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  1. TB meningitis diagnostikis zogierTi sakiTxi Sorena sabanaZe, TinaTin bakuraZe, “samSabaToba”, 01.02.11

  2. TBmeningitituberkulozis erT-erTi yvelaze mZime formaa • droulad dasmuli diagnozi da Sesabamisi mkurnalobis dawyeba mniSvnelovnad amcirebs garTulebebis da sikvdilianobis maCvenebels; • M. tuberculosis aRwevs ra subaraqnoidalur sivrces iwvevs cns-is dazianebas da Sesabamisad yalibdeba sxvadasxva tipi: • TB meningiti; • TB meningo-encefaliti; • TB meningo-encefalo-mieliti; • cns-is tuberkulomebi.

  3. TBmeningitimeoradidaavadebaa, romlisdrosacpirveladikeraaris: • filtvisdafiltvgareTatuberkulozissxvadasxva forma, • miliarulituberkulozi, • diagnozisdasmisdrosmxedvelobaSimiiReba: • gadataniliTB, • gadataniliTB -s Semdgominazi, an tlanqinarCenicvlilebebi, • kontaqtiTBpacientTan. • tuberkulozissxvadasxvaformasTanSeuRlebuliTB meningitis diagnozisdasmasiZnelesarwarmoadgens; • “izolirebuli” meningitis dros, rodesacpirveladikerisdagenaverxerxdeba, diagnostikagarkveulsiZneleebTanarisdakavSirebuli.

  4. 2009 wlismaisSisamxreTafrikis q. keiptaunSiCatarda 3 dRianiseminari, romelicTBdiagnostikissakiTxebsmieZRvna; • mizaniTB meningitis diagnostikisZiriTadikriteriumebisSemuSavebisdroskonsensusismiRwevaiyo; • Sexvedras 7 qveynis (aSS; didibritaneTi; malaizia; samxreTafrika; indoeTi; indonezia; vietnami) 41 warmomadgenelieswreboda: • 13 saerTaSorisoeqsperti, • bavSvTadamozrdilTanevrologebi, • neiroqirurgebi, • infeqcionistebi, • mikrobiologebi, • mecniermuSakebi.

  5. seminaris monawileTa azriT TB meningitis diagnostikaSi ZiriTad kriteriumad tuberkulozis pirveladi keris dadgena CaiTvala rodesac TB meningiti SeuRlebulia filtvis da filtvgareTa tuberkulozis formebTan warmoebs: • naxvelis, an biologiuri masalis baqterioskopiuli da kulturaluri gamokvleva; • rentgenogramebis gadaReba; • avadmyofobis anamnezis dawvilebiTi Seswavla.

  6. vinaidan ukanaskneli 10-15 wlis ganmavlobaSi e.w. “izolirebuli” meningitis xvedriTma wonam 5-6-jer moimata, liqvoridan mJavagamZle baqteriis amoTesva ki dabal procentSi xdeba, seminamrma diagnozis dasmis dros ZiriTad kriteriumad miiCnia: • klinikuri; • liqvoraluri; • radiologiuri kriteriumebi.

  7. klinikuri kriteriumebi: • TB meningitis dasawyisi moicavs 2-4 kviras; • TB meningitisaTvis damaxasiaTebelia: • fsiqoasTeniuri sindromi, • subfebriluri, an febriluri cxeleba, • Tavis tkivilebi, • gulisreva pirRebinebiT dReSi 3-4-jer; • meningialuri niSnebi – kefis kunTebis rigidoba da kernigis niSani ormxriv; • dadebiTi zeda da qveda bruZinskis niSnebi, simfizis fenomeni, babinskis paTologiuri refleqsi;

  8. bazaluri meningitis dros ziandeba: • III; • VI; • VII wyvili nervebi. da yalibdeba: • fTozi; • egzofTalmi; • diplopia; • SigniTa da gareTa sielme; • saxis nervis qvemo totis parezi.

  9. daavadebis progresirebis SemTxvevaSi yalibdeba tuberkulozuri meningo-encefaliti: • metyvelebis moSla, cnobierebis Secvla; • epilefsiuri gulyrebi; • hemiparezebi, hemiplegiebi. tuberkulozuri meningo-encefalo-mielitisaTvis damaxasiaTebelia: • tkivilebi qvemo kidurebSi; • mcire menjis Rrus organoebis funqciis moSla Sardis Sekaveba an Seukavebloba, yabzoba; • qvemo paraparezebi da paraplegiebi.

  10. daavadebis terminalur stadiaSi viTardeba bulbaluri sindromi, ziandeba • IX; • X; • XII wyvili nervebi; Sesabamisad pacients aqvs: • slokini; • ylapvis gaZneleba; • sunTqvis riTmis darRveva; bulbaluri sindromis ganviTareba pacientisaTvis arakeTilsaimedo prognozis maCvenebelia.

