yakshma

Tuberculosis
vargeekaran evam baahya saadhan
Tuberculosis-x-ray-1.jpg
Chest X-ray of a person with advanced tuberculosis. Infection in both lungs is marked by white arrow-heads, and the formation of a cavity is marked by black arrows.
aaiseedi-10 A15.–A19.
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oemaaaiem 607948
dijeej-deebi 8515
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imedisin med/2324 emerg/618 radio/411
M.iesaech D014376

yakshma, tapedik, kshayarog, emateebi ya teebi (tubercle bacillus ka laghu roop) ek aam aur kai maamalon mein ghaatak sankraamak beemaari hai jo maaikrobaikteeriya, aamtaur par maaikobaikteeriym tapedik ke vibhinn prakaaron ki vajah se hoti hai.[1] kshaya rog aam taur par fefadon par hamla karta hai, lekin yeh shareer ke anya bhaagon ko bhi prabhaavit kar sakta hain. yeh hava ke maadhyam se tab failata hai, jab ve log jo sakriya teebi sankraman se grasit hain, khaansi, chheenk, ya kisi anya prakaar se hava ke maadhyam se apna laar sanchaarit kar dete hain.[2] jyaadaatar sankraman sparshonmukh aur bheetari hote hain, lekin das mein se ek bheetari sankraman, antat: sakriya rog mein badal jaate hain, jinko agar bina upachaar kiye chhod diya jaaye to aise sankramit logon mein se 50% se adhik ki mrutyu ho jaati hai.

sakriya teebi sankraman ke aadarsh lakshan khoon-waali thook ke saath puraani khaansi, bukhaar, raat ko paseena aana aur vajan ghatna hain (baad ka yeh shabd hi pehle ise "kha jaane wala/yakshma" kaha jaane ke liye jimmedaar hai). anya angon ka sankraman, lakshanon ki ek vistrut shrrunkhala prastut karta hai. sakriya teebi ka nidaan rediyoloji, (aam taur par chhaati ka ex-re) ke saath-saath maaikroskopik jaanch tatha shareer ke taralon ki maaikrobaayolaujikl kalchar par nirbhar karta hai. bheetari ya chhipi teebi ka nidaan tyoobarakyoolaain tvacha pareekshan (TST) aur/ya rakt pareekshanon par nirbhar karta hai. upachaar mushkil hai aur iske liye, samay ki ek lambi avadhi mein kai enteebaayotik davaaon ke maadhyam se upachaar ki aavashyakta padti hai. yadi aavashyak ho to saamaajik sanparkon ki bhi jaanch aur upachaar kiya jaata hai. davaaon ke pratirodhi tapedik (MDR-TB) sankramanon mein enteebaayotik pratirodh ek badhti hui samasya hai. rokathaam jaanch kaaryakramon aur besils kaalmet-guerin baikseen dvaara teekaakaran par nirbhar karti hai.

aisa maana jaata hai ki duniya ki aabaadi ka ek tihaai M.tapedik,[3] se sankramit hai, naye sankraman prati second ek vyakti ki dar se badh rahe hain.[3] ek anumaan ke anusaar, 2007 mein vishv mein, 13.7 million jatil sakriya maamale the,[4] jabki 2010 mein lagbhag 8.8 million naye maamale aur 1.5 million sambandhit mautein hui jo ki adhiktar vikaasasheel deshon mein hui theen.[5] 2006 ke baad se tapedik maamalon ki kul sankhya kam hui hai aur 2002 ke baad se naye maamalon mein kami I hai.[5] tapedik ka vitran duniya bhar mein ek samaan naheen hai; kai Asiaee aur afreeki deshon mein janasankhya ka 80% tyoobarakyoolaain pareekshanon mein sakaaraatmak paayi gayi, jabki sanyukt raajya America ki aabaadi ka 5-10% pareekshanon ke prati sakaaraatmak raha hai.[1] pratirksha mein samjhaute ke kaaran, vikaasasheel duniya ke adhik log tapedik se peedit hote hain, jo ki mukhya roop se HIV sankraman ki uchch dar aur uske eds mein vikaas ke kaaran hota hai.[6]

anukram

sanket evam lakshan

inmein se kai lakshan iske bhinn roopon ke saath milte huye hai jabki anya bhinn roopon ke saath doosare adhik vishisht (lekin poori tarah naheen) hain. ek saath ekaadhik bhinn roop upasthit ho sakte hain.]] tapedik se sankramit 5 se 10% log, jinko echaaaivi nahi hota hai, unke jeevan kaal ke dauraan sakriya rog viksit ho jaata hai.[7] iske vipreet, echaaaivi se sanyukt roop se sankramit logon mein se 30% mein sakriya rog ka vikaas ho jaata hai.[7] tapedik shareer ke kisi bhi bhaag ko sankramit kar sakta hai, lekin aam taur par sabse adhik fefadon (fuffuseeya tapedik ke roop mein jaana jaata hai) mein hota hai.[8] itarafuffuseeya teebi tab hoti hai jab tapedik fefadon ke baahar viksit hota hai. itarafuffuseeya teebi ke saath fuffuseeya teebi bhi sanyukt roop se ho sakti hai.[8] saamaanya chihnon aur lakshanon mein bukhaar, thand lagana, raat me paseena aana, bhookh na lagana, vajan ghatna aur thakaan shaamil hain[8] aur mahatvapoorn roop se ungali ke poron mein soojan bhi ho sakti hai.[7]

fuffuseeya yakshma

yadi tapedik sankraman sakriya ho jaata hai, yeh aam taur par fefadon (90% maamalon mein) ko prabhaavit karta hai.[6][9] lakshanon mein seene mein dard aur lambi avadhi tak khaansi va balagam hona shaamil ho sakte hain. lagbhag 25% logon ko kisi bhi tarah ke lakshan naheen (yaani ve "alaakshanik" bane rah sakte hain) bhi ho sakte hain.[6] kabhi-kabhi, logon ki khaansi ke saath thodi maatra mein rakt aa sakta hai aur bahut durlabh maamalon mein, sankraman fuffuseeya dhamani tak pahunch sakta hai jiske kaaran bhaari raktasraav (raasamussen enyurism) ho sakta hai. tapedik ek puraani beemaari hai aur fefadon ke oopari bhaagon mein vyaapak ghaav paida kar sakti hai. fefadon ke oopari bhaagon mein nichle bhaagon ki apeksha tapedik sankraman prabhaav ki sambhaavana adhik hoti hai.[8] is antar ke kaaran poori tarah se spasht naheen hai.[1] yeh ya to behtar vaayu pravaah, ke kaaran ho sakta hai[1] ya oopari fefadon ke bheetar kharaab limf pravaah ke kaaran ho sakta hai.[8]

