Kanin Monositotopik Ehrlichiozis
Özet
Köpeklerin monositik ehrlichiosisi (CME), Ehrlichia canis tarafından oluşturulan ve dünya genelinde yaygın olarak görülen, kene kaynaklı sistemik bir enfeksiyondur. Hastalık, başta kahverengi köpek kenesi (Rhipicephalus sanguineus) aracılığıyla bulaşmakta olup tüm ırk ve yaş gruplarındaki köpekleri etkileyebilmektedir. CME; akut, subklinik ve kronik olmak üzere üç klinik evrede seyretmekte ve hastalığın şiddeti ilerleyen evrelerde belirgin şekilde artmaktadır. Akut faz genellikle ateş, depresyon, lenfadenomegali ve kanama eğilimi ile karakterize edilirken, kronik evrede pansitopeni, şiddetli hemorajiler ve yüksek mortalite oranları ön plana çıkmaktadır. Hematolojik olarak trombositopeni, non-rejeneratif anemi ve lökopeni hastalığın temel laboratuvar bulguları arasında yer almakta; kronik evrede ise kemik iliği baskılanmasına bağlı pansitopeni gelişebilmektedir. Biyokimyasal açıdan özellikle karaciğer enzimlerindeki yükselme, hipoalbüminemi, hiperglobulinemi ve renal fonksiyon bozuklukları CME ile ilişkilendirilmektedir. Son yıllarda yapılan çalışmalar, karaciğer ve böbrek hasarının erken belirlenmesinde yeni biyobelirteçlerin potansiyel rolüne dikkat çekmektedir. CME tanısı; epidemiyolojik öykü, klinik ve klinikopatolojik bulgular ile serolojik ve moleküler testlerin birlikte değerlendirilmesine dayanmaktadır. Serolojik testler maruziyeti gösterirken, polimeraz zincir reaksiyonu aktif enfeksiyonun saptanmasında yüksek duyarlılık ve özgüllük sunmaktadır. Tedavide temel yaklaşım, etkenin eliminasyonu ve klinik iyileşmenin sağlanmasıdır. Doksisiklin, CME tedavisinde ilk tercih edilen antibiyotik olup, rifampisin belirli olgularda alternatif bir seçenek olarak değerlendirilmektedir. Bu bölümde CME’nin epidemiyolojisi, klinik bulguları, tanısal yaklaşımları ve tedavi stratejileri güncel literatür ışığında kapsamlı biçimde ele alınmıştır.
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