  11. liqvoraluri kriteriumi: • Tav-zurg tvinis siTxeSi momatebulia cila 0.99% _ 1.65% da meti; • zomierad momatebulia pleocitozi, ZiriTadad limfocitebis xarjze _ 200-400 da meti; • mkveTrad dadebiTia pandis reaqcia, dadebiTia none-apeltis reaqcia, uaryofiTia veix-Sbrotis reaqcia; • dabalia Saqari, rac paTognomuria TB meningitisaTvis; • warmoiqmneba nazi fibrinuli bade;

  12. radiologiuri kriteriumi _ Tavis tvinis kompiuteruli da magnitur-rezonansuli gamokvlevis Sedegebis Sefaseba TB meningitisaTvis damaxasiaTebelia: • intrakranialuri hipertenzia dinamikaSi hidrocefaliiT; • Tavis tvinis TeTr nivTierebaSi hiperintensiuri kerebi; subkortikalurad hiperintensiuri kerebi fiqsirdeba naoWebis saxiT; • vaskuliti – kapilarebis doneze sisxlZarRvebis dazianeba irgvliv iSemiuri kerebiT;

  13. TB meningitisaTvis damaxasiaTebeli struqturuli cvlilebebi fiqsirdeba: • naTxemis qvemo fexebSi; • naTxemis hemisferos kaudalur midamoSi; • safeTqlis mediobazalur struqturebSi; Tavis tvinis kontrastuli gamokvlevis Sedegad aRiniSneba: • Tavis tvinis garsebis; • parkuWis kedlebis; • liqvoro-cirkularuli gzebis kontrastuli gaZliereba; • cns-is tuberkulomebis dros hipointensiuri kerebi, irgvliv zomieri perifokaluri SeSupebiT.

  14. radiologiurikvleva • TB-s SemTxvevaSikt-s sarwmunoeba 50%-ia; • bazaluri meningitis droskt-s cvlilebebivlindeba 80%-Si; • hidrocefalia – 70%; • infarqti – 10% • tuberkuloma – 20%

  15. seminarma konsensusis saxiT SeimuSava TB meningitis diagnostikis ZiriTadi principebi, romelic eyrdnoba: • klinikuri; • liqvoraluri; • radiologiuri kriteriumebis Sejamebas da analizs. damatebiT gamokvlevebad CaiTvala: • bavSvebSi mantus sinji; • liqvoris gamokvleva PCR-iT.

  16. TB meningitis diagnostikis dros difdiagnostika unda gatardes: • sxva etiologiis neiroinfeqciebTan: • baqteriuli; • virusuli; • kandidozuri; • kriptokokuli meningitebi; • Tavis tvinis moculobiT procesebTan; • Tavis tvinis sisxlis mimoqcevis moSlasTan.

  17. q. keiptaunSi calke jgufad gamoiyo pacientebi eWviT TB meningitze, maTTanac: • diagnostika emyareba klinikur, liqvoralur da radiologiur kriteriumebs; • tubsawinaaRmdego mkurnaloba mTeli sifarTiT iwyeba eWvis gaCenis pirvelsave dRes da wydeba rodesac mTlianad gamoiricxeba specifiuri procesi;

  18. TB meningitis atipiuri SemTxvevebi: • daavadebis mwvaved dawyeba; • daavadebis dawyeba arteriuli hipertenziiT, fsiqikis SecvliT, abdominaluri da radikulitis CivilebiT; • TB meningitis duned dawyeba mcired gamoxatuli meningialuri niSnebiT; • TB meningiti arapaTognomuri liqvoriT; • TB meningitis mcire simptomebiT dawyeba im pacientebSi, romlebic adre, an TB meningitze gamokvlevis dros mkurnalobdnen antituberkulozuri preparatebiT; • xanSiSesulTa meningiti; • orsulTa meningiti, rodesac meningitis Civilebs miaweren orsulTa toqsikozebs; • TB meningiti Sidsis dros.

  19. atipiuri mimdinareobis mqone pacientebi xvdebian: Terapiul, infeqciur, nevrologiur, fsiqiatriul, qirurgiul klinikebSi maT usvamen: qolecistitis, gastritis, muclis tifis, radikulitis, arteriuli hipertoniis, fsiqozis diagnozebs utardebaT operaciebi: apendicitis, frontitis gamo specifiur klinikaSi ki gadmohyavT mxolod mas Semdeg, rac yalibdeba meningialuri sindromi.

  20. HIV/AIDS – TB ko-infeqcia • TB meningiti, iseve rogorc tuberkulozis sxva formebi xSirad atipiurad mimdinareobs; • sustad aris gamoxatuli meningialuri niSnebi – kefis kunTebis rigidoba da kernigis niSani ormxriv; • liqvorSi gamoxatulia mcire anTebiTi cvlilebebi: • pleocitozi – normis farglebSi an mcired momatebuli; • cila mkveTrad momatebuli 0.99%-3.3%-mde da meti; • mniSvnelovnad daklebulia Saqari; • HIV/AIDS – TB ko-infeqciis dros Tavis tvinis kompiuteruli gamokvleviT sWarbobs encefaliti; • difdiagnostikis dros pirvel rigSi unda gamoiricxos kriptokokuli meningiti.

