{"id":23300,"date":"2021-08-27T08:00:13","date_gmt":"2021-08-27T05:00:13","guid":{"rendered":"https:\/\/www.klimikdergisi.org\/?p=23300"},"modified":"2021-08-26T17:34:06","modified_gmt":"2021-08-26T14:34:06","slug":"hiv-infekte-pjp-olgulari","status":"publish","type":"post","link":"https:\/\/www.klimikdergisi.org\/tr\/2021\/08\/27\/hiv-infekte-pjp-olgulari\/","title":{"rendered":"HIV \u0130nfekte Pneumocystis jiroveci<\/i> Pn\u00f6monisi (PJP) Olgular\u0131nda Mortaliteyi Etkileyen Fakt\u00f6rler"},"content":{"rendered":"

G\u0130R\u0130\u015e<\/b><\/h2>\n

Pneumocystis jiroveci<\/i>, imm\u00fcn sistemi bask\u0131lanm\u0131\u015f hastalarda akci\u011fer tutulumu ile seyreden oport\u00fcnistik<\/span> bir patojen olup klinik bulgular\u0131 dispne, ta\u015fipne, \u00f6ks\u00fcr\u00fck ve ate\u015ftir. \u0130nsan ba\u011f\u0131\u015f\u0131kl\u0131k yetmezlik vir\u00fcs\u00fc (HIV) infeksiyonu olgular\u0131nda Pneumocystis jiroveci<\/i> s\u0131k rastlanan bir f\u0131rsat\u00e7\u0131 infeksiyondur ve bu hastalarda \u00f6nemli bir morbidite ve mortalite nedenidir. Pneumocystis jirovecii<\/i> pn\u00f6monisi (PJP), imm\u00fcn sistemi bask\u0131lanm\u0131\u015f hastalarda s\u0131k g\u00f6r\u00fclen f\u0131rsat\u00e7\u0131 bir infeksiyondur. Bu infeksiyonun epidemiyolojisi ve patogenezi tam olarak anla\u015f\u0131lmam\u0131\u015ft\u0131r.\u00a0 <\/span>PJP, Amerika Birle\u015fik Devletleri\u2019ndeki HIV ile infekte olmu\u015f hastalarda morbidite ve mortalitenin \u00f6nde gelen nedenlerindendir ve y\u00fcksek morbidite ve mortalite ile seyretti\u011finden, etkenin\u00a0 <\/span>h\u0131zl\u0131 ve do\u011fru tan\u0131s\u0131 olduk\u00e7a \u00f6nemli olmaktad\u0131r (1-6).<\/p>\n

PJP etkeni daha \u00f6nceleri bir protozoon olarak bilinmekte iken art\u0131k g\u00fcn\u00fcm\u00fczde mantar olarak d\u00fc\u015f\u00fcn\u00fclmektedir. Bronkoalveolar lavaj ile \u00f6rnek al\u0131nmas\u0131 PJP tan\u0131s\u0131 i\u00e7in alt\u0131n standart y\u00f6ntemdir ancak invaziv olmayan tan\u0131 testleri ve biyobelirte\u00e7lerde bulunmaktad\u0131r. Trimetoprim-s\u00fclfametoksazol, \u00f6nerilen tedavi ve profilaksi rejimidir, ancak trimetoprim-s\u00fclfametoksazol ila\u00e7 direnci de bir endi\u015fe kayna\u011f\u0131d\u0131r (7,8).<\/p>\n

Balgam ind\u00fcksiyonu, bronkoalveolar lavajdan (BAL) daha az duyarl\u0131 olmas\u0131na ra\u011fmen, HIV pozitif hastalarda PJP tan\u0131s\u0131 i\u00e7in basit ve invazif olmayan bir i\u015flemdir. PJP, imm\u00fcn sistemi bask\u0131lanm\u0131\u015f konakta g\u00f6r\u00fclen pulmoner parankimin infeksiyonudur. Radyografik bulgular de\u011fi\u015fkendir ve normalden bilateral buzlu cam opasitelerine kadar de\u011fi\u015fmektedir. PJP, tipik olarak g\u00f6\u011f\u00fcs bilgisayarl\u0131 tomografisinde (BT) buzlu cam opasiteleri ile interstisyel ve alveoler tutulum olarak ortaya \u00e7\u0131kmaktad\u0131r.\u00a0 <\/span>BT\u2019de buzlu cam opasitelerinin olmamas\u0131, HIV infekte\u00a0 <\/span>bireylerin, PJP i\u00e7in y\u00fcksek negatif prediktif de\u011fere sahip oldu\u011fu d\u00fc\u015f\u00fcn\u00fclmektedir (9-11).<\/p>\n

