I-Stevens-Johnson syndrome (i-SJS) ivame ukucatshangwa njengendlela ephawulekayo ye-erythema multiform, okuyiyona eyona uhlobo lwe-hypersensitivity yokusabela kumuthi, kufaka phakathi izidakamizwa ezingaphezu kwemithi, noma ukutheleleka, njenge-herpes noma ukuhamba nge-pneumonia okubangelwa yiMycoplasma pneumoniae .
Olunye ochwepheshe bacabanga ngeStevens-Johnson syndrome njengendlela ehlukile e-erythema multiforme, okuyinto esikhundleni sabo abahlukanisa ibe i-erythema multiforme encane ne-erythema amaforomo amakhulu ama-multiform.
Ukuze wenze izinto zidideke nakakhulu, kunesimo esibi se-Stevens-Johnson syndrome: I-Toxic Epidermal Necrolysis (TEN), eyaziwa nangokuthi i-Lyell's Syndrome.
Stevens-Johnson Syndrome
Ochwepheshe ababili bezingane, u-Albert Mason Stevens noFrank Chambliss Johnson, bathola i-Stevens-Johnson syndrome ngo-1922. I-Stevens-Johnson syndrome ingasongela ukuphila futhi ingabangela izimpawu ezinzima, njengezikhukhula ezinkulu esikhumbeni kanye nokulahla isikhumba somntwana.
I-Stevens-Johnson syndrome yenzeka ngesigameko samacala angu-1.5 kuya kwangu-2 kubantu abayizigidi ngonyaka, ngakho-ke akuvamile. Ngeshwa, amaphesenti angaba ngu-5 abantu abanesifo se-Stevens-Johnson syndrome kanye namaphesenti angu-30 abane- Toxic Epidermal Necrolysis banezimpawu ezinzima kangangokuthi ababuyiselwa.
Izingane zanoma yimuphi ubudala kanye nabantu abadala zingathinteka yi-Stevens-Johnson syndrome, nakuba abantu abangazivikeli kahle, njengokuthi bane- HIV , cishe bangengozi.
Izimpawu zikaStevens-Johnson Syndrome
I-Stevens-Johnson syndrome ngokuvamile iqala izimpawu ezifana nezifo , ezifana nomkhuhlane, umkhuhlane, nokukhwehlela. Okulandelayo, emva kwezinsuku ezi-1 kuya kwezingu-3, ingane ene-Stevens-Johnson syndrome izokhula:
- ukuzwa okuvuthayo ezindebeni, ngaphakathi kwezihlathi zabo (buccal mucosa), namehlo
- ukuqhuma okubomvu okwesibhakabhaka, okungenzeka kube nezikhungo ezimnyama, noma ukuthuthuka zibe amabhulashi
- ukuvuvukala ubuso, izinkophezelo, kanye / noma ulimi
- obomvu, amehlo egazi
- ukuzwela ukukhanya (photophobia)
- izilonda ezibuhlungu noma izidakamizwa emlonyeni, impumlo, amehlo, kanye nomcosa wesisu, okungabangela ukubola
Izinkinga ze-Stevens-Johnson syndrome zingabandakanya isilonda esiswini kanye nobuphofu, i-pneumonitis, i-myocarditis, i-hepatitis, i-hematuria, ukuhluleka kwezinso, nokuhlukunyezwa kwezinso.
Isibonakaliso esihle sikaNicolsky, lapho izingqimba eziphezulu zesikhumba kwengane ziphuma lapho zihlutshiwe, luphawu lwe-Stevens-Johnson syndrome enamandla noma ukuthi luye lwaba yi-Toxic Epidermal Necrolysis.
Ingane iphinda ibekwa ngokuthi ine-Toxic Epidermal Necrolysis uma inamaphesenti angaphezu kwezingama-30 e-epidermal (isikhumba).
Izimbangela zikaStevens-Johnson Syndrome
Nakuba imithi engaphezu kuka-200 ingabangela noma idale uStevens-Johnson syndrome, okuvame kakhulu kuhlanganisa:
- ama-anticonvulsants (ukwelashwa kwesithuthwane noma ukuthunjwa), kuhlanganise neTegretol (Carbamazepine), i-Dilantin (i-Phenytoin), iPhenobarbital, i-Depakote (i-Valproic Acid), ne-Lamictal (i-Lamotrigine)
- i-sulfonamide antibiotics, njengeBactrim (Trimethoprim / Sulfamethoxazole), ejwayele ukusetshenziselwa ukwelapha i-UTIs ne- MRSA
- i-beta-lactam antibiotics, kuhlanganise ne- penicillin kanye ne-cephalosporins
- izidakamizwa ezingavimba ukuvuvukala, ikakhulukazi kohlobo lwe-oxicam, njengoFeldene (Piroxicam) (ngokuvamile okungenqunyelwe izingane)
- I-Zyloprim (allopurinol), evame ukusetshenziselwa ukwelapha i-gout
I-Stevens-Johnson syndrome ngokuvamile icatshangwa ukuthi ibangelwa ukusabela kwezidakamizwa, kodwa izifo ezingase zihlotshaniswe nayo zingabandakanya lezo ezibangelwa yi:
- i-herpes simplex virus
- I-Mycoplasma pneumoniae amagciwane (ukuhamba nge-pneumonia)
- isibindi C
- I-Histoplasma capsulatum fungus (i-Histoplasmosis)
- I-Epstein-Barr virus ( mono )
- I-Adenovirus
Ukwelashwa kukaStevens-Johnson Syndrome
Izindlela zokwelashwa kwe-Stevens-Johnson syndrome zivame ukuqala ngokuyeka noma yikuphi izidakamizwa okungenzeka zenze ukusabela bese zisekelwa ukunakekelwa kuze kube yilapho isiguli sithola cishe emavikini amane.
Lezi ziguli zidinga ukunakekelwa eNyunithi Yokunakekelwa Okuningi, ngezokwelapha okungase zifake:
- UV fluids
- izithako zokudla okunomsoco
- ama-antibiotics ukuphatha izifo eziyisibili
- imithi yobuhlungu
- ukunakekelwa kwezilonda
- i-steroids kanye ne-immunoglobulin (IVIG), nakuba ukusetshenziswa kwabo kusekhona impikiswano
Izifo zokwelashwa zikaStevens-Johnson zivame ukuhlanganiswa ngendlela yeqembu, nodokotela we-ICU, i-dermatologist, i-ophthalmologist, i-pulmonologist, ne-gastroenterologist.
Abazali kufanele bafune usizo lwezokwelapha ngokushesha uma becabanga ukuthi ingane yabo ingaba ne-Stevens-Johnson syndrome.
Imithombo:
UHabif: Isidakamizwa se-Clinical, 5th ed.
I-Kliegman: UNelson Bookbook of Pediatrics, 18th ed.
I-Koh MJ. I-Stevens-Johnson syndrome ne-necrolysis eyingozi ye-epidermal ezinganeni zase-Asia. J Am Acad Dermatol - 01-JAN-2010; 62 (1): 54-60.
Mandell: Mandell, Douglas, kanye nemigomo ye-Bennett kanye nokuzijwayeza kwezifo ezithathelwanayo, umhla ka-7.
Natacha Levi, PharmD. Imithi njengengozi ye-Stevens-Johnson Syndrome ne-Toxic Epidermal Necrolysis Ezinganeni: Ukuhlaziywa Okuxubile. I-Pediatrics, Feb 2009; 123: e297 - e304.