131
garTulebebi 264 etiologia 128
garTulebebis mkurnaloba 270 klinika 130
gaweris vadebi 271 mezadeniti 133
diagnozi 266 mkurnaloba 134
desensibilizaciis meTodi 270 nawlavuri fioma 132
diferenciuli diagnozi: 267 serozuli meningiti 131
epidemiuri parotiti 268 specifikuri profilaqtika 134
infeqciuri mononukleozi 268 paTogenezi da paTmorfologia 122
nekrozuli angina 267 prognozi 134
paratonziliti 267 herpesuli angina 130
simanovski-plaut-vensanis angina 267 enterovirusuli infeqciebi 119
sokovani angina 267 epidemiologia 119
xorxSi da traqeaSi ucxo sxeuli 268 etiologia 119
epidemiologia 254 eozinofilebi 22
etiologia 253 epidemiuri procesi 11
Tavisebureba wlamde asakis bavSvebSi 265 etiotropuli mkurnaloba 30
Tvalis 263 eSerixiozi 402
kanis da Wrilobis 264 garTuleba 407
klinika 257 diagnozi 408
mimdinareoba 261 diferenciuli diagnozi 408
mkurnaloba 268 enteroagregaciuli nawlavis
nervuli sistemis mxriv cvlilebebi 265 Cxiri 404
nefrozi 265 enteroinvaziuri nawlavis
paTogenezi 256 Cxiri 403, 404, 405, 406
prognozi 271 enteropaTogenuri nawlavis
profilaqtika 271 Cxiri 403, 404, 405
cxviris 262 enterotoqsigenuri nawlavis
xaxis gavrcelebuli 259 Cxiri 403, 404, 407
xaxis lokaluri 259 enterohemoragiuli nawlavis
xaxis toqsiuri 259 Cxiri 403, 407
xorxis difTeria, difTeriuli krupi 261 enteropaTogenuri nawlavis CxiriT
hemo ragiul
hemoragiul
ragiulii da hi pertoqsikur
pertoqsikurii gamowveuli infeqcia 405
formebi 260 enterotoqsigenuri nawlavis CxiriT
ebolas cxeleba 199 gamowveuli infeqcia 407
diagnozi da diferenciuli diagnozi 200 enterohemoragiuli nawlavis CxiriT
etiologia 199 gamowveuli infeqcia 407
klinika 199 epidemiologia 403
mkurnaloba 200 etiologia 402
paTogenezi da imuniteti 199 etiotropuli mkurnaloba 409
prognozi 200 K-is
-is deficitis dasaangariSebeli
514
sagnobrivi saZiebeli. e - k
formula 409 mkurnaloba 118

