RESUMO
Background: Bronchiectasis, dilatation of bronchi with diameter more than 2 mm is a septic and inflammatory process of the lung, caused by infections and systemic or local defense abnormalities of tracheobronchial tree that may lead to destruction of bronchial wall. Infections usually cause inflammatory reaction and destruction of bronchial wall, this further leads to more disturbance in local defense and a vicious cycle of inflammation and bacterial colonization occurs. These bacteria divided to Potentially Pathogen Microorganism [PPM] or non-PPM. The purpose of this study was to find microbiologic pattern and associated [risk] factors in Iranian population and use of more narrow spectrum antibiotics
Materials and Methods: Forty patients with proven diagnosis of bronchiectasis by HRCT in a clinically stable condition fulfilled the inclusion criteria. Fiberoptic bronchoscopy was performed just after spirometry and BAL sampling was achieved. Cut off point of 10000 CFU was considered for positivity of culture media
Results: S. pneumoniae was the predominant pathogen. There was 85% rate of colonization by PPM. We found FEV1< 80% and FVC< 80% as risk factors for bacterial colonization by PPM and S. pneumoniae. Age of diagnosis <20 years was the additional risk factor for colonization of S. pneumoniae. Cystic bronchiectasis was predominant type of lesion and was more common in women
Conclusion: We have found some differences regarding the rate of colonization, number of patients with airflow limitation, and the predominant pathogen as compared with Western societies
RESUMO
Chemical weapons, [mainly mustard gas-MG] were heavily used by Iraq against Iranian soldiers between 1984-1986. It has acute effects on respiratory tract in the form of tracheobronchitis and ARDS, whereas chronic respiratory complications include chronic bronchitis, bronchiectasis, asthma and pulmonary fibrosis. There are few reports about human victims. Some of them describe acute effects while our purpose is to define chronic sequelae and their microbiologic, radiologic and physiologic behavior. Fourty four chemical weapon injured patients with moderate to severe disability were selected by AMA criteria [1]. All of them underwent history taking and physical examination, ABG, spirometry, CXR, HRCT, bronchoscopy and BAL for cytology and quantitative culture. Of fourty four patients; 29[66%] had diagnosis of chronic bronchitis by ATS criteria [2], 8 [18%] and 7 [16%] had diagnosis of bronchiectasis and asthma respectively. The most common HRCT finding was ground glass appearance. In one-fourth of patients BAL culture was positive and revealed unusual organisms [S.aureus, S.coagulase negative, E.coli]., BAL neutrophils were increased in bronchiectatic group [258 136 hpf] vs. [96 49 hpf], [148 133 hpf] [p<0.01 p]. Bronchiectatic patients were younger than the other groups [35.5 6.1 yr] vs. [43.5 5.2 yr], and [42.3 5.2 yr] [p<0.01]. The most common respiratory complication of MG is chronic bronchitis. Unusual microorganisms should be considered in the treatment of pulmonary infections. Persons who are exposed to mustard gas at younger age maybe more prone to development of bronchiectasis