{"id":26408,"date":"2023-03-06T14:14:25","date_gmt":"2023-03-06T11:14:25","guid":{"rendered":"https:\/\/www.klimikdergisi.org\/?p=26408"},"modified":"2023-03-21T12:47:14","modified_gmt":"2023-03-21T09:47:14","slug":"ekstrapulmoner-tuberkuloz-olgulari","status":"publish","type":"post","link":"https:\/\/www.klimikdergisi.org\/tr\/2023\/03\/06\/ekstrapulmoner-tuberkuloz-olgulari\/","title":{"rendered":"Eri\u015fkin Ekstrapulmoner T\u00fcberk\u00fcloz Olgular\u0131n\u0131n \u0130rdelenmesi"},"content":{"rendered":"<h2 class=\"p1\">G\u0130R\u0130\u015e<span class=\"Apple-converted-space\">\u00a0<\/span><\/h2>\n<p class=\"p2\">T\u00fcberk\u00fcloz, \u00f6zellikle geli\u015fmekte olan \u00fclkelerde, morbidite ve mortalitenin ana nedenlerindendir. D\u00fc\u015f\u00fck sosyoekonomik durum, g\u00f6\u00e7, imm\u00fcns\u00fcpresif ajan kullan\u0131m\u0131 ve HIV\/AIDS hastal\u0131\u011f\u0131n\u0131n g\u00f6r\u00fclme s\u0131kl\u0131\u011f\u0131ndaki art\u0131\u015fla birlikte t\u00fcberk\u00fcloz insidans\u0131nda art\u0131\u015f olmu\u015ftur. Ekstrapulmoner t\u00fcberk\u00fcloz (EPTB), t\u00fcberk\u00fclozun akci\u011fer d\u0131\u015f\u0131ndaki organlarda yerle\u015fimidir. D\u00fcnya genelinde 2017 y\u0131l\u0131nda 6.4 milyon yeni t\u00fcberk\u00fcloz olgusu tespit edilmi\u015ftir. Bunun %14\u2019\u00fcn\u00fc EPTB olgular\u0131 olu\u015fturmaktad\u0131r. EPTB\u2019nin tan\u0131s\u0131nda zorluk olup klinik \u015f\u00fcphe tan\u0131da \u00f6nemli bir rol oynamaktad\u0131r. Bu nedenle t\u00fcberk\u00fclozun endemik olarak g\u00f6r\u00fcld\u00fc\u011f\u00fc b\u00f6lgelerde, \u00f6zellikle nedeni bilinmeyen ate\u015f EPTB\u2019nin ay\u0131r\u0131c\u0131 tan\u0131s\u0131nda mutlaka ak\u0131lda tutulmal\u0131d\u0131r. T\u00fcrkiye Verem Sava\u015f\u0131 Raporu\u2019nda \u00fclkemizde 2017 y\u0131l\u0131nda t\u00fcberk\u00fcloz tan\u0131s\u0131 alan hasta say\u0131s\u0131 12 046 iken akci\u011fer d\u0131\u015f\u0131 organ tutulum oran\u0131 %33.9\u2019dur (1). EPTB\u2019de; lenf d\u00fc\u011f\u00fcm\u00fc, plevra, kemik-eklem, genito\u00fcriner veya santral sinir sistemi (SSS) tutulumlar\u0131 yayg\u0131n olmakla birlikte v\u00fccuttaki herhangi bir organ sistemi de etkilenebilir (2).<span class=\"Apple-converted-space\">\u00a0<\/span><\/p>\n<p class=\"p2\">Bu \u00e7al\u0131\u015fmada, hastanemize \u00e7e\u015fitli \u015fikayetlerle ba\u015fvurup EPTB tan\u0131s\u0131 alan 119 olgu demografik \u00f6zellikleri, tutulum b\u00f6lgeleri, mikrobiyolojik \u00f6zellikleri ve ila\u00e7 yan etkileri a\u00e7\u0131s\u0131ndan irdelendi.<\/p>\n<h2 class=\"p1\">Y\u00d6NTEMLER<\/h2>\n<p class=\"p2\">\u00c7al\u0131\u015fma kapsam\u0131nda, 2005-2018 y\u0131llar\u0131 aras\u0131nda Ondokuz May\u0131s \u00dcniversitesi T\u0131p Fak\u00fcltesi Hastanesi\u2019nde EPTB tan\u0131s\u0131 ile takip edilen 18 ya\u015f ve \u00fcst\u00fc olgular\u0131n hastane otomasyon kay\u0131t sisteminde bulunan verileri retrospektif olarak de\u011ferlendirildi. EPTB, akci\u011fer tutulumu olmaks\u0131z\u0131n v\u00fccuttaki di\u011fer organ veya sistemlerin tutulumu olarak tan\u0131mland\u0131. \u00c7al\u0131\u015fmaya akci\u011ferlerde t\u00fcberk\u00fcloza ait radyolojik bulgular\u0131 olan olgular dahil edilmedi. EPTB tan\u0131s\u0131nda, t\u00fcberk\u00fcloz ile uyumlu klinik bulgular varl\u0131\u011f\u0131nda a\u015fa\u011f\u0131daki kriterlerden biri veya birka\u00e7\u0131 kullan\u0131ld\u0131:<span class=\"Apple-converted-space\">\u00a0<\/span><\/p>\n<ul>\n<li class=\"p4\">Tutulum g\u00f6r\u00fclen organ ve\/veya dokudan al\u0131nan \u00f6rne\u011fin bakteriyolojik k\u00fclt\u00fcr\u00fcnde <i>Mycobacterium tuberculosis\u2019<\/i>in \u00fcremesi,<span class=\"Apple-converted-space\">\u00a0<\/span><\/li>\n<li class=\"p4\">Al\u0131nan \u00f6rnekte Ehrlich-Ziehl-Neelsen \u201cacid-resistant bacilli\u201d (ARB) boyama y\u00f6ntemiyle <i>M. tuberculosis\u2019in<\/i> g\u00f6sterilmesi,<\/li>\n<li class=\"p4\">Al\u0131nan \u00f6rnekte \u201cpolymerase chain reaction\u201d (PCR) y\u00f6ntemiyle <i>M. tuberculosis<\/i> g\u00f6sterilmesi,<\/li>\n<li class=\"p4\">Biyopsi materyalinde t\u00fcberk\u00fclozla uyumlu histopatolojik morfolojinin g\u00f6r\u00fclmesi.<\/li>\n<li class=\"p5\">Olgulara ait demografik \u00f6zellikler, altta yatan hastal\u0131klar, fizik muayene ve laboratuvar bulgular\u0131, t\u00fcberk\u00fclozun organ ve\/veya sistem tutulumu, tedavi rejimleri ile antit\u00fcberk\u00fcloz ila\u00e7lar\u0131n yan etkileri ve hastal\u0131\u011fa ba\u011fl\u0131 sekel ile mortalite oranlar\u0131 incelendi.<span class=\"Apple-converted-space\">\u00a0<\/span><\/li>\n<\/ul>\n<p class=\"p5\">T\u00fcberk\u00fcloz menenjit evreleri, \u0130ngiliz T\u0131bbi Ara\u015ft\u0131rma Konseyi (Medical Research Council \u2013 MRC)\u2019nin kriterlerine uygun olarak a\u015fa\u011f\u0131da verildi\u011fi \u015fekilde tan\u0131mland\u0131:<\/p>\n<ul>\n<li class=\"p6\">Evre-I; \u015fuur a\u00e7\u0131k, semptomlar nonspesifik ve n\u00f6rolojik defisit yok, <span class=\"Apple-converted-space\">\u00a0<\/span><\/li>\n<li class=\"p6\">Evre-II; meningeal iritasyon bulgular\u0131, letarji ve min\u00f6r n\u00f6rolojik defisit, <span class=\"Apple-converted-space\">\u00a0<\/span><\/li>\n<li class=\"p6\">Evre-III; stupor, koma, konv\u00fclziyon ve a\u011f\u0131r n\u00f6rolojik defisit olarak tan\u0131mland\u0131 (3).