{"id":30783,"date":"2025-09-27T15:25:36","date_gmt":"2025-09-27T12:25:36","guid":{"rendered":"https:\/\/www.klimikdergisi.org\/?p=30783"},"modified":"2025-09-30T17:46:15","modified_gmt":"2025-09-30T14:46:15","slug":"alanyada-akdeniz-benekli-atesi","status":"publish","type":"post","link":"https:\/\/www.klimikdergisi.org\/tr\/2025\/09\/27\/alanyada-akdeniz-benekli-atesi\/","title":{"rendered":"Alanya\u2019da Saptanan A\u011f\u0131r Seyirli Akdeniz Benekli Ate\u015fi: Bir Olgu Sunumu"},"content":{"rendered":"

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

Akdeniz benekli ate\u015fi (ABA), Rickettsia conorii<\/i> subspecies conorii<\/i>\u2019nin etkeni oldu\u011fu zoonotik bir hastal\u0131kt\u0131r.\u00a0 <\/span>R. conorii<\/i> rezervuar\u0131 k\u00f6pek kenesidir (Rhipicephalus sanguineus<\/i>) ve kene \u0131s\u0131r\u0131\u011f\u0131 sonucu bula\u015f\u0131r. Lenf sisteminde \u00e7o\u011falan bakteri hematojen yolla t\u00fcm v\u00fccuda yay\u0131l\u0131r ve k\u00fc\u00e7\u00fck damarlar\u0131n endotel h\u00fccrelerinde \u00e7o\u011falarak endotel hasar\u0131na, doku nekrozuna yol a\u00e7ar. Bunu p\u0131ht\u0131la\u015fma bozukluklar\u0131 ve akut faz yan\u0131t\u0131 izler. Kulu\u00e7ka s\u00fcresi 5\u20137 g\u00fcnd\u00fcr ancak literat\u00fcrde daha uzun s\u00fcreler bildirilmi\u015ftir.\u00a0 <\/span>Akdeniz benekli ate\u015fi genellikle benign seyirli bir hastal\u0131k olmas\u0131na ra\u011fmen olgular\u0131n %5\u201310\u2019unda ciddi komplikasyonlar ortaya \u00e7\u0131kar. Komplikasyonlar altta yatan hastal\u0131\u011f\u0131 olanlarda ve ileri ya\u015fta daha s\u0131k g\u00f6r\u00fcl\u00fcr. Mortalite %1\u20132.5 oran\u0131nda geli\u015fmektedir. Erken ve uygun antibiyotik tedavisi, komplikasyonlar\u0131 ve mortaliteyi azaltmas\u0131 a\u00e7\u0131s\u0131ndan \u00f6nemlidir. Tetrasiklinler ilk se\u00e7enektir. Hastal\u0131\u011f\u0131n endemik oldu\u011fu b\u00f6lgelerde ya\u015fayanlar ve bu b\u00f6lgelere seyahat edecek ki\u015filer, k\u00f6peklerle temas\u0131 en aza indirme ve kene \u0131s\u0131r\u0131klar\u0131ndan korunma konusunda e\u011fitilmelidir (1-5). \u00dclkemizde ABA endemiktir. Akdeniz B\u00f6lgesi\u2019nden bildirilen olgu yoktur. Bu nedenle, Akdeniz B\u00f6lgesi\u2019nde de olgular\u0131n saptand\u0131\u011f\u0131n\u0131 bildirmesi a\u00e7\u0131s\u0131ndan olgumuz \u00f6nemlidir. Bu yaz\u0131da Alanya\u2019da saptanan ciddi seyirli bir ABA olgusu sunuldu ve ilgili literat\u00fcr g\u00f6zden ge\u00e7irildi.<\/p>\n

