Sivas, Cumhuriyet Üniversitesi’ne Başvuran Kırım-Kongo Kanamalı Ateş’li Çocukların Klinik ve Rutin Laboratuvar Testleri Yanında İmmünolojik Açıdan Değerlendirilmesi

Yıl 2015, , 13 - 20, 01.06.2015

Mevlüt Demir Fatma Duksal , Melih Timuçin Doğan Utku Aygüneş Ali Kaya Ahmet Sami Güven Ömer Cevit

https://doi.org/10.4274/jcp.51523

Öz

Giriş: Çalışmamızda, Kırım-Kongo Kanamalı Ateşi KKKA tanısıyla izlenen çocuk hastaların klinik ve rutin laboratuvar bulgularıyla birlikte, serum immünglobulin ve kompleman düzeylerinin değerlendirilmesi amaçlandı.Gereç ve Yöntem: Sivas, Cumhuriyet Üniversitesi’nde 2011-2012 tarihleri arasında, Enzyme-Linked Immunosorbent Assay ELISA veya polimeraz zincir reaksiyonu PCR kanıtlı KKKA tanısı alan 72 hastanın tıbbi kayıtları geriye dönük incelenmiştir. Epidemiyolojik, klinik özellikleri ve laboratuvar verileri hakkındaki bilgiler kaydedilmiştir.Bulgular: Çalışmaya alınan yetmiş iki çocuk hasta ortalama yaş; 11,95±3,95 yıl Tokat, Sivas, Yozgat, Giresun ve Erzincan’dan geliyordu. Başvuru esnasında başlıca ateş %94,4 , kusma %54,2 , halsizlik %52,8 , iştahsızlık %50 , baş ağrısı %47,2 , üst solunum yolu enfeksiyonu bulguları %41,7 , daha nadir olarak peteşi-purpura-ekimoz, epistaksis, ishal, melena, makülopapüler döküntü, hematemez, hematüri, hepatomegali, splenomegali, lenfadenopati bulguları vardı. Başvuruda hastaların laboratuvar bulguları şu şekildedir: %80,6 trombositopeni, %70,8 lökopeni, %50 nötropeni, %73,6 yüksek aspartate transaminaz, %26,4 yüksek alanine transaminaz, %71,6 yüksek laktat dehidrogenaz, %68,1 yüksek keratin kinaz, %54,2 uzamış protrombin zamanı, %52,8 uzamış parsiyel tromboplastin zamanı saptanmıştır. Ayrıca düşük IgG, düşük IgA, düşük C3 ve düşük C4 sırasıyla 4, 3, 12 ve 1 hastada saptanmıştır. Tüm hastalar sıvı-elektrolit tedavisi alırken, bir kısmı kan ürünü almıştır. Dört hasta intravenöz immünglobulin IVIG , 69 hasta ribavirin tedavisi almıştır.Sonuç: Çocuklarda KKKA klinik bulguları erişkinlerdekine benzerdir. Serum immünglobulinleri düşük bulunan hastalarda verilen intravenöz immünglobulin IVIG tedavisi dışında diğer tedaviler benzer bulunmuştur. KKKA’da immün yetmezlik araştırılması konusunda daha geniş çaplı çalışmalara ihtiyaç vardır

Anahtar Kelimeler

Çocuk, immünglobulin, Kırım-Kongo Kanamalı Ateşi, tedavi

Immunological Evaluation of Children with Crimean-Congo Hemorrhagic Fever in Addition to Routine Clinical and Laboratory Tests Who Were Admitted to Sivas, Cumhuriyet University

Öz

Introduction: In our study, it was aimed to evaluate clinical and routine laboratory findings and serum immunoglobulin and complement levels of pediatric patients with the diagnosis of Crimean-Congo Hemorrhagic Fever CCHF .Materials and Methods: Medical records of 72 patients that diagnosed with CCHF proven by ELISA or polymerase chain reaction PCR in Sivas, Cumhuriyet University between 2011 and 2012 were reviewed retrospectively. The information about the epidemiological, clinical features and laboratory findings were recorded. Results: Seventy-two patients who participated in the study, mean age11.95±3.95 years came from Tokat, Sivas, Yozgat, Giresun and Erzincan. During the admission, patients mainly had fever 94.4% , vomiting 54.2% , fatigue 52.8% , anorexia 50% , headache 47.2% , upper respiratory tract infection findings 41.7% ; rarely, petechiae-purpura, ecchymosis, epistaxis, diarrhea, melena, maculopapular rash, hematemesis, hematuria, hepatomegaly, splenomegaly, lymphadenopathy were seen. At admission, laboratory findings of the patients were as follows; thrombocytopenia, 80.6%; leucopenia,70.8%; neutropenia, 50%; high aspartate transaminase, 73.6%; high alanine transaminase, 26.4%; high lactate dehydrogenase 71.6%; high creatine kinase, 68.1%; prolonged protrombine time, 54.2%; prolonged partial thromboplastin time, 52.8%. In addition low IgG, low IgA, low C3, low C4 were found in 4, 3, 12 and 1 patient respectively. All patients received intravenous fluid therapy; some received blood products. Four patients received intravenous immunoglobulin, 69 patients were treated with ribavirin. Conclusions: Clinical findings of CCHF in children are similar to those in adults; in patients with low serum immunoglobulin outside the intravenous immunoglobulin IVIG treatment, other treatments are similar in all patients. In CCHF to investigate immunodeficiency status, further large-scale study is needed.

Anahtar Kelimeler

Child, immunoglobulin, Crimean-Congo Hemorrhagic Fever, treatment

Kaynakça

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