Ukuphatha Kwemithambo Yomzimba: Kuyisisekelo Sokuthola Isibonelo Esikhulu

Ukuthembelwa Kwemithambo Yomzimba Ngokwesibonelo Nokuthembelwa Kwemithambo Yomzimba Ngokwesibonelo

Ukuthamba kwe-viral kumzimba ngokugcwele ngokwesibonelo esikhulu ngokwesibonelo esikhulu

INasopharynx iyasebenza njengendawo yokuqala yokuphatha kweziviro zokugula kwezinye, kubanzi kuka-SARS‑CoV‑2, influenza, ne-RSV. Ngeminyaka eyisithathu–ezihlanu yokuqala yokugula, ukukhishwa kwesiviro kufika ekupheleni lapha—kubhekwe ngumkhakha ophezulu wezicelo zokuhlela kwezinye neziqulelo zeziqulelo zika-ACE‑2—futhi kuyinto engeyona yamakhono okwenzela ukuthi yingxenye enkulu kakhulu yezinkambo zokugula phambi kokuthi kusale kwezinye izindawo zomzimba. Umahluko wokuvumela kwe-2023 wabonisa ukuthi izikhathi zokunqamuka kwenasopharynx zavuma umkhakha wokuphatha wesiviro owenziwe ngemilogi ezimbili (iziqulelo zeziqulelo zika-Ct ezingama-6–8), okuyinto eyenza ukuthi ukuthola kwezinkambo zokugula kufika emaqhingini amashumi amashanu–amashumi amabili ngokuphakeme kusasa kwezinqumo. Lokhu kucacisa ukuthi kutholakala kuzo izinkambo zokugula ezingama-10³–10⁶ ngomililita, okusiza ukuthi kutholakale kahle noma kusebenzisa izindlela zokuzikhipha ngokushesha nokuzikhipha kwezinkambo zokugula ngokujabulisa.

Ukufihla kwezicelo zokugula kwezinye neziqulelo zika-Waldeyer’s ring ziyenza ukuthi kutholakale kahle izinkambo zokugula

INasopharynx iyile ngaphansi yokuqala kwe-skull futhi iyambula i-Waldeyer’s ring—umkhakha wemithombo yezinkonzo zokulungisa ezihlanganisa izinkonzo zokulungisa zase-adeno nezinkonzo zokulungisa zase-tubal. Lokhu kubeka isikhundla sokulungisa esisodwa kuphela lapho izinhlobo zokuhlupha zokufika kusukela emhlabeni ziyabona kuqala umkhakha wemithombo yezinkonzo zokulungisa okuhlanganisa umsila. I-Influenza A ne Neisseria meningitidis , ngokomfanekiso, ziyabandakanya ngokuphelele kumkhakha wokubhala okungafanele kwe-nasopharyngeal vault kabefore ukufika kusendaweni enzima. Ngokufaka i-swab ku-≥6 cm, abadokotela bavula lokhu kumkhakha wokubhala–nezinkonzo zokulungisa, bavula izinhlobo zokuhlupha ezingafihli noma zingafihli kumkhakha. Umgcino wamthombo ubonisa ukuthi ukuzwela i-swab nokugcina kusuka 15 seconds kuvula umkhakha omkhulu wemithombo yokuqala yemihlaba yokuqala nezinkonzo zokulungisa—kuvula isibonelo esikhulu sokuxhumana kwe-host–pathogen. Lokhu kubhekisa ukuthi ukuvula kwe-nasopharyngeal kuyasebenza kahle kunezindlela zokuvula kuphela kwe-throat uma kufuneka kuvulwe abantu abanegama laba-bacterial meningitis noma i-Influenza eyisinye, nakho ekhanda elincane.

