Visceral leishmaniasis (VL), yomwe imadziwika kuti kala-azar ku India, ndi matenda opatsirana omwe amayamba chifukwa cha Leishmania yomwe imapezeka m'nkhalango yomwe imatha kupha ngati sichitha kuchiritsidwa mwachangu. Ntchentche ya sandfly Phlebotomus argentipes ndiyo yokhayo yotsimikizika ya VL ku Southeast Asia, komwe imayendetsedwa ndi kupopera mankhwala otsala m'nyumba (IRS), mankhwala ophera tizilombo. Kugwiritsa ntchito DDT mu mapulogalamu owongolera VL kwapangitsa kuti pakhale kukana kwa ntchentche za sandfly, kotero DDT yasinthidwa ndi mankhwala ophera tizilombo otchedwa alpha-cypermethrin. Komabe, alpha-cypermethrin imagwira ntchito mofanana ndi DDT, kotero chiopsezo cha kukana kwa ntchentche za sandfly chimawonjezeka chifukwa cha kupsinjika komwe kumachitika chifukwa chokumana ndi tizilombo toyambitsa matenda mobwerezabwereza. Mu kafukufukuyu, tinayesa momwe udzudzu wakuthengo ndi ana awo a F1 angathandizire kufalikira pogwiritsa ntchito njira ya CDC yoyesera botolo.
Tinasonkhanitsa udzudzu kuchokera m'midzi 10 m'boma la Muzaffarpur ku Bihar, India. Midzi isanu ndi itatu inapitiriza kugwiritsa ntchito mphamvu zambiri.cypermethrinPopopera mankhwala m'nyumba, mudzi wina unasiya kugwiritsa ntchito cypermethrin yokhala ndi mphamvu zambiri popopera mankhwala m'nyumba, ndipo mudzi wina sunagwiritsepo ntchito cypermethrin yokhala ndi mphamvu zambiri popopera mankhwala m'nyumba. Udzudzu womwe unasonkhanitsidwa unapezeka ndi mlingo wodziwikiratu kwa nthawi yodziwika bwino (3 μg/ml kwa mphindi 40), ndipo chiŵerengero cha imfa ndi kutsika kwa udzudzu zinalembedwa maola 24 pambuyo popopera mankhwala.
Chiwerengero cha anthu omwe anaphedwa ndi udzudzu wakuthengo chinali kuyambira pa 91.19% mpaka 99.47%, ndipo anthu omwe anafa ndi udzudzu wa F1 anali kuyambira pa 91.70% mpaka 98.89%. Maola makumi awiri mphambu anayi atadwala matendawa, anthu omwe anafa ndi udzudzu wakuthengo anali kuyambira pa 89.34% mpaka 98.93%, ndipo anthu omwe anafa ndi udzudzu wa F1 anali kuyambira pa 90.16% mpaka 98.33%.
Zotsatira za kafukufukuyu zikusonyeza kuti kukana kungayambike mu P. argentipes, zomwe zikusonyeza kufunika kopitiliza kuyang'anira ndi kusamala kuti azitha kulamulira akangomaliza kuwononga.
Visceral leishmaniasis (VL), yomwe imadziwika kuti kala-azar ku India, ndi matenda opatsirana omwe amayamba chifukwa cha Leishmania yomwe imafalikira kudzera mu kuluma kwa ntchentche zazikazi zomwe zili ndi kachilomboka (Diptera: Myrmecophaga). Ntchentche zam'mphepete mwa nyanja ndiye matenda okhawo omwe amatsimikizira kuti matendawa afalikira ku Southeast Asia. India yatsala pang'ono kukwaniritsa cholinga chothetsa VL. Komabe, kuti pakhalebe kuchuluka kochepa kwa matendawa pambuyo pothetsedwa, ndikofunikira kuchepetsa kuchuluka kwa tizilombo toyambitsa matenda kuti tipewe kufalikira kwa matendawa.
