Ukusebenzisa i-Nasopharyngeal Swab: Amaphawu okuthi ngokuzwakalisa

Ukubala kwezinto neNkqubo: Ukwenza i-Nasopharyngeal Swab esebenza kahle

Ukuphepha okuhle kwezindlela zokudiagnostics kuyadlula ngokusebenzisa inkqubo eyodwa ngokuphepha kwezinto ezifanayo, ekuvumela ukuthi i-Nasopharyngeal Swab ifikele ku-mucosa eyodwa ngaphandle kokugcina ubukhulu bokufakwa kwesampuli.

Izindlela zokubala kwezinto eziphambili ezivumela ukufaka kahle i-Nasopharyngeal Swab

I-nasopharynx liyisemva sase-nasal cavity, futhi ukufaka kwe-swab ngokuphelele kudinga ukuthi iswab ibe nendlela eyodwa ne-floor yase-nose. Isilumkiso esibalulekileyo kukude phakathi kwe-nostril yomuntu no-ear, okuyinto ekubonisa ukude okudingekayo ukufikelela kwe-nasopharyngeal mucosa. I-CDC ibizwa ukuthi umuntu afake isikhumba sakhe emuva ngamadehri 70 futhi afake iswab esifanayo nesifunda ngokuphelele kwe-palate—akafane noma kusuka kuze kufika kwe-resistance ekubonisa ukuthi iswab isebenzi kwe-posterior nasopharynx. Ukubona i-nasal floor njenge-line yomphakathi kusiza ukungafaka iswab kwe-superior turbinate, okunciphisa ububi nokukhwehla kwamanzi emnyango. Iswab kufanele ifike phambili kwe-inferior turbinate, futhi ishaft iyofana ngokuphelele nesikhumba sase-nose. Ukungazi isilumkiso lesi kusho ukuthi iswab isizwe kwe-anterior nares, okungahleli ukuthi ubuchwepheshe bokuvimba kwe-virus bengaphezu kwezinyanga ezimbili. Iswab esifanayo nesifunda esinamandla, esiyisintu sokunqoba, sibalulekile ukufaka kulesi simo esifanayo nesikhumba ngaphandle kokugcina.

Umbuzo wokugcina kanye nokukhathazeka kwezinkinga eziphakanyisiwe ngabantu abasebenzisa

Qala ngokuthi uthathe izinto zokulinda umuntu ngokupheleleyo futhi uqinisekise ukuthi isihlwa sesilungu sibhekene ngaphambili ngamashumi ayisikhombisa. Faka kancane iswab ethi yommini-ithip, esiyakhiwe ngokusebenzisa isifuba sokunqula kusuka emhlabathini wendawo yokufaka kwenhliziyo, kubhekana ngokupheleleyo nesifuba sokunqula. Faka kancane kuze kube yisikhombisa kusukela emhlabathini kusuka endaweni yokufaka kwenhliziyo noma kube yisiphelo esincane, emva koko yenza iswab ifuna kancane amashumi amabili kanye namashumi ayisikhombisa ukuze libeke kancane kusukela emhlabathini kusukela endaweni yokufaka kwenhliziyo ukuze libeke kancane kusukela emhlabathini kusukela endaweni yokufaka kwenhliziyo. Yenza ukuthi usuke kancane futhi uye ngokushesha ufaka iswab kumidiya wokuthumela amavirus. Amaphutha amaninzi okusebenzisa iswab ayizokuthi: ukufaka iswab ngaphezulu—okuyoba yisiphelo esincane—futhi ukusebenzisa iswab esinezincamo zemthwalo noma iswab esinezincamo zemthwalo. I-CDC iyabika ngokucacile ukuthi akufanele usebenzise i-calcium alginate noma izincamo zemthwalo, ngoba kungalungile ukuthi kuzobeka phansi ukusebenza kwamaphuzu. Amaphutha abaningi angaphandle kwezi zingaba: ukufaka kancane kakhulu, ukungafaka kancane, futhi ukuthi ukuprosesa kungabekwe ngokushesha, okuyoba yisiphelo esincane sokugcina ukuthi kungabeki phansi ngamashumi amabili (Smith et al., 2022).

