Tekereza ko utangiye gufata umuti mushya w’indwara runaka. Nyuma y’icyumweru kimwe cyangwa bibiri, wumva utameze neza, nk’aho ugiye gufatwa n’ibicurane. Umubiri wawe urababara, ukumva ufite umuriro, uratitira ... Hanyuma mu buryo butunguranye, umubiri wawe utangira kugaragaramo uduce dutukura duhinduka udusebe tw’amazi, maze uruhu rwawe rutangira gushwanyuka nk’aho wahiye. Iyi ni indwara iteye ubwoba cyane, ibabaza, kandi ishobora gushyira ubuzima mu kaga. Uyu munsi turimo kuvuga kuri iyi ndwara iteje akaga, ari yo Toxic Epidermal Necrolysis (TEN) .
Mu magambo make, ni iki cyitwa Toxic Epidermal Necrolysis (TEN)?
Mu magambo make, uruhu rubabaza cyane kandi rushobora gushyira ubuzima mu kaga. Rutera uduheri n'uduheri mu bice binini by'umubiri wawe, akenshi byibuze 30% by'umubiri wawe. Uku gushibuka gushobora no kubaho mu bice bifite uturemangingo, nko mu kanwa, mu maso no mu myanya ndangagitsina.
Iyi ndwara iteje akaga ikunze kubaho bitewe n’ingaruka zikomeye ku miti imwe n’imwe dufata. Iyo uruhu rwangiritse cyane, hari ibyago byinshi byo kubura amazi mu mubiri no kwandura indwara zikomeye.
Mu by’ukuri, TEN ni yo ndwara ikomeye cyane y’indi ndwara y’uruhu yitwa Stevens-Johnson syndrome (SJS). Muri SJS, munsi ya 10% by’uruhu rw’umubiri rucika. Iyo 10% kugeza kuri 30% by’umubiri byafashwe n’iyi ndwara, tuyita SJS-TEN ihurirana. Iyo uruhu rurenga 30% rucitse, bifatwa nka TEN.
Ni nde uri mu kaga gakomeye ko kurwara iyi ndwara?
Abantu bafite ubudahangarwa bw'umubiri budakomeye bafite amahirwe menshi yo kurwara indwara ya Stevens-Johnson syndrome (SJS) cyangwa TEN. Hari impamvu nyinshi zishobora gutuma ubudahangarwa bw'umubiri bugabanuka.
- Abantu banduye virusi itera SIDA (HIV).
- Abantu bafite kanseri zimwe na zimwe, nka lymphoma.
Byongeye kandi, ibintu bigize imiterere y’uturemangingo nabyo bishobora kugira uruhare. Imibiri ya bamwe ntibashobora kwangirika no guhindura imiti imwe n’imwe mu buryo busanzwe. Ibi ni ibintu bituruka ku ngirabuzimafatizo zabo. Muri ibyo bihe, iyo miti ishobora kwirundanya mu mubiri igatera ingaruka zikomeye nka SJS cyangwa TEN. Nanone, bitewe n’impinduka (mutations) muri ngirabuzimafatizo zimwe na zimwe, bamwe mu bantu bashobora kugira ingaruka ku miti imwe n’imwe.
Nubwo TEN ishobora kubaho mu myaka iyo ari yo yose, ikunze kugaragara ku bantu bakuze. Ariko, ni indwara idakunze kugaragara .Ni ngombwa kwibuka ko ku isi yose, SJS na TEN byose hamwe bigira ingaruka ku bantu bagera kuri miliyoni imwe cyangwa ebyiri gusa ku mwaka.
Ni izihe mpamvu nyamukuru zitera TEN?
Kenshi na kenshi, abaganga bizera ko imiti imwe n'imwe ari yo itera TEN. Reka turebere hamwe imiti iri mu kaga gakomeye.
| Icyiciro cy'ibiyobyabwenge | Ibisobanuro byoroshye |
|---|---|
| Allopurinol | Umuti ukoreshwa mu kuvura indwara nka amabuye mu mpyiko na goutte. |
| Imiti igabanya ububabare | Ubwoko bw'imiti ihabwa abantu kugira ngo barwanye indwara nk'ibicurane. |
| Imiti igabanya ubukana bwa virusi itera SIDA | Cyane cyane imiti ikoreshwa mu kuvura ubwandu bwa virusi itera SIDA (urugero: nevirapine). |
| Oxicams | Iyi ni ubwoko bw'imiti igabanya ububabare n'imiti igabanya ububabare iri mu itsinda rya NSAID. |
| Sulfonamides | Iyi ni ubwoko bw'imiti ivura udukoko. |
Uretse iyi miti, ni gake cyane, indwara zimwe na zimwe cyangwa inkingo zishobora gutera TEN. Ariko ibi ni gake cyane. Hari igihe icyateye TEN kitaboneka.
