{"id":29184,"date":"2024-09-27T11:28:37","date_gmt":"2024-09-27T08:28:37","guid":{"rendered":"https:\/\/www.klimikdergisi.org\/?p=29184"},"modified":"2024-09-27T14:13:10","modified_gmt":"2024-09-27T11:13:10","slug":"dang-atesi-seyahat-iliskili-bir-olgu","status":"publish","type":"post","link":"https:\/\/www.klimikdergisi.org\/tr\/2024\/09\/27\/dang-atesi-seyahat-iliskili-bir-olgu\/","title":{"rendered":"Dang Ate\u015fi: Seyahat \u0130li\u015fkili Bir Olgu"},"content":{"rendered":"

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

Dang ate\u015fi, g\u00fcn\u00fcm\u00fczde en yayg\u0131n arboviral infeksiyonlardan biri olarak kabul edilmektedir (1). D\u00fcnya Sa\u011fl\u0131k \u00d6rg\u00fct\u00fc (DS\u00d6) verilerine g\u00f6re 2000-2019 y\u0131llar\u0131 aras\u0131nda olgu say\u0131s\u0131 10 kat artarak 5.2 milyona y\u00fckselmi\u015ftir (1). T\u00fcrkiye\u2019den az say\u0131da seyahat ili\u015fkili olgu rapor edilmi\u015f olup tamam\u0131 yabanc\u0131 uyruklu hastalard\u0131r; bu nedenle, seyahat ili\u015fkili olsa da ilk kez bir T\u00fcrk vatanda\u015f\u0131nda Dang ate\u015finin tespit edilmesi \u00f6nemlidir. Bu yaz\u0131da, y\u00fcksek ate\u015f ve d\u00f6k\u00fcnt\u00fc \u015fikayetleri ile ba\u015fvuran T\u00fcrk vatanda\u015f\u0131 hastalarda da yurtd\u0131\u015f\u0131 seyahat ge\u00e7mi\u015finin sorgulanmas\u0131 ve Dang ate\u015finin de ay\u0131r\u0131c\u0131 tan\u0131lar aras\u0131nda d\u00fc\u015f\u00fcn\u00fclmesinin vurgulanmas\u0131 ama\u00e7land\u0131.<\/p>\n

OLGU<\/h2>\n
\"\"<\/a>

Resim 1.<\/strong> K\u0131rm\u0131z\u0131 Denizde Beyaz Adac\u0131klar Formunda Cilt D\u00f6ku\u0308ntu\u0308su\u0308<\/p><\/div>\n