PJP tan\u0131s\u0131nda yard\u0131mc\u0131 olacak invaziv olmayan, uygun maliyetli y\u00f6ntemler \u00f6nerilmi\u015ftir; bunlar akci\u011fer grafisi, serum laktat dehidrojenaz (LDH) seviyeleri, CD4 say\u0131lar\u0131, solunum fonksiyon testleri, arter kan gaz\u0131 analizi \u00f6l\u00e7\u00fcmlerini i\u00e7ermektedir. PJP i\u00e7in hastane mortalite oranlar\u0131 %10 ile %60 aras\u0131nda de\u011fi\u015fmektedir (12,13).<\/p>\n

Bu \u00e7al\u0131\u015fmada amac\u0131m\u0131z klini\u011fimizde takip edilen HIV infekte PJP olgular\u0131nda mortalite oran\u0131 ve mortaliteyi etkileyen fakt\u00f6rleri ara\u015ft\u0131rmakt\u0131r.\u00a0 \u00a0<\/span><\/p>\n

Y\u00d6NTEMLER<\/b><\/h2>\n

\u00c7al\u0131\u015fmam\u0131za 2012-2019 tarihleri aras\u0131nda klini\u011fimizde takip edilmi\u015f olan HIV-positif olgular al\u0131nm\u0131\u015ft\u0131r. Olgular\u0131n retrospektif olarak bilgisayar kay\u0131tlar\u0131 incelenerek, klinik radyolojik ve laboratuvar olarak PJP tan\u0131s\u0131 koyulmu\u015f olan hastalar kaydedilmi\u015ftir. Bu hastalar\u0131n tan\u0131 s\u0131ras\u0131nda kaydedilmi\u015f olan ya\u015f, cinsiyet, komorbidite durumu, LDH, CD4, lenfosit, albumin de\u011ferleri ve kan gaz\u0131 sonu\u00e7lar\u0131 de\u011ferlendirilmi\u015ftir. Olgular\u0131n tamam\u0131n\u0131n kan gaz\u0131 sonu\u00e7lar\u0131na ula\u015f\u0131lamam\u0131\u015f oldu\u011fundan istatistiksel de\u011ferlendirme mevcut say\u0131lar \u00fczerinden yap\u0131lm\u0131\u015ft\u0131r. Olgular \u00f6l\u00fcmle sonu\u00e7lananlar ve sonu\u00e7lanmayanlar olarak iki gruba \u00a0 <\/span>ayr\u0131lm\u0131\u015f, bu olgularda mortalite oran\u0131 ve mortaliteyi etkileyen fakt\u00f6rler de\u011ferlendirilmi\u015ftir.\u00a0<\/span><\/p>\n

\u00c7al\u0131\u015fmam\u0131za Sa\u011fl\u0131k Bilimleri \u00dcniversitesi \u0130stanbul E\u011fitim Ara\u015ft\u0131rma Hastanesi Klinik Ara\u015ft\u0131rmalar Etik Kurulu taraf\u0131ndan 22.11.2019 tarih ve 2059 karar numaras\u0131 ile etik kurul onay\u0131 verilmi\u015ftir. Bu \u00e7al\u0131\u015fmada kesitsel retrospektif ara\u015ft\u0131rma y\u00f6ntemi kullan\u0131lm\u0131\u015ft\u0131r.<\/p>\n