<\/li>\n<\/ul>\n<p class=\"p5\">\u00c7al\u0131\u015fma, Ondokuz May\u0131s \u00dcniversitesi T\u0131p Fak\u00fcltesi Klinik Ara\u015ft\u0131rma Etik Kurulu taraf\u0131ndan 08 Temmuz 2021 tarih ve KAEK 2021\/356 karar numaras\u0131yla onayland\u0131.<span class=\"Apple-converted-space\">\u00a0<\/span><\/p>\n<h2 class=\"p1\">BULGULAR<\/h2>\n<div id=\"attachment_26549\" style=\"width: 1079px\" class=\"wp-caption alignright\"><a href=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2023\/03\/KD.C36.S1_4206_Tablo.1.png\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-26549\" class=\"size-full wp-image-26549\" src=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2023\/03\/KD.C36.S1_4206_Tablo.1.png\" alt=\"\" width=\"1069\" height=\"1984\" srcset=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2023\/03\/KD.C36.S1_4206_Tablo.1.png 1069w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2023\/03\/KD.C36.S1_4206_Tablo.1-140x260.png 140w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2023\/03\/KD.C36.S1_4206_Tablo.1-291x540.png 291w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2023\/03\/KD.C36.S1_4206_Tablo.1-768x1425.png 768w\" sizes=\"auto, (max-width: 1069px) 100vw, 1069px\" \/><\/a><p id=\"caption-attachment-26549\" class=\"wp-caption-text\"><strong>Tablo 1.<\/strong> Olgular\u0131n Demografik \u00d6zellikleri<\/p><\/div>\n<p class=\"p2\">\u00c7al\u0131\u015fma d\u00f6neminde; toplam 119 olgu EPTB tan\u0131s\u0131 ile antit\u00fcberk\u00fcloz tedavisi alm\u0131\u015f ve 97 (%81.5) olgunun tedavisi tamamlanm\u0131\u015ft\u0131; 14 (%18.5) olgunun tedavisi halen s\u00fcr\u00fcyordu. Olgular\u0131n 75 (%63)\u2019i kad\u0131n, 44 (%37)\u2019\u00fc erkek olup ya\u015f ortalamas\u0131 48.4\u00b117.8 y\u0131l idi. Kad\u0131nlar\u0131n ya\u015f ortalamas\u0131 51.8\u00b116.7 y\u0131l, erkeklerin ya\u015f ortalamas\u0131 ise 42.6\u00b118.4 y\u0131l olarak tespit edildi. Kad\u0131n ve erkeklerin ya\u015f ortalamalar\u0131 kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131\u011f\u0131nda, ekstrapulmoner t\u00fcberk\u00fcloz tan\u0131s\u0131 alan kad\u0131nlar\u0131n ya\u015f\u0131 erkeklerden istatistiksel olarak anlaml\u0131 d\u00fczeyde y\u00fcksekti (<i>p<\/i>&lt;0.05). Kentsel b\u00f6lgede ya\u015fayan olgu say\u0131s\u0131 54 (%45.4), k\u0131rsal b\u00f6lgede ya\u015fayan olgu say\u0131s\u0131 ise 48 (%40) idi.<\/p>\n<p class=\"p5\">Olgular\u0131n, 81 (%68.1)\u2019inin t\u00fcberk\u00fcloz ge\u00e7irme \u00f6yk\u00fcs\u00fc ve 82 (%68.9)\u2019sinin t\u00fcberk\u00fclozlu ki\u015filerle temas bilgisi yoktu; 84 (%70.6)\u2019\u00fcnde e\u015flik eden ek hastal\u0131k tespit edilmedi (Tablo 1).<\/p>\n<p class=\"p5\">Olgular\u0131n 49 (%41.1)\u2019u lenf d\u00fc\u011f\u00fcm\u00fcnde \u015fi\u015flik, 23 (%19.3)\u2019\u00fc ate\u015f, 15 (%12.6)\u2019i bel a\u011fr\u0131s\u0131, 8 (%6.7)\u2019i ba\u015f a\u011fr\u0131s\u0131, 7 (%5.8)\u2019si bilin\u00e7 de\u011fi\u015fikli\u011fi, 6 (%5)\u2019s\u0131 kar\u0131nda \u015fi\u015flik, 5 (%4.2)\u2019i kilo kayb\u0131 ve 4 (%3.3)\u2019\u00fc halsizlik \u015fikayetiyle ba\u015fvurmu\u015ftu.<\/p>\n<p class=\"p5\">EPTB tutulum b\u00f6lgelerine bak\u0131ld\u0131\u011f\u0131nda; olgular\u0131n 60 (%50.4)\u2019\u0131nda lenf nodu, 15 (%12.6)\u2019inde merkezi sinir sistemi, 14 (%11.8)\u2019\u00fcnde vertebral kolon, 7 (%5.9)\u2019sinde kemik dokusu, 7 (%5.9)\u2019sinde \u00fcrogenital sistem, 6 (%5)\u2019s\u0131nda periton, 6 (%5)\u2019s\u0131nda gastrointestinal sistem, 3 (%2.5)\u2019\u00fcnde plevra ve 1 (%0.8)\u2019inde g\u00f6z tutulumu mevcuttu.<\/p>\n<p class=\"p5\">Lenf nodu tutulumu olan 60 olgunun 25 (%41.7)\u2019inde servikal, 12 (%2)\u2019sinde aksilla, 10 (%16.7)\u2019unda mediasten, 6 (%10)\u2019s\u0131nda supraklavik\u00fcler, 4 (%6.7)\u2019\u00fcnde intraabdominal ve 3 (%5)\u2019\u00fcnde inguinal b\u00f6lge tutulumu oldu\u011fu g\u00f6r\u00fcld\u00fc.<span class=\"Apple-converted-space\">\u00a0<\/span><\/p>\n<div id=\"attachment_26553\" style=\"width: 1074px\" class=\"wp-caption alignright\"><a href=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2023\/03\/KD.C36.S1_4206_Tablo.2.png\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-26553\" class=\"wp-image-26553 size-full\" src=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2023\/03\/KD.C36.S1_4206_Tablo.2.png\" alt=\"\" width=\"1064\" height=\"1211\" srcset=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2023\/03\/KD.C36.S1_4206_Tablo.2.png 1064w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2023\/03\/KD.C36.S1_4206_Tablo.2-228x260.png 228w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2023\/03\/KD.C36.S1_4206_Tablo.2-474x540.png 474w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2023\/03\/KD.C36.S1_4206_Tablo.2-768x874.png 768w\" sizes=\"auto, (max-width: 1064px) 100vw, 1064px\" \/><\/a><p id=\"caption-attachment-26553\" class=\"wp-caption-text\"><strong>Tablo 2.