Evaluation of RSV frequency in acute bronchiolitis By different methods

Hacimustafaoglu, Mustafa; KÖKSAL, N.; ÇELEBİ, S.; GÖRAL, G.; SINIRTAŞ, M.; AYNACI, E.

Evaluation of RSV frequency in acute bronchiolitis By different methods

Mustafa HACIMUSTAFAOĞLU, (Uludağ Üniversitesi, Tıp Fakültesi, Çocuk Sağlığı ve Hastalıkları Anabilim Dalı, Bursa, Türkiye)

S. ÇELEBİ, (Uludağ Üniversitesi, Tıp Fakültesi, Çocuk Sağlığı ve Hastalıkları Anabilim Dalı, Bursa, Türkiye)

E. AYNACI, (Uludağ Üniversitesi, Tıp Fakültesi, Çocuk Sağlığı ve Hastalıkları Anabilim Dalı, Bursa, Türkiye)

N. KÖKSAL, (Uludağ Üniversitesi, Tıp Fakültesi, Çocuk Sağlığı ve Hastalıkları Anabilim Dalı, Bursa, Türkiye)

M. SINIRTAŞ, (Uludağ Üniversitesi, Tıp Fakültesi, Enfeksiyon Hastalıkları ve Mikrobiyoloji Anabilim Dalı, Bursa, Türkiye)

G. GÖRAL (Uludağ Üniversitesi, Tıp Fakültesi, Enfeksiyon Hastalıkları ve Mikrobiyoloji Anabilim Dalı, Bursa, Türkiye)

Çocuk Enfeksiyon Dergisi

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Yıl: 2008 Cilt: 2 Sayı: 4 Sayfa Aralığı: 156 - 161 Metin Dili: Türkçe İndeks Tarihi: 29-07-2022

Evaluation of RSV frequency in acute bronchiolitis By different methods

Öz:

Amaç: (Akut Bronşiyolitte RSV Sıklığının Farklı Yöntemlerle Değerlendirilmesi) Ülkemizde RSV için çocuklarda etyolojik ve epidemiyolojik yayınlar az sayıdadır. Bu çalışma bölgemizde A.bronşiyolitlerde RSV sıklığı, genel epidemiyolojik özellikleri, farklı tanı yöntemlerinin değerlendirilmesi ve maliyet-etkinlik analizlerinin yapılması için planlandı. Acil ve normal çocuk polikliniğine başvuran ve klinik olarak akut viral bronşiolit tanısı konan 2 yaşından küçük 76 çocuk çalışmaya alındı. Birkaç gündür devam eden nonspesifik viral ÜSYE sonrası, wheezing olan ve/veya muayenede yaygın sibilan ronküs saptanan ve PA akciğer grafisinde havalanma artışı olan bebekler klinik olarak akut bronşiolit tanısıyla çalışmaya dahil edildi. Muhtemel başka bakteriyel enfeksiyonu kanıtlanmış olan olgular çalışmaya dahil edilmedi. Olguların nazofarengeal sekresyonları; RSV antijeni (Test PackR, Abbott) bakılmak, serumları; anti-RSV-IgG (14 gün arayla 2 kez) ve anti-RSV-IgM antikorları (ELISA, Euroimmun) bakılmak için derin dondurucuda (-2oC) saklandı. Sonuçlar daha sonra ve toplu olarak çalışıldı. Çalışmaya alınan 76 akut bronşiolitli olgunun %73.6’sı erkek, %26.4’ü kız olup tanı anındaki ortalama yaşları 9.4±5.3ay (X±SD)(dağılım; 2-24) arasındaydı. Yaş dağılımı %26.3 olguda 2-6 ay, %52.6olguda 7-12 ay, %21.1olguda 13-24 ay idi. Nazofarengeal sekresyonda RSV antijeni 36 olguda (%47.3), serumda anti-RSV-IgM 4 olguda (%5.2) pozitif saptandı. Anti-RSV-IgM pozitif saptanan üç ek olguyla beraber RSV akut bronşiolit olgu sayısı 39’ a (%51.2) yükseldi. Anti-RSV-IgG düzeyi çalışılabilen 16 olguda çift serum örneğinde anti-RSV-IgG titre artışı 2 olguda (%12.5) saptandı. RSV pozitif saptanan olgularda erkek/kız oranı 31/8, RSV negatif saptanan olgularda erkek/kız oranı 25/12 bulundu (p>0.05). RSV ve non-RSV olgular arasında başvuru yaşları arasında anlamlı fark yoktu (p>0.05). Akut bronşiolit tanısı konan 76 olgunun 70’i (%92) Ekim-Nisan ayları arasında başvurdu. RSV saptanan ve saptanmayan olgular arasında başvuru ayları arasında anlamlı bir farklılık yoktu (p>0.05). Olguların 42’si (%55) kliniğe yatırılırken 34’ü (%45) ayaktan takibe alındı. Olguların antibiyotik ve tanı yöntemleri ölçüm maliyetleri hesaplandı. Sadece antibiyotik maliyeti RSV saptanan olgularda 45+30 USD, RSV saptanmayan olgularda 90.5+90.5 USD bulundu. RSV antijen (bir kez) çıplak maliyeti 13.3 USD, anti RSV-IgM (bir kez) 4.58 USD, anti-RSV-IgG (iki kez) 6.6 USD bulundu. Bu değerlerle; bütün tanı kitleri aynı hastada kullanılsa bile, lüzumsuz verilecek olan antibiyotik maliyetinin daha altında bulundu. Sonuç olarak; A.bronşiyolitlerin yaklaşık yarısında RSV etyolojisi saptandı. EIA ile hızlı RSV antijen saptanmasına kıyasla, serolojik tetkikler (ELISA IgM ve IgG) yüksek oranda yanlış negatif bulundu. Tanıda nazofarengeal sekresyonda antijen arama yönteminin özellikle RSV nin epidemi yaptığı aylarda ilk tercih edilecek yöntem olması gerektiği kanısına varıldı.

