{"id":25856,"date":"2022-11-17T11:44:13","date_gmt":"2022-11-17T08:44:13","guid":{"rendered":"https:\/\/www.klimikdergisi.org\/?p=25856"},"modified":"2023-01-13T11:13:53","modified_gmt":"2023-01-13T08:13:53","slug":"maymun-cicegi-virusu-infeksiyonu-ilk-iki-olgu","status":"publish","type":"post","link":"https:\/\/www.klimikdergisi.org\/tr\/2022\/11\/17\/maymun-cicegi-virusu-infeksiyonu-ilk-iki-olgu\/","title":{"rendered":"Maymun \u00c7i\u00e7e\u011fi Virusu \u0130nfeksiyonu: T\u00fcrkiye\u2019de G\u00f6r\u00fclen \u0130lk \u0130ki Olgu"},"content":{"rendered":"

G\u0130R\u0130\u015e\u00a0<\/span><\/h2>\n

Maymun \u00e7i\u00e7e\u011fi virusu (\u201cMonkeypox virus \u2013 MPV\u201d) infeksiyonu Poxviridae<\/i> ailesindeki Orthopoxvirus <\/i>cinsinin bir \u00fcyesi olan MPV\u2019nin etken oldu\u011fu zoonotik bir hastal\u0131kt\u0131r. Orta ve Bat\u0131 Afrika\u2019n\u0131n ya\u011fmur ormanlar\u0131nda endemik olarak g\u00f6r\u00fclen MPV, infekte hayvan ya da insanlar arac\u0131l\u0131\u011f\u0131yla di\u011fer k\u0131talara ta\u015f\u0131nmas\u0131 sonucu b\u00f6lgesel olgu k\u00fcmelenmelerine neden olmaktad\u0131r.<\/span> \u0130nk\u00fcbasyon periyodu 6-14 g\u00fcn olup ate\u015f, ba\u015f a\u011fr\u0131s\u0131, yorgunluk, yayg\u0131n v\u00fccut a\u011fr\u0131lar\u0131, lenfadenopati ve cilt d\u00f6k\u00fcnt\u00fcleri ortaya \u00e7\u0131kabilmektedir. Lezyonlar; mak\u00fcl, pap\u00fcl, vezik\u00fcl ve ard\u0131ndan p\u00fcst\u00fcl g\u00f6r\u00fcn\u00fcm\u00fc al\u0131rlar. P\u00fcst\u00fcller, genellikle kurutlanarak kendili\u011finden ortadan kalkar. Bu s\u00fcre\u00e7, genellikle 2-4 hafta s\u00fcrmektedir. Ancak imm\u00fcns\u00fcprese ki\u015filerde hastal\u0131k a\u011f\u0131r seyrederek bakteriyel infeksiyon, pn\u00f6moni, sepsis, ensefalit komplikasyonlar\u0131 g\u00f6r\u00fclebilir (1, 2).\u00a0<\/span><\/span><\/p>\n

Olgular klini\u011fimizde izlenen ve \u00fclkemizde g\u00f6r\u00fclen ilk iki MPV infeksiyonu olma \u00f6zelli\u011fi ta\u015f\u0131d\u0131\u011f\u0131ndan sunulmaya de\u011fer bulunmu\u015ftur.\u00a0<\/span><\/p>\n

OLGU 1<\/h2>\n
\"\"<\/a>

Resim 1A, 1B, 1C.<\/strong> Olgu 1\u2019in ba\u015fvurusu s\u0131ras\u0131ndaki p\u00fcst\u00fcler lezyonlar\u0131n\u0131n g\u00f6r\u00fcn\u00fcm\u00fc<\/p><\/div>\n