itar fuffuseeya yakshma

15-20% sakriya maamalon mein sankraman, shvasan angon ke baahar fail jaata hai, jiske kaaran anya prakaar ke teebi ho jaate hain.[10] saamoohik roop se inko "itar fuffuseeya tapedik" ke roop mein chihnit kiya jaata hai.[11] itar fuffuseeya teebi kamjor pratirodhak kshamata vaale vyaktiyon aur chhote bachchon mein adhik aam hota hai. echaaaivi se peedit logon mein, yeh 50% se adhik maamalon mein hota hai.[11] ullekhaneeya itar fuffuseeya sankraman bhaagon mein anya hisson ke saath, fefadon ka aavaran (tapedik ke parifuffusashoth mein), keindreeya tantrika tantr (tapedik maininjaaitis mein), lasika pranaali (gardan ki gandamaala mein), janan mootreeya pranaali (mootrajananaangi tapedik mein) aur haddiyon va jodon (reedh ki haddi ke pauts rog mein), shaamil hain. jab yeh haddiyon mein failata hai to ise "haddeevaale tapedik" ke roop mein jaana jaata hai jo asthikop[12]ka ek prakaar hai.[1] ek sambhaavit roop se adhik gambhir, teebi ka vyaapak roop "faila hua" teebi hota hai jise aam taur par miliyri tapedik ke roop mein bhi jaana jaata hai.[8] miliyri teebi, itarafuffuseeya maamalon ka 10% hota hai.[13]

kaaran

maaikrobaikteeriya

maaikobaikteeriym tapedik ka skaining ilektraun maaikrograaf

teebi ka mukhya kaaran tapedik maaikobaikteeriym hai jo ki ek chhota, erobik, chalne mein aksham dandaanu hota hai.[8] is rogajanak ki uchch lipid saamagri iski apni anoothi naidaanik visheshataaon ke liye jimmedaar hai.[14] yeh har 16 se 20 ghante mein vibhaajit hota hai, jo ki anya baikteeriya ki tulana mein kaafi dheema hai, jo ki aam taur par ek ghante se kam samay mein vibhaajit ho jaate hain.[15] maaikrobaikteeriya ki baahari jhilli lipid ki do-parat ki hoti hai.[16] yadi gram sten pareekshan kiya jaata hai, emateebi ya to bahut kamjor "gram sakaaraatmak" roop se dhabbe banaata hai ya apni koshika deevaar ke uchch lipid aur maaikaulik esid saamagri ke parinaam ke roop mein daai naheen rakhata hai.[17] emateebi kamjor sankramanakartaaon ka naash karne vaalon ka pratirodh kar sakte hai aur sookhi avastha mein hafton tak jeevit rah sakte hain. prakruti mein, jeevaanu keval ek mejabaan jeev ki koshikaaon ke bheetar badh sakte hain lekin M. tapedik ko prayogashaala mein sanvardhit kiya ja sakta hai.[18]

kaf (jise "balagam" bhi kehte hain) se liye gaye khaansi ke namoonon par puraane dhabbon ka upayog karte hue vaigyaaniko ek saamaanya maaikroskop (prakaash) ke neeche emateebi ki pehchaan kar sakte hain. choonki emateebi, amleeya ghol ke saath upachaar kiye jaane ke baavajood kuchh dhabbon ko banaaye rakhata hai isaliye isko esid fast dandaanu (eefabi) ke roop mein vargeekrut kiya jaata hai.[1][17] sabse aam esid fast stening takaneek jaaehal-neelsan sten hai jo eefabi ko chamakadaar laal mein daai kar deta hai jisse yeh neeli prushthabhoomi[19] mein spasht roop se dikhta hai iske alaava oraamaain-rodaamaain sten aur floroseins maaikroskaapi bhi aisi hi takaneeke hain.[20]

M. tapedik complex (emateebeesi) mein chaar anya teebi paida karne vaale maaikrobaikteeriya shaamil hain: M.bovis, M. afrikenam, M. kaanetti aur M. maaikroti.[21] M. afrikenam bahut vyaapak naheen hai, lekin Africa ke kuchh hisson mein yeh tapedik ka ek mahatvapoorn kaaran hai.[22][23] pehle M. bovis tapedik ka ek aam kaaran tha, lekin paaschureekrut doodh ki shurooaat ne kaafi had tak viksit deshon mein is saarvajanik svaasthya samasya ka safaaya kar diya.[1][24] M. kaanetti durlabh hai aur Africa ke haurn tak hi seemit dikhta hai, haalaanki kuchh maamalon mein afreeki pravaasiyon ko isse peedit dekha gaya hai.[25][26] M. maaikroti bhi durlabh hai aur jyaadaatar kam pratirodhi kshamata vaale logon mein dekha jaata hai, haalaanki is rogajanak ke prasaar ko sanbhavat: kaafi kam karke aanka gaya hai.[27]

anya gyaat rogajanak maaikrobaikteeriya mein M. lepare, M.eviym aur M. kaanasaai shaamil hai. baad ki do prajaatiyon ko "gair-tapedik maaikrobaikteeriya" (enateeem) ke roop mein vargeekrut kiya gaya hai. enateeem na to teebi aur na hi kushth rog ka kaaran hai, lekin ve fefade mein teebi ke sadrush rog paida karte hain.[28]

