\u00a0 <\/span>doksisiklin+gentamisin, 13 (%5.4)\u2019\u00fcne doksisiklin+streptomisin ve 70 (%29.7)\u2019ine doksisiklin+rifampisin+gentamisin kombinasyonu ba\u015fland\u0131\u011f\u0131 tespit edildi. Geriye kalan 54 (%22.9) hastaya ise alternatif tedavi rejimleri ba\u015flanm\u0131\u015ft\u0131. Medyan tedavi s\u00fcresi alt\u0131 hafta olup tedavi s\u00fcreleri 1-72 hafta aras\u0131nda de\u011fi\u015fiyordu. Hastalar\u0131n 24 (%10.1)\u2019\u00fc tedavisini tamamlamam\u0131\u015ft\u0131. S\u00f6z konusu hastalar 1-5 hafta aras\u0131 tedavi al\u0131p tedaviyi kendileri b\u0131rakm\u0131\u015ft\u0131.<\/p>\n\u0130RDELEME<\/h2>\n
Brusellozun semptomlar\u0131 non-spesifik oldu\u011fundan ay\u0131r\u0131c\u0131 tan\u0131s\u0131 olduk\u00e7a geni\u015ftir ve hastalar yanl\u0131\u015f tan\u0131 alabilmektedir. Bruselloz ve KKKA, k\u0131rsal kesimde ya\u015fayan ve hayvanc\u0131l\u0131kla u\u011fra\u015fanlarda s\u0131k g\u00f6r\u00fclen iki zoonotik infeksiyondur. Ate\u015f, kas-eklem a\u011fr\u0131lar\u0131, ba\u015f a\u011fr\u0131s\u0131 her iki infeksiyondaki ortak semptomlar olup l\u00f6kopeni, anemi, trombositopeni ve karaci\u011fer enzim y\u00fcksekli\u011fi ortak laboratuvar bulgular\u0131d\u0131r (18,19). Duygu ve arkada\u015flar\u0131n\u0131n (18) \u00e7al\u0131\u015fmas\u0131nda, KKKA \u00f6n tan\u0131s\u0131 ile yat\u0131r\u0131lan hastalar\u0131n %5.3\u2019\u00fcnde bruselloz saptanm\u0131\u015ft\u0131r. Ayn\u0131 \u00e7al\u0131\u015fmada bruselloz ve KKKA koinfeksiyonu saptanan hasta oran\u0131 ise %5 olarak bulunmu\u015ftur. Literat\u00fcrde, KKKA ve bruselloz koinfeksiyonu \u015feklinde bildirilen olgu sunumlar\u0131n\u0131n yan\u0131 s\u0131ra s\u00f6z konusu infeksiyonlar\u0131n birbirini taklit etmesi nedeniyle ba\u015flang\u0131\u00e7ta hekimi yan\u0131ltan monoinfeksiyon \u015feklinde olgu sunumlar\u0131 da bulunmaktad\u0131r (19-22). Bizim \u00e7al\u0131\u015fmam\u0131zda da KKKA \u00f6n tan\u0131s\u0131 ile yatan yedi hastaya akut bruselloz tan\u0131s\u0131 konuldu\u011fu tespit edildi. Endemik b\u00f6lgelerde ya\u015fayan ve hayvanc\u0131l\u0131kla u\u011fra\u015fan KKKA \u00f6n tan\u0131l\u0131 hastalar\u0131n ay\u0131r\u0131c\u0131 tan\u0131s\u0131nda bruselloz mutlaka yer almal\u0131d\u0131r.<\/p>\n
Bruselloz, \u00e7o\u011fu \u00fclkede varl\u0131\u011f\u0131n\u0131 devam ettiren global bir halk sa\u011fl\u0131\u011f\u0131 sorunudur. Her ya\u015ftan ve her iki cinsiyetten bireylere bula\u015fabilmektedir. Hayvanc\u0131l\u0131kla u\u011fra\u015fanlar, taze s\u00fct ve s\u00fct \u00fcr\u00fcn\u00fc t\u00fcketenler risk alt\u0131ndad\u0131r (7,23). \u00c7al\u0131\u015fmam\u0131zda da her iki cinsiyetten hasta olmakla birlikte erkek olgu (%72) yo\u011funlu\u011fu daha fazlayd\u0131. \u00c7al\u0131\u015fmam\u0131za dahil edilen olgular\u0131n %53\u2019\u00fcn\u00fcn hayvanc\u0131l\u0131kla u\u011fra\u015ft\u0131\u011f\u0131, %21.6\u2019s\u0131n\u0131n ise taze s\u00fct ve\/veya s\u00fct \u00fcr\u00fcn\u00fc t\u00fcketti\u011fi tespit edildi. Erkek olgular\u0131n fazla olmas\u0131n\u0131n nedeninin riskli faaliyetlerle daha fazla u\u011fra\u015fmalar\u0131ndan kaynakl\u0131 oldu\u011fu d\u00fc\u015f\u00fcn\u00fcld\u00fc.<\/p>\n
