‫ﻋﻘﺪﻳﺔ ﻣﻘﻴﺤﺔ‬

‫ﻧﻮع ﻣﻦ ﺑﺪاﺋﻴﺎت اﻟﻨﻮى‬

 ‫اﻟﻌﻘﺪﻳﺔ اﻟﻤﻘﻴﺤﺔ‬

‫اﻟﻌﻘﺪﻳﺎت اﻟﻤﻘﻴﺤﺔ ﺑﺘﻜﺒﻴﺮ ‪×900‬‬

‫ﻧﻮع‪ ‬‬ ‫اﻟﻤﺮﺗﺒﺔ اﻟﺘﺼﻨﻴﻔﻴﺔ‬

‫اﻟﺘﺼﻨﻴﻒ اﻟﻌﻠﻤﻲ‬

‫ﺑﻜﺘﻴﺮﻳﺎ‬ ‫اﻟﻤﻤﻠﻜﺔ‪:‬‬
‫ﻓﻴﺮﻣﻴﻜﻴﺘﻮس‬ ‫اﻟﺸﻌﺒﺔ‪:‬‬
‫ﻋﺼﻴﺎت‬ ‫اﻟﻄﺎﺋﻔﺔ‪:‬‬
‫ﻣﻠﺒﻨﻴﺎت‬ ‫اﻟﺮﺗﺒﺔ‪:‬‬
‫ﻋﻘﺪﻳﺎت‬ ‫اﻟﻔﺼﻴﻠﺔ‪:‬‬
‫ﻋﻘﺪﻳﺔ‬ ‫اﻟﺠﻨﺲ‪:‬‬
‫اﻟﻌﻘﺪﻳﺔ اﻟﻤﻘﻴﺤﺔ‬ ‫اﻟﻨﻮع‪:‬‬

‫اﻻﺳﻢ اﻟﻌﻠﻤﻲ‬

‫‪Streptococcus pyogenes‬‬
‫‪Rosenbach 1884‬‬
‫ﺗﻌﺪﻳﻞ ﻣﺼﺪري )‪https://ar.wikipedia.org/w/index.php?title=%D8%B9%D9%82%D8%AF%D9%8A%D8%A9_%D9%85%D9%82%D9%8A%‬‬
‫‪ -‬ﺗﻌﺪﻳﻞ )‪https://ar.wikipedia.org/w/index.php?title=%D8%B9%D9%82%D8%AF%D9%8‬‬ ‫‪(D8%AD%D8%A9&action=edit&section=0‬‬
‫‪(A%D8%A9_%D9%85%D9%82%D9%8A%D8%AD%D8%A9&veaction=edit‬‬
‫‪ ‬‬
 ‫اﻟﻌ ْﻘ ّ‬
‫ﺪﻳﺔ اﻟﻤﻘﻴﺤﺔ أو اﻟﻤﻜﻮرة اﻟﻌﻘﺪﻳﺔ اﻟﻤﻘﻴﺤﺔ )ﺑﺎﻟﻼﺗﻴﻨﻴﺔ‪ (St rept ococcus pyogenes :‬ﻧﻮع ﻣﻦ اﻟﺒﻜﺘﻴﺮﻳﺎ‬ ‫ِ‬
‫ً‬
‫ﻧﺎدرا‬ ‫إﻳﺠﺎﺑﻴﺔ اﻟﻐﺮام‪ [3][2][1].‬وﻣﺜﻞ ﻛﻞ اﻟﻌﻘﺪﻳﺎت اﻷﺧﺮى‪ ،‬ﻟﻬﺎ دور ﻣﻬﻢ ﻓﻲ اﻷﻣﺮاض اﻟﺘﻲ ﺗﺼﻴﺐ اﻹﻧﺴﺎن‪ .‬اﻹﺻﺎﺑﺔ ﺑﻬﺎ‬
‫ﻣﺎﺗﺤﺪث‪ ،‬ﻟﻜﻨﻬﺎ ﻋﺎدة ﻣﺎ ﺗﻜﻮن ُﻣﻤﺮﺿﺔ‪ ،‬رﻏﻢ أﻧﻬﺎ ﺗﺘﻮاﺟﺪ ﻛﺠﺰء ﻣﻦ ﻓﻠﻮرا اﻟﺠﻠﺪ‪ .‬وﻫﻲ إﻳﻀﺎ ﺿﻤﻦ اﻟﻤﺠﻤﻮﻋﺔ أ ﻣﻦ‬
‫ﻻﻧﺴﻔﻴﻠﺪ وﻫﻲ ﻏﺎﻟﺒﺎ ﻣﺎﺗﺴﻤﻰ ﻋﻘﺪﻳﺎت اﻟﻤﺠﻤﻮﻋﺔ أ )‪ ،(GAS‬ﻹﻧﻬﺎ ﺗﺤﻤﻞ اﻷﻧﺘﺠﻴﻦ أ ﻋﻠﻰ اﻟﺴﻄﺢ اﻟﺨﻠﻮي‪ .‬إﺻﺎﺑﺎت‬
‫اﻟﻤﺠﻤﻮﻋﺔ أ ﻣﻦ اﻟﻌﻘﺪﻳﺎت ﻳﻤﻜﻦ أن ﺗﺆدي ﻟﺤﺪوث أﻣﺮاض‪ ،‬واﻟﺘﻲ ﻏﺎﻟﺒﺎ ﻣﺎﺗﻨﺘﺞ ﻣﺴﺎﺣﺎت ﺻﻐﻴﺮة ﻣﻦ ﺗﺤﻠﻞ دﻣﻮي ﻣﻦ اﻟﻨﻮع‬
‫ﺑﻴﺘﺎ‪ ،‬و ﺗﺪﻣﻴﺮ ﺷﺎﻣﻞ ﻟﻜﻞ ﺧﻼﻳﺎ اﻟﺪم اﻟﺤﻤﺮاء‪ ) .‬ﻣﻨﻄﻘﺔ ﻋﺎدة ﻣﺎﺗﻜﻮن ذات ﻣﺴﺎﺣﺔ ﺗﺘﺮواح ﻣﺎﺑﻴﻦ ‪ 3-2‬ﻣﻠﻢ ( ﻟﺬﻟﻚ ﻓﻬﻲ‬
‫ً‬
‫أﻳﻀﺎ اﻟﻤﺠﻤﻮﻋﺔ أ ) اﻟﻤﺤﻠﻠﺔ ﻟﻠﺪم ‪ -‬ﺑﻴﺘﺎ ( ﻣﻦ اﻟﻌﻘﺪﻳﺎت ) ‪. ( GABHS‬‬ ‫ﺗﺴﻤﻰ‬

‫ﻣﺜﻞ اﻟﻤﻜﻮرات اﻻﺧﺮى‪ ،‬اﻟﻌﻘﺪﻳﺎت ﻫﻲ ﺑﻜﺘﺮﻳﺎ ﻣﻜﻮرة‪ .‬اﻷﺳﻢ ﻣﺸﺘﻖ ﻣﻦ اﻟﻜﻠﻤﺔ اﻟﻼﺗﻴﻨﻴﺔ "‪ ،"st rept os‬واﻟﺘﻲ ﺗﻌﻨﻲ‬
‫اﻟﺴﻠﺴﻠﺔ اﻟﻤﻠﺘﻮﻳﺔ‪ ،‬ﻹن ﻫﺬه اﻟﺨﻼﻳﺎ اﻟﻌﻘﺪﻳﺔ ﺗﻤﻴﻞ ﻟﻼرﺗﺒﺎط ﺑﺒﻌﻀﻬﺎ ﻓﻲ ﻫﻴﺌﺔ ﺳﻼﺳﻞ‪ ،‬واﻟﺘﻲ ﺗﺸﺒﻪ ﻋﻘﺪ ﻟﺆﻟﺆ ﻋﻨﺪﻣﺎ ﻳﺘﻢ‬
‫ﻓﺤﺼﻬﺎ ﺗﺤﺖ اﻟﻤﺠﻬﺮ‪ [5][4].‬اﻟﻌﻘﺪﻳﺎت ﻫﻲ ﺳﺎﻟﺒﺔ اﺧﺘﺒﺎر اﻟﻜﺘﺎﻟﻴﺰ و ﻣﻮﺟﺒﺔ ﺻﺒﻐﺔ ﺟﺮام‪ " [5].‬اﻟﻌﻘﺪﻳﺎت اﻟﻤﻘﻴﺤﺔ" ﻳﻤﻜﻦ أن‬
‫أﻳﺎم‪[6].‬‬
‫ﺗﺘﻢ زراﻋﺘﻬﺎ ﻋﻠﻰ اﻵﺟﺎر اﻟﺪﻣﻮي‪ .‬ﺗﺤﺖ اﻟﻈﺮوف اﻟﻤﺜﺎﻟﻴﺔ‪ ،‬ﻟﻬﺎ ﻓﺘﺮة ﺣﻀﺎﻧﺔ ﺗﺘﺮواح ﻣﻦ ﻳﻮم إﻟﻰ ﺛﻼﺛﺔ‬

‫َ‬
‫ﺳﻨﻮﻳﺎ‪ .‬ﻓﻲ ﺣﻴﻦ أن ﻣﻌﺪل اﻟﻮﻓﻴﺎت اﻹﺟﻤﺎﻟﻲ ﺑﺴﺒﺐ ﻫﺬه‬ ‫ﻳﻘﺪر ﻋﺪد اﻹﺻﺎﺑﺎت ﺣﻮل اﻟﻌﺎﻟﻢ ﺑﻤﺎ ﻳﻘﺎرب ‪ 700‬ﻣﻠﻴﻮن أﺻﺎﺑﺔ‬
‫اﻟﺒﻜﺘﺮﻳﺎ ﻫﻮ ‪ ،٪0.1‬وﻓﻲ أﻛﺜﺮ ﻣﻦ ‪ 650,000‬ﺣﺎﻟﺔ ﺗﻜﻮن اﻹﺻﺎﺑﺔ ﺷﺪﻳﺪة وﻣﺠﺘﺎﺣﺔ )ﻏﺎزﻳﺔ ﻟﻸﻧﺴﺠﺔ اﻷﺧﺮى(‪ ،‬ﻛﻤﺎ أن ﻧﺴﺒﺔ‬
‫اﻟﻮﻓﺎة ﺗﺒﻠﻎ ‪ [7].٪25‬ﻳﻌﺘﺒﺮ اﻟﺘﺸﺨﻴﺺ اﻟﻤﺒﻜﺮ واﻟﻌﻼج ﻣﻦ اﻷﻣﻮر ﺑﺎﻟﻐﺔ اﻷﻫﻤﻴﺔ؛ اﻟﺘﺸﺨﻴﺺ اﻟﺨﺎﻃﻲء ﻗﺪ ﻳﺆدي إﻟﻰ ﺗﻌﻔﻦ‬
‫واﻟﻤﻮت‪[9][8].‬‬
‫اﻟﺪم‬

