{"id":26008,"date":"2022-12-26T10:00:07","date_gmt":"2022-12-26T07:00:07","guid":{"rendered":"https:\/\/www.klimikdergisi.org\/?p=26008"},"modified":"2023-01-13T11:08:52","modified_gmt":"2023-01-13T08:08:52","slug":"tatarcik-hummasi","status":"publish","type":"post","link":"https:\/\/www.klimikdergisi.org\/tr\/2022\/12\/26\/tatarcik-hummasi\/","title":{"rendered":"Antalya B\u00f6lgesinde Vekt\u00f6r \u0130li\u015fkili Endemik Viral \u0130nfeksiyon: Tatarc\u0131k Hummas\u0131"},"content":{"rendered":"

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

Tatarc\u0131k hummas\u0131, Phlebotomus cinsi tatarc\u0131k sine\u011finin vekt\u00f6r oldu\u011fu, Arboviruslar aras\u0131nda yer alan Bunyavirideae ailesinden Phlebovirus cinsine ait \u201csandfly fever\u201d virusunun (SFV) neden oldu\u011fu viral bir infeksiyondur. SFV\u2019nin tan\u0131mlanm\u0131\u015f serotipleri; \u201csandfly Sicilian\u201d virusu (SFSV; Sicilya serotipi), \u201csandfly Cyprus\u201d virusu (SFCV; K\u0131br\u0131s serotipi), \u201csandfly Naples\u201d virusu (SFNV; Napoli serotipi) ve \u201cToscana\u201d virusu (TOSV; Toskana serotipi)\u2019dur (1). Virusun neden oldu\u011fu \u201csandfly fever (SF)\u201d hastal\u0131\u011f\u0131 literat\u00fcrde; kum sine\u011fi ate\u015fi, filebotom ate\u015fi, papatasi ate\u015fi gibi farkl\u0131 adlarla an\u0131lmakta olup bir\u00e7ok Akdeniz \u00fclkesinde de \u00fc\u00e7 g\u00fcn ate\u015fi olarak bilinmektedir.\u00a0<\/span><\/p>\n

\u0130lk kez \u0130kinci D\u00fcnya Sava\u015f\u0131 (1938-1945) s\u0131ras\u0131nda \u0130talya\u2019da m\u00fcttefik askerlerinde g\u00f6zlenmi\u015f ve hastalardan SFSV izole edilmi\u015ftir (2). SFV\u2019leri, Akdeniz havzas\u0131, Kuzey Afrika, Orta Do\u011fu ve G\u00fcney Asya gibi subtropikal b\u00f6lgelerde \u00f6nemli bir sa\u011fl\u0131k sorunudur (3). T\u00fcrkiye\u2019de Akdeniz\u2019e k\u0131y\u0131s\u0131 olan illerimizde yaz aylar\u0131nda endemik olarak g\u00f6r\u00fclmekte olup \u0130\u00e7 Anadolu B\u00f6lgesi\u2019nde sanitasyon sorunu olan yerle\u015fim yerlerinde salg\u0131n \u015feklinde tatarc\u0131k hummas\u0131 olgular\u0131 bildirilmi\u015ftir (4, 5). SFSV, SFCV ve SFNV serotipleri insanlarda kendi kendini s\u0131n\u0131rlayan ate\u015fli hastal\u0131\u011fa; TOSV serotipi ise n\u00f6rotropik bir virus olup semptomatik meningoensefalite neden olur. Hastal\u0131\u011f\u0131n kulu\u00e7ka d\u00f6nemi 3-6 g\u00fcn olarak bilinmektedir. Ate\u015f, ba\u015f a\u011fr\u0131s\u0131, retroorbital a\u011fr\u0131, miyalji, halsizlik, bulant\u0131-kusma, konjunktival k\u0131zar\u0131kl\u0131k, ishal, i\u015ftahs\u0131zl\u0131k l\u00f6kopeni, trombositopeni, alanin aminotransferaz (ALT), aspartat aminotransferaz (AST) ve kreatin kinaz (CK) y\u00fcksekli\u011fi en \u00f6nemli klinik ve laboratuvar bulgular\u0131d\u0131r. Tan\u0131; epidemiyolojik, klinik, laboratuvar ve serolojik testler ile koyulmaktad\u0131r. Hastal\u0131k mortalite ile ili\u015fkili olmamas\u0131na ra\u011fmen akut d\u00f6nemindeki konstit\u00fcsyonel semptomlar ve infeksiyon sonras\u0131 d\u00f6nemde kronik yorgunluk ki\u015filerde ciddi halsizlik ve bitkinli\u011fe neden oldu\u011fu i\u00e7in i\u015f g\u00fcc\u00fc kayb\u0131na ve psikolojik sorunlara neden olmaktad\u0131r (6, 7).<\/p>\n

