Enterik Ate\u015f; <\/p>\n
Bir di\u011fer ad\u0131 da enterik ate\u015f olan tifo ve paratifo hastal\u0131klar\u0131 hemen hemen ayn\u0131d\u0131r; tek farklar\u0131 hastal\u0131klar\u0131 olu\u015fturan mikroplard\u0131r. Bilin\u00e7 bulan\u0131kl\u0131\u011f\u0131, d\u00fc\u015fmeyen ate\u015f, ba\u015f a\u011fr\u0131s\u0131, kar\u0131n a\u011fr\u0131s\u0131 ile karakterize hastal\u0131k; kirli besinler ve sularla a\u011f\u0131z yolundan bula\u015f\u0131r, baz\u0131 \u00fclkelerde zaman zaman salg\u0131nlar yapar, tedavi edilmezse \u00f6l\u00fcmle bile sonu\u00e7lanabilir. <\/p>\n
Tan\u0131m: <\/p>\n
Tifo, S.typhi ; paratifo ise S.paratyphi A, B, C isimli basil t\u00fcr\u00fc bakterilerin neden oldu\u011fu hastal\u0131klard\u0131r. Bilin\u00e7 bulan\u0131kl\u0131\u011f\u0131, d\u00fc\u015fmeyen ate\u015f, ba\u015f a\u011fr\u0131s\u0131, kar\u0131n a\u011fr\u0131s\u0131, (ate\u015fin y\u00fckselmesine ra\u011fmen) nab\u0131z say\u0131s\u0131n\u0131n azalmas\u0131, dalakta b\u00fcy\u00fcme,kandaki akyuvar h\u00fccrelerinin say\u0131s\u0131nda azalma, g\u00f6\u011f\u00fcs-kar\u0131n cildinde g\u00fcl kurusu renginde lekeler ile karakterize, insanlara \u00f6zg\u00fc sistemik infeksiyon hastal\u0131klar\u0131d\u0131r. Daha \u00e7ok kirli besinler ve sularla a\u011f\u0131z yolundan bula\u015fan, baz\u0131 \u00fclkelerde zaman zaman salg\u0131n yapan, tedavi edilmezse \u00e7e\u015fitli komplikasyonlar ile \u00f6l\u00fcmle sonu\u00e7lanabilen hastal\u0131klard\u0131r. <\/p>\n
Etkenler: <\/p>\n
S.typhi ve S.paratyphi A, B ve C sadece insan infeksiyonlar\u0131ndan sorumludur, insan-insan bula\u015f\u0131 s\u00f6z konusudur, mikrobun ya\u015fad\u0131\u011f\u0131 tek canl\u0131 insand\u0131r. Genelde hasta insan\u0131n basil y\u00fckl\u00fc \u00e7\u0131kart\u0131lar\u0131 yoluyla mikrobun bula\u015ft\u0131\u011f\u0131 besin ve sularla bula\u015f\u0131r.Hastal\u0131\u011f\u0131n su yoluyla sakg\u0131n yapmas\u0131 nadir de\u011fildir. Hastalar d\u0131\u015fk\u0131 ve idrarlar\u0131yla bol miktarda basil \u00e7\u0131kard\u0131klar\u0131 gibi, di\u011fer \u00e7\u0131kart\u0131lar\u0131nda da (solunum yolu salg\u0131lar\u0131, kusmuk v.s) bulunabilir. Ta\u015f\u0131y\u0131c\u0131lar \u00e7ok fazla say\u0131da bakteri yayarlar, bu ki\u015filerin d\u0131\u015fk\u0131lar\u0131n\u0131n 1 gram\u0131nda 1,000,000,000-100,000,000,000 tifo basili oldu\u011fu saptanm\u0131\u015ft\u0131r. <\/p>\n
Hastal\u0131\u011f\u0131n meydana geli\u015fi: <\/p>\n
