Usuku lweHlabathi lweSifo sePhepha 2026: Ewe! Singasiphelisa iSifo sePhepha

Ngomhla wama-24 kweyoKwindla, ngowama-2026, ngumhla wama-31 weSuku leSifo sePhepha kwiHlabathi. UMbutho wezeMpilo weHlabathi (i-WHO) ubhengeze umxholo wehlabathi walo nyaka njengo"Ewe! Singasiphelisa isifo sephepha!", egxininisa ukuba ubunkokeli obuqinileyo bukarhulumente, ukuzibophelela okuqhubekayo kwezopolitiko, kunye nezenzo ezidibeneyo zamacandelo amaninzi zibalulekile ekupheliseni ubhubhane wesifo sephepha (TB).

Inkqubela phambili yeHlabathi kunye nemingeni eseleyo

NgokweNgxelo yeHlabathi yeSifo soFuba ka-2025, ulawulo lwe-TB kwihlabathi liphela lufikelele kwinqanaba elibalulekileyo ngo-2024, zombini ezi zinto zimbiniukwehla kweemeko nokufaokokuqala ukusukela oko kwaqhambuka ubhubhane we-COVID-19.

UqikeleloAbantu abazizigidi ezili-10.7yaba nesifo sephepha ngo-2024, kuquka ama-54% amadoda, ama-35% abasetyhini, kunye ne-11% yabantwana kunye nabakwishumi elivisayo. Phakathi kwezi meko, malunga619,000 (5.8%)babene-HIV kunye nabo, kwaye390,000 (3.6%)babene-TB engamelani namayeza amaninzi okanye i-rifampicin engamelaniyo ne-TB (MDR/RR-TB).

Isifo sephepha esibangelwa malungaAbantu ababhubhileyo abazizigidi ezili-1.23ngo-2024, isaqhubeka nokuba ngunobangela ophambili wokufa kwihlabathi liphela, idlula i-COVID-19. Emva kweminyaka emithathu yokwanda phakathi kowama-2021 nowama-2023, ukwanda kwesifo sephepha kwihlabathi liphela kwehla phantse nge-2% ngo-2024, nto leyo ebonisa ukubuyela kweenkonzo zesifo sephepha kancinci kancinci.[1]

Ngokwendawo,67% yamatyalazaziqokelelene kumazwe asibhozo: iIndiya, iIndonesia, iPhilippines, iTshayina, iPakistan, iNigeria, iDemocratic Republic of the Congo, kunye neBangladesh.

Nangona kukho inkqubela phambili, i-TB isaqhubeka nokuba yimbangela yokufa kwabantu abaphila ne-HIV kwaye inegalelo elikhulu ekufeni okunxulunyaniswa nokuxhathisa iintsholongwane. Inkxaso-mali yehlabathi iyaqhubeka nokusilela, kuphela ngenxa yokuba i-TB isasalele phambili.I-US$5.9 yezigidigidiiyafumaneka ngo-2024—ingaphantsi kakhulu kuneIthagethi yonyaka ye-US$22 yeebhiliyoniimiselwe u-2027.

La manani agxininisa imfuneko engxamisekileyo yokuqinisa iinkqubo zokulawula i-TB kwihlabathi liphela, kugxilwe ekwandiseni ukufikelela ekuxilongweni, ukuphucula iziphumo zonyango, kunye nokujongana nezizathu zentlalo eziqhuba ukusasazeka kwe-TB. I-TB iyaqhubeka ifuna intsebenziswano eqinileyo yamazwe ngamazwe kunye nokuzibophelela kwezopolitiko ukufezekisa iinjongo zeSicwangciso sokuphelisa i-TB​

Isifo sephepha seMycobacterium: I-Pathogenesis kunye noHlelo

I-Mycobacterium tuberculosis (MTB/M. tuberculosis) yeyona pathogen iphambili nexhaphakileyo ebangela isifo sephepha (TB). Ingangena emzimbeni womntu ngendlela yokuphefumla, indlela yokugaya ukutya, okanye ulusu olonakeleyo kunye ne-mucous membranes, yosulele amalungu amaninzi kwaye ibangele iintlobo ezahlukeneyo zesifo sephepha. I-Pulmonary TB, edluliselwa kakhulu ngamathontsi, ibangela ngaphezulu kwama-80% eemeko zesifo sephepha. Iimpawu eziqhelekileyo ziquka ukukhwehlela, ukuveliswa kwe-sputum, kunye ne-hemoptysis. Emva kokosuleleka emiphungeni, intsholongwane inokusasazeka ngegazi ukuya kwiinkqubo ezahlukeneyo, okunokukhokelela kwi-TB yamathambo, yomchamo, okanye yesisu.[2]

