{"id":27999,"date":"2023-12-25T16:40:01","date_gmt":"2023-12-25T13:40:01","guid":{"rendered":"https:\/\/www.klimikdergisi.org\/?p=27999"},"modified":"2024-06-25T15:03:26","modified_gmt":"2024-06-25T12:03:26","slug":"kirim-kongo-kanamali-atesinin-cinsel-yolla-bulasmasi","status":"publish","type":"post","link":"https:\/\/www.klimikdergisi.org\/tr\/2023\/12\/25\/kirim-kongo-kanamali-atesinin-cinsel-yolla-bulasmasi\/","title":{"rendered":"Olas\u0131 Cinsel Yolla Bula\u015fan K\u0131r\u0131m-Kongo Kanamal\u0131 Ate\u015fi Olgu Sunumu"},"content":{"rendered":"

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

K\u0131r\u0131m-Kongo kanamal\u0131 ate\u015fi (KKKA), insanlarda mortal seyredebilen zoonotik bir hastal\u0131kt\u0131r. Hastal\u0131k; Afrika, Asya, Do\u011fu Avrupa ve Orta Do\u011fu\u2019da olmak \u00fczere d\u00fcnya genelinde 30\u2019dan fazla \u00fclkede g\u00f6r\u00fclm\u00fc\u015ft\u00fcr.\u00a0T\u00fcrkiye\u2019de 2002 y\u0131l\u0131ndan beri g\u00f6r\u00fclmektedir (1). Etken, negatif sarmall\u0131, Bunyavirales<\/i> tak\u0131m\u0131 i\u00e7indeki\u00a0Nairoviridae ailesindeki Orthonairovirus<\/i> cinsi i\u00e7inde yer alan bir RNA virusudur.\u00a0<\/i>Bula\u015fma en s\u0131k olarak infekte Hyalomma<\/i> cinsi kene ile temas sonucu ger\u00e7ekle\u015fmekle birlikte infekte insan veya hayvanlar\u0131n kan veya dokular\u0131na temasla da olabilmektedir. Kulu\u00e7ka s\u00fcresi kene tutunmas\u0131 sonras\u0131 ortalama 1-3 g\u00fcnd\u00fcr; ancak bu s\u00fcre 9-10 g\u00fcne kadar uzayabilmektedir. \u0130nfekte kan, v\u00fccut s\u0131v\u0131s\u0131 veya di\u011fer dokularla do\u011frudan temas sonras\u0131 olan bula\u015fmada ink\u00fcbasyon s\u00fcresi ortalama 5-6 g\u00fcn olup en fazla 13 g\u00fcnd\u00fcr.\u00a0Klinik belirtilerin spektrumu, subklinik hastal\u0131ktan kanamal\u0131 akut infeksiyona ve \u00e7oklu organ yetmezli\u011fine kadar de\u011fi\u015fkenlik g\u00f6stermektedir (1-3).<\/span><\/p>\n

Bu yaz\u0131da; endemik k\u0131rsal b\u00f6lge ziyareti, kene temas\u0131 ve hayvanc\u0131l\u0131k \u00f6yk\u00fcs\u00fc olmayan ancak KKKA hastal\u0131\u011f\u0131n\u0131n konvelesan d\u00f6nemindeki birincil olgu ile cinsel temas \u00f6yk\u00fcs\u00fc olan bir KKKA olgusu sunuldu. Her iki hastan\u0131n tan\u0131s\u0131 Halk Sa\u011fl\u0131\u011f\u0131 Laboratuvar\u0131\u2019nda yap\u0131lan polimeraz zincir reaksiyonu (PZR) testinin pozitif olmas\u0131 ile do\u011fruland\u0131.<\/p>\n

