SARS Associated Corona Virus (SCV)
Transkript
975 Konu 114 SARS Associated Corona Virus (SCV) $\GÕQ06$56$VVRFLDWHG&RURQD9LUXV6&9(G&HQJL]0ÕVÕUOÕJLO$\GÕQ7ÕSYHGLúKHNLPOL÷LQGH genel ve özel Mikrobiyoloji. Konu 114. Sa:975-*QHú\D\ÕQHYL$QNDUD *(1(/g=(//ø./(5 %X KDVWDOÕN \ÕOÕQÕQ LNLQFL \DUÕVÕQGD X]DNGR÷X $V\D¶GD JULSDO LQIHNVL\RQ JLEL RUWD\D oÕNPÕúWÕU 6ROXQXP \HWPH]OL÷L VHEHEL\OH |OPOH VRQXoODQDQ YDND VD\ÕVÕ KHU JHoHQ D\JLGHUHNDUWPÕúWÕU%XKDVWDOÕ÷DVHUWDNXWVROXQXPVHQGURPXDQODPÕQD JHOHQ6HYHUH$FXWH5HVSLUDWRU\6\QGURPH6$56LVPLYHULOPLúWLU &'& YH 'Q\D VD÷OÕN |UJWQH LON UDSRUODU dLQ +RQJ .RQJ .DQDGD øQGRQH]\D)LOLSLQOHU6LQJDSXU7D\ODQGYH9LHWQDP¶GDQJHOPLúWLU\ÕOÕúXEDWÕQGD KDVWDOÕN WDP RODUDN WDQÕPODQDELOPLúWLU 'DKD VRQUD øQJLOWHUH 6ORYHQ\D $PHULND $OPDQ\D¶GDQYDNDUDSRUODUÕJHOPLúWLU-Nisan-¶WHONHGHWHVSLWHGLOPLúNHQ0D\ÕV-WDULKLQHNDGDUWRSODPONHGHQYDNDUDSRUODUÕELOGLULOPLúWLU HastalDUÕQ oR÷X - \Dú DUDVÕQGDGÕU \DúÕQ DOWÕQGD VDGHFH ELUNDo YDND YDUGÕU +DVWDODU DUDVÕQGD FLQVL\HW D\ÕUÕPÕ WHVSLW HGLOHPHPLúWLU %XQD UD÷PHQ HUNHN KDVWDODUÕQRUDQÕFLYDUÕQGDGÕU (7.(1ø (OGHNL ELOJLOHUH J|UH 6$56 KDVWDOÕ÷ÕQÕQ HWNHQL NRURQDYLUXV 7RU VXúXGXU %X virusa SARS-DVVRFLDWHG&RURQD9LUXV6&9LVPLYHULOPLúWLU'L÷HUNRURQDYLUXVODUJLEL 80-QPE\NO÷QGHSOHRPRUILNVIHULNYH\DHOLSVúHNOLQGHKHOLNDOVLPHWULGHGLU <]H\LQGHNL oÕNÕQWÕODU SHSORPHU QP JHQLúOL÷LQGH QP X]XQOX÷XQGDGÕU 7HN VDUPDO51$VÕYDUGÕUdHYUHVLQGH-QPNDOÕQOÕ÷ÕQGDOLSLWELU]DUÕEXOXQXU6&9µQX izole edip Macaca fascicularis PD\PXQODUÕQD KDVWDOÕ÷Õ EXODúWÕUPDN PPNQ ROPXúWXU Bu virusun 29751-ED]oLIWOLNJHQRPXQXQVHNDQVÕWHVSLWHGLOPLúWLUWDQe ORF 2SHQ5HDGLQJ)UDPHXFXEXOXQPDNWDGÕU%XUDGDQDQODúÕOGÕ÷ÕQDJ|UHL\LELOLQHQKHU iki koronavirus genomuna (HCoV-OC43 ve HCoV-229E) orta seviyede bir benzerlik göstermektedir (300 nükleotitten %50-NDGDUÕEHQ]HPHNWHGLU 6$56 KDVWDVÕQÕQ VROXQXP VÕYÕODUÕQGDQ KXPDQ PHWDSQHXPRYLUXV L]ROH HGLOPLúWLU %X GXUXPGD PHWDSQHXPRYLUXV¶XQ ELU NR-LQIHNW|U P ROGX÷X YH\D 6$56 KDVWDOÕ÷ÕQÕQ EX LNL YLUXVXQ ELUOLNWHOL÷L LOH PL PH\GDQD oÕNWÕ÷Õ \ROXQGD GH÷LúLN