ağızdan mikrob iyoloj ik materyal alınması

153
Konu 18
AöIZDAN
MøKROBøYOLOJøK MATERYAL ALINMASI
$\GÕQ 0 $÷Õ]GDQ PLNUREL\RORMLN PDWHU\DO DOÕQPDVÕ (G &HQJL] 0ÕVÕUOÕJLO $\GÕQ 7ÕS YH GLú
-
KHNLPOL÷LQGHJHQHOYH|]HO0LNUREL\RORML.RQX6D *QHú\D\ÕQHYL$QNDUD
%X LúOHP D÷Õ]ÕQ PLNUREL\RORMLN PXD\HQHVLQLQ LON EDVDPDNODUÕQGHQ ELULGLU
øQIHNWH IORUDQÕQ GR÷UXGDQ PLNURVNRSLVLQL SDWRMHQ PLNURRUJDQL]PDQÕQ NOWUQ YH
DQWLEL\RWLNGX\DUOÕOÕNWHVWOHULQL\DSDELOPHNLoLQLoLQD÷Õ]GDQPDWHU\DODOÕQPDVÕJHUHNLU
1RUPDOD÷Õ]IORUDVÕQÕQ|QHPOLELUNÕVPÕDQDHURSWXU3HULRGRQWLWLVOLYH\DLQIHNWH
GLúL EXOXQDQ ELUH\OHUGH DQDHURS EDNWHULOHULQ IORUD\D KDNLPL\HWOHUL DUWDU %X VHEHSOH
D÷Õ]GDQ PLNUREL\RORMLN PDWHU\DO DOÕQÕUNHQ DQDHURS PLNURRUJDQL]PDODUÕQ UHWLOPHVL
hedeflenir.
0ø.52%ø<2/2-ø.08$<(1((1'ø.$6<21/$5,
$úD÷ÕGDNLGXUXPODUGDD÷Õ]GDQNOWU\DSÕOPDVÕJHUHNOLGLU
øNLQFL KDIWDVÕQÕ GROGXUGX÷X KDOGH WHGDYL\H GLUHQHQ YH L\LOHúPH\HQ EWQ
PXNR]DLQIHNVL\RQODUÕQGDQ
3HULDSLNDOEDúOD\ÕSJLGHUHNGHULQGRNXODUD\D\ÕODQLQIHNVL\RQODUGDQ
$÷Õ]ÕQ EHOLUOL ELU E|OJHVLQGH VÕN WHNUDUOD\DQ YH\D JHQLú VSHNWUXPOX
DQWLEL\RWLNOHUHGLUHQHQ\XPXúDNGRNXLQIHNVL\RQODUÕQGDQ
%LUELUH\LQGLúoU÷QHPH\LOLQLQ|OoOPHVLLVWHQGL÷LQGHD÷Õ]GDNLNDUL\RMHQLN
EDNWHUL NRORQL]DV\RQXQXQ WHVSLW HGLOPHVL JHUHNWL÷LQGH VDO\DVÕQGDQ YH\D GLú
SOD÷ÕQGDQ
7HGDYLVL ELWLULOHQ YH NOLQLN úLND\HWOHUL ND\ERODQ ELU LQIHNVL\RQXQ WDPDPHQ
L\LOHúWL÷LQLQ PLNUREL\RORMLN RODUDN GR÷UXODQPDVÕ JHUHNWL÷LQGH HVNL LQIHNVL\RQ
merkezinden,
&HS GHULQOLNOHULQLQ WDNLS HGLOGL÷L YDNDODUGD SHU\odik muayene prosedürü
içerisine mikrobiyolojik muayene ilave edildiyse, periodontal ceplerden,
1DGLUHQGHROVDWHGDYL\HLQDWODGLUHQHQJLQJLYLWLVYDNDODUÕQGDPLNUREL\RORMLN
LQFHOHPHLVWHQGL÷LQGHSHULRGRQWDOFHSWHQJLQJLYLWLVGLúWDúÕYHSODNODUÕQX]DNODúWÕUÕOPDVÕQGDQ
VRQUDoR÷XQOXNODNHQGLOL÷LQGHQL\LOHúLU).
7HNUDUOD\DQ N|N NDQDOÕ WHGDYLOHULQGH SDWRMHQ PLNURRUJDQL]PDQÕQ QH
ROGX÷XQXQ ELOLQPHVL JHUHNWL÷LQGH N|N NDQDOÕQGDQ Periapikal infeksiyonlar, infekte kök
sonra genellikle antibiyotik tedavisine gerek kalmadan
Streptococcus faecalis veya Actinomyces WUOHUL LVH LQDWoÕ
NDQDOÕQÕQ EL\RPHNDQLN SUHSDUDV\RQXQGDQ
L\LOHúLUOHU (÷HU SDWRMHQ PLNURRUJDQL]PD
).
9. Antibiyotik tedavisine kDUDU YHULOGL÷LQGH HQ LVDEHWOL DQWLEL\RWL÷LQ VHoLOPHVL
gereken derin ve yüzeysel bütün oral infeksiyonlardan,
øQIHNVL\RQLOHDODNDOÕROGX÷XGúQOHQEL\RSVLPDWHU\DOLQGHQ
kültür yapmak gerekir.
HNVWUDUDGLNOHUOH]\RQODU\DSDUODUYHN|NNDQDOÕWHGDYLVLQHGLUHQLUOHU
154
Aft, lichen, eritema multiforme, pemfigus gibi immün kayQDNOÕD÷Õ]OH]\RQODUÕ
XoXN JLEL KHUSHV OH]\RQODUÕ YH\D YLUDO ND\QDNOÕ ROGX÷X GúQOHQ GL÷HU OH]\RQODU
.RSOLN OHNHOHUL KHUSDQMLQ HUR]LI PXNR]D OH]\RQODUÕ WHUPLN YH\D NLP\DVDO PXNR]D
WUDYPDODUÕ SDSLOORP ILEUR HSLWHO\DO SROLS KHPDQML\RP PXNRVHO JLEi tümöral
ROXúXPODUGDQ NOWU \DSÕOPDVÕQD GROD\ÕVÕ\OD PLNUREL\RORMLN PDWHU\DO DOÕQPDVÕQD
gerek yoktur.
ÖN HAZIRLIK:
$÷Õ]GDQ DOÕQDQ PDWHU\DOGH UHPHVL EHNOHQHQ SDWRMHQ EDNWHULQLQ GDLPD ELU
DQDHURS ROGX÷X YDUVD\ÕOÕU (÷HU SDWRMHQ PLNURRUJDQL]PD IDNOWDWLI aerop ise, bu
EDNWHULOHUDQDHURSNOWULoHULVLQGHUDKDWoDUH\HELOHFHNYHND\EROPD\DFDNWÕU%LUGLú
NOLQL÷LQGH D÷Õ]GDQ PDWHU\DO DOÕQÕS PLNUREL\RORMLN PXD\HQH \DSÕOPDN LVWHGL÷LQGH
NOLQLNWHúXKD]ÕUOÕNODU\DSPDOÕGÕU
'LúKHNLPL NHQGL NOLQL÷LQH \DNÕQ RODQ ELU PLNUREL\RORML ODERUDWXYDUÕ LOH
|QFHGHQ J|UúPHOLGLU /DERUDWXYDUÕQ DQDHURELN EDNWHUL\RORML oDOÕúÕS oDOÕúPDGÕ÷ÕQÕ
anerobik kavanoz, glove-box, gas-SDFN DQDHURELN EHVL\HUL JLEL KD]ÕUOÕNODUÕQÕQ
EXOXQXS EXOXQPDGÕ÷ÕQÕ |÷UHQPHOLGLU (÷HU ODERUDWXYDU DQDHrobik bakteriyolojik
WHWNLNOHU\DSDELOHFHNG]HQH÷HVDKLSGH÷LOVHN|NNDQDOÕQGDQNOWU\DSÕOPDVÕDQODPOÕ
GH÷LOGLU $QDHURSODU GÕúÕQGDNL EDNWHULOHUL oDOÕúDELOHQ ELU ODERUDWXYDUD D÷Õ]GDQ DOÕQDQ
materyali yollamak fevkalade gereksizdir.
