{"id":28311,"date":"2024-03-28T10:00:12","date_gmt":"2024-03-28T07:00:12","guid":{"rendered":"https:\/\/www.klimikdergisi.org\/?p=28311"},"modified":"2024-06-25T14:27:31","modified_gmt":"2024-06-25T11:27:31","slug":"influenza-sonrasi-gelisen-akut-pankreatit","status":"publish","type":"post","link":"https:\/\/www.klimikdergisi.org\/tr\/2024\/03\/28\/influenza-sonrasi-gelisen-akut-pankreatit\/","title":{"rendered":"\u0130nfluenza Virusu \u0130nfeksiyonu Sonras\u0131 Nadir Geli\u015fen Akut Pankreatit: Bir Olgu Sunumu"},"content":{"rendered":"

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

Akut pankreatit etiyolojisinde, safra ta\u015flar\u0131 ve alkolizmin en yayg\u0131n iki fakt\u00f6r oldu\u011fu bilinmekle birlikte, olgular\u0131n yakla\u015f\u0131k %10\u2019u infeksiy\u00f6z viruslardan [insan immun yetmezlik virusu (HIV), kabakulak virusu, hepatit B virusu, Coxsackie virus, sitomegalovirus (CMV), varisella-zoster virus (VZV), Herpes simpleks virus (HSV), vb.], bakterilerilerden (Mycoplasma, Legionella, Leptospira, Salmonella, <\/i>vb.), parazitlerden (Toxoplasma gondii<\/i>, Cryptosporidium<\/i> ve Ascaris lumbricoides<\/i>, vb.) ve mantarlardan (Aspergillus<\/i> spp., vb.) kaynaklanmaktad\u0131r (1,2). Son ara\u015ft\u0131rmalar, influenza A virusunun insan pankreas h\u00fccrelerine ba\u011flanarak \u00e7o\u011falabildi\u011fini, apoptozu ind\u00fckleyebildi\u011fini ve proinflamatuar sitokinlerin ve kemokinlerin sal\u0131n\u0131m\u0131n\u0131 tetikleyebildi\u011fini g\u00f6stermi\u015ftir (3).<\/p>\n