Ellerde, g\u00f6vdede, al\u0131nda ve anal b\u00f6lgede yer alan p\u00fcst\u00fcler d\u00f6k\u00fcnt\u00fc \u015fik\u00e2yeti ile poliklini\u011fimize ba\u015fvuran 37 ya\u015f\u0131ndaki erkek hastan\u0131n \u015fikayetleri 4-5 g\u00fcn \u00f6nce ba\u015flam\u0131\u015ft\u0131. \u0130mm\u00fcn yetersizlik ile takipli olan hastan\u0131n yakla\u015f\u0131k 20 g\u00fcn \u00f6ncesine dayanan korunmas\u0131z cinsel temas \u00f6yk\u00fcs\u00fc mevcuttu. Seyahat \u00f6yk\u00fcs\u00fc ve \u00e7evresinde benzer \u015fikayetleri olan ki\u015fi yoktu. <\/span>D\u00f6k\u00fcnt\u00fclerin ba\u015flang\u0131c\u0131nda yakla\u015f\u0131k bir g\u00fcn s\u00fcren ate\u015f \u015fik\u00e2yeti ve ayn\u0131 zamanda ba\u015flayarak e\u015flik eden kar\u0131n a\u011fr\u0131s\u0131, bo\u011faz a\u011fr\u0131s\u0131 ve i\u015ftahs\u0131zl\u0131k \u015fikayetleri mevcuttu. D\u00f6k\u00fcnt\u00fcn\u00fcn \u00f6zellikleri; t\u00fcm v\u00fccutta yayg\u0131n, p\u00fcst\u00fcler ve ka\u015f\u0131nt\u0131l\u0131 olmas\u0131yd\u0131. Ayr\u0131ca anal b\u00f6lgedeki lezyonlara a\u011fr\u0131 da e\u015flik etmekteydi. Fizik muayenesinde; ate\u015f 37.2 \u00b0C, kan bas\u0131nc\u0131 110\/70 mmHg, nab\u0131z 85\/dakika olarak \u00f6l\u00e7\u00fcld\u00fc. Her iki elin dorsal ve plantar y\u00fcz\u00fcnde, frontal b\u00f6lgede, anal b\u00f6lgede, sa\u011f omuz ve kar\u0131n b\u00f6lgesinde p\u00fcst\u00fcler lezyonlar g\u00f6r\u00fcld\u00fc (Resim 1A, 1B, 1C). Lezyonlar\u0131n her birinin farkl\u0131 evrede oldu\u011fu tespit edildi. Frontal b\u00f6lgedeki lezyon ka\u015f\u0131nt\u0131 nedeniyle hemorajik ak\u0131nt\u0131l\u0131yd\u0131. Dudakta vezik\u00fcler d\u00f6k\u00fcnt\u00fc olup di\u011fer sistem muayeneleri do\u011fald\u0131. Laboratuvar tetkiklerinde; l\u00f6kosit (WBC) 9570\/mm3<\/sup>, lenfosit (Lym) 3230\/mm3<\/sup>, hemoglobin (Hgb) 14.4 gr\/dl, C-reaktif protein (CRP) 15 mg\/lt, anti-varisella zoster virus (VZV) imm\u00fcnoglob\u00fclin M (IgM) negatif, anti-VZV imm\u00fcnoglob\u00fclin G (IgG) pozitif, anti-herpes simpleks virus(HSV) tip 1\/2 IgM negatif, anti-HSV tip 1\/2 IgG pozitif, Treponema pallidum<\/i> hemaglutinasyon (TPHA) testi pozitif, \u201cVenereal Disease Research Laboratory 1(VDRL)\u201d testi negatifti. Hasta daha \u00f6nce sifilis nedeniyle tedavi alm\u0131\u015ft\u0131. Di\u011fer biyokimyasal testler normal s\u0131n\u0131rlarda bulundu.\u00a0<\/span><\/p>\n

Hasta, p\u00fcst\u00fcler lezyonlar\u0131n\u0131n etyolojisinin ara\u015ft\u0131r\u0131lmas\u0131 ve MPV infeksiyonu \u00f6n tan\u0131s\u0131 ile takip ve izolasyonunun yap\u0131lmas\u0131 i\u00e7in servisimize yat\u0131r\u0131ld\u0131. E\u015flik eden dudaktaki vezik\u00fcler d\u00f6k\u00fcnt\u00fcler nedeniyle ampirik olarak valasiklovir 3x1gr PO, ka\u015f\u0131nt\u0131 i\u00e7in setirizin 10 mg tablet 1×1, anal b\u00f6lgedeki a\u011fr\u0131l\u0131 lezyonlar i\u00e7in topikal lidokain pomad tedavileri ba\u015fland\u0131.<\/p>\n

