Abstract
Background: Community acquired pneumonia is one of the major health problem in India. Early diagnosis of patients with CAP and appropriate treatment are important features with impact on overall mortality.
Aims and Objectives: To study the causes and clinical profile of community acquired pneumonia and to analyse the factors that contribute to clinical outcome of such patients.
Methods: This is a cross sectional study conducted at Sri Ramachandra Medical college and research institute. Cases are collected from the department of general medicine between april 2014 and april 2015. All patients presenting with symptoms of an acute lower respiratory tract illness (cough and at least one other lower respiratory tract symptom) were included in the study. A basic laboratory workup along with Chest X ray was done in all patients. Culture of sputum, blood, urine and trachea was done.
Results: A total of 216 consecutive patients with community acquired pneumonia (CAP) were studied. The most common presenting symptom in our study is cough 97.4% (n=210), followed by expectoration 75%( n=162), 70.4% (n=152) had fever, 33.3% (n=72) of patients had breathlessness. Among the comorbid conditions diabetes mellitus (33.7%; n=73) and hypertension (32.4%; n=70) were common. Viral etiology is much more common (proven H1 N1positive were 28%) than bacterial etiology. 75.4% (n=32) of patients of the patients had no complications. Pleural effusion was seen in 14.8% (n=32) of patients, ARDS in 7.4% (n=16) of patients. Commonest bacterial organisms found were Streptococcous pneumoniae 23.0% (n=3) and Klebsiella pneumoniae 23.0% (n=3), followed by Staphylococcous aureus 15.3% (n=2) and E.coli 15.3% (n=2). Mortality seen in this study was 4.5% (n=10) among which 6 deaths were noted in patients diagnosed to have H1N1 positive status.
Conclusion: Community acquired pneumonia is common among young and middle aged males. Most common presenting feature is cough (97.4%) followed by expectoration (75%) and fever (70.4%). Viral etiology is much more common (proven H1 N1positive were 28%) than bacterial etiology. Most common complication noted was pleural effusion (14.8%). Mortality is noted more in patients aged more than 60 years of age, contributes to 50% of overall mortality.
Keywords: Community acquired pneumonia, H1N1, Klebsiella, Pleural effusion, Steptococcu.
References
- Capelastegui A, Espana PP, Quintana JM, et al. Validation of a predictive rule for the management of community-acquired pneumonia. Eur Respir J. 2006;27:151-157.
- Aujesky D, Auble TE, Yealy DM, et al. Prospective comparison of three validated prediction rules for prognosis in community acquired pneumonia. Am J Med. 2005;118:384-3921.
- Morimoto K, Suzuki M, Ishifuji T, YaegashiM, Asoh N, Hamashige N, et al. (2015) The Burden and Etiology of Community-Onset Pneumonia in the Aging Japanese Population: A Multicenter Prospective Study. PLoS ONE 10(3): e0122247. doi:10.1371/journal.pone.0122247.
- Almirall, I Bolíbar, X. Balanz et al Risk factors for community-acquired pneum-onia in adults: a population-based case–control study European Respiratory Journal Volume 13, Issue 2, pages 349– 355.
- Predictors of Viral Pneumonia in Patients with Community-Acquired Pneumonia Ji Eun Kim,Uh Jin Kim,Hee Kyung Kim,Soo Kyung Cho,Joon Hwan An,Seung-Ji Kang,Kyung-Hwa Park,Sook-In Jung, Hee-Chang Jang Published: December 22, 2014
- Dey AB, Chaudhry R, Kumar P et al. Mycoplasma pneumoniae and community-acquired pneumonia. Natl Med J India 2000;13:66–70.
- Bansal S, Kashyap S, Pal LS et al. Clinical and bacteriological profile of community acquired pneumonia in Shimla, Himachal Pradesh. Indian J Chest Dis Allied Sci 2004;46:17–22.
- Oberoi A, Aggarwal A. Bacteriological profile, serology and antibiotic sensitivity pattern of microorganisms from community acquired pneumonia. JK Sci 2006;8:79–82.
- Shankar EM, Kumarasamy N, Vignesh R et al. Epidemiological studies on pulmonary pathogens in HIV-positive and -negative subjects with or without community-acquired pneumonia with special emphasis on Mycoplasma pneumoniae. Jpn J Infect Dis 2007;60:337–
- Song JH, Oh WS, Kang CI et al. Epidemiology and clinical outcomes of community-acquired pneumonia in adult patients in Asian countries: a prospective study by the Asian Network for surveillance of resistant pathogens. Int J Antimicrob Agents 2008;31:107–14.
- Saito A, Kohno S, Matsushima T et al. Prospective multicenter study of the causative organisms of community-acquired pneumonia in adults in Japan. J Infect Chemother 2006;12:63–9.
- Jan C Holter, Fredrik Müller,Ola Bjørang, Helvi H Samdal, Jon B Marthinsen, Pål A Jenum, Etiology of community-acquired pneumonia and diagnostic yields of microbiological methods: a 3-year prospective study in Norway BMC Infectious Diseases (2015) 15:6.
- George et al Clinical cure rates in subjects treated with azithromycin for community-acquired respiratory tract infections caused by azithromycin-susceptible or azithromycin-resistant Streptococcus pneumoniae: analysis of Phase 3 clinical trial data J Antimicrob Chemother 2014; 69: 2835–2840 11 June 2014.
- Tessmer, T. Welte, P. Martus et al, Impact of intravenous b-lactam/macrolide versus b-lactam monotherapy on mortality in hospitalized patients with community-acquired pneumonia Journal of Antimicrobial Chemotherapy (2009) 63, 1025–1033.
- Alexandra Kovaleva, Hilde H. F. Remmelts et al Immunomodulatory effects of macrolides during community-acquired pneumonia: a literature review J Antimicrob Chemother 2012; 67: 530–540.
Corresponding Author
Dr Vasanthan. K
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