OLGU<\/b><\/h2>\n

Alanya\u2019da ya\u015fayan 40 ya\u015f\u0131nda kad\u0131n hasta 28 May\u0131s 2024 tarihinde Alanya Alaaddin Keykubat \u00dcniversitesi E\u011fitim ve Ara\u015ft\u0131rma Hastanesi acil servisine y\u00fcksek ate\u015f, ba\u015f a\u011fr\u0131s\u0131, yayg\u0131n eklem a\u011fr\u0131lar\u0131 ve d\u00f6k\u00fcnt\u00fcleri ile ba\u015fvurdu. Hastaneye yat\u0131\u015f s\u0131ras\u0131nda \u015fiddetli eklem a\u011fr\u0131lar\u0131 olan hasta ancak yard\u0131mla g\u00fcnl\u00fck i\u015flerini yapabiliyordu. \u00adAntibiyotik kulland\u0131ktan sonra oldu\u011funu d\u00fc\u015f\u00fcnd\u00fc\u011f\u00fc siyah renkli, yumu\u015fak d\u0131\u015fk\u0131lama tarifliyordu. Sistemlerin sorgulamas\u0131nda \u00f6ks\u00fcr\u00fck, balgam, solunum s\u0131k\u0131nt\u0131s\u0131 saptanmad\u0131. \u00d6zge\u00e7mi\u015finde, 23 May\u0131s 2024 tarihinde y\u00fcksek ate\u015f ve halsizlik \u015fik\u00e2yeti ile acil servise ba\u015fvurdu\u011fu ve amoksisilin-klavulanat 2×1 g oral tedavi ba\u015fland\u0131\u011f\u0131 \u00f6\u011frenildi. Takip eden g\u00fcnlerde benzer \u015fik\u00e2yetlerle acil servise m\u00fckerrer ba\u015fvurular\u0131 olmu\u015ftu. V\u00fccudunda geli\u015fen yayg\u0131n d\u00f6k\u00fcnt\u00fcler antibiyotik tedavisine ba\u011flanm\u0131\u015ft\u0131. Kronik hastal\u0131\u011f\u0131 ve son \u00fc\u00e7 ay i\u00e7inde seyahat \u00f6yk\u00fcs\u00fc yoktu. \u015eehir merkezinde ya\u015fayan hasta 7-8\u00a0 <\/span>g\u00fcn \u00f6nce \u015fehir d\u0131\u015f\u0131ndaki bir bah\u00e7eye gitmi\u015fti. Sol uyluk b\u00f6lgesine kene yap\u0131\u015ft\u0131\u011f\u0131 ve keneyi kendisinin \u00e7\u0131kard\u0131\u011f\u0131 \u00f6\u011frenildi. \u00c7evresinde benzer \u015fik\u00e2yeti olan yoktu. Evde k\u00f6pek beslemiyordu ama gitti\u011fi bah\u00e7ede k\u00f6peklerin dola\u015ft\u0131\u011f\u0131n\u0131 ifade etti.<\/p>\n

\"\"<\/a>

Resim 1.<\/strong> Ayaklarda ve Bacaklarda G\u00f6ru\u0308len Yayg\u0131n Maku\u0308lopapu\u0308ler D\u00f6ku\u0308ntu\u0308ler<\/p><\/div>\n

\"\"<\/a>

Resim 2.<\/strong> S\u0131rt B\u00f6lgesinde G\u00f6ru\u0308len Yayg\u0131n Maku\u0308lopapu\u0308ler D\u00f6ku\u0308ntu\u0308ler<\/p><\/div>\n

\"\"<\/a>

Resim 3.<\/strong> Avu\u00e7 \u0130\u00e7lerinde G\u00f6ru\u0308len Maku\u0308lopapu\u0308ler D\u00f6ku\u0308ntu\u0308ler<\/p><\/div>\n