‫ﻋ…‬
‫اﻷﻧﻤﺎط اﻟﻤﺼﻠﻴﺔ‬

‫ﻓﻲ ‪ ،1928‬ﻗﺎﻣﺖ رﻳﺒﻜﺎ ﻻﻧﺴﻔﻴﻠﺪ ﺑﻨﺸﺮ ﻃﺮﻳﻘﺔ ﻟﻠﺘﺼﻨﻴﻒ اﻟﻤﺼﻠﻲ ﻟﺒﻜﺘﺮﻳﺎ ‪ S. pyogenes‬اﻋﺘﻤﺎدا ﻋﻠﻰ ﺑﺮوﺗﻴﻦ م‪ ،‬وﻋﻮاﻣﻞ‬
‫ﻻﺣﻘﺎ‪ ،‬ﻓﻲ ‪ ،1946‬وﺻﻔﺖ ﻻﻧﺴﻔﻴﻠﺪ اﻟﺘﺼﻨﻴﻒ اﻟﻤﺼﻠﻲ ﻟﻠﻌﺰﻻت وﻓﻘﺎ ﻟﻺﻧﺘﺠﻴﻦ‬ ‫َ‬ ‫اﻟﻀﺮاوة اﻟﻤﻮﺟﻮدة ﻋﻠﻰ ﺳﻄﺤﻬﺎ‪[10].‬‬

‫اﻟﺴﻄﺤﻲ ت‪ [11].‬أرﺑﻊ ﻣﻦ اﻟﻌﺸﺮﻳﻦ ﻧﻮع ﻟﻼﻧﺘﺠﻴﻦ ت ﺗﻢ اﻟﺘﻌﺮف ﻋﻠﻴﻬﺎ ﻋﻠﻰ أﻧﻬﺎ أﻫﺪاب‪ ،‬واﻟﺘﻲ ﺗﺴﺘﺨﺪﻣﻬﺎ اﻟﺒﻜﺘﺮﻳﺎ‬
‫اﻟﻌﺎﺋﻞ‪[12].‬‬
‫ﻫﻨﺎك ﻣﺎﻳﻘﺎرب ‪ 220‬ﻧﻤﻂ ﻣﺼﻠﻲ ﻟﻠﺒﺮوﺗﻴﻦ م وﺣﻮاﻟﻲ ‪ 20‬ﻧﻮع ﻣﺼﻠﻲ ﻟﻠﺒﺮوﺗﻴﻦ ت‬ ‫ﻛﻄﺮﻳﻘﺔ ﻟﻼﻟﺘﺼﺎق ﺑﺨﻼﻳﺎ‬
‫واﻟﺘﻲ ﺗﻢ اﻛﺘﺸﺎﻓﻬﺎ ﺣﺘﻰ اﻻن‪ .‬ﻟﺬﻟﻚ ﻳﺘﻢ اﺳﺘﺨﺪام اﻟﻤﺼﻄﻠﺢ اﻟﺠﻤﻌﻲ " اﻟﻤﺠﻤﻮﻋﺔ أ ﻣﻦ اﻟﺴﺘﺮﺑﺘﻮﻛﻮﻛﺎي " )إﺷﺎرة ﻟﻸﻧﻮاع‬
‫اﻟﻤﺼﻠﻴﺔ( واﻟﻤﺼﻄﻠﺢ اﻟﻔﺮدي "اﻟﻤﺠﻤﻮﻋﺔ أ ﻣﻦ اﻟﺴﺘﺮﺑﺘﻮﻛﻮﻛﺲ " )إﺷﺎرة ﻟﻠﻨﻮع اﻟﻤﺼﻠﻲ اﻟﻮاﺣﺪ( وﻛﻼﻫﻤﺎ ﺷﺎﺋﻊ‬
‫اﻻﺳﺘﺨﺪام‪.‬‬

‫ﻋ…‬
‫اﻹﻣﺮاﺿﻴﻪ‬

‫ ﻃﺎﻟﻊ ً‬
‫أﻳﻀﺎ‪Group A streptococcal infection :‬‬

‫"اﻟﻌﻘﺪﻳﺎت اﻟﻤﻘﻴﺤﺔ" ﻫﻲ اﻟﻤﺴﺒﺒﺔ ﻟﻜﺜﻴﺮ ﻣﻦ اﻷﻣﺮاض اﻟﺒﺸﺮﻳﺔ‪ ،‬ﺗﺘﺪرج ﻣﻦ إﺻﺎﺑﺎت ﺟﻠﺪﻳﺔ ﺳﻄﺤﻴﺔ ﻃﻔﻴﻔﺔ إﻟﻰ أﻣﺮاض‬
‫ﺟﻬﺎزﻳﺔ ﺗﻬﺪد اﻟﺤﻴﺎة‪ [5].‬ﺗﺒﺪأ اﻟﻌﺪوى ﻋﺎدة ﻓﻲ اﻟﺤﻨﺠﺮة أو اﻟﺠﻠﺪ‪ .‬أﻛﺜﺮ اﻟﻌﻼﻣﺎت اﻟﺘﻲ ﺗﻤﻴﺰﻫﺎ ﻫﻮ ﻃﻔﺢ ﺟﻠﺪي ﻳﺸﺒﻪ‬
‫اﻟﻔﺮاوﻟﺔ‪ .‬ﻣﻦ اﻷﻣﺜﻠﺔ ﻋﻠﻰ ﺑﻌﺾ اﻷﺻﺎﺑﺎت اﻟﺨﻔﻴﻔﺔ اﻟﺘﻲ ﺗﺘﺴﺒﺐ ﺑﻬﺎ اﻟﻌﻘﺪﻳﺎت اﻟﻤﻘﻴﺤﺔ إﻟﺘﻬﺎب اﻟﺒﻠﻌﻮم ) اﻟﺘﻬﺎب اﻟﺤﻠﻖ( و‬
‫إﺻﺎﺑﺎت ﺟﻠﺪﻳﺔ ﻣﺘﻤﺮﻛﺰة )اﻟﻘﻮﺑﺎء(‪ .‬ﻛﻼ ﻣﻦ اﻟﺤﻤﺮة )ﻣﺮض ﺟﻠﺪي ﻣﻌﺪي ﻳﺤﻤﺮ ﻣﻮﺿﻊ اﻹﺻﺎﺑﺔ( و إﻟﺘﻬﺎب اﻟﻨﺴﻴﺞ اﻟﺨﻠﻮي‬
 ‫ﺗﺘﻤﻴﺰ ﺑﺘﻜﺎﺛﺮ اﻟﻌﻘﺪﻳﺎت اﻟﻤﻘﻴﺤﺔ واﻧﺘﺸﺎرﻫﺎ ﻓﻲ اﻟﻄﺒﻘﺎت اﻟﻌﻤﻴﻘﺔ ﻣﻦ اﻟﺠﻠﺪ‪ .‬اﺟﺘﻴﺎج وﺗﻜﺎﺛﺮ اﻟﻌﻘﺪﻳﺎت اﻟﻤﻘﻴﺤﺔ ﻓﻲ‬
‫اﻟﻠﻔﺎﻓﺎت ) ﻣﺠﻤﻮﻋﺔ ﻣﻦ اﻟﻨﺴﻴﺞ اﻟﻀﺎم ﺗﻘﻊ إﻣﺎ اﺳﻔﻞ اﻟﺠﻠﺪ أو ﺑﺸﻜﻞ ﻏﺎﺋﺮ( ﻗﺪ ﻳﺆدي إﻟﻰ إﻟﺘﻬﺎب اﻟﻠﻔﺎﻓﺎت اﻟﻨﺎﺧﺮ‪ ،‬وﻫﻲ‬
‫ﺣﺎﻟﺔ ﺧﻄﻴﺮة ﺗﻬﺪد اﻟﺤﻴﺎة وﺗﺘﻄﻠﺐ اﻟﺘﺪﺧﻞ اﻟﺠﺮاﺣﻲ‪ .‬ﺑﻌﺾ اﻹﺻﺎﺑﺎت ﺑﺴﻼﻻت ﻣﻌﻴﻨﺔ ﻣﻦ اﻟﻌﻘﺪﻳﺎت اﻟﻤﻘﻴﺤﺔ ﻳﻤﻜﻦ أن‬
‫ﻳﺮاﻓﻘﻬﺎ إﻃﻼق ﺳﻤﻮم ﺑﻜﺘﻴﺮﻳﺔ‪ .‬إﺻﺎﺑﺎت اﻟﺤﻨﺠﺮة ﻳﺮاﻓﻘﻬﺎ إﻃﻼق ﺳﻤﻮم ﺗﺆدي إﻟﻰ اﻟﺤﻤﻰ اﻟﻘﺮﻣﺰﻳﺔ‪ .‬ﺑﻌﺾ اﻟﺴﻼﻻت‬
‫ً‬
‫ﺟﺪا‪[5].‬‬
‫اﻷﺧﺮى ذات اﻟﺴﻤﻴﺔ ﻗﺪ ﻳﻨﺘﺞ ﻋﻨﻬﺎ ﻣﺘﻼزﻣﺔ اﻟﺼﺪﻣﺔ اﻟﺴﻤﻴﺔ اﻟﻌﻘﺪﻳﺔ‪ ،‬واﻟﺘﻲ ﺗﻌﺘﺒﺮ ﺧﻄﻴﺮة‬

‫ً‬
‫إﻳﻀﺎ ﻣﺘﻼزﻣﺎت ﺗﻠﻰ اﻟﻌﺪوى ﺑﺸﻜﻞ "ﻏﻴﺮ ﻣﺘﻘﻴﺢ" ) ﻏﻴﺮ ﻣﺮﺗﺒﻂ ﻣﻊ وﺟﻮد ﺑﻜﺘﺮﻳﺎ‬ ‫اﻟﻌﻘﺪﻳﺎت اﻟﻤﻘﻴﺤﺔ ﻳﻤﻜﻦ أن ﺗﺴﺒﺐ‬
‫ﻣﺘﻤﺮﻛﺰة وﻣﺘﻜﺎﺛﺮة وﻣﻜﻮﻧﺔ ﻟﻠﺼﺪﻳﺪ(‪ .‬ﻫﺬه اﻟﻤﻀﺎﻋﻔﺎت اﻟﺘﻲ ﺗﺘﻮﻟﺪ ﻋﻦ ﻃﺮﻳﻖ اﻟﻤﻨﺎﻋﺔ اﻟﺬاﺗﻴﺔ ﺗﻠﻲ ﻧﺴﺒﺔ ﺑﺴﻴﻄﺔ ﻣﻦ‬
‫اﻻﺻﺎﺑﺎت وﺗﺸﻤﻞ اﻟﺤﻤﻰ اﻟﺮوﻣﺎﺗﻴﺰﻣﻴﺔ و إﻟﺘﻬﺎب ﻛﺒﻴﺒﺎت اﻟﻜﻠﻰ اﻟﺤﺎداﻟﺘﺎﻟﻲ ﻟﻺﺻﺎﺑﺎت‪ .‬ﻛﻠﺘﺎ اﻟﺤﺎﻟﺘﻴﻦ ﺗﻈﻬﺮ ﺑﻌﺪ ﻋﺪة أﺳﺎﺑﻴﻊ‬
‫ﻣﻦ اﻟﻌﺪوى اﻟﻤﺒﺪﺋﻴﺔ ﻟﻠﻌﻘﺪﻳﺎت‪ .‬اﻟﺤﻤﻰ اﻟﺮوﻣﺎﺗﻴﺰﻣﻴﺔ ﺗﺘﻤﻴﺰ ﺑﺎﻟﺘﻬﺎب اﻟﻤﻔﺎﺻﻞ و‪ /‬أو اﻟﺘﻬﺎب اﻟﻘﻠﺐ ﺗﻠﻲ ﺳﻠﺴﻠﺔ ﻣﻦ إﻟﺘﻬﺎب‬
‫اﻟﺤﻨﺠﺮة اﻟﻌﻘﺪي‪ .‬اﻟﺘﻬﺎب ﻛﺒﻴﺒﺎت اﻟﻜﻠﻰ اﻟﺤﺎد‪ ،‬اﻟﺘﻬﺎب ﻛﺒﻴﺒﺔ اﻟﻜﻠﻴﺔ‪ ،‬ﻳﻤﻜﻦ أن ﻳﺘﺒﻊ اﻟﺘﻬﺎب اﻟﺤﻨﺠﺮة اﻟﻌﻘﺪي أو ﻋﺪوى‬
‫اﻟﺠﻠﺪ‪.‬‬

