Kuba akafaananyi ng’olina omusujja, omubiri gukuluma, n’otandika okumira eddagala omusawo ly’akulagidde. Watya singa, mu nnaku ntono, mpozzi wiiki emu oba bbiri, mu bwangu ofuna amabala amamyufu ku mubiri gwo, amabwa munda mu kamwa, mu maaso go, ne mu bitundu byo eby’ekyama, olususu lwo ne lutandika okuwunya n’okusekula ng’olinga eyayokebwa? Mazima ddala eno embeera ya ntiisa, ya bulabe nnyo era etali ya bulijjo. Leero tugenda kwogera ku mbeera eno eyitibwa Stevens-Johnson Syndrome (SJS). Kikulu nnyo buli muntu okukimanya ku nsonga eno.
SJS ne TEN kye ki? Njawulo ki eriwo wakati w’ebintu bino byombi?
Obulwadde bwa Stevens-Johnson Syndrome (SJS) bulwadde bwa maanyi obw’okuwulira obubi, ebiseera ebisinga ku ddagala. Kizingiramu okwonooneka kw’olususu lwaffe n’obuwuka obuyitibwa mucous membranes, ekivaako obutoffaali okufa n’olususu okusekula. Obuwuka obuyitibwa mucous membranes bwe buwuzi obugonvu era obunnyogovu obubeera mu layini y’akamwa kaffe, ennyindo, amaaso, ebitundu by’ekyama n’omumwa gwa nnabaana.
Waliwo engeri endala ey’amaanyi ey’embeera eno, gye tuyita Toxic Epidermal Necrolysis (TEN) . Mu ngeri ennyangu, SJS ne TEN ziringa enjuyi bbiri ez’obulwadde bwe bumu.
- SJS (Stevens-Johnson Syndrome): Mu mbeera eno , ebitundu ebitakka wansi wa 10% eby’olususu lw’omubiri biba bifuuse sloughed off.
- TEN (Toxic Epidermal Necrolysis): Eno mbeera ya maanyi nnyo era eyinza okutta omuntu ng’olususu lw’omubiri olusukka mu 30% lubula.
Embeera zino zombi za maanyi nnyo, kale omulwadde alina okuweebwa ekitanda , oluusi mu kifo ekirabirira abalwadde abayi (ICU) oba mu kifo eky’okwokya.
Ani asinga okukwatibwa obulwadde buno?
Wadde nga SJS esobola okubaawo ku myaka gyonna, esinga kubeera mu baana n’abavubuka abakulu abali wansi w’emyaka 30. Era esobola okubaawo mu bantu abakadde. SJS esingako katono mu bakyala okusinga mu basajja.
Waliwo enjawulo entono ng’otunuulira ensonga:
- Ekisinga okuvaako SJS mu baana ze mbeera ezisiigibwa nga ekifuba .
- Ekisinga okuvaako SJS/TEN mu bantu abakulu kwe kukwatibwa allergy eri eddagala .
Bubonero ki ddala obwa SJS?
Kikulu nnyo okumanya obubonero buno, kubanga gy’okoma okubutegeera amangu, gy’okoma okunoonya obujjanjabi amangu. Obubonero butera okulabika mu wiiki emu oba ssatu ng’omaze okutandika eddagala.
Obubonero obusooka bwe bubonero bw’omusujja, okulumwa omubiri, okulumwa omutwe, n’okusesema. Kino kizibuwalira okuzuula SJS mu nnaku ezisooka. Olwo lwokka obubonero obw’amaanyi obw’olususu we bulabika.
Wansi waliwo obubonero obukulu obulaga SJS.