OLGU<\/h2>\n

Bilinen meme karsinomu tan\u0131s\u0131 olan 66 ya\u015f\u0131nda kad\u0131n hasta, acil servise \u00fc\u00e7 g\u00fcnd\u00fcr devam eden ba\u015f a\u011fr\u0131s\u0131 ve epigastrik a\u011fr\u0131 yak\u0131nmalar\u0131yla ba\u015fvurdu. Meme karsinomu tan\u0131s\u0131 ile mastektomi \u00f6yk\u00fcs\u00fc mevcuttu; hastal\u0131k remisyonda olup olgumuz sadece aromataz inhibit\u00f6r\u00fc ila\u00e7 kullanmaktayd\u0131. Acil serviste yap\u0131lan tetkiklerinde; l\u00f6kosit say\u0131s\u0131 1500\/mm3<\/sup>, hemoglobin (Hgb) de\u011feri 13 gr\/dl, trombosit say\u0131s\u0131 61 000\/mm3<\/sup>, \u00fcre de\u011feri 113 mg\/dl, kreatinin de\u011feri 2.63 mg\/dl, alanin aminotransferaz (ALT) de\u011feri 41 \u00dc\/lt, aspartat aminotransferaz (AST) de\u011feri 113 \u00dc\/lt, laktat dehidrogenaz (LDH) de\u011feri 335 \u00dc\/lt, kreatinin kinaz (KK) de\u011feri 98 \u00dc\/lt olarak saptand\u0131. Hasta, mevcut klinik ve laboratuvar bulgular\u0131 ile KKKA hastal\u0131\u011f\u0131 \u00f6n tan\u0131s\u0131yla yatakl\u0131 servise yat\u0131r\u0131ld\u0131 ve izole edildi. Erzincan ili merkezinde ikamet eden hastadan al\u0131nan ayr\u0131nt\u0131l\u0131 anamnezde; endemik k\u0131rsal b\u00f6lge ziyareti, kene temas\u0131 ve hayvanc\u0131l\u0131k \u00f6yk\u00fcs\u00fc yoktu. Ancak hastan\u0131n e\u015finin k\u0131rsal b\u00f6lgeye seyahat etti\u011fi,
\nkene temas\u0131 \u00f6yk\u00fcs\u00fc oldu\u011fu, sonras\u0131nda KKKA hastal\u0131\u011f\u0131 kesin tan\u0131s\u0131 ald\u0131\u011f\u0131 ve 18 g\u00fcn \u00f6nce \u015fifa ile taburcu edildi\u011fi \u00f6\u011frenildi. Taburcu edilirken hastal\u0131\u011f\u0131n bula\u015fma yollar\u0131yla ilgili ayr\u0131nt\u0131l\u0131 bilgi verilmesine ra\u011fmen sosyok\u00fclt\u00fcrel d\u00fczeyi d\u00fc\u015f\u00fck olan hastam\u0131z\u0131n ve e\u015finin (birincil olgu) bir hafta \u00f6nce korunmas\u0131z cinsel temas \u00f6yk\u00fcs\u00fc oldu\u011fu tespit edildi.\u00a0 <\/span>Hasta cinsel <\/span>temastan \u00fc\u00e7 g\u00fcn sonra semptomlar\u0131n\u0131n ba\u015flad\u0131\u011f\u0131n\u0131 ifade etti.<\/p>\n

\"\"<\/a>

Tablo 1.<\/strong> Hastan\u0131n G\u00fcnl\u00fck Takip Edilen Laboratuvar Sonu\u00e7lar\u0131<\/p><\/div>\n

Hastan\u0131n yat\u0131\u015f\u0131n\u0131n ilk g\u00fcn\u00fcnde serum amilaz ve lipaz enzimleri normalin \u00fc\u00e7 kat\u0131ndan fazla saptand\u0131. \u00dcre\/kreatinin de\u011ferlerinin de y\u00fcksek olmas\u0131 nedeniyle bat\u0131n ultrasonografisi (USG) \u00e7ekildi. Bat\u0131n USG\u2019de pankreatit bulgusu yoktu; b\u00f6breklerin lokalizasyonu, boyutlar\u0131 ve yap\u0131s\u0131 ola\u011fand\u0131. Hastan\u0131n yat\u0131\u015f\u0131n\u0131n birinci g\u00fcn\u00fcnden itibaren (klini\u011finin \u00fc\u00e7\u00fcnc\u00fc g\u00fcn\u00fc) trombosit de\u011ferleri h\u0131zl\u0131 d\u00fc\u015ft\u00fc ve 50 000\/mm3 <\/sup>alt\u0131nda seyretti. Yat\u0131\u015f\u0131n\u0131n d\u00f6rd\u00fcnc\u00fc g\u00fcn\u00fcnde hematokezya saptanan hastaya iki \u00fcnite taze donmu\u015f plazma (TDP) ve iki \u00fcnite havuzlanm\u0131\u015f trombosit verildi. Hastan\u0131n bu esnada bak\u0131lan serum \u201cinternational normalized ratio\u201d <\/span>(INR)<\/span> seviyesi normaldi. Takiplerinde hemoglobin d\u00fc\u015f\u00fc\u015f\u00fc izlenmedi ve kanamas\u0131 tekrarlamad\u0131. Takibinin alt\u0131nc\u0131 g\u00fcn\u00fcnde epistaksis geli\u015fen hastaya kulak-burun-bo\u011faz hastal\u0131klar\u0131 taraf\u0131ndan intranazal tampon uyguland\u0131. Ayr\u0131ca hastaya bu esnada iki \u00fcnite daha TDP ve havuzlanm\u0131\u015f trombosit verildi. Takiplerinde epistaksis tekrarlamad\u0131 ve hemoglobin d\u00fc\u015f\u00fckl\u00fc\u011f\u00fc izlenmedi. \u015euur durumunda gerileme (somnolans) olan hasta, bilin\u00e7 durumu ve vitalleri a\u00e7\u0131s\u0131ndan yak\u0131n takibe al\u0131nd\u0131. <\/span>Kooperasyon ve oryantasyonda bozulma izlenmedi. Yat\u0131\u015f\u0131n\u0131n yedinci g\u00fcn\u00fcnde l\u00f6kopeni ve trombositopeni d\u00fczelme e\u011filimi g\u00f6stermeye ba\u015flad\u0131. Takibinin sekizinci g\u00fcn\u00fcnde somnolans tablosu geriledi. G\u00fcnl\u00fck hemogram takiplerine g\u00f6re yat\u0131\u015f s\u00fcresi boyunca hastaya toplamda sekiz \u00fcnite havuzlanm\u0131\u015f trombosit ve d\u00f6rt \u00fcnite TDP verildi. Hastan\u0131n takip ve tedavisi boyunca yap\u0131lan g\u00fcnl\u00fck tetkikleri Tablo 1\u2019de \u00f6zetlendi. Hasta, servisimizde 12 g\u00fcn boyunca takip edilerek \u015fifa ile taburcu edildi.<\/p>\n

