Pivane javaxiSvilis saxelobis Tbilisis saxelmwifo

universiteti

Mmedicinis fakulteti

K dermato-venerologiis departamenti

xaTuna kudava

Tavis Tmiani aris mikozebis klinikur-epidemiologiuri

analizi

disertacia

warmodgenili medicinis doqtoris akademiuri xarisxis

mosapoveblad

samecniero xelmZRvaneli:

asocirebuli profesori Tina qituaSvili

Tbilisi, 2014 weli

  1

avtoris stili daculia

Sinaarsi

1. Sesavali

1.1. kvlevis aqtualoba---------------------------------------------------------------------------3-8

1.2. kvlevis mizani da amocanebi--------------------------------------------------------------8

1.3. kvlevis mecnieruli siaxle -------------------------------------------------------------9

1.4. kvlevis praqtikuli Rirebuleba-------------------------------------------------------9

1.5. naSromis aprobacia -------------------------------------------------------------------------10

1.6. gamoqveynebuli Sromebi -----------------------------------------------------------------10-11

2. literaturis mimoxilva--------------------------------------------------------------------------12-41

2.1. Tavis Tmiani aris mikozebis epidemiologiuri sakiTxebi

(gavrceleba, etiologiuri agentebi, cvalebadoba drosa da garemoSi,

kavSiri sqesTan da asakTan, kontagiozuroba da wyaro) ------------------------12-29

2.2. Tavis Tmiani aris mikozebis klinikuri manifestacia da

diagnostika---------------------------------------------------------------------------------------------------29-37

2.3. Tavis Tmiani aris mikozebis mkurnalobis principebi----------------37-41

3. kvlevis masala da meTodebi-------------------------------------------------------------------42-44

4. kvlevis Sedegebi--------------------------------------------------------------------------------------45-62

5. ganxilva---------------------------------------------------------------------------------------------------63-72

6. daskvnebi---------------------------------------------------------------------------------------------------73-74

7. gamoyenebuli literatura----------------------------------------------------------------------75-86

8. danarTi---------------------------------------------------------------------------------------------------- 87-101

9. reziume inglisur enaze-------------------------------------------------------------------------102-106

  2

1.1 problemis aqtualoba

Tavis Tmiani aris mikozi (Tinea Capitis), dermatofitebiT gamowveuli

sokovani infeqcia, farTod gavrcelebuli dermatomikozia bavSvTa

asakSi. aRniSnuli daavadeba jandacvis mniSvnelovan problemas

warmoadgens da msoflio mecnierTaTvis dRemde rCeba aqtiuri Seswavlis

sagnad.

ukanasknel periodamde Tavis Tmiani aris mikozi ZiriTadad

iTvleboda ganviTarebadi qveynebis daavadebad mWidro dasaxlebis, cudi

higienuri pirobebisa da dabali socialur-ekonomiuri standartebis

gamo. Tumca gasul aTwleulebSi moxda mniSvnelovani epidemiologiuri

cvlileba da igi gavrcelda evropis kontinentisa da amerikis

maRalganviTarebul qveynebSic. CrdiloeT da dasavleT evropaSi Tavis

Tmiani aris mikozebma zerele sokovani infeqciebis SemTxvevaTa 1%

Seadgina (Ginter-Hanselmayer 2007). evropis qveynebSi, rogoricaa avstria,

safrangeTi, britaneTi, italia, saberZneTi, espaneTi, irlandia, poloneTi

da litva, Tavis Tmiani aris mikozebi mniSvnelovan problemas

warmoadgens (Binder B 2011, Simonnet C 2011, Fuller LC. 2009, Borman AM 2007,

Asticcioli S et al 2008, Mapelli ET 2013, Maraki S 2007, Tsoumani M 2011, Bennassar A 2010,

Del Boz J et al 2011, Hackett BC 2006, Budak A 2013, Paškevičius A 2013). daavadebis

sixSiris matebas aRniSnaven aSS-sa ( Alvarez MS 2006, Panackal AA 2009, Coloe JR

2010, Chapman JC 2011) da braziliaSic (Cortez AC 2012, Moraes MS 2006).

daavadeba farTod gavrcelebulia aziis qveynebSic: iranSi, TurqeTSi,

nepalSi, indoeTsa da CineTSi ( Naseri A 2013, Bassiri Jahromi S 2006, Ilkit M et al

2008, Akbaba M 2008, Mathur M 2012, Kundu D 2012, Das S 2007, Grover C 2010, Zhu M

2010). Tavis Tmiani aris mikozi endemuri daavadebaა tropikuli

afrikisTvis ( Hogewoning AA 2011). igi farTodaa gavrcelebuli tunisSi,

tanzaniaSi, nigeriaSi, saharaSi, eTiopiaSi, marokosa da alJirSi (Neji S

2009, Sellami A 2008, Zaraa I et al 2013, Saghrouni F 2011, Komba EV et al 2010, Ayanbimpe

GM et al 2008, Emele FE 2008, Ngwogu AC 2007, Nweze EI 2010, Patel GA 2011, Ali J et al

2009, Woldeamanuel Y 2005, Elmaataoui A2012, Benmezdad A et al 2012). Tavis Tmiani

  3

aris mikozebi gavrcelebulia egviptesa da avstraliaSic (Zaki SM et al

2009, Mutch RC 2012).

saqarTveloSi Tavis Tmiani aris sokovani daavadebebis Seswavla da

maT winaaRmdeg brZola mudmivad mimdinareobda. me-20 saukunis 70-ian

wlebSi praqtikulad likvidirebuli iqna favusi, romlis gamomwvevad

gvevlineboda Trichophyton shoenleinii, Tumca bolo 27 wlis manZilze

daavadebis mdgomareoba Seuswavleli darCa. mizezi mravalia. maT Soris

mniSvnelovania bolo wlebSi dermatovenerologiur dawesebulebebs,

veterinarul samsaxursa da sanepidsadgurebs Soris koordinirebuli

muSaobis darRveva. daudgeneli daavadebis wyaro, daavadebulTa ojaxis

wevrebisa da maTTan kontaqtSi myof sxva pirTa profilaqtikuri

Semowmebis ugulebelyofa, infeqciis kerebis sanaciis ararseboba xels

uwyobda daavadebis gavrcelebasa da epidsaSiSi mdgomareobis Seqmnas.

mdgomareobas arTulebda mosaxleobis arasakmarisi sanitaruli

ganaTlebac. daavadebis gavrcelebis amsaxveli monacemebis

arasrulyofileba ki ukavSirdeboda Tavis Tmiani aris mikozebis

arasrul aRricxvianobas. am problemis mizezi klasifikaciis cvlilebac

iyo. adre arsebuli klasifikaciis mixedviT, romelic eyrdnoboda

gamomwvevis identifikacias, rac xSirad SeuZlebeli da xelmiuwvdomeli

iyo dermato-venerologiuri profilis yvela struqturuli

erTeulisaTvis, gamoiyofoda triqofitiisa da mikrosporiis diagnozi.

mas Semdeg, rac moxda klasifikaciis cvlileba da misi safuZveli gaxda

daavadebis lokalizacia daavadebis gamomwvevis miuxedavad, Tavis Tmiani

aris dermatomikozebi gamoyofil iqna erT calke diagnozad. Tumca

statistikuri forma IV-06-Si uaxloes warsulamde Zveli klasifikaciiT

xdeba aRricxva da gamoiyofa triqofitia da mikrosporia, ris gamoc

arsebuli informacia ar aris realuri monacemebis Sesabamisi.

Tavis Tmiani aris mikozebi gamoirCeva maRali kontagiozurobiT

(Chapman JC 2011, Magill SS 2007). am maxasiaTeblis gamo igi xSirad

mikroepidemiebis mizezic xdeba. antropofiluri etiologiuri agentebiT

gamowveuli formebi advilad vrceldeba ojaxebSi, sadac mravali wevri

erTad cxovrobs, TanaklaselebSi, sportsmenebSi ( Emele FE 2008, Carod JF et

  4

al 2011, Grosset-Janin A 2012, Pleacher MD 2007, Ilkit M et al 2010 ). Tavis Tmiani aris

mikozebis zoofilur formaTa wyarosa da gadamtanebs cxovelebi

warmoadgens. usaxlkaro ZaRlebi da katebi, aseve Sinauri lekvebi,

knutebi da kurdRlebi, msxvilfexa rqosani pirutyvi ( Bennassar A 2010, Yin

B 2013, Blömer RH 2012 ) da inficireba SeiZleba moxdes daavadebulis

TmebTan, savarcxelTan da qudTan kontaqtiT ( Grimalt R 2007). saqarTveloSi

80-ian wlebSi Catarebuli kvlevis mixedviT triqofitiiT daavadebulTa

60% gamovlenili iyo ojaxis wevrebs Soris. amasTan aRiniSneboda

dominanti antroponozuli formebis Semcirebisa da zoofiluri

formebis zrdis tendencia (Твалиашвили Г.М. 1986).Mmas Semdeg

epidemiologiuri TvalsazrisiT es metad mniSvnelovani sakiTxi

saqarTveloSi ar yofila Seswavlili.

droSi mudmivad cvalebadia gansazRvrul geografiul arealSi

Tavis Tmiani aris mikozebis sxvadasxva etiologiuri agentis gavrceleba.

zogadad am daavadebisa da misi konkretuli gamomwvevis erTi

qveynidan meoreSi gavrcelebas xSirad xels uwyobs migraciuli

procesebi, emigraciuli gadaadgilebebi da mogzaurobebi( Alexander CL et al

2009, Jankowska-Konsur A et al 2009, Raccurt CP et al 2009, Binder B et al 2011,Ginter-

Hanselmayer G 2007, Del Boz J et al 2011, Magill SS et al 2007, McPherson ME et al 2008,

Hällgren J et al 2004, Lehmann S et al 2004 ). zoofiluri Microsporum canis rCeba

yvelaze gavrcelebul etiologiur agentad xmelTaSua zRvisa da maT

mosazRvre qveynebSi, rogoricaa avstria, ungreTi, Ggermania da

poloneTi, Tumca evropis qalaqebSi aRiniSneba antropofilur

gamomwvevTa speqtris cvlileba Trichophyton tonsurans-is matebisken

tendenciiT (Bennassar A et al, 2010). zemoaRniSnul cvlilebebTan erTad

safrangeTSi gamovlinda Trichophyton soudanense-s da Microsporum audouinii –s

mateba (Ginter-Hanselmayer G 2007). italiaSi adre Catarebuli kvlevebis

mixedviT Tavis Tmiani aris mikozebis ZiriTadi gamomwvevebi zoofiluri

agentebi iyo, Tumca uaxlesi kvleviT dominanti antropofiluri

Trichophyton violaceum aRmoCnda (Asticcioli S et al, 2008, Mapelli ET 2013).

  5

saqarTveloSi 1984 wlisTvis Trichophyton violaceum-iT gamowveuli

formebi Seadgenda saerTo triqofitiebis 62,4%-s, xolo Trichophyton

mentagrophytes var gypseum-37,6%-s, kvlevis bolo wlebisTvis ki aRiniSneboda

ukanasknelis mateba (Твалиашвили Г. М. 1986).Mmas SemdegAmonacemebi

saqarTveloSi Tavis Tmiani aris mikozebis gamomwvevebis Sesaxeb ar

arsebobs.

gansxvavebulia mosazrebebi da monacemebi daavadebis sqesTan

kavSiris Sesaxeb. rigi kvlevebis mixedviT Tavis Tmiani aris mikozebi

ufro gavrcelebuli aRmoCnda mamrobiTi sqesis pirebSi (Ayanbimpe GM

2008, Del Boz J et al 2011, Prohic A 2008, Zaraa I 2013, Raccurt CP 2009, Fulgence KK 2013,

Komba EV 2010, Razzaq Adel AA 2007, Bassiri Jahromi S 2006, Hackett BC 2006, Emele FE

2008, White JM et al 2007, Mirmirani P 2013, Kundu D 2012). sxva mecnierebis

monacemebiT Tavis Tmiani aris mikozebi ufro gavrcelebulia

mdedrobiTi sqesis pirebSi (East-Innis A 2006, Zhu M 2010, Jha BN 2006, Brilhante

RS 2004). evropeli mecnierebis monacemebiT ki daavadeba sqesTan kavSirSi

ar aris (Ginter-Hanselmayer 2007). saqarTveloSi 80-ian wlebSi Catarebuli

kvlevis mixedviT triqofitiis SemTxvevebi Warbobda mamrobiT sqesSi

(60%-40%) (Твалиашвили Г. М. 1986). dReisaTvis am mimarTulebis monacemebi

ar gvaqvs.

Tavis Tmiani aris mikozebis SemTxvevebi gvxvdeba yvela asakis

adamianSi, Tumca is yvelaze gavrcelebuli bavSvebSia, upiratesad

prepubertatul periodSi (Bennassar A 2010). amas adasturebs msoflios

sxvadasxva qveyanaSi Tavis Tmiani aris mikozebis Sesaswavlad

Catarebuli mravali kvleva (Ginter-Hanselmayer 2007, Sarabi K 2007, Bassiri Jahromi

S 2006, Chapman JC 2011, Grover C 2010, Del Boz J et al 2011, Prohic A 2008, Zaraa I et al

2013, Saghrouni F 2011, Razzaq Adel AA et al 2007, Binder B 2011, Zhu M 2010, Thakur R

2013, Hackett BC 2006, Raccurt CP 2009, Moraes MS 2006, Brilhante RS 2004). (Lari AR

2005, Patel GA 2011, Cortez AC 2012, Mapelli ET 2013, Jha BN 2006, Lange M 2004, Abanmi

A 2008, Nweze EI 2010, Koussidou-Eremondi T 2005). am daavadebis bavSvTa asakSi

gavrcelebaze mniSvnelovan informacias iZleva bavSvTa organizebul

dawesebulebebSi, skolebSi Catarebuli kvlevebi (Sidat MM 2007, Sidat MM

2006,Ali J et al 2009, Woldeamanuel Y 2005, Adefemi SA et al 2011, Ayanbimpe GM et al

  6

2008, Fulgence KK 2013, Carod JF 2011, Komba EV et al 2010, Kundu D 2012, Emele FE

2008, Triviño-Duran L 2005, Pérez-González M 2009, Abdel-Rahman SM 2010). Cvil

bavSvebSi dermatofitozuli infeqciiT daavadeba iSviaTia, Tumca misi

araerTi SemTxvevaa aRwerili Tavis Tmiani aris mikozebis saxiT (Michaels

BD 2012, Hackett BC 2006, Atanasovski M et al 2011, Larralde M et al 2010, Mapelli ET 2012,

Valari M 2006). bolo dros aRiniSneba Tavis Tmiani aris mikozebis mateba

mozrdilTa da moxucebulTa populaciebSic (Ginter-Hanselmayer G 2007).

zrdasrul asakSi Tavis Tmiani aris mikozebis SemTxvevebi gamovlinda

sxvadasxva qveyanaSi Catarebuli kvlevebis Sedegad ( Binder B et al

2011,Mebazaa A et al 2010,Saghrouni F 2011,Binder B 2011,Zhu M 2010,Rezusta A 2011,Chen

W 2010 ).

saqarTveloSi 80-ian wlebSi Catarebuli kvlevis mixedviT

triqofitia yvelaze gavrcelebuli iyo 4-7 wlis asakis bavSvebSi da

Seadgenda saerTo raodenobis 65-70%-s. (Твалиашвили Г. М. 1986). Mmas Semdeg

es sakiTxi Seuswavleli iyo.

daavadeba gamoirCeva klinikuri gamovlinebis mravalferovnebiT.

asimptomuri da inkognito formebi daavadebis atipiuri mimdinareobis

gamo xSirad diagnostikuri Secdomis mizezi xdeba. Aamitomac isini rCeba

daavadebis farul wyarod kontaqtSi myof pirTaTvis da daavadebis

Semdgom gavrcelebas uwyobs xels. zogi mecnieris azriT xSirad

daavadebis klinikuri suraTi imdenad tipiuria, rom diagnostirebis

saSualebasac ki iZleva (Kelly BP 2012), sxvebi ki am sakiTxs rTul da

sakamaTo Temad Tvlian, radgan daavadeba SeiZleba gamovlindes rogorc

umniSvnelo, zerele dazianebis simptomebiT gamoxatuli eriTemiT,

aqercvliT, Tmis cveniTa da alopeciiT, ise Cirqovani procesebiTa da

Rrma anTebiTi qerionis formiT ( Mapelli ET 2012, Ali S 2007, Sarabi K 2007,

Mounsey AL 2009, Hackett BC 2006, Patel GA 2011 ). diagnostikisa da mkurnalobis

formebis SerCevisaTvis arsebiTi mniSvneloba aqvs sokovan infeqciaze

ganviTarebul alergiul dermatofitul reaqciebs. misi swori Sefaseba

metad mniSvnelovania araswori diagnostikisa da masTan dakavSirebuli

Sedegebis Tavidan asacileblad (Cheng N 2011, Payne LK 2012). saqarTveloSi

  7

Tavis Tmiani aris mikozebis klinikuri formebis Sesaxeb monacemebi ar

arsebobs.

metad mniSvnelovan da aqtualur sakiTxad rCeba Tavis Tmiani aris

mikozebis mkurnalobac. daavadebis mkurnalobisTvis arasakmarisia

mxolod adgilobrivi antifungaluri mkurnaloba topikuri

preparatebiT, radgan isini ver aRweven da ver axdenen infeqciis

eradikacias Tmis folikulebidan da aucilebelia sistemuri

preparatebis gamoyeneba (Ali S 2007, Andrews MD 2008, Bennassar A 2010).

sxvadasxva preparatis gansxvavebuli efeqturoba, moxmarebis

xangrZlivoba da gverdiTi movlenebis arseboba mudmivad axali

preparatis Ziebis safuZveli xdeba.

Aamgvarad, Tavis Tmiani aris mikozebis Sesaxeb arasruli, amasTan

ararealuri monacemebi gaxda sakiTxis Seswavlis safuZveli.

1.2 kvlevis mizani da amocanebi

kvlevis mizani iyo Tavis Tmiani aris mikozebis  klinikur-

epidemiologiur TaviseburebaTa Seswavla 2009-2013 wlebSi.

Mmiznis gansaxorcieleblad dasaxuli iyo Semdegi amocanebi:

1. daavadebis gavrcelebis Seswavla da maRali avadobiT

gamorCeuli regionebis gamovlena.

2. Tavis Tmiani aris  mikozebis  daavadebis sqesTan da asakTan

kavSiris Seswavla.

3. daavadebis gamomwvevTa speqtris Seswavla Tavis Tmiani aris 

mikozebis dominanti etiologiuri agentebis gamosavlenad.

4. Tavis Tmiani aris mikozebis klinikuri simptomatikis Seswavla

dominanti klinikuri formebis gamosavlenad.

5. miRebuli kvlevis Sedegebis damuSaveba Tavis Tmiani aris

mikozebis  klinikur-etiologiuri kavSiris gamosavlenad.

  8

1.3 kvlevis mecnieruli siaxle

1. Seswavlili iyo Tavis Tmiani aris mikozebis epidemiologiuri da

klinikuri Taviseburebani bolo xuTi wlis monacemebiT.

2. gamovlinda saqarTveloSi Tavis Tmiani aris mikozebis adre

Catarebuli kvlevebis monacemebisgan gansxvavebuli etiologiuri

speqtri.

3. pirvelad gamovlinda Trichophyton verrucosum, rogorc saqarTveloSi

Tavis Tmiani aris mikozebis gamomwvevi.

K 1.4 kvlevis praqtikuli Rirebuleba

1. gamovlinda Tavis Tmiani aris mikozebis aRricxvianobaSi arsebuli

problemebi, rac dakavSirebuli iyo dermatofitozebis axali

klasifikaciis danergvasTan. aRricxvianobis gaumjobesebis mizniT:

1.1 avadmyofobaTa da janmrTelobasTan dakavSirebuli

problemebis saerTaSoriso statistikuri klasifikaciis me-10

gadaxedvis dasanergad saqarTvelos dermato-venerologTa sam

konferenciaze moxda misi ganxilva da dermato-venerologTa

swavleba am mimarTulebiT.

1.2 daavadebaTa kontrolisa da sazogadoebrivi janmrTelobis

erovnul centrs mieca rekomendacia, rom statistikur forma

IV-06-Si, romlis mixedviTac aRiricxeba sicocxleSi pirvelad

dadgenili triqofitia da mikrosporia, axali klasifikatoris

mixedviT Setanili yofiliyo Tavis Tmiani aris mikozebi,

ramdenadac diagnozi triqofitia da mikrosporia Tavis Tmiani

aris mikozis garda moicavs triqofitonebiTa da

mikrosporumebiT gamowveul sxva lokalizaciis mikozebsac. E

2. zemoaRniSnuli cvlileba statistikur formaSi Tavis Tmiani aris

mikozebis aRricxvianobis srulyofasTan erTad mogvcems mTeli qveynis

masStabiT daavadebis statistikuri analizis SesaZleblobas.

  9

1.5 naSromis aprobacia

Ddisertaciis ZiriTadi debulebebi moxsenebuli da ganxilulia:

• medikosTa 27-e saerTaSoriso skola-konferenciaze ,,Tanamedrove

klinikuri da eqsperimentuli medicina, miRwevebi da uaxlesi

teqnologiebi.” bakuriani, 27 Tebervali-7 marti, 2010 weli.

• me-6 erovnul kongresze alergologiasa da imunologiaSi, Tbilisi-

wyaltubo, 1-3 oqtomberi, 2010 weli.

• medikosTa 32-e saerTaSoriso skola-konferenciaze ,,Tanamedrove

klinikuri da eqsperimentuli medicina, miRwevebi da uaxlesi

teqnologiebi.” Caqvi, 21-28 ivlisi, 2012weli.

disertaciis moculoba da struqtura

sadisertacio naSromi moicavs 106 nabeWd gverds. Mmoicavs Sesavals,

literaturi mimoxilvas, kvlevis masalisa da meTodebis aRweras,

kvlevis Sedegebsa da maT ganxilvas, daskvnebs, gamoyenebuli

literaturis sias, danarTsa da reziumes inglisur enaze. disertacia

ilustrirebulia eqvsi diagramiT, ToTxmeti cxriliTa da TxuTmeti

suraTiT. literaturis sia moicavs 164 naSroms.

1.6 gamoqveynebuli Sromebi:

1. Tina Kituashvili, Khatuna Kudava, George Tvaliashvili. The Case of Zoo-Anthroponosic

Trichophytosis with Atypical Localization. J.”South Caucasian Dermatology and Venereology

News,” Issue#1(8), 2010. P.55.

