Hastanemizde çocuk yoğun bakım ünitesinde menenjit tanısı ile yatan ve lomber ponksiyon yapılan hastaların biyokimyasal ve mikrobiyolojik analizlerinin retrospektif incelenmesi
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Dosyalar
Tarih
2022
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Tekirdağ Namık Kemal Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Menenjit leptomeninkslerin ve subaraknoid alanın enflamasyonu ile giden bir merkezi sinir sistemi enfeksiyon hastalığıdır. Tanı testleri ve tedavi yöntemlerindeki ilerlemelere karşın halen ciddi mortalite ve morbiditeye sahiptir. Bu nedenle erken tanı koymak ve bir an evvel etkene yönelik ampirik tedaviye başlamak oldukça önemlidir. Çalışmamıza hastanemizde menenjit tanısı almış 70 hasta dahil edilmiştir. Hastaların anamnez, fizik muayene, laboratuar sonuçları ve başlanan tedavileri retrospektif olarak incelenmiştir. Hastalarımızın çoğunluğu (%58,6) erkek ve %38,6'sı 1 yaş ve altındadır. İlkbahar ve yaz aylarında toplam başvuran hasta sayısı sonbahar kış aylarındaki başvuranlara göre daha fazladır. Hastalarımızın en sık başvuru şikayeti %84,3 ile ateştir. Meningeal irritasyon bulgusu 2 yaş ve üzerindeki hastalarda %86 oranında pozitifken bu oran 2 yaş altında %22,4 tür. Meningeal irritasyon bulgularının durumuna göre nötrofil, lenfosit ve platelet değerleri açısından istatistiksel olarak anlamlı farklılık tespit edilmiştir (p<0,05). Meningeal irritasyon bulguları pozitif olanların nötrofil değerleri, meningeal irritasyon bulguları olmayanlara göre anlamlı düzeyde daha yüksektir. Meningeal irritasyon bulguları pozitif olanların lenfosit ve platelet değerleri, olmayanlara göre anlamlı düzeyde daha düşüktür. Hastaların kan ve BOS analizleri incelendiğinde medyan değerler hemoglobin için 11,5 g/dL, lökosit için 11220/uL ,platelet için 321500/uL ,CRP için 25,9 mg/dl , ESR için 29 mm/sa , BOS glikozu için 61,2 mg/dL, BOS proteini için 37,4 mg/dl ve hücre sayısı için 100/mm3'tür. Hastalarımızın 4 tanesinde BOS kültüründe etken mikroorganizma saptanmıştır. Kültür negatif hastaların 3 tanesinde ise BOS PCR da etken patojen tespit edilmiştir. Hastalara başlanan en sık tercih edilen ampirik antimikrobiyal tedavi vankomisin ve 3.kuşak sefalosporin kombinasyonudur.
Meningitis is a central nervous system infectious disease with inflammation of the leptomeninges and subarachnoid space. Despite advances in diagnostic tests and treatment methods, it still has serious mortality and morbidity. Therefore, it is very important to make an early diagnosis and start empirical treatment for the causative agent as soon as possible. Seventy patients diagnosed with meningitis in our hospital were included into this study .The anamnesis , physical examination, laboratory results, and initiated treatments of these patients were retrospectively reviewed. The majority of our patients (58.6%) are male and 38.6% are 1 year old or younger. The total number of patients who refer to the hospital in the spring and summer months is higher than the ones who refer to the hospital in the autumn and winter months. The most common complaint of our patients was fever with 84.3%. Meningeal irritation sign is 86% positive in patients aged 2 years and older, while this rate is 22.4% under 2 years of age. A statistically significant difference was found in terms of neutrophil, lymphocyte, and platelet values according to the meningeal irritation findings (p <0.05). The neutrophil values of those with positive signs of meningeal irritation were significantly higher than those without signs of meningeal irritation. The lymphocyte and platelet values of those with positive signs of meningeal irritation were significantly lower than those without meningeal irritation signs. When the blood and CSF analyzes of the patients were examined, the median values were 11.5 g/dL for hemoglobin, 11220/uL for leukocytes, 321500/uL for platelets, 25.9 mg/dl for CRP, 29 mm/h for ESR, 61.2 mg/dL for CSF glucose, 37.4 for CSF protein and 100/mm3 for the number of cells. The causative microorganism was detected in the CSF culture in 4 of our patients. In 3 of the culture-negative patients, the causative pathogen was detected in the CSF PCR. The most preferred empirical antimicrobial therapy initiated for patients is the combination of vancomycin and a third-generation cephalosporin.
Meningitis is a central nervous system infectious disease with inflammation of the leptomeninges and subarachnoid space. Despite advances in diagnostic tests and treatment methods, it still has serious mortality and morbidity. Therefore, it is very important to make an early diagnosis and start empirical treatment for the causative agent as soon as possible. Seventy patients diagnosed with meningitis in our hospital were included into this study .The anamnesis , physical examination, laboratory results, and initiated treatments of these patients were retrospectively reviewed. The majority of our patients (58.6%) are male and 38.6% are 1 year old or younger. The total number of patients who refer to the hospital in the spring and summer months is higher than the ones who refer to the hospital in the autumn and winter months. The most common complaint of our patients was fever with 84.3%. Meningeal irritation sign is 86% positive in patients aged 2 years and older, while this rate is 22.4% under 2 years of age. A statistically significant difference was found in terms of neutrophil, lymphocyte, and platelet values according to the meningeal irritation findings (p <0.05). The neutrophil values of those with positive signs of meningeal irritation were significantly higher than those without signs of meningeal irritation. The lymphocyte and platelet values of those with positive signs of meningeal irritation were significantly lower than those without meningeal irritation signs. When the blood and CSF analyzes of the patients were examined, the median values were 11.5 g/dL for hemoglobin, 11220/uL for leukocytes, 321500/uL for platelets, 25.9 mg/dl for CRP, 29 mm/h for ESR, 61.2 mg/dL for CSF glucose, 37.4 for CSF protein and 100/mm3 for the number of cells. The causative microorganism was detected in the CSF culture in 4 of our patients. In 3 of the culture-negative patients, the causative pathogen was detected in the CSF PCR. The most preferred empirical antimicrobial therapy initiated for patients is the combination of vancomycin and a third-generation cephalosporin.
Açıklama
Anahtar Kelimeler
Menenjit, Ateş, Meningeal İrritasyon Bulguları, Beyin Omurilik Sıvısı, Meningitis, Fever, Meningeal Irritation Signs, Cerebrospinal Fluid, Çocuk Sağlığı ve Hastalıkları, Child Health and Diseases
