Turkiye Klinikleri Journal of Medical Sciences

.: ORIGINAL RESEARCH
Toplum Kökenli Menenjit/Meningoensefalitler: Beş Yılın Retrospektif Değerlendirilmesi
Community Acquired Meningitis/Meningoencephalitis: Retrospective Evaluation of Five Years
Yusuf Ziya DEMİROĞLUa, Tuba TURUNÇa, Hikmet ALIŞKANb, Şule ÇOLAKOĞLUb, A. Ferit ERDOĞANc, Hande ARSLANd
aEnfeksiyon Hastalıkları ve Klinik Mikrobiyoloji AD, bMikrobiyoloji ve Klinik Mikrobiyoloji AD, cAile Hekimliği, Başkent Üniversitesi Tıp Fakültesi, Adana Uygulama ve Araştırma Merkezi, Adana dEnfeksiyon Hastalıkları ve Klinik Mikrobiyoloji AD, Başkent Üniversitesi Tıp Fakültesi, Ankara
Turkiye Klinikleri J Med Sci. 2010;30(1):218-26
doi: 10.5336/medsci.2008-8623
Article Language: TR
Full Text
ÖZET
 Amaç: Bu çalışma kliniğimizde izlediğimiz menenjit / meningoensefalit olgularının etiyolojik faktörlerini, morbiditesini, fatalite oranlarını ve maliyetini değerlendirmek, ülkemiz ve dünya verileriyle karşılaştırmak amacıyla yapıldı. Gereç ve Yöntemler: Kliniğimizde Nisan 2003-Mayıs 2008 tarihleri arasında izlenen 51 erişkin menenjit/meningoensefalit olgusu retrospektif olarak değerlendirildi. Hastaların demografik özellikleri ve klinik bilgileri hasta dosyalarından elde edildi. Menenjit/meningoensefalit tanısı uygun klinik bulgular varlığında, beyin omurilik sıvısı (BOS) incelemeleri ve gerektiğinde görüntüleme yöntemleri ile konuldu. Bulgular: Elli bir olgunun 29'una (%56.9) akut bakteriyel menenjit, 12'sine (%23.5) viral meneningoensefalit, 10'una (%19.6) tüberküloz menenjit tanısı konuldu. Menenjitin klasik bulguları olan ateş, ense sertliği ve bilinç değişikliği akut bakteriyel menenjit olgularının %69'unda, viral meningoensefalit olgularının %50'sinde, tüberküloz menenjit olgularının %40'ında saptandı. Kan beyaz küre sayısı akut bakteriyel menenjit olgularında 19.308/mm³, viral meningoensefalit olgularında 10.389/mm³, tüberküloz menenjit olgularında 9980/mm³ olarak tespit edildi. Akut bakteriyel menenjit olgularında kan beyaz küre sayısının yüksek olması istatistiksel olarak anlamlıydı (p< 0.05). Akut bakteriyel menenjit olgularında beyin-omurilik sıvısında lökosit sayısı 4254.0/mm³ iken, viral meningoensefalitlerde 282.5/mm³, tüberküloz menenjitte 365/mm³ olarak saptandı. Akut bakteriyel menenjit ile izlenen 29 olgunun 15'inde (%51.7) etken izole edildi; 10'unda (%34.4) Streptococcus pneumoniae, üçünde (%10.34) Listeria monocytogenes, birinde (%3.4) Staphylococcus aureus, birinde (%3.4) Streptococcus pyogenes. Tüberküloz menenjit tanısı ile izlenen 10 olgunun ikisinde (%20) BOS kültüründe Mycobacterium tuberculosis üretildi. Viral meningoensefalit tanısı ile izlenen 12 hastanın 2'sinin BOS'unda PCR ile HSV-DNA tip 1 pozitif bulundu. Toplum kökenli menenjit/meningoensefalit olgularında ortalama hastanede yatış süresi 17.76 gün saptandı. Tüberküloz menenjit olgularında yatış süresi anlamlı olarak daha uzundu (p< 0.05). Toplum menenjit/meningoensefalit olgularında ortalama 4860.95 USD ilaç ve hastane masrafına yol açtığı tespit edildi. Viral meningoensefalit olgularında ölüm gözlenmezken, akut bakteriyel menenjitte olgu fatalite oranı %37.9 (11/29), tüberküloz menenjitte %10 (1/10) olarak saptandı. Viral meningoensefalitli üç, akut bakteriyel menenjitli ve tüberküloz menenjitli ikişer olgu sekel ile iyileşti. Sonuç: Tıptaki gelişmelere rağmen menenjit/meningoensefalitler uzun süre hastanede yatışa neden olan, yüksek fatalite oranına sahip, ciddi sekeller bırakan, tedavisi pahalı olan bir enfeksiyon hastalığıdır.

