A Study on Bacterial and Fungal Infections in Patients with Systemic Lupus Erythematosus and their Antimicrobial Susceptibility Pattern in a Tertiary Care Hospital.

Shiney John, V (2013) A Study on Bacterial and Fungal Infections in Patients with Systemic Lupus Erythematosus and their Antimicrobial Susceptibility Pattern in a Tertiary Care Hospital. Masters thesis, Madras Medical College, Chennai.

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Abstract

INTRODUCTION : Systemic Lupus Erythematosus (SLE) is an autoimmune disorder in which multiple systems are affected. In SLE, there is production of autoantibodies, which are directed against nuclear and cytoplasmic constituents of the cell.It is a chronic disease which manifest by periods of alternating exacerbations and remissions. SLE causes injury mainly to skin, joints, and kidney. In certain population the prevalence of SLE may be high. It is a disease which predominantly affects women in their peak reproductive period and is an important cause of morbidity and mortality in that age group of females. Many environmental, genetic and hormonal factors have been associated with the pathogenesis of SLE. SLE may present with variable symptoms which may range from skin and joint Involvement to major organ involvement. The progression of the disease is not predictable. With proper therapy the disease runs a course of flare-ups and remissions which may extent a period of years or sometimes even decades. Corticosteroids and other Immunosuppressants are used for treating disease exacerbations. Sometimes the course of SLE may be benign and without taking any medications the patients may survive for Years. With recent advances in diagnostic and therapeutic approaches there is significant Improvement in the outcome of SLE. AIMS AND OBJECTIVES : 1) To isolate and identify the various bacterial and fungal pathogens associated with infections in patients with SLE. 2) To study the antimicrobial susceptibility pattern of the isolates. 3) To correlate the association of steroid therapy with occurrence of infect ions in patients with SLE. 4) To study the immunological profile in SLE patients. MATERIALS AND METHODS : This cross sectional study was conducted in the Institute of Microbiology, Madras Medical College in association with Department of Rheumatology, and Department of Nephrology, Rajiv Gandhi Government General Hospital, Chennai. Approval was obtained from the Institutional Ethical Committee before the commencement of the study. Informed consent was obtained from the study population. All patients satisfying the inclusion criteria were documented. Patients were interviewed by structured questionnaire. Total of 110 patients fulfilling the 1982 revised American Rheumatism Association criteria for the classification of SLE with clinically suspected infections were included in the study. Infection in SLE patients is suspected based on clinical data like fever, lower abdominal pain, frequency / pain during urination, cough with expectoration, loss of weight, and skin lesions. EXCLUSION CRITERIA - SLE patients with malignancy, transplant recipients, prolonged antibiotic therapy, and HIV were excluded from the study. CONCLUSION : The present study was done to identify the bacterial and fungal infections in patients with SLE, which is the most common autoimmune disease involving multiple organ systems. Among the patients with SLE, arthritis was the most common manifestation followed by fever and skin rash. Infections were present in 54.55% of SLE patients. It was found that bacterial infections were common than fungal infections and urinary tract was the most common site of infection. Escherechia coli was the most common bacteria isolated and Candida was the common fungus isolated. Study of antimicrobial susceptibility of the isolates showed resistance to wide range of antibiotics. Among the 53 Gram negative bacteria isolated, 30 were ESBL producers. Out of the 10 Staphylococcus aureus isolated, 8 were found to be MRSA. In this study statistically significant association was found between infection and Prednisolone dose ≥ 20 mg/day and Prednisolone + cyclophosphamide.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Bacterial ; Fungal Infections ; Patients Systemic Lupus ; Erythematosus ; Antimicrobial Susceptibility Pattern ; Tertiary Care Hospital.
Subjects: MEDICAL > Microbiology
Depositing User: Subramani R
Date Deposited: 02 Aug 2017 01:22
Last Modified: 02 Aug 2017 01:22
URI: http://repository-tnmgrmu.ac.in/id/eprint/1731

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