Hakan HAKKOYMAZ, Selçuk NAZİK, Ali İhsan KİLCİ, Özlem GÜLER, Murat TEPE, Nazmi YAMAN

Üniversite Hastanesi Acil Servisine Başvuran Akut Gastroenteritli Hastalarda Parazitik Ajanların Analizi

Amaç Akut gastroenterit, ishal ile karakterize bir hastalıktır. Bu hastalıkta virüs, bakteri ve parazit en yaygın faktörlerdir. Bu çalışmada, acil servise (AS) başvuran gastroenteritli hastalarda intestinal parazitlerinin çeşitliliğini değerlendirmeyi amaçladık. Gereç ve Yöntem Bu tanımlayıcı ve kesitsel çalışmada, Kasım 2014 - Kasım 2017 tarihleri arasında hastanemiz acil servisine başvuran akut gastroenteritli (ICD: K52.9) toplam 4177 hasta kaydı retrospektif olarak değerlendirildi. Bulgular Olguların % 45,9'u (n = 188) erkek, % 54,1'i (n = 222) kadın cinsiyette idi. Paraziter ishalin en sık nedeni E. histolytica (% 85.2) idi. Çalışmaya alınan 410 hastanın% 34,6'sında (n = 142) mikroskopik incelemede lökosit vardı. Lökositli hastaların% 62,7'sinin (n = 89) mikroskopik incelemesinde de parazitler görülmüştür. Dışkı örneğinde parazit ve lökosit birlikteliği değerlendirildiğinde, dışkı örneğinde parazit bulunan hastalarda lökositlerin varlığı anlamlı olarak daha yüksekti (p <0.0001). Dışkı örneğindeki parazit ve eritrosit birlikteliği birlikte değerlendirildiğinde, dışkı örneğindeki parazit bulunan hastalarda eritrosit varlığı anlamlı olarak daha yüksek bulundu (p <0.0001). Sonuç E. histolytica, bölgemizde ve tüm dünyada önemli bir halk sağlığı sorunudur. Bu sorunun kanalizasyon ve altyapı çalışmaları ve içme ve kullanma suyunun temizliği ile azaltılacağına inanıyoruz.

Anahtar Kelimeler:

Gastroenterit, Parazit, Acil Servis

AN ANALYSIS OF PARASITIC AGENTS IN PATIENTS WITH GASTROENTERITIS ADMITTED TO A UNIVERSITY HOSPITAL EMERGENCY DEPARTMENT

Objective Acute gastroenteritis is a disease characterized by diarrhea. In this disease, virus, bacteria and parasite are the most common factors. In this study, we aimed to evaluate the diversity of intestinal parasites in patients with gastroenteritis who applied to the Emergency Department (ED). Material and Methods In this descriptive and cross-sectional study, a total of 4177 records of patients with acute gastroenteritis (ICD: K52.9) who were admitted to the ED of our hospital between November 2014 and November 2017 were evaluated retrospectively. A total 410 stool samples for intestinal parasites using the standard parasitological methods were examined. Results 45.9% of the cases (n=188) were male and 54.1% (n=222) were female. The most common cause of parasitic diarrhea was E. histolytica (85.2%). Of the 410 patients included in the study, 34.6% (n = 142) had leukocytes in the microscopic examination. The microscopic examination of 62.7% (n = 89) of patients with leukocytes also showed parasites. Evaluating the coexistence of parasites and leukocytes together in the stool sample the presence of leukocytes was significantly higher in patients with parasites in the stool sample (p <0.0001). When the coexistence of parasites and erythrocytes in the stool sample were evaluated together, the presence of erythrocytes was significantly higher in patients with parasites in the stool sample (p <0.0001). Conclusion E. histolytica is an important public health problem in our region and all over the world. We believe that this problem will be reduced by sewage and infrastructure works and by improvement in sanitation of drinking and utility water.

