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Diyabetik ayak enfeksiyonu ile takipli hastalarda HBV seroprevalansı

Year 2025, Volume: 64 Issue: 2, 319 - 323, 10.06.2025

Nazlıhan Yalçın , Gökçen Kocabaş Tansu Yamazhan , Hüsnü Pullukçu , Anıl Murat Öztürk , Meltem Taşbakan

https://doi.org/10.19161/etd.1579449

Abstract

Amaç: Hepatit B virüsü (HBV), kronik karaciğer hastalıklarına ve hepatoselüler karsinoma neden olarak yılda 3 milyon kişinin ölümüne yol açan küresel bir sağlık sorunudur. Dünya Sağlık Örgütü 254 milyon kişinin kronik hepatit B ile yaşadığını tahmin etmektedir. Hastalık Kontrol ve Önleme Merkezleri, HBsAg prevalansının %2'yi aştığı bölgelerde HBV taraması yapılmasını önermektedir. Türkiye, %4,5 prevalans oranı ile orta endemisite bölgesindedir.
Diyabetik ayak enfeksiyonu olan hastalar, sık sağlık hizmeti başvuruları nedeniyle HBV’ye maruziyet açsından daha yüksek risk altındadır. Bu çalışma, bu hassas popülasyonda HBV seroprevalansını araştırmayı amaçlamaktadır.
Gereç ve Yöntem: 2016-2024 yılları arasında Ege Üniversitesi Enfeksiyon Hastalıkları kliniğinde diyabetik ayak enfeksiyonu nedeniyle yatırılarak takip ve tedavi edilen olgular, elektronik hasta kayıtları üzerinden retrospektif olarak incelenmiştir. Hastaların demografik verileri, HBsAg, Anti-HBs, Anti-HBc IgG ve gerekli durumlarda HBV DNA sonuçları kaydedildi.
Bulgular: Altı yüz otuz iki (n: 632, Erkek/Kadın: 449/183, ortalama yaş: 63,02± 11,429) hastanın, HBsAg, Anti-HBs ve Anti-HBc IgG pozitiflik oranları sırasıyla; %1,89, %36,07 ve %32,1 idi. Hastaların 164’ü enfeksiyonu doğal yolla geçirerek 79’u ise aşılama ile bağışıklık kazanmıştır. Yine hastaların 53'ünde izole Anti-HBc IgG pozitifliği tespit edilmişken, 12 hastada kronik hepatit B enfeksiyonu saptanmıştır. Hastaların 303’ünün (%47,9) ise HBV ile hiç karşılaşmamış ve aşısız olduğu dikkat çekmiştir. Beklediğimizin aksine HBsAg seropozitiflik oranları genel popülasyon ortalamasının altında bulunmuştur. Yirmi bir hastanın eksik verisi olması nedeni ile klinik sınıflaması yapılamamıştır.
Sonuç: Diyabetik ayak enfeksiyonu ile yaşayan hasta grubu HBV açısından çeşitli risk faktörlerine maruz kalmaktadır. Bu nedenle sistematik olarak taranmalı ve aşısız olanların aşılaması yapılmalı, gerekli hastalarda tedavi başlanmalıdır.

