{"id":225,"date":"2024-11-28T20:38:56","date_gmt":"2024-11-28T20:38:56","guid":{"rendered":"https:\/\/dremrekaraagac.com\/?p=225"},"modified":"2025-01-02T12:45:07","modified_gmt":"2025-01-02T12:45:07","slug":"sik-hastalanma","status":"publish","type":"post","link":"https:\/\/dremrekaraagac.com\/?p=225","title":{"rendered":"S\u0131k Hastalanan \u00c7ocuklara Yakla\u015f\u0131m"},"content":{"rendered":"

\u00d6zellikle kre\u015f ve okula ba\u015flad\u0131ktan sonra ba\u015flayan, neredeyse her ay hastalanan, s\u00fcrekli antibiyotik ila\u00e7 kullanan \u00e7ocuklar\u0131n anne babalar\u0131, bu yaz\u0131 sizler i\u00e7in haz\u0131rland\u0131.<\/p>\n

Geni\u015f bir konu oldu\u011fu i\u00e7in uzun ve detayl\u0131 bir yaz\u0131 olacak. Bu nedenle sonuna kadar sab\u0131rla okuman\u0131z\u0131 tavsiye ederim. \u00d6ncelikle s\u0131k hastal\u0131k derken neyi kastediyoruz bunu konu\u015fmal\u0131y\u0131z. \u00c7\u00fcnk\u00fc hastal\u0131\u011f\u0131n t\u00fcr\u00fcne, semtomlar\u0131na g\u00f6re farkl\u0131 klinik tan\u0131lara y\u00f6nelmekteyiz. Daha kolay anla\u015f\u0131lmas\u0131 i\u00e7in birka\u00e7 fakl\u0131 senaryo ve ba\u015fl\u0131k halinde s\u0131k hastalanma konusunu konu\u015faca\u011f\u0131z ve eminim ki en az bir senaryo sizin \u00e7ocu\u011funuzu anlat\u0131yor olacakt\u0131r.<\/p>\n

\u0130lk olarak s\u0131k ate\u015flenen \u00e7ocuk senaryolar\u0131n\u0131 konu\u015faca\u011f\u0131z. S\u0131k ate\u015flenen \u00e7ocuklar\u0131 3 ana hastal\u0131k grubunda de\u011ferlendiriyoruz.<\/p>\n

    \n
  1. Ba\u011f\u0131\u015fl\u0131k sisteminin zay\u0131fl\u0131\u011f\u0131 ile giden imm\u00fcn yetmezlik hastal\u0131klar\u0131<\/li>\n
  2. D\u00fczenli aral\u0131klarla olan, mikrobiyal maruziyet yokken de v\u00fccudun mikrop varm\u0131\u015f gibi tepki verdi\u011fi romatizmal gruptaki Periyodik Ate\u015f Sendromlar\u0131<\/li>\n
  3. \u00c7ocu\u011fun sa\u011fl\u0131kl\u0131 olmas\u0131na ra\u011fmen, okul ve kre\u015f gibi ortamlarda s\u0131k mikroba maruz kalma<\/li>\n<\/ol>\n

    1) \u0130MM\u00dcN YETMEZL\u0130KLER<\/span><\/p>\n

    V\u00fccudumuza herhangi bir mikrop girmeye \u00e7al\u0131\u015ft\u0131\u011f\u0131 andan itibaren bir\u00e7ok farkl\u0131 basamakta, farkl\u0131 h\u00fccresel elemanlarla v\u00fccut savunulmaktad\u0131r. Savunma sistemimizin b\u00fct\u00fcn h\u00fccrelerine ve organizasyonuna imm\u00fcn sistem demekteyiz. \u0130mm\u00fcn sistemin herhangi bir basama\u011f\u0131nda zafiyet olu\u015fmas\u0131 durumunda mikroorganizmalar tekrarlayan enfeksiyonlara yol a\u00e7abilmektedir. \u0130mm\u00fcn yetmezlikler olarak s\u0131n\u0131fland\u0131rd\u0131\u011f\u0131m\u0131z bu hastal\u0131klar\u0131n b\u00fcy\u00fck bir b\u00f6l\u00fcm\u00fc genetik ve do\u011fu\u015ftan olup, ilerleyen ya\u015flarda daha sonra da geli\u015febilmektedir. \u0130mm\u00fcn yetmezli\u011fin \u015fiddeti de organizasyonun neresinde aksakl\u0131k oldu\u011funa g\u00f6re de\u011fi\u015fmektedir. \u00c7ok a\u011f\u0131r formlar\u0131nda yenido\u011fan d\u00f6neminden itibaren a\u011f\u0131r enfeksiyonlar nedeniyle tekrarlayan yo\u011fun bak\u0131m ve hastane yat\u0131\u015flar\u0131 g\u00f6r\u00fclmekteyken, sadece s\u0131k grip olma gibi hafif seyreden formlar\u0131 da mevcuttur. En s\u0131k g\u00f6rd\u00fc\u011f\u00fcm\u00fcz imm\u00fcn yetmezlik sa\u011fl\u0131k bir \u00e7ocukta da g\u00f6r\u00fclen S\u00fct \u00c7ocu\u011fu Ge\u00e7ici Hipogamaglob\u00fclinemisi ve ikinci s\u0131kl\u0131kta g\u00f6r\u00fclen \u0130mm\u00fcnoglob\u00fclin A Eksikli\u011fidir.<\/p>\n

