Postmortem Süreçte COVID-19 Enfeksiyon Etkeninin Pozitif Kalma Süresi
DOI:
https://doi.org/10.17986/blm.1671Anahtar Kelimeler:
Covid-19- SARS-CoV-2- sürüntü örneği- doku örneği- PCR- postmortemÖz
Amaç: Çalışmalar, Koronavirüs hastalığı-2019 (COVID-19) tanılı hastalarda örnek alım teknikleri ve örnek alınan bölgeler gibi faktörlere bağlı olarak polimeraz zincir reaksiyon (PZR) testlerinin hatalı negatif sonuç verebildiğini göstermektedir. Bu çalışmada; bilgisayarlı tomografi (BT) veya PZR ile doğrulanmış COVID-19 enfeksiyonu nedeniyle tedavi gördüğü sırada ölen olgularda ölümle birlikte 6 saat aralıklarla alınan ardışık akciğerden tru-cut iğne biyopsi örneklerinden PZR yöntemiyle virüs RNA’sının pozitifliği çalışılmış, virüsün postmortem pozitif kalım süresini tespit edebilmek amaçlanmıştır.
Yöntem: Klinik ve/veya sürüntü örneğinden RNA tespiti ile tanısı konmuş COVID-19 enfeksiyonu nedeniyle tedavi gördüğü sırada vefat eden 21 olgu çalışmaya dahil edilmiştir. Olguların antemortem sürüntü, postmortem nazofarenks sürüntü ve postmortem akciğer doku örneklerinden yapılan PZR ile virüs RNA tespiti sonuçları klinikleriyle birlikte karşılaştırılmıştır.
Bulgular: Yirmi bir olgunun 15’i (%71,4) erkek, 6’sı %28,6 kadındır. Yaş ortalaması 71,9’dur (standart sapma=12,079). Hastaneye yatış şikayetleri sıklıkla solunum semptomlarıdır. Hastane yatışındaki akciğer BT bulgularının hepsinde buzlu cam görünümü, 3 olguda plevral efüzyon mevcuttur. Olguların ölene kadarki hastane yatış süreleri ortalaması 11,7 gün, en uzun 43 gündür. Antemortem 13 olguda (%61,9) nazofarengeal virüs pozitifliği, postmortem 5 olguda (%23,8) nazofarengeal virüs pozitifliği, 7 olguda (%33,3) akciğer doku örneğinde virüs pozitifliği gösterilmiştir. Nazofaringeal sürüntü ve akciğer doku örneğinde virüs pozitifliği açısından anlamlı bir ilişki saptanmamış, uyumsuzluk oranı %19,1 olarak olup istatistiksel anlamlı bulunmuştur.
Sonuç: Çalışma kısıtlılıkları nedeniyle hedeflenen örneklem sayısına ulaşamamakla birlikte nazofarengeal sürüntü örnekleriyle akciğer doku örneklerinde virüs pozitifliğindeki uyumsuzluk anlamlıdır. Virüsün postmortem sağkalım süresi, klinik ve yarattığı organ hasarı açısından karşılaştırmalı geniş örneklemde çalışmalara ihtiyaç olduğu kesindir.
İndirmeler
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