J|UúOHU YDUGÕU SINIFLANDIRMASI: $VOÕQGD Coronaviridae IDPLO\DVÕQGD \HU DODQ YLUXVODUÕQ E\N oR÷XQOX÷X VDGHFH KD\YDQGD KDVWDOÕN \DSDU %XQODUÕQ LoHULVLQGH LQVDQGD VROXQXP \ROX KDVWDOÕ÷ÕQDVHEHSRODQ+XPDQUHVSLUDWRU\&RURQD9LUXV+&9µXQUKLQRYLUXVODUJLEL VW VROXQXP \ROXQGD KDVWDOÕN \DSDELOGL÷L |QFHGHQ ELOLQL\RUGX \ÕOÕQGD 7\UHO YH %\QRHD\UÕFD\ÕOÕQGD+DPUHYH3URFNQRZEXYLUXVXVR÷XNDOJÕQOÕ÷ÕEHOLUWLOHUL RODQ LQVDQÕQ QD]RIDULQJHDO \ÕNDPD VX\XQGDQ L]ROH HGHUHN J|QOO LQVDQODUD X\JXODPÕú YH EX LQVDQODUGD VR÷XN DOJÕQOÕ÷ÕQD EHQ]HU ELU KDVWDOÕN ROXúWXUPD\Õ EDúDUPÕúODUGÕ%XYLUXVODUDVÕUDVÕ\OD%YH(LVPLQLYHUPLúOHUGL¶GHWDQH 976 GDKD NRURQDYLUXV WHVSLW HGLOPLúWLU <HQL EXOXQDQODUÕQ oR÷X VÕoDQGD YH NXúODUGD SQ|PRQL\DSDELOGL÷LLoLQYH|OGUFROPDGÕ÷ÕLoLQ]HULQGH\HWHULQFHGXUXOPDPÕúWÕ 6&9LVHPXKWHPHOHQEXYLUXVODUGDQELUWDQHVLQLQVSRQWDQPXWDV\RQJHoLUPLú ELU IRUPXGXU %L\RORMLN VDYDú DPDFÕ\OD JHQHWLN PKHQGLVOHUL WDUDIÕQGDQ \DUDWÕOGÕ÷ÕQD GDLUV|\OHQWLOHUGHYDUGÕU $17ø-(1<$3,6,h5(7ø/0(6ø SCV viryonun kapsitindeki M(pro) antijeni, konak dokuda replikasyon IDDOL\HWOHULQL \|QHWHQ ELU SURWHLQD]GÕU GL÷HU LVPL &/SUR GXU 9LUXVXQ D\UÕFD KHPDJOWLQLQOHUL YDUGÕU%XKHPDJOWLQLQOHU0\[RYLUXVODUGDROGX÷XJLELHULWURVLWOHUGHQ NHQGLOL÷LQGHQD\UÕOPD]ODU Transmissible gastroenteritis virus (TGEV)’un M(pro) antijeni ile SCV’un 0SURDQWLMHQLDUDVÕQGDPROHNOHUELUEHQ]HUOLNYDUGÕU%XVHEHSOH7*(9LQIHNVL\RQX geçirenlerin anti-6&9DQWLNRUXWDúÕPDODUÕPPNQGU &RURQDYLULGDH IDPLO\DVÕQGDNL YLUXVODU IDUNOÕ DQWLMHQLN JXUXED D\UÕOÕUODU g]JO RODUDN 6&9¶XQ KDQJL DQWLMHQLN JXUXS LoHULVLQH \HUOHúWLULOHFH÷L KHQ] NHVLQOLN ND]DQPDPÕúWÕUDPDKHUELUJXUXSLoLQGH\HUDODQNRURQDYLUXVODUGL÷HUJXUXEXQ\HOHUL LOH oDUSUD] UHDNVL\RQ YHUHELOPHNWHGLU %X |]HOOLN NRURQDYLUXV WHúKLV NLWOerinin SCV WDQÕVÕQGDNXOODQÕOPDVÕNROD\OÕ÷ÕQÕJHWLULU Koronaviruslar, insan embriyonu trekae organ kültüründe, bebek fare EH\QLQGHWHNWDEDNDOÕGRNXNOWUOHULQGHUHWLOHELOLU6&9LoLQHQX\JXQYDVDW9HUR( hücre kültürüdür. 