Çocuklarda Tularemi: Tularemili 15 Olgunun Klinik, Laboratuvar ve Tedavi Sonuçlarının Değerlendirilmesi
Öz
Girifl: Tularemi Francisella tularensis’in neden olduğu zoonotik hastalıktır. Bu çalışmanın amacı tularemi tanısı konan 15 çocuk olgunun klinik ve laboratuvar bulgularının değerlendirilmesidir. Gereç ve Yöntem: Çocuk Enfeksiyon Hastalıkları Polikliniğine ateş, boğaz ağrısı ve lenfadenopati LAP yakınması ile başvurup mikroaglütinasyon test MAT titresi 1/160 ve üstünde olan 15 olgu geriye dönük olarak değerlendirilerek sosyo-demografik özellikleri, hayvan ile temas ve kene ısırığı öyküleri, yakınma süreleri, klinik ve laboratuvar bulguları, tedavileri ve klinik gidişleri incelendi. Bulgular: Olguların yaş ortalaması 11,5±5,1 yıl 3-17 ve %53’ü erkek idi. Olguların %53,3’ü kırsal kesimde yaşıyor ve kuyu suyu kullanıyordu. En sık başvuru yakınmaları olan boyunda şişlik %93,3 , boğaz ağrısı %66,7 ve ateş yüksekliği %66,7 idi. Olgularda en sık orofarengeal tularemi %66,7 saptandı. Cerrahi olarak olguların %27’sinin LAP’si boşaltılırken, %13,3’ünde ise LAP kendi kendine drene olmuştu. Bulgular başladıktan sonraki ortalama başvuru süresi 53±45,3 5-150 gün bulundu. Başvuru öncesi olguların %60’ında betalaktam grubu antibiyotik alımı vardı. Lenf bezleri süpüre olan 6 olgunun başvuru ortancası 61 20- 150 gün, diğerlerinin ise 35 5-75 gün olarak saptandı p
Anahtar Kelimeler
Kaynakça
- 1. Ellis J, Oyston PC, Green M, Titball RW. Tularemia. Clin Microbiol Rev 2002;15:631-46.
- 2. Penn RL. Francisella Tularensis (Tularemia). In: Mandell GL, Douglas RG, Bennett JE (eds). Mandell, Dougles, and Bennett’s Principles and Practice of Infectious Diseases. 7th ed. New York: Churchill Livingstone; 2010. p. 2927-37.
- 3. Helvaci S, Gedikoğlu S, Akalin H, Oral HB. Tularemia in Bursa, Turkey: 205 cases in ten years. Eur J Epidemiol 2000;16:271-6.
- 4. Christova I, Velinov T, Kantardjiev T, Galev A. Tularaemia outbreak in Bulgaria. Scand J Infect Dis 2004;36:785-9.
- 5. Bıçakçı Z, Öztürk B. The Contamination of tuleramia from the saliva of cow to a two year-old boy: case report by long-term observation. J Child 2008;8:197-9.
- 6. Gürcan S. Francisella tularensis and tularemia in Turkey. Mikrobiyol Bul 2007;41:621-36.
- 7. Kılıç S. Francisella tularensis ve Türkiye’de tularemi epidemiyolojisine genel bir bakış. Flora 2010;15:37-58.
- 8. Yeşilyurt M, Kılıç S, Çağaşar Ö, Çelebi B, Gül S. Yozgat ilinde kene kaynaklı iki tularemi olgusu. Mikrobiyol Bul 2011;45:746- 54.
- 9. Schutze GE, Jacobs RF. Tularemia (Francisella tularensis). In: Kliegman RM, Stanton BF, Geme JW, Schor NF, Behrman RE, eds. Nelson Text Book of Pediatrics. 19th ed. Philadelphia: Elsevier Saunders; 2011. p. 978-80.
- 10. Ulu Kılıç A, Kılıç S, Sencan I, Ciçek Şentürk G, Gürbüz Y, Tütüncü EE, et al. A water-borne tularemia outbreak caused by Francisella tularensis subspecies holarctica in Central Anatolia region. Mikrobiyol Bul 2011;45:234-47.
