Erişkin Hastalarda Akut Bakteriyel Tonsillit Tanısını Öngörmede Mutlak Nötrofil Sayısının (MNS) Kullanımı

Abstract

Tonsillit; tüm dünyada en sık görülen hastalıklardan olup, hastalığın bakteriyel veya viral kökenli olduğunu saptamak kimi zaman çok zor olabilir. Bu çalışmada, ‘’Mutlak Nötrofil Sayısının (MNS)’’  akut bakteriyel tonsillit tanısını öngörmede prediktör olarak kullanılıp kullanılamayacağı araştırılmak istenmiştir. Çalışma Mayıs 2015-  Mayıs 2016 tarihleri arasında boğaz ağrısı, ateş ve odinofaji şikayetleri ile değerlendirilen 42 hasta üzerinden yürütülmüştür. Kan testleri ve boğaz kültürleri uygulanmış ve MNS her hasta için tedavi başlamadan önce hesaplanmıştır. Lökosit sayısı ve MNS, pozitif boğaz kültürü olan 26 hastada istatistiksel olarak anlamlı şekilde yüksek bulunmuştur(p<0,001). Buna ek olarak; MNS≥6.82 olması  %92.3 sensitivite ve %93.7 spesifite ile pozitif boğaz kültürü sonuçlarının varlığını istatistiksel olarak anlamlı olacak şekilde öngörmüştür(p<0,001). Bu bilgiler ışığında MNS’ nin kolay uygulanabilir, hızlı ve güvenilir bir prediktör olarak akut bakteriyel tonsillit tanısında yüksek sensitivite ve spesifite ile kullanılabileceği ve yüksek MNS düzeyi olan hastalara boğaz kültürü sonucu beklenmeden antibiyotik tedavisinin başlanması önerilmektedir.

Keywords

• Mutlak nötrofil sayısı,prediktör,boğaz kültürü,tonsillit

Usage of Absolute Neutrophil Count (ANC) as A Predictor for Acute Bacterial Tonsillitis in Adult Patients

Abstract

Tonsillitis is a very common disease all over the world and it can be confusing to detect if it has bacterial or viral origin. In this study, it was aimed to investigate if absolute neutrophil count (ANC) can be used as a predictor to display acute bacterial tosillitis.42 patients with the complaints of sore throat, fever and odynophagia were examined by the physician between May 2015 and May 2016. Supporting blood tests and throat cultures were performed and ANC was calculated for all patients individually before the initiaiton of treatment. White blood cell count (WBCC) and ANC were significantly higher in 26 patients with positive throat culture (p<0.001). Moreover, it was detected that ANC ≥ 6.82 was able to predict positive culture results with %92.3 sensitivity and %93.7 specificity which was also statistically significant (p<0.001).According to this, ANC can be used as an easy, fast and reliable predictor for acute bacterial tonsillitis with high sensitivity and specifity. In this sense, patients with high ANC can be treated with antibiotics without waiting for culture results.

Keywords

• Absolute neutrophil count,predictor,throat culture,tonsillitis

References

1. 1. McLafferty E, Hendry C, Farley A. The lymphatic system. Nurs Stand 2013;27(17):37-42.
2. 2. Bathala S, Eccles R. A review on the mechanism of sore throat in tonsillitis. J Laryngol Otol 2013;127(3):227–32.
3. 3. Shulman ST, Bisno AL, Clegg HW et al. Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. Clin Infect Dis 2012;55:1279–82.
4. 4. Group ESTG, Pelucchi C, Grigoryan L Guideline for the management of acute sore throat. Clin Microbiol Infect 2012;18:1–28.
5. 5. Chiappini E, Regoli M, Bonsignori F et al. Analysis of different recommendations from international guidelines for the management of acute pharyngitis in adults and children. Clin Ther 2011;33:48–58.
6. 6. Windfuhr JP, Toepfner N, Steffen G, Waldfahrer F, Berner R. Clinical practice guideline: tonsillitis I. Diagnostics and nonsurgical management. Eur Arch Otorhinolaryngol 2016;273(4):973-87.
7. 7. Vicedomini D, Lalinga G, Lugli N, D’Avino A. [Diagnosis and management of acute pharyngotonsillitis in the primary care pediatrician’s office]. [Article in Italian]. Minerva Pediatr 2014;66:69–76.
8. 8. C. Galer, E. Holbrook, J. Treves, et al. Grisel’s syndrome: a case report and review of the literature, Int. J. Pediatr. Otorhinolaryngol 2005;69:1689–92.