OLGU<\/h2>\n

COVID-19 pandemisi s\u00fcrecinde acile gelen 95 ya\u015f\u0131ndaki erkek hastan\u0131n; ate\u015f, \u00f6ks\u00fcr\u00fck, nefes darl\u0131\u011f\u0131 ve yayg\u0131n kas eklem a\u011fr\u0131s\u0131 \u015fikayetleri vard\u0131. Genel durumu, orta, bilin\u00e7 a\u00e7\u0131k, oryante ve koopere idi; ate\u015f 38.5 \u00b0C, nab\u0131z 100\/dk, kan bas\u0131nc\u0131 110\/80 mmHg, solunum say\u0131s\u0131 16\/dk, oksijen sat\u00fcrasyon d\u00fczeyi %85-89 olup akci\u011fer osk\u00fcltasyonunda bilateral orta alt zonlarda ronk\u00fcs mevcuttu. \u00c7ekilen toraks bilgisayarl\u0131 tomografi (BT) sonucu; \u201cHer iki akci\u011ferde yer yer fokal tree-in-bud g\u00f6r\u00fcn\u00fcmleri izlenmi\u015ftir.<\/i>\u201d \u015feklinde raporlanm\u0131\u015f olup hasta COVID-19 pandemi servisine olas\u0131 SARS-CoV-2 infeksiyonu \u00f6n tan\u0131s\u0131yla yat\u0131r\u0131ld\u0131. Kronik iskemik kalp hastal\u0131\u011f\u0131 \u00f6yk\u00fcs\u00fc olan hastan\u0131n yap\u0131lan laboratuvar tetkiklerinde; l\u00f6kosit say\u0131s\u0131 11 100 [referans aral\u0131\u011f\u0131 (RA)=3200-10 600] K\/\u00b5l, n\u00f6trofil oran\u0131 %75 (RA=44-76), hemoglobin de\u011feri 11.5 (RA=13.5-17.5) g\/dl, kreatinin de\u011feri 1.38 (RA=0.67-1.17) mg\/dl, aspartat aminotransferaz (AST) de\u011feri 173 (RA=0-50) \u0130\u00dc\/lt, alanin aminotransferaz (ALT) de\u011feri 69 (RA=0-50) \u0130\u00dc\/lt, laktat dehidrojenaz (LDH) de\u011feri 392 (RA=0-248) \u0130\u00dc\/lt, gamma-glutamil transferaz (GGT) de\u011feri 75 (RA=0-55) \u0130\u00dc\/lt, amilaz de\u011feri 188 (RA=28-100) \u0130\u00dc\/lt idi; 4 lt\/dk maske O2<\/sub> alt\u0131nda\u00a0 <\/span>al\u0131nan arter kan gaz\u0131nda SO2<\/sub> %90 olarak saptand\u0131. Hastan\u0131n destek tedavisine ba\u015fland\u0131 ve COVID-19 i\u00e7in bak\u0131lan PCR testi sonucu negatif olan hastan\u0131n klinik \u015fikayetleri ve mevsim \u015fartlar\u0131 g\u00f6z \u00f6n\u00fcnde bulundurularak nazofarengial s\u00fcr\u00fcnt\u00fc \u00f6rne\u011finden influenza A\/B h\u0131zl\u0131 antijen tan\u0131 testi istendi. Test sonucu influenza A pozitif olan hastaya oseltamivir 2×75 mg ba\u015fland\u0131. Yat\u0131\u015f\u0131n\u0131n ikinci g\u00fcn\u00fcnde; \u015fiddetli, s\u0131rta vuran bilateral \u00fcst kar\u0131n a\u011fr\u0131s\u0131 ortaya \u00e7\u0131kan hastan\u0131n yap\u0131lan bat\u0131n muayenesinde epigastrik b\u00f6lgede hassasiyet saptand\u0131. Yap\u0131lan tetkiklerin sonucunda karaci\u011fer enzim y\u00fcksekli\u011finin yan\u0131 s\u0131ra amilaz de\u011ferinin 1540 \u0130\u00dc\/lt oldu\u011fu g\u00f6r\u00fcld\u00fc. Tedavi \u00f6ncesi bak\u0131lan amilaz de\u011ferinin de y\u00fcksek oldu\u011fu fark edildi. Akut pankreatit \u00f6n tan\u0131s\u0131yla gastroenterolojiye kons\u00fclte edilen hastan\u0131n oral ila\u00e7 tedavisi kesildi ve hidrasyona ba\u015fland\u0131. Akut pankreatit \u00f6n tan\u0131s\u0131yla planlanan bat\u0131n tomografisi b\u00f6brek fonksiyon test sonu\u00e7lar\u0131 y\u00fcksek oldu\u011fu i\u00e7in ertelendi. Bat\u0131n ultrasonografi\u2019sinde hepatosteatoz saptand\u0131. Pankreas;\u00a0boyut, kontur, parankim yap\u0131s\u0131 gaz distansiyonu nedeniyle de\u011ferlendirilemedi. Uygulanan antiviral tedavinin \u00fc\u00e7\u00fcnc\u00fc g\u00fcn\u00fcnde ate\u015f yan\u0131t\u0131 al\u0131nd\u0131. \u00d6ks\u00fcr\u00fck, nefes darl\u0131\u011f\u0131 \u015fikayetinde gerileme tarif eden hastan\u0131n oksijen ihtiyac\u0131nda da azalma mevcuttu. Amilaz de\u011feri tedavinin d\u00f6rd\u00fcnc\u00fc g\u00fcn\u00fcnde 1004 \u0130\u00dc\/lt iken be\u015finci g\u00fcn\u00fcnde 345 \u0130\u00dc\/lt idi; ALT, AST, LDH ve GGT de\u011ferlerinde de gerileme g\u00f6r\u00fcld\u00fc. Gastroenteroloji B\u00f6l\u00fcm\u00fc\u2019n\u00fcn \u00f6nerisiyle hastan\u0131n oseltamivir tedavisi oral olarak be\u015f g\u00fcne tamamland\u0131. Takibinin yedinci g\u00fcn\u00fcnde oksijen destek ihtiyac\u0131 kalmayan ve kar\u0131n a\u011fr\u0131s\u0131 gerileyen hasta taburcu edildi.<\/p>\n