    A) S\u00fct \u00c7ocu\u011fu Ge\u00e7ici Hipogamaglob\u00fclinemisi<\/span><\/p>\n

    Ba\u011f\u0131\u015f\u0131kl\u0131k sistemi h\u00fccrelerimizin en \u00f6nemli silah\u0131 olan antikorlar\u0131n s\u00fct \u00e7ocuklu\u011fu d\u00f6neminde \u00fcretiminde eksiklik g\u00f6r\u00fcld\u00fc\u011f\u00fc daha sonra \u00e7ocuk b\u00fcy\u00fcd\u00fck\u00e7e normale geldi\u011fi hastal\u0131kt\u0131r. Ge\u00e7icidir ve s\u0131k enfeksiyon ge\u00e7iren \u00e7ocuklarda ilk ara\u015ft\u0131rd\u0131\u011f\u0131m\u0131z hastal\u0131kt\u0131r. Di\u011fer antikor eksikliklerinden \u00e7ocu\u011fun ya\u015f ald\u0131k\u00e7a ya\u015f\u0131na g\u00f6re immunoglobulin d\u00fczeyleri<\/a>nin normale d\u00f6nmesiyle ayr\u0131l\u0131r. Di\u011fer antikor yap\u0131m defektlerinde y\u00fckselme g\u00f6r\u00fclmez. Bu nedenle ge\u00e7ici hipogamaglobulinemi d\u00fc\u015f\u00fcnd\u00fc\u011f\u00fcm\u00fcz hastalar\u0131n de\u011ferlerinin normale d\u00f6nd\u00fc\u011f\u00fcn\u00fc g\u00f6rene kadar takip etmek gerekir. Enfeksiyon nedeniyle yo\u011fun bak\u0131m yada servis yat\u0131\u015f\u0131 gerektirecek ciddiyette a\u011f\u0131r enfeksiyonlar genelde g\u00f6r\u00fclmez. Ba\u011f\u0131\u015f\u0131kl\u0131k sistemi normale d\u00f6nene kadar zay\u0131f d\u00f6nemlerde destek vitamin minarel ve bitkisel tedaviler kullan\u0131l\u0131r. S\u0131k hastalanan \u00e7ocuklarda \u00f6nerilen takviye vitamin mineral ve g\u0131dalar\u0131n oldu\u011fu yaz\u0131m\u0131 inceleyebilirsiniz.<\/p>\n

    B) \u0130zole \u0130gA Eksikli\u011fi<\/span><\/p>\n

    En s\u0131k 2. g\u00f6rd\u00fc\u011f\u00fcm\u00fcz imm\u00fcn yetmezliktir. Antikorlar\u0131n i\u00e7inden sadece \u0130gA cinsi antikorlar\u0131n eksikli\u011fi g\u00f6r\u00fcl\u00fcr. \u00d6zellikle solunum yolu ve sindirim sistemi mukozas\u0131n\u0131 korudu\u011fu i\u00e7in eksikli\u011finde bu iki sistemin enfeksiyonlar\u0131 s\u0131kla\u015f\u0131r. S\u00fct \u00e7ocu\u011fu ge\u00e7ici hipoglobulinemisinden fark\u0131 ge\u00e7ici olmamas\u0131 ve \u0130gG ve \u0130gM gibi di\u011fer antikorlar\u0131n d\u00fczeyleri normaldir. Enfeksiyon nedeniyle yo\u011fun bak\u0131m yada servis yat\u0131\u015f\u0131 gerektirecek ciddiyette a\u011f\u0131r enfeksiyonlar genelde g\u00f6r\u00fclmez. Kesin tedavisi yoktur. Ba\u011f\u0131\u015f\u0131kl\u0131k sistemini g\u00fc\u00e7lendiren destek vitamin minarel ve bitkisel tedaviler kullan\u0131l\u0131r.<\/p>\n

    C) Di\u011fer \u0130mm\u00fcn Yetmezlikler<\/span><\/p>\n

    \u0130mmn yetmezlik grubu hastal\u0131klar derya deniz oldu\u011fu i\u00e7in hesini bu yaz\u0131da anlatamayaca\u011f\u0131m. Kabaca di\u011fer t\u00fcrleri genellikle genetik ge\u00e7i\u015fli a\u011f\u0131r formlar olmaktad\u0131r. B\u00f6brek enfeksiyonu, orta kulak iltihab\u0131, zat\u00fcrre, deri enfeksiyonlar\u0131 gibi birbirinden fakl\u0131 sistemlerde farkl\u0131 zamanlarda a\u011f\u0131r enfeksiyonlar g\u00f6r\u00fcl\u00fcr. K\u00fc\u00e7\u00fck ya\u015flardan itibaren tekrarlayan hastane yat\u0131\u015f\u0131 gerektirecek enfeksiyonlar\u0131 olur. Yeti\u015fkinlik \u00e7a\u011f\u0131na geldiklerinde ise genelde s\u0131k akci\u011fer enfeksiyonu ge\u00e7irmeye ba\u011fl\u0131 akci\u011ferlerde kal\u0131c\u0131 hasarlanmalar, eri\u015fkin ast\u0131m\u0131 ve koah gibi kronik akci\u011fer hastal\u0131klar\u0131 g\u00f6r\u00fcl\u00fcr. Bu hastalara 3-4 hafta bir d\u00fczenli olarak antikor tedavisi \u0130V\u0130G verilir.<\/p>\n

