Ingaba ulusu lwakho lujika lube bomvu ngequbuliso, lube namadyungudyungu, luze luqhekeke? Masifunde ngale Stevens-Johnson Syndrome (SJS) iyingozi?

Ngaba wakha wayibona, okanye yakha yenzeka kuwe, irhashalala emzimbeni wakho ejika ibe bomvu, ibonakale ngathi yirhashalala, emva koko kuvela amadyungudyungu kwaye ulusu luqhekeke? Ezi zilonda zinokuvela nangaphakathi emlonyeni, emehlweni, nakwindawo yangasese. Le ayisiyonto ilula, kwaye inokuba yimeko enzima efuna ukulaliswa esibhedlele ngokukhawuleza . Namhlanje, siza kuthetha ngale meko ibizwa ngokuba yiStevens-Johnson Syndrome (SJS).

Yintoni iStevens-Johnson Syndrome (SJS)?

Ngamafutshane, iStevens-Johnson Syndrome (SJS) kunye neToxic Epidermal Necrolysis (TEN) zizifo ezimbini eziyingozi kakhulu zesikhumba. Okwenzekayo kukuba ulusu lwakho luqala ngequbuliso ukuba namaqhuma abomvu, arhawuzelelayo, aze emva koko aqhekeke aze aqhekeke. Oku kunokuchaphazela namehlo akho, amalungu esini, kunye ne-mucous membranes emlonyeni wakho. Ukuba uhlangabezana nezi meko, ngokuqinisekileyo kuya kufuneka ulaliswe esibhedlele ukuze ufumane unyango.

Abanye oogqirha bacinga ukuba i-SJS kunye ne-TEN zizifo ezimbini ezahlukeneyo, ngelixa abanye besithi ziinqanaba ezahlukeneyo zesifo esinye. I-SJS luhlobo lwesifo olungenzima kangako kune-TEN. Umzekelo, kwi-SJS, ngaphantsi kwe-10% yolusu emzimbeni wonke inokulahleka. Kwi-TEN, ngaphezulu kwe-30% yolusu inokulahleka. Nangona kunjalo, kubalulekile ukukhumbula ukuba zombini ezi meko zinokuba yingozi ebomini .

Ngawaphi amanye amagama anawo i-SJS?

Ewe, oku kubizwa ngamanye amagama aliqela. Umzekelo:

• Isifo sikaLyell
• Isifo sikaStevens-Johnson/i-toxic epidermal necrolysis
• Isifo sikaStevens-Johnson esinobuthi kwi-epidermal necrolysis spectrum

Ngamanye amaxesha, igama liyatshintsha ngokuxhomekeke kwisizathu. Ukuba ibangelwa liyeza elithile, ingabizwa ngokuba yi-"drug-induced Stevens-Johnson syndrome", kwaye ukuba ibangelwa lusulelo olubizwa ngokuba yi-"Mycoplasma", ingabizwa ngokuba yi-"mycoplasma-induced Stevens-Johnson syndrome".

Ngubani onokuba nethuba elingcono lokuphuhlisa i-SJS?

I-SJS idla ngokubonakala kubantu abancinci abangaphantsi kweminyaka engama-30 ubudala nakubantwana abancinci. Nangona kunjalo, inokwenzeka nakubantu banoma yiphi na iminyaka, ingakumbi abantu abadala. Abafazi banamathuba amaninzi okufumana i-SJS kunamadoda.

Khawucinge nje, ukuba umntwana omncinci ufumana usulelo olufana ne-pneumonia aze abe nengxaki yolusu efana nale... isenokuba yi-SJS. Isizathu esiphambili se-SJS ebantwaneni zizifo ezifana ne-pneumonia. Kodwa kubantu abadala, i-SJS/TEN ibangelwa kakhulu ngamayeza abawasebenzisayo.

Ziziphi izinto ezibangela umngcipheko wokuphuhlisa i-SJS?

Akukho sizathu sinye sesi sifo, kodwa yindibaniselwano yezinto. Eyona nto ibalulekileyo kwezi kukuthanda kwezakhi zofuzo. Oko kukuthi, izakhi zofuzo zakho zinokuba nefuthe elithile. Ezinye izinto ezingqongileyo nazo zinokuvuselela ezo zakhi zofuzo. Enye yezi zinto zezakhi zofuzo ziindawo ezikhethekileyo zomzimba wethu ezibizwa ngokuba yi-`(Human Leukocyte Antigens - HLAs). Abantu abaneentlobo ezithile zezi `(HLAs)` basengozini enkulu yokuphuhlisa i-SJS okanye i-TEN kunezinye.

