Olususu lwo lumyufu mu bwangu, ne luvaamu ebizimba n’okusekula? Ka tuyige ku bulwadde buno obw’akabi obwa Stevens-Johnson Syndrome (SJS)?

Wali olabye, oba kikutuuseeko, ekizimba eky’amangu ku mubiri gwo ne kifuuka ekimyufu, ne kifaanana ng’ekizimba, olwo ebizimba ne bivaamu olususu ne lusekula? Ebiwundu bino era bisobola okulabika munda mu kamwa, mu maaso ne mu bitundu by’ekyama. Kino si kintu kyangu, era kiyinza okuba embeera ey’amaanyi eyeetaaga okuweebwa ekitanda mu ddwaaliro mu bwangu . Leero, tugenda kwogera ku mbeera eno eyitibwa Stevens-Johnson Syndrome (SJS).

Obulwadde bwa Stevens-Johnson Syndrome (SJS) kye ki?

Mu ngeri ennyangu, obulwadde bwa Stevens-Johnson Syndrome (SJS) ne Toxic Epidermal Necrolysis (TEN) mbeera bbiri ez’amaanyi ennyo ez’olususu. Ekibaawo, olususu lwo lutandika mangu okufuna ebizimba ebimyufu, ebisiiwa, oluvannyuma ne bivaamu ebizimba ne bisekula. Era kiyinza okukosa amaaso go, ebitundu by’ekyama n’obusimu obuyitibwa mucous membranes munda mu kamwa ko. Bw’ofuna embeera zino, mazima ddala ojja kwetaaga okuweebwa ekitanda mu ddwaaliro okufuna obujjanjabi.

Abasawo abamu batwala SJS ne TEN ng’endwadde bbiri ez’enjawulo, ate abalala bagamba nti mitendera gya njawulo egy’obulwadde bwe bumu. SJS ngeri ya bulwadde buno etali ya maanyi nnyo okusinga TEN. Okugeza mu SJS, olususu olutakka wansi wa 10% ku mubiri gwonna luyinza okubula. Mu TEN, ebitundu ebisukka mu 30% eby’olususu biyinza okubula. Kyokka, kikulu okukijjukira nti embeera zombi ziyinza okutta omuntu .

Amannya ki amalala SJS g’erina?

Yee, kino kiyitibwa amannya amalala agawerako. Okugeza nga:

• Obulwadde bwa Lyell
• Obulwadde bwa Stevens-Johnson/okufa kw’olususu okw’obutwa
• Obulwadde bwa Stevens-Johnson obutwa obuyitibwa epidermal necrolysis spectrum

Oluusi, erinnya likyuka okusinziira ku kivaako. Singa kiva ku ddagala erimu, kiyinza okuyitibwa ``drug-induced Stevens-Johnson syndrome'', era bwe kiba nga kiva ku yinfekisoni eyitibwa ``Mycoplasma'', kiyinza okuyitibwa ``mycoplasma-induced Stevens-Johnson syndrome''.

Ani asinga okulwala SJS?

SJS esinga kulabibwa mu bavubuka abali wansi w’emyaka 30 ne mu baana abato. Kyokka buyinza okubaawo mu bantu ab’emyaka gyonna naddala abakadde. Abakyala batera okulwala SJS okusinga abasajja.

Teebereza, singa omwana omuto afuna yinfekisoni nga pneumonia ate n’afuna ekizibu ky’olususu nga kino... kiyinza okuba SJS. Ekisinga okuvaako SJS mu baana ye yinfekisoni nga pneumonia. Naye mu bantu abakulu, SJS/TEN esinga kuva ku ddagala lye bamira.

Biki ebiyinza okuvaako okukulaakulanya SJS?

Tewali kintu kimu ekivaako obulwadde buno, wabula ensonga ezigatta. Ekisinga obukulu ku bino kwe kukwatibwa obuzaale. Kwe kugamba, obuzaale bwo buyinza okubaako kye bukola. Ensonga ezimu ezikwata ku butonde nazo zisobola okukola obuzaale obwo. Ekimu ku bintu bino eby’obuzaale bye bitundu eby’enjawulo eby’omubiri gwaffe ebiyitibwa `(Human Leukocyte Antigens - HLAs). Abantu abalina enjawulo ezimu eza `(HLAs)` zino bali mu bulabe bwa maanyi obw'okufuna SJS oba TEN okusinga abalala.

