{"id":29548,"date":"2024-12-29T11:53:09","date_gmt":"2024-12-29T08:53:09","guid":{"rendered":"https:\/\/www.klimikdergisi.org\/?p=29548"},"modified":"2024-12-29T11:53:09","modified_gmt":"2024-12-29T08:53:09","slug":"parotit-aseptik-menenjit-ve-orsit-olgulari","status":"publish","type":"post","link":"https:\/\/www.klimikdergisi.org\/tr\/2024\/12\/29\/parotit-aseptik-menenjit-ve-orsit-olgulari\/","title":{"rendered":"K\u0131zam\u0131k-Kabakulak-K\u0131zam\u0131k\u00e7\u0131k A\u015f\u0131s\u0131 Sonras\u0131 Geli\u015fen Kabakulak A\u015f\u0131s\u0131 \u0130li\u015fkili Parotit, Aseptik Menenjit ve Or\u015fit Olgular\u0131"},"content":{"rendered":"

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

G\u00fcn\u00fcm\u00fczde, a\u015f\u0131lar sayesinde hayat\u0131 tehdit eden 20\u2019den fazla hastal\u0131k \u00f6nlenmekte, daha uzun \u00f6m\u00fcr ve daha sa\u011fl\u0131kl\u0131 ya\u015fam m\u00fcmk\u00fcn olabilmektedir. D\u00fcnya Sa\u011fl\u0131k \u00d6rg\u00fct\u00fc (DS\u00d6), a\u015f\u0131lama ile her y\u0131l 3.5-5 milyon \u00f6l\u00fcm\u00fcn \u00f6nlendi\u011fini bildirmi\u015ftir (1). Kabakulak, k\u0131zam\u0131k ve k\u0131zam\u0131k\u00e7\u0131k (KKK) a\u015f\u0131lama ile \u00f6nlenebilen hastal\u0131klar aras\u0131nda yer al\u0131r; a\u015f\u0131lar sadece \u00e7ocukluk \u00e7a\u011f\u0131nda de\u011fil, ba\u015fta sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131 olmak \u00fczere eri\u015fkinlerde de (ba\u011f\u0131\u015f\u0131kl\u0131\u011f\u0131 bask\u0131lanm\u0131\u015f ki\u015filerin ev halk\u0131 \/ yak\u0131n temasl\u0131lar\u0131, uluslararas\u0131 seyahat edenler, \u00fcniversite \u00f6\u011frencileri, gebe olmayan ve k\u0131zam\u0131k\u00e7\u0131k i\u00e7in ba\u011f\u0131\u015f\u0131k olmayan do\u011furganl\u0131k \u00e7a\u011f\u0131ndaki kad\u0131nlar, vb.) tavsiye edilir (2).<\/p>\n

Canl\u0131 aten\u00fce a\u015f\u0131lar olan KKK a\u015f\u0131lar\u0131 olduk\u00e7a etkin ve g\u00fcvenlidir; ciddi yan etkileri az olup istemeyen yan etkiler a\u015f\u0131n\u0131n i\u00e7eri\u011fine g\u00f6re de\u011fi\u015fmektedir (3). Kullan\u0131lan k\u0131zam\u0131k su\u015flar\u0131 tavuk embriyo h\u00fccrelerinden, kabakulak su\u015flar\u0131 ya tavuk embriyo h\u00fccrelerinden ya da insan diploid h\u00fccrelerinden, k\u0131zam\u0131k\u00e7\u0131k virusu ise insan diploid h\u00fccrelerinden pasajlanarak elde edilmektedir (4-6). Bu yaz\u0131da, Edmonston-Zagreb k\u0131zam\u0131k, Leningrad-Zagreb (L-Z) kabakulak ve Wistar RA 27\/3 k\u0131zam\u0131k\u00e7\u0131k su\u015flar\u0131n\u0131 i\u00e7eren aten\u00fce KKK a\u015f\u0131s\u0131 (Tresivac\u00ae<\/span>, \u201cSerum Institute of India\u201d, Hindistan) ile a\u015f\u0131land\u0131ktan sonra istenmeyen yan etki geli\u015fen \u00fc\u00e7 olgu sunuldu.<\/p>\n