Tatarc\u0131k hummas\u0131n\u0131n subtropikal b\u00f6lgelerde endemik olmas\u0131n\u0131n ana sebebi vekt\u00f6r ili\u015fkili bir viral infeksiyon olmas\u0131d\u0131r. Hastal\u0131\u011f\u0131n ana vekt\u00f6r\u00fc olan Phlebotomus papatasi bu b\u00f6lgelerde yayg\u0131n olarak bulunmaktad\u0131r. Phlebotomus t\u00fcr\u00fc sineklerin en uygun ya\u015fam ko\u015fullar\u0131 25-28 o<\/sup><\/span>C s\u0131cakl\u0131k ve nem oran\u0131n\u0131n %50 ve \u00fczeri oldu\u011fu subtropikal b\u00f6lgelerdir. Boyutlar\u0131 birka\u00e7 mm kadar k\u00fc\u00e7\u00fck oldu\u011fu i\u00e7in fark edilemeyebilirler; esinti ve r\u00fczg\u00e2rdan etkilendikleri i\u00e7in genelde zemine yak\u0131n y\u00fckseklikte u\u00e7ar ve en fazla \u00fc\u00e7 metre y\u00fcksekli\u011fe kadar \u00e7\u0131kabilirler.\u00a0 <\/span>Is\u0131rd\u0131klar\u0131 yerde ge\u00e7ici yanma ve ka\u015f\u0131nt\u0131 oldu\u011fu i\u00e7in halk aras\u0131nda yaka\u011fan, yakarca, g\u00fcbd\u00fc\u015fen olarak da bilinir.\u00a0<\/span><\/p>\n

\u00dclkemizde de \u00f6zellikle Akdeniz k\u0131y\u0131lar\u0131nda tatarc\u0131k hummas\u0131 yaz aylar\u0131nda yayg\u0131n olarak g\u00f6r\u00fclmektedir. Subtropikal bir b\u00f6lge olan Antalya ili ve \u00e7evresinde tatarc\u0131k hummas\u0131 yaz aylar\u0131nda en s\u0131k g\u00f6r\u00fclen viral infeksiyonlardan biridir.\u00a0 <\/span>Bu \u00e7al\u0131\u015fmada, tatarc\u0131k hummas\u0131 \u00f6n tan\u0131s\u0131yla takip edilen hastalar\u0131n demografik, klinik ve laboratuvar verilerinin irdelenmesi ama\u00e7land\u0131.<\/p>\n

Y\u00d6NTEMLER<\/h2>\n

\u00c7al\u0131\u015fmaya, Ocak 2011-Aral\u0131k 2018 tarihleri aras\u0131nda Sa\u011fl\u0131k Bilimleri \u00dcniversitesi Antalya E\u011fitim ve Ara\u015ft\u0131rma Hastanesi\u2019nde tatarc\u0131k hummas\u0131 \u00f6n tan\u0131s\u0131 ile takip edilen hastalar dahil edildi. Brusella, sitomegalovirus (CMV), Epstein-Barr virus (EBV), toksoplazma, hepatit A, B ve C, kazan\u0131lm\u0131\u015f ba\u011f\u0131\u015f\u0131kl\u0131k yetersizli\u011fi sendromu (\u201cacquired\u00a0 <\/span>immune deficinecy syndrome\u00a0 <\/span>– AIDS\u201d) , sifiliz gibi di\u011fer infeksiyonlar ekarte edildi. Tan\u0131mlay\u0131c\u0131 ve retrospektif y\u00f6ntemle y\u00fcr\u00fct\u00fclen \u00e7al\u0131\u015fmada hasta verilerine; hastane elektronik bilgi sisteminden \u201cA 93.1 Kum Sine\u011fi Ate\u015fi ICD 10\u201d tan\u0131 kodunun taranmas\u0131yla ula\u015f\u0131ld\u0131. Tatarc\u0131k hummas\u0131n\u0131n serolojik tan\u0131s\u0131 i\u00e7in, T.C. Sa\u011fl\u0131k Bakanl\u0131\u011f\u0131 Halk Sa\u011fl\u0131\u011f\u0131 Genel M\u00fcd\u00fcrl\u00fc\u011f\u00fc Mikrobiyoloji Referans Laboratuvar\u0131\u2019na 2 ml serum \u00f6rnekleri g\u00f6nderilmi\u015f olup SF IgM ve IgG testleri imm\u00fcnfloresan antikor y\u00f6ntemi ile \u00e7al\u0131\u015f\u0131lm\u0131\u015ft\u0131r.\u00a0<\/span><\/p>\n

