Rajiv Garg

Cavitary Pulmonary Zygomycosis Caused by Rhizopus homothallicus

ABSTRACT We report the first two proven cases of cavitary pulmonary zygomycosis caused by Rhizopus homothallicus. The diagnosis in each case was based on histology, culture of the causal agent, and the nucleotide sequence of the D1/D2 region of the 28S ribosomal DNA.

A case-control study of tobacco smoking and tuberculosis in India.

OBJECTIVES: To evaluate the role of smoking as a risk factor for the development of pulmonary tuberculosis. MATERIALS AND METHODS: A total of 111 sputum smear—positive patients of pulmonary tuberculosis and 333 controls matched for age and sex were interviewed according to a predesigned questionnaire. RESULTS: The adjusted odd ratio of the association between tobacco smoking and pulmonary tuberculosis was 3.8 (95% confidence interval, 2.0 to 7.0; P value, <.0001). A positive relationship between pack years, body mass index and socioeconomic class was also observed. CONCLUSION: There is a positive association between tobacco smoking and pulmonary tuberculosis.

Lessons from patients with hemoptysis attending a chest clinic in India.

OBJECTIVE: To evaluate the various etiologies of hemoptysis. MATERIALS AND METHODS: Four hundred and seventy-six consecutive patients of hemoptysis who were admitted to the Department of Pulmonary Medicine between January 1996 and December 2002 were included in this study. Hemoptysis was categorized as mild (< 100 ml/day), moderate (100–400 ml/day), and massive (>400 ml/day). We also categorized the patients according to the primary etiology of the hemoptysis. RESULTS: Of the 476 patients with hemoptysis included in this study, 352 were males and 124 were females. Pulmonary tuberculosis was the leading cause of hemoptysis. There were 377 (79.2%) patients in the pulmonary tuberculosis group, 25 (5.7%) in the neoplasm group, 19 (4.0%) in the chronic bronchitis group, 18 (3.8%) in the bronchiectasis group, and 35 (7.3%) patients with hemoptysis due to other causes. About one-third of the patients with hemoptysis had been misdiagnosed by the referring doctor as having active pulmonary tuberculosis. CONCLUSION: Although pulmonary tuberculosis is the most important cause of hemoptysis in India, it may also occur due to a variety of other causes. Awareness should be increased among general physicians about the various etiologies of hemoptysis in pulmonary tuberculosis patients.

Intralobar sequestration of lung

Intralobar pulmonary sequestration is characterized by the presence of nonfunctional parenchymal lung tissue, receiving systemic arterial blood supply. It lacks normal communication with tracheobronchial tree. Failure to diagnose and treat this condition can lead to recurrent pneumonia and fatal hemoptysis. The aim of this case report is to increase awareness about the condition and to review criteria of its definitive diagnosis and subsequent treatment.

Isoniazid- and ethambutol-induced psychosis

Most cases of antituberculous agent–associated psychoses were caused by isoniazid (INH), with ethambutol (EMB)-induced psychosis being rare. The concomitant occurrence of INH- and EMB- induced psychosis and in a single individual is extremely uncommon. We report a case of 28-year-old male who developed psychotic symptoms on start of EMB initially and later on INH also. He was prescribed rifampicin, pyrazinamide, and ofloxacin and had no further psychotic symptoms.

Comparative Study of Biofilm Formation in Pseudomonas aeruginosa Isolates from Patients of Lower Respiratory Tract Infection.

BACKGROUND This study assessed biofilm formations of P.aeruginosa which was isolated from patients with Lower Respiratory Tract Infections (LRTIs). OBJECTIVE This study was conducted to compare different methods of biofilm formations seen in P. aeruginosa which was obtained from LRTI patients. MATERIALS AND METHODS In this cross-sectional study, we investigated a total of 80 P. aeruginosa isolates obtained from LRTI patients by different methods. Tube method (TM), tissue culture plate (TCP) method and modified tissue culture plate (MTCP) method. They were subjected to biofilm detection methods. RESULTS The MTCP method produced a higher accuracy ratio than TCP method. In terms of sensitivity and specificity, the MTCP method was considered to be superior to TM. We observed a higher antibiotic resistance in biofilm producing bacteria than in non-biofilm producers. CONCLUSION In our study, MTCP was found to be more sensitive and specific method for biofilm detection than TCP and TM.