<\/strong> T\u00fcberk\u00fcloz Lenfadenit Olgular\u0131n\u0131n Klinik \u00d6zellikleri ve Lokalizasyonlar\u0131<\/p><\/div>\n<p class=\"p5\">T\u00fcberk\u00fcloz lenfadenit nedeniyle tedavi alan olgular\u0131n tan\u0131s\u0131; 55 (%91.7) olguda histopatolojik incelemede t\u00fcberk\u00fclozla uyumlu histopatolojik bulgular\u0131n saptanmas\u0131yla, 2 (%3.3) olguda <i>M. tuberculosis<\/i> \u00fcremesinin olmas\u0131 nedeniyle, 2 (%3.3) olguda PCR y\u00f6ntemiyle <i>M. tuberculosis<\/i>\u2019in g\u00f6sterilmesiyle ve geriye kalan 1 (%1.7) olguda klinik ve radyolojik bulgularla koyuldu. Ayr\u0131ca histopatolojik incelemeyle tan\u0131 koyulan olgular\u0131n alt\u0131s\u0131nda <i>M. tuberculosis<\/i> \u00fcremesi saptanm\u0131\u015ft\u0131; lenfadenitli olgular\u0131n %13.3\u2019\u00fcnde <i>M. tuberculosis<\/i> izolasyonu elde edildi\u011fi g\u00f6r\u00fcld\u00fc (Tablo 2). <span class=\"Apple-converted-space\">\u00a0<\/span><\/p>\n<div id=\"attachment_26556\" style=\"width: 1078px\" class=\"wp-caption alignright\"><a href=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2023\/03\/KD.C36.S1_4206_Tablo.3.png\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-26556\" class=\"wp-image-26556 size-full\" src=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2023\/03\/KD.C36.S1_4206_Tablo.3.png\" alt=\"\" width=\"1068\" height=\"863\" srcset=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2023\/03\/KD.C36.S1_4206_Tablo.3.png 1068w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2023\/03\/KD.C36.S1_4206_Tablo.3-322x260.png 322w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2023\/03\/KD.C36.S1_4206_Tablo.3-668x540.png 668w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2023\/03\/KD.C36.S1_4206_Tablo.3-768x621.png 768w\" sizes=\"auto, (max-width: 1068px) 100vw, 1068px\" \/><\/a><p id=\"caption-attachment-26556\" class=\"wp-caption-text\"><strong>Tablo 3.<\/strong> T\u00fcberk\u00fcloz Menenjit Olgular\u0131n\u0131n Klinik \u00d6zellikleri ve Evreleri<\/p><\/div>\n<div id=\"attachment_26558\" style=\"width: 1078px\" class=\"wp-caption alignright\"><a href=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2023\/03\/KD.C36.S1_4206_Tablo.4.png\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-26558\" class=\"wp-image-26558 size-full\" src=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2023\/03\/KD.C36.S1_4206_Tablo.4.png\" alt=\"\" width=\"1068\" height=\"942\" srcset=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2023\/03\/KD.C36.S1_4206_Tablo.4.png 1068w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2023\/03\/KD.C36.S1_4206_Tablo.4-295x260.png 295w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2023\/03\/KD.C36.S1_4206_Tablo.4-612x540.png 612w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2023\/03\/KD.C36.S1_4206_Tablo.4-768x677.png 768w\" sizes=\"auto, (max-width: 1068px) 100vw, 1068px\" \/><\/a><p id=\"caption-attachment-26558\" class=\"wp-caption-text\"><strong>Tablo 4.<\/strong> T\u00fcberk\u00fcloza Ba\u011fl\u0131 Vertebral Kolon Tutulumu Olan Olgular\u0131n Klinik ve Laboratuvar \u00d6zellikleri<\/p><\/div>\n<p class=\"p5\">T\u00fcberk\u00fcloz menenjit tan\u0131l\u0131 15 olguda en s\u0131k kar\u015f\u0131la\u015f\u0131lan ba\u015fvuru yak\u0131nmalar\u0131; 9 (%60) olguda ate\u015f, 7 (%46.6) olguda ba\u015f a\u011fr\u0131s\u0131 ve 7 (%46.6) olguda bilin\u00e7 de\u011fi\u015fikli\u011fi olarak tespit edildi. Ba\u015fvuru esnas\u0131nda; 10 olgunun evre-2\u2019de, d\u00f6rt olgunun evre-1\u2019de ve bir olgunun evre-3\u2019te oldu\u011fu g\u00f6r\u00fcld\u00fc. Beyin-omurilik s\u0131v\u0131s\u0131 (BOS) \u00f6rneklerinin hi\u00e7birinde ARB pozitifli\u011fi saptanmam\u0131\u015ft\u0131; PCR pozitifli\u011fi olgular\u0131n %71.4 (5\/7)\u2019\u00fcnde ve k\u00fclt\u00fcrde <i>M. tuberculosis<\/i> izolasyonu ise olgular\u0131n %58.3 (7\/12)\u2019\u00fcnde tespit edilmi\u015fti (Tablo 3). Kranial g\u00f6r\u00fcnt\u00fcleme y\u00f6ntemleri ile bak\u0131ld\u0131\u011f\u0131nda en s\u0131k kar\u015f\u0131la\u015f\u0131lan kranial sinir tutulumunun yan\u0131 s\u0131ra hidrosefali, meningeal ve\/veya parankimal tutulum da tespit edilmi\u015fti. Vertebral kolon tutulumu olan 14 olgunun ba\u015fvurular\u0131nda en s\u0131k kar\u015f\u0131la\u015f\u0131lan yak\u0131nman\u0131n s\u0131rt-bel a\u011fr\u0131s\u0131 oldu\u011fu g\u00f6r\u00fcld\u00fc. Olgular\u0131n 6 (%42.8)\u2019s\u0131nda torakal, 3 (%21.4)\u2019\u00fcnde lomber ve 5 (%35.7)\u2019inde torakal ve lomber vertebralar\u0131n birlikte tutulumu mevcuttu. S\u00f6z konusu olgular\u0131n be\u015fine kemik biyopsi \u00f6rne\u011finde <i>M. tuberculosis<\/i> \u00fcremesi ve patolojik bulgular\u0131n t\u00fcberk\u00fclozla uyumlu olmas\u0131; d\u00f6rd\u00fcne kemik biyopsi \u00f6rne\u011finde <i>M. tuberculosis<\/i> \u00fcremesi olmas\u0131; ikisine kemik biyopsi \u00f6rne\u011finin patolojik incelemesinin t\u00fcberk\u00fclozla uyumlu olmas\u0131; ikisine kemik biyopsi \u00f6rne\u011finde PCR pozitifli\u011fi olmas\u0131 ve birine de klinik yak\u0131nmalar\u0131n g\u00f6r\u00fcnt\u00fcleme y\u00f6ntemleri ile uyumlu olmas\u0131 nedeniyle EPTB tan\u0131s\u0131 koyuldu\u011fu tespit edildi (Tablo 4).<b><span class=\"Apple-converted-space\">\u00a0<\/span><\/b><\/p>\n<p class=\"p5\">Osteomyeliti olan yedi kad\u0131n olgunun; metakarpal, femur, iliak kemik, humerus, nazal kemik tutulumlar\u0131n\u0131n oldu\u011fu g\u00f6r\u00fcld\u00fc. Olgular ilgili kemikte ak\u0131nt\u0131 ve a\u011fr\u0131 yak\u0131nmalar\u0131 ile ba\u015fvurmu\u015ftu. Yedi olguya kemik biyopsi \u00f6rne\u011finde patolojik bulgular\u0131n t\u00fcberk\u00fclozla uyumlu olmas\u0131 ve iki olguya da di\u011fer bulgularla birlikte kemik k\u00fclt\u00fcr\u00fcnde <i>M. tuberculosis<\/i> \u00fcremesi olmas\u0131 nedeniyle EPTB tan\u0131s\u0131 koyuldu\u011fu tespit edildi. \u00dcrogenital sistem t\u00fcberk\u00fclozlu yedi olgunun en s\u0131k g\u00f6r\u00fclen yak\u0131nmas\u0131 diz\u00fcri idi. Olgulara idrarda ARB pozitifli\u011fi ve\/veya histopatolojik y\u00f6ntemlerle tan\u0131 koyuldu\u011fu saptand\u0131.