{"id":28064,"date":"2023-12-25T16:49:00","date_gmt":"2023-12-25T13:49:00","guid":{"rendered":"https:\/\/www.klimikdergisi.org\/?p=28064"},"modified":"2024-06-25T15:08:31","modified_gmt":"2024-06-25T12:08:31","slug":"sitmada-erken-tani","status":"publish","type":"post","link":"https:\/\/www.klimikdergisi.org\/tr\/2023\/12\/25\/sitmada-erken-tani\/","title":{"rendered":"H\u0131zl\u0131 Tan\u0131 Testi ile S\u0131tmada Erken Tan\u0131"},"content":{"rendered":"

G\u00fcn\u00fcm\u00fczde s\u0131tma halen y\u00fcksek \u00f6l\u00fcm oranlar\u0131na neden olan yayg\u0131n bir hastal\u0131k olarak kar\u015f\u0131m\u0131za \u00e7\u0131kmaktad\u0131r. D\u00fcnya Sa\u011fl\u0131k \u00d6rg\u00fct\u00fcn (DS\u00d6)\u2019n\u00fcn son raporuna g\u00f6re, 2020 y\u0131l\u0131nda d\u00fcnya genelinde tahmini olarak 241 milyon olgu tespit edilmi\u015f ve 627 000 \u00f6l\u00fcm meydana gelmi\u015ftir (1). \u00dclkemizde uzun y\u0131llard\u0131r \u00f6nemli bir halk sa\u011fl\u0131\u011f\u0131 sorunu olan s\u0131tma hastal\u0131\u011f\u0131nda olgu say\u0131lar\u0131 ba\u015far\u0131l\u0131 kontrol programlar\u0131n\u0131n sonucu giderek azalm\u0131\u015f ve yerel olgu say\u0131s\u0131 2009\u2019da 38, 2010\u2019da s\u0131f\u0131r ve 2011\u2019de d\u00f6rt n\u00fcks olarak kaydedilmi\u015ftir. Son y\u0131llarda \u00fclkemizden bildirilen s\u0131tma olgular\u0131 yurtd\u0131\u015f\u0131 k\u00f6kenli olup 2016 y\u0131l\u0131nda 208 ve 2017 y\u0131l\u0131nda 204 importe olgu bildirilmi\u015ftir<\/span> (1).<\/p>\n

S\u0131tma, tan\u0131 ve tedavisi aciliyet gerektiren bir infeksiyon hastal\u0131\u011f\u0131d\u0131r. Kesin tan\u0131s\u0131 kal\u0131n damla ve ince yayma preparatlar\u0131nda Plasmodium<\/i>\u2019lar\u0131n g\u00f6r\u00fclmesi ile konur. D\u00fc\u015f\u00fck parazitemiye ve inceleyenin tecr\u00fcbesine ba\u011fl\u0131 olarak s\u0131tma tan\u0131s\u0131 ve t\u00fcr tayinin yap\u0131lmas\u0131 mikroskopik inceleme ile zor olabilir. Son y\u0131llarda, \u00f6zellikle saha \u00e7al\u0131\u015fmalar\u0131nda kullan\u0131lmak \u00fczere Plasmodium<\/i> t\u00fcrlerini ay\u0131rt edebilen s\u0131tmaya \u00f6zg\u00fc h\u0131zl\u0131 tan\u0131 testleri kullan\u0131ma girmi\u015ftir (2). Bu testler mikroskopinin yerini alamaz ancak nispeten deneyimsiz personel taraf\u0131ndan s\u0131tma tan\u0131s\u0131nda ek bir test olarak yararl\u0131 olabilir (3).<\/span> Bu mektupla, kar\u015f\u0131la\u015ft\u0131\u011f\u0131m\u0131z bir olgudan hareketle s\u00f6z konusu testlere dikkat \u00e7ekmeyi ama\u00e7lad\u0131k.<\/p>\n

\"\"<\/a>

Resim 1.<\/strong> Bioline\u2122 Malaria Ag Pf\/Pan (Abbott, ABD) H\u0131zl\u0131 Tan\u0131 Testi<\/p><\/div>\n

\"\"<\/a>

Resim 2.<\/strong> Ate\u015fli D\u00f6nemde Al\u0131nan \u0130nce Yaymada Eritrositler \u0130\u00e7inde Ta\u015fl\u0131 Y\u00fcz\u00fck Formasyonlar\u0131.<\/p><\/div>\n

