\u00c7ocukluk \u00e7a\u011f\u0131nda g\u00f6r\u00fclen akut, bula\u015f\u0131c\u0131 bir solunum sistemi hastal\u0131\u011f\u0131d\u0131r. Her ya\u015ftaki duyarl\u0131 ki\u015filerde g\u00f6r\u00fclmekle birlikte \u00f6zellikle \u00e7ocukluk ya\u015flar\u0131nda a\u011f\u0131r seyreder. ”Bo\u011fmaca” ad\u0131 hastal\u0131\u011f\u0131n klinik tablosunu \u00e7ok g\u00fczel tan\u0131mlamaktad\u0131r. Hastal\u0131\u011f\u0131n zorlu ve uzun s\u00fcren \u00f6ks\u00fcr\u00fc\u011f\u00fcn\u00fc dile getirir. Hastal\u0131\u011f\u0131n etkeni ”Bordatella pertussis” ad\u0131 verilen bir bakteridir. Bula\u015fma damlac\u0131k yoluyla olur. Yani solunum yolundan \u00f6ks\u00fcr\u00fck gibi nedenlerle at\u0131lan ve Havada serbest halde bulunan as\u0131l\u0131 k\u00fc\u00e7\u00fck damlalar\u0131n ba\u015fka ki\u015filer taraf\u0131ndan solunum yolundan al\u0131nmas\u0131 ile olu\u015fur. Ancak, hi\u00e7bir \u015fikayeti bulunmayan ve hastal\u0131\u011f\u0131 ta\u015f\u0131d\u0131\u011f\u0131n\u0131n fark\u0131nda olmayan bir ki\u015fi de bu hastal\u0131\u011f\u0131 ba\u015fkalar\u0131na bula\u015ft\u0131rabilir.\u00a0 Hafif ya da atipik hastal\u0131\u011f\u0131 olan eri\u015fkinler ve b\u00fcy\u00fck \u00e7ocuklar hastal\u0131\u011f\u0131 a\u015f\u0131s\u0131z bebek ve k\u00fc\u00e7\u00fck \u00e7ocuklara bula\u015ft\u0131r\u0131rlar. Hastal\u0131k \u00e7ok bula\u015f\u0131c\u0131d\u0131r. Bula\u015f\u0131c\u0131l\u0131k \u015fikayetlerin ba\u015flad\u0131\u011f\u0131 tarihten \u00fc\u00e7 hafta sonras\u0131na kadar uzayabilir.<\/p>\n
A\u015f\u0131 uygulamas\u0131n\u0131n yayg\u0131nla\u015fmas\u0131ndan sonra d\u00fcnyadaki olgu say\u0131s\u0131 % 99 azalm\u0131\u015ft\u0131r. A\u015f\u0131lanm\u0131\u015f toplumlarda olgular\u0131n % 50’si ilk ya\u015fta ve \u00e7o\u011funlukla 6 aydan k\u00fc\u00e7\u00fck bebeklerde g\u00f6r\u00fcl\u00fcr. Olgular\u0131n % 25’i ergen ve gen\u00e7 eri\u015fkinlerde g\u00f6r\u00fcl\u00fcr.\u00a0 Bu durum, ba\u011f\u0131\u015f\u0131kl\u0131\u011f\u0131n ya\u015fla azalmas\u0131na ve a\u015f\u0131l\u0131 toplumlarda hastal\u0131k olmad\u0131\u011f\u0131 i\u00e7in ba\u011f\u0131\u015f\u0131kl\u0131k sisteminin yeniden uyar\u0131lmas\u0131ndaki yetersizli\u011fe ba\u011fl\u0131d\u0131r. T\u00fcrkiye’de yayg\u0131n a\u015f\u0131 uygulamas\u0131 sonucunda hastal\u0131\u011f\u0131n g\u00f6r\u00fclme h\u0131z\u0131 giderek azalm\u0131\u015ft\u0131r.<\/p>\n
BEL\u0130RT\u0130LER<\/p>\n
Kulu\u00e7ka d\u00f6nemi 6-20 G\u00fcn (ortalama 10 g\u00fcn) d\u00fcr. Hastal\u0131k 6-10 hafta s\u00fcrer ve \u00fc\u00e7 d\u00f6nemi vard\u0131r.<\/p>\n
