ISMJ 2014; 17(5): يا يه به آزمايشگاهيبيمارانمبتال مالتوارتباط آنباتيترآزمايشرايت
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1 ISMJ 2; (5): 88 جنب طب دماهنامه فارس خليج زيستپزشكي پژهشكده بشهر درماني بهداشتي خدمات پزشكي علم دانشگاه صفحه 5 شماره هفدهم سال )3131 دی )آذر بت يژگ يا يه به آزمايشگاهيبيمارانمبتال مالتارتباط آنباتيترآزمايشرايت يل ع اصغر *3 فرازی صفيان معصمه 2 3 سعيدی قاضي مرضيه 1 يا بيماريه امزشي گره گرمسيري عفني يا بيماريه سل تحقيقات مرکز 2 ايران اراک اراک پزشکي علم دانشگاه ليعصر بيمارستان ايران اراک اراک پزشکي علم دانشگاه اطفال عفني 32/2/1( مقاله: پذيرش 33/3/22 مقاله: )دريافت چكيده یا يژگيه از يكي زمينه: است. بده رايت آزمايش تيتر با آنها برز ارتباط ني تعي تنع اين بررسي مطالعه اين هدف ميباشد. مبتال بيماران آزمايشگاهي تظاهرات در تنع مالت تب 3138 سال در اراک شهر در مالت تب به مبتال بيمار 33 ری بر مقطعي تحليلي تصيفي بهصرت مطالعه اين رشها: ماد با سازگار باليني عالئم 3/28 2 مرکاپتاتانل 3/8 رايت آگلتيناسين تيتر اقل حد بيماری تشخيص معيارهای گيد. انجام نرمافر کمک با سپس استخراج بيماران پرنده اساس بر دادهها بد. برسلز ين س ميانگين بدند مذکر درصد 8/ بررسي م بيمار 33 تعداد از يافتهها: شد. تحليل تجزيه 38 يرايش SPSS بد. /3±35/1 زنان در 1/±/1 مان در حد در بيماران درصد 25 در )( اکنشي پرتئين مين بد بين درصد 22/5 در ال ساعت )( سديمانتاسين مين درصد 3 در لكپني بد. باالتر +2 ارجحيت سللي شمارش درصد 2/ در شد. ديده درصد /2 ترمبسيتپني درصد 33 آنمي درصد 2/ در داشتند. درصد 5 از بيش آئزينفيلي بيماران درصد /5 در بد لنفسيت با درصد 3/8 لكپني با همراه آنمي ترمبسيتپني لكپني برز سديمانتاسين مين ج با رايت تيتر مين بين ارتباطي بررسي اين در داشت. جد پايتپني يل )8/85>P(. نداشت جد آنمي بد. معنيدار بهصرت هماتلژيک عارض نتيجهگيری: ندا. جد بيماران در رايت تيتر با تظاهرات اين یا يژگيه مالت تب کليدی: اژگان ارتباط )8/83=P( سال 25 از بيشتر سن )8/8883=P( باالتر کيفي+ 2 با رايت تيتر بين يل ميکند برز مالت تب بيماری در ترمبسيتپني لكپني آنمي 2ME آزمايش رايت آزمايش ارتباط آزمايشگاهي برز بين ارتباطي dr.farazi@arakmu.ac.ir عفني بخش ليعصر بيمارستان پزشکي علم دانشگاه اراک *
2 فرازی همكاران يژگيهای آزمايشگاهي بيماران مبتال به تب مالت / 83 مقدمه تب مالت بهعنان يک مشکل عمده سالمتي اقتصادي در بسياري از نقاط جهان از جمله کشرهاي مديترانه خارميانه مطرح ميباشد )1(. سازمان بهداشت جهاني تخمين زده است که تعداد ما جديد برسلز در جهان بيش از 55 هر نفر در سال ميباشد )2(. اگر چه تب مالت در بسياري از کشرهاي تسعه يافته کنترل شده است اما بهعنان يک مشکل مهم نظام سالمت در کشرهاي در حال تسعه باقي مانده است )3(. عامل بيماري به نام برسال کک باسيلي کچک غير متحرک گرم منفي بدن اسپر ميباشد که در محيط هازي رشد مينمايد )4(. بيماري در تمام جهان به يژه در کشرهاي اطراف مديترانه )ارپاي جنبي شمال شرق آفريقا( خارميانه هندستان آسياي مرکزي مشاهده ميشد )(. اين بيماري در ايران از ساليان پيش بهصرت بمي جد داشته نخستين بارعامل بيماري برسال تسط کارشناسان اتيت پاستر در سال 1311 از خن يک بيمار جدا شد. نتيجه بررسيها نشان ميدهد برز بيماري در استان مرکزي حدد 8 تا 135 در صد هر نفر جمعيت )آلدگي شديد( ميباشد )(. برسلز در اان بهصرت حاد يا بيماري مزمن با تب اناع عالئم ظاهر ميشد دره کمن اين بيماري از 1 تا هفته