'ø5(1d/ø/ø. dHYUH NRúXOODUÕQD GLUHQFL RUWDPÕQ QHP PLNWDUÕQD YHVÕFDNOÕ÷ÕQDED÷OÕGÕU.XUX RUWDPGD ]DPDQOD LQIHNWLYLWHVLQL ND\EHGHU 6R÷XNWD YH YFXW VDOJÕODUÕQÕQ LoHULVLQGH daha uzun süre infektif kalabilir. 6&9¶QXQ OLSLW ]DUIÕ EXOXQPDVÕ VHEHEL\OH DONRO YH HWHU JLEL OLSLW o|]Fülere IHYNDODGHGX\DUOÕGÕU $QWLVHSWLNOHUH GX\DUOÕGÕU $QWLWEHUNOR DQWLVHSWLNOHU YH KLSR LOH NÕVD VUHGH LQKLEH ROXU 'URSOHWOHU KDOLQGH KDYD\D NDUÕúWÕ÷ÕQGD DQWLVHSWLN X\JXODPDVÕ VSUH\ úHNOLQGH ROPDOÕGÕU 'XYDU ]HPLQ YH NRQWDPLQH PDWHU\DO KLSR YH\D DONollü antiseptik solüsyonlar ile silinmelidir. <$37,ö,+$67$/,./$5 øQVDQGD YH PD\PXQGD 6$56 KDVWDOÕ÷Õ \DSWÕ÷Õ ELOLQPHNWHGLU $\QÕ DLOHGHNL GL÷HU YLUXVODUD EHQ]HU RODUDN KD\YDQGD SQ|PRQL HWNHQL ROPDVÕ GD PXKWHPHOGLU +DVWDOÕN ED]Õ LQVDQODUGD VXENOLQLN VH\UHWPHNWHGLU %D]Õ LQVDQODUGD LVH |OGUF RODELOPHNWHGLU %D÷ÕúÕNOÕN EÕUDNÕS EÕUDNPDGÕ÷Õ KHQ] LQFHOHQPHPLúWLU 'X\DUOÕ ELUH\OHUGH ELOKDVVD GL\DEHWLNOHUGH SURJQR]XQ D÷ÕU VH\UHWPHVL PPNQGU %WQ YDNDODU D\QÕ VHUWOLNWH VH\UHWPH] $NFL÷HU EHOLUWLVL ELOH YHUPHGHQ L\LOHúHQ YDNDODU YDUGÕU .URQLNOHúWL÷LUDSRUHGLOPHPLúWLU3RUW|UONUDSRUHGLOPHPLúWLU %(/ø57ø/(5ø øQNEDV\RQ SHU\RGX - JQGU DPD JQH NDGDU X]D\DELOLU øQNEDV\RQ peryodu uzun olan vakalar daha hafif seyreder. 5DVWODQPDVÕNOÕ÷ÕQDJ|UHLONNOLQLNEHOLUWLOHUL\NVHNDWHú!&KX]XUVX]OXN KLVVL WLWUHPH ER÷D] \DQPDVÕ |NVUN NDV D÷UÕVÕ EDú D÷UÕVÕ ELODWHUDO SQ|PRQL VROXQXPXQ GHULQOL÷LQLQ NÕVDOPDVÕ YH\D ]RU QHIHV DOPD úHNOLQGHGLU $OÕúÕODJHOPLú VROXQXP\ROXKDVWDOÕ÷ÕQDEHQ]HUEHlirtiler verir. '|NQW UHQDO JDVWURLQWHVWLQDO YH Q|URORMLN EXOJXVX \RNWXU %D]Õ YDNDODUGD \NVHNDWHúG|QHPLQGHGL\DUHUDSRUHGLOPLúWLU 977 +DVWDODUÕQ -¶QGH LON EHOLUWL DWHúWLU VLQGH úPH YH WLWUHPH %49-¶ÕQGDNDVD÷UÕVÕ-69’unda öksürüktür, %42 sinde ise ilk belirti dispnedir. 9DNDODUÕQ DQFDN - NDGDUÕQGD KDVWDOÕ÷ÕQ J|UOPHVLQGHQ -7 gün sonra DOW VROXQXP \ROODUÕ ROD\D NDWÕOÕU gNVUN NXUX YH VHUWWLU GLVSQH JHQHOOLNOH VRQUDGDQ RUWD\D oÕNDU (QWEDV\RQ YH\D YHQWLODV\RQ FLKD]Õ LOH VROXQXPD \DUGÕP HGLOPHVL JHUHNHELOLU%XQDUD÷PHQYDNDODUÕQVDGHFH-NDGDUÕKLSRNVLVROXQXPNROODSVÕYH |OPLOHVRQXoODQDELOLU'LDEHWOLKDVWDODUGD6$56VHEHEL\OH|OPRUDQÕWXU +DVWDOÕN DWLSLN EHOLUWLOHU GH YHUHELOLU gUQH÷LQ GLVHPLQH LQWravasküler NRDJORSDWL EHOLUWLVL YHUHQ ELU KDVWDQÕQ DNFL÷HU U|QWJHQOHULQGH ELU GH÷LúLNOLN J|UOPHPLú DPD NRPSWHUL]H WRPRJUDIL &7 LOH DNFL÷HUGH NRQVROLGH RGDNODU WHVSLW HGLOPLú YH VROXQXP VDOJÕVÕQGD 6&9 J|VWHULOPLúWLU 7LSLN 6$56 NOLQL÷L VRQUDGDQ JHOLúPLúWLU (UNHQG|QHPGHDNFL÷HUU|QWJHQOHULQRUPDOJ|UQWYHULUøOHUOH\HQG|QHPOHUGH oHNLOHQ DNFL÷HU U|QWJHQOHULQGH IRNDO LQWHUVWLV\DO LQILOWUDWODUD ED÷OÕ NRQVROLGH VDKDODU hemen daima tespit edilir. TANI: (Q VDGÕN WDQÕ \|QWHPL DNFL÷HULQ UDG\RORMLN RODUDN LQFHOHQPHVLGLU 6DOJÕQ E|OJHVLQGHNL 6$56 úSKHOL YDNDODUGD U|QWJHQ YH NDQ EXOJXODUÕ WHúKLV LoLQ \HWHUOLGLU +DVWDOÕ÷ÕQ HUNHQ G|QHPLQGH YH\D LON GHID RUWD\D oÕNWÕ÷ÕQGD VROXQXP VDOJÕODUÕQGD HOHNWURQPLNURVNRSLOHYLUVQYDUOÕ÷ÕQÕJ|VWHUPHNYH\DNOWUGHretmek gerekebilir. Koronaviruslara özgül immünolojik testler SCV için de uygulanabilir. Radyolojik testler: $NFL÷HU URQWJHQLQGH NRQVROLGDV\RQ DUDQPDOÕGÕU $NFL÷HU SHUNV\RQGD GROJXQGXU RVNOWDV\RQ LSXFX YHUPH\HELOLU %LU oDOÕúPDGD U|QWJHQ EHOLUWLVL YHren 23 KDVWD KHQ] U|QWJHQ EHOLUWLVL YHUPH\HQ 6$56 KDVWDVÕ YH U|QWJHQ EHOLUWLVL YHUPH\HQ WDQH 6$56 úSKHOL KDVWDQÕQ DNFL÷HUL RSDVLWH YH NRQVROLGDV\RQ DoÕVÕQGDQ &7 LOHLQFHOHQPLú6$56KDVWDOÕ÷ÕQÕQU|QWJHQEHOLUWLVLYHUPHGHQ|QFH&7 LOHWHúKLVHGLOHELOHFH÷LJ|UOPúWU7RSODPWDQHHWNLOHQHQDNFL÷HUVHJPHQWLQGHQ WDQHVL DNFL÷HULQ DOW OREXGXU +HSVLQGH RUWDN EXOJX RSDVLILNDV\RQ JURXQG-glass opacification), konsolidasyon, interlobuler septalarda ve interstisyal fragmanlarda NDOÕQODúPDGÕU 5|QWJHQ EHOLUWLVL YHUPHGHQ |QFH EX OH]\RQODUÕQ VD\ÕVÕ YH oDSÕ NoNWUDNFL÷HULQSHULIHULQGH\HUOHúLUOHU5|QWJHQGHEHOLUWLYHUHQOH]\RQODUJHQHOOLNOH DNFL÷HULQKHPPHUNH]LQGHKHPGHSHULIHULQGHRODELOLUOHUDPDVDQWUDOOH]\RQODUKHPHQ KHUYDNDGDVD\ÕFDD]GÕU øPPQRORMLNWHVWOHU 6ROXQXP VDOJÕODUÕQGD JXUXS , NRURQDYLUXV SROLNORQDO DQWLNRUODUÕQ IORUHVDQ ER\DODUOD J|VWHULOPHVL WDQÕ\D \DUGÕP HGHU 6ROXQXP VDOJÕODUÕQÕQ 9HUR ( KFUH kültürüne inokülasyonu ile virusun