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

Tablo 1.<\/strong> Olgular\u0131n Demografik \u00d6zellikleri ve Klinik Tan\u0131lar\u0131<\/p><\/div>\n

\u0130kisi hem\u015fire, biri doktor olarak \u00e7al\u0131\u015fan \u00fc\u00e7 sa\u011fl\u0131k \u00e7al\u0131\u015fan\u0131, KKK a\u015f\u0131s\u0131 sonras\u0131 geli\u015fen or\u015fit, parotit ve parotitin e\u015flik etti\u011fi aseptik menenjit tan\u0131s\u0131 ile izlendi. Olgular\u0131n demografik \u00f6zellikleri ve klinik tan\u0131lar\u0131 Tablo 1\u2019de verildi.<\/p>\n

OLGU 1<\/h3>\n

Hasta \u00fc\u00e7 g\u00fcnd\u00fcr devam eden ba\u015f a\u011fr\u0131s\u0131, ate\u015f, bulant\u0131 ve kusma \u015fik\u00e2yeti ile ba\u015fvurdu. Fizik muayenesinde ense sertli\u011fi ve bilin\u00e7 de\u011fi\u015fikli\u011fi saptanmad\u0131. Sol parotis lojunda a\u011fr\u0131 ve hassasiyet mevcuttu. \u015eiddetli ba\u015f a\u011fr\u0131s\u0131 ve ate\u015f olmas\u0131 nedeniyle lomber ponksiyon yap\u0131ld\u0131. Beyin omurilik s\u0131v\u0131s\u0131 (BOS) g\u00f6r\u00fcn\u00fcm\u00fc berrakt\u0131 ve bas\u0131n\u00e7 hafif artm\u0131\u015ft\u0131; mikroskobik incelemede l\u00f6kosit say\u0131s\u0131 200 \/mm3 <\/sup><\/span>(%98 lenfosit), glukoz de\u011feri 49 mg\/dl, protein de\u011feri 82 mg\/dl, e\u015f zamanl\u0131 kan \u015fekeri de\u011feri 109 mg\/dl olarak saptand\u0131. Serumda kabakulak IgM ve IgG pozitif olup BOS kabakulak IgG de pozitifti. Herpes viruslar\u0131 i\u00e7in \u00e7al\u0131\u015f\u0131lan viral menenjit PCR paneli [herpes simpleks virusu 1 (HSV-1), herpes simpleks virusu 2 (HSV-2) ve varicella zoster\u00a0virus (VZV)] sonu\u00e7lar\u0131 negatif idi. Beyin omurilik s\u0131v\u0131s\u0131 k\u00fclt\u00fcr\u00fcnde \u00fcreme olmad\u0131 ve beyin manyetik rezonans incelemesinde patoloji saptanmad\u0131. Takibinin \u00fc\u00e7\u00fcnc\u00fc g\u00fcn\u00fcnde ate\u015fi d\u00fc\u015fen ve ba\u015f a\u011fr\u0131s\u0131 d\u00fczelen hasta be\u015finci g\u00fcn \u015fifa ile taburcu edildi.<\/p>\n

OLGU 2<\/h3>\n

Hasta sol parotis lojunda a\u011fr\u0131 ve \u015fi\u015flik ile ba\u015fvurdu. Tetkiklerinde l\u00f6kositoz yoktu, C-reaktif protein (CRP) de\u011feri normaldi ve amilaz y\u00fcksekli\u011fi (292 \u0130\u00dc\/lt) mevcuttu. Antipiretik ve analjezik tedavi ile yedi g\u00fcn i\u00e7inde iyile\u015fme ger\u00e7ekle\u015fti.<\/p>\n