Kulamulira udzudzu ku Southeast Asia kumachitika kudzera mu kupopera mankhwala ophera tizilombo m'nyumba (IRS) pogwiritsa ntchito mankhwala ophera tizilombo. Khalidwe lobisala la miyendo yasiliva limapangitsa kuti ikhale chandamale choyenera chowongolera tizilombo kudzera mu kupopera mankhwala ophera tizilombo m'nyumba [1]. Kupopera mankhwala ophera tizilombo m'nyumba mwa dichlorodiphenyltrichloroethane (DDT) pansi pa National Malaria Control Programme ku India kwakhala ndi zotsatirapo zazikulu pakulamulira kuchuluka kwa udzudzu komanso kuchepetsa kwambiri milandu ya VL [2]. Kulamulira kwa VL kosakonzekera kumeneku kunapangitsa kuti Indian VL Eradication Programme iyambe kugwiritsa ntchito kupopera mankhwala ophera tizilombo m'nyumba ngati njira yayikulu yowongolera matenda a siliva. Mu 2005, maboma a India, Bangladesh, ndi Nepal adasaina chikalata chogwirizana ndi cholinga chothetsa VL pofika chaka cha 2015 [3]. Ntchito zochotsa matendawa, zomwe zikuphatikizapo kuphatikiza njira zowongolera tizilombo komanso kuzindikira mwachangu komanso kuchiza matenda a anthu, cholinga chake chinali kulowa mu gawo lophatikizana pofika chaka cha 2015, cholinga chomwe pambuyo pake chinasinthidwa kukhala 2017 kenako 2020.[4] Njira yatsopano yapadziko lonse yochotsera matenda otentha omwe sanasamalidwe ikuphatikizapo kuthetseratu VL pofika chaka cha 2030.[5]
Pamene India ikulowa mu gawo la BCVD pambuyo pochotsa BCVD, ndikofunikira kuonetsetsa kuti kukana kwakukulu kwa beta-cypermethrin sikukukula. Chifukwa cha kukana ndikuti DDT ndi cypermethrin zonse zili ndi njira yofanana yogwirira ntchito, yomwe ndi, zimalimbana ndi puloteni ya VGSC [21]. Chifukwa chake, chiopsezo cha kukana kwa tizilombo toyambitsa matenda m'mchenga chikhoza kuwonjezeka chifukwa cha kupsinjika komwe kumachitika chifukwa chokumana ndi cypermethrin yamphamvu kwambiri. Chifukwa chake ndikofunikira kuyang'anira ndikupeza kuchuluka kwa tizilombo toyambitsa matenda tomwe titha kukana ku tizilombo toyambitsa matenda. Pachifukwa ichi, cholinga cha kafukufukuyu chinali kuyang'anira momwe tizilombo toyambitsa matenda akuthengo tingathere pogwiritsa ntchito mlingo wodziwira matenda komanso nthawi yomwe tizilombo toyambitsa matenda timapezeka. Chaubey et al. [20] adaphunzira za P. argentipes ochokera m'midzi yosiyanasiyana m'chigawo cha Muzaffarpur ku Bihar, India, chomwe chimagwiritsa ntchito njira zopopera zamkati zomwe zimathandizidwa ndi cypermethrin (midzi yopitilira ya IPS). Kuopsa kwa tizilombo ta P. argentipes tomwe timachokera ku midzi yomwe idasiya kugwiritsa ntchito njira zopopera m'nyumba zomwe zimathiridwa ndi cypermethrin (midzi yakale ya IPS) ndi yomwe sinagwiritsepo ntchito njira zopopera m'nyumba zomwe zimathiridwa ndi cypermethrin (midzi yomwe si ya IPS) kunayerekezeredwa pogwiritsa ntchito njira ya CDC bottle bioassay.
