Nötropenik ateş ve laboratuvar

Year 2022, , 85 - 88, 27.06.2022

Selim Öncel

https://doi.org/10.53446/actamednicomedia.1036810

Abstract

Nötropenik ateş, özellikle kemoterapi sonucu meydana geldiğinde gerekli laboratuvar tetkiklerinin süratle tamamlanıp uygun bir antimikrobiyal rejiminin başlanmaması durumunda ciddi bakteri enfeksiyonu olasılığının yüksek olması nedeniyle çocuğun yaşamını tehlikeye sokabilen bir durumdur.
Tam kan sayımı ve periferik yayma, serum elektrolitleri, kreatinin, kan üre azotu, transaminazlar, toplam bilirübin ve kan kültürü her nötropenik ateşli hastadan istenmesi gereken tetkiklerdir.
İdrar yolu enfeksiyonu bulunan nötropenik çocuklarda piyüri saptanmama olasılığı çok yüksektir; bu nedenle böyle hastalarda tam idrar tahlilinde piyüri olmamasına bakarak idrar yolu enfeksiyonu enfeksiyonu bulunmadığına karar vermek doğru değildir.
Boğaz kültürü, solunum yolu patojenleriyie ilgili moleküler testler, akciğer grafisi, sinüs bilgisayarlı tomografisi ve lomber ponksiyon rutin değildir, ancak gereğinde istenmeli veya yapılmalıdır.
Karın ağrısı veya ishali olan çocuklarda nötropenik enterokolit (tiflit) bulunabilir. Bu hastalara mutlaka abdominal ultrasonografi yapılmalıdır. İshal varsa Clostridioides difficile ve diğer gastrointestinal patojen testleri istenebilir.
β-D-glükan, kanda fungal polimeraz zincir reaksiyonu ve serumda galaktomannan çalışılması, rutin olarak önerilmemektedir.
Kaynağı belirlenemeyen tüm nötropenik ateşli hastalarda ağır akut respiratuar sendrom koronavirüsü 2 enfeksiyonunun araştırılması ve bunun için moleküler yöntemlerin kullanılması tavsiye edilmektedir.

Keywords

Febril Nötropeni, belirteç, laboratuvar, Lomber ponksiyon, Clostridioides difficile

Supporting Institution

Yok

Project Number

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Thanks

Yok

Neutropenic fever and laboratory

Abstract

Neutropenic fever is a situation jeopardizing children's lives unless suitable laboratory tests are ordered and an appropriate antimicrobial regimen is started especially in chemotherapy-induced cases.
Complete blood count with differentials, serum electrolytes, creatinine, blood urea nitrogen, transaminases, total bilirubin, and blood cultures should be ordered for every child with neutropenic fever .
Detection of pyuria may not be of high yield in neutropenic children. For that reason, it is erroneous to exclude urinary tract infections on the basis of absence of pyuria.
Throat culture, molecular tests related to respiratory pathogens, chest x-ray, computed tomography of sinuses, and lumber puncture are not routine tests, thus should be ordered only when indicated.
In children with abdominal pain or diarrhea, neutropenic colitis (typhlitis) may be present. These patients should undergo abdominal ultrasonography. Clostridioides difficile and other gastrointestinal pathogen tests may be ordered if the patient is passing watery stools.
β-D-glucan, fungal polimerase chain reaction in blood, and serum galactomannan are not routinely recomennded.
In all neutropenic fever syndromes without an identified source, severe respiratory syndrome coronavirus 2 infection should be sought by means of molecular methods.

Keywords

febrile neutropenia, marker, laboratory, lumbar puncture, Clostridioides difficile

Project Number

Yok

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