Arif Dogan HABİLOGLU, Duygu MERT, Niyazi KARAMAN, Guray TOGRAL, Mustafa ERTEK

Üçüncü basamak bir hastanede 2006-2016 yılları arasında kistik ekinokokkozis vakaları

Amaç: Ekinokokkoz, Echinococcus türlerinin neden olduğu zoonotik bir hastalıktır. Echinococcus granulosus hastalığın en sık etkenidir. Önemli oranda mortalite ve morbiditeye neden olmaktadır. Bu çalışmada hepatik ve ekstrahepatik tutulumu olan kist hidatik vakalarının klinik ve laboratuvar bulgularını karşılaştırarak serolojik, biyokimyasal ve rekürrens açısından anlamlı bir fark olup olmadığını tespit etmek amaçlanmıştır.Yöntem: Çalışma retrospektif olarak planlandı. Toplam 82 hasta değerlendirildi. Hastalar, hepatik ve ekstrahepatik tutulumu olanlar olarak iki gruba ayrıldı. Hepatik tutulum 45 hastada, ekstrahepatik tutulum ise 37 hastada saptandı. Bulgular: Hepatik tutulumu olan grupta 20 erkek ve 25 kadın hasta vardı. Hastaların ortalama yaşı 47 idi. Laboratuvar tetkiklerinde; %25’inde lökositoz ve %4’ünde eozinofili belirlendi. Hastaların %44’ünde C-reaktif protein CRP , %8’inde globulin fraksiyonu, %35’inde karaciğer fonksiyon testleri KCFT veya bilirubin değerlerinde artma saptandı. Hastaların %60’ında indirekt hemaglutinasyon antikor IHA testi pozitif bulundu. 20 hastada rekürrens saptandı. Ekstrahepatik tutulumu olan grupta 14 erkek of liver function test LFT or bilirubin were found. Indirect hemagglutination antibody IHA test was positive in 60% of patients. 20 patients had recurrence.In group of extrahepatic involvement 14 patients were male and 20 patients were female. The mean age of the patients was 48. In the laboratory examination; in 16% of patients leukocytosis and in 5% of patients eosinophilia were detected. In 8% of patients increase of globulin fraction, in 16% of patients increase of CRP, in 38% of patients increase of LFT or bilirubin were detected. In 50% of patients IHA test positivity were found. 17 patients had recurrence. Conclusion: In the group with hepatic involvement, leukocytosis, CRP increase, diabetes mellitus DM comorbidity, IHA test positivity and recurrence development were higher compared to the extrahepatic patients. The increase in globulin fraction, LFT or

Anahtar Kelimeler:

Ekinokokkozis, hepatik tutulum, ekstrahepatik tutulum

Cystic echinococcosis cases in a tertiary hospital between 2006 and 2016

Objective: Echinococcosis is a zoonotic disease caused by Echinococcus species. Echinococcus granulosus is the most frequent factor of disease. It is the cause of significant morbidity and mortality. The aim of this study was to compare the clinic and laboratory findings in hepatic and extrahepatic involvement of hydatid cysts cases and to determine whether there was a significant difference in terms of serological, biochemical and recurrence in both group.Methods: The study was planned retrospectively. Total of 82 patients were evaluated. Patients were divided into two groups as hepatic and extrahepatic involvement. Hepatic involvement was detected in 45 patients and extrahepatic involvement was detected in 37 patients.Results: In group of hepatic involvement, 20 patients were male and 25 patients were female. The mean age of the patients was 47 years. In the laboratory examination; in 25% of patients leukocytosis and in 4% of patients eosinophilia were detected. In 8% of patients increase of globulin fraction, in 44% of patients increase of C-reactive protein CRP , in 35% of patients increase 1Hacettepe University Faculty of Medicine, Department of Internal Medicine, Intensive Care Unit, Ankara2University of Health Sciences, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara3University of Health Sciences Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Department of General Surgery, Ankara,4University of Health Sciences, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Department of Orthopedics, Ankaraof liver function test LFT or bilirubin were found. Indirect hemagglutination antibody IHA test was positive in 60% of patients. 20 patients had recurrence.In group of extrahepatic involvement 14 patients were male and 20 patients were female. The mean age of the patients was 48. In the laboratory examination; in 16% of patients leukocytosis and in 5% of patients eosinophilia were detected. In 8% of patients increase of globulin fraction, in 16% of patients increase of CRP, in 38% of patients increase of LFT or bilirubin were detected. In 50% of patients IHA test positivity were found. 17 patients had recurrence. Conclusion: In the group with hepatic involvement, leukocytosis, CRP increase, diabetes mellitus DM comorbidity, IHA test positivity and recurrence development were higher compared to the extrahepatic patients. The increase in globulin fraction, LFT or bilirubin increase, eosinophilia, gender distribution, mean age and underlying malignancy were similar in both groups. No statistically significant difference was found between the findings of the hepatic involvement and extra hepatic involvement

Keywords:

