Pediatrik Tüberküloz Olgularının Klinik ve Laboratuvar Özelliklerinin Nutrisyon Göstergeleri Eşliğinde Incelenmesi

Year 2019, Volume: 19 Issue: 1, 96 - 107, 22.03.2019

Özlem Tezol , Mehmet Alakaya Asuman Akar Necdet Kuyucu

https://doi.org/10.17098/amj.542155

Abstract

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

Keywords

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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