Ekstrapulmoner tüberküloz olgularının retrospektif değerlendirilmesi
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Tarih
2022
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Yayıncı
Trakya Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Tüberküloz genellikle Mycobacterium tuberculosis complex olarak adlandırılan bir grup mikobakterinin etken olduğu, granülomatöz lezyonlarla seyreden bir enfeksiyon hastalığıdır. Tüm doku ve organları etkileyebilir. Ekstrapulmoner tüberküloz akciğer dışı organların tutulumunu ifade eder. Çalışmamızda ekstrapulmoner tüberküloz olguları retrospektif olarak değerlendirildi. Trakya Üniversitesi Sağlık Uygulama ve Araştırma Merkezi Enfeksiyon Hastalıkları kliniğinde ve polikliniğinde 01 Ocak 2013 ile 31 Aralık 2019 tarihleri arasında ekstrapulmoner tüberküloz tanısı ile takip ve tedavi edilen, 18 yaşından büyük hastalar çalışmaya alındı. Çalışmada yer alan 85 hastanın 53’ü (%62,4) kadın, 32’si (%37,6) erkekti. Yaş ortalaması 48,52±19 idi. En sık görülen ek hastalıklar hipertansiyon (%50) ve diyabetes mellitus (%17) idi. Hastalarımızın birinde HIV seropozitifliği saptandı. Gastrointestinal sistem tüberkülozu %21,2, kas-iskelet sistemi tüberkülozu %20, lenf bezi tüberkülozu %18,8, santral sinir sistemi TB %17,6, genitoüriner sistem tüberkülozu %9,4, diğer organ tutulumları %13 oranında görüldü. Tüberküloz peritonit tanılı olgularında periton sıvısında lökosit sayısı ortalama 1297 hücre/mm 3 (56-3200 arasında) saptandı. On üç olgunun 11’inden alınan periton sıvısında ortalama adenozin deaminaz aktivitesi 93,9 U/L (54-126 arasında) saptandı. Hastalara tanı en sık histopatolojik ve mikrobiyolojik yöntemlerle konuldu. Histopatoloji ve mikrobiyoloji sonuçlarıyla tanı alan olgu sayısı sırasıyla 48 (%56,4) ve 44 (%41) saptandı. Güncel literatürde en sık görülen klinik form lenf bezi tüberkülozudur. Çalışmamızda gastrointestinal sistem tüberkülozu ve kas-iskelet sistemi tüberkülozu olguları daha fazla görüldü. Hastaların önemli bir kısmının malignite araştırması sırasında tanı aldığı saptandı. Malignite araştırılırken yapılan histopatolojik incelemeler sonucunda ekstrapulmoner tüberküloz olgularının saptanması, ülkemizde tüberküloz enfeksiyonunun halen yaygın olduğu göstermektedir. Mikrobiyolojik tanıda etkenin kültürde üretilmesi altın standart yöntemdir. Ancak histopatolojik inceleme ile tanı konulan olgularımızın daha fazla olduğu saptandı. Tanıda mikrobiyolojik, histopatolojik, klinik, radyolojik bulgular birlikte değerlendirilmelidir. Tüberküloz hastalığının endemik olduğu bölgelerde spesifik belirtilerle başvurmayan hastalarda ayrıcı tanıda ekstrapulmoner tüberküloz akla getirilmelidir.
