Ngaphezu nje kwe-shingles
I-Varicella zoster virus (VZV) inezindlela eziningi ezahlukahlukene zokusiza ekuhluphekeni komuntu. Ekuqaleni, kubangelwa ukukhukhuka kwezinkukhu. Ngokujwayelekile, noma ngabe igciwane alihambanga ngempela uma kuqhuma ukuqhuma. Esikhundleni salokho, igciwane lifihlekile, lilele emangqamuzaneni e-ganglionic nerve eduze komgogodla, elinde ithuba lokubukeka olunye.
Ama-shingles ungenye yezindlela ezaziwa kakhulu i-VZV ebuya kuzozonke ezimbili.
Igciwane liyaphuma esikhumbeni esinezinzwa ezithile, okuholela ekugqibeleni okukhulu. Ngisho nangemva kokuqeda ukuqhuma, ubuhlungu bungase buqhubekele kulokho okubizwa nge-neuralgia ye-postherpetic.
Ama-shingles ayaziwa kahle kodwa i-VZV ngezinye izikhathi ingaholela ku-vasculitis, i-meningoencephalitis, i-myelopathy, i-necrosis ye-retinal, i-vasculopathy, noma i-Ramsay Hunt syndrome. Zonke lezi zinkinga zingase zenzeke ngaphandle kokushona noma izinyanga ngemva kokushayeka. Ukuhlola okuvamile kwama-laboratory okufana nokuba khona kweVZV DNA noma amaseli angavamile ku- cerebrospinal fluid (CSF) kuyasiza uma ukhona, kepha lesi sifo singenzeka ngisho noma lezi zitholakala zingekho. Ngisho noma ukusolakala ngemitholampilo, ukwelashwa kwezifo ze-neurologic ezibangelwa i-VZV kungaba yinselele.
I-Herpes Zoster
I-Herpes zoster, ebizwa ngokuthi i-shingles, ingenye yezinhlobo ezivame kakhulu zokutheleleka kwe-VZV. Ngenxa yokuthi iveza ukukhwabanisa, abanye abantu abakucabangi njengesiyaluyalu senhliziyo.
Noma kunjalo, ukuqhuma kufakazela lokho okubizwa ngokuthi ukusatshalaliswa kwe-dermatomal , okusho indawo yesikhumba engasetshenziswa yizimpande ezithile zesisindo. Lokhu kungenxa yokuthi izimpande ze-nerve, noma i-ganglion, yilapho igciwane libeke khona isikhathi eside kuze kube yilapho liba nethuba lokuvuselela futhi. Empeleni, i- imagery magnetic resonance (MRI) ingabonisa ukuthuthukiswa kwe-ganglion ethintekile.
Isiyaluyalu siyabuhlungu kakhulu. Ukwelapha kune-valacyclovir cishe izinsuku eziyisikhombisa.
I-Neuralgia yangemva kwesikhashana
I-neuralgia yangemva kwesinye isikhathi igcizelela ukuthi i-herpes zoster iyisifo esiyinhloko ngokuyisisekelo. Ngisho nangemva kokuqedwa kwezimoto, ubuhlungu phezu kwalowo dermatome buyaqhubeka. Uma kwenzeka njalo izinyanga ezingaphezu kwezintathu, ukuxilongwa kwe-neuralgia ye-postherpetic (PHN) kungenziwa. Into ebaluleke kakhulu engozini yokuthuthukisa i-PHN ingu-age, kanti amaphesenti angaphezu kwangu-30 alabo abaneminyaka engaphezu kwengu-60 abanama-shingles aqhubeka nokuthuthukisa i-PHN. Lesi sifo singase sibe ngenxa yokuvuvukala okungapheli ngenxa yokutheleleka kwegciwane lesandulela ngculazi, njengamaseli angama-inflammatory ayitholakali kubantu abano-PHN besikhathi eside kuze kube ngu-2, ne-VZV DNA namaprotheni atholakala egazini leziguli eziningi ezine-PHN. Ezinye iziguli zithuthukisiwe nge-anti-viral treatment enkulu, nakuba ukwelashwa nge-IV acyclovir akuvunyelwe yi-Food and Drug Administration (FDA), futhi kunesidingo sokuvivinywa kokwelashwa kahle. Kungaba nzima kakhulu ukulawula ubuhlungu be-PHN. I-tricyclic anti-depressant, i-gabapentin, i-pregabalin noma i-lidocaine i-patches ngokuvamile iyindlela yokuqala yokwelapha, ilandelwa i-opioids, i-tramadol, noma i-capsaicin njengokwelashwa kwesibili noma kwesithathu.
Inhlanganisela yokwelapha ingase iphumelele nakakhulu. Ukugqugquzelwa kwamagciwane angama-percutaneous nerve, lapho kuphakanyiswa khona ama-electrode ngaphansi kwendawo ebuhlungu obukhulu, kungase kuhlinzekwe nokukhululeka.
I-Zoster Sine Herpete
Ngokuyinhloko, "i-zoster sine herpete" yayizobhekwa njenge-neuralgia yangemva kwesikhathi, kodwa kwakungekho nanoma yisiphi isisindo se-vesicular (isondo) sokuqala. Lesi sifo singatholwa yi-antibody ku-CSF. Ezinye izimbangela zobuhlungu obukhulu, ezifana nokusabalalisa kwesifo sikashukela noma ukungena kwesibindi, kufanele futhi kukhishwe izifundo ze-neuroimaging. Ukwelashwa kuhilela i-high dose acyclovir, ukwelashwa ubuhlungu ngendlela efana ne-PHN.
