Bronchial Colonisation and Inflammation in patients with clinically stable Bronchiectasis- Microbiological pattern and Risk factors

INTRODUCTION: Bronchiectasis is a chronic pulmonary disease characterized by an abnormal irreversible dilatation of one or more bronchi often with wall thickening. The current view of the pathogenesis of Bronchiectasis considers initial colonization of the lower respiratory tract by different microorganisms as the first step leading to inflammatory response characterized by neutrophil migration within the airways and secondary secretion of variety of tissue damaging oxidants and enzymes such as neutrophil elastase, myeloperoxidase and cytokines [interleukins]. Persistence of microorganisms in the airways because of impairment in mucus clearance may lead to a vicious circle of events characterized by chronic bacterial colonization, persistent inflammatory reaction and progressive tissue damage and morbidity life. In order to evaluate the Bacterial colonisation and level of bronchial inflammation in relation with bacterial colonisation; we did bronchoalveolor lavage of patients admitted with HRCT Chest[taken within 3 months] evidence of bronchiectasis and fulfill with inclusion criteria of study. The obtained sample was divided into 3parts-One part was sent to microbiology for bacterial culture, second one was sent to pathology for Total and Differential cell count estimation and third part was centrifuged and stored in 2 to 8'C temperature for IL-8 estimation. METHOD OF STUDY: Continuous prospective study. Study Period: This study was done for a period of 7 months from February 2014 to August 2014. Study Population: 90 patients. Study Centre: This study was done in Rajiv Gandhi Govt General Hospital, Madras Medical College, Chennai-03. INCLUSION CRITERIA: 1. Patients admitted with HRCT Chest diagnosis of Bronchiectasis {non cystic fibrosis}, 2. Age >14 years, 3. SpO2> 90% in Room air. EXCLUSION CRITERIA: 1. Patients with complications like Hemoptysis, Lung abscess and Amyloidosis. 2. Patients with Cystic fibrosis. 3. SPO2<90% in room air. 4. Patients with prior Hospitalisation within 2 months and had antibiotic within 4 weeks. 5. Patients with cardiac illness and Recent Myocardial infection 6. Patients with Renal failure. RESULTS: Among 90 study population analysis showed females were 58% and males were 42%. Cylindrical bronchiectasis 53%, followed by cystic bronchiectasis36% in predominance: and positive culture growth rate for sputum samples were 68% and BAL samples were 77%. The micro organisms isolated predominantly were H.influenza, Pseudomonas, Streptococci, Staphylocci and etc. Regarding airway inflammation, the total counts of BAL fluid were increased in all the patients with slight higher level in positive culture growth patients with slight Neutrophilic predominance. [90-210X10*3 cells in range and 120x10*3 cells in median]. The IL-8 measured showed increased level in all three groups comparing control groups indicating earlier establishment of inflammation in bronchiectasis. [81-835pg/dl in range and 556pg/dl in median]. CONCLUSION: A. The risk factors identified for increased colonisation were; 1.long duration of symptoms, 2.Cystic and Varicose bronchiectasis, 3. Presence of alcoholism and smoking. B. Sputum culture is non invasive, alternative to broncho alveolar lavage fluid culture.