maleriya

maleriya
vargeekaran evam baahya saadhan
Plasmodium.jpg
maanav rakt mein plaasmodiym failseepairam valaya-roop tatha yugmak.
aaiseedi-10 B50.
aaiseedi-9 084
oemaaaiem 248310
dijeej-deebi 7728
medalaain plas 000621
imedisin med/1385 emerg/305 ped/1357
M.iesaech C03.752.250.552

maleriya ya durvaat ek vaahak-janit sankraamak rog hai jo protojoaa parajeevi dvaara failata hai. yeh mukhya roop se America, Asia aur Africa mahaadveepon ke ushn tatha uposhn katibandhi kshetron mein faila hua hai. pratyek varsh yeh 51.5 karod logon ko prabhaavit karta hai tatha 10 se 30 lakh logon ki mrutyu ka kaaran banta hai jinmein se adhiktar up-sahaara Africa ke yuva bachche hote hain.[1] maleriya ko aamtaur par gareebi se jod kar dekha jaata hai kintu yeh khud apne aap mein gareebi ka kaaran hai tatha aarthik vikaas ka pramukh avarodhak hai.

maleriya sabse prachalit sankraamak rogon mein se ek hai tatha bhanyakar jan svaasthya samasya hai. yeh rog plaasmodiym gan ke protojoaa parajeevi ke maadhyam se failata hai. keval chaar prakaar ke plaasmodiym (Plasmodium) parajeevi manushya ko prabhaavit karte hai jinmein se sarvaadhik khatarnaak plaasmodiym failseepairam (Plasmodium falciparum) tatha plaasmodiym vivaiks (Plasmodium vivax) maane jaate hain, saath hi plaasmodiym ovel (Plasmodium ovale) tatha plaasmodiym maleriye (Plasmodium malariae) bhi maanav ko prabhaavit karte hain. is saare samooh ko 'maleriya parajeevi' kehte hain.

maleriya ke parajeevi ka vaahak maada enofilej (Anopheles) machhar hai. iske kaatne par maleriya ke parajeevi laal rakt koshikaaon mein pravesh kar ke bahugunit hote hain jisse raktaheenata (eneemiya) ke lakshan ubharate hain (chakkar aana, saaains foolana, drutanaadi ityaadi). iske alaava avishisht lakshan jaise ki bukhaar, sardi, ubakaai aur jukhaam jaisi anubhooti bhi dekhe jaate hain. gambhir maamalon mein mareej moorchha mein ja sakta hai aur mrutyu bhi ho sakti hai.

maleriya ke failaav ko rokane ke liye kai upaaya kiye ja sakte hain. machharadaani aur keede bhagaane waali davaaen machhar kaatne se bachaati hain, to keetanaashak dava ke chhidkaav tatha sthir jal (jis par machhar ande dete hain) ki nikaasi se machharon ka niyantran kiya ja sakta hai. maleriya ki rokathaam ke liye yadyapi teeke/vaikseen par shodh jaari hai, lekin abhi tak koi upalabdh naheen ho saka hai. maleriya se bachane ke liye nirodhak davaaen lambe samay tak leni padti hain aur itni mahangi hoti hain ki maleriya prabhaavit logon ki pahuainch se aksar baahar hoti hai. maleriya prabhaavi ilaake ke jyaadaatar vayask logon me baar-baar maleriya hone ki pravrutti hoti hai saath hi unamein is ke virooddh aanshik pratirodhak kshamata bhi aa jaati hai, kintu yeh pratirodhak kshamata us samay kam ho jaati hai jab ve aise kshetr me chale jaate hai jo maleriya se prabhaavit naheen ho. yadi ve prabhaavit kshetr me vaapas lautate hain to unhe fir se poorn saavadhaani baratani chaahiye. maleriya sankraman ka ilaaj kunain ya aartimeesinin jaisi maleriyaarodhi davaaon se kiya jaata hai yadyapi dava pratirodhakata ke maamale teji se saamaanya hote ja rahe hain.

anukram

itihaas

sar ronald Ross

maleriya maanav ko 50,000 varshon se prabhaavit kar raha hai shaayad yeh sadaiv se manushya jaati par parajeevi raha hai. is parajeevi ke niktavarti rishtedaar hamaare niktavarti rishtedaaron me yaani chimpaanji me rahate hain. jab se itihaas likha ja raha hai tabase maleriya ke varnan milte hain. sabse puraana varnan cheen se 2700 isa poorv ka milta hai. maleriya shabd ki utpatti madhyakaaleen itaaliyn bhaasha ke shabdon maala area se hui hai jinka arth hai 'buri hava'. ise 'daladali bukhaar' (angreji: marsh fever, marsh feevar) ya 'eg' (angreji: ague) bhi kaha jaata tha kyonki yeh daladali kshetron mein vyaapak roop se failata tha.

maleriya par pehle pahal gambhir vaigyaanik adhyayan 1880 me hua tha jab ek fraanseesi sainya chikitsak Charles lui alfons laiveran ne Algeria mein kaam karte hue pehli baar laal rakt koshika ke andar parajeevi ko dekha tha. tab usane yeh prastaavit kiya ki maleriya rog ka kaaran yeh protojoaa parajeevi hai. is tatha anya khojon hetu use 1907 ka chikitsa Nobel puraskaar diya gaya.