2. K.Kudava, T. Kituashvili. Tinea capitis: Spectrum of causatives in Georgia.

20th Congress of the European Academy of Dermatology and Venereology. Lisbon, Portugal, 21-

24 October, 2011. P. 482.

3. Kudava K, Galdava G, Tvaliashvili G, Kituashvili T. Tinea capitis: Dermatophytid reaction.

9th EADV Spring Symposium “A dermatological opera”. 6-10 June, 2012, Verona, Italy. P. 352.

  10

4. Китуашвили Т.А, Кудава Х.Т. К вопросу этиологии дерматофитозов волосистой части

головы . «Современная микология в россии». Тезисы докладов третьего съезда микологов

россии. т.3. Москва 2012, стр. 473.

5. x.kudava, g.galdava, T.qituaSvili. Tavis Tmiani aris mikozebis ZiriTadi

etiologiuri faqtorebi saqarTveloSi. samecniero-praqtikuli Jurnali

„eqsperimentuli da klinikuri medicina.“ Tbilisi 2012. N5. gv. 64-66.

6. Кудава Х.Т., Твалиашвили Г.М., Китуашвили Т.А. Керион Цельса в Грузии. Успехи

медицинской микологии. Москва 2013, стр. 139-140.

7. Kituashvili T, Kudava K. Clinical Manifestations of Tinea Capitis. 22th EADV Congress.

,,Dermatovenereology in a Changing World”. Istanbul, 02-06 October, 2013. P.1023.

8. Kudava Kh. Clinical specificities of tinea capitis in Georgia population. Georgian Medical

News, 2013; N 11(224). p26-30.

9. Khatuna Kudava, Tina Kituashvili, Manana Sekania, George Galdava. Some Characteristics of

Tinea Capitis. Iranian Journal of Pediatrics, 2013; Vol 23, No6, p707-708.

10. x.kudava, T.qituaSvili. terbinafinis efeqturoba Tavis Tmiani aris

mikozebis mkurnalobaSi. samecniero-praqtikuli Jurnali „eqsperimentuli

da klinikuri medicina.“ Tbilisi 2013. N5. gv. 65-67.

  11

2. literaturis mimoxilva

2.1. Tavis Tmiani aris mikozebis epidemiologiuri sakiTxebi (gavrceleba,

etiologiuri agentebi, cvalebadoba drosa da garemoSi, kavSiri sqesTan

da asakTan, kontagiozuroba da wyaro)

Tavis Tmiani aris mikozebi gavrcelebulia mTels msoflioSi, რasac

adasturebs sxvadasxva qveyanaSi Catarebuli kvlevebi. rig qveynebSi es

daavadeba yvelaze gavrcelebuli dermatomikozia. kairoSi, egvipteSi

Catarebuli kvlevis Sedegad Tavis Tmiani aris mikozebi yvelaze

gavrcelebuli dermatomikozi aRmoCnda da Seadgina misi 76,4% (Zaki SM et

al, 2009). es daavadeba, aseve, dominanti dermatofitozi aRmoCnda eTiopiasa

da aRmosavleT nigeriaSi. eTiopiaSi Tavis Tmiani aris mikozebi

gamovlinda dermatofitozebis 76.5%-Si (Woldeamanuel Y  et al, 2005),

aRmosavleT nigeriis soflis mosaxleobaSi ki _ 67%-Si (Ngwogu AC  et al,

2007). mniSvnelovan monacemebs gvaZlevs sfaqsSi, tunisSi Catarebuli

kvlevebic. qalaqis hospitalSi Catarebuli kvlevis Sedegad Tavis Tmiani

aris mikozebi bavSvTa populaciaSi dermatofitozebis 69,4%-Si

gamovlinda (Sellami A  et al, 2008), zogadad dermatofitozebis

epidemiologiis Semswavleli kvlevis Sedegad ki _ 9,6%-Si (Neji S et al,

2009). Ees daavadeba farTod gavrcelebulia evropaSic. CrdiloeT da

dasavleT evropaSi kanis zerele sokovani infeqciebis Seswavlis dros

aRricxul SemTxvevaTa 1% Tavis Tmiani aris mikozebi aRmoCnda (Ginter-

Hanselmayer et al, 2007). guianaSi, safrangeTSi es daavadeba zerele mikozebis

27,8%-Si gamovlinda (Simonnet C  et al, 2011). samxreT-dasavleT saberZneTSi

dermatofitebis Tvrametwliani cvlilebebis mimoxilvis Sedegad

aRmoCnda, rom Tavis Tmiani aris mikozebi Seadgenda dermatofitozebis

11,8%-s (Tsoumani M  et al, 2011). amave qveyanaSi daavadebis gavrcelebas

adasturebs kretas kunZulze Catarebuli Svidwliani da aTenSi

Trichophyton violaceum_iT gamowveuli zerele mikozebis Semswavleli

kvlevebi (Maraki S  et al, 2007, Frangoulis E  et al, 2005). lituaniaSi, vilniusSi

dermatomikozebs Soris gavrcelebis mxriv Tavis Tmiani aris mikozebi

  12

meore adgils ikavebda (Paškevičius A et al, 2013). es daavadeba gavrcelebulia

evropis sxva qveynebSic, maT Soris poloneTsa da xorvatiaSi (Budak A et

al, 2013, Brajac I  et al, 2004). aSS-Si Catarebuli kanis sokovani infeqciebis

kvlevis Sedegad aRmoCnda, rom Tavis Tmiani aris mikozebi maT 15%-s

Seadgenda da upiratesad Savkanian bavSvebSi iyo gavrcelebuli (Panackal

AA et al, 2009). Dam daavadebis epidemiologiis Seswavla aqtualuria aziis

qveynebisTvisac. Crdilo-aRmosavleT iranSi Tavis Tmiani aris mikozebi

gavrcelebis mxriv meore adgilze aRmoCnda sxeulis mikozebis Semdeg da

saerTo dermatofitozebis 32,5% Seadgina (Naseri A  et al, 2013), samxreT-

dasavleT iranSi ki dermatofitozebis _ 11,3% (Mahmoudabadi AZ et al, 2005).

indoeTSi zerele sokovani infeqciebis epidemiologiis Seswavlis

Sedegad gamovlinda, rom es daavadeba mikozebis saerTo raodenobis

6,2%-s Seadgenda (Das S  et al, 2007). Ddaavadeba, aseve, gavrcelebulia

montreiSi, meqsikaSi (Welsh O et al, 2006), centralur nepalSi (Mathur M et al,

2012), dasavleT avstraliaSi (Mutch RC  et al, 2012), iemenis respublikaSi

(Mahmoud AL  et al, 2002), lebanonSi, libanSi (Araj GF  et al, 2004), haitSi

(Neuberger A et al, 2012), makedoniis respublikasa (Starova A  et al, 2010) da

singapurSi (Tan HH  et al, 2005).

Tavis Tmiani aris mikozebis gamomwvevebi dermatofitebi

mikrosporumebi da triqofitonebia (Patel GA et al, 2011, Bennassar A et al, 2010).

gansxvavebulia maTi zoofiluri da antropofiluri saxeobebis

gavrceleba msoflios sxvadasxva qveyanaSi. zoofiluri dermatofitebi

daavadebis upiratesi gamomwvevebi aRmoCnda CrdiloeT italiasa da

sloveniaSi (Asticcioli S et al, 2008, Dolenc-Voljc M et al, 2005).

yvelaze gavrcelebuli Tavis Tmiani aris mikozebis zoofilur

etiologiur agentebs Soris aris Microsporum canis. es gamomwvevi dominanti

aRmoCnda bevr qveyanaSi Catarebuli kvlevis Sedegad. samxreT-aRmosavleT

avstriaSi Microsporum canis Tavis Tmiani aris mikozebis etiologiur

agentTa 84,4%-s Seadgenda (Binder B et al, 2011), samxreT-dasavleT

poloneTSi _ 63,2%-s (Jankowska-Konsur A et al, 2009), samxreT espaneTSi _

63,5%-s (Del Boz J et al, 2011), braziliaSi, san pauloSi _ 70,5%-s (Moraes MS  et

  13

al, 2006), bosnia da hercegovinaSi _ 90,4%-s (Prohic A  et al, 2008), samxreT-

aRmosavleT CineTSi _ 62,4%-s (Zhu M et al, 2010), samxreT kuveitSi ki _

62,5%-s (Razzaq Adel AA et al, 2007). Microsporum canis-iT gamowveuli Tavis

Tmiani aris mikozebis gavrceleba aRiniSna sxva qveynebSic. tunisSi,

susis regionSi Catarebuli kvlevis monacemebiT, Mmisma raodenobam

Seadgina am daavadebis gamomwvevTa saerTo raodenobis 29,3% (Saghrouni F et

al, 2011, Prohic A  et al, 2008), rabatSi, marokoSi _ 21,6% (Elmaataoui A et al, 2012),

xolo iranSi, TeiranSi _ 18,6% (Bassiri Jahromi S  et al, 2006). Bbolo dros

aRiniSneba Microsporum canis, rogorc Tavis Tmiani aris mikozebis

gamomwvevis zrda makedoniis respublikaSi (Starova A  et al, 2010). misi

SemTxvevebi gamovlinda samxreT-dasavleT saberZneTSi (Tsoumani M  et al,

2011), irlandiaSi, dublinis pediatriul populaciaSi (Hackett BC et al, 2006),

alJirSi (Benmezdad A et al, 2012), tanzaniasa (Komba EV et al, 2010) da

CrdiloeT tunisSic (Zaraa I et al, 2013).

SedarebiT naklebadaa gavrcelebuli zoofiluri Trichophyton

mentagrophytes-iT gamowveuli Tavis Tmiani aris mikozebi. samxreT ivori

kostaSi, kodiuaris bavSvTa populaciaSi Catarebuli kvlevis

monacemebiT, misma raodenobam Seadgina Tavis Tmiani aris mikozebis

gamomwvevTa saerTo raodenobis 19,7% (Fulgence KK  et al, 2013), anambraSi,

nigeriaSi _ daavadebis etiologiur agentTa 16% (Emele FE et al, 2008), xolo

aRmosavleT nepalSi _ 15,38% (Jha BN et al, 2006). Trichophyton mentagrophytes-iT

gamowveuli Tavis Tmiani aris mikozebis erTeuli SemTxvevebi gamoavlina

sxva qveynebSi Catarebulma kvlevebmac. braziliaSi, sanpauloSi es

gamomwvevi Seadgenda daavadebis etiologiur agentTa 3,6%-s (Moraes MS et

al, 2006), tunisSi, susis regionSi _ 1,1%-s (Saghrouni F  et al, 2011), iranSi,

TeiranSi ki _ 0,5%-s (Bassiri Jahromi S et al, 2006).

  14

ramdenime qveyanaSi gamovlinda Trichophyton verrucosum-iT gamowveuli

Tavis Tmiani aris mikozebi. iranSi, TeiranSi Catarebuli kvlevis

monacemebiT, am etiologiurma faqtorma Seadgina Tavis Tmiani aris

mikozebis gamomwvevTa saerTo raodenobis 14,8% (Bassiri Jahromi S et al, 2006),

irlandiis pediatriul populaciaSi ki _ 1,6% (Hackett BC  et al, 2006). misi

erTeuli SemTxvevebi gamovlinda tunisSic, susis regionsa da CrdiloeT

tunisSi Catarebuli kvlevebis Sedegadac (Saghrouni F et al, 2011, Zaraa I et al,

2013).

Tavis Tmiani aris mikozebis iSviaTi gamomwvevia zoofiluri

Trichophyton schoenleinii. iranSi, TeiranSi Catarebuli kvlevis mixedviT is

gamovlinda daavadebis gamomwvevTa 21,5%-Si (Bassiri Jahromi S et al, 2006),

bosnia da hercegovinaSi _ 2,4%-Si (Prohic A et al, 2008), xolo tunisSi, susis

regionSi _ 1,6%-Si (Saghrouni F et al, 2011). Trichophyton schoenleinii-iT

gamowveuli daavadebis erTeuli SemTxvevebi dafiqsirda dasavleT

CineTSic (Deng S et al, 2008).

Tavis Tmiani aris mikozebis antropofiluri gamomwvevebidan yvelaze

gavrcelebulia Trichophyton tonsurans da Trichophyton violaceum. Trichophyton

tonsurans am daavadebis yvelaze xSiri etiologiuri agentia aSS-Si.

ohaioSi Catarebuli kvlevis monacemebiT igi Tavis Tmiani aris mikozebis

gamomwvevTa 88,9%-s Seadgenda (Coloe JR et al, 2010), CrdiloeT kaliforniaSi

ki _ 91,8%-s (Mirmirani P et al, 2013). Trichophyton tonsurans, rogorc Tavis Tmiani

aris mikozebis yvelaze xSiri gamomwvevi, aseve, gamovlinda braziliaSi

amazonaSi (Cortez AC et al, 2012), sanpauloSi ki man daavadebis gamomwvevTa

23,2% Seadgina (Moraes MS  et al, 2006). misi SemTxvevebi gamovlinda

birminghamSic (Cantrell WC et al, 2011). Trichophyton tonsurans Tavis Tmiani aris

mikozebis dominanturi etiologiuri agenti aRmoCnda safrangeTSi,

irlandiasa da haitSic. safrangeTSi, guianaSi Catarebuli kvlevis

monacemebiT is am daavadebis gamomwvevTa 73,9%-Si gamovlinda (Simonnet C  et

al, 2011), irlandiis pediatriul populaciaSi _ 75.8%-Si (Hackett BC  et al,

2006) da haitSi _ 63,6%-Si (Raccurt CP et al, 2009). Trichophyton tonsurans-iT

gamowveuli Tavis Tmiani aris mikozebi aRiricxa sxva qveynebSi

Catarebuli kvlevebis Sedegadac. gabonSi is gamomwvevTa 27,9%-s

Seadgenda (Hogewoning AA et al, 2011 ), samxreT kuveitSi 13,1%-s (Razzaq Adel AA

et al, 2007), samxreT-aRmosavleT CineTSi _ 9,8%-s (Zhu M et al, 2010), iranSi,

TeiranSi ki _ 5,3%-s (Bassiri Jahromi S et al, 2006).

  15

msoflios mraval qveyanaSia gavrcelebuli antropofiluri Trichophyton

violaceum. rig qveynebSi es gamomwvevi Tavis Tmiani aris mikozebis

dominanti etiologiuri agentia. italiaSi, milanis pediatriul

populaciaSi Catarebuli kvlevis monacemebiT Trichophyton violaceum am

daavadebis yvelaze xSiri gamomwvevi aRmoCnda (Mapelli ET  et al, 2013). igi,

aseve, Tavis Tmiani aris mikozebis yvelaze gavrcelebuli gamomwvevi iyo

botsvanasa (Thakur R et al, 2013) da CrdiloeT indoeTSic (Grover C et al, 2010).

rabatSi, marokoSi Catarebuli kvlevis mixedviT Trichophyton violaceum

Tavis Tmiani aris mikozebis gamomwvevTa 60,8%-s Seadgenda (Elmaataoui A   et

al, 2012), tunisSi, susis regionSi _ 66,7%-s (Saghrouni F et al, 2011). igi yvelaze

gavrcelebuli etiologiuri agenti iyo CrdiloeT tunisSic (Zaraa I  et al,

2013). Trichophyton violaceum farTod gavrcelebuli aRmoCnda, agreTve,

eTiopiaSi Catarebuli kvlevebis monacemebiT. Crdilo-dasavleT

eTiopiaSi, gondarSi Trichophyton violaceum Tavis Tmiani aris mikozebis

gamomwvevTa 86,2%-s Seadgenda (Ali J et al, 2009), eTiopiis dedaqalaqSi, adis

ababaSi ki 87-90%-Si gamovlinda (Woldeamanuel Y et al, 2005). es gamomwvevi

gavrcelebuli aRmoCnda sxva qveynebSi Catarebuli kvlevebis

monacemebiTac. aRmosavleT nepalSi igi Tavis Tmiani aris mikozebis

gamomwvevTa 48,71% iyo (Jha BN et al, 2006), iranSi, TeiranSi _ 37,3% (Bassiri

Jahromi S et al, 2006), samxreT kuveitSi _ 19.3% (Razzaq Adel AA et al, 2007),

samxreT-aRmosavleT CineTSi _ 19% (Zhu M et al, 2010), aSS-Si, ohaioSi _ 4,2%

(Coloe JR et al 2010), bosnia da hercegovinaSi ki _ 1,9% (Prohic A et al, 2008).

Trichophyton violaceum-iT gamowveuli Tavis Tmiani aris mikozebis erTeuli

SemTxvevebi gamovlinda dasavleT CineTsa da marokoSi Catarebuli

kvlevebis Sedegadac (Deng S et al, 2008, Elmaataoui A et al, 2012).

  16

Trichophyton violaceum Trichophyton soudanense-Tan erTad aRmoCnda Tavis

Tmiani aris mikozebis ZiriTadi gamomwvevi SveicariaSi Catarebuli

kvlevis monacemebiT, romlis mixedviTac am ori etiologiuri agentis

raodenobam Seadgina gamomwvevTa 81,6% (Drakensjö IT et al, 2011). msoflioSi

naklebad gavrcelebuli antropofiluri Trichophyton soudanense dominanti

gamomwvevi aRmoCnda samxreT ivori kostaSi, kodiuaris bavSvTa

populaciaSi Catarebuli kvlevis Sedegad da gamovlinda etiologiur

agentTa 56,7%-Si (Fulgence KK et al, 2013). igi Tavis Tmiani aris mikozebis

yvelaze xSiri etiologiuri agenti iyo gabonSic, sadac gamomwvevTa

29,4%-Si gamovlinda (Hogewoning AA et al, 2011). Trichophyton soudanense-is

SemTxvevebi dafiqsirda centralur nepalSic (Ayanbimpe GM et al, 2008).

zogierTi mecnieris monacemiT, Trichophyton soudanense da Microsporum Audouinii-

iT gamowveuli Tavis Tmiani aris mikozebi upiratesad ganviTarebad

qveynebSia gavrcelebuli (Havlickova B et al, 2008).

mxolod ramdenime qveyanaSi gamovlinda Microsporum audouinii-iT

gamowveuli Tavis Tmiani aris mikozebi. nigeriaSi, anambraSi Catarebuli

kvlevis monacemebiT, is daavadebis dominanti etiologiuri agenti

aRmoCnda da gamomwvevTa 42%-Si gamovlinda (Emele FE et al, 2008). Microsporum

audouinii gabonSi Tavis Tmiani aris mikozebis gamomwvevTa 25%-s Seadgenda

(Hogewoning AA et al, 2011). misi erTeuli SemTxvevebi gamovlinda, agreTve,

SveicariaSi svisSi, tunisSi, susis regionsa da mozambikaSi, maputoSi

(Donghi D et al, 2011, Saghrouni F et al, 2011, Sidat MM et al, 2006, Sidat MM et al, 2007).

Tavis Tmiani aris mikozebis iSviaT antropofilur gamomwvevebs

miekuTvneba, agreTve, Microsporum langeronii da Microsporum ferrugineum.

Microsporum langeronii-is gavrceleba gamovlinda samxreT ivori kostaSi,

kodiuaris bavSvTa populaciaSi, sadac man Tavis Tmiani aris mikozebis

gamomwvevTa 21,4% Seadgina (Fulgence KK et al, 2013), misi erTeuli SemTxvevebi

ki aRiricxa madagaskarSi (Carod JF et al, 2011). nigeriaSi, anambraSi

Catarebuli kvlevis monacemebiT Microsporum ferrugineum Seadgenda Tavis

Tmiani aris mikozebis gamomwvevTa 17%-s (Emele FE  et al,  2008), am

etiologiuri agentiT gamowveuli daavadebis erTeuli SemTxvevebi

dafiqsirda dasavleT CineTSic ( Deng S et al, 2008).

iSviaTia Trichophyton rubrum-iT gamowveuli Tavis Tmiani aris mikozebic.

iranSi, TeiranSi es etiologiuri agenti daavadebis gamomwvevTa saerTo

raodenobis 1%-s Seadgenda (Bassiri Jahromi S et al, 2006), braziliaSi,

sanpauloSi _ 0,9%-s (Moraes MS  et al, 2006), tunisSi, susis regionSi ki _

0,2%-s (Saghrouni F et al, 2011). literaturaSi aRwerilia Trichophyton rubrum-iT

  17

gamowveuli Tavis Tmiani aris mikozebis erTeuli SemTxvevebic. adanaSi

Catarebuli kvlevis Sedegad, romliTac xdeboda pregnantuli, pre da

postmenopauzis asakis qalebSi Tavis Tmiani aris dermatofituli

dazianebebis Sedareba, gamoavlines Trichophyton rubrum-iT gamowveuli Tavis

Tmiani aris mikozis erTi SemTxveva (Toksöz L et al, 2011). saintereso

aRmoCnda 83 wlis mamakacze aRwerili Trichophyton rubrum-iT gamowveuli

Tavis Tmiani aris mikozis SemTxveva, romlis wyaroc iyo dazianebuli

frCxilebi (Kuklová I et al, 2011).

geofiluri Microsporum gypseum-is dabali sixSiriT gavrceleba

aRiniSna ramdenime qveyanaSi. braziliaSi, sanpauloSi Catarebuli

kvlevis monacemebiT, es gamomwvevi gamovlinda Tavis Tmiani aris

mikozebis etiologiuri agentTa 1,8%-Si (Moraes MS et al, 2006), iranSi,

TeiranSi _ 1%-Si (Bassiri Jahromi S et al, 2006), xolo tunisSi, susis regionSi

_ 0,1%-Si (Saghrouni F et al, 2011).

Tavis Tmiani aris gavrcelebul daavadebebs Soris mikozebs

mniSvnelovani adgili uWiravs (Elewski BE et al, 2005), misi epidemiologiis

Seswavla ki dRemde sirTules warmoadgens TiToeul geografiul

arealSi mudmivi cvalebadobis gamo. es daavadeba endemiuria tropikuli

afrikisTvis (Hogewoning AA et al, 2011), Tumca xSirad ucnobia endemur

kerebSi misi gavrcelebis raodenoba (Ayanbimpe GM et al, 2008). bolo

dromde es daavadeba asocirdeboda dabal higienasa da cud

sayofacxovrebo pirobebTan, Tumca gasul aTwleulebSi moxda

mniSvnelovani cvlileba da is gavrcelda evropis kontinentsa da aSS-is

maRalganviTarebul qveynebSi (Ginter-Hanselmayer G et al, 2007). zogadad, bolo

ori aTwleulis ganmavlobaSi aRiniSneba Tavis Tmiani aris mikozebis

sixSiris mateba (Alvarez MS et al, 2006).