Hastalar; epidemiyolojik \u00f6yk\u00fc, klinik durum, laboratuvar bulgular\u0131 ve serolojik testlerle de\u011ferlendirildi. Tatarc\u0131k temas\u0131n\u0131n veya \u0131s\u0131r\u0131k izinin olmas\u0131 epidemiyolojik \u00f6yk\u00fc olarak tan\u0131mland\u0131. Klinik durum olarak, ate\u015f, ciddi halsizlik, miyalji, ba\u015f a\u011fr\u0131s\u0131, bulant\u0131, kusma ve konjunktival k\u0131zar\u0131kl\u0131\u011fa bak\u0131ld\u0131. Hastaneye ilk kabulde laboratuvar bulgular\u0131ndaki l\u00f6kopeni, trombositopeni, ALT ve AST y\u00fcksekli\u011fi pozitif bulgular olarak kabul edildi. Epidemiyolojik \u00f6yk\u00fc, klinik durum ve laboratuvar bulgular\u0131 olan hastalar \u201colas\u0131 olgu\u201d, beraberinde IgM pozitif olan hastalar \u201ckesin olgu\u201d olarak kabul edildi.\u00a0<\/span><\/p>\n

Verilerin istatistiksel analizinde SPSS (\u201cStatistical Package for the Social Sciences\u201d) versiyon 20.0 program\u0131 (IBM Corp., Armonk, NY, ABD) kullan\u0131ld\u0131.\u00a0Say\u0131sal veriler ortalama \u00b1 standart sapma olarak, kategorik veriler oran ve y\u00fczde olarak verildi.<\/p>\n

\u00c7al\u0131\u015fma i\u00e7in Sa\u011fl\u0131k Bilimleri \u00dcniversitesi Antalya E\u011fitim ve Ara\u015ft\u0131rma Hastanesi Etik Kurulu\u2019ndan 17 May\u0131s 2018 tarih ve 10\/15 karar numaras\u0131yla onay al\u0131nm\u0131\u015ft\u0131r.\u00a0<\/span><\/p>\n

BULGULAR<\/h2>\n
\"\"<\/a>

Tablo 1.<\/strong> Hastalar\u0131n Demografik \u00d6zellikleri ve Klinik Bulgular<\/p><\/div>\n

\"\"<\/a>

Tablo 2.<\/strong> Hastalar\u0131n Laboratuvar Bulgular\u0131<\/p><\/div>\n

Hastane elektronik bilgi sisteminden \u201cA 93.1 Kum Sine\u011fi Ate\u015fi ICD 10\u201d tan\u0131 kodunun taranmas\u0131yla 64 hastan\u0131n verilerine ula\u015f\u0131ld\u0131; ortalama ya\u015f 33.1\u00b19.7 (minimum=19-<\/p>\n

maksimum=58) y\u0131ld\u0131. Hastalar\u0131n 29 (%45.3)\u2019u kad\u0131n, 35(%54.7)\u2019i erkekti. Phlebotomus t\u00fcr\u00fc sinekler al\u00e7ak seviyelerde u\u00e7abildi\u011fi i\u00e7in riskli temas y\u00f6n\u00fcnden hastalar\u0131n ikamet etti\u011fi kat y\u00fcksekli\u011fi sorguland\u0131\u011f\u0131nda; hastalar\u0131n 13 (%20.3)\u2019\u00fc giri\u015f kat\u0131nda, 45 (%70.3)\u2019i birinci katta, 6 (%9.4)\u2019s\u0131n\u0131n ise ikinci kat veya \u00fcst\u00fcndeki katlarda oturdu\u011fu g\u00f6r\u00fcld\u00fc. Hastalar\u0131n 34 (%53.1)\u2019\u00fcnde tatarc\u0131k temas \u00f6yk\u00fcs\u00fc mevcut olmakla birlikte 59 (%92.2)\u2019unda tatarc\u0131k \u0131s\u0131r\u0131k izi saptand\u0131. En s\u0131k rastlanan semptom %95.3 oran\u0131yla ate\u015f olmakla birlikte, hastalar\u0131n %89\u2019unda miyalji ve halsizlik, %79.6\u2019s\u0131nda ba\u015f a\u011fr\u0131s\u0131, %57.9\u2019unda artralji, %50\u2019sinde konjunktival k\u0131zar\u0131kl\u0131k ve %29.7\u2019sinde bulant\u0131-kusma mevcuttu. Kar\u0131n a\u011fr\u0131s\u0131 en az g\u00f6r\u00fclen \u015fikayetti (Tablo 1).<\/p>\n