<span class=\"Apple-converted-space\">\u00a0<\/span><\/p>\n<p class=\"p5\">Peritonitli olgularda en s\u0131k kar\u015f\u0131la\u015f\u0131lan yak\u0131nma kar\u0131nda \u015fi\u015flik, ate\u015f ve kilo kayb\u0131yd\u0131. Be\u015f olguya periton s\u0131v\u0131s\u0131nda <i>M. tuberculosis<\/i> \u00fcremesi, bir olguya ise g\u00f6r\u00fcnt\u00fcleme ve direkt mikroskobik inceleme y\u00f6ntemleriyle tan\u0131 koyulmu\u015ftu. Gastrointestinal sistem (G\u0130S) t\u00fcberk\u00fclozunda en s\u0131k g\u00f6r\u00fclen yak\u0131nma kar\u0131n a\u011fr\u0131s\u0131 olup terminal ileum, omentum, jejenum ve kolon tutulumu da mevcuttu. Olgulara doku \u00f6rneklerinin patolojik incelemelerinin yan\u0131 s\u0131ra radyolojik sonu\u00e7larla da tan\u0131 koyuldu\u011fu tespit edildi.<span class=\"Apple-converted-space\">\u00a0<\/span><\/p>\n<p class=\"p5\">Pl\u00f6rezisi olan olgularda nefes darl\u0131\u011f\u0131 yak\u0131nmas\u0131 \u00f6n planda olup plevra s\u0131v\u0131s\u0131nda ADA (adenozin deaminaz) y\u00fcksekli\u011fi ve k\u00fclt\u00fcrde <i>M. tuberculosis<\/i> \u00fcremesi ile tan\u0131 koyuldu\u011fu g\u00f6r\u00fcld\u00fc.<\/p>\n<p class=\"p5\">G\u00f6rme azl\u0131\u011f\u0131 olan bir olguda fizik muayene bulgular\u0131n\u0131n yan\u0131 s\u0131ra interferon gama sal\u0131n\u0131m testinin pozitif olmas\u0131 nedeniyle t\u00fcberk\u00fcloz \u00fcveit tan\u0131s\u0131 koyuldu\u011fu tespit edildi.<\/p>\n<p class=\"p5\">EPTB tan\u0131s\u0131 alan 119 olgunun 8 (%6.7)\u2019i tedavi s\u0131ras\u0131nda kaybedilmi\u015fti. Bu olgular\u0131n 4 (%50)\u2019\u00fcnde SSS, 2 (%25)\u2019sinde lenf nodu, 1 (%12.5)\u2019inde periton ve 1 (%12.5)\u2019inde \u00fcrogenital sistem tutulumu oldu\u011fu saptand\u0131. Olgular\u0131n \u00fc\u00e7\u00fcnde \u00f6l\u00fcm nedeni t\u00fcberk\u00fcloz olup di\u011fer be\u015f olguda t\u00fcberk\u00fcloza ba\u011fl\u0131 olmayan nedenlerle \u00f6l\u00fcm ger\u00e7ekle\u015fti\u011fi g\u00f6r\u00fcld\u00fc. T\u00fcberk\u00fcloza ba\u011fl\u0131 \u00f6l\u00fcmlerin ikisinde SSS tutulumu ve birinde periton tutulumu saptand\u0131; t\u00fcberk\u00fcloza ba\u011fl\u0131 olmayan \u00f6l\u00fcmlerin ikisi serebrovask\u00fcler olay, biri malignite, biri kan dola\u015f\u0131m\u0131 infeksiyonu ve biri \u00fcrosepsis idi.<\/p>\n<p class=\"p5\">Olgulardan al\u0131nan 49 \u00f6rnekte ARB pozitifli\u011fi oran\u0131 %8.1 (4\/49), 33 \u00f6rnekte PCR pozitifli\u011fi oran\u0131 %48.4 (16\/33) ve \u00e7al\u0131\u015f\u0131lan 60 hasta k\u00fclt\u00fcr\u00fcnde t\u00fcberk\u00fcloz pozitifli\u011fi oran\u0131 %48.3 (29\/60) olarak tespit edildi. K\u00fclt\u00fcrlerinde <i>M. tuberculosis<\/i> \u00fcreyen 29 \u00f6rne\u011fin 16\u2019s\u0131nda antit\u00fcberk\u00fcloz ila\u00e7 direnci \u00e7al\u0131\u015f\u0131lm\u0131\u015f olup 12 \u00f6rnekte ila\u00e7lara diren\u00e7 saptanmazken \u00fc\u00e7 \u00f6rnekte streptomisin direnci (3\/16-%18.7) ve bir \u00f6rnekte izoniyazid (INH) direnci (1\/16-%6.2) tespit edildi.<span class=\"Apple-converted-space\">\u00a0<\/span><\/p>\n<div id=\"attachment_26560\" style=\"width: 1073px\" class=\"wp-caption alignright\"><a href=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2023\/03\/KD.C36.S1_4206_Tablo.5.png\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-26560\" class=\"size-full wp-image-26560\" src=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2023\/03\/KD.C36.S1_4206_Tablo.5.png\" alt=\"\" width=\"1063\" height=\"584\" srcset=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2023\/03\/KD.C36.S1_4206_Tablo.5.png 1063w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2023\/03\/KD.C36.S1_4206_Tablo.5-390x214.png 390w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2023\/03\/KD.C36.S1_4206_Tablo.5-810x445.png 810w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2023\/03\/KD.C36.S1_4206_Tablo.5-768x422.png 768w\" sizes=\"auto, (max-width: 1063px) 100vw, 1063px\" \/><\/a><p id=\"caption-attachment-26560\" class=\"wp-caption-text\"><strong>Tablo 5.<\/strong> Histopatolojik Bulgular\u0131n Da\u011f\u0131l\u0131m\u0131<\/p><\/div>\n<p class=\"p5\">Olgular\u0131n 93\u2019\u00fcnden al\u0131nan \u00f6rneklerde patolojik inceleme yap\u0131lm\u0131\u015f olup en s\u0131k kar\u015f\u0131la\u015f\u0131lan bulgu %41.2 oran\u0131yla kazeifiye gran\u00fclomat\u00f6z iltihapt\u0131r (%41.2) (Tablo 5).<span class=\"Apple-converted-space\">\u00a0<\/span><\/p>\n<div id=\"attachment_26562\" style=\"width: 1078px\" class=\"wp-caption alignright\"><a href=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2023\/03\/KD.C36.S1_4206_Tablo.6.png\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-26562\" class=\"size-full wp-image-26562\" src=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2023\/03\/KD.C36.S1_4206_Tablo.6.png\" alt=\"\" width=\"1068\" height=\"450\" srcset=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2023\/03\/KD.C36.S1_4206_Tablo.6.png 1068w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2023\/03\/KD.C36.S1_4206_Tablo.6-390x164.png 390w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2023\/03\/KD.C36.S1_4206_Tablo.6-810x341.png 810w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2023\/03\/KD.C36.S1_4206_Tablo.6-768x324.png 768w\" sizes=\"auto, (max-width: 1068px) 100vw, 1068px\" \/><\/a><p id=\"caption-attachment-26562\" class=\"wp-caption-text\"><strong>Tablo 6.