KADRİYE KART YAŞAR, Filiz PEHLİVANOĞLU, Gülten ÇİÇEK, Gönül ŞENGÖZ

21. Yüzyılın ilk pandemisi H1N1: Kesin tanılı hastaneye yatırılan olguların değerlendirilmesi

Amaç: Yirmi birinci yüzyılın ilk grip pandemisi olan H1N1 pandemisi, ülkemiz dahil dünyanın hemen her bölgesini etkilemiştir. Bu çalışmada; kliniğimizde H1N1 gribi tanısı kesinleşmiş bulunan ve yatırılarak izlenen 46 olgunun klinik, laboratuvar ve radyolojik özellikleri değerlendirilmiştir. Gereç ve Yöntem: Hastanemize, H1N1 için “olası olgu” tanımına uygun olup yatırılan hastalardan, burun sürüntüsü örneğinde gerçek zamanlı (realtime) PCR ile İnfluenza A H1N1 RNA pozitif saptanan 46 olgu çalışmaya dahil edilmiştir. Olguların tamamına oseltamivir ve bakteriyel süperinfeksiyon düşünülenlere nonspesifik antibiyotik tedavisi de verilmiştir. Bulgular: Olguların 30’u (%65) kadın, altısı (%13) gebe ve 10’u (%22) import olguydu. Yaş aralığı 17-58 olan olgularda median yaş 30,65±10,21 idi. Ateş, öksürük, boğaz ağrısı ve myalji en sık saptanan semptomlardı. Hastaneye başvurana dek geçen semptom süresi ortalama üç gündü. Olguların büyük bir kısmında, akciğer grafisinde bilateral yaygın interstisyel pnömoni bulguları vardı. Altta yatan hastalığı bulunan olgulardan dördü (%9) yoğun bakım ünitesine (YBÜ) sevkedildi ve üçü (%7) kaybedildi. Oseltamivir yanında antibiyotiğin de kullanıldığı hasta sayısı 23 (%50) idi. Sonuç: Yeni bir influenza A H1N1 virüsüyle gelişen pandemi, ülkemizde de en çok çocuk ve genç erişkin popülasyonu, sağlıklı yetişkinleri ve gebeleri etkilemiştir. Ciddi pnömoni ve YBÜ ihtiyacı nedeniyle hastanelere başvuru ve yatış oranları artmış, altta yatan hastalığı bulunanlarda ciddi seyir ve ölüm gözlenmiştir. Bu nedenle riskli grupların aşılanması ve toplumun, bulaş zincirini kıracak el yıkama gibi basit önlemler açısından bilinçlendirilmesi gereklidir.

H1N1, the first pandemic of 21st century: Evaluation of hospitalized confirmed cases

Objective: H1N1 pandemic which is the first pandemic of 21st century has currently affected worldwide including our country. The aim of the present research was to analyze the clinical, laboratory and radiological characteristics of 46 confirmed cases who were hospitalized with H1N1 influenza in our clinic. Materials and Methods: Among probable patients for H1N1, 46 confirmed cases who tested positive for the H1N1 virus by real-time PCR were included in present study. All of them were treated with oseltamivir while patients suggested bacterial superinfection were also treated with antibiotics. Results: Thirty (65%) were females; six were pregnant and 10 (22%) were imported cases. They aged between 17 and 58 years old (median: 30,65±10,21). Fever, cough, sore throat and myalgia were the most frequent symptoms. The median time from the onset of illness to hospital admission was three days. Most of patients had diffuse bilateral pulmonary infiltrates in chest X-rays. Four patients had been admitted to an intensive care unit (ICU); three (7%) of them died; all of them had an underlying disease. Twenty three (50%) patients received antibiotics in addition to oseltamivir. Conclusion: The influenza A pandemic due to novel H1N1; mostly affected children, young adults, healthy people and pregnants in Turkey as other countries. The hospitalization rates rised due to severe pneumonia and need for ICU. Severe course and death were seen especially in patients who had underlying disease. Therefore, risky groups should be vaccinated, public should be informed about measures which will prevent contamination like hand washing.

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