Laboratuvar bulgular\u0131 incelendi\u011finde, ALT y\u00fcksekli\u011fi ortalama 284.7 U\/lt olup hastalar\u0131n %93\u2019\u00fcnde normal s\u0131n\u0131r\u0131n \u00fcst\u00fcndeydi; AST ise %92\u2019sinde y\u00fcksekti ve ortalama de\u011feri 243.5 U\/lt olarak tespit edildi. L\u00f6kopeni %79.6, trombositopeni %78 ve CK y\u00fcksekli\u011fi %54 oranlar\u0131nda g\u00f6zlendi (Tablo 2).\u00a0<\/span><\/p>\n

C-reaktif protein (CRP) d\u00fczeyi ortalama 12.4 mg\/lt idi. Tatarc\u0131k hummas\u0131n\u0131n serolojik tan\u0131s\u0131 i\u00e7in g\u00f6nderilen 19 hasta \u00f6rne\u011finin 15 (%78.9)\u2019inde IgM pozitif iken 4 (%21)\u2019\u00fcnde negatif saptand\u0131; 10 (%52.6) hasta \u00f6rne\u011finde ise IgG pozitif olup 9 hasta \u00f6rne\u011finde IgG ve IgM beraber pozitif saptand\u0131. Sadece bir hastada izole IgG pozitifli\u011fi g\u00f6r\u00fcld\u00fc. Bu bulgulara g\u00f6re 19 hastan\u0131n %78.9\u2019u \u201ckesin olgu\u201d olarak kabul edilirken toplam\u0131 olu\u015fturan 64 hastan\u0131n %23.4\u2019\u00fc \u201ckesin olgu\u201d, %76.6\u2019s\u0131 ise \u201colas\u0131 olgu\u201d olarak de\u011ferlendirildi.\u00a0<\/span><\/span><\/p>\n

\u0130RDELEME\u00a0<\/span><\/h2>\n

Subtropikal b\u00f6lgede olan ilimizde, yaz ve sonbahar aylar\u0131nda vekt\u00f6r ili\u015fkili bir infeksiyon olan tatarc\u0131k hummas\u0131 s\u0131k g\u00f6r\u00fclmektedir. Tatarc\u0131k hummas\u0131; 3-6 g\u00fcnl\u00fck ink\u00fcbasyon d\u00f6nemi sonras\u0131nda 39-40 o<\/sup><\/span>C\u2019ye kadar \u00e7\u0131kan ate\u015f, ba\u015f a\u011fr\u0131s\u0131, kas eklem a\u011fr\u0131s\u0131, fotofobi, retroorbital a\u011fr\u0131, halsizlik, i\u015ftahs\u0131zl\u0131k ile seyreden kendi kendini s\u0131n\u0131rlayan bir viral hastal\u0131kt\u0131r (6).\u00a0 <\/span>Ate\u015f hastal\u0131\u011f\u0131n olmazsa olmaz klinik bulgusu olmas\u0131 nedeniyle, \u00fc\u00e7 g\u00fcn ate\u015fi ve kum sine\u011fi ate\u015fi gibi adlarla da an\u0131lmaktad\u0131r; ortalama 3-4 g\u00fcn s\u00fcrmekte ve kendili\u011finden kaybolmaktad\u0131r. Halsizlik uzun s\u00fcre devam etti\u011fi i\u00e7in hastalar\u0131n tamamen iyile\u015fmesi bir ay\u0131 bulmaktad\u0131r. \u00c7al\u0131\u015fmam\u0131zda ate\u015f %95.3 oran\u0131yla en s\u0131k g\u00f6r\u00fclen bulgu olup myalji ve halsizlik %89 oran\u0131yla ikinci s\u0131radayd\u0131. 2008-2009 y\u0131llar\u0131nda Ankara-Mamak b\u00f6lgesinde ya\u015fanan salg\u0131nda 50 olgunun hepsinde ate\u015f, %96\u2019s\u0131nda halsizlik, %80\u2019inde kas a\u011fr\u0131s\u0131 ve\/veya eklem a\u011fr\u0131s\u0131, %66\u2019s\u0131nda ba\u015f a\u011fr\u0131s\u0131, %56\u2019s\u0131nda ise \u0131\u015f\u0131\u011fa duyarl\u0131l\u0131k ve g\u00f6zlerde k\u0131zar\u0131kl\u0131k saptanm\u0131\u015ft\u0131r (8). K\u0131br\u0131s ve Mallorca\u2019y\u0131 ziyaret sonras\u0131 SFSV ile infekte olan \u0130sve\u00e7li turistlerin hepsinde de ate\u015f ve miyalji saptanm\u0131\u015ft\u0131r (9). Di\u011fer \u00e7al\u0131\u015fmalar da incelendi\u011finde ate\u015f en s\u0131k g\u00f6r\u00fclen klinik bulgudur (7, 10, 11).\u00a0<\/span><\/p>\n

