Nkima, Macaque, ne Baboon badi basuma anyi bapanda ku ntempelo: Herpes B Virus (Macacine Alphaherpesvirus 1), Valacyclovir, ne Rabies RIG¶

Kusumibua, kukosa, anyi kuela mate mu dîsu kudi nkima udi wenda nkayende mu ntempelo wa ba-vendeur, muaba udibu balame bintu bia mu bufuki anyi mu parc wa mu tshimenga, misangu ya bungi mbua wa Old World Rhesus Macaque (Macaca mulatta), Macaque wa mukila mule / udi udia mbua (Macaca fascicularis), Macaque wa mu Japon (Macaca fuscata), Barbary Macaque (Macaca sylvanus), anyi Baboon (Papio mishindu) mu Bali (Ubud), Thailande (Lopburi, Phuket), Inde (Varanasi, Jaipur, Shimla), Gibraltar, Japon (Arashiyama), Nepal, anyi Afrike, udi tshilumbu tshia lukasa tshia mitu ne tshia masama abidi. Pa kumbusha dikala ne virus wa Rabies (100 percent fatal once neurological symptoms appear) ne bactérie ya bite ya bungi, 70 too ne ku 90 pa lukama ya mbua ya Old World Macaque (genus Macaca) badi ne disama dia Macacine alphaherpesvirus 1 (Herpes B Virus / Cercopithecine herpesvirus 1). Nansha mudi Herpes B kayi wenza bualu bukuabu to, anu mputa ya mukana idi kayiyi ne njiwu mu nyama ya nsengu, padibu bamutua mu muntu ku diambuluisha dia disuma dia nkima, dikosa dia mate, anyi dipuekesha dia mêsu, **disama dia virus wa Herpes B dia muntu didi kadiyi diondapibua didi difikisha ku disama dia encephalomyelitis ne disama dia mupuya ne bungi bua bantu badi bafua budi bufika ku 800 pa lukama.

Wewe anyi muntu uudi wenza nende luendu udi ne disama dia dikoba didi ditshibula, dikosa, anyi dibutuka dia mubidi/disu dia nyama wa macaque anyi wa mbua, tuadija kusukula mputa mu minite 15 ne nsabanga ne povidone-iodine anyi chlorhexidine mu minite 5 ya kumpala, pashishe ndaku diakamue ku lupitadi lua pa buloba bujima anyi bua luendu lukole anyi ** Valacyclovir (1 g PO three times daily for 14 days)** ne Dikuba dia disama dia tshiadi (Human Rabies Immune Globulin [HRIG] + 4-dose rabies vaccine). Bua kupeta ambulanse wa muaba unudi anyi diambuluisha dia munganga, bikila nimero wa njiwu wa muaba unudi (112 anyi 119 mu Indonésie, 1669 mu Thailande, 112 mu India ne mu matunga a ku Mputu / Gibraltar, 119 mu Japon, 999 mu Royaume-Uni, 911 mu États-Unis ne mu Canada) anyi tangila mukanda wetu wa buloba bujima wa nomba ya tshimpitshimpi. Bua kumanya malu makuabu adi atangila disuma dia nyama ne dia disama dia tshiadi, bala dipeta dia disama dia tshiadi ne dikuba dia panyima pa dipeta, disuma dia nyama ne disama dia mputa, ne dikanda dia mashi makole.

