Enfeksiyonlar ve Karın Ağrısı: (Salmonellosis ve Brusellosis)
Özet
Karın ağrısı, acil servise başvuran hastalarda en sık karşılaşılan semptomlardan biri olup, geniş ayırıcı tanı yelpazesi nedeniyle tanısal açıdan önemli güçlükler içermektedir. Enfeksiyöz nedenler, özellikle ateş ve sistemik bulguların eşlik ettiği karın ağrısı olgularında öncelikli olarak değerlendirilmesi gereken etiyolojiler arasında yer almaktadır. Salmonellosis ve brucellosis, bu bağlamda hem klinik benzerlikleri hem de farklı seyir ve yönetim özellikleri nedeniyle acil servis pratiğinde ayırıcı tanıda dikkatle ele alınması gereken iki önemli enfeksiyon hastalığıdır. Her iki enfeksiyon da karın ağrısı, ateş, halsizlik ve nonspesifik semptomlarla başvurabildiğinden, diğer akut batın nedenleriyle kolaylıkla karışabilmekte ve tanıda gecikmelere yol açabilmektedir. Bu bölümde salmonellosis ve brucellosis, acil servis perspektifiyle ele alınarak patofizyolojik mekanizmaları, klinik sunum özellikleri ve ayırıcı tanı noktaları karşılaştırmalı olarak incelenmiştir. Ayrıca acil serviste tanıyı kolaylaştırmaya yönelik pratik ipuçları, tanısal algoritmalar, klinik tuzaklar ve özel hasta gruplarındaki farklılıklar güncel literatür ışığında tartışılmıştır. Amaç, karın ağrısı ile acil servise başvuran hastalarda bu iki enfeksiyonun erken tanınmasını desteklemek, uygun yönetim stratejilerinin uygulanmasını kolaylaştırmak ve olası komplikasyonların önlenmesine katkı sağlamaktır.
Abdominal pain is one of the most frequent reasons for emergency department admissions and represents a diagnostic challenge due to its broad differential diagnosis. Infectious causes should be carefully considered, particularly when abdominal pain is accompanied by fever and systemic symptoms. Among these, salmonellosis and brucellosis constitute two clinically important infections that may present with overlapping yet pathophysiologically distinct features, often leading to diagnostic uncertainty in the acute care setting. Salmonellosis typically manifests as an acute gastrointestinal illness with prominent abdominal pain and diarrhea, whereas brucellosis tends to present with a more insidious onset, systemic involvement, and subacute or chronic clinical patterns. In this chapter, the mechanisms of infection-related abdominal pain are briefly reviewed, followed by a comparative discussion of salmonellosis and brucellosis from an emergency medicine perspective. Emphasis is placed on clinical presentation, diagnostic reasoning, and practical decision-making points rather than pathogen-centered algorithms. The primary aim is to support early recognition of these infections in patients presenting with abdominal pain, to facilitate appropriate management strategies, and to reduce the risk of delayed diagnosis and preventable complications.
Referanslar
Shane AL, Mody RK, Crump JA, et al. 2017 IDSA Clinical Practice Guidelines for the Diagnosis and Management of Infectious Diarrhea. Clin Infect Dis. 2017;65(12):e45–e80. doi:10.1093/cid/cix669
Qi X, Li P, Chen J, et al. Epidemiological and molecular investigations on Salmonella infections. Front Microbiol. 2019;10:2025. doi:10.3389/fmicb.2019.02025
Popa GL, Papa MI. Salmonella spp. infection – a continuous threat worldwide. Infect Drug Resist. 2021;14:2717–2730. doi:10.2147/IDR.S308367
Herekar F, Gupta P, Shah N, et al. Clinical spectrum and outcomes of patients with different resistance patterns of Salmonella enterica. Infect Drug Resist. 2022;15:229–238. doi:10.2147/IDR.S346271
Pagani G, D’Antonio D, Romano A, et al.
Invasive and non-invasive human salmonellosis cases.