\"\"<\/a>

Resim 1D, 1E.<\/strong> Olgu 1\u2019in yat\u0131\u015f\u0131n\u0131n 3. g\u00fcn\u00fcnde lezyonlar\u0131n\u0131n g\u00f6r\u00fcn\u00fcm\u00fc<\/p><\/div>\n

\"\"<\/a>

Resim 1F.<\/strong> Olgu1\u2019in tedavisinin 4. g\u00fcn\u00fcnde lezyonlar\u0131n g\u00f6r\u00fcn\u00fcm\u00fc<\/p><\/div>\n

\u0130nfeksiyondan korunma \u00f6nemlerine uyularak, lezyonlardan ve orofarenksten al\u0131nan s\u00fcr\u00fcnt\u00fc \u00f6rnekleri, MPV polimeraz zincir reaksiyonu (PZR) tetkiki \u00e7al\u0131\u015f\u0131lmas\u0131 i\u00e7in Sa\u011fl\u0131k Bakanl\u0131\u011f\u0131 Halk Sa\u011fl\u0131\u011f\u0131 Genel M\u00fcd\u00fcrl\u00fc\u011f\u00fc Viroloji Laboratuvar\u0131\u2019na, biyog\u00fcvenlik \u00f6nlemleri gere\u011fince \u00fc\u00e7l\u00fc ta\u015f\u0131ma sistemiyle so\u011fuk zincir kurallar\u0131na uyularak g\u00f6nderildi. <\/span>Hastan\u0131n takibinin 3. g\u00fcn\u00fcnde lezyonlar kurutlanmaya ba\u015flad\u0131 (Resim 1D, 1E). Ayn\u0131 g\u00fcn MPV PZR sonucu pozitif olarak sonu\u00e7land\u0131. Hasta, valasiklovir tedavisi kesilerek semptomatik tedavi ile yedi g\u00fcn boyunca izole edilerek takip edildi; bu s\u00fcre\u00e7te ate\u015fi olmad\u0131. Ka\u015f\u0131nt\u0131 ve a\u011fr\u0131 \u015fikayetleri tedavi ile d\u00fczeldi. Lezyonlar\u0131n kurutlanarak iyile\u015fmesi nedeniyle tedavisi tamamlanarak, bula\u015fma yollar\u0131 ve izolasyon ile ilgili olarak bilgilendirilen hasta; bir hafta sonra infeksiyon hastal\u0131klar\u0131 ve klinik mikrobiyoloji poliklinik kontrol\u00fc \u00f6nerilerek taburcu edildi (Resim 1F).\u00a0<\/span><\/p>\n

OLGU 2<\/h2>\n

\u0130mm\u00fcn yetersizlik nedeniyle takipli olan 52 ya\u015f\u0131ndaki erkek hasta; 4-5 g\u00fcn devam eden penis ve skrotumda a\u011fr\u0131l\u0131 p\u00fcst\u00fcler lezyonlar\u0131n yan\u0131 s\u0131ra son 2 g\u00fcn ortaya \u00e7\u0131kan ate\u015f, eklem a\u011fr\u0131s\u0131, penil ve skrotal \u00f6dem, hiperemi ve bilateral a\u011fr\u0131l\u0131 ing\u00fcinal lenfadenopati \u015fik\u00e2yet ve bulgular\u0131yla poliklini\u011fimize ba\u015fvurdu. Yakla\u015f\u0131k 2 hafta \u00f6nce bir kez olan ve daha sonra tekrarlamayan genital ak\u0131nt\u0131 \u015fik\u00e2yeti olmas\u0131 nedeniyle d\u0131\u015f merkezde sef-triakson tedavisi uyguland\u0131\u011f\u0131n\u0131 belirtti. Hastan\u0131n yakla\u015f\u0131k bir hafta \u00f6nce korunmas\u0131z cinsel temas \u00f6yk\u00fcs\u00fc mevcut olup partnerinde benzer \u015fikayetler yoktu. Hasta ve partnerinin seyahat \u00f6yk\u00fcs\u00fc de bulunmamaktayd\u0131. \u00c7ocukken \u00e7i\u00e7ek a\u015f\u0131s\u0131 yap\u0131ld\u0131\u011f\u0131 \u00f6\u011frenildi.\u00a0<\/span><\/p>\n