Tavis Tmiani aris mikozebis epidemiologiis Seswavlas arTulebs is

garemoebac, rom droSi mudmivad cvalebadia TiToeul qveyanaSi

konkretuli gamomwvevis gavrcelebac. am TvalsazrisiT mniSvnelovan

informacias gvawvdis mimoxilviTi naSromebi. evropeli mecnierebis mier

daavadebis epidemiologiis mimdinare mdgomareobisa da cvlilebebis

Sesaswavlad Catarebuli kvlevis Sedegad gamovlinda, rom bolo

  18

aTwleulebSi sxvadasxva geografiul regionebSi sporadiuli an

epidemiis xasiaTiT gamovlenili Tavis Tmiani aris mikozebis

raodenobriv zrdasTan erTad aRiniSneba TiToeuli gamomwvevis

gavrcelebis gaxSirebac. zoofiluri Microsporum canis darCa yvelaze

gavrcelebul etiologiur agentad xmelTaSuazRvisa da maT mosazRvre

qveynebSi, rogoricaa avstria, ungreTi, Ggermania da poloneTi, Tumca

evropis qalaqebSi Seicvala antropofilur gamomwvevTa speqtri. Ddid

britaneTSi aRiniSna Trichophyton tonsurans-is mateba, safrangeTSi ki

Trichophyton soudanense-is da Microsporum audouinii-is (Ginter-Hanselmayer G 2007).

centralur da samxreT evropaSi, xmelTaSuazRvis auzis qveynebSi

Microsporum canis dominirebas adasturebs sxva kvlevebic (Fuller LC, 2009,

Seebacher C, 2008, Bennassar A et al, 2010), Tumca amasTan erTad aRiniSneba

Microsporum canis-iT gamowveuli Tavis Tmiani aris mikozebis raodenobis

Semcireba koreaSi (Lee WJ  et al, 2012). evropaSiBbolo dros ori

antropofiluri gamomwvevis Trichophyton tonsurans-isa da Trichophyton violaceum-

is mkveTr matebas adasturebs araerTi kvleva (Fuller LC, 2009, Borman AM et

al, 2007, Bennassar A et al, 2010, Simonnet C et al, 2011). bolo wlebSi mkveTrad

imata Trichophyton tonsurans-isa da Trichophyton violaceum-is raodenobam aSS-Si

(Coloe JR 2010). Ddominanti Microsporum audouinii-is Trichophyton tonsurans-iT

Canacvleba aRiniSna iamaikaSic (East-Innis A et al, 2006). Eepidemiologiuri

TvalsazrisiT saintereso aRmoCnda italiaSi Catarebuli kvlevebis

monacemebi. wina wlebSi Catarebuli kvlevebiT Tavis Tmiani aris

mikozebis ZiriTadi gamomwvevebi zoofiluri agentebi iyo, milanSi

Catarebulma uaxlesma kvlevam ki italiaSi bolo wlebSi pirvelad

gamoavlina dominanti antropofiluri Trichophyton violaceum (Asticcioli S et al,

2008, Mapelli ET 2013).

msoflioSi mkveTrad Semcirda favusi. am qronikuli anTebiTi

dermatofituli infeqciis gamomwvevi 90%-Si aris antropofiluri

Trichophyton schoenleinii. Tumca adre es gamomwvevi Tavis Tmiani aris

mikozebis dominanti gamomwvevi iyo, dRes misi gamovlena aqtualuria

mxolod CineTSi, nigeriasa da iranSi (Ilkit M, 2010). tunisSi, susis

  19

regionSi ki aRiniSneba favusis likvidaciisa da Microsporum-iT

gamowveuli anTebiTi formebis zrdis tendencia (Saghrouni F et al, 2011).

konkretuli gamomwvevis erTi qveynidan meoreSi gavrcelebas xSirad

xels uwyobs migraciuli procesebi, rasac araerTi kvleva adasturebs.

dasavleT SotlandiaSi Trichophyton violaceum-iT da Trichophyton tonsurans-iT

gamowveuli Tavis Tmiani aris mikozebis raodenobis zrda ganpirobebuli

iyo am gamomwvevebisaTvis endemiuri kerebidan, afrikidan da pakistanidan,

mosaxleobis migraciiT (Alexander CL et al, 2009). haitSi Trichophyton tonsurans-is

mkveTri matebis mizezi gaxda haiteli diasporis gadaadgilebis zrda

(Raccurt CP et al, 2009). emigraciul gadaadgilebebs miiCneven avstrieli

mecnierebi qveyanaSi daavadebebis gamomwvevebis cvlilebebisa da qveyanaSi

Trichophyton soudanense-sa da Trichophyton tonsurans-is gamovlenis erT-erT

mizezad, riTac am qveyanaSi daavadebis epidemiologia mosazRvre

qveynebis msgavsi gaxda (Binder B, 2011). samxreT-dasavleT poloneTSi

Trichophyton tonsurans-is sagrZnobi mateba mkvlevarebma daukavSires

poloneli mosaxleobis aqtiur gadaadgilebas (Jankowska-Konsur A et al, 2009).

evropis qveynebSi antropofiluri infeqciebis geografiulad

SemosazRvruli gavrceleba mecnierebma afriikis qveynebidan emigraciiT

axsnes (Ginter-Hanselmayer G, 2007). samxreT espaneTSi Catarebuli kvlevis

Sedegebis analizis Sedegad aRmoCnda, rom daavadebulTa Soris 12

emigranti bavSvi iyo. mecnierebis azriT, miuxedavad imisa, rom aqamde

dermatofitebis saxeobebi arsebiTiTad ar Seclila, momavalSi,

emigraciuli procesebis gazrdasTan erTad SeiZleba moxdes cvlileba

etiologiur speqtrSi ( Del Boz J  et al,  2011). baltimorSi, merilendSi,

Catarebuli kvleviT gamovlinda am regionisTvis aratipiuri

etiologiuri agentebis, Trichophyton violaceum-is da Trichophyton soudanense-is,

SemTxvevebi, romlebic warmoadgenen xSir gamomwvevebs afrikisa da

dasavleT aziis qveynebSi da gvxvdeba aSS-ic. am qalaqSi aRniSnuli

gamomwvevebis gavrceleba SeiZleba ukavSirdebodes sxva qalaqebidan

migraciis process (Magill SS, 2007). melburnSi, inglisurenovan skolaSi

Catarebuli kvlevis Sedegad daavadebis maRali sixSiriT gavrceleba

gamovlinda migrant moswavleebSi. maTi umravlesoba iyo afrikidan,

  20

ZiriTadad sudanidan da arabuli qveynebidan gadmosuli. dermatofitebis

saxeobrivi identifikacia moxda rogorc daavadebuli bavSvebidan, ise

mtreblebidan. gamovlinda sami etiologiuri agenti, Trichophyton soudanense,

Trichophyton violaceum da Microsporum audouinii, romlebic iSviaTad gvxvdeboda

da aratipiuri iyo avstraliur skolebSi (McPherson ME, 2008). afrikidan

migraciuli procesebis gazrdas daukavSires mkvlevarebma Trichophyton

violaceum-iT gamowveuli Tavis Tmiani aris mikozebis raodenobis gazrda

stokholmSic (Hällgren J, 2004). zogi mecnieri Tvlis, rom gazrdili

migraciis gamo yvela gamomwvevma SeiZina mniSvneloba (Lehmann S, 2004).

ar arsebobs erTiani monacemebi daavadebis sqesTan kavSiris Sesaxeb.

rigi kvlevebis mixedviT Tavis Tmiani aris mikozebi ufro gavrcelebuli

aRmoCnda mamrobiTi sqesis pirebSi. centralur nigeriaSi gamovlenil

daavadebulTa 78,2% mamrobiTi sqesis piri iyo (Ayanbimpe GM, 2008),

samxreT espaneTSi _ 61,5% (Del Boz J et al, 2011), bostniasa da hercegovinaSi _

56,5% (Prohic A, 2008), CrdiloeT tunisSi _ 68,6% (Zaraa I, 2013), haitSi _ 70%

(Raccurt CP, 2009), samxreT ivori kostaSi _ 74% (Fulgence KK, 2013), tanzaniaSi

dar-es-salamSi _ 51% (Komba EV, 2010), samxreT kuveitSi _ 54,2% (Razzaq Adel

AA, 2007), iranSi, TeiranSi _ 67.5% (Bassiri Jahromi S, 2006), irlandiis

pediatriul populaciaSi ki _ 56% (Hackett BC 2006). anambraSi, nigeriaSi

miRebuli monacemebiT mamrobiTi da mdedrobiTi pirebis Tanafardoba

1,6:1 iyo (Emele FE 2008). londonSi, Trichophyton tonsurans asimptomuri

formebis Seswavlis dros daavadebis gavrceleba mamrobiT sqesSi

statistikurad mniSvnelovani aRmoCnda (White JM et al 2007). daavadebis

mamrobiT sqesTan kavSirs adasturebs samxreT kaliforniasa da

dasavleT bengalSi Catarebuli kvlevebic (Mirmirani P 2013, Kundu D 2012).

sxva mecnierebis monacemebiT Tavis Tmiani aris mikozebi ufro

gavrcelebulia mdedrobiTi sqesis pirebSi. Crdilo-dasavleT eTiopiaSi

gamovlenil Tavis Tmiani aris mikozebiT daavadebulTa 61% mdedrobiTi

sqesis piri iyo (Ali J, 2009), braziliaSi, fortalezaSi, dermatologiur

centrSi _ 64.2% (Brilhante RS 2004), iamaikaze _ 55.7% (East-Innis A 2006),

samxreT_aRmosavleT CineTSi ki _ 56% (Zhu M 2010). aRmosavleT nepalSi

Tavis Tmiani aris mikozebiT daavadebulebSi mamrobiTsa da

  21

mdedrobiTi sqesis pirebs Soris Tanafardoba iyo 1:1,9 (Jha BN 2006).

evropeli mecnierebis monacemebiT daavadeba sqesTan kavSirSi ar aris

(Ginter-Hanselmayer, 2007).

Tavis Tmiani aris mikozebi bavSvebSi yvelaze gavrcelebuli

dermatomikozia, rasac adasturebs rogorc konkretulad Tavis Tmiani

aris, ise pediatriul populaciaSi dermatofitozebis gavrcelebis

Semswavleli araerTi kvleva. samxreT TeiranSi bavSvTa asakSi

dermatofitozebis maxasiaTeblebis Seswavlis Sedegad aRmoCnda, rom

yvelaze gavrcelebuli Tavis Tmiani aris mikozebi iyo da es daavadeba

dermatofitozebis saerTo raodenobis 39,6%-s Seadgenda (Lari AR, 2005).

evropeli mecnierebis monacemebiT is upiratesad 3-7 wlis asakis

bavSvebSia gavrcelebuli (Ginter-Hanselmayer, 2007). amerikeli mecnierebi

Tavis Tmiani aris mikozebis mimoxilviT statiaSi aRniSnaven, rom

daavadeba gvxvdeba upiratesad 12 wlamde asakis bavSvebSi da

afroamerikelebSi (Sarabi K, 2007). iranSi, TeiranSi Catarebuli kvleviT

daavadeba yvelaze gavrcelebuli 3-11 wlis asakis bavSvebSia (Bassiri

Jahromi S, 2006). saharaSi Catarebuli kvlevis monacemebiT Tavis Tmiani aris

mikozebi predominantuli dermatomikozi iyo 12 wlamde asakis bavSvebSi

(Patel GA, 2011). misisipSi, Tavis Tmiani aris dermatofitozebiT gamowveuli

mikozebis TxuTmetwliani retrospeqtruli kvlevis Sedegad aRmoCnda,

rom daavadebulTa umravlesobas 13 wlamde asakis bavSvebi Seadgenda

(Chapman JC et al, 2011). braziliaSi, amazonaSi 12 wlamde asakSi

dermatofitozebis Seswavlam aCvena, rom yvelaze gavrcelebuli Tavis

Tmiani aris mikozebi iyo (Cortez AC, 2012). CrdiloeT indoeTSi

Catarebuli kvlevis mixedviT daavadeba yvelaze gavrcelebuli 8-10 wlis

asakis bavSvebSi aRmoCnda (Grover C et al, 2010). samxreT espaneTSi, bavSvTa

populaciaSi Tavis Tmiani aris mikozebis yvelaze didma 30 wlianma

kvlevam gamoavlina, rom misi gavrcelebis sixSire yvelaze maRali iyo

4-9 wlis asakis bavSvebSi da Seadgenda saerTo raodenobis 66,9%-s (Del

Boz J et al, 2011). sarajevoSi, bosnia da hercegovinaSi Tavis Tmiani aris

mikozebis epidemiologiis Seswavlis aTwlianma kvlevam gamoavlina, rom

daavadebulTa 52,6% 10 wlamde asakis bavSvi iyo (Prohic A, 2008). CrdiloeT

  22

tunisSi anTebiTi Tavis Tmiani aris mikozebis 12 wlianma kvlevam

gamoavlina, rom daavadebulTa 71.9% 10 wlamde asakis, xolo daavadebis

saSualo asaki 8 weli iyo (Zaraa I et al, 2013), aseve, tunisSi, susis regionSi

daavadebis mikologiuri da epidemiologiuri aspeqtebis Seswavlisas

aRmoCnda, rom daavadebulTa 89,3 % 12 wlamde asakis bavSvi iyo (Saghrouni

F 2011). samxreT kuveitSi Catarebulma kvlevam Tavis Tmiani aris

mikozebis gavrcelebis yvelaze maRali maCvenebeli gamoavlina 5 welze

ufrosi asakis bavSvebis jgufSi (Razzaq Adel AA et al, 2007). samxreT-

aRmosavleT avstriaSi daavadebis gavrcelebis Sesaswavlad Catarebuli

kvlevis Sedegad 714 gamovlenili daavadebulidan 517 iyo bavSvi (Binder B,

2011). samxreT-aRmosavleT CineTSi Catarebulma 16-wlianma mimoxilviTma

kvlevem aCvena, rom Tavis Tmiani aris mikozebiT daavadebulTa saSualo

asaki 10,5 weli iyo, daavadebis piki ki 48,5%-iT modioda 6-10 wlis

asakovan jgufze (Zhu M, 2010). milanSi, italiaSi pediatriul populaciaSi

Catarebuli kvlevis mixedviT gamovlinda Tavis Tmiani aris mikozebis 86

SemTxveva da is yvelaze gavrcelebuli aRmoCnda dermatomikozebs Soris

(Mapelli ET, 2013). aRmosavleT nepalSi Catarebuli kvlevis monacemebiT,

sadac Tavis Tmiani aris mikozebi Seadgenda mTliani dermatofitozebis

4,6%, daavadebulTa 68,1% iyo 11 wlamde asakis bavSvi (Jha BN, 2006).

botsvanaSi daavadebis 81% gamovlinda 1-15 wlis asakis bavSvebSi (Thakur

R, 2013). dublinSi, irlandiaSi, pediatriul populaciaSi Catarebuli

Tavis Tmiani aris mikozebis gamokvlevis Sedegad, sadac daavadebulTa

85.5%-s afrikuli warmoSobis bavSvebi Seadgenda, asakobrivi diapazoni

Seadgenda 1-163 Tves, saSualo asaki ki _ 4.02 wels (Hackett BC, 2006). haitSi

Trichophyton tonsurans-iT gamowveuli Tavis Tmiani aris mikozebis

gavrcelebis Seswavlam gamoavlina, rom daavadebulTa asakobrivi

Sualedi 1-16 weli, xolo saSualo asaki _ 6,1 weli iyo (Raccurt CP, 2009).

san pauloSi, braziliaSi am daavadebis Seswavlisas aRmoCnda, rom

daavadebulTa 75%-s Seadgenda 8 wlamde asakis bavSvebi (Moraes MS, 2006).

poloneTSi, gdanskSi Catarebuli dermatofitozebis Semswavleli

kvlevis Sedegad aRmoCnda, rom bavSvebSi gavrcelebuli

  23

dermatofitozebis 30%-s Tavis Tmiani aris mikozebi Seadgenda,

daavadebis piki ki 4-7 wlis asakis bavSvebze modioda (Lange M, 2004).

saudis arabeTSi zerele sokovani infeqciebis maxasiaTeblebis Seswavlis

Sedegad gamovlinda, rom bavSvebSi yvelaze gavrcelebuli iyo Tavis

Tmiani aris mikozebi (Abanmi A, 2008). samxreT-aRmosavleT nigeriaSi mwyems

bavSvebSi daermatofitozebis kvlevis Sedegad aRmoCnda, rom maT Soris

predominantuli forma Tavis Tmiani aris mikozebi iyo (Nweze EI, 2010).

aseve nigeriaSi, ibadanSi skolis moswavleebSi kanis daavadebebis

gavrcelebis Seswavlam aCvena, rom dermatofitozebs Soris yvelaze

xSiri Tavis Tmiani aris mikozebi iyo (Ogunbiyi AO, 2005). bavSvTa asakis

janmrTelobis problemad CaTvales es daavadeba mecnierebma tailandSic,

mikozebis Semswavleli kvlevis Sedegebis gaTvaliswinebiT (Ungpakorn R,

2005). prepubertatuli periodis bavSvebSi Tavis Tmiani aris aqercvladi

dazianebebis Seswavlis Sedegad aRmoCnda, rom am paTologiis erT-erTi

mizezi Tavis Tmiani aris mikozebi iyo (Williams JV, 2005). samxreT

saberZneTSi bavSvebSi dermatomikozebis epidemiologiis Seswavlis

Sedegad miRebuli monacemebiT gamovlinda yvelaze gavrcelebuli

klinikuri forma _ Microsporum canis-iT gamowveuli Tavis Tmiani aris

mikozebi (Koussidou-Eremondi T, 2005). braziliaSi, fortalezaSi,

dermatologiur centrSi Catarebuli kvlevis Sedegad, sadac Tavis

Tmiani aris mikozebis ZiriTadi gamomwvevi iyo Trichophyton tonsurans,

daavadebulTa umravlesoba aRiricxa prepubertatul populaciaSi

(Brilhante RS, 2004). Aam periodSi daavadebis yvelaze maRal sixSires

aRniSnavs zogi sxva mecnieric (Bennassar A, 2010).

gansakuTrebulad mniSvnelovan informacias iZleva bavSvTa

organizebul dawesebulebebSi Catarebuli kvlevebi. maputoSi,

mozambikaSi qalaqisa da soflis skolebis bavSvebis gamokvlevam aCvena,

rom yvelaze gavrcelebuli dermatofitozi Tavis Tmiani aris mikozebi

iyo (Sidat MM 2007, Sidat MM 2006). Crdilo-dasavleT eTiopiaSi, gondarSi

skolis bavSvebSi Catarebuli kvlevis mixedviT daavadebulTa 98%-s

Seadgenda 5-15 wlis bavSvebi, xolo saSualo asaki iyo 10 weli (Ali J et al,

  24

2009). aseve informatiulia eTiopiis dedaqalaqSi, adisababas or skolaSi

Catarebuli kvleva, romlis mixedviTac daavadeba gamovlinda 55-62%-Si

(Woldeamanuel Y, 2005). kvaras StatSi dawyebiT skolaSi dermatomikozebis

gavrcelebis Seswavlam aCvena, rom yvelaze gavrcelebuli Tavis Tmiani

aris mikozebi iyo (Adefemi SA et al, 2011). centralur nigeriaSi dawyebiT

skolaSi Catarebuli kvleviT gamovlinda daavadebul bavSvTa

dominantuli da predominantuli asakobrivi jgufebi, romlebic

Seadgenda Sesabamisad 10-14 da 5-9 wlis asakovan jgufebs (Ayanbimpe GM et

al, 2008). aseve nigeriaSi, anambraSi Catarebuli kvlevis monacemebiT, Tavis

Tmiani aris mikozebiT daavadebulTa 10 wlamde asaki statistikurad

mniSvnelovani aRmoCnda (Emele FE, 2008). kodiuaris Svidi qalaqisa da

soflis dawyebiTi skolebis moswavleebis gamokvlevisas aRmoCnda, rom

Tavis Tmiani aris mikozebi yvelaze gavrcelebuli 9-12 da 4-8 wlis

asakobriv jgufebSi iyo da Seadgenda Sesabamisad saerTo raodenobis

54,3%-sa da 38,1%-s (Fulgence KK, 2013). Tavis Tmiani aris mikozebis 27

SemTxveva gamovlinda madagaskarSic, antananarivos dawyebiT skolebSi

Catarebulma gamokvleviT (Carod JF, 2011). dar-es-salamSi (tanzania)

dawyebiT skolaSi dermatologiuri paTologiebis Seswavlam

gamoavlina, rom yvelaze gavrcelebul dermatomikozs Tavis Tmiani aris

mikozebi warmoadgenda da is saerTo raodenobis 71,4%-s Seadgenda (Komba

EV et al, 2010). kalkutSi, dasavleT bengalSi, qalaqis skolis bavSvebSi

Catarebulma kvlevam gamoavlina am daavadebis farTo gavrceleba.

avadobis maCvenebeli 6-8, 9-11 da 12-14 wlis asakovan jgufebSi TiTqmis

Tanabari iyo (Kundu D, 2012). skolis moswavleebSi Catarebuli kvlevis

Sedegad Trichophyton tonsurans-iT gamowveuli infeqciis yvelaze maRali

maCvenebeli dafiqsirda Savkanian bavSvebSi (Abdel-Rahman SM, 2010).

barselonas skolebSi Catarebuli gamokvlevebis mixedviT daavadebis

gavrcelebam 0.23% Seadgina da gacilebiT naklebi aRmoCnda, vidre

varaudobdnen (Triviño-Duran L 2005, Pérez-González M, 2009).

pediatriul populaciaSi Tavis Tmiani aris mikozebis farTod

gavrcelebis miuxedavad, wlamde asakis periodSi daavadeba Zalian

iSviaTia. Tumca dermatofitul infeqciaze savaraudo yvela SemTxvevaSi

  25

aucilebelia laboratoriuli gamokvlevebis Catareba. daavadebis

gamovlenis SemTxvevaSi ki mkurnalobis kursis sworad SerCevisaTvis

saWiroa gamomwvevis saxeobrivi identifikacia (Michaels BD, 2012). Cvil

bavSvebSi gamovlenili Tavis Tmiani aris mikozebi ZiriTadad aRwerilia

kerZo SemTxvevebis saxiT. wlamde asakis xuTi SemTxveva gamovlinda

dublinSi, irlandiaSi pediatriul populaciaSi Tavis Tmiani aris

mikozebis kvlevis dros (Hackett BC, 2006). aSS-Si, miCiganSi aRweres sami

kviris Cvil bavSvSi gamovlenili SemTxveva, Tavis Tmiani aris dazianebis

mravlobiTi kerebiT, romlis gamomwvevic iyo Microsporum canis (Atanasovski M

et al, 2011). argentinaSi, buenos airesSi gamoavlines neonataluri

periodisaTvis iSviaTi Kerion Celsi-is sami SemTxveva. dadginda, rom or

maTgans hqonda arapirdapiri kontaqti daavadebul kurdRelTan da maTi

infeqciis etiologiuri agenti iyo Trichophyton mentagrophytes var.

mentagrophytes, mesame bavSvis daavadebis wyaro ki aRmoCnda xelis mtevnebis

dermatomikoziT daavadebuli mama, gamomwvevi ki _ Trichophyton rubrum

(Larralde M et al, 2010). italielma mecnierebma aRweres iSviaTi SemTxveva:

TxuTmeti dRis gogona Tavis Tmian areSi sqvamozuri dazianebiT

daavadebuli aRmoCnda Trichophyton rubrum-iT gamowveuli Tavis Tmiani

aris mikoziT. daavadebis wyaro iyo fsoriazis diagnoziTa da

steroiduli TerapiiT arasworad namkurnalebi deda, romelsac

aReniSneboda aseve Trichophyton rubrum-iT gamowveuli sxeulis mikozi

(Mapelli ET, 2012). Trichophyton rubrum-iT iyo gamowveuli sami Tvis

axalSobilSi aRwerili Tavis Tmiani aris mikozis SemTxvevac (Valari M,

2006).

miuxedavad imisa, rom Tavis Tmiani aris mikozebi rCeba yvelaze

gavrcelebul infeqciad bavSvTa asakSi, bolo dros aRiniSneba misi

mateba mozrdilTa da moxucebulTa populaciebSic (Ginter-Hanselmayer G,

2007). samxreT-aRmosavleT avstriaSi am daavadebis Seswavlis Sedegad

pacientTa umravlesoba iyo bavSvTa asakis, Tumca ocdaerTi SemTxveva

gamovlinda mozrdilebSic (Binder B et al, 2011). mozrdilebSi daavadebis 175

SemTxveva gamovlinda tunisSi, susis regionSi daavadebis mikologiuri

  26

da epidemiologiuri aspeqtebis Seswavlisas (Saghrouni F, 2011). aseve

tunisSi, mozrdilTa asakSi Tavis Tmiani aris mikozebis Seswavlisas

aRmoCnda, rom daavadebis ZiriTadi gamomwvevi Trichophyton violaceum iyo da

amasTanave aRiniSneboda Microsporum canis-is gavrcelebis tendencia

Sinauri cxovelebis mier misi usimptomo mtareblobis gamo (Mebazaa A et al,

2010). moxucebulTa Soris SemTxvevebi gamovlinda CineTSi Catarebuli

kvlevis Sedegad (Zhu M, 2010). espaneTSi, senegalSi, 31 wlis qals

gamouvlinda erTdroulad ori etiologiuri agentiT Trichophyton

soudanense da Microsporum audouinii gamowveuli Tavis Tmiani aris mikozi.

