Çocukluk Çağı Gastroenteritlerinin Etken, Sosyodemografik, Klinik ve Laboratuvar Özelliklerinin ve C Reaktif Protein ile İlişkisinin İncelenmesi

Amaç: Akut gastroenteritler çocukluk çağının önemli mortalite ve morbidite nedenlerinin başında gelmektedir. Acilservise gastroenterit şikayeti ile başvuran çocuklarda enfeksiyon kontrolü ve akılcı ilaç kullanımı açısından etkeninayrımı önemlidir. Özellikle gastroenterit salgınlarının arttığı dönemlerde yoğun başvuru olan Çocuk Acil Polikliklerindetedavi ve takip planı için ise etken ve çocuğun klinik durumu yanında ailenin sosyal durumu da önemlidir. Bu çalışmadagastroenterit etkenleri ile birlikte hastaların sosyodemografik/klinik özellikleri ve etkenlerin CRP (C Reaktif Protein) ileilişkisi incelenmiştir.Gereç ve Yöntemler: Çocuk acil polikliniğine akut gastroenterit şikayetiyle başvuran 2 ay -14 yaş arasındaki 400 hastanın katılımıyla yapıldı. CRP, hasta serumunda kantitatif olarak nefelometrik yöntemle belirlendi (1 mg/dl ve üzerindekideğer pozitif ). Ayrıca kan sayımı ve serum elektrolit düzeyleri, gaitada direkt mikroskobik inceleme ile lökosit ve parazitaraştırılması, hızlı antijen testi yöntemiyle gaitada Rotavirüs ile Adenovirüs antijen tayini ve gaita kültürü yapıldı.Bulgular: Hastaların %46’sında düşük sosyoekonomik düzey, % 29’unda kalabalık aile, %23’ünde ailede diğer bireylerdede eş zamanlı gastroenterit gözlendi ve %16’sı kreşe veya okula gitmekteydi. CRP (+)’liği kalabalık aile (p=0.043) ve kreş/okula gidenlerde (p=0.006) anlamlı derecede yüksek bulundu. Bulantı-kusma, ateş ve kanlı gaita şikayeti olanlardaCRP (+)’liği yüksek bulundu (hepsi için p

Investigation of the Childhood Gastroenterites in Terms of the Etiology, Socioodemographic, Clinical, Laboratory Properties and Relationship with C Reactive Protein

Objective: Acute gastroenteritis is one of the major cause of mortality and morbidity in childhood. Differantiating the pathogen is important for infection control and choosing appropriate treatment in children who present to emergency department with acute gastroenteritis. Beside the pathogen and clinical status of child and social status of the family is also important for the treatment and follow-up plan in pediatric Emergency department, especially during the increased periods of acute gastroenteritis epidemies. In this study beside the pathogens of gastroenteritis patients’ sociodemographic and clinical status and their relationship with C Reactive Protein CRP were investigated. Material and Methods: A total of 400 patients between the ages of 2 months and 14 years who had applied to pediatric emergency department with the complaint of acute gastroenteritis were admitted to the study. CRP was quantitatively determined by nephelometric method in patients’ serums; Values above 1 mg / dl and above were considered positive. In addition, whole blood count and serum electrolyte levels, direct microscopic examination of leukocytes and parasites of stool were investigated, fast antigen test method of Rotavirus Adenovirus antigen and also stool culture was done. Results: 46% of the patients had low socioeconomic status, 29% had a crowded family, 23% had a simultaneous gastroenteritis in the family, and 16% of them were attending nursery or school. CRP positiveness was significantly higher in the groups of crowded family (p = 0.043) and in the nursery / school (p = 0.006). CRP levels were found to be high in patients with nausea, vomiting, fever and bloody stool. (all p = 0.001) No pathogenic microorganism was detected in gaita cultures, CRP positivity was significantly high in patients with fever and blood stool and leukocytosis. In addition, CRP positiveness was significantly higher in Rotavirus, Adenovirus, and both positive cases (p = 0.02, p = 0.003, p = 0.0001, respectively). The rate of Rotavirus and Adenovirus positivity was high in hospitalized patients rather than not hospitalized. Conclusion: In conclusion, although CRP is frequently used as a bacterial marker, in addition to bacterial infections it may increase also in viral infections like patients who presented to the pediatric emergency department with gastroenteritis symptoms.