Ukuqondisa Ukusebenza Kweswab Yokunqamuka KweNasopharynx Phakathi Kweminye Imithombo Yomoya Yokuqonda

Ukuthola i-SARS-CoV-2: Ukuphatha Kakhulu, Isikhathi, Nokuxhuma Kwezindlela Zokuzilungiselela

Umbhali wokugcina umsila wase-nasopharynx (NPS) uyisampulu esikhundleni sokuziphatha kwezilinganiso zomfanekiso we-SARS-CoV-2, nokuthi ukuthembeka kuyaphambana ngokupheleleyo nesikhathi sokugcina. Ukuqwalaselwa kwemibhalo yoku-2021 yezinkampani ezi-23 kubonisa ukuthi ukuthembeka kwezinkampani ezihlukene kuyi-89% kubantu abanemithambo eminyakeni eyokuqala yokubhekana nezimithambo, futhi kuhlala kwi-54% emva kweyisikhathi se-14. Umkhakha omkhulu wemizinhlelo eminingi wabonisa ukuthi amaqanda ase-viral ayadlula kuminyakeni eyokuqala e-5 yokufa, okunika ukuthi kutholakala ngokupheleleyo kwe-97% uma umbhali wokugcina umsila wase-nasopharynx uyagcinwa ngokupheleleyo. Ngakho, ukugcina kabusha—ngeminyakeni eyokuqala e-24 emva kokubhekana—kanye nokugcina umbhali ngokungafanelekileyo kungahlela ekutholeni okungafanele, njengoba isikhathi sase-nasopharynx singasikwazi ukuba sena amaqanda ase-viral angaphele. Ukuchazwa kwemithambo kuyisisekelo esibalulekile: abantu abanenqinamba ephelele yokuthola izimithambo (isibonelo, izimithambo ezihlukene kanye nokubhekana ngokupheleleyo) kodwa abanenqinamba engafanele yase-NPS kufanele bahlale bavakashelwe, kakhulu noma kubhekana nesampulu yase-lower respiratory tract uma izimithambo zihlala. Lezi zifundo zibonisa ukuthi umbhali wokugcina umsila wase-nasopharynx akayi isikhundla esisodwa; ukutholakala kwakhe kufanele kuchazwe ngokuxhumana nesikhathi sokufa kanye nokuchazwa kwemithambo.

Ukufutha, i-RSV, ne-Pertussis: Ukuphakanyiswa Kwemboni Ngokusebenzisa Iziphakamiso Zokuziphatha Ngokwemboni Kungaphandle Kokubhekana Nokulinganisa

Kukufutha kwe-A ne-B, i-NPS ibonisa ukusebenza okuhle kunezikhumba zomphakathi wokuphuma. Umthombo wokugcina we-2019 wamasithili amashumi amabili athi i-NPS yasendula isensitiviti yayo yokuqondwa kwekufutha ngokuphakamisa kwe-88–95%, ngaphandle kokuthi izikhumba zomphakathi wokuphuma ziyasebenza ngokuphakamisa kwe-70–80%. Kuzintwana, umgama uphakamisa futhi: ukusukuma kwesikhumba sesinye sokunqamuka kwakuyisebenzisa ukuthola i-respiratory syncytial virus (RSV) ngokuphakamisa kwe-94% kumthombo wokugcina we-2020, ngaphandle kokuthi izikhumba zomnqamuka zazisebenza ngokuphakamisa kwe-71%, okubonisa ukuthi ukusukuma kwezinkundla zezimboni zokunqamuka kuyisisekelo esihle. Ku- Bordetella pertussis , I-NPS ekubenzelweni nesiko sokuqondisa nokuphatha kwe-PCR kusinika isensitivithi sokugcina kwesikhathi esingu-97% uma iziqondiso zisukwe ngeminyaka yombili eyokuqala yokugqoka. Iziswabi zesiNkambo sezimboni neziswabi zesiNkambo zesibhakabhaka, njengoba zingaphansi kwezinye, zibonisa ukuthi kuzokwenzeka ukuthi kungafiki kuphela kulezi ziqondiso zokufumana lezi ziqondiso. Ubukhulu bokusebenza kwe-NPS kuyasekwa kubunzima beceli zokugqoka ezingaphansi kwezicelo zokugqoka—lobunzima abazigcina abazifumana emizini yezinqondiso ezinye. Ngakho-ke, uma kubonakala ukuthi kunezinkinga zokugqoka futhi ukuthi kufanele ukuthi kufumaneke ngokushesha nokuphepha kakhulu, i-NPS ibuyela yinkimbinkimbi yokuqala eyayisisekelo lokugcina kwe-influenza, RSV, ne-pertussis.

