amakuru

Imyaka ijana irashize, umusore wimyaka 24 yinjiye mubitaro bikuru bya Massachusetts (MGH) afite umuriro, inkorora, ndetse no guhumeka neza.
Umurwayi yari amaze iminsi itatu afite ubuzima bwiza mbere yo kwinjira, hanyuma atangira kumva atameze neza, afite umunaniro rusange, kubabara umutwe no kubabara umugongo. Ubuzima bwe bwarushijeho kwiyongera mu minsi ibiri yakurikiyeho kandi yamaze igihe kinini mu buriri. Umunsi umwe mbere yo kwinjira, yagize umuriro mwinshi, inkorora yumye hamwe n'ubukonje, umurwayi yavuze ko "yunamye" kandi adashobora kuva mu buriri. Yafashe mg 648 ya aspirine buri masaha ane kandi akoroherwa gato no kubabara umutwe no kubabara umugongo. Icyakora, ku munsi wo kwinjira, yaje mu bitaro nyuma yo kubyuka mu gitondo afite dyspnea, aherekejwe n'ububabare bwo mu gatuza bwa subxiphoide, bwariyongereye kubera guhumeka cyane no gukorora.
Kwinjira, ubushyuhe bwurukiramende bwari 39.5 ° C kugeza 40.8 ° C, umuvuduko wumutima ni 92 kugeza 145 gukubita / min, naho guhumeka byari 28 kugeza 58 gukubita / min. Umurwayi afite ubwoba kandi bukabije. Nubwo yapfunyitse mu bitambaro byinshi, ubukonje bwarakomeje. Guhumeka neza, biherekejwe na paroxysme yinkorora ikabije, bikaviramo ububabare bukabije munsi yigitereko, gukorora ibara ryijimye, ryijimye, ryuzuye.
Indwara ya pissique yagaragaye neza mumwanya wa gatanu wa intercostal kuruhande rwibumoso bwa sternum, kandi nta kwaguka k'umutima kwagaragaye kuri percussion. Auscultation yerekanye umuvuduko wumutima wihuse, injyana yumutima ihamye, yumvikana hejuru yumutima, no kwitotomba kwa systolike. Kugabanya amajwi yo guhumeka kuruhande rwiburyo rwinyuma uhereye kuri kimwe cya gatatu munsi yicyuma cyigitugu, ariko nta rale cyangwa fricatif yunvikana. Umutuku muto no kubyimba mu muhogo, toni yakuweho. Inkovu yo kubaga inguinal hernia yo kubaga igaragara ku nda, kandi nta kubyimba cyangwa ubwuzu mu nda. Uruhu rwumye, ubushyuhe bwuruhu rwinshi. Umubare w'amaraso yera yari hagati ya 3700 na 14500 / ul, na neutrophile yari 79%. Nta mikurire ya bagiteri yagaragaye mu muco w'amaraso.
Isanduku ya radiografi yerekana igicucu kijimye ku mpande zombi z'ibihaha, cyane cyane mu gice cyo hejuru cy'iburyo no hepfo y'ibumoso, byerekana umusonga. Kwiyongera kwa hilum ibumoso yibihaha byerekana ko lymph node ishobora kwaguka, usibye kwibeshya kwi bumoso.

Ku munsi wa kabiri wo gushyirwa mu bitaro, umurwayi yagize dyspnea no kubabara mu gatuza, kandi ururenda rwari rwuzuye kandi rwamaraso. Isuzuma ry'umubiri ryerekanye ko hejuru ya sisitemu yo kwitotomba kwa systolique, kandi percussion hepfo yibihaha by'iburyo yaracecetse. Papula ntoya, yuzuye igaragara kumukindo wibumoso nintoki yiburyo. Abaganga basobanuye uko umurwayi ameze “mubi”. Ku munsi wa gatatu, ibibyimba bya purulent byagaragaye cyane. Ubucucike bwinyuma bwibumoso bwarushijeho kwiyongera mugihe guhinda umushyitsi byariyongereye. Amajwi yo guhumeka ya Bronchial hamwe na rale nkeya birashobora kumvikana inyuma yibumoso kimwe cya gatatu cyinzira kumanuka uva ku rutugu. Gukubita ku mugongo wiburyo biracecetse gato, amajwi yo guhumeka ni kure, kandi rimwe na rimwe rale irumvikana.
Ku munsi wa kane, umurwayi yarushijeho kuba mubi maze apfa muri iryo joro.