Bakteriler sa\u011fl\u0131kl\u0131 ve duyarl\u0131 ki\u015fi taraf\u0131ndan a\u011f\u0131z yolundan al\u0131nd\u0131ktan sonra mideye gelir. Salmonellalar mide asidine duyarl\u0131d\u0131r ve burada \u00f6l\u00fcrler, ancak besinlerle ya da bol s\u0131v\u0131 ile al\u0131nd\u0131\u011f\u0131nda bu etkiden korunabilirler. Di\u011fer yandan mide asiditesinde bozukluk oldu\u011fu (aklorhidri, gastrektomi, antiasid kullan\u0131m\u0131 gibi) durumlarda bu engeli kolayca a\u015farlar. Bakterinin al\u0131nan miktar\u0131 hastal\u0131k olu\u015fma olas\u0131l\u0131\u011f\u0131n\u0131 etkiler. A\u011f\u0131z yolundan al\u0131nan bakteri miktar\u0131 109 kadarsa %95 olas\u0131l\u0131kla hastal\u0131k geli\u015fir. <\/p>\n
Klinik: <\/p>\n
Enterik ate\u015fin kulu\u00e7ka s\u00fcresi ortalama 10-14 g\u00fcnd\u00fcr; 3-5 g\u00fcn gibi k\u0131sa olabilece\u011fi gibi 60 g\u00fcne kadar da uzayabilir. Al\u0131nan bakteri miktar\u0131 artt\u0131k\u00e7a ink\u00fcbasyon s\u00fcresi k\u0131salmaktad\u0131r. Hafif belirtilerle, ak\u015famlar\u0131 37.5-38oC ate\u015fle kendini g\u00f6steren gribe benzer \u015fekilde seyredebilir. Bazen \u00e7ok a\u011f\u0131r seyir g\u00f6sterebilir. Bazen de sekiz haftay\u0131 ge\u00e7en s\u00fcrelerde devam eden klinik \u015fekilleri olabilir. Tipik bir enterik ate\u015fin seyrinde ise hastal\u0131\u011f\u0131n s\u00fcresi ortalama d\u00f6rt haftad\u0131r. <\/p>\n
1. Hafta: \u00c7o\u011fu kez 1-2 g\u00fcn s\u00fcren k\u0131r\u0131kl\u0131k, i\u015ftahs\u0131zl\u0131k, \u00fcrpermeler, ba\u015f a\u011fr\u0131s\u0131 gibi yak\u0131nmalarla ba\u015flar. Her g\u00fcn 1-20C y\u00fckselen v\u00fccut \u0131s\u0131s\u0131 bu haftan\u0131n sonunda 39-40 0C\u2019ye ula\u015f\u0131r. \u0130\u015ftahs\u0131zl\u0131k, yorgunluk, v\u00fccut a\u011fr\u0131lar\u0131, al\u0131nda fazla olmak \u00fczere k\u00fcnt, s\u00fcrekli ba\u015f a\u011fr\u0131s\u0131, uykuya meyil ate\u015fe e\u015flik eder, \u00f6ks\u00fcr\u00fck ve burun kanamas\u0131 g\u00f6r\u00fclebilir. Kar\u0131n a\u011fr\u0131s\u0131 ve kar\u0131nda rahats\u0131zl\u0131k hissi vard\u0131r. Deri s\u0131cak ve kurudur. \u00c7o\u011fu kez terleme olmaz. Bu haftada hastalar daha \u00e7ok kab\u0131zl\u0131ktan yak\u0131n\u0131r, bazen ishal yak\u0131nmas\u0131 da olabilir. <\/p>\n
2. ve 3. Hafta : T\u00fcm belirtilerde \u015fiddetlenme olur, ate\u015f 39.5-400C bazen 41-42 0C\u2019ye \u00e7\u0131kar, devaml\u0131 bir hal al\u0131r. Hastan\u0131n genel durumu bozuktur, a\u011f\u0131r hasta g\u00f6r\u00fcn\u00fcm\u00fcndedir. \u00c7o\u011fu kez zeka faaliyetleri durmu\u015f, bak\u0131\u015flar sabit, donuk olup hastan\u0131n mimikleri kaybolur. Hastan\u0131n etraf\u0131yla ilgisi kesilmi\u015ftir. Kendine verilen yiyecek ve i\u00e7ece\u011fin fark\u0131nda de\u011fildir. <\/p>\n
