aiv infeqcia/SidsiT avadmyofTa mkurnaloba da movla (klinikuri ...
aiv infeqcia/SidsiT avadmyofTa mkurnaloba da movla (klinikuri ... aiv infeqcia/SidsiT avadmyofTa mkurnaloba da movla (klinikuri ...
o eqspoziciis Sedegad daavadebis ganviTareba damokidebulia rogorc maspinZlis imunur sistemaze aseve gamomwvevis raodenobaze. o diseminaciis aRkveTaze pasuxismgebelia intaqturi ujreddamokirebuli imuniteti. mwvave daavadeba gripismagvaria da axasiaTebs: o cxeleba o anoreqsia o arTralgia o mialgia o mSrali xveleba o tkivili gul-mkerdis areSi. o diseminacia imunosupresiul avadmyofSi swarfad viTardeba da axasiaTebs: o wonaSi dakleba o oraluri da kanis dazianebuli ubnebi o mkerdis niSnebi o RviZlis, elenTis da limfuri kvanZebis gadideba. o oraluri ubnebisTvis damaxasiaTebelia nekruzuli wylulebi. sesaZlebelia ganviTareds sasis perforacia da rbili qsovilis destruqcia. diagnostika diagnostika efuZneba klinikur suraTs da dasturdeba sokos kulturiT an qsovilis bioftatis histologiuri gamokvleviT. mwvave daavadebisas gul-mkerdis rentgenologiuri gamokvleva gviCvenebs: o Suasayaris limfadenopaTias o mravlobiT infiltratebs o qvemo wilis kvanZebs. o hispoplazmozis diagnostisTvis unda Catardes sisxlis da kanis testebi, Tumca isini ar aris farTod gamoyenebuli. mkurnaloba imunokompetentur adamianSi hispoplazmozi TviTgankurnebadia da ar sWirdeba mkurnaloba. imunosupresiis SemTxvebSi mkurnaloba unda Catardes me-14 cxrilSi mocemuli sqemebis mixedviT. cxrili 32. histoplazmozis mkurnaloba (28) (AI) antifunfaluri agenti dozireba miRebis sixSire amfotericni B 0.7-1 mg/kg erTxel dReSi miRebis gza IV xangrZlivoba 10 dRe sawyis mkurnalobas mohyveba 3 Tviani mkurnaloba imunorekonstituciamde >100 CD4 ujrediT, Sedegi medikamentebiT: o itrakonazoli 200 mg 2X dReSi PO o flukonazoli 200 mg 2X dReSi PO o amfotericini B 1 mg/kg IV kviraSi erTxel. 88
alternatiul reJims warmoadgens itrakonazoli 200 mg samjer dReSi - 3 dRe, Semdeg 200 mg 2X dReSi 12 kvira (sakvebTan erTad). 3.1.9. kapoSis sarkoma o kapoSis sarkomas iwvevs me-8 tipis herpes virusi (HHV8), romelic aseve cnobilia kapoSis sarkomasTan asocirebuli herpes virusis saxeliT (KSHV). o nebismieri pacienti kapoSis sarkomis savaraudi diagnioziT unda gaigzavnos onkologTan. o imunodeficitis mqone aiv inficirebulebSi daavadeba mimdinareobs mZimed, diseminaciis tendenciiT da ufro male progresirebs, vidre daavadebis endemuri formis mqone arainficirebul adamianebSi. diagnostikaAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA kapoSis sarkomis winaswari diagnozi ismeba klinikuri suraTis safuZvelze da dasturdeba kanis dazianebuli ubnebidan aRebuli bioptatis histologiuri gamokvleviT. klinikuri niSnebi moicavs Semdegs: o kapoSis sarkomis elementebi SeiZleba aRmovaCinoT kanisa da lorwovanis nebismier areze. kanze elementebi warmodgenilia cisferi an mewamuli feris papulebiT an kvanZebiT, araiSviaTad garSemo arsebuli kanis limfuri SeSupebiT. xSirad ziandeba sasa, filtvebi kuW-nawlavis traqti da limfuri kvanZebi. o piris RruSi kapoSis sarkomis elementebi yvelaze xSirad ganlagebulia magar sasaze, iSviaTad enaze, xaxaze, nuSura jirkvlebsa da RrZilebze. isini warmoadgenen mewamuli feris papulebs, romlebic Cveulebriv ar aris mtkivneuli. xandaxan SeiZleba Segvxvdes msxvili elementebic da elementebi kanze. o filtvis parenqimis dazianeba atarebs infiltraciul xasiaTs. xSirad viTardeba sunTqvis ukmarisoba. filtvis infiltraciuli dazianebis mqone avadmyofebs arakeTilsaimedo prognozi aqvT da maTSi maRalia sikvdilianoba. o aucilebelia ganvasxvavoT kapoSis sarkoma baqteriuli angiomatozisagan, romelic warmoadgens infeqciur daavadebas (gamomwvevi: Bartonella spp.) da aseve gvxvdeba aiv inficirebulebSi. mkurnalobaAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA o kapoSis sarkomis mkurnaloba tardeba onkologis mier. o kapoSis sarkoma avTvisebiani simsivnea. lokaluri formis samkurnalod gamoiyeneba sxivuri Terapia, generalizirebuli formis samkurnalod iniSneba citotoqsiuri qimioTerapia. o efeqturobis sxvadasxva xarisxiT gamoiyeneba simsivnis sawinaaRmdego preparatebis Semdegi kombinaciebi: o liposomuri doksorubiciniT monoTerapia (saukeTeso Sedegebi) (29- 31) (BII) o bleomicini o vinkristini o daunorubicini o vinblastini o etopozidi. 89
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- Page 39 and 40: - tabletebis Cveneba pacientisTvis
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- Page 43 and 44: igulisxmeba im medikamentebis kombi
- Page 45 and 46: X (arv): testebi, romlebic unda Cat
- Page 47 and 48: maRali mgrZnobeloba abakaviri (ABC
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- Page 66 and 67: mcire mutacia muSaobs kombinaciaSi.