‫ﻻﺗﺰال ﻫﺬه اﻟﺒﻜﺘﺮﻳﺎ ﺷﺪﻳﺪة اﻟﺤﺴﺎﺳﻴﺔ ﺿﺪ اﻟﺒﻨﺴﻴﻠﻴﻦ‪ .‬وﻓﻲ ﺣﺎﻟﺔ ﻓﺸﻞ اﻟﻌﻼج ﺑﺎﻟﺒﻨﺴﻴﻠﻴﻦ ﻗﺪ ﻳﻜﻮن ذﻟﻚ ﻏﺎﻟﺒﺎ ﺑﺴﺒﺐ‬
‫إﻧﺘﺎج اﻟﻜﺎﺋﻨﺎت اﻟﻤﺘﻌﺎﻳﺸﺔ اﻟﻤﺤﻠﻴﺔ ﻹﻧﺰﻳﻢ ﺑﻴﺘﺎ ﻻﻛﺘﺎﻣﺎز‪ ،‬أو اﻟﻔﺸﻞ ﻓﻲ اﻟﻮﺻﻮل ﻟﻺﻧﺴﺠﺔ اﻟﻤﻼﺋﻤﺔ ﻣﻦ اﻟﺤﻨﺠﺮة‪ .‬ﺑﻌﺾ‬
‫اﻟﺴﻼﻻت أﺻﺒﺤﺖ ﺗﻤﺘﻠﻚ ﻣﻘﺎوﻣﺔ ﺿﺪ اﻟﻤﻀﺎدات اﻟﺤﻴﻮﻳﺔ ﻣﺜﻞ اﻟﻤﺎﻛﺮوﻟﻴﺪات‪ ،‬اﻟﺘﺘﺮاﺳﻜﻠﻴﻨﺎت و اﻟﻜﻠﻴﻨﺪاﻣﻴﺴﻴﻦ‪.‬‬

‫ﻋ…‬
‫ﻋﻮاﻣﻞ اﻟﻀﺮاوة‬

‫اﻟﻌﻘﺪﻳﺎت اﻟﻤﻘﻴﺤﺔ ﻟﻬﺎ ﻋﺪة ﻋﻮاﻣﻞ ﺿﺮاوة واﻟﺘﻲ ﺗﻤﻜﻨﻬﺎ ﻣﻦ اﻻﻟﺘﺼﺎق ﺑﺎﻧﺴﺠﺔ اﻟﻌﺎﺋﻞ‪ ،‬ﺑﺎﻹﺿﺎﻓﺔ إﻟﻰ اﻻﻧﺘﺸﺎر واﺧﺘﺮاق‬
‫ﻃﺒﻘﺎت اﻧﺴﺠﺘﻪ وﺗﺠﻨﺐ ردود ﻓﻌﻠﻪ اﻟﻤﻨﺎﻋﻴﺔ‪ [13].‬ﺑﺎﻹﺿﺎﻓﺔ ﻟﻮﺟﻮد ﻛﺒﺴﻮﻟﺔ ﺑﻜﺘﻴﺮﻳﺔ ﺗﺤﻴﻂ ﺑﻜﻞ اﻟﺒﻜﺘﺮﻳﺎ ﻗﻮاﻣﻬﺎ ﻣﻦ‬
‫اﻟﻜﺮﺑﻮﻫﻴﺪرات وﺗﺘﺄﻟﻒ ﻣﻦ ﺣﻤﺾ اﻟﻬﻴﺎﻟﻮروﻧﻴﻚ‪ ،‬وﺗﺤﻤﻴﻬﺎ ﻣﻦ اﻟﺒﻠﻌﻤﺔ ) ‪ ( phagocyt osis‬ﺑﻮاﺳﻄﺔ اﻟﺨﻼﻳﺎ اﻟﻤﺘﻌﺎدﻟﺔ )‬
‫‪ [5].( neut rophils‬ﺑﺎﻹﺿﺎﻓﺔ ﻟﺬﻟﻚ‪ ،‬ﻓﺈن اﻟﻜﺒﺴﻮﻟﺔ وﻋﺪة ﻋﻮاﻣﻞ ﺗﺘﻮاﺟﺪ ﻓﻲ اﻟﺠﺪار اﻟﺨﻠﻮي ﻣﺜﻞ ﺑﺮوﺗﻴﻦ م‪ ،‬ﺣﻤﺾ‬
‫اﻟﻌﺎﺋﻞ‪[14].‬‬
‫اﻟﻠﻴﺒﺘﻮﺗﺸﻮﻳﻚ‪ ،‬و ﺑﺮوﺗﻴﻦ ف )‪ (SfbI‬ﻛﻠﻬﺎ ﺗﺴﻬﻞ اﻟﺘﺼﺎق اﻟﺒﻜﺘﺮﻳﺎ ﺑﺄﻧﻮاع ﻣﺨﺘﻠﻔﺔ ﻣﻦ ﺧﻼﻳﺎ‬

‫ً‬
‫إﻳﻀﺎ ﺑﺘﺜﺒﻴﻂ ﻋﻤﻠﻴﺎت اﻟﻬﻀﻢ )‪ (opsonizat ion‬واﻟﺘﻲ ﺗﺘﻢ ﻋﻦ ﻃﺮﻳﻖ اﻟﻨﻈﺎم اﻟﻤﺘﻤﻢ اﻟﺒﺪﻳﻞ‪ ،‬ﻳﺘﻢ‬ ‫اﻟﺒﺮوﺗﻴﻦ م ﻳﻘﻮم‬
‫اﻟﺘﺜﺒﻴﻂ ﻋﻦ ﻃﺮﻳﻖ اﻻرﺗﺒﺎط ﺑﺎﻟﺨﻼﻳﺎ اﻟﻤﺴﺆوﻟﺔ ﻋﻦ ﺗﻨﻈﻴﻢ ﻋﻤﻞ اﻟﻤﺘﻤﻢ ﻓﻲ اﻟﻌﺎﺋﻞ ﻧﻔﺴﻪ‪ .‬ﺑﻌﺾ اﻟﺴﻼﻻت ﻳﺘﻮاﺟﺪ ﺑﻬﺎ‬
‫اﻟﺒﺮوﺗﻴﻦ م وﻟﺪﻳﻪ ﻗﺪرة إﺿﺎﻓﻴﺔ ﻟﻤﻨﻊ اﻟﻬﻀﻢ ﻋﻦ ﻃﺮﻳﻖ اﻻرﺗﺒﺎط ﻣﻊ اﻟﻔﻴﺒﺮﻳﻨﻮﺟﻴﻦ‪ [5].‬ﻣﻊ ذﻟﻚ‪ ،‬ﻓﺈن اﻟﺒﺮوﺗﻴﻦ م ﻫﻮ أﻳﻀﺎ‬
‫أﺿﻌﻒ آﻟﻴﺎت دﻓﺎع اﻟﻜﺎﺋﻦ اﻟﻤﻤﺮض‪ ،‬ﺣﻴﺚ أﻧﻪ ﻳﺘﻢ إﻧﺘﺎج أﺟﺴﺎم ﻣﻀﺎدة ﺑﻮاﺳﻄﺔ اﻟﺠﻬﺎز اﻟﻤﻨﺎﻋﻲ ﺿﺪ اﻟﺒﺮوﺗﻴﻦ م ﺗﺠﻌﻞ‬
‫اﻟﺒﻜﺘﺮﻳﺎ ﻣﺴﺘﻬﺪﻓﺔ ﻟﺤﺪوث اﻹﺑﺘﻼع‪ .‬اﻟﺒﺮوﺗﻴﻦ م ﻣﻤﻴﺰ ﻟﻜﻞ ﺳﻼﻟﺔ‪ ،‬وﻳﻤﻜﻦ أن ﻳﺘﻢ إﺳﺘﺨﺪاﻣﺔ ﻛﻮﺳﻴﻠﺔ ﻟﺘﺤﺪﻳﺪ اﻟﺴﻼﻟﺔ‬
‫اﻟﻤﺴﺒﺒﺔ ﻟﻠﻤﺮض‪.‬‬

‫ﻋ…‬
‫اﻹﺳﺘﺬاﺑﺔ‬
‫ﻛﻞ ﺳﻼﻻت اﻟﻌﻘﺪﻳﺎت اﻟﻤﻘﻴﺤﺔ ﺗﻌﺘﺒﺮ ﻣﺘﻌﺪدة اﻟﻤﺴﺘﺬﻳﺒﺎت‪ ،‬ﺣﻴﺚ أﻧﻬﺎ ﺗﺤﻤﻞ واﺣﺪ أو أﻛﺜﺮ ﻣﻦ اﻟﻼﻗﻤﺎت ) ﻓﻴﺮوس ﻳﻠﺘﻬﻢ‬
‫اﻟﺒﻜﺘﺮﻳﺎ ‪ (bact eriophage‬ﻓﻲ اﻟﺠﻴﻨﻮم اﻟﺨﺎص ﺑﻬﺎ‪ [15].‬ﺑﻌﺾ اﻟﻼﻗﻤﺎت ﻗﺪ ﺗﻜﻮن ﻧﺎﻗﺼﺔ أو ﺑﻬﺎ ﺧﻠﻞ‪ ،‬وﻟﻜﻦ اﻟﻼﻗﻤﺎت‬
‫اﻟﻨﺸﻄﺔ ﻓﻲ ﺑﻌﺾ اﻟﺤﺎﻻت ﺗﻌﻮض ﺧﻠﻞ اﻟﻼﻗﻤﺎت اﻷﺧﺮى‪ [16].‬ﺑﺸﻜﻞ ﻋﺎم‪ ،‬ﻓﻲ ﺟﻴﻨﻮم ﺳﻼﻻت اﻟﻌﻘﺪﻳﺎت اﻟﻤﻘﻴﺤﺔ اﻟﻤﻌﺰوﻟﺔ‬
‫اﻟﺘﻲ ﺗﺤﻤﻠﻬﺎ‪[17].‬‬
‫ﺧﻼل اﻟﻤﺮض وﺟﺪ أن < ‪ %90‬ﻣﺘﻄﺎﺑﻘﺔ‪ ،‬وﻟﻜﻦ اﻻﺧﺘﻼف ﻳﺤﺪث ﻓﻘﻂ ﻓﻲ اﻟﻼﻗﻤﺔ‬
 ‫اﻟﻮﺻﻒ‬ ‫اﻻﺳﻢ‬

