Tüberküloz Hastalarında Kronik Ağrı
Özet
Tüberküloz (TB) binlerce yıllık tarihi boyunca insanlığın en ölümcül enfeksiyonlarından biri olarak kabul edilmiştir. Günümüzde ise yalnızca pulmoner bir hastalık olarak değil, kas-iskelet sistemini etkileyen ve kronik ağrıya yol açan kompleks bir klinik tablo olarak karşımıza çıkmaktadır. Miliyer tüberküloz vakalarında bu durum akılda tutulmalıdır. Başlangıçta non-spesifik nöromüsküloskeletal ağrı olarak tanımlanan vakalarda tekrar başvurulardan sonra, görüntüleme ile kemik taramalarında vertebralarda osteolitik lezyonlar görülebilmektedir. Bu durumda da kemik biyopsisi yapıldığında mikrobiyolojik inceleme yoluyla asidorezistan boyama yöntemleri ve kültür ile Mycobacterium tuberculosis aranmalıdır. Spinal tüberküloz, kemik ve eklem TB vakalarının yaklaşık %50'sinde omurgayı etkilemektedir. Kas-iskelet TB hastalarının %70,9'unda en sık görülen şikayet geçmeyen ilerleyici sırt ağrısıdır. Bu bakımdan sırt ağrısı kronikleşmiş hastalarda bu olasılık akılda tutulmalıdır.
Throughout its history spanning thousands of years, tuberculosis (TB) has been recognized as one of humanity’s deadliest infections. Today, however, it is not merely a pulmonary disease but presents as a complex clinical condition that affects the musculoskeletal system and leads to chronic pain. This should be kept in mind in cases of miliary tuberculosis. In cases initially described as nonspecific neuromusculoskeletal pain, osteolytic lesions in the vertebrae may be observed on bone scans following repeat visits. In such cases, a bone biopsy should be performed to search for Mycobacterium tuberculosis through microbiological examination using acid-fast staining methods and culture. Spinal tuberculosis affects the spine in approximately 50% of cases of bone and joint TB. In 70.9% of patients with musculoskeletal TB, the most common complaint is persistent, progressive back pain. Therefore, this possibility should be kept in mind in patients with chronic back pain.
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