- 11. Celebi S, Hacimustafaoglu M, Gedikoglu S. Tularemia in children. Indian J Pediatr 2008;75:1129-32.
- 12. Ozdemir D, Sencan I, Annakkaya AN, Karadenizli A, Guclu E, Sert E, et al. Comparison of the 2000 and 2005 outbreaks of tularemia in the Duzce region of Turkey. Jpn J Infect Dis 2007;60:51-2.
- 13. Gurcan S, Eskiocak M, Varol G, Uzun C, Tatman-Otkun M, Sakru N, et al. Tularemia reemerging in European part of Turkey after 60 years. Jpn J Infect Dis 2006;59:391-3.
- 14. Celebi G, Baruönü F, Ayoğlu F, Cinar F, Karadenizli A, Uğur MB,et al. Tularemia, a reemerging disease in northwest Turkey: epidemiological investigation and evaluation of treatment responses. Jpn J Infect Dis 2006;59:229-34.
- 15. Tatman Otkun M, Akçalı A, Karadenizli A, Ozbey N, Gazel D, Sener A, et al. Çanakkale’de hızla önlenen bir tularemi salgınının epidemiyolojik olarak değerlendirilmesi. Mikrobiyol Bul 2011;45:48-57
- 16. Meric M, Sayan M, Dundar D, Willke A. Tularaemia outbreaks in Sakarya, Turkey: case-control and environmental studies. Singapore Med J 2010;51:655-9.
- 17. Leblebicioglu H, Esen S, Turan D, Tanyeri Y, Karadenizli A, Ziyagil F, et al. Outbreak of tularemia: a case-control study and environmental investigation in Turkey. Int J Infect Dis 2008;12:265-9.
- 18. Acicbe Ö, Aydın H, Doğancı L. Endemic of Tularemia in HavzaSamsun Region: A Retrospective Evaluation of the Cases. İnfeksiyon Dergisi 2007;21:55-8.
- 19. Akdiş AC, Kilicturgay K, Helvaci S, Mistik R, Oral B. Immunological evaluotion of erythema nodosum in tularemia. Br J Dermatol 1993;129:275-9.
- 20. Evans ME, Gregory DW, Schaffner W, McGee ZA. Tularemia: a 30-year experience with 88 cases. Medicine (Baltimore) 1985;64:251-69.
- 21. Snowden J, Stovall S. Tularemia: retrospective review of 10 years’ experience in Arkansas. Clin Pediatr (Phila) 2011;50:64- 8.
- 22. Kaya A, Deveci K, Uysal IO, Güven AS, Demir M, Uysal EB, et al. Tularemia in children: evaluation of clinical, laboratory and therapeutic features of 27 tularemia cases. Turk J Pediatr 2012;54:105-12.
- 23. Syrjala H. Peripheral blood leukocyte counts, erytrocyte sedimentation rate and C-reactive protein in tularemia caused by the type B strain of Francisella tularensis. Infection 1986;14:51-4.
- 24. Bevanger l, Maeland JA, Naess AI. Agglutinins and antibodies to Francisella tularensis outer membrane antigens in the early diagnosis of disease during an outbreak of tularemia. J Clin Microbiol 1988;26:433-7.
- 25. Schell O, Reiersen R, Hoel T. Treatment of tularemia with ciprofloxacin. Eur J Clin Microbiol Infect Dis 1992;11:447-8.
- 26. World Health Organization (WHO). WHO Guidelines on tularaemia. Geneva: World Health Organization; 2007. WHO/CDS/EPR/2007.7. (http://whqlibdoc.who.int/ publications/2007/9789241547376_eng.pdf. Erişim tarihi 12.11.12012.
- 27. Risi GF, Pomo DJ. Relaps of tularemia after aminoglycoside therapy: case report and discussion of therapeutic options. Clin Infect Dis 1995;20:174-5.
- 28. Penn RL, Kinasewitz GT. Factors associated with a poor outcome in tularemia. Arch Intern Med 1987;147:265-8.
- 29. Önen S, Paksoy D, Bilge YD. Çocukluk çağında tularemi olguları. J Pediatr Inf 2012;6:94-100.
