{"id":709,"date":"2025-07-16T09:59:54","date_gmt":"2025-07-16T06:59:54","guid":{"rendered":"https:\/\/tatd.org.tr\/geriatri\/?p=709"},"modified":"2025-07-16T10:00:45","modified_gmt":"2025-07-16T07:00:45","slug":"yaslilarda-immun-yetmezlik-ve-acil-servis-yonetimi","status":"publish","type":"post","link":"https:\/\/tatd.org.tr\/geriatri\/genel\/yaslilarda-immun-yetmezlik-ve-acil-servis-yonetimi\/","title":{"rendered":"Ya\u015fl\u0131larda \u0130mmun Yetmezlik Ve Acil Servis Y\u00f6netimi"},"content":{"rendered":"\n

*Eyl\u00fcl 2024’de yaz\u0131lan bu blog yaz\u0131s\u0131 teknik sorunlar nedeni ile Temmuz 2025’de yay\u0131nlanm\u0131\u015ft\u0131r.<\/p>\n\n\n\n

\u0130mmun ya\u015flanma (imm\u00fcnosenesans), ba\u011f\u0131\u015f\u0131kl\u0131k sistemindeki ya\u015flanmayla ili\u015fkili de\u011fi\u015fiklikleri ifade eder [1]. Bu de\u011fi\u015fiklikler, ba\u011f\u0131\u015f\u0131kl\u0131k sistemindeki neredeyse t\u00fcm h\u00fccre soylar\u0131n\u0131 etkiler ve hem do\u011fu\u015ftan gelen ba\u011f\u0131\u015f\u0131kl\u0131kta hem de kazan\u0131lm\u0131\u015f ba\u011f\u0131\u015f\u0131kl\u0131kta de\u011fi\u015fen tepkilere yol a\u00e7ar. Do\u011fu\u015ftan gelen ba\u011f\u0131\u015f\u0131kl\u0131k sistemi, patojenlerle veya a\u015f\u0131larla ilk etkile\u015fimlerden olu\u015fmakta iken, B h\u00fccreleri ve T h\u00fccreleri taraf\u0131ndan y\u00f6netilen kazan\u0131lm\u0131\u015f ba\u011f\u0131\u015f\u0131kl\u0131k, ya\u015fla birlikte \u00f6nemli i\u015flevsel de\u011fi\u015fikliklere u\u011frar. Bu de\u011fi\u015fiklikler, kemik ili\u011findeki hematopoetik k\u00f6k h\u00fccrelere (HSC’ler) kadar uzan\u0131r. Ya\u015flanmayla ili\u015fkili ba\u011f\u0131\u015f\u0131kl\u0131k de\u011fi\u015fiklikleri, h\u00fccresel sinyal iletiminde ve ba\u011f\u0131\u015f\u0131kl\u0131k fonksiyonunda ortaya \u00e7\u0131kan de\u011fi\u015fikliklerle kendini g\u00f6sterir. Genetik mekanizmalar\u0131n yan\u0131 s\u0131ra d\u0131\u015f fakt\u00f6rlerden de etkilenir. Bu d\u0131\u015f fakt\u00f6rler aras\u0131nda kronik veya tekrarlayan enfeksiyonlar (\u00f6rne\u011fin herpes vir\u00fcs\u00fc reaktivasyonu veya HIV), hormonal de\u011fi\u015fiklikler ve kronik t\u0131bbi durumlar nedeniyle ortaya \u00e7\u0131kan h\u00fccresel hasar bulunur [2].<\/p>\n\n\n\n

Ya\u015fl\u0131l\u0131\u011fa ba\u011fl\u0131 geli\u015fen immun yetmezlik enfeksiyon hastal\u0131klar\u0131na ba\u011fl\u0131 morbidite ve mortalite art\u0131r\u0131r. \u00d6rne\u011fin, ya\u015fl\u0131lar t\u00fcberk\u00fclozun reaktivasyonu ve varisella zoster vir\u00fcs\u00fc (VZV) enfeksiyonlar\u0131na kar\u015f\u0131 daha hassast\u0131r. Ya\u015f, ayn\u0131 zamanda sepsis ve COVID-19’a neden olan \u015fiddetli akut solunum yolu sendromu koronavir\u00fcs 2 (SARS-CoV-2) enfeksiyonlar\u0131ndan kaynaklanan daha y\u00fcksek \u00f6l\u00fcm oranlar\u0131 ve k\u00f6t\u00fcle\u015fmi\u015f sonu\u00e7lar i\u00e7in ba\u011f\u0131ms\u0131z bir risk fakt\u00f6r\u00fcd\u00fcr [1].<\/p>\n\n\n\n