jokhim kaarak

kai saare kaarak logon ko aur teebi sankraman ke liye adhik samvedansheel banaate hain. duniya bhar mein sabse mahatvapoorn jokhim kaarak echaaaivi hai, teebi ke sabhi maamalon ke 13% log is virus se sankramit hain.[5] up - sahaara Africa mein yeh ek vishesh samasya hai, jahaan echaaaivi ki dar adhik hoti hai.[29][30] tapedik, bheedbhaad aur kuposhan dono se juda hua hai, jo isko gareebi ki ek pramukh beemaari banaate hain.[6] uchch jokhim mein nimn log shaamil hain: jo log sui dvaara avaidh davaayein lete hain, aise sthaanon ke nivaasi aur karmachaari jahaan par samvedansheel log ekatrit hote hain (jaise jail aur beghar aashray), chikitsakeeya vanchit aur sansaadhan vanchit samudaaya, uchch jokhim vaale jaateeya-alpasankhyak, uchch jokhim shreni mareejon ke nikat sampark mein rahane vaale bachche aur aise logon ko seva pradaan karne vaale svaasthya seva pradaata.[31] fefadon ka puraana rog ek anya mahatvapoorn jokhim kaarak hai - jabki silikosis, jokhim ko 30 guna tak badhaata hai.[32] jo log cigarette peete hain unako teebi hone ka doguna jokhim hota hai.[33] anya rog avasthaayein bhi tapedik vikaas ke jokhim ko badha sakti hain jaise sharaab ka sevan[6] aur madhumeh (teen guna jokhim vruddhi).[34] kuchh davaayein jaise kaurtikaustaraued aur inafilikseemaib (ek αaTNF-virodhi monoklonal enteebaudi) teji se mahatvapoorn jokhim kaarak banti ja rahi hain, vishesh roop se viksit duniya mein.[6] aanuvanshik sanvedanasheelata bhi ek kaarak hai[35] jiska samagr mahatva abhi bhi anirdhaarit hai.[6]

kaaryapranaali

saarvajanik svaasthya abhiyaanon ne 1920 ke dashak mein teebi ke prasaar ko rokane ka prayaas kiya.

prasaar

jab sakriya fuffuseeya teebi se peedit log khaansate, chheenkate, gaate, thookate ya doosaron ke saath baatein karte hain to ve 0.5 se 5.0 µaam aakaar ki sankraamak eyarosol boondon ko baahar nikaalate hain. ek chheenk se lagbhag 40,000 boondein nikal sakti hain.[36] in boondon mein se har ek rog sanchaarit kar sakti hai, kyonki tapedik ki sankraamak khuraak bahut kam (10 se bhi kam baikteeriya bheetar lene se sankraman ho sakta hai) hoti hai.[37]

teebi se peedit logon ke saath lambe samay tak aur aksar, ya kareebi sampark vaale logon mein sankramit hone ka vishesh jokhim hota hai, jiski sankraman dar 22% tak hai.[38] sakriya lekin ilaaj naheen kiye gaye tapedik se peedit vyakti prati varsh 10-15 (ya adhik) logon ko sankramit kar sakta hai.[3] prasaar keval un logon ke saath hona chaahiye jinko sakriya teebi hai- avyakt sankraman vaale log sankraamak naheen maane jaate hain.[1] ek vyakti se doosare mein prasaar ki sambhaavana kai kaarakon par nirbhar karti hai jismein vaahak dvaara sankraamak boondon ko baahar karna, vaayu sanchaar ki prabhaavasheelata, sankraamak ke saath rahane ki avadhi, M.tapedik prabhaav ki ugrata, asankramit vyakti mein pratirodh ka star tatha anya shaamil hai.[39] sakriya ("prakat") teebi se peedit logon ko alag karke tatha unako teebi virodhi dava ki vyavastha mein rakhakar, vyakti se vyakti ke prasaar ke pravaah ko prabhaavi dhang se roka ja sakta hai. prabhaavi upachaar ke do saptaah ke baad, gairapratirodhi sakriya sankraman vaale log aam taur par doosaron ke liye sankraamak naheen rah jaate hain.[38] agar koi sankramit ho jaata hai, to naye sankramit vyakti ko doosare vyakti tak sankraman pahunchaane laayak banane mein aam taur par teen se chaar saptaah lagte hain.[40]

rog ki vyutpatti (paithojenesis)

M.tapedik se sankramit logon mein se 90% ko sparshonmukh, avyakt teebi sankraman (kabhi-kabhi LTBI kaha jaata hai) hota hai,[41] jeevanakaal mein keval 10% sambhaavana hoti hai ki avyakt sankraman, prakat, sakriya tapedik rog mein badle.[42] echaaaivi se peedit logon mein sakriya teebi ke vikaas ka jokhim ek saal mein lagbhag 10% badhta hai.[42] yadi prabhaavi upachaar naheen diya jaata hai to, sakriya teebi ke maamalon mein mrutyu dar 66% tak hai.[3]

teebi sankraman tab shuru hota hai jab maaikrobaikteeriya fefade ki koopika (alveoli), mein pahunch jaate hain jahaan ve vaayukosheeya maikrofej ke endosom par aakraman karte hain aur unke pratiroop banaate hain.[1][43] fefadon mein sankraman ka praathamik sthal jise "ghon focus" kehte hain, aam taur par ya to oopari hisse ke nichle lob ya nichle hisse ke oopari lob mein sthit hota hai.[1] fefadon ka tapedik rakt pravaah se sankraman ke maadhyam se bhi ho sakta hai. yeh Simon focus ke roop mein jaana jaata hai aur aam taur par fefadon ke sheersh mein paaya jaata hai.[44] is rakt se hone wala prasaar bahut door ki jagahon par bhi sankraman faila sakta hai jaise ki paridheeya limf nods, gurde, mastishk aur haddiyaan.[1][45] shareer ke sabhi bhaag rog se prabhaavit ho sakte hain, haalaanki agyaat kaaranon se yeh dil, kankaal tantr sambandhi maansapeshiyon, agnaashaya ya thaayarauyad ko behad kam prabhaavit karta hai.[46]