    2) OTO\u0130NFLAMATUAR HASTALIKLAR\/ PER\u0130YOD\u0130K ATE\u015e SENDROMLARI<\/span><\/p>\n

    Ba\u011f\u0131\u015f\u0131kl\u0131k sisteminin herhangi bir sebeple aktifle\u015fip organize bir \u015fekilde \u00e7al\u0131\u015f\u0131p savunma mekanizmalar\u0131n\u0131 ba\u015flatmas\u0131na inflamasyon ve T\u00fcrk\u00e7e kar\u015f\u0131l\u0131\u011f\u0131 olan yang\u0131 demekteyiz. \u00c7o\u011fu zaman yanl\u0131\u015f anla\u015f\u0131lmalara da sebep olan “kan\u0131nda enfeksiyon varm\u0131\u015f” c\u00fcmlesi buradan gelmektedir. \u0130lk \u00f6nce bu konuyu a\u00e7\u0131kl\u0131\u011fa kavu\u015fturmak istiyorum. Bir inflamasyon s\u00fcrecinde ba\u011f\u0131\u015f\u0131kl\u0131k sistemi h\u00fccreleri birbirleriyle organize olarak \u00e7al\u0131\u015fabilmek i\u00e7in haberle\u015fme amac\u0131yla S\u0130TOK\u0130N ad\u0131n\u0131 verdi\u011fimiz maddeler \u00fcretmektedir. \u00d6rnek verecek olursak mesela akci\u011ferlere bir mikrop geldi\u011fini ve orada enfeksiyon ba\u015flatt\u0131\u011f\u0131n\u0131 d\u00fc\u015f\u00fcnelim. Akci\u011ferde mikropla ilk kar\u015f\u0131la\u015fan ba\u011f\u0131\u015f\u0131kl\u0131k sistemi h\u00fccrelerimiz oraya destek kuvvet \u00e7a\u011f\u0131rmak i\u00e7in interl\u00f6kin dedi\u011fimiz maddeler \u00fcretir. Bunun sonucunda b\u00f6lgeye yeni gelen ekip de yeterli olamayaca\u011f\u0131 d\u00fc\u015f\u00fcn\u00fcl\u00fcrse topyek\u00fcn taarruz i\u00e7in karaci\u011fere sinyal proteinleri g\u00f6nderilir. Karaci\u011ferde t\u00fcm sistemleri sava\u015f moduna almak i\u00e7in CRP, prokalsitonin, interl\u00f6kinler, TNF-alfa gibi bir\u00e7ok madde \u00fcretilir. Bu maddeler de v\u00fccutta ate\u015f y\u00fcksekli\u011fi yapma, kan dola\u015f\u0131m\u0131n\u0131 h\u0131zland\u0131rma, i\u015ftah\u0131 azaltma, a\u011fr\u0131 hissi verme gibi bir\u00e7ok farkl\u0131 i\u015f yaparlar.<\/p>\n

    Biz hastal\u0131k d\u00f6nemlerinde \u00e7o\u011fu zaman tahlillerde direkt enfeksiyonun kendisini g\u00f6rmeyiz. Enfeksiyon d\u00f6neminde \u00fcretilen bu maddeleri kanda \u00f6l\u00e7eriz ve y\u00fcksekli\u011fi durumunda ba\u011f\u0131\u015f\u0131kl\u0131k sistemini sava\u015f moduna alm\u0131\u015f bir durum var deriz. Asl\u0131nda acil serviste veya polikliniklerde kullan\u0131lan “KANINDA ENFEKS\u0130YON VARMI\u015e” ifadesinin as\u0131l do\u011frusu “ENFEKS\u0130YON D\u00d6NEM\u0130NDE G\u00d6RD\u00dc\u011e\u00dcM\u00dcZ BA\u011eI\u015eIKLIK S\u0130STEM\u0130 AKT\u0130VASYONU D\u00dc\u015e\u00dcN\u00dcD\u00dcR DE\u011eERLER KANINIZDA Y\u00dcKSEK \u00c7IKTI” gibi bir ifade daha do\u011fru olur.\u00a0 Muayene, \u00f6yk\u00fc, ve t\u00fcm bulgular\u0131 bir araya getirip enfeksiyonun nerde oldu\u011funu anlamaya \u00e7al\u0131\u015f\u0131r\u0131z. Peki bunlar\u0131 neden anlatt\u0131m. Kafa \u015fi\u015firmek i\u00e7in de\u011fil tabiki \ud83d\ude42 \u0130\u015fte otoinflamatuar hastal\u0131klarda bu inflamasyon s\u00fcreci bir mikrop v\u00fccuda girmeden ba\u015flat\u0131lmakta ve mikrop varm\u0131\u015f gibi savunma sistemi aktifle\u015fmektedir. Bunun sonucunda ortada mikrop yokken ate\u015f y\u00fcksekli\u011fi, bo\u011faz a\u011fr\u0131s\u0131, bademciklerde \u015fi\u015fme, lenf bezlerinde \u015fi\u015fme, i\u015ftahs\u0131zl\u0131k, kar\u0131n a\u011fr\u0131s\u0131, eklem a\u011fr\u0131s\u0131, g\u00f6\u011f\u00fcs a\u011fr\u0131s\u0131 gibi semptomlar g\u00f6r\u00fclmekte ve enfeksiyon hastal\u0131klar\u0131yla kar\u0131\u015ft\u0131r\u0131lmaktad\u0131r. Kan tetkiklerine bak\u0131ld\u0131\u011f\u0131nda yine enfeksiyon d\u00f6neminde g\u00f6rd\u00fc\u011f\u00fcm\u00fcz de\u011fi\u015fiklikleri g\u00f6rmekteyiz. Bu nedenle bu hastalar\u0131n tan\u0131nmas\u0131 zordur.\u00a0 Bu hastal\u0131klar genetik ge\u00e7i\u015fli olup tekrarlayan ate\u015f y\u00fckseklikleri ile karakterizedir. Farkl\u0131 alt t\u00fcrleri olsa da bu yaz\u0131mda en s\u0131k kar\u015f\u0131la\u015ft\u0131\u011f\u0131m\u0131z PFAPPA ve FMF hastal\u0131\u011f\u0131ndan bahsedece\u011fim.<\/p>\n

