I-Aspergillosis yesigulana kunye neNkxaso yoMkhathaleli

Ibonelelwa yi-NHS National Aspergillosis Centre

I-Antifungals ye-aspergillosis

Unyango losulelo lomngundo lunokuchazwa ngokubanzi ngokweeklasi ezintathu ze-antifungals. I-echinocandins, i-azoles kunye ne-polyenes.

IiPolyenes

Amphotericin B isoloko isetyenziswa emithanjeni ukunyanga usulelo lomngundo lwenkqubo. Isebenza ngokuzibophelela kudonga lweseli lomngundo olubizwa ngokuba yi-ergosterol. I-Amphotericin B mhlawumbi yeyona ntsholongwane ibanzi kwi-intravenous antifungal ekhoyo. Inomsebenzi ochasene neAspergillus, Blastomyces, Candida (zonke iintlobo ngaphandle kweCandida krusei kunye neCandida lutania), iCoccidioides, iCryptococcus, iHistoplasma, iParacoccidiodes kunye neearhente ezininzi zezygomycosis (Mucorales), iFusarium kunye nezinye iifungi ezinqabileyo. Ayisebenzi ngokwaneleyo ngokuchasene ne-Scedosporium apiospermum, Aspergillus terreus, Trichosporon spp., uninzi lweentlobo ezibanga i-mycetoma kunye nosulelo lwenkqubo ngenxa ye-Sporothrix schenkii. Ukuxhathisa okufunyenweyo kwi-amphotericin B kuye kwachazwa kwiindawo ezizimeleyo ngamaxesha athile, ngokuqhelekileyo emva konyango lwexesha elide kwimeko ye-endocarditis, kodwa inqabile. I-Amphotericin B inokubangela iziphumo ebezingalindelekanga ezininzi ezinokuthi kwezinye iimeko zibenzima kakhulu.

I-Amphotericin ingakhutshwa nge-nebuliser. Jonga ividiyo apha.

Echinocandins

I-Echinocandins isoloko isetyenziselwa ukunyanga izifo ze-fungal ze-systemic kwizigulane ezingenayo i-immune - la mayeza avimbela ukuhlanganiswa kwe-glucan eyona nxalenye ethile yodonga lweseli lomngundo. Ziquka i-micafungin, i-caspofungin kunye ne-anidulafungin. I-Echinocandins ilawulwa kakuhle ngokusetyenziswa kwe-intravenous ngenxa yokufunxa kakubi.

ICaspofungin iyasebenza kakhulu kuzo zonke iintlobo zeAspergillus. Ayibulali iAspergillus ngokupheleleyo kwityhubhu yovavanyo. Kukho umlinganiselo omncinci womsebenzi ochasene ne-Coccidioides immitis, i-Blastomyces dermatitidis, iintlobo ze-Scedosporium, i-Paecilomyces varioti kunye ne-Histoplasma capsulata kodwa kunokwenzeka ukuba umsebenzi awukwanelanga ukusetyenziswa kwekliniki.

Triazoles 

I-Itraconazole, i-fluconazole, i-voriconazole kunye ne-posaconazole - indlela yokusebenza ye-itraconazole iyafana nezinye i-azole antifungals: inqanda i-fungal cytochrome P450 oxidase-mediated synthesis ye-ergosterol.

Fluconazole iyasebenza ngokuchasene neentlobo ezininzi zeCandida, ngaphandle ngokupheleleyo kweCandida krusei kunye nenxalenye yeCandida glabrata, kunye nenani elincinci leCandida albicans, Candida tropicalis, Candida parapsilosis kunye nezinye iintlobo ezinqabileyo. Ikwasebenza ngokuchasene noninzi lweCryptococcus neoformans yodwa. Iyasebenza ngokuchasene namanye amagwele amaninzi aquka iTrichosporon beigelii, iRhodotorula rubra, kunye ne-dimorphic endemic fungi kuquka iBlastomyces dermatitidis, iCoccidioides immitis, iHistoplasma capsulatund Paracoccidioides brasiliensis. Ayisebenzi kangako kune-itraconazole ngokuchasene nezi fungi ze-dimorphic. Ayisebenzi ngokuchasene ne-Aspergillus okanye i-Mucorales. Iyasebenza ngokuchasene nokungunda kwesikhumba njengeTrichophyton.

