Bruselloz tanılı hastaların klinik, laboratuvar ve epidemiyolojik özelliklerinin incelenmesi
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Tarih
2021
Yazarlar
Dergi Başlığı
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Cilt Başlığı
Yayıncı
Dicle Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Ocak 2017 Aralık 2018 Tarihleri Arasında Dicle Üniversitesi Tıp Fakültesi Hastanesinde İzlenen Bruselloz Tanılı Yetişkin Hastaların Retrospektif Olarak Değerlendirilmesi Amaç: Bu araştırmada Dicle Üniversitesi Tıp Fakültesi Enfeksiyon Hastalıkları servis ve/veya polikliniğinde izlenen, bruselloz tanısı almış hastaların; demografik özellikleri, klinik, laboratuvar, radyolojik bulguları ve uygulanan tedavi rejimlerinin değerlendirilmesinin yanısıra brusella capture titresi ile kan kültür pozitifliği arasındaki ilişkinin de değerlendirilmesi amaçlanmıştır. Ayrıca hastaların müracaat ettikleri branşlar ile tanı sonrası hastalık bildiriminin yapılma oranları irdelenmiştir. Gereç ve Yöntemler: Ocak 2017-Aralık 2018 tarihleri arasında Dicle Üniversitesi Tıp Fakültesi Enfeksiyon Hastalıkları Kliniği ve/veya Polikliniği'nde izlenen bruselloz tanısı almış 214 hastanın dosyaları retrospektif olarak incelendi. Çalışmaya alınan 118 hastanın demografik ve klinik özellikleri kaydedildi. Hastaların rose bengal, brusella capture testleri ve hemokültürleri Dicle Üniversitesi Tıp Fakültesi Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Laboratuvarında diğer laboratuvar testleri ise Merkez Laboratuvarında çalışıldı. Bulgular: Hastaların yaş ortalaması 39,54±17,123 olup, hastaların %50'si erkek %50'si idi. Hastaların %58,5'i kırsal alanda yaşarken; %41,5'i kent merkezinde yaşıyordu. Başvuru anında en sık iki şikâyetin %89 ile ateş, %73,7 ile kemik-eklem ağrısı olduğu tespit edilmiştir. Hastalarının tanı anındaki en sık iki fizik muayene bulgusu %89 ile ateş %73,7 ile kemik ve eklemlerde hassasiyet olarak tespit edilmiştir. Eritrosit sedimentasyon hızı yüksekliği hastaların %29,6'sında, CRP yüksekliği ise hastaların %55,9'unda tespit edildi. Tanı anında en sık iki hematolojik bulgu: %45,8 ile anemi %26,3 ile lenfomonositoz olarak saptandı. En sık görülen iki tutulum %31,4 ile sakroileit, %25,4 ile splenomegali olarak saptandı. Hastaların %59,3'ünde hastalık bildiriminin yapıldığı, enfeksiyon hastalıkları kliniğinde bildirim oranının %64,7 olduğu, enfeksiyon dışı kliniklerde ise bildirimin %25'te kaldığı saptandı. Hastaların %86,4'ünün enfeksiyon hastalıkları kliniğine başvurduğu saptandı. Hastaların enfeksiyon dışı kliniklere başvuruları incelendiğinde hastaların %50'sinin dahiliye, %31,25'inin ise Fizik Tedavi-Rehabilitasyon, %6,25 Üroloji, %6,25 Kadın doğum, %6,25 Psikiyatri kliniğine başvurduğu saptanmıştır. Bruselloz nedeniyle takipli 118 hastanın 56'sından kan kültürü alındığı bunlardan 30'unda üreme olduğu saptanmış olup; üreyen mikroorganizmaların tamamı B. Melitensis idi. Brusella capture titresi ?1280 olan hastaların %62,5'inde; <1280 olan hastaların %31,25'inde kan kültüründe üreme olduğu saptanmıştır. Sonuç: Bruselloza bağlı anemi, lökopeni ve trombositopeni gibi hematolojik bulguları olan hastalarda sakroileit ve splenomegali gelişme oranında istatiksel olarak anlamlı fark bulunmuştır (p<0.05). Hastaların brusella capture titresi yükseldikçe (1/320 den 1/5120'ye doğru gidildikçe) kan kültüründe brusella bakterisini izole etme oranında istatiksel olarak anlamlı bir fark saptandı.(p<0.05) Brusella açısından endemik kabul edilen ülkemizde özellikle kırsal kesimden, ateş ve kemik eklem ağrısı ile gelen hastaların brusella açısından ayrıntılı öyküsünün alınması ile erken tanı konularak olası komplikasyonların önünde geçilmesi hedeflenmelidir. Bu amaçla enfeksiyon hastalıkları alanında uzman olmayan hekimlerin de tanı, tedavi ve takip açısından bilgi ve becerilerinin yeterli düzeyde olabilmesi için gerekli farkındalık oluşturulmalı ve periyodik eğitimler verilmelidir.
