Prince James

Tuberculosis infection among young nursing trainees in South India.

Background Among healthcare workers in developing countries, nurses spend a large amount of time in direct contact with tuberculosis (TB) patients, and are at high risk for acquisition of TB infection and disease. To better understand the epidemiology of nosocomial TB among nurses, we recruited a cohort of young nursing trainees at Christian Medical College, a large, tertiary medical school hospital in Southern India. Methodology/Principal Findings Among 535 nursing students enrolled in 2007, 468 gave consent to participate, and 436 underwent two-step tuberculin skin testing (TST). A majority (95%) were females, and almost 80% were under 22 years of age. Detailed TB exposure information was obtained using interviews and clinical log books. Prevalence of latent TB infection (LTBI) was estimated using Bayesian latent class analyses (LCA). Logistic regression analyses were done to determine the association between LTBI prevalence and TB exposure and risk factors. 219 of 436 students (50.2%, 95% CI: 45.4–55.0) were TST positive using the 10 mm or greater cut-off. Based on the LCA, the prevalence of LTBI was 47.8% (95% credible interval 17.8% to 65.6%). In the multivariate analysis, TST positivity was strongly associated with time spent in health care, after adjusting for age at entry into healthcare. Conclusions Our study showed a high prevalence of LTBI even in young nursing trainees. With the recent TB infection control (TBIC) policy guidance from the World Health Organization as the reference, Indian healthcare providers and the Indian Revised National TB Control Programme will need to implement TBIC interventions, and enhance capacity for TBIC at the country level. Young trainees and nurses, in particular, will need to be targeted for TBIC interventions.

High annual risk of tuberculosis infection among nursing students in South India: a cohort study.

Background Nurses in developing countries are frequently exposed to infectious tuberculosis (TB) patients, and have a high prevalence of TB infection. To estimate the incidence of new TB infection, we recruited a cohort of young nursing trainees at the Christian Medical College in Southern India. Annual tuberculin skin testing (TST) was conducted to assess the annual risk of TB infection (ARTI) in this cohort. Methodology/Principal Findings 436 nursing students completed baseline two-step TST testing in 2007 and 217 were TST-negative and therefore eligible for repeat testing in 2008. 181 subjects completed a detailed questionnaire on exposure to tuberculosis from workplace and social contacts. A physician verified the questionnaire and clinical log book and screened the subjects for symptoms of active TB. The majority of nursing students (96.7%) were females, almost 84% were under 22 years of age, and 80% had BCG scars. Among those students who underwent repeat testing in 2008, 14 had TST conversions using the ATS/CDC/IDSA conversion definition of 10 mm or greater increase over baseline. The ARTI was therefore estimated as 7.8% (95%CI: 4.3–12.8%). This was significantly higher than the national average ARTI of 1.5%. Sputum collection and caring for pulmonary TB patients were both high risk activities that were associated with TST conversions in this young nursing cohort. Conclusions Our study showed a high ARTI among young nursing trainees, substantially higher than that seen in the general Indian population. Indian healthcare providers and the Indian Revised National TB Control Programme will need to implement internationally recommended TB infection control interventions to protect its health care workforce.

Clinicopathological study of bronchogenic carcinoma

Objective:  The present study was undertaken to explore the clinicopathological profile of bronchogenic carcinoma.

MDR- and XDR-TB among suspected drug-resistant TB patients in a tertiary care hospital in India

Aim:  To study the anti‐tubercular drug resistance pattern among suspected cases of drug‐resistant TB.

Thoracoscopic pleural biopsy improves yield of Xpert MTB/RIF for diagnosis of pleural tuberculosis: Xpert in thoracoscopic pleural biopsy

Extrapulmonary tuberculosis (EPTB) accounts for ~15% of all TB patients, and TB pleural effusion is the second most common site of EPTB. The diagnosis of pleural TB is challenging due to the pauci‐bacillary nature of the disease. Histopathology of thoracoscopically obtained pleural biopsy provides the highest diagnostic yield. The Xpert MTB/RIF assay (Xpert) is a PCR test that can identify both Mycobacterium tuberculosis (MTB) and rifampicin resistance. Currently, there is a lack of clarity regarding the value of Xpert on pleural tissue. We report our experience of using Xpert on thoracoscopic pleural biopsy samples.

Medical thoracoscopic removal of a metal needle from the pleural space

Medical thoracoscopy is an excellent diagnostic and therapeutic tool for management of pleural diseases. There have been case reports of removal of foreign bodies from pleural spaces with video-assisted thoracoscopic surgery under general anaesthesia by thoracic surgeons. We present a case of successful removal of an 8 cm long metal needle from the pleural space with single port medical semirigid thoracoscopy under local anaesthesia by a chest physician. Removal of a foreign body from the pleural space is one more indication for medical thoracoscopy, however, an experienced chest physician and proper case selection are very important for safety and a successful outcome of this procedure.

Bronchiolitis obliterans organising pneumonia in systemic lupus erythematosus with anti-phospholipid antibody syndrome – an unusual presentation

A 34-year-old non-smoking male presented with bilateral leg swelling, tachypnoea and hypoxaemia. He gave history of dry cough, oral ulcers and malar rash, also repeated episodes of deep venous thrombosis and treatment with anticoagulants. Respiratory system examination revealed right infrascapular end-inspiratory crackles. Chest X-ray showed bilateral patchy peripheral alveolar opacities (Fig. 1). Blood investigations showed a bicytopenia with haemoglobin of 9.7 gm/dL and white blood cell counts of 3300 cells/cc and high erythrocyte sedimentation rate. Arterial blood gas analysis showed a type I respiratory failure with PaO2 of 58 mmHg. Colour doppler of lower limbs revealed deep vein thrombosis involving ileofemoral and popliteal veins bilaterally. In addition, 24-h urine analysis showed proteinuria. Connective tissue disease work-up showed positive antinuclear antibody (speckled), elevated anti-DsDNA and low complement levels. Lupus anticoagulants, anticardiolipin antibody and direct Coombs test were positive. Activated partial thromboplastin time was prolonged. Computed tomography pulmonary angiography was negative for pulmonary thromboembolism; however, it showed bilateral multifocal areas of peripheral consolidation and ground glass opacities in a lobular distribution (Fig. 2).crj_163 125..126

Endogenous excess cortisol production and diabetes mellitus as predisposing factors for pulmonary cryptococcosis: A case report and literature review

Pulmonary cryptococcosis usually occurs as an opportunistic infection in immunocompromised patients. Endogenous Cushings syndrome is associated with cortisol excess and can predispose to development of cryptococcal infections. We report a case of diabetic patient with ACTH secreting pituitary tumour who developed a cavitating lung mass. Computed tomography-guided biopsy of the lesion revealed mucicarminophilic budding forms of cryptococcus. Broncheoalveolar lavage culture grew Cryptococcus neoformans. There was radiological response to treatment with liposomal Amphotericin, but patient ultimately succumbed to septicemia and multiorgan failure. Opportunistic infections with organisms like Cryptococcus neoformans, should be considered in patients with endogenous Cushings syndrome and a pulmonary infiltrate.