يا چند ماه )1( متغير است )7(. عالئم بيماري حاد بهصرت تب لرز س د عضله مفصل ضعف خستگي تهع تعريق شبانه از دست دادن اشتها ميباشد مشخص شده است که ايمني تيپ 1 در کنترل عفنت برساليي نقش مهمي دا. در اين ارتباط ماکرفاژها نقش اساسي دارند. اينترلکين 15 که يک سايتکاين تيپ 2 است سبب کن غيرفعال ماکرفاژها معکس بر بيماري ميباشد )(. برسلز دستگاه بيماري گارش چند قلب سيستمي ميگد عرق مي باشد داراي خاز اثرات درگيري عصبي اسکلتي ريي پستي چشمي در آن گرش شده است )8(. همچنين اختالالت خني مانند کمخني لکپني ترمبسيتپني pancytopenia bicytopenia همليز حاد گاها انعقاد داخل عرقي منتشر )DIC( در آن ديده ميشد )15(. با آن در اين مقاله تظاهرات خني بيماري برسلز ارتباط است. گرفته قرار بررسي م رايت تيتر مين هدف از انجام اين پژهش در هله ال تأکيد بر آشنايي برسلز همراه خني اختالالت با بيشتر تا ميباشد بهيژه در نقاطي که بيماري اندميک است به آن تجه بيشتر گد از سيي پاسخ به اين که آيا تيتر سؤال آزمايش رايت ميتاند بهعنان يک عامل پيشآگهي در برز اين تظاهرات باشد يا خير. بنراين پژهش کنني با در نظر گرفتن اهداف ياد شده انجام شده است. ماد رشها مطالعه به صرت تصيفي تحليلي مقطعي در شهر اراک در سال 1385 انجام گيد. معيارهاي تشخيص بيماري داشتن عالئم باليني سازگار با برسلز حداقل تيتر آگلتيناسين 1/5 رايت 2 مرکاپتاتانل 1/45 بد. در مجمع از پرنده بيمار 2 پرنده به دليل همراهي با بيماريهاي زمينهاي مثل بيماريهاي مزمن کبدي کليي قلبي ريي همچنين تالئ به نقص ايمني مبتاليان به اناع بدخيمي يا کمخنيهاي با نقص يا آهن فقر کمخني مانند مشخص علت اطالعات پرنده از گره مطالعه کنار گذاشته شدند برسلز به مبتال بيمار 18 اطالعات نهايتا طي يک
3 82 بنج بط/ هرامش /مهدفه لاس ید رذآ / يليلحت يعطقم درم رارق تفرگ ياهيبايزرا يهاگشيامزآ لمعم لماش لماک نخ ريمسا نخ يطيحم نازيم بسر تيسرتيرا )( نييعت 2ME ياهريغتم سنج. مامت ياه يهاگشيامزآ لماش ياهلبلگ ديفس نخ يطيحم هليس ياههاگتسد رزيلانآ يتيسکل هاگتسد( لس رتناک سکمسيس )1555K( يريگهدنا شر نيرگرتس يشر يفيک latex. ينخمک لگمه )HB( مرگ يسد رتيل نانز 13/ مرگ رتيليسد فيرعت نينچمه تکلاپ 15 رازه ينپتيسبمرت دادعت تيسکل 4 رازه نانع ينپکل رظن هتفرگ.)11( يارب هيزجت ليلحت اههداد SPSS رازفامرن SPSS ( Inc Chicago )USA Il شياري 1 ساحم يناارف نيگنايم فارحنا نمزآ رايعم رذجم ياک نمزآ رشيف ساحم تبسن سناش هلصاف نانيمطا 8 دص هدافتسا Pvalue 5/5 رادينعم رظن. هتفرگ لحارم شهژپ هيلک تصم هتيمک قلاخا هاگشناد ملع يکشزپ کارا تياعر.ديدرگ اههتفاي دادعت 18 راميب رفن 7/( )دص رکذم.دندب نيگنايم ي 37/±23/3 نانز 3/8±1/3.دب ني لاتبا 25 يگهام ني 7 يگلاس.دب تعاس لا / دص 45 دب 11/1 دص 415 2/1 دص رتلا 5.دب دص ه شر يفيک دح 2+ رتلا دب 3 دص درام 1+ ه.دب زرب ينپکل 8 دص زتيسکل 2/3 دص دص ينپتيسبمرت 7/4 دص هديد. 27/ دص يللس تيحجرا تيسفنل دب 7/ دص يليفنيزئا شيب دص.دنتشاد 4/ دص مأت ينپکل ي( )ينپتيس 1/ دص ينپتيسناپ دج.تشاد نيسانيتلگا ياهلل دص ات 1/15 34/7 دص دح 1/325 1 دص 1/45 /3 دص 1/5 رتلا.دب نينچمه 2ME 2 دص ات 1/5 33/3 دص 1/15 8/3 دص 1/325 /3 دص 1/45.دب يطترا نازيم سنج )P=5/38( نازيم )P=5/3( زرب ينپکل )P=5/453( ينپتيسبمرت )P=5/3( )P=5/151( دج.تشادن يل يفيک 2+ رتلا )P>/5551( لاس ))P=5/5( طترا رادينعم دب لدج(.)1 لدج )3 طترا طترا اهريغتم کيفارگمد يهاگشيامزآ هدافتسا نمزآ رشيف رييغتم سناش تبسن )OR( هلصاف نانيمطا )CI( 35 دص P.value سنج رکذم 5/7 5/381/434 5/38 رتلا لاس 2/22 1/14/247 5/5 ++ 4/3 2/378/227 >5/5551 يعيبط ريغ 1/451 5/742/35 5/33 زرب ينپتيسبمرت 5/34 5/531/774 5/3 زرب 5/42 5/11/57 5/151 زرب ينپکل 5/48 5/131/784 5/453 ثحب
