To Determine the Previlance of Fungal Infection Among Patient with Sputum Negative Old Treated Pulmonary Tuberculosis

A descriptive study was conducted in the Department of Respiratory Medicine in a tertiary care center ofAmbala. Aim of the study was to determine the prevalence of fungal infection among patient presents withsputum negative old treated pulmonary tuberculosis. The study was carried out among 39 post treated casesof Pulmonary Tuberculosis, whose sputum or bronchial wash showed isolation of Aspergillus. Demographicdetails and clinical findings were noted. Data collected were entered into Excel spreadsheet and quantitativedata were expressed as number and percentage. The presentation of pulmonary aspergillosis in treated casesof pulmonary TB varies from aspergilloma (51.3%) to chronic necrotizing pulmonary aspergillosis (38.4%) toallergic bronchopulmonary aspergillosis (10.3%). Hemoptysis (79.5%) of varying severity was the mostcommon symptom. Most of the patients were farmers by occupation. The most common species wereAspergillus fumigatus; others were Aspergillus flavus, Aspergillus niger and Aspergillus terrus in 23.2%,20.5%, and 12.8 %, respectively. Here we conclude that Aspergillus fumigatus was the most frequentlyisolated species in our region and aspergilloma was the commonest pulmonary manifestation as post-TBsequel.

Coexistence of pneumothorax and chilaiditi sign:A case report

We present a case of 50 year old male patient with coexistence of Pneumothorax and Chilaiditi sign. Chilaiditi sign is an incidental radiographic finding of a usually asymptomatic condition in which a part of intestine is located between the liver and diaphragm; however, the term“Chilaiditi syndrome”is used for symptomatic hepatodiaphragmatic interposition. The patient had no symptoms of abdominal pain, constipation, diarrhea, or emesis. Incidentally, Chilaiditi sign was diagnosed on chest radiography. Pneumothorax is defined as air in the pleural space. Pneumothoraces are classified as spontaneous or traumatic. Spontaneous pneumothorax is labelled as primary when no underlying lung disease is present, or secondary, when it is associated with pre-existing lung disease. Our case is the rare in the literature indicating the coexistence of Chilaiditi sign and pneumothorax.

Tuberculous Dactylitis - A rare manifestation of adult Skeletal Tuberculosis.

Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis and manifested by formation of tubercles and caseous necrosis in tissues. In the musculoskeletal system, tuberculous spondylitis is the most typical form of the disease; however, joint changes in extraspinal sites, such as the hip, knee, wrist and elbow, also may occur. Other abnormalities commonly encountered are tuberculous dactylitis and involvement of the tendon sheath. Characteristically, the tissues respond to the mycobacterial infection by forming tubercles. Clusters of epithelial cells surround a central zone of caseating necrosis, with the central part of the tubercle being composed of multinucleated giant cells and the periphery consisting of a mantle of lymphocytes. Special types of tuberculous osteomyelitis include cystic tuberculosis and tuberculous dactylitis. The radiographic characteristics of cystic tuberculosis resemble those of eosinophilic granuloma, sarcoidosis, cystic angiomatosis, plasma cell myeloma, fungal infections, metastases and other conditions. Tuberculous dactylitis involving the short tubular bones of the hands and feet occurs especially frequently in children. In addition to soft tissue swelling, periostitis of phalanges, metacarpals or metatarsals may be evident. Expansion of the bone with cystic quality is termed spina ventosa.Tuberculosis of the metacarpals ,metatarsals and phalanges is uncommon after the age of five years.