Ni ibihe bimenyetso bya TEN?
Ibimenyetso icumi bikunze kugaragara mu byumweru bike uhereye igihe utangiye imiti mishya. Bitangirana n'ibimenyetso bisa n'ibicurane.
- Ububabare bw'umubiri
- Inkorora
- Umuriro n'ubukonje
- Umutwe
- Gutukura no kubyimba kw'amaso
Nyuma y'ibi bimenyetso bya mbere, ibisebe bitukura bibabaza (uduheri) bitangira kugaragara ku ruhu. Ibi bibara bigenda byiyongera buhoro buhoro, bigahinduka uduheri twuzuye amazi, amaherezo uruhu rutangira gushwanyuka. Ibikomere bivuka iyo uruhu rushwanyutse byitwa erosions . Ibi ni ibikomere bibabaza cyane, bifunguye bisa n'ubushye bukomeye.
Ibi bikomere bibanza kugaragara mu maso no mu gituza, hanyuma bigakwirakwira no mu bindi bice by'umubiri.
- Amaso: Imbere mu jisho (conjunctiva) n'inyuma mu jisho ry'umukara (cornea) bishobora kwangirika.
- Uduce tw'imikaya: Ibisebe bishobora kugaragara mu kanwa, mu mazuru, mu muhogo no mu nzira z'ubuhumekero.
- Uduce tw'inkari, ikibuno n'imyanya ndangagitsina: Utwo duce natwo dushobora gukomereka cyane.
Izi mvune zituma n'imirimo yoroshye nko kurya, kumira, guhumeka, gufunga amaso no kunyara bibabaza cyane kandi bikagorana.
Ingorane zikomeye zishobora guterwa na TEN
TEN si ikibazo cyo gufatwa nk'ikintu cyoroshye. Gishobora gutera ingorane zikomeye kandi zishobora gushyira ubuzima mu kaga.
- Kwandura indwara: Iyo uruhu rwangiritse, hari amahirwe menshi ko mikorobe zinjira mu mubiri. Iyo izi mikorobe zinjiye mu maraso, indwara ikomeye cyane yitwa sepsis ishobora kubaho.
- Kunanirwa kw'ingingo nyinshi: Kubyimba gukabije no kwandura indwara mu mubiri bishobora gutuma ingingo z'imbere nk'impyiko, umwijima n'ibihaha binanirwa gukora.
- Umusonga: Hari ibyago byinshi byo kwandura ibihaha bitewe n'ibikomere mu nzira y'ubuhumekero.
Kubera ko bishobora gutera ingorane zikomeye nk'izo, umuntu ufite ibimenyetso bya TEN agomba kujya mu bitaro agahita avurwa .
Ni gute abaganga basuzuma iyi ndwara?
Ubusanzwe umuganga w’inzobere ashobora gusuzuma TEN asuzuma uruhu rwawe akanakubaza ibimenyetso byarwo. Hari igihe biba ngombwa ko hakorwa isuzuma ry’uruhu kugira ngo hemezwe ko ari indwara.
Ibi bikubiyemo gufata agace gato cyane k'uruhu kavuye ku gisebe cy'uruhu hakoreshejwe ikinya hanyuma ukagasuzuma ukoresheje mikorosikopi. Iki kizamini gishobora kwerekana neza niba hari uturemangingo tw'uruhu twapfuye (uturemangingo twa necrotic) ndetse niba urwego rwo hejuru rw'uruhu (epidermis) rwaratandukanye n'urwego rwo hasi.
Ni ubuhe buryo bwo kuvura ibi?
Icy'ingenzi kurushaho, TEN ni ikibazo cyihutirwa cy'ubuvuzi.Iyi si indwara ishobora kuvurirwa mu rugo. Ugomba kujya mu bitaro byihutirwa (ETU) vuba vuba ibimenyetso bikimara gutangira.
Mu bitaro, umurwayi akunze kwakirwa mu cyumba cy’indembe (ICU) cyangwa ikigo cy’ubushye, kuko aba barwayi bakeneye ubuvuzi bwihariye nk’ubwo buhabwa umurwayi wahiye.