\"\"<\/a>

Resim 2.<\/strong> Olgu 2\u2019nin takibinin ilk g\u00fcn\u00fc skrotal lezyonlar\u0131n\u0131n g\u00f6r\u00fcn\u00fcm\u00fc<\/p><\/div>\n

Fizik muayenede; tansiyon 110\/70 mmHg, oda havas\u0131nda \u00f6l\u00e7\u00fclen SpO2 \u00a0<\/span><\/sub> %99, ate\u015f 36.9 \u00b0C, nab\u0131z 87\/dk olarak \u00f6l\u00e7\u00fcld\u00fc. Penis ve skrotumda yayg\u0131n multiple g\u00f6bekli p\u00fcst\u00fcler lezyonlar ile diff\u00fcz \u00f6dem ve hiperemi (Resim 2), bilateral inguinal b\u00f6lgelerde ise palpasyonla a\u011fr\u0131l\u0131, sert k\u0131vamda, yakla\u015f\u0131k \u00e7aplar\u0131 1cm b\u00fcy\u00fckl\u00fc\u011f\u00fcnde lenfadenopatiler mevcuttu. \u00a0<\/span><\/p>\n

Laboratuvar tetkiklerinde; WBC 11 000\/mm3<\/sup>, CRP 27 mg\/lt, Hgb 15.2g\/dl, Lym 2.27 mm3<\/sup>, anti-VZV IgM negatif, anti-VZV IgG pozitif, anti-HSV tip 1\/2 IgM negatif, anti HSV tip 1\/2 IgG pozitif, TPHA ve VDRL testleri negatifti. Di\u011fer biyokimyasal testler normal s\u0131n\u0131rlarda bulundu.\u00a0<\/span><\/p>\n

Hasta MPV infeksiyonu \u00f6n tan\u0131s\u0131yla tetkik tedavi ve izolasyon amac\u0131yla servisimize yat\u0131r\u0131ld\u0131. Hastaya ampirik olarak seftriakson 2×1 gr ve doksisiklin 2×100 mg tablet ba\u015fland\u0131. \u00d6rnek al\u0131m\u0131 ve \u00f6rneklerin laboratuvara g\u00f6nderimi s\u0131ras\u0131nda biyog\u00fcvenlik \u00f6nlem ve prosed\u00fcrlerine uyularak, testisteki p\u00fcst\u00fcler lezyonlar\u0131ndan ve orofarenksten al\u0131nan s\u00fcr\u00fcnt\u00fc \u00f6rnekleri, Sa\u011fl\u0131k Bakanl\u0131\u011f\u0131 Halk Sa\u011fl\u0131\u011f\u0131 Genel M\u00fcd\u00fcrl\u00fc\u011f\u00fc Viroloji Laboratuvar\u0131\u2019na MPV PZR tetkiki \u00e7al\u0131\u015f\u0131lmas\u0131 amac\u0131yla g\u00f6nderildi. Hastan\u0131n servisimizdeki takipleri s\u0131ras\u0131nda ek \u015fik\u00e2yeti olmad\u0131. Penis ve testisteki \u00f6dem ve d\u00f6k\u00fcnt\u00fc \u015fikayetleri geriledi. Takibinin \u00fc\u00e7\u00fcnc\u00fc g\u00fcn\u00fcnde MPV PZR tetkikinin pozitif olarak raporlanmas\u0131 nedeniyle ampirik ba\u015flanan antibiyoterapisi kesildi. Takiple \u015fikayetleri d\u00fczelen hasta, takip ve tedaviyi reddetti\u011fini belirten imzal\u0131 belge vermesi nedeniyle servisimizden kendi iste\u011fi ile ayr\u0131ld\u0131. Bir hafta sonra infeksiyon hastal\u0131klar\u0131 ve klinik mikrobiyoloji poliklinik kontrol\u00fc \u00f6nerildi. Hastaya bula\u015fma yollar\u0131 ve izolasyon ile ilgili bilgilendirme yap\u0131larak hastan\u0131n evde izolasyonu \u00f6nerildi.<\/p>\n