0DWHU\DO DOÕQDFD÷Õ JQ LNL DGHW DQDHURS VÕYÕ EHVL\HUL WHUFLKDQ 3<* YH\D
WKLRJOXFRODWHEX\\RQ%N]%HVL\HUOHULYH\DDQDHURSWUDQVSRUWEHVL\HULNOLQLNWHKD]ÕU
EXOXQGXUXOXU gQFHGHQ V|\OHQGL÷LQGH ODERUDWXYDU EX EHVL\HUOHULQL ELU JQ
|QFHVLQGHQKD]ÕUOD\DUDNGLúNOLQL÷LQHXODúWÕUDELOLU
.OLQLNWH DOÕQDQ PDWHU\DOOHUGH EX\\RQ NXOODQÕOPDVÕ GDKD SUDWLNWLU LODYH ELU
WHoKL]DWD JHUHN EÕUDNPD] $PD H÷HU EX\\RQ \HULQH NDWÕ EHVL\HUL NXOODQÕODFDNVD EX
durumda, iki adet anaerop agar (AnaBAP), bir adet anaerop kavanoz ve bir adet gaz
paNHWLNOLQLNWHKD]ÕUEXOXQGXUXOXU
%LUDGHWEXQ]HQEHNLYH\DLVSLUWRRFD÷ÕGLúNOLQL÷LQGHKD]ÕUEXOXQGXUXOXU
(÷HU N|N NDQDOÕQGDQ ILVWO RODQ ELU DSVHGHQ YH\D SHULRGRQWDO FHSWHQ
PDWHU\DO DOÕQDFDNVD IDUNOÕ NDOÕQOÕNWD ELUNDo WDQH ND÷ÕW NRQL VWHULOL]H HGLOHUHN KD]ÕU
EXOXQGXUXOXU%XQXQLoLQND÷ÕWNRQLOHU[FPHEDGÕQGDNHVLOHQDPEDODMND÷ÕWODUÕQDWHN
WHNVDUÕODUDN]HUOHULQHoDSODUÕQÕQNDoPLOLPHWUHROGX÷XNXUúXQNDOHPLOH\D]ÕOÕU%XQODU
NXUXVÕFDNVWHULOL]DW|UHYH\DRWRNODYDNRQDUDNVWHULOL]HHGLOLU%XVXUHWOHVWHULOL]HHGLOPLú
ND÷ÕW NRQLOHULQ DPEDODMODUÕ DoÕOPDGDQ UDI |PUOHUL JQ NDGDUGÕU 5XWXEHWOHQLUVH
DPEDODMÕDoÕOÕUVDYH\DJQONUDI|PUGROPXúVD\HQLELUDPEDODMND÷ÕGÕQDVDUÕODUDN
yeniden sterilize edilebilir.
4. Salyadan materyaO DOÕQDFDNVD VWHULO ELU SHWUL NXWXVX PLNUREL\RORML
ODERUDWXYDUÕQGDQJUSDUDILQWLFDUHWWHQWHPLQHGLOLSNOLQLNWHKD]ÕUEXOXQGXUXOXU
'LOGHQ PDWHU\DO DOÕQDFDNVD VWHULO ELU VNDUSHO YH VWHULO ODVWLN VLOJLoOHU
(mikrobiyoloji laboratuvardan temin edilir)|QFHGHQKD]ÕUODQPDOÕGÕU
%L\RSVL PDWHU\DOLQLQ PLNUREL\RORMLN PXD\HQHVL \DSÕODFDNVD FHUUDKL
PDO]HPHOHU\DQÕQGDODVWLNVLOJLoOHUELUDQDHURSNDYDQR]YH\DEXUJXNDSDNOÕWSYH\D
VWHULOELUúLúHEXOXQGXUXOXU
ùDUWROPDPDNODELUOLNWHQDULQDQDHURSODUÕQ üretilmesi hedefleniyorsa bir adet
PDQRPHWUHVL EXOXQDQ D]RW JD]Õ WDQNÕ YH VWHULO ELU NDQO KD]ÕU EXOXQGXUXOXU %LU
\DUGÕPFÕ LúOHP VÕUDVÕQGD EX NDQOGHQ JHOHQ D]RW JD]ÕQÕ PDWHU\DOLQ DOÕQGÕ÷Õ GRNX\D
\DNÕQ RODUDN WXWDU %|\OHFH DQDHURS EDNWHULOHU KDYDQÕQ RNVLMHQL \HULQH D]RW JD]Õ LOH
temas ederler.
(÷HUVÕYÕEHVL\HULNXOODQÕODFDNLVHEXEHVL\HULLoHULVLQGHNLo|]QPúDWPRVIHU
RNVLMHQLQLQ X]DNODúWÕUÕOPDVÕ JHUHNLU %X DPDoOD ELU ND\QDWPD NDEÕ VWHULO ROPDVÕ
155
JHUHNPH]LoHULVLQHoHúPHVX\XGROGXUXOXUVÕYÕbesiyeri içeren tüp bu suyun içerisine
NRQXODUDN RFD÷D \HUOHúWLULOLU YH ND\QDPD\D EÕUDNÕOÕU 7RSODP GDNLND ND\QDPDVÕ
LoHULVLQGHNL (K LQGLNDW|UQQ UHQNVL]OHúPHVL LoLQ \HWHUOLGLU %N] $QDHUREL]P 6RQUD
NHQGL KDOLQGH VR÷XPDVÕ EHNOHQLU %X LúOHP KDVWDQÕQ randevusundan 15 dakika önce
ELWPLúROPDOÕGÕU.DWÕEHVL\HULQHHNLP\DSÕODFDNVDEXLúOHPOHUJHUHNPH]
+DVWD HQ D] JQ |QFHVLQGHQ EHUL KLoELU DQWLEL\RWLN NXOODQPÕ\RU ROPDOÕ
D÷Õ]ÕQD KLoELU ORNDO DQWLVHSWLN X\JXODPÕ\RU ROPDOÕGÕU dQN KDVWDQÕQ NXOODQmakta
ROGX÷X DQWLEL\RWL÷LQ HWNLVL\OH LQFHOHQHQ IORUDGDNL EDNWHULOHULQ VD\Õ oHúLWOLOLN YH
NLPOLNOHULQGHYHKDWWDDQWLEL\RWLNGX\DUOÕOÕNWHVWOHULQGH|QFHGHQNHVWLULOHPH\HQVDSPDODU
RUWD\D oÕNDELOLU $QWLEL\RWLN YH\D DQWLVHSWLN PROHNO LOH NDUúÕODúDQ ELU Eakteri hücresi
|OPHGHQ |QFH GHIHNWLI IRUPODUÕQD G|QHU /-form gibi). Uzayabilir, hareketli ise
KDUHNHWVL]OHúHELOLU IDUNOÕ ER\DQDELOLU YH PLNUREL\RORML ODERUDWXYDUÕQÕ \DQÕOWDUDN \DQOÕú
identifikasyona sebep olabilir.