is protojoaa ka naam plaasmodiym itaaliyn vaigyaaniko ettore maarchiyaafaava tatha aanjelo seli ne rakha tha. iske ek varsh baad kyubaai chikitsak kaarlos finle ne peet jvar ka ilaaj karte hue pehli baar yeh daava kiya ki machhar rog ko ek manushya se doosare manushya tak failaate hain. kintu ise akaatya roop pramaanit karne ka kaarya Britain ke sar ronaald Ross ne Secundarabad mein kaam karte hue 1898 mein kiya tha. inhonne machharon ki vishesh jaatiyon se pakshiyon ko katava kar un machharon ki laar granthiyon se parajeevi alag kar ke dikhaaya jinhe unhonne sankramit pakshiyon mein paala tha. is kaarya hetu unhe 1902 ka chikitsa Nobel mila. baad mein bhaarateeya chikitsa seva se tyaagapatr dekar Ross ne navasthaapit livrapool school of traupikl medisin mein kaarya kiya tatha misr, panaama, yoonaan tatha maareeshas jaise kai deshon me maleriya niyantran kaaryon me yogadaan diya. finle tatha Ross ki khojon ki pushti vaaltar reed ki adhyakshata mein ek chikitsakeeya board ne 1900 mein ki. iski salaahon ka paalan William si. gorgas ne panaama nahar ke nirmaan ke samay kiya, jiske chalte hajaaron majadooron ki jaan bach saki. in upaayon ka prayog bhavishy me is beemaari ke virooddh kiya gaya.

maleriya ke virooddh pehla prabhaavi upachaar sinkona vruksh ki chhaal se kiya gaya tha jismein kunain pai jaati hai. yeh vruksh peru desh mein endeej parvaton ki dhalaanon par ugata hai. is chhaal ka prayog sthaaneeya log lambe samay se maleriya ke virooddh karte rahe the. jeesuit paadariyon ne kareeb 1640 isvi mein yeh ilaaj Europe pahuaincha diya, jahaaain yeh bahut lokapriya hua. parantu chhaal se kunain ko 1820 tak alag naheen kiya ja saka. yeh kaarya antat: fraanseesi rasaayanavidon piyer Joseph peletiye tatha Joseph biyaaainneme kaiveintu ne kiya tha, inhonne hi kunain ko yeh naam diya.

beesaveen sadi ke praarambh mein, enteebaayotik davaaon ke abhaav mein, upadansh (sifilis) ke rogiyon ko jaan boojh kar maleriya se sankramit kiya jaata tha. iske baad kunain dene se maleriya aur upadansh donon kaaboo mein aa jaate the. yadyapi kuchh mareejon ki mrutyu maleriya se ho jaati thi, upadansh se hone waali nishchit mrutyu se yeh nitaant behtar maana jaata tha. yadhapi maleriya parajeevi ke jeevan ke rakt charan aur machhar charan ka pata bahut pehle lag gaya tha, kintu yeh 1980 me ja kar pata laga ki yeh yakrut me chhipe roop se maujood rah sakta hai. is khoj se yeh gutthi sulajhi ki kyon maleriya se ubare mareej varshon baad achaanak rog se grast ho jaate hain.

rog ka vitran tatha prabhaav

maleriya prativrsh 40 se 90 karod bukhaar ke maamalo ka kaaran banta hai, vaheen isse 10 se 30 lakh mautein har saal hoti hain, jiska arth hai prati 30 saikend mein ek maut. inmein se jyaadaatar paaainch varsh se kam aayu vaale bachchein hote hain, vaheen garbhavati mahilaaeain bhi is rog ke prati samvedansheel hoti hain. sankraman rokane ke prayaas tatha ilaaj karne ke prayaason ke hote hue bhi 1992 ke baad iske maamalon mein abhi tak koi giraavat naheen aayi hai. yadi maleriya ki vartamaan prasaar dar bani rahi to agale 20 varshon me mrutyu dar doguni ho sakti hai. maleriya ke baare mein vaastavik aakainde anupalabdh hain kyonki jyaadaatar rogi graameen ilaakon me rahate hain, na to ve chikitsaalaya jaate hain aur na unke maamalon ka lekha jokha rakha jaata hai.

maleriya aur H.I.vi. ka ek saath sankraman hone se mrutyu ki sambhaavana badh jaati hai.[2] maleriya choonki H.I.vi. se alag aayu-varg mein hota hai, isliye yeh mel H.I.vi. - ti.bi. (kshaya rog) ke mel se kam vyaapak aur ghaatak hota hai. tathaapi ye dono rog ek doosare ke prasaar ko failaane me yogadaan dete hain- maleriya se vaayaral bhaar badh jaata hai, vaheen eds sankraman se vyakti ki pratirodhak kshamata kamjor ho jaane se vah rog ki chapet me aa jaata hai.

vartamaan mein maleriya bhoomadhya rekha ke donon taraf vistrut kshetr mein faila hua hai in kshetron mein America, Asia tatha jyaadaatar Africa aata hai, lekin inmein se sabse jyaada maute (lagbhag 85 se 90 % tak) up-sahaara Africa me hoti hain. maleriya ka vitran samajhna thoda jatil hai, maleriya prabhaavit tatha maleriya mukt kshetr praaya saath saath hote hain. sookhe kshetron mein iske prasaar ka varsha ki maatra se gahra sambandh hai. deingoo bukhaar ke vipreet yeh shaharon ki apeksha gaaainvon mein jyaada failata hai. udaaharanaarth viytanaam, laaos aur kambodiya ke nagar maleriya mukt hain, jabki in deshon ke gaaainv is se peedit hain. apavaad-svaroop Africa mein nagar-graameen sabhi kshetr is se grast hain, yadyapi bade nagaron mein khatra kam rahata hai. 1960 ke dashak ke baad se kabhi iske vishv vitran ko maapa naheen gaya hai. haal hi mein Britain ki velakam trast ne maleriya etalas pariyojana ko is kaarya hetu vitteeya sahaayata di hai, jisse maleriya ke vartamaan tatha bhavishya ke vitran ka behtar dhaing se adhyayan kiya ja sakega.

