Difficult - to - Cure Infections from Diagnosis to Treatment

Çocuklarda Sistemik Paraziter Enfeksiyonlar
Systemic Parasitic Infections in Children
İrem Ceren ERBAŞa, Şilem ÖZDEM ALATAŞa, Nurşen BELETa
aDokuz Eylül Üniversitesi Tıp Fakültesi, Çocuk Enfeksiyon Hastalıkları BD, İzmir, Türkiye
Erbaş İC, Özdem Alataş Ş, Belet N. Çocuklarda sistemik paraziter enfeksiyonlar. Çelik Ü, editör. Tanıdan Tedaviye Zorlu Enfeksiyonlar. 1. Baskı. Ankara: Türkiye Klinikleri; 2022. p.10-20.
Article Language: TR
ÖZET
Echinococcus granulosus, tenya ailesinden kist hidatik hastalığına neden olan bir parazittir. Koyunların ve diğer çiftlik hayvanlarının yetiştirildiği, sakatatla beslenilen bölgelerde sık görülür. Vakaların yaklaşık %50'si asemptomatiktir. Genellikle çocukluk çağında bulaşır ve yetişkin döneme kadar semptom vermez. Tanıda sıklıkla görüntüleme yöntemleri ve serolojik testler kullanılır. Kist hidatik hastalığında cerrahi, medikal tedavi, kist ponksiyonu ve PAIR (Ponksiyon, aspirasyon, enjeksiyon, yeniden aspirasyon) gibi yöntemler kullanılır. Amebiyaz, Entamoeba histolytica'nın etken olduğu, bağırsak ve bağırsak dışı yerleşim gösterebilen paraziter bir hastalıktır. Tüm dünyada özellikle tropikal, subtropikal bölgeler ve ülkemizde önemli bir halk sağlığı sorunudur. %90'ı asemptomatiktir ancak kolon duvarını istila ederek, ishale, amip kolitine, akut dizanteriye veya kronik ishale neden olabilir. Tanıda mikroskopi, antijen testleri, serolojik testler, moleküler yöntemler ve görüntüleme yöntemleri kullanılabilir. Tedavide asemptomatik enfeksiyonlar paromomisin veya diloksanid furoat, amebik kolitte ise nitroimidazoller tercih edilir. Fasciola hepatica, büyükbaş ve küçükbaş hayvanlarda sık rastlanan bir trematottur. Yıkanmamış bitki ve arıtılmamış sulardaki metaserkaryalar ile bulaşır. Parazit gelişimini tamamlamak için kesin ve ara konaklara ihtiyaç duymaktadır. Yaklaşık %85'i asemptomatiktir. Genellikle klinik hafiftir, karın ağrısı en sık görülen semptomdur. Tanıda mikroskopi, antijen testleri, serolojik testler, moleküler yöntemler kullanılır. Tedavisi triklabendazoldür. Cryptosporidium tüm dünyada yaygın görülen, gastroenterite neden olan hücre içi protozoondur. Beş yaşından küçük çocuklarda ishale bağlı morbidite ve mortalitenin önde gelen nedenlerindendir. İçme suları, az pişmiş yiyecekler, pastörize edilmemiş süt veya endemik bölgelere seyahat ile bulaşır. Bağışıklığı baskılanmış çocuklarda ağır klinik tablolara, bağışıklığı tam olanlarda su kaynaklı ishal salgınlarına neden olur. Bağışıklığı baskılanmış bireylerde kronik ishal, kolera benzeri hastalık ve ekstraintestinal tutulum şeklinde görülebilir. Tanıda boyalı mikroskopi, PCR ve antijen tespitine dayalı testler kullanılır. Temel tedavi hidrasyon ve destekleyici bakımdır. Genellikle ishal iki hafta sürer ve kendini sınırlar. Şiddetli ishal olanlarda nitazoksanid, nitrotiazolil-salisilamit türevi olan ilaçlar kullanılabilir.

Anahtar Kelimeler: Parazit; enfeksiyonlar; çocuk; antiparazitik ajanlar
ABSTRACT
Echinococcus granulosus is a parasite of the tapeworm family that causes cyst hydatid disease. It is common in offal-fed areas and where sheep and other farm animals are raised. Nearly half of the patients are asymptomatic. It is usually transmitted in childhood and does not cause symptoms until adulthood. Imaging methods and serological tests are frequently used in the diagnosis. Methods such as surgery, medical treatment, cyst puncture and PAIR (puncture, aspiration, injection, re-aspiration) are used in cyst hydatid. Amebiasis is a parasitic disease caused by Entamoeba histolytica, which can be located in and out of the intestine. It is an important public health problem all over the world, especially in tropical and subtropical regions and in our country. Although it is asymptomatic in 90%, it can invade the colon wall, causing diarrhea, amoebic colitis, acute dysentery, or chronic diarrhea. Microscopy, antigen tests, serological tests, molecular methods and imaging methods can be used for diagnosis. Paromomycin or diloxanide furoate is preferred in the treatment of asymptomatic infections, and nitroimidazoles are preferred in amebic colitis. Fasciola hepatica is a common trematode in cattle, sheep, and goats. It is transmitted by metacercariae in unwashed plants and untreated waters. The parasite needs definitive and intermediate hosts to complete its development. Approximately 85% of the patients are asymptomatic. It is usually clinically mild and the most common symptom is abdominal pain. Microscopy, antigen tests, serological tests and molecular methods are used in diagnosis. Triclabendazole is used for treatment. Cryptosporidium is an intracellular protozoan that is common over the world and causes gastroenteritis. It is one of the leading causes of diarrhea-related morbidity and mortality in children younger than five years of age. It is transmitted through drinking water, undercooked food, unpasteurized milk, and during traveling to endemic areas. It causes severe clinical disease in immunocompromised children, and water-borne diarrhea outbreaks in immunocompetent patients. It can be presented with chronic diarrhea, cholera-like disease, and extraintestinal involvement in immunocompromised patients. Stained microscopy, PCR and tests based on antigen detection are used for the diagnosis. The main treatment includes hydration and supportive care. Diarrhea usually lasts for two weeks and is self-limiting. Nitazoxanide and nitrothiazolylsalicylamide derivative drugs can be used in patients with severe diarrhea.

Keywords: Parasites; infections; child; antiparasitic agents

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