%X KD]ÕUOÕNODU \DSÕOGÕNWDQ VRQUD D÷Õ]ÕQ muhtelif bölgelerinden mikrobiyolojik
PDWHU\DODOÕQDELOLU
øQIHNWHN|NNDQDOÕQGDQPDWHU\DODOÕQPDVÕ
øQIHNWHN|NNDQDOÕQGDQNOWU\DSÕOPDVÕGLúKHNLPLQLQN|NNDQDOÕLoHULVLQGHKDQJL
PLNURRUJDQL]PD LOH NDUúÕ NDUúÕ\D EXOXQGX÷XQX ELOPHVLQL GR÷UX WHGDYL SROLWLNDVÕQÕ
EHOLUOHPHVLQL YH L\LOHúPH\L PRQLW|UL]H HWPHVLQL PPNQ NÕODU Möller metodu halen
NXOODQÕODQ PHWRWWXU (QIHNWH N|N NDQDOÕQÕQ VWHULO NRúXOODU DOWÕQGD DoÕOPDVÕ YH LoHULVLQH
VWHULO ELU ND÷ÕW NRQL VRNXODUDN N|N NDQDOÕ LoHULVLQGHNL PLNURRUJDQL]PDODUÕQ EX ND÷ÕW
NRQL\HEXODúPDVÕVD÷ODQÕU'DKDVRQUDEXND÷ÕWNRQLDQDHURSWUDQVSRUWEHVL\HULQHYH\D
GR÷UXGDQ DQDHURS EHVL\HULQH LQRNOH HGLOLU øQNEDV\RQX WDNLEHQ UH\HQ EDNWHULOHU
LGHQWLIL\HHGLOLUYHDQWLEL\RWLNGX\DUOÕOÕNWHVWOHULLoLQVDIODúWÕUÕOÕU
KökNDQDOODUÕELUVUHGLU\DNODúÕNJQD÷Õ]RUWDPÕQDDoÕNYD]L\HWWHEXOXQX\RU
LVH EX GXUXPGD NOWU \DSÕOPDPDOÕGÕU 8]XQ VUH DoÕN NDOPÕú N|N NDQDOÕQGDQ L]ROH
HGLOHELOHFHN EDNWHULOHU D÷Õ] IORUDVÕQÕQ VDSURILW \HOHUL RODFDNWÕU YH JHUoHN N|N NDQDO
patojeni RODQ EDNWHULOHU \R÷XQ NDQGLGD VWDILORNRN YH Neisseria NRORQLOHUL DUDVÕQGD
PDVNHOHQHUHN J|]GHQ NDoDELOHFHNWLU (Q D] JQ ER\XQFD N|N NDQDOODUÕQÕQ NDSDOÕ
NDOPDVÕ GXUXPXQGD NDQDOÕQ HNRORMLVLQH X\DQ SDWRMHQ PLNRRUJDQL]PD WHNUDU GRPLQDQW
KDOHJHOHFH÷LLoLQL]RODV\RQúDQVÕNXYYHWOHQHFHNWLU%|\ODHNVSR]HNDQDOODUDQWLVHSWLN
X\JXODPDGDQVHUXPIL]\RORMLNLOH\ÕNDQÕSNDSDWÕOPDOÕEHNOHQPHOLGLU
7HNUDUOD\DQNDQDOWHGDYLVL\DSÕOPÕúELUGLúLQN|NNDQDOÕQGDQNOWU\DSÕODFDNVD
kanal içerisindeki eski kanal dolgusu sökülmeli, steril serum fizyolojik ile bol irigasyon
\DSÕOPDOÕ-JQNDGDUNDQDOODUERúDPDNDYLWHVÕNÕFDNDSDOÕRODUDNEHNOHQPHOLGLU
6RQ JQOHUGH KHNLP PGDKDOHVL J|UPú NDQDOODUGDQ NOWU \DSPDN GD KDWDOÕ
sonuçlara sebep olur. Önceki müdahale VÕUDVÕQGDNDQDOLoHULVLQHX\JXODQPÕú1D2&O
H2O2 YH\D GL÷HU DQWLVHSWLNOHU EDNWHUL KFUHOHULQLQ PRUIRORMLOHUL YH PHWDEROL]PDODUÕ
]HULQGH DWLSLN GH÷LúLPOHUH VHEHS ROXU <DQOÕú LGHQWLILNDV\RQ YH \DQOÕú DQWLEL\RWLN
GX\DUOÕOÕN VRQXoODUÕQD VHEHS ROXU 8\JXQ NRúXOODU ROXúWXUXOGXNWDQ VRQUD DúD÷ÕGDNL
LúOHPOHUVÕUDLOH\DSÕOÕU
LQFL DGÕP 0DWHU\DOLQ DOÕQDFD÷ÕQGDQ ELU NDo VDDW |QFH PLNUREL\RORML
ODERUDWXYDUÕQÕ DQDHURS PDWHU\DOLQ \ROODQDFD÷Õ NRQXVXQGD WHOHIRQ LOH ELOJLOHQGLUPHN
GR÷UXROXU
LQFLDGÕP6RUXQOXGLúDoÕOPDGDQ|QFH
D+DVWDD÷Õ]ÕQÕGDNLNDER\XQFDVXLOHoDONDODU
b) Steril bir pamuk pelet %10 poviodon-iodine (Batticon, Betadine, Iodeks, Isosol,
%DWLRGLQ3RO\RGVROXV\RQXQDEDWÕUÕODUDNVWHULOELUSHQVLOHGLú]HULQHEÕUDNÕOÕUGDNLND
EXúHNLOGe beklenir,
156
F+DVWDD÷Õ]ÕQÕWHNUDUGDNLNDER\XQFDVXLOHoDONDODUUXEEHUGDPEXDúDPDGD
WDNÕOÕUVDO\DHPLFL\HUOHúWLULOLU
G6WHULOELUSDPXNSHOHWOLNHWLODONROHEDWÕUÕOÕUúLúHQLQNHQDUÕQDEDVWÕUÕODUDN
ID]OD DONRO SDPXN ]HULQGHQ DOÕQÕU YH SDPXN SHOHW GLúLQ \]H\LQH VDUÕOÕU bu müdahale
EDNWHULOHUL|OGUPH]EDNWHULOHULGLú\]H\LQH\DSÕúWÕUÕUYHRUDGDQNDONPDVÕQDHQJHOROXU), böylece biraz
VRQUD NXOODQÕODFDN RODQ ND÷ÕW NRQL GLú NXURQXQD \DQOÕúOÕNOD WHPDV HWVH ELOH
NRQWDPLQDV\RQULVNLD]DOÕU(QD]LNLDQWLVHSWLNNXOODQÕODQ\]H\GH]HQIHNVL\RQLúOHPLQGH
ELOHNRQWDPLQDV\RQULVNLVHYL\HVLQGHGLUYHVÕNOÕNODRUDOIORUDEDNWHULOHULQGHQLEDUHWWLU
(Q VÕN UDVWODQDQ NRQWDPLQDQW NDQGLGD FLQVL PDQWDUODUGÕU 'DKD D] VÕNOÕNOD VWDILORNRN
difteroid, Gram negatif barsak bakterileridir.
