Yoğun Bakımda Akciğer Tüberkülozu: Tanı, Tedavi ve İzolasyon
Özet
Tüberküloz (TB), Mycobacterium tuberculosis complex olarak tanımlanan bir grup mikobakteri tarafından oluşturulan, çok değişik klinik görünümlere sahip kronik, nekrozitan bir enfeksiyondur. Basiller, çoğunlukla akciğerlerde hastalık oluşturmaları dışında lenfatik sistem, kemik yapı, santral sinir sistemi, üriner sistem, sindirim sistemi ve genital sistemi de etkileyebilmektedir. Tüberküloz, önlenebilen, tedavi edilip iyileştirilebilen, toplumsal açıdan da önemli bir hastalıktır. Akciğer Tüberkülozu; akciğer parankimini tutan TB için kullanılır. Akciğer parankimi tutulumu olmayan, plevra effüzyonu ya da toraks içi (hilusta, mediastende) tutulumlar da dahil diğer tüm sistemlerdeki tutulumlar, akciğer dışı tüberküloz olarak kabul edilir. Tüberküloz ciddi ve potansiyel olarak ölümcül seyredebilen bir hastalık olabilir, ancak erken tanı ve etkin tedavinin iyileşme üzerindeki etkisi büyüktür.
Yoğun bakımda tüberkülozlu hasta yönetimi karmaşık ve çok yönlüdür, çünkü yoğun bakım gereksinimi genellikle ileri evre hastalık veya tedaviye dirençli tüberküloz formları nedeniyle olur. Ayrıca bu hastalarda tüberküloza bağlı komplikasyonlar ya da eşlik eden tıbbi durumların yönetimi de gerekli olabilir. Mekanik ventilasyon desteği, sıvı dengenin sağlanması, besin desteği ve eşlik eden diğer durumların yönetimi de kritik önem taşır. Yoğun bakım ünitelerinde tüberküloz hastalarının takibi sırasında; hem sağlık çalışanlarının hem de diğer hastaların güvenliğini sağlamak için uygun izolasyon önlemleri almak son derece önemlidir. Tüberküloz, hava yoluyla bulaşabilen bir enfeksiyon olduğundan, hastalar uygun izolasyon koşullarında, negatif basınçlı odalarda takip edilmelidir. Tüberküloz hastalarıyla çalışacak sağlık personelinin gerekli kişisel koruyucu ekipmanlar ile çalışmaları konusunda gerekli özeni göstermemiz önemlidir.
Tuberculosis (TB) is a chronic, necrotic infection with a wide variety of clinical manifestations caused by a group of mycobacteria defined as Mycobacterium tuberculosis complex. Apart from causing disease mostly in the lungs, bacilli can also affect the lymphatic system, bone structure, central nervous system, urinary system, digestive system and genital system. Tuberculosis is a socially important disease that can be prevented, treated and cured. Pulmonary Tuberculosis is used for TB involving the lung parenchyma. Involvement in all other systems, including pleural effusion or intrathoracic (hilus, mediastinum) involvement without lung parenchymal involvement, is considered extrapulmonary tuberculosis. Tuberculosis can be a serious and potentially fatal disease, but early diagnosis and effective treatment have a major impact on recovery.
Management of patients with tuberculosis in the intensive care unit is complex and multifaceted, as the need for intensive care is often due to advanced disease or treatment-resistant forms of tuberculosis. In addition, management of tuberculosis-related complications or comorbid medical conditions may be necessary in these patients. Mechanical ventilation support, maintenance of fluid balance, nutritional support, and management of other comorbid conditions are also critical. During the follow-up of tuberculosis patients in intensive care units, it is extremely important to take appropriate isolation precautions to ensure the safety of both healthcare professionals and other patients. Since tuberculosis is an infection that can be transmitted through the air, patients should be monitored in appropriate isolation conditions, in negative pressure rooms. It is important that we take the necessary care to ensure that healthcare personnel who will work with tuberculosis patients wear the necessary personal protective equipment.
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