Mültecilerin kabulünden sonra bir referans çocuk hastanesinde çocukluk çağı tüberkülozu

Year 2021, Volume: 11 Issue: 2, 160 - 165, 25.03.2021

Ozge Metin Ayşe Kaman

https://doi.org/10.16899/jcm.848937

Cited By: 1

Abstract

Amaç: Pediatrik tüberküloz (TB) hastalarının epidemiyolojik, klinik, laboratuvar, mikrobiyolojik özellikleri, tedavisi ve sonuçlarını değerlendirerek göçmen hastalara dikkat çekmeyi amaçladık.
Gereç-Yöntemler: Ocak 2015-Eylül 2016 tarihleri arasında 18 yaş altı TB'li çocukların tıbbi kayıtlarını geriye dönük olarak incelendi.
Bulgular: Yaş ortalaması 135,5 ± 52,6 ay olan 13'ü (%65) kadın ve 7'si (%35) erkek olmak üzere toplam 20 TB hastası (%35'i Suriyeli mülteci) değerlendirildi. On dört (%70) hasta ergendi. Yedi (%35) hastanın aktif bir TB hastası ile temas öyküsü mevcuttu. Dört (%20) hastanın başvuru anında hiçbir şikayeti yokken en sık görülen semptom 2 haftadan uzun süren inatçı öksürüktü. On beş (%75) hastanın Bacillus Calmette-Guérin skarı vardı. Onaltı (%80) hasta tüberkülin deri testi (TDT) pozitifti. Toplam dört (%20) hastada mikrobiyolojik doğrulama sağlandı. Başvuru anında en sık görülen akciğer grafisi bulgusu hiler lenfadenopatiydi. On (%50) hastanın akciğer grafisi normaldi ve anormal toraks tomografi bulguları ile tanı konulmuştu. Yalnızca miliyer tüberküloz tanısı ile izlenen bir hastada tedavi başarısızlığı olup hasta kaybedilmişti.
Sonuç: Tüberküloz önemli bir bulaşıcı hastalık olup çocuklarda mikrobiyolojik doğrulama her zaman olmayabilir. Çocukluk çağı TB tanısı, temas öyküsü, pozitif TDT reaksiyonu, uyumlu spesifik olmayan semptomlar ve radyolojik bulgularla doğrulanabilir. Tüberküloz hastalığının epidemiyolojik özellikleri ve yaşadığımız yerdeki göçmen yoğunluğu dikkate alınarak Suriyeli mültecilere özel dikkat gösterilebilir.

Keywords

Çocuk, Suriyeli mülteciler, tüberküloz

Childhood tuberculosis in a reference children's hospital after admission of refugees

Abstract

Aim: We aimed to evaluate epidemiologic, clinical, laboratory, microbiologic features, treatment and outcomes of pediatric tuberculosis (TB) patients also to draw attention to immigrant patients.
Material- Methods: We retrospectively conducted the medical records of children below 18 years of age with TB between January 2015 and September 2016.
Results: A total of 20 TB patients (35% were Syrian refugees, total 65% female) with a median age of 135.5±52.6 months were evaluated. Fourteen (70%) patients were adolescent. The history of contact with an active TB disease patient was found in seven (35%) patients. Four (20%) patients had no complaint at admission whereas the most common symptom was prolonged cough > 2 weeks. Fifteen (75%) patients had a Bacillus Calmette–Guérin scar on the left shoulder. A total of 16 (80%) patients had a positive tuberculin skin test (TST) result. Microbiological confirmation was provided in four (20%) patients totally. The most common chest X-ray findings on admission were hilar lymphadenopathy. Ten (50%) patients had normal chest X-ray and were diagosed with abnormal thorax tomography findings. All of the patients were treated succesfully except one Syrian patients with miliary TB who died.
Conclusion: Microbiological confirmation of childhood TB may be absent and the diagnosis can be confirmed in the light of contact history, positive TST reaction, compatible symtomps and radiological evidence. Particular attention might be paid to Syrian refugees, taking into epidemiological characteristics of TB disease and the density of immigrants in the place we live in.