saamaajik evam aarthik prabhaav

maleriya gareebi se juda to hai hi, yeh apne aap mein khud gareebi ka kaaran hai tatha aarthik vikaas mein baadhak hai. jin kshetron mein yeh vyaapak roop se failata hai vahaaain yeh anek prakaar ke nakaaraatmak aarthik prabhaav daalata hai. prati vyakti ji.di.pi ki tulana yadi 1995 ke aadhaar par karein (khareed kshamata ko samaayojit karke), to maleriya mukt kshetron aur maleriya prabhaavit kshetron mein ismein paaainch guna ka antar najar aata hai (1,526 dollar banaam 8,268 dollar). jin deshon me maleriya failata hai unke ji.di.pi me 1965 se 1990 ke madhya keval prativrsh 0.4% ki vruddhi hui vaheen maleriya se mukt deshon mein yeh 2.4% hui. yadyapi saath mein hone bhar se hi gareebi aur maleriya ke beech kaaran ka sambandh naheen joda sakta hai, bahut se gareeb deshon mein maleriya ki rokathaam karne ke liye paryaapt dhan upalabdh naheen ho paata hai. keval Africa mein hi prativrsh 12 arab American dollar ka nuksaan maleriya ke chalte hota hai, ismein svaasthya vyaya, kaaryadivson ki haani, shiksha ki haani, dimaagi maleriya ke chalte maanasik kshamata ki haani tatha nivesh evam paryatan ki haani shaamil hain. kuchh deshon me yeh kul jan svaasthaya bajat ka 40% tak kha jaata hai. in deshon mein aspataalon mein bharti hone vaale mareejon mein se 30 se 50% aur baahya-rogi vibhaagon mein dekhe jaane vaale rogiyon mein se 50% tak rogi maleriya ke hote hain.[3] eds aur tapedik ke mukaabale 2007 ke November maah mein maleriya ke liye dugane se bhi jyaada 46.9 karod dollar ki sahaayata raashi kharch ki gayi.[4]

rog ke lakshan

maleriya ke lakshanon mein shaamil hain- jvar, kanpakanpi, jodon mein dard, ulti, raktaalpata (rakt vinaash se), mootr mein heemoglobin aur daure. maleriya ka sabse aam lakshan hai achaanak tej kanpakanpi ke saath sheet lagana, jiske fauran baad jvar aata hai. 4 se 6 ghante ke baad jvar utarata hai aur paseena aata hai. pi. failseepairam ke sankraman mein yeh poori prakriya har 36 se 48 ghante mein hoti hai ya lagaataar jvar rah sakta hai; pi. vivaiks aur pi. ovel se hone vaale maleriya mein har do din mein jvar aata hai, tatha pi. maleriye se har teen din mein.[5]

maleriya ke gambhir maamale lagbhag hamesha pi. failseepairam se hote hain. yeh sankraman ke 6 se 14 din baad hota hai. tilli aur yakrut ka aakaar badhna, teevr sirdard aur adhomadhuraktata (rakt mein glookoj ki kami) bhi anya gambhir lakshan hain. mootr mein heemoglobin ka utsarjan aur isse gurdon ki vifalta tak ho sakti hai, jise kaalaapaani bukhaar (angreji: blackwater fever, black vaatar feevar) kehte hain. gambhir maleriya se moorchha ya mrutyu bhi ho sakti hai, yuva bachche tatha garbhavati mahilaaon me aisa hone ka khatra bahut jyaada hota hai. atyant gambhir maamalon mein mrutyu kuchh ghanton tak mein ho sakti hai. gambhir maamalon mein uchit ilaaj hone par bhi mrutyu dar 20% tak ho sakti hai. mahaamaari vaale kshetr me praaya upachaar santoshajanak naheen ho paata, at: mrutyu dar kaafi ooainchi hoti hai aur maleriya ke pratyek 10 mareejon mein se 1 mrutyu ko praapt hota hai.

maleriya yuva bachchon ke vikaasasheel mastishk ko gambhir kshati pahuncha sakta hai. bachchon mein dimaagi maleriya hone ki sambhaavana adhik rahati hai aur aisa hone par dimaag mein rakt ki aapoorti kam ho sakti hai aur aksar mastishk ko seedhe bhi haani pahuainchaati hai. atyadhik kshati hone par haath-paanv ajeeb tarah se mud-tud jaate hain. deergh kaal mein gambhir maleriya se ubare bachchon mein aksar alp maanasik vikaas dekha jaata hai. garbhavati striyaaain machharon ke liye bahut aakarshak hoti hain aur maleriya se garbh ki mrutyu, nimn janm bhaar aur shishu ki mrutyu tak ho sakte hain. mukhyataya yeh pi. failseepairam ke sankraman se hota hai, lekin pi. vivaiks bhi aisa kar sakta hai. pi. vivaiks tatha pi. ovel parajeevi varshon tak yakrut me chhupe rah sakte hain. at: rakt se rog mit jaane par bhi rog se poornataya mukti mil gayi hai aisa maan lena galat hai. pi. vivaiks me sankraman ke 30 saal baad tak fir se maleriya ho sakta hai. samasheetoshn kshetron mein pi. vivaiks ke har paaainch me se ek maamala thand ke mausam mein chhupa rah kar agale saal achaanak ubharata hai.