    A)PFAPA Sendromu (<\/span>Periodic<\/span><\/span> F<\/span>ever:<\/span> Periyodik ate\u015f,<\/span> A<\/span>phthous stomatitis: A\u011f\u0131z i\u00e7i aft,<\/span> P<\/span>haryngitis: Faranjit,<\/span> A<\/span>denitis: Lenf bezi b\u00fcy\u00fcmesi)<\/span><\/p>\n

    En s\u0131k g\u00f6rd\u00fc\u011f\u00fcm\u00fcz \u00f6zellikle bo\u011faz enfeksiyonunu taklit eden romatolojik bir hastal\u0131kt\u0131r. Ortalama ayda bir ate\u015f y\u00fcksekli\u011fi, bademciklerde \u015fi\u015fme, a\u011f\u0131zda aftlar, boyundaki lenf bezlerinde \u015fi\u015fme ile ba\u015fvurur. Bo\u011faz enfeksiyonu ile birebir ayn\u0131 semptomlarla gelir. Kan tahlilleri de ayn\u0131d\u0131r. Enfeksiyondan ay\u0131rt etmede kulland\u0131\u011f\u0131m\u0131z en \u00f6nemli tahlil ate\u015f ataklar\u0131 esnas\u0131nda bak\u0131lan Serum Amiloid A de\u011feridir. Bu de\u011fer bo\u011faz enfeksiyonunda da biraz y\u00fckselmekte fakat PFAPA da \u00e7ok \u00e7ok y\u00fcksek de\u011ferlere \u00e7\u0131kmaktad\u0131r. Tan\u0131 koymak i\u00e7in direkt bir testi yoktur. Tek doz verilen kortizon ile ata\u011f\u0131n durdu\u011fu g\u00f6r\u00fcl\u00fcr. Fakat kortizol atak s\u0131kl\u0131\u011f\u0131n\u0131 art\u0131rmas\u0131 nedeniyle sadece tan\u0131sal ama\u00e7l\u0131 \u015f\u00fcphelendi\u011fimiz hastalarda deneme ama\u00e7l\u0131 veririz. Tedavide ba\u011f\u0131\u015f\u0131kl\u0131k sisteminin kordinasyonunu d\u00fczenlemesi nedeniyle d\u00fczenli B12 tedavisi kullan\u0131l\u0131r. Diren\u00e7li ise tedavisine ba\u015fka romatolojik hastal\u0131klarda da kulland\u0131\u011f\u0131m\u0131z ba\u011f\u0131\u015f\u0131kl\u0131k sistemini sakinle\u015ftici etkisi olan kol\u015fisin kullan\u0131l\u0131r. Yine yan\u0131t al\u0131namazsa bademciklerin ameliyatla \u00e7\u0131kar\u0131lmas\u0131 \u00f6nerilir. Yeti\u015fkinlik \u00e7a\u011f\u0131na ge\u00e7ince hastal\u0131\u011f\u0131n iyile\u015fmesini bekleriz. Hangi genlerle aktar\u0131ld\u0131\u011f\u0131 net olarak bilinmese de PFAPA d\u00fc\u015f\u00fcn\u00fclen hastalar\u0131n anne veya babalar\u0131nda ya da yak\u0131n akrabalar\u0131nda \u00e7ocukluk d\u00f6nemlerinde tekrarlayan bo\u011faz enfeksiyonu ataklar\u0131 ve s\u0131k penisilin tedavisi ba\u015flanma \u00f6yk\u00fcleri dikkat \u00e7ekicidir. FMF ten ay\u0131rt etmek i\u00e7in genetik tetkik \u00e7al\u0131\u015ft\u0131r\u0131lmaktad\u0131r.<\/p>\n