Anahtar Kelime:

Konular: Enfeksiyon Hastalıkları

Akut bronfliyolitte RSV sıklığının farklı yöntemlerle değerlendirilmesi

Öz:

Aim: Etiological and epidemiological studies of respiratory syncytial virus (RSV) infections in our country are not abundant. The aim of this study was to determine the frequency and general epidemiological properties of RSV in acute bronchiolitis (AB) and to investigate the accuracy and cost-effectivity of various diagnostic methods.A total of 76 children younger than 2 years of age who had the diagnosis of AB in the outpatient clinic or the emergency room were included. The criteria for the clinical diagnosis of viral AB were wheezing and sibilant rhonchi following a nonspecific viral upper respiratory infection of a few days along with hyperaeration on the chest X-ray. Patients with evidence of bacterial infection were excluded.The nasopharyngeal secretions (NS) and sera of the patients were obtained and stored at -20°C to be subsequently tested for RSV antigen (Test Pack?, Abbott) in the NS and anti-RSV-IgG (two samples 14 days apart) as well as anti-RSV IgM antibodies in sera (ELISA, Euroimmune?). The assays were run simultaneously on the same batch.Of the 76 patients with AB, 73.6% were male and 26.4% were female. Their mean age was 9.4±5.3 months (X±SD; range: 2-24). The age distribution was 2-6 months in 26.3% patients, 7-12 months in 52.6% patients, and 13-24 months in 21.1% patients.RSV antigen in NS was positive in 36 (47.3%) patients, 4 of whom (5.2%) had anti-RSV-IgM in sera as well. Anti-RSV IgM was detected in an additional 3 patients whose NS were antigen-negative adding up to 39 (51.2%) patients with AB. Four patients tested positive for anti-RSV IgM only one of whom had a positive antigen in the NS. Out of 16 patients who had anti-RSV IgG concentration and were assayed twice after 14 days, 2 (12.5%) patients had increased concentrations of anti-RSV IgG in the second sample.Male/female ratio was 31/8 in RSV positive patients, and 25/12 in RSV negative patients (p>0.05). The age of patients with and without RSV was not significantly different (p>0.05). Seventy out of 76 (92%) patients presented between October and April. The month of presentation between the RSV positive and negative patients was not different (p>0.05). Forty-two (55%) patients were hospitalized and 34 (45%) were treated as outpatients.The cost of antibiotics and diagnostic tests were calculated for each patient. The cost of antibiotics was 45+30 USD in RSV positive patients, and 90.5+90.5USD in RSV negative patients. One test for RSV antigen cost ~13.3 USD, anti RSV IgM 4.58 USD, and anti-RSV IgG (two assays) 6.6 USD. The total cost even when all tests were done on one patient was less expensive than an unnecessary antibiotic treatment. RSV was detected in approximately half of the patients with AB. When compared to fast RSV antigen detection by EIA, serologic tests (ELISA IgM and IgG) had a high frequency of false negativity. Antigen detection in NS should be the preferred method for the diagnosis of RSV in AB which is highly cost-effective especially during the epidemic months.

