Pivane javaxiSvilis saxelobis Tbilisis saxelmwifo ...
Transcript of Pivane javaxiSvilis saxelobis Tbilisis saxelmwifo ...
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
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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
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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
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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
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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).
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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
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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
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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.
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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.
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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.
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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.
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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
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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,
29
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
33
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,
36
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,
37
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
67
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
68
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
69
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
71
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
87
suraTi #2. kerioni dazianebis erTeuli keriT
N
88
suraTi #3. nacrisferi laqebi dazianebis erTeuli kerebiT
89
suraTi #4. nacrisferi laqebi dazianebis erTeuli kerebiT
90
suraTi #5. Savwertilovani forma
91
suraTi #6. kerionis fonze ganviTarebuli
dermatofitiduli reaqcia
92
suraTi #7. kerionis fonze ganviTarebuli
dermatofitiduli reaqcia
93
suraTi #8. Tavis Tmiani arisa da sada kanis kerionis fonze
ganviTarebuli dermatofitiduli reaqcia
94
suraTi #9. Trichopyton verrucosum
95
suraTi #10. Microsporum canis
96
suraTi #11. Trichophyton mentagrophytes
97
suraTi #12. Trichophyton mentagrophytes
98
suraTi #13. Trichophyton violaceum
99
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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