{"id":31140,"date":"2025-12-29T13:06:11","date_gmt":"2025-12-29T10:06:11","guid":{"rendered":"https:\/\/www.klimikdergisi.org\/?p=31140"},"modified":"2026-01-15T11:58:37","modified_gmt":"2026-01-15T08:58:37","slug":"akut-ve-kronik-fascioliasis","status":"publish","type":"post","link":"https:\/\/www.klimikdergisi.org\/tr\/2025\/12\/29\/akut-ve-kronik-fascioliasis\/","title":{"rendered":"Endemik Olmayan Bir B\u00f6lgede Akut ve Kronik Fascioliasis: Klinik, Laboratuvar ve G\u00f6r\u00fcnt\u00fcleme \u00d6zellikleri"},"content":{"rendered":"

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

Fasciola hepatica<\/i>, yayg\u0131n olarak \u201ckaraci\u011fer kelebe\u011fi\u201d olarak adland\u0131r\u0131lan, insanlarda ve \u00f6zellikle s\u0131\u011f\u0131r ile koyun gibi ot\u00e7ul hayvanlarda infeksiyon yapan \u00f6nemli bir parazittir. Bu parazitin yol a\u00e7t\u0131\u011f\u0131 infeksiyon fascioliasis veya hepatik distomatozis olarak adland\u0131r\u0131lmakta olup akut ve kronik evrelerde karaci\u011fer ve safra yollar\u0131nda ciddi patolojilere neden olabilmektedir (1,2). D\u00fcnya Sa\u011fl\u0131k \u00d6rg\u00fct\u00fc (DS\u00d6) taraf\u0131ndan \u201c\u0130hmal Edilmi\u015f Tropikal Hastal\u0131klar\u201d grubu i\u00e7inde s\u0131n\u0131fland\u0131r\u0131lan fascioliasis, g\u00fcn\u00fcm\u00fczde de \u00f6nemli klinik ve ekonomik kay\u0131plara yol a\u00e7maktad\u0131r (3).<\/p>\n

Parazitin ya\u015fam d\u00f6ng\u00fcs\u00fc, infekte konaklar\u0131n d\u0131\u015fk\u0131s\u0131 ile at\u0131lan yumurtalar\u0131n tatl\u0131 suya ula\u015fmas\u0131yla ba\u015flar. Yumurtalardan \u00e7\u0131kan miracidia, tatl\u0131 su salyangozlar\u0131n\u0131 infekte eder ve burada geli\u015ferek serkaryalara d\u00f6n\u00fc\u015f\u00fcr. Metaserkaryalar kontamine sucul bitkiler \u00fczerinde kistlenmi\u015f halde bulunur; bu bitkilerin \u00e7i\u011f ya da yeterince y\u0131kanmadan t\u00fcketilmesi sonucu insanlarda infeksiyon geli\u015fmektedir. Parazitler v\u00fccuda al\u0131nd\u0131ktan sonra karaci\u011fer parankimini ge\u00e7erek safra kanallar\u0131na yerle\u015fir ve burada uzun s\u00fcre kal\u0131c\u0131 patolojiye neden olabilir (4,5).<\/p>\n

Fascioliasis; G\u00fcney Amerika, Afrika ve Asya\u2019n\u0131n baz\u0131 b\u00f6lgelerinde endemiktir. \u00d6zellikle hayvanc\u0131l\u0131\u011f\u0131n yo\u011fun oldu\u011fu, sucul ve yaprakl\u0131 sebze t\u00fcketiminin yayg\u0131n oldu\u011fu co\u011frafyalarda insidans daha y\u00fcksektir (6). \u0130klim de\u011fi\u015fikli\u011fi, g\u00f6\u00e7 hareketleri ve g\u0131da ticaretinin art\u0131\u015f\u0131 ile birlikte parazitin geleneksel endemik b\u00f6lgeler d\u0131\u015f\u0131nda da yay\u0131l\u0131m g\u00f6sterdi\u011fi bildirilmi\u015ftir (3). T\u00fcrkiye\u2019nin farkl\u0131 co\u011frafi b\u00f6lgelerinden rapor edilen fascioliasis olgu serileri, hastal\u0131\u011f\u0131n \u00fclke i\u00e7inde b\u00f6lgesel da\u011f\u0131l\u0131m\u0131nda heterojenite olabilece\u011fini d\u00fc\u015f\u00fcnd\u00fcrmektedir (7-9).<\/p>\n