Anahtar Kelime:

Konular: Enfeksiyon Hastalıkları

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

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APA	Hacimustafaoglu M, ÇELEBİ S, AYNACI E, KÖKSAL N, SINIRTAŞ M, GÖRAL G (2008). Evaluation of RSV frequency in acute bronchiolitis By different methods. , 156 - 161.
Chicago	Hacimustafaoglu Mustafa,ÇELEBİ S.,AYNACI E.,KÖKSAL N.,SINIRTAŞ M.,GÖRAL G. Evaluation of RSV frequency in acute bronchiolitis By different methods. (2008): 156 - 161.
MLA	Hacimustafaoglu Mustafa,ÇELEBİ S.,AYNACI E.,KÖKSAL N.,SINIRTAŞ M.,GÖRAL G. Evaluation of RSV frequency in acute bronchiolitis By different methods. , 2008, ss.156 - 161.
AMA	Hacimustafaoglu M,ÇELEBİ S,AYNACI E,KÖKSAL N,SINIRTAŞ M,GÖRAL G Evaluation of RSV frequency in acute bronchiolitis By different methods. . 2008; 156 - 161.
Vancouver	Hacimustafaoglu M,ÇELEBİ S,AYNACI E,KÖKSAL N,SINIRTAŞ M,GÖRAL G Evaluation of RSV frequency in acute bronchiolitis By different methods. . 2008; 156 - 161.
IEEE	Hacimustafaoglu M,ÇELEBİ S,AYNACI E,KÖKSAL N,SINIRTAŞ M,GÖRAL G "Evaluation of RSV frequency in acute bronchiolitis By different methods." , ss.156 - 161, 2008.
ISNAD	Hacimustafaoglu, Mustafa vd. "Evaluation of RSV frequency in acute bronchiolitis By different methods". (2008), 156-161.

APA	Hacimustafaoglu M, ÇELEBİ S, AYNACI E, KÖKSAL N, SINIRTAŞ M, GÖRAL G (2008). Evaluation of RSV frequency in acute bronchiolitis By different methods. Çocuk Enfeksiyon Dergisi, 2(4), 156 - 161.
Chicago	Hacimustafaoglu Mustafa,ÇELEBİ S.,AYNACI E.,KÖKSAL N.,SINIRTAŞ M.,GÖRAL G. Evaluation of RSV frequency in acute bronchiolitis By different methods. Çocuk Enfeksiyon Dergisi 2, no.4 (2008): 156 - 161.
MLA	Hacimustafaoglu Mustafa,ÇELEBİ S.,AYNACI E.,KÖKSAL N.,SINIRTAŞ M.,GÖRAL G. Evaluation of RSV frequency in acute bronchiolitis By different methods. Çocuk Enfeksiyon Dergisi, vol.2, no.4, 2008, ss.156 - 161.
AMA	Hacimustafaoglu M,ÇELEBİ S,AYNACI E,KÖKSAL N,SINIRTAŞ M,GÖRAL G Evaluation of RSV frequency in acute bronchiolitis By different methods. Çocuk Enfeksiyon Dergisi. 2008; 2(4): 156 - 161.
Vancouver	Hacimustafaoglu M,ÇELEBİ S,AYNACI E,KÖKSAL N,SINIRTAŞ M,GÖRAL G Evaluation of RSV frequency in acute bronchiolitis By different methods. Çocuk Enfeksiyon Dergisi. 2008; 2(4): 156 - 161.
IEEE	Hacimustafaoglu M,ÇELEBİ S,AYNACI E,KÖKSAL N,SINIRTAŞ M,GÖRAL G "Evaluation of RSV frequency in acute bronchiolitis By different methods." Çocuk Enfeksiyon Dergisi, 2, ss.156 - 161, 2008.
ISNAD	Hacimustafaoglu, Mustafa vd. "Evaluation of RSV frequency in acute bronchiolitis By different methods". Çocuk Enfeksiyon Dergisi 2/4 (2008), 156-161.