\u0130statistiksel y\u00f6ntem olarak Mann-Whitney U test, nitel ba\u011f\u0131ms\u0131z verilerin analizinde \u00a0 <\/span>\u03c72 test, \u03c72 test ko\u015fullar\u0131 sa\u011flanamad\u0131\u011f\u0131nda Ficher\u2019\u0131n kesin testi kullan\u0131lm\u0131\u015ft\u0131r ve p<0.05 olmas\u0131 istatistiksel olarak anlaml\u0131 kabul edilmi\u015ftir.<\/p>\n

BULGULAR<\/b><\/h2>\n

\u00c7al\u0131\u015fmam\u0131za PJP tan\u0131s\u0131 ile takip edilen toplam 28 HIV infekte olgu al\u0131nm\u0131\u015ft\u0131r. Olgular\u0131n ya\u015f ortalamas\u0131 45.7 y\u0131l iken erkek oran\u0131n\u0131n %78.6 (18\/28) oldu\u011fu belirlenmi\u015ftir.\u00a0 <\/span>Olgular\u0131m\u0131zda genel hastane mortalite oran\u0131n\u0131n %35.7 (10\/28), yo\u011fun bak\u0131m \u00fcnitesinde takip edilmi\u015f ve mekanik ventilasyon ihtiyac\u0131 olanlarda %80 (4\/5) oldu\u011fu belirlenmi\u015ftir. \u00c7al\u0131\u015fmam\u0131zda LDH y\u00fcksekli\u011finin, kad\u0131n cinsiyetin, ART alm\u0131yor olman\u0131n, lenfosit ve alb\u00fcmin de\u011ferinin d\u00fc\u015f\u00fckl\u00fc\u011f\u00fcn\u00fcn mortaliteyi etkileyen fakt\u00f6rler oldu\u011fu belirlenmi\u015ftir. Mortalitesi olan ve olmayan olgular\u0131m\u0131z\u0131n demografik \u00f6zellikleri ve laboratuvar de\u011ferleri Tablo 1\u2019de g\u00f6r\u00fclmektedir.<\/p>\n

\"\"<\/a>

Tablo 1.<\/strong> \u00d6l\u00fcmle Sonu\u00e7lanan ve Sonu\u00e7lanmayan Olgular\u0131m\u0131z\u0131n Demografik ve Laboratuvar De\u011ferlerinin Kar\u015f\u0131la\u015ft\u0131rmas\u0131<\/p><\/div>\n

TARTI\u015eMA<\/b><\/h2>\n

PJP, imm\u00fcn sistemi bask\u0131lanm\u0131\u015f hastalarda ya\u015fam\u0131 tehdit eden bir infeksiyondur.\u00a0 <\/span>Molek\u00fcler teknikler, bu etkenin kompleks h\u00fccre biyolojisine yeni bak\u0131\u015f a\u00e7\u0131lar\u0131 sa\u011flam\u0131\u015ft\u0131r (14,15).\u00a0<\/span><\/p>\n

Pneumocystis pn\u00f6monisi, ba\u011f\u0131\u015f\u0131kl\u0131\u011f\u0131 bask\u0131lanm\u0131\u015f pop\u00fclasyonda ve \u00f6zellikle HIV infekte olan hastalarda ortaya \u00e7\u0131kan f\u0131rsat\u00e7\u0131 bir infeksiyondur (16).<\/p>\n

Perreira ve arkada\u015flar\u0131n\u0131n \u0130spanya\u2019da yapt\u0131klar\u0131, PJP epidemiyolojisi ve risk fakt\u00f6rlerindeki de\u011fi\u015fimlerin ara\u015ft\u0131r\u0131ld\u0131\u011f\u0131 \u00e7al\u0131\u015fmalar\u0131nda ise 4554 PJP vakas\u0131 rapor edilmi\u015f ve 1204\u2019\u00fcn\u00fcn (%26.4) HIV-negatif oldu\u011fu belirlenmi\u015ftir. \u00c7al\u0131\u015fma s\u00fcresince, HIV-negatif hastalarda 4.4\u2019ten 6.3\u2019e y\u00fckseldi\u011fi ve HIV infekte hastalarda 15.5\u2019den 13.4\u2019e d\u00fc\u015ft\u00fc\u011f\u00fc belirlenmi\u015ftir. HIV-negatif vakalar de\u011ferlendirildi\u011finde hematolojik neoplazmlar (%29), kronik akci\u011fer hastal\u0131klar\u0131 (%15.9) ve hematolojik olmayan kanserler (%14.9) oldu\u011fu g\u00f6r\u00fclm\u00fc\u015ft\u00fcr (17).<\/p>\n

