M. SOYLAR, I. ALTUĞ, R. SERTÖZ, A. ZEYTİNOĞLU, D. AYDIN, F. AKKOYUN

Ege Üniversitesi Hastanesi'ne başvuran santral sinir sistemi enfeksiyonu olgularında saptanan viral etkenler

Amaç: Santral sinir sistemi enfeksiyonları, hızlı ilerleme potansiyeli ve kalıcı nörolojik hasar olasılığı nedeniyle çoğunlukla acil tanı ve tedavi yaklaşımı gerektirir. Bu çalışmada Ege Üniversitesi Tıp Fakültesi Tıbbi Mikrobiyoloji Anabilim Dalına viral santral sinir sistemi enfeksiyonu ön tanısı düşünülerek gönderilen beyin omurilik sıvısı (BOS) örneklerinde nükleik asit testleri ile saptanan viral etkenlerin değerlendirilmesi amaçlandı. Gereç ve Yöntem: Ege Üniversitesi Tıp Fakültesi Tıbbi Mikrobiyoloji Anabilim Dalı Laboratuvarına, Ocak 2012- Aralık 2012 tarihleri arasında viral santral sinir sistemi enfeksiyonu ön tanısı düşünülerek nükleik asit testleri yapılması amacı ile gönderilen toplam 289 BOS örneğinin sonucu retrospektif olarak değerlendirildi. Toplam 198 BOS örneği HSV DNA (LightCycler HSV 1⁄2 Qual Kit, Roche, Almanya), 46 örnek CMV DNA (Fluorion CMV QNP 3.0 Real-Time PCR, İontek, Türkiye), 20 örnek EBV DNA (LightMix Kit Epstein-Barr virus, TIB MOLBIOL, Almanya), 25 örnek Enterovirus RNA (GeneXpert Xpert EV, Cepheid, ABD) varlığı açısından araştırıldı. Bulgular: Hastaların 153ü kadın, 136si erkekti ve yaşları 0 - 88 arasında değişmekte idi (median yaş 39). HSV DNA ncelemesi yapılan 198 olgunun ikisinde (%1) pozitiflik, CMV DNA incelemesi yapılan 46 olgunun birinde (%2) pozitiflik, EBV DNA incelemesi yapılan 20 olgunun üçünde (%15) pozitiflik ve Enterovirus RNA incelemesi yapılan 25 olgunun birinde (%4) pozitiflik saptandı. Sonuç: SSS viral enfeksiyonları klinikte nadir görülmemekle birlikte insidansları net olarak belirlenmemiştir. Mortalitesinin yüksek olması, hızlı ilerlemesi ve sekel bırakma olasılığının fazla olması nedeni ile önemli bir hastalık grubudur. Birçok olgunun etiyolojisi bilinmemekle birlikte özellikle moleküler tekniklerin gelişimi ile viral etkenlerin saptanmasında artış olmuştur.

Viral agents in patients with central nervous infections admitted to Ege University Hospital

Aim: Central Nervous system (CNS) infections require a rapid diagnosis and treatment approach due to their potential of rapid progression and the possibility of permanent neurological damage. In this study, viral agents detected by nucleic acid tests in the cerebrospinal fluid samples of patients with a suspicion of viral CNS infection were sent to Medical Microbiology Laboratory of Ege University Hospital and evaluated. Materials and Methods: A total number of 289 CSF samples submitted to Medical Microbiology Laboratory from January 2012 to December 2012 for viral nucleic acid testing were evaluated retrospectively. One hundred ninety eight CSF samples were tested for HSV DNA (HSV LightCycler 1⁄2 Qual Kit, Roche, Germany), 46 samples for CMV DNA (CMV Fluorion QNP 3.0 Real-Time PCR, İontek, Turkey), 20 samples for EBV DNA (Lightmix Kit Epstein-Barr virus, TIB MOLBIOL, Germany) and 25 samples for Enterovirus RNA (GeneXpert Xpert EV, Cepheid, USA). Results: One hundred fifty three patients were females and 136 were males, ages ranging from 0 to 88 (median age 39) years. HSV DNA was detected by nucleic acid testing in two of the 198 patients (1%), CMV DNA in one of the 46 patients (2%), EBV DNA three of the 20 patients (15%) and enterovirus RNA in one of the 25 patients (4%). Conclusion: Even though CNS infections are not rare, the incidence is not clearly established. Due to high mortality rate and potential of neurological damage, they are extremely important. Even though the etiology is unknown in many cases, the development of molecular techniques has increased the detection rate of viral agents.

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