H'LúQLWLQLQKDYDYHVXWDQNODUÕQGDILOLWUHNXOODQÕOÕ\RULVHGLúKDYD-su spreyi ile
\ÕNDQÕU DNVL KDOGH KDYD-VX VSUH\L NXOODQÕOPDPDOÕGÕU oQN DHUDW|UQ VX YH KDYD
WDQNÕQGDEXOXQDELOHFHNEDNWHULOHUKLoGHD]ÕPVDQDFDNPLNWDUGDGH÷LOGLUOHU
I6WHULOELUIUH]LOHNDYLWHDoÕOÕUDoÕNVDJHQLúOHWLOLUYHNDQDOD÷Õ]ODUÕEXOXQXU$]RW
JD]Õ NDQO NXOODQÕODFDNVD EX DúDPDGD ELU \DUGÕPFÕ SHUVRQHO D]RW JD]Õ NDQOQ
NDYLWHLoHULVLQHNHQDUÕQD\DNÕQODúWÕUÕUYHEXUDGDWXWDU
g)6WHULOELUQXPDUDNDQDOH÷HVLLOHDSHNVHNDGDULOHUOHQLUYHKDILIoHND]ÕQDUDN
GÕúDUÕoHNLOLU.DQDOÕQGDQNOWU\DSÕOPDVÕGúQOHQGLúOHU]DWHQGHYLWDOROGX÷XQGDQEX
LúOHPLoLQDQHVWH]LJHUHNPH]
QFDGÕP(÷HUNDQDOGDQHNVGDJHOL\RULVHVWHULObir enjektör kanala sokulur,
DVSLUDV\RQ\DSÕOÕU%X\|QWHPHQLGHDODQDHURELNPDWHU\DODOPD\|QWHPLGLUYH0|OOHU¶LQ
ND÷ÕWNRQL\|QWHPLQGHQGDKDVWQGU)DNDWKHU]DPDQPPNQRODPDPDNWDGÕU%X
úHNLOGH PDWHU\DO DOPDN PPNQ ROPXúVD HQMHNW|UH ILVNH YXUXODUDN HNVGDQÕQ
N|SNOHQPHVL JLGHULOLU HQMHNW|UQ KDYDVÕ DOÕQÕU VRQUD L÷QHQLQ GÕú \]H\LQH EXODúPÕú
RODELOHFHNEDNWHULOHUL|OGUPHNLoLQHQMHNW|UQL÷QHVLDOHYGHQJHoLULOLUø÷QHVÕYÕEHVL\HUL
LoHULVLQHHQGHULQHGDOGÕUÕOÕUYHSLVWRQDKDILIoHEDVWÕUÕODUDNHNVGDEXUD\D\DYDú-\DYDú
ERúDOPDVÕ VD÷ODQÕU %X DúDPDGD WS VDOODPDNWDQ NDoÕQÕOPDOÕGÕU øVWHQLUVH EX
LQMHNW|UQ KDYDVÕ DOÕQÕS ODERUDWXYDUD EX úHNLOGH \ROODQDELOLU øQMHNW|UGHNL PDWHU\DO
\HWHUOL\VH ELU NÕVPÕ VÕYÕ EHVL\HULQH HNLOLU JHUL NDODQ NÕVPÕ ODERUDWXYDUD \ROODQÕU
<ROODQPDGDQ|QFHL÷QHXFXLNL\HNDWODQPDOÕYH\DL÷QHXFXELUNXUúXQNDOHPVLOJLVLQH
VDSODQPDOÕGÕU%|\OHFHHQMHNW|UQLoHULVLQHKDYDJLUPHVLHQJHOOHQLU
Kanaldan eksüda gelmiyorsa (genellikle gelmeyebilir), bunzen beki veya ispirto
RFD÷Õ \DNÕOÕU |QFHGHQ VWHULOL]H HGLOPLú YH NDQDO LoHULVLQGH UDKDW KDUHNHW HGHELOHFH÷L
GúQOHQoDSWDNLND÷ÕWNRQLVWHULOL]DV\RQLoLQVDUÕOGÕ÷ÕND÷ÕWDPEDODMÕQGDQoÕNDUÕOÕUBu
LúOHP DOHYH HQ \DNÕQ \HUGH \DSÕOPDOÕGÕU YH NRQWDPLQDV\RQ ULVNLQL D]DOWPDN LoLQ EX
VÕUDGDRGDGDNXYYHWOLKDYDDNÕPÕEXOXQPDPDOÕGÕU6WHULOELUSHQVLOHND÷ÕWNRQLQLQNDOÕQ
WDUDIÕQGDQ WXWXODUDN LQFH XFX NDQDO LoHULVLQH LWLOLU 0PNQ RODQ HQ GHULQ úHNLOGH
LOHUOHWLOLU KDVWD D÷UÕ GX\GX÷XQX LúDUHW YH\D WHONLQ HGL\RUVD PP NDGDU GÕúDUÕ oHkilir.
+DILIoH R\QDWÕODUDN NDQDO GXYDUODUÕQD VUWQPHVL VD÷ODQÕU %X YD]L\HWWH -10 saniye
EHNOHQLU VRQUD GÕúDUÕ oHNLOLU (÷HU ND÷ÕW NRQLQLQ oDSÕ DSHNVH JLUPH\H X\JXQ GH÷LOVH
X\JXQoDSOÕELU\HQLVLLOHD\QÕLúOHPWHNUDUODQÕU
QF DGÕP .D÷ÕW NRQL NDQDOGDQ oÕNDUÕOGÕNWDQ VRQUD ELU NDo YDU\DVRQ WDULI
HGLOPLúWLU
.D÷ÕWNRQLQXFXNXUXLVH
$ 'R÷UXGDQ HNLOLU 6HUHQH YH 0FGRQDOG \DSWÕNODUÕ oDOÕúPDODUÕQGD LON NXOODQÕODQ
ND÷ÕWNRQLOHULQGDKD\NVHNRUDQGDSR]LWLINOWUVRQXoODUÕJ|VWHUGL÷LQLELOGLUPLúOHUGLU Bu
VHEHSOH NDQDOD VRNXODQ LON ND÷ÕW NRQLQLQ XFX ÕVODN ROPDVD ELOH GHUKDO EHVL\HULQH
HNLOPHVLQL|QHUPLúOHUGLU'R÷UXRODQ\|QWHPNXUXELOHROVDLONND÷ÕWNRQLQLQHNLOPHVLGLU
<R÷XQUHPHROGX÷X|QFHGHQELOLQHQGLúOHUGHLONND÷ÕWNRQLDWÕODELOLU
157
%øONND÷ÕWNRQLDWÕOÕU%DúNDoDOÕúPDODUNDQDOGDQoÕNDQLONND÷ÕWNRQLQLQXFXNXUX
LVH\HWHUOLPLNWDUGDEDNWHULEXOXQPD\DELOHFH÷LGúQFHVL\OHDWÕOPDVÕQÕPOVWHULOVHUXP
IL]\RORMLN LOH NDQDOÕQ \ÕNDQPDVÕQÕ \HQLGHQ ND÷ÕW NRQL \HUOHúWLULOPHVLQL YH EX \HQL ND÷ÕW
NRQLQLQEHVL\HULQHHNLOPHVLQL|QHUPHNWHGLU%X\|QWHPGHNRQWDPLQDV\RQULVNLYDUGÕU
.D÷ÕWNRQLQLQXFXÕVODNLVH
$ 'R÷UXGDQ HNLOLU .RQWDPLQDV\RQ ULVNL GDKD D] ROGX÷X LoLQ EX \|QWHP
X\JXODQPDOÕGÕU.D÷ÕWNRQLQLQNDQDOGDQXFXQXQÕVODNoÕNPDVÕELULVDEHttir.