\u0130mmun ya\u015flanma \u015fu durumlarla ili\u015fkilidir [3]:<\/p>\n\n\n\n

    \n
  1. Enfeksiyonlara, \u00f6zellikle de h\u00fccre i\u00e7i bakterilere kar\u015f\u0131 artan duyarl\u0131l\u0131k<\/li>\n\n\n\n
  2. Enfeksiyon sonras\u0131 daha uzun iyile\u015fme s\u00fcresi<\/li>\n\n\n\n
  3. A\u015f\u0131ya kar\u015f\u0131 daha d\u00fc\u015f\u00fck duyarl\u0131l\u0131k<\/li>\n\n\n\n
  4. Artan neoplastik ve otoimm\u00fcn yatk\u0131nl\u0131k\u00a0<\/li>\n<\/ol>\n\n\n\n

    Hekimler, ba\u011f\u0131\u015f\u0131kl\u0131k sisteminin ya\u015flanmas\u0131na dair \u00f6zel durumlar\u0131n fark\u0131nda olmayabilir. Bu bilgi eksikli\u011fi tan\u0131da gecikmelere ve antibiyotik tedavisinin gereksiz \u015fekilde art\u0131r\u0131lmas\u0131na yol a\u00e7abilir. \u00d6zellikle geni\u015f spektrumlu antibiyotiklerin ve kortikosteroidlerin uygunsuz kullan\u0131m\u0131 f\u0131rsat\u00e7\u0131 enfeksiyon riskini art\u0131r\u0131r.<\/p>\n\n\n\n

    K\u0131r\u0131lgan ya\u015fl\u0131 ki\u015filer genellikle \u015fiddetli protein-enerji maln\u00fctrisyonu (PEM) ile de kar\u015f\u0131 kar\u015f\u0131ya kal\u0131r. PEM, k\u0131r\u0131lganl\u0131k sendromunun bir\u00e7ok sonucuna ve \u00f6zellikle imm\u00fcn yetmezlik hastalar\u0131nda g\u00f6zlemlenen mantar enfeksiyonlar\u0131 da dahil olmak \u00fczere enfeksiyonlara kar\u015f\u0131 duyarl\u0131l\u0131\u011fa katk\u0131da bulunur [4]. <\/p>\n\n\n\n

    Ya\u015fl\u0131larda immun yetmezlik ile PEM aras\u0131ndaki ili\u015fki iki fakt\u00f6re dayanmaktad\u0131r:
    1- Kronik inflamasyonun<\/strong> tetikledi\u011fi ve makrofajlar\u0131n proinflamatuar sitokinlerinin aktivasyonu ile ili\u015fkili PEM kaynakl\u0131 hiperkatabolizma, protein rezervlerinin azalmas\u0131 nedeni ile immun yetmezlik geli\u015fir [5].<\/p>\n\n\n\n

    2-PEM ile ili\u015fkili mikro besin eksiklikleri<\/strong>, immun yetmezli\u011fi \u015fiddetlendirir. \u00d6zellikle \u00e7inko, D vitamini ve E vitamini eksiklikleri bu duruma katk\u0131da bulunur [6].<\/p>\n\n\n\n

    \u00c7inko<\/strong> h\u00fccre \u00e7o\u011falmas\u0131nda rol oynayan mikro besindir ve ba\u011f\u0131\u015f\u0131kl\u0131k yan\u0131t\u0131 i\u00e7in hayati \u00f6nem ta\u015f\u0131r. Ancak organizman\u0131n \u00e7inkoyu depolama yetene\u011finin olmamas\u0131 nedeniyle bu mikro besindeki eksiklik (serum seviyesi < 70 g\/dL), ba\u011f\u0131\u015f\u0131kl\u0131k yan\u0131t\u0131n\u0131 olumsuz etkiler. \u00c7inko takviyesinin ba\u011f\u0131\u015f\u0131kl\u0131k yan\u0131t\u0131n\u0131 geri kazanmada faydalar\u0131n\u0131 rapor eden birka\u00e7 randomize \u00e7al\u0131\u015fma olmas\u0131na ra\u011fmen, dozaj rejimleri konusunda bir fikir birli\u011fi yoktur [6].<\/p>\n\n\n\n

