Ümit TÖZALGAN, Gönül ŞENGÖZ, Sibel AL, Sevim MAVİ, Mehmet BAKAR

Çok ilaca dirençli tüberkülozda aile içi bulaş: Aynı ailede yedi olgu

Bu çalışmada 11 kişilik aileden yedisi çok ilaca dirençli tüberküloz olan sekiz olgu incelenmiştir. İndeks olgu 23 yaşında erkek hasta, Güneydoğu Anadolu bölgesinden İstanbul’a çalışmak için gelmiş ancak hastalanınca aile üyeleri farklı zamanlarda ona bakmak için yanına gelmişler ve İstanbul’a yerleşmişler. 11 kişi iki odalı bir evde oturuyor ve kaymakamlık fonundan yardım alarak geçiniyorlar. Temaslı taraması sırasında ailede beş kardeşte ve iki kuzende de tüberküloz saptandı. Olgularda tanı mikrobiyolojik ve radyolojik olarak kondu. Balgamda aside dirençli bakteri sekiz olguda pozitif bulundu (bir olguda açlık mide sıvısında) ve yedi olguda Löwenstein-Jensen besiyerinde üreyen ve Mycobacterium tuberculosis complex olarak identifiye edilen bakterilerde, TK Otomatize Antibiyogram (Salubris, Inc. MA, USA) sistemiyle izoniazid ve rifampisine direnç tespit edildi. Tedavi ofloksasin, sikloserin, paraaminosalisilik asid ve protionamid olarak değiştirildi. Çok ilaca dirençli tüberküloz, yönetimi zor ve tedavisi pahalı bir tablodur ve toplum sağlığını tehdit eden en önemli unsurlardan biridir. Solunum yolu ile bulaşan bu hastalıkta, yakın temaslıların hastalık yönünden taranmaları, olguların erken bulunması ve yeni olguların ortaya çıkışının engellenmesi açısından çok önemlidir.

Intrafamilial transmission of multidrug resistant tuberculosis: Seven cases in a family

We evaluated eight cases (six brothers and sisters and two cousins), seven of whom were multidrug resistant tuberculosis (MDR TB) in a family of 11. Index case, 23 years old male, migrated to Istanbul from southeastern part of Turkey to work, and after he got sick, family members came to look after him on different times and settled. They all live in a place with two rooms and got governmental help. During case contact screening, the disease was detected in other seven cases. The diagnosis was made by microbiological and radiological tests. Sputum microscopy was positive in eight cases (one in gastric fluid) for acid fast bacilli and Lowenstein Jensen cultures were positive for Mycobacterium tuberculosis complex in seven cases. Antituberculous drug resistances were searched by TK Automated Antibiogram System (Salubris, Inc. MA, USA). Isoniazid and rifampicin resistance were detected. Therapy was switched to ofloxacin, cycloserine, para-aminosalicylic acid and prothionamid. MDR TB is difficult to manage, has an expensive treatment and is also one of the most important factors threatening public health. Screen of close contacts is very important in this respiratory transmitted disease for early diagnosis of cases and prevent new infections.

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