Keywords:

Gastroenteritis, Parasite, Emergency Medicine,

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1. NICE. NICE Clinical Knowledge Summaries: Gastroenteritis. 2015. . URL: http://cks.nice.org.uk/ gastroenteritis (accessed 1 November 2015).
2. Leder K. Intestinal Protozoa: Giardia, Amebiasis, Cyclospora, Blastocystis hominis, Dientamoeba fragilis, and Cryptosporidium parvum. In: Shwartz E (ed). Tropical Diseases in Travelers. Singapore: Wiley-Blackwell; 2009. p.294-302.
3. Uyar Y, Taylan Ozkan A. Antigen detection methods in diagnosis of amebiasis, giardiasis and cryptosporidiosis. Turkiye Parazitol Derg 2009; 33:140-50.
4. Pogge TW. Human rights and global health: a Research program. Metaphilosophy 2005;36:182–209.
5. Değirmenci A, Sevil N, Güneş K, Yolasiğmaz A, Turgay N. Distribution of intestinal parasites detected in the parasitology laboratory of the Ege University Medical School Hospital, in 2005. Turkiye Parazitol Derg 2007; 31:133-5.
6. WHO: Water-related diseases. Geneva (Switzerland): WHO, 2016. URL: https://www.who.int/water_sanitation_health/diseases risks/diseases/diarrhoea/en/
7. Garcia LS, Arrowood M, Kokoskin E, Paltridge GP, Pillai DR, Procop GW, et al. Laboratory diagnosis of parasites from the gastrointestinal tract. Clin Microbiol Rev 2018;31:20-40.
8. Kuk S, Erensoy A, Keleştimur N. Results of Parasitological Examination of Stools in the Parasitology Laboratory of the Firat University Firat Medical Central inside the last year. Fırat Tıp Dergisi 2006;11:113-115.
9. Eren ŞH, Oğuztürk H. Prevalance of Intestinal Protozoa in Diarrheic Patients. Cumhuriyet Üniversitesi Tıp Fakültesi Dergisi 2005;27:11-14.
10. Emiroğlu HH, Kösecik M, Altunay H, Oğuz S, Öztürk M, Nazlıgül Y. Incidence of amebiasis with diarrhea in Şırnak Province. Klimik Dergisi 1999; 12:79-81.
11. Sönmez TG, Çalışkan Ş, Willke A. Distribution of Intestinal Parasites among Patients Who Presented at the Parasitology Laboratory of the Kocaeli University School of Medicine Hospital. Turkiye Parazitol Derg 2008; 32:126-129.
12. Usluca S, Yalçin G, Over L, Tuncay S, Sahin S, Inceboz T, Aksoy U. The distribution of intestinal parasites detected in the Dokuz Eylul University Medical Faculty Hospital between 2003 and 2004. Turkiye Parazitol Derg 2006;30:308-12.
13. Göncü, S. (2015). Çocuklardaki akut gastroenteritte akut faz belirteçlerinin ayırıcı tanıdaki rolü (Tıpta Uzmanlık Tezi). Selçuk Üniversitesi, Konya.
14. Bozdemir MN, Kuk S, Yıldız M, Ateşçelik M, Baştürk M, Kılıçaslan İ. Evaluation of the Patients who Presented Emergengy Department Complaining of Diarrhea. Fırat Tıp Dergisi 2007; 12:118-120.
15. Guerrant RL, Gilder TV, Steiner TS et al. Practice guidelines for the management of infectious diarrhea. Clin Infect Dis 2001;32:331-351.
16. Koçak Tufan Z, Altun Ş, Bulut C, Kınıklı S, Demiröz AP. Protozoal Antigen Positivity in Diarrheal Patients Admitted to Emergency Service: A Point Prevalence Study. Mikrobiyol Bul 2011;45: 765-767.
17. Akyar I, Gültekin M. Five year surveillance of Entamoeba histolytica and Giardia antigen of stool samples by ELISA method. Turkiye Parazitol Derg 2012;36:12-6.
18. Çelik T, Bayındır Y, Tevfik M, Daldal N. İnönü Üniversitesi Tıp Fakültesi Turgut Özal Tıp Merkezi Parazitoloji Laboratuvarına başvuran hastalarda bağırsak parazitlerinin dağılımı. Turkiye Parazitol Derg 2000; 24: 380-383.
19. Reinthaler FF, Linck G, Klem G, Mascher F, Sixl W. Intestinal parasites in children with diarrhea in El Salvador. Geogr Med. 1988;18:175-80.
20. Çelik T, Güler E, Berksoy EA, Sorguç Y, Arslan N. Mean Platelet Volume in Children with Acute Gastroenteritis Caused by Entamoeba histolytica. Turkiye Parazitol Derg 2015;39:205-8.