Göğüs Ağrısının Enfeksiyöz Nedenleri: Klinik ve Mikrobiyolojik Yaklaşım
Özet
Göğüs ağrısı, acil servis başvurularının en sık nedenlerinden biri olup öncelikle akut koroner sendrom, pulmoner emboli ve aort diseksiyonu gibi yaşamı tehdit eden durumların dışlanmasını gerektirir. Bununla birlikte enfeksiyöz hastalıklar da pulmoner, plevral, perikardiyal, miyokardiyal, endokardiyal, mediastinal ve göğüs duvarı tutulumları yoluyla göğüs ağrısına neden olabilir. Bu bölümde enfeksiyöz göğüs ağrısının patofizyolojisi, klinik değerlendirmesi ve ayırıcı tanısı multidisipliner bir bakış açısıyla ele alınmıştır. Toplum kökenli pnömoni, parapnömonik efüzyon, ampiyem, akut mediastinit, herpes zoster, perikardit, miyokardit, infektif endokardit, tüberküloz ve invaziv fungal enfeksiyonların klinik özellikleri ile mikrobiyolojik tanı yöntemleri güncel kılavuzlar doğrultusunda özetlenmiştir. Mikrobiyolojik tanıda uygun örnek seçimi, doğru zamanda örnekleme, kültür, moleküler yöntemler, MALDI-TOF MS, antijen ve serolojik testlerin uygun klinik bağlamda kullanımı vurgulanmıştır. Ayrıca preanalitik süreç, örnek transportu, laboratuvar raporlarının yorumlanması ve kritik sonuç bildiriminin tanısal başarıdaki önemi değerlendirilmiştir. Enfeksiyöz göğüs ağrısında tek bir laboratuvar testinin tanı koydurucu olmadığı, klinik bulguların, görüntüleme yöntemlerinin ve mikrobiyolojik sonuçların birlikte değerlendirilmesinin doğru tanı ve uygun antimikrobiyal tedavi açısından temel yaklaşım olduğu sonucuna varılmıştır.
Chest pain is one of the most common reasons for emergency department admission, and life-threatening conditions such as acute coronary syndrome, pulmonary embolism, and aortic dissection should be excluded first. However, infectious diseases may also present with chest pain through involvement of the lungs, pleura, pericardium, myocardium, endocardium, mediastinum, and chest wall. This chapter provides a comprehensive multidisciplinary overview of the pathophysiology, clinical evaluation, differential diagnosis, and microbiological approach to infectious causes of chest pain. Common infectious conditions, including community-acquired pneumonia, parapneumonic effusion, empyema, acute mediastinitis, herpes zoster, pericarditis, myocarditis, infective endocarditis, tuberculosis, and invasive fungal infections, are discussed in accordance with current international guidelines. Particular emphasis is placed on appropriate specimen selection, optimal timing of specimen collection, and the rational use of conventional culture, molecular diagnostic techniques, MALDI-TOF mass spectrometry, antigen detection, and serological assays. The importance of the preanalytical phase, specimen transport, laboratory reporting, and timely communication of critical microbiological results is also highlighted. The chapter emphasizes that no single laboratory test is sufficient for diagnosis and that accurate diagnosis requires integration of clinical findings, imaging studies, and microbiological data. Close collaboration between clinicians and microbiology laboratories is essential for timely diagnosis, targeted antimicrobial therapy, and improved patient outcomes.
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