Enza nunku mpindieu¶

1. KOSA BIPOTA BIKOLE MU MINITE 15 MIJIMA DIAMUE (THE SINGLE MOST IMPORTANT STEP): Kuindidi too ne paudi ufika ku lupitadi bua kuowa mputa to. Virus wa Herpes B ne virus wa rabies i virus idi mibuikila kudi mafuta idi munda mua selile ya pa mutu pa dikoba mu minite mikese ya kumpala kumpala kua kubuela mu ndekelu kua mijilu ya ku mpenga. Diakamue, udi mua kusukula ne kuowa tshitupa tshidi tshikuma anyi tshidi tshikosa misangu yonso munkatshi mua minite 15 mijima bilondeshile dîba** ne povidone-iodine (Betadine), chlorhexidine gluconate (Hibiclens), anyi nsabanga wa tshiamu tshia kusukula natshi bilamba (dish soap / laundry bar) ne mayi adi apita.
2. BIWIKALA MU DISU NANSHA MUKANA, ELA MEJI NE MÂYI NANSHA MU MUKA MU MINITE 15 (NO SOAP IN EYES): Shi mbua wa macaque udi wela mbila, utua mate, anyi ukuela mayi/mata mu dîsu diebe, mu mishiku, anyi mukana muebe, sukula dîsu diunzuluke anyi tshitupa tshia mubidi tshidi tshiunzuluke misangu yonso munkatshi mua minite 15 ne mâyi a kunua a mu milondo mimpe anyi ne mâyi a mukele a sterile (kuela tshintu tshikole tshia kusukula nabi, maluvu anyi tshiamu tshia kuowa natshi mu dîsu to, tshidi mua kunyanga tshitupa tshia dîsu).
3. KULEKELA MUSHINDU WA MUDIMU WA MUDIMU WA MUSHINDU WA KUSUMA MU MUTU: Kukanga tshintu tshidi tshisuma kudi nyama wa nyama ne tusonji anyi ne tshilamba tshia dikoba kudi kukuata tshipupu tshia Herpes B, tshipupu tshia rabies, ne tshipupu tshia ku mishiku (Eikenella corrodens, Bacteroides, Pasteurella) tshidi tshinyanga mijilu ya mijilu ne dikumi. Lekela mputa muunzulula bua kupatuka (anyi lekela anu pabuipi panyima pa dibuela dia Rabies Immune Globulin).
4. TUANGA VALACYCLOVIR (1 GRAM THREE TIMES DAILY) MU MÊBA 24 TO NE 72 BUA KUDIMUENA BUA MACAQUE: Anu mbua ya mu tshisumbu tshia Macaca (Macaques mu Azia ne mu Gibraltar) badi ne tshipupu tshia Herpes B. Ikala ulomba bua kutuadija Prophylaxie wa panyima pa dipeta dia masama (PEP) ne Valacyclovir wa ku mishiku 1,000 mg (1 g) every 8 hours (TID) for 14 days (anyi Acyclovir wa ku mishiku 800 mg 5 times daily for 14 days) mu mêba 24 (and up to 72 hours) wa dimanyisha, kumpala kua tshipupu tshisabuka mu tshitupa tshia munkatshi tshia mijilu.
5. LOMBA GLOBULIN IMMUNE WA RABIE (HRIG / ERIG) NE VACCIN WA RABIE MU DITUKU DIA 0: Disuma dia nkima anyi dia mbuji yonso didi dikoka mashi mu Azia, mu Afrike anyi mu Amerike wa ku Sud didi Dipeta dia Rabies dia mulongo wa III dia WHO. Shi kuena muanji kupeta dikuba dia disama dia tshiadi, dikuba dia disama dia tshiadi nkayadi ki ndikumbane to, udi kabidi ne tshia kupeta Rabies Immune Globulin (HRIG 20 IU/kg anyi ERIG 40 IU/kg) udi ubuela buludiludi mu tshilonda ne pabuipi natshi mu dituku dia 0 bua kujikija tshipupu mu matuku 7 too ne ku 14 kumpala kua mubidi webe kuenzaye bintu biende bidi bikuba mubidi.
6. KUANGATA AMOXICILLIN-CLAVULANATE (AUGMENTIN) NE BUALU BUA TETANUS: Mishiku ya nyama idi ifuanangana ne bikunyibua bia bantu (the most infectious mammalian bite); angata amoxicillin-clavulanate 875/125 mg PO BID for 5 to 7 days ne kujadika dikuba diebe dia disama dia tetanus (Tdap).

Mutshi wa mapangadika: dilama dia nkima, makaku, ne nyama wa nzolo¶

Londa mutshi wa mapangadika a mu lupitadi ne a mu budimi dîba didi dipetangana ne nyama wa tshisuku didi difikisha ku disuma, ku dikosa anyi ku dikuma dia mubidi:

flowchart TD
    Exposure["Disuma, dikosa, anyi diela dia mate pa dikoba/disu"] --> WashNow{"1. Dilengeja dia lukasa (mu minite 0 too ne ku 5)"}
    WashNow -->|"Disuma dia kikoba, ditapa, anyi ditapa"| Scrub15["KUSUMBA BIKOLE MU MINITE 15 MIJIMA: Enza mudimu ne Povidone-Iodine, Chlorhexidine, anyi Sabuni wa Detergent + Mashi adi apita -> Lekela mashi apatuka bimpe -> Kukanga nansha kakese"]
    WashNow -->|"Mashi adi apueka mu dîsu, mu mishiku anyi mukana"| FlushEye["KUELA DISU / MUCOSA MU MINUTE 15: Enza mudimu ne mayi a mu milondo anyi 0.9% ya saline (kuela nsabanga anyi iode mu mêsu nansha kakese)"]
    Scrub15 --> PrimateID{"2. Umanye kasumbu ka nyama ne muaba udibu basombele"}
    FlushEye --> PrimateID
    PrimateID -->|"MACAQUE wa kale (Genus Macaca: Bali, Thailand, India, Japan, Gibraltar, Chine, Philippines)"| DualRisk["NYIKA MINENE BIA HERPES B VIRUS + RABIES + BACTERIA: Ndaku ku lupitadi lua ngendu lua pa buloba bujima / lupitadi mu meba 24"]
    PrimateID -->|"Nyama udi kayi makaku (Baboon, Vervet, Langur, Capuchin, Squirrel Monkey, Marmoset)"| RabiesOnly["KAKUENA NYIKA YA HERPES B -> NYIKA MUNENE YA RABIES + BACTERIA: Ndaku ku lupitadi bua Rabies PEP + Antibiotics"]
    DualRisk --> MedProtocol["3. Kufila tshikebelu tshia luondapu tshia panyima pa dimanyisha (dituku 0)"]
    RabiesOnly --> MedProtocol
    MedProtocol --> Regimen["1. HERPES B PEP (Macaques Only): Valacyclovir 1 g PO TID x 14 days (anyi Acyclovir 800 mg PO 5x/day x 14 days)\n2. RABIES PEP (WHO Cat III): Infiltrate HRIG (20 IU/kg) in wound + Rabies Vaccine Days 0, 3, 7, 14\n3. ANTIBIOTICS & TETANUS: Amoxicillin-Clavulanate 875/125 mg PO BID + Tdap Booster"]
    Regimen --> NeuroWatch{"."}
    NeuroWatch -->|"EYOWA: Bimanyinu bia kumpala bia Neuro / Dikoba"| IVGanciclovir["KUBUELA MU LUPITU: Tuadija diakamue IV Acyclovir (12.5-15 mg/kg q8h) anyi IV Ganciclovir (5 mg/kg q12h) diakamue"]

Tshitupa 1: Mbifukibua kayi bidi ne tshipupu tshia Herpes B anyi tshia Rabies (Species and temple guide)¶

Ki mbua yonso idi pa buloba idi ne disama dia Herpes B to, ne ki mbua yonso idi ne disama dia tshipupu dia muomumue to. Kumanya bimpe menemene nyama kayi uvua mukusume anyi mukukose ke kudi kuleja munganga webe wa diluisha masama.

1. Tshisumbu tshia nyama ya nsongo tshia pa buloba bujima: Macaques vs. Baboons, Langurs, ne New World Monkeys¶

2. Bua tshinyi mbua ya mu ntempelo itu iluisha benyi (And How to Escape Without Being Bitten)¶

Malongesha a mu mpata wa Ubud mu Bali, mu ntempelo ya Lopburi mu Thailande, ne mu Gibraltar mu Upper Rock adi aleja ne: 85 pa lukama ya nyama ya nsengu idi yenzeka mu bikondo bisatu bia bantu: 1. Kulama biakudia, mifuku ya plastike, milondo ya mayi, makalashi a dîba, anyi telefone: Ba-macaque ba mu ntempelo mbalongeshibue ku dimanya diabu bua kukuata makalashi a mêsu, bifulu, telefone, ne mifuku ya crinkly, babakuata too ne padi muena mudimu ubapesha tshitupa tshia mamuma (a learned bartering behavior). Shi nkima mukuate tshibombi tshieba, manyanu a dîba, anyi mulondo wa mayi, LEKA DIAMUE. Kukoka kunyima kudi kufikisha ku disuma dia lukasa dia mbua ku tshianza tshiebe anyi ku diboko diebe. 2. Kuseka ne Meno Male anyi Kutangila buludiludi (Primate Threat Display): Mu ngakuilu wa mubidi wa nyama wa macaque ne wa baboon, kukanga mêsu buludiludi ne kukoka mishiku yebe panyima bua kuleja meno ebe (a human smile for a selfie) i tshienzedi tshia nyama wa pa buloba bujima tshia buôwa-diluisha ne diluisha. Lama mishiku yebe mikange pa mutu pa meno eba, kuepuka kutangila buludiludi, ne kuikadi nansha kakese panshi pabuipi ne mêsu ne nyama wa macaque mulume mukole anyi mamu udi ne muana. 3. Kubanda pa makaya a benyi (Head and Neck Bite Hazard): Kuitabi nansha kakese muena mudimu wa mu ntempelo bua kukuteka nkunde anyi nkunde ku mutu anyi ku makaya ebe bua nyama wa makaku abanda pa nshingu webe. Kusuma anyi kutapa ku mutu, ku mpala, anyi ku nshingu kudi ne njiwu mikole ya lufu lua tshipupu tshia Herpes B ne tshia Rabies bualu mijilu ya mu mutu (trigeminal, facial) kufila njila muipi menemene (just centimeters) buludiludi mu tshitupa tshia buongo kumpala kua dikuba dia panyima pa dipeta dia disama edi kuenza mudimu.