I-MTB yinxalenye ye-genus Mycobacterium, equka:

• I-Mycobacterium tuberculosis complex (MTBC): Iquka i-M. tuberculosis, i-M. bovis, i-M. africanum, i-M. canettii, kunye ne-M. microti, phakathi kwezinye. Nangona i-M. tuberculosis iyeyona nto iphambili ebangela i-TB, i-M. bovis kunye ne-M. africanum nazo zinokubangela esi sifo.
• I-mycobacteria engeyo-tuberculous (NTM).
• I-Mycobacterium leprae, unobangela weqhenqa.

Iindlela Zokuxilonga Zelebhu

Ukuxilongwa ngokuchanekileyo nangokufanelekileyo kubalulekile ukuze kulawulwe i-TB ngempumelelo. I-World Health Organization igxininisa ukubaUbuchwepheshe bokuxilonga iimolekyuli ngokukhawuleza butshintshe ngokusisiseko ukufunyanwa kwesifo sephepha ngokuvumela ukuchonga iintsholongwane ezinobuthathaka kakhulu nezicacileyo ngelixa ngaxeshanye kufunyanwa ukunganyangeki ngamayeza.[1].

- I-Microscopy kunye neNkcubekoe: Inkcubeko isengumgangatho ophambili wokuxilongwa kwesifo sephepha, njengoko ivumela ukuchongwa okuqinisekileyo kwezinto eziphilayo kwaye ixhasa uvavanyo lokuchaphazeleka ngamayeza kunye nohlalutyo lwe-genomic. Nangona kunjalo, ngenxa yokukhula kancinci kwesifo sephepha iMycobacterium, iziphumo zihlala zifuna iiveki ezi-2-8, nto leyo ethintela ukusetyenziswa kwayo kwezonyango ekwenzeni izigqibo ngokukhawuleza.

-Uvavanyo lwe-Immunological: Iindlela zokuzikhusela komzimba, kuquka uvavanyo lwesikhumba lwe-tuberculin (TST) kunye nee-interferon-gamma release assays (IGRAs), zifumanisa iimpendulo zomzimba zomntu kwisifo se-TB. Nangona ziluncedo ekuchongeni usulelo olufihlakeleyo, ezi zilingo azinakwahlula ngokuthembekileyo phakathi kosulelo olusebenzayo nolwangaphambili kwaye ngenxa yoko zinokuchongwa okulinganiselweyo kwiindawo ezinomthwalo omkhulu.

-Ukuxilongwa kweMolekyuli (i-NAAT): Uvavanyo olusekelwe kwi-DNA olufana ne-nucleic acid amplification (NAAT) luyacetyiswa ngenxa yokuba lunovakalelo oluphezulu kunye nokuchaneka kwalo.

-Ulandelelwano lweSizukulwana Esilandelayo olujoliswe kulo (tNGS): Iitekhnoloji zokulandelelanisa ezijolise ekujoliswe kuzo zibonelela ngokuchongwa okuphezulu kotshintsho oluhambelana nokuchasana. Izikhokelo ze-WHO zicebisa i-tNGS njengesixhobo esiphambili sokufumanisa ukuchasana namayeza emva kokuxilongwa, zixhasa amaqhinga okunyanga ngokuchanekileyo [3].

-Ulandelelwano lweMetagenomic Next-Generation (mNGS): Ulandelelwano lwe-metagenomic lwenza ukuba kubonwe uluhlu olubanzi lwezifo ngaphandle kokukhetha kwangaphambili. Le ndlela ibaluleke kakhulu kwiimeko ezinzima okanye ezingacacanga zeklinikhi, kubandakanya usulelo oluxutyiweyo kunye nezigulane ezine-immunocompromised, apho ukuxilongwa okuqhelekileyo kunganelanga.