Pathogens. 2023;12(11):1298.
doi:10.3390/pathogens12111298
Rosso F, Pardo AM, Agudelo M, et al. Clinical and microbiological characterization of Salmonella infections: a 10-year study. BMC Infect Dis. 2023;23:625. doi:10.1186/s12879-023-08603-9
Wang X, Li Y, Zhang S, et al. Analysis of human brucellosis cases between 2010 and 2020. Infect Drug Resist. 2022;15:1339–1348. doi:10.2147/IDR.S350859
Jin M, Liu X, Sun J, et al. Research progress on complications of brucellosis. Front Cell Infect Microbiol. 2023;13:1136674.
doi:10.3389/fcimb.2023.1136674
Ma L, Zhang L, Li Z, et al. A 10-year retrospective comparative analysis of the clinical features of brucellosis. J Infect Dev Ctries. 2021;15(9):1312–1318. doi:10.3855/jidc.13908
Wu Z, Wang Y, Zhang Y, et al. Human brucellosis and fever of unknown origin. BMC Infect Dis. 2022;22:868. doi:10.1186/s12879-022-07815-6
Huang Y, Chen X, Li J, et al. Brucellosis peritonitis and aortitis in a peritoneal dialysis patient. IDCases. 2024;36:e01948. doi:10.1016/j.idcr.2024.e01948
Suvak B, Dulger AC, Karadas S, et al. Brucellosis-related acute pancreatitis: a rare complication. J Int Med Res. 2016;44(1):131–135. doi:10.1177/0300060515605900
Referanslar
Shane AL, Mody RK, Crump JA, et al. 2017 IDSA Clinical Practice Guidelines for the Diagnosis and Management of Infectious Diarrhea. Clin Infect Dis. 2017;65(12):e45–e80. doi:10.1093/cid/cix669
Qi X, Li P, Chen J, et al. Epidemiological and molecular investigations on Salmonella infections. Front Microbiol. 2019;10:2025. doi:10.3389/fmicb.2019.02025
Popa GL, Papa MI. Salmonella spp. infection – a continuous threat worldwide. Infect Drug Resist. 2021;14:2717–2730. doi:10.2147/IDR.S308367
Herekar F, Gupta P, Shah N, et al. Clinical spectrum and outcomes of patients with different resistance patterns of Salmonella enterica. Infect Drug Resist. 2022;15:229–238. doi:10.2147/IDR.S346271
Pagani G, D’Antonio D, Romano A, et al.
Invasive and non-invasive human salmonellosis cases.
Pathogens. 2023;12(11):1298.
doi:10.3390/pathogens12111298
Rosso F, Pardo AM, Agudelo M, et al. Clinical and microbiological characterization of Salmonella infections: a 10-year study. BMC Infect Dis. 2023;23:625. doi:10.1186/s12879-023-08603-9
Wang X, Li Y, Zhang S, et al. Analysis of human brucellosis cases between 2010 and 2020. Infect Drug Resist. 2022;15:1339–1348. doi:10.2147/IDR.S350859
Jin M, Liu X, Sun J, et al. Research progress on complications of brucellosis. Front Cell Infect Microbiol. 2023;13:1136674.
doi:10.3389/fcimb.2023.1136674
Ma L, Zhang L, Li Z, et al. A 10-year retrospective comparative analysis of the clinical features of brucellosis. J Infect Dev Ctries. 2021;15(9):1312–1318. doi:10.3855/jidc.13908
Wu Z, Wang Y, Zhang Y, et al. Human brucellosis and fever of unknown origin. BMC Infect Dis. 2022;22:868. doi:10.1186/s12879-022-07815-6
Huang Y, Chen X, Li J, et al. Brucellosis peritonitis and aortitis in a peritoneal dialysis patient. IDCases. 2024;36:e01948. doi:10.1016/j.idcr.2024.e01948
Suvak B, Dulger AC, Karadas S, et al. Brucellosis-related acute pancreatitis: a rare complication. J Int Med Res. 2016;44(1):131–135. doi:10.1177/0300060515605900