Tshitupa 2: Diambuluisha dia kumpala dia ku kakese ku kakese ne dikuba dia mubidi (First 15 minutes to 72 hours)¶

Padi nyama wa macaque anyi wa baboon utshibula dikoba anyi utua tshilamba tshia mucose, londa tshikondo etshi tshijalame.

1. Minite 0 to ne minite 15: Dipangisha dia tshipupu tshia tshiamu ne tshia tshimuma¶

   [ MINUTE 0: MACAQUE BITE, SCRATCH, OR SALIVA SPLASH ]
                            |
                            v
   +--------------------------------------------------------------------+
   |  DO NOT WAIT FOR A CLINIC START 15-MINUTE SCRUB IMMEDIATELY      |
   |  1. Skin Wound: Scrub for 15 FULL MINUTES with:                    |
   |     - Povidone-Iodine (Betadine), Chlorhexidine, OR                |
   |     - Concentrated Detergent / Dish Soap / Hand Soap + Water.      |
   |  2. Eye/Mouth Splash: Flush 15 FULL MINUTES with Plain Bottled     |
   |     Water or 0.9% Sterile Saline ONLY (No soap/iodine in eye).     |
   +--------------------------------------------------------------------+
                            |
                            v
   [ HOUR 1 TO HOUR 24: HOSPITAL POST-EXPOSURE PROPHYLAXIS (PEP) ]
     - Valacyclovir 1,000 mg (1 g) PO TID x 14 days (for Macaques)
     - Rabies HRIG (20 IU/kg) infiltrated into wound + Vaccine Day 0
     - Amoxicillin-Clavulanate 875/125 mg PO BID + Tetanus Booster

• Bua tshinyi minite 15 mijima idi ne tshia kuenzeka: Kasumbu ka mudimu ka CDC Herpes B Virus (Cohen et al., Clinical Infectious Diseases) ne Bulongolodi bua makanda a mubidi pa buloba bujima (WHO) Mikenji ya Rabies idi ileja minite 15 ya disukula ne disukula dia tshiamu** (enza mudimu ne tshilamba tshikezuke anyi tshilamba tshimpe bua kusukula bitekete bitekete munda mua dinu didibu bashipe anyi dikosa, bua kulekela mashi makese a mu mishipa apatula mate).
• Mbintu kayi bidi bishipa bipupu bidi bienza mudimu ku Herpes B ne Rabies?:
• Disungula dia kumpala dia kikoba: Povidone-iodine (Betadine 7.5% to 10%), chlorhexidine gluconate (2% to 4%), benzalkonium chloride, anyi tshiamu tshia kusukula natshi mu nzubu / sabuni wa malongo / sabuni wa mu bar ne mayi a bungi.
• Ntshinyi tshiudi mua kuenza wewe muikale mu njila wa ntempelo anu ne mulondo wa mayi ne tshintu tshia kusukula natshi bianza?: Sukula diakamue ne tshitupa tshia mayi ebe a kunua paudi usukula tshilonda bikole, wela tshintu tshia kusukula natshi bianza tshia 70% tshia maluvu, ne uya lubilu mu minite 3 anyi 5 ku nzubu wa diambuluisha dia kumpala wa ntempelo, ku tshiibi tshia kuowa mâyi, anyi ku tshisalu tshia pabuipi povidone-iodine ne nsabanga bua disukula dia minite 15. (Dimanya: Ku Ubud Sacred Monkey Forest mu Bali ne ku ntempelo minene ya mu Thaïlande, nzubu wa luondapu wa kumpala udi ne povidone-iodine, ndaku diakamue, wowa mâyi mu minite 15, pashishe ndaku buludiludi ku lupitadi lua pa buloba bujima bua Valacyclovir ne Rabies RIG, bualu nzubu ya ntempelo itu anu iteka Betadine pa dikoba ne ifila manga a NOT).

2. Dîba 1 too ne ku Dîba 72: Dikuba dia disama dia Herpes B (Valacyclovir vs. Acyclovir)¶

Bilondeshile Tshibambalu tshia diluisha ne dikuba dia masama tshia mu États-Unis (CDC) ne Tshibambalu tshia malu a tshipupu tshia B tshia ditunga (Georgia State University) mikenji ya luondapu:

3. Dikuba dia disama dia tshiadi dia musangu umue panyima pa dipetangana (HRIG + 4-Dose Vaccine Schedule)¶

Padi bendakanyi ba mu États-Unis anyi ba ku Mputu batamba kubala mikanda idi ileja ni mbua ya muitu anyi ya mu laboratware idi mu buloko idi dijinga ne dilama dia Herpes B anyi dia Rabies, ku ntempelo ya benyi ya mu Asie ne ya mu Afrike, udi ne bua kuondopa BIONSO musangu umue. Kulekedi nzubu wa luondapu wa muaba uudi ukupesha anu dikuba dia disama dia nsukadi kuyi ne Valacyclovir, ne kuangatshi anu Valacyclovir kuyi ne PEP wa disama dia nsukadi to:

1. Bua bena ngendu badi kabayi bapeta disama dia tshiadi (No Prior Pre-Exposure Rabies Series):
2. Tshitupa A: Dikuba dia mubidi (Day 0 Only): Infiltrate Human Rabies Immune Globulin (HRIG ku 20 IU/kg bujitu bua mubidi), anyi Equine Rabies Immune Globuline (ERIG ku 40 IU/kg) pikala HRIG kayiku, mu buondoke ne ku mpenga kua tshimanyinu tshionso tshia disuma ne tshia dikosa. Bungi buonso budi bushala budi kabuyi mua kubuela mu mputa anyi mputa (tshilejilu, disuma dia ku mutu kua munu) budi bubueja mu mubidi muaba wa kule (such as the anterior thigh or deltoid opposite the vaccine arm).
3. Critical 7-Day HRIG Window: Shi nzubu wa lupitadi wa kule uudi mupeta manga a tshinyangu tshia dituku dia 0 kayi ne HRIG (a common issue at small island clinics in Indonesia or rural India), udi ne dituku dia 7 kunyima kua dikuba dia kumpala bua kuya mu ndeke anyi kuya ku lupitadi lunene (Denpasar, Bangkok, Singapore, New Delhi, or home) bua kupeta HRIG injection. Kupeshi HRIG kunyima kua dituku dia 7 to, bualu nebipangishe diandamuna dia anticorps wa tshiamu tshia dikuba natshi.
4. Tshitupa B: Dikuba dia mubidi (4-Dose Intramuscular Vaccine Series): Kuela 1.0 mL (anyi 0.5 mL bilondeshela tshimanyinu: Verorab, Rabipur/RabAvert, Imovax) intramuscularly into the deltoid muscle (never into the gluteal/buttock muscle, anyi anterolateral thigh in young children) mu Matuku 0, 3, 7, ne 14 (ne Dituku 28 pikala makanda a mubidi manyanguke).
5. Bua bena ngendu bakadi bapeta disama dia tshiadi (Completed Pre-Exposure PrEP or Prior PEP):
6. KUPEDI HRIG. Udi mua kufila 2 intramuscular booster doses ya tshiamu tshia nsongo mu dituku dia 0 ne dia 3 anu.

4. Dikuba dia bactérie ya polymicrobial (Why Monkey Bites Infect Within 12 Hours)¶

Mishipa ya nyama idi kayiyi ya bantu idi ne bungi bua alpha-hemolytic Streptococci, Staphylococcus aureus, Eikenella corrodens, Pasteurella, Bacteroides, ne Fusobacterium: - First-Line Oral Antibiotic: Amoxicillin-clavulanate (Augmentin 875/125 mg PO every 12 hours bua matuku 5 too ne ku 7). - Bantu badi ne disama dia penicillin: Doxycycline (100 mg PO BID) anyi Moxifloxacin (400 mg PO daily), anyi Ciprofloxacin (500 mg PO BID) PLUS Metronidazole (500 mg PO TID) anyi Clindamycin (300-450 mg PO TID) (never use a single cephalosporin, macrolide, or clindamycin alone, which miss Eikenella and Pasteurella).

Tshitupa 3: Kujingulula bimanyinu bia tshipupu tshia Herpes B (The 3-to-30-day neurological red-flag window)¶

Nansha kunyima kua dijikija dia disukula dia mputa ne dibanga dia Valacyclovir, muntu yense udibu basuma anyi bashipa kudi mbua udi ne tshia kuditangila dituku dionso munkatshi mua matuku 30 (most clinical Herpes B cases present within 3 to 21 days of exposure, though incubation up to 5 weeks can occur).

   STAGE 1: LOCAL & PERIPHERAL NERVE SIGNS (Days 2 to 10)
   - Fluid-filled blisters (vesicles) or ulceration at the bite/scratch site
   - Shooting pain, electric tingling (paresthesia), numbness, or intense itching
     radiating UP the bitten arm or leg toward the spine
   - Regional swollen lymph nodes, unexplained fever, myalgia, or severe headache
                            |
                            v
   STAGE 2: BRAINSTEM & SPINAL CORD INVASION (Ascending Encephalomyelitis)
   - Persistent intractable HICCUPS (classic sign of brainstem/phrenic nerve involvement)
   - Double vision (diplopia), drooping eyelid, dizziness (ataxia), or slurred speech
   - Neck stiffness (meningismus), confusion, urinary retention, or leg weakness
                            |
                            v
   --> IMMEDIATE ICU ADMISSION FOR INTRAVENOUS GANCICLOVIR OR HIGH-DOSE IV ACYCLOVIR