Ukubonakala Kwemithombo Yekliniki: Ukuchaza Kwezinkampani Zokuphatha Umoya Ngokujwayelekile

Ukulinganisa Ukuthambeka: 92.4% kukaSARS-CoV-2 ngaphandle kuka-75.8% kwezikhumba zokuphatha umoya (NEJM, 2022)

Isigaba esisodwa se-2022 Inyanga Yezempilo YaseNew England umsebenzi wokufunda owaphathelene ngqo kwezithombe zokuphatha: izikhumba zokuphatha kwe-nasopharyngeal zazifika emva kwe-92.4% yokuqinisa kwe-SARS-CoV-2, ngakho-ke izikhumba zokuphatha kwe-anterior nasal zazifika kuphela emva kwe-75.8%. Le phakade yezingu-16.6 yezingu-kuhlanganisa kubonisa ukuthi kukhona ukungafani kwe-viral load okwanele kwi-nasopharynx ngeminyaka yokuqala yokuvala—lapho ukuphatha okuthe ngokushesha nokuphatha okuphelele kuyisisekelo sokuphatha kwemiphumela yokuziphatha kwezindawo zokusebenza nekukhulula ukuthi umuntu ayilungile. Ukuphatha okugcwele kakhulu kuyabhekisa ku-epithelium yamaphakathi apho ukuphatha kwe-virus kuyasebenza ngokuphelele, futhi kususa ngokuphelele ukungafani kokuphatha okungafanele okuhlanganisa ngezindlela zokuphatha ezincane. Ngakho-ke izimithetho zokuphatha zaseNingizimu Afrika nezilaboratori zasezindawo zokusebenza ziyabhekisa ukuphatha kwe-nasopharyngeal njengesibalo sokuphatha esihle kakhulu kwezimithetho zokuphatha ngokwezimithetho zokuphatha kwezinto ezingenakwenzeka kwezindawo zokusebenza nezindawo zokuphatha okunconywa ngokuphelele.

Ukuphatha okuphelele okuphambili kwe-influenza A/B, RSV, nezinhlobo zama-bacteria okuphatha amandla kwe-meningitis

Ngaphandle kwe-SARS-CoV-2, izikhumba zomphakathi wendlela yezinyawo zinakwenzela ukuthola okuphelele kwezifundo zokuhlanzwa ngokuphathelene ne-influenza A/B, i-RSV, nokuthi kubizwa ngamazwi amaningi emisebenzi yokuqondisa ukuthi kungani umuntu uyadlula isibonelo se-bacterial meningitis. Kuma-maphetha we-influenza, ukusukuma kwendlela yezinyawo kuyasezinye ngaphezu kwe-90%—kufana kakhulu nesikhumba sezinyawo noma sesikhumba se-mid-turbinate. Kuma-RSV—ngaphakathi kwezindlu zezintwana—kuyisibonelo esihlukileyo ngokwesibonelo sika-CDC no-AAP. Kuma- Neisseria meningitidis kanti Haemophilus influenzae , ukuthi kubizwa ngamazwi amaningi kuyasezinye kuqala kumphakathi wendlela yezinyawo; ngakho-ke, ukusukuma kwendlela yezinyawo kuyisidingo sokuthola okuphelele kokuthi kungani umuntu uyadlula isibonelo. Lokhu kucacisa ukuthi kuyasezinye ngokuzimela kumakhasi asekhaya nokuthi kubizwa ngamazwi amaningi kwe-Waldeyer’s ring lymphoid tissue—kuyizindawo ezithile zokuphatha izinkambo zokuthi kungani umuntu uyadlula isibonelo nokuthi kubizwa ngamazwi amaningi kwezindlela zokuthi kungani umuntu uyadlula isibonelo. Ngakho-ke, iziphakamiso zezincamango zokuthi kungani umuntu uyadlula isibonelo ziyavumiswa ngokuvumela isikhumba sendlela yezinyawo njengesibonelo, ukuze sizamele ukuthi kuyasezinye ngokuvumela ukuthi kuyasezinye kwezincamango zokuthi kungani umuntu uyadlula isibonelo futhi ukuthi kuyasezinye ngokuvumela ukuthi kuyasezinye kwezindlela zokuthi kungani umuntu uyadlula isibonelo.