kshaya rog ek grenyulometas inflemetari rog ke roop mein vargeekrut kiya gaya hai. maikrofej, ti linfosaaits, bi linfosaaits aur faaibroblaast ve koshikaaen hain jo milkar grenyuloma banaate hain jabki linfosaait, sankramit maikrofej ke chaaron or hoti hain. grenyuloma, maaikrobaikteeriya ke prasaar ko rokata hai aur pratirksha pranaali ki koshikaaon ki ant:kriya ke liye ek sthaaneeya vaataavaran pradaan karta hai. jeevaanu, grenyuloma ke andar nishkriya ho jaate hain, jiske parinaamasvaroop avyakt sankraman hota hai. tyoobarakal ke kendra mein asaamaanya koshika mrutyu (nekrosis) ka vikaas, grainyuloma ki ek anya visheshata hai. nagn aankhon se dekhne par, yeh naram, safed paneer ki banaavat jaisa hota hai aur kesiys nekrosis kaha jaata hai.[47]

yadi teebi ke jeevaanu kshatigrast ootakon ke kshetr se khoon mein pravesh kar jaate hain to, ve poore shareer mein fail sakte hain aur sankraman ke kai kendra bana sakte hain, ye sabhi ootakon mein chhote, safed tyoobarakal ke roop mein dikhaai dete hain.[48] yeh teebi rog ka ek gambhir roop hai jo chhote bachchon aur echaaaivi peedit logon mein sabse adhik aam hai, ise miliyri tapedik kaha jaata hai.[49] is teebi se peedit logon mein upachaar ke baavajood uchch mrutyu dar (lagbhag 30%) hoti hai.[13][50]

kai logon mein, sankraman ghatata-badhta rahata hai. ootak vinaash aur pariglan aksar chikitsa aur faaibrosis se santulit hote hain.[47] prabhaavit ootak ka sthaan chakatte aur khaali jagah le leti hai jo kesiyl naikrotik saamagri se bhari hoti hai. sakriya rog ke dauraan, in khaali sthaanon mein se kuchh vaayu maarg braankaai se jud jaate hain aur yeh saamagri kaf ke roop mein baahar aa sakti hai. inmein jeevit baikteeriya hote hain, isaliye sankraman fail sakta hai. upayukt enteebaayotiks ke saath upachaar karne se jeevaanu mar sakte hain aur upachaar sambhav ho sakta hai. theek ho jaane par, prabhaavit kshetr antat: ootakon dvaara pratisthaapit ho jaate hain.[47]

rog-nidaan

thook mein maaikobaikteeriym tapedik (laal dhabbe)

sakriya tapedik

sakriya tapedik ka keval chihnon aur lakshanon ke aadhaar par nidaan karna mushkil hai[51], isi prakaar kamjor pratirksha vaale logon mein rog ka nidaan bhi mushkil hai.[52] halaanki teebi ka nidaan un logon mein kiya jaana chaahiye jinmein fefadon ke rog ke chinh hai ya do se adhik saptaah se svaabhaavik lakshan hain.[52] chhaati ka ex-re aur esid fast besili ke liye kai thook-kalchar aam taur par praarambhik moolyaankan ka hissa hain.[52] intaraferaun-γ release asaaes aur tyoobarakyooleen tvacha pareekshan vikaasasheel duniya mein kam upayog kiye jaate hain.[53][54] aaijeeaarae ki bhi echaaaivi peedit logon ki tarah ki seemaayein hain.[54][55]

teebi ka ek nishchit nidaan naidaanik namoone (jaise thook, mavaad ya ek ootak baayopsi) mein M.tapedik ki pehchaan dvaara kiya jaata hai. haalaanki, is dheemi gati se badhne vaale jeev ke liye, khoon ya thook ki kathin kalchar prakriya mein do ko chhah saptaah lag sakte hain.[56] is prakaar upachaar aksar kalchar ki pushti se pehle shuroo kar diya jaata hai.[57]

nyooklik esid pravardhan pareekshan aur edenoseen diyaamenas pareekshan teebi ka tvarit nidaan kar sakta hai.[51] halaanki in pareekshanon ki sifaarish niyamit roop se naheen ki jaati hai, kyonki ye vyakti ke upachaar ko behad kam prabhaavit karte hain.[57] enteebaudi ka pata lagaane ke liye kiye jaane vaale rakt pareekshan vishisht ya samvedansheel naheen hote hain, isliye inki sifaarish naheen ki jaati hai.[58]

avyakt tapedik

mainatauks tyoobarakyoolaain tvacha pareekshan

teebi ke uchch jokhim vaale logon mein pehchaan ke liye aksar mainatauks tyabarakyuleen tvacha pareekshan kiya jaata hai.[52] jo log pehle se pratirkshit hain un par pareekshan ka galat sakaaraatmak parinaam praapt ho sakta hai.[59] saarakauidosis, haujakins linfoma, kuposhan, ya behad vishesh roop se sakriya tapedik se peedit logon mein pareekshan galat roop se nakaaraatmak parinaam dikha sakta hain.[1] mainatauks pareekshan ke prati sakaaraatmak logon ke rakt namoone par intaraferaun gaama release asaaes (aaijeeaarae) ki sifaarish ki jaati hai.[57] ye teekaakaran ya paryaavaran maaikrobaikteeriya, dvaara aprabhaavit rahate hain isaliye galat sakaaraatmak parinaam utpann karte hain.[60] haalaanki ve M.sajulgaai, M. maarinm aur M. kaanasaasi se prabhaavit hote hain.[61] yadi tvacha pareekshan ke saath aaijeeaarae ka upayog kiya jaaye to sanvedanasheelata badh sakti hai lekin akele tvacha pareekshan ka upayog kiye jaane ki tulana mein kam samvedansheel ho sakta hai.[62]

rokathaam

tapedik ki rokathaam aur niyantran mukhya roop se navajaat shishuon ke teekaakaran aur sakriya maamalon ke upayukt upachaar par nirbhar hai.[6] vishv svaasthya sangathan ke sanshodhit upachaar pathya ke maadhyam se kuchh safalta haasil hui hai aur maamalon ki sankhya mein thodi si kami aayi hai.[6]

