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İNVAZİV ASPERGİLLOZUN ÖN TANIMINDA GALAKTOMANNAN ANTİJENİNİ BELİRLEMENİN YERİ VE ÖNEMİ

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Abstract (Original Language): 
İnvaziv aspergillozun kesin tanısı steril bir vücut bölgesine ait örneğin doğrudan mikroskopta incelenmesiyle Aspergillus varlığının gösterilmesi ve kültürde mantarın üretilmesi ile konulmaktadır. Ancak invaziv yöntemler hastanın sitopenisi veya kritik koşulları sebebiyle ekseri engellendiğinden kesin tanıya artık mantarın önlenemeyeceği ve tedavinin başarılı olamayacağı bir aşamaya kadar ulaşılamamaktadır. GM antijeni bir eksoantijendir; mantarın hücre duvarı yapısında bulunmakta ve üreme sırasında ortama salınmaktadır. Dolaşan GM antijeninin serumda ve daha nadiren BAL ve diğer vücut sıvılarında saptanması bilgisayarlı tomografi bulgularıyla birleştirilerek değerlendirildiğinde invaziv aspergillozun ön tanısına anlamlı katkıda bulunmaktadır. Güncel mikolojide empirik tedavinin yerini yüksek risk grubu hastalara yönelik ve İA varlığından kuşkulandıran klinik, radyolojik ve mikrobiyolojik verilere dayanan “kısmen hedeflenmiş” “preemptive” tedavi anlayışı yer almaktadır. GM antijeni LA veya EIA ile belirlenebilir. LA testi özellikle kültürler negatif kaldığında, seri örneklerle çalışıldığında ve akciğer aspergillozlu hastaların BAL örnekleriyle çalışıldığında yararlı bulunmuştur. Sandviç EIA deneyinin ekseri klinik belirtiler ve radyolojik bulgular ortaya çıkmadan galaktomannanemiyi belirleyebildiği belirtilmiştir. Yalancı pozitifliğe sebep olabilecek hususlar dikkate alınmak kaydıyla GM antijen pozitifliğinin BT veya radyografi ile birlikte değerlendirildiğinde İA’un erken aşamada ön tanımı için çok yararlı ve kısmen hedeflenmiş tedavi uygulanması için yol gösterici olacağı öne sürülmektedir. Bu yazıda galaktomannan antijeni belirlenmesinin invaziv aspergilloz ön tanımındaki yeri ve önemi gözden geçirilmiştir.
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