DBD Infeksi
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BI
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90l7` &,
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laelr1 4kbltl`lnslbllb MEM mkrlolt DD mlb DDD ( Vuaekr1 Mkpks *D, %&&-)
E. &!bsk' Lsuclb &k'krl;ltlb
'. 4kbinlodlb
4kbinlodlb ylbi khkntdh plml M#G ltlupub MVV md rulbi DM
mdmlslrnlb plml nkalapulb lbl`dsds nrdtds pkrllt ubtun
akaprkmdnsdnlb, akbikbl`d mlb akbkbtunlb mkbilb kplt plsdkb mkbilbMVV ltlu pjtkbsdl` MVV skcdbiil mlplt mdekrdnlb pkblbilblb ylbi kplt
pu`l, nlrkbl nktkr`laeltlb rksusdtlsd mlplt akbdbinltnlb rksdnj
ajrtl`dtls. #l` dbd slbilt mdmunubi j`kc pkbiktlculb pkrllt tkbtlbi cl`6
cl` ylbi clrus mdnlod plml plsdkb mkbilb M#G ltlu MVV, tkralsun
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albdhkstlsd n`dbds ylbi aubindb aubu` ml`la sktdlp tlclp mlrd pkbylndt
tkrskeut. Vklrl uaua aubu`byl tlbml mlb ikol`l bykrd ltlu tkbmkrbkss
plml lemjakb, aubtlc tkrus akbkrus, lnuau`lsd ldrlb adsl`byl khusd
p`kurl ltld lsdtks,pkrmlrlclb aunjsl,pkburublb nkslmlrlb 1 `ktlrid,
ik`dslc, pkaekslrlb `dvkr (N%a),pkbdbinltlb ckaltjnrdt mkbilb
pkburublb oua`lc p`ltk`kt sklrl kplt akruplnlb dbmdnltjr elcl
mdpkr`unlb kvl`uld akmds skikrl. 7M7 (7kbtkr Mdsklsk 7jbtrj` lbm
4rkvkbtdjb) akbok`lsnlb elcl hjnus pkbinlodlb ubtun nkilltlb plml
M#G ylbi mdnkbl` mkbilb MVV lml`lc skelild ekrdnut (7M7, %&'&)1
l. *dlylt mkala
*dlylt mkala ylbi lnurlt pkbtdbi ubtun nktkpltlb mdlibjsds mlb
akaelbtu prkmdnsd nkcd`lbilb ldrlb, mlb hlsk pkbylndt. ;krmlplt
pkrekmllb nlrlntkrdstdn mkala plml 1
MG mkala lnut edlslbyl % clrd ltlu `kedc
M#G 1 %6+ clrd
MVV 1pkburublb tkapkrltur ylbi tdel6tdel (B3=.&C7 akbolmd
tkapkrltur bjral` ltlu suebjral`)
e. ;lbml6tlbml vdtl`
;lbml6tlbml nkilltlb9nrdtds lml`lc nktdnl mdmlpltnlb blmd kplt mlb
`kalc, tknlblb blmd ylbi skapdt (;M sdstj`dn6;M mdlstj`dn U%&aa
#i) ltlu cdpjtkbsd ekrmlslrnlb tknlblb mlrlc sksuld usdl.