Kar\u0131n \u00fcst k\u0131sm\u0131nda ve g\u00f6\u011f\u00fcs cildinde ciltten kabar\u0131k, bas\u0131nca solan, birka\u00e7 mm \u00e7ap\u0131nda, g\u00fcl kurusu (pembe) renkte d\u00f6k\u00fcnt\u00fcler belirir, 2-3 g\u00fcn s\u00fcrer. A\u015f\u0131r\u0131 halsizlik, bilin\u00e7te k\u00fcntle\u015fme, baz\u0131 hastalarda delilik hali g\u00f6r\u00fcl\u00fcr. Kar\u0131nda rahats\u0131zl\u0131k hissi, \u015fi\u015fkinlik artar. Karaci\u011fer ve dalaktaki b\u00fcy\u00fcme saptanmaya ba\u015flar. Bu haftada ishal yak\u0131nmas\u0131 kab\u0131zl\u0131\u011fa g\u00f6re daha fazlad\u0131r. D\u0131\u015fk\u0131da kan bulunabilir. Baz\u0131 hastalar\u0131n parmaklar\u0131 ritmik hareketlerle \u00f6rt\u00fcleri toplar; bu dikkat \u00e7ekici bir belirtidir. <\/p>\n
4. Hafta: Komplikasyon g\u00f6r\u00fclmezse \u00fc\u00e7\u00fcnc\u00fc haftadan sonra ate\u015f d\u00fc\u015fmeye ba\u015flar, yava\u015f yava\u015f d\u00fc\u015ferek d\u00f6rd\u00fcnc\u00fc haftan\u0131n sonuna do\u011fru v\u00fccut \u0131s\u0131s\u0131 normale d\u00f6ner. Be\u015finci hafta nekahat d\u00f6nemidir. <\/p>\n
Tan\u0131: <\/p>\n
Kesin tan\u0131; kan, kemik ili\u011fi, d\u0131\u015fk\u0131 veya idrardan etkenin \u00fcretilmesi ile konur. Hasta antibiyotik kullanmadan \u00f6nce bu \u00f6rneklerden birden fazla k\u00fclt\u00fcr yap\u0131lmas\u0131 bakterinin \u00fcretilme \u015fans\u0131n\u0131 art\u0131rmaktad\u0131r. \u00dclkemizde ise hastalar \u00e7o\u011fu kez antibiyotik kullanarak hekime ba\u015fvurdu\u011fu i\u00e7in kan k\u00fclt\u00fcrlerinde bakterinin \u00fcretilme \u015fans\u0131 azalmaktad\u0131r. <\/p>\n
1. haftada \u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026. Kan k\u00fclt\u00fcr\u00fc <\/p>\n
2. haftada \u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026. \u00d6ncelikle d\u0131\u015fk\u0131 k\u00fclt\u00fcr\u00fc, kan k\u00fclt\u00fcr\u00fc de (+) olabilir <\/p>\n
3. haftada \u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026. \u00d6ncelikle idrar k\u00fclt\u00fcr\u00fc, d\u0131\u015fk\u0131 k\u00fclt\u00fcr\u00fc de (+) olabilir <\/p>\n
4. hafta ve sonras\u0131nda \u2026\u2026\u2026…\u2026…..\u00d6ncelikle safra k\u00fclt\u00fcr\u00fc, d\u0131\u015fk\u0131 k\u00fclt\u00fcr\u00fc de (+) olabilir <\/p>\n
Bu tip \u00f6zg\u00fcl tan\u0131 y\u00f6ntemleri yan\u0131nda di\u011fer baz\u0131 laboratuvar testleri enterik ate\u015f tan\u0131s\u0131na yard\u0131mc\u0131 olabilir. Hemogram,l\u00f6kosit form\u00fcl\u00fc, sedimantasyon yap\u0131l\u0131r. <\/p>\n
Komplikasyonlar: <\/p>\n