I-WHO igxininisa ngakumbi ukuba ukuqinisekiswa kwe-microbiological kubalulekile ekuqaliseni unyango olufanelekileyo kunye nokuphucula iziphumo zesigulana, nto leyo eqinisa ukubaluleka kokudibanisa ukuxilongwa kweemolekyuli eziphambili kwiinkqubo zokulawula i-TB [1].

Izisombululo ezipheleleyo zokuxilonga iimolekyuli ezivela kwiMacro kunye neMicro-Test

1.Ukufunyanwa kwe-Multiplex PCR yokujonga i-TB kunye nokuxhathisa amayezaIsifo sephepha

Xa kukho urhanelwa olukhulu lwezonyango lwesifo sephepha (TB),I-HWTS-RT147Uvavanyo luyacetyiswa ukuze kufunyanwe usulelo lwe-MTB kunye nesifo sephepha esinganyangekiyo ngamayeza amaninzi (MDR-TB). Olu vavanyo luchonga utshintsho kwi-i-rpoB gene, ezikhokelela ekuchaseni kwe-rifampicin (RIF), kunye notshintsho kwi-iijini ze-katG kunye ne-InhA, ezinxulunyaniswa nokuxhathisa i-isoniazid (INH). Ibonelela ngovavanyo olusebenzayo nolusebenza kube kanye kwi-MTB nakwi-MDR-TB, ibandakanya ulawulo lwangaphakathi lomgangatho ukunciphisa iziphumo ezingezizo ezilungileyo, ukuqinisekisa iziphumo ezikhawulezayo nezichanekileyo.

2.Ulandelelwano olujolise kwi-PTNseq lweePathogens zokuphefumla kunye neProfayili yokumelana

Kwiimeko zezifo zokuphefumla ezixutyiweyo (kubandakanya izifo zokuphefumla ezisezantsi neziphezulu, isifo sephepha, kunye nezifo zokuphefumla ezingapheliyo), okanye xa kufuneka uhlalutyo lwezakhi zofuzo ezichasene namayeza (umz., isifo sephepha esirhanelwa ukuba asimelani namayeza),Uthotho lwe-PTNseq lokufunyanwa kwezakhi zofuzo ezijolise ekuphuhlisweni okuphezuluingasetyenziswa. Ngokusekelwe kwitekhnoloji yokulandelelanisa ejolise phambili, i-PTNseq isebenzisa i-ultra-multiplex PCR ukuze ityebise ulandelelwano oluthile lweethagethi, idityaniswe ne-high-throughput sequencing kunye netekhnoloji ye-nanopore yesizukulwana sesithathu ukuze kufunyanwe ngokupheleleyo i-pathogen kunye neprofayili yokumelana namayeza.

Le nkqubo isebenzisa iiprimer ezinelungelo elilodwa lomenzi, ezineenkcukacha eziphezulu zokwandisa iijini ekujoliswe kuzo. Ixhaswa yidathabheyisi eyimfihlo kunye nee-algorithms ezikrelekrele ze-bioinformatics, ibonelela ngokuchongwa kwe-pathogen ngokuchanekileyo kunye nokumelana namayeza kunye nohlalutyo lwe-virulence gene. Ukutyebisa okujoliswe kuko kunciphisa ukuphazamiseka kwi-DNA yomninimzi, kuphucula uvakalelo kwiisampuli ezinemvelaphi ephezulu yabantu kwaye kuvumela ukubonwa ngempumelelo kweethagethi ezinzima ezifanaIsifo sephepha seMycobacterium, iifungi, iibhaktheriya zangaphakathi kwiseli, iintsholongwane ze-RNA, kunye ne-resistance okanye i-virulence genes.

I-PTNseq ifikelela kumda wokufunyanwangaphantsi njengeekopi ezili-100/mLkunye nezigqubutheloIintsholongwane zokuphefumla eziqhelekileyo ezili-175, kuquka iibhaktheriya ezingama-76, iintsholongwane ezingama-73, iifungi ezili-19, ii-mycoplasmas ezisi-7, kunyeI-Chlamydia, URickettsiakunye ne-54 ye-genes yokumelana namayezaIphaneli ibandakanyaIsifo sephepha seMycobacteriumi-mycobacteria eyinkimbinkimbi neyinkulu engenasifo sephepha.