kaarak

maleriya parajeevi

maleriya plaasmodiym gan ke protojoaa parajeeviyon se failata hai. is gan ke chaar sadasya manushyon ko sankramit karte hain- plaasmodiym failseepairam, plaasmodiym vivaiks, plaasmodiym ovel tatha plaasmodiym maleriye. inmein se sarvaadhik khatarnaak pi. failseepairam maana jaata hai, yeh maleriya ke 80 pratishat maamalon aur 90 pratishat mrutyuon ke liye jimmedaar hota hai.[6] yeh parajeevi pakshiyon, reaingane vaale jeevon, bandaron, chimpaanjiyon tatha choohon ko bhi sankramit karta hai.[7] kai anya prakaar ke plaasmodiym se bhi manushya mein sankraman gyaat hain kintu pi. naaulesi (P. knowlesi) ke alaava yeh naganya hain.[8] pakshiyon mein paae jaane vaale maleriya se murgiyaaain mar sakti hain lekin isse murgi-paalakon ko adhik nuksaan hota naheen paaya gaya hai.[9] havaai dweep samooh mein jab manushya ke saath yeh rog pahuaincha to vahaaain ki kai pakshi prajaatiyaaain isse vinsht ho gayeen kyonki iske virooddh koi praakrutik pratirodh kshamata unamein naheen thi.[10]

plaasmodiym parajeevi, maleriya failaane vaale machhar ki madhya-antadi ki andarooni parat ki koshika ke koshikaadravya ka sankraman karte hue, ilaiktraun sookshmadarshi se chitrit.

machhar

maleriya parajeevi ki praathamik poshak maada enofileej machhar hoti hai, joki maleriya ka sankraman failaane mein bhi madad karti hai. enofileej gan ke machhar saare sansaar mein faile hue hain. keval maada machhar khoon se poshan leti hai, at: yeh hi vaahak hoti hai na ki nar. maada machhar enofileej raat ko hi kaatati hai. shaam hote hi yeh shikaar ki talaash me nikal padti hai tatha tab tak ghoomti hai jab tak shikaar mil naheen jaata. yeh khade paani ke andar ande deti hai. andon aur unase nikalne vaale laarava donon ko paani ki atyant sakht jarurat hoti hai. iske atirikt laarava ko saans lene ke liye paani ki satah par baar-baar aana padta hai. ande-laarava-pyoopa aur fir vayask hone mein machhar lagbhag 10-14 din ka samay lete hain. vayask machhar Parag aur sharkara vaale anya bhojya-padaarthon par palate hain, lekin maada machhar ko ande dene ke liye rakt ki aavashyakta hoti hai.

plaasmodiym ka jeevan chakr

maleriya parajeevi ka pehla shikaar tatha vaahak maada enofileej machhar banti hai. yuva machhar sankramit maanav ko kaatne par uske rakt se maleriya parajeevi ko grahan kar lete hain. rakt mein maujood parajeevi ke jananaanu (angreji:gametocytes, gaimeetosaaits) machhar ke pet mein nar aur maada ke roop mein viksit ho jaate hain aur fir milkar andaanu (angreji:oocytes, oosaaits) bana lete hain jo machhar ki antadiyon ki deevaar mein palane lagte hain. paripakva hone par ye footate hain aur ismein se nikalne vaale beejaanu (angreji:sporozoites, sporojauts) us machhar ki laar-granthiyon mein pahuainch jaate hain. machhar fir jab svasth manushya ko kaatata hai to tvacha mein laar ke saath-saath beejaanu bhi bhej deta hai.[11] maanav shareer mein ye beejaanu fir palakar jananaanu banaate hain (neeche dekhein), jo fir aage sankraman failaate hain.

iske alaava maleriya sankramit rakt ko chadhaane se bhi fail sakta hai, lekin aisa hona bahut asaadhaaran hai.[12]

maanav shareer mein rog ka vikaas

mukhya lekh : maleriya ka maanav jeenom par prabhaav

maleriya parajeevi ka maanav mein vikaas do charanon mein hota hai: yakrut mein pratham charan aur laal rakt koshikaaon mein doosra charan. jab ek sankramit machhar maanav ko kaatata hai to beejaanu (angreji: sporozoites, sporojauits) maanav rakt mein pravesh kar yakrut mein pahuainchate hain aur shareer mein pravesh paane ke 30 minute ke bheetar yakrut ki koshikaaon ko sankramit kar dete hain. fir ye yakrut mein alaingik janan karne lagte hain. yeh charan 6 se 15 din chalta hai. is janan se hajaaron anshaanu (angreji: merozoites, meerojauits) bante hain jo apni mehmaan koshikaaon ko tod kar rakt mein pravesh kar jaatein hain tatha laal rakt koshikaaon ko sankramit karna shuroo kar dete hain.[13]

maleriya parajeevi ka maanav shareer mein jeevan chakr

isse rog ka doosra charan shuru hota hai. pi. vivaiks aur pi. ovel ke kuchh beejaanu yakrut ko hi sankramit karke ruk jaate hain aur suptaanu (angreji: hypnozoites, hipnojauits) ke roop mein nishkriya ho jaate hain. ye 6 se 12 maas tak nishkriya rah kar fir achaanak anshaanuon ke roop mein prakat ho jaate hain aur rog paida kar dete hain.[14]