klinika 405 infeqciuri mononukleozi 108
mozrdili asakis bavSvTa 406 garTuleba 113
msubuqi 406 diagnozi 114
mZime 406 epidemiologia 109
saSualo simZimis 406 etiologia 109
paTogenezi da paTmorfologia 404 klasifikacia 113
prognozi 408 klinika 111
profilaqtika 409 mkurnaloba 116
vaqcinebi 45, 501, 502 paTmorfologia 110
zogierTi labo rato
laborato
ratorriuli maCveneblebi 52 profilaqtika 116
Tandayolili virusuli respiraciuli infeqciuri procesi 11
infeqcia 72 kavasakis daavadeba
iersiniozi 379 (mukokutaneuri sindromi) 248
diagnozi 382 diagnozi 251
diferenciuli diagnozi 383 epidemiologia 248
epidemiologia 379 etiologia 248
etiologia 379 klinika 250
kvanZovani forma 382 laboratoriuli monacemebi 251
mkurnaloba 383 paTmorfologia 248
mcire asakis bavSvebSi 382 profilaqtika 253
profilaqtika 383 kampilobaqteriozi_vibriozi 420
saxsrovani forma 382 garTulebebi 422
fsevdoapentikularuli forma 381 diagnozi da diferenciuli diagnozi 422
hepatiti 382 epidemiologia 421
imunizacia 44 etiologia 420
aqtiuri 44 klinika 422
pasiuri 46 mkurnaloba 423
imuniteti 13 paTogenezi 421
bunebrivi 13 profilaqtika 423
SeZenili 13 kandidozi 441
imunoglobulinebi 27 diagnostika 444
A 27 epidemiologia 442
M 27, 29 etiologia 441
G 27, 29 vulvovaginiti 443
D 27 Tandayolili kandidozi 442
E 27 mkurnaloba 444
imunuri kompleqsuri preparatebi 32 paTogenezi 442
interleikini (citokini) 25 prognozi 445
interferencia 17 qronikuli kandidozi 443
interferoni 23 katis nakawri 239
infeqtologia 9 diferenciuli diagnozi 242
infeqcia 16 epidemiologia 239
infeqciuri avadmyofis arsi 19 etiologia 239
infeqciuri daavadeba 16 klinika 240
infeqciuri daavadebis mimdinareoba 16 mkurnaloba da prognozi 242
inaparantuli 16 paTogenezi 239
koinfeqcia 17 profilaqtika 242
L formebi 16 klasifikacia 12
miqstinfeqcia 17 zoonozebis ekoepidemiuri 14
monoinfeqcia17 infeqciuri agentis lokalizaciiT 12
neli infeqcia 17 klinikuri 15
nozokomialuri infeqcia 17, 19 klebsielebiT gamowveuli
persistuli infeqcia 16 nawlavTa mwvave infeqcia 423
reinfeqcia 17 epidemiologia 424
infeqciuri eriTema anu mexuTe daavadeba 117 etiologia 423
garTuleba 118 paTmorfologia 424
diferenciuli diagnozi 118 paTogenezi 424
etiologia da epidemiologia 117 profilaqtika 425
515
sagnobrivi saZiebeli. k - m
mkurnaloba 425 prognozi 461

klostridia dificileTi gamowveuli nawlavTa profilaqtika 462
mwvave infeqcia 431 leptospirozi 229
garTuleba 433 garTulebebi 232
imuniteti 432 klinika 231
paTogenezi 432 profilaqtika 234
profilaqtika 434 lizocimi 23
fsevdomembranuli koliti 433 limfociti 24
klostridia perfringensiT gamowveuli B limfociti 24
nawlavTa mwvave infeqcia 430 T limfociti 24
diagnozi 431 listeriozi 242
epidemiologia 430 anginozuri, anginozur-septiuri 244
etiologia 430 diagnozi 246
paTogenezi 430 Tandayolili listeriozi 245
profilaqtika 430 Tval-jirkvlovani 245
komplementis sistema 23 klinika 244
konvenciuri daavadeba 18 mimdinareoba 246
kontagiozuri indeqsi 13 mkurnaloba 247
lambliozi 482 nervuli forma 245
diagnozi 483 paTogenezi 243
epidemiologia 482 prognozi 247
etiologia 482 profilaqtika 247
klinika 483 tifoiduri forma 245
metronidazoli 483 ZuZumwovar bavSvebSi 246
mkurnaloba 483 malaria 472
paTogenezi 482 garTuleba 477
legionelozi 355 diagnozi 478
garTuleba 357 diferenciuli diagnozi 479
diagnostika 357 epidemiologia 473
diferenciuli diagnozi 358 etiologia 472
epidemiologia 355 Tandayolili malaria 477
etiologia 355 Tirkmlis mwvave ukmarisoba 478
imuniteti 356 infeqciur-toqsikuri Soki (malariuli
klinika 356 algidi) 478
mkurnaloba 358 klinika 475
paTogenezi 356 mkurnaloba 479
profilaqtika 358 ovale-malaria 476
ti pur
purii fo rma 356
forma paTogenezi da paTmorfologia 474
mwvave r espiraciul
respiraciul
espiraciulii daavadebis ti piT prognozi 481
mimdinare 357 profilaqtika 481
cxelebiT da egzanTemiT mimdinare recidivi 477
(fortbragis daavadeba) 357 samdRiani malaria 475
leiSmaniozi 456 tvinis SeSupeba 478
glukantimi 461 tropikuli malaria 477
diagnozi da diferenciuli diagnozi 461 cerebruli forma (malariuli koma) 477
epidemiologia 457 hemoglobinuri cxeleba 478
etiologia 457 marburgis cxeleba 197
kanis anTroponozuli (birovskis diagnozi 198
daavadeba) 461 epidemiologia 197
kanis zoonozuri 460 etiologia 197
mkurnaloba 461 mkurnaloba 199
paTogenezi 457 paTogenezi 198
pentostami 461 prognozi 199
516
sagnobrivi saZiebeli. m - p
profilaqtika 199 paTogenezi da paTmorfologia 360