(Rezusta A, 2011). bolo dros aqtualuri gaxda dakvirveba postmenopauzis

periodSi Tavis Tmiani aris mikozebis gavrcelebaze (Chen W, 2010).

Tavis Tmiani aris mikozebi gamoirCeva maRali kontagiozurobiT,

upiratesad bavSvTa asakSi da amitomac igi jandacvis mniSvnelovan

problemas warmoadgens (Chapman JC 2011, Magill SS 2007). am maxasiaTeblis

gamo igi xSirad mikroepidemiebis mizezic xdeba, wyaro ki gansxvavebulia

gamomwvevis Tvisebebisgan gamomdinare. Tavis Tmian areSi folikulebis

didi raodenoba da cximis gamoyofis maRali maCvenebeli xelsayrel

pirobebs qmnis zerele sokovani infeqciis ganviTarebisTvis. garedan

infeqciis moxvedra ki SeiZleba moxdes TmebTan an Tavis kanTan

dainficirebuli sagnebis, savarcxlisa da qudis kontaqtis Sedegad

(Grimalt R, 2007).

Tavis Tmiani aris mikozebis antropofilur formaTa wyarosa da

gadamtanebs adamianebi warmoadgenen. daavadebis maRali kontagiozurobis

gamo es daavadeba xSirad advilad vrceldeba ojaxebSi, sadac mravali

wevri erTad cxovrobs. literaturaSi arsebobs am mosazrebis

damadasturebeli araerTi kvleva. anambraSi, nigeriaSi Catarebuli

kvlevis monacemebiT daavadebuli bavSvebis 91% mWidrod mcxovrebi

mravalSviliani ojaxebidan iyo (Emele FE, 2008). madagaskarSi,

antananarivos dawyebiT skolaSi dafiqsirebuli antropofiluri

Microsporum langeronii-iT gamowveuli epidemiis Seswavlam gamoavlina, rom

infeqciis wyaros daavadebulTa da-Zmebi d Tanaklaselebi

warmoadgendnen (Carod JF et al, 2011). Aaseve mWidro kontaqts ukavSirdeba

  27

antropofiluri formebis xSiri gavrceleba sportsmenebSi.

antropofiluri Trichophyton tonsurans gaxda adanaSi, TurqeTSi

sportsmenebSi Tavis Tmiani aris gavrcelebis mizezi, sadac daavadeba

rva SemTxvevaSi asimptomuri formiT, xolo xuTSi Tavis Tmiani aris

zerele formiT gamovlinda (Ilkit M et al, 2010). sportsmenebSi

gavrcelebuli daavadebebis 20 wliani literaturuli mimoxilvis

Sedegad erT-erTi mniSvnelovani aRmoCnda Tavis Tmiani aris mikozebi

(Grosset-Janin A, 2012). daavadebis xSiri gavrcelebas sportsmenebSi

aRniSnaven sxva mecnierebic (Pleacher MD, 2007). Tavis Tmiani aris mikozebis

zoofilur formaTa wyarosa da gadamtanebs cxovelebi warmoadgens.

Microsporum canis-iT gamowveuli infeqciebis ZiriTadi mtareblebi da

gadamtanebi usaxlkaro ZaRlebi da katebi, aseve Sinauri lekvebi, knutebi

da kurdRlebi arian (Bennassar A, 2010). CineTSi aRwerili iyo ojaxuri

SemTxveva, romlis drosac gamovlinda Tavis Tmiani aris mikoziT

daavadebuli ori mcirewlovani bavSvi da sxeulis mikoziT daavadebuli

deda. Microsporum canis gamowveuli infeqciis wyaro iyo Sinauri ZaRli (Yin

B 2013). miuxedavad imisa, rom Microsporum canis aris zoofiluri gamomwvevi,

literaturaSi aRwerilia SemTxveva, roca misi gavrceleba moxda

adamianidan adamianzec dawyebiTi skolis bavSvebSi (Grills CE, 2007).

Trichophyton verrucosum-is gadamtanebi ZiriTadad msxvilfexa rqosani

pirutyvia. germaniaSi aRwerili daavadebis Rrma forma 2,8 wlis bavSvze,

romelic cxovrobda fermaSi, sadac imyofeboda Zroxebi da xboebi

(Blömer RH, 2012). arsebobs iSviaTi SemTxvevebic. amis magaliTia xuTi

wlis gogona, romelsac ganuviTarda Trichophyton mentagrophytes-iT

gamowveuli Kerion Celsi, romlis wyaroc iyo zRvis goWi (Jaspers GJ, 2011).

daavadebis gavrcelebaze gavlenas axdens rogorc mosaxleobis

informaciuloba da ganaTleba, aseve swori diagnozis drouli

gamovlena da daavadebis srulyofili mkurnaloba, risTvisac Zalze

mniSvnelovania dermatologebis, mikologiuri samsaxurisa da ojaxis

eqimebis koordinirebuli muSaoba. aseTi daskvna gakeTda sxvadasxva

qveyanaSi Catarebuli araerTi kvlevis Sedegad. CrdiloeT kaliforniaSi

Catarebuli kvlevis periodSi Tavis Tmiani aris mikozebis Semcirebis

  28

savaraudo mizezebad mkvlevarebma ganaTlebis, diagnostirebisa da

mkurnalobis gaumjobeseba daasaxeles (Mirmirani P, 2013). Sotlandieli

mecnierebi daavadebis raodenobis zrdas misi aqtiuri gamovlinebiT

xsnian, rac zogadi praqtikis eqimebisa da dermatologebis mikologiur

klinikasTan aqtiuri TanamSromlobis Sedegi aRmoCnda (Alexander CL, 2009).

avstrieli mecnierebi epidemiologiur cvlilebebs zogadi praqtikis

eqimebis, dermatologebisa da veterinarebis saerTo problemad miiCneven

da gamosavals maT erTobliv muSaobaSi xedaven (Binder B et al, 2011). zogadi

praqtikis eqimebsa da dermatologebs Soris kavSiris ararseboba

gamoavlina samxreT espaneTSi Catarebuli kvlevis periodSi gamovlenil

SemTxvevaTa ganxilvam (Del Boz J et al, 2011). zogadi praqtikis eqimebis,

mikologebis, dermatologebisa da veterinarebis interdisciplinaruli

TanamSromlobis rekomendacias iZlevian evropeli mecnierebic

daavadebaze epidzedamxedvelobis, misi drouli diagnostirebisa da

mkurnalobis gansaxorcieleblad, raTa man epidemiis saxe ar miiRos

axlo momavalSi (Ginter-Hanselmayer G, 2007).

populaciis SigniT infeqciis gavrceleba xSirad gvxvdeba dabali

ekonomikuri ganviTarebis qveynebSi da ukavSirdeba arasakmaris higienur

pirobebs. centraluri nepalis zogierT nawilSi daavadebis gavrcelebas

mecnierebi miwasTan da cxovelebTan xSiri kontaqtis mqone mosaxleobis

dabal sanitarul ganaTlebas (rogorc pirad, aseve ekologiur higienaSi)

miiCneven (Ayanbimpe GM, 2008). araxelsayreli socialur-sayofacxovrebo

pirobebiT axsnes mecnierebma daavadebis gavrceleba alJirSic

(Benmezdad A, 2012). Tumca zogi mecnieri am azrs ar eTanxmeba. dasavleT

bengalSi Catarebuli kvlevis Sedegad ar gamovlenila higienur

pirobebSi gansxvaveba Tavis Tmiani aris mikozebiT daavadebul da

janmrTel mosaxleobas Soris (Kundu D, 2012).

2.2. Tavis Tmiani aris mikozebis klinikuri manifestacia da

diagnostika

Tavis Tmiani aris mikozebis klinika mravalferovania da moicavs

rogorc asimptomur, ise gamoxatuli simptomebisa da inkognito formebs.

asimptomaturi formebis, rogorc infeqciis faruli wyaros gamovlena,

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metad mniSvnelovania daavadebis gavrcelebis prevenciisaTvis. aseT

formebs xSirad iwvevs antropofiluri gamomwvevebi: Trichophyton tonsurans

da Trichophyton violaceum. samxreT londonSi Catarebuli kvlevis Sedegad

gamovlenili asimptomuri formebis gavrcelebis mizezi iyo ojaxis

wevrebTan kavSiri, romlebsac ar hqondaT simptomuri gamovlineba da

warmoadgendnen infeqciis wyaros kontaqtSi myof pirTaTvis. am

SemTxvevaSi gamovlenili gamomwvevi aRmoCnda Trichophyton tonsurans (White JM

et al, 2007). svisis skolaSi, SveicariaSi gamoavlines am regionisaTvis

aratipiuri etiologiuri agentiT, Microsporum audouinii, gamowveuli Tavis

Tmiani aris mikozebis sami SemTxveva 7-8 wlis asakis bavSvebSi.

kontaqtebis gamokvlevis Sedegad ki aRmoCda, rom daavadebulTa sami

ojaxis wevri da xuTi klaseli iyo am infeqciis asimptomuri mtarebeli

(Donghi D et al, 2011). TurqeTSi Catarebuli kvlevebis mixedviT asimptomur

formebs iwveven rogorc antropofiluri, ise zoofiluri etiologiuri

agentebi. adanas skolaSi asimptomuri Tavis Tmiani aris mikozebis

Seswavlis Sedegad aRmoCnda, rom misi gavrceleba simptomuri formebis

analogiuri iyo, ZiriTadi gamomwvevebiki-zoofiluri agentebi Microsporum

canis da Trichophyton mentagrophytes var. Mentagrophytes (Ilkit M et al, 2007). Aaseve,

TurqeTSi, asimptomuri Tavis Tmiani aris dermatofituli dazianebebis

laboratoriuli diagnostirebis, epidemiologiisa da menejmentis

Seswavlisas gamovlinda am formebis kavSiri or anTropofilur

gamomwvevTan, Trichophyton tonsurans-Tan da Trichophyton violaceum-Tan, daavadeba

upiratesad gavrcelebuli iyo 4-8 wlis bavSvebSi, jansaRi Tmis RerebiTa

da dazianebuli Tavis Tmiani aris kaniT, romlebic warmoadgendnen

infeqciis wyaros rogorc TanaklaselebisTvis, ise ojaxis wevrebisTvis

(Ilkit M et al, 2008). TurqeTSi Catarebuli erT-erTi kvlevis Sedegad

aRmoaCines sami daavadebis mtarebeli bavSvi, romelTagan ori aRmoCnda

Trichophyton tonsurans-iT, erTi _ Trichophyton mentagrophytes-iT dainficirebuli,

ojaxis wevrebis gasinjvis Sedegad ki gamovlinda rom Trichophyton

mentagrophytes-is usimptomo kolonizaciiT mtarebeli biWis xuTi wlis da

aseve iyo Trichophyton mentagrophytes-is infeqciis mtarebeli (Kurdak H, 2009).

asimptomuri dermatofitebis sadiagnostikod Catarebuli sxva kvleviT

  30

miRebuli SedegebiT, am formis dominanturi gamomwvevi iyo aseve

zoofiluri Trichophyton mentagrophytes. ar gamovlenila misi kavSiri arc

asakTan, arc sqesTan da arc sxva dermatofitozis arsebobasTan. mxolod

arabuli warmomavloba CaiTvala erTaderT risk-faqtorad (Akbaba M,

2008). asimptomuri Tavis Tmiani aris mikozebis SemTxvevebi gamovlinda

palestinaSic nablus regionSi dawyebiTi skolebis bavSvebis

gamokvlevis drosac (Ali-Shtayeh MS, 2002).

inkognito formebis SemTxvevebSi kanis sxva paTologiebTan Zlieri

msgavsebis gamo diferencialuri diagnozis gatareba sakmaod

garTulebulia. es problema xSirad ukavSirdeba topikuri an sistemuri

kortokosteroidebis araswor moxmarebas, ris Sedegadac icvleba

dermatofitozebis klinikuri gamovlineba sxva dermatozebis imitaciis

formiT. msgavsi formebi aRwerilia araerT kvlevaSi. iranSi inkognito

sokovani daavadebebis klinikur-epidemiologiuri da mikologiuri

aspeqtebis Seswavlisas gamovlinda Tavis Tmiani aris mikozebis

inkognito formis sami SemTxveva, rac Seadgenda saerTo inkognito

infeqciebis 5,4%-s. ori maTgani diagnostirda, rogorc folikuliti,

erTi ki-alopecia. folikulitis msgavsi formebis gamomwvevi aRmoCnda

Trichophyton verrucosum da Trichophyton schoenleinii, xolo alopeciis-Trichophyton

violaceum (Ansar A, 2011). italieli mecnierebis mier 56 wlis mamakacze

aRwerili Tavis Tmiani aris mikozi axdenda jgufuri folikulitis

imitacias (Baroni A, 2009). literaturaSi aseve aRwerilia zrdasrul

mamakacze Microsporum canis-iT gamowveuli da difuzuri alopeciiTa da

folikuluri pustulebiT gamoxatuli Tavis Tmiani aris mikozis forma,

romelsac SecdomiT daesva diagnozi folliculitis decalvans (Tangjaturonrusamee C,

2011). san diegoSi, kaliforniaSi aRweres Trichophyton tonsurans-iT

gamowveuli daavadebis anTebiTi forma, romelmac moaxdina celulitis

imitireba (Stein LL, 2013). eroziuli pustulozuri dermatozi swored is

daavadebaa, romelic Tavis Tmiani aris mikozis msgavsi simptomatikis

gamo araerTxel gamxdara diagnostikuri Secdomis mizezi. Tavis Tmiani

areSi pustulebis, eroziebisa da qerqebis arseboba aucilebelad

moiTxovs gamoiricxos dermatofitozis arseboba. es daavadeba rogorc

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wesi, moxucTa asakSi viTardeba da am asakSi Tmiani aris mikozis

anTebiTi forma metad iSviaTia, Tumca mainc arsebobs. arizonaSi

mecnierebma aRweres qerionis sami SemTxveva, moxucebi, romelTac Tavis

Tmian areSi aReniSnebodaT pustulozuri gamonayari. pirvelad

Catarebulma kulturaluri da biofsiuri kvlevis Sedegebma gamoricxes

sokovani infeqciis arseboba da daavadeba Sefasda, rogorc eroziuli

pustulozuri dermatozi. mogvianebiT, kulturaluri kvleviT moxda

dermatofitebis gamovlena. erT pacientSi gamovlinda triqofitonis

saxeobis etiologiuri agenti, orSi ki-mikrosporumis saxeobis.

sabolood daisva swori, qerionis diagnozi da pacientebis terbinafiniT

mkurnaloba Sesabamisad aRmoCnda Sedegiani (Chia C, 2013). aRwerilia

SemTxvevebic, roca eroziuli pustulozuri dermatiti Sefasda rogorc

Tavis Tmiani aris mikozi. swored aseTi SemTxveva aRweres espanelma

mecnierebma 80 wlis kavkasiel mamakacze daavadebis samTviani istoriiT,

romelsac simptomebi ganuviTarda aqtinuri keratozis krioTerapiis

Semdeg. Tavis Tmian areSi ganviTarebuli mtkivneuli eriTematozuli

eroziebi da qerqebi Sefasda rogorc Tavis Tmian aris mikozi da

pacienti mkurnalobda uSedegod mupirociniTa da antifungaluri

saSualebebiT (Vano-Galvan S, 2012).

Tavis Tmiani aris mikozebis simptomatika metad mravalferovania.

triqofitonebiT gamowveuli infeqciebi SeiZleba gamovlindes rogorc

zerele, ise Rrma dazianebis formiT. zerele formebis SemTxvevaSi

momrgvalo formisa da araswori sazRvrebis mqone wvrili an

msxvilkerovani ubnebi sustad anTebiTia da dafarulia vercxlisferi

qerclebiT. kerebSi aRiniSneba gadamtvreuli Tmis Rerebi. Qqronikuli

mimdinareobis SemTxvevaSi vlindeba rogorc Savi wertilebi. Rrma

formis SemTxvevaSi viTardeba folikuluri abscesebiT warmodgenili

mtkivneuli, mkvrivi ubnebi – Kerion Celsi (Скрипкин Ю, 1999). Trichophyton

tonsurans-iT gamowveuli Tavis Tmiani aris mikozebis oTxi ZiriTadi

klinika forma gamoyo Хэбиф Т. П-m seboreuli, qerioni, Savwertilovani

da pustulozuri (2008).

xSirad Tavis Tmiani aris mikozebis klinikuri suraTi imdenad

tipiuria, rom diagnostirebis saSualebasac ki iZleva, gansakuTrebiT

  32

maSin, roca gadidebulia kefis limfuri jirkvlebi (Kelly BP, 2012). Aam

daavadebis diagnozis dasma gansakuTrebiT gaZnelebulia araanTebiTi

antropofiluri formebis dros, upiratesad Savkanian pacientebSi

skalpis eriTemis Sefasebis sirTulis gamo  (Mapelli ET, 2012). rTul,

sakamaTo Temad miiCneven Tavis Tmiani aris mikozebis diagnostirebas

kanadeli mecnierebic da am sirTules daavadebis klinikuri suraTis

mravalferovnebiT xsnian: is SeiZleba gamoixatos rogorc mxolod

minimalurad gamoxatuli prurigos simptomiT Tmis cvenis gareSe, ise

Cirqovani procesebiTa da xangrZlivi Seuqcevadi danawiburebiTac ki

anTebiTi qerionis SemTxvevaSi (Ali S, 2007). Kerion celsi-is gamoyofen

daavadebis anTebiTi dazianebebis simptomatikis tipiuri da iSviaTi

formebis ganxilvis drosac, rogorc dayovnebul hipersensitul

reaqcias dermatofitul gamomwvevze (Proudfoot LE, 2011).

Mmravalferovania sxva mecnierebis mier CamoTvlili klinikuri

maxasiaTeblebic. Tavis Tmiani aris mikozebis mimoxilviT statiaSi

amerikeli mecnierebi ZiriTad simptomebad asaxeleben Tmis cvenas,

aqercvlas, eriTemasa da impetigos-msgavs gamonayars (Sarabi K, 2007). zogjer

daavadeba vlindeba alopeciuri ubnebis warmoqmniT, romelic SeiZleba

iyos eriTematozuli da aqercvladi zedapiriT (Mounsey AL, 2009). swored

alopeciuri formebis sixSires asaxavs samxreT-aRmosavleT nigeriaSi

bavSvTa asakSi Tmis Rerebis dakargvis banaluri da iSviaTi SemTxvevebis

Semswavleli kvleva, romlis monacemebis mixedviTac am paTologiis

yvelaze xSiri mizezi Tavis Tmiani aris mikozebi iyo 54,9% (Nnoruka EN,

2007).

gansxvavebulia sxvadasxva qveyanaSi Tavis Tmiani aris mikozebis

klinikuri formebis gavrceleba. irlandiaSi pediatriul populaciaSi

Tavis Tmiani aris mikozebis kvlevis dros gamovlenili klinikuri

simptomebi Semdegnairad gadanawilda: aqercvla (35,47%), aqercvla da

alopecia (53,24%), alopecia da qerioni (11,29%) (Hackett BC, 2006). samxreT

kuveitSi nacrisferi laqebi iyo yvelaze gavrcelebuli klinikuri

forma (Razzaq Adel AA, 2007). antatanarivoSi, madagaskarSi daavadebis

ZiriTadi klinikuri forma iyo Microsporum langeronii-iT gamowveuli

nacrisferi laqebi (Carod JF, 2011). Aaseve nacrisferi laqebi aRmoCnda

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yvelaze gavrcelebuli klinikuri forma dasavleT CineTSi (Deng S, 2008)

da aRmosavleT nepalSic, sadac klinikuri formebis ganawileba iyo

Semdegi: nacrisferi laqebi iyo yvelaze gavrcelebuli forma (52.2%),

Semdeg Savwertilovani forma (17.4%), seboreuli dermatitis (13%),

budobrivi alopecia (11.6%) da pustularuli (4.3%) (Jha BN,2006).

