Ngaphezulu nje kweengqungquthela
I-Varicella virus ye-zoster (VZV) ineendlela ezahlukeneyo zokufaka isandla kwiintlungu zabantu. Ekuqaleni, kubangelwa nje inkukhu. Ngokuqhelekileyo, nangona intsholongwane ayiyi kuhamba ngokukhawuleza. Kunoko, intsholongwane ifihlakele, igxininise kwiiseli zamangqamuzana ezinjenge-ganglion kufuphi nomtya womgca, zilindele ithuba lokuba wenze enye into.
Iingqungquthela yenye yeendlela eziyaziwayo kakhulu i-VZV ibuyela ngeenxa ezimbini.
Intsholongwane ikhuphuka kwesikhumba esilungelwe yintsimbi ethile, ekhokelela ekugqibeleni okukhulu. Nangona emva kokuqhaqhaqhaqhabalaka, intlungu ingaphikelela kwizinto ezibizwa ngokuba yi-neuralgia ye-postherpetic.
Izibonda ziyaziwayo kodwa iVZV ngamanye amaxesha ingakhokelela kwi-vasculitis, i-meningoencephalitis, i-myelopathy, i-retinal necrosis, i-vasculopathy, okanye i-Ramsay Hunt syndrome. Zonke ezi ngxaki zingenzeka ngaphandle kokugqithisa okanye iinyanga emva kokugqithisa. Uvavanyo oluqhelekileyo lwebhoratri ezifana nobukho be-VZV DNA okanye iiseli ezingaqhelekanga kwi- cerebrospinal fluid (CSF) luncedo ukuba lukhoyo, kodwa eso sifo sinokuthi senzeke nangona ezi ziphumo zingekho. Nangona ukuba ukrokrelwa kwikliniki, unyango lwezifo ze-neurologic ezibangelwa yi-VZV lunokuba ngumngeni.
Herpes Zoster
I-Herpes zoster, ebizwa nangokuthi i-shingles, yenye yezona zihlobo ezifunyenwe kakhulu kwi-VZV. Ngenxa yokuba iveza ngokukhawuleza, abanye abantu abayicingi njengengxaki yengqondo.
Nangona kunjalo, i-rash isasazeka ngaphezu kwento ebizwa ngokuba yi- dermatomal distribution , okubhekisela kwindawo yesikhumba engabanjwanga ngenye ingcambu. Oku kungenxa yokuba ingcambu yesigulane, okanye i-ganglion, apho i-virus ibeke khona idalala ize ibe nethuba lokuvuselela kwakhona. Enyanisweni, ukucinga ngomfanekiso we-magnetic resonance (MRI) kunokubonisa ukuphuculwa kwegrikhili echaphazelekayo.
Ingxaki ibuhlungu kakhulu. Unyango i-valacyclovir malunga neentsuku ezisixhenxe.
Postherpetic Neuralgia
I-postherpetic neuralgia igxininisa into yokuba i-herpes zoster ngokuyisiseko igugu legazi . Nangona emva kokuqhaqhabalaka kwanyamalala, intlungu phezu kweso sidima sinokuqhubeka. Ukuba yenza njalo ngaphezu kweenyanga ezintathu, ukuxilongwa kwe-neuralgia ye-postural (PHN) ingenziwa. Into ebaluleke kakhulu yengozi yokuphuhlisa i-PHN ingumdala, kunye neepesenti ezingaphezu kwe-30 yabangaphezu kweminyaka engama-60 kunye neengqungqelo eziqhubekayo ukuphuhlisa i-PHN. Esi sifo sinokubangelwa ukuvuvukala okungapheliyo ngenxa yokusuleleka kwintsholongwane yegciwane lesandulela ngculaza, njengamaseli angapheliyo atholakala kubantu abano-PHN beminyaka engama-2 ubudala, kunye ne-VZV DNA kunye nama-proteins atholakala kwigazi lezigulane ezininzi ezine-PHN. Ezinye izigulane ziphuculwe ngonyango olukhuselekileyo lwentsholongwane, nangona unyango nge-IV acyclovir aluvunyelwanga yi-Food and Drug Administration (FDA), kwaye kukho imfuno yezilingo ezilungiselelwe kakuhle. Kunokuba nzima kakhulu ukulawula intlungu ye-PHN. I-tricyclic antidepressant, i-gabapentin, i-pregabalin okanye i-lidocaine i-patches iqhelekileyo yindlela yokuqala yokwelapha, ilandelwa i-opioids, tramadol, okanye i-capsaicin njengonyango lwesibini okanye yesithathu.
Udibaniso lwezonyango luya kusebenza ngakumbi. Ukukhuthazwa kwintsimi ye-peripheral peripheral field, apho kuphakanyiswa i-electrodes phantsi kwendawo eninzi intlungu, kunokunika uncedo.
Zoster Sine Herpete
Okubaluleke kakhulu, "i-zoster sine herpete" yayiza kuthathwa njenge-neuralgia yangaphambili, kodwa kwakungekho nantoni na yeyona ndawo. Esi sifo sinokufunyanwa ngu-antibody kwi-CSF. Ezinye izizathu zokubandezeleka okukhulu , ezifana ne-radiospathy yesifo sikashukela okanye ukunyanzelwa kwesibindi, kufuneka kwakhona zikhutshwe ngaphandle kwezifundo ze-neuroimaging. Utyando lubandakanya i-acyclovir ye-dose ephezulu, unyango lweentlungu ngendlela efana neFN.