Uburyo bwo kuvura bushobora kugabanywamo ibice bibiri by'ingenzi.
| Uburyo bwo kuvura TEN | |
|---|---|
| Kuvurwa ako kanya | |
| Guhagarika umuti utera indwara | Imiti yose ikekwaho gutera TEN ihita ihagarikwa. |
| Kugenzura urugero rw'amazi mu mubiri | Gukura uruhu bituma amazi menshi ava mu mubiri. Kubwibyo, amazi ya saline (IV fluids) atangwa binyuze mu mitsi kugira ngo agenzure urugero rw'amazi mu mubiri. |
| Kwirinda kwandura | Amavuta yo kwisiga cyangwa amavuta yo kwisiga akoreshwa mu kwica udukoko ashyirwa ku bikomere bifunguye. Imiti igabanya ubukana itangwa iyo hagaragaye ibimenyetso bya mbere by'ubwandu. |
| Ubundi buryo bwihariye bwo kuvura | |
| Globulin y'ubudahangarwa bw'umubiri (IVIG) | Iyi ni amazi atangwa binyuze mu mutsi. Irimo uturemangingo twakuwe mu maraso y'abantu bazima. Ibi bifasha mu kugenzura uburyo ubudahangarwa bw'umubiri butera ingaruka mbi. |
| Imiti igabanya ubudahangarwa bw'umubiri | Imiti itangwa kugira ngo ihagarike ubudahangarwa bw'umubiri kwibasira uturemangingo twawo, bigatuma imikorere yabwo igabanuka. |
| Plasmapheresis | Ibi bikubiyemo kohereza amaraso y'umurwayi mu mashini yihariye, gutandukanya no gukuraho uturemangingo twangiza mu maraso, no gusubiza amaraso yeze mu mubiri. |
Ingaruka z'igihe kirekire nyuma yo gukira
Abarokotse TEN bashobora kugira ingaruka z'igihe kirekire. Nubwo uruhu rwakira burundu, hari n'ibindi bibazo bishobora kuvuka.
- Uruhu, umusatsi n'inzara: gukura cyangwa gutakaza inzara ku buryo budasanzwe, uduheri tw'uruhu (umukara cyangwa umweru), gutakaza umusatsi mu bice bimwe na bimwe (alopecia areata), uruhu rwumye kandi rushyuha, ibyuya byinshi.
- Amaso: Kubyimba cyangwa gutukura kw'amaso igihe kirekire, amaso yumye, indwara z'amaso zidasanzwe, kumva urumuri, kutabona neza cyangwa, gake cyane, ubuhumyi.
- Mu kanwa, mu mazuru no mu myanya y'ubuhumekero: Bronchite, indwara z'ibihaha nka COPD, umunwa wumye, indwara y'ishinya, kubura uburyohe n'impumuro, kwangirika kw'ibihaha.
- Uruhu rw'inkari n'urw'imyororokere: Gukomereka cyangwa kubyimba k'umuyoboro w'inkari, imboro, cyangwa igitsina, kugorwa no kunyara, kuma k'umuyoboro w'inkari ku bagore.
Ni ingenzi cyane kuganira na muganga wawe ku ngaruka z'igihe kirekire no gushaka ubuvuzi bukenewe.
Ubutumwa bwo kujyana mu rugo
- Indwara ya TEN (Toxic Epidermal Necrolysis) ni ingaruka mbi cyane ku miti imwe n'imwe, ishobora gushyira ubuzima mu kaga.
- Bitangirana n'ibimenyetso bisanzwe nk'umuriro n'ububabare bw'umubiri, ariko hanyuma bigatera udusebe tubabaza n'ubushye butuma uruhu rucika.
- Iki ni ikibazo cyihutirwa cy’ubuvuzi. Niba ubonye ibi bimenyetso, ugomba guhita ujya mu bitaro by’ibitaro bivura ibibazo byihutirwa (ETU).
- Niba ugize uduheri ku ruhu, uduheri, cyangwa ibindi bimenyetso bidasanzwe nyuma yo gutangira umuti mushya, ntukirengagize. Shaka muganga wawe ako kanya.
- Niba warigeze kugira ubwivumbure ku miti iyo ari yo yose, menya neza ko ubimenyesha muganga wawe igihe cyose ugiye gufata imiti.
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