CrdiloeT indoeTSi klinikuri formebis 56,5%-s Seadgenda araanTebiTi

formebi (Grover C, 2010), saharaSi Tavis Tmiani aris mikozebis

gavrcelebuli simptomebi iyo Tmis cvena, aqercvla, eriTema da impetigos

msgavsi gamonayari (Patel GA, 2011), samxreT afrikaSi ki daavadebis

klinikuri formebis 50%-s Seadgenda Savwertilovani forma (Morar N,

2004).

gansxvavebulia sxvadasxva etiologiuri agentebiT gamowveuli

klinikuri simptomebic. araanTebiT formebs iwveven rogorc zoofiluri,

ise antropofiluri gamomwvevebi. samxreT espaneTSi Catarebuli kvlevis

mixedviT yvelaze gavrcelebuli Tavis Tmiani midamos mikozebis

araanTebiTi formebis upiratesi gamomwvevi iyo zoofiluri

etiologiuri agenti-Microsporum canis (Del Boz J, 2011). Trichophyton tonsurans- iT

gamowveuli daavadeba ki xSirad gamoixateba aqercvliTa da mcired

gamoxatuli Tmis cveniT, Tumca is intensiuri anTebiTi procesebis

mizezic SeiZleba gaxdes (Trovato MJ 2006). anTebiTi Tavis Tmiani aris

mikozebi, rogoricaa, favusi, Kerion Celsi, dermatofituli granuloma da

micetoma, SeiZleba gamoiwvios Microsporum canis-ma, Trichophyton mentagrophytes-

ma, Trichophyton tonsurans-ma, Trichophyton rubrum-ma da Microsporum gypseum-ma (Isa-Isa

R, 2010). samxreT- aRmosavleT CineTSi qerionis ZiriTadi gamomwvevi iyo

Trichophyton rubrum ( Zhu M, 2010). CrdiloeT tunisSi iSviaTi, Tumca soflis

ojaxebSi sakmaod gavrcelebuli anTebiTi forma, gamowveuli iyo

Trichophyton violaceum-iT ( Zaraa I 2013). Microsporum canis, Trichophyton violaceum da

Trichophyton rubrum iyo qerionisTvis ZiriTadi gamomwvevebi samxreT-

aRmosavleT CineTSi (Zhu M, 2010).

gansakuTrebiT rTulia klinikuri niSnebis Sefaseba daavadebis sxva

paTologiasTan erTdrouli arsebobis SemTxvevaSi. zogjer qerioni sxva

daavadebebis inicirebas iwvevs da maTTan asocirebuli formiT

  34

gvevlineba. Castriota M-m aRwera iSviaTi SemTxveva-Erythema nodosum-is

asociacia Tavis Tmiani aris dermatomikozTan. cxra wlis gogonas Tavis

Tmiani aris ocipitalur areze gauCnda Erythema nodosum-is gamonayari,

romelic inicirebuli iyo Kerion Celsi-iT. dazianebuli keris aridan

aRebuli masalis mikroskopuli gamokvleviT gamovlinda eqtotriqsis

tipis gamomwvevi, kulturaluri kvlevis Sedegad ki _ Trichophyton

mentagrophytes (Castriota M, 2013). msgavsi SemTxvevebi aRweres sxva

mecnierebmac. Calista-m gamoavlina daavadebuli xuTi wlis gogona, Zaraa-m

Svidi wlis biWi da Morrone-m 35 wlis qali. samive maTgans Tavis Tmian

midamoSi aReniSnebodaT Kerion Celsi-Tan asocirebuli Erythema nodosum-is

gamonayari. Tavis Tmiani aris dermatomikozis gamomwvevi samive

SemTxvevaSi iyo Trichophyton mentagrophytes (Calista D et al 2001, Zaraa I et al 2012,

Morrone A 2011). qerionis SemTxvevaSi Tavis Tmiani aris mikozebi SeiZleba

gaxdes diagnostirebisa da Sesabamisad mkurnalobis seriozuli

Secdomis mizezic. Sveicareli mecnierebis mier aRwerilia ori bavSvis

SemTxveva, romelTagan erTs gaukeTda qerionis keris qirurgiuli

gakveTa da meores-amokveTa (Von Laer Tschudin L, 2007). qerioni zogjer

sakmaod rTulad mimdinareobs. literaturaSi aRwerilia 5-wlis gogona,

romelsac ganuviTarda Trichophyton mentagrophytes-iT gamowveuli Kerion Celsi

da daavadebis gamosavali iyo alopeciuri kerebi (Jaspers GJ, 2011).

rogorc qronikulma, ise mwvave anTebiTma infeqciebma SeiZleba daazianos

Tmis folikuli da gamoiwvios meoradi nawiburovani alopecia. Tumca

arsebobs literaturaSi aRwerili iSviaTi SemTxvevebi, roca

nawiburovani alopecia daavadebis dasawyisSive gamovlinda (Mirmirani P,

2009), amitomac saWiroa budobrivi alopeciis diferencialuri diagnozis

gatareba Tavis Tmiani aris mikozebTan (Finner AM, 2011).

Tavis Tmiani aris mikozebis klinikuri manifestaciis Semadgenel

nawils warmoadgens alergiuli dermatofitiduli reaqciebi. arcTu

iSviaTi gamovlinebisa da arsebiTi klinikuri mniSvnelobisa miuxedavad,

masze literaturuli monacemebi mcirea. mecnierebi Tvlian, rom Tavis

Tmiani mikozebis dros meoradad ganviTarebuli alergiuli

dermatofitiduli reaqciebi gacilebiT xSiria, vidre amas arsebuli

  35

informacia asaxavs. am gamovlinebas mSoblebi da klinicistebi xSirad

preparatze alergiul reaqciad miiCneven. egzematozuri formiT

gamovlenili dermatofitidebi ar aris kavSirSi sistemur TerapiasTan.

dermatofitiduli reaqcia SeiZleba ganviTardes rogorc antimikozuri

sistemuri Terapiis dawyebamde, ise TerapiiT inicirebis Semdegac da is

ar unda warmoadgendes mkurnalobis Sewyvetis mizezs (Cheng N, 2011).

amerikeli mecnierebis azriT misi swori Sefaseba metad mniSvnelovania

araswori diagnostikisa da masTan dakavSirebuli Sedegebis Tavidan

asacileblad (Payne LK, 2012).

aucilebelia daavadebis klinikurad saeWvo SemTxvevebis

dadastureba mikroskopulad da kulturalurad (Möhrenschlager M, 2005).

mikroskopuli gamokvleva, aRebuli masalis 10-20% KOH-is xsnariT

damuSaveba, romlis Sedegadac xdeba sokos sporebisa da miceliumebis

gamovlena, Tavis Tmiani aris mikozebis gamomwvevebis Semswavleli yvela

kvlevis nawilia. Aam meTodiT aseve xdeba Tmis Reris dazianebis formis

gansazRvrac. Aarsebobs Tmis Rerebis dazianebis ori forma.

eqtotriqsis dros xdeba Tmis dazianeba garedan da arTrosporebis mier

kutikulis darRveva tvinovani da qerqovani Sreebis dazianebis gareSe,

endotriqsis SemTxvevaSi ki Tmis Reri ziandeba Signidan, arTrosporebi

warmoiqmneba tvinovan da qerqovan SreebSi, kutikula ki dauzianebeli

rCeba (Томас П. Хэбиф 2008, Кей-Шу-Мей Кейн 2011). mikroskopuli

gamokvlevisTvis nimuSis aRebis meTodebis Sesaxeb arsebobs

gansxvavebuli mosazrebebi. britaneli mecnierebi Tvlian, rom diagnozis

dasadastureblad umjobesia gamoyenebul iqnas nimuSis aRebis ramdenime

meTodi skalpis masaJori jagrisiT, kbilis jagrisiT, bambis dolbandis

teniani tamponebiTa an citojagrisiT, mgrZnobelobis asamaRleblad

(Fuller LC, 2009) tradiciul meTodebTan SedarebiT citojagrisis

gamoyenebis upiratesobas aRniSnaven sxva mecnierebic (Bonifaz A et al, 2007).

Tavis Tmiani aris asimptomuri dazianebebis sadiagnostikod Tmis

jagrisis, kbilis jagrisisa da bambis tamponis meTodebis Sesadarebeli

kvlevis Sedegad aseve aRmoCnda, rom laboratoriuli

diagnostirebisTvis arcerTi maTgani ar warmoadgenda oqros standarts,

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amitomac mecnierebma rekomendacia kvlav kombinirebul diagnostikas

gauwies (Akbaba M et al, 2008).

Tavis Tmiani aris gamomwvevis saxeobrivi identifikaciisaTvis

iyeneben kulturalur kvlevas, mxolod gansxvavebulia niadagebi

romelzec xdeba aRebuli masalis daTesva. mkvlevarma Chapman JC

gamoiyena mikozel agari cikloheqsimidiTa da qloramfenikoliT(Chapman

JC, 2011), Ilkit M saburos glukoz agari cikloheqsimidiT,

qloramfenikoliTa da gentamiciniT (Ilkit M, 2007). Kurdak H saburos glukoz

agari( Kurdak H, 2009), Lee WJ deqstroz agari qloramfenikoliT(Lee WJ, 2012),

Thakur R dermaselis agari da saburos deqstroz agari (Thakur R, 2013).

saxeobrivi identifikaciisaTvis gamoyenebuli axali meTodi P PCR-

diagnostika gvaZlevs saSualebas Zalian swrafad, 24 sT-is ganmavlobaSi

moxdes gamomwvevis saxeobis identifikacia (Fuller LC, 2009). Microsporum canis

sadiagnostikod PCR-diagnostikis 100% specifiurobasa da mgrZnobelobas

aRniSnaven poloneli mecnierebi ( Brillowska-Dabrowska A, 2013).

2.3. Tavis Tmiani aris mikozebis mkurnalobis principebi

gansxvavebulia im kvlevebis Sedegebi, romlebic sazRvraven Tavis

Tmiani aris mkurnalobaSi sxvadasxva preparatebis efeqturobas.

kanadeli mecnierebi Tvlian, rom sistemuri Terapia aucilebelia,

radgan topikuri preparatebi ver aRweven da ver axdenen infeqciis

eradikacias Tmis Rerebidan. oraluri grizeofulvini rCeba mkurnalobis

standartSi, Tumca terbinafini da itrakonazoli warmoadgenen mis

efeqtur alternativas (Ali S, 2007). bavSvebSi gavrcelebuli sokovani

daavadebebis mkurnalobis principebis mimoxilvisas amerikeli mecnierebi

aRniSnavdnen, rom umravlesi sokovani infeqciebis mkurnaloba

SesaZlebelia topikuri preparatebiT, oraluri Terapia ki unda iyos

rezervuarad Tavis Tmiani aris mkurnalobisTvis. oraluri

grizeofulvini warmoadgens misi mkurnalobis standarts, Tumca ufro

axali oraluri antifungaluri preparatebi, rogoricaa terbinafini,

itrakonazoli da flukonazoli aris efeqturi, usafrTxo da aqvT

mkurnalobis mokle kursi (Andrews MD, 2008). espanelma mecnierebma

bavSvebSi Tavis Tmiani aris mikozebis menejmentis ganxilvisas aRniSnes,

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rom es daavadeba yovelTvis saWiroebs sistemur mkurnalobas, radgan

topikuri antifungaluri saSualebebi ver aRweven Tmis folikulebis

Rrma SreebSi. 1950 wlis bolodan grizeofulvini iTvleboda sistemuri

mkurnalobis oqros standartad. grizeofulvinis arakomfortuloba misi

xangrZlivi miRebaa, rac SeiZleba yuradRebis modunebiT damTavrdes.

SedarebiT axali preparatebi, rogoricaa terbinafini, itrakonazoli,

ketokonazoli da flukonazoli, aris sakmaod efeqturi da saWiroebs

mkurnalobis mokle kurss grizeofulvinTan SedarebiT triqofitonebis

saxeobebis SemTxvevaSi, mxolod isini ZviradRirebulia (Bennassar A, 2010).

12 wlamde asakis bavSvebSi (infeqciis gamomwvevi iyo T. violaceum)

Catarebulma kvlevam, romlis mizanic iyo Tavis Tmiani aris mikozebis

mkurnalobaSi grizeofulvinis, terbinafinisa da flukonazolis

efeqturobis Sedareba, gamoavlina efeqturoba Semdegi procentuli

maCveneblebiT: grizeofulvinis SemTxvevaSi 96%, terbinafinis-88% da

flukonazolis-84%, amitomac grizeofulvini rCeba arCevis preparatad,

terbinafini aris rigiT meore preparati, romelic SesaZleblobas

gvaZlevs CavataroT mokle kursi, flukonazoli ki aRmoCnda dabal

efeqturi. (Grover C et al, 2012). dasavleT CineTSi Catarebulma

randomizebulma kvlevam, romelic axdenda terbinafinisa da

grizeofulvinis efeqturobis Sedarebas Tavis Tmiani aris mikozebis

mkurnalobaSi, gamoavlina, rom terbinafini efeqturia triqofitoniT

gamowveuli infeqciebis samkurnalod (T. violaceum; Arthroderma vanbreuseghemii;

and T. tonsurans). terbinafinis 2-4 kviriani kursi iseve efeqturia, rogorc

grizeofulvinis 4-kviriani kursi da terbinafini aris efeqturi

alternativa triqofitoniT gamowveuli infeqciebis samkurnalod (Deng S,

2011). terbinafinisa da grizeofulvinis sacdeli kontrolorebadi,

randomizebuli kvlevis (romelic axdenda terbinafinisa da

grizeofulvinis Sedarebas Tavis Tmiani aris mikozebis mkurnalobaSi)

metaanalizis Sedegad erTmaneTs Seadares grizeofulvinis 8-kviriani

(mkurnalobis diapazoni 6-12 kvira) da terbinafinis 4-kviriani (diapazoni

2-6 kvira) mkurnalobis Sedegi. aRmoCnda, rom Mmikrosporumis saxeobiT

gamowveuli Tavis Tmiani aris mikozebis SemTxvevaSi ufro

  38

maRalefeqturia grizeofulvini, xolo triqofitonis saxeobiT

gamowveuli Tavis Tmiani aris mikozebis SemTxvevaSi-terbinafini (Tey HL,

2011). amerikaSi farTod gamoyenebadi antimikozuri preparatebis

grizeofulvinisa da terbinafinis efeqturobaSi statistikurad

mniSvnelovani gansxvavebis gansazazRvrad Catarda metaanalizi.

erTmaneTs Seadares grizeofulvinis 8-kviriani (doza 6.25-12.5 mg/kg/dReSi)

da terbinafinis 4-kviriani (doza 3.125-6.25 mg/kg/dReSi) mkurnalobis

Sedegebi. aRmoCnda, rom mniSvnelovani gansxvaveba am ori preparatis

saerTo efeqturobaSi ar aRiniSneba, Tumca igi vlindeba TiToeuli

maTganis konkretul gamomwvevTan mimarTebaSi. Mmikrosporumis saxeobiT

gamowveuli Tavis Tmiani aris mikozebis SemTxvevaSi ufro

maRalefeqturia grizeofulvini, xolo triqofitonis saxeobiT

gamowveuli Tavis Tmiani aris mikozebis SemTxvevaSi ki-terbinafini (Gupta

AK et al, 2013). Tavis Tmiani aris mikozebis menejmentisaTvis SemuSavebul

gaidlainSi berZeni mecnierebi aRniSnaven, rom igi yovelTvis saWiroebs

sistemur mkurnalobas, radgan topikuri antifungaluri saSualebebi ver

aRweven Tmis folikulebSi. adgilobrivi mkurnaloba warmoadgens

mxolod damxmares. grizeofulvinTan SedarebiT ufro xanmokle kursi

saWiroebs terbinafiniT, itrakonazoliTa da flukonazoliT

mkurnaloba, triqofitonis saxeobiT gamowveul Tavis Tmiani aris

mikozebis SemTxvevaSi, Tumca es preparatebi ufro Zviria.

grizeofulvini Seucvlelia mikrosporumebis SemTxvevaSi. misi

efeqturoba aWarbebs terbinafinis efeqturobas., itrakonazolTan da

flukonazolTan SedarebiT ki bevrad iafia (Kakourou T, 2010). avsrtielma

mecnierebma kritikulad Seafases Tavis Tmiani aris mikozebis

mkurnaloba. grizeofulvini 1958 wlidan dRemde rCeba mkurnalobis

oqros standartad aSS-Si. miuxedavad axali Taobis preparatebis,

rogoricaa terbinafini, itrakonazoli da flukonazoli, mkurnalobis

xangrZlivobis Semcireba mainc ver moxda. amis mizezebia: Tmis

folikulis anatomiuri struqtura, cximis pasiuri warmoqmna

pubertatul periodamde da axali antifungaluri preparatebis

moqmedebis SesaZlebloba. bavSvTa asakSi MmikrosporumebiT gamowveuli

infeqciebis mkurnaloba gansakuTrebiT mniSvnelovania. terbinafinis

  39

gansakuTrebuli farmakokinetikuri Tvisebebi: misi gamoyofa

prepubertatul periodSi ver xdeba verc ofliT da verc cximiT, misi

CarTva xdeba anagenis fazis Tmis Rerebis keratinSi, bavSvebSi is ver

erTveba Tmis ZirebSi da ver aRwevs skalpis zedapiramde, sadac

moTavsebulia mikrosporiis arTrosporebi. es specifiuroba klinikuri

kvlevebSi ar aris ganxiluli (Ginter-Hanselmayer G, 2011). Tavis Tmiani aris

mikozebis gamoxatuli klinikuri simptomebis mqone 1-12 wlamde asakis

bavSvebSi Catarebuli kvlevis Sedegad gamovlinda, rom sistemuri

grizeofulvini doziT 20-25 mg/kg dReSi damatebiT dasabanad selenis

sulfidis SampunTan erTad 6kviris ganmavlobaSi efeqturi aRmoCnda

samkurnalod ( Lorch Dauk KC, 2010). SveicariaSi am regionisaTvis aratipiuri

infeqciuri agentiT, Microsporum audouinii gamowveuli Tavis Tmiani aris

mikozebis 3 SemTxvevis samkurnalod terbinafinisa da flukonazolis

gamoyeneba uefeqto aRmoCnda, maSin roca 2 maTganis gankurneba moxda

grizeofulvinis, erTis ki-itrakonazolis sistemuri Terapiis Sedegad

(Donghi D, 2011). grizeofulviniT umkurnales CrdiloeT tuniziaSic Tavis

Tmiani aris mikozebis anTebiT formebs (Zaraa I, 2013). multicentruli,

internacionaluri, ori randomizebuli, brma kvlevis monacemebze

dayrdnobiT terbinafini aRmoCnda grizeofulvinis efeqturi

alternativa T. tonsurans-iT gamowveuli Tavis Tmiani aris mikozebis

samkurnalod (Elewski BE, 2008). Tumca did britaneTSi grizeofulvini

Tavis Tmiani aris mikozebis samkurnalod miRebuli preparatia,

metaanalizma daadastura, rom axali Taobis terbinafini iyo gacilebiT

efeqturi T. tonsurans-iT gamowveuli daavadebis samkurnalod (Fuller LC, 2009)

sistemuri terbinafinisa da grizeofulvinis gamoyenebis aucilebelobas

aRniSnavs Kelly BP CrdiloeT amerikaSi, sadac daavadebis gamomwvevi

TiTqmis yovelTvis aris T. Tonsurans (2012). iraneli mecnierebi Tvlian, rom

sistemuri Terapia aucilebelia., maT mier Catarebuli kvlevis Sedegad

ki aRmoCnda ,rom Sesabamisi dozebiT(20kg-mde wonis SemTxvevaSi 62,5 mg,

xolo 20-40 kg wonis SemTxvevaSi 125mg dReSi) terbinafinis miReba

usafrTxoa da efeqturi pediatriul pacientebSi Tavis Tmiani aris

mikozebis samkurnalod (Sabzghabaee AM, 2009). daavadebis mkurnalobaSi

  40

grizeofulvinisa da flukonazolis SedarebiTi kvlevis monacemebiT

mniSvnelovani gansxvaveba maT efeqturobaSi ar gamovlinda, Tumca orive

maTganis SemTxvevaSi mkurnalobis xangrZlivoba damokidebuli iyo

dozaze. dabali dozebis SemTxvevaSi mkurnalobis kursi iyo gacilebiT

xangrZlivi, vidre maRali dozirebis SemTxvevaSi (Shemer A, 2013).

terbinafinis minimaluri gverdiTi efeqtebs, sxva medikamentebTan

naklebi urTierTqmedebasa da usafrTxoebas miiCneven mniSvnelovnad

amerikeli mecnierebic (Van Duyn Graham L, 2011). Meadows-Oliver M

grizeofulvinis 6-8 kviriani mkurnalobis alternativad Tvlis

terbinafinis mkurnalobis 6-kvirian kurss (2009). britaneTSi, pediatriul

mosaxleobaSi, Trichophyton tonsurans infeqciiT gamowveuli qerionis

menejmentis Seswavlad Catarda retrospeqtruli kvleva 10 wlamde

asakis bavSvebSi, ris Sedegadac dadasturda, rom misi mkurnalobisTvis

saWiro konkretuli dermatofitiis sawinaaRmdego mkurnaloba da igi ar

saWiroebs damatebiT kortikosteroidul Terapias (Proudfoot LE, 2011).

amerikeli mecnierebis monacemebiT grizeofulvini, romelic iTvleboda

mkurnalobis oqros standartad 20% pacientebSi uSedegoa (Alvarez MS,

2006). itrakonazoli aRmoCnda usafrTxo da efeqturi Microsporum canis

samkurnalod wlamde asakis bavSvebSi (Binder B, 2009) axalSobilSi

efeqturi aRmoCnda oraluri grizeofulvini da ketokonazolis Sampuni

(Atanasovski M, 2011).

  41

3. masala da meTodebi

kvleva Catarda 27 665 pacientze, romelTac bolo xuTi wlis

ganmavlobaSi momarTes kanisa da vensneulebaTa samecniero-kvleviT

erovnul centrs ambulatoriuli mkurnalobisTvis. gamokvleuli iyo

Tavis Tmiani aris mikozze saeWvo yvela SemTxveva. daavadebis klinikuri

simptomebis arsebobis SemTxvevaSi diagnozis dadastureba xdeboda

mikroskopuli da kulturaluri kvlevebiT. damatebiT gamoyenebul iqna

luminescenturi naTebis Sefaseba vudis naTuris qveS. TiToeuli

pacientisTvis kvlevaSi CarTvis kriteriumad miCneul iqna klinikuri

simptomebis arseboba da mikroskopuli gamokvlevis dadebiTi pasuxi

erTdroulad.

masalis aReba laboratoriuli gamokvlevebisaTvis xdeboda yvela

dazianebuli keridan, rogorc Tavis Tmiani aridan, ise tanidan da

kidurebidan. masalas warmoadgenda qercli da Tmis Rerebi. kanidan

qerclis asaRebad gamoyenebul iqna erTjeradi skalpelebi, xolo

dazianebuli Tmis RerebisTvis-erTjeradi pincetebi.

