Tshwene, Makake, le Tshwene di Loma kgotsa di Ngapa kwa Ditempele: Mogare wa Herpes B (Mogare wa Alphaherpes wa Makacine 1), Valacyclovir, le Rabies RIG¶

Go longwa, go ngapiwa, kgotsa go kgwelwa mathe mo leitlhong ke tshwene e e tsamayang e gololesegile kwa tempeleng ya bajanala, kwa lefelong la tshireletso ya tlhago, kgotsa kwa phakeng ya toropo, gantsi e le Old World Rhesus Macaque (Macaca mulatta), Makake wa Mogatla o moleele / o o jang lekakaie (Macaca fascicularis), Makake wa Sejapane (Macaca fuscata), Makake wa Barbary (Macaca sylvanus), kgotsa Thwene (Papio mefuta) go kgabaganya Bali (Ubud), Thaile (Lopburi, Phuket), India (Varanasi, Jaipur, Shimla), kwa Gibraltar, kwa Japane (Arashiyama), Nepal, kgotsa Afrika, ke boemo jwa tshoganyetso jwa methapo le megare e e nang le dikarolo tse pedi. Mo godimo ga go rwala mogare wa Rabies (100 percent fatal once neurological symptoms appear) le dibakateria tse di tseneletseng tsa go loma ga ditshedinyana tse dintsi, diperesente di le 70 go ya go di le 90 tsa ditshwene tse di godileng tsa Old World Macaque (genus Macaca) ke batho ba ba nang le mogare wa Macacine alphaherpes 1 (Herpes B Virus / Cercopithecine herpesvirus 1). Le fa Herpes B e sa bake sepe se sele fa e se diso tse di seng kotsi tsa molomo mo di-macaques, fa e entiwa mo mothong ka go loma ga tshwene, go ngapa go go kgotletsweng ke mathe, kgotsa go gasetsa mo matlhong, **tshwaetsego ya mogare wa Herpes B ya motho e e sa alafiwang e baka go tlhatloga ga encephalomyelitis le go swa ditokololo ga go hema go go **0.

Fa wena kgotsa molekane wa gago wa mosepele a ka longwa ke tshwene kgotsa tshwene ya macaque e e thubang letlalo, ya ngapiwa, kgotsa ya gasega mo matlhong a a thubang letlalo, simolola go gotlha ntho ka sesepa le povidone-iodine kgotsa chlorhexidine ka metsotso e le 15 mo metsotsong ya ntlha e le 5, go tswa foo ya kwa bookelong jwa boditšhabatšhaba kgotsa jwa kalafi Valasikolovir e e nowang (1 g PO three times daily for 14 days)** le Thibelo ya Rabies Morago ga go Tsena mo go yone (Human Rabies Immune Globulin [HRIG] + 4-dose rabies vaccine). Go bona ambulense ya selegae kgotsa thuso ya kalafi, leletsa nomoro ya tshoganyetso ya selegae (112 kgotsa 119 kwa Indonesia, 1669 kwa Thailand, 112 kwa India le kwa Kopanong ya Yuropa, 119 kwa Japane, 999 kwa Bogosi jo bo Kopaneng, 911 kwa United States le kwa Canada) kgotsa tlhola lenaane la rona la lefatshe lotlhe la . dinomoro tsa tshoganyetso. Go bona diporothokholo tse di anameng tsa go longwa ke diphologolo le rabies, leba go tlhagelela mo bolwetseng jwa bogale le thibelo ya morago ga go tlhagelela mo go jone, tlhokomelo ya go longwa ke diphologolo le go tshwaetsega ga dintho, le taolo e e tseneletseng ya go dutla madi.