‫ﺳﻢ ﺧﺎرﺟﻲ‪ ،‬وأﺣﺪ أﻫﻢ ﺧﺼﺎﺋﺺ اﻟﻜﺎﺋﻦ اﻟﻤﺤﻠﻞ ﻟﻠﺪم ﻣﻦ اﻟﻨﻮع ﺑﻴﺘﺎ‪ ،‬ﺳﺘﺮﺑﺘﻮﻟﻴﺴﻴﻦ وﻳﺴﺒﺐ‬
‫ﺣﺪوث رد ﻓﻌﻞ ﻣﻨﺎﻋﻲ وﻳﻤﻜﻦ إﻳﺠﺎد اﻷﺟﺴﺎم اﻟﻤﻀﺎدة ﻟﻪ؛ ‪ (ant ist rept olysin O (ASO‬ﻳﻤﻜﻦ‬ ‫‪St rept olysin O‬‬
‫أن ﺗﺴﺘﺨﺪم إﻛﻠﻴﻨﻴﻜﻴﺎ ﻟﻠﺘﺄﻛﺪ ﻣﻦ ﺣﺪوث إﺻﺎﺑﺔ ﺣﺪﻳﺜﺔ‪.‬‬

‫ﺳﻢ ﺧﺎرﺟﻲ ﻳﺆﺛﺮ ﻋﻠﻰ اﻟﻘﻠﺐ‪ ،‬وﻣﻦ اﻟﻤﻜﻮﻧﺎت اﻻﺧﺮى ﻟﺘﺤﻠﻞ اﻟﺪم ﻣﻦ ﻧﻮع ﺑﻴﺘﺎ‪ ،‬ﻻﻳﻮﻟﺪ رد ﻓﻌﻞ‬
‫ﻣﻨﺎﻋﻲ وﺛﺎﺑﺖ ﻓﻲ وﺟﻮد ‪ : O2‬ﻫﺬا اﻟﺴﻢ اﻟﺨﻠﻮي ﻟﻪ ﺗﺄﺛﻴﺮ ﻗﻮي ﻋﻠﻰ أﻧﻮاع ﻣﺨﺘﻠﻔﺔ ﻣﻦ اﻟﺨﻼﻳﺎ‬ ‫‪St rept olysin S‬‬
‫ﻣﺜﻞ ‪ ,neut rophils‬اﻟﺼﻔﺎﺋﺢ‪ ،‬واﻟﻌﻀﻴﺎت ﺗﺤﺖ ﺧﻠﻮﻳﺔ‪.‬‬

‫‪St rept ococcal‬‬

‫‪pyrogenic‬‬
‫‪exot oxin A‬‬
‫ﻣﺴﺘﻀﺪ ﻓﻮﻗﻲ ﺗﻔﺮزه اﻟﻌﺪﻳﺪ ﻣﻦ ﺳﻼﻻت اﻟﻌﻘﺪﻳﺎت اﻟﻤﻘﻴﺤﺔ‪ :‬ﻫﺬا اﻟﺴﻢ اﻟﺨﺎرﺟﻲ اﻟﻤﻮﻟﺪ ﻟﻠﺤﻤﻰ‬
‫‪((SpeA‬‬
‫ﻫﻮ اﻟﻤﺴﻮؤل ﻋﻦ اﻟﻄﻔﺢ ﻟﻠﺤﻤﻰ اﻟﻘﺮﻣﺰﻳﺔ وﻛﺜﺮ ﻣﻦ أﻋﺮاض ﻣﺘﻼزﻣﺔ اﻟﺼﺪﻣﺔ اﻟﺴﻤﻴﺔ ﻟﻠﻌﻘﺪﻳﺎت‪،‬‬
‫‪St rept ococcal‬‬
‫ﻛﻤﺎ أﻧﻬﺎ ُﺗﻌﺮف ﺑﺄﺳﻢ ‪.(t oxic shock like syndrome(TSLS‬‬
‫‪pyrogenic‬‬
‫‪exot oxin C‬‬
‫‪((SpeC‬‬
‫ً‬
‫أﻧﺰﻳﻤﻴﺎ‪ ،‬وﻫﻮ أﻧﺰﻳﻢ ﺑﺮوﺗﻴﻨﻲ‪ ،‬إﻟﻰ ﺑﻼزﻣﻴﻦ‪،‬‬ ‫ﻳﻘﻮم ﺑﺘﻨﺸﻴﻂ اﻟﺒﻼزﻣﻴﻨﻮﺟﻴﻦ‬
‫ﺳﺘﺮﺑﺘﻮﻛﺎﻳﻨﻴﺰ‬
‫واﻟﺬي ﺑﺪوره ﻳﻬﻀﻢ اﻟﻔﺎﻳﺒﺮﻳﻦ واﻟﺒﺮوﺗﻴﻨﺎت اﻷﺧﺮى‪.‬‬

‫ﻫﻨﺎك إﻋﺘﻘﺎد ﺷﺎﺋﻊ ﺑﺄن إﻧﺰﻳﻢ اﻟﻬﻴﺎﻟﻮروﻧﻴﺪاز ﻳﺴﻬﻞ اﻧﺘﺸﺎر اﻟﺒﻜﺘﺮﻳﺎ ﺧﻼل اﻷﻧﺴﺠﺔ ﻋﺒﺮ ﺗﺤﻄﻴﻢ‬
‫ﺣﻤﺾ اﻟﻬﻴﺎﻟﻮرﻧﻴﻚ‪ ،‬وﻫﻮ أﺣﺪ اﻟﻤﻜﻮﻧﺎت اﻟﻤﻬﻤﺔ ﻓﻲ اﻟﻨﺴﻴﺞ اﻟﻀﺎم‪ .‬وﻣﻊ ذﻟﻚ‪ ،‬ﻋﺪد ﻗﻠﻴﻞ ﻣﻦ‬
‫ﻋﺰﻻت اﻟﻌﻘﺪﻳﺎت اﻟﻤﻘﻴﺤﺔ ﺗﻜﻮن ﻗﺎدرة ﻋﻠﻰ إﻓﺮاز ﻫﺬا اﻹﻧﺰﻳﻢ ﺑﺸﻜﻞ ﻓﻌﺎل ﺑﺴﺒﺐ ﻃﻔﺮات ﻓﻲ‬
‫ﻫﻴﺎﻟﻮروﻧﻴﺪاز‬
‫اﻟﺠﻴﻦ اﻟﻤﺴﺆول ﻋﻦ ﺗﻜﻮﻳﻦ ﻫﺬا اﻹﻧﺰﻳﻢ‪ .‬ﻋﻼوة ﻋﻠﻰ ذﻟﻚ‪ ،‬ﻓﺈن اﻟﻌﺰﻻت اﻟﻘﻠﻴﻠﺔ اﻟﻤﻔﺮزة ﻟﻬﺬا‬
‫اﻹﻧﺰﻳﻢ ﻻ ﻳﺒﺪو أﻧﻬﺎ ﺑﺤﺎﺟﺔ ﻟﻺﻧﺘﺸﺎر ﻓﻲ اﻷﻧﺴﺠﺔ أو اﻟﺘﺴﺒﺐ ﺑﺂﻓﺎت ﺟﻠﺪﻳﺔ‪ [18].‬ﻟﺬﻟﻚ‪ ،‬ﻓﺈن اﻟﺪور‬
‫ً‬
‫ﻣﻌﺮوﻓﺎ‪.‬‬ ‫اﻟﺤﻘﻴﻘﻲ ﻓﻲ اﻹﻣﺮاﺿﻴﺔ‪ ،‬ﻫﺬا إن وﺟﺪ‪ ،‬ﻳﻈﻞ ﻏﻴﺮ‬

‫ﻣﻌﻈﻢ ﺳﻼﻻت اﻟﻌﻘﺪﻳﺎت اﻟﻤﻘﻴﺤﺔ ﺗﻔﺮز ﻣﺎﻳﻘﺎرب أرﺑﻊ أﻧﻮاع ﻣﻦ إﻧﺰﻳﻢ دﻳﻮﻛﺴﻲ رﻳﺒﻮ ﻧﻮﻛﻠﻴﺎز‪،‬‬
‫واﻟﺘﻲ أﺣﻴﺎﻧﺎ ﺗﺴﻤﻰ ‪.st rept odornase‬إﻧﺰﻳﻢ ‪ DNases‬ﻳﺤﻤﻲ اﻟﺒﻜﺘﺮﻳﺎ ﻣﻦ أن ﺗﺘﻢ ﻣﺤﺎﺻﺮﺗﻬﺎ‬
‫‪ St rept odornase‬ﺑﻮاﺳﻄﺔ أﻓﺨﺎخ اﻟﺨﻼﻳﺎ اﻟﻤﺘﻌﺎدﻟﺔ اﻟﺨﺎرﺟﻴﺔ ﻣﺼﺎﺋﺪ اﻟﻌﺪﻻت ﺧﺎرج اﻟﺨﻠﻴﺔ )‪ (NETs‬ﻋﻦ ﻃﺮﻳﻖ‬
‫ﻫﻀﻢ ﺷﺒﻜﺔ اﻟﺤﻤﺾ اﻟﻨﻮوي دﻧﺎ ﻟﻬﺬه اﻷﻓﺨﺎخ‪ ،‬واﻟﺘﻲ ﺗﻜﻮن ﻣﺮﺗﺒﻄﺔ ﻣﻊ ﺧﻠﻴﺔ ﻣﺘﻌﺎدﻟﺔ ﺑﺮوﺗﻴﻴﺰ‬
‫اﻟﺒﻜﺘﺮﻳﺎ‪[19].‬‬
‫اﻟﺴﻴﺮﻳﻦ ﻟﻜﻲ ﺗﺴﺘﻄﻴﻊ ﻗﺘﻞ‬

