İntravezikal BCG İmmunoterapisine Bağlı BCG Enfeksiyonunun Tanısında Laboratuvarın Rolü

Öz

Mesane kanseri tüm dünyada yaygın olarak görülen bir kanser türüdür ve tedavi edilmediğinde morbidite ve mortaliteye neden olabilen önemli bir hastalıktır. Cerrahi tedavinin yanında intavezikal BCG immünoterapisi etkili bir tedavi yöntemi olarak uzun yıllardır kullanılmaktadır. Bu tedavi yöntemi genellikle iyi tolere edilebilmesine karşın hem lokal hem de sistemik enfeksiyöz komplikasyonlar ortaya çıkabilmektedir. İntravezikal BCG tedavisi ile ilişkili enfeksiyöz komplikasyonlar hakkındaki bilgilerimizin çoğu vaka raporlarından ibarettir. Ayrıca bu enfeksiyonların klinik ve laboratuvar tanısına yönelik standardize edilmiş kriterler bulunmamaktadır. Hastalık belirtileri ve görüntüleme bulguları birçok hastalıkla kolaylıkla karışabildiğinden BCG enfeksiyonlarının klinik tanısı zordur. İnatçı ve tekrarlayan semptomları olan hastalarda BCG enfeksiyonundan kuşkulanılmalıdır. Histopatolojik tanıda granülomların izlenmesi yol gösterici olabilir. Tüberkülozda olduğu gibi BCG enfeksiyonunun kesin tanısı da mikrobiyolojik olarak konur. Mikrobiyolojik tanıda mikobakteri kültürü ve moleküler tanı yöntemleri birlikte kullanılır. ARB boyalı mikroskobik incelemenin duyarlılığı düşüktür. Lokal enfeksiyonların tanısı için idrar ve mesane dokusunun, sistemik enfeksiyonlarda ise kuşkulu klinik örneklerin mikobakteriyoloji laboratuvarına gönderilerek ARB boyalı mikroskobik inceleme, mikobakteri kültürü ve nükleik asit amplifikasyon testleri istenmelidir. BCG tedavisi sonrası basilin idrarda uzun süre kalabilmesi sık rastlanmasa da tanıda sorunlara yol açabilir. Kültürde üreme olduktan sonra üreyen mikobakterinin türü ayırt edilerek Mycobacterium bovis BCG olduğunun moleküler yöntemlerle doğrulanması önemlidir. İdrarda moleküler test pozitifliği tedaviye başlamak için tek başına kriter olarak kabul edilmemelidir. Klinisyen mikrobiyolojik test sonuçlarını klinik belirtiler ve diğer laboratuvar test sonuçları ile birlikte değerlendirmelidir. Ayrıca tedavinin etkinliği de laboratuvar bulgularıyla ve hastanın kliniğiyle birlikte izlenmeli ve mikrobiyolojik testler tekrar edilmelidir.

Anahtar Kelimeler

• Mycobacterium bovis BCG
• Mesane Kanseri
• Kültür
• Nükleik asit çoğaltma yöntemi
• Bladder cancer
• Culture
• Nucleic acid amplification method

The Role of the Laboratory in the Diagnosis of BCG Infection due to Intravesical BCG Immunotherapy

Öz

Bladder cancer is a common type of cancer all over the world and is an important disease that can cause morbidity and mortality if left untreated. In addition to surgical treatment intravesical BCG immunotherapy has been used for many years as an effective treatment method. This treatment method is generally well tolerated, but sometimes both local and systemic infectious complications may occur. Most of our knowledge on infectious complications associated with intravesical BCG therapy consists of case reports. Furthermore, there are no standardized criteria for the clinical and laboratory diagnosis of these infections. Clinical diagnosis of BCG infections is difficult because disease symptoms and imaging findings can be easily confused with many diseases. BCG infection should be suspected in patients with persistent and recurrent symptoms. Monitoring of granulomas can be helpful in histopathological diagnosis. As in tuberculosis, the definitive diagnosis of BCG infection is made microbiologically. Mycobacterial culture and molecular diagnostic methods are used together in microbiological diagnosis. ARB-smear microscopic examination has low sensitivity. For the diagnosis of local infections, urine and bladder tissue, and in systemic infections, suspicious clinical samples should be sent to the mycobacteriology laboratory and ARB-smear microscopic examination, mycobacterial culture and nucleic acid amplification tests should be requested. Although it is not common for the bacillus to remain in the urine for a long time after BCG treatment, it may cause diagnostic problems. It is important to distinguish the type of mycobacterium that reproduces after growth in culture and to confirm that it is Mycobacterium bovis BCG by molecular methods. Molecular test positivity in urine should not be considered as the sole criterion for initiating treatment. Clinician should evaluate microbiological test results together with clinical signs and other laboratory test results. In addition, the effectiveness of the treatment should be monitored together with the laboratory findings and the patient's clinic, and microbiological tests should be repeated.

Anahtar Kelimeler

• Mycobacterium bovis BCG
• Bladder cancer
• Culture
• Nucleic acid amplification method

Kaynakça

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