Dira se jaanong¶

1. GOGETSA LEBADI KA MATLA METSOTSO E LE 15 KA BONAKO (THE SINGLE MOST IMPORTANT STEP): O se ka wa leta go fitlha o fitlha kwa tleliniking go tlhapa ntho. Mogare wa Herpes B le mogare wa rabies ke megare e e khurumeditsweng ke mafura e e nnang mo teng ga disele tsa letlalo tse di kwa godimo mo metsotsong e le mmalwa ya ntlha pele e tsena mo diphelelong tsa ditshika tse di kwa ntle. Tlhatswa ka bonako le go gotlha lefelo le le lomilweng kgotsa le le ngapileng ka metlha metsotso e le 15 e e tletseng ka tshupanako o dirisa povidone-iodine (Betadine), glukoneite ya tlelorehekisidine (Hibiclens), kgotsa sesepa se se tseneletseng sa sesepa (dish soap / laundry bar) le metsi a a elelang.
2. FA E KA KGOTSWA MO LEITLHONG KGOTSA MO MOLOMONG, NOSESA KA METSI A A TLHOLEGILENG KGOTSA LETSWAI METSOTSO E LE 15 (NO SOAP IN EYES): Fa macaque e tlhotlhora, e kgwa mathe, kgotsa e gasaganya metsi/mathe mo leitlhong la gago, mo nkong, kgotsa mo molomong, tlhatswa leitlho le le bulegileng kgotsa legogo ka metlha ka metsotso e le 15 ka metsi a a phepa a a nowang a a mo mabotlolong kgotsa tharabololo e e tlwaelegileng ya letswai e e senang megare (o se ke wa tsenya sesepa se se bogale, bojalwa, kgotsa the surgical the screa).
3. O SE KE WA LETLELA MOROKO WA KLELINIKI KGOTSA GO TLHOMA GO TSWALA: Go tswala go loma ga diphologolo tse dikgolo ka go roka kgotsa sekgomaretsi sa letlalo go tshwara mogare wa Herpes B, mogare wa segajaja, le di-anaebe tsa molomo (Eikenella corrodens, Bacteroides) te. Tlogela ntho e bulegile go tswa metsi (kgotsa letla fela go atamela go go sa gagamalang morago ga go tsenelela ka Rabies Immune Globulin).
4. SIMOLOLA VALASIKOLOVIRI YA MONOMO (1 GRAM THREE TIMES DAILY) MO DIURENG DI LE 24 GO YA GO LE 72 GO TLHOTLHELELA DI-MACAQUE: Ke ditshwene fela tsa mofuta wa Macaca (Macaques go kgabaganya Asia le Gibraltar) di na le mogare wa Herpes B. Gatelela go simolola Thibelo ya Morago ga go Tsenwa ke Bolwetse (PEP) ka Valacyclovir e e nowang ka molomo 1,000 mg (1 g) every 8 hours (TID) for 14 days (kgotsa Acyclovir e e nowang ka molomo 800 mg 5 times daily for 14 days) go ka nna molemo mo diureng di le 24 (and up to 72 hours) ya go tlhagelela, pele ga mogare o kgabaganyetsa mo thulaganyong ya methapo ya bogareng.
5. BATLAKA GLOBULINI YA MASOLELO A MMELE A BOTLHOKWA KA BOBEDI (HRIG / ERIG) LE MOENTO WA RABIES KA LETSATSI LE 0: Go loma kgotsa go ngapa gongwe le gongwe ga tshwene kgotsa tshwene go go gogang madi kwa Asia, Afrika, kgotsa Latin America ke Go Tsenwa ke Rabies ga Setlhopha sa III sa WHO. Fa o sa enta pele ga go tlhagelela mo bolwetseng jwa segajaja, moento wa segajaja o le osi GA O a lekana, o tshwanetse gape go amogela Rabies Immune Globulin (HRIG 20 IU/kg kgotsa ERIG 40 IU/kg) e tseneletse ka tlhamalalo mo lebadi le go dikologa lone ka Letsatsi la 0 go fokotsa mogare mo malatsing a le 7 go ya go a le 14 pele ga mmele wa gago o itirela dilwantsha-mogare.
6. AMOGELA AMOKSISILINI-KLAVULANATE (AUGMENTIN) LE SETLHOTLHOMI SA TETANUS: Melomo ya diphologolo tse di tshelang e etsisa dimela tsa go longwa ke batho (the most infectious mammalian bite); tsaya amokisisilini-klavulanate 875/125 mg PO BID for 5 to 7 days mme o netefatse moento wa gago wa tetanus (Tdap).

Setlhare sa tshwetso: taolo ya go longwa ke tshwene, makake, le tshwene kgotsa go ngapa¶

Latela setlhare seno sa ditshwetso tsa kalafi le tsa tshimo ka nako ya fa go kopana le diphologolo tse dikgolo go felela ka gore di lomiwe, di ngapiwe, kgotsa di phaphase ka legogo:

flowchart TD
    Exposure["Go Loma ga Diphologolo, go Ngapa, kgotsa go Gasetsa Mathe mo Letlalong/Leitlhong"] --> WashNow{"1. Go Tlhatswa Kgotlelego ka Bofefo (Mo Metsotsong e le 0 go ya go e le 5)"}
    WashNow -->|"Go Loma ga Letlalo, go Punya, kgotsa go Ngapa"| Scrub15["GOTLHA KA MATLA METSOTSO E LE 15 E E TLETSENG: Dirisa Povidone-Iodine, Chlorhexidine, kgotsa Sesepa sa Setlhatswa + Metsi a a Elang -> Dira gore madi a tswe ka kgololesego -> Le ka motlha o se ka wa roka"]
    WashNow -->|"Mathe a Gasetsa mo Leitlhong, mo Nkong, kgotsa mo Molomong"| FlushEye["NOSESA LEITLHO / MUCOSA METSOTSO e le 15: Dirisa Metsi a a Tlwaelegileng a a mo Mabotlolong kgotsa a a Senang Mogare wa 0.9% Saline FELA (O se ka wa tsenya sesepa kgotsa iodine mo matlhong)"]
    Scrub15 --> PrimateID{"2. Supa Setlhopha sa Diphologolo le Thutafatshe"}
    FlushEye --> PrimateID
    PrimateID -->|"MACAQUE a Lefatshe la Bogologolo (Mofuta wa Macaca: Bali, Thailand, India, Japane, Gibraltar, China, Philippines)"| DualRisk["KOTSI E E KGOLO YA MOGARE WA HERPES B + RABIES + BAKTERIA: Ya kwa Tliliniking / Bookelong jwa Boditšhabatšhaba jwa Maeto mo Diureng di le 24"]
    PrimateID -->|"Diphologolo tse e seng tsa Macaque (Tshwene, Vervet, Langur, Mokapuchini, Tshwene ya Mokgwa, Marmoset)"| RabiesOnly["GA GO NA KOTSI YA HERPES B -> KOTSI E E KGOLO YA RABIES + DIBAKETERIA: Ya kwa Bookelong jwa Rabies PEP + Dibolayamegare"]
    DualRisk --> MedProtocol["3. Tsamaisa Thulaganyo e e Feletseng ya Kalafi ya Morago ga go Tsenwa (Letsatsi 0)"]
    RabiesOnly --> MedProtocol
    MedProtocol --> Regimen["1. PEP ya HERPES B (Di-Macaques Fela): Valacyclovir 1 g PO TID x malatsi a le 14 (kgotsa Acyclovir 800 mg PO 5x/letsatsi x malatsi a le 14)\n2. PEP YA BOGATSHI (Katse ya WHO III): Tsenya HRIG (20 IU/kg) mo lebadi + Moento wa Bogatsi Malatsi a le 0, 3, 7, 14\n3. DIBOLANYABAYOTIKI LE TETANUS: Amokisisilini-Klavulanate 875/125 mg ya PO BID + Sethusi sa Tdap"]
    Regimen --> NeuroWatch{"4. Tlhokomela Malatsi a le 21: A go na le Di-Vesicle, Go tlhotlhorega, Letshoroma, Pono e e Gabedi, kgotsa Go Hiccups?"}
    NeuroWatch -->|"EE: Matshwao a Pele a Methapo / Letlalo"| IVGanciclovir["GO AMOGELWA MO BOOKELELONG KA TSHOGANYETSO: Simolola Acyclovir ya Selekanyo se se Kwa Godimo sa IV (12.5-15 mg/kg q8h) kgotsa Ganciclovir ya IV (5 mg/kg q12h) Ka bonako"]

Kgato 1: Ke diphologolo dife tse di nang le mogare wa Herpes B kgatlhanong le Rabies (Species and temple guide)¶

Ga se tshwene nngwe le nngwe mo Lefatsheng e e nang le mogare wa Herpes B, mme ga se kgaolo nngwe le nngwe ya diphologolo tse di nang le bolwetse jo bo tshwanang jwa rabies. Go itse sentle gore ke primate efe e e go tlhomileng kgotsa e e go ngapileng go laola taelo ya gago ya antiviral.

1. Lenaneo la Lefatshe Lotlhe la Diphathojene Tsa Diphologolo: Di-Macaque kgatlhanong le Ditshwene, Di-Langur, le Ditshwene tsa Lefatshe le Lesha¶

2. Goreng Di-Macaque tsa Tempele di Tlhasela Bajanala (And How to Escape Without Being Bitten)¶

Dipatlisiso kwa Sekgweng sa Ditshwene sa Ubud kwa Bali, kwa ditempele tsa Lopburi kwa Thailand le kwa Upper Rock kwa Gibraltar di bontsha gore diperesente di feta 85 tsa go longwa ke di- macaque di diragala ka nako ya fa batho ba itshwara ka tsela e meraro e e rileng: 1. Go Tshwara Dijo, Dikgetsi tsa Polasetiki, Mabotlolo a Metsi, Digalase tsa Letsatsi, Kgotsa Difouno: Di-macaque tsa tempele di katisiwa ka maitemogelo go phamola digalase tsa matlho, dihutshe, difouno le dikgetsi tse di tlhotlhoregang, di di tshwara e le batho ba ba tshwerweng go fitlha motho yo o di tshwarang a di rekisetsa leungo (a learned bartering behavior). Fa tshwene e ka tshwara kgetsana ya gago, digalase tsa letsatsi, kgotsa lebotlolo la metsi, LETLHELA GO TSAMAYA KA BONAKO. Go gogela morago go tsosa go loma ga ntša ka bonako go go tseneletseng mo seatleng sa gago kgotsa mo letsogong la gago la pele. 2. Go Nyenya ka Meno a a Tlhamalang kgotsa go Leba ka Tlhamalalo (Primate Threat Display): Mo puong ya mmele ya macaque le baboon, go lotlela go leba motho mo matlhong ka tlhamalalo le go gogela dipounama tsa gago kwa morago go bontsha meno a gago (a human smile for a selfie) ke sesupo sa lefatshe lotlhe sa diphologolo tse di tshelang sa poifo-go nna bogale le go gwetlha. Boloka dipounama tsa gago di tswaletswe mo godimo ga meno a gago, tila go leba ka tlhamalalo, mme le ka motlha o se ka wa kokobala fa fatshe go lekana le matlho le macaque e tonanyana e e godileng kgotsa mmè yo o tshotseng lesea. 3. Go Palama Magetla a Bajanala (Head and Neck Bite Hazard): Le ka motlha o se letle morekisi wa tempele go go baya matonkomane kgotsa dipanana mo tlhogong kgotsa mo magetleng gore macaque e go palamele mo molaleng. Go loma kgotsa go ngapa mo tlhogong, mo sefatlhegong, kgotsa mo molaleng go na le kotsi e kgolo ya dintsho tsa mogare wa Herpes B le Rabies ka gonne ditshika tsa tlhogo (trigeminal, facial) e tlamela ka tsela e khutshwane thata (just centimeters) ka tlhamalalo mo kutung ya boboko pele ga thibelo ya morago ga go tlhagelela e ka simolola go dira.