Yirmi sekiz ya\u015f\u0131ndaki kad\u0131n hasta, d\u00f6rt g\u00fcnd\u00fcr devam eden y\u00fcksek ate\u015f, \u015fiddetli eklem a\u011fr\u0131lar\u0131, a\u011fr\u0131l\u0131 g\u00f6z hareketleri ve t\u00fcm v\u00fccutta k\u0131zar\u0131kl\u0131k \u015fikayetleriyle poliklini\u011fe ba\u015fvurdu. Hastan\u0131n bir hafta \u00f6nce yedi g\u00fcnl\u00fck turistik ama\u00e7l\u0131 M\u0131s\u0131r seyahatinden d\u00f6nd\u00fc\u011f\u00fc \u00f6\u011frenildi. Fizik muayenesinde ate\u015finin 39\u00b0C oldu\u011fu, v\u00fccutta yayg\u0131n skarlatinoform d\u00f6k\u00fcnt\u00fclerin bulundu\u011fu saptand\u0131. Laboratuvar sonu\u00e7lar\u0131na g\u00f6re l\u00f6kosit say\u0131s\u0131 3070\/\u00b5l, trombosit say\u0131s\u0131 141 000\/\u00b5l idi. Anti-HIV, anti-Rubella<\/i> (imm\u00fcnoglobulin) IgM, anti-VCA IgM, anti-toksoplazma IgM, anti- sitomegalovirus (CMV) IgM, parvovirus B19 Ig M antikor testleri negatif saptand\u0131. S\u0131tma testleri negatif, seyahat \u00f6yk\u00fcs\u00fc g\u00f6z \u00f6n\u00fcne al\u0131narak Dang ate\u015fi i\u00e7in yap\u0131lan turnike testi pozitifti. Halk Sa\u011fl\u0131\u011f\u0131 Genel M\u00fcd\u00fcrl\u00fc\u011f\u00fc Ulusal Arbovir\u00fcs ve Viral Zoonotik Hastal\u0131klar Laboratuvar\u0131na g\u00f6nderilen hastan\u0131n numunesi; Dengue, Chikungunya ve Zika viruslar\u0131n\u0131n IgM ve IgG \u00f6zg\u00fcl antikorlar\u0131 a\u00e7\u0131s\u0131ndan indirekt imm\u00fcnfloresan y\u00f6ntemi (Arbovirus Fever Mosaic 2 IIFT; Euroimmun, Almanya) ile test edildi. Viral genom varl\u0131\u011f\u0131n\u0131 ara\u015ft\u0131rmak i\u00e7in ger\u00e7ek zamanl\u0131 ters transkriptaz polimeraz zincir reaksiyonu (\u201cCDC Trioplex rRT-PCR assay\u201d) ile Dengue, Chikungunya ve Zika viruslar\u0131 i\u00e7in PCR testleri \u00e7al\u0131\u015f\u0131ld\u0131 ve Dang virusu saptand\u0131. DENV 1, 2, 3 ve 4 alt tipleri de PCR testi ile ara\u015ft\u0131r\u0131ld\u0131 (CDC DENV-1-4 rRT-PCR Multiplex Test). Anti-DENV-IgM antikorlar d\u00fc\u015f\u00fck d\u00fczey pozitif, DENV IgG antikorlar negatif olarak de\u011ferlendirildi. Zika ve Chikungunya viruslar\u0131 IgM ve G antikorlar\u0131 negatif olarak de\u011ferlendirildi. DENV-1 serotipi tespit edildi. Parasetamol ve s\u0131v\u0131 tedavisi ba\u015flanan hastan\u0131n ate\u015fi bir g\u00fcn sonra normale s\u0131n\u0131rlara indi. Ekstremitelerindeki d\u00f6k\u00fcnt\u00fcler Dang ate\u015fi i\u00e7in spesifik olan \u201ck\u0131rm\u0131z\u0131 denizde beyaz adac\u0131klar\u201d olarak adland\u0131r\u0131lan, diff\u00fcz hiperemik zeminde adac\u0131klar \u015feklinde korunmu\u015f beyaz b\u00f6lgelerin oldu\u011fu g\u00f6r\u00fcn\u00fcm\u00fcn\u00fc ald\u0131 (Resim 1). Genel durumu stabil seyreden hastan\u0131n l\u00f6kosit ve trombosit de\u011ferleri normale d\u00f6nd\u00fc, d\u00f6k\u00fcnt\u00fcler iki hafta sonra tamamen kayboldu.<\/p>\n

\u0130RDELEME<\/h2>\n

Dang viruslar\u0131 Aedes<\/i> cinsi sivrisinekler arac\u0131l\u0131\u011f\u0131yla insanlara bula\u015f\u0131r ve bu bula\u015fma s\u00fcreci insan-sivrisinek-insan d\u00f6ng\u00fcs\u00fcyle devam eder. Dang virusu Flaviviridae<\/i> ailesine aittir ve DENV 1, DENV 2, DENV 3 ve DENV 4 olmak \u00fczere d\u00f6rt farkl\u0131 serotipi bulunmaktad\u0131r (2). \u0130nfeksiyon olu\u015fturan tipe kar\u015f\u0131 \u00f6m\u00fcr boyu ba\u011f\u0131\u015f\u0131kl\u0131k geli\u015firken, di\u011fer serotiplere kar\u015f\u0131 k\u0131sa s\u00fcreli \u00e7apraz koruma sa\u011flan\u0131r (2). Y\u0131lda yakla\u015f\u0131k 390 milyon ki\u015fi infekte olmaktad\u0131r; bunlar\u0131n sadece %25\u2019inde klinik bulgu ortaya \u00e7\u0131kmakta ve yakla\u015f\u0131k 20 000\u2019ni \u00f6l\u00fcmle sonu\u00e7lanmakt\u0131r.\u00a0 <\/span>En s\u0131k g\u00f6r\u00fcld\u00fc\u011f\u00fc b\u00f6lgeler; Do\u011fu Akdeniz, G\u00fcneydo\u011fu Asya, Afrika, Bat\u0131 Pasifik ve G\u00fcney Amerika\u2019d\u0131r (1,2).<\/p>\n