\u0130ki ay s\u00fcreyle Liberya\u2019da \u00e7al\u0131\u015fan, 24 ya\u015f\u0131nda erkek hasta, T\u00fcrkiye\u2019ye d\u00f6nd\u00fckten be\u015f g\u00fcn sonra ba\u015flayan ate\u015f, \u00fc\u015f\u00fcme, titreme, halsizlik, i\u015ftahs\u0131zl\u0131k, bulant\u0131-kusma, kas a\u011fr\u0131lar\u0131 \u015fikayetleri ile hastanemize ba\u015fvurdu. \u00c7al\u0131\u015ft\u0131\u011f\u0131 \u015firket taraf\u0131ndan kendisine verilen Bioline\u2122 Malaria Ag Pf\/Pan (Abbott, ABD) h\u0131zl\u0131 tan\u0131 testini uygulayan hasta pozitif sonu\u00e7lanan kiti yan\u0131nda getirmi\u015fti (Resim 1). Hasta daha \u00f6nce s\u0131tma ge\u00e7irmedi\u011fini ve s\u0131tma i\u00e7in proflaksi almad\u0131\u011f\u0131n\u0131 bildirdi; 38.4\u00b0C ate\u015fi d\u0131\u015f\u0131nda fizik muayenesi ve ba\u015fvuru tetkiklerinde CRP y\u00fcksekli\u011fi (16.4 mg\/l) d\u0131\u015f\u0131ndaki de\u011ferleri normaldi. Ate\u015fli d\u00f6nemde al\u0131nan ince yaymada eritrositler i\u00e7inde ta\u015fl\u0131 y\u00fcz\u00fck formasyonlar\u0131 g\u00f6r\u00fcld\u00fc (Resim 2). Artemeter 20 mg\/ lumefantrin 120 mg (2×4 tablet) tedavisine hemen ba\u015fland\u0131 ve ila\u00e7 \u00fc\u00e7 g\u00fcn verildi. Tedavinin \u00fc\u00e7\u00fcnc\u00fc g\u00fcn\u00fcnde yaymada parazite rastlanmad\u0131, trombositopeni, l\u00f6kopeni, alanin aminotransferaz (ALT), aspartat transferaz (AST) ve bilirubin de\u011ferleri y\u00fckseldi. Hepatit ve HIV test sonu\u00e7lar\u0131 negatifti. Yat\u0131\u015f\u0131n\u0131n alt\u0131nc\u0131 g\u00fcn\u00fc hastan\u0131n ate\u015fi normale d\u00f6nd\u00fc ve \u015fifa ile taburcu edildi.<\/p>\n

\u00dclkemizde s\u0131tman\u0131n yay\u0131lmas\u0131n\u0131 \u00f6nlemek, morbidite ve mortaliteyi azaltmak i\u00e7in importe olgular\u0131n h\u0131zl\u0131 te\u015fhis ve tedavisi kritik bir \u00f6neme sahiptir.\u00a0Tedavi edilmemi\u015f P. <\/i><\/span>falciparum<\/i> s\u0131tmas\u0131; bir iki saat i\u00e7erisinde \u015fiddetli hastal\u0131\u011fa ilerleyebilmekte ve koma (serebral s\u0131tma), metabolik asidoz, a\u011f\u0131r anemi, hipoglisemi, akut b\u00f6brek yetmezli\u011fi veya akut pulmoner \u00f6dem bulgular\u0131ndan biri veya birka\u00e7\u0131 ile kendini g\u00f6stermektedir. Bu nedenle s\u0131tma semptomlar\u0131n\u0131n ba\u015flad\u0131\u011f\u0131 ilk 24-48 saat i\u00e7erisinde tedaviye ba\u015flanmas\u0131 son derece \u00f6nemlidir (2).\u00a0<\/span><\/p>\n

H\u0131zl\u0131 tan\u0131 testlerinde; t\u00fcm Plasmodium<\/i> t\u00fcrlerinde bulunan Plasmodium<\/i> laktat dehidrogenaz (pLDH) Ag ve P. falciparum<\/i>\u2019a \u00f6zg\u00fc histidin a\u00e7\u0131s\u0131ndan zengin protein II (HRP-II) Ag varl\u0131\u011f\u0131 antikor arac\u0131l\u0131\u011f\u0131yla aranmaktad\u0131r. Mikroskopi ile kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131\u011f\u0131nda pLDH tabanl\u0131 testin duyarl\u0131l\u0131\u011f\u0131 %88 ve \u00f6zg\u00fcll\u00fc\u011f\u00fc %92, HRP-II tabanl\u0131 testin duyarl\u0131l\u0131\u011f\u0131 %97, \u00f6zg\u00fcll\u00fc\u011f\u00fc %71\u2019dir (4).\u00a0<\/span><\/span><\/p>\n

Olgumuzdaki gibi hastalar\u0131n kendi uygulayabilece\u011fi kadar basit olan h\u0131zl\u0131 tan\u0131 testlerinin \u00f6zellikle mikroskopik incelemede uzman olmayan birimler i\u00e7in erken tan\u0131 ve t\u00fcr tayinine katk\u0131s\u0131 \u00e7ok kritik olabilir.<\/p>\n","protected":false},"excerpt":{"rendered":"

G\u00fcn\u00fcm\u00fczde s\u0131tma halen y\u00fcksek \u00f6l\u00fcm oranlar\u0131na neden olan yayg\u0131n bir hastal\u0131k olarak kar\u015f\u0131m\u0131za \u00e7\u0131kmaktad\u0131r. D\u00fcnya Sa\u011fl\u0131k \u00d6rg\u00fct\u00fcn (DS\u00d6)\u2019n\u00fcn son raporuna g\u00f6re, 2020 y\u0131l\u0131nda d\u00fcnya genelinde tahmini olarak 241 milyon olgu tespit edilmi\u015f ve 627 000 \u00f6l\u00fcm meydana gelmi\u015ftir (1). \u00dclkemizde uzun y\u0131llard\u0131r \u00f6nemli bir halk sa\u011fl\u0131\u011f\u0131 sorunu olan s\u0131tma hastal\u0131\u011f\u0131nda olgu say\u0131lar\u0131 ba\u015far\u0131l\u0131 kontrol programlar\u0131n\u0131n […]<\/p>\n","protected":false},"author":6,"featured_media":28257,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[5139],"tags":[5831,3409,2971],"class_list":["post-28064","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-editore-mektup","tag-hizli-tani-testi","tag-plasmodium-falciparum","tag-sitma"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/28064","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=28064"}],"version-history":[{"count":4,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/28064\/revisions"}],"predecessor-version":[{"id":28787,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/28064\/revisions\/28787"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/media\/28257"}],"wp:attachment":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/media?parent=28064"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/categories?post=28064"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/tags?post=28064"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}