Gusuzuma

Muri Werurwe 1923, uyu musore w’imyaka 24 yajyanywe mu bitaro afite umuriro ukabije, gukonja, kubabara imitsi, guhumeka neza, no kubabara mu gatuza. Ibimenyetso n'ibimenyetso bye bihuye cyane no kwandura virusi y'ubuhumekero, nka grippe, hamwe na bagiteri zishobora kwandura. Urebye ko ibyo bimenyetso bisa cyane n’ibibazo by’icyorezo cya grippe yo mu 1918, ibicurane birashoboka ko ari byo byumvikana.

Nubwo kwigaragaza kwa clinique nibibazo bya grippe ya kijyambere bisa cyane n’ibyorezo by’icyorezo cyo mu 1918, umuryango w’ubumenyi wateye intambwe ikomeye mu myaka mike ishize ishize, harimo kumenya no guha akato virusi y’ibicurane, guteza imbere uburyo bwo gusuzuma bwihuse, gushyiraho uburyo bunoze bwo kuvura virusi, no gushyira mu bikorwa gahunda zo gukurikirana no gukingira. Iyo usubije amaso inyuma ukareba icyorezo cya grippe 1918 ntabwo kigaragaza gusa amasomo yamateka, ahubwo kiranadutegurira neza icyorezo kizaza.
Icyorezo cya grippe 1918 cyatangiriye muri Amerika. Urubanza rwa mbere rwemejwe rwabaye ku ya 4 Werurwe 1918, mu guteka Ingabo i Fort Riley, muri Kansas. Hanyuma, Lorrin Miner, umuganga wo mu Ntara ya Haskell, muri Kansas, yanditse inyandiko 18 z’ibicurane bikabije, harimo n’impfu eshatu. Yabimenyesheje Minisiteri y’ubuzima rusange muri Amerika, ariko ntibyakiriwe neza.
Abahanga mu by'amateka bemeza ko kuba inzego z'ubuzima rusange zananiwe gutabara icyo cyorezo byari bifitanye isano rya bugufi n'imiterere yihariye y'intambara ya mbere y'isi yose. Kugira ngo birinde kugira ingaruka ku ntambara, guverinoma yacecetse ku bijyanye n'uburemere bw'icyo cyorezo. John Barry, umwanditsi w'igicurane kinini, yanenze iki kibazo mu kiganiro cyo mu 2020: “Guverinoma irabeshya, babyita ubukonje busanzwe, kandi ntibabwira abaturage ukuri.” Ibinyuranye n'ibyo, Espagne, igihugu kidafite aho kibogamiye muri kiriya gihe, ni cyo cya mbere cyatangaje ibicurane mu bitangazamakuru, bituma ubwandu bushya bwa virusi bwitwa “ibicurane byo muri Esipanye,” nubwo indwara za mbere zanditswe muri Amerika.
Hagati ya Nzeri na Ukuboza 1918, abantu bagera ku 300.000 bapfuye bazize ibicurane muri Amerika, bikubye inshuro 10 impfu zatewe n'impamvu zose zabaye muri Amerika mu gihe kimwe cyo mu 1915.Ibicurane bikwirakwira vuba binyuze mu gisirikare no mu mutwe w'abakozi. Abasirikare ntibimutse gusa hagati y’ibigo bitwara abantu mu burasirazuba, ahubwo banatwaye virusi ku rugamba rw’i Burayi, bakwirakwiza ibicurane ku isi. Bivugwa ko abantu barenga miliyoni 500 banduye kandi abagera kuri miliyoni 100 bahasize ubuzima.
Kuvura byari bike cyane. Ubuvuzi ni palliative, harimo no gukoresha aspirine na opiates. Umuti wonyine ushobora kuba ingirakamaro ni plasma infusion - izwi muri iki gihe nka plasma ivura. Icyakora, inkingo z’ibicurane zatinze kuhagera kubera ko abahanga bataramenya icyateye ibicurane. Byongeye kandi, abarenga kimwe cya gatatu cy’abaganga n’abaforomo b’abanyamerika bakuweho kubera uruhare bagize mu ntambara, bigatuma umutungo w’ubuvuzi uba muke. Nubwo inkingo zaboneka kuri kolera, tifoyide, icyorezo n’ibicurane, iterambere ry’urukingo rw’ibicurane ryari rikibura.
Binyuze mu masomo ababaje y’icyorezo cya grippe 1918, twamenye akamaro ko gutangaza amakuru mu mucyo, guteza imbere ubushakashatsi bwa siyansi, n’ubufatanye mu buzima bw’isi. Inararibonye zitanga ubumenyi bwingenzi mugukemura ibibazo byugarije ubuzima bwisi yose mugihe kizaza.