D\u00fcnya Sa\u011fl\u0131k \u00d6rg\u00fct\u00fc\u2019ne g\u00f6re endemik b\u00f6lgede ya\u015fayan veya seyahat ge\u00e7mi\u015fi olan hastalarda; ate\u015fle birlikte bulant\u0131, d\u00f6k\u00fcnt\u00fc, ba\u015f a\u011fr\u0131s\u0131, kas veya eklem a\u011fr\u0131s\u0131 gibi belirtiler veya l\u00f6kopeni ve pozitif turnike testi gibi en az iki bulgu, Dang infeksiyonunu d\u00fc\u015f\u00fcnd\u00fcrmelidir (1,2). Turnike testinde hastan\u0131n kan bas\u0131nc\u0131 \u00f6l\u00e7\u00fcl\u00fcr ve ard\u0131ndan man\u015fet, sistolik ve diastolik bas\u0131n\u00e7 ortalamas\u0131nda \u015fi\u015firilerek bir dakika beklenir; bas\u0131n\u00e7 azalt\u0131l\u0131p iki dakika daha beklenir ve dirsek \u00e7ukurunda bir kare in\u00e7lik alanda 10 veya daha fazla pete\u015fi olmas\u0131 pozitif kabul edilir (1). Dang ate\u015fi genellikle asemptomatik veya hafif semptomlarla seyrederken, baz\u0131 hastalarda iyile\u015fme d\u00f6nemini takiben \u015fiddetli bir klinik tablo geli\u015febilir (1). Hastal\u0131k DS\u00d6 taraf\u0131ndan, hafif, ciddi ve \u015fiddetli Dang ate\u015fi olmak \u00fczere \u00fc\u00e7 gruba ayr\u0131lm\u0131\u015ft\u0131r (1,2). Bahsedilen belirtilere sahip hastalarda; kar\u0131n a\u011fr\u0131s\u0131 veya hassasiyeti, s\u00fcrekli kusma, \u00fc\u00e7\u00fcnc\u00fc bo\u015fluklara do\u011fru geli\u015fen s\u0131v\u0131 kayb\u0131 (asit, plevral ef\u00fczyon), mukozal kanama, hepatomegali ve trombosit say\u0131s\u0131nda h\u0131zl\u0131 d\u00fc\u015f\u00fc\u015f ile e\u015f zamanl\u0131 geli\u015fen hematokrit art\u0131\u015f\u0131 gibi uyar\u0131c\u0131 belirtilerin varl\u0131\u011f\u0131nda, hastal\u0131\u011f\u0131n \u015fiddetli evreye ge\u00e7me riski d\u00fc\u015f\u00fcn\u00fclmelidir (1,2). Tan\u0131, genellikle hastal\u0131\u011f\u0131n ilk g\u00fcnlerinde viral n\u00fckleik asit veya viral antijen yap\u0131sal olmayan protein 1 (NS1) tespiti ile veya d\u00f6rt g\u00fcn sonra ortaya \u00e7\u0131kan IgM tespiti ile konur; ancak bu testlerin endemik b\u00f6lgelerde her zaman kolayca ula\u015f\u0131labilir olmad\u0131\u011f\u0131 bilinmektedir (1,2). \u00dclkemizde bu testler genellikle referans laboratuvarlarda yap\u0131l\u0131r ve sonu\u00e7lar\u0131n al\u0131nmas\u0131 3-4 g\u00fcn s\u00fcrebilir. \u00d6zellikle ciddi Dang olgular\u0131nda, tedaviye bir an \u00f6nce ba\u015flanmas\u0131n\u0131n \u00f6nemi g\u00f6z \u00f6n\u00fcne al\u0131nd\u0131\u011f\u0131nda h\u0131zl\u0131 tan\u0131 b\u00fcy\u00fck bir \u00f6neme sahiptir. Fizik muayene ve semptomlarla birlikte di\u011fer laboratuvar testlerinin olas\u0131 bir tan\u0131y\u0131 \u00f6ng\u00f6rmede ne kadar etkili olabilece\u011fi \u00fczerine yap\u0131lan ve sekiz \u00fclkenin kat\u0131ld\u0131\u011f\u0131 \u00e7ok merkezli bir ara\u015ft\u0131rmada, toplam 7428 hasta incelenmi\u015f ve Dang ate\u015fini di\u011fer ate\u015fli hastal\u0131klardan ay\u0131rt etmek i\u00e7in klinik semptomlar ve rutin laboratuvar testlerinin entegrasyonuyla geli\u015ftirilen modeller incelenmi\u015ftir. S\u00f6z konusu ara\u015ft\u0131rmada; Dang ate\u015fi tan\u0131s\u0131nda hastal\u0131k g\u00fcn\u00fcn\u00fcn \u00f6nemi vurgulamakta olup hastal\u0131\u011f\u0131n 2. ve 5. g\u00fcnleri aras\u0131nda d\u00fc\u015f\u00fck mutlak beyaz kan h\u00fccresi ve trombosit say\u0131s\u0131 ile Dang ate\u015fi aras\u0131nda ili\u015fki oldu\u011fu bildirilmi\u015ftir; di\u011fer yanda, \u00f6ks\u00fcr\u00fck ve rinit di\u011fer ate\u015fli hastal\u0131klarla g\u00fc\u00e7l\u00fc bir ili\u015fkiye sahipken, kanama ve cilt d\u00f6k\u00fcnt\u00fcs\u00fc b\u00fcy\u00fck \u00f6l\u00e7\u00fcde Dang ate\u015fi ile ili\u015fkilendirilmi\u015ftir (3).<\/p>\n

