Fadıl VARDAR, Dilek ÇİFTDOĞAN YILMAZ, Nuri BAYRAM, Aşan ÖNDER

Çocuklarda Pnömokok Enfeksiyonlarında Üriner Antijen Taraması

Streptococcus pneumoniae çocukluk çağındaki menenjit, bakteriyemi, pnömoni ve otitlerin en önemli nedenidir. Pnömokokkal enfeksiyonların tanısı halen problemdir. Binax NOW, idrarda S. pneumoniae C- polisakkarit antijenini tarayan hızlı bir immunkromotografik testtir (İKT).Biz çalışmamızda, çocuklardaki pnömokok enfeksiyonlarının tanısında İKT in kullanılabilirliğini araştırdık. Çalışmamıza 50 sağlıklı çocuk (kontrol grubu) ile sepsis, pnömoni, otit ve menenjit tanılı 50 çocuk (hasta grubu) alındı. Tüm olgulardan idrar örnekleri ve nasofaringeal kültürler elde edildi. Ayrıca hasta grubunda uygun olan olgulardan kan, transtrekeal aspirat, idrar ve BOS (beyin omurilik sıvısı) örnekleri alındı.Kontrol grubunda 7 olguda ve hasta grubunda da 10 olguda üriner antijen pozitifliği bulduk. Nazofarinkslerinde S. pneumoniae taşıyan 3 çocuktan (1 kontrol grubunda, 2 hasta grubunda) hepsinde IKT pozitifti. Biz 1 kan kültüründe, 2 BOS kültüründe olmak üzere 3 olguda pnömokok saptadık. Hepsinde İKT pozitifti. Antimikrobial tedavinin, aşılamanın ve akut faz reaktan düzeylerinin üriner antijen tarama testi üzerine etkisi yoktu.Biz, çocuklardaki pnömokoksik enfeksiyonların tanısında yüksek taşıyıcılık oranlarının yanlış pozitifliğe yol açması nedeniyle bu testin kullanılabilir olmadığı sonucuna vardık. Bu test, sadece diğer geleneksel mikrobiyolojik yöntemlerle birlikte destekleyici yöntem olarak denenebilir.

Anahtar Kelimeler:

Streptokokus pnömonia, üriner antijen, çocuk

URINARY ANTIGEN SCREENING IN PNEUMOCOCCAL INFECTIONS IN CHILDREN

Streptococcus pneumoniae is a leading cause of meningitis, bacteremia, pneumonia and otitis media in childhood. The diagnosis of pneumococcal infections still remains problematic. Binax NOW® is a rapid immunochromatographic test (ICT) that detects S. pneumoniae C-polysaccharide antigen in the urine. We evaluated the usefulness of ICT in the diagnosis of pneumococcal infections in children in our study. Fifty children with sepsis, pneumonia, otitis or meningitis (patient group) and 50 healthy children (control group) were enrolled in the study. Urine samples and nasopharyngeal cultures were obtained from all cases. Blood, transtracheal aspirate, urine and CSF (cerebrospinal fluid) cultures were also taken from the patient group when possible. We found urinary antigen positivity in 7 cases in the control group and 10 cases in the patient group. All the children who carried S. pneumoniae in their nasopharynx (1 in the control group and 2 in the patient group for a total of 3 cases) had positive ICT. We detected S. pneumoniae in 3 patients (1 blood culture and 2 CSF cultures) and ICT was positive in all. There was no effect of antimicrobial treatment, vaccination and acute phase reactant levels on the urinary antigen detection test. We concluded that this test is not useful in the diagnosis of pneumococcal infections in children as high carrier rates cause false positivity. This test can only be used with other conventional microbiological tests as a supplementary method

Keywords:

Streptococcus pneumoniae, urinary antigen, children,

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