- 30. Jounio U, Renko M, Uhari M. An outbreak of holarcticatype tularemia in pediatric patients. Pediatr Infect Dis J 2010;29:160-2.
Tularemia in Children: Evaluation of Clinical, Laboratory and Treatment Outcomes of 15 Tularemia Cases
Öz
Introduction: Tularemia is a zoonotic diseases caused by Francisella tularensis. The aim of this study was to evaluate the clinical and laboratory findings of 15 children with the diagnosis of tularemia. Materials and Methods: Fifteen cases admitted with fever, sore throat, lymphadenopathy and a F. tularensis antibody titer of 1/160 and above in the microagglutination test MAT were evaluated retrospectively. Their sociodemographic characteristics, contact with animals, history of tick bite, duration of complaints, clinical and laboratory findings, treatments and clinical courses were studied. Results: The mean age of patients was 11.5±5.1 3-17 years and 61.3% were male. Fiftythree percent of the patients were living in rural areas, and had contact with contaminated water. Swelling in the neck 93.3% , sore throat 66.7% and fever 66.7% were the most frequently observed symptoms. Oropharyngeal tularemia 66.7% was predominated. In 27% of the patients LAPs were drained surgically, and in 13.3% of cases they were drained by itself. The mean duration between onset of tularemia symptoms and diagnosis was 53±45.3 5- 150 days. Sixty percent of patients were received beta-lactam-antibiotics before admission. It was noted that 6 patients with suppurative lymph nodes were admitted to hospital within median 61 20-150 days, while others were admitted within median 35 5-75 days p
Anahtar Kelimeler
Kaynakça
- 1. Ellis J, Oyston PC, Green M, Titball RW. Tularemia. Clin Microbiol Rev 2002;15:631-46.
- 2. Penn RL. Francisella Tularensis (Tularemia). In: Mandell GL, Douglas RG, Bennett JE (eds). Mandell, Dougles, and Bennett’s Principles and Practice of Infectious Diseases. 7th ed. New York: Churchill Livingstone; 2010. p. 2927-37.
- 3. Helvaci S, Gedikoğlu S, Akalin H, Oral HB. Tularemia in Bursa, Turkey: 205 cases in ten years. Eur J Epidemiol 2000;16:271-6.
- 4. Christova I, Velinov T, Kantardjiev T, Galev A. Tularaemia outbreak in Bulgaria. Scand J Infect Dis 2004;36:785-9.
- 5. Bıçakçı Z, Öztürk B. The Contamination of tuleramia from the saliva of cow to a two year-old boy: case report by long-term observation. J Child 2008;8:197-9.
- 6. Gürcan S. Francisella tularensis and tularemia in Turkey. Mikrobiyol Bul 2007;41:621-36.
- 7. Kılıç S. Francisella tularensis ve Türkiye’de tularemi epidemiyolojisine genel bir bakış. Flora 2010;15:37-58.
- 8. Yeşilyurt M, Kılıç S, Çağaşar Ö, Çelebi B, Gül S. Yozgat ilinde kene kaynaklı iki tularemi olgusu. Mikrobiyol Bul 2011;45:746- 54.
- 9. Schutze GE, Jacobs RF. Tularemia (Francisella tularensis). In: Kliegman RM, Stanton BF, Geme JW, Schor NF, Behrman RE, eds. Nelson Text Book of Pediatrics. 19th ed. Philadelphia: Elsevier Saunders; 2011. p. 978-80.
- 10. Ulu Kılıç A, Kılıç S, Sencan I, Ciçek Şentürk G, Gürbüz Y, Tütüncü EE, et al. A water-borne tularemia outbreak caused by Francisella tularensis subspecies holarctica in Central Anatolia region. Mikrobiyol Bul 2011;45:234-47.
- 11. Celebi S, Hacimustafaoglu M, Gedikoglu S. Tularemia in children. Indian J Pediatr 2008;75:1129-32.
- 12. Ozdemir D, Sencan I, Annakkaya AN, Karadenizli A, Guclu E, Sert E, et al. Comparison of the 2000 and 2005 outbreaks of tularemia in the Duzce region of Turkey. Jpn J Infect Dis 2007;60:51-2.