    B) FMF (Familial Mediterranean Fever – Ailevi Akdeniz Ate\u015fi)<\/span><\/p>\n

    Genetik ge\u00e7i\u015fli olup tekrarlayan ate\u015f nedeniyle mevucttur. \u00dclkemizde s\u0131k g\u00f6r\u00fclmekte olup farkl\u0131 genetik mutasyonlar bu hastal\u0131\u011fa sebep olmaktad\u0131r. Hastal\u0131\u011f\u0131n \u015fiddeti ve s\u0131kl\u0131\u011f\u0131 hastadan hastaya de\u011fi\u015fmektedir. PFAPA gibi\u00a0 bo\u011faz enfeksiyonunu taklit ederek tekrarlayan ate\u015fli periyotlara sebep olabilirken, sadece ate\u015f y\u00fcksekli\u011fi ve ya ate\u015f y\u00fcksekli\u011fine ilave kar\u0131n a\u011fr\u0131s\u0131, eklem a\u011fr\u0131s\u0131, g\u00f6\u011f\u00fcs a\u011fr\u0131s\u0131, ciltte k\u0131zar\u0131kl\u0131k gibi semptomlarla kar\u015f\u0131m\u0131za \u00e7\u0131kabilir. Tetkiklerinde PFAPA da oldu\u011fu gibi Serum Amiloid A de\u011ferinin anormal y\u00fcksekli\u011fi tan\u0131da \u00f6nemlidir. Genetik tetkikleri bir\u00e7ok yerde yap\u0131labildi\u011fi i\u00e7in tekrarlayan ate\u015f hastal\u0131klar\u0131nda ilk olarak FMF geneti\u011fi bak\u0131lmal\u0131d\u0131r. Negatif gelmesi durumunda daha sonra di\u011fer periyodik ate\u015f sendromlar\u0131 genetik \u00e7al\u0131\u015fmalar\u0131 yap\u0131lmal\u0131d\u0131r. Atak esnas\u0131nda tedavi olarak serum ve a\u011fr\u0131 kesici tedavi verilmektedir. Uzun d\u00f6nem tedavi i\u00e7in ise KOL\u015e\u0130S\u0130N tedavisi verilmektedir. Tedavi aksat\u0131ld\u0131\u011f\u0131 zaman kanda y\u00fcksek seyreden Amiloid proteini uzun vadede b\u00f6brek ba\u015fta olmak \u00fczere organlarda birikerek organ yetmezli\u011fine kadar ilerleyici hasara yol a\u00e7abilir. \u0130la\u00e7lar\u0131n\u0131 d\u00fczenli kullanmayan FMF hastalar\u0131n\u0131n ilerleyen ya\u015flarda diyaliz hastas\u0131 olmas\u0131 s\u0131k g\u00f6rd\u00fc\u011f\u00fcm\u00fcz bir durumdur.<\/p>\n

    C)Di\u011fer Periyodik Ate\u015f Sendromlar\u0131<\/span><\/p>\n

    PFAPA ve FMF d\u0131\u015flanan s\u0131k tekrarlayan ate\u015f y\u00fcksekli\u011fi olan hastada di\u011fer periyodik ate\u015f sendromlar\u0131 geneti\u011fi \u00e7al\u0131\u015ft\u0131r\u0131lmal\u0131d\u0131r. TRAPS, HIDS, CAPS, FCAS di\u011fer periyodik ate\u015f sendromlar\u0131ndan baz\u0131lar\u0131d\u0131r.<\/p>\n

    3. SIK M\u0130KROBA MARUZ KALMA<\/span><\/p>\n

    \u00d6zellikle kre\u015fe veya okula ba\u015flad\u0131klar\u0131 ilk y\u0131l yeni mikroplarla tan\u0131\u015fmalar\u0131 nedeniyle sa\u011fl\u0131kl\u0131 bir \u00e7ocukta da tekrarlayan enfeksiyonlar g\u00f6r\u00fclmektedir. Di\u011fer hastal\u0131klar d\u0131\u015fland\u0131ktan sonra \u00f6yk\u00fc de uyumluysa bu hastalarda s\u0131k mikroba maruziyete ba\u011fl\u0131 hastalanma d\u00fc\u015f\u00fcn\u00fcl\u00fcr. Hasta okul\/kre\u015f gibi biryere gitmese bile ev i\u00e7inde ta\u015f\u0131y\u0131c\u0131 bir birey de olabilir. \u00d6zellikle ebeveynlerinde \u00f6\u011fretmen, sa\u011fl\u0131k \u00e7al\u0131\u015fan\u0131, kuaf\u00f6r gibi mesle\u011fi olan \u00e7ocuklarda veya karde\u015fi okula yeni ba\u015flayanlarda s\u0131k enfeksiyona maruziyet ta\u015f\u0131y\u0131c\u0131lar nedeniyle olmaktad\u0131r. Mevcut enfeksiyonu tedavi etmek d\u0131\u015f\u0131nda ek tedaviye gerek yoktur.<\/p>\n

    SOLUNUM YOLU ALERJ\u0130LER\u0130 ASTIM VE ALERJ\u0130K R\u0130N\u0130T<\/span><\/p>\n