Klinik olarak akut evrede ate\u015f, sa\u011f \u00fcst kadran a\u011fr\u0131s\u0131 ve belirgin eozinofili s\u0131k izlenirken; kronik evrede safra yollar\u0131na yerle\u015fen parazitlere ba\u011fl\u0131 obstr\u00fcksiyon, kolanjit ve kolestaz gibi bulgular \u00f6n plana \u00e7\u0131kmaktad\u0131r (2,5). Tan\u0131da serolojik testler, g\u00f6r\u00fcnt\u00fcleme y\u00f6ntemleri (ultrasonografi, bilgisayarl\u0131 tomografi, manyetik rezonans g\u00f6r\u00fcnt\u00fcleme) ile d\u0131\u015fk\u0131 ve safra \u00f6rneklerinde parazit yumurtalar\u0131n\u0131n g\u00f6sterilmesinden yararlan\u0131lmaktad\u0131r (10,11). G\u00f6r\u00fcnt\u00fcleme bulgular\u0131 aras\u0131nda \u00f6zellikle akut evrede subkaps\u00fcler hipodens nod\u00fcler lezyonlar ve \u201ct\u00fcnel\u201d ve \u201cma\u011fara\u201d g\u00f6r\u00fcn\u00fcm\u00fc; kronik evrede ise safra yollar\u0131nda dilatasyon ve duktal duvar kal\u0131nla\u015fmas\u0131 tan\u0131 a\u00e7\u0131dan \u00f6nem ta\u015f\u0131maktad\u0131r (12-15).<\/p>\n

Tedavide hem juvenil hem de eri\u015fkin formlara etkili olmas\u0131 nedeniyle triclabendazol tercih edilen ajand\u0131r (16). Ancak son y\u0131llarda ilaca diren\u00e7 bildirimleri yap\u0131lm\u0131\u015f, alternatif tedavi yakla\u015f\u0131mlar\u0131 ve tekrar doz gereksinimi tart\u0131\u015fma konusu olmu\u015ftur (17,18).\u00a0<\/span><\/p>\n

Bu \u00e7al\u0131\u015fmada, endemik olmayan bir b\u00f6lgede izlenen akut ve kronik fascioliasis olgular\u0131n\u0131n klinik, laboratuvar ve g\u00f6r\u00fcnt\u00fcleme \u00f6zelliklerinin kar\u015f\u0131la\u015ft\u0131rmal\u0131 olarak de\u011ferlendirilmesi ama\u00e7land\u0131.<\/p>\n

Y\u00d6NTEMLER<\/b><\/h2>\n

Bu retrospektif g\u00f6zlemsel \u00e7al\u0131\u015fma, Eyl\u00fcl 2016\u2013Ekim 2020 tarihleri aras\u0131nda T\u00fcrkiye\u2019nin endemik olmayan bir b\u00f6lgesinde yer alan Dicle \u00dcniversitesi T\u0131p Fak\u00fcltesi E\u011fitim ve Ara\u015ft\u0131rma Hastanesi\u2019nde y\u00fcr\u00fct\u00fcld\u00fc.<\/p>\n

\u00c7al\u0131\u015fmaya 18 ya\u015f ve \u00fczerindeki eri\u015fkin hastalar d\u00e2hil edildi. Fascioliasis tan\u0131s\u0131; klinik bulgular (ate\u015f, sa\u011f \u00fcst kadran a\u011fr\u0131s\u0131), laboratuvar bulgular\u0131 (eozinofili) ve\/veya d\u0131\u015fk\u0131 ya da safra \u00f6rneklerinde parazit yumurtas\u0131n\u0131n g\u00f6sterilmesi ile birlikte F. hepatica<\/i> imm\u00fcnglobulin G antikorlar\u0131n\u0131n enzim ba\u011flant\u0131l\u0131 imm\u00fcnosorbent testi (ELISA) ile saptanmas\u0131 sonucu konuldu. Tan\u0131, ELISA testindeki (NovaTec Immundiagnostica GmbH, Dietzenbach, Almanya) pozitiflik ile do\u011fruland\u0131. Tedavi ve izlem s\u00fcreci merkezimizde tamamlanmayan, eksik verisi bulunan veya e\u015flik eden ba\u015fka bir paraziter infeksiyonu olan hastalar \u00e7al\u0131\u015fma d\u0131\u015f\u0131 b\u0131rak\u0131ld\u0131.<\/p>\n