• Bua tshinyi disama dia nsongo, diplopia, anyi disama dia tshitupa tshia mubidi didi dilomba manga a IV Antivirals:
• Bishilangane na mputa ya mashika ya bantu (HSV-1), tshipupu tshia Herpes B tshitu misangu ya bungi tshienda tshipita mu mijilu ya ku mpenga kayi nansha tshienza tshipupu tshia pa dikoba tshidi tshimueneka muaba udibu bamulume (> 50% of patients never develop local vesicles).
• Pamutu pa nanku, tshimanyinu tshia kumpala tshia didimuija ntshia disama dia mu mikolo, diosha, dipanga dia lungenyi, anyi disama dia nsukadi dikole (pruritus) udi wenda pabuipi ne tshitupa tshidibu basuma, ulonda kudi luya lua buena lua grippe, tshipupu tshidi katshiyi tshijika (singultus, mufumina ku disama dia tshipupu tshia medulla oblongata), dimona dia misangu ibidi (diplopia), lutatu lua kumina (dysphagia), anyi butekete bua tshitupa tshia mubidi tshidi tshienda tshibandila (Landry-type ascending paralysis).
• Diondapangana dia mu lupitadi bua disama dia Herpes B: Valacyclovir wa ku mishiku udi anu bua kuepuka (PEP)* kumpala kua bimanyinu bimueneka. Padi tshipupu anyi tshimanyishilu tshia mu mitu tshipatuka, mubedi udi dijinga ne dibuela dia lukasa mu lupitadi ne diondapangana dia mu mishipa:
  1. Kakuyi bimanyinu bia CNS (Local skin vesicles or peripheral paresthesia only): Intravenous Acyclovir (12.5 to 15 mg/kg IV every 8 hours) NANSHA Ganciclovir wa mu mishipa (5 mg/kg IV every 12 hours) mu mafuku 14 to ne 21 too ne padi bimanyinu bionso bijika ne bipimu bia PCR bia virus bijika.
  2. Ne bimanyinu bionso bia CNS / Brainstem (Fever + headache, tingling, hiccups, diplopia, ataxia, or weakness): Intravenous Ganciclovir (5 mg/kg IV every 12 hours) i manga a kusungula adibu balomba kudi CDC Herpes B Working Group bualu ganciclovir udi uleja bukole bua bungi in vitro ne in vivo bua kuluisha Macacine alphaherpesvirus 1 munda mua tshitupa tshia mubidi tshia munkatshi mua mijilu kupita acyclovir.

Nomba ya njiwu ya mu tshijengu, nzubu ya luondapu ya pa buloba bujima, ne laboratware ya tshikebelu¶

Paudi ujikija disukula dia mputa dia minite 15 pa muaba, ndaku buludiludi ku lupitadi lua pa buloba bujima anyi ku lupitadi lua buanga lua ngendu (do not rely solely on a temple first-aid booth or hotel nurse):

• Bali & Indonesia: Dial 112 anyi 119 bua ambulanse. Mu Bali (Ubud / Kuta / Nusa Dua / Canggu), ndaku buludiludi ku lupitadi lua BIMC (Kuta: +62 361 761263 / Nusa Dua: +62 361 3000911 / Ubud Medical Centre: +62 361 971313), Siloam Hospital Denpasar (+62 361 779900), anyi SOS Medika Clinic Bali (+62 361 710505), tshidi tshifila HRIG (Berirab/HyperRAB), tshiamu tshia Verorab, ne Valacyclovir wa ku mishiku (Valtrex).
• Thailand (Bangkok, Phuket, Lopburi, Krabi, Chiang Mai): Dial 1669 bua EMS anyi 1155 bua bampulushi ba benyi. Enda ku Queen Saovabha Memorial Institute (Thai Red Cross Society Snake & Rabies Clinic, Bangkok: +66 2 252 0161), Lupitadi lua Bangkok Phuket (+66 76 254 425), anyi Bumrungrad International Hospital (+66 2 066 8888).
• India & Nepal: Dial 112 (108 ambulanse) mu India; mu Kathmandu (Swayambhunath Monkey Temple), ndaku buludiludi ku CIWEC Hospital Travel Medicine Center (+977 1 4524111), nzubu wa luondapu lua nyama ya nsongo mu tshitupa etshi. Mu Inde, ndaku ku lupitadi lua mudimu munene (Apollo, Max, Fortis, Manipal) ne kulomba bionso bibidi Human Rabies Immune Globuline (HRIG) ne Valacyclovir 1,000 mg bipese (Valcivir).
• Gibraltar, Royaume-Uni, ne Union européenne: Dial 112 anyi 190 mu Gibraltar (St Bernard's Hospital udi ne protocole wa disuma dia Barbary Macaque). Mu UK, dila 999 anyi 111 (UKHSA Rabies and Monkey B Virus Service); mu UE mujima, funda 112.
• Japon, Hong Kong, Singapour, ne Malaysia: Dial 119 mu Japon, 999 mu Hong Kong (Queen Elizabeth / Prince of Wales A&E) ne Malaysie, anyi 995 mu Singapour (Tan Tock Seng Hospital / National Centre for Infectious Diseases [NCID]).
• Ditunga dia États-Unis ne Laboratoire wa Herpes B wa pa buloba bujima: Bikila 911 bua malu a tshimpitshimpi. Baminganga ba pa buloba bujima badi mua kuya ku National B Virus Resource Center ku Georgia State University (Atlanta, USA) 24/7 Telefone wa tshimpitshimpi ku +1-404-413-6550 anyi CDC Emergency Operations Center (+1-770-488-7100) bua PCR/serology diagnostics ne buludiki bua antiviral.

