23-Nguyen Thi Thuy Huong.pptx

[Virtual Presenter] Dear Dr Đỗ Văn Thành - the Council's Chairman and distinguished Council members and fellow friends are present at the Infectious Diseases Graduation Dissertation Council today. My name is Nguyen Thi Thuy Huong, a medical student at University of Medicine and Pharmacy, Vietnam National University. I’m very happy that today I can defense my dissertation with title: “Clinical features, laboratory characteristics, and treatment outcomes of melioidosis pneumonia in the Center for Tropical Diseases at Bach Mai Hospital” Under the direct supervision of Dr. Nguyen Quang Huy and Dr. Nguyen Thi Ngoc Chi..

[Audio] My presentation consists of 6 parts.. CONTENT.

[Audio] First is Part 1: Introduction oDefinition: Melioidosis (Whitmore's disease) is a severe infection caused by the bacterium Burkholderia pseudomallei, found in soil and contaminated water. Recognized by WHO as a neglected tropical disease, ~ 89.000 deaths per year worldwide. Gold standard to diagnose meiloidosis pneumonia is culture. Pneumonia in ~ 50% of cases. Melioidosis pneumonia can mimic tuberculosis and pneumococcal pneumonia, and with a high mortality rate, especially when accompanied by septic shock, it can result in severe complications or death and challenges in treatment management..

[Audio] To enhance the effectiveness of diagnosis and treatment of melioidosis pneumonia, we conducted this study with two OBJECTIVES - The first is Describe clinical features and laboratory characteristics of melioidosis pneumonia - The second is Describe treatment outcomes of melioidosis pneumonia.

[Audio] The second part is the literature overview. Melioidosis is endemic in certain tropical regions, particularly in Northern Australia and Southeast Asia, but cases have also been reported worldwide. A modelling study estimated that there were approximately 165.000 melioidosis cases causing 89.000 deaths per year globally in 2015..

[Audio] Factors that increase the risk of melioidosis pneumonia include occupational exposure, underlying conditions, and excessive alcohol use, with diabetes and occupational exposure being the top two risk factors..

[Audio] Melioidosis has a wide range of manifestations. Acute melioidosis is defined as symptoms lasting less than 2 months, while chronic melioidosis lasts more than 2 months. It can affect multiple organ systems, with pulmonary melioidosis being the most common, presenting with fever, cough, and dyspnea..

[Audio] Culture is a gold standard. LITERATURE REVIEW: Diagnosis.

[Audio] Duration for treatment with antibiotics in intensive phase for pneumonia is 2-4 weeks and at least 3 months in eradication phase.

[Audio] Moving to the next part, part 3: Participants and methods. "Cross-sectional study conducted at BM Hospital's Center for Tropical Diseases from January 2022 to March 2024. Convenient sampling was employed, gathering data from 38 diagnosed melioidosis pneumonia cases Regarded inclusion criteria... Exclusion criteria...".

[Audio] This is the research procedure Chest imaging results were collected from radiologists' diagnoses in medical records..

[Audio] Statistical Analysis Data Processing: "We imported collected data into Excel using a predefined template based on the case report form." Statistical Analysis (SPSS 26.0): "Using SPSS 26.0, we conducted descriptive statistics (frequencies, percentages, means) to summarize study characteristics and inferential statistics to assess variable associations and compare groups. A p-value <0.05 was considered statistically significant..

[Audio] Part 4. Results and discussions In our study, most participants were aged between 41 and 60 (55.3%). The average age matched Le Viet Nghia's study (53.1 yo) but exceeded Nguyen Quang Huy's (46.8 years). Males dominated significantly, with 92% men and 8% women, which was notably higher than the 72% male prevalence in Thai research. This could be attributed to increased exposure to soil and water in agriculture, along with higher rates of alcoholism and chronic diseases among men.

[Audio] In our study, farmers accounted for 63% of cases, aligning with Limmathurotsakul's findings in Northeast Thailand, where 81% were farmers. This highlights occupational exposure, particularly through activities involving soil and contaminated water..

[Audio] Diabetes mellitus is the most prevalent risk factor, responsible for nearly 70% of cases, aligning with Chantratita's findings. The rising trend of diabetes in the community contributes to the increased number of melioidosis cases..

[Audio] The disease manifests acutely in 92% of cases, with symptoms occurring less than 60 days before hospital admission, and only 8% have chronic progression. This aligns with Ella M. Meumann's study (91% acute/subacute) and Darwin's study (88% acute, 9% chronic)..

[Audio] Our study found that nearly 95% of patients had fever symptoms, consistent with Nguyen Hoang Son's findings. Respiratory symptoms such as cough, rales, and dyspnea were common. A study in Thailand reported similar symptom proportions but with a higher prevalence of dyspnea..

[Audio] Elevated AST levels were found in 60.5% of cases, bilirubin levels in 68.4%, and decreased albumin levels in 93.1%. These changes are typical in sepsis due to decreased liver synthesis, increased interstitial leakage, and protein catabolism..