Fizik muayenesinde genel durum orta, bilinci a\u00e7\u0131k, oryante, koopere idi. V\u00fccut s\u0131cakl\u0131\u011f\u0131 37.8\u00b0C, tansiyon arteriyel 100\/70 mmHg, nab\u0131z 96 \/dakika, solunum say\u0131s\u0131 14\/dakika \u00f6l\u00e7\u00fcld\u00fc. Meninks irritasyon bulgusu yoktu. Akci\u011fer osk\u00fcltasyonunda ral ve ronkus saptanmad\u0131. Kalp muayenesinde ritim d\u00fczenliydi, ek ses ve \u00fcf\u00fcr\u00fcm saptanmad\u0131. Bat\u0131n palpasyonunda hassasiyet vard\u0131, karaci\u011fer subkostal s\u0131n\u0131rda palpe ediliyordu. El ve ayak tabanlar\u0131 dahil olmak \u00fczere t\u00fcm v\u00fccudunda yayg\u0131n maku\u0308lopapu\u0308ler d\u00f6k\u00fcnt\u00fc izlendi (Resim 1-3). Kene \u0131s\u0131r\u0131\u011f\u0131 b\u00f6lgesinde siyah eskar saptanmad\u0131. Takip eden g\u00fcnlerde hastada tek tarafl\u0131 konjunktival hiperemi geli\u015fti. \u00a0<\/span><\/p>\n

Yat\u0131\u015f s\u0131ras\u0131nda yap\u0131lan laboratuvar tetkikleri \u015fu \u015fekildeydi: Beyaz k\u00fcre 7800\/\u03bcl (3980\u201310 040), lenfosit 400\/\u03bcL (1180\u20133740), n\u00f6trofil 7270 \/\u03bcL (1560\u20136130), hemoglobin 12.4 g\/dl (11.2\u201315.7), trombosit 94 000 \/\u03bcL (182 000\u2013369 000), C-reaktif protein 286.8 mg\/lt (0\u20135), sodyum 125 mmol\/lt (137\u2013147), alanin aminotransferaz 71 U\/lt (0\u201334), total bilirubin 1.92 mg\/dl (0.3\u20131.1), direkt bilirubin 1.06 mg\/dl (0.1\u20130.4), aspartat aminotransferaz 102 U\/lt (0\u201331), laktat dehidrogenaz 349 U\/lt (0\u2013247), alkalen fosfataz 198 U\/lt (30\u2013120), gamma-glutamil transferaz 170 U\/lt (0\u201332), amilaz 127 U\/lt (28\u2013100), kalsiyum 7.3 mg\/dl (8.8\u201310.6), ferritin 1203 ng\/ml (10\u2013291), sedimantasyon 7 mm\/saat (0\u201315). Gaita mikroskobisinde yumu\u015fak k\u0131vaml\u0131 d\u0131\u015fk\u0131da 7\u20138 l\u00f6kosit, 2\u20133 eritrosit saptand\u0131. Akci\u011fer grafisinde dansite art\u0131\u015f\u0131 izlenmedi. Olgu sistemik viral infeksiyon, K\u0131r\u0131m-Kongo kanamal\u0131 ate\u015fi, bruselloz, salmonelloz, leptospiroz, Epstein-Barr virus (EBV) infeksiyonu, sepsis, ABA \u00f6n tan\u0131lar\u0131 ile servise yat\u0131r\u0131ld\u0131. K\u0131r\u0131m-Kongo kanamal\u0131 ate\u015fi ve ABA i\u00e7in T\u00fcrkiye Halk Sa\u011fl\u0131\u011f\u0131 Kurumu Mikrobiyoloji Referans Laboratuvar\u0131\u2019na serum \u00f6rne\u011fi g\u00f6nderildi. \u0130drar ve iki set kan k\u00fclt\u00fcr\u00fc al\u0131nd\u0131. Y\u00fcksek ate\u015fi oldu\u011fu i\u00e7in kan k\u00fclt\u00fcrleri 3 g\u00fcn boyunca iki\u015fer set olarak tekrarland\u0131. Bat\u0131n ultrasonografisinde karaci\u011ferin kraniokaudal boyutu 190 mm \u00f6l\u00e7\u00fcld\u00fc (hepatomegali), dalak uzunlu\u011fu 130 mm olup normalin \u00fcst s\u0131n\u0131r\u0131nda idi. Seftriakson 2000 mg\/g\u00fcn intravenous (\u0130V) ve siprofloksasin 2×400 mg \u0130V tedavi ba\u015fland\u0131. Akdeniz benekli ate\u015fi d\u00fc\u015f\u00fcn\u00fclen hastada yat\u0131\u015f\u0131n\u0131n ikinci g\u00fcn\u00fc seftriakson, siprofloksasin tedavisi kesildi, doksisiklin 2×100 mg oral ba\u015fland\u0131. Takiplerde v\u00fccut s\u0131cakl\u0131\u011f\u0131 39.6\u00b0C\u2019ye \u00e7\u0131kt\u0131 ve oksijen sat\u00fcrasyonu %94\u201395\u2019e d\u00fc\u015ft\u00fc. Ate\u015f yan\u0131t\u0131 d\u00f6rd\u00fcnc\u00fc g\u00fcnde al\u0131nd\u0131. \u015eikayetleri kaybolan ve laboratuvar parametreleri d\u00fczelen hasta yat\u0131\u015f\u0131n\u0131n 10. g\u00fcn\u00fc taburcu edildi. Doksisiklin tedavisi ayaktan 14 g\u00fcne tamamland\u0131.<\/p>\n

