Çocukluk Çağı Tüberkülozunu Toplum Kaynaklı Pnömoniden Ayırmada Yeni Parametreler Arayışı - Mümkün mü?

Abstract

Giriş: Nötrofil-lenfosit oranı (NLO) ve monosit-lenfosit oranı (MLO), bakteriyemi, hastalık aktivitesi, nüks oranı, sürveyans ve prognozu değerlendirmek için birçok hastalıkta kullanılan yararlı inflamasyon biyobelirteçleridir. Amaç: Bu çalışmanın amacı akciğer tüberkülozu olan çocukların TKP'den ayırıcı tanısında NLO ve MLO' nı değerlendirmektir. Gereç ve Yöntemler: Haziran 2016 ile Aralık 2018 tarihleri ​​arasında Çocuk Enfeksiyon Hastalıkları Servisi'nde akciğer tüberkülozu olan 50 çocuğun hastane kayıtlarını incelenerek NLO ve MLO değerleri 50 TKP ve 50 sağlıklı çocuk ile karşılaştırıldı. Ayrıca; tüberküloz ve TKP grubu arasında eritrosit sedimantasyon hızı (ESR) ve C-reaktif protein değerleri (CRP) karşılaştırıldı. Bulgular: 3 grup karşılaştırıldığında, 3 grup arasında NLO ve MLO değerleri arasında anlamlı fark vardı. İkili karşılaştırmalarda, sağlıklı kontrollere karşı tüberküloz ve TKP ile sağlıklı kontroller arasında NLO ve MLO değerleri arasında anlamlı fark vardı. Ancak tüberküloz ve TKP grupları arasında NLO, MLO değerleri arasında anlamlı bir fark yoktu. Sonuç: Bu çalışma, çocukluk çağı tüberküloz ayırıcı tanısında NLO ve MLO'nı değerlendiren ilk çalışmadır. NLO ve MLO değerleri, hem akciğer tüberkülozu hem de TKP'de ayrı ayrı iyi birer inflamasyon biyobelirteci olmasına rağmen, çocuklarda tüberkülozu TKP'den ayırmada beklendiği kadar yararlı değildir.

Keywords

• tüberküloz
• toplum kaynaklı pnömoni
• çocuk
• notrofil lenfosit oranı
• monosit lenfosit oranı

Seeking New Parameters In Differentiating Child Tuberculosis From Community Acquired Pneumonia- Is It Possible?”

Abstract

Abstract Background: The neutrophil-lymphocyte ratio (NLR) and monocyte-lymphocyte ratio(MLR) are useful biomarkers of inflammation used in many diseases to evaluate bacteremia, disease activity, recurrence rate, surveillance and prognosis. Objective: Aim of this study was to evaluate NLR and MLR in the differential diagnosis of children with pulmonary tuberculosis disease from CAP. Materials and Methods: I reviewed hospital-records of 50 children with pulmonary tuberculosis disease in the Pediatric Infectious Disease Ward between June 2016 and December 2018, and compared; NLR and MLR with 50 CAP and 50 healthy children. Also; erythrocyte sedimentation rate(ESR) and C-reactive protein(CRP) were compared between the tuberculosis and CAP group. Results: When 3 groups were compared there was significant difference among NLR and MLR values between 3 groups. In pairwise-comparisons, there was significant difference among NLR and MLR values between tuberculosis versus healthy controls, and CAP versus healthy controls. However, there was no significant difference among NLR, MLR values between tuberculosis versus CAP groups. Conclusion: This study is unique that evluates NLR and MLR in tuberculosis differentiation. Although NLR and MLR values are useful biomarkers of inflammation in both pulmonary tuberculosis and CAP seperately, they’re not as useful as expected in differentiating tuberculosis from CAP in children.

Keywords

• tuberculosis
• community acquired pneumonia
• child
• neutrophil to lymphocyte ratio
• monocyte to lymphocyte ratio

References

1. 1. Kliegman R., Stanton B., St. Geme, JW., Schor NF., & Behrman, RE. Nelson textbook of pediatrics (Edition 20). Phialdelphia, PA: Elsevier 2015;1445-61 2. Farr K, Ravindran R, Strnad L, Chang E, Chaisson LH, Yoon C, et al. Diagnostic performance of blood inflammatory markers for tuberculosis screening in people living with HIV. PLoS One. 2018; 13(10):e0206119.
2. 3. Togun TO, MacLean E, Kampmann B, Pai M. Biomarkers for diagnosis of childhood tuberculosis: A systematic review. PLoS One. 2018;13(9):e0204029.
3. 4. Alavi SM, Bakhtiyariniya P, Albagi A. Factors associated with delay in diagnosis and treatment of pulmonary tuberculosis. Jundishapur J Microbiol. 2015; 8(3):e19238
4. 5. Demir F, Karadeniz C, Ozdemir R, Yozgat Y, Çelegen K, Karaaslan U,et al. Usefulness of neutrophil to lymphocyte ratio in prediction of coronary artery lesions in patients with Kawasaki disease. Balkan Med J 2015; 32: 371-76.
5. 6. Uygur F, Tanriverdi H, Aktop Z,Erboy F, Altinsoy B, Damar M, et al. The neutro¬phil-to-lymphocyte ratio in patients with obstructive sleep apnoea syndrome and its relationship with cardiovascular disease. Heart Lung 2016; 45: 121-25.
6. 7. Kucuk A, Erol MF, Senel S, Eroler E, Yumun HA, Uslu AU, et al. The role of neutrophil lymphocyte ratio to leverage the differential diagnosis of familial Mediterranean fever attack and acute appendici¬tis. Korean J Intern Med 2016; 31: 386-91.
7. 8. Gokcen K, Dundar G, Gulbahar H, Gokce G, Gultekin EY. Can routine peripheral blood counts like neutrophil-to-lymphocyte ratio be beneficial in prediagnosis of testicular cancer and its stages?J Res Med Sci. 2018; 26;23:64.
8. 9. Atan D, Ikinciogullari A, Koseoglu S, Özcan KM, Çetin MA, Ensari S,et al. New predic-tive parameters of Bell’s palsy: neutrophil to lymphocyte ratio and platelet to lymphocyte ratio. Balkan Med J 2015; 32: 167-70.