Kataral D\u00f6nem: Nezle, g\u00f6zlerde k\u0131zar\u0131kl\u0131k ve hafif \u00f6ks\u00fcr\u00fck g\u00f6r\u00fcl\u00fcr. Ate\u015f y\u00fcksek de\u011fildir. Bu d\u00f6nem iki hafta kadar s\u00fcrer. Paroksismal \u00d6ks\u00fcr\u00fck D\u00f6nemi: \u0130lk d\u00f6nemdeki kuru \u00f6ks\u00fcr\u00fck giderek artar, daha \u00e7ok geceleri ve n\u00f6betler halinde gelir. Beslenme, a\u011flama, duman, \u00f6ks\u00fcr\u00fck sesi duyma n\u00f6beti ba\u015flatan uyaranlard\u0131r. Bo\u011fulurcas\u0131na ard\u0131 ard\u0131na \u00f6ks\u00fcr\u00fck, morarma, kusma ve derin sesli bir i\u00e7 \u00e7ekme (huup!) olur. Her n\u00f6bette 10-30 kez \u00f6ks\u00fcrme ger\u00e7ekle\u015fir. N\u00f6betten sonra bulant\u0131 s\u0131kt\u0131r ve \u00e7ocuk bitkinle\u015fir. Bu d\u00f6nem 2-6 hafta s\u00fcrer. <\/p>\n
\u0130yile\u015fme D\u00f6nemi: N\u00f6betler giderek seyrekle\u015fir. Bir Ay i\u00e7inde t\u00fcmden yok olur. \u00a0<\/p>\n
\u00dc\u00e7 aydan k\u00fc\u00e7\u00fck bebeklerde klasik tablo genelde g\u00f6r\u00fclmez, kataral d\u00f6nem k\u0131sa, paroksismal d\u00f6nem ise a\u011f\u0131r ve uzundur. Bebe\u011fin ate\u015finin olmamas\u0131, ataklar aras\u0131nda iyi olmas\u0131 bo\u011fmaca i\u00e7in \u00f6zg\u00fcn bulgulard\u0131r.<\/p>\n
TANI<\/p>\n
Hastal\u0131\u011f\u0131n tan\u0131s\u0131 klinik olarak ve bakterinin geniz ve bo\u011faz mukus k\u00fclt\u00fcr\u00fcnden \u00fcretilmesi ile konur. D\u00fcnya Sa\u011fl\u0131k \u00d6rg\u00fct\u00fc (DS\u00d6)’n\u00fcn klinik tan\u0131 i\u00e7in \u00f6l\u00e7\u00fctler belirlemi\u015ftir. Buna g\u00f6re;<\/p>\n
\u00d6ks\u00fcr\u00fc\u011f\u00fcn en az 2 hafta s\u00fcrmesine ek olarak,\u00d6ks\u00fcr\u00fck n\u00f6betleri, nefes al\u0131rken huup sesinin duyulmas\u0131 ya da\u00d6ks\u00fcr\u00fck sonras\u0131 kusmadan en az birinin bulunmas\u0131 veBu tabloyu a\u00e7\u0131klayacak ba\u015fka bir neden olmamas\u0131 Bo\u011fmaca tan\u0131s\u0131n\u0131 koydurur.<\/p>\n
Hastal\u0131\u011f\u0131n laboratuvar tan\u0131s\u0131nda kullan\u0131lan \u00e7e\u015fitli y\u00f6ntemler vard\u0131r. Bunun i\u00e7in burun yoluyla girilerek genizden k\u00fclt\u00fcr veya burun y\u0131kama s\u0131v\u0131s\u0131 al\u0131nmal\u0131d\u0131r.<\/p>\n
PROGNOZ<\/p>\n
Hastan\u0131n ya\u015f\u0131 ne kadar k\u00fc\u00e7\u00fckse prognoz o kadar\u00a0 k\u00f6t\u00fcd\u00fcr.Bebe\u011fin 6 aydan k\u00fc\u00e7\u00fck ya da premat\u00fcre olmas\u0131 \u00f6l\u00fcm riskini artt\u0131r\u0131r. A\u015f\u0131lanma, iyi bak\u0131m, iyi beslenme, solunum deste\u011fi \u00f6l\u00fcm olas\u0131l\u0131\u011f\u0131n\u0131 azalt\u0131r. \u00d6ks\u00fcr\u00fck n\u00f6betleri sonucu beynin Oksijensiz kalmas\u0131, kafai\u00e7i Bas\u0131nc\u0131n\u0131n artmas\u0131, uzun s\u00fcreli kan \u015fekerinin d\u00fc\u015fmesi epileptik n\u00f6bet, zeka gerili\u011fi, davran\u0131\u015f bozukluklar\u0131 gibi kal\u0131c\u0131 izler b\u0131rakabilir.<\/p>\n
TEDAV\u0130<\/p>\n
