| Abstract | Cilj istraživanja: Ciljevi ovog istraživanja bili su utvrditi povezanost dobi i spola sa pojavom parotitisa, cijepni status bolesnika, najčešćeg uzročnika parotitisa, odrediti kliničke simptome, komplikacije i laboratorijska obilježja virusnog i bakterijskog parotitisa, duljinu trajanja liječenja i terapiju koja je korištena u liječenju virusnog i bakterijskog parotitisa te sekundarni cilj ispitati povezanost između pušenja i pojavnosti parotitisa u bolesnika liječenih u Klinici za infektologiju KBC-a Split u razdoblju od 2000. do 2015. godine.
Ustroj istraživanja: retrospektivno istraživanje
Mjesto istraživanja: Klinika za infektologiju KBC-a Split.
Materijal i metode: U istraživanje je uključeno 39 bolesnika liječenih zbog parotitisa u Klinici za infektologiju KBC Split u razdoblju od 2000. do 2015. godine. Kriterij uključenja je bila otpusna dijagnoza parotitisa. Podaci su prikupljeni iz povijesti bolesti ispitanika.
Rezultati: Ukupan broj oboljelih od parotitisa u promatranom razdoblju iznosio je 39, od toga 8 žena (20,5%) i 31 muškarac (79,5%) te su muškarci 3,87 puta češće bolnički liječeni od parotitisa. Najveći broj bolesnika je bio u dobnoj skupini 25-40 godina (35,9%). Najviši prosječni godišnji pobol od parotitisa u Splitsko–dalmatinskoj županiji bio je u dobnoj skupini 16-24 godine, a najmanji pobol u starijih od 40 godina. Prema godinama hospitalizacije, najveći broj oboljelih bio je 2012. godine (njih 8), slijede 2009. i 2011. s 5 bolesnika, dok 2001. i 2013. nije bilo oboljelih. Temeljem epidemiološke anamneze dvije doze cjepiva primilo je 42,4% bolesnika, jednu dozu cjepiva 9,1%, nije cijepljeno 12,1% te je za 36,4% nepoznat cijepni status. Temeljem otpusne dijagnoze virusni parotitisi su bili zastupljeniji sa 84,6%, u odnosu na bakterijski parotitis kojeg je bilo 15,4%. Na uzorku od 11 bolesnika najčešći poznati izolirani uzročnik bio je Mumps virus sa 81,8%. U jednom slučaju izolirana je Mycoplasma pneumoniae, a u jednom slučaju Staphylococcus aureus. Najčešći klinički simptom virusnog parotitisa bio je obostrani otok parotide sa učestalošću od 69,7%, zatim temperatura sa 39,3%, glavobolja kao i jednostrani otok parotide sa 30,3%, te povraćanje/mučnina sa 27,2%. Gubitak apetita bio je zastupljen u 18,1%, povećani limfni čvorovi sa 15,1%, bol u predjelu ugla mandibule sa 12,8 te zimica i otok ostalih žlijezda slinovnica sa najmanjom učestalošću od 12,1%. Jednostrani otok parotide bio je najučestaliji simptom bakterijskog parotitisa i zabilježen je u svih bolesnika. Ostale simptome čine temperatura sa 66,6%, povećani limfni čvorovi sa 33,3% i zimica i bol u predjelu ugla mandibule sa 16,6%. Najčešća komplikacija virusnog parotitisa bio je orhitis sa učestalošću od 60,6%, a slijede ga pankreatitis sa 12.1% i meningitis sa 6,0%, dok u oboljelih od bakterijskog parotitisa nije bilo komplikacija. U laboratorijskim parametrima virusnog parotitisa povišena vrijednost alfa-amilaze u serumu zabilježena je u 84,8% bolesnika, a 96,9% bolesnika imalo je povišenu vrijednost alfa-amilaze u urinu. Povišena vrijednost C-reaktivnog proteina (CRP), zabilježena je u 79,2% bolesnika, povišena vrijednost sedimentacije eritrocita (SE) u 52,0%, te leukocitoza u 36,4% bolesnika. Kod