Post transplant lung infection – Environmental pollution ? Association NIMS + EPTRI Hyderabad

Dr.Bharathi

.. Infections are the main cause of morbidity and mortality of patients who are on immunosuppression medications. From january 2016, we have series of patients on immunosuppression who got admitted with respiratory tract infections.

Age/sex Pri.diag infection confirmation outcome Area ofresidence Preandpost trans3m Time of infection 30/m renaltrans PCP HPE,LUNG death santoshnagar 6m 28/m Recovered masabtank 40/m PCP,CMV BAL cytology recoverd warngal punjagutta 8yrs 36/f HPE kukatpally 2yrs 50/m PNEMONIA STERILE LBnagar PNEUMONIA 3m 30/f 11m 38/f ECOLI sputumcultu recovered karimnagar 10yrs 58/f PTB SPUTUM dilshuknagar 2m 52/m rhinocerebralmucor Swabc/s sytemicmucor srnagar 1yr

Hypothesis: Environmental pollution is the source of infection. To test this hypothesis ,we did air culture from 4 different areas to which patients are frequently exposed. Both bacterial and fungal culture A1-Transplant op A2- sample collection room A3-residential area A4-KTU.

SAMPLAIR

Z

A1 – Transplant OP area

A2 – Blood Sample collection room

A3 – Residential area

A4 - KTU

Common organisms in environment

Dr.Uma

EPTRI -DATA

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Dr.Kamala

Dr.Bharathi

DISCUSSION  A new WHO air quality model- 92% of the world’s population lives in places where air quality levels exceed WHO limits* 3 million deaths a year are linked to exposure to outdoor air pollution. Nearly 90% of air-pollution-related deaths occur in low- and middle-income countries, with nearly 2 out of 3 occurring in WHO’s South-East Asia and Western Pacific regions.

Aerobiology is the study of the processes involved in the movement of microorganisms in the atmosphere from one geographical location to another, including the aerosolized transmission of disease. droplet and airborne

Droplet transmission - expelled particles that are likely to settle to a surface quickly. airborne transmission -expelled particles that remain suspended in air for long periods of time. World Health Organization uses a particle diameter of 5𝜇m to delineate between airborne (≤5𝜇m) and droplet (>5𝜇m) transmission.

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AIRBORNE INFECTION

Journal of pathogens,2002

prevention Concerning personal controls, an essential personal protective practice is the regular and proper wearing of N95respirator masks. Escombe et al. demonstrated that, provided that there is a sufficient circulation inside the room to mix the air, upper-room UV fixtures have been shown to be an effective intervention for use in infection control in high-risk clinicalsettings (e.g., tuberculosis)

Advances in Preventive Medicine Volume 2011, Article ID 124064

… Kowalski and Bahnfleth showed that under certain conditions, using recirculated air with high-efficiency particulate air (HEPA) filters reduces particulate concentration for indoor air similar to full outside air system. Healthcare facilities are subject to regulations and requirements relating to their HVAC systems . Based on these regulations, hospitals currently attempt to reduce the airborne infectious disease load by increasing the air changes per hour (a measure of how many times the air within a defined space is replaced per hour) in areas known to be problematic 2) utilizing different ventilation configurations and systems in specific areas

Public awareness WHO is rolling out BreatheLife, a global communications campaign to increase public awareness of air pollution as a major health and climate risk. 

..  "For people to be healthy, they must breathe clean air from their first breath to their last.”