\u00c7al\u0131\u015fmam\u0131zda, hastalar\u0131m\u0131z\u0131n ya\u015f ortalamas\u0131n\u0131n 45.7 ve %78.6\u2019s\u0131n\u0131n erkek oldu\u011fu belirlenmi\u015ftir. Konuyla ilgili olarak yap\u0131lan benzer \u00e7al\u0131\u015fmalar incelendi\u011finde, ya\u015f ortalamalar\u0131n\u0131n 42.1, 36(21-72), 40(23-68), 53, 38, 34(18-70) ve erkek oran\u0131n %60.5, %94.3, %84.2, %41.4, %97, %95.7 oldu\u011fu tespit edilmi\u015f olup \u00e7al\u0131\u015fmam\u0131zla benzerdir (17,18,19,20,21,22).<\/p>\n

Yapm\u0131\u015f oldu\u011fumuz \u00e7al\u0131\u015fmada genel hastane mortalite oran\u0131m\u0131z %35.7 ve yo\u011fun bak\u0131m \u00fcnitesinde (YB\u00dc) takip edilmi\u015f olan olgular\u0131m\u0131z ise % 80\u2019dir. Benzer \u00e7al\u0131\u015fmalarda genel hastane mortalitesine bak\u0131ld\u0131\u011f\u0131nda s\u0131ras\u0131yla %13.5, %11.6, %75.6, %56.4, %28 ve %25.4 olarak belirlenmi\u015ftir (18,19,20,21,22,23). YB\u00dc\u2019de takip edilmi\u015f ya da mekanik ventilasyon ihtiyac\u0131 olan hastalarda ise bu oran\u0131n s\u0131ras\u0131yla %29, %79, %58 oldu\u011fu\u00a0 <\/span>bildirilmi\u015ftir (19,22,23).<\/p>\n

PJP\u2019de mortalite a\u00e7\u0131s\u0131ndan risk fakt\u00f6rlerini belirleyebilmeyi ama\u00e7lad\u0131\u011f\u0131m\u0131z \u00e7al\u0131\u015fmam\u0131zda LDH y\u00fcksekli\u011finin, alb\u00fcmin d\u00fc\u015f\u00fckl\u00fc\u011f\u00fcn\u00fcn, kad\u0131n cinsiyetin, lenfosit say\u0131s\u0131 d\u00fc\u015f\u00fckl\u00fc\u011f\u00fcn\u00fcn ve ART alm\u0131yor olman\u0131n mortalite a\u00e7\u0131s\u0131ndan\u00a0 <\/span>risk fakt\u00f6r\u00fc oldu\u011fu belirlenmi\u015ftir. PJP\u00a0 <\/span>tan\u0131s\u0131\u00a0 <\/span>alm\u0131\u015f 262 hastan\u0131n de\u011ferlendirildi\u011fi bir\u00a0 <\/span>\u00e7al\u0131\u015fmada ise mekanik ventilasyon \u00a0 <\/span>ihtiyac\u0131,\u00a0 <\/span>pn\u00f6motoraks geli\u015fimi ve d\u00fc\u015f\u00fck serum alb\u00fcmini, mortalitenin artmas\u0131n\u0131n ba\u011f\u0131ms\u0131z belirleyicileri oldu\u011fu bildirilmi\u015ftir ve antiretroviral tedavinin\u00a0 <\/span>(ART)\u00a0 <\/span>hastanede yatmadan \u00f6nce veya hastanede yat\u0131\u015f s\u0131ras\u0131nda ba\u015flanm\u0131\u015f olmas\u0131yla mortalite aras\u0131nda ise ili\u015fki olmad\u0131\u011f\u0131 belirlenmi\u015ftir (19).<\/p>\n

