Zambiri kuposa kung'ung'udza
Varicella zoster HIV (VZV) ili ndi njira zosiyanasiyana zoperekera mavuto aumunthu. Poyambirira, imangoyambitsa nkhuku. Kawirikawiri, ngakhale kachilombo kameneka sikamachoka pamene mphutsi imatha. M'malo mwake, kachilomboka kamabisala, ndikulowa m'magulu a mitsempha yam'mimba pafupi ndi msana, kuyembekezera mwayi wowonekera.
Nkhwangwa ndi imodzi mwa njira zodziwika bwino za VZV yobwerera kumbali ziwiri.
Kachilomboka kamatulutsa khungu kansalu kamodzi kokha, motsogolere kuphulika koopsa. Ngakhalenso kuthamanga kwatha, kupweteka kungapitirize ku zomwe zimatchedwa postherpetic neuralgia.
Matendawa amadziwika bwino koma VZV nthawi zina imayambitsa matenda a vasculitis, meningoencephalitis, myelopathy, retinal necrosis, vasculopathy, kapena Ramsay Hunt matenda. Matenda onsewa akhoza kuchitika popanda kuthamanga kapena miyezi itatha. Kuyeza kafukufuku wamakono monga kukhalapo kwa VZV DNA kapena maselo osadziwika mu cerebrospinal fluid (CSF) ndi othandiza ngati alipo, koma matendawa angakhoze kuchitika ngakhale izi sizipezeka. Ngakhale ngati mukuganiza kuti, mankhwala a matenda a ubongo omwe amachititsidwa ndi VZV angakhale ovuta.
Herpes Zoster
Herpes zoster, yomwe imatchedwanso shingles, ndi imodzi mwa mitundu yodziwika kwambiri ya matenda a VZV. Chifukwa chakuti limapereka chidziwitso chodziwika bwino, anthu ena saganiza kuti ndi matendawa.
Komabe, kutukuka kumafalikira pa zomwe zimatchedwa kugawanika kwa dermatomal , kutanthauza malo a khungu omwe sakhala ndi mitsempha imodzi. Izi ndi chifukwa chakuti mitsempha ya mitsempha, kapena kachilomboka, ndi kumene kachilomboka kanakhala kofikira mpaka itakhala ndi mwayi wowonjezera. Ndipotu, kujambula kwa magnetic resonance (MRI) kungasonyeze kupititsa patsogolo gulu la ganglion.
Matendawa ndi opweteka kwambiri. Chithandizo chili ndi valacyclovir kwa pafupi masiku asanu ndi awiri.
Pambuyo pa Neuralgia
Zakale zakuthambo za neuralgia zimatsindika mfundo yakuti herpes zoster ndi matenda a ubongo. Ngakhalenso mphutsi itatha, kupweteka pa dermatome kumatha. Ngati izo zichita izo kwa miyezi itatu, chidziwitso cha postherpetic neuralgia (PHN) chikhoza kupangidwa. Chinthu chofunika kwambiri pa chiopsezo cha PHN ndi zaka, ndipo opitirira 30 peresenti ya anthu oposa 60 ali ndi shingles akupitiliza PHN. Matendawa angakhale chifukwa cha kutupa kwachilendo chifukwa cha matenda opatsirana a tizilombo, pamene maselo akuluakulu otupa amapezeka mwa anthu omwe ali ndi PHN kwa zaka ziwiri, ndipo VZV DNA ndi mapuloteni amapezeka m'magazi a odwala ambiri omwe ali ndi PHN. Odwala ena ali ndi mphamvu yowononga tizilombo toyambitsa matenda, ngakhale kuti chithandizo cha IV acyclovir sichivomerezedwa ndi Food and Drug Administration (FDA), ndipo pali zofunikira zowonongeka bwino. Zingakhale zovuta kwambiri kuthetsa ululu wa PHN. Matenda a tricyclic odetsa nkhaŵa, gabapentin, pregabalin kapena lidocaine zimakhala mankhwala oyamba, opioids, tramadol, kapena capsaicin monga mankhwala achiwiri kapena atatu.
Kusakaniza mankhwala kungakhale kovuta kwambiri. Nthenda yothamangira mitsempha yowonjezera, yomwe imapangitsa kuti magetsi azisungidwa pansi pa ululu waukulu, angaperekenso mpumulo.
Zoster Sine Herpete
Chofunikira kwambiri, "zoster sine herpete" zikanatengedwa kuti ndizomwe zakuthambo zakuthambo zisanafike, koma panalibe vuto lililonse loyamba. Matendawa amatha kudziwika ndi antibody mu CSF. Zina zomwe zimayambitsa kupweteka kwakukulu, monga matenda a shuga kapena kusungunuka kwa mitsempha, ziyenera kukhazikitsidwa ndi maphunziro a ubongo. Chithandizo chimaphatikizapo mkulu wa dozi acyclovir, pochiza ululu m'mafashoni ofanana ndi PHN.
