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OLGU BİLDİRİMİ: BİR AKCİĞER ASPERGİLLOZU OLGUSUNUN MİKOLOJİ YÖNÜNDEN İZLENMESİ

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Abstract (2. Language): 
Aspergillosis, the infection caused by Aspergillus species, mostly occurs as pulmonary disease. Aspergilloma is the term given to the colonization of an intrthoracic cavity by Aspergillus, and the most frequent localization is in healed tuberculosis cavities. In the present paper we report the two years clinical and laboratory co-operative follow up of a pulmonary aspergillosis caused by Aspergillus niger in a male patient with diabetes mellitus and former tuberculosis. Fungal elements were observed in three subsequent microscopical examination of sputum specimens and A.niger growth in culture. Pulmonary aspergillosis (aspergilloma) was diagnosed based on his clinical symptoms, radiographic features and laboratory data. The isolate was found in vitro susceptible against itraconazole (MIC 0.5 μg/ml). After administration of itraconazole therapy of 8 months patient’s cough and hemoptysis has completely been prevented, furthermore no fungal elements were observed in and no growth obtained from sputum specimens that indicate the inactivity of the fungus. During subsequent periodical controls, only a few fungal elements were observed once and therefore a short term therapy was given again. The patient has still being followed up. The present case report suggests that despite the patient seemed to respond to antifungal therapy having clinical and mycological improvement, should continuously be followed up in conservative treatment of pulmonary aspergillosis.
Abstract (Original Language): 
Aspergillus türlerinin insanda oluşturduğu aspergillozun en sık karşılaşılan yerleşim yeri akciğerlerdir. Aspergilloma intratorasik bir kavitenin Aspergillus’larla kolonize olmasını ifade eden terimdir ve sıklıkla yerleştiği yer tüberkülozun iyileştikten sonra geri kalan kavernleridir. Bu yazıda, geçirilmiş tüberkülozlu diabetik bir hastada Aspergillus niger’in etken olduğu bir akciğer aspergillozu olgusunun iki yıllık sürede klinik ve laboratuvar işbirliği ile izlenmesi bildirilmiştir. Art arda üç kez tekrarlanan balgamın mikolojik incelemesinde mantar elemanları görülmüş ve A.niger üretilmiş; klinik ve görüntüleme bulguları ile birleştirilerek akciğer aspergillozu (aspergilloma) tanısı konmuştur. Ayrılan köken in vitro antifungal duyarlılık deneyinde İTZ’ye duyarlı (MIC 0.5 μg/ ml) bulunmuş ve bu ilaçla 8 aylık tedaviden sonra hastanın öksürük ve hemoptizisi tamamen kesilmiş; balgam örneklerinde de mantar elemanları görülmemiş ve ürememiş, sonraki kontrollerden birinde tekrar az sayıda olarak görülmüş ve kısa süreli tedavi edilmiştir. Halen takip ve tedavisi devam etmektedir. Bu bildiri akciğer aspergillozunda klinik ve laboratuvar incelemeleriyle tedaviye yanıt alınmış gibi görünmesine karşın hastaların daha sonra da izlenmesi gerektiğini vurgulamak amacıyla sunulmaktadır.

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