Lenfadenopati Tanısı ile Servis Yatışı Olan Çocukların Retrospektif Olarak Değerlendirilmesi

Öz

Amaç: Lenfadenit çoğunlukla enfeksiyona sekonder ortaya çıkmakla beraber nadiren altta yatan malign bir hastalığın belirtisi de olabilir. Klinisyenler için zorluk, altta yatan ciddi hastalığı atlamamak için dikkat ederken, bir yandan da agresif değerlendirmeyi ne zaman yapması gerektiğini belirlemektir. Çalışmamızda, konu hakkındaki bilgilerimizi arttırmak ve klinisyene tanı koymada ve tedaviyi belirlemede yardımcı olacak özellikleri belirlemek istedik. Gereç ve Yöntem: Retrospektif olarak 01.03.2019-31.10.2022 tarihleri arasında hastanemiz çocuk servislerinde lenfadenit tanısı ile yatan, 1 ay-18 yaş aralığındaki hastalar dahil edildi. Lenfadenitin saptandığı bölgeye göre hastalar 3 gruba ayrıldı: i) aksiller lenfadenit, ii) servikal lenfadenit ve iii) inguinal lenfadenit. Bulgular: Çalışmada hastaların 21’i (%60) erkekti ve hastaların yaş ortancası 75 (7-191) aydı. En sık Epstein Barr Virusu (%39) saptanırken, doku ve abse kültüründe en sık metisiline dirençli staphylococcus aureus (%37.5) üremesi görüldü. Ampisilin-sulbaktam (%91.4) ve klindamisin (%60) en sık uygulanan tedavilerdi. Hastaların %82.9’u başlangıç tedavisi ile klinik olarak düzelirken, altı hastanın tedavisi tekrar düzenlendi. Hastaların yatış süresi 8 (2-24) gün, hastanede intravenöz tedavi süresi 8 (2-21) gün olarak saptandı. ALT değeri servikal lenfadenit grubunda diğer iki gruba göre istatistiksel olarak anlamlı yüksekti (p=0.017). Servikal ve inguinal lenfadenit gruplarında CRP ve Sedim düzeyleri aksiller gruba göre istatistiksel anlamlı yüksek saptandı (p<0.001). LDH düzeyleri ise inguinal grupta diğer iki gruba göre anlamlı yüksekti (p<0.001). Sonuç: Servis yatış ihtiyacı olan tüm hastalardan, gerekli endikasyonlara göre mikrobiyolojik etkenlere yönelik tahlilleri gönderilmesi tedavi etkinliği ve süresinin belirlenmesi açısından uygun olabileceğini düşünmekteyiz. Ülkemizde MRSA görülme sıklığı sebebiyle Klindamisin tedavisinin ampirik başlanması düşünülebilir. Antibiyoterapinin en az 7 gün verilmesi komplikasyon ve relapsları önleyebilir.

Anahtar Kelimeler

• Antibiyotik Direnci
• Çocuk
• Lenfadenit
• Tedavi

Retrospective Evaluation of Hospitalized Children with a Diagnosis of Lymphadenitis

Abstract

Aim: Lymphadenitis mostly occurs secondary to infection, it may rarely be a symptom of an underlying malignant disease. In this study, we wanted to increase our knowledge on the subject and to identify features that will help the clinician to diagnose and determine the treatment. Materials and Methods: Patients aged between 1 month and 18 years who were diagnosed with lymphadenitis in the Pediatric Services between 01.03.2019 and 31.10.2022 were included in retrospective study. Patients were divided into 3 groups according to the region of lymphadenitis: i) axillary lymphadenitis, ii) cervical lymphadenitis and iii) inguinal lymphadenitis. Results: 21 of the patients were male and the median age of the patients was 75 (7-191) months. While Epstein Barr Virus was detected most frequently, methicillin-resistant staphylococcus aureus growth was most common in tissue and abscess cultures. Ampicillin-sulbactam and clindamycin were the most common treatments. While 82.9% of the patients improved clinically with the initial treatment, the treatment of six patients was adjusted. ALT value was statistically significantly higher in the cervical lymphadenitis group than in the other two groups (p=0.017). CRP and Sedim levels in cervical and inguinal lymphadenitis groups were found to be statistically significantly higher than in the axillary group (p<0.001). LDH levels were significantly higher in the inguinal group than the other two groups (p<0.001). Conclusion: Due to the prevalence of MRSA in our country, empirical initiation of clindamycin treatment may be considered. Administration of antibiotics for at least 7 days can prevent complications and relapses.

Keywords

• Antibiotic Resistance
• Child
• Lymphadenitis
• Treatment

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