Göðüs Hastanesi Dergisi. 2004; 18(2): 77-81

YAYMA NEGATÝF TÜBERKÜLOZ OLGULARINDA TÜBERKÜLOZ TEDAVÝSÝ SONUÇLARI

Kadri ÇIRAK¹, Serkan KARACA¹, Sibel YANIKOÐLU¹, Rýfat ÖZACAR¹
Göðüs Hastalýklarý ve Cerrahisi Eðitim ve Araþtýrma Hastanesi, Ýzmir

Bakteriyolojik v e patolojik taný olmadan uygun klinik, laboratuar ve radyolojik veriler nedeniyle, olasý tanýlar dýþlandýktan sonra, tüberküloza yönelik medikal tedavi baþlanýp yanýt alýnmasý tüberküloz (Tb) taný yöntemlerinden biridir. Ocak 1997 - Aralýk 2000 yýllarý arasýnda 872 tüberküloz olgusundan yayma negatif ve tüberküloz tedavisi uygulanan 73 (%8.4) olgu çalýþmaya alýndý. Tümü erkek olan olgularýmýzýn yaþ ortalamasý 39.5 (17-74) ve en sýk saptanan semptomlar öksürük, kilo kaybý, gece terlemesi, göðüs aðrýsý ve hemoptizi idi. Ortalama eritrosit sedimentasyon hýzý 60.1 mm/h idi. Tüberkülin deri testi 65 olguda deðerlendirildi; 51'inde müspet bulundu. Posteroanterior akciðer radyogramlarýnda olgularýn 33'ünde bilateral tutulum 32'sinde bronkojen yayýlým, 29'unda konsolidasyon, 22'sinde kavite saptandý. Toraks yüksek rezolüsyonlu bilgisayarlý tomografi (YRBT) incelemesi yapýlan ellidokuz olgunun 35'inde lezyonlar ýn özellikleri ve yaygýnlýðý açýsýndan akciðer radyogramýa göre daha fazla bulgu saptandý. Ellibeþ olguya fiberoptik bronkoskopi uygulandý. Empirik tb tedavisi baþlama kararý vermeden önce olgu baþýna balgam, bronþ aspirasyonu, bronkoalveolar yýkama suyu ve postbronkoskopik balgam gibi örneklerde homojenizasyon yöntemiyle asido-rezistan basil (ARB) baký sayýsý ortalama 4.9 (3-7) idi. Tedavi altýndaki olgularýn 62'sinde klinik radyolojik iyileþme, 24'ünde ayný zamanda kültürde ARB olumluluðu da saptandý. Klinik, laboratuar ve radyolojik verilere dayanarak doðru Tb tanýsý koyabilme oranýmýz %85 olarak hesaplandý.

Anahtar Kelimeler: Tüberküloz tedavisi, yayma negatif olgular

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THE RESULTS OF TUBERCULOSIS THERAPY IN THE SMEAR NEGATIVE TUBERCULOSIS CASES

Kadri ÇIRAK¹, Serkan KARACA¹, Sibel YANIKOÐLU¹, Rýfat ÖZACAR¹
Göðüs Hastalýklarý ve Cerrahisi Eðitim ve Araþtýrma Hastanesi, Ýzmir

One of the diagnostic methods of tuberculosis is getting response after starting medical treatment due to clinical, laboratory and radiological data, without bacteriological and pathological diagnosis after all possible diagnoses are excluded. Between January 1997 - December 2000, among 872 tuberculosis cases, only 73 (8.4%) cases have taken into this study who was smear negative and got tuberculosis treatment. Our all cases were men and their median age was 39.5 (17-74). The most frequent symptoms were cough, the loss of weight, night sweating, chest pain, and haemoptysis. The average erythrocyte sedimentation rate was 60.1 mm/h. Tuberculin skin test has been evaluated in 65 cases, and it's found positive for 51 cases. On posteroanterior chest radiograms, 33 cases had bilateral involvement, 32 cases had bronchogenic spread, 29 cases had consolidation and 22 cases had cavities. Compared to chest radiogram, more findings have been observed on 35 out of 59 cases who had thorax high resolution computerized tomography in terms of the features of lesions and their prevalence. Fiberoptic bronchoscope has been applied to 55 patients. Before making the decision of starting empirical tuberculosis treatment, through homogenization style, in each case acide fast bacille (AFB) investigation number average was 4.9 (3-7), in such samples like sputum, bronchial aspiration, bronchoalveolar washing fluid and post bronchoscope sputum. Sixty-two cases had clinical and radiological recovery on first or second months of treatment, in the meantime AFB positiveness has been found in the culture of 24 patients. On the basis of clinical, laboratory, and radiological data, our accuracy rate calculated 85% in terms of diagnosing tuberculosis.

Keywords: Tuberculosis therapy, smear negative cases

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ATIF KOPYALA