%PDF-1.3 %âãÏÓ 1 0 obj << /OPM 1 /Type/ExtGState >> endobj 2 0 obj << /FL 1 /SM 0.01 /Type/ExtGState >> endobj 3 0 obj << /OP true /Type/ExtGState >> endobj 4 0 obj << /OP false /Type/ExtGState >> endobj 5 0 obj << /Length 10695 >> stream /GS0 gs q 0 0.89 595 841 re W n 1 g 0 841.89 0 0 re f Q /GS1 gs q /GS2 gs 0 0 0 0 k 56.693 152.237 481.89 468.551 re f Q /GS2 gs q BT /F0 1 Tf 9 0 0 9 146.5879 613.0751 Tm 0 Tr 0 0 0 1 k 0 Tc 0 Tw (SUMMARY)Tj -4.01307 -2.22221 TD (Rickettsia Meningoencephalitis)Tj ET Q /GS3 gs /GS2 gs q BT /F1 1 Tf 9 0 0 9 57.6929 573.0751 Tm 0 Tr 0 0 0 1 k 0.0043 Tc (A)Tj 0.99027 0 Td 0.004 Tc 0.121 Tw (35 years-old female patient with the complaints of confu-)Tj -0.99027 -1.11111 TD 0 Tc 0.105 Tw (sion, widespread eruptions and ichterus was admitted to our)Tj T* 0.094 Tw (clinic. Diagnosis of rickettsia meningoencephalitis was made)Tj T* 0.092 Tw (clinically with eruption, Tache Noire and cerebrospinal fluid)Tj 0 -1.11112 TD 0.025 Tc 0.099 Tw (findings and it was confirmed with laboratory findings. 4)Tj 0 -1.11111 TD 0.002 Tc 0.123 Tw (grams/day chloramphenicol was administered intravenously.)Tj T* 0.006 Tc 0.119 Tw (Considering the multiorgan effect (known in literature) that)Tj T* 0 Tc 0.036 Tw (could relaps the disease following the treatment, also doxocy-)Tj 0 -1.11112 TD 0.059 Tw (clin 200 mg/day was given orally to the patient for one week.)Tj 0 -1.11111 TD 0.012 Tc 0.113 Tw (After a long convalescence period of 4 months patient was)Tj T* 0 Tc 0 Tw (recovered.)Tj ET Q /GS3 gs /GS2 gs q BT /F2 1 Tf 9 0 0 9 57.6929 453.0751 Tm 0 Tr 0 0 0 1 k 0 Tc 0 Tw (Key words:)Tj ET Q /GS3 gs /GS2 gs q BT /F1 1 Tf 9 0 0 9 101.1834 453.0751 Tm 0 Tr 0 0 0 1 k 0 Tc 0 Tw (Rickettsia, meningoencephalitis)Tj ET Q /GS3 gs /GS2 gs q BT /F2 1 Tf 9 0 0 9 57.6929 433.0751 Tm 0 Tr 0 0 0 1 k 0 Tc 0 Tw (Anahtar kelimeler:)Tj ET Q /GS3 gs /GS2 gs q BT /F1 1 Tf 9 0 0 9 130.6839 433.0751 Tm 0 Tr 0 0 0 1 k 0 Tc 0 Tw (Riketsiya, meningoensefalit)Tj ET Q /GS3 gs /GS2 gs q BT /F0 1 Tf 10 0 0 10 57.6929 400.0751 Tm 0 Tr 0 0 0 1 k 0 Tc 0 Tw (OLGU)Tj ET Q /GS3 gs /GS2 gs q BT /F3 1 Tf 9 0 0 9 57.6929 377.0751 Tm 0 Tr 0 0 0 1 k 0 Tc 0.001 Tw (35 ya\337\335nda bayan hasta y\237ksek ate\337, v\237cudunda yayg\335n d\232k\237n)Tj 24.753 