teeke

2011 mein ekamaatr upalabdh vaikseen baisils kaalmet-guerin (beeseeji) hai, jo ki bachapan mein faile rog par prabhaavi hai aur fefadon ki teebi ke viruddh asangat sanrakshan pradaan karti hai.[63] fir bhi, duniya bhar mein yeh sabse vyaapak roop se istemaal kiya jaane wala teeka hai, sabhi bachchon mein se 90% se adhik bachchon ka teekaakaran kiya ja raha hai.[6] haalaanki, iske dvaara pradaan ki gayi pratirksha das varshon ke baad ghatne lagti hai.[6] kyonki adhikaansh Canada, Britain aur sanyukt raajya America mein tapedik asaamaanya hai, beeseeji keval uchch jokhim vaale logon ko diya jaata hai.[64][65][66] tyoobarakyuleen tvacha pareekshan ko galat tareeke se sakaaraatmak bataane ke kaaran, teeke ke istemaal ke khilaaf bahas ki jaati hai aur isliye, screening mein iska koi faayda naheen hai.[66] vartamaan samay mein kai naye teekon ka vikaas kiya ja raha hai.[6]

saarvajanik svaasthya

vishv svaasthya sangathan ne 1993 mein[6] teebi ko "vaishvik svaasthya aapaat sthiti" ghoshit kiya tha aur 2006 mein stop teebi paartanaraship ne tapedik ko rokane ke liye ek vaishvik yojana viksit ki jiska lakshya iski shuruaat se 2015 ke beech mein 14 million jeevan bachaana hai.[67] unke dvaara nirdhaarit kai saare lakshya 2015 tak haasil naheen kiye ja sakeinge, mukhya roop se echaaaivi se jude tapedik mein vruddhi ke kaaran aur ekaadhik dava-pratirodhi tapedik (emadeeaar - teebi) ke ubharane ke kaaran aisa hoga.[6] ameriki thoraikik society dvaara viksit tapedik vargeekaran pranaali ko saarvajanik svaasthya kaaryakramon mein mukhya roop se upayog ki ja raha hai.[68]

prabandhan

teebi ke upachaar mein enteebaayotik davaaon ka upayog karke baikteeriya ko maara jaata hai. maaikrobaikteeriya koshika deevaar ki asaamaanya sanrachana aur raasaayanik sanghatan ke kaaran prabhaavi teebi ka upachaar kathin hai, jo ki davaaon ke pravesh ko baadhit karte hain aur kai enteebaayotik davaaon ko aprabhaavi karte hain.[69] do sabse adhik istemaal ki jaane waali enteebaayotik davaayein aaisoniyaajid aur rifaimpisin hain aur upachaar, lambe samay ka ho sakta hai jisme kai maheenein lag sakte hain.[39] avyakt teebi ke upachaar mein aam taur par ek enteebaayotik ka upayog kiya jaata hai,[70] jabki sakriya teebi rog mein kai enteebaayotik davaaon ke sanyojan ka upayog kiya jaata hai jisse ki enteebaayotik pratirodh viksit karne vaale baikteeriya ke jokhim ko kam kiya ja sake.[6] avyakt sankramanon se peedit logon ko baad mein jeevan mein sakriya teebi rog ke viksit hone se bachaav ke liye bhi upachaar diya jaata hai.[70] pratyaksh roop se di jaane waali chikitsa, arthaat ek svaasthya seva pradaata is baat ka dhyaan rakhata hai ki log apni davaayein lein. is tarah ki chikitsa ki dablyooechao dvaara sifaarish ki gayi hai jo un logon ki sankhya ko ghataane ka prayaas hai jo apni davaaon ko niyamit taur par naheen lete hain.[71] is abhyaas aur logon ke apne aap svatantr roop se davaayein lene ke maamale mein tulana karne par is maamale ke samarthan mein mile saakshya kamjor hain.[72] lekin upachaar ke mahatva ko, logon ko yaad dilaane ke tareeke prabhaavi dikhaai dete hain.[73]

nai shuruaat

2010 mein, naye shuru huye fuffuseeya tapedik ke sujhaaye gaye chh: maas ke upachaar mein pehle do maah tak rifaimpisin, aaisoniyaajid, paairaajinaamaaid aur ethemabyootaul jaisi enteebaayotik ke sanyojan upayog kiya jaata hai tatha baad ke chaar maah mein keval rifaimpisin aur aaisonijid ka upayog kiya jaata hai.[6] jin maamalon mein aaisoniyaajid ke liye uchch pratirodh hota hai, unamein baad ke chaar maahon mein ethemabyootaul joda ja sakta hai.[6]

aavartak rog

yadi tapedik fir se hota hai to, upachaar ka nirdhaaran karne ke pehle is baat ka pareekshan karke nirdhaaran kar lena chaahiye ki yeh kis enteebaayotik ke prati samvedansheel hai.[6] yadi ek se adhik dava pratirodhi teebi (emadeeaar - teebi) ka pata chala hai to 18 se 24 maheenon ke liye kam se kam chaar prabhaavi enteebaayotik davaaon ke saath upachaar ki sifaarish ki jaati hai.[6]

dava/upachaar pratirodh

praathamik pratirodh tab hota hai jab ek vyakti teebi ke pratirodhi tanaav se sankramit ho jaata hai. aparyaapt upachaar aur bataayi gayi vidhi ko upayukt tareeka na apnaane (anupaalan ki kami) ya dava ki kam maatra ke upayog ke kaaran poori tarah se atisanvedanasheel teebi vaale vyakti mein upachaar ke dauraan dviteeyak (adhigraheet) pratirodh viksit ho sakta hai.[74] kai vikaasasheel deshon mein dava pratirodhi teebi ek gambhir saarvajanik svaasthya mudda hai, kyonki iska upachaar lamba hai aur ismein adhik mahangi davaaon ki aavashyakta padti hai. emadeeaar teebi ko sarvaadhik prabhaavi, pehli pankti ki teebi davaaon rifaimpisin aur aaisoniyaajid ke prati pratirodhi ke roop mein paribhaashit kiya gaya hai. bade paimaane par dava pratirodhi teebi bhi dviteeya pankti ki davaaon ke teen ya chh: vargon ke prati pratirodhi hai.[75] pehli baar Italy mein 2003 mein dekha gaya lekin 2012 tak vyaapak roop se na dekha gaya poori tarah se dava pratirodhi teebi bhi vartamaan samay mein upayog ki ja rahi sabhi davaaon ke prati pratirodhi hai.[76]