Olu luhlu lwe-PTNseq ludibanisa uvakalelo oluphezulu kunye nokusebenza kakuhle kweendleko, luphucula amazinga okufunyaniswa kwezifo kunye nokuxhasa unyango olulwa neentsholongwane oluzimeleyo ngelixa lunceda ekunciphiseni ukuxhathisa iintsholongwane. Idityaniswe nenkqubo yokulungiselela ilayibrari yokulandelelana kwezakhi zofuzo ezenzekelayo ngokupheleleyo (AIOS), ibonelela ngesisombululo esicwangcisiweyo, esisesibhedlele esinexesha lokutshintsha ngokukhawuleza njengeeyure eziyi-6.5 ukusuka kwisampuli ukuya kwisiphumo.

3. Ulandelelwano lweMetagenomic lokuFunyanwa kwePathogen yeBroad-Spectrum

Xa ukuxilongwa kweklinikhi kungacacanga,Ukufunyanwa kwezakhi zofuzo ezisebenzisa i-mNGS pathogen ephezuluingenziwa kwiisampuli ezahlukeneyo ezivela kwisigulana, kubandakanya ulwelo lokuhlamba i-bronchoalveolar, i-sputum, i-throat swabs, igazi, i-pleural effusion, i-pus, kunye neesampuli zezicubu. Le ndlela isebenzisa itekhnoloji yokulandelelana kwe-metagenomic, apho iisampuli ezahlukeneyo zifumana unyango olujoliswe kuyo ngaphambi kokuba kulandelwe yi-nucleic acid extraction kusetyenziswa iiglasi kunye nee-enzymes zokugaya udonga, nto leyo ephucula ukusebenza kakuhle kokukhupha. Ukulandelelana kulungelelaniswe kwiiplatifomu ezininzi, kuqinisekisa ubungakanani bedatha ephezulu yokuphucula uvakalelo lwe-mNGS kunye nokuthembeka kokuhlanganisa. Idatha ihlalutywa kusetyenziswa isiseko sedatha esakhelwe ngokwakho kunye nee-algorithms ezikrelekrele zokufumanisaiintsholongwane ezingaphezu kwama-20,000, kuquka iibhaktheriya, iifungi, iintsholongwane, kunye neeparasites, zibonelela ngolwazi ngeentsholongwane ezibangela izifo ezirhanelekayo. Le ndlela ifanelekile kwizigulana ekunzima ukuzixilonga, ezigula kakhulu, okanye ezinesifo sokuzikhusela komzimba, kuquka nokuchongwa kwazoI-MTBubunzimakwayeI-NTMkunye nosulelo oluxutyiweyo. Iphucula kakhulu amazinga okufunyaniswa kwezifo kwaye inceda ekukhokeleni ukusetyenziswa kwee-antibiotics ezijoliswe kwiklinikhi, ivumela ukuxilongwa kosulelo ngokuchanekileyo.

Isiphelo

Nangona kuphunyezwe inkqubela phambili enkulu, isifo sephepha sisengumngeni omkhulu wezempilo kwihlabathi liphela, ingakumbi kwimeko yokungaxhathisi ngamayeza, ukunqongophala kwemali, kunye nokufikelela ngokulinganayo ekuxilongweni.

I-WHO igxininisa ukuba ukwandisa ukufikelela kwiindlela ezikhawulezayo zokuxilongwa kweemolekyuli kunye nobuchwepheshe obuphambili bokulandelelana kubalulekile ekufezekiseni iinjongo zeSicwangciso soKuphelisa iTB. Ngokuqhubeka nokuvelisa izinto ezintsha, utyalo-mali, kunye nentsebenziswano yehlabathi, ukuphelisa iTB akuseyonto ifunekayo, kodwa yinjongo enokufezekiswa.

Iireferensi:

1. Umbutho wezeMpilo weHlabathi. Ingxelo yeSifo sePhepha seHlabathi ka-2024/2025: Uvavanyo lokuxilongwa kunye noNyango.
2. UMbutho wezeMpilo weHlabathi. Incwadi ye-WHO yoKhetho lweeMvavanyo zokuHlola eziKhawulezayo eziCetyiswa yi-WHO zokuFumanisa iSifo sePhepha kunye neSifo sePhepha esiNgenaMayeza.
3. UMbutho wezeMpilo weHlabathi. Izikhokelo eziDibeneyo ze-WHO kwiSifo sePhepha: Imodyuli 3 - Ukuxilongwa (Uhlaziyo luka-2024).