Retinal N ecrosis
Ukukhulelwa kweso ngeVZV kunokubangela ukuba ukufa kweeseli kuqhubeke kwi- retina. Oku kubangela intlungu ecaleni kweso, kunye nombono ongenangqondo. Umbono wePheripher ulahlekile kuqala. Xa ugqirha enza uvavanyo lwe-fundoscopic banokubona ukuphazamiseka kunye nokugcotshwa kwe-retina. Ezinye ii-virus, ezifana ne-HSV kunye ne-cytomegalovirus, zinokubangela i-retinal necrosis. Ngokuqhelekileyo, oku kwenzeka kumagulane anesifo sengculazi esabalwa yi-T-cell (low <10 cells / mm ^ 3). Unyango luqhelekile nge-IV acyclovir, kunye ne-steroids kunye ne-aspirin. Injectvitreal injection ye-anti-anti-agents ziye zasebenza.
Meningoencephalitis
Ixesha elithi meningoencephalitis lithetha ukuvuvukala kwengqondo kunye nezicubu ezijikelezayo. Oku kungenza intloko, iinguqu zengqondo, kunye neempawu zeengxaki zegazi okanye iimpawu ezinjengeenkathazo zokuthetha okanye ubuthathaka kwelinye icala lomzimba. Oku kuya kwenzeka nokuba ngaphandle kokuqhaqha. I-MRI ingabonisa ukuphuculwa kwezicubu ezijikeleze ubuchopho, kwaye ukugqithiswa kwe-lumbar kungabonakalisa i-anti-VBV ne-VZV DNA okanye i-VZV DNA kwi-cerebrospinal fluid. Unyango lunomlinganiselo ophezulu we-acyclovir kathathu imihla ngemihla iintsuku ezili-10 ukuya kwezi-14.
Myelopathy
I- myelopathy ibonakalisa umonakalo kwintambo yomthambo. Oku kunokukhokelela ekubuthathaka okuqhubekayo kwemilenze, kunye nokunyuka okanye ukungahambisani nesisu kunye nesilwane. I-MRI ingabonisa i-lesion enkulu okanye i-stroke ngaphakathi kwintambo yomthambo. Ucwaningo lwe-Cerebrospinal lubonisa ukufumana okufanayo okulindelekileyo kwi-VZV meningoencephalitis, kunye ne-anti-VZV antibodies okanye i-VZV DNA. Njengoko i-VZV meningoencephalitis, unyango lunomlinganiselo ophezulu we-acyclovir.
Vasculopathy
I-VZV inokuchaphazela imithana yegazi yengqondo kunye nenkqubo yesifo, ekhokelela kwiipatheni eziyinkimbinkimbi zempawu ezibangelwa ukuhamba kwegazi. Oku kunokukhokelela ekubanjeni intloko, ukuguquka kwengqondo, kunye neempawu kunye neempawu zeengxaki ze-neurological. I-MRI iya kubonisa izilonda ezikufutshane malunga nombuthano omhlophe, oqhelekileyo ngaphakathi kwengqondo. Ngamanye amaxesha, i-VZV inokujolisa kwi-artery ye-temporal, eyenza i-arteritis yesikhashana kunye nokulahlekelwa kwimbono kunye nentlungu ecaleni kweso. Ucwaningo lwe-CSF lufana nelo maneka kwi-meningoencephalitis okanye nge-myelopathy, kwaye unyango lubandakanya umthamo omkhulu we-acyclovir.
Ramsay Hunt Syndrome
Ukongezelela kwiingcambu ze-gangs ezijikeleze umlanjana, i-VZV ingakwazi ukuvalela kwi-ganglia yeentsholongwane ze-cranial. Xa intsholongwane ifaka kwakhona kwi-cranial nerve ganglia, inokuvelisa iimpawu ezahlukileyo ezibizwa ngokuba yi- Ramsay Hunt syndrome, ezinokubangela ubuthathaka ebusweni ngokubhekiselele kuBell, kunye nezinye iimpawu. Umqondiso weklasi weRamsay Hunt yintsikelelo ye-vesicular ngaphakathi kwimbumba yendlebe
Ukuthintelwa kweZifo eziManyeneyo
I-VZV idlulile kwi-90% yabantu. Ukugonya kweVVV kwaqaliswa ngo-2006 ukukhuthaza ukukhuselwa kweVVV. I-vaccine iphakanyiswa okwangoku kubantu abangenakho iimpumelelo ngaphezu kweminyaka engama-60 ukuba akukho mlando we-zoster esandula kutshanje. Nangona siphumelele, ukugonya kusetshenziselwa ukusetyenziswa, kwaye ukungaphumeleli kwintsebenzo ngokusekelwe kubuhlanga kunye nobuhlanga kuye kwaphawulwa.
> Imithombo:
> Nagel MA, Gilden D. Isigulane esinzima nesifo se-varicella-zoster virus. I-Neurology isenzo seKlinikhi ye-2013; 3: 109-117