martivi herpesi 90 fulginozuri ena 365
generalizebuli sistemuri herpesuli neitrofilebis fagocituri funqcia
infeqcia 95 niadagSi mobinadre amebebiT
genitaluri herpesi 94 gamowveuli daavadeba 453
diagnozi 95 ameburi keratiti 454
epidemiologia 90 diagnostikuri testebi 454
Tvalis dazianeba 94 klinika 453
kanis herpesuli gamonayari 93 meningoencfaliti 453
mkurnaloba 96 omskis hemoragiuli cxeleba 190
mwvave herpesuli gingivo-stomatiti 94 diagnozi 191
paTogenezi 91 diferenciuli diagnozi 191
prognozi 96 epidemiologia 190
cns-is dazianeba 95 etiologia 190
meningokokuri infeqcia 272 klinika 191
diferenciuli diagnozi 282 paTogenezi 191
elviseburi 280 profilaqtika 191
epidemiologia 273 orniTozi 225
iariS heqsheimeris fenomeni 284 diferenciuli diagnozi 227
meningokokemia 278 etiologia 225
meningokokuri meningiti 276 klinika 226
meningokokuri meningiti gul-sisxlZarRvTa sistema 226
ependimatitiT 281 periferiuli sisxli 226
mimdinareoba 281 saWmlis momnelebeli sistema 226
mkurnaloba 283 mkurnaloba 227
msubuqi, abortuli forma 279 paTogenezi 225
mwvave nazofaringiti 276 prognozi 227
pnevmonia 276 paTogenezuri Terapia 32
prognozi 285 paragr
paragrii pi 59
profilaqtika 285 diagnozi 61
uoterhaus-fredriqsenis sindromi 280 diferenciuli diagnozi 61
mikoplazmuri infeqcia 218 epidemiologia 60
garTuleba 219 etiologia 59
diagnozi 220 eqspres-diagnostika 61
diferenciuli diagnozi 220 klasifikacia 61
epidemiologia 218 klinika 60
etiologia 218 mkurnaloba 62
klinika 219 paTmorfologia 60
paTogenezi da paTmorfologia 218 profilaqtika 62
prognozi 220 paratifi A,, B da C 359
profilaqtika 220 garTulebebi 366
mtarebloba 16 diagnozi 367
mwvave 16 diferenciuli diagnozi 368
qronikuli 16 etiologia 359
janmrTeli 16 klinika 367
muclis tifi 359 mkurnaloba 369
baqteriamtarebloba 366 profilaqtika 370
garTulebebi 366 parayivanaxvela 337
klasifikacia 365 klinika 337
mcire asakis bavSvebSi 367 profilaqtika 338
517
sagnobrivi saZiebeli. p - s
parotituli infeqcia 83 prionebi 495