Kgato 2: Thuso ya potlako kgato ka kgato le thibelo ya kalafi (First 15 minutes to 72 hours)¶

Fa macaque kgotsa tshwene e thuba letlalo kgotsa e gasetsa lera la legogo, latela mola ono o o tlhomameng wa tatelano ya ditiragalo.

1. Motsotso 0 go ya go Motsotso 15: Go sa Direng ga Baerase ka Metšhini le ka Dikhemikale¶

   [ 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

• Ke ka ntlha yang fa Metsotso e le 15 e e Tletseng e Tlhokegile: Bobedi Setlhopha sa Tiro sa Mogare wa Herpes B sa CDC (Cohen et al., Clinical Infectious Diseases) le Mokgatlho wa Lefatshe Lotlhe wa Pholo (WHO) Dikaelo tsa Rabies di totobatsa metsotso e le 15 e e tletseng ya go tlhapa ka go tswelela le go gotlha ka motšhini (dirisa sethibela gauze se se phepa kgotsa letsela le le boleta go gotlha ka bonolo mo teng ga leino le le phuntsweng kgotsa motlhala wa go ngapa, go letla go tswa madi a mannye mo ditshikaneng go ntsha mathe).
• Ke Dibolayamegare dife tse di Dirang mo Herpes B le Rabies?:
• Tlhopho ya Ntlha ya Letlalo: Povidone-iodine (Betadine 7.5% go ya go 10%), tlelorehekisidine glukoneite (2% to 4%), benzalkonium chloride, kgotsa setlhatswadijana sa mo gae se se tseneletseng / sesepa sa dijana se se metsi / sesepa sa dibara se se nang le metsi a mantsi a a elelang.
• Go tweng fa o le mo tseleng ya tempele o na le lebotlolo la metsi le setlhatswadiatla fela?: Tlhatswa ka bonako ka halofo ya metsi a gago a a nowang a a mo lebotlolong fa o ntse o gotlha ntho ka maatla, tshasa 70% ya bojalwa reka setlhatswadiatla, mme o itlhaganele kwa phaposing ya boikhutso ya booth, sinar povidone-iodine le sesepa sa go tlhatswa ka botlalo metsotso e le 15. (Ela tlhoko: Kwa Sekgweng sa Ditshwene se se Boitshepo sa Ubud kwa Bali le kwa ditempeleng tse dikgolo tsa Thailand, tleliniki ya thuso ya potlako e e mo lefelong leo e na le povidone-iodine, ya koo ka bonako, tlhapa metsotso e le 15, mme morago ga moo o ye ka tlhamalalo kwa bookelong jwa boditšhabatšhaba jwa Valacyclovir le Rabies RIG, ka gonne matlo a tempele a beya fela Betbiral dikenti).

2. Ura 1 go ya go Ura 72: Thibelo ya Dibolayamegare ya Herpes B (Valacyclovir kgatlhanong le Acyclovir)¶

Go ya ka Ditheo tsa United States tsa Taolo le Thibelo ya Malwetse (CDC) le Lefelo la Bosetšhaba la Didirisiwa tsa Baerase ya B (Georgia State University) dikaelo tsa kalafi:

3. Thibelo ya Rabies ka nako e le nngwe morago ga go tlhagelela (HRIG + 4-Dose Vaccine Schedule)¶

Fa batsamai kwa United States kgotsa Yuropa gantsi ba bala dipampiri tse di ngangisanang ka gore a di-macaque tsa laboratori tse di tlhaga kgatlhanong le tse di tshwerweng di tlhoka tlhokomelo ya Herpes B kgatlhanong le Rabies, kwa ditempeleng tsa bajanala tsa Asia le Aforika, o tshwanetse go alafa KA BOBEDI ka nako e le nngwe. O se ke wa dumella tleliniki ya lehae ho o fa ente ya bogale ntle le Valacyclovir, mme o se nwe Valacyclovir feela ntle le PEP ya Bogale:

1. Go Batsamai ba ba sa Kentiwang (No Prior Pre-Exposure Rabies Series):
2. Kgato A: Masole a mmele a a sa direng sepe (Day 0 Only): Go tsenelela Globulin ya Masole a Mmele a Bogale jwa Batho (HRIG ka 20 IU/kg bokete jwa mmele), kgotsa e e phepafaditsweng Globulin ya Masole a Mmele a Rabies ya Dipitse (ERIG ka 40 IU/kg) fa HRIG e se teng, ka tlhamalalo mo boteng le mo dintlheng tsa letshwao lengwe le lengwe la go loma le go ngapa. Bolumu epe e e setseng e e sa kgoneng go tsena mo (di)nthong (ka sekai, go loma mo ntlheng ya monwana) e tlhabelwa mo mesifeng kwa lefelong le le kgakala (such as the anterior thigh or deltoid opposite the vaccine arm).
3. Fensetere e e Botlhokwa ya HRIG ya Malatsi a le 7: Fa e le gore tleliniki e e kgakala kwa o amogelang moento wa gago wa Letsatsi la 0 la segajaja e fedile ka setoko sa HRIG (a common issue at small island clinics in Indonesia or rural India), o na le nako go fitlha ka Letsatsi la bo 7 morago ga selekanyo sa ntlha sa moento go fofa kgotsa go tsaya loeto go ya kwa bookelong jo bogolo (Denpasar, Bangkok, Singapore, New Delhi, or home) go tlhabelwa HRIG. O se ke wa tsamaisa HRIG kamora Letsatsi la 7, kaha e tla hatella karabelo ya hao ya dilwantsha-moento tse sebetsang.
4. Kgato B: Moento o o Matlhagatlhaga (4-Dose Intramuscular Vaccine Series): Tlhaba 1.0 mL (kgotsa 0.5 mL go ikaegile ka letshwaokgwebo: Verorab, Rabipur/RabAvert, Imovax) ka mo mesifeng mo mesifeng ya deltoid (never into the gluteal/buttock muscle, kgotsa anterolateral thigh in young children) ka Malatsi a 0, 3, 7, le 14 (go tlhakantswe le Letsatsi la 28 fa masole a mmele a sa nonofa).
5. Go Bajanala ba ba Kileng ba Kentiwa (Completed Pre-Exposure PrEP or Prior PEP):
6. O SE KE wa fa HRIG. Tsamaisa Ditekanyo di le 2 tsa moento wa rabies tse di tsenngwang mo mesifeng ka Letsatsi la 0 le Letsatsi la 3 fela.

4. Thibelo ya Dibakateria tsa Ditshedinyana tse dintsi (Why Monkey Bites Infect Within 12 Hours)¶

Dikhuti tsa molomo tsa diphologolo tse di seng tsa batho di na le dilekanyo tse di kwa godimo tsa Streptococci, Staphylococcus aureus, Eikenella corrodens, Pasteurella, Bacteroides, le Fusobacterium: - Sebolayamegare sa Mola wa Ntlha: Amokisisilini-klavulanate (Augmentin 875/125 mg PO every 12 hours malatsi a le 5 go ya go a le 7). - Balwetse ba ba Aleji ya Penisilini: Dokisisaekelene (100 mg PO BID) kgotsa Mokisifloksasin (400 mg PO daily), kgotsa Siporofloksasin (500 mg PO BID) LE Metronidazole (500 mg PO TID) kgotsa Kelintamaesini (300-450 mg PO TID) (never use a single cephalosporin, macrolide, or clindamycin alone, which miss Eikenella and Pasteurella).

Kgato 3: Go Lemoga matshwao a mogare wa Herpes B (The 3-to-30-day neurological red-flag window)¶

Le morago ga go fetsa go kgotlha dintho le go simolola Valacyclovir, motho mongwe le mongwe yo o lomilweng kgotsa yo o ngapiwang ke macaque o tshwanetse go itlhokomela letsatsi le letsatsi mo lobakeng lwa malatsi a le 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

