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ARB Yayma ve Kültürü

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Diğer Adları: Tüberküloz kültürü ve duyarlılığı; Mikobakteri yayma ve kültürü
Resmi adı: Aside dirençli basil sürüntü örneği ve kültürü ve duyarlılığı

Bir Bakışta

Niçin Testi Yaptıracaksınız?

Bir mikobakteriyel enfeksiyonun tanımlanmasına, tüberküloz (Tbc) tanısı koymaya, tedavinin etkinliğini izlemeye yardımcı olmak için kullanılır.

Ne Zaman Testi Yaptıracaksınız?

Tüberküloz (Tbc) veya başka bir mikobakteriyel enfeksiyonla bağlantılı olabilen uzun süreli öksürük, kilo kaybı, ateş, üşüme-titreme yakınmalarınız varsa, doktorunuz aktif Tbc’niz olduğundan kuşkulanıyorsa ve doktorunuz Tbc tedavisinin etkinliğini izlemeyi istiyorsa ARB testi yapılır.

Gerekli Numune Nedir?

Genellikle farklı günlerde sabah erkenden üç balgam örneği toplanır. Hasta balgam çıkartamıyorsa bronkoskopi denilen bir girişim sırasında sıvı alınabilir. Çocuklarda mide yıkantı suları/aspiratları alınabilir. Belirtilere göre idrar, beyin-omurilik sıvısı (BOS), başka vücut sıvıları veya biopsi ile alınan doku örnekleri kültüre gönderilebilir.

Test Numunesi

Ne test edilmektedir?

Aside dirençli basiller (ARB), cam lamlar üzerinde ARB sürüntü örneği denilen özel olarak boyanmış preparatlarla mikroskop altında görülebilen ve sayılan çomak şeklinde bakterilerdir. En sık görülen aside dirençli basiller Mycobacterium türünün üyelerine aittir.

Mycobacterium tuberculosis mikobakterilerin en yaygın ve en bulaşıcı türüdür. ARB sürüntüleri ve kültürleri için verilen örneklerin çoğu doktorun hastada Tbc enfeksiyonu olduğundan kuşkulanması sonucunda toplanmıştır. Tanımlanmış 60’ı aşkın mikobakter türünden yalnızca birkaçı insanlarda enfeksiyonlara neden olmaktadır.Örneğin

  • M. africanum, dünyanın belli bazı yörelerinde Tbc'ye benzer bir hastalığa neden olmaktadır.
  • Mycobacteria avium-intracellulare kompleksi (MAC): bağışıklık sistemi baskılanmış hastalarda, örneğin yaşlılarda, AIDS’lilerde akciğer enfeksiyonuna neden olabilmektedir. Bu enfeksiyon bulaşıcı olmamakla birlikte antibiyotiklere çok dirençli olma eğilimi gösterdiğinden tedavi edilmesi güçleşebilmektedir.
  • Mycobacterium marinum benzeri başka mikobakteri türleri su içinde, balık tanklarında çoğalmakta ve deri enfeksiyonlarına neden olabilmektedir. Başka hızla çoğalan mikobakteriler yaraları ve protezleri enfekte edebilmektedir.
  • M. bovis, gibi birkaç mikobakteri bazen hayvanlardan insanlara bulaşabilmektedir.

Basil sayısı günden güne değiştiğinden farklı örneklerden birkaç ARB sürüntü örneği taranmalıdır. Sürüntü örneklerinden herhangi birinde aside dirençli basiller mevcutsa bir mikobakteri enfeksiyonu olassıdır. Solunum yolu enfeksiyonlarının nedeni olarak en sık görülen mikobakteri M. tuberculosis olduğundan tahminen Tbc tanısı konabilirse de aside dirençli basillerin M. tuberculosis veya başka bir mikobakteri türü olduğunu kesinlikle belirlemek için başka izlem testleri de yapılmalıdır.

Hastadan alınan örnekler sürüntü örnekleriyle eşzamanlı olarak ARB kültürleri için de işleme tabi tutulur. Laboratuvarda aside dirençli basiller üretmek için kültürler kullanılır. Vücut sıvısı ve doku örnekleri normal solunum florasını elimine etmek için dekontamine edilir , müküsü emülsiyon haline getirmek için özütlenir ve konsantre hale getirilerek besleyici madde ortamına konup inkübe etmeden önce bakteri sayıları artırılır. Mikobakteriler yavaş çoğaldığından mevcut türlerin kesin tanımlanması günler hatta birkaç hafta sürebilir. Negatif sonuçların ( mikobakteri yokluğu) doğrulanması ise 6-8 hafta alabilir.

Test için numune nasıl toplanır?

M. tuberculosis ve M. avium, sıklıkla akciğeri (pulmoner) enfekte ettiğinden balgam en çok test edilen örnektir. Balgam akciğerlerden öksürükle dışarı atılan kıvamlı bir müküstür. Genellikle tek tek steril kaplar içine ardışık günlerde sabah erkenden üç ila beş örnek alınır.

Balgam çıkartamıyorsanız doktorunuz bronkoskopi denilen yöntemle solunum yolundan örnekler alabilir. Bronkoskopi doktorunuzun bronşlar ve bronşiyollerinize bakmanızı ve örneklerin alınmasını sağlar. Bu dallanmış borucuklar boğazınızda trakeayı akciğerlerinize bağlayarak havanın akciğerlerinize girmesi için bir yol oluşturur. Trakea üzerine lokal anestetik madde püskürtüldükten sonra doktorunuz bronşlar ve daha küçük bronşiyoller içine bir tüp sokabilir ve test için sıvı örnekleri aspire eder. Bazen tüpler yoluyla bronşlar içine az miktarda salin verilecek ve daha sonra aspire ederek bronş yıkantı suları toplanır.

Küçük çocuklar balgam örneği veremediğinden mide aspiratlar toplanabilir. Bu işlem bir tüp içinden mide içine salin verilir, ardından sıvı aspire edilir.

Doktorunuz, AIDS hastalarında oldukça sık olmakla birlikte akciğerler dışında başka bir organ ve dokuda, Tbc'den kuşkulanıyorsa diğer vücut sıvıları ve dokularından örnek alabilir. Örneğin, doktorunuz Tbc'nin böbreklerinize bulaştığından kuşkulanıyorsa bir veya daha fazla sayıda idrar örneği toplayabilirsiniz. Eklemlerinizden veya perikard veya karın içi gibi başka vücut boşluklarından sıvı almak için enjektör kullanılabilir. Ara sıra doktorunuz beyin-omurilik sıvısından (BOS) örnek almak veya doku biyopsisi elde etme amacıyla minör bir cerrahi işlem yapmak için enjektör kullanmaya gerek duyabilir.

Test

Sık Sorulan Sorular

Bir Laboratuvar Uzmanına Sorun

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Makalenin Kaynakları

« İlgili Sayfalara Geri dönün

NOT: Bu makale, burada söz edilen kaynaklarla birlikte Lab Tests Online Editörler İnceleme Kurulunun toplu deneyiminden yararlanan araştırmaya dayanmaktadır. Bu makale belli aralıklarla Editörler Kurulu tarafından gözden geçirilmekte ve inceleme sonuçlarına göre güncelleştirilebilmektedir. Alıntı yapılan her yeni kaynak listeye eklenecek ve kullanılan orijinal kaynaklardan ayırt edilecektir.

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