Dang ate\u015finin nadir g\u00f6r\u00fcld\u00fc\u011f\u00fc \u00fclkelerde; \u015f\u00fcphe durumunda kesin sonu\u00e7lar elde edilene kadar, detayl\u0131 hasta \u00f6yk\u00fcs\u00fc ile birlikte kolay ula\u015f\u0131labilir laboratuvar testleri, turnike testi, cilt bulgular\u0131 gibi fizik muayene bulgular\u0131n\u0131n ortak yorumlanmas\u0131, spesifik testlerin daha erken istenmesinde yard\u0131mc\u0131 olabilir. Bizim olgumuzda, hastan\u0131n seyahat \u00f6yk\u00fcs\u00fcyle birlikte, \u00fc\u00e7 g\u00fcn s\u00fcren y\u00fcksek ate\u015f, yayg\u0131n v\u00fccut d\u00f6k\u00fcnt\u00fcs\u00fc ve l\u00f6kopeni ile trombositopeninin varl\u0131\u011f\u0131 literat\u00fcrle uyumlu idi. Ayr\u0131ca, DS\u00d6 taraf\u0131ndan tan\u0131 kriterleri aras\u0131nda yer alan pozitif turnike testi, tan\u0131y\u0131 desteklemi\u015f ve hastan\u0131n kesin sonu\u00e7lar\u0131 elde edilmeden \u00f6nce olas\u0131 Dang ate\u015fi tan\u0131s\u0131yla hastan\u0131n serviste yat\u0131r\u0131lmas\u0131na ve semptomatik tedaviye ba\u015flanmas\u0131na olanak vermi\u015fti.<\/p>\n

T\u00fcrkiye\u2019den bildirilen ve seyahatleri nedeniyle \u00fclkemizde olan yabanc\u0131 uyruklu olgularda y\u00fcksek ate\u015f, cilt d\u00f6k\u00fcnt\u00fcs\u00fc, l\u00f6kopeni ve trombositopeni saptanm\u0131\u015ft\u0131r.\u00a0 <\/span>Olgular\u0131n \u00e7o\u011fu komplikasyonsuz bir \u015fekilde iyile\u015fmi\u015f ancak bir olgu yayg\u0131n hemoraji ve \u00e7oklu organ yetmezli\u011fi nedeniyle kaybedilmi\u015ftir (4-7).<\/p>\n

