Çocuklarda tularemi: Tularemili 15 olgunun klinik, laboratuvar ve tedavi sonuçlarının değerlendirilmesi
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Date
2013-03-12
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Uludağ Üniversitesi
Abstract
Giriş: Tularemi Francisella tularensis’in neden olduğu zoonotik hastalıktır. Bu çalışmanın amacı tularemi tanısı konan 15 çocuk olgunun klinik ve laboratuvar bulgularının değerlendirilmesidir. Gereç ve Yöntem: Çocuk Enfeksiyon Hastalıkları Polikliniğine ateş, boğaz ağrısı ve lenfadenopati (LAP) yakınması ile başvurup mikroaglütinasyon test (MAT) titresi 1/160 ve üstünde olan 15 olgu geriye dönük olarak değerlendirilerek sosyo-demografik özellikleri, hayvan ile temas ve kene ısırığı öyküleri, yakınma süreleri, klinik ve laboratuvar bulguları, tedavileri ve klinik gidişleri incelendi. Bulgular: Olguların yaş ortalaması 11,5±5,1 yıl (3-17) ve %53’ü erkek idi. Olguların %53,3’ü kırsal kesimde yaşıyor ve kuyu suyu kullanıyordu. En sık başvuru yakınmaları olan boyunda şişlik (%93,3), boğaz ağrısı (%66,7) ve ateş yüksekliği (%66,7) idi. Olgularda en sık orofarengeal tularemi (%66,7) saptandı. Cerrahi olarak olguların %27’sinin LAP’si boşaltılırken, %13,3’ünde ise LAP kendi kendine drene olmuştu. Bulgular başladıktan sonraki ortalama başvuru süresi 53±45,3 (5-150) gün bulundu. Başvuru öncesi olguların %60’ında betalaktam grubu antibiyotik alımı vardı. Lenf bezleri süpüre olan 6 olgunun başvuru ortancası 61 (20- 150)gün, diğerlerinin ise 35 (5-75) gün olarak saptandı p<0,05. Laboratuvar incelemelerinde; lökosit sayısı 8558,6±1384,5 (6030-11400)/mm3, CRP düzeyi 5,8±2,9 (1-6,7) mg/dl, ESH 33,1±28,9 (6-103) mm/saat olarak bulundu. MAT titreleri 1/160 ile 1/1280 arasında idi. Yedi (%47) olguya gentamisin, beş olguya (%33) streptomisin, üç olguya (%20) doksisiklin tedavisi uygulandı. Sonuç: Tularemi, kırsal alanda yaşayan ve beta-laktam antibiyotiklere yanıt vermeyen tonsilofarenjit ve servikal LAP’lı olgularda ayırıcı tanıda düşünülmelidir.
Introduction: Tularemia is a zoonotic diseases caused by Francisella tularensis. The aim of this study was to evaluate the clinical and laboratory findings of 15 children with the diagnosis of tularemia. Materials and Methods: Fifteen cases admitted with fever, sore throat, lymphadenopathy and a F. tularensis antibody titer of 1/160 and above in the microagglutination test (MAT) were evaluated retrospectively. Their sociodemographic characteristics, contact with animals, history of tick bite, duration of complaints, clinical and laboratory findings, treatments and clinical courses were studied. Results: The mean age of patients was 11.5±5.1 (3-17) years and 61.3% were male. Fiftythree percent of the patients were living in rural areas, and had contact with contaminated water. Swelling in the neck (93.3%), sore throat (66.7%) and fever (66.7%) were the most frequently observed symptoms. Oropharyngeal tularemia (66.7%) was predominated. In 27% of the patients LAPs were drained surgically, and in 13.3% of cases they were drained by itself. The mean duration between onset of tularemia symptoms and diagnosis was 53±45.3 (5- 150) days. Sixty percent of patients were received beta-lactam-antibiotics before admission. It was noted that 6 patients with suppurative lymph nodes were admitted to hospital within median 61 (20-150) days, while others were admitted within median 35 (5-75) days (p<0.05). Mean leukocyte count was 8558.6±1384.5 (6030-11400)/mm3, mean CRP was 5.8±2.9 (1-6.7) mg/dl, and mean ESR was 33.1±28.9 (6-103) mm/h. MAT showed that titers ranged from 1/160 to 1/1280. Gentamicin was given in seven patients (47%), streptomycin in five patients (33%), and doxycycline in 3 patients (20%). Conclusions: Tularemia should to be taken into account in the differential diagnosis in patients having tonsillopharyngitis and cervical lymphadenopathy without response to beta-lactam antibiotics in rural areas.
Introduction: Tularemia is a zoonotic diseases caused by Francisella tularensis. The aim of this study was to evaluate the clinical and laboratory findings of 15 children with the diagnosis of tularemia. Materials and Methods: Fifteen cases admitted with fever, sore throat, lymphadenopathy and a F. tularensis antibody titer of 1/160 and above in the microagglutination test (MAT) were evaluated retrospectively. Their sociodemographic characteristics, contact with animals, history of tick bite, duration of complaints, clinical and laboratory findings, treatments and clinical courses were studied. Results: The mean age of patients was 11.5±5.1 (3-17) years and 61.3% were male. Fiftythree percent of the patients were living in rural areas, and had contact with contaminated water. Swelling in the neck (93.3%), sore throat (66.7%) and fever (66.7%) were the most frequently observed symptoms. Oropharyngeal tularemia (66.7%) was predominated. In 27% of the patients LAPs were drained surgically, and in 13.3% of cases they were drained by itself. The mean duration between onset of tularemia symptoms and diagnosis was 53±45.3 (5- 150) days. Sixty percent of patients were received beta-lactam-antibiotics before admission. It was noted that 6 patients with suppurative lymph nodes were admitted to hospital within median 61 (20-150) days, while others were admitted within median 35 (5-75) days (p<0.05). Mean leukocyte count was 8558.6±1384.5 (6030-11400)/mm3, mean CRP was 5.8±2.9 (1-6.7) mg/dl, and mean ESR was 33.1±28.9 (6-103) mm/h. MAT showed that titers ranged from 1/160 to 1/1280. Gentamicin was given in seven patients (47%), streptomycin in five patients (33%), and doxycycline in 3 patients (20%). Conclusions: Tularemia should to be taken into account in the differential diagnosis in patients having tonsillopharyngitis and cervical lymphadenopathy without response to beta-lactam antibiotics in rural areas.
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Keywords
Francisella tularensis, Tularemi, Çocuk, Francisella tularensis, Tularemia, Child
Citation
Çelebi, S. vd. (2013). "Çocuklarda tularemi: Tularemili 15 olgunun klinik, laboratuvar ve tedavi sonuçlarının değerlendirilmesi". Güncel Pediatri, 11(2), 57-62.