0 TD (-)Tj -24.753 -1.11111 TD 0.074 Tw (t\237, v\237cudunda ve g\232z aklar\335nda sararma, \337uur bulan\335kl\335l\335\333\335 ve)Tj T* 0.013 Tw (huzursuzluk \337ikayetleri ile \334nfeksiyon Hastal\335klar\335 Klini\333imize)Tj T* 0.004 Tc 0.12 Tw (ba\337vurdu. On g\237n \232ncesine kadar hi\215bir yak\335nmas\335 olmayan)Tj T* 0.007 Tc 0.117 Tw (hastan\335n bu tarihten itibaren halsizlik, ate\337 ve hafif \232ks\237r\237k)Tj T* 0 Tc 0.043 Tw (\337ikayetleri ba\337lam\335\337. So\333uk alg\335nl\335\333\335 tan\335s\335 ile baz\335 ila\215lar kul-)Tj T* 0.004 Tc 0.12 Tw (lan\335rken \337ikayetlerinde azalma olmad\335\333\335 gibi \232nce g\232vdeden)Tj 0 -1.11112 TD 0.001 Tc 0.124 Tw (ba\337layan d\232k\237nt\237leri olmu\337, bacak eklemlerinde ve s\335rtta ol-)Tj 0 -1.11111 TD 0.009 Tc 0.116 Tw (duk\215a \337iddetli a\333r\335lar\335 ba\337lam\335\337. D\232k\237nt\237leri nedeniyle ba\337-)Tj T* 0.035 Tc 0.09 Tw (vurdu\333u doktor taraf\335ndan \322ila\215 alerjisi\323 tan\335s\335 ile tedavi)Tj T* 0 Tc 0.042 Tw (g\232rm\237\337, fakat d\232k\237nt\237leri giderek artm\335\337, g\232z aklar\335nda sarar-)Tj T* 0.06 Tw (ma ve kusmalar\335 ba\337lam\335\337. \336ikayetlerinin 10. g\237n\237 sabah zor-)Tj T* 0.005 Tc 0.12 Tw (lukla uyand\335r\335labilen, etraf\335ndakileri ve bulundu\333u yeri ay\335rt)Tj 0 -1.11112 TD 0.011 Tc 0.114 Tw (edemeyip anlams\335z konu\337tu\333u, huzursuz oldu\333u fark edilen)Tj 0 -1.11111 TD 0 Tc 0.075 Tw (hasta bir hastaneye g\232t\237r\237lm\237\337 ve k\335zam\335k \232n tan\335s\335 ile klini-)Tj T* 0.029 Tw (\333imize sevk edilmi\337. Ba\337vurusu s\335ras\335nda hastan\335n \337uuru bula-)Tj T* 0.093 Tw (n\335k, tam koopere olmad\335\333\335 i\215in anamnezi hasta yak\335nlar\335ndan)Tj 0 -1.11111 TD 0.013 Tc 0.112 Tw (al\335nd\335. \205zge\215mi\337 ve soyge\215mi\337inde bir \232zellik bulunmayan)Tj 0 -1.11111 TD 0.001 Tc 0.124 Tw (hastan\335n sistem sorgulamas\335nda; i\337tahta son g\237nlerde azalma)Tj T* 0 Tc 0 Tw (ve idrar\335n\335 tutamama \337ikayeti tespit edildi.)Tj 0 -2.22222 TD 0.006 Tc 0.119 Tw (Fizik muayenede; kan bas\335nc\335 150/90 mmHg, nab\335z 100/dk,)Tj 0 -1.11111 TD 0.009 Tc 0.116 Tw (ate\337 38.7\241C, \337uur bulan\335k, tam kooperasyon kurulam\335yordu.)Tj 