Hastalar klinik ve radyolojik bulgular temel al\u0131narak akut ve kronik d\u00f6nem olarak s\u0131n\u0131fland\u0131r\u0131ld\u0131. Akut d\u00f6nem; ate\u015f, eozinofili ve parazitin karaci\u011fer parankimindeki g\u00f6\u00e7\u00fcne ba\u011fl\u0131 yeni geli\u015fen semptomlarla tan\u0131mlan\u0131rken, kronik d\u00f6nem safra yollar\u0131na ait tekrarlayan veya kal\u0131c\u0131 komplikasyonlar (kolanjit, biliyer obstr\u00fcksiyon) ve buna e\u015flik eden karaci\u011fer enzim y\u00fcksekli\u011fi ile karakterize edildi. G\u00f6r\u00fcnt\u00fcleme y\u00f6ntemlerinde \u00f6zellikle safra yolu dilatasyonu ve parazitin hareketine ait bulgular dikkate al\u0131nd\u0131.<\/p>\n

Hastalar\u0131n demografik bilgileri, klinik bulgular\u0131, laboratuvar sonu\u00e7lar\u0131, g\u00f6r\u00fcnt\u00fcleme verileri ve tedavi bilgileri hastane elektronik kay\u0131t sisteminden elde edildi. Veriler anonim hale getirildikten sonra g\u00fcvenli bir veri setine aktar\u0131larak istatistiksel analizler i\u00e7in haz\u0131rland\u0131.<\/p>\n

\u0130statistiksel analizler R program\u0131 s\u00fcr\u00fcm 4.3.3 (R Foundation for Statistical Computing, Viyana, Avusturya) kullan\u0131larak yap\u0131ld\u0131. S\u00fcrekli de\u011fi\u015fkenlerin normal da\u011f\u0131l\u0131ma uygunlu\u011fu Shapiro-Wilk testi ile de\u011ferlendirildi. Normal da\u011f\u0131l\u0131m g\u00f6steren de\u011fi\u015fkenler ortalama \u00b1 standart sapma (SS), normal da\u011f\u0131l\u0131ma uymayan de\u011fi\u015fkenler ise medyan ve \u00e7eyrekler aras\u0131 aral\u0131k (IQR) [1. \u00e7eyrek\u20133. \u00e7eyrek] olarak sunuldu. Kategorik de\u011fi\u015fkenler say\u0131 (n) ve y\u00fczde (%) \u015feklinde raporland\u0131. Gruplar aras\u0131 kar\u015f\u0131la\u015ft\u0131rmalarda normal da\u011f\u0131l\u0131m s\u00fcrekli de\u011fi\u015fkenler i\u00e7in Welch t<\/i>-testi, normal da\u011f\u0131lmayan s\u00fcrekli de\u011fi\u015fkenler i\u00e7in Mann-Whitney U testi kullan\u0131ld\u0131.<\/p>\n

\u00c7al\u0131\u015fma i\u00e7in Medipol \u00dcniversitesi Giri\u015fimsel Olmayan Klinik Ara\u015ft\u0131rmalar Etik Kurulu\u2019ndan 28 Kas\u0131m 2024 tarih ve 1144 karar numaras\u0131yla onay al\u0131nd\u0131.<\/p>\n

BULGULAR\u00a0<\/span><\/b><\/h2>\n

\u00c7al\u0131\u015fmaya toplam 25 olgu d\u00e2hil edildi; bunlar\u0131n 19\u2019u (%76.0) kad\u0131nd\u0131. T\u00fcm grup i\u00e7in ya\u015f ortalamas\u0131 45.4 \u00b1 16.0 y\u0131l olarak bulundu. Hastalar\u0131n 15\u2019i (%60.0) hayvanc\u0131l\u0131kla u\u011fra\u015fmakta, 20\u2019si (%80.0) ise k\u0131rsal alanda ikamet etmekteydi; 16 (%64) hastada su teresi t\u00fcketim \u00f6yk\u00fcs\u00fc mevcuttu. Olgular\u0131n 6\u2019s\u0131nda (%24) serpigin\u00f6z cilt lezyonlar\u0131 saptand\u0131. Ba\u015fvuru a\u015famas\u0131nda olgular\u0131n 20\u2019si (%80.0) akut (hepatik) evre, 5\u2019i (%20.0) ise kronik (biliyer) evre olarak de\u011ferlendirildi.\u00a0<\/span><\/p>\n

