Matenda a Stevens-Johnson (SJS) amawoneka ngati mawonekedwe oopsa a erythema multiforme, omwewo ndiwo mtundu wa hypersensitivity reaction kwa mankhwala, kuphatikizapo mankhwala osokoneza bongo, kapena matenda, monga herpes kapena kuyenda chibayo chomwe chiri chifukwa cha Mycoplasma pneumoniae .
Akatswiri ena amaganiza za matenda a Stevens-Johnson monga chikhalidwe chosiyana kuchokera ku erythema multiforme, zomwe zimagawanika kukhala erythema multiform ang'onoang'ono komanso erythema multiform mitundu yosiyanasiyana.
Kuti zinthu zisokoneze kwambiri, palinso matenda aakulu a Stevens-Johnson matenda: Toxic Epidermal Necrolysis (TEN), yomwe imadziwika kuti Lyell's Syndrome.
Stevens-Johnson Syndrome
Ana awiri a ana, Albert Mason Stevens ndi Frank Chambliss Johnson, anapeza matenda a Stevens-Johnson m'chaka cha 1922. Matenda a Stevens-Johnson akhoza kuika moyo pachiswe ndipo akhoza kuwonetsa zizindikiro zazikulu, monga zilonda zamatenda ndi kutaya khungu la mwana.
Matenda a Stevens-Johnson amapezeka ndi anthu pafupifupi mamiliyoni 1.5 mpaka 2 pa chaka, choncho ndizosowa. Mwamwayi, pafupifupi 5 peresenti ya anthu omwe ali ndi matenda a Stevens-Johnson ndi 30 peresenti ndi Toxic Epidermal Necrolysis ali ndi zizindikiro zoopsa kotero kuti sakuchira.
Ana a msinkhu uliwonse ndi akuluakulu angakhudzidwe ndi matenda a Stevens-Johnson, ngakhale kuti anthu omwe ali ndi kachilombo ka HIV , omwe ali ndi kachirombo ka HIV , amakhala pachiopsezo.
Zizindikiro za Stevens-Johnson Syndrome
Matenda a Stevens-Johnson kawirikawiri amayamba ndi zizindikiro monga chimfine , monga malungo, zilonda, ndi chifuwa. Kenaka, patapita masiku atatu kapena atatu, mwana yemwe ali ndi matenda a Stevens-Johnson adzakhala:
- kutentha kwa milomo, mkati mwa masaya (buccal mucosa), ndi maso
- kuthamanga kofiira, komwe kungakhale ndi malo amdima, kapena kukhala mabulter
- Kutupa kwa nkhope, maso, ndi / kapena lirime
- zofiira, maso a magazi
- kuzindikira mphamvu (photophobia)
- zilonda zowawa m'makamwa, mphuno, maso, ndi mucosa zamtundu, zomwe zingayambitse kupweteka
Zovuta za matenda a Stevens-Johnson angaphatikizepo zilonda zam'mimba ndi khungu, pneumonitis, myocarditis, hepatitis, hematuria, kusokonezeka kwa impso, ndi sepsis.
Chizindikiro chabwino cha Nikolsky, chomwe chimapangidwira khungu la mwana pakhungu, chimakhala chizindikiro cha matenda aakulu a Stevens-Johnson kapena kuti asanduka Toxic Epidermal Necrolysis.
Mwana amadziwika kuti ali ndi Toxic Epidermal Necrolysis ngati ali ndi 30 peresenti ya gulu la epidermal (khungu).
Zifukwa za Stevens-Johnson Syndrome
Ngakhale mankhwala oposa 200 angayambitse kapena amachititsa matenda a Stevens-Johnson, omwe amapezeka kwambiri ndi awa:
- Mankhwala osokoneza bongo (odwala matenda a khunyu kapena odwala), kuphatikizapo Tegretol (Carbamazepine), Dilantin (Phenytoin), Phenobarbital, Depakote (Valproic Acid), ndi Lamictal (Lamotrigine)
- mankhwala a sulfonamide, monga Bactrim (Trimethoprim / Sulfamethoxazole), omwe amagwiritsidwa ntchito pochiza UTIs ndi MRSA
- mabakiteriya a beta-lactam, kuphatikizapo penicillin ndi cephalosporins
- mankhwala osakanikirana ndi mankhwala osakanikirana, makamaka a mtundu wa oxicam, monga Feldene (Piroxicam) (omwe sagwiritsidwa ntchito kwa ana)
- Zyloprim (allopurinol), omwe amagwiritsidwa ntchito pochizira gout
Matenda a Stevens-Johnson nthawi zambiri amaganiza kuti amayamba chifukwa cha mankhwala, koma matenda omwe angagwirizanenso nawo angaphatikizepo:
- herpes simplex HIV
- Mabakiteriya a Mycoplasma pneumoniae (kuyenda chibayo)
- hepatitis C
- Histoplasma capsulatum fungus (Histoplasmosis)
- Epstein-Barr HIV ( mono )
- Adenovirus
Kuchiza kwa Stevens-Johnson Syndrome
Mankhwala odwala matenda a Stevens-Johnson amayamba mwa kuleka mankhwala alionse amene amachititsa kuti ayambe kuchitapo kanthu ndikuthandizira chisamaliro mpaka wodwalayo atayambiranso pafupi masabata 4.
Odwalawa nthawi zambiri amafunika kusamalidwa m'Chipatala chachikulu cha Care, ndi mankhwala omwe angaphatikizepo:
- IV
- zakudya zowonjezera
- maantibayotiki kuti apeze matenda opatsirana
- mankhwala opweteka
- chisamaliro cha zilonda
- steroids ndi intravenous immunoglobulin (IVIG), ngakhale kuti ntchito yawo ikutsutsanabe
Mankhwala a Stevens-Johnson matenda nthawi zambiri amawongolera njira yothandizira, ndi dokotala wa ICU, dermatologist, katswiri wa ophthalmologist, pulmonologist, ndi gastroenterologist.
Makolo ayenera kupita kuchipatala mwamsanga ngati aganiza kuti mwana wawo akhoza kukhala ndi matenda a Stevens-Johnson.
Zotsatira:
Habif: Dermatology Clinic, 5th.
Kliegman: Nelson Buku Lophunzitsa za Ana, 18th ed.
Koh MJ. Matenda a Stevens-Johnson ndi matenda oopsa a epidermal necrolysis ku ana a Asia. J Am Acad Dermatol - 01-JAN-2010; 62 (1): 54-60.
Mandell: Mandell, Douglas, ndi Bennett's Principles and Practice of Infectious Diseases, 7th ed.
Natacha Levi, PharmD. Mankhwala monga Zoopsa za Stevens-Johnson Syndrome ndi Toxic Epidermal Necrolysis kwa Ana: Kusokonezedwa Kwadothi. Matenda, Feb 2009; 123: e297 - e304.