OLGU 3<\/h3>\n

Hasta sa\u011f skrotumda a\u011fr\u0131 ve y\u00fcksek ate\u015f \u015fik\u00e2yeti ile ba\u015fvurdu. Kan k\u00fclt\u00fcr\u00fc ve idrar k\u00fclt\u00fcr\u00fcnde \u00fcreme saptanmad\u0131. Brucella<\/i> standart t\u00fcp agl\u00fctinasyon (STA) test sonucu negatifti. Ate\u015fi yedi g\u00fcn devam eden hasta konservatif tedavi ile iyile\u015fti.<\/p>\n

\u0130lk olgu ba\u015fka bir hastanede, ikinci olgu ise hastanemizde hem\u015fire olarak g\u00f6rev yapmaktayd\u0131. Yap\u0131lan serolojik testlerde k\u0131zam\u0131k\u00e7\u0131k ve kabakulak antikorlar\u0131 olmad\u0131\u011f\u0131 i\u00e7in KKK a\u015f\u0131s\u0131 uygulanm\u0131\u015ft\u0131. \u00dc\u00e7\u00fcnc\u00fc olgu ise yabanc\u0131 \u00fclke vatanda\u015f\u0131 bir doktordu; \u00e7ocukluk \u00e7a\u011f\u0131nda hi\u00e7bir a\u015f\u0131n\u0131n yap\u0131lmad\u0131\u011f\u0131n\u0131 ve daha \u00f6nce kabakulak ge\u00e7irmedi\u011fini beyan etmi\u015fti. K\u0131zam\u0131k tan\u0131l\u0131 bir hasta ile temas etti\u011fi i\u00e7in KKK a\u015f\u0131s\u0131 uygulanm\u0131\u015ft\u0131.<\/p>\n

Olgular ile ilgili olarak \u201cA\u015f\u0131 Sonras\u0131 \u0130stenmeyen Etki Bildirim ve \u0130nceleme Formu\u201d dolduruldu ve \u0130l Sa\u011fl\u0131k M\u00fcd\u00fcrl\u00fc\u011f\u00fc\u2019ne bilgi verildi.<\/p>\n

\u0130RDELEME<\/h2>\n

Kabakulak, k\u0131zam\u0131k ve k\u0131zam\u0131k\u00e7\u0131k a\u015f\u0131lar\u0131 iyi tolere edilen, g\u00fcvenli a\u015f\u0131lard\u0131r. Adolesan ve eri\u015fkin ki\u015filerde uygulanm\u0131\u015f olan 276 327 doz KKK a\u015f\u0131s\u0131n\u0131n de\u011ferlendirildi\u011fi bir \u00e7al\u0131\u015fmada, ciddi yan etkilerin (anaflaksi, ensefalit\/myelit, Gullian-Barr\u00e9 sendromu, imm\u00fcn trombositopeni, menenjit ve n\u00f6bet) her 100 000 dozda 6\u2019dan az saptand\u0131\u011f\u0131 bildirilmi\u015ftir. Ayn\u0131 \u00e7al\u0131\u015fmada, klinik olarak ciddi olmayan yan etki insidans\u0131 (enjeksiyon yeri reaksiyonu, ate\u015f, lenfadenopati, alerjik reaksiyon, artropati, parotit, d\u00f6k\u00fcnt\u00fc, senkop, alerjik reaksiyon) parotit i\u00e7in 100 000 dozda 3.4\u2019ten artropati i\u00e7in 100.000 dozda 263\u2019a kadar de\u011fi\u015fiyordu. (7). A\u015f\u0131lar\u0131n i\u00e7erisindeki su\u015flara ba\u011fl\u0131 olarak etkinlik ve yan etki s\u0131kl\u0131klar\u0131 de\u011fi\u015fmektedir. Febril n\u00f6bet ve imm\u00fcn trombositopeni gibi yan etkiler daha \u00e7ok k\u0131zam\u0131k komponenti ile aseptik menenjit gibi yan etkiler ise kabakulak komponenti ile ili\u015fkilendirilmi\u015ftir (3).<\/p>\n