Akut (hepatik) evredeki olgular\u0131n ya\u015f ortalamas\u0131 46.20 \u00b1 16.14 y\u0131l olup
\nb\u00fcy\u00fck \u00e7o\u011funlu\u011fu kad\u0131nd\u0131 (n=17, %85.0). Bu grupta olgular\u0131n %60.0\u2019\u0131 hayvanc\u0131l\u0131kla u\u011fra\u015fmakta, %85.0\u2019i k\u0131rsal b\u00f6lgede ya\u015famaktayd\u0131. En s\u0131k ba\u015fvuru semptomlar\u0131 kar\u0131n a\u011fr\u0131s\u0131 (%90.0) ve kusma (%85.0) idi; ate\u015f %45.0 ve \u00fcrtiker %50.0 oran\u0131nda saptand\u0131. Tan\u0131sal ama\u00e7l\u0131 endoskopik retrograd kolanjiyopankreatografi (ERCP) \u00f6yk\u00fcs\u00fc 2 (%10.0) olguda da mevcuttu.<\/p>\n

Kronik (biliyer) evredeki olgular\u0131n ya\u015f ortalamas\u0131 42.40 \u00b1 17.10 y\u0131l olup 2\u2019si (%40.0) kad\u0131nd\u0131. Bu grupta olgular\u0131n 3\u2019\u00fc (%60.0) hayvanc\u0131l\u0131kla u\u011fra\u015fmakta ve 3\u2019\u00fc (%60.0) k\u0131rsal b\u00f6lgede ya\u015famaktayd\u0131. T\u00fcm olgularda kar\u0131n a\u011fr\u0131s\u0131 ve kusma mevcuttu; ate\u015f 2 (%40.0) ve \u00fcrtiker 1 (%20.0) olguda izlendi. Hepatomegali 1 (%20.0) olguda saptand\u0131. Tan\u0131sal ama\u00e7l\u0131 ERCP \u00f6yk\u00fcs\u00fc 3 (%60.0) olguda mevcuttu.<\/p>\n

Laboratuvar bulgular\u0131 evrelere g\u00f6re kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131\u011f\u0131nda eozinofil say\u0131s\u0131n\u0131n akut evrede kronik evreye k\u0131yasla anlaml\u0131 derecede y\u00fcksek oldu\u011fu g\u00f6r\u00fcld\u00fc (3730 [244\u20139170] vs. 682 [629\u20131,410]\/mm\u00b3; p<\/i>=0.015). L\u00f6kosit ve hemoglobin d\u00fczeyleri a\u00e7\u0131s\u0131ndan iki grup aras\u0131nda anlaml\u0131 fark saptanmad\u0131 (l\u00f6kosit i\u00e7in 9490 [6927\u201315 137] vs. 8930 [8690\u20139150]\/mm\u00b3; p<\/i>=0.760); hemoglobin i\u00e7in (13.39\u00b11.89 vs. 14.24\u00b11.67 g\/dl; p<\/i>=0.357). \u0130nflamatuar belirte\u00e7lerden eritrosit sedimantasyon h\u0131z\u0131 (ESH) kronik evrede daha y\u00fcksek olup (30 [20\u201335] vs. 11.50 [6.00\u201317.50] mm\/saat), bu fark istatistiksel olarak anlaml\u0131yd\u0131 (p<\/i>=0.025). Buna kar\u015f\u0131n C-reaktif protein (CRP) d\u00fczeyleri akut ve kronik evreler aras\u0131nda benzerdi (3.0 [1.0\u201312.0] vs. 1.50 [0.30\u20138.00] mg\/lt; p<\/i>=0.518).<\/p>\n

\"\"<\/a>

\u015eekil 1.<\/strong> Akut ve Kronik Evrede Laboratuvar Parametrelerinin Da\u011f\u0131l\u0131m\u0131*
*Grafikler, akut (mavi) ve kronik (k\u0131rm\u0131z\u0131) evrelerdeki laboratuvar parametrelerinin bireysel da\u011f\u0131l\u0131m\u0131n\u0131 g\u00f6stermektedir. Her bir paneldeki noktalar tekil hasta de\u011ferlerini, elmas bi\u00e7imindeki i\u015faret\u00e7iler ise ilgili evreye ait merkezi e\u011filim de\u011ferlerini temsil etmektedir. Akut ve kronik evreler kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131\u011f\u0131nda, \u00f6zellikle akut evrede eozinofil d\u00fczeylerinin belirgin olarak daha y\u00fcksek oldu\u011fu g\u00f6r\u00fclmektedir.<\/p><\/div>\n