Retrospective Evaluation of Adult Patients with Brucella Followed up in Dicle University Medical Faculty Hospital between 2017-2019 Objective: The present study included patients that were followed up in Dicle University Medical Faculty Infectious Diseases Department inpatient and/or outpatient clinics due to a diagnosis of brucellosis. The primary aim was to evaluate the relationship between brucella capture titer and blood culture positivity and to examine demographic, characteristics and clinical, laboratory, radiological findings of the patients as well as the treatment regimens administered in each patient. In addition, the departments to which the patients first applied and the rates of reporting the disease after diagnosis were also examined. Materials and Methods: Medical records of 214 patients diagnosed with brucellosis who were followed up in Dicle University Medical Faculty Infectious Diseases Department inpatient and/or outpatient clinics between January 2017 and December 2018 were retrospectively analyzed. Of these, 118 patients were included in the study. Rose bengal, brucella capture tests, and hemocultures of the patients were studied in the Dicle University Medical Faculty Infectious Diseases and Clinical Microbiology Laboratory, and other laboratory tests were performed in the Central Laboratory. Results: Patients comprised 59 (50%) men and 59 (50%) women with a mean age of 39.54 ± 17.123 years. While 58.5% of the patients lived in a rural area, 41.5% of the them lived in the city center. The two most common presenting symptoms were fever (89%) and bone-joint pain (73.7%). The two most common physical examination findings of the patients at the time of diagnosis were fever (89%) and tenderness in bones and joints (73.7%). An elevated erythrocyte sedimentation rate (ESR) was detected in 29.6% of patients, and an elevated C-reactive protein (CRP) was detected in 55.9% of patients. The two most common hematological findings at the time of diagnosis were anemia (45.8%) and lymphomonocytosis (26.3%) The two most common comorbidities were sacroiliitis (31.4%) and splenomegaly (25.4%). It was determined that 59.3% of the patients were notified about the disease, whereby the rate of notification was 64.7% in the clinics of infectious diseases and was 25% in the clinics of non-infectious diseases. Of all patients, 86.4% of them applied to the infectious diseases clinic. Among the patients applied to the clinics of non-infectious diseases, 50% of them applied to internal medicine, 31.25% to physical therapy-rehabilitation, 6.25% to urology, 6.25% to obstetrics, and 6.25% to psychiatry. Blood culture was taken from 56 (47.5%) out of 118 patients and 30 of them were found to be reproductive. All the microorganisms isolated from the culture specimens were B. Melitensis and 62.5% of the patients had a capture titer of 1280. It was also found that 31.25% of the patients with a titer of <1280 had reproduction in the blood culture. Conclusion: Patients with hematological findings such as anemia, leukopenia and thrombocytopenia due to brucellosis were found to have a significantly higher risk of developing sacroiliitis and splenomegaly (p<0.05).) As the brucella capture titer of the patients increased (from 1/320 to 1/5120), a statistically significant difference was found in the rate of isolation of brucella bacteria in blood culture (p <0.05). In our country, which is considered endemic in terms of brucellosis, patients that reside in rural areas and present with fever and a bone-joint pain should be diagnosed promptly and possible complications should be prevented by taking a detailed history of brucellosis. Accordingly, necessary awareness should be created and periodic trainings should be provided to ensure that physicians working in the clinics of non-infectious diseases have sufficient knowledge and skills in terms of diagnosis, treatment, and follow-up.
