Haematological abnormalities in patients with severe community acquired pneumonia who did not require mechanical ventilation and in patients with severe pulmonary tuberculosis

During the 10-year follow-up period (2008-2019) authors analyzed the different hematological changes in 1280 hospitalized patients with sever community acquired pneumonia (CAP) who did not require mechanical ventilation. The severity of illness was identified by the „pneumonia serverity index” and by the „CURB” (confusion, urea nitrogen, respiratory rate, blood pressure) severity scores. Normochromic-normocytic type of aneamia was diagnosed in 12% of patients: hypocromic microcytic type of anemia was observed on 8% of patients: immune-mediated-hemolytic anemia occurred in 6 patients. Usual degree of leucocytosis with left shifted periferial blood smear was detected in 32% of patients: extreme degree of leucocytosis was observed in 20%, leucopenia (granulocytopaenia) occured in 16% of patients. Elevated plateled count was defined in 18% while thrombocytopaenia was found in 6% of patients. Authors prospectively followed 380 patients with pulmnary tuberculosis according to the characteristics of chest radiograph and sputum Ziehl-Neelsen’s stain positivity, and a result of quantiferon test. In 380 patients with severe pulmonary tuberculosis anemia was present in 52% of patients: leukocytosis occured in 20% leucopenia, granulocytopedia and lymphopenia was observed in 16% of patients. Elevated platelet count occured in 26% which was compicated with deep vein leg thrombosis in 18 patients. Dysmyelopoietic bone marrow alteration with peripheal pancytopenia was diagnosed in one case as the result of mycobacterial sespsis. This survey has revealed that the various haematological abnormalities are common in cases of community acquired pneumonia, and in patients with severe pulmonary tuberculosis. The other clinical consequence is that the special haematological alterations, such as extreme leucocytosis, leucopenia, granulocytopenia and severe degree of anemia are useful indicators of the severity of lower respiratory tract infection. *Correspondence to: Géza Bozóky, Department of Pulmology and Internal Medicine, Hospital of Bács-Kiskun County Municipality, Bács-Kiskun County, E-mail: bozokyg@freemail.hu Received: September 03, 2019; Accepted: September 20, 2019; Published: September 24, 2019 Introduction Community acquired pneumonia (CAP) is an important healthcare concern, and is the most common cause of death associated with infectious disease and the sixth most comon cause of death [1-3]. The annual incidence rate in the USA 6/1000 in the 18-39 age group, and 34/1000 in people aged 75 [3]. Admission to the hospital in patients with CAP is needed in 20-40% and about 5-10% of these patients are admitted to intnsive care unit (ICU) [3,4]. The mortality rate of CAP in outpatients setting is in the range of <1-5%, but among patients who require hospitalization, the rate averages 12% [1,3]. Severe CAP (sepsis syndrome and septic shock syndrome) has been separeted from cases of less severe pneumonia requiring hopsitalization, because of the high mortality rate (up to 50%) Although there is no uniformly accepted definition of sever CAP, the original ATS guidelines, and in one more recent study nine criteria was identified for severe illness, and the presence of any one was used to define severe CAP [1-7]. The nine criteria for severe CAP were divided into five „minor” criteria that could be present on admission and four „major” criteria [3,7]. The minor criteria included respiratory rate ≥30/ min, Pao2/Fio2<250, bilateral or multilobar pneumonia, systolic BP ≤90 Hgmm, and diastolic BP ≤60 Hgmm. The major criteria included a need for mechanical ventilation, an increase in the size of infiltrates by >50%, septic shock or the need for pressors and acute renal failure. During the 10 year follow-up period (2008-2018) we have analyzed prospectively the different hematological changes in 1280 hospitalized patients with severe CAP, who didn’t required mechanical ventilation. In the other part of this survey we retrospectively followed 380 patients with pulmonary tuberculosis according to the characteristics of chest radiograph and Ziehl-Neelsen stain positivity, and quantiferon test in association with haematological changes.