• Ke Eng fa go Tshwara Go Tlhatswa, Diplopia, kgotsa Go Tlhatswa Letsogo go Tlhoka Dipilisi Tsa IV tsa Ka Bonako:
• Go farologana le diso tsa serame tsa batho (HSV-1), mogare wa Herpes B gantsi o tsamaya o tlhatloga ditshika tse di fa thoko kwantle ga go dira le fa e le letshoroma le le bonalang mo letlalong le o lomilweng mo go lone (> 50% of patients never develop local vesicles).
• Go na le moo, letshwao la tlhagiso la ntlha ke botlhoko jwa methapo, go tuka, go utlwa botlhoko, kgotsa go tlhotlhonya thata (pruritus) e e phatsimang gaufi le ntlha e e lomilweng, e latelwa ke letshoroma le le tshwanang le mokgotlhwane, go tlhotlhorega go go sa kgaotseng (singultus, e e bakiwang ke thurugo ya megare ya medulla oblongata), pono gabedi (diplopia), bothata jwa go kometsa (dysphagia), kgotsa bokoa jwa maoto jo bo tlhatlogang (Landry-type ascending paralysis).
• Kalafi ya Molwetse yo o Robadiwang kwa Bookelong ya Herpes B e e Nang le Matshwao: Valacyclovir e e nowang ka molomo e diretswe fela thibelo (PEP) pele ga matshwao a tlhagelela. Fa go sena go nna le letshoroma lengwe le lengwe la selegae kgotsa letshwao la methapo, molwetse o tlhoka go robadiwa kwa bookelong ka bonako le kalafi ya sebolayamegare e e tsenngwang mo ditshikaneng:
  1. Kwantle ga Matshwao a CNS (Local skin vesicles or peripheral paresthesia only): Acyclovir e e tsenngwang mo ditshikaneng (12.5 to 15 mg/kg IV every 8 hours) KGOTSA Gansiklovir e e tsenngwang mo ditshikaneng (5 mg/kg IV every 12 hours) bonnye malatsi a le 14 go ya go a le 21 go fitlha matshwao otlhe a rarabologa mme ditso tsa PCR tsa megare di sa supe sepe.
  2. Ka Matshwao ape a CNS / Kutu ya Boboko (Fever + headache, tingling, hiccups, diplopia, ataxia, or weakness): Gansiklovir e e tsenngwang mo ditshikaneng (5 mg/kg IV every 12 hours) ke seokobatsi sa tlhopho se se kgothalediwang ke Setlhopha sa Tiro sa Herpes B sa CDC ka gonne ganciclovir e bontsha maatla a magolo thata mo setsheding le mo setsheding kgatlhanong le Macacine alphaherpesvirus 1 mo teng ga thulaganyo ya methapo ya bogareng go feta acyclovir.

Dinomoro tsa maemo a tshoganyetso tsa kgaolo, ditleliniki tsa boditšhabatšhaba, le dilaboratori tsa ditshupiso¶

Fa o sena go fetsa go tlhatswa ntho ka bonako mo lefelong la metsotso e le 15, ya ka tlhamalalo kwa kokelong ya boditšhabatšhaba kgotsa kwa tliliniking e e kgethegileng ya melemo ya mosepele (do not rely solely on a temple first-aid booth or hotel nurse):

• Bali le Indonesia: Letsa 112 kgotsa 119 go bona ambulense. Kwa Bali (Ubud / Kuta / Nusa Dua / Canggu), ya ka tlhamalalo kwa Bookelong jwa BIMC (Kuta: +62 361 761263 / Nusa Dua: +62 361 3000911 / Ubud Medical Centre: +62 361 971313), Bookelo jwa Siloame jwa Denpasar (+62 361 779900), kgotsa Tleliniki ya SOS ya Kalafi ya Bali (+62 361 710505), ke setoko sefe se se rometsweng kwa ntle HRIG (Berirab/HyperRAB), moento wa Verorab, le Valacyclovir e e nowang (Valtrex).
• Thailand (Bangkok, Phuket, Lopburi, Krabi, Chiang Mai): Daela 1669 ya EMS kgotsa 1155 ya Sepodisi sa Bajanala. Eya kwa Setheo sa Segopotso sa Kgosigadi Saovabha (Thai Red Cross Society Snake & Rabies Clinic, Bangkok: +66 2 252 0161), Bookelo jwa Bangkok Phuket (+66 76 254 425), kgotsa Bookelo jwa Boditšhabatšhaba jwa Bumrungrad (+66 2 066 8888).
• India le Nepal: Daela 112 (108 ambulense) kwa India; kwa Kathmandu (Swayambhunath Monkey Temple), ya ka tlhamalalo kwa Senthara ya Kalafi ya Maeto ya Bookelo jwa CIWEC (+977 1 4524111), tleliniki ya go loma ga diphologolo tse dikgolo ya maemo a gauta mo kgaolong. Kwa India, ya kwa bookelong jo bogolo jwa dikhamphani tsa maemo a a kwa godimo (Apollo, Max, Fortis, Manipal) le go kopa bobedi Globulin ya Masole a Mmele a Bogale jwa Batho (HRIG) le Balasaikolovir 1,000 mg matlapa (Valcivir).
• Gibraltar, Bogosi jo bo Kopaneng, le Kopano ya Yuropa: Daela 112 kgotsa 190 kwa Gibraltare (St Bernard's Hospital e na le prothokholo e e kgethegileng ya go loma ga Barbary Macaque). Kwa UK, daela 999 kgotsa 111 (UKHSA Rabies and Monkey B Virus Service); go ralala EU, daela 112.
• Japane, Hong Kong, Singapore, le Malaysia: Daela 119 kwa Japane, 999 kwa Hong Kong (Queen Elizabeth / Prince of Wales A&E) le Malesia, kgotsa 995 kwa Singapore (Tan Tock Seng Hospital / National Centre for Infectious Diseases [NCID]).
• Laboratori ya Tshupetso ya Herpes B ya United States le ya Lefatshe Lotlhe: Leletsa 911 bakeng sa maemo a tshohanyetso. Dingaka lefatshe ka bophara di ka buisana le Lefelo la Bosetšhaba la Didirisiwa tsa Mogare wa B kwa Yunibesithing ya Naga ya Georgia (Atlanta, USA) Mogala wa Tshoganyetso wa 24/7 kwa +1-404-413-6550 kgotsa Lefelo la Ditiro tsa Maemo a Tshoganyetso la CDC (+1-770-488-7100) ya diteko tsa PCR/serology le kaelo ya kalafi ya go lwantsha megare.

