Date of Award

Summer 8-8-2017

Degree Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

Public Health

First Advisor

Dr Ike Okosun

Second Advisor

Dr Ruiyan Luo

Abstract

Introduction - Community-acquired pneumonia (CAP) is one of the most common infectious diseases addressed by clinicians and is an important cause of mortality and morbidity worldwide. Pneumonia is one of the leading causes of death and morbidity, both in developing and developed countries and is the commonest cause (10%) of hospitalization in adult and children. Estimates of the incidence of community-acquired pneumonia range from 4 million to 5 million cases per year, with about 25% requiring hospitalization. Community-acquired pneumonia refers to pneumonia acquired outside of hospitals or extended-care facilities. The objective of the project to study etiological profile, clinical and radiological profile and hospital outcome, the applicability of PSI score for the outcome, the outcome related to age, gender, and risk factors in patients with CAP.

Method – The data was primarily collected in the department of medicine who were diagnosed as community acquired pneumonia at GCS medical college, Ahmedabad, India during 2014 to 2015. It is a retrospective clinical observational study which includes 50 adult patients with CAP at admission to the hospital. Detailed relevant history and clinical examination were done according to predesign and pre-tested format. The patients were classified according to PSI score classification. The collected data was analyzed and compared with previous studies on same/similar topics. Statistical analysis like chi square test, mean, standard deviation of the mean, and Fischer exact test were done.

Result – In this study, 48% patients were with bacteriological pneumonia, and 38% were H1N1 pneumonia. Among those patients, risk factors for CAP like upper respiratory tract infection (24%), Lung pathology (14%), Smoking (24%), and Diabetes mellitus (14%) were present and statistically significant(p<0.05). Also, a radiological profile like lobar pneumonia was most common in bacterial pneumonia (75%), and bronchopneumonia was most common in H1N1 pneumonia (52.6%) which found statistically significant (p<0.05) in the research study. In this study, death had occurred in 8.33% bacterial pneumonia, and 36.8% H1N1 pneumonia which was statistically significant as p value is <0.05 by chi square test. In the present study, 50% patients in PSI class IV and class V died which was statistically significant (p<0.05), 100% patients of class V and 87.5% patients of class IV developed complications, and most common complication was respiratory failure (47.3%) in H1N1 pneumonia, and most common complication was pleural effusion (20.8%) in bacterial pneumonia.

Conclusion – In present study, H1N1 is most common pathogen (38%) in CAP followed by Streptococcus pneumonia (28%) and death due to CAP was higher in H1N1(36.8%) in compare to bacterial cause (8.33%) because this study’s data was taken in September 2014 to September 2015 which was the time of H1N1 epidemic in that region of India. In the present study, most common chest x ray finding was patchy consolidation followed by left lower zone involvement and right lower zone involvement. PSI (pneumonia severity index) score is used for determination of hospital admission and assess 30-days mortality. Clinical trials demonstrate that routine use of the PSI score results in lower admission rates for a class I and class II patients. Patients in class III could ideally be admitted to an observation unit until a further decision can be made. In the present study, mortality was 50% in class IV and class V patients.

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