| Obubonero | Nga kinnyonnyoddwa mu ngeri ennyangu |
|---|---|
| Obulumi obw’amaanyi ku lususu | Okuwulira obulumi obw’okwokya nga buyitiridde nga tosobola kukwata ku lususu lwo. |
| Omusujja n’okulumwa omubiri | Obubonero buno mulimu omusujja omungi, okulumwa omubiri n’okulumwa omutwe. |
| Ebitundu ebimyufu n’ebitundutundu | Ebitundu ebimyufu oba ebiwundu ebitandikira mu maaso ne mu kifuba ne bisaasaana mu mubiri gwonna. |
| Ebizimba n’ebiwundu | Ebizimba n’amabwa ebiruma ku lususu, munda mu kamwa, emimiro, amaaso, ebitundu by’ekyama, n’omumwa gwa nnabaana. |
| Okusekula olususu | Ebizimba bikutuka era olususu olw’okungulu ne lusekula mu bikuta ebinene. |
| Okufuuwa amalusu okuva mu kamwa | Okukulukuta amalusu olw’amabwa mu kamwa, obutasobola kukuuma kamwa nga kaggaddwa. |
| Okutunula mu maaso | Ebizimba n’okuzimba mu maaso, ekizibu okuzibula amaaso. |
| Obulumi ng’ofulumya omusulo | Obulumi obw’amaanyi ng’ofulumya omusulo olw’okuzimba ebizimba mu bitundu by’omubiri ebiyitibwa mucous membranes. |
Ebikulu ebivaako n’ebika by’eddagala eriyinza okuleeta SJS
Ekisinga okuvaako SJS kwe kukwatibwa allergy eri eddagala erimu. Kyokka kino tekibaawo ku ddagala lyonna. Waliwo ebika by’eddagala ebiwerako ebisinga okuleeta SJS.
| Ensonga | Okunnyonnyola |
|---|---|
| Alergy eri eddagala | Kino kye kivaako emisango gya SJS ne TEN egisinga obungi. |
| Yinfekisoni | Naddala mu baana, kiyinza okuva ku yinfekisoni nga Mycoplasma pneumonia, Herpes, ne Hepatitis A. |
| Ensonga endala | Obulwadde bwa Graft-versus-host, ekizibu ekibaawo oluvannyuma lw’okusimbuliza obusigo bw’amagumba, okugema (butera nnyo), era oluusi tewali kivaako kiyinza kuzuulibwa. |
Eddagala eririna obulabe obw’amaanyi obw’okuleeta SJS
- Eddagala lya sulfa eritta obuwuka: Ebika by’eddagala eritta obuwuka.
- Eddagala eriweweeza ku bulwadde bw’okusannyalala: Okugeza, eddagala nga `Phenytoin (Dilantin®)`, `Carbamazepine (Tegretol®)`, `Lamotrigine (Lamictal®)`, `Phenobarbital (Luminal®)`.
- Allopurinol: Eddagala erikozesebwa okujjanjaba gaasi n’ebika ebimu eby’amayinja mu kibumba (`Aloprim®`, `Zyloprim®`).
- Eddagala eriweweeza ku bulumi (NSAIDs): Eddagala eriweweeza ku bulumi eritali lya steroid nga `Piroxicam (Feldene®)`, `Diclofenac (Cambia®, Flector®)`. Eddagala eddala nga `Nevirapine (Viramune®)`.
- Eddagala eddala eritta obuwuka: Ebika by’eddagala ebirala ebimu nabyo bisobola okuvaako kino.
Ekikulu: Si buli muntu nti ajja kufuna SJS okuva mu ddagala eriwandiikiddwa wano. Obukadde n’obukadde bw’abantu bazikozesa. Wabula eddagala lino lizuuliddwa nga lirina obulabe obw’amaanyi obw’okulwala SJS. Tolekera awo kumira ddagala eriwandiikiddwa omusawo ng’asinziira ku kitundu kino.
Okuzuula n’okujjanjaba obulwadde buno
Singa ggwe oba omuntu gw’omanyi afuna obubonero obwo waggulu naddala ng’obadde waakatandika okukozesa eddagala eppya, kyetaagisa okugenda amangu mu kitongole ky’abalwadde ab’amangu (ETU) mu ddwaaliro erikuli okumpi .
Abasawo bazuula obulwadde buno nga:
- Nga okebera olususu lwo n’obusimu obuyitibwa mucous membranes (nga akamwa, amaaso).
- Nga obuuza ku ddaala ly’obulumi bw’owulira.
- Nga tutunuulira omutindo obubonero bw’olususu bwe busaasaana n’obungi bwe busaasaana.
- Bwe kiba kyetaagisa, akatundu akatono ak’olususu kasobola okutwalibwa ne kakeberebwa (skin biopsy).
Obujjanjabi bwa SJS
Ebigendererwa ebikulu eby’obujjanjabi bwa SJS kwe kuyimiriza eddagala eryaleeta obulwadde buno, okufuga obubonero, okuziyiza ebizibu, n’okuyamba olususu okudda engulu. Okuweebwa ekitanda mu ddwaaliro kikakatako ku kino.
