Proforma for Dissertation

SYNOPSIS

Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore

“OPPORTUNISTIC PULMONARY INFECTIONS IN THE IMMUNOCOMPROMISED INDIVIDUALS.”

Name of the candidate : Dr. SHREEVIDYA.K

Guide : Dr. BEENA ANTONY

Course and Subject : M.D. Microbiology.

Department of Microbiology,

Father Muller Medical College,

Kankanady, Mangalore – 575002.

2008 RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

KARNATAKA, BANGALORE.

ANNEXURE II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR

DISSERATION

1 Name of the candidate and DR.SHREEVIDYA.K

address (in block letters) Resident,

Department of Microbiology,

Fr. Muller Medical College,

Mangalore – 575002. 2 Name of the Institution FATHER MULLER MEDICAL COLLEGE

MANGALORE. 3 Course of study and Subject M.D. Microbiology. 4 Date of admission to course 29.04.2008

5 Title of the Topic

OPPORTUNISTIC PULMONARY INFECTIONS IN THE

IMMUNOCOMPROMISED INDIVIDUALS

6 BRIEF RESUME OF THE INTENDED WORK:

6.1: NEED FOR THE STUDY:

The patient population at risk for opportunistic pulmonary infections has

increased during the last decade. The spectrum of organisms causing opportunistic

infections has also grown.

The term “immunocompromised host” describes a patient who is at increased

risk for life-threatening infection as a consequence of decrease in immunity. During the

past few years, the population of immunocompromised hosts has expanded enormously

reflecting the increased use of immunosuppressive agents for treatment of malignancies,

collagen vascular diseases, prevention of rejection in organ transplant recipients and also

due to increased incidence of HIV infections and malignancies.

Lung is one of the most frequently involved organ in a variety of complications,

infection being one of the most common and accounts for about 75% of pulmonary

complications and associated with high morbidity and mortality.1

There are reports of various studies, but they have been done on individual

immunonocompromised conditions. Hence, this study is taken up to cover most of the

immunocompromised conditions presenting with pulmonary infection.

This study is designed to document the incidence of opportunistic pulmonary

infection in the immunocompromised, in a tertiary care hospital, Mangalore. Such study

has not been undertaken before in this region.

6.2 Review of Literature: Patients who are at risk of acquiring opportunistic infection are individuals who are immuno suppressed or who have a decreased number of leucocytes or compromised functions of the circulating polymorphonuclear leucocytes.

Respiratory infection represents a significant source of morbidity and mortality in the immunocompromised patients of paediatric age 2 group as well as adults.

Shelhamer et al3 have found in their study on immunocompromised patients that, they are prone to develop pneumonia due to a spectrum of organisms including bacteria, viruses, fungi, protozoa. In the study conducted by Shailaja and colleagues4 on HIV patients, they isolated several pathogens causing lower respiratory tract infections. Among them 44.3% were bacteria, 42.9% were mycobacteria and 12.8% fungi. Bacterial pathogens were Klebsiella pneumoniae, Streptococcus pneumoniae, Staphylococcus aureus, Pseudomonas aeruginosa, Moraxella catarrhalis, Eschericia coli, Nocardia asteroids. Fungal isolates were Candida albicans, Cryptococcus neoformans and

Aspergillus niger. Parasitic isolation was Pneumocystis carinii.

Study on cancer patients by Jacobson and researchers5 have found the occurrence of Legionella pneumonia in patients with an underlying malignancy on chemotherapy.

Lorocque and coworkers6 in their study have suggested that utility of sputum induction is useful in the diagnosis of Pneumocystis carinii pneumonia not only in HIV patients but also in other immunocompromised patients without HIV. Kono et al7 have isolated

Pneumocystis jiroveci in a patient with an underlying malignant thymoma on chemotherapy and steroids who presented with pneumonia.

6.3 Objectives of the study

1. To isolate the different bacteria and fungi from the sputum of

immunocompromised individuals.

2. To compare the different pulmonary infections in HIV and NON-HIV

Immunocompromised patients.

3. To detect the ability of biofilm formation in these isolates. 7. 7: Materials And Methods:

7.1: Source Of Data: Around 100 patients admitted to Fr.Muller

Hospital,Kankanady,Mangalore,clinically diagnosed to be immunocompromised,who

present with symptoms of lower respiratory tract infection will be included in this study.