Tuberculosis is an infectious disease with granulomatous lesions, usually caused by a group of mycobacteria called Mycobacterim tuberculosis complex. Tuberculosis is a disease that can affect all tissues and organs. Extrapulmonary tuberculosis refers to the involvement of extrapulmonary organs. In our study, extrapulmonary tuberculosis cases were evaluated retrospectively. Patients older than 18 years of age, who were followed up and treated with the diagnosis of extrapulmonary tuberculosis between January 01, 2013 and December 31, 2019 in the Trakya University Medical Health Application and Research Center Infectious Diseases clinic and polyclinic were included in the study. Of the 85 patients included in the study, 53 (62.4%) were female and 32 (37.6%) were male. The mean age was 48.52±19. The most common comorbidities were hypertension (50%) and diabetes mellitus (17%). Among our patients, only one patient had HIV seropositivity. Gastrointestinal system tuberculosis was seen in 21.2%, musculoskeletal system tuberculosis in 20%, lymph node tuberculosis in 18.8%, central nervous system tuberculosis in 17.6%, genitourinary system tuberculosis in 9.4%, other organ involvements in %13 of the patients. The mean leukocyte count in peritoneal fluid samples from patients with tuberculous peritonitis was 1297 cells/mm3 (range 56-3200). The mean adenosine deaminase activity level in peritoneal fluid samples taken from 11 of 13 cases was 93.9 U/L (range 54-126). Most of our patients were diagnosed by histopathological and/or microbiological methods. The number of cases diagnosed with histopathology and microbiology results were 48 (56.4%) and 44 (%41), respectiveley. Although lymph node tuberculosis is the most common clinical form in the current literature, gastrointestinal system tuberculosis and musculoskeletal system tuberculosis were the most common clinical forms in our study. When we examined the patients files, we saw that most of the patients were diagnosed during malignancy investigations. Although cultivating the causative microorganism in culture systems is the gold standard method in microbiological diagnosis, we found that most of our extrapulmonary tuberculosis cases were diagnosed by histopathological methods. Extrapulmonary tuberculosis should be considered in the differential diagnosis of patients who do not present with specific signs in regions where tuberculosis disease is endemic. The high rate of detection of extrapulmonary tuberculosis cases in our study, as a result of histopathological examinations performed during malignancy investigations, points that tuberculosis infection is still common in Turkey.
Tuberculosis is an infectious disease with granulomatous lesions, usually caused by a group of mycobacteria called Mycobacterim tuberculosis complex. Tuberculosis is a disease that can affect all tissues and organs. Extrapulmonary tuberculosis refers to the involvement of extrapulmonary organs. In our study, extrapulmonary tuberculosis cases were evaluated retrospectively. Patients older than 18 years of age, who were followed up and treated with the diagnosis of extrapulmonary tuberculosis between January 01, 2013 and December 31, 2019 in the Trakya University Medical Health Application and Research Center Infectious Diseases clinic and polyclinic were included in the study. Of the 85 patients included in the study, 53 (62.4%) were female and 32 (37.6%) were male. The mean age was 48.52±19. The most common comorbidities were hypertension (50%) and diabetes mellitus (17%). Among our patients, only one patient had HIV seropositivity. Gastrointestinal system tuberculosis was seen in 21.2%, musculoskeletal system tuberculosis in 20%, lymph node tuberculosis in 18.8%, central nervous system tuberculosis in 17.6%, genitourinary system tuberculosis in 9.4%, other organ involvements in %13 of the patients. The mean leukocyte count in peritoneal fluid samples from patients with tuberculous peritonitis was 1297 cells/mm3 (range 56-3200). The mean adenosine deaminase activity level in peritoneal fluid samples taken from 11 of 13 cases was 93.9 U/L (range 54-126). Most of our patients were diagnosed by histopathological and/or microbiological methods. The number of cases diagnosed with histopathology and microbiology results were 48 (56.4%) and 44 (%41), respectiveley. Although lymph node tuberculosis is the most common clinical form in the current literature, gastrointestinal system tuberculosis and musculoskeletal system tuberculosis were the most common clinical forms in our study. When we examined the patients files, we saw that most of the patients were diagnosed during malignancy investigations. Although cultivating the causative microorganism in culture systems is the gold standard method in microbiological diagnosis, we found that most of our extrapulmonary tuberculosis cases were diagnosed by histopathological methods. Extrapulmonary tuberculosis should be considered in the differential diagnosis of patients who do not present with specific signs in regions where tuberculosis disease is endemic. The high rate of detection of extrapulmonary tuberculosis cases in our study, as a result of histopathological examinations performed during malignancy investigations, points that tuberculosis infection is still common in Turkey.
Açıklama
Anahtar Kelimeler
Tüberküloz, Ekstrapulmoner tüberküloz, Antitüberküloz tedavi, Tuberculosis, Extrapulmonary tuberculosis, Antituberculosis treatment
