Tammarao Gurulingappa Patil 1 , Nagaraja V. T 2 , Naga Raghunandan Thota
BACKGROUND AIMS AND OBJECTIVES Diabetes mellitus is an immunosuppressed state. Immunosuppressed state is known to affect the clinical course of a disease. This study is carried out to study the clinical course of pulmonary infections in diabetics and comparing the clinical profile with the non-diabetics with pulmonary infections. MATERIALS AND METHODS The study was carried out in SSIMS & RC, Davangere over a period of 2 years from October 2012 to October 2014. 120 patients with type 2 diabetes mellitus meeting the inclusion criteria were included and were compared with 80 age and sex matched healthy controls, fulfilling the inclusion and exclusion criteria. A detailed proforma was filled up for each patient, which included age, sex, IP number, detailed history, past and personal history. A detailed clinical examination was done. Laboratory parameters including fasting and postprandial blood glucose, HbA1C, renal function tests, ECG and routine urine examination were done. Patient is investigated for chest x-ray, sputum for gram stain, culture and sensitivity pattern, AFB, fungal culture methods, BAL along with routine haematology and basic chemistry tests. Diagnosis of diabetes is done based on FBS/PPBS, oral glucose tolerance and HbA1c criteria i.e. FBS>126 mg/dl, OGT>200 mg/dl. When needed tests like 24 hour urine protein excretion, ECG, ophthalmoscopy, echocardiography The proposed study is conducted over a sample size of 150-200 cases fulfilling the inclusion and exclusion criteria. RESULTS Diabetics with pulmonary infections were found to have a more severe form of clinical illness compared to non-diabetics. Extensive involvement of lung parenchyma was noted in diabetics. Diabetics were associated with more complications. Outcome of the illness was worse in the form of increased mortality in diabetics compared to non-diabetics. CONCLUSION There appear to be certain types of pulmonary infections that may be more common in diabetics than in non-diabetics. Diabetic patients also appear to be at an increased risk of complications of pneumonia, such as bacteraemia, or recurrent or chronic bacterial pneumonia, and have an increase in mortality that may be related to the coexistent medical disease. The predisposition may be based on conditions that interfere with normal clearance mechanisms or disturbance of pulmonary immune cell function. The predisposition is further to be complicated by coexisting medical conditions including malnutrition, cardiovascular disease, vascular insufficiency, and chronic renal disease.