<\/strong> Antit\u00fcberk\u00fcloz \u0130la\u00e7 Yan Etkileri<\/p><\/div>\n<p class=\"p5\">Olgulara d\u00f6rtl\u00fc antit\u00fcberk\u00fcloz tedavi [INH 300 mg\/kg\/g\u00fcn, rifampisin (RIF) 600\/kg\/g\u00fcn, pirazinamid (PZA) veya morfazinamid 25mg\/kg\/g\u00fcn ve streptomisin 1 gr\/g\u00fcn veya etambutol 20-25mg\/kg\/g\u00fcn] ba\u015flanm\u0131\u015f olup tedavi s\u00fcresi menenjit ve kemik-eklem t\u00fcberk\u00fclozunda 12-18 ay ve di\u011fer organ-sistem t\u00fcberk\u00fcloz hastal\u0131klar\u0131nda ise 6 ayd\u0131r. Tedaviye ba\u011fl\u0131 yan etkiler 48 olguda tespit edilmi\u015ftir; en s\u0131k g\u00f6r\u00fclen yan etki %50 (24\/48) oran\u0131yla hepatotoksisite olup bunu %18.75 (9\/48) oran\u0131yla \u00fcrik asit art\u0131\u015f\u0131 izlemi\u015ftir (Tablo 6).<span class=\"Apple-converted-space\">\u00a0<\/span><\/p>\n<h2 class=\"p1\">\u0130RDELEME<\/h2>\n<p class=\"p5\">EPTB, <i>M. tuberculosis<\/i>\u2019in<i> <\/i>akci\u011fer d\u0131\u015f\u0131ndaki herhangi bir organ veya dokuyu etkilemesidir. Hastal\u0131k t\u00fcberk\u00fcloz basilinin akci\u011ferdeki odaktan lenfohematojen yolla yay\u0131lmas\u0131, aktif akci\u011fer t\u00fcberk\u00fclozlu olgular\u0131n infekte balgamlar\u0131n\u0131n solunum yollar\u0131 veya G\u0130S mukozalar\u0131na ula\u015fmas\u0131 veya kom\u015fuluk yoluyla di\u011fer organlara yay\u0131lmas\u0131yla ortaya \u00e7\u0131kar (4). Genellikle semptomlar akci\u011fer t\u00fcberk\u00fclozundaki gibi belirgin olmad\u0131\u011f\u0131 i\u00e7in tan\u0131 koymada g\u00fc\u00e7l\u00fck ve gecikme ya\u015fanabilir. Akci\u011fer t\u00fcberk\u00fclozunda kad\u0131n ve erkek oran\u0131 e\u015fitken EPTB kad\u0131nlarda daha s\u0131k g\u00f6r\u00fclmektedir (1). \u00c7al\u0131\u015fmam\u0131z kapsam\u0131nda incelenen EPTB tan\u0131s\u0131 alm\u0131\u015f olgular\u0131n \u00e7o\u011funlu\u011fu %63 oran\u0131yla kad\u0131nlard\u0131 ve kad\u0131nlar erkeklere k\u0131yasla istatistiksel olarak anlaml\u0131 \u015fekilde daha ileri ya\u015flarda EPTB tan\u0131s\u0131 alm\u0131\u015ft\u0131. \u00dclkemizden yap\u0131lan farkl\u0131 \u00e7al\u0131\u015fmalarda da EPTB tan\u0131s\u0131 alan kad\u0131nlar\u0131n benzer \u015fekilde daha fazla oldu\u011fu bildirilmi\u015ftir (5-8). Smaoui ve arkada\u015flar\u0131 (9) da \u00e7al\u0131\u015fmalar\u0131nda, 181 t\u00fcberk\u00fcloz lenfadenit olgusunun \u00e7o\u011funlu\u011funun (%64) kad\u0131n oldu\u011funu bildirmi\u015ftir.<\/p>\n<p class=\"p5\">Dosyalar\u0131ndan, ya\u015fad\u0131\u011f\u0131 yer bilgisine ula\u015f\u0131lan olgular\u0131n %45.4\u2019\u00fcn\u00fcn kentsel ve %40\u2019\u0131n\u0131n k\u0131rsal b\u00f6lgede ya\u015fad\u0131\u011f\u0131 tespit edildi. Farkl\u0131 \u00e7al\u0131\u015fmalarda da benzer \u015fekilde EPTB olgular\u0131n\u0131n daha \u00e7ok kentsel b\u00f6lgeden ba\u015fvurdu\u011fu bildirilmi\u015ftir (4, 9).<span class=\"Apple-converted-space\">\u00a0<\/span><\/p>\n<p class=\"p5\">\u00c7al\u0131\u015fmam\u0131zda, olgular\u0131n %10.1\u2019inde daha \u00f6nce t\u00fcberk\u00fcloz ge\u00e7irme \u00f6yk\u00fcs\u00fc ve %10.1\u2019inde de t\u00fcberk\u00fclozlu hasta ile temas \u00f6yk\u00fcs\u00fc mevcuttu. Hitit ve arkada\u015flar\u0131n\u0131n (8) \u00e7al\u0131\u015fmas\u0131nda, %29.8 oran\u0131nda t\u00fcberk\u00fcloz ge\u00e7irme \u00f6yk\u00fcs\u00fc varken, Turun\u00e7 ve arkada\u015flar\u0131n\u0131n (5) \u00e7al\u0131\u015fmas\u0131nda t\u00fcberk\u00fcloz ge\u00e7irme \u00f6yk\u00fcs\u00fc %11.5 ve t\u00fcberk\u00fclozlu ki\u015fi ile temas %22.1 olarak tespit edilmi\u015fti (5). \u00c7al\u0131\u015fmam\u0131zdaki oran\u0131n d\u00fc\u015f\u00fckl\u00fc\u011f\u00fcn\u00fcn nedeni; olgular\u0131n bir k\u0131sm\u0131n\u0131n yeterli \u00f6yk\u00fc vermemesine ve i\u00e7inde olduklar\u0131 d\u00fc\u015f\u00fck sosyok\u00fclt\u00fcrel seviyeye ba\u011fl\u0131 olabilir.<\/p>\n<p class=\"p5\">Malignite, kronik b\u00f6brek yetmezli\u011fi, diyabet, kemoterapi, uzun s\u00fcreli steroid kullan\u0131m\u0131, HIV\/AIDS gibi ba\u011f\u0131\u015f\u0131kl\u0131\u011f\u0131n bask\u0131land\u0131\u011f\u0131 durumlar t\u00fcberk\u00fclozun reaktivasyonuna yol a\u00e7abilir. Bu nedenle olgular\u0131n altta yatan hastal\u0131klar a\u00e7\u0131s\u0131ndan sorgulanmas\u0131 ve imm\u00fcns\u00fcprese hastalarda uzun s\u00fcreli nedeni bilinmeyen ate\u015f varl\u0131\u011f\u0131nda t\u00fcberk\u00fclozun da ay\u0131r\u0131c\u0131 tan\u0131da d\u00fc\u015f\u00fcn\u00fclmesi gerekmektedir. \u00c7al\u0131\u015fmam\u0131zda olgular\u0131n b\u00fcy\u00fck bir b\u00f6l\u00fcm\u00fc (%70.6) altta yatan bir hastal\u0131k bildirmemi\u015fti. Farkl\u0131 \u00e7al\u0131\u015fmalarda ise altta yatan hastal\u0131k oran\u0131 %14.9-35 olarak bildirilmi\u015ftir (6-8).