\u0130RDELEME<\/h2>\n

MPV taksonomik olarak, variola ve vaksinya virus ile birlikte Poxviridae <\/i>ailesinin Orthopoxvirus <\/i>cinsi i\u00e7erisinde yer almaktad\u0131r. Zarfl\u0131, \u00e7ift sarmall\u0131 bir DNA virusu olup Orta Afrika ve Bat\u0131 Afrika k\u00f6kenli iki farkl\u0131 su\u015fu bulunmaktad\u0131r. Orta Afrika su\u015funun daha bula\u015f\u0131c\u0131 ve a\u011f\u0131r klinik tablolara neden oldu\u011fu belirtilmektedir (3, 4). 1970 y\u0131l\u0131nda Demokratik Kongo Cumhuriyeti\u2019nde, virusun insanlarda maymun \u00e7i\u00e7e\u011fi hastal\u0131\u011f\u0131na neden oldu\u011fu tan\u0131mlanm\u0131\u015ft\u0131r (5). Hastal\u0131k; 1977 y\u0131l\u0131nda \u00e7i\u00e7ek hastal\u0131\u011f\u0131n\u0131n eradike <\/i>edilmesi nedeniyle, 1980 y\u0131l\u0131ndan itibaren rutin \u00e7i\u00e7ek hastal\u0131\u011f\u0131 ba\u011f\u0131\u015f\u0131klamas\u0131n\u0131n terkedilmesinden <\/i>g\u00fcn\u00fcm\u00fcze kadar ge\u00e7en d\u00f6nemde, Orta ve Bat\u0131 Afrika b\u00f6lgesinde endemik olarak g\u00f6r\u00fclmeye devam etmi\u015ftir.<\/p>\n

Di\u011fer b\u00f6lgelerde ise endemik b\u00f6lgelere seyahat \u00f6yk\u00fcs\u00fc olan sporadik olgular \u015feklinde ortaya \u00e7\u0131km\u0131\u015ft\u0131r (6). Afrika b\u00f6lgesi d\u0131\u015f\u0131nda g\u00f6r\u00fclen ilk salg\u0131n 2003 y\u0131l\u0131nda Amerika Birle\u015fik Devletleri\u2019nde meydana gelmi\u015f olup 71 ki\u015fi maymun \u00e7i\u00e7e\u011fi hastal\u0131\u011f\u0131 tan\u0131s\u0131 alm\u0131\u015ft\u0131r (7-9). G\u00fcn\u00fcm\u00fczde k\u00fcresel olarak devam eden MPV salg\u0131n\u0131, Avrupa\u2019da 2022 y\u0131l\u0131 May\u0131s ay\u0131nda ba\u015flayarak di\u011fer b\u00f6lgelere yay\u0131lm\u0131\u015f ve Temmuz ay\u0131nda 79 \u00fclkede laboratuvarlar taraf\u0131ndan do\u011frulanm\u0131\u015f 22 485 olgu bildirilmi\u015ftir (10).\u00a0 <\/span>\u00dclkemizde ise do\u011frulanm\u0131\u015f ilk olguyu 30 Haziran 2022 tarihinde Sa\u011fl\u0131k Bakan\u0131 a\u00e7\u0131klam\u0131\u015ft\u0131r (11).<\/p>\n

Hastal\u0131\u011f\u0131n; do\u011frudan infekte hayvan ve insanlar\u0131n cilt lezyonlar\u0131yla veya dolayl\u0131 olarak kontamine giysiler ve yatak \u00e7ar\u015faflar\u0131yla temas d\u0131\u015f\u0131nda damlac\u0131k yoluyla da yay\u0131labilece\u011fi bildirilmi\u015ftir. Cinsel yolla bula\u015f\u0131n temas yoluyla bula\u015fa katk\u0131da bulunup bulunmad\u0131\u011f\u0131 belirsiz olup salg\u0131n s\u0131ras\u0131nda olgulardan izole edilen bask\u0131n su\u015fun, mortalite oran\u0131 %1\u2019den az olarak bildirilen Bat\u0131 Afrika su\u015fu olmas\u0131 ve olgular\u0131n \u00e7o\u011funun bu b\u00f6lgeye seyahat \u00f6yk\u00fcs\u00fcn\u00fcn olmamas\u0131 yak\u0131n temasla bula\u015f\u0131n rol\u00fcne dikkatleri \u00e7ekmi\u015ftir (12).<\/p>\n

