Bilinmeyen Ateş Etiyolojisinde Girişimsel Hematolojik Tetkiklerin Yeri

Year 2018, Volume: 18 Issue: 1, 76 - 83, 28.03.2018

Mehmet Gündüz , Samet Yaman Şule Mine Bakanay Öztürk Ayşe Kalem Kaya Aydan Kılıçarslan Aysun Şentürk Yıkılmaz İmran Hasanoğlu Sema Akıncı Rahmet Güner İmdat Dilek

https://doi.org/10.17098/amj.370672

Abstract

Amaç:
Nedeni bilinmeyen
ateş (NBA) etiyolojisi çoğu zaman klinisyenleri
uğraştıran, tanı için invaziv işlemler gerektiren klinik bir tablodur. Kemik
iliği kültürü ve biyopsisi ile lenf nodu biyopsisi bu amaçla tercih edilen
invaziv girişimlerdir. Çalışmamızda NBA etiyolojisi araştırdığımız
hastalarımıza ait bu incelemelerin tanıdaki rolü ve sonuçları tartışılmıştır.

Materyal ve Metot: Ankara
Atatürk Eğitim ve Araştırma Hastanesi Enfeksiyon Hastalıkları Kliniği’nde NBA etiyolojisine
yönelik kemik iliği (Kİ) kültürü ve biyopsisi amacı ile Hematoloji ile konsülte
edilen ve lenf nodu biyopsisi değerlendirilen hastalar incelenerek, tanıda bu
invaziv girişimlerin rolü değerlendirilmiştir.

Bulgular: Kemik iliği kültürü-biyopsisi yapılan 18 erkek, 14 kadın,
toplam 32 hastadan alınan kemik iliği kültürlerinin altısında üreme saptandı.
İki hastada eş zamanlı olarak hem kan, hem de kemik iliği kültüründe üreme
vardı. İki hastanın sadece kemik iliği kültüründe Brucella spp. üredi.Kemik iliği biyopsilerinden 24’ü (%75,00)  normoselüler, 6’sı (%19,00) hiperselüler,
biri (%3,00) lenfoma tutulumu gösteren kemik iliği ve bir diğeri ise poliklonal
plazma hücre artışı gösteren hiposelüler kemik iliği şeklinde raporlandı. Fizik
muayenede lenfadenopatisi saptanan dokuz hastaya lenf nodu biyopsisi  yapıldı. Lenf nodu biyopsileri ile bir
hastada Leishmania spp., bir hastada
EBV  ve iki hastada diffüz büyük B
hücreli non-Hodgkin lenfoma (NHL) saptandı.

Sonuç: NBA etiyolojisinde kemik iliği biyopsisi ve kültürü ve lenf nodu biyopsisi
invaziv tanısal girişimler olup, kemik iliği tutulumu ile seyreden brusella
gibi zoonotik enfeksiyonlar başta olmak üzere lösemi, lenfoma, tüberküloz gibi
durumları ortaya koymada altın standart testtir. NBA etyolojisi araştırılırken
girişimsel hematolojik işlemlerin değeri göz ardı edilmemelidir. Birinci
basamak hekimleri, bu işlemlerin gerekliliği ve zamanlaması konusunda bilgi
sahibi olmalıdır.

Keywords

Nedeni bilinmeyen ateş etiyoloji, kemik iliği kültürü ve biyopsisi, lenf nodu biyopsisi

The Place of Interventional Hematologic Investigations in Unknown Fever Etiology

Abstract

Objectives: Fever of unknown origin (FUO) is a usually challenging clinical condition for physicians. The diagnostic work-up requires invasive procedures including culture of bone marrow aspirates and bone marrow/lymph node biopsies. In this study, we have investigated the results of diagnostic procedures employed for the work-up of FUO.

Materials and Methods: Patients who were requested hematological consultation for bone marrow aspiration for culture during the work-up for FUO in the Infectious Diseases Department of Ankara Atatürk Training and Research Hospital were included in the study. Patients with detected lymphadenopathies during physical examination had also underwent pathological investigation of bone marrow and lymph node biopsies.

Results: Bone marrow cultures revealed positive results in 6 out of 32 patients(18 male and 14 female). Two patients had simultaneous positivity of both blood and bone marrow cultures. Brucella spp. was detected in bone marrow cultures of two other patients. Among the bone marrow biopsies 24(75.00%) were normocellular, 6(19.00%) were hypercellular, 1(3.00%)revealed lymphoma involvement and 1(3.00%) revealed polyclonal expansion of plasma cells. Nine patients with with lymphadenopathies in physical examination were performed lymph node biopsies. Lymph node biopsies demonstrated Leishmania spp. in 1 patient, EBV in 1 patientand diffuse large B-celllymphoma in 2 patients.

Conclusion: Bone marrow biopsy and culture and lymph node biopsy are invasive diagnostic tests for the work-up of FUO. Bone marrow culture is the golden standard for the diagnosis of zoonotic infections including brucellosis and granulomatous infections including tuberculosis, as well as infiltration with leukemia and lymphoma. The value of interventional hematological procedures should not be underestimated during the work-up of FUO. The primary care physicians must be aware of this necessity and of the timing for these procedures.

Keywords

: Fever of unknown origin etiology, bone marrow culture and biopsy, lymph node biopsy

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