Özlem TEZOL, Mehmet ALAKAYA, Asuman AKAR, Necdet KUYUCU

Pediatrik Tüberküloz Olgularının Klinik ve Laboratuvar Özelliklerinin Nutrisyon Göstergeleri Eşliğinde Incelenmesi

Amaç: Çocukluk çağı tüberkülozu önemli bir halk sağlığı sorunudur. Pediatrik tüberküloza sıklıkla zayıflık ile karakterize malnutrisyon eşlik eder. Bu çalışmada pediatrik tüberküloz hastalarının nutrisyon göstergeleri eşliğinde değerlendirilmesi amaçlandı.Materyal ve Metot: Tüberküloz tanısı almış hastaların demografik, klinik, antropometrik, mikrobiyolojik, histopatolojik ve radyolojik özellikleri geriye dönük olarak incelendi.Bulgular: Çalışmaya 77 olgunun verileri dahil edildi. Olguların ortalama yaşı 9,32±4,91 yıl, %63’ü erkekti. Kesin tüberküloz tanısı alan 24 (%31), olası tüberküloz tanısı alan 39 (%50) ve latent tüberküloz tanısı alan 14 (%18) hasta vardı. Kesin tanılı grupta olguların %33’ünde aside dirençli bakteri görüldü, %20’sinde kültür pozitifti, %45’inde hem aside dirençli bakteri görüldü hem kültür pozitifti. Olguların %40’ı akciğer, %32’si akciğer dışı, %6’sı miliyer, %2’si akciğer ve akciğer dışı tüberküloz birlikteliğiydi. Akciğer tübekülozu tanılı hastaların yaş ortalaması akciğer dışı + miliyer tüberküloz tanılı hastaların yaşortalamasından anlamlı olarak daha büyüktü (p=0,003). Kültür pozitifliği oranı akciğer tüberkülozu grubunda, tanısal histopatolojik örnekleme oranı akciğer dışı + miliyer tüberküloz grubunda daha yüksekti (p=0,019, p=0,012). Temas öyküsü oranı %37, ev içi temas oranı %23 olarak saptandı, en sık indeks vakalar babalardı. Tüberkülin deri testi kesin tüberküloz tanılı 11 hastada (%45), olası tüberküloz tanılı 15 hastada (%38) pozitifti. Kesin ve olası tüberküloz grupları arasında cinsiyet, ortalama yaş, yakınma süresi, tüberkülin testi pozitifliği, Bacille Calmette‐Guerin skarı varlığı, temas öyküsü oranı, hematolojik testler ve antropometrik ölçümler açısından anlamlı farklılık yoktu (p>0,05). Olguların tanı anında yaşa göre boy median yüzde değerlerinin ortalaması (94,35±7,50) ve boya göre ağırlık median yüzde değerlerinin ortalaması (85,72±6,92) hafif malnutrisyonu göstermekteydi ve bu durum tedavi bitiminde de devam etmekteydi. Yaşa göre boy dikkate alındığında kronik malnutre olan grup olası tüberküloz grubuydu, bu grupta yakınma süresi ortancası 3 aydı. Boya göre ağırlık (0,05). Sonuç: Pediatrik tüberküloz hastalarının nutrisyon durumlarının izlenmesi, antitüberküloz tedavi ile birlikte beslenme eksikliklerinin ve hatalarının giderilmesi ihmal edilebilmektedir. Çocuklarda tüberküloz yönetimi ile malnutrisyon izlemi bütünleştirilmelidir

Clinical and Laboratory Evaluation of Pediatric Tuberculosis Cases in Light of Nutritional Indicators

Objectives: Pediatric tuberculosis is a major public health problem. Malnutrition characterized withwasting is prevalent among pediatric tuberculosis patients. We aimed to review pediatric tuberculosiscases by considering their nutrition manifestations. Materials and Methods: The study evaluated demographical, clinical, anthropometric,microbiological, histopathological and radiological characteristics of tuberculosis patients,retrospectively. Results: The study involved 77 tuberculosis cases. Sixty‐three percent of the patients were male with amean age of 9.32±4.91 years. Twenty‐four patients (31%) diagnosed with definite tuberculosis, thirty‐nine patients (50%) with probable tuberculosis, and fourteen patients (18%) with latent tuberculosisinfection. Acid resistant bacteria were observed in 33%, culture positivity was observed in 20%, bothacid resistant bacteria and culture positivity was observed in 45% of definite diagnosed group. Fortypercent of patients had pulmonary, 32% had extrapulmonary, 6% had miliary, 2% had both pulmonaryand extrapulmonary tuberculosis. Pulmonary tuberculosis diagnosed patients were significantly olderthan extrapulmonary plus miliary group (p=0.003). Culture positivity rate was significantly higher inpulmonary, diagnostic histopathological sampling rate was significantly higher in extrapulmonary plusmiliary group (p=0.019, p=0.012). Thirty seven percent of patients had a contact history, 23% of thosehad household contact, and the most common index cases were fathers. The tuberculin test waspositive in 11 patients (45%) with definite and 15 patients (38%) with probable tuberculosis. Nosignificant difference has been observed between definite and probable tuberculosis groups accordingto the sex, average age, symptom duration, tuberculin test positivity, Bacille Calmette‐Guerin vaccinescar presence, contact history rate, hematologic tests, and anthropometric measurements (p>0.05). Atthe time of diagnosis mean (SD) values of height for age and weight for height medians [ 94.35 (7.50) %and 85.72 (6.92) %, respectively] refered to mild malnutrition, the same conditions were remaining atthe end of treatment. When height for age taken into consideration the chronic malnutrated group wasprobable tuberculosis group. Weight for height (for 0.05). Conclusion: Nutrition status monitoring, correcting nutritional deficiencies and failures can beneglected in course of antituberculosis treatment. Tuberculosis management should be integrated withmalnutrition monitoring in pediatric cases.

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