Balgamın Direkt Bakısı ve Kültürü
Özet
Balgam, solunum yollarında koruyucu bir mukus tabakası olarak görev yapar ve çeşitli patolojik durumlarda tanı için değerli bir tanısal materyaldir. Balgamın analizi, çıplak gözle inceleme, mikroskopi, kültür, sitolojik ve moleküler yöntemlerle gerçekleştirilir. En sık kullanılan testler arasında Gram boyama, asit-hızlı basil (AFB) aranması ve balgam kültürü yer alır. Bu yöntemler bakteriyel, fungal ve viral enfeksiyonların yanı sıra akciğer kanserinin ve diğer solunum yolu hastalıklarının teşhisinde de uygulanmaktadır. Balgamın rengi, kıvamı ve miktarı, altta yatan hastalığa bağlı olarak değişir. Balgam örneklerinin kalitesi ve doğru toplanması, testlerin duyarlılığını doğrudan etkiler. Moleküler yöntemler, özellikle polimeraz zincir reaksiyonu (PCR) ve izotermal döngü aracılı amplifikasyon testleri (LAMP), tanı doğruluğunu artırmaktadır, ancak maliyet nedeniyle yayma mikroskopisi düşük gelirli bölgelerde halen tercih edilmektedir. Pediatrik popülasyonda ise balgam örneği elde etmenin güçlükleri nedeniyle nazogastrik aspirat gibi alternatif yöntemler önerilmektedir. Doğru ve güvenilir balgam analizi, hem bireysel hasta yönetiminde hem de toplum sağlığı açısından kritik öneme sahiptir. Gelecekte yapay zekâ destekli analiz teknikleri ve yeni nesil moleküler testlerin, balgam incelemelerinin tanısal doğruluğunu ve klinik değerini daha da artıracağı öngörülmektedir.
Referanslar
Steingart KR, Henry M, Ng V, Hopewell PC, Ramsay A, Cunningham J, Urbanczik R, Perkins MD, Aziz MA, Pai M. Fluorescence versus conventional sputum smear microscopy for tuberculosis: a systematic review. Lancet Infect Dis. 2006;6(9):570–581. doi:10.1016/S1473-3099(06)70578-3; PMID:16931408.
Luelmo F. What is the role of sputum microscopy in patients attending health facilities? In: Frieden T, editor. Toman's Tuberculosis: Case Detection, Treatment, and Monitoring—Questions and Answers. 2nd ed.. World Health Organization. Geneva; World Health Organization; 2004. pp. 7–13. Erişim: 05 September 2025, https://apps.who.int/iris/bitstream/handle/10665/42701/9241546034.pdf
Beveridge TJ, Davies JA. Cellular responses of Bacillus subtilis and Escherichia coli to the Gram stain. J Bacteriol. 1983;156(2):846–858. doi:10.1128/jb.156.2.846-858.1983; PMID:6195148; PMCID:PMC217903.
Rawat J, Biswas D, Sindhwani G, Kesharwani V, Masih V, Chauhan BS. Diagnostic defaulters: an overlooked aspect in the Indian Revised National Tuberculosis Control Program. J Infect Dev Ctries. 2012;6(1):20–22. doi:10.3855/jidc.1895; PMID:22240423. Erişim: 05 September 2025, https://jidc.org/index.php/journal/article/view/22240423
Datta S, Shah L, Gilman RH, Evans CA, et al.. Comparison of sputum collection methods for tuberculosis diagnosis: a systematic review and pairwise and network meta-analysis. Lancet Glob Health. 2017;5(8):e760–e771. doi:10.1016/S2214-109X(17)30201-2; PMID:28625793; PMCID:PMC5567202.
Nayak P, Kumar AM, Agrawal TK, Claassens M, Enarson DA, Satyanarayana S, Kundu D, Rao R. Same-day light-emitting diode fluorescence microscopy for the diagnosis of tuberculosis in Chhattisgarh, India. Int J Tuberc Lung Dis. 2014;18(6):666–670. doi:10.5588/ijtld.13.0848; PMID:24903936.
Shen F, Zubair M, Sergi C. Sputum Analysis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. Updated 2025 May 4. StatPearls. 2025; Erişim: 05 September 2025, https://www.ncbi.nlm.nih.gov/books/NBK563195/
Rosai J. Why microscopy will remain a cornerstone of surgical pathology. Lab Invest. 2007;87(5):403–408. doi:10.1038/labinvest.3700551; PMID:17401434.
Idowu MO, Powers CN. Lung cancer cytology: potential pitfalls and mimics - a review. Int J Clin Exp Pathol. 2010 Mar 25;3(4):367-85. PMID: 20490328; PMCID: PMC2872744.
Rivera MP, Mehta AC, Wahidi MM. Establishing the diagnosis of lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013;143(5 Suppl):e142S–e165S. doi:10.1378/chest.12-2353; PMID:23649436.