Bruselloz, \u00fclkemizde y\u0131l\u0131n her d\u00f6neminde g\u00f6r\u00fclmekle birlikte, k\u0131rsal alanda faaliyetlerin artt\u0131\u011f\u0131, koyunlar\u0131n yavrulama d\u00f6nemleriyle birlikte, taze s\u00fct ve s\u00fct \u00fcr\u00fcnleri t\u00fcketiminin yo\u011funla\u015ft\u0131\u011f\u0131, ilkbahar ve yaz aylar\u0131nda daha s\u0131k kar\u015f\u0131m\u0131za \u00e7\u0131kmaktad\u0131r. \u00c7al\u0131\u015fmam\u0131za benzer \u015fekilde, Sa\u011fmak-Tartar\u2019\u0131n (24) ve G\u00fcr ve arkada\u015flar\u0131n\u0131n (25) \u00e7al\u0131\u015fmalar\u0131nda da en s\u0131k olgu say\u0131s\u0131na ilkbahar ve yaz aylar\u0131nda ula\u015f\u0131lm\u0131\u015ft\u0131r.<\/p>\n
\u00c7e\u015fitli \u00e7al\u0131\u015fmalarda, Brucella<\/i> \u201cbroth\u201d-subk\u00fclt\u00fcr ve Castaneda y\u00f6ntemi ile kan k\u00fclt\u00fcrlerinde Brucella <\/i>spp. izolasyon oran\u0131 akut bruselloz olgular\u0131nda %54.7-83.3, kronik bruselloz olgular\u0131nda ise %0-40 oranlar\u0131nda bildirilmi\u015ftir (26-28). Otomatize kan k\u00fclt\u00fcr\u00fc sistemlerinde yedi g\u00fcnl\u00fck ink\u00fcbasyon sonras\u0131 \u00fcreme oran\u0131n\u0131n %100\u2019e \u00e7\u0131kabildi\u011fi g\u00f6sterilmi\u015ftir (6). \u00c7al\u0131\u015fmam\u0131zda, t\u00fcm olgular aras\u0131nda k\u00fclt\u00fcr pozitifli\u011fi %5 olarak tespit edilmi\u015fken k\u00fclt\u00fcr al\u0131nan olgular aras\u0131nda pozitiflik oran\u0131 %25 idi. Hastalar\u0131n \u00e7o\u011fu poliklinikte takip edildi\u011fi i\u00e7in kan k\u00fclt\u00fcr\u00fc alma oran\u0131 \u00e7ok d\u00fc\u015f\u00fck olarak tespit edildi. Bu oran\u0131n d\u00fc\u015f\u00fck olmas\u0131 nedeniyle kan k\u00fclt\u00fcr\u00fc pozitiflik oran\u0131n\u0131n da d\u00fc\u015f\u00fck oldu\u011fu kan\u0131s\u0131nday\u0131z.<\/p>\n
Bruselloz tipik olarak, ate\u015f y\u00fcksekli\u011fi, gece terlemeleri ve halsizlikle karakterizedir; kilo kayb\u0131, s\u0131rt a\u011fr\u0131s\u0131, ba\u015f d\u00f6nmesi, ba\u015f a\u011fr\u0131s\u0131, dispeptik yak\u0131nmalar, kar\u0131n a\u011fr\u0131s\u0131, \u00f6ks\u00fcr\u00fck ve depresif belirtiler de g\u00f6r\u00fclebilir (7). \u00c7al\u0131\u015fmam\u0131zda en s\u0131k g\u00f6r\u00fclen semptomlar kas ve eklem a\u011fr\u0131lar\u0131n\u0131n (%70.3) yan\u0131 s\u0131ra ate\u015fti (%50.8). Buzgan ve arkada\u015flar\u0131 (29) ile K\u00f6se ve arkada\u015flar\u0131n\u0131n (30) \u00e7al\u0131\u015fmalar\u0131nda da en s\u0131k saptanan bulgular ate\u015f y\u00fcksekli\u011fi ile birlikte kas ve eklem a\u011fr\u0131lar\u0131d\u0131r. Bruselloz seyrindeki fizik muayene bulgular\u0131 ise olduk\u00e7a \u00e7e\u015fitli ve non-spesifiktir (7). \u0130ran\u2019da yap\u0131lan bir \u00e7al\u0131\u015fmada, splenomegali %5.7 oran\u0131 ile en s\u0131k saptanan fizik muayene bulgular\u0131 aras\u0131ndayd\u0131 (31). I\u015flak-Demir ve arkada\u015flar\u0131n\u0131n (32) \u00e7al\u0131\u015fmas\u0131nda, lenfadenopati %1.7 oran\u0131nda saptanm\u0131\u015ft\u0131r. Kara ve arkada\u015flar\u0131n\u0131n (33) \u00e7al\u0131\u015fmas\u0131nda da %8.5 oran\u0131nda hepatomegali tespit edilmi\u015ftir. \u00c7al\u0131\u015fmam\u0131zda ise olgular\u0131n %4.7\u2019sinde splenomegali, %3.4\u2019\u00fcnde hepatomegali, %2.1\u2019inde lenfadenopati saptanm\u0131\u015f olup bulgular\u0131m\u0131z literat\u00fcrle benzerdi.<\/p>\n
