Yaşar TOPAL, Hatice TOPAL, Betül BATTALOĞLU İNANÇ

ENFEKSİYÖZ MONONÜKLEOZLU ÇOCUKLARDA HASTANEYE YATIRMA BELİRTEÇLERİ

GİRİŞ: Ateş, lenfadenopati ve farenjit ile karakterize olan enfeksiyöz mononükleoz (IM), Epstein-Barr virüsünün (EBV) neden olduğu yaygın bir bulaşıcı hastalıktır. Bu çalışmada, EBV nedenli IM’li çocukların hastaneye yatış belirteçlerini belirlemek için klinik bulgular, laboratuvar veriler ve yönetimler geriye dönük olarak incelendi. GEREÇ VE YÖNTEMLER: Muğla Sıtkı Koçman Üniversitesi Tıp Fakültesi Hastanesi'nde 31 Ekim 2017 - 31 Ekim 2018 tarihleri arasında, İM tanısı alan 18 yaş altındaki hastaların tıbbi kayıtları geriye dönük olarak incelendi. Çalışma popülasyonu, 0-4 yaş, 5-10 yaş ve 10 yaş üstü olmak üzere 3 gruba ayrıldı. Hastaların şikayet, fizik muayene bulguları, laboratuvar verileri, komplikasyonları ve tedavi stratejileri bu gruplarda karşılaştırıldı. Hastaneye yatışla ilişkili faktörler ve hastaneye yatışın belirteçleri de incelenmiştir. BULGULAR: Çalışmaya 158 hasta dahil edildi. Hastaların yaş ortalaması 88,9 ± 53,5 ay ve 93'ü (% 58,9) erkek idi. En sık görülen şikayet ateş (% 57,6), en sık görülen fizik muayene bulgusu hepatomegali (% 73,4) idi. Ateş, döküntü, trombositopeni ve AST artışının dışında, klinik ve laboratuvar bulguları ile yaş grupları arasında anlamlı bir fark bulunmadı. Hastaların % 44'üne antibiyotik tedavisi uygulandı ve hastaların % 34,8'i hastanede yatarak tedavi gördü. Hastaneye yatırılan hastaların daha fazla semptom ve fizik muayene bulgularına, daha yüksek akut faz reaktanlarına sahip oldukları saptandı. Hastaneye yatış için önemli olduğu saptanan değişkenler ateş, damakta peteşi veya eksudatif tonsillit varlığı ve başvuruda yüksek C-reaktif protein seviyeleri idi. SONUÇLAR: Enfeksiyöz mononükleozlu çocukların üçte birinden fazlası hastanede yattırılarak tedavi gördü. Ateş, palatal peteşi veya eksüdatif tonsillit varlığı ve başvuru sırasında yüksek C-reaktif protein düzeyleri daha yüksek hastaneye yatış oranları ile ilişkilendirildi.

PREDICTORS OF HOSPITALIZATION IN CHILDREN WITH INFECTIOUS MONONUCLEOSIS

AIM: Infectious mononucleosis (IM), characterized by fever,lymphadenopathy and pharyngitis, is a common infectious diseasecaused by Epstein-Barr virus (EBV). In this study, we performeda retrospective analysis of the clinical findings, laboratory dataand management of children with IM due to EBV to find out thepredictors of hospitalizations.MATERIAL AND METHODS: We retrospectively reviewed themedical records of patients under the age of 18 years who werediagnosed with IM between October 31, 2017 and October 31, 2018at Muğla Sıtkı Koçman University Medical Faculty Hospital. Thestudy population was categorized into three groups according tothe age; the 0-4 years, 5-10 years, and above 10 years. Complaints,physical examination findings, laboratory data, complicationsand treatment strategies of the patients were compared in thesegroups. Factors associated with hospitalizations and predictors ofhospitalization were also investigated.RESULTS: This study included 158 patients. The mean age of thepatients was 88.9 ± 53.5 months and 93 (58.9%) were male. Themost common complaint was fever (57.6%), and the most commonphysical examination finding was hepatomegaly (73.4%). Exceptfor fever, rash, thrombocytopenia and AST elevation, no significantdifference was found between the age groups and the clinical andlaboratory findings. Antibiotic therapy was applied to 44% of thepatients and 34.8% were hospitalized.Patients who needed hospitalization were more symptomatic, hadmore physical examination findings and had higher acute phasereactants. Presence of fever, palatal petechiae, or exudative tonsillitisand higher levels of C-reactive protein at presentation were found tobe significant predictors of hospitalizationCONCLUSIONS: More than one third of the children with IMrequired hospitalization. Presence of fever, palatal petechiae, orexudative tonsillitis and higher levels of C-reactive protein atpresentation were associated with higher rates of hospitalizations.

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