Pediatrik Tüberküloz Olgularının Klinik ve Laboratuvar Özelliklerinin Nutrisyon Göstergeleri Eşliğinde Incelenmesi

Öz

Amaç: Çocukluk çağı tüberkülozu önemli bir halk sağlığı sorunudur. Pediatrik tüberküloza sıklıkla zayıflık ile karakterize malnutrisyon eşlik eder. Bu çalışmada pediatrik tüberküloz hastalarının nutrisyon göstergeleri eşliğinde değerlendirilmesi amaçlandı. 

Materyal ve Metot: Tüberküloz tanısı almış hastaların demografik, klinik, antropometrik, mikrobiyolojik, histopatolojik ve radyolojik özellikleri geriye dönük olarak incelendi. 

Bulgular: Çalışmaya 77 olgunun verileri dahil edildi. Olguların ortalama yaşı 9,32±4,91 yıl, %63’ü erkekti. Kesin tüberküloz tanısı alan 24 (%31), olası tüberküloz tanısı alan 39 (%50) ve latent tüberküloz tanısı alan 14 (%18) hasta vardı. Kesin tanılı grupta olguların %33’ünde aside dirençli bakteri görüldü, %20’sinde kültür pozitifti, %45’inde hem aside dirençli bakteri görüldü hem kültür pozitifti. Olguların %40’ı akciğer, %32’si akciğer dışı, %6’sı miliyer, %2’si akciğer ve akciğer dışı tüberküloz birlikteliğiydi. Akciğer tübekülozu tanılı hastaların yaş ortalaması akciğer dışı + miliyer tüberküloz tanılı hastaların yaş ortalamasından anlamlı olarak daha büyüktü (p=0,003). Kültür pozitifliği oranı akciğer tüberkülozu grubunda, tanısal histopatolojik örnekleme oranı akciğer dışı + miliyer tüberküloz grubunda daha yüksekti (p=0,019, p=0,012). Temas öyküsü oranı %37, ev içi temas oranı %23 olarak saptandı, en sık indeks vakalar babalardı. Tüberkülin deri testi kesin tüberküloz tanılı 11 hastada (%45), olası tüberküloz tanılı 15 hastada (%38) pozitifti. Kesin ve olası tüberküloz grupları arasında cinsiyet, ortalama yaş, yakınma süresi, tüberkülin testi pozitifliği, Bacille Calmette-Guerin skarı varlığı, temas öyküsü oranı, hematolojik testler ve antropometrik ölçümler açısından anlamlı farklılık yoktu (p>0,05). Olguların tanı anında yaşa göre boy median yüzde değerlerinin ortalaması (94,35±7,50) ve boya göre ağırlık median yüzde değerlerinin ortalaması (85,72±6,92) hafif malnutrisyonu göstermekteydi ve bu durum tedavi bitiminde de devam etmekteydi. Yaşa göre boy dikkate alındığında kronik malnutre olan grup olası tüberküloz grubuydu, bu grupta yakınma süresi ortancası 3 aydı. Boya göre ağırlık (<5 yaş hastalar için) ve vücut kitle indeksi (≥5 yaş hastalar için) Z skoru -2 standart sapma değerinden düşük olan 16 hasta (%25) vardı ve orta derecede malnutre olan bu olguların tedavi bitiminde de aynı kaldığı görüldü. Hem kesin hem olası tüberküloz grubunda tanı anındaki ve tedavi bitimindeki antropometrik ölçümler arasında istatistiksel olarak anlamlı fark yoktu (p>0,05).

Sonuç: Pediatrik tüberküloz hastalarının nutrisyon durumlarının izlenmesi, antitüberküloz tedavi ile birlikte beslenme eksikliklerinin ve hatalarının giderilmesi ihmal edilebilmektedir. Çocuklarda tüberküloz yönetimi ile malnutrisyon izlemi bütünleştirilmelidir

Anahtar Kelimeler

• çocuk,malnutrisyon,tüberküloz

Clinical and Laboratory Evaluation of Pediatric Tuberculosis Cases in Light of Nutritional Indicators

Abstract

Objectives: Pediatric tuberculosis is a major public health problem. Malnutrition characterized with wasting is prevalent among pediatric tuberculosis patients. We aimed to review pediatric tuberculosis cases by considering their nutrition manifestations. 
Materials and Methods: The study evaluated demographical, clinical, anthropometric, microbiological, histopathological and radiological characteristics of tuberculosis patients, retrospectively. 
Results: The study involved 77 tuberculosis cases. Sixty-three percent of the patients were male with a mean age of 9.32±4.91 years. Twenty-four patients (31%) diagnosed with definite tuberculosis, thirty-nine patients (50%) with probable tuberculosis, and fourteen patients (18%) with latent tuberculosis infection. Acid resistant bacteria were observed in 33%, culture positivity was observed in 20%, both acid resistant bacteria and culture positivity was observed in 45% of definite diagnosed group. Forty percent of patients had pulmonary, 32% had extrapulmonary, 6% had miliary, 2% had both pulmonary and extrapulmonary tuberculosis. Pulmonary tuberculosis diagnosed patients were significantly older than extrapulmonary plus miliary group (p=0.003). Culture positivity rate was significantly higher in pulmonary, diagnostic histopathological sampling rate was significantly higher in extrapulmonary plus miliary group (p=0.019, p=0.012). Thirty seven percent of patients had a contact history, 23% of those had household contact, and the most common index cases were fathers. The tuberculin test was positive in 11 patients (45%) with definite and 15 patients (38%) with probable tuberculosis. No significant difference has been observed between definite and probable tuberculosis groups according to the sex, average age, symptom duration, tuberculin test positivity, Bacille Calmette-Guerin vaccine scar presence, contact history rate, hematologic tests, and anthropometric measurements (p>0.05). At the time of diagnosis mean (SD) values of height for age and weight for height medians [ 94.35 (7.50) % and 85.72 (6.92) %, respectively] refered to mild malnutrition, the same conditions were remaining at the end of treatment. When height for age taken into consideration the chronic malnutrated group was probable tuberculosis group. Weight for height (for <5 years old cases) and body mass index (for ≥5 years old cases) Z scores of sixteen patients were less than -2 SD value and these moderae malnutrated cases were remaining at the end of treatment. There was not a statistical significance between anthropometric measurements at the time of diagnosis and at the end of antituberculosis treatment (p>0.05). 
Conclusion: Nutrition status monitoring, correcting nutritional deficiencies and failures can be neglected in course of antituberculosis treatment. Tuberculosis management should be integrated with malnutrition monitoring in pediatric cases. 

Keywords

• child,malnutrition,tuberculosis

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