Ravikumar, G (2013) Evaluation of Pulmonary Manifestations in Hematological Malignancies. Masters thesis, Madras Medical College, Chennai.
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Abstract
BACKGROUND: Leukemias and lymphomas are a diverse group of disorders in which various pulmonary manifestations are noted. These pulmonary manifestations are dependent upon multiple factors, including the type of leukemia, the nature and time course of treatment, and presence or absence of significant neutropenia and thrombocytopenia. Many of the pulmonary abnormalities are not due to the leukemia itself, but are caused by the patient’s immunocompromised status, medications, or a complicating medical illness. Not many studies are available regarding pulmonary manifestations in hematological malignancies. Hence this study was done to analyze the various pulmonary manifestations in these disorders. AIM : To evaluate the pulmonary manifestations of patients with hematological malignancies in a tertiary care Institution. METHOD : Patients diagnosed with hematological malignancies having respiratory manifestations or with chest radiological abnormalities were subjected to various diagnostic tests including CBC, RFT, RBS, LFT, sputum AFB, sputum gram stain, sputum nontuberculous culture, sputum fungal smear& culture, sputum cytology for malignant cells, chest X-ray, CT/HRCT chest, pleural fluid analysis. RESULTS : we included 124 patients (male/female: 42/82) with hematological malignancies (51 Acute Myeloid leukemia, 8 Chronic Myeloid leukemia, 47 Acute lymphoblastic leukemia, 17 Chronic lymphoid leukemia and one Hodgkin lymphoma) who presented with respiratory symptoms and signs during examination. 47% of the patients had an absolute neutrophil count lower than 1000 cells/μl. out of 124 patients, 60 patients had no parenchymal infiltrates, 6 patients had pleural effusion, 58 patients had parenchymal infiltrates (31 focal/27 diffuse) were identified. An etiological diagnosis was obtained in 109 (88%) of the 124 patients. 60 (48%) patients had Upper respiratory tract infection and acute bronchitis, 28 (22.58%) had bacterial pneumonia, 14(11%) patients had fungal pneumonia, 6 (5%) patients had exudative pleural effusion and one patient was infected with mycobacterium tuberculosis. Bacterial pneumonia predominantly presented as focal infiltrates and fungal pneumonia as diffuse infiltrates. The sputum culture reports were positive more for bacterial organisms followed by fungal organisms. Among them Pseudomonas aeroginosa was the predominant organism, followed by Klebsiella pneumonia and Aspergillus fumigates. CONCLUSION : Pulmonary infections are common cause for increased morbidity and mortality in patients with hematological malignancies. Upper respiratory tract infection and acute bronchitis are the most common associated respiratory diagnosis in patients with hematological malignancies. Neutropenia is the major factor in determining the development of pulmonary infections. Bacterial pneumonia predominantly present as focal infiltrates and fungal pneumonia as diffuse infiltrates. Pulmonary infections are predominantly caused by gram-negative bacteria (Pseudomonas aeroginosa & Klebsiella pneumonia) followed by fungal (Aspergillus fumigates) organisms.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | hematological malignancies ; neutropenia ; parenchymal infiltrate ; pulmonary infection. |
| Subjects: | MEDICAL > Tuberculosis and Respiratory Medicine |
| Depositing User: | Subramani R |
| Date Deposited: | 28 Feb 2018 17:31 |
| Last Modified: | 28 Feb 2018 17:31 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/5917 |
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