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Tablo 1.<\/strong> Olgunun Laboratuvar De\u011ferleri (23 May\u0131s \u2013 6 Haziran 2024)<\/p><\/div>\n

Hastan\u0131n acil servise ba\u015fvurular\u0131 ve hastanede yatt\u0131\u011f\u0131 s\u00fcre boyunca yap\u0131lan laboratuvar testleri Tablo 1\u2019de \u00f6zetlendi. K\u0131r\u0131m-Kongo kanamal\u0131 ate\u015fi i\u00e7in ger\u00e7ek zamanl\u0131 polimeraz zincir reaksiyonu (RT-PCR) testinde viral RNA saptanmad\u0131. Brucella<\/i> agl\u00fctinasyon titresi ((BRUCELLACAPT\u00ae, Vircell, Granada, \u0130spanya) negatif idi. Kan ve idrar k\u00fclt\u00fcrlerinde \u00fcreme olmad\u0131. Sitomegalovirus (CMV) ve EBV i\u00e7in RT-PCR testi sonucu negatif idi. Hastan\u0131n al\u0131nan kan k\u00fclt\u00fcrlerinde \u00fcreme olmad\u0131.\u00a0<\/span><\/p>\n

\"\"<\/a>

Tablo 2.<\/strong> Avrupa Kene ile Bula\u015fan Bakteriyel Hastal\u0131klar Akdeniz Benekli Ate\u015f Tan\u0131 K\u0131lavuzu\u2019na G\u00f6re Olgumuzun Skoru<\/p><\/div>\n

Avrupa ESCAR \u00e7al\u0131\u015fma grubu (ESCMID Study Group for Coxiella, Anaplasma, Rickettsia and Bartonella), ABA tan\u0131s\u0131 i\u00e7in kriterler belirlemi\u015f ve skorun 25\u2019in \u00fczerinde olmas\u0131n\u0131n tan\u0131 koydurucu oldu\u011funu bildirmi\u015ftir. Avrupa tan\u0131 k\u0131lavuzu kriterlerine g\u00f6re hastam\u0131z\u0131n ba\u015fvuru an\u0131ndaki skoru 31 olarak hesapland\u0131 (Tablo 2) (6). Yat\u0131\u015f s\u0131ras\u0131nda al\u0131nan indirekt floresan antikor (IFA) testi ile bak\u0131lan R. conorii<\/i> imm\u00fcnoglobulin M (IgM) 1\/192 titrede pozitif, IgG negatif bulundu. 25 Ekim 2024 tarihinde yinelenen IFA testinde R. conorii<\/i> IgM 1\/192, IgG ise 1\/320 titrede pozitif saptand\u0131.<\/p>\n