    E vitamini,<\/strong> h\u00fccre zar\u0131n\u0131 oksidatif strese kar\u015f\u0131 koruyan bir antioksidand\u0131r. Bu fenomen, do\u011fu\u015ftan gelen ba\u011f\u0131\u015f\u0131kl\u0131k i\u015fleyi\u015finde (NK h\u00fccreleri) yer alan mekanizmalardan biridir, bu nedenle E vitamini, sitotoksik ba\u011f\u0131\u015f\u0131kl\u0131k yan\u0131t\u0131 s\u0131ras\u0131nda h\u00fccrelerin b\u00fct\u00fcnl\u00fc\u011f\u00fcn\u00fc korumada kritik bir rol oynar. Yap\u0131lan epidemiyolojik \u00e7al\u0131\u015fmalar, enfeksiyonlar ile E vitamini eksikli\u011fi aras\u0131ndaki ili\u015fkiyi ortaya koymu\u015ftur [6].<\/p>\n\n\n\n

    D vitamininin<\/strong> kalsiyum homeostaz\u0131 mekanizmalar\u0131n\u0131n d\u00fczenlenmesindeki rol\u00fc iyi bilinmektedir. Ancak bu fonksiyonlarla hi\u00e7bir ilgisi olmayan h\u00fccrelerde bile D vitamini resept\u00f6rleri bulunur. Biyokimyasal \u00e7al\u0131\u015fmalar, D vitamini resept\u00f6rlerinin ba\u011f\u0131\u015f\u0131kl\u0131k h\u00fccrelerinde bask\u0131n oldu\u011funu ortaya koymu\u015ftur. D vitamininin do\u011fu\u015ftan gelen ve adaptif ba\u011f\u0131\u015f\u0131kl\u0131k yan\u0131tlar\u0131n\u0131n temel bir uyar\u0131c\u0131s\u0131 olarak hareket etti\u011fi d\u00fc\u015f\u00fcn\u00fclmektedir. Epidemiyoloji a\u00e7\u0131s\u0131ndan D vitamini eksikli\u011fi ile ba\u011f\u0131\u015f\u0131kl\u0131k duyarl\u0131l\u0131\u011f\u0131 aras\u0131ndaki ili\u015fki de vurgulanm\u0131\u015ft\u0131r [7].<\/p>\n\n\n\n

    \u0130mmun ya\u015flanmaya; PEM\u2019 in yan\u0131s\u0131ra, ba\u011f\u0131\u015f\u0131kl\u0131k sisteminin i\u015fleyi\u015finin korunmas\u0131, komorbiditeler ve ilgili ila\u00e7 kullan\u0131m\u0131 katk\u0131da bulunur [8]. Kronik obstr\u00fcktif akci\u011fer hastal\u0131\u011f\u0131 (KOAH) veya diyabet gibi baz\u0131 kronik hastal\u0131klar\u0131n imm\u00fcnosupresif do\u011fas\u0131 iyi bilinmektedir. Kortikosteroidler gibi tedaviler imm\u00fcnosupresyonu daha da \u015fiddetlendirir [9]. Son olarak ciddi durumlarda antibiyotik kullan\u0131m\u0131 floray\u0131 bozarak f\u0131rsat\u00e7\u0131 enfeksiyonlara katk\u0131da bulunur ve genel olarak \u00e7ok fakt\u00f6rl\u00fc ba\u011f\u0131\u015f\u0131kl\u0131k yetmezli\u011fini kolayla\u015ft\u0131r\u0131r. Bu durumlar kandida enfeksiyonu gibi di\u011fer enfeksiyonlara yatk\u0131nl\u0131\u011f\u0131 art\u0131r\u0131r [10].<\/p>\n\n\n\n