9. 10. Yin X, Xiao Y, Li F, Qi S, Yin Z, Gao J. Prognostic role of neutrophil-to-lymphocyte ratio in prostate cancer: a sys¬tematic review and meta-analysis. Medicine (Baltimore) 2016; 95: e2544. 11. Bahadır A, Baltacı D, Türker Y, Türker Y, Iliev D, Öztürk S, et al. Is the neutrophil-to-lymphocyte ratio indicative of inflammatory state in patients with obesity and metabolic syndrome? Anatol J Cardiol. 2015; 15(10): 816-22.
10. 12. Grilz E, Posch F, Königsbrügge O, Schwarzinger I, Lang IM, Marosi C, et al. Association of Platelet-to-Lymphocyte Ratio and Neutrophil-to-Lymphocyte Ratio with the Risk of Thromboembolism and Mortality in Patients with Cancer. Thromb Haemost. 2018; 118(11): 1875-84.
11. 13. Beneri CA, Aaron L, Kim S, Jean-Philippe P, Madhi S, Violari A, et al. Understanding NIH clinical case definitions for pediatric intrathoracic TB by applying them to a clinical trial. Int J Tuberc Lung Dis. 2016; 20(1): 93-100.
12. 14. Mackenzie G. The definition and classification of pneumonia. Pneumonia (Nathan). 2016; 8: 14.
13. 15. Scott JA, Wonodi C, Moïsi JC, Deloria-Knoll M, DeLuca AN, Karron RA, et al; Pneumonia Methods Working Group. The definition of pneumonia, the assessment of severity, and clinical standardization in the Pneumonia Etiology Research for Child Health study.Clin Infect Dis. 2012; 54(2) 2:S109-16.
14. 16. Kerry-Ann F O’Grady, Paul J Torzillo, Kieran Frawley, Anne B Chang. The radiological diagnosis of pneumonia in children.Pneumonia. 2014; 5: 38–51.
15. 17. Yoon NB, Son C, Um SJ. Role of the neutrophil-lymphocyte count ratio in the differential diagnosis between pulmonary tuberculosis and bacterial community-acquired pneumonia.Ann Lab Med. 2013; 33(2):105-10.
16. 18. Yimer SA, Bjune GA, Holm-Hansen C. Time to first consultation, diagnosis and treatment of TB among patients attending a referral hospital in Northwest, Ethiopia. BMC Infect Dis. 2014; 14:19.
17. 19. Jilma B, Blann A, Pernerstorfer T,Stohlawetz P, Eichler HG, Vondrovec B, et al. Regulation of adhesionmolecules during human endotoxemia. No acuteeffects of aspirin. Am J Respir Crit Care Med 1999; 159:857-63.
18. 20.Kiran B, Cagatay T, Clark P, Kosar F, Cagatay P, Yurt S et al. Can immune parameters be used as predictors to distinguish between pulmonary multidrug-resistant and drug-sensitive tuberculosis? Arch Med Sci 2010; 6: 77-82.
19. 21. Abakay O, Abakay A, Sen HS, Tanrikulu AC. The relationship between inflammatory marker levels and pulmonary tuberculosis severity. Inflammation. 2015; 8(2): 691-6.
20. 22. Naranbhai V, Hill AV, Abdool Karim SS, Naidoo K, Abdool Karim Q, Warimwe GM,et al. Ratio of monocytes to lymphocytes in peripheral blood identifies adults at risk of incident tuberculosis among HIV-infected adults initiating antiretroviral therapy. J Infect Dis. 2014; 209:500-9.
21. 23. Ozdemir C, Sokucu SN, Tural Onur S. Can neutrophil/lymphocyte ratio and platelet/lymphocyte ratio be used in differential diagnosis of Stage I sarcoidosis from tuberculosis lymphadenopathy? Eurasian J Pulmonol. 2018; 20(1): 22-6.
22. 24. Caner SS, Köksal D, Özkara Ș, Berkoglu M, Aksaray S,Tarhan D. The relation of serum interleukin-2 and C-reactive protein levels with clinical and radiological findings in patients with pulmonary tuberculosis. Tuberk Toraks2007; 55: 238-45.
23. 25. Immanuel C, Acharyulu GS, Kannapiran M, Segaran R,Sarma GR. Acute phase proteins in tuberculous patients.Indian J Chest Dis Allied Sci 1990; 32: 15-23.
24. 26. Kang YA, Kwon SY, Yoon HI, Lee JH, Lee CT. Role of C-reactive protein and procalcitonin in differentiation of tuberculosis from bacterial community acquired pneumonia. Korean J Intern Med. 2009; 24(4): 337-42.
25. 27. Schleicher GK, Herbert V, Brink A, Martin S, Maraj R, et al. Procalcitonin andC-reactive protein levels in HIV-positive subjectswith tuberculosis and pneumonia. Eur Respir J 2005;25: 688-92.