Konuyla ilgili 82 hasta ile yap\u0131lm\u0131\u015f bir di\u011fer \u00e7al\u0131\u015fmada ise k\u00f6t\u00fc prognostik fakt\u00f6rler i\u00e7inde ya\u015f\u0131n b\u00fcy\u00fck olmas\u0131 (55 \u00b1 16 ve 45 \u00b1 17, p = 0.014) ve y\u00fcksek APACHE II skoru (20 \u00b1 5 ve 17 \u00b1 5, p = 0.01) oldu\u011fu belirlenmi\u015f; Forest ve arkada\u015flar\u0131n\u0131n AIDS ile ili\u015fkili PJP\u2019nin neden oldu\u011fu solunum yetmezli\u011fi olan hastalar\u0131n de\u011ferlendirildi\u011fi \u00e7al\u0131\u015fmada alb\u00fcmin ve LDH de\u011ferinin s\u0131ras\u0131yla \u00f6len olgularda 22.5 g\/L , 1850 U\/L ya\u015fayan olgularda ise 24.5 g\/L ,1370 U\/L oldu\u011fu\u00a0 <\/span>g\u00f6sterilmi\u015ftir (20,21).<\/p>\n

Fernandez ve arkada\u015flar\u0131n\u0131n AIDS\u2019li hastalarda PJP sonucunu etkileyen prognostik fakt\u00f6rleri\u00a0 <\/span>ara\u015ft\u0131rd\u0131\u011f\u0131 \u00e7al\u0131\u015fmada, tek de\u011fi\u015fkenli analize g\u00f6re ya\u015f>35 olmas\u0131n\u0131n, ba\u015fvuru s\u0131ras\u0131ndaki ciddi akut solunum yetmezli\u011finin, ba\u015fvuru s\u0131ras\u0131ndaki serum laktat dehidrojenaz (LDH) de\u011ferinin y\u00fcksekli\u011finin ve serum alb\u00fcmin seviyesinin d\u00fc\u015f\u00fck olmas\u0131n\u0131n k\u00f6t\u00fc prognozla ili\u015fkili oldu\u011funu g\u00f6sterilmi\u015ftir (22).<\/p>\n

Almanya\u2019dan Schmidt ve arkada\u015flar\u0131n\u0131n yapt\u0131\u011f\u0131 PJP tan\u0131s\u0131 alan 240 hastan\u0131n yakla\u015f\u0131k yar\u0131s\u0131n\u0131n\u00a0 <\/span>HIV-pozitif (%52) oldu\u011fu \u00e7al\u0131\u015fmadaki\u00a0 <\/span>\u00e7ok de\u011fi\u015fkenli regresyon analizinde ise\u00a0 <\/span>LDH d\u00fczeyi hastane mortalitesinin belirleyicisi olarak tan\u0131mlanm\u0131\u015f ve mortalite \u00f6ng\u00f6r\u00fcs\u00fcnde LDH d\u00fczeyi 495 U\/L e\u015fik de\u011ferinin\u00a0 <\/span>duyarl\u0131l\u0131k ve \u00f6zg\u00fcll\u00fc\u011f\u00fcn\u00fcn %70 oldu\u011fu\u00a0 <\/span>bildirilmi\u015ftir (16).<\/p>\n