Karaci\u011fer fonksiyon testlerinden total bilirubin, gamma-glutamil transferaz (GGT) ve alkalin fosfataz (ALP) d\u00fczeyleri a\u00e7\u0131s\u0131ndan gruplar aras\u0131nda anlaml\u0131 fark izlenmedi (p<\/i>>0.05). Laboratuvar parametrelerinin akut ve kronik evrelere g\u00f6re da\u011f\u0131l\u0131mlar\u0131 \u015eekil 1\u2019de sunuldu.<\/p>\n

G\u00f6r\u00fcnt\u00fcleme Bulgular\u0131<\/strong><\/p>\n

\"\"<\/a>

\u015eekil 2.<\/strong> Akut ve Kronik Fascioliasis Olgular\u0131nda G\u00f6r\u00fcnt\u00fcleme Bulgular\u0131n\u0131n Evrelere G\u00f6re Da\u011f\u0131l\u0131m\u0131*
* G\u00f6r\u00fcnt\u00fcleme bulgular\u0131 akut (hepatik) ve kronik (biliyer) evrelere g\u00f6re s\u0131n\u0131fland\u0131r\u0131ld\u0131. Akut evrede hepatik parankimde koalesans e\u011filimi g\u00f6steren hipodens t\u00fcb\u00fcler lezyonlar daha s\u0131k izlenirken, kronik evrede safra yollar\u0131na ait bulgular \u00f6n plandad\u0131r. Kronik evrede \u00f6zellikle biliyer dilatasyon, intraduktal parazit g\u00f6r\u00fcn\u00fcm\u00fc ve duktal duvar kal\u0131nla\u015fmas\u0131 daha s\u0131k saptand\u0131.<\/p><\/div>\n

Olgular\u0131n 6\u2019s\u0131nda (%24.0) bilgisayarl\u0131 tomografi \u00e7ekilmi\u015f, 19\u2019unda (%76.0) manyetik rezonans g\u00f6r\u00fcnt\u00fcleme yap\u0131lm\u0131\u015ft\u0131. Akut evrede en s\u0131k saptanan bulgu, birle\u015fme e\u011filimi g\u00f6steren \u00e7ok say\u0131da t\u00fcb\u00fcler hipodens lezyondu (n=14, %70.0). Ayr\u0131ca 4 (%20.0) olguda patolojik bulguya rastlanmazken, 2 (%10.0) olguda karaci\u011fer sa\u011f lob ile segment 4\u2019te yamal\u0131 dif\u00fczyon k\u0131s\u0131tl\u0131l\u0131\u011f\u0131 alanlar\u0131 izlendi. Kronik evrede ise safra yollar\u0131ndaki anormallikler \u00f6n plandayd\u0131: intraduktal parazitin e\u015flik etti\u011fi dilatasyon 3 (%60.0) olguda, duktal duvar kal\u0131nla\u015fmas\u0131n\u0131n e\u015flik etti\u011fi dilatasyon ise 2 (%40.0) olguda saptand\u0131 (\u015eekil 2).<\/p>\n

Tedavi ve \u0130zlem<\/strong><\/p>\n

Olgular\u0131n tamam\u0131na triclabendazol tedavisi uygulanm\u0131\u015ft\u0131 (10 mg\/kg, 12 saatte bir, toplam 2 doz). Tedavi sonras\u0131 ger\u00e7ekle\u015ftirilen \u00fc\u00e7\u00fcnc\u00fc ay ve birinci y\u0131l kontrollerinde t\u00fcm hastalar\u0131n komplikasyonsuz olarak iyile\u015fti\u011fi g\u00f6r\u00fcld\u00fc.<\/p>\n