laal rakt koshika mein pravesh karke ye parajeevi khud ko fir se gunit karte rahate hain. ye valaya roop mein viksit hokar fir bhojaanu (angreji: trophozoites, trofojauits) aur fir bahunaabhikeeya shaaijaunt (angreji: schizont) aur fir anekon anshaanu bana dete hain. samay samay par ye anshaanu poshak koshikaaon ko todkar nayeen laal rakt koshikaaon ko sankramit kar dete hain. aise kai charan chalte hain. maleriya mein bukhaar ke daure aane ka kaaran hota hai hajaaron anshaanuon ka ekasaath nai laal rakt koshikaaon ko prabhaavit karna.

maleriya parajeevi apne jeevan ka lagbhag sabhi samay yakrut ki koshikaaon ya laal rakt koshikaaon mein chhupa rahakar bitaata hai, isliye maanav shareer ke pratirksha tantr se bacha rah jaata hai. tilli mein nasht hone se bachane ke liye pi. failseepairam ek anya chaal chalta hai- yeh laal rakt koshika ki satah par ek chipkaaoo proteen pradarshit kara deta hai jisse sankramit rakt koshikaaeain ko chhoti rakt vaahikaaon mein chipk jaati hain aur tilli tak pahuainch naheen paati hain.[15] is kaaran raktadhaara mein keval valaya roop hi dikhte hain, anya sabhi vikaas ke charanon mein yeh chhoti rakt vaahikaaon ki satahon mein chipka rahata hai. is chipchipaahat ke chalte hi maleriya raktastraav ki samasya karta hai.

yadyapi sankramit laal rakt koshika ki satah par pradarshit proteen peeefaiemapee1 (Plasmodium falciparum erythrocyte membrane protein 1, plaasmodiym failseepairam irithrosaait maimbren proteen 1) shareer ke pratirksha tantr ka shikaar ban sakta hai, aisa hota naheen hai kyonki is proteen mein vividhta bahut jyaada hoti hai. har parajeevi ke paas iske 60 prakaar hote hai vaheen sabhi ke paas mila kar asankhya roopon mein ye is proteen ko pradarshit kar sakte hain. ve baar baar is proteen ko badal kar shareer ke pratirksha tantr se ek kadam aage rahate hain. kuchh anshaanu nar-maada jananaanuon mein badal jaate hain aur jab machhar kaatata hai to rakt ke saath unhein bhi le jaata hai. yahaaain ve fir se apna jeevan chakr poora karte hain.

nidaan

lakshanon ke aadhaar par

anek maleriya-grast kshetron mein bukhaar ke har mareej ko maleriya ka aanumaanik nidaan de diya jaata hai aur kunain se ilaaj shuru kar diya jaata hai.[16] iske saath hi rakt ki pattikaaeain bhi bana li jaati hain, lekin ilaaj shuru karne ke liye iske parinaamon ki prateeksha naheen ki jaati. aisa kai aise kshetron mein bhi kiya jaata hai jahaaain saamaanya prayogashaala pareekshanon ki suvidhaae upalabdh naheen hon. lekin malaavi mein hua ek adhyayan bataata hai ki bukhaar ke saath-saath yadi guda ka taapamaan, naakhoonon mein raktaheenata aur tilli ke aakaar ko bhi dhyaan mein liya jaae to maleriya ke anaavashyak upachaar se bahut bacha ja sakta hai (nidaan mein 21 se 41 tak badhotri).).[17]

rakt ki sookshmadarshi se jaanch

pi. failseepairam kalchar (K1 strain) ka ek rakt dhabba. kai rakt koshikaaon mein valaya charan dekhe ja sakte hain. kendra ke nikat hai ek shaaijaunt evam baaen par hai bhojaanu

rakt pattikaaon ka sookshmadarshi se pareekshan karna maleriya ke nidaan ka sabse sasta, achha tatha bharosemand tareeka maana jaata hai. is pareekshan se chaaron maleriya parajeeviyon ke vishisht lakshanon ke dvaara alag-alag nidaan kiya ja sakta hai. rakt pattikaaeain do tarah se banaai jaati hain - patali aur moti. patali pattikaaon mein parajeevi ki banaavat ko behtar dhang se surakshit rakha ja sakta hai, vaheen doosari or moti pattikaaon se kam samay mein rakt ki adhik maatra ki jaaainch ki ja sakti hai aur isse kam maatra ke sankraman ka bhi nidaan kiya ja sakta hai. anubhavi pareekshak rakt mein 0.0000001 pratishat tak ke sankraman ko pehchaan sakte hain. in kaaranon se moti aur patali donon pattiyaaain banaai jaati hain. saath hi ek se adhik valaya charanon ki jaaainch karna jaroori hota hai, kyonki chaaron parajeeviyon ke valaya charan bahudha ek jaise dikhte hain..[18]

