A Study of Bacterial and Fungal Pathogens with Emphasis on Mycoplasma in Lower Respiratory Infections in HIV Sero-Positive Patients.

Nirmala, S (2007) A Study of Bacterial and Fungal Pathogens with Emphasis on Mycoplasma in Lower Respiratory Infections in HIV Sero-Positive Patients. Masters thesis, Coimbatore Medical College, Coimbatore.

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Abstract

INTRODUCTION : Human immunodeficiency virus (HIV) infection / Acquired immune deficiency syndrome (AIDS) is a global pandemic and is the most important public health problem of the 21st century. Though HIV made a delayed entry into India in 1986 its spread has been very rapid and at present is in an advanced stage of the pandemic in some states of our country. India has a population of one billion with HIV infection spreading among them at an increasing rate. The spread of HIV in India has been diverse with much of India having a low rate of infection and the epidemic being most extreme in the southern half of the country and in the far north-east. The highest HIV prevalence rates are found in Maharashtra, Andhra Pradesh, Karnataka, Nagaland, Gujarat, Tamil Nadu, Manipur and West Bengal. The Indian National AIDS control organization (NACO) estimates that 5.21 million people were living with HIV in 2005 giving an adult prevalence of 0.91%. It also estimates that 111,608 people were living with AIDS at the end of July 2005 and the average HIV prevalence among women attending antenatal clinics in India is 0.88% and in Tamil Nadu is 0.5% AIMS AND OBJECTIVES : 1. To evaluate the bacterial and fungal etiology of lower respiratory tract infections in the HIV sero-positive patients. 2. To study the incidence of Mycoplasma pneumoniae among the bacterial isolates. 3. To ascertain the significance of serology in diagnosis of Mycoplasma. pneumoniae infection in HIV sero-positive patients. 4. To study the various haematological and clinico-radiological findings in lower respiratory tract infections in HIV sero-positive patients. 5. To assess the antibiotic susceptibility pattern of various bacterial isolates in HIV sero-positive patients. MATERIALS AND METHODS : This prospective study was conducted on 100 HIV sero-positive patients attending the outpatient department or admitted in the Medical, Venereology and Thoracic Medicine Departments with signs of lower respiratory infection at Coimbatore Medical College Hospital, Coimbatore. Specimens for the study were collected over a period of one year and eight months from January 2005 to August 2006. Approval was obtained from the ethical committee prior to conducting the study and Informed consent from all patients under study was also obtained. • Inclusion criteria: One hundred consecutive HIV sero-positive patients with symptoms and signs suggestive of lower respiratory tract infection and who have not received antibiotics for minimum of 2 weeks prior to this study. • Exclusion criteria: Pediatric HIV sero-positive patients were excluded. The name, age, sex, address, date of admission, inpatient number, clinical history of the patient were noted. A thorough general examination and systemic examination of the patient was also done. HIV antibodies had been determined by Enzyme immuno assay by micro ELISA and confirmed by rapid ELISA (Immuno chromatography and Immuno comb). RESULTS : This study included 100 HIV seropositive patients with lower respiratory tract infections. Among the 100 cases, 71 were males with range of age from 27–55 years and mean age 37.6 and 29 were females with range of age from 28–65 years and mean age of 36.2. Among the 71 males,14 were in 21–30 year age group, 35 were in 31–40 year age group, 2 were in 51–60 year age group and among the females, 8 were in 21–30 year age group, 17 were in 31–40 year age group and 2 were in 40–50 year and 1 female was 65 years of age. CONCLUSION : This prospective study on one hundred HIV seropositive patients with lower respiratory infections was conducted in order to record clinical and microbiological observations to study bacterial and fungal etiology of LRTI, the incidence of M.pneumoniae infection,the significance of serology in M.pneumoniae diagnosis,the hematological and clinico radiological findings and the antibiotic susceptibility pattern of the bacterial isolates. Klebsiella pneumoniae, Pseudomonas aeruginosa and Staphylococcus aureus were the most common bacterial isolates.M.tuberculosis was also commonly isolated. Candida sp, Aspergillus sp, Cryptococcus neofomans, Penicillium marneffei were the fungal isolates. We were able to isolate and identify M.pneumoniae in culture and the incidence was 19%. M.pneumoniae IgM ELISA was positive in all the culture positive cases. Hence diagnosis of M.pneumoniae by IgM ELISA was found to be significant and hence its use has to be considered as an important diagnostic tool as the culture of M.pneumoniae is time consuming and laborious. CD4 lymphocyte count and clinical staging of the patients and radiological and haemotological findings were also helpful in diagnosing LRTI in our study cases. As the CD4 lymphocyte count declined HIV seropositive patients were susceptible to a variety of bacterial and fungal lower respiratory pathogens.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Bacterial ; Fungal Pathogens ; Emphasis ; Mycoplasma ; Lower Respiratory Infections ; HIV Sero-Positive Patients.
Subjects: MEDICAL > Microbiology
Depositing User: Subramani R
Date Deposited: 14 Aug 2017 06:20
Last Modified: 14 Aug 2017 06:20
URI: http://repository-tnmgrmu.ac.in/id/eprint/1445

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