Olgular, semptom s\u00fcresine g\u00f6re akut, subakut ve kronik bruselloz olarak s\u0131n\u0131fland\u0131r\u0131lmaktad\u0131r. Kronik olgular genelde be\u015f y\u0131l i\u00e7inde tan\u0131 almalar\u0131na kar\u015f\u0131n literat\u00fcrde 57 y\u0131l sonra tan\u0131 alan olgu bildirimi bulunmaktad\u0131r (34). \u00dclkemizde yap\u0131lan 1028 serilik bir \u00e7al\u0131\u015fmada, bruselloz olgular\u0131n\u0131n %61.6\u2019s\u0131 akut, %21.6\u2019s\u0131 subakut, %13.6\u2019s\u0131 ise kronik olarak tespit edilmi\u015ftir (29). \u00c7al\u0131\u015fmam\u0131zda yer alan olgular\u0131n ise %76.6\u2019s\u0131 akut, %19.9\u2019u subakut, %3.8\u2019i ise kronik bruselloz hastas\u0131yd\u0131.<\/p>\n
Brusellozda \u00e7e\u015fitli organ tutulumlar\u0131na s\u0131k rastlan\u0131r. En yayg\u0131n olarak osteoartik\u00fcler organlar tutulmakta olup sakroileit \u00f6ne \u00e7\u0131kmaktad\u0131r. Genito\u00fcriner bruselloz ikinci en yayg\u0131n organ tutulumudur; klinikte s\u0131kl\u0131kla or\u015fit\/epididimoor\u015fit \u015feklinde ortaya \u00e7\u0131kar. N\u00f6robruselloz \u00e7e\u015fitli serilerde %10\u2019a varan oranlarda bildirilirken, kardiyak tutulum olgular\u0131n %3\u2019\u00fcnde kar\u015f\u0131m\u0131za \u00e7\u0131kmaktad\u0131r (7). \u00c7al\u0131\u015fmam\u0131zda da en s\u0131k saptanan tutulumlar sakroileit (%29.7), diskit (%13.6) ve or\u015fit (%8.2) idi. \u015eahin ve arkada\u015flar\u0131n\u0131n (30) \u00e7al\u0131\u015fmas\u0131nda, osteoartik\u00fcler organ tutulum oran\u0131 %13.2, K\u00f6se ve arkada\u015flar\u0131n\u0131n (35) \u00e7al\u0131\u015fmas\u0131nda ise %13.9 oran\u0131nda bulunmu\u015ftur. Epididimoor\u015fit ve endokardit oranlar\u0131 ise farkl\u0131 \u00e7al\u0131\u015fmalarda s\u0131ras\u0131yla %0.9-14.3 ve %0.9-3.7 aras\u0131nda bildirilmi\u015ftir (29,30,36,37). Buzgan ve arkada\u015flar\u0131n\u0131n (29) \u00e7al\u0131\u015fmas\u0131nda, olgular\u0131n %5.6\u2019s\u0131nda n\u00f6robruselloz saptanm\u0131\u015ft\u0131r. Bizim \u00e7al\u0131\u015fmam\u0131zda ise yaln\u0131zca birer olguda endokardit ve n\u00f6robruselloz tespit edildi; osteoartik\u00fcler tutulum ise literat\u00fcrden daha fazla oranda saptand\u0131. Bu durumun, kal\u00e7a ve bel a\u011fr\u0131s\u0131 tarifleyen hastalarda radyolojik tetkiklerin s\u0131k kullan\u0131m\u0131yla ili\u015fkili oldu\u011fu kan\u0131s\u0131nday\u0131z.<\/p>\n