kshetr pareekshan

maleriya ke nidaan ke liye anek enteejan-aadhaarit dipstik (angreji: dipstick) pareekshan ya maleriya raipid enteejan test (angreji: Malaria Rapid Antigen Tests, maleriya tvarit enteejan pareekshan) bhi upalabdh hain. inhein rakt ki keval ek boond ki aavashyakta hoti hai, aur sirf 15-20 minute mein hi parinaam saamane aa jaata hai, prayogashaala ki aavashyakta naheen hoti hai. ye sookshmadarshi jaanch se thode kamtar maane jaate hai. lekin jin kshetron mein sookshmadarshi jaanch ki suvidha upalabdh naheen hoti ya pareekshakon ko maleriya ke nidaan ka anubhav naheen hota vahaaain prabhaavit kshetr mein ja kar rakt ki ek boond se enteejan pareekshan kar liya jaata hai. sabse pehle in pareekshanon ka vikaas pi. failseepairam ke kinvak glootaamet deehaaidrojanej ko enteejan ke roop mein prayog karke kiya gaya.[19] lekin jaldi hi ek anya kinvak laiktet deehaadrojanej ka prayog karke optiml-IT (angreji: Optimal-IT) naamak pareekshan ka vikaas kiya gaya.[20] ye kinvak rakt mein adhik samay tak maujood naheen rahate aur parajeevi ka khaatma ho jaane par ye bhi rakt se nikal jaate hain, at: in pareekshanon ka upayog ilaaj ki safalta ya vifalta jaanane ke liye bhi kiya jaata hai. optiml-IT failseepairam aur gair-failseepairam maleriya mein antar bhi kar sakta hai. yeh pi. failseepairam ka 0.01 pratishat aur gair-failseepairam maleriya parajeeviyon ka 0.1 pratishat tak rakt mein nidaan kar sakta hai. iske atirikt pi. failseepairam vishisht histideen-bharpoor proteenon (angreji: P. falciparum specific histidine-rich proteins) par aadhaarit pairaachaik-peeef (angreji: Paracheck-Pf) rakt mein 0.002 pratishat tak maleriya parajeevi ka nidaan kar sakta hai, lekin yeh failseepairam aur gair-failseepairam maleriya mein antar naheen kar paata hai.

anya pareekshan

inke atirikt pauleemarej shrrunkhala abhikriya (angreji: polymerase chain reaction, PCR) ka prayog karke aur aanavik vidhiyon ke prayog se bhi kuchh pareekshan viksit kiye gaye hain, lekin ye abhi kaafi mahange hain, tatha keval vishisht prayogashaalaaon mein hi upalabdh hain. saste, samvedi tatha saral pareekshanon ke vikaas ki ab bhi aavashyakta hai, jinka prayog kshetr mein, maleriya ke nidaan ke liye kiya ja sake.[21]

gambhir maleriya ka nidaan

gambhir maleriya ko Africa me praay: pehchaan lene mein galati hoti hai, jiske chalte anya praanaghaatak beemaariyon ka ilaaj bhi naheen ho paata hai. rakt mein parajeevi ki maujoodagi keval gambhir maleriya se hi naheen, anya kai jaanleva beemaariyon ke chalte bhi ho sakti hai. haal ke adhyayan bataate hain ki maleriya-janit moorchha aur gair-maleriya-janit moorchha mein antar karne ke liye maleriyl retinopaithi (aaainkh ke retina ke aadhaar par pehchaan) kisi bhi anya pareekshan se behtar hai.[22]