Tatarc\u0131k hummas\u0131 \u00f6zellikle gen\u00e7 n\u00fcfusu etkilemektedir (9). \u00c7al\u0131\u015fmam\u0131zda hastalar\u0131n ya\u015f ortalamas\u0131 33.1\u00b19.7 (minimum=19-maksimum=58) y\u0131ld\u0131. \u00dclkemizde yap\u0131lan \u00e7al\u0131\u015fmalarda da en s\u0131k \u00fc\u00e7\u00fcnc\u00fc ve d\u00f6rd\u00fcnc\u00fc dekadda olan ki\u015filerin etkilendi\u011fi g\u00f6zlenmi\u015ftir (4, 5, 8). \u00c7al\u0131\u015fmam\u0131zda tespit edilen ya\u015f ortalamas\u0131 literat\u00fcrle uyumluydu. B\u00f6lgemizdeki iklim ko\u015fullar\u0131 g\u00f6z \u00f6n\u00fcne al\u0131nd\u0131\u011f\u0131nda, hastal\u0131\u011f\u0131n \u00f6zellikle \u00fc\u00e7\u00fcnc\u00fc dekadda daha s\u0131k g\u00f6r\u00fclmesinin nedeni olarak yaz aylar\u0131nda a\u015f\u0131r\u0131 nem ve s\u0131caktan dolay\u0131 daha \u00e7ok gen\u00e7 ya\u015f grubunun balkon ve dam gibi a\u00e7\u0131k havada yatmas\u0131 nedeniyle Phlebotomus\u2019lar ile temas kaynakl\u0131 oldu\u011fu d\u00fc\u015f\u00fcn\u00fclmektedir. Ayr\u0131ca son y\u0131llarda pop\u00fcler hale gelen kamp yapma etkinlikleri Phlebotomus\u2019larla temas riskini art\u0131rmaktad\u0131r.<\/p>\n

Fizik muayene bulgusu olarak hastalarda, \u00f6zellikle ekstremitelerde \u0131s\u0131r\u0131k izleri, hepatosplenomegali, omuz ve g\u00f6\u011f\u00fcs b\u00f6lgesinde pembe eritemat\u00f6z d\u00f6k\u00fcnt\u00fcler g\u00f6r\u00fclebilmektedir (12).\u00a0 <\/span>Tatarc\u0131k hummas\u0131nda y\u00fcz ve boyunda k\u0131zar\u0131kl\u0131k g\u00f6r\u00fclebilir. G\u00f6zde konjonktivadaki kanlanma, ucu korneaya varan bir \u00fc\u00e7gen \u015feklinde dikkati \u00e7eker (Pick belirtisi), fotofobi ve g\u00f6zde ya\u015farma olabilir. A\u011f\u0131zda yumu\u015fak damakta ve yuta\u011f\u0131n arka kenar\u0131nda kanlanma olabilir. Nadiren splenomegali geli\u015fir fakat lenfadenopati g\u00f6zlenmez (13). \u00c7al\u0131\u015fmam\u0131zda hastalar\u0131n %50\u2019sinde konjonktival k\u0131zar\u0131kl\u0131k mevcuttu. Fizik muayenede splenomegali ise sadece alt\u0131 hastada saptand\u0131.\u00a0<\/span><\/span><\/p>\n