\u0130RDELEME<\/b><\/h2>\n

Akdeniz benekli ate\u015fi (ABA) ilk kez 1910 y\u0131l\u0131nda Tunus\u2019ta tan\u0131mlanm\u0131\u015f ve k\u0131sa s\u00fcrede Akdeniz havzas\u0131n\u0131n di\u011fer b\u00f6lgelerinden (\u00f6rne\u011fin \u0130talya, Yunanistan, \u0130spanya) olgu bildirimleri yap\u0131lm\u0131\u015ft\u0131r (2). \u00dclkemizde ABA\u2019ya ili\u015fkin epidemiyolojik bilgiler s\u0131n\u0131rl\u0131d\u0131r. Bildirimlerin \u00e7o\u011fu, Trakya ba\u015fta olmak \u00fczere Marmara B\u00f6lgesi\u2019nden yap\u0131lm\u0131\u015ft\u0131r (2-5). Antalya\u2019dan bildirilen tek \u00e7al\u0131\u015fma olan ve 1993 y\u0131l\u0131nda Vural ve arkada\u015flar\u0131 (7) taraf\u0131ndan yap\u0131lan ara\u015ft\u0131rmada, ge\u00e7im kayna\u011f\u0131 hayvanc\u0131l\u0131k olan 98 ki\u015fiden 13\u2019\u00fcnde IFA ile saptanan ABA antikorlar\u0131 pozitif olarak bildirilmi\u015ftir. Ancak literat\u00fcr taramas\u0131nda Akdeniz B\u00f6lgesi\u2019nde bildirilen do\u011frulanm\u0131\u015f bir ABA olgusu bulunamam\u0131\u015ft\u0131r. Bu durum, \u00fclkemizde ABA tan\u0131s\u0131na y\u00f6nelik klinik fark\u0131ndal\u0131\u011f\u0131n ve laboratuvar tan\u0131s\u0131n\u0131n yetersiz olabilece\u011fini d\u00fc\u015f\u00fcnd\u00fcrmektedir.<\/p>\n

Hastal\u0131\u011f\u0131n tan\u0131s\u0131nda klinik \u015f\u00fcphe esast\u0131r. Olgular\u0131n yakla\u015f\u0131k %90\u2019\u0131 kenenin \u00fcreme d\u00f6ng\u00fcs\u00fcn\u00fcn bir yans\u0131mas\u0131 olarak Haziran-Eyl\u00fcl aylar\u0131 aras\u0131nda tan\u0131 al\u0131r. Y\u00fcksek ate\u015f, maku\u0308lopapu\u0308ler d\u00f6k\u00fcnt\u00fc ve kenenin \u0131s\u0131rd\u0131\u011f\u0131 yerde eskar (tache noire) ABA\u2019n\u0131n klasik triad\u0131n\u0131 olu\u015fturur. Bu olguda eskar saptanmam\u0131\u015f olmakla birlikte, giri\u015f kap\u0131s\u0131 konjunktiva olabilir ya da eskar, ergin olmayan kenelerin \u0131s\u0131r\u0131klar\u0131nda g\u00f6r\u00fclmeyebilir. Ate\u015f genellikle ani ba\u015flang\u0131\u00e7l\u0131d\u0131r ve \u00e7o\u011funlukla 39\u201341\u00b0C aras\u0131nda de\u011fi\u015fir. Ate\u015f ba\u015flang\u0131c\u0131ndan 2\u20136 g\u00fcn sonra, ka\u015f\u0131nt\u0131s\u0131z ve t\u00fcm v\u00fccuda yay\u0131lm\u0131\u015f, elleri ve ayaklar\u0131 da i\u00e7eren yayg\u0131n maku\u0308lopapu\u0308ler deri d\u00f6k\u00fcnt\u00fcs\u00fc geli\u015fir. Ba\u015f a\u011fr\u0131s\u0131, miyalji, artralji gibi grip benzeri semptomlar s\u0131kl\u0131kla e\u015flik eder (1). \u00dclkemizde bildirilen ABA olgular\u0131n\u0131n de\u011ferlendirildi\u011fi \u00e7al\u0131\u015fmalarda, y\u00fcksek ate\u015f %100, mak\u00fclopap\u00fcler d\u00f6k\u00fcnt\u00fc %100, pete\u015fi %2\u201333, kene \u00f6yk\u00fcs\u00fc %3\u201329, \u201ctache noire\u201d %14\u201363, halsizlik %27\u201391, ba\u015f a\u011fr\u0131s\u0131 %63\u201388, konjonktivit %11\u201314, bilin\u00e7 bulan\u0131kl\u0131\u011f\u0131 %13\u201315 aral\u0131\u011f\u0131nda bildirilmi\u015ftir (2-5). Laboratuvar bulgular\u0131 aras\u0131nda l\u00f6kopeni, lenfopeni, normokromik anemi, trombositopeni, karaci\u011fer fonksiyon testlerinde art\u0131\u015f, kreatin y\u00fcksekli\u011fi, hemat\u00fcri, protein\u00fcri s\u0131k saptan\u0131r. Olgumuzda saptanan ciddi trombositopeni, ciddi hiponatremi, hipokalsemi, prokalsitonin y\u00fcksekli\u011fi ve karaci\u011fer fonksiyon testlerinde bozukluk malign seyirli ABA ile uyumludur. Olgumuzun hastaneye yat\u0131\u015f\u0131 s\u0131ras\u0131nda, \u201cSequential Organ Failure Assessment\u201d (SOFA) skoru 3 olup sepsis ile uyumludur. Literat\u00fcrde sepsis benzeri klinik tablo ile seyreden ABA olgular\u0131 bildirilmi\u015ftir (2,8).<\/p>\n

