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CNAA / Theses / 2008 / May /

Clinical and evolutional peculiarities of pneumonia in patients with diabetes mellitus


Author: Cornelia Talmaci
Degree:doctor of medicine
Speciality: 14.00.05 - Internal Diseases (with specification: Pulmonology, Gastroenterology, Hepatology, Nephrology, Functional Diagnostics and Endoscopy)
Year:2008
Scientific adviser: Sergiu Matcovschi
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Scientific consultant: Zinaida Anestiadi
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Institution:
Scientific council:

Status

The thesis was presented on the 7 May, 2008
Approved by NCAA on the 19 June, 2008

Abstract

Adobe PDF document0.29 Mb / in romanian

Thesis

CZU 616.24-002+616.379-008.64

Adobe PDF document 0.84 Mb / in romanian
117 pages


Keywords

community-acquired pneumonia, diabetes mellitus type 1 and type 2, community-acquired pneumonia in diabetes mellitus, clinical and evolutional particularities, etiology.

Summary

A study of 121 patients with community-acquired pneumonia (CAP) was performed. The patients were divided into two groups according to the presence of diabetes mellitus. The first group consisted of 81 patients with CAP and diabetes mellitus and the second one included 40 CAP patients without diabetes mellitus. Clinical and evolution peculiarities of CAP in diabetic versus non-diabetic patients, as well as the CAP peculiarities according to the type of diabetes mellitus were examined.

In this way, the fact that diabetic patients manifest protracted and frequently severe pneumonia evolution with the tendency of bilateral lung involvement was revealed. The clinical manifestations of CAP in patients with diabetes are subfebrility (65.4%), dry cough (38.3%), less typical or atypical lung consolidation (54.3%), tachypnoea and tachycardia. Paraclinical manifestations included anemia in 1/3 diabetic patients, leucocytosis in 37.0% diabetic patients (with left deviation in 70.4% cases), lymphopenia in 43.2% patients and increased ESR in 69.1% diabetic patients with CAP. The mean duration of diabetes mellitus in our study was 7.9±0.8 years. Pneumonia developed in patients manifesting diabetic microangiopathy and on the background of decompensate diabetes. However, elevated plasma glucose can be an independent factor of pneumonia development regardless of the presence of microangiopathy. This statement can be explained by the fact that diabetes was primarily diagnosed in 22.2% of CAP patients. It is to be mentioned that due to the presence of ketoacidosis in 65.0% cases, the patients with type 1 diabetes mellitus presented a more severe evolution than those with type 2 diabetes.

The evolution of clinical and paraclinical data in patients with pneumonia is more protracted in diabetic patients.

The increased incidence of gram-negative pathogens and Staphylococcus aureus are etiological peculiarities of CAP in patients with diabetes mellitus. At the same time, Streptococcus pneumoniae does not loose its role and is considered one of the main pathogens in both diabetic and non-diabetic patients with CAP.

The correction of glucose values and compensation of diabetes should be an important clue in the treatment of diabetic patients with CAP.

Finally, the association of CAP with diabetes mellitus leads to the reciprocal aggravation and more severe evolution of these diseases. Thus, the treatment must include both antibacterial therapy of pneumonia and glucose level correction.