Midzi khumi inasankhidwa kuti igwiritsidwe ntchito pa kafukufukuyu (Chithunzi 1; Gome 1), yomwe isanu ndi itatu mwa iyo inali ndi mbiri yopopera mankhwala opangidwa m'nyumba mosalekeza (hypermethrin; yomwe imatchedwa midzi yopitilira ya hypermethrin) ndipo inali ndi milandu ya VL (osachepera mmodzi) m'zaka zitatu zapitazi. Mwa midzi iwiri yotsalayo mu kafukufukuyu, mudzi umodzi womwe sunagwiritse ntchito kupopera mankhwala m'nyumba kwa beta-cypermethrin (mudzi wosapopera mankhwala m'nyumba) unasankhidwa kukhala mudzi wolamulira ndipo mudzi wina womwe unali ndi kupopera mankhwala m'nyumba mosalekeza kwa beta-cypermethrin (mudzi wopopera mankhwala m'nyumba nthawi zina/mudzi wakale wopopera mankhwala m'nyumba) unasankhidwa kukhala mudzi wolamulira. Kusankhidwa kwa midzi iyi kunachokera pa mgwirizano ndi Dipatimenti ya Zaumoyo ndi Gulu Lopopera Mankhwala M'nyumba komanso kutsimikizika kwa Ndondomeko Yopopera Mankhwala M'nyumba ku Chigawo cha Muzaffarpur.
Mapu a malo a chigawo cha Muzaffarpur omwe akuwonetsa malo a midzi yomwe yaphatikizidwa mu kafukufukuyu (1–10). Malo ophunzirira: 1, Manifulkaha; 2, Ramdas Majhauli; 3, Madhubani; 4, Anandpur Haruni; 5, Pandey; 6, Hirapur; 7, Madhopur Hazari; 8, Hamidpur; 9, Noonfara; 10, Simara. Mapuwa adakonzedwa pogwiritsa ntchito pulogalamu ya QGIS (mtundu 3.30.3) ndi Open Assessment Shapefile.
Mabotolo oyesera kuonekera kwa madzi anakonzedwa motsatira njira za Chaubey et al. [20] ndi Denlinger et al. [22]. Mwachidule, mabotolo agalasi 500 mL anakonzedwa tsiku limodzi mayeso asanachitike ndipo khoma lamkati la mabotolo linali litakutidwa ndi mankhwala ophera tizilombo omwe adawonetsedwa (mlingo wozindikira wa α-cypermethrin unali 3 μg/mL) poika acetone solution ya mankhwala ophera tizilombo (2.0 mL) pansi, makoma ndi chivindikiro cha mabotolo. Botolo lililonse linaumitsidwa pa makina opukutira kwa mphindi 30. Panthawiyi, tsegulani pang'onopang'ono chivundikirocho kuti acetone iume. Pambuyo pa mphindi 30 zouma, chotsani chivundikirocho ndikuzungulira botolo mpaka acetone yonse iume. Mabotolowo anasiyidwa otseguka kuti aume usiku wonse. Pa mayeso aliwonse obwerezabwereza, botolo limodzi, logwiritsidwa ntchito ngati chowongolera, linakutidwa ndi 2.0 mL ya acetone. Mabotolo onse anagwiritsidwanso ntchito panthawi yonse yoyeserayo atayeretsedwa moyenera malinga ndi njira yomwe Denlinger et al adafotokoza. ndi World Health Organization [22, 23].