Spontaneous pneumothorax: an unusual complication of pregnancy--a case report and review of literature.

Spontaneous pneumothorax complicating pregnancy is rare. Only 55 cases have been reported till now. We describe a case of a 30-year-old Indian woman with spontaneous pneumothorax during her 28th week of pregnancy.

Drug-resistant tuberculous meningitis

Drug-resistant tuberculosis, including drug-resistant tuberculous meningitis, is an emerging health problem in many countries. An association with Beijing strains and drug resistance-related mutations, such as mutations in katG and rpoB genes, has been found. The pathology, clinical features and neuroimaging characteristics of drug-resistant tuberculous meningitis are similar to drug-responsive tuberculous meningitis. Detection of mycobacteria in cerebrospinal fluid (CSF) by conventional methods (smear examination or culture) is often difficult. Nucleic acid amplification assays are better methods owing to their rapidity and high sensitivity. The Xpert® MTB/RIF assay (Cepheid, CA, USA) is a fully-automated test that has also been found to be effective for CSF samples. Treatment of multidrug-resistant tuberculous meningitis depends on the drug susceptibility pattern of the isolate and/or the previous treatment history of the patient. Second-line drugs with good penetration of the CSF should be preferred. Isoniazid monoresistant disease requires addition of another drug with better CSF penetration. Drug-resistant tuberculous meningitis is associated with a high mortality. HIV infected patients with drug-resistant tuberculous meningitis have severe clinical manifestations with exceptionally high mortality. Prevention of tuberculosis is the key to reduce drug-resistant tuberculous meningitis.

A prospective study of ocular toxicity in patients receiving ethambutol as a part of directly observed treatment strategy therapy.

Background and Objectives: India is among the largest countries to implement the revised National Tuberculosis Control Program (RNTCP). This program provides intermittent regimens to the patients, where the doses of isoniazid and ethambutol are more as compared to the daily regimen, which is a cause of concern, particularly with regard to the ocular toxicity of ethambutol. The present study was undertaken to explore the ocular toxicity in the patients registered under the program. Materials and Methods: This was a prospective single center cohort study of 64 patients of categories I and II, coming to the RNTCP-Directly Observed Treatment Strategy (DOTS) center at a tertiary care referral hospital. The detailed history, best corrected visual acuity, fundus examination, and color vision test were carried out in all patients at the start of treatment and then at the first and second month of treatment. Results: Loss in visual acuity from the baseline was noted at the second month follow up in 12 (9.4%) eyes (P = 0.001), visual field defects were seen in eight (6.3%) eyes (P = 0.0412), and optic disc abnormalities were observed in six (4.7%) (P = 0.013) eyes. Color vision abnormalities were noted in 16 (12.6%) eyes (P = 0.003), four eyes showed impairment in red-green color perception, and the others showed impairment in blue-yellow color perception as well. Patients with ocular symptoms were advised to stop ethambutol and they showed improvement in visual acuity after follow up of one to two months. The overall outcome of treatment was not affected by discontinuation of ethambutol in these patients. Conclusion: Ethambutol when taken according to program could cause ocular toxicity. The early recognition of ocular symptoms is important to prevent unnecessary delay in diagnosis and probable irreversible visual loss.

Poland sequence: Series of two cases and brief review of the literature

Poland sequence is a rare congenital anomaly involving the chest wall and arm, displaying differing degrees of severity, functional and aesthetic impairments. Here we report a series of two cases that presented to us with this anomaly. These cases illustrate, for physicians, the importance of physical diagnosis and reinforce the practice of looking for additional anomalies when one is discovered.