    Yukar\u0131da ate\u015fle gelen tekrarlayan enfeksiyon yakla\u015f\u0131m\u0131n\u0131 konu\u015ftuk. Fakat bir k\u0131s\u0131m hastam\u0131n ate\u015fsiz d\u00f6nemde de kronik \u00f6ks\u00fcr\u00fck, burun ak\u0131nt\u0131s\u0131\/t\u0131kan\u0131kl\u0131\u011f\u0131, h\u0131r\u0131lt\u0131l\u0131 solunum, tekrarlayan bron\u015fit\/bron\u015fiolit gibi solunum sistemi hastal\u0131klar\u0131 ge\u00e7irmektedir. Bu hastalarda imm\u00fcn yetmezlik grubu hastal\u0131klar d\u0131\u015fland\u0131ktan sonra \u00f6n planda solunum yolunun alerjik hastal\u0131klar\u0131n\u0131 d\u00fc\u015f\u00fcnmekteyiz. Burun \u015fikayetleri \u00f6n planda olan hastalarda alerjik rinit, akci\u011ferle ilgili \u015fikayetlerin \u00f6n planda oldu\u011fu durumlarda ast\u0131m veya daha hafif formu olan bron\u015fial hiperreaktivite d\u00fc\u015f\u00fcnmekteyiz. Bu hastalara uzun d\u00f6nem kullanmak \u00fczere alerji ila\u00e7lar\u0131 ve kana kar\u0131\u015fmad\u0131\u011f\u0131 i\u00e7in yan etkik yapmayan lokal kortizol tedavileri vermekteyiz.<\/p>\n

    \u00d6ZET OLARAK<\/span><\/p>\n

    -Tekrarlayan ate\u015fli hastal\u0131klarda imm\u00fcn yetmezlikler, periyodik romatizmal ate\u015fler veya s\u0131k mikroba maruziyet d\u00fc\u015f\u00fcnmekteyken ate\u015fsiz s\u0131k solunum yolu hastal\u0131\u011f\u0131 ge\u00e7irenlerde ast\u0131m ve alerjik rinit gibi solunum yolu alerjik hastal\u0131klar\u0131 d\u00fc\u015f\u00fcnmekteyiz. \u00c7ocuk zamanda bunlar\u0131n birka\u00e7\u0131n\u0131n birlikte kombinasyonunu g\u00f6rmekteyiz. Mesala \u0130gA eksikli\u011fi + alerjik rinit+ ast\u0131m kombinasyonu en s\u0131k g\u00f6rd\u00fc\u011f\u00fcm\u00fcz kombinasyonlardan birisidir.<\/p>\n","protected":false},"excerpt":{"rendered":"