Brusellozlu olgularda, hematolojik bulgulara s\u0131k rastlanmaktad\u0131r. Hatta baz\u0131 hastalarda hematolojik hastal\u0131klar\u0131 taklit edebilir ve bruselloz tan\u0131s\u0131 gecikebilir (38). Demir ve arkada\u015flar\u0131n\u0131n (32) \u00e7al\u0131\u015fmas\u0131nda, hastalar\u0131n %25\u2019inde anemi, %11.7\u2019sinde l\u00f6kopeni ve %8.3\u2019\u00fcnde trombositopeni saptanm\u0131\u015ft\u0131r. Tatl\u0131-K\u0131\u015f ve arkada\u015flar\u0131n\u0131n (36) \u00e7al\u0131\u015fmas\u0131nda ise hastalar\u0131n %44\u2019\u00fcnde hematolojik tutulum saptanm\u0131\u015f olup anemi %37.8, l\u00f6kopeni %3.6, trombositopeni %2.7 s\u0131kl\u0131\u011f\u0131nda tespit edilmi\u015ftir. \u00c7al\u0131\u015fmam\u0131zda ise hematolojik bulgular aras\u0131nda en s\u0131k g\u00f6r\u00fclen \u00fc\u00e7 bulgu s\u0131ras\u0131 ile anemi (%28), l\u00f6kopeni (%10.6) ve trombositopeni (%8.5) idi. Brusellozda karaci\u011fer tutulumu da s\u0131k g\u00f6r\u00fclmekte olup karaci\u011fer enzim y\u00fcksekli\u011fine rastlanmaktad\u0131r; %15-43 oran\u0131nda karaci\u011fer enzim y\u00fcksekli\u011fi tespit edilen \u00e7al\u0131\u015fmalar mevcuttur (24,29,36). \u00c7al\u0131\u015fmam\u0131zda olgular\u0131n %27.6\u2019s\u0131nda aspartat aminotransferaz (AST), %31.1\u2019inde alanin aminotransferaz (ALT) y\u00fcksekli\u011fi saptand\u0131.<\/p>\n
Ulu\u011f ve arkada\u015flar\u0131n\u0131n (39) \u00e7al\u0131\u015fmas\u0131nda, akut faz yan\u0131t\u0131n\u0131n g\u00f6stergelerinden olan C-reaktif protein (CRP) de\u011feri brusellozlu bireylerde kontrol grubuna g\u00f6re yakla\u015f\u0131k alt\u0131 kat daha y\u00fcksek bulunmu\u015ftur (39). \u00dclkemizde farkl\u0131 b\u00f6lgelerde yap\u0131lan \u00e7al\u0131\u015fmalarda ise, brusellozlu olgularda %36-86 oran\u0131nda CRP y\u00fcksekli\u011fi, %42-82 oran\u0131nda ise eritrosit sedimantasyon h\u0131z\u0131 (ESH) y\u00fcksekli\u011fi bildirilmi\u015ftir (24,36,40-42). Bizim \u00e7al\u0131\u015fmam\u0131zda ise olgular\u0131n %91.5\u2019inde CRP y\u00fcksekli\u011fi, %48.3\u2019\u00fcnde ESH y\u00fcksekli\u011fi saptand\u0131. <\/span><\/p>\nLokalize hastal\u0131\u011f\u0131n olmad\u0131\u011f\u0131 eri\u015fkin brusellozunda \u00f6nerilen birinci se\u00e7enek ila\u00e7lar; alt\u0131 hafta s\u00fcre ile oral rifampisin ve doksisiklin kombinasyonu ya da alt\u0131 haftal\u0131k oral doksisikline ek olarak 7-10 g\u00fcnl\u00fck intraven\u00f6z gentamisin ya da 15 g\u00fcnl\u00fck streptomisin kullan\u0131m\u0131d\u0131r (23). \u00c7al\u0131\u015fmam\u0131zda da hastalar\u0131n %47.2\u2019sine primer tedavi rejimlerinden biri verilmi\u015f olup organ tutulumu olan %29.7 oran\u0131ndaki hastaya da doksisiklin+rifampisin+gentamisin kombinasyonu ba\u015flanm\u0131\u015ft\u0131.<\/p>\n
Bruselloz tedavisini takiben %5-15 oran\u0131nda relaps g\u00f6r\u00fclebilmektedir (43). \u00c7al\u0131\u015fmam\u0131za dahil etti\u011fimiz 236 hastan\u0131n %9.3\u2019\u00fc relaps bruselloz hastas\u0131yd\u0131. Relaps nedeni; olgular\u0131n %50\u2019sinde tedavi s\u00fcresinin az olmas\u0131, %18.2\u2019inde eksik dozda ila\u00e7 kullan\u0131m\u0131 olarak belirlenirken, %31.8 olguda neden belirlenemedi. Literat\u00fcrde de relaps\u0131n nedenleri aras\u0131nda; antibiyotik dozu ve s\u00fcresinin yetersiz olmas\u0131, tedaviye uyum sorunu veya lokalize tutulum varl\u0131\u011f\u0131 yer almaktad\u0131r (7). \u00c7al\u0131\u015fmam\u0131zdaki relaps oran\u0131 ve nedenleri literat\u00fcrle uyumludur.