4 لاتبم يهاگشيامزآ یاهيگژي ناراكمه یرف تلام بت / 81 ين ا زرب يراميب نانز دب تبسن( درم 2/1=نز )1 هک يشان سامت يلغش.يم 2 دص درام ني 1 لاس هدب.تسا شخبدس ناتسراميب ينيمخماما نارهت 43/ دص ينپکل 13/8 دص ينپتيسبمرت / دص ينپتيسناپ 2/4 دص /8 دص ++ 4/7 دص.)( يسع ناتسراميب نامقل نارهت دص زتيسکل 4 دص ينپکل دص ينپتيسناپ دص زتيسفنل دص 4 دص 5 دص درام.)13( ن ناتسا دزي 42/7 دص 45/7 دص نانز ينپکل / دص ينپتيسبمرت 13 دص.)( نشر لامش ناريا 1/1 دص ينپکل 3 دص ينپتيسبمرت /2 دص ينپتيسناپ 3/4 دص 77/ دص 8/1 دص.)1( رگنهتشذگ ک يد ل )Dilek( هيکرت ير 77 درم زلسرب زرب ينپتيسبمرت دص ينپکل دص 43 دص هارمه ينپکل 7 دص هارمه ينپتيسبمرت دص ينپتيسناپ دص ينپکل هارمه ينپتيسبمرت 4 دص ديدرگ.)1( رگيد طست زيندکا )Akdeniz( هيکرت ير 233 راميب ينپکل دص دص ينپتيسبمرن 2 دص ينپتيسناپ دص زتيسفنل 45 دص 1 دص 3 دص درام.)( يبرک )Crosby( رشک رپ ينپکل دص 74 دص ينپتيسبمرت 38/ دص ينپتيسناپ دص.)1( لل )Lulu( تيک 7 دص ينپکل دص ينپتيسبمرت دص زتيسفنل 3 دص 77 دص 4 دص درام.)( رنملاک )colmenero( ايناپسا 4/1 دص ينپکل 2/7 دص زتيسکل / دص ينپتيسبمرت /4 دص زتيسفنل 28 دص ينپتيسناپ دص دص.)25( ناگزب )Buzgan( هيکرت 45/3 دص ينپکل 15/8 دص زتيسکل 8 دص ينپتيسبمرت 8/ دص ينپتيسناپ 4/8 دص زتيسفنل 2/2 دص 31/7 دص /4 دص.)( يسيعلا )AlEissa( ناتسبرع ير 115 کدک لاتبم زلسرب دص ينپکل 33 دص ينپتيسبمرت دص. )22( لدج(.)2 هجت جياتن هلصاح رياس تاعلاطم ياهناتسا رگيد رياس اهرشک رظن دسريم زرب ينپکل ينپتيسبمرت ينپتيسناپ لاتبم بت تلام رشک ام رياس اهرشک.يم لاح صيخشت يقارتفا تارهاظت هجت عيش اتبسن يلا ءلاتبا بت تلام رشک هرامه دي درم رظن رارق.دريگ طترا تارهاظت ينخ بت تلام يا ننکات هن.تسا ام
5 82 /طب جنب ارتباط معنيداري بين برز تظاهرات خني مين تيتر اگلتيناسين رايت مشخص نشد بيماري با تنها در سال هفدهم/ شماره 5/ آذر دی 3131 تجزيه تحليل آماري ارتباط معنيدار بين تيتر رايت با سن بيماران شدت مثبت شدن بهدست آمد. جدل 2( مقايسه تظاهرات خني مبتاليان به تب مالت در مطالعه کنني با ساير مطالعات مثبت مطالعه/ متغير آنمي لكپني ترمبسيتپني پايتپني لنفسيتز افيش 1 7/7 27/ 1/ 7/4 8 مطالعه کنني 4/7 /8 2/4 / 13/8 43/ سدبخش همکاران )تهران( عباسي همکاران )تهران( 8/1 22/2 3/4 3 1/1 رشن همکاران )بل( 13 / 42/7 ف. بهناز همکاران )يزد( لل همکاران )کيت( 38/ 74 کرازبي همکاران )پر( 5 28 /4 2/7 4/1 کالمنر همکاران )اسپا( 33 العيسي همکاران )عربستان( 43 ديلک همکاران )ترکيه( اکدنيز همکاران )ترکيه( /4 31/7 2/2 4/8 8/ 15/8 45/3 بزگان همکاران )ترکيه( اين زمينه انجام گي تا بتان به نتايج قطعيتري در اين يا از محدديته اين مطالعه حجم کم نمنه بررسي زمينه دست يافت. کليه اشکال باليني برسلز)اعم از حاد مزمن يا فرمه يا فکال بيماري( در يک گره بدن تفکيک آنها همچنين طراحي مطالعه بهصرت گذشتهنگر محدد بدن ان به بيماران در يک شهرستان ميباشد. لذا پيشنهاد ميشد مطالعه کاملتري بهصرت چند مرکزي با حجم نمنه بيشتر بهصرت آيندهنگر در سپاس قداني بدييله از همکاري خب کارکنان بيمارستان ليعصر آزمايشگاه کلينيک تخصصي امام رضا معانت آمزش تحقيقات دانشگاه علم پزشکي اراک کمال تشکر بهعمل ميآيد. References: 1.Namiduru M, Gungor K, Dikensoy O, et al. Epidemiological, clinical and laboratory features of brucellosis: A prospective evaluation of adult patients.int J Clin Pract 23;57: Tasbakan MI, Yamazhan T, Gökengin D, et al. Brucellosis: a retrospective evaluation. Trop Doct 23; 33: Pappas G, Papadimitriou P, Akriditis N, et al. The new global map of human brucellosis. Lancet Infect Dis 2;:1. 