Pa tsiku lotsatira kukonzekera mankhwala ophera tizilombo, udzudzu 30-40 wogwidwa kuthengo (akazi omwe ali ndi njala) unachotsedwa m'mabokosi m'mabotolo ndipo unalowetsedwa pang'onopang'ono mu botolo lililonse. Pafupifupi chiwerengero chomwecho cha ntchentche chinagwiritsidwa ntchito pa botolo lililonse lophimbidwa ndi mankhwala ophera tizilombo, kuphatikizapo chowongolera. Bwerezani izi osachepera kasanu kapena kasanu ndi kamodzi m'mudzi uliwonse. Pambuyo pa mphindi 40 mutakumana ndi mankhwala ophera tizilombo, chiwerengero cha ntchentche zomwe zinagwetsedwa chinalembedwa. Ntchentche zonse zinagwidwa ndi makina opumira, zinayikidwa m'zidebe za makatoni okhala ndi mapini ophimbidwa ndi ukonde wabwino, ndipo zinayikidwa mu chosungira chosiyana pansi pa chinyezi ndi kutentha komweko komwe kuli gwero lomwelo la chakudya (mabolo a thonje omwe amanyowa mu 30% shuga solution) monga madera omwe sanalandire chithandizo. Imfa inalembedwa maola 24 mutakumana ndi mankhwala ophera tizilombo. Udzudzu wonse unadulidwa ndi kufufuzidwa kuti utsimikizire mtundu wa mtundu. Njira yomweyo inachitidwa ndi ntchentche za ana a F1. Kugwa ndi kufa kunalembedwa maola 24 mutakumana ndi mankhwala ophera tizilombo. Ngati imfa m'mabotolo ophera tizilombo inali <5%, palibe kukonza imfa komwe kunapangidwa m'mabotolo obwerezabwereza. Ngati imfa mu botolo lowongolera inali ≥ 5% ndi ≤ 20%, imfa mu mabotolo oyesera a chitsanzo chimenecho zinakonzedwa pogwiritsa ntchito njira ya Abbott. Ngati imfa mu gulu lowongolera inapitirira 20%, gulu lonse loyesera linatayidwa [24, 25, 26].
Avereji ya imfa ya udzudzu wa P. argentipes womwe wagwidwa kuthengo. Mipiringidzo yolakwika ikuyimira zolakwika za avareji. Kulumikizana kwa mizere iwiri yofiira yopingasa ndi graph (90% ndi 98% ya imfa, motsatana) kumasonyeza zenera la imfa momwe kukana kungakulire.[25]
Avereji ya imfa ya ana a F1 a P. argentipes omwe agwidwa kuthengo. Mipiringidzo yolakwika ikuyimira zolakwika za avereji. Ma curve omwe amakumana ndi mizere iwiri yofiira yopingasa (90% ndi 98% ya imfa, motsatana) akuyimira kuchuluka kwa imfa zomwe kukana kungakulire [25].
Udzudzu womwe uli m'mudzi wolamulira/wosakhala wa IRS (Manifulkaha) unapezeka kuti ndi wovuta kwambiri ku mankhwala ophera tizilombo. Avereji ya imfa (±SE) ya udzudzu womwe unagwidwa kuthengo maola 24 pambuyo poti wagwetsedwa ndi kufalikira unali 99.47 ± 0.52% ndi 98.93 ± 0.65%, motsatana, ndipo avereji ya imfa ya ana a F1 inali 98.89 ± 1.11% ndi 98.33 ± 1.11%, motsatana (Matebulo 2, 3).
Zotsatira za kafukufukuyu zikusonyeza kuti ntchentche zamchenga zasiliva zimatha kukhala ndi mphamvu yolimbana ndi pyrethroid (SP) α-cypermethrin yopangidwa m'midzi momwe pyrethroid (SP) α-cypermethrin inkagwiritsidwa ntchito nthawi zonse. Mosiyana ndi zimenezi, ntchentche zamchenga zasiliva zomwe zinasonkhanitsidwa m'midzi yomwe siili ndi pulogalamu ya IRS/yoyang'anira zinapezeka kuti ndi zotetezeka kwambiri. Kuyang'anira kuchuluka kwa ntchentche zamchenga zakuthengo ndikofunikira poyang'anira momwe mankhwala ophera tizilombo amagwiritsidwa ntchito, chifukwa izi zingathandize polimbana ndi mankhwala ophera tizilombo. Kuchuluka kwa kukana kwa DDT kwakhala kunenedwa nthawi zonse mu ntchentche zamchenga zochokera kumadera omwe ali ku Bihar chifukwa cha kukakamizidwa kwa IRS kosankha mankhwala ophera tizilombo [1].