gösterilmesi veya serolojik olarak koronaviruslara |]JONRURQDYLUXVUHYHUVWUDQVNULSWD]ODUÕLOH\DSÕODQ3&5WHVWOHULWDQÕ\ÕGR÷UXODU Transmisyon elektron mikroskopunda standart boyama prosedürü ile lobut úHNOLQGHNLSHSORPHUOHULL]OHQHELOLU Hematolojik testler: Erken dönemde lökopeni yoktur veya a]GÕUDPDOHQIRVLWVD\ÕVÕD]DOPÕúRODUDN EXOXQXU+DVWDODUÕQ¶LQGHODFWDWHGHK\GURJHQDVH!8/¶LQGHNUHDWLQ fosfokinaz yükselebilir (>3,000 IU/L), hepatik transaminazlar normalin 2- NDWÕQD kadar yükselebilir. +DVWDODUÕQVLQGHLONYHRUtak laboratuvar bulgusu lactate dehydrogenase \NVHOPHVLGLU¶ÕQGDKLSRNDOVHPL-¶VÕQGDOHQIRSHQLVLQGHUKLQRUUKHD GÕU 978 øOHUOH\HQG|QHPGHKDVWDODUÕQ-VLQGHWURPERVLWRSHQLYDUGÕU-150,000/µL). $\ÕUGHGLFLWDQÕ Balgam ve kaQ ER\DQDUDN YH NOWU \DSÕODUDN EDNWHUL\HO SQ|PRQL HOLPLQH edilmelidir. Atipik pnömoni etkenleri (Mycoplasma pneumoniae, Chlamydia pneumoniae, Legionella pneumophilaDUDQPDOÕYHHOLPLQHHGLOPHOLGLU,QIOXHQ]D$% YHVROXQXPVLQVLW\DOYLUXVKDVWDOÕNODUÕQGDQD\UÕOPDVÕJHUHNOLGLU 7('$9ø +DVWD NDUDQWLQD\D DOÕQPDOÕGÕU +DVWDQÕQ \DNÕQ WHPDVWD EXOXQGX÷X \DNÕQODUÕ X\DUÕOPDOÕYHHQD]ELUKDIWDER\XQFDDNFL÷HUEHOLUWLOHULL]OHQPHOLGLU %X JQN ELOJLOHULPL]H J|UH EX KDVWDOÕN DQWLEL\RWLNULEDYLULQNRUWLNRVWHUoid oOV LOH WHGDYL HGLOPHNWHGLU $WLSLN EDNWHUL\HO SQ|PRQLGH NXOODQÕODQ ELU DQWLEL\RWLN verilmesinin sebebi konservatiftir. Mesela beta laktam veya bir makrolit seçilebilir. 0DNVLPXPHIHNWLIGR]KDVWDQÕQNLORVXQDX\JXQELoLPGHD\DUODQÕU Ribavirin iseNRURQDYLUXVODU]HULQHHWNLOLRODQDQWLYLUDOLODoWÕU5LEDYLULQ¶LQGR]X JQGH GHID J GÕU 5LEDYLULQ X\JXODQDQ 6$56¶OÕ KDVWDODUÕQ ¶VÕQGD KHPROL] J|UOPHNWH¶XQGDKHPRJORELQVHYL\HVLJG/¶QLQDOWÕQDGúPHNWHGLU$PDKDOD en uygun tedavidir. 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Anand K, Ziebuhr J, Wadhwani P, et al., Coronavirus Main Proteinase (3CLpro) Structure: Basis for Design of Anti-SARS Drugs. Science, 2003; May 13 (in press). 3. Booth CM, Matukas LM, Tomlinson GA, et al.,Clinical Features and Short-term Outcomes of 144 Patients With SARS in the Greater Toronto Area. JAMA, 2003; May 6 (in press). 