nhau

Makore zana apfuura, mumwe murume ane makore 24 okukura akapinzwa muMassachusetts General Hospital (MGH) nefivha, kukosora, uye kunetseka kufema.
Murwere anga aine hutano kwemazuva matatu asati apinda, akabva atanga kunzwa kusanzwa zvakanaka, nekuneta kwese, kutemwa nemusoro uye musana. Chimiro chake chakawedzera kuipa mumazuva maviri akatevera uye aipedza nguva yake yakawanda ari pamubhedha. Rimwe zuva asati abvumirwa, akaita fivha yakanyanya, chikosoro chakaoma uye kutonhora, izvo murwere akatsanangura se "akagwadama" uye asingakwanise zvachose kumuka pamubhedha. Akatora 648 mg ye aspirin maawa mana oga oga uye akawana zororo zvishoma kubva mumusoro uye kurwadziwa shure. Zvisinei, pazuva rekupinzwa, akauya kuchipatara mushure mekumuka mangwanani aine dyspnea, achiperekedzwa nekurwadziwa kwechipfuva che subxiphoid, iyo yakawedzera nekufema kwakanyanya uye kukosora.
Pakubvumirwa, tembiricha yerectal yaive 39.5 ° C kusvika 40.8 ° C, chiyero chemoyo chaive 92 kusvika 145 beats / min, uye kufema kwaive 28 kusvika 58 kurova / min. Murwere ane chitarisiko chekutya uye chakaoma. Kunyangwe akaputirwa mumagumbeze akawanda, kutonhora kwakaramba kuchienderera. Kupfupika kwekufema, pamwe chete ne paroxysms yekukosora kwakanyanya, zvichikonzera kurwadziwa kwakanyanya pasi pe sternum, kukosora phlegm pink, viscous, zvishoma purulent.
Apical pulsation yainzwika munzvimbo yechishanu yeintercostal parutivi rwekuruboshwe rwe sternum, uye hapana kuwedzera kwemoyo kwakaonekwa pakurova. Auscultation yakaratidza kukurumidza kurova kwemoyo, rhythm yemwoyo isingachinji, inonzwika kumusoro kwemoyo, uye kugunun'una kudiki kwesystolic. Kuderedza kufema kunonzwika kurutivi rworudyi rwemusana kubva pachikamu chimwe chete muzvitatu pasi pemafudzi, asi hapana rales kana pleural fricatives yakanzwika. Kutsvuka zvishoma uye kuzvimba muhuro, tonsils kubviswa. The vanga rekuruboshwe inguinal hernia kugadziriswa oparesheni inoonekwa padumbu, uye hapana kuzvimba kana kunyorova mudumbu. Ganda rakaoma, kupisa kweganda. Kuwanda kwemasero machena eropa kwaive pakati pe3700 ne14500 / ul, uye neutrophils yakaita 79%. Hapana kukura kwebhakitiriya kwakaonekwa mutsika yeropa.
Chipfuva radiograph inoratidza mimvuri ine zvigamba pamativi ese emapapu, kunyanya murobe rekumusoro rekurudyi uye rezasi rekuruboshwe, zvichiratidza mabayo. Kuwedzera kweruboshwe hilum yemapapu kunoratidza kuti lymph node inogona kuwedzera, kunze kwekubuda kweruboshwe.

Pazuva rechipiri rechipatara, murwere aiva nedyspnea uye anoramba achirwadza muchipfuva, uye sputum yakanga iri purulent uye ropa. Kuongororwa kwepanyama kwakaratidza kuti pakanga paine systolic kugunun'una pamusoro pemapapu, uye kurova pasi kwemapapu ekurudyi kwakadzima. Madiki, akazara papules anoonekwa kuruboshwe kuruboshwe uye kurudyi index finger. Vanachiremba vakatsanangura mamiriro emurwere se“kusiririsa”. Pazuva rechitatu, purulent sputum yakava pachena. Kugomara kwekuruboshwe kuzasi kumashure kwakakwidziridzwa uku kudengenyeka kwetactile kwakawedzera. Bronchial kufema manzwi uye mashoma rales anogona kunzwika kuruboshwe kumashure chikamu chimwe muzvitatu chekudzika kubva pabendekete. Kurohwa kumusana kwekurudyi kwakagomara zvishoma, manzwi ekufema ari kure, uye pano neapo marales anonzwika.
Pazuva rechina, murwere wacho akawedzera kuipa uye akafa usiku ihwohwo.