ati pur
purii 85 properdini 32
axalSobilebsa da wlamde asakis proteusiT gamowveuli nawlavTa infeqcia 425
bavSvebSi 87 epidemiologia 425
garTuleba 88 etiologia 425
diagnozi 87 klinika 426
diferenciuli diagnozi 87 mkurnaloba 427
enisqveSa sanerwyve jirkvlebis profilaqtika 427
dazianeba 85 profilaqtika specifikuri 43
epidemiologia 83 reias sindromi 59, 100, 101
etiologia 83 reovirusuli infeqcia 71
Tireoiditi 86 diagnozi 71
klasifikacia 85 epidemiologia 71
klinika 84 etiologia 71
kuWqveSa jirkvlis forma 86 klinika 71
gastriti, ooforiti, barToliniti 86 mkurnaloba 71
miokarditi 86 paTogenezi 71
mkurnaloba 88 profilaqtika 71
morfologiuri cvlilebebi 84 respiraciul-sincitiuri cxeleba 65
paTogenezi 84 garTuleba 68
prostatiti 86 diagnozi da diferenciuli diagnozi 67
profilaqtika 88 epidemiologia 66
sasqeso jirkvlebis dazianeba 86 etiologia 65
siyrue 86 klinika 66
ybayura 85 mkurnaloba 68
cns-is dazianeba 87 paTmorfologia da paTogenezi 66
pirveladi afeqti 18 profilaqtika 68
plur
plurii potenciur
potenciurii hemopoezur
hemopoezurii ujr edi 23
ujredi rehidratacia 34
pnevmoqlamidiozi 228 rinovirusuli infeqcia 69
diagnozi 228 axalSobilebsa da wlamde asakis
epidemiologia 228 bavSvebSi 70
etiologia 228 diagnozi da diferenciuli diagnozi 70
poliomieliti 120 klinika 69
abortuli anu visceruli forma 122 mkurnaloba 70
araparalizuri forma 122 paTogenezi 69
aRdgeniTi periodi 125 profilaqtika 70
acril bavSvebSi 122 rotavirusuli da sxva diareagenuli virusuli
axalSobilebsa da wlamde asakis infeqciebi 176
bavSvebSi 122 diagnozi 179
bulburi forma 124 dif. diagnozi 179
diagnozi 125 epidemiologia 177
encefalituri forma 125 klinika 178
epidemiologia 120 mkurnaloba 179
etiologia 120 paTogenezi 177
virusuli da serologiuri Astroviruses 176, 179
gamokvlevebi 125 Calciviruses 176
klinika 121 Worwolk 176, 179
meningialuri forma 122 salmonelozi 393
mkurnaloba 126 axalSobilTa salmonelozi 398
paTogenezi da paTmorfologia 120 garTuleba 398
paralizuri periodi 123 gastrituli da gastroenterituli
pontinuri forma 125 forma 396
preparalizuri periodi 123 gastroenterokoliti da
prognozi 127 enterokoliti 397
profilaqtika 127 diagnozi 399
residualuri periodi 125 diferenciuli diagnozi 399
sezonuroba 120 epidemiologia 393
pjr (polimerizuri jaWvuri reaqcia) 155 etiologia 393
518
sagnobrivi saZiebeli. s - t
imuniteti 395 nikolskis simptomi 316