%LONND÷ÕWNRQLDWÕOÕU.DQDOD\HQLELUND÷ÕWNRQLLWLOLU\D\JÕQÕVODNOÕNND\EROXQFD\D
NDGDU \HQL ELU ND÷ÕW NRQL LOH GH÷LúWLULOLU .D÷ÕW NRQLQLQ DSHNV RWXUDQ XFXQGD KDILI ELU
ÕVODNOÕN WHVSLW HGLOHELOL\RUVD VRQ X\JXODQDQ ND÷ÕW NRQL HNLOLU %XUDGDNL GúQFH úXGXU
(÷HU SHULDSLNDO HNVGD ID]OD LVH LoHULVLQGH EXOXQGXUDELOHFH÷L NRQDN DQWLNRUODUÕQÕ
EHVL\HULQH WDúÕPDPDN YHE|\OHFHEHVL\HULQHDNWDUÕODQEDNWHULOHULQGDKDEROUHPHVLQL
WHPLQ HWPHNWLU +DOEXNL VÕYÕ EHVL\HUL NXOODQÕOGÕ÷ÕQGD NDQDOGDQ EHVL\HULQH WDúÕQDELOHQ
DQWLNRUODU ]DWHQ GLOH ROPDNWDGÕU %HONLGH EX YDU\DQW VDGHFH NDWÕ EHVL\HULQH HNLP
\DSÕODFD÷ÕQGDX\JXODQPDOÕGÕU'L÷HU\DQGDQJHUH÷LQGHQID]ODPDQSODV\RQYH]DPDQ
ND\EÕQDED÷OÕRODUDNED]ÕQDULQDQDHURSODUÕQKDYDLOHWHPDVHGHUHN|OPHVLJLEi bir riski
YDUGÕU$\UÕFDLQRNOPPLNWDUÕYHSDWRMHQEDNWHUL\LL]ROHHWPHúDQVÕKHUND÷ÕWNRQLGH
JLGHUHND]DOPDNWDGÕU)DUEHUYH6HOW]HUEXDúDPDGDNDQDOLoHULVLQHD]RWJD]ՁIOH\HQ
ELUNDQOVRNXOPDVÕQÕQID\GDVÕQÕJ|VWHUPLúOHUGLUFusobacterium ve bazÕBacteroides’ler
oksijene; Actinomyces, PropionibacteriumYHVWUHSWRNRNODUGDQGDKDGX\DUOÕGÕU
$\QÕ YDNDQÕQ SHU\RGLN WDNLELQLQ \DSÕOGÕ÷Õ GXUXPODUGD KDQJL YDU\DV\RQ LOH
PDWHU\DODOÕQGÕ\VDGDLPDD\QÕYDU\DV\RQLOHPDWHU\DODOÕQPDVÕJHUHNLU
LQFL DGÕP YXNDUÕGDNL PHWRWODUGDQ KHUKDQJL ELULVL LOH DOÕQPÕú RODQ PDWHU\DO
KDVWD\DQÕQGDEHVL\HULQHHNLOLU
.DWÕEHVL\HULQHHNLPSHWULNXWXVXQXQNDSD÷ÕDOHYLQ\DQÕQGDDoÕOÕUVWHULOSHQVLOH
WXWXODQND÷ÕWNRQLDJDU\]H\LQHEDVWÕUÕOÕUVHUWKDUHNHWOHUOHVUWOU\]H\HL\LFH\D\ÕOÕU
ND÷ÕWNRQLDJDU\]H\LQHELUNDoNHUHVDSODQÕUVRQVDSODQGÕ÷Õ\HUGHVDSODQPÕúúHNLOGH
EÕUDNÕOÕU 3HWUL NXWXVXQXQ NDSD÷Õ NDSDWÕOÕU +Lo YDNLW ND\EHWPHGHQ DQDHURELN NDYDQR]
LoHULVLQHNRQXU%LUDGHWJD]SDNHWLQLQDPEDODMÕ\ÕUWÕOÕULoHULVLQHPOoHúPHVX\XLODYH
HGLOHUHN NDYDQR] LoHULVLQH EÕUDNÕOÕU NDYDQR]XQ NDSD÷Õ VUDWOH NDSDWÕOÕU L\LFH VÕNÕOÕU
$QDHURSODUÕQ RNVLMHQ WHPDVÕQD WDKDPPOV]ROGX÷XGDLPDKDWÕUODQPDOÕGÕU.D÷ÕWNRQL
D÷Õ]GDQ oÕNWÕNWDQ VRQUDNL LúOHPOHU - GDNLND\Õ JHoPHPelidir. Bu kavanoz, yana
H÷LOPHGHQODERUDWXYDUDWHVOLPHGLOLU$\QÕoDSWDNLELUEDúNDND÷ÕWNRQL\HQLGHQNDQDOD
VRNXODUDN\HQLELUNDWÕEHVL\HULQHGDKDHNLP\DSÕOÕUYHEXDHURSúDUWODUGDLQNEHHGLOLU
6ÕYÕ EHVL\HULQH HNLP .D\QDPÕú YH \DQDN \DNPD\DFDN NDGDU VR÷XPXú -42
Û&RODQEHVL\HULQLQWSQNDSD÷ÕELUEXQ]HQEHNLQLQ\DQÕQGDDoÕOÕUND÷ÕWNRQLWSQ
LoHULVLQH VÕYÕ EHVL\HULQLQ WSH WHPDV HWWL÷L FDP \]H\H \DNÕQ úHNLOGH GDOGÕUÕOÕU
JHUHNLUVHNoNILVNHOHUOHND÷ÕWNRQLQLQVÕYÕEHVL\HULQLQGLELQHo|NPHVLQH\DUGÕPHGLOLU
YH WSQ NDSD÷Õ KHPHQ NDSDWÕOÕU %X LúOHPL oDEXN \DSPDN YH DOHYLQ HQ oRN -2 cm
X]D÷ÕQGDoDOÕúPDNJHUHNLU(Q|QHPOLNXUDORNVLMHQWHPDVÕQÕHQD]VHYL\HGHWXWPDNLoLQ
WSVHUWoHVDOODPDPDNWÕULaboratuvar bunu anaerop inkübe edeceNWLU$\QÕoDSWDNLELU
EDúNDND÷ÕWNRQL\HQLGHQNDQDODVRNXODUDN\HQLELUPDWHU\DOGDKDDOÕQÕUEXPDWHU\DOELU
EDúNDVÕYÕEHVL\HULQHHNLOLU%XLNLQFLEHVL\HULDHURSúDUWODUGDLQNEHHGLOHFH÷LLoLQKDYD
ile temas etmesinde bir mahzur yoktur. Tüpler sallanmadan laboratuvara teslim edilir.
0DWHU\DOLODERUDWXYDUDWHVOLPHGHUNHQKDVWDDGÕVR\DGÕ\DúÕPDWHU\DOLQLQIHNWH
N|NNDQDOÕQGDQDOÕQGÕ÷ÕKHNLPLQDGÕYHWHOHIRQX\D]ÕOPDOÕGÕU
%X DGÕPGD NXOODQÕODELOHFHN ED]Õ KD]ÕU SDNHWOHU YDUGÕU +DVWD EDúÕQGD DQDHURp
PDWHU\DODOPDYHWUDQVSRUWLúOHPLQGHNXOODQPDNLoLQWLFDUHWWHQWHPLQHGLOHELOHFHNED]Õ
NLWOHUúXQODUGLU%$&7(&%$&7(&15%$&7(&15%$&7(&15
BACTEC NR 7A, BACTEC NR 17A, BACTEC NR 27, BACTEC Plus 26/27, BACTEC
158
460. Bu besiyerlerinin NXOODQÕP WDOLPDWODUÕQD X\XOGX÷XQGD NOLQLN |QHPL RODQ SHNoRN
DQDHURS PLNURRUJDQL]PDQÕQ L]RODV\RQX PPNQGU *HQHO RODUDN LoHULNOHULQGH 3<*
broth, Chopped-Meat broth, Enriched Thioglucolate broth, PY broth bulunur, ambalaj ve
VWDQGDUGL]DV\RQODUÕKDVWDEDúÕQGDoDOÕúPD\DPVDLWWLUELUoR÷XLoLQD\UÕFDELUWUDQVSRUW
EHVL\HULJHUHNVLQLPL\RNWXU3URVSHNWVOHULYHNXOODQÕPNÕODYX]ODUÕDPEDODMÕQLoHULVLQGH
bulunur. <DOQÕ]N|NNDQDOÕHQIHNVL\RQODUÕLoLQGH÷LOD\QÕ]DPDQGDGHULQSHULPDQGLEOHU
localardan ve periodRQWDO HQIHNVL\RQODUGDQ GD PDWHU\DO DOPDN DPDFÕ\OD NXOODQÕPD
PVDLWWLU%D]ÕWLFDULNLWOHUHIDNOWDWLIDQDHURSEDNWHULOHULLQKLEHHWPHNLoLQ636Sodium
Polyanethol Sulfonate) ilave edilmektedir. Bir dezavantaj olarak bu madde
Peptostreptococcus anaerobius’X GD LQKLEH HWPHNWHGLU (÷HU 636 NDWNÕVÕ EXOXQDQ ELU
WLFDUL NLW NXOODQÕODFDNVD EHVL\HUL LoHULVLQH - MHODWLQ NDWÕOÕUDN EX LQKLELV\RQ HQ D]D
LQGLULOPHOLGLU øoHULVLQH IHQLO HWLO DONRO LODYH HGLOPLú DQDHURS WLFDUL NLWOHU Clostridium,
Bacteroides, Fusobacterium¶ODUÕ VHoHU IDNDW KHP IDNOWDWLI DQDHURSODUÕ YH KHP GH
Capnocytophaga¶ODUÕ LQKLEH HGHU %X LQKLELV\RQX HQJHOOHPHQLQ SUDWLN ELU \ROX \RNWXU
%|\OH WLFDUL NLWOHUGH UDG\RPHWULN RODUDN YH IORUHVDQ YHULS YHUPHGL÷LQH EDNDUDN
identifikasyon yapabilecek sistHPOHUGHEXOXQPDNWDGÕU%DF7-Alert (Organon,NC) ticari
kiti inokülasyonu takiben ortama derhal anaerobik atmosfer temin eder, Eh indikatörü ile
GÕúDUÕGDQ L]OHPH\H PVDLWWLU .RORULPHWULN WHúKLVH J|WUHQ EDúND NLWOHU GH YDUGÕU
(BACTEC 9240 gibi).