Bo\u011fmacan\u0131n tedavisi b\u00fcy\u00fck oranda destekleyicidir. Yatak istirahat\u0131 \u015fartt\u0131r. \u00c7o\u011fu hasta evde tedavi edilebilir. Ancak 6 aydan k\u00fc\u00e7\u00fck bebekler ve a\u011f\u0131r olgular hastaneye yat\u0131r\u0131lmal\u0131d\u0131r. Yeterli beslenme ve S\u0131v\u0131 deste\u011finin sa\u011flanmas\u0131 \u00f6nemlidir. Hastaya s\u0131k s\u0131k fakat az miktarda yumu\u015fak yiyecekler verilmelidir. Buhar\u0131n yarar\u0131 g\u00f6sterilememi\u015ftir. N\u00f6beti ba\u015flatan uyaranlardan ka\u00e7\u0131nmal\u0131d\u0131r. \u00c7ok a\u011f\u0131r olgularda solunum deste\u011fi gerekebilir. Antibiyotik tedavisi erken ba\u015flarsa klinik seyri hafifletebilir, bula\u015ft\u0131r\u0131c\u0131l\u0131\u011f\u0131 azalt\u0131r. Bunun i\u00e7in m\u00fcmk\u00fcn oldu\u011funca erken d\u00f6nemde hastalar bir sa\u011fl\u0131k merkezine (aile hekimlerine) ba\u015fvurmal\u0131d\u0131r.<\/p>\n
KOMPL\u0130KASYONLAR<\/p>\n
Hastan\u0131n ya\u015f\u0131 ne kadar k\u00fc\u00e7\u00fckse komplikasyonlar o kadar s\u0131kt\u0131r. En s\u0131k solunum sistemi komplikasyonlar\u0131 g\u00f6r\u00fcl\u00fcr. B. pertussis’in kendisine ya da ikincil bakteri enfeksiyonlar\u0131na ba\u011fl\u0131 zat\u00fcrre, orta kulak iltihab\u0131 geli\u015febilir. \u00d6l\u00fcmlerin ba\u015fl\u0131ca nedeni zat\u00fcrredir. Bo\u011fmaca hastalar\u0131nda, \u015fiddetli ve uzun s\u00fcreli \u00f6ks\u00fcrme n\u00f6betleri y\u00fcz\u00fcnden, beyin hasar\u0131na yol a\u00e7abilecek Oksijen eksikli\u011fi, beyin kanamalar\u0131, bilin\u00e7 kayb\u0131, n\u00f6betler, g\u00f6rme-konu\u015fma bozukluklar\u0131, sa\u011f\u0131rl\u0131k g\u00f6r\u00fclebilir. Paroksismal d\u00f6nemde burun kanamas\u0131, g\u00f6zde kanlanma, siyah renkli d\u0131\u015fk\u0131lama, kas\u0131k f\u0131t\u0131\u011f\u0131 geli\u015febilir. S\u0131k s\u0131k kusma ve beslenememe sonucu zay\u0131flama g\u00f6r\u00fclebilir.<\/p>\n
KORUNMA<\/p>\n
Ne do\u011fal enfeksiyon ne de a\u015f\u0131lama ya\u015fam boyu ba\u011f\u0131\u015f\u0131kl\u0131k sa\u011flamaz. Hastal\u0131\u011f\u0131 ge\u00e7mi\u015fte atlatm\u0131\u015f olan ki\u015filer de \u00f6m\u00fcr boyu ba\u011f\u0131\u015f\u0131kl\u0131k kazanm\u0131\u015f olmazlar. \u0130nsanlar, bu hastal\u0131\u011fa kar\u015f\u0131 a\u015f\u0131lanm\u0131\u015f veya bu hastal\u0131\u011f\u0131 ge\u00e7irmi\u015f olsalar bile bo\u011fmaca enfeksiyonu ile tekrar hastalanma riski daima bulunur. Ancak, bu ki\u015filerin hastalanmalar\u0131 halinde hastal\u0131k \u00e7ok daha hafif ve \u0131l\u0131ml\u0131 seyreder. Bu nedenle korunmada en etkili y\u00f6ntem a\u015f\u0131lamad\u0131r. Difteri ve tetanoz toksoidleri ile karma olarak haz\u0131rlanm\u0131\u015f iki \u00e7e\u015fit a\u015f\u0131s\u0131 vard\u0131r. Her iki a\u015f\u0131n\u0131n da ilk dozu ya\u015fam\u0131n ikinci ay\u0131nda kas i\u00e7ine yap\u0131l\u0131r. Bir ya da iki ay arayla iki kez tekrarlan\u0131r. Son dozdan 6\u201312 ay sonra peki\u015ftirme dozu gerekir. Sa\u011fl\u0131k Bakanl\u0131\u011f\u0131 A\u015eI TAKV\u0130M\u0130’ne g\u00f6re: Do\u011fumdan sonra; 2.ay\u0131n sonu, 3. ay\u0131n sonu, 4. ay\u0131n sonu ve 16\u201324. aylarda yap\u0131lacak 4 doz a\u015f\u0131 ile yeterli ba\u011f\u0131\u015f\u0131kl\u0131k sa\u011flan\u0131r. A\u015f\u0131n\u0131n 5. dozu 4\u20136 ya\u015flar aras\u0131nda \u00f6nerilmektedir. Her iki a\u015f\u0131 da 7 ya\u015f\u0131ndan b\u00fcy\u00fcklere yap\u0131lmaz. \u00dclkemizde DBT a\u015f\u0131s\u0131\/ Karma a\u015f\u0131 (Difteri-Bo\u011fmaca-Tetanoz) n\u0131n ikinci peki\u015ftirme dozu 4-6 ya\u015flarda de\u011fil, ilkokul birinci s\u0131n\u0131fta yap\u0131ld\u0131\u011f\u0131ndan bo\u011fmaca \u00f6\u011fesi \u00e7\u0131kar\u0131lmaktad\u0131r. Bo\u011fmacan\u0131n s\u0131k g\u00f6r\u00fcld\u00fc\u011f\u00fc toplumlarda en erken 6 haftal\u0131k bebeklere a\u015f\u0131lama ba\u015flan\u0131r ve dozlar 4 hafta ara ile verilebilir. Herhangi bir nedenle a\u015f\u0131lamaya ara verilmi\u015fse uygulama kal\u0131nan yerden s\u00fcrd\u00fcr\u00fcl\u00fcr.\u00a0<\/p>\n
Ergen ve gen\u00e7 eri\u015fkin ya\u015f grubunda ba\u011f\u0131\u015f\u0131kl\u0131\u011f\u0131n y\u0131llar i\u00e7inde azalmas\u0131 nedeniyle enfeksiyon h\u0131z\u0131 artmaktad\u0131r. Bu nedenle son y\u0131llarda ergen ve eri\u015fkinlere de ek doz a\u015f\u0131 yap\u0131lmas\u0131 g\u00fcndeme gelmi\u015ftir. A\u015f\u0131n\u0131n koruyucu de\u011feri % 80-90’d\u0131r. A\u015f\u0131ya ba\u011fl\u0131 koruyuculuk 3-5 y\u0131ldan sonra giderek azal\u0131r. 12 y\u0131ldan sonra \u00e7ok d\u00fc\u015f\u00fck d\u00fczeylere iner. \u00d6nceden a\u015f\u0131l\u0131lar yakalansalar bile hastal\u0131\u011f\u0131 hafif ge\u00e7irirler.<\/p>\n
A\u015f\u0131n\u0131n Yan Etkileri<\/p>\n
Yerel ve genel olarak ikiye ayr\u0131l\u0131r. Yerel yan etkiler a\u015f\u0131 yerinde k\u0131zar\u0131kl\u0131k, \u015fi\u015fme, a\u011fr\u0131d\u0131r. Genel yan etkiler ise 38 derecenin \u00fczerinde ate\u015f, halsizlik, uyku hali, huzursuzluk, i\u015ftahs\u0131zl\u0131k, kusma olup a\u015f\u0131dan 4-6 Saat sonra ortaya \u00e7\u0131kar. Ate\u015f d\u00fc\u015f\u00fcr\u00fcc\u00fc ve a\u011fr\u0131 kesicilere yan\u0131t verir. Bu belirtiler olu\u015fsa bile a\u015f\u0131lama s\u00fcrd\u00fcr\u00fcl\u00fcr. Bu gibi yan etkilerin s\u0131kl\u0131\u011f\u0131 ya\u015f ilerledik\u00e7e artar.<\/p>\n
Hafif yan etkilerde ate\u015f d\u00fc\u015f\u00fcr\u00fcc\u00fc kullan\u0131m\u0131 yararl\u0131 olabilir, ama genelde buna gerek duyulmaz. Ate\u015flenme halinde havadar ve serin tutan giysiler giymek, so\u011fuk ve nemli s\u00fcngerle veya so\u011fuk banyoyla v\u00fccudun ate\u015fini d\u00fc\u015f\u00fcrmek genelde yeterli olur. Ancak, aniden olu\u015fan ve \u015fiddeti y\u00fcksek olan yan etkilerde derhal Aile hekimiyle irtibata ge\u00e7ilmelidir. \u00c7\u00fcnk\u00fc, b\u00f6ylesi yan etkiler farkl\u0131 bir rahats\u0131zl\u0131\u011f\u0131n \u00f6rne\u011fin ciddi bir enfeksiyon hastal\u0131\u011f\u0131n\u0131n \u00f6n belirtileri de olabilir.<\/p>\n