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- Page 72 and 73: 122. Koval CE et al. Immune reconst
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- Page 94 and 95: • imunodeficitis mqone pacientebS
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- Page 108 and 109: 20. Chen XM et al. Cryptosporidiosi
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- Page 136 and 137: 5. mkurnaloba a) rekomendebuli pirv
o eqspoziciis Sedegad <strong>da</strong>avadebis ganviTareba <strong>da</strong>mokidebulia<br />
rogorc maspinZlis imunur sistemaze aseve gamomwvevis<br />
raodenobaze.<br />
o diseminaciis aRkveTaze pasuxismgebelia intaqturi ujred<strong>da</strong>mokirebuli<br />
imuniteti. mwvave <strong>da</strong>avadeba gripismagvaria <strong>da</strong><br />
axasiaTebs:<br />
o cxeleba<br />
o anoreqsia<br />
o arTralgia<br />
o mialgia<br />
o mSrali xveleba<br />
o tkivili gul-mkerdis areSi.<br />
o diseminacia imunosupresiul avadmyofSi swarfad viTardeba <strong>da</strong><br />
axasiaTebs:<br />
o wonaSi <strong>da</strong>kleba<br />
o oraluri <strong>da</strong> kanis <strong>da</strong>zianebuli ubnebi<br />
o mkerdis niSnebi<br />
o RviZlis, elenTis <strong>da</strong> limfuri kvanZebis gadideba.<br />
o oraluri ubnebisTvis <strong>da</strong>maxasiaTebelia nekruzuli wylulebi.<br />
sesaZlebelia ganviTareds sasis perforacia <strong>da</strong> rbili qsovilis<br />
destruqcia.<br />
diagnostika<br />
diagnostika efuZneba klinikur suraTs <strong>da</strong> <strong>da</strong>sturdeba sokos kulturiT<br />
an qsovilis bioftatis histologiuri gamokvleviT.<br />
mwvave <strong>da</strong>avadebisas gul-mkerdis rentgenologiuri gamokvleva gviCvenebs:<br />
o Suasayaris limfadenopaTias<br />
o mravlobiT infiltratebs<br />
o qvemo wilis kvanZebs.<br />
o hispoplazmozis diagnostisTvis un<strong>da</strong> Catardes sisxlis <strong>da</strong> kanis<br />
testebi, Tumca isini ar aris farTod gamoyenebuli.<br />
<strong>mkurnaloba</strong><br />
imunokompetentur a<strong>da</strong>mianSi hispoplazmozi TviTgankurnebadia <strong>da</strong> ar<br />
sWirdeba <strong>mkurnaloba</strong>. imunosupresiis SemTxvebSi <strong>mkurnaloba</strong> un<strong>da</strong><br />
Catardes me-14 cxrilSi mocemuli sqemebis mixedviT.<br />
cxrili 32. histoplazmozis <strong>mkurnaloba</strong> (28) (AI)<br />
antifunfaluri<br />
agenti<br />
dozireba miRebis<br />
sixSire<br />
amfotericni B 0.7-1 mg/kg erTxel<br />
dReSi<br />
miRebis gza<br />
IV<br />
xangrZlivoba<br />
10 dRe<br />
sawyis <strong>mkurnaloba</strong>s mohyveba 3 Tviani <strong>mkurnaloba</strong> imunorekonstituciamde<br />
>100 CD4 ujrediT, Sedegi medikamentebiT:<br />
o itrakonazoli 200 mg 2X dReSi PO<br />
o flukonazoli 200 mg 2X dReSi PO<br />
o amfotericini B 1 mg/kg IV kviraSi erTxel.<br />
88
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