Keywords

Diabetes Mellitus Diyabetik ayak enfeksiyonu HBV prevalansı

References

  • Maynard JE. Hepatitis B: global importance and need for control. Vaccine. 1990;(8): 18-23.
  • Ott JJ, Stevens GA, Groeger J, Wiersma ST. Global epidemiology of hepatitis B virus infection: new estimates of age-specific HBsAg seroprevalence and endemicity. Vaccine. 2012;30(12):2212-19.
  • The World Health Organization.Global Hepatitis Report, 2017 [updated 16 May 2022; [cited 17 June 2020]. Available from: https://apps.who.int/iris/bitstream/handle/10665/255016/9789241565455-eng.pdf
  • The World Health Organization. Hepatitis B [cited 9 April 2024]. Available from: https https://www.who.int/news-room/fact-sheets/detail/hepatitis
  • Türkiye viral hepatit önlem ve kontrol programı 2018-2023. [Erişim tarihi:09 Mayıs 2023].
  • World Health Organization. Guidelines on assessing donor suitability for blood donation [Cited 7 December 2015]. Available from: https://www.who.int/publications/i/item/9789241548519
  • Thompson ND, Perz JF, Moorman AC, Holmberg SD. Nonhospital health care-associated hepatitis B and C virus transmission: United States, 1998-2008. Ann Intern Med. 2009;150(1):33-9.
  • Centers for Disease Control and Prevention (CDC). Health care-Associated Hepatitis B and C Outbreaks (≥2 cases) Reported to the Centers for Disease Control and Prevention (CDC) 2008-2019 [cited 17 March 2022]. Available from: https://archive.cdc.gov/www_cdc_gov/hepatitis/outbreaks/healthcarehepoutbreaktable.htm.
  • Tosun S. Türkiye’de viral hepatit B epidemiyolojisi-Yayınların metaanalizi. In: Tabak F, Tosun S, eds. Viral Hepatit-2013. İstanbul: Viral Hepatitle Savaşım Derneği Yayını, İstanbul Tıp Kitapevi, 2013: 25-81.
  • Centers for Disease Control and Prevention (CDC). Screening and Testing Recommendations for Chronic Hepatitis B Virus Infection (HBV) [cited 28 March 2022]. Available from: https://www.cdc.gov/hepatitis/hbv/testingchronic.htm.
  • Tosun S. Dünyada ve Türkiye’de viral hepatit B epidemiyolojisi. In: Tabak F, Güner R, eds.
  • Viral Hepatit-2018. İstanbul: Viral Hepatitle Savaşım Derneği Yayını, İstanbul Tıp Kitapevi, 2018:13-33.
  • Uluturk R. Kan donörlerinde yapılan rutin tarama testlerinin 11 yıllık değerlendirilmesi. Türk Mikrobiyol Cemiy Derg. 2010;40(1):41-7. 21.
  • Ozsoy MF, Oncul O, Cavuslu S, Erdemoglu A, Emekdas G, Pahsa A. Seroprevalences of hepatitis B and C among health care workers in Turkey. J Viral Hepat. 2003;10(2):150-56.
  • Toy M, Önder FO, Wörmann T, et al. Age- and region-specific hepatitis B prevalence in Turkey estimated using generalized linear mixed models: a systematic review. BMC Infect Dis. 2011; 11:337.
  • Tosun S. Dünyada ve Türkiye’de viral hepatit B epidemiyolojisi. In: Tabak F, Güner R, eds.
  • Viral Hepatit-2018. İstanbul: Viral Hepatitle Savaşım Derneği Yayını, İstanbul Tıp Kitapevi, 2018: 13-33
  • Jeng WJ, Papatheodoridis GV, Lok ASF. Hepatitis B. Lancet. 2023;401(10381):1039-52.
  • Huang SC, Yang HC, Kao JH. Hepatitis B reactivation: diagnosis and management. Expert Rev Gastroenterol Hepatol. 2020;14(7):565-78.
  • Lei S, Chen S, Zhao X, et al. Hepatitis B virus infection and diabetes mellitus: the Kailuan prospective cohort study in China. Hepatol Int. 2020;14(5):743-53.
  • Holstein A, Hinze S, Thiessen E, Plaschke A, Egberts EH. Clinical implications of hepatogenous diabetes in liver cirrhosis. J Gastroenterol Hepatol. 2002;17(6):677-81.
  • IDF diabetes Atlas: Global estimates of undiagnosed diabetes in adults for 2021.Ogurtsova, Katherine et al.Diabetes Research and Clinical Practice, Volume 183, 109118
  • Peters EJ, Childs MR, Wunderlich RP, Harkless LB, Armstrong DG, Lavery LA. Functional status of persons with diabetes-related lower-extremity amputations. Diabetes Care. 2001;24(10):1799-1804.
  • Lavery LA, Armstrong DG, Murdoch DP, Peters EJ, Lipsky BA. Validation of the Infectious Diseases Society of America's diabetic foot infection classification system. Clin Infect Dis. 2007;44(4):562-65.
  • Karaaslan H, Keskin C. Analysis of Hepatitis B and C Seroprevalence and Anti-Hbs Antibody Titers in Type 2 Diabetic Patients with and without Diabetic Foot Ulcers. Harran Üniversitesi Tıp Fakültesi Dergisi. 2024;21(2):206-10.
  • Ndosi M, Wright-Hughes A, Brown S, et al. Prognosis of the infected diabetic foot ulcer: a 12-month prospective observational study. Diabet Med. 2018;35(1):78-88.