ÕQFÕDGÕm:6HDQVODUDUDVÕNRQWDPLQDV\RQXHQJHOOHPHNDPDFÕ\ODNDQDOoRNL\L
NXUXWXOXSNDYLWHJD\HWVÕNÕELUúHNLOGHNDSDWÕOÕU.DQDOÕQNXUXEÕUDNÕOPDVÕ|QHPOLGLU
.DYLWH\L NDSDWPDN LoLQ UH]LQ HVDVOÕ JHoLFL GROJX GH÷LO SROLNDUERNVLODU VLPDQODU WHUFLK
edilmelidir. HDVWD\D ODERUDWXYDU WHVW VRQXoODUÕQÕQ EHOOL RODFD÷Õ WDULKH J|UH \HQL ELU
randevu verilir.
<XNDUÕGD DQODWÕODQ PDWHU\DO DOPD SURVHGUOHUL SHULRGRQWLW SHULNRURQLW SDUXOLV
EWQSHULDSLNDOHQIHNVL\RQODUYHUHWURPDQGLEOHUHQIHNVL\RQODUGDNXOODQÕODELOLU
LabRUDWXYDU KDQJL SDWRMHQ EDNWHULQLQ UHGL÷LQL YH R EDNWHULQLQ DQWLEL\RWLN
GX\DUOÕOÕN WHVW VRQXoODUÕQÕ ELU UDSRU KDOLQGH GLúKHNLPLQH ELOGLULU 5DSRU IRUPDWÕ KHU
ODERUDWXYDULoLQIDUNOÕGÕUYHEXQXQKLoELUSUDWLN|QHPL\RNWXU)DNDWJHQHOOLNOHLONVDWÕUGD
hasWDDGÕVR\DGÕ\DúÕPDWHU\DOLQQHUHGHQDOÕQGÕ÷ÕELOJLOHULEXOXQXU'DKDVRQUDKDQJL
EDNWHULQLQ UHGL÷L \D]ÕOÕGÕU (÷HU LQIHNWH N|N NDQDOÕQGD UH\HQ EDNWHUL HQGRGRQWLN
PLNUREL\RORMLNRQXVXQGDDQODWÕODQN|NNDQDOÕSDWRMHQOHULQGHQELULVLGH÷LOVHYH\DRQODUOa
DNUDEDOÕ÷ÕRODQELUEDNWHULGH÷LOVHNOWUQGR÷UXODPDDPDFÕLOHNOWUQWHNUDUODQPDVÕ
JHUHNHELOLUgUQH÷LQODERUDWXYDUELUNesisseria, Candida, difteroid, Gram negatif barsak
oRPDNODUÕ YH\D VWDILORNRNX SDWRMHQ PLNURRUJDQL]PD RODUDN ELOGLUPLúVH PDWHU\Dl alma
LúOHPLQGHELUNRQWDPLQDV\RQROGX÷XDoÕNoDEHOOOLGLU9H\DODERUDWXYDUKDWDOÕDQDHURELN
oDOÕúPD\DSPÕúGDRODELOLU
3DWRMHQ PLNURRUJDQL]PDQÕQ WHVSLW HGLOPHVLQGHQ VRQUD DQWLEL\RWLN GX\DUOÕOÕN
testleri Wilkins-7KLHO PHWRGXQD J|UH \DSÕOÕU .LUE\-Bauer yöntemi oral patojenler için
X\JXQGH÷LOGLU
3HULRGRQWDOFHSWHQPLNUREL\RORMLNPDWHU\DODOÕQPDVÕ
hVWED]HQDOWELULQFLE\ND]ÕODUÕQYHVWLEOGHNLGLúHWLFHELEXLúLoLQWHUFLKHGLOLU
dQNEXGLúVWHQRQNDQDOÕQÕQD÷Õ]ÕQDHQ\DNÕQNRQXPGD\HUDOÕU(÷HUD÷Õ]GDEXGLú
EXOXQPX\RUVDoHNLOPLúLVHEXGLúHHQ\DNÕQGLúWHUFLKHGLOLUøQIHNWHN|NNDQDOÕQGDQ
PDWHU\DO DOÕQPDVÕ EDúOÕ÷ÕQGD DQODWÕOGÕ÷Õ JLEL GLúH DQWLVHSWLN X\JXODQÕU +DVWDQÕQ
\XPXúDN GRNXODUÕ HNDUW|U LOH NHQDUD oHNLOLU LQIHNWH N|N NDQDOÕQGDQ PDWHU\DO DOÕQÕUNHQ
X\JXODQDQ 0|OOHU PHWRGX X\JXODQDUDN PDWHU\DO DOÕQÕU &HS LoHULVLQH VRNXODQ ND÷ÕW
NRQLOHUGDKDJHQLú\]H\HWHPDVHGHELOPHVLLoLQ\DWD\G]OHPLOHDoÕ\DSDFDNúHNLOGH
X\JXODQPDOÕGÕU)L]\RORMLNGLúHWLROX÷XOLNLWLVHEHEL\OHND÷ÕWNRQLOHULQXFXJHQHOOLNOHÕVODN
oÕNDFDNWÕUøQIHNWHN|NNDQDOÕEDúOÕ÷ÕQGDDQODWÕODQúHNLOGHLQRNOHHGLOLU
159
$OÕQDQ PDWHU\DOGHQ Actinobacillus actinomycetemcomitans üretilmesi
KHGHIOHQL\RUVD UH ]HQJLQ EHVL\HULQH LQRNODV\RQ \DSÕODELOLU YH &22’li atmosferde
inkübe edilebilir.
'HQWRDOYHROHUDSVHGHQPLNUREL\RORMLNPDWHU\DODOÕQPDVÕ
øQIHNWHN|NNDQDOÕQGDQPDWHU\DODOÕQÕUNHQDQODWÕODQ\]H\GH]HQIHNVL\RQXQGDQ
sonra :
Fistül bulunuyorsa: X\JXQ oDSWDNL ELU ND÷ÕW NRQL ILVWO D÷Õ]ÕQGDQ LWLOLU NHPLN
içerisine ilerletilir, inIHNVL\RQ PHUNH]LQH JLULOLU YH ND÷ÕGÕQ ELU PLNWDU VÕYÕ HPPHVL
EHNOHQLU %X LúOHP JHQHOOLNOH DQHVWH]L\H JHUHN NDOPD\DFDN NDGDU D÷UÕVÕ]GÕU øQIHNWH
N|NNDQDOÕEDúOÕ÷ÕQGDDQODWÕODQúHNLOGHLQRNOHHGLOLU
Fistül bulunmuyorsa: Fluktuan apselerde bistüri ile drHQDM\DSÕOÕUOH]\RQGDQLON
DNDQGH÷LOELUVUHVRQUDVÕ]DQFHUDKDW\DHQMHNW|ULOHYH\DVWHULOND÷ÕWNRQLOHUOHEHVL
\HULQHWDúÕQÕU+LoLQVL]\RQ\DSPDGDQX\JXQoDSOÕELUHQMHNW|ULOHOH]\RQXQLoHULVLQH
GR÷UXGDQJLUPHNGHPNQGULezyon merkezine anestH]L\DSÕOPD]*HUHNLUVHoHYUHVLQHULQJ
EORNDM X\JXODQÕUøQMHNW|ULOHDSVHPHUNH]LQGHQPDWHU\DODOPDNVWQELUX\JXODPDGÕU
%X LúOHPGHQ |QFH LQIHNWH N|N NDQDOÕQGDQ PDWHU\DO DOÕQÕUNHQ X\JXODQDQ \]H\
GH]HQIHNVL\RQLúOHPOHUL\DSÕOPDOÕGÕU
6DO\DQÕQPLNUREiyolojik muayenesi:
8\DUÕOPDGDQ <HPHN \HGLNWHQ HQ HUNHQ VDDW VRQUD KDVWD ELU NROWX÷D GLN
RODUDN RWXUWXOXU EDúÕ VWHULO ELU SHWUL NXWXVXQXQ LoHULVLQH H÷LOHUHN EXUQXQGDQ QHIHV
DOPDVÕ YH D÷Õ]ÕQÕ DoÕN EÕUDNPDVÕ LVWHQLU %X úHNLOGH GDNLNDGD PO VDO\D
toplanabilir.
