“A Study of Clinico Radiologicaland Bronchoalveolar Lavage Fluid Profile of People Living With Acquired Immuno Deficiency Syndrome With Lower Respiratory Tract Infections (Lrti).”

Abstract

BACKGROUND AND SIGNIFICANCE: Infection with HIV results in progressive immunodeficiency and renders the infected person become increasingly vulnerable to wide range of pathogens, referred to as Opportunistic Infections. Expert clinical assessment with early diagnosis and aggressive treatment are required for a positive outcome. Hence this study was planned. AIMS AND OBJECTIVES: • To study the clinical, radiological, BAL fluid profile and common organisms responsible for lower respiratory tract infections (LRTI) in PLHIV/AIDS who are sputum CBNAAT negative and have LRTI. MATERIALS AND METHODS: • Patients admitted to Respiratory Medicine Department, Sir T Hospital, Bhavnagar, from August 2019 to July 2020, were recruited based on the inclusion and exclusion criteria.  Inclusion criteria:  Sputum CBNAAT negative PLHA patients aged >18 years with 4S symptoms positive (cough, fever, weight loss, night sweats) with abnormal chest X- ray.  Exclusion criteria:  Drowsy or comatose patients, pregnant females, severely hypoxic patients, patients requiring ICU admissions for cardiac, hepatic or renal disease. Detailed history taking, general and clinical examination was carried out and routine laboratory investigations were sent. Chest X-ray, CT Thorax and bronchoscopy were done. BAL fluid was sent for staining, CBNAAT, bacterial and fungal culture. RESULTS: Male preponderance is seen with cough (92%) as the most common presenting complaint, tachypnea (69%) and crepitations (77%) as most consistent signs. Most common X-ray and CT finding was consolidation (65%) with bilateral lower lobe preponderance (35%). Most common etiology was bacterial pneumonia (23%) and most common organism was pseudomonas (23%). Bacterial pneumonia and tuberculosis were more prevalent when CD4 count >350 cells/ cumm; Fungal pneumonia and PCP when CD4 count <350 cells/ cumm. CONCLUSION: Bacterial pneumonia is most common etiology with Pseudomonas aeruginosa being the most common etiological agent. The susceptibility for LRTI increases when CD4 count falls below 500 cells/ cumm.