sandarbh

  1. ↑ "maleriya ke liye karodon dollar". BBC. http://www.bbc.co.uk/hindi/news/030921_gates_malaria_pp.shtml. abhigman tithi: 31 October 2008.
  2. ↑ "echaaaivi-eds aur maleriya mein sambandh". BBC. http://www.bbc.co.uk/hindi/science/story/2006/12/061208_hiv_malaria.shtml. abhigman tithi: 31 October 2008.
  3. ↑ Roll Back Malaria. "Economic costs of malaria". WHO. http://www.rbm.who.int/cmc_upload/0/000/015/363/RBMInfosheet_10.htm. abhigman tithi: 2006-09-21.
  4. ↑ "maleriya se ladne ke liye aage aae daanakarta". hindi nest. http://samachar.boloji.com/200712a/14701.htm. abhigman tithi: 31 October 2008.
  5. ↑ Malaria life cycle & pathogenesis. Malaria in Armenia. Accessed October 31, 2006.
  6. ↑ Mendis K, Sina B, Marchesini P, Carter R (2001). "The neglected burden of Plasmodium vivax malaria.". Am J Trop Med Hyg 64 (1-2 Suppl): 97-106. PMID 11425182. http://www.ajtmh.org/cgi/reprint/64/1_suppl/97.pdf.
  7. ↑ Escalante A, Ayala F (1994). "Phylogeny of the malarial genus Plasmodium, derived from rRNA gene sequences.". Proc Natl Acad Sci U S A 91 (24): 11373-7. doi:10.1073/pnas.91.24.11373. PMID 7972067.
  8. ↑ Garnham, PCC (1966). Malaria parasites and other haemosporidia. Blackwell Scientific Publications.
  9. ↑ Investing in Animal Health Research to Alleviate Poverty. International Livestock Research Institute. Permin A. and Madsen M. (2001) Appendix 2: review on disease occurrence and impact (smallholder poultry). Accessed 29 Oct 2006
  10. ↑ Atkinson CT, Woods KL, Dusek RJ, Sileo LS, Iko WM (1995). "Wildlife disease and conservation in Hawaii: pathogenicity of avian malaria (Plasmodium relictum) in experimentally infected iiwi (Vestiaria coccinea)". Parasitology 111 Suppl: S59-69. PMID 8632925.
  11. ↑ Talman A, Domarle O, McKenzie F, Ariey F, Robert V. "Gametocytogenesis: the puberty of Plasmodium falciparum.". Malar J 3: 24. PMID 15253774.
  12. ↑ Marcucci C, Madjdpour C, Spahn D. "Allogeneic blood transfusions: benefit, risks and clinical indications in countries with a low or high human development index.". Br Med Bull 70: 15-28. PMID 15339855.
  13. ↑ Bledsoe, G. H. (December 2005) "Malaria primer for clinicians in the United States" Southern Medical Journal 98(12): pp. 1197-204, (PMID 16440920);
  14. ↑ Cogswell F (1992). "The hypnozoite and relapse in primate malaria.". Clin Microbiol Rev 5 (1): 26–35. PMID 1735093. http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=358221&blobtype=pdf.
  15. ↑ "maleriya se nipatne ke liye nai khoj" (esaechateeemael). BBC. http://www.bbc.co.uk/hindi/science/story/2008/07/080714_malaria_breakthrough.shtml. abhigman tithi: 2008.
  16. ↑ "Treatment of Malaria". http://www.malariasite.com/malaria/Treatment1.htm.
  17. ↑ Redd S, Kazembe P, Luby S, Nwanyanwu O, Hightower A, Ziba C, Wirima J, Chitsulo L, Franco C, Olivar M (2006). "Clinical algorithm for treatment of Plasmodium falciparum malaria in children". Lancet 347 (8996): 80. doi:10.1016/S0140-6736(96)90404-3. PMID 8551881. .
  18. ↑ Warhurst DC, Williams JE (1996). "Laboratory diagnosis of malaria". J Clin Pathol 49: 533–38. doi:10.1136/jcp.49.7.533. PMID 8813948.
  19. ↑ Ling IT., Cooksley S., Bates PA., Hempelmann E., Wilson RJM. (1986). "Antibodies to the glutamate dehydrogenase of Plasmodium falciparum.". Parasitology 92,: 313–24. PMID 3086819.
  20. ↑ Pattanasin S, Proux S, Chompasuk D, Luwiradaj K, Jacquier P, Looareesuwan S, Nosten F (2003). "Evaluation of a new Plasmodium lactate dehydrogenase assay (OptiMAL-IT®) for the detection of malaria". Transact Royal Soc Trop Med 97: 672–4. doi:10.1016/S0035-9203(03)80100-1. PMID 16117960.
  21. ↑ Redd S, Kazembe P, Luby S, Nwanyanwu O, Hightower A, Ziba C, Wirima J, Chitsulo L, Franco C, Olivar M (2006). "Clinical algorithm for treatment of Plasmodium falciparum malaria in children". Lancet 347 (8996): 80. doi:10.1016/S0140-6736(96)90404-3. PMID 8551881.
  22. ↑ Beare NA et al. (2006). Am J Trop Med Hyg 75 (5): 790-797.

upachaar

mukhya lekh : maleriya ka upachaar
maleriya failaane waali maada enofileej machhar

maleriya ke kuchh maamale aapaatkaaleen hote hai tatha mareej ko poornataya svasth hone tak nigraani me rakhana anivaarya hota hai, kintu anya prakaar ke maleriya mein aisa aavashyak naheen hain, ilaaj bahirang vibhaag mein kiya ja sakta hai. uchit ilaaj hone par mareej bilkul theek ho jaata hai. kuchh lakshanon ka upachaar saamaanya davaaon se kiya jaata hai, saath mein maleriya-rodhi davaaeain bhi di jaati hai. ye davaaen do prakaar ki hoti hain- pehli jo pratirodhak hoti hain aur rog hone se pehle liye jaane par rog se suraksha karti hain tatha doosari ve jinka rog se sankramit ho jaane ke baad prayog kiya jaata hai. anek davaaeain keval pratirodh ya keval upachaar ke liye istemaal hoti hain, jabki anya kai donon tarah se prayog mein laai ja sakti hain. kuchh davaaeain ek-doosare ke prabhaav ko badhaati hain aur inka prayog saath mein kiya jaata hai. pratirodhak davaaon ka prayog aksar saamoohik roop se hi kiya jaata hai.

kunain par aadhaarit anek aushadhiyon ko maleriya ka achha upachaar samjha jaata hai. iske atirikt aartimeesinin jaisi aushadhiyaaain, jo aartimeesiya ennuaa (angreji:Artemisia annua) naamak paudhe se taiyaar ki jaati hai, maleriya ke ilaaj mein prabhaavi pai gayi hain. kuchh anya aushadhiyon ka prayog bhi maleriya ke viruddh safal hua hai. kuchh aushadhiyon par prayog jaari hai. dava ke chunaav mein sabse pramukh kaarak hota hai us kshetr mein maleriya parajeevi kin davaaon ke prati pratirodh viksit kar chuka hai. anek davaaeain jinka prayog pehle maleriya ke viruddh safal samjha jaata tha aajkal safal naheen samjha jaata kyon ki maleriya ke parajeevi dheere dheere unke prati pratirodhak kshamata praapt kar chuke hain.

homyopaithi mein maleriya ka upachaar upalabdh hai, haalaanki anek chikitsakon ka maanana hai ki maleriya jaisi gambhir beemaari ka ilaaj elopaithik davaaon se hi kiya jaana chaahiye, kyonki ye vaigyaanik shodh par aadhaarit hain. yahaaain tak ki british homiyopaithik association ki salaah yahi hai ki maleriya ke upachaar ke liye homyopaithi par nirbhar naheen karna chaahiye.[1] aayurved mein maleriya ko visham jvar kaha jaata hai aur iske upachaar ke liye anek aushadhiyaaain upalabdh hain.