Kuongororwa

Murume wemakore makumi maviri nemana akaiswa muchipatara muna Kurume 1923 aine fivha yakanyanya, kutonhora, kurwadza kwemhasuru, kutadza kufema, uye kurwadziwa kwechipfuva. Zviratidzo zvake uye zviratidzo zvinopindirana zvakanyanya nehutachiona hwehutachiona hwekufema, hwakadai sefuruwenza, pamwe nehutachiona hwechipiri hwebhakitiriya. Tichifunga kuti zviratidzo izvi zvakangofanana nezviitiko panguva yedenda refuruwenza ra1918, furuwenza ndiyo inonyanya kunzwisisika kuongororwa.

Kunyangwe kuratidzwa kwekiriniki uye kuomerwa kwefuruwenza yemazuva ano yakafanana nedenda ra1918, nharaunda yesainzi yakaita budiriro mumakumi mashoma emakore apfuura, kusanganisira kuzivikanwa uye kuparadzaniswa kwehutachiona hwefuruwenza, kuvandudzwa kwemaitiro ekukurumidza ekuongorora, kuunzwa kweanoshanda antiviral marapirwo, uye kuitwa kwehurongwa hwekudzivirira. Tichitarisa kumashure padenda refuruwenza ra1918 haringoratidzi chete nezvezvidzidzo zvenhoroondo, asi zvakare rinotigadzirira zvirinani kune remangwana denda.
Denda refuruwenza ra1918 rakatanga muUnited States. Mhosva yekutanga yakasimbiswa yakaitika munaKurume 4, 1918, mune mubiki Wemauto kuFort Riley, Kansas. Ipapo Lorrin Miner, chiremba muHaskell County, Kansas, akanyora nyaya gumi nesere dzefuruwenza, kusanganisira vatatu vakafa. Akataura izvi zvakawanikwa kuUS department rePublic Health, asi hazvina kutorwa zvakanyanya.
Vanyori venhoroondo vanotenda kuti kutadza kwevakuru vehutano hweveruzhinji panguva iyoyo kupindura kubuda kwacho kwaive kwakabatana nemamiriro akakosha eHondo Yenyika Yekutanga. Kuti irege kukanganisa mafambiro ehondo, hurumende yakaramba yakanyarara nezvekuipa kwechirwere ichi. John Barry, munyori weThe Great Flu, akashoropodza chiitiko ichi mubvunzurudzo ya2020: "Hurumende iri kunyepa, vari kuidaidza kuti chando, uye havasi kuudza veruzhinji chokwadi." Kusiyana neizvi, Spain, nyika isina kwayakarerekera panguva iyoyo, yaive yekutanga kutaura furuwenza munhau, zvichikonzera kuti hutachiona hutsva hunzi "Spanish flu," kunyangwe nyaya dzekutanga dzakanyorwa muUnited States.
Pakati paSeptember naDecember 1918, vanhu vanofungidzirwa kuva 300 000 vakafa nefuruwenza muUnited States, kakapetwa ka10 nhamba yenzufu kubva kuzvikonzero zvose muUnited States munguva imwe cheteyo muna 1915. Fruu inopararira nokukurumidza kupfurikidza nokutumirwa kwechiuto uye kufamba kwevashandi. Mauto haana kungofamba pakati penzvimbo dzekufambisa kumabvazuva, asi zvakare akatakura hutachiona kuenda kunhandare dzehondo dzeEurope, achiparadzira furuwenza pasirese. Zvinonzi vanhu vanodarika mamiriyoni mazana mashanu vakabatwa nechirwere ichi uye vanosvika mamiriyoni zana vakarasikirwa neupenyu.
Kurapwa kwakanga kwakaganhurirwa zvikuru. Kurapa kunonyanya kurwadza, kusanganisira kushandisa aspirin uye opiates. Mushonga chete ungangoshanda ndeye convalescent plasma infusion - inozivikanwa nhasi seconvalescent plasma therapy. Zvakadaro, mishonga yekudzivirira furuu yanonoka kusvika nekuti masayendisiti haasati aziva chakakonzera furuwenza. Pamusoro pezvo, vanopfuura chikamu chimwe muzvitatu chevanachiremba nevakoti vekuAmerica vakabviswa nekuda kwekupinda kwavo muhondo, zvichisiya zviwanikwa zvekurapa zvichitonyanya kushomeka. Kunyange zvazvo majekiseni ekudzivirira cholera, typhoid, denda, uye chibhokisi akanga aripo, kugadzirwa kwemushonga wefuruwenza kwakanga kuchiri kushaikwa.
Kuburikidza nezvidzidzo zvinorwadza zvedenda refuruwenza ra1918, takadzidza kukosha kwekubuda pachena kweruzivo, kufambira mberi kwetsvakiridzo yesainzi, uye kubatana muhutano hwepasirese. Izvi zviitiko zvinopa maonero akakosha ekugadzirisa zvakafanana kutyisidzira kwehutano hwepasirese mune ramangwana.