Enkola ezimu ez’obujjanjabi ziwandiikiddwa wansi:
| Enkola y’obujjanjabi | Okunnyonnyola |
|---|---|
| Okuyimiriza eddagala eriweweeza ku bulwadde | Guno gwe mutendera ogusooka era ogusinga obukulu. Eddagala eriteeberezebwa okuleeta SJS liyimirizibwa mangu. |
| Okuwa omubiri amazzi n’eminnyo | Okusekula kw’olususu kuleetera amazzi amangi okubula okuva mu mubiri, kale amazzi aga IV ge gakozesebwa okuwa amazzi ageetaagisa n’obusannyalazo. |
| Okujjanjaba olususu | Olususu olulumizibwa lubikkibwako ebizigo eby’enjawulo ebitali bya kwesiba, okufaananako n’okujjanjaba okwokya. |
| Okuwa ebiriisa | Kizibu okulya olw’amabwa mu kamwa. Okuva bwe kiri nti kyetaagisa amaanyi mangi okuwona, emmere erimu kalori nnyingi eweebwa okuyita mu ttanka eyisibwa mu nnyindo okuyingira mu lubuto (tube-feeding). |
| Okufuga obulumi | Eno embeera eruma nnyo, kale eddagala ery’amaanyi eriweweeza ku bulumi liweebwa. |
| Empeereza y’ebyobujjanjabi ey’ekikugu | Noonya obuyambi bw’omusawo w’ensusu era singa amaaso gakosebwa, omusawo w’amaaso. |
Ebizibu ebiva mu SJS n‟ebivaamu oluvannyuma lw‟okuwona
SJS mbeera ya maanyi nnyo eyinza n’okuviirako okufa. Abalwadde nga 10% abalina SJS n’abalwadde abawera 50% abalina ekika ekisinga okuba eky’amaanyi, TEN, bafa. Ebisinga okuvaako okufa bye bizibu eby’amaanyi nga sepsis, pneumonia, n’okulemererwa kw’ebitundu by’omubiri ebingi.
Obulwadde buno ne bwe buwona, abantu abamu bayinza okufuna ebizibu eby’ekiseera ekiwanvu.
- Enkyukakyuka mu lususu: Olususu olukalu, okusiiwa, olususu okukyuka langi.
- Ebizibu by’amaaso: amaaso amakalu, amaaso obutabeera bulungi nnyo, okulaba obutalabika bulungi, okukaluubirirwa okutunuulira ekitangaala (photophobia).
- Ebirala: Okutuuyana ennyo, amawuggwe okwonooneka, emisumaali okugwa oba okulema, enviiri okugwa, okutaataaganyizibwa mu buwoomi.
Kikulu nnyo: Singa oddamu okukwatibwa eddagala eryaleeta SJS, omulundi ogwokubiri embeera eyinza okuba ey’amaanyi ennyo okusinga eyasooka. N’olwekyo kyetaagisa okujjukira erinnya ly’eddagala eryaleeta SJS n’eddagala erifaananako bwe lityo obulamu bwo bwonna n’okutegeeza buli musawo gw’olaba.
Obubaka Obutwala Awaka
- Obulwadde bwa Stevens-Johnson Syndrome (SJS) bulwadde bwa maanyi, obutta obulamu bw’olususu, ebiseera ebisinga buva ku ddagala.
- Obubonero obusooka mulimu omusujja n’okulumwa omubiri, naye oluvannyuma ne bituuka ku bitundu ebimyufu ebiruma ku lususu, ebizimba n’okusekula olususu.
- Bw’ofuna obubonero buno ng’omaze okutandika okukozesa eddagala eppya, genda mu kitongole ky’eddwaaliro eky’amangu (ETU) amangu ddala awatali kulwa.
- Obujjanjabi obukulu kwe kuzuula n’okukomya eddagala eryaleeta obulwadde buno, n’okuwa obujjanjabi obuyambi mu ddwaaliro.
- Jjukira erinnya ly’eddagala eryakuleetera SJS obulamu bwo bwonna era otegeeze omusawo wo buli lw’ogenda okujjanjabibwa. Kino kiyinza okutaasa obulamu bwo.
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