\u00a0 \u00a0<\/span><\/span><\/p>\n\u00c7al\u0131\u015fmam\u0131z\u0131n en \u00f6nemli k\u0131s\u0131tl\u0131l\u0131\u011f\u0131 retrospektif olarak ger\u00e7ekle\u015ftirilmesidir. Hastalar\u0131n \u00e7o\u011fundan kan k\u00fclt\u00fcr\u00fc al\u0131nmam\u0131\u015f olmas\u0131 k\u00fclt\u00fcr pozitiflik oran\u0131n d\u00fc\u015f\u00fck olmas\u0131na neden olmu\u015f olabilir. Hastalar b\u00fcy\u00fck \u00f6l\u00e7\u00fcde poliklinikten takip edilip yat\u0131\u015f verilmedi\u011fi i\u00e7in kan k\u00fclt\u00fcr\u00fc al\u0131nma oran\u0131 da d\u00fc\u015f\u00fck kalm\u0131\u015ft\u0131r. <\/span><\/p>\nSonu\u00e7 olarak; bruselloz \u00fclkemiz i\u00e7in hala \u00f6nemini koruyan bir infeksiyon hastal\u0131\u011f\u0131d\u0131r. Ate\u015f, kas-eklem a\u011fr\u0131s\u0131 ve terleme ile ba\u015fvuran, epidemiyolojik \u00f6yk\u00fcs\u00fc olan, akut faz reaktan\u0131 y\u00fcksekli\u011fi ve sitopenisi olan hastalarda \u00f6n tan\u0131da yer almal\u0131d\u0131r. Ayr\u0131ca KKKA ve di\u011fer viral hemorajik hastal\u0131klar\u0131n ay\u0131r\u0131c\u0131 tan\u0131s\u0131nda bruselloz mutlaka akla gelmelidir.<\/p>\n","protected":false},"excerpt":{"rendered":"
G\u0130R\u0130\u015e Bruselloz, geli\u015fmemi\u015f ve geli\u015fmekte olan \u00fclkelerde endemik olarak g\u00f6r\u00fclen, insan ve \u00e7iftlik hayvanlar\u0131nda morbiditelere neden olan bir infeksiyon hastal\u0131\u011f\u0131d\u0131r (1). Brucella bakterileri, 0.5 ila 0.7 mikron \u00e7ap\u0131nda ve 0.6 ila 1.5 mikron uzunlu\u011funda, k\u00fc\u00e7\u00fck, hareketsiz, fak\u00fcltatif h\u00fccre i\u00e7i aerob basillerdir (2). Gram boyamada, tek, k\u00fc\u00e7\u00fck, Gram-negatif kokobasiller olarak izlenirler (3). Brucella su\u015flar\u0131n\u0131 izole edebilmek […]<\/p>\n","protected":false},"author":4,"featured_media":27545,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[5129],"tags":[5752,2821,2660],"class_list":["post-27268","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-ozgun-arastirma","tag-brucella-spp-2","tag-bruselloz","tag-epidemiyoloji"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/27268","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=27268"}],"version-history":[{"count":2,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/27268\/revisions"}],"predecessor-version":[{"id":27555,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/27268\/revisions\/27555"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/media\/27545"}],"wp:attachment":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/media?parent=27268"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/categories?post=27268"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/tags?post=27268"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
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