{"id":16139,"date":"2021-01-05T01:24:43","date_gmt":"2021-01-04T22:24:43","guid":{"rendered":"https:\/\/www.klimikdergisi.org\/\/2021\/01\/05\/bir-cop-toplayicisinda-gelisen-ikterik-leptospiroz-olgusu\/"},"modified":"2023-01-16T13:36:07","modified_gmt":"2023-01-16T10:36:07","slug":"bir-cop-toplayicisinda-gelisen-ikterik-leptospiroz-olgusu","status":"publish","type":"post","link":"https:\/\/www.klimikdergisi.org\/tr\/2021\/01\/05\/bir-cop-toplayicisinda-gelisen-ikterik-leptospiroz-olgusu\/","title":{"rendered":"Bir \u00c7\u00f6p Toplay\u0131c\u0131s\u0131nda Geli\u015fen \u0130kterik Leptospiroz Olgusu"},"content":{"rendered":"<p><a href=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/01\/kd.2012_25-1.tif\"><img decoding=\"async\" class=\"alignnone size-full wp-image-26342\" src=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/01\/kd.2012_25-1.tif\" alt=\"\" \/><\/a>Say\u0131n Edit\u00f6r,<br \/>\n\u00dcnsal ve arkada\u015flar\u0131 (1)\u2019n\u0131n Klimik Dergisi\u2019nin 2011 Aral\u0131k say\u0131s\u0131nda yay\u0131mlanm\u0131\u015f olan \u201cBir \u00e7\u00f6p toplay\u0131c\u0131s\u0131nda geli\u015fen ikterik leptospiroz olgusu\u201d ba\u015fl\u0131kl\u0131 olgu sunumunu, klini\u011fimizde yatmakta olan bir ba\u015fka \u00e7\u00f6p toplay\u0131c\u0131s\u0131n\u0131n Weil hastal\u0131\u011f\u0131 tan\u0131s\u0131yla takip edilmekte olmas\u0131 nedeniyle ilgiyle okudum. Leptospiroz ku\u015fkulu olgular\u0131n klinik tan\u0131s\u0131ndaki \u00f6nemi nedeniyle, kendi olgumuzda kar\u015f\u0131la\u015ft\u0131\u011f\u0131m\u0131z ve muayenede g\u00f6zden ka\u00e7abilecek bir bulguyu payla\u015fmak istiyorum.<\/p>\n<div id=\"attachment_26345\" style=\"width: 718px\" class=\"wp-caption alignright\"><a href=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/01\/kd.2012_25-1.png\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-26345\" class=\"wp-image-26345\" src=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/01\/kd.2012_25-1.png\" alt=\"\" width=\"708\" height=\"315\" \/><\/a><p id=\"caption-attachment-26345\" class=\"wp-caption-text\"><strong>Resim 1<\/strong> Leptospiroz olgusunda skleralarda ikter ve s\u00fcfizyon.<\/p><\/div>\n<p>Yirmi dokuz ya\u015f\u0131ndaki erkek hasta klini\u011fimize bulant\u0131 kusma ve sar\u0131l\u0131k yak\u0131nmalar\u0131yla ba\u015fvurdu. Hastal\u0131\u011f\u0131n bir hafta \u00f6nce ate\u015f y\u00fckselmesiyle ba\u015flad\u0131\u011f\u0131 ve hastam\u0131z\u0131n yakla\u015f\u0131k bir ay \u00f6nce Adana\u2019dan \u0130stanbul\u2019a akrabalar\u0131n\u0131n yan\u0131na gelerek \u00e7\u00f6p toplay\u0131c\u0131l\u0131k yapmaya ba\u015flad\u0131\u011f\u0131 \u00f6\u011frenildi. Yat\u0131\u015f\u0131nda ate\u015fi yoktu, izleminde de y\u00fckselmedi ve derinin ikterik olmas\u0131 d\u0131\u015f\u0131nda belirgin bir fizik muayene bulgusu saptanmad\u0131. Laboratuvar incelemesinde l\u00f6kosit say\u0131s\u0131 15 300\/mm3, polimorfon\u00fckleer l\u00f6kosit oran\u0131 %69, hemoglobin 11.1 gr\/dl, trombosit say\u0131s\u0131 32 300\/mm3, fibrinojen 799 mg\/dl, D-dimer 2.4 mg\/dl, \u00fcre 118 mg\/dl, kreatinin 2.82 mg\/dl, total bilir\u00fcbin 13.38 mg\/dl, direkt bilir\u00fcbin 9 mg\/dl, aspartat aminotransaminaz 56 \u0130\u00dc\/lt, alanin aminotransaminaz 40 \u0130\u00dc\/lt, hafif d\u00fczeyde \u03b3-glutamil transferaz, kreatinin kinaz, laktat dehidrojenaz ve amilaz art\u0131\u015f\u0131 bulundu. Koag\u00fclasyon de\u011ferleri normaldi. Leptospiroz \u00f6n tan\u0131s\u0131yla hastaya 