Tan\u0131da kullan\u0131lan laboratuvar tetkiklerinde; en s\u0131k olarak l\u00f6kopeni, trombositopeni, ALT, AST ve CK d\u00fczeylerinde y\u00fckseklik saptanmaktad\u0131r. \u00c7al\u0131\u015fmam\u0131zdaki laboratuvar parametreleri incelendi\u011finde; hastalar\u0131n %80\u2019ine yak\u0131n\u0131nda l\u00f6kopeni ve trombositopeni, %90\u2019dan fazlas\u0131nda karaci\u011fer enzim d\u00fczeylerinde ortalama 5-6 kat art\u0131\u015f, yar\u0131s\u0131nda ise CK d\u00fczeyinde 3-4 kat art\u0131\u015f tespit edildi. Bulgular\u0131m\u0131z literat\u00fcrdeki di\u011fer \u00e7al\u0131\u015fmalar ile benzerdi (4, 5, 8). Tatarc\u0131k hummas\u0131n\u0131n laboratuvar bulgular\u0131 di\u011fer hepatit yapan etkenlerin neden oldu\u011fu laboratuvar bulgular\u0131ndan farkl\u0131 de\u011fildir. Bu nedenle, laboratuvar bulgular\u0131n\u0131n ay\u0131r\u0131c\u0131 tan\u0131da de\u011feri d\u00fc\u015f\u00fckt\u00fcr. \u00d6zellikle hepatit bulgular\u0131 olan hastalarda; brusella, CMV, EBV, toksoplazma, hepatit A, B, C, AIDS ve sifiliz gibi infeksiyonlar ekarte edildikten sonra epidemiyolojik \u00f6yk\u00fcs\u00fc olan hastalarda tatarc\u0131k hummas\u0131 akla gelmelidir.\u00a0<\/span><\/p>\n

\u00a0<\/span>Hastal\u0131\u011f\u0131n klinik ve laboratuvar bulgular\u0131 di\u011fer viral infeksiyonlar ile benzer oldu\u011fundan endemik b\u00f6lgelerde epidemiyolojik \u00f6yk\u00fc tan\u0131 koymada \u00f6nemlidir. Hastan\u0131n ya\u015fad\u0131\u011f\u0131 yer, ka\u00e7\u0131nc\u0131 katta oturdu\u011fu, tatarc\u0131k temas\u0131 ve seyahat \u00f6yk\u00fcs\u00fc sorgulanmal\u0131d\u0131r. Phlebotomus\u2019lar y\u00fcksek seviyelerde u\u00e7amad\u0131\u011f\u0131ndan temas i\u00e7in risk fakt\u00f6rlerinden biri binalar\u0131n alt katlar\u0131nda ikamet etmektir (13, 14). \u00c7al\u0131\u015fmam\u0131zda hastalar\u0131n %91.6\u2019s\u0131 zemin ve birinci katta oturmaktayd\u0131. Phlebotomus\u2019lar\u0131n hem g\u00f6zle g\u00f6r\u00fclemeyecek kadar k\u00fc\u00e7\u00fck olmalar\u0131 hem de daha \u00e7ok ak\u015famlar\u0131 insanlardan kan emmesi nedeniyle \u0131s\u0131r\u0131k yerinde hafif yanma hissi d\u0131\u015f\u0131nda \u015fik\u00e2yet olmamas\u0131 m\u00fcmk\u00fcnd\u00fcr; bu nedenle her zaman \u0131s\u0131r\u0131k \u00f6yk\u00fcs\u00fc olamayabilece\u011fi ak\u0131lda tutulmal\u0131d\u0131r. Benzer \u015fekilde bizim \u00e7al\u0131\u015fmam\u0131zda da temas \u00f6yk\u00fcs\u00fc; %53.1 oran\u0131yla %92.2 olan \u0131s\u0131r\u0131k izi oran\u0131ndan daha d\u00fc\u015f\u00fckt\u00fcr. Fizik muayenede \u00f6zellikle ekstremite gibi cildin a\u00e7\u0131k b\u00f6lgelerinde \u0131s\u0131rmalara ba\u011fl\u0131 1-2 mm \u00e7ap\u0131nda pap\u00fcler lezyonlar mutlaka ara\u015ft\u0131r\u0131lmal\u0131d\u0131r.\u00a0<\/span><\/p>\n

Endemik b\u00f6lgelere seyahat eden ki\u015filerde tatarc\u0131k hummas\u0131 seyahat ili\u015fkili infeksiyonlar aras\u0131nda \u00f6nemli bir paya sahiptir. Literat\u00fcrde, ba\u015fta Kuzey K\u0131br\u0131s olmak \u00fczere Akdeniz \u00fclkelerine tatil ama\u00e7l\u0131 seyahatler sonras\u0131 olgular ve endemik b\u00f6lgelerde g\u00f6revlendirilen askeri birliklerde salg\u0131nlar bildirilmektedir (9, 15, 16). Tatarc\u0131k hummas\u0131n\u0131n endemik oldu\u011fu Antalya ili, turizm b\u00f6lgesi olup her y\u0131l y\u00fcz binlerce yerli ve yabanc\u0131 turisti a\u011f\u0131rlamaktad\u0131r. Bu nedenle ate\u015fin e\u015flik etti\u011fi hepatit klini\u011fi ve b\u00f6lgemize seyahat \u00f6yk\u00fcs\u00fc olan hastalarda tatarc\u0131k hummas\u0131 akla gelmelidir.\u00a0<\/span><\/p>\n