    \u00d6zellikle kre\u015f ve okula ba\u015flad\u0131ktan sonra ba\u015flayan, neredeyse her ay hastalanan, s\u00fcrekli antibiyotik ila\u00e7 kullanan \u00e7ocuklar\u0131n anne babalar\u0131, bu yaz\u0131 sizler i\u00e7in haz\u0131rland\u0131.<\/p>\n","protected":false},"author":1,"featured_media":226,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"neve_meta_sidebar":"","neve_meta_container":"","neve_meta_enable_content_width":"","neve_meta_content_width":0,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":"","footnotes":""},"categories":[1,18,14],"tags":[],"class_list":["post-225","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-aileler-icin","category-hastalik-yaklasim","category-saglik-profesyonelleri-icin"],"yoast_head":"\nS\u0131k Hastalanan \u00c7ocuklara Yakla\u015f\u0131m - Uzm. Dr. Emre KARAA\u011eA\u00c7<\/title>\n<meta name=\"description\" content=\"Kre\u015f veya okula ba\u015flad\u0131ktan sonra s\u0131k hastalanan bir \u00e7ocu\u011funuz varsa buraya, sebepleri nelerdir, neler yapmal\u0131y\u0131z\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/dremrekaraagac.com\/?p=225\" \/>\n<meta property=\"og:locale\" content=\"tr_TR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"S\u0131k Hastalanan \u00c7ocuklara Yakla\u015f\u0131m - Uzm. Dr. Emre KARAA\u011eA\u00c7\" \/>\n<meta property=\"og:description\" content=\"Kre\u015f veya okula ba\u015flad\u0131ktan sonra s\u0131k hastalanan bir \u00e7ocu\u011funuz varsa buraya, sebepleri nelerdir, neler yapmal\u0131y\u0131z\" \/>\n<meta property=\"og:url\" content=\"https:\/\/dremrekaraagac.com\/?p=225\" \/>\n<meta property=\"og:site_name\" content=\"Uzm. Dr. Emre KARAA\u011eA\u00c7\" \/>\n<meta property=\"article:published_time\" content=\"2024-11-28T20:38:56+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2025-01-02T12:45:07+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/dremrekaraagac.com\/wp-content\/uploads\/2024\/11\/2883dbeb-1f10-472f-aa91-f8e7e1db1b93.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"1792\" \/>\n\t<meta property=\"og:image:height\" content=\"972\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"author\" content=\"Uzm. Dr. Emre KARAA\u011eA\u00c7\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Yazan:\" \/>\n\t<meta name=\"twitter:data1\" content=\"Uzm. Dr. Emre KARAA\u011eA\u00c7\" \/>\n\t<meta name=\"twitter:label2\" content=\"Tahmini okuma s\u00fcresi\" \/>\n\t<meta name=\"twitter:data2\" content=\"9 dakika\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/dremrekaraagac.com\/?p=225\",\"url\":\"https:\/\/dremrekaraagac.com\/?p=225\",\"name\":\"S\u0131k Hastalanan \u00c7ocuklara Yakla\u015f\u0131m - Uzm. Dr. Emre KARAA\u011eA\u00c7\",\"isPartOf\":{\"@id\":\"https:\/\/dremrekaraagac.com\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\/\/dremrekaraagac.com\/?p=225#primaryimage\"},\"image\":{\"@id\":\"https:\/\/dremrekaraagac.com\/?p=225#primaryimage\"},\"thumbnailUrl\":\"https:\/\/dremrekaraagac.com\/wp-content\/uploads\/2024\/11\/2883dbeb-1f10-472f-aa91-f8e7e1db1b93.jpg\",\"datePublished\":\"2024-11-28T20:38:56+00:00\",\"dateModified\":\"2025-01-02T12:45:07+00:00\",\"author\":{\"@id\":\"https:\/\/dremrekaraagac.com\/#\/schema\/person\/41003ef606e627d3c4bda81aaff81558\"},\"description\":\"Kre\u015f veya okula ba\u015flad\u0131ktan sonra s\u0131k hastalanan bir \u00e7ocu\u011funuz varsa buraya, sebepleri nelerdir, neler yapmal\u0131y\u0131z\",\"breadcrumb\":{\"@id\":\"https:\/\/dremrekaraagac.com\/?p=225#breadcrumb\"},\"inLanguage\":\"tr\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/dremrekaraagac.com\/?p=225\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"tr\",\"@id\":\"https:\/\/dremrekaraagac.com\/?p=225#primaryimage\",\"url\":\"https:\/\/dremrekaraagac.com\/wp-content\/uploads\/2024\/11\/2883dbeb-1f10-472f-aa91-f8e7e1db1b93.jpg\",\"contentUrl\":\"https:\/\/dremrekaraagac.com\/wp-content\/uploads\/2024\/11\/2883dbeb-1f10-472f-aa91-f8e7e1db1b93.jpg\",\"width\":1792,\"height\":972},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/dremrekaraagac.com\/?p=225#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Anasayfa\",\"item\":\"https:\/\/dremrekaraagac.com\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"S\u0131k Hastalanan \u00c7ocuklara Yakla\u015f\u0131m\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/dremrekaraagac.com\/#website\",\"url\":\"https:\/\/dremrekaraagac.com\/\",\"name\":\"Uzm. Dr. Emre KARAA\u011eA\u00c7\",\"description\":\"\u00c7ocuk Sa\u011fl\u0131\u011f\u0131 Ve Hastal\u0131klar\u0131 Uzman\u0131, En \u0130yi \u00c7ocuk Doktoru\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/dremrekaraagac.com\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"tr\"},{\"@type\":\"Person\",\"@id\":\"https:\/\/dremrekaraagac.com\/#\/schema\/person\/41003ef606e627d3c4bda81aaff81558\",\"name\":\"Uzm. Dr. Emre KARAA\u011eA\u00c7\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"tr\",\"@id\":\"https:\/\/dremrekaraagac.com\/#\/schema\/person\/image\/\",\"url\":\"https:\/\/secure.gravatar.com\/avatar\/0327b585ce8193be031cdb8a4499120709a8870a28d15aa8ee18b945912d3857?s=96&d=mm&r=g\",\"contentUrl\":\"https:\/\/secure.gravatar.com\/avatar\/0327b585ce8193be031cdb8a4499120709a8870a28d15aa8ee18b945912d3857?s=96&d=mm&r=g\",\"caption\":\"Uzm. Dr. Emre KARAA\u011eA\u00c7\"},\"description\":\"\u00c7ocuk Sa\u011fl\u0131\u011f\u0131 Ve Hastal\u0131klar\u0131 Uzman Doktor \u00c7ocuk Doktoru\",\"sameAs\":[\"https:\/\/dremrekaraagac.com\",\"https:\/\/www.instagram.com\/bebedoktoruemre\/profilecard\/\",\"https:\/\/www.youtube.com\/channel\/UCfHpGWZXnsEEmW-xa_ANznA\"],\"url\":\"https:\/\/dremrekaraagac.com\/?author=1\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"S\u0131k