A study of clinical profile and factors associated with community acquired pneumonia at tertiary health care center

 

 

Abstract              Background:  Pneumonia is one most prevalent disease among the community with greater lost as man work days   Aims and Objectives: study clinical profile and factors associated with Community acquired pneumonia at tertiary health care center. Methodology:  This was a cross-sectional study carried out in the patients who were admitted to the department of General medicine with community acquired pneumonia(CAP)  at tertiary health care centre during the one year period i.e. March 2017 to March 2018 . In the one year there were 56 patients with CAP were admitted with written and explained consent. All details of the patients like, age, sex, common symptoms and signs and associated morbidities if any were noted. The data was entered to excel sheet and analyzed by excel software for windows 10. Result:  The majority of the patients were in the age group of >60were 30.36%; followed by  50-60  were 26.79%;  40-50  were 23.21%,  30-40  were 12.50%;  20-30  were 7.14%The majority of the patients were Male i.e. 62.50% and female were 37.50.The most common Symptoms were  Chest pain with  breathing   were 87.50%; followed by  Fatigue in 83.93%;  Cough with expectoration   were 80.36%;  Confusion   in 57.14%;  Fever with chills  in 44.64%;  Shortness of breath  In 33.93%.  The most common Signs were Fever in 94.64%; followed by Crepitation in 87.50%; Pleuritic chest pain   in 76.79%; Dyspnoea in 57.14%; Cyanosis in 23.21%; Haemoptysis in 12.50. The most common co-morbidities conditions were Diabetes in 37.50%; followed by Alcohol abuse-35.71; in H/o Smoking in 33.93; Old age in 30.36; K/c/o CVD   in 23.21%; H/o CRF   in 16.07%; H/o Immuno-compromised disease   in 8.93. Conclusion:  It can be concluded from our study that the majority of the patients were in the age group of >60, majority of the patients were male i.e. 62.21% the most common Symptoms were Chest pain with breathing   followed by Fatigue, Cough with expectoration, Confusion, Fever with chills. The most common Signs were Fever followed by Crepitation. The most common co-morbidities conditions were Diabetes followed by Alcohol abuse H/o Smoking; Old age   K/c/o CVD; H/o CRF; H/o Immuno-compromised  disease etc.

Key Word: Community acquired pneumonia (CAP); CO-morbidities of CAP, Risk factors of CAP

 

INTRODUCTION

Pneumonia is one most prevalent disease among the community with greater lost as man work days. ¹ Pneumonia is broadly defined as any infection of lung parenchyma. Pneumonia is clinically divided into community acquired pneumonia (CAP) and nosocomial pneumonia. Infectious diseases Society of America defines CAP as “an acute infection of the pulmonary parenchyma that is associated with at least some symptoms of acute infection, accompanied by the presence of an acute infiltrate on a chest radiogram or auscultatory findings consistent with pneumonia in a patient not hospitalized or residing in a long-term care facility for more than 14 days before onset of symptoms. ^1-4   So, we have done study of clinical profile and factors associated with Community acquired pneumonia at tertiary health care center. 

 

METHODOLOGY

This was a cross-sectional study carried out in the patients who were admitted to the department of General medicine with community acquired pneumonia(CAP)  at tertiary health care centre during the one year period i.e. March 2017 to March 2018 . In the one year there were 56 patients with CAP were admitted with written and explained consent. All details of the patients like, age, sex, common symptoms and signs and associated morbidities if any were noted. The data was entered to excel sheet and analyzed by excel software for windows 10.

 

RESULT

Table 1: Distribution of the patients as per the age

The majority of the patients were in the age group of >60    were 30.36%; followed by 50-60 were 26.79%; 40-50 were 23.21%, 30-40 were 12.50%; 20-30 were 7.14%.

 

Table 2: Distribution of the patients as per the sex

The majority of the patients were Male i.e. 62.50% and female were 37.50.