Tan\u0131da \u00e7o\u011fu zaman IgG ve IgM antikorlar\u0131n\u0131n ara\u015ft\u0131r\u0131ld\u0131\u011f\u0131 imm\u00fcnofloresan antikor testi veya EL\u0130SA gibi serolojik testler kullan\u0131lmaktad\u0131r. Ancak son y\u0131llarda PCR testi de yap\u0131lmaktad\u0131r (10, 17). \u00c7al\u0131\u015fmam\u0131zda \u00f6rnekleri g\u00f6nderilen 19 hastan\u0131n %78.9\u2019unda IgM pozitifli\u011fi saptand\u0131. Yo\u011fun poliklinik ko\u015fullar\u0131nda tan\u0131 do\u011frulu\u011fu i\u00e7in T.C. Sa\u011fl\u0131k Bakanl\u0131\u011f\u0131 Halk Sa\u011fl\u0131\u011f\u0131 Genel M\u00fcd\u00fcrl\u00fc\u011f\u00fc Referans Laboratuvarlar\u0131\u2019na \u00f6rnek g\u00f6nderimi s\u00fcreci ek zaman ve i\u015f g\u00fcc\u00fc gerektirmektedir. Tatarc\u0131k hummas\u0131, iyi tan\u0131nd\u0131\u011f\u0131 ve test sonu\u00e7lar\u0131 takip ve tedaviyi etkilemedi\u011fi i\u00e7in klinisyenlerin \u00e7o\u011fu taraf\u0131ndan her hasta i\u00e7in \u00f6rnek g\u00f6nderimi yap\u0131lmamaktad\u0131r. \u00d6rnek g\u00f6nderimi yap\u0131lmad\u0131\u011f\u0131 i\u00e7in hastalar\u0131n elektronik kay\u0131t bilgilerine \u201cB34 viral infeksiyon ICD\u201d tan\u0131 kodu girilmektedir. Tatarc\u0131k hummas\u0131 d\u00fc\u015f\u00fcn\u00fclen her hasta i\u00e7in \u00f6rnek g\u00f6nderilmemesi ve hasta kay\u0131tlar\u0131na tatarc\u0131k hummas\u0131 tan\u0131s\u0131 ile veri girilmemesi nedeniyle tahmin edilenden az olan olgu say\u0131m\u0131z, \u00e7al\u0131\u015fmam\u0131z\u0131n en \u00f6nemli k\u0131s\u0131tl\u0131l\u0131\u011f\u0131 olarak de\u011ferlendirildi.<\/p>\n

Antalya ili tatarc\u0131k hummas\u0131 i\u00e7in endemik b\u00f6lge olmas\u0131na ra\u011fmen \u015fimdiye kadar serotip \u00e7al\u0131\u015fmas\u0131 yap\u0131lmam\u0131\u015ft\u0131r. Son dekadda T\u00fcrkiye\u2019nin farkl\u0131 co\u011frafi b\u00f6lgelerinde ate\u015fli hepatit olgular\u0131n\u0131n k\u00fcmelenme g\u00f6stermesi sonras\u0131 yap\u0131lan ara\u015ft\u0131rmalarda tatarc\u0131k hummas\u0131 saptanm\u0131\u015ft\u0131r.\u00a0 <\/span>\u00c7arhan ve arkada\u015flar\u0131 (2), Adana, \u0130zmir ve Ankara illerinden bildirilen toplam 106 tatarc\u0131k hummas\u0131 olgusunu serotip olarak incelemi\u015f ve hastalar\u0131n %38\u2019sinde SFSV, %12\u2019sinde SFSV\/SFCV ve %4\u2019\u00fcnde SFCV serotipini saptam\u0131\u015ft\u0131r; \u201csandfly fever Turkey\u201d virusu (SFTV) ilk kez bu \u00e7al\u0131\u015fma ile tan\u0131mlanm\u0131\u015ft\u0131r. Torun ve arkada\u015flar\u0131n\u0131n (4) 2010 y\u0131l\u0131nda yapt\u0131\u011f\u0131 \u00e7al\u0131\u015fmada, K\u0131r\u0131kkale b\u00f6lgesinde sekiz hastan\u0131n be\u015finde SFNV, \u00fc\u00e7\u00fcnde SFSV; G\u00fcler ve arkada\u015flar\u0131n\u0131n (5) 2012 y\u0131l\u0131nda Kahramanmara\u015f b\u00f6lgesinden yapt\u0131\u011f\u0131 \u00e7al\u0131\u015fmada ise dokuz hastan\u0131n yedisinde SFSV, ikisinde SFCV bildirilmi\u015ftir. \u00c7al\u0131\u015fmam\u0131zda hastal\u0131\u011f\u0131n tan\u0131s\u0131 anamnez, epidemiyolojik \u00f6yk\u00fc, klinik ve laboratuvar bulgular\u0131 ile koyulmu\u015f olup serotiplendirme yap\u0131lmad\u0131. B\u00f6lgemizde endemik olan tatarc\u0131k hummas\u0131n\u0131n serotiplendirilmesine y\u00f6nelik ileriye d\u00f6n\u00fck ara\u015ft\u0131rmalar\u0131n yap\u0131lmas\u0131 gerekmektedir. \u00a0<\/span><\/p>\n

Sonu\u00e7 olarak; \u00f6zellikle yaz aylar\u0131nda subtropikal b\u00f6lgelerde ya\u015fayan veya bu b\u00f6lgelere seyahat \u00f6yk\u00fcs\u00fc olan bireyler; ate\u015f, ba\u015f a\u011fr\u0131s\u0131, kas eklem a\u011fr\u0131s\u0131, bulant\u0131-kusma, g\u00f6zlerde k\u0131zar\u0131kl\u0131k gibi \u015fikayetler ile sa\u011fl\u0131k kurulu\u015flar\u0131na ba\u015fvurduklar\u0131nda, bunu l\u00f6kopeni, trombositopeni, CK ve karaci\u011fer enzim y\u00fcksekli\u011fi gibi laboratuvar bulgular\u0131 izliyorsa tatarc\u0131k hummas\u0131 akla gelmelidir. Hemen hemen di\u011fer t\u00fcm viral infeksiyonlarda da tatarc\u0131k hummas\u0131na benzer semptom ve laboratuvar bulgular\u0131 mevcuttur. Bu nedenle tatarc\u0131k hummas\u0131 tan\u0131s\u0131 i\u00e7in epidemiyolojik \u00f6yk\u00fc olmazsa olmazd\u0131r. \u00d6zellikle subtropikal endemik b\u00f6lgelere seyahat \u00f6yk\u00fcs\u00fc, kamp yapma \u00f6yk\u00fcs\u00fc, ikamet edilen yerin kat y\u00fcksekli\u011fi, \u00e7evresinde sinekler i\u00e7in uygun yerlerin varl\u0131\u011f\u0131 gibi tatarc\u0131k temas\u0131 i\u00e7in riskler mutlaka sorgulanmal\u0131, tatarc\u0131k hummas\u0131n\u0131n endemik ve vekt\u00f6r ili\u015fkili bir hastal\u0131k oldu\u011fu unutulmamal\u0131d\u0131r.<\/p>\n","protected":false},"excerpt":{"rendered":"

G\u0130R\u0130\u015e Tatarc\u0131k hummas\u0131, Phlebotomus cinsi tatarc\u0131k sine\u011finin vekt\u00f6r oldu\u011fu, Arboviruslar aras\u0131nda yer alan Bunyavirideae ailesinden Phlebovirus cinsine ait \u201csandfly fever\u201d virusunun (SFV) neden oldu\u011fu viral bir infeksiyondur. SFV\u2019nin tan\u0131mlanm\u0131\u015f serotipleri; \u201csandfly Sicilian\u201d virusu (SFSV; Sicilya serotipi), \u201csandfly Cyprus\u201d virusu (SFCV; K\u0131br\u0131s serotipi), \u201csandfly Naples\u201d virusu (SFNV; Napoli serotipi) ve \u201cToscana\u201d virusu (TOSV; Toskana serotipi)\u2019dur (1). […]<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[5129],"tags":[3112,5595,5594,5596],"class_list":["post-26008","post","type-post","status-publish","format-standard","hentry","category-ozgun-arastirma","tag-ates","tag-sandfly-fever-virus","tag-tatarcik-hummasi","tag-vektor"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/26008","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=26008"}],"version-history":[{"count":4,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/26008\/revisions"}],"predecessor-version":[{"id":26311,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/26008\/revisions\/26311"}],"wp:attachment":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/media?parent=26008"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/categories?post=26008"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/tags?post=26008"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}