9. 9. K. Ungkanont, R.F. Yellon, J.L. Weissman, et al. Head and neck space infections in infants and children, Otolaryngol. Head Neck Surg 1995;112:375–82.
10. 10. Aalbers J, O'Brien KK, Chan WS, et al. Predicting streptococcal pharyngitis in adults in primary care: a systematic review of the diagnostic accuracy of symptoms and signs and validation of the Centor score. BMC Med 2011;9:67.
11. 11. Fine AM, Nizet V, Mandl KD. Large-scale validation of the Centor and McIsaac scores to predict group A streptococcal pharyngitis. Arch Intern Med 2012;172:847-52.
12. 12. Saengcharoen W, Jaisawang P, Udomcharoensab P, Buathong K, Lerkiatbundit S. Appropriateness of diagnosis of streptococcal pharyngitis among Thai community pharmacists according to the Centor criteria. Int J Clin Pharm 2016;38:1318-25.
13. 13. A. Mantovani, M.A. Cassatella, C. Costantini, S. Jaillon, Neutrophils in the activation and regulation of innate and adaptive immunity, Nat. Rev. Immunol 2011;11:519–31.
14. 14. B. Amulic, C. Cazalet, G.L. Hayes, K.D. Metzler, A. Zychlinsky, Neutrophil function: from mechanisms to disease, Annu. Rev. Immunol 2012;30:459– 89.
15. 15. Bachur RG, Dayan PS, Dudley NC, et al. The Influence of Age on the Diagnostic Performance of White Blood Cell Count and Absolute Neutrophil Count in Suspected Pediatric Appendicitis. Acad Emerg Med 2016; Jun 2. doi: 10.1111/acem.13018. [Epub ahead of print]
16. 16. Little P, Stuart B, Hobbs FD, et al. Predictors of suppurative complications for acute sore throat in primary care: prospective clinical cohort study. BMJ 2013;25:347:f6867. doi: 10.1136/bmj.f6867.
17. 17. Wilkinson AE. Use of antibiotics in the management of sore throat. Emerg Nurse 2015;22:34-7.
18. 18. Lean WL, Arnup S, Danchin M, Steer AC. Rapid diagnostic tests for group A streptococcal pharyngitis: a meta-analysis. Pediatrics 2014;134:771-81.
19. 19. Dingle TC, Abbott AN, Fang FC. Reflexive culture in adolescents and adults with group A streptococcal pharyngitis. Clin Infect Dis 2014;159:643-50.
20. 20. Y. Jin, X. Ye, C. He, et al. Pretreatment neutrophil: lymphocyte ratio predicts survival for patients with metastatic nasopharyngealcarcinoma, Head Neck 2013; [Epub ahead of print].
21. 21. J. Nunez, E. Nunez, V. Bodi, et al. Usefulness of the neutrophil to lymphocyte ratio in predicting long-term mortality in ST segment elevation myocardial infarction, Am. J. Cardiol 2008;101:747–52.
22. 22. Ozbay, C. Kahraman, H.H. Balikci, et al. Neutrophil-to-lymphocyte ratio in patients with peripheral vertigo: a prospective controlled clinical study, Am. J. Otolaryngol 2014;35:699–702.
23. 23. M. Dogan, A. Akyel, M. Bilgin, et al. Can admission neutrophil to lymphocyte ratio predict infarct-related artery patency in ST-segment elevation myo- cardial infarction, Clin. Appl. Thromb. Hemost 2015; 21:172– 76.
24. 24. Jin F, Han A, Shi F, Kong L, Yu J. The postoperative neutrophil-to-lymphocyte ratio and changes in this ratio predict survival after the complete resection of stage I non-small cell lung cancer. Onco Targets Ther 2016;9:6529-37.
25. 25. Kawamura Y, Takeshita S, Kanai T, Yoshida Y, Nonoyama S. The Combined Usefulness of the Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios in Predicting Intravenous Immunoglobulin Resistance with Kawasaki Disease. J Pediatr 2016;178:281-84.
26. 26. Tekin Baglam, Adem Binnetoglu, Ali Cemal Yumusakhuylu, Fethullah Gerin, Berat Demir, Murat Sari. Predictive value of the neutrophil-to-lymphocyte ratio in patients with deep neck space infection secondary to acute bacterial tonsillitis. Int J Pediatr Otorhinolaryngol 2015;79:1421-4.
27. 27. Corkum KS, Oyetunji TA, Grabowski JE, Rigsby CK, Lautz TB. Absolute neutrophil count as a diagnostic guide for the use of MRI in the workup of suspected appendicitis in children. J Pediatr Surg 2018;6:22.
28. 28. Bachur RG, Dayan PS, Dudley NC, et al. The Influence of age on the diagnostic performance of white blood cell count and absolute neutrophil count in suspected pediatric appendicitis. Acad Emerg Med 2016;23:1235-42.
29. 29. Zarkesh M, Sedaghat F, Heidarzadeh A, et al. Diagnostic value of IL-6, CRP, WBC, and absolute neutrophil count to predict serious bacterial infection in febrile infants. Acta Med Iran 2015;53:408-11.
30. 30. Rauf SE, Khan SA, Ali N, Afridi NK, Haroon M, Arslan A. Immature reticulocyte fraction and absolute neutrophil count as predictor of hemopoietic recovery in patients with acute lymphoblastic leukemia on remission induction chemotherapy. Turk J Haematol 2016;33:131-4.
31. 31. Koh YW, Kang HJ, Park C, et al. Prognostic significance of the ratio of absolute neutrophil count to absolute lymphocyte count in classic Hodgkin lymphoma. Am J Clin Pathol 2012;138:846-54
32. 32. Al-Gwaiz LA, Babay HH. The diagnostic value of absolute neutrophil count, band count and morphologic changes of neutrophils in predicting bacterial infections. Med Princ Pract 2007;16:344-7.
33. 33. Wallbach M, Vasko R, Hoffmann S, Niewold TB, Müller GA, Korsten P. Elevated procalcitonin levels in a severe lupus flare without infection. Lupus 2016;25:1625-6.
34. 34. Mussap M, Degrandi R, Cataldi L, Fanos V, Plebani M. Biochemical Markers for the Early Assessment of Neonatal Sepsis: the Role of Procalcitonin. J Chemother 2007;19:35-8.