klinika 395 paTogenezi da paTanatomia 310
prognozi 401 stafilokokuri `daTuTquli~ kanis
profilaqtika 401 sindromi 316
septiuri forma 397 stafilokokuri qunTruSismagvari
tifoiduri forma 397 mimdinareoba 316
waSlili forma 397 stafilokokuri kvebiTi toqsikoinfeqcia
wlamde asakis bavSvebSi 398 (intoqsikacia): 316
sartyliseburi herpesi 102 diagnozi 316
diagnozi 103 klinikuri gamovlineba 316
epidemiologia 102 mkurnaloba 316
etiologia 102 stafilokokuri toqsikuri Sokis
klinika 103 sindromi 317
laboratoriuli gamokvleva 103 traqeiti 317
mkurnaloba 103 traqeitis diagnostika 317
prognozi 104 fsevdomembranuli koliti: 315
profilaqtika 104 mkurnaloba 315
sefsisi 318 streptokokuri infeqcia 290
axalSobilebSi 324 alergiuli sindromi 293
ganmarteba 319 diagnozi 295
diagnostika 327 epidemiologia 291
kanis da lorwovani garsebis impetigo 294
dazianeba 327 infeqciuri sindromi 293
klinika 323 klinika: 294
komplementis sistema 325 6 Tvemde asakis bavSvebSi 294
kuW-nawlavis traqti 326 3 -dan 12 wlamde asakis bavSvebSi 294
mkurnalobis Zir iTadi pr
ZiriTadi inci pebi 328
princi mkurnaloba 296
monocit-makrofaguri sistema 326 paTogenezi 293
mwvave sefsisi 323 profilaqtika 296
neonataluri 324 toqsikuri sindromi 293
sefsisi da Sokis paTogenezi 319 GBS infeqciis klinika 294
qvemwvave 323 strongiloidozi 487
qronikuli 323 diagnozi 489
cns-is dazianeba 326 diseminirebuli strongiloidozi 488
Sokis mkurnaloba 328 epidemiologia 488
sinji 46 etiologia 487
alergiuli 46 klinika 488
kanis testi 47 kuW-nawlavis forma 488
nakawri 47 mkurnaloba 489
stafilokokuri infeqcia 309 paTogenezi da paTmorfologia 488
garTulebis mkurnaloba: 314 profilaqtika 489
empiema da pnevmoToraqsi 314 tki pismier
pismierii encefaliti 180
stafilokokuri enterokoliti 315 diagnozi da diferenciuli diagnozi 183
stafilokokuri osteomieliti 314 encefalituri forma 182
fibroToraqsi 314 epidemiologia 180
diagnozi 317 etiologia 180
diferenciuli diagnozi: 313 klinika 181
mukoviscidozTan 313 meningialuri forma 182
mwvave bronqitTan 313 mkurnaloba 183
ucxo sxeuli sasunTq gzebSi 313 paTogenezi 181
endokarditebi 317 poliomielituri sindromi 182
etiologia 309 poliratikulonevrituli forma 183
eqsfoliaciuri sindromi epidermuli prognozi 183
nekroziT 316 profilaqtika 184
imuniteti 311 cxelebis forma 181
klinika 312 tki pismier
pismierii laim-bo relozi 234
laim-bor
meningokokemiis msgavsi daavadeba 317 diagnozi da diferenciuli diagnozi 237
mkurnaloba 317 epidemiologia 235
519
sagnobrivi saZiebeli. t - q