Keywords

Syrian refugees, tuberculosis, children

References

• Reference1. Mete Yesil A, Yalcin E, Ademhan Turhal D, et al. From Diagnosis to Treatment of Pediatric Tuberculosis: Ten Years Experience in a Single Institution. Clin Pediatr (Phila). 2020 May;59(4-5):476-482. doi: 10.1177/0009922820906488.
• Reference2. Lamb GS, Starke JR. 2017. Tuberculosis in infants and children. Microbiol Spectrum 5(2):TNMI7-0037-2016. Review
• Reference3. World Health Organization. Global tuberculosis report 2020. file:///C:/Users/acer/Downloads/9789240013131-eng%20(1).pdf. Accessed December 26, 2020.
• Reference4. Türkiye’de Verem Savaşı 2019 Raporu. Sağlık Bakanlığı, Yayın No: 1168, Ankara 2020.https://hsgm.saglik.gov.tr/depo/birimler/tuberkuloz_db/raporlar/Tu_rkiye_de_Verem_Savas_2019_Raporu_son_1.pdf. Accessed December 26, 2020.
• Reference5. Ergönül Ö, Tülek N, Kayı I, Irmak H, Erdem O, Dara M. Profiling infectious diseases in Turkey after the influx of 3.5 million Syrian refugees. Clin Microbiol Infect. 2020 Mar;26(3):307-312. doi: 10.1016/j.cmi.2019.06.022.
• Reference6. Doganay M, Demiraslan H. Refugees of the Syrian Civil War: Impact on Reemerging Infections, Health Services, and Biosecurity in Turkey. Health Secur. 2016 Jul-Aug;14(4):220-5. doi: 10.1089/hs.2016.0054. Epub 2016 Jun 30. PMID: 27362427.
• Reference7. T.C. Sağlik Bakanliği. Tüberküloz Tanı ve Tedavi Rehberi: Sağlık Bakanlığı Yayın No: 1129, Ankara, Mayıs 2019. https://hsgm.saglik.gov.tr/depo/birimler/tuberkuloz_db/haberler/Tuberkuloz_Tani_Ve_Tedavi_Rehberi_/Tuberkuloz_Tani_ve_Tedavi_Rehberi.pdf Accessed December 26, 2020.
• Reference8. From Dallman, P.R., 1977. blood and blood forming tissues.In: rudolpg, A.M. (Ed), Pediatrics, sixteenth ed. Appleteon-Century-Crofts, Norwalk, CT.
• Reference9. Long SS, Vodzak J. Laboratory Manifestations of Infectious Diseases. In: Long SS, Ficher M, Prober CG, editors. Principles and practice of pediatric infectious diseases. 5th ed. Philadelphia, PA: Elsevier; 2018. p.1447-1459.
• Reference10. Chiang SS, Starke JR. Mycobacterium tuberculosis. In: Long SS, Ficher M, Prober CG, editors. Principles and practice of pediatric infectious diseases. 5th ed. Philadelphia, PA: Elsevier; 2018. p. 790-806.
• Reference11. Bayhan Gİ, Tanır G, Metin Ö, et al. Pediatric Tuberculosis in Turkey: A Review of 8-Years Period in a Tertiary Care Hospital. Turk J Pediatr. 2015 Sep-Oct;57(5):431-8.
• Reference12. Pekcan S, Tana Aslan A, Kiper N, et al. Multicentric analysis of childhood tuberculosis in Turkey. Turk J Pediatr. 2013 Mar-Apr;55(2):121-9
• Reference13. Liyew Ayalew M, Birhan Yigzaw W, Tigabu A, Gelaw Tarekegn B. Prevalence, Associated Risk Factors and Rifampicin Resistance Pattern of Pulmonary Tuberculosis Among Children at Debre Markos Referral Hospital, Northwest, Ethiopia. Infect Drug Resist. 2020 Oct 29;13:3863-3872.
• Reference14. Turel O, Kazanci S, Gonen I, Aydogmus C, Karaoglan E, Siraneci R. Paediatric Tuberculosis at a Referral Hospital in Istanbul: Analysis of 250 Cases. Biomed Res Int. 2016;2016:6896279.
• Reference15. Savaş N, Barutcu G, Yeniçeri A. Evaluation of purified protein derivates test at tuberculosis dispensary in Hatay, Turkey, applied to Turks and Syrian refugees (2012-2015). Cent Eur J Public Health. 2018 Dec;26(4):247-252.
• Reference16. Cano APG, Romaneli MTN, Pereira RM, Tresoldi AT. Tuberculosıs ın pedıatrıc patıents: how has the dıagnosıs been made?. Rev Paul Pediatr. 2017 Apr-Jun;35(2):165-170.
• Reference17. Peng SS, Chan PC, Chang YC, Shih TT. Computed tomography of children with pulmonary Mycobacterium tuberculosis infection. Journal of the Formosan Med Assoc 2011; 110: 744.
• Reference18. Dos Santos TCS, Setúbal S, Dos Santos AASMD, Boechat M, Cardoso CAA. Radiological aspects in computed tomography as determinants in the diagnosis of pulmonary tuberculosis in immunocompetent infants. Radiol Bras. 2019 Mar-Apr;52(2):71-77.
• Reference19. Hosten E, Mehta M, Andre E, Abu Rumman K, Van der Linden D. Tuberculosis contact-tracing among Syrian refugee populations: lessons from Jordan. Confl Health. 2018 Jul 16;12:25.
• Reference20. Cookson ST, Abaza H, Clarke KR, Burton A, Sabrah NA, Rumman KA, et al. Impact of and response to increased tuberculosis prevalence among Syrian refugees compared with Jordanian tuberculosis prevalence: case study of a tuberculosis public health strategy. Confl Health. 2015 May 18;9:18.