I-N ecrosis yokubuyisela
Ukwelashwa kweso ngeVZV kungabangela ukufa kweseli okuqhubekayo ku- retina. Lokhu kubangela ubuhlungu eduze kweso, kanye nombono ongenangqondo. Umbono wendawo yokulahleka ulahlekile kuqala. Uma udokotela enza ukuhlolwa kwe-fundoscopic bangase babone ukubola nokugcoba kwe-retina. Amanye amagciwane, afana ne-HSV ne-cytomegalovirus, angabangela i-necrosis ye-retinal. Ngokuvamile, lokhu kwenzeka kwiziguli ezine-AIDS ezibalwe yi-T-cell kakhulu (<10 amaseli / mm ^ 3). Ukwelapha ngokuvamile kune-IV acyclovir, kanye ne-steroids ne-aspirin. I-Intravitreal injection yama-anti-antiviral aye esebenza kahle.
Meningoencephalitis
Igama elithi meningoencephalitis lisho ukuvuvukala kobuchopho nezicubu ezungezile. Lokhu kungabangela ukuphathwa ikhanda, izinguquko zengqondo, kanye nezimpawu ezisemqoka zezinzwa noma izimpawu ezinjengokukhathazeka ukukhuluma noma ubuthakathaka ohlangothini olulodwa lomzimba. Lokhu konke kungenzeka ngisho nangaphandle kokushaywa kwe-telltale. I-MRI ingabonisa ukuthuthukiswa kwezicubu ezizungezile ubuchopho, futhi ukukhishwa kwe-lumbar kungabonisa antibodies anti-VZV IgG kanye IgM noma i-VZV DNA ku-fluere cerebrospinal. Ukwelashwa kunomthamo ophezulu we-acyclovir kathathu nsuku zonke izinsuku ezingu-10 kuya kwezingu-14.
I-Myelopathy
I- myelopathy kusho ukulimala komgogodla. Lokhu kungaholela ekubuthakathakeni okuqhubekayo kwemilenze, kanye nokushonta noma ukungahambisani nesisu nesibilini. I-MRI ingabonisa i-lesion enkulu noma isisu ngaphakathi komgogodla. Ucwaningo lwe-Cerebrospinal fluid lungabonisa okufanayo okulindeleke ku-VZV meningoencephalitis, ngamagciwane okulwa ne-VZV noma i-VZV DNA. Njenge-VZV meningoencephalitis, ukwelashwa kunomthamo ophezulu we-acyclovir.
I-Vasculopathy
I-VZV ingaba nomthelela emithanjeni yegazi ebuchosheni kanye nesistimu yezinzwa, okuholela emaphethini ezinzima zezibonakaliso ezibangelwa ukwehla kwegazi. Lokhu kungaholela ekuhloleni ikhanda, izinguquko zengqondo, kanye nezibonakaliso nezimpawu eziphathelene neurologist. I-MRI izobonisa izilonda kakhulu eduze kwe-gray-white junction, ngokuvamile ejulile ngaphakathi kobuchopho. Ngesinye isikhathi, i-VZV ingabhekisela ku-artery ye-temporal, okuholela ekubeni i-arteritis yesikhashana ngokulahlekelwa umbono kanye nobuhlungu eduze kweso. Ucwaningo lwe-CSF lufana nalolu olutholakala kumama-dentencephalitis noma imyelopathy, kanti ukwelashwa kuhilela i-high dose IV acyclovir.
I-Ramsay Hunt Syndrome
Ngaphandle kwezingcingo ze-ganglia ezizungeze umgogodla, i-VZV ingase igxile kwi-ganglia yezinzwa ze-cranial. Uma igciwane liphinde lisebenzise i-cranial nerve ganglia, likwazi ukuveza izimpawu ezihlukile ezaziwa ngokuthi i- Ramsay Hunt syndrome, ezingabangela ubuthakathaka ebusweni ngokuvumelana nokukhubazeka kukaBell, kanye nezinye izimpawu eziningi. Isibonakaliso sokuqala sikaRamsay Hunt siyisigubhu se-vesicular ngaphakathi kwendwangu yendlebe
Ukuvimbela Ukugula Okuhlobene Ne-Zoster
I-VZV igxile kubantu abangaba ngu-90%. Imishanguzo ye-VZV yasungulwa ngo-2006 ukuze kukhuliswe umkhuhlane we-VZV. Umgomo okwamanje unconywa ngabantu abangenakho ukuzivikela abangaphezu kweminyaka engama-60 uma kungekho mlando wamuva we-zoster. Naphezu kokusebenza kwayo, umuthi wokugoma ungasetshenziselwa ukusetshenziswa, futhi ukuphazamiseka okuhambisana nokuhlanga nobuzwe kuye kwaphawulwa.
> Imithombo:
> Nagel MA, Gilden D. Isiguli esiyinselele ngesifo se-varicella-zoster virus. I-Neurology Practice Clinical 2013; 3: 109-117