Avrupa\u2019da 2023 y\u0131l\u0131 itibariyle g\u00f6r\u00fclen olgular\u0131n tamam\u0131 yurtd\u0131\u015f\u0131 kaynakl\u0131d\u0131r; Fransa\u2019n\u0131n farkl\u0131 b\u00f6lgelerinden 43, \u0130talya\u2019dan ise 81 olgu bildirilmi\u015ftir (8). \u0130spanya\u2019da 2023\u2019te bildirilen d\u00f6rt yerel olgunun ortak noktas\u0131, indeks olgunun ya\u015fad\u0131\u011f\u0131 kasabada bulunmalar\u0131d\u0131r; kayna\u011f\u0131n kasabadaki Aedes albopictus<\/i> sivrisinekleri oldu\u011fu d\u00fc\u015f\u00fcn\u00fclm\u00fc\u015ft\u00fcr (9). S\u00f6z konusu \u00e7al\u0131\u015fma, hastal\u0131\u011f\u0131n saptanmas\u0131n\u0131n yan\u0131 s\u0131ra kaynak ara\u015ft\u0131rmas\u0131n\u0131n da \u00f6nemini vurgulamaktad\u0131r. Co\u015fgun ve arkada\u015flar\u0131 vekt\u00f6rler \u00fczerine yapt\u0131klar\u0131 ara\u015ft\u0131rmada, Karadeniz B\u00f6lgesi\u2019nin 51 farkl\u0131 noktas\u0131ndan toplanan 267 Aedes <\/i>cinsi sivrisinekte Dang virusu varl\u0131\u011f\u0131n\u0131 ara\u015ft\u0131rm\u0131\u015flar ancak herhangi bir pozitiflik saptamam\u0131\u015flard\u0131r (10).<\/p>\n

\u00dclkemizde Dang hastal\u0131\u011f\u0131 bildirimi zorunlu olup \u015fu ana kadar yerli bir olgu bildirilmemi\u015ftir. Ancak, uygun \u00e7evre ko\u015fullar\u0131n\u0131n ve vekt\u00f6rlerin varl\u0131\u011f\u0131 nedeniyle yerli olgular\u0131n ortaya \u00e7\u0131kma riski de bulunmaktad\u0131r. Sonu\u00e7 olarak; vekt\u00f6rlerle ilgili geni\u015f kapsaml\u0131 epidemiyolojik \u00e7al\u0131\u015fmalar\u0131n yap\u0131lmas\u0131, sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n fark\u0131ndal\u0131\u011f\u0131n\u0131n art\u0131r\u0131lmas\u0131 ve toplumun bilgilendirilmesi \u00f6nemlidir.<\/p>\n","protected":false},"excerpt":{"rendered":"

G\u0130R\u0130\u015e Dang ate\u015fi, g\u00fcn\u00fcm\u00fczde en yayg\u0131n arboviral infeksiyonlardan biri olarak kabul edilmektedir (1). D\u00fcnya Sa\u011fl\u0131k \u00d6rg\u00fct\u00fc (DS\u00d6) verilerine g\u00f6re 2000-2019 y\u0131llar\u0131 aras\u0131nda olgu say\u0131s\u0131 10 kat artarak 5.2 milyona y\u00fckselmi\u015ftir (1). T\u00fcrkiye\u2019den az say\u0131da seyahat ili\u015fkili olgu rapor edilmi\u015f olup tamam\u0131 yabanc\u0131 uyruklu hastalard\u0131r; bu nedenle, seyahat ili\u015fkili olsa da ilk kez bir T\u00fcrk vatanda\u015f\u0131nda […]<\/p>\n","protected":false},"author":4,"featured_media":29383,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[5131],"tags":[3112,5984,2683,5985],"class_list":["post-29184","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-olgu-sunumu","tag-ates","tag-dang-atesi","tag-dokuntu","tag-seyahat"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/29184","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=29184"}],"version-history":[{"count":4,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/29184\/revisions"}],"predecessor-version":[{"id":29510,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/29184\/revisions\/29510"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/media\/29383"}],"wp:attachment":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/media?parent=29184"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/categories?post=29184"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/tags?post=29184"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}