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A Dissertation On A Dissertation on Clinical, Bacteriological and Radiological Study of Community Acquired Pneumonia Dissertation Submitted to THE TAMILNADU Dr.M.G.R. MEDICAL UNIVERSITY CHENNAI - 600 032 With partial fulfillment of the regulations for the award of the degree of M.D. GENERAL MEDICINE BRANCH-I COIMBATORE MEDICAL COLLEGE, COIMBATORE MAY 2018 CERTIFICATE Certified that this is the bonafide dissertation done by Dr. REKA.R and submitted in partial fulfillment of the requirements for the Degree of M.D.,General Medicine , Branch I of The Tamilnadu Dr. M.G.R. Medical University, Chennai. Date: Guide, Professor & Head Department of Medicine Date: Dean Coimbatore Medical College Coimbatore DECLARATION I solemnly declare that the dissertation titled “Clinical, Bacteriological and Radiological Study of Community Acquired Pneumonia ” was done by me from JULY 2016 to JUNE 2017 under the guidance and supervision of Professor Dr. KUMAR NATARAJAN M.D (General Medicine) This dissertation is submitted to The Tamilnadu Dr.M.G.R.Medical University towards the partial fulfillment of the requirement for the award of MD Degree in General Medicine (Branch I). Place: Coimbatore Dr. REKA .R Date: ACKNOWLEDGEMENT I wish to express my sincere thanks to our respected Dean Dr. B.ASHOKAN M.S.,Mch for having allowed me to conduct this study in our hospital. I express my heartfelt thanks and deep gratitude to the Head of the Department of Medicine Prof. Dr.KUMAR NATARAJAN M.D . (General Medicine) for his generous help and guidance in the course of the study. I sincerely thank all professors and Asst. Professors- Dr.P.S.MANSHUR M.D, (General Medicine) DR.V.UVARAJ MURUGANANDAM M.D for their guidance and kind help. My sincere thanks to Dr. S.KEERTHIVASAN M.D., CHEST MEDICINE, Chief, Department of Thoracic Medicine, for his help. My sincere thanks to all my friends and post-graduate colleagues for their whole hearted support and companionship during my studies. I thank all my PATIENTS , who formed the backbone of this study without whom this study would not have been possible. Lastly, I am ever grateful to the ALMIGHTY GOD for always showering His blessings on me and my family. DATE: Dr. REKA .R CERTIFICATE – II This is to certify that this dissertation work titled Clinical, Bacteriological and Radiological Study of Community Acquired Pneumonia of the candidate Dr. REKA .R with registration Number 201511311 for the award of M.D in the branch of General Medicine I personally verified the urkund.com website for the purpose of plagiarism Check. I found that the uploaded thesis file contains from introduction to conclusion pages and result shows 0% (zero percentage) percentage of plagiarism in the dissertation. Guide & Supervisor sign with Seal. LIST OF ABBREVIATIONS USED CAP - COMMUNITY ACQUIRED PNEUMONIA HIV - HUMAN IMMUNO DEFICIENCY VIRUS COPD - CHRONIC OBSTRUCTIVE PULMONARY DISEASE CNS - CENTRAL NERVOUS SYSTEM DNA - DEOXYRIBONUCLEIC ACID RNA - RIBONUCLEIC ACID PCR - POLYMERASE CHAIN REACTION ICU - INTENSIVE CARE UNIT WBC - WHITE BLOOD COUNT BUN - BLOOD UREA NITROGEN PSI - PNEUMONIA SEVERITY INDEX DIC - DISSEMINATED INTRAVASCULAR COAGULATION MDR - MULTI DRUG RESISTANCE ACIP - ADVISORY COMMITTEE ON IMMUNIZATION PRACTICES CA MRSA - COMMUNITY ASSOCIATED METHICILLIN- RESISTANT STAPHYLOCOCCUS AUREUS HCAP - HEALTHCARE-ASSOCIATED PNEUMONIA CMCH - COIMBATORE MEDICAL COLLEGE HOSPITAL CONTENTS S/No Title Page No 1 INTRODUCTION 1 2 AIM AND OBJECTIVES 2 3 REVIEW OF LITERATURE 3-43 4 MATERIALS AND METHODS 44-46 5 RESULTS 47-102 6 DISCUSSION 103-108 7 CONCLUSION 109 8 BIBLIOGRAPHY 110-117 9 ANNEXURES 118-126 • A 1 – PROFORMA • A2 – MASTER CHART • A3 – CONSENT FORM LIST OF TABLES S/No TABLE PAGE NO 1 Causes of CAP 5 2 Pathogens commonly encountered in CAP 6-8 3 Antibiotic Treatment of CAP 40 4 Age Distribution in decades, in the Study Population 47 5 Age Distribution in the Study Population 48 6 Sex Distribution in the Study Population. 49 7 Age Vs Sex 50 8 Cough Manifestation in The Study Population 51 9 Cough Vs Age 52 10 Fever Manifestation in the Study Population 53 11 Age Vs Fever 54 12 Expectoration in the Study Population 55 13 Age Vs Expectoration 56 14 Pleuritic Chest in the Study Population 57 15 Age Vs Pleuritic Chest Pain 58 16 Dyspnoea in the Study Population 59 17 Age Vs Dyspnoea 60 18 Hemoptysis in the Study Population 61 19 Age Vs Hemoptysis 62 20 Crepitation in the Study Population 63 21 Age Vs Crepitation 64 22 Cyanosis in the Study Population 65 23 Age Vs Cyanosis 66 24 Bronchial Breath Sounds in the Study Population 67 25 Age Vs Bronchial Breath Sounds 68 26 Altered Sensorium in the Study Population 69 27 Age Vs Altered