Ukusebenzisa Okwanele: Indlela Yokusukuma Kwendlela Yezinyawo Yokuvumela Ukuthi Kuyasezinye

Ukufikwa kwezinkambo zokudlala ngokupheleleyo kwe-“nasopharyngeal swab” kuyidinga ukuthi usebenze ngokujabulisa kwezinhlobo zokugcina izindlela zokugcina izinto. Uma kusenziwa isiphazimboni esincinci, kungathinteka ubukhulu bezinto—ngakho ke konke okufanele kwenziwe ngokupheleleyo nokubaluleka kokubaluleka.

Izinyathelo ezingavumelekileyo zokusebenza: ubude (≥6 cm), ukuzwela, isikhathi sokuhlala (10–15 sec), nokusebenzisa izinkambo zokuhambisa ezifanele

Ukugcina okuphelele kuyadlula ngokulandela indlela yokubeka umuntu: isihlathi sibekwe emuva ngemithambo engu-70 ukuze kuhlanganise indlela yomnyango wendawo yomnyango. Ngokusebenzisa iswab ethi ephakeme, engeyona yezinkomo noma yezinkomo zezincalcium alginate (okuzokungqoba i-PCR), umdlali uyafaka ngokuchaphazela ekusweni lwesikhumba—ngokuphakanyiswa kwesikhumba—kuya kufika ku-6 cm noma kufika kwezinyathelo zokukhupha kwezindawo zokugcina zeminyango. Uma iswab isebekwe kahle, iyashwa ama-3–5 ukuze ikhutshwe amaseli wepithelium, emva koko iyabeka phansi ngemizuzu engu-10–15 ukuze ikhutshwe amasithili. Ngokushesha emva kokukhupha, isihlathi siyakhupha kumidiya yokuthumela uvirus (VTM) noma umidiya wokuthumela wonke (UTM), okuyakugcinela amaNucleic acids futhi ukungqoba ukuphila kakhulu kwebakteriya. Amasampuli kufanele abekwe emhlabathini wokuhlala kwezinkumbulo futhi athumelwe ngemizuzu engu-72; ukubeka kahle kwezinkumbulo kuyakubonisa amavirus ayingaqondi amanqambu kanye nokuphula kwezinto ezinconywa.

Ukunciphisa ukuguqula okuthi kuyisibonelo sokusebenzisa umsebenzi ngokufundwa nokusetshenziswa kwezilisthi zokujabula

Ukuchitha kwezindlela kuyisibonelo esiphambili sokuthola iziphumo ezingavumelekile—kepha ukufundisa okubhekisele kumlando kusiza kakhulu ekuphakanyiseni kwezinto ezifanele ukutholakala. Amamodi okusetshenziswa kwemithombo yezinye izinye nezivideo zokubonisa kusiza abasemthwakathini ukuziqondisa ngokuphelele ukugcina isikhala, ubude, nokushaya kwesikhathi. Ukudibanisa ukufundisa kwanqaku nokuqiniseka kokwazi kwesikhathi esizodlula kusiza ukugcina lokho okufundwe. Isilumkiso esingaphansi kwezindlela esingabhekisele kumlando—esikhiqiza ukuthi umuntu aqale ngokuthanda ukuphambuka, isithuthu saswab, ubude besikhathi sokufaka, inombolo yesikhathi sokukhuluma, isikhathi sokushaya, nokufaka ngokushesha emediyeni yokuthumela—kusiza ukuncima ukuthi kungafakwa. Emaziphiyeni amaningi, amathuba okuthi amathuba ayisilinganiso akhona kwezinto ezifanele ukutholakala akhona kusuka ku-68% ukuze kube ngaphezu kwe-90% ngeminyaka eyisithupha. Ukufundisa ngokusebenzisa imithombo yokubonisa ngokushesha kusiza kakhulu ukuncima ukuphanya phakathi kwebalulekile nabalungile—ukunika isikhathi sonke sokuthola isikhathi esifanele.