\u0130RDELEME<\/h2>\n

K\u0131r\u0131m-Kongo kanamal\u0131 ate\u015fi hastal\u0131\u011f\u0131nda en s\u0131k bula\u015fma yolunun kene temas\u0131 olmas\u0131 nedeniyle tar\u0131m ve hayvanc\u0131l\u0131kla u\u011fra\u015fanlar y\u00fcksek risk alt\u0131ndad\u0131r (2,3). Bula\u015fma, insandan insana infekte v\u00fccut s\u0131v\u0131lar\u0131yla temas sonucu olabilmektedir (3). Tan\u0131 alm\u0131\u015f olan hastalar\u0131n yak\u0131n temasl\u0131lar\u0131n\u0131n ve akrabalar\u0131n\u0131n bula\u015fma yolu a\u00e7\u0131s\u0131ndan izlendi\u011fi bir \u00e7al\u0131\u015fmada; 90 hastan\u0131n 116 yak\u0131n temasl\u0131s\u0131 serolojik a\u00e7\u0131dan prospektif olarak izlenmi\u015f ve herhangi bir bula\u015fma saptanmam\u0131\u015ft\u0131r. Ancak s\u00f6z konusu \u00e7al\u0131\u015fmada temasl\u0131lar\u0131n hi\u00e7birinde cinsel temas \u00f6yk\u00fcs\u00fc olmad\u0131\u011f\u0131 belirtilmi\u015ftir (4). Ba\u015fka bir \u00e7al\u0131\u015fmada, 12 KKKA hastas\u0131n\u0131n 57 yak\u0131n temasl\u0131s\u0131 irdelenmi\u015f ve bir ki\u015fide cinsel temas \u00f6yk\u00fcs\u00fc olmakla birlikte KKKA hastal\u0131\u011f\u0131 a\u00e7\u0131s\u0131ndan herhangi bir bula\u015fma tespit edilmemi\u015ftir; t\u00fcm bula\u015fma yollar\u0131 de\u011ferlendirildi\u011finde temas yoluyla bula\u015fma ihtimalinin d\u00fc\u015f\u00fck oldu\u011fu vurgulanm\u0131\u015ft\u0131r (5). Bu \u00e7al\u0131\u015fmalar damlac\u0131k\/temas yoluyla bula\u015f ihtimalinin d\u00fc\u015f\u00fck oldu\u011fu y\u00f6n\u00fcnde kan\u0131tlar sunmakla beraber cinsel yolla bula\u015f a\u00e7\u0131s\u0131ndan herhangi bir kan\u0131t sunmamaktad\u0131r. Bununla birlikte hastal\u0131\u011f\u0131n olas\u0131 bula\u015fma yolunun cinsel yol oldu\u011funu \u00f6ng\u00f6ren \u00e7al\u0131\u015fmalarda; birincil olgu ile konvelesan d\u00f6neminde cinsel temas\u0131 takiben KKKA hastal\u0131\u011f\u0131 tan\u0131s\u0131 alan bir olgu (6) ve birincil olgu ile ink\u00fcbasyon\/prehemorajik d\u00f6nemde cinsel temas\u0131 olup kesin tan\u0131 alan \u00fc\u00e7 olgu bildirimi mevcuttur (7). Literat\u00fcrde s\u0131n\u0131rl\u0131 say\u0131da bulunan bu \u00e7al\u0131\u015fmalar, hastal\u0131\u011f\u0131n cinsel yolla bula\u015fma ihtimali \u00fczerinde durulmas\u0131 gerekti\u011fini vurgulamaktad\u0131r. Ayn\u0131 zamanda epididimoor\u015fit saptanan KKKA tan\u0131l\u0131 bir olgu raporu (8) ve yap\u0131lan di\u011fer \u00e7al\u0131\u015fmalarda idrarda KKKA virusunun tespit edilmesi genito\u00fcriner sisteme ge\u00e7i\u015fi g\u00f6stermektedir (9,10). Viral kanamal\u0131 ate\u015f yapan hastal\u0131klarda (Ebola, Marburg, Lassa, vb.), viral RNA hastal\u0131k ba\u015flang\u0131c\u0131ndan birka\u00e7 g\u00fcn sonra ve ortalama iki hafta s\u00fcresince serumda saptanabilir. Bu nedenle konvelesan fazda bula\u015fma riski devam etmektedir. Seminal s\u0131v\u0131da, filoviruslar\u0131n ve arenaviruslar\u0131n yakla\u015f\u0131k \u00fc\u00e7 ay bulundu\u011funu g\u00f6steren \u00e7al\u0131\u015fmalar vard\u0131r (6).\u00a0<\/span><\/span><\/p>\n

