Role of Bronchoscopy in Diagnosis of Pulmonary Infections in Non-HIV Immunocompromised Host

Palaniappan, C (2017) Role of Bronchoscopy in Diagnosis of Pulmonary Infections in Non-HIV Immunocompromised Host. Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION: Immunocompromised patients are prone to develop pulmonary infections and appearance of lung infiltrate is not uncommon. Most causes are infectious but upto 30% may have non-infectious causes. Hence identifying the right cause and initiating specific therapy leads to avoidance of use of large number of empirical antimicrobials. Bronchoscopy and bronchoalveolar lavage is considered as fast and reliable procedure and has been extensively used. AIM OF THE STUDY: To evaluate the diagnostic efficacy and safety of bronchoscopy in non-HIV immunocompromised with pulmonary infiltrates. MATERIALS AND METHODS: We included 65 consecutive NON-HIV immunocompromised patients with new pulmonary infiltrates from DEC 2015 to JUNE 2016 who were sputum AFB smear negative. All patients were subjected to flexible bronchoscopy and BAL after CBC, BT, CT Chest Xray and CT Scan was done. The main indication of bronchoscopy was failure to respond to empirical antimicrobial therapy. BAL samples were sent Bacterial & Fungal Culture, KOH, grams & AFB stain, GeneXpert for MTB, cytology and special stains like Pneumocystis carini. RESULTS: The patients included in our study were cancer patients receiving chemotherapy, Post Renal Transplant on immunosuppresives, Chronic Kidney Disease On maintenance Haemodialysis, Haematological malignancies, Rheumatological disorders on treatment with immunosuppresants and Biological agents. An etiological diagnosis was obtained in 52 (80%) out of 65. Infectious causes were identified in 41 cases (63%) and non-infectious causes in 10 cases (17%). Bronchoscopy led to change of treatment in 37 cases (56%). Only minor complications like transient hypoxemia, minor bleeding were observed apart from one case of pneumothorax. CONCLUSION: FOB and BAL are useful and safe in immunocompromised patients led to 56% change in treatment plan in our study which was statistically significant.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Bronchoscopy, Non-HIV immunocompromised, pulmonary infections.
Subjects: MEDICAL > Tuberculosis and Respiratory Medicine
Depositing User: Subramani R
Date Deposited: 29 Feb 2020 01:55
Last Modified: 29 Feb 2020 01:55

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