klinika: 235 imuniteti 373
adreuli diseminaciis periodi 236 klinika 374
adreuli lokalizaciis periodi 236 mkurnaloba 378
mogvianebiTi periodi 237 paTogenezi 372
prognozi 239 qvemwvave masklerozebeli encefaliti
profilaqtika 239 qimioTerapia 30
toqsoplazmozi 462 qlamidiuri infeqciebi 221
diagnostika 469 diagnozi da diferenciuli diagnozi 223
diferenciuli diagnozi 470 epidemiologia 221
epidemiologia 464 etiologia 221
Tandayolili toqsoplazmozi 465, 467 mkurnaloba 224
klinika 466 qolera 410
mkurnaloba 470 algidi 415
orsul qalTa mkurnaloba 471 diagnozi da diferenciuli diagnozi 416
paTogenezi: 464 epidemiologia 410
prognozi 471 etiologia 410
profilaqtika 471 klasifikacia 415
SeZenili mwvave 466 klinika 114
SeZenili qronikuli 466 mkurnaloba 417
triqinelozi 490 paTogenezi da paTanatomia 411
diagnozi 492 prognozi 417
epidemiologia 490 profilaqtika 418
etiologia 490 qunTruSa 296
klinika 491 gadacemis meqanizmi 297
mkurnaloba 492 garTulebebi: 302
mcire asakis bavSvebSi 491 alergiuli 303
paTmorfologia 491 recidivi 303
paTogenezi 490 gul-sisxlZarRvTa sistema 301
prognozi 492 diagnozi 304
profilaqtika 492 dikis reaqcia 297
triqocefalozi 494 diferenciuli diagnozi: 304
epidemiologia 494 iersiniozi 304
etiologia 494 stafilokokuri infeqcia 304
klinikuri gamovlineba 494 wiTela 304
mkurnaloba 494 wiTura 304
uecari egzanTema anu meeqvse daavadeba 116 epidemiologia 297
epidemiologia 117 imuniteti: 297
etiologia 116 wlamde asakis bavSvebSi 298
klinika 117 iSviaTi formebi 302
mkurnaloba 117 klasifikacia 301
paTogenezi 117 klinika 299
prognozi 117 letaloba: 303
fagoTerapia 32 wlamde asakis bavSvebSi 303
fagocituri sistema 22 mimdinareoba: 302
fsevdomonuri nawlavTa mwvave infeqcia 428 msubuqi 302
epidemiologia 428 mZime 302
etiologia 428 saSualo simZimis 302
klinika 429 septiuri 302
mkurnaloba 429 toqsikuri 302
paTogenezi 428 mkurnaloba 305
profilaqtika 429 paTogenezi da paTmorfologia 298
fsevdotuberkulozi 371 periferiuli sisxli 301
garTulebebi 376 profilaqtika 305
diagnostika 376 saSarde sistema 301
diferenciuli diagnostika 377 saWmlis momnelebeli traqti 301
epidemiologia 372 sezonuroba 298
520
sagnobrivi saZiebeli. y - h
yivanaxvela 329 diferenciuli diagnozi 204

acril bavSvebSi 334 epidemiologia 201
garTulebebi 334 etiologia 201
diagnozi 335 imunizacia: 205
diferenciuli diagnozi 335 aqtiuri 205
epidemiologia 330 pasiuri 205
klasifikacia 334 laboratoriuli diagnostika 205
klinika 332 mimRebloba 202
laboratoriuli diagnozi 335 mkurnaloba 205
paTmorfologia da paTogenezi 331 paralizuri periodi 204
profilaqtika 336 prodromuli periodi 203
uxtomskis dominanti 331 profilaqtika 207
wlamde asakis bavSvebSi 334 wiTela 72
yirim-kongos cxeleba 192 garTulebebi 76
diferenciuli diagnozi 193 diferenciuli diagnozi 77
etiologia 192 etiologia da epidemiologia 72
klinika 193 klasifikacia 76
mkurnaloba 193 klinika 74
paTogenezi da paTanatomia 192 mkurnaloba 78
profilaqtika 193 paTogenezi 73
Soki 40, 321 profilaqtika 78
Cutyvavila 97 wlamde asakis bavSvebSi 77
axalSobilebsa da wlamde asakis wiTeli qari 305
bavSvebSi 100 axalSobilebsa da wlamde asakis
garTuleba 100 bavSvebSi 307
diagnozi 101 diferenciuli diagnostika: 307
diferenciuli diagnozi 101 sartylisebuli liqeni 307
elviseburi purpura 100 epidemiologia 306
encefalititi da cerebruli ataqsia 100 etiologia 306
epidemiologia 97 klasifikacia 306
Tandayolili Cutyvavila 99 mkurnaloba 307
klinika 98 paTogenezi da paTmorfologia 306
mkurnaloba 101 pirveladi wiTeli qari 306
pnevmonia 100 recidivi 307
prognozi 101 wiTura 79
profilaqtika 102 garTulebebi da prognozi 82
sunTqvis mwvave ukmarisoba 100 diagnozi da diferenciuli diagnozi 81
citokini 22, 25 epidemiologia 79
citomegalovirusuli infeqcia 104 etiologia 79
diagnozi 106 Tandayolili wiTura 80
diferenciuli diagnozi 107 klinika 80
epidemiologia 104 laboratoriuli diganostika 82
klinika 105 paTogenezi 80
mkurnaloba 108 profilaqtika 82
paTogenezi 105 hemolizur-uremiuli sindromi 407
profilaqtika 108 hemoragiuli cxelebebi 185
citrobaqteriuli nawlavTa hemoragiuli cxeleba
mwvave infeqcia 427 Tirkmlis sindromiT 186
klinika 427 dispanseruli dakvirveba 190
paTogenezi 427 epidemiologia 186
profilaqtika 427 etiologia 186
cofi 201 klinika 187
agznebis periodi 203 mimdinareoba 189
521
sagnobrivi saZiebeli. h - h
oliguriis periodi 188 paTmorfologia 155