Takeuchi K, Choi YL, Soda M, et al.. Multiplex reverse transcription-PCR screening for EML4-ALK fusion transcripts. Clin Cancer Res. 2008;14(20):6618–6624. doi:10.1158/1078-0432.CCR-08-1018; PMID:18927303.
Petsky HL, Li A, Chang AB. Tailored Interventions Based on Sputum Eosinophils versus Clinical Symptoms for Asthma in Children and Adults. Cochrane Database Syst Rev. 2017;8:CD005603. doi:10.1002/14651858.CD005603.pub3; PMID:28837221; PMCID:PMC6483759.
Rohde G, Wiethege A, Borg I, et al.. Respiratory viruses in exacerbations of chronic obstructive pulmonary disease requiring hospitalisation: a case-control study. Thorax. 2003;58(1):37–42. doi:10.1136/thorax.58.1.37; PMID:12511718; PMCID:PMC1746460.
Mawaddah A, Gendeh HS, Lum SG, Marina MB. Upper respiratory tract sampling in COVID-19. Malays J Pathol. 2020;42(1):23–35. PMID:32342928. Erişim: 05 September 2025, https://www.mjpath.org.my/2020/v42n1/sampling-in-COVID-19.pdf
Shete PB, Farr K, Strnad L, Gray CM, Cattamanchi A. Diagnostic accuracy of TB-LAMP for pulmonary tuberculosis: a systematic review and meta-analysis. BMC Infect Dis. 2019;19(1):268. doi:10.1186/s12879-019-3881-y; PMID:30890135; PMCID:PMC6425614.
Leung E, Minion J, Benedetti A, Pai M, Menzies D. Microcolony culture techniques for tuberculosis diagnosis: a systematic review. Int J Tuberc Lung Dis. 2012;16(1):16–23. doi:10.5588/ijtld.10.0065; PMID:21986554.
Andama A, Whitman GR, Crowder R, et al.. Accuracy of Tongue Swab Testing Using Xpert MTB/RIF Ultra for Tuberculosis Diagnosis. J Clin Microbiol. 2022;60(7):e00421-22. doi:10.1128/jcm.00421-22; PMID:35758702; PMCID:PMC9297831.
Cattamanchi A, Davis JL, Worodria W, den Boon S, Yoo S, Matovu J, Kiidha J, Nankya F, Kyeyune R, Byanyima P, Andama A, Joloba M, Osmond DH, Hopewell PC, Huang L. Sensitivity and specificity of fluorescence microscopy for diagnosing pulmonary tuberculosis in a high HIV prevalence setting. Int J Tuberc Lung Dis. 2009;13(9):1130–1136. PMID:19723403; PMCID:PMC2754584.
Schonhofer C, Bilawka J, Apperley S, Lowe CF, Payne M, Matic N, Leung V, Romney MG, Tang P, Stefanovic A. Xpert MTB/RIF Ultra performance on bronchial specimens in diagnosing pulmonary tuberculosis in Vancouver, Canada. J Med Microbiol. 2025;74(6):002022. doi:10.1099/jmm.0.002022; PMID:40476851; PMCID:PMC12144317.
Zifodya JS, Kreniske JS, Schiller I, Kohli M, Dendukuri N, Schumacher SG, Ochodo EA, Haraka F, Zwerling AA, Pai M, Steingart KR, Horne DJ. Xpert Ultra versus Xpert MTB/RIF for pulmonary tuberculosis and rifampicin resistance in adults with presumptive pulmonary tuberculosis. Cochrane Database Syst Rev. 2021 Feb 22;2(2):CD009593. doi: 10.1002/14651858.CD009593.pub5. PMID: 33616229; PMCID: PMC12045032.
Zar HJ, Workman LJ, Prins M, Bateman LJ, Mbhele SP, Whitman CB, Denkinger CM, Nicol MP. Tuberculosis Diagnosis in Children Using Xpert Ultra on Different Respiratory Specimens. Am J Respir Crit Care Med. 2019;200(12):1531–1538. doi:10.1164/rccm.201904-0772OC; PMID:31381861; PMCID:PMC6909828.
Desikan P. Sputum smear microscopy in tuberculosis: Is it still relevant?. Indian J Med Res. 2013;137(3):442–444. doi:10.4103/0971-5916.112417; PMID:23640550; PMCID:PMC3705651.
Keeler E, Perkins MD, Small P, Hanson C, Reed S, Cunningham J, Aledort JE, Hillborne L, Rafael ME, Girosi F, Dye C. Reducing the global burden of tuberculosis: the contribution of improved diagnostics. Nature. 2006;444(Suppl 1):49–57. doi:10.1038/nature05446; PMID:17159894. Erişim: 05 September 2025, https://www.nature.com/articles/nature05446