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

Bu \u00e7al\u0131\u015fma, T\u00fcrkiye\u2019nin endemik olmayan bir b\u00f6lgesinde tan\u0131 alan fascioliasis olgular\u0131nda akut ve kronik evrelerin kar\u015f\u0131la\u015ft\u0131rmal\u0131 de\u011ferlendirmesini sunmaktad\u0131r. Bulgular\u0131m\u0131z, her iki evre aras\u0131nda klinik, laboratuvar ve g\u00f6r\u00fcnt\u00fcleme \u00f6zellikleri a\u00e7\u0131s\u0131ndan belirgin farkl\u0131l\u0131klar bulundu\u011funu g\u00f6stermektedir. Akut evrede eozinofili \u00f6n planda iken, kronik evrede safra yollar\u0131na ait komplikasyonlar\u0131n daha s\u0131k g\u00f6r\u00fcld\u00fc\u011f\u00fc saptanm\u0131\u015ft\u0131r. Bu bulgular, d\u00fc\u015f\u00fck prevalansl\u0131 b\u00f6lgelerde dahi evreye \u00f6zg\u00fc klinik ipu\u00e7lar\u0131n\u0131n tan\u0131 a\u00e7\u0131s\u0131ndan kritik \u00f6nem ta\u015f\u0131d\u0131\u011f\u0131n\u0131 ortaya koymaktad\u0131r.<\/p>\n

Serimizde kad\u0131n predominans\u0131 (%76) ve k\u0131rsal b\u00f6lgede ya\u015fama \u00f6yk\u00fcs\u00fc (%80) dikkat \u00e7ekicidir. Literat\u00fcrde de fascioliasis\u2019in kad\u0131nlarda daha s\u0131k g\u00f6r\u00fcld\u00fc\u011f\u00fc ve k\u0131rsal ya\u015fam\u0131n en \u00f6nemli risk fakt\u00f6rlerinden biri oldu\u011fu bildirilmi\u015ftir (12). Ayr\u0131ca hastalar\u0131m\u0131z\u0131n %64\u2019\u00fcnde su teresi t\u00fcketim \u00f6yk\u00fcs\u00fcn\u00fcn bulunmas\u0131, literat\u00fcrde bildirilen %50\u201370 aral\u0131\u011f\u0131 ile uyumludur (9,10). Bu bulgular, infeksiyon kayna\u011f\u0131 olarak \u00f6zellikle sucul bitkilerin \u00f6nemini bir kez daha do\u011frulamaktad\u0131r.<\/p>\n

\u00c7al\u0131\u015fmam\u0131zda akut evrede en s\u0131k semptom kar\u0131n a\u011fr\u0131s\u0131 (%90) iken kronik evrede biliyer semptomlar (kolanjit, kusma) \u00f6n plandayd\u0131. Tun\u00e7 ve arkada\u015flar\u0131n\u0131n (19) \u00e7al\u0131\u015fmas\u0131nda, akut olgularda abdominal a\u011fr\u0131n\u0131n daha s\u0131k g\u00f6r\u00fcld\u00fc\u011f\u00fc, kronik olgularda ise biliyer semptomlar\u0131n \u00f6n planda oldu\u011fu bildirilmi\u015ftir. Bu veriler, fascioliasis evrelerine g\u00f6re klinik prezentasyonun belirgin \u015fekilde farkl\u0131la\u015ft\u0131\u011f\u0131n\u0131 g\u00f6stermektedir.<\/p>\n

Literat\u00fcrde kronik fascioliasis olgular\u0131nda semptomlar\u0131n nonspesifik olmas\u0131 nedeniyle tan\u0131da aylar s\u00fcren, hatta baz\u0131 serilerde y\u0131llara (4 y\u0131la) varan gecikmeler bildirilmektedir (20). Bu durumun, kronik evrede nonspesifik semptomlar\u0131n bask\u0131n olmas\u0131 ve eozinofilinin s\u0131kl\u0131kla kaybolmas\u0131 nedeniyle tan\u0131sal belirsizlikten kaynakland\u0131\u011f\u0131 d\u00fc\u015f\u00fcn\u00fclmektedir.<\/p>\n

Ayr\u0131ca olgular\u0131m\u0131z\u0131n %24\u2019\u00fcnde serpigin\u00f6z cilt lezyonlar\u0131 izlenmi\u015f olup bu oran literat\u00fcrde bildirilen %15\u201330 aral\u0131\u011f\u0131yla uyumludur (6,12,16). Evrelere g\u00f6re de\u011ferlendirildi\u011finde bu lezyonlar\u0131n kronik evrede %60 oran\u0131 ile daha s\u0131k g\u00f6r\u00fclmesi, antijenlere uzun s\u00fcreli maruziyet ve imm\u00fcn yan\u0131t\u0131n kronikle\u015fmesi ile ili\u015fkilendirilebilir.<\/p>\n