Zithini iimpawu ze-SJS?

Kukho iimpawu ezininzi ezinokubakho kwi-SJS. Kubalulekile ukuzazi ezi:

• Intlungu ebuhlungu eluswini: Okokuqala, ulusu luqala ukuba buhlungu.
• Umkhuhlane: Unomkhuhlane.
• Intlungu yomzimba: Ivakala ngathi umzimba wakho wonke ubuhlungu.
• Amabala abomvu okanye amabala eluswini: Amabala abomvu okanye amabala avela eluswini.
• Ukukhwehlela.
• Amaqhuqhuva kunye nezilonda: Amaqhuqhuva kunye nezilonda azinakwenzeka kuphela eluswini, kodwa nakwiinwebu ezingaphakathi kwiindawo ezifana nomlomo, umphimbo, amehlo, amalungu esini, kunye ne-rectum. Khawuthelekelele, izilonda ngaphakathi emlonyeni zenza kube nzima kungekuphela nje ukutya kodwa nokuthetha.
• Ukuxobuka kwesikhumba: Ulusu luyaxobuka kwiimpumlo.
• Ukuvuza amathe: Ngenxa yezilonda emlonyeni, amathe ayaphuma xa ungakwazi ukuwuvala umlomo wakho.
• Ukudumba kwamehlo: Amaqhuqhuva kunye nokudumba kwamehlo kubangela ukuba amehlo adumbe kangangokuba angakwazi ukuvulwa.
• Intlungu ngexesha lokuchama: Amaqhuqhuva kwi-mucous membranes abangela iintlungu eziqatha ngexesha lokuchama.

Khawuthelekelele ukuba uqalise amayeza amatsha, kwaye kwiintsuku ezimbalwa uzive ungaphilanga kakuhle, unomkhuhlane, kwaye uneentlungu, uze ngequbuliso uvele amabala abomvu eluswini lwakho kwaye kuvela amadyungudyungu... Kulapho ke kufuneka uqale ukurhanela ukuba le yi-SJS.

Yintoni ebangela i-SJS?

Kukho izizathu ezininzi eziphambili ze-SJS:

• Ukusabela kwi-allergy kwiyeza: Le yeyona nto ibangela uninzi lwe-SJS kunye nazo zonke iimeko ze-TEN. Oku kunokwenzeka ukuba uphoswe yidosi yeyeza olisebenzisayo.
• Iintsholongwane: Umzekelo, izifo ezifana neMycoplasma pneumonia, iHerpes virus, kunye neHepatitis A.
• Isifo se-graft-versus-host: Esi sisifo esinokwenzeka, ingakumbi emva kokufakelwa umongo wethambo.
• Akukho sizathu sifunyenweyo: Ngamanye amaxesha i-SJS inokukhula ngaphandle kwesizathu esicacileyo.

Ukuba une-SJS ngenxa yeyeza, iimpawu zihlala ziqala ukubonakala kwiveki enye, ezimbini, okanye ezintathu emva kokuqala iyeza. Ungaqala ngomkhuhlane, ukukhwehlela, kunye nentloko ebuhlungu, kulandele ukurhawuzelela kwesikhumba kunye nokuxobuka. Kwabanye abantu abane-TEN, iinwele kunye neenzipho zinokuwa. Kunqabile kakhulu, i-SJS ibikwe ukuba ibangelwa kukugonywa kutshanje.

Ngawaphi amayeza anokubangela i-SJS?

Kukho amayeza athile anomngcipheko omkhulu wokubangela i-SJS. La aquka:

• Amayeza e-sulfa alwa neentsholongwane.
• Amayeza okulwa nesifo sokuwa: Imizekelo iquka iPhenytoin (Dilantin®), iCarbamazepine (Tegretol®), iLamotrigine (Lamictal®), kunye nePhenobarbital (Luminal®).
• `(I-Allopurinol (Aloprim®, iZyloprim®))`: Eli liyeza elisetyenziselwa i-gout kunye namatye ezintso.
• Amayeza angengowe-steroidal alwa nokuvuvukala (ii-NSAID): Imizekelo ibandakanya iPiroxicam (iFeldene®), iNevirapine (iViramune®), kunye neDiclofenac (iCambia®, iFlector®).
• Amanye amayeza okubulala iintsholongwane.