‫إﻧﺰﻳﻢ اﻟﺒﺒﺘﻴﺪﻳﺰ ‪ C5a‬ﻳﺸﻄﺮ ﻣﻮاد وﻇﻴﻔﺘﻬﺎ أن ﺗﻘﻮم ﺑﺎﻟﺠﺬب اﻟﻘﻮي ﻟﻠﺨﻼﻳﺎ اﻟﻤﺘﻌﺎدﻟﺔ ﺧﻠﻴﺔ‬ ‫ﻣﻜﻮن اﻟﻤﺘﻤﻤﺔ ‪5‬أ‬
‫اﻟﻤﺘﻤﻤﺔ‪[20].‬‬ ‫ﻣﺘﻌﺎدﻟﺔ و ﺗﺴﻤﻰ ﻣﻜﻮن اﻟﻤﺘﻤﻤﺔ ‪5‬أ‪ ،‬و ﻳﺘﻢ إﻧﺘﺎﺟﻬﺎ ﺑﻮاﺳﻄﺔ اﻟﻨﻈﺎم اﻟﻤﺘﻤﻢ ﺟﻤﻠﺔ‬ ‫ﺑﺒﺘﻴﺪاز‬
‫إﻧﺰﻳﻢ اﻟﺒﺒﺘﻴﺪﻳﺰ ‪ C5a‬ﺿﺮوري ﻟﺘﻘﻠﻴﻞ ﺗﺪﻓﻖ اﻟﺨﻼﻳﺎ اﻟﻤﺘﻌﺎدﻟﺔ ﻋﻨﺪ ﺑﺪء اﻹﺻﺎﺑﺔ ﺑﺎﻟﺒﻜﺘﺮﻳﺎ ﻟﻜﻲ‬
‫ﻫﺬا اﻹﻧﺰﻳﻢ‪ ،‬رﻏﻢ أﻫﻤﻴﺘﻪ ﻓﻲ ﺗﺤﻄﻴﻢ ﺟﺎذﺑﺎت اﻟﺨﻼﻳﺎ‬ ‫اﻟﻌﺎﺋﻞ‪[21].‬‬ ‫ﺗﺴﺘﻄﻴﻊ أن ﺗﺴﺘﻮﻃﻦ اﻧﺴﺠﺔ‬
 ‫اﻟﻤﺘﻌﺎدﻟﺔ ﻓﻲ اﻟﻤﺮاﺣﻞ اﻟﻤﺒﻜﺮة ﻣﻦ اﻹﺻﺎﺑﺔ‪ ،‬إﻻ أﻧﻪ ﻟﻴﺲ ذو أﻫﻤﻴﺔ ﺑﻌﺪ أن ﺗﻜﻮن اﻟﺒﻜﺘﺮﻳﺎ ﻓﺪ‬
‫ﻟﻔﺎﻓﺔ‪[22].‬‬ ‫أﻧﺘﺸﺮت ﻋﺒﺮ اﻟﻠﻔﺎﻓﺎت‬

‫ﻓﻲ اﻻﻧﺴﺠﺔ اﻟﻤﺘﻀﺮرة ﻟﻠﻤﺮﺿﻰ ذوي اﻟﺤﺎﻻت اﻟﻤﺘﻘﺪﻣﺔ ﻣﻦ اﻟﺘﻬﺎب اﻟﻠﻔﺎﻓﺎت اﻟﻨﺎﺧﺮ ﻻﻳﻮﺟﺪ إي‬
‫ﺧﻼﻳﺎ ﻣﺘﻌﺎدﻟﺔ )‪.(neut rophils‬‬
‫‪St rept ococcal‬‬
‫ﺑﺮوﺗﻴﻴﺰ اﻟﺴﻴﺮﻳﻦ إﺧﺘﺼﺎره ‪ ،ScpC‬واﻟﺬي ﺗﻔﺮزه اﻟﻌﻘﺪﻳﺎت اﻟﻤﻘﻴﺤﺔ‪ ،‬ﻫﻮ اﻟﻤﺴﺆول ﻋﻦ ﻣﻨﻊ‬ ‫]‪[23‬‬
‫‪chemokine‬‬
‫ﻫﺠﺮة اﻟﺨﻼﻳﺎ اﻟﻤﺘﻌﺎدﻟﺔ ﻟﻤﻜﺎن اﻧﺘﺸﺎر اﻹﺻﺎﺑﺔ‪ .‬ﻳﻘﻮم ‪ ScpC‬ﺑﺘﺪﻣﻴﺮ ﻛﻴﻤﻮﻛﻴﻦ إﻧﺘﺮﻟﻮﻛﻴﻦ ‪،8‬‬ ‫‪prot ease‬‬
‫]‪[22][21‬‬
‫واﻟﺘﻲ ﻳﻔﺘﺮض أن ﺗﻘﻮم ﺑﺠﺬب اﻟﺨﻼﻳﺎ اﻟﻤﺘﻌﺎدﻟﺔ ﻟﻤﻮﻗﻊ اﻹﺻﺎﺑﺔ‪.‬‬

‫ﻋ…‬
‫اﻟﺘﺸﺨﻴﺺ‬

‫ﻋﺎدة‪ ،‬ﺗﺆﺧﺬ ﻣﺴﺤﺔ ﻣﻦ اﻟﺤﻨﺠﺮة ﻟﻠﻤﺨﺘﺒﺮ ﻟﻜﻲ ﻳﺘﻢ ﻓﺤﺼﻬﺎ‪ .‬ﻳﺘﻢ ﻋﻤﻞ ﺻﺒﻐﺔ ﺟﺮام ﻟﺘﻈﻬﺮ ﻟﻨﺎ اﻟﻤﻜﻮرات ﻣﻮﺟﺒﺔ اﻟﺠﺮام‬
‫واﻟﺘﻲ ﺗﺘﻮاﺟﺪ ﻓﻲ ﺳﻼﺳﻞ‪ .‬ﺛﻢ‪ ،‬ﺗﺘﻢ زراﻋﺔ اﻟﻜﺎﺋﻦ اﻟﺤﻲ ﻋﻠﻰ آﺟﺎر اﻟﺪم ﻣﻊ إﺿﺎﻓﺔ ﻗﺮص ﻣﻦ اﻟﻤﻀﺎد اﻟﺤﻴﻮي ﺑﺎﺳﻴﺘﺮاﺳﻴﻦ‬
‫ﻹﻇﻬﺎر ﻣﺴﺘﻌﻤﺮات ﺗﺤﻠﻞ اﻟﺪم‪-‬ﺑﻴﺘﺎ و ﻣﺪى ﺣﺴﺎﺳﻴﺘﻬﺎ ﻟﻠﻤﻀﺎدات اﻟﺤﻴﻮﻳﺔ ) ﻣﻨﻄﻘﺔ ﻳُ ﺜﺒﻂ ﻓﻴﻬﺎ اﻟﻨﻤﻮ ﺣﻮل اﻟﻘﺮص (‪ .‬ﺛﻢ‬
‫ﺗﺘﻢ زراﻋﺘﻬﺎ ﻋﻠﻰ آﺟﺎر ﻻﻳﺤﺘﻮي ﻋﻠﻰ دم‪ ،‬ﻹﺟﺮاء أﺧﺘﺒﺎر اﻟﻜﺎﺗﺎﻟﻴﺰ واﻟﺬي ﻳﻌﻄﻲ ﻧﺘﻴﺠﺔ ﺳﻠﺒﻴﺔ ﻟﻜﻞ اﻟﻌﻘﺪﻳﺎت‪ .‬اﻟﻌﻘﺪﻳﺎت‬
‫ً‬
‫)ﺳﻴﺮوﻟﻮﺟﻴﺎ( ﻳﺘﻢ‬ ‫ً‬
‫ﻣﺼﻠﻴﺎ‬ ‫اﻟﻤﻘﻴﺤﺔ ﺗﻜﻮن ﻧﺘﻴﺠﺘﻬﺎ ﺳﺎﻟﺒﺔ ﻻﺧﺘﺒﺎري ‪ CAMP‬و ﺣﻤﺾ اﻟﻬﻴﺒﻮرﻳﻚ‪ .‬ﻟﻠﺘﻌﺮف ﻋﻠﻰ اﻟﻜﺎﺋﻦ‬
‫]‪[25][24‬‬
‫ﺑﺎﻟﻜﺸﻒ ﻋﻦ وﺟﻮد ﻋﺪﻳﺪ اﻟﺴﻜﺮﻳﺎت اﻟﺨﺎص ﺑﺎﻟﻤﺠﻤﻮﻋﺔ أ ﻓﻲ ﺟﺪار اﻟﺒﻜﺘﺮﻳﺎ اﻟﺨﻠﻮي ﺑﺈﺟﺮاء ‪.Phadebact t est‬‬
‫ﻳﻌﺘﺒﺮ اﺧﺘﺒﺎر ‪ (Pyrrolidonyl Arylamidase (PYR‬ﻃﺮﻳﻘﺔ ﺳﺮﻳﻌﺔ ﺗﺴﺘﺨﺪم ﻟﻠﺘﻌﺮف اﻟﻤﺒﺪﺋﻲ ﻋﻠﻰ اﻟﻌﻘﺪﻳﺎت اﻟﻤﺤﻠﻠﺔ‬
‫اﻻﺧﺘﺒﺎر‪[26].‬‬ ‫ﻟﻠﺪم ﻣﻦ ﻧﻮع ﺑﻴﺘﺎ‪ GBS .‬ﺗﻌﻄﻲ ﻧﺘﻴﺠﺔ ﺳﻠﺒﻴﺔ ﻟﻬﺬا‬

‫ﻋ…‬
‫اﻟﻌﻼج‬
‫اﻷﻗﻞ‪[27].‬‬ ‫أﻓﻀﻞ ﻋﻼج ﻫﻮ اﻟﺒﻴﻨﺴﻴﻠﻴﻦ‪ ،‬اﻟﻤﺪة اﻟﻤﺜﻠﻰ اﻟﻼزﻣﺔ ﺗﻜﻮن ﻋﺸﺮة أﻳﺎم ﻋﻠﻰ‬

‫أﻣﺎ ﻓﻴﻤﺎ ﻳﺨﺺ ﻣﺘﻼزﻣﺔ اﻟﺼﺪﻣﺔ اﻟﺴﻤﻴﺔ وﻧﺨﺮ اﻟﻠﻔﺎﻓﺎت‪ ،‬ﻳﺘﻢ اﺳﺘﺨﺪام ﺟﺮﻋﺎت أﻋﻠﻰ ﻣﻦ اﻟﺒﻴﻨﻴﺴﻠﻴﻦ‪ .‬ﺑﺎﻹﺿﺎﻓﺔ ﻟﺬﻟﻚ‪ ،‬ﻻﺑﺪ‬
‫]‪[28‬‬
‫ﻣﻦ اﻟﺘﺪﺧﻞ اﻟﺠﺮاﺣﻲ ﻓﻲ ﺣﺎﻟﺔ ﻧﺨﺮ اﻟﻠﻔﺎﻓﺎت‪ ،‬ﻟﻜﻲ ﻳﺘﻢ إزاﻟﺔ اﻹﻧﺴﺠﺔ اﻟﻤﺘﻀﺮرة وإﻳﻘﺎف اﻧﺘﺸﺎر اﻹﺻﺎﺑﺔ‪.‬‬

