Clinical Importance Of Nontuberculous Mycobacteria In Chronic Pulmonary Lung Diseases

Introduction: The isolation of non – tuberculous mycobacteria (NTM) from clinical specimens is becoming common in mycobacteriology laboratories. Globally, the NTM’ s are perceived as a contaminant only. Concomitantly NTMs are observed to be another major causative agent of pulmonary and extrapulmonary diseases in immunocompetent patients. It calls for a different line of diagnosis. To complement the paradox on role of NTM, its isolation, identification and diagnosis, a study was carried out in symptomatic patients attending OPD of NITRD New Delhi. Materials & Methods: The study was conducted on the patients whose first sputum culture report was positive for NTM in the microbiology laboratory. At the time of enrollment, second sputum sample was collected along with patient’s clinical data and radiological finding. The results of 2 sputum culture along with clinical & radiological features were recorded and co–related. During the study, tracing of the patients was done mainly through 3 different methods (i) Patients were traced during the report collection in microbiology laboratory by clinical microbiologist, (ii) Through laboratory records registration number address and/or phone number iii)By the help of field worker of the DOTS Centre. Cultures were done in MGIT 960 automated bacterial culture system and identification was done through routine biochemical character. Conclusion : It is imperative on the part of microbiologist to carry out identification tests on all culture isolates before DST is done as 50 % of the laboratory isolates were positive for NTM in repeat samples. Any of the standard tests for M. Tb complexes turn out to be negative;microbiologist shall look for NTM’s. For this purpose a checklist to be developed to avoid delay in diagnosis of NTM related diseases.

Conventional cytology, visual tests and evaluation of P16INK4A as a biomarker in cervical intraepithelial neoplasia.

OBJECTIVES: (1) To detect cervical intraepithelial neoplasia (CIN) using Papanicolaou test (PAP test), visual tests (visual inspection after the application of acetic acid [VIA], visual inspection after the application of Lugol’s iodine [VILI]), colposcopy, and biopsy. (2) To study the biomarker p16INK4A expression by immunostaining. MATERIALS AND METHODS: Experimental study was conducted from November 2009 to April 2011. 1500 women were screened for cancer cervix using conventional PAP test, VIA, and VILI. Sensitivity, specificity, positive, and negative predictive values of these tests were calculated individually, sequentially, and in parallel. Women having positive results underwent colposcopy and biopsy if required. p16INK4Aexpression in biopsy samples was studied using immunohistochemistry. RESULTS: All test positive cases (n = 235) underwent colposcopy. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of PAP with atypical squamous cells of undetermined significance (ASCUS) as cut‑off was 40%, 99.25%, 35.25%, and 99.39%; VIA was 60%, 93.06%, 8.03%, and 99.56% and VILI was 80%, 86.06%, 5.4%, and 99.76%, respectively. When PAP, VIA, and VILI were used in parallel sensitivity, specificity, PPV, and NPV improved to 100%, 85.18%, 6.38%, and 100%, respectively. Colposcopic abnormalities were detected in 83 and biopsy proven CIN in 15. p16INK4A expression was seen in eight of 15 CIN cases. CONCLUSIONS: (1) PAP test and visual techniques are complementary. (2) p16INK4Aexpression was seen in majority of CIN 2 lesions suggesting a higher grade lesion.

Applications of ultrasonography in respiratory intensive care.

Emerging evidence suggests that ultrasonography of lung is a fast, inexpensive, widely available bed-side diagnostic tool which is useful for quick and early diagnosis of respiratory diseases. It is useful in the differential diagnosis of pulmonary infiltrates and has good accuracy in identifying consolidation and alveolar-interstitial syndrome. This technique can also be useful in the immediate evaluation of patients with dyspnoea or acute respiratory failure in the respiratory intensive care unit and helps in monitoring treatment response. Ultrasonography of lung has also been found to be useful in the diagnosis of pulmonary embolism, traumatic lung contusion and lung consolidation as well. There is a need for developing specific guidelines for establishing the standards of training and education regarding lung ultrasonography in India.

Tuberculosis of the ilium: a case report.

A twenty year old man presented with pain in the upper part of right hip. CT scan showed multiple osteolytic areas in the right ilium, suggesting malignancy. CT guided needle biopsy was done and diagnosis of tuberculosis was made. The patient was cured with medical management only. Isolated tuberculosis of the ilium is an extremely rare condition. It is important to have a high clinical suspicion to diagnose early and manage the patient without surgical intervention.