Kubalulekile: Oku akuthethi ukuba wonke umntu osela la mayeza uza kuba ne-SJS. Nangona kunjalo, la mayeza afunyenwe enxulumene nomngcipheko okhulayo wokufumana i-SJS.

Ngaba kukho ezinye izinto ezibangela umngcipheko wokufumana i-SJS?

Ewe, kukho ezinye iimeko ezonyusa umngcipheko wokufumana i-SJS. Nazi:

• Emva kokuba ndifakelwe umongo wethambo.
• Ukuba nezifo zokuzikhusela komzimba ezifana ne-`(Systemic lupus erythematosus - SLE)`.
• Usulelo lwentsholongwane yokungakwazi ukuzikhusela komzimba (i-HIV).
• Ezinye izifo ezingapheliyo zamalungu kunye nezicubu ezidibeneyo.
• Umhlaza.
• Ukuba nenkqubo yomzimba yokuzikhusela ebuthathaka.
• Ukuba kukho umntu kusapho lwakho okhe waba ne-SJS (imbali yosapho).
• Ukuba nohlobo oluthile lwejini ethile ebizwa ngokuba yi-``Human Leukocyte Antigen-B - HLA-B''.

Oogqirha bayixilonga njani le meko ye-SJS?

Oogqirha baxilonga i-SJS kunye ne-TEN ngokuqwalasela ezi zinto:

• Ukuhlolwa kolusu oluchaphazelekayo kunye neenwebu ze-mucous: Ngokwesiqhelo ubuncinane iinwebu ze-mucous ezimbini ziyachaphazeleka.
• Kuxhomekeke kwinqanaba lentlungu oyivayo.
• Kuxhomekeke ekubeni ulusu lwakho luchaphazeleke ngokukhawuleza kangakanani.
• Kuxhomekeke ekubeni ulusu lwakho luchaphazeleke kangakanani.
• I-biopsy yolusu: Ngamanye amaxesha, kuthathwa isampulu encinci yolusu ize ihlolwe phantsi kwemakroskopu ukuqinisekisa ukuxilongwa.

Iphathwa njani i-SJS?

I-SJS yimeko efuna ukulaliswa esibhedlele ngokukhawuleza kunye nonyango. Ukuzama ukuyinyanga ekhaya kunokuyenza imeko ibe mandundu. Nazi ezinye zeendlela zonyango:

• Yeka ngoko nangoko amayeza ekucingelwa ukuba abangela ingxaki: Le yinto yokuqala ekufuneka uyenze.
• Ulwelo olufakwa kwimithambo yegazi (IV) ukubuyisela ii-electrolytes: Oku kwenzelwa ukulawula ukulahleka kolwelo emzimbeni njengoko ulusu lukhula.
• Ukufaka iibhanti ezinganamatheliyo kulusu oluchaphazelekayo.
• Ukumnika ukutya okuneekhalori eziphezulu ukuze akhawulezise ukuchacha: Ngamanye amaxesha, ukumnika ukutya ngetyhubhu kusenokufuneka.
• Ukunika amayeza okubulala iintsholongwane ukuba kuyimfuneko ukuthintela usulelo.
• Ukunika amayeza okudambisa iintlungu.
• Unyango esibhedlele, mhlawumbi kwiYunithi yoKhathalelo oluPhezulu (ICU) okanye kwiYunithi yokuTsha.
• Ukufuna uncedo kumaqela eengcali afana neDermatology kunye neOphthalmology (ukuba amehlo achaphazelekile).
• Kwezinye iimeko, unyango oluthile olufana ne-IV immunoglobulin, i-cyclosporine, i-IV steroids, okanye i-amniotic membrane grafts (yamehlo) lunokunikwa.

Ziziphi iingxaki ezinokubakho ze-SJS?

Ngenxa yokuba i-SJS kunye ne-TEN ziimeko ezinzima, iingxaki zinokuba nzima kakhulu.

• Ukufa: Le yeyona ngxaki inzima kakhulu. Malunga ne-10% yezigulana ezine-SJS kunye malunga ne-50% yezigulana ezine-TEN zinokufa.
• Ukukrala kwemiphunga.
• I-Sepsis: Olu luhlobo losulelo oluyingozi kakhulu olubangelwa yintsholongwane, olufana nokutyhefa igazi.
• Imeko yokothuka `(Ukothuka)`.
• Ukungasebenzi kakuhle kwamalungu amaninzi.