‫ﻟﻢ ﻳﺘﻢ اﻹﺑﻼغ ﻋﻦ إي ﺣﺎﻻت ﻣﻘﺎوﻣﺔ ﻟﻠﺒﻨﻴﺴﻴﻠﻴﻦ إﻟﻰ ﻳﻮﻣﻨﺎ ﻫﺬا‪ ،‬ﻋﻠﻰ اﻟﺮﻏﻢ ﻣﻦ أﻧﻪ ﻣﻨﺬ ﻋﺎم ‪ ،1985‬ﻇﻬﺮت ﻋﺪة ﺗﻘﺎرﻳﺮ‬
‫ً‬
‫ﻏﺎﻟﺒﺎ ﻋﺪم اﻟﺘﺰام اﻟﻤﺮﻳﺾ‬ ‫ﺗﻔﻴﺪ ﺑﺤﺪوث ﺗﺤﻤﻞ ﻟﻠﺒﻨﻴﺴﻴﻠﻴﻦ‪ [29].‬اﻟﺴﺒﺐ ﻟﻔﺸﻞ ﻣﻌﺎﻟﺠﺔ اﻟﻌﻘﺪﻳﺎت اﻟﻤﻘﻴﺤﺔ ﺑﺎﻟﺒﻨﻴﺴﻴﻠﻴﻦ ﻳﻜﻮن‬
‫ﺑﺄﺧﺬ اﻟﺪواء‪ ،‬وأﻣﺎ ﻓﻲ ﺣﺎل ﻋﺠﺰ اﻟﻤﻀﺎد ﻋﻦ إﺣﺪاث اﻟﺘﺄﺛﻴﺮ اﻟﻤﻄﻠﻮب رﻏﻢ إاﻟﺘﺰام اﻟﻤﺮﻳﺾ ﺑﻪ‪ ،‬ﻣﻦ اﻟﺸﺎﺋﻊ أن ﻳﺘﻢ ﺑﺪء‬
‫]‪[30‬‬
‫دورة ﻋﻼﺟﻴﺔ أﺧﺮى ﺑﺈﺳﺘﺨﺪام اﻟﺴﻴﻔﺎﻟﻮﺳﺒﻮرﻳﻦ‪.‬‬
 ‫ﻓﻲ اﻷﻓﺮاد اﻟﺬﻳﻦ ﻳﻌﺎﻧﻮن ﻣﻦ ﺣﺴﺎﺳﻴﺔ اﻟﺒﻨﻴﺴﻴﻠﻴﻦ‪ ،‬وﺟﺪ أن ﻛﻼ ﻣﻦ اﻹرﻳﺜﺮوﻣﻴﺴﻴﻦ‪ ،‬اﻟﻤﺎﻛﺮوﻟﻴﺪات‪ ,‬و اﻟﺴﻴﻔﺎﻟﻮﺳﺒﻮرﻳﻦ‬
‫اﻟﻌﻼج‪[30].‬‬ ‫ﺗﻜﻮن ذات ﻓﻌﺎﻟﻴﺔ ﻋﻨﺪ‬

‫ﻋ…‬
‫اﻟﻮﻗﺎﻳﺔ‬

‫َ‬
‫ﺣﺎﻟﻴﺎ إي ﻟﻘﺎﺣﺎت‬ ‫أﻓﻀﻞ ﻃﺮﻳﻘﺔ ﻟﻠﻮﻗﺎﻳﺔ ﻣﻦ "اﻟﺒﻜﺘﺮﻳﺎ اﻟﻌﻘﺪﻳﺔ اﻟﻤﻘﻴﺤﺔ" ﺗﻜﻮن ﻋﺒﺮ ﻧﻈﺎﻓﺔ اﻹﻳﺪي اﻟﻔﻌﺎﻟﺔ‪ [28].‬ﻻﻳﻮﺟﺪ‬
‫ﻣﺘﻮﻓﺮة ﻟﻠﺤﻤﺎﻳﺔ ﺿﺪ ﻋﺪوى " اﻟﺒﻜﺘﺮﻳﺎ اﻟﻌﻘﺪﻳﺔ اﻟﻤﻘﻴﺤﺔ"‪ ،‬رﻏﻢ أن اﻷﺑﺤﺎث ﺗﺠﺮي ﻟﺘﻄﻮﻳﺮ ﻟﻘﺎح ﺿﺪﻫﺎ‪ [31].‬ﻣﻦ اﻟﺼﻌﻮﺑﺎت‬
‫اﻟﺘﻲ ﻳﺘﻢ ﻣﻮاﺟﻬﺘﻬﺎ ﻋﻨﺪ ﺗﻄﻮﻳﺮ ﻟﻘﺎح ﺿﺪ ﻫﺬه اﻟﺒﻜﺘﺮﻳﺎ ﻫﻲ اﻟﺘﻨﻮع اﻟﻜﺒﻴﺮ ﻓﻲ ﺳﻼﻻﺗﻬﺎ اﻟﺘﻲ ﺗﺘﻮاﺟﺪ ﻓﻲ اﻟﺒﻴﺌﺔ ﺑﺎﻹﺿﺎﻓﺔ‬
‫وﺳﻼﻣﺘﻪ‪[32][31].‬‬ ‫ﻟﻠﻮﻗﺖ وﻋﺪد اﻷﺷﺨﺎص اﻟﻜﺒﻴﺮ اﻟﺬي ﻳﺠﺐ ﺗﻮﻓﺮة ﻟﻠﻘﻴﺎم ﺑﺎﻟﺪراﺳﺎت اﻟﻀﺮورﻳﺔ ﻟﻔﻌﺎﻟﻴﺔ اﻟﻠﻘﺎح‬

‫ﻋ…‬
‫ﺗﻄﺒﻴﻘﺎت ﻓﻲ ﻣﺠﺎل ﺗﻜﻨﻮﻟﻮﺟﻴﺎ اﻟﻨﺎﻧﻮ اﻟﺤﻴﻮﻳﺔ‬

‫ﻛﺜﻴﺮ ﻣﻦ ﺑﺮوﺗﻴﻨﺎت اﻟﻌﻘﺪﻳﺎت اﻟﻤﻘﻴﺤﺔ واﻟﺘﻲ ﺗﻤﺘﻠﻚ ﺧﺼﺎﺋﺺ ﻓﺮﻳﺪة ﻣﻦ ﻧﻮﻋﻬﺎ‪ ،‬ﺗﻢ إﺳﺘﻐﻼﻟﻬﺎ واﻻﺳﺘﻔﺎدة ﻣﻨﻬﺎ ﻓﻲ‬
‫اﻟﺴﻨﻮات اﻷﺧﻴﺮة ﻹﻧﺘﺎج ﻣﻮاد ﻋﻠﻰ ﻗﺪر ﻋﺎﻟﻲ ﻣﻦ اﻟﺘﺨﺼﺺ وﻟﻬﺎ ﻗﺪرات ﺻﻤﻐﻴﺔ ﺧﺎرﻗﺔ ]‪ [34][33‬وﺳﺒﻴﻞ ﻟﺘﻌﺰﻳﺰ ﻓﻌﺎﻟﻴﺔ‬
‫]‪[35‬‬
‫اﻟﻌﻼج ﺑﺎﻟﻤﻀﺎدات اﻟﺤﻴﻮﻳﺔ‪.‬‬

‫ﻋ…‬
‫اﻟﺠﻴﻨﻮم‬

‫ﺗﻢ إﻳﺠﺎد اﻟﺘﺴﻠﺴﻞ اﻟﺠﻴﻨﻲ ﻟﺴﻼﻻت ﻣﺨﺘﻠﻔﺔ ) ﺣﺠﻢ اﻟﺠﻴﻨﻮم ‪ [36] (Mbp 1.9 - 1.8‬واﻟﺘﻲ ﺗﺤﻤﻞ اﻟﺸﻔﺮات اﻟﺨﺎﺻﺔ‬
‫ﺑﺘﻜﻮﻳﻦ ‪ 1900-1700‬ﻣﻦ اﻟﺒﺮوﺗﻴﻨﺎت ) ‪ 1700‬ﻓﻲ اﻟﺴﻼﻟﺔ ‪ [38][37] ،NZ131‬و ‪ 1865‬ﻓﻲ اﻟﺴﻼﻟﺔ‬
‫‪([40][39]MGAS5005‬‬

‫ﻋ…‬
‫ﻣﺮاﺟﻊ‬

‫‪Wexler DE, Chenoweth DE, Cleary PP (1985). "Mechanism of action of the group A streptococcal .1‬‬
‫‪C5a inactivator" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC391459). Proc Natl Acad Sci‬‬
‫‪USA. 82 (23): 8144–8. doi:10.1073/pnas.82.23.8144 (https://doi.org/10.1073%2Fpnas.82.23.814‬‬
‫‪4). PMC  391459 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC391459). PMID 3906656 (htt‬‬
‫‪. (ps://pubmed.ncbi.nlm.nih.gov/3906656‬‬

‫‪Streptococcus pyogenes NZ131" (https://web.archive.org/web/20200511095517/http://microbeso" .2‬‬

‫‪ . (nline.org/cgi-bin/genomeInfo.cgi?tId=471876‬ﻣﺆرﺷﻒ ﻣﻦ اﻷﺻﻞ )‪http://microbesonline.org/cgi-bin/‬‬
‫ﻓﻲ ‪ 11‬ﻣﺎﻳﻮ ‪.2020‬‬ ‫‪(genomeInfo.cgi?tId=471876‬‬
 Ferretti JJ; McShan WM; Ajdic D; Savic DJ; Savic G; Lyon K; et al. (2001). "Complete Genome .3
Sequence of an M1 Strain of Streptococcus pyogenes" (https://www.ncbi.nlm.nih.gov/pmc/articles/
PMC31890). Proc Natl Acad Sci USA. 98: 4658–63. doi:10.1073/pnas.071559398 (https://doi.or
g/10.1073%2Fpnas.071559398). PMC 31890 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC
. ( 31890). PMID 11296296 (https://pubmed.ncbi.nlm.nih.gov/11296296

Definition of Streptococcus pneumoniae (pneumococcus)" (https://web.archive.org/web/20140225" .4

http) ‫ ﻣﺆرﺷﻒ ﻣﻦ اﻷﺻﻞ‬. (095619/http://www.medterms.com/script/main/art.asp?articlekey=11270
‫ ﻓﺒﺮاﻳﺮ‬25 ‫ﻓﻲ‬ (s://www.medicinenet.com/streptococcus_pneumoniae_pneumococcus/definition.htm
.2012 ‫ ﻧﻮﻓﻤﺒﺮ‬21 ‫ اﻃﻠﻊ ﻋﻠﻴﻪ ﺑﺘﺎرﻳﺦ‬.2014

