Cem GÜN, Süha TÜRKMEN, Hasan ALDİNÇ, Orhan ÇINAR, Serpil YAYLACI, Gürdal YILMAZ

Endemik Olmayan Ülkelerin Acil Servislerinde Seyahate Bağlı Sıtma Yönetimi Nasıl Olmalı? Tek Merkezli Çalışma

Amaç: Hava yolu ulaşımındaki gelişmeler ve artış, sıtmanın endemik olduğu Afrika ülkelerine olan seyahatlerinde artmasını sağladı. Bu gelişmelerle birlikte ithal sıtma vakalarının da dünya genelinde artmasına sebep oldu. Bu çalışma, hastalığı endemik olmayan ülkelere ithal eden sıtma hastalarının acil servislere nasıl geldiklerini özetlemeyi ve bu tür durumlarla başa çıkmak için pratik yaklaşımlar için önerilerde bulunarak acil servislerdeki hekimleri aydınlatmayı amaçlamaktadır. Yöntemler: Bu çalışma 1 Ocak 2014-1 Mart 2022 tarihleri arasında bir üniversite hastanesi kayıtları incelenerek retrospektif olarak yürütülmüştür. Acil serviste sıtma şüphesi veya kesin tanısı ile başvuran hastaların yedi yıllık acil servis kayıtları çalışmaya dahil edilerek, epidemiyolojik ve klinik özellikler değerlendirildi. Sıtma tanısı alan hastalara tekrar ulaşılarak anket düzenlendi. Bulgular: 892 hastanın acil serviste sıtma ön tanısıyla değerlendirildiği tespit edildi. Bu hastaların 30’u sıtma teşhisi aldı ve 892 hastanın 846’sı havayolu kabin ekibi üyesiydi. 28 hasta ithal sıtma tanısı aldı. Kabin ekibinin %94,3’ünün (n = 798) sıtma için koruyucu ilaç kullanmadığı saptandı. Hastaların yaş ortalaması 33.2±8.5 idi. Yirmi beş hastaya periferik kan yayması, kalan üç hastaya PCR ile tanı konuldu. 28 hastanın 26’sında hızlı tanı testleri pozitifti. Sonuç: Kısa süreli ziyaretlere ve havaalanında sınırlı kalışlara rağmen sıtmaya yakalanma riski hala yüksektir. Acil hekimleri tarafından ateş şikayeti olan hastalara rutin olarak seyahat öyküsü sorulmalıdır. Kabin ekibi de dahil olmak üzere sıtmanın endemik olduğu ülkelere seyahat eden kişilerin sıtma profilaksisi ve sivrisinek ısırıklarını önlemeye yönelik koruyucu önlemler alması, sıtmayı önlemede çok önemli bir rol oynamaktadır.

How should Travel-Related Malaria Management in Emergency Departments of Non-endemic Countries? Single-center Study

Purpose: Advancements in air travel enabled an increase in traveling to malaria-endemic countries such as those in sub-Saharan Africa. An increase in the incidence of imported malaria accompanied these advancements. This study aims to summarize how malaria patients who have imported the disease into non-endemic countries present to the emergency departments and to enlighten physicians in emergency departments by providing suggestions for practical approaches to handling such situations. Methods: This study was conducted retrospectively in a university hospital, from January 1, 2014 to March 1, 2022. Seven years of emergency department records of patients who were examined in the emergency department with a suspected, or definitive diagnosis of malaria were included in the study. Epidemiological and clinical characteristics were evaluated. Results: 892 patients were admitted to the emergency department with suspicion of malaria. Thirty of these patients were diagnosed with malaria, and 846 of the 892 patients were members of airline cabin crews. 94.3% (n=798) of the cabin crew did not use prophylactic medication for malaria. The mean age of the patients was 33.2±8.5. Twenty-five patients were diagnosed via peripheral blood smears, and the remaining three patients were diagnosed with PCR. Rapid diagnostic tests were positive in 26 out of 28 patients. Conclusion: The risk of acquiring malaria is still high despite short-term visits and airport-limited stays. Travel history should be routinely asked of patients by emergency physicians. Education of people traveling to malaria-endemic countries, including cabin crew, regarding malaria prophylaxis and protective measures to prevent mosquito bites plays a crucial role in preventing malaria.

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