Tinapeza kuti P. argentipes ndi mankhwala opha tizilombo toyambitsa matenda omwe amakhudza kwambiri tizilombo toyambitsa matenda, ndipo mayeso a kumunda ku India, Bangladesh ndi Nepal adawonetsa kuti IRS inali ndi mphamvu yayikulu yogwiritsira ntchito tizilombo toyambitsa matenda ikagwiritsidwa ntchito limodzi ndi cypermethrin kapena deltamethrin [19, 26, 27, 28, 29]. Posachedwapa, Roy et al. [18] adanenanso kuti P. argentipes inali ndi mphamvu yolimbana ndi tizilombo toyambitsa matenda ku Nepal. Kafukufuku wathu wokhudza tizilombo toyambitsa matenda m'munda unawonetsa kuti tizilombo toyambitsa matenda tomwe tinasonkhanitsidwa m'midzi yomwe si ya IRS tinali osavuta kuigwiritsa ntchito, koma tizilombo tomwe tinasonkhanitsidwa m'midzi ya IRS/yakale komanso ya IRS yopitilira (imfa inali kuyambira 90% mpaka 97% kupatula tizilombo toyambitsa matenda kuchokera ku Anandpur-Haruni yomwe inali ndi imfa ya 89.34% maola 24 itatha kufalikira) mwina inali yolimba ku cypermethrin yogwira ntchito kwambiri [25]. Chifukwa chimodzi chomwe chingayambitse kukana kumeneku ndi kupanikizika komwe kumachitika chifukwa cha kupopera mankhwala m'nyumba (IRS) ndi mapulogalamu opopera mankhwala m'deralo, omwe ndi njira zodziwika bwino zoyendetsera kufalikira kwa matenda a kala-azar m'madera/malo ozungulira/midzi (Standard Operating Procedure for Outbreak Investigation and Management [30]. Zotsatira za kafukufukuyu zikuwonetsa koyamba za kukula kwa kukakamizidwa kosankha motsutsana ndi cypermethrin yogwira ntchito kwambiri. Tsoka ilo, deta yakale yokhudza kukhudzidwa ndi matendawa m'derali, yomwe idapezeka pogwiritsa ntchito CDC bottle bioassay, sikupezeka kuti iyerekezedwe; maphunziro onse am'mbuyomu adayang'anira kukhudzidwa ndi P. argentipes pogwiritsa ntchito pepala lopangidwa ndi WHO lophera tizilombo. Mlingo wozindikira wa mankhwala ophera tizilombo m'mizere yoyesera ya WHO ndi kuchuluka kwa mankhwala ophera tizilombo omwe amagwiritsidwa ntchito motsutsana ndi ma vectors a malungo (Anopheles gambiae), ndipo kugwiritsidwa ntchito kwa kuchuluka kumeneku ku bakiteriya sikukudziwika bwino chifukwa bakiteriya amauluka pafupipafupi kuposa udzudzu, ndipo amakhala nthawi yayitali akukhudzana ndi substrate mu bioassay [23].