Ukonyuka kokunganyangeki kwi-Candida albicans kwizigulana ezine-AIDS kuye kwabikwa. Amazinga aqhelekileyo okumelana neCandida albicans kwisibhedlele esiqhelekileyo yi-3-6%, kwiCandida albicans kwi-AIDS 10-15%, eCandida krusei 100%, eCandida glabrata ~ 50-70%, eCandida tropicalis 10-30% kunye kwezinye iintlobo zeCandida ngaphantsi kwe-5%.

Itraconazole yenye yezona antifungals ezibanzi ezikhoyo kwaye ibandakanya umsebenzi ngokuchasene neAspergillus, Blastomyces Candida (zonke iintlobo ezibandakanya i-fluconazole resistant isolates) I-Coccidioides, i-Cryptoccocus, i-Histoplasma, i-Paracoccidioides, i-Scedosporium apiospermum kunye ne-Sporothrix schenkii. Ikwasebenza kuzo zonke iintsholongwane zolusu. Ayisebenzi ngokuchasene neMucorales okanye iFusarium kunye nezinye iifungi ezimbalwa ezinqabileyo. Yeyona arhente ichasene nokungunda okumnyama, kubandakanya iBipolaris, iExserohilum njl.njl. Ukuchasana ne-itraconazole kuchazwa kwiCandida, nangona kuncinci kune-fluconazole kunye nakwi-Aspergillus.

I-Voriconazole inombono obanzi kakhulu. Isebenza ngokuchasene noninzi lweentlobo zeCandida, iCryptococcus neoformans, zonke iintlobo zeAspergillus, iScedosporium agiospermum, ezinye iindawo ezikwanti zeFusarium kunye nenkitha yeentsholongwane ezinqabileyo. Ayisebenzi ngokuchasene neentlobo ze-Mucorales ezifana ne-Mucor spp, i-Rhizopus spp, i-Rhizomucor spp, i-Absidia spp kunye nezinye. I-Voriconazole iye yaba luncedo kakhulu kunyango lwe-aspergillosis.

Posaconazole inoluhlu olubanzi kakhulu lwesenzo. Ifungi ekukhuleni kwayo kuthintelwe yi-posaconazole ibandakanya iAspergillus, Candida, Coccidioides, Histoplasma, Paracoccidioides, Blastomyces, Cryptococcus, Sporothrix, iintlobo ezahlukeneyo zeMucorales (ezibangela iZygomyetes) kunye nezinye iimbumba ezimnyama ezinjengeBipolaris kunye neExserohilum. Uninzi lwee-Aspergillus isolate zibulawa yi-posaconazole kwiindawo ezifanelekileyo zeklinikhi. Ukuxhathisa okufunyenweyo kwi-posaconazole kwenzeka kwi-Aspergillus fumigatus kunye ne-Candida albicans kodwa kunqabile.

Imiphumo emibi yeziyobisi ze-azole zibonakaliswe kakuhle kwaye kukho nokusebenzisana okubalulekileyo kweziyobisi ezingabandakanyi ukusetyenziswa kokumisela izidakamizwa ezithile ngexesha elifanayo. Ukufumana ukuqonda okungaphezulu kwale miba jonga amaphecana olwazi lwesigulana ngasinye (PIL) ngechiza ngalinye (ezantsi kwephepha).

Ukuphutha

Amanye amayeza e-antifungal (umz itraconazole) zithathwa ngomlomo kwaye kunokuba nzima ukufunxa, ngakumbi ukuba uvuliwe Isichasi iyeza (iyeza elisetyenziselwa ukunyanga ukutya, izilonda zesisu okanye isitshisa). Oku kungenxa yokuba enye iasidi esiswini iyafuneka ukunyibilikisa iicapsules kwaye ivumele ukufunxa.