Mmikroskopuli gamokvlevisTvis aRebuli masala Tavsdeboda sasagne

minaze da muSavdeboda KOH-is 20%-iani xsnaris ramdenime wveTiT. 30

wuTis Semdeg warmoebda preparatis daTvaliereba mikroskopis qveS.

mikroskopuli gamokvleviT xdeboda sokos miceliumebisa da sporebis

aRmoCena, aseve, Tmis dazianebis formis gamovlena, kerZod, endotriqsisa

da eqtotriqsis gansazRvra.

K gamomwvevTa saxeobrivi identifikacia xdeboda kulturaluri

gamokvleviT, risTvisac gamoiyeneboda saburos niadagi

qloramfenikoliT. paTologiuri keridan aRebuli masala iTeseboda

niadagis Semcvel petris finjnebsa da sinjarebSi, romlebic Tavsdeboda

specialur TermostatSi temperaturaze 25-30°C. zrdaze dakvirveba

xdeboda oTxi kviris ganmavlobaSi da igi fasdeboda kviraSi erTxel.

pasuxi iTvleboda dadebiTad, Tu koloniis zrda aRiniSneboda me-14, 21-e

an 28-e dRes da uaryofiTad, Tu koloniis zrda ar aRiniSneboda 28-e

dResac. etiologiuri agentis saboloo identificireba xdeboda

morfologiuri da mikroskopuli maxasiaTeblebis gaTvaliswinebiT.

  42

yvela pacienti gaisinja vudis naTuris qveS. mwvane luminescenturi

naTeba vlindeboda mxolod mikrosporumebiT gamowveuli infeqciebis

SemTxvevebSi, gamomwvevis specifikis miuxedavad. swored amitom am

meTodis Sedegis Sefaseba informatiuli iyo mikrosporuli

etiologiuri agentebiT ganpirobebuli dermatofitozebis

sadiagnostikod da triqofitonebiT gamowveuli dermatofitozebisgan

sadiferenciaciod.

Tavis Tmiani aris mikozebis klinikuri formebis gamoyofa moxda

simptomebis safuZvelze. klinikuri gamovlinebani daiyo anTebiT da

araanTebiT (umniSvnelo anTebiTi reaqciebis mqone) dazianebebad.

araanTebiT dazianebebSi gamoiyo: nacrisferi laqebi dazianebis erTeuli

an mravlobiTi kerebiT (erTi didi zomis da ramdenime SedarebiT patara

mkveTrad SemosazRvruli, momrgvalo formis, movercxlisfro-TeTri

feris qercliT dafaruli eriTemuli laqebi, keraSi 2-3 mm gadamtvreuli

Tmis RerebiT), seboreuli dermatitis msgavsi forma (TiTqmis Tanabari

zomis, araswori moxazulobisa da aramkveTri sazRvrebis mqone

movercxlisfro-TeTri feris qercliT dafaruli eriTemuli laqebi,

keraSi gadamtvreuli Tmis RerebiT) da Savwertilovani dermatofitozi

(difuzuri dazianeba aramkveTri sazRvrebiT, keraSi kanis doneze

gadamtvreuli Tmis RerebiT, Savi wertilebiT). anTebiT formebSi

folikulebis dazianebis xarisxis gaTvaliswinebiT gamoiyo: qerioni

(mtkivneuli, rbili kvanZebiTa da balTebiT warmodgenili kera,

romelSic Tmis folikulebis SesarTavebidan uxvad gamoiyofa Cirqi da

keraSi moryeuli Tmebi advilad Zvreba) da Sejgufebuli folikulitebi

(balTebi, zomierad gamoxatuli anTebiTi reaqciiT, romlis zedapirzec

aRiniSneba Tmis folikulebis SesarTavebTan pustulebis arseboba).

saxeze, tansa da kidurebze sada kanze arsebuli gamonayaris

Sesafaseblad, am areebSi sokovani infeqciebis gamosaricxad da

dermatofitiduli reaqciebis gamosavlenad, Catarda yvela aRniSnuli

keridan aRebuli masalis mikroskopuli gamokvleva.

Tavis Tmiani aris mikozebis mkurnalobaSi terbinafinis efeqturobis

Sesafaseblad kvlevaSi CaerTvnen klinikurad gamoxatuli simptomebis

mqone pacientebi, romelTa diagnozic dadasturebuli iyo rogorc

  43

mikroskopulad, ise kulturalurad. klinikur formebidan gamoiyo ori,

Tavis Tmiani aris mkveTri anTebiTi dazianebis niSnebis mqone qerionis

forma da Tavis Tmiani aris umniSvnelo anTebiTi dazianebis niSnebis

mqone–nacrisferi laqebis dazianebis erTeuli kerebiT forma.

kvlevisTvis Seiqmna ori jgufi. jgufebSi pacientebis ganawileba moxda

klinikuri niSnebisa da gamomwvevis saxeobis gaTvaliswinebiT

gamomwvevTa antimikozuri preparatebis mimarT gansxvavebuli

mgrZnobelobis gamo. pirvel jgufSi gaerTianda qerionis formiT

daavadebuli 38 pacienti, romelTa daavadebis gamomwvevi iyo Trichophyton

mentagrophytes, meoreSi ki – nacrisferi laqebis dazianebis erTeuli

kerebis formiT daavadebuli 34 pacienti, romelTa daavadebis gamomwvevi

iyo Microsporum canis. pacientebs terbinafini eZleodaT mowodebuli

doziT: 10-20 kg wonis bavSvebs - 62,5mg dReSi erTjeradad; 21-40kg wonis

bavSvebs - 125mg dReSi erTjeradad; 40kg-ze meti wonis bavSvebs - 250mg

dReSi erTjeradad. pacientebi dakvirvebis qveS imyofebodnen ori Tvis

ganmavlobaSi. terbinafinis efeqturobis gansazRvra xdeboda klinikuri

simptomebis, mikroskopuli kvlevis Sedegebisa da vudis naTuris qveS

luminescenturi naTebis Sefasebis Sedegad kviraSi erTxel me-7, me-14, 21-

e, 28-e, 35-e, 42-e, 49-e da 56-e dRes (vudis naTuris qveS luminescenturi

naTebis Sefaseba xdeboda mxolod meore jgufisaTvis, radgan dasawyisSi

pirveli jgufis yvela pacientisaTvis igi iyo uaryofiTi, xolo meore

jgufis yvela pacientisaTvis _ dadebiTi).

statistikiuri analizisTvis gamoyenebuli iyo SPSS sistema, Pearson

Chi-Square, Likelihood Ratio Chi-Square da Fisher’s exact testebi. P<0,05 miRebul

iqna statistikurad sarwmunod.

  44

4. kvlevis Sedegebi

kvleva Catarda 27665 dermatologiur pacientze. ganisazRvra Tavis

Tmiani aris mikozebis procentuli raodenoba mTlianad dermatologiur

da mikozebiT daavadebul pacientTa Soris wlebis mixedviT. Tavis Tmiani

aris mikozebi dermatologiur pacientTa Soris Seadgenda 2009 wlisTvis

1,95%-s (52/2660), 2010 wlisTvis 2,0%-s (55/2725), 2011 wlisTvis 1,67%-s

(100/5996), 2012 wlisTvis 1,45%-s (110/7583) da 2013 wlisTvis 1,6%-s (137/8701).

aRniSnuli monacemebi asaxulia cxrilSi N1.

cxrili N1

wlebi Ddermatologiur

pacientTa raodenoba

maT Soris Tavis Tmiani

midamos mikozebiT

daavadebulTa

xvedriTi wili

2009 2660 52 (1,95%)

2010 2725 55 (2,0%)

2011 5996 100 (1,67%)

2012 7583 110 (1,45%)

2013 8701 137 (1,6%)

mikozebiT daavadebul pacientTa Soris Tavis Tmiani aris mikozebi

2009 wlisTvis Seadgenda 8,3%-s (52/630), 2010 wlisTvis 6,2%-s (55/890), 2011

wlisTvis 6,4%-s (100/1574), 2012 wlisTvis 6,2%-s (110/1771), 2013 wlisTvis

6,6%-s (137/2072). aRniSnuli monacemebi asaxulia cxrilSi N2.

  45

cxrili N2

wlebi mikozebiT daavadebul

pacientTa raodenoba

maT Soris Tavis Tmiani

midamos mikozebiT

daavadebulTa

xvedriTi wili

2009 630 52 (8,3%)

2010 890 55 (6,2%)

2011 1574 100 (6,4%)

2012 1771 110 (6,2%)

2013 2072 137 (6,6%)

Cvens mier kvlevaSi CarTuli 176 pacientidan 27 (15,3%) iyo qalaqis

mosaxle, 149 (84,7%) ki-soflis.

cxrili N3

soflis mosaxle-qalaqis mosaxle: miRebuli monacemebis

statistikuri damuSaveba

   sixSire procenti validuri

procenti

Kkumulaciuri

procenti

soflis

mosaxle 149 84,7 84,7 84,7

qalaqis

mosaxle 27 15,3 15,3 100,0

validuroba

sul 176 100,0 100,0

  46

Tavis Tmiani aris mikozebis gamovlena gansxvavdeboda sxvadasxva

regionisTvis. Cvens mier aRricxuli SemTxvevebis ganawileba asaxulia

cxrilSi N4.

cxrili N4

regioni daavadebulTa

raodenoba

procentuli

maCvenebeli

marneulis raioni 32 18,2%

bolnisis raioni 28 16%

Tbilisi 19 10,8%

ambrolauris raioni 16 9,1%

sagarejos raioni 15 8,5%

Ggardabnis raioni 11 6,3%

rusTavi 8 4,5%

Kkaspis raioni 7 4%

Aaxalcixis raioni 5 2,8%

Ggurjaanis raioni 5 2,8%

aWaris regioni 5 2,8%

yvarlis raioni 4 2,3%

walka 4 2,3%

dedofliswyaro 4 2,3%

aspinZa 4 2,3%

wyneTi 3 1,7%

WiaTura 2 1,1%

vanis raioni 2 1,1%

surami 2 1,1%

  47

gansxvavdeboda triqofitonebisa da mikrosporumebis calkeuli

saxeobebis gavrcelebac sxvadasxva geografiul arealSi.

Cvens mier aRricxuli SemTxvevebidan Microsporum canis, rogorc

etiologiuri agenti, gamovlinda 41 SemTxvevaSi. maTgan ToTxmeti (34,2%)

iyo Tbilisis mosaxle, xuTi (12,2%)-sagarejos raionis, sami (7,3%)-

rusTavis, sami (7,3%)-gardabnis raionis, sami (7,3%)-aspinZis, sami (7,3%)-

yvarlis, ori (4,9%)-axalcixis, ori (4,9%)-walkis, ori (4,9%)-wyneTis, ori

(4,9%)-gurjaanis, erTi (2,4%)-suramis, erTi (2,4%)-WiaTuris.

Microsporum ferrugineum, rogorc daavadebis gamomwvevi gamovlinda Svid

SemTxvevaSi. maTgan xuTi (71,4%) iyo ambrolauris raionis mosaxle, ori

(28,6%) ki-axalcixis.

Trichophyton mentagrophytes gamovlinda 47 SemTxvevaSi. maTgan 19 (40,4%) iyo

marneulis mosaxle, 16 (34%)-bolnisis, oTxi (8,5%)-sagarejos raionis,

oTxi (8,5%)-gardabnis, ori (4,3%)-dedofliswyaros, ori (4,3%)-rusTavis.

Trichophyton violaceum gamovlinda 11 SemTxvevaSi, romelTaganac eqvsi

(54,5%) iyo ambrolauris raionis mosaxle, sami (27,3%)-kaspis da ori

(18,2%)-marneulis.

Trichophyton verrucosum-is eqvsi SemTxvevidan sami (50%) iyo marneulis

raionis mosaxle, ori (33,3%)-bolnisis, xolo erTi (16,7%)-gardabnis.

Aambrolauris raionis mosaxleobaSi daavadeba atarebda

mikroepidemiis xasiaTs moWidave sportsmenebsa da maTTan kontaqtSi myof

bavSvebSi. gamovlinda 16 Tavis Tmiani aris dermatomikoziT daavadebuli

bavSvi, romelTagan aTs aReniSneboda seboreuli dermatitis msgavsi,

xolo eqvss-nacrisferi laqebi dazianebis erTeuli kerebiT forma.

maTgan etiologiuri agentis saxeobrivi identifikacia moxda 11

SemTxvevaSi. xuT SemTxvevaSi aRmoCnda Microsporum ferrugineum, eqvsSi ki-

Trichophyton violaceum.

  48

gamokvleuli 176 pacientidan 129(73, 3%) iyo mamrobiTi sqesis da 47

(26,7%)-mdedrobiTi (diagrama N1).

DdiagramaN1

daavadebulTa sqesi

mamrobiTi

mdedrobiTi

cxrili N5

sqesi: miRebuli monacemebis statistikuri damuSaveba

sixSire procenti validuri

procenti

Kkumulaciuri

procenti

mamrobiTi 129 73,3 73,3 73,3

mdedrobiTi 47 26,7 26,7 100,0

validuroba

sul 176 100,0 100,0

daavadebis kavSiris dasadgenad sqesTan gamoyenebul iqna Likelihood

Ratio Chi-Square da Fisher’s exact testebi. orive testis Sedegad P<0,05.

  49

pacientTa ganawileba asakobriv jgufebSi iyo Semdegi: 1-4 wlis

asakovriv jgufSi gaerTianda 49 (27,8%) pacienti, 5-9 wlis asakovriv

jgufSi _ 91 (51,7%) da 10-14 wlis asakobriv jgufSi _ 36 (20,5%).

aRniSnuli monacemebi asaxuli diagramaze N2.

diagrama N2

pacientTa

ganawileba

asakobriv

jgufebSi 

1-4 wlis

49 (27,8%) 

5-9 wlis

91 (51,7%) 

10-14 wlis

36 (20,5%).

cxrili N6

asaki: miRebuli monacemebis statistikuri

damuSaveba

   sixSire procenti validuri

procenti

kumulaciuri

procenti

1-4 49 27,8 27,8 27,8

5-9 91 51,7 51,7 79,5

10-14

36 20,5 20,5 100,0

validuroba

sul 176 100,0 100,0

daavadebis kavSiris dasadgenad asakTan gamoyenebul iqna Likelihood Ratio

Chi-Square da Fisher’s exact testebi. orive testis Sedegad P<0,05.

  50

klinikuri gamovlenis mixedviT kvlevaSi CarTuli pacientebidan 85

(48,3%) SemTxvevaSi gamovlinda anTebiTi, xolo 91 (51,7%) SemTxvevaSi-

araanTebiTi. Tavis Tmiani aris mikozebis anTebiTi formebidan yvelaze

gavrcelebuli iyo qerioni. igi gamovlinda anTebiTi formebis 73 (85,9%)

SemTxvevaSi, xolo danarCeni 12 (14,1%) SemTxveva gamovlinda

dajgufebuli folikulitebis saxiT (diagrama N3).

D

diagrama N3

  51

Tavis Tmiani aris mikozebis araanTebiTi formebidan yvelaze xSirad

gvxvdeboda nacrisferi laqebi dazianebis erTeuli kerebiT. igi aRiniSna

araanTebiTi formebis 71 (78%) SemTxvevaSi, danarCeni SemTxvevebi ki

ganawilda Semdegnairad: seboreuli dermatitis msgavsi forma 14 (15,4%)

SemTxvevaSi, Savwertilovani dermatofitozi _ 6(6,6%)-Si (diagrama N4).

diagrama N4

  52

mTlianad klinikuri formebis raodenobrivi da procentuli

ganawileba ki aisaxa Semdegnairad: qerioni 73 (41,5%), nacrisferi laqebi

dazianebis erTeuli kerebiT 71 (40,3%), seboreuli dermatitis msgavsi

forma 14 (8%), dajgufebuli folikulitebi 12 (6,8%) da Savwertilovani

dermatofitozi 6 (3,4%). aRniSnuli monacemebi asaxulia diagramaze N5.

diagrama N5

0

10

20

30

40

50

60

70

80კერიონი

ნაცრისფერილაქები

სებორეულიდერმატიტისმსგავსი

დაჯგუფებულიფოლიკულიტე  

  53

cxrili N7

klinikuri formebi: miRebuli monacemebis statistikuri damuSaveba

sixSire procenti validuri

procenti

kumulaciuri

procenti

Savwertilovani

forma

6 3,4 3,4 3,4

Sejgufebuli

folikulitebi

12 6,8 6,8 10,2

Nnacrisferi

laqebi

71 40,3 40,3 50,5

qerioni 73 41,5 41,5 92,0

seboreuli

dermatitis

msgavsi forma

14 8,0 8,0 100,0

valid

uroba

sul 176 100,0 100,0

qerionis 54 (74%) SemTxveva gamovlinda dazianebis erTeuli keriT, xolo

19 (26%)-dazianebis mravlobiTi keriT. 36 (20,5%) SemTxvevaSi gamonayari

Tavis Tmian aresTan erTad aRiniSna saxeze, tansa da kidurebzec. maTgan

16 (9,1%) gamovlinda diseminirebuli gamonayaris, xolo 20 (11,4%)-

dazianebis erTeuli kerebis saxiT. diseminirebuli gamonayari 14 (87,5%)

SemTxvevaSi Tan axlda qerions da 2 (12,5%)-Si dajgufebul

folikulitebs.

  54

cxrili N8

klinikuri formasa da sqess Soris kavSiri:

miRebuli monacemebis statistikuri damuSaveba (crosstabulation)

sqesi

sul

mamrobiTi mdedrobiTi

raodenoba 4 2 6 Savwertilovani

forma procenti 66,7% 33,3% 100,0%

raodenoba 9 3 12 Sejgufebuli

folikulitebi procenti 75,0% 25,0% 100,0%

raodenoba 48 23 71 nacrisferi

laqebi procenti 67,6% 32,4% 100,0%

raodenoba 57 16 73 qerioni

procenti 78,1% 21,9% 100,0%

raodenoba 11 3 14

Kklinikuri

formebi

seboreuli

dermatitis

msgavsi

procenti 78,6% 21,4% 100,0%

raodenoba 129 47 176 sul

procenti 73,3% 26,7% 100,0%

cxrili N9

korelacia klinikur formasa da sqess Soris (xi-kvadratis testebi)

Value df Asymp. Sig. (2-sided)

Pearson Chi-Square 2.381a 4 ,666

Likelihood Ratio 2,374 4 ,667

Linear-by-Linear Association 1,197 1 ,274

N of Valid Cases 176

  55

cxrili N10

klinikuri formasa da asaks Soris kavSiri:

miRebuli monacemebis statistikuri damuSaveba (crosstabulation)

asaki   

1-4 5-9 10-14

sul

raodenoba 1 2 3 6 Savwertilovani

forma procenti 16,7% 33,3% 50,0% 100,0%

raodenoba 1 10 1 12 Sejgufebuli

folikulitebi procenti 8,3% 83,3% 8,3% 100,0%

raodenoba 21 34 16 71 Nnacrisferi

laqebi procenti 29,6% 47,9% 22,5% 100,0%

raodenoba 25 44 4 73 qerioni

procenti 34,2% 60,3% 5,5% 100,0%

raodenoba 1 1a 12 14

kl

inikuri

formebi

seboreuli

dermatitis

msgavsi procenti 7,1% 7,1% 85,7% 100,0%

raodenoba 49 91 36 176 sul

procenti 27,8% 51,7% 20,5% 100,0%

cxrili N11

korelacia klinikur formasa da asaks Soris (xi-kvadratis testebi)

Value df Asymp. Sig. (2-sided)

Pearson Chi-Square 55.269 8 0,000

Likelihood Ratio 49,364 8 0,000

Linear-by-Linear

Association

0,115 1 0,735

N of Valid Cases 176

  56

Tavis Tmiani aridan aRebuli masalis mikroskopuli gamokvleviT

eqtotriqsis tipis etiologiuri agenti gamovlinda 155 (88,1%)

SemTxvevaSi, endotriqsis tipis ki _ 21 (11,9%)-Si. kulturaluri

gamokvlevis Sedegi dadebiTi iyo 112 (63,6%) SemTxvevaSi. zoofiluri

gamomwvevi gamovlinda 94 (83,9%) SemTxvevaSi, antropofiluri _ 18 (16,1%)-

Si. maTgan yvelaze xSiri etiologiuri agenti aRmoCnda Trichophyton

mentagrophytes. is gamovlinda sul 47(42%) SemTxvevaSi, Semdeg Microsporum

canis, romelic gamovlinda 41(36, 6%) SemTxvevaSi, Trichophyton violaceum-11(9,

8%) SemTxvevaSi, Microsporum ferrugineum-7(6, 2%) da Trichophyton verrucosum-6(5, 4%)

SemTxvevaSi (diagrama N6).

diagrama N6.

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%T.mentagrophytes

M.canis

T.violaceum

M.ferrugineum

T.verrucosum

  57

cxrili N12

gamomwvevebi: miRebuli monacemebis statistikuri damuSaveba

 

  

sixSire procenti validuri

procenti

Kkumulaciuri

procenti

Trichophyton violaceum

11 6,3 9,8 9,8

Trichophyton verrucosum

6 3,4 5,4 15,2

Trichophyton mentagrophytes

47 26,7 42,0 57,2

Microsporum

ferrugineum

7 4,0 6,2 63,4

Microsporum

canis

41 23,3 36,6 100,0

val

iduroba

sul 112 63,6 100,0   

Missing System 64 36,4   

sul 176 100,0   

qerionis SemTxvevebidan etiologiuri agenti gamovlinda 46 (63%)-Si.

maTgan 41 (89,1%) iyo Trichophyton mentagrophytes da 5 (10, 9%) Trichophyton

verrucosum; dajgufebuli folikulitebis SemTxvevebidan gamomwvevi

gamovlinda 7(58,3%)-Si. maTgan 6(85,7%) iyo Trichophyton mentagrophytes da 1

(14,3%) Trichophyton verrucosum; nacrisferi laqebi dazianebis erTeuli

kerebis SemTxvevebidan etiologiuri agenti gamovlinda 48 (67,6%)

SemTxvevaSi, maTgan 41 (85,4%) iyo Microsporum canis da 7 (14, 6%) Microsporum

ferrugineum. seboreuli dermatitis msgavsi formis SemTxvevebidan

gamomwvevi gamovlinda 8 (57,1%)-Si, xolo Savwertilovani

dermatofitozis SemTxvevebidan _ 3 (50%)-Si da yvela maTganSi

etiologiuri agenti iyo Trichophyton violaceum. aRniSnuli Sedegebi anu

  58

Tavis Tmiani aris mikozebis klinikur formebsa da etiologiur agentebs

Soris kavSiri asaxulia cxrilSi N13.

cxrili N13

dermatofiti

klinikuri forma

Trichophyton mentagrophytes n (%)

Trichophyton verrucosum n(%)

Trichophyton violaceum n(%)

Microsporum canis n(%)

Microsporum ferrugineum n(%)

nacrisferi laqebi dazianebis erTeuli kerebiT

41 (85,4%) 7 (14, 6%)

seboreuli dermatitis msgavsi forma

8 (100%)

Savwertilovani dermatofitozi

3 (100%)

qerioni 41(89, 1%) 5(10, 9%)

dajgufebuli folikulitebi

6(85, 7%) 1(14, 3%)

sul 47(42%)

6(5, 4%) 11(9, 8%)

41(36, 6%) 7(6, 2%)

saxeze, tansa da kidurebze arsebuli diseminirebuli gamonayaridan

aRebuli arcerTi masalis mikroskopuli gamokvleviT soko ar aRmoCnda.

amave midamoebidan dazianebis erTeuli kerebis SemTxvevebSi masalis

mikroskopuli gamokvlevis Sedegi 7 (35%) SemTxvevaSi iyo uaryofiTi da

13 (65%)-Si dadebiTi (4 (30,8%) gamovlinda qerionis da 9 (69,2%)

nacrisferi laqebi dazianebis erTeuli kerebis SemTxvevaSi).

