Enfeksiyon ile İlişkili Baş Ağrıları
Özet
Enfeksiyon hastalıklarına bağlı sekonder baş ağrılarının patofizyolojisini, klinik özelliklerini, tanı ve tedavi yaklaşımlarını ele alan bu çalışma; akut rinosinüzit, bakteriyel ve viral menenjit, kronik menenjit, nörosifiliz, Lyme hastalığı ile COVID-19 ve HIV gibi sistemik enfeksiyonları baş ağrısının başlıca nedenleri olarak sunmaktadır. Bakteriyel menenjit acil tedavi gerektiren, retroorbital veya holokraniyal şiddetli ağrıyla seyrederken, viral menenjitler genellikle daha hafif seyreder ve yaz-sonbahar aylarında enterovirüslere bağlı olarak artış gösterir. Tüberküloz menenjiti ise sinsi ilerleyen, beyin bazalini tutan ve yüksek mortaliteye sahip kronik bir formdur. HIV pozitif hastalarda immünsüpresyonun derecesine bağlı olarak kriptokok menenjiti ve serebral toksoplazmozis gibi fırsatçı enfeksiyonlar fokal veya diffüz baş ağrılarına yol açar. Tanıda bilgisayarlı tomografi (BT) ve manyetik rezonans (MR) gibi görüntüleme yöntemlerinin yanı sıra, beyin omurilik sıvısı (BOS) analizi ve özellikle BOS PCR testleri etken mikroorganizmanın hızlıca saptanmasında kritik rol oynamaktadır. Sekonder baş ağrılarında temel yaklaşım, altta yatan enfeksiyon odağının ampirik veya hedefe yönelik antimikrobiyal tedavilerle ortadan kaldırılmasıdır.
This study, which addresses the pathophysiology, clinical features, diagnosis, and treatment approaches of secondary headaches due to infectious diseases, presents acute rhinosinusitis, bacterial and viral meningitis, chronic meningitis, neurosyphilis, Lyme disease, and systemic infections such as COVID-19 and HIV as the primary causes of headache. While bacterial meningitis requires urgent treatment and presents with severe retroorbital or holocranial pain, viral meningitis generally follows a milder course and increases during summer and autumn due to enteroviruses. Tuberculous meningitis is a chronically progressing form with high mortality that affects the basal areas of the brain. In HIV-positive patients, depending on the degree of immunosuppression, opportunistic infections like cryptococcal meningitis and cerebral toxoplasmosis lead to focal or diffuse headaches. In diagnosis, along with imaging modalities such as computed tomography (CT) and magnetic resonance imaging (MRI), cerebrospinal fluid (CSF) analysis and particularly CSF PCR tests play a critical role in the rapid detection of the causative microorganism. The fundamental approach to secondary headaches is the eradication of the underlying infectious source through empirical or targeted antimicrobial therapies.
Referanslar
Digre, K. B.(2020). Headaches and Other Head Pain. L. Goldman, A. I. Schafer (Eds.), Goldman-Cecil Medicine, (26TH ed., pp. 2316-2323), New York: Elsevier
Garza, I., Robertson, C. E., Smith J. H. & Whealy, M. A.(2022). Headache and Other Craniofacial Pain. Joseph J., John C. M., Scott L. P., Nancy, J. N. (Eds.), Bradley and Daroff's Neurology in Clinical Practice, (8nd ed. pp.1745-1782). United States: Elsevier
Gladstone J, Bigal ME. Headaches attributable to infectious diseases. Curr Pain Headache Rep. 2010 Aug;14(4):299-308. doi: 10.1007/s11916-010-0125-7.
Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018 Jan;38(1):1-211. doi: 10.1177/0333102417738202.
Zhu K, Born DW, Dilli E.: Secondary headache: Current update. Headache 2020; 60: pp. 2654-2664.
Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, et al. Clinical practice guideline (update): Adult sinusitis. Otolaryngol - Head Neck Surg (United States). 2015;152:S1-S39.
Walter, S. M. Laderman, M. Polk, P. Pediatric Headache Attributed to Infection. Seminars in Pediatric Neurology, 2021-12-01, Volume 40, Article 100923, 2021 Elsevier
Van de Beek D., de Gans J., Spanjaard L., et. al.: Clinical features and prognostic factors in adults with bacterial meningitis. New England Journal of Medicine. 2004; 351, 1849-1859
Van de Beek D, Cabellos C, Dzupova O. ESCMID guideline: diagnosis and treatment of acute bacterial meningitis. Clin Microbiol Infect. May 2016, Suppl 3, 37-62. doi: 10.1016/j.cmi.2016.01.007.