poorvaanumaan

teebi sankraman se prakat teebi rog ki or pragati tab hoti hai jab besili, pratirksha pranaali ki suraksha par kaaboo pa leta hai aur sankhya badhaana shuru kar deta hai. praathamik teebi rog mein (kuchh 1-5% maamalon mein), aisa aaranbhik sankraman ke turant baad hi hota hai.[1] haalaanki, adhikaansh maamalon mein, ek avyakt sankraman mein koi spasht lakshan naheen hote hain.[1] ye nishkriya besili, in avyakt maamalon ke 5-10% mein sakriya tapedik paida karte hain aksar aisa sankraman ke kai varshon ke baad hota hai.[7]

pratirksha ki kameen ke saath fir se sakriya hone ka jokhim badh jaata hai, jaise ki echaaaivi sankraman mein hota hai. M.tapedik tatha echaaaivi se ek saath peedit logon mein har varsh ke saath fir se sakriya hone ka jokhim 10% tak badh jaata hai.[1] M. tepadik ki DNA fingar printing ka upayog karte huye kiye gaye adhyayan dikhaate hain ki fir se hone vaale teebi mein pun: sankraman, pehle ki soch ke vipreet adhik paryaapt roop se yogadaan karta hai,[77] aankalan hai ki yeh teebi ke aam kshetron mein pun: sakriya maamalon ke 50% se adhik mein yogadaan karta hai.[78] 2008 mein, tapedik ke maamale mein mrutyu ki sambhaavana 4% hai jo ki 1995 ke 8% se kam ho gayi hai.[6]

mahaamaari vigyaan

World map with sub-Saharan Africa in various shades of yellow, marking prevalences above 300 per 100,000, and with the U.S., Canada, Australia, and northern Europe in shades of deep blue, marking prevalences around 10 per 100,000. Asia is yellow but not quite so bright, marking prevalences around 200 per 100,000 range. South America is a darker yellow.
2007 mein prati 100,000 logon par teebi ke prasaar up sahaara Africa mein sabse adhik tha aur yeh Asia mein bhi apekshaakrut adhik tha<ref. Name=WHO2009-Burden> [229] </ ref>

mote taur par duniya ki aabaadi ka ek tihaai bhaag M. tapedik se sankramit hai aur vaishvik star par ek prati sankeind ki dar se badh raha hai.[3] haalaanki M.tapedik ke adhikaansh sankraman teebi ke rog mein parivrtit naheen hote hain[79] aur sankraman ke 90-95% sparshonmukh rahate hain.[41] ek anumaan ke anusaar 2007 mein, lagbhag 13.7 million sakriya maamale the.[4] 2010 mein, teebi ke 8.8 lakh naye maamalon ka pata chala hai aur 1.45 million mautein huyi hain, inmein se adhikaansh vikaasasheel deshon mein huyi thi.[5] in 1.4 million mauton mein se lagbhag 0.35 million unki mautein hai jo echaaaivi se bhi sankramit the.[80]

kshaya rog, sankraamak rogon se hone waali mauton ka doosra sabse aam kaaran (echaaaivi / eds ke baad) hai.[8] 2005 ke baad se teebi maamalon ("vyaapakata") ki kul sankhya kam huyi hai, jabki 2002 ke baad se naye maamalon ("ghatanaayein") mein giraavat I hai.[5] cheen ne vishesh roop se naatakeeya pragati haasil ki hai, jahaan par 1990 aur 2010 ke beech lagbhag teebi mrutyu dar mein 80% ki kami aayi hai.[80] kshaya rog vikaasasheel deshon mein adhik aam hai, kai Asiaee aur afreeki deshon mein lagbhag 80 pratishat janasankhya tyoobarakalaain pareekshan mein sakaaraatmak utarati hai jabki Amreeki janasankhya keval 5-10% sakaaraatmak hoti hai.[1] rog ko poori tarah se niyantrit karne ki ummeedein kai kaarakon ke kaaran naatakeeya roop se kam ho jaati hain, jismein prabhaavi teeke ke vikaas mein pesh aa rahi kathinaai, mahangi tatha samay-khapaaoo nidaan prakriya, kai mahinon tak upachaar ki zaroorat tatha echaaaivi sambaddh tapedik maamalon mein vruddhi tatha 1980 ke dashak mein dava-pratirodhi maamalon ki shuruaat bhi shaamil hai.[6] [[File:TB incidence.png|thumb|left|naye darj kiye gaye teebi ke maamalon ki vaarshik sankhya dablyooechao ke aankadesandarbh truti: <ref> taig ke liye samaapti </ref> taig naheen mila viksit deshon mein, tapedik kam aam hai aur mukhya roop se shahari kshetron mein paaya jaata hai. 201 mein duniya ke vibhinn kshetron mein prati 100,000 logon ki darein : vishv star par 178, Africa 332, America 36, poorvi bhoomadhya 173, Europe 63, dakshin poorv Asia 278, pashchimi prashaant 139[80] Canada aur Australia mein, tapedik aadivaasi logon ke beech vishesh roop se dooradaraaj ke kshetron mein aam hai.[81][82] sanyukt raajya America mein aadivaasiyon me teebi ke kaaran paanch guni adhik mrutyu dar hai.[83]

teebi ke maamale umr ke saath badalate rahate hai. Africa mein yeh mukhya roop se kishoron aur yuva vayaskon ko prabhaavit karta hai.[84] haalaanki, jin deshon mein ghatna daron mein naatakeeya roop se giraavat I hai (jaise sanyukt raajya America), teebi mukhya roop se bujurg logon tatha kam pratirodhak kshamata vaale logon ki beemaari hai.[1][85]

itihaas

british sangrahaalaya mein misr ki mami - misr ki mamiyon ki reedh mein tyubarakular kshaya paaya gaya hai.

