Bayanin gabaɗaya
Makogwaro (diphtheria) cuta ce mai haɗari da ƙwayar Corynebacterium diphtheriae ke haifarwa. Tana haifar da kauri mai kauri a maƙogwaro wanda zai iya toshe hanyar iska.
Alamomi
Alamomi | Yawan faruwa | Tsanani | Farawa |
|---|---|---|---|
| Wahalar haɗiya | 75% | Matsakaici | Farkon cuta |
| Zazzabi | 70% | Dan kadan | Farkon cuta |
| Rashin jin daɗi | 85% | Dan kadan | Farkon cuta |
| Ciwon maƙogwaro | 90% | Matsakaici | Farkon cuta |
| Ciwon kai | 50% | Dan kadan | Farkon cuta |
| Rashin son ci | 65% | Dan kadan | Farkon cuta |
| Tashin zuciya | 30% | Dan kadan | Farkon cuta |
| Toshewar hanci | 8% | Dan kadan | Farkon cuta |
| Kumburin jiki | 25% | Matsakaici | Kololuwar cuta |
| Ƙarancin numfashi | 25% | Mai tsanani | Kololuwar cuta |
| Kumburin ƙwayoyin lymph | 70% | Matsakaici | Kololuwar cuta |
| Tari | 40% | Dan kadan | Kololuwar cuta |
| Amai | 15% | Dan kadan | Kololuwar cuta |
| Raguwar matsin jini | 10% | Mai tsanani | Ƙarshen cuta |
| Shanyewar gaɓoɓi | 5% | Mai tsanani | Ƙarshen cuta |
| Saurin bugun zuciya | 20% | Matsakaici | Ƙarshen cuta |
| Duhu a gani | 8% | Dan kadan | Ƙarshen cuta |
| Jin ƙaiƙayi/cizon allura | 10% | Dan kadan | Ƙarshen cuta |
| Gajiya | 80% | Dan kadan | Kowane lokaci |
| Gyambon fata | 20% | Matsakaici | Kowane lokaci |
Hanyoyin yaduwa
Bayanin gabaɗaya
Diphtheriya cuta ce mai tsanani ta numfashi da Corynebacterium diphtheriae ke haddasa ta, wanda ke samar da guba mai lalata zuciya da jijiyoyin jiki. Alama ta musamman ita ce farin ƙirji (membrane) mai launin toka a cikin makogwaro da ke iya toshe hanyar numfashi. CFR 5–10% ko da tare da magani. Cutar tana yaɗuwa ta hanyar ɗigon numfashi. An rage ta sosai ta hanyar allurar DTP amma tana ci gaba da bayyana a yankunan da ke da ƙarancin allurar rigakafi.
Bayanin gabaɗaya
Diphtheria cutar kwayoyin cuta ce da Corynebacterium diphtheriae mai samar da guba (toxin) ke haddasa ta. Tana haifar da wani farin/toka-toka (membrane) mai mannewa a cikin makogwaro da na'ura ta numfashi. Matsaloli masu hatsari sun hada da kumburin zuciya saboda guba (toxic myocarditis) — wanda shine babban sanadin mutuwa — da lalacewar jijiyoyi (polyneuropathy).
Barkewar cuta a Najeriya 2022-2023: Najeriya ta fuskanci babbar barkewar diphtheria da ta fara a Kano a watan Mayun 2022 kuma ta bazu zuwa fiye da jihohi 20. NCDC ta tabbatar da fiye da shari'o'i 17,000 da ake zargi tare da fiye da mutuwar 600. Wannan ita ce mafi girmar barkewar diphtheria a tarihin Najeriya na baya-bayan nan. Dalilai sun hada da: karancin rigakafin yara na yau da kullum (DPT3 coverage ~57%), cunkoson jama'a a birane, da rashin isassun kayan aikin lafiya.
Barkewar ta fi shafar yara 'yan shekaru 5–14 da ba a yi musu allurar rigakafi ba a Arewacin Najeriya (Kano, Katsina, Yobe, Borno, Bauchi). NCDC da NPHCDA sun gudanar da yakin neman rigakafin gaggawa. Cuta ce da dole a bayar da rahotonta nan take.
Alamomin gaggawa
GAGGAWA — a nemi likita nan take:
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Farin/toka-toka (membrane) a makogwaro
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Muryar sautin karfe (stridor) ko wahalar numfashi
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"Wuyan bijimi" (bull neck) — kumburin wuya
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Rashin bugun zuciya na daidai (arrhythmia) ko ciwo a kirji
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A nemi antitoxin nan take — kowane minti yana da muhimmanci!