Anderson, N. C., Koshy, A. A. & Roos, K. L.(2022). Bacterial, Fungal, and Parasitic Diseases of the Nervous System. Joseph J., John C. M., Scott L. P., Nancy, J. N. (Eds.), Bradley and Daroff's Neurology in Clinical Practice, (8nd ed. pp.1214-1225). United States: Elsevier
Hasbun R, Abrahams J, Jekel J. Computed tomography of the head before lumbar puncture in adults with suspected meningitis. N Engl J Med. 2001; 345: 1727-1733
Van Ettekoven C.N., van de Beek D., Brouwer M.C. Update on community-acquired bacterial meningitis: guidance and challenges. Clin Microbiol Infect. 2017 Sep;23(9):601-606. doi: 10.1016/j.cmi.2017.04.019
Roos, K. L., Tyler, K. L. (2017). Meningitis, Encephalitis, Brain Abscess, and Empyema. D. L. Kasper, A. S. Fauci (Eds.). Harrison Infectious Diseases (3nd pp.334-368). China:McGraw-Hill Education
Kayabaş Ü. (2017). Santral Sinir Sistemi Enfeksiyonları. Ayşe Willke Topcu, Güner Söyletir, Mehmet Doğanay (Ed.), Enfeksiyon Hastalıkları ve Klinik Mikrobiyolojisi içinde(1313-1321). İstanbul: Nobel Tıp Kitabevleri
Raviglione, M. C.(2017). Tuberculosis. D. L. Kasper, A. S. Fauci (Eds.). Harrison Infectious Diseases (3nd pp.612-629). China:McGraw-Hill Education
Bennett, J. E. & Hoover, S. E.(2020). Chronic Meningitis. J. E. Bennett, R. Dolin & M. J. Blaser. (Eds.), Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. (9nd pp. 1220-1225).Philedelphia: Elsevier
Thwaites G, Fisher M, Hemingway C. British Infection Society. British Infection Society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system in adults and children. J Infect. 2009 Sep;59(3):167-87. doi: 10.1016/j.jinf.2009.06.011.
Bahr, N. C., Nuwagira, E. Evans, E. E. Diagnostic accuracy of Xpert MTB/RIF Ultra for tuberculous meningitis in HIV-infected adults: a prospective cohort study. Lancet Infect Dis 2018; 18: 68-75
Fitzgerald, D. W., Sterling T. R. & Haas, D.W.(2020). Mycobacteium tuberculosis. J. E. Bennett, R. Dolin & M. J. Blaser. (Eds.), Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases.(9nd pp.2985-3021).Philedelphia: Elsevier
CDC.(2021). Signs and symptoms of untreated lyme disease. Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Vector-Borne Diseases (DVBD) Web site. https://www.cdc.gov/lyme/signs_symptoms/index.html. Published 2021. Updated January 15, 2021.
Lukehart. S. A. (2017). Syphilis. D. L. Kasper, A. S. Fauci (Eds.). Harrison Infectious Diseases (3nd pp.658-667). China:McGraw-Hill Education
Dumaresq, J. Langevin, S. Gagnon, S. Clinical prediction and diagnosis of neurosyphilis in HIV-infected patients with early Syphilis. J Clin Microbiol. 2013 Dec;51(12):4060-6. doi: 10.1128/JCM.01989-13.
Radolf, J. D., Tramont, E. C. & Salazar, J. C.(2020). Syphilis (Treponema pallidum). . J. E. Bennett, R. Dolin & M. J. Blaser. (Eds.), Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, .(9nd pp. 2865-2892). Philadelphia:Elsevier
Toptan T, Aktan Ç, Başarı A. Case series of headache characteristics in COVID-19: Headache can be an isolated symptom. Headache 2020; 60: pp. 1788-1792.
Corey, L. (2017) Herpes Simplex Virus Infections. D. L. Kasper, A. S. Fauci (Eds.). Harrison Infectious Diseases (3nd pp.737-746). China:McGraw-Hill Education.
Whitley RJ. Herpes simplex encephalitis: adolescents and adults. Antiviral Res. 2006 Sep;71(2-3):141-8. doi: 10.1016/j.antiviral.2006.04.002.
Koroshetz,W. J., Nath. A.(2017) Chronic and Recurrent Meningitis. D. L. Kasper, A. S. Fauci (Eds.). Harrison Infectious Diseases (3nd pp.361-372). China:McGraw-Hill Education
Ekizoglu, E., Gezegen, H., Yalınay Dikmen, P. The characteristics of COVID-19 vaccine-related headache: Clues gathered from the healthcare personnel in the pandemic. Cephalalgia. 2021 Sep 12;3331024211042390. doi: 10.1177/03331024211042390.
Sheikh HU, Cho TA. Clinical aspects of headache in HIV. Headache. 2014 May;54(5):939-45. doi: 10.1111/head.12357.
Fauci, A. S., Lane, H.C.(2017). Human Immunodeficiency Virus disease: AIDS and related disorders. D. L. Kasper, A. S. Fauci (Eds.). Harrison Infectious Diseases (3nd pp.790-878). China:McGraw-Hill Education
Siddiqi, O. K., Agnihotri, S. & Koralnik, I. J. (2020). Neurologic Diseases Caused by Human Immunodeficiency Virus Type 1 and Opportunistic Infection. J. E. Bennett, R. Dolin & M. J. Blaser. (Eds.), Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. (9nd pp. 1690-1706).Philedelphia: Elsevier
Casadevall, A.(2017). Cryptococcosis. D. L. Kasper, A. S. Fauci (Eds.). Harrison Infectious Diseases (3nd pp.1007-1010). China:McGraw-Hill Education
Verma, A. & Berger, J. R.(2022). Neurological Manifestations of Human Immunodeficiency Virus Infection in Adults. Joseph J., John C. M., Scott L. P., Nancy, J. N. (Eds.), Bradley and Daroff's Neurology in Clinical Practice, (8nd ed. pp.1165-1183). United States: Elsevier
Perfect, J. R.(2020). Cryptococcosis (Cryptococcus neoformans and Cryptococcus gattii). J. E. Bennett, R. Dolin & M. J. Blaser. (Eds.), Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. (9nd pp. 3146-3161).Philedelphia: Elsevier
Bennett, J. E. & Hoover, S. E.(2020). Chronic Meningitis. J. E. Bennett, R. Dolin & M. J. Blaser. (Eds.), Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. (9nd pp. 1220-1225).Philedelphia: Elsevier