yadyapi maleriya ke aaj prabhaavi upachaar upalabdh hai, lekin vishv ke anek avikisit kshetron mein maleriya peedit kshetron mein ya to yeh milta naheen hain ya itna mahanga hota hai ki aam mareej usaka upayog naheen kar paata hai. maleriya ki davaaon ki badhti maaaing ko dekhkar anek prabhaavit deshon me bade paimaane par nakali davaaon ka kaarobaar hota hai, jo anek mrutyuon ka kaaran banta hai. aajkal kampaniyaaain nai takaneekon ka prayog karke is samasya se nipatne ka prayaas kar rahi hain.

rokathaam tatha niyantran

mukhya lekh : maleriya ki rokathaam tatha niyantran

maleriya ka prasaar in kaarakon par nirbhar karta hai- maanav janasankhya ka ghanatv, machharon ki janasankhya ka ghanatv, machharon se manushyon tak prasaar aur manushyon se machharon tak prasaar. in kaarakon mein se kisi ek ko bhi bahut kam kar diya jaae to us kshetr se maleriya ko mitaaya ja sakta hai. iseeliye maleriya prabhaavit kshetron me rog ka prasaar rokane hetu davaaon ke saath-saath machharon ka unmoolan ya unase kaatne se bachane ke upaaya kiye jaate hain. anek anusandhaan karta daava karte hain ki maleriya ke upachaar ki tulana me us se bachaav ka vyaya deergh kaal me kam rahega. 1956-1960 ke dashak me vishv star par maleriya unmoolan ke vyaapak prayaas kiye gaye (vaise hi jaise chechak unmoolan hetu kiye gaye the). kintu uname safalta naheen mil saki aur maleriya aaj bhi Africa me usi star par maujood hai.

machharon ke prajanan sthalon ko nasht karke maleriya par bahut niyantran paaya ja sakta hai. khade paani mein machhar apna prajanan karte hain, aise khade paani ki jagahon ko dhak kar rakhana, sukha dena ya baha dena chaahiye ya paani ki satah par tel daal dena chaahiye, jisse machharon ke laarava saans na le paaen. iske atirikt maleriya-prabhaavit kshetron mein aksar gharon ki deevaaron par keetanaashak davaaon ka chhidkaav kiya jaata hai. anek prajaatiyon ke machhar manushya ka khoon choosane ke baad deevaar par baith kar ise hajam karte hain. aise mein agar deevaaron par keetanaashakon ka chhidkaav kar diya jaae to deevaar par baithate hi machhar mar jaaega, kisi aur manushya ko kaatne ke pehle hi. vishv svaasthya sangathan ne maleriya prabhaavit kshetron mein chhidkaav ke liye lagbhag 12 davaaon ko maanyata di hai. inmein deedeeti ke alaava paramaithrin aur deltaamaithrin jaisi davaaeain shaamil hain, khaaskar un kshetron me jahaaain machhar deedeeti ke prati rodhak kshamata viksit kar chuke hai.

machharadaaniyaaain machharon ko logon se door rakhane me safal rahati hain tatha maleriya sankraman ko kaafi had tak rokati hain. enofileej machhar choonki raat ko kaatata hai isliye badi machharadaani ko chaarapaai/bistar pe lataka dene tatha iske dvaara bistar ko chaaron taraf se poornat: gher dene se suraksha poori ho jaati hai. machharadaaniyaaain apne aap mein bahut prabhaavi upaaya naheen hain kintu yadi unhein raasaayanik roop se upachaarit kar dein to ve bahut upayogi ho jaati hain. maleriya-prabhaavit kshetron mein maleriya ke prati jaagrukta failaane se maleriya mein 20 pratishat tak ki kami dekhi gayi hai. saath hi maleriya ka nidaan aur ilaaj jald se jald karne se bhi iske prasaar mein kami hoti hai. anya prayaason mein shaamil hai- maleriya sambandhi jaankaari ikatthi karke usaka bade paimaane par vishleshan karna aur maleriya niyantran ke tareeke kitne prabhaavi hain iski jaanch karna. aise ek vishleshan mein pata laga ki lakshan-viheen sankraman vaale logon ka ilaaj karna bahut aavashyak hota hai, kyonki inmein bahut maatra mein maleriya sanchit rahata hai.

maleriya ke virooddh teeke viksit kiye ja rahe hai yadyapi abhi tak safalta naheen mili hai. pehli baar prayaas 1967 mein choohe pe kiya gaya tha jise jeevit kintu vikirn se upachaarit beejaanuon ka teeka diya gaya. iski safalta dar 60% thi. esapeeefa66 (angreji: SPf66) pehla teeka tha jiska kshetr pareekshan hua, yeh shuroo mein safal raha kintu baad me safalta dar 30% se neeche jaane se asafal maan liya gaya. aaj aarateees, esaeesa02e (angreji: RTS,S/AS02A) teeka pareekshanon mein sabse aage ke star par hai. aasha ki jaati hai ki pi. failseeparam ke jeenom ki poori koding mil jaane se nayi davaaon ka tatha teekon ka vikaas evam pareekshan karne mein aasaani hogi.

sandarbh

  1. ↑ The Faculty of Homeopathy. "Faculty advises against homeopathy for malaria prevention". British Homeopathic Association. http://www.trusthomeopathy.org/csArticles/articles/000001/000107.htm.

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