Echinococcosis, hepatic involvement, extrahepatic involvement,

PDF

___

1. Yılmaz GR, Babur C. Diagnosis of echinococcosis. Turk Hij Den Biyol Derg, 2007; 64(3): 35-44.
2. Kılınc N, Uzunlar AK, Ozaydın M. Uncommonly localized cases of echinococcosis (Report of 45 cases). Tr J Ecopathol, 2003; 9(1-2): 25-30.
3. Koksal AS, Arhan M, Oguz D. Kist hidatik. Guncel Gastroenteroloji, 2004; 8(1): 61-67.
4. Ozin Y, Kilic ZMY, Parlak E, Kacar S, Turhan N, Sasmaz N, et al. Hepatic Echinococcus multilocularis (alveolaris), case report and review of the literature. Turk J Gastroenterol, 2008; 7(2): 106-110.
5. Arslan MK, Eren A, Karanfil R, Cekin C. The hydatid cyst in sudden deaths. Journal of Forensic Medicine, 2007; 21(2): 20-24.
6. Kaplan M, Aygen E, Ozyurtkan MO, Bakal U. Cystic echinococcosis cases in Firat University Hospital Between 2005 and 2007. FU Sag Bil Tıp Derg, 2010; 24(2): 109-113.
7. Gavidia CM, Gonzalez AE, Zhang W, McManus DP, Lopera L, Ninaquispe B, et.al. Diagnosis of cystic echinococcosis, central Peruvian Highlands. Emerg Infect Dis, 2008; 14(2): 260-266.
8. Menghebat L, Jiang L, Chai J. A retrospective survey for surgical cases of cystic echinococcosis in the Xinjiang Uygur Autonomous Region, PRC (1951– 90). In: Andersen F, Chai J, Liu F, eds. Compendium on Cystic Echinococcosis with Special Reference to the Xinjiang Uygur Autonomous Region, People’s Republic of China. Provo: Brigham Young University Print Services, 1993: 135-145.
9. Esgin M, Aktas M, Coskun S. The investigation of antibody presence in the sera of patients with a suspicion of cystic echinococcosis by using indirect hemaglutination test (IHA). Turkiye Parazitol Derg, 2007; 31(4): 283- 2.
10. Demirci E, Altun E, Calık M, Subası ID, Sipal S, Gundogdu OB. Hydatid cyst cases with different localization: region of Erzurum. Turkiye Parazitol Derg, 2015; 39: 103-107.
11. Force L, Torres JM, Carrillo A, Buscà J. Evaluation of eight serological tests in the diagnosis of human echinococcosis and follow-up. Clin Infect Dis, 1992; 15(3): 473-480.
12. Erkan H.D. Akciğer kist hidatiğinde serolojik testlerin (spesifik IgE, spesifik IgG ve indirek hemaglütinasyon testi) tanısal değeri. Uzmanlık tezi. T.C. Sağlık Bakanlığı Yedikule Göğüs Hastalıkları ve Göğüs Cerrahisi Eğitim ve Araştırma Hastanesi Merkezi, İstanbul, 2004.
13. Isitmangil T, Gorur R, Yiyit N, Erdik O, Yıldızhan A, Candas F, et al. Evaluation of 308 patients surgically treated for thoracic hydatidosis. Turk Gogus Kalp Damar, 2010; 18(1): 27-33.
14. Agacfidan A, Badur S, Hazar H, Emre A, Cetin ET. Comparison of the indirect hemagglutination test and enzyme immunoassay for serodiagnosis of hydatid cyst. Klimik Derg, 1992; 5(2): 107-109.
15. Gavidia GM. Cystic echinococcosis in Peru: human prevalence study and chemotherapy evaluation in sheep. Ann Arbor: ProQuest LLC, 2009.
16. Sahin EM, Yuksek YN, Daglar G, Gozalan U, Kama NA. Diagnosis and treatment of hydatid cysts: results of 120 patients. Balkan Med J, 2008; 25(1): 6-14.
17. Pitt HA, Korzellus J, Tompkins RK. Management of hepatic echinococcosis in Southern California. Am J Surg, 1986; 152(1): 110-115.
18. Behrns KE, van Heerden JA. Surgical management of hepatic hydatid disease. Mayo Clin Proc, 1991; 66: 1193-1197.
19. Safioleas M, Misiakos E, Manti C, Katsikas D, Skalkeas G. Diagnostic evaluation and surgical management of hydatid disease of the liver. World J Surg, 1994; 18: 859-865.
20. Uysal S, Uyan A, Tasbakan MI, Sipahi OR, Yamazhan T, Pullukcu H, et al. Clinical evaluation of fifteen cases of hydatid disease. Mediterr J Infect Microb Antimicrob, 2015; 4: 13.
21. Refik M, Mehmet N, Durmaz R. Postoperative changes in serum cytokines profile and oxide levels in patients with cystic echinococcosis. Parasite, 2005; 12: 265- 269.
22. Wellinghausen N, Jöchle W, Reuter S, Flegel WA, Grünert A, Kern P. Zinc status in patients with alveolar echinococcosis is related to disease progression. Parasite Immunol, 1999; 21(5): 237-41
23. Sura BK. A study of some biochemical changes in hydatid cyst patients before and after surgical removal of hydatid cyst. AJPS, 2013; 13(2): 103- 108.