Kwindaba ye itraconazole ingcebiso eqhelekileyo kukuqinisekisa ukuba kukho iasidi eninzi esiswini ngokuthatha isiselo esihlwahlwazayo esifana ne-cola kunye neyeza (ikharbon diokside ebangela i-fizz yenza isiselo sibe neasidi kakhulu). Abanye abantu abazithandi iziselo ezihlwahlwazayo ngoko ke batshintshe incindi yeziqhamo umz. isiselo se-orenji.

Iipilisi ze-Itraconazole zithathwa emva isidlo kunye neeyure ezi-2 ngaphambi kokuthatha i-antacids. Isisombululo se-Itraconazole sithathwa iyure enye phambi kokuba isidlo njengoko sifunxeka ngokulula.

Kufanelekile ukufunda incwadi IPhepha leNgcaciso yesiGulane ipakishwe ngamayeza akho njengoko oku kukunika lonke ulwazi oludingayo ukuze uligcine kwaye ulisebenzise. Sinikezela ngoluhlu lwawona mayeza axhaphakileyo ezantsi kweli phepha, kunye namakhonkco kwiiPIL zawo.

Kwanasemva kokulandela yonke imiyalelo yabenzi bamachiza, ukufunxa kwamanye amayeza akuqikelekanga. Unokufumanisa ukuba ugqirha wakho uya kuthatha iisampulu zegazi ukujonga ukuba umzimba wakho uwufunxa kangakanani na i-antifungal

Imiphumela

Onke amachiza aneziphumo ebezingalindelekanga ('iziphumo ezibi') kwaye abavelisi bamachiza kufuneka bawadwelise kwiPhepha leNgcaciso yesiGulane (PIL). Uninzi luncinci, kodwa zonke zifanelekile ukukhankanya ugqirha wakho kutyelelo lwakho olulandelayo. Iziphumo ebezingalindelekanga zinokuhluka kakhulu kwaye zihlala zingalindelekanga ngokupheleleyo. Ukuba uziva ungaphilanga kusoloko kufanelekile ukujonga uluhlu lweziphumo ebezingalindelekanga kwi-PIL njengoko kusenokwenzeka ukuba ichiza olithathayo libangela ingxaki. Ukuba uyathandabuza soloko ufuna ingcebiso kagqirha wakho.

Steroids zidla ngokubangela iziphumo ebezingalindelekanga ezininzi ezingemnandanga. Kukho ulwazi oluchanekileyo kwimiphumo emibi ye-steroid kunye nendlela engcono yokuthatha i-steroids Apha.

Izigulana ezifumana iziphumo ebezingalindelekanga zinikwa uluhlu lweengcebiso – kusenokwenzeka ukuba ukuzingisa ekuthatheni iyeza kubangela ukuba ingxaki iphele, okanye kusenokwenzeka ukuba isigulana kufuneka sinqanyulwe ukusela ichiza. Ngamanye amaxesha elinye iyeza liya kumiselwa ukuchasana nesiphumo esibi.

Ngaphandle kwezona meko zinzima kakhulu akucebisi ukuba isigulane siyeke ukuthatha iyeza ngaphandle kokubonisana nogqirha wabo.

Kukho unxibelelwano oluninzi phakathi kwamachiza ahlukeneyo abantu abaninzi ekufuneka bewathathile okunokubangela iziphumo ebezingalindelekanga ezimandundu. Jonga intsebenziswano phakathi kwamachiza e-antifungal kunye nawo nawaphi na amanye amayeza onokuwathatha ngokuwakhangela kwethu I-database yonxibelelwano lwe-Antifungal.