4.Young EJ. Brucella Species. Mandell GL, et al. Principles and practice of infectious diseases. Vol 2. 7th. Elsevier Churchill Livingstone Co. 21; pp: Ozden M, Demirdaq K, Kolkan A, et al. A case of brucella spondylodiscitis with extended multiple level involvement. South Med J(ISMJ) 25; 8(2): Brucellosis Statistics of Iran, Communicable Disease Management Center, Ministry of Health and Medical Education,Iran,1388.[Persian] 7.Kokoglu OF, Hosoglu S, Geyik MF, et al.clinical and laboratory features of brucellosis in two university hospitals in Southeast Turkey. Trop Doct 2; 3: Rasouli M, Kiani S, Beh bin M. Interleukin1
6 فرازی همكاران يژگيهای آزمايشگاهي بيماران مبتال به تب مالت / 85 gene promoter polymorphisms and susceptibility to brucellosis in Iranian patients. ISMJ. 2; 11 (2) :138..Sari I, Altuntas F, Hacioglu S, et al. A multicenter retrospective study defining the clinical and hematological manifestations of brucellosis and pancytopenia in a large series: Hematological malignancies, the unusual cause of pancytopenia in patients with brucellosis. Am J Hematol 28; 83: Kokoglu OF, Hosoglu S, Geyik MF,et al. Clinical and laboratory features of brucellosis in two university hospitals in Southeast Turkey. Trop Doct 2; 3: Perkins SL. Normal blood and bone marrow values in humans. In: Lee GR,Foerster J, Lukens J, et al., editors. Wintrobe s Clinical Hematology, 11th edn.philadelphia, PA, USA: Lippincott Williams and Wilkins.23, pp : Z. AbdiLiae, A. Soudbakhsh, S. Jafari, et al., Hematological Manifestaions of Brucellosis, Acta Medica Iranica, 27;45(2) : Besharat M, Abbasi F, Korooni S., Epidemiological features, hematologic characteristics and clinical manifestations in adult patients with brucellosis,iranian Journal of Clinical Infectious Diseases (Iran J Clin Infect Dis),21;5(3):1..Behnaz F., MohammadiMoghadam M., Mohammadzadeh M, Hematologic Manifestations of Brucellosis in Yazd, Iran J Ped Hematol Fall 21; 1(1 (Supplement1)): Hasanjani Roushan MR, Mohrez M, Smailnejad Gangi SM, et al. Epidemiological features and clinical manifestations in 4 adult patients with brucellosis in Northern Iran. Epidemiol Infect. 24;132():11. 