Amaphakade nezinkinga zokubhekisa kwezinye izinto zokusetshenziswa kweswab yase-nasopharyngeal

Nakuba kubona ukuthi kuyasebenza kahle kakhulu, iswab ye-nasopharyngeal (NP) inebandla lezinkinga zokusebenza. Ukufaka ku-≥6 cm kuyisibonelo sokungafanele kakhulu futhi kungathintela ukugaga, ukuchitha noma ukuvula kwezinyawo—kodwa kufuneka abaprofesiwane bokugcina amehluko baphatheke kakhulu futhi akukwazi ukwenza ngokwakho. Ngakho, izwab ze-nasopharyngeal zingasifundisi kahle kuma-program yokuqonda kwesifundazwe, apho ukuthi kufanele kubhekwe ukuthi kusenziwa kahle, ukuthi umuntu osebenzisa ayihluphe kakhulu, nokuthi kufanele kube lula ukuzilungiselela. Ngokulinganisa nezizwab zomhlabathi wokuphambuka—ezinika ukuthi kusenziwa kahle ngokwesibonelo se-75.8% kubani i-SARS-CoV-2 kodwa kuyenza ukuthi umuntu asebenzise ngokwakho—ukuthi iswab ye-nasopharyngeal isinika ukuthi kusenziwa kahle ngokwesibonelo se-92.4%, kodwa kunezinkinga eziningi zokusebenza, kufuneka kubhekwe ukuthi kufanele kubhekwe abantu abanamandla, nokuthi kunezinkinga zokuthi kubhekwe ukuthi kubhekwe izinkambo zokuhlanzwa. Emaphoyinti e-drive-through, emazikoleni noma emazinkondlo okungabi namanjele, lezi zinkinga zizimela ukuthi zisetyenziswa kahle. Ngakho, nakuba izwab ze-nasopharyngeal ziyisibonelo esikhundleni sokuthi kusenziwa kahle kubani, ukusebenzisa kwayo kufanele kubhekwe ngokwesimo esiphatha abantu abanamandla, ukuthi umuntu osebenzisa ayihluphe kakhulu, nokuthi kufanele kube lula ukuzilungiselela.

Isikhombisi Sokuqala

Isilokhu esisodwa sokuphatha kweziviro zokugula umlomo nesinye kusuku lokuqala lokugula?

Isilokhu sokuphatha kweziviro zokugula umlomo nesinye kusuku lokuqala lokugula sibhekise kumkhakha wamaphakathi amakhulu okwesibhakabhaka nokuthi kuneziquketho zika-ACE-2 ezinkulu.

Kungani iswabhi yomkhakha wamaphakathi yisilinganiso esihle kune yomkhakha wamaphakathi wokunqamuka kwesinye?

Iziswabi zomkhakha wamaphakathi zifika ekupheleni kokubhala ukuthi kuyisiphephelo ngokwenzeka kokuthi kubhala iziviro ezingaphezu kwezinye ezikhiqizwe kumkhakha wamaphakathi kusuku lokuqala lokugula.

Ingaba iswabhi yomkhakha wamaphakathi iyasebenza kumaprojekthi yokubhala ukuthi kuyisiphephelo kwezinkululeko zokugula?

Cha, ngoba yilokho okubhekisekile kumzimba futhi kufuneka kubhekiswe kubaphathi abaqinisekile kubusika, akuyona inkulumo eyodwa yezifundo ezinkulu zemithambo yezindawo.

Izinyathelo zokusebenza eziphambili zokukhokha iswabhi yesikhumba senasopharynx ziyini?

Izinyathelo eziphambili zivela kuzihlupha umphakathi, ukufaka iswabhi ≥6 cm, ukuzikhipha kabusha, ukudlala phakathi kwe-10–15 sekondi, nokufaka isikhumba ngokushesha emediyeni yokuhambisa uvirus.

Izinkinga zokukhokha iswabhi yesikhumba senasopharynx ziyini?

Izinkinga zivela kwezinhloko zokungafaneleka, ukugagula, ukuvula kwamanzi, nokuguqulwa kokusebenza okufune ukufundiswa okuphambili nokuhlola kabusha ukususa lokho.