Bubonero ki obwa SJS?

Waliwo obubonero obuwerako obuyinza okulabika mu SJS. Kikulu okumanya bino:

• Obulumi obw’amaanyi mu lususu: Okusooka, olususu lutandika okuluma.
• Omusujja: Olina omusujja.
• Obulumi bw’omubiri: Owulira ng’omubiri gwo gwonna gukuluma.
• Amabala oba ebitundu ebimyufu ku lususu: Amabala oba ebitundu ebimyufu birabika ku lususu.
• Okukolola.
• Ebizimba n’amabwa: Ebizimba n’amabwa tebiyinza kubaawo ku lususu lwokka, wabula ne ku nnywanto z’omubiri mu bifo ng’akamwa, emimiro, amaaso, ebitundu by’ekyama, n’omumwa gwa nnabaana. Teebereza, amabwa agali munda mu kamwa tegazibuwalira kulya kwokka wabula n’okwogera.
• Okusekula olususu: Olususu lusekula okuva mu bizimba.
• Okukulukuta: Olw’amabwa mu kamwa, amalusu gavaayo ng’otosobola kusiba kamwa.
• Okuzimba ebibikka by’amaaso: Ebizimba n’okuzimba mu maaso bivaako amaaso okuzimba ennyo ne gatasobola kugguka.
• Obulumi ng’ofulumya omusulo: Ebizimba mu bitundu by’omubiri ebiyitibwa mucous membranes bireeta obulumi obw’amaanyi ng’ofulumya omusulo.

Teebereza nti watandika eddagala eppya, era mu nnaku ntono n’owulira nga tolina bulungi, n’ofuna omusujja, n’okuluma, olwo amangu ago amabala amamyufu ne galabika ku lususu lwo ne wabaawo ebizimba... Wano w’osaanidde okutandika okuteebereza nti ono ye SJS.

Kiki ekivaako SJS?

Waliwo ebikulu ebiwerako ebivaako SJS:

• Allergic reaction to a drug: Kino kye kisinga okuvaako SJS ezisinga obungi n’abalwadde bonna TEN. Kino kiyinza okubaawo singa osubwa ddoozi y’eddagala ly’omira.
• Yinfekisoni: Okugeza yinfekisoni nga Mycoplasma pneumonia, Herpes virus, ne Hepatitis A.
• Obulwadde bwa Graft-versus-host: Eno mbeera eyinza okubaawo naddala oluvannyuma lw’okusimbuliza obusigo bw’amagumba.
• Tewali kivaako kizuuliddwa: Oluusi SJS esobola okukula nga tewali kivaako kyeyoleka.

Bw’oba ​​olina SJS olw’eddagala, obubonero butera okutandika okulabika mu wiiki emu, bbiri oba ssatu ng’omaze okutandika eddagala. Oyinza okutandika n’omusujja, okusesema n’okulumwa omutwe, n’oddako okusiiyibwa ku lususu n’okusekula. Mu bantu abamu abalina TEN, enviiri n’emisumaali biyinza n’okugwa. Tekitera nnyo, SJS ebadde etegeezebwa nti eva ku kugema okwakakolebwa.

Eddagala ki erisinga okuleeta SJS?

Waliwo eddagala erimu eririna obulabe obw’amaanyi obw’okuleeta SJS. Mu bino mulimu:

• Eddagala eritta obuwuka erya sulfa.
• Eddagala eriweweeza ku bulwadde bw’okusannyalala: Eby’okulabirako mulimu Phenytoin (Dilantin®), Carbamazepine (Tegretol®), Lamotrigine (Lamictal®), ne Phenobarbital (Luminal®).
• `(Allopurinol (Aloprim®, Zyloprim®))`: Lino ddagala erikozesebwa ku gaasi n’amayinja mu kibumba.
• Eddagala eriziyiza okuzimba eritali lya steroid (NSAIDs): Eby’okulabirako mulimu Piroxicam (Feldene®), Nevirapine (Viramune®), ne Diclofenac (Cambia®, Flector®).
• Eddagala eddala eritta obuwuka.