HASTALI\u011eIN KONTROL\u00dc<\/p>\n
Bo\u011fmacal\u0131 bir hasta ile temas\u0131 olanlar en az 21 g\u00fcn boyunca hastal\u0131\u011f\u0131n belirtileri y\u00f6n\u00fcnden izlenir. Hastan\u0131n ev halk\u0131 ve di\u011fer yak\u0131n ili\u015fkide olanlara a\u015f\u0131lama durumlar\u0131na ve klinik belirtilerinin olmas\u0131na bak\u0131lmaks\u0131z\u0131n antibiyotik tedavisi verilir. \u0130lac\u0131n ba\u015flanmas\u0131ndan 5 g\u00fcn sonra bula\u015ft\u0131r\u0131c\u0131l\u0131k sona erer. Bundan sonra \u00e7ocuk iyiyse kre\u015fe ya da okula gitmesine izin verilir. Yak\u0131n \u00e7evredeki 7 ya\u015f\u0131ndan k\u00fc\u00e7\u00fck a\u015f\u0131s\u0131z ya da eksik a\u015f\u0131l\u0131lar\u0131n a\u015f\u0131lar\u0131 tamamlan\u0131r.<\/p>\n
HAZIRLAYAN; Dr. Serdar \u00d6ZER<\/p>\n
KAYNAKLARTop\u00e7u AW, S\u00f6yletir G, Do\u011fanay M. Enfeksiyon Hastal\u0131klar\u0131 ve Mikrobiyoloji, 2008, 3. Bask\u0131, 784-786. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases, 2005, 6th Edition. 2701-2706.<\/p>\n","protected":false},"excerpt":{"rendered":"
\u00c7ocukluk \u00e7a\u011f\u0131nda g\u00f6r\u00fclen akut, bula\u015f\u0131c\u0131 bir solunum sistemi hastal\u0131\u011f\u0131d\u0131r. Her ya\u015ftaki duyarl\u0131 ki\u015filerde g\u00f6r\u00fclmekle birlikte \u00f6zellikle \u00e7ocukluk ya\u015flar\u0131nda a\u011f\u0131r seyreder. ”Bo\u011fmaca” ad\u0131 hastal\u0131\u011f\u0131n klinik tablosunu \u00e7ok g\u00fczel tan\u0131mlamaktad\u0131r. Hastal\u0131\u011f\u0131n zorlu ve uzun s\u00fcren \u00f6ks\u00fcr\u00fc\u011f\u00fcn\u00fc dile getirir. Hastal\u0131\u011f\u0131n etkeni ”Bordatella pertussis” ad\u0131 verilen bir bakteridir. Bula\u015fma damlac\u0131k yoluyla olur. Yani solunum yolundan \u00f6ks\u00fcr\u00fck gibi nedenlerle at\u0131lan ve Havada serbest halde bulunan[Devam\u0131n\u0131 Oku…]<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[22524],"tags":[23030,23028],"_links":{"self":[{"href":"https:\/\/gncz.net\/index.php\/wp-json\/wp\/v2\/posts\/13185"}],"collection":[{"href":"https:\/\/gncz.net\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/gncz.net\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/gncz.net\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/gncz.net\/index.php\/wp-json\/wp\/v2\/comments?post=13185"}],"version-history":[{"count":0,"href":"https:\/\/gncz.net\/index.php\/wp-json\/wp\/v2\/posts\/13185\/revisions"}],"wp:attachment":[{"href":"https:\/\/gncz.net\/index.php\/wp-json\/wp\/v2\/media?parent=13185"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/gncz.net\/index.php\/wp-json\/wp\/v2\/categories?post=13185"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/gncz.net\/index.php\/wp-json\/wp\/v2\/tags?post=13185"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}