Tan\u0131da serolojik testler ve PCR kullan\u0131l\u0131r. Serolojik testler yayg\u0131n kullan\u0131lan, kolay uygulanabilen y\u00f6ntemlerdir ancak antikor olu\u015fumu i\u00e7in zamana ihtiya\u00e7 duyuldu\u011fundan erken d\u00f6nemde s\u0131n\u0131rl\u0131 duyarl\u0131l\u0131\u011fa sahiptir. Alt\u0131n standart y\u00f6ntem IFA\u2019d\u0131r ve referans test olarak kabul edilir. Kandaki bakteriyel y\u00fck\u00fcn d\u00fc\u015f\u00fck olmas\u0131 nedeniyle duyarl\u0131l\u0131\u011f\u0131 s\u0131n\u0131rl\u0131 olmakla birlikte PCR i\u00e7in genellikle kan ve biyopsi \u00f6rnekleri kullan\u0131l\u0131r. Eskar\u0131n eksudas\u0131 veya \u201cpunch\u201d biyopsisi \u00f6rnekleri PCR i\u00e7in k\u0131ymetlidir. Riketsiyalar ancak biyog\u00fcvenlik d\u00fczeyi 3 olan laboratuvarlarda in vitro<\/i> ko\u015fullarda h\u00fccre k\u00fclt\u00fcr\u00fc ile \u00fcretilebilmekte olup olduk\u00e7a zordur (1,2). Bu nedenle, olgumuzda oldu\u011fu gibi klinik \u015f\u00fcphe durumlar\u0131nda T\u00fcrkiye Halk Sa\u011fl\u0131\u011f\u0131 Kurumu Mikrobiyoloji Referans Laboratuvar\u0131 ile temasa ge\u00e7ilmesi ve \u00f6rnek g\u00f6nderilmesi \u00f6nemlidir. Olgumuzda yat\u0131\u015f s\u0131ras\u0131nda R. conorii<\/i> i\u00e7in IFA ile yap\u0131lan serolojik incelemede IgM 1\/192 titrede pozitif saptand\u0131; taburculuk sonras\u0131 bak\u0131lan tetkiklerinde ise IgG pozitifli\u011fi ile serokonversiyon g\u00f6sterildi.\u00a0<\/span><\/p>\n