8\DUÕODUDN+DVWDQÕQD÷Õ]ÕQDSDUDILQYHULOLUYH\XPXúD\ÕQFD\DNDGDUoL÷QHPHVL
LVWHQLU +DVWDQÕQ EDúÕ |QH H÷LOHUHN VDO\D WRSODQÕU %X VXUHWOH GDNLNDGD PO QLQ
]HULQGH VDO\D WRSODPDN PPNQGU+DVWDQÕQWNUPHVLVDO\DQÕQN|SNOHQPHVLQH
yol açar bu istenmeyen bir durumdur.
%D]HQVDO\DoRND]RODELOLUYHSDUDILQLOHVDO\D\ÕX\DUPDNELOH\HWHUVL]NDODELOLU
%|\OH GXUXPODUGD SDUDVHPSDWLN X\DUÕFÕ RODUDN D÷Õ]D SLORNDUSLQ LoHUHQ ELU J|]
GDPODVÕGDPODWÕOÕU3LORNDUVRO3LORPLQ3LORVHGJ|]GDPODVÕ%LUD]EHNOHQLUYHVDO\D
WRSODQÕU3LORNDUSLQYDJRWRQLNWLUGLODOWÕPXNR]DVÕQGDQD]GDROVDNDQDJHoHELOLU
+HU LNL PHWRW LOH LVWHQLOHQ PLNWDU VDO\D WRSODQGÕNWDQ VRQUD JHUHNL\RUVD YROP
|OoOGNWHQ VRQUD LQIHNWH N|N NDQDOÕQGDQ PDWHU\DO DOPDN EDúOÕ÷ÕQGD DQODWÕODQ
úHNLOGH LQRNOH HGLOLU 6DO\D WRSODPDN LoLQ 6FKDHIIHU NXSDVÕ DGÕ YHULOHQ |]HO NDSODU
YDUGÕU%XDPDoODVWHULOSHWULNXWXVXNXOODQPDN\DQOÕúGH÷LOGLU
(NY\RQ LOH VDO\DQÕQ EHVL\HULQH WDúÕQPDVÕ GD PPNQGU )DNDW SDPXN
HO\DIODUÕ DUDVÕQGD NDODFDN KDYD VHEHEL\OH DQDHURSODUÕ UHWPH úDQVÕ D]GÕU 0XWODND
VUQWPDWHU\DODOÕQPDVÕJHUHNL\RUVDODVWLNVLOJLoOHUNXOODQÕOPDOÕGÕU7DEOR
'LO\]H\LQGHQPLNUREL\RORMLNPDWHU\DODOÕQPDVÕ
6WHULOELUJD]OÕEH]LOHGLOLQDSHNVLXFNÕVPÕWXWXOXUYHGÕúDUÕoHNLOLU%LUVNrapel
LOH GLO \]H\LQLQ LVWHQLOHQ E|OJHVL ND]ÕQDUDN EXQ]HQ EHNLQLQ KHPHQ \DQÕQGD HNLP
\DSÕOÕU%XLúOHPD]RWJD]ÕWHPLQHGHQNDQOHúOL÷LQGH\DSÕODFDNVDKÕ]OÕoDOÕúÕOPDOÕYH
KDVWDQÕQD]RWVROXPDVUHVLHQD]ROPDOÕGÕU
Biyopsi materyalinin mikrobiyolojik muayenesi:
7D]H DOÕQPÕú EL\RSVL PDWHU\DOL VWHULO NXP LOH G|YOHUHN DQDHURS EHVL\HUOHULQH
HNLOHELOLU DQFDN EX LúOHP JORYH ER[ DGÕ YHULOHQ DQDHURS NDELQOHUGH \DSÕOPDOÕGÕU
.LOLQLNWH DOÕQDQ EL\RSVL PDWHU\DOL DOHYLQ \DQÕQGD VWHULO ELU EXUJX NDSDNOÕ WSH YH\D
úLúH\HNRQXU/DERUDWXYDUDEXúHNLOGH\ROODQÕU
$1$(5230$7(5<$/ø17$ù,10$6,
160
$÷Õ] LoHULVLQGHQ DOÕQDQ PDWHU\DOLQ \DUÕP VDDW LoHULVLQGH ODERUDWXYDUD
XODúWÕUÕOPDVÕPPNQVH\XNDUGDDQODWÕODQPHWRWODUGDDQDHURELNWUDQVSRUWEHVL\HULQH
gHUHN \RNWXU %|\OHFH EHVL\HULQGHQ EHVL\HULQH PDWHU\DO DNWDUÕOPDGÕ÷Õ LoLQ
NRQWDPLQDV\RQ ULVNL GH ELU |OoGH D]DOPÕú ROXU )DNDW PDWHU\DOLQ ODERUDWXYDUD
\ROODQPDVÕ JHFLNHFHNVH EX GXUXPGD WUDQVSRUW EHVL\HUL JHUHNVLQLPL YDUGÕU %N]
Besiyerleri)
Enjektör ile aspire edilen materyal; 1 ml den az ise en çok 10 dakika, 1-2 ml ise
en çok 30 dakika, 2 ml den çok ise en çok 2-3 saat içerisinde anaerop besiyerine
ekilmelidir. Transport besiyerlerine konulan materyalin orada bekletilme süresi
VÕQÕUOÕGÕU (NLOPLú ELU Dnaerop transport besiyeri, ençok 2-3 saat bekleyebilir.