Ekikulu: Kino tekitegeeza nti buli muntu amira eddagala lino ajja kufuna SJS. Wabula eddagala lino lizuuliddwa nga likwatagana n’obulabe obw’okwongera okukwatibwa SJS.

Waliwo ensonga endala eyongera ku bulabe bw’okufuna SJS?

Yee, waliwo embeera endala eyongera ku bulabe bw’okufuna SJS. Bbo bali:

• Olw’okuba yasimbulizibwa obusigo bw’amagumba.
• Okubeera n’endwadde z’abaserikale b’omubiri nga `(Systemic lupus erythematosus - SLE)`.
• Obulwadde bw’akawuka ka siriimu mu bantu.
• Endwadde endala ezitawona ez’ennyondo n’ebitundu ebiyunga.
• Kookolo.
• Okubeera n’abaserikale b’omubiri abanafuye.
• Singa omuntu mu maka go eyasooka okulwala SJS (family history).
• Okubeera n'enjawulo y'obuzaale obw'enjawulo obuyitibwa ``Human Leukocyte Antigen-B - HLA-B''.

Abasawo bazuula batya embeera eno eya SJS?

Abasawo bazuula SJS ne TEN nga balowooza ku nsonga zino:

• Okukebera olususu olukoseddwa n’obuwuka obuyitibwa mucous membranes: Ebiseera ebisinga waakiri mucous membranes bbiri zikosebwa.
• Okusinziira ku ddaala ly’obulumi bw’owulira.
• Okusinziira ku ngeri olususu lwo gye lwakosebwa amangu.
• Okusinziira ku ngeri olususu lwo lwe lukosebwamu.
• Okukebera olususu: Oluusi, baggyibwako akatundu akatono ak’olususu ne keekebejjebwa mu microscope okukakasa nti obulwadde buzuuliddwa.

SJS ejjanjabwa etya ?

SJS mbeera eyeetaaga okuweebwa ekitanda mu ddwaaliro mu bwangu n’okujjanjabibwa. Okugezaako okubujjanjaba awaka kiyinza okwonoona embeera eno. Wammanga bwe bumu ku bujjanjabi:

• Amangu ago eddagala erilowoozebwa nti lye lireeta obuzibu: Kino kye kintu ekisooka okukola.
• Amazzi agayingira mu misuwa (IV) okuzzaawo amasannyalaze: Kino kikolebwa okufuga okufiirwa amazzi okuva mu mubiri ng’olususu lusekula.
• Okusiiga ebizigo ebitali bya kwesiiga ku lususu olukoseddwa.
• Okuwa emmere erimu kalori nnyingi okusobola okwanguya okuwona: Oluusi, kiyinza okwetaagisa okuliisa mu ttanka.
• Okugaba eddagala eritta obuwuka bwe kiba kyetaagisa okuziyiza okukwatibwa obuwuka.
• Okuwa eddagala eriweweeza ku bulumi.
• Obujjanjabi mu ddwaaliro, nga kiyinzika okuba mu Intensive Care Unit (ICU) oba Burn Unit.
• Okunoonya obuyambi okuva mu ttiimu z’abakugu nga Dermatology ne Ophthalmology (singa amaaso gakoseddwa).
• Mu mbeera ezimu, obujjanjabi obw’enjawulo nga IV immunoglobulin, cyclosporine, IV steroids, oba amniotic membrane grafts (eri amaaso) buyinza okuweebwa.

Bizibu ki ebiyinza okuva mu SJS?

Olw’okuba SJS ne TEN mbeera za maanyi, ebizibu biyinza okuba eby’amaanyi.

• Okufa: Kino kye kizibu ekisinga okuba eky’amaanyi. Abalwadde nga 10% abalina SJS ate nga 50% ku balwadde abalina TEN basobola okufa.
• Obulwadde bw’ekifuba.
• Sepsis: Buno bulwadde bwa bakitiriya obw’amaanyi, okufaananako n’obutwa mu musaayi.
• Embeera y'okukankana `(Okukankana)`.
• Okulemererwa kw’ebitundu by’omubiri ebingi.

Olw’ebizibu bino eby’amaanyi, embeera za SJS/TEN zeetaaga okuweebwa ekitanda mu ddwaaliro mu bwangu.