1.Imdat Dilek & et.al, Hematological Complications in 787 cases of acute Brucellosis in Eastern Turkey, Turk.J.Med.Sci., 28;38(5) :4424.Akdeniz H, Irmak H, Seckinli T, et al. Hematological manifestations in brucellosis cases in Turkey. Acta Med Okayama 18;52:3 5..Crosby E, Ilosa L, Miro QM, et al. Hematologic changes in brucellosis. J.Infect.Dis.184;15: A. R. LULU, et al. Human Brucellosis in Kuwait: A Prospective Study of Cases, QJM (188) (1): Colmenero JD, Reguera JM, Martos F, et al. Complications associated with Brucella melitensis infection: A study of 53 cases. Medicine (Baltimore)1;75: Buzgan T, Karahocagil M, Irmak H, et al. Clinical manifestations and complications in 128 cases of brucellosis: a retrospective evaluation and review of the literature,int J Infect Dis,Volume, Issue, Pages e4 e478, June AlEissa Y, AlNasser M. Haematological manifestations of childhood brucellosis,infection, 13 JanFeb;(1):23.
7 ISMJ 2; (5):88 Original Article Laboratory features of patients with Brucellosis and its association with titer of Wright agglutination test A.Farazi * 1, M.Sofian 1, M.Ghazisaeedi 2 1 Department of Infectious disease and Tuberculosis and Pediatric Infectious Research Center, School of Medicine, Arak University of Medical Sciences, Arak/IRAN 2 Valiasr Hospital, Arak University of Medical Sciences, Arak/IRAN (Received Dec, 2 Accepted 23 Apr, 213) Abstract Background: One of the features of Malta fever is diversity of hematologic manifestations. The Aim of This study was to evaluate hematologic findings of brucellosis and its association with titer of wright agglutination test. Materials & Methods: This study was a cross sectional and analytical study that was conducted on patients with brucellosis in the Arak in 211. The diagnostic criteria of the disease were the Wright test and 2Mercaptoethanol (2ME) agglutinin assay with titers greater than 1:1 and 1:8, respectively, and clinical symptoms compatible with brucellosis. Data were obtained from patient records and were analyzed with SPSS version 1. Results: From patients with Brucellosis who were enrolled in study 7.8% was male, Mean age in men was 37.8±23.3 years and in women 3.±15.3 years. Erythrocyte sedimentation rate in.5% was between and in 2.1% was above. 45% of patients had qualitative levels higher than +2. Leukopenia in %, anemia 1%, thrombocytopenia 7.4% was seen. In 27.8% the lymphocyte cell count was predominant. 7.5% of patients had eosinophilia of more than 5% and 4.8% with bicytopenia and 1.% had pancytopenia. The association between titer of wright test and sex,, leucopenia, thrombocytopenia and anemia was not observed, (P>.5) but with >1+ (P=.1) and age over 45 years (P=. association was significant. Conclusion: Brucellosis should be considered as a differential diagnosis among patients whose blood picture reveals anemia, leukopenia, thrombocytopenia or pancytopenia. There is no relation between wright titer and hematologic manifestation. In comparison with similar studies in other countries, hematologic abnormality is lower in our patients. Key words: Brucellosis, Laboratory features, Relationship, Wright test, 2ME test Address for correspondence: Department of Infectious diseases, Valieasr hospital, Arak University of Medical Sciences, Arak, IRAN. dr.farazi@arakmu.ac.ir Website: Journal Address:
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