{"id":3257,"date":"2018-10-15T13:26:18","date_gmt":"2018-10-15T10:26:18","guid":{"rendered":"https:\/\/blog.annebebekkulubu.com\/?p=3257"},"modified":"2018-10-15T13:26:18","modified_gmt":"2018-10-15T10:26:18","slug":"cocuklarda-tekrarlayan-ates","status":"publish","type":"post","link":"https:\/\/annebebekkulubu.com\/blog\/cocuklarda-tekrarlayan-ates\/","title":{"rendered":"\u00c7ocuklarda tekrarlayan ate\u015f"},"content":{"rendered":"

Ate\u015f<\/strong> \u00e7ocukluk \u00e7a\u011f\u0131nda en s\u0131k olarak viral \u00fcst solunum yolu enfeksiyonlar\u0131<\/strong> nedeniyle g\u00f6r\u00fcl\u00fcr. \u00c7ocuklarda y\u0131lda 8-9 kere \u00fcst solunum yolu enfeksiyonlar\u0131na ba\u011fl\u0131 ate\u015flenme<\/strong> normaldir, \u00f6zellikle okul ve kres\u0327 c\u0327ocuklar\u0131nda y\u0131l ic\u0327erisindeki ates\u0327lenme ataklar\u0131 10-12\u2019ye kadar c\u0327\u0131kabilir. Ate\u015fin tekrarlad\u0131\u011f\u0131 ve enfeksiyonlar\u0131n e\u015flik etmedi\u011fi durumlarda neoplastik ve romatolojik hastal\u0131klar, ba\u011f\u0131\u015f\u0131kl\u0131k sistemi yetersizlikleri ve \u00e7e\u015fitli endokrin ya da metabolik sebepler d\u00fc\u015f\u00fcn\u00fclebilir. \u00c7ocukluk \u00e7a\u011f\u0131nda tekrarlayan ve sebebi a\u00e7\u0131klanamayan ate\u015f<\/strong> hem aileleri hem de hekimleri endi\u015felendirmekte, tan\u0131 i\u00e7in bir \u00e7ok ayr\u0131nt\u0131l\u0131 testin yap\u0131lmas\u0131na yol a\u00e7maktad\u0131r. Ate\u015fin belirli zaman aral\u0131klar\u0131yla tekrarlad\u0131\u011f\u0131 ve sebebinin anla\u015f\u0131lamad\u0131\u011f\u0131 durumlara \u2018periyodik ate\u015f sendromlar\u0131<\/strong>\u2019 denir.<\/p>\n

Genel olarak periyodik ate\u015f sendromlar\u0131nda, tekrarlayan ate\u015fli d\u00f6nemler aras\u0131nda en az yedi g\u00fcn bulunmas\u0131 ve alt\u0131 ay i\u00e7inde en az \u00fc\u00e7 sefer ate\u015fli d\u00f6nemin g\u00f6r\u00fclmesi ortak bulgudur.<\/p>\n

Ate\u015fsiz ara d\u00f6nemlerde \u00e7ocuk tamamen normaldir. Periyodik ate\u015fe neden olan tablolar aras\u0131nda;<\/strong>
\n-PFAPA sendromu,
\n– Siklik n\u00f6tropeni
\n– Ailevi Akdeniz Ate\u015fi (FMF),
\n– Hiper Ig D sendromu (HIDS),
\n– T\u00fcm\u00f6r nekroz fakt\u00f6r\u00fc ile ili\u015fkili periyodik sendrom (TRAPS),
\n– Ailesel so\u011fuk \u00fcrtikeri (FCU) ve Muckle-Wells sendromu (MWS) say\u0131labilir.<\/p>\n

PFAPA:<\/strong> \u00dcst solunum yolu enfeksiyonu bulgular\u0131 \u00e7ok belirgin olmamakla birlikte a\u011f\u0131z i\u00e7inde beyaz renkli aftlar , farenjit ve boyunda lenfnodu b\u00fcy\u00fcmesi ile birlikte 3-6 g\u00fcn s\u00fcren ve 3-6 haftada bir tekrarlayan y\u00fcksek ate\u015f (38-41 \u00baC) ataklar\u0131yla karakterizedir. PFAPA sendromununda aral\u0131kl\u0131 ate\u015f aylarca s\u00fcrebilir. Ancak \u00e7ocuk b\u00fcy\u00fcd\u00fck\u00e7e ataklar aras\u0131ndaki s\u00fcre giderek uzar. Sendrom baz\u0131 \u00e7ocuklarda kronik olmas\u0131na ra\u011fmen genellikle 4 ile 8 y\u0131l i\u00e7inde kendili\u011finden iyile\u015fir.<\/p>\n