 

Table 3: Distribution of the patients as per the clinical features

The most common Symptoms were Chest pain with breathing   were 87.50%; followed by Fatigue in 83.93%; Cough with expectoration   were 80.36%; Confusion   in 57.14%; Fever with chills in 44.64%; Shortness of breath In 33.93%.  The most common Signs were Fever in 94.64%; followed by Crepitation in 87.50%; Pleuritic chest pain   in 76.79%; Dyspnoea in 57.14%;  Cyanosis  in 23.21%;  Haemoptysis  in 12.50.

 

Table 4: Distribution of the patients as per the co-morbidities

 

Figure 1: Distribution of the patients as per the co-morbidities

The most common co-morbidities conditions were Diabetes in 37.50%; followed by Alcohol abuse-35.71; in H/o Smoking in 33.93; Old age in 30.36; K/c/o CVD   in 23.21%; H/o CRF   in 16.07%; H/o Immuno-compromised disease   in 8.93.

 

DISCUSSION

Pneumonia is an infection of pulmonary parenchyma.⁵ It is a major cause of morbidity and mortality with an incidence of 20-30% in the developing countries and 3-4% in developed countries.⁶ Since pneumonia is not a reportable illness its incidence is based on crude estimates. It is estimated that India , Nepal,  Bangladesh and Indonesia account for 40% of global acute respiratory infections.⁷ pneumonia and enteric fever was found to be the main cause of fever.⁸ Community acquired pneumonia (CAP) is the leading cause of death due to infectious diseases in the United states.⁹ Mortality ranges from about 5-35% with a worse prognosis in older people, men, and people with chronic diseases.¹⁰ Despite the advances in diagnostic techniques, in approximately 50% of the cases, etiology is not found.¹⁰The study carried out by Rehab H El-Sokkary  included 270 adult patients diagnosed with CAP. Smokers represented (52.5%) of cases. Smoking is a reported risk factor for CAP. It increases the susceptibility to respiratory infection through disturbance of the host defense mechanisms. The association between smoking habits and CAP development was confirmed in previous studies.¹¹ Co-morbid conditions were present in 40% of patients. Diabetes mellitus was the most common comorbidity followed by hypertension and ischemic heart diseases. Similar co-morbidities were previously reported.¹²This highlights chronic debilitating conditions, particularly diabetes, as risk factors in CAP.   In our study we have found that The majority of the patients were in the age group of >60    were 30.36%; followed by 50-60 were 26.79%; 40-50 were 23.21%, 30-40 were 12.50%; 20-30 were 7.14%The majority of the patients were Male i.e. 62.50% and female were 37.50.The most common Symptoms were Chest pain with breathing were 87.50%; followed by Fatigue in 83.93%; Cough with expectoration   were 80.36%; Confusion   in 57.14%; Fever with chills in 44.64%; Shortness of breath In 33.93%.  The most common Signs  were Fever  in 94.64%; followed by  Crepitation in 87.50%;  Pleuritic chest pain   in 76.79%;  Dyspnoea  in 57.14%;  Cyanosis  in 23.21%;  Haemoptysis  in 12.50.The most common co-morbidities conditions were Diabetes in 37.50%; followed by Alcohol abuse-35.71; in H/o Smoking in 33.93; Old age in 30.36; K/c/o CVD   in 23.21%; H/o CRF in 16.07%; H/o Immuno-compromised disease in 8.93.These findings are similar to ^13,14,15 Risk of severe pneumonia, empyema, and septicemia is linked with comorbidities. For patients with CAP, diabetes mellitus is one of the most common underlying diseases that may be associated with other comorbidities and complications. Initially, diabetic morbidity was linked to altered immune responses, but now it is proposed to be due to worsening of preexisting cardiovascular and kidney diseases. Similarly, alcoholism may be linked to more severe pneumonia which is associated with septicemia and mortality.

