Srividhya, G (2008) Spectrum of Pleuropulmonary Infections in Diabetes Mellitus. Masters thesis, Madras Medical College, Chennai.
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Abstract
INTRODUCTION : Diabetes and Pleuropulmonary Infections – A tale of two troubles. DM is a chronic metabolic disorder seen in 5 to 10 % of the elderly population (1) .At the turn of the century many diabetic patients died of overwhelming infections. The introduction of insulin dramatically altered this situation and today noncommunicable diseases are the major cause of death in diabetic patients. However infections in diabetics still poses a great challenge to physicians. It is a wake up call for all Clinicians and researchers to gear up to meet the challenge of the brewing double trouble. Clinicians have generally believed that diabetics are more susceptible to infections and that infections are generally more severe in diabetics than they are in non-diabetics. Pulmonary infections (including PTB as well as other bacterial pneumonia) accounts for about 31% of infections in DM (2). Infections continue to be an important cause of concern in diabetics especially in developing countries like India and there has been a scarcity of controlled studies (3) that have conclusively shown that certain infections are more common in diabetics as compared to non-diabetics. We conducted a prospective study to analyse the spectrum of pleuropulmonary infections in Diabetes Mellitus. AIM OF THE STUDY : The aim of our study is to analyse the clinical, radiological and microbiological aspects of Pleuropulmonary Infections in Diabetes Mellitus. STUDY DESIGN : Prospective study. This study was examined and approved by the Ethical Committee of the institution. MATERIALS AND METHODS : Known diabetic patients/cases recently diagnosed to have DM during the course of hospital stay who had features of pleuropulmonary infections clinically in the form of fever, cough, pleuritic chest pain with or without hemoptysis with radiological features supporting the same, between January 2006 to June 2007 were evaluated for inclusion in this study. In all these patients, a detailed history was taken and a thorough clinical examination was done as well. These cases were then subjected to investigations after getting informed consent. Basic hematological and biochemical investigations included Complete Hemogram with Total count and Differential count, Fasting and Post Prandial Blood sugar, Blood Urea, Serum Creatinine, Serum Electrolytes and Liver function tests. In patients with impaired glucose tolerance, Oral glucose tolerance testing was done and the following criteria was used to diagnose diabetes mellitus. CONCLUSIONS : Following were the inference drawn from this study: 1. The peak incidence of pleuropulmonary infections in this study were in the age group of third decade to fifth decade. Thus it would be prudent to screen all patients in this age group presenting with respiratory infection, for diabetes mellitus. 2. Majority of pleuropulmonary infections of Non Tuberculous etiology were due to Gram Positive Organisms – Staphylococcus pneumonia and Streptococcus pneumonia (25%) and Gram Negative Organisms – Pseudomonas, Klebsiella, H. Influenza (40%). 3. The application of this knowledge is very important in tailoring early appropriate antibiotic therapy for diabetic patients where culture facilities are not available as even a short delay in initiating treatment may lead to rapid progression of infection leading to increased mortality and morbidity. 5. Risk stratification of Bacterial pneumonia in diabetes using CURB 65 scoring system shows that around 60% of patients were categorized under group 2 and group 3 suggesting that bacterial infections tend to be more aggressive in diabetics especially those with uncontrolled hyperglycemia. 6. Pulmonary Tuberculosis tends to occur with increased severity in diabetics as evidenced by the occurrence of B/L extensive lesion with multiple radiological patterns in around 40% of cases in our study. Further to support this, bacillary loads were high among diabetics with poor glycemic control (as assessed by increased grading of sputum positivity). 7. Association of pulmonary infections with pleural involvement occurs in about 30% of diabetics demanding protracted course of antibiotics and ICD for a duration of about 6 – 8 weeks and increases the morbidity in such patients. 8. From the analysis of mortality among patients with pleuropulmonary infections and DM, predictors of mortality were a combination of advancing age, poor glycemic control, chronic debilitation with low BMI (especially among PTB patients), Diabetic keto Acidosis, multilobar involvement and bacteremia. Hence cases with the above mentioned risk factors require special attention and aggressive treatment of infection.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Spectrum ; Pleuropulmonary Infections ; Diabetes Mellitus. |
| Subjects: | MEDICAL > Tuberculosis and Respiratory Medicine |
| Depositing User: | Subramani R |
| Date Deposited: | 28 Feb 2018 16:22 |
| Last Modified: | 28 Feb 2018 16:22 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/5906 |
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