I-Voriconazole kunye ne-squamous cell carcinoma: Uphononongo lwango-2019 lwabantu abangama-3710 abafumene uqhaqho-fakelo lwemiphunga okanye ukufakelwa kweeseli ze-hematopoietic bafumene ikhonkco elibalulekileyo phakathi kokusetyenziswa kwe-voriconazole kunye ne-squamous cell carcinoma kwezi zigulana. Ubude bexesha elide kunye needosi eziphezulu ze-voriconazole zidibene nomngcipheko okhulayo we-SCC. Uphononongo luxhasa imfuno yokuhlolwa rhoqo kwe-dermatologic kwi-LT kunye nezigulane ze-HCT kwi-voriconazole, kunye nesiphakamiso sokuba unyango olulolunye luthathwe, ngakumbi ukuba isigulane sele sisengozini yokwanda kwe-SCC. Ababhali baqaphela ukuba idatha yayinomda kwaye uphando olungakumbi luyafuneka ukuphonononga ngakumbi olu xhulumaniso. Funda iphepha apha.

Ukunika ingxelo ngeziphumo ebezingalindelekanga zechiza:

UK: E-UK, i-MHRA ine- Ikhadi eliphuzi iskimu apho unokunika ingxelo ngeziphumo ebezingalindelekanga kunye nesehlo esibi samayeza, ugonyo, unyango olongezelelweyo kunye nezixhobo zonyango. Kukho ifom efumaneka kwi-intanethi ekulula ukuyizalisa – awudingi ukuba wenze oku ngogqirha wakho. Ukuba ufuna uncedo ngefomu, fikelela kumntu othile eNAC okanye ubuze umntu okwiqela lenkxaso likaFacebook.

US: E-US, unokunika ingxelo ngeziphumo ebezingalindelekanga ngqo kwi-FDA ngokusebenzisa yabo IMedWatch icebo.

Ukufumaneka kweAntifungal:

Ngelishwa ayingawo onke amayeza e-antifungal akhoyo kulo lonke ilizwe kwihlabathi jikelele kwaye, nokuba akhona, ixabiso linokwahluka kakhulu kwilizwe nelizwe. IGlobal Action Fund for fungal Infections (GAFFI) yenze uluhlu lweemephu ezibonisa ukufumaneka kwamachiza aphambili alwa nokungunda kwihlabathi jikelele.

Cofa apha ukujonga imephu yokufumaneka kwe-GAFFI antifungal

Inkcukacha ezithe vetshe

Awona machiza aqhelekileyo amiselwe ukusetyenziswa ixesha elide kubantu abane-aspergillosis adweliswe ngolwazi oluneenkcukacha apha ngezantsi. Kukwakho noluhlu lolwazi olwenziwe lula kuninzi lwala machiza Apha.

Kufanelekile ukuba ufunde amaphecana olwazi lwesigulana (i-PIL) malunga neyeza oza kuqalisa ukulithatha kwaye uqaphele naziphi na izilumkiso, iziphumo ebezingalindelekanga kunye noluhlu lwamayeza angahambelaniyo. Le ikwayindawo entle yokufunda izikhokelo ezithile malunga nendlela yokuthatha amayeza akho. Sinikezela ngeekopi ezihlaziyiweyo ngezantsi:

(PIL – iPhepha leNgcaciso leZigulane) (BNF – Ifomula yeSizwe yaseBritani) 

steroids:

Amachiza okufunga:

  • I-Amphotericin B (Abelcet, I-Ambiosome, iFungizone) (BNF)
  • I-Anidulafungin (ECALTA) (PIL)
  • I-Caspofungin (CANCIDAS) (PIL)
  • I-Fluconazole (iDiflucan) (PIL)
  • Iflucytosine (Ancotil) (BNF)
  • IMicafungin (Mycamine) (PIL)
  • Posaconazole (Noxafil) (PIL)
  • I-Voriconazole (VFEND) (PIL)

Imiphumela - bona amaphecana e-PIL & VIPIL adweliswe ngasentla kodwa ubone neengxelo ezipheleleyo ezivela kwi-EU Ikhadi eliMthubi le-MRHA inkqubo yokunika ingxelo apha