  21. Sidsis dros SesaZlebelia SeuRlebuli oportunistuli infeqciebis arseboba: • citomegalovirusi, herpesvirusi, toqsoplazmozi, ebStein-baris virusi, kandidozi; • diagnozi ismeba serologiuri reaqciebis daxmarebiT; • difdiagnostika unda Catardes Tavis tvinis limfomebTan da toqsoplazmebTan: • limfomebis dros Tavis tvinis kompiuteruli tomografiiT korZiani sxeulis da parkuWis sxeulis garSemo Warbobs hipointensiuri ubani, romelic mkveTrad irTavs kontrasts; • toqsoplazmebis dros Tavis tvinis TeTr nivTierebaSi aRiniSneba hiperintensiuri ubnebi mas efeqtiT;

  22. Sidsis dros TB meningiti mZimed, xangrZlivad da talRiseburad, perioduli gamwvavebis da naTeli periodebis monacvleobiT mimdinareobs; prognozi arakeTilsaimedoa;

  23. TBmeningitisaqarTveloSi TBmeningitidafiltvisTB

  24. TB meningiti da filtvgareTa TB

  25. “izolirebuli” TB meningiti TBmeningiti Sidsi sikvdilianoba

  26. 27 wlis 6 Tvis fexmZime pacienti stacionarSi Semovida 8/IV-10-Si; • kaspis raionis macxovrebeli; • daavadeba daewyo TandaTanobiT, Tavis tkiviliT, umadobiT, SeuCerebeli RebinebiT; • cxeleba t38C; • cnobierebis Secvla; • tfdec-Si moTavsda daavadebis dawyebidan 2-3 kviris Semdeg; Catarda: • liqvoris saerTo analizi; • baqterioskopia; • baqteriologiuri kvleva; • magnitur-rezonansuli kvleva; • sisxlis klinikuri da bio-qimiuri kvleva;

  27. PDR-B masalisaRebisTariRi: 12/IV rezistentuli: S H E Eto; snsitiuri: R Km Cm Ofx PAS Cs DOTS+ programaSiCaerTo 4/V-dan

  28. 04.07.10 - marjvenagverdiTiparkuWissxeuliszedakedlismciredeformacia, konveqsitaluriqselqveSasivrceebizomieradgafarToebuli.

  29. daskvna: • diagnostikis sirTule adreul etapze ganapiroba pacientis fexmZimobam; • intoqsikaciis niSnebi: gulisreva, umadoba, Tavis tkivili, pirRebineba aRqmul iqna rogorc orsulTa toqsikozis niSnebi; • ar iyo gaTvaliswinebuli ojaxuri TB kontaqti; • yovelivem ganapiroba gviani diagnostika, pacientis mdgomareobis damZimeba da mkurnalobis aradrouli dawyeba (3 kviris Semdeg);

  30. pacientis CarTva MDR-TB programaSi moxda • kliniko-laboratoriuli monacemebis gauaresebis; • TB kontaqtis gamovlenis safuZvelze; • CarTvisas SeirCa empiriuli samkurnalo reJimi; • DST profilis gansazRvris Semdeg dainiSna individualuri samkurnalo sqema;

  31. 27 wlis pacienti stacionarSi Semovida 2/VI-10-Si; • kaxeTis regionis macxovrebeli; • TB kontaqtis dadgena ver moxerxda; • xangrZlivi anamneziT; • daavadeba daewyo TandaTanobiT, hospitalizacia moxda klinikuri niSnebis gamovlenidan 21 dRis Tavze; • cxeleba t38C; • bazaluri simptomatikis gamovlena; • cnobierebis Secvla; Catarda: • liqvoris saerTo analizi; • baqterioskopia; • baqteriologiuri kvleva; • magnitur-rezonansuli kvleva; • sisxlis klinikuri da bio-qimiuri kvleva;

  32. MDR masalisaRebisTariRi: 3/VI rezistentuli: S H R E Eto; snsitiuri: Km Cm Ofx PAS Cs DOTS+ programaSiCaerTo 25/VI-dan

  33. 03.06.10 - zomierihidrocefalia • 10.11.10 – iSemiuriubanimarjvnivTalamusSi, • zomierihodrocefalia, kortikaluriatrofiebi (neiroinfeqcia, vaskuliti);

  34. daskvna: • dagvianebulma diagnostikam da mkurnalobis dawyebam gamoiwvia garTulebebis ganviTareba • hidrocefalia; • iSemiuri kera TalamusSi; rac SesaZloa arakeTilsaimedo gamosavalis mizezi gaxdes.

  35. gmadlobT yuradRebisTvis