- 13. Gurcan S, Eskiocak M, Varol G, Uzun C, Tatman-Otkun M, Sakru N, et al. Tularemia reemerging in European part of Turkey after 60 years. Jpn J Infect Dis 2006;59:391-3.
- 14. Celebi G, Baruönü F, Ayoğlu F, Cinar F, Karadenizli A, Uğur MB,et al. Tularemia, a reemerging disease in northwest Turkey: epidemiological investigation and evaluation of treatment responses. Jpn J Infect Dis 2006;59:229-34.
- 15. Tatman Otkun M, Akçalı A, Karadenizli A, Ozbey N, Gazel D, Sener A, et al. Çanakkale’de hızla önlenen bir tularemi salgınının epidemiyolojik olarak değerlendirilmesi. Mikrobiyol Bul 2011;45:48-57
- 16. Meric M, Sayan M, Dundar D, Willke A. Tularaemia outbreaks in Sakarya, Turkey: case-control and environmental studies. Singapore Med J 2010;51:655-9.
- 17. Leblebicioglu H, Esen S, Turan D, Tanyeri Y, Karadenizli A, Ziyagil F, et al. Outbreak of tularemia: a case-control study and environmental investigation in Turkey. Int J Infect Dis 2008;12:265-9.
- 18. Acicbe Ö, Aydın H, Doğancı L. Endemic of Tularemia in HavzaSamsun Region: A Retrospective Evaluation of the Cases. İnfeksiyon Dergisi 2007;21:55-8.
- 19. Akdiş AC, Kilicturgay K, Helvaci S, Mistik R, Oral B. Immunological evaluotion of erythema nodosum in tularemia. Br J Dermatol 1993;129:275-9.
- 20. Evans ME, Gregory DW, Schaffner W, McGee ZA. Tularemia: a 30-year experience with 88 cases. Medicine (Baltimore) 1985;64:251-69.
- 21. Snowden J, Stovall S. Tularemia: retrospective review of 10 years’ experience in Arkansas. Clin Pediatr (Phila) 2011;50:64- 8.
- 22. Kaya A, Deveci K, Uysal IO, Güven AS, Demir M, Uysal EB, et al. Tularemia in children: evaluation of clinical, laboratory and therapeutic features of 27 tularemia cases. Turk J Pediatr 2012;54:105-12.
- 23. Syrjala H. Peripheral blood leukocyte counts, erytrocyte sedimentation rate and C-reactive protein in tularemia caused by the type B strain of Francisella tularensis. Infection 1986;14:51-4.
- 24. Bevanger l, Maeland JA, Naess AI. Agglutinins and antibodies to Francisella tularensis outer membrane antigens in the early diagnosis of disease during an outbreak of tularemia. J Clin Microbiol 1988;26:433-7.
- 25. Schell O, Reiersen R, Hoel T. Treatment of tularemia with ciprofloxacin. Eur J Clin Microbiol Infect Dis 1992;11:447-8.
- 26. World Health Organization (WHO). WHO Guidelines on tularaemia. Geneva: World Health Organization; 2007. WHO/CDS/EPR/2007.7. (http://whqlibdoc.who.int/ publications/2007/9789241547376_eng.pdf. Erişim tarihi 12.11.12012.
- 27. Risi GF, Pomo DJ. Relaps of tularemia after aminoglycoside therapy: case report and discussion of therapeutic options. Clin Infect Dis 1995;20:174-5.
- 28. Penn RL, Kinasewitz GT. Factors associated with a poor outcome in tularemia. Arch Intern Med 1987;147:265-8.
- 29. Önen S, Paksoy D, Bilge YD. Çocukluk çağında tularemi olguları. J Pediatr Inf 2012;6:94-100.
- 30. Jounio U, Renko M, Uhari M. An outbreak of holarcticatype tularemia in pediatric patients. Pediatr Infect Dis J 2010;29:160-2.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Bölüm | Research Article |
| Yazarlar | |
| Yayımlanma Tarihi | 1 Eylül 2013 |
| Yayımlandığı Sayı | Yıl 2013 Cilt: 11 Sayı: 2 |