 

CONCLUSION

It can be concluded from our study that the majority of the patients were in the age group of >60, majority of the patients were male i.e. 62.21% the most common Symptoms were Chest pain with breathing followed by Fatigue, Cough with expectoration, Confusion, Fever with chills. The most common Signs were Fever followed by Crepitation. The most common co- morbidities conditions were Diabetes followed by Alcohol abuse H/o Smoking; Old age   K/c/o CVD; H/o CRF; H/o Immuno-compromised disease etc.

 

REFERENCES

1. Acharya VK, Padyana M, Unnikrishnan B, Anand R, Acharya PR, Juneja DJ. Microbiological profile and drug sensitivity pattern among community acquired pneumonia patients in tertiary care centre in Mangalore, Coastal Karnataka. Indian J Clin Diagn Res. 2014;8(6):MC04–MC06.
2. Giriraj B, Manthale D. Clinico-microbiological profile of community acquired pneumonia in a Tertiary care hospital. Journal of Biomedical and Pharmaceutical Research. 2015;4(4):65-68.
3. Community-acquired pneumonia: Bacterial profile and microbiological Investigations. Supplement to Journal of Association of Physicians of India. 2013;61:9-11.
4. Bansal S, Kashyap S. A clinical and bacteriological profile of community acquired pneumonia in Shimla, Himachal Pradesh. Indian Journal of Chest Diseases and Allied Sciences. 2004;46:17-22
5. Mandell LA, Wunderink R. Pneumonia. In: Fauci AS, Braunwald E, Kasper D, et al ed. Harrison’s principles of Internal Medicine. Volume 2. 17th edn. McGraw-Hill; 2008:1619-28.
6. Shah BA, Ahmed W, Dhobi GN, et al. Validity of Pneumonia Severity Index and CURB-65 severity scoring systems in Community acquired pneumonia in an Indian setting. Indian J Chest Dis Allied Sci 2010;52:9-17.
7. Murdroch DR, Woods CW, Zimmerman MD, et al. The etiology of febrile illness in adults presenting to Patan hospital in Kathmandu, Nepal. Am J Trop Med Hyg 2004;6:670-5.
8. Marston BJ, Plouffe JF, File TM, et al. Incidence of community aquired pneumonia requiring hospitalization. Arch Intern Med 1997;157:1709-18.
9. Mauricio R, Santiago E, Maria AM, et al. Etiology of Community acquired Pneumonia. Am J Resp Crit Care med 1999;160:2397-405
10. Almirall J, Bolibar I, Vidal J, et al. Epidemiology of community acquired pneumonia in adults: a population based study. Eur Respir J 2000;15:757-63.
11. Millett ER, De Stavola BL, Quint JK, Smeeth L, Thomas SL. Risk factors for hospital admission in the 28 days following a community-acquired pneumonia diagnosis in older adults, and their contribution to increasing hospitalisation rates over time: a cohort study. BMJ Open. 2015;5(12):e008737.
12. Confalonieri M, Urbino R, Potena A, et al. Hydrocortisone infusion for severe community-acquired pneumonia: a preliminary randomized study. Am J Respir Crit Care Med. 2005;171(3):242–248
13.  Gupta D, Agarwal R, Aggarwal AN, Singh N, Mishra N, Khilnani GC, et al. Guidelines for diagnosis and management of community‑ and hospital‑acquired pneumonia in adults: Joint ICS/NCCP(I) recommendations. Lung India 2012;29:S27‑62.
14. Falguera M, Pifarre R, Martin A, Sheikh A, Moreno A. Etiology and outcome of community‑acquired pneumonia in patients with diabetes mellitus. Chest 2005;128:3233‑9.
15.  Lim WS, Macfarlane JT, Boswell TC, Harrison TG, Rose D, Leinonen M, et al. Study of community acquired pneumonia aetiology (SCAPA) in adults admitted to hospital: Implications for management guidelines. Thorax 2001;56:296‑301.

 

 

 

 

 

 

 

 

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