[Audio] Our study reported a higher thrombocytopenia rate (44.7%) compared to Le Viet Nghia's (25.7%), but similar to Nguyen Quang Huy's study (41.1%) while our proportion of decreased PT was lower. However, we observed higher rates of increased fibrinogen levels (63%) and prolonged APTT (54%) compared to Le Viet Nghia's findings st 59.5% and 31% respectively..

[Audio] In our research, the median PCT is 84.79 ng/ml, which is significant higher than that of Le Viet Nghia's (2.02 ng/ml). Our study showed similar CRP results to Cheng's study, with an average CRP level of 164 mg/l. In our study, the average CRP level was 100.9 mg/l..

[Audio] In our study, nodular (nɒdʒ.ə.lər) lesions were most common (72.4%), followed by consolidation (37.5%) and cavitary ˈka-və-ˌter-ē lesions (21.8%). In contrast, Carrillo-Bayona found consolidation most prevalent (86%), nodules (26%), but cavities at 20%, showing similar rates of cavitary lesions. Le Viet Nghia reported 53.2% consolidation lesions. Our study showed a higher prevalence of nodular lesions, while other studies observed more consolidation. Most lung lesions involved multiple lobes (78.1%), higher than Currie's research at 33%. Effusion was observed in 46.9% of cases..

[Audio] Imaging findings are not specific to melioidosis and can resemble other infections like tuberculosis. CT scans provide detailed images, often showing multifocal consolidation, abscesses, cavitary lesions, and sometimes pleural effusion. "This chest X-ray film of a patient from BM Hospital shows an abscess in the lower lobe of the left lung. The CT scan revealed bilateral masses and consolidation, with an abscess forming a cavity in the left lung. Bilateral pulmonary emphysema. Additionally, multiple lymph nodes were observed in the mediastinum.".

[Audio] The most common initial antibiotic regimen in our study was IV antibiotics plus TMP-SMX (38.8%), followed by meropenem monotherapy (31.5%). In Le Viet Nghia's study, the rates were 32.9% for IV antibiotics plus TMP-SMX and 31.6% for ceftazidime monotherapy..

[Audio] Our study found similar sensitivity rates for imipenem, meropenem, and ceftazidime compared to P. H. Nhung's and Mai Van Tuan's studies, but higher than a recent study by Le Viet Nghia in Vietnam. Doxycycline sensitivity was 100%, consistent with Pham Hong Nhung's study, indicating continued effectiveness of these antibiotics. The TMP-SMX resistance rate in our study is 11.5%, higher than the 5.9% reported by Koshy in India (2014). Resistance mechanisms include exclusion from cells, efflux, enzymatic inactivation, and altered target sites. Efflux  cotri, amox: Amino acid substitutions in class A β-lactamase cause amoxicillin–clavulanic acid resistance. We also found a high resistance rate to amoxicillin + clavulanic acid at 42.9%, compared to Pham Hong Nhung's study, 100% sensitivity. This increased resistance may be due to the common overuse of this antibiotic, particularly in treating upper respiratory infections..

[Audio] Among the 38 cases of melioidosis pneumonia, 44.7% of cases needed oxygen support, with 6 cases (15.8%) requiring invasive ventilation. This percentage is significantly lower than the 74% of supplemental oxygen reported in the study in Thailand..

[Audio] In our study, 97.4% of patients recovered and were referred to lower level hospitals, with a mortality rate lower than that reported by Churuangsuk (9.86%) and Currie (14%). One fatal case experienced septic shock. The enhanced survival rates observed over time can be attributed to several factors, including improved early diagnosis of melioidosis due to heightened awareness among both the public and healthcare providers regarding the possibility of the disease..

[Audio] The average hospital stay in our study is 18.8 days, higher than the 15.5 days reported in Nguyen Quang Huy's study. The average fever resolution time is 7.1 days, with 57.9% of patients recovering within 7 days. This suggests prompt administration of appropriate antibiotics and the use of broad-spectrum antibiotics for patients..

[Audio] There was no difference in the average hospital stay and the average fever resolution time between the two groups treated with monotherapy and those treated combination therapy..

[Audio] This study offers insights into the clinical aspects, lab findings, antibiotic sensitivity and treatment outcomes of melioidosis pneumonia in the Centre for Tropical Diseases, Bach Mai Hospital. The study emphasizes the significance of early diagnosis and proper management of this potentially lethal infection, which mainly impacts older men with existing health conditions like diabetes..

[Audio] For the second aim, we have found that…. CONCLUSION.

[Audio] Research limitations: a small sample size and the use of a cross-sectional study design. Future studies: expand the sample size and employ analytical research methodologies for a more comprehensive understanding of melioidosis pneumonia..

[Audio] I sincerely thank you all for your attention. As with any research, there may be shortcomings in my dissertation. I'm happy to take any questions you may have. I welcome any comments and suggestions from you to help improve and finalize my work. Thank you. Finally, I would like to express my deepest gratitude to my instructors, Dr. Nguyen Quang Huy and Dr. Nguyen Thi Ngoc Chi, for their invaluable guidance and support throughout the process of completing my dissertation..