Retrospective Evaluation of Adult Patients with Brucella Followed up in Dicle University Medical Faculty Hospital between 2017-2019 Objective: The present study included patients that were followed up in Dicle University Medical Faculty Infectious Diseases Department inpatient and/or outpatient clinics due to a diagnosis of brucellosis. The primary aim was to evaluate the relationship between brucella capture titer and blood culture positivity and to examine demographic, characteristics and clinical, laboratory, radiological findings of the patients as well as the treatment regimens administered in each patient. In addition, the departments to which the patients first applied and the rates of reporting the disease after diagnosis were also examined. Materials and Methods: Medical records of 214 patients diagnosed with brucellosis who were followed up in Dicle University Medical Faculty Infectious Diseases Department inpatient and/or outpatient clinics between January 2017 and December 2018 were retrospectively analyzed. Of these, 118 patients were included in the study. Rose bengal, brucella capture tests, and hemocultures of the patients were studied in the Dicle University Medical Faculty Infectious Diseases and Clinical Microbiology Laboratory, and other laboratory tests were performed in the Central Laboratory. Results: Patients comprised 59 (50%) men and 59 (50%) women with a mean age of 39.54 ± 17.123 years. While 58.5% of the patients lived in a rural area, 41.5% of the them lived in the city center. The two most common presenting symptoms were fever (89%) and bone-joint pain (73.7%). The two most common physical examination findings of the patients at the time of diagnosis were fever (89%) and tenderness in bones and joints (73.7%). An elevated erythrocyte sedimentation rate (ESR) was detected in 29.6% of patients, and an elevated C-reactive protein (CRP) was detected in 55.9% of patients. The two most common hematological findings at the time of diagnosis were anemia (45.8%) and lymphomonocytosis (26.3%) The two most common comorbidities were sacroiliitis (31.4%) and splenomegaly (25.4%). It was determined that 59.3% of the patients were notified about the disease, whereby the rate of notification was 64.7% in the clinics of infectious diseases and was 25% in the clinics of non-infectious diseases. Of all patients, 86.4% of them applied to the infectious diseases clinic. Among the patients applied to the clinics of non-infectious diseases, 50% of them applied to internal medicine, 31.25% to physical therapy-rehabilitation, 6.25% to urology, 6.25% to obstetrics, and 6.25% to psychiatry. Blood culture was taken from 56 (47.5%) out of 118 patients and 30 of them were found to be reproductive. All the microorganisms isolated from the culture specimens were B. Melitensis and 62.5% of the patients had a capture titer of 1280. It was also found that 31.25% of the patients with a titer of <1280 had reproduction in the blood culture. Conclusion: Patients with hematological findings such as anemia, leukopenia and thrombocytopenia due to brucellosis were found to have a significantly higher risk of developing sacroiliitis and splenomegaly (p<0.05).) As the brucella capture titer of the patients increased (from 1/320 to 1/5120), a statistically significant difference was found in the rate of isolation of brucella bacteria in blood culture (p <0.05). In our country, which is considered endemic in terms of brucellosis, patients that reside in rural areas and present with fever and a bone-joint pain should be diagnosed promptly and possible complications should be prevented by taking a detailed history of brucellosis. Accordingly, necessary awareness should be created and periodic trainings should be provided to ensure that physicians working in the clinics of non-infectious diseases have sufficient knowledge and skills in terms of diagnosis, treatment, and follow-up.
Açıklama
Anahtar Kelimeler
Brusella, Capture, Kan kültürü, Komplikasyon, Brucella, Blood culture, Complication
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Çiçek, Y. (2021). Bruselloz tanılı hastaların klinik, laboratuvar ve epidemiyolojik özelliklerinin incelenmesi. Yayımlanmamış uzmanlık tezi, Dicle Üniversitesi, Diyarbakır.