Enterik ate\u015fin komplikasyonlar\u0131 \u00e7ok \u00e7e\u015fitlidir, ba\u015fl\u0131calar\u0131 \u015funlard\u0131r: Endotoksik \u015fok, mide kanamas\u0131, barsak delinmesi, safra kesesi iltihab\u0131, sar\u0131l\u0131k, damar iltihab\u0131, deliryum (delilik hali), havale, zat\u00fcrre, bron\u015fit, b\u00f6brek-kas-eklem iltihaplar\u0131, tromboflebit (bir \u00e7e\u015fit damar iltihab\u0131), menenjit. <\/p>\n
Ba\u011f\u0131\u015f\u0131kl\u0131k : <\/p>\n
Tifo hastal\u0131\u011f\u0131 ge\u00e7iren ki\u015filerde ba\u011f\u0131\u015f\u0131kl\u0131k geli\u015fir. Ki\u015fi, ikinci kez tifo basili ile kar\u015f\u0131la\u015ft\u0131\u011f\u0131nda genellikle tekrar hastalanmaz, ancak antibiyotik tedavisi erken ba\u015flanan hastalar ikinci kez tifo ge\u00e7irebilir. <\/p>\n
Prognoz : <\/p>\n
Komplikasyonlardan \u00f6nemli \u015fekilde etkilenir. Antibiyotik \u00f6ncesi d\u00f6nemde \u00f6l\u00fcm oran\u0131 % 15 civar\u0131nda iken, tedavi g\u00f6ren hastalarda % 1-2\u2019ye d\u00fc\u015fm\u00fc\u015ft\u00fcr. \u00d6l\u00fcm nedeni genelde a\u011f\u0131r toksemi (mikrobun \u00fcretti\u011fi zehirli toksinlerin kana kar\u0131\u015fmas\u0131) , dola\u015f\u0131m yetmezli\u011fi, barsak delinmesi, mide kanamas\u0131 ile zat\u00fcrredir. <\/p>\n
Tedavi: <\/p>\n
Tifoda mikroba kar\u015f\u0131 yap\u0131lan tedavide ilk kullan\u0131lacak ila\u00e7 kloramfenikold\u00fcr. Ate\u015f genellikle 3-5 g\u00fcn i\u00e7inde d\u00fc\u015fer. \u00d6l\u00fcm oran\u0131da % 20\u2019lerden % 1\u2019e d\u00fc\u015fm\u00fc\u015ft\u00fcr. Kinolon grubu ila\u00e7lar paratifoda ilk se\u00e7enektir. Tifoda da etkili bi\u00e7imde kullan\u0131lmaktad\u0131r. Ate\u015f \u00fc\u00e7 g\u00fcn i\u00e7inde kontrol alt\u0131na al\u0131nmaktad\u0131r. Di\u011fer bir se\u00e7enek, 3. ku\u015fak sefalosporinlerdir. \u00c7ocuklarda, gebelerde, s\u00fct veren annelerde tercih edilir. <\/p>\n
Tedaviye yan\u0131t al\u0131namayan a\u011f\u0131r toksemik hastalarda steroid kullan\u0131labilir. Perforasyon durumunda 4-6 saat i\u00e7inde cerrahi m\u00fcdahale gerekmektedir. <\/p>\n
Ate\u015f d\u00fc\u015f\u00fcr\u00fcc\u00fc ila\u00e7lardan \u00f6zellikle Aspirin ate\u015fi anormal \u015fekilde a\u015f\u0131r\u0131 d\u00fc\u015f\u00fcrebilece\u011fin kullan\u0131lmamal\u0131d\u0131r. Ate\u015fi d\u00fc\u015f\u00fcrmek amac\u0131 ile \u0131slak kompres yap\u0131lmal\u0131d\u0131r. Kab\u0131zl\u0131k i\u00e7in ila\u00e7 ve lavmanlar kullan\u0131lmaz. <\/p>\n
Kronik (s\u00fcregen) ta\u015f\u0131y\u0131c\u0131larda da ampisilin, amoksisilin ya da kinolon grubu antibiyotikler kullan\u0131l\u0131r. <\/p>\n
Korunma: <\/p>\n