Dipotso tse di bodiwang kgapetsakgapetsa¶

Ke ditshwene dife tse di nang le mogare wa Herpes B, mme a ditshwene tsotlhe di na le one?¶

Nnyaa, ke fela ditshwene tsa Lefatshe la Bogologolo tsa mofuta wa Macaca (di-makake), go akaretsa le ditshwene tsa Rhesus, Di-makake tsa mogatla o moleele (tse di jang lekakaie), di-makake tsa Japane, le di-makake tsa Barbary tse di fitlhelwang go ralala Bali, Thailand, India, Nepal, Malaysia, Singapore, Hong Kong, Japane, le Gibraltar, tse di nang le baerase ya tlholego ya diperesente di le 70 go ya go di le 90 tsa di- macaque tse di godileng di e tshotse di se na matshwao ape. Ditshwene, ditshwene tsa vervet, ditshwene tsa Asia, le ditshwene tsotlhe tsa Amerika Bogare le Borwa (Lefatshe le Lešwa) jaaka di-capuchin, ditshwene tsa squirrel, le di-marmoset GA DI rwale mogare wa Herpes B ka tlhago, le fa di santse di tlhoka Thibelo ya Rabies ka bonako ya Morago ga go Tsenngwa ke Mogare le dibolayamegare.

Ke ka ntlha yang fa go kgotlha go loma kgotsa go ngapa ga macaque ka metsotso e le 15 ka yone nako eo go le botlhokwa jaana?¶

Mogare wa Herpes B le mogare wa rabies di dikologilwe ke enfelopo e e bokoa ya mafura (mafura) mme di nna mo diseleng tsa letlalo tse di fa godimo metsotso e le mmalwa fela morago ga go longwa kgotsa go ngapiwa pele ga di golagana le ditshika tsa maikutlo tse di kwa ntle mme di tsamaye go ya kwa godimo go tsena mo mokwatleng le bobokong. Fa mogare ono o setse o tsene mo axon ya methapo, dibolayamegare tse di mo godimo ga lefatshe ga di tlhole di kgona go o fitlhelela. Go gotlha ntho ka bonako ka metsotso e le 15 e e tletseng ka povidone-iodine (Betadine), chlorhexidine, kgotsa sesepa se se tseneletseng sa sesepa le metsi a a elelang go phatlalatsa enfelope ya mafura a mogare fa o kopana le one mme go tlhatswa diperesente di feta 99 tsa mogare pele ga go tsena mo methapong.

Ke selekanyo sefe se se tlhomameng sa Valacyclovir kgotsa Acyclovir se se tlhokegang go thibela mogare wa Herpes B morago ga go longwa ke macaque?¶

Ka gonne mogare wa Herpes B o ka nna makgetlo a le 10 kwa tlase mo dibolayamegareng go feta herpes ya batho ya serame (HSV-1), taelo e e tlwaelegileng ya selekanyo se se kwa tlase ya serame ga e a lekana. Go ya ka dikaelo tsa Setlhopha sa Tiro sa Mogare wa Herpes B wa CDC, bagolo ba tlhoka Valacyclovir 1,000 mg (gerama e le 1) e e nowang makgetlo a le mararo ka letsatsi (diura dingwe le dingwe di le 8) mo malatsing a le 14 a a tletseng, kgotsa ka tsela e nngwe Acyclovir 800 mg e e nowang makgetlo a le matlhano ka letsatsi go simolola ka diura di le 14, go ngapa, kgotsa go gasagasa matlho.

Ke tshwanetse go dira eng fa tshwene ya macaque e ntshela mathe kgotsa e nkgasetsa metsi mo leitlhong?¶

Go gasagasa ga mathe a macaque mo matlhong kgotsa metsi a serubi/letamo ke tsela e e kwadilweng ya phetiso ya mogare wa Herpes B o o bolayang wa motho ka methapo ya conjunctiva le ya optic/trigeminal. O SE KE wa tsenya sesepa, povidone-iodine, kgotsa bojalwa mo leitlhong la gago; go na le moo, tshwara diphatla tsa gago di bulegile mme o tlhatswe leitlho ka metlha e e tletseng metsotso e le 15 ka metsi a a phepa a a nowang a a mo mabotlolong kgotsa letswai le le tlwaelegileng la 0.9% le le senang megare, morago ga moo o ye ka bonako kwa bookelong go simolola go nwa Valacyclovir (1 g makgetlo a le mararo ka letsatsi mo malatsing a le 14) mme o buisane ka raxis prophyla.