Anahtar Kelimeler: Bakteriyel menenjit; viral meningoensefalit; tüberküloz menenjit
ABSTRACT
 Objective: This study was conducted in order to determine the etiological factors, morbidity, case fatality rate and cost of meningitis/meningoencephalitis cases followed in our clinic and to compare our data with national and international ones. Material and Methods: Fifty-one meningitis/meningoencephalitis cases followed in our clinic between April 2003 and May 2008 were evaluated retrospectively. Demographic characteristics and clinical data of the patients were obtained from the records. Diagnosis of meningitis/meningoencephalitis depended on cerebro spinal fluid (CSF) and radiological findings in the presence of clinical findings. Results: Among 51 patients, 29 (56.9%) were diagnosed as acute bacterial meningitis, 12 (23.5%) as viral meningoencephalitis and 10 (19.6%) as tuberculosis meningitis. Classical findings of meningitis such as fever, neck stiffness and change in conciuosness were present in 69% of the cases with acute bacterial meningitis, in 50% of the ones with viral meningitis, and in 40% of the ones with tuberculosis meningitis. Blood white blood cell count was 19.308/mm³ in acute bacterial meningitis, 10.389/mm³ in viral meningitis, and 9980/mm³ in tuberculosis meningitis. Increased blood white blood cell count was statistically significant in acute bacterial meningitis (p< 0.05). CSF white blood cell count was 4254.0/mm³ in acute bacterial meningitis, 282.5/mm³ in viral meningitis, and 365/ mm³ in tuberculosis meningitis. Causative pathogen was isolated in 15 (51.7%) of the 29 cases with acute bacterial meningitis; it was Streptococcus pneumoniae in 10 (34.4%), Listeria monocytogenes in 3 (10.34%), Staphylococcus aureus in 1 (3.4%), and Streptococcus pyogenes in one (3.4%) patient. Mycobacterium tuberculosis was isolated in CSF culture in 2 (20%) of the 10 patients with tuberculosis meningitis. CSF was positive for HSV-DNA with PCR in two of 12 patients with viral meningoencephalitis. Mean period of hospitalization was 17.76 days in patients with community acquired meningitis/meningoencephalitis; this period was significantly longer in the tuberculosis meningitis cases (p< 0.05). Mean cost of hospitalization and medication was 4860.95 USD for the cases with community acquired meningitis/meningoencephalitis. No mortality was seen in the cases with viral meningoencephalitis, whereas case fatality rate was 37.9% (11/29) in acute bacterial meningitis and 10% (1/10) in tuberculosis meningitis. Three cases with viral meningoencephalitis, two cases with acute bacterial meningitis and two cases with tuberculosis meningitis healed with sequelae. Conclusion: Despite developments in medicine, cases with meningitis/meningoencephalitis require prolonged hospitalization, have high fatality rate and cost, and the disease leads to serious sequelae.

Keywords: Meningitis, bacterial; meningitis, viral; tuberculosis, meningeal

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30.03.2014

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