Utachiona

Kwemakore akawanda, iyo causative agent ye "Spanish flu" yaifungidzirwa kuva bhakitiriya Pfeiffer (yava kunzi Haemophilus influenzae), iyo yakawanikwa mune sputum yevakawanda, asi kwete vose, varwere. Nekudaro, bhakitiriya iri rinoonekwa serakaoma kutsika nekuda kwemamiriro ekunze etsika, uye nekuti harisati raonekwa muzviitiko zvese, nharaunda yesainzi yagara ichibvunza basa rayo sepathogen. Ongororo dzakazotevera dzakaratidza kuti Haemophilus influenzae ndiyo chaiyo pathogen yebhakitiriya yakapetwa kaviri utachiona hunowanikwa mufuruwenza, pane hutachiona hunokonzera zvakananga furuwenza.
Muna 1933, Wilson Smith nechikwata chake vakaita budiriro. Vakatora samples kubva ku pharyngeal flusher kubva kuvarwere vefuruwenza, vakamhanyisa kuburikidza nebhakitiriya sefa kuti vabvise utachiona, ndokuzoyedza iyo sterile filtrate pamaferrets. Mushure memazuva maviri ekudzivirira, mafiritsi akabuda akatanga kuratidza zviratidzo zvakafanana nefuruwenza yemunhu. Ongororo iyi ndiyo yekutanga kusimbisa kuti furuwenza inokonzerwa nemavhairasi kwete mabhakitiriya. Mukutaura zvakawanikwa izvi, vaongorori vakacherekedzawo kuti hutachiona hwakapfuura nehutachiona hunogona kudzivirira kutapukirwazve kwehutachiona humwe, hunoisa hwaro hwedzidziso hwekuvandudza vaccine.
Makore mashoma gare gare, shamwari yaSmith Charles Stuart-Harris, achiona ferret yakabatwa nefuruwenza, akabata hutachiona netsaona kubva pakuva pedyo nekuhotsira kweferret. Hutachiona hwakaparadzaniswa kubva kuHarris hwakabva hwabudirira kutapurira ferret isina utachiona, zvichisimbisa kugona kwemavhairasi efuruwenza kupararira pakati pevanhu nemhuka. Mune mumwe mushumo wakabatana, vanyori vakati "zvinogoneka kuti hutachiona hwemurabhoritari hunogona kunge huri mavambo ehosha."