Hastal\u0131k, genellikle yak\u0131n veya cinsel temas \u00f6yk\u00fcs\u00fc olan erkeklerle seks yapan erkeklerde (\u201cmen who have sex with men – MSM\u201d) g\u00f6r\u00fclm\u00fc\u015f olmakla birlikte olgular\u0131n sadece bu bireylerle s\u0131n\u0131rl\u0131 olmad\u0131\u011f\u0131 g\u00f6zlenmi\u015ftir. MSM bireyler aras\u0131nda bula\u015fma zincirleri oldu\u011fu da bildirilmektedir (12). Hastal\u0131kla ilgili olarak ki\u015filerde olu\u015fabilecek etiketlenme ve damgalanma korkusunun, sa\u011fl\u0131k hizmeti almaktan ka\u00e7\u0131nmaya neden olabilece\u011finin t\u00fcm sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131 ve konu ile ilgili meslek gruplar\u0131 taraf\u0131ndan salg\u0131nla m\u00fccadele kapsam\u0131nda g\u00f6z \u00f6n\u00fcnde bulundurulmas\u0131 gerekti\u011fini d\u00fc\u015f\u00fcnmekteyiz.<\/p>\n

Semptomlar, maruziyetten 5-21 (ortalama 6-16) g\u00fcn sonra ortaya \u00e7\u0131kmakta olup (12) olgular\u0131m\u0131z\u0131n \u00f6yk\u00fclerinde de bu s\u00fcrelerle uyumlu yak\u0131n temas \u00f6yk\u00fcs\u00fc bulunmaktayd\u0131. Literat\u00fcrde, prodromal d\u00f6nemde ate\u015f, halsizlik, lenfadenopati ve ba\u015f a\u011fr\u0131s\u0131 olabilece\u011fi belirtilmi\u015ftir (12). Bununla uyumlu olarak ilk olgumuz d\u00f6k\u00fcnt\u00fc \u00f6ncesinde ate\u015f ve halsizlik, ikinci olgumuz ise ate\u015f, eklem a\u011fr\u0131s\u0131 ve lenf nodlar\u0131nda \u015fi\u015flik tariflemekteydi.<\/p>\n

Literat\u00fcrde prodromal belirtilerden 1-5 g\u00fcn sonra, y\u00fcz veya genital b\u00f6lgede ba\u015flay\u0131p daha sonra kol ve bacaklara yay\u0131lan, farkl\u0131 veya e\u015f zamanlarda g\u00f6r\u00fclebilen mak\u00fcl, g\u00f6bekle\u015fen vezik\u00fcl, pap\u00fcl ve \u00fclser \u015feklinde d\u00f6k\u00fcnt\u00fclerin ortaya \u00e7\u0131kaca\u011f\u0131 bildirilmi\u015ftir (12, 13). \u0130lk olguda d\u00f6k\u00fcnt\u00fcler literat\u00fcrle uyumlu \u015fekil ve s\u0131ra ile g\u00f6r\u00fcld\u00fc; ikinci olguda ise genital b\u00f6lgeyle s\u0131n\u0131rl\u0131 kald\u0131. D\u00f6k\u00fcnt\u00fclerin farkl\u0131 evre ve tipte g\u00f6r\u00fclmeleri sifilis, VZV, HSV infenksiyonlar\u0131n\u0131n ay\u0131r\u0131c\u0131 tan\u0131s\u0131n\u0131n yap\u0131lmas\u0131n\u0131 gerekli k\u0131lmaktad\u0131r (12); olgular\u0131m\u0131zda bu hastal\u0131klar serolojik tetkiklerle ekarte edildi.<\/p>\n

Virusun genetik materyalinin PZR ile tespit edilmesi yoluyla hastal\u0131\u011f\u0131n tan\u0131s\u0131 koyulmaktad\u0131r; hastal\u0131\u011fa \u00f6zg\u00fc IgM ve IgG tipi antikorlar\u0131 ELISA y\u00f6ntemiyle saptayan serolojik testler de yak\u0131n zamanda \u00fcretilmi\u015ftir (14). Olgular\u0131m\u0131z\u0131n tan\u0131s\u0131 ise PZR ile koyulmu\u015ftur.\u00a0<\/span><\/p>\n