Eozinofili, fascioliasis akut evrenin en karakteristik laboratuvar bulgular\u0131ndan biri olarak tan\u0131mlanmaktad\u0131r (6,8,11). \u00c7al\u0131\u015fmam\u0131zda da akut evrede eozinofil d\u00fczeylerinin kronik evreye k\u0131yasla anlaml\u0131 derecede daha y\u00fcksek saptanmas\u0131, bu evreye \u00f6zg\u00fc imm\u00fcnolojik yan\u0131t paternini desteklemektedir.<\/p>\n

\u00c7al\u0131\u015fmam\u0131zda bilirubin, ALP, GGT, CRP ve l\u00f6kosit say\u0131s\u0131 a\u00e7\u0131s\u0131ndan iki evre aras\u0131nda belirgin bir fark g\u00f6r\u00fclmedi. Literat\u00fcrde de kolestatik enzimlerin fascioliasis\u2019te s\u00fcrekli de\u011fil, d\u00f6nemsel art\u0131\u015f g\u00f6sterebildi\u011fi, bunun da intermittan duktal obstr\u00fcksiyon ile ili\u015fkili olabilece\u011fi bildirilmi\u015ftir (2,6,8,13).<\/p>\n

Radyolojik incelemelerde akut evrede olgular\u0131n %70\u2019inde hepatik parankimde koalesans e\u011filimi g\u00f6steren \u00e7ok say\u0131da t\u00fcb\u00fcler hipodens lezyon saptand\u0131. Bu oran, Ko\u00e7 ve arkada\u015flar\u0131n\u0131n (13) \u00e7al\u0131\u015fmas\u0131nda %60, Dusak ve arkada\u015flar\u0131n\u0131n (14) \u00e7al\u0131\u015fmas\u0131nda ise %75 olarak bildirilen sonu\u00e7larla uyumludur. Kronik evrede ise safra yolu dilatasyonu %60, intraduktal parazit g\u00f6r\u00fcn\u00fcm\u00fc %60 ve duktal duvar kal\u0131nla\u015fmas\u0131 %40 oranlar\u0131nda saptand\u0131. Bu bulgular, kronik evrede biliyer sistem hasar\u0131n\u0131n bask\u0131n oldu\u011funu g\u00f6stermekte olup literat\u00fcr ile uyumludur.<\/p>\n

Literat\u00fcrde kronik evre fascioliasis olgular\u0131nda ERCP gereksinimi %40\u201370 oran\u0131nda bildirilmi\u015ftir (13,19). Bizim serimizde de t\u00fcm olgular\u0131n %24\u2019\u00fcnde, kronik evre hastalar\u0131n\u0131n ise %60\u2019\u0131nda ERCP gereksinimi mevcuttu. Bu sonu\u00e7, kronik evrede biliyer obstr\u00fcksiyon ve intraduktal parazit varl\u0131\u011f\u0131n\u0131n daha s\u0131k endoskopik m\u00fcdahale gerektirdi\u011fini desteklemektedir.<\/p>\n

Olgular\u0131n tamam\u0131nda triclabendazol tedavisi uygulanm\u0131\u015f ve tam iyile\u015fme sa\u011flanm\u0131\u015ft\u0131r. Literat\u00fcrde tedavi ba\u015far\u0131s\u0131 genellikle %90\u2019\u0131n \u00fczerinde olmakla birlikte, baz\u0131 b\u00f6lgelerde diren\u00e7 ve tedavi ba\u015far\u0131s\u0131zl\u0131\u011f\u0131 bildirilmi\u015ftir (17,18). Serimizde n\u00fcks izlenmemesi, d\u00fc\u015f\u00fck endemisiteye sahip b\u00f6lgelerde ilac\u0131n etkinli\u011finin devam etti\u011fini d\u00fc\u015f\u00fcnd\u00fcrmektedir.<\/p>\n