HBV seroprevalence in patients with diabetic foot infection

Year 2025, Volume: 64 Issue: 2, 319 - 323, 10.06.2025

Nazlıhan Yalçın , Gökçen Kocabaş Tansu Yamazhan , Hüsnü Pullukçu , Anıl Murat Öztürk , Meltem Taşbakan

https://doi.org/10.19161/etd.1579449

Abstract

ABSTRACT:

Introduction and Objective :

Hepatitis B virus (HBV) is a global health problem that causes chronic liver disease and hepatocellular carcinoma, killing 3 million people annually. The World Health Organization estimates that 254 million people are living with chronic hepatitis B. The Centers for Disease Control and Prevention recommends HBV screening in areas where HBsAg prevalence exceeds 2%. Turkey is in a medium endemicity area with a prevalence rate of 4.5%.
Patients with diabetic foot infection are at higher risk of HBV exposure due to frequent healthcare visits. This study aims to investigate HBV seroprevalence in this vulnerable population.


Materials and Methods:

Patients hospitalized and treated for diabetic foot infection at Ege University Infectious Diseases Clinic between 2016 and 2024 were retrospectively analyzed through electronic patient records. Demographic data, HBsAg, Anti-HBs, Anti-HBs, Anti-HBc IgG and HBV DNA results were recorded when necessary.



Results:

Six hundred and thirty-two (n: 632, M/F: 449/183, mean age: 63.02± 11,429) patients had HBsAg, Anti-HBs and Anti-HBc IgG positivity rates of 1.89%, 36.07% and 32.1%, respectively. Of this group of patients, 164 acquired the infection naturally and 79 were immunized by vaccination. Isolated anti-HBc IgG positivity was detected in 53 of the group, while 12 patients had chronic hepatitis B infection. It was noteworthy that 303 (47.9%) of this group had never encountered HBV and were not vaccinated. Contrary to our expectations, HBsAg seropositivity rates were below the general population average. Twenty-one patients could not be clinically classified due to missing data.