Virus

Haraheze imyaka myinshi, intandaro y '“ibicurane byo muri Espanye” yatekerezaga ko ari bagiteri Pfeiffer (ubu yitwa Haemophilus grippee), wasangaga mu gihimba cy’abarwayi benshi, ariko si bose. Nyamara, iyi bagiteri ifatwa nkigora umuco kubera umuco wacyo wo hejuru, kandi kubera ko itigeze igaragara muri byose, abahanga mu bya siyansi bahora bibaza uruhare rwayo nka virusi. Ubushakashatsi bwakurikiyeho bwerekanye ko ibicurane bya Haemophilus mu byukuri ari byo bitera indwara ya bagiteri ikunze kwibasira ibicurane, aho kuba virusi itera ibicurane.
Mu 1933, Wilson Smith n'itsinda rye bagize intambwe. Bafashe ingero zo mu bwoko bwa pharyngeal flusher ku barwayi b'ibicurane, babirukana muyungurura ya bagiteri kugira ngo bakureho bagiteri, hanyuma bagerageza kuyungurura sterile kuri ferrets. Nyuma yigihe cya incububasi yiminsi ibiri, ferrets yagaragaye yatangiye kwerekana ibimenyetso bisa na grippe yabantu. Ubushakashatsi nubwa mbere bwemeza ko ibicurane biterwa na virusi aho kuba bagiteri. Mu gutanga raporo y'ibyavuye mu bushakashatsi, abashakashatsi bavuze kandi ko kwandura virusi mbere bishobora kwanduza neza kwandura virusi imwe, ibyo bikaba ari byo shingiro ry’iterambere ry’inkingo.
Nyuma yimyaka mike, mugenzi wa Smith, Charles Stuart-Harris, ubwo yitegerezaga ferret yanduye ibicurane, ku bw'impanuka yanduye virusi biturutse ku guhura na ferret. Virusi yitandukanije na Harris yahise yanduza ferret itanduye, yongera gushimangira ubushobozi bwa virusi yibicurane ikwirakwira hagati y’abantu n’inyamaswa. Muri raporo ifitanye isano, abanditsi bavuze ko “umuntu ashobora gutekereza ko kwandura laboratoire bishobora kuba intangiriro y'ibyorezo.”