Vaccine

Kamwe hutachiona hwefuruu hwakange hwaparadzaniswa uye hwaonekwa, vesainzi vakabva vatanga kugadzira mushonga wekudzivirira. Muna 1936, Frank Macfarlane Burnet akatanga kuratidza kuti mavhairasi efuruwenza anogona kukura zvakanaka mumazai akaomeswa, kuwanikwa kwakapa tekinoroji yebudiriro yekugadzirwa kwejekiseni ichiri kushandiswa zvakanyanya nhasi. Muna 1940, Thomas Francis naJonas Salk vakabudirira kugadzira mushonga wekutanga wekudzivirira furuwenza.
Kudiwa kwejekiseni kwainyanya kudzvanya kumauto eUS, tichitarisa kurwadza kwefuruwenza kumauto eUS mukati meHondo Yenyika I. Mukutanga kwema1940, masoja eU. Pakazosvika 1942, zvidzidzo zvakasimbisa kuti jekiseni raishanda mukupa dziviriro, uye vanhu vakabayiwa vanga vasinganyanyi kubatwa nefuruwenza. Muna 1946, mushonga wekutanga wekudzivirira furuwenza wakabvumidzwa kuti ushandiswe nevanhuwo zvavo, kuvhura chitsauko chitsva mukudzivirira nekudzora furuwenza.
Zvinoitika kuti kuwana mushonga wefuruwenza kune mhedzisiro yakakosha: vanhu vasina kubayiwa vane mukana wenguva gumi kusvika makumi maviri neshanu wekubata furuwenza kupfuura avo vanoita.

Kuongorora

Kuongororwa kwefuruwenza uye hutachiwana hwayo hwakakosha kutungamira mhinduro dzehutano hweveruzhinji uye kugadzira zvirongwa zvekudzivirira. Tichifunga nezvemamiriro epasi rose efuruwenza, masisitimu ekutarisa epasirese uye epasi rose anonyanya kukosha.
Centers for Disease Control and Prevention (CDC) yakavambwa muna 1946 uye yakatanga yakanangana nekutsvagisa zvirwere zvakaita semarariya, typhus uye chibhokisi. Mukati memakore mashanu ekugadzirwa kwayo, CDC yakagadzira Epidemic Intelligence Service kuti ipe dzidziso yakasarudzika yekuongorora kubuda kwechirwere. Muna 1954, CDC yakamisa hurongwa hwayo hwekutanga hwefuruwenza uye yakatanga kuburitsa mishumo yenguva dzose pamusoro pechiitiko chefuruwenza, ichiisa hwaro hwekudzivirira nekudzora furuwenza.
Padanho repasi rose, World Health Organisation (WHO) yakagadzira Global Influenza Surveillance and Response System muna 1952, ichishanda pamwe chete neGlobal Sharing of Influenza Data Initiative (GISAID) kugadzira hurongwa hwepasi rose hwekuongorora furuwenza. Muna 1956, WHO yakawedzera kudoma CDC senzvimbo yayo yekubatana mumunda wekuongorora furuwenza, epidemiology uye kutonga, ichipa rutsigiro rwehunyanzvi uye gwara resainzi rekudzivirira nekudzora furuwenza pasi rose. Kugadzwa uye kuenderera mberi kwekushanda kweaya masisitimu ekutarisa kunopa chengetedzo yakakosha yemhinduro yepasirese kuzvirwere zvefuruwenza uye denda.

Parizvino, CDC yakagadzira yakawedzera furuwenza surveillance network. Izvo zvina zvakakosha zvikamu zvekuongororwa kwefuruwenza zvinosanganisira kuongororwa murabhoritari, kuongororwa kwemurwere ari kunze, kuongororwa kwemurwere, uye kuongororwa kwerufu. Iyi yakabatanidzwa yekutarisa sisitimu inopa rutsigiro rwakakosha kutungamira sarudzo dzehutano hweveruzhinji uye mhinduro kune denda refuruwenza..

Global Influenza Surveillance and Response System inobata nyika zana negumi neina uye ine nzvimbo 144 yenyika dzefuruwenza, idzo dzinoona kuenderera mberi kwefuruwenza gore rose. CDC, senhengo, inoshanda nemarabhoritari kune dzimwe nyika kutumira hutachiona hwefuruwenza kune WHO kune antigenic uye genetic profiling, yakafanana nemaitiro ayo maLabhoritari eUS anoendesa ari ega kuCDC. Kudyidzana pakati peUnited States neChina mumakore makumi mana apfuura kwave chikamu chakakosha chekuchengetedza hutano hwepasirese uye diplomacy.