KKK a\u015f\u0131lar\u0131 i\u00e7erisinde bulunan k\u0131zam\u0131k a\u015f\u0131s\u0131 Edmonston, Schwarz, Moraten veya Edmonston-Zagreb su\u015flar\u0131ndan, k\u0131zam\u0131k\u00e7\u0131k a\u015f\u0131s\u0131 ise Wistar RA 27\/3 su\u015fundan \u00fcretilmektedir (4,5). Kabakulak i\u00e7inse 10\u2019dan fazla su\u015f (Jerry-Lynn, RIT 4385, Urabe, Hoshino, Rubini, Leningrad-3, Leningrad-Zagreb, Miyahara, Torii, NK-M46, S-12) mevcuttur. Farkl\u0131 firmalar taraf\u0131ndan \u00fcretilen KKK a\u015f\u0131lar\u0131nda \u00fc\u00e7 hastal\u0131\u011f\u0131n etkenleri i\u00e7in de farkl\u0131 su\u015flar, farkl\u0131 doku k\u00fclt\u00fcr infektif dozlar\u0131nda (DK\u0130D50) kullan\u0131lm\u0131\u015ft\u0131r. \u00d6rne\u011fin bir firma taraf\u0131ndan \u00fcretilen KKK a\u015f\u0131s\u0131 i\u00e7erinde yer alan kabakulak su\u015fu Jeryl Lynn (>2000 DK\u0130D50) iken ba\u015fka bir firma taraf\u0131ndan \u00fcretilen a\u015f\u0131n\u0131n i\u00e7erinde Urabe AM9 (>5000 DK\u0130D50) yer almaktad\u0131r (6). Bizim olgular\u0131m\u0131za uygulanm\u0131\u015f olan ve Hindistan\u2019da \u00fcretilen a\u015f\u0131n\u0131n i\u00e7erisinde ise L-Z (>5000 DK\u0130D50) kabakulak su\u015fu yer almaktayd\u0131.<\/p>\n

Cochrane veritaban\u0131nda yer alan sistematik analize g\u00f6re, KKK a\u015f\u0131lar\u0131 ile ili\u015fkili aseptik menenjit daha \u00e7ok kabakulak su\u015fu olarak L-Z ve Urabe su\u015fu i\u00e7eren a\u015f\u0131larda g\u00f6r\u00fcl\u00fcrken, Jerry-Lynn su\u015fu ile ili\u015fkili aseptik menenjit riskinde art\u0131\u015f saptanmam\u0131\u015ft\u0131r (3). Jerry-Lynn su\u015fu ile aseptik menenjit riski farkl\u0131 \u00e7al\u0131\u015fmalarda, genel olarak d\u00fc\u015f\u00fck oranlarda bildirilmi\u015f olup bir \u00e7al\u0131\u015fmada 525 312 ki\u015fide birden az olarak hesaplanm\u0131\u015ft\u0131r. Ayn\u0131 \u00e7al\u0131\u015fmada, L-Z su\u015funa ba\u011fl\u0131 aseptik menenjit ise 10 bin dozda 1.7 olgu olarak bildirilmi\u015ftir. Vah\u015fi kabakulak virusu 400 olguda bir menenjite, olgular\u0131n %0.02- 0.3\u2019\u00fcnde ensefalite neden olabilir ve n\u00f6rolojik sekeller\u00a0 <\/span>\u00f6l\u00fcme yol a\u00e7abilir (8). Kullan\u0131mda olan hi\u00e7bir KKK a\u015f\u0131s\u0131nda do\u011fal virusun yol a\u00e7t\u0131\u011f\u0131 kadar y\u00fcksek oranda menenjit ve ensefalit g\u00f6r\u00fclmemi\u015ftir. Bizim olgumuzda da semptomlar be\u015f g\u00fcn i\u00e7inde geriledi.<\/p>\n