Hastalanan \u00c7ocuklara Yakla\u015f\u0131m - Uzm. Dr. Emre KARAA\u011eA\u00c7","description":"Kre\u015f veya okula ba\u015flad\u0131ktan sonra s\u0131k hastalanan bir \u00e7ocu\u011funuz varsa buraya, sebepleri nelerdir, neler yapmal\u0131y\u0131z","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/dremrekaraagac.com\/?p=225","og_locale":"tr_TR","og_type":"article","og_title":"S\u0131k Hastalanan \u00c7ocuklara Yakla\u015f\u0131m - Uzm. Dr. Emre KARAA\u011eA\u00c7","og_description":"Kre\u015f veya okula ba\u015flad\u0131ktan sonra s\u0131k hastalanan bir \u00e7ocu\u011funuz varsa buraya, sebepleri nelerdir, neler yapmal\u0131y\u0131z","og_url":"https:\/\/dremrekaraagac.com\/?p=225","og_site_name":"Uzm. Dr. Emre KARAA\u011eA\u00c7","article_published_time":"2024-11-28T20:38:56+00:00","article_modified_time":"2025-01-02T12:45:07+00:00","og_image":[{"width":1792,"height":972,"url":"https:\/\/dremrekaraagac.com\/wp-content\/uploads\/2024\/11\/2883dbeb-1f10-472f-aa91-f8e7e1db1b93.jpg","type":"image\/jpeg"}],"author":"Uzm. Dr. Emre KARAA\u011eA\u00c7","twitter_card":"summary_large_image","twitter_misc":{"Yazan:":"Uzm. Dr. Emre KARAA\u011eA\u00c7","Tahmini okuma s\u00fcresi":"9 dakika"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/dremrekaraagac.com\/?p=225","url":"https:\/\/dremrekaraagac.com\/?p=225","name":"S\u0131k Hastalanan \u00c7ocuklara Yakla\u015f\u0131m - Uzm. Dr. Emre KARAA\u011eA\u00c7","isPartOf":{"@id":"https:\/\/dremrekaraagac.com\/#website"},"primaryImageOfPage":{"@id":"https:\/\/dremrekaraagac.com\/?p=225#primaryimage"},"image":{"@id":"https:\/\/dremrekaraagac.com\/?p=225#primaryimage"},"thumbnailUrl":"https:\/\/dremrekaraagac.com\/wp-content\/uploads\/2024\/11\/2883dbeb-1f10-472f-aa91-f8e7e1db1b93.jpg","datePublished":"2024-11-28T20:38:56+00:00","dateModified":"2025-01-02T12:45:07+00:00","author":{"@id":"https:\/\/dremrekaraagac.com\/#\/schema\/person\/41003ef606e627d3c4bda81aaff81558"},"description":"Kre\u015f veya okula ba\u015flad\u0131ktan sonra s\u0131k hastalanan bir \u00e7ocu\u011funuz varsa buraya, sebepleri nelerdir, neler yapmal\u0131y\u0131z","breadcrumb":{"@id":"https:\/\/dremrekaraagac.com\/?p=225#breadcrumb"},"inLanguage":"tr","potentialAction":[{"@type":"ReadAction","target":["https:\/\/dremrekaraagac.com\/?p=225"]}]},{"@type":"ImageObject","inLanguage":"tr","@id":"https:\/\/dremrekaraagac.com\/?p=225#primaryimage","url":"https:\/\/dremrekaraagac.com\/wp-content\/uploads\/2024\/11\/2883dbeb-1f10-472f-aa91-f8e7e1db1b93.jpg","contentUrl":"https:\/\/dremrekaraagac.com\/wp-content\/uploads\/2024\/11\/2883dbeb-1f10-472f-aa91-f8e7e1db1b93.jpg","width":1792,"height":972},{"@type":"BreadcrumbList","@id":"https:\/\/dremrekaraagac.com\/?p=225#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Anasayfa","item":"https:\/\/dremrekaraagac.com\/"},{"@type":"ListItem","position":2,"name":"S\u0131k Hastalanan \u00c7ocuklara Yakla\u015f\u0131m"}]},{"@type":"WebSite","@id":"https:\/\/dremrekaraagac.com\/#website","url":"https:\/\/dremrekaraagac.com\/","name":"Uzm. Dr. Emre KARAA\u011eA\u00c7","description":"\u00c7ocuk Sa\u011fl\u0131\u011f\u0131 Ve Hastal\u0131klar\u0131 Uzman\u0131, En \u0130yi \u00c7ocuk Doktoru","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/dremrekaraagac.com\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"tr"},{"@type":"Person","@id":"https:\/\/dremrekaraagac.com\/#\/schema\/person\/41003ef606e627d3c4bda81aaff81558","name":"Uzm. Dr. Emre KARAA\u011eA\u00c7","image":{"@type":"ImageObject","inLanguage":"tr","@id":"https:\/\/dremrekaraagac.com\/#\/schema\/person\/image\/","url":"https:\/\/secure.gravatar.com\/avatar\/0327b585ce8193be031cdb8a4499120709a8870a28d15aa8ee18b945912d3857?s=96&d=mm&r=g","contentUrl":"https:\/\/secure.gravatar.com\/avatar\/0327b585ce8193be031cdb8a4499120709a8870a28d15aa8ee18b945912d3857?s=96&d=mm&r=g","caption":"Uzm. Dr. Emre KARAA\u011eA\u00c7"},"description":"\u00c7ocuk Sa\u011fl\u0131\u011f\u0131 Ve Hastal\u0131klar\u0131 Uzman Doktor \u00c7ocuk Doktoru","sameAs":["https:\/\/dremrekaraagac.com","https:\/\/www.instagram.com\/bebedoktoruemre\/profilecard\/","https:\/\/www.youtube.com\/channel\/UCfHpGWZXnsEEmW-xa_ANznA"],"url":"https:\/\/dremrekaraagac.com\/?author=1"}]}},"_links":{"self":[{"href":"https:\/\/dremrekaraagac.com\/index.php?rest_route=\/wp\/v2\/posts\/225","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/dremrekaraagac.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/dremrekaraagac.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/dremrekaraagac.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/dremrekaraagac.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=225"}],"version-history":[{"count":13,"href":"https:\/\/dremrekaraagac.com\/index.php?rest_route=\/wp\/v2\/posts\/225\/revisions"}],"predecessor-version":[{"id":257,"href":"https:\/\/dremrekaraagac.com\/index.php?rest_route=\/wp\/v2\/posts\/225\/revisions\/257"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/dremrekaraagac.com\/index.php?rest_route=\/wp\/v2\/media\/226"}],"wp:attachment":[{"href":"https:\/\/dremrekaraagac.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=225"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/dremrekaraagac.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=225"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/dremrekaraagac.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=225"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}