%X]GRODEÕQGDÛ&¶GHEXVUHELUD]GDKDX]XQGXU'RNXEL\RSVLPDWHU\DOLHQoRN
dakika havada ve en çok 2-3 saat transport besiyerinde bekleyebilir. Anaerobik lastik
silgiçler nemli anaerobik atmosferde en çok 1 saat bekleyebilir, anerobik transport
besiyerinde ise en çok 2- VDDW EHNOH\HELOLU (Q X\JXQ NRúXOODUGD ELOH PDWHU\DO X]XQ
VUHEHNOHWLOPHPHOLYHHQNÕVD]DPDQGDX\JXQEHVL\HUOHULQHLQRNOHHGLOLSDQDHURS
DWPRVIHUNRúXOODUÕQGDLQNEDV\RQDEDúODQPDOÕGÕU
$1$(5230$7(5<$/ø1'2ö58'$108$<(1(6ø
$OÕQDQ PDWHU\DOLQ J|] LOH PXD\HQHVL PHYFXW PLNURRUJDQL]PDODUÕQ NLPOL÷L
]HULQGH ELU |Q WDKPLQGH EXOXQPD\Õ NROD\ODúWÕUDELOLU gUQH÷LQ NDQDOGDQND÷ÕWNRQL\H
HPGLULOHQ YH\D HQMHNW|UH DOÕQDQ PD\LL NR\X VDUÕ UHQNWH JUDQOHU \DSÕGD\VD
DNWLQRPLNR]DSVHVLGúQOPHOLGLU)HQDNRNXOXLVHDQDHURSEDNWHULOHULQPHYFXGL\HWL
GúQOPHOLGLU6L\DKUHQNOLELUDNÕQWÕMetanobacterFLQVLQLDUDPD\ÕJHUHNWLUHELOLU
0LNURVNRSLN PXD\HQH DPDFÕ\OD ELUD] ID]OD PDWHU\DO DOÕQDELOLU YH\D DOÕQDQ
PDWHU\DOGHQ DUWDNDODQ NÕVPÕ ELU ODP ]HULQH DOÕQÕS .RRSOHU
V PRGLILNDV\RQ *UDP
ER\DPD YH\D *LHPVD ZULJKW DNULGLQ RUDQJH ER\DODUÕ LOH ER\DQDELOLU 'DKD L\LVL
SUHSDUDW HWLNHWOHQHUHN NOWU VRQXFXQXQ RNXQDFD÷Õ ]DPDQD NDGDU EHNOHWLOPHOLGLU
0DWHU\DOLQ GR÷UXGDQ PXD\HQHVLQGH J|UOG÷ KDOGH NOWUGH UHPHPLú EDNWHULOHU
YDUVD DQDHURELN DWPRVIHULQ ROXúXS ROXúPDGÕ÷Õ DWPRVIHU LQGLNDW|UOHUL LOH J|]GHQ
JHoLULOPHOLEHVL\HULVHoLPLQGHYHEHVL\HULNDOLWHVLQGHSUREOHPROXSROPDGÕ÷ÕJ|]GHQ
geçirLOPHOL JHUHNLUVH \HQLGHQ PDWHU\DO DOÕS X\JXQ EHVL\HUOHULQGH NOWU
WHNUDUODQPDOÕGÕU $QFDN ED]Õ DQDHURSODU GLVJRQLN ROXS LON L]RODV\RQGD UHPHOHUL LNLQFL
KDIWD\D NDGDU X]D\DELOPHNWHGLU hUHPH ROPD\DQ EHVL\HUOHUL LNLQFL KDIWDQÕQ VRQXQD
kadar bekletilmelidir. (Q LGHDO NRúXOODUGD ELOH D÷Õ]GDNL PLNURRUJDQL]PDODUÕQ DQFDN
\DUÕVÕQÕQNOWUSOD÷ÕQGDUH\HELOGL÷LELOLQPHOLGLU
øQIHNVL\RQVDKDVÕQGDEXOXQGX÷XQGDQúSKHGX\XODQELUEDNWHULFLQVLYDUVDEX
safhada materyale floresan boyalar uygulanabilir. Bilhassa belirli bir bakteri cinsinin
PHYFXGL\HWLQGHQ úSKHOHQLOL\RUVD YH\D EX EDNWHULQLQ YDUOÕ÷Õ DUDQÕ\RUVD |UQH÷LQ
materyalde A. actinomycetemcomitans veya P. gingivalis DUDQÕ\RUVD), bu bakteriye özel ticari
IORUHVDQ ER\DODU NXOODQÕODUDN PDWHU\DO ELU ODP ]HULQGH ER\DQÕU 1RW QRQWRNVLMHQLN
Clostridium’ODU LoLQ NXOODQÕODQ IORUHVDQ ER\DODU Peptostreptococcus anaerobius ile
çarpraz reaksiyon verebilmektedir). Aranan bakteri materyalde bulunuyorsa, floresan
PLNURVNRSWDÕúÕOWÕOÕJ|UQHFHNWLU
161
Anaerop materyalin Önerilen
DOÕQDFD÷Õ
RUJDQ anaerop materyal
veya doku
-boyun
%Dú
(QMHNW|ULOHDSVHDVSLUDWÕ
Önerilmeyen
anaerop materyal
Eküvyon
Biyopsi materyali,
$VSLUDV\RQRODQDNVÕ]VD/DVWLNVLOJLo
'LúLQN|NNDQDOÕ
(QMHNW|ULOHDSVHDVSLUDWÕ
.D÷ÕWNRQL
'LúHWLFHEL
.D÷ÕWNRQL
Salya
$÷Õ]ÕDoDUDNGDPODWPD
lastik silgiç
Dil
.D]ÕPDPDWHU\DOL
$NFL÷HU
Lastik silgic
Transtrakeal aspirat,
$NFL÷HUSRQNVL\RQPDWHU\DOL
Biyopsi materyali,
Bilerek aOÕQDQEURQNRVNRSLN|UQHNOHU
Torakotomi örnekleri,
Cerrahi yoldan lastik silgiç*.
Santral sinir sistemi
(QMHNW|ULOHDSVHDVSLUDWÕ
Pamuk meç,
kanal aleti
Pamuk meç,
eküvyon
Tükürmek,
Eküvyon
Eküvyon
Öksürülen balgam,
Balgam,
Endotrakeal aspirat,
%DúND
DPDoOD
DOÕQDQ
bronkoskopik örnekler.
Eküvyon
Biyopsi materyali,
Cerrahi yoldan lastik silgiç*.
Abdomen
Enjektörle periton mayi,
Eküvyon
(QMHNW|UOHDSVHDVSLUDWÕ
Biyopsi materyali,
Safra,
Cerrahi yoldan lastik silgiç*.
Üriner sistem
.DGÕQJHQLWDOVLVWHPL
(QMHNW|UOHDOÕQDQVXSUDSXELNLGUDU
Kuldoskopi materyali,
Aspiratör ile endometrial aspirat,
'R÷UXGDQLGUDU
Eküvyon
Eküvyon
(QMHNW|ULOHDSVHDVSLUDWÕ
Biyopsi materyali,
Lastik silgiç,
øQWUDXWHULQFLKD]ÕQNHQGLVL
Ostomiyelit, artrit
(QMHNW|ULOHDSVHDVSLUDWÕ
Eküvyon
Biyopsi materyali,
Cerrahi yoldan lastik silgiç*.
<XPXúDNGRNX
(QMHNW|ULOHDSVHDVSLUDWÕ
Eküvyon
Biyopsi materyali,
Cerrahi yoldan lastik silgiç*.
Maksiller sinüs
2UWDPHDGDQHQMHNW|ULOHDOÕQDQDVSLUDW
Eküvyon,
Sümük
Tablo 18-1dHúLWOLRUJDQYHGRNXODUGDQDQDHURSPDWHU\DODOÕQÕUNHQL]OHQHFHNSURVHGür.
*
&HUUDKL \ROGDQ ODVWLN VLOJLo LIDGHVL\OH LQVL]\RQ LOH LQIHNVL\RQ PHUNH]L DoÕODUDN VUOHQ ODVWLN VLOJLo
kastedilmektedir.
162
KAYNAKLAR
1. $\GÕQ 0 (QGRGRQWLN PLNUREL\RORML In: $ODFDP 7 HGV (QGRGRQWL $QNDUD %DUÕú <D\ÕQODUÕ
2000:313-385.
2. Aydin M, Gunay I, Koksal F, et al. Taksometri ve bakteriyel identifikasyonda bilgisayar
NXOODQÕPÕMikrobiyol Bült 1996, 30:281-287
3. Elmer WK, Stephen DA, William MJ, et al. Color atlas and textbook of diagnostic
microbiology. 4.th ed, Lippincott JB Company, Philadelphia, 1992, 94-.
4. Finegold SM, Martin WJ, Scoot EG. Bailey and Scoott's Diagnostic Microbiology, 5th ed,
St.Louis, CV Mosby 1978:490-.
5. .Õ\DQ 0 $QDHURE EDNWHULOHU In: 8VWDoHOHEL ù (G 7HPHO YH .OLQLN 0LNUREL\RORML $QNDUD
*QHú.LWDSHYL999: 611-668.
6. Koleman EW, Stephen DA, William MJ. Diagnostic Microbiology, 4.th ed., J.B.Lippincott Comp,
Philadelphia, 1992: 520-602.
7. Könönen E. Jousimies SH, Asikainen S. The most frequently isolated Gram-negative
anaerobes in saliva and subgingival samples taken from young women. Oral Microbiol Immunol 1994; 9:
126-128.
8. Norell SA, Messley KE. Microbiology Lab Manual: Principles and Applications. New Jersey:
Prentice-Hall, Inc. 1997: 54-.
9. Pajukanta R, Asikainen S, Forsblom B, Jousimies SH. Evaluation of the E test for antimicrobial
susceptibility testing of Porphyromonas gingivalis. Oral Microbiol Immunol 1994; 9: 123-125.
10. Sundqvist G. Associations between microbial species in dental root canal infections. Oral
Microbiol Immunol 1992; 7:257-262.