<\/p>\n<p class=\"p5\">Ate\u015f, kilo kayb\u0131, gece terlemesi gibi akci\u011fer t\u00fcberk\u00fclozunda s\u0131k\u00e7a g\u00f6r\u00fclen yak\u0131nmalar EPTB\u2019de daha nadir veya belirsizdir. \u00dclkemizden yap\u0131lan ve nedeni bilinmeyen ate\u015f (NBA)\u2019in kaynaklar\u0131n\u0131n irdelendi\u011fi \u00e7ok merkezli bir \u00e7al\u0131\u015fmada, infeksiy\u00f6z kaynakl\u0131 NBA\u2019de EPTB brusellozdan sonra %6.4 oran\u0131yla ikinci s\u0131kl\u0131kta tespit edilmi\u015ftir (10). \u00c7al\u0131\u015fmam\u0131zda ate\u015f yak\u0131nmas\u0131 en s\u0131k menenjit olgular\u0131nda (%60) g\u00f6r\u00fclm\u00fc\u015f olup bunu peritonit geli\u015fen (%33.3) ve lenfadenit (%15) tan\u0131s\u0131 alan olgular takip ediyordu. EPTB olgular\u0131n\u0131n irdelendi\u011fi farkl\u0131 \u00e7al\u0131\u015fmalarda, ate\u015f s\u0131kl\u0131\u011f\u0131 \u00e7al\u0131\u015fmam\u0131zla benzer \u015fekilde %21, %24.7 ve %51 olarak bildirilmi\u015ftir (6, 9, 11). En s\u0131k tutulum b\u00f6lgesi olarak tespit etti\u011fimiz lenfadenitli olgular b\u00fcy\u00fck oranda lenf nodunda \u015fi\u015flik<span class=\"Apple-converted-space\">\u00a0 <\/span>(%80) yak\u0131nmas\u0131 ile ba\u015fvurmu\u015ftu. Benzer \u015fekilde Smaoui ve arkada\u015flar\u0131 (9) \u00e7al\u0131\u015fmalar\u0131nda, t\u00fcberk\u00fcloz lenfadenit olgular\u0131n\u0131n %55.2 s\u0131kl\u0131kla lenf nodunda \u015fi\u015flik yak\u0131nmas\u0131 ile ba\u015fvurdu\u011funu bildirmi\u015ftir.<span class=\"Apple-converted-space\">\u00a0<\/span><\/p>\n<p class=\"p5\">\u00c7al\u0131\u015fmam\u0131zda, t\u00fcberk\u00fcloz menenjitli olgularda ate\u015fe ek olarak bilin\u00e7 de\u011fi\u015fikli\u011fi, kemik eklem t\u00fcberk\u00fclozu olan olgularda ilgili b\u00f6lgede a\u011fr\u0131, di\u011fer olgularda da kar\u0131n a\u011fr\u0131s\u0131, kar\u0131nda \u015fi\u015flik ve diz\u00fcri gibi yak\u0131nmalar\u0131n oldu\u011fu tespit edildi.<span class=\"Apple-converted-space\">\u00a0<\/span><\/p>\n<p class=\"p5\">Lenfadenit, EPTB\u2019nin en s\u0131k g\u00f6r\u00fclen formudur. Tipik olarak kronik ve a\u011fr\u0131s\u0131z lenfadenopati (LAP) olarak g\u00f6r\u00fcl\u00fcr (2). \u00dclkemizden yap\u0131lan ve periferik LAP\u2019\u0131n etiyolojik, klinik ve laboratuvar bulgular\u0131 a\u00e7\u0131s\u0131ndan irdelendi\u011fi \u00e7ok merkezli bir \u00e7al\u0131\u015fmada, hastal\u0131\u011f\u0131n en s\u0131k kar\u015f\u0131la\u015f\u0131lan nedeninin %16.8 oran\u0131yla EPTB oldu\u011fu bildirilmi\u015ftir (12). \u00c7al\u0131\u015fmam\u0131zda da en s\u0131k kar\u015f\u0131la\u015f\u0131lan EPTB formunun %50.4 oran\u0131yla lenfadenit oldu\u011fu tespit edildi; bunu s\u0131ras\u0131yla %12.6 oran\u0131nda menenjit ve %11.8 oran\u0131nda spondilodiskit izliyordu. EPTB\u2019nin irdelendi\u011fi farkl\u0131 \u00e7al\u0131\u015fmalarda t\u00fcberk\u00fcloz lenfadenit oran\u0131; %26.5- %49 aras\u0131nda bulunmu\u015ftur (4, 5, 13). Ta\u015fova ve arkada\u015flar\u0131 (6), olgularda en s\u0131k g\u00f6r\u00fclen EPTB\u2019nin menenjit (%48.9) oldu\u011funu, bunu izleyen periferik lenfadenitin ise %81.5 oran\u0131nda servikal b\u00f6lgede yerle\u015fti\u011fini bildirmi\u015ftir. T\u00fcberk\u00fcloz lenfadenitlerin irdelendi\u011fi farkl\u0131 \u00e7al\u0131\u015fmalarda, %57-83.4 oranlar\u0131 aras\u0131nda servikal lenf nodu tutulumunun g\u00f6r\u00fcld\u00fc\u011f\u00fc bildirilmi\u015ftir (9, 14, 15). \u00c7al\u0131\u015fmam\u0131zda, di\u011fer \u00e7al\u0131\u015fmalardan daha d\u00fc\u015f\u00fck oranda olmakla birlikte, servikal t\u00fcberk\u00fcloz lenfadenit %41.7 oran\u0131yla ilk s\u0131rada yer almaktad\u0131r.<span class=\"Apple-converted-space\">\u00a0<\/span><\/p>\n<p class=\"p5\">T\u00fcberk\u00fcloz menenjit, t\u00fcberk\u00fclozun en s\u0131k g\u00f6r\u00fclen SSS tutulumudur; t\u00fcm EPTB olgular\u0131n\u0131n %5\u2019ini olu\u015fturur (16). \u00c7al\u0131\u015fmam\u0131zdaki EPTB olgular\u0131n\u0131n %12.6\u2019s\u0131n\u0131 menenjit olu\u015fturmaktayd\u0131 ve ba\u015fvuru esnas\u0131nda olgular\u0131n \u00e7o\u011funlu\u011funun (%66.6) evre-2\u2019de oldu\u011fu tespit edildi. Benzer \u015fekilde Ta\u015fova ve arkada\u015flar\u0131 (6) da ilk de\u011ferlendirmelerinde olgular\u0131n %50\u2019sinin evre-2\u2019de oldu\u011funu tespit etmi\u015fti (6).<span class=\"Apple-converted-space\">\u00a0<\/span><\/p>\n<p class=\"p5\">Kemik-eklem t\u00fcberk\u00fclozu, EPTB olgular\u0131n\u0131n %35\u2019inden fazlas\u0131nda g\u00f6r\u00fclmekte olup en s\u0131k olarak kar\u015f\u0131la\u015f\u0131lan vertebra tutulumudur; vertebra t\u00fcberk\u00fclozu (Pott hastal\u0131\u011f\u0131) s\u0131kl\u0131kla torakal vertebralar\u0131 etkilemektedir (2, 17). \u00c7al\u0131\u015fmam\u0131zda, %42.8 oran\u0131nda torakal ve %35.7 oran\u0131nda torakolomber tutulumu tespit edildi. Farkl\u0131 \u00e7al\u0131\u015fmalarda da \u00e7al\u0131\u015fmam\u0131za benzer \u015fekilde en s\u0131k torakal ve lomber vertebra tutulumlar\u0131 g\u00f6zlenmi\u015ftir (6, 7, 18).<span class=\"Apple-converted-space\">\u00a0<\/span><\/p>\n<p class=\"p5\">Genital sistem t\u00fcberk\u00fclozu EPTB olgular\u0131n\u0131n %5 ila %30\u2019unu olu\u015fturmaktad\u0131r; \u00fcriner sistemde basil s\u0131k\u00e7a b\u00f6bre\u011fe yerle\u015fir, diz\u00fcri ve yan a\u011fr\u0131s\u0131na yol a\u00e7ar (19). \u00c7al\u0131\u015fmam\u0131zda olgular\u0131n %5.9\u2019unda genital sistem t\u00fcberk\u00fclozu tespit edilmi\u015f olup en s\u0131k kar\u015f\u0131la\u015f\u0131lan yak\u0131nma diz\u00fcri idi. \u00d6ztop ve arkada\u015flar\u0131 (20) da genito\u00fcriner t\u00fcberk\u00fcloz olgular\u0131n\u0131n \u00e7o\u011funda (%60) diz\u00fcri, hemat\u00fcri yak\u0131nmas\u0131 oldu\u011funu bildirmi\u015ftir.