  59

dermatofitiduli reaqcia gamovlinda 16 (9,1%) SemTxvevaSi. yvela

maTganSi igi atarebda diseminirebuli folikuluri papulebis saxes.

maTgan 2 (12,5%) gamovlinda dajgufebuli folikulitebis SemTxvevaSi,

rac Seadgenda am klinikuri formis 16,7%-s (dajgufebuli

folikulitebis 12 SemTxvevidan id reaqcia gamovlinda orSi). 14 (87,5%)

gamovlinda qerionis SemTxvevaSi da Seadgina daavadebis am klinikuri

formis 19,2% (qerionis 73 SemTxvevidan id reaqcia gamoixata 14-Si). yvela

am SemTxvevaSi qerioni warmodgenili iyo dazianebis mravlobiTi keriT.

id-reaqciebis 16 SemTxvevidan Tavis Tmiani aris mikozis gamomwvevi

dadgenili iyo 12 (75%) SemTxvevaSi, saidanac infeqciis 11 (68,7%)-Si

gamomwvevi iyo Trychophyton mentagrophytes da igi Seadgenda am etiologiuri

agentiT gamowveuli infeqciebis 23,4%-s (Trychophyton mentagrophytes-iT

gamowveuli 47 SemTxvevidan id-reaqcia gamovlinda 11-Si). erT (6,3%)

SemTxvevaSi etiologiuri agenti iyo Trichophyton verrucosum, rac Seadgenda

etiologiuri agentiT gamowveuli infeqciebis 16,7%-s (Trichophyton

verrucosum-iT gamowveuli eqvsi SemTxvevidan id-reaqcia gamovlinda

erTSi), 4(25%) SemTxvevaSi daavadebis gamomwvevi ar iyo dadgenili.

vudis naTuriT daTvalierebis dros mwvane naTeba aRiniSna 54 (31,6%)

SemTxvevaSi. yvela maTgani klinikurad gamovlinda rogorc nacrisferi

laqebi dazianebis erTeuli kerebiT. Ddaavadebis gamomwvevi 41 (75,9%)

SemTxvevaSi iyo Microsporum canis, 7 (13%)-Si ki _ Microsporu ferrugineum,

danarCen 6 (11,1%) SemTxvevaSi gamomwvevi ar iyo dadgenili.

Cveni kvleviT moxda infeqciis wyaros gamovlenac. Trychophyton

mentagrophytes-is yvela 47 da Trychophyton verrucosum-is 6 SemTxvevaSi

daavadebis wyaro iyo msxvilfexa rqosani pirutyvi. Microsporum canis-is 41

SemTxvevidan 36 (87,8%)-Si daavadebis wyaro iyo kata, xolo xuTSi (12,2%)

ver gamovlinda. Aaseve ver moxerxda wyaros gamovlena Trichopyton

violaceum-is Svid da Microsporum ferrugineum-is xuT SemTxvevaSi. Trichopyton

violaceum-is oTx da Microsporum ferrugineum-is or SemTxvevaSi ki daavadebis

wyaro iyo kontaqtSi myofi aseve daavadebuli bavSvi.

Cveni kvlevis Sedegad moxda, agreTve, terbinafinis efeqturobis

gansazRvra Tavis Tmiani aris mikozebis sxvadasxva etiologiuri

  60

agentebiT gamowveuli klinikuri formebis mkurnalobaSi. klinikuri

gamojanmrTelebis xangrZlivoba da Mmikroskopuli gamokvlevis

Sedegebis monacemebi asaxulia cxrilSi N14.

cxrili N14

klinikuri

gamojanmrTelebis

xangrZlivoba

Ppirveli

jgufisTvis

Mmikroskopuli

gamokvlevis

uaryofiTi

Sedegi

Ppirveli

jgufisTvis

klinikuri

gamojanmrTelebis

xangrZlivoba P

meore jgufisTvis

Mmikroskopuli

gamokvlevis

uaryofiTi

Sedegi P meore

jgufisTvis

10(26,3%)

SemTxvevaSi 21

dRe

Svid(18,4%)

SemTxvevaSi

dafiqsirda 21-e

dRes

cxra(26,5%)

SemTxvevaSi 28

dRe

xuT(14,7%)

SemTxvevaSi

dafiqsirda 28-e

dRes

24(63,2%)

SemTxvevaSi 28

dRe

25(65,8%)

SemTxvevaSi

dafiqsirda 28-e

dRes

17(50%)

SemTxvevaSi 35

dRe

15(44,1%)

SemTxvevaSi

dafiqsirda 35-e

dRes

oTx(10,5%)

SemTxvevaSi 35

dRe

eqvs(15,8%)

SemTxvevaSi

dafiqsirda 35-e

dRes

eqvs (17,6%)

SemTxvevaSi 42

dRe

10(29,4%)

SemTxvevaSi

dafiqsirda 42-e

dRes

or(5,8%)

SemTxvevaSi 49

dRe

oTx(11,8%)

SemTxvevaSi

dafiqsirda 49-e

dRes

meore jgufisTvis vudis naTuris qveS luminescenturi naTeba ar

aRiniSna 18 (52,9%) SemTxvevaSi 28-e dRes, 14 (41,2%) SemTxvevaSi _ 35-e dRes

da or (5,9%) SemTxvevaSi – 42-e dRes.

recidivis arcerTi SemTxveva ar gamovlenila. monacemTa damuSavebiT

aRmoCnda, rom Trichophyton mentagrophytes-iT gamowveuli qerionisTvis

  61

terbinafiniT mkurnalobis saSualo xangrZlivoba Seadgens 27,8 dRes,

xolo Microsporum canis-iT gamowveuli nacrisferi laqebi dazianebis

erTeuli kerebis SemTxvevaSi _ 37,6 dRes. amrigad, terbinafini efeqturi

aRmoCnda rogorc Tavis Tmiani aris mikozis qerionis formis, ise

nacrisferi laqebi dazianebis erTeuli kerebis formebis SemTxvevaSi,

Sesabamisad, rogorc Trichophyton mentagrophytes-is mimarT, ise Microsporum

canis mimarTac. Mmxolod aRsaniSnavia, rom Microsporum canis-iT gamowveuli

formebis samkurnalod misi gamoyeneba saWiro aRmoCnda ufro

xangrZlivad, vidre Trichophyton mentagrophytes-iT gamowveuli qerionis

samkurnalod.

  62

5. miRebuli Sedegebis ganxilva

saqarTveloSi dReisaTvis ar arsebobs Tavis Tmiani aris mikozebis

gavrcelebis amsaxveli sruli monacemebi. am problemis ramdenime mizezi

arsebobs. erTerTi mTavari mizezi kanisa da misi danamatebis sokovan

daavadebaTa aRricxvianobis moSlaa, rac nawilobriv dakavSirebulia

mikozebis klasifikaciis cvlilebasTan. saqarTveloSi adre miRebuli

klasifikaciiT kanisa da misi danamatebis (Tma,FfrCxilebi) sokovan

daavadebaTa, kerZod, dermatofitozebis, diagnozis formulireba

xdeboda gamomwvevis saxeobis mixedviT da gamoiyofoda klinikuri

formebi: triqofitia, favusi, mikrosporia, rubrofitia da epidermofitia.

daavadebaTa saerTaSoriso klasifikatoris me-10 gadasinjvis mixedviT,

romelic dReisaTvis moqmedebs saqarTveloSi, dermatofitozebis

klasifikacia efuZneba dazianebis lokalizacias, romelSic Tavis Tmiani

aris mikozebi gamoyofilia calke nozologiad daavadebis gamomwvevis

miuxedavad. amdenad statistikuri forma IV-06, romelic iTvaliswinebda

sicocxleSi pirvelad dadgenili triqofitiisa da mikrosporiis

diagnozis aRricxvas, sruliad Seusabamo aRmoCnda, ramdenadac

savaldebulo aRricxvas daqvemdebarebuli es mikozebi moicavda

sxvadasxva saxeobis triqofitonebiTa da mikrosporumebiT gamomwveul

rogorc Tavis, aseve sxva lokalizaciis sokovan daavadebebs.

Tavis Tmiani arisMmikozebis aRricxvianobis moSla, rac iwvevs

epidemiologiuri monacemebis arasrulyofilebas, aseve mniSvnelovnad

ganpirobebulia dermato-venerologiuri dawesebulebebis, veterinaruli

da sanitarul-epidemiologiuri samsaxurebis koordinirebuli muSaobis

darRvevis mizeziT. Tavis Tmiani aris mikozebiT daavadebulTan

kontaqtSi myofi pirebis profilaqtikuri Semowmebebis ararseboba,

daavadebuli cxovelis mkurnalobisa da infeqciis keris sanaciis

ugulebelyofa xels uwyobs infeqciis faruli wyaros warmoqmnasa da

mis Semdgom gavrcelebas.

Aar arsebobs ojaxis eqimebsa da dermato-venerologebs Soris

erTiani muSaobis sistemac, ris gamoc xSirad Tavis Tmiani aris mikozi

aRuricxavi rCeba.

  63

Cvens mier kanisa da vensneulebaTa samecniero-kvleviTi erovnuli

centris bazaze Catarebuli kvleviT gamovlinda Tavis Tmiani aris

mikozebis mniSvnelovani epidemiologiuri Taviseburebani.

Tavis Tmiani aris mikozebiT daavadebulTa Seswavlam wlebis

mixedviT gamoavlina, rom dermatologiur pacientTa Soris misi

xvedriTi wili dinamikaSi arsebiTad ar icvleboda. kerZod, Tu 2009

wlisTvis igi Seadgenda 1,95%-s (52/2660), 2010 wlisTvis _ 2,0%-s (55/2725),

2011 wlisTvis _ 1,67%-s (100/5996), 2012 wlisTvis _ 1,45%-s (110/7583), xolo

2013 wlisTvis _ 1,6%-s (137/8701).

dinamikaSi arsebiTad ar Secvlila, agreTve, bolo xuTi wlis

ganmavlobaSi mTlianad mikozebiT daavadebul pacientTa Soris Tavis

Tmiani aris mikozebis xvedriTi wili. kerZod, 2009 wlisTvis man Seadgina

8,3% (52/630), 2010 wlisTvis _ 6,2% (55/890), 2011 wlisTvis _ 6,4% (100/1574),

2012 wlisTvis _ 6,2% (110/1771), xolo 2013 wlisTvis _ 6,6% (137/2072).

sul bolo xuTi wlis ganmavlobaSi klinikas momarTa 454-ma Tavis

Tmiani aris mikoziT daavadebulma pacientma (weliwadSi saSualod 90,8

pacienti). Tavis Tmiani aris mikozebis Yyvelaze maRali sixSiriT

momarTvianoba aRiniSna 2013 wels, rac 1,5-jer aRemateboda saSualo

maCvenebels.

kvlevaSi CarTul pacientTa monacemebis mixedviT epidemiologiuri

TvalsazrisiT saintereso aRmoCnda daavadebis upiratesi gavrceleba

soflis mosaxleobaSi, romelic Seadgenda saerTo raodenobis 84,7%-s da

es maCvenebeli 5,5-jer aRemateboda qalaqis mosaxleobaSi daavadebulTa

raodenobas.

gansxvavdeboda daavadebis gavrceleba sxvadasxva regionisTvisac.

gamoirCa regionebi, sadac Tavis Tmiani aris mikozebi gansakuTrebiT

gavrcelebuli aRmoCnda. es regionebi iyo marneulis, bolnisis,

ambrolauris, sagarejosa da gardabnis raionebi da qalaqi Tbilisi.

aRricxul pacientTa Soris marneulis raionis mosaxle iyo 18,2%,

bolnisis _ 16%, ambrolauris _ 9,1%, sagarejos _ 8,5%, gardabnis _ 6,3%,

xolo Tbilisis _ 10,8%.

movaxdineT ra Cvens mier miRebuli Sedegebis Cvenamde arsebuli wina

kvlevis monacemebTan Sedareba, rac moicavs 80-ian wlebSi saqarTveloSi

  64

arsebul klinikur-epidemiologiuri kvlevis monacemebs, aRmoCnda, rom

mniSvnelovnad Seicvala triqofitiis gamomwvevTa speqtri. dRes

daavadebis ZiriTad gamomwvevs zoofiluri etiologiuri agentebi

warmoadgens, maSin roca 80-ian wlebSi dominanti antropofiluri

gamomwvevebi iyo, Tumca wina wlebTan SedarebiT SeiniSneboda maTi

procentuli Semcireba. aRmoCnda, rom im periodisaTvis ukve dawyebuli

tendencia, romelic gamoixateboda zoofiluri etiologiuri agentebis

mniSvnelobis zrdaSi, gagrZelda.

mkveTrad Semcirda 80-ian wlebSi dominanti antropofiluri

Trichophyton violaceum-is raodenoba. Cveni kvlevis mixedviT dRes igi Tavis

Tmiani aris mikozebis gamomwvevTa naklebad gavrcelebul etiologiur

agentebs miekuTvneba. igi mxolod erTeul SemTxvevebSi gvxvdeba da Tavis

Tmiani aris mikozebis gamomwvevTa mxolod 9,8%-s Seadgens. im

periodisaTvis saqarTveloSi SedarebiT naklebad gavrcelebuli

zoofiluri Trichophyton mentagrophytes dRes Tavis Tmiani aris mikozebis

dominanti gamomwvevia, yvelaze xSirad gvxvdeba da etiologiur agentTa

42%-s Seadgens.

dReisaTvis zoofiluri gamomwvevebis farTo gavrcelebas asaxavs

Microsporum canis maRali sixSiriT gamovlenac. saqarTveloSi wina wlebSiA

Microsporum canis Seswavlili ar yofila da misi gavrcelebis Sesaxeb

monacemebi ar gvaqvs. Cveni kvlevis Sedegad aRmoCnda, rom igi Tavis

Tmiani aris mikozebis predominantuli gamomwvevia da am daavadebis

etiologiur agentTa 36,6%-s Seadgens. sxva qveynebSi warmoebuli

kvlevebis mixedviT am etiologiuri agentis maRali sixSiriT gamovlena,

rac msoflioSi Microsporum canis-is farTo gavrcelebas asaxavs, Tanxvdeba

Cveni kvlevis monacemebs.

Cveni kvleviT gamovlinda mesame zoofiluri etiologiuri agentic-

Trichophyton verrucosum. igi mxolod erTeul SemTxvevebSi aRmoCnda Tavis

Tmiani aris mikozebis gamomwvevi da Seadgina saerTo etiologiur

agentTa 5,4%, Tumca unda aRiniSnos misi gamovlenis gansakuTrebuli

mniSvneloba, radgan saqarTveloSi Trichophyton verrucosum-iT gamowveuli

Tavis Tmiani aris mikozebis SemTxvevebi adre ar dafiqsirebula.

  65

gamovlinda anTroponozuli Microsporum ferrugineum-iT gamowveuli

Tavis Tmiani aris mikozebis erTeul SemTxvevebic. Aam etiologiurma

agentma daavadebis saerTo gamomwvevTa 6,2% Seadgina. anTroponozuli

mikozebis mkveTri Semcireba Sedegia 80-ian wlebSi saqarTveloSi

mizanmimarTulad Catarebuli muSaobisa, rac moicavda Tavis Tmiani aris

mikozebis kontaqtebis ucilobel Semowmebas, daavadebis aqtiur

gamovlenasa da daavadebulebis mkurnalobaSi CarTvas, rasac

axorcielebdnen regionuli kanisa da vensneulebaTa dispanserebi kanisa

da vensneulebaTa samecniero-kvleviTi institutis moZrav mikologiur

razmTan erTad.

gansxvavebuli aRmoCnda TiToeuli gamomwvevis gavrcelebac

sxvadasxva regionisTvis. Microsporum canis-iT gamowveuli SemTxvevebis

41,5% gavrcelebuli iyo qalaqis mosaxleobaSi, 58,5% ki _ soflis

mosaxleobaSi. miuxedavad aseTi ganawilebisa, saerTo raodenobis

yvelaze maRali procentuli maCvenebeli aRiniSna Tbilisis

mosaxleobaSi (34,2%). am gamomwvevis gavrcelebis sixSiris mixedviT

Semdegi regioni aRmoCnda sagarejos raioni (12, 2%). mxolod erTeuli

SemTxvevebi gamovlinda rusTavSi, wyneTSi, suramSi, agreTve, gardabnis,

aspinZis, yvarlis, axalcixis, walkis, gurjaanisa da WiaTuris raionebSi.

qalaqis mosaxleobaSi, kerZod, TbilisSi, Microsporum canis-is xSiri

gavrceleba SeiZleba aixsnas daavadebis gadamtanis, katis, qalaqis

macxovreblebTan mWidro kontaqtiT.

zoofiluri Trichophyton mentagrophytes-iT gamowveuli Tavis Tmiani

aris mikozebis SemTxvevaTa mxolod 4,3% gamovlinda qalaqis

mosaxleobaSi, ZiriTadi 95,7% ki _ soflis mosaxleobaSi. Aam gamomwvevis

gavrcelebiT gamorCeuli regionebi aRmoCnda marneuli (40,4%), bolnisi

(34%), sagarejos raioni (8,5%) da gardabani (8,5%). Mmisi mxolod erTeuli

SemTxvevebi dafiqsirda rusTavsa da dedofliswyaros raionSi.

aRsaniSnavia, rom zemoaRniSnuli raionebis mosaxleoba ZiriTadad

dakavebulia mecxoveleobiT da daavadebis gadamtani (wyaro) Trichophyton

mentagrophytes-iT gamowveuli Tavis Tmiani aris mikozis yvela SemTxvevaSi

aRmoCnda msxvilfexa rqosani pirutyvi.M

  66

marneulis, bolnisisa da gardabnis raionebSi gamovlinda

zoofiluri Trichophyton verrucosum-iT gamowveuli Tavis Tmiani aris

mikozebiT daavadebulebi, romelTa sixSirec, Sesabamisad gamoixateboda

50%, 33,3% da 16,7%-iT. sxva raionebsa da qalaqis mosaxleobaSi am

etiologiuri agentiT gamowveuli SemTxvevebi ar dafiqsirebula.

antropofiluri Trichophyton violaceum-iT gamowveuli daavadebis

SemTxvevebi gamovlinda mxolod sam raionSi ambrolauris, kaspisa da

marneulis, Sesabamisad 54,5%-Si, 27,3%-Si da 18,2%-Si, xolo Microsporum

ferrugineum-iT gamowveuli aRiniSna mxolod or raionSi ambrolaursa da

axalcixeSi, Sesabamisad 71,4%-Si da 28,6%-Si. am ori antropofiluri

etiologiuri agentiT gamowveuli Tavis Tmiani aris mikozebis

SemTxvevebi raionis organizebul mosaxleobaSi, kerZod moWidaveebSi,

gamovlinda.

gamomwvevTa speqtrSi mniSvnelovanma cvlilebebma ganapiroba Tavis

Tmiani aris mikozebis gavrcelebis formis cvlilebac. Tu 80-iani wlebis

periodSi antropofiluri etiologiuri agentebis dominirebis fonze

daavadeba xSirad atarebda mikroepidemiis xasiaTs da upiratesad

gvxvdeboda ojaxis wevrebis inficireba, Cveni kvlevis Sedegebis

ganxilviT daavadebis gamovlinebis es forma Seicvala. daavadebulTa

umravlesoba gamovlinda rogorc sporadiuli SemTxveva da

mikroepidemiebis SemTxvevebi iyo mxolod erTeuli. swored aseTi

mikroepidemia aRiniSna ambrolauris raionis moWidave sportsmenebsa da

maTTan kontaqtSi myof bavSvebSi, sadac erTdroulad gamovlinda ori

anTroponozuli etiologiuri agentiT, Trichophyton violaceum-iTa da

Microsporum ferrugineum-iT gamowveuli Tavis Tmiani aris mikozebi.

identificirebuli etiologiuri agentebis 45% modioda Microsporum

ferrugineum-ze, xolo 55% _ Trichophyton violaceum-ze. unda aRiniSnos, rom

Cveni kvlevis mixedviT, dReisTvis es orive anTroponozuli gamomwvevi

miekuTvneba Tavis Tmiani aris mikozebis iSviaT etiologiur agentebs,

amitomac vvaraudobT, rom maTi gavrceleba SesaZloa ukavSirdebodes

sportsmeni bavSvebis gadaadgilebas Sejibrebebis dros.

kvlevis Sedegad gamovlinda daavadebis kavSiri sqesTan. Tavis

Tmiani aris mikozebi upiratesad gavrcelebuli iyo mamrobiTi sqesis

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pirebSi. is gamovlinda saerTo raodenobis 73,3%-Si da misi raodenobrivi

maCvenebeli 2,7-jer Warbobda daavadebulTa ricxvs mdedrobiT sqesSi.

aseve Warbobda daavadebis TiToeuli klinikuri formis raodenobrivi

maCvenebeli mamrobiT sqesSi, Tumca monacemTa statistikuri damuSavebiT

sarwmuno kavSiri klinikur formasa da sqess Soris ar gamovlenila.

saqarTveloSi 80-ian wlebSi Catarebuli kvlevis mixedviT triqofitia,

aseve, ufro gavrcelebuli iyo mamrobiTi sqesis pirebSi. daavadebis

mamrobiT sqesSi upirates gavrcelebas adasturebs msoflios sxvadasxva

qveyanaSi Catarebuli kvlevebic (Fulgence KK et al, 2013, Zaraa I et al, 2013,

Mirmirani P et al, 2013, Kundu D et al, 2012, Del Boz J et al, 2011, Komba EV et al, 2010).

Tumca arsebobs kvlevebi, romlebic daavadebis maRal sixSires

mdedrobiTi sqesis pirebSi aRniSnaven (Zhu M et al, 2010, East-Innis A et al, 2006,

Jha BN et al, 2006). zogierTi evropeli mecnierebis monacemebiT ki daavadeba

sqesTan kavSirSi ar aris (Ginter-Hanselmayer 2007).

