Mycobacterium bovıs bcg suşunun neden olduğu fatal disemine enfeksiyon olgusu ve izolatın spoligotiplendirme ile tanımlanması
Küçük Resim Yok
Dosyalar
Tarih
2010
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Cilt Başlığı
Yayıncı
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Öz: Aşı suşu olarak kullanılan Mycobacterium bovis BCG, bağışıklık yetmezliği olan bireylerde yaygın ve ciddi enfeksiyonlara yol açabilmektedir. Bu raporda, kistik fibrozis ön tanısı ile ileri incelemeye alınan ve dışkı örneğinden aside dirençli basil (ARB) izole edilerek spoligotiplendirme ile M.bovis BCG suşu olarak tanımlanan disemine fatal bir tüberküloz olgusu sunulmaktadır. Bir yaşındaki erkek hasta, 20 gündür devam eden ateş, öksürük ve ishal şikayeti ile hastaneye yatırılmış ve öyküsünden, 4 aylıktan itibaren tekrarlayan alt solunum yolu enfeksiyonları geçirdiği öğrenilmiştir. Olgunun ailesinde tüberküloz geçirme ya da hasta bir kişiyle temas öyküsü yoktur. Klinik muayenede fiziksel gelişme geriliği saptanan olgunun akciğer grafisinde retiküler ve retikülonodüler infiltrasyon belirlenmiştir. Hastanın ter testi, kistik fibrozis gen mutasyonu ve metabolik taramaları normal bulunmuş, yatışının 12. günü antibiyotik tedavisine rağmen ateşinin devam etmesi ve akciğer infiltrasyonlarının olması nedeniyle PPD uygulanarak, üç gün üst üste alınan mide açlık suyu ve dışkı örneklerinde aside dirençli basil (ARB) varlığı araştırılmıştır. PPD’si negatif olan ve örneklerin direkt mikroskobik incelemesinde ARB görülemeyen olgunun dışkı kültüründe Löwenstein-Jensen besiyerinde 38. günde ARB üremesi saptanmıştır. BACTEC MGIT (Mycobacterial Growth In- dicator Tube) 960 sistemiyle (Becton-Dickinson, ABD) yapılan duyarlılık testinde, izolatın rifampin, izoniazid, streptomisin ve etambutole duyarlı olduğu belirlenmiştir. İzolatın PNB (para-nitrobenzoic acid) be- siyerinde ürememesi ve niasin ve nitrat aktivitesinin negatif olması üzerine spoligotiplendirme (spacer oligonucleotide typing) yapılmış ve M.bovis BCG suşu için karakteristik olan DR lokuslarının varlığı saptanmıştır. Kültür pozitifliği kliniğe bildirildiği zaman ise hastanın yaklaşık iki hafta önce kaybedildiği öğrenilmiştir. Sonuç olarak sunulan bu olgu, mikobakteriyoloji laboratuvarlarının daha etkin kullanılması gerekliliğini ve erken tanı ve tedavi ile morbidite ve mortalite oranının azaltılmasında klinik-laboratuvar iş birliğinin önemini vurgulamaktadır.
Abstract: The vaccine strain Mycobacterium bovis BCG may lead to disseminated infection in patients with immune deficiency. In this report a patient who developed fatal disseminated tuberculosis caused by M.bovis BCG strain was presented. One year old male patient with the previous history of recurrent lower respiratory tract infection, was admitted to the hospital with the complaints of fever, cough and diarrhea continuing for 20 days. There was no family history of tuberculosis or history of contact with a tuberculosis case. Physical examination of the case revealed growth retardation and reticular and reticulonodular infiltration was detected in his chest X-ray. The results of sweat test, cystic fibrosis gene mutation analysis and metabolic screening tests were normal. Since fever continued and infiltrations persisted in the chest X-ray despite antibiotic therapy, PPD test was applied and acid-fast bacilli (AFB) were investigated in his gastric aspirate and stool samples for three consecutive days. PPD test was negative and no AFB were detected in the microscopic examination of the clinical samples. However, growth in Lowens- tein-Jensen medium was detected in the stool sample on the 38th day of incubation. The antimycobac- terial susceptibility testing performed at BACTEC MGIT (Mycobacterial Growth Indicator Tube) 960 sys- tem (Becton-Dickinson, USA) revealed that the isolate was susceptible to rifampin, isoniazid, streptomicin and ethambutol. Since the isolates did not grow at PNB (para-nitro benzoic acid) medium and ni- acin and nitrate activities were negative, spoligotyping (spacer oligonucleotide typing) was performed and DR loci characteristic for M.bovis BCG strain were detected. However, the patient died 2 weeks before the culture results were obtained. The effective use of mycobacteriology laboratories and cooperation between laboratory and clinics provide advantages in the early diagnosis and treatment of tubercu- losis cases, decreasing the morbidity and the mortality.
Abstract: The vaccine strain Mycobacterium bovis BCG may lead to disseminated infection in patients with immune deficiency. In this report a patient who developed fatal disseminated tuberculosis caused by M.bovis BCG strain was presented. One year old male patient with the previous history of recurrent lower respiratory tract infection, was admitted to the hospital with the complaints of fever, cough and diarrhea continuing for 20 days. There was no family history of tuberculosis or history of contact with a tuberculosis case. Physical examination of the case revealed growth retardation and reticular and reticulonodular infiltration was detected in his chest X-ray. The results of sweat test, cystic fibrosis gene mutation analysis and metabolic screening tests were normal. Since fever continued and infiltrations persisted in the chest X-ray despite antibiotic therapy, PPD test was applied and acid-fast bacilli (AFB) were investigated in his gastric aspirate and stool samples for three consecutive days. PPD test was negative and no AFB were detected in the microscopic examination of the clinical samples. However, growth in Lowens- tein-Jensen medium was detected in the stool sample on the 38th day of incubation. The antimycobac- terial susceptibility testing performed at BACTEC MGIT (Mycobacterial Growth Indicator Tube) 960 sys- tem (Becton-Dickinson, USA) revealed that the isolate was susceptible to rifampin, isoniazid, streptomicin and ethambutol. Since the isolates did not grow at PNB (para-nitro benzoic acid) medium and ni- acin and nitrate activities were negative, spoligotyping (spacer oligonucleotide typing) was performed and DR loci characteristic for M.bovis BCG strain were detected. However, the patient died 2 weeks before the culture results were obtained. The effective use of mycobacteriology laboratories and cooperation between laboratory and clinics provide advantages in the early diagnosis and treatment of tubercu- losis cases, decreasing the morbidity and the mortality.
Açıklama
Anahtar Kelimeler
Kaynak
Mikrobiyoloji Bülteni
WoS Q Değeri
Scopus Q Değeri
Cilt
44
Sayı
2
Künye
ASLAN G,KUYUCU N,AYDIN E,GÜNAL S,EMEKDAŞ G (2010). Mycobacterium bovıs bcg suşunun neden olduğu fatal disemine enfeksiyon olgusu ve izolatın spoligotiplendirme ile tanımlanması. Mikrobiyoloji Bülteni, 44(2), 297 - 302.
