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თარიღი: 25 მაისი, 2023

 

ბოლო პერიოდში საქართველოში დაფიქსირდა ყირიმ-კონგოს ჰემორაგიული ცხელების 8 შემთხვევა, ძირითადად სამცხე-ჯავახეთის და შიდა ქართლის რეგიონებში. რვავე პაციენტი მოთავსებულ იქნა ინფექციური პათოლოგიის და შიდსის ცენტრში. ყველა გადარჩა. 6 მათგანი უკვე გაეწერა, 2 პაციენტი აგრძელებს მკურნალობას.

ცხელი სეზონის დადგომასთან ერთად საქართველოში, ისევე როგორც მსოფლიოს მრავალ ქვეყანაში აქტუალური ხდება ყირიმ-კონგოს ჰემორაგიული ცხელების გავრცელება.

ყირიმ-კონგოს ჰემორაგიული ცხელება განეკუთვნება განსაკუთრებით საშიშ ინფექციებს, რაც განპირობებულია ამ დაავადებით გამოწვეული მაღალი ლეტალობით: 10-40% (ჯანმრთელობის მსოფლიო ორგანიზაცია), მაღალი გადამდებლობით და ეფექტიანი სპეციფიკური სამკურნალო მედიკამენტების/ვაქცინების პრაქტიკულად არარსებობით. განიხილება ანტივირუსული მედიკამენტის რიბავირინის გამოყენება, თუმცა მყარი მტკიცებულებები მის ეფექტიანობაზე ჯერ-ჯერობით არ არის.

ინფექციის რეზერვუარები არიან მრავალრიცხოვანი შინაური და გარეული ცხოველები (თაგვები, ზღარბები, კურდღლები, ძროხები, ცხვრები, თხები და სხვ.), რომლებზეც ტკიპები პარაზიტობენ.

ადამიანების 80-90% ინფიცირდება ტკიპების ნაკბენის, ასევე ინფიცირებული ცხოველის/საქონლის სისხლთან ან ქსოვილებთან პირდაპირი კონტაქტის შედეგად (მაგალითად ცხოველის დაკვლის დროს). ადამიანიდან ადამიანზე ვირუსის გადაცემა შესაძლებელია დაავადებული ადამიანის სისხლთან და/ან ბიოლოგიურ  სითხეებთან შეხებისას (რისკი მაღალია სამედიცინო მანიპულაციების ან გვამთან შეხების დროს). შესაბამისად, რისკის ჯგუფებს მიეკუთვნება: სოფლის მეურნეობის მუშაკები, მესაქონლეები, ცხოველთა სასაკლაოს მუშაკები, ვეტერინარები, სამხედროები, მედიცინის მუშაკები, მოგზაურები (ყირიმ–კონგოს ჰემორაგიული ცხელების ენდემიურ რეგიონებში) და

საქართველოში ინფექცია ძირითადად გხვდება სამცხე-ჯავახეთში (ახალციხის, ადიგენის, ასპინძის რაიონები) და შიდა ქართლში (კასპის, ხაშურის, გორის რაიონები), თუმცა იშვიათად ერთეული შემთხვევები გხვდება სხვა რაიონებშიც. ინფექციის შემთხვევები ძირითადად გხვდება აპრილ-მაისიდან ოქტომბრამდე - როცა ტკიპები აქტიურდებიან.

აღსანიშნავია, რომ მხოლოდ 2022 წელს ქვეყანაში დაფიქსირებული იყო ყირიმ-კონგოს ჰემორაგიული ცხელების 47 დადასტურებული შემთხვევა, მათგან 39 პაციენტი მკურნალობდა ინფექციური პათოლოგიის და შიდსის ცენტრში, ხოლო 8 პაციენტი - სხვა კლინიკებში. 2022 წელს ინფექციური პათოლოგიის და შიდსის ცენტრში ნამკურნალები პაციენტებს შორის არცერთი ლეტალური შემთხვევა არ დაფიქსირებულა. სხვა კლინიკებში მყოფი 8 პაციენტიდან გარდაიცვალა 3 პაციენტი.