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1. Cheryl S.Y. Li, Paul K.S. Chan, Julian W. Tang. Prevalance of diarrhea viruses in hospitalized children in Hong Kong in 2008. J Med Virol 2009; 81:1903-11.
2. Dennehy PH. Acute diarrheal disease in children: epidemiology, prevention and treatment. Infect Dis Clin North Am 2005;19:585- 602.
3. Kosek M, Bern C, Guerrant RL. The global burden of diarrhoeal disease, as estimated from studies published between 1992 and 2000. Bull World Health Organ 2003;81: 197-204.
4. Szajewska H, Dziechciarz P. Gastrointestinal infections in pediatric population. Curr Opin Gastroenterol 2010;26:36-44.
5. Cunliffe NA, Booth JA, Elliot C, Lowe SJ, Sopwith W, Kitchin N et al. Healthcare-associated viral gastroentritis among children in a large pediatric hospital, United Kingdom. Emerg Infect Dis 2010;16:55-62.
6. WHO 2004 report. Diarrhoeal Diseases (Updated February 2009). http://www.who.int/vaccine_research/diseases/diarrhoeal/ en (15/05/2009).
7. Rosenfeldt V, Vesikari T, Pang XL, Zeng SQ, Tvede M, Paerregaard A. Viral etiology and incidence of acute gastroenteritis in young children attending day-care centers. Pediatr Infect Dis J 2005; 24:962-5.
8. Özkasap S, Yıldırım A, Yüksel S. Akut gastroenterit ve tedavisi. Klinik pediatri 2004; 3:12-18.
9. Marcus N, Mor M, Amir L, Mimouni M, Waisman Y. The quick-read C-reactive protein test for the prediction of bacterial gastroenteritis in the pediatric emergency department. Pediatr Emerg Care 2007;23:634-7.
10. Korczowski B, Szybist W. Serum procalsitonin and C- reactive protein in children with diarrhoea of various aetiologies. Acta Paediatr 2004;93:169-73.
11. Liu LJ, Yang YJ, Kuo PH, Wang SM, Liu CC. Diagnostic value of bacterial stool cultures and viral antigen tests based on clinical manifestations of acute gastroenteritis in pediatric patients Eur J Clin Microbiol Infect Dis 2005;24:559-61.
12. Tekin D.,Suskan E.,Atay G.,Belgemen T. Çocukluk çağında akut gastroenteritler, Poster 89, 1. Uludağ Pediatri Kış Kongresi 2005 20-23 Şubat Uludağ,Bursa,Türkiye
13. Biçer S, Tunca Şahin G, Koncay B, Yavuzcan D, Gemici H, Engerek N ve ark. Çocuk acil servisinde saptanan rotavirüs gastroenteriti olgularının sıklığı . J Pediatr Inf 2008; 3:96-9.
14. Akıncı N, Erener Ercan T, Yalman N, Eren A, Severge B, Ercan G. Akut gastroenteritli çocuklarda adenovirüs ve rotavirüs J Pediatr Inf 2007;1:98-11.
15. Altındiş M, Beştepe G, Çeri A, Yavru S, Kalaycı S. Akut ishal yakınmalı çocuklarda rotavirüs ve enterik adenovirüs sıklığı. Suleyman Demirel Univ Tıp Fak Derg 2008; 15:17-20.
16. Gimenez-Sanchez F, Delgado-Rubio A, Martinon-Torres F, Bernaola-Iturbe E. Rotascore Research Group. Multicenter prospecitve study analysing the role of rotavirus on acute gastroenteritis in Spain. Acta Paediatr 2010; 99:738-42.
17. Kanra G,Kara A. ishal patogenezi. Katkı pediatri dergisi 2000;21:6- 15.
18. Ceyhan M. Viral gastroenteritler. Katkı pediatri dergisi 2000;21:30- 38.
19. Özmert E, Yurdakök K. Dünyada ve Türkiye’de İshalli Hastalıklar. Katkı Pediatri Dergisi 2000;1-5.
20. Yurdakök K. İshalli çocuğa yaklaşım. Katkı Pediatri Dergisi 2000;21:94-104.
21. Bulut Y., İşeri L., Akut Gastroenterit ön tanılı çocuklarda rotavirüs pozitifliği İnonu Unv Tıp Fak Derg 2003;10:143-5.
22. Gül M, Garipardıç M, Çıracıgil P, Aral M. 0-5 yaş arası gastroenteritli çocuklarda Rotavirüs ve Adenovirüs Tip 40/41 araştırılması ANKEM Derg 2005; 19:64-67.
23. Gürbüz F, Tezer H, Şaylı TR, Akut Gastroenterit nedeniyle hastaneye yatan hastalarda etkenler ve klinik bulgular : Epidemiyolojik Çalışma. Turkish J. Pediatr. Dis. 2010; 4: 211-8.
24. Bates PR, Bailey AS, Wood DJ, Morris DJ, Comparative epidemiology of rotavirus, subgenus F(types 40 and 41) adenovirus, and astrovirus gastroenteritis in children. J Med Virol 1993; 39:224- 8.