Endobronchial tuberculosis presenting as tumorous mass.

We report a case of an 18-year-old boy presenting with features of right middle lobe collapse. On bronchoscopy, a tumorous type of endobronchial tuberculosis was found to be obstructing the lumen of the right middle lobe bronchus. On treatment with anti-tuberculous drugs the growth resolved significantly within three months. The patient, however, developed mild stenosis of the airway.

Trends of Extra-pulmonary Tuberculosis under Revised National Tuberculosis Control Programme: A study from south Delhi.

Background & Objectives: Extra-pulmonary tuberculosis (EPTB) cases have been treated with a daily short course chemotherapy (SCC) regimens in past. Following the success of Directly Observed Treatment-Short Course (DOTS) programme over recent years, a study was carried out to determine prevalence of EPTB, to draw comparison between annual case detection of pulmonary TB (PTB) and extra-pulmonary TB and to assess outcome of DOTS in EPTB in a patient population of Delhi. Methods: All consecutive EPTB cases of Delhi, diagnosed within LRS Institute of TB and Respiratory Diseases between January 1996 to March 2003 and subsequently given DOTS at the area DOTS Centres, constituted the study group. Results: Of overall 14185 cases, 2849 (20%) had EPTB. A significantly higher prevalence was observed in females (57%) and in young age (mean + standard deviation of 23.4 + 12.8 years). Commonest involved site was lymph node (54%). Whereas number of PTB and EPTB cases have increased over successive years, percentage of former declined significantly through 84 in 1996 to 78 in 2002 and that of latter rose significantly through 16 to 22 correspondingly. EPTB to PTB ratio changed significantly from 1:5 at start to about 1:3.5 at study-conclusion. Treatment completion was observed in 94% (1775/1885) of EPTB cases. Conclusions: Under Revised National TB Control Programme (RNTCP) employing a DOTS strategy, annual case detection has improved for both pulmonary and extra-pulmonary TB. Cure of infectious disease is likely to have resulted in a relative rise of the annual EPTB case detection. DOTS effected an acceptable treatment outcome in EPTB case management.

Emphysematous pyelonephritis: a consequence of adenocarcinoma of urinary bladder in a nondiabetic patient.

Emphysematous pyelonephritis (EP) is a life threatening condition of acute necrotising renal parenchymal infection that encompasses a much wider spectrum of complicated urinary tract infections such as renal abscesses, emphysematous pyelitis, pyelonephritis, acute renal papillary necrosis, and sepsis. We report an unusual case of adenocarcinoma bladder in a middle aged nondiabetic patient, presenting with EP. Emphysematous pyelonephritis was the initial symptom in this case with an underlying carcinoma of the bladder. The role of imaging is prime in management of such cases, if an early diagnosis is to be made and a potentially devastating outcome is to be avoided. The literature regarding EP has been reviewed and discussed. The goals of managing EP should be (1) early institution of parenteral antibiotics and a (2) a staged nephrectomy (preceded by a temporary percutaneous drainage particularly with antibiotic resistant septicemia) so as to maximize survival rather than proceeding directly to emergency nephrectomy.

Influence of pre-treatment bacillary load on treatment outcome of pulmonary tuberculosis patients receiving DOTS under revised national tuberculosis control programme.

OBJECTIVE: To study the influence of initial bacillary load on sputum conversion rates and treatment outcome of new smear positive pulmonary tuberculosis patients. METHODS: A retrospective study was done among 2938 new smear positive pulmonary tuberculosis patients, registered at the peripheral centres, covering a population of 1.6 million in Delhi, India. The patients pre-treatment sputum smears were graded as 1+, 2+ or 3+ based on three samples. Patients were given intermittent short-course chemotherapy under supervision and the treatment outcome was analysed. RESULTS: Sputum conversion rates among patients graded as sputum 3+ and rest of the patients (combined graded sputum 1+ and 2+) at the end of two months were 62.2% and 76.8% respectively (p<0.001), and at the end of three months were 81.3% and 89.5% respectively (p<0.001). Cure rates among same group of patients were 76.6% and 85.1% respectively (p<0.001), and failure rates were 7.7% and 4.5% respectively (p<0.001). CONCLUSIONS: Under field conditions even with directly observed treatment (DOT) new smear positive patients with heavy bacillary load showed statistically significant poor sputum conversion rates at two and three months and higher failure rates as compared to patients with lesser bacillary load. To investigate possible reasons for this poor response and possible solutions further studies are needed.