. 4kakrdnsllb hdsdn hjnus mlb albdhkstlsd pkrmlrlclb
jbmdsd plsdkb au`ld nrdtds nktdnl mdmlpltnlb tlbml6tlbml albdhkstlsd
n`dbds pkrmlrlclb ltlu tks tjrbdIukt pjsdtdh mdskrtld tlbml aubu`byl
lsdtks mlb ltlu khusd p`kurl, nu`dtmlb knstrkadtls tkrlel mdbidb, elslc,
nkslmlrlb akburub (`ktlrid ltlu ik`dslc),7*;B% mktdn, j`diurdl, tlbml6
tlbml scjn (4clbakksun Vunsdb, %&&
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%) #kajnjskbtrlsd ( pkbdbinltlb ckaltjrdt N%&/mdltls rltl6rltl
sksuld usdl ltlu pkburublb ckaltjrdt N%&/ mlrd tkrlpd ldrlb ylbi
mdpkr`unlb, cdpjprjtkdbkadl, cdpjnj`kstkrj`kadl
Mktknsd mdbd akbolmd slbilt pkbtdbi nlrkbl nksl`lclb ml`la
akbikbl`d tlbml6tlbml nrdtds mlplt akbykelenlb nktkr`laeltlb rkusdtlsd
kplt ylbi mlplt akbykelenlb plsdkb alsun nkml`la njap`dnlsd ltlu
ylbi mdtlbmld mkbilb pkrmlrlclb alsdh mlb ilbiiulb aktlej`dsak skpkrtd
cdpjnl`skadl, cdpji dnkadl, cdpkri`dnkadl, lsdmjsds `lntlt, mlb
cdpjbltrkadl (7M7). Vkcdbiil ajbdtjr nktlt j`kc pkrllt tkrclmlp
vj`uak dbtrlvlsnu`lr, hubisd jrilb vdtl`, mlb rkspjb plsdkb tkrclmlp
trkltakbt, okbds ldrlb ylbi alsun, skrtl nkaubindblb suaekr pkrmlrlclb
`ldbbyl akbolmd slbilt pkbtdbi. 5lnl, ubtun nkpkr`ulb tkrskeut alnl
pkrllt skelild pktuils ylbi %8 ola mdmknlt plsdkb akad`dnd pkrlb ylbi
sdibdhdnlb ml`la khkntdhdtls jeskrvlsd tkrskeut (4clbakksun Vunsdb,
%&&kbs" ?
Dbtkrvkbsd prdjrdtls 0D7
') utjtrlbhusd pkbiuapu`lb mlb rkdbhusd mlrlc ylbi cd`lbi lndelt
pkrmlrlclb
%) 4kbik`j`llb k`kntrj`dt pkbdbinltlb nkskdaelbilb k`kntrj`dt mlbpkbkilclb njap`dnlsd lndelt nlmlr k`kntrj`dt skrua ylbi tdmln
bjral` ltlu tdmln mddbidbnlb (adsl`byl 1 nl`sdua,
nl`dua.libksdua, bltrdua mlb hjshlt ml`la skrua).
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3) 4kbik`j`llb ldrlb 1 pkbdbinltlb mlb lbl`dsds mltl pldskb ubtun
akbiltur nkskdaelbilb ldrlb
8) 4kbik`j`llb cdpjvj`kadl 1 k@plbsd vj`uak ldrlb dbtrlvlsnu`lr
plml plsdkb ylbi akbil`lad pkburublb vj`uak.
-) ;krlpd dbtrlvkbl 1 4kaekrdlb mlb pkalbtlulb ldrlb mlb jelt
dbtrlvkbl
) 4kbik`j`llb syjn , vj`uak 1 pkbdbinltlb nklmknultlb pkrhusd
olrdbilb plml plsdkb ylbi akbil`lad alsl`lc vj`uak
dbtrlvlsnu`lr ylbi ekrlt
ntdhdtls kpkrlltlb
') 4lbtlu lrbl, oua`lc, mlb hrknukbsd nkcd`lbilb ldrlb
%) $eskrvlsd ncusus tkrclmlp nkcd lbilb ldrlb mlb k`kntrj`dt ylbi
tdbiid
3) 4lbtlu pkrmlrlclb
8) Dmkbtdhdnlsd hlntjr6hlntjr ylbi ekrnjbtrdeusd tkrclmlp ekrtlaelc
eurunbyl mkcdmrlsd
-) ;dbolu u`lbi k`kntrj`dt tkrutlal bltrdua, nl`dua mlb n`jrdml.
) lod jrdkbtlsd tkrclmlp jrlbi, tkaplt mlb lntu.
+) 4kbik`j`llb ldrlb (0D7) 1
l) 4lbtlu stltus cdmrlsd
e) 4lbtlu clsd` `lejrltjrdua ylbi rk`kvlb mkbilb nkskdaelbilb
ldrlb
) 4krtlclbnlb nklnurltlb lsuplb mlb nk`ulrlb.