\u0130RDELEME<\/h2>\n

Akut pankreatit, kar\u0131n a\u011fr\u0131s\u0131 ve y\u00fcksek pankreatik enzim seviyeleri ile karakterizedir. Tan\u0131s\u0131 i\u00e7in; 1) akut pankreatite \u00f6zg\u00fc kar\u0131n a\u011fr\u0131s\u0131, 2) serum amilaz ve\/veya lipaz\u0131n normal \u00fcst s\u0131n\u0131r\u0131n \u00fc\u00e7 kat\u0131na e\u015fit veya daha fazla olmas\u0131 ve 3) BT\u2019de karakteristik bulgu, durumlar\u0131ndan en az ikisinin varl\u0131\u011f\u0131 gerekmektedir (4). Olgumuzda, yat\u0131\u015f\u0131n\u0131n ikinci g\u00fcn\u00fcnde s\u0131rta vuran \u015fiddetli \u00fcst kar\u0131n a\u011fr\u0131s\u0131 \u015fik\u00e2yeti olup amilaz de\u011feri \u00fcst s\u0131n\u0131r\u0131n \u00fc\u00e7 kat\u0131ndan y\u00fcksekti. Hastanemizde lipaz \u00e7al\u0131\u015f\u0131lamad\u0131\u011f\u0131 i\u00e7in kriter olarak de\u011ferlendirilemedi. Hastan\u0131n \u00f6yk\u00fcs\u00fcnde; alkol kullan\u0131m\u0131, safra ta\u015f \u00f6yk\u00fcs\u00fc, ila\u00e7 kullan\u0131m\u0131, hiperlipidemi ve hiperkalsemi yoktu. Tedavi \u00f6ncesinde bak\u0131lan amilaz de\u011ferinin y\u00fcksek olmas\u0131 geli\u015fen tablonun tedavi ama\u00e7l\u0131 kullan\u0131lan antiviral ajana ba\u011fl\u0131 olmad\u0131\u011f\u0131n\u0131 desteklemekteydi. Oseltamivir tedavisinin devam etmesiyle klinik ve laboratuvar yan\u0131t al\u0131nd\u0131.<\/p>\n

Akut pankreatit, H1N1 influenza virusu infeksiyonunun nadiren ortaya \u00e7\u0131kan bir \u00f6zelli\u011fi veya komplikasyonudur. Hayvan modellerinde yap\u0131lan in vitro<\/i> \u00e7al\u0131\u015fmalar, influenza virusunun insan pankreatik adac\u0131klar\u0131nda ve pankreatik beta h\u00fccre dizilerinde replike oldu\u011funu ve h\u00fccre hasar\u0131 yaparak akut pankreatit ve diyabete neden oldu\u011funu do\u011frularken; interferon-gamma (IFN-\u03b3) ile ind\u00fcklenebilir kemokinler, IP-10\/CXCL10 ve MIG\/CXCL9\u2019un influenza virus infeksiyonundan sonra en y\u00fcksek seviyede oldu\u011funu g\u00f6stermi\u015ftir. Bu sonu\u00e7, influenza virusunun pankreas adac\u0131klar\u0131nda proinflamatuar yan\u0131ta da neden olabilece\u011fini ortaya \u00e7\u0131karm\u0131\u015ft\u0131r (3,5).<\/span><\/p>\n

Sonu\u00e7 olarak; influenza infeksiyonunun en s\u0131k komplikasyonu pn\u00f6moni olmakla birlikte akut pankreatitin etiyolojisinde nadir bir viral etken olarak influenza virusu da ak\u0131lda tutulmal\u0131d\u0131r.<\/p>\n","protected":false},"excerpt":{"rendered":"

G\u0130R\u0130\u015e Akut pankreatit etiyolojisinde, safra ta\u015flar\u0131 ve alkolizmin en yayg\u0131n iki fakt\u00f6r oldu\u011fu bilinmekle birlikte, olgular\u0131n yakla\u015f\u0131k %10\u2019u infeksiy\u00f6z viruslardan [insan immun yetmezlik virusu (HIV), kabakulak virusu, hepatit B virusu, Coxsackie virus, sitomegalovirus (CMV), varisella-zoster virus (VZV), Herpes simpleks virus (HSV), vb.], bakterilerilerden (Mycoplasma, Legionella, Leptospira, Salmonella, vb.), parazitlerden (Toxoplasma gondii, Cryptosporidium ve Ascaris lumbricoides, […]<\/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":[5828,3638,5373,5863],"class_list":["post-28311","post","type-post","status-publish","format-standard","hentry","category-olgu-sunumu","tag-influenza-2","tag-pankreatit","tag-salgin","tag-virus"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/28311","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=28311"}],"version-history":[{"count":4,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/28311\/revisions"}],"predecessor-version":[{"id":28765,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/28311\/revisions\/28765"}],"wp:attachment":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/media?parent=28311"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/categories?post=28311"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/tags?post=28311"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}