Pediyatrik Tüberküloz: Bir Üniversite Hastanesinin Beş Yıllık Deneyimi

Yıl 2017, , 43 - 52, 01.04.2017

İbrahim Kamer Murat Sütçü Manolya Acar Oğuz Bülent Erol Selda Hançerli Törün Nuran Salman Ayper Somer

https://doi.org/10.5222/j.child.2017.043

Öz

Amaç: Bu çalışmanın amacı, 2008-2013 yılları arasında merkezimizdeki pediatrik tüberküloz ve latent tüberküloz vakalarının klinik, radyolojik, mikrobiyolojik, laboratuvar sonuçlarını içeren demografik özelliklerini ve tedavi karakteristiklerini değerlendirmek olarak belirlenmiştir.Gereç ve Yöntem: Çalışmaya alınan 236 çocuğun yaş ortalaması 94.39±58.73 ay olan vakaların klinik özellikleri ve laboratuvar sonuçları retrospektif olarak incelendi. Tüberküloz hastalığı veya latent tüberküloz tanısı TDT, IGRA, PA akciğer grafisi, toraks BT, ARB ve kültür duyarlılık testleri kullanılarak konuldu.Bulgular: Yetmiş altı 33 kız/43 erkek TB vakasının 34’ü %44.7 akciğer TB, 26’sı %33.8 akciğer dışı TB ve 16’sı %21,5 hem akciğer hem de akciğer dışı TB tanısı aldı. Akciğer grafisi ve toraks BT görüntülemelerinde en sık görülen imajlar sırasıyla %30 ve %64 olarak lenfadenopatiydi. En yaygın akciğer dışı tutulum 12 %15.8 vaka ile lenf nodu TB’idi. Temas öyküsü, vakalarının 24’ünde %31.6 belirlendi. Mikrobiyolojik örnek alınabilen %54 vakanın %21’inde ARB ve %34’ünde kültür pozitifliği saptandı. İlaç dirençi ise vakaların 6’sında %7.9 mevcuttu. Takibi tamamlanan TB vakalarının tedavisi başarı ile tamamlandı, ancak izleminde, %11.8’inde sekel gelişti. Yüz altmış 63 kız/ 97 erkek latent TB tanısı alan vakanın %20’sinde aile taraması pozitif saptandı. TDT pozitifliği %91.9 saptanırken, IGRA testi %19.4 idi. Belirsiz IGRA sonuçları %0.6 saptandı.Sonuç: TB vakalarından temas öyküsü sıklığı LT vakalarından daha fazlaydı. Ev teması ve yapılan taramalar TB kontrolu için çok önemlidir. Mikrobiyolojik tanı oranı dünya ile benzer şekilde düşük saptandı ve ilaç direnci açısından çocukluk TB’si hakkında sınırlı veri elde edilebildi. Bu konu ile ilgili daha çok çalışmaya gereksinim vardır

Anahtar Kelimeler

Tüberküloz, çocuk, latent tüberküloz, IGRA

Pediatric Tuberculosis: A 5-Year Experience from a Turkish Tertiary Pediatric Hospital

Öz

Objective: The aim of this study was to analyze the demographical attributes such as clinical findings; radiology, microbiology, and laboratory test results along with treatment characteristics of pediatric tuberculosis patients followed by our clinic from 2008 to 2013. Material and Method: Clinical features and laboratory test results of 236 children included in our study with mean age of 94.39±58.73 months were analyzed retrospectively. Tuberculosis or latent tuberculosis diagnosis were made via Mantoux tuberculin skin test, interferon-gamma release assay IGRA , posterior-anterior chest X-ray, thorax CT, sputum cultures for acid-fast bacilli and culture sensitivity tests.Results: Seventy-six 33 female/43 male cases with TB were diagnosed as pulmonary TB n=34; 44.7% , extrapulmonary TB n=26; 33.8% and both pulmonary and extrapulmonary TB n=16; 21,5% Chest X-ray and thorax BT demonstrated mostly lymphadenopathies in 30% and 64% of the cases, respectively. Most prevalent extrapulmonary involvement was lymph node TB with 12 cases 15.8% . History of contact with a TB patient was detected in 24 31,6% cases. Acid-fast bacilli and 34% culture sensitivity were detected in 21, and 34 % of the patients in 54 % of the cases from whom microbiological specimens were collected. Drug resistance was detected in 6 7.9% cases. Treatment of TB patients with completed follow-up was successful, however, 11,8% developed sequellae. Positive family screening results were obtained in 20% of 160 63 female / 97 male patients diagnosed as latent TB. TDT positivity was detected in 91,9%, and IGRA positivity in 19.4% of the patients. Indeterminate IGRA results were obtained in 0.6% of the cases.Conclusion: History of contact with a TB patient was more prevalent in active TB patients compared to latent TB patients. History of contact with a TB patient at home, and medical screenings had most importance in TB control. Rate of microbiological diagnosis was found to be low which was similar with global rates and the drug resistance data of childhood TB was limited. Further research should be conducted on this issue

Anahtar Kelimeler

Tuberculosis, child, latent tuberculosis, IGRA

Kaynakça

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