Cveni kvleviT, aseve, gamovlinda daavadebis kavSiri asakTan. Tavis

Tmiani aris mikozebi SesaZloa yvela asakSi Segvxvdes, Tumca araerTxel

da mravali kvleviTaa dadasturebuli misi upiratesi gavrceleba bavSvTa

asakSi. msgavsad, Cvens mier gamovlenili yvela SemTxveva dafiqsirda

bavSvebSi 1-dan 14 wlamde. Cvil da 14 wlis zemoT bavSvebSi daavadebis

SemTxvevebi ar gamovlenila. Aar dafiqsirebula arcerTi SemTxveva

mozrdilTa da moxucebulTa populaciaSic. kvlevis Sedegebis

damuSavebiT aRmoCnda, rom Tavis Tmiani aris mikozebi yvelaze

gavrcelebuli iyo 5-9 wlis asakovan jgufSi, romelSic gamovlinda

daavadebulTa 51,7%. predominanti aRmoCnda 1-4 wlis asakovani jgufi,

romelSic 27,8% gaerTianda, yvelaze mcire raodenoba ki dafiqsirda 10-

14 wlis asakovan jgufSi da Seadgina saerTo daavadebulTa 20,5%.

sabolood, 5-9 wlis asakovan (dominantur) jgufSi gaerTianebul

pacientTa raodenoba 1,9-jer aRemateboda 1-4 wlis asakovani jgufSi da

2,5-jer aRemateboda 10-14 wlis asakovani jgufSi Semaval daavadebulTa

raodenobas. monacemTa statistikuri damuSavebiT gamovlinda sarwmuno

kavSiri daavadebis klinikur formasa da asaks Sorisac. Tu am monacemebs

SevadarebT saqarTveloSi 80-ian wlebSi triqofitiis asakobrivi

gavrcelebis maCveneblebs, aRmovaCenT, rom asakobrivi diapazoni

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mniSvnelovnad ar Secvlila (80-ian wlebSi Catarebuli kvlevis mixedviT

triqofitia yvelaze gavrcelebuli iyo 4-7 wlis asakis bavSvebSi da

Seadgenda saerTo raodenobis 65-70%-s).

daavadebis klinikuri manifestaciis Seswavlis Sedegad gamovlinda

upiratesad gavrcelebuli klinikuri formebi da maTi mniSvnelovani

kavSiri etiologiur agentebTan.

Tavis Tmiani aris mikozebis klinikuri formebidan araanTebiTi

formebi mcired Warbobdnen da maTi raodenoba mxolod 1,1-jer

aRemateboda anTebiT formebs. anTebiTi formebis ZiriTad nawils

warmoadgenda Rrma formis dazianeba _ qerioni, xolo misi mcire nawili

warmodgenili iyo dajgufebuli folikulitebiT. dominanati qerioni

Seadgenda anTebiTi formebis 85,9%-s da misi raodenoba 6,1-jer

aRemateboda dajgufebuli folikulitebis SemTxvevebs. Qqerionis

SemTxvevaSi umravlesobas (74%) Seadgenda erTeuli keriT warmodgenili

formebi da maTi raodenobrivi gamovlinebis sixSire 2,8-jer Warbobda

mravlobiTi kerebiT warmodgenil formebs.

Tavis Tmiani aris mikozebis araanTebiT formebSi dominanti

aRmoCnda nacrisferi laqebi dazianebis erTeuli kerebiT, romelmac

saerTo araanTebiTi formebis 78% Seadgina, darCenili 22% ki ganawilda

seboreuli dermatitis msgavs da Savwertilovan formebze, Sesabamisad

15,4% d 6,6%. sabolood aRmoCnda, rom araanTebiTi nacrisferi laqebi

dazianebis erTeuli kerebis raodenoba 5,1-jer aRemateboda seboreuli

dermatitis msgavs formasa da 11,8-jer _ Savwertilovan dermatofitozs.

mTlianad klinikuri formebis raodenobrivi Sedegebis ganxilvis

Sedegad gamovlinda ori yvelaze gavrcelebuli klinikuri forma

qerioni da nacrisferi laqebi dazianebis erTeuli kerebiT, romlebic

gamovlinda Tavis Tmiani aris mikozebis SemTxvevaTa 41,5%-Si da 40,3%-Si

Sesabamisad. sixSiriT Semdegi formebi aRmoCnda seboreuli dermatitis

msgavsi 8%-Si da dajgufebuli folikulitebi _ 6,8%-Si gamovleniT.

yvelaze iSviaTi Savwertilovani dermatofitozi dafiqsirda mxolod

3,4%-Si.

kvlevis Sedegad SesaZlebeli gaxda gangvesazRvra zoo- da

antropofilurobisa da Tmis invaziis formis mniSvneloba klinikuri

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niSnebis CamoyalibebaSi. aRmoCnda, rom verc erTi maTgani calkeulad

ver gansazRvravs klinikur suraTs. kvlevam aCvena, rom zoofiluri

sokoebi (Trichophyton mentagrophytes, Trichophyton verrucosum da Microsporum canis)

iwveven Tmis erTgvar, eqtotriqsis tipis invazias, Tumca Trichophyton

mentagrophytes da Trichophyton verrucosum gamowveuli klinikuri formebi

gamoirCeva mkveTri anTebiTi cvlilebebiT, maSin roca Microsporum canis

gamowveuli infeqcia vlindeba mcired gamoxatuli anTebiTi

dazianebebiT. anTropofiluri sokoebis SemTxvevaSi ki, gansxvavebuli

invaziis formebis miuxedavad, klinikuri gamovlinebani erTgvarovania.

kerZod, Microsporum ferrugineum iwvevs eqtotriqsis tipis invazias,

Trichophyton violaceum _ endotriqsis tipis, orive maTgani ki vlindeba

naklebad gamoxatuli anTebiTi reaqciebiT. kvlevis Sedegad gamovlinda

mniSvnelovani klinikur-etiologiuri kavSiri rogorc qerionsa da

Trichophyton mentagrophytes, aseve nacrisfer laqebs dazianebis erTeuli

kerebiTa da Microsporum canis Soris.

Cveni kvlevis monacemebis 80-ian wlebSi saqarTveloSi Catarebuli

kvlevis monacemebTan Sedarebis Sedegad gamovavlineT, agreTve,

zoofiluri triqofitiis klinikuri formis cvlileba, kerZod, adre

Catarebuli kvlevis mixedviT, Trichophyton mentagrophytes var gypseum-iT

gamowveuli triqofitia qarTul populaciaSi mimdinareobda upiratesad

zerele dazianebis formiT, SedarebiT naklebad vlindeboda

infiltraciuli forma da mxolod erTeul SemTxvevebSi _

damaCirqebeli. Cveni kvlevis monacemebi sruliad gansxvavdeba misgan.

Trichophyton mentagrophytes-iT gamowveuli KTavis Tmiani aris mikozebis

yvela forma iyo anTebiTi, maTgan umravlesoba Rrma dazianebis _

qerionis formis, mcire nawili ki mkveTrad anTebiTi _ dajgufebuli

folikulitis formis. am mxriv cvlileba ar gamovlenila

anTropofiluri etiologiuri agentiT gamowveuli daavadebis klinikur

suraTSi. 80-ian wlebSi Catarebuli kvlevis mixedviT, Trichophyton violaceum

vlindeboda araanTebiTi, pitiroidul-skvamozuri kerebiT. Cvens mier

gamovlenili yvela SemTxveva, aseve, gamoixata araanTebadi seboreuli

dermatitis msgavsi formiT.

  70

am TvalsazrisiT Cveni kvlevisgan gansxvavebulia sxvadasxva

qveyanaSi Catarebuli kvlevebis monacemebi. samxreT_aRmosavleT CineTSi

qerionis yvelaze xSiri gamomwvevi aRmoCnda Microsporum canis, Trichophyton

violaceum da Trichophyton rubrum (Zhu M et al, 2010), CrdiloeT tunisSi anTebiTi

Tavis Tmiani aris mikozebis gamomwvevi iyo Trichophyton violaceum (Zaraa I et al,

2013), xolo samxreT ivori kostaSi Tavis Tmiani aris mikozebis zerele

dazianebis yvelaze gavrcelebuli gamomwvevebi iyo Trichophyton soudanense,

Microsporum langeronii, da Trichophyton mentagrophytes (Fulgence KK et al, 2013).

kvlevis Sedegad gamovlinda, agreTve, daavadebis wyaro konkretuli

gamomwvevisTvis. aRmoCnda, rom Trichophyton mentagrophytes-iT da Trichophyton

verrucosum-iT gamowveuli Tavis Tmiani aris mikozebis ZiriTadi wyaro

iyo msxvilfexa rqosani pirutyvi, Microsporum canis-iT gamowveulis _

katebi, Trichophyton violaceum-iTa da Microsporum ferrugineum-iT gamowveulis ki

_ daavadebuli adamiani.

klinikuri formebis Seswavlisas gamovlenili iyo Tavis Tmiani aris

mikozebis dros ganviTarebuli alergiuli reaqciebic. tansa da

kidurebze diseminirebuli gamonayaridan sokos gamoricxvis Semdeg isini

diagnostirda rogorc dermatofitiduli gamonayari da dadginda maTi

kavSiri rogorc klinikur formasTan, aseve etiologiur agentTan.

aRmoCnda, rom dermatofitiduli reaqciis yvela SemTxveva ganviTarda

mxolod mkveTri anTebiTi dazianebebis fonze da igi ar gamovlenila

araanTebiTi Tavis Tmiani aris mikozebis arcerT SemTxvevaSi. am mxriv

gamoirCeoda qerioni. dermatofitidul reaqciaTa 87,5% swored

dazianebis mravlobiTi keriT warmodgenili qerionis dros gamovlinda

da mxolod 12,5%-Si gamoixata dajgufebul folikulitebTan erTad.

mniSvnelovania, rom dermatofitiduli reaqciebi Tan axlda mxolod

zoofiluri etiologiuri agentebiT gamowveul Tavis Tmiani aris

mikozebs da arcerTi SemTxveva ar gamovlenila anTroponozul

infeqciasTan erTad. zoofiluri gamomwvevebidan ki gamovlinda mxolod

triqofitonebis jgufis gamomwvevebi Trichophyton mentagrophytes da

Trichophyton verrucosum. sokovan infeqciaze gamovlenili alergiuli

reaqciebis SemTxvevebSi ZiriTadi daavadebis etiologiuri agentebis

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68,7%-s Seadgenda Trychophyton mentagrophytes da 6,3%-s _ Trichophyton verrucosum.

am maCvenebliT naTlad gamoixata dermatofitiduli reaqciebis maRali

sixSire Trychophyton mentagrophytes-iT gamowveuli Tavis Tmiani aris

mikozebis dros.

aRsaniSnavia isic, rom Cveni kvleviT aRwerili mikidebis yvela

SemTxveva warmodgenili iyo erTi saxis klinikuri formiT, kerZod,

diseminirebuli folikuluri papulebis saxiT, Tumca literaturaSi

aRwerilia misi ramodenime forma.

kvlevis dros pacientTa mkurnalobisas gamoyenebuli iqna Tanamedrove

antimikozuri sistemuri moqmedebis preparati _ terbinafini. ganisazRvra

terbinafinis efeqturoba Tavis Tmiani aris mikozebis mkurnalobaSi,

rogorc konkretuli klinikuri formisTvis, ise gamomwvevTan

mimarTebaSi. Sedegad aRmoCnda, rom es preparati efeqturia rogorc

Tavis Tmiani aris Rrma anTebiTi qerionis formis, ise araanTebadi

nacrisferi laqebis dazianebis erTeuli kerebis formebis SemTxvevaSi,

mxolod gansxvavebuli aRmoCnda misi gamoyenebis xangrZlivoba.

terbinafini efeqturi aRmoCnda rogorc triqofitonebiT, ise

mikrosporumebiT gamowveuli infeqciebis samkurnalod, kerZod, rogorc

Trichophyton mentagrophytes-is mimarT, ise Microsporum canis mimarTac.

aRsaniSnavia, rom Microsporum canis-iT gamowveuli nacrisferi laqebis

erTeuli kerebis samkurnalod misi gamoyeneba saWiro aRmoCnda 1,4-jer

ufro xangrZlivi droiT, vidre Trichophyton mentagrophytes-iT gamowveuli

qerionis samkurnalod.

L 

 

 

D

  72

6. daskvnebi 1. Catarebuli kvlevis mixedviT bolo xuTi wlis ganmavlobaSi ar

SeiniSneba arsebiTi cvlileba Tavis Tmiani aris mikozebis

sixSiris TvalsazrisiT.

2. Tavis Tmiani aris mikozebis gavrceleba soflis mosaxleobaSi

maRalia, vidre qalaqis mosaxleobaSi.

3. gamovlinda regionebi, romlebic gamoirCeva Tavis Tmiani aris

mikozebis gavrcelebiT: marneulis, bolnisis, ambrolauris,

sagarejosa da gardabnis raionebi da qalaqi Tbilisi.

4. gamovlinda Tavis Tmiani aris mikozebis kavSiri sqesTan. igi

upiratesad gavrcelebulia mamrobiTi sqesis pirebSi, Tumca sqesis

sarwmuno kavSiri daavadebis klinikur formebTan ar gamovlinda.

5. gamovlinda Tavis Tmiani aris mikozebis kavSiri asakTan. igi

yvelaze gavrcelebuli aRmoCnda 5-9 wlis asakobriv jgufSi. aseve

gamovlinda sarwmuno kavSiri asaksa da klinikur formebs Soris.

6. Catarebuli kvlevis mixedviT Tavis Tmiani aris mikozebis

dominanti etiologiuri agentebia zoofiluri gamomwvevebi:

Trichophyton mentagrophytes da Microsporum canis. P

7. Tavis Tmiani aris mikozebis gamomwvevTa Soris saqarTveloSi

pirvelad gamovlinda Trichophyton verrucosum.

8. Tavis Tmiani aris mikozis dominanti klinikuri formebia qerioni

da nacrisferi laqebi dazianebis erTeuli kerebiT.

9. dadginda klinikur-etiologiuri korelacia qerionsa da

Trichophyton mentagrophytes-s Soris, agreTve, nacrisfer laqebsa

dazianebis erTeuli kerebiTa da Microsporum canis-s Soris.

10. Ddermatofitiduli reaqcia gamoixateba ZiriTadad Trichophyton

mentagrophytes-iT gamowveuli anTebiTi formebis, upiratesad

qerionis SemTxvevebSi diseminirebuli folikuluri papulebis

saxiT.

  73

11. Ggamovlinda Tavis Tmiani aris mikozebis prevenciuli

RonisZiebebis gafarToebisa da epidemiologiuri kontrolis

meTodebis srulyofis aucilebloba.

12. Tavis Tmiani aris mikozebis gansakuTrebuli gavrceleba

mecxoveleobis mimdevar raionebSi aucilebels xdis garkveuli

struqturuli da saorganizacio RonisZiebebis gatarebas, raTa

aRdges dermato-venerologiuri profilis dawesebulebebsa da

veterinarul samsaxurebs Soris koordinirebuli saqmianoba.

  74

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8. danarTi

suraTi #1. qerioni dazianebis mravlobiTi keriT

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suraTi #2. kerioni dazianebis erTeuli keriT

 

 

 

N

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suraTi #3. nacrisferi laqebi dazianebis erTeuli kerebiT

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suraTi #4. nacrisferi laqebi dazianebis erTeuli kerebiT

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suraTi #5. Savwertilovani forma

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suraTi #6. kerionis fonze ganviTarebuli

dermatofitiduli reaqcia

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suraTi #7. kerionis fonze ganviTarebuli

dermatofitiduli reaqcia

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suraTi #8. Tavis Tmiani arisa da sada kanis kerionis fonze

ganviTarebuli dermatofitiduli reaqcia

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suraTi #9. Trichopyton verrucosum

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suraTi #10. Microsporum canis

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suraTi #11. Trichophyton mentagrophytes

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suraTi #12. Trichophyton mentagrophytes

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suraTi #13. Trichophyton violaceum

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suraTi #14. Microsporum ferrugineum

  100

suraTi #15.

marcxnidan marjvniv Trichopyton verrucosum, Trichopyton mentagrophytes, gamomwvevi ar gamovlinda

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Ivane Javakhishvili Tbilisi State University

Faculty of Medicine

Department of Dermato-venereology

Khatuna Kudava

Clinical-epidemiologic Analysis of Scalp Mycoses

Dissertation

Submitted in Candidacy for Higher Doctorate Academic Degree

Academic Adviser:

Tina Kituashvili, Associated Professor

Tbilisi, 2014

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Actuality of Problem

Scalp mycosis (Tinea Capitis), fungal infection caused by dermatophytes, is a widely

spread infection among children. The disease represents a significant health care problem

and still remains a subject of intensive scientific study worldwide. As a result of rigorous

measures undertaken against scalp fungal infections in 70-ies of the past century favus

has been actually eradicated in Georgia. However, situation in relation to the scalp

mycoses in Georgia during last 27 years is not studied.

Aims and Objectives of Study

The aim of the study was to research clinical-epidemiologic characteristics of the scalp

mycoses in 2009-2013. Following objectives were set to accomplish the aim:

1. To study prevalence of the disease and to identify regions with high incidence.

2. To study scalp mycoses in relation to gender and age.

3. To study a specter of the disease causatives to identify prevailing etiological

agents.

4. To study clinical manifestations of the disease to identify prevailing clinical

forms.

5. To process the study results to identify clinical-etiological relationship of the scalp

mycoses.

Novelty of Scientific Research

1. Epidemiologic and clinical characteristics of the scalp mycoses were studied according

to the data of last five years.

2. Etiologic specter different from data of studies of the scalp mycoses undertaken in

Georgia earlier was identified.

3. For the first time Trichophyton verrucosum was identified as a causative agent of the

scalp mycoses in Georgia.

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K Practical Value of Study

1. Problems existing in registration of the scalp mycoses were identified; this was related

to introduction of new classification of dermatophytoses. In order to improve registration:

1.1 To introduce International Classification of Diseases, Tenth Revision, it has

been discussed at three conferences of Dermato-venereologists of Georgia and

training of dermatologists and venereologists has been conducted.

1.2 Recommendation was given to the National Center of Disease Control and

Public Health to record scalp mycoses according to the new classifier into a

statistical form IV-06 that is used to registered trichophitia and microsporia

diagnosed for the first time throughout life, as far as apart from the scalp mycoses

the diagnosis trichophitia and microsporia includes also mycoses of other

locatlization caused by trychophytons and microsporiums.

2. Together with the improvement of the scalp mycoses registration abovementioned

amendment in the statistical form will also provide opportunity to undertake countrywide

statistical analysis of the disease.

Materials and methods: The study was undertaken on 27 655 patients who had addressed the

Scientific-Research Institute of Dermatology and Venereology as outpatients during last five

years. A criterion for inclusion into the study for each patient was simultaneous presence of

clinical symptoms and positive results of microscopic examination. Identification of the

causative species was done by culturing on Saburo growth medium with antibiotic

chloramphenicol. Evaluation of luminescence under the Wood lamp was used as a

supplementary method. For statistical analysis was used SPSS system, Pearson Chi-Square and

Likelihood Ratio Chi-Square Test. P<0,05 was accepted as statistically valid.

Study results and discussion: Study of the patients with scalp mycoses revealed that its share

among dermatological patients during last five years has not changed substantially and it varied

between 1,45% - 2%. No significant difference was identified in the share of the scalp mycoses

in total patients with mycoses (6,2%-8,3%). 87,4% of the patients was from villages. The regions

were identified where scalp mycoses were remarkably highly prevalent: Marneuli (18,2%),

Bolnisi (16%), Ambrolauri (9,1%), Sagarejo (8,5%) and Gardabani districts and the city Tbilisi

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(10,8%). Most of the patients were male (73,3%) and of 5-9 age group (51,7%). In the 1-4 and

10-14 age groups distribution of the patients was 27,8% and 20,5% respectively.

Prevailing clinical forms turned out to be kerion (41,5%) and grey spots with single lesions

(40,3%). Distribution of the other clinical forms was reflected in following way: seborrheic

dermatitis-like form – 8%, agminate folliculities folliculitis in groups 6,8% and black-dot

dermatophytosis 3,4%. Most frequent etiological agentს turned out to be Trichophyton

mentagrophytes (42%) and Microsporum canis

(36, 6%). Less frequent were Trichophyton violaceum (9, 8%), Microsporum ferrugineum

(6,2%) and Trichophyton verrucosum (5,4%). In relation to the clinical forms – 89,1% of

etiological agents identified for the kerion was Trichophyton mentagrophytes, whereas for the

grey spots with single lesions Microsporum canis was 85,4%. In other cases correlation between

the clinical forms and etiological agents was not identified. Dermatophytid response, that in all

cases was revealed as disseminated follicular papullae, was manifested in 87,5% when kerion

was present, and in 68,7% its etiological agent was Trychophyton mentagrophytes. Upon

viewing with Wood lamp green light was manifested in 75,9% in case of grey spots caused by

Microsporum canis. For the most widespread causatives, in particular, for Trychophyton

mentagrophytes, source of the disease in all cases was cattle, while in 87,8% of cases caused by

Microsporum canis source of the disease was a cat.

Conclusions:

1. According to the undertaken study during last five years no significant changes are

observed in relation to the frequency of scalp mycoses.

2. Prevalence of the scalp mycoses in village population is reliably higher than in city

population.

3. The regions were identified with prevalent spread of the scalp mycoses: Marneuli,

Bolnisi, Ambrolauri, Sagarejo and Gardabani districts and the city Tbilisi.

4. Relation of the scalp mycoses with sex was identified. The disease is mostly prevalent in

males.

5. Relation of the scalp mycoses with age was identified. The disease I mostly prevalent in

children of 5-9 age group.

6. According to the undertaken study prevailing etiological agents of the scalp mycoses are

zoophylous causatives: Trichophyton mentagrophytes and Microsporum canis. P

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7. Among the causatives of the scalp mycoses Trichophyton verrucosum was identified for

the first time in Georgia.

8. Prevailing clinical forms of the scalp mycoses are kerion and grey spots with single

lesions.

9. Clinical-etiological correlation between kerion and Trichophyton mentagrophytes, as

well as between grey spots with single lesions and Microsporium canis was identified.

10. Dermatophytid response is manifested mainly as inflammatory forms caused by

Trichophyton mentagrophytes, predominantly in case of kerion as disseminated follicular

papullae.

11. Necessity was revealed to expand the scalp mycoses preventive measures and to improve

methods of epidemiologic control.

12. Particular prevalence of the scalp mycoses in animal husbandry regions necessitates

implementation of special structural and organizational measures to restore coordinated

activities between dermato-venereological institutions and veterinary services.

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