0- 4th). McGraw Hill. ISBN ‫ )اﻟﻄﺒﻌﺔ‬Ryan KJ, Ray CG (editors) (2004). Sherris Medical Microbiology .5
.8385-8529-9

Streptococcal Pharyngitis (https://web.archive.org/web/20120513215033/http://www.dhs.wisconsi .

http://www.dhs.) ‫ ﻣﺆرﺷﻒ ﻣﻦ اﻷﺻﻞ‬, (n.gov/communicable/factsheets/StreptococcalPharyngitis.htm
2012 ‫ ﻣﺎﻳﻮ‬13 ‫ﻓﻲ‬ (wisconsin.gov/communicable/factsheets/StreptococcalPharyngitis.htm

Aziz RK, Kansal R, Aronow BJ, Taylor WL, Rowe SL, Kubal M, Chhatwal GS, Walker MJ, Kotb M .7
Microevolution of Group A Streptococci In Vivo: Capturing" .(‫( )اﻟﻤﺤﺮر‬2010). Ahmed, Niyaz
Regulatory Networks Engaged in Sociomicrobiology, Niche Adaptation, and Hypervirulence" (https://
‫ ﺑﻠﻮس‬. (web.archive.org/web/20200225163813/http://dx.plos.org/10.1371/journal.pone.0009798
e9798. doi:10.1371/journal.pone.0009798 (https://doi.org/10.1371%2Fjournal.pone.000 :(4) 5 .‫ون‬
9798). PMC  2854683 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2854683).
https://journals.pl) ‫ ﻣﺆرﺷﻒ ﻣﻦ اﻷﺻﻞ‬. (PMID 20418946 (https://pubmed.ncbi.nlm.nih.gov/20418946
12 ‫ اﻃﻠﻊ ﻋﻠﻴﻪ ﺑﺘﺎرﻳﺦ‬.2020 ‫ ﻓﺒﺮاﻳﺮ‬25 ‫ﻓﻲ‬ (os.org/plosone/article?id=10.1371/journal.pone.0009798
.2011 ‫أﻏﺴﻄﺲ‬

Jim Dwyer (July 11, 2012). "An Infection, Unnoticed, Turns Unstoppable" (https://web.archive.org/we .
b/20180522023300/https://www.nytimes.com/2012/07/12/nyregion/in-rory-stauntons-fight-for-his-
https://www.nytimes.co) ‫ ﻣﺆرﺷﻒ ﻣﻦ اﻷﺻﻞ‬. life-signs-that-went-unheeded.html). The New York Times
22 ‫ﻓﻲ‬ (m/2012/07/12/nyregion/in-rory-stauntons-fight-for-his-life-signs-that-went-unheeded.html
.2012 ‫ ﻳﻮﻟﻴﻮ‬12 ‫ اﻃﻠﻊ ﻋﻠﻴﻪ ﺑﺘﺎرﻳﺦ‬.2018 ‫ﻣﺎﻳﻮ‬

Jim Dwyer (July 18, 2012). "After Boy's Death, Hospital Alters Discharging Procedures" (https://web. .9
archive.org/web/20180522023147/https://www.nytimes.com/2012/07/19/nyregion/after-rory-stau
http) ‫ ﻣﺆرﺷﻒ ﻣﻦ اﻷﺻﻞ‬. ntons-death-hospital-alters-discharge-procedures.html). The New York Times
s://www.nytimes.com/2012/07/19/nyregion/after-rory-stauntons-death-hospital-alters-discharge-pr
.2012 ‫ ﻳﻮﻟﻴﻮ‬19 ‫ اﻃﻠﻊ ﻋﻠﻴﻪ ﺑﺘﺎرﻳﺦ‬.2018 ‫ ﻣﺎﻳﻮ‬22 ‫ﻓﻲ‬ (ocedures.html
Lancefield RC (1928). "The antigenic complex of Streptococcus hemolyticus" (https://web.archive.or .10
g/web/20081011082611/http://www.jem.org/cgi/content/abstract/47/1/91). J Exp Med. 47 (1):
https://) ‫ ﻣﺆرﺷﻒ ﻣﻦ اﻷﺻﻞ‬. (9–10. doi:10.1084/jem.47.1.91 (https://doi.org/10.1084%2Fjem.47.1.91
rupress.org/jem/article/47/1/91/9722/THE-ANTIGENIC-COMPLEX-OF-STREPTOCOCCUS-HAMOL
.2008 ‫ أﻛﺘﻮﺑﺮ‬11 ‫ﻓﻲ‬ (YTICUS

Lancefield RC, Dole VP (1946). "The properties of T antigen extracted from group A hemolytic .11
streptococci" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2135665). J Exp Med. 84 (5): 449–
71. doi: 10.1084/jem.84.5.449 (https://doi.org/10.1084%2Fjem.84.5.449). PMC 2135665 (https://
www.ncbi.nlm.nih.gov/pmc/articles/PMC2135665). PMID 19871581 (https://pubmed.ncbi.nlm.ni
. (h.gov/19871581

Mora M, Bensi G, Capo S, Falugi F, Zingaretti C, Manetti AG, Maggi T, Taddei AR, Grandi G, Telford JL .12
(2005). "Group A Streptococcus produce pilus-like structures containing protective antigens and
Lancefield T antigens" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1253647). Proc Natl Acad
Sci USA. 102 (43): 15641–6. doi:10.1073/pnas.0507808102 (https://doi.org/10.1073%2Fpnas.0507
808102). PMC  1253647 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1253647).
. (PMID 16223875 (https://pubmed.ncbi.nlm.nih.gov/16223875

Patterson MJ (1996). Streptococcus. In: Baron's Medical Microbiology (Baron S et al., eds.) (https:// .13
web.archive.org/web/20090425130604/http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=mmed.secti
https://w) ‫ ﻣﺆرﺷﻒ ﻣﻦ اﻷﺻﻞ‬.0-9631172-1-1 4th). Univ of Texas Medical Branch. ISBN ‫)اﻟﻄﺒﻌﺔ‬ (on.824
.2009 ‫ أﺑﺮﻳﻞ‬25 ‫ﻓﻲ‬ (/ww.ncbi.nlm.nih.gov/books/NBK7611

Bisno AL, Brito MO, Collins CM (2003). "Molecular basis of group A streptococcal virulence". Lancet .14
Infect Dis. 3 (4): 191–200. doi:10.1016/S1473-3099(03)00576-0 (https://doi.org/10.1016%2FS1473
. ( -3099%2803%2900576-0). PMID 12679262 (https://pubmed.ncbi.nlm.nih.gov/12679262

Ferretti JJ, McShan WM, Ajdic D, Savic DJ, Savic G, Lyon K; et al. (2001). "Complete Genome .15
Sequence of an M1 Strain of Streptococcus pyogenes". Proc Natl Acad Sci USA. 98: 4658–63.
=‫ |ﻣﺆﻟﻒ‬:PMID  11296296 (https://pubmed.ncbi.nlm.nih.gov/11296296). Explicit use of et al. in
(‫)ﻣﺴﺎﻋﺪة‬

Canchaya C, Desiere F, McShan WM, Ferretti JJ, Parkhill J, Brussow H (2002). "Genome analysis of .1
an inducible prophage and prophage remnants integrated in the Streptococcus pyogenes strain
. (SF370". Virology. 302: 245–58. PMID 12441069 (https://pubmed.ncbi.nlm.nih.gov/12441069

Banks DJ, Porcella SF, Barbian KD, Martin JM, Musser JM (2003). "Structure and distribution of an .17
unusual chimeric genetic element encoding macrolide resistance in phylogenetically diverse clones
of group A Streptococcus". J Infect Dis. 188: 1898–908. PMID 14673771 (https://pubmed.ncbi.nlm.
. (nih.gov/14673771
 Starr CR, Engleberg NC (2006). "Role of Hyaluronidase in Subcutaneous Spread and Growth of .1
Group A Streptococcus" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1346594). Infect
Immun. 74 (1): 40–8. doi:10.1128/IAI.74.1.40-48.2006 (https://doi.org/10.1128%2FIAI.74.1.40-4
8.2006). PMC  1346594 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1346594).
. (PMID 16368955 (https://pubmed.ncbi.nlm.nih.gov/16368955

Buchanan JT, Simpson AJ, Aziz RK, Liu GY, Kristian SA, Kotb M, Feramisco J, Nizet V (2006). .19
"DNase expression allows the pathogen group A Streptococcus to escape killing in neutrophil
extracellular traps". Curr Biol. 16 (4): 396–400. doi:10.1016/j.cub.2005.12.039 (https://doi.org/10.1
. ( 016%2Fj.cub.2005.12.039). PMID 16488874 (https://pubmed.ncbi.nlm.nih.gov/16488874

Wexler DE, Chenoweth DE, Cleary PP (1985). "Mechanism of action of the group A streptococcal .20
C5a inactivator" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC391459). Proc Natl Acad Sci
USA. 82 (23): 8144–8. doi:10.1073/pnas.82.23.8144 (https://doi.org/10.1073%2Fpnas.82.23.814
4). PMC  391459 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC391459). PMID 3906656 (htt
. (ps://pubmed.ncbi.nlm.nih.gov/3906656

Ji Y, McLandsborough L, Kondagunta A, Cleary PP (1996). "C5a peptidase alters clearance and .21
trafficking of group A streptococci by infected mice" (https://www.ncbi.nlm.nih.gov/pmc/articles/PM
C173793). Infect Immun. 64 (2): 503–10. PMC 173793 (https://www.ncbi.nlm.nih.gov/pmc/article
. ( s/PMC173793). PMID 8550199 (https://pubmed.ncbi.nlm.nih.gov/8550199

Hidalgo-Grass C, Mishalian I, Dan-Goor M, Belotserkovsky I, Eran Y, Nizet V, Peled A, Hanski E .22

(2006). "A streptococcal protease that degrades CXC chemokines and impairs bacterial clearance
from infected tissues" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1589981). EMBO J. 25
(19): 4628–37. doi: 10.1038/sj.emboj.7601327 (https://doi.org/10.1038%2Fsj.emboj.7601327).
PMC  1589981 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1589981). PMID 16977314 (http
. (s://pubmed.ncbi.nlm.nih.gov/16977314

Hidalgo-Grass C, Dan-Goor M, Maly A, Eran Y, Kwinn LA, Nizet V, Ravins M, Jaffe J, Peyser A, Moses .23
AE, Hanski E (2004). "Effect of a bacterial pheromone peptide on host chemokine degradation in
group A streptococcal necrotising soft-tissue infections". Lancet. 363 (9410): 696–703.
doi:10.1016/S0140-6736(04)15643-2 (https://doi.org/10.1016%2FS0140-6736%2804%2915643-
. ( 2). PMID 15001327 (https://pubmed.ncbi.nlm.nih.gov/15001327