Keywords

Key words: Diabetes Mellitus Diabetic foot infection HBV prevalence

References

  • Maynard JE. Hepatitis B: global importance and need for control. Vaccine. 1990;(8): 18-23.
  • Ott JJ, Stevens GA, Groeger J, Wiersma ST. Global epidemiology of hepatitis B virus infection: new estimates of age-specific HBsAg seroprevalence and endemicity. Vaccine. 2012;30(12):2212-19.
  • The World Health Organization.Global Hepatitis Report, 2017 [updated 16 May 2022; [cited 17 June 2020]. Available from: https://apps.who.int/iris/bitstream/handle/10665/255016/9789241565455-eng.pdf
  • The World Health Organization. Hepatitis B [cited 9 April 2024]. Available from: https https://www.who.int/news-room/fact-sheets/detail/hepatitis
  • Türkiye viral hepatit önlem ve kontrol programı 2018-2023. [Erişim tarihi:09 Mayıs 2023].
  • World Health Organization. Guidelines on assessing donor suitability for blood donation [Cited 7 December 2015]. Available from: https://www.who.int/publications/i/item/9789241548519
  • Thompson ND, Perz JF, Moorman AC, Holmberg SD. Nonhospital health care-associated hepatitis B and C virus transmission: United States, 1998-2008. Ann Intern Med. 2009;150(1):33-9.
  • Centers for Disease Control and Prevention (CDC). Health care-Associated Hepatitis B and C Outbreaks (≥2 cases) Reported to the Centers for Disease Control and Prevention (CDC) 2008-2019 [cited 17 March 2022]. Available from: https://archive.cdc.gov/www_cdc_gov/hepatitis/outbreaks/healthcarehepoutbreaktable.htm.
  • Tosun S. Türkiye’de viral hepatit B epidemiyolojisi-Yayınların metaanalizi. In: Tabak F, Tosun S, eds. Viral Hepatit-2013. İstanbul: Viral Hepatitle Savaşım Derneği Yayını, İstanbul Tıp Kitapevi, 2013: 25-81.
  • Centers for Disease Control and Prevention (CDC). Screening and Testing Recommendations for Chronic Hepatitis B Virus Infection (HBV) [cited 28 March 2022]. Available from: https://www.cdc.gov/hepatitis/hbv/testingchronic.htm.
  • Tosun S. Dünyada ve Türkiye’de viral hepatit B epidemiyolojisi. In: Tabak F, Güner R, eds.
  • Viral Hepatit-2018. İstanbul: Viral Hepatitle Savaşım Derneği Yayını, İstanbul Tıp Kitapevi, 2018:13-33.
  • Uluturk R. Kan donörlerinde yapılan rutin tarama testlerinin 11 yıllık değerlendirilmesi. Türk Mikrobiyol Cemiy Derg. 2010;40(1):41-7. 21.
  • Ozsoy MF, Oncul O, Cavuslu S, Erdemoglu A, Emekdas G, Pahsa A. Seroprevalences of hepatitis B and C among health care workers in Turkey. J Viral Hepat. 2003;10(2):150-56.
  • Toy M, Önder FO, Wörmann T, et al. Age- and region-specific hepatitis B prevalence in Turkey estimated using generalized linear mixed models: a systematic review. BMC Infect Dis. 2011; 11:337.
  • Tosun S. Dünyada ve Türkiye’de viral hepatit B epidemiyolojisi. In: Tabak F, Güner R, eds.
  • Viral Hepatit-2018. İstanbul: Viral Hepatitle Savaşım Derneği Yayını, İstanbul Tıp Kitapevi, 2018: 13-33
  • Jeng WJ, Papatheodoridis GV, Lok ASF. Hepatitis B. Lancet. 2023;401(10381):1039-52.
  • Huang SC, Yang HC, Kao JH. Hepatitis B reactivation: diagnosis and management. Expert Rev Gastroenterol Hepatol. 2020;14(7):565-78.
  • Lei S, Chen S, Zhao X, et al. Hepatitis B virus infection and diabetes mellitus: the Kailuan prospective cohort study in China. Hepatol Int. 2020;14(5):743-53.
  • Holstein A, Hinze S, Thiessen E, Plaschke A, Egberts EH. Clinical implications of hepatogenous diabetes in liver cirrhosis. J Gastroenterol Hepatol. 2002;17(6):677-81.
  • IDF diabetes Atlas: Global estimates of undiagnosed diabetes in adults for 2021.Ogurtsova, Katherine et al.Diabetes Research and Clinical Practice, Volume 183, 109118
  • Peters EJ, Childs MR, Wunderlich RP, Harkless LB, Armstrong DG, Lavery LA. Functional status of persons with diabetes-related lower-extremity amputations. Diabetes Care. 2001;24(10):1799-1804.
  • Lavery LA, Armstrong DG, Murdoch DP, Peters EJ, Lipsky BA. Validation of the Infectious Diseases Society of America's diabetic foot infection classification system. Clin Infect Dis. 2007;44(4):562-65.
  • Karaaslan H, Keskin C. Analysis of Hepatitis B and C Seroprevalence and Anti-Hbs Antibody Titers in Type 2 Diabetic Patients with and without Diabetic Foot Ulcers. Harran Üniversitesi Tıp Fakültesi Dergisi. 2024;21(2):206-10.
  • Ndosi M, Wright-Hughes A, Brown S, et al. Prognosis of the infected diabetic foot ulcer: a 12-month prospective observational study. Diabet Med. 2018;35(1):78-88.
There are 26 citations in total.

Details

Primary Language Turkish
Subjects Infectious Diseases
Journal Section Research Articles
Authors

Nazlıhan Yalçın 0000-0003-2113-3155

Gökçen Kocabaş 0000-0002-1849-3179

Tansu Yamazhan 0000-0001-5950-0702

Hüsnü Pullukçu

Anıl Murat Öztürk

Meltem Taşbakan

Publication Date June 10, 2025
Submission Date November 5, 2024
Acceptance Date March 10, 2025
Published in Issue Year 2025 Volume: 64 Issue: 2

Cite

Vancouver Yalçın N, Kocabaş G, Yamazhan T, Pullukçu H, Öztürk AM, Taşbakan M. Diyabetik ayak enfeksiyonu ile takipli hastalarda HBV seroprevalansı. EJM. 2025;64(2):319-23.
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