Retinal N ecrosis
Kugonjetsa diso ndi VZV kungayambitse selo yopita patsogolo mu retina. Izi zimapweteka pafupi ndi diso, komanso masomphenya osasangalatsa. Masomphenya a pulogalamu amatha atayika poyamba. Dokotala akamapanga mayeso a fundoscopic amatha kuona kutaya magazi ndi kutayira kwa retina. Mavairasi ena, monga HSV ndi cytomegalovirus, angayambitsenso retinal necrosis. Kawirikawiri, izi zimachitika kwa odwala omwe ali ndi Edzi omwe T-cell amawerengera ndi otsika kwambiri (<10 cells / mm ^ 3). Chithandizochi chimakhala ndi IV acyclovir, komanso steroids ndi aspirin. Majekeseni a Intravitreal a anti-antiretroal agwiranso ntchito.
Meningoencephalitis
Mawu akuti meningoencephalitis amatanthauza kutupa kwa ubongo ndi ziwalo zozungulira. Izi zingachititse mutu, kusintha maganizo, komanso zizindikiro za matenda a ubongo kapena zizindikiro monga kuyankhula kapena kufooketsa mbali imodzi ya thupi. Zonsezi zikhoza kuchitika ngakhale popanda kuthamanga. MRI ingasonyeze kuti zowonjezera ubongo zimayambitsidwa, ndipo kutuluka kwa mimba kungasonyeze anti-VZV IgG ndi IgM antibodies kapena VZV DNA mu cerebrospinal fluid. Chithandizo chili ndi dozi yapamwamba intravenous acyclovir katatu tsiku lililonse kwa masiku 10 mpaka 14.
Myelopathy
Myelopathy amatanthauza kuwonongeka kwa msana wa msana. Izi zikhoza kufooka kufooka kwa miyendo, komanso kufooka kapena kusadziletsa kwa chikhodzodzo ndi matumbo. MRI ikhoza kusonyeza chilonda chachikulu kapena kupweteka pakati pa msana. Kufufuza kwa madzi amadzimadzi amatha kusonyeza zofanana zomwe zimayembekezeka ku VZV meningoencephalitis, ndi ma antibodies anti-VZV kapena VZV DNA. Monga ndi VZV meningoencephalitis, mankhwala ali ndi mlingo wapamwamba intravenous acyclovir.
Vasculopathy
VZV ikhoza kumakhudza mitsempha ya ubongo ya ubongo ndi zamanjenje, zomwe zimachititsa kuti zikhale zovuta zowonetsera zizindikiro za kuchepa kwa magazi. Zimenezi zingayambitse mutu, kusintha kwa chidziwitso, komanso zizindikiro za matenda a ubongo. MRI idzawonetsa zilonda zomwe zili pafupi kwambiri ndi magulu a imvi, makamaka mkati mwa ubongo. Nthawi zina, VZV imatha kugwiritsira ntchito mitsempha yamakono, yomwe imabweretsa arteritis yam'tsogolo ndi kutaya masomphenya ndi ululu pafupi ndi diso. Maphunziro a CSF ali ofanana ndi omwe amapezeka mu meningoencephalitis kapena myelopathy, ndipo mankhwala amaphatikizapo mlingo wa IV acyclovir.
Ramsay Hunt Syndrome
Kuphatikizana ndi mizu yotchedwa ganglia pafupi ndi msana, VZV ikhoza kukhala yochuluka kwambiri m'magulu a mitsempha. Pamene kachilomboka kamayambitsa kachilombo ka cranial nerve ganglia, ikhoza kutulutsa zizindikiro zosiyana siyana zomwe zimatchedwa Ramsay Hunt matenda, omwe angayambitse kufooka kwa nkhope mofanana ndi matenda a Bell, komanso zizindikiro zina zambiri. Chizindikiro chachikale cha Ramsay Hunt ndi mphutsi yambiri mkati mwa nthano za khutu
Kupewa Zodwala Zina
VZV imakhala yosachepera mpaka 90% ya anthu. Katemera wa VZV unayambitsidwa mu 2006 kuti apititse patsogolo chitetezo cha VZV. Katemerayu akulimbikitsidwa kwa anthu omwe ali ndi zaka zosaposa 60 ngati sangakhalepo kale ngati palibe zochitika zatsopano za zoster. Ngakhale kuti katemerawa amagwira ntchito bwino, katemerawa sagwiritsidwa ntchito, ndipo zovuta zomwe zimapezeka chifukwa cha mtundu ndi fuko zimatchulidwanso.
> Zotsatira:
> Nagel MA, Gilden D. Wodwala wovuta ndi varicella-zoster virus matenda. Neurology Clinical practice 2013; 3: 109-117