tapedik manushyon mein praacheen kaal se upasthit hai.[6] M.tapedik ki sabse puraani aur suspasht pehchaan lagbhag 17,000 saal puraane baayasan (bhainse) ke avasheshon mein hui.[86] haalaanki, yeh abhi bhi aspasht hai ki tapedik boviyn mein utpann hokar maanavo mein faila ya kisi aam poorvaj se dono mein faila.[87] maanavon mein M.tapedik samooh ke jeen (emateebeesi) aur pashuon mein emateebeesi ki tulana yeh ishaara karti hai ki maanavon ne pashuon ko paalatoo banaate samay emateebeesi ko pashuon se haasil naheen kiya hai, jaisa ki pehle vishvaas kiya jaata tha. teebi baikteeriya ke donon upabhed ek aam poorvaj saajha karte hain, jisne maanavon ko navapaashaan kraanti ke kaal mein sankramit kiya hoga.[88] kankaalon ke avashesh darshaate hai ki praagaitihaasik maanavon (4000 E.poo.) ko teebi tha aur shodhakartaaon ko 3000-2400 isa poorv ki misr ki mamiyon mein tapedikeeya kshaya mile hain.[89] yakshma (Phthisis), khapat ke liye ek greek shabd hai, fuffuseeya tapedik ke liye upayog kiya jaane wala ek puraana shabd hai,[90] 460 E.poo. ke aaspaas, hippokrets ne yakshma ki pehchaan us samay ke sabse vyaapak rog ke roop mein ki thi. ismein bukhaar aur rakt bhari khaaainsi shaamil thi aur ye lagbhag har baar ghaatak tha.[91] aanuvaanshik adhyayan bataate hain amareekiyon mein teebi doosari shataabdi (100 isvi) se maujood thi.[92]

audyogik kraanti se pehle, lokageeton mein tapedik ko aksar pishaach ke saath joda jaata tha. jab parivaar ke ek sadasya se mrutyu ho jaati to anya sankramit sadasyon ka svaasthya bhi dheere - dheere kharaab hota jaata. logon ka maanana tha ki parivaar ke anya sadasyon ke jeevan par aaya khatra, teebi ke kaaran mool roop se mrut vyakti ke kaaran tha.[93]

haalaanki tapedik ke fuffuseeya svaroop ko paitholoji ke roop mein 1689 mein dau॰aarichrd maurtan dvaara sthaapit kiya gaya tha,[94][95] lekin apne lakshanon ki vividhta ke kaaran teebi ko ekal rog ke roop mein 1820 tak naheen pahachaana gaya tha aur isko 1839 mein J.L.sholaain dvaara tyoobarakalosis (tapedik) naam diya gaya tha.[96] 1838-1845 ki avadhi ke dauraan, maimath kev ke maalik dau॰ John kraughan, tapedik se peedit kai logon ko gufa mein is aasha ke saath laaye the ki ve log gufa ke sam taapamaan aur shuddh hava se theek ho jaayeinge, lekin ve ek varsh ke bheetar mar gaye.[97] haraman brehaman ne 1859 mein sokolovosko, Poland mein pehla teebi senetoriya khola.[98]

dau॰ Robert kaukh ne tapedik besils ki khoj ki.

maaikobaikteeriym tapedik baisils Robert kaukh dvaara 24 March 1882 ko pahachaana aur varnit kiya gaya tha. unki is khoj ke liye unako 1905 mein fijiyolauji ya chikitsa ka Nobel puraskaar diya gaya tha.[99] kaukh ko bovaain (pashu) aur maanav tapedik mein samaanata par vishvaas naheen tha jisne sankramit doodh ko sankraman ke srot ke roop mein maanyata mein vilamb kar diya. baad mein, is srot se sancharan ka jokhim paaschureekaran prakriya ke aavishkaar ke kaaran naatakeeya roop se kam ho gaya tha. kaukh ne 1890 mein tapedik ke ek "upaaya" ke roop tyoobarakal besili ke ek glisreen nishkarshan ki ghoshana ki, jise 'tyoobarakyulaain' ka naam diya. haalaanki yeh prabhaavi naheen tha lekin baad mein ise poorvalaakshanik tapedik ki upasthiti ki screening jaanch ke roop mein safalataapoorvak roopaantarit kar diya gaya.[100]

kamjor bovaain-vikruti tapedik ka upayog karte huye albart kaalmet aur kaimil guerin 1906 mein tapedik ke khilaaf pratirkshan mein pehli asli safalta haasil ki thi. ise kaalmet aur guerin ka baisils (beeseeji) kaha gaya tha. beeseeji vaikseen sabse pehle 1921 mein France mein manushyon par istemaal kiya gaya tha,[101] lekin keval amareeka, great Britain aur Germany mein dviteeya vishv yuddh ke baad vyaapak roop se sveekruti praapt kar paaya.[102]

19 veen aur 20 veen shataabdi mein tapedik shahari gareebon ke sthaanik rog ke roop mein sabse vyaapak saarvajanik chinta ka kaaran bana tha. 1815 mein, England mein chaar mein se ek mrutyu "yakshma" ke kaaran hui thi. 1918 tak, France mein chhah mein ek mrutyu teebi ki vajah se ho rahi thi. 1880 ke dashak mein rog ka nirdhaaran sankraamak rog ke roop mein karne ke baad, teebi ko Britain mein mahatvapoorn rogon ki soochi mein rakha gaya tha, saarvajanik sthalon par thookane se logon ko rokane ke liye abhiyaan shuru kiye gaye the aur sankramit gareeb logon ko senetoriya mein jaane ke liye "protsaahit" kiya gaya tha jo dekhne mein jail jaise lagte the (madhyam tatha uchch vargon ke logon ke liye bane senetoriya mein achhi dekhbhaal aur satat chikitsa dhyaan pradaan kiya jaata tha).[98] senetoriya mein "taaji hava" aur shram ke jo bhi (kathit) laabh, sarvashreshth paristhitiyon mein bhi rahe hon, bharti logon mein se 50% ki mrutyu paanch varshon ke andar ho jaati thi (sirka 1916).[98]