7.2:Method Of Collection Of Data:

a) Study Type: Prospective study b) Sample Size: Sputum samples of 100 patients who will be included in this study will be taken. c) Methods: Around 100 early morning samples of sputum wiil be collected separately in sterile containers from all patients included in this study. Quality of the sputum will be assessed. Bartlett’s scoring method8 will be used for microscopic evaluation of the sputum. The samples will be subjected to microscopic examination using the following staining methods: Gram stain for bacteria, Ziehl Neelson stain[20% acid fast] for mycobacteria, Ziehl Neelson stain[1% acid fast] for Nocardia, 10% KOH mount and saline mount for fungi, Giemsa stain, Toluidine blue stain, Methinamine silver stain for Pneumocystis carinii. All samples will be cultured on Sheep blood agar, Chocolate agar, Mac-Conkey agar, Saboraud’s dextrose agar, LJ media, BHI Blood agar and will be processed according to the standard microbiological procedure.9 d) Selection Criteria: Inclusion criteria: Patients to be included in this study are those who present with symptoms of lower respiratory tract infection with underlying:

1. Malignancies on radiotherapy, chemotherapy

2. Chronic illnesses on long-term steroid therapy.

3. HIV infected patients

4. Diabetic patients

5. Other immunosuppressed states.

Exclusion criteria:

1. Immunocompromised patients without symptoms of lower respiratory tract

infections.

2. Patients who present with lower respiratory tract infections but non-

immunocompromised are excluded from this study.

e) Data Analysis: Data will be analysed by chi square tests.

7.3: DOES THE STUDY REQUIRE ANY INVESTIGATIONS OR

INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR OTHER HUMANS

OR ANIMALS? :

8. LIST OF REFERENCES:

1. Whan Yu Oh,Effmann L and Godwin J, Pulmonary infections in

immunocompromised hosts:The importance of correlating the conventional

raddiologic appearance with the clinical setting, Radiology 2000;217:647-656.

2. Puligandla PS, Laberge JM; Respiratory infections :Pneumonia,lung abscess

and empyema,Seminar pediatric surgery 2008;17[1]:42-52. 3. Shelhamer H, Gill J, Quinn C, et al ,The laboratory evaluation of opportunistic

pulmonary infections, Annals of Internal Medicine,15 march 1996;124[6]:585-

4. Shailaja V V,Pai LA, Mathur, Lakshmi V, Prevalence of bacterial and fungal

agents causing lower respiratory tract infections in patients with Human

Immunodeficiency Virus Infection, Indian Journal of Medical Microbiology,

2004;22[1]:28-33.

5. Jacobson K L, Miceli M H, Tarrand J J, Kontoyiannis D P, Legionella

pneumonia in cancer patients, Medicine[Baltimore] 2008 may ; 87[3]:152

6. LaRocque R C, Katz J T, Perruzzi P, Baden L R, The utility of sputum

induction for diagnosis of pneumocystis pneumonia in immunocompromised

patients without Human Immunodeficiency Virus,Clin Infect Dis,2003 nov

15 ; 37[10]:1380-3, Epub 2003 oct 13.

7. Kono M, Fujii M, Akamatsu T, Suda T, Chida K, A Case of Pneumocystis

jiroveci pneumonia that presented with cavity and cystic changes in a

malignant thymoma patient, Nihan Kokyuki Gakkai Zasshi,2008

apr;46[4]:297-301.

8. Washington Jr, et al. Introduction to microbiology : part 1 ; Koneman’s colour

atlas and textbook of diagnostic Microbiology, Philadelphia, PA; Lippincott

Williams & wilkins, 2006, 6th edn; 1-66

9. Collee J.G, Marr W, Culture of bacteria; Mackie and Mc cartney practical

Medical Microbiology, New York; Churchill livingstore 1996, 14th edn ; 113-

9 Signature of candidate

10 Remarks of the guide This study investigates the profile of pulmonary

pathogens encountered in

immunocompromised individuals. The

results of this study will be helpful to

identify the associated pathogens and

reduce the mortality in this group of

patients. 11 Name & Designation of

(in block letters)

Dr. BEENA ANTONY MSc,Ph.D 11.1 Guide

PROFESSOR

DEPT. OF MICROBIOLOGY,

KANKANADY, MANGALORE.

11.2 Signature 11.3 Head of DR. B. REKHA M.B.B.S, MD.,

Department ASSOCIATE PROFESSOR AND HOD,

DEPARTMENT OF MICROBIOLOGY,

FATHER MULLER MEDICAL COLLEGE,

KANKANADY, MANGALORE. 11.4 Signature

12 12.1 Remarks of the

Chairman and Principal

12.2 Signature