Mankhwala opangidwa ndi pyrethroids akhala akugwiritsidwa ntchito m'madera opezeka anthu ambiri ku Nepal kuyambira mu 1992, akusinthana ndi SPs alpha-cypermethrin ndi lambda-cyhalothrin poletsa ntchentche za mchenga [31], ndipo deltamethrin yagwiritsidwanso ntchito ku Bangladesh kuyambira mu 2012 [32]. Kukana kwa phenotypic kwapezeka m'magulu a ntchentche za mchenga zokhala ndi miyendo yasiliva m'madera omwe pyrethroids zopangidwa zakhala zikugwiritsidwa ntchito kwa nthawi yayitali [18, 33, 34]. Kusintha kosafanana (L1014F) kwapezeka m'magulu a ntchentche za mchenga za ku India ndipo kwagwirizanitsidwa ndi kukana kwa DDT, zomwe zikusonyeza kuti kukana kwa pyrethroid kumachitika pamlingo wa mamolekyulu, chifukwa DDT ndi pyrethroid (alpha-cypermethrin) zonse zimayang'ana jini lomwelo mu dongosolo la mitsempha ya tizilombo [17, 34]. Chifukwa chake, kuwunika mwadongosolo kwa cypermethrin ndikuwunika kukana kwa udzudzu ndikofunikira panthawi yochotsa ndi kuwononga.
Cholepheretsa cha kafukufukuyu ndichakuti tinagwiritsa ntchito CDC vial bioassay poyesa kuopsa kwa matendawa, koma kufananiza konse kunagwiritsa ntchito zotsatira za kafukufuku wakale pogwiritsa ntchito WHO bioassay kit. Zotsatira za CDC vial assay ziwirizi sizingafanane mwachindunji chifukwa CDC vial bioassay imayesa kugwetsa kumapeto kwa nthawi yodziwira matenda, pomwe WHO kit bioassay imayesa kufa patatha maola 24 kapena 72 munthu atapezeka ndi matendawa (chomalizachi cha mankhwala omwe amagwira ntchito pang'onopang'ono) [35]. Cholepheretsa china chomwe chingakhalepo ndi kuchuluka kwa midzi ya IRS mu kafukufukuyu poyerekeza ndi mudzi umodzi wosakhala wa IRS ndi umodzi wosakhala wa IRS/kale wa IRS. Sitingaganize kuti kuchuluka kwa kuopsa kwa udzudzu komwe kumawonedwa m'midzi iliyonse m'chigawo chimodzi kukuyimira kuchuluka kwa kuopsa kwa matendawa m'midzi ina ndi m'maboma ku Bihar. Pamene India ikulowa mu gawo la kachilombo ka leukemia pambuyo pochotsa matendawa, ndikofunikira kupewa kukula kwakukulu kwa kukana. Kuyang'anira mwachangu kukana kwa ntchentche zam'madzi kuchokera m'maboma osiyanasiyana, m'mabwalo ndi m'malo osiyanasiyana ndikofunikira. Deta yomwe yaperekedwa mu kafukufukuyu ndi yoyambirira ndipo iyenera kutsimikiziridwa poyerekeza ndi kuchuluka kwa matenda omwe adafalitsidwa ndi World Health Organization [35] kuti apeze lingaliro lenileni la momwe P. argentipes imakhalira ndi kachilomboka m'madera awa asanasinthe mapulogalamu owongolera tizilombo toyambitsa matenda kuti asunge kuchuluka kwa tizilombo tating'onoting'ono ta mchenga ndikuthandizira kuchotsedwa kwa kachilombo ka leukemia.
Udzudzu wa P. argentipes, womwe umayambitsa kachilombo ka leukosis, ungayambe kusonyeza zizindikiro zoyambirira za kukana mankhwala a cypermethrin omwe amagwira ntchito bwino kwambiri. Kuyang'anira nthawi zonse kukana mankhwala ophera tizilombo m'nkhalango za P. argentipes ndikofunikira kuti pakhalebe mphamvu yolimbana ndi matenda a tizilombo. Kusinthana kwa mankhwala ophera tizilombo ndi njira zosiyanasiyana zogwirira ntchito ndi/kapena kuwunika ndi kulembetsa mankhwala atsopano ophera tizilombo ndikofunikira ndipo kumalimbikitsidwa kuti tiyang'anire kukana mankhwala ophera tizilombo ndikuthandizira kuthetsa kachilombo ka leukosis ku India.
Nthawi yotumizira: Feb-17-2025