A ke sa ntse ke tlhoka Rabies Immune Globulin (HRIG) fa ke bona moento wa rabies ka letsatsi la go longwa ke tshwene?¶

Ee, fa e le gore ga o ise o ko o amogele dikenti tsa bolwetse jwa segajaja pele ga o tsenwa ke tsone pele ga loeto, go loma kgotsa go ngapa ga tshwene gongwe le gongwe go go thubang letlalo mo nageng e e nang le bolwetse jwa segajaja (e e jaaka Indonesia/Bali, Thailand, India, Nepal, Aforika, kgotsa Latin America) ke go tlhagelela ga motseletsele wa WHO wa Setlhopha sa III go go tlhokang BOBEDI moento wa Rabi o o fetang I Globulin (HRIG, 20 IU/kg) e ne ya tsenelela ka tlhamalalo mo nthong le go e dikologa. Ka gonne moento wa rabies o tsaya malatsi a le 7 go ya go a le 14 go tlhotlheletsa masole a gago a mmele go itirela dilwantsha-ditwatsi tsa one, HRIG e tlamela ka dilwantsha-ditwatsi tse di fokotsang maatla ka bonako gone mo lefelong le le lomilweng mo bekeng eo ya ntlha e e kotsi.

Ke matshwao afe a tlhagiso mo malatsing a ntlha a le 30 morago ga go longwa ke macaque a a rayang gore ke tlhoka kalafi ya tshoganyetso ya IV?¶

Batla kamogelo ya tshoganyetso kwa bookelong ka bonako go bona Ganciclovir e e tsenngwang mo ditshikaneng (5 mg/kg IV diura dingwe le dingwe di le 12) kgotsa Acyclovir ya selekanyo se se kwa godimo ya IV fa o ka nna le nngwe ya tse di latelang mo malatsing a le 3 go ya go a le 30 morago ga go tlhagelela mo macaque: mafofa a a tletseng dieledi kgotsa diso gaufi le ntho; go tuka, go tlhotlhorega, go tlhotlhorega, kgotsa go tlhotlhorega go go tseneletseng go go phatsimang mo letsogong kgotsa mo leotong le le lomilweng; letshoroma le le sa tlhalosiweng kgotsa go opiwa ke tlhogo thata; go tlhotlhorega go go sa kgaotseng go go sa rarabologeng (letshwao la bogologolo la go ruruga ga kutu ya boboko ya Herpes B); pono e e gabedi, go tsewa ke sedidi, go nna le bothata jwa go kometsa, kgotsa go nna bokoa mo ditokololong.

Dikaedi tse di tsamaelanang¶

• Go tlhagelela mo bolwetseng jwa segajaja, go kopana le bommamathwane, le thibelo ya morago ga go tlhagelela
• Tlhokomelo ya go longwa ke diphologolo le go tshwaetsega ga dintho
• Phokoje e e bogale, rakhune, coyote, kgotsa skunk e e tlhaselang motshegare
• Go dutla madi thata le taolo ya go dutla madi

Metswedi le kaelo ya semmuso¶

• Disenthara tsa Taolo le Thibelo ya Malwetse (CDC, United States): Buka e Setlha ya CDC (Tshedimosetso ya Boitekanelo ya Maeto a Boditšhabatšhaba): Go Tsenngwa ke Ditshenekegi: Go Loma, go Ngwa, le Dikotsi Tse Dingwe Tsa Ditshwene Tsa Macaque (Herpes B Virus / Macacine alphaherpesvirus 1) le Rabies.
• Cohen, J. I., Davenport, D. S., Stewart, J. A., le ba bangwe. (B Virus Working Group, Malwetse a a Tshelanang / CDC): Dikatlanegiso tsa Thibelo le Kalafi ya go Tsenwa ke Mogare wa B (Cercopithecine Herpesvirus 1).
• Senthara ya Bosetšhaba ya Didirisiwa tsa Baerase ya B (Georgia State University, Atlanta, USA): Ditsamaiso tsa Tiro tsa Maemo a Tshoganyetso tsa go Tlosa Kgotlelego ya go Loma/Go Kgwatlha ga Macaque, Diteko tsa go Tlhatlhoba Bolwetse, le Thibelo ya Morago ga go Tsenwa ke Macaque.
• Mokgatlho wa Lefatshe Lotlhe wa Pholo (WHO): Therisano ya Baitseanape ba WHO ka ga Rabies: Taolo ya go Tsenngwa mo Dinthong tsa Setlhopha sa III, Go Tsena ga Immunoglobulin ya Rabies mo Dinthong tsa Selegae (HRIG/ERIG), le Dithulaganyo tsa Moento.
• Mokgatlho wa Malwetse a a Tshelanwang wa Amerika (IDSA): Dikaelo tsa Tiriso tsa go Tlhatlhoba le go Laola Ditshwaetso tsa Letlalo le tsa Dithishu tse di Bonolo Morago ga go Lomiwa ke Diphologolo tse e seng tsa Batho.