Seminal s\u0131v\u0131da virusun bak\u0131lamamas\u0131 \u00e7al\u0131\u015fmam\u0131z\u0131n k\u0131s\u0131tl\u0131l\u0131\u011f\u0131d\u0131r. Bununla birlikte hastam\u0131zda endemik k\u0131rsal alan ziyareti, hayvanc\u0131l\u0131k \u00f6yk\u00fcs\u00fc ve kene temas\u0131n\u0131n olmamas\u0131 cinsel yolla bula\u015fmay\u0131 desteklemektedir. Ayr\u0131ca ink\u00fcbasyon s\u00fcresi g\u00f6z \u00f6n\u00fcne al\u0131nd\u0131\u011f\u0131nda cinsel temas\u0131 takiben hastan\u0131n klini\u011finin ortaya \u00e7\u0131kmas\u0131, cinsel yolla bula\u015fmay\u0131 \u00f6ncelikli olarak d\u00fc\u015f\u00fcnd\u00fcrm\u00fc\u015ft\u00fcr.\u00a0<\/span><\/p>\n

Sonu\u00e7 olarak; KKKA hastal\u0131\u011f\u0131n\u0131n konvelesan d\u00f6nemde cinsel temas sonucu bula\u015fabilece\u011fi ile ilgili literat\u00fcrde s\u0131n\u0131rl\u0131 say\u0131da \u00e7al\u0131\u015fma mevcuttur. Tan\u0131 alan hastalar bula\u015fma yollar\u0131 a\u00e7\u0131s\u0131ndan detayl\u0131 bir \u015fekilde bilgilendirilmeli ve bula\u015fma yolu olarak cinsel temas da mutlaka sorgulanmal\u0131d\u0131r.<\/p>\n","protected":false},"excerpt":{"rendered":"

G\u0130R\u0130\u015e K\u0131r\u0131m-Kongo kanamal\u0131 ate\u015fi (KKKA), insanlarda mortal seyredebilen zoonotik bir hastal\u0131kt\u0131r. Hastal\u0131k; Afrika, Asya, Do\u011fu Avrupa ve Orta Do\u011fu\u2019da olmak \u00fczere d\u00fcnya genelinde 30\u2019dan fazla \u00fclkede g\u00f6r\u00fclm\u00fc\u015ft\u00fcr.\u00a0T\u00fcrkiye\u2019de 2002 y\u0131l\u0131ndan beri g\u00f6r\u00fclmektedir (1). Etken, negatif sarmall\u0131, Bunyavirales tak\u0131m\u0131 i\u00e7indeki\u00a0Nairoviridae ailesindeki Orthonairovirus cinsi i\u00e7inde yer alan bir RNA virusudur.\u00a0Bula\u015fma en s\u0131k olarak infekte Hyalomma cinsi kene ile […]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[5131],"tags":[5818,5692,2592],"class_list":["post-27999","post","type-post","status-publish","format-standard","hentry","category-olgu-sunumu","tag-cinsel-yolla-bulasma","tag-kirim-kongo-kanamali-atesi","tag-zoonoz"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/27999","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\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/comments?post=27999"}],"version-history":[{"count":4,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/27999\/revisions"}],"predecessor-version":[{"id":28783,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/27999\/revisions\/28783"}],"wp:attachment":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/media?parent=27999"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/categories?post=27999"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/tags?post=27999"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}