28.23535 50.62955 TD 0 Tc 0.011 Tw (Deri hafif ikterli, derialt\335 ya\333 dokusu, turgor tonus normal, pu-)Tj 0 -1.11111 TD 0.125 Tw (piller izokorik, skleralar ikterli olarak tespit edildi. Herhangi)Tj T* 0.029 Tw (bir b\232lgede LAP saptanmad\335. Kardiyovask\237ler sistem ve solu-)Tj T* 0.101 Tw (num sistemi muayeneleri normal olarak bulundu. Bat\335n mua-)Tj T* 0.001 Tc 0.124 Tw (yenesinde; t\237m v\237cutta yayg\335n, basmakla solmayan, vask\237lit)Tj T* 0 Tc 0.039 Tw (tarz\335nda soluk mor renkli d\232k\237nt\237ler mevcuttu. Organomegali)Tj T* 0.005 Tc 0.12 Tw (saptanmad\335. N\232rolojik muayenesinde ense sertli\333i mevcuttu.)Tj T* 0.008 Tc 0.117 Tw (Kerning-Brudzinski negatif olarak de\333erlendirildi, ba\337ka bir)Tj 0 -1.11112 TD 0 Tc 0 Tw (patolojik refleks tespit edilmedi.)Tj 0 -2.22222 TD 0.101 Tw (Hastada \337uur bulan\335kl\335\333\335, ense sertli\333i, y\237ksek ate\337, l\232kositoz)Tj 0 -1.11111 TD 0.023 Tc (ve pete\337iel d\232k\237nt\237lerin mevcudiyeti nedeniyle ilk planda)Tj 0 -1.11112 TD 0.043 Tc 0.082 Tw (menengokoksemi+menengokoksik menenjit d\237\337\237n\237lerek)Tj 0 -1.11111 TD 0.013 Tc 0.111 Tw (lomber ponksiyon (LP) yap\335lmas\335na karar verildi. G\232z dibi)Tj T* 0 Tc 0.012 Tw (muayenesi yap\335ld\335 ve papil \232demi tespit edilmeyen hastaya LP)Tj T* 0.033 Tc 0.092 Tw (yap\335ld\335. Beyin omurilik s\335v\335s\335 (BOS) ksantokromik g\232r\237-)Tj T* 0 Tc 0.108 Tw (n\237mde, bas\335n\215 hafif artm\335\337, Pandy (+), 400 eritrosit/mm)Tj ET Q /GS3 gs /GS2 gs q BT /F3 1 Tf 7 0 0 7 519.6127 452.7411 Tm 0 Tr 0 0 0 1 k 0 Tc (3)Tj ET Q /GS3 gs /GS2 gs q BT /F3 1 Tf 9 0 0 9 523.1127 452.7411 Tm 0 Tr 0 0 0 1 k 0 Tc (,)Tj 0.60777 0 Td (52)Tj -24.08573 -1.11111 TD 0 Tw (l\232kosit/mm)Tj ET Q /GS3 gs /GS2 gs q BT /F3 1 Tf 7 0 0 7 352.8142 442.7411 Tm 0 Tr 0 0 0 1 k 0 Tc (3)Tj ET Q /GS3 gs /GS2 gs q BT /F3 1 Tf 9 0 0 9 359.3707 442.7411 Tm 0 Tr 0 0 0 1 k 0 Tc 0.09 Tw ((% 80 PNL), protein 146 mg, \337eker 47 mg, klor)Tj -5.28441 -1.11111 TD 0.059 Tw (117 mEq/l, e\337 zamanl\335 kan \337ekeri 153 mg olarak tespit edildi.)Tj T* 0.094 Tw (Hastan\335n pete\337ial lezyonlar\335ndan k\237lt\237r, hemok\237lt\237r al\335nd\335 ve)Tj T* -0.03 Tc 0.032 Tw [(b)-30(u)-30( )-30(BOS bulgular\335 \335\337\335\333\335nda hastaya anti\232dem tedavisi ile birlikte 24)]TJ T* -0.002 Tc 0.097 Tw (milyon \206/g\237n kristalize penisilin G tedavisi ba\337land\335. 