I-Stevens-Johnson syndrome (i-SJS) idlalwa njengoluhlobo olunzulu lwe-erythema multiforme, eyona yinto efana neyayimpendulo ye-hypersensitive to a drug, kuquka ne-anti-counter-counter-drug, okanye isifo, njenge-herpes okanye ihamba nge-pneumonia kubangelwa yiMycoplasma pneumoniae .
Ezinye iingcali zicinga ngesifo seStevens-Johnson njengesimo esahlukileyo ukusuka kwi-erythema multiform, ekwahluleni ukwahlula kwi-erythema ye-multiform encinci kunye neefrime ezininzi zeefom.
Ukwenza izinto zidideke ngakumbi, kukho uhlobo olubi lwe-Stevens-Johnson syndrome: I-Toxic Epidermal Necrolysis (TEN), eyaziwa nangokuthi yi-Lyell's Syndrome.
Stevens-Johnson Syndrome
Abantwana ababini, uAlbert Mason Stevens noFrank Chambliss Johnson, bafumana isifo sikaStevens-Johnson ngowe-1922. I-Stevens-Johnson syndrome ingasongela ubomi kwaye ingabangela iimpawu ezinzulu, ezinjenge-blisters ezinkulu kunye nokuchithwa kwesikhumba somntwana.
Isifo seStevens-Johnson senzeke ngesiganeko sama-1.5 ukuya kwe-2 amatyala abantu abayizigidi ngamnye ngonyaka, ngoko akunakwenzeka. Ngelishwa, malunga neepesenti ezi-5 zabantu abane-syndrome ye-Stevens-Johnson kunye neepesenti ezingama-30 kunye ne- Toxic Epidermal Necrolysis baneempawu ezinzima kangangokuthi ababuyisanga.
Abantwana banoma yiphina ubudala kunye nabadala banokuchaphazeleka yi-Stevens-Johnson syndrome, nangona abantu abangenakho ukuxilongwa, njengokuba bane-HIV , banokubeka engozini.
Iimpawu zeStevens-Johnson Syndrome
I-stvens-Johnson syndrome ngokuqhelekileyo iqala ngeempawu ezinjengomkhuhlane , ezifana nomkhuhlane, umkhuhlane kunye nokukhwehlela. Emva koko, iintsuku ezi-1 ukuya kwezi-3 kamva, umntwana ophethe isifo seStevens-Johnson uya kuphuhlisa:
- ukuvutha komlilo emlonyeni, ngaphakathi kwezihlathi zabo (buccal mucosa), kunye namaso
- ukukhwabanisa okubomvu, okungaba namaziko amnyama, okanye ukukhula kube ngamabhanti
- ukuvuvukala ubuso, iinkophe, kunye / okanye ulwimi
- obomvu, amehlo egazi
- uvakalelo ekukhanyeni (photophobia)
- izilonda ezibuhlungu okanye imilomo emlonyeni, impumlo, amehlo kunye ne-genital mucosa, ezinokubangela ukuba
Iingxaki ze-Stevens-Johnson syndrome zingabandakanywa isilonda esiswini kunye nobumfama, i-pneumonitis, i-myocarditis, i-hepatitis, i-hematuria, ukungaphumeleli kwezintso kunye ne-sepsis.
Isibonakaliso esihle se-Nikolsky, apho iindawo eziphezulu zesikhumba somntwana ziphuma xa zihluthwe, luphawu lwe-Stevens-Johnson syndrome enamandla okanye ukuba luye lwavela kwi-Toxic Epidermal Necrolysis.
Umntwana ukwahlulwa njenge-Toxic Epidermal Necrolysis ukuba anama-30 engama-30 ekhulwini le-epidermal (isikhumba).
Izizathu zeStevens-Johnson Syndrome
Nangona amayeza angaphezu kwama-200 angabangela okanye angabangela isifo seStevens-Johnson, eziqhelekileyo ziquka:
- i-anticonbulsants (ukuhluthwa okanye ukunyanga), kuquka neTegretol (Carbamazepine), i-Dilantin (iPhenytoin), i-Phenobarbital, i-Depakote (iValproic Acid) kunye neLamictal (iLamotrigine)
- i-sulfonamide antibiotics, njengeBactrim (Trimethoprim / Sulfamethoxazole), esetyenziswa rhoqo ekuphatheni i-UTIs ne- MRSA
- i-beta-lactam antibiotics, kuquka i- penicillins kunye ne-cephalosporins
- izidakamizwa ezichasayo ezingabhubhisiyo, ngokukodwa uhlobo lwe-oxicam, njengeFeldene (Piroxicam) (ayidla ngokumiselwa kubantwana)
- I-Zyloprim (allopurinol), eqhelekileyo isetyenziselwa ukuphathwa gout
I-Stevens-Johnson syndrome ngokuqhelekileyo icinga ukuba ibangelwa yimpendulo yeziyobisi, kodwa izifo ezinokuthi zidibaniswe nazo zingaquka ezibangelwa ngu:
- virus ye-herpes simplex
- I-Mycoplasma pneumoniae ibhakteria (ukuhamba kwepneumonia)
- i-hepatitis C
- I-Histoplasma capsulatum fungus (i-Histoplasmosis)
- I-Epstein-Barr virus ( mono )
- Adenovirus
Unyango lweStevens-Johnson Syndrome
Unyango lwe-Stevens-Johnson syndrome ngokuqhelekileyo luqala ngokuyeka zonke iziyobisi ezingabangela ukuba ziphendule kwaye zonyamekele ukunyamekela ukuba isiguli sifumane kwiiveki ezi-4.
Ezi zi gulane zihlala zidinga ukunakekelwa kwiNyunithi yoLondolozo oluPheleleyo, kunye nezo kunyango ezingabandakanya:
- IV fluids
- zondlo
- amayeza okubulala unyango lwesibini
- imilenze
- ukunakekelwa kwilonda
- i-steroids kunye ne-immunoglobulin (IVIG), nangona ukusetyenziswa kwabo kusekhona impikiswano
Izifo zonyango zikaStevens-Johnson zihlala zilungelelaniswa kwinqanaba leqela, kunye nodokotela we-ICU, udermatologist, i-ophthalmologist, i-pulmonologist, kunye ne-gastroenterologist.
Abazali mabafune unyango ngokukhawuleza ukuba bacinga ukuba umntwana wabo unokuba ne-Stevens-Johnson syndrome.
Imithombo:
Habif: I-Clinical Dermatology, yesihlanu.
I-Kliegman: uNelson Inkcazelo yeePediatrics, 18th.
Koh MJ. Isifo se-Stevens-Johnson kunye nesifo soxhepha se-epidermal necrolysis kwabantwana base-Asia. J Am Acad Dermatol - 01-JAN-2010; 62 (1): 54-60.
Mandell: Mandell, Douglas, kunye ne-Bennett's Principles and Practice of Infectious Diseases, 7.
Natacha Levi, PharmD. Amachiza njengeziphumo zobungozi be-Stevens-Johnson Syndrome kunye ne-Toxic Epidermal Necrolysis kwaBantwana: Uhlalutyo oluPhakanyisiweyo. I-Pediatrics, Feb 2009; 123: e297 - e304.