Siklik N\u00f6tropeni:<\/strong> PFAPA sendromu ile klinik olarak kolayca kar\u0131\u015fabilir. Ortalama 21 g\u00fcnde bir tekrarlayan ate\u015f, farenjit, a\u011f\u0131zda \u00fclserler, a\u011fr\u0131l\u0131 boyun lenfnodu b\u00fcy\u00fcmesi ve tekrarlayan sel\u00fclit ile seyreder. \u00dclserler genelikle derin yerle\u015fimli ve a\u011fr\u0131l\u0131d\u0131r. Bu hastalarda sin\u00fczit, orta kulak iltihab\u0131, farenjit ve zat\u00fcrre de g\u00f6r\u00fclebilir. N\u00f6tropeni ( kanda beyaz k\u00fcre d\u00fc\u015f\u00fckl\u00fc\u011f\u00fc ile birlikte veya de\u011fil) olmad\u0131\u011f\u0131 d\u00f6nemlerde hastalar\u0131n muayeneleri normaldir. Otozomal dominant ge\u00e7i\u015fli olabilir. N\u00f6tropeni genelikle 3-6 g\u00fcn devam eder ve bu d\u00f6nemde enfeksiyonlar g\u00f6r\u00fcl\u00fcr. Hastada siklik n\u00f6tropeni bulunup bulunmad\u0131\u011f\u0131n\u0131 ara\u015ft\u0131rmak i\u00e7in, \u00e7ocukta en az bir kez ate\u015fli atak g\u00f6r\u00fclen 2 ayl\u0131k bir zaman dilimi i\u00e7inde, haftada 2 ya da 3 kez l\u00f6kosit say\u0131m\u0131 ve l\u00f6kosit form\u00fcl\u00fc incelenmelidir. Mutlak n\u00f6trofil say\u0131s\u0131n\u0131n <500\/m3 oldu\u011fu bulunur ve t\u0131bbi herhangi bir giri\u015fim olmaks\u0131z\u0131n n\u00f6trofil say\u0131s\u0131 normale d\u00f6nerse, siklik n\u00f6tropeni d\u00fc\u015f\u00fcn\u00fclebilir.<\/p>\n

FMF (A\u0130LEV\u0130 AKDEN\u0130Z ATE\u015e\u0130):<\/strong> Ate\u015f genellikle 38\u00b0C\u2019nin \u00fczerindedir ve 12-72 saat s\u00fcrer. Hastalar\u0131n ataklar aras\u0131nda \u015fikayetleri yoktur. Ate\u015fe s\u0131kl\u0131kla artrit (eklem iltihab\u0131) ve kar\u0131n a\u011fr\u0131s\u0131 da e\u015flik eder. Kar\u0131n a\u011fr\u0131s\u0131 akut apandisiti d\u00fc\u015f\u00fcnd\u00fcrecek kadar \u015fiddetlidir. Artrit genelikle tek eklemi tutar ve s\u0131kl\u0131kla bacaklardaki b\u00fcy\u00fck eklemleri tutar. D\u00f6k\u00fcnt\u00fcler daha \u00e7ok bacaklar\u0131n \u00f6n y\u00fcz\u00fcnde veya ayak s\u0131rt\u0131nda g\u00f6r\u00fcl\u00fcr. Bu hastalarda ataklar s\u0131ras\u0131nda l\u00f6kosit say\u0131s\u0131, CRP, sedimentasyon, fibrinojen ve serum amiloid A d\u00fczeyleri y\u00fckselir. Fakat bu bulgular FMF i\u00e7in \u00f6zg\u00fcl de\u011fildir. Ayr\u0131ca FMF mutasyon analizi yap\u0131lmaktad\u0131r.<\/p>\n

Hiper IgD Sendromu (HIDS)<\/strong> Mevalonat kinaz genindeki mutasyonun neden oldu\u011fu otozomal resesif ge\u00e7i\u015fli (akraba evlili\u011fi hastal\u0131k riskini artt\u0131r\u0131r<\/strong>) bir hastal\u0131kt\u0131r. Tekrarlayan ate\u015f, kar\u0131n a\u011fr\u0131s\u0131, eklem ve cilt tutulumu hastal\u0131\u011f\u0131n karakteristik \u00f6zelli\u011fidir. Hiper IgD sendromlu hastalar\u0131n hemen hepsinde ate\u015f vard\u0131r. Lenfadenopati ve ishal ate\u015fe e\u015flik eder. Di\u011fer bulgular ba\u015f a\u011fr\u0131s\u0131, kar\u0131n a\u011fr\u0131s\u0131, poliartrit, deri d\u00f6k\u00fcnt\u00fcs\u00fc ve dalak b\u00fcy\u00fcmesidir. Artrit b\u00fcy\u00fck eklemleri tutar.<\/p>\n

Hiper IgD sendromlu hastalar\u0131n b\u00fcy\u00fck \u00e7o\u011funlu\u011funda ilk atak s\u00fct\u00e7ocuklu\u011fu d\u00f6neminde ba\u015flar. Travma, fiziksel ve duygusal stres ve enfeksiyonlar ataklar\u0131 tetikler. Serum IgD d\u00fczeyi 100 mg\/dL\u2019nin \u00fczerindedir. S\u0131kl\u0131kla y\u00fcksek serum IgA seviyeleri e\u015flik edebilir. Kesin tan\u0131 mevalonat kinaz enzim aktivitesindeki azalman\u0131n g\u00f6sterilmesi ile konulur.<\/p>\n