24 saat)Tj T* -0.03 Tc 0.075 Tw (sonunda hastan\335n ate\337i 37.5\241C\325a d\237\337\237p nispi bir iyilik hali g\232zlen)Tj 24.75298 0 TD 0 Tc (-)Tj -24.75298 -1.11112 TD -0.03 Tc 0.096 Tw (mesine ra\333men 48. saatte hastan\335n ate\337i 39\241C\325a y\237kseldi ve genel)Tj 0 -1.11111 TD -0.007 Tc 0.102 Tw (durumda bozulma g\232r\237ld\237. Hastan\335n yat\335\337\335n\335n ilk g\237n\237 tetkik)Tj 24.75285 0 TD 0 Tc (-)Tj -24.75285 -1.11111 TD -0.03 Tc 0.068 Tw (lerinde; SGOT 324 U/l, SGPT 377 U/l, LDH 1290 U/l, GGT 508)Tj 0 -1.11112 TD 0 Tc 0.064 Tw [(U)30(/)30(l)30(,)-284(alkalen fosfataz 1343 U/l, total protein 7.2 g/dL, albumin)]TJ 0 -1.11111 TD 0.056 Tw (2.9 g/dL, globulin 4.3 g/dL, total bilir\237bin 8.53 mg/dL, direkt)Tj T* 0.005 Tw (bilir\237bin 6.34 mg/dL, beyaz k\237re 27.000 (PNL hakimiyeti ile),)Tj T* 0.021 Tc 0.104 Tw (Hb 9.2, Hct % 29.2, trombosit 278.000, ESR 28 mm/saat,)Tj T* 0 Tc 0.099 Tw (CRP 96 mg/lt, Anti HAV IgM, HBsAg, AntiHBc IgG, Anti)Tj 24.75297 0.00001 TD (-)Tj -24.75297 -1.11112 TD 0 Tw (HCV negatif bulundu.)Tj 0 -2.22222 TD 0.125 Tw (48. saatteki genel durum bozuklu\333u nedeniyle tekrar yap\335lan)Tj 0 -1.11111 TD 0.1 Tw (fizik muayene ile ilk muayenede g\232zden ka\215an sa\333 alt bacak)Tj T* 0.043 Tw (d\335\337 yan y\237z\237nde etraf\335 soyulmaya ba\337lam\335\337, \237zeri halen krutlu)Tj 0 -1.11112 TD 0.004 Tc 0.121 Tw (eskar izine rastland\335. Hastan\335n, \337ikayetlerinin ba\337lang\335c\335ndan)Tj 0 -1.11111 TD 0 Tc 0.078 Tw (yakla\337\335k bir hafta \232nce, kendi k\232peklerine ait kene taraf\335ndan)Tj T* 0.064 Tw (\335s\335r\335ld\335\333\335 ve kenenin ciltten zor ayr\335ld\335\333\335 \232\333renildi. Bu bilgiler)Tj T* 0.025 Tc 0.1 Tw (\335\337\335\333\335nda Weil Felix agl\237tinasyon testi sonucu OX2 1/320,)Tj T* 0.002 Tc 0.123 Tw (OX19 1/640 titrasyonunda pozitif OXK negatif olarak tespit)Tj T* 0 Tc 0 Tw (edildi.)Tj 0 -2.22223 TD 0.003 Tc 0.122 Tw (Kloramfenikol tedavisinin ba\337lang\335c\335ndan 48 saat sonra has-)Tj 0 -1.11111 TD 0.026 Tc 0.098 Tw (tan\335n ate\337i d\237\337t\237 ve kooperasyon