Hastal\u0131k \u00e7o\u011funlukla kendini s\u0131n\u0131rlay\u0131c\u0131 \u00f6zellikte olup tedavisi semptomatiktir; ilerleyici ve \u015fiddetli olgularda \u00e7i\u00e7ek hastal\u0131\u011f\u0131 virusuna kar\u015f\u0131 etkili oldu\u011fu kan\u0131tlanm\u0131\u015f tecovirimat, sidofovir ve brinsidofovir gibi antiviral ajanlar\u0131n kesin olmamakla birlikte maymun \u00e7i\u00e7e\u011fi hastal\u0131\u011f\u0131nda da etkili olabilece\u011fi belirtilmektedir (1). Olgular\u0131m\u0131z\u0131n takibi s\u0131ras\u0131nda, destek tedavi ile hastal\u0131\u011f\u0131n kendini s\u0131n\u0131rlayarak komplikasyon geli\u015fmeden iyile\u015fti\u011fi g\u00f6zlendi.<\/p>\n

\u00c7i\u00e7ek a\u015f\u0131s\u0131n\u0131n, maymun \u00e7i\u00e7e\u011fi hastal\u0131\u011f\u0131n\u0131 \u00f6nlemede yakla\u015f\u0131k %85 oran\u0131nda etkili oldu\u011fu g\u00f6zlemsel bir \u00e7al\u0131\u015fmada g\u00f6sterilmi\u015ftir (15). G\u00fcn\u00fcm\u00fczde \u00e7i\u00e7ek a\u015f\u0131lar\u0131 klinik kullan\u0131ma sunulmu\u015f olmamakla birlikte ABD G\u0131da ve \u0130la\u00e7 Kurumu (FDA) ve Avrupa \u0130la\u00e7 Kurumu (EMA) 2019 y\u0131l\u0131nda hastal\u0131\u011f\u0131n \u00f6nlenmesi i\u00e7in modifiye edilmi\u015f aten\u00fce a\u015f\u0131 virusuna (Ankara su\u015fu) dayal\u0131 yeni bir a\u015f\u0131y\u0131 onaylam\u0131\u015ft\u0131r. Ancak a\u015f\u0131 k\u0131s\u0131tl\u0131 bir \u015fekilde ula\u015f\u0131labilir durumdad\u0131r (1). Takip etti\u011fimiz ilk olguda \u00e7i\u00e7ek a\u015f\u0131s\u0131 \u00f6yk\u00fcs\u00fc mevcut olmay\u0131p ikinci olgunun \u00e7ocuklu\u011funda \u00e7i\u00e7ek a\u015f\u0131s\u0131 yap\u0131lm\u0131\u015f olmas\u0131 dikkat \u00e7ekici noktalardan biriydi.<\/p>\n","protected":false},"excerpt":{"rendered":"

G\u0130R\u0130\u015e\u00a0 Maymun \u00e7i\u00e7e\u011fi virusu (\u201cMonkeypox virus \u2013 MPV\u201d) infeksiyonu Poxviridae ailesindeki Orthopoxvirus cinsinin bir \u00fcyesi olan MPV\u2019nin etken oldu\u011fu zoonotik bir hastal\u0131kt\u0131r. Orta ve Bat\u0131 Afrika\u2019n\u0131n ya\u011fmur ormanlar\u0131nda endemik olarak g\u00f6r\u00fclen MPV, infekte hayvan ya da insanlar arac\u0131l\u0131\u011f\u0131yla di\u011fer k\u0131talara ta\u015f\u0131nmas\u0131 sonucu b\u00f6lgesel olgu k\u00fcmelenmelerine neden olmaktad\u0131r. \u0130nk\u00fcbasyon periyodu 6-14 g\u00fcn olup ate\u015f, ba\u015f a\u011fr\u0131s\u0131, […]<\/p>\n","protected":false},"author":4,"featured_media":26274,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[5131],"tags":[2683,5561,5373,5562],"class_list":["post-25856","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-olgu-sunumu","tag-dokuntu","tag-maymun-cicegi","tag-salgin","tag-virus-infeksiyonu"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/25856","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\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/comments?post=25856"}],"version-history":[{"count":5,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/25856\/revisions"}],"predecessor-version":[{"id":26347,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/25856\/revisions\/26347"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/media\/26274"}],"wp:attachment":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/media?parent=25856"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/categories?post=25856"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/tags?post=25856"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}