PJP tan\u0131l\u0131 HIV-pozitif 1001 hastan\u0131n dahil edildi\u011fi bir di\u011fer \u00e7al\u0131\u015fmada, LDH>350 U\/L, PaO2 <70mmHg, anemi, CD4<50 h\u00fccrenin k\u00f6t\u00fc prognoz ile ili\u015fkili olabilece\u011fi bildirilmi\u015ftir (23). Sun ve arkada\u015flar\u0131n\u0131n AIDS tan\u0131l\u0131 PJP hastalar\u0131nda \u015fiddeti ve mortaliteyi tahmin etmek i\u00e7in kan biyobelirte\u00e7leriyle yapm\u0131\u015f oldu\u011fu \u00e7al\u0131\u015fmada ise 32 hasta \u00e7al\u0131\u015fmaya al\u0131nm\u0131\u015f ve CRP, WBC, LDH ve ferritin d\u00fczeylerinin s\u0131ras\u0131yla ya\u015fayan hastalarda 44.17 mg\/L, 5.6109\/L, 358.16 U\/L, 870.95 ng\/mL oldu\u011fu, \u00f6len hastalarda ise 73.16 mg\/L, 7.7309\/L, 586.29 U\/L, 1789.83 ng\/mL oldu\u011fu belirlenmi\u015ftir. Ayr\u0131ca plazma IL-8, LDH ve IL-6 \/ IL-10 oran\u0131n\u0131n PCP hastalar\u0131nda ciddiyetin erken de\u011ferlendirilmesi ve \u00f6l\u00fcmc\u00fcl sonu\u00e7lar\u0131n \u00f6ng\u00f6r\u00fclmesi i\u00e7in faydal\u0131 olabilece\u011fi bildirilmi\u015ftir (24).<\/p>\n

PJP\u2019li hastalarda pulmoner komplikasyonlar\u0131n incelendi\u011fi bir di\u011fer \u00e7al\u0131\u015fmada da HIV bula\u015f yolunun ya\u015f, e\u011fitim, sigara i\u00e7me \u00f6yk\u00fcs\u00fc veya antiretroviral tedavi kullan\u0131m\u0131n\u0131n risk a\u00e7\u0131s\u0131ndan anlaml\u0131 bir fark yaratmad\u0131\u011f\u0131, d\u00fc\u015f\u00fck CD4 say\u0131s\u0131n\u0131n ve \u0131rk farkl\u0131l\u0131klar\u0131n\u0131n etkili oldu\u011fu belirlenmi\u015f; 522 hasta ile yap\u0131lan bir di\u011fer \u00e7al\u0131\u015fmada ise \u00e7al\u0131\u015fmaya al\u0131nan olgular\u0131n \u00a0 <\/span>121\u2019ine (%23) yeni HIV tan\u0131s\u0131 kondu\u011fu bu hastalarla daha \u00f6nce HIV infeksiyonu tan\u0131s\u0131 alm\u0131\u015f olan\u00a0 <\/span>hastalar kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131\u011f\u0131nda, mortalite, mekanik ventilasyon s\u0131kl\u0131\u011f\u0131 veya yo\u011fun bak\u0131ma giri\u015f a\u00e7\u0131s\u0131ndan arada\u00a0 <\/span>fark olmad\u0131\u011f\u0131 g\u00f6r\u00fclm\u00fc\u015ft\u00fcr (25,26).<\/p>\n

HIV negatif hastalar ile yap\u0131lan \u00e7al\u0131\u015fmalara bak\u0131ld\u0131\u011f\u0131nda; hematolojik malignitesi olan eri\u015fkin hastalarda \u00a0 <\/span>risk fakt\u00f6rlerini de\u011ferlendirmek i\u00e7in yap\u0131lm\u0131\u015f olan \u00e7al\u0131\u015fmada ya\u015f ortalamas\u0131n\u0131n 51, PJP\u2019nin\u00a0 <\/span>vincristin kullan\u0131m\u0131 ve bir\u00a0 <\/span>aydan fazla g\u00fcnl\u00fck kortikosteroid tedavisi al\u0131nmas\u0131n\u0131n risk fakt\u00f6r\u00fc olabilece\u011fini bildirilmi\u015ftir (27). Kageyama ve arkada\u015flar\u0131n\u0131n \u00e7al\u0131\u015fmas\u0131nda ise sistemik otoimm\u00fcn hastal\u0131\u011f\u0131 olan hastalarda, PJP mortalite oran\u0131n\u0131n %44.2 olup PJP tan\u0131s\u0131ndaki ya\u015f\u0131n ileri ve lenfosit say\u0131s\u0131n\u0131n d\u00fc\u015f\u00fck olmas\u0131n\u0131n mortalite a\u00e7\u0131s\u0131ndan ba\u011f\u0131ms\u0131z risk fakt\u00f6rleri oldu\u011fu bildirilmi\u015ftir (28).<\/p>\n