kurulmaya ba\337land\335. Bir)Tj T* 0.024 Tc 0.101 Tw (hafta sonra kontrol LP ile al\335nan BOS berrak g\232r\237n\237mde,)Tj ET 0 0 0 0 k 56.693 655.788 481.89 72.716 re f Q /GS3 gs /GS2 gs q BT /F0 1 Tf 20 0 0 20 57.6929 712.5873 Tm 0 Tr 0 0 0 1 k 0 Tc 0 Tw (Riketsiya Meningoensefaliti)Tj ET Q /GS3 gs /GS2 gs q BT /F0 1 Tf 10 0 0 10 57.6929 660.5873 Tm 0 Tr 0 0 0 1 k 0 Tc 0 Tw (N\237ket CEYLAN (*), Nail \205ZG\206NE\336 (**), Tahir CEYLAN (***), P\335nar ERGEN (*))Tj ET 0 J 0 j 10 M []0 d 1 w 0 0 0 1 K 56.693 638.7961 m 538.583 638.7961 l S 0 0 0 0 k 56.693 119.055 481.89 19.843 re f Q /GS3 gs /GS2 gs q BT /F3 1 Tf 8 0 0 8 57.6929 131.6344 Tm 0 Tr 0 0 0 1 k 0.023 Tc 0.102 Tw (SSK G\232ztepe E\333itim Hastanesi \334nfeksiyon Hastal\335klar\335 ve Klinik Mikrobiyoloji Uz. Dr.*; Klinik \336efi**; SSK Kartal Hastanesi \334nfeksiyon)Tj 0 -1.125 TD 0 Tc 0 Tw (Hastal\335klar\335 ve Klinik Mikrobiyoloji Uz. Dr.***)Tj ET 0 J 0 j 10 M []0 d 1 w 0 0 0 1 K 56.693 145.89 m 538.583 145.89 l S 56.693 421.678 m 283.465 421.678 l S 57.78 755.355 m 539.669 755.355 l S /GS3 gs 0 0 0 0 k 56.693 752.851 481.89 13 re f Q /GS3 gs /GS2 gs q BT /F0 1 Tf 10 0 0 10 57.6929 757.021 Tm 0 Tr 0 0 0 1 k 0.1 Tc 0 Tw (OLGU SUNUMU)Tj ET Q /GS3 gs /GS2 gs q BT /F1 1 Tf 10 0 0 10 485.1928 757.021 Tm 0 Tr 0 0 0 1 k 0.1 Tc 0 Tw (\334nfeksiyon)Tj ET 0 J 0 j 10 M []0 d 1 w 0 0 0 1 K 56.693 748.351 m 538.583 748.351 l S 56.693 771.024 m 538.583 771.024 l S 0 0 0 0 k 56.693 788.3701 121 11 re f Q /GS3 gs /GS2 gs q BT /F1 1 Tf 8 0 0 8 57.6929 792.4114 Tm 0 Tr 0 0 0 1 k 0 Tc 0 Tw (G\232ztepe T\335p Dergisi 16: 63-64, 2001)Tj ET 0 0 0 0 k 526.244 91.146 12.339 12 re f Q /GS3 gs /GS2 gs q BT /F0 1 Tf 10 0 0 10 527.2443 94.6874 Tm 0 Tr 0 0 0 1 k 0 Tc 0 Tw (63)Tj ET 0 0 0 0 k 471.071 787.6771 67.512 11.693 re f Q /GS3 gs /GS2 gs q BT /F0 1 Tf 9 0 0 9 472.0711 791.6577 Tm 0 Tr 0 0 0 1 k 0 Tc 0 Tw (ISSN 1300-526X)Tj ET Q endstream endobj 6 0 obj << /Length 14771 >> stream /GS0 gs q 0 0.89 595 841 re W n 1 g 0 841.89 0 0 re f Q /GS1 gs q /GS2 gs 0 0 0 0 k 56.693 132.055 481.89 624.796 re f Q /GS2 gs q BT /F3 1 Tf 9 0 0 9 57.6929 748.0599 Tm 0 Tr 0 0 0 1 k 0.001 Tc 0.124 Tw (bas\335n\215 hafif artm\335\337, Pandy (+), 67 l\232kosit/mm)Tj ET Q /GS3 gs /GS2 gs q BT /F3 1 Tf 7 0 0 7 228.786 750.3699 Tm 0 Tr 0 0 0 1 k 0 Tc (3)Tj ET Q /GS3 gs /GS2 gs q BT /F3 1 Tf 9 0 0 9 235.6672 748.0599 Tm 0 Tr 0 0 0 1 k 0.001 Tc 0.124 Tw (\(% 80 lenfo-)Tj -19.77492 -1.11111 TD 0 Tc 0.102 Tw (sit\), protein 128 mg, \337eker 41 mg, CI 120 mEq/l, e\337 zamanl\335)Tj T* 0.012 Tc 0.113 Tw (kan \337ekeri 95 mg olarak bulundu. Bu arada \215ekilen kranial)Tj -0.0001 Tc (B)' 0.66692 0.00001 TD 0 Tc 0.032 Tw (T\325de pons sol yar\335s\335nda yakla\337\335k 8 mm boyutunda infarkt ile)Tj -0.66692 -1.11112 TD 0.0208 Tc (u)Tj 0.5208 0.00001 TD 0.021 Tc 0.104 Tw (yumlu lezyon tespit edildi. EEG\325de yayg\335n, 4-5 frekansl\335)Tj -0.5208 -1.11111 TD -0.0001 Tc (y)Tj 0.49991 0.00001 TD 0 Tc 0.078 Tw (ava\337 dalga faaliyeti saptand\335. Hastan\335n yatt\335\333\335 g\237n al\335nan bi-)Tj -0.49991 -1.11112 TD 0.097 Tw (yokimyasal de\333erlerde g\232r\237len bariz y\237kseklik tedavi ile bir-)Tj 0 -1.11111 TD 0.014 Tc 0.111 Tw (likte 2 hafta i\215inde tamamen normal seviyelere indi. Teda-)Tj T* 0 Tc 0.046 Tw (vinin 10. g\237n\237nde tekrarlanan LP ile BOS berrak g\232r\237n\237mde,)Tj T* 0.034 Tw [(bas\335n\215 normal, Pandy (-), 1)15(3)15( )15(l)15<9A>15(k)15(o)15(s)15(i)15(t)15(/)15(m)15(m)]TJ ET Q /GS3 gs /GS2 gs q BT /F3 1 Tf 7 0 0 7 203.1957 660.3699 Tm 0 Tr 0 0 0 1 k 0 Tc (3)Tj ET Q /GS3 gs /GS2 gs q BT /F3 1 Tf 9 0 0 9 206.5907 658.0599 Tm 0 Tr 0 0 0 1 k -0.0151 Tc (,)Tj 0.50411 0 Td -0.015 Tc 0.034 Tw (protein 36 mg, \337eker)Tj -17.04831 -1.11111 TD 0 Tw (54 mg, CI 125 mEq/l idi.)Tj 0 -2.22222 TD -0.0001 Tc (H)Tj 0.72192 0.00001 TD 0 Tc 0.013 Tw (astaya toplam 12 g\237n s\237re ile kloramfenikol 4 g/g\237n tedavisi)Tj -0.72192 -1.11112 TD -0.0001 Tc (u)Tj 0.4999 0.00001 TD 0 Tc 0.032 Tw [(yguland\335. Olas\335 relapslar\335 \232nlemek i\215in,)20( )20(1)20(2)20( )20(g)20<9F>20(n)20(l)20<9F>20(k)20( )20(b)20(u)20( )20(t)20(e)20(d)20(a)20(v)20(i)20(y)20(i)]TJ -0.4999 -1.11111 TD 0.0086 Tc (t)Tj 0.28659 0.00001 TD -0.001 Tc 0.096 Tw [(a)-10(k)-10(i)-10(b)-10(e)-10(n)-10( )-10(h)-10(a)-10(s)-10(t)-10(a)-10( )-10(t)-10(a)-10(b)-10(u)-10(r)-10(c)-10(u)-10( )-10(olurken 7 g\237n s\237re ile doksosiklin 200)]TJ -0.28659 -1.11112 TD 0.025 Tc 0.1 Tw [(m)30(g)30(/)30(g)30<9F>30(n)30( )30(a)30(l)30(m)30(a)30(s)30