Study of drug resistance in pulmonary tuberculosis cases in south coastal Karnataka

The present cross-sectional study was conducted for the first time from the Udupi district of coastal Karnataka to know the prevalence of drug resistance and comparative analysis of MDR and non-MDR cases of pulmonary tuberculosis. Details of 862 smear positive cases of pulmonary tuberculosis with age >/=15 years from 12 designated microscopy centres of the Udupi district were studied. Initially 2 sputum samples trailed by one follow-up sample were collected from each patient and processed for culture and drug sensitivity on the Lowenstein-Jensen medium. A total resistance of 33.4% was observed that includes the mono-resistance of 22.5%, multidrug resistance [MDR] of 6.3% and extensive drug resistance [XDR] of 0.3%. Significant odds ratio [OR] was observed in category 2 cases [OR 3.9] for the development of MDR tuberculosis. A significant statistical association was observed using Fisher's exact test while comparing mortality rate [19.3% vs. 1.8%], treatment failure [8.8% vs. 3.8%] and cure rate [68.4% vs. 85.4%] between MDR and non-MDR cases [p < 0.001]. Category 2 patients are important risk factors for the development of MDR in pulmonary tuberculosis. Due to high mortality and low cure rate in MDR cases it is imperative to know the drug sensitivity report before institution of anti-tubercular treatment

A rare case of community acquired Burkholderia cepacia infection presenting as pyopneumothorax in an immunocompetent individual

Burkholderia cepacia (B. cepacia) infection is rarely reported in an immunocompetent host. It is a well known occurence in patients with cystic fibrosis and chronic granulomatous disease where it increases both morbidity and mortality. It has also been included in the list of organisms causing nosocomial infections in an immunocompetent host, most of them transmitted from the immunocompromised patient in which this organism harbors. We report a rare case of isolation of B. cepacia from the bronchoalveolar lavage fluid of an immunocompetent agriculturist who presented with productive cough and fever associated with a pyopneumothorax. This is the first case of community acquired infection reported in an immunocompetent person in India.

Pulmonary nocardiosis due to Nocardia otitidiscaviarum in an immunocompetent host- a rare case report

Nocardiosis is a localized or disseminated infection caused by soil-borne aerobic actinomycetes. Pulmonary nocardiosis is a rare infection mostly occurring in immunocompromised patients. We reported a case of 36 year old immunocompetent non-smoker female patient with no premorbid illness who presented with fever, cough with scanty sputum, hemoptysis, left sided chest pain and exertional dyspnea for two weeks. There was no past history of tuberculosis, diabetes mellitus or steroid therapy. Chest X-ray showed homogenous peripherally based opacity in the left upper zone. Bronchoscopy was done and brushing sent for culture, which showed colonies with features of Nocardia species after 48 hours. Further phenotypic characterization revealed it to be Nocardia otitidiscaviarum. Patient was treated with cotrimaxazole for six months after which complete recovery was evidenced symptomatically and radiologically. We report this case to emphasize the fact that among the Nocardia species, Nocardia otitidiscaviarum as causative agent of pulmonary disease is rarely reported even in immunocompromised individuals.