    Ya\u015fl\u0131 bireylerde akut enfeksiyon vakalar\u0131nda, hekimler multifakt\u00f6riyel ba\u011f\u0131\u015f\u0131kl\u0131k yetmezli\u011fine yol a\u00e7abilecek enfeksiyonlardan, potansiyel olarak yayg\u0131n Candidiasis gibi f\u0131rsat\u00e7\u0131 enfeksiyonlardan sorumlu olabilecek \u00f6nleyici ve tetikleyici fakt\u00f6rleri ara\u015ft\u0131rmal\u0131d\u0131r. Bu fakt\u00f6rler \u015funlard\u0131r:<\/p>\n\n\n\n

    1-Do\u011fu\u015ftan gelen ve adaptif ba\u011f\u0131\u015f\u0131kl\u0131k sistemlerinin bozulmas\u0131ndan sorumlu hiperkatabolizma<\/p>\n\n\n\n

    2-PEM varl\u0131\u011f\u0131<\/p>\n\n\n\n

    3-Birden fazla hastal\u0131\u011f\u0131n varl\u0131\u011f\u0131<\/p>\n\n\n\n

    4-\u00c7oklu ila\u00e7 kullan\u0131m\u0131 [11].<\/p>\n\n\n\n

    Geni\u015f spektrumlu antibiyotiklerin ve\/veya kortikosteroidlerin akut durumlarda kullan\u0131m\u0131, sistemik veya lokal f\u0131rsat\u00e7\u0131 enfeksiyonlar i\u00e7in tetikleyici bir fakt\u00f6r olarak kabul edilir. Bu fakt\u00f6rler aras\u0131nda PEM \u00f6nemli bir rol oynar ve bu nedenle her zaman \u00e7ok erken d\u00f6nemde taranmal\u0131 ve erken y\u00f6netim uygulanmal\u0131d\u0131r. Tarama ve tedaviye y\u00f6nelik y\u00f6netimle birlikte, di\u011fer de\u011fi\u015ftirilebilir fakt\u00f6rlerin erken y\u00f6netimi gereklidir. Bu y\u00f6netim, \u00f6zellikle acil serviste standart geriyatrik de\u011ferlendirmeye ve akut durumlarda re\u00e7etelenen ila\u00e7lar\u0131n analizine dayanarak, uygunsuz antibiyotik re\u00e7etelerinin azalt\u0131lmas\u0131n\u0131, ayr\u0131ca multidisipliner bir y\u00f6netimi (\u00f6zellikle beslenme, duygu durumu ve motor y\u00f6netim) i\u00e7erir. Bu kapsaml\u0131 multidisipliner yakla\u015f\u0131m, multifakt\u00f6riyel ba\u011f\u0131\u015f\u0131kl\u0131k yetmezli\u011fi olan ya\u015fl\u0131 hastalar\u0131n uygun y\u00f6netimine yol a\u00e7ar.<\/p>\n\n\n\n

    Acil servis y\u00f6netimi<\/strong><\/p>\n\n\n\n

    Acil serviste ya\u015fl\u0131 yastalar de\u011ferlendirilirken ba\u011f\u0131\u015f\u0131kl\u0131k sistemi de\u011ferlendirilmelidir. \u0130mmun yetmezlik durumu g\u00f6zden ge\u00e7irilmelidir. Aktif immun yetmezli\u011fi olan hastalar, uygun hasta odalar\u0131na y\u00f6nlendirilmeli ve enfeksiyon hastal\u0131klar\u0131ndan korunmal\u0131d\u0131r. \u0130mmun yetmezlik ile acilde geli\u015f \u015fikayetleri aras\u0131nda ili\u015fki olup olmad\u0131\u011f\u0131 ara\u015ft\u0131r\u0131lmal\u0131d\u0131r. \u0130mmun ya\u015flanma kavram\u0131 unutulmamal\u0131 ve katk\u0131da bulunan fakt\u00f6rler g\u00f6zden ge\u00e7irilmelidir. \u00d6rne\u011fin hastan\u0131n protein enerji malnutrisyonu h\u0131zl\u0131 testlerle tespit edilmelidir. Uygunsuz antibiyotikler ve endikasyon d\u0131\u015f\u0131 kullan\u0131lan steroid ila\u00e7lar\u0131n ba\u011f\u0131\u015f\u0131kl\u0131k sistemine olumsuz etkileri g\u00f6z ard\u0131 edilmemeli. Ya\u015fl\u0131 hastalarda ate\u015f ve beyaz k\u00fcre y\u00fcksekli\u011fi gibi durumlar eri\u015fkinlerden farkl\u0131 olarak g\u00f6zlenmeyebilir. Bu durum ya\u015fl\u0131 hastan\u0131n tan\u0131s\u0131nda yan\u0131lmalara neden olabilir. Ya\u015fl\u0131 hastalar acil serviste ba\u011f\u0131\u015f\u0131kl\u0131k a\u00e7\u0131s\u0131ndan da kapsaml\u0131 geriatrik de\u011ferlendirmeye tabi tutulmal\u0131d\u0131r. <\/p>\n\n\n\n