Kungenxa yezi ngxaki zinzima ezenza ukuba iimeko ze-SJS/TEN zifune ukulaliswa esibhedlele ngokukhawuleza.

Ngaba i-SJS ingathintelwa?

Enyanisweni, kwiimeko ezininzi, i-SJS ayinakuthintelwa. Ngenxa yokuba idla ngokubangelwa kukusabela okungalindelekanga kumayeza, akukho ndlela yokwazi ukuba oku kuya kwenzeka ngaphambi kokuba uthathe amayeza.

Nangona kunjalo, ukuba ufunyaniswe unemeko ebangelwa liyeza, eyona nto ibalulekileyo kukuba ungaze uphinde usebenzise elo yeza okanye olunye uhlobo lwamayeza afanayo. Kubaluleke kakhulu ukwazisa ugqirha wakho ngale nto kwaye uyibhale kwiirekhodi zakho zonyango.

Injani imbono yomntu one-SJS? (Imbono)

Ayingabo bonke abantu abane-SJS abafumana iimpawu ezifanayo. Abanye abantu bayaphila kwiiveki ezimbalwa. Nangona kunjalo, ukuba iimpawu zinzima, kungathatha iinyanga ukuba baphile ngokupheleleyo. Abanye abantu banokufumana iziphumo zexesha elide. Umzekelo:

• Ulusu: Ulusu olomileyo, ukurhawuzelela, ukutshintsha kombala wolusu.
• Amehlo: Ukudumba rhoqo kunye/okanye ukoma, ukudumba rhoqo kwamehlo, ukubona okufipheleyo, ukungakwazi ukubona ukukhanya (photophobia).
• Ukubila okugqithisileyo.
• Ukonakala kwemiphunga: Iimeko ezifana nesifo esingapheliyo sokuvaleka kwemiphunga (COPD), i-asthma.
• Izipikili ziyawa okanye ziyaguquguquka.
• Ukulahleka kweenwele (i-Alopecia).
• Ukoma kwe-mucous membranes: Oku kunokubangela ubunzima bokuchama.
• Isifo sokudinwa okungapheliyo.
• Utshintsho kwincasa.

Okubalulekileyo kukuba, esi sifo sinokuphinda sibuye ukuba umntu uphinde wachatshazelwa liyeza elabangela i-SJS kwasekuqaleni. Ukuba oko kuyenzeka, iimpawu zihlala zinzima ngakumbi okwesibini.

Malunga ne-10% yezigulana ze-SJS kunye ne-30% yezigulana ze-TEN ziyafa, ikakhulu ngenxa ye-sepsis, i-acute respiratory distress syndrome (ARDS), kunye nokusilela kwamalungu amaninzi omzimba.

Nazi ezinye izinto ekufuneka uzikhumbule kwinto esithethe ngayo (Umyalezo Wokubuyela Ekhaya):

Kulungile, ngoko ke sithethe kakhulu ngale meko iyingozi ebizwa ngokuba yi-SJS. Nazi ezinye izinto ekufuneka uzikhumbule:

• I-Stevens-Johnson Syndrome (SJS) kunye ne-Toxic Epidermal Necrolysis (TEN) zizinto ezinobungozi kakhulu, zide zibeke ubomi esichengeni.
• Ukuba ufumanisa iimpawu ezifana neentlungu zesikhumba, amabala abomvu, amadyungudyungu, ulusu oluxobukayo, okanye izilonda zomlomo okanye zamehlo emva kokuqala iyeza elitsha, ingakumbi kwiveki enye okanye ezimbini, funa ingcebiso kagqirha ngoko nangoko. Isenokuba yi-SJS.
• Soloko uxelela ugqirha wakho ukuba ukhe waba ne-allergy okanye uneempendulo ezimbi kakhulu kumayeza ngaphambili.
• Ungaze usebenzise iyeza okanye amayeza afanayo afunyenwe ebangela i-SJS kwakhona.**
• Ukuba urhanela ukuba le meko inokwenzeka, musa ukuhlala ekhaya, yiya esibhedlele ngoko nangoko. Unyango olukhawulezileyo lunokusindisa ubomi bakho.

Ndiyathemba ukuba olu lwazi luluncedo kuwe. Hlala usempilweni!

Isifo sikaStevens -Johnson, i-SJS, i-Toxic Epidermal Necrolysis, i-TEN, Izifo zolusu, ii-Allergies, Iziphumo ebezingalindelekanga zamayeza, iiBlisters, ukurhawuzelela kolusu, Izifo zesikhumba