Liu ve arkada\u015flar\u0131n\u0131n HIV negatif hastalarda PJP sonu\u00e7lar\u0131 ile ili\u015fkili klinik \u00f6zellikleri ve fakt\u00f6rleri tan\u0131mlamak i\u00e7in yapm\u0131\u015f oldu\u011fu meta-analizde ise mortalite oran\u0131 %30.6 ve PJP geli\u015fimi i\u00e7in en s\u0131k g\u00f6r\u00fclen altta yatan hastal\u0131\u011f\u0131n\u00a0 <\/span>hematolojik maligniteler (%29.1) oldu\u011fu ve\u00a0 <\/span>bunu otoimm\u00fcn hastal\u0131k (%20.1), organ veya kemik ili\u011fi nakli (%14.0) ve solid t\u00fcm\u00f6rlerin takip etti\u011fi\u00a0 <\/span>(%6.0) g\u00f6r\u00fclm\u00fc\u015ft\u00fcr. Ya\u015fl\u0131l\u0131k, kad\u0131n cinsiyeti, semptomlar\u0131n ba\u015flang\u0131c\u0131ndan tan\u0131ya kadar ge\u00e7en s\u00fcre, solunum yetmezli\u011fi, solid t\u00fcm\u00f6rler, y\u00fcksek laktat dehidrogenaz, d\u00fc\u015f\u00fck serum alb\u00fcmin d\u00fczeyinin mortalite ile ili\u015fkili risk fakt\u00f6rleri oldu\u011funu belirtmi\u015flerdir (29).<\/p>\n

Sonu\u00e7 olarak hasta say\u0131m\u0131z\u0131n az olmas\u0131 \u00e7al\u0131\u015fman\u0131n k\u0131s\u0131tl\u0131l\u0131\u011f\u0131n\u0131 olu\u015ftururken, geli\u015fen teknolojik olanaklar \u00e7er\u00e7evesinde bu hastalarda etkene y\u00f6nelik tan\u0131 testleri ve duyarl\u0131l\u0131k ara\u015ft\u0131rmalar\u0131 yap\u0131lmas\u0131n\u0131n konuyu daha ileri boyutlara ta\u015f\u0131yabilece\u011fini, bu hastalarda tan\u0131, takip ve erken tedavi a\u00e7\u0131s\u0131ndan faydal\u0131 olabilece\u011fini d\u00fc\u015f\u00fcnmekteyiz.\u00a0<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

G\u0130R\u0130\u015e Pneumocystis jiroveci, imm\u00fcn sistemi bask\u0131lanm\u0131\u015f hastalarda akci\u011fer tutulumu ile seyreden oport\u00fcnistik bir patojen olup klinik bulgular\u0131 dispne, ta\u015fipne, \u00f6ks\u00fcr\u00fck ve ate\u015ftir. \u0130nsan ba\u011f\u0131\u015f\u0131kl\u0131k yetmezlik vir\u00fcs\u00fc (HIV) infeksiyonu olgular\u0131nda Pneumocystis jiroveci s\u0131k rastlanan bir f\u0131rsat\u00e7\u0131 infeksiyondur ve bu hastalarda \u00f6nemli bir morbidite ve mortalite nedenidir. Pneumocystis jirovecii pn\u00f6monisi (PJP), imm\u00fcn sistemi bask\u0131lanm\u0131\u015f hastalarda s\u0131k g\u00f6r\u00fclen […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[5129],"tags":[5163,2997,5250],"class_list":["post-23300","post","type-post","status-publish","format-standard","hentry","category-ozgun-arastirma","tag-hiv-2","tag-mortalite","tag-pjp"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/23300","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\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/comments?post=23300"}],"version-history":[{"count":4,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/23300\/revisions"}],"predecessor-version":[{"id":23546,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/23300\/revisions\/23546"}],"wp:attachment":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/media?parent=23300"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/categories?post=23300"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/tags?post=23300"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}