4. Drosten C, Gunther S, Preiser W, et al. Identification of a novel coronavirus in patients with severe acute respiratory syndrome. N Engl J Med, 2003; 348(20):1967-1976. 5. Fouchier RA, Kuiken T, Schutten M, et al. Aetiology: Koch's postulates fulfilled for SARS virus. Nature, 2003; 423(6937):240. 6. Ksiazek TG, Erdman D, Goldsmith CS, et al. A novel coronavirus associated with severe acute respiratory syndrome. N Engl J Med, 2003; 348(20):1953-1966. 7. Lapinsky SE, Hawryluck L. ICU management of severe acute respiratory syndrome. Intensive Care Med, 2003; May 9 (in press). 8. Lee N, Hui D, Wu A, et al. A major outbreak of severe acute respiratory syndrome in Hong Kong. N Engl J Med, 2003; 348(20):1986-1994. 9. Rickerts V, Wolf T, Rottmann C, et al.Clinical presentation and management of the severe acute respiratory syndrome (SARS). Dtsch Med Wochenschr, 2003; 128(20):1109-1114. 10. Marra MA, Jones SJ, Astell CR, et al. The Genome Sequence of the SARS-Associated Coronavirus. Science, 2003; May 1 (in press). 11. Peiris JS, Lai ST, Poon LL, et al. Coronavirus as a possible cause of severe acute respiratory syndrome. Lancet 2003;361(9366):1319-25. 12. Seto WH, Tsang D, Yung R, et al. Effectiveness of precautions against droplets and contact in prevention of nosocomial transmission of severe acute respiratory syndrome (SARS). Lancet, 2003; 361(9368):1519-1520. 13. So LK, Lau AC, Yam LY, et al. Development of a standard treatment protocol for severe acute respiratory syndrome. Lancet, 2003; 361(9369):1615-1617. 14. Tsang KW, Ho PL, Ooi GC, et al. A cluster of cases of severe acute respiratory syndrome in Hong Kong. N Engl J Med, 2003; 348(20):1977-1985. 15. Wong KT, Antonio GE, Hui DS, et al. Thin-Section CT of Severe Acute Respiratory Syndrome: Evaluation of 74 Patients Exposed to or with the Disease. Radiology, 2003; May 8 (in press).
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