Kellogg JA, Bankert DA, Elder CJ, Gibbs JL, Smith MC (September 2001). "Identification of .24
Streptococcus pneumoniae revisited" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC88350). J.
Clin. Microbiol. 39 (9): 3373–5. doi:10.1128/jcm.39.9.3373-3375.2001 (https://doi.org/10.1128%2Fj
cm.39.9.3373-3375.2001). PMC 88350 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8835
. ( 0). PMID 11526182 (https://pubmed.ncbi.nlm.nih.gov/11526182
 Burdash NM, West ME (March 1982). "Identification of Streptococcus pneumoniae by the .25
Phadebact coagglutination test" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC272105). J.
Clin. Microbiol. 15 (3): 391–4. PMC 272105 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC272
. ( 105). PMID 7076811 (https://pubmed.ncbi.nlm.nih.gov/7076811

Pyrrolidonyl Arylamidase (PYR) Test: Principle, procedure and results - microbeonline" (https://web.a" .2
rchive.org/web/20190407204158/https://microbeonline.com/pyrrolidonyl-arylamidase-pyr-test-princ
https://microbeonline.com/pyrrolidonyl-arylamidase-pyr-t) ‫ ﻣﺆرﺷﻒ ﻣﻦ اﻷﺻﻞ‬. (/iple-procedure-results
.2019 ‫ أﺑﺮﻳﻞ‬07 ‫ﻓﻲ‬ (/est-principle-procedure-results

Falagas ME, Vouloumanou EK, Matthaiou DK, Kapaskelis AM, Karageorgopoulos DE (2008). .27
"Effectiveness and safety of short-course vs long-course antibiotic therapy for group a beta
hemolytic streptococcal tonsillopharyngitis: a meta-analysis of randomized trials" (https://archive.or
g/details/sim_mayo-clinic-proceedings_2008-08_83_8/page/880). Mayo Clin Proc. 83 (8): 880–9.
doi: 10.4065/83.8.880 (https://doi.org/10.4065%2F83.8.880). PMID 18674472 (https://pubmed.n
. (cbi.nlm.nih.gov/18674472

Group A Strep" (https://web.archive.org/web/20180909022029/https://www.cdc.gov/groupAstrep/" .2

https://www.cdc.gov/groupastrep/about/faq) ‫ ﻣﺆرﺷﻒ ﻣﻦ اﻷﺻﻞ‬. about/faqs.html). CDC.gov. CDC
.2014 ‫ دﻳﺴﻤﺒﺮ‬07 ‫ اﻃﻠﻊ ﻋﻠﻴﻪ ﺑﺘﺎرﻳﺦ‬.2018 ‫ ﺳﺒﺘﻤﺒﺮ‬09 ‫ﻓﻲ‬ (s.html

Kim KS, Kaplan EL (1985). "Association of penicillin tolerance with failure to eradicate group A .29
streptococci from patients with pharyngitis". J Pediatr. 107 (5): 681–4. doi:10.1016/S0022-
3476(85)80392-9 (https://doi.org/10.1016%2FS0022-3476%2885%2980392-9). PMID 3903089 (h
. (ttps://pubmed.ncbi.nlm.nih.gov/3903089

Khan, Zartash. "Group A Streptococcal Infections Treatment & Management" (https://web.archive.or .30
g/web/20171007223338/http://emedicine.medscape.com:80/article/228936-treatment).
(https://emedicine.medscape.com/article/228936-treatment#a1156) ‫ ﻣﺆرﺷﻒ ﻣﻦ اﻷﺻﻞ‬.Medscape
.2014 ‫ دﻳﺴﻤﺒﺮ‬07 ‫ اﻃﻠﻊ ﻋﻠﻴﻪ ﺑﺘﺎرﻳﺦ‬.2017 ‫ أﻛﺘﻮﺑﺮ‬07 ‫ﻓﻲ‬

Good MF, Batzloff MR, Pandey M (November 2013). "Strategies in the development of vaccines to .31
prevent infections with group A streptococcus" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC398
1849). Human vaccine & immunotherapeutics. 9 (11): 2393–7. doi:10.4161/hv.25506 (https://doi.
org/10.4161%2Fhv.25506). PMC 3981849 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC398
. ( 1849). PMID 23863455 (https://pubmed.ncbi.nlm.nih.gov/23863455

Initiative for Vaccine Research (IVR) – Group A Streptococcus" (https://web.archive.org/web/20130" .32

727124000/http://www.who.int:80/vaccine_research/diseases/soa_bacterial/en/index3.html).
27 ‫ﻓﻲ‬ (/https://www.who.int/immunization/research) ‫ ﻣﺆرﺷﻒ ﻣﻦ اﻷﺻﻞ‬.World Health Organization
.2012 ‫ ﻳﻮﻧﻴﻮ‬15 ‫ اﻃﻠﻊ ﻋﻠﻴﻪ ﺑﺘﺎرﻳﺦ‬.2013 ‫ﻳﻮﻟﻴﻮ‬
 Flesh-eating bacteria inspire superglue" (https://web.archive.org/web/20190504134058/http://ww" .33
https://ww) ‫ ﻣﺆرﺷﻒ ﻣﻦ اﻷﺻﻞ‬. (w.ox.ac.uk/news/science-blog/flesh-eating-bacteria-inspire-superglue
.2019 ‫ ﻣﺎﻳﻮ‬04 ‫ﻓﻲ‬ (w.ox.ac.uk/news/science-blog/flesh-eating-bacteria-inspire-superglue

Zakeri B, Fierer JO, Celik E, Chittock EC, Schwarz-Linek U, Moy VT, Howarth M (2012). "Peptide tag .34
forming a rapid covalent bond to a protein, through engineering a bacterial adhesin" (https://www.n
cbi.nlm.nih.gov/pmc/articles/PMC3311370). Proceedings of the National Academy of Sciences.
109 (12): E690–7. doi:10.1073/pnas.1115485109 (https://doi.org/10.1073%2Fpnas.111548510
9). PMC  3311370 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3311370). PMID 22366317
. ((https://pubmed.ncbi.nlm.nih.gov/22366317

Baruah K, Bowden TA, Krishna BA, Dwek RA, Crispin M, Scanlan CN (2012). "Selective Deactivation .35
of Serum IgG: A General Strategy for the Enhancement of Monoclonal Antibody Receptor
Interactions" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3437440). Journal of Molecular
Biology. 420 (1–2): 1–7. doi:10.1016/j.jmb.2012.04.002 (https://doi.org/10.1016%2Fj.jmb.2012.0
4.002). PMC  3437440 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3437440).
. (PMID 22484364 (https://pubmed.ncbi.nlm.nih.gov/22484364

Beres SB, Richter EW, Nagiec MJ, Sumby P, Porcella SF, DeLeo FR, Musser JM (2006). "Molecular .3
genetic anatomy of inter- and intraserotype variation in the human bacterial pathogen group a
Streptococcus" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1459018). Proceedings of the
National Academy of Sciences. 103 (18): 7059–64. doi:10.1073/pnas.0510279103 (https://doi.org/
10.1073%2Fpnas.0510279103). PMC 1459018 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC
. ( 1459018). PMID 16636287 (https://pubmed.ncbi.nlm.nih.gov/16636287

Streptococcus pyogenes NZ131 (http://microbesonline.org/cgi-bin/genomeInfo.cgi?tId=471876) .37

https://web.archive.org/web/2017123) ‫ﻧﺴﺨﺔ ﻣﺤﻔﻮﻇﺔ‬ (in MicrobesOnline (http://microbesonline.org
.‫ ﻋﻠﻰ ﻣﻮﻗﻊ واي ﺑﺎك ﻣﺸﻴﻦ‬2017 ‫دﻳﺴﻤﺒﺮ‬ 1080026/http://www.microbesonline.org/) 31

McShan, W. M.; Ferretti, J. J.; Karasawa, T; Suvorov, A. N.; Lin, S; Qin, B; Jia, H; Kenton, S; Najar, F; .3
Wu, H; Scott, J; Roe, B. A.; Savic, D. J. (2008). "Genome sequence of a nephritogenic and highly
transformable M49 strain of Streptococcus pyogenes" (https://www.ncbi.nlm.nih.gov/pmc/articles/
PMC2583620). Journal of Bacteriology. 190 (23): 7773–85. doi:10.1128/JB.00672-08 (https://do
i.org/10.1128%2FJB.00672-08). PMC 2583620 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2
. ( 583620). PMID 18820018 (https://pubmed.ncbi.nlm.nih.gov/18820018

Sumby, P; Porcella, S. F.; Madrigal, A. G.; Barbian, K. D.; Virtaneva, K; Ricklefs, S. M.; Sturdevant, D. .39
E.; Graham, M. R.; Vuopio-Varkila, J; Hoe, N. P.; Musser, J. M. (2005). "Evolutionary origin and
emergence of a highly successful clone of serotype M1 group a Streptococcus involved multiple
horizontal gene transfer events". The Journal of Infectious Diseases. 192 (5): 771–82.
doi: 10.1086/432514 (https://doi.org/10.1086%2F432514). PMID 16088826 (https://pubmed.ncbi.
. (nlm.nih.gov/16088826
 Streptococcus pyogenes MGAS5005 (http://microbesonline.org/cgi-bin/genomeInfo.cgi?tId=2936 .40
https://web.archive.org/web/20) ‫ﻧﺴﺨﺔ ﻣﺤﻔﻮﻇﺔ‬ ( 53) in MicrobesOnline (http://microbesonline.org
.‫ ﻋﻠﻰ ﻣﻮﻗﻊ واي ﺑﺎك ﻣﺸﻴﻦ‬2017 ‫دﻳﺴﻤﺒﺮ‬ 171231080026/http://www.microbesonline.org/) 31

‫ﺑﻮاﺑﺔ ﺗﻤﺮﻳﺾ‬

‫ﺑﻮاﺑﺔ ﻃﺐ‬

‫ﺑﻮاﺑﺔ ﻋﻠﻢ اﻷﺣﻴﺎء‬

‫ﺑﻮاﺑﺔ ﻋﻠﻢ اﻷﺣﻴﺎء اﻟﺪﻗﻴﻘﺔ‬

‫ﻋﻘﺪﻳﺔ ﻣﻘﻴﺤﺔ ﻓﻲ اﻟﻤﺸﺎرﻳﻊ اﻟﺸﻘﻴﻘﺔ‬

‫ﺻﻮر وﻣﻠﻔﺎت ﺻﻮﺗﻴﺔ ﻣﻦ ﻛﻮﻣﻨﺰ‬

.‫أﻧﻮاع ﻣﻦ وﻳﻜﻲ أﻧﻮاع‬

https://ar.wikipedia.org/w/index.php?» ‫ﻣﺠﻠﻮﺑﺔ ﻣﻦ‬

«title=‫&ﻋﻘﺪﻳﺔ_ﻣﻘﻴﺤﺔ‬oldid=55643329

‫ ﺷﻬﻮر‬4 ‫ آﺧﺮ ﺗﻌﺪﻳﻞ ﻗﺒﻞ‬InternetArchiveBot ‫اﺿﺎف‬