laboratorijskih parametara bakterijskog parotitisa povišena vrijednost alfa-amilaze u serumu zabilježena je u 75,0% bolesnika, a 66,7% bolesnika imalo je povišenu alfa-amilazu u urinu Povišena vrijednost C-reaktivnog proteina (CRP) zabilježena je u 83,3% bolesnika te povišena vrijednost sedimentacije eritrocita (SE) i leukocitoza u svih bolesnika. Nema značajne razlike u raspodjeli bolesnika prema statusu konzumiranja cigareta odnosno nije dokazana povezanost između pušenja i pojavnosti parotitisa u 39 bolesnika liječenih od parotitisa. Najveći broj bolesnika oboljelih od bakterijskog parotitisa, njih 4 (33,3%) bio je liječen klindamicinom. Od preostalih ispitanika, 3 bolesnika (25,0%) liječena su antibioticima iz skupine cefalosprina, njih 2 (16,7%) netilmicinom, a ostalim antibioticima je liječeno 3 bolesnika (25,0%). U skupini ispitanika s virusnim parotitisom 21 bolesnik (70,0%) liječen je nesteroidnim protuupalnim lijekovima (NSAID), a 9 bolesnika (30,0%) paracetamolom. Najčešće korišteni kortikosteroidi bili su metilprednizolon s 41% i dexametazon s 41%, a rjeđe prednizon s 14% i betametazon s 4%. Prosječna duljina trajanja hospitalizacije bolesnika liječenih zbog parotitisa u Klinici za infektologiju KBC-a Split iznosila je 7 dana, u rasponu od 1 do 16 dana.
Zaključak: Između promatranih ispitanika, u određenom razdoblju, bilo je značajno više muškaraca, nego žena (31:8). Najviši pobol bio je u dobnoj skupini 16-24 godine. Prema otpusnoj dijagnozi virusni parotitisi su bili zastupljeniji sa 84,6%, a najčešći poznati izolirani uzročnik bio je Mumps virus (81,8%). Najčešći klinički simptom virusnog parotitisa bio je obostrani otok parotide sa 69,7%, a najčešća komplikacija bio je orhitis sa 60,6%. Jednostrani otok parotide bio je najučestaliji simptom bakterijskog parotitisa zabilježen u svih bolesnika, dok komplikacije nisu zabilježene. Najčešća korištena skupina lijekova u liječenju bakterijskog parotitisa bili su linkozamidi (klindamicin) sa 33,3%, a kod virusnog parotitisa nesteroidni protuupalni lijekovi (NSAID) sa 70,0% te kortikosteroidi metilprednizolon i deksametazon sa zastupljenošću od 41,0%. Prosječna duljina trajanja hospitalizacije praćenih bolesnika je iznosila 7 dana, u rasponu od 1 do 16 dana. |
| Abstract (english) | Research goal: The goals of this research were to determine connection between age and gender with the emergence of parotitis, patient vaccine status, most common cause of parotitis, determine the clinical symptoms complications and laboratory features of viral and bacterial parotitis, duration of treatment and therapy used in the treatment of viral and bacterial parotitis at patients and connection between emergence of parotitis and smoking treated in the Department of infectology clinic at the University Hospital of Split from 2000. to 2015. year.
Research Structure: Retrospective research
Settings: Department of infectology clinic at the University Hospital of Split
Material and methods: The study included 39 patients treated from parotitis at University Hospital of Split at Department of infectology clinic from 2000. to 2015. The inclusion criterion was a release diagnosis of parotitis. The data were collected from the history of the disease of the respondent.