Akdeniz benekli ate\u015fi \u015f\u00fcphesi varsa tan\u0131 do\u011frulanmas\u0131 beklenmeden uygun ampirik antibiyotik tedavisine ba\u015flanmal\u0131d\u0131r. Doksisiklin (200 mg\/g\u00fcn) ABA i\u00e7in tercih edilen tedavi olmaya devam etmektedir. Tedaviden genellikle 2\u20134 g\u00fcn sonra klinik yan\u0131t al\u0131n\u0131r.\u00a0 <\/span>Makrolidler (klaritromisin, azitromisin) ve florokinolonlar tedavide kullan\u0131labilecek di\u011fer ila\u00e7lard\u0131r (1,9). Retrospektif bir \u00e7al\u0131\u015fmada, florokinolon tedavisi ile a\u011f\u0131r seyirli ABA geli\u015fimi aras\u0131nda anlaml\u0131 ili\u015fki oldu\u011fu bildirilmi\u015ftir (10). Kloramfenikol, gebelerdeki ABA tedavisinde kullan\u0131labilecek alternatif bir ila\u00e7t\u0131r. Antibiyotiklerin tedavi s\u00fcresi hafif olgularda 7 g\u00fcn, a\u011f\u0131r seyirli olgularda ise 14 g\u00fcn olarak \u00f6nerilmektedir. K\u0131sa s\u00fcreli tedavilerin de ba\u015far\u0131l\u0131 oldu\u011funu bildiren \u00e7al\u0131\u015fmalar mevcuttur (9). Olgumuzda yat\u0131\u015f\u0131n\u0131n ikinci g\u00fcn\u00fcnden itibaren sadece doksisiklin 200 mg\/g\u00fcn tedavisi ba\u015fland\u0131 ve hasta \u015fifa ile taburcu edildi. Tedavi ayaktan 14 g\u00fcne tamamland\u0131.<\/p>\n

Sonu\u00e7 olarak; Alanya hem \u00fclkemizin ve hem de d\u00fcnyan\u0131n \u00f6nemli turizm b\u00f6lgeleri aras\u0131nda yer almaktad\u0131r. Alanya b\u00f6lgesine seyahat \u00f6yk\u00fcs\u00fc olan ve y\u00fcksek ate\u015f ile d\u00f6k\u00fcnt\u00fc semptomlar\u0131 g\u00f6steren hastalar\u0131n ay\u0131r\u0131c\u0131 tan\u0131s\u0131nda ABA da mutlaka g\u00f6z \u00f6n\u00fcnde tutulmal\u0131d\u0131r.<\/p>\n","protected":false},"excerpt":{"rendered":"

G\u0130R\u0130\u015e Akdeniz benekli ate\u015fi (ABA), Rickettsia conorii subspecies conorii\u2019nin etkeni oldu\u011fu zoonotik bir hastal\u0131kt\u0131r.\u00a0 R. conorii rezervuar\u0131 k\u00f6pek kenesidir (Rhipicephalus sanguineus) ve kene \u0131s\u0131r\u0131\u011f\u0131 sonucu bula\u015f\u0131r. Lenf sisteminde \u00e7o\u011falan bakteri hematojen yolla t\u00fcm v\u00fccuda yay\u0131l\u0131r ve k\u00fc\u00e7\u00fck damarlar\u0131n endotel h\u00fccrelerinde \u00e7o\u011falarak endotel hasar\u0131na, doku nekrozuna yol a\u00e7ar. Bunu p\u0131ht\u0131la\u015fma bozukluklar\u0131 ve akut faz yan\u0131t\u0131 izler. […]<\/p>\n","protected":false},"author":5,"featured_media":30943,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[5131],"tags":[3492,6167,6168],"class_list":["post-30783","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-olgu-sunumu","tag-akdeniz-benekli-atesi","tag-rhipicephalus-sanguineus","tag-rickettsia-conorii-2"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/30783","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\/5"}],"replies":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/comments?post=30783"}],"version-history":[{"count":3,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/30783\/revisions"}],"predecessor-version":[{"id":30973,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/30783\/revisions\/30973"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/media\/30943"}],"wp:attachment":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/media?parent=30783"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/categories?post=30783"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/tags?post=30783"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}