Nkonko itubu bela misangu ya bungi¶

Nkama kayi idi ne tshipupu tshia Herpes B, ne ntambue yonso idi nayi anyi?¶

Aa, anu ntambue ya kale ya mu tshisumbu tshia Macaca (macaques), bu mudi Rhesus macaques, Long-tailed (crab-eating) macaques, Japanese macaques, ne Barbary macaques idi mu Bali, Thailande, India, Nepal, Malaysia, Singapour, Hong Kong, Japon, ne Gibraltar, ke idi miaba ya pa buayi ya Macacine alphaperus (H1), ne virus 70 too ne ku 90 pa lukama ya mbua mikole idi ne disama edi kayiyi ne bimanyinu. Baboon, vervet monkeys, Asian langurs, ne monkeys yonso ya mu Amerike wa pankatshi ne wa ku Sud (Buloba bupiabupia) bu mudi capucins, squirrel monkeys, ne marmosets kabena ne tshipupu tshia Herpes B to, nansha mudibu anu dijinga ne luondapu lua lukasa lua Rabies Post-Exposure Prophylaxis ne antibiotics.

Bua tshinyi kusukula nyama wa ntambue mu minite 15 diakamue kudi ne mushinga wa bungi?¶

Virus wa Herpes B ne virus wa rabies bidi binyunguluka kudi tshilamba tshia mafuta (mafuta) tshidi katshiyi tshikole ne bidi bishala pa mutu pa selile ya dikoba anu minite mikese kunyima kua disuma anyi dikosa kumpala kua kulamakaja ku mijilu ya ku mpenga ne kuya mu muonji wa mukolo ne mu buongo. Padi tshipupu tshibuela mu tshitupa tshia mijilu, manga a pa mutu kaena mua kufika kabidi to. Kusukula mputa diakamue munkatshi mua minite 15 ne povidone-iodine (Betadine), chlorhexidine, anyi nsabanga wa tshiamu tshia kusukula natshi ne mayi adi apueka kudi kunyangakaja tshitupa tshia mafuta a virus padibu batshikuma ne kusukula 99 pa lukama ya virus kumpala kua dibuela dia mijilu.

Bungi bua Valacyclovir anyi Acyclovir budi bukengedibua bua kuepuka tshipupu tshia Herpes B kunyima kua disuma dia mbua ntshinyi?¶

Bualu bua tshipupu tshia Herpes B tshidi ne bukole bua bungi misangu 10 ku manga adi aluisha tshipupu etshi kupita disama dia mashika dia bantu (HSV-1), mukanda wa manga makese wa disama dia mashika kawena mua kukumbana to. Bilondeshile mikenji ya CDC Herpes B Virus Working Group, bantu bakole badi dijinga ne Valacyclovir 1,000 mg (1 gram) misangu isatu ku dituku (mêba 8 onso) mu matuku 14 mujima, anyi Acyclovir 800 mg misangu itanu ku dituku mu matuku 14, bimpe menemene kutuadija ne mêba 24 too ne ku 27 kusuma, kukosa, anyi kuela mâyi ku mêsu.