SJS esobola okuziyizibwa?

Mu butuufu, emirundi egisinga, SJS tesobola kuziyizibwa. Olw’okuba kitera okuva ku ngeri omuntu gy’akwatamu eddagala mu ngeri etasuubirwa, tewali ngeri yonna gy’oyinza kumanya oba kino kinaabaawo nga tonnamira ddagala.

Kyokka, bw’ozuulibwa ng’olina obulwadde obuva ku ddagala, ekisinga obukulu kwe butaddamu kukozesa ddagala eryo oba ekika ky’eddagala erifaananako bwe lityo. Kikulu nnyo okutegeeza omusawo wo ku nsonga eno n’okukiwandiika mu biwandiiko byo eby’obujjanjabi.

Endowooza etya eri omuntu alina SJS? (Endowooza)

Si buli muntu alina SJS nti afuna obubonero bwe bumu. Abantu abamu bawona mu wiiki ntono. Kyokka singa obubonero buba bwa maanyi, kiyinza okutwala emyezi okuwona mu bujjuvu. Abantu abamu bayinza okufuna ebizibu eby’ekiseera ekiwanvu. Okugeza nga:

• Olususu: Olususu olukalu, okusiiwa, olususu okukyuka langi.
• Amaaso: Okuzimba ennyo ne/oba okukala, okuzimba amaaso emirundi mingi, okulaba obubi, okuwulira ekitangaala (photophobia).
• Okutuuyana ekisusse.
• Okwonooneka kw’amawuggwe: Embeera nga obulwadde bw’amawuggwe obutawona (COPD), asima.
• Emisumaali okugwa oba okufuuka ekifu.
• Okugwa kw’enviiri (Alopecia).
• Okukala kw’obusimu obuyitibwa mucous membranes: Kino kiyinza okuvaako ebintu ng’okukaluubirirwa okufulumya omusulo.
• Obulwadde bw’obukoowu obutawona.
• Enkyukakyuka mu buwoomi.

Ekikulu, obulwadde buno busobola okuddamu singa omuntu addamu okukwatibwa eddagala eryaleeta SJS mu kusooka. Ekyo bwe kibaawo, obubonero butera okubeera obw’amaanyi omulundi ogw’okubiri.

Ebitundu nga 10% ku balwadde ba SJS ne 30% ku balwadde ba TEN bafa, okusinga olw’obulwadde bwa sepsis, acute respiratory distress syndrome (ARDS), n’okulemererwa kw’ebitundu by’omubiri ebingi.

Bino bye bimu ku bintu by’osaanidde okujjukira okusinziira ku bye twogeddeko (Take-Home Message):

Okay, kale twogedde nnyo ku mbeera eno ey'akabi eyitibwa SJS. Bino bye bimu ku bintu by’olina okujjukira:

• Obulwadde bwa Stevens-Johnson Syndrome (SJS) ne Toxic Epidermal Necrolysis (TEN) buzibu nnyo, n’okutuuka n’okutta obulamu bw’olususu.
• Bw’ofuna obubonero ng’okulumwa olususu, amabala amamyufu, ebizimba, okusekula olususu, oba amabwa mu kamwa oba amaaso ng’omaze okutandika eddagala eppya naddala mu wiiki emu oba bbiri, genda mangu omusawo amagezi. Kiyinza okuba nga kya SJS.
• Bulijjo tegeeza omusawo wo bw’oba ​​obaddeko alergy oba obuzibu obw’amaanyi ku ddagala.
• Toddamu kukozesa ddagala oba eddagala erifaananako bwe lityo erizuuliddwa nti lireeta SJS .**
• Bw’oba ​​oteebereza embeera eno, tosigala waka, genda mu ddwaaliro mu bwangu. Obujjanjabi obw’amangu busobola okutaasa obulamu bwo.

Nsuubira nti amawulire gano ga mugaso gy’oli. Sigala nga oli mulamu bulungi!

` Stevens-Johnson Syndrome, SJS, Toxic Epidermal Necrolysis, TEN, Endwadde z’olususu, Alergy, Ebizibu by’eddagala, Ebizimba, Ebizimba ku lususu, Endwadde z’olususu