\u00c7al\u0131\u015fmam\u0131z\u0131n g\u00fc\u00e7l\u00fc y\u00f6nleri; endemik olmayan bir b\u00f6lgede tan\u0131 alan fascioliasis olgular\u0131n\u0131n ayr\u0131nt\u0131l\u0131 klinik, laboratuvar ve g\u00f6r\u00fcnt\u00fcleme bulgular\u0131 ile evrelere g\u00f6re sistematik olarak kar\u015f\u0131la\u015ft\u0131r\u0131lm\u0131\u015f olmas\u0131d\u0131r. K\u0131s\u0131tl\u0131l\u0131\u011f\u0131 ise retrospektif, tek merkezli ve nispeten k\u00fc\u00e7\u00fck \u00f6rneklem b\u00fcy\u00fckl\u00fc\u011f\u00fcne sahip bir \u00e7al\u0131\u015fma olmas\u0131d\u0131r. \u00d6zellikle kronik evredeki \u00f6rneklem b\u00fcy\u00fckl\u00fc\u011f\u00fcn\u00fcn (n=5) d\u00fc\u015f\u00fck olmas\u0131, bu grupta elde edilen medyan ve IQR de\u011ferlerinin yorumlanmas\u0131n\u0131 s\u0131n\u0131rlamakta olup sonu\u00e7lar bu durum g\u00f6z \u00f6n\u00fcnde bulundurularak de\u011ferlendirilmelidir.<\/p>\n

Sonu\u00e7 olarak; bulgular\u0131m\u0131z fascioliasis infeksiyonunun endemik olmayan b\u00f6lgelerde de dikkate al\u0131nmas\u0131 gerekti\u011fini ortaya koymaktad\u0131r. Akut evrede eozinofili ve hepatik hipodens lezyonlar, kronik evrede ESH art\u0131\u015f\u0131 ve safra yollar\u0131na ait komplikasyonlar tan\u0131da yol g\u00f6sterici bulgulard\u0131r. Ayr\u0131ca klinisyenler i\u00e7in kronik evrede daha uzun semptom\u2013tan\u0131 aral\u0131\u011f\u0131 \u00f6nemli bir uyar\u0131 niteli\u011findedir. Kronik olgularda ERCP gereksiniminin daha y\u00fcksek olmas\u0131, biliyer evre komplikasyonlar\u0131n\u0131n y\u00f6netiminde endoskopik yakla\u015f\u0131m\u0131n \u00f6nemini g\u00f6stermektedir. Klinik fark\u0131ndal\u0131\u011f\u0131n art\u0131r\u0131lmas\u0131, \u00f6zellikle d\u00fc\u015f\u00fck prevalansl\u0131 b\u00f6lgelerde tan\u0131daki gecikmelerin azalt\u0131lmas\u0131na ve buna ba\u011fl\u0131 olarak hasta prognozunun iyile\u015ftirilmesine katk\u0131 sa\u011flayacakt\u0131r.<\/p>\n","protected":false},"excerpt":{"rendered":"

G\u0130R\u0130\u015e Fasciola hepatica, yayg\u0131n olarak \u201ckaraci\u011fer kelebe\u011fi\u201d olarak adland\u0131r\u0131lan, insanlarda ve \u00f6zellikle s\u0131\u011f\u0131r ile koyun gibi ot\u00e7ul hayvanlarda infeksiyon yapan \u00f6nemli bir parazittir. Bu parazitin yol a\u00e7t\u0131\u011f\u0131 infeksiyon fascioliasis veya hepatik distomatozis olarak adland\u0131r\u0131lmakta olup akut ve kronik evrelerde karaci\u011fer ve safra yollar\u0131nda ciddi patolojilere neden olabilmektedir (1,2). D\u00fcnya Sa\u011fl\u0131k \u00d6rg\u00fct\u00fc (DS\u00d6) taraf\u0131ndan \u201c\u0130hmal Edilmi\u015f […]<\/p>\n","protected":false},"author":5,"featured_media":31385,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[5129],"tags":[6219,2776,6221,6218,6220],"class_list":["post-31140","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-ozgun-arastirma","tag-akut-evre","tag-eozinofili","tag-fasciola-hepatica-2","tag-fascioliasis","tag-kronik-evre"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/31140","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=31140"}],"version-history":[{"count":4,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/31140\/revisions"}],"predecessor-version":[{"id":31447,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/31140\/revisions\/31447"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/media\/31385"}],"wp:attachment":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/media?parent=31140"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/categories?post=31140"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/tags?post=31140"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}