1600 ki shuruaat mein Europe mein, tapedik ki daron mein badhat shuru ho gayi aur 1800 mein adhiktam star tak pahunch gayi, jis samay mein sabhi mauton ke 25% ka kaaran yeh hi tha.[103] 1950 ke dashak mein mrutyu dar lagbhag 90% ki kami hui.[104] saarvajanik svaasthya mein sudhaar ke kaaran streptomaaisin aur anya enteebaayotik davaaon ke aane se pehle hi tapedik ki daron mein kami aane lagi thi, halaanki rog saarvajanik svaasthya ke liye itna mahatvapoorn khatra bana raha ki jab 1913 mein Britain mein chikitsa anusandhaan parishad ka gathan kiya gaya, to iska praarambhik dhyaan tapedik anusandhaan par tha.[105]

1946 mein, enteebaayotik streptomaaisin ke vikaas ne teebi ke prabhaavi upachaar aur svasth karne ko vaastavikta pradaan ki. is dava ki shurooaat se pehle ekamaatr upachaar (senetoriya ko chhodkar) shalya chikitsa thi, "nyoomothoraiks takaneek" jismein sankramit fefade ka nipaat karke use "aaraam" de kar tapedikeeya ghaavon ko theek hone diya jaata tha.[106] emadeeaar teebi ke udbhav ne teebi sankraman ke upachaar mein dekhbhaal ke aam taur par sveekaar kiye jaane vaale maanakon ke bheetar shalyakriya ko fir se ek vikalp ke roop mein prastut kiya hai. vartamaan shalya hastakshepon mein fefadon mein rogaatmak chhaati kotaron (kaiviteej) ("blaae") ko nikaalna shaamil hota hai jisse ki jeevaanuon ki sankhya ko kam aur shesh jeevaanuon ko rakt ke pravaah mein shaamil davaaon ke prati anaavaran mein vruddhi ki ja sake, jisse ki kul jeevaanu bhaar ko kam kiya jaata hai aur pranaaleegat enteebaayotik chikitsa ki prabhaavasheelata ko badhaaya jaata hai.[107] 1980 mein dava-pratirodhi vikrutiyon mein vruddhi ke baad teebi ko (chechak ki tarah) poori tarah se samaapt karne ki ummeed gharaashaayi ho gayi thi. tapedik ke parinaami punarutthaan ke kaaran 1993 mein vishv svaasthya sangathan dvaara vaishvik svaasthya aapaat sthiti ki ghoshana ki gayi.[108]

samaaj aur sanskruti

vishv svaasthya sangathan aur bill va melinda Gates foundation ek naye aur teji se kaam karne vaale nidaan pareekshan ko, kam aur madhyam aay vaale deshon mein upayog kiye jaane ke liye subsidy pradaan rahe hain.[109][110] 2011 mein sansaadhan se gareeb kai sthaanon par abhi bhi keval thook maaikroskopi ka upayog kiya jaata hai.[111]

2010 mein, poori duniya mein Bhaarat mein teebi ke sabse adhik maamale the, iske kaaranon mein ek niji svaasthya dekhbhaal kshetr mein kharaab rog prabandhan hai. sanshodhit raashtreeya kshayarog niyantran kaaryakram jaise kaaryakram, saarvajanik svaasthya seva praapt karne vaale logon mein teebi star kam karne mein sahaayata pradaan kar rahe hain.[112][113]

shodh

beeseeji vaikseen ki seemaaeain hain aur teebi ke naye teeke ko viksit karne ke liye anusandhaan jaari hai.[114] vartamaan samay mein kai sambhaavit ummeedavaar, chikitseeya pareekshan ke pehle va doosare charan mein hain.[114] upalabdh teekon ki prabhaavakaarita mein sudhaar karne ka prayaas karne mein do mukhya drushtikon upayog kiye ja rahe hain. ek drushtikon mein beeseeji mein ek sabayoonit vaikseen jodna shaamil hai, jabki doosari rananeeti mein naye aur behtar jeevit teeke banaane ka prayaas ho raha hai.[114]MVA85A, sabayoonit vaikseen ka ek udaaharan hai jis par vartamaan samay mein dakshin Africa mein pareekshan chal rahe hain aur yeh aanuvanshik roop se sanshodhit chechak (vaiseeniya) virus par aadhaarit hai.[115] avyakt aur sakriya dono tarah ke rogon ke upachaar mein teeko dvaara ek mahatvapoorn bhoomika nibhaaye jaane ki aasha ki ja rahi hai.[116]

aage ki khoj ko protsaahit karne ke liye, shodhakartaaon aur neeti nirmaataaon dvaara teeke ke vikaas hetu naye aarthik modelon ko protsaahan diya ja raha hai, jismein puraskaar, kar protsaahan aur agrim baajaar pratibddhataaen shaamil hain.[117][118] stop teebi paartanaraship,[119] dakshin afreeki kshaya rog vaikseen ineeshiyetiv aur eras global teebi vaikseen foundation, jaise kai samooh shodh mein shaamil hain.[120] inmein se uchch bojh vaale deshon mein tapedik ke viruddh ek behtar teeke ke vikaas va license ke liye eras global teebi vaikseen foundation ko bill va melinda Gates foundation se 280 million dollar (America) se adhik ka upahaar praapt hua hai.[121][122]

anya praaniyon mein

maaikrobaikteeriya, pakshiyon[123] sahit kai bhinn jaanvaron, kruntakon,[124] sareesrup[125] ko sankramit karte hain. haalaanki, maaikobaikteeriym tapedik, upajaati shaayad hi kabhi jangali jaanvaron mein maujood rahi ho.[126] nyoojeelaind ke hiran jhundon tatha pashuon se maaikobaikteeriym bovis dvaara hone vaale vobaain tapedik ko samaapt karne ka prayaas apekshaakrut safal raha hai.[127] great Britain mein aise prayaas kam safal rahe hain.[128][129]

sandarbh

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saaaincha:Gram-positive actinobacteria diseases saaaincha:Tuberculosis saaaincha:Diseases of Poverty