Ntshinyi tshindi mua kuenza pikala mbua wa macaque muele mate anyi muele mayi mu dîsu dianyi?¶

Dipuekesha dia mate a nyama wa ntambue anyi dia mayi a mu tshina tshia mâyi didi njila mufunda wa ditangalaka dia tshipupu tshia Herpes B tshia lufu ku diambuluisha dia mijilu ya mêsu ne ya tshiadi. KUTEKI nsabanga, povidone-iodine, anyi maluvu mu dîsu diebe to; Pamutu pa nanku, ikala ne bipese bia mêsu biunzulula ne usukule dîsu mu minite 15 mijima ne mayi a kunua a mu milondo mimpe anyi 0,9% ya mâyi a mukele, pashishe ndaku diakamue ku lupitadi bua kutuadija kunua Valacyclovir (1 g misangu isatu ku dituku munkatshi mua matuku 14) ne kuyukila bua dikuba dia disama dia nsukadi.

Ndi anu dijinga ne Rabies Immune Globulin (HRIG) meme mupeta tshiamu tshia dikuba natshi bantu ku disama dia Rabies dituku dia disuma dia nkima anyi?¶

Eyowa, shi kuyi muanji kupeta dikuba dia tshipupu kumpala kua luendu, tshintu tshionso tshidi tshikuma anyi tshikosa tshia nkima mu ditunga didi ne tshipupu (bu mudi: Indonésie/Bali, Thailande, Inde, Nepal, Afrique, anyi Latin America) ntshipeta tshia OMS tshia mu tshitupa tshia III tshidi tshikengela 4-dose vaccine passive NE Human Rabine Globine Gbuline (HRIG, 20 IU/kg) udi ubuela buludiludi munda ne pabuipi ne tshilonda. Bu mudi manga a disama dia nsukadi angata matuku 7 too ne ku 14 bua kusaka tshiluilu tshiebe tshia mubidi bua kuenza makanda ende, HRIG udi ufila makanda a mubidi adi mua kujikija diakamue muaba udibu bakusume mu lumingu lua kumpala lua njiwu.

Bimanyinu kayi bia didimuija mu matuku 30 a kumpala kunyima kua disuma dia mbua bidi biumvuija ne ndi dijinga ne luondapu lua lukasa lua IV?¶

Keba diakamue lupitadi lua lukasa bua kupeta Ganciclovir (5 mg/kg IV kunyima kua mêba 12 onso) anyi IV Acyclovir wa bungi wewe mupete tshimue tshia ku bintu bidi bilonda ebi mu matuku 3 anyi 30 a dipetangana ne nyama wa macaque: bipumbishi biuwule tente ne mâyi anyi mputa pabuipi ne mputa; kuosha, kutshioka, kutshioka, anyi kutshioka tshikole tshidi tshitangalaka ku diboko anyi ku dikasa didibu basuma; luya ludi kaluyi lumvuija anyi mutu usama bikole; tshipupu tshidi katshiyi tshijika (tshimanyinu tshia kale tshia disama dia mutshima wa Herpes B); kumona misangu ibidi, disama dia tshiadi, lutatu lua kumina, anyi butekete bua bitupa bia mubidi.

Malu adi apetangana¶

• Dipetangana ne disama dia nsukadi, dipetangana ne mbua, ne dikuba dia panyima pa dipetangana nadi
• Disuma dia nyama ne disama dia mputa
• Mbua wa tshiji, mbua, coyote, anyi skunk udi udikuba ku dibunda dia munya
• Dipatuka dia mashi dikole ne dilama dia dipatuka dia mashi

Miaba ne buludiki bua mbulamatadi¶

• Bibambalu bia diluisha ne dikuba dia masama (CDC, États-Unis): CDC Yellow Book (Health Information for International Travel): Zoonotic Exposures: Bites, Scratches, and Other Hazards from Macaque Monkeys (Herpes B Virus / Macacine alphaherpesvirus 1) ne Rabies.
• Cohen, J. I., Davenport, D. S., Stewart, J. A., ne bakuabu. (B Virus Working Group, Masama a masama a mu lupitadi / CDC): Malu adibu bafila bua kuepuka ne kuondopa disama dia B Virus (Cercopithecine Herpesvirus 1).
• Tshibambalu tshia malu a tshipupu tshia B tshia ditunga (Georgia State University, Atlanta, USA): Mishindu ya kuenza mudimu mu tshimpitshimpi bua diondopangana dia nyama ya nsengu, diteta dia disama, ne dikuba dia panyima pa disama edi.
• Bulongolodi bua makanda a mubidi pa buloba bujima (WHO): Diyukidilangana dia bamanyi ba OMS pa disama dia tshiadi: Dilombola dia tshitupa tshisatu, dibuela dia mputa ya immunoglobuline ya disama dia tshiadi (HRIG/ERIG), ne programe ya dikuba.
• Tshisumbu tshia masama a masama a mu Amerike (IDSA): Mibelu ya dienza dia mudimu bua kumanya ne kulama masama a kikoba ne a bitupa bia mubidi bidi bilonda disuma dia nyama idi kayiyi ya bantu.