paTogenezi 186 panacinuri nekrozi 156
poliuriis periodi 188 polimerazuli jaWvuri reaqcia 155
profilaqtika 190 ujredebis dazianebis meqanizmi 153
hemofiluri infeqcia 286 xiduri nekrozi 156
ento da perikarditi 288 citolizi 153
epiglotiti mwvave 287 RviZlismieri encefalopaTia 160
epidemiologia 286 wlamde asakis hepatiti 162
etiologia 286 Foeter hepatica 161
klinika 287 HBeAg - negatiuri qronikuli hepatiti 157
mkurnaloba 288 hepatiti virusuli C 167
paTogenezi 286 diagnozi 169
panikuliti 288 diferenciuli diagnozi 170
profilaqtika da RonisZiebani daavadebis etiologia 167
keraSi 289 klinika 168
osteomieliti 288 mkurnaloba 170
Cirqovani arTriti 288 paTogenezi 168
hepatiti virusuli 135 profilaqtika 170
hepatiti virusuli A 138 hepatiti virusuli D 170
diagnostika 143 diagnostika 172
diferenciuli diagnostika 144 etiologia 170
epidemiologia 138 klinika 172
klasifikacia 142 paTogenezi 171
klinika 141 profilaqtika 172
metaboluri Terapiis saSualebani 146 hepatiti virusuli E 173
mimdinareoba da gamosavali 143 diagnozi 174
mkurnaloba 149 diferenciuli diagnozi 174
paTogenezi 139 epidemiologia 174
profilaqtika 147 etiologia 173
sezonuroba 139 klinika 174
hepatiti virusuli B 149 mkurnaloba 174
avTvisebiani mimdinareoba 160 paTogenezi da paTmorfologia 174
amplifikaciis meTodi 155 profilaqtika 174
deinis nawilaki 149 hepatiti virusuli arc A-E 175
vaqcinebi 165 hi pernatr iemia 37
pernatriemia
virusis antigeni 150 hi pokaliemia 37
virusis antisxeuli 150 hospitaluri Stamebi 17
Tandayolili hepatiti 163 CD 25
imunoprofilaqtika 165 CD4 25
imunuri pasuxi 153 CD8 25
inkubaciuri periodi 157 Crawford and associates - dozebis
klasifikacia 159 gaangariSeba 502
klinika 157 Erythema migrans 236
koma 161 MMR 78
laqovani nekrozi 156 MMRS 78
markerebis dinamika 154 Mosteller -is formula 501
mkurnaloba 164 NK 24
mutanti-virusi 152 status typhosus 18, 362
522

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a. xoWava, m.