Cikakkun alamomi
Alamomi da alamu mafi yawa
Lokacin kwanciyar cuta: Kwanaki 2–5
Diphtheria na makogwaro (pharyngeal — mafi yawa):
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Ciwon makogwaro mai matsakaici
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Dan zazzabi (37.5–38.5°C)
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Farin/toka-toka (greyish-white membrane) a kan tonsils/pharynx — mai mannewa sosai, yana zubar da jini idan aka yi kokarin cirewa
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Kumburin glandin lymph a wuya — "wuyan bijimi" (bull neck)
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Mummunan wari a baki
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Muryar hanci (nasal voice)
Diphtheria na na'ura ta numfashi (laryngeal):
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Muryar sautin karfe (stridor/croup)
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Wahalar numfashi — gaggawa
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Toshewar hanyar numfashi — na iya kashe cikin sa'o'i
Diphtheria na fata (cutaneous):
- Raunin fata mara warkewa tare da membrane — ya fi yaduwa a yankunan dumi
Matsaloli na guba (toxic complications — za su iya bayyana makonni bayan cutar ta warke):
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Kumburin zuciya (toxic myocarditis): matsalar da ta fi kashe mutane, tana iya bayyana kwanaki 10–14 bayan cutar
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Lalacewar jijiyoyi (polyneuropathy): gurguwar muƙamuƙi, wahalar hadiya, raunin ƙafafu
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Rashin aikin koda (nephrotoxicity)
Sanin alamomi shine mataki na farko don amsa cikin sauri.
Tafiyar cuta
Matakan cutar diphtheria (na maƙogwaro/tonsil):
- Lokacin ɓoye cuta: Kwanaki 2–5.
- Farawa: Ciwon maƙogwaro, ɗan zazzaɓi, rashin jin daɗi. Kumburin ƙwayoyin lymfa na wuya ("wuyan bijimi" a mummunan yanayi).
- Samuwar ƙarya-fata (kwanaki 2–3): Tsayayyen ƙarya-fata mai launin toka-fari a kan tonsil/maƙogwaro. Yana zubar da jini idan aka yi ƙoƙarin cirewa. Na iya yaɗuwa zuwa maƙogwaro na ƙasa wanda ke haifar da wahalar numfashi.
- Matsalolin da guba ke haddasa (makonni 1–6):
- Cutar zuciya: matsalar bugun zuciya, gazawar zuciya (mako na 1–2).
- Lalacewar jijiyoyi: raunin bakin ciki, muryar hanci, wahalar haɗiyewa (mako na 3–5). Shanyen jijiyoyin motsi na waje (mako na 5–7).
- Warkarwa: Warkarwa a hankali tare da maganin ƙwayoyin cuta + antitoxin. Ƙarya-fata tana ɓacewa cikin kwanaki bayan magani.
Bayani: Cutar diphtheria na fata (ƙurar fata) galibi mai sauƙi ce tare da ƙarancin gubar jiki amma tana zama wurin ajiyar ƙwayoyin cuta.
Binciken cuta
Yadda ake gano wannan cutar
Ana fara magani kafin sakamakon gwaji — kada a jira!
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Binciken asibiti: membrane mai toka-toka a makogwaro a cikin yaro da ba a yi masa allura ba yana da isasshen zargin diphtheria
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Swab daga karkashin membrane don culture a kan Löffler's medium ko tellurite agar
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PCR don gano kwayar cuta da tox gene
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Elek test don tabbatar da samar da guba (toxigenicity)
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A Najeriya: a bayar da rahoto nan take ga NCDC ta hanyar IDSR — case-based surveillance
Magani
Hanyoyin magani da ake da su
Gaggawa — kowane minti yana da muhimmanci:
-
Diphtheria Antitoxin (DAT) IV nan take — kafin sakamakon gwajin dakin gwaje-gwaje! Adadin ya danganta da tsananin cuta (20,000–120,000 IU). Ana buƙatar gwajin sensitivity kafin bayarwa.
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Erythromycin 14 kwanaki ko Penicillin G don kashe kwayar cutar
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Kulawar ICU
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Sa ido na zuciya (cardiac monitoring) na yau da kullum — ECG kowace rana na aƙalla mako 2
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Tracheostomy idan hanyar numfashi ta toshe
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A lokacin barkewar cuta a Najeriya 2022-2023: karancin DAT ya kasance babban kalubale — NCDC ta nemi taimako daga WHO da kasashen duniya
Rigakafi bayan magani: Dole a yi wa mai cuta allurar rigakafi yayin warwarewa saboda cutar ba ta ba da cikakkiyar kariya ta dabi'a.
Yawancin lokuta ana magance su yadda ya kamata tare da gano cutar da wuri.