En etkili y\u00f6ntem i\u00e7me ve kullanma sular\u0131n\u0131n gerekli ar\u0131tma sistemlerinden ge\u00e7irilerek temiz su temini ve sa\u011fl\u0131kl\u0131 bir at\u0131k giderim sisteminin kurulmas\u0131d\u0131r. Tifolu hastalar\u0131n kulland\u0131\u011f\u0131 tuvaletler dezenfekte edilmelidir. Ki\u015fisel hijyen \u00f6nemlidir. <\/p>\n
Tifodan korunmada di\u011fer etkili bir y\u00f6ntem de a\u015f\u0131lamad\u0131r. Bir g\u00fcn ara ile \u00fc\u00e7 doz \u015feklinde al\u0131nd\u0131\u011f\u0131nda koruyuculu\u011fu <\/p>\n
% 43-96 aras\u0131ndad\u0131r.<\/p>\n","protected":false},"excerpt":{"rendered":"
Enterik Ate\u015f; Bir di\u011fer ad\u0131 da enterik ate\u015f olan tifo ve paratifo hastal\u0131klar\u0131 hemen hemen ayn\u0131d\u0131r; tek farklar\u0131 hastal\u0131klar\u0131 olu\u015fturan mikroplard\u0131r. Bilin\u00e7 bulan\u0131kl\u0131\u011f\u0131, d\u00fc\u015fmeyen ate\u015f, ba\u015f a\u011fr\u0131s\u0131, kar\u0131n a\u011fr\u0131s\u0131 ile karakterize hastal\u0131k; kirli besinler ve sularla a\u011f\u0131z yolundan bula\u015f\u0131r, baz\u0131 \u00fclkelerde zaman zaman salg\u0131nlar yapar, tedavi edilmezse \u00f6l\u00fcmle bile sonu\u00e7lanabilir. Tan\u0131m: Tifo, S.typhi ; paratifo …<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1407,1403],"tags":[5840,5842,2181,5836,5841,5844,5843,5838,5837,5839,5835],"class_list":["post-2314","post","type-post","status-publish","format-standard","hentry","category-fen-ve-teknoloji-odevleri","category-odevler","tag-aklorhidri","tag-antiasid","tag-bakteri","tag-enterik-ates","tag-gastrektomi","tag-kloramfenikol","tag-prognoz","tag-s-paratyphi","tag-s-typhi","tag-salmonella","tag-tifo-ve-paratifo"],"_links":{"self":[{"href":"https:\/\/www.islamidavet.com\/kutuphane\/wp-json\/wp\/v2\/posts\/2314","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.islamidavet.com\/kutuphane\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.islamidavet.com\/kutuphane\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.islamidavet.com\/kutuphane\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.islamidavet.com\/kutuphane\/wp-json\/wp\/v2\/comments?post=2314"}],"version-history":[{"count":0,"href":"https:\/\/www.islamidavet.com\/kutuphane\/wp-json\/wp\/v2\/posts\/2314\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.islamidavet.com\/kutuphane\/wp-json\/wp\/v2\/media?parent=2314"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.islamidavet.com\/kutuphane\/wp-json\/wp\/v2\/categories?post=2314"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.islamidavet.com\/kutuphane\/wp-json\/wp\/v2\/tags?post=2314"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}