Urukingo

Virusi y'ibicurane imaze kwigunga no kumenyekana, abahanga mu bya siyansi bahise batangira gukora urukingo. Mu 1936, Frank Macfarlane Burnet yerekanye bwa mbere ko virusi ya grippe ishobora gukura neza mu magi yatewe, ivumburwa ryatanze ikoranabuhanga rigezweho mu gutanga inkingo kugeza na n'ubu rikoreshwa henshi. Mu 1940, Thomas Francis na Jonas Salk bakoze urukingo rwa mbere rw'ibicurane.
Igikenewe cyari gikenewe cyane cyane ku gisirikare cy’Amerika, bitewe n’ingaruka mbi z’ibicurane ku ngabo z’Amerika mu gihe cy’Intambara ya Mbere y'Isi Yose, Mu ntangiriro ya za 1940, abasirikare b'ingabo z’Amerika bari mu ba mbere bahawe urukingo rw'ibicurane. Kugeza mu 1942, ubushakashatsi bwemeje ko urukingo rwagize akamaro mu kurinda umutekano, kandi abantu bakingiwe ntibakunze kwandura ibicurane. Mu 1946, urukingo rwa mbere rw'ibicurane rwemejwe gukoreshwa n'abasivili, rufungura igice gishya mu gukumira no kurwanya ibicurane.
Biragaragara ko kubona urukingo rw'ibicurane bifite ingaruka zikomeye: abantu badakingiwe bashobora kwandura ibicurane inshuro 10 kugeza kuri 25 kurusha ababikora.

Gukurikirana

Kugenzura ibicurane hamwe na virusi yihariye ni ngombwa mu kuyobora ibisubizo by’ubuzima rusange no gutegura gahunda yo gukingira. Urebye imiterere yibicurane ku isi, sisitemu zo kugenzura igihugu ndetse n’amahanga zirakenewe cyane.
Ikigo gishinzwe kurwanya no gukumira indwara (CDC) cyashinzwe mu 1946 kandi kibanza kwibanda ku bushakashatsi ku byorezo by’indwara nka malariya, tifusi n’ibicurane. Mu myaka itanu imaze ishinzwe, CDC yashyizeho Serivisi ishinzwe ubutasi kugira ngo itange amahugurwa yihariye yo gukora iperereza ku byorezo by’indwara. Mu 1954, CDC yashyizeho uburyo bwa mbere bwo kugenzura ibicurane kandi itangira gutanga raporo buri gihe ku bikorwa by'ibicurane, ishyiraho urufatiro rwo gukumira no kurwanya ibicurane.
Ku rwego mpuzamahanga, Ishami ry'Umuryango w'Abibumbye ryita ku Buzima (OMS) ryashyizeho uburyo bwo kurwanya no kurwanya ibicurane ku isi mu 1952, rikorana cyane na Global Sharing of Global ibicurane by’ibicurane (GISAID) kugira ngo hashyizweho uburyo bwo kugenzura ibicurane ku isi. Mu 1956, OMS yongeye kwerekana CDC nk'ikigo gikorana mu rwego rwo kurwanya ibicurane, epidemiologiya no kurwanya ibicurane, bitanga ubufasha bwa tekiniki n'ubuyobozi bwa siyansi mu gukumira no kurwanya ibicurane ku isi. Gushiraho no gukomeza gukoresha ubwo buryo bwo kugenzura bitanga uburyo bukomeye bwo guhangana n’isi yose ku byorezo by’ibicurane n’ibyorezo.

Kugeza ubu, CDC yashyizeho umuyoboro mugari wo kugenzura ibicurane mu gihugu. Ibintu bine by'ingenzi bigize igenzura ry'ibicurane harimo gupima laboratoire, gukurikirana abarwayi hanze, gukurikirana abarwayi, no gukurikirana urupfu. Ubu buryo bukurikiranwa butanga inkunga ikomeye yo kuyobora ibyemezo byubuzima rusange no guhangana nicyorezo cya grippe.

Sisitemu yo kurwanya no kurwanya ibicurane ku isi ikubiyemo ibihugu 114 kandi ifite ibigo 144 by’ibicurane by’ibicurane, bishinzwe gukurikirana ibicurane by’ibicurane mu mwaka wose. CDC, nk'umunyamuryango, ikorana na laboratoire zo mu bindi bihugu mu kohereza virusi y’ibicurane muri OMS kugira ngo yandike antigenic na genetique, bisa n’uburyo laboratoire zo muri Amerika zitanga akato kuri CDC. Ubufatanye hagati y’Amerika n’Ubushinwa mu myaka 40 ishize bwabaye igice cy’umutekano w’ubuzima ku isi na diplomasi.