\u00dclkemizde ayn\u0131 su\u015flar\u0131 i\u00e7eren bir a\u015f\u0131n\u0131n uygulanmas\u0131 sonucu ortaya \u00e7\u0131kan parotit ve or\u015fit olgular\u0131 bildirilmi\u015ftir (9,10). Her iki \u00e7al\u0131\u015fmada da olgular L-Z su\u015fu ile ili\u015fkilendirilmi\u015ftir. Yaz\u0131m\u0131zda sunulan olgulara da farkl\u0131 lot numaralar\u0131na sahip olmakla birlikte ayn\u0131 i\u00e7erikte a\u015f\u0131lar uygulanm\u0131\u015ft\u0131r; bu nedenle biz de kar\u015f\u0131la\u015ft\u0131\u011f\u0131m\u0131z durumun L-Z su\u015fu ile ilgili oldu\u011funu d\u00fc\u015f\u00fcn\u00fcyoruz. Her \u00fc\u00e7 olguda da serolojik olarak kabakulak IgM pozitifli\u011fi g\u00f6sterildi. Ancak KKK a\u015f\u0131 i\u00e7eri\u011finde bulunan, L-Z kabakulak su\u015funun etken oldu\u011fu d\u00fc\u015f\u00fcn\u00fclmesine kar\u015f\u0131n molek\u00fcler olarak kan\u0131tlanamad\u0131. Bununla birlikte olgular\u0131m\u0131z\u0131n tedavi edildi\u011fi d\u00f6nemde bir salg\u0131n olmamas\u0131, benzer su\u015flar\u0131 i\u00e7eren a\u015f\u0131lar ile benzer tablolar\u0131n olu\u015fmas\u0131, a\u015f\u0131lanma ile olgularda ortaya \u00e7\u0131kan hastal\u0131klar aras\u0131ndaki s\u00fcrenin k\u0131sa olmas\u0131 kuvvetli bir ili\u015fkiyi d\u00fc\u015f\u00fcnd\u00fcrm\u00fc\u015ft\u00fcr. Sonu\u00e7 olarak; KKK a\u015f\u0131lamas\u0131 sonras\u0131 parotit, or\u015fit ve aseptik menenjit geli\u015febilece\u011fi ak\u0131lda tutulmal\u0131d\u0131r.<\/p>\n","protected":false},"excerpt":{"rendered":"

G\u0130R\u0130\u015e G\u00fcn\u00fcm\u00fczde, a\u015f\u0131lar sayesinde hayat\u0131 tehdit eden 20\u2019den fazla hastal\u0131k \u00f6nlenmekte, daha uzun \u00f6m\u00fcr ve daha sa\u011fl\u0131kl\u0131 ya\u015fam m\u00fcmk\u00fcn olabilmektedir. D\u00fcnya Sa\u011fl\u0131k \u00d6rg\u00fct\u00fc (DS\u00d6), a\u015f\u0131lama ile her y\u0131l 3.5-5 milyon \u00f6l\u00fcm\u00fcn \u00f6nlendi\u011fini bildirmi\u015ftir (1). Kabakulak, k\u0131zam\u0131k ve k\u0131zam\u0131k\u00e7\u0131k (KKK) a\u015f\u0131lama ile \u00f6nlenebilen hastal\u0131klar aras\u0131nda yer al\u0131r; a\u015f\u0131lar sadece \u00e7ocukluk \u00e7a\u011f\u0131nda de\u011fil, ba\u015fta sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131 olmak […]<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[5131],"tags":[5998,5396,5395,4255,3965],"class_list":["post-29548","post","type-post","status-publish","format-standard","hentry","category-olgu-sunumu","tag-aseptik-menenjit","tag-asi-yan-etkileri","tag-kkk-asisi","tag-orsit","tag-parotit"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/29548","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=29548"}],"version-history":[{"count":3,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/29548\/revisions"}],"predecessor-version":[{"id":29915,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/29548\/revisions\/29915"}],"wp:attachment":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/media?parent=29548"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/categories?post=29548"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/tags?post=29548"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}