I-Nasopharyngeal Swab vs. Izinqondiso Ezinye: Lapho Noma Yini Uyakwahluka Okunye

Ukulinganisa Ukuthi Kufumaneke: I-Anterior Nares, I-Oropharyngeal, I-Saliva, Ne-Lower Respiratory Samples

U iswab yokunqula kwisikhumba (NPS) kuyisibonelo esiphambili sokusukuma izinyawo zokugcina umsila wokuphuma kwemithambo, kodwa ukuthi kuyini ukuthi kubhekwa ngokulinganisa isikhundla, ukusebenza kahle, nokwakhiwa kwesikhathi sokufa. Ukuchazwa okungqondweni kokulinganisa ukuthi kuyini ukuthi kubhekwa ngokulinganisa—kubase kwezinkimbinkimbi zokuthi kuyini ukuthi kubhekwa ngokulinganisa—kusiza abadokotela ukuziqonda ukuthi yini inkimbinkimbi eyodwa ekhetha ngalokho lokusho.

Amasampuli we-anterior nares ne-saliva asinika izindlela ezinkulu zokusebenzisa ngokushesha, futhi zilahlela umkhawulo wokuphula okuncane ukuze bakhululeke ngokushesha nokungafani. Kwezimboni ezingaphansi, amasampuli wesihlangothi sesiphansi asebenza kahle kune-NPS ngoba ukuphula kwesivirus kushintsha kusihlangothi sesiphansi. Ukuchaza kuyaphendula kumlando wokugcina, izinkinga zokuphula kwesikhathi, nokuthi isivirus iyaphula kanjani.

Izinto zokugcina phambi kokuchaza ozokuthinta ukusebenza kwe-Nasopharyngeal Swab

Ukuphakanyiswa kweziphumo zokugcina kwinkambo yase-nasopharynx akwenzeka kuphela ngokusebenzisa i-laboratory assay; kuyaphakanyiswa kakhulu ngamathuba amaningi okwakhiwa phambi kokuchazwa kwesampuli. Lezi zinto ziyizindlela eziningi kakhulu nezimangalisayo zokwenza iziphulo emitholeni yokuchaza, ziyabonelela ngqo ukuthi iphepha lokugcina kuyakhiwa kanjani nokubona kahle kwezinye izinto ezingenabizo.

Isibalo esikhulu sokuvula kuyisampuli yekhanda yokuqonda. Ukuthi yini isampuli yekhanda yokuqonda yenza kanye nokuthi yini isampuli yekhanda yokuqonda yenza kuyizindlela ezikhethekileyo zokugcina. Ukuqondisa kubonisa ukuthi inani lezinto zokugcina ezinconyelwe—kubhalwa ngokuthi yini inani lezinto zokugcina zokuhlanganisa GAPDH i-gene—kungakwazi ukuguqula kakhulu phakathi kwezikhetho zomkhuhlu wokusebenza, nokuthi kubonakala ukuguqula kungenani kwe-100 ngokuphelele—kuya ku-4.36 × 10⁸ amakophi/mL kuya ku-6.98 × 10¹⁰ amakophi/mL. Lokhu kuthiwa ukuthi imaterial yomkhuhlu wokusebenza yisidingo esiphambili sokukhetha isampuli, kuyaphinda kuthintela ubukhulu bekho lokuthi isampuli ibe yini yokuthola isithakazelo sokugcina isithakazelo. Ngokufanayo, ubukhulu bekho bomkhuhlu wokusebenza bokuthintela ubukhulu bekho lokuthi umuntu abe yini nokuthi umsebenzisi akwazi ukwenza umkhuhlu wokusebenza kusendaweni esifanayo, okuthintela ngokungafanani ubukhulu bekho lokuthi isampuli ibe yini.