4kbmdmdnlb ubtun plsdkb mlb nk`ulril
') bournlb plsdkb ubtun ak`lpjrlnlb nkpml pkrllt ed`l clus
ntdvdtls nj`lejrltdh 1
') `lpjrnlb mlb ltlt nk`ulrlb ($utput)
%) `lpjrnlb lebjral`dtls k`kntrj dt
3) ekrdnlb tkrlpd D: sksuld mkbilb lbourlb
ntdhdtls `ldb
') ekrsdcnlb au`ut sklrl tkrltur,
%) tkbtunlb oua`lc ldrlb ml`la %8 ola
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3) tdbinltnlb lsuplb jr l, plslbi nltktkr ed`l pkr`u
8) ekrdnlb ldrlb sksuld dbmdnlsd
e. Mdlibjsl nkpkrlltlb1 4kbdbinltlb sucu tueuc `kedc mlrd bjral`
ekrcueubilb mkbilb tkrolmdbyl vdrkadl
Mdtlbmld mkbilb 1 sucu tueuc ``kedc mlrd bjral` (3.-6 3+ 7), nu`dt
akakrlc (cdpkrkad), ** akbdbinlt, nu`dt clbilt, tlcdnlrmd
rdtkrdl #lsd`1 Vucu tueuc 0jral` (3-63+ 7), ** mlb blmd 0jral`,
pkrueclb lrbl nu`dt tdmln lml.klmllb uaua unup
Dbtkr>kbs" ?
Dbtkrvkbsd prdjrdtls 0D7
') 4kbijeltlb mkala pkbik`j`llb plsdkb mkbilb cdpkrtkradl ylbi
mdskelenlb j`kc hlntjr6hlntjr ylbi eunlb mlrd `dbinubilb
%) *kiu`lsd sucu akblpld mlb ltlu ubtun akapkrtlclbnlb sucu
tueuc ml`la rkbtlbi bjral`
3) 4kalbtlulb tlbml vdtl` pkbiuapu`lb mlb lbl`dsds mltl
nlrmdjvlsn`ulr, rkspdrlsd, sucu tueuc ubtun akbkbtunlb skrtl
akbkilc njap`dnlsd
ntdvdtls kpkrlltlb
') 4lbtlu lntdvdtls nkolbi
%) 4lbtlu cdmrlsd
3) 4lbtlu tnlblb mlrlc mlb, blmd mlb pkrblhlslb,k
8) *kiu`lsd sucu (0D7) 1 plbtlu sucu tueuc adbdal` tdlp % olasksuld mkbilb nkeutuclb mkbik plbtlu lrbl nu`dt mlb sucu
4kbmdmdnlb ubtun plsdkb mlb nk`ulril
') olrnlb dbmdnlsd nk`ktdclb nlrkbl plbls mlb tdbmlnlb nkmlrurltlb
ybli mdpkr`unlb sksuld mkbilb nkeutuclb
ntdhdtls nj`lejrltdh 1
') Ekrdnlb jeltlbtdpdrktdn sksuld mkbilb nkeutuclb
%) ublnlb ldr olbilt ubtun akbiltlsd ilbiiulb sucu tueuc sksuld
mkbilb nkeutuclb
ntdhdtls `ldb 1
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') >kplsnlb plnldlb ylbi ylbi ekr`kedcb
%) bournlb lsuplb ldrlb jrl`
3) ublnlb sk`daut
8) ublnbl njaprks plml lnsd`l, nkbdbi, `kckr mlb dplt plcl
. Mdlibjsl kpkrlltlb1 urlbi pkbiktlculb tkbtlbi prjsks pkbylndt,
mdkt mlb pkrlltlb plsdkb M#G skcueubilb mkbilb nurlbibyl
dbhjralsd.
;uoulb 1 4kbiktlculb n`dkb9nk`ulril tkbtlbi prjsks pkbylndt, mdkt,
pkrlltlb akbdbinlt skcdbiil n`dkb9nk`ulril akapkr`dcltnlb
pkrd`lnu ylbi njjpkrltdh.
Dbtkrvkbsd1
') lod tdbinlt pkbiktlculb n dkb9nk`ulril tkbtlbi pkbylndt M#G
%) lod ltlr ek`lnlbi pkbmdmdnlb n`dkb9 nk`ulril.
3) Fk`lsnlb tkbtlbi prjsks pkbylndt, mdkt, pkrlltlb mlb jelt6jeltlb
plml n`dkb mkbilb elclsl mlb nltl6nltl ylbi aumlc mdakbikrtd.
