Saravanavasan, R (2016) To study the sociodemographic, microbio-pathological, clinico-radiological profile and etiology of patients with non-resolving pneumonia in a tertiary care hospital. Masters thesis, Madras Medical College, Chennai, Tamil Nadu, India.
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Abstract
To study the SOCIODEMOGRAPHIC PROFILE CLINICO-RADIOLOGICAL PROFILE and MICROBIO-PATHOLOGICAL ETIOLOGY of patients admitted with Non-resolving pneumonia in a Tertiary care hospital. To study the co morbidities associated with non-resolving pneumonia. To study the usefulness/diagnostic yield of bronchoscopy in non-resolving pneumonia. To study the usefulness of Bronchial wash gene-xpert in diagnosing tuberculosis in non-resolving pneumonia. To compare Bronchial wash gene-xpert Vs. Bronchial wash AFB (Acid Fast Bacilli) smear in diagnosing tuberculosis in non-resolving pneumonia. To compare Bronchial wash gene-xpert Vs. Post bronchoscopy sputum AFB smear in diagnosing tuberculosis in non-resolving pneumonia. Non-resolving pneumonia was observed to be more common in patients >40 years of age which constitutes around 80% of study population. The most common presenting symptom was persistent cough with expectoration. Chest pain followed by hemoptysis were the presenting symptoms when cause for non-resolving pneumonia was diagnosed as malignancy. In our study smoking and alcoholism was found to be associated with nonresolving pneumonia in 47% patients and 55% patients respectively. Non resolving pneumonia was found to be associated with co morbidities in around 80% of our study population. Diabetes mellitus (40%) and COPD (22%) were the most common co morbidities. Non resolving pneumonia in diabetic patients is more likely to be tuberculosis with 50% of diabetics in our study were diagnosed with tuberculosis. Non resolving pneumonia in COPD patients, is an ominous sign, more chances of it being diagnosed as malignancy. Bronchoscopy was found to be a safe and useful procedure in non-resolving pneumonia patients and no serious complications were encountered. The diagnostic yield of bronchoscopy in our study was 71%. Tuberculosis was the most common cause for non-resolving pneumonia in around 42% of patients. Bacterial pneumonia (15%) and malignancy (15%) were the next two causes. Bronchial wash Gene Xpert, as a single investigation has a diagnostic yield of around 42% in non-resolving pneumonia. Bronchial wash Gene Xpert has an additional yield of 48% in diagnosing tuberculosis against bronchial wash AFB smear. Bronchial wash Gene Xpert has an additional yield of 83% in diagnosing tuberculosis against Post Bronchoscopy sputum AFB smear. Our study suggests that Bronchial wash Gene Xpert can be included in the non-resolving pneumonia investigation panel, because it has a good diagnostic yield and provides an early diagnosis of tuberculosis before the patient becomes bronchial wash AFB or sputum AFB smear positive. Early bronchoscopy (after 2 weeks of antibiotics), is needed in non-resolving pneumonia for early diagnosis of tuberculosis.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Sociodemographic; Microbio-Pathological; Clinico-Radiological; Etiology; Pneumonia |
| Subjects: | MEDICAL > Tuberculosis and Respiratory Medicine |
| Depositing User: | Punitha K |
| Date Deposited: | 25 Jul 2017 11:53 |
| Last Modified: | 25 Jul 2017 11:53 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/2172 |
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