2 gr\/g\u00fcn seftriakson tedavisi ba\u015fland\u0131. Hastada di\u011fer olas\u0131 etkenlerin d\u0131\u015flanmas\u0131 ve anti-Leptospira IgM antikor pozitifli\u011fi g\u00f6sterilmesiyle tan\u0131 konuldu. \u0130ki hafta sonunda hasta \u015fifayla taburcu edildi. Yat\u0131\u015f\u0131n\u0131n ilk g\u00fcn\u00fcnde hastan\u0131n direkt kar\u015f\u0131ya bak\u0131\u015f\u0131nda fark edilmeyen, ancak \u00fcst g\u00f6zkapaklar\u0131 kald\u0131r\u0131larak a\u015fa\u011f\u0131ya bakt\u0131r\u0131ld\u0131\u011f\u0131 zaman ortaya \u00e7\u0131kan skleralar\u0131n \u00fcst yar\u0131s\u0131nda yerle\u015fik eritemli \u00f6demli subkonjonktival hemoraji g\u00f6r\u00fcnt\u00fcs\u00fc veren konjunktival s\u00fcfizyon (\u201csuffusion\u201d) fark edildi (Resim 1). Deri ve mukozalar\u0131nda ba\u015fka hemorajik bulgusu olmayan hastada iridosiklit veya koryoretinit saptanmad\u0131. Tedavinin be\u015finci g\u00fcn\u00fcnde lezyonlar kendili\u011finden kayboldu.<\/p>\n<p>Leptospiroz olgu serilerinde %28-99 oranlar\u0131nda p\u00fcr\u00fclan bir ak\u0131nt\u0131 olmaks\u0131z\u0131n konjunktival s\u00fcfizyon bulgusunun saptand\u0131\u011f\u0131 belirtilmektedir (2). Konjunktival s\u00fcfizyon leptospiroz d\u0131\u015f\u0131nda di\u011fer baz\u0131 infeksiyon hastal\u0131klar\u0131nda da bulunabilir. Tri\u015finelloz ve bitle bula\u015fan d\u00f6nek ate\u015fte (Borrelia recurrentis infeksiyonu) genellikle bulunur. S\u0131tma ve fare \u0131s\u0131r\u0131\u011f\u0131 ate\u015finde (Spirillum minus veya Streptobacillus moniliformis infeksiyonu) daha az oranda rastlanabilir. \u0130nfeksiyon d\u0131\u015f\u0131 ate\u015f nedenleri aras\u0131nda eri\u015fkin Still hastal\u0131\u011f\u0131nda g\u00f6r\u00fclebilir (3). Konjunktival tutulum, leptospiroz tan\u0131s\u0131nda Centers for Disease Control and Prevention (CDC) klinik kriterleri aras\u0131nda yer almaktad\u0131r (4).<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Say\u0131n Edit\u00f6r, \u00dcnsal ve arkada\u015flar\u0131 (1)\u2019n\u0131n Klimik Dergisi\u2019nin 2011 Aral\u0131k say\u0131s\u0131nda yay\u0131mlanm\u0131\u015f olan \u201cBir \u00e7\u00f6p toplay\u0131c\u0131s\u0131nda geli\u015fen ikterik leptospiroz olgusu\u201d ba\u015fl\u0131kl\u0131 olgu sunumunu, klini\u011fimizde yatmakta olan bir ba\u015fka \u00e7\u00f6p toplay\u0131c\u0131s\u0131n\u0131n Weil hastal\u0131\u011f\u0131 tan\u0131s\u0131yla takip edilmekte olmas\u0131 nedeniyle ilgiyle okudum. Leptospiroz ku\u015fkulu olgular\u0131n klinik tan\u0131s\u0131ndaki \u00f6nemi nedeniyle, kendi olgumuzda kar\u015f\u0131la\u015ft\u0131\u011f\u0131m\u0131z ve muayenede g\u00f6zden ka\u00e7abilecek bir bulguyu [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[5139],"tags":[],"class_list":["post-16139","post","type-post","status-publish","format-standard","hentry","category-editore-mektup"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/16139","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/comments?post=16139"}],"version-history":[{"count":4,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/16139\/revisions"}],"predecessor-version":[{"id":26352,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/16139\/revisions\/26352"}],"wp:attachment":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/media?parent=16139"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/categories?post=16139"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/tags?post=16139"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}