8) Fk`lsnlb skaul prjskmur ylbi lnlb md lnunlb mlb albhlltbyl
plml n`dkb.
-) Ekrdnlb nkskapltlb plml n`dkb9 nk`ulril ubtun akblbylnlb cl`6
cl` ylbi dbidb mdnktlcud skcueubilb mkbilb pkbylndt ylbi mdmkrdtl
n`dkb.
) ublnlb `klh kt ltlu ilaelr6ilaelr ml`la akaekrdnlb
pkbok`lslb.
F. &ks"a'u`lb =lb 8lrlb
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skrtl alsylrlnlt ml`la pkaekrlbtlslb slrlbi bylaun alnl skekslr
lplpub mlbl ylbi mdnk`ulrnlb mlb skelius lplpub prjirla pkakrdbtlc
tdmln lnlb jptdal` ml`la pkblbiiu`lbilb mlb pkaekrlbtlslb pkbylndt
mkala ekrmlrlc. 2btun mlplt akrllt plsdkb MEM mkbilb eldn,
mdpkr`unlb mjntkr mlb pkrllt ylbi tkrlapd`, slrlbl `lejrltjrdua ylbi
akalmld, ldrlb nrdstl`jdm mlbnj`jdm, skrtl elbn mlrlc ylbi skblbtdlsl
sdlp ed`l mdpkr`unlb. ubd nkekrclsd`lb tltl`lnslbl MEM9MVV tkr`ktln
plml nktrlapd`lb plrl mjntkr ubtun mlplt akbiltlsd alsl pkrl`dclb mlrd
hlsk mkala nk hlsk pkburublb sucu (hlsk nrdtds, hlsk syjn) mkbilb eldn.
5. 8lrlb
l. Mdpkr`unlb pkrlb alsylrlnlt mlb pkakrdbtlc sklrl `uls ubtun
ekrslal6slal akbol`lbnlb prjirla6prjirla ylbi tk`lc mdeult
ml`la pkblbiiu`lbilb MEM.
e. Mdeutucnlb pkrlb skrtl pkrllt 4usnksals skelild `dbd tkrmkplb
ml`la pkbkilclb MEM md `dbinubilb alsylrlnlt mkbilb mktknsd
mdbd mlb pkbdbinltlb pkbmdmdnlb nkskcltlb alsylrlnlt tkrnldt MEM.
ML0]L% W[8]L&L
calmd, G.2. %&'&. 5lblokakb mkala ekrmlrlc ekrelsds d`lylc. Eu`ktdb
kbmk`l kpdmk!dj`jid" # ($)% $ & '
Elidlb 4ltj`jid `dbdn. (%&&
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Erlsdkr. . *., Fu. #., lrdl. F., Vprltt. #. 5., Gjrscky. E. 5., #k`sky. L. V.
(%&'%). tcrkk6japjbkbt edjalrnkr plbk` hjr prkmdtdjb jh mkbiuk
ckajrrlicd hkvkr. a. F. ;rjp.*km" Cyi" +,(#)% '-$.'-+"
7M7 (7kbtkrs hjr Mdsklsk lbm 4rkvkbtdjb). (%&'&). Mkbiuk Erlbc.7l[lml
VlbFulb,4ukrtj*dj.Grja1cttp199.m.ijv9mkbiuk9`dbdl``le9`dbdl`.ct
a` mdlnsks %& prd` %&'3
Mlbby, "drlmclral. %&&
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6kk. .
#. (%&''). 7ju`m pkln prjtkdburdl mktkradbk cktckr pltdkbt dtc mkbiuk
hkvkr mkvk`jp mkbiuk ckajrrlicd9mkbiuk scjn sybmrjak96 prjspktdvk
jcjrt stumy.E*2 ;bhkftdjus dsklsks"
"d`ndbsjb, Fumdtc 5. %&&+.Eunu 8lnu dlibjsds 7kpkrl:ltlb mkbilb dbtrkvkbsd
9;2 mlb nrdtkrdl clsd` 9J2"L7. Flnlrtl.
"jr`m #kl`tc $rilbdKltdjb ("#$). ('