damtkicebulia saqarTvelos ganaTlebis

medicinis mecnierebaTa doqtori, profesori,

medicinis mecnierebaTa doqtori, profesori

medicinis mecnierebaTa doqtori, profesori

winasityvaoba (a. xoWava, m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

II. kerZo nawili . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51

wiTela (a. xoWava, m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72

wiTura (m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79

parotituli infeqcia (m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83

herpesis ojaxis virusebiT gamowveuli daavadebebi . . . . . . . . . . . . . . . 90

infeqciuri eriTema anu mexuTe daavadeba (m. xoWava) . . . . . . . . . . . . . . . 117

virusuli hepatitebi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135

rotavirusuli da sxva diareagenuli virusuli infeqciebi

hemoragiuli cxelebebi (a. xoWava, m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . 185

cofi (m. xoWava, a. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201

aiv/Sidsi (a. xoWava, m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207

mikoplazmuri infeqcia (a. xoWava, m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . 218

qlamidiuri infeqciebi (m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221

leptospirozi (a. xoWava, m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229

katis nakawris daavadeba (m. xoWava, a. xoWava) . . . . . . . . . . . . . . . . . . . . . 239

listeriozi (a. xoWava, m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 242

kavasakis daavadeba (m. xoWava, a. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . 248

difTeria (a. xoWava, m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253

hemofiluri infeqcia (m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 286

streptokokuri infeqcia ((GAS, GBS)) (m. xoWava, a. xoWava) . . . . . . . . . . . . 290

stafilokokuri infeqcia (a. xoWava, m. xoWava) . . . . . . . . . . . . . . . . . . . . . . 309

sefsisi (a. xoWava, m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 318

yivanaxvela (m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 329

parayivanaxvela (m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 337

botulizmi (a. xoWava, m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 338

gaSeSeba (a. xoWava, m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 344

brucelozi (a. xoWava, m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 349

legionelozi (a. xoWava, m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 355

muclis tifi da paratifebi A,, B,, C (a. xoWava, m. xoWava) . . . . . . . . . . . . . . 359

iersiniuli infeqcia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 371

baqteriuli dizenteria (m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 384

salmonelozi (m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 393

eSerixiozi (m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 402

qolera (a. xoWava, m. xoWava) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 410

zogierTi araqoleragenuli vibrionebiT gamowveuli infeqciebi

zogierTi pirobiTpaTogenuri floriT gamowveuli mwvave infeqcia

nawlavTa disbaqteriozi (a. xoWava, m. xoWava) . . . . . . . . . . . . . . . . . . . . . 435

protozouli infeqciebi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 446

zogierTi neli infeqcia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 495

sxeulis zedapiris farTobis gamoTvlis nomograma

masis, sxeulis zedapiris farTobis da mozrdilTa

sagnobrivi saZiebeli . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 513

umaRlesi saswavleblebis studenti-medikosebisaTvis SemoTavazebuli saxelmZRvanelo

mokle istoriuli cnobebi

infeqciuri sneulebani uZvelesi droidanaa cnobili. amas mowmobs hi pokrates

Tavis mxriv, infeqtologiis ganviTarebaSi didi wvlili Seitanes qarTvelma

infeqciur daavadebaTa epidemiologiis

Tu infeqciur process warmovidgenT, rogorc infeqciuri agentisa da makroorganizmis

SeiZleba warmovidginoT Semdegi Tanmimdevruli stadiebis ganxorcielebiT: 1) avadmyofi

daavadebulTa procentiT anda gamoisaxeba aTwiladebiT 1,0-mde.

etiologiur princi ps da dayofil iqnas Semdegnairad _ baqteriozi (baqteriuli

infeqciuri paTologiis zogierTi

infeqciuri paTologiis zogierTi terminologiuri ganmarteba unda eyrdnobodes

endogenuri autoinfeqciebi, romlebic viTardebian mcire asakis bavSvebSi sxvadasxva

struqturis gaSifvras, saTanado etiotropuli da paTogenezuri ( sakmaod rTuli )

infeqciuri daavadebis paTogenezisa da klinikuri