Ngaphezu kwezinkampani, indlela yokukhipha nokubuyisela okulandelayo kuyinto eyodwa esikhundleni esikhulu sokugcina phambi kokuchazwa. Umsebenzi wokukhipha kufanele ukwenziwe ngokupheleleyo ukuze kutholakale isivinini esikhulu sokubhala isibonelo seselula esisikhiwe. Ngemva kwesikhathi esifanayo ngenkathi yokukhipha, ukwahluka kwezinkampani zokubuyisela nokulawula isikhathi nokutempuretya kuyinto eyodwa esikhundleni. Inkampani yokuqonda kufanele ikhathazise i-nucleic acid yokuhlangana—umzekelo, ukusebenzisa inkampani eyokuvula uvirus futhi ekhathazisa i-RNA kuma-test ethu emitholweni. Ukuzimisa kwezinkampani noma ukubhekiswa kwezintempuretya eziningi kungabangela ukuthwasa kwemitholwana yezinsizakalo ngamaphuzu ayesikhiwe kusibonelo. Ukuze kuthululeke lokhu, amaswab afanayo nezinkampani zokuchaza zihlalwa ngokupheleleyo ukuba abe nge-nuclease-free, futhi izinto zabo zihlalwa ukuze zingavumele umsebenzi wokugcina—ukuthi isibonelo sikhathaziswe kusukela ekukhipheni kuya ekuchazweni.

Isikhombisi Sokuqala

Yini indlela eyodwa ukukhipha umswab we-nasopharyngeal?

Indlela eyisifanekileyo ibonisa ukuthi umuntu ofakwe ngokubeka isikhumba sakhe emuva ngamadehri 70, ukulandela iswabhi ngokufanana nesikhebhu sesinye sesinye, ukufaka kuye kuze kube nesixhobo sokugcina esikhundleni sesinye sesinye, ukuzinga ngamasekondi angu-5–10, futhi ukususa kahle.

Kungani ubukhulu bekuphakanyiswa kweswabhi yesinye sesinye bubi?

Ubukhulu bekuphakanyiswa kubalulekile ukuthi kutholwe izinkomo zokuhlanza ngokuphelele, ikakhulu emaqheleni okuhlanza. Ukufaka kwezikhundla zokufaka kususa amaphozi akhawuleza ngokuthi kutholwe isampuli esihle kusuka kumukosa wokuzihlanganisa.

Isampuli yonke iyathuthukisa ukuthola ukuthi kuyini?

Ukuthola ukuthi kuyini kuyahamba kahle ngokwahlukaniswa kwezinhlobo zezampuli. Izikhundla zesinye sesinye zinika ubukhulu bekuphakanyiswa obungaphelele kwezinkomo zokuhlanza kwezinye zesinye ngokulingana nezinye ezithile njengezikhundla zesinye sesinye nesampuli yesaliva.

Izizindaba ziphi ezingena ngokuvamile kubukhulu bekuphakanyiswa kabefore analysis?

Izizindaba ezibalulekile ziyizikhundla, indlela yokufaka, ubukhulu bekumediya yokuthumela, nokunciphisa izikhathi zokuthumela noma izilingo zokuguqula kwezintemperatura ekuthumeleni.

Izinkomo ziphi eziphakanyiswa ngokuphelele ngokusebenzisa izikhundla zesinye sesinye?

Amaswab ethu esinamaphakathi kwe-nasopharynx ayisisekelo esihle kakhulu ukuthola i-SARS-CoV-2, i-influenza, i-RSV, nokuphazimula kwe-pertussis ngoba kunezikhungo zokufa zezincili zezincili zokugcina ezinamaphakathi kwe-nasopharynx.