Sensorium 70 28 Pleural Effusion in the Study Population 71 29 Age Vs Pleural Effusion 72 30 Smokers in the Study Population 73 31 Age Vs Smokers 74 32 Alcoholics in the Study Population 75 33 Age Vs Alcoholics 76 34 Diabetes Mellitus Patients in the Study Population 77 35 Age Vs Diabetes Mellitus 78 36 Hypertension Patients in the Study Population 79 37 Age Vs Hypertension 80 38 COPD Patients in the Study Population 81 39 Age Vs COPD 82 40 Sputum Culture results in the Study Population 83 41 Gram Staining results in the Study Population 84 42 Age Vs Gram Staining 85 43 Culture Organisms in the Study Population 86 44 Age Vs Culture Organism 87 45 Blood Culture Growth Results in the Study Population 88 46 Age Vs Blood Culture Growth 89 47 Pleural Fluid Growth Results in the Study Population 90 48 Age Vs Pleural Fluid Growth 91 49 Consolidation in X Ray Results in the Study 92 Population 50 Age Vs Consolidation in X Ray 93 51 Consolidation in CT Chest Results in the Study 94 Population 52 Age Vs Consolidation in CT Chest 95 53 Signs And Symptoms in the Study Population 96 54 Co Morbidities in the Study Population 97 55 Culture Specimens in the Study Population 98 56 Correlation between Gram Negative Organism and 99 factors like smoking and COPD 57 Age Vs Duration of Disease 100 58 Disease Outcome in the Study Population 101 59 Age Vs Disease Outcome 102 LIST OF CHARTS S/No CHARTS PAGE NO 1 Age Distribution in decades, in the Study Population 47 2 Age Distribution in the Study Population 48 3 Sex Distribution in the Study Population 49 4 Age Vs Sex 50 5 Cough Manifestation in The Study Population 51 6 Cough Vs Age 52 7 Fever Manifestation in the Study Population 53 8 Age Vs Fever 54 9 Expectoration in the Study Population 55 10 Age Vs Expectoration 56 11 Pleuritic Chest in the Study Population 57 12 Age Vs Pleuritic Chest Pain 58 13 Dyspnoea in the Study Population 59 14 Age Vs Dyspnoea 60 15 Hemoptysis in the Study Population 61 16 Age Vs Hemoptysis 62 17 Crepitation in the Study Population 63 18 Age Vs Crepitation 64 19 Cyanosis in the Study Population 65 20 Age Vs Cyanosis 66 21 Bronchial Breath Sounds in the Study Population 67 22 Age Vs Bronchial Breath Sounds 68 23 Altered Sensorium in the Study Population 69 24 Age Vs Altered Sensorium 70 25 Pleural Effusion in the Study Population 71 26 Age Vs Pleural Effusion 72 27 Smokers in the Study Population 73 28 Age Vs Smokers 74 29 Alcoholics in the Study Population 75 30 Age Vs Alcoholics 76 31 Diabetes Mellitus Patients in the Study Population 77 32 Age Vs Diabetes Mellitus 78 33 Hypertension Patients in the Study Population 79 34 Age Vs Hypertension 80 35 COPD Patients in the Study Population 81 36 Age Vs COPD 82 37 Sputum Culture results in the Study Population 83 38 Gram Staining results in the Study Population 84 39 Age Vs Gram Staining 85 40 Culture Organisms in the Study Population 86 41 Age Vs Culture Organism 87 42 Blood Culture Growth Results in the Study Population 88 43 Age Vs Blood Culture Growth 89 44 Pleural Fluid Growth Results in the Study Population 90 45 Age Vs Pleural Fluid Growth 91 46 Consolidation in X Ray Results in the Study 92 Population 47 Age Vs Consolidation in X Ray 93 48 Consolidation in CT Chest Results in the Study 94 population 49 Age Vs Consolidation in CT Chest 95 50 Signs And Symptoms in the Study Population 96 51 Co Morbidities in the Study Population 97 52 Culture Specimens in the Study Population 98 53 Correlation between Gram Negative Organism and 99 factors like smoking and COPD 54 Mean Duration of Disease 100 55 Disease Outcome in the Study Population 101 56 Age Vs Disease Outcome 102 LIST OF FIGURES S/No FIGURES PAGE NO 1. X Ray Chest, Right Lobe Pneumonia 27 2. CT chest, Lobar Pneumonia. 27 3. Gram Staining, Gram Positive diplococci in 31 sputum gram stain INTRODUCTION Pneumonia is major cause of mortality and morbidity in both developing countries and developed countries. It is next to diarrhea among all acute infectious disease in mortality. It affects all age groups. Pneumonia is the major cause of death in children under five years and extremes of age. Due to over usage and misusage of oral and intra venous antibiotics, patients are infected with multidrug resistant pathogens. This can lead to healthcare associated pneumonia. Due to lack of knowledge, lack of facilities, pneumonia most often misdiagnosed, under estimated and mistreated. One other reason for poor outcome of patients is, failure to assess the severity of the disease and to treat patient as outpatient or in hospital setup or in intensive care unit. Pneumonia is more common in immune compromised like Diabetes, HIV and patient with chronic lung disease.
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