    Kaynaklar <\/strong><\/p>\n\n\n\n

    1-Albert C. Shaw; Thilinie D. Bandaranayake, 2024,New York. Hazzard’s Geriatric Medicine and Gerontology, 8e, Chapter 3: Immunology and Inflammation. <\/strong>Mcgraw Hill,<\/p>\n\n\n\n

    2-Cr\u00e9tel E, Veen I, Pierres A, Bongrand P, Gavazzi G. Immunos\u00e9nescence et infections, mythe ou r\u00e9alit\u00e9? [Immunosenescence and infections, myth or reality?]. Med Mal Infect<\/em>. 2010;40(6):307-318. <\/p>\n\n\n\n

    3-B\u00fcrkle A, Caselli G, Franceschi C, Mariani E, Sansoni P, Santoni A, et al. Pathophysiology of ageing, longevity and age-related diseases. Immun Ageing 2007;4:4.<\/p>\n\n\n\n

    4-De Pauw B, Walsh TJ, Donnelly JP, Stevens DA, Edwards JE, Calandra T, et al. Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer\/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC\/MSG) Consensus Group. Clin Infect Dis 2008;46:1813\u201321.<\/p>\n\n\n\n

    5-Franceschi C, Campisi J. Chronic inflammation (inflammaging) and its potential contribution to age-associated diseases. J Gerontol Ser A 2014;69:S4\u20139.<\/p>\n\n\n\n

    6-Pae M, Wu D. Nutritional modulation of age-related changes in the immune system and risk of infection. Nutr Res 2017;41:14\u201335.<\/p>\n\n\n\n

    7-Holick MF. Vitamin D Deficiency. N Engl J Med 2007;357:266\u201381.<\/p>\n\n\n\n

    8- Castle SC, Uyemura K, Rafi A, Akande O, Makinodan T. Comorbidity is a better predictor of impaired immunity than chronological age in older adults. J Am Geriatr Soc 2005;53:1565\u20139. <\/p>\n\n\n\n

    9- Michaud M, Balardy L, Moulis G, Gaudin C, Peyrot C, Vellas B, et al. Proinflammatory cytokines, aging, and age-related diseases. J Am Med Dir Assoc 2013;14:877\u201382. <\/p>\n\n\n\n

    10- Sims CR, Ostrosky-Zeichner L, Rex JH. Invasive Candidiasis in immunocompromised hospitalized patients. Arch Med Res 2005;36:660\u201371.<\/p>\n\n\n\n

    11-Tannou T, Koeberle S, Manckoundia P, Aubry R. Multifactorial immunodeficiency in frail elderly patients: Contributing factors and management. Med Mal Infect<\/em>. 2019;49(3):167-172.<\/p>\n\n\n\n

    <\/p>\n","protected":false},"excerpt":{"rendered":"

    *Eyl\u00fcl 2024’de yaz\u0131lan bu blog yaz\u0131s\u0131 teknik sorunlar nedeni ile Temmuz 2025’de yay\u0131nlanm\u0131\u015ft\u0131r. \u0130mmun ya\u015flanma (imm\u00fcnosenesans), ba\u011f\u0131\u015f\u0131kl\u0131k sistemindeki ya\u015flanmayla ili\u015fkili de\u011fi\u015fiklikleri ifade…<\/p>\n","protected":false},"author":1185,"featured_media":710,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"inline_featured_image":false,"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[1,10014],"tags":[10020,10059],"class_list":["post-709","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-genel","category-akademik-blog-yazisi","tag-acil-tip","tag-immun-yetmezlik"],"acf":[],"_links":{"self":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/posts\/709","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/users\/1185"}],"replies":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/comments?post=709"}],"version-history":[{"count":0,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/posts\/709\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/media\/710"}],"wp:attachment":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/media?parent=709"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/categories?post=709"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/tags?post=709"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}