TO STUDY THE CLINICAL, RADIOLOGICAL AND MICROBIAL PROFILE OF PULMONARY INFECTION IN IMMUNOCOMPROMISED PATIENTS

Abstract

BACKGROUND The lung is one of the most frequently involved organs in complications of immunocompromised host. Among these, pulmonary infection is the most common complication. The chest radiograph is initial diagnostic tool for detection of suspected pulmonary infection in immunocompromised. However, chest radiograph ndings are nonspecic in determining pathogens. The early use of Computed Tomography (CT) is helpful in detecting pulmonary lesions which may not be evident on routine chest radiographs. But there is overlap of CT nding in different infections. This study is therefore, designed to document the clinical, radiological & microbial prole of pulmonary infection in immunocompromised patients. AIM To study the clinical, radiological and microbial prole of pulmonary infection in immunocompromised patients, and to study diagnostic yield of sputum examination, induced Sputum examination & bronchoscopic BAL examination. METHODS The present prospective descriptive observational study was conducted in the Department of Chest Medicine at King Edward Memorial Hospital, Pune. It included immunocompromised patients with lower respiratory tract infection symptoms. A total number of 70 indoor & OPD patient with urban & rural background were included in the study. Among them 45 patients were HIV reactive group and 25 patients were having Non-HIV immunocompromised condition. All of them had pulmonary infection. The study was conducted over a period of 15 months. RESULTS Incidence of pulmonary infection was higher in age 31-40 years (28.58%). There were 51 males and 19 females. Opportunistic infections were more common in males as compared to females. Majority of immunocompromised patients were HIV reactive (64.3%) followed by of Malignancy (15.7%). Focal non homogenous opacity (37.5%) was most common radiological nding followed by consolidation with air brochogram (25%). Pulmonary Tuberculosis (40.5%) was most common opportunistic infection in immunocompromised patients followed by bacterial (30.38 %) and fungal infections (17.72%). Sputum (40.98), induced sputum examination (19.29), and Bronchoscopy with BAL (91.42%) had good diagnostic yield in diagnosis of pulmonary infection in immunocompromised patients. CONCLUSION Induced sputum had less diagnostic yield in immunocompromised patients and also it is time consuming.Early bronchoscopy with BAL remains crucial to establish the diagnosis in immunocompromised patients with pulmonary infection when the cause is infectious in nature.