T\u00fcm\u00f6r Nekroz Fakt\u00f6r\u00fc (TNF) Resept\u00f6r\u00fcyle Ba\u011flant\u0131l\u0131 Periyodik Sendrom (TRAPS):<\/strong> Bir kas grubunda lokalize a\u011fr\u0131 ve gerginlikle birlikte tekrarlayan ate\u015f ve belirtilerin gezici \u00f6zellikte olmas\u0131 ile karakterizedir. Ate\u015f ataklar\u0131 yakla\u015f\u0131k 1 hafta s\u00fcrer. TRAPS\u2019ta en ciddi komplikasyon b\u00f6brek tutulumlu amiloidozdur.<\/p>\n

Ailesel So\u011fuk \u00dcrtikeri (Familial Cold Urt\u0131caria-FCU) ve Muckle-Wells Sendromu:<\/strong> Ailesel so\u011fuk \u00fcrtikeri so\u011fu\u011fa maruz kald\u0131ktan sonra zaman zaman da r\u00fczgarl\u0131 ve ya\u011fmurlu havalarda geli\u015fen aral\u0131kl\u0131 d\u00f6k\u00fcnt\u00fc, eklem a\u011fr\u0131s\u0131, ate\u015f ve konjonktivit \u015feklinde g\u00f6r\u00fcl\u00fcr. Genelikle erken bebeklik d\u00f6neminde bulgular ba\u015flar ve ataklar s\u0131ras\u0131nda d\u00f6k\u00fcnt\u00fc ve eklem a\u011fr\u0131lar\u0131 olur. D\u00f6k\u00fcnt\u00fcler \u00fcrtikeri and\u0131r\u0131r ve ka\u015f\u0131nt\u0131l\u0131d\u0131r, kol ve bacaklardan ba\u015flay\u0131p t\u00fcm v\u00fccuda yay\u0131l\u0131r.<\/p>\n","protected":false},"excerpt":{"rendered":"

Ate\u015f \u00e7ocukluk \u00e7a\u011f\u0131nda en s\u0131k olarak viral \u00fcst solunum yolu enfeksiyonlar\u0131 nedeniyle g\u00f6r\u00fcl\u00fcr. \u00c7ocuklarda y\u0131lda 8-9 kere \u00fcst solunum yolu enfeksiyonlar\u0131na ba\u011fl\u0131 ate\u015flenme normaldir, \u00f6zellikle okul ve kres\u0327 c\u0327ocuklar\u0131nda y\u0131l ic\u0327erisindeki ates\u0327lenme ataklar\u0131 10-12\u2019ye kadar c\u0327\u0131kabilir. Ate\u015fin tekrarlad\u0131\u011f\u0131 ve enfeksiyonlar\u0131n e\u015flik etmedi\u011fi durumlarda neoplastik ve romatolojik hastal\u0131klar, ba\u011f\u0131\u015f\u0131kl\u0131k sistemi yetersizlikleri ve \u00e7e\u015fitli endokrin ya da […]<\/p>\n","protected":false},"author":36,"featured_media":3261,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[7],"tags":[2605,2603,2604],"class_list":{"0":"post-3257","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-saglik","8":"tag-cocuklarda-ates","9":"tag-cocuklarda-tekrarlayan-ates","10":"tag-periyodik-ates-sendromlari"},"jetpack_sharing_enabled":true,"jetpack_featured_media_url":"https:\/\/i0.wp.com\/annebebekkulubu.com\/blog\/wp-content\/uploads\/2018\/10\/children-s-doctor-weighing-the-baby_1398-4465.jpg?fit=626%2C417&ssl=1","jetpack-related-posts":[],"_links":{"self":[{"href":"https:\/\/annebebekkulubu.com\/blog\/wp-json\/wp\/v2\/posts\/3257","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/annebebekkulubu.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/annebebekkulubu.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/annebebekkulubu.com\/blog\/wp-json\/wp\/v2\/users\/36"}],"replies":[{"embeddable":true,"href":"https:\/\/annebebekkulubu.com\/blog\/wp-json\/wp\/v2\/comments?post=3257"}],"version-history":[{"count":0,"href":"https:\/\/annebebekkulubu.com\/blog\/wp-json\/wp\/v2\/posts\/3257\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/annebebekkulubu.com\/blog\/wp-json\/wp\/v2\/media\/3261"}],"wp:attachment":[{"href":"https:\/\/annebebekkulubu.com\/blog\/wp-json\/wp\/v2\/media?parent=3257"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/annebebekkulubu.com\/blog\/wp-json\/wp\/v2\/categories?post=3257"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/annebebekkulubu.com\/blog\/wp-json\/wp\/v2\/tags?post=3257"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}