შესაბამისად, 2022 წელს ქვეყანაში გამოვლენილ ყირიმ-კონგოს ჰემორაგიული ცხელებით პაციენტებში ლეტალობის მაჩვენებელმა შეადგენა 6,4%-ს, რაც ამ დაავადებისთვის ძალიან დაბალი მაჩვენებელია. ხოლო ბოლო 10 წლის მანძილზე ლეტალობის მაჩვენებელი საშუალოდ დაახლოებით 10-11%-ია, რაც ასევე ერთ-ერთი ყველაზე დაბალი მაჩვენებელია ევროპის ქვეყნებში.

ყირიმ-კონგოს ჰემორაგიული ცხელება იწყება უეცრად და ახასიათებს შემდგომი სიმპტომები: თავის ტკივილი, მაღალი ტემპერატურა, ზოგადი სისუსტე, თვალების, სახის და კისრის მიდამოს სიწითლე, სისხლჩაქცევები (წითელი, ყავისფერი ან იასამნისფერი ლაქები კანზე), სისხლდენა ღრძილებიდან და შინაგანი ორგანოებიდან, გამონაყარი (პეტექიური, მაკულო-პაპულოზური) სახსრებისა და კუნთების ტკივილი, ტკივილი მუცლის არეში, ღებინება, სიყვითლე, სისხლში თრომბოციტოპენია, ლეიკოპენია და სხვ. შესაძლოა იყოს ფარდობითი ბრადიკარდია.

დიაგნოზის დადასტურება ხდება ლაბორატორიული კვლევებით (PCR ტესტი, ანტისხეულები და სხვ.). მკურნალობა მოიცავს, როგორც ანტივირუსულ მკურნალობას (რიბავირინით), ისე დამხმარე და სიმპტომურ თერაპიას.  

დაავადების პრევენცია გულისხმობს: ტკიპების საწინააღმდეგოდ პირადი პროფილაქტიკის დაცვას (სპეცტანსაცმელი, რეზინის ფეხსაცმელი, ხელთათმანები); ტანსაცმლის და ფეხსაცმლის დამუშავებას აკარაციდებით (ტკიპების გამანადგურებლებით); კანის რეპელენტების (მწერების, ტკიპების დამაფრთხობლების) გამოყენებას; ავადმყოფი ცხოველის იზოლაციას; საქონლის დაკვლაში მონაწილეობისას ხელთათმანების გამოყენებას და სხვ. მნიშვნელოვანია, რომ ტკიპა ადამიანის კანიდან მოცილებული უნდა იყოს შეძლებისდაგვარად მალე პინცეტის მეშვეობით, ისე რომ კანში არ ჩარჩეს ტკიპის პირის ნაწილები. ტკიპის მოშორების შემდეგ ნაკბენი ადგილი და ხელები საფუძვლიანად უნდა დამუშავდეს ალკოჰოლის შემცველი ხსნარით, ან საპნითა და წყლით.

დაავადების დამძიმების და შესაბამისად, არასახარბიელო გამოსავლების თავიდან ასაცილებლად უაღრესად მნიშვნელოვანია მკურნალობის დროული დაწყება, ამიტომ პაციენტმა დაავადების კლინიკური ნიშნების გამოვლენისთანავე დაუყოვნებლივ უნდა მიმართოს სამედიცინო დაწესებულებას, რათა ექიმის მიერ მოხდეს დროული და ზუსტი დიაგნოსტირება და შესაბამისი მკურნალობის ჩატარება.

მინდა მივმართო აგრეთვე ოჯახის ექიმებს და კლინიკებს, რომ ვინაიდან ყირიმ-კონგოს ჰემორაგიული ცხელება მიეკუთვნება განსაკუთრებით საშიშ ინფექციებს მაღალი ლეტალობით, სასურველია, რომ ამ დაავადებაზე საეჭვო ყველა ავადმყოფი გადაყვანილ იქნას ინფექციური პროფილის სპეციალიზებულ რეფერალურ კლინიკაში, რომელთაც აქვთ ამ დაავადების მართვის სერიოზული გამოცდილება.