Results: The total number of parotitis patients in the observed period was 39, 8 women (20.5%) and 31 males (79.5%), mens are 3.87 times more often hospitalized from parotitis. The largest number of patients was in the group from 25-40 years (35.9%). The highest average annual parotitis morbidity in the Split-Dalmatia County was in the age group of 16-24 years, and the lowest was the worse in the age of 40. According to the years of hospitalization, the largest number of ill patients was in 2012 (8), followed by 2009 and 2011 with 5 patients, while in 2001 and 2013 there were no illnesses. As stated to the epidemiological history, two doses of the vaccine received 42.4% of the patients, one dose of the vaccine 9,1%, no vaccine 12,1%, and 36,4% had unknown status. Based on the release diagnosis, viral parotitis were more common with 84.6% than bacterial parotitis with 15.4%. In the sample of 11 patients, the most commonly known isolated cause was the Mumps virus with 81.8%. In 9.1% of cases, Mycoplasma pneumoniae was isolated, and in 9.1% Staphylococcus aureus. The most common clinical symptom of viral parotitis was a both-sided parotid glands swell with a frequency of 69.7%, then the temperature with 39.3%, headache as well as one-sided parotid gland swell with 30.3% and nausea with 27.2%. Loss of appetite was present in 18.1%, swelling of the lymph nodes with 15.1%, pain in the angle of mandible 12.8%, chills and swelling of other salivary glands with the lowest frequency of 12.1%. One-sided swell of parotid gland was the most common symptom of bacterial parotitis which affected all patients. Other symptoms include temperature with 66.6%, enlarged lymph nodes with 33.3%, chills and pain in the angle of mandible with 16.6%. The most common complication of viral parotitis was orchitis with a frequency of 60.6% followed by pancreatitis with 12.1% and meningitis with 6.0%, while other patients with bacterial parotitis had no complications. In laboratory parameters of viral parotitis, 84.8% of patients had elevation of alpha-amylase value and 96.9% patients had elevation of urinary alpha-amylase score. The elevated C-reactive protein (CRP) value was recorded in 79.2% of patients. Elevated erythrocyte sedimentation rate (ESR) had 52.0% and 36.4% of patients had leukocytosis. In laboratory parameters of bacterial parotitis elevated value of alfa-amylase in serum was found in 75.0% of patients and 66.7% of patients had elevated alpha-amylase in urine. The elevated value of C-reactive protein (CRP) was recorded in 83.3% of patients. The elevated value of erythrocyte sedimentation rate (ESR) and leukocytosis was present in all patients. There is no significant difference in the distribution of patients according to the status of cigarette consumption, there was no correlation between the occurrence of parotitis and smoking in 39 patients. The largest number of patients with bacterial parotitis, 4 (33.3%) were treated with clindamycin. 3 (25.0%) patients were treated by cephalosporin antibiotics, 2 (16.7%) with netilmicin, and other antibiotics were used in 3 (25.0%) patients. In the group of patients with viral parotitis 21 patients (70.0%) were treated with nonsteroidal anti-inflammatory drugs (NSAIDs), 9 patients (30.0%) with paracetamol. The most commonly used corticosteroids were methylprednisolone with 41% and dexamethasone with 41%, prednisone with 14% and betamethasone with 4%. The average patient hospitalization treated from parotitis at University Hospital of Split was 7 days, ranging from 1 to 16 days.
Conclusion: Among the observed subjects, there were significantly more men than women in a given period (31: 8). The largest morbidity was in the group from 25-40 years. According to the release diagnosis, viral parotitis was more common with 84.6%, and the most commonly known isolated cause was the Mumps virus (81.8%). The most common clinical symptom of viral parotitis was swell of both-sided parotid glands with 69.7%, and the most common complication was orchitis with 60.6%. One-sided swell of parotid gland was the most common symptom of bacterial parotitis with 100%, while complications were not recorded. The most commonly used drug group in the treatment of bacterial parotitis was the linkozamides (clindamycin) with 33.3%, and in the case of viral parotitis, nonsteroidal anti-inflammatory drugs (NSAIDs) with 70.0% and corticosteroids methylprednisolone and dexamethasone with a 41.0%. The average patient hospitalization treated from parotitis at University Hospital of Split was 7 days, ranging from 1 to 16 days. |