Cikakkun bayanin rigakafi
Yadda za ka kare kanka
Rigakafi — matakin da ya fi muhimmanci:
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Allurar DPT/Pentavalent: A cikin jadawalin NPHCDA — a makonni 6, 10, da 14 na rayuwa
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DPT3 coverage a Najeriya: ~57% (kasa da matsakaicin duniya na 86%) — wannan ita ce babbar matsalar da ta haifar da barkewar 2022-2023
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Allura ta kara karfi: Td a shekara 6 da 12 (jadawalin Najeriya — amma yawancin yara ba su samu ba)
Darasin barkewar 2022-2023:
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Karin rigakafin yau da kullum (RI) shine mafita na dogon lokaci
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NCDC da NPHCDA sun gudanar da yakin neman rigakafin gaggawa a jihohin da suka fi shafuwa
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Bukatar da za a kara yin masa karfi: sa ido (surveillance) don gano shari'o'in da wuri
Rigakafi bayan fuskanci cutar (post-exposure prophylaxis):
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Maganin rigakafin kwayoyin cuta (erythromycin 7–10 kwanaki ko penicillin) ga duk wanda ya yi mu'amala da mai cuta
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Allura ta kara karfi idan ba a kammala rigakafi ba
Shirye-shirye shine mafi kyawun kariya.
Shawarar tafiya
Masu tafiya zuwa Najeriya:
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A tabbatar an kammala rigakafin DPT/Td da kuma allura ta kara karfi idan shekaru 10 sun wuce tun allura ta karshe
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Hadari na musamman a yankunan cunkoson jama'a na Arewacin Najeriya
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Idan an ga ciwon makogwaro tare da membrane mai toka-toka — a nemi likita nan take
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Masu tafiya na dogon lokaci musamman a karkara: a yi la'akari da Tdap (tetanus, diphtheria, pertussis) booster
Yaya yawancinta?
Ƙididdiga da bayanan yanki
Barkewar Najeriya 2022-2023 — mafi girma a tarihin baya-bayan nan:
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17,000 shari'o'in da ake zargi, >600 mutuwa
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Ta fara a Kano, ta bazu zuwa jihohi 20+
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Yara 'yan shekaru 5–14 da ba a yi musu allura ba sun fi shafuwa
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Jihohin da suka fi shafuwa: Kano, Katsina, Yobe, Lagos, Borno, Bauchi
Dalilan barkewar:
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Karancin DPT3 coverage (~57% a Najeriya)
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Cunkoson jama'a a birane
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Rashin isassun kayan aikin lafiya da DAT
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Sakaci a rigakafin yau da kullum na tsawon shekaru
A duniya: diphtheria ba ta yadu a kasashen da suka ci gaban rigakafi amma barkewar tana faruwa inda rigakafin ya yi kasa.
Dalilan haɗari
Wanene ke cikin haɗarin mafi girma
Rashin allurar rigakafi ko allurar da ba ta cika ba (mafi muhimmancin haɗari), zama a ƙasashen da ke da ƙarancin allurar rigakafi, talauci, cunkoson mutane, zamantakewa da mai cutar, rashin ƙarfin rigakafi.
Cikakkun bayanan matsaloli
Rikitarwa da za ta iya faruwa
Matsaloli — sun fi hatsari idan ba a ba da antitoxin da sauri ba:
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Kumburin zuciya (Toxic myocarditis): Babban sanadin mutuwa. Yana bayyana kwanaki 10–14. ECG: block na zuciya, arrhythmias. A lokacin barkewar Najeriya, mutuwar kwatsam saboda matsalar zuciya ta faru a wasu yara da suke kamar sun warke.
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Lalacewar jijiyoyi (Polyneuropathy): Gurguwar muƙamuƙi (mako 3–6), wahalar hadiya (hatsarin shaƙewa), raunin ƙafafu da hannaye (mako 6–10). Yawanci ana warkewa cikakke.
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Toshewar hanyar numfashi: Membrane na iya toshe hanyar numfashi — mutuwa idan ba a yi tracheostomy ba
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Cutar koda (Nephrotoxicity)
Mutuwa: 5–10% baki daya; ya fi girma idan ba a ba da antitoxin da wuri ba. A lokacin barkewar Najeriya 2022-2023: kashi na mutuwa ~3.6% (CFR) amma ya fi girma a yankunan da ba su da isassun kayan aikin lafiya.
Murmurewa da hasashe
Sakamakon da ake tsammani da murmurewa
Tare da antitoxin + maganin ƙwayoyin cuta: CFR 5–10%.
Ba tare da magani ba: CFR 30–50%.
Matsalolin da ke ƙayyade hasashen warkarwa:
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Cutar zuciya (myocarditis): 10–25% na marasa lafiya, na iya kashe mutum. Na iya faruwa makonni 1–2 bayan farawa.
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Lalacewar jijiyoyi: shanyen jijiyoyin kai (na bakin ciki, na ido), shanyen jijiyoyin waje (makonni 3–7 bayan farawa). Yawanci ana warke cikin makonni zuwa watanni.
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Toshewar numfashi: daga ci gaban ƙarya-fata. Na iya buƙatar buɗe maƙogwaro.
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Lalacewar ƙoda (ba kasafai ba).
Warkarwa: Tare da magani, mafi yawan marasa lafiya suna warke gaba ɗaya cikin makonni 4–6. Cutar zuciya na da mafi munin hasashen warkarwa.