Melike EMİROĞLU, Rahmi ÖRS, Osman KOÇ, Sadiye SERT, Uğur ARSLAN

Konya’da Ekim 2008 - Şubat 2010 tarihleri arasındaki çocukluk çağında toplum kökenli pnömoni tanısı ile hastaneye yatırılan hastalarda bakteriyel ve viral etkenlerin insidansı ve klinik özellikleri

Amaç: Bu çalışmada; toplum kökenli pnömoni tanısı (TKP) ile hastaneye yatırılan hastalarda bakteriyel ve viral etkenlerin insidansı ve klinik özellikleri araştırılması amaçlanmıştır.Yöntem: 1 Ekim 2008-28 Şubat 2010 tarihleri arasında Selçuk Üniversitesi Meram Tıp Fakültesi Çocuk Poliklinikleri ve Çocuk Acil Servisine başvuran ve yatırılarak tedavi edilmesi gereken, başvurudan 48 saat öncesine kadar antibiyotik kullanmayan, klinik olarak TKP tanısı olan, yaşları 1 ay ile 16 yaş arasındaki toplam 91 hasta çalışma kapsamına alındı. Bu hastaların demografik ve klinik özellikleri kaydedildi. Hastane başvurusu esnasında tam kan sayımı, eritrosit sedimantasyon hızı, C-reaktif protein, prokalsitonin, kan kültürü için kan numuneleri ve viral etiyolojiyi gerçek zamanlı polimeraz zincir reaksiyonu (RT-PCR) ile saptamak amacıyla nazofaringeal aspirat numuneleri alındı. Tüm hastaların PA akciğer radyografileri kontrol edildi.Bulgular:Hastaların %24,2 (22/91)'sinde pnömoni etkeni saptanırken, %75,8 (69/91)'inde herhangi bir pnömoni etkeni saptanamadı. 91 hastanın 11 (%12,1)'inde viral enfeksiyon, dokuzunda (%9,9) sadece bakteriyel enfeksiyon, üçünde (%3.3) viral koenfeksiyon, ikisinde (%2,2) hem virus hem de bakteri vardı. Virus tespit edilen 11 hastanın yedisinde Parainfluenza (PIV) 2, ikisinde PIV 3, birinde adenovirus, ikisinde hem PIV3 hem remains a leading cause of morbidity and mortality Childhood community-acquired pneumonia (CAP) adenovirus, birinde hem PIV2 hem de PIV3 tespit edildi. Hastaların hiçbirinde RSV, PIV1, hMPV saptanmadı. Bakteri tespit edilen 11 hastanın beşinde Stafilokokus epidermidis, ikisinde S. saprophyticus, birinde S. shominis, birinde S. capitis, birinde S. sobrinus ve birinde S. mitis tespit edildi. Hastaların ikisinde de viral-bakteriyel karma etken olduğu saptandı. Klinik olarak pnömoni tanısı alan 91 hastanın 59 (%64,7)'unda radyolojik olarak pnömoni varlığı belirlendi. Sonuç: Çalışmamız TKP'de viral etkenlerin etiyolojik etkisini gösterdi. Parainfluenza virus 2 tüm yaş gruplarında en sık tespit edilen viral etkendi. Viral enfeksiyonların etiyolojik tanılarının iyileştirilmesi ile gereksiz antibiyotik kullanımından kaçınılabilir. Sonuçlarımızı doğrulamak için daha kapsamlı ve randomize kontrollü çalışmalara gereksinim vardır

Clinical characteristics and incidence of bacterial and viral pathogens in patients hospitalized with community acquired pneumonia in childhood in Konya between October 2008 and February 2010

Objective: It was aimed to investigate clinical characteristics and incidence of bacterial and viral pathogens in patients who were hospitalized with the clinical diagnosis of community acquired pneumonia (CAP). Method: In this study 91 patients at the ages between one month and six years who required hospitalization and were admitted to pediatrics clinics and pediatric emergency services of the Selçuk University Meram Medical Faculty, and also who did not use antibiotics for 48 hours before hospital admission and had the clinical diagnosis of CAP were investigated from October 2008 to February 2010. Demographic and clinic characteristics of the patients were recorded. Blood samples for complete blood count, erytrocyte sedimentation rate, C-reactive protein, procalcitonin, blood culture and nasopharyngeal aspirate samples for detection of the viral etiologies by real time polymerase chain reaction (RT-PCR) were taken at the time of hospital admission. Initial posteroanterior (PA) chest X-rays of all patients were checked. Results: The agents of pneumonia were detected in 24.2% (22/91) but not in 75.8% (69/91) of our patients. Of 91 patients, 11 (12.1%) were positive for viral infections, 9 (9.9%) were positive for only bacterial infections, 3 (3.3%) had viral coenfection, 2 (2.2%) were positive for both viral and bacterial infections. Out of 11 viral positive patients, 7, 2, 1, 2, and 1 patients were detected to have parainfluenza virus (PIV) 2, PIV 3, adenovirus, both PIV 3 and adenovirus, both PIV 2 and PIV 3, respectively. RSV, PIV 1 and human metapneumovirus (hMPV) were not detected in any of cases. Out of 11 bacteria positive patients, 5, 2, 1, 1, 1, and 1 patients were detected to have Staphylococcus epidermidis, S. saprophyticus, S. hominis, S. capitis, S. sobrinus and S. mitis. Also mixed viral-bacterial agent presence were detected in 2 (2.2%) of our patients. Out of ninety one pneumonia patients those having their diagnosis clinically, 59 (64.7%) had radiological signs. Conclusion: Our study demonstrated the etiological influence of viral agents in CAP. Parainfluenza virus 2 was the most common viral agent among detected viruses in all age groups. Improving the etiological diagnosis of viral infections may avoid unnecessary the use of antibiotic. Further comprehensive and randomized controlled studies are needed to confirm our results.

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