<span class=\"Apple-converted-space\">\u00a0<\/span><\/p>\n<p class=\"p5\">T\u00fcberk\u00fcloz peritonitte kar\u0131n a\u011fr\u0131s\u0131 s\u0131kl\u0131kla g\u00f6r\u00fclen bir semptom olup periton ve mezenterin inflamasyonuna ba\u011fl\u0131d\u0131r. \u00c7al\u0131\u015fmam\u0131zda peritonit tan\u0131s\u0131 alm\u0131\u015f olan olgularda en s\u0131k g\u00f6r\u00fclen yak\u0131nmalar kar\u0131nda \u015fi\u015flik, ate\u015f ve kilo kayb\u0131 olarak tespit edildi.<span class=\"Apple-converted-space\">\u00a0<\/span><\/p>\n<p class=\"p5\">G\u0130S t\u00fcberk\u00fclozunda s\u0131kl\u0131kla ileo\u00e7ekal b\u00f6lge etkilenir; lenf nodundan zengin, ak\u0131m\u0131n yava\u015f ve absorbsiyonun y\u00fcksek oldu\u011fu bu b\u00f6lgede basil invazyonu da fazlad\u0131r (21). \u00c7al\u0131\u015fmam\u0131zda, G\u0130S t\u00fcberk\u00fclozunda en s\u0131k yak\u0131nma kar\u0131n a\u011fr\u0131s\u0131 olup terminal ileum, omentum, jejenum ve kolon tutulumu da tespit edildi.<span class=\"Apple-converted-space\">\u00a0<\/span><\/p>\n<p class=\"p5\">T\u00fcberk\u00fcloz pl\u00f6rezide ise \u00f6ks\u00fcr\u00fck ve pl\u00f6retik g\u00f6\u011f\u00fcs a\u011fr\u0131s\u0131 en \u00f6nemli semptomlard\u0131r. \u00c7al\u0131\u015fmam\u0131zdaki olgularda nefes darl\u0131\u011f\u0131 yak\u0131nmas\u0131 en \u00f6nemli semptomlardan birisi olarak tespit edildi.<span class=\"Apple-converted-space\">\u00a0<\/span><\/p>\n<p class=\"p5\">T\u00fcberk\u00fcloz tan\u0131s\u0131nda en \u00f6nemli nokta ay\u0131r\u0131c\u0131 tan\u0131da EPTB\u2019nin akla gelmesidir. EPTB\u2019de klinik \u00f6zellikler tutulan organa spesifik oldu\u011fu i\u00e7in ilgili b\u00f6lgeden al\u0131nan \u00f6rneklerde \u00e7al\u0131\u015f\u0131lacak mikrobiyolojik ve patolojik analizlerin yan\u0131 s\u0131ra ve gerekti\u011fi durumlarda radyolojik incelemelerin yap\u0131lmas\u0131 \u00e7ok kritiktir. T\u00fcberk\u00fcloz tan\u0131s\u0131nda boyama ile direkt mikrobiyolojik inceleme ve t\u00fcberk\u00fcloz k\u00fclt\u00fcr\u00fc en s\u0131k ba\u015fvurulan ve alt\u0131n standart olan y\u00f6ntemlerdir. ARB pozitifli\u011fi i\u00e7in dokuda 10<sup>6<span class=\"Apple-converted-space\">\u00a0 <\/span><\/sup>bakteri\/gr olmas\u0131 gerekir; bu nedenle EPTB\u2019da tan\u0131sal de\u011fer %0-%40 aras\u0131ndad\u0131r (22). \u00c7al\u0131\u015fmam\u0131zda incelenen olgularda; %8.1 oran\u0131nda ARB pozitifli\u011fi, %48.3 oran\u0131nda k\u00fclt\u00fcr pozitifli\u011fi saptanm\u0131\u015ft\u0131r. Ta\u015fova ve arkada\u015flar\u0131n\u0131n (6) yapt\u0131\u011f\u0131 \u00e7al\u0131\u015fmada, ARB pozitifli\u011fi %21.4, k\u00fclt\u00fcr pozitifli\u011fi ise %20.5 oran\u0131nda saptanm\u0131\u015ft\u0131r. Fain ve arkada\u015flar\u0131 (13) 141 EPTB hastas\u0131n\u0131 kapsayan \u00e7al\u0131\u015fmalar\u0131nda; toplam 68 <i>M. tuberculosis <\/i>su\u015fu izole ettiklerini, bunlar\u0131n 27\u2019sinin direkt bak\u0131 ve k\u00fclt\u00fcr sonu\u00e7lar\u0131n\u0131n pozitif oldu\u011funu ve 41\u2019inin ise sadece k\u00fclt\u00fcr pozitifli\u011fi oldu\u011funu bildirmi\u015ftir. Hitit ve arkada\u015flar\u0131n\u0131n (8) \u00e7al\u0131\u015fmas\u0131nda da k\u00fclt\u00fcr pozitifli\u011fi oran\u0131 %26.6\u2019d\u0131r. \u00c7al\u0131\u015fmam\u0131zda, ARB pozitifli\u011fi oranlar\u0131n\u0131n d\u00fc\u015f\u00fck tespit edilmesi \u00f6rnek miktar\u0131n\u0131n yetersiz ve\/veya incelemenin uzun s\u00fcre yap\u0131lmam\u0131\u015f olmas\u0131na ba\u011fl\u0131 olabilir.<\/p>\n<p class=\"p5\">SSS t\u00fcberk\u00fclozunda tan\u0131 koymak g\u00fc\u00e7t\u00fcr. Mikobakteri k\u00fclt\u00fcr\u00fcnde \u00fcreme zaman alaca\u011f\u0131 i\u00e7in BOS PCR y\u00f6ntemi k\u00fclt\u00fcrden daha duyarl\u0131d\u0131r. Ancak negatif PCR sonucu t\u00fcberk\u00fcloz menenjiti tan\u0131s\u0131n\u0131 ekarte ettirmez (16). \u00c7al\u0131\u015fmam\u0131zda BOS \u00f6rneklerinin hi\u00e7birinde ARB pozitifli\u011fi saptanmam\u0131\u015f olup PCR pozitifli\u011finin %71.4 oran\u0131nda, t\u00fcberk\u00fcloz k\u00fclt\u00fcr\u00fcnde \u00fcremenin ise %58.3 oran\u0131nda oldu\u011fu g\u00f6r\u00fclm\u00fc\u015ft\u00fcr. Farkl\u0131 \u00e7al\u0131\u015fmalarda BOS k\u00fclt\u00fcr\u00fcnde <i>M. tuberculosis <\/i>\u00fcremesi %18.7 ve %48 oranlar\u0131nda bulunmu\u015ftur (6, 7). \u00c7al\u0131\u015fmam\u0131zdaki olgularda, BOS\u2019da ARB pozitifli\u011finin saptanmamas\u0131n\u0131n nedeni gerekli miktarda BOS al\u0131namamas\u0131 veya iyi santrif\u00fcj edilip yeterli s\u00fcrede preparat\u0131n incelenememi\u015f olmas\u0131na ba\u011fl\u0131 olabilir.<\/p>\n<p class=\"p5\">T\u00fcberk\u00fcloz tan\u0131s\u0131nda patolojik inceleme de olduk\u00e7a yol g\u00f6stericidir. Bir \u00e7al\u0131\u015fmada, eksizyonel biyopsinin i\u011fne aspirasyon biyopsisine g\u00f6re daha duyarl\u0131 oldu\u011fu ve elde edilen patolojik bulgunun kazeifikasyon nekrozu olan\/veya olmayan epiteloid gran\u00fclomlar ve Langerhans h\u00fccreleri oldu\u011fu belirtilmi\u015ftir (9). \u00dclkemizden yap\u0131lan bir \u00e7al\u0131\u015fmada da biyopsi yap\u0131lan olgularda %82.2 oran\u0131nda kazeifiye ve non-kazeifiye gran\u00fclomlar saptanm\u0131\u015ft\u0131r (8). \u00c7al\u0131\u015fmam\u0131zda \u00f6rneklerin %78.2\u2019sinde patolojik inceleme yap\u0131ld\u0131\u011f\u0131 tespit edilmi\u015ftir; en s\u0131k kar\u015f\u0131la\u015f\u0131lan patolojik bulgu kazeifiye gran\u00fclomat\u00f6z iltihapt\u0131r (%41.2). Bu durum tan\u0131 i\u00e7in mikrobiyolojik inceleme yan\u0131nda doku incelemesinin de olduk\u00e7a faydal\u0131 bir y\u00f6ntem oldu\u011funu g\u00f6stermektedir. <span class=\"Apple-converted-space\">\u00a0<\/span><\/p>\n<p class=\"p5\"><span class=\"s1\">Plevra t\u00fcberk\u00fclozunun tan\u0131s\u0131 genel olarak plevra s\u0131v\u0131s\u0131n\u0131n analizi ve\/veya plevra biyopsisi ile koyulur. Plevra s\u0131v\u0131s\u0131nda adenosin deaminaz (ADA) enzim d\u00fczeyinin &gt;50 \u00fcnite\/lt olmas\u0131n\u0131n t\u00fcberk\u00fcloz pl\u00f6rezi tan\u0131s\u0131nda duyarl\u0131k ve \u00f6zg\u00fcll\u00fc\u011f\u00fc y\u00fcksektir (23). \u00c7al\u0131\u015fmam\u0131zda, t\u00fcberk\u00fcloz pl\u00f6rezi tan\u0131s\u0131 alan olgular\u0131n hepsinde ADA d\u00fczeyi &gt;50 \u00fcnite\/lt olarak y\u00fcksek tespit edilmi\u015ftir.<\/span><\/p>\n<p class=\"p5\">T\u00fcberk\u00fcloz tedavisinde ba\u015flang\u0131\u00e7ta iki ay d\u00f6rtl\u00fc daha sonra 4-7 ay ikili tedavi \u00f6nerilmektedir. Ancak t\u00fcberk\u00fcloz menenjitte tedavi s\u00fcresi 12 aya uzat\u0131labilir. Antit\u00fcberk\u00fcloz tedaviye; 6-8 hafta deksametazon veya prednizolon eklenmesi, meningeal inflamasyonun ve intrakranial bas\u0131nc\u0131n azalt\u0131lmas\u0131 i\u00e7in \u00f6nerilmektedir (16). \u00c7al\u0131\u015fmam\u0131zdaki SSS t\u00fcberk\u00fcloz olgular\u0131na, 12 ay antit\u00fcberk\u00fcloz tedavi ve alt\u0131 hafta steroid tedavisi uygulanm\u0131\u015ft\u0131r.<span class=\"Apple-converted-space\">\u00a0<\/span><\/p>\n<p class=\"p5\">T\u00fcberk\u00fcloz tedavisi s\u0131ras\u0131nda en s\u0131k rastlanan yan etki hepatotoksisitedir. INH, RIF ve PZA hepatotoksik ila\u00e7lar olup birlikte kullan\u0131ld\u0131\u011f\u0131nda yan etki riski de artmaktad\u0131r. PZA, b\u00f6brek tubuluslar\u0131nda \u00fcrik asit sekresyonunu engelledi\u011fi i\u00e7in \u00fcrik asit seviyesi y\u00fckselir. \u00c7al\u0131\u015fmam\u0131zda, tedaviye ba\u011fl\u0131 yan etki 48 (%40) olguda tespit edildi. En s\u0131k g\u00f6r\u00fclen yan etki, %50 (24\/48) oran\u0131yla hepatotoksisite olup bunu %18.5 ile \u00fcrik asit art\u0131\u015f\u0131 izledi.<\/p>\n<p class=\"p5\">EPTB tan\u0131s\u0131 alan 119 olgunun 8 (%6.7)\u2019i tedavi s\u0131ras\u0131nda hayat\u0131n\u0131 kaybetmi\u015fti. S\u00f6z konusu olgular\u0131n; d\u00f6rd\u00fc t\u00fcberk\u00fcloz menenjit olup biri e\u015flik eden kateter ili\u015fkili kan dola\u015f\u0131m infeksiyonu, biri e\u015flik eden malignite ve ikisi t\u00fcberk\u00fcloz nedeniyle; t\u00fcberk\u00fcloz lenfadenit olan iki olgunun ise serebrovak\u00fcsler hastal\u0131k nedeniyle hayat\u0131n\u0131 kaybetti\u011fi tespit edildi. T\u00fcberk\u00fcloz peritonitli bir olgunun peritonit ve komplikasyonlar\u0131 ve \u00fcrogenital sistem t\u00fcberk\u00fclozu olan bir di\u011fer olgunun da bakteriyel kaynakl\u0131 sepsis nedeniyle hayat\u0131n\u0131 kaybetti\u011fi g\u00f6r\u00fcld\u00fc.<\/p>\n<p class=\"p5\">Sonu\u00e7 olarak; t\u00fcberk\u00fcloz halen \u00f6nemli bir sa\u011fl\u0131k sorunudur. \u00d6zellikle lenfadenopati, ate\u015f, halsizlik ve kilo kayb\u0131 ile gelen hastalarda t\u00fcberk\u00fcloz ay\u0131r\u0131c\u0131 tan\u0131da mutlaka d\u00fc\u015f\u00fcn\u00fclmelidir.<span class=\"Apple-converted-space\">\u00a0<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>G\u0130R\u0130\u015e\u00a0 T\u00fcberk\u00fcloz, \u00f6zellikle geli\u015fmekte olan \u00fclkelerde, morbidite ve mortalitenin ana nedenlerindendir. D\u00fc\u015f\u00fck sosyoekonomik durum, g\u00f6\u00e7, imm\u00fcns\u00fcpresif ajan kullan\u0131m\u0131 ve HIV\/AIDS hastal\u0131\u011f\u0131n\u0131n g\u00f6r\u00fclme s\u0131kl\u0131\u011f\u0131ndaki art\u0131\u015fla birlikte t\u00fcberk\u00fcloz insidans\u0131nda art\u0131\u015f olmu\u015ftur. Ekstrapulmoner t\u00fcberk\u00fcloz (EPTB), t\u00fcberk\u00fclozun akci\u011fer d\u0131\u015f\u0131ndaki organlarda yerle\u015fimidir. D\u00fcnya genelinde 2017 y\u0131l\u0131nda 6.4 milyon yeni t\u00fcberk\u00fcloz olgusu tespit edilmi\u015ftir. Bunun %14\u2019\u00fcn\u00fc EPTB olgular\u0131 olu\u015fturmaktad\u0131r. EPTB\u2019nin tan\u0131s\u0131nda [&hellip;]<\/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":[3134,5654,3716],"class_list":["post-26408","post","type-post","status-publish","format-standard","hentry","category-ozgun-arastirma","tag-ekstrapulmoner-tuberkuloz","tag-klinik-tablo","tag-tani"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/26408","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=26408"}],"version-history":[{"count":3,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/26408\/revisions"}],"predecessor-version":[{"id":26810,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/26408\/revisions\/26810"}],"wp:attachment":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/media?parent=26408"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/categories?post=26408"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/tags?post=26408"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}