aiv infeqcia/SidsiT avadmyofTa mkurnaloba da movla (klinikuri ...
aiv infeqcia/SidsiT avadmyofTa mkurnaloba da movla (klinikuri ... aiv infeqcia/SidsiT avadmyofTa mkurnaloba da movla (klinikuri ...
qimioTerapiiT (mag : B-ALL reJimi) diskusiis Temas warmoadgens da specifikuri rekomendaciebi dRevandeli dRisTvis ar arsebobs (35,36) (Va). o berkitis–tipis limfomebis SemTxvevebSi qimioTerapias Tan unda axldes dasxiveba savaraudo pirveladi keris. o SesaZlebelia ara hojkinis limfomebis mkurnaloba CD4 ujredebis ricxvisgan damoukideblad, Tumca mkurnalobis efeqturobisTvis arT unda dainiSnos ufro adre. qimioTerapiis ganmavlobaSi CD4 ujredebis ricxvi >350 mm3 dakavSirebulia relapsis maRal maCveneblebTan arT gareSe (37) (BII). o intakranilauri limfomebis (metastazebi) sasurvelia Tavis dasxiveba, simsivnis sawinaaRmdego preparatebTan da glukokortikoidebTan erTad (38) (BII). cns-is pirveladi limfomis dros erTaderTi efeqturi mtkicebulebaze dafuZnebuli Terapiaa sxivuri Terapia. dauyonebliv unda daiwyos arT (39,40) (AI). 3.1.12. centraluri nervuli sistemis infeqciebi adamianis imunodeficitis virusis nervul sistemaze pirdapir zemoqmedebas mivyavarT encefalopaTiis, mielopaTiis da periferiuli neiropaTiis ganviTarebamde. aiv infeqcias ukavSireben iseT nevrologiur darRvevebs, rogoricaa o Tavis tvinis nivTierebis atrofia da degeneracia, o Sids-demenciis kompleqsi, o naTxemis atrofia, o vakuoluri mielopaTia, o saxis nervis dambla, o gien-baris sindromi da o sensorul-motoruli periferiuli neiropaTia tkivilis sindromiT. cns-is darRvevebi aseve SeiZleba mogvces baqteriulma, virusulma da sokovanma oportunistulma infeqciebma (mag: kriptokokulma meningitma). 3.1.13. toqsoplazmozi ganviTarebul qveynebSi toqsoplazmozi farTod aris gavrcelebuli. toqsoplazmozi iwvevs Tavis tvinSi mravlobiTi anTebadi ubnebis warmoqmnas. aiv inficirebulebSi toqsoplazmozi ZiriTadad gamovlindeba encefalitis an diseminirebuli daavadebis saxiT. diagnostikaAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA toqsoplazmozze eWvi SeiZleba gamoiTqvas klinikuri suraTis mixedviT: o cnobierebis darRveva o cxeleba o krunCxvebi o Tavis tkivili o kerovani nevrologiuri simptomatika motoruli deficitis, kraniuli nervis parezis, moZraobis SezRudvis, dismetriis, mxedvelobis dakargvis da afaziis CaTvliT. 92
o Tavis tvinis MAC an MRI skanirebiT aRmoCndeba mravlobiTi rgoliseburi kerebi. o Tu es meTodebi ar aris xelmisawvdomi diagnozis dadgenaSi gvexmareba serologiuri testebi toqsoplazmis sawinaaRmdegod gamomuSavebul antisxeulebze (IgG klasis). o cerebraluri toqsoplazmozis mqone pacientebis umravlesobas aReniSneba Toxoplasma gondii-iT gamowveuli infeqciis gadatanis serologiuri niSnebi. o toqsoplazmozze eWvis dros iniSneba sacdeli mkurnaloba o 2 kviris manZilze mkurnalobis araefeqturobis SemTxvevebSi dgeba sakiTxi Tavis tvinis biofsiis Sesaxeb. o diagnozs adasturebs Tavis tvinis qsovilis histologiuri gamokvleva. mkurnalobaA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA cxrili 15. toqsoplazmozis mkurnaloba (41-43) (AI) preparati doza M miRebis sixSire miRebis gza mkurnalobis xangrZlivoba mkurnaloba pirimetamini 200 mg erTjeradad PO erTjeradad (gajerebiTi doza) Semdeg pirimetamini 25 mg 3-jer dReSi PO 6-8 kvira an 50 mg 2-jer dReSi + foliumis 15 mg dReSi PO 6-8 kvira mJava erTxel + sulfadiazini 1 g 4-jer dReSi PO 6-8 kvira am sqemaSi sulfadiazini SeiZleba Seicvalos: • klindamiciniT 600 mg i/v an PO dReSi 4-jer 6 kvira • azitromiciniT 1200 mg PO dReSi erTxel 6 kvira • klariTromiciniT 1 g PO 2-jer dReSi 6 kvira • atovakvoniT 750 mg PO 4-jer dReSi 6 kvira. • zogierT pacients sWirdeba xangrZlivi mkurnaloba toqsoplazmozis gamo. gadawyvetileba efuZneba klinikur mdgomareobas da ganmeorebiT CAT skanirebas. • meoradi profilaqtika grZeldeba efeqturi reJimis ganaxevrebuli dozebiT manamde sanam CD4 ujredebs ricxvi sami Tvis ganmavlobaSi stabulurad ar moimatebs (200 ujredi da meti). 3.1.14. martivi herpesiT gamowveuli infeqciebi • martivi herpesiT gamowveuli infeqciebi xSiria klinikur praqtikaSi. • herpesis pirvelad epizods xSirad axlavs recidivi. 93
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- Page 66 and 67: mcire mutacia muSaobs kombinaciaSi.
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o Tavis tvinis MAC an MRI skanirebiT aRmoCndeba mravlobiTi<br />
rgoliseburi kerebi.<br />
o Tu es meTodebi ar aris xelmisawvdomi diagnozis <strong>da</strong>dgenaSi<br />
gvexmareba serologiuri testebi toqsoplazmis sawinaaRmdegod<br />
gamomuSavebul antisxeulebze (IgG klasis).<br />
o cerebraluri toqsoplazmozis mqone pacientebis umravlesobas<br />
aReniSneba Toxoplasma gondii-iT gamowveuli infeqciis ga<strong>da</strong>tanis<br />
serologiuri niSnebi.<br />
o toqsoplazmozze eWvis dros iniSneba sacdeli <strong>mkurnaloba</strong><br />
o 2 kviris manZilze mkurnalobis araefeqturobis SemTxvevebSi dgeba<br />
sakiTxi Tavis tvinis biofsiis Sesaxeb.<br />
o diagnozs a<strong>da</strong>sturebs Tavis tvinis qsovilis histologiuri<br />
gamokvleva.<br />
<strong>mkurnaloba</strong>A<br />
AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA<br />
cxrili 15. toqsoplazmozis <strong>mkurnaloba</strong> (41-43) (AI)<br />
preparati doza M miRebis<br />
sixSire<br />
miRebis<br />
gza<br />
mkurnalobis<br />
xangrZlivoba<br />
<strong>mkurnaloba</strong><br />
pirimetamini 200 mg erTjera<strong>da</strong>d PO<br />
erTjera<strong>da</strong>d<br />
(gajerebiTi doza)<br />
Semdeg<br />
pirimetamini 25 mg<br />
3-jer dReSi PO<br />
6-8 kvira<br />
an 50 mg 2-jer dReSi<br />
+<br />
foliumis 15 mg dReSi PO<br />
6-8 kvira<br />
mJava<br />
erTxel<br />
+<br />
sulfadiazini 1 g 4-jer dReSi PO 6-8 kvira<br />
am sqemaSi sulfadiazini SeiZleba Seicvalos:<br />
• klin<strong>da</strong>miciniT 600 mg i/v an PO dReSi 4-jer 6 kvira<br />
• azitromiciniT 1200 mg PO dReSi erTxel 6 kvira<br />
• klariTromiciniT 1 g PO 2-jer dReSi 6 kvira<br />
• atovakvoniT 750 mg PO 4-jer dReSi 6 kvira.<br />
• zogierT pacients sWirdeba xangrZlivi <strong>mkurnaloba</strong><br />
toqsoplazmozis gamo. ga<strong>da</strong>wyvetileba efuZneba klinikur<br />
mdgomareobas <strong>da</strong> ganmeorebiT CAT skanirebas.<br />
• meoradi profilaqtika grZeldeba efeqturi reJimis ganaxevrebuli<br />
dozebiT manamde sanam CD4 ujredebs ricxvi sami Tvis ganmavlobaSi<br />
stabulurad ar moimatebs (200 ujredi <strong>da</strong> meti).<br />
3.1.14. martivi